4618 1_2 Penkwe WayDate:
City of Eapil
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Tenant:
Use BLUE or BLACK Ink
Permit Fee: � . SO
Date Received:
Staff:
2010 MECHANICAL PERMIT
24/6 Site Address: I ig / - /Q/) fol e. Al
Mcr.14
UGCIt
Suite #:
J
RESIDENT / OWNER
Name: ULL f inotr- f7) Phone: C. 2-7/ ` ?oc
L
Address/City/Zip: 56ts2 pP/1kt4 Ivy 4, SzP/22
CONTRACTOR
Name: 600 ViiffassA SP. kc License #:
Address: City:
State: Zip: Phone:
Contact: Email:
TYPE OF WORK
New X Replacement Additional Alteration Demolition
Description of work: Furnace_, 04(1 A G im)ir
NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City.
Code. Please contact the Mechanical Inspector for information on permitted screening methods. '.
PERMIT TYPE
RESIDENTIAL
) ..Furnace
COMMERCIAL
_ New Construction Interior Improvement
)(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 Tess 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. CaII Gopher State One Call 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. 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 1 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 1
Applicant's Printed Name pplicant's Signature
FOR OFFICE USE
Required inspections;
erior HVAC Screening Insp
City of Ea an
Residential Sanitary Sewer Service
Compliance Inspection
t •
Date / / 7/ ,ic Time /0
Name 'Q ,v..v Disk #
Poor Pipe Joints
Mineral Deposits
4" to 6" Transition:
White Copy: Pi operty Owner
Owner /Occupant Signature
Compliance
K No foundation drain connection
} No roof drain connection
Sump pit not connected to
sanitary sewer
0 Sump pump properly piped
No sump pump
Service Lateral Inspection Findings
Roots
0
Sag /Pipe Deflection
Damaged Pipe
Transition crit 6
am
0 pm
Length of Service:
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Record Number --
Yellow Copy: City of Eagan
PID Number
°
House Number ( Atli/ Street Name t % / ".!1f & - /,./ S f.1...
//
Alternative Mailing Address Phoned
° r) Z7 /a 2 /
/ ,am
Time /0 • c 0 pm
Inspector Signature
For information call 651.470.2788
Obstruction
Unable to push past
feet
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Number of stacks_, / Entered S L at i'r7r.;r
Final Cleanout:
Pink Copy: SEH
Total
N otes
°�
rte.
i
•--°
L'
4 /4/X, 1 -<- .2 4 - 1,, ,
C 3 J
4.-4., ' '�,,�/'
�,
c,. 2, /
P.7
Number
Discharged
Correctly
Incorrectly Unknown
Sump pumps
r -)--
Foundation drains?
Roof drains
�
_ _._ _
._�___.._^.___..
City of Ea an
Residential Sanitary Sewer Service
Compliance Inspection
t •
Date / / 7/ ,ic Time /0
Name 'Q ,v..v Disk #
Poor Pipe Joints
Mineral Deposits
4" to 6" Transition:
White Copy: Pi operty Owner
Owner /Occupant Signature
Compliance
K No foundation drain connection
} No roof drain connection
Sump pit not connected to
sanitary sewer
0 Sump pump properly piped
No sump pump
Service Lateral Inspection Findings
Roots
0
Sag /Pipe Deflection
Damaged Pipe
Transition crit 6
am
0 pm
Length of Service:
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Record Number --
Yellow Copy: City of Eagan
PID Number
°
House Number ( Atli/ Street Name t % / ".!1f & - /,./ S f.1...
//
Alternative Mailing Address Phoned
° r) Z7 /a 2 /
/ ,am
Time /0 • c 0 pm
Inspector Signature
For information call 651.470.2788
Obstruction
Unable to push past
feet
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Number of stacks_, / Entered S L at i'r7r.;r
Final Cleanout:
Pink Copy: SEH
El Estimate
la Warranty
U ContractMODEL
(a Cash
CI Charge
C3 COD
Harmon Air, Inc.
Heating & Air Conditioning
6528 53rd St. North
Oakdale, MN 55128
(651) 770-3203
0 SERVICE PHONEDATE
() INSTALL 64 Id
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ekk
DATE " - •
TIME IN
TIME an
QUANTITY
PART
NUMBER
DESCRIPTION OF PARTS OR MATERIALS
AMOUNT
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LABOR PREFORMEDD i
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TOTAL
MATERIAL
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TAX
TOTAL
LABOR
TOTAL
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Estimates are for Labor anly, Material additional. We will not be relponsibM for loss. or damage caused by**, theft, tesdng or any other =SW beyond our control.
Please pay from this invoice, no statement vAl be sent. Thank Yaul
Service Authorized by
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