4494 Lakeshore Ter Use BLUE or BLACK Ink
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I For Office Use �
' � Permit#: � � ��� I
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1� 0 � �� I Permit Fee: �
3830 Pilot Knob Road � �
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 I �
Fax: (651)675-5694 i Staff: i
2015 RESIDENTIAL BUILDING PERMIT APPLICATION
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Date: Site Address:
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������� Applicant is: Owner Contractor
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.�.�$ Q���� Description of work: ��n� �
y Construction Cost: Multi-Family Building: (Yes /No� � �
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� � Company: �t�� (�Ytf.�+� [�w1�.G�d 1� �hc, Contact:/-�`�f y� �� ��"' �
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3 Address: �Sab (�l�G�11�1wv� L�/J � Sulf�. .�s/ City: ,/ l I1�t� �
Con#raeto�r
� State:�Zip: �Sy�'� Phone: '7�3-5.��.vn''�.1 Email: ��� � �o��.I�,�in.c��(.�n��G�✓,�,
� ' License# �C ��� 7�,3 Lead Certificate#
� 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? �
�
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 su��a��tlocu��r���th�yoc����ar�e ca�s�t�red t4 t�p��rr�far�, l�p�o��af
t�i�in�orr�ation r�ra�6e c�s���ed a�nan p����f�t��rro�e spec�rea�or�t�a��t�per�#t�Cl�t�'
co��l�ds t��t t�� �trade sec�+��. ��
CALL BEFORE YOU DIG. Call Gopher State One Call at(651 j 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 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.
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Applicant's Printed Name Appli s Sign ture
Page 1 of 3
Use BLUE or BLACK Ink
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I For Office Use �
� �3 3`� � ►
C��� O� n���� � Permit#: �
� I �� I
� Permit Fee:
3830 Pilot Knob Road � �
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 I �
Fax: (651)675-5694 � Staff: I
I �
2015 RESID�NTIAL BUILDING PERMIT APPLICATION
N��. -�lq� � �, s�.s�z z
Date: � 2 �-S > � Site Address: ��-���.r��y� /-��a �'�" ���r Unit#:
�w� F .�:.Name: r. _�w,°.^1�l`�., ...,��i�,�... S��l'. ._,��.�,.,.d� w . ....���...�d_aPhone: ._�..�,...__��...,�.w,�...,�.�_w�
" � �
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(,)��{;1'' Address/City/Zip: �' � ,lwo<- `��d'�, ct- G�^ /J
�
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Applicant is: Owner Contractor
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� Description of work: J f��i'�
7'yp+e a�F 1�lar� /,�
� � Construction Cost: /�� �' �� Multi-Family Building: (Yes /No� �
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�Y� � Company:�� cS ���4e� �U�%fr���-y��nr. Contact: ���5 vo9 kA.,�, ,�.�.,.�,,�.,.�,�,.�
a �
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� Address: �`5S s� City: �' �j/7�a� • �
Co�a�ractor
� �..�y�% Phone:�G3�.�.Sb-�� Email: L.cf'i.fc� �eJL.� �� � �
:� State:�Zip: . �l3 �.u� �u ���,
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License# ��U o �7 /3 Lead Certificate#:
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� If the project is exempt from lead certification, please explain why:
� _ �,.,.��..�..,�,���..,o.�,.��,�.,��_ ��.....,_.�s,_ _.�,u...���.o�e�.�.,���,,.��..._ �..�.........��. - -
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? �
,
9
�
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�T�:#����$and�r�p�ar���docu�»+en�tfi�a��ou��s��are co�»��ed to be p��r�i�fic x�r�o�tf�. Po�ar�s c�#' ;:k
t�e iu��'�rnra#i��►r���r�e cfa�si�ed a�n�n pe�b�e�`y��pro�v�s�pec��rea�nr�s tha#t�a�r�p�t���:G3�+�a
� c�r��l�r/�#�a�'t�s �re t�°a�le,�c�°e#�. �
CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. CaII 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.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 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 St e uilding Code must be completed within 180
days of permit issuance.
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ApplicanYs Printed Name App c s Si ature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA156422
Date Issued:06/28/2019
Permit Category:ePermit
Site Address: 4494 Lakeshore Ter
Lot:1 Block: 03 Addition: Cliff Lake Shores
PID:10-17785-03-010
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 -
Lorraine M Ovshak
11192 Aspen Glen Dr
Boynton Beach FL 33437
Haley Comfort Systems
4320 Hwy 52 N
West Frontage Rd
Rochester MN 55901
(507) 281-0138
Applicant/Permitee: Signature Issued By: Signature