3768 Burgundy DrRESIDENT / OWNER
N ame: A(Y\..L C ' G�r'� Phone: Q S1'{ Qgk _Cl l R�
Address / City / Zip: )( u11cp rA Or Eco Op k .n 5 -)' - .
CONTRACTOR
Name: BURNSVILLE HEATING & A/C, INC. License #: ( G.c6Le 7/ 3
3451 W. Burnsville Parkway
Address: Suite 120 Cit y:
_
5
State: ZipSumsville MN 55337 Phone: C4 S c (. 000
Cl Rot_ Email:
TYPE OF WORK
New X Replacement Additional) Alteration Demolition
Description of work: (((-Q , ± t CCAO U2
NOTE R � d glued meted m � . , is requi to tamed
Code Pt+ ; contact the Mechanical insp rfor flan on.' i d eni r .; ..
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:
$55.00 Minimum Add -on
or alteration to an existing unit (includes
burned out appliances, ductwork, etc.) (includes
$5.00 State Surcharge) _l_____-_ !,
$5.00 State Surcharge) $ —... t V 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 Tess than
Fee = $ Surcharge
- If the Permit Fee is > $10,010,
(i.e. a $10,010 - $11,010 Permit
_ $ TOTAL FEE
City of Eta
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675-5694
(Ore
JUN 1 6
ii 2011 MECHANICAL PERMIT APPLICATION
Date: IS-- t \ 1 Site Address: ?) T ULAC)(14
Tenant: 'Ps'11 J,
Applicant's Printed Name
x
Applicant's Signature
Use BLUE or BLACK ink
Permit Fee: ' SST (-/0
Date Received:
Staff:
Suite #:
-J
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.aopherstateonecali.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 pproved plan in the case of work which requires a review and approval of plans.
Use BLUE or BLACK Ink
r---
I For Office Use I
q Z'I
City of EPermit#: I 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 1
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 21,'? 1113 Site Address: ~ 614 77d &62/ Unit
Name: Phone:
g Resident/
Owner Address / City / Zip: 3744~- 37;g43770 ~Ll~rd1li(
Applicant is: Owner _K Contractor
Type of Work Description of work: S'/
Construction Cost- e~ Multi-Family Building: (Yes / No
Company: Contact: sce_
Address: City: _&z)ls
Contractor
i -
State: Zip: Phone: 46 4P - ' a609
i
License A ge'2' Lead Certificate #:&q :3~ 9 /r11
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
i
COMPLETE THIS AREA ONLY IF CONSTRUCTING A .NEW BUILDING
i
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
i
_Yes No If yes, date and address of master plan:
i
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
i
3
Sewer & Water Contractor: Phone:
j 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.oopherstateonecall.oro
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 com I in 180
days of permit issuance.
X_ ! 1G C_ W1
x
Applicant's Printed Name Applic nt Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA178196
Date Issued:08/04/2022
Permit Category:ePermit
Site Address: 3768 Burgundy Dr
Lot:2 Block: 12 Addition: Seneca Hills
PID:10-67125-12-020
Use:
Description:
Sub Type:Furnace
Work Type:Replace
Description:
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507)
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
Surcharge-Fixed $1.00 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 -
Ami Sela
3768 Burgundy Dr
Eagan MN 55122
One Hour Heating & Air
15191 Boulder Ct
Rosemount MN 55068
(651) 437-4177
Applicant/Permitee: Signature Issued By: Signature