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
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