3230 Black Oak Dr
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. ? ? INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE:
3$30 Pilot Knob Road Permit Number:
Eagan, Minnesota 55123 Date Issued:
(612) 681-4675
SITE ADDRESS: APPLICANT:
PERMIT SUBTYPE: ., TYPE OF WORK:
F
L
?
Permtt No. Permit Holder Date Telephone #
S/W
PLUMBING
HVAC
ELECTRI
ELECTRIC
Inspection Date ? Insp. Comments
Footings I Yl`iy /p
z? c
Foundation
Framing All
Roofing
Rough Pibg.
Rough Htg.
/0?(
Isul.
`
Fi replace
Final Htg.
Orsat Test r
Final Plbg. f/?
_? Plbg. Inspector- Notify Plumber
Const. Meter
Engr./Plan
Bldg. Final ,
Deck Ftg.
Deck Final
Well
Pr. Disp.
5 a9-y 1 ,4?
.?"/3 y' nd ?
?`
'
N ., 2 3 ? ? (lit,, _
7
7
Request Oate Fire No. Rough-In Inpseclion Required
(Vou must eall inspeclor when ready) Inspection Other Than Rough-In
? qeady Now ? Will Notily Inspector
0' Ves ? No Date Read
Iicensed contractor D owner hereby request inspection of above electrical work at:
Job Address (Str t. Box or ute No.)
?a?
1 • City ?,
.
Section No. ._
Township Name or No. Range No. C
i
Oc pant IPRINT)
' '? Phone No.
`A `(.G,
Power Suppher Address
Electnc Contractor (Company Name) Contractor's License No.
A C.-) (D 9
Madhng Address ?Contractor or r Mak,ng Instailation)
???
?
1J 1 J Ldw'?-
• ? {?
zed Signature (Contractor?Owner Mak?ng Instail tion?
? ? 5? a LI
rT
Phon umber
` a' c C? ?(a
MINNI[SOA STATE BOARD OF ELECTRI Y THIS INSPECTION REQUEST WILL NOT
Griggs-Midway Bldg. - Room 5-173 BE ACCEPTED 6Y 7HE S7A7E BOARD
1821 University Ave., St. Paul. MN 55704 UNLESS PROPER INSPECTION FEE IS
Phone (812) 802-0800 ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION ee-00001 -08
/ ? Ses i,rucums br completing this torm on back of yellow copy.
11 32938 "X" Be/ow Work Covered by This Requesi
e4v Adti r.'avp- T Ap pliancesWired EquipmeniWired
Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Load Management
iCommJlndustrial Fumace Other (Speciiy)
? I Farm Air Conditioner
Other (speciry) Contractor's Remarks'
r-T -
--
Compute lnspection Fee Below:
# Other Fee # Service Entrance Size Fee # Cirouits/Feeders Fee
Swimming Pool
Transformers ?
SIgf1S 0 to 200 Amps 0 to 100 Amps
Above 200 Amps Above 100 Amps
Inspector5 Use Only: /?
`TOL
_
Irrigation Booms ?
`?
?
Special Inspection
Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 HS. :
I, the Electrical Inspector, hereby
i
h
h Rough-in /f ' afe ?
t
at t
cert
e above ins ection has
? p
been made.
Final
oate,
OFFICE USE ONLY
This request void 18 months from
?S`' y?,???
FI • i
Wel.'nftCQ#e nf cCC1tpQliC?
Wit4 of Wagan
Zepartateat af exitiiug 3nf3p¢ction
This Cenificate issued pursuant to the requirements of the Uniform Building Code
certifying that at t/ie iime of issuance this srructure was in compliance with the various
orrlinances of the City nguluting building constntction or use. For the followin,q:
Use Classification: SF DWG Bidg. Yermit Nu. 232C)7
pccvpancy Type RUN Zoaing District RI Type Const. VN -
o,,,or e,iiaj,g TEIE WIBIDWOOU rJWANY IM a&h,,j. P.O. BOX 2432q, APPiE VAiIEY
s,iai,g naa,= 3230 BLAaOYaAK D?tiVE L;VLb, B8, P8[t QAiC HIILS 2N1ID
Dazc_
Building Official `
POST IN A CONSPICUOUS PLACE
?adress 3230 mLACx oAK nxIvE Zip 5512 1
Lo, . ?
t. 6 Blk 8 Sub s[nt oAx HnLs 2ND
THESE ITEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECTION.
Date: 01(Olf Yes No Inspector:
Final grade (6" from siding) V--1,
Permanent steps (garage) ?
Permanent steps (main entry)
Permanent driveway j/
Permanent gas
Sod/Seeded gass ?
TraiUcurb 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.
Contact engineering division at 681-4645 before working in right-of-way or installing underground sprinkler system. ?
White - City Copy Yellow - Resident Copy Pink - Contractor Copy
i'00T I IJi"i', ? l?iMtihlDA t t{i?t =3
?P AM1. Wt HOF1F 1:MFi
INS1# #- A 1 [ iA hi f I k t. I I I At: E
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?E *S. P? NmAft am 7dapfA9Cl6 $
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Finel Pltrg, W@g. tr?pg?t?r ?&doidp PIuffftY
COW. M?Cer
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?eck Final
WeR
Pr. Risp.
1994 PLUMBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3834 PILOT KNOB RD
EAGAN MN 55122
(612) 6814675
PLEASE COMPLETE FOR SiNGLE FAMILY DWELLINGS. ALSO, FOR TOWNH4MES AND
COND4S WHEN PERMITS ARE REQUIRED FQR EACH UNIT.
NO. FIXTURES F.ACH TOTAL
SHOWER 3.00
.._.L__. WATEP. C? QcET 3.00 :3. ao
BATH TUB 3.00 S. ck,
LAVAT4RY 3.00 .2. o0
? KITCHEN SINK 3.00 3_oD
LAiTNDRY TRAY 3.00 3_ 00
HOT TUB/SPA 3.00
? WATER HEATER 3.00
FL44R DRAIN 3.00 3. ao
GAS PIPING OUTLET 3.00
.?? ROUGH OPENINGS 1.50
WATER SOFTENER 5.00
PRIVATE DISP. • DeLcXy. uc. 20.00
U.G. SPRINKLER • hom undw oona. 3.00
ALTERATIONS ? to «iaung 20.00
WATER TURN AROUND 20.00
STATE 5URCHARGE .50
TOTAL:
SITE ADDRESS: 3--)30 04J-04? 66tx_
OVJNER Np.llM: (,11 r ? ?r??. ??s
INSTALLER:__
CITY: STA1"E: 1)) IJ ZIP CODE: SSb a
PHONE #: ?1?-3- 373n
SIGN OF PERM E
r
1"4 pLUMMnvc pExMrr (coAUKRCrAL)
crIY oF EaGAv
3834 PILUT KNOB RD
EAGAN MN 55122
(512) 581-4675
PLEASE COMPLETE FOR ALL COMMERCIALJINDUSTRIAL BUII,DINGS. ALSO FOR MULTI
FAMILY BUILDINGS WHEN SEPARATE PERMTTS ARE NOT REQUIRED FOR EACH
DWELLING UNIT.
NEW CONSTRUCTION
ADD ON
REPAIR
woRK nESCRIMorr:
corr°rRacT pRIcE: $
FEM 1% oF coxTxACr r-EE.
STATE SURCHARGE: $.50 FQR EACH $1,000 UF .. FEE.
MIINIMUM FEE: $ 25.00 .•? ?`.'"?
CONTRACT PRICE X 1°fo
STATE SURCHARGE
T4TAL
SITE ADDRESS:
$
$
$
TENANT NAME: STE. #
OWNER NAME:
INSTALLER•
ADDRESS•
CITY:
PHONE #:
STATE: ZIP CODE:
FOR:
CITY OF EAGAN APPLICANT
y
Y
PLEASE COMPLETE FOR SINGLE FAMII,Y DWELLINGS. ALSO, FOR TOWNHOMES AND
CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
-------- ?---------------------------------------------------------- ..._------------ _ ----
NEW CONSTRUCTION
P,DD-Or: RJC
ADD-ON FURNACE
FIREPLACE INSER
DATE
HVAC: 0-100 M BTU
ADDITIONAL 50 M BTU
GAS OUTLETS (MINIMUM 1 @ $3.00 EACH)
ADD-ON/REMODEL (ExISTING CONSTRUCTioN)
STATE SURCHARGE
TOTAL
srrE aDDxESS: . 32:53,30 &ac4t 4a4?- I F? .
t7WNER NAME:
INST
CITY: ' STATE:
TELEPHONE #:
FEES
$ 24.00
6.00
?
$ 20.00
.50
#: &/- ?? oiz `"
.. /!17e__
ZIP CODE:
SIGNATURE OF
1994 MECHANICAL PERMIT (RESIDENI7AL)
CITY OF EAGAN
3834 PILOT KNOB RD
EAGAN MN 55122
(612) 6814675
1"4 MEcaaxtcaL pExMrr (coMMMcUL)
CITY OF EAGAN
3830 PII.OT KNOB RD
EAGAN MN 55122
(612) 6814675
PLEASE COMPLETE FOR ALL COMMERCWUINDUSTRIAL BUILDINGS. AISO COMPLETE
FOR APARTMENT BUILDINGS OR OTHER MULTI-FAMILY BUILDINGS WHEN SEPARATE
PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT.
DA'TE:
CONTRACT PRICE: $
NEW BUII.DING
IlVTERIOR IlVIPROVEMENT
WORK DESCRIPTION:
FEES
1% OF FPN'`.?'.?,;_?FEE $
PROCESSED PIPING: $25.00
MINIMUM FEE: $25.00
STATE SURCHARGE $.50 FOR EACH $1,000 OF FEE.
TOTAL $
Si I E ABDRE SS:
4WNER NAME: 1'ELEPHONE #:
TENANT NAME: (MPROVEMENTS ONLY)
INS'!'AI„LER:
ADDRESS:
CITY: STATE: ZIP CODE:
TELEPHONE #:
SIGNATURE OF PERMITTEE CTTY INSPECTOR
X CITY OF EAGAN
. 3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
PERMIT
PERMIT TYPE:
Permit Number:
Date Issued:
BUi(IDII 023297 ?
04/13/94
SITE ADDRESS:
P.I.N.e 10-15501-060-08
3230 BLACK AAK DR
LOTs 6 BLOGK: 8
BUF2 pAK HILLS 2ND
DESCRIPTION:
Building Permit Type SF DWG
Building Wnrk Type NEW
UBC Qccupancy R-3 M-1
ConStruction Type V-N
Zoning R-1
Building Lsngth 59
Building Width 46
Bui.iding staries 1
.
REMARKS:
S& W PLBR -- DRESHER EXCRVATIN6
FEE SUMMARY:
VALUATION
Base Fee
Plan Review
Surcharge
SAC
SAG %
sac ur,its
subtotal
$594.50
$386.43
$45.00
$800.00
100
1
$1,825.53
$90,@00
MISCELLANEOU5 11,828.50
Tntal Fee $3,654.43
CONTRACTOR: - Appi i c a n t- sr . L I C. pWNER:
WINDWOOD CO INC 18914605 0002197 THE WINDWOOD CO IMC
P 0 BpX 24329 P 0 BOX 24329
APPLE VALLEY MN 55124 APPLE VALLEY MN 55124
(612) 891-4605 (512)891-4605
I hereby acknowledge that I have read this application and state that the
infarmatian is correct and agree to compl.y with all applicable State of Mn.
Statutes and C.ity afi Eagan prdinances.
?.
P T/PERMIT SIGNATURE ? SUED ? B: 6,01A
SI NATU?
_ IS
qp ?
REACTIVATE
K-RMIT I , j
23 miq 11
cirY oF EaGAN
19W BUiLDING PERMIT
04 681-4675
moltA _
APPLICATI?
?i661
42 $ 0 Sdd
(, ? ?, ?,.
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, l capy of energy
calcs.
COMMERCIAL 2 sets of architectural & structural plans, I set af
specifications, 1 copy of energy calcs.
Penalty applies: 1) when permit is typed, but not picked up by last warking day of manth
in which request is made, 2) address is changed ar 3) lat thange is requested once permit
is issued.
Da;te 4 94" Val uati on of work
Site Address:32-3c) RtA,,L QA1Z-
StREET SU[TE #
Tenant Name: (commerciai only)
LOT Gf BL(!C& ? SUBD. n•? ??A?
PJI/ ?f?-. P. T. D.? .
pescri tion of work: '-0J
The appl i cant i s: Qwner Contractor ?Oth@1" .(Descr.ibe)
Name Phone
Property LAST FIitST
Qwner The wri?xfwwd Company, Wc.
Address 12 , n Q..,. 04329 -
5TPfjf* Vday, MkmBM 65124 STE 0
c;ty state zip
Company _ Phone
Gontractor Addres5 License # Exp.
City StaLe Zip
Cocnpany Phane
krchitect/
EflgiflCEt' Name Registration #
Address
City State ZiP ,
Sewer & water licensed plumber ??W+'nA& . Processing time for
sewer & water permits is two days ance area has been approved.
I fiereby acknowledge that I havad this a lication and state that the informatian is
correct and agree to comply wi al tate of Minnesota Statutes and City af
Eagan Ordinances.
Signature of Applicant:
?
OFFICE USE C?NLY
BUILDING PERMIT TYPE ? Ol Foundat i on O 05 Duplex ? 11 Apt. jLodgi ng
El 02 5F Dwg. ? 07 4-P7ex E3 12 Mu1ti. Misc.
? 03 SF Addition ? 08 8-Plex ? 13 Garage/Accessory
? 04 SF Porch D 09 12-Plex ? 14 Fireplace
? 05 5F Misc. ? IO Multi. Add'1. ? 15 Deck
WORK TYPE
0 31 New ? 33 A1terations ? 35 Tenant Finish
0 32 Additian ? 34 Repair ? 36 Move
GENERAL INFORMATION
,
?
.?
'sh
O Swim Popl
E3 18 Conm.JInd.
? 19 Comm./Ind. Misc.
? 20 Pubiic Facility
? 21 Miscellanenus
? 37 Demolish
Const. (Aetual)
All
bl ?? Basement sq. ft. /9?
l
t F1
f MWCC System
Cit
W
t
owa
e)
6 .
? s
. sq.
t. ? y
a
er
UBC ccupancy ,
?;-.? h•?-/ 2nd Fl. sq. ft. PRV Required
Zoning ?-/ Sq. Ft. total Booster Pump
# of Stories 1 Footprint Sq. ft. ? ?'ire Sprir?kler
Length z,.ra On-site we11 Census Code ?
Depth On-site sewage SAC Code ?
APPROVALS
Planning Building . Assessments
Engineering . Variance
REQUIRED INSPECTiONS
D Site
? Wallboard
0 Footing
ER Final
@ Framing
? Draintile
-a Insulation
? Fireplace
Permit Fee
Surcharge
Plan Review
License
MWCC SAC
City SAG
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1..
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total :
SAC %
SaC Units
vatustion:
z7P
2oky - ??
1l ')z?-?
,
APR 07 194 13: 31 TO 8915674 FROh1 F'ROBE EMG I hJtER I NG T-926 P. 03
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1004 EABT 148Ih STRCEY, eURNSvtLl.E, hltNliE80TA 56337 PFi 432-3000
CERTlFICATE OF SURVEY
Leval` Descri tion; 4471, A = u 4 o•v
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ri CKIKK) QENOTES EXiST{NG ELEVATION
( 89'7 ? z) QENt)TES PROPO$ED ELEVATION
?-- INDICATES DlRECT113M QF SURFACE URAINAGE
8 7•S'd +? FINISHED GARAt3E FLt3QR ELEVATION
Offlt 79 m gq$eMEXVT FLOOR ELEVATION
897. 8 n TQP QF Fi)UNDA?TfCIhE ELEVATION
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: hereby aertify that tilis ia a true and oorreat reprssentation af a tract of
.en an shvwn and demortbed hereQn. As preparecd by me this 7"? -- day of
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Registerec! Lsad zurveyor s3qriaturo sr,d compariy
Svildinq Permft Applicant
Ireqal deQerigtion .
11ddras•
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Houss type (ramblsr. ?,ralkout, split r/o, split
ra
loakout. atc.)
Direct#oaal drainaqa arrows vith slcgefqrsdisnt t.
Proposed/existinQ ssvss and vater setv3ass
btsset name - Drivsvay
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structures requtrirQ permaneat =ootings)
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� For Office Use j
C�� (�f��] (j'(� I Permit#:�l � ! / �`� �
y Ul Q�QII �
�`_. � ;
� Permit Fee:
3830 Pilot Knob Road � �
Eagarl MN 55122 , I Date Received: �
Phone: (651) 675-5675 ' I I
( � � staTf: �
Fax: 651 675-5694
��������.���������J
2015 RESIDENTIAL PLIaMBI(VG PERMIT APPLICATIO(�
��
Date: Site Address: � � " �� [ ,����
Tenant: Suite#:
��
�,.�e�iC��e11,.�4� Name: '�l Phone: lU,�� d- �-`�'� �`���
Address/City/Zip: r
_;;� �-��1. �'►n� .���/
K�°` ���� ���`° �� � � � 1t�lilbert Corr�pany�Inc dba Culligan�Nater� � WC641376�
Name: - License#:
� ���,��tQ qaa�ess. ��18�1 SO�h St East c�ty: Inver Grove Hgts.
� state: Mn Z�p; 55077 Phone: 651-451-2241'
�: �
� Contact: W1111aYY1 R M11bePt
= EmaiL•
G�.� _New �Replacement _Repair _Rebuild Modify Space Work in R.O.W.
�. — —
Description of work:
a��
RESIDENTIAL
a i��� Water Heater
Lawn lrri ation ,,�Water Softener .
o,� � 9 (_RPZ/_PVB)
Septic System Add Plumbing Fixtures�Main/_Lower Level)
,�
�
_New Water Tumaround
� _Abandonment
RESIDENTIAL FEE�:
$60.00 Water Heater,Water Softener,or Water Heater and Softener(includes$5.00 State Surcharge)
$60.00 Lawn Irrigati0n(includes$S:OO minimum State Surcharge)
$60.OQ Add Plumb�ng Fixtures, Septie Svsterri Aban�onment,Water Turnaround*(includes$5.00 State Surcharge)
*Water Tumaround(add$200.00 if a 5/8"meter is required)
$115.00 Septic Svstem New($10.00 per as built)(includes County fee and$5.00 State Surcharge) /�
TOTAL FEES$ �/ D O
CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www.qopherstateonecall.or4
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(n the case of work which requires a review and approval of plans.
, X !� ,��
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Applicant s rinted Name ApplicanYs Signa re
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t � C�m,
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA137431
Date Issued:07/05/2016
Permit Category:ePermit
Site Address: 3230 Black Oak Dr
Lot:6 Block: 8 Addition: Bur Oak Hills 2nd
PID:10-15501-08-060
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
Census Code:434 -
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: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 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 -
Craig W Gieselman
3230 Black Oak Dr
Eagan MN 55121
Renewal Andersen
1920 County Road C West
Roseville MN 55113
(651) 264-4777
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA164803
Date Issued:10/08/2020
Permit Category:ePermit
Site Address: 3230 Black Oak Dr
Lot:6 Block: 8 Addition: Bur Oak Hills 2nd
PID:10-15501-08-060
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 -
Craig W & Catherine A Gieselman
3230 Black Oak Dr
Eagan MN 55121
(612) 242-8915
Rji Professionals Inc
6063 Main St Suite F
North Branch MN 55056
(651) 674-5158
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA171497
Date Issued:08/18/2021
Permit Category:ePermit
Site Address: 3230 Black Oak Dr
Lot:6 Block: 8 Addition: Bur Oak Hills 2nd
PID:10-15501-08-060
Use:
Description:
Sub Type:Siding & Windows/Doors
Work Type:Replace
Description:
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of house wrap and leave on site for 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.
Valuation: 10,000.00
Fee Summary:BL - Base Fee $10K $191.75 0801.4085
Surcharge - Based on Valuation $10K $5.00 9001.2195
$196.75 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 -
Craig W & Catherine A Gieselman
3230 Black Oak Dr
Eagan MN 55121
(612) 242-8915 X1
Rji Professionals Inc
26583 Forest Blvd
Wyoming MN 55092
(651) 674-5158
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA176134
Date Issued:05/03/2022
Permit Category:ePermit
Site Address: 3230 Black Oak Dr
Lot:6 Block: 8 Addition: Bur Oak Hills 2nd
PID:10-15501-08-060
Use:
Description:
Sub Type:Underground Sprinkler System
Work Type:New
Description:
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 - RPZ/PVB/Lawn Irrigation $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 -
Craig W & Catherine A Gieselman
3230 Black Oak Dr
Eagan MN 55121
(612) 242-8915
Cedar Plumbing Llc
20612 Monroe St NE
Cedar MN 55011
(763) 753-3464
Applicant/Permitee: Signature Issued By: Signature