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2oos RESIDENTIAL PLUMBING PeRnniT aaPUCarioN
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings.
~ate~~l~I~
~
Site Street Address ° Unit #
Property Owner 1~Lr~fi} (~(~(,~S , Telephone # ( )
Contrector Telephone # ( ) ~y ~ ~ 3~ b
Address City State/~4~ Zip 551~3
The Applicant is: _ Owner ~'~contractor _Other
Septic System _ New _ Refurbished Submit 2 sets of plans and MPC license Includes County fee
$ 100.00
Per as-built $ 10.00
Alterations to existing dwelling $ 50.00
~ _ Add plumbing fixtures. This fee includes installation of a water softener and/or water
I heater at the same time !f you are installing onlv a water softener and/or water
heater, do not complete this section; move to the neut section and check the
appliance(s) you are installing.
_ Septic System Abandonment
_Water Tumaround (add $130.00 if a 5/8" meter is required)
Other:
Water Softener ~Water Heater $ 15.00
_ new ! replacement
Lawn irrigation _RPZ _PV6 _new _repair _rebuild $ 30 00
State Surcharge $ 50
Total $
I hereby apply for a Residential Plumbing Permit and acknowledge that the information is complete and accurate; that the
work wiil be in conformance with the ordinances and codes of the City of Eagan and the plumbing codes; that I
understand this is not a permit, but only an application For a permit, work is not to start without a permit and work will be in
accordance with the approved plan in the event a plan is required to be revi wed and approved.
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ApplicanYs Printed Name ApplicanYs ig a ure
nCr 2 s 20a6
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} WATER SERYI P101itti
t eLis!f
`icato PERMIT NO.
� :
leieee;hfitt : s551211 DATE: 4x - '
Igo. of Units: c
t)rri Tht tdn. - Home
sit m 46 -- t 1 4: 147t 4t L2 r3 .7ideClife2nt.
Ce az Ryan
spa :
Connection Barge: 3°r) • O.
*erg AosoUnt Deposit:
Permit Fee: 10 0` tic
' ° #CIS SS�;i am CAT of SmPa Surcharge: ai; Pc
Misc. Gorges 60.r;0 ?deter,
Total:
Dote Pad:
of d Insp..
SEWER SERVO* ass .;, - ;;�_. . , ;
Zoning. �' � DA's.
IF
" — — _ r
Owfler: 9 C • , ; Flo. of tJnPts: 7I i / 1 n .! e
Address; • �r-
Site Address: 4ryC2` • • • • • rre ti
an k . c* .. u f 3
Pitmlber i
/6/R0 1`1227
1 "MO, of t Connection Chomp: pc`t
fo1 Ci75 t(°
Account Deposit:
Permit Fee: t a0
By surcharge;
Date
Toil Charges'
.
/...) 4. - ' Date Paid
4111'
City of Earn
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:
Date Received: 2 10-
Staff:
J
2013 RESIDENTIAL/BUILDING PERMIT APPLICATION
T
Date: Site Address: _ / /// �('Ai'I V /C/ Unit #:
Name:
X'Fil4-241,e(s•
Phone:l ?5,4 ‘37 -
Address
/
Address / City / Zip:
Applicant is: Owner
fr Contractor
{ j repkce. r�ryivmt� 2 tad
Description of work:� it/Mk2// -v t a a' /Asii/d%%g 1Q �1/t om t3 kaart
- Rig %q,i7 1 44
Construction Cost:; �''� 2 orIV Multi -Family Building: (Yes )
Company �y �,/
Address: W8 g/1 ir/ r
D/'r 4°17d/7,y s72 /-
74140.1_,4. eontact: /J/2&if/�Q le/7 %/Z_ C
City: /-/i, OJi S
.ss �� j Phone: �j /01 � —d3 03
License #off 3�� / Y' Lead Certificate #:
State: kid Zip:cc:5-41/
If the project is exempt from Ieal certifiiatiofi, ptfease explain why: (see Page 3 for additional information)
.,3 uL I(cid
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. Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
CALL BEFORE YOU DIG. CaII 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
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 1 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
egf
cant's ts Signature
Page 1 of 3
SUB TYPES
Foundation
T Single Family
_ ulti
01 ofyPiex
Accessory Building
WORK TYPES
New
Addition
Alteration
Replace
Retaining Wall
DESCRIPTION
Valuation
Plan Review
(25%_ 100%✓)
Census Code
# of Units
# of Buildings
Type of Construction
DO NOT WRITE BELOW THIS LINE
Fireplace
Garage
Deck
Lower Level
Porch (3 -Season)
Porch (4 -Season)
_ Porch (Screen/Gazebo/Pergola)
Pool
Interior Improvement
T Move Building
_ Fire Repair
Repair
11311
Occupancy
Code Edition
Zoning
Stones
Square Feet
Length
Width
REQUIRED INSPECTIONS
Footings (New Building)
Footings (Deck)
Footings (Addition)
Foundation
Drain Tile
Roof: _Ice & Water Final
1- Framing
Fireplace: _Rough In Air Test _Final
Insulation
Sheathing
Sheetrock
Reviewed By:
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
73 v5
111
3@ Olt
TOTAL
— Siding
Reroof
Windows
Storm Damage
Exterior Alteration (Single Family)
Exterior Alteration (Multi)
Miscellaneous
_ Demolish Building*
_ Demolish Interior
Demolish Foundation
Egress Window Water Damage
*Demolition of entire building — give PCA handout to applicant
7/k -1
Z
R-3
MCES System
SAC Units
City Water
Booster Pump
PRV
Fire Sprinklers
Meter Size:
Final / C.O. Required
.� Final / No C.O. Required
HVAC _ Gas Service Test Gas Line Air Test
Other:
Pool: _Footings Air/Gas Tests Final
Siding: _Stucco Lath Stone Lath _Brick
Windows
Retaining Wall: Footings — Backfill _ Final
Radon Control
Erosion Control
Building Inspector
Page 2 of 3
Use BLUE or BLACK Ink
r
For Office Use
Permit
fiG
City of EaEd ; L[JOA5
Permit Fee.
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675
I I
Fax: (651) 675-5694 I Staff:
I I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: 7// 7 AJ ,/010t' 9"7 8 7 ^.Unit
Name: Phone:
Resident/
Owner Address / City / Zip:
Applicant is: Owner Contractor
Type of Work Description of work: V e " re U
Construction Cost: J b Multi-Family Building: (Yes JC / No )
Company: l1A/ 7rt A ng- ~Y Contact: r=ib Doe
Contractor Address: `t~s' City: 6U~~
State: _AI Zip: .~S'3 Phone: 01 _ FIV
License 6 6 4 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: 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 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.gopherstateonecall.org
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.
'a-41 gi=_ x x
Applic nt's Printed Name cant' nature
Page 1 of 3