4526 Mallard Tr SRESIDENT / OWNER
Name: Phone:
Address / City /
CONTRACTOR
Name: 1�1iOt \ 4t_-- �S a �' License #:
Address: "E>r) Y 1+ City: f''O�'
State: i Ai Zip: e�3l $gj Phone: &S 1 "'L 0 2
Contact: L.('.(,,QAr®s'1 Email: f'�fra, {Gl1Gy 14 (fit �0,... ,1.1'Dr L.O
TYPE OF WORK
New X Replacement Additional J Alteration Demolition
_
Description of work:
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
Furnace
COMMERCIAL
New Construction Interior Improvement
(`
2C Air Conditioner
Air Exchanger
Install Piping Processed
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)
$5.00 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,
(i.e. a $10,010 - $11,010 Permit
_ $ TOTAL FEE
C!ty of Eapp
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
2011 MECHANICAL PERMIT APPL CATION
Date: It /2l / Site Address: +5 Y4.fr
Tenant: (VW bl Of ict
-avon &A'' ®
Applicant's Printed Name
Use BLUE or BLACK Ink
Permit #: /0 2 J /0
Permit Fee:
Date Received:
Staff:
Suite #:
Applicant's Signature
m
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454 -0002 for protection against underground utility damage. Call 48 hours
,lpefore you intend to dig to receive locates of underground utilities. www.qopherstateonecall.org
Thereby 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.
FOR OFFICE USE
Reviewed By: Date: '<
Required Inspections: Under Ground Rough In Air Test Gas Service Test __In-floor Heat Final
Exterior HVAC Screening Inspection
SEWER & WATER PERMIT OFFICE USE ONLY
CITY OF EAGAN - 0 5/69/9
METER # PERMIT DATE 0
3830 Pilot Knob Rd. 11377
Eagan, MN 55122 -1897 P # P ERM1'r.#
METER SIZE B.P, RECEIPT # F 7042
DATE May 1 , ! 990 ISSUE DATE Bcp. REIPT DATE AU07 /
X PRV BOOSTER PUMP
SITE s 4526 South MalIrd 'Trail' PERM1TREQJESTED
2
3 Thomas Lake Woods
LOT BOCK SEC/SUB
SEWER X. WATER _ TAPS
APPucANT: Thomas Lake Development, Lt d.
ADDRESS: 6 648 Rustic Road .S . E . .._ _ COMMIIND RESIDENTIAL
CITY, STATE Pri or Lakej MN ZIp 55372 X. NEW EXISTING
PHONE: 447 -2424.
• Lawn Sprinkler Meters are to be Installed
PLi1MCER. Genz- Ryatl' Plumb , & L1?ating At►ead of'Domestic meters on m Line.
ADDRESS: 14745 South Robert =Trail ` Credit WILL ROT begi n forDeductMeters.'
CITY,STATERosemoun MN 55068
42 -11
PHONE
I AGREE TO,COMPLY WITH CITY Of
OWNER: Thotftas. Lake Development", Ltsl. EAGAI4ORthNANCES
ADDRESS: 6648 Rustic Road S.E.
CITY,STATEP Lake, MN - zip 55372
447-2424 SIGNATURE bytes METER ISSUED
fr . ;r. # . fl +'. r. CATS 4544220 FOR INSPECTtf tS' � F STORM
SEWER PERMITS, C AC1'' DEPT-
I For Office Use j
f ~
City of EaV~ , Permit#:~~~
I Permit Fee:. S
3830 Pilot Knob Road I
Eagan MN 55122 Date Received: $ 1
-n I
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff: -
I
1
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address:
~1 Unit
Name: ~l
G~ d y, 7 ~lfa . '7 s-~) r Phone:
Resident/ J> /
Owner Address /City./ Zip:. a~ mac. ~ ~a
Applicant is: Owner Contractor
Type of Work Description of work: )FC roo j'"
Construction Cost: I 31."" 0 00 ( CIO / Multi-Family Building: (Yes No. )
Company: ~~l d C~ 1. ip A Contact: leo F:•~~ .CU~
Contractor Address: 00 %1V ity: Lc~'/ '
State: Zip: G Phone: (D~r 6
-630e
License Sc 63 1 635- 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
1 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:
i
Licensed Plumber:
I Phone: 1
Mechanical Contractor: Phone:
{
1
i 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. wrrv.gooherstateonecall 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 1 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 C k66/1) x
Applicant's Printed Name Applicant's Signature
Page 1 of 3
443 Lafayette Road N. �IN1�+I�S+t��'A QE1P.�'�Rel'ME�`�IT �3F'. (651)284-5005
St. Paul, Minnesota 55155 � �r 1-800-342-5354 I
www.dli.mn.gov : ���� � ����+7���
�
3/4/2015
APPROVED FOR USE
Martin I��sLauriers
4526 i�all�rd Trl
EAGAN,1l�IN 55
RE: R�S STAIR CHAIR LIFT Elevator ID# ELV-1025366
Site: Ma��_•i�DesLauriers
452€;Mallard Trl
E�i(}AN, MN 55122
Dear Sir/Madam: _
Minnesota Statutes Chapter 326B provides that the Department of Labor and Industry, Construction
Codes &Licensing Unit, Elevator Safety Section, inspect and approve elevators and manlift� (endless
belt lifts}before they can be legally used in Minnesota. An Inspector from the Elevator.Safety Section
recently inspected your facility and deternuned it meets requirements of the Minnesota Elevator Safety
Code.
NOTI�': �ompliance with Minnesota Rules and thz ANSUASME A17.1, Safety Code for Elevators and
Escalators does not necessarily assure compliance with the Americans With Disabilities
Act of 1990.
Sincerely, �
CO UCTI�JN CODES &I ICENSI�C's
� ^
�������
Brad Underdahl
State Elevator Inspector
c: City of Eagan Building Official
ACCESS LIFTS INC
ElFormCE2R
This information can be provided to you in aiternative formats(Braiile,large print or audio).
An Equal Opportunity Employer �