2071 Pin Oak Dr - Site SurveyCity oi8tao
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
Permit #:
Permit Fee:
Date Received: ' Y
Staff:
2011 MECHANICAL PERMIT APPLICATION
Date: Site Address: 2071 Ping Oak Dr
Tenant: Suite #:
J
RESIDENT / OWNER
Name: Matthew Sultan Phone: 651-981-1427
Address/City/Zip: 2071 Pinn Oak Dr, Eagan MN 55122
CONTRACTOR
Name: Erickson PHC License#:
Address: 1471 92nd Ln NE City: Blaine
State: MN Zip: 55449
Phone:
763-783-4545
Contact: Zach Erickson Email: zerickson@ihearterickson. com
TYPE OF WORK
New X Replacement Additional Alteration Demolition
Description of work:
f moon = nd ground
ase contact the MechF
PERMIT TYPE
RESIDENTIAL
1 Fumace
Air Conditioner
Air Exchanger
_ Heat Pump
Other
COMMERCIAL
New Construction Interior Improvement
Install Piping Processed
Gas Exterior HVAC Unit
Under / Above ground Tank ( Install /_ Remove)
**When installing/removing tank(s), call for inspection by Fire
Marshal and Plumbing Inspector
RESIDENTIAL FEES:
$55.00 Minimum Add-on or alteration to an existing unit (includes $5.00 State Surcharge)
$95.00 Fire repair (replace bumed out appliances, ductwork, etc.) (includes $5.00 State Surcharge) $ 55 . 00 TOTAL FEE
COMMERCIAL FEES:
$75.00 Underground tank installation/removal OR Contract Value $ x 1%
$55.00 Minimum (includes State Surcharge)
_ $ Permit Fee
- If the Permit Fee is less than $10,010, surcharge is $ 5.00
- If the Permit Fee is > $10,010, surcharge increases by $.50 for each $1,000 Permit Fee = $ Surcharge
(i.e. a $10,010-$11,010 Permit Fee requires a $ 5.50 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.aopherstateonecaliorq
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 start vdthout 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 plan
x Stacy Erickson
Applicant's Printed Name
x
Applicant's
gnature
FOR OFFICE I
Required Insps
fndLo L o/ I N H. H E D L U N D 772s Marpan Avsnw SoutA
Rich}Iald,Minnesota 85423
Surveyor Civll Enyinear PAone : 866-2523
survellarofs catificate
xx<41or J08 N0.
SURVEY FOR? Stikbilt Homes
DESCRIBED AS: Lot 11, Block i} VIENNA WOODS, City of Eagan, Hennepin county,
Minnesota and reserving easementa of record.
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CERTIFICATE OF SURVEY
I hereby certify that on Q/ 6 / g 4 I surveyed the property described above and thot
the obove plat is a correct representotion of said survey.
Calvin H. Hedlund, Minn. Reg. No. 5942