4074 Durham Ct06/17/2014 15:07 Les Jones Roofing, Inc. TAX)9528817009 P.015/020
41/111' City of Eaaali
Date:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (661) 676-8694 .
Use BLUE or BLACK Ink
For Office Use �%
Permit #: I a3 `f �1. (p
Permit Fee:
Date Received:
Staff:
a
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
6/(7 y Site Address: 4/Do-V(62407a- £/Q7 y076-i/07b'-1/0k0- r/D8,2. bags -M -/f CDU. .%
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Name: yo P2oP T`' G'4.f I. NC.. Phone: /A57- .524-2/- f94//,?°'R
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Address / City / Zip: 'P.O. Bp k 212 5- /N1� n. ✓,1 4itah Ai 6570 74
Applicant is: Owner X Contractor
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Description of work: F /Wig/NO
190
Construction Cost ' 27, 5Lf7 , Multi -Family Building: (Yee X I No )
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Company: Ars r?2M/6 Rcat-wiz-f Ave_ Contact: CNa+ s r Jag -sod
Address: 95t l 14/. d'D TN S7"/LE%' City: lie '4 d to A/
State: .4W Zip: frieze) Phone: 9S2 - 74 7 - 428/9
License #: 6561) Lead Certificate #: 4/4r `f o . 9 R -
If the project Is exempt
from lead certification, please explain why: (see Page 3 for additional information)
In the last 12 months,
_Yes _No if
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDER
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;
Phone:
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CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 464-0002 for protection against underground utility damage. Call 48 hours
before you Intend to dig to receive locates of underground utilities. www.gooherstateonecall.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 wilt be In
accordance with the approved plan In the case of work which requires a review and approval of plans.
Exterior work authorized bye building permit Issued In accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
x CIPS IS 4I40072s-04/
Applicant's Printed Name
de -
Applicant's Signature
Page 1 of 3
0211912014 12:36 Les Jones Roofing, Inc. (FAK)9528817009 P.0151020
Date:
City of Eaaall
3830 Pilot Knob Road
Eagan MN 56122
Phone: (661) 678-6676
Fax: (661) 675-5694
RECEIVED
FEB 1 9 2014
Use BLUE or BLACK Ink
For Office Use 7
Permit #: -L SY(;
Permit Fee: c'1) 0 11
Date Received:
Staff:
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
J
i 9 b % Site Address: L/7:/l 0YzO7 -/Y0 f'1O7/
4:4 go7S, go8'O,C %OJ28. 2- Unit
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Name: yo PeoPWI'Y G AizE LNG-• Phone: /57— 5-3-1/- VI Lill
Address
Applicant
/ City I Zip: Bo. Bo K 2t 2 5 /Nva Co -wit l M' 61S20 24
is: Owner X Contractor
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�:Multi-Family
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Descriptlon
Construction
444,491/1 Q /egg £,oF LrA 9°.:14-5
of work: R'N
Cost k � 2i fig, Building: ....._j(Yes x ! No
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Company:
Address:
State-
AES �TaNES CtOfifiVir /.VG Contact CAI/at s �wLSO /
9 Y 1 W. 8a m i"/ City:P__4 uL.ylrre2.✓
MA/ Zip: Phone: 9SA 7' 0? /
License #: 6.5-64 Lead Certificate #: ,g4r 4`C 3 VR- /
If the project is exempt
from lead certification, please explain why: (see Page 3 for additional Information)
In the last 12 months,
Yes No If
COMPLETE
has the
yes, date
THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
City of Eagan issued a permit for a similar plan based on a master plan?
and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
Phone:
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, C � 1'� �� - ..,. , =� : , �.
CALL BEFORE YOU PIG. Call 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. www.aooherstateonecall.ora
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 penult, but only an application for a permit, end 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 State Building Code must be completed within 180
days of permit issuance.
x�i -Rts 110072s0AI
Applicant's Printed Name
Applicant's Signature
Page 1 of 3
City of Eagan
PERMIT
City of Eaan
Permit Type: Mechanical
Permit Number: EA137761
Date Issued: 07/21/2016
Permit Category: ePermit
Site Address: 4074 Durham Ct
Lot: 114 Block: 04 Addition: Diffley Commons
PID: 10-20450-04-114
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.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Fee Summary:
ME - Permit Fee (Replacements) $59.00
Surcharge -Fixed $1.00
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:
Robin Cullip
4074 Durham Ct
Eagan MN 55121
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
SEDGWICK HEATING & AIR CONDITIONING CO.
1408 NORTHLAND DRIVE, SUITE 310 • MENDOTA HEIGHTS, MN 55120 • (952) 881-9000
ADDRESS 274/heaCA-144.,de« CITY
OCCUPANT f 1
SOLD BY
MAKE
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SERIAL NO
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THERMOSTAT
VALVE
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LIMIT SETTING
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PILOT TYPE
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IGNITION MODEL J,/<)
PILOT TIMING
PRESSURE
INPUT CFH
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STACK TEMP.
FORM 235 (REV. 10/10)
PERCENT CO2
PERCENT 02
PERCENT CO
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id
OWNER
HEATING
TEST RECORD
01671 -Ai
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INPUT
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TYPE OF LINER S tie,el-
LINER SIZE
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FILTERS: SIZE /tXevx ! NUMBER
WIRING V
TEST TAG
LIGHTING INST.
DATE TESTED
COMPANY TESTING
NAME OF TESTER
77:9 16,
sev cle
FORM DISTRIBUTION: WHITE COPY - JOB FILE YELLOW COPY - CITY