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4551 Villa Pkwy CO_AMRCLAL BUII.DING Permit Applicafion City Of Eagan ~ 3830 Pilot Knob Road, Eagan Mn 55122 Telephone # 651-675-5675 FAX # 651-675-5694 Foundation Onl New Buildin Interior Im rovement . Structurai Plans (2) sets • Architectural Plans (2) sets . Architectural Plans (2) se5 • Civil Plans (2) . Structural Plans (2) • Code Analysis (1) " - CertificateofSurvey (1) . CivilPians (2) . ProjectSpecs (1) . Code Analysis (1) " . Landscaping Plans (2) . Key Plan (1) . • Project Specs (1) • Code Analysis (1) . Master 6cit Plan (1) . Spec. Insp. & Testing Schedule " • Certifcate of Survey (1) . Energy Calculations (1) not always" Soifs Report . (1) • Spec. Insp. & 7esting SchedWe (1) . Elec. Power & Lighfing Fofm (1) not always'* . Meter size must be estabiished . Meter size must be esta6iished • Meter size must be established-if applicable 1 , • ProjectSpecs (1) ~ . 1 • EnergyCalculations (1) y - 1 . Electric Power& Lighting Form (1)" y • Master Exit Pian (1) y . - 1 . ~ . Emergency Response Site Plan (1) - - y . - 1 • SoilsReport (1) y SAC determination - call 651-602-1000 • SAC determination - cail 651-602-1000 SAC determination - call 651-602-1000 Calt MN Dept of Health at 651-215-0700 For details regazding food & beverage or lodging facilities. " Contact Buildmg Inspections for sample and if required when it states "not always". Pemut for new building or addition will not be processed without Emergency Response Site Plan. Date /22___ / 03 V l lla pKwy, Construction Cost SiteAddress `Erin Drive and Nicols Road Blda # 7 UniUSte # Tenant Name Eagan d r Former Tenant Name DescriptionofWork'(34)Townhomes and (1) office in 7 buildings Property Owner Dakota County CDA Telephone#( 651) 675-4400 Contractor Frana and Sons, Inc Address 633 2nd Avenue"Soui-h City unnkins State Minnesota Zip 55343 Telephone#(q52 ) 935-8600 . . . . , . . i,_.~- ft Arch/Engr Registrafion# 17402 ^F ' Adaress 250 Third ven e City Minneapolis State Minnesota Zip45401 Telephone#(6 12) 33~g BY.~ Licensed plumber installing new sewerlwater service: Phone I hereby apply for a Commercial 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 withouf a permit; that the work will be in accordance with the approved plan in the case of wark which requires a review and approval of plans. Stuart~~s~a~ Applicant's Printed Name ApplicanYs Signature OFFICE USE ONLY Sub Types ? 01 Foundation ? 26 PuUlic Facility ? 30 Accessory Bldg. ? 14 Aparhnents ? 27 Commerciai/Industrial ? 32 ExtAlt - Apts. ? 15 Lodging u 28 Greenhouse ? 34 Ext Alt - Comm. ? 25 Miscellaneous ? 29 Antennae ? 35 Eat Alt - PF ? 37 Nail Salon Work Types ? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding ? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 33 Alteration ? 37 Demolish (Bldg)' ? 43 Reroof ? 46 WindowslDOOrs ? 34 Replacemerlt *Demolition (Entire Bldg only) - Give PCA handout to applicant Valuation 3760 000 r~ Occupancy R' Z MC/ES System Census Code 10r Zoning City Water V7~ SAC Units & Stories ~ Booster Pump Nbr. of Units ` Sq. Ft. b r~j I PRV Nbr. of Bldgs I Length Fire Sprinklered ? Type of Const V 8'. Width REQULRED INSPECTIONS ? Foorings(new bldg) ~ FinaUC.O. _ Footings (deck) FinaUNo C.O. Foorings (addi6on) ? Plumbing ~Foundation ~ HVAC ? Drain Tile Other Roof ? Ice & Water v/ Fjnal Pool Ftgs Air/Gas Tests Final ~ Frarrung _ Sid3ng Stucco Stone Fireplace _ R.I. _ Au Test _ Final _ Windows (new/replacement) ? Insulation _ Retaining Wall Approved By C~KW11z,~ , Building Inspector ~ BaseFee 3S4, G.21- 4vA-7S-0_ MErr&2 - Surcharge Z-837 ~ \ ~ Plan Review Z.3 .66 MC/ES SAC 7 6 S-0 • City SAC L a o•"" Water Supply & Storage S/W Permit / a o, a.o S/W Surcharge d • S~?3 Treafinent Plant Park Dedication ^ Trails Dedication Water Quality Copies ' Other Total i =P- v`' .~r S Mv . , ~a ME,MQAANDUM ~ I ~6 TO: DAVE BENNETT, UTILITY CONSTRUCTION INSPECTOR #S DALE WEGLEITNER, FIRE MARSHAL ERIC MACBETH, WATER RESOURCES COORDINATOR GREGG HOVE, CITY FORESTER JOHN GORDER, ASSISTANT CITY ENGINEER KENT THERKELSEN, CHIEF OF POLICE MARK ANDERSON, ELECTRICAL INSPECTOR MIKE RIDLEY, SEIVIOR PLANNER PAUL HEUER, SYSTEMS ANALYST SCOTT PETERSON, BUILDING INSPECTOR TOM COLBERT, DIRECTOR OF PUBLIC WORKS TOM PEPPER, CHIEF FINANCIAL OFFICER FROM: CRAIG NOVACZYK, SENIOR INSPECTOR DATE: SEPTEMBER 10, 2003 RE: PLAN REVIEW FOR EAGAN CEDAR FAMILY HOUSING (CDA) LOT 1 BLOCK 1 CEDAR VILLAS 2172 CEDAR LANE 2180 CEDAR LANE 4551 VILLA PKWY 2175 CEDAR LANE 4552 VILLA DRIVE 2176 CEDAR PASS 4558 VILLA DRIVE The plans are in our plan review section for your review and comment. Please return this form to mv attention with your siped comments and the date of review within seven days. If you have any concerns with these plans, please so indicate on this form and notify and resolve these issues with the affected parties. If you aze requesting that issuance of the building permit be held, please fill out the proper "hold" request form. Comments• Indicate any fees that are to be collected with the building pemrit: AMOUNT ? Yes ? No landscape security required Z O N I N G? ? Yes ? No water quality dedication METER SIZE ? Yes ? No park dedication ? Yes ? No trail dedication ? Yes ? No tree dedication ? Yes ? No PRV Required Signature Date ; M,EIVIORA'NDUM TO: DAVE BENNETT, UTILITY CONSTRUCTION INSPECTOR ~S DALE WEGLEITNER, FIItE MARSHAL ERIC MACBETH, WATER RESOURCES COORDINATOR GREGG HOVE, CITY FORESTER JOHN GORDER, ASSISTANT CITY ENGINEER KENT THERKELSEN, CHIEF OF POLICE MARK ANDERSON, ELECTRICAL INSPECTOR MIKE RIDLEY, SElYIOR PLANNER PAUL HEUER, SYSTEMS AAiALYST SCOTT PETERSON, BUII.DING INSPECTOR TOM COLBERT, DII2ECTOR OF PUBLIC WORKS TOM PEPPER, CHIEF FINANCIAL OFFICER FROM: CRAIG NOVACZYK, SENIOR INSPECTOR DATE: SEPTEMBER 10, 2003 RE: PLAuN REVIEW FOR EAGAN CEDAR FAirIILY HOUSING (CDA) LOT 1 BLOCK 1 CEDAR VILLAS ( 2172 CEDAR LANE 2180 CEDAR LANE L 4551 VILLA PKWY ~ 2175 CEDAR LANE 4552 VII.LA DffiVE 2176 CED.1R PASS 4558 VII.LA DRIVE The plans are in our plan review section for your review and comment. Please retum this form to mv attention with your signed comments and the date of review within seven days. If you have any concems with these plans, please so indicate on this form and notify and resolve these issues with the affected parties. If you aze requesfing that issuance of the building permit be held, please fill out the proper "hold" request form. Comments: Indicate any fees that aze to be collected with the building pemut: , AMOUNT ? Yes ? No landscape security required Z O N I N G? ? Yes ? No water quality dedication METER SIZE ? Yes ? No park dedication ? Yes ? No trail dedication ? Yes ? No tree dedication ? Yes ? No PRV Required Signature Date RESIDENTIAL MECHAIVICAL Permit Application City Of Eagan 3830 Pilot Knob Road, Eagan Mn 55122 a q Telephone # 651-675-5675 Please complete for. Single Family Dwellings & Townhomes and Condos when pertni[s aze required for each unit Date 03 n Site Address /Zi~~ H' f'~7~ C.l/ Unit # ? G ProperTy Owner "/'7!? .EZ I t /v S / Telephone # ,S--S o ~10 i Contractor (i' V StreetAddress City State Zip Telephone # (76? Bond Ezpires: The Applicant is _ Owner Contractor _ Other Add-on, modification or alteration to ezisting dwelling unit $ 30.00 furnace replacement _ air exchanger _ air conditioner ~ New _ Replacement other t- State Surcharge $ .50 lUJ L5 ~ ij~ I 'L 1 LUU3 Total " ~4 ~ ~ By I hereby apply for a Residential 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 tlus is not a pemut, but only an applicaflon for a permit, and work is not to star[ without a pernrit; that the work will be in accordance with the approved n in the case of A2's requires a review and approval of plans. ~ ApplicanYs Prin ed N e Applicant's S COMMERCIAL MECHANICAL Permit Application City Of Eagan 3830 Pilot Kuob Road, Eagan Mn 55122 Telephone # 651-675-5675 Please complete for: commerciaUindustrial buildings multi-family buildings when sepazate permits are not required for each dwelling unit Date Site Street Address Unit # Tenant Name (if applieable) Previous Tenant Name Property Owner Telephone # ( ) Contractor Sheet Address City State Zip Telephone # ( ) Bond Expires: The Applicant is _ Owner Contractor Other Work Type _ New construction _Install _Remove Underground Tank _ Interior Improvement Schedule inspection during instaliatlon or removal of tank Processed Piping Nature of Work: Permit Fee $50.50 inimum Fee (incWdes Sq[e Surcharge) , Contract Value x 1°/a Percnit Fee • If permit fee is $1,000 or less, add $.50 ~ $ State Surcbarge If permit fee is over $1,000, add $.50 per $1,000 Perxnit Fee $ Total Fee I hereby apply for a Commercial Mechanical Permit and aclmowledge that the information is complete and accurate; that the work will be in wnformance with the ordinances and codes of the Ciry of Eagan and with the Mechanical Codes; that I understand tlns is not a permit, but only an applicauon for a permit, and work is not to start without a pemrit; 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 Date: PLUMBING (RESIDENTIAL) Permit ApplicaHon City Of Eagan 3830 Pilot Knob Road, Eagan Mn 55122• Telephone 9 651-675-5675 FAX # 651-675-5694 Please complete for. Single Family Dwellings Townhomes and Condos when permits are required for each unit Date /0 / 171 0-? Site Address S~SS/ -(Z, L G p- ~Jt wV Unit k 7 Property Owner Telephone k ~-2-) ~ ~ ~~41n6 Contractor lrt 11' Cr- Address 7342- n al , n State r Zip Telephone # The Applicant is _ Owner X Contractor _ Other Septic System New _ Refurbished Submit 2 sets of plans and MPC license $ 100.00 Includes County fee. Additlonal consultant fees may apply. Alterations To Existing Dweliing Unit, Including $ 50.00 _ Adding fixtures to lower levels or room additions, excluding water softener and water heater _ Abandonmenl of septic system _ Water turnaround 5/8" meter if needed -$121.00) Other: _ RPZ _ new installation _ repair _ rebuild $ 30.00 _ Lawn irrigation system _ Water softener _ Water heater $ 15.00 _ replacement _ additional State Surcharge $ 50 OCT 1 7 2003 . Total $ C). I hereby appty for a Residential Plumbing Permit and acknowledge that ' ' nd accurare; that the work will be in conformance with the ordinances and codes of the Ciry of Eagan and with the Plumbing 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. ~ ~-C-h A 4 Applicant's P mted me ApplicanPs S' ature 06/02/2009 01:46 7637834566 ERICKSON PHC PAGE 02/04 ---i I ~ ~ City of FW ~ Pen."C 9830 pllot Knob Road ; a~""'t •5~ i pOf~C~6'S~BT35675 ~ Pateaaeerved~ Fax: (851) 675•5694 ; staff. 2009 COMMERClAL PLUMBING PERM{TAPRLICATION Date: {2"j"C`~' p sNo add.ess: L4 -3 ( Y i 1\O- ~ ~-~Li . , ~ . T8n8iH• j...QLR_. ' PROPEHTY Name: ~ Pa Phane: OWNER CONTRACTOR Name: ~ C\ ctsn QIA C. . License i!: adaress:,}J-1l 9ra„8 l,.r, N E cmr: r"~ln:,sta1e:10MZjv- Phone:-1 (.o3•-'1$3-'-1S^~~u- ContactFerson: TYPE OF New _ Replacemenrt R"r _)L_Re6uild _ModHY Space _wWk In R.O.W. waRK ~ osscription of wa1c: PERMIT TYPE COA9A+?ERCIAL . New Construclbn _ ModMY SPece IrtlgaNan 8yatem Yes rW) (--L RPZ / _ PVB) . • Rain sensors raquired on inipation systems . . Avg. GPM _(2" turbo required unless smaller s¢e albwed by Public Warks) fneiers cap (651) 6755sae to vemy ms[ msts aassed wfiw ro oicwnn uo meeef. . DOMB6tIC: Size 8 7ype . FVO: SIZB & Pnce 9/4" mBt81' ?3 Q3 W' - Avg GPN FU9b demaM devicu? Yes _No Flimhqneters _Yes No COMMERCIAL FEES: $60.50 Miniminn (indudes Stato Sureharge) OR comraetva4ieS x 1% PeimR Fea R9quLed on ALL newbuiWlrMs and boulavard irrigstion sy9tems 4= $ Rad'0 Mete( RMd -it'FgglslossWnS1PO6.sumher9a esE.5o ~5) - II Pemdt Fee ie > St.OW, su(dl2l'ge klCreases by E-50 for eech S1,000 51.000 Pem7k Fea (I.e- a$1.OR1.52.Q00 Pertnil Fae requ~es a E7.00 s~achafqe). = S- Stete fiaChs~ge Following foes apply WhO.n 1n5talling a*rew lawn erigatiai syBtCm. $ Wffier Penait Call Ne GWs Engineerin9 D"rtrnerH, (651) 8755846, for 2puved fee amouMa. E Treahnent PIaM . . . g Water 9upWy & 5trnage . S Stale Swdiarge T07AL FEES S 5 I hereby aClmmMedAe Mal tl+is'vMarmatlon Is eamWete arW acatrete: ihat the worR wiu he-in mrHOkmanm wlm tlm «Anarwes ai Rmdea of ¢te Gly of EaparKthat i ucdemlaM thls Is rot a peimi4 but onry an epo"W^ for a pertnk and work is na m startwrthart that llv.~Awk w01 M accadance wiN~ Ma approveA ptan in d+e ~ase of wark vAhich requiree a ramew ana.approvai d piarrs. _ A ~Jk x x . . . ppplicanYs Printed Name Appli e S1g ure . . . Page i of 3 Use BLUE or BLACK'Ink For Office Uae - - - - - - - i . ~ - i i City of Ea an ; Permit 0: 3830 Pilot Knob Road I Permit Fee: I Eagan MN 55122 ~ Gate Received: ~ Phone: (651) 675-5675 t Fax: (651) 6755694 i Stan: - - 2011 RESIDENTIAL 6UIL`DING'PERMIT APPLICATION Date: f~ Site Address: - X6 I/ Unit Name Phone: ro7 RESIDENT / t? . OWNER Address i City I Zip; , Applicant Is: .Owner .Contractor TYPE OF WORK Description of work: _ EG1.~liGs~.. Construction Cost: • Mulg-Family B tiding: (Yes / No Company: ''Ti./i~'C~' ' JOA035: TeOK Contact: 5/6 Me Ds /?Ol-~~~~rL r Address: ~ / Q9N )6 City:JPL~ , CONTRACTOR State: -14A). Zip:- Phone: clS.~l ' 99 V -F'56 -F5Q Ucense _ ©3s'o©gzr Lead Cergfiaate _ /1 A 7 - 7X3-7,3- I If the project Is exempt.from lead certlflcti<ilan, please explain witty: (see Page 3 for additional information) COMPLETE THIS AREA CND IF'CQNSTRUCTIN'G A NEW BUILDING In the last 12 months, has the City of Eagan Issued a permit fora elmllar plan based-on a master plan? _Yes _No If yes, date and address of master plan: Wcensed Plumber: Phone: Mechanical Contractor, Phone: Sewer & Water Contractor. Phone: NOTE: Plans and supporting documents that yousub►»JttQ cQRS/dieted to' be public Information. Portions of the Information may 4e classified as t(0•pc(4.11C,lfy0u9,Yfse~sII~ t+easons that would penult the Clfy to 5c61117 udt#'tlfat•fhe at~'t~ad~,secr+t~s. ' ^5'.:o- ~,;..;•;v t , . CALL BEFORE YOU DIG, Call Gopher State ono,04 it (tt61) 464-0002 (a protection against underground utility damage. Call 48 hours before you Intend to dig to receive locate= of underyround il►IUaf,' aooherstaleone,~ail ore i Ate •t!•R Y"l.K ti., ti. 5 I hereby acknowledge that this Information 1s complete atld aCCUrate; that th0 Work Will be In Conformance with the ordinances and codes of the City of Eagan; that I understand W3 Is not a pgmlt, bill Only an application for a permit, end•.Wprk 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 rWow and approval 6f Mini.- Exterior work authorized by a building permit Issued In accordance With the Minnesota State Sul days of permit Issuance. lding Code must be completed within 180 x SfE~~ i+ &-,a- Applicant's Printed Name X A4pc a nt s Signature Page i of 3 To: Page 8 of 8 2014-09-26 13:33:42(GMT) 18772375198 From: Danielle Merritt : Us�B�U�or BLA+�I�t�k v_��___�.-°___°___._.� � �ortSfFfce Us� � + I Pertnii#: �l O'� Jl O i tJd�� ��1l���� i � .��4�L.��---� E Fermit Fe�: i 383Q P61ot Knvb i�o�d E _ t �agan M�i 55122 1 C�ate.t��ceived: � PhBne�{fiSt'�fi7'S-5&75 � � ��x:(651}.6%5�5694 � Statf: °" I �.._ — �-..� a����E�iD��1rfA� �u�L��t�� ������r �►���rc�►�rtc�� �,�t�•:��'� .�Site A�idress: �3 t 1 � `� � '�..+„�+'" '- c � �� ,�,. �'' �; Dat�� � �3 �'"` � � �f � � "� � w: Unit#. >� h ' � � �':; .�. �f � j� f /'� �rA'`,��r' a�1� :�r:i �8f1'IB; tw...`b � t_...C:. "[.1 6 �d � F PFK3116. Address!City/�ip: � �"� �� '.���(1� �L'i��l�� �!�� �,��',,�Yi� .�.+�U �� � A�:pficant is: C7wner �,C�snfracEar s � �° �escription nf wc�ric:„� C` ' �(�1�`�" �"f'� �.�' �wl� �' �'�� i�.,.3 �onsinaction Cast: . ����:a ��;��"�,. Mufti=Family Building;(Yes�,I lVa,.,;;;� Cornpany'� ��`f E� � �a�''c����M�'{ �t G�� Gonta�t; .�.�,�� �` � � . l; Rddress: -� �i ���. ����� �C3�:' �7�- City: ` d C" ��� P ,:, State:f Rl P�!Zip:��J'��� .Phan�:�E1��"'������Em�il• �G�t I!'�� E"Y`1�����f�� �'t�S��C9�" � tt�$`�+ -� - � ��fi'�'4 �; ;` �(�-( � � � Lead Certif[Cate#: /1� �''��� �. � ,� ,F � l.icens�#:. � If the project is exernpt irom tead ceetificati�an;:please exR�ain why: (ses Page.3 for additi�nal infarma�iort) CC'kMFLET�THI�ARE,4 ClNL.Y IF C[?NSTRt1CTIAIG A h1E1N�UlL.L71NG : !n ehe iast�2 months,ha�the�ity of�a.gan issuad a pertnit for a simitar plan basecf on a mast�r plan7 Y�;s No .if yes,.date�nd addr�ss of mastee pfan: : _ , ` Licens�d Plumher: ` Phane: Mechan`rc�l Contractar: P.hane: ` �evrer S�VVater Ccntrackor: _ Phane: i�/kLL�E�'CrR�'1((1�1 D��a. Cail Gopher Steit�Qrte Csll at(651j 45b-0042 for protection against under�rounci uti{ity damage. Cstl AA hchu�5' �aefoee yQ�:itttend to dig ta reeeive locates pf unclergr�4and utlltties..v�!ww.�;aoher� EeoneeaEi.nra 6 hereby�acknowtladge that#his ir'tformatiorr is:camplete anC accurate;thet ths work wiit be in contprmanGe wi4h the.ard'rnances And co�Jes of Fh�:Gitxr of �aga�n;that I undsrstand this is nat�.permit, but arrly an aOPiieatiop far a perrrrit,ant�wark is:not ic�stark wiihout:�pesmit;#h3tt t��::u�r�uall.b�t� �cca�dc�rice�nnth itie e.pgtaved pl�n iri the cae,�af v�orfc which reGuires a r�view�nd ap�arnval af plans E9cterier wark authorix�d by a bu.ifding pettntt issued in accordance with the Minneaota State Buiidi►�g Code m:ust b8 cc+mpteted wtithin 984 day�s of.permit is�uance, `, �. � % .Lr'��t� C ��,4�; �. ���f � �� � �i'�...�.,+i..��� .. APAI"►c�nt's Printed:Name Applirant's'�ignatesre _. ` Re,�e'i ai� For Office Use �j , Permit#: g / /• (G �- `- •I "� E AGA N Permit Fee: (if 69 -od Staff: 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 Payment Recvd: ^Yes No (651)675-5675 I TDD: (651)454-8535 I FAX: (651)675-5694 Email: buildinginspectionsa.citvofeacian.com Plans: Electronic Paper Plan Submittal:eplans((T7.citvofeagan.com J 2019 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 Date: 11/07/19 Site Address: 4551 Villa Parkway Tenant: Erin Place Family Townhomes Suite#: Property Owner Name: Dakota County, Nick Sisterman Phone: (651)675-4480 Name: Norblom Plumbing License#: 643133 ContractorAddress: 1465 Selby Avenue City: St. Paul State: MN Zip: 55104 Phone: (612)827-4033 Email: service@norblomplumbing.com New Construction Addition Modify Space 1 Replacement Repair Rebuild Work in Right-Of-Way Description of work: Replace water heaters in units: A, B, D, E, F Type of Work Irrigation System( yes 1 no)( RPZ/_PVB) • Rain sensors required on Irrigation systems • Avg.GPM (2"turbo required unless smaller size allowed by Public Works) Meter Required-Call Utilities at(651)675-5200 to verity tests passed prior to picking up meter. Domestic:Size&Type Fire: 1 Average GPM High demand devices?_Yes_No Flushometers_Yes_No COMMERCIAL FEES Contract Value$ 4000.00 x.015 $60.00 Permit Fee Minimum60.00 $60.00 PVB/RPZ Permit(includes State Surcharge) $ Permit Fee $ 2.00 Surcharge Surcharge=Contract Value x$0.0005 If theproject valuation is over$1 million, please call Cityfor Surcharge $ 62.00 TOTAL FEE 9 The following fees may apply when installing a new lawn irrigation system or $ Water Permit connecting a new water service. $ Treatment Plant Contact the City's Engineering Department,(651)675-5646,for required fee amounts. $ Meter Fee $ Radio Read $ State Surcharge =$ 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.citvofeaaan.com/subscribe. CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. 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. Jeffrey L. Norblom Applicant's Printed Name A icant's ignature Page 1 of 4 EVIIckson Plumbing- Heating -Air- Electrical REDUCED PRESSURE BACKFLOW PREVENTER TEST REPORT OR TESTABLE DOUBLE CHECKS Service Name: �Z ��' j %�/?�-� Contact Person/Tele: _ Address: S % L1,17, % 11/ k'/)V City: State:f? Zip:�`1r,�. Device Location: �._ ( , t erve what system: j �,r-�i �;.� j ".." 7 Account No: Serial Number: Type: _ & %0 Make Rebuild Due Date: / G !! 7 J" —c-� e-) Model: Size: ?_ Test Due Date: ,� ' j ;, ) annual Report unecK valve #i Pressure Check Valve #2 Pressure Differential Pressure Relief Valve Opened at psid reduced pressure. Did not open Cleaned Cleaned Cleaned Replaced Replaced Replaced R Disc Disc Disc E Spring Spring Spring P Guide Guide Guide A Pin Retainer Pin Retainer Diaphragm, Large I Hinge Pin Hinge Pin Lower R Seat Seat Upper S Diaphragm Diaphragm Diaphragm, Small Other, describe Other, describe Lower Upper Spacer, Lower Other, describe Sign and date Tag The above is certified correct. Signed Tested by (Print Name) ,► c��r Company Name: EY_ I(_ k'S 4 Company Telephone Number DateTested:�2-- Certification Number License Number PC6H33��