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1782 Brant Cir Use BLUE or BLACK Ink r---------------- For Office Use of I I City Ol on Permit#: I Permit Fee: 3830 Pilot Knob Road 1 Eagan MN 55122 Date Received: I'D Phone: (651) 675-5675 I I Fax: (651) 675-5694 1 Staff: I I 2010 RESIDENTIAL BUILDING PERMIT APPLICATION Date: /Site Address: Tenant: Suite RESIDENT/ OWNER Name: 64-f-N 19 Phone: t ,5I -A~~~~ Address / City/ Zip: / /'j Applicant is: Owner ✓ Contractor n TYPE OF WORK Description of work:' Construction Cost: Gds Multi-Family Building: (Yes No CONTRACTOR Name: 1 ge-. License#: 26b33ooel Address: 1?C City: jdao(e State: M/u Zip: 55~ / I Phone: to f!' 36J - s-'F 449, Contact: Vet IVt t L mail: - I 4Lak~j 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 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 the 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.gopherstateonecall.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 for a permit, and work is not to start without , ermit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. X x Ap icant's Print d ame Applic s 1 ature Page 1 of 2 Parcel Files Cover Sheet Unique ID: 2153 1782 Brant Cir 104725305002 INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55122-1897 Date Issued: 0 .t H (612) 681-4675 I SITE ADDRESS: I APPLICANT: ~ • t HO., A'6 I ":c -A). i it ; t i 131fsf Y I NI I ltr! l t+I;'`Iilt t Ff•e lIII ~t i.' 1 i tf PERMIT SUBTYPE: TYPE OF WORK: I fit It, Jf it INSPECTION DATE INSPTA. • TYPE DATE INSPTR. ~ fill f t t~tl~', F• ittli~3j1/i I 1 f t t i; ' ~ ! t l t'. ! t ~ ~ td t' 'i i' "r I !11 t t`fltllyi{ t it 11; Ir l~ffi'vlt ! i 1i i f i't 4i I I!:!. 2: } 1 Vd i- I t t_.t { E. t: I, I F t f I P > t (f i i , ? b; 1 r ; I_ j r- r Permit No. Permit Holder Date Telephone # ELECTRIC qT PLUMBING HVAC S/ J~ ~p ~lj Inspection Insp. Comments FOOTINGS e FOUND FRAMING 1-11 7 ~ `6/Q7 ~L ROOFING / { I~ ROUGH PLUMBING ,tL PLBG AIRTEST ,.y ROUGH HEATING GAS SVC fatllel, TEST 1 INSUL GYP BOARD FIREPLACE AIRTEST CE 4 J, IF ~ FINAL PLBG -3-11-7730- FINAL HTG ORSAT TEST BLDG FINAL "ft/f l BSMT R.I. i BSMT FINAL DECK FTG i/ DECK FINAL T 1 i C~► ericate a~ ~ccpa~c~~ - s (OM Of 0"- r This Certificate issued pursuant to the requirements of the Uniform Building Cade certifying that at the time of issuance this structure was in compliance with the various ij ordinances of the City regulating building construction or use. For the following. use boa SF DWG BM& PaaKt No. 28779, Y TWO R-3 U-1 Zooia~ fJistriec Va TyI.C..M. R-1 OW.Oesam" BUTLER HOUSING CORPAd&,. P 0 BOX 24597, APPLE VALLEY, MH 1782 BRANT i;IR t aw«y LS, B2, MALLARD PARK 477 Daw POST IN A CCNNSPIUMS PLACE 1782 BRANT CUR Zip 5512 J1 5 Blk 2 Sub HALLAU PARK 4TH THESE ITEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECTION. Date: / 97 Yes No Inspector: Final grade (6" from siding) Permanent steps (garage) Permanent steps (main entry) Permanent driveway Permanent gas' Sod/Seeded grass Trail/curb damage Porch Basement finish L/ Deck Please verify with the builder the removal of roof test caps from the plumbing system and the shut-off of water supply to the outside lawn faucet before freeze potential exists. Contact engineering division at 6814645 before working in right-of-way or installing underground sprinkler system. White - City Copy Yellow - Resident Copy Pink - Contractor COPY OFFICE USE ONLY This request void 18 months from validation date printed in this box. 353-450 ❑7 ~0 PLEASE PRINT OR TYPE,L4r,6 Req to Rough-in inspection wired. Y es No Inspection Other Than Rough-In: ❑ Ready Now Will Call X (You must call the inspector when ready) Dale Ready: I, lic nsed contractor ❑ owner hereby request inspection of the above electrical work at: Jo do (S at, Route No.) CRY Zip Code Section No. Township Name or No. Range No. Fire No. CountyI Oc "OR +ier Pho 3 t 3 Z-► pier re r Elect ractor( mpa m V-A M {C e) Contr r N Master Lie. No. (Plant Elect. Only) " _Yontracr 'N tor or Owner Pe mi Ins= do cop un r ntr or r O rfor ing Inst a ion) Pho EB-000o1A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY P } REQUEST FOR ELECTRICAL INSPECTION 69 Ave., oRm of Electricity IIIIIIIIIi1t1~~NI~~Rllll~lllllll~~IIIN~I~IIIII Minnesota Board 821 S-128 St. Paul, MN 55104 * 0 3 5 3 4 8 0 7* Phone (612) 642-0800 Home Duplex Apt. Bldg. Other: New Addn Commercial Industrial Farm Remod Repair Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: Dryer Range Elec. Heat emp. Service "X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only. li Calculate Inspection Fee - This inspection Request will not be accepted without the correct fee: Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Mobile Home Park Stall 0 to 200 Amps IiAho 0 to 100 Amps 1901-10- Street Ltg_/Traffic Sig. Above 200 Amps bove 100 Amps Transformer/ Generator INSPECTOR'S USE ONLY /1 ~/►1 ,~j TOTAL ® -40 Sign/Outline Ltg. Xfmr. Alarm/Remote Control J Swimming Pool I hereby cert fy that 1. sped ica latio described herein on the dates t Irrigation Boom Rough-In Special Inspection --jwm Investigative Fee Final Date I THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTH i' . ~ ~ ~ 9~~1'_.i~i!~~~)iir II Vii, ~r • :1., - 0 5 6 ? 6 COY OF EAGAN CASH:[E'6= C T'E:RHTNAK Non 539 IIA7E: O9./36 7IMEe 1 ;.00;.'.,6 " NAME: PF HPLOTNG CO ;~,d Il, j " 2256 9001 022 BRANT CIR 4,708.38 I- i S I ~ I. ~ Total Receipt WOW : 4..70S.38 USER T;'i;; NANCY C„ r ~ . I , L 1 ' Ill r 1 1' " r' 1 1 11 i ill • '1 t 4 PERMIT CITY OFEAGAN 3830 Pilot Knob Road PERMIT TYPE: BUILDING Eagan, Minnesota 55122-1897 Permit Number: 0 2 8 7 7 9 (612) 681-4675 Date Issued: 09/18/96 SITE ADDRESS: 1782 BRANT CIR LOT: 5 BLOCK: 2 MALLARD PARK 4TH 'P.I.N.: 10-47253-050-02 DESCRIPTION: B~ildin Permit Type SF 0WG uilding abrk Type NEW lJ'<9C flccupncy R-3 U-1 .''CpristYUCti)o`n`'7}e V-N Zoning =z R-1 Building Aenqth; 51 8ui„1<41n9 .W*tlth 55 B i d e ries 11,61E LAIL, F~et Csc~G,vi 101 1 - FAM. DETACH R f r If N! tzl' REMARKS: PRV S & W PLBR - WELTER & BLAYLOCK PLBG FEE SUMMARY: VALUATION $163,000 Base Fee $1,202.25 MISCELLANEOUS $1,923.50 Plan Review $601.13 Total Fee $4,708.38 Surcharge $81.50 SAC $900.00 SAC % 100 SAC Units 1 Subtotal $2,784.88 CONTRACTOR: - Applicant - ST. LIC OWNER: BUTLER HOUSING CORP 14314132 0001715 BUTLER HOUSING CORP P 0 BOX 24597 P 0 BOX 24597 APPLE VALLEY MN 55124 APPLE VALLEY MN 55124 (612) 431-4132 (612)431-4132 I hereby acknowledge that -I have read rthis application and stare that the =nforinaona tarot an`egrF tc csinply 't;nth a$: aPP1i,1~b1B=;tate,f ILI Statutes and city of Eagah--Ordinances.: f ~~tE PPLICANT/PERMITEE SIGNATURE BY. S NA R CITY OF EAGAN 41 1 0 U. M 3830 PILOT KNOB RD - 55122 1996 BUILDING PERMIT APPLICATION (RESIDENTIAL)~~ 681-4675 New Construction Reouirements Remodel Repair Reouirements ♦ 3 registered site surveys ♦ 2 copies of plan ♦ 2 copies of plans (include beam & window sizes; poured Ind. design; etc.) ♦ 2 site surveys (erdedor additions & decks) ♦ 1 energy calculations ♦ 1 energy calculations for heated additions ♦ 3 copies of tree preservatio:9 n d lot stied after 711/93 required: _ Yes No ~ o -Frz ,i S po 1 DATE: -P-> ~c2Co CONSTRUCTION ~CgOS~T-~~ DESCRIPTION OF WORK: 77 11 n -e-Qvyl i U3 ` f a STREET ADDRESS: r p 5 Mallard fC f LOT BLOCK SUBD./P.I.D. a~rlL41~ ` PROPERTY Name: l er I Ou!!~ Phone 45(-4132- OWNER XST Street Address- o E)CQ ZASCI-7 Arbe V--!7 State: Zip: zq- City CONTRACTOR Company:/ ~ClS( Phone#: ~~-`7`4(3Z Street Address: ` 1. D,1 -?->C)X, License I~~r 17- City : t1 In~2 lc~ l~U State: VV' ~ zip: ARCHITECT/ Company: 3z~ L~ t' 1~ D r Phone 0L2ffi ENGINEER / ~Ij 1A ~ Name: k R IJ Cic1~~ l~ Registration --1-~- Street Address- CCM City: 630✓Yll Vl ~O State: I Zip: Sewer & water licensed plumber: /•lPenalty applies when address change and lot change are requested once permit is issued. 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. Signature of Applicant: / OFFICE USE ONLY R EC E MME DD Certificates of Survey Received Y No Tree Preservation Plan Received Yes No OFFICE USE ONLY BUILDING PERMIT TYPE ❑ 01 Foundation ❑ 06 Duplex ❑ 11 Apt./Lodging ❑ 16 Basement Finish 0'02 SF Dwelling ❑ 07 4-plex ❑ 12 Multi Repair/Rem. ❑ 17 Swim Pool ❑ 03 SF Addition ❑ 08 8-plex ❑ 13 Garage/Accessory ❑ 20 Public Facility ❑ 04 SF Porch ❑ 09 12-plex ❑ 14 Fireplace ❑ 21 Miscellaneous ❑ 05 SF Misc. ❑ 10 = plex ❑ 15 Deck WORK TYPE )a- OR31 New ❑ 33 Alterations ❑ 36 . Move ❑ 32 Addition ❑ 34 Repair ❑ 37 Demolition GENERAL INFORMATION Const. (Actual) VrJ Basement sq. ft. go4/ MCNVS System (Allowable) 1i d Main level sq. ft. 1,104 City Water ~ sq. ft. -7 114 Fire Sprinklered UBC Occupancy 3. U_ Lemm Zoning R i sq. ft. PRV # of Stories sq. ft. Booster Pump Length 77sq. ft. Census Code. lot Depth sal, 9 - Footprint sq. ft. I.(, + 8 SAC Code 61 Census Bldg l Census Unit l APPROVALS Planning Building MP3 Engineering Variance Permit Fee Valuation: $ 3, vvo. - Surcharge Bast, J-- Plan Review License 2-,. s u S~ y o z- r MCNVS SAC 13 x 3 C. 3 3 H 7 L_ 3 City SAC u, 33 2 - Water Conn. u s = ~r tea' s Water Meter ~ a o 3 , s Acct. Deposit s t SNV Permit SNV Surcharge 4" S y o3, s u sy = + o z , ~9. - Treatment PI. Road Unit Park Dad. Trails Dad. 20U Other Copies , s. 3 3 G z Total: 'a7.33+r ~q 57G • 3 21zzz.6~ v5.3 %SAC 7/ ' 0,`= fl, `/7.G SAC Units 1 Z,, 1i 9 N I o - ' Siur~r's C~ittftaanGe SMge~Y FOR : Butler Housing Corp. OESMIBM AS : Lot 5, Block 2, NALIg1% PSBR 4TH ADDITION, City of Eagan, Dakota County, Minnesota and reserving easements of recor 2633 20, cc 1 ~ tr a L_ I. I 1 998. X42. e N870 32' 33' E 70.57 30 ~p.~P~` y- 0606 / ~ 1 1}11 • A~ / / e 2A 5A~ ' I1gp n: n~ry! 991. s// t ° y 8. o czG 1U. d g r I aT 1 I °o a M C U 1 o I I ° 26.00 0 30.00 I I I 2. DO -may, .ti I o 26.33 ,,rape o yxx~ni ` q~-1'l.0 w I 9?2~ 1" ~r an I I peek 1 ~ 9. 33 3 u J I I • 1 r --e- Proposed I ~ o e I C1~ I ° Raa lar iO 13ea. ■ia e 950. to C{3ci,~ y 2.00 iw I ti I 440,0 a 114~ Q Q4 3 I f 47.00 n f y e o I 1 BSS o / 114, lz~ G4ku..5 / 946. 5 ca,~3 i LOT SO. FOOTAGE = 18, 323E ~S PROPOSED ELEVATIONS BENCHMARK, Top of Foundation .951.3 rwm @ 4318 W to Garage Floor °950q Fleu•4glo.4~ Basement Floor =942,5 Aprox. Sewer Service Elev. °a3v.o*- Proposed Elev. ° O MIN. SETBACK REQUIREMENTS Existing Elev. _ Drainage Directions Front -ao House Side -Io Denotes offset Stake ° SCALE : i inch ° 30 Feet Rear -2s Garage Side -5 JOB NO: I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION %R-295 I~EOL~//1/0 OF THE BOUNDARIES OF THE ABOVE DESCRIBED PROPERTY AS SURVEYED BY ME OR UNDER MY DIRECT SUPERVISION AND DOES NOT PURPORT TO BOOK: PAGE: SHOW IMPROVEMENTS OR ENCROACHMENTS, EXCEPT AS SHOW! Planning Engineering Surveying 9201 Fpt el°wlMt p prMwe"I2e, MInOO°L 5120 Date JE Y L OPEN. LANG SU EYOR CADD FILE: IC N AML NUMBER 4376 ~,«ICr9o LOT SURVEY CHECKLIST FOR RESIDENTIAL BLAMING PER IT APPLICATION PROPERTY LEGAL: S Z DATE OF SURVEY: .rZ I Ell- LATEST REVISION: m DOCUMENT STANDARDS a z° ❑ • Registered Land Surveyor signature and company ❑ ❑ • Building Permit Applicant ❑ • Legal description El ❑ ❑ • Address 51 ❑ • North arrow and scale p/ ❑ ❑ • House type (rambler, walkout, split w/o, split entry, lookout, etc) ❑ • Directional drainage arrows with slope/gradient % ❑ • Proposed/existing sewer and water services & invert elevation >r ❑ ❑ Street name a---❑ ❑ • Driveway ELEVATIONS tin V ❑ ❑ • Sewer service (or Proposed) ❑ ❑ • Property comers ❑ • Top of curb at the driveway ❑ ❑ • Elevations of any existing adjacent homes Proposed d ❑ ❑ • Garage floor Er ❑ ❑ • First floor 12" ❑ ❑ • Lowest exposed elevation (walkout/window) 0~ ❑ ❑ • Property comers ❑ cr-'a • Front and rear of home at the foundation PONDING AREA (if aoclicable) ❑ [d' ❑ Easement line ❑ M' ❑ • NWL ❑ tr ❑ • HWL ❑ g" [3 Pond # designation ❑ ❑ • Emergency Overflow Elevation DIMENSIONS er' ❑ ❑ Lot lines/Bearings & dimensions ❑ ❑ • Right-of-way and street width (to back of curb) Er' ❑ ❑ Proposed home dimensions including any proposed decks, overhangs greater than 2', porches, etc. (i.e. all structures requiring permanent footings) ❑ ❑ • Show all easements of record and any City utilities within those easements Setbacks of proposed structure and sideyard setback of adjacent existing structures ❑ y~ ❑ • Retaining wall requiremen Reviewed: N -a' m e Date/ January 1998 CRA1G1990aLDGPRMTFM S-1+42 MH 20 ~93P. 45 MH 19 r \ S-0+94 935.0 i 1 F -!ig EEN 93s.5 43 6`1132 BEND D \ \ 44 HYDRANT 6"x 6" TEE / \ H s-o+78 ! 1 939.0 / ~ 4 \ 43 T CIRCLE 44 1 Hi 19 f I f ! ( MH, 18 345 6'PO SED GRROE MAT . C, E 9E 2 3D . PVC 1 t \ 1. i i 1 $ PV .li 1.2Qf - j 83 LF 8.' PVC f` E 9. Q n rL+ 4: 3 _ j i is S-1+95 9445 16 ,n ==i E" f 1 iE BEND 28 ! 5 s 27 NT WORKSHEET FOR 1 & 2 FAMILY DWELLINGS ENERGY pCODE SITE ADDRESS p ~l ( y sCry 0126z~ aa .CITY A Y9J4N //COMPLETED BY: r C PHONE q J I- 232 DATE :O BUILDING CLASSIFICATION: ❑ category 1 (must include ventilation) or ❑ category 2 (standard) MINIMUM CRITERIA Foundation Insulation-R10 Walla & Windows Roof Attic Insulation: (See table on reverse side Slab on Grade Insulation-R10 for allowable percentages) R44-With Attic No Heel Floor over unheated 5paces-R24 R38-With Attic Raised Heel Foundation Windows 1/2" R38 & R5-Solid Rafters insulated Glass. -Wood or Vinyl Frame STEP 1 Window & Door Area STEP 2 Calculate area as a percent of wall A. Total Window & Door Area in Sq. Feet WINDOWS (Including Foundation Windows): WINDOW MANUFACTURE NAME: p ~/f'0= C. From Step 1 divide box A (Window & Door D - 14 1CL Fo Area) by box B (total wall area) times 100 WINDOW MANUFACTURE TYPE: Ge(t) - equals the window and door area as a e 3~/ percent of wall area (box C). WINDOW MANUFACTURE U FACTOR: 3~~•9 R. O. Quantity sq. ft.Area BOX A _I X 100 = C = / Dimensions BOX B3 193 ~ l (D X STEP 3 Design Features X ASSEMBLY X FRAMING TYPE: Q X STANDARD FRAMING 16 studs 16" o.c. X ADVANCED FRAMING studs 24" o.c. X CAVITY INSULATION / X SHEATHING TYPE: ✓ X LESS THAN < R-5 X R-5 > OR MORE y[Q X U-FACTOR D 7 / DOORS: From the table, (reverse side) determine the maximum percent window & door area for the design options selected and enter the 4 value X in Box D below based on the window mfg. U- factor: X 7/• ,p D Total Area of A!= 78q• t. Windows & Doors B. Total Wall Area in Sq. Ft. The % value from the table in Box D shall be equal to or greater than the % in Box C Wall Total Height Area Perimet let 4~9_c~ Total Area of Walls B= sq.ft w Page 1 OF 2 CALCULATIONS EQ$p_ 1251 @$ANI CIRCLE EAMR, W. WINDOW AND DOOR SCHEDULE QUANTITY TYPE SIZE FACTOR WINDOW OPENING 0 BASEMENT 27 X 14 2.60 0.00 0 PATIO DR 6 X 6 36.00 0.00 3 CASEMENT 20 X 38 5.30 15.90 0 CASEMENT 24 X 48 8.00 0.00 5 CASEMENT 26 X 60 10.80 54.00 3 CASEMENT 26 X 36 6.50 19.50 3 CASEMENT 26 X 44 7.90 23.70 0 CASEMENT 16 X 48 5.30 0.00 0 TRANSOMS 20 X 24 3.30 0.00 0 DBLE HUNGS 32X24136 15.80 0.00 2 DBLE HUNGS 26 X 26 9.40 18.80 0 DBLE HUNGS 20 X 20 5.60 0.00 12 DBLE HUNGS 36 X 26 13.00 156.00 0 DOLE HUNGS 32 X 16 7.10 0.00 2 SIDE LTS. 1 X 1.3 6.20 12.40 30 TOTAL GLASS AREA: 300.30 DOOR SCHEDULE QUANTITY TYPE SIZE FACTOR DOOR OPENING 2 THERMATRU 3'-0' X 6 19.00 38.00 2 THERMATRU 2'-8° X 6 16.80 33.60 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 TOTAL DOOR AREA: 71.60 Page 2 OF 2 TOTAL WALL WINDOW AREA: 300.30 U-VALUE 0.361 TOTAL PATIO DOOR AREA: 0.00 U-VALUE 0.367 TOTAL BASEMENT WOW AREA: 0.00 U-VALUE 0.421 TOTAL WINDOW AREA 300.30 TOTAL DOOR AREA: 71.60 U-VALUE 0.066 TOTAL AREA- WINDOWS & DOORS: 371.90 (A] TOTAL AREA OF WALL: 3,193.00 (B) ACTUAL. WOW & DOOR AREA AS % OF WALL: 11.65% (A] \ [B] [STANDARD WALL FRAMIN61 SNEATHIING )R_5, INSWL, R14~ WINDOW 14.00% MAX WDW/DR AREA CALCULATIONS M. 1781 9RW CIRCLE. EAriAN, Ma CITY USE ONLY L _ BL RECEIPT SUB a l v~_ DATE: 1996 MECHANICAL PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (612) 681-4675 Please complete for: ► single family dwellings ► townhomes and condos when permits are required for each unit Iol New construction Add-on furnace Add-on air conditioning Add-on air exchanger, i.e. Vanee system, etc. Date: ati-clL EM ► Minimum Fee: Add-on/Remodel (existing residence only) $20.00. ► HVAC: 0-100 M BTU 24.00 Additional 50 M BTU 6.00 ► Gas Outlets (minimum of 1 required @ $3.00 each) ► State Surcharge 22 zz .50 TOTAL ar-i SO SITE ADDRESS: OWNER NAME: "I PHONE INSTALLER NAME: n ' STREET ADDRESS:. CITY: /I'/rI~ STATES ZIP: 55-107 PHONE ( CITY USE ONLY L _ BL RECEIPT SUBD. DATE: 1996 MECHANICAL PERMIT (COMMERCIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (612) 681-4675 Please complete for: ► all commercial/industrial buildings. multi-family buildings when separate permits are IIQt required for each dwelling unit. DATE: CONTRACT PRICE: WORK TYPE: NEW CONSTRUCTION INTERIOR IMPROVEMENT DESCRIPTION OF WORK: FEES: ► $25.00 minimum fee 91 1% of contract price, whichever is greater. ► Processed piping - $25.00 ► State surcharge of $.50 per $1,000 of permit fee due on all permits. CONTRACT PRICE x 1% PROCESSED PIPING STATE SURCHARGE TOTAL SITE ADDRESS: OWNER NAME: TELEPHONE TENANT NAME: (IMPROVEMENTS ONLY) INSTALLER: ADDRESS: CITY: STATE: ZIP: PHONE SIGNATURE: SIGNATURE OF PERMITTEE CITY INSPECTOR ~ ~ ' - L Bl. CITY USE ONLY RECEIPT#: tI 73 oS o~G SUBD(q!, ~ ~y ry DATE: 1996 PLUMBING PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (612) 681-4675 Please complete for: single family dwellings ► townhomes and condos when permits are required for each unit FIXTURES EACH )YQ. TOTAL Shower 3.00 x = 3,60 Water Closet 3.00 x 13 = 17,00 Bath Tub 3.00 x = 6,00 Lavatory 3.00 Y /a.00 Kitchen Sink 3.00 x 3,00 Laundry Tray bQ r s i; 3.00 x -;z _ 6,60 Hot Tub/Spa 3.00 x = Water Heater 3.00 x = 3.60 Floor Drain 3.00 x 00 Gas Piping Outlet " minimum -1 3.00 x 2.00 Rough Openings 1.50 x _ Water Softener 5.00 x = Private Disposal " Dakota Cty. license 65.00 = (new and refurbished systems) U.G. Sprinkler " home under const. 3.00 = Alterations • to existing 20.00 = Water Turn Around 20.00 STATE SURCHARGE .50 TOTAL yS, Sy C i N r~ SITE ADDRESS: / $ a ~dP44 OWNER NAME: ,d u f /e t- HO 14 S l N ry Co ✓ bo INSTALLER NAME: fee a- 6 /a /o e ~Zh c_ STREETADDRESS: /S-0 9 Hwy /3 CITY: 1:14 rOs vi //-e.> STATE: A/1/ ZIP: 5-5337 PHONE (~i a) 8!3 a - B b SS l OFFICE USE ONLY ' L BL RECEIPT SUBD. DATE: 1996 PLUMBING PERMIT (COMMERCIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (612) 6814675 Please complete for: w all c:ommercialfindustrial buildings. W multi-family buildings when separate permits are nW required for each dwelling unit. DATE: CONTRACT PRICE: WORK TYPE: NEW CONSTRUCTION ADD ON REPAIR DESCRIPTION OF WORK: IS WATER METER REQUIRED? - YES _ NO. IF SO, PLEASE PROVIDE THE FOLLOWING: WATER FLOW: GPM. ARE FLUSHOMETERS TO BE INSTALLED? YES NO. FAILURE TO PROVIDE THIS INFORMATION WILL RESULTIN A DELAY OF METER ISSUANCE. WILL YOU BE INSTALLING A METER FOR A FUTURE U.G. SPRINKLER SYSTEM? _ YES _ NO. IF SO, YOU MUST APPLY FOR A SEPARATE U.G. SPRINKLER PERMIT. FEE: $25.00 minimum fee or 1% of contract price, whichever is greater. State surcharge of $.50 per $1,000 of permit fee due on all permits. CONTRACT PRICE x 1% STATE SURCHARGE TOTAL SITE ADDRESS TENANT NAME: STE. # OWNER NAME: INSTALLER: ADDRESS: CITY: STATE: ZIP: PHONE SIGNATURE: APPLICANT OFFICE USE ONLY METER SIZE: DATE: INSPECTOR: 1 ~-----ce------------ ~ I For Offi Use j Permit City I Permit Fee: 3830 Pilot Knob Road I I Eagan MN 55122 j Date Received; j Phone: (651) 675-5675 Fax: (651) 675-5694 Start: 2009 J RESIDENTIAL BUILDING PERMIT APPLICATION 130 Date: U - 15 -09 Site Address: 17 SA r- 0. eL+ <-; t` E a.a m,y. may. Tenant: Suite RESIDENT/ OWNER Name: GG.ru i tAlLrv CAav-. Phone: &51 ' J.05 0 7 ~ L Address/ City/ Zip: 1 a.n 1r' <:.r Igd,a a, h 55 12-2, Applicant is: Owner Contractor TYPE OF WORK Description of work: R r_ %.,U X g n g e-z-k LO / e.,,.1 RoLk n15 Construction Cost: Multi-Family Building: (Yes / No CONTRACTOR Name: 0 ~ws vn,i r License Address: City: State: Zip: Phone: Contact Person: COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Category 1 Minnesota Rules 7672 Energy Code • Residential Ventilation Category 1 Worksheet New Energy Code Worksheet Category Submitted Submitted submission type) • Energy Envelope Calculations Submitted 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 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 the are trade secrets. 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. x MOD'E'4", - it, )h. 9~~ - - 4.^A kv~a Applicant's Printed Name Applican ignature 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 Occupancy MCES System Plan Review Code Edition SAC Units (25%100% Zoning City Water Census Code Stories Booster Pump # of Units Square Feet PRV # of Buildings Length Fire Sprinklers Type of Construction Width REQUIRED INSPECTIONS Footings (New Building) Sheetrock Footings (Deck) Final / C.O. Required Footings (Addition) Final / No C.O. Required Foundation -7k- HVAC 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 Meter Size: Erosion Control Reviewed By: Building Inspector RESIDENTIAL FEES Base Fee Surcharge Plan Review MCES SAC City SAC Utility Connection Charge iu S&W Permit & Surcharge Treatment Plant ' Copies TOTAL l 62 Page 2 of 3 suneorsrWI SURVEY FOR : Butler Housing Corp. DEM,W AS , Lot 5, Block 2, MALLA64.93 PARR 4TH ADDITION,- City of Ewan, Dakota County, Minnesota and reserving easements of recor • 26.33 28.00 c 1 1-r- a L 99$. 91 qN870 32' 33° E 70. 57 7 < to 30 - --1 10 o D0 / / to 1..-1 N 99I. Z / /q-,w o m G uU.~ / y t---+ J 0 4r 4T 4p ^m 26.00 °o N 30.00 + t`l L, o f II ~y~ c°o I p 2.00 I 26.33 Garage o ~ ` V l % Deck v 1 ( I 9.33 Apro>< ~ I I 6 ° I Proposed I `-I CD v w1 ° IIaND I or o ` cvc~ -Sir ".z t 13cs. will C, 9 0, to C1. s 47 2.00 49Qo I~ a G92,Z ' 47. oo rr o o cil S4 --I ~ / oo .x:~ ~~t., .x a:: 946. 5• Gt°' qy`3 U LOT SQ. FOOTAGE = 18, 323-+ a S PROPOSED ELEVATIONS BENCHM11 S" Top of Foundation = 951,3 Garage Floor =4509 Frees -C14(o.9-7 Basement Floor = 942,5 Aprox. Sewer Service Elev. =%(q-o3 Proposed Elev. = C) N MIN. SETBACK REQUIREMENTS Existing Elev. _ I Drainage Directions Front -3o House Side -1o Denotes offset Stake _ o SCALE L Inch 30 Feet Rear -2s Garage Side - s : • JOB NO: I HEREBY CERTIFY THAT THIS IS A TRUE AND `CORRECT REPRESENTATION 9(oR-295 OF THE BOUNDARIES OF THE ABOVE DESCRIBED PROPERTY AS SURVEYED A A CA OLUN® BY WE OR UNDER WY DIRECT SUPERVISION AND DOES NOT PURPORT TO BOOK: PAGE: SHOW IMPROVEMENTS OR ENCROACHMENTS, EXCEPT AS SHOW Planning Engineering Surveying 9201 East 9looolngton Promy alooolnoton. Minnesota 95420 Date Telephone 16121 W-0289 JE Y L GREN, LAND SU EYOR CADD FILE: DWG. CHK. N 0 LICENSE NUMBER 14376 PERMIT City of Eagan Permit Type: Plumbing Eaaan. Permit Number: EA099916 Date Issued: 07/01/2011 OR Permit Category: ePermit 41~ it~ of E3 E Site Address: 1782 Brant Cir Lot: 5 Block: 2 Addition: Mallard Park 4th PID: 10-47253-02-050 Use: Description: Sub Type: e - Water Heater Work Type: New Description: Water Heater Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments: Josh McGuire 1424 3rd St N Minneapolis. MN 55411 612-604-4285 Fee Summary: PL - Permit Fee (WS &or WH) $50.00 0801.4087 Surcharge-Fixed $5.00 9001.2195 Total: $».00 Contractor: - Applicant - Owner: Benjamin Franklin Plumbing GaiTv P Hoden 1424 N 3rd St. 1782 Brant Cir Minneapolis NIN 55411 Eagan NIN 55122 (612) 604-428 X61 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 Cite of Eaaan Ordinances. ApplicantiPermitee: Signature Issued Bv: Signature PERMIT City of Eagan Permit Type: Mechanical Permit Number: EA106053 Date Issued: 0810812012 itj of 0n Permit Category: ePermit R Site Address: 1782 Brant Cir Lot: 5 Block: 2 Addition: Mallard Park 4th PID: 10-47253-02-050 Use: Description: Sub Type: e - Air Conditioner Work Type: New Description: Air Conditioner Comments: Questions regarding electrical permit requirements should be directed to Mark Anderson, State Electrical Inspector, (952) 445-2840 Andrea Preusse 4145 Sibley Memorial Hwy Fee Summary: ME - Permit Fee (Replacements) $55.00 0801.4088 Surcharge-Fixed $5.00 9001.2195 Total: $60.00 Contractor: - Applicant - Owner: Wenzel Heating & Air Conditioning Garry P Hoden 4145 Sibley Memorial Hwy 1782 Brant Cir Eagan MN 55122 Eagan MN 55122 (651) 894-9898 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 PERMIT City of Eagan Permit Type:Building Permit Number:EA114843 Date Issued:09/19/2013 Permit Category:ePermit Site Address: 1782 Brant Cir Lot:5 Block: 2 Addition: Mallard Park 4th PID:10-47253-02-050 Use: Description: Sub Type:Reroof & Siding Work Type:Replace Description: Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar. Pictures are not acceptable in lieu of inspections. When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to ensure maximum ventilation to attic. Call for final inspection after installation. Valuation: 8,000.00 Fee Summary:BL - Base Fee $8K $162.25 0801.4085 Surcharge - Based on Valuation $8K $4.00 9001.2195 $166.25 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 - Garry P Hoden 1782 Brant Cir Eagan MN 55122 (651) 293-7148 New Exteriors By Sma Inc 10701 93rd Avenue North, Suite E Maple Grove MN 55369 (763) 315-8900 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA120131 Date Issued:01/21/2014 Permit Category:ePermit Site Address: 1782 Brant Cir Lot:5 Block: 2 Addition: Mallard Park 4th PID:10-47253-02-050 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. Josh Mcguire 1424 3rd St N Minneapolis, MN 55411 Fee Summary:PL - Permit Fee (WS &/or WH)$55.00 0801.4087 Surcharge-Fixed $5.00 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 - Garry P Hoden 1782 Brant Cir Eagan MN 55122 Benjamin Franklin Plumbing 1424 N 3rd St. Minneapolis MN 55411 (612) 604-4285 X61 Applicant/Permitee: Signature Issued By: Signature PF. r SHALL NOT RF SUPPORTED SY C :212D 1 WI I riCIUT SPECIFIC ENGINEERING. WALKING SURFACES GREATER THEN 30" AB VE AREA BELOW REQUIRE GUARDRAILS MINIMUM 36" IN HEIGHT AND DESIGNED SUCH 'THAT A 4" SPHERE WILL NOT PASS THROUGH 4 r-- e s r-trn rrr f9.1 P7.117,41 , w S ittf a I r141 V Gil t id" STAIR TREADS AND RISER& 7 % MAXIMUM RISER TREAD • 10" MINIMUM TREAD DEPTH 36719-7(D Stairs of four or more risers shall have a graspable handrail between 34" & 38" measured vertically from the nose of the tread. STAIRS SHALL BE PROVIDED WITH ILLUMINATION IN THE IMMEDIATE VICINITY OF THE TOP LANDING. TREATED WOOD MAY REQUIRE SPECIAL .-.STEVERS, HANGERS, AND :NI -ACT YOUR LUMBER SUPPLIER FOR MORE INFORMATION. d-6 17' EAGAN REVIE ,NSP 0411511 10' - S DIVISION Use BLUE or BLACK Ink �------------ --, � For Office Use/� /� � ,�( 7 � j Permit#: /`�_ � � �I ���� ������� � Permit Fee: �• � I 3830 Pilot Knob Road � �_ �/—�� Eagan MN 55122 ������, t Phone:(651 j 675-5675 � Date Received: Fax:(651)675-5694 j AUG 1 1 2014 � Staff: � I����������������J 2014 MECI� IT APPLICATION ❑ Please submit two(2)sets of plans with all commercial applicati si Date: �~���� Site Address: / �����fl�'� �/�G'�� � Tenant: Suite#• tF <`y' R�Sldefl't/OYVfIe[ Name: `►4� Phone: ��` ��� '�� / 71 ' Address/City/Zip: � � � ,.+���: �s�.�. ��,n� � � � �� , � ��� ;�'�, ; � ��� Name: � 2i ��. G. O� License#� � � � � � w� Address: {� � City: �'S� �'At7tCa3CfqT :° s- p�.. �� . . k� � �/ Or� / p� . . � State: �Y► Zip: JJ 7(�� Phone: ��O�4�✓(7�J � � � � � ta�p.�. � a � ��s� r . --� �_��_���a . . e..�"� .�. .,��.� Contact: EmaiL � � ��� �� �`� � �������� < ������� � New Replacement Additional Alter ion Demolition � � 1"yp�p�U►�pt'{( Descript�on of work tJ�kf��t �l.�L..� �7� µ� 1� ?h �v � z � ����"� .������ T yINQ'FE R;oof�rr�unfed�r���i'au�d�eunted,C��=��an�cal eqiriprnent ts�eqc�c��d�t��i�e scr+�er�sd b�Qitji a � � . � � �'& R6r° 1 - j ,a,w,� +»' i � ix x�a. ::�x �, �,e' t�;;sa �m�Cpd�,;��lease�anta�t�E�e N�echanic'����nspector for'[nform�flon dr�p����ited sereer��t�g ir�ett�ods, xr�; `�"� �����'� � � � � RES/DENTIAL � � � � �� COMMERCIAL ��� � �°�� � � � y , z� ..`+;v:.?��s � � . . � ��s "�� : ���; 1%Furnace New Construction Interior Improvement �� k��- — — ` Air Conditioner Install Pi in Processed � ��1'l�11������ a,,� — � — P 9 _ � ����� � ' ��,����` ���� � _Air Exchanger _Gas � _E�erior HVAC Unit � � „�,�� �,y,�, . Heat Pum ' �� �i�� `x'�`��•� — p � _Under/Above ground Tank (_Install/_Remove) _,�� � � " ��� �`-� � ' ...�..,.�� Other RES/DENT/AL FEES $60.00 Minimum Add or alteration to an existing unit(includes$5.00 State Surcharge) � $100.00 Residential New(includes$5.00 State Surcharge) _$ �, TOTAL FEE COMMERCIAL FEES . Contract Value$ x.01 $55.00 Permit Fee Minimum $70.00 Underground tank installation/removal =$ Permit Fee *If contract value is LESS than$10,010, Surcharge=$5.00 =� Surcharge* "'If contract value is GREATER than$10,010, Surcharge=Contract Value x$0.0005 ***if the project valuation is over$1 million, please call for Surcharge =� TOTAL FEE I hereby acknowledge that this information is compiete and accurate; that the work will be in conformanc the ordinances d codes of the City of Eagan;that I understand this is not a permit,but only an application for a permit,and work is not to start ' a permit;that the rk will be in accordance with the approved plan in the case of work which requires a review and approval of plans. x � �i � �r � X � Applican 's Printed Name Applican s Signature FC7F�O�'FIG�l�� � � ' �,��v � �� � �� � �� � � ` d �� �,� � � � }ZeC}t�IF�L�FT1$(�@�C�bdS����. :'����r � , .,�:� M . fi� � x � ai`� .�"�! ��'' 0 , = ; z f z c �3 - ���` � "i ii i� ����s�2U1@WQC��� r �'��8, > r �n �=-Unc�erground"`� ' * �F2ou�h E�r�f �„�ir Test x� '�a.s�er�aee 7�t ;;�(r�f�o�ar Heat � � °"?; �inal::: � H�/��.�Scre�nrng ;° � .�,-�-- PERMIT City of Eagan Permit Type:Building Permit Number:EA161205 Date Issued:05/12/2020 Permit Category:ePermit Site Address: 1782 Brant Cir Lot:5 Block: 2 Addition: Mallard Park 4th PID:10-47253-02-050 Use: Description: Sub Type:Windows/Doors Work Type:Overhead Garage Door Description: Census Code:434 - Residential Additions, Alterations Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings, call for framing inspection. Call for final inspection after installation. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Valuation: 1,500.00 Fee Summary:BL - Base Fee $1500 $62.50 0801.4085 Surcharge - Based on Valuation $1500 $0.75 9001.2195 $63.25 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 - Tyler Johnson 1782 Brant Cir Eagan MN 55122 (763) 442-4694 Overhead Door Company Of The Northland 3195 Terminal Drive Eagan MN 55121 (651) 683-0307 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA163323 Date Issued:08/26/2020 Permit Category:ePermit Site Address: 1782 Brant Cir Lot:5 Block: 2 Addition: Mallard Park 4th PID:10-47253-02-050 Use: Description: Sub Type:Reroof Work Type:Replace Description:Does not include skylight(s) Census Code:434 - Residential Additions, Alterations Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Please print pictures of ice and water protection and leave on site. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). Valuation: 5,000.00 Fee Summary:BL - Base Fee $5K $118.00 0801.4085 Surcharge - Based on Valuation $5K $2.50 9001.2195 $120.50 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 - Tyler Johnson 1782 Brant Cir Eagan MN 55122 (763) 442-4694 Ashton Mcgee Restoration Group Llc 5555 W 78th St, Suite J Minneapolis MN 55439 (952) 426-3736 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA166476 Date Issued:01/12/2021 Permit Category:ePermit Site Address: 1782 Brant Cir Lot:5 Block: 2 Addition: Mallard Park 4th PID:10-47253-02-050 Use: Description: Sub Type:Windows/Doors Work Type:Replace Description:Two or More Windows/Doors Census Code:434 - Residential Additions, Alterations Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow windows, call for framing inspection. Call for final inspection after installation. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Valuation: 5,000.00 Fee Summary:BL - Base Fee $5K $118.00 0801.4085 Surcharge - Based on Valuation $5K $2.50 9001.2195 $120.50 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 - Tyler & Deirdre Johnson 1782 Brant Cir Eagan MN 55122 (763) 442-4694 Ashton Mcgee Restoration Group Llc 5555 W 78th St, Suite J Minneapolis MN 55439 (952) 426-3736 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA171860 Date Issued:09/03/2021 Permit Category:ePermit Site Address: 1782 Brant Cir Lot:5 Block: 2 Addition: Mallard Park 4th PID:10-47253-02-050 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 - Tyler & Deirdre Johnson 1782 Brant Cir Eagan MN 55122 Appliance Connections Inc 12850 Louisville Road Shakopee MN 55379 (952) 445-4803 Applicant/Permitee: Signature Issued By: Signature