2160 Cedar LaneSEDGWICK HEATING & AIR CONDITIONING CO. HeanNc
8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •($52) 881-9000 TEST RECORD
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SERIAL NO. /
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IGNITION MODEL
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PRESSURE PERCENTGOz ?
INPUTCFH PERCENTOZ
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STACK TEMP. 1? U PERCENT CO
FORM 235 (REV. 11/B9)
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OWNER
JOBNO./')4D?` ?
INSTALLED BY r ?
MODEL V 0?,4 vDn'3?6,o7v
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VENT SIZE
TVPE OF LINER t/rn
LINER SIZE
FILTEHS: SIZE /6X "- Zx l NUMBER
WIRING
7E5T TAG
LIGHTING INST.
DATE TESTED 1` 13- oq
COMPANYTESTING ?r
NAME OF TESTER
FOflMUI$TRIBUTION: WHITECOPY - JOBFILE VELIOWCOPI' - CIN
' HEATING
SEDGWICK HEATING & AIR CONDITIONING CO. JoaNO.
8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, M. 55420 •(952) 881-9000 TESTRECORD
ADDRESS ?/?/' O?f? r ?1+? ?(/ CI7V
OCCUPANT `/? i7 ? Y S? S OWNER
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VALVE ? NPE OF LINER \ ? r it
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PILOTTYPE ? ?l TESTTAG
IGNITION MODEL
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PRESSURE
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INPUTCFH 2
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FORM 235 (RE¢ fl/89)
LIGHTING INST.
DATE TESTED
COMPANY TESTING
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NAMEOFTESTER
FORMDISTRIBUTION: WHITECOPY - JOBFILE VELLOWCOPY - CITV
!
SEDGWICK HEATING & AIR CONDITIONING CO. HEaTING JoaNO??
8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 5/?{20 •(952) 881-9000 TEST RECORD .
ADDRESS ? ? " v Cf[yp y` ?1'7, ( a4 1?-c) TV ? -7
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PILOTTYPE
IGNITION MODEL
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PRESSURE PERCENT COz 7 5
INPUT CFH PERCENT Oz
STACK TEMP. PERCENT CO ?-
FORM 235 (REV. H/88)
VENT SIZE
TVPE OF LINER [L
LWER SIZE
FILTERS: SIZE /(? Z?X I NUMBER ?
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TESTTAG ?
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LIGHTING INST. .
DATE TESTED ? /_ n/
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NAME OF 7EST.ER
'?FORMDISTRIBUTION: WFIITECOPY-JOBFlLE VELLOWCOPV - CITY
... .
SEDGWICK HEATING & AIR CONDITIONING CO. HEaTiNG
8970 WENTWORTH AVENUE SOUTH • MINNEAPOLIMN 55420-• y952)881-9000 TEST RECORD
ADDRESS :)!L? O CPi Il? tVI 1tAl l? ^N CITY `-' q Qh
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OCCUPANT = r,20 ? OWNER
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VENT SIZE
NPE OF LINER ?- ?
LINER SIZE /
FILTERS: SIZE /?Y Z?X I IJUMeER
PILOTTIMING -`
PRESSURE ? ' ? ??• ? PERCENT COz
INPUT CFH PERCENT Oz
STACKTEMP. 3 pERCENTCO
FORM 235 (REV. 11/89)
WIRING ?
TESTTAG _-
LIGHTING INST. ^-
_ 13- 6?
DATETESTED
COMPANYTESTING
NAMEOFTESTER
FORMOISTRIBUTION: WHITECOPV-JDBFILE YELLOWCAPY - CITY
IGNITION MOOEI
SEDGWICK HEATING & AIR CONDITIONING CO.
8910 WENTWORTH AVENUE SOUTH • MI/NNEAPOLIS, MN 55420 •(952) 687-q 0
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INPUT CFH PERCENT Oz r 0 ?
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HEATING
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TVPE OF LINFR
LINER SIZE ?
FILTERS: SIZE If L?ka S x ? NUMBER /
WIRING !
TEST TAG ?-
LIGHTING INST.
DATE TESTED ?/3 0
COMPANV TESTING
NAMEOFTESTER
FORMDISTRIBUTION: WHITEGOPY - JOBFILE VELLOWCOPV - CITY
SEDGWICK HEATING & AtR CONDITIONING CO. HeanNC JpgNO."? "O g2
8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, N 55420 •(9 2) 881-9000 TEST RECORD
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LINER SIZE
FILTEFS: SIZE NUMBER /
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LIGHTING INST. ?
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DA7E TESTED
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COMPANYTESTING
NAME OF TESTER
FORMDISiRIBIIrION: WHITEGOPV - JOBFILE VELLOWCOPV - CITV
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SEDGWICK HEATING & AIR CONDITIONING CO. HE^TiNC JpBNO. ?
8910 WEN7WORTH AVENUE S/O(UTH • MINNEAPOrlv,11?1-GL MN 55420 •(952) 881-9000 TEST RECORD
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INPUT
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TVPE OF LINER ?? ?7?
LINER SIZE
FILTERS: SIZE l,G X 2 S?C I NUMBER
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LIGHTING INST.
DATE TESTED / - / ?a V
COMPANVTESTING
NAME OF TESTER
FORMDISTAI6UTION: WHITECOPY - JOBFlLE VELLOWCOPY - CITY
SEDGWICK HEATING & AIR CONDITIONING CO. HEAri"G
8910 WENTN/ORTH AVENl1E SOpUTH • MINNEAPOL15, MJV 55420 •(95 881-9000 TEST RECORO
ADDRESSOI?? r U? I
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FANSETfING PILOTNPE ? e?
IGNITION MODEI
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PRESSURE PERCENT COz
INPUT CFH PERCENT Oz
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STACK TEMP. pERCENT CO
FORM 235 (REV. 1 1/89) arv C?
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FILTERS: SIZE NUMBER
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NAMEOFTESTEfi
FOPM DISTRIBIITION: WHITE COPV -JOB FILE YELLOW COW -CITV
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conaMERCUAL
28M BUILDING PERMIT APPLICATION
CITY OF EAGAN
y? q 651-681-4675
• SWClurel Plans (2) sets
• Civil Plans (2)
• Certifiqte of Survey (1)
• CodaAnalyrsis (t) "
. ProjectSPea (1)
• Spec.Inap.B.Testina Schedule"
• SoIISReport (1)
• Meler size must be established
1
1
t
1
1
• MCIES SAC datermination 1eUer
-`S
(2) sefs • /vchitecWral Plans (2) sets
(2) • CodC/V121Y515 (1) ••
(2) • proJect3pecs (1)
(2) • KeYPlan (1)
(1) " • MasterFYitPlan (i)
(1) • EnergyCalculations (1)notalways"
(1) " • Elec. Power & LiBhtlng Form (1) aot always••
• Meter size must be esfablished - if appliqbie
(?)
(1) •` 1
(1) " 1
??a 1
(1)"' 1
(?) 1
• MC/ES SAC detertnination lettsr
FoOtl S beverdqe or latlging faciltties - submtt plan to MN Departmem ot Neami. can 001-zlo-vrw ror unWas.
Contact BuAding Inspections for sampie.
Pertnitfor new buildings oradditlons wili not be processed wilhout Emergency Response Site Plan. Ask Buiiding Inspections for requiremerNs.
? 1-??-
a-?
DATE: //- /oZ.2I02 WO?( TYPEj'? X NEW _ REMODEL CONSTRUCTION COST:
l?`E_S4n`?cf L.?V?? ?• ??
SITEADDRESS: e
TENANTNAME: Cedar Villas Housing
SUITE #:
FORMEi2 TENANT NAME, IF APPLICABLE:
DESCRIPTION OF WORK
PROPERTY
OWNLR
CONTRACl'OR
f1llVlll l liCT/
ENGINEER
Name: Cedar Villas, LLP.
Last First
Pbone#: 6( 12 ? 347-7800
StreetAddiess: 900 Second Avenue South, Suite 880
Cit,. Minneapolis
Company: Frana and Sons, Inc, Phone#:
Street
• nrrnitecWral F'lans
. StrucWral Plans
• Civil Plans
. Landscaping Plans
• Cotle Marysis
• Certifipte M Surney
• Spec. Insp.?& TesUng Schedule
• Meler size must be established
• Project Specs
• EnergyCalculations
. Eledric Power 8 Lighting Fortn
. Master ExJt Plan
. Emergency Response SRe Plan
. Soils Report
• MC/ES SAC detemiination lerier
633 Second Avenue
_ Zip: 55402
?'?
95.9? ?8'6 0 '• ,?n? ?al? 2 ? 2c?2 U
City: Hopkins State: MN Zip: 155343 ----- _!
?--
1? ?
Company: Elness Swenson Graham ArchitectsPhone#: ( 612 ) 339-5508
Num: David Graham
StreetAddress: 700 Third Street South
City:
Minneapolis
Licensedplum6erlnstallingnewsoxrerlwaterservice: Imperial Developers phone#: 6( 51 ) 454-3330
= hereby aclcnowiedge thffi 1 have read this applicatbn, sfate tliat the iMortnafbn is correct, ree yo?o all applicable State of
h9innesota Statutes and City of Eagan Ordinances.
SlgnaWre ofApplicant:,4_
State: MN
State: MN
Registrarion ti: 7 4 8 0 8
Z;P: 55415
Updated 7/02
OFFICE USE ONLY
SUBTYPE
D-/ 01 Foundarion
Fd 14 Apaztments
? 15 Lodging
? 25 Miscellaneous
W9RK TYPE
0' 31 New.
? 32 Addirion
? 33 Alterations
O 34 Replacement
0 26 Public Facility
? 27 Cotnmercia]/fndustrial
? 28 Greenhouse
? 29 Antennae
? 30 Accessory Bldg.
0 32 Fact Alt - Apts.
? 34 Eact Alt - Comm
? 35 Ext Alt - PF
? 37 Nail Salon
? 35 Tenant Impr ? 42 Demolish (Foundation) ? 46 Windows/Doors
? 36 Move Bldg ? 43 Reroof ? 47 Repair -.
? 37 Demolish (Bldg) p 44 Siding ? 48 Authorization
? 38 Demolish (Int) ? 45 Fire Repair
GENERAL {NFORMATION
Census Code /0 S"
SAC Code
No. ofUnits
No. of Bldgs. ?
Consk (Actuat)
(Allowable)
UBC Occupancy o_ /
??_-
# of Stgories
I.ength.
Widzh
Basement sq. ft.
Fust Floor sq. ft.
sq. ft.
MISCELLAlVEOUS INSPECTIONS
? Gas Service Test ? Heating
APPROVALS
Planning
Permit Fee
Surcharge
-'lan Review
wcIEs s,ac
rily SAC
Nater Suppty & Storage
3/W Pertnit
i/W Surcharge
.-reatment Plant
'ark Dedication
'rails Dedication
Vater Quality
)ther
:opies
otai
Building
a`"sssC?il?
aoo.oc?
.?;0U U t7
`7 LF0.-CH?
ioo .E)o
.So
?
C?
J
"?U O
?D sq. ft.
sq. ft.
sq• fL
Sqft - _,
MC/ES System
City Water
Fire Sprinklered e
.?? P,S?
'N?1
? Insulation
EnBincering
VALUATION $
% SAC
SAC Units
Meter Size
? ?,C?,'?
Q Piumbing ? Stucco/Stone
Variance
? 541 oly-i1
PLUMBING (RESIDENTIAL)
Permit Application
City Of Eagan
3830 Pilot Knoh Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5694
Please complete for: Single Family Dwellings
Townhomes and Condos when permits are required for each unit
Date 7 / g / oj
Site Address ?l&O Lq? C f1C',kAj Unit #
W
Property Owner F/G/la d- SonS Telephone #(
Contractor a??Pnh PlUMb,"19
Address `d [p ? Qlja (G? A v C . City or??..I _
State V 14 /(f Zip Telephone # (5s,4) yya ??dl _
The Applicant is Owner X Contractor _ Other _
Septic System " New _ Refurbished Submd 2 sets of plans and MPC license $ 100.00
Includes County fee. Additional consulWnt fees may apply.
Alteratians To Existing Dwelling Unit, Including $ 50.00
_ Adding fxtures to lower levels or room additions, excluding water soRener and water heater
_ Abandonment of septic system
_ Water turnaround (+ 5/8" meter if needed -$121.00)
Other:
_ RPZ _ new installation _ repair _ rebuild $ 30.00
_ Lawn irrigation system
_ Water softener _ Water heater II I? 2 ?'' ' ? ?
$
15.00
_ replacement _ additional 1
I
$ 50
StateSurcharge
Total ? 90 sO x g.? ?=y $ ?a???
I hereby apply for a Residential Plumbing Permit and acknowledge that the informaYion is complete and accarate; that fhe work will
be in conformance with the ordinances and codes of the City of Eagan and with the Plumbing Codes; that I understand this is not ?
permit, but only an application for a permit, and work is not m start without a permit; that the work will be in accordance wiih ihc
approved plan in the case of work which requires a review and approval of plans.
S't?5h,ja k'614
Appli t scan P?nr ted Name Ap licant's Signature
0 _ P???
? ?? ul?r
RESIDENTIAL MECHANICAL
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675
Please complete for: Single Family Dwellings & Townhomes and Condos when pemii[s are required for each unit
Lo.?
Date '? / f / ?j
Sit
Add
/ j ?
C i
#
e
ress oC
J lC!/}2e. Un
t
J
Property Owner 24,4? r ? Telephone #
Contractor
StreetAddress City
(852) 881-90!'l
State ip Telephone # ( )
Bond #: Expires:
The Applicant is _ Owner _ Contractor _ Other
Add-on, modification or alteration to esisti¢g dwelling unit $ 30A0
fumace replacement
air exchanger
conditioner _ New _ Replacement
uther
? ?
_ j
State Sareharge F
' $ 50
.` or
T
[
l d X ?rJ ? ?' ' ? $ ?
o
a
=3y--- - .. .--i
I hereby apply for a Residential Mechanical Permit and aclmowledge that the information is complete and accurate; that the work will
be in wnformance vrith the ordinances and codes of the City of Eagan and with the Mechanical Codes; that I understand this is not a
pemvt, but only an applicarion for a permit, and work is not to start without a pemut; that the work will he in accordance with the
approved plan in the case of work which requires a review and approval of plans. j
SE?CIr!ins? f ?T? ? ,
- l'r' -lfi! ( o
Applicant's Printed Name ApplicanYs 3ignature
oi I 6 0 Cc./•*o? G.?.%.
CLAIM VOUCHER - REFUND REQUEST
CITY OF EAGAN
MAKE CHECK PAYABLE TO: VALLEY PLUMBIN G
ADDRESS: 860 QUAKER AVE
JORDAN MN 55352
RECEIPT #/DATE: 50926 7/10/03
51203 7/15/03
52185 7/31/03
52788 8/13/03
REASON FOR REFLiND: INCORRECTLY CHARGED PERMIT #: 60180; 60183, 60271, 60272
60273,60561,60562,60563
60564,60969
TYPE OF REFUND:
Plumbing Pernvt 9001.4087 $
Mechanical Permit 9001.4088 $
Building Permit Fee 9001.4085 $
Plan Review Fee 9001.4222 $
SAC(MC/WS) 92202275 $
SAC (Ciry) 9379.4681 $
SAC (Admin) 9001.4246 $
Water Connection 92203865 $
Sewer Permit 9220.4532 $
WaterPemut 9220.4507 $
Account Deposit 9220.2252 $
WaterMeter 9220.4509 $
WaterTreatment 9220.4685 $
Water Supply & Storage 9220.4680 $
Surcharge 90012195 $ 26.50
Overpayment 9001.2250 $
Gtiub Box Deposit Refund 92202253 $
Construcrion Meter Dep Refund 92202254 $
Other - Fire Pemut 9001.4096 $
TOTAL $ 26.50
I declare under the penalties of law that this account, claim, or demand is just and that no paR of it has been paid.
XeYA 8/19/03
i SIGNATURE DATE
Use BLUE or BLACK Ink
I For Office Use
Permit t 5 I
City of Ea
EaI Permit Fee: 5 0 A`
3830 Pilot Knob Road I
Eagan MN 55122 I I
I Date Received: ~J I
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff: j
I
L-----------------I
2013 COMMERCIAL BUILDING PERMIT APPLICATION
Date: j - Site Address: 9160 ar bn - qlLq Tenant Name: L11edor 11/ 11a $ (Tenant is: New / Existing) Suite
Former Tenant:
Name: 4,,e Ipc C. ,0,/'PC rA ko''1 Phone: ~ ~
Property Owner J
Address /City /Zip: / 0 &r o d 51 /'ou
Applicant is: Owner Contractor
Type Of Work Description of work: T l ~t •r J C i j
F
Construction Cost: 3 0v' 16
Name: License #:7
Contractor Address: IL Ale, Al City: ~ Id e,, yg lte`:7
State: 'n Zip: 551-01 Phone:? G3 - /300
Contact: V `iyl vt1 Email: UQ NI
Name: Registration
Architect/Engineer Address: City:
State: Zip: Phone:
I Contact Person: Email:
Licensed plumber installing new sewer/water service: 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. r
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and
codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without 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 21,f V/~ lb
/ L r'°I fpl x
Applicant's Printed Name Applica is Signature
Page 1 of 3