869 Ivy LaneCityafaQau
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
Date: \CDs 1
RESIDENT / OWNER
CONTRACTOR
TYPE OF WORK
PERMIT TYPE
Cn
Name: (Y `�J /1 Phone: (125—\ - " (1S3-"S
Address / City / Zip: c3- \ U tj LK\ . ---(1 M (a 3
Name:
Address:
State:
BURNSVILLE HEATING & A/C, INC.
3451 W. Burnsville Parkway
Suite 120 City:
Burnsville, MN 55337 �_
Zip: Phone:
Contact: 6\ pet-
License #: 65 ( 1 '�
Email:
New
Description of work:
X Replacement
RESIDENTIAL
Furnace
_gNir Conditioner
Air Exchanger
_ Heat Pump
Other t t{ 11t Q -
Additional
New Construction
Install Piping
Gas
Alteration
Demolition
COMMERCIAL
_ Interior Improvement
Processed
Exterior HVAC Unit
Under / Above ground Tank ( Install / Remove)
** When installing /removing tank(s), call for inspection by Fire
Marshal and Plumbing Inspector
RESIDENTIAL FEES:
$50.50 Minimum Add -on or alteration to an existing unit
$90.50 Fire repair (replace burned out appliances, ductwork, etc.)
(includes AtC0
tate Surcharge)
(includes ate Surcharge)
$ 00 TOTAL FEE
COMMERCIAL FEES:
$70.50 Underground tank installation /removal OR Contract Value $ x 1%
$50.50 Minimum (includes State Surcharge)
_ $ Permit Fee
- If Permit Fee is less than $1,000, surcharge is $.50.
- If Permit Fee is > $1,000, surcharge increases by $.50 for each = $ Surcharge
$1,000 Permit Fee (i.e. a $1,001 - $2,000 Permit Fee requires a $1.00 surcharge).
= $ TOTAL FEE
Tenant:
M(Q Q
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 proved plan in the case of work which requires a review and approval of plans
t\■ CICY 0..11
Applicant's Printed Name
RECEIVED
OCT 1 8 2010
2010 MECHANICAL PERMIT APPLICATION
Site Address: I \) t.. l-t 1
Applicants Signature
x
Use BLUE or BLACK Ink
Permit #:
Permit Fee:
Date Received:
Staff:
Suite #:
J
Use BL.UE o�BLACK ink
�--___--------�---�
� For office usB �
� - �
�• � Permit#: � I
��� O` L"�""` I Pertnit Fee; l� ' - � I
3830 pilot Knob Road j I
Eagan MN 55122 � Date Received;l�� � �1 — l� �
Phone:�661)6T6-6675 �; �
Fax:(651)676-5694 �`�� q � '3 '�!-.:� j Staff: � I
I��__.�.....�������__._.J
n,n
J�;�:; � � �v�i.�
2015 RESIDENTIAL BUILDIN� PERMIT APPLICr4TION
W ou 15 t ri.�,J 4 C.a v,.,�^�e Y �+•n z 5
Date: --r��� ��' �/S� Slte Address: 8�a 9 �� Y L.J Unit#:
Name: C�� ��- �! l�R�u�+l�t M E..�'i Phone:
Res�d�nt�
Owner Address!City t Zip: �.5� k�f.C r�r�Q A�• .c� "��M �o e,�E ti I�w L�t:r .�'J.� s'S y,Z'7
Applicant is: Ow�er � ContracCor
Type of Wo�k Description of work: T�:,42 0�� � �Z t- R c*o� _
ConsUuction Cast: �, g 9 S. � Mulci-Family 8uilding:(Yes I No�
Company, 1� � 1 ��c�rt.,2�o 2 /�'1+�.�;. �'�^�2n Contact: D+a� � ��'��14. i s
Contractor Address: �/o s' L..1 G���7T' S•r, City: ���• s•
• State: m� Zip: �� Phone: ��,t••��,�-G�Z Y� EmaiL --'��`" �`'J f,��/K,'.� ,. Lo�K
License�: �� ����� � Lead Certlflcate#,
If the project is exempt from lead certlfication, please explain why:
�:,,L.� .�r��� i'� ) � -- .vc�•� �J;S7-u/:fSi�J4� �H�,�.l'y-8.� S•--•:Z ,�r9c:E.S
COMpI.E'TE TMIS AREA ONLY IF CONSTRUCTING A NEW BUILDIAIG
In the last 12 months,has the City of Eagan issued a permit for a simllar plan bas�d on a tnaster plan?
Yes No If yes,date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
5�w�r&Water Contractor: Phone:
Fire Suppressfon Contractor. Phon�;
NOTE;Plans aad supp,ortin�documents.that y�ou,subn�l!are consldered Ev be pilbHc!nlornta�i�n. Pprtions�of
the information may'be c�lassi�ed as nun-pu4���1fYou pr.ovlde sp�c�c reasons•t��f i�voald permlt�t�re�City tu
��cor�cFude that.the „a�e t�ade secrets. • � '•
CALL BEFORE YOU DIG. Call Gopher State One Cal!at(651)45a-oo02 for protection agelnst underground utllity dsmage, Ceil 46 hours
before you intend to dig to receive locates of unde�ground u1lNtles. www• oq,eherstateonecall.org
I hereby acknowledge tnat this Information is complete and accu►ate;that the work w911 ba in oonlortnanco wlth lne ordinances�nd codes of lhe Gity oi
Eagan; that I understand this is not a permit, but only �n applicatian tor a permit, and work Is not to 8tan with0ut a permit; thaf the work wlll be Yn
accordance wlth the approvEd plan In Ihe casd oi work whfch requiras a review and approval of plans.
Exterior work eutharizad by a building parmit lssued in accordenca with the Minnasota State 8u g Cod�must be completed wlthin 180
days of permft issuancv.
X �A✓i ;� y,�j�f►:2/S
Applicant's Printed Name Applicant's Signature
Page 1 of 3
ZZ/!0 3JG'd 1NItJW 1X3 I3g L9Z9Z98ZZ9 E9�Et 9T9Z/9Z/90
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA165307
Date Issued:10/27/2020
Permit Category:ePermit
Site Address: 869 Ivy Lane
Lot:8 Block: 01 Addition: The Woodlands North 3rd
PID:10-75892-01-080
Use:
Description:
Sub Type:Residential
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 -
Clark J Tste Simpson
869 Ivy Ln
Saint Paul MN 55123--242
Tony's Appliance
2090 County Road 42 West
Burnsville MN 55337
(952) 435-2442
Applicant/Permitee: Signature Issued By: Signature