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3891 Dolomite Dr ÿð ÿ þýý üûÿúûúú ùýýÿðúþ þ âööìö ææâ þýö þýüûúù ø öì ö øöûúù õ öùø öì ö ð öþÛ ð öûúù ðýàýö öþ öõýóü öô ó õýóü ö þÛ úí ú ý ôõ ñìå þûÿðõ çâæè öóí ÝøþÙ÷öøìÜäéâéâè õù þýöö íØ äéæéæ ôüüó öòñ ùù à ×ýóü Ùì ðöúò ôùá âæ ó ö þýðõ ðõ ÝçÜâæè ö üú á ö ùù àöóöö ö óùúùùü þ àð þý òúà ñö é ùù÷ öó þ ýö ý úþ ýö CITY OF EAGAN WATER SERVICE PERMIT PERMIT NO.: 3795 Pilot Knob Road DATE: Eagan, MN 55122 No. of Units: Zoning: _ — Owner: Address: Sire Address: Plumber: Connection Charge: Meter No.: — — Account Deposit: - -- Si Permit Fee: Reader No.: Surcharge: I agree to comply with the City of Eagan S urch Charges: Misc. Ordinances. / Total: Date Paid: By G = �� r Insp.: Dote o Insp.: — SEWER SERVICE PERMIT CITY OF EAGAN IT NO.: 3795 Pilot Knob Road PERMIT Eagan, MN 55122 _ No. of Units: Zoning: _ Owner: —_ Address: Site Address: Plumber: 1 agree to comply with the City of Eagan Connection Charge: Account Deposit: Ordinances. Permit Fee: Surcharge: Misc. Charges: By Total: Date of Insp.: Date Paid: Insp.: City of kali 3630 Pilot Knob Road Eagan MN55122 Phone: (551) 8755875 Fax: (651) 875.5614 Use BLUE or BLACK Ink For Office Use j Permitit IX13° Permit Fee: .° Date Received: 1/62 (0113 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Daps: 7' le— /3 Site Address: 3 8 8J, '3 I". 3 S 79,1V 9 / I l b G o'- r rt b t. . Unit 8: J Name: 4_/9SSoc,4.rio.J cZ. M,t.,A..64,011_47 phony 763- 5 -37A7 Address / City /Zip: i 02 2 £. .t",ss, 1,474e. Ah 01,404E 626./4', Ss 3 s/ Applicant is: — Owner iC Contractor '44 WOlc Description of work: 7-14A- o FA' .a Q d - Agro F Construction Cost: /i/s :46°,00 Multi -Family Building: (Yes )0 / No ) Company: t E/ ExrtR'0 m*rv:. �0.2P. Contact: b Li4 4..2/t/� Address: 1/c.5- t 6 c r• Sr City: /19,0G S State: /17A) Zip: - 3 41 !C Phone: GTR -b '4/-4.zy3 License #: G y // 3 / Lead Certificate #' If the project is exempt from lead certU9Cation, 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: Mechanical Contractor, Sewer & Water Contractor Phone: Phone: • Phone; NOW snr ' e: : Phos 'lr'1,+�l►tigr Pas' CALL BEFORE YQU DIG, Call Gopher Stsle One CMI at (651)484-0002 for protection against underground utak( dameye. Cal 48 hours before you intend to dig to receive Incites of underground utilities . me,stagiscobsweoliGut I hereby acknowledge that this adonmatkun is complete and accurate; that the work will be In conformance with the ordinances and codes of the City of Eagan: drat I understand this is not a permit, but only an appkation for a permit, and work is not to start without aPerm b I that the work WIbe In aCCOrdance with the apptovetl pion in the case of worst which requires a review and apprrnJ cf pram• Dander work authorized by a bulidbng permit Issued in accordance with the Minnesota b Bullring be completed within 180 days of permit Issuance. Applicant's Printed Name TO/T0 39 d Applicant's Signature Page 1 of 3 1NItiW 1X3 Iia L9Z9T98ZT9 LT:OT ETOZ/9Z/L0 Use BLUE or BLACK ink I For Office Use j Permit 501 City of EaElan 3 , t,~ Peet I:ee. -73830 Pilot Knob Road Eagan MN 66122 i Date Received; t 0 ` E I Phone; (661) 6755675 1 I Fax: (651) 676-6694 I Staff. I I I 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: 3775,3M 3Y~i, 3 g 9 ~ ~o 4o wa r r ~ bit. _ Unit it; Name: 4-0 f~ G Y /V A r.J 4 4,L M E A.) 7- Phone: •743 - S9 3 ~ 7 7 a OVm. or ' Address / City /Zip* 95 iD E C A Yv,Q AV ,t~ ,2 p ~oe~► E.J 1~rK~i' Applicant is; Owner 12C Contractor . Type_ o *Q'. Descriptlon of work: -7--1,+f2 Construction Cost: Multi-Family Building: (Yes No Company Ex -f->:2~aR 0147a . 611'P ~r~v~~.~ I r S Contact Address: Voss E3 61)"t S~ . City: PL S . state: Ni j Zip: 575,V1 9 Phone: 6 License Lead Certificate If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) ~LD(o5 t.aE2E. 4 " I L r Pos7 l g7 F 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: INOT,:;.PJB ~@:.~j~!t~i~/i9R; , .,G9"17~P ; : , ,,,s; tf ,,,,,,fi~ee ,ri.:r~'•i>' .:,~•.•i. .:gip.-..• J,.ti, ~Y~r .G .ii ..I. .a.. ;it??'. I"•.a... W . J .f 4.I~c!....,_'-... trlY.1~i¢+'~:y;:,_, •~''~'ry'~,'f ' CALL 13EFORI= Y U DIG. Call Gopher State one gall at (651) 464.0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utillties. www.aooherstateoneaall,or„g 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 worts is not to start without 8 permit; that the wok 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 Buildin Code must be completed within 180 days of permit Issuance. X bAV/N q, ID s x ApplicanCs printed Name Applicant's Signature Page 1 of 3 £e/T0 3J7d 1NIVW 1X3 I3$ L9Z9T98Z19 9Z:bT £TOZ/T0/0T 411' CityofEaaii 3830 Pilot Knob Road Eagan MN 56122 Phone: (651) 8754675 Fax: (651) 675.5694 Use BLUE or BLACK Ink For Office Use Permit .1`b9/3 Permit Fee: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: -7-/y site Addrt;,ss:309s", 3 F ]eS9, 3v9/ iot,.OMoT 62. unit p: Resldenv Owner Name: eJC 4t' ,e,s 46£Is£A;"i .�•J C. Phone: 74 -S"!3- 977 Address / City / Zip: :SO D C t4 ru Q 4v, , , 2 A Gol. E.4..1 i4 r /x7.0 Ssin7 Applicant is: Owner 2f Contractor TYPe of.Work, Description of worle f.•K e C a• {C E AL A -c- f- 1/ D / P.6's / a AIL 7-4 L - Construction Cost /14 gar), G1D Multi -Family Building: (Yes /No Contractor Company: a E I £,r - a 2 ii%i ex -r- . CaAP. Contact Nur 0 av/iu/ S Address: VP -3- (.) tc)01.1 ¢• City: /h PL State: /'7^S Zip: 5-3-4// g Phone: Col z ' 8 to / - Co 24/3 License d: 4.3 C- 2 %' / / 3 J _ Lead Certificate #: If the project is exempt from Toad cert1f cation, please explain why: (see Page 3 for additional information) lnpLl,(pSPas7Y' COMPLETE THIS AREA ONLY IF CONSTRUCTING A MENfilUILDING In the iaet 12 menthe, has the City of began issued a permit for a similar plan based on a master plan? ___,Yes _No If yes, date and address of master plan: Ucensed Plumber: Phone: Mechanical Contractor Phone: Sewer & Water Contractor: Phone: CAI,, BEFORE (OU DIG. Call Gopher Stater One CaII at (651)4544002 for protection against underground utility damage. CaII 48 hours before you intend to dlp to receive locates of underground utttdies. www.00pharstafAonecaii.ona I hereby acknowledge that this Information is complete and aowrate, 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 ordy an application far 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 e review and approval of plans. Exterior work authorised by a building permit issued In accordance with the Minnesota State BuildingCode must be computed within 180 days of permit Issuance. x 4 ✓' 4 %24,2-2, Applicant's Printed Name E0/Z0 39td Applicant's Signature 30.e.,7 7'3 Page 1 of 3 1NI 1 1X3 I3S L9Z9I98ZI9 ZI:Oi t?tOZ/L0/E0 PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA130305 Date Issued:04/16/2015 Permit Category:ePermit Site Address: 3891 Dolomite Dr Lot:8 Block: 01 Addition: Briar Hill 3rd PID:10-14992-01-080 Use: Description: Sub Type:Residential Work Type:Replace Description:Furnace Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Applicant: Holly Flood 1408 Northland Dr #310 Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088 Surcharge-Fixed $5.00 9001.2195 $60.00 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Mary L Chase 3891 Dolomite Dr Eagan MN 55122 Sedgwick Heating & Air Conditioning 1408 Northland Drive, Suite 310 Mendota Heights MN 55120 (952) 881-9000 Applicant/Permitee: Signature Issued By: Signature SEDGWICK HEATING & AIR CONDITIONING CO. TESTRECORD �OBNO.�� /L _ 1408 NORTHLAND DRIVE,SUITE 310 • MENDOTA HEIGHTS,MN 55120 • (952)881-9000 ADDRESS ��I ��1 C"✓��"`�' C1TY�LS�� OCCUPANT OWNER /d��'�Y"/r'N �/�'I-J� SOLD BY � �� iNSTALLED BY MAKE /��L�=?V6DW(� MODEL �(�'�'O�� /� �� SERIAL NO. � � / � � j� / 7� INPUT [� .�/ `�--� L '� THERMOSTAT,_�_��cT� VENT SIZE � VALVE ��n�•�C'/C�i TYPE OF LINER �� LiNitT 5 /7 cx� LINER SIZE .:� LIMITSETTWG ��✓�� FILTERS: SIZE ��x�� NUMBER ��"'� FAN SE7TING �i''`� WIRING _._�_.._-�..._... PILOT TYPE n a 1� TEST TAG ^ IGNITION MODEL /�� ~�� LIGHTING INST. PILOT TIMING � � `�L�:`�� I I l � � DATE TESTED PRESSURE �-�'�' ��' PERCENT GOZ �+ � f � INPUT CFH " � PERCENT 02 (s� /(1� COMPANY TESTING �,4,� '� ��L�a� / � � STACK TEMP�- PERCENT CO /(� NAME OF TESTER �-�y . �'� FORM 235(REV.10/10) . FORM DISTRIBUTION: WHITE COPY-JOB FILE YELLOW COPY-CITY