4191 Beaver Dam RdCity of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
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Permit# 9 /qt/iv
Permit Fee: yi Z�
Date Received:
Staff:
2010 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: tb) (Z)t(> PPSite Address: 41 "7( SEA vEJL OA -M ?QAT)
anittant
Tenant:
Suite #:
RESIDENT / OWNER
Name: CO G A%) k( 4&e/lA ?NT Phone:
Address / City / Zip: b`133 CITY 0 PKAA1v. EOE ►1?At 12A6- ,u It( -S 3 4 L
Applicant is: Owner Contractor
TYPE OF WORK
Description of work: kr-A1OVE AN (€1:, 66 eth/1/DOb-JS
Construction Cost: tt ZVO�.---- Multi -Family Building: (Yes / No )
CONTRACTOR
Name: Jif EXrELt oT lel. at IUT, cap License #: a 6 z u(1 3(
Address: 65 V., Goist SM6Yr City: , tNWe»(714 3
/
AAA) A) Zip: 5-51115 Phone: G' i Z. - %1- 6213
Contact: 1/c2 (J M Email: RA:C1.> e -t K.Gtn . (.:Om
COMPLETE
In the last 12 months, has
_Yes No 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:
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. Cali Gopher State Onel 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 informatio 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 rmit, 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 th case of work which requires a review and approval o - - ns
C'_,,ts rs)2sC7
Applicant's Printed Name
x
Applicant's Signature
Page 1 of 2
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 4191 Beaver Dam Rd
Lot: 4 Block: 01 Addition: Diffley Commons
PID:10- 20450- 040 -01
Use:
Description:
Sub Type: e - Furnace
Work Type: New
Description: Furnace
Comments:
Fee Summary:
Contractor:
Haley Comfort Systems
122 West 3rd St
Hastings MN 55033
(651) 437 -0338
Quesetions regarding elec
952- 445 -2840
Geoffrey Smith
122 West Third Street
ME - Permit Fee (Replacements)
Surcharge -Fixed
Total:
Applicant/Permitee: Signature
PERMIT
City of Eaan
Permit Type:
Permit Number:
Date Issued:
Permit Category:
cal permit requirements should be directed to Mark Anderson, State Elec
- Applicant -
Owner:
Leann Lehmann
4191 Beaver Dam Rd
Eagan MN 55122
$50.00 0801.4088
$0.50 9001.2195
$50.50
Issued By: Signature
Mechanical
EA092014
11/13/2009
ePermit
cal Inspector,
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
651 437 9745
12/10/2009 THU 14:22 FAX 651 437 9745 HALEY COMFORT SYSTEMS
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05/0612014 09:42 Les Jones Roofing, Inc. (FAX)9528817009 P.011 1011
Use BLUE or BLACK Ink
1
For Office
j Permit
City of Eagan l Permit Fee,
3830 Pilot Knob Road
l
Eagan MN 66122 I Date Rscelved. jig
Phone: (661) 675-6676 I I
Fax: (651) 676-6694 1 staff. 15. 1
Z2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date-. SlteAddress: y/S? `t/7! S"'1 Ale--"6-k 4)Xm ?oA Unit fl:
'I'Ma Name: ~_o P9OPE72Ty G4 E , 6 NC.. Phone: 57- 5Y- 9y 4/~
Address I City / Zip: O• i30 212 5
,p NI Applicant is: Owner
Contractor
Description of work: gAire o/- AV-d 1 ~✓G.~~ rP
9
sf: '4'1 Construction Cost
Multi-Femlly Building: (Yes x / No
S.
Company: AE5 .7ONd3 RQQ gaz~ fiVG Contact C~l.Qt s /~,VDEs72s0~
12.Address: 911 W. eD s°rY city: &Qazu.vGTbA✓
State: MIJ Zip: JJ Phone: 9,5"R - 76 7 - a8/9
,M CM1b" dI 4 °
License N. Lead Certificate .U,4T `f p -
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 Egan 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:
41
CALL BEPORLe YOU DIG. Call Gopher state one call at (661) 464.0002 for protection against underground utility damage. Call 48 hours
before you Intend to dig to receive locates of underground utilities. www.goaharstateonecall.org
I hereby acknowledge that this Information Is complete end accurate; that the work will be In conformance with the ordinances and codes of the City of
Eagan; Oat I understand this Is not a permit, but only an application for a permit, and work la 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 State Building Code must be completed within 160
daye of permit Issuance.
x_ G1¢45 fti 0000-od x . .
Applicant's Printed Name Applicant's Signature
Page 1 of 3
05/21/2014 10:17 Les Jones Roofing, Inc. ffAX)9528817009 P.002/011
Date:
C!ty of Eap
3630 Pilot Knob Road
Eagan MN 66122
Phone: (651) 675.6676
Fax: (661) 676-5694
Use BLUE or BLACK Ink
For Office Use
Permit#: ' 22,13c
Permit Fee:
Date Received:
Staff:
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
-fir, 44/ Site Address: 1#87,'lr ?/, 4,4/9 5 ,?`/ 49 &-AA/cxt. WA -M 2340 units:
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`4"ic a;; ' „ ;y`
Name: yo PeoPa2Ty G4?.6 t Ne... Phone: 457- 51-c/- ff'7421'-,
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Address / City / Zip: 10- BOX 212 . //'fl_ ezr--o%d Ali 03-4) 24
Applicant le: Owner X Contractor
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Description of work: R?Mov6 A,wO Rd°P'- 4. 50416- 4441 /44119)S/O/Nlir'
Construction Cost .-4;' A -gi i Multi -Family Building: (Yes X / No
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Company: 4 3 ,ThN53 A wzr- five Contact G/�l�t i �or�so AV
Address: 9'tt w. go"' inzz r- city: to�au ler_J-ae/
State: AV Zip: f$'20 Phone: 9$ - 76 7- X819
License #. 45-64 Lead Certificate #: .(.) 7- `t O 3 V - /
.! _"„,0', ,7
If the project Is exempt
from lead certification, please explain why: (see Page 3 for additional Information)
In the last 12 months,
If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Began issued a permit for a similar plan based on a master plan?
yes, date and address of master plan: "
_Yes _No
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
Phone:
' %in ftbg h". Otikltkif tig L 0 % -°!dOi'e > QLD/ diff i O; TAIIQf4
' Ute"triffYYi fpnil:etgilActo. bier ,0149 •> (.14,4*,* $ N6volitd e ,titroito
t ill?t 3'4 a1r,tyA ti • g1 g•.,W9.A: 1`dC:.,J.iiuC :%• .„.„,, ?7. •+
CALL BEFORE YOU DIG. Call Gopher State One Cali at (861) 454-0002 for protection against underground utility damage. CaII 48 hours
before you Intend to dig to receive locates of underground utilities. m w.aooherstateonecallsorq
1 hereby acknowledge that thls 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 le 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 plane.
Exterior work authorized by a building permit Issued In accordance with the Minnesota State Building Code must bo completed within 180
days of permit Issuance.
x C/f,2iS 444D6720'0d
Applicant's Printed Name
x
Applicant's Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA133243
Date Issued:09/30/2015
Permit Category:ePermit
Site Address: 4191 Beaver Dam Rd
Lot:4 Block: 01 Addition: Diffley Commons
PID:10-20450-01-040
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Softener
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 -
John A Kujawski
4191 Beaver Dam Rd
Eagan MN 55122
(651) 457-1414
Appliance Installers Of Mn
14105 Rutgers St NE
Prior Lake MN 55372
(952) 469-8341
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA179219
Date Issued:09/26/2022
Permit Category:ePermit
Site Address: 4191 Beaver Dam Rd
Lot:4 Block: 01 Addition: Diffley Commons
PID:10-20450-01-040
Use:
Description:
Sub Type:Water Softener
Work Type:Replace
Description:
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:
This permit shall be null and void if work does not start within 180 days of issuance, or if work is suspended for 180 days or more after
started.
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 -
Noel Kujawski
4191 Beaver Dam Rd
Eagan MN 55122
(651) 457-1414
Milbert Company (culligan)
1801 50th St E
Inver Grove Heights MN 55077
(651) 451-2241
Applicant/Permitee: Signature Issued By: Signature