1227 Timbershore LaneSEDGWICK HEATING & AIR CONDITIONING CO. HEATING No `! 1/3
1408 NORTHLAND DRIVE SUITE 310 TEST RECOFIECEIVCI�
• MENDOTA HEIGHTS, MN 55120 (952) 881 9000
/6"1.01
�Jf9ol r n'
ADDRESS y"� /. ► / .�*� CITY
OCCUPANT
SOLD BY
MAKE
Afre-ify
SERIAL NO S ) 3 /13 Y1,29'
THERMOSTATv ' J f� j
VALVE % is Ut.�-j (40 L C
L
(SNP*
LIMIT
j JAN 1 5 2013
OWNER v 66v4&e4VAI (GGC--•
INSTALLED BY / t - / A9A-"-t -
MODEL
INPUT
owi co 70
VENT SIZE
le40/ etc,
TYPE OF LINER
LINER SIZE
(9`t
LIMIT SETTING 1 go FILTERS. SIZE 1 LeA-.)-'-X (
/
FAN SETTING "' WIRING 00CA- '-tir-'e
PILOT TYPE UVV
NSti
IGNITION MODEL 1.4 S J
PILOT TIMING
PRESSURE
INPUT CFH
3.y
7c GVL%
STACK TEMP. 3/k
FORM 235 (REV. 10/10)
PERCENT CO2
PERCENT 02
PERCENT CO
—
TEST TAG
NUMBER
LIGHTING INST.
DATE TESTED (?
�uCE mittsIC
COMPANY TESTING
NAME OF TESTER
FORM DISTRIBUTION: WHITE COPY - JOB FILE
YELLOW COPY - CITY
City of Eagan
PERMIT
City of Eaan
Permit Type: Mechanical
Permit Number: EA119685
Date Issued: 12/12/2013
Permit Category: ePermit
Site Address: 1227 Timbershore Lane
Lot: 1 Block: 09 Addition: Timbershore 4th
PID: 10-76503-09-010
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.
Holly Flood
1408 Northland Dr #310
Fee Summary:
ME - Permit Fee (Replacements) $55.00
Surcharge -Fixed $5.00
0801.4088
9001.2195
Total: $60.00
Contractor:
Sedgwick Heating & Air Conditioning
1408 Northland Drive, Suite 310
Mendota Heights MN 55120
(952) 881-9000
- Applicant -
Owner:
Christina Trust
1610 St Andrew Pl E Ste B150
Santa Ana CA 92705
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.
Applicant/Permitee: Signature
Issued By: Signature
City of Eagan
PERMIT
City of Eaan
Permit Type: Plumbing
Permit Number: EA119686
Date Issued: 12/12/2013
Permit Category: ePermit
Site Address: 1227 Timbershore Lane
Lot: 1 Block: 09 Addition: Timbershore 4th
PID: 10-76503-09-010
Use:
Description:
Sub Type: Residential
Work Type: Replace
Description: 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.
Holly Flood
1408 Northland Dr #310
Mendota Heights, MN 55340
Fee Summary:
PL - Permit Fee (WS &/or WH) $55.00
Surcharge -Fixed $5.00
0801.4087
9001.2195
Total: $60.00
Contractor:
Sedgwick Heating & Air Conditioning
1408 Northland Drive, Suite 310
Mendota Heights MN 55120
(952) 881-9000
- Applicant -
Owner:
Christina Trust
1610 St Andrew Pl E Ste B150
Santa Ana CA 92705
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.
Applicant/Permitee: Signature
Issued By: Signature
Jul 28 2014 09:52AM HP FaxGates G.C. 7634987710 page 23
Date:
cit
of Eapll
3830 Pilot nob Road
Eagan MN 122
Phone: (65 ► 675-5675
Fax: (651) : r 5-5694
Use BLUE or BLACK Ink
For Office Use
LAS
Permit #:
Permit Fee:
Date Received: 7! «/'/
Staff:
J
014 RESIDENTIAL BUILDING PERMIT APPLICATION
Site Address: . 7 Z-;":" s ' ZZ--) , % Z. Z , / 41 `� Y Unit #:
Name: (Hji%ne% /�4 Phone: ,ply?
Resident!
Owner
Address / City / Zip:„
Applicant is: Owner
Type of Work
Contractor
Description of work: . p'
Construction Cost: ` A ''`° • •
Contractor
)
Multi -Family Building: (Yesf'' / No )
Company: 7G ef:). Lt;i.4.14.4../-
Contact:
Address: 35'?n Y ?;/-,(.5-14”,
//14"° 2, // . i City: j/ ;'
J .
State: f l' zip: 5 ` / •i Phone: (0/1'.'Z4-0.? 1;.. Email: /_:::':/f C -,c,' -;tee)' 1 Gro +::C6,.. -c%°
License #: Lead Certificate #:
If the project is exe
In the last 12 month
Yes No I
Licensed Plumber:
Mechanical Contra
Sewer & Water Con
NOTE: Plans an
j the information)
pt from lead certification, please explain why: (see Page 3 for additional information)
•COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
, has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
Phone:
Phone:
ctor: Phone:
CALL BEFORE
before you intend to dig
supporting documents that you submit are considered to be public information. Portions of
ay be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
EF RE Y • DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground Wilily damage. Call 48 hours
receive locates of underground utilities. www.000herslateonecall.orq
t this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
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
ved plan in the case of work which requires a review and approval of plans.
by a buildin ermit issued in accordance with the Minnesota S •=,y ng Code must be c ple =d within 180
I hereby acknowledge th
Eagan; that I underslan
accordance the ap
Ex . nor w rk authoriz
days of pe t issuanc
x
Appli 0 nt's Printed
me
x
Applicants Signature
Page 1 of 3