4093 Durham CtRESIDENT / OWNER
Name: 1a_u Vi ,e LL. Phont6taa I 519
Address / City / Zip:
CONTRACTOR
Name: License #�
Address: 1313 Danita Cr
City: Shakopee, MN 5537 Mate: Zip:
952- 445 -
4 8
Phone: -9-445 Contact Person:
TYPE OF WORK
New Replacement Rebuild Space Work in R
_ Repair _ Modify
Description of work: " - ,-
PERMIT TYPE
RESIDENTIAL
Water Heater Water Softener
V
Lawn Irrigation Add Plumbing Fixtures
( 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
550.50 Add Plumbing Fixtures,
`Water Turnaround
$100.50 Septic System
$90.50 Fire Repair (replace
(includes $.50 State Surcharge)
Septic System Abandonment, Water Turnaround' (includes $.50 State Surcharge)
(add $136.00 if a 5/8" meter is required) '
New ($10.00 per as built) (includes County fee and $.50 State Surcharge)
burned out appliances, ductwork, etc.) (includes $.50 State Surcharge)
. 'TOTAL FFFS S OD a
citj ot3ayll
Tenant:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
x
Applicant's Pri
FOR OFFICE USE
d Name
Required Inspections:
Reviewed By:
x
'Applican
atu're
VEItiMM
g3 /ice?
Permit Fee: , J"7)
Permit #
Staff:
2008 RESIDENTIAL PLUMBING PERMIT APPLICATION
�- ? Jo 0(kira
Date. ( � Site Address: � � � M
Under Ground _Rough -In Air Test Gas Test Final
,Date Received.
Suite #:
i nereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes ci :ne
Eagan. that I understand this is not a permit, but only an appTication for a permit, and work is not to start without a permit: that :ne ,,ork
accordance with approved plan i the case of work which requires a review and approval of plans.
Date:
06117/2014 15:06 Les Jones Roofing,Inc. �AX�528817�9 P.013/020
Use BLUE or BLACK Ink
iForOittceusa---------�
• j Permit#: ` ����� j
Crt� of�a�a� , . . ,� ,
� Permll Fee: �
3830 Pllot Knob Road
Eagan MN 66122 j Dete Received: j
Phone:(661)67b-567G I I
Fax:(851)875-5694 . � Staff: �
V�������—....�.�������J
2014 RESIDEIVTIAL BUILDING PERMIT APPLICATION
yo� �0�6��f068- 4�OZD
pate: Site Address:_40$9- �109l- S�os3- y45'S' R�Q�f�lrrt Cowt� Unit#:
� 'A'�. I1(';� .!�,�'..
��'� ��' ;• r.�,r:.:��:.�.. :
��,:� _,:,,',;`':::;�:;��;;,. `;:;:';;,'';; Name: �10 ��eoPa2rY G�� l N� _ _ Phone: �s�-s-.rs�/-99y9
;, n���'id���i-:,�;; .
�' .0���� �t��:'=ti'� Address/City/Zip: �O. BO k 2►2 5 /NvEJ���✓€ -��+� /�it� c4"5 d� 7�
':1:� �I.h....i•,:,��' 1
�� :�.j.1:I. �::�::::; r�:l'�i�.$',''..
;;�:`;�y^;;:;; �•`��'''' ' Applicent is: Ownar �ConVector
:.vo.;' ;;1L
'.' ' �.'.C�'.^'�:.:1......+e�.:..
.�';''�;.�;V.�';'':':::__.��1,�1��:,�1'�'i�::�i, p �
�,'-.:.�'./,;..��'?.:�.;1:.
:,,. '' � = i�".�-�•,��%'''`""'� Description of work: � OvE �4N� .2�F�A,C.�' .J/D/NG;
'{�'i?��',bf�ui�����:�'; -
��•r.'`"���"� ';`'�` '`'' '"'�:� construct�on�ost:�23�oD7� �� Multl-Famlly Bullding:(Yes x /No�
:M1.'4�::' �..'1�`::'S'+
�'�+,�,J ',i/1` �.;':�I'rl���..�'� �':��1`.�.'. /
"�;� '� ' '�"� Compeny: �E� ,ToNE3' RGOFfi✓lr /NG Contact:C�l�et� �D�72so�/
, -'. ;;,.,� - . ,:�,,i;.:
; ,,,^• ';,;c';;:•_ .s,w
.:,•,�;;,..:...R�;,..:.:, ,r',...�,�.,:..;
...'b.'i'.)IN:�'. . :.s:�('�.. -�.:�
..x,. . ,,;.,:.....,.:.:.,r -�:,, Address: 9�f� W. 80� srR..��r'" c� .vl�-�n.✓
��::,;,% ;.: `{:>., . . ,, , ,_....,....__ �v= ��,ac?��..�_ �n ..___,,..._...
,,;4britrac��;r' �rs
r�?;"'�,;9':'�::;�r= :`r�:��: :> $��:�rZlp: �fk�'�� Phone: 9SA- 7(0 7-0�8/7
':.i���:::^ ,;;:����..;��': �•'. -
';�i �� i �i.�
�� ��- .;; ���<!� ��cense st: �S6D Lead Certlflcate tl: .UA-T `r`� � 7�-/
If the project is exempt from lead certlflcatlon,please explein why: (see Page 3 for edditionel information)
COMP�.ET�THIS AREA ONL.Y IF CONSTRUCTING A NEW BU(1,DING
(n the last 12 months,has the Clty af�agan(ssued a permlt for a slmllar plan based on a master plan?
� Yes _No If yes,dele end addresB of inester plen:
Llcensed Plumber: Phone:
Mechanlcal Cvntractor; Phone;
8ewe�&Water Contractor: Phone:
... .... . ...-..>:�-.,.,....,>�.��....,,:.,.,•.:�,,..,.>. . ,,, ,,, _ ,.:. �S
. . �,/ ,:,... .. ;•,.
:,..:�,�..,.::
........ �-� ,�:,,.:,�.,,.:.::.,:,..
��Vd..�:�Plan�:an1µ;suPp.or.�t(tl,�rd't�,atl�e���fha�you�sul5rtl�,t���'�1fr���d�`Y,e.ai'�fb;�ti��'Pt►6y�4�'rl�dr►5t��t�atl�.�f.',�i"� i��t's�}�f::,�
5 p � � 4 , f I�.0 ' - {'t %1,. s �_ � � ,. ��.� .I s:v' i � � f�r �r_�,�Y A,! •^1�'r.y'`` — I• r,. �
J����'���,�I�t�or�i�z��n.M'ayibe,Cl��s�.,�l�� �a��'n�r.'i:p�6��e l��Q�;,��,,la�fld���p�g;.�)�f�r'�a��ns;��,af;vy�ul�►�per°rrt����:��.;���y.,�b;:•�:,
�v V It i ,. : ,,i, y ,�5�r,, e, ie 3.���� tu �� „i�•. +�:.4� a � �7� �� r �v �i .. .� .
/ r � '` '.^^• 'I /4 . ����., p.,.0 . .
, ` ° . {�u � .�i,tiS. t� c b4\1 F,�g:�;�r�
:c � ,Yz y „ ?,i'';�, F ' ' a�14, ;' ,�t��cade�t a�`�t�IC., �l,C�i� °���:$ Q "J• SJ�� ��.� �J���1"�
.� ;, y�
..�. �' • •......a.._.. .... '..r � ..... ... �f. .1.. . .t�..Th?si. •t i. .:�.� .D. 1.
CALL BEFORE YOU DIG. Call Gophar Stata Ono Call at(861)A64-0002 fo�pratecflon egelnst underground uUl(ty demage. Call 48 houra
before you Intend to dlg to recelve locetea of underground ut111Ges, www.00pherstaleQnecaA.ara �
I hereby acknowledge Ihet thls Infarmatlon Is complefe and aocurate;that the work will be In CoMormanCe with lhe ordlnanCee anQ codee of the Clry of
Eagan;thel I understend thls Ia not a pertnlf, but only an eppllcatlon for e permlt, end wotk is not to etert wtlhout e pertnit;thal the w0�k will be In
aCCOrdance wlEh the epproved plan In the case of work whlch requlres e�eview end approvel of plans.
Extarlor work authorizad by a bullding perml!Issued In accordenco wlth the Mlnnesota 9tate Bullding Code mu9t be completed wlthln 780
days of permlt Issuance.
x cH�krs f�MD�2sa�1/ x �� G��-��
Appllcant's Printed Neme Appllcant's Slgnature
Page 1 M 9
0211912014 12:35 Les Jones Roofing,Inc. �A��528817009 P.0131020
Use BLUE or BLACK Ink
r.���������������� �
� �or O(fice Use �
• ; P8►mu�: �7 5� i
City of �a�aIl ��������a � � � ��
� Permlt Fee:
3830 Pllot Knob Road F�$ ' � �O'� I I
�agan MN 65122 ( Deta Recalved: �
Phone:(6g1)6�'G-K67'g j staff: I
Fax:(651)67b-568q . � �
r����������������d
2014 RESIDENTIAL BUII�DING PERMI�APPLICATION
! �loGy yo�G. 40�� �O�o � .
Date: 2' I� � 31te Address: Unit#;
,,.�.<.�.,.fd,,..`Y ........ :, . .
;.;�,..�.,a�•:,, r �j �`;E
;�� .,���;,���y;;�:;�°� �ta,;;, � Name: yo P2oP42rY �A-�.E. 6/vL. Phone: �5�- S.st/- 99�l9
k'F,�,W 1 �.1;: •i,.�d
r �'��,L/�s � I/
P f��dy�y������Q''6���.'1'.Y��•
:��,�.^���<�V1�.Kgl�:o.` Address/Cily/Zip: �P�• Bp fL �l2 5 /NvEJ2�-0✓d -�zl�is4'Y: /u�tt� �3Xy 9Gi
�i.� . N�'`, /��'y�•y ?, �
��� �'",'y�"�'t''M��*'� �� Applicant is: Owner �Contractor
,
_���.�s.,: r. .,,�
,;`':f'�'�'' ��t�`"��y;`. ;1� l�GMo �.D
,, .. ��.�-�.��: , ' -.� bescription ofwork: GLc l��'� �o,df
.,��';R���_o�r�;v.c�:�l�;,:,; ��
�' , ,-,�..,�'�i�����._,.:a�,, A 3 9 x �
i; , ,.,�_ f , Constructlon Cos� Multl-Famlly Bullding: (Yes 1 No_)
�.ry, .T'i.•YYY�� '�AC%, ��/y' :.'�!,%fA,YA
���+,,a�>�� !1'•'�*'�? .. ,�`;�,i Compeny: �E5 �'oN63 RciO�s�/lr. 1.vG ConEact: C�sier s ,4ivDd72so�
r:u ' �,.�,;�,. �
�....f '�,k'"' �� � . �^��,:1 1. . /
i:a. . >a_.��'a ., ,; Addl'A99: 7�f � 80� �Ti�`ti'7� Clhl: ��lLl�N ,
'„y�,'(�a°Orl�,�r� I�ra..s�,�;t�.
����
r:,,,..,. ...+.,.y, . �f:�,;.
p ��`"-„�fv,'•a�'"�v,�..�?�„;� State: A Inl Zlp: .�.�`��20 Phone: 9'SA� 7�+ 7-e�8/9
:�;::59.;��,�,.'�< i f�
,, -,�' � •�''',.��1�;�: a.
4: ��
:,.x�y�;.�>:��.,�;�F,'.h,>;�i;���.:���, Llcense#: ���oD - --�eadCe�tlFlcate#: .vA.7— `f039R-/
If the proJect Is exempt from lead ce�Eification, please explaln why:(see Page 3 for add(ttonal informatlon)
CdMPLETE THIS AREA ONLY I� CONSTaUC71NG A NEW BUILbING
In the last 12 monthe,haa the Clty of EagAn lesued e permlt tor a almllar plen based on a mester plen?
_Yes _No If yes,date and address of master plan:
Llcensed Plumber. Phone:
Mechanlcal Contrector: Phone:
Sewer 8 Water Contractor: Phone:
�a,���fiil ,T " ! "< <� � , cf� �t ,�ct'�s, �� t?- q ��.a R � �R', �;���L`� G�!� `.¢�,��
����tr�Jf�fQ� ��a�+,�� ,�e;��/as�stf.�����:;�� ��u �`a �u� �� � . � �. ��rh��f�w��'�"� ��tY��-��k >t �;'�
�; ;!� t �.. �' �, -,.. .,� . �. �:� �;,-.Y� p►��, �`p. �'�,:w � .��_ �.� ,� � ,� .,.,,;�,;��
_ �
�� ,��'�4.': 1������._!rr ° � . w"'r 1 a A� .� fN py .��.-..A (� /�(. . �. t��.�`),� � piM, ...l� q
_ '.
, ,.. ,,; � 4:iF, f�� ..:' „':..1 ...�. ::...�i i.io,'I `Y}�5 3 �'�.V. c1S.l w.d �.x. .:i14
_ , ., ... .. . .
, . . �. . , • .. ...;
,,{�,'
CALL B��OR�YOU DI�. Call Gophar State One Call at(661y 484-0002 for protecGon agalnat under�round ullllty damape. Catl 48 houra
be/ora you Intend to dlg to rocelve locetes of underground ulNltles.
I heroby ecknowladge lhet thls Informatlon la Complate end accurate;lhat the wodc wlll ba In conformance wllh Iha ordlnances and codes of 1ha Clty of
Eepan; thet I understand lhls Is nol a pennit,but only en appllcaUon for a paRnit,and work la nol to slart wllhout a permlt; thal Ihe work wtll be In
ac�ordance wllh the epproved plan In the cese of wo�C whtc�requlres a revlew and approval of plans.
�xterlor work euthorized by e bullding pArmlt lssued In accordanco wlth lhe Mlnnesota Stata Bullding Coda must ba complatad wlthtn 1A0
days of qermlt Issuance.
x GI•f-2r3 �ND6�2s0it/ x /k�� G�C�iGr�Gr-�
AppllcanYs Printed Name Appllcant'a Slgnsture
Paae 1 of 3'