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759 Camberwell Dr INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55123 Date Issued: (612) 681-4675 SITE ADDRESS: ` • APPLICANT: I I J PERMIT SUBTYPE: TYPE OF WORK: INSPECTION TYPE .DATE INSPTR. INSPECTION TYPE DATE INSPTR. Permit No. Permit Holder Date Telephone # S/W PLUMBING H VAC 3 ELECTRIC ELECTRIC Inspection Date Insp. Comments Footings I Foundation I Framing Roofing Rough Plbg. Rough Htg. isul. I Fireplace Final Htg. Orsat Test Final Pibg. Plbg. Inspector - Notify Plumber Const. Meter EngrJPlan Bldg. Final Deck Ftg. Deck Final 1A ~y well PODisp. I t f~ (rr#iftro#r of (Orrupaury Citp of t!agan JDrw ttt of ia bkq 3noprrtinn This Certificate 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.- Lik clasg;ficaloon = SF DWG/CAR Bldg. Permit No. 19598 { - C- 0(Rww„Q8 Tim MTnM-OD DC AM= 520 E RNTM- W, FRIDM-- / , 3RD 11/21/91/ naa: POST IN A CONSPICUOUS PLACE CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 ' PHONE: 454-8100 BUILDING PERMIT' Receipt # ,j To be used for SF DWG/fit Est. Value $147,000 Date AUG 23 tg~_ Site Address 759 CA!lIRMLL DR OFFICE USE ONLY Lot 13 Block -2 Sec/Sub. - HILLS OF Parcel No. STONEBRIDGE Occupancy R-3 11--1 FEES s Zoning FD 1-1 w Name THE ~D CO INC (Actual) Const ~ Bldg. Permit $04.00 ' Address _ S9011 S RWER RD (Allowable) V-N , ~gg q City FRIDIXY Phone 571•-0304 # of Stories Surcharge 73.50 t3tld :j SAME ' Length s8l Plan Review Name q Depth- SAC, City 100,00 pU Address S.F. Total ~F SAC, MCWCC 6%.00 City Phone S.F. Footprints On Site Sewage Water Conn b~d+~ Name On Site Well ~W Water Meter 95400 Fw Zza' Address MWCC system a.OO <W City Phone City Water- Acct. Deposit ' PRV Required S/W Permit 30,00 I hereby acknowlege that I have read this application and state that the Booster Pump S/W Surcharge +30 information is correct and agree to comply-with all applicable State of Minnesota Statutes and City,of Ea Or l antes. Treatment PI 2711.00 l Signature of Permitee. APPROVALS Road Unit 370•(}0 , A Building Permit is issued to: THI ROTTL MD CO INC Planner Park Ded. x on the express condition that all work shall be done in accordance with all Council applicable State of Minnesota Statutes and City of Eagan Ordinances. Bldg. pry. Copies Building Official " i : ' ! ' Variance TOTAL 3,612.00 Permit No. Permit Holder Date Telephone # WATER as 90 SEVGER PWMBIINGG ELECTRIC QIpZ I i ''7 of / Inspection Date Insp. Comments Footings I Foundation Framing- 30.9/ Roofing Rough Plbg. , Rough Htg. 3e, S/ isul. /0 • _ S Fireplace Final Htg. ,l Orstat Test Final Plbg. / Plbg. Inspector - Notify Plumber Const. Meter Engr./Plan Bldg. Final Deck Fig. Deck Final Well Pr. Disp. SEWER & WATER PERMIT OFFICE USE ONLY CITY OF EAGAN _ METER #~b PERMIT DATE 0`x/1,7/91 3830 Pilot Knob Rd. Eagan, MN 55122-1897 CHIP # ell/20 3 PERMIT # 1 % METER SIZE B.P. RECEIPT # C 1515E DATE 8-20-91. ISSUE DATE S B. P. RECEIPT DATE Q8 2 91 PRV -BOOSTER PUMP SITE ADDRESS 259 Cambez-we-1.1 Dri S. PERMIT REQUESTED LOT L BLOCK 41. SEC/SUB E.1016 co_ X SEWER X WATER -TAPS APPLICANT: 'Php gntt111A16 f Inn- ADDRESS: 5201, Pi vnr aar5 _ COMM/IND X RESIDENTIAL CITY, STATE i ejleY, ,n, ZIP ,"6421 X NEW _ EXISTING PHONE: _571-0204 Lawn Spfhl er 4eters arp .to be installed PLUMBER: 31a11eyP~t~r Ahead/,6f Domestic Meters on Water Line. ADDRESS: X117 Cr k Credi(WILL NOI ,"liven for D UCt.Meters. CITY, STATE Tf^Y[i ,r~ ~2n_ ZIPF PHONE: 4S2-2127 AGREE TO COMPLY WITH CITY OF OWNER: The Rot_L1i,nd Cc The EAGAN ORDINANC S I ADDRESS: 5001 E River Road ;44~ CITY, STATE F'ridley, P.In r ZIP PHONE: 571--0304 NATURE WHEN METER" SUED PLEASE;;i4LLO1N TWO WORKING DAYS FOR PROCESSING. CALL 454-5220 FOR INSPECTIONS. FOR STORM w SEWER PERMITS, CONTACT ENGINEERING DEPT. SEINER. & WATER PERMIT OFFICE USE ONLY CITY OF EAGAN ae METER # PERMIT DATE 09/17/91 3830 Pilot Knob Rd. $ CHIP # PERMIT # 12290 Eagan, MN 55122-1897 METER SIZE B.P. RECEIPT # C 15156 ISSUE DATE B.P. RECEIPT DATE 0V 28/91. DATE 3-2f-'41 - PRV _ BOOSTER PUMP SITE ADDRESS 759 .Cwber ell Drivv*: s. PERMIT REQUESTED LOT _1.1 BLOCK SEC/SUB i T 1' j c-r *~R~r x~ • SEWER X WATER TAPS APPLICANT: The Bcit:L'',t-.lx~j Co ; 10C - COMM/IND X RESIDENTIAL ADDRESS: 201 R. River gryu. CITY, STATE ?ric?1. Mn ► ZIP 55'V.1 X NEW EXISTING PHONE: 571-02,04 Lawn Spj.irikler Meters are-to be Installed PLUMBER: Vallee 21=bing Ahead,.6f Domestic Maters on Water Line. , ADDRESS: 610 Cr*&k bane ` Credit WILL NOT b given for Deduct Meters.. CITY, STATE ant dai3 p Mv, _ ZIPS PHONE: ~ i2:2121 I AGREE TO COMPLY WITH CITY OF OWNER: The Rct.'t:l=6- r A:;. Tric. EAGAN ORDINANCES ADDRESS: 5201 E. River. Ri;: tct CITY, STATE A i idley, Vin ZIP5` 2' i PHONE: ~7~•"~`3.r,' SIGNATURE WHEN METER ISSUED PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. CALL 454-5.220 FOR INSPECTIONS. FOR STORM SEWER PERMITS, CONTACT ENGINEERING DEPT. w-. _ e...l. _._...CVy.~,ra.,_L:tu,L ....r....w.x..., y:.. _i,....z__ ..a DATE: SEP 17, 1991 RE: 759 ,CAMBERWELL DR S (THE ROTTLUND CO INC) Your Sewer & Water Permit for the above property has been completed. It will be held at the Public Works Garage (3501 Coachman Road) until the meter is picked up. BE SURE TO CALL PUBLIC WORKS (454-5220) FOR YOUR PERMANENT WATER TURN ON. Your Sewer & Water Permit for the above property cannot be completed for the following reasons: Your Sewer & Water Permit for the above property has been completed, but the meter cannot be issued or occupancy allowed until further notice. COMMERCIAL PROJECTS ONLY: Please pay for meter at City Hall. Meter size must be confirmed by Bill Adams or Dirk House (Plumbing Inspectors - 454-8100) before issuance. WARNING: BEFORE DIGGING, CALL LOCAL UTILITIES - TELEPHONE, ELECTRIC, GAS, ETC. - REQUIRED BY LAW. s CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICY. H Secretary, Building Inspections Dept. y CITY OF EAGAN NO 19598 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 BUILDING PERMIT' PHONE: 454-8100 Receipt # l~ l To be used for SF DWG/GAR Est. Value $147,000 Date AUG 23 , tg-U- Site Address 759 CAMBERWELL DR Lot 13 Block 2 Sec/Sub. HILLS OF OFFICE USE ONLY Parcel No. STONEBRIDGE 3 Occupancy R-3 IL-1 FEES Zoning PD RR=1 W Name THE ROTTLUND CO INC (Actual)Const V=N Bldg Permit 804.00 o Address 5201 E RIVER RD (Allowable) V N surcharge 73.50 City FRIDLEY Phone 571-0304 # of Stories Length 58' Plan Review 573.00 o Name SAME Depth 34' SAC, City 100.00 g< Address S.F.Total 650.00 • City Phone S F. Footprints SAC, M nn 660.00 On Site te Sewage Water Conn ti Name On Site Wall X Water Meter 95.00 Address MWCC System iw City Phone City Water Acct. Deposit 30.00 PRV Required SfW Permit 30.00 1 hereby acknowlege that 1 is ap' ion and state that the Booster Pump SM! Surcharge .50 information is correct antl aapplicable State of Minnesota Statutes and Treatment PI 276.00 Signature of Permitee APPROVALS Road Unit 370.00 A Building Permit is issued to: THE ROTTLUND CO INC Planner Park Ded. on the express condition that all work shall be done in accordance with all Council applicable State of Minnesota Statutes and City of Eagan Ordinances. Bldg, Olt, Copies Building Official -J-1014 A.ei . Mid Variance - TOTAL 3.612.00 Address: 759 rMapaEL DRIVE Lot 13 Blk 2 Sec/SubRELLS OF SIONEBRUM 310 These items, were/were not complete at the time of a final inspection. 11/21/91 Yes No 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 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. xtcueo r~xn White - City copy Yellow - Resident copy Pink - Contractor copy io/~71yi io 3a s%~;' 101211 "l 00 Request Data 9 ) Ire No Roughen Inspection ` e ( RYeB ' C No Ready Now yl~Nnl Notify Inspector When R eady I,2~fjcensecl contractor 7) owner hereby request inspection of above electrical work at Job Address street Box c ome No I City b "qll Section No Township Name or No Range No County Occupa IPRINTr~ I Phonee!{/'N\"o POwer SU er Atlamas =?I L - 1)4L Electrical njIC n NameI Contractor's License No _ .-1P-3 Mailing A dress (contractor o, Ow r Making Installation) Authorized Signature IC_Ontraco caner u g Installauonl Phone Number _ ~~-0to MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REOUEST WILL NOT Gnggs-M(dway Bldg. - Room S-173 BE ACCEPTED BYTHE STATE BOARD 1821 University Ave., St Paul. MN 55104 UNLESS PROPER INSPECTION FEE IS Phone(612)642-0800 ENCLOSED ~p• ~j/~~ REQUEST FOR ELECTRICAL INSPECTION EB-OMOI-08 ► See AirucWns for completing this form on back of yellow copy 8 ~b "X" Below Work Covered by This Request ew Add Rep~peof Building ApphancesWlred EquipmentWlred Home Range Temporary Service Duplex Water Heater Electric Heating Apt. Bwlding Dryer Other (Specify) Comm flndustnal Furnace Farm Air Conditioner Other (specify) Commotors 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 Inspector's Use Only. TOTAL Irrigation Booms 15 Special Inspection Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT Other Fee COMPLETED WITHIN 18 MONTHS. h the Electrical Inspector, hereby Rough-in Dare certify that the above inspection has Final Dare been made OFFICE USE ONLY This request void 16 months from Vol 1 7/r8' d ~a tea' N 2 22444f3,134 Request Data Fire No. Roug I npseclion Required Inspechon Other Than Rough-In (you at call inspector when ready) ❑ Ready Now X Will Notify inspector 7-11- ❑ Yes No Dale Ready IXlicensed contractor ❑ owner hereby request inspection of above electrical work at: Job Address (Street. Box or Rohe No City Section No Township Name or No Range No County Occupant (PRIM) Phon o Power Supplier Address Electric I councilor (Company Name Contractors License No Co Gi4 0 Ma(hng Address (Contractor or r Making Installation) y t2 aSC'vl` Authorized n turn (COMra rNwn Making Installation) Phone Number c _ MINNE TA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT Griggs-Midway Bldg. - Room 5-173 BE ACCEPTED BY THE STATE BOARD 1621 University Ave., St. Paul, MN 55106 UNLESS PROPER INSPECTION FEE IS Phone (612) 642-0800 ENCLOSED i ' REQUEST FOR ELECTRICAL INSPECTION `~y EB-ogoOlAs f r / ► See in itrudwns for completing this form on back of yellow copy N 244 /t X" Below Work Covered by This Request ' ew Add •Rep Typeof8widmg Appliances Wired Equipment Wired Home Range Temporary Service Duplex Water Heater Electric Heating Apt Building Dryer Load Management Comm./Industrial Furnace Other (Specify) Farm Alr conditioner Other lspecny) Contractors Rare" / Compute Inspection Fee Below: Ccz-w~ 14 # Other Fee # Service Entrance Size Fee # Clrcurts/Feeders Fee Swimming Pool 0 to 200 Amps 0 to 00 Amps Transformers Above 200-Amps Abo 100-Amps Signs Inspector's U. Only TOTAL Irrigation Booms owt~ Special Inspection Alarm/Communication THIS INSTALLATION MAV B RED DISCONNECTED IF NOT Other Fee COMPLETED WITHIN 18 MONTHS. I, the Electrical Inspector, hereby Rough-in Date Certify that the above inspection has Final been made. OFFICE USE ONLY This request void to months from 103A 97 0121 c 3 S A 3~~a Request Date R. No ugtl-in Inspection equiredl ❑ Ready Now Vvis0ill Nmity Inspector des _ No When Ready? Licensed contractor 7) owner hereby request inspection of above electrical work at: Job 1 Address iS 511 (reet Be r Rome ^ ^ , Qty Section No Township Name or No Range No County AA Occupan RINTI Phone No PoNer Su ter Address Electncal n1wrior IQompsny Namel Cori License No If Mailing Address (Contractor or Own r Making Installation) Authorized Signature (Contractor ner MM+n Installation) Phone umber Installation) Phone umber - ,3k/v MINNESOTA STATE BOARD OF ELECTRICITY I THIS INSPECTION REQUEST WILL NOT Griggs-Midway Bldg - Room S-173 BE ACCEPTED BY THE STATE BOARD 1021 University Ave., St Paul, MN 55104 UNLESS PROPER INSPECTION PEE IS Phone(612)642-0600 ENCLOSED ~3 /D 9 REQUEST FOR ELECTRICAL INSPECTION EB-00001-0e ji~ See iheruc~mus formmplelmg this form on back of yellow copy i nipi? "X" Below Work Covered by This Request New AQd Re Type of Building Appliances Wired Equipment Wired Home Range Temporary Service A I Duplex Water Heater Electnc Heating Apt Building Dryer Other (Specify) Comm./Industrial Furnace Farm Air Conditioner Other (speafy) Contractor's Remarks Compute Inspechon Fee Below. he Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Swimming Pool O to 200 Amps 11 0 to 100 Amps Transformers Above 200 _ Amps Above 100 Amps Signs inspectors use Only TOTAL Irrigation Booms tom` Special Inspection Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT Other Fee COMPLETED WITHIN 18 MONTHS. 1. the Electrical Inspector, hereby Rough-in / Date certify that the above Inspection has Final at _ , been made OFFICE USE ONLY This request voi0 18 months from Y RESIDENTIAL q a BUILDING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD, EAGAN MN 55122 651-681-4675 15 7 New Construction Reguiremsnts RemodellReoair Requirements • 3 registered ads 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 additions • 2 copies of plan showing beam 6 window sizes; poured found design, etc.) • 1 site surrey 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 lot platted after 711/93 • Rim Joist Detail Options selection sheet (Ndgs with 3 or less omits) r-~ ~-7 DATE Y ck;2. VALUATIO, ~r N `P lr SITE ADDDRRESS 'I 9 MULTI-FAMILY BLDG _Y TYPED WO ~r-hooo4- ae SS• FIREPLACE(S) _ 0 ✓ 1 _ 2 APPLICANT ame l res C2.y aacAks ~Zic, STREET ADDRESS I;?91/7 N,~o/lwt u(1,~, S. CITY&z u&1e STATEMAI ZIP-6-T-33-7 TELEPHONE #1?V-7o7-6955 CELL PHONE #i FAX # - PROPERTY OWNER D46. Tiurm TELEPHONE # 615/-152 - Ss/S COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category MINNESOTA RULES 7670 CATEGORY I _ MINNESOTA RULES 7672 (J submission type) • Residential Ventilation Category 1 Worksheet Submitted • Ne y ~~ggq~CW rk~Ree~bm tied • Energy Envelope Calculations Submitted D " J AU6 0 2 2002 Plumbing Contractor: Phone # _ _ Plumbing system includes: Water Softener Lawn Sprinkler gy___Fee:-$~ Water Heater _ No. of R.I. Baths No. of Baths Mechanical Contractor. Phone # Mechanical system includes: - Air Conditioning Fee: $70.00 - Heat Recovery System Sewer/Water Contractor. Phone # 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 Ordinances. Signature of Applicant ICJ~~tN• W' OFFICE USE ONLY Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ Updated 4102 RESIDENTIAL BUILDING PERMIT APPLICATION CITY OF EAGAN 3 l' 3830 PILOT KRD, G N MN 55122 651-681-4675 New Construction Requirements RemodeReoair Requirements • 3 registered site surveys shoeing sq. R of lot, sq. fl. of house; and all roofed areas • 2 copies of plan (20% maximum lot coverage allowed) • 1 set of Energy Calculations for heated additions • 2 copies of plan showing beam & window saes; poured found design, etc.) t 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 lot platted after VV93 • Rim Joist Detad Options selection sheet (bldgs with 3 or less units) DATE 7h3 oX VALUATION I~ pv~y-~ SITE ADDRESS 751 MULTI-FAMILY BLDG _ Y ✓N TYPE OF WORK IL r ~FIREPLACE(S) -0 t/1 -2 APPLICANTJj1ei/Can Rum COWA-aaf75~ Si e' _ STREET ADDRESS 02 ` -Z fie, S. CITYAvrhsui/~ STATE NWZIP.6031 TELEPHONE # q_~J-707-0,W CELL PHONE # FAX # 1-2 PROPERTY OWNER hM&, /YN TELEPHONE #S.7 -5S/S' COMPLETE THIS SECTION FOR KNEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINNESOTA RLJI ES 7670 CATEGORY I _ MINNESOTA R " (J submission type) • Residential Ventilation Category 1 Worksheet Submitted de Y Y~e bmitted • Energy Envelope Calculations Submitted FAZ 0 2 2002 Plumbing Contractor: Phone # Plumbing system includes: Water Softener Lawn Sprinkler _ eg Water Heater No. of R.I. Baths No. of Baths Mechanical Contractor. Phone # Mechanical system includes: Air Conditioning Fee: $70.00 Heat Recovery System Sewer/Water Contractor: Phone # 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 rdinances.(1 Signature of Applicant 44-Yn,`Q M OFFICE USE ONLY Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ Updated 4102 PERMIT CITY OF EAGAN ~ 34~ 3830 Pilot Knob Road PERMIT TYPE: B U I L D I N G Eagan, Minnesota 55123 Permit Number: 0 2 3 6 7 6 (612) 681-4675 Date Issued: 05/20/94 SITE ADDRESS: 759 CAMBERWELL OR LOT: 13 BLOCK: 2 HILLS OF STONEBRIDGE 3RD P.I.N.: 10-32992-130-02 DESCRIPTION: Bl lding',Permit Type DECK d Building W6,r-k Type NEW REMARKS: FEE SUMMARY: Base Fee $30.00 Surcharge $.50 Total Fee $30.50 CONTRACTOR: OWNER: - Applicant - MCCLURG JOHN 759 CAMBERWELL DR EAGAN MN (612)463-3997 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 Mn. L Statutes and City of Eagan Ordinances. J APPLICANT/PERMITEE SIGNATURE ISSUED BI S1 NAT R' CITY OF EAGANl®1b5 1994 BUILDING PERMIT APPLICATION MAY 8 194 681-4675 30S~ SINGLE & MULTI-FAMILY 2 sets o plans, 3 registered site surveys, 1 copy of energy calcs. COMMERCIAL 2 sets of architectural & structural plans, 1 set of specifications, 1 copy of energy calcs. Penalty applies: 1) when permit is typed, but not picked up by last working day of month in which request is made, 2) address is changed or 3) lot change is requested once permit is issued. Date Valuation of work &Zza o Site Addr s: 7Sin P r w )e - STREET SUITE # Tenant Name: (commercial only) # LOT BLACK SUBD.~ S © I. D. P 6t" 4 ' Description of work: / The applicant is: Owner ❑ Contractor ❑ Other (Describe) 11 Name 7 DO 4Q Ld c CL is r ~ Phone 8'6 9SS13 Property LAST p iFIRST Owner Address 7-S(7 o ro (r er w-e STREET STE # City /G SLI s--0 State a;414 &A J 4 Zip any Phone Contractor Address Exp. City Zip Architect/ Phone Engineer Name Regist Address Cit State Zip Sewer & water licensed plumber Processing for sewer & water permits is two days once area has been approved. 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: v`~ OFFICE USE ONLY BUILDING PERMIT TYPE ❑ 01 Foundation ❑ 06 Duplex ❑ 11 Apt./Lodging ❑ 16 Basement Finish ❑ 02 SF Dwg. ❑ 07 4-Plex ❑ 12 Multi. Misc. ❑ 17 Swim Pool ❑ 03 SF Addition ❑ 08 8-Plex ❑ 13 Garage/Accessory ❑ 18 Comm./Ind. ❑ 04 SF Porch ❑ 09 12-Plex ❑ 14 Fireplace ❑ 19 Comm./Ind. Misc. ❑ 05 SF Misc. ❑ 10 Multi. Add'l. 4$1-15 Deck ❑ 20 Public Facility ❑ 21 Miscellaneous WORK TYPE ~T 31 New ❑ 33 Alterations ❑ 35 Tenant Finish ❑ 37 Demolish ❑ 32 Addition ❑ 34 Repair ❑ .36 Move GENERAL INFORMATION Const. (Actual) Basement sq. ft. MWCC System (Allowable) 1st F1. sq. ft. City Water UBC Occupancy 2nd Fl. sq. ft. PRY Required Zoning Sq. Ft. total Booster Pump # of Stories Footprint Sq. ft. Fire Sprinkler Length On-site well Census Code ~3y Depth On-site sewage SAC Code ~L Census Bldg / APPROVALS Census Unit a Planning Building Assessments Engineering Variance REQUIRED INSPECTIONS ❑ .Site M Footing ❑ Framing ❑ Insulation ❑ Wallboard 0 Final ❑ Draintile ❑ Fireplace Permit Fee vetuseio,: g Surcharge Plan Review License MWCC SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surchargge Treatment P1. Road Unit Park Ded. Trails Ded. Copies Other Total. SAC % SAC Units !i C7 N 89° 3'24" opiR 5\ ay6 4539 17Y a St j Av I I to 0 V. 0M~ ~U1 ~ k xti ~M~ON X11 qo I.So 1IF76i a0M 3b.0 a v ~c0 ~ M ``N+l~ 22.c - Q 1 f Fop riF T $ at- m' R n~ ns° 11.0 'IZS O'O.BO21_ _ 908.5! ~iz.tyx zs.o _ - - goy, W 91o.P ~ ~f~; ZS O SLR ezZ87.! vs <10q.0 o i Sera:cc o , _ R=~O 0 28 00 7 ob9v5.9 a/5,7/ °O ~ d=S°35'roo qo1' 589°07- 4-'LJ X00 '~~cAMB~Zt~t/ELL D91VE -900.0 Denotes Exislin¢¢ Elevation PPOPOS£O HOUSE EIEV4rIQ oo. o Denotes Prnpo3led Elevation Lowest floor Eleva ion o z .:0 Denotes Drdina¢eiUtiti~ty Easement Top otr'Block flevation o Denotes DraincYO~le RoWDireclion Gara0e Stab Elevation 910.3 o Oerides Monu►fient &arin~s shown are assumed n Derr es o+ / s F-6b LOT 0 D , BLOCAIZ 7 1{(LL5 Of a5TONEMIDGf 3R ADD. COUNTY f MINNESOTA 1 hereby certify that this survey, plan or report wa'~spprepared by me or undFi my direct supervision and that 1 am duly Registered Land Surveyor under the laws of the State of Minnesota. Oath this 1'r"~p^ day of A"~°s A O 19Cxt_ 1.^# n1 ;SCOrk: d~O-"R' bQ- NefNFR1_ E i LI L5_PEO. NO-faaU _ -'Fri L.gm il ~ 24 a 19,94 MECHANICAL PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD, EAGAN MN 55122 (612) 681-4675 PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS: ALSO, FOR TOWNHOMES AND CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. - - - - - - - - NEW CONSTRUCTION ADD-ON A/C ADD-ON FURNACE FIREPLACE IN S RT DATE FEES HVAC: 0-100 M BTU $ 24.00 ADDITIONAL 50 M BTU 6.00 GAS OUTLETS (MINIMUM 1 @ $3.00 EACH) ADD-ON/REMODEL (EXISTING CONSTRUCTION) $ 20.00 STATE SURCHARGE .50 TOTAL SITE ADDRESS: '1511 L VY, e r w`\\ 2 o. / OWNER NAME:)f lV1 li 12 c' TELEPHONE /"a(o ` INSTALLER:_ ~QLsA Z ct WelGL t 'A ADDRESS: ~'o Tf }2 l CITY: S lT e t' STATE: 0i ZIP CODE:, 4XII TELEPHONE SI ATURE OF PERMITTEE 1991 BUIJIM SLICATION CITY OF EAGAN SINGLE FAMILY DWELLINGS MULTIPLE DWELLINGS COMMERCIAL i~ 2 SETS OF PLANS 2 SETS OF PLANS 2 SETS OF ARCHITEC 3 REGISTERED SITE SURVEYS REGISTERED SITE SURVEYS - & STRUCTURAL PLANS 1 SET OF ENERGY CALCULATIONS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS 1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS OF RENTAL UNITS OF FOR SALE UNITS PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING DAY OF MONTH IN WHICH REQUEST IS MADE. LOT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED. NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. CHANGES WILL BE ED ONCE BUIID~~77 ING PERMIT I ISSUED, PROCESSING TIME FOR SEWER & WATER 0J4~0 A PERMIT HAS BEEN COMPLETED. PERMIT MUST SHOW A LICENSED PLUMB CC 2 !9;~) To Be Used For: ~LY• Val ate: 1 Site Address ?GP) USE ONLY - Lot _j3_ Block l417, 000 2 FEES Occupancy R3 h Bldg. Permit Zoning f 777-T Surcharge 3tSP Parcel/Sub 14qLr~ of ISs Jhq66 ~naAca Actual Const V-N Plan Review SZ&OD 'Allowable V-N SAC, City (00,00 Owner -r7?E ~t,rT~„aye # of stories SAC, MWCC (PSG 10 Length Water Conn. Address z:701 F. Pir,F,l' R:P6. Depth „3y Water Meter S, OD S.F. Total Acct. Deposit 0,00 City/Zip Code %OLE c tr~c/Z/ Footprint S.F. S/w Permit ~0,00 S/W Surcharge 60 Phone On site sewage- Treatment PL,. 276,00 On site well Road Unit 394), Go Contractor aE. MWCC System _kof Park Ded. City water Trail Ded. Address PRV Copies Booster Pump City/Zip Code SUBTOTAL APPROVALS Penalty Phone Planner Lot Change Council TOTAL Arch. /Engr. Bldg. Off. Variance Address City/Zip Code Phone # Sewer/Water Licensed Contr. agrees that all work shall be done in accordance with (Signature of Contractor) all applicable State of Minnesota Statutes and City of Eagan Ordinances, Z2 x2z= 4Kt1 ;pr5= 726o 32 x36~= x/52 Lly /2 y e _ Cy) E3,6 0q lG o72o•A 03.0050r 2 2. 0,3 40 2N9 -F-~o~vZ. ~~T I f ~~(jX~ ~ to ni l ~l 6~ 2-q o Vl, I y -7/ ov~^ eight"' N 55120 IONA9 * Er hgII•Ieg•ND -1914 ~Ty `O7TLUND COMPANY Certificate of Survey for: TN,5 )Q NORTH v , a.~ N89°D3'24° coy h~ 89c 45.39 0 °'sri° t~J~e~o is o N'% V? gqb wee` R32Q Aj 'i y I C06 5 6°. Ije ~ J ~ M O 17 o- I 25 I p rt~ U~ as x~ i 3 N `Ioz,o o°~ o° O +IE78 og9 0 36.0 - 30• - O Z 01 N ~GO M I r I ~ 22.0 Q~Q JSE 2 VU a 4- H~ rom I M Il,o :ie.5 ac gon QI "o `7p8.51 Izz tyx Zs,o _ - - - goy, W 910.0 1106 25 o SLR --_j 4 ~z 87.i os gpga o 1 Se tce e l R=/o O 28.00 75.00 0 go5.9 /57/ •oo t d=S°35'!0" cio" 589°o3'Z4 iJ b" 4-yD°00' 908,23 -~cAM8E2itlELL DRIVE C la • 900.0 Denotes &Ii nO Elevation Pr~i~eis t3/ j"J 1 Sc " D H PT e oo.o Nennteseropo Ed Elevation Lowest loorEleva ioh 9oz,zo - Denotes Ordinv eiUfili1~yyEasement Topo~'BloCA/ levation 410.33 - Denotes Onrinoy~~ee FloWDireetion Garage Stab Elevation cilo.3 o Denotes Monu~'rent Bearings shown are assumed oDeno ee ollse l-kb LOT 07 Bt OCI1 Z 7 14ILL5 Of STONE45PW64E 3jep ADD. COUNTY I MINNESOTA hereby certify that this survey, plan or report was prepared by me or and my direct supervision and that I am duly Registered Land Surveyor under the laws of the State of Minnesota. Dated this (`r"'^ day of A-gosTrr A.D. 19 91 / 1 077V(•LI Scale :1 /RC ° 4 nonFnT siKt H I_, 5. nEG. NO. 14991 EY MLOR i:NVELOi'E. AVENAGE "U" CUMPUTATION NO~M.4NDy - OWN ER SITE ADDRESS Lm 13, 13t_ou<Zi 1iILLsocS-r u er 32a A~n'u CONTRACTOR P-oTTL. VIVD I✓ C9 • DATE. PfiONE Determin working; square foot:u;e of each. 1. Total exposed wall area 057 { ~J• sq. ft. x 0.11 = 2BV.2 sq. ft. x 8026 = ~jO•~L 2. Total roof/ceiling area r179•fF Total exposed wail area above floor Z. a. Total wall window area /4s4,?- b. Total door area C. Total sliding glass door area d. Total fireplace wall area 2 e. Total wall framing area (average 10i) f. Total net wall area above floor _ /e3 47• C/ g. Total rim joist area SolA.5 Total exposed foundation area h. Total foundation window area ~J~•75 !iy i. Total net foundation area above grade Determine "U" value of each wall segment. a. 1 S 4.2 x .lull p, ¢2 = 71-3(e b. bola. ¢Z x lull 7.78 C. x hull d. 2'T x "ii" • / = 2 • T e•. 2/0.7'f x."u,l 0,089 = 18.75 f. l8 97.ar x flu" of D~3 _ 81.57 9- X fluff h. lrJ•7,5 x lull Z9- D, l4 = /3,ZS i. q'~• G~ x lull If item 13 is the same as, or less than item //1, you have met the intent of Ssc 6oo6(c)2. Total exposed roof/ceilinG area Ali Total gross roof/ceilint, area = J. Total skylight area 7 R. Total roof/ceiling framing area " 1. Total net insulated roof/ceiling area G 5 S Determine "U" value for Inch ruof/ecilinl. scimcnt. r 'lull _ J. x - 3:1$ o-L z. 23..35 4 . Total Z li. G✓ 3 If total of #4 is the sane as, or less than N2, you have met the intent of Sac 6oo6(c)l. To utilize the total envelope system method, the values established by the sum of items H3 and 14 shall not be greater. than the sum of items N1 and 12. 1. + 2. 3- + 4. _ I 2 i C 3 4 5 0.027 U X583 2 1 - ~ -J'~ lN~.►~~ 4-4.4 P~0.. -777 0.022 r- ~~U 3 - - VALUG GAI.GULATIaNei (6oNT). -,~IZAM~ WALL G~ INS-II.A~IoN LoMPoNf,N~i . - . R-vAU.I~ oi.{f;:-ADE AIP HI,M 0,11 =-%L INSULA (l~td• 19.0 6 [~51~IE Alz- FILN} _ G = 23.01 = ` 1 0.043 , -PFAMG WAW. C ►D LoMPVNLNjg F- -VALUL - ' , I o_uj~IaE RjR~ F1Ld1. o .1"1 • - 1 2 I 2 •oCr _ 3 3 IN to 4 0 XC, hTAo(F C IN6,I05 Miz FILM - view. ~L 1 =G~J4tP~.I~U~=~0.12Xo.o~9>t(o,SbXo.o43> O,o4- 0 ~'_-=hl? AIM avih , I • SS 4 - I O -Ht RAVIN(o. 2,GG O5 (DING---- - -p, ce'L j t ~y~NDPc~I~N 12 ,.13 CITY OF EAGAN FOR CITY USE ONLY 3830 PILOT KNOB ROAD ` EAGAN, MN 55122 PERMIT # PHONE: (612) 454-8100 RECEIPT # O O ".1104+., DATE: O 91, SIAEl4TSAS PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS & TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. -7---------------------- WORK DESCRIPTION FEES NEW CONST X ADD-ON MINIMUM $15.00 ADD ON HVAC 0-100 M BTU 24.00 REPAIR ADDITIONAL 50 M BTU 6.00 jj GAS OUTLETS - MINIMUM 3.00 OWNER NAME: I 1"I'ol 1ct Co. OF 1 PER PERMIT SUBTOTAL: $ c y 7 SITE ADDRESS: r r7. STATE SURCHARGE: .50 3~ TOTAL: $ ~ZJU LOT: 1 BLOCK SUBD. A,& 0 INSTALLER: FIARE • s INC. ADDRESS: W PhrMo h A& Na IGNATURE PE ITTEE GWW VaRay, MN. 55427 CITY: ZIP: PHONE ~`1(~'- 1 I L COMMERCIAI/NDITSTk(T;:: PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS, APARTMENT BUILDINGS, AND MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT. CONTRACT PRICE: FEES OWNER NAME: 18 OF CONTRACT FEE. STATE SURCHARGE _ $.50 FOR SITE ADDRESS: EACH $1,000 OF PERMIT FEE. PROCESSED PIPING - $25.00 LOT: BLOCK SUBD. $25.00 MINIMUM FEE. INSTALLER: CONTRACT PRICE x 18 $ ADDRESS: STATE SURCHARGE $ CITY: ZIP: TOTAL: $ PHONE (SIGNATURE) FOR: CITY OF EAGAN CITY OF EAGAN FOR CITY USE ONLY 3830 PILOT KNOB ROAD EAGAN, MN 55122 PERMIT # PHONE: (612) 454-8100 RECEIPT # g6 Mm"T DATE: /l STDt11;" PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS & TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. WORK DESCRIPTION COMPLETE THE FOLLOWING: NO. FIXTURES EA. TOTAL NEW CONST ADD-ON MINIMUM 15.00 ADD ON 1 SHOWER 3.00 REPAIR WATER CLOSET 3.00 ° 2 BATH TUB 3.00 6 LAVATORY 3.00 i~ OWNER NAME: n14~ KITCHEN SINK 3.00 O LAUNDRY TRAY 3.00 3 SITE ADDRESS: S ID1 C Ot r-N~<o. e11 01v S HOT TUB/SPA 3.00 WATER HEATER 3.00 3 LOT:, BLOCK SUBD / 11 j ! FLOOR DRAIN 3.00 -3 GAS PIPING OUT. INSTALLER: ~.u 1 ~c (MINIMUM - 1) 3.00 3 OPENINGS 1.50 ADDRESS:- (gI U C 2 z cu C OTHER • S _ WATER SOFTENER 5.00 CITY: cJ vic~ n ZIP: ~S^3 ) a PRIVATE DISP. 15.00 ~G l ~~a 1 U.G. SPRINKLER 3.00 PHONE 1 d SUBTOTAL $ U .s& ST. SURCHARGE .50 SIGNATURE OF PE ITTEE S U TOTAL: $ 0MMEiCpyIbiDUS;TRIfI;€ PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS AND MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT. CONTRACT PRICE: FEES OWNER NAME: 1% OF CONTRACT FEE. STATE SURCHARGE - $.50 FOR SITE ADDRESS: EACH $1,000 OF PERMIT FEE. LOT: BLOCK SUBD. $25.00 MINIMUM FEE. INSTALLER: CONTRACT PRICE x 1% $ ADDRESS: STATE SURCHARGE $ CITY: ZIP: TOTAL: $ PHONE (SIGNATURE) FOR: CITY OF EAGAN CITY USE ONLY L ~ BL RECEIPT c~ r q, ~ a SUBD. RECEIPT DATE: PERMIT # JAS 1 O 1999 PLUMBING PERMrr (RESIDENTIW CITY OF EALGAN 3830 PILOT KNOB RD EAeAN. MN 55122 (851) 681-4675 Please complete for: > single family dwellings > townhomes and condos when permits are required for each unit > backflow preventer for underground sprinkler system FIXTURES EACH # TOTAL Bath tub $ 3.00 x = $ Floor drain 3.00 x = $ Gas piping outlet ' minimum -1 3.00 x $ Hot tub/spa 3.00 x = $ Kitchen sink 3.00 x = $ Laundry tray 3.00 x = $ Lavatory 3.00 x = $ Minimum fee alterations to existing dwelling 30.00 x = $ ~O Private Disposal System new/refurbished ' requires MPC lie. 75.00 x = $ Private Disposal System abandonment 30.00 x = $ RPZ new installation/re air 30.00 x = $ Rough opening 1.50 x = $ Shower 3.00 x = $ Underground srinkler if dwelling is under construction 3.00 x = $ Underground srinkler if existing dwelling 30.00 x = $ Water closet 3.00 x = $ Water heater 3.00 x = $ Water softener if dwelling under construction 5.00 x = $ Water softener if existing dwelling 30.00 x = $ Water turnaround 30.00 x _ $ State Surchar a .50 > > $ Total > $ 3O S Reminder. Call for inspections of alterations, i.e. water heaters, water softeners, etc. - - - I hereby acknowledge Nat I have read this appliptlon, state that the information is correct, and agree to comply with all applicable City of Eagan ordinances. It is the applicant's responsibility to notify the property owner that the City of Eagan assumes no liability for any damages caused by the City during its normal operational and maintenance activities to the facilities constructed under this permit within City property/right-of-way/easement. SITE ADDRESS: 7 ~9 rLfBF~2 /rJ~LL ~Q F~"Gi(/ ~1/V ~5-~a~.~ OWNER NAME:: 7`RL/iyl-- M:6 TELEPHONE 6•S 274iS~- Sri- (AREA CODE) INSTALLER NAME: S'4 m e- TELEPHONE (AREA CODE) STREET ADDRESS: CITY: STATE: ZIP: SIGNATURE OF RMITTEE 1999 BUILDING PERMIT APPLICATION (RESIDENTIAL) CITY OF EAGAN ~ g~ -1 3850 PILOT KNOB RD - 55122 C - 0 651-681-4675 New Construction Reauiremerds Remodel/Repair Reaukemerds 3 registered site surveys showing sq. ff. of lot, sq. R. of house 2 copies of plan and g_R roofed areas 120% maximum lot coverage allowed) 1 set of energy calculations for heated additions ➢ 2 copies of plans (slow beam S window sizes: poured fnd. design: etc.) 1 site survey for extedor additions 6 decks ➢ 1 set of energy calculations 3 copies of free preservation plan R lot platted after 7/l/93 DATE: Jz - /h - 9`I / ) FCONSTRUCTION COST: DESCRIPTION OF WORK: Lowe-R L_G c- L ey l cA STREET ADDRESS: 7S9 CAry16~~e%uELL D~ E/l~<1IN_ AZ& Y S4a3 LOT: --Ei- BLOCK: SUBD./P.I.D. # ~S ~Z 9 K LA rQ 2 - Q7-~ Name: D/go ZX'yA/6~ Phone 6:2 ZAS PROPERTY Last Find OWNER Street Address: 54 M E City State: Zip: Company: YY) Phone (area code) CONTRACTOR Street Address: License # Exp. City State: Zip: ARCHITECT/ ENGINEER Company Name: Telephone area code ( ) Street Address: Registration City State: Zip: Sewer fL water licensed plumber freauired for new construction onN): Penalty applies when address change and lot change Is requested once permit is issued. 1 hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all oppllcabl State of Minnesota Stotutes and City of Eagan Ordinances. Signature of Applicant: OFFICE USE ONLY Certificates of Survey Received Yes No Tree Preservation Plan Received Yes No - Not Required PERMIT City of Eagan Permit Type:Building Permit Number:EA170454 Date Issued:07/02/2021 Permit Category:ePermit Site Address: 759 Camberwell Dr Lot:13 Block: 2 Addition: Hills Of Stonebridge 3rd PID:10-32992-02-130 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. If water damage is encountered, please call (651) 675-5675 to schedule a site visit to verify the extent of the damage. Any repairs must be inspected prior to covering. The inspector will determine if an additional permit will be required to repair the water damage. 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 - David J & Amy S Ramaley 759 Camberwell Dr Eagan MN 55123--393 (651) 592-4545 Legacy Restoration Llc 15350 25th Ave N, Suite 114 Plymouth MN 55447 (763) 354-7660 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA172426 Date Issued:09/29/2021 Permit Category:ePermit Site Address: 759 Camberwell Dr Lot:13 Block: 2 Addition: Hills Of Stonebridge 3rd PID:10-32992-02-130 Use: Description: Sub Type:Siding Work Type:Replace Description: Census Code:434 - Residential Additions, Alterations Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Please leave printed pictures of house wrap on site for the final inspection. 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. When a weather barrier is installed or 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 - David J & Amy S Ramaley 759 Camberwell Dr Eagan MN 55123--393 (651) 592-4545 Legacy Restoration Llc 15350 25th Ave N, Suite 114 Plymouth MN 55447 (763) 354-7660 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA177590 Date Issued:07/08/2022 Permit Category:ePermit Site Address: 759 Camberwell Dr Lot:13 Block: 2 Addition: Hills Of Stonebridge 3rd PID:10-32992-02-130 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 - David J & Amy S Ramaley 759 Camberwell Dr Eagan MN 55123--393 Window Nation 8110 Maple Lawn Blvd Fulton MD 20759 (860) 952-4112 Applicant/Permitee: Signature Issued By: Signature