3170 Sibley Memorial HwyCASH RECEIPT
CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN. MINNESOTA 55122
-7
DATE 19
RECEIVED
AMOUNT I- I
-& _DOLLARS
IOu
? CASH ? CHECK
r
/DDOgG10Da,6&oZ
BY
White-Payers Copy
( Yellow-Posting Copy
Pink-File Copy
Thank You
CITY OF EAGAN Remarks
Addition Section 9 Lot Blk Parcel 10 00900 020 32
Ownec: L.- I' Street 3170 Sibley Mem. Hwy. State Eagan,MN 55121
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK 1968 110.00 .66 0
SEWER LATERAL 1973 282j4.82 141.24 20 Paid
WATERMAIN
WATER LATERAL flj? 1 1397.69 .1 1 Paid
WATER AREA -1 1977 8o.oo 25.33 1
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. 50.00 35501 4-2T-83
BUILDING PER.
SAC 525.00
n
M
PARK
CITY if EAGAN
3795 Pilot Knob Road
Eagan, MN 55122
Zoning:
Owner t:^
Address:
Site Address:
Plumber:
1 agree to comply with the City of Eagan
Ordinances.
R..
SEWER SERVICE PERMIT
PERMIT NO.:
DATE:
No. of Units:
Connection Charge:
Account Deposit:
Permit Fee:
Surcharge:
Misc. Charges:
Total:
Date Paid:
Date of Insp.:
I nsp.:
CITY ', FAGAN WATER SERVIC E PERMIT
3795 Pilot Knob R oad PERMIT NO.:
Eager., MN 55122 DATE:
Zoning: No. of Units:
Owner: ' .'
Address:
Site Address: d Or? C7 Q Qzp 3 .
Plumber: N `
Meter No.: ` Connection Charge:
Size: Account Deposit:
Reader No.: Permit Fee:
agree to comply with the City of Eagan Surcharge:
Ordinances. Misc. Charges:
Total:
BY Date Paid:
Dote of Insp.: Insp.:
CITY USE ONLY
L BL
SUBD.
RECEIPT #:
DATE:
1996 MECHANICAL PERMIT (COMMERCIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 681-4675
Please complete for: all commercial/industrial buildings.
? multi-family buildings when separate permits are = required
for each dwelling unit.
DATE:
CONTRACT PRICE:
WORK TYPE: NEW CONSTRUCTION
DESCRIPTION OF WORK:
INTERIOR IMPROVEMENT
FEES: $25.00 minimum fee g[ 1% of contract price, whichever is greater.
? Processed piping - $25.00
? State surcharge of $.50 per $1,000 of pgajt fee due on all permits.
CONTRACT PRICE x 1%
PROCESSED PIPING
STATE SURCHARGE
TOTAL
SITE ADDRESS:
OWNER NAME:
TENANT NAME: (IMPROVEMENTS ONLY)
INSTALLER:
ADDRESS:.
CITY:
PHONE #:
TELEPHONE #:
STATE: ZIP:
SIGNATURE:
SIGNATURE OF PERMITTEE CITY INSPECTOR
00 goo
L BL
SUBD. /D- 00FOO- D,;aO -4ol-
CITY USE ONLY - ?- / ?,'
RECEIPT #: ??
DATE: _/0
1996 MECHANICAL PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 681-4675
Please complete for: single family dwellings
? townhomes and condos when permits are required for each unit
New construction _ Add-on furnace
Add-on air conditioning Add-on air exchanger, i.e. Vanee system, etc.
Date:
Minimum Fee: Add-on/Remodel (existing residence only) 20. 0
? HVAC: 0-100 M BTU 24.00
Additional 50 M BTU 6.00
Gas Outlets (minimum of 1 required @ $3.00 each)
01 State Surcharge
TOTAL
?v
??,? ????i?'?.?12?
SITE ADDRESS:,,
OWNER NAME: PHONE #: -??
INSTALLER NAME:
STREET ADDRESS:
CITY: L?STATE: zip: PHONE #: ( ) Aw"'
City of Eall(IR
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r-----------------
For'Office Use I
Permit #: 9 dLO-Gc?- ?
I Permit Fee:
I I
Date Received: 2 -J 7'
I I
Staff:
02?
2008 SEWER AND WATER REPAIR / DISCONNECT PERMIT
Date: ` - Fee: $50.50
w
Cit
S Water Repair Disconnect
Cit
y
e
er y
Description Of Work: P Q
Street Address for Proposed Work 17? r p?/ /? ?l Gl I
OWNER Name: ?l Phone:
Address / City / Zip:
Applicant is: ner ontract.r
Licensed Pipelayer? Master Plumbe Property Owner
Name: d T--?' Phone:
Address I City / Zip:
Pipelayer Training Certification Card or Master Plumber License 9:
I acknowledge th t the information is complete and accurate and that the work will be in conformance with the ordinances and codes
of the City of n and the State of MN Statutes. I understand this is not a permit, but only an application for a permit, and work is
rt wi out permit.
V
r
nn me) Applicant's Signature
Date:
C!ty of Eaaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use
Permit #: /0// ?
0_oo
Permit Fee:
Date Received:
Staff:
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
0- 3- //
Site Address: 31'20 �c lOtat/ 4.
$ . i4jh Unit #:
Name: 1)A - L1°71� l 44e-01 ( Phone:
Address / City / Zip: `224 -row/L) C.4-4 It _ -'‘C), 2. --
Applicant is: Owner [/"Contractor ,-- pi(, x S'if1'Zf ►a.t k.�GN =wL
Description of work: ivki' v,4- d 24 LO1Vt
Construction Cost: ` l o r Civ
J
ter- £7-4' L
C
Multi -Family Building: (Yes / No t)
Company: /14,01- 5-6, ht 1
Address: ”*.v"-)
State: IW Zip: l Phone:
Contact
Opt du -tike
City: L', r4, ru
(6.5-1- 444 - 62LZl%
License #: Lead Certificate #:
If the project is exempt from lead certification, please explai why: (see Page 3 for additional information)
Jam. 1Z914k eaVo
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. Al Phone:
Mechanical Contractor Phone:
Sewer & Water Contractor Phone:
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.cooherstateonecall.ora
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 O
days of permit issuance.
6Wf k
Applicants Printed Name Applic "nt.'s
.0 must be leted within 180
il
riiff
nature
Page 1 of 3
City otEapll
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
Permit #:
Permit Fee: g' CO
ived: 7C/ --(2V--//
2011 SEWER AND WATER CONNECTION AND AVAILABILITY CHARGES
EXISTING COMMERCIAL PROPERTY
Date: 'C%Pliii6 `
FOR OFFICE USE ONLY
Property Owner:
PRV required
City R -O -W Permit
Address: le Phone Number:
—
-- County R -O -W Permit
Plumber: e es Iv 1, f 'r Contact Name:) --.7g9 -Ll 630-
SEWER
WATER
Sewer Service ^`/
Water Service
e
Water lateral charge
g
Water trunk
Water supply storage
Receipt #:
Sewer lateral charge
Sewer trunk
City SAC @ $100 / unit
MCES SAC @ $2,230 / unit
, Date:
Receipt #: , Date:
Treatment Plant @ $765
Permit Fee
State Surcharge
*Plumbing Permit Required
acquired with building permit
/ unit
Septic abandonment $ 50.00
$ 50.00
Permit Fee $ 50.00
$ 5.00
State Surcharge $ 5.00
- water meter to be
TOTAL:
TOTAL:
SEWER & WATER
Sewer Service
Water Service
Sewer lateral charge
Water lateral charge
Sewer trunk
Water trunk
City SAC
MCES SAC
Receipt # ,
<-r-
-
Date
/ /1 jun >�
( 6
Water supply & storage
Receipt # ,
Date
( S t
Treatment plant
Septic abandonment
Permit Fee
State Surcharge
*Plumbing Permit Required - water
acquired with building permit
$ 50.00
$ 100.00
$ 5.00
meter to be
TOTAL:
umber of SAC units is determined by the Metropolitan Council Environmental Services (651) 602-1000.
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
Cc: City of Eagan Finance Department