4679 Lista PtCity of Eaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use
Permit#: /Z'(�io'
Permit Fee: ✓ / /- �J
Date Received: : /io/iy
Staff:
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date:
tel° 11 yC/!' !t pt «/6f %((V het .�- Unit#:
Site Address: y
%� L�3
Resident/
Owner
Type of Work
Name: AiObeC l 6- /5.1.
Phone:
��, � N
Address / City / Zip: r'
Applicant is: Owner Contractor
Description of work: 5/ 0/ '-5
Construction Cost: 51 9- 0 ado • Multi -Family Building: (Yes X / No )
Contractor
Company: )V12 .14a.,_ i+ Contact: D'ilElla' ,ero
Address: I3?-& 51b2 City: Ovled%SO`le--
State: 1/1111 Zip: SC 3 31 Phone: (01 2- —i-/— lib 5
License #: a- 03f b 7 Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
In the last 12 months,
_Yes _No If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
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.
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.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 Building Code must be completed within 180
days of permit issuance. 6b#1 /1 Cll. e ,
Applicant's Printed Name
x
Appli s Signa
Page 1 of 3
City of Eagan
Eagan,
PERMIT
City of Eaan
Permit Type: Mechanical
Permit Number: EA098511
Date Issued: 04/07/2011
Permit Category: ePermit
Site Address: 4679 Lista Pt
Lot: 2 Block: 02 Addition: Ridgecliffe 3rd
PID: 10-63982-020-02
Use:
Description:
Sub Type: e - Air Conditioner
Work Type: New
Description: Air Conditioner
Comments:
Questions regarding electrical permit requirements should be directed to Mark Anderson, State Electrical Inspector, (952)
445-2840
Renae Freinwald
2200 Hwy 13 W
Fee Summary:
ME - Permit Fee (Replacements) $50.00
Surcharge -Fixed $5.00
0801.4088
9001.2195
Total: $55.00
Contractor:
Genz Ryan Plumbing & Heating
2200 West Highway 13
Burnsville MN 55337
(952) 767-1000
- Applicant -
Owner:
Michael B Merryfield
4679 Lista Pt
Eagan MN 55122
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.
Applicant/Permitee: Signature
Issued By: Signature
Date:
City of Eap
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
r
For Office Us
Permit #: 1 0'
i
Permit Fee:
Date Received:
Staff:
2009 RESIDENTIAL BUILDING PERMIT APPLICATION
/6 ( Site Address: �6' 7 V 4/'Sv ,Z L
Tenant:
Suite #:
RESIDENT / OWNER
Name:/ {��dr /YA
4 Phone:
Address / City / Zip: 4' H l /SAt 1 -11 --
Applicant is: Owner ,K Contractor
TYPE OF WORK
Description of work: (2° 5 i`
Construction Cost: 43 Cl. / Multi -Family Building: (Yes >( / No
_)
CONTRACTOR
Name: /‘/(C License #:(-4_` 31e,,..."`'
Address: "71-ff ("2,,- jet 't 73
City: a‘hS6ct State: /,,(/(/2 Zip: ,-V-7:).-- '3/ ''
Phone: 7!//,27 � l?i/ Contact Person: ,..56C1L /LL'"/�/ 1"t
COMPLETE
In the last 12 months, has
If yes,
THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
the City of Eagan issued a permit for a similar plan based on a master plan?
date and address of master plan:
_Yes _No
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.
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,tart 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.
fib
Applicant's Printed Name 7
Page 1 of 3
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675-5675
www.ci.eagan.mn.us
PERMIT
City of En
Permit Type:
Permit Number:
Date Issued:
Permit Category:
Mechanical
EA087876
12/29/2008
ePermit
Site Address: 4679 Lista Pt
Lot: 2 Block: 02 Addition: Ridgecliffe 3rd
PID:10-63982-020-02
Use:
Description:
Sub Type: e - Furnace
Work Type: New
Description: Furnace
Comments:
Quesetions regarding elec
952-445-2840
Stephanie Johnson
2200 W. Hwv 13
cal permit requirements should be directed to Mark Anderson, State Elec
cal Inspector,
Fee Summary:
ME - Permit Fee (Replacements)
Surcharge -Fixed
$50.00 0801.4088
$0.50 9001.2195
Total:
$50.50
Contractor:
Genz Ryan Plumbing & Heating
2200 West Highway 13
Burnsville MN 55337
(952) 767-1000
- Applicant -
Owner:
Michael B Merryfield
4679 Lista Pt
Eagan MN 55122
I hereby acknowledge that I have read this application and state that the informa
of Minnesota Statutes and City of Eagan Ordinances.
on is correct and agree to comply
h all applicable State
Applicant/Permitee: Signature
Issued By: Signature
CITY of EAGAN WATER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO •
Eajon, MN 55122 DATE.
Zoning: No. of Units.
Owner:
Address:
Site Address.
Plumber:
Meter No.: Connection Charge.
Size: Account Deposit:
Reader No.: Permit Fee:
I agree to comply with the City of Eagan Surcharge.
Ordinances. J,
it
By
Date of
Misc. Charges:
Total.
Date Paid•
Insp •
•
CITY QF EAGAN SEWER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO •
r
Eagan, MN 55122 DATE.
Zoning: No. of Units:
Owner:
Address.
Site Address:
Plumber:
agree to comply with the City of Eagan Connection Charge:
Ordinances. Account Deposit.
Permit Fee•
Surcharge:
By Misc. Charges.
Dote of Insp.: Total.
Insp.: Date Paid:
444')
City of Ea�au
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
For Office Usej (C+L
Permit#: .I 1 �w
Permit Fee: L j —1 �5. 5°
Date Received: 1'0 / 013
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 11)/7/0 Site Address: V`7qj9W3Li5414- I6 8 0.,ituf //Ir4 / ,,J
Unit #:
Name: Ralie Gl.,, p2 8.14-
Phone:
Address / City / Zip:
Applicant is:
Description of work:
Construction Cost:
Owner )4., Contractor
Multi -Family Building: (Yes / No
Company: 6/2/24P/ //Z4M P , yhJ' , Contact: f! 45-7,7....h,"
Address: /2? City: &/".400:04,4
State: 0? Zip: JT3,? 7 Phone: 4/e1- el ‘ — 57:F6'
License #: ?- Iti C 6 7
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:
Sewer & Water Contractor:
NOTE: Plans and supporting documents that you. submit are considered rto bE
the information maybe classified as non public rf you provide specific reaso
conclude, that they are trade secrets.
Phone:
Phone:
ouolic information
s Haat would permit
ons,
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.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 State Building Code must be completed within 180
days of permit issuance.
Applicant's Printed Name
x
Applicant's Signature
Page 1 of 3