4428 Lakeshore TerPERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA110302
Date Issued:05/02/2013
Permit Category:ePermit
Site Address: 4428 Lakeshore Ter
Lot:28 Block: 01 Addition: Cliff Lake Shores
PID:10-17785-01-280
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Phil Holmin
900 Park Knoll Drive
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 -
Tanya L Gilbertson
4428 Lakeshore Ter
Eagan MN 55122
Holmin Heating & Cooling LLC
900 Park Knoll Drive
Eagan MN 55123
(651) 405-3853
Applicant/Permitee: Signature Issued By: Signature
Oct 07 2014 0827AM HP Fax page 16
Use BLUE or BLACK Ink
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3830 PIIOt Knob Road
Eagan MN 55122 � Date Received: �
Phone:(651)675-5675 I I
Fax:(651) 675�b694 I Staff: I
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2014 RESIDENTIAL BUILDING PERMIT APPLICATION
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Description of work: �� - s' .�' r 'x;,•� °`''�.
Type of Work ,.
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If the project is exempt from lead certlficaiion, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 mo�ha,has the Clty of Eagan Issued a permit for a similar plan based o�a master plan?
_Yes _No If yes,date and address of master plan:
Llcensed Plumber: Phone:
Mechanlcal Contractor: Phone:
Sewer&WaEer ContraCtor: Phone:
NOTE:P/ans and supporting documents that you submit are consldered to be public information, Portlons of
the/nformatlon may be c/assifled as non-�ubl/c!f you provlde specific r�asons that would permlt!`he City to
conclude that the are trade secrets.
CAL� BEFORE YOU DIG. Call Gopher State One Call at�651)454-0002 for rotection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. wwn�v.4opherstatvnnecall.o�a
I hereby acknowledge that this intormation is complete and accurate;fhat the work will be in conformance with the ordinances and codes of the City o(
Eagan; lhat I undersland this is not a permit, but only an application fo� a perrnii, and work is not to start without a permit that the work will be in
accordance with the approved plan in the case of woric which requires a review and approval of plans.
Extertor qthortzed by a bullding permlt issued In accordance wlfh the Minnesota State Bulldlna Code must e completed wlthln 1 Bp
day perml�'(gsuance. �s°^^'.-'�"'�
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Applicant's Printed Name ApplicanYs Slgnelure �
Page 1 oi 3
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3830 Pilot Knob Road � �
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 1 �
Fax: (651)675-5694 � Staff: I
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2015 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: �� 1���Sr Site Address: �`�f�" ���3�V` � �V��" ���� �� �SUni#:
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� If the project is exempt from lead certification, please explain why:
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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:
Fire Suppression Contractor: Phone:
N�?T�':P�ans a�tl s���ort���t�a�curr�er��t�tha�yo�►s.w�rr��t a�e co���red�o ibe���b�i��crr��a#it�. Po�o�s o#'
t#�8 i�r�orrr�ation�nay be class+�ed as non pu�bf���y�t�pro�r�t�e s�ec�'��re�o�s t�a�wo�a�t�p�rr���h� Ci�y t�
���� �c�r�c��ale t�aa�t�e are tra+de��c�e�s. '�
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.qopherstateonecall.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 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 S t Building Code must be completed within 180
days of permit issuance.
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Applicant's Printed Name Appli s Sign ture
Page 1 of 3