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4486 Lakeshore Ter Use BLUE or BLACK Ink r----^-----------� I For Office Use � I . ' �yy�� Cl� Ol jl� l,lll i Permit#: �� i � � � � Permit Fee: � 3830 Pilot Knob Road � j Eagan MN 55122 � Date Received: � Phone: (651)675-5675 � � Fax: (651)675-5694 � Staff: i I � 2015 RESIDENTIAL BUILDING PERMIT APPLICATION Date: tZ 1�/ �S/ Site Address: ��l U � ��'""✓✓ ��"` �/� �� Unit#: �.� � Name:�� _.�,n�IYY._�....��....��,._„��.oV��.,��.._.,�.�.�mb..�...�.,a.�,.,�_.�.,...Phone..��.�......w..,...,��..��,�,.� v � Ft�s�ti�#1 � • � �< �j�y��;r; Address/City/Zip: ��"�`'�' � Applicant is: Owner Contractor T�� r� Description of work: ��►'�� ' � Construction Cost: Multi-Family Building: (Yes !No� � � �� ..�,�, � �._ �.., ! � � �� ; Company:J,t�� (�-Ytfi�� (��G�d J� �hc, Contact: �f �'� �� i � > }��f'' � Address: ��GTb ��G�1�1i.w� l,�/� A� Suif�. �.�S/ City: ✓ / � � � C Q11#1'�C#O�' .� � State:�Zip: SSy�� Phone: "7(�3-5.�� .GA'�''1 Email: �� av�.I,��u��'°`'J. �� License# �G �� q.3 Lead Certificate#: ,�....�,.��.��,�_��,.�....�� ..��w,.�,..a��.��...�.�,�.�.,.m..�.,.,��,.,�.�.,�..��.,�.�..�..�,.�...,.�..�....�.,�..,�,.....o...m.,��,�...w.� �..�.,. If the project is exempt from lead certification, please explain why: 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? a � Yes No If yes, date and address of master plan: � Licensed Plumber: Phone: � Mechanical Contractor: Phone: Sewer&Water Contractor: Phone: Fire Suppression Contractor: Phone: �N�T�':P��s a�d��ar��tlaocu�er��s tha�ya��i�aree can�r�ed to�e p�ta��. Pc3�o�s o� ' t�e�n�'�rr��on r�a�r be c#�ss��etl a�'nur�p��b��%��a�r p�o�e�pec�c r�a��t��a#�airl�per�t t�t�;C�t� e�rr�d�r#e��i�t'i�e are trade�e��, CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. Ca1148 hours before you intend to dig to receive locates of underground utilities. www.qopherstateonecall.orq 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 1 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 �(.t�,5� �YP.(��v��-� x Applicant's Printed Name Appli s Sign ture Page 1 of 3 Use BLUE or BLACK ink r-----------------, I For Office Use � ' � Permit#: � � � ! i Clt� of �� Permit Fee: � 3830 Pilot Knob Road � � Eagan MN 55122 � Date Received: � Phone: (651)675-5675 I I Fax: (651)675-5694 � Staff: I I I 2015 RESIDENTIAL BUILDING PERMIT APPLICATION p ll 5�.1�z Z. Date: � � �-S �T� Site Addres�d�-7�� r%r-��.T��y� �WR �"` ��N Unit#: � , �_Name:��._.'V�;;-I�/"�.,_ �r�(�i�,...... 5��1'�.....a_A..�w...�_., , .�u.H�,.�M Phone: �,�.,,.�,...�,�.�...,�d..�..,w..,�.,�� R�i�isn�l g . �1�o� � �� /� .� a SS/az � ��Vi��i' � Address/City/Z�p: D �Gf✓�<.I�•�c.ovL � lJd� cc.. C� C�--. ' Applicant is: Owner Contractor � �,�,,.��,»�...�,u_...�.�. _,,_.�.,�.,.�.�....e.�,_.,�.,..��,�...�.� �,,,.�_a......��...�.�,..�.�.,��,. � � � Description of work: �C��h .Yµ � Type of w�ork ,, � � � Construction Cost: /7� �' �� Multi-Family Building: (Yes /No� � �,�.� ��..�.��_.m.,�d.�.��. �,.,.��.,,�.........m�.�...�,. ._.,....�,�, .� �.. ,� �..� � ' � Company: �� f C U�r.v�-/ ��'I+%�'r�� nc. Contact: ��5 ��`09� � � � ��J � CO#�t'�C#=UP � Address: JJ� ��s�ta��, G� l�� s�f` �sr c�ty: �'��/�w� • � � State:�Zip: �Sy�7 Phone:��3-'S.S6-�� Email: L�'�.1��e-1Z.�°..��,.�(�ey�,/lu��,r� , �� License# ��v � �a 7 �!3 Lead Certificate#: �,.,��.�„_,�.W„�.„.,w� �,�.�,,�_��,a.�,,.��,��.�..��,....�,z�..�.��..�.��A.�,,,�.�..�.��.�._.�.�..�.�.��.,�.�.,.o...,�.�:�.,�,.�.,�,,.�.,�.�a..e...�..��..�,.,� If the project is exempt from lead certification, please explain why: 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? g � ; Yes No If yes, date and address of master plan: � � Licensed Plumber: Phone: � Mechanical Contractor: Phone: Sewer&Water Contractor: Phone: Fire Suppression Contractor: Phone: .�lV�JT�:#'�s a�d��vort��g+docu��rr�s tf�a�yo��u�b��re ca��r•ed�tr be ptrbl�c i�#ri�raa��. Po�cu��af � t�►�i�r�'nrr�a�i��s c�a�s��ed�r�;�n p��if y��pro��l�e�pec�c r�aso��at��!pert�i�t t�e C�ta �,.,�,, __:� � c�r��,ol�a i�hat t� are�te s�e#s. CALL BEFORE YOU DIG. Call Gopher State One Call 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.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 will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Exteriorwork authorized by a building permit issued in accordance with the Minnesota S e uilding Code must be completed within 180 days of permit issuance. ��'.� / d�(��—c� �..—� x X Applicant's Printed Name App c s Si ature Page 1 of 3 PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA136846 Date Issued:06/02/2016 Permit Category:ePermit Site Address: 4486 Lakeshore Ter Lot:5 Block: 03 Addition: Cliff Lake Shores PID:10-17785-03-050 Use: Description: Sub Type:Residential Work Type:Replace Description:Water Heater Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). 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 - David G Koepp 15260 Ventura Blvd. #1040 Sherman Oaks CA 91043 (651) 452-6361 Genz Ryan Plumbing & Heating 2200 West Highway 13 Burnsville MN 55337 (952) 767-1000 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA159053 Date Issued:11/19/2019 Permit Category:ePermit Site Address: 4486 Lakeshore Ter Lot:5 Block: 03 Addition: Cliff Lake Shores PID:10-17785-03-050 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 - Patricia A Hartman 4486 Lakeshore Ter Eagan MN 55122 (651) 666-2572 K & S Heating, A/c & Plumbing Llc 4205 West Hwy 14 Rochester MN 55901 (507) 282-4328 Applicant/Permitee: Signature Issued By: Signature