4261 Carlson Lake Lane NBUILDING PERMI
CITY OF EAGAN
3830 Pilot Knob Road, P.Q. Box 21-199, Eagan, MN 55121
....?
?i 2
11q?9
PHONE: 454-8100
T r Receipt #
To be used for vAAAGE Est Value $3,200 Date MAY 20 , 19
Site Address 4261 NO C:A1ZI.SpN LAiS
?JILVEIiN
Lot 25 Block 1 Secisub E LN Erect [3L
£SS ktUN Remodel ? Occupancy t'll
Zoning itr,l
.
Parcel No. 5'rH Repair ?
Addition ? Type of Const tvn
No. Stories
a Name Ui?IdNIS &.TOlrii??] LiL Move ? Length 12
= SAXL Demolish ? Depth Z?
o Address I
I
? Ft
S
City •Phone 452-1608 nt
mpr.
Install ? q.
.
¢
o
SAi•f
E
Name Approvals Faea
o? .
-_
Address Assessment Permit $44.50
` City Phone Water 8 Sew. Surcharge 2.00
1-01 Police Plan Review
F = Name Fire SAC
¢ = Address Eng. Water Conn.
`W City Phone Planner Water Meter
Council Road Unit
Iherebyacknowledgethatlhavereadthis'applicationandstatethatthe BIdg.Off. 5/20/8 Tr. PI.
information is correct and agree to comply with all applicable State of
Minnesota Statutes and City of Eagan Ordinances. APC Parks
Signature of Permittee VaY. Date Copies
7otal $46.50
A Building Permit is issued to: DENN IS & JOANIV LEE on the express condition that
all work shall be done in accordance with alyapplicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official `?? '
I I wm,n No. I wrmn Maa.r I oaee I TN.vho- # I
Hty.
"tY•
Plbg•
Occ.
Frmg.
Dlsp.
PERMIT #
MECHANICAL PEFiMIT RECEIPT t1
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: _
PRICE: 51. ..... PHONE: 454-8100 FOr OffICe L
m Name
.g Addre;
c Ciry _
? Name
3 Addre
p CitY -
'TYPE OF WORK
Forced Air
Boiler
Unit Heater
Air Cond.
Vent
Gas Piping Outlets #
Other
M BTU
M BTU
M BTU
M BTU
CFM
I
BLDG. TYPE WORK DESCRIPTION
Res. ? New
Mutt. Add-on Comm. Repair
Other
FEES
RES. HVAC 0-100 M BTU -$24.00
ADDITIONAI 50 M BTU - 6.00
(RES. HVAC INCLUDES A/C ON NEW
CONSTRUCTION)
GAS OUTLETS (MINIMUM - 1 PER PERMIn - 1.50 EA. ;
COMM/IND FEE - 196 OF CONTRACT FEE ?
APT BLDGS. - COMM. RATE APPLIES
TOWNHOUSE & CONDOS - RES. RATE APPLIES ?
MINIMUM RESIDENTIAL FEE - ALL ADD-ON 8 ?
REMODELS - 12.00 i ?
MINIMUM COMMERCIAL FEE - 20.00 7
STATE SURCHARGE PER PERMIT - .50 -- "y
(ADD $.50 S/C IF PERMIT PRICE GOES ?
BEYOND $1,000) ?
R
FEE L
SI RM E
S/C: "
TOTAL: ??' '? ? FOR: CITY OF EAGAN
?? ?-.?
?1,??/9-7
4261 N Carlson Lake Lane Ea an
Section No. Town ship Name or No. Ra nge No. Cou My
Dakota
Occupartl(PRINT) Phone No.
D is Lee 452-8886
Power Suppiier pdd ress
Electrical Conhactor (C ompany Name) CoM ractar's License No.
Mailing Addrggs (Con4actor or Owner Making installation)
1 Aq'A Ch=T.inco Dra _ G•-..
Mm
;D W ELECTRICITY ? THIS INSPECTION REQUEST WILL NOT
oom S-173 BE ACCEPTED BY THE ST.4TE BOARD
Iaul, MN 55104 UNLESS PROPER INSPECTION FEE IS
ENCLOSED.
,f'f ?8..?7?
%W
" uyn
T J?.
I
)I7 FPP APIf1W' UO b f? 2O(? 771
Circuits/Feeders
700 Amps
Ircigation Booms
Special Inspection
Alarm/Communication
()thar Fao ?
been made.
)FF7CE USE ONLY
'his request wid 78 months from
__ --- - -- - .? , _? --- -- --' -_ -- ----
CITY OF EAGAN Remarks
Addicion W lderness R n Sth Addition Loc 25 Rik 1 Parcel lo 84354 250 01
Owner rli 5treet 4261 No. Carlson Lake Ln. Scate Eagan, MN 55123
?
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK t 1973 $132.60 $6.63 20 3aS? 9 S/?
SEWER LATERAL
WATERMAIN
WATER LATERAI
WATER AREA
STORM SEW TRK ,^ 1981 247.57 24.20 1$ O C''Ia3 IG "-9
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. $320.00 3368 7-8-76
HUILDING PER. #4010 3368 7-8-76
Sac 7-5-76
PARK
Czrrf OF a,CI:rz
3795 Pilot xnob r^.oaa
Ea?an, A11-nnescta 55122
PERMIT NO.: 700
T'ie City of Eagan hereby grants to Louie Ii. Peter Co.
of 1854 Gzan3 Ave. ,
PLU14EING Permit for: (Owner) Tilsen Aomes
Lane (NOrth) u ;,4235 14261 Carlson Lake , pursuant to .:pFlication dated _ 7/20/76___
c2e Pai.d: _ $40.00 dated this 21 day of July . 19 76__
1.00 s/c
Euilding Inspector
b'zchar.ical Permits:
Did _ct:;l:
VILLAOE OF EApAN WATER SERVICE PERMIT
3795 Pilot?i 'nob Read PERMIT NO.: _.2027
Eagan,MN 55122 DATE: 7129176
Zoning: RII No. of Units: 1
Owner: Tilsen Halnea
Address:
Site Addresa:4261 NO. Carlson Lake Ln' L25B1 WRS
Plumber. _Bey!!_I?oc - Peter Plb q. :60.
Meter No:--7-'' -' 4; G G 6 i! Connection Charge: 160.00 13d
Size: ?r Account Deposit:
er No.: Permit Fee: 10. 00
/
I,ag??r??e--a to co ply with tha Vilkye of Eayon
O
e??? G Surcharge: .50
60
00
rd t?e7K .
Misc. Charges:
\ 1 ? C TotaL
By Y t' Date Paid:
Date of Insp.: - Insp.:
YILLAGE dF EAOAN SEWER SERVICE PERMIT
?gf)ff -?a77'
M
3795 Pilot Kno6 Road IT NO.: _.
-
PER
Eagan, MN 55122 DATE: ?/2q/76
Zaring: RII No. of Uni[s:
Owner: m; 7 ae.. sxnmcQ
Address:
Site Address: 4261 ._ __,,... _ r-+-- . 125R7 WRS
Plumber: Bey-Roc - Peter Plbg.
7/8/76 #3368 100.00 pd
I agra, fo eomplY with tM Village of Eagan Connection Charge: 350.00 pd
Ordinuneas. Account Deposit:
Permit Fee: 10.00
Surchazge: . 50
gy. Misc. Charges:
Dace of Insp.: TotaL• -
Insp.: Date Paid:
6 9 (qg
2005 RESIDENTIAL BUILDING PERMTI' APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX 4 651-675-5694
o
New Construdion Reouirements RemodellReoair Reaulrements Offce Use Onlv
3 registered site surveys showing sq. fl. of lot, sq. ft. of house; and all roofed areas 2 copies of plan Cert of Survey Reoi _ Y _ N
(20%mazimum bt cove2ge allmved) t set of Energy Calculations foi heated addifions Tree Pms Plan Recd _ Y _N.
2 copies of plan showing beam & windaw sizes; poured found deslgn, etc. 7 sAe survey for additions & decks Tree Pres Required _ Y _ N
1 sel of Energy Calculations AddRion • indicete it on-site septic sysfem On-s@e Septic Syslem _ Y _ N
3 copies W Tvee Preservation Plan if bt plaried afler 711193
Rim Joist DefaN OpGons seleclion sheet (buildings with 3 orless units)
Date 5' l 0?5 / o <
Site Address 14aU ? jj!'j/'•j•}'1 C(1 {` (?? Construction Cost _24 cR (0 V
'j Y) LQ ,t] -Q Unit/Ste #
Description of Work I 10 "(L) p'^
Mutti-Family Bldg _ YXN Fireplace(s) _ 0 _ 1 _ 2
Property Owoer D24n l S d 5 0Ct /I 1? VLO (_? Telephane #((pSr ) y5 oZ ?41,90 e
concCaccor Renct ' l'a rs
Address y ?
State mti
Zip 553IL9 9 ?/
CitylJfOUe
Telephone #(7b 3) 7,fp ' aDOC')
COMPLETE THIS AREA ONLY IF CONBTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 _ Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(4 submissiontype) Submitled Submitted
• Energy Envelope Calculations SubmiHed
Have you previously constructed a building in Eagan with a similar plan2 _ Y _ N if so, 25% plan review
fee appliet.
Licensed Plumber
Mechanical Contractor
Sewer)Water Contracfior
Telephone # (
Telephone #(
Telephone #(
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the oxdinances and codes of the City of Eagan and the State of MN
Statutes; 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.
?
A 11
&e4b-124
Applicant's Prmted Name Applicant's Signature I 'YiW ?8 2005
?
L ? ? ? Q ' ?? RESIDENTIAL
?t?as
BUILDING PERMIT APPLICATION
?FILED NOU 25 2%%0 PILOT KN B RD, EAGAN MN 55122
651-681-4675
NewConstructian Raoulrements
• 3 registered sRe surveys showing sq. fl. of lot, sq. ft. of house; aM all roofad areas
(200/o mar,imum lot coverage aliowed)
• 2 copies of plan showing beam & window sizes; poured found design, etc.)
• lsetofErrergyCalculaUons
. 3 copies of Tree Preservation Plan if lol platted afler 711193
• Rim Joist Detail Options seleUion sheet (bldgs wilh 3 or less unils)
RemodeUReoair Reauirements
• 2 copies of plan
• 1 set of Energy Calculations for heated additions
. 9 site survey (or exterior additions 8 decks
• IiMicate if home served by septk system for additions
DATE 11-a --:s0Q
VALUATION 't 31POD99
SITE ADDRESS 4o'Zl2l hl ('n,!' )`)o/1 Lako I„nl MULTI-FAMILY BLDG _Y ? N
TYPE OF WORKWjnAtx.l 10 (i1'o 4- FIREPLACE(5) _ 0_ 1_ 2
STREETADDRESS 24100 - [1!)P• All 5?i?_ AIacLCITY r uk1 r TATE `Irt\ZIPr_-'5'LkL.IS
TELEPHONE #llo3-?I?S-?_,?_ CELL PHONE # 7A3-39/-831 3 FAX # 7103- 39l ' a3to0
PROPERTYOWNERDenrtir..l. Sr.n„n LaP TELEPHONE#? ?S<<=i-l.S0-I11)b'R
------------°-----------------'-""_"""""-------------°-'__"'--------------""_"'°-
COMPLETE THIS SECTION POR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RUI.F.S 7670 CATEGORY 1 MINIQESOTA RULES 7672
(J submission type) . Residential Ventilafion Calegory 1 Worksheet Su6mitted • New Energy Code Worksheet Submitted
• Energy Envelope Calculations Submitted
Plumbing Contractor. Phone # _________
Plumbing system includes: Watcr Softcner Lawn Spiinkler ree: $90.00
Water Heater No. of R.I. Baths
No. of Baths
Mechanical Contractor: Phone #
Mechanical system includes: Air Conditioning ree: $70.00
Heal Recovery System
Sewer/Water Contractor: Phone #
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply
with aR applicable State of Minnesota Statutes and City of Eagan Ordinances.
Signaiure of Applicant
"-"'-""--'-""----7 -7'-'_'-'j'?."'-'
------------------------------------ -°------------------- ------ --------------------
-------------- ----- --
OFFICE USE ONLY ? I
CeAificates of Survey Received Tree Preservation Plan Received _ Not Requiretl
?a"' J Updated 4102
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
BUILDING PERMIT
Assessment
Water & Sew.
Potice
Fire
Eng.
Planner
Council
eidy. on. 5/20/8E
APC
Var. Date
Receipt q
7o be used for GARAGE Est. Value $3,2 0 0 Date MAY Z 0 ,1 g 8
SiteAddress 4261 NO CARLSON LAKE LN Erect L? Occupancy Ml
Lot 25 Block 1 Sec/Sub. WILDERNESS RUN Remodel ? Zoning R1
Parcel No. STH Repair ? Type of Const._.IZ ;-
Addition ? No. Slories
Name DENNIS & JOANN LEE Move ? Length
]
- S?E Demolish ? Depth 22
?
, Addies, Int.lmpr. ? Sq.Ft
Ciry Phone 452-1608 mstau ?
? Name SAME
i
$ c Address
a
? Ciry Phone
?Q
F W Name
u ? Address
a W City Phone
I hereby acknowletlge thaf I have reatl this application and state that the
information is correct and agree to comply with all applicable State of
Minnesota StaWtes and Ciry ^of Eagan Ordinances. ?p
, Signatureo(Permittae?f?ny+--?- Ll.YC?
.ii A Building Permit is issued to: DENNIS & JOANN LRF
all work shall be done in accordaaee.with . oolica6le 9tatp'kif Minnncn
N° 11989
n Z--) i, ?
Fees
Permit $44.50
SUfChafg@ 2.00
Plan Feview
water Conn.
Water Meter
Road Unit
Tr. PI.
Parks
Copies
7ota1 $46.50
on the express condition that
Statutes and Ciry of Eagan Ordioances.
Building Oflicial ?-?--°-
?
1986 BiIILDIffiG PERlfIT APPLICAYION - i
NOTE: ALL CONTRACYORS MQST BB LICfiNSBD llITH THS CITY OF EAG6N
SIHGLE FAFIIC.Y Di1EC,LINGS
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS
HQLTIPLE DiiELLINGS - RESIDENTIAL R6NTAI. UNSTS FOR SAL6 IINITS
INCLUDE 2 SETS OF PLANS, CER
1 SET OF ENERGY CALCULATIONS
CO1+AfERCIAC
OF SQRVEY - CHECK WITH BLDG. DEPT.v
ZNCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONS,
$2,000 LANDSCAPE HOND
S
To Be Used For: 6qp_ q, f' Valuation: zad6?=av Date:
Site Address ?a ? i N. c,???a•? zx
Lot -v ?- Block ?
Parcel/Sub
Owner U FlVNSS -°F Jo i+NN LE1F---
Address yL(o/ A). ?f"eSorr CK?fJ.
City/Zip Code ff16Ai`-) s S/ 2-is
Phone yS ? -/(a o ?
Contraetor 0 WNf?-
Address 2(c / N. CA-,2tS ar-, LKc- n?
City/Zip Code FA-64ri SS/Z?
Phone 4&.2 -/lo o(p
Areh./Engr. S f}rnF w S "C}8a?j'C
Address
City/Zip Code
Phone lF
Erect Oceupaney {%'//
Remodel Zoning 77-
Repair _ Type oP Const ?
Addition # of Stories
Move _ Length ?-
Demolish _ Depth 2L
Int.impr. Sq Ft
Install
APPROVAIS FEES
Assessments Permit yyi SD
Water/Sewer Surcharge 'L
Police Plan Review
Fire SAC
Engr Water Conn
Planner Water Meter
Council Road Unit
Bldg Offf Treatment P1
APC Parks
Variance Copies
1Y)T9L
NOTE: ADDRBSSES EDR CORNER LOTS - CONTRACTOR/HOMEOfiNER MQST DESIGNATS WHICH ADDRfiSS
IS DfiSIRED. NO CHANGES iIILL BE ALLOiiED ONCE BOILDING PERMIT IS ISSDED.
..
CITY of EAGAN ni2 4010
O wna: .. rLC.1?uw .....!??-?a."c..°?/?.:?!KGe...... ...............°•
Addrese (PresanS) suilaer ...................rS2.LY ./.h2?........_.............................................
Addreas ..............................................................................................
BUILDING PERMIT
3795 Pilo! Kxob Road
Eagan, Minnesoia 55122
454-8100
Dale ..i.Y... . f....... ..................
Sioxies To Ba Used For Fron! Deplh Heigh!
I Es2. Coe! ermit Fea Remasks
- -- 3 i?.--su
`_?_°?
This permit does not auihorize the use of sizeeffi, roads, alleys or sidewalks nor doee i! Bive the oaaes or h4 ageat
the righ! Yo creafe any aituation whieh is a nuisance or whieh preseals a hasasd !o the heallh, aafeYp, eoavenienes aad
ganeral melfare !o anpona in the eommunitp.
THIS PERMIT MUST BMEPT ON THE PREMISE WHILE THE WOAK IS IN YAOGRESS.
This ia !o eerlifp, !hal... 44k'k.'w./...A'4? ......................... haepermiesioa 3o ereet ........ _.._upon
the above described premise subjec! !o the provisions of all applicable Ordinanees fos the Citp of Eagan.
.l..TC.....?G"?:f. ............. ........--°°-........................... Pez ..-°- ???:.'leYl---.............?.?...............
May or Svilding Inapaeto
DAmL;
BUILD:NG PE:IIITT AP: UCn:;:TM? CHECK
Loti? Block? Additiaa
Parcel and section number _
Street//, ?? che1,u
OwnerPi., Address
Developnr zlp ?. Adczressr
?
Zone-Orc3inance #52
Lot S:ize
Total area
Y.
Platted Unplatted
Builcling 83ze X
Occupan.cY 4L ?0--
Typ8 O£ CC??St,Y'11C't7.Ori
Setbacks: Street sides
` Sides
Rear
Paric.r..ge Total area
Park_ing area set6acks;
Street side ftear
Landscape appraval
Special Assessments:
.`?in"' Ch3Tge
Total
'Y,?,lL.
Te:Le
To+,al -rea
spaces
S3es %
d
Bond required
@ $450.00 =
/
Water areao
9ssessed Unassessed?
If assessed: Connection charga
If uiZassessed: Connection charge
Lot divisiona
Additional assessments needed
Lateralsc
Assessed
Not needed
Not assessed
Waiver of hearinga
Needed Not needed
Assessment clk !^later & Sewer Dept F3uilding Dept
i
0
Police Dept Fire Dept (Comm & Ind only)
!
en Homes, In
SOUTH SNELLING AVENUE
PAUL, MINNESOTA 55116
PHONE: 698-5501
SUbj6Ct yutf?aLlYJ Date 's o2ta °,26
MessBge
dA
?
?.
PLEASE REPLY TO Signed Ali?zt,
Repty -
Signed Date
Form No. QL3 SEND PARTS 1 AND 3 WITM CARBON INTACT - PART 3 WILL BE RETURNED WITM REPLY
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rRoNT'_?Roi?FfZ..TY___ LINE ? I
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V`?- LUT -PL AN
MASTER CARD
IOCATION
OWNER
STRUCTUR: AND
LAND USED AS
Permii
No.
Issued Issued To
Contractor I Owner
BUILDING youio 7- } 9G I _,?? I
PLUMBING
CESSPOOL - SEPTIC TANK
VJELL
ELECTRIGAL
HEATING
GAS INSTALLING I
SANITARY SEWER I
OTHER
OTHER
Items Approved
(Inifial)
Date
Remarks
Distance From Well
FOOTING SEPTIC
FOUNDATION
i CESSPOOL
FRaMING TILE FIELD FT.
FINAL
ELECTRICAL
HEATING
I,`17-JL DEPTH
OF WELL
GAS INSTALLATION
SEPTIC TANK
CESSPOOL
DRAINFIELD
PLUMBING WELL
SANITARY SEWER
10
-
? ?
Violations No}ed
on Back
COMMENTS:
Use BLUE or BLACK Ink
� r------�----------�
I For Office Use I
� � Permit#: � ��� �T I
Clty of ����� ; . i%l, � �� �
Permit Fee: !U � I
3830 Pilot Knob Road � �
Eagan MN 55122 � Date Received: � � � I
Phone: (651) 675-5675 I I
Fax: (651)675-5694 I Staff: �
I I
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
.� ( )
Date: Site Address: C�\Q �V1 1�.� L Unit#:
Name:_ �� ��J �� Phone: +e�'`��� �Q f`�?�
Resident!
' Owner ' Address/City/Zip: _ �/�.��
;! Applicant is: Owner ontractor
Type of'Work ' Description of work: °�
Construction Cost: Multi-Family Building: (Yes /No_�
p Y� � Contact:
Com an � "' � `� ��G�1�t..Q,�
COtltt'1CtOr Address: ��J �W� ��— � City: �� �
Statel"1�ip�>_���O Phone:��`"(��il:
License#:_f�'.r-� �V�✓�� Lead Certificate#:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
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:
NOTE:Plans and supporting documents that you submit are considered#o be public information. Portions of
the information maybe classified as non-public if you provide specific reasons that would permit fhe City to
conc/ude that they are#rade secrets.
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.popherstateonecall.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 State Buildi g Cod e completed within 180
days of permit issuance.
x � Gv X
ApplicanYs Printed Name Appl' s Sig ature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA171741
Date Issued:08/30/2021
Permit Category:ePermit
Site Address: 4261 Carlson Lake Lane N
Lot:025 Block: 001 Addition: Wilderness Run 5th
PID:10-84354-01-250
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507)
210-0754.
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 -
Dennis A & Joann M Tstes Lee
4261 Carlson Lake Ln
Eagan MN 55123
Haley Comfort Systems
3708 Broadway Ave N
Rochester MN 55906
(507) 281-0138
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA175184
Date Issued:03/17/2022
Permit Category:ePermit
Site Address: 4261 Carlson Lake Lane N
Lot:025 Block: 001 Addition: Wilderness Run 5th
PID:10-84354-01-250
Use:
Description:
Sub Type:Water Heater
Work Type:Replace
Description:Standard Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
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 -
Dennis A & Joann M Tstes Lee
4261 Carlson Lake Ln
Eagan MN 55123
(651) 452-1608
Clearwater Plumbing & Heating
19260 Mushtown Rd
Prior Lake MN 55372
(952) 440-3779
Applicant/Permitee: Signature Issued By: Signature