1570 Clemson Dr B^----------------
For Office Use
Permit #:
City of Eau I Permit Fee: 71, 0 69 1
3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 Staff:
---------------
2009 RESIDENTIAL BUILDING PERMIT APPLICATION C ((
Date: (49 Site Address: 0 ?? SU rJ Jr- Tenant: Suite #:
RESIDENT / OWNER ? o Phone:
Name: 6? ?
?
/ ?''
?
I U 11 C L'Ffd 8P- L t' /
Address / City / Zip: 1 J
Applicant is: Owner Contractor
TYPE OF WORK Description of work: r%t 0 d G-
Construction Cost: _oZ 0 0 d t Multi-Family Building: (Yes / No
CONTRACTOR Name: e/. S V
mo
' License #: 0 C3 'j7 3
? _ I
'
Address: (SS- tied / -ff'/v C, o 1 LJ S
City: _ . S/ - __ ( AI\J State: M "'j- Zip,..S
Phon Contact Person: __Z)a v
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7672
Minnesota Rules 7670 Category 1
_
Energy Code • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
Category Submitted Submitted
(I submission type) • 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?
_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.
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
Eag n; 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
acco ante with the a proved plan in the Nf work which requires a review and approva f plans.
5::?? 1-1 C ejl? X_
App is Printed Name Appli s Signature
.•"""' Page 1 of 3
E-?3
DO NOT WRITE BELOW THIS LINE
SUB TYPES
Foundation _ Fireplace Porch (3-Season) - Storm Damage
Single Family Garage Porch (4-Season) - Exterior Alteration (Single Family)
Multi _ Deck _ Porch (Screen/Gazebo/Pergola) _ Exterior Alteration (Multi)
01 of Plex _ Lower Level Pool _ Miscellaneous
Accessory Building
WORK TYPES
_ New Interior Improvement _ Siding Demolish Building*
Addition Move Building Reroof _ Demolish Interior
Alteration Fire Repair Windows Demolish Foundation
_ Replace _ Repair _ Egress Window _ Water Damage
Retaining Wall *Demolition of entire building - give PCA handout to applicant
DESCRIPTION
V
l
ti
O(7k)
2
O
t
MCES S
a
ua
on 1
, ccupancy ys
em
Plan Review Code Edition % q SAC Units
(25%_ 100%4) Zoning City Water
Census Code Stories Booster Pump
# of Units Square Feet PRV
# of Buildings Length Fire Sprinklers
Type of Construction xfet7 Width
REQUIRED INSPECTIONS
Footings (New Building)
Footings (Deck)
Footings (Addition)
Foundation
Drain Tile
Roof: -Ice & Water _Final
Framing
Fireplace: _Rough In Air Test -Final
Insulation
Meter Size:
Sheetrock
Final / C.O. Required
Final I No C.O. Required
HVAC
Other:
Pool: -Footings Air/Gas Tests -Final
Siding: -Stucco Lath -Stone Lath -Brick
Windows
Retaining Wall
Erosion Control
Reviewed By: - , Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 3
---------------1
For Office Use
* / /
Permit #:
Permit Fee: _5® `:5
Date Received:
Staff:
- - - - - - - - - - - - - - - -
009 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: qj;1I Site Address: I 'C ') 0 € S-d m_ Dr-
Tenant:
Suite #:
RESIDENT/OWNER Name: Oct" hone:
Address / City / Zip: 1,1-70
C: ?"er ?f`?>Cs ??
CONTRACTOR Name: o i
icense #: _Pm
v
Address: 7 °t
City: ?e-® ? r (, State: L _ Zip:
Phone: So-/' ?,?' ?t Ztv 9 Contact Person: 1T6411r.
TYPE OF WORK -New Replacement Repair -Rebuild _ Modify Space _ Work in R.O.W.
Description of work:
PERMIT TYPE RESIDENTIAL
Water Heater Water Softener
Fixtures
La
I
i
ti
Add Pl
mbin
wn
rr
ga
on
g
u
RPZ PVB) („„Main _ Lower Level)
Septic System Water Turnaround
New
Abandonment
RESIDENTIAL FEES:
$50.50 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $.50 State Surcharge)
$30.50 Lawn Irrigation (includes $.50 State Surcharge)
$50.50 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $.50 State Surcharge)
*Water Turnaround (add $165.00 if a 5/8" meter is required)
$100.50 Septic System New ($10.00 per as built) (includes County fee and $.50 State Surcharge)
$90.50 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge)
TOTAL FEES $
i nereoy aacnowieage tnai mis mrormation is complete ana accurate; that me work wiii oe in conrormance witn the orainances ana coxes or the city or
Eagan; that I understand this is not a permit, but only an application for a permit, and worl?j 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 pl s.
x .anJ`edy mky y x Az"aa
Applicant's Printed Name Applicant's Signature
FOR OFFICE USE Reviewed By: ___ Date:
Required Inspections: --Under Ground Rough-In Air Test Gas Test Final
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 1570 Clemson Dr B
Lot: 30 Block: 01 Addition: Thomas Lake Heights 2nd
PID:10- 75951- 300 -01
Use:
Description:
Sub Type: e - Fixtures
Work Type: Replace
Description: Second Floor
Meter Size Meter Type
Comments:
Fee Summary:
4/30/08 Notification letter sent regarding expired permit pf
Jason LaBelle
700 Prior Ave N
PL - Permit Fee (miscellaneous)
Surcharge -Fixed
Total:
Manufacturer
Contractor: - Applicant -
Home Depot Plumbing Contractor - Jason LaBelle
40805 Forest Blvd.
North Branch MN 55056
(651) 645 -5040
Applicant/Bermitee: Signature
PERMIT
City of Eaan
Permit Type:
Permit Number:
Date Issued:
Permit Category:
Serial Number Remote Number
$50.50
Owner:
Debra A Salo
1570 Clemson Dr B
Eagan MN 55122
$50.00 0801.4087
$0.50 9001.2195
Issued By: Signature
Plumbing
EA080316
10/08/2007
ePermit
Line Size
I hereby acknowledge that I have read this application and state that the informa
of Minnesota Statutes and City of Eagan Ordinances.
on is correct and agree to comply
h all applicable State
CITY CF CAGAN WATER SERVICE PERMIT
3830 Pilot Knob Road
P. O. :.;:.21: PERMIT NO.:
Eagai , MN 55121 DATE:
Zoning: No. of Units:
Owner: _
Address:
Site Address:
Plumber:
Meter No.: Connection Charge:
Size: Account Deposit:
Reader No.• Permit Fee:
I agree to comply with the City of Eagan Surcharge:
Ordinances. Misc. Charges:
Total:
By Dote Paid: _
Date of Insp.: (2 7 y Insp.•
CITY OF EAGAN
3830 PiloKAvb Road SEWER
P. O. Box 21199 SERVICE PERMIT
Eagan, MN 55121 PERMIT No.:
Zoning: . DATE:
Owner: — --- Na. of Unit
Address: _'
Site Address:
Plumber:
1 ogres to eonnpg, with the City of Eogon
0r agree
es. Connection Charge;
Account Deposit:
Permit Fee:
By Surcharge;
Date of Insp.: _______ Misc. Charges:
I ate Total:
Date Paid:
.1s "71
)4'11. a i w.o
C.)
Use BLUE or BLACK Ink
I For Office Use
j Permit* I I (oq co
My of Eapn I
Permit Fee: _
3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 t 1
Fax: (651) 675-5694 I sue` I
L----_-.,---------.-J
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
4
Date: 16 - ) 3 Site Address:) ~ Unit
Name: ri 6.//7 i?f/IS'I Phone: ?21.- f Dd---
R.BSide1'1
Owner Address / City / Zip:
Applicant is: Owner _ Contractor
Type of Work Description of work: Re roo F r10~
Construction Cost: 4- j OU Multi-Family Building: (Yes No
Company: _~S 6CIn$T (/C- /dAlN-A Contact: Ln
l " 1 i ~/~CYI 1 _ City: a t iDC 1°~L~PLPLIIL
Cpl tr~CtCtGi` Address: s7 O -2
State: Zip:Sy04 Phone: 6Zc~ - 7 2-1 - 5,506
1
License - 1 10 b Z-- Lead Certificate - 2 !!e? Y?
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 maybe classified as non-public if you provide specific reasons that would permit the City to
conclude that the are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 4540002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.oooherstateonecall.om
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 authorised by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance. r
x rel/t Z t beiA G nq efi x gw.r4d..._
Applicant's Printed Name Applicanys Signature
Page 1 of 3
' I , For Office Use/ 1(� I
`�% i ;f Permit#: ( ( ( u l
.., E AGA N
`•� •�•• Permit Fee: (� ..
i�1
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810IVED Date Received:
(651)675-5675 I TDD: (651)454-8535 I FAX: (651)675-5694Staff:
buildinginspectionsCa)cityofeaaan.com MAY U 2018 L 1
2018 MECHANICAL PERMIT APPLICATION
El Please submit two(2)sets of plans C1 with all commercial applications.Date: q - 0- 1 Site Address: /.14 t) !V fL71t)//4L $/)-
Tenant: j), `` Suite#:
Resident/OwnerName: /ti L414i Phone:49b/`` A 0 F. / P U
Address/City I Zip: /5'
Jr 7,0 t-n t44 tt.4)4 . LA 4A- )4 ✓:5 ;-
Name at, '
*4/L. - License#: `
Contractor Address: it g! 2 i- !UJ1YII City: //gin V37
State Zip: .33 7 Phone 5' ' , , 4/-w L/a ,
4
Contact: / _ . , } Email: ry5, lW . ' Cm
New k Replacement Additional Alteration Demolition
Type of Work Description of work:
NOTE:Roof mounted and ground mechanical equipment is required to be screened by City
Code. Please contact the Mechanical Inspector for information on permitted screening methods.
RESIDENTIAL COMMERCIAL
Furnace NI r go 0, b x 4 New Construction _Interior Improvement
Air Conditioner Install Piping Processed
Permit Type — —
Air Exchanger Gas Exterior HVAC Unit
Heat Pump Under/Above ground Tank ( Install/ Remove)
Other
RESIDENTIAL FEES
$60.00 Minimum Add or alteration to an existing unit, includes State Surcharge
$100.00 Residential New, includes State Surcharge =$ `i 19• 0 0 TOTAL FEE
COMMERCIAL FEES
$60.00 Permit Fee Minimum Contract Value$ x.01
$75.00 Underground tank installation/removal, includes State Surcharge =$ Permit Fee
_$ Surcharge
Surcharge=Contract Value x$0.0005
If the project valuation is over$1 million, please call for Surcharge =$ 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.citvofeagan.comisubscribe.
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.
x ;h)4',rt ii . 51 fest X 1 rdl)fre-1144
Applicants Printed Name Applicants Signature
FOR OFFICE USE
Required Inspections: Reviewed By: Date:
Underground Rough In Air Test Gas Service Test -, In-floor Heat Final HVAC Screening
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