1542 Aspen DrJun. 1. 2010 4:00RM SELA ROOFING No. 1929 P, 2
Use BLUE or BLACK ink
City of hp
41111P
Date:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 6755694
2010 RESIDENTIAL BUILDING PERMIT APPLICATION
Permit 0: `7 `t' J- `-0—
Permit Fee:01-.57, 75
Date Received:
Staff:
Site Address:
Tenant:
Suite*:
RESIDENT 1 OWNER
Phone:
Name; �, 95Aq, -5:Z
� ,�� // /� '�''�'�/�, r � i/� , _ • ' j�, ,;
694743
Address / City / Zip: i.!!T (fl t.�V l`-tih-� � [ t'it,LCM
Applicant is: Owner X Contractor Crr
_
TYPE OF WORK
?(52_„ir
te/._, _/-_.,/ i �` !r'.
Description of work: l; . � . ' 1 " _%
_
Construction Cost 2ra
' t3) _&OO Multi -Family Building: (Yes X / No )
CONTRACTOR
Name: LS614W ZV /A & License #:raD 105D
Address: T I D r // I dy City; - f 49& ,C -Pit
State: Zip: . ler Phone: i .� l l nii
Contact: r /"4 VAA Viaraiamaii;-`;�C.il dt,L 1 d ttel/
COMPLETE
In the last 12 months, has
_Yes _No It yes,
Licensed Plumber:
THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
tho City of Eagan issued a permit for a similar plan based on a master pian?
date and address of master plan:
Phone:
Mechanical Contractor.
Sewer & Water Contractor:
Phone:
Phone:
-
NOTE: Plans a 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.
CaII 48 hours before you intend to dig to receive locates of underground utilities. www-aoaherstateonecall,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 1 understand this Is not a permit, but only an application for a permit, and work is not to Start without a • • that the work will be in
accordance with the approved pian in the case of work which requires a review and approvplans,
x c VAAJVi
Applicant's Printed Name
x
Applicant's Signature
Page 1 of 2
411,1k•
City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
Permit #: 6 9c/7.5 -7
Permit Fee:
ss
Date Received: l -l0
Staff: In L
"� 2010 MECHANICAL��PERMIT APPLICATION
/
Date: / a Site Address: I[ -0 4S' 8l 171
Tenant:
tS7 a' ) / //I c '
Suite #:
RESIDENT / OWNER
Name: '21c.57"4.."..1 4 1 //-c-(/ Phone:57- 4- `--,t 7
Address / City / Zip: 1S a 4SP-0'I Q/ Ct5c✓/,/"!fJ• ✓ Td
CONTRACTOR
Name: it d—NR f C:✓!''[ P4V License #:
Address: l600/t'i 4"G i City. / r /Ce vti 1 t f
State: Zip: U V Gqy Phone: 5,0,-8,(3-7- J
Contact: /1 Email: arhCe kilav ce..4`1/66/6- -il:efOe,-/e `
TYPE OF WORK
New to Replacement Additional Alteration Demolition
Description of work: e ptede ai. s, 1e c_..0-7 aI- --0 ---
NOTE Roof mounted and ground mounted mechanical equipment is required to be screened b City
Code ,Please contact the Mechanical Inspector for= M.formation on permitted screening meth ids w
PERMIT TYPE
RESIDENTIAL
Furnace
COMMERCIAL
New Construction Interior Improvement
1 Air Conditioner
Install Piping Processed
Air Exchanger
Gas Exterior HVAC Unit
Heat Pump
Under / Above ground Tank (_ Install / _ Remove)
Other
** When installing/removing tank(s), call for inspection by Fire
Marshal and Plumbing Inspector
RESIDENTIAL FEES:
$50.50 Minimum Add-on
or alteration to an existing unit (includes
burned out appliances, ductwork, etc.) (includes
$.50 State Surcharge)
$.50 State Surcharge) $ TOTAL FEE
$90.50 Fire repair (replace
COMMERCIAL FEES:
$70.50 Underground tank
$50.50 Minimum (includes
installation/removal OR
State Surcharge)
surcharge is $.50.
increases by $.50 for each
Permit Fee requires a $1.00 surcharge).
Contract Value $ x 1%
_ $ Permit Fee
- If Permit Fee is less than $1,000,
=,$ Surcharge
- If Permit Fee is > $1,000, surcharge
$1,000 Permit Fee (i.e. a $1,001-$2,000
= $ TOTAL FEE
CALL BEFORE YOU DIG. Call Gopher State One CaII 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 n in the case of work which requires a review and approval of plans.
x � � C.//i 74 x
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Cal-'
Applicants, Sigiure
Applicant's Printed Name
City of Eaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use
Permit #:
Permit Fee:
100‘.
Date Received:
Staff:
INFLOW & INFILTRATION PERMIT APPLICATION
Plumbing / Sewer & Water
Date:
.v q 7/5
Site Address:
1
45.9m41S (Sor /1 -(iv 572 a.
Tenant: Suite #:
Address / City / Zip: / 51-7' 4- ,$ 7 !� lei �sls� �� /s -s '72
Phone: U c/ 60L- t2
Name: License #:
Address: City:
State: Zip: Phone:
Contact: Email:
PLUMBING (Within the building envelope)
Sump Pump Repair
Other:
SEWER & WATER (Outside the building envelope)
Repair
V Other:
Description of work:
FEES
$60.00 / Each (includes $5.00 State Surcharge)
TOTAL FEE $
*Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit 1/1 repair costs for
reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors
can be found by visiting www.citvofeagan.com/inflow, or City Hall at 3830 Pilot Knob Rd.
CALL BEFORE YOU DIG. CaII 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 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.
nn1�,�, .�.�A,�
x ib ��I0'_l l (reV
Applicant's Printed Name
eApplX I` 0/ (Al ,V1 (Y/61 -
Applicant's
icant's Signature