4724 Anne PtRESIDENT / OWNER
Name: hR i) b , -i< B � J Phone: 1 So9 - 1 4°1 ° t / 7?
r
Address / City / Zip: t4: yaitao et .
CONTRACTOR
Name: 51 - o )4011E sla1r-1#cense #:
•
Address: CO a � 13 I.L- e City: Ili PL✓ S
State: A /v Zip: C� ZY/ w Phone: qG"-a c7_ 9 44
�j
Contact: P ((S?2)/ Email: E I L 1,1 '1 . _1i1.! 1 11 J
TYPE OF WORK
1/
New 2 Replacement Additional Alteration Demolition
—
Description of work: Iue rueliyofe �
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
X 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:
$55.00 Minimum Add -on
or alteration to an existing unit (includes
burned out appliances, ductwork, etc.) (includes
$5.00 State Surcharge) - 5 - _ �
$5.00 State Surcharge) $ TOTAL FEE
$95.00 Fire repair (replace
COMMERCIAL FEES:
$75.00 Underground tank
$55.00 Minimum (includes
installation /removal OR
State Surcharge)
$10,010, surcharge is $ 5.00
surcharge increases by $.50 for each $1,000 Permit
Fee requires a $ 5.50 surcharge)
Contract Value $ x 1%
= $ Permit Fee
- If the Permit Fee is less than
Fee = $ Surcharge
- If the Permit Fee is > $10,010,
(Le. a $10,010 - $11,010 Permit
$ TOTAL FEE
J / 2010 MECHANICAL PERMIT APPLICATION &)9671k)
Date: 1 0 l0 U Site Address: 47 a�-k� tJ "r
AP61t) wcKAek.G
Tenant:
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454 -0002 for protection against underground utility damage. Can 48 hours
before you intend to dig to receive locates of underground utilities. www.uopherstateonecall.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 }f b approved plan he case of work which requires a review and approval of plans.
City of Eataft
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: 4651) 675 -5694
r5fECTME
OCT 1 2 2.0i0
x ISov^-
Applican tune
Use BLUE or BLACK Ink
1
Permit #: c1 N. \D 4
Permit Fee:
Date Received:
Staff:
Suite #:
J
FOR OFFICE USE
Required Inspections: Under Ground
Reviewed By: Date:
_ Rough In _Air Test ' Gas Service Test _In -floor Heat _Final
Exterior HVAC Screening Inspection
.GiTT DF EAGAN WATER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: _ No. of Units:
Owner:
Address:
Site Address:
Plumber:
Meter No.: _ Connection Charge:
Size: Account Deposit:
Reader No.: Permit Fee:
1 agree to comply with the City of Eagan Surcharge:
Ordinances. Misc. Charges:
Total:
By 4f Date Paid:
Date of Insp.: Insp.•
-CITY " EAGAN SEWER SERVICE PERMIT
3795 Pilot Kggb Road
Eagan, MN 55122 PERMIT NO.:
Zoning: DATE:
Owner: No. of Units: —
Address: —
Site Address:
Plumber: -- - - --
1 agree to comply with the City of Eagan Connection Charge:
Ordinances.
Account Deposit:
Permit Fee:
B Y Surcharge:
Misc. Charges:
Date of Ins
p"
Total:
Insp.:
Date Paid:
Use BLUE or BLACK Ink
r
For Office UseI r(~ ;
Permit
City of Eap
Permit Fee.
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff: I
I I
72013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 3
147,L .4~
Site Address: 7'~+1 y~ZS ~/x X711 Unit
Name: lJ ~ Phone:
Resident/
Owner Address / City / Zip:
Applicant is: Owner Contractor
Description of work:d L'
Type of Work
Construction Cost: f 2,0d o J J Multi-Family Building: (Yes / No )
Company: Contact:
Contractor Address: ~~~Dr~ Gfi City:
State: Zip: Y2 7 Phone: 7
License Lead Certificate
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 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 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.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
x x'
Appl ant's Printed Name Applicant's SignaHFe
Page 1 of 3
Use BLUE or BLACK Ink
r - - - - - - - - - - - - - - - - -
I For Office Use
Permit I
City of EaEd I Permit Fee: J~
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
10 /Q4/13
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff: I
I I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: /6/23X:2 Site Address:", 101T 6Pf. 'V7'Z2, ~7W LL4,0 & Unit M
Name:A9^ 15r Phone:
Resident/
Owner Address / City / Zip:
Applicant is: Owner 14
Contractor
Type of Work Description of work: 71 ky 4L0_ " 4Jf_
Construction Co $ a Multi-Family Building: (Yes / No )
Company: k4w_ :7~41I y4 4'tlontact:
Contractor Address: aaor d:Aetwe4,a of City: (9491 i/AVW 'C
State: - Zip: ~53M Phone: 4 /2-
License #:6 4-7 Lead Certificate
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 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 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.aopherstateonecall.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 plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Co ust be completed within 180
days of permit issuance.
x Z'-'~V 44M x
Applicant's Printed ame Appi 's Si ature
Page 1 of 3