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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