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854 Ivy LaneCity of Eagan PERMIT City of Eaan Permit Type: Mechanical Permit Number: EA128706 Date Issued: 12/01/2014 Permit Category: ePermit Site Address: 854 Ivy Lane Lot: 12 Block: 02 Addition: The Woodlands North 3rd PID: 10-75892-02-120 Use: Description: Sub Type: Residential Work Type: Replace Description: Furnace Comments: Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Holly Flood 1408 Northland Dr #310 Fee Summary: ME - Permit Fee (Replacements) $55.00 Surcharge -Fixed $5.00 0801.4088 9001.2195 Total: $60.00 Contractor: Sedgwick Heating & Air Conditioning 1408 Northland Drive, Suite 310 Mendota Heights MN 55120 (952) 881-9000 - Applicant - Owner: Mary C Gannon Tste 854 Ivy Lane Eagan MN 55123--242 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 4011) City of Eau 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 r Use BLUE or BLACK Ink Permit #: /� Permit Fee: ' O 0 Date Received: Staff: INFLOW & INFILTRATION PERMIT APPLICATION Plumbing / () Sewer & Water Date: 40-//c./ / U /Site Address: L� 5 £4i �r� �e,74, filet 67.4/t Tenant: Suite #: RESIDENT / OWNER Name: illr&cm/tic"Yi Phone: C CI-- ce 3Y:- 75 -?5 - Address I City I Zip: 3 5-'1 . wl. /i.p 6rtel �S i , CONTRACTOR Name: (3&/1 j i 4-i K /').1 fii; ski License #: G0041 Address: l 4 -/d -q %l/ 3r- / City: + ih`ter%s- State: AV Zip: 5 5 -4 -fl I Phone: 5 -- g,?-, - 5�%�� Contact: f / (.P yr 2_ Email: Sly (u4t /yi t- Z OpAl&i / . ( cls► TYPE OF WORK PLUMBING (Within the building envelope) SEWER & WATER (Outside the building envelope) Sump Pump Repair Repair Other: Other: DESCRIPTION Description of work: PIrkieP < loi.A Ol r aIet/-C C/ -Pan cm (IL FEES $55.00 / Each (includes $5.00 State Surcharge) TOTAL FEE $ * *Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit Ill repair costs for reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors can be found by visiting www.cityofeac>an.com/inflow, or City Hall at 3830 Pilot Knob Rd. 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. Applicants Printe .'' me /14)44 (cwi L x Applicant's Signature Required Ins SEDGWICK HEATING & AIR CONDITIONING CO. 1408 NORTHLAND DRIVE, SUITE 310 • �M�ENNDDOTA HEIGHTS, MN 55120 • (952) 881-9000 ADDRESS g6-21 rtiP � L49J€ � CITY OCCUPANT Avey 4tjr3& OWNER SOLD BY MAKE AMODEL s`yryl 3 ' °`/ HEATING TEST RECORD INSTALLED BY C 1 SERIAL NO. INPUT JOB NO5r et`QDe;) rt THERMOSTAT VENT SIZE 1 VALVE 0 41''G TYPE OF LINER \3 LINER SIZE 54 FILTERS. SIZE Il1� 'IC* 1 NUMBER FAN SETTING G«✓� vk WIRING �" 4I; C TEST TAG y v LIGHTING INST. 0 fil- LIMIT i 511\ Oixscitic7 LIMIT SETTING PILOT TYPE 1 IGNITION MODEL 01(11.- 1 PILOT TIMING 1/F PRESSURE lf`ck^ PERCENT CO2 q r` INPUT CFH PERCENT 02 ` ° STACK TEMP. J1 r7 PERCENT CO at( DATE TESTED COMPANY TESTING SL)""' `G`\ NAME OF TESTER A040 FORM 235 (REV. 10/10) FORM DISTRIBUTION: WHITE COPY - JOB FILE YELLOW COPY - CITY City of Eakan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink rz," For Office Use Permit #: 7 7 Permit Fee: /05_ Date Received: Staff: 2016 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: e)51-1 0..) Unit #: Name: VIA -12--/ 04-62,0L, -7-5rt- 6 14-1,40 6..1 Phone: Address I City I Zip: e 51-t Resident/ Owner - 6444,4 - 5-5-713 Applicant is: Owner "(-- Contractor Description of work: FIA1Z-TIA-L Type of Work - Construction Cost,i2- S Multi -Family Building: (Yes / No Cootir.,01.07-it-A Company: CAIN\-ct—sety,s_ric.4.4 Contact: Lit,e2S,e4 Address. 5-) it`10"-.15rrZ-4"4— -Jc City: td14-41--€1- Contractor I State Zip 553s1 Phone -76'5 7 4c)c'Email &1140LA License # 6e--7"*' 475 Lead Certificate # 5-z-851 - I If the project is exempt from lead certification, please explain why: iCOMPLETE 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: Fire Suppression 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.qopherstateonecall.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 permitbut 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 Stat B lding Code must be completed within 180 days of permit issuance. 4.x LA -Qs -J."4 Applicant's Printed Name Applicant's Signature Page 1 of 3