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4677 Aspen Ridge CirAddtesS 467 7 A s p e o P i d g e Oi r ZIp 5512? IAt 3 BIk i .SUb nakgnintP nf F.agan ?nd Arlrlirinn THESE 1TEMS WERE / WERE NOT COMPLETE AT THE TIME QP THE FINAL INSPEGTION. ;? Date: Yes o Inspedor: Final grade (6" from siding) Permanent steps (gazage) Permanent steps (main entry) Perntanent driveway Permanent gas Sod/Seeded grass TraiUcurb damage Porch Basement finish Deck ? Please verify with the builder the removal of roof test caps from the plumbing system and the shut-off of water supply W the outside lawn faucet before freeze potential exists. ContaIX engineering division at 681-4645 before working in rightof-way or installing underground sprinkler system. ? White - City Copy Yellow - Resident Copy Pink - Contractor Copy *******************************X?x"r?"?-^.. CITY OF EAGAN -44- L-,() `3 ?s CASHIER: JS TERMINAL NO: 775 DATE: 04/20/00 TIME: 09:30:39 ID: NAME: JOSEPH P VARLEY CONSTRUCTION 2252 9220 4677 ASPN RDG C 30.00 3210 9001 4677 ASPN RDG C 1,032.95 3866 9379 4677 ASPN RDG C 100.00 3422 9001 4677 ASPN RDG C 671.42 2275 9220 4677 ASPN RDG C 1,089.00 3446 9001 4677 ASPN RDG C 11.00 2155 9001 4677 ASPN RDG C 0.50 3743 9220 4677 ASPN RDG C 50.00 2155 9001 4677 ASPN RDG C 53.50 3868 9220 4677 ASPN RDG C 492.00 CR127038 ** CONTINU USER ID: JAN ** CONTINU **?*?**** *?*** t*+?? ***?*?** ???*****?*** ****t?********?x*?+****,t,t*?**** CONTINU CITY OF EAGAN CASHIER: JS TERMINAL N0: 775 DATE: 04/20/00 TIME: 09:30:40 ID: NAME: JOSEPH P VARLEY CONSTRUCTION 3716 9220 4677 ASPN RDG C 114.00 3713 9220 4677 ASPN RDG C 50.00 3865 9220 4677 ASPN RDG C 840.00 Total Receipt Amount: 4,534.37 CR127038 USER ID: JAN 440450 -2000 BUILDING PERMIT APPLICATION (RESIDENTIAL) cin oF EAauu 3830 PILOT KNOB RD - 55122 - ' 851-681-4675 ygw Qn%i=,goWNwm Remodel/Reoalr ReaulremeMs D 3 roplsA9reC slte wrvoys flwwinp sq. N. of lot, W. rt. ol Nouse and 9!!roqtetl a[ans f20?6 maximum lof coveraae albwetl) D 2 coples oi? Wan% (thow bemn ? wincbw si?e? Pa+red hxl. dedpn; etc.) ? 1 wf o/ enerpy oaleulations > 3 coplet of hee Preaervallon Ga N bt plaMed aRer 7/1/93 2 eoWes of plan 1 set W energy ca9cWaMOna ra heated adtllMOm 1 tlfe wrvey lor exteda additlons 3 decka oA,E: CoNSTR?,CTIoN CoST: r DESCRIPTION OF WORK: E /?C '= SiREET ADDRESS: ? LOT: ? BLOCK: ? SUBD./P.I.D. t: 4?41- Name: &VC6? /0 C Phone Y: ?Qla-&/, v/? 7 PROPERTY lwt Flrat OWNER Sheet Address: d ? ciy e;?-60 srare: /Li /C) LP: . Company. -,?o P!/ ,oP? So 7-?3?f (area eode) COMRACTOR Sheet Address: /0140 U/ LGG? ucense # cny stare: nP: S S?d ?,L ARCHITECT/ ENGINEER Company: Name: Telephone C ( J?1 % ) -S? JI s - /;" / Sheei Address:? RegistraHon M: CHy S? r Q! > l- State: IfA /j 73p: Sewer/water licensed plumber (H installina sewer/water): /-?' 7°T w 1 h?' PKon§ t{:6L?S?,) ? 7?" `? ? 7 7 1 hereby aCknowledpe ihat 1 have read this applicalion. slWe Mhat 1he infomatbn k rtect, and agree to WY wiTh aC apPpcable ?e ol Minnesota Stalufes and CMy ot Eagan OMinances. ? ? ? Signaiure ot Applicant C7)-?'? ? OFFICE USE ONLY Certiflcates of Survey Received ---(V Yes ' Tree PreservaUon Plan Received ? Yes No U _ No ?Ot Required + -e S Q? Y? d- .JNk tkA-1? A?A 445A.31 NI J vwcrv K?4 OFFICE USE ONLY BUILDING PERMIT SUBTYPES ? 01 Foundation ? 07 05-plex ? 13 16plex O 21 Porch (3sea.) O X 02 SF DwelBng O OB 06-plex O 17 Garege O 22 Poroh/Addn. (4sea.) O ? 03 01 of _ piex p 09 07-plex ? 18 Deck p 23 Poreh (screened) G O 04 02-plex O 10 08-piex 0 19 Lower Level 0 24 Storm Damage .' O 05 03-plex O 11 10-piex Plbg _Yor_N O 25 Miscellaneous O 06 04-plex p 12 12-plex O 20 Pool O 30 Accessory Bldg. WORK TYPE )[ 31 New O 36 Move Bidg. O 43 Reroof O 32 Addition O 37 Demolish (Bldg)" O 44 Siding O 33 Alteration O 38 Demoiish (Interior) O 45 Fire Repair O 34 Repair O 42 Demolish (Foundation) 0 46 Windows/Doors • Give PCA handout to applicant for demolition permit y 31 E?f Ait - Multl 33 Eict. Alt - SF 36 MuNi 10 GENERAL INFORMATION ? SAC Code _Q(_ # of 5tories _ sq. ft. . No. of Units Length ? sq. ft. No. of Buildings ! Width - - Footprint sq. ft. ? Const. (Actual) 7t V Basement sq. ft. Census Code / b/ (Allowable) ? Main level sq. ft. ? MC/ES System UBC Occupancy ,Q3Ij a hib sq. ft. ?2 / 2 City Water Zoning ?a (4? sq, ft. I.1 N D Booster Pump PRV V I7n Fire Sprinklered MISCELLANEOUS I1)1SPEC7IO ? Stucco/Stone I ? l APPROVALS .. Planning Building zlg-q Engineering Variance Permit Fee Valuation: $ ? V PDo Surcharge Plan Review License MC/ES SAC City SAC Water Conn. - -j Acxt. Deposit Y) /?A S/W Permit S/W Surcharge ? y d Treatment PL Park Ded. Trails Ded. Other e? r ? j`r? ' ? `? ?/y(' X 71 iu Copies y I ? - -- -- - I rotal: 0 4-e4lc I - ? SAC Units % SAC 'OV2,L (a ? 1(90)r N o y , a ? /o4 i : < ?* * * PIOMI * Bh * * * * 2422 Enterprise Orive Mendota Heights, MN 55120 (651) 681-1914 FAX:681-9488 LNID SURVEYd15 • tlNl ENpNEFRS E-moil: PI ONEEROPRESSEN TER. COM uxo n.umms• iurourse u`parccrs 625 Hi hwa 10 N E Certificate of Survey for: Ng? •00$4X LOT AREA = 7,716 sq.fL S . HOUSE AREA = 1,280 sq.ft. COVERAGE=17% HOUSE TYPE=2 STORY L.O. H-31-/ ? BENCH MARK J•TOP OF PIPE ,' ELE V. =935.61 ? ? c'9_ (D PONO AP-14 ? NWL=912.1 HWL=921.6 9 Y Blaine, MN 55434 (612) 783-1880 FAX:783-1883 E-mail: PIONEER20PRESSENTER.COM -OCP HOMES, INC. 4677 ASPEN RIDGE CIRCLE X939.5 4 sx,or osE??"' 1 PR?PIN ? 928.6 o - o 1? x r" m --- 3 9 _ 11.6 p ' ..' U(91E.4 ? ?N DRAINAGE M UnIIT qN0 IN W1933.6 PlA ?. EASEMENT PE0. & SEWE0. a o?l 934.1 PONOING. WATER, 128164 _ EASEMENT DOC. N0. 930.6 931.5Exj' _ 55.57 00'41nE H( (qz3 ? N81' \\\ ? EDGE OF POND PER GRADING PLAN NOTE: PROPOSEU GRAOES SHOWN PER GRAOING PLAN BY: POINEER NOTE: BVILDINC DIMENSIONS SHOWN ARE FOR HORIZONTAL ANO VER7ICAL LOCATION OF STRUCiURES ONLY. SEE ARCHITECIUAL PLANS FOR BWLDING AND FOUNDAPON DIMENSIONS. NOIE: NO SPECIFIC SOILS INVESTIGATION HAS BEEN COMPLETED ON 114IS LOT BY THE SURVEYOR. TNE SUITABILITY OF SOILS TO SUPPORT THE SPECIFlC HOUSE PROPOSE9 IS NOT THE RESPONSIBILITY OF THE SURVEYOR. 12 934.3 *yp Ln T ? rn Z o1 70 a` O `° ? IT1 01l n 933.3 (n , _p9'33"10" ? -1oo.oo \? y ? 6.68 i` 932.5 ,4 > ?? 1 1 7 31.39sa?.a ,146.96 \ ``BENCH MARK TOP OF PIPE ELEV.=935.03 P, kl TS M P n E_\`53 l:/ ° R L-0 PRpPOSED HOUSE ELEVATION LOWEST FLOOR ELEVATION: 9zSs•'?'? MAIN FLOOR ELEVATION 937• 7 GARAGE SLAB ELEVATION: Li 3j t T08 @ LOOKOUT ELEVATION: 15Y 3 0 NOTE: iHIS CERTIFlCATE DOES NOT PURPORT i0 SHOW EASEMENTS OTHEft THAN X 000.00 DENOTES EXISTINC ELEVA710N THOSE SHOWN ON 7NE RECORDEO PLAT. ( 000.00 ) DENOTES PROPOSEO ELEVATION DENOTES DRAINAGE ANO U7ILITY EASEMENT NOTE: CONTRACTOR Ml1Si VERIFY DRIVEWAY DESIGN. DENOTES ORAINAGE Fl.OW DIRECPON NOIE: 9EARINGS SHONTJ ARE BASEO ON AN ASSUMED OATUM 9 DENOTES MONUMENT -6 DENOTES OFFSET HU6 WE HEREBY CERTIFY TO OCP HOMES, INC. THAT THIS IS A TRUE AND CORRECT REPRESENTA710N OF A SURVEY OF THE 6011NDARIES OF: LOT 3, BLOCK 1, OAKPOINTE OF EAGAN 2ND ADDITION DAKOTA COUNTY, MINNESOTA IT DOES NOT PURPORT TO SHOW IMPROVEMENTS OR ENCHROACHMENTS, EXCEPT OWN, AS SUR4EYED BY ME OR UNDER MY DIRECT SUPERVfS10N THIS 22 DAY OF MARCH, 2000. SI NED: PIONEER EN EERI , P.A. SCALE : 1 INCH = 30 FEET r- Y: ? . _ _ _ , _ _ . ..... John C. Lorson, L.S. Reg. No. 19828 berrmFn mAP 3 d = .? ? cirx of EacAx Esreeiox eWiE.orF evEasce IuI coKrurerior SIiE ADDHF43: corsseczog: VARL.?Y c.of-1 S-i?e?'_ narE: 3- 23 - Do peo?:6?__ • d I a7' ONREN: O C P I-l O N1.E-5 _ 4677 A-SP?N R?DC ? G?RG??LcTI' 3 DeLermine vorldng aquere footege of eac6: 1. Total esposed xall area ... SQ. rt. X .11 317 2, Total roof/ceiling area ... I 1462 aq. ft. z.o26 ? 3 0 Total esposed ra]1 area above floor c 2 15? ?.37 S. Total wall window area ...... ........... .....•••••• b. Total door area ................................... p c. Total aliding glass area .......................... ? 1bLa1 fireplace aall erea ......................... d , e. Total xall framing area (average 10'1) ••••.•••••••• .. f. Total net wall area.above f oor ................. g. Total rim joist area .............................. I (a C) Total e:posed fouadatioa area = ? h. Total foundation xindoW erea ....................... ? i. Total neL foundetion area sbove grade .............. Determine 'U' value of each wall aepent: 237 X ,U, ,?39 = SI x ' U' b. 3 ? 6 c. x 'll' .34 x ' U. -- ° ?-' d. x'U' e. JR ? f. 1437 x'U' g. - h. - x 'U' - i. ? x 'U' . 07G = t ? ? ? ........... Total . . 3 . .................................... . ??- If item /3 is Lhe same as or less Lhan item 41. Yoy haVe meti tbe intent of SBC 6006(c)2. Total ezpoxd roof/ceiling aree • J. Total akyllght area ............................... e tOf) • ..•• k. Total roof/ceiling framing area (averag '? 1. Total net insulated roof/cel2ing area .............. OYER Determfne 'U' value for eacb roof/eeiliag seBment: J. ? x 'U' _ 0 C k. (t9 x out .o?? = 3 i. I D2l? : oot . oa? _ .23 4 . ...................................................... Totel. = 2-6 If total of /4 is the aame as or less than i2, qou heve met the intent of SHC 60D6(c)1.. Alternate 8uilding t}?velope Design io utilize tre total envelope sqatem mettiod, the valuea established by the sum.. of Items 63 and /Y shall not be greater than the sum of Itema !7 and /2. i. 417 + z. 30 s 3-17 3. a 5 D .4. 26 a a.76 2 Cities DiRital itv Control The following image represents the best available image from the original page. Every effort was made to capture the content from the original page. , Spac .' ? G) 0 RODF I C:.IL1Nf, 1t1'jU1o1? PaR fJL,%1 4h5utAtloN ?'` `? , (R) ? .6? .S EX'j6??p(5TiLL) 7o7AL u =. o? WAtL (R) vi 0 4 9 0 Q 11 trrc-r-1or- RlR fIIM 169 le ?G'te' Bn' . . . .4; wsuLA7loN sia''I144 vI N Y L slDlrCa .? E01.04mi Are. FiLtl . ? - ToTaL (??=x; °fi ? It+TEi'-lor. Aic- FIu1. 5 1fi Irscx:+T?aa4 p -t FlR Ru-ry W?isT c u/5.2" sti!T.-Ari . -. C,&j V IrtYG, __ s1o1rG Q .Exj'cRuR A?x fN.f'1 ToTP: (R)= ?aJr??AT?or? V =, Cn) ' Q tNTeWDIL A?rc ? ? Ca tz"xacc,rsc,. SUK. . 1 .17 ? EXj?r.toz pirr FuM --' r (rc)=13 ?l5•5 V=.o7 Floozs orz: unheated spaces oust lwvs ainia= R-factor of R-20 (tuek-undet gazages)• Floots ov.^r outdoor sir (ovcrhangs) rnsst bive a ninimum R-faetor of &-33. , CITY USE ONLY LOT (3 BL I PERMIT #: y' OK SUBD. Gtl ? bDi MfC RECEIPT #: ?sog I D RECEIPT DATE: OCI 2000 MECHANICAI. PERMIT (RESIDENTIAL) Date: 51?6U? Complete this section onlv if you are installing HVAC in a single family dwelling, townhome or condo under oonstracticn and not owner/occupied. • HVAC: 0-100 M B T U $ 30.00 ADDITIONAL 50 M BTU 6.00 3.Uu • Gas outlets (minimum of one required @$3.00 ea.)by P(Wy4_-V State Surchazge .50 Total $ 33.5d Complete this section onlv if you are remodeline, addins to, or re airin an existing single-family dwelling, townhome, or condo. Piease indicate if it is a new item, alteration, or repair. 7- New Alteration ? Furnace Air exchanger _ Repair V__ Other Air conditioning Other Fee State Surcharge Total Reminder: Cal1 for inspections SITEADDRESS: QV1-1 C.xa-c' $ $ 30.00 .50 30.50 OWNERNAME: VO-YlPJ.A lfiPHONE#: 5-0-7 _ ?? 663 INSTALLER NAME: rnAlI CtiJfS?I 4?-a1 l? PHONE #: (ARECGSI - `W a- a?S STREETADDRESS: ??Sp (ARE^COOe) C[TY: STATE: i"""" ZIP: ?IZZ CITY OF EAGAN 3830 PIIAT FINOB RD EAGAN tMI 55122 651-691-4675 ? ?.. G??A? Ani SIGNATURE OF PERMI E L BL I CITY USE ONLY SUBD. O na RECEIPT fi: GR ? 3 I°I 7 RECEIPT DATE: V Q PERMIT# 8000 PLIJM$INfi PERMiT (fiESIDENTIA1.) crrY oF Eweaiu 3830 Paor xxos Rn gpflAN, MN 551 EE 631-8$1-4675 Please complete for: ? single family dwellings ? townhomes and condos when permits are required for each unit ? backflow preventer for underground sprinkler system crvTi locc EACH # TOTAL f?I?l Vf?VV Atterations to existing dwelling - minimum fee Describe: $ 30.00 I Bath tub $ 3.00 x = - $ $ ? Floor drain 3.00 x = $ Gas i in outlet ` minimum - t 3.00 x $ Hot tub/s a 3.00 x _ - $ Kitchen sink 3.00 x = $ Laund tra 3.00 x - $ ? Lavato 3.00 x _ $ i S0 tIC S StOm newlrefur6ished 're uires MPC lic. 75.00 % = $ I Se tIC S Stem abandonment 30.00 X - $ ? RPZ newinstallation/re air/rebuim 30.00 X 3 = ? Rou h o enin 1.5 0 x = $ ? Shower 0 3.0 x = $ UndOf t0ufldS flnklef ifdwellin isundercansWction 3.00 x = $ ? in existlng ell Under round s rinkler if dw 30.00 0 x 3 ? ? W ater closet 3.0 x _ $ a? ? Water heater 3.00 X ? = $ I W ater softener If dwelling under construction 5.00 x = $ Watersoftener itexistin dwewng 30.00 x - _ $ Waterturnaround 30.00 x - > --' $ 50 State Surchar e .50 --> --- - Total Reminder: Call for inspections of alterations, i.e. water heaters, water softeners, etc. t0,0j ? -------?----•-- -------------------------------•----•------•-----------------------•---• •-------------------•--•---- ?I hereby acknowledge fhat I have read this applicabon, state that the infortnadon is correct. and agree to comply with ail applipble Ciry of Eagan ordinances. It is the applicant's responsi6ility to noUfy the proparty owner Uat Ihe City of Eagan assumes no Iiabiiity (or any damages caused hy the City during its rwrmal operational and maintenance acGvitles to the (adlities consWCtad under this permit within City property/right-of-way/easement. SITE ADDRESS: OW NER NAME: : INSTALLER NAME: STREET ADDRESS: TELEPHONE#: 5'-7 3---5q- 1,03y (AREA CODE) TELEPHONE #: ?51_ "?,IP' (AREA CODE) CITY: 7AL. j STAT •,?Y'I ZIP: `JrSIOg ' )w GNATURE OF PERMITTEE Y rtt,6l CW Development d Lot Number Address Builder Tree Protection Reauirements: (SEE ATTACHMENTS) J_??(e",- L3 RI OU kPoi nf e, of Euqah Z ? ?J ? Tree Fencing L"', Oak Tree Pruning ( I wounds during April 15 to July? Therepeutic Pruning Retaining Wall Other: Renlacement Trees: ? Not Required As Follows: Attachments: ? Yes No Additional Notes: ?.w a ??? ??? ?.c ? 1 ? ?r?`?"e J re cw o?L ?? ???RY M9610H Ws99 0 a?! ?..._---- 3 Block Number l Tree Preservation Plan Oakpointe of Eagan Lot 3, Block / a?:!D ??yD 1 `rio 0 (Site Plan Attached) Address: ZY 6 77 ,f 2-PE'? k?'i L??-O'ro OWf12r: OCP Homes, Inc. BUIIdef: Joseph P. Varley Construction 8609 Lyndale Ave. So. 4101B 16800 Shieldsville Bivd. Bloomington, MN 55420 Faribautt, MN 55021 881-0127 507-334-6034 Sianificant 7rees on Lot: None Sionificant Trees: (Numbers Per Tree 5urvey) # Tvoe Size 161 6 P E"er? r 9 ?, 0 A E' 139 Ck+ErPRY u? li O?£k i. Z S_ )40 2D Z w i.l o R,e ? 1 ri 4 6 ? K 0.4 /f Protective I?(easures: Qj" ? Tree Fencing _ Oak Pruning (April 15 - July 15) _ Retaining Wall Retain or Remove ?" OV 'E? -17f i/If 2? TLV?N /2 ? nf/iY ,eE'TX/A/ QL--77Y //(/ /e-E Therapuefic Pruning K Other: /' o Re lacemerit Trees: Not Required As Fouows: s E E NA ? ? ? T f?4CN Notes: Q?„ C ?,, -o „ . _ ?y?°??? I ? ?d! 915 __-- ? _ . ? _. . - ' ---- -__ , ?? - - -- NP.- --- '- _ -- ? ------ - -- • j ?, i ; ` Y? LJ ui, p ? '' % , ? ? w '?? ? -!'?' ! ?` • ?. ` ?j,. '!'1. ., 1•I ? I ??_ I Y? . W 17.G77 ? - ? ------'-"- ? sr ? ;?'c 93 ??Q . ............ .? -f- ;`--•, _, '?; ' - " ` ? ' ? y ? f I , ?? ? 9 _-?---'_ ? •.?3 ;z''' , V' ?? LG'1 H ?-_ ---?_ R - 6TO' Ob Cq of Talan 3830 Pilot Knob Road Eagan MN 55122 Phone: (657) 6754675 Fax:(651)675-5694 as a-710 ------------ - ; ---- i aeMam ob i , ?. ; pmyit Fee: ? ; Date Aeceivac: ? i ? i Stwf: ? !----------------? 2008 RESIDENTIAL BUILDING PERMfT aPPUCAnOH owe: l ? S/oY> sae,ada?ess: ?s n?? r??' ( Sume C`'1tkE Mc.o?? Pnone: RESIDENTlOWNER Name: Address ! City / Zip: Appricantis: _Ovmer ?CnntrQGOr ?----- TYPE OF WORK Description of worlc: 'T??? ConstructionCost: CON7RAC'fOR Mulo-Famiy &n'Idin9: (Yes _./ N4,? L Ucense naa?ass. .• • -- - City: ZN11C?'n?-et' Phow.t 5i • 439-uV0 00nW aenon: knc?e,?1 - COMPLETE'i'IiIS AREA ONLY IF CONSTRUCTING A,N„M BUILDING _ Jhr-41152%211es 76T0 Catsaorv 1 _ Adinnesot8 Rules 7672 Ejwrgy CpQe . pe&denfial Verm'Iadon.Categcry t Waksheet . . Nexr EMgy Coda WaAOheat cmgory SubyiMed SLbrnitted {J submission type} ' eww ? GWMAMN &byftd . ' In ths Ias[ 12 mordhs, has ihe CitY of Ea9an issusd e PemK ter a Simll8r Plan bssetl on a mesOSr Plan? _Yes ---- No tf yes, dste and sddreas of master VcwL,ed Piumber: Meehaniea! Contraotor: Phorte' Sewer & Wazer ContractOr. Phom. t nemby adaawtadge Nst tltis,irtannatlon is aomPlefeaM aocsue0e: UWt C?¢ Mwk rA4 6a M?narKS ?Mtlf tl?e ordina? ? tl» work v?be in ? a? ?dn, n+e ? epproved ? a? n ? a? wa?kwtaa, ? ?? a vr?not . co star? w?n a a«mn: axw X Applicant's Prarted Narne ??PPIicarR's Si9reWre pW t of 3 PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA122091 Date Issued:04/24/2014 Permit Category:ePermit Site Address: 4677 Aspen Ridge Cir Lot:3 Block: 1 Addition: Oakpointe Of Eagan 2nd PID:10-53776-01-030 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. Deb Larson 8815 209th St Lakeville, MN 55044 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 - Michael J Moore 4677 Aspen Ridge Cir Eagan MN 55122 (651) 687-0470 Drain Pro Plumbing 8815 - 209th Street W Lakeville MN 55044 (952) 469-6999 Applicant/Permitee: Signature Issued By: Signature