3697 Denmark AveCity of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 - 5675
Fax: (651) 675 -5694
2010 MECHANICAL PERMIT APPLICATION
Site Address: 3G i 7 De i v ? ) , 0 4 - k: fl-
Tenant: Suite #:
Date: l 061/o
RESIDENT / OWNER
CONTRACTOR
TYPE OF WORK
PERMIT TYPE
en ALk( 14 ' r"
Applicant's Printed Name
Name: Li Sc E1e rr cd Phone C 17- 7 /
Address / City / Zip: 3s &j ' , bci a t e_ (jr Rose va /t , ssiu
Name: 51 PCO. A f1 (,� L U License #:
Address: CA ! rO ii
State: MA) Zip: �S 1 d Phone:
Contact: ve... n P - re r Email:
New " \ Replacement Additional Alteration Demolition
Description of work:
RESIDENTIAL
X _ Furnace
Air Conditioner
Air Exchanger
_ Heat Pump
Other
COMMERCIAL FEES:
$70.50 Underground tank installation /removal
$50.50 Minimum (includes State Surcharge)
- If Permit Fee is less than $1,000, surcharge is $.50.
- If Permit Fee is > $1,000, surcharge increases by $.50 for each
$1,000 Permit Fee (Le. a $1,001 - $2,000 Permit Fee requires a $1.00 surcharge).
OR
New Construction
Install Piping
Gas
RESIDENTIAL FEES:
$50.50 Minimum Add -on or alteration to ari existing unit (includes $.50 State Surcharge)
$90.50 Fire repair (replace bumed out appliances, ductwork, etc.) (includes $.50 State Surcharge)
x
Appl
eviewed ;
Rough Air Test Gas Service.Tes
erior, HVAC Screening; Inspection
Use BLUE or BLACK Ink
Permit #:
Permit Fee:
Date Received:
Staff:
COMMERCIAL
_ Interior Improvement
Processed
Exterior HVAC Unit
_ Under / Above ground Tank ( Install / _ Remove)
** When installing/removing tank(s), call for inspection by Fire
Marshal and Plumbing Inspector
$. 0 • S0 TOTAL FEE
Contract Value $ x 1%
$ Permit Fee
_ $ Surcharge
= $ TOTAL FEE
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
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 to sta- without a ermit; that the work will be in accordance
with the approved plan in the case of work which requires a review and approval of plans.
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In -floor Heat , �Firta
Jul 10 13 07:32a Gates General Contractors 7634387710 p.4
Use BLUE or BLACK Ink
-------e----------
I For Office Use I
Permit 9:
Clay of Ea EaIl
~ Permit Fee: ~
3830 Pilot Knob Road vi~ I
Eagan MN 55122 I Date Received: I
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 1 Staff: 1
1 I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: O / Site Address 3 3 ~3G 9 3(i -7 ~ Unit :
Narne:_F1 ~'GJ~~ ~~y~ L 014 Phone: It 1y~0 7~~"/ / Z_
Resident/
Owner Address I City / Zip:
Applicant is: Owner A/ Contractor
Type of Work Description of work: 7
I G o.cp
Construction Cost: Multi-Family Building: (YesNom
Companyt:~;enT s rV C,ert Contact: L e-
Addre-3-S2Py 9, 4✓ 57-1-' 949,0-S-~_Xcity:
Contractor ,r
State: A4,6~ Zip:
T 7 -7 Phone: 72- 7>_l 5
License k Lead Certificate Z 3 f-~ l
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
qua
COMPLETE THIS AREA ONLY 1 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 maybe 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 4540002 for rot2gion against underground utility damage. Call 48 hours
before you intend to dig to receive locales of underground utilities. : Tjv,,_oooherstateonecall or,
1 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 or authorized by a buildin permit issued in accordance with the Minnesota Building Code sl be completed within 180
day pe it issuance. /
x )~j{/Gt/ tw rte/ x
Applicant's Printed Name Applicant's Signatu
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