1837 Trailway Dr I
`CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 ~
PHONE: 4548100
BUILDING PERMIT Receipt
To 6e fted ior Est. Volue ;'3l3, f;'`; ` Dote ~",P7'l:i;B1;".? , 19 ~
~
SiteAddress i}-"' Erect 0 dccupancy ~
ELx`,CICHA41i{ Remodel ? Zoning
Lot ~ Block ~ Sec/Sub. O~ qgpair ? Type of Const. ~
Parcel No. ~ ~ I~~' `~`p Additian ? Na. Stories
~ Name :?AILS N1ove ? Length FS~
Demolish ? Depth
; Address ~{XES ,AV,~, ~i/ Int Impr. ? 4.i
b 8 3 5- sa. Fc.
City Phone Install ? 7,200
~ Neme -iT II`1C AVPirovab Faea
a~ Address 90U X E;RX E c AlT'r; S!i Assessment Permit
U''
y
u~ Cit 1""~~14 Phone 8 3 5-~J 23 2 L Woter & Sew. Surcharge i6
Y Police Plan Review 556.5r
GW r:CJRSLiNf'N_KY, KRANK, ERIC:'K:,ON 3360, oG
W W Name _ Fire SAC ,
tz :~20 ~WC~iVE :'0 3.200.OG
+4~~~ Eny. WaterConn.
~ W City ~L'" Phone 339+4 20{~ Plonner Water Meter 120.00
Council Road Unft 1, 792 ' 00
I hereby ocknowledge thot I hava read this opplicotion ond stote that Bldg. Off. 9/13/85 Tr. PI. -646 00
the information is correcr and agree to comply with oll applicoble qPC
State of Minnesoto Statutes and City of Eagon Ordirwnces. PaAcs
~
Var. Date CopieS
Sipnature of Permittee -,1 S 0 Tal 8ullding Pertnit Is iuued ta on the express condition thoi
oll work shall be done in ocoordonce with oll opplicabla State of Minnesatu Statutes and City of Eopan Ordinonces.
Buildirq Official
Permit No. Permit Holder Daft Telephone #
Piumbinp ~p,l-,;{ ~ 1 ~>c -'iL , t.?.. 'i~_~. ~'~c~ / • r~ } r~~:- J - ~ .
H.VA.C. 0 o
Elestric
gottensr
(ntpection Dats Insp. Other
Footings I
Footings II
Foundatlon
Framing ~ ~LA.~?/M
Roofing
Rouyh Plbg.
Rough Hty.
Inwl.
Flreplace
6~5
Final Htg.
Flnal Plbg. - ~ ,
Final
Cert/Occ. ~
Weter
~
w.ti
Sawer
Pr. Dlsp.
PERMIT # `i' '
` MECHANIQAL PERMIT RECEIPT
C1TY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE
CONTRACT PRICE: PHONE: 454-8100
5ite Address l BIDG. TYPE WORK DESCRIPTION
Lot Block _~ec/Su
Res. v New v
~ Nam B RBAN IR CON ITIONINGi C. J ~
Mult Add-on
~ Address ~ 1 CENTER DRIVE
Comm. Repair
c City hone pther
L Name 's FEES
c Address RES. HVAC 0-100 M BTU -$24.00
p Cily Pho ADDITIONAL 50 M BTU - 6.00
ADD-ON AIR COMD. 0-24 BTU - 12.00
c. ADDITIONAL 6 M BTU - 6.00
TYPE OF WORK ~vr ~ J GAS OUTLETS - 1.50 EA.
Forced Air Q 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
Vent CFM (ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000. )
Gas Piping Outlefs #
Other ~
~c FEE , ~ . ,
S/C. SIGNATURE OF P MITTEE
TOTAL• 1011
FOR: CITY OF EAGAN
SITE ADDRESS 1837 TRAILWAY DR Unit N 1 Pertnit # 14960
TYPE PERMIT M PERMIT CONTRACTOR DATE TELEPHONE
PLUMBING
H.V.A.C.
ELECTRIC
INSPECTION QATE INSPECTOR OTHER
FRAMING
ROUGH PLBG.
ROUGH HTG.
INSUL 7
FIREPLACE
FINAL HTG
FINAL PLBG
UNIT FINAL &)9Y ~
CERT/0CC
INSPECTION DATE INSPECTOR COMMENTS
SITE ADDRESS 1837 TRAILWAY DR Unit N 2 Pennit # 10960
TYPE PERMIT# PERMIT CONTRACTOR DATE TELEPHONE#
PLUMBING
H.V.A.C.
ELECTRIC JjC1~
INSPECTION DATE INSPECTOR OTHER
FRAMING
ROUGH PLBG.
ROUGH HTG.
INSUL
FIREPLACE
FINAL HT6 pL_
FINAL PLBG
UNIT FINAL
CERT/OCC
INSPECTION DATE INSPECTOR COMMENTS
SITE ADDRESS 1837 TRAILWAY DR Unit M 4 pefmit # 10960
TYPE PERMIT N PERMIT CONTRACTOR DATE TELEPHONE #
r
PLUMBING x
.
~J
H.V.A.C.
ELECTRIC 1,))
INSPECTION DATE INSPECTOR OTHER
FRAMING
ROUGH PLBG.
ROUGH HTG. ~I/v /f'({ ~il•f/
INSUL
FIREPLACE 7
FINAL HTG
FINAL PLBG
UNITFINAL
CERT/OCC
INSPECTION DATE INSPECTOR COMMENTS
SITE ADDRESS 1837 TR.AILWAY DR Unit # 5 Permit # 10960
TYPE PERMIT # PERMIT CONTRACTOR UATE TELEPHONE #
PLUMBING
~ cL 12,
H.V.A.C.
ELECTRIC ~ 12-
INSPECTION DATE INSPECTOR OTHER
FRAMING
ROUGH PLBG.
ROUGH HTG.
INSUL
FIREPLACE 7~ ~CL
FINAL HTG
FINAL PLBG
UNIT FINAL ~~02~ `'SS~o QU
CERT/OCC
INSPECTION DATE INSPECTOR COMMENTS
SITE ADDRESS 1837 TRAILWAY DR Unit # 3 permit N 10960
TYPE PERMIT # PERMIT CONTHACTOR DATE TELEPHONE N
PLUMBING CG~- L , ; / - -
H.V.A.C.
ELECTRIC
INSPECTION DATE INSPECTOR OTHER
FRAMING
ROUGH PLBG.
rj&,,
ROUGH HTG. 711,01
INSUL 7 / ~ zf,
FIREPLACE
FINAL HTG
FINAL PLB6 -
UNIT FINAL
CERTIOCC
INSPECTION DATE INSPECTOR COMMENTS
SITE ADDRESS 1837 TRAILWAY DR Unit N 8 Permit # 10960
TYPE PERMfT # PERMIT CONTR,4CTOR ORTE TELEPHONE #
PLUMBING
H.V,A.C.
ELECTRIC
INSPECTION DATE INSPECTOR OTHER
FRAMING .
ROUGH PLBG.
ROUGH HTG.
INSUL
FIREPLACE
FINAL HTG
FINAL PLBG
UNIT FINAL
CERTIOCC
INSPECTION DA7E INSPECTOR COMMENTS
SITE ADORESS 1837 TRAILWAY DR Unit M 7 Permit # 10960
TYPE PERMIT # PERMIT CONTRACTOR DATE TELEPHONE #
~
PLUMBING
H.V.A.C.
ELECTRIC
INSPECTION DATE INSPECTOR OTHER
FRAMING
ROUGH PLBG.
ROUGH HTG.
INSUL
FIREPLACE
FINAL HTG
FINAL PLB6 -
UNITFINAL AZal&9
CERT/OCC
INSPECTION DATE INSPECTOR COMMENTS
SITE ADDRESS 1837 TRAILWAY DR Unit M 6 Permit N 10960
TYPE PERMIT # PERMIT CONTRACTOR DATE TELEPHONE #
PLUMBIN6 i~r -,.~,.,..F,. „ ; • , ' r_, ~ . ; . _r `1
H.V.A.C.
ELECTRIC
INSPECTION DATE INSPECTOR OTHER
FRAMING
ROUGH PLBG.
ROUGH HTG.
INSUL
FIREPLACE
FINAL HTG
FINAL PLBG - '
UNIT FINAL ~f~• ~p~o
CERT/OCC
INSPECTION DATE INSPECTOR COMMENTS
SITE ADDRESS 1839 TRAILWAY DR Unit 1 Permit N 10959
TYPE PERMIT # PERMIT CONTRACTOR DATE TELEPHONE #
,
PLUMBING
H.V.A.C.
ELECTRIC -INSPECTION DATE INSPECTOR OTHER
FRAMING
ROUGH PLBG.
ROUGH HTG.
INSUL
FIHEPLACE
FINAL HTG ~ ~ ~y`~?7
FINAL PLBG
UNIT FINAL
CERTlOCC
INSPECTION DATE INSPECTOR COMMENTS
SITE ADDRESS 1$39 TRAILWAY DR Unit # 2 Permit il 10959
TYPE PERMIT N PERMIT CONTRACTOR DATE TELEPHONE k
PLUMBING
H.V.A.C. Q d GC 1 l~(v !~5
ELECTRIC 1
INSPECTION DATE INSPECTOR OTHER
FRAMING
ROUGH PLBG.
ROUGH HTG.
INSUL
FIREPLACE
FINAL HTG
FINAL PLBG
UNIT FINAL
CERT/OCC
INSPECTION DATE INSPECTOR COMMENTS
SITE ADDRESS 1839 TRAILWAY DR Unit M 3 Permit # 10959
TYPE PERMIT N PERMIT CONTRACTOR DATE TELEPHONE #
PLUMBING
H.V.A.C.
ELECTRIC bq ' 04
INSPECTION DATE INSPECTOR OTHEA
FRAMING
ROUGH PLBG.
ROUGH HTG.
INSUL
FIREPLAGE
FINAL HTG
FINAL PLBG ~-~g-~~
UNITFINAL /J ~p
CERT/OCC
INSPEGTION DATE INSPECTOR COMMENTS
SITE ADDRESS 1$39 TRAILWAY DR Unit # 4 Permit # 10959
TYPE PERMIT # PERMIT CONTRACTOR QATE TELEPHONE #
PLUMBING
H.V.A.C.
ELECTRIC
INSPECTION DATE INSPECTOR OTHER
FRAMING
ROUGH PLBG.
ROUGH HTG.
INSUL
FIREPLACE 7 3,0 FINAL HTG . ~ _
FINAL PLBG
UNIT FINAL fsf/ ~~S'(
CERT/OCC
INSPECTION DATE INSPECTOR COMMENTS
SITE ADDRESS 1839 TRAILWAY DR Unit # 5 Pertnit #k 10959
TYPE PERMIT # PERMIT CONTRACTOR DATE TELEPHONE #
~
PLUMBING "Z ~ ~ C~ I•~ ~ o . L1~, r; ~ - ~ _
H.V.A.C. 5 ~ r 1A.
ELECTRIC
INSPECTION DATE INSPECTOR OTHER
FRAMING
ROUGH PLBG,
ROUGH HTG.
INSUL
FIREPLACE
FINAL HTG
FINAL PLBG
UNIT FINAL
CERT/OCC
INSPECTION DATE INSPECTOR COMMENTS
SITE ADDRESS 1839 TRAILWAY DR Unit ~k 6 Permit # 10959
TYPE PERMIT N PERMIT CONTRACTOR DATE TELEPHONE #
PLUMBING
H.V.A.C.
ELECTRIC ~~l I ? ~ L' I o~ ( IX l~ ~ ~ ~
INSPECTION DATE INSPECTOR OTHER
FRAMING
ROUGH PLBG.
ROUGH HTG.
INSUL
FIREPLACE
FINAL HT6
FI NAL PLBG
UNIT FINAL
CERT/OCC
INSPECTION DATE iNSPECTOR COMMENTS
SITE ADDRESS 1839 TRAILWAY DR Unit # 7 permit # 10959
TYPE PERMIT # PERMl7 CON7RACTQA DATE TELEPHONE #
PLUMBING
H.V.A.C. ELECTRIC +fJ 6).1`1`~
INSPECTION DATE INSPECTOR OTHER
FRAMING
ROUGH PLBG.
ROUGH HTG.
INSUL
FIREPLACE 717 ?/yee ~{f
FINAL HTG
FINAL PLBG
UNIT FINAL
cFRr/occ
INSPECTION DATE INSPECTOR COMMENTS
SITE ADDRESS 1839 TRAILWAY DR Unit #k 8 Permit # 10959
TYPE PERMIT # PERMIT CONTRACTOR DATE TELEPHONE #
PLUMBING
~ l tJ f iL~ G:1 ~v ~ I 4( I
H.V.A.C. ELECTRIC
INSPECTION DATE INSPECTOR OTHER
FRAMING
ROUGH PLBG.
ROUGH HTG.
INSUL
FIREPLACE 713e t
pC/
FINAL HTG
FINAL PLBG
UNIT FINAL
CERTlOCC
INSPECTION DATE IN,riP'CCTOR COMMENTS
SITE ADDRESS 1841 TRAILWAY DR Unit # 1 Permit ~f 10958
TYPE PERMIT # PERMIT CONTRAGTOR DATE TELEPHONE #
PLUMBING
H.V.A.C.
ELECTRIC
INSPECTION DATE INSPECTOR OTHER
FRAMING
ROUGH PLBG.
ROUGH HTG. f f 8~ ~LL(J
/ i / 7 .nr
INSUL
FIREPLACE
FINAL HTG x4gl
FINAL PLBG
UNIT FINAL
CERT/OCC
INSPECTION DATE INSPECTOR COMMENTS
SITE ADDRESS 1841 TRAILWAY DR Unit N 2 Permit M 10958
TYPE PERMIT # PERMIT CONTRACTOR DATE TELEPHONE #
PLUMBING ~ ~ ~ ~ c• , , ; _6 , ~r ~ . , ~ _ i . ~
H.V.A.C.
ELECTRIC ~ ~ I ~ ~ a.~ ~ l~ ~ ~ ~ 2~
INSPECTION DATE INSPECTOR OTHER
FRAMING
ROUGH PLBG.
ROUGH HTG.
ia ~ t $ti
INSUL FIREPLACE
FINAL HTG
FINAL PLBG - _
UNIT FINAL
CERTI OCC
INSPECTION DATE INSPECTOR COMMENTS
SITE ADDRESS 3841 TRAILWAY DR Unit # 3 Permit N - 1495$
TYPE PERMIT # PERMIT CONTRACTOR DATE TELEPHONE #
PLUMBING
H.V.A.C.
ELECTRIC LI
INSPECTION DATE INSPECTOR OTHER
FRAMING
ROUGH PLBG,
ROUGH HTG.
INSUL
FIREPLACE
FINAL HTG
FINAL PLBG
UNIT FINAL la l~ ~
CERT/OCC
INSPECTION DATE INSPECTOR COMMENTS
SITE ADDRESS 1841 TRAILWAY DR Unit # 4 Permit # 10958
TYPE PFRM17# PERMIT CONTRACTOR DATE TELEPHONE #
PLUM8ING
H.V.A.C.
ELEGTRIC j12-
INSPECTION DATE INSPECTOR OTHER
FRAMING
ROUGH PLBG.
ROUGH HTG.
INSUL
FIREPLAGE
FINAL HTG .!-vc l • ,
FINAL PLBG
UNIT FINAL
CERT/OCC
INSPECTION DATE INSPECTOR COMMENTS
SITE ADDRESS 1841 TRAILWAY DR Unit # 5 Permit # 10958
TYPE PERMIT # PERMIT CONTRACTOR DATE TELEPHONE M
PLUMBING
H.V.A.C.
ELECTRIC l Z-
INSPECTION DATE INSPECTOR OTHER
FRAMING
ROUGH PLBG.
ROUGH HTG.
INSUL
FIREPLACE
FINAL HTG ~
FINAL PLBG UNIT FINAL kz gj
CERT/OCC
INSPECTION DATE INSPECTOR COMMENTS
SITE ADDRESS 1841 TRAILWAY DR Unit # 6 Permit # 1095$
TYPE PERMIT M PERMIT CONTRACTOR DATE TELEPHONE #
PLUMBING ( /
H.V.A.C. ELECTRIC `-t a
INSPECTION DATE INSPECTOR OTHER
FRAMING
ROl1GH PLBG.
ROUGH HTG.
INSUL
FIREPLACE
FINAL HTG
FINAL PLBG S
UNIT FINAL
CERT/OCC
INSPECTION DATE INSPECTOR COMMENTS
SITE ADDRESS 1841 TRAILWAY DR Unit # 7 Permit # 10958
TYFE PFRMIT # PERMIT CONTRACTOR DATE TELEPHONE #
PLUMBING
H.V_A.G.
ELECTRIC
INSPECTION DATE INSPECTOR OTHER
FRAMING
ROUGH PLBG.
ROUGH HTG.
INSUL
FIREPLACE
FfNAL HTG
FINAL PLBG UNIT FINAI
CERT/OCC
INSPECTION DATE INSPECTOR COMMENTS
SITE ADDRESS 1841 TRAILWAY DR Unit #8 permit # 10958
TYPE PERMIT # PERMIT CONTRACTOR DATE TELEPHONE #
PLUMBING l l ' i/ `
H.V.A.C.
ELECTRIC
INSPECTION DATE INSPECTOR OTHER
FRAMING
HOUGH PLBG.
ROU6H HTG.
INSUL
FIREPLACE
FfNAL HTG
FINAL PLBG
UNIT FINAL ~ F
CERT/OCC
INSPECTION DATE INSPECTOR COMMENTS
Recsipt r~ MECHANICAL PERMIT Permit Na. •
CITY OF EAGAN
FN
' fill in numbered Aoaces S/C
TYPe or Prini /egibly Tot
1. Date - 2. Installation Cost
. . • ' .
3. JobAddresa " Blk. Tract
-r-
4. Owner
~ - _
5. Contractor ~ I*one
:
*
8. Address ' - 7. City ~ State Zip
4
8. Building Type: Residential Commercial ? Institutionaf 0 ~f?
9. Work Description: New QS Add O Alter O Repair ?
10. Desaibe Fuel Type
11. No. Equioment STU - M. Ea. No. Eauipment CFM
r Forced Air - ,
Air Handling:
Mfg. • - , %
8oilers Mech, Exhaust
Mfg.
Unit Heater
Mfg. Other
Air Cond.
Mfg.
~Gas, P'iping Outlets
12. I hereby certify that the above information is true and oorrect, and I apree to
comply with all ordinancea and Codas governing this type of work.
5igned :
for
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-6100
~ i
Reoeipt PLUMBING PERMIT f Parmit No.
CITY OF EAGAN Fee
~
~ v Fill in numbered spaces S/C -
TYPe or Print /egibty Tot
1. Date 2, Installation Cost
3. Job Address > - Lot Blk. ~ Tract
4. Owner
5. Contractor Phone
6. Address -7. City State Zip '
~ S. Building Type: Fiesidential ? Commercial O Institutional ?
9. Work Description: New ~.7 Add ? Alter ? Repair O
10. Describe
11. No. Fixtures No. Fixtures
~ - Water Closet Cesspool/Drainfield
Bath tubs
Septic Tank
Lavatory Softner
Shower Well
~ - Kitchen Sink
Urinal/Bidet Other
Laundry Tray
-~Floor Drains
Drinking Ftn.
Slap Sink
Gas Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all prdinances and codes governing this type of work.
c -
Signed : for
Rough Final
Inspections: Date Insp. Date Insp.
This is Your permit when numbered and approved.
Approved CITY OF EAGAN 454,8100
CITY OF EAGAN Remarks
Addition BLACKHAWK TOWNHOUSE APTS Lot_ 2 Rlk 0 Parcel Ao 14389 020 OQ
Owner Street 1 37, 39, 41 State Eagan, MN 55122
ral way rlve
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. S88 p rcel 02900 O1 07 for origi al assessm ts
STREET RESTOR.
GRADING
SAN SEW TRUNK
SEWER LATERAL
WATEFMAIN
WATER LATERAL
WATER AREA
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
Road Unit 280.00 5383,84,&85 9 13 85
WATER CONN. 500.00 TV IT
BUILDING PER. O SH S9 &
SAC
PARK
CITY OF EAGAN 10J 6 Q
3530 Pilot Knob Rosd, P.O. Box 21-199, Eagan, MN 55121
' PHONE: 454-8100 BUII.DING PERMIT ae«ipr #
To bt wwd iee Est. Volue -J Dote t•~ r. , 19
' d Erect Occupancy
Site Addrep
Lot Block Sec/Sub. ''-r' vII};: 'A RemodAl ? 20ning Percel No. Repair ? T
!~l? YPe of Const.
Additfon ? No. Stories
, Move ? Length
W N~e Demolish ? Depth
; Address : : i . l ' . . "'.4 Impr. ? Sq. FL
a City Phone r i~`• L' Install ?
Name APprovah Ftes
u~ Addreas /~ssessment Permft
~ City Phone Water b Sew. Surcharpe
Police Plan Review
tioe r.;~iJK i.Rlt'tiSC;Ir
Name Fin SAC -
Address Enp. Weter Conn.
tW City Phone Planner WaterMeter :
Cou+xil Road Unit ~
1 hereby acknowledga that I how ?eod this application and stote thet eldg. Off. Tr. PL
fhe iniormetion is torrett ond ogree to wmply with oll opplicable APC paAce
5tote of Minnewta Stotutes ond City of Eagan Ordirances.
Var. Date C~~~
Sipnoture of Permittee -7--F-
'
' Totel
~ A Buildinfl Pe?mit Is iuued to: on the exprcss corditbn thot
all work sholl be done in otcordonte with all oppliaoble State of Minnesoto Stotutes ond Ciy of Eaqan Ordinonces.
Buildinp Offitiol
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. PERMIT #
~ MECNANICAL PERMIT RECEIPT #
CIT1f OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE:
CONTRAG'T PRICE PHONE 454•8100
Site Add l /BLDt3. TYPE WORK DESCRIPTION
Lot Blvck 1 u ' ~'IZ
~ Res. _ New ~
m Name Mult ~ Add-on
2 Address Comm. Repair
c City Phone ' J pmer
~ Name ll'~ FEES
c 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
TYPE OF WORK ~ ADDITIONAL 6 M BTU - 6.00
ur I?~ - 0CC) GAS OUTLETS - 1.50 EA.
Forced Air M BTU COMM/IND FEE - 146 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
Vent CFM (ADD $.50 5/C IF PERMIT PRICE GOES
BEYOND $1,000.00) ~
Gas Piping OuUets #
Other ; ~
FEE I , ~ - ;
S'C, 100 SIGNATURE OF PERMITTEE i
TOTAL• I 9C'r
FOR: CITY OF EAGAN
~ CITY OF EAGAN 959
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
OUILDINCs PERMIT Receipt #
TO ?y~ N"/ for W. Value 0, r'l pote , 19
5ite Addreu ~ r Erect Occupancy
Lot _ Blcek spc/Sub. ' 1 Lr.~:,; f':~.Y` l~• _ Remodel ? 2oning
- Repair ? Type of Const.
Parcel No. n Addition ? No. Stories
Move ? Length
W Name pemolish ? Oepth
~ Address ' . t {
Tnt Impc Sq. Ft.
City Phone 6 3 4- V Instell ?
AvVrovol Fns
, Name `
A~~s Assessment Permit
City Phona Woter 8 Sew. Surcharge
Polite Plan Revfew
UAName ' =~kA NK, ~'kiK`:t~I7 Fin SAC
~Z - ,i, - „i.i•.
Addres: E,
- Enp. Water Conrt t W City Phone Plonner Water Meter ,i . ll
Council Road Unit 79
~ • ~ ~
I hercby acknowledfle thot I have reod this opplicorion ond stete that Bldg. Off. Tr. PI. i .
the informotion is wrrect ond agree to comply with all applicoble APC Perks
Staf* of Minnesoto Stotutes and Ciry of Eogan Ordinonces.
Var. Date Copies
Sipnoture of Pertnittaa . , '
ti l . Total
H Bufiding Permit Is issued fo: ~ on the expreas conditlon thoo
all work sholl be done in acwrdonce with oll opplicoble 5tote of Minnesota Stotutea ond Cily o4 Eapon Ordinances.
, Buildinp Official
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CITY 6F EAGAN WATER SERVICE PERMIT
3830 Rilut KniDb Road ,
P. P. Box 21199 PERMIT NO.:
Esgsn, MN 55121 , OATE:
ZOflIY1D: _ r, 4 NO. Of Uf1itS: ,
Owrwr: S revest, nc.
S/ Ih /lddrasa: } r ^ 7 , r , ~ •e. _nTaclMawt~
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a . ae~ir,j~?9.: • ~ p
Size: ~lo.~ ~fC ~Q` . 0'„~~~;; Oeposit: D". p,
; Reoder'(No.. /
nr
' 1 pn~ !o ooaplp nN6 t~1~ u~horyr ~ ' ~ ~ ~ T-P
OrliM i" Mlsc. Chorya: - ' ' • p
metet
gy Date Paid:
Dnte of Insp.: + Inq.:
CITY f?F EAGAN SE1AIQt SBtVICE PERMR
3830 Pilot Knob Rosd
P. O. Box 21199 PERMIT NO.: '
Eagen, MN 55121 DATE:
Zoninp: No. af Units: '
ow,..:
Addross:
I:- ?R I8~~1 ' =1
Slre Address: , 16,
Plurnber. SETUUSCn 14 ;,r • : ri ~~i'~`.' ~ + .
_ i •j_ ~ ~ KSZf:" =1 . ~
¦ Conrwction C)wrpe:
I so« N wilb !V Qf? of IMP
OriiMwa~. Accvur?t Deposit: _
Permit Fas:
Surchorpe:
gy Misc. Ci+arg"
Dots of Insp.: Total:
Insp,; DoN Pold:
TOWNHOUSE
CITY OF EAGAN N_ 10960
3830 Pilot Knob Road, P.O. Box 27-199, Eagan, MN 55121
PHONE:454-8100
BUILDING PERMIT Receipt # 7
T. be aad !or $-UNIT M.D. Est, yol„e $373,000 pote SEPTEMBER 13 1 q 85
SiceAddreee 1837 TRAILWAY DR Ered Occupancy Rl
2 1 ¢ BLACKHAWK TOWN- Remodel ? Zoniny R4
Lot Block eclSub.
Parcel No. HOUSE APTS Repair ? Type of Const. V 1 HR
Addition ? No. Stories 2
WALNUT TRAILS Move 0 Length 83
5 Nme Demolish ? Depth 43
Address 7900 XERXES AVE SO.. STE 173~ALImpr. ? Sq.Ft.
MPLS pnone 835-0822 inS1ell ? 7,200
City
SHAREVEST INC Avworels Fees
o Name
Addrees SAME Assessment Permit 1 .o4
i- City Phane ~Nater & Sew. Surcharge 1$ 6. 0 C
G~ RORSUNSKY~ KRANK ERICKSON POlice PlanReviaw ~ SC
~Z Name 570 GALAXY BLDG ' Firo SnC 3 360.OC
x~ Address Enq. WaterConn. ~..ZQQ.0 Q
~W City MPLS phone 339-4200 P1Onner WaterMeter 1 20 _ 00
Council Road Unit 1,792 - 0 C
I hereby acknowledge thnf I have read this cppiicotion nd stote that Bldg. Off. 9 13 ~ 8 S Tc PI. 848. O C
ihe inlormation is correct and ogree to comply wit II app\icoble
Stote of Minrwwm 5 tute and Ci~y'of Eago Ord nces. APC Parka
Var. Date Coples
Sionoturc of Permm 7otal $11, 175. SC
A Building Permit is issued ro: AREVEST INC on tha exprcss condition thot
oll work sFall be done in accordante with all 'coble Stote of innewt ond City of Eopon Ordinancea
Buildinq Officiol
TOWNHOUSE . CITY OF EAGAN N°_ 10959
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 4548100
BUILDING PERMIT Receivt #
Te bo wad for 8 UNIT M.D. Est. Volue $373,000 p0fe SEPTEMBER 13 ~y 85
Site Addresn 1839 TRAILWAY DR erect E2 Occupancy Rl
~
Lot Z elock 1 Sec/Sub. BLACKHAWK TOWN- Remoeel ? Zoniny R4
Parcel No. HOUSE APTS Repeir ? 7ype of Const. V 1 t3R
Addltion ? No. Stories a
a Neme W+NUT TRAILS Move ? Length 83
W amolish ? Depth
= Address 7900 XERXES AVE SO., STE 173frLImpr. ? S°. Ft. 43
~ MPLS Phone 835-0822 Install 7,200
?
City
SHAREVEST INC Avwovals Faes
g Name
o~ Address S~E Assezsment Permit 1 113.0(
u~ CitY Phone Woter 8 Sew. Sulcharge 186.0(
Polica Plen Review 55E• 5(
P. Name KORSUNSKY KRANK ERICKSON Fire SAC 3.3f(l _ O(
i~ Address 570 GALAXY BLDG WaterCOnn. 3,200.0(
uW City MPLS Phone 339-4200 planMr WaterMeter 120 O(
Cauncil Road Unit 1,792 - Ol
I hereby acknowfedga that I have read this apDlication and state that gidq. Off. 9I13I $ S Tr. PI. 848.0(
tlH: inlormotion is cortect and agree to Comply M~i~ h oll ~pplicable APC Parks
State of Minnesoto Stat es an 'Ciry of Ea n inonces.
Var. Date Copiea
Sipnatun of Perm~ ' 7otel $11,175.5(
HAREVEST INC
A Building Permif Is issued . on the express conditlon Ihal
oll work sMll be done in accordonce with applicoble St ot Minn totufes ond City of Eaqon Ordinonces.
Buildirq Official
.AV
TOWNHOUSE CITY OF EAGAN N°_ 10958
3830 Pilot Kno6 Road, P.O. Box 21•199, Eagan, MN 55121
PHONE: 454-8100
BUILDING PERMIT 2eceipr *
T. M waA ier 8 UNIT M.D. Esr. Value $373,000 pote SEPTEMBER 3 1q 85
~ 1841 TRAILWAY DR Erect CR Occupancy Rl
Slte Addreas
l.ot 2 elock 1 cec(Sub. BLACKHAWK TOWN-Remodel ? Zoning Rd
Percel No. HOUSE APTS Repair ? Type of Conat. ~g } ci~_
Additian ? No. Stories 2_
WALNUT TRAILS Move ? Length 83
~ N~^g Demolish ? Depth
nddress 7900 XERXES AVE SO mtlmpr. ? gq.pt. 43
city BLMTN phone 835-0822 lnstall ? 7,200
SHAREVEST INC Avvrorab Faes
o Name
~u Addfe95 7900 XERXES AVE $O Assessment Permit S 1,11'2 QQ
u~ City BLMTN phone $35-0822 Worer85ew. 3urcherge 1R6_00
Police PlanReview 556.50
r,w Name KORSUNDKY, KRANK, ERICKSON Firo SAC 3.360.00
320 2ND AVE SO
x~ Address Enp. waterConn. 3,200..00
~W City MPLS phone 339-4200 Plonner WaterMeter 1.20.00
Council RoadUnit 1,792•00
1 hereby acknowledge tFwt 1 hove reud this oD0licotiqii ond stote that g[dy, Off. 9 13 85 Tr. PI. 848.00
fhe informotion Is correct and o9ree to comply w' i oll aOGlicable APC Parks
Stote of Minnesoto atute ~ and of Eo n O inonces.
` Var. Date Cap1B3
Sipnotum of Permittee ~
HAREVEST INC 7otal $11,175.50
A Buildin9 Permif Is issued M: on the ezpreu conAftlon Ihal
all work ahall be done in occordance wifh oll uppli/c~(bJIp Se~ate of Min esoto Sf ules and Ciry of Eoqon Ordimnces.
Buildinp Offidal
as
1985 BUILDING PERMIT APPLICATION - CITY OF EAGAN
HOiE: ALL CONTRACTORS MUSi BE LICENSED IiITH THE CZTY OF EAGAN
INCLUDE 2 SETS OF PLANS
3 CERTIFICATES OF SURVEY
1 SET OF ENERGY CALCULATIONS
To Be Used For: g(~L.Cx Valuation: -Y13,cco Date:
Site Address: OFFICT E USE ONLY
Lot~ Block Sect/Sut$lackhawk 7nreptjouse AptsQccupancy ~-I
Remodel Zoning R-¢
Parcel ll gil Repair Type of Const Y I HR.
Addition ll of Stories Z
Owner walnut Trails ' Move Length g3
Demolish Depth ~
Address7900 Xerxes Ave. S. #1733 Int,Impr. Sq Ft 'IZOo
Install ~
Cit y/ Z ip am e o m i n g t o n, M N 55431
Phone $35-0822 ApPROV9I.S FEES
Contractor Sharevest, Inc. Assessments Permit
Water/Sewer ~ Surcharge
Address 7900 Xerxes Ave. S. #1733 police ^ Plan Review
Fire SAC
City/Zip Code Bloomingiton, MN 55431 Engr Water Conn
Planner Water Meter
Phone 835-0822 Council Road Onit
B1dg 01 Treatment P1
Arch./Engr.Korsundkp Krank Erickson APC Parks
Variance Copies
Address 320 Second Ave. S. TOTAL
City/Zip CodeKinneaeolis, MN 55401
Phone 11 339-4200
~jCf P T'~ ~V~
1985 BUILDING PERMIT APPLICATION - CITY OF EAGAN
AOTE: ALL CONTRACTORS MIUST BE LICENSED HITH THE CITY OF EAGAN
INCLUDE 2 SETS OF PLANS
3 CERTIFICATES OF SURVEY
1 SET OF ENERGY CALCULATZONS
To Be Used For: Valuation: 3 -73,OCJd Date:
Site Address: 4? ~ y A-L' OFFIC~ E USE ONLY
C
Lot:~ Blo k~ Sect/Sjlackhawk TE9*etoase Aptspecupaney
Remodel Zoning
Parcel # - - Repair Type of Const
Walnut Trails Addition _ fl of Stories
Owner . Move Length
7900 Rerxes Ave. S. #1733 Demolish Depth
Address Int,Impr. _ Sq Ft
City/Zip &;gomington, MN 55431 Install
835-0822.
Phone APPROVALS FEES
Sharevest, Inc.
Contractor Assessments Permit
7900 Xerxes Ave. S. #1733 Water/Sewer Surcharge
Address police ' Plan Review
Bloomington, MN 55431 Fire SAC
City/Zip Code Engr Water Conn
835-0822 Planner Water Meter
Phone Council oad Unit
Bldg OffQ Treatment P1
Arch./Engr,Korsundky Krank Erickson APC Parks
Variance Copies
Address 320 Second Ave. S. TOTAL
City/Zip Code inneapolis, MN 55401
Phone # 339-4200
1985 Bl1ILDING PERMIT APPLICATION - CITY OF EAGAN
NOTE: ALG CONTRACTORS MUST BE LICENSED fiITH THE CITY OF EAGAN
INCLUDE 2 SETS OF PLANS
3 CERTIFICATES OF SURVEY
1 SET OF ENERGY CALCULATIONS •
To Be Used For: Valuation: -~-~°J,OG0 Date:
Site Add ress: 1~7 OFFICTE_USE ONLY
Lot,'..~- Block ~ Sect/Sul$lackhawk 1&anbouse AptsQccupancy
i Remodel Zoning
Parcel 11 ' 0--v^'z7vR--o~~- Repair ^ Type of Const
Addition 1/ of Stories
Owner Walnut Trails ' Move Length
~
Address900 Xerxes Ave. S. #1733 Demolish Depth
Int.Impr, _ Sq Ft
Install
C i t y/ Z ip l%boo m i n g t o n, M N 55431
Phone $35-0822 6PPROVAI.S FEES
Contractor Sharevest, Inc. Assessments Permit
Water/Sewer Surcharge
Address 7900 Xerxes Ave. S. #1733 police ' Plan Review ~
Fire SAC
City/Zip Code Bloomington, MN 55431 Engr Water Conn
Planner Water Meter
Phone 835-0822 Council Road Unit
Bldg Off reatment P1
Arch./Engr.Korsundky Krank Erickson APC Parks
Variance Cop3es
Address 320 Second Ave. S. TOTAL
City/Zip Codd4inneapolis, MN 55401
Phone # 339-4200
. • i ~ • i ~ i • . . .
• • • • • ~ a~ • • ~
•r i •
CITY OF EAGAN
APPLICATION FOR PERICT SEWEE2 ADID/OR WATER CONNECTION
(Please Pr
i) Pxo~txY ~xxESS: intG at~~'-e
. ~
T•FY;AT• DESCRIrriorr: ,
(Lot Block Subdivision or Tax Parcel I.D. Number)
IF EXISTING STRtiC'I4'RE, DATE OF ORIGINAL BUILDING PERMIT ISSC'ANCE:
(Mon Year)
PRESENT ZONING/PROPOSID USE: R-1 SINGLE FAMILY
R-2 DCPLEX ('IWO Onits)
R-3 'InWNIiOL~5E (Three + Lnits) ( Units)
R-4 APARTMENP/CONIDONIINI[ M Y Lnits)
COMNIEE2CIAL/RETAIL/OFFICE
IAIDL'STRIAL
INS'II'IUTIONAL/GOVEF2IT~=
2) ~
NArE:
ADDxESS: 9>~0 ,bar411'a
CITY, STATE, ZIP:
-S
PHONE:
3) • r.~' / For City Use
~ ~ NAME: ~W d- 77 S° 7? ~~G ~l a
Plumbers License
ADDRESS: ~ve
czTr, STATE, zrP: -?7 7 -n. Expirea
PxoNE: 9~~ 9o,7,r % MASTII2 LICENSE #/o{~Y (=.P,/ t;vra
Sta f Initial
4) • ~ c''~
NAME: Jfl~r-e- j~es'ze 1"-7 c'..
ADDxEss: 7yvl X er,t'es
CITY, STATE, ZIP: A/047-i7/I w rZt~j
PHONE: 0 A 'p-
5) u • ~
~ CONNBCTION TO CITY SE44ER CONNBCTIO[V TO CITY VATEEt
Q OTIiERR (Please Describe)
6) i90 • i
~ PLEASE HOLD APPROVED PERNffT FOR PICK-L'P BY ONE OF AHOVE
d PLEASE MAIL APPRO\1FA PERMIT 7U 1, 2, 3, 4, ABOVE
(Circle one)
F O R C I T Y U S E O N L Y
PE2MIT u ISSUED
F°ES: $
SBi•iEB nE3MrT (I`iCL:;DE SU.°.C'i?RGc)
WATER PERPIIT (INCL'uDE SliRCAARGE)
.
$ WATER METER/COPPERHORN/OUTSIDE READER
$ WATER TAP (INCLUDE CORPORATIOAI STOP)
$ SESdER TA?
a_..=R
$ ACCOUNT DEPOSIT - p7ATER
$ ~ZC-cc . ~U WAC
'S SP.C
$ TRG'NK WATER ASSESSi•?ENT
$ TRuVK SEIdER ASSESSb1ENT
'S LrITEP,P.L BENEFIT/TRUNK SE?:TEF
$ LATERAL BEVEFIT/TRUNK SVAT°R
$ _.1/~/ •
WATER TREATMENT PLANT SURCHARGE
$ OTHER:
$ TOTAL
$ AMOII::T PAID; RECEIPT
V l/,/7.TS
k
DOES UTILITY CONNECTI~O~~~$_UIRE EXCAVATION IN PUBLIC RIG~i~i~S~ iJiT~?
7-7 YES IF YES, THEN A "PERMIT FOR 'r70RK WITHIN
PUBLIC ROADWAY" MUST BE ISSUED BY THE
E:= NO ENGINEERING DIVISION. LIST AS A CONDI-
TION.
SUBJECT TO THE FOLLOS9ING CONDITIONS:
~
APPROVED BY; ~
TI:LE:
DATr ; ~
-
$
y of EaiaIl
Cit ;
I Permit Fee: '156
~
3830 Pllot Knob Road i 3-
Eagan MN 55122 I Date ReceNed: 1
Phone: (651) 675-5675 ~ C~ i
Fsx: (651) 675-5694 I Statf-------------- J
` 2008 MECHANICAL PERMIT APPLICATION
Date: Slte Address:
Tenant: Suke
RESIDENT / OWNER Name: ~~tlr Phone,
Address / Ciry / Zip:
CONTRACTOR Name: License#:
Address: ,,~,~,~'J '~d--- ~ ?cr?~
Gity: _ State: ~ Zip:
Phone: Sr- Contact Person:
TYPE OF WORK - Ne"' .-"aPtacement _/+dditional _ Alteration _ Demolition
~
Description of work:
u NOTE Both-roof.rimo nfed and grvund mo`untetl friechanlca/ equiprrient !s: requlred to "
.
:'be scneenetl byCity.Code , Please contact the MechanJcaf Inspector o~.one of~the" ~
anners;%rlntormaHon.on~' , tted.screeir ihethcal's:
ENTIAL COhIMERC/AL
PERMIT TYPE New Construcrion Interior Improvement
Pumace -
AlrCondidoner - InstallPiping _ Processed
Air Exchanger - Gas _ Exterior FIVAC Unit
• HVAC units must 6e screened
_ Heat Pump Under f Above ground Tank Install I_ Remove)
Other " When installfnWremoving tank(s), caN for inspection by Fire
- Marshal and PlumWn I or
RES/DENTIAL FEES:
$50.50 Minimum Add-on or aReration to an existing unit (includes $.50 State Surcharge)
$90.50 Fire repair (replace bumed out appliances, ductwork, etc.) (InGudes $.50 State Surcharge) ~
$ TOTAL FEE
COMMERC/AL FEES:
$70.50 Underground tank installation/removal OR Contract value $ x 1%
$50.50 Inimum (includes State Surcharge)
Permit Fee
• if ~ Esa ts iess men r,ooo, surcnerge is $.so.
• If Perm fga is > $7,000, surcharge Increases by $•50 for each State Surcharge
$1,000 Permft Fee (I.e. a$1,007-$2,000 Permit Fee requlres a$1.00 surcharge). $ TOTAL FEE
I hereby ackraxiedBe that this IMamatlon is complete and acwrate; Mat the xork will Ce in coNOrmance with the orclinances and cades of the Ciry ot Eqqen; tha[
I understend Nia is rot a petmit but onty an ep{iICStlon for a permlt, arM work is not lo start wiVwul a Pertnit; Net the lwrk will bB in accordanOe rfth the approved
plari in the case of work which requirea a review end epprwai of plans,
x X
AppllcanYS Prlnted Neme AppllcenYs Slgnature
,
' FOR OFFICE USE Revlewed 8y ~ s
. . ~ .
R"ulred tnspecUo ns - 3 Undar Ground Rough in. Air Test Gas Ser,vKe Test In-floqr Heat "Flnal n
11 x -
Use BLUE or BLACK Ink
I
r-------= ^---'---r
I
I For Office Use
I
Permit U^
City of Ea
Ed I Permit Fee::
3qn(,
830 Pilot Knob Road r I
Eagan MN 55122 i Date Received:
Phone: (651) 675-5675 t i
Fax: (651) 675-5694 j Staff: I
t---------"--------1
2014 COMMERCIAL BUILDING PERMIT APPLICATION
Date: Site Address:
Tenant Name: U1&1 1 &r fitgf / (Tenant is: New / Existing) Suite
Former Tenant
Name: 001-26 x/142 f2,0'"7 Phone: tp -770 0V
Property Owner el? ► ~
Address /City /Zip: Az,
L Applicant is: Owner Contractor
Type of Work Description of work: -fe64 t°`- 0 f- " f
i Construction Cost: _ - -t i c1q0
i Name: az Lu' e ! C o 4 /d l frY Oo License
Contractor Address: 'l
!fie 7 ~ 1 3 City: State: Zip: Phone: b ! I
Contact: Email:
Name: Registration
Architect/Engineer Address: City:
State: Zip: Phone:
Contact Person: Email:
Licensed plumber installing new sewer/water service: 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 Gall 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 Ich requires a review and approval of plans.
Applicant's Printed Name is nt's Signat
Pagel of 3
t S 0
t
IL
e c
��,��. •,mow �AGAIN
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651) 675-5675 1 TDD: (651) 454-8535 1 FAX: (651) 675-5694
Email: buildinginspections(D-citvofeagan.com
Plan Submittal: eplansa-cityofeagan.com
j For Office Use j
Permit #:
I I
I Permit Fee: 6 6I
I I
Staff:
Payment Recvd: Yes No I
I I
I I
I Plans: Electronic Paper I
I -----------------J
2018 COMMERCIAL PLUMBING PERMIT APPLICATION
❑ Please submit two (2) sets of paper plans with all commercial applications as well as an electronic set of the submittal,
submitted via email, CD or flash drive
"'r' r.
Date: %;1 ' "' Site Address: �• "00"i
Tenant: Suite #:
Property �"'-c^
Owner Name: 1A � � ! 1J t� l [r l hone: � / •- �J
Name:
Contractor Address: /� �
! 1City :
l9 ��i�.,G.-
i .
Phone: CS 5 -7 •�w,./.-,.Email:
New Replacement Repair
Type of Work -^ . -
- •
Description of work
COMMERCIAL
New Construction
DA) State)
Rebuild Modify Space
Modify Space
�`✓ Zip': Q �) q
Work in R.O.W.
Irrigation System (_ yes / _ no) RPZ / _ PVB)
Rain sensors required on irrigation systems
Permit Type Avg. GPM (2" turbo required unless smaller size allowed by Public Works)
Meters Call (651) 675-5646 to verity that tests passed prior to picking up meter.
Domestic: Size & Type Fire: 1
_ _Avg. GPM High demand devices? —Yes —No _...4w Flushometers_Yes _No
COMMERCIAL FEESContract Value $ ® C) X.01
$60.00 Permit Fee Minimum
$60.00 PVB/RPZ Permit (includes State Surcharge)
Permit Fee F
FOR OFFICE USE
Approved By:
Date:
Required Inspections: Under Ground Rough -In Air Test Gas Test Final PRV Required: Yes No
Meter Related Items: Meter Size Radio Read Manometer Staff:
Page 1 of 3
_ $
Surcharge
Surcharge = Contract Value x $0.0005
=
If the project valuation is over $1 million, please call for Surcharge
= $
TOTAL FEE
Following fees apply when installing a new lawn irrigation system
$
Water Permit
I
Contact the City's Engineering Department, (651) 675-5646, for required fee amounts.
l
$
Treatment Plant 3
�
$
Water Supply & Storage
$
State Surcharge
--- --- ---------- —`- --- --- - - -- -- -
=$
y
, �,; , /�- (1 TOTAL FEE
You may subscribe to receive an electronic notification from the City of proposed ordinances
by signing up for an email update on the City's website at
www.cltyofeanan.com/subscribe.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground uti'
amage.
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with a or ances and co
s o the City of Eagan; that I understand this is not a
permit, but only an applicationa permit, and work is not to start wi ut a permit; that the work will be iLcoan
'e wi the rove plan in the case of work which requires a review
and a Val of plans.
pa
X J ` X
Applicant's Printed Name Applicant's
Signature
FOR OFFICE USE
Approved By:
Date:
Required Inspections: Under Ground Rough -In Air Test Gas Test Final PRV Required: Yes No
Meter Related Items: Meter Size Radio Read Manometer Staff:
Page 1 of 3