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4430 Lakeshore Ter Oct 07 2014 0827AM HP Fax page 16 Use BLUE or BLACK Ink �----------------- � For Office Use � � j Pertnit#� ��lY� I C�ty of Ea�a� ; /��; i Pertn�t Fee: ��[ � 3830 PIIOt Knob Road Eagan MN 55122 � Date Received: � Phone:(651)675-5675 I I Fax:(651) 675�b694 I Staff: I 1 I L��J 2014 RESIDENTIAL BUILDING PERMIT APPLICATION �� Date: J� � � � SiteAddress: �Z� �`�Z(�° `�yL� `f�3C� �`�� Name: ��°�� Z��u:� /� /,f, �- Phone: Resident/ Owner Address�city�zip: ' S�t— Applicant is: Owner �"��Contractor f Description of work: �� - s' .�' r 'x;,•� °`''�. Type of Work ,. l, Constructipn Cost� ��S�y Z" ��✓��` Multi-Family Building: (Yes ��No_� �°' � � � � �°"° �, � Company�s" �'a,�,r°°sv.-.�.`�,c.�,�,��?�''�-�� Contaci: � ;�"�a�,,��.,�:�_.. COr1�1^BCtOf Address`� '-'L� �.±'�•''�;r��r,�,tl� t�-sJ' 5.��'��•, ;;?�� City: ri�tif`d.��'>�� State�� Zip: .�- �;� Phone: �r �� %�' ? ��J Email: :��'E.r� °�!'e.��`:� °GS.�:��' - '� � ,� �, •^ �icense t�� D�°�'P�/,;� �ead CeNiticaie#: .��'!��'"�� ' � If the project is exempt from lead certlficaiion, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 mo�ha,has the Clty of Eagan Issued a permit for a similar plan based o�a master plan? _Yes _No If yes,date and address of master plan: Llcensed Plumber: Phone: Mechanlcal Contractor: Phone: Sewer&WaEer ContraCtor: Phone: NOTE:P/ans and supporting documents that you submit are consldered to be public information, Portlons of the/nformatlon may be c/assifled as non-�ubl/c!f you provlde specific r�asons that would permlt!`he City to conclude that the are trade secrets. CAL� BEFORE YOU DIG. Call Gopher State One Call at�651)454-0002 for rotection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. wwn�v.4opherstatvnnecall.o�a I hereby acknowledge that this intormation is complete and accurate;fhat the work will be in conformance with the ordinances and codes of the City o( Eagan; lhat I undersland this is not a permit, but only an application fo� a perrnii, and work is not to start without a permit that the work will be in accordance with the approved plan in the case of woric which requires a review and approval of plans. Extertor qthortzed by a bullding permlt issued In accordance wlfh the Minnesota State Bulldlna Code must e completed wlthln 1 Bp day perml�'(gsuance. �s°^^'.-'�"'� �f ��..: --�` � ..__ ,�. � °'``� : 1 X �_ . -. . ,rr„„",�.., ....pR.,..._.... � �.-` �`�.d.i l',.,'�.__-... � .�`�--'`1.' X ��_�_�'�---'•-_ " l.......... Applicant's Printed Name ApplicanYs Slgnelure � Page 1 oi 3 Use BLUE or BLACK Ink r----------------� 1 For Office Use � . ; ( �3� � C�� 0� n�� Permit#: � ; � �� Permit Fee: 3830 Pilot Knob Road � � Eagan MN 55122 � Date Received: � Phone: (651)675-5675 I � Fax: (651)675-5694 I Staff: I I � ------------------- 2015 RESIDENTIAL BUILDING PERMIT APPLICATION Date: �� /�S/ Site Address: �� L��`��`" ►°�'`�'�"``"�' r�/""- �N �Unit# �p� $�Name:,.�LL.��l YY �......,_.v��L..�.... .b��.e�✓�$ m.�,...��.�...w.v,�n�,w,�....w.d.w.� Phone:�,.._.��a...��...,��.n._.�..,�.x.� G S �e��d��:� ; � �, Q1�Wi�Er Address/City/Zip: ��^^'�- , � ' � Applicant is: Owner Contractor g ,�,�,�..�,.,��.�,_.�_ . w.,�,,��.,.��.�.wW.��W..�..�.�.�...��.�.,�� .m.�.,ti �� Description ofwork: �� TYpe af Warf� � . . � �; ' , � Construction Cost: Multi-Family Buildmg: (Yes /No� � �,�..�„t,m�.a.,��.�.,�,;. � �,_.....�..��.,...��. � � ,�,�. � ,�,�,.�.�.�..�_,.�,.,�.,.,�,...,�.�.,.�,.�.�,.�., .W..�....,�,.�,�.,.....�.��„W,�.�w�,�.,�.� �` � />(,j�S� �y�.{�,� ��(��1" !�"I„T ��. �---� � # Company: t �hc. Contact: 1'� r� �� qo��. y'�� Address: 350--b �'G��w�-� �i/`J �U Sui�c .�s/ City: � � � Gan�ractor � / r �. � State:�Zip: �5��"�/ Phone: '71�3-5,��-�n'�.T Email: �� ovf.19�.n,c�w1 (�n��r"�. � � � License# �C �� 7�.3 Lead Cert�ficate#. ,��.�,.�,�.,.��,�.�.�...�,��.�.�...�.,��r�,�,,�.,. ._m.�.,�. - �.,s.,�,�.�,�.,�..��.��,.. �.�,.ti.�.,�...�,�.,.�..,�.��,��.�. ,�F....�,��,..��....�....�_�,mo�„�,� � If the project is exempt from lead certification, please explain why: W,�..,,�..�. ..�,�...,.a...��_.�..��b�..µ.�4...�.�,��a.��,�.,��..K.,��..��.�. ..w�.,.��., .�:��- .�.�..V,� �d.�,,..�,w.�..�.�.� 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, date and address of master plan: � � t Licensed Plumber: Phone: � Mechanical Contractor: Phone: Sewer&Water Contractor: Phone: Fire Suppression Contractor: Phone: , �N�1`E. PI��s a�d su�}�ort��doc�r�e;��s�h�t yo�s�b�%�are�cv�cfered�o be�p�ab�c��iun. Fort�a�s o� t�re+��`orma�o�►r�ary he c�as��`�d as non pc��i�c rf po�pro�l�e:�ec�hc re��o�s t�ha#3woul�f p�rr��#t�re Cf�y t� .�, ��cor�c{�de t��t�ae ��e t�~a�(e secre#,�, ry�� CALL BEFORE YOU DIG. Call Gopher State One Cafl 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.qopherstateonecall.orq 1 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. Exterior work authorized by a building permit issued in accordance with the Minnesota S t Building Code must be completed within 180 days of permit issuance. X �u�f �rP,��,��.. --' X ApplicanYs Printed Name Appli s Sign ture Page 1 of 3 PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA150488 Date Issued:07/11/2018 Permit Category:ePermit Site Address: 4430 Lakeshore Ter Lot:27 Block: 01 Addition: Cliff Lake Shores PID:10-17785-01-270 Use: Description: Sub Type:Residential Work Type:Replace Description: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 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 - Deborah D Riley 4430 Lakeshore Ter Eagan MN 55122 (319) 270-8759 Holmin Heating & Cooling Llc 3432 Denmark Avenue, #228 Eagan MN 55123 (651) 405-3853 Applicant/Permitee: Signature Issued By: Signature