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4130 Beaver Dam Rd
06/17/2014 15:08 Les Jones Roofing,Inc. ffAX�528817009 P.0201020 Use sL.U�or BLACK Ink � For Oifice Use^ ^ ^ ^ � • ; Pa�,��#: �3��� ; C��� �� ����� � Pertnit Fee: � � I 3830 Pllot Knob Road I I Eagan MN 55122 j Date Recelved: j Pho�e:(s��)sy�-�sy� i � Fax:(661)675�694 . ' I SIeN: I I I ���--���������������J 2014 RESIDEN7IAL. BUILDING PERMIT APPLICATION , o�te. �a y- �riaG ���a8��r3o- yi3�--�r�� �i�6 � ���7 � SIEe Address: /3 S' L3Eht�.Q pA�9 ,�D/!O Unit#: I _;-,,:.�;;:�; �.,,�. :;•;t�r-:,, ;:r.>�:_; � "'`�,, �'�, ,, ; �r °`� ", Name:,fio P2o��Ty G•4-�E. 6NG. ---- ---Phone: �05l— 5"S"�/- 99'�/q � ����;�:;��t side' �'";%;; ;.;, , • ;r4�,,, •-. ,,; .,r ;��`.�,�n�gl',.;�;:'.+..,... Address/City/Zp: �P O. Bp 7C 2►� 5 �N�/�7Z�7�✓� ��j; b',��67 '1�o ;:cti=':��w:yr{cl;7.�".•+•�ii ,�:p�1,�'�Y, � ;'��: ^?•�,�'.�'yra:j1`F;`''; ` '��:�.'�'�, „?a, ;.i'%`�;�.,::=.;;;,;;;;'�7' Appllcentls: Owner X Contractor ,,..., 'r:.,,,;':':.'��.�.; .> a�;< .�.'"� ,'1� .A:���(J 1..'..t'•'%1l j '�� ��i�� �I":: �5��!i�y�..,���' ^�.1';�.r i���:�a�e . � ,^,:A' r,","��::��"`°` Deac�IpUon of work: l��Q� �/y ��P�� �l�O!/1/�-� Y<° ��;, f. �,,......�. � � ^; ;,"�y eE"��:: pC ' r7 _;:,Q�� . ,+.!!YI`�:,Ik�.` . '';;;�-;���:��";�' '' ;;` �onstrucnon�ost: a�3 , d� Multl-Femlly Buliding:(Yes X /No� :,.: ;�,�;;'�;.�:�;:::,�;;,;:� `•'/i�,l`1t�..:.,��'11�:'. '':�.i". .�.. � r� '�, ' ''�:��'�.n"'; ,.1: <`.i��1;�%'.�:;�,' ;,"�;��`''��c, Company: �E�S .TQ,y�RtaDfs�/lr. /�vG Contect:Css�er s �04��0 �n���' i�u'� ��i.��"P°;i'��3..�i.,-ir �;���y;:a�`�'C��.'.,:.�.�y�q)��.%•;`'1�::1<�l ; �z�� ,,;< Aad�ess:9�� w 8o r''' s°i-�' aty: ,,Bcaa�u�.�rr�.�/ %�;���,i��l'ai�t��'.-�::.; •,�� :l.�:�::I � �:Q'... �:�..�'!'��:' � .�: ..:Au�..•'(�'.. . ;.":l.i ,.:: ;���;>.•�:�,��� ...;��>.,;?;:��:t-. State:_�Zip: .�.i�4�2D Phone: 9'SR- 76 7-a8/9 :d:�<, '.�"' r r,,:;�x�.,� :.a�3';:,,4�'•:�'�`.,,;'�e;;`:��;t��,:;�:`1*.'1/;: �'i11:..!T.,�H:,I;'`';:;:;: �-,�;:; '::�;;� Licensa#: �S7o� Lead Certiflcate�i: .U.47^ �O 3 9R�-/ `?,:-' •�.v; ;':r,::;,,; :;,'r:':::>�.i If the proJect(s exempt from lead certlflcatlon,pieeae explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONL.Y IF CONSTRUCTINO A NEW BUILDING In the laat 12 monfha,has the Clty of�agan issued a pemlit for�simllar plan based on a master plan9 _Yas _No If yes,date and address of inester plan: Llcensed plumber: Phone: Mechanical ConEractor. Phone: Sewer&Water Contractor: phona: .. ..>.,._,.- e y./ y� - y� :.p . ,�. ,� .� , .�.,..�„ � . , •��'�.'�r; ��,o ,'�'$ Ai�l�'Ib'�'��'.�n s� ��i�iF�'��s:;ha;y'�iu�su�, ��,aie;a�q�s�i��Y��,'�:'`b��/rU�'ll,�_rlf�3►7Y1� l��fr..a �'Nr" ,�`.bf �: ��;i,���c<� .r;�.� �,�i: .r.:��.�,T .r�„ �'•1�3(>, .�� 'T�'1,,,� .:y:.,,.. ,��+...�.L.. >•• �„�� ,,..��rr�.,.,,�r,`: ,,,�� �•�...,•. ,X: ,. Q,, ,�. .. �/ �:� �I �� � :t 'j 'i 'S"'�.5�'� 4 � i d t �y .ry,� '�'• {� °,;y�ft�`FI.fo' �It. ►1R' ,r _�IS' s d''' ' �1.: �j c=,1, /�:� `o�i�de;�<.,ea u�.�.�a +#�ia,�'V�ul�1: e e�lE'':'`�3':��':': �::�?! .C. .,�4�,..�!��!�...i�. .::r�._/,�4�.,n.��`� Q. p'�b�_ fJ!g,..P�' ..,P .,r. ..te.,_�QAI��.,�, �1.�...!'i�lt�;;�...:,,. -.y. ,.,., _ y'��.' °,<% �. .d._,�,; �.. '.t o ,�_� !1,. n� .na `� �n,.1. ,.�,h;,.!.. .1xi�V.�:' ,.h. �. p�� •��,.:•.r�;-d;,E',.� .x, x;�: }n.°iT �r ' •U .f'rl„ ,/[��� �, r„ �'�'��S.s11��t�: �r.�.°,;�:'S ;3.. �t.:�:!�:'.,�.;�F`I.i;:�;•i1 �ti r':�.:,ar�n::`:;;1;. .�1�* �F��`i�:.lr�. �p� :��'i.r, .S.,. �..i,:� ��-.'.i..�n ti . ..,�,� �'e'�' at: e`.';a, d,,, e �:s, ;..; '-s� , -, .. :., �1 , ; ., ..., ., . �..;:�f-�:�.i, � ,i':,`!q:. F..;,.a:•:�•,..),... ' ,::1';�5��1`aY '�i,� ./..s.. .Q.n..P...�..,. :'L1e Jf; rr.. r4+.;. h'�.`i;��;�� ' � _ , +....�:. "' ' u`'..�..�:>:' � ,� V 1 .�... . .�.r.-•1:... ,.•�..a. ,..� , ..: ��. .. .. ..__•__ . !:i'1:::. ��. 1..:�C�. CAI.�,S��OR�YOU dIG, Call Gophar State Ona Ca11 at ig61)464•0002 for prolecllon against underground utllity damape. Call 48 houre b0foro you Intend to dlg to recelve locales oi underground utllfUea. w�vw.pooherstateonecaU.om I heroby acknaMedge that this Iniormetlon Is complete and accurete;that the work will be In coMormance wllh lhe orcllnancea and codeo of(he Clty of Eegen; lhat 1 understand lhls le not e permlt, but only an appllcaUon for e pertnk,and wofk le nol to etart Without a permit;that the worlc wlll be In eccordance wllh the approved plan In the caee of wak whlch raqulres a revlew and epprovel of plene. Exlerior work authorized by a buliding permit 156ued In aecordence with the Mlnne9ota State Buildlne Code muet be completed within 180 aays of permlt issuance. x G�2ts �4tiD�I2S'o,�I x ��� G���4 Appllcant's Printed Name AppllcanYs 8lgnature Pege 1 Of 3 02t19/2014 12:38 Les Jones Roofing,Inc. ffA��9528817�9 P.0201020 Use BLUE or BI.ACK Ink ' � �or Office usa---- I I C• � Pertnitii: ��" ' j �ty Of�a��� ��������� ; � ��-���-� � Pemtll Fee: � � 3830 Pilot Knob Road �agan MN 66122 ��� 1 91�t4 � Date Received: i Phone:(651)675-6676 � S�� I Fax:(661)676-6694 . � � �������___��.....rr��J 2014 RESIDENTIAL BUIL.DING PERMIT APP ICATION ��f, y�a�, y��g, �t«o� �f/32 Date: � � ` 31te Address: yi 3 S' � V� a� Unit�: .,,�_;�, , :ti•E;�w,,., . .. �.. ., 1;: . ,r'i jj . =r`'i,";�.' �,�,.� . .:.:r' �� Gs'�� ss-�J- 99� :�;.;� ,.,,..::.: I Y�'.. c, �;1�;�;;,};_ :F.,�,; �.��, ,,:�a,. Name: �10 P�opE+2Ty C.A-�.� 6 NG.. Phone: � t� ��.i`�c: .�,�;:. :, ' "'.� "�;�Cieh �^' ;:..,..�,�,t� ��'';:.:; '�r'''�y� 4 ' "� '"`i'��'�'" Addres8/City I Zlp: 'P O. �k 212 5 /Nv�z C-r�2o✓d %�: /Llit/ 5,�� �L� y, ,�,4Y���;,,i � �, �y,.':�'..v , �x ,�;,;'S,;'. �J� .,:1 i �dL.�1 �.:ci� t�'��"'�;��:�>-' � �Jm�r "��'��'i Applicant is: Owner x Contrector y;�'��„ .e.�r'. ��,..a ri::5:. ;�:.N.,�..y ;rri,�R?�•i�, Y�r,. 4'�. � ": ...\1� '��1�ti1!.I� '.�t... :'.'::-r �`� "!'� Description of worlc ��t6//b �iSecG,c. , i r.�_...�!v :..„. �'I✓� UO� „..T�rFp��;:����;��`:<� � ..�i �.ywy •;: � )i.. J;��r�" �� �� �o �' a �� B���d� Yes x �No .fe,, `.� ;'��' ,;,,.';�,�;�., nstructlon Cost: �� • � Muld-Fam y ri9-( � :,>.••.r;:;_;:;~�=��'�A,-,`"!;<,,..,...�.. �;±` , 71`'r wR' { %,�;�;:' �. �,a�.1.'�r.; , ?r. :°�. :s,.;�,�;�;�a�>ry;�;�eN ,,' ..,5�� Company: �E,S �TaNE3' fi Fs�/lr /NG Contact Css�s ��t�2so ; i �,S ;�s' ,;�;._,:�:,..��...�;''�'��°•rr�"�4��:i 77+1 ,,,;°�'`�.� �. . �.J �,r:�� Address: ! City: BiaQiul.�.r� ;= :>:,(�'.�� �('7� ��`:;,Y,r �,.�! ,,.�.���.,�.; ;;4? F'f"�,-,��,',�..yr'`,;�>.`.;�=ir�' State: Ml� Zip: .�,��20 Phone• 9' A 7rv 7-a8/9 ,n;:';�;��!'rY>�,.,�,3a✓'`r:,;:E"`�6'�'�.`r! r I 1'-'k��' �a C y�:��'��.. .,:.,�.���( �'�t:r� ��:t�:�-.�;.;,�:�:,;"�'" ,�,: Llcense�: ��/v� Lead Ce�tiflcate#:�UA�7� �f0 3 7�—/ f,l....::1Q�w ::.i.�'?/f If the proJect is exempk from lead certificatlon, please explain why: (see Page 3 for additional Information) COMPLE'1'E 7HIS AREA ONL.Y 1F CONS7RUCTING A�BUILDING In the laet 12 months�has the Clty of Eagan issued a permit for a slmllar plan based oh a maeter plan? �Yes No IF yes,date and address of maeter plan: L(censed Plumber: Phone: Mechanlcel Contractor: Phone: Sewer�Wate�Contractor; Phohe; ,�.��.��-. �ws... .��r�r•. �. o`v , N"` •' 1• i :e �h ,v ��. k;,. 1�!�� � �'�i�•:d�"bl��" �S�• �Q►d� VN �.._. ,�' '?"�pnslal,��d�.4�,�,.e ��.' ,�/C1�i� 'a '�1�r'�?��°���� �js�f���'; , �.a: �.�p�y��°,� �i:..��� :,.k � r :r`., )• Y��yr �/ ,,.., M� �.4T ��t ��.�,a s �J,�, y �.�,�: �,���� .� 1.'���ry�'' :fA;C1c' �6. ., 0I) •t1�.14�/,f� t'�.N• ,:�/ '6�S'j'� ,Ij/,�,f�p O' 3�uJ ;a .l���� .���..��1,�:±'%��j/y'f�r '+ �g. C.� !��S!F�1���5,?.!;'�•�Y 6.:��, •��r �•V�� .71:yr / � � `!I,..f'!.".• ..J:e" (•.^.F:�;; � ,;���if.'1;r.e� �.�' �1. "��¢ :i�.J A�;� r;,�i:;,,� ,;�,�±s; �1, s�.,;Cb. ��. a � �,,r � .a: °� � ap , �•S' �� .<ry�r �.. ,a�. �i• �':.' cH.a. .,7 �., . , _ .<;... � .. 'E;, , .., :.. _..•. � ' .. 'i?'i.: �`n e�� 1. . ;....�.��C'.�.:t,..: :.:1.�h�:.,�. �O'..,,wi�,::a�u:Fik�,ee:�.,."+i�:.m e� �;CF�O ll'}�,PT,�������I,i> ? @. .��s a'a.��'Il.,.���.° �:'S�i� •bi•9�n:,.. a4 .,,r...;w .�i�'as :�;Y�Gi.�i.,r ��. CAI.I. B '�ORE YOU DIG. Call Gophar Stato Ono Cell el(661)464�OOOZ for protection againat underpround utlllty damage. Cell 48 houre before you Intend to dig to receive(oCetas of undergro�md utlllUee. m�vw.aonherstaleonQ�all.or� I hereby acknowtedge that thls InformaUon la compiete end accurete;thst the work will be m conforrnance wlth the ordlnences and codes ol the Clly ot Eepen; thet 1 understend tF�e le not e permit, but onty en eppllCallon fo�a permit, and work le not to efati viAthout a permit;that lhe wortt wlll be In eccordance wtth the epproved plan In lhe ceae of work wtikh requlrea a rovlew and approval of plens. Exterlorwork authorized by a buliding pArmlt Isauad In accordance wlth tho Minnosota state Building Code musf ba completed wlthin 18� days of permlt Issuance. . X Gµ2is f�MD�Rso�1/_ X GG'�� Applicant's Printed Name Appilcant's 8lgnature Pege 7 Of 3 PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA154198 Date Issued:02/28/2019 Permit Category:ePermit Site Address: 4130 Beaver Dam Rd Lot:168 Block: 04 Addition: Diffley Commons PID:10-20450-04-168 Use: Description: Sub Type:Residential Work Type:Replace Description:Furnace 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 - Dale E Carlson 4130 Beaver Dam Rd Eagan MN 55122 (651) 452-2203 Blue Ox Heating & Air Llc 5720 International Pkwy New Hope MN 55428 (612) 238-9709 Applicant/Permitee: Signature Issued By: Signature