4030 Cedarvale DrCITY OF EAGAN Remarks 7't
Addition S2CtlOri 19 Lot Rik parcel 10 01900 100 08
Owner ? L` Street State EAGAN NIN 55122
7
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
_31?- SERVICES -- V""
SAN SEW TRUNK G,
SEWER LATERAL
CEDAR GROVE ACQ.
ATERMAIN
WATER LATERAL
WATER AREA
STORM SEW TRK
STORM SEW LAT
QoS a8 rlc? rq8 ,J7-aoo 1.,5r.a0 Co i/ss 3 i3 8?
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER. 7728
SAC 11970 $414.00 $82.80 5 PAID
. -' 37lS Pilet Knob Road Eegen, MN 55122
PHONEs 454-8100
BUILDING PERMIT Receipt #
Site Addrcss
Lot Block Sec/Sub. ?
Pcrcel #
ac Nome
W
; Address .
b _
?o Nome
r
uU Address
Nume _
Addross
I hereby ockrawledge thut I have read this oppiication and stote That
fhe intormotion is correct and ogree to wmply with all opplicable
State of Minnesoto Statutes ond City of Eogon Ordinances.
7?2$
Eroct ? Occuponcy
Nlter ? Zoning
Repoir ? Fire Zona
Enlo?ps ? Type of Const.
Move ? # Stories
Demolish ? Length
/lssessment
Water 8 Sew.
Police
Fire
Enp.
Ptanner
Councll
Bldg. Off.
APC
Permit
Plan check
SAG
Water Conn.
Woter Meter
Road Unit
Totol '
Signoturc of Permittes I
/1 Building Permit ls issued to: on the axprcss condition thn,
all work sholl be done in occordance wirh oll opplicable Stote of Mlnnesota Stotutes and City of Ea9an Ordinances.
euildi??o osrlciol
Permit No. Psrmit Holdsr Misc. Permit No. Holder
Plumbin9 z^f ?
H.V.A.C.
Wdl
Water
Disp.
Sawar
Electric w otq ?,? a ?L?. ! z7 -?3
Inspection Date Insp. Other
Footinyt 'o704
Foundation
Freming
Rouyh PIb9. 3-?
RouQF+ HVA
Inwlation
Final Plby. 4 /1-Y r.fJ
Final HVAC
Final
wa"r Doraibs Location:
MWII
Savwr
Pr. Disp.
Receipt PLUMBING PERMIT Permit No.
CITY OF EAGAN
Fea
Fill in numbered speces S/C
Type or Print legib/y Tot.
1. Date 2. Installation Cost
. .
3. Job Address Lot Bik. Tract
4. Owner
5. Contractor Phone
6. Address
7. City State Zip
8. Building Type: Residential O
9. Work Description: New O
Commercial q" Institutional O
Add 1:1 Alter L7: Repair ?
10. Describe
11
No. Fixtures
Water Closet No. Fixtures
C
l
/D
f
Bath tubs esspool
rain
ie
d
T
S
i
k
Lavatory ept
c
an
f
S
Shower o
tner
W
l I
Kitchen Sink e
Urinal/Bidet O
h
Laundry Tray t
er
Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed :
for
Rough Final
. Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
,Approved CITY OF EAGAN 454-6100
.. ?:
r .,
cirY oF EA"N
8795 Pilet Knob Read Eagan, MN 55122
PHONE: 454-8100
BUILDING PERMIT
T_ ? ...? L_ r?: I)Elt1:A'a!P
ZQ,00Q•
Site Address ` `z • " `_ 1 `" -" `
Lot Block Sec/Sub. 9
Parael #
c Name
L" - ?•:ia,?•:a?e Drive
Zg Addrass
b - <.,.
g Name _
°u? Addr?ss
Name
Addreu
I hereby ocknowledge thot I hove read this application ond state that
the information Is correct and agres to oomply with nli appliccbie
Stote of Minnesota Statutes and Ciry of Eagan Ordinances.
Siynaturo of Permittee
A Building Permit is issued to: im `Se `c,
all work shall be done in accordonce with nll applicable Stoft of
Building Officiul "
N4 5722
Receipt
7n
Erect ? Occuparxy '
("SCT)
Alter ? Zoning
Repalr Fire Zone
Enlarpe ? Type of Const.
Move ? # Stories
Demolish ? Front ft.
Grode p Depth ft.
Appro vab Fses
Assessment -
Woter 8 Sew.
Pol ice
Fire
Eng.
Plonner
Council
Bldg. Off. -
APC
Permit - ? r? -
Surcharge
Plan check
SAC
Water Conn.
Water Meter
Total ), 3 • ' 1
on the express condition that
Statutes and City of Eagan Ordinances.
,?
Pwnk # Deh Iswed Poeedtew
Plumbing
Mechanical U[ Ic{ ; I ,k-cc't
V ?
t,-
INSPECTIONS DATE INSP•
Rouph-In Flnal
Footings Dote Insp. Oote Irrp.
Foundotion Plumbing
Frame/ins. Mechanical
Finol I
Remorks: // d C, - ') o
,VET1T
CITY OF EAGAN
3795 Pilot Knob Rood
Ecgsn, Minnasota 65142
Phone: 454-8100
PERMIT
' 0-18-78
rA.,ro• 1
Site Address: `'`?30 Cec?a.*vale ??rive
-Rok
10 :` 1_!1Ci--
Lot Block Sub/Sec. _
Name Gling K. Seta (?louse of Wi.ng.)
3 Address '"' :C Ceda7-v<t.3 e Drive
O
City '-.r?n Phone:
Name ='reierr.ed Stieet Metai
? Address ?V)88 RiCe
c
0
55l1._ ?? 4 --727"
City ?• ?Phone:
This Permit is issued on the express condition that all work shall be
Minnesota Stotutes and City of Eagan Ordinances.
No. 319
Receipt No.: I2102
Single
Residential
Multi Res., Comm./Ind.
New/Alter./Repnir
, •,,i,?
Cost of Installation
Permit Fee 1(; . 00
,;n
Surcharge
I Toto I
done in accordance with all appiicable Stote of
Building Officiol
.
? i
- ?:
NECf1A.RIGL h"EATING
CITY OF EAGAN
3795 Pilot Knob RoaA
Eagan, Minnesota 55122
Phone: 454-8100
PERMIT
No. :." s
Date: 30, IGTq Receipt No.: _•'? ?I
Single
Site Address: 4030 C'ec=aj' AitE=. /redzu-va 1e- rzt tvF Residential I
Lot Block Sub/Sec. Multi Res.
Comm./Ind. I `
_ ,
Nome Yoube of W:..-,:-
/Re
air
/Alt
r
N repair
.
p
ew
e
.
A 13"i Cada2`°?? : i_ iiX? : va ? ?- '.+x
3 ddress Cost of Installotion
O
City E"qan 5512` Phone: Permit Fee 7`. 00
Nome `..LKidz' Surcharge
?
? Address " ` ,. r
e
V
City
" aG irl
Phone:
Total I
'
This Permit is issued on the express condition that all work shall be done in accordance with all applicoble Stote of
Minnesoto Statutes and City of Eagon Ordinances.
coMBasTroN Arx WarIRSn
Building Official
ZZiS?
n LlCbns¢tl tIBCVICdI COn[fBCtOI I I hal06y laqVBSt inspBCflOn of BboVB
Owner electncal work ingtalled at
Street do3vdress, Bos or Route No, City _
ecUOn o. Township Name or No. Range No. Comity
?
Occu nt (PRINT)
vV ? ?I Phone Na.
Power Supplier Atldress
al Con ractor ICOmpany Name)
EIe
Cj
nF Contractor's License No.
/
/
a
Mailing AtlJress (ConVactor or Owner MakinB Instailation)
,0.41 553
Aut orize Signat re(C nvaclor/Owner Making Insta lati Phone Number
„ c D-
MIQNESOTp STATE BOAD OIVELECTflICITY ? THIS INSPECTION REQUEST WILL NOT
Gri09s•Midwey Bldg. - Noom N•191 BE ACCEPTED BV THE STqTE BOARD
VNLESS PNOPEfl INSPECTION FEE IS
1821 lJniverai[y Ave.. St. Peul, MN 66104
.,.1-1 ..o I... ENCLOSED.
est void
18 This monrequchs from
REQUEST FOR ELECTRICAL INSPECTION 0 E8-00001.04
- , See insM1UCtions for completirg lhis form on back oi yellow copy.
' X?" BeloD4Pbr Mered by This Request .3 LI T ZS
e AAd Rep. TYPa of BuilEing Appliancns Wired Equipment Wired '
Home Range Temporary Service
Duplex Water Heater Lightinq-Fixtures
Apt. Building Dryer Electric Heatin
Commercial Bldg. Furnace Silo Unloader
Industrial Bidg. Air Conditioner Bulk Milk Tanl<
Farm Other oeci y 1herlSOer.if?1
t nr uecify t er 01h.r
Compute lnspection Fee Below
# Fee ServicaEnhance5ize k Pae Feeders/5ubfaedars M Fen Circuits
U to 200 Am s 0 to 30 Am s . 1o 30 Am s
Above 200 qm s 31 to 100 Amps o? 31 to 100 Am s
Swimming Pool Above 100_Am s Above 100_Am s
Transtnrmer5 Irrigation Boorris PdrtiaL'Ot
Signs Speciallnspection S
Remarks TO L?E? ?
RouBh-in ( Dnte ? t
?cal
in,pe<br, he.eby
cartify that the nbove
Findl :2?( D^.t4 jngpaction hes been
??L O mede.
•Meraeuaefvoltll8montlrelrOm ' '
Thisrequestvoidf- z? l? Ot160 /Dp Og' aqtgq
18 months Irom
W 061467 i 10* 0,6
, . ___? -? , ------ .
+1 FequireA ady Now oWill Piiti1Y Inspec-
? a? ??? ?Yes ?NO Re lur WFen ReadY
kLicensed Elec[rical ConVnc[or I hereby requesl inspaction ot ebove
E awner electrical work installad at
Stree Address, Boa or Fou No. City _
ecbon o. Townshi0 ame or No. Range No. Counly
/
Oc pant IPflINT) . ?- Phone Ne. ,
Power Suppli r 41 Addrass
Eigal Co vactor ICom any Nxmel? Conlracmr's License No.
???7yQ?>3
f/ - ?CC fl
Mailing Address IContrac[or or Own r Meking InstailatioN
/ Q 4,41 37
Auffi ize Sig^a[ure 1 onVac[or Owner Making Inscallat'onl Phone Nmnber
? f?d-35
,
MINNf50TA STATE BOARO OR"ELECTHICITY THIS INSPECTION HEQUEST WILL NOT
Griges•Midwey BIdB. - poom N-191 BE ACCEPTED BY THE STATE 80ARO
1821 University Ave., St. Peul, MN 55104 UNLESS PflOPEH INSPECTION fEE IS
_. ,e..,..,,,?.,... ENCLOSED.
? REQUEST FOR ELECTRICAL INSPECTION EB-00001-04
' See inatructions for completing thia torm on back of yellow copV.
?'j
' X"' BelotJ'Wdr? Cr?ed by This Request
3q(3q
e Hdd Reo. Typa ot BuiltlinB APphancns Wiretl Equipmenl Wired
Home Ranye Teniporary Service
Duplex Water Heater Liyhtiny Fixtures
Apt. Building Dryer Electric Heatin
Commercial 81dy. Furnace Siio Unluade.r
Indiistrial BIAg. Air Conditioner Bulk Milk Tank
Farm omvi Pecrrv ther Isoucifyl
t rsr pecify ther (liher
Compute /nspection Fee Below ?
k Fee ServiceEntrance5ixe k Fea Fantlers/SUbfaeAera k Fea Circuits,
U to 200 qm s- 0 to 30 Am s 0 to 30 Am s
Above 200 qmps 31 to 100 qinps 31 to 100 A s
Swimmin Pool Above 100_A2s Above 100_Am
Transiormers Irrigation Booms Pdrtial-'Other Fee
Signs Speciallnspection S
??,k??t.• ._ .._ .?? i• r - TOTAL FE
i,??
---°-- --- ° ---- I, the ElacVicel
Inspactor, heraby
certify thet the abo.'.
Final Drte inspaction has br'
e _ ? mda. '
rMarweueatvolal8monihsirom ? 4 ? _ Aa
This request void 18 months from
Date this Request /?/o /`? P 4 819 3'
I, as (?Licensed Electrical Contractor ? 13"er, do hereby request inspection of the above electri-
cal wiring installed at: '
?,,,,,,?
Street Address or Route No. ? c?t? iC., D? C_itey'_?Q'?'t,+V
Section Township Range County DH?i- -
Which is occupied by 6'7C71lS.? O'r V1p G tV l^s
(Name of O<cupant) ?
Is a roughin inspection required on this job? No o Yes ? Ready Now ? Will Call ?
Power Supplier 1?? ? S? P Address NQ ????
Electrical Contractor ? L?? ??'? • Contwctor's License No 37_ 07
(Company Name)
Mailing Address - AN Al
( lectrl I ontracto,r r wner Making This I nstallatlon) .
Authorized Signatur ? V Phone No. 4C-2-YSu-
,(ElectA<al Contractor or Owner Making Thlz Installation)
STAYE OARD. COPY '72-9?4
_,A Minnesota Sute Board of Electricity
1954 University Ave., St. Paul, Minn. 55104-Phone 645•7703
REQUEST FOR ELECTRICAL INSPECTION
CHECK BELOW WORK COVERED BY THIS REQUEST
P 48193
Type of Building New Add. Rep. Check Appliances Wiced Foi Check Equipment Wired Foi
Home ? ? ? Range ? Temporary Wiring ? .
Duplex ? ? ? Water Heatei ? Lighting Futures ?
Apt. Bldg. ? 0 Dr
? Electric Heating ?
Commercial Bldg. Fu
F Silo Unloader ?
Industrial Bldg. ? ? ? A'v t ?
n Bulk Milk Tank ?
Lis List
Other_ ? ? 0 Q
Heiers ? ?ehers{
COMPUTE INSPECTION FEE BELAW
Secvice Entrance Size: # Fee Fcedeis&Sub[eeders: # Fee Circuits: # Fae?
0 to 100 Am s. 1 1 0 to 30 Am res 0 to ?30 Am e[es
SOl to 200 Am s. 31 to 100 Am res 31 to 100 Am eres
Above 200 Amps. Above 100 Amps. Above 100 Amps.
Transformers RemoteControlCirc. Partialorotherfee
Signs Special Ins ction Minimum fee
Remarks
s _ TOTALF E d, o? Q??@
I, the Electrical Inspector, hereby cert ' at e ifispec 'on has been made. _tb-
(Rough-in) ,?. Date U.-/3'7d /d??
(Final) Date /f- 1-7
This request void 18 months from
Tlus request void 18 months from (. ?
Y
/?7<5,,-x
7- R . 59103
Date o his Request ?
I, as censed Electrical?Contractor 0 Owner, do hereby request inspection of the above electri-
cal wiring installed at:
Stree[ Address or Route No. [iYCr7 City
`_-----?._S - - _. ---- -- ?
Section Township Range County ?
Which is occupied by/?7U ??
Name af Occupant)
Is a roughin inspection required on this job? No?L Yes ? Ready Now)kr. Will Call ?
Power Supplier Address _
?
?o. _
Electrical Contractor Contactor's Licenseo
('Company Name) Mailing Address 31p ?i9 GN/OL1'1- 140%?e
lectrf al Gont act r or nar Makln9 This Installatlon)
Authorized Signature?,? ,.[14 Phone No,, 7s-i7G?79
6(Elecirital Cont att or Owner Makln9 ThIS Installatlan)
???i ?? ????yn? ???? This inspec6on request will not he accepted 6y the
Y`? State Baard unless proper inspection fee is endosed.
Minnesota State Board of Electricity
? W4 University Ave., St. Paul, Minn. 55104-Phone 645-7703
fFEQUEST FOR ELECTRICAL INSPECTION
CfITCK BELOW WORK COVERED BY THIS REQUEST
R -591:83
Type of Building New Add. Rep. Check Appliances W'ved Fo: Check Fquipment W¢ed For
Home ? ? ? Range ? Temporary Wiring ?
Duplex ? ? ? Watet Heater ? Lighting Fixtures ?
Apt. Hldg. ? El ? Dryer ?
I Electric Heating ?
Commereial Bldg. ? ? D Fumace ,?
ICr Silo Unloadei ?
Industtial Bldg. ? ? ? A'u Conditioner ? Bulk Milk Tank ?
Farm ? ? List
) List t
?
Othe
? }
Hehe?s)
Hehe?s?
COMPOTE INSPECTION FEE BELOW
Service Entrance Sizc:
0 to 100 Am s. x Fce Feeders& Subfeeders: #
A res Fee Cucuits:
0 to 30 Am eres n Fee
101 to 200 Am s. 3 0 r 31 to 100 Am exes
Above 200_Amps. ve I Above 100 Am s.
Transfoxmers Remote ontro Pxrtialorothexfee
Signs Speciallns ection Minimum fee SS
Remazks
TOTAL F 8' Ov
.?O
I, the Electrical Inspector, hereby cedify that the above inspection has been made: ?
(Rough-in) Date
(Final) 7/7 i -_ m Date
This request void 18 months from
q 036- 4rc?6 le_ i?
Pat Geagan
MAYOR
Peggy Carlson
Cyndee Fields
Mike Maguire
Meg Tilley
COl1NCIL MEMBERS
Thomas Hedges
CffV ADMINISTRATOR
MUNICIPAL CENTER
3830 Pilot Knob Road
Eagan, MN 55122•1610
651.675.5000 phone
651.675.5012 fax
651.454.8535 TDD
MAINTENANCE FACILITY
3501 Coachman Point
Eagan, MN 55122
651.675.5300 phone
651.675.5360fax
651.454.8535 TDD
www.cityofeagan.com
THE LONE OAN TREE
The symbol of
sirength and growth
in our community.
July 6, 2005
WING SETO
4730 OAK CLIFF DR
EAGAN MN 55122
Re: Project No. 800R
Assessment Deferment Agreement
Dear Mr. Seto:
For your files, I am enclosing a copy of a fully signed and recorded Assessment
Deferment Agreement. The recorded document number is 2331722.
If you have any questions, please contact the Engineering Division at 651-675-
5646.
Sincerely,
Enclosure:
Secretuy
Agreement
d
a
O
0
W, Za• o O
?o
a o ma ° ? ? cc
v rp O W W U
ui = z V (?d ? Q ? W
'j
m O pC ?
C?i ? w I'- V? y U
W
L6a?o? -?i ?"'r U
? „' `?' g.` ?
n
w? W W ° tm-' tC?J r=
¢
LL.
? W a
O a W? m LL U
?
W
0
S
U
o ° o
3 w
0
?
U
--?"°
?
?
?
N ?
?
?
ASSESSMENT DEFERRAL AGREEMENT
2331722
THiS ASSESSMENT DEFERRAL AGREEMENT ("Agreement") is made this ,ii? day
of l14 A" 1 2005, by and between WING K. SLTO, a single person, (hexeinafter
"LANDOWl ER") and the CITY OF EAGAN, a MinnesoYa municipai corporation (hexeinafter
the "CITY"). (Landowner and City are collectively referred to as the "Parties.")
WHEREAS, Landowner is the fee owner of certain property in the City oi' Eagan. County
of llakota, State of Minnesota and legally described as:
?
? That part of the Northeast Quarter (NE '/4) of Section Nineteen (19) Township
Twenty Seven (27), Range Twenty Three (23), llakota County, Minnesota,
described as follows: Commencing at the Southwest Cornex of said Northeast
m Quarter (NE '/<); thence North, assumed bearing along the West line of said
k I ? Northeast Quarter (NE '/a) a distance of 198.82 feet; thence East 33.0 feet to the
Z? easterly right of way line of Cedar Avenue, which is the point of beginning;
thence North 47 degrees 00 minutes East a distance of 49.61 feet thence North 79
degrees 22 minutes 20 seconds East, a distance of 336.72 feet to the
Northwesterly right of way line of Beau-De-Rue Drive; thence South 56 degrees
'L 41 minutes West along tl-te Northwesterly right of way line of Beau-De-Rue Drive
439.46 feet to the Easterly right of way line of said Cedar Avenue; thenee NorthpZC,,,.,;, _MAIL
along said easterly right of way line 145.5 feet to the point of beginning.
Containing 0.72 acres, according to the Govexnment Survey thereof. 'JUN u p 2005
(hereinafter the "Properry"); and DaK _
WHEREAS, as part of Public Improvement Project No. 800R (hereinafrer the "ProjecP")
the City is proposii2g to assess the Property for street improvement costs in the amoutrt of
$7,485.36; aud
WHERLAS, the City is willing to defer the assessment for a lin2ited time in anticipation
of redevelopment of the Property; and
WHEREAS, Landowner is willing to accept the deFerment and pay the assessment all
upon the terms and conditions contained herein.
DATE RECEIVED 1f z,ns'
DAKOTP, COUNTY
TREASURER-AUDITORk/4
+ • J
NOW, THEREFORE, in consideration of the inutual promises contained herein and other
good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged,
the Parties do agree as follows:
]. DEFSaaED AssESSnnE!vT. The Parties agxee that the street improvement
costs wider the Project in the amount of $7,48536 shall be deferred
without intexest until the earlier of the following:
A. `1'he Property is sold;
B. The Property is subdivided;
C. The Property is platted; or
D. June 1, 2008.
At such time, the deferred assessment shall be payable in equal
installments over a period of ten years with interest thereon at interest of
seven percent (7%) per annum.
2. Wnrvea. The Landowner hereby accepts the defened assessment for
street improvement costs in connection with the Ptoject in the total
amounY o'F $7,485.36. The Landowner hereby waives the right to object or
appeal the assessments pursuant to M1NN. STnT. § 429.081 and further
waives notice of hearing on this Agreement.
3. BttvDINa EFFEC'r. This Agreement shall be binding upon and inure to the
benefit of the Parties' heirs, successors and assigns aud shall rLm with the
land.
CITY OF.E GAN: LANDOWNER:
By: t4?
Pat Gea Wing K. Seto
Its: Mayor
By: mQ(? WP.(O?
Maria Petersen
Its: Clerk
?, . ?
STATE OF MINNES01'A)
) ss.
COLJNTY OF DAKOTA )
The foregoing instrwnent was acknowledged before me this A?day of
. 2005, by Wing K. Seto, a single person.
?
Notazy Pu ic
STATE OF MINNESOTA)
) ss.
couNrv or DAxoTa >
GI?OANLAMM?rrr?aL OThe foregoing instrwnent was acknowledged before me this 31S-? day of
mo? 2005, by Pat Geagan and Maria Petersen, the Mayor and Clerk of the City
of Ea?, a Minnesota municipal corporation, on behalf of the municipal corporation.
AYPROVED AS TO PORM:
City Attorney's Office
Dated:
APPROVED AS TO CONTENT:
?--C ?
Pub ic Works Department
Dated: / -/
THIS 1NSTRiJMEN"f WAS DRAFTED BY:
-?_
(No ry Pu lic ?
JUDY M. JENKIivS
.' NOTARYPUBLIC-MINNESOTA
MY??EYp?ft JNL 31.2D10
SEVERSON, SHELDON, DOUGHERTY & MOLENDA, Y.A.
7300 West 147th Street, Suite 600
Apple Valley, MN 55124
(952) 432-3 ] 36
(RBB: #206-20268)
>
EAGANv TOWNSHtP
BUILDING PERMIT
Addrees
Aaa=ass
---............................... -- ??...._??.......................
'r?/ ?-a ?-c..?,,?. 0 ...?.1-
presenl) ......_." ...............""' __............................................. 7.......... [i.. ................ .----........ _ . ---- -- -....
x? 3070
Eagan Township
Town Hall
ae:a .Z.-.S.-. 73 ......................
ories To Se Used For Fronf Depih Heighf Esl. Cos2 ezmif Fea Remarks
7 ' ? a ? ??
LOCA
1'his permit does not authosise the use of alxeeis, :oads, alleps ox sidewalks nor does it give the owner or 6is agen!
the =igh2 !o erea3e any situelion whieh is a nuisanee or whlch presenls a ha:ard to the healih, safetp, convanienee and
general weltare !o anpona ia the communifp.
THIS PERMIT MUST SE,J?EPT ON..THE PREMISE WHILE THE WOAK IS IN PROGAESB. ..
This is to COrtifp. !hal...1? =.-_? ?-5:?c.5?--__-----.-.-.--_----.---Las permission !o erect a.?.`.:?_ ??^?..--.....: npon
the above deaeribed premise subjeei Yo the provisiona ot the Building Ordinanea for Eagan Township adopled April 11,
1855. /?
..................
!.`-?...... Per ................. ....?:??..-- ?---.....- ---..._ ................
Chairm n of Tnwn Boaifl }L Buildinp Impec!
v?J
?A
3 ci
os
/D 0/900 /oc o8'
/d D/9w /Od D ir
l
MASTER CARD
Permit
No.
Issued Issued To
Coniractor Owner
BUILDING
?f
3
7 lf ? ?r?.y
? ??
PLUMBING _
--? j
S
CESSPOOL - SEPTIC TANK
WELL
ELECTRIGAL
HEATING ?
GAS INSTALLING
SANITARV SEWER i
OTHER I
OTHER
Items Approved
(Initial)
Date
Remarks
Distante From Well
=00TING SEPTIC
FOUNDATION CESSPOOL
FRAMING TILE FIEID FT.
FINAL
ELECTRICAL
HEATING DEPTH
OF WELL
GAS IN$TALLATION
SEPTIC TANK
CESSPOOL
DRAINFIELD
PLUMBING
WELL
SANITARY SEWER ,
-15' 7
/
Violations Noted
on 8ack
COMMENTS:
7/
: v
EAGAN TOWNSHtP
BUILDING PERMIT
/- ---.e_.._............................
oWno: -- -----------.!?f ........
,?JAddress (Preeeai) .£.4.....,2..L-`.:f-..
Builder ..--?-------.7r?..-......???-'L.n'.Q-L - -?ei___`-c°?`C- .
/-'/... /
Address . ...........
-R?.¢.
? `?- • DESCRIPTION
N° 3182
Eagan Towmhip
Town Hall
v
Daie ..... ./_--' - // - T.._i.-'----.
Stosies o Be Used For Froai Depfh Heighf Esi. Cos! •Permit Fee Remazks to
V LOCATION ?1i. 1-Y-V Sireei, Road or oiher Deserlpnon ox LocaIion I Lot I 731ocK I Aaalrion os Tsact
-SlD
/o 4019o0 /oo 08'
This permit does aof aufhori:a the use of slreels, roada, alleps or sidewalks aor does it give the ownes or LG agen!
the :ighifo cseale anp aifualion which is e nuisance or which presenla a haaard !o the heallh, safeip, convenieaee and
ganeral welfare to anpoxe in the communify.
THIS PERMIT MUST BEEPT ON THE PREMISE W.PILE THE WORK I5 IN PAO RESS. Q
This fs fo cerlifp, permission !o ereci a-x.xz.?t.? -L _upoa
the a6ove described premise subjec! !o the provisiona of the Suildi dinance tor a Township adopled April 11.
1955
°(1
C
.`
.
-------° ............. . :°°-°---- .... --- ...... :--.... Pes ..-
.....- -- --- -- _,L-°°°°°?-- . ...........----°-°°---....._°--°-
ith?-Hdard!Gei? Buildin nspector
, Eagan ?r
Dakoia Counlp. Minnesofa
Application for Bnilding Permit
Tppe of building or wozk confemplafed. Circle correcf descripfions.
Aesideaiial ((
?E
Euild Ealarge
Dimensions ....e
0
Delails or remar1
Locafion
Indusirial Olher
Aepair Iasiall Move Wreck Other.... ..........
PERMI-„T? NO. :-??r1.:?Y ......
Daie d"`.T..?--•.-?$-.???%?cl
Numbex Sizee! Beiween whaf czoss sfreeis - Size Esi. Valualion
'?.? l ?\?7?k_-t{?
Lo3 Bloclc Addilian Rearsangement or Traa!
se ', 19 fo D1Po9 090 08'
?
Owner .. ... d -L..: ?? >!;?`-? ..... Address
Con2racfor .. ' '- -?;: ..!t?..?.? .. ...::... ._.. Address --_ Z
?
U J
S'v ) ?
$.... /-3 ..... - - ---... s? S!-_
Tofal fee eollecied.
Permi2 fees are not
refundable. .
g,p?? , ?
The undersignad here ?ia es app byfl ion foa aQpermif? °
do work as herein specit?ed, agreeing to do all work ia sirici
accordance w' Yhe buil ' g or ance adopled April 11, 1955
by !he a omaship Bo of :visors. .
. .e . .. .. .... y.... x-r r?
5igned
/ D Q/ j'OD /OD O r
MA5TER CARD
STRUCTLIR: AND
LAND USED AS
Permit
No.
Issued Issued Ta
Contractor Owner
BUILDING 3/BZ ? ? ? W ?1?•??
PLUMBING
CESSPOOL - SEPTIC TANK
VJELL
ELECTRIGAL
HEATING
GAS INSTALLING
SANIiARY SEWER
OTHER
07HER I
Items Appraved
(Initial)
Date
Remarks
Distance From Well
'OOTING SEPTIC
FOUNDATION CESSPOOL
FRAMING TILE fIELD FT.
FINAL
ELECTRICAL
HE,4TING DEPTH
OF WELL
GAS INSTALLATION
SEPTIC TANK
CESSPOOL
DRAINFIELD
PLUMBING
WELL
SANITARY SEWER -
Violations Noted
on Back
COMMENTS: ?/
?
cITr oF eac,AN
379$ Pilet Knob Rond Eogan, MN 55122 N2 5122
PHONiSM8100 ?
BUILDING PERMIT APPLICATION ? 2eceivt _-
Te be umd tor Fire Damage Rgpaiggst Vojue 20,000. pate 10-16 , 1978
Site Address 4030 Cedarvale Drive
Lot Blxk Sec/Sub. 19
parcel # 100-08
rc Name Wing K. Seto
z 4030 Cedarvale Drive
; Address
o ,,,. Eagan 454-7200
p Name_
Addrea
Nome _
Addreu
I hereby acknawledge thot I have read this applicotion and state thut
the information is correct and agree to comply with ail opplicable
Srote of Minnewta Statutes and Ciry of Eagan Ordinonces.
Signoture of Permittee _
A Building Permit is issued
ull work shall be done in c
Erect ? Occupancy FZ -
Alter ? Zoning CSCD _
Repoir B Fire Zorre 3
Enlorge ? Type of Const.
Move ? # Stories
Derrrolish ? Front ft.
Grode ? Depth ft.
Anmeml2 Faes
Assessment -
Woter & Sew.
Police
Fire
Eng.
Plonner -
Council _
Bldg. Off. _
APC
Permit "?•"" _
SurcFwrgel0. 00
Plan theck
SAC
Water Conn.
Water Meter
Toral 73.00
, Set on the expren candition thot
oll te of Minqewta Statutes and City ot Eagan Ordinnnces.
Building Official
. naaE I n ? J?
BUILDING PERMIT APPLICATION
Inelude 2 sets of plans, 1 site plan w/elevatioas and 1 set of energy calculations.
ib be used for b r? oqQ?TaluaEion 4 C,`? 0 U`Z3 _
Site Addresc: 4?&P-7,9 (e C> or6a
Lot Block See. Su6.
>9
Rmer `A; z
? 'tc?
Address i t-1n?/o (' F? e r? nI n llr.
( 3 rn n )"1,I
?
Contzactor ??_vn (.,
AZdrese
Parcel Number / oc'.-p :?
?A-`7 a c c`
Telephone La ?
Telephone
Arch./Fh9• -
Address
Grade Telephone
t7ect
Alter
Eeepair
Hslarge _
4tove
Der»lish
OFFICE USE
occuPancY ?
Zoning ?-' S ? ??
Pire Zone 3
lype of Const.
; of Stories
FL'Ortt
Depth
OFFICE USE
Dnte of Approval s Initial
Assessment
Nates/Serrez
Police
Fire
En9 •
Ylanner
Oouncil
Bldq. Off.
A.P.C.
FEES
rexmit
Suzctear4e /d ?.
'pian Check
SHC
t?ater Qonn.
water Meter
TOTAL ?3 ??
BUILDING PERMIT
Sih Address 4
CITY OF EA6AN
3795 WIM Knob Rmd Fagan, MN 55I22 Ng 7728
PHONE: 434-8100
Receipt #
'N.
Lot 10 glak $ Sec/Sub. Section 19'
Parcel # 10 01900 100 08
p I Name House o£ Wing
z Addrca 4030 Cedarvale Drive
? _. .?.?.. .?. -.......
g Name Raymond Dunn
ou Address 10225 Lyndale Ave. So.
? r:..,Bloom. 55420 w...__ 884-2764
Nome _
Address
I hereby ackrwwledge thot I have read this opplicotion ond stote thof
the inlormotion is correct ond ogree to comply with oll applicoble
State of Minnesoto Statutes and City of Eagan Ordinonces.
Siynature of Permittee
A Building Permit Is issued to: RaymOna Dllnn
oll work sholl be done in occordonce with all ooolicnh
Building Official
000
Ered p , Occupancy A-3
Alter ? Zoning C$G
Repeir ? Fire Zone NA
Enlarge ? Type of Const. Vn
Move ? # Stories 1
Demolish ? Length_16
Grode ? Depth 38 gq, Ft.608
ADProvals Feet
Assessmenr _
Water 8 Sew.
Police ?
Fire
Enp.
Flanner -
Council _
Blde. Off. _
APC
Permit
Surcharge 12.50
Plan.check 85.25
SACk 3150.00
Water Conn. NA
Woter Meter _NA-
Raad Unit 774_6f1
Torol 53.691.85
p,the express conAitlon Ihm
of Eagan Ordinonces.
l
<f S'?- j'i az,
, ? CYTY OF EAGAN Irclude 2 sets of plans,
b? ? ??? ' 1 site plan w/el.evatians &
BUILDING PERMIT P,PPLICATION 1 set of energy,calculations.
To Be Used For gs--LnOC'aValuation Date -I4 a?--
site Aaaress: 403o aA4ovkV trN ? oFFic.E usE oru,Y
I,ot 10 slocx S' sec./sub.Sfc-+tbvt (I Erect Occupancg, 4-3
Parcel #: tO o( Q D C7 (OU 09- Alter
Repair
Oamer: T3 S ' " J?,/?l;.1? ?? 9e?
Address: lEla ? 0 CE da rrj cx ?e Z?ri ?e Desmlish
City/zip Code: fGa ZZ, M 7?. Grade -
s
Phone #: l fWej -`J? D 0 APPrCVAIS
Zoning
Fire Zone
'Iype of Const. ,.-?
# Stories
Front ft.
Depth ft.
Contractor:&711-1 Assessments Pexnut
Address: Water/Secaer Surcharge
y Police Plan Ched
city/zip r/-SS?.Zo Fire SAC L.AO .9?
Water
Phone p ?er Water
blrch./Ehg.: Council Rnad
- Bldg. Off.?Z
Psidress: ApC
' City/zip Code:
' Phone #:
Conn.
Meter
zs
ea
6&
- ?'a?D60 IAn c?i?.
_ TOTAI, ?a! (0 q ti g rJ
'
. . .
EXTERIOR ENYELOPE AVERAG£ "U" COMPUTATION
4 54.7Zov
OwNER h( a v g8 d F w lH<
SITE ADDRESS 0362 CE 17R7 v?PLL (?1?. fC qrZRi
CONTRACTOR DA7E PHONE
Deteimine working square footage of each. ?
y
l. Total exposFd vaall area ...... sq. ft. x ,11 s?
,0-4
2. Total roof/ceiling arE,v ,,.,.,_.??f34 sq. ft. z-,05' • d,4C
7otal expc5ed r;all area above floor • Wt,-70,
a. ToCal wall window area ...........................
b, Total door area ., ...........................
c. 7otal sliding ylass door area ................... --4
d. Total fireplace wall area ....... .. ............ -
e, Total wall frarniny area (avQrage 10%)...,........
f. Totat net wall area above floor .................
g. Total rim joist area ............................
Totat e:?posed foundation arLa = -?-
h, ToCai faundaC;cr. vindow area..................... i, Toal net fou(idatiof) area above grac;e ,...,......,
Oetr_•rmine "U" value of each e.all segment,
a. .?---? X Aull
b, 20.42,?X "uu
C. -- X xull
d. --
e .
4-
<-
..-- ,
X itut,
X „ua ?
?
-- ,
r. '706:(o6 z „u^ ra- _ 7" 6_
110 ` r
g, A y 11t!
h. "- '-"X "U" ' • ?
3 . ............,........,.7ota1 ` _? =a
If item 13 is the sam2 as, or less than item il, you have met tYe intent
of 58C 6006(c)2. /
\
?
? i
? .
?otal exposed roof/ceiling area = ( E1 8loo
j. Total skyliqht area.... . ,,.... ,...,. . .
k. Total roof/ceiling framing area (average
1. Total net insulated roof/ceilinq area........,.. D od_??'
Determine "U" value for each roof/eeiling segment.
j X 'lull a
k. X "U" •
1. 0. 00 _ X"U" 0?- _50,4V
4 .................? ??..,..,,,,Total • L7 ?O
If total of 04 Ss the same as, or less than 12, you have met the inteni; of
SBC 6406(c)l,
Alternate 8ui)ding Envelope Design
To utillze the total envelope system method, the values established Dy the
sum of ltems 03 and 94 shali not be greater than the sum of item5 !1 and 02.
t'? `L353 -----' 2.J 30-40 _ 153-93
3. 7S.Z6 + 4. 30-4() t 03. GG
7804 Melody Lene 6903083
Burnsville, Minnesote.
WEPJA CO. PLAN SERVICE
ED ANDERSON
qRCHITECTURAL OESIGNWG AND PLANNING
Oftice:27 J l?[.p'Yf ?4 VHi6 i IftCCE
U29-Criff-RM Oftice:
Burnsville, Minnesota 8964636
i
s
dersy Bopveilar
Hamrah Foodsexroice
5901 Wayzata Eoulevard
Hl.nneajwlis, Fiiimesota 55416
.. ... . . . ,.. ....,: ....:'-...?.?.. e r.:..,..,v..r? Y:ii:.?? ?
December 2. 1982
Dear Mr. Kopvei,lers
° 8es Hause ot Wing Restaurarit, o3nor ldtchen remodeling md.th ea-
larged customer eeating area snd located in city oP Bagan,
Dakata Countqt }93.nneaota.
ta'e have received and reviswad the plane and apeciPlcatiaris covexissg
the food and baverage servtce equi.pment laycnzt to eerve tha above+.
deaiguated proje¢t. The plans and spedfYcationa appear to be its
general caafoxndty mdth the atandaxds o4 this Departmeut. ..
At euch time as car?structian ar r8modeling ie completed, please
communtcate md.fi.h Mr. Jamea Nitkowski at 623-55569 5anitarian in
our Metro Distirict UMS.ce, in o:der to arrange tor a fYnal on--site
inspaction.
IY yau have questiase conceming this matter, gleaae cowmmi.cate
ud.th ua at 612/?-$P3?-5M.
RALsce
tet Jim Witko+eald.
Yoars aexY ?.rcaYj
?,: . .
Robert A. Eashbrookl R.S.
Assistant Section Chiaf • .
Hotels, Resorts ancl Restaurants
? =J
Houae oY Wing ?
4030 Cedarvale Drie9
Eagaa, M3.rs,esota 55122
ie:?1nm1. dty OF CCItJC901
3795 PILOT KNOB ROAD, P.O. BOX 21199 BEA BLOM9UIST
EAGAN, MINNESOTA 55121 rotovar
PHONE: (612) 454$700 THOMAS EGAN
JAMES A. SMITH
JERRV THOMAS
THEOD0t7E WACHTER
Councu Memoars
December ].C, 19$2 THOMASHEDGES
City Adminsirata
EUGENE VAN OVERBEHF
Gty C?k
House of Wing
4034 Cedarvale Drive
Eagan, 14N 55122
Dear Sir:
Please note the red-lined requirements on the site plan and the building plans.
This permit is issued to you with the full understanding that you agree to
comply with the City of Eagan`s ordinances and policies.
Sincerely,
??2?
Dale S. Peterosn
Chief Auilding Official
CC: Parcel File (10 01400 100 0$)
DSP/bar
THE LONE OAK TREE...THE SVMBOL AND GROWTH IN OUR COMMUNITY
r
r'--I ?
/0 01900 Oyb a S'
EAvAN T3WNSkTP
3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 454-5242
PERMIT FOR SEvdER SSRVICE CONNECTiON
DA';E:(1C_;..= " i-7 7
NUMBER A"
OWNER: Jl/S? r,.t/,5 Address.;.?,r? • i_; .=' ?%-_ .. .- ,;y,i?,=' __?
PL'JcYBRB /,CI_ ti),-;--_ TYPE OF PIPE i ? L . - ? _.._..._..
DESCRIPTION OF BUILDING
Induatriall Cummerciall Residential I Multiple Dwelling I No. c, unita
Location of Connections:
PermiY Fee
Street Repairs
62a
Total i°//7/6 7
Inapected bys
Date1_(.??
Remarka• e?>Ie-l- ,
In cnn^:5ezation of ehe issua an3 dalivery to me of tha above permit,:, i
hereby agree eo do the prop:sed work in accordance xcieh the rules and
regulations of Eagan Tormship, Dakota County, 14innesota
Conaection Charge??.
By-A rENZEL_PJ-RG. & WTG., IMC._.?a.
P1eaae notify iahen ready fcr inspectioa an3 cor.aect3.e, and bef+lze a;1.' po'cCiC:l
of the wark is covered.
.
*,Cfly of Eap
3830 Pilot Knob Road
Eagan MN 55122
Phone:(651) 675-5675
Fax:(651)675-5694
-----------------
orOfficeUse
j F
I Permit #:
I
i i
? Date Received: I
?
i
I Stan: i
?
I - ---------------- ?
2008 COMMERCIAL BUILDING PERMIT APPLICATION
Date: sCp,S SiteAddress:_4J0 LPdavvelP. I?IyC
TenantName:LAGQr4 (YOrme-r kOUSG 4 yyina? (Tenantls:_New/_Existing) Suite#:
PROPERTYOWNER Name: C4tt o? Fqlqn EDq Phorie: UJ 1- U1.15 -5415
ndarass fcaY?zP: 3930 pi?o+ ICnob 2oad, Eaglan, Mnl _56'iaa
Applicant is: _ Owner A Contractor
TYPEOFWORK Descriptionofwork: lJUi Det7lph+?0Y1
Constmcuon Cost: -% lo i100. DO
CONTRACTOR Name: PDkJO5t2 P,&i -* SUY1S Ire. License #:
address: 95ao Co nbA 11oAd i9,
Ciry: Ub[40 Shte: MN Zip: 5J'C357
Phone7163A7 8-6945 tY?2.a49 ComactPerson:TOm pjcvrrrl
ARCHITECT/ Name:RO65'1ovql ScrvIce ZndlJ57nt,5 Registration#:
ENGINEER ,ddress: a14-1 UnlyeVs'1+1 AVe.W. -4 a05
cjTy: S+. Pa v i smte: MO ziP: 5,5114
Phone:651-644-8149(!4 11 CortactPerson: MtLkaeI Tiodevi
Licensed plumber installing riew sewer/water service: Phone #:
NOTE: Plans and supporting documenfs that you submit are considered to be public intormation. Portions of
the intormation may be classified as non-public if you provide specific reasons that would permit the City to
Conclude that the are trade secrets.
I hareby acknowledge That th4s irrfwmation is complete and accurate; that the work wdl be in contom'ance with the ordinances a+id codes of the City of
Eagan; that I Untlerstand this 's not a permit, but ordy an application tor a permR, and xwk is not to start withoUt a permd; Ihat the work will be in
accordarce with the apprwed plan in the case of work which requires a review and approval of plans.
X tJIkPS
Applicant's Printed Name
:x
ApplicaM's Signature
Page 1 of 3
i?
-v?
lNlinnesota Pollution Control A;ency
Notification ofIntent to Perform a Aemolition
TypeofIVotiliation: O-Originol ( )ameaded I JYrojetYCancellatioa
' Derriolitioo Contractor:
I Z?22' c.?
?.der?u "Ir.' 44?W' rY
I Ciry.SntqZip: :a+•'G/?J !"f/'? .S$3S7
ContaaPessan: '7-7m T£i,"r,.l
' PhoneNumbu{s} 762- 1/7?-
Buildine Informatioa:
a-??
46 +
Bvildi:+g Nurc:, /? ' NS A AA-f lk L.?-
Ad&:syLxacion: -7 99;. S? l lty Mtmorti'? ?1 FI`"?
csn, s;:ce, ziy: ?'? ??,.e Mni s's ? a 3
. ---?_.
Covnty. ? E o^f ft- •
PhoneNumbc(s} /^?lr? ? •
Age of B1d& (years7 S'r..eotSidb (sc,. R}.
BtTtlding OwDEr: .. . I``°°'b°ofF7ooalnclu3ingBasanentLevcl(sx--?
P:esmtUseof8ldy:_- KiS4^cernryf- ? .
? Tlamc /?}?o-l?a- (?lk • 5i Gf?./} . PriorUseofBldg: uAlkC.:.6 +?f- . , .
Addnss_ ?? ?i? ?r.,.? .l?:e?P? TJr.`i/e . -•
I • • Aates when demoIitioa or intentional burning
wM Begin S` )08 & End r 9 0-o •
Cri.snle,r,;, Lajd,f %tN SS/;)3
. Notifiat{on mest be portmxzktd or reeeived ten (IO) workSag 8xys
Contxspersox Mt / !lY'iq 2"?,?J9( D rtil bdore demoLtlon begSac 'See itemf5 for emerEeary demoticioas,
/_ y75^_c?sp?, • . BoihBr?Saain?aadEndinedntess6ouldbe:mendcdiawritiaess ,
PhoneNwnbc(s): _ 65,
. aecesary to rctleet enrreyt pnjed dates •. It t5ere fs>260 linesr feet or>160 sqnare fcet of Regnlated Asbestos-Containiag Material (RAQ12) in tLe beildirig
to be demolisbed; it mnst be removed by a licensed asliestes eontractor prior to demolition. The State of MTI- Notiee of Intent to Perform an Asbestos Abstemest Ptroject mnst be used to notify for the asbutos removal. _
Is n onlriable AChipreseat fa.tLe strnefare fo be demotished 2 ? j 1'ES bn-2Q0
If'YES comp]ete items 1-9. IfNO cosaplete items 3.9.
1. If ACMveil1 be left in pIaee for the demolition indicate tLe amount of Category I and/or Category II
nbnfriable ACM left fn place. . ' ?
Gteg.l ' • LinarFr_t '
Sqnare Fxt
....
Cubic'Fat
Cat coorv 1 nonHabte I.CM Micsru sspqYpS,cpntxmin8 packyngs,'.
Ps$eu, res?7i:nt tloor eovering, md, asphilt rootmg produrs
:ontaining more thzn one parcent ttbestos, .•
'Cateeory 1 oonfriable ACht is aot anowed to remaia tn plnce
for demolitioa if it is fa poar roadition. .
Categ.I1
Linmr Feet
square Foa •
Cubio Fed
Gterorvll nonfrisbte P,CM mezris anymatc:al, adu3'mg
Cstegory I nonfriable ACM, rontaining more.than.one pacent
ksbstos tkat, whcn dry, eanaot be aumbled, pulvdrsrJ, or
reduccd ro ipowder by haad premue.
•Gtetory II noafriahle ACM is cof sllaNred to rcmain in platt
for d:molltion it 1; Das a AigL probabiliry of beeoming ernmbled,
yn}verIzed, or rtdneed fo i powder darine demolition, traasport,
or disposal (ex traasite, cemea; state roofiae)
!• I)escription & Loeatioa of ACM reaaining ifipIace (i$clnding IIoor Miad room 1.): '
Rcvised 109
C ompan y . and/or individual that condvcted the building iaspection and fhe proce3ure ased to determine the
prssenca or absence o! ACM, (qnc]uding analytic metLod): 'Prior 1o denofition all bui(dings musi $e Enspecyed
5y an U. S. En+^onmextal ProrcctioaAgenry (EPA) accrediled inspcctor..
. Description of pianned demolition and tbe specific method(s) ihat xill be used: ?
? f.4 L/ce?4p.KF er -1L d u,.e s'?1 r
. If the demolition was ordered by a government 2geaey, pinse identify fhe ageacy and attach a copy of tbe ?
order:
HamO: A? Titlc ?. ? Authority: '
Date of Order (M/Dl1): . • ? • Date Ordercd to Begin (2vI/D1Y): * • • I
* xvtifietioa !or xn cmergenq demoGtioa murt be sobmitted at arly ss possble belore demolition be=ins, bninot Iater Ihaa the foltawia= working day. A demolition is cocsidered an emergency ONLY wfiet the faeiliry Eu beea dcemed rtrnctun!}y aa'so¢nd xnd
ia danger of immiaeat eollapse If t]ie strvetonlly nnsouod buSldiat is knowo to tontain tny regulnted ACM or is saspec{ey tp eppg3io ?
aay t'eLnlated ACM, speriai procedures MUS2 be foAovred. Jtyou ire naaware ol l6e syec4al procednres, instroctioashegyingons nn
be obtained by contacting tbe MPCA at tbbiddrss or p6oue nnmber listed bdox. '. Description'of proeedure to be followed in the event that vnexpected RACM is fonnd orCat II nonfriable ?
ACM becomes ernmbled, puIver.ized or re.d^nced to powder: •
U2r9fIV_ L49
!S'?1J' `uYLM f.A ?+G'.f?rJ`T?4 F Q""t4?OT e? ?C[ •
. G'- ?}b?^T!'VYJ
'. WasteTraasporter(s)Information: S. WasteDisgosalInformation: ,
I
TransponerT[artr /g_&?Sae?s.s ? ?6 Lc%cds LandfillTtama
.. Transponc Cobtaa:_ ?r,'n N•?i r.4- ! Owner/Opetator _PAsd-c MAx+.a.. e.. r.
rransponaAaar= ?i /=Q°`' A.#,A,t. IL! ' i d 9 NW
m i,aa?n,omt;oi: r?k.?
Cir?'. snee, r.,p:_ ?tn a,(; e eL3n/ S s'f/l
C;ry,StuqZip: •?lk Rr'rcr,.MN Sc.7 7,5
Phone Numba:_ G I z - !o a Phone Nusnba: 76 ?3 - 4°?f/- ?y' ' ' •
? ?
. I certify that the above information is-correct aad I.am a booafide represeatative of the.demotition
.
.
contractor or building owner aad have anthority to enter iato agreements for my empIoyer •..:
.
>ignatureofContractor/Owner Date'
Srnd to: Minnesota Potlution Control Agrncy For quu6ons call: •
'
• 2
rfetro DisUicts - Regular Bacilitia Section 651-296-7300 .
520I4fayctte Road North . 1-800-657-3864 . ?
StPauI,MN SS1554194 pAX:651-215-1593 •
'CB RemOVal IIIfOrination Polychlorinared bipheny(e (JCgs) murt be renoved from tfre burldiag prior to danolitiox. PCBs
acy be jound 'ut Iight bal7asts, srna11 capaeirorsfound in o1d appliancc, and trmcsjornta niLs: For questions eaII theMPC:!' .
f?crdovs Wasie (HFi? bYSinus essirtmfee unit ar l-80Q6S7-372d. . '
'C'SremovaaucrJaddresslphonemssnbc • '
'CS rec:iver namdaddreu(pbone number. • ?
vlercuryRemovalInformation Mercurycnnlainingmoter,'oFmvsrberemovcdromthebvildingpriortodemofitioR.
6ereurycontaining materials ma
indud
l
c s
y
e j
uorts
cn7, mctol halidt, high pressvre sodium, neoa; mercury wporlamps, mercvty ?
ivilchu, tSermastat probes, manomefers, and gagu. For, qveslions call the MPC.! XW brurnus assrirence uait ar 1-800-657•3714. •
Qcreury rcmovcr namrJaddress/phone number:
+lereury recciv:i rar.xladdras/phone number: • •
2efrigerants(CFCS/FiCFCsRecovery IDformatioa,{cerrledrecl:nicicnmicrrrecoverrefrigerantsjromrefrigeretion `
!qvipme.al and rystems in thc bvild:ng prior io demolition. For qvestions cell ihe CFCprogram'ai J-800-657.3364. t
tcFrigerant recoverer name/address/phone nwnbet:'
t:frigerant re:tivct name/addtess?phone number.
?9 . Z
° ; , ~
:i , , . ~t _
_ ~ _ _ ~ _ . ia N "C' : i~.. t , . _ , f . . . _ . , , , ,
. ~ ~ ~-~""_°"w " ~ ~:r~ , . . . „ i a i ~ ` s ' - .
~ , ~ ~.K~~ _~.~tl.AN~ "(;.f~rr~tY~~i~t~t ~t~l E ) ,'r~,U ~ ~,~,~tb ..t'~ta~~,.~~ ~ . S "f.~, ~ . ~ ~ ~ ~ ~ , ~ ~ , , . . , , w , r ~ . , . ~ , , . ~
. : ~ , . ~ , ~ " ~ Cw 1~ f~ ~ ~ 2 _ . . 3 ` ~r . t, . . } ! , . _ ~ , , . ,,3 ~ , r
2 ~ ~ ~ i ; ~ ~ . l I:: S ~.C~ ~ i~ ' r~, ~ • . ~ . ~ ~ b"~ ~ - , ,
, ~ . ~ ; , , j , ~ . . , , ~ ~ ~ , . . . _ , . ~ ~ ~ q e , . . . ~~,~:if't~~,~ ~~^'d fJ',{~} - .i , . . r ~j ~ :R~rr,~! . . . . . .
. _ f. _ _ " ~ .~t~ta~.~tu~» ~'w ' ' , ~ ' ~ . ~ , i
, _ Q t 1 -.P ,/r , ~ ; ; : , ~ _ ,A Y'~1 k~C P ~ ~ , ` r . "`u„ ~`!1 ~ ~ ' ~ e { , 1 , r . ~ . ~ - ...,,,a.._...,. : . . . . . _ , . . / . . " r ~ k ~ . . P .
, . , . : . . C.nt,'~1Y2+~~i;~,Q,e.utw S~~iuc,~ ' > . - , ~t_~:. ` ~ ~i3•~. ~ ,,,s . _ , , ~ - x
_ _ . . . _ , ~ , _ ` - 1 U' fi i r~ 1, ~ T ~ p t_ _ S3 r~i. _ D~ ~
" ~ ~ , .S . . ~1 . ~.J~ . F. ~ ~ . ~ { ~ ~ ` " r ~ ~ , : _ •r '
- ~ "1, ~ ~,v~ ~ '~3 ~a ~ °3 I p ~ ;r < ~a~ i:. I M~Ktt ~t?I^[Tf~~~ ~ 4 ~ , , Q ~ - _ ~ ~ _ ~ ~-----•~---~r ~ ~ ~ ~ ~ ~ ~ ~ x
_ ' ~ . rt , I ^ p : f'` , . :
' A~ ~ ` r t~ , . ~
, ; , i . . . E ~ ~ ~ ~ .
. . ~ ~ . ~ , . . . ~ . . ~ ~ . . . - . ~ ~ ~ . ~ ~ ~ . ~ ~ : . ~ _ . ~ F"J . . . . . ~ . _ . , . . . . . . . . . , . , . ~ . ' . ~ ~ . .
~ . , . . . ~ , ' . . ~ ~ . ~ . . . . . : . . . . ~ . . . ~ ~ . . ~ . ~ . - ' . . ~ ~ . . ~ . ~ . . < . . ti . ~ ~ . ' ~ f . . ~ .
, . ~ . ~ . ~ . . ' . ~ . ~ . F' . ~ . ~ , . -t, . . . . . . ~ ' . . ` . ' , . . . . . . . . . . , ~ . . , . . , . ~ , ~ . . ' . ~ . ~ ~ . . . . . . . ~ . . ~ ~ . ~ ` . . ~ ~ - .
r~^ ~ ~E ~ e
~ ~ ~r' ~ 3 - ~ . . . ' ~ ' ~ . .
~ , o ~ 6 ~ c~ ~ ~ ~ ~ . . ~ : . . .
~ ! ~ ~ . , , ~ ~ . ~ L ~ ~ ~ . ~ , ~ , . , ' ~ . ~ ~ . . . . . . ~ ~
~ ~ ~ _ ~ , ; g ~ . _ ~ , , , ; , 3 ~ ~ . ~ e ~ ~ 4 ~ ~9 17 le3. , . F F:
r `v. 'y~s, r; . . . ~ ~ , !y. iJ . 1 ~ . . A,,, _ . , ~ / . , ~..'^°~--_-.~.-.„»n-.o-;?; ~ r s ~
, ~ , z ' ' ~ ~ . ° S,, ~ ~~lJ, ~ ~ ' c ~ ;~t~° k ~ ~ t~y ~ J ~ _ _ E~
4 . ? . / ` ~ , . ! ~ ' ~ ~ ~ : ~ k ~7 ~
. . ~ ~ 1 s' 1 t • _ ~ : ~ i ~ ~ - i ~ ~ ~ .6~' ~ ~ 4..4:~~ i . ~ ! . . . . . , . ;
~ ~ ~ ~ ~ / C~ 9' ~ ; 1 E f~, , ~ ~i ~ Zp p ; e;Q.
• , _ a _ . . ~ ' i ~ ~,r''' ' , . , , ~v, ~j , . ` ~ . . _ f ~ .
~ ^ i, g ' j '
~ k ` f;'' ~„r^ E , \ , ~ ~ ~ ~ {l~ f` ~ . i . .
_ . . . / i. . ~ . . . . ^f" 'r`~, ~ ~ . . ~ , ~ , F ~ - . . . ~ . . . . , _ t . , . ~ ~ , ~ ~ , :s 1 ~ ~ ~ / ~ ~ ~ ~ ~ ~ ~ f ` . ~ ~ ~ ~ ~ y , 4
~ ~ , ~ ~ . ~ . ~ ~ ~ ~ . : ~ ~s~ ~ i . , ~ , ~ _ ~ ~ ~ „ ~~y, ~ ` . y. ~ ~ ~ ~ ~ t ~ ~ ~ ~ { .
. ' ' ~ . . . , . ~'4<'` j . . ' ~ . , . . ~ lt` . 'fi~A ~ I _ . . '~d. . ~ t~ , ' . . . r ,.h' 'y,. :i ~ J. '~,,y, ~ ~ . t' ~ ` ' ~ I ~ ~ " , ; t~%' f ?
~ , ; C~ ,f + 4~ , , ~ ~ _ ~ k I >„~4 ~ i . V~ q
~ ~ ~ ~ ~ ~ ~ , ~ _ ~ , • ,qr,~ 1 2r . ~ j , i ~ d ~ ~ ~ ,a., ~I ~ ~ _ ~
~ ~ ~ ~ ~ . ~ ' . ~ r~•~d . e ~ : y, ~ ~.a .,i ! ~ ~ ~ . , ~~...E..~i ~ ~ : \ . , ~ . ` ~ , ~ y. i~ ~1 e r # , . .
~ a ~,1r ~ ~ ~ ~ Y ~ , , ~ ~A . ~~F ;fr - z, ~ ~ , ,I I > ` , ~ c'., , ~ i D~ ~ _ . . < . f. ~ A y~ ~ ~ ~ ~ ~~~~p~ ! ~ ~ ~j l , , ~ ~ ,
. . . . , . ~ `*~1, . ~ ~ ~ ~ ~''y J . . q . , ; ~ . 1 I Q / . ~ ~ . k ~ b : ~y . . ,~~i. ~ . _ .
. . ~ / . /f ~t . ~ ~ . . . '.4 . . . . . . ~ ' . ' ~ , 1 ~ - C ..r' ~ . ~9'~~r ,~j~ `P~4., , :1 }
- ~ t ,ti.. , , ti ; i ' ~ ~ . ~ I: ~ _ ~ . ;l ''7" \ ~ j,.. '~r° ` ~ _ r
. . . ~ ~ . , ~ r.-~" . ~i.. . . / ~r. m ~r ~ ~ ~ ~ ~
~ t ~ ~ ~ ~ ~ i ~ , i r~, ~ - *'e , ~ , „ , ~ ; ~ ,e ~ t2~' f~ . ' l ; t ; ~ r t , ~ , , f
, ~ F,r~ ~i .y 7 l'~ ' / ~ ~ , . . , . ; .
' ~ ~ f , . , , y ' F'~~, i~ ~.3~ ~ / ~ ~ ' . `z~ ~ ga, , ti , : A°`f' , / , ~ 3 i
, w , _ _ ~ , ~ , , ~ ~ r~'~, t ~ \ .~fs 1~~, t ~ . / ~ ` ~ ~ : y , , , _ _ / \ ~ ~ yN E ~ j 1
~ ~ ~ ~ ~ ~ ~ ~ ~ L ~ ` ~ t ~ ~a ~ ~ ~ , _ pR~c,r;_ ~ r ~ ~ ~i ~ i . ~ ~ _ 6 ~ t u..; ~ ~ - - ~ _ ~ y.; ~ _ _ r - ; _ ~ - . ; _
~ / v ~ ~ ~ ~ _ - - = , _ _ ~ _ _ . , _ ~ , l ~ - , j ~ h~;4<l<, l f-: . _ ~ ~ < s~ a., ~ ' r ~ ~ : ~ ~ ~ ~ ~ : ` s . / . ~ ;
~ ~ ~ : ' / t. , Y . t~~ f ; ' . ~ . ~j . , - ~ . . ~ - . . ~ ^ ~ , } ' ,'it" ~ ~
~ ' ~ . , ~ ~ ~ . ~ ~ \ / - . , f,~ . . . ~ ~ , , _ i ~ ; , ~ .:e _ ti~ ,i . . . ~ . , ~'r ~ , / ~ , j . , . , - _ . ; . r
1 y . ~ - ~ i ~ ' ~ ~ ` ` . ~ J' , ~ 4 - ~ . . , ' ` . " . . ~ , : . ~ . , S' . . ~ .t. ( Y~ . . / . . , . ~ ~ ' . _ / d ~ . . ~ 1 . ~ . . . .
~ . . . . ~f • . . , . ~ . ~ : w . . ' . , 't . . ' .~q l.r ~ ~ p,.. ` ~i . ~ . . . . . .1 . ° ~ ~ . . . . . i ~ r . . l . . i , ~ ' . 1 ~ i . / ~ ~ •~tl ~.a'°"~ ~ ~..tpc tl . . !L ~ . ~^"~u'~ '
, ~ ~ ~ ~ ~ ~ ~ ~ ,,~`"~,t ~ ~ ' ~ ~ ~ ~ 1. ~ ~ , . , ~ „ ; 4? ~r l , , ~ , ~ i i / r ' \ %a'' ' ~ J ~ zoz
; r~, .G t y ; , , ~ - . ~ ~ ~ . - i < . . ~g~ /~~~k ! ' / . . . .L . ~ . i ~ ~ . 4 . . . . . . . . ~ . i . / N~ . ~ . . . . . ~ - ~ ~l ~ I . ~ ~ ~ J~j . ...~.;..r%'' , --+""'.r . . ~
` ~ . . ~ ~ ~ . . . . . _ . ~ _ : ? ~ . ~~ff''~~ ~ , ~ \ . , ~ `1~F . . . , , . ' ~ Ki7:~ t i:' j ' " R . ~ . . - . 1 ~ ~~~c,~ ~ , , ~ ~ ; 4 . . _ . . '
/ ~ ~ , ~ ~ _ i, '.,,,,:wrr...._ ' \ ~ l`~ - " , ~ . . . til 0 E
, ~ , ~ ~ - " ~ . ; ~o I f ~ ~ , ~ .-f' ' _ , ~ . . . ; ~-r ` , . ' i" -1~ , , a ~ - / - ~ _ ,
, , , , ' z , s ~ < < ~ ~ _ _ ~ ~ .
- ~ ; , r ?i , , ~ ~ ~ ~ _ , „ . ~ , . ~ . ~ . , ~ , d , . . - ~
~ ' . ~ ; ` , ` ~ ' ' . ~ ~ ~ . , , 'p~ r d ~
. . 7 ~ , ~ ' 'Y~ ~,~~Fj ' ` ' . " ! . ~ . . . % . , f . y 6/ ~ . . . - , . ~ 1 .
. . !t ~ ' ' . . . - V ~ . . . ~ P1_ . . i . . . ~ . . , . ~ , . ~ . . ~ ; ~:;I^.,-.'- , . . . .
~ ~ / 1- ~ . - . . - ~ ~ , . • / ~ . ~ ! y- . ~ . . 6 ~ + ~ ~ ` . ~ ,a ~ . , ' ~ r ~r, i~ ` ~ ~ ~ , ~ ~ ' Q I~ ~
i , , , - ~.~-_w , ; ~ ~ ~P i ~ ~ . . ~ . g'.
. i ~ ; ( ~ p
s' ~ ~ ~ ~ ~ . ~ ~ ~ ~ ~ ~ i' ~ ~ ~ ~ ~ c J^= = Z _ _ c~- .
l=--=-- -
_.l----~-- ~ ~ , - s t_ -r .
, _ . . ~w - - . _ . _ a.. ' a ~
_ _ - b ~ - ,
, ~
~ ~ ~I~ ~ ~ ~ ~ r'~r ~ ~ ~ ~ ~
I 1~,1'CL:. ~;'~~i; ij ~ ~ I ' ,
I ~
~ ~ . ~
~ J ~ , , ~
0 0 C3 ~ ~Qo
l (
~ ~ , ~ ~ ~ ~-1 ~ t.a ° i ~^t t~
~ q t~ 3 C7 c. i~~ar~v K l., ~ C;1 rr t, ~ri ~ \ ~ ~a t~':, r ~•'t r,„tF
~
~ 45~G~`7Z~~ ~ ~
I
~ . . . . . . . . ~~.~.1 ~ a i.~: ~i ~l ~ ~ l.~ 'rt i. ~ i
~ ~ ~ ~ ~ ~ ~ ~ ~ h:~t:1~:.:~ R~QCa~ C~t12c 1.~:.~, ~aLa',t:-E; ~;.Jt ~
i 9 Q~ C~ ~ , .
~ a~._ ~