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1607 Ashbury PlCITY OF EAGAN 3830 Pflot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHON E: 454-8100 BUILDING PERMIT To be used for 6r Df1C!','A? Est. Value ? 1 l7 ,OftO Site Address 1607 ASI1I3i r: Y 2'LACE. Lot Block 4 Sec/Sub. BL.A(;KHA1r`( GLEN 2 Parcel No. Q Name I,l NDGbtEN BRUS CUHS'I 3 Address 915 E WAYZATA $LYi,) 0 City A't"A Phone 473-1 i31 Zp Na'pe ? a Address ? City Phone r¢ Vj W Name y _ F W Address az City- aW I hereby pcknowledge that 4 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 Permittee _- • R Building Permit is issued to:_ on the express condition that al I work shal I be done in accordance with all applicable State ol Minnesota Statutes and City of Eagan Ordinances. Receipt 1 14221 Date ` ' i t' ,19k. 7 OFFICE USE ONLY On Site Sewage Occupancy "j MWCC System Zoning K 1 On 51te Well (Actual) Const Y Ciry Water ? (Allowable) v PRV Required x it of Stories 8ooster Pump Length 64 ' 35 Depth S.F. Total FootPrint S.F. APPROVALS FEES Engr./Assess. Permit 4 554.50 ' 5630 Planner Surcharge Council Plan Review 277.25 - 00 100 BIdg.Off. SAC,City • Variance SAC, MWCC 525.00 water Conn. ' 525.00 Water Meter 67.00 ' RoadUnit 3[15-?10 Treatment P1 180.00 Parks TOTAL $1,591,75 CiTY OF EAGAN Permit No: 93,110 pate; 9 -' 9 `} 7 3830 PNot Knob Road Meter No: 3 q"kSize: ' P.O. B"•211?9 Reader No: 8 -1 Pl Data ?0 -I Jr' f) Eagan, MN 55121 Owner. SiteAddress: 1607 .AY::lbU Place 1.4 '2F 1.11awlc !'1e,_a II Plumber. Lunc:.igzen BrcUl Ln y Conn. Chg: 525• 00' d ut1lttl@S r?l -riutt Acct Dep: 15.0O . RIVnQAs EtC. 1. Permit Fee: lO • 0()D, ?y Surcharga • 5,??n Dg?elto 6Wwith thE Clty of Eagan Tr. Plant Ordinances. Meter. Misc.:-_`''' • t'A? VP: FL'.QUI1I"gy ?erCLk S WATER SERVICE PERMfT CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHON E: 454-8100 BUILDING PERMIT Receipt # To be used for Est Value ! Date Site Address ' OFFIC Lot Block Sec/Sub . "4`'0. -' A _ On 5ite 5ewage MWCC System Parcel No. On Site Well a Name .: i City water w z Address '•'' PRV Required ° City Phone ? ? - - ! eooster Pump ao Name . ? ? Address r- City Phone °C Mame City 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 5tatutes and City of Eagan Ordinances. Signature of Permittee A Building Permit is issued ta--' on the express condition that all work shal I be done i n accordance with all ? .t : , ?;• ?,..l.'.? ? rt? APPROVALS Engr./Assess. Planner Council Bldg. OH. Variance Occupancy } Zaning (Actuaq Const (Allowable) # of Stories Length Depth S.F. Total Footprint S.F. FEES Permit Surcharge Plan Review = + SAC, City I SAC, MWCC `' ? •'-'? ,I Water Conn. 5 .OU ? Water Meter , %_:?} `y Road Unit .) 9 Treatment P1 Parks TOTAL • ? ; Permit No. - Permit Holder Date TeIsphone it Plumbing ,` _;"',•? ; ?, , ?, r ? '?`'y?S-`• H.'IA.C. U °; .: ,?? •.:. ; ; , • / ?t'I_i` /? ? ??/:vj???? Electric /-5/ j? ? !?'"!z ?zC?r•0 l;? ^ ?" ? ??'f??? `?. / i -c' 7 o / ;25, , i? C' ? ni Softener Inspectfon oata Insp. CQmments Footings I ?e Footings II Foundation Framing Roofing Rough Plbg. 1- Rough Htg. / ? Isul. ? ? I Fireplace ?o ? ?j Final Htg. Final Plbg. Bldg. Final ? ?. Cert Occ. Temp. LP DeCk Ftg. Deck Final Well Pr. Disp. G CONTRACT PRICE Site Address f Lot Block Sec Sub , f m Name t 4<< ? Address c City Phone Name ? 3 Address / p City Phone FEES COMM/IND FEE - 196 OF CONTRACT FEE APT. BLDGS - COMM RATE APPLIES TOWNHOUSE 8? CONDO - RES. RATE APPLIES MINIMUM - RESIDENTIAL FEE - $12.00 MINIMUM - COMM/IND FEE - $20.00 STATE SURCHARGE PER PERMIT - .50 (ADD $.50 S/C IF PERMIT PRICE GOES BEYOND $1,000.00) Z?? SIGNATURE OF PERMITTEE FOR: CITY 0 F EAGAN . PERMIT # PIUMBtNG PERMIT RECEIPT # 7 F ?- CITY OF EAGAN 3830 PIIOT KNOB ROAD, EAGAN, MN 55122 DATE: ?`Z' PHONE: 454-8100 BLDG. TYPE WORK DESCAIPTION ? Res _ New L-" Mult. Add-on Comm. Repair Other RES. PLBG. ONLY - COMPLETE THE FOLLOWING: N0. FIXTURES yTOTAL _?5_Water Closet - $3.00 I Bath Tubs - $3.00 j-_Lavatory - $3.00 9 -' _LShower - $3.00 Z Kltchen Sink - $3.00 2 ? Urinal/Bidet - $3.00 -Z Laundry Tray - $3.00 _LFloor Drains - $1.50 ?• 2!?7_ O ?Water Heater - $1.50 Whirlpool - $3.00 _L_Gas Piping Outlets - $1.50 ?• ? J (MINIMUM - 1 PER PERMIn Sottener - $5.00 Well - S10.00 Prfvate Disp. - $10.00 Rough Openings - $1.50 FEE: ?STATE S/C: L GRAND TOTAL: r ' C7 U , . , , • MECHANICAL PERMIT RECEIPT # 2 56G 7 _ :. CITY OF EAGAN ? i' • 3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: 1?=?d 'RACT PRICE: ,t.JCZ, Cy-?' PHANF• asa.nlnn Site ? Name 4 m Address c City " Name c Address p Ciry hone T1fPE OF-W4RK :.. _. _ = -- Forced Air M BTU Boiler M BTU Unit Heater M BTU Air Cond. M BTU %- <C Vent. CFM Gas Piping OuUets # tz?' FEE: S/C: TOTAL: BLDG. TYPE WORK DESCRIPTION Res. New M ult Add-on Comm. Repair Other FEES RES. HVAC 0-100 M BTU -$24.00 ADDITIONAL 50 M BTU - 6.00 (RES. HVAC INCLUDES A/C ON NEW CONSTRUCTION) GAS OUTLETS (MINIMUM - 1 PER PERMIn - 1.50 EA. COMM/IND FEE - 1% OF CONTRACT FEE APT-BtBl33. -COMM. RATE APPLIES TOWNHOUSE & CONDOS - RES. RATE APPLIES MINIMUM RESIDENTIAL FEE - ALL ADD-ON & REMODELS - 12.00 MINIMUM COMMERCIAL FEE - 20.00 STATE SURCHARGE PER PERMIT - .50 (ADD $.50 S/C IF PERMIT PRICE GOES BEYOND $1,000) /t ? 1 f SIGNATURE OF PEFiM FOR: CITY OF EAGAN ? CASH RECEIPT ? + CITY OF EAGAN 3830 PILOT KNOB ROAD EAGAN, MINNESOTA 55122 DATE " 19 R<C61VED P'wom . AMOUNT $ t :-..! • r [:] CASH [-] CHECK DOLLARS too rOR ?j?' % ?' c 7 ?? ?,c-??Z,? ? ??: «•c?.. . / - ; . FUNO I CODE I AMOUNT ? ?.. Thank Yk BY °`; " ;3 ! ? White-PaYero CoPV Yellow-Posting Copy Pink-File Copy 1-- 01-3210 01-3422 01-3445 01-3446 '01-2155 17-3860 20-2275 20-3865 -B'LbG. PERMIT 20-3868 20-3716 20-2252 20-3713 20-3743 79-3866 11-3855 Bldg. Permit Plan Check Surch./Adm. SAC/Adm. Surcharge Road Unit 5AC Water Conn. Water Trmt. Water Meter Acct. Dep. Water Permit Sewer Permit Sewer Conn. Park Ded. ? ?._. cz.uUt? 1??? `; •_ ' ?,., _...-, TOTAL CITY OF EAGAN 3830 Pllot Knob Road P.O. Box 21199 + Eagan, M?i 55121 Owner. Site Ad Conn. Chg: •525:M, pd Acct Dep: 15. 00p4 Permit Fee: - - 14.00pd Surcharge: • Supd Tr. Plant 1'_0.011Pd Meter. Misc.: '"'T VAI.VB .QCI?.E D Permit No: Meter No: Reader No: Date: 9-29'97 Size: Date: Luadgren Bros. Zoning: No. of Units: 1 I agree to comply with the City ot Eayan Ordlnancea. er WATER SERVICE PERMIT CITY OF EACaAN 3830 PIIoI?nob Road P.O. Box 21199 Eagan, MN59n2f Permit No: 10252 B/P No: Z7R1? Date: 9-29-87 Date: 9-28-el Owner. Zxindvr-' 2 B ro s. Site Address: :607 ?? s::.:t:ry PZace L9 B4 Bleckl?+wk G1en II MWCC: '.52 5 : sJUF(j City Chg: IC-0• ?'Opd Acct Dep: 7 ? t 10pe' Permlt Fee: 1c), oOmi Surcherge: • :';opd Zoning, No. of Units: I agree to comply with the Clty of Eagan Ordfnances. BY SEWEii SERVICE PERMIT i (Itr#i#ira#t uf (Orrupanry titp of (Eagan ]Rpparhnrtct of gttdbatg iwjerfina Tltis Certificate issued pursuant to the requirements of Section 306 of the Unifonn Building Code cenifying rlurt at the time of issuance rhrs strucrure was in compliartce with the various ordrnances of 1he City regulatrng building construction or use. For the following. Uae Chsmfuation Bldg. Ptrtnit No. . I OMMP-Y TYa R' zoein nimia g j .rype coOSL V QwnerdBuilding LU?-L? BRW, `:% A?; Addrde G 3c, : W.'UATA 1-1:?71 ? A;'i,! aWw;oeAdd. lfl?"f .4.<?=F?,?'+' 1''.E?:' [,o?;ry F?, bt?. ??C C3A[?: Q.? n„e: DECEtM. 29s 4987 &ulmng 016cia1 - POST IN A CONSPICUOUS PLACE This requast void 18 months from / D 51352/g/ rne. I qe9p., etli nsuecluon IIFIfteetlv Nuw []WiII Nnuty InsPec'I 9 aC.J ?Q El Yes witle- [or When ReadV 49-LTCensed Electncal ConVacmr I hereby retluest mspecYion ol above 0 O`9^er elactncal work installed at Street Address, Boz or poute No. 6 ` Ci 0 7 SV/3vx ??cz. ? ecuon o. Townshiv Name or o. anpe No. Co 1v '"07A Occ u pa 4 t IPRINTI Phone No. ? ? / W I L.AD F._ Po r $upDl i er Ad ress / ? ,, 4? Nl ?1CTl - ?ocd ?J/ /g Electncal Convactor (COmpany Name) Cnn[raci r'z L¢ense No. Standard Electric Co. 40837 Mailing qdJress (ConVactor or Owner MBkina InsinilaUOnl 2672 M 1 ood Dr., Maplewood, Mn 55109 AuNonzed 5 ure (Cont uctor Ow r a Inv[allaLOn) Phone Number 1 484-8044 MINNi STATE BOAND OF ELECTRICITY ? THIS INSPECTION XEQUEST WllL NOT Gri09s-Midway Bldg. - Room N•191 BE ACCEPTED BV THE STATE BOANO 1821 Unirersitv Ave.. SI. Veul, MN 65100 UNlE55 PflUVEN INSPECTION FEE IS Phone(612) 642-0800 •ENCLOSED. ?j/??'/&'/j REQUEST FOR ELECTRICAL INSPECTION ee-ooooi?-/os ' See instructions lor comvleL ethis form on beck ot vellow copV. D 51352 "x BeloW Wak Covered by This Request Add FaO. TVOe ol 8wltling ApOlmnceeWvaJ Equiyment Wved F.% Heat I I I I Commercial Bidct. I I Furnace I I silo Unloader I I I I I InAustnal 81Aa. 1 I Air CondiUOner I I dolk Milk Iank I C Fee ServicaEntranceSixe H Fee Fnndeis/Subteednrs N Fa,a Circuits 0 to 200 Am s 0 to 30 qm s U to 30 An s Above 200 qmps 31 to 100 Amps 31 to 100 A s Swmmung Pool Above 100-Amps Above 100_Am s Transiormers Irrigation Eboms ,• O Partial Ot ziigns ?Veviei ii"Ne".uii $ 3?p TOTA?FE?-? Remarks / G^? ? %? C. I noo9n-?n '. " I•••••` I I. ns fhe l4aciueSr I peclor, ?BreCy LBr11ty lhet 1h@ TbOVO Final I ? ? _. ? ???C'? inspection hes Eeen /?i T mede. TMn This reques't vmej/ 18 nwnths (mm ? 6 57 6 4«.2,? ? -;?4/' Request Dale ire No. Rouph-in InsVer,UOn Reqwred' 1 ?fleady Nuw ?]'?II Notrty Inspec- 1?-g-$7 ?NU tor When Reatly CR'Ccensed Electncal Contncmr I hareby requast inspactian ol ebove Q Owner elactrical work installed at' Street Address. Box or Roufe Na. C'tv 1607 Ashbury Place Eagan ectmn o. Townshi0 Name or No. flange No. Counry Dakota Occupam (PNINT) Phone No. Wilde (Lundgren Bros Constr.) Power SupOlier Atldress Dakota Electric 4300-220th StW.Farmington, 55024 Becfncal GonVacmr ICOmuany Namel Conernctor's License No. Standard Electric Co. 40837 MailinB P.dJress ICOMrac[or or Owner Makiny Instailauonl 2672 M plewood Dr., Maplewood, Mn 55109 Author e iPnature (COnVact O ne king Ins[allation) Phone Number 484-8044 MINNESOTA STATE BOAAD OF ELECTflICITY TMIS INSPECTION REQUEST WIIL N01 GrigBS-Midway Bltl9. - Room N•191 BE ACCEPTED BY THE STATE BOARD 1821 lJniversitv Ava.. St, Peul, MN 55100 l1NLESS PflOPEN INSPECTION FEE IS PM1nnn 19191 662-OHOO ENCLOSEO. 91bREQUEST FOR ELECTRICAL INSPECTION eeC-oaooi-os 1 See instructions for com0letrn9 this lorm on back ol vellow coOV. 0 ' 65764 "X" Below Work Covered by This Request ev4 Addj Rep. TyOe ol B.iltlin8 Acoliancea Wved-- Eqmument Wved liL Home Range Temporary ServiCe Duplex Water Heater Lighniiy Fixtures Apt BwlAing Dryei Electri:; HeaUn Commeraal Bidg. Fumace Silo Unlonder Industnal Bldg. An Condrtioner Buik Milk Tenk Farm O?n?•? .oec? v .?nrr ?SUCC?ivi t er Sueci y Orhe, Mh,,, Compuie Inspection fee 8elow p Fee ServuceEnVenceSixe n Fae Fexders/Subleeders # Fr Cvcuils / 0 to 200 qm s 0 to 30 qm s 0 to 30 An >s Above 200 qmps 31 to 100 qmps .? 31 to 100'Am s Swinvning Pool Above 100_Amps Above 100_Amis Transiormers Irngation Booms ?0 ParLal- Other lie? Signs Speciallnspecbon S4 ? I ?p TOTAL FE ` Nemarks ,.--. ? li, iv , ? 1 '• - Pou9h-?n 5 , n I, the Elacv Insoectoq herahy cerlily Ihnl 'he nbove Final mspeetion has baen ' mada. rniareauestvoiClBmontnalrom i? . GOLD COPY PERMIT RELEASE FORM PERMIT li ? t C) c-) ADDRESS `(.p V I ?? V l???I? ?? PICKED UP BY ? riarF: PAxrFnrr aF FEE AT szrE oF APrtacATzoN ooFS Nar CONSTITUTE APrROVar, oF rERruT. INSPF7CrION OF SFWER ANID/OR M'LER Tt1STAi.7ATTQN$ Wn[. NOj' $r,' $('H¢D_ ULFD UNTII, PFdtNIIT AAS BEM APPRdVID. 1) PROPERTY ADDRESS: 1007 LEGAL DESCRIPTION: (,o{- 2) iLOC/nlocx/buDaivlsion or Tax Parcel ID $) . IF E2QSTING STRCY.'ILRE, DATE OF ORIGINAL BLILDING pERMIT ISSL'ANCE: 9:' . PRFSENP ZONING/PROPOSID t-ISE: Mon ear 0 CAMMERCIAL/RETAII,/OFFZCE ? R-1 SINGLE FAMILY r7 IND-'STRLaL Q R-2 DUPLEX (Two IInits) C] INSTIZ[)TIONAL/GOVEWdENT R-3 TOWNiOC?SE (Three + Units) ( t?nits) R-4 APARTNENT/CObIDOMINIUM ( Units ) NAME:-LVn>4C'{r" o (moS. P-13: AoDRFSS: 013 5- l=. . W n,2w?+? ? ?..? CITY. STATE. ZIP' 4?U Y a? yL? N y' ? 3ci I PAONE: .4') CITY OF EAGAN APPLICATION FOR PERMIT SEWER AND/OR WATER CONNECTION 3) • ?: a• NAME: ADDRESS: . CITY. STATE, ZIP: PHONE: ?a71, - 1'1.11 MAST'ER LICa1SE# ACtiVe FScpired Not recorded St? tial 4) •• • i?• NAME: ADDRFSS: CITY, STATE, ZIP: w?,?,t2a,(?? PHONE: ?7 3 -1'Z3 1 5) ?? a• • ?• : a • a? • ?? ? CONImC'PION 1+0 CITY SEWII2 ? CONNE(.TION TO CITY WATII2 6) ?? • • r Q onm?? ? PLEASE HOLD APPROVID PERMIT FOR PICK-UP BY ONE OF ABOVE PLEASE MAIL ApPROVID PERMIT T0 1, 2, 3, 4, ABOVE , .? , 11-? (Circle one) FOR -CITY USE ONLY . , PERMIT # ISSDED n ? Pd w/Bldg. Permit FEES: $ $ SEWER PERMIT (INCLUDE SURCHARGE) $ WATER PERMIT (INCLUDE SLiRCHARGE) $ $ WATER METER/COPPERHORN/OUTSIDE READER $ $ WATER TAP (INCLODE CORPORATION STOP) $ $ SEWER TAP $ $ ACCOUNT DEPOSIT - SEWER $ ?•S`?U $ ACCOONT DEPOSIT - WATER $ ?~ Z t Cr'O $ WAC S l? ? S- rrG $ sac $ $ TRLNK WATER ASSESSMENT $ $ TRUNK SEWER ASSESSMENT $ $ LATERAL BENEFIT/TRUNK SEWER $ $ LATERAL BENEFIT/TRONK WATER $ U U $ • WATER TREATMENT PLANT SLRCHARGE $ $ OTHER: $ /'(16I6 o o $ TOTAL -7-7 RECEIPT RECEIPT DOES LTILITY CO NNECTION REQUIRE EXCA VATION IN POBLIC RIGHT OF WAY? ? YES IF YES, THEN A" PERMIT FOR WORK LVITHIN PUBLIC Q NO ROADWAY" MUST BE DIVIS ISSLED BY THE ENGINEERING ION. LIST AS A CONDITION. SD BJECT TO THE FOLLOWING CONDITIONS: APPROVED By; TITLE: DATE: 5?2 J? 5? , ' ' CITY OF EAGAN No- 14221 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 BUILDING PERMIT PHONE:454-8100 7,7 9/` Receipt# ,- Tobeusedfor SF DWG/GAR Est.Value $117,000 Date SEPTEMBER 28 ,1g87 Site Address 1607 ASHBORY PLACE OFFICE USE ONLY 9 4 BLACKHAWK GLEN 2 Lot Block Sec/Sub On Stte Sewaee Occupancy R3 . MWCC Systam X Zoning Rl Parcel No. V On Site Well (ACtuap Const Name LUNDGREN BROS CONST Citywater X (Allowable) V W = Address 935 E WAYZATA BLVD PRV Requiretl _ u of Stories ? City WAYZATA Phone 473-1231 Booster Pump _ Length 64 Depth 35 , o Name SAME S.F.TOfal zoa Address FootprintS.F. ? City Phone APPROVALS FEES wW Name EngalAssess._ ___ Permd $ 554.50 t i _ . Address Planner Surcnarge 58.50 -- w City Phone Council PlanReview 277•25 a Bltlg OB SAC Gty 100.00 I hereby acknowledge that I h e read t's applic tion and ate that the . . Vanance . SAC, MWCC 525.00 mtormahon is correct a m wit all ap ca le State ot Water Conn. 525.00 Minnesota Statutes and r i nc s. C, Water Meter __?2? o00 A Signahre of Permdtee ` Road Unit ?D-00 A euilding Permit is issuDGRE BROS_ C $?_ Treatment P1 ?80.00 ontheexpresscondition[hatallworkshalibetloneinaccord cewithall apphcable S[ate of Minne. ta Statutes an ity of Eagan Ordmances. Parks $2 592.25 BuiltlmgOHicial_ - TOTAL , / 1987 BIIILDING PERMIT APPLICATIOA - CITY OF EAGAN SINGLE FAMILY DWELLINGS INCLDDE 2 SETS OF PLANS, 3 CERTIFICATSS OF SIJHVEY, 1 SET OF ENERGY CALCQLAYIOHS NOTE: ADDRESSES FOR CORNER LORS - COHTRACTOR/HOMEOiiNER HQST DESIGBATE WHICH 9DDRESS IS DFSIRED. NO CHANGES WILL BE ALLOWED ONCE HDILDING PERMIT IS ISSOSD. MOLTIPLS D5IELLINGS - RFSIDENTIAL RENT9L IINITS FOR SALE ONITS INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SQR9SY - CHECK BITH BLDG. DEPT., 1 SET OF ENERGY CALCULATIONS C0M4BRCIAL INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS, \v $2,000 LANDSCAPE BOND ' I ? 71 , LI B d F T U l 4?jV ti ?- Date: se o e or: ua on: Site Address ?1p0 OFFICS USE ONLY C Lot I Block On Site Sewage Occupancy 2. 3 ;? N? _ MWCC System ? Zoning ? I Parcel/Sub - Site Well -96 Type of Const ? City Water ? (Actual) Owner (Allowable) ? Ik of Stories q Address Length C04 ?,,• Depth 3_S City/Zip S.F. Total Footprint S.F. Phone APPROV6LS FEFS c Contractor d? Assessments Permit 554.L . Water/Sewer Sureharge 59.2 Address Police Plan Review 2'7? Fire SAC, City I po . City/Zip Code Engr SAC, MWCC S?215- Planner Water Conn 25. Phone Council . Water Meter (07, Bldg Off Road Unit 30 S Areh./Engr. APC Treatment P1 (p,D. Variance Parks Address Copies TOTAL City/Zip Code S Phone ll d 20 1(oo -7 & 4?24 q-qo x f2 ` ?28c? ? (z = ?q?a 8 = I Wx 2r -? ?-- 4358q-- ?????? .?. `?F. SURVEYOR'S CERTIFICATE N W 33D 833.0? ?2!/)/? ,% 3 \ \ .? ? i ? ? 828.6 / ? LOT\ 9 ? ?a \\ ? 3> ??ORAlNAGE 6 UTlLITY ? S) EASEMENl PEA PLAT y 1 ?o 835.5?-.- > ?o 833.0\ \ ? :?.v±,,•S? O__ 1, ?• >s, . ? 834.9 ? ? f \ \1b Q/ \ ??? / \ \ ? \O ?- SIGNEII: JAId[5_R. IIIIL, iPIC. t// 4- 6Y: ) 0, P-.? IIAROI(1 C. PE7ERS0I4, LAIID 5l1RVEY0R MIWPIE50TA LICENSE IdUI•IQER 12294 835.0 ? ? ?34.9 \ -? DEN07E5 PROPOSED SURFACE ORAINAGE O ,DEN07ES iRON HON(JI•".ENT SE7 • DeNorES IRON h10NUMEPlT FOUf7D X000.0 DENOTES E1l15T1Nf EI.EVA710N (000.0) DEIIOTES PROPOSED ELEVATION llE IIEREE3Y CERTIFY TO SIENNA CORPORAI'ION REPRESENTA7ION OF A SURVEY DF 711E DOUNPARIES OF: SIENNA CORPORATION 1l ?o) l 1 1,a "J 830.9 `- _ f" ? i - J ?? , _J ? 4?- Q C_ (D •W ?/ (_) ,-- ? >r W ?= l J \ / L J tZ C j `? ;r- _ ?r) ?r6,<,??-- 9? \ J REV ISED 9-I I- 8T 70 'SHOW PROPoSED I-IC/JSE d EXISTIN6 ELM. FOR LUNDGREN BROS. CON57. SCAL[: 1 tNCI{ a 30 FEET PROPOSE[l GARltGE FLOOR e?37.g FEE7 PROPOSEO LOl•lE5T FLOOR A 83n.1 FEET PRDPOSED TOP Of f3LOCK = PS3s3.z FEET 711A7 T111S IS /l TRUE APlD CORR@CT Lot 9 Olock 4 BLACKHAWK GLEN 2ND ADDITION, accnrding to the recorded plat thereof, Dakota County, Mlnnesota. IT DOES NOT PIIRPORT 'TO SIi0W 1MPROVEtIENTS OR EMCft0AClihIEN75, IF ANY. /1S SURVEYEO [3Y 1-1E OR UNOER MY DIRECT SUPERVISION THIS 30TH pAY OF DECEP1BER , 19 86. TIIE LEGAL DESCRIPTIdN USED ON THIS SURVEY W[LL BECOME VALID UPON FILING THE PLAT OF BLACK- IIA4JK GLEN 2ND ADDITIDN. AOJECT NO. 85618 F1LE NO. FoLoER ROOK / PAG 2a?/21 ptoominplon, Mn. 55431 612-864-3020 i r 90 - ?GSFFO ; % "J)x834.9 ' ?? ?? .s ?°/ a? s ?a ry h y?/ i/y M?? [ `?' ` 0? • \? S ,' ?? „ _ ? JAMES R. f-IILL, INC,. Planners / Cngfneers / 5urveyors 0200 Humboldt Avonin South ?COI?CIRUC110N ---- ---- -____ <<o . 12 47's-1231 , WNYZNTP. 80ULEVNRD •?'?`? YZHTA. ?lIIJNESOTh ???y i (^o) 9.,5 EAST EY.7EP.IOF. E(J'JELOPE P.VEP,F.GE U C0;'iPU7hT)01-0 aN? ? ? ? Lot? B1ock? , ? Site Address •° ? /Ge 7 ? R u R 8 5 _O58 Opaoue Walls - _.117 blall Framing Areas - - 1- .023 Ceiling Insulation Area - .027 Ceiling Framing Frea - -' .04 Rjn JOiSL .14 iSasonry Wall - .26 !iindows Double Hung - 4E Casenents - .18 Doors -- ? - .46 Patio Doors .47 Sidelites - 1) Lower Level (Basement) ? Total exposed wall area f ?x (U) -058 = ?-- ppaoue ldall Area - ? X (U) .117 = iJood Frame Area - _- _ X (U) .04 = ? Rim Joist gox (U) -14 = Exposed block 46 ? = J ? Window Area Casement x ?-x (U) (U) - 26 - ? • Double Hung _ X (U) .46 = __- Sliding Glass Door - t x I (U) .18 = __- Door Area ?- - Total , L V r? ? ?? ?? c H (CCONSIRUC110N p d, u,4C. 2) ? , ? - - . WNYZNTl,, I?,U:NESOTA SS391 ' (612) 473-1231 935 EAST vdAYZATF. BOULEVhRD lst or mzin rioor iotal er.posed wa11 area ppacue wall area blood frame area Rim jo5st l?indow Area Casements Doubl e Hung Sliding Glass Door Door area Sidelites 3) 2nd fIloor if 2 story ' 7ota1 exoesed wall area ' Ooaque wall area k'ood irame area 1•lindow area Sliding glass door Door area 4) Total ceiling area Wood frame area Opaque ceiling area Skylight C- Casements Double Hung 52? X (U)' _053 = UL x (U) -117 = (U) .04 = s, ? ax (U) .46 -26 'j?0 x I U) .46 = ??-{--- ia ? g x (u) _ 13X (U) .47 = ??- 16) J ? 7otal / G8D X ( u) .058 = ?? (u) -117 = -Z-X -?LX ? ?U? .46 .26 ?x ( U) .46 = .? -- _-x (u) - 18 = ?-- ? ? Total - ? ?' _ - ? - ? -? Fl1-ix ( U) -023 = 02 .2 --x (U) .55 Total °? ? _ ??j ?co??siaucI?o?J '?:!J ?. IfJC. --- - ?- . , ?1?IIJN[SOTA SJ.?.?'? • (6'iz) 473-1231 935 ENST VJkYZNTA BOULEVhRD IJf.YZF.7/'„ X 11inn. U Factors Total exposed wall area c- y, .020 = ?-S F;inn. U Factors Total exposed ceiling area ?_? (A) 7ota1 - ?? Item Item I?em 32/. ?.3t Item 4a If total of Items 1- 4 is less tnan Item (A), building complies with SBC 6006 (C)s C _. cr O69317 y ; Requesl Da[e r I?p `' ? ire No Rough-in Inspecpon NOTICE: Vou Must Call Eletlnwl Inspector ReqwretlT II A poughln Inspection \ 7 ? Ves 'V.No Is Requiretl I J$1'licensed contractor ? owner hereby request inspection of a6ove elec rical work at: Job Atldress (Street, Box or Route No.) ' City ) \V40 1 tftGRJ, Secuon No Township Name or No Range No Cou?-nry Occupant(PRINT) Phone PJO. -TD ?4x Powe Supplier Atldress . (' M.' OOe.-? . 4 Y(MA'?\ /•? M+? W?`1 Eledncal Contractor (Company Name) ? Contrector§ License No, .OcUeL??.L Meihng Atltlress ( nVacfor or Owner Mekin InstallationJ r1 Aulho Signature (CO or/Ow Making Installaeorl) ber Phon e Num \ ? ? ?" `Q1 MINNESO7A STATE BOWF ELECTpICITV THIS INSPECTION REQUEST WILL NOT Grigga-Midwey BIEg. -Zioom S-173 V BE ACCEPTED BYTHE STATE BOARO 1821 Oniversiry qve., SI. Paul, MN 55104 UNLESS PROPEF INSPECTION FEE IS Phone(612) 612-0800 ENCLOSED REQUEST FOR ELECTRICAL INSPECTION 11- See insiructions iw compleling ihis form on back of yellow copy lol p? ? 6 6-3 17 "X" Helow Work Cavered by This Request EB-00001-OB ??•. ew A64a Rep. Type of Building AppliancesWired EqmpmentWved Home Range Temporary Service Duplex Water Heater edric Heahng Apt. BuAding Dryer I oad Management Comm /Indusinal Fumace ther (Speary) Farm Air CondRioner Olher (specily) Contraclor's Remarks Compute lnspection Fee Below. # Other Fee # ServiceEniranceSize Fee # CircuM1S/Feeders Fee Swimming Pool 0 to 200 Amps 0 to 100 Amps Transformers Above 200 _ Amps Above 100 _ Amps Signs Inspecmr5 Use Only \ TOTAL `a Irrigation eooms ?G IQ* Special Inspection Alarm/Communication THIS INSTALLATION MAY 8 ED DISCONNECTED IF NOT Other Fee COMPLETED WITHIN 18 MONTHS. I, the Electrical Inspector, hereby Rough-in oate cerirfy that the above inspeciion has been made. 6 Q OFFICE USE ONLY This aquesl vaid 18 months imm ?-BUILDING PERMIT APPLICATION (RESIDENTIAL) CITY OF EAGAN ?? ? 3830 PILOT KNOB RD - 35122 851-681-4875 R 3 registered aHe wweys flwwing p. fl. of lof, 2% n, ol houae ana gH rooted areas t7096 maxlmum lot covemae allowe? 2 caples of plana (ahow beam & wlndow alzes: poured fitl. deqgn: efcJ I ser a energy cma,lanona ? 3 coples ol tree preaervatl plan I1 lot plaMed alter 7/1/93 DATE: I2?Z7o ? Rertadel/Reoalr Reauire?menhe? a -U I ?( 2 copies of plan iz I n ? 1 1 set ol enargy calcWOtlons br healed addlHOns 1 sife wrvey for exterbr addiflons 8 decki CONSTRUCTION C05T: / 5, DESCRIPTION OF WORK: ??/? STREET ADDRESS: LOT: ? BLOCK: ? SUBDJP.I.D. ri: ?L?Ir e- C. C-a'j L Name: %0plt ?i( !? 1,C- V Phone?: PROPER7Y Loat First OWNER Sfreei Address:/?'az 4a6/!?A' • City le- 4'&4? State: Itolil IIp: S.Sl 2.L -/ L Z3 G . Company: ???Plsone M: (area code) CONTRACTOR SheetAddtess: LS- <??n.? Llcense# ?5?,8 Exp Jy?? --f t city state: ziq: ??5 o7Z_ ARCHRECT/ ENGINEER Comparry:, Name: Telephone Y: ( ) Sheet Address: RegishaNon CHy State: Lp: Sewerfwaler licensed plumber (if installina aewarlwaterl: Ph°"e #: (? I hereby acknowledge Ihat I have read this applicaHon, state tFwt fhe infortnayorlRe and agre * com?ly wHh a ppuca of Minnesota Stafutea and Cify of Eagnn Ordinances. .( / ?? 2? ?,ti ? . Sigrmture of ApplicanY. ? ? '` .c.¢xc+ OFFICE USE ONLY Certificates of Survey Received _ Yes _ No ' DEC 2 7 2000 Tree Preservation Plan Received _ Yes _ No _ Not Required ^ ? OFFICE USE ONLY BUILDING PERMIT SUBTYPES ? 01 Foundation ? 07 05-plex ? 02 SF Dwelling ? OS 06-plex ? 03 01 of _ plex ? 09 07-plex ? 04 02-piex ? 10 OS-plex ? 05 03-plex ? 11 10-plex ? 06 04-plex ? 12 12-plex WORK TYPE p 31 New ? 32 Addition ? 33 Alteration ? 34 Repair Zoning ? 13 16-plex ? 21 Poroh (3-sea.) GENERAL INFOI SAC Code No. of Units No. of Buildings Const. (Actual) (Allowable) UBC Occupancy ? 17 Garage ? 22 Porch/Addn.(4-sea.) ? 18 Deck ? 23 Porch (screened) ?Q 19 Lower Level ? 24 Storm Damage Pibg _Yor_N ? 25 Miscellaneous ? 20 Pool p 30 Accessory Bidg. ? 36 Move Bldg. ? 43 Reroof ? 37 Demolish (Bldg)' ? 44 Siding O 38 Demolish (Interior) ? 45 Fire Repair O 42 Demolish (Foundation) ? 46 Windows/Doors ' Give PCA handout to applicant for demolition permit # of Stories Length W idth Basement sq. ft. Main level sq. ft. sq.ft. sq.ft. sq. ft. sq. ft. Footprint sq. ft. Census Code MC/ES System City Water Booster Pump PRV Fire Sprinklered MISCELLANEOUS INSPECTIONS ? Stucco/Stone APPROVALS Planning _ Permit Fee Surcharge Plan Review License MC/ES SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment PI. Park Ded. Trails Ded. Other Copies Total: Building l,( Engineering Variance Valuation: $ ";00(9, aa ? 31 Ext. Alt - Mutti ? 33 Ext. AR - SF ? 36 MuRi SAC Units % SAC PERMIT# Hq.572 RECEIPT DATE: 9 IG I MIDENTIAL f'LUM$INfi f'EitM1T ALPPI1CATION crrY oF EAsa?v S$SO PII.OT KFOB RD EAfiAN, E1P 55122 651-6$1-4675 Please complete for: ? single family dwellings ? townhomes and condos when permits are required for each unit ? backFlow preventer for irrigation system SITE ADDRESS: OW NER NAME: :?pver?v `,t PS? ?ec mn,(\ TELEPHONE #: (aRe.a cooe) INSTALLERNAME: McGUITE Ft 2`01e3 TELEPHONE#: 95a 931-9WIj2 Veul±t; .(:u (AREACODE) STREET ADDRESS: HG i(i(i'4NTiU 55343 CITY: Place a check mark next to the oermit work tvoe STATE: ZIP: New residential dwelling unit under construction and not owner/occupied $ 90.00 ? Add-on, modification or alteration to existinp dwelling unit, including: $ 50.00 • abandonment of septic system • new installationlrepair/rebuild of RPZ • lawn irrigation system • waterturnaround Nature of work: \Dlinc,e l. le.r '?\Pm WJK Septic System, new/refurbished - $ 225.00 ? • indudes County & Consulting Inspector fees • reqwres NirC iicense State Surcharge $ .50 Tota I $4Z ,5D Reminder. Be sure to schedule inspections of alteretions, i.e. water heaters, water softeners, etc. I herebyacknowledge that I have read this application, state thatthe information is correct, and agree to complywith all applicable Cityof Eagan ordinances. It is the applirant's responsibility to notify the property owner tha[ the City of Eagan assumes no lia6ility for any damages caused by the Ciry during ils normal operational and maintenance activities to the facilities constructed under this permit within Ciry proRdFty/right-of-way/easement. OF P Updated 1/Ot PERMIT # q `' k ?--? RECEIPT DATE: I - O- U ( p?- `__I r?a_c,k,?nci,_w--k Please complete for: SITE ADDRESS: OWNER NAME: : INSTALLER NAME: STREET ADDRESS: TELEPHONE #: 65"1 4Sa - 805? (AREA CODE) TELEPHONE #: /o5I Y'.23 - 3`1C30 (AREA CODE) CITY: ?A??,LY1 v STATE: 7,W ZIP: S50i3 ? Place a check mark next to the uermit work tvoe New residential dwelling unit under construction and not owner/occupied $ 90.00 / Add-on, modification or alteration to existin dwelling unit, including: $ 50.00 • abandonment of septic system . new installation/repair/rebuild of RPZ • lawn irrigation system • waterturnaround Nature of work: JiiY/N? -5jv Yi,nr,c?' 4AJ!4 Septic System, newirefurbished - I $ 225.00 • includes Cuunty & Consulting Inspector fees • requires MPC license State Surcharge $ 50 r? L5 rotal ,JAN 4 2001 So.50 $ Reminder: Be sure to schedule inspections of alterations, .e. water heaters, wat r softeners, etc. I hereby acknowledge that I have read this application, state that the informafion is correct,?rse?23? cable City of Eagan ordinances. It is the applicanPS responsibility to notify the property owner that the Ciry of Eagan assumes no liability for any damages caused by the City during its normal operational and maintenance activities to the facilities consUucted under this permit within Ciry property/right-of-wayleasement. SIGNAqURE OF PERMITTEE MIDENTIAL PLU14IBIN6 PFgMIT APPLICATION G I-? v, -4-1?-o CITY OF EAfiAN 3$30 PILOT KNOB RD EAfiAN, MN 55122 651-681-4675 ? single family dwellings ? townhomes and condos when permits are required for each unit ? backflow preventer for irrigation system Updated 1l01 CITY DF E:AfAN CA'iH:CI:Rt JS Th.F'MINAL Npe OU? DATC: f.37/15/?9 T'Ci1F: 10:32:41 ITi u NAML"-::: iEl._A fi0C1F'LNG f: fiFMODEI.ING 3210 9001 007 i151-IbUfiY P'L_ L39.25 055 9001 1607 A51•IRl.1RY I*L 3,50 ? 'iota1 Fieceipt Ainount: i4r.'..7`; Gfi:l.13436 USI':F. TD: .7AN 1999 BUILDING PERMIT APPLICATION (RESIDENTIAL) I?f a. 7S CITY OF EAGAN 3830 PILOT KNOB RD - 55122 651-681-4675 New Construcflon Reauirements Remodel/Reoair Reauiremenfs 9 3 regfstered sHe surveys showing sq. ri. of lot, sq. fl. 01 house 2 coples of plan and all rooled areas (207, maxlmum lot coveraae allowed) 1 set of energy ealculafions tor heated addMlons > 2 copies of plans (show beam & window sfzes; poured fnd. design; etc.) ' 1 sRe suney for exlerlor addRfons 8 tlecks 7 seT ol energy calculaffons > 3 copies oi Tree preservafion plan H lot platled afler 7/1/93 DATE: 7-I ¢_ % l CONSTRUCTION COST: ?'S oa DESCRIPTION OF WORK: NoUSP /'r STREETADDRE55: _160F- SUBD./P.I.D. #: Z -0 A •?s ? LpT: I BLOCK: 4- Name: -5?e!'?/ e?M" i3everJZ Phone#: 8S?"?5?a-??fJ?? PROPERTY tast FIM OWNER Street Address: 144 ? City State: Zip: Company: Phone #: 612 £5A 3 ^1* a??-E 4i00 EXCELSIOR BLVD. (area code) CONTRACTOR O`P, LOUIS PARK, MN 55416 Street Address: ID #00(11n.sn License # 1EXp, 3l3/ '9O ARCHITECT/ ENGINEER Ci1y Telephone #: area code ( ) State: Zip: Name: Street Address: Registration #: City I Sewer 8 water Ilcensed plumber (reaulred for new consirucfion onlv): State: , Penalty applfes when address change and lot change is requested once permit is issued. Zip: I hereby acknowledge that I have read this application, state that the information is cortect, and agree fo comply wifh all appllcable State of Minnesota Slatutes and City of Ecgan Ordinances. Signature of Appifcant: ? OFFICE USE ONLY Certificates of Survey Received _ Yes _ No Tree Preservation Plan Received _ Yes _ No _ Not Required OFFICE USE ONLY BUILDING PERMIT TYPE ? 01 Foundation ? 06 4-plex ? 11 10-piex ? 16 Fireplace ? 21 Porch (3-sea.) ? 02 SF Dwelling ? 07 5-plex ? 12 12-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 03 1 of _ plex ? 08 6-plex ? 13 16-plex ? 18 Deck ? 23 Porch (screened) ? 04 2-plex ? 09 7-plex ? 14 Apartments ? 19 Lower Level ? 24 Storm Damage ? 05 3-piex ? 10 8-plex ? 15 Lodging ? 20 Pool ? 25 Miscellaneous WORK TYPE ? 31 New ? 35 Tenant Impr 0 39 Gas Line Only ? 43 Siding/Soffits/Fascia ? 32 Addition ? 36 Move Bidg. 0 40 Gas Insert ? 44 Windows/Doors ? 33 Alteration ? 37 Demolish Bldg. ? 41 Wood Stove ? 45 Fire Repair ? 34 Repair ? 38 Demolish (Interior) ? 42 Reroof GENERAL INFORMATION Const. (Actual) (Allowable) UBC Occupancy Zoning # of Stories Length Width APPROVALS Planning Basement sq. ft. Main level sq. ft. sq. ft. sq. ft. sq. ft. sq. ft. Footprint sq. ft. Building Engineering Census Code SAC Code No. of Units No. of Bldgs MC/ES System City Water Booster Pump PRV Fire Sprinklered Variance Permit Fee Surcharge 3, 5p Plan Review License MC/ES SAC City SAC Water Conn. Water Meter Acct. Deposit 5/W Permit S/W Surcharge Treatment PI. Park Ded. Trails Ded. Other Copies Total: )La .15 SAC Units Valuation: $ ! oo D ? % SAC ?3 2 41) 2006 RESIDENTIAL MECHANICAL nERMiT arrLrca'rioN City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Teleplione # 651-675-5675 Please complele for single Tamily dweltings & townhomes/condos when pennits aie required for eac6 uni[ $30.So Datc ld I,?d l G'lo Site Address & f Unit # Property Owner sj 6 rr& i)? 17 kJ Telephone # Coutractor Street Address City ? State ?Yfl?• Zip Telephone# Bond Expires: 4 ' O?U - d7 The Applicant is _ Ownex _ ConVactoc _ Other Add-on or alferaYion to existing dwelling unit $ 30.00 TtivGY6 furnace 7rmJL- _Additional _Replacement _ New air exchanger ? air conditioner`I Y( Q?Z_. 3/?A) - l?I SL?'l heat pump other State Surcharge V $ .50 <?lij ti Sv $ Total NY "lz ? ?v I hereby apply for a Residential Mechanical Pe? d acknowledge that tl?e information is complete and accurate; that the work will be i?? conforma?ice with the ordinances and codes o the CiTy of Eagan and with the Mechanical Codes; that I unders[and this is not a permit, but only an application for a permit, and work is oot to start without a permit tliat the work will be in accordance with the appmv d plan in t6e case of work which requires a review and approval of plans. ?t'1?? ApplicanYs Printed Naine ApplicanPs Signature PERMIT Permit Type: Building City of Eagan Permit Number: EA105616 Date Issued: 07/23/2012 Permit Category: ePermit Site Address: 1607 Ashbury Pl Lot: 9 Block: 4 Addition: Blackhawk Glen 2nd PID: 10-14351-04-090 Use: Description: Sub Type: e-Reroof Construction Type: Work Type: Replace Description: House & Garage Census Code: 434 - Occupancy: Zoning: Square Feet: 0 If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar. Pictures are Comments: not acceptable in lieu of inspections. Carbon monoxide detectors are required by law in ALL single family homes. BL - Base Fee $4K $103.25 0801.4085 Fee Summary: Surcharge - Based on Valuation $4K $2.00 9001.2195 Valuation: 5,200.00 Total: $105.25 Contractor: Owner: - Applicant - Reroof America Thomas D Siefferman 10740 Lyndale Ave S 1607 Ashbury Pl Suite 10W Eagan MN 55122 Bloomington MN 55420 (952) 888-8440 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 PERMIT City of Eagan Permit Type:Building Permit Number:EA116563 Date Issued:10/08/2013 Permit Category:ePermit Site Address: 1607 Ashbury Pl Lot:9 Block: 4 Addition: Blackhawk Glen 2nd PID:10-14351-04-090 Use: Description: Sub Type:Reroof Work Type:Replace Description: Census Code:434 - 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 by law in ALL single family homes . jackie terrell 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 - Thomas D Siefferman 1607 Ashbury Pl Eagan MN 55122 Walker Roofing Company 2274 Capp Rd St Paul MN 55114 (651) 251-0910 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA121256 Date Issued:03/21/2014 Permit Category:ePermit Site Address: 1607 Ashbury Pl Lot:9 Block: 4 Addition: Blackhawk Glen 2nd PID:10-14351-04-090 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. Kris Oien 3670 Dodd Rd Eagan, MN 55123 Fee Summary:PL - Permit Fee (WS &/or WH)$55.00 0801.4087 Surcharge-Fixed $5.00 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 - Thomas D Siefferman 1607 Ashbury Pl Eagan MN 55122 Champion Plumbing 3670 Dodd Rd., #100 Eagan MN 55123 (651) 365-1340 Applicant/Permitee: Signature Issued By: Signature