3779 Burgundy Dr
Use BLUE or BLACK Ink
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I For Office Use
CitV of EaRd11 i Permit 7 J I✓'
J I Permit Fee:
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I~.
Fax: (651) 675-5694 I Staff:
I I
2013 RESIDENTIAL BUILDING PERMIT APP/)LICATION
Unit
Date: /3 Site Address: !f
/g oq
Name: Phone:
Resident/
Owner Address / City / Zip: 5-777- x 772_AJT! It l ~
Applicant is: Owner Contractor
I
Type of Work ' Description of work: 4''
Construction Cost: s Multi-Family Building: (Yes / No
Company: 0/TES Contact: nose-he-
Address: 2iih~rei^ City: ~!S
Contractor
State: /?2'/7 Zip:'!5 $ '411'3 Phone: 141a - 1T V _ B6 I?
9 w~/J~
License #:'6e:6'1a ye Lead Certificate 444T - 7'W,2
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
d 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:
i
F
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
.
n_ _ .
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.gopherstateonecall.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 to uilding Code must be completed within 180
days of permit issuance,
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Applicant's Printed Name App ant's Signat re
Page 1 of 3
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA162105
Date Issued:06/26/2020
Permit Category:ePermit
Site Address: 3779 Burgundy Dr
Lot:1 Block: 02 Addition: Seneca Hills
PID:10-67125-02-010
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 -
Jay K Fitzgerald
3779 Burgundy Dr
Eagan MN 55121
(612) 816-4793
Appliance Connections Inc
12850 Chestnut Blvd
Shakopee MN 55379
(952) 445-4803
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA162106
Date Issued:06/26/2020
Permit Category:ePermit
Site Address: 3779 Burgundy Dr
Lot:1 Block: 02 Addition: Seneca Hills
PID:10-67125-02-010
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.
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
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 -
Jay K Fitzgerald
3779 Burgundy Dr
Eagan MN 55121
(612) 816-4793
Appliance Connections Inc
12850 Chestnut Blvd
Shakopee MN 55379
(952) 445-4803
Applicant/Permitee: Signature Issued By: Signature