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1629 Boardwalk Parcel Files Cover Sheet Unique ID: 1919 1629 Boardwalk 103190032002 MY OF. AGAN , WATER SERVICE PERMIT r 383,p Plot Knob Road P .O. Box 21199 PERMIT NO.: T 810 - Eagan, MN 55121 DATE: ` 116-78-86 Zoning: R1 No. of Units: 3 i✓. Owner xonr 4-er Midwest Address: Site Addess: 167Z~a~rAI-111 Heights ,vr Plumber Meter No.: rt C ige' -3:2(,2 =500.00pd Size: S191) dOC %~~Q~, n~ LL1 . Reader No.: 1 I agree to comply th the City agars rn Ordinances. isc. Charges: Total: By Date Paid: Date of Insp.: Insp.: CITY OF EA,GAN WATER SERVICE PERMIT 3830 PilotlCnob Road P.O. 21199 - W-!1 - PERMIT NO.:I-0$ Eagan, MN 55121 DATE: 3.3 ?E~Bi Zoning: F-7. No. of Units: Owner: lErcot ! er Midwest Address: Site Addess: 1629 Roar-dwRIk 122 Plumber: Star Pltf bixig Meter No.: Connection Charge: Size: Account Deposit: , Reader No.: Permit Fee: , I I agree to comply with the City of Eagan Surcharge: Ordinances. Misc. Charges: 15 6. 00pd-TP- Total: By Date Paid: Date of Insp.: Insp.: CITY OF EAGAN SkW6R SCE iAfiT ` 3830 Pilot Knob Road X256 P. O. Box 21199 PERAMT NO.: 9256 Eagan; MN 55121 BATE: Zcninp: Ill No. of Units: 1 Owner: Frontier Midwest Addrew. site Addrem 1_629 bardwalk L32 R TfstggjEou He ht Pturt*er: i Ar Plumbl tsg 0-27-85 67753 100.00pd 1 dom to empk w" toe Citirof 6"00 Connection Charge: 475 - Account deposit: 15,_ ljid- Permit Fee: 14~ - Qfl~d' r x . , Surcharge: . 5{ham . BY Misc. Charges: Date of Fnsp.: Total: Insp.: We Polk A&W CASH RECEIPT CITY OF EAGAN 3830 PILOT KNOB ROAD EAGAN, MINNEES .TA 55122 DATE 19 RECEIVED k~, 2, FROM Je~ 3 -•'f C_ G..-✓: AMOUNT $ CASH i" KK FUND CODE AMOUNT Thank Yoe 67793 White-Payers Copy Yellow-Posting Copy ('ink-File Copy BLDG. PERMIT NO. 01-3210 Bldg efmi `l` J 01-3422 Plan ChecK$ ; S 01-3445 Surch./Adm, i~ 01-3446 SAC/Adm. '7S 01-2155 Surcharge 17-3860 Road Unit 20-2275 SAC _ id ' 20-3865 Water Conn. v U 20-3868 Water Trmt 20-3716 Water Meter 20-2252 Acct, Dep.' c~ 20-3713 Water Permit /d G{~ 20-3743 Sewer Permit 79-3866 Sewer Conn. 11-3855 Park Ded. TOTAL// { - ice, c CITY OF EAGAN 1$30 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121N2 12801 PHONE: 454-8100 k BUILDING PERMIT Receipt # i To be used for SF' DING/GAR Est. Value $56,000 Date O='~RER 2 ~ 19 Site Address 1629 BOARDWALK Erect M Occupancy R3 i Lot 3.2 Block ` 2 Sec/Sub. HAMPTON KTS Remodel ❑ Zoning Parcel No. Repair ❑ Type of Const. Addition ❑ No. Stories Name FRONTIER COMPANIES Move ❑ Length 34 i Z 39,08 SZBLEY nEM HWY, BLDG EDemoiish El Depth c Address Mt. Impr. ❑ Sq. Ft City EAGAN Phone 454-0433 Install ❑ z o Name S Approvals Fees i ¢ Address Assessment Permit 301 * 0 City Phone Water & Sew. Surcharge 28.00 i Police Plan Review 150 • W Name Fire SAC 575.00 0 Address Eng. Water Conn. 500 00-1 R w City Phone Planner Water Meter 63.50' Council Road Unit 290.00 Ihereby acknowledge that Ihave read this applicatio ndsta atthe Bldg. Off. 10~ 6Tr. PL 156.00 information is correct and agree to comply with a; plic a State of Minnesota Statutes andCity o Ea arny ~ APC Parks Signature of Perm ifra '"y Var. Date Copies 06 00{ Totals • A Building Permit is issued to: FRONTIER COMPANIES on the express condition that all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. WOO t Building Official Permit No. Permit Holder , Date Telephone # Pib'rnwg ~7 t e 1 e( 11 HS.A.C. Electric Softener Inspection Date Insp. Comments Footings l Footings If Foundation Framing Roofing Rough Plbg. I o~~ ~7 s -/7-LA I. C Rough Hill. y Insui. r { Fireplace Final Htg. _ Final Pibg. eft ` Bldg. Final Cori. Occ. .y27~ Deck Fig. i✓o7- s fa fit Q 1 Pv~~' E Deck Frmg. Well ✓ Pr. Disp. J PERMIT # PLUMBING PERMIT RECEIPT # - _ CITY OF-EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE: CONTRACT PRICE: PHONE: 454-8100 Site Address BLDG. TYPE WORK DESCRIPTION Lot 3 a Block Sec/Sub f f r' /7i /-~j0 /1/ S Res. „ New Name Mult Add-on Address Comm. Repair c city A Phone $/v Other NO FIXTURES TOTAL Name Y' O t, { ~)1 l Water Closet - $3.00 3,00 a~ C Address Q S• b /r em Jtu -Bath Tubs - $3.00 3,00 - p City ~Iq Phone _U 4 -.L-Lavatory - $3.00 --7100 Shower - $3.00 FEES =Kitchen Sink - $3.00 3 COMM/IND FEE - 1% OF CONTRACT FEE Urinal/Bidet - $3.00 00 ' MINIMUM -RESIDENTIAL FEE _$10.00 Laundry Tray - $3.00 MINIMUM - COMM/IND FEE - 20.00 Floor Drains - $1.50 - $1.50 STATE SURCHARGE PER PERMIT - .50 Whirlpool Water - Heater $3.00 (ADD $.50 S/C IF PERMIT PRICE GOES ©p BEYOND $1,000.00) =Gas Piping Outlets - $1.50 Softener - $5.00 Well - $10.00 Private Disp. $10.00 =Rough Openings - $1.50 ' J 3 NATURE OF PERMITtElff FEE- 50 STATE S/C: 50 o7to, .OLD FOR: CITY OF EAGAN GRAND TOTAL: , .xrwti ....-.r i-n»e '4"-•9n r. fi_.. r-.i--~ ru'~YR. ~:.-q-. f.:. "~,il` t'~'4, °{t,_ i~rv '5: ~"`~~~,~„"~r'snr.:,. ,y-.. ~tr'•x v PERMIT # MECHANICAL PERMIT RECEIPT # CL ~L~1~' CITY OF EAGAN 12/1 86 1600.00 3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE: CONTRACT PRICE: PHONE: 454-8100 Site Address 1629 Boardwalk BLDG. TYPE WORK DESCRIPTION Lot 74 Blocl 2 Sec/Sub Res. ~ New ~ WENZEL MECHANICAL Name Mult Add-on Address 3600 Kennebec Drive Comm. Repair C City Eagan Phone 452-2565 Other Name' Frontier Companies FEES i c Address 3908 Sibley Memorial Hwy. RES. HVAC 0-100 M BTU -$24.00 p City Eagan Phone 454-0433 ADDITIONAL 50 M BTU 6.00 ADD-ON AIR COND. 0-24 BTU - 12.00 TYPE OF WORK ADDITIONAL 6 M BTU - 6.00 GAS OUTLETS 1.50 EA. Forced Air 80,000 M BTU 24.00 COMM/IND FEE - 1% OF CONTRACT FEE Boiler M BTU MINIMUM - RESIDENTIAL FEE - 10.00 Unit Heater M BTU MINIMUM - COMM/IND FEE - 20.00 Air Cond. M BTU STATE SURCHARGE PER PERMIT - .50 Vent CFM (ADD $.50 S/C IF PERMIT PRICE GOES 1.50 BEYOND $1,000.00) Gas Piping Outlets # Other FEE: 25`50 .50 SIGNATURE OF PERMITTEE S/C: TOTAL- FOR: $26.0(3 FOR: CITY OF EAGAN Trrtifiratr of CJOrrupaury Citp of (Eagan ~r#rnrtmpnf n# ~iuil~ing ,~nnp~r~inn This Certifwate issued pursuant to the requirements of Section 306 of the Uniform Building Code certifying that at the time of issuance this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following: Use Classification SIC IMAal~,~ Bldg. Permit No. 12801 Occupancy Type _ R3 Zoning District } r Type Cont. y - Owner of Building MCM C"WTU Address 3908 SP ' 7 EA Building Address 1629 BaARNMX Locality L32, BZp H RRIGM Date: AW41AV 26, 1987 Building Official -er POST IN A CONSPICUOUS PLACE PERMIT # PLUMBING PERMIT CITY OF EAGAN RECEIPT # 3830 PILOT KNOB ROAD, INN 55122 DAT CONTRACT PRICE: PHONE: 454-8100 Site Address BLDG. TYPE WORK DESCRIPTION Lot lock ec/ u Res. New / ' , Mult Add-on Name r . Comm. Repair 19 Address - Other U) City Phone RES. PLBG. ONLY - COMPLETE THE FOLL G: NO. FIXTURES AL Name _-5-F-4914 MCLIP; Water Closet - $3.00 $ 3 Address p Bath Tubs - $3.00 Lavatory $3.00 p City Phone Shower - $3.00 Kitchen Sink - $3.00 FEES Urinal/Bidet - $3.00 COMM/IND. FEE 1% OF CONTRACT FEE Laundry Tray - $3.Q0 I APT. BLDGS'- COMM RATE APPLIES Floor Drains - $1.50 TOWNHOUSE & CONDO - RES. RATE APPLIES Water Heater - $1.50: MINIMUM - RESIDENTIAL FEE -$12.00 Whirlpool $3.00 MINIMUM - COMM/IND FEE $20.00 Gas Piping Outlets - $1.50 STATE SURCHARGE PER PERMIT - .50 (MINIMUM= 1 PER PERMIT) (ADD $.50 S/C IF PERMIT PRICE GOES Softener - $5.00 BEYQ D $1,000.00) Well $10.00 Private%Disp. - $10.00 j' Rough Openings - $1.50 AA r SIGN # RE OF M 'TEE Fly: STATE S/Ct ' FOR: CITY OF EAGAN GRAND TOTAL: I ~-4 - E 95893, Request Date Fire No. Rough-in Inspe ion Required? ❑ Ready Now ❑ Will Notify Inspector J❑ Yes ❑ No When Ready? I ❑ licensed contractor owner hereby request inspection of above electrical work at: Job Address (Street, Box or Route No.) City P~ LA~"!-' G ea n Section No. Township Name or No. Range No. County 11 l l i Occupant (PRINT) Phone No. Mc. NoY Power Supplier Address - Electrical Contractor (Company Name) Contractor's License No. Mailing Address (Contractor or Owner Making Installation) Au riz fy~er Maki g Ista lion) Phone Number MINNESO STATE O RD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT Griggs- i ay Bid -Room S-173 BE ACCEPTED BY THE STATE BOARD 1821 Un rsity Ave., St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS Phone (612) 642-0800 ENCLOSED. REQUEST FOR ELECTRICAL INSPECTION .r-. EI3-00001-07 10. See instructions for completing this form on back of yellow copy. W% ~v E J J O 9 1 `:tit" Below Work Covered by This Request New Add Rep. Type of Building Appliances Wired EquipmentWired Home Range Temporary Service Duplex Water Heater Electric Heating Apt. Building Dryer Other (Specify) Comm./Industrial Furnace Farm Air Conditioner Other (specify) Contractor's Remarks: - Compute Inspection Fee Below: # Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Swimming Pool 0 to 200 Amps 0 to 100 Amps Transformers Above 200 Amps Above 100 Amps Signs Inspectors Use Only: , j TOTAL Irrigation Booms "lJ 2 P j Special Inspection l Alarm/Communication Other Fee f I, the Electrical Inspector, hereby lough-in , e certify that the above inspection has Final Date been made. 412 01'Zo OFFICE USE ONLY This request void 18 months from This request void l'f, f 18 months from 69607/ Requ . Date Fire No.n Rough-in Inspection Requrr ? Ready Now I No ❑ tify. Inspeo- l U es No for when Ready tensed Electrical Contractor I hereby request inspection of above 0 Owner electrical work installed at: Street dd ;s, or Route No C i ecvon No. Township Name or No. Range No. County Occupant (PRINT) Ph ne o. ` S,TL~-V Po r . ' tier Address Electrical Contractor (Compan Contractors License No. lillffirfing nation) 5124 Aut at r br wrier Making Installation) Phone Number MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT Griggs-Midwev Bldg. - Room N-191 BE ACCEPTED BY THE STATE BOARD 1821 University Ave.. St. Paul, M14 55104 UNLESS PROPER INSPECTION FEE IS Phone (612) 642-0800 ENCLOSED. 7 REQUEST FOR ELECTRICAL INSPECTION Es 00001-05 See instructions for completing this form on back of yellow copy. ""X'' Below Work'Cov6red by This Request [NevifAwjA RQp- Type of Building Appliances Wired Equipment` Wired APO Home Range Te j;iorary Service Duplex Water Heater Ighting Fixtures Apt., Building Dryer Electric Heating Commercial Bldg. ace Silo Unloader Industrial Bldg. Air Conditioner- Bulk Milk Tank Farm Other (Specify) Other (Specify) t er Speci y Other Other Compute Inspection Fee Below p Fee Service Entrance Size tt Fee [Above eedersFS'bfeeders # Fees Circuits 0 to 200 Amps o 30 Amps _ 0 to 30 Amps Above 200^Amps ' to 100 Amps ' 31 to 100 Amps Swimming Pool 100-Am s Above 100_Am s Transformers igation Booms PartiaG`Other Fee Signs ecial Inspection TOTAL F Remarks 3 17 ~Qv Rough-jn Date I" the Electrical 12 Inspector. hereby c certify that the above Final Date r inspection has been ® made. This request void 18 months from ► 1 2004 RRS1DBJV r~ ~Fp3m p CA razv v O Y Of Eager 3 83 Q Plot xzob Ro c , E Y T 122 - - a9491 - - - - plzo~ze 65-67 X67 --SAY G7 5694- _ - t<te'K Consfnicfion R uiremenis - - 3 registered site surveys showing•sq, ft of lot sq. it of house; and al[ roofed areas Remo (20l deVReoairr Reouiremen{s - - maximum [of coverage allowed) 2 rropis of (an shovrin beam & window size ; 2 copr~s of plan 1 PW- set le € t'P Mooing be 1 set of Energy calculations for heated'addifions ~ of Galculaffons ~ Poured found design, eta 1 site survey for additions & decks 3 copies of Tree Preservation Plan if lot puffed of ter 7/1183 Rim Joist [}efai[ Opfions selecfion sheet (bldgs Milt 3 or less units 4ddrfi°it - indicate if on-site septic system Date- L A\M Site Address Construction Cost Unit/Ste # Description of Pork Multi-Family Bldg Y N Fireplace(s) _ p _ 1 - 2r~ Property Owner VY)c Telephone Contractor Address State _a - City~~ p CJ5112) Telephone # (%l) -17- C9 -Li - u -I -I COMPLETE T-WS AREA O_!r(Ly r..-CONSTRUCTING AN ENf BU[03IN[G Energy Code Category Minnesota Rn1es 7670 Cate o 1 (4 submission type) Residential Ventilation Cafe 'a rY 1 Worksheet - Minnesota Rizles,7672r Submitted 9: New Etje • Ene F>r tgjr Code Worksheet Energy Envelope Calculations Submffted Submitted lave you previously constructed a building in Cagan wifih a sim =e applies. Tar plan? Y _ N If so, 25% plan review sensed Plumber echanical Contractor Telephone # ( ) Telephone wer/Wafer Contractor ) Telephone C I FS ji ereb Y apply. for a Residential Building f the work Permit and acknowledge that the information it c 'acid accurate• Will be, in confomaance with the ordinances and codes of the Ci Cafes; I understand this i ° a ty of Eagan th mplete~,e, s not a e Wit; that the work wi11 be accordance with the an. application fora ermz . w P t and work is net to start without a "oval o plans. approved plan in the case of wozk which requires a review and ?licant's PrinteName App cant's Si gnatux'er I OMB ITS: ONLY Sub Types _ - - - _ • - - - Q- 30--Accessory Bldg 01' Foundation- El- 07 0 =p[e J❑~13-1 pfex F1 20 -pooh . - - El 02 SF Dwefiing ❑ 08 06-plea ❑ 16 Fireplace- ❑ 21 Porch (3-sea.) - , • 31- ' - Ext. Alt- tfttuiti El: oa -oil of p[ex : EQ 09 OZ-piex ❑ i 17 Garage ❑ 22 Porcfi/Addn. (4-sea.)- 0:: ~33 : Ekt: Alf=SF =;:_k 4 ER 04- Q2 pfex • 10 08-pfex ❑ 18 -Deck ❑ 23 Porch (screenigazef5o) • 36 Multi Mfse: CI ` 05•' 03 plex Q 11 10-6iex El 19 Lower Level ❑ 24 Storm Damage ❑ 06 04-pfex ❑ 12 12-p€ex' Plbg Y or _ N ❑ 25 Mi's'cellaneous Work Types El 31.New ❑ 35 Int Improvement ❑ - 38 Demolish interior ❑ 44 Siding 32 addition ❑ • 36 Move Building ❑ 42 Demolish Foundation ❑ 45 . Fire Repair ❑ 33.Alteration ❑ 37 Demolish Building's ❑ 43 Reroof ❑ 46 Windows/Doors El 34 Replacement 'Den[olition (Enfire Bldg) Givei PCA handout to applicant r: Valuation Occupancy MCES System Zoning City Water Census Code SAC Units slides Booster Pump # ,Of Units Sq. Ft. PRV of Bidgs Length Fire Sprinklered _ Type of Const Width REQUIRED INSPECTIONS )Footings (new bldg) _ Final/C.O. - Footings (deck) _ Final/No C O Footings (addition) . Foundation` - Drain Tile Other , Roof Ice; & Waters S _ . Final - Pool Figs : Air/Gas Tests Final _ Franii ag ' _ Sidmg Stucco Stone _ Brie - Fireplace est , Final _ Windows Insulation - Refairiirig WaII'y Approved By: , Building Inspector - : Base Fee Surcharge Plan Review MC[ES SAC City SAO Utility Connection Charge -•-S&W Permit &Surcharge. Treatment Ptant LICeQ e Search Copies Other Total ~ a • sv-O.s suv s~ . vu rtsd, t of a J i •g48i} tt~P{LiTh~.a, ~Uatt~lSPi W VU re a June 7, 2001 - ' - - City of nwm 3836 Pilot gnoli Road Eager MN 55122 To whom it may Concern: Elder Jones is authori2ed to p buiIdin Elder Jones to g petits for Renewal by Md . please aIIow Provide tieseivltoc for us in Eag$n. 'This date be authorization is valid for any yond 616101; until a t~anewaj by Andcasen mmuor, enmdy revokes it in wii to the City- I request this sntli0r=fioa be accepted-expeciiEiously, a to not dale our building permit,, my faxt$cr. pleas, c,Ii me If thcco arc nn y in the Pr'o6mWlig of i contacted at 763 502-4706_ Y Qa~ons.. Ican be Your Immgdiatc attontion to this matter Is al predated. Sincoialy, _ _ - Ymond-R. Rau ustaliation Manager Renewal by Anderson Corporation K~-FTc}ex Tnnee . Cc': "my Mtnr~ Received Time Ju-n. 7. 1: 07P M PLUMBING (RESIDENTIAL) Permit Application' City Of Eagan 3830 Pilot Knob Road, Eagan Mn 55122 . Telephone # 651-675-5675 FAX # 651-675-5694 Please complete for: Single Family Dwellings Townhomes and Condos when permits are required for each unit Date '0 Site Address 9 /SCI a. ) Unit # - Property Owner ~5 r10 Z Telephone # Contractor a <:2 Address City State Zip Telephone # The Applicant is Owner -KContractor Other _ Septic System _ New _ Refurbished Submit 2 sets of plans and MPC license $ 100.00 5ncludes County fee. Additional consultant fees may apply. Alterations To Existing Dwelling Unit, Including $ 50.00 Adding fixtures to lower levels or room additions, excluding water softener and water heater Abandonment of septic system Water turnaround 5/8" meter if needed - $121.00) Other: RPZ _ new installation repair _ rebuild 30.00 Lawn irrigation system Water softener Water heater $ 15.00 ,acement additional State Surcharge T $ .50 Total $ I hereby apply for a Residential Plumbing Permit and acknowledge that the information is comp ete an accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan and with the Plumbing Codes; 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 wor will be in accordance with the approved plan i the case of work which requires a review and approval of plans. L9 X le 9f Applicant's Printed Name p ant's Si g re RESIDENTIAL BUILDING PERMIT APPLICATION t t CITY OF EAG 3830 PILOT KNOB RD, , EAGAN MN 55122 851-881-4875 New construction Reauiremente Remode fflMir Rea erg Q • 3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas • 2 copies of plan (20% maximum lot coverage allowed) . 1 set of Energy Calculations for heated Willons • 2 copies of plan showing beam & window sizes, poured found design, etc.) • 1 site survey for exterior additions & decks • 1 set of Energy Calculations . Indicate if home served by septic system for additions • 3 copies of Tree Preservation Plan if of platted after 7/1/93 • Rim Joist Detail Options selection sheet (bldgs with 3 or less units) DATE VALUATION 5®D SITE ADDRESS 16 02~D//Pd1 Gt9/4LlC fW MULTI-FAMILY BLDG _ Y TYPE OF WORK `2,E FIREPLACE(S) 0_1 -2 APPLICANT r --XTE~R." E5 O f 'Y 7 STREET ADDRESS 15.2/.-2 7r* sw r-, Nza CITYAN mot sSTATEAtl ZIP TELEPHONE # CELL PHONE # Id 1,2- 715 (4,3 FAX # 7_4 il - !f fA -ef1 Z6 PROPERTY OWNER TELEPHONE # - 0_,,:~Ja COMPLETE THIS SECTION FOR G%EW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINNESOTA' RULES 7670 CATEGORY 1 MINNESOTA RULES 7672 (4 submission type) • Residential Ventilation Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted • Energy Envelope Calculations Submitted Plumbing Contractor: Phone # Plumbing system includes: Y Water Softener Lawn Sprinkler Fee: $90.00 N Water Heater No. of R.I. Baths _ No. of Baths Mechanical Contractor: Phone # Mechanical system includes: Air Conditioning D Me Heat Recovery System APR 1 9 2002 Sewer/Water Contractor: Phone # - Y I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordina es. Signature of Applicant - OFFICE USE ONLY - Certificates of Survey Received _ Tree Preservation Plan Received Not Required _ Updated 4/02 OFFICE USE ONLY ❑ 01 Foundation ❑ 07 05-pfex ❑ 13 16-pfex ❑ 20 Pool ❑ 30 AccessoryBtdg ❑ 02 SF Dwelling ❑ 08 06-pfex ❑ 16 Fireplace ❑ 21 Porch (3-sea.) ❑ 31 Ext. Aft - Mufti ❑ 03 01 of_ plex ❑ 09 07-plex ❑ 17 Garage ❑ 22 Porch/Addn. (4-sea.) ❑ 33 Ext. Aft SF ❑ 04 02-plex ❑ 10 08-plex ❑ 18 Deck ❑ 23 Porch (screened) ❑ 36 Mufti ❑ 05 03-pfex ❑ 11 10-pfex ❑ 19 Lower Level ❑ 24 Storm Damage ❑ 06 04-pfex ❑ 12 12-pfex Plbg_Y or N ❑ 25 Miscellaneous ❑ 31 New ❑ 35 Int Improvement ❑ 38 Demolish (Interior) 0 44 Siding ❑ 32 Addition ❑ 36 Move Bldg. ❑ 42 Demolish (Foundation) ❑ 45 Fire Repair ❑ 33 Alteration ❑ 37 Demolish (Bldg)* ❑ 43 Reroof ❑ 46 Windows/Doors ❑ 34 Replacement *Demolition (Entire Bldg only) - Give PCA handout to applicant Valuation Occupancy MC/ES System Census Code Zoning City Water SAC Units Stories Booster Pump Nbr. of Units Sq. Ft. PRV Nbr. of Bldgs Length Fire Sprinklered Type of Const Width REQUIRED INSPECTIONS Footings (new bldg) _ Final/C.O. Footings (deck) _ Final/No C.O. Footings (addition) Plumbing _ Foundation _ HVAC _ Drain Tile Other Roof _ Ice Water _ Final Pool Ftgs Air/Gas Tests ` Final Framing - Siding Stucco Stone Fireplace _ R.I. Air Test Final Windows (new/replacement) Insulation - - Retaining Wall Approved By Building Inspector - - - - - - - - - - - - - - - - - - - - - Base Fee Surcharge Plan Review MC/ES SAC City SAC Water Supply & Storage S&W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other Total CITY OF EAGAN p .1 1 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121. _ BUILDING PERMIT PHONE: 454-8100 Receipt # To be used for SF DWG/GAR Est. Value $56,000 Date OCTOBER 23 19--U Site Address 1629 BOARDWALK Erect 13 Occupancy R3 Lot 32 Block 2 Sec/Sub. HAMPTON HTS Remodel ❑ Zoning R] Parcel No. Repair ❑ Type of Const.V Addition ❑ No. Stories 3 Name FRONTIER COMPANIES Move C3 Length R 3 Address 3908 SIBLEY MEM HWY, BLDG E Demolish El Depth 46 c Int. Impr. ❑ Sq. Ft city EAGAN phone 454-0433 Install ❑ z o Name SAME Approvals Fees 0.4 Address Assessment Permit $ 301.00 City Phone Water & Sew. Surcharge 2 8 . 0 0 Police Plan Review 150.50 F W Name Fire SAC 575.00 Z Address 500.00 CC i Eng. Water Conn. W City Phone Planner Water Meter 63.50 Council Road Unit 290.00 Ihereby acknowledge that Ihave read this application dstate tthe Bldg. Off. 10/22/8 Tr. Pl. 156.00 information is correct and agree to comply with all lica tate of Minnesota Statutes and f E r ' ce . APC Parks Signature of Permittf Var. Date Copies Total $2,064.00 A Building Permit is issued to: FRONTIER COMPANIES on the express condition that all work shall be done in accordance with all applicabl tate of Minn sota ut and City of Eagan Ordinances. Building Official MCNEIL HARTFORD t&l 1986 BUILDING "PERMIT APPLICATION - CITY OF EAGAN NOTE: ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN COMMERCIAL SINGLE FAMILY DWELLINGS INCLUDE 2 SETS OF ARCHITECTURAL INCLUDE 2 SETS OF PLANS & STRUCTURAL PLANS, 1 SET OF 3 CERTIFICATES OF SURVEY SPECIFICATIONS AND 1 SET OF 1 SET OF ENERGY CALCULATIONS ENERGY CALCULATIONS~ + $2,000 LANDSCAPE BOND To Be Used For: SINGLE FAMILY Valuation: 51r9-89 Date: 9-26-86 Site Address 1629 Boardwalk OFFICE USE ONLY Lot 32 Block 2 Erect Occupancy K 3 Remodel Zoning F-l Parcel/Sub Hampton Heights Repair Type of Const -S;r- Addition # of Stories Owner McNeil, Jerry Move Lengths Demolish Depth 4(0 Address 1447 Robl n Ave. Int.Impr. Sq Ft Install City/Zip Code St. Paul, MN. 55104 Phone 644-7154 APPROVALS FEES Contrac FRONTIER COMPANIES Assessments Permit 50f, is highway Bldg. E Water/Sewer Surcharge ' Zb. Address Eagan, MN 55122 Police Plan Review (50, Fire SAC 5"15 , City/Zip Code Engr Water Conn Soo. Planner Water Meter Cr~3. SO Phone 454-0433 Council Road Unit 290: Bldg Off b.Zz.&&~MTreatment Pl 15Co, Arch./Engr. APC Parks Variance Copies Address TOTAL Y. City/Zip Code Phone # NOTE: ADDRESSES FOR CORNER -LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED. i !la's j'~iwit~4 t,CS i4r+J • Page 1 of 4 IOR ENVELOPE AVERAGE "il" COMPitT/1Ti0tJ AAW'r-M ~N;S. ~r ryY►4~.. OWNER: DATF SITE ADDRESS: PHONE: CONTRACTOR: Determine working square footage of each '1. 'Total exposed wall area..... JBS ~z S sq. ft, x .lI = - dl 2. Total roof/ceiling area..... 4660 sq. ft. x .026 Z t~ Total exposed wall area above floor=51 a. Total wall window area ~t b. Total door area " ' " " c. Total sliding glass door area . " d. Total fireplace wall area " " " Z e. Total wall framing area (average 10a) f. Total rim joist area........ tz - 9• net wall area above floor.L,~ ! " " " h. `wall area above floor - i • -wall 1 area above floor....:..... j frame wall area at foundation Total exposed foundation area= k., Total foundation window area. 1. Total net foundation area above grade Determine "u" value of each wall segment (e.g. window, door, each separate wall section) a r r 3 X U" 3 Az_ r C. Z• X -u-- .45 X -lu-- 4. 84s i s j , X ' 0„ If item #3 i k, X n U n s t h e' S a J as, or less than ter 1. #1, You have r et, t'64 -~4• Z X D~, = 1► ~O intent of SBC.6.06.'ai Total = , Pic ,rior Envnlopo Rvernge "U" Computation Page 2 of 4 -n Total exposed roof/ceiling area in. Total skylight area n. Total roof/ceiling, framing area (average 10%)... o. Total net insulated roof/ceiling area........... Determine "U" value for each roof/ceiling segment = in. 40mump~ X lout, n. 94S x out, 4 Total = t, If total of ,64 is the same as, or less than 42, you have met the intent of SBC 6006 (c) 1. Alternate Building Envelope Design To utilize the total envelope' system method, the values established by the stun of items 43 and 44 shall not be greater than the sum of items (E1 and ((2. I I'. ..;Urr ~~t t~~~ali0r w.111 nrt'h fut• com,.l rucl lun C n .t i u t• V.1!%I • Y' .G~ .t$ `tom ~ .~4 5 7. vo 6. t:x r .1i l i; U~17~ . 4 Oro 3 PIG. 91 TO11VIEN OF FIIAHI: HALT, Intrrlnr ,lir i lnl 0.611 2. - 11 G. Fxtorior oir Ci1',,`~ _ _0.11 FIG. 02 ,l`oUlI lnt.r`eitir ,sir fitm__ (I.6:1 J7. 3. .11 1 F, x t t• r l_o r A i c_ f i l rn IV To 4= r) v W03 tntol i,ic ,1(r tt.(,n_ -~_z Q, 4. `17 Ji I1.'1: r i!i•1 _ 0-1'1 1. t t I SLAB ON (;RAl)li 77 ito FIG. 04 G. 13 di2oth and ~ 1 1'1'1;• (n~ltl:nC~: ; ti _ I ' C L , ~1 1 I lil,r ;r r7~ iC ;1~ ri x,oorlcEZLZ.cc • Construction R-VaZ~~c. 1. Interior air film 0.61 • 4. Exterior air film (still) 40•G~ Tot&l % _ -~--0 nCed Dear- flow I. Interior air files 0.61 . ; up z . c. 11.~Svt., 38.3' 4, rxterio~- air film istal • - 'total >ric. 45 • art S~+ c opt- 4w t. ✓ C r/ ap y+~~ ,.1 • lam.. t aJ-r -.v 1 •~•..Z~ t✓ n t.t ~7 •G. r- 1- Inside air filin 0.61 . 2- 3- 4. S. Outside air. film 0.17 40/ r :j Total z 3 1. Inside air filin 0.61 . 2. Reat floe up , 1 vented 3_ ' 4. _ S. Outside air film 0.17 • .~IC_ f 6... _ . ' : Total v 1_ Inside air film - 0.61 5. Out,idc air filin 0.17 / Total HQa_:PLD Note: Use additional sheets if more spaca i_ needed for details and calculations. . Heat - flov up 3r7:r_ f7 r• . . rlnt:r, ,•rr, ~'rc{1a;1 , ' bR1 c K ~:,.U;.~ ~yti 'oP c\ttt~tlur w,1111 Arca rov Cun t t tu. i i; n h_ V 11 u t Cr~-Imf; tiVtitl I rvc JUR. ,I - 10 it _~ttZE. _.$.1.i7GK..,.$" k.~1t _1.11 , _kip, -S'PACZ U_. 17 ~t G. Eyt.t:rii,r ntt !i!III ' FIG..91 W)VVIEV OF it FItA E WALU 1. TRt:vrlov air `i !+n Ea:Ccrictr`nii' Gtl,t FIG. F+4l2. 1'ut:~l `I 1 1. Jilt.cl'iur ni r t ilm _ _ t) ftl m-_ ' ) , 1 ` ~ ' , 6 , }.xtr• r nir f i l m IRt,•ti,t .,(r fll , t1.Gtt S. t~ G. l:alci'it I. it lAll Od (MADE 46' j 94 VI. lok FIG. 04 let X h G. 13 '2 "R" VAIUC, (It.i)1:11 IlRCt ,,,1•h'r `,t i1't'i. Ind LnC..: t.'t! 1n x ,~Y~~~~!y~~; \ et. i ►)1,1•'.:rr+tt'1C of in:;Ill,lt_LOn... PLA Q *t:- L c tit E,,AL FT, E..POSEO WALL L.OG k. ; 7Z-+ 1'0,z 178-S \,Lt. ti ;:ULLI ~ lz-+ $ rZ~ r 3 _ ►3Loc.K , l Z$• S K, S 64. ZS r PULL I r Z6 . x 6 rv zi F , A{8 To-rA L, F-X PosE--D GEcLcuq e8o W DW5 Doors 3t 7,4(46 ~ 4 = 3 ?.0/60►= 3 25 ?A-r(o D.S 4z Zvi = is SIGMA HOUSE CERTIFICATE FOR: • HOME BUILDERS SURVFEYI NG LAND DEVELOPERS REALTORS SERVICES. MW 3908 Sibley Memorial Highway FRONT; COMPANIES Eagan. Minnesota 55122 i _ Phone: (612) 452-3077 , 400 LI HARrtoKP hcA.L_ E • I "z4-01 ~.r I '.9 0$ _ s t r DRA 1 T L1't"'( ! A b ISM' T• LOT '02 I is %I-w-r 33 i L0 1 6'o nit 0 a 6~j; • a 15 X . X 8ss ~ ~~~`~aaalwunnuiur~nnn~~ ```°~NNE...... ~ CORDES I 14676 4 r3 U HIP PROPOSED PROPOSED GARAGE FLOOR ELEVATION= -LEGEND O Denotes Iron MorPROPOSED Top of Block ELEVATION= 51. A Hub Set PROPOSED BASEMENT FLOOR ELEVATION- S ,q.3_ Denotes Wood x95140 Denotes Existing Spot Elevation MOTE Verify all floor heights with Final House Plans. ROY dj Denotes Proposed Spot Elevation ( -----Denotes Drainage Direction ,YOU' CERTIFICAT►aV_- 1 hereby certify that this survey, plan or report -PROPERTY DESCRIPTION- was prepared by me or under my direct supervision LOTS , aocK and that I am a duly Registered Lard Surveyor under the laws of the State of Minnesota. Dacca d ing to the retarded plat thereof, W 04 , Date: _ 1124 DAICOTA~ County, Minnesota Wayne D. Cordes, Minn. Reg. No. 14675 ~7c77rxx+x exxzzzzzzr acxac:ar ac a. aarac ar ar aarzar ar aaor w f !a0'PE: P.AYl ' OF FM AT TIME OF. I • CITY OF E A G A N * APPLICAMON DOES NOT CONSTITUTE APPROVAL OF PERMIT. APPLICATION FOR PERMIT INSPFX.'1'IO~T OF SEWER AND/OR MM UZATIONSNILL NOT BE SCMM- SEWER AND/OR WATER CONNECTION tILED UNTIL PERMIT HAS EEM ~ * APPROVED. _ *******#~****~iri~•kkir**ir~t*it~rk~k****~l~t (Please Print l) PROPERTY ADDRESS: 1629 Boardwalk Eagan, MN. 55121' - LEGAL DESCRIPTION: Lot 32 Block 2 Hampton Heights. ---(Lot/Block/Subdivision or Tax Parcel-ID IF EXISTING STRUCTURE, DATE OF ORIGINAL BUILDING PERMIT ISSUANCE: (Month/Year) PRESENT ZONING/PROPOSED LSE: t Q CM"ERCIAL/RETAIL/OFFICE. -R-1 SINGLE FAMILY N` Q INDLISTRIAL' Q R-2 DUPLEX (Two Units) INSTIT =ONAL/GOVEM4ENT R-3 i0t?SE (Three + Units) ( Units ) k R-4 APARTMENT/CONDOMTNILIM ( Units) _ r 2) IMMURERM NAME: FRONTIER MIDWEST HOMES CORPORATION ADDRESS: 3908 Sibley Memorial Highway Bldg. E CITY, STATE, ZIP.- Eagan, MN.. 55122 PHONE: 454-0433 3) u For City Use NAME: STAR PLUMBING Plumbers License: ADDRESS: 1018 Mound Springs Terrace Active e E~E CITY, STATE, ZIP: Bloomington, MN.` 55420 :Noot t recorded PHONE: 884-4149 MASTER LICENSE# 3329 Staff =t1al 1,A1v1E: McNeil, Jerry . ADDRESS: 1447 Roblyn Ave. CITY, STATE, ZIP: St. Paul, MN. 55104 PHONE: 644-7154 5 FT, ~X CONNECTION T0' CITY SEWER, = CONNECTION TO CITY WATER OTHER "11 • CM PLEASE HOLD APPROVED PERMIT FOR PICK-LIP BY ONE OF ABOVE Q PLEASE MAIL APPROVED PERMIT TO 1, 2, 3, 4, ABOVE (Circle one) ti: • r• tc ■ • • • • r . a• • • • a i~• n • • 5(• • a• s . FOR -CITY USE ONLY -PERMIT # ISSUED Pd w/Bldg. Permit FEES: $ Z` $ SEWER PERMIT (INCLUDE SURCHARGE) $ $ WATER PERMIT (INCLUDE SURCHARGE) $ $ WATER METER/COPPERHORN/OUTSIDE READER $ $ WATER TAP (INCLUDE CORPORATION STOP) $ $ SEWER TAP $ c, $ ACCOUNT DEPOSIT - SEWER ACCOUNT DEPOSIT - WATER $ `1 . ( $ WAC $ SAC $ $ TRUNK WATER ASSESSMENT $ $ TRUNK- SEWER. ASSESSMENT $ $ LATERAL BENEFIT/TRUNK SEWER $ $ LATERAL BENEFIT/TRUNK WATER x $ l t"° $ WATER- TREATMENT- PLANT SURCHARGE $ OTHERc 3 TOTAL $ 77: RECEIPT RECEIPT DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY? YES 'IF YES, THEN A "PERMIT FOR WORK WITHIN PUBLIC ROADWAY MUST BE ISSUED BY THE ENGINEERING NO DIVISION., LIST AS <A CONDITION. SUBJECT TO THE FOLLOWING CONDITIONS: APPROVED BY: TITLE: DATE: Rear Cpl I -FCC 4 Le< Q c"t yxLl o II q fFa~ched +0 host 51- P'T7L"0 boor opening N°USe /G ~ 9 rc~w~/k 7 ~-c~ N • SS/a o 2006 RESIDENTIAL MECHANICAL PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 Please complete for: single family dwellings & townhomes/condos when permits are required for each unit Date Site Address Nod lam- Unit # Property Owner r Telephone # (~61 ) (f R `Le)Js, flOCNkA Contractor Tffk4l~_ lta~l YVV Street Address PS' City State Zip Telephone # Bond 1` O Ci Expires: - The Applicant is Owner Contractor Other Add-on or alteration to existing dwelling unit $ 30.00 furnace _Additional Replacement New air exchanger air conditioner heat pump other State Surcharge $ .50 Total $ I hereby apply for a Residential Mechanical Permit and acknowledge that the information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan and with the Mechanical Codes; 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. Applicant's Printed Name Applicant's Signa e s Use BLUE or BLACK Ink For Office Use I o" CC, I ~~T City of Eap Permit V V I G)jp I ` i Permit Fee: L i I 3830 Pilot Knob Road Eagan MN 55122 Date Received: Phone: 651 675-5675 Fax: (651) 675-5694 Staff: 2012 RESIDENTIAL BUILDING PERMIT APPLICATION a o -1 I_ po,f l(wk1 K Unit M Date: ~ Site Address: b ✓ ~ Name: .J WAS GL' 1E~ hq°yw_ the 1 Phone: 651 ~y3 y -1?1,f 7P RESIDENT / D OWNER Address / City / Zip: lb olct .&!%I'dt cd t~ Eq ~"n I✓ S/`2Z" Applicant is: Owner Contractor Description of work: ✓ ~"/2,L,/ QeGt~ TYPE OF WORK Construction Cost Multi-Family Building: (Yes / No Company: Contact: CONTRACTOR Address: City: State: Zip: Phone: License M Lead Certificate If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) Boo- t: 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: Phone: Sewer & Water Contractor: Phone: NOTE: Plans and supporting documents that you submit e considered to be public information. Portions of the information may be classified as non-public if you pry ide specific reasons that would permit the City to conclude that the are trade secrets. ` CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 4540002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.oor)herstateonecall.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 fora 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. X_ Q r t', V%vi e ~1 cn e ~ I x Applicant's Printed Name App cant's Signature Page 1 of 3 DO NOT WRITE BELOW THIS LINE SUB TYPES Foundation _ Fireplace _ Porch (3-Season) _ Storm Damage _ Single Family _ Garage _ Porch (4-Season) _ Exterior Alteration (Single Family) Multi Deck _ Porch (Screen/Gazebo/Pergola) _ Exterior Alteration (Multi) _ 01 of Plex _ Lower Level _ Pool Miscellaneous Accessory Building WORK TYPES New _ Interior Improvement _ Siding _ Demolish Building" Addition _ Move Building _ Reroof _ Demolish Interior Alteration _ Fire Repair _ Windows _ Demolish Foundation Replace _ Repair _ Egress Window _ Water Damage Retaining Wall 'Demolition of entire building - give PCA handout to applicant DESCRIPTION Valuation 00-060 Occupancy c, MCES System Plan Review Code Edition cad? SAC Units (25%_ 100%~ Zoning City Water - Census Code y 3y Stories - Booster Pump - # of Units Square Feet- PRV - # of Buildings Length ~y Fire Sprinklers - Type of Construction Width 3G REQUIRED INSPECTIONS Footings (New Building) Meter Size: Footings (Deck) Final / C.O. Required Footings (Addition) Final / No C.O. Required Foundation HVAC _ Gas Service Test Gas Line Air Test Drain Tile Other: Roof: -Ice & Water -Final Pool: -Footings -Air/Gas Tests -Final Framing Siding: -Stucco Lath -Stone Lath -Brick Fireplace: -Rough In Air Test -Final Windows Insulation Retaining Wall: _ Footings _ Backfill _ Final Sheathing Radon Control Sheetrock Erosion Control Reviewed B , Building Inspector 4 Ck..Vt, RESIDENTIAL FEES /Y X g G = 501f o oq Base Fee r 5-(,p Surcharge Plan Review JOT MCES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Copies 9 o'L3 aq, TOTAL Page 2 of 3 V ,SIGMA , HOUSE CERTIFICATE FOR: + NOME S U RV~ TYI N A LAND fELOPERS REALTORS SERVICES. w ; ; 3908 Sibley Memorial Highway .FRONT COMPANIES Eagan. Minnesota 55122 Phone: (612) 452.3077 HOP L ~ NARTtp tv RA-' LOT '02 i i. As x'~r ~Q ' 40 LUT 33 I , 5 o a $r,1.bx'faC I'(0-W.... • gyi,~ ~G.L`} ~ 8ss p NlESrtnr''~nii,, /.WAYNE D.~'~ EAGAN CORDES I r= REVIEWED s ...14675 } BY. } 71ONS DIVI SIGN - PROPOSED 6ARA6E FLOOR ELEVATION= 857.0 9 3'. 0 Denotes Iron Monument PROPOSED Top of Block ELEVATION= 5?. A Denotes Wood Hub Set PROPOSED BASEMENT FLOOR ELEVATION-- 85 `f•3 ~08~5710 Denotes Existing Spot Elevation Verify all floor. heights with Final House Plans. (xy~}q„ lOj Denotes Proposed Spot Elevation --Denotes Drainage Direction tg SUM QWIFIC01 I hereby certify that this survey, plan or report -PACFERTY MSCRIPTION- was prepared by me or under my direct supervision LOt_.0 8LO K and that I am a duly Registered Land Surveyor under the laws of the State of Minnesota. according to the recorded plat thereof, 4uH-'- Date: DA4OT-N County. Minnesota Wayne D. Cordes, Minn. Reg. No. 14675 PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA147149 Date Issued:12/13/2017 Permit Category:ePermit Site Address: 1629 Boardwalk Lot:32 Block: 2 Addition: Hampton Heights PID:10-31900-02-320 Use: Description: Sub Type:Residential Work Type:Replace Description:Water Heater & 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. Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener). 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 - Breanne Schultz Mcneil 1629 Boardwalk Eagan MN 55122--123 (612) 558-4014 Dean's Professional Plumbing 7400 Kirkwood Court N Maple Grove MN 55369 (763) 428-1321 Applicant/Permitee: Signature Issued By: Signature