1426 Appaloosa Trq_-)650
New Construction Reauirements
• 3 registered site surveys showing sq ft. of lot, sq ft. o( house; anc9ll rooFed areas
t20% maximum lot coverage albwed)
• 2 copies of plan showing beam & window sizes, poured found design, etc )
• 1 set of Energy Galculations
• 3 cropies of Tree Preservation Plan i( lot pWtted aRer 711193
. Rim Joust Delail Op6ons selecUon sheet (bldgs with 3 or less uniLS)
DATE
JOB SITE A
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD • 55122
651-681-4675
0
IF MULTI-FAMILY BUILDING, HOW MANY UNI
PROPERTY OWNER 'Q -T'` '4, __%:
120 °°
YYID??
?
1o??z
RemodellReoairReauirements
• 2 copies ot pian
• 1 selof Energy Calculations for heated addiGons
• 1 site survey for exterioraddihons & decks
. Indipte if home served by sepfic system foradditions
v=?
VALUXION
Ns ? ?
TYPE OF WORK S' '• - '• S `b-, \ e ? a u- I A ` ? "?, FIREPLACE(S) _ 0 ? 1 _ 2
APPLICANT?- --- ? -) ?r- PHONE# 61 Z - 7s?1 -? 1_??3
ADDRESS / S o' 7 ^' S- ZIPCODE -o
PAGER # CELL PHONE # ? I
- -7 fl - °L q _
Phone #
NEW RESIDENTIAL BUILDING ONLY- FILL OUT COMPLETELY
Energy Code Cate9ory _ NIINNESOTA RUI.ES 7670 CATEGORY 1
(check one) • Residential Ventilation Category 1 Worksheet Submitted
- Energy Envelope Calculatlons Submitted
MINNESOTA RULES 7672
- New Energy Cade Worksheet Submitted
Plumbing Contractor: _
Plumbing Syslem Indudes:
Mechanical Contractor:
Vlcctianical System Includes:
Sewer/Water Contractor:
.air Conditioning
I-Icat Recovery System
All above information must be submitted prior to processing of applicaGon.
FAX #
Fec: $90.00
Pee: $70A0
Phone# Vt? ' IS 11 1'1
Qc??AD?
I hereby acknowiedge that I have read this application, state ihat the information is
with all applicable State of Minnesota Statutes and City of EagaVrdinances. _ e
Signature of Applicant
_ Water Softener
Water Heater
No. oF Baths
Phone #:
I.awn Sprinkler
No. ot' R.I. Baths
Certificates of Survey Received - Tree Preservation Plan Received _\,JNot Required _
Updated 1l01
OFFICE USE ONLY
? Ot Foundation
? 02 SF Dwelling
O 03 Ot of _ plex
? 04 02-plex
? OS 03-plex
? 06 04-plex
? 31 New
? 32 Addition
? 33 Alteration
? 34 Replacement
Valuation
Census Code
SAC Units
Nbr. of Units
Nbr. of Bldgs
Type of Const
?
?
Other
_ Pool _ Ftgs _ Air/Gas Tests _
_ Siding Stucco Stone
_ Windows (new/replacement)
Approved By
? 07 05-plex ? 13 16-plex
? 08 06-plex ? 16 Fireplace
? 09 07-plex ? 17 Garage
? 10 OS-plex ? 18 Deck
? 17 10-plex A 19 Lower Level
? 12 12-plex Plbg_Y or_ N
? 20 Pool
? 21 Porch (3-sea.)
? 22 Porch/Addn. (4-sea.)
? 23 Porch (screened)
? 24 Storm Damage
? 25 Miscellaneous
? 30 Accessory Bldg
? 31 Ext. Alt - Multi
? 33 Ext. Alt - SF
? 36 Multi
? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 37 Demolish (Bldg)* ? 43 Reroof ? 46 Windows/Doors
`DemoliNon (Entire Bldg only) - Give PCA handout to applicant
Occupancy 9 J - 1WJ- MC/ES System
)' 6?`?7
Y
!J !2L4
-YA-)
Zoning City Water
Stories Booster Pump
Sq. Ft. PRV
Length Fire Sprinklered
W idth
REQUIRED INSPECTIONS
Footings (new bldg)
Footings (deck) FinaU.Io C.O.
Footin.s (addition)
Foundation HVAC
Drain Tile
Roof Ice & Water Final
Framing
Fireplace * R.I. ? Air Test ? Final
Insulation
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
W ater Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
Buiiding Inspector
j
Z??, 00
FinaUC.O.
?
Plumbing
?
DATE: JAN 24, 1991
,+Fr--?s -? •?
R?.. 1426 APPAI.OOSA TR (JOE HILLEH HOMES)
X 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 foliowing
reasons:
Your Sewer & Water Permit for the above property has been completed, but the meter cannot
be issued or occupancy allawed until further notice.
COMMERCIXL 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.
- REGlUIRED BY LAW.
CONTACT COMMUNtTY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICY.
Secretary, Building Inspections Dept.
CASH RECEIPT
GITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE
Ji
wECEnreo ? i i r I a
rnoM
AMOUNT S ? -_," ?'? e' ,
J
& DOLLARS
ta 9
? CASH ? CHECK
9
?
wn
? L
9
SEVNER 8 WATER PERMIT
CITY OF EAGAIi
3830 Pilot Knob Rd.
Eagan, MN'55122-1897
DATE
OFFICE USE ONLY
METER #.666 aa y4JJ PERMIT DATE 01 /24% 9 i
CHIP # 0 -7 12 99 -"722 PERMIT # 11757
METER SIZES S B.P. RECEiPT # r 11814
ISSUE DATE B.P. RECEIPT DATE 01123 91
_ BOOSTER PUMP
SITE ADDRESS .14F26.A.? ? ? ?pos.a?r?
LOT -I 2BLOCK i_SEC/SUB ? ti.,,a?.?,.•. ? ? ? ? ?•? ?
APPLICANT:
ADDRESS:_
CITY, STATE
PHONE: -
ZIP
PERMIT REOUESTED
-/SEWER ? WATER - TAPS
_ COMMlIND ? RESIDENTIAL
-V- NEW - EXISTING
,t ' Lawn Sprinkler Meters are to be Installed
PLUMBER: Ahead of Domestic Meters on Water Line.
ADDRESS: r ? r ? Cre,d'`WILL NOT be Rivnen for Qeduct Meters.
CITY, STATE ZIP O1Q? PHONE:
?n _n A i I AQ EE TO COMPLY,WiTH CITY OF
ADDRESS: J? ?I-i '5 2 4 jt .? ?
CITY, STATE 41?4f' zJ ir1 ZIP
PHONE: (-K% I
PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. CALL 4545220 FOR INSP£CTIONS. FOR STORM
SEWER PERMITS, CONTACT ENGINEERING DEPT.
, -
,
SEWER & WA'P'ER PERMIT
CITY OF EA{3*A
3830 Pilot?nob Rd.
Eagan, M 55122-1897
DATE 1 -17 - 91
OFFICE USf ONLY
METER # PERMIT OATE
CHIP # PERMIT # 117$7
METER SIZE B.P. RECEIPT # C 7 1 t i?.
ISSUE DATE B.P. RECEIPT DATE
_ PRV - BOOSTER PUMP
SITE ADDRESS 1426 Aw n n 1., o.- t.-. i t
LOTIrBLOCK_I SEC/SUBS}+eruooa flnvnd
APPLICANT:
ennRFCC-
CITY, STATE ZIP
PHONE:
PLUMBER:
ADDRESS:
CITY, STAI
ZIP
PERMIT REGIUESTED
-/SEWER ? WATER - TAPS
- COMM/IND -k? RESIDENTIAL
i
? NEW - EXISTING
Lawn Sprinkler Meters are to be Installed
Ahead of Domestic Meters on Water Line.
Credit WILL NOT be aiven for Deduct Meters.
I AGREE TO COMPLY WITH CITY OF
EACiAN ORDINANCES
ADDRESS:
CITY, STAI
PHONE: 16
ZIP
SIGNATURE WHEN METER ISSUED
PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. CALL 454-5220 FOR INSPECTIONS. FOR STORM
SEWER PERMITS, CONTACT ENGINEERING DEPT.
r.t?1yv1.1u) rvfc u%,ic u7lm/Y[ ` •'
PE-JR ??Wl 6e3-(Y423 CITY OF EAGAN 18668
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
?fBUILOING'PEFfMIT PHONE: 454-8100
Receipt #
To be used for ?? ??/GAR Est. Vaiue s142.000 Date JAN 18 19 91
Site Aidiess
Lot Block SeGSub.
Parcel No.
Name _
Address
Clty _
77
I hereby acknowie<
information is corr(
Minnesota Statutes
Signature of Permit
on
Building Offiaal
OFFICE USE ONLY
Occ,pancY ?- ? -? ?I • ' ? FEES
2oning
jAc[ual} Const
Bldg. Permil
767.00
71.00
jAllowable) -
Surcharge
* ot Slories ? 511.00
Length Plan Revfew
100.00
Depth SAC, City
S.F.Total - SAC.MCWCC 650.00
S.F. Footprinfs _ 660.00
Qn Site Sewage _ Water Conn
90. 00
On Site weu water Mater
MWCCSystem ? Aec1 peposit 30.00
?
City Water - 30.00
PFV Required _ SNV Permit
Booster Pump - S!W SurCharge ? ?
276.00
Treatment PI
APPROVALS ?70• ?
Road Unit
planner - Park Ded.
CounCil --
Bldg. Olf. _ Copies ' S
F
Variance
- TOTAL .
.
Permk ko. PermR Holder Date Telaphone #
WATER
SEWER
PLUMBING
H.VA.C. ? w Q - W
ELECTRIC ?rfl
kupsction Date tnsp. Commems
Footirgs 1 ?- Z • / ??'
L ?/l/?b o s
17-
Fourdatio.
F?amirig 2 24 p --
Roofing
Rough Plbg.
Fiar9h FIt9• "J_? z t
Isul. ?-Q
?replace ?? ? &)
Final Ht9. j 1 C- 1
Fnal PIb9. ? ? T f^/.vls ? /
Const. Meter Plbg. Inspec,KOr - Notily Ptumber
Engr.iPlan f=u? Noul +'
Bldg. Final
oeck Fiy_ c34..P
Dedc Final ?.w --C ??? Sf? Ol/?v C?
Well
Pr. Disp. / [l?O?•L G?? ? o ' /`
s ?? 3 ?79Y ?
? T ? INSP I N R-EMR-D
CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued: ?' ?? e?' I`? `' i
(651) 681-4675
,
SITE ADDRESS:
I ,, i•Al ou%A I
11 t.,L.l114111 11116JN'-.
PERMIT SUBTYPE:
MAV!
fF
i t r;i ?)Cr
? APPLICANT:
ti:? •? +)
TYPE OF WORK:
, ' , i I i r IlW
1G ftf-F+npf Ilim•.t /1NIl i,f;1?At,1" flllr- I-C,
111(sf
tN
A
?
?
Permit Holder Date Telephone A
EWER/
WATER
PLUMBING
HVAC
Inspection Date Insp. Comments
FOOTINGS
FOUND
FFIAMING
ROOFING
ROUGH
PLUM8ING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
DOMESTIC
METER
IRRIGATION
METER
FLUSH
MAINS
CONDUCTIVITY
TEST
HYDROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
ao d-
? 3 141?, j ?D
? ?
Flequesi Dete
F e b. ] 8? Fire No. Rouqh-in Inspactqn
Requvetl' ? Reetly Now ? W II Notly Inspeclor
Ves G No wlwn ReaN/'
1X licensed conVactor p owner here6y request inspection of above electrical work at:
,wo Aaaross (SVeel. ew w flate No.) CiN
1426 Appaloosa Trail Ea an
Seclwn No
7ownship Name or No
RangB No
Counry
I I DAKOTA
Occupant (PRINT) Phona No
Joe Miller Homes 431-2001
Power Supplier Atltlress G 5 O?4
akota Electric 4300 220th St. SW Farming on,MN
Eleclrcal Conhxmr (COmpany Name) COnVacbry L?cense No
1idland Electric 41610
Mmhng NEEress ICOmraciw or Owmr Mekng Instelletian)
7630 145th St W
AutMraed ?Sg?a/tmy ?ConlranouNwner Me?k,pp?yJ?alietwn)
c// / //% Phone Num?er .
?- ? ? i
M A?SL1TE BOAHD O LECiRICITV THIS INSPECTION FEOUEST WILL NOT • -Griqqs-YlOwey BMg. - Noo S1T! BE ACCEPTED BV THE STATE BOARD
1821 UNwnlry Pve • SL VWI, MN 55100 ' UNLESSPFOPEP INSPECTION FEE IS
Phone(81Z) 863-0800 ENCLOSED.
REQUESTfOR ELECTRICAL INSPECTION °'"`"`?? p? ,-oe I
Y.°.., ?
?D / ? See instructions 1ar comvleUng this form on back of yellow wpy
?_ 3 9 141 X" Below Work Covered by This Request '"•`"'
ew Adtl R. TypeofBwltlmg App6ancesWired EqwpmentWired
Home Range 7emporary Service
Duplex Water Heater Eleciric Heating
ApL Bmlding Dryer Other (Spacity)
Comm.llntlustrial ' Furnace
Farm Air Conditioner
Olhar (spenty) Con[rectori Remarka
Campute Inspecfion Fee Below:
# Other Fee # SernceEntrenceSae Fee # CirouilsiFeeder5 Fee
Swimming Pool ? 0 to 200 Amps 0 to 700 Amps
Transformers Above 200 _ Amps A6ove 100 Amps
Si9n5 Inspector5 Use Only TOTAL
Irngation Booms C
Special Inspection
Alarm/Communication THIS INSTALLATION MAY B ORDERED I5CONNECTED IF NOT
Other Fee COMPLETED WITHIN 1 HS.
I, the Electrical Inspector, hereby
R°uyn-'" +
"? ?.a
pv
certiry that the above inspection has
been made. F,nai
- _C?l
OFFlCE USE ONIY
Tliis request vai0 18 montM irom
. CITY OF EAGAN NO 1$668
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
' PHONE:454-8100 (j ?
BUILDING PERMIT Receipt # ?r?y.'
L/ ?
To 6e used tor SF DWG/GAR Esi. Value $142,000 Date JAN 18 , 79 91
Site Address 1426 APPALOOSA TR
Lot 13 Black 1 Sec/Suh. SHERWOOD DOWNS
Parcel No.
w Name JOE MILLER HOMES
; Address 18133 CEDAR AVE 5
° Crty FARMINGTON phone 431-2001
o Name SAME
?a Address
,
.
City
Phone
?
W W
Name
?z Address
a W City Phone
I hereby acknowlege ihat I have read this application and slate that ihe
information is correct and agree to comply with all applica6le State of
Mmnesota StaWtes and C f Eagan Ordi es.
Signature of Permrtee_ l
A Building Permit is issued to: JOE MILLER HOMES
on the ezpress contlrtion that all work shall be done in accordance wdh all
applicable Stale of Mm.n(?esota? ,S,ta(t?ut•ees.a'ndr City of Eagan Ordmances.
BuildingOfficial? ??W?tlidt?L
OFFICE USE ONLY
Occupancy R-3 M_1
Zoning R=1
(ACtuaq Cons1 V-N Bldg. Permit
(Allowable) -V-- N Surcharge
B ofStones -
Length 71'
oePth 38'
S.F. Total -
S.F. Footprints _
On $ite Sewaga _
OnStBWell -
MWCC System -XL
City Waler X
PFV Required _
Booster Pump -
APPHOVALS
Planner -
Councd
eiay. 011.
-
Variance -
Plan Review
FEES
787.00
71.00
511_00
snc, ci,Y i nn _ nn
snc,rncwcc 650_00
WaterConn 660.00
WaterMeter 90-0
?
Acct Oeoosil 30.0
?
S/W Permit 30_ n(1
SM! Surcharge - 50
Treatmenl PI 776 _ (10
Road Unit 37(1 _ fln
Park Oad.
Copies
TOTAL 3,575.50
6hress: 1426 AppLppSA TRAIL Lot 13 Blk I Sac/Sub SHEWD DOWNS
These items were/were not complete at the time of the final inspection.
Date: 4/I/91 Yes No
Final grade (6" from siding) ?
Permanent steps - garage
Permanent steps - main entry c?
Permanent driveway ?
Permanent gas ?
Sod/seeded grass ?
Trail/curb damage L__?
Porch ?
Basement finish ?
Deck
Please verify with the builder the removal of roof tast caps from the plumbing
system and the shut-off oE vatar supply to the outside lawn faucet before
freeze potential exists. ?j
v?
HL1IIf4XIM
' White - City copy Yellow - Resident copy Pink - Contractor copy
Gj t?; G7 ? 2004 RESIDENTIAL PLUMBING PERMIT APPLICATION
CITY OF EAGAN
' 3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings.
/S-Scl
Date 6 I 3_ ! O q
Site Street Address yJ Unit #
Property Owner Telephone # (4,!51 )4P3 -aVo2 4,
Contractor W -16, la4 n1?d) Telephone # ((Rj[ )s365 -)3 ?16
Address ?3/, 70 X?n,rQa City Statern,-)• ZipXS/`?3
The Applicant is: _ Owner t' Contractor _Other
Alterations to existing dwelling
_Add fixtures to rooms, excluding water softener and water heater
_Septic System Abandonment
_ Water Tumaround (add $121.00 if a 5!8" meter is required)
Other: $ 50.00
i
Water S/oftener ?Water Heater
? replacement _ additionaf $ 15.00
Lawn Irrigation System RPZ_ new _ repair _rehuild $ 30.00
State Surcharge $ 50
Total $ .SQ
I hereby apply for a Residential Plumbing 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 the plumbing codes; that I understand this is not a permit, but only an application for a
permit, work is not to start without a permit and work will be in accordance with the approved plan in
the event a plan is required to be reviewed and approved.
U I pplicant's Si nature
Printed NamO II ! JUN 14 2004 A
_,,,
Cvy? ??
- 2004 RESIDENTIAL PLUMBING PERMIT APPLICATION
CITY OF EAGAN
• 3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings.
j5-5d
Date164
Site Street Address 6 dwm=&t?A/Nu Unit #
Property Owner ` Telephone # {o6/ )/0f'3 -D?f?746
Contractor lel go -?Ck uJa4,k.,aJ Telephone# (661)J65-/J116
J.- 2ip
Address 3 (Q 16 A(o-tL4L (Wd City ? State__ZZ2/
The Applicant is: _ Owner ?ontractor _Other
Alterations to existing dwelling
_Add fixtures to rooms, excluding water softener and water heater
_Septic System Abandonment
_Water Turnaround (add $121.00 if a 5/8" meter is required)
Other: $ 50.00
r Water Softener Water Heater
- e-` replacement _ additionai $ 15.00
Lawn Irrigation System RPZ_ new _ repair _rebuild $ 30.00
State Surcharge $ .50
Total $ /S So
I hereby apply for a Residential Plumbing 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 the plumbing codes; that I understand this is not a permit, but only an application for a
permit, work is not to start without a permit and work will be in accordance with the approved plan in
the event a plan is required to be reviewed and approved.
ApplicanYs Printed Name p L u? ?'
14 2004
icant's 3iqnature
1999 BUILDING PERMIT APPLICATION (RE$IDENTIAL)
CITY OF EAGAN
O? 3830 PII.OT KNOB RD - 65122
(651) 681-4675
New Construction Reauirements
? 3 registerad site surveys
• 2 wpies of pians (inGude beam 8 window sizes; poured fid. design; etc.)
? 1 energy calculations
? 3 copies af tree preservation plan 'rf lot platted after 7!1/93
required: _Yes _ No
DATE: J I I I q e?
DESCRIPTION OF
RemodeVReoair Reauirements
? 2 copies of plan
? 1 site surveys (exterior eddKions 8 Cedcs)
? t energy calculationa Por heated additions
CONSTRUCTION COST:
?
STREET ADDRESS: IAW *?'? <o-,
LOT: BLOCK: ? S BD./P.I.D. :# 9ao
?-2 Y Wo o& U o.] vKMkel-ori
Name:
PROPERTY
OWNER
Last
Street
City
State:
Zip:
Company: W• Phone #:
CONTRACTOR /-
Sueet Address: 441,ej ?" ,1l/???1?,,,,?,lX License #Exp.
City /,& State: Kvt Zip: 414
ARCHITECT/
ENGINEER Company:
Street
City
Sewer & water licensed plumber (new construction only): _
change and lot change is requested once permit is issued.
I hereby acknowledge that I have read this application, state that the
State of Minnesota Statutes and City of Eagan Ordinancss.
OFFICE USE ONLY
Certifcates of Survey Received _ Yes No
Tree ?
Preservation Plan Received Yes No Not Required
to coqaply with all applicable
Signature of Applican FL!-
Is ii
V
First
Phone #:
Registration #: _
State: Zip:
Phone #: (6' Q00 ' (/+ 21?
Penalty applies when address
OFFICE USE ONLY
BUiLDING PERMIT TYPE
? 01 Foundation ? 06 Duplex ? 11 Apt./Lodging ? 16 Basement Finish
? 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
? 31 New ? 33 Alterations ? 36 Move
? 32 Addition ? 34 Repair ? 37 Demolition
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Width
APPROVALS
Planning
Permit Fee
Surcharge
Pian Review
License
MC/ES SAC
Ciry SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
Basement sq. ft.
Main levei sq. ft.
sq. ft.
sq. ft.
sq.ft.
sq.ft.
Footprint sq. ft.
Building
Engineering .
Valuation:
Census Code
SAC Code
Census Units
Census Bldg
MC/ES System
City Water
Booster Pump
PRV
Fire Sprinklered
Variance
% SAC
SAC Units
V A?
G ARAG-'E
-----
IZx22= ZGy
P-oX 24 _ ?I c6 0
4xro = ?aN
lD F300
BsM --r
_._
62a y a ? - ? a3
Z 2 X l t4 = 3a$
4 `? (o = ? ??N ..-
i I IS ?c iti: 15 ? In
?f ous? ?-
bSr+n-r = t ? ? 5
__---°
Ilz`?x 1•?51?8_
1 ?/568 0?2 1L42,ooo'
r
O•T
7f37•UU+
71 •00 F
SI1•00*
2)206•50}
? 3'575•50*
?
787•OU+
%1•00+
511•00+
2.20o•5U+
3+575•50*
1991 BII? ING?? LICATION
CITY OF EAGAN
SINCLE FAMILY DWELLINGS
2 SETS OF PLANS
3 REGISTERED SITE SURVEYS
1 SET OF ENERGY CALCULATIONS
M[TLTIPLE DWELLZNGS
COMMERCIAL
2 SETS OF PLANS 2 SETS OF ARCHITECTURAL
REGISTERED SITE SURVEYS - & STRUCTURAL PLANS
(CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS
1 SET OF ENERGY CALCUTATIONS 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 IAST WORKING DAY
OF MONTH IN WHICH REQUEST IS HADE.
LOT CHANGE IS REQUESTED f?FICE PERMIT IS ISSUED.
NOTE: ADDRESSES FOR CORNER IATS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS
DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
PROCESSING TIME FOR SEWER 6 WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED.
PERMIT MUST SHOW A LICENSED PLUMBER.
444
To Be Used For: Valuat'ion:-ZW]
Date:
Site Address l`t?(?p
Lot /3 Block /
I42I 000"'
FEES
occupancy
2oning
Yarcel/Sub 12? & Actual Const V-N Bldg. Permit 787 a0
Allowable V-N Surchar e 17
Owner # of stories
Length Address Depth 35'
S.F. Total
City/2ip Code Footprint S.F.
Phone On site sewage_
On site well
Contractor MWCC System ?
L?I City water ?
Address ??/? I.Q PRV
?UnZdDt_j?_ _)?) /5s-bA Booster Pump _
City/Zip Code ?
Phone ?'2A -Q?I / , Ylanne?S
Council
Arch./Engr. Bldg. Off.
Variance
Address
City/Zip Code
Phone #
Signature of Contractor)
8
Plan Review
511, Ob
SAC, City fOO-DO
saC, MwCC , 650.00
Water Conn 61O,D0
Water Meter 90,00
Acct. Deposit 30.00
S/W Permit 30,00
S/W Surcharge y q
Treatment Pl. 2'7/e, DD
Road Unit ,00
Park Ded.
Copies
SUBTOTAL
Penalty
Lot Change
TOTAL
agrees that all work shall be done in accordance with
11 applicable State of Minnesota Statutes and City of Eagan Ordinances.
F' i onaer Ene i near i ns 5819498
4C
? PIONEER
* enginecring..
??**
-A?:: ?..
Cert;f;cate o, Su?vey fp,:.IOSEPN M. MILLER L'pN5'T. C0.
APPALDOSA TRAILNoarN
N 8?°37'3Z E...8...5 ca e
"r?
a p1
?_ ?
_? .? O
?~ I
N
is..a ? Z7?
II.b7 r ' • 4.6? 5.f e??1.•
: " ?[. ?1,K11
I
D I
<Sl
re
I•nu 4!
w ?z
. hj
? ?
?5itlo? ?2.0 \?
'-
]a ? ?-
tn knl
N 44 F
M 1 ? ?
I'
,
2422 EnterprisB Drive
Mandvta Heights, MN 55120
S
x-900•00 Uenoks £xistinl flevnfions
} oa.oo Denofes proposed Elevafions
-----'- OcnofcsOminae U1?lify Easemenf
- O[nofPS Onaino?e ?low, xlrrows
pe ofe 4Uon ume t
?.,
/
.
,
2La
a ow
e
? L,1
P.02
{612} 681-1814
?? .... . -. . . .
_ ; :?;. _ ...., ..
Pannr-rosEn NousE EtFV,artoas
Lowest f7oor Elrvah'on 904. 4e
T?p' of Bloc;? E/eVolron 912,10
Garase S/ab E/evafion 9?1, s3
o n? n myef Nub
gearins Shown are asoumed o peno/es a f{
LOT 1?,b BL QCk J SNER wooa D4WNS
pQKOTA COUN7}'2 MINNESOTA H ? 5ubject to earemtnfs o^record ?
I nereby certlfy thet this sUrvey, plan ar report wn pr ered hy me or under my direct superviclon ead that 1 am duty Re9iatersA Lead 9urveyol
under the lawf OF the State of Minnssote. Oat¢d this?day Of ---UUW? A•D• 19--?-.
?
Scal?
6R7 B. SIKI l.S. RfiG. NO. 14891
`.1 L
A lC
NC7L= ? .G? FtiCtdl YAKU 7tir3ri?N :,.. .__._. . _.. --
? nintiesarn srnIL ENEfIGY couE cn?cuLnrions
onsEU oi? ciin?r€R 5 OF 111E
' HODEI,GNERGY COUE - 1903 EDliloll
. . Adopt]on Effectlve
I -J;I.1 i 7tf'hone _
'Owncr
^Slte AdJress
Q03
bate' '
'.? .. ?
o ?
Phone
Contrac[or UuIlJing Class{.flcatlon: Type AI (Single Family L Duplex) A TYpe A2(fleslderi[lal) ,
13 storles or essy .
11015: Cample[c pages 3 and h flrst. (Other)(over 3 storles)
GEIIGtIAL IflFOR11AT1011
I. Oulldlny Perlme[er?EE" Q•,?_??-f_I_?t.
z
2. Uall helyht (yround to eave) ft.
j, 1, x 2. (above) gross wall area ?3 ft. •. ?.
? 2
fI. Uulldltig Jliiieiisloris (l) ? x?W) <r1.? f?. raorfloorerea '
5.• Square foot area of rlm Jolst - Floor ]olst sfze (Z x r? ? Z ?L?? ftz
X Perlme[er ° Rlm )ojst area °
151? . ? „• ,
12
G. Uoors - lliea I 1149
fhfckness ln. U factor . ?ft.
Type oF Constructlon Perlmeter
,
. Hanufacturer
7. Total door's perlmeter ft.
. ?
U. Wlndows: 1lanufacturer???jUL C1??7f(S??' State approved,_ '___,_
U factor ' .
?
TYPE ' SIZE nnen (Ft.Z) NUIIAER OF TOTAL FEfT
• EACII UNITS • .' ,'
?
. . • ______=---, ' ,
. 9. 7ota1 ft.Z Glass ??01
j? - • , '
• -- Ft.Z .
= " . • ,
10, Fiteplace area:' Wldth X helght x
• x ? ) . _ ? ????/ ?_. Ft.
11. ExposeJ founJatlon: Ilelght X Perlmetert ? ?.?..-.
COHPLETION OF THIS FORII IS REQUIREU FOR ALL U€FISTRUCT 011, IIAJD?ENU E111G Al1U OUIL,UIIIGS DE
HOVED NIIERE EIIERGY, OTIIER TIIAII TIIE HIIlIPIAI COUE AL1041ANCE, IS USEU.,
I2.
13
(raminy area = lOX o( yross wall area.
Gross rral l area ? 39 1
2•
Hindo:r area A ' ?--ft_
ft.2
R 1 m Jo 1 s t ar e a A ? I ?------ Z
ft.
Uoor area A Z
??J4T10 1•??' G?-?.,?' ft.
FlVejila,Ce"area A _
ft.2
Exposed'(oundatton A
?A( ? ????- Z
Framiny area A_? ? "
IleL wall area n Z 1 5
(17I3)
ft.Z
"
x
U winJoris U
--_------
?{I
U A'.
n
/y?
x
U rim JOiSt ° f`? ,
/?,,
area = U'x 11.' ll'?
d
oor
U
UPW?eplate•= U x A
u foui,datioi, _ 10(a - u x n -------
(?
'E
Z
U fr a m i n g a r e a ? 1 (915 U -s-
x A
U wall U
, U x A,
z? ? c
' p e I
TOTIIL '. . . . . . . . . . x
L.. , a
_ j
14. Gross wall area ic 0.11 (A-1 single familY L duplex
(1J, above) •
x 0.23 (A-i olbu;,?ingd;ntfal)
15.
15A.
150
15C.
15U.
1G.
? alloviable U x A/Code ,
x ,23 (Ot ier
x.2p (Over 3 stoi•ies) . r} -7y p7Ull.'??1ust.be:larqer thai
I/3-uFf ; 1311 dbOVB
n.... ??;, f3 x U Cgde,? I' -'-', ( or 't.he. same as)
Ce' iling framing area (AF) equals 10'X of ceillii g area ??, t,2
f, x ?w? ..,. a
Grvss ceiling area ' =??) ?/a ft.?
Jo1st are5 (Af), = lOb ce111ng area = ? ?? ' ,•
ft.?
t{et ceil ing area (Ac) (15A - 15D) '
U ce i 1 i nq x h c= i X---'-?`-
Ax (o II 7?5'?. U framtng x A f= - ZC,> •' TotnL'u x n ..................... ..............
Ce111ng area (15A) x 0.026 (11-1 single family 5 duPlex - code allovrable U x A,1•
x 0.033 (A-2 other resiJeatial): .
x 0:06 (oLhe? Z ? . dauil I-lust belarggr„ than •15D ('abovi
(or_ tiie same%a,s.),`
A (15n) I" l(-? _ x U(code -
?
IIOTE: Use U and A values ob[aliied 1.
from pages I1•3 and
ues
n
S
f
1
I I? C
n
t
e 111nneso?a
F
State
the
rtexceeJs
u
e
s
?'?Cfej?
. tlia[
?n? here
g
bullJi
the o
mAe[s
u-IUed
de
Energy Conservatlon Act.
. - S gna[ure • •
Uate • ' . . . , ,
?.
2. , ,. '
__. ? :.? i : ? ? _ . ? ?? .. .. .. . .. . _ . . .. . . .._ _ . ... . ?.;: .
. ..
.. ._....----= ? G?'?'? ?? ?,?C_ ??-_ -i:f?: ._. ?--? _.. . . _ ... .... : _.; ......... -.---- ,
' r- r ' _ T.?J.'}-Z ?, ? ..I ?L?? ? ?--' •---?•-'a....._.. _ ._.?.,-:
.; l??ar'.`{X? ?'1?`?` .I' . . ??-- •,;.
? , ...... ....:.. ._.
.2
----------- ; . --- -- ?
. ..._.._ ......__ . 3.. . .. .... ___.-?--....._ ,
._.._..___. .
. . . . .... .....
?lyz??'._ 107 5
, ..
?... ... ..... _. ----? .. , . .
---- ,
------ ; . .._..----. ......_..__. _ ._ ...._ .. . .. . .
----- ? ???? ... ..?. :....... ... _ .. ....__....Z?/.?. _.. ?._.. . ..._?. .___._?----------r---?. . ..
,
z ? ? ---?------- ? .
?1L,...? ., W?SL?._-.... ..?...?:; .._ .... _.------
-- --??----- , a .. - __.z?? ? o__.. _ ? ._ . :. .
Zl v ...__ _ ... ... - ---------._.... --
____--- ? . __. ..---._._ ..._ _.,,__ . _. ... ......_ ___?1. I ?_o. _ _. _.._---• .. .. . ---?----.....----.._,. _.. ... .
,
.
.
? ._ ..
? ---...,.. ....--- _. _..?._. -
? ....._._ ..___..?___--__.-• .
I .... ......- ---.. ...._._.. _._....._. __.. .,
.
---------
_.. .. - ---------? ? ?
-. ,
..__. _ ; . .
, ? _ ? _---- -,
•----- ? _ . ?----,---•--_...-- -•--•-•----...?.. ----- -...?_ .._- ?--.-?'•- `=-,?----' '
----. ........ _._. . . ---- ? ?
-------• lil . -•...------`?------ . .. _` ... .: . ........._.._ ' _.._...__ - . -•'
. -
.i .?
?? .... .._..... _.___ ? .
, . .. .....,_. .. ,
...... ... . . .. .. . .
+ . __....----?---....... _ _.-
I ; _ ? ..... .... .. . r. _. . .
, , y. ,• ' . .. ,f • .
i ' , ,
,-- ?
?
?
-(i-'IT?IUE
? C11111i111G ;
0.
1 _
6 - ----
Atr Film - It YnluL
CEIll14G .. '
U.G1 '
_
_
C
?
! G •? Insulatlon
Jolst L??".0?7 ? `
, ,
'
, ??P Cell ln9 ./?
Alr Fllm U.G)
? ' OZ"Z • . ? ?oZ3 u=?[ ? ?
? . ,
_ --?--- ,
' rl.nt rtooF aii cninEUiin? ?Ettuia
?._...??.? ..
R`yilue , CEI'LI11G '
? Q- - ? FRAIIItIG
J UVIV - _ - • U.61 . Ins1Je alr t11m 0.61 . ?
• _ __ Jolst ?SEu?j
'?`? InsUlaNon
n ir sha cd
- Rvot deck?ng
T- insulation ?
? ?- Uullt-up root _
U.17 UutslJe blr tilm U.11?-
. ' lotal h
. ? U
IInjoH ?r,?lltrallon 5 cim/lineal tout of craek
lesldenEldl Joor InfllfI-ation U.5 cfm/square foot ar door duJ minimum cade requlremen!
lun-tesldei?tlal duor inilltrai.lon li.U cfm/11nea1 foot of r-rack
12°'toncrete block i,o insulatfon ?.47 (t,2.1 . ,
12'? tnncrete bloek lnsulated eores ?.26 R 3.0 .
Jb• 124 llght-.+elglit block c32 R 3.1 . . . .
)b 12'l 11yh1velyht U1ock Insulated`eures n tI2 R 8?1 •?• "
1 91ngi A glass = 1 .13; rillh storin talnJoW .54 . ' J dvubl@ glass n .55 .. . , '
1 lriple glass = .41 111 @x1.2r1or walls and ce111ngs musE Iiave A v.??vr Uarrler (O.IU peim mAx.)v,'," ''.
;apor barrler must be on the inside (heated s?dey oF riallI
japor barriers of the polyethelene Eh1n fflm haJe nv fl valUe.
. ? .. ?
• ' - ' li ' ' "
• . . , , ' ? • ?? '
.. ' '• . , ,
. . .. . , ?
• A. , . . , . • ' , ,
UNDERGROUND SPRINKLER SYSTEM
PLUMBING PERMIT
Date: ? 1 /,,(Permit #
I Date 7419/
Receipt # /Oc? // `J
_ Commercial: $25.50 + water tap if required. (City installs all taps up to 1"). If
a' g new service, a water perniit w<ll be required, as well.
Eavsting residential: $15.50 (Plumbing permit not required if backtlow preventor was
previously instailed). "
_ Residential developments: Fee to be determined by building inspections department.
May require payment of water permit, plumbing permit, WAC, and water ueatment
plant fees. 4,15,
(Address :o te sprinklered)
Homeowne /Plumber 77" 64rC--
Phone #: 1?f r=3p4(o
Street Address:
City, State, Zip:
Owner Name:
Street Address:
Phone #:
Irrigation Contractor:
Phone #:
??'? C? ?n??7=?
I hereby aclmowledge that I have read this application and state that the information is
correct and gree to comply with all applicable City of Eagan Ordinances
? -
cc: Engineering Department
GITY OF EAGAN
3830 PILOT RNOB ROAD
EAGAN, lIIi 55122
PHONE: (612) 454-8100
. .. .. .
«,?.??
PLEASE COMPLETE IIPPER PO&TION ONLY FOR SINGLE FAMILY DWELLINGS
TOWNHOMES/CONDOS AHEN PERMITS ARE REQIIIRED FOR EACS iJNIT.
WORK DESCRIPTZON
NEW CONST !/
ADD ON
REPAIR
OWNER NAME: l1d?e. ??I.c.P.ee.( ?-p/????.e-o'3'l CA
7P
SITEPADDRESS:v ? ?O ct
LAT: ") BLOCK / SUSD. ???rc..D /J'QLr/Sla I'rr
,
INSTALLER: GENZ-RYAN PLUMBING & HEATING C0.
aDDRESS: 14745 South Robert Trail
CITY: Rosemount, MN Zip; 55068
PHONE #:_ (612) 423-1144
ZIP:
PLEASE COMPLETE THIS PORTION FOR ALL C014IERCIAL/INDUSTRIAL BUILDINGS AND
MIILTI-FAMILY BUILDINGS AHEN SEPARATE PERMITS ARE NOT REQIIIRED FOR EACN
DWELLING IINIT.
CONTRACT PRICE:
OWNER N_9ME:
SITE ADDRESS:
LOT: BIACK SUBD.
INSTALLER:
ADDRESS:
CITY:
PHDNE
FOR:
CITY OF EAGAN
(SIGNATURE)
FOR CITY IISE ONLY
PERMIT #
RECEIPT # 0-?
DATE: 3
COMPLETE THE FOLLAWING:
N0. FIXTURES EA. TOTAL
ADD-ON MINIMUM 15.00
l SHOWER 3.00
? WATER CIASET 3.00
BATH TUB 3.00 4,
IAVATORY 3.00 ?
? KITCHEN SINK 3.00 3 ?
? LAUNDRY TRAY 3.00 ??3
HOT TUB/SPA 3.00
? WATER HEATER 3.00 ?
FLOOR DRAIN 3.00 ;;3
r_ec nIPI::G 0*JT.
(MINIMUM - 1) 3.00
? ROUGH OPENINGS 1.50 ?
oTHER
? WATER SOFTENER 5.00
_ PRIVATE DISP. 15.00
_ U.G. SPRINKLER 3.00
SUBTOTAL S .!5-/ So
ST. SURCHARGE .SO
TOTAL: $ S,? d2-
FEES
ie aF WivTxnCT rnS.
STATE SURCHARGE - $.50 FOR
EACH $1,000 OF PERMIT FEE.
$25.00 MINIMUM FEE.
CONTRACT PRIGE x 19 $
STATE SURCHARGE $
TOTAL:
$
I
CITY OF EAGAN
3830 PIIAT KNOS ROAD
EAGAN, MN 55122
PHONE: (612) 454-8100
FOR CITY USE ONLY
PERMIT # /
RECEIPT
DATE:
pg"nItCL;:` PI.EASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS &
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH IINIT.
-----------------°---
WORK DESCRIPTION
/
NEW CONST
ADD ON _
REPAIR
OWNER NAME:
SITE ADDRESS:?? ???JU?--???-?J??-' 1 •,\ f U
LOT: BLOCK SUBD.?C1F"Cl3.;c?C>?`-
INSTALLER:
ADDRESS: CI rJ?ti Ct,
CITY: ?F_ C:'. ?. .? ZIP: J?? ? Cf
PHONE #:
FEES
ADD-ON MININNM
HVAC 0-100 M BTU
ADDITIONAL 50 M BTU:
GAS OUTLETS - MINIMUM
OF 1 PER PERMIT
SUBTOTAL:
STATE SURCHARGE:
$15.00
24.00
6.00
3.00
.50
C(TMM??CIAI;JIT?7TS!US'?Et'Ii?+?::' PLEASE COMPLETE THZS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS,
_. .... . .... <
APARTMENT SUILDINGS, AND MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE
NOT REQUIRED FOR EACH DWELLING UNIT.
ZIP:
FEES
18 OF CONTRACT FEE.
STATE SURCHARGE - $.50 FOR
EACH $1,000 OF PERMIT FEE.
ODnrECCCfJ ?IPIN(„` - v25.00
$25.00 MINIMUM FEE.
CONTRACT PRICE x 18
STATE SURCHARGE
TOTAL:
$
$
(SIGNATURE)
CONTRACT PRICE:
OWNER NAME:
SITE ADDRESS:
LOT: BLOCK _ SUSD.
INSTALLER:
ADDRESS:_
CITY: _
PHONE
FOR: ?
CITY OF EAGAN,
mnmeT • ?70,
PERMIT #
[IlLGI)
CITY OF EAGAN
1992 BUILDING PERMIT APPLICATION
681-4675 AIAr a A RECO
SINGLE & MULTI-FAMILY 2 sets of 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 when typing of permit 9s requested, but not picked up by last working day
of month in which re uest is made or lot than e is re uested once ermit is issued.
Date _Qt&A, / ;t ?1- /lq Valuation of work '.nnt?x IDUO•pb
Site Address: 0 1`?a-(v (?-oo0.lo-o? ?T'?'. Lcc--Acc", MN 551?-?-
-
STkEET STE /
Tenant Name: (commercial only)
LOT _ u BLDCK _,_,l,_, SUBD. J
(i `,}?JC?YII P.I.D. M
Descri tion of work: a"t!M P(\ 0,+'\ a?CCt.e.d. Gj_C? ^' V`6" 04 ?0 ?D\L-j'
The applicant is: 1$[ Owner ? Contractor ? Other (Deseribe)
Name ?o?1r?S6Y1 PrAe.(' Phone 063'0`4?"3
Property LAST ?1v-nz: fIRS, CAVA'Sklne- (w) (oa(?- dBKCr
Owner Address 4 a ? r.
STR E SiE *
City E0.?0.n State MO Zip
Company N Phone
C017tf8Ct01' Address License # Exp.
City State ZiP
Company N /Or Phone
Architect/
Engineer Name Registration #
Address
City State Zip
Sewer & water licensed plumber Processing time 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:
IS
OFFICE USE ONLY
BUILDING PERMIT TYPE
O 01 Foundation ? 05 Apt. Bldg ? 09 Basement Finish
0 02 SF Dwg. O 06 Garage/Accessory ? 10 Swim Pool
? 03 Two family ? 07 Fireplace ? 11 Res. Add.
? 04 Multi-fam. T.H. ? 08 Deck ? 12 Res. Porch
WORK TYPE
•t •
l? ? ? ? • .
tew*
? 13 Comm/Ind ? 14 Comm/Ind Add
? 15 Comn/Ind Rem
? 16 Public Fac.
? 17 Agricultural
Vg 31 New ? 33 Alterations O 35 Move
? 32 Addition ? 34 Tenant Finish ? 36 Demolish
GENERAL INF ORMATION
Const. Actual) Basemen_ sq. ft.
' MWCC System
(Al?owable) lst F1. sq. ft. City Water
UBC Occupancy R-3 2nd F1. sq. ft. PRY Required
Zoning Sq. Ft. total Booster Pump
t of Stories Footprint Sq. ft. ' Fire Sprinkler
Length On-site well Census Code
Depth ?6t On-site sewage SAC Code
APPROVALS
Planning Building -!"L 9z Assessments
Engineering Variance
REQUIRED INSPECTIONS
? Site
? Wallboard
Footing
l? Final
0 Framing
O Draintile
-qT7
0 Insulation
? Fireplace
Permit Fee
Surcharge
Plan Review
License
FiWCC 3nC
City SAC
Mater Conn.
Mater Meter
Acct. Deposit
S/W Permit
5/W Surcharge
Treatment Pi.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
?
AS,Do r.iwc;an: s .
.SD
SAC %
SAC Units
'- Ceirtificate af Survey for:JOSEPN M. MILLER CC1NS
1c/,2?,APPALoosA TgAIg .?
?/ 86s,37 32
1 °?
?
v Denafes Exis
vD Den09?PS PrOf
- Dtno fcs l.7ron
-- UCnOlPS Ura/I
Dtnofe; ,4fonc
n---' . .
`Tjj. Z
, Elevations
? E/QVQf10/1S
' f tl/rlif y Fasemen1
t
a o ? ,?,,. ?
l op?
5(9'
yo513
PROPbSfD NOUSE Ei
Lowest rloor Eleva
rp o"elock E/evo;
Gara?e Slab E/eva?
?
CITY OF EAGAN PERMIT
PERMIT TYPE:
3830 Pdot Knob Road t; U I l u'l. Pd o
Eagan, Minnesota 55122-1897 Permit Number. P 3 R r 0 6
(651) 681-4675 Date Issued: O3!0 'l. / 9 9
SITE ADDRESS:
1426 Af'Pitl OQSt', 7H
I_ rl 1 ? I:> 9 I_ 0 C Y - 7.
SHEI1W001.; 70WN5
P. ]". N. : 7 0 - 67C,7 0 - 7 341-0 ]
DESCRIPTION:
?-? -f.0. & RFft00F
8ti v.(ld3nu, P rrrni.r_ 1'ypa
81, ilJinu W'Uy?E, i v'un:
t?ansii:: (:+7d.o 4
?
,
V ?
'_'('':7 F2 U'I D/Y t! A(7 F
IFPA] ti
n" i . r1E:71orrarlA L
REMARKS:
I .n aoottiuus: nWn rut. to sir,??!(; i,ar(n(;;=.
FEE SUMMARY:
CONTRACTOR: - nppli-r.ant - r? . L rc. pWNER:
6opt+i:a r,o,, itvc. rat_ontz cH rzts
915 MALCOLM AV£NUE SE APPAlUOSA 713
MlAINEAPOL],t M M 11S13 4 14 ?.h,i;RIV MN 66122
( 517_) 331-5 837 ?6=•1)6 HS-0 123
I I
1 harehu a cknoW.0 ciqv that I Pinv ee rea d th.S.e, q (acil.xca4lori ?nd ,T.;etcq thaC 1.11 ::
ininrmuLx 1r i? cor: ar1. .-_.i;i r.oree to comniq w n.YYi aonclc Staie oi i'ti,.
3L?ituCrU ?ar'id Gxt,! nf Ca qo t, OrGtria ncas.
APPLICANT/PERMITEE SIGNATURE
?`\??` IS UED BI?J?.VJI R?
PERRIIT X ? --1 -15 D
RECEIPT OATE. 10 - 1 -7 "cJ t
U.SIDENT[1hL PLUMBINfi PEf2M1T APPLICATION
CtTYOf £AfitkN
9$30 PILOT K,YO$ RD
EkfiA.Y, M.Y 55122
651 f 91-4675
Please complete for:
SITE ADDRESS:
OWNERNAME:: Illii??'??i?-/.G Dy?nu TELEPHONE#: vv ?P.3 • O?
(AREA CODC)
INSTALLER NAME: M24hecr) Zanre(5 INC • TELEPHONE #: 651 423 -3,730
/ ? ? (AREA CODE)
STREET ADDRESS 1t'Z??Q o rra -
CITY: A00'SeM0 1, rrf' STATE: ZiP: SS06y
Place a check mark next to the nermit work tvoe
?
I -
New residential dwelling unit under consUuction and not ownerJoccupied ?
s 90 00
?
'? Add-on, modification or alteration to existin dwelling unit, including: $ 50.00
I • abandonment of septic system
• new installation/repair/rebuild of RPZ ?
• lawn irrigation system
I • water tumaround ?
i
Nature of work: 3 i
i
Septic System, newlrefurbished - $ 225.00 ?
• indudes Ccunty 8 Cc^su'ting Inspeciar fees I
• requires MPC license
State Surcharge $ .50
Total $ 15-6. A2_
Reminder: Be sure to schedule inspections of alterations, i.e. water heaters, water softeners, etc.
I hereby acknowledge thaF I have read this application, slate that the information is cortect, and agree to comply wiih all applicable City of Eagan ordinances.
It is the applicanPS responsibility to notify lhe property owner that the City of Eagan assumes no liability for any damages caused by the City during its
nortnal operational and maintenance activities to the facilities consVUCted under this permit within City pro9erty/right•of-wayfeasement.
SIGNA'CURE OF PERMITTEE
single family dwellings
% townhomes and condos When permits are required for each unit
. backflow preventer for irri9ation system
Updated 1/Ot
r
Use BLUE or BLACK Ink
City of Eapll
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
For Office Use
Permit #:
Permit Fee:
Li 520
uo
Date Received: C'% J 5 J 15
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit #:
Resident/
Owner
Name: erta..1 C"-' V o t%134 Phone: Gs/ - 4'63 -b`/ Z?
Address / City / Zip: / V-2 6 4ff4` Cz T44/L
Applicant is: Owner d Contractor
Type of Work
Description of work: ,72-e- - s< "�
Construction Cost: 9, DUm - //! Xu'r Multi -Family Building: (Yes / No N/)
Contractor
Company: el2c4157--A/ Ek7-497r 5 Contact: ' `.- ?� v l'.2Al
Address: *.05 %r/vNe�3 ,t✓e 5 - City: 17ekt,11,:,fo,d
State: 74/`/ Zip: 5SO S Phone: hS/ 278'/Z b'
License #: ZC G 3373 /P Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
In the last 12 months,
_Yes No If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.orq
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
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 (Jfl/r'Ii✓S
4 v, nstxi
Applicant's Printed Name
Page 1 of 3
Use BLUE or BLACK ink
�-----------------
� For Office Use �
� � �� I
' i Permit#:� j
Clty of ����n � C�. �
� Permit Fee: 7 �
3830 Pilot Knob Road � I
Eagan MN 55122 � Date Received: j
Phone: (651)675-5675 i �
Fax: (651)675-5694 I Staff: I
I I
`�����_���������_J
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit#:
�� ,
�x � Name: ��'�1�' ��I(I�SO� � �h��S 1 ` � d n 7.� Phone:�OJ � �i �3 Q Q�3
����� �
� ��Resident/��� q � � �
�
� ,Owner'�` � Address/City/Zip: � �{ � (p �`1 D tD C'a 1 C�QS-Q.��r.
� � ,� �, �
}�_������`������,�;; Applicant is: Owner �Contractor �
���
`�a �'� ��� Description of work: � �f i1��� � �-�P �a���� + �C,� �
Type ofFWork :
� �
� � ��� � �� a� � �c� a
, Construction Cost: � Multi-Family Building: (Yes /No )
� ; � �� � i`,� �a v-Q �'L.f n t �
,�:� s `, Company: ��� � !�G'F�h f7���/ �1'Yl�Contact:
� � ' ' 3 q3� ,l.�ec��� � y � � �
� C�oritractor ��;' Address: �oo L� ��" cit : � �--��� S i'G✓ 1�-
����
�:� state� z�p: �54�-�Pnor,e�, �0 � ����i.►�;nr►-cG.Q�l�s� tuel(in�cinhorn�.
�4'1 G4 A � �.M r�ve_rr�n��C o m
�� , � License#: � Lead Certificate#:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
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:
NO.TE Plans antl,support�ng-documents that you sutimif are consralered to be public"�nfor"mat�on��Port�ons of ,'
thelinformat�on<may be;class�fred as non,=publ�c if,;you prov�tle spec�fic reasons�that wou/tl perm�t the�C�ty to �'
"`� �' ' t ;,�conclude thattheyare��raole;s.ec`r,ets, . ". '��",��;.� „` rR� ���" ' � , ,�
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.popherstateonecall.orct
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.
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.
�^�;� I71 �C� Y� X
ApplicanYs Printe Name Applicant's Signature
Page 1 of 3
�...�.�.,..�,.�>� ...._�_.�. .�.,...w_,.�,�rn,
��.�������.��� �������..
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA153450
Date Issued:12/19/2018
Permit Category:ePermit
Site Address: 1426 Appaloosa Tr
Lot:13 Block: 1 Addition: Sherwood Downs
PID:10-67670-01-130
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
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 -
Peter R Johnson
1426 Appaloosa Tr
Eagan MN 55122
Ray N Welter Heating
4637 Chicago Ave S
Minneapolis MN 55407
(612) 825-6867
Applicant/Permitee: Signature Issued By: Signature
.11(\
For Office Use
��
E AG N
s' i�b �.�., � Permit:e:' IIPermit I/
Date Received: !v 2 I CC_
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5675 I TDD: (651)454-8535 I FAX: (651)675-5694 � . , Staff: j
buildinginspections(a�citvofeaaan.com L
OCT 08 2019
2019 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 10/9/19 Site Address: 1426 Appaloosa Trail Unit#:
Name: Christine J Alonzi Phone: (651) 683-0423
1426 Appaloosa Trail Eagan, MN 55122
mer Address/City/Zip:
Applicant is: Owner ✓ Contractor I \Q—,
Type of!Fork
Description of work: Installation of a flush roof mounted solar array
t n
Construction Cost: 5359.00 Multi-Family Building: (Yes /No ✓ )
Company: All Energy Solar Contact: Isaac Lindstrom
Contractor'
Address: 1264 Energy Lane City. St.Paul
State: MN Zip: 55108 Phone: 651-842-9404 Email: isaac.Lindstrom@allenergysolar.com
License#: BC665819 Lead Certificate#:
if the project is exempt from lead certification, please explain why:
LESS THAN 6 SQFT DISTURBED
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:
Fire Suppression Contractor: Phone:
NOTE:Pians and supporting documents that you submit are considered to,be public Information Portions oft o information maybe
ctassilleGiai rtonlrrbllc H you provide specific reasons that would permit the City to conclude that theists hada secret
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at www.citvofeaoan.comisubscribe.
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.
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.gooherstateonecall.orq
I hereby acknowledge that this information is complete and accurate;that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
x Isaac Lindstrom a � of
Applicant's Printed Name Applicant's Signature
•
UA-if Tom , l �'S `7�
DO NOT WRITE BELOW THIS LINE ��
SUB TYPES
_ Foundation _ Fireplace —
Porch(3-Season) _ Exterior Alteration(Single Family)
XSingle Family _ Garage _ Porch(4-Season) _ Exterior Alteration(Multi)
Multi _ Deck _ Porch(Screen/Gazebo/Pergola) _ Miscellaneous
01 of_Plex _ Lower Level _ Pool _ Accessory Building
WORK TYPES
New _ Interior Improvement _ Siding _ Demolish Building*
_ Addition _ Move Building _ Reroof _ Demolish Interior
XAlteration _ 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 r rMCES System
Plan Review / Code Edition Wt.,I II.SAC Units
(25% 100%g ) Zoning City Water
Census Code JJJ��� Stories Booster Pump
#of Units Square Feet PRV
#of Buildings / Length Fire Suppression Required
Type of Construction IS
Width
REQUIRED INSPECTI•NS �✓
Footings(New Building) Meter Size:
Footings(Deck) Final/C.O. Required
Footings(Addition) 4 Final/No C.O. Required
Foundation Foundation Before Backfill HVAC_Service Test Gas Line Air Test_Hood
Roof:_Ice&Water _Final Pool:_Footings Air/Gas Tests _Final
Framing f 30 Minutes 1 Hour _ Drain Tile
Fireplace:_Rough In Air Test _Final Siding:_Stucco Lath _Stone Lath _Brick_EFIS
Insulation Windows
Sheathing Retaining Wall:_Footings_Backfill_Final
Sheetrock Radon Control
Fire Walls Fire Suppression:_Rough In_Final
Braced Walls Erosion Control
Shower Pan Other:
Reviewed By: 1-'2 , Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge ,50/4 1`
Plan Review
MCES SAC
City SAC
f-P-1-3 ,
Utility Connection Charge
R
S&W Permit&Surcharge
Treatment Plant
Copies /
TOTAL
Page2of3
1
o�
10
i
i
% •.vO
EAGAN
3830 PILOT KNOB ROAD 1 EAGAN, MN 55122-1810
CEIVE
buildinginspections(7a cityofeagan.com
(651) 675-5675 I TDD: (651) 454-8535 I FAX: (651) 675-5694 '�� p 1 5 2020
r
For Office Use
to 11 A �, .11
Permit #: / P
Permit Fee: " 39
Date Received: t� —'�- .1)1
Staff:
r
2020 RESIDENTIAL BUIEbING-PERMIT APPLICATION
Date: 4-15-&-zu Site Address: I M26 Appwi..aosx Tie..
J
Unit #:
Resident)
Owner
Name: GNiizs ALPAJZZ PeT7ft '3o HN Sorel Phone: (9I1- IRO- 1I1 l9
Address / City / Zip: 1 y2.b AK1►c.cws4 Ta. P.AGA; NN Sst2L
Applicant is: Owner 'iG Contractor I' 1 Skat6000k,
(10/]
Type of Work
Description of work: kwrc.tiou Q,eruoA (
Construction Cost: , (eor yt't. (oe Multi -Family Building: (Yes / No k )
Contractor
Company: CiteA7 AletTrtfjW 'Sza.A aLs Contact: N hie
Address:33z.•0 Tr�i dawutt.. DE City: CACouu
State: P40 Zip: Um l Phone:l.St- NSf-1S i t Email: rtem.1R.. !_'we.,n.c.awt
License #: gc4.31.—INSLead Certificate #: WAN- t O3 I. 9 i—a
If the project is exempt from lead certification, please explain why:
L Z(.-1 h -r 4141
COMPLETE THIS AREA ONLY IF CONSTRUCTING A
In the last 12 months, has the City of Eagan issued a permit for a similar plan based
Yes No If yes, date and address of master plan:
NEW BUILDING
on a master plan?
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Fire Suppression Contractor:
Phone:
Phone:
Phone:
Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of the information may be
classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets.
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at www.citvofeagan.com/subscribe.
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.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. CaII 48 hours before you
intend to dig to receive locates of underground utilities. www.qopherstateonecall.orq
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approv ofiplans.
x N41 er azi--st ../
Applicant's Printed Name
x
Applicant's Signatur
DO NOT WRITE BELOW THIS LINE
SUB TYPES
Foundation
Single Family
Multi
01 of Plex
WORK TYPES
New
Addition
Alteration
_ Replace
Retaining Wall
DESCRIPTION
Valuation
Plan Review
(25%_ 100%_)
Census Code
Fireplace
Garage
Deck
Lower Level
/4-(& Affi4 I c o si)
/ Interior Improvement
Move Building
Fire Repair
Porch (3-Season)
Porch (4-Season)
Porch (Screen/Gazebo/Pergola)
Pool
Siding
Reroof
Windows
_ Repair Egress Window
# of Units
# of Buildings
Type of Construction .5
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
REQUIRED INSPECTIONS
Footings (New Building)
Footings (Deck)
Footings (Addition)
Foundation Foundation Before Backfill
Roof: _Ice & Water _Final
Framing 30 Minutes 1 Hour
Fireplace: _Rough In _Air Test _Final
Insulation
Sheathing
Sheetrock
Fire Walls
Braced Walls
Shower Pan
Reviewed By:
S b°
Exterior Alteration (Single Family)
Exterior Alteration (Multi)
Miscellaneous
Accessory Building
Demolish Building*
Demolish Interior
Demolish Foundation
Water Damage
*Demolition of entire building — give PCA handout to applicant
R - ( MCES System
%zz Z0 26 SAC Units
City Water
Booster Pump
14 9 O PRV
Fire Suppression Required
Meter Size:
Final / C.O. Required
Final / No C.O. Required
HVAC _ Service Test Gas Line Air Test _ Hood
Pool: _Footings _Air/Gas Tests _Final
Drain Tile
Siding: _Stucco Lath _Stone Lath _Brick _ EFIS
Windows
Retaining Wall: _ Footings _ Backfill _ Final
Radon Control
Fire Suppression: _Rough In _Final
Erosion Control
Other:
, Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Radio Meter Read
Copies
TOTAL
If 430
a °
Page 2 of 3
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA163005
Date Issued:08/10/2020
Permit Category:ePermit
Site Address: 1426 Appaloosa Tr
Lot:13 Block: 1 Addition: Sherwood Downs
PID:10-67670-01-130
Use:
Description:
Sub Type:Residential
Work Type:Alteration
Description:Fixtures
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.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Fee Summary:PL - Permit Fee (miscellaneous)$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 -
Peter R Johnson
1426 Appaloosa Tr
Eagan MN 55122
Wenzel-plymouth Plumbing & Heating
1959 Shawnee Rd, Suite 130
Eagan MN 55122
(651) 452-1565
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA165197
Date Issued:10/22/2020
Permit Category:ePermit
Site Address: 1426 Appaloosa Tr
Lot:13 Block: 1 Addition: Sherwood Downs
PID:10-67670-01-130
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Standard Water Heater & Water Softener
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 -
Peter R Johnson
1426 Appaloosa Trl
Saint Paul MN 55122--382
(651) 683-0423
Bonfe's Plumbing & Heating
455 Hardman Ave
South St. Paul MN 55075
(651) 228-7140
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA177085
Date Issued:06/15/2022
Permit Category:ePermit
Site Address: 1426 Appaloosa Tr
Lot:13 Block: 1 Addition: Sherwood Downs
PID:10-67670-01-130
Use:
Description:
Sub Type:Fixtures
Work Type:Alteration
Description:Bathroom(s)
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.
All tiled shower bases require a water test.
Fee Summary:PL - Permit Fee (miscellaneous)$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 -
Peter R Johnson
1426 Appaloosa Trl
Saint Paul MN 55122--382
Wenzel Plymouth Plumbing & Heating Llc
1959 Shawnee Rd, Suite 130
Eagan MN 55122
(651) 452-1565
Applicant/Permitee: Signature Issued By: Signature