3095 Shields DrCITY OF EAGAN WATER SERVICE PERMIT
3830 Pilot Knob Road
P. O. Box 211W PERMIT JO.:
Eagan, MN 55121 DATE:
Zoning: No. of Units:
Owner:
Address:
Site Address: ,2 ?. r
Plumber.
Meter No.: 7V- a+ o
Size: 'l I IJG
ulgg
Ilea No.: 7-41
I 6
ree to e
l
h
Ni
Q
9
mp y w
t
e
hr
rge:
orangeows. EQUIRw ?
Total.
By Date Paid: _
Date of Insp. insp.:
1 a - z- y - gio
1
.pq
CITY OF EAGAN
I 3830 Pilot Knob Road
i p. O. Be- 2119.0
Eagan, MN 55121
Zoning:
Owner: -
Address. S
. ? llt n'? ?'t ?-1-
Site Address:
Plumber:
7
I yree to ees+ * wkb tie Chit of iWw
pr?laonew
By
Date of InsP.:
pEWIT NO.:
DATE:
_ No. of Units:
w
Cormection Charlie:
Account DePadt'
permit Fee: K
Surcharge:
Misc. Charges:
Total:
Date Paid:
WATER SERVICE PERM
Pilot Knob Road PERMIT NO.:
Bc '. 21199
t, 414N 55121 DATE:
No. of Units:
V: -
?Lomes
No..
h gin* w" the cay of Eegae
Connection Charge:
Account Deposit: _
permit Fee:
Surcharge:
Misc. Charges: -
Total: --
Dote Paid:
.8
CITY OF EAGAN
.• 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 N2 2157
PHONE: '454-8100 lp??
BUILDING PERMIT Receipt #
To be used for SF DWG/GAR Est. Value $5'2 , 000 Date JULY 28 19 86
3095 SHIELDS DR Erect IN Occupancy R3
Site Address
Lot 2 Block 1 S,c/Sub. LEMAY LAKE HILIiISmodel ? Zoning PD
Parcel No. Repair ? Type of Const II.A
Addition ? No. Stories
RSM HOMES Move ? Length 36
W Name Demolish ? Depth 4-6
Address 18308 MURPHY LAKE BLVD Int. Impr. ? Sq. Ft
City PRIOR ;&ne 432-2440 Install ?
g Name SAME
R Address
~ City Phone
U IX
W u,
F =
U
M_
t W
Assessment _
Water & Sew.
Police
Name A _ P _ S _ 1)F.S TGN Fire
Address Eng.
City Phone
I hereby acknowledge that I have read this application and state that the
information is correct and agree to comply with all applicable State of
Minnesota Statutes and ity Ea an Ordinances.
Signature of Permi e
A Building Permit is issue to: RSM HOMES
all work shall be done in accordance with all applicabktStple of Minnesc
Planner
Council
6
Bldg. Off. 6/19/8
Permit '?
Surcharge _
Plan Review
SAC
Water Conn.
Water Meter
Road Unit_
Tr. PI.
Parks
Var. Date I Copies
Total $2,094.00
on the express condition that
Statu Aand City of Eagan Ordinances.
Building Official
- CITY OF EAGAN t?
-0, 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 f t1 1 2 1 5 7
PHONE: 454-8100 S? '1
BUILDING PERMIT Receipt #
To be used for SF DWG/GAR Est. Value $ 62 ? 00 U Date JULY 28 19 86
Site Address 3095 -`,"I i.-'j5 DR
; Erect ff Occupancy R3
Lot 2 Block Sec/Sub. LEMAY L
1 AKE HILib6nodel ? Zoning D
Parcel No Repair ? Type of Const. Vn
. Addition ? No. Stories
RSM HOMES Move ? Length 3 6
W Name 30 MURPHY LUKE B LVD Demolish ? Depth 46
a Address t
I
I
? Ft
S
PRI _
OR .
mpr.
n q.
City WSne Install ?
a SAME Approvals
o Name
Address Assessment
o:
~ City Phone Water & Sew.
Police
Name A. P . S . DESIGN Fire _
Address
City
I hereby acknowledge that I have read this application and state that the
information is correct and a ee to comply with all applicable State of
Minnesota Statutes and City E Ordinances.
Signature of Permittee
A Building Permit is issued to.. RSM HOMES
all work shall be done in accordance with all applicable State of Minnesc
Building Official - -- /? -" c
Eng.
Planner
Council
Bldg. Off. 6/19/81
Var.
Permit a '"" %F %F
Surcharge 31-.00
Plan Review?y '' S 0
SAC 575-.00
-
. 00
500
Water Conn.
Water Meter ? 0 50
0
Road Unit 00
Tr. PI.
Copies
Total U
on the express condition that
of Eagan Ordinances.
I Permit No.. Permit Holder Date Teiephom #
Plembing /
/ -SL" L) a ?Lti. ?t `?
oko ?v
H.V.A,C!
Electric
softener
Inspection Date Imp. Commenis
IFoofings A? `
IFoolings 11 if-•l B
IFoundation
I Framing 6
Roofing
IRough Plbg. dL
Rough Htg.
Insul. 9-//-?? CrJ rf'
Fireplace
IFInal Htg. D GO
Final Plbg.
Ifildg. Final O !A O? .^r
Icaft Dec.
I
Deck Fig.
I Deck Fang.
Wen Describe Location:
Pr. Dlsp.
PERMIT # `j
MECHANICAL PERMIT RECEIPT # 6? y 7
CITY OF EAGAN _
CONTRACT PRICE/(p`?v'' 38M PILOT KNOB ROAD, EAGAN, MN 55121 DATE ' ' ??
PHONE: 454-8100
Site Address 1- BLDG. TYPE WORK DESCRIPTION
LotBlock Sec/Su
Res. New
m Name V_ fk)(- • Mutt Add-on
m Address b Comm. Repair
C City is, L iLl,? Phone Other
Name
c Addre
O City
TYPE OF WORK
Forced Air
Boiler
Unit Heater
Air Cond.
Vent
Gas Piping Outlets #
Other
M BTU
M BTU
M PTU
M BTU
CFM
FEE:
SIC:
TOTAL
FEES
RES. HVAC 0-100 M BTU -$24.00
ADDITIONAL 50 M BTU - 6.00
ADD-ON AIR COND. 0-24 BTU - 12.00
ADDITIONAL 6 M BTU - 6.00
GAS OUTLETS - 1.50 EA.
COMM/IND FEE - 1% OF CONTRACT FEE
MINIMUM - RESIDENTIAL FEE - 10.00
MINIMUM - COMM/IND FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 SIC IF PERMIT PRICE GOES
BEYOND $1,000.00)
SIGN TURE OF PER
FOR: CITY OF EAGAN
1% t,A
PERMIT # /
PLUMBING PERMIT RECEIPT #
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE: J
Site Address ` 5 = ? / ''. • G - k ,
Lot 7 Block ? Sec/Sub
Name
Address / C
c City - ?n? Phone
Name _
3 Address
p City -
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
MINIMUM - RESIDENTIAL FEE -$10.00
MINIMUM - COMM/IND FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $50 S/C IF PERMIT PRICE GOES
BEYOND $1,000.00)
OF
FOR: CITY OF EAGAN
BLDG. TYPE WORK DESCRIPTION
Res. N New -k
Mult. Add-on
Comm. Repair
Other
NO. FIXTURES TOTAL
Water closet - $3
00 S
.
Bath Tubs - $3.00
Lavatory - $3.00
Shower - $3
00
.
_LKitchen Sink - $3.00
Urinal/Bidet - $3.00
Laundry Tra
- $3
00
y
.
Floor Drains - $1.50
Water Heater - $1.50
Whirlpool - $3.00
Gas Piping Outlets - $1.50
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
Rough Openings - $1.50
FEE
STATE SIC: '
GRAND TOTAL-
?> > ?'
2004 RESIDENTIAL MECHANICAL PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for: single family dwellings & townhomesteondos when permits are required for each unit
Date O / /07 1 Site Address 30 / S C ? ?' 1 7 ?f Q/.S !--/Q - Unit #
Property Owner/?? Telephone #(&{ ;i) 7(2r
Contractor
Street Address ?/I l? Y S S i . l?C Je Sf City ' J l
?
State
Zip SSD ?O a q
-y
Telephone #
Bond #: Expires:
The Applicant is Owner Contractor Other
Add-on or alteration to existing dwelling unit $ 30.00
furnace -Additional -Replacement
_ air exchanger
air conditioner -New replacement
other
State Surcharge D
`. s
TP $ .50
JUL 16 L` ?
Total $
I hereby apply for a Residential Mechanical Permit and acknowledge that ibe-mt
,-be-in- ortnance with the ordinances and codes of the City of Eagan and with
permit t only an application for a permit, and work is not to start wit t
app d plan in the case o>) ork which requiles a review and approval of p
Applic is Printed ame C,/ Appli
ation is complete and accurate; that the work will
Mechanical Codes; that I understand this is not a
nit; that the work will be in accordance. with the
Signature
2004 COMMERCIAL MECHANICAL PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for. commercial/industrial buildings
multi-family buildings when separate permits are not required for each dwelling unit
Date -#
Site Street Address - ?' unit #
Tenant Name (if applicable) Previous Tenant Name
Property Owner Telephone # ( )
Contractor
Street Address City
State Zip
( )
Telephone #
Bond #• Expires:
The Applicant is Owner Contractor Other
Work Type
_ New Construction _ Underground Tank _ Install -Remove "*see below
Interior Improvement _ Install Piping - Processed -Gas
Nature of Work:
"When installing/removing underground tank, call for Inspection by Fire Marshal and Plumbing Inspector
Permit Fees: $70.50 Underground tank installationhwroval
$50.50 'nLnwn (includes State Surcharge)
or
Contract Value $ x 1% Permit Fee
If permit fee is $1,000 or less, add $.50 $ State Surcharge
If ce 't fee is over $1,000, add $.50 for
every $1,000 permit fee $ Total Fee
I hereby apply for a Commercial Mechanical Permit and acknowledge that the information is complete and accurate; that the work
will be in conformance with the ordinances and codes of the City of Eagan and with the Mechanical Codes; that I understand this is
not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with
the approved plan in the case of work which requires a review and approval of plans.
Applicant's Printed Name
Applicant's Signature
Approved By: , Inspector
/ ?
1985 BUILDING PERMIT APPLICATION - CITY OF EAGAN j
NOTE: ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN
COMMERCIAL
SINGLE FAMILY DWELLINGS
INCLUDE 2 SETS OF ARCHITECTURAL INCLUDE 2 SETS OF PLANS
& STRUCTURAL PLANS, 1 SET OF 3 CERTIFICATES OF SURVEY
SPECIFICATIONS AND 1'SET OF 1 SET OF ENERGY CALCULATIONS
ENERGY CALCULATIONS
$2,000 LANDSCAPE BOND joecoo
To Be Used For: ?F\Z Valuation: Date: X2/86`
Site Address OFFICE USE ONLY
Lot Z Block `
Parcel/Sub L Q M o"A `.a te
Owner C_,M, LQ=L
Address
City/Zip Code V 6nrL4 ke. IMat..-
Phone s Z- z ?l g o
Contractor k'
Address 1.
City/Zip Code
Phone
Arch./Engr. /-\ J \\ -
Address
City/Zip Code
Erect
Remodel
Repair
Addition
Move
Demolish
Int.Impr.
Install ?..
APPROVALS
Occupancy
Zoning
Type of Const
# of Stories
Length
Depth
Sq Ft
FEES
Assessments Permit
Water/Sewer Surcharge
Police Plan Review
Fire SAC
Engr Water Conn
Planner Water Meter
Council Road Unit
Bldg Of 6i5e6Treatment P1
APC Parks
Variance Copies
TOTAL
Phone #
/ROSE
ENGINEERING
COMPRNY, INC.
1000 EAST 14611 67REET,
Cer
I
Z.eQ41 Dle.?c Zion: LOT 2, BLOCK 1, LEMAY LAKE HILLS,
DAKOTA COUNTY, MINNE50TA
,TDZ_s) DENOTE5 EX15T11Q6 ELEVATION
(a e.s) DENOTE5 PRapo5Eo ELEVATION
INDICATE5 DIRECTION OF SURFACE DRAINAGE
qjC,00.= FINI5HED EARA6E FLOOR ELEVATION
4?DrncS
NORTH
SCALE : I" - 30'
DRAINAGE AMD
UTILITY EASEMENT
,00
4
O
0
0
J
I"i
W
00
o?
o O
O \
iorl -
(Rm. .ioM
_ L
3o' FRONT BUILDING
5E7'3ACK LINE
.- y
5 09' 44' ?8"E ?1 ZS,oo
/2Z /7
v ` `'lgo4??? ,
o u ? `
to ??• 0 20.67 _? yI/10
f? a 25.4"1 It ? o 0 I -
C4 i)
lU 9.00
30.0
?-? ? ??NI w a n
'-' r?l a ??? I g
h
L?
,o LOT 2 '°p 'g - -
ti
/07.67 • v h. 00
A/ 89044'28"E I t"
roWERV/EW ROAD
I hereby certify that this is a true and correct representation of a tract of
land as shown' and described hereon.. As prepared by me on this !o n1 day of
S?* ? 19 g'G . •
CONSULTING ENGINEERS
IIRVEYOIIS
plR11NEAS and `AND j
BURNSVILLE, MINNESOTA 56331 PH 132'1600
Ref. No. /ar-
?r •
?,o f Z
EXTERIOR ENVELUE AVERAGE "U ` CUIPUTATION
OWNER 1?-. J . 141 1 .
SITE ADDRESS
CONTRACTOR/75/s2.-/,/,,,,,,; DATE__/12?d'(-PIIOPIE
Determine working square footage of each. 3 °1-41
1. Total exposed wall area .... /??O.O sq. ft. x .1%
2. Total roof/ceiling area .... //D H./2 sq. ft. x = G
.
Total exposed wall area above floor 9.5"0,o
a. Total wall wirizow area 9.?•y
b. Total door area .................... O.?
c. Total sliding glass area ..........
d. Total fireplace wall area ......
e. Total wall framing area (average*l0i)....
. / 5.0
f. Total net wall area above floor ........ yo.
G. Total rim joist area ...............
Total exposed foundation area =
h. Total foundation window area O
1. Total net foundation area above grade . 96.0
Determine "U" value of each wall segment.
a. X
b. yo• r X "U" , olc = 3•
D. 0 X °U" o +? o
e._/9s-0 X 1.U11
a7 /3.7
f. /590 y X "U" _ G 9. 9
g. X "U'` ova s. a
h. 73 X U' d = o
3 ............................................Total s
If Item N3 is the same as, or less than item k'1, you t met the
intent of SBC 6066(c)2.
"3 C/G3.7?) L
r
Total exposed roof/ceiling area =
J. Total skylight area ... ...... ... p
k. Total roof/ceiling framing area (average 10•,
1. Total net insulated roof/ceilinS area ....... ":9,6
Determine "U' value for each roof/ceiling segment.
v b
j.? p X 1-U.1
k. //o f X ' U''' , o,;, u 3•1
4.......' ............. ... .........Total = fps.
-?ktv n y CjS, o? L? N a CG.1? OIL 5l?c lrooa(?)/
If total of P4 is the same as, or less than f2, you have met the
intent of SBC 6006(c)l.
Alternate Building Envelope Design
To utilize the total envelope system method, the values established
by the sum of items #3 and #4 shall not be Sreater than the sum.of
items #1 and 92.
3. IV 0 + 4. _
CV. -e'w- a, K-6?7
?= ys, y
-e'4 a?
Lvi?? -?
5? " _ z x s?sLu?
d-
h
XVS-.Y= - 0.2')?
r/fib
CITY OF EAGAN
APPLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
NOTR: PAYMENT OF FEE AT TIME OF
APPLICATION DOES NOT CONSTITUTE
APPROVAL OF PERMIT.
INSPECTION OF SEWER AND/OR WATER
INSTALLATIONS WILL NOT BE SCHED•- ,
ULED UNTIL PERMIT BAS BEEN
APPROVED. ;
1) PROPERTY ADDRESS:
LEGAL DESCRIPTION:
Lot Block Subdiv ion or Tax Parcel ID
IF EXISTING STRUCTURE, DATE OF ORIGINAL BUILDING PERMIT ISSUANCE:
i
PRESENT ZONING/PROPOSED USE: Pbn Year
p COMMERCLALAWAIL/OFFICE
Q INDUSTRIAL
n INSTITUTIONAL/GOVERNMENT
R-1 SINGLE FAMILY
R-2 DUPLEX (Tun Units)
R-3 TOWNHOUSE (Three + Units) ( Units)
R-4 APARTMENT/CONDOMINIUM ( Units)
2)
ADD
CITY, STATE,
P
3) u .:•
ADDRESS:
i CITY, STATE, ZIP:
PHONE:
4)
N
ADDR
CITY, STATE,
PH
5} u (W -.-y •:i• :: • o? a?
CONNECTION TO CITY SEWER p( CONNECTION TO CITY WATER OTHER
6) • r Q PLEASE HOLD APPROVED PERMIT FOR PICK-UP BY ONE OF ABOVE
PLEASE MAIL APPROVED PERMIT TO 1, 2,0 4, ABOVE
/L (Circe one)
n r'or city use
Plumbers License:
Active
Expired
Y1,? J`-J'??3 %? Not recorded
MASTER LICENSE# DQ..) iJ ?JQ Staff IniFial
FOR CITY USE ONLY
PERMIT # ISSUED
L ?; ?xg
Pd W/Bldg. Permit FEES:
$ $_- ('?-_' c SEWER PERMIT (INCLUDE SURCHARGE)
$ $ ?6 'Sa WATER PERMIT (INCLUDE SURCHARGE)
$ / S
CO 7" SD $
WATER METER/COPPERHORN/OUTSIDE READER
$ $ WATER TAP (INCLUDE CORPORATION STOP)
$ $ SEWER TAP
$ `T $ ?i ACCOUNT DEPOSIT - SEWER
$ r $ ?,S D U ACCOUNT DEPOSIT - WATER
$ S L7?J U O $ WAC
$ J?7 S OD $ SAC
$ $ TRUNK WATER ASSESSMENT
$ $ TRUNK SEWER ASSESSMENT
$ $ LATERAL BENEFIT/TRUNK SEWER
$ $ LATERAL BENEFIT/TRUNK WATER
$ l $ WATER TREATMENT PLANT SURCHARGE
$ $ OTHER:
$ / 7 -0 $ J A S ? TOTAL
?:5-6 74
RECEIPT RECEIPT
DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
Q YES IF YES, THEN A "PERMIT FOR WORK WITHIN PUBLIC
Q ROADWAY" MOST BE ISSUED BY THE ENGINEERING
NO DIVISION. LIST AS A CONDITION.
SUBJECT TO THE FOLLOWING CbNDITIONS:
APPROVED BY:
TITLE: q
DATE:
Ab? City of Eapn
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 6755675
Fax: (651)676-5694
---------
r Office.. pss I
Fo
j Permft#:
Permit Fee: < O
I I
Date Received: j
I I
I Staff: I
-----------------
2009 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 1 I 10 '-7 ll Site Address: C7 J VA 1 GI S 'DF-
Tenant: -7??,``-t.` \ V,-C C "?- C-'20 Suite #:
RESIDENT / OWNER Name: 1 C?k LS n Q l e y Phone: ??? ?'6 b1'??J
Address / City / Zip: Q ?y S J ?? l Q. l C,I S ?? .
A
li
t i
O
pp
can
s: -
wner Contractor
TYPE OF WORK Description of work: rG \ .2 o
Construction Cate CJ /3y C Multi-Family Building: (Yes No<?-cl)
CONTRACTOR
#: ?J c7 ?,-
Name: CR-e-?-(i
v S ArUGc?) License
f
(\
Address:
? c' 1
City: 0 S
State: M? Zip: r?? ?l I
! r[? ''
Phone: (i 12 - to v ` 2 Contact Person: I[ _ eJ ct r tiQ-? S r.J?'J
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7672
_ Minnesota Rules 7670 Category 1
_
Energy Code . Residential Ventilation Category 1 Worksheet New Energy Code Worksheet
Category Submitted Submitted
(4 submission type) • Energy Envelope Calculations Submitted
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
-Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that the are trade secrets.
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval oof plans. w r--\ C) I
x L6J r'1 l 4-?S dY1
Applicamfa Printed Name ApplicanJ7 Signature
Page 1 of 3
411111.
City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
For Office Use
Permit #:cc__
Permit Fee: /e S,
Date Received:
Staff:
( 2012 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 9" 1-(— 12.-- Site Address: 3 09 C s 4 'e kis S dr Unit #:
RESIDENT /
OWNER
CONTRACTOR
Name: / 7`-KOi' C7 rQ Hoc/ 5/119 Phone: D 5/ 2 7;25-76
30, Q(cl 5 car 0,11_1
Address / City / Zip:
Applicant is: Owner X Contractor
Description of work:
12e Ace 7 ,-(`�104,5
Construction Cost: 2 SOO
Company:
Multi -Family Building: (Yes / No X )
/�fd�Q SQ A AC71 0/1V44e, -'<)Contact: o
Address: It -oto t6(e. /1/6.'
City: �-112 ""[
16/
State: et/ Zip: 57 `(5
License #: �C 2 OK 39 ('C/
Phone: CV' tJ p 7 — 53(
Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes No If yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Phone:
Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public informationPortions of.,
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.qopherstateonecall.orq
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
Applicant's Printed Name
x
Applicant's Signature
Page 1 of 3
11,11
City of Eaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
For Office Use
Permit #:
Permit Fee: ( 0i C7
Date Received:
Staff:
2012 RESIDENTIAL PLUMBINGPERMIT APPLICATION
Date: ///(. AZ- Site Address: 3 QgS 5-4,. et S Or
Tenant:
Suite #:
RESIDENT'/ OWNER
I °4-r d -6i / hd C Phone: 6S%- 2 ler —2-S-70
Name:
Address / City / Zip:
CONTRACTOR
Name: 6ea i aed, P(4'G t J✓t-, k License #:
Address: VMBale fri CGGrir City: elee//
State: 711/1 Zip: SF- Phone: 667- 33..C-Wo
Contact: ( Email: i ,wK;i''i' -eV / COili«i S% /ti
er-
TYPE OF WORK
• i
New X Replacement Repair Rebuild Modify Space Work in R.O.W.
— _
Description of work: _-� �j' H wast( Cela, V`-- 5 u'"ZI_ ht ut
PERMIT TYPE
RESIDENTIAL {cl `(ici, o(c l
Water Heater
P
- p-)1 !Gi'l4I 4 SC /i/' - ej6. c.tre (G'�.
Water Softener
Lawn Irrigation (_ RPZ / PVB)
Add Plumbing Fixtures ( Main / Lower Level)
_
Septic System
Water Turnaround
New
Abandonment
RESIDENTIAL FEES:
$60.00 Minimum Water
Heater, Water Softener, or Water Heater
(includes $5.00 State Surcharge)
Fixtures, Septic System Abandonment, Water
and Softener (includes $5.00 State Surcharge)
$60.00 Lawn Irrigation
$60.00 Add Plumbing
*Water Turnaround
$105.00 Septic System
Turnaround* (includes $5.00 State Surcharge)
and $5.00 State Surcharge)
TOTAL FEES $
(add $189.00 if a 5/8" meter is required)
New ($10.00 per as built) (includes County fee
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.orq
1 hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, a d k is not to stajwiithout a permit; that the work will be in
accprcjance with the approved plan in the case of work which requires a review and ap, rovf plans.
x Y� ri r% r ft,/Applicant'sPrinted Nae
Applicant's - g ature
FOR OFFICE USE
Required Inspections:
Reviewed By:
ate:
Under Ground
Rough -In Air Test
as Test