4341 Medary Ave7
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
PERMIT. Sl1BTYPE:
PERMIT TYPE:
Permit Number:
Date lssued:
APPLICANT:
TYPE OF WORK: Rk,I,Art?
I " I . , ' ! tW i .a. 4 Pt:aouf ?
° =r e
V
d
Permtt Holder Dete Telephone #
PLUMBING
HVAC
Inspection Date Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING ?
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYPBOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
DOMESTIC
METEF
IRRI6ATION
METER
FLUSH
MAINS
coNOUCnvin
TEST
HYDROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
CITY OF EAGAN Remarks
Addition RiVPS H111S 9th Lot § Blk ?-Parcel ?246 6#400 060 03
Owner i' . ?ri"! I Street 4341 Meddly Ave. State Eaaan.MN 55122
improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
i SAN SEW TflUNK
*SEWER LATERAL
i
WATERMAIN
*INATER LATERAL
WATER AREA
STORM SEW TRK
*STORM SEW LAT 1,976 3
CURB & GUTTER
SIDEWALK
STREET LIGHT 1980 ?^y$Q 13.56 $
WATER CONN. $r 3V 205.00 1362 10-117-75
BUILDING PER. 1362 10-75
sa,C -75
PARK
I
ve?L"'GE OF EAGAN WATER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.: 1911
Eognn,MN 55122 DATE: 12/15/75
Zoning: RII No. of Units: 1
Owner: Wi nrjgor nPV Cprp_
Address: -
Site Address: 43Q1_1
Plumber: Thom?. Son Pl
Meter No?2'd/?
Size: ? d
Reader No.: ??7 7 ?pZ'o
1 agree to compl /witb the Village of Eogan
Ordinanees. /(? 117
?
r--?
gy d-'M
Date of Insp.:
Connection Charge: 205.00 Pd
Account Deposit:
Permit Fee: 10.00 bi e
Surcharge: .50 i e
Misc. Charges: 60.00 pd
Total:
Date Paid:
Insp.:
h«aE oF E?oaN SEWER SERVICE PERMIT
3795 Vilot Knob Road PERMIT NO.: 2668
Eagan, MN 55722 DATE; 12/15/75
7,oning: RII No. of Units: 1
Owner: Windsor dev. Corp .
Address:
siee Addreas: 4341 Medary Ave. L6 B8 RH 9th
Plumber: Thompson Plumbing Co.
10/17/75-#1362
I agree ro eomplr with the ViIlape of Eogan Connection Chazge: 425.00 pd
Jrdinanees. Account Deposit:
Permit Fee: 10.00 billed
Surchazge: • 0 b11 ed
3y: Misc. Charges: ?
7ate of Insp.: Total:
nsp.: Date Paid: ? -
.
?
CITY OF EA JAN
3795 P11ot Knob Road
Eagan, Minnesota 55122
PERMI'F N0. t ?e,_
The City of Eagan hereby grants to 496yS"_ '
Of
a Permit for: (Owner)
22f?9.,,Clark St. &
8t d3j17Medarv Ave. , pursuant to application dated 114 .
Fee Paid: ,$40.00 dated this 7 day of NOv. , 19 75 .
1.00 s/c
. ..ti. Q???laiflef TTCTCl?+AI'?
cIi'Yr .,, 16? &VeloC> l`)(aG e,3`
'1.1_Ot, D!c;YJ ,",v:Cl /C!I-e/'/v/z%f 9tl)/
Ci4-- ? .
o, _,-n I=r ?
??; to Thompson Plu-hinq Oo_------
c: i
a PLUPff3It.G ?'s',;-,it fo,°
1?2^l. "!i.nnetonY.a P?1_v('..
Windsor Dev. Corp.
a? _ Ml e?'az? - 12/15/75 .
Billed: r _- --------
.'(2e 4«-r o,r r•?c. J? 75
s/c --- ? « -' -------
.i?il_ii.,?
- --- . - _r?l :
CITY of EAGAN
BUILDING PERMIT
Ownes _..
Addrecs (presen!)
.!.:.`.:?
Hailder .......
Address .............:
.
?
..........................
?.?..?'.:.1?.??..
..........................
DESCAIPTiON
?
.; ?.
N2 3771
3795 Pilot Knob Road
Eagan. Minneso3a 55122
454-8100
/ s?
a8t. .? . ?LC.1-
? /fn -.-••.................
5losiecI To B
e Used For
? Fron! Depth Heigh! I Esl. ost ermit Fae Romaslu
?
-
- ,?
? '"J
°77
LOCATION
SireOt, Road ot oiher Deseription o1 Loeatton I Lo! I Bloek I Addltioa os Tsact !
"3yi
C`? 13
This permit doas noi aulhoriag the use of streets, roads, allays or sidawalke nor doos i!`?ihe odx per or his ageat
the right to ereate aay siYuation which is a nuisance ox which presents a haaard !o the health, aafely, ¢oavenianes aad
ganeral welfare 3o anyone in the eommunily.
THIS PERMIT MUST BE KEP QN THE PISE( WHILE THE WO]
This is to eertify, thal....?-?.:?.«-s.. ....... haspermissla
the above described premise subject_. the pxovisions af all applicable Or
4-
.
c..............? ... ..... Per .---?--?
Mayor
/6 /e s?,?46 4106 v?
C=Y OF E;,G.3N
37 ,5 Pi.1ot Yneb Poad
Eygan, Ninnesota'55122
PEPMTT N0. a 11
The City oi Eagan hereby grGnts to Milbert Co• (Culligan)
of 1001 Marie Ave., So. 5t. Paul 55075
? Will Jeffrey
a_gg?gr sogt8ner.A Permit for: (OGmer) Lee Weiss
3 1 Medary Ave.
wt „766-?yar Sluff Ct. pursuGnt to appiica+ion da-ted 2/9/76
Fc-e $10.00 dF>ted this 23 day of _Feb. , 19_76`
1.00 s/c ?
Mechanicwl Permits:
Bid Total:
?-T ?a9
??qL)
6--q D ? Z)
RESIDENTTAL BUILDING
Permit Applicatiou ?
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5674
? ?S 7 aS
New Construction Reauiremenis RemodeUReoair Reauirements Office Use Onlv
3 registered site surveys showing sq. ft of lot, sq. ft of house; and all rooted areas 2 copies of plan Cert of Survey Recd
(20% maximum lot wverage allowed) 1 set of Energy CalculaGons tor heated addi6ons Tree Pres Plan Reod
2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks Tree Pres Not Reqd
1 set of Energy Calculations Addffion - indicate i/on-site septic system _ On-site Sep6c System
3 copies of Tree Preservation Plan if lot platted after 711193
Rim Joist Detail Options selection sheet (bldgs with 3 or less unifs
Date 04 / -Lv a
Construction Costi 6
Site Address r Q f l? Ve
T- ., UniUSte #
\
DescriptionofWorC-A?e(npo ik, -_?p p`d c O 3W1tXdpca5 A, LO C!?.A (?)UA 61L'C?P
Cn ? ??
Property Owner A !rN NLN, P +4::c c?' Telephone # ((prjJ ) $ $ o? - 4P EoZ ?
Contractor wh1?Am_o dQ?A-1Nl
Address 'R ?tpp - tg_ld?% AISP ?(03 CitY r?t]Yiu n f'L
State"?, yCs Zip :4:;.?5q 41 S_ Telephone # (?( ) ?$a ^ (oc? c?' ?
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category
• Residential VenGlation Category 1 Worksheet • New Energy Code Worksheet
(J submission type) Submitted Submitted
. Energy Envelo e-?Calculations- i ,d
? ?°
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone # (
Telephone # (
Telephone # (
I hereby apply for a Residential Building Pernut and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances 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.
Okis+i,, HeuPc ?.c?r1
Applicant's Printed Name plicant's Signature
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.)
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.)
? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screen/gazebo)
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
Work Types
? 30 Accessory Bldg
? 31 Ext. Alt - Multi
? 33 Ext. Alt - SF
? 36 Multi Misc.
? 31 New ? 35 Int Improvement ?1 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Altera6on ? 37 Demolish (Bldg)' ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement •Demolition (Entire Bldg) - Give PCA handout to applicant
Valuation Occupancy MC/ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new bldg) _ FinaUC.O.
_ Footings (deck) _ FinaUNo C.O.
_ Foorings (addition) _ Plumbing
Foundarion HVAC
Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests _ Final
_ Framing _ Siding Stucco Stone
_ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement)
_ Insulation _ Retaining Wall
Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
Building Inspector
RESIDENTIAL
BUILDINC PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New Construction Reauirements RemodeilReoair Reauirements
• 3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas • 2 copies of plan
(20% mazimum lot coverage allowed) . 1 set of Energy Calculations for heated addi6ons
• 2 copies of plan showing beam & window sizes; paured tound design, etc.) • 1 site survey for exterior addilions & decks
• 1 set of Energy Calculations . Indicate it home served by septic system for additlons
• 3 copies of Tree Preserva6on Plan 'rf lot platted after 711193
• Rim Joist Detad Op6ons selecdon sheet (bldgs with 3 or less units) '
DATE 0141D VALUATION Zempo, go 0
SITE ADDRESS
TYPE OF WORI
APPLICANT
STREET ADDRE
TELEPHONE fi
IULTI-FAMILYBLDG _Y _N
FIREPLACE(S) _ 0 O_ 2
CELL PHONE # NY/ "17` 7 FAX #
PROPERTYOWNER ?i7V?II(? Vf•??f'J/q'? TELEPHONE#
COMPLETE FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RULES 7670 CATEGORY i MINNESOTA RUI.ES 7672
(4 submission type) • Residential Ventilation Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted
• Energy Envelope Calculations Submitted
Plumbing Contractor: Phone #
Plumbing system includes: _ Water Softener _ Iawn Sprinkler
Water Heater No, of R.I. Baths
Fee: $90.00
A No. of Baths
Mechanical Contraqi • ? ? Phone #
Mechanical system includes: Air Conditioning Fee: $70.00
_ Heat Recovery System ??'- -- -! ^ ?I'
n'
?
Sewer/Water Contractor. Phone
,
I hereby acknowledge that I have read this application, state that the information i o[r_ecf._and-agreeto rompiy
with all applicable State of Minnesota Statutes and City of Eagan es.
Signature of Applicant • ?
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4/02
OFFICE USE ONLY
? 01 Foundation
? 02 SF Dwelling
O 03 01 of _ plex
? 04 02-plex
? 05 03-plex
? 06 04-plex
? 07 05-plex ? 13 16-plex
? 08 06-plex ? 16 Firepiace
? 09 07-plex ? 17 Garage
O 10 08-plex ? 18 Deck
? 11 10-plex ? 19 Lower Level
? 12 12-plex Pibg_Y or _ N
? 20 Pool
? 21 Porch (3-sea.)
? 22 Porch/Addn. (4-sea.)
? 23 Porch (screened)
? 24 Storm Damage
0 25 Miscellaneous
? 30 Accessory Bldg
? 31 Ext. Alt - Multi
? 33 Ext. Alt - SF
? 36 Muiti
? 31 New ? 35 Int improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addifion ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)* ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement •Demolition (Entire Bldg only) - Give PCA handout to applicant
Valuation Occupancy MC/ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new bldg) FinaUC.O.
_ Footings (deck) FinaUNo C.O.
_ Footings (addition) _ plumbing
_ Foundarion HVAC
_ Draia Tile Other
Roof _ Ice & Water _ Final Pool
Ftgs
Air/Gas Tests Final
_ Framing _
_ _
_
Siding Stucco Stone _
_ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement)
_ Insulafion _ Retaining Wall
Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City 5AC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
Building Inspector
PERMIT
CITY OF EAGAN
3830 PiloWflob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
p.I.N.: 10-64400-060-03
4341 MtnARV AvE
LUT: 6 BLOCK: 3
RIVER HILL5 9TH
PERMIT TYPE: a u r LDr Nr
Permit Number: 0 3 8 3 6 8
Date Issued: Q 9/22/g$
DESCRIPTION:
T.O. & REftOpF
Bua.x?T?hvµ,A P e r m i t T y p e 5TORh1 DAMRGE
?g B,111ding `G1o,:.zrk Type REPATR
,jc`ensu?s: Code",=? 434 ALT. RESIDEN7IAL
?. _ , . ?..
?.
??-
(.
Mn ` r
..? .. . ` RkY?
P
4?_e
Wft F'
? fj_?
8 iba? V?
`-aa f :3?-H 6tlmG: ?-?? aTmm?w
t } b d., z ? l( 4n?„ ?
RENiARKS:
FEE SUMMARY:
?UftPd'?TET]'IiR SUPPLY- Hpp1115410304 20014207 ? sNER poN
705 N HWY 169 4341 ME[7ARY AVE
PLYMOUTH MN 65441 EAGAN MN 55122
(612) 541--4207 (651)297-4027
1998 BUILDING PERMIT APPLICATION (RESIDENTIAL)
. CITY OF EAGAN
3830 PILOT HNOB RD - 55122
? b 681-4675
New Construdion Reauirements RemodeVReoair Reauirements
? 3 registered site surveys ? 2 copies of plan
• 2 wpies of plans (inGude beam 8 window saes; poured fid. design; etc.) ? 2 site surveys (exterior additions 8 deeks)
? 7 energy ealeulations ' 4 1 energy calculations for heated additions
? 3 copies of tree presenation plan if lot platted after 7l1193
required: _ Yes _ No
DATE: I g/ S CONSTRUCTION COST;
DESCRIP N OF WORK:
ST EI?E T ADDRESS: 1-13 4{J ?I t?p ?J ?JF ?
?
LOT: x?' BLOCK: 3 SUBD./P.I.D.
Name: lJ ((J?) A' ? ?D0f? 4'?eN CV l.Y Phone #: 2(?? 7U Z7
PROPERTY ?-asc Fint
owrrER Street Address: 4j3c.( ( ?,=Q P-CZJq A U??
?
City ?6A N State: ("Q I Zip: ss/ ZZ
Company: WESTU" (-EJOF, vL)PPC.?I Phone #: 6-`t' 1 -d 3U q
CONTRACTOR '?'"? -?,` ,/
5treet Address: ? U? N t 4-?CW(1. 16c( License # L.-c? ol `t 2,0 7
City ? l?l.?n(?.()?{.?- State: 1 1?Iv L Zip: 65Y?
ARCHITECT/
ENGINEER Company: Phone #:
Name: Registration
Street
City State:
Zip:
Sewer 8 water licensed plumber (new construction only): . Penalty applies when address chang
and lot change is requested once peRnit is issued.
I hereby acknowledge that I have read this application and state that the information is correct and agree to compy with all applipbl
State of Minnesota Statutes and Ciry of Eagan Ordinances.
Signature of Applicant: , iLild,
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No
Tree Preserva6on Plan Received _ Yes _ No _ Not Required
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex
,0 02 SF Dwelling ? 07 4-plex
0 03 SF Addition ? 08 8-plex
? 04 SF Porch ? 09 12-plex
? 05 SF Misc. ? 10 = plex
WORK TYPE
0 31 New ? 33 Alterations
? 32 Addition ? 34 Repair
GENERAL INFORMATION
OFFICE USE ONLY
? 11 Apt./Lodging ? 16 Basement Finish
? 12 Multi RepairlRem. ? 17 Swim Pool
? 13 Garage/Accessory ? 20 Public Facility
0 14 Fireplace ? 21 Miscellaneous
? 15 Deck
? 36 Move
? 37 Demolition
Const. (Actual) Basement sq. ft.
(Allowable) Main level sq. ft.
UBC Occupancy sq. ft.
Zoning sq. ft.
# of Stories sq. ft.
Length sq. ft.
Depth Footprint sq. ft.
APPROVALS
Planning
Building
MC/WS System
City Water
Fire Sprinklered
PRV
Booster Pump
Census Code.
SAC Code
Census Bldg
Census Unit
Engineering Variance
Permit Fee
Surcharge
Plan Review
License
MCNVS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
Valuation: $
°k SAC
SAC Units
? .? . . i
3?7 r _ /4 D_A-
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41fJ41 MASTER CARD
w . i .
LOCATION ///J14lAIIILIItA . J=2=2= A '
OWNER 7 (/(/? oe dror
STRUCTURE
LAND USED ASD ;P,
Permit
BUILDING
No.
tr' 71
Issued
ID Issued To
Contractor Owner
PLUMBING y ? ?? ? ?' /J SD
CESSPOOL - SEPTIC TANK
WELL
ELECTRICAL
HEATING Zri
GAS INSTALLING
SANITARY SEWER I
OTHER I
OTHER I
Items Approved
(Initial)
Date
Remarks
Distance From Well
FOOTING ? SEPTIC
FOUNDATION CESSPOOL
FRAMING 7 ???? TILE FIELD FT.
FINAL
ELECTRICAL
HEATING DEPTH
OF WELL
GAS INSTALLATION
SEPTIC TANK
CESSPOOL
DRAINFIELD
PLUMBING
WELL ?
SANITARY SEWER
-l3? L
Violations Noted
on Back
COMMENTS:
COMPLIANCE INSPECTION REPORTS
TO BE USED ONIY IN EVENT OP OBSERVED VIOLATIONS
PERMIT NO.
CONDITIONS OF CONSTRUCTION AT THIS INSPECTION
? NO EVIDENCE OF NON-COMPLIANCE
OBSERVED.
1:1 ACCEPTABLE SUBSTITUTIONS OR
DEVIATIONS.
DATE OF INSPECTION
n NON•COMPLIANCE. BUILDER WILL COMPLY
I? WITHOUT DELAY.
ITEMIZED AND DESCRIBED AS FOLLOWS:
? NON-COMPLIANCE. BUILDER DOES NOT
INiEND TO COMPLY.
? COMPLETION OF CERTAIN IMPROVEMENTS
WILL BE DELAYED BY CONDITIONS BEYOND
CONTROL.
? REINSPECTION REQUIRED
REINSPECTION REVEALED
DATE OF REINSPECTION
CERTI FICATION - I certify thai I have carefully inspected the above in which I have no interest present or prospective, and that I have reponed herein
all significant conditions observed to be at variance with ordinances of the Town of Eagan, approved plans and specifications, and any specific require-
ments for off-site improvements relating to the property inspected.
? ALL IMPROVEMENTS ACCEPTABIY COMPLETED
COMMENTS:
BUILDING INSPECTOR
DATE
.01? 22
Use BLUE or BLACK Ink
r
I For Office Use
Permit
fit]
City of EaRdfl I Icf
I Permit Fee:
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 i Staff:
- - - - - - - - - - - - - - - -
2011 RESIDENTIAL) BUILDING PERMIT APPLICATION
Date: Site Address: Unit
Name: r) Phone:
RESIDENT / _
OWNER Address / City / Zip: 'r,5~l 40E-
Applicant is: X Owner Contractor
TYPE OF WORK Description of work:
Construction Cost 300C> Multi-Family Building: (Yes / No )
Company: Contact:
CONTRACTOR Address: City:
State: Zip: Phone:
License 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 to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets. _J
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.-gopherstateonecall.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.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issua e.
X LT,-,kJ x - -
Appli ant's Printed Name Appl cant's ignature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA163886
Date Issued:09/15/2020
Permit Category:ePermit
Site Address: 4341 Medary Ave
Lot:6 Block: 3 Addition: River Hills 9th
PID:10-64400-03-060
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
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 -
Fred L Oltman
4341 Medary Ave
Eagan MN 55122
(651) 882-6281
Apple Lake Heating & Air Conditioning
207 150th Street West
Apple Valley MN 55124
(952) 431-4328
Applicant/Permitee: Signature Issued By: Signature