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3935 Blackhawk Rd
PERMIT City of Eagan Permit Type: Building 3830 Pilot Knob Rd Permit Number: EA089157 Eagan, MN 55122 . Date Issued: 05/13/2009 (651) 675-5675~~~ EPermit Category: ePermit www.ci.eagan.mn.us lflflUl tflflLLL Site Address: 3935 Blackhawk Rd Lot: 55 Block: 6 Addition: Cedar Grove 6th PID 10-16705-550-06 Use Description: Sub Type: e-Reroof Construction Type: Work Type: Replace Description: House Census Code: 434- Occupancy: Zoning: Square Feet: 0 Comments: If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar. Pictures are not acceptable in lieu of inspections. Carbon monoxide detectors are required by law in ALL single family homes. Fee Summary: BL - Base Fee $3K $88.50 0801.4085 Surcharge - Based on Valuation $3K $1.50 9001.2195 Valuation: 3,000.00 Total: $90.00 Contractor: -Applicant - Owner: Lindus Construction Daniel Simon 879 Hwy 63 3935 Blackhawk Rd Baldwin WI 54002 Eagan MN 55122 (715) 684-4647 I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Applicant/Permitee: Signature Issued By: Signature r„-s} CITY OF EAGAN 3795 Pilot Knob Road Eagan, MN 55122 N4 5 57 PHONE: 454-8100 I` BUILDING PERMIT Receipt # To be used for Est. Value Date 19 Site Address Erect d Occupancy Lot Block Sec/Sub. Alter Zoning Parcel # Repair ❑ Fire Zone Enlarge ❑ Type of Const. W Name Move ❑ # Stories 3 Address Demolish ❑ Front ft. City Phone Grade ❑ Depth ft. p NameC .X 'c Approvals Fees i Address (3$ t Fa-S ~e r l i W sK,.ment Permit city hone 34QVater & Sew. Surcharge Police Plan check vW Name Fire SAC u~ Address Eng. Water Conn. ,C. City Phone Planner Water Meter Council hereby acknowledge that I have read this application and state that Bldg. Off. the information is correct and agree to comply with all applicable APC Total State of Minnesota Statutes and City of Eagan Ordinances. Signature of Permittee A Building Permit is issued to: on the express condition that all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official 7 Permit # - 1fe luu d Parmittee Plumbing 6, 17 1 ~d d P UV ~f fr Mechanical T ' ~cC9• S 37~~ 4-2~- ~ xf INSPECTIONS DATE INSP. Rough-In Final Footings Dote Insp. Date Insp. Foundation Plumbing Frame/ins. -75 Mechanical Final Remarks: f ` 7~ CITY OF EAGAN Remarks Sew & wtr permits and sew 00m, -pd.. on 3-17.69 Addition Cedar Grove Lot 55 Blk 6 Parcel 10 16705 550 06 Owner r T Street 3935 Blackhawk Rd. State Eagan,MN 55122 Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. to z, 1971 1060.15 1 .02 10 Paid STREET RESTOR. GRADING SAN SEW TRUNK SEWER LATERAL 7 1970 1472.00 20 Paid WATERMAIN 3 WATER LATERAL 1970 20 WATER AREA 3E STORM SEW TRK 1970 20 STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. 200.00 1262 3-20.,69 BUILDING PER. SAC 1 200.00 1262 3-2o-69 PARK EAGAN TOWNSHIP . 1960 BUILDING PERMIT N0 Owner ...&Vtl_L..., t n`!_._..6141. Eagan Township Addr (present) Town Hall Build r Date 3~................... Addr DESCRIPTION Stt To Be Used For Front Depth Height Est. Cost 'Permit Fee Remarks " LOCATION Street, Road or other Description of Location I Lot Block Addition or Tract 3 This Permit does not authorize the use of streets, roads, alleys or l sidewalks nor does it give the owner or his agent the ri ht to create any situation which is a nuisance or which presents a hazard to the health, safety, convenience and general welfare to anyone in the community. THIS PERMIT MUST BE KEPT ON THE PREMISE WHILE THE WORK IS IN PROGRESS. This ' !o certify, that.._±"'4. ? ...._..has permission to erect a.... f~.W.---...-upon the above described premise subject to the provisions of the Building Ordinance for Eagan Township adopted April 11. 1855 hi Per ....=u &hait, of~Board Building Ins r This request void 18 months from ~ --y 9 g Date of this Request 6 / ~o 9 4 U 6 5 I, as ,Licensed Electrical Contractor ❑ Owner, do hereby request inspection of the above electri- cal wrong installed at: -01 Street Address or Route No. City Section Township Range County Which is occupied by (Name of Occupant) Is a roughin inspection required on this job? No~ Yes El Ready NowX Will Call 0 Power Supplier j ddress~ Electrical Contractor Contractor's License No. (Company Name) Mailing Address G (Ele is ontrac o wner Making This Installation) Authorized Signature Phone No. 'ror, (Electrical Contractor or owner Maki hIs Installation) gpopy STATE BOARD This inspection request will not be accepted by the State Board unless proper inspection fee is enclosed. Minnesota State Board of Electricity 1954 University Ave., St. Paul, Minn. 55104-Phone 645-7703/~~ - REQUEST FOR ELECTRICAL INSPECTION CfJECK BELOW WORK COVERED BY THIS REQUEST I~ 94065 Type of Building New Add. Rep. Check Appliances Wired For Check Equipment Wired For Home ❑ ❑ Range ❑ Temporary Wiring ❑ Duplex ❑ ❑ ❑ Water Heater ❑ Lighting Fixtures ❑ Apt.,Uldg. ❑ ❑ ❑ Dryer ❑ Electric Heating ❑ Commercial Bldg. ❑ ❑ ❑ Furnace ❑ Silo Unloader ❑ Industrial Bldg. ❑ ❑ ❑ Air Conditioner ❑ Bulk Milk Tank ❑ Farm ❑ ❑ ❑ List List Other E3 ❑ ❑ Rehr Hereers COMPUTE INSPECTION FEE BELOF' 'I Service Entrance Size: # Fee F eeXrs&1, fee ee Circuits: # Fee 0 to 100 Amps. 0 to 30 Amperes 0 to 30 Amperes 101 to 200 Amps. 31 to 100 Amperes 31 to 100 Amperes Above 200 Amps. Above 100 Amps. Above 100 Amps. Transformers Remote Control Circ. Partial or other fee Signs Special Inspection Minimum fee Remarks TOTAL FE /0. 1, the Electrical Inspector, hereby certify ~ e ab6'e ection as been made. r (Rough-in) ` ~r ; mate 7` (Final) o Date f ? This request void 18 months from This request void 18 months from _4 f-7 37269 Date of> Request I, as tT Licensed Electrical Contractor 0 Owner, do hereby request inspection of the above electri- cal wiring installed at: . f Street Address or Route No. tu Il ZV City < y-- , ' Section Township Range Count r Which is occupied by , V (Name of Occupant) Is a roughin inspection required on this job? No ❑ Yes ❑ Ready Now Ell"'. Will Call ❑ Power Supplier --e Address 37 7 Electrical Contractor ~ 4 ek_ ,c'' -ic Contractor's License No. Company Name) Mailing Address 3Cra o~'ji ,-e ' a`✓ lectn al Cnt~ractor r wner Making This installation Authorized Signature J ~ f Phone No. (Electrical Contractor or Owner Making This Installation) slip "A" TE BOARD LU This inspection request will not be accepted by the State Board unless proper inspection fee is enclosed. Minnesota State Board of Electricity .1954 University Ave., St. Paul, Minn. 55104-Phone 645-7703 REQUEST FOR ELECTRICAL INSPECTION CHECK BELOW WORK COVERED BY THIS REQUEST' pe of Building New Add ep. Check Appliances Wired For Check Equipment Wired For Home ❑ Range ❑ Temporary Wiring ❑ Duplex ❑ ❑ ❑ Water Heater ❑ Lighting Fixtures ❑ Apt. Bldg. ❑ ❑ ❑ ❑ Electric Heating ❑ Commercial Bldg. ❑ ❑ ❑ ce RftftJ7l Silo Unloader ❑ Industrial Bldg. ❑ ❑ ❑ o ' er Bulk Milk Tank ❑ Farm El El El ist List Other ❑ ❑ ❑ ere Hehers COMPUTE INSPECTION FEE BELOW Service Entrance Size: # Fee Feeders&Subfeeders: # Fee Circuits: # Fee 0 to 100 Amps. 0 to 30 Amperes 0 to 30 Amperes 101 to 200 Amps. f ,g " ,7 31 to 100 Amperes 31 to 100 Amperes Above 200 Amps. Above 100 Amps. Above 100 Amps. Transformers Remote Control Circ. Partial or other fee Signs Special Inspection Minimum f / .;00 Remarks i o /L(fex `L t/ x g x TOTAL F E . I, the Electrical Inspector, hereby certi t th a itlspection has been e. (Rough-in) Date ~7" (Final)e „fate This request void 18 months from ~ t This request void 18 months from 5a 4- 37263 Date of this Request ~J s I, as 2 ricensed Electrical Contractor ❑ O , o her d' rs inspection of the above electri- cal wiring installed at: 5~_ ~3 Street Address or Route No. 3 -3s ~/~``r~- s- Cit Section Township Range County Which is occupied by ex (Name of Occupant) Is a roughin inspection required on this job? No LET Yes ❑ Ready Now Er- -will call ❑ Power,SuppIier , t .r Address _,1,2-,-. e Electrical Contractor 's X-71 L~ Contractors License No. (Comps y Name) Mailing Address r-Nectrical Contr t r or owner Making This Installation) Authorized Signature Phone No. nl S~J (Electrical Contractor or Owner Making This Installation) STATE BOARD COPY This inspection request will not be accepted by the State Board unless proper inspection fee is enclosed. I_ l Minnesota State Board of Electricity4 19 University Ave., St. Paul, Minn. 55104-Phone 645-7703 REQUEST FOR ELECTRICAL INSPECTION S CH K BELOW WORK COVERED BY THIS REQUEST Type of Building New Add. Rep. Check Appliances Wired For Check Equipment Wired For Home ❑ 230-0 Range ❑ Temporary Wiring ❑ Duplex ❑ ❑ ❑ Water Heater ❑ Lighting Fixtures ❑ 'Apt. Bldg. ❑ ❑ ❑ Dryer ❑ Electric Heating ❑ Commercial Bldg. ❑ ❑ ❑ Furnace l~ Silo Unloader ❑ Industrial Bldg. ❑ ❑ ❑ Air Cond" Bulk Milk Tank ❑ Farm ❑ ❑ ❑ List List Other ❑ E3 ❑ Herers ' ~ A*- P- AV A%N, Here COMPUTE INSPECTION FEE BELOW #a . Service Entrance Size: # Fee Feeders&Subfeeders: # Circuits: # Fee qtr 0 to 100 Amps. 0 to 30 Amperes 0 to 30 Amperes 101 to 200 Amps. 31 to 100 Amperes 31 to 100 Amperes Above 00 Amps. Above 100 Amps. Above 100 Amps. Transformers Remote Control Circ. Partial or other fee Signs Special Inspection Minimum fee $5.00 Remarks TOTAL FEE I, the Electrical Inspector, hereby certify that the above inspection has been made. l (Rough-in) { Date `(Final) Date This request void 18 months from - s- 4 This requSg void 18 months from Date Fcen'QElectrical is uest 8 40 • 7 6 P 48183 I, as Contractor O Owner, do hereby request inspection of the above electri- cal winstalled at: S$reet Address or Route No. 1 17~f ~Q~43~ city. e~w Section Township Range County Which is occupied by 'Z-aMph (Name of Occupant) ~5G Is a roughin inspection required on this job? No 0 Yes ❑1 `Ready Now O Will Call Power Supplier I V ~ Address c~~ W AAA - Electrical Contractor_ Contractor's License No. (Company Name) . Mailing Address C. be ctricai C tractor wn1r Making This Installation) Authorized Signature Phone No. I (Electrical Contractor or Owner Making This Installation) STATE BOARD COPY Minnesota State Board of Electricity 1954 University Ave., St. Paul, Minn. 55104-Phone 645-7703 REQUEST FOR ELECTRICAL INSPECTION p CHECK BELOW WORK COVERED BY THIS REQUEST 48183 Type of Building New Add. Rep. Check Appliances Wired For Check Equipment Wired For Home ❑ ❑ Range ❑ Temporary Wiring ❑ Duplex ❑ ❑ ❑ Water Heater ❑ Lighting Fixtures ❑ Apt. Bldg. ❑ ❑ ❑ Dryer ❑ Electric Heating ❑ Commercial Bldg. ❑ ❑ ❑ Furnace ❑ Silo Unloader ❑ Bulk Milk Tank ❑ Industrial Bldg. ❑ ❑ ❑ Air C gg& boner 11 Farm 171 C1 El List pLList Other ❑ ❑ ❑ Here Herers COMPUTE INSPECTION FEE BE LO Service Entrance Size: # Fee Feeders&Subfeeders: # Fee 11 Circuits: # Fee !Vb to 30 Am res 0 to 30 Amperes 00 0 to 100 Amps. 7 •J 101 to 200 Am s. 31 to 100 Amperes 31 to 100 Amperes Above 200 Amps. Above 100 Amps. Above 100 Amps. Transformers Remote Control Circ. Partial or other fee Signs Special Inspection Minimum fee Remarks ` TOTAL FE ti~'p . I, the Electrical Inspector, hereby certify t e ab ijrspection has been de. T , (Rough-in)/mar Date (Final) /t ~'bate This request void 18 months from 7~"7_, i 1 - ; . 7 d. Ilk CITY OF EAGAN X7195 Pilot Knob Road Eagan, MN 55122 N2 5457 F PHONE: 454-8100 l _ BUILDING PERMIT APPLICATION Receipt # To be used for Garage $ Dwlg Addiut. Value 24, 500. Date 10-10 19 79 Site Address 3935 B1aCkhawk Road Erect R3 55 6 Cedar Grove F6 ❑ Occupancy Lot Block Set/Sub. Alter ❑ Zoning Rl Parcel 10 16705 550 06 Repair ❑ Fire Zone 3 Enlarge Type of Const. V W Name Father Daniel Simon Move ❑ # Stories Address 335 Blackhawk Road Demolish ❑ Front ft. C; Eagan SS122 Phone 454-5108 Grade ❑ Depth ft. x Name Co , i 5S Approvals Fees O Addre s -20376 HOI DAP 1,3 S I f as* ` tri 5 1 t;ssr eni Permit 78 _ 00 015 U§ a ex, e t" city Phone 4 ' Water & Sew. Surcharge 12.50 Police Plan check uw Name tw Fire SAC Address Eng. Water Conn. W city Phone Planner Water Meter Council hereby acknowledge that I have read this application and state that Bldg. Off. the information is correct and agree to comply with all applicable APC Total 9(1.50- State of Minnesota Statutes and City of an Ordir~n s. Signature of Permittee iz A Building Permit is issued to: Father Daniel Simon on the express condition that oil work shall be done in accord wit all ap -cable to of innesoto Statutes and City of Eagan Ordinances. Building Officials L CITY of EAGAN N2 3755 BUILDING PERMIT . ~t 3795 Pilot Knob Road Owner ::...t. a Eagan, Minnesota 55122 Address (present) . • 454-8100 Builder . ` Date 7................ Address 2 2 E.: . DESCRIPTION Stories To Be Used For Front Depth Height Est. Cost Permit Fee Remarks LOCATION- Street, Road or other Description of Location Lot Block Addition or Tract This permit does not authorize the use of streets, roads, alleys or sidewalks nor does it give the owner or his agent the right to create any situation which is a nuisance or which presents a hazard to the health, safety, convenience and general welfare to anyone in the community. THIS PERMIT MUST BE KEPT QN THE PREMISE WHILE THE WORK IS IN PROGRESS. This is to certify, that... .J" -1-' " . has permission to erect a.... O-Z- 5: ............_upon the above described premise subject to the provisions of all applicable Ordinances for the City of Eagan. F:.. ~ Per yor~ ---.....J.... ~ Building Inspector Ma 1 4 DATE 7 l BUILDING PERMIT APPLICATION Include 2 sets of plans, 1 site plan w/elevations and 1 set of energy calculations. To be sed for G _f C e Valuation Site AddresE : ~ l l~ ~ k✓~ t { ~ c~ Lot Block See. Sub. Parcel Number /G' 1, /ICS C 0 Owner Telephone Address `yq~i.~~~ Contractor Telephone c KCyr' 11"I L/ ? • Address ~ ~ , Arch,/Eng. Telephone Address OFFICE USE Erect Occupancy Alter Zoning Repair Fire Zone 3 Enlarge Type of Cont. Move # of Stories Der,~lish Front Grade Depth OFFICE USE Date of Approval & Initial FEES Assessment, /©~/nPermit 1-7 Water/Sewer Surcharge Police "'Plan Check Fire SAC Eng. Water Conn. Planner Water Meter Council Bldg. Off. TO AL C A.P.C. l our i t"' i f,7 ! c s~ 1 p ~ ~ C -OVr - C 0,,, -c 1-n• ~ `Le~ r ~ G 1 1) c,; t. ~;s s. r ~ L/' a r.' s 5 1. k Z aj w 3 fi Yi t !u n i 'u e _ - t 4 ` i t I 25- yy~4 .C C qj ~ 11J 4J. v1 3 'moo . Q 41 14.{~ 1 - LOT 55 9L0CV CEDED. &aOVE NO G pAKOTA COLI"7 MIriNc70TA Ue17O4~5 Z~al,,70ya O~o~Lwi~iis/c~ e,7se/Y:eal Pr'd (Q[%YL7 / l JYO turri' f,~er lore chow fscrrhe:d U't1 a~ I ' ~avf~Q~ all b-,J-- s, Th/S p fr'u' /=f ~wy7{J. rl:n' L! iherrixl , o7d 0• r YlSr[' ' f/7UYX1 ~/,T °(7TS , , OJ !r 1%C/ 7 V. J,7 50~ IC~. ,ft,s S A Yf(~ /i mC ' XZi y J7 4V)f CG A( l Affil ! l l.~'jy z C' l MTI rte'/ A a'q/f:;Vd X nc O~krrlq avd on hvbil! s ors~nled ext rf , .'i; rc v~e~ o~'surS ;r:owfy~1 c" ~f~,~;: ~nftresf Qrlhsr t~ . rZaSY? ' N/c~l /Trs( 3y1(, . {{1~ /LJLIti 4/ ~d4'lffi~:X3F1'[ir~(.AAp/7f.S fXYe:Yell L,:Y'd Ap [SlOIJ/IS~JJIJj ~JI ~!/C5 Q% GGU Cl(f Gr7~S. 50UP85AN £NC'Nf~liiiVv, i";C A ri'l LOT: _ BLOCK: b SUBD./P.I.D Cedar arm -*h 2000 BUILDING PERMIT APPLICATION (RESIDENTIAL) CITY OF EAGAN %75 3830 PILOT KNOB RD - 55122 651-681-4675 New Construction Reauirements Remodel/Repair Requirements 3 registered site surveys showing sq. ft, of lot, sq. ft. of house 2 copies of plan and all roofed areas (20% maximum lot coverage allowed) 1 set of energy calculations for heated additions ➢ 2 copies of plans (show beam & window sizes; poured fnd. design; etc.) 1 site survey for exterior additions & decks 1 set of energy calculations ➢ 3 copies of tree preservation plan ff lot platted after 7/1/93 ➢ Rim Joist Detail Options selection sheet (buildings with 3 or less units) DATE: CONSTRUCTION COST: &e7- DESCRIPTION OF WORK: If multi-family bldg., how many units? STREET ADDRESS: -"-t Name: > 1'`%1~ S1". ~2, ~1 Phone S y /O PROPERTY Last First OWNER Street Address: k city , L State: Zip: Company: Phone (area code) CONTRACTOR ,A/ Street Address: p License # Exp. City State: Zip: ARCHITECT/ / ENGINEER Company: N f Name: Telephone ( ) Street Address: Registration City State: Zip: Sewertwater licensed lumber (if installing sewertwater 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. r Signature of Applicant: &j XA, lvl"~ OFFICE USE ONLY Certificates of Survey Received Yes No Tree Preservation Plan Received Yes No Not Required I OFFICE USE ONLY ❑ 01 Foundation ❑ 07 05-plex ❑ 13 16-Plex ❑ 20 Pool ❑ 30 Accessory Bldg ❑ 02 SF Dwelling ❑ 08 06-plex ❑ 16 Fireplace ❑ 21 Porch (3-sea.) ❑ 31 Ext. Alt - Multi ❑ 03 01 of ` plex ❑ 09 07-plex ❑ 17 Garage ❑ 22 Porch/Addn. (4-sea.) ❑ 33 Ext. Alt - SF ❑ 04 02-plex ❑ 10 08-plex ❑ 18 Deck ❑ 23 Porch (screened) ❑ 36 Multi ❑ 05 03-plex ❑ 11 10-plex ❑ 19 Lower Level ❑ 24 Storm Damage ❑ 06 04-plex ❑ 12 12-plex Plbg Y or_ N ❑ 25 Miscellaneous ❑ 31 New ❑ 35 Int Improvement ❑ 42 Demolish (Foundation) ❑ 45 Fire Repair ❑ 32 Addition ❑ 36 Move Bldg. ❑ 43 Reroof ❑ 46 Windows/Doors ❑ 33 Alteration ❑ 37 Demolish (Bldg)* ❑ 44 Siding ❑ 34 Replacement ❑ 38 Demolish (Interior) * Demolition (Entire Bldg only) permit - Give PCA handout to applicant VALUATION Occupancy MC/ES System Census Code Zoning City Water SAC Units Stories Booster Pump Nbr. of Units Sq. Ft. PRV Nbr. ofBldgs Length Fire Sprinklered Type of Const Width INSPECTIONS REQUIRED Footings: New Bldg _ Insulation - Windows - new/replacement Footings: Deck _ Final/C.O. _ Siding Footings: Addition _ Final/No C.O. Stucco/Stone Foundation Fireplace: _ r.i. _ air test _ final Roof: - ice & water final _ Framing Fool: ftgs _ air/gas tests _ final APPROVALS Planning Building Engineering Variance Base Fee Surcharge Plan Review MC/ES SAC City SAC Water Supply & Storage S&W Permit & Surcharge Treatment Plant Park Dedication Trails Dedication License Search Copies Other Total: MASTER CARD LOCATION A J OWNER A-A J^ STRUCTURE AND LAND USED AS issued To Permit No. Issued Contractor Owner BUILDING PLUMBING CESSPOOL - SEPTIC TANK WELL ELECTRICAL I - HEATING GAS INSTALLING SANITARY SEWER OTHER OTHER Approved Items (Initial) Date Remarks Distance From Well FOOTING SEPTIC FOUNDATION CESSPOOL FRAMING TILE FIELD FT. FINAL ELECTRICAL DEPTH HEATING OF WELL GAS INSTALLATION SEPTIC TANK CESSPOOL DRAINFIELD PLUMBING WELL SANITARY SEWER Violations Noted on Back COMMENTS: COMPLIANCE INSPECTION REPORTS TO BE USED ONLY IN EVENT OF OBSERVED VIOLATIONS PERMIT NO. DATE OF INSPECTION CONDITIONS OF CONSTRUCTION AT THIS INSPECTION OBSERVED. EVIDENCE OF NON-COMPLIANCE NON-COMPLIANCE. BUILDER DOES NOT OBSERVED. ~ INTEND TO COMPLY. ❑ ACCEPTABLE SUBSTITUTIONS OR DEVIATIONS. COMPLETION OF CERTAIN IMPROVEMENTS WILL BE DELAYED BY CONDITIONS BEYOND ❑ NON-COMPLIANCE. BUILDER WILL COMPLY CONTROL. WITHOUT DELAY. ITEMIZED AND DESCRIBED AS FOLLOWS: ❑ REINSPECTION REQUIRED DATE OF REINSPECTION REINSPECTION REVEALED CERTIFICATION-1 certify that I have carefully inspected the above in which I have no interest present or prospective, and that I have reported herein all significant conditions observed to be at variance with ordinances of the Town of Eagan, approved plans and specifications, and any specific require- ments for off-site improvements relating to the property inspected. ❑ ALL IMPROVEMENTS ACCEPTABLY COMPLETED BUILDING INSPECTOR DATE COMMENTS: 23 L EAGAN TOWNSHIP IJ795 Pilot Knob Road St. Paul, Minnesota 55111 Telephone 454-5242 PERMIT FOR SEWER SERVICE CONNECTION DATE: NUMBER 359 OWNEF' Address . ~ P i PLUMBER TYPE OF PIPE ~GL'1 DESCRIPTION OF BUILDING Industrial Commercial Residential Multiple Dwelling No. of units J 2~ Location of Connections: Connection Charge 200.00 Permit Fee 7.50 Street Repairs Total Inspected by: Date Remarks: BY Chief Inspector In consideration of the issue and delivery to me of the above permit, I hereby agree to do the proposed work in accordance with the rules and regulations of Eagan Township, Dakota County, Minnesota By Please notify when ready for inspection and connection and before any portion of the work is covered. I EAGAN TOWNSHIP 3795 Pilot Knob Road St. Paul, Minnesota 55111 Telephone 454-5242 PER1.1IT FOR WATER SERVICE CONNECTION Date:~~ Number: 39 Billing Name: Site Address: Owner4~G4~__ Aye--Billing Address Plumber: Location of Connection Meter Size Connection Chg. 200.00 4=~--~"' Meter No.~ Permit Fee . ~n Meter Readings Meter Dep. Meter Sealed: Yes Add'l Chg. NO Total Chg. Inspected by Date Building is a: Remarks: Residence Multiple No. Units Commercial Industrial By; Chief Inspector Other In consideration of the issue and delivery to me of the above permit, I hereby agree to do tle proposed work in accordance with the rules and regulations of Eagan Township, Dakota Coun y, Minnesota. By: Please notify the above office when ready for inspection and connection. I / RESIDENTIAL BUILDING " l 1 ?j Permit Application City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 New Construction Reauirements Remodel/Repair Requirements Office Use Only 3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas 2 copies of plan Cert of Survey Recd _Y _N (20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions Tree Pres Plan Recd _Y _N 2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks Tree Pres Reqd _Y _N 1 set of Energy Calculations Addition - indicate if on-site septic system On-site Septic System _Y _N 3 copies of Tree Preservation Plan if lot platted after 7/1/93 Rim Joist Detail Options selection sheet (bldgs with 3 or less units Date 1 / Construction Cost Site Address 3 q ~ I arz& ha MA fi, N A2,5_,57 oZ Jnit/Ste # Description of Work VN Multi-Family Bldg Y Fireplace(s) - 0 V", - 2 Pro er Owner P h' ~(~'~'~TX {,c vi fly °Pi~,z- t `/'~Yl J ► ~l~f~ (telephone # (JL5-/) T.~ y d O Contractor ~e Address City State Zip Telephone # ( ) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672 Energy Code Category Residential Ventilation Category 1 Worksheet New Energy Code Worksheet (4 submission type) Submitted Submitted • Energy Envelope Calculations Submitted E Have you previously constructed a building in Eagan with a similar plan? _ 11 D - N I so, 5% n review fee applies. SCE' 2 3 2003 1 Licensed Plumber Telephon # ( ) Mechanical Contractor Telephone # ( ) Sewer/Water Contractor Telephone # ( ) I hereby aPP1Y for a Residential Building 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 State of MN Statutes; 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. L Fa r I f'I'1 D n Applicant's Panted Name Applicant's Signature OFFICE USE ONLY Sub Types ❑ 01 Foundation ❑ 07 05-plex ❑ 13 16-plex ❑ 20, Pool ❑ 30 AccessoryBldg ❑ 02 SF Dwelling ❑ 08 06-plex ❑ 16 Fireplace ❑ 21 Porch (3-sea.) ❑ 31 Ext. Alt - Multi ❑ 03 01 of_ plex ❑ 09 07-plex ❑ 17 Garage ❑ 22 Porch/Addn. (4-sea.) ❑ 33 Ext. Alt - SF ❑ 04 02-plex ❑ 10 08-plex ❑ 18 Deck ❑ 23 Porch (screen/gazebo) ❑ 36 Multi Misc. ❑ 05 03-plex ❑ 11 10-plex ❑ 19 Lower Level ❑ 24 Storm Damage ❑ 06 04-plex ❑ 12 12-plex Plbg_Y or _ N ❑ 25 Miscellaneous Work Types ❑ 31 New ❑ 35 Int Improvement ❑ 38 Demolish (Interior) ❑ 44 Siding ❑ 32 Addition ❑ 36 Move Bldg. ❑ 42 Demolish (Foundation) ❑ 45 Fire Repair ❑ 33 Alteration ❑ 37 Demolish (Bldgr ❑ 43 Reroof ❑ 46 Windows/Doors ❑ 34 Replacement 'Demolition (Entire Bldg) - Give PCA handout to applicant Valuation Occupancy MC/ES System Census Code Zoning City Water SAC Units Stories Booster Pump Nbr. of Units Sq. Ft. PRV Nbr. of Bldgs Length Fire Sprinklered Type of Const Width REQUIRED INSPECTIONS - Footings (new bldg) _ Final/C.O. - Footings (deck) _ Final/No C.O. Footings (addition) _ Plumbing Foundation _ HVAC Drain Tile Other Roof _ Ice & Water _ Final - Pool _ Ftgs _ Air/Gas Tests -Final Framing _ Siding _ Stucco _ Stone _ Fireplace _ R.I. - Air Test - Final - Windows (new/replacement) Insulation _ Retaining Wall Approved By , Building Inspector - - - - - - - - - - - - - - Base Fee Surcharge Plan Review MC/ES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search Copies Other Total ►Rr rtr ' 1650 RecO4* No- 16965 ' lkhsWk`: Road Sir ` 6 Cedar Grove #6 F ,Ssi lSea., f mum Res-, Cc .7lrsd. - *thtt Dinietl aim n r Alh ~w t{Attar./ PW~ 29- h 3~Blakhawk Rd: _ , N SSI2 _ Phom 4~4; 10 R... 1. '4 .OL ti ►he Ht$;_& Sheet Metal SO t a 5.50 4 oxi&M~5i Ow i ~MM CITY OF EAGAN • 3795 Pilot Knob Road Eagan, Minnesota 55122 Phone: 454-8100 1•;.ew. " PERMIT No. r r I J1 126 7 t! Date: Receipt No.: Single Site Address: 39,35 31ack'hawk Pr' _ _ _ Residential tot Block Sub/Sec. Multi Res., Comm./Ind. Name New/Alter./Repair. < 3 Address Cost of Installation O J:aan City Phone: Permit Fee - Name Surcharge 0 ° Address I . 3 `"`s -._r" e 0 City Phone: Total This Permit is issued on the express condition that all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official 443 Lafayette Road N. MINNESOTA DEPARTMENT OF (651) 284-5005 St. Paul, Minnesota 55155 1-800-DIAL-DLI www.dli.mn.gov LABOR & INDUSTRY TTY: (651) 297-4198 i 9/7/2012 APPROVED FOR USE Daniel Simon 3935 Blackhawk Rd EAGAN, MN 55122 RE: RES STAIR CHAIR LIFT Elevator ID# ELV-1007710 Site: Daniel Simon Unit 2 3935 Blackhawk Rd EAGAN, MN 55122 Dear Sir/Madam: Minnesota Statutes Chapter 326B provides that the Department of Labor and Industry, Construction Codes & Licensing Unit, Elevator Safety Section, inspect and approve elevators and manlifts (endless belt lifts) before they can be legally used in Minnesota. An Inspector from the Elevator Safety Section recently inspected your facility and determined it meets requirements of the Minnesota Elevator Safety Code. NOTE: Compliance with Minnesota Rules and the ANSI/ASME A17.1, Safety Code for Elevators and Escalators does not necessarily assure compliance with the Americans With Disabilities Act of 1990. Sincerely, CONSTRUCTION CODES & LICENSING Tim Warren State Elevator Inspector c: City of Eagan Building Official ABILITY SOLUTIONS ElFormCE2R This information can be provided to you in alternative formats (Braille, large print or audio). An Equal Opportunity Employer 443 Lafayette Road N. MINNESOTA DEPARTMENT OF (651) 284-5005 St. Paul, Minnesota 55155 LABOR 1-800-DIAL-DLI www.dli.mn.gov INDUSTRY TTY: (651) 297-4198 i 9/7/2012 APPROVED FOR USE Daniel Simon 3935 Blackhawk Rd EAGAN, MN 55122 RE: RES STAIR CHAIR LIFT Elevator ID# ELV-1007709 Site: Daniel Simon Unit I 3935 Blackhawk Rd EAGAN, MN 55122 Dear Sir/Madam: Minnesota Statutes Chapter 326B provides that the Department of Labor and Industry, Construction Codes & Licensing Unit, Elevator Safety Section, inspect and approve elevators and manlifts (endless belt lifts) before they can be legally used in Minnesota. An Inspector from the Elevator Safety Section recently inspected your facility and determined it meets requirements of the Minnesota Elevator Safety Code. NOTE: Compliance with Minnesota Rules and the ANSI/ASME A17.1, Safety Code for Elevators and Escalators does not necessarily assure compliance with the Americans With Disabilities Act of 1990. Sincerely, CONSTRUCTION CODES & LICENSING Tim Warren State Elevator Inspector c: City of Eagan Building Official ABILITY SOLUTIONS E1FormCE2R This information can be provided to you in alternative formats (Braille, large print or audio). An Equal Opportunity Employer This information can be provided to you in alternative formats (Braille, large print or audio). An Equal Opportunity Employer r City of Eaaall 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Use, ,�, Permit #: 19 (I Permit Fee: Date Received: Staff: J \� r C 2012 RESIDENTIAL BUILDING PERMIT APPLICATION Date: la 25 /�3 Site Address: 3935 alei .6L��1 Unit #: Name:020/71W s/ 2dAi Phone: 0/ ry5' -5./ag Address / City / Zip: 5955'8.6li/ (_,1/ M17� 4-2"//An/ 55/ Applicant is: Owner Contractor Description of work: *bet O /11 deck /�G J e i �,f/i y Construction Cost: _ /,/� J Multi -Family Building: (Yes / No ) Company: Da/65 (2C47, Address: 67/ % Y W (o3 City: (,1(k)ffL State: LO Zip: AlOQ Phone: eco -873 /A/5/ Contact: License #: 917 Lead Certificate #: / or- 50799 ' If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) tz- 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: 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.000herstateonecatl.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 011110--issuanc.x 0-- CASON'C Applicant's Printed Name AlAie x la II IIMMIWA. Applicant's Signature Page 1 of 3 Y' DO -NOT WRITE BELOW THIS LINE SUB TYPES Foundation Single Family Multi 01 of _ Plex Accessory Building WORK TYPES New Addition Alteration Replace Retaining Wall DESCRIPTION Valuation Plan Review (25% 100%_) Census Code # of Units # of Buildings Type of Construction _ Fireplace _ Garage Deck Lower Level _ Porch (3 -Season) _ _ Porch (4 -Season) _ _ Porch (Screen/Gazebo/Pergola) _ Pool _ Interior Improvement Move Building Fire Repair Repair REQUIRED INSPECTIONS Footings (New Buildi Footings (Deck) .� Footings (Addition) Foundation Drain Tile Occupancy Code Edition Zoning Stories Square Feet Length Width Roof: _Ice & Water Final Framing Fireplace: _Rough In Air Test Insulation Sheathing Sheetrock Reviewed By: RESIDENTIAL FEES Base Fee Surcharge Plan Review MCES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Copies TOTAL Siding Reroof Windows Egress Window 1199(17 Storm Damage Exterior Alteration (Single Family) Exterior Alteration (Multi) Miscellaneous Demolish Building* _ Demolish Interior Demolish Foundation Water Damage *Demolition of entire building - give PCA handout to applicant MCES System SAC Units City Water Booster Pump PRV Fire Sprinklers Meter Size: Final / C.O. Required V Final / No C.O. Required HVAC Gas Service Test Gas Line Air Test Other: Pool: _Footings _Air/Gas Tests Final Siding: _Stucco Lath _Stone Lath _Brick Final Windows Retaining Wall: Footings _ Backfill _ Final Radon Control Erosion Control Building Inspector Page 2 of 3 11'0(0°1 PERMIT City of Eagan Permit Type:Building Permit Number:EA123225 Date Issued:06/02/2014 Permit Category:ePermit Site Address: 3935 Blackhawk Rd Lot:55 Block: 6 Addition: Cedar Grove 6th PID:10-16705-06-550 Use: Description: Sub Type:Reroof & Siding Work Type:Replace Description: Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Please print pictures of ice and water protection and house wrap and leave on site. When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to ensure maximum ventilation to attic. Call for final inspection after installation. Valuation: 8,000.00 Fee Summary:BL - Base Fee $8K $162.25 0801.4085 Surcharge - Based on Valuation $8K $4.00 9001.2195 $166.25 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Daniel Simon 3935 Blackhawk Rd Eagan MN 55122 Lindus Construction 879 Hwy 63 Baldwin WI 54002 (715) 684-4647 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA143060 Date Issued:06/01/2017 Permit Category:ePermit Site Address: 3935 Blackhawk Rd Lot:55 Block: 6 Addition: Cedar Grove 6th PID:10-16705-06-550 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. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State 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 - Daniel Simon 3935 Blackhawk Rd Eagan MN 55122 (651) 454-5108 Controlled Air 21210 Eaton Ave Farmington MN 55024 (651) 460-6022 X253 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA149230 Date Issued:05/14/2018 Permit Category:ePermit Site Address: 3935 Blackhawk Rd Lot:55 Block: 6 Addition: Cedar Grove 6th PID:10-16705-06-550 Use: Description: Sub Type:Residential Work Type:Replace Description:Water Heater Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener). Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087 Surcharge-Fixed $1.00 9001.2195 $60.00 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Daniel Simon 3935 Blackhawk Rd Eagan MN 55122 Tony's Appliance 2090 County Road 42 West Burnsville MN 55337 (952) 435-2442 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA153173 Date Issued:11/28/2018 Permit Category:ePermit Site Address: 3935 Blackhawk Rd Lot:55 Block: 6 Addition: Cedar Grove 6th PID:10-16705-06-550 Use: Description: Sub Type:Fireplace Work Type:Gas Insert Description: Census Code:434 - Residential Additions, Alterations Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Improvements to the home may require smoke detectors in all bedrooms. Chimney / flue must be inspected prior to concealing. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Valuation: 3,000.00 Fee Summary:BL - Base Fee $3K $88.50 0801.4085 Surcharge - Based on Valuation $3K $1.50 9001.2195 $90.00 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 - Daniel Simon 3935 Blackhawk Rd Eagan MN 55122 Fireside Hearth & Home 2700 Fairview Ave N Roseville MN 55113 (651) 633-2561 Applicant/Permitee: Signature Issued By: Signature �7+ , , For Office Use --77.7 i � � • I Permit#: EAGANPermit Fee: ' 041 AUG 2 9 2019 Date Received: 0-1019-117 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 (651)675-5675 I TDD: (651)454-8535 I FAX:(651)675-5694 Staff: buildinginspections@citvofeacian.com _—j 2019 RESIDENTIAL BUILDING PERMIT APPLICATION Date: g�a/0/j Site Address: 3935 35 BI 1Ca. Unit#: Name: F YI xx` L &'IIeL airn4CYJ Phone: 651 - -5108 R@SidelCtti 5512-Z Ow' tier Address/City/Zip: 3935 i G� iQ�t-t) C� rq t ► r lJ V Applicant is: Owner l( Contractor `1 Description of work: / CAR, Qfl1Od-ef Type afWasrk ( A Construction Cost: (pOH dn° Multi-Family Building: (Yes /No X ) • J Company:,J A((�L)5 eo4Ir ('1/o"J Contact: 00)1/1 a Qlso'J Address: 8r/c? OS 14L.0 . (D-3 City: 45a/0441;Q ContragtO r : S'IOOl 1 -967 - O3 : donr .Olson State' ,_ Zip: Phone: il� of�. License#: 71 Q (U I Lead Certificate#: MT-(51 9A ' If the project is exempt from lead certification, please explain why: 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: Nom'PlanAnd supportingdocuments that you submit are considered to be public information. Portions of the information maybe classified as non-public if you pnwldt specific reasons that would permit the City to conclude that the 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. 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. &K)SO+J x . Applicant's Printed Name Appl s Signature /� Q_, L nc�v3 C9'n uC Oki q-, s el, /�>o� P{., /$ 777qDO NOT WRITE BELOW THIS LINE / SUB TYPES _ Foundation _ Fireplace _ Porch(3-Season) _ Exterior Alteration(Single Family) Single FamilyT 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 10 Alteration — Fire Repair _ Windows _ Demolish Foundation T Replace Repair _ Egress Window _ Water Damage Retaining Wall *Demolition of entire building-give PCA handout to applicant DESCRIPTION Valuation '.iy 5Le O•" Occupancy 1 RC 1 MCES System Plan Review Code Edition Mei 2 n I S" SAC Units (25% 100% 20) Zoning g--.( City Water Census Code Stories Booster Pump #of Units Square Feet PRV #of Buildings Length Fire Suppression Required Type of Construction if 3. Width REQUIRED INSPECTIONS Footings(New Building) Meter Size: Footings(Deck) Final/C.O. Required Footings(Addition) )0 Final/No C.O. Required Foundation Foundation Before Backfill Z4 HVAC Service Test A Gas Line Air Test Hood Roof: Ice&Water Final Pool: Footings Air/Gas Tests Final A Framing 30 Minutes 1 Hour Drain Tile Fireplace: Rough In Air Test Final Siding: Stucco Lath Stone Lath Brick EFIS 14 Insulation 16 Windows Sheathing Retaining Wall: Footings Backfill Final Sheetrock Radon Control Fire Walls Fire Suppression: Rough In Final Braced Walls Erosion Control Shower Pan Other: 3 Reviewed By: i /n f/t!I1 Y/¢ , Building Inspector RESIDENTIAL FEES r Se—(0 Base Fee 2 J ( S%Q ' e r Surcharge 6 ' Z D .D 0 55 . It- Plan Review MCES SAC City SAC /,- a✓74?0tui Utility Connection Charge ,' coo . S&W Permit&Surcharge Treatment Plant Radio Meter Read Copies TOTAL Page 2 of 3 PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA168038 Date Issued:04/07/2021 Permit Category:ePermit Site Address: 3935 Blackhawk Rd Lot:55 Block: 6 Addition: Cedar Grove 6th PID:10-16705-06-550 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 - Rev Father Danielsimon Trust 3935 Blackhawk Rd Eagan MN 55122 Visionary Plumbing Llc 11944 100th St S Hastings MN 55033 (651) 769-9267 Applicant/Permitee: Signature Issued By: Signature