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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
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA159796
Date Issued:01/21/2020
Permit Category:ePermit
Site Address: 4530 Mallard Tr S
Lot:21 Block: 03 Addition: Thomas Lake Woods
PID:10-76100-03-210
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Standard Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener).
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
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 -
Susan K Ude
4530 Mallard Tr S
Eagan MN 55122
Tony's Appliance
2090 County Road 42 West
Burnsville MN 55337
(952) 435-2442
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA161946
Date Issued:06/19/2020
Permit Category:ePermit
Site Address: 4530 Mallard Tr S
Lot:21 Block: 03 Addition: Thomas Lake Woods
PID:10-76100-03-210
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
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 -
Susan K Ude
4530 Mallard Tr S
Eagan MN 55122
(612) 801-8818
Sedgwick Heating & Air Conditioning
1408 Northland Drive, Suite 310
Mendota Heights MN 55120
(952) 881-9000
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA161946
Date Issued:06/19/2020
Permit Category:ePermit
Site Address: 4530 Mallard Tr S
Lot:21 Block: 03 Addition: Thomas Lake Woods
PID:10-76100-03-210
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
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 -
Susan K Ude
4530 Mallard Tr S
Eagan MN 55122
(612) 801-8818
Sedgwick Heating & Air Conditioning
1408 Northland Drive, Suite 310
Mendota Heights MN 55120
(952) 881-9000
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA174124
Date Issued:12/28/2021
Permit Category:ePermit
Site Address: 4530 Mallard Tr S
Lot:21 Block: 03 Addition: Thomas Lake Woods
PID:10-76100-03-210
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Softener
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
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 -
Diane Metzler
4530 Mallard Trl S
Eagan MN 55122
Haferman Water Conditioning
12142 12th Ave.
Burnsville MN 55337
(952) 894-4040
Applicant/Permitee: Signature Issued By: Signature