3155 Coachman Rd Unit 215RESIDENT / OWNER
/
Name: C '3NV2 Ct,, ck �V u Phone: C 7Y '4- . ?1- 7 f�
Address / City / Zip:
CONTRACTOR
` q
Name: �' � ; :.j e,( " .. `I TiNW it,, rn,3'J License #: v` 1% ?%
Address: ' )- .} k 1 3 l oe f F 22 y City: L CDc 1 d._
State: 1\s� f`1 Zi �— ‘—a 6)' 2/9/- , .-r
p : :a - 7 2 Phone: / v - f
Contact) �4- � Email:
TYPE OF WORK
, /
New , Replacement Repair Rebuild Modify Space Work in R.O.W.
_ _
Description of work: \ k \ r \ \r• Et \Cdc' - . \(1 l'n v:.n
PERMIT TYPE
RESIDENTIAL
Water Softener
Water Heater
> Add Plumbing Fixtures (Main / Lower Level)
Lawn Irrigation (_ RPZ / PVB)
Water Turnaround
Septic System
New
Abandonment
RESIDENTIAL FEES:
$55.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge)
$35.00 Lawn Irrigation
$55.00 Add Plumbing
*Water Turnaround
$105.00 Septic System
$95.00 Fire Repair (replace
(includes $5.00 State Surcharge)
Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge)
(add $166.00 if a 5/8" meter is required)
New ($10.00 per as built) (includes County fee and $5.00 State Surcharge)
burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge)
TOTAL FEES $
4 City otEaQau
Date:
Tenant:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
Applicant's Printed Name Applicant's Signature
Permit #:
Permit Fee:
2010 RESIDENTIAL PLUMBING PERMIT APPLICATION
Site Address:
Use BLUE or BLACK Ink
Date Received:
Staff:,,,
1
J
Suite #:
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.
x F
L
RESIDENT / OWNER
Name: Pry .r.) e. ‘-‘. ,./ (c 4\ 1 Phone: (
Address / City / Zip: 36' — C``.11..1 itYl (IN ad E -cj eA: ,fl/ti 55k d
Applicant is: Owner Contractor
TYPE OF WORK
Description of wor e ` 1303 � l 1 - ) ILt . al
Construction Cost' 1 ( Multi- Family Building: (Yes I i No )
-
CONTRACTOR
Name: i ' 1 , : ►*._1 [_- License #: a c.) I P‘ LO.L i
Address:' `_ l , c l 4 t v� Cit AA ' L I -4 �' � 0
, ' ^�
I
State: ({)t�.j Zip: .5-54 CAS) Phone: (-12 ) e' l. l , � ; V - ) � I `�?
Contact:' i c 1�,1 � ' ) Entail: (Y\ C('}'C.I 16 . i..L.) I. g i, Cleila
COMPLETE
In the last 12 months, has
No If yes,
THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
the City of Eagan issued a permit for a similar plan based on a master plan?
date and address of master plan:
_Yos
Licensed Plumber: _ .. Phone:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
NQT : Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non it you provide specific reasons that would permit the City to
conclude that they are trade secrets.
ilik ofr. Dec. 15. 2010 11:12AM No. 9074 P. 2
v
4 111/ C!ty of EaQau
3$30 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -6675
Fax: (651) 675 4694
x
Appli ' = nt's Printed Name
ants SIgnaiurif
Use BLUE or BLACK Ink
For Office Use
Permit #:
Permit Fee; / `
Date Received:
Staff:
2010 RESIDEN IAL BUILDING PERMIT APPLICATION L -k i`4(/&.
i 3\ 5 c'> c CITi r off.'. . 2 C� /. - r /U Tenant:
Date: g (,�? � 1'� Site Address: �
Suite #: (79 15
CALL BEFORE YOU DIG, Call Gopher State One Call at (651) 4540002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www.dopherstateonecall,orq
1 hereby acknowledge that this information is complete and accurate; that the work will be In conformance with the ordinances and codes of the City or
Eagan; that I understand this is not a permit, but only an application for a permit, and work i= not to start without a • that the work will be in
accordap ='with the approved plan in the case of work which requires a review and approval of ans.
Page 1 of 2
Dec. 15. 2010 11:12AM
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L L oAckiinA1
SUB TYPES
Foundation
�( Single Family
`°` Multi
Addition
Alteration
Replace
Retaining Wall
Reviewed By
DESCRIPTION
Valuation
Plan Review
(25 % 100% .. )
Census Code
# of Units
# of Buildings
Type of Construction
Fireplace
Garage
Deck
01 of Piex Lower Level
_ Accessory Building
WORK TYPES
New
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S &W Permit & Surcharge
Treatment Plant
Copies
_ Interior improvement
Move Building
Fire Repair
Repair
REQUIRED INSPECTIONS
Footings (New Building)
Footings (Deck)
Footings (Addition)
Foundation
Drain Tile
Roof: _ ice & Water _ Final
( Framing
Fireplace: _ Rough In Air Test
Y Insulation
`r Meter Size:
TOTAL
DO NOT WRITE BELOW THIS LINE
Final
Porch (3- Season)
Porch (4- Season)
o r j 1t i o IA',s
Porch (Screen/Gazebo /Pergola)
Pool
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
Siding
Reroof
Windows
Egress Window
Storm Damage
No. 9074 P. 3
Exterior Alteration (Single Family)
_ Exterior Alteration (Multi)
Miscellaneous
Demolish Building*
Demolish Interior
_ Demolish Foundation
_ Water Damage
*Demolition of entire building give PCA handout to applicant
MCES System
SAC Units
City Water
Booster Pump
PRV
Fire Sprinklers
g
Sheetrock
Final 1 G.O. Required
Final / No C.O. Required
HVAC
Other:
Pool: _Footings Air/Gas Tests Final
Siding: _ Stucco Lath _Stone Lath _Brick
Windows
Retaining Wall: _ Footings _ BackfIll _ Final
Radon Control
Erosion Control
1 j Building Inspector