4171 Arbor Lane 0512312014 11:26 Les Jones Roofing, Inc. (FAX)8528817009 P.004/016
Use BLUE or BLACK ink
For Office Use
Permit C q77
1
City of Evan ; -7-6 11
3830 Pilot Knob Road I Pemtll Fee. 1. 1
Eagan MN 66122 Dale Received: i"
Phone: (661) 676-6676 I i
Pax: (651) 875-6684 I stem 1
I - - - -
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date; oZ 3 . Site Address: UW- 41-71 - .41-73 4t75 Agag1L Un(t
Name: p ,.6 AamRs soc. ~A K hone: - 4 e S sLC
Address/ City/ Zip: Lf-fo AIZE10
9 I
Applicant Is: Owner x Contractor
Description of work: r2 ct-t v
p ~
Construction Cost: - 3 2 2 *7 ! Multi-Family Building: (Yes x / No
Company: AiFS jaN63 R oamy ; /NG. Contact: CNR-r x 101v0APZS0A/
Address: 4YL W. ?d city: BGOtNG,t/
Stets: Zip: ,~,l~~f2a Phone: 9'F;I - 76 7 - &W/7
License Lead Certlflcate -/A-7' 'V O S ?.7
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
In the last 12 months, has the City of Fagan Issued a permit for a almllar plan based on a master plan?
`Yea -_No If yes, date and address of master plan:.
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor; Phone:
CCALL. BEFORE YOU DIG. Cal Gopher State One Call at (661) 464.0002 for protection against underground utility damage. Call 48 hours
before you Intend to dig to receive locates of underground utilities. mmoer aoohwstateonecall.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, 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 plane.
Exterior work authorized by a building permit Issued In accordance with tho Minnesota State Building Code must be completed within 180
days of permit Issuance.
x_Gi'At5 4AiDE9b'0A1 x
Appllcanr s Printed Name Applicant's Signature
Page 1 of 3
Use BLUE or BLACK Ink
-----------------,
For Office Use � / x Permit#: V
4* L
City of EaJ RECEIVED I �
3830 Pilot Knob Road juN 10 2016 Permit Fee:
Eagan MN 55122 j Date Received:
Phone.(651)675-5675
Fax:(651)675-5694 I I
Staff:
-----------------
J
2016 MECHANICAL PERMIT APPLICATION
❑ Please submit two(2)sets of plans with all commercial applications.
Date:6/1/2016 Site Address:4171 ARBOR LN, EAGAN, MN 55122
Tenant: Suite#:
0` Name: GARY UNDESSER Phone: 651-686-0320
UK W,: l0w rE
Address/City/Zip: SAME
-�' K&S HEATING AIRCONDITIONING&PLUMBING INC 43689
Name: License#:
._C4tltradt
Address: 4205 HWY 14 W City: ROCHESTER
State: MN Zip: 55901 Phone: 507-361-2332
contact: HEIDI BROWN Email: hbrown @ksheating.com
New _/ Replacement Additional Alteration Demolition
'ypelNr 3`. Description of work: REPLACE FURNACE &AIR CONDITIONER.
O $arf muntarI rand rrtrnted r1811� a �t t ITe o renecf bra !fir
Plot_1 tacttheMew � ct4 psrmi_#ted� Mr tltcd'�
sN
RESIDENTIAL COMMERCIAL
Furnace _New Construction —Interior Improvement
Air Conditioner —Install Piping —Processed
Air Exchanger Gas Exterior HVAC Unit
T! —
_Heat Pump Under/Above ground Tank (_Install/—Remove)
Other
RESIDENTIAL FEES
$60.00 Minimum Add or alteration to an existing unit, includes State Surcharge
$100.00 Residential New, includes State Surcharge =$60.00 TOTAL FEE
COMMERCIAL FEES Contract Value$ X.01
$60.00 Permit Fee Minimum
$70.00 Underground tank installation/removal =$ Permit Fee
Surcharge=Contract Value x$0.0005 =$ Surcharge
If the project valuation is over$1 million, please call for Surcharge =$ TOTAL FEE
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.
x BRIAN KEEHN x
Applicant's Printed Name pplicant's Signature
Required,In$peCdCl�f _ a = iewedBy Dates
tJndergccun h In # E T— as Sei Te6t Inu opt Heat' z? Flrtal H /a C ring=