1131 Tiffany DrCITY OF EAGAN WATER SERVICE PERMIT
3830 Pilot Knob Road
P.O. Box 21199 PERMIT NO.: 8102
Eagan, MN 55121 DATE: 10-23-86
Zoning: _ R1 No. of Units: - 1
Owner. Rvend Petercnn rnnst
Address:
SiteAddess: 1131 Tiffany Drivp T1% R1 Ca tcrh" : Pone-st
Plumber. r-ear-R-nn
Meter No.: -3 7V YIA' 3 15-
har e: 500 nOTd
Size: 4r?t,,tes 15 OOPd
Reader No.: a_2Q? g ?Ei0le 0%
? { ?;?$ E1Ia. tJt 40pd
1 agree to comply with the City Uwjp S rc ar e:
Ordinances. REUt^tVIRODCf r es
1t Total: Meter
Date Paid:
Date of Insp.: Insp.:
- - ?? f - k6
CITY OF EAGAN WATER SERVICE PERMIT
3830 Pilot Knob Road
P.O. Box 2118) PERMIT NO.: P, 102
Eagan, MN 55121 DATE:- 1 o-23-86
Zoning:• r'-1 No. of Units: - 1
Owner 4v nd P tnrSon fnnS?
Address:
SiteAddess: 11 31 Tiffany Drime T 1 S TO r-terbu
ry >?orect:
Plumber: _
Meter No.:
Size:
Reader No.:
1 agree to comply with the City of Eagan
Ordinances.
Connection Charge: 500 00Pd
Account Deposit: 15 , 0411
Permit Fee: 11) 00pd
Surcharge: . 50Pd
Misc. Charges: 156.00pd TV
Total:
By Date Paid:
Date of Insp.: Insp.:
CITY OF EAGAN SEWER SERVICE PERMIT
3830 Pilot Knob Road
P. O. Box 21199 PERMIT NO.: `
Eagan, MN 55121 DATE
Zoning: No. of Units: '
Owner: r;-
Address: -
Site Address: -? 'L.Lffar.
Plumber: - -"'•
I agree to eoaytlr wtdr as Cky of Itysu Connection Charge: -00
Ordirreftem Account DepoeR: -
Permit Foe:
Surchome:
BY -
Date
of Insp.:
Misc. Charges:
Total:
Doty Paid:
BLDG. PERMIT NO.
„ (o
01-3210 Bldg. lgermit?
01-3422 Plan Check
01-3445 Surch./Adm.
01-3446 SAC/Adm.
01-2155 Surcharge
17-3860 Road Unit
20-2275 SAC
20-3865 Water Conn.
20-3868 Water Trmt.
20-3716
20-2252
20-3713
20-3743
79-3866
11-3855
Water Meter
Acct. Dep.
Water Permit
Sewer Permit
Sewer Conn.
Park Ded.
TOTAL
CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATA 19 L
RECEIVED- i?
FROM
AMOUNT
DOLLARS
too
? GASH ? CHECK
FUND I CODE I AMOUNT
Thank You
666V
White-Payers Copy
Yellow-Posting Copy
Pink-File Copy
' CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 124Ss
PHONE: 454-8100
BUILDING PERMIT Receiptff
SF DWG/GAR $117,000 86
AUGUST 18
To be used for Est Value Date 19
Site Address
15 1131 TIFFANY DRIVE
CA14TERB Erect J' l_i}x?
URY ?O:
" Occupancy R3
PD
Lot .
Block Sec/Sub. J4
el [I Zoning
Repair ? Type of Const V n
Parcel No.
Addition ? No. Stories
'WEND PETERSEN CONST Move ? Length
Name 3 b
1 Demolish 11 Depth
Address
U W
10TH ST
4
71
I
I
t
11
S
FT
c 'P 8134-5144
''S mpr.
n
. q.
City Phone Install ?
o Name SAM Approvals
Address Assessment
~ City Phone Water & Sew.
Police
au i Name Fire
a Address Eng.
W City Phone Planner
I hereby acknowledge that I have rei
information is correct and agree to
Minnesota Statutes anct_City of EaA
Signature of
SvEiiU ;TS1'11.4
A Building Permit is issued to:
all work shall be done in accordance with all applicable State of A
Bldg. Off. 0/J-010
APC
Permit rasa 475.51
Surcharge -"T' 51
Plan Review 7 .7'
SAC --575• 0 i
Water Conn. 5U0.01
Water Meter b3. 51
Road Unit --2'gV` 01
Tr. Pl. Iti6. 01
Parks
Copie
52,356.2.'
Ti.MI
on the express condition that
and City of Eagan Ordinances.
Building Official
Permit No. Permit Holder Date Tslaphone N
Plumbbig izLier I
H.V.4.C.
Electric
tioflener
Inspection Date Insp. Comnwnts
Footings I ?? ! It !>
Footings 11
Foundation
Framing
Rooting
Rough Pibg.
Rough Htg.
Insul.
i7 Q
C?K!
Fireplace ,?s p
Final Hill.
Final Plbg. _ g!
Bldg. Final
Deck Fig.
Deck Fnng.
Well
Pr. Dlsp.
s :. . PERMIT # l lC i
- PLUMBING PERMIT RECEIPT #
CITY OF EAGAN
i
3830 PIL OT KNOB ROAD, EAGAN, MN 55121 DATE: /
CONTRACT PRICE: PHONE: 454-8100
Site Address. BLDG. TYPE WORK DESCRIPTION
Lot Block i Sec/
ub
S
.
-
( - , .. Res. New
m Name -----`' Mull Add-on
Address Comm. Repair
c City Phone ?? - Other
NO. FIXTURES TOTAL
L Name Water Closet - $3
L
00 $
_:
-
.
3 Address Bath Tubs - $3.00
p _ I
City- -' Phone - - Lavatory - $3.00
Shower - $3.00
Kitchen Sink - $3.00
FEES
COMM/IND FEE - 1% OF CONTRACT FEE -T-Urinal/Bidet - $3.00
Laundry Tray - $3.00
MINIMUM - RESIDENTIAL FEE _$10.00 -/Floor Drains - $1.50
MINIMUM - COMM/IND FEE - 20.00 : Water Heater - $1.50
STATE SURCHARGE PER PERMIT - .50 Whirlpool - $3.00
(ADD $50 S/C IF PERMIT PRICE GOES Gas Pi
in
Outlets - $1
50
BEYOND $1,000.00) g
.
p
Softener - $5.00
Well - $10
00
.
Private Disp. - $10.00
?- Rough Openings - $1.50
SIGNATURE OF PERMITTEE FEE:
STATE S/C:
FOR: CITY OF EAGAN GRAND TOTAL-
PERMIT #
MECHANICAL PERMIT RECEIPT #
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE
CONTRACT PRICE: PHONE: 454-8100
Site Address BLDG. TYPE WORK DESCRIPTION
Lot Block Sec/Sub
Res. New
Name
A Mint Add-on
Address
9 Comm. Repair
c City Phone
Other
Name FEES
3 Address RES. HVAC 0-100 M BTU -$24.00
p City Phone ADDITIONAL 50 M BTU - 6.00
ADD-ON AIR COND. 0-24 BTU - 12.00
ADDITIONAL 6 M BTU - 6.00
TYPE OF WORK GAS OUTLETS - 1.50 EA.
Forced Air M BTU COMM/IND FEE - 1% OF CONTRACT FEE
Boiler M BTU MINIMUM - RESIDENTIAL FEE - 10.00
Unit Heater M BTU MINIMUM - COMM/IND FEE - 20.00
Air Cond. M BTU STATE SURCHARGE PER PERMIT - .50
(ADD $.50 SIC IF PERMIT PRICE GOES
Vent CFM BEYOND $1,000.00)
Gas Piping Outlets #
Other
FEE-
S/C: SIGNATURE OF PERMITTEE
TOTAL:
FOR: CITY OF EAGAN
CITY OF EAGAN Remarks by) r1U2 l y
Addition, CANTERBURY FOREST Lot 15
Owne x. C4 ti 4 51 .. ` i { Street 1131 TIFFANY DRIVE
uu u ,.f 1tv r ?, r
State EAGAN FIN 55123
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. 1979 Paid Un a ri 'na
STREET RESTOR.
GRADING $ 1981 106.78 5.34 20 8S.46 A013446 1-12-84
SAN SEW TRUNK Z 1973 Paid und@ original pd rcel
* SEWER LATERAL 1981 439.42 21.97 20 A013"6 1-12-84
WATERMAIN
* WATER LATERAL 1981 20
WATER AREA qo 1979 Paid unde r original pd rcel
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
13UILDING PER.
SAC
PARK
This request void
1 8 months from
C- 9 6 3 6 cis. gi, l!?
lag/a/
CGY'60
Re uest Oite? -
e
e.
1 Fire No.
I
Req Ro ug H_iredA?Inspection
ui
?Ready Nuw ? Will Nntifv. In.pec-
for Wh
n R
?
?t Dyes ?No e
eady
? Licensed Electrical Contractor I hereby request inspection of above
? Owner electrical work installed at:
Street Address, Be. or Ro e No.
v-
f Cit,
r
ac 1 n We. Township Name or N z Rangq No. _ County ?r
Occupant I pxw-,-- Phone No.
O V /
f'
eT u plier F? Address 'l
+
V
EIg c} ncal Contra r (Company Name) / ntractor's License No.
t7 o b 3
Mailing Address (Contractor or Ow r Ma mg Instaila I
v S
Author iz. of 51gpa l on r for,wn aking I stalls nl Phon Number
MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT
Griggs-Midway Bldg. - Room N-191 BE ACCEPTED BY THE STATE BOARD
UNLESS PROPER INSPECTION FEE IS
1821 University Ave.. St. Paul. MN 55104
19 1111 2471111 ENCLOSED.
rG / o tp REGUFSTTUR I L 1 m- EB-00001-04 dA^ See instructions for completing this form on back of yellow copy.
C 9636 "X'. Below Work Covered by This Request
Add ype of Building Appliances Wired Equipment Wired
me Range Temporary Service
plex Water Heater Lighting Fixtures
I t. Building Dryer Electr
ic Heabn
mmercial Bldg. Furnace Silo lJnloader.
ustrial Bldg. Air Conditioner Bulk Milk Tank
m Omer peel y Othee (Sper.ify)
Other pecify OI er Oiher
ompute Inspection Fee Below
N Fee Servic ce Size h Fee bfeeders a Fee cacu,ts
0to OOA s p? Otn 30 Am s
ove 200 Am ps mps 31 to 100 Arn s
Swimming Pool g
_Am s bove 100_Amps
Transformers ooms Pa ial.Oer ee
Signs pection $ ?
TOTAL FE
Bough-in r/ Date
I, the Electrical
nspactpr, hereby
certify that the above
Final ` D '}tPy 'napec tion has been
71 de.
This request vold 18 months from
• CASH RECEIPT •
CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MIN TA,55122
DATE
REC V ?I
AMOUNT ^y ...5%? n Q
&DOLLARS
? CASH / ??CY
FOR
41
FUND CODE AMOUNT
U ell
?L
0 i ooc
/ b
Thank You
N-2 67741 BY
White-Payers Copy
Yellow-Posting Copy
Pink-File Copy
CITY OF EAGAN
t . N2 12466
° . 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100 j
BUILDING PERMIT
Receipt#
To be used for SF DWG/GAR Est value $117,000 Date AUGUST 18 y 86
Site Address 1131 TIFFANY DRIVE Erect L Occupancy R3
Lot 15 Block 1 Sec/Sub. CANTERBURY FORIAS%del ? Zoning PD
Repair
Parcel No ? Type of Const V.p
.
Addition
?
No. Stories
SVEND PETERSEN CONST Move ? Length
56
z Name
4701 W 110TH ST Demolish ? Depth 16
c Address Int. Impr.
MPLS
884-5144 ? Sq. Ft
City
Phone
Install ?
SAME
o Approvals Fees
Name $ 475.51
8¢ Address Assessment Permit
City Phone Water & Sew. Surcharge 58.51
Police Plan Review 237.7'
W Name Fire SAC
575.01
ua Address Eng. Water Conn. 500.01
a W City Phone Planner Water Meter 63.51
Council Road Unit 290.01
I hereby acknowledge that l have read sapp ation and state that the BIdg.Off. 8/18/86 Tr. PI. 156.01
information is correct and agree to mp ith a is ble tate of
Minnesota Statutes of rdina APC Parks
r. Date Copies
Signature of Pe rmt $2
Total
!
,356.2
A Building Permit is issued to. SVEND PETERSEN CONST on the express condition that
all work shall be done in accordance with all ap i le State of inne t-oaS-ttatutes and City of Eagan Ordinances.
Building Official
W7
NOTE: ALL
p''Z 1?I770 ei
SINGLE FAMILY DWELLINGS
Sf9/??= ? s
-413 3 0
Lz:7-en
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS
MULTIPLE DWELLINGS - RESIDENTIAL RENTAL UNITS FOR SALE UNITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECK WITH BLDG. DEPT.,
1 SET OF ENERGY CALCULATIONS
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONS,
$2,000 LANDSCAPE BOND
To Be Used For:
Site Address
Lot Block
Parcel/Sub eWA/76?7p, e/j,ey f0124-Z-s7--
Owner A0.v5,--- '"d
Address dV2 o / W // o 72:( S-15-
City/Zip Code
Phone 2'P'e71 - S % 4t 4z
Contractor
Address
City/Zip Code
Phone
Arch./Engr. _
Address
mac`
City/Zip Code
Phone #
e 7
Date: -??
Erect Occupancy
Remodel Zoning
Repair Type of Const
Addition # of Stories
Move Length
Demolish Depth
Int.Impr. Sq Ft
Install
APPROVALS FEES
Assessments Permit y75
Water/Sewer Surcharge 4amm f56, 5o
Police Plan Review 3 7 7
Fire SAC S 7
Engr Water Conn >00
Planner Water Meter
^
Council Road Unit U
Bldg Off Treatment P1 /
APC Parks
Variance Copies
TOTAL
/
} S
2:7
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR /HOMEOWNER MUST DESIGNATE WHICH ADDRESS
IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
MUST BE LICENSED WITH THE CITY OF KAGAN
Certificate for: _ Bk: 100/19
vend Peterson
4701 West 110th Street
Bloomington, Minnesota 55437
DELMAR H. SCHWANZ
LAND SURVEYORS INC
Rnq.itwwl Undw Laws N Ina Stay nl M. wmM.
14750 SOUTH ROBERT TRAIL ROSEMOUNT. MINNESOTA SSM PHONE 613 432-1769
SURVEYOR'S CERTIFICATE
.I ,
Scale: 1 inch = 30 feet
O Denotes iron monument I VF
?4GCK s
Denotes set wood hub M
N ?
I 0 Denotes existing elevation
i ?
Denotes proposed elevation
0
a n/?j?8
48 /0/ a /oy, y r R #Uts
1/ 3G S6 dub •6S
26 Proposed ?'f w all
- - -
I hereby certify that this ? 10
is a true and correct represen- 4 House 6 ?Q,
tation of Lot 15, Block 1, M 32 `e
99.9) Garage y/S
CANTERBURY FOREST, according 6
to the recorded plat thereof, Ile -I/-3S j- ___ 30 7aP?
Dakota County, Minnesota. y4 2 /? O O /0%2 ` 10Y 60
Also showing the location of
a proposed house as staked M O
thereon. r
y4 O /00,3
Dated: August 7, 1986. -110j ZZ-/'Y-S8 L. /20.00 /C'= i09.U2 x ??
MINNESOTA REGISTRATION NO. 8625
CITY OF EAGAN
APPLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
Y***#**********fifiYYY#Yfifi#**aa#Y*
!1107 11: PAyww..C OP F TT, AT Tlt,:; OF
APPLICATION DOES NOT CONSTIt^•'IE
APPROVAL OF PERMIT.
INSPECTION OF SEWER AND/OR W T R
INSTALLATIONS WILL NOT BE SC.•iE>-
ULED UNTIL PERMIT HAS BEEN
APPROVED.
--
P ease PrintI
1) PROPERTY ADDRESS:
LEGAL DESCRIPTION:
IF EXISTING STRUCTURE, DATE OF ORIGINAL BUILDING PERMIT ISSUANCE:
(Mon Year)
PRESENT ZONING/PROPOSED USE:
M COMMERCIAL/RETAIL/OFFICE
Q INDUSTRIAL
n INSTITUTIONAL/GOVERR4=
R-1 SINGLE FAMILY
Q R-2 DUPLEX (Two Units)
R-3 TOWNHOUSE (Three + Units) ( Units)
R-4 APARTMENT/CONDOMINIUM ( Units)
2)
NAME:
ADDRESS:
S17ND PETERSEN CONSTRUCTION INC.
4701 West 110th Street
CITY, STATE, ZIP: Bloomington, MN 55437
PHONE: u&1_155_
NAME: GENZ-RYAN PLUMBING & HEATING COMPANY
CITY, STATEf ZIP: --Rosemount, MN 55068
PHONE: 423-1144 MASTER LICENSE# 1849M
..
Active
Expired
Not recorded
Staff Ial
4) oea o ia•
NAME:
ADDRESS:
CITY, STATE, ZIP:
PHONE:
-5) d jMXIgaiia. x. a ocyo-cyuo-?
{ CONNECTION TO CITY SEWER EC CONfU=ION TO CITY WATER OTHER
6) LUID?i• PLEASE HOLD APPROVED PERMIT FOR PICK-UP BY ONE OF ABOVE "
®C PLEASE MAIL APPROVED PERMIT TO 1, 2,P 4, ABOVE
_?./f? O (Circ e one)
ADDRESS: 14745 South Robert Trail
FOR CITY USE ONLY
PERMIT # ISSUED
al l
Pd w/Bldg. Permit FEES:
$ $ m .?? SEWER PERMIT (INCLUDE SURCHARGE)
$ $ //} S d WATER PERMIT (INCLUDE SURCHARGE)
//
$ G;.3 SZ $ WATER METER/COPPERHORN/OUTSIDE READER
$ $ WATER TAP (INCLUDE CORPORATION STOP)
$ $ SEWER TAP
$ $ J 6--0 ACCOUNT DEPOSIT - SEWER
$ $ / S 'Ct d ACCOUNT DEPOSIT - WATER
s n n C $ WAC
$ J 7 S CZ7 $ SAC
$ $ TRUNK WATER ASSESSMENT
$ $ TRUNK SEWER-ASSESSMENT
$ $ LATERAL BENEFIT/TRUNK SEWER
$ $ LATERAL BENEFIT/TRUNK WATER
$ WATER TREATMENT PLANT SURCHARGE
... f7
$ $ OTHER:
$ TOTAL
RECEIPT RECEIPT
DOES UTILITY CONNEC TION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
0 YES IF YES, THEN A " PERMIT FOR WORK IWITHIN PUBLIC
NO
Q ROADWAY" MUST BE
DIVISION
LIST ISSUED BY THE ENGINEERING
. AS A CONDITION.
SUBJECT TO THE FOLL OWING CONDITIONS:
APPROVED BY:
TITLE:
DATE:
r/ 0(
2006 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Corm udion Rsauirements
3 registered site surveys showing sq. It, of lot, sq. R of house; and all roofed aress
(20% maximum lot coverage allayed)
2 copies of plan shaving beam & window sizes; poured found design, etc.
1 set of Energy Calculations
3 copies of Tree Preservation Plan if lot platted after 711!93
Rim Joist Detail options selection sheet (buildings with 3 or less units)
Mimregasco mechanical ventilation farm
RemodeWeoair Reouiremenls
2 copies of plan showing footings, beams, joists
1 set of Energy Calculations fa heated additions
i site survey for additions & decks
Addition-indicate ffon sits septic system
?-)o.a)
office Use Only
Carl of Survey Recd _ Y _ N
Tree Pres Man Recd _ Y _ N.
Tree Res Required _ Y _ N
On-site Septic System _Y _N
Date .: Construction Cost
Site Address 3114 unit/Ste #
Description of Work r
1 C? G
/&-A
Multi-Family Bldg _ Y _ NFireplace(s) - 0 _ 1 - 2
Property Owner ?
Telephone #(421;'0 394- -I -A/ a2
Contractor The Gopher Company License # 8617 -
Address 2701 - 36th Avenue South CityMinneapolis
State MN Zip 55406 Teiephone#(1512) 331-1555
. COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Cate orv 1 _ Minnesota Rules 7672
Energy Code Category • Residential Ventilation Category 1 Worksheet New Energy Code Worksheet
(J submission type) Submitted Submitted
• 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?
Y - N If yes, date and address of master plan:
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone # (
Telephone # (
Telephone #(
I hereby apply for a Residential Building 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 the State of MN
Statutes; 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 c Zwhich requires a review and
approval of plans.
MAR I, ???pE2
Applicant' Printed Name Applicant Signa ure
DO NOT WRITE BELOW THIS LINE
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Acoessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screenigazebo) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex ? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building' ? 43 Reroof ? 46 Windows(Doors
? 34 Replacement 'Demolition (Entire Bldg) - Give PCA handout to applicant
Description: Water Damage _ Yes
Valuation Occupancy MCES System
Plan Review _ 100% or _ 25%
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
- Footings (new bldg) _ Sheetrock
_ Footings (deck) _ Final/C.O.
_ Footings (addition) _ Final/No C.O.
Foundation HVAC
Drain Tile Other
Roof
Ice & Water Final Pool _ Figs _ Air/Gas Tests _ Final
_
Framing _
_
_ Siding _ Stucco Lath - Stone Lath -Brick
R.I. _ Air Test _ Final _
Fireplace Windows
_
_
Insulation Retaining Wall
Approved By: Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
7ato9g
Zoos RESIDENTIAL PLUMBING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings.
/, ,6-D
Date 3 1 A J?
Site Street Address Unit #
T ephone # i,5-/) s'?- R 76Cj
Property Owner
Telephone # (6j A Y•l r-'??
Contractor 2State'Mn) Zip
Address 1;2JlIS? City
The Applicant is: _ Owner Contractor her
Septic System _ New _ Refurbished Sub i 2 ets of plans and MPC license Includes County fee
100.00
Per as-built $ 10.00
$ 50.00
Alterations to existing dwelling
Add plumbing fixtures. This fee Intl stallation of a water softener and/or water - -
_
heater at the same time. If you ar r falling onl a water softener and/or water
heater, do not complete this ; move to the next section and check the ,
appliance(s) you are installing. -
-Septic System Abandonment
Water Turnaround (add $130.00 a 5/8" meter is required)
Other:
-
Water Softener -Water Heater $ 15.00
_ new replacement
_ Lawn Irrigation _RPZ _PVB -new -repair -rebuild $ 30.00
.50
State Surcharge
$
Total
__ ,., ea o tha} Oho information is complete and accurate; that the
I hereby apply for a rtesicenuai riurnuuiy Ve . , ain+ ?- - -• - -
work will be in conformance with the ordinances and codes of the City of Eagan and the plumbing codes; that
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 t e reviewed and a roved.
1
Air s ??-
pli ant's Printed Name A lit nt's Signature
r7,-;tb7X
2006 RESIDENTIAL PLUMBING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings.
Date I 1_
Unit #
Site Street Address
y /
Telephone #
-p
-
Property Owner
d ? / t?11 Telephone # (?? o?- ??-? 7 d
Contractor
Stated Zip&:,-?7
SG"1 L'
?
L
'
_
,
City ?
6
Address
The Applicant is: _ Owner _ Contractor -Other
plans and MPC license
Refurbished Submit
New
stem
tic S
S
fee
fee
Includes 1
:
_
y
ep
_ 00.00
Per as-built $ 10.00
$ 50.00
Alterations to existing dwelling
Add plumbing fixtures. This fee includes installation of a water softener and/or water- ..
_
heater at the same time. If you are installing onl a water softener and/or water)
heater, do not complete this section; move to the next section and check the
^(
you are installing.
appliance(s)y
,
Septic System Abandonment
Water Turnaround (add $130.00 if a 518" meter is required) - - --- -?_.___ _ -
Other:
Water Softener -Water Heater $ 15.00
new 3< replacement
Lawn Irrigation _RPZ _PVB ,-new -repair -rebuild $ 30.00
I $ 50
State Surcharge
$ S . l
Total
Inrnrmntinn is compl ete and accurate; that the
I hereby apply for a Residential Plumbing rennu dnu 4„", °•- .-- -- -
work will 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
accords a with the approved plan in the event a plan is required to be reviewed and approved.
A plicant's Printed Name Ap ica is Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA107829
Date Issued:10/30/2012
Permit Category:ePermit
Site Address: 1131 Tiffany Dr
Lot:15 Block: 1 Addition: Canterbury Forest
PID:10-16350-01-150
Use:
Description:
Sub Type:e - Furnace
Work Type:Replace
Description:Furnace
Comments:Questions regarding electrical permit requirements should be directed to Mark Anderson , State Electrical Inspector,
952-445-2840
Janel Behrends
122 West 3rd S
Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088
Surcharge-Fixed $5.00 9001.2195
$60.00 Total:
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 City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Stephen J Martyr
1131 Tiffany Dr
Eagan MN 55123
Haley Comfort Systems
122 West 3rd St
Hastings MN 55033
(651) 437-0338
Applicant/Permitee: Signature Issued By: Signature