4166 Arbor Lane 05/2312014 11:25 Les Jones Roofing, Inc. OAX)9528817009 P.0021016
Use BLUE or BLACK Ink
For Office Use
75
1 Permit ! 1
City of Wan I ~7 J~ I
Permit Fee: ! / I
3830 Pilot Knob Road I r % I
Eagan MN 65122 1 Date Received: / I
Phone; (661) 576-5676
I t
Fax: (661) 6765694 1 Staff: I
2 ! ~a
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: SiteAddress: 4%(o0" 41f.2- "eq--4ttet- A12GOR C"ir Unit
Name: o T E Aemas Assoc JE Ana", hone: Io Sl - 4 o-S- T SSC'
Address / City/ Zip: 4 C C1o AsBO Q : 1- 4mg
i Applicant Is: Owner X Contractor
Description of work: Ks-M o vE p
Construction Cost: , 79 7. y Multi-Family Building: (Yee x / No
Company: sS &&AeS RwFe* /NG. -contact: Gillet sAzwa Zsod
Address: 'i f W. 80 7I/ .0- City: BGO`vtcs.t&z.,dZ
4r
r State: Zip; XfV20 Phone: q5-A - 76 7 - e78/9
License lead certificate WA1- If O 3 9 a = /
If the project Is exempt from lead certificatlon, please explain why: (see Page 3 for additional Information)
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, data and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor; Phone:
Sewer l~ Water Contractor.. Phone:
CALL BEFORE YOU DIG. Call Gopher State One Calf 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.aooherstateonecsll.oro
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, end work Is not to start without a permit; that the work wilt 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.
Applicants Printed Name Applicante Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA165723
Date Issued:11/17/2020
Permit Category:ePermit
Site Address: 4166 Arbor Lane
Lot:034 Block: 001 Addition: Wenzel 1st
PID:10-83570-01-340
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & Air Conditioner
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
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 -
Carol Ann Nelson
4166 Arbor Ln
Eagan MN 55122
(651) 429-6163
Blue Ox Heating & Air Llc
5720 International Pkwy
New Hope MN 55428
(612) 238-9709
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA165724
Date Issued:11/17/2020
Permit Category:ePermit
Site Address: 4166 Arbor Lane
Lot:034 Block: 001 Addition: Wenzel 1st
PID:10-83570-01-340
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Standard Water Heater & 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 -
Carol Ann Nelson
4166 Arbor Ln
Eagan MN 55122
(651) 429-6163
Noah Acquisitions Llc
5718 International Pkwy
Brooklyn Park MN 55428
(612) 822-5292
Applicant/Permitee: Signature Issued By: Signature