732 Castleton CtCITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21 -199, Eagan, MN 55121
PH O N E: 454-8 100
BUILDING PERMIT Receipt # • i ' - ? ?
To be used for }j' ? tif;/GAit Est. Value s'?'??? Date ,1 gr: ;
Site Address 732 CASTLETON COl': T OFFICE USE ONLY
?1L1,? .=,Tntii3-
Lot ` Block ? Sec/Sub On Site Sewa
9e
Occupency ? t
.
gR(Li; H, MWCC System ? Zoning
Parcel No. Vn
On Site Well (Actual) Const
cc Namd TliE ROTT UV.NU CCl jNC Ciry water K (Allowable) Vn
z AddreSS P• J. $Ox 383 PRV Required # of Stories
? City 4?`>5EU Phone 571?304 ??terPump Length 54.66
DePth 4j.?7
.0 Name SAr'•E S.F. rotai
? ? Address Footprfnt S.F.
cc
City Phone
APPROVALS
FEES
yVj W Name + Engr./Assess. Permit Z 444.tiC?
4
5
_ = gddress ' Planner Surcharge 0
1.
°Cw CitY PhOne Council PlanReview 227.001
a Bldg. Off. SAC, City 100 .00
I hereby acknowledge that I have read this application and state that the Variance SAC, MWCC 525.00
infornaetion is correct and agree to comply with all applicabie 5tate of
Minneseta Statutes and Cit
ot Ea
an Qrdinan
eS Water Conn. 52 5•W''
y
g
e
.
?
.
Water tweter
67 • 00
?
Signature of,Permittee
RoadUnit
305_4i0
A Building Permit is issued to:_ Treatment P1 100.00
on the express condition that all work shall be done in accordance with all
applicable State ol Minnesota Statutes and City of Eagan Ordinances.
iparxs c c t' Y
?
?Z
4?J
TOTAL ,
•
Building Off icial
<;'T : '... `,'•? _L? ?
CITY OF EA6AN Permit No; Date: 1'1
"
3830,P41ot Knob Road Meter No: :,z Size:
P.D. Box 21199 Reader No: 63 q ?f 5^ Date: IJ- - f Er
Eagan, MM 55121
Owner. -.,
SiteAddress: ;'? ! astleton Coi_rt L9 I;S ?':iI?_:a c bri:i;
Plumber. `?;ci17_ey Plumbixig; ;,-,,i??? .
Conn. Chg:
Acct Dep:_
Permit Fee:
Surcharge?
Tr. Plant_
Meter. _
525.0013d
with the City oi Eagan
Ordinances.
? ey? ?
WATER SERVICE PER?ITJ
i 4
.. ;' i
(texftfiratit u# (Orrupanry
Citp of (Eagan
EP#1a1'tMPIIY Af Wltt?l'tlo JItSpPl'ttDU
This Certicate rssued pursuant to the requirements of Sectian 306 of the Urtiform Building
Code certifying that at the time of issuance tius strueture was in compliairce with ihe various
ordrnrrnces of the City regulating building construction or use. For the following.•
u. cwwfimd,. S-t" Dwc" e?. Permit No. 14497
,
oaup.-Y Type R3 zon;ng n&rict Type cowL
owwror euiiahns lii1: VQIIL?ND iXi 11%. ,?aaress U.0 BM 2:' 3 , 05-M
l'<].::dS ??!r SR?IDCE
suddtng aaaress ?' ?' "??-???; j L40Mi??y 15?. F81
ng?o: `VJtrF, 8. 1988
POST IN A CONSPICUOUS PLACE
• PLUMBING PERMIT
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55122
OTRACT PRICE: PHONE: 454-8100
Site Address -1 ? ? L" , 1 1, A, _ . c i
lot `? Block ?& SeclSub
? Name _14J.jx.
?v Address 1,? "k
c Ciry ? ?.
? Name _
c Address
3
p Ciry ?
COMM/IND FEE - 1% OF CONTRACT FEE
APT. BLDGS - COMM RATE APPLIES
TOWNHOUSE R CONDO - RES. RATE APPLIES
MtNIMUM - RESIDENTIAI FEE - $12.00
MINIMUM - COMMlIND FEE - $20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S!C IF PERMIT PRICE GOES
PERMIT # ?
RECEIPT #
DATE:
BLDG. TYPE WORK DESCRIPTION
Res. x New 1?
Mult. .
Comm
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES TOTAL
-:1-Water Closet - $3.00 S L
___4L_Bath Tubs - $3.00 L
?Lavatory - $3.00 L
? Shower - $3.00
Kitchen Sink - $3.00 3
Urinal/Bidet - $3.00
--4_Laundry Tray - $3.00 . ?
_LFloor Drains - $1.50 ?- ?-L
? Water Heater - $1 50
Whiripool - $300
_L-Gas Piping Outlets - $1.50
(MINIMUM - 1 PER PERMIn
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
___]?_Rough Openings - $1.50 4
FEE: } L
II STATE S/C: ?
CITY OF EAGAN GRAND TOTAL: ' ?
PERMIT #
MECHANICAL PERMIT
RECEIPT #
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN $5122 DATE:
CONTRACT PRICE: PHONE: 454-8100
Site Address t BLDG. TYPE WORK DESCRIPTION
Lot `Block
/ f- Sec/Sub
- Res. V New
N Mult. Add-on
°-' ame Comm. Repair
c Address
City
Phone
_
Other
?
Name
" FEES
RES. HVAC 0-100 M BTU ?
-$24.00
3 Address AODITIONAL 50 M BTU - 6.00
p City Phone (RES. HVAC INCLUDES A/C ON NEW
CONSTRUCTION)
GAS
UTLET
M
N
M
'
S (
O
I
I
UM - 1 PER PERMiI
) - 1.50 EA,
TYPE OF WORK COMM/IND FEE - 1% OF CONTRACT FEE
Forced Air M BTU APT. BIDGS. - COMM. RATE APPUES
Boiler
M BTU ? TOWNHOUSE & CONDOS - RES. RATE APPLIES
MINIMUM RESIDENTIAL FEE - ALL ADD-ON &
Unit Heater M BTU ? - REMODELS 12.00
Air Cond
M BTU MINIMUM COMMERCIAL FEE - - 20.00
.
Vent
CFM STATE SURCHARGE PER PERMIT - .50
. (qDD $.50 S/C IF PERMIT PRICE GOES
Gas Piping Outlets # BEYOND $1,000) "
Other
FEE:
V
S/C: SIGNATURE OF PERMITTEE
TOTAL•
FOR: CITY OF EAGAN
btEACAIVATED FOR DECK 5J89
GARt. _,bChOER - CITY OF EAGAN
j 688-9469 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
721-2133 tl?,l?? ' PHONE:454-8100
t
BUILDING
PERMIT Receipt#
,
To be used for Est. Value Date ,19
Site Address ' OFFICE USE ONLY
Lot BIoCk Sec/Sub. ' On Site Sewage Occupancy ?
MWCC Syatem Zoning
Parcel Na On Site weu (Actual) Const
a Name City water (Allowable)
W
;
Address PRV Required # of Stories
0
City Phone
Booster Pump
Length ?
Depth
o Name S.F.Total
,
? ? Address Footprint S.F.
a City Phone APPROVALS FEES
? W Engr./Assess. Permit
W Name
W
?
z
Planner
Surcharge
_ Address i
.
U Z Council Plen Review
?
`W City Phone
Bldg. Off.
SAC, City
'
I hereby acknowledge that I have read this application and state that the Variance SAC. MWCC
information is Correct and agree to comply with all applicable State of Water Conn.
Minnesota Statutes and City of Eagan Ordinances. Water Meter
Signature of Permittee -- -- Road Unit
A Building Permit is issued ta_ Treatment P1
on the expresscondition that all work shall be done in accordance with all Parks
applicable State of Minnesota Statutes and City of Eagan Ordinances.
TOTAL
Building Official -
Permft No. Permit Holder Wte Telephone it
Ptumbing
- -
-
H.V.AC.
EleCtric
r ? l Wa 0,0
Softener
Inspection Dats Insp. Comments
Footings I
Footings II
Foundation
Framing
Roofing
Rough Pibg.
Rough Htg. - s q ?
IsuL /,o z -"/y
Fireplace
Final Htg. ?
Final Plbg.
Bldg. Final
Cert Occ. ?
Temp. LP
Deck Ftg. Sf t
Deck Final
Well
Pr. Disp.
551DO-7 RESIDENTIAL ?s
BUILDING PERMIT APPLICATION
CITY OP EACAN
3830 PILOT KNOB RD, EAGAN MN 55122
851•881-4875
New ConsVUCfbn Heaulremenu
. 9 registeretl site surveys showing sq. n. of bt, sq, tt. of house; and all roofed areas
(20% maxlmum bt coverage albwad)
. 2 copies of plan showing beam & winCOw sizes; poured fourW design, etc.)
• 1SetofEnergyCakulatbns
• 3 copies of Tree Preservatbn Plen tl lat platted after 711/98
• Rim Jolst Detail Options saledbn sheet (bl0gs wtlh 3 or less units)
DATE O /,egg /_Q `2
SITE ADDRESS
TYPE OF
_ Water Softener
? Water Heater
_ No. of Baths
APPLICANT G- rOP?1/`7" fr. xte.Y' [OY'S
STREETADDRESS 153'S.Z 1?6ttc0 .." CliY&'l STATE,Y,&ZIP SS/?
TELEPHONE #IeT10S ?SU CELL PHONE #6151.jq8 !:Ej!yS- FAX #?i 5YoV7 DI YS
PROPERNOWNER 1[;499!Y'dl/oe-L' TELEPHONE# GI2 IV?S qYQS
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNFSOTA RUi.FS 7670 CATEGORY 1 MIA'NESOTA RLJLFS 7672
(4 submission type) • Residential VeMilation Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted
• Energy Envelape Calculations Submitted
Plumbinq Contractor: _- _
Plumbing system includes:
Mechanical Conhactor:
Mechanical system includes:
Sewer/WaTer Conhactor:
Air Conditioning
Heat Recovery System
$70.00
I hereby acknowledge ihat I have read this applicatlon, state fhat me informotion Is correct, and agree to comply
with all applicable State of Minnesota Statutes and City of Eagan Ordinances. ?
SignatureofApplieanf &ti(
-°----...... ..._......... _._......... _ ............... _.... _..._.......?..r..._.____--.__._
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4102
MULTI-FAMILY BLDG 'MY 1?CN
_ FIREPLACE(S) _ 0 _ 1 _ 2
_ Phone #
Iawn Spimkler
No. of R.I. Baths
BemodeUNepah Heguiremems
. 2 copies of plen
• lsetofEnergyCakulatronslorheatetladAAbns
. 7 sAe survey tor extefior addBbns & decks
• Indicate If home served by septic syslem Por adtlAions
VALUATION ? LI 9I1?
Fee: $90.00
This reques[ void
18 rrqnths twm d
? 7 4.4 4 9;/9 r3 ,? -IzeL, b2 ??X1CLL:???
Fa&oo
;?/ e? e, -0
Request Date ire No. R ph-m InsNeclion ?/ }}}yyy
I r?/? ??
?
' P wred>
? ?ReaAy Now `y? W?ll Nn1ify Inspec-
?? lor Wh
R
? O
YOS No en
eady
? Licensed Elei.tncal Contractor I hereby requesi inspection of above
? Owner electrical work mstalletl et.
Street Atldress, Bo or Route N. Cnv
ec o o. Township a e or No. Fnnyu No, County
?
Occu nt IPRI?Nj) Phone No .
Power Suuolier
az'?1v\ Ad?dress
Elect I Comracmr iCOmOnny Na
? Cmvz r's License No.
Mailipp AAdres=lCOnVac[pr or r Making Instailauo
I V ?
Author ;d Sienature IConnac dOwner Makmp histallabonl
5 Phone Num?er
(o
Od
MINNESOTq STATE(QOAFD Of ELECTqICITY ? THIS INSPECTION REQUEST WILL NOT
GrigBS-MOdway BICg. - Room N-191 BE ACCEPTED BY THE STATE 60Afl0
1821 Universitv Ava.. St. Paul, MN 55104 UNLESS PqOPEX INSPECTION FEE IS
Phonef6t21642-0800 ENCLOSEO.
REQUEST FOR ELECTRICAL INSPECTION ee-oo/aoi-os
1 See instruchans for comoleling this farm on beck ol yellaw copV.
D -,74 44 9 R"' Be/ow Work Covered by 7h?s kequest
Ada fleo. Tvoe of euilaing Aoobancas Wrtea Equiumenl Wvea
Home Fange Temporery $crvice
Duplex Water Heater Liqhtiny fixtures
Apt. Bwlding Dryei Electnc Heatui
Commercial Bldg. Fumace Silo Unloader
Industnal Bldg. Art Condinoner Bulk Mllk Tank
Farm Other pec- v Other ISnontyl
I?11:1 Syl`(GIIV IhCf ntM1l:f
Comoute InsDecuon Fee Below _
p Fee ServweEntrance5¢e tt Fee FAAtlers/Subfeeders b Fee Circurts
U to 200 qm s 0 [0 30 Am s 0 m 30 An s
Above 200 Amps 31 to 100 Amps 31 to 100'Am s
Swimming Pool Above 100-Amps Above 100_Ampa
Transtormers Imgation BooMs Partial'Other Fee
Signs SpeciallnspecLOn S TOTA
Pertmrks ?
Kg?
BouBn-un D:'re I. the E , al
' InspBClm, hereby
ceruty that [he above
Final insDacbon has been
mede.
Thia repuesl volA 10montfia from
This repaest void??'i/?r„
18 n?n?hs from I?
8
D r 9 3 8 Q 2k? ??`
? e?
;
A vesYUate
_ .
t
Rre No. ouph-ui Insperuon
pmretl'
E]RenAy Now
,II Nn(ity InsUec-
1'es EINo tor When Reatly
? Licensetl Eleclncal Contractor
? Owner I heraby repuastinspecfion o1 nbove
electrical work inatallnd at.
Stree[ Address, ox or flw[e No. C?? .
?
ection o. Townshi0 Name or No. RanBe No.
Oc pdnt ( INT) Phnne Na.
Po Supplier
vyr Atldress
E.? ncal Conhactor (Company am I Co yt 'sr -Li?c/e?n-s?e/')X?Q
! / V
?
MailinB.4ddress ICon a tor or Wner kinp InstailaUOnl
.4 or¢ed.5ienature IConhaclor Owner Makiny InstallaUUn) Phonc Number
6 - 000
MINNESOiA STATE APD OF ELECTNICITY TMIS I SPECTION REQUEST WILL NOT
Grigvs-Mldway Bld9. - Aoom N-191 gE ACCEPTED BY THE STATE BOAPD
1821 Univei Ava.. St. Peul, MN 65104 UNLESS PNOPEN INSPECTION FEE IS
Phone(612) 642-0800 ENCLOSED.
?/????r REQUEST FOR ELECTRICAL INSPECTION AV% ea-ooooi-os.
, See instrucbans lor com0lehiq ihis form on back o1 Vellow copV.
0' 9s34$ 02 "X" Be/ow Work Covered by This Request
4ina HAd Hap. TVVe ol Bwlding Apobances Wuetl EqmUmen[ WueA
Home Range Temporaiy Service
Duplex Water Heater LightinG Fixtures
Apt Bwldmg Dryei Electnc Heaun
Commercial Bidy. Fumace Silo Unloader
Industnal BIAg. Air Conditioner Bulk Mllk Tank
Farm Otbrr oei,i v -?herlSnecifvl
i er u.cifY Othcr Othe,
Comuute lnsoectwn Fee 8e/ow ,^
p ServiceEnffenceSize N Fae Faxders/Sublenders # l Cucuits
U to 200 qm s 0 to 30 Am s 0 to 30 An+ s
Above 200 qmps 31 to 100 qntps 31 to 100 A s
Swimming Pool Above 100_Am s Above 100_F+mPs
Transiormers IrngaUOn Liooms Parbal'Other Fee
Signs Speclallnspection
T AL F
EE
Nertyiks
_ / • ,
i /J'7 O
Nough-m 21,
u110/ /?' I, e ElacVical
? - ? ? Insoe y
cerldy ihat tha nbove
Dnte
Final `q Inspecbon hes been
I maa.
Thie reVUest void 18 montha fmm
cinr oF eacaL N_ 14 4 9 7
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
?C1 ?ry 8-C+,
BUILDING PERMIT PHONE:454-8100 Receipt# ' 1
Tobeusedtor SF DWG/GAR Est.Value $83,000 Date DECEMBER 16 1987
Site Address 732 CASTLETON COGRT OFFICE USE ONLY
HILLS OF STONE-
Lot 9 Block 8 Sec/Sub On SRe Sewa9e _ Occupancy R3
.
BRIDGE MWCCSystem X Zoning R1
ParcelNo. Vn
On Site Well (ACtuaq Const
a Name THE ROTTLUND CO INC Grywater X (Allowable) Vn
W Address P• 0. BOX 383 PRV rtequired # of Stories
0 City 0$$EO PhOne 571-0304 Booster PumO - Length 50.66
DepTh 43.87
, o Name SAME S F. Total
oa Address FootprintS.F.
u
1-
City Phone
APPROVALS
FEES
1-w
W
Name Engr./Assess. Permit $ 444.00
? ? i
x
Address
Planner
Surcharge 41.50
aw City PhOne Council PlanReview 222.00
BIdg.Off. SAG Ciry 100.00
I hereby acknowledge that I ve read this applicahon and state that the Variance SAC, MWCC 525.00
mformation is correct a
ae o co all applicable State of Water Conn. 525.00
%
MinnesotaStatutesandrtl aln. WaterMeter 67.00
Signature of Permittee
Road Unrt
__-305-00
A ewlding Permit is issued to: THE ROTTLliND .CO 7reatment P1 180.00
on the express contlition that all work shall be done in accordance with all
a
l
hl
St
t
f M
(copy)
?
50
pp
ica
e
a
e o
innesota S Wtes and Crty agan Ordmances
T
L $Z ? 410.0
0
Building OHicial ?-
?
?
V
?
?
1987 BUILDING PERMIT APPLICATION CITY OF EAGAN
SINGLE FAMILY DWELLINGS
7.NCLIIDE 2 SETS OF PLANS, 3
RENT9L USdITS FOR SALE OIiITS
BOTE: ADDRESSES FOB C08NER LOTS - CONTRACTOR/HOMEOWNER HQST DESIGH1Tfi TiHICH ADDRESS
IS DFSIRED. NO CHANGES NILL BS ALLOWED ONCE BIIILDING PERMIT IS ISSQ6D.
M[TLTIPLE DWELLINGS - RESIDENTIAL
INCLUDE 2 SETS OF PLANS, CEA
1 SET OF ENERGY CALCULATIONS
COiVERCIAL
OF SIIRVEY - CIiECK RITH BLDG. DEPT.,
OF SQftOEY, 1 SET OF ENERGY CALCULATIOAS
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONS,
$2,000 LANDSCAPE BOND EiU i,7EC i 1E87
To Be Used For: / P7qm _ nWL:LLWlValuation: Date: Jo2-/- ??
%
Site Address T:?Q
Lot Ci Block $_
Parcel/Sub R16) pF ,
Owner 1"7A-F dQnzr'i_i ).!
nddress YD. 1?'?r 3573
City/Zip Code Dv?SED,MN. SS3ln?
Phone :5°]!- 030g
Contractor 5{tly1E
Address
City/Zip Code
Phone
Arch./Eng'r. S}cM r5,
Address
City/Zip Code
Phone #
Urrlt;h Mri udLx
OOc7'On Site Sewage_ Occupancy
MWCC System ?,e Zoning ?I
On Site Well Type of Const
City Water _L/ (Actual) ?/-
(Allowable) ?
# of Stories
Length
Depth y3,87
S.F. Total
Footprint S.F.
APPROV9LS FEgS
Assessments
Water/Sewer
Police
Fire
Engr
Planner
Council
Bldg Off
APC
Variance
Permit 4q4l, 00
Surcharge yI,SD
Plan Review 222, 00
SAC, City 100,00
SAC, MWCC $2 . DD
Water Conn 525, nD
Water Meter 0, ao
Road Unit S,DD
Treatment Pl 100, pp
Parks
Copies SD _
TOTAL
LUAi IbN - I9$?
---------.r_..? .
___
GARRG
ZZXZZ= t484X12= SBoB
l3ASEMFN7'
---?_
ZS ,( z6 r12?
73G x ?y= lo3oy
HousE7
3v )( y'-! _ (3zv
6 KGn
12 x??-?zo
?Ay =ly
lsiy x yv
?2?28
?
• ?, ? ? ?. .
?
* * * *
* P10N
* engin
Lnho suRVE?Ows. cfvIt [NCIMEr1Ya
lARD VLANNER$ • LI1Np$C/.PE IIRCNITECTS
2422 Enterpnse Dnve
Mendota Heights, MN 55120
i6121681-1914
Certificate of Survey for:_TjqL ROTT L UNQ COMpAf V1
4
NoATN
ai?!n O
OD?00
m ai Hl
(
4 0
:?.94 ?9 N y3e
¢?9,33 ?
137
`.
`? g? 3 ,qpza2
r ?. 36C
m o:
y
so.a.
0
? a
? N
? N W ? 11 O
m a? `?
m opc o p a.o
? P 0.? i
GALL
r
@ 9 ?
?
N/3?.40p w
. 900.0 Denofes existinQ flevafton
. yoo.o Denofes propcNd flevation
------DenofesDrarr?ae ?Ufilrf,Y Easemenf
(lenoles Orqinae Flow u+'rowr
m
/
C,4S,
C T
oO
F
qrS` Tv osc.?ts c?u
i
? ?tPp I
$
? \ T?Z 4
.v
/ ?b\
?
/ ?pro
9°1 1k `
PROPOSED NDUSE EL£VATIONS
lowest Floor flevafion = g01oZ
Top ai 8/ock Elevaft "on :
o Denoles monumenf C?'ara?2 Slab E/evafion = 9o4.3z
gecrrin?s shown are assumed
LDT 9 , BLOck ,8 , 141LL5 oF STONEBRIDGE
DAKOTq CDUNTY, MINNESOTA SUSI£C]" 7U £ASEMEN75 OFRECORD
? 1 here6y certity that this is s vut and COnttt represemation ol a wrvtY of the pour,danee nf [he abovt d•u,-6M 'antl„ nA o1 the bcatron o,.l 7all
buildings, iherean, aM all vlsible encrpachmentr, d any, from p on ujd IanC. A+ swveyed by me in,s?dav o! ?•?n /a.0. 19r,, ?.
Scale=Pln ` 40 ild rr.?..,-?
RC.pCAT B. 51KiCH L.S. R NO. 14891
Lo
-$A7 Slpt
t
EXTERIOR ENVELOPE AVERt1GE "U" COMPUTATION
ow[vsa Tfi . G?O'T`F Whl?? C-b
SITE ADDRESS f .?Z CF?ST1.-.ET"C?/? ??UtZ!
CONTRACTOR SAM? DATE PHONE 571-4340Y
Determine working square footage of each.
1. Total exposed wall area ..... I`] S sq. ft. x./?
2. Total roof/ceiling area ..... sq. ft. x °`FZ , `f `C3
Total exposed wall area above floor = G'Z
a. Total wall window area ............................. `1 O
b. Total door area ...................................
c. Total sliding glass door area ..................... 7_9,((,
d. Total fireplace wall area ..........................
e. Total wall framing area (average 10%) ................ 1? 'T
f. Tota1 net wa11 area above floor ..................... IU?Irt.`i
g. Total rim joist area ............................... \C?5?'1
Total exposed foundation area = 11-A"
h. Total foundation window area .......
i. Total net foundation area above grade ...............
Determine "U" value of each wall segment.
??7?? x, S' 2 1 Y,rnc, 32
a. S'? '?i.l vX ?U?? .1 7
h. J ci v, 2 ? glfull = y , 'f C?
c. -;'I iCa
X?fvll , v G = I 3, 6 1-
d. -- g Ifjjn _. _ .,
e. 1 1`7 X"U" c Gc"-7 = 1 b, I C3
f. lU`1 ?1,5 gTIU" o04-12 = 441U ?
g. X ?lU?l (114U = (_, `rZ
h. ' g „Un
i. x'lUll
3 ......................................Tota1 = ?•?,?,e5 )
If item 1! 3 is the same as, or less than item Ifl, you have met the intent
of SsC 6006(c)2.
t
Total exposed roof/ceiling area = -'+?'(
Total gross roof/ceiling area = ', Y
j. Total skylight area ........................ -
k. Total roof/ceiling framing area ............ °tc°2
l. Total net insulated roof/ceiling area ...... /S ?(r,
Determine "U" value for each roof(ceiLing segment.
X nUn
k. n! r"? X n Un
1. /?' 7 L7 X rrUti ,02 S"' ?lC7e?? V
4 ..................................... Total =
If total of I14 is the same as, or less than l12, you have met the intent of
SBC 6006(c)1. I
To utilize the total envelope system method, the values established 6y the
sum of items 113 and U4 shall not be greater than the sum of items 1i1 and 1l2.
+ z. ?(2cG = 2_?;?? I
3. ?Og.5 7 + 4.
OUTG: Use J.b2 of opaque wall area for
-irame construction
. ,.
?'•. ?• • •
FRRtiE iInLL
?
i'uJu J C11: 4
Construction
R-Value
1. Interior air' film 0.68
2. ? cnl Y-P 13 R D ? y s-
3. ZX(. STC/65
(anrbg
, 9. 25/32 SHTC-
5. S/L%riC-n UVC/< /CEG7' / ?? h
6. Exterior air film 0.17
Tota1
v? so?-7
1. Tnterior air film 0.66
• 2. YL" C-? Y P 13 OZ D ? y ?r-
3. fUG L
4. z 5132 5?-r>(?- 2 r7G .
s. si/?%UC- ove,e F?c,- I al_ 6
6. Exterior air film 017
' Totai 2 3, C.
Z
, U_ ov4l Z
1,
2. Interior air film
/NSV? • 0.68'
/ fvUO
3. '2 X- /7f (`/l ?af5g
4. 2 5/3 '2 S t-I 2
5. S/Oi.riG> CJ VE /r /- [-'t zC
6. Exi:erior air film 0.17
__ Total 2 5.O S
O?U
1. Interior air film 0.68
2. _ /2-// /•fiSVC. // UG
3 ?,r-I FuR R ? rv C>
n. izco•z-13 cocre- /,zFs
s.
6. Exterio: air film 0.17
Total /30/3
• :. ? ._ (/-_ ,a•7?
e . ? . .
,y,?
r
•
..S?t=. f? tx L
q
Z:
/l( ? .. , •,?
V
rri , •' , ..
Fxc: iM iri ?
O
\ )• /II ?
W ir:^-x
. II3 '.
. o . ` •
? ? ? c?
• ? Roor•/cesz,iNc
VulT
? . • ? • \J ?`J .
Vented Heat flow
. uP
? . „
.
.. ?
. ? . .
- - - ?
1. Interior a?ir film• 0.61
Z• l)??J ??J Y 1 I J F`?J 2 V
3. i,v5vc ove i' >itUS S ;"-I ,I c-
4. Ekterior air film sti 1. I'
Zotal 3(?,-7 y
U = .oz*7
. -_ • , • • • .
?
. • ?'
v
. ? ? : •
? . ??.C' •. .
• NOi7-4EA'1T:D •. • •
-,' i' '. • '.
' . HeaL '
,- ? f].our up ? .
?7 ' . , .
ConstrucL•ion R-Vtilue
. 1. Intcrior air film , . 0.61
2. S/P? " C?YT? f3 58
, 1
3. ('c_Cc, .4.
iAf 5 v C. r'r7
4. Exterior air film (still 0.61
'rotal 3?'lae5 o.
•i •
i . .
? .
i . . ,
?
1. Insi.de ai.r filin 0.G1
2.
3. ' • " '
4.
5. Outside air film 0.17
TOtal
NoL•c: Use additioi)aI sheets if more cpaco ie
needecl for deL•ails and calculat:ians.
.
, •
Y.aac floci up • ?_ . vented
? . • :i ?`
FIG. A6.:
.?... • ? ? •- .. .' .
APFLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
NJ7'E: PAYME71 OF FFE AT TIME OF ?
; nrMIraxZ«N ooES rM caa- ;
; srizvre nrrxavnt, oF pMuT. ;
.
; iNseFrriaa oe sMM aaa/mi wnxm .
;
? I[1STALIATIOW" WILL N02 BE SCIDfIIID i
? (!NPIL PIItFIIT HAS B}.?'Id APPROVfD. e
dtV fi34+444*#Yf4kff4ifilti4tff41?tiSif4f!
OF CC1gC8n
(PLEASE PRINT
i) PtoPEaxY ADnxFSS: -1 3'a C G ? i? F? ? c?
LEGAL DESCRIPTION'
Lot B oc S ivon o Tax Parcel ID
IF EXISTING STRL'CTURE, DATE OF ORIGINAL BiJILDING PERMZT ISSOANCE:
Nlont Year
PRESENT 7ANING/PROPOSID USE:
Q CONA7ERCIAL/RETAIL/OFFICE Iyj R-1 SINGLE FAMILY
Q INDUSTRIAL ? R-2 nJPLEX ('ifao Units)
a INSTIZUt'IONAi,/GOVII2NNIENT Q R-3 TOWN-IOOSE (Three + Units) ( L'nits)
Q R-4 APARTMENT/CODIDOMINIUM ( Units)
2) NAME:
ADDRESS: (vl U CRce lc L_
CITY, STATE. ZIP: 30 .2i?_
r
PHONE: ?-I F )L -a. i .?. i
For City Lse
3) ' ?:?• NAME: Plumbers License:
ADDRESS: Active
Ebcpired
CITY, STATE, ZIP: 7z,- ij Not recorded
PHONE: MASTII2 LICENSE # St aff ila?
4)
NAME:
Fv7DP.FSS :
CITY, STATE, ZIP:
PHONE: 5 T i - >zu?
5)
6)
M CONNECTION 'IC) CITY SEWER M CONNECTION TO CITY WATER O OTHII2
********?+**?*?*****?*:r***,c?:*******+****************.?********,r+*****??*****+****?*********,r****
* THE GOLD COPY OF THE PERNffT WII,L BE SENP DIRDLTLY TO PLBLIC WURKS 1U FACILITATE MEPER PIQC-UP.
* PLEASE ALLOW TWO WORKING DAYS FOR PROCFSSING. SOMEONE FROM TM CITY WILL CONTALT Y00 IF Tf1ERE
* ARE ANY PROSLENIS.
FOR CITY USE ONLY
PERMIT # ISSOED
Pd w/Bldg. Permit
S
s
$
$
$
S
$
s Gzs•oa
$
$
$
$
$ CJ-7J
S
$ ? :3 0
RECEIPT
FEES:
?0•5z'
$
$ /o- ?
$
$
$
$
s
S
$
$
$
$
$
RECEIPT #-
,
SEWER PERMIT (INCLODE SURCHARGE)
WATER PERMIT (INCLUDE SDRCHARGE)
WATER METER/COPPERHORN/OUTSIDE READER
WATER TAP (INCLUDE CORPORATION STOP)
SEWER TAP
ACCOUNT DEPOSIT - SEWER
ACCOONT DEPOSIT - WATER
WAC
SAC
TRUNK WATER ASSESSMENT
TRUNK SEWER ASSESSMENT
LATERAL BENEFIT/TRUNK SEWER
LATERAL BENEFIT/TRLNK WATER
WATER TREATMENT PLANT SURCHARGE
OTHER:
TOTAL
DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
F__j YES 'IF YES, THEN A"PERMIT FOR WORK WITHIN PDBLIC
Q ROADWAY" MUST BE ISSUED BY THE ENGINEERING
NO DIVISION. LIST AS A CONDITION.
SLBJECT TO THE FOLLOWING CONDITIONS:
APPROVED BY:
TITLE:
DATE :
1989 HITILDI9G PSffiiIT EPPLZCATIOA - CITY OF fiAGAN
: %
SIPGLE FAMII.Y DWELLI9GS
INCLIIDE 2 SETS OF PLANS, 3 CERTIFICATES OF SORVEY, 1 SET OF ENERGY CA TIONS
NOTEt ADDBESSE4 FOH CORNER LOYS - CONT@ACTOR/SOMEOiiNBH M0.4T DESIGNATE AHICH ADDBESS
IS DESIRED. HO CBANGFS iTII.L SE ALLOWED OBCE BOII.DffiG PBRlIIT IS LSSOED.
MULTIPLE DWEI.LINGS HEATAL II9ITS FOE S9LE D19IT3 • OF OBIT3
INCLQDE 2 SETS OF PLANS, CERTIFICATE OF SQH4EY - CHECS i1TTH HLDG. DSPS.v 1 SEf OF ENERGY
CALCULATIONS
COMACIAL
INCLUDE 'L SETS OF 6RCHITECTURAL & STROCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS 4 AY o 9 j989
DEC< Valuation: Date: MAJ
To Be Used For:
Site 9ddress -7j2 CA57-E1`ORl CT
Lot 9 Bloek q
Pareel/Sub I`F(U_S G F ?'T71.1?t /; ?2rL) Io1
Ownerr AeWFT'l4 t/CJ4,4)&f7'
Address 1 j 2 ('q
City/Zip, Code ?G?.fIA.?
}?
Phone &Rq -O?'J(v"cl ? 2r? Z I 3'!
GA2y
Contractor 5 ELF
Address
City/Zip Code
Phone
Areh./Engr. _
Address
City/Zip Code
Phone 0
Oceupaney FS
Zoning
iletual Const Bldg. Per
Allowable Sureharge
# oF stories Plan Review
Length SAC, City
Depth 14" SAC, MWCC
S.F. Total Water Conn
Footprint S.F. Water Meter
Aeet. Depos
On site sewage S/W Permit
On site well 5/W Surchar
MWCC System _ Treatment
City water _ Road Unit
PRV required _ Park Ded.
Booster Pump Copies
_ TOTAL
APP$OVALS
Planner _
Couneil
Bldg. Off. 5 10
oarianee
r
'04
HOTE: Sewer b Water Permit Pees and aecount deposit fees will be ineluded in the building
permit fee. Processing time for aexer aad water permits is txo daqs onae a lioensed
plumber has applied for a permit at City Hall.
i •
* PIONEER
* engineering..
^ L *?
T
2422 Eni:rprise Orive
Mendata Heights, h1N 55110
LANO PLANNCRS, LwNDSCAPE ARCMITCCTS
Certiticate of Survey for:?!'-? ?0---' L ?'v?Y??H??
NaaTIl
I ?
4 0
ty. ? Ai 73•
94 ? /jT 4 ?9 33 , W
• '? 53szi __, qz
uno sunvE r
?h0
N?1co
v
I ?
I
If
L_
' N ? I
Vi
ra?- ?O
L
?h
_?
m - /
gp.61.
n h W
ma?
0
Y ?= po
J
a ,
;T
N rb?J ?W
? 900.0 Denotes ezistin? Elevafion
?oo.o Denoles propnt d Elevotron
-- --' -- peno(ts Dra!rla?e tutili l) Easemeni
° 2a
N ?3
01 pcnoles Drqrna e Flaw Arrows
(6121 681 -1914
? Co(J?FTO'Y
?
?G r•P o? c..u cLr
p
v ?
0
b \
?
? ?
t?' it \
PROPOSEO {-IOUS£ ELCVATIONS
Cowest Flaor Elevat;an ='9 O f. 2
Top oi Block flevafiorl : 9 0`l.`l
cara,i j 5lob Elevofion ? 90432
o Dcnoles monument
Bearln15 shownare assumed
L01w c7 , BLOck $, N1Ll5 oF STONEBRIdGE
QaKOTA CouNTY, MlNNE$OTR SUBJ£CT TO EASEMENTS OF f;EC'URD , 01
tNt th?a is ? Iruc ?nd ConKt ltDrmenlabon ol & wrveY ol Nt WunJOn?6 ol lhe abovt(?Q} ticnUed qnd, nd ol Ih A.D. 19^
1 hvabY unilY ?'
lt?IL-OaV ol .
p.iildinps. Ihetmn, end aII visiEle encrwchmentl, d any. Iiom or on said I?nd At w?veY? hY mt lh
'
A /
indj = ? j Ct 1 ?„ {'•
?wl HT d.S?KI Cf1 L.S. H n0. U69
F7 //C.LO
L BL cirv use oNLv
r
SUBD. NV16? `1aj 2
RECEIPT #: I 1I f UA
RECEIPT DATE: ' U- '
PERMIT # D
1999 PLUM$INC PERMIT mStUENTIAL)
crry oF EAeauv
S$SO PILOT KNOB itD
EAfiAN, Mx 55122
(651) 6$1-4675
Please complete for: ? single family dwellings
? townhomes and condos when permits are required for each unit
? backflow preventer for underground sprinkler system
FlXTURES
EACH #
TOiAL
Bath tub $ 3.00 x = $
Floor drain 3.00 x = a
Gas i in outlet " minimum - 1 3.00 X = $
Hot tub/s a 3.00 x = $
Kitchen sink 3.00 x = $
Laund tra 3.00 x = $
Lavato 3.00 x = $
Minimum fee alterations to existin dwellin 30.00 x = $
Private Dis osal S stem newlrefurbished ' re uires MPC iic. 75.00 x = $
Private Dis osal S stem abandonment 30.00 x = $
RP2 new installationlre air 30.00 x = $
Rou h c enin 1.50 x = $
Shower 3.00 x = $
Under round s rinkler if dwellin is under construction 3.00 x = $
Under round s rinkler if existin dwellin 30.00 x = $
Water closet 3.00 x = $
ater hea 3.00 x = $
Wa ef 2f If dwelling under construction 5.00 X = $
Water softener if existin dwellin 30.00 x = $
Water turnaround 30.00 x ---- _ $
State Surchar e .50 --> ----> ----> $ 50
Total --> --? ----> ....> $
Reminder: Call for inspections of alteretions, i.e. water heaters, water softeners, etc.
------------------------------•----------------,--------------------------------••---------------------------••-•-------- --------------
I hereby acknowled9e that I have read this appliption state that the information is cortect, and agree to comply with all applicable City of Eagan ordinances.
It is the applicanPS responsibility to notify the property owner that the City oi Eagan assumes no liability for any damages causetl by the Ciry during ds
normal operational and maintenance aclivities to the facilities constructed under this pertnit within City property/right-of-wayleasement.
SITE ADDRESS
OWNER NAME: :
INSTALLER
STREET ADDRESS:
TELEPHONE #: /°5/
(AREA CODE)
TELEPHONE #:
(AREA CODE)
cIrv: -C?T, P,A-uI STATL?06? z?P:.4SI03-?a,?V
SIGNATURE OF PERMITTEE
1
?
1%
CLAIM VOUCHER - REF[IND REQUEST
CITY OF EAGAN
CLAIMANTM'LNNEGASCO
ADDRESSp,O. BOX 1165
MINNEAPOLIS. MN 55440
Location 732 CASTLETON COURT
L9. B8. HILLS OF STONEBRIDGE
Receipt No./Date $2423/3-31-88
Reason for Refund TtNNECESSARY PERMIT
Type of Refund Electrical Permit 01-3211 $
Plumbing Permit 01-3212 $
Mechanical Permit 01-3213 $ 12.00
Surcharge 01-2155 $
Water Connection Permit 20-3713 $
Sewer Connection Permit 20-3743 , $
Account Deposit 20-2252 $
Utility Account Over-Fayment 20-2250 $
Other: $
$
, TOTAL $ 12.00
I declare under the penalties of law that this account, claim or demand is just and
that no part of it has been paid.
,
?-" -; C_
`- APRIL 1. 1988
V Signature Date
.
,
1
CONTRACT PRICE: •Site
Lot.
? Name _
m Address
= City mr
632.
MECHANICAL PERMIT
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55122
PHONE: 454-8700
PERMIT#
RECEIPT #
DATE:
BLDG.TYPE
Res. +
Mult
Camm.
Othef
WORK DESCRIPTION
New
Add-on
Repair
IlkC]J S 2CCi^Cll'C
- FEES
Name Ca.q. , Toc live, RES. HVAC 0-100 M BTU -$24.00
c Address ame ADDITIONAL 50 M BTU - 6.00
p City 4
Phone ,n (RES. HVAC INCLUDES A/C ON NEW
_ CONSTRUCTION)
GAS OUTLETS (MINIMUM - i PER PERMIn - 1.50 EA.
TYPE OF WORK COMM/IND FEE - 1% OF CONTRACT FEE
Forced Air M BTU APT. BLDGS. - COMM.-RATE APPLIES
TOWNHOUSE & CONOOS - RES. RATE APPLIES
Boiler MBTU MINIMUMRESIDENTIALFEE - ALLADD-ON&
Unit Heater M BTU R%.n ra (' n pr REMODELS - 12.00
Air Cond. M BTU '? MIfSIMb?i1"COlv?aFGIAYFEE
STATE SUFCHARGE PER PERMIT - 20.00
- .50
Vent CFM $ (ADD $.50 S/C IF PERMIT PRICE GOES
Gas Piping Outlets # $_ BEYOND $1,000)
Otner Replace $ ».nn
007 FEE: 12. 0?
l.c,Wi.
'
S/C:
rifl
SIGNATURE OF PERMITTEE
? ?
, JII l g
f-1 ( TOTAL: 12.51
FOR: CITY OF EAGAN
? RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN .
3830 PILOT KNOB RD, EAGAN MN 55122
651-687-4675
New Conetructbn ReouMememe
• 3 registered ste sunreys ahowing sq. f1. of bt, sq, tt. ol house; antl gR roofed areas
(20% maximum bf coverage albwed)
• 2 copiea of plan ahowing beam & windav slzes; poured found deslgn, etc.)
• 7setafEnergyCalculatbns
• 3 coples N Tree Preservatbn Plan N Wt platled aiter 711l93
• Rim Joisl Detall Options seledion sheel (hlGgs wMh 3 or less unAS)
DATE
Isf7.),5
pemodallRepalr Heaulrements
• 2 coples of plen
• i sef ot Energy Cakuletions Ior heated addHions
• lsilesurveyforaMerioraOdNOns&decks
• IndlCdte fl home Senetl 6y septlc SySiem fot edditi0n5
11 ()D
VALUATION ( 25r
AULTI-FAMILY BLDG Y t/ N
FIREPLACE(S) _ 0 _ 1 _ 2
APPIJCANT STREET ADDRESS' I??-I? tV lC.??`'`? CITY_?`lJ?('i?j I-STATE ?'1?/ZIP L
TELEPHONE f'''-CELL PHONE # FAX # ?)W?p
PROPERTYOWNER TO c(GIT" a, yLLp/ TELEPHONE# 0?944- /16 S
COMPLETE THIS SECTION FOR -NEW- RESIDENTIAL BUILDINGS ONLY
Energy Code Category MINNESOTA RIJL.ES 7670 CATEGORY 1 MINNES
(4 submission type) • Residential VentilaHOn Category t Worksheet Submitted • New En d, o{ksheet Ubir
• Enargy Envelope Calculafions Submitted
? JUI 0 3 2002
Plumbing Conhactor:
Piumbing system includes:
Mechanical Conhacfor: _
Mechanical system includes:
Sewer/Water Conhacfor.
_ Air Condirioning
_ Heat Recovery System
Phone #
Phone #
Fee: $70.00
I hereby acknowledge thaT I have read this application, state that ihe information is correct, and agree to comply
with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Signature ofApplicanf LltA<"M&?&
....... _._...... _._._...... --°......... -°°-'...... --?......__.__.?.._.____?r............?.._.v.__.?..._.._.______..
OFFICE USE ONLY H
_ Water Softener
_ Waier Heater
_ No. of Baths
Phone #
Lawn Sprinkler
No. of R.I. Baths
Certificates of Survey Received _ Tree Preservatfon Plan Received _ Not Required _
Updated 4l02
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CITY of EAGAN Permit No: Date:
3830 Pilot Knob Road B/P No: Date:
P.O. Box 21199
Eagan, MN 55121
Owner:
Site Address:
Plumber:
MWCC: Zoning
City Chg: No. of Units:
Acct. Deb: I agree to comply with the City of Eagan
Permit Fee: Ordinances.
Surcharge:
Misc.: By
/
SEWER SERVICE PERMIT
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA138503
Date Issued:08/31/2016
Permit Category:ePermit
Site Address: 732 Castleton Ct
Lot:9 Block: 8 Addition: Hills Of Stonebridge
PID:10-32990-08-090
Use:
Description:
Sub Type:Siding
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please leave printed pictures of house wrap on site for the final inspection.
When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to
ensure maximum ventilation to attic. Call for final inspection after installation.
Valuation: 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 -
Todd A Trainer
732 Castleton Ct
Eagan MN 55123
(612) 518-1176
Home Depot At Home Services
6224 Lakeland Avenue N, #102
Booklyn Park MN 55428
(763) 542-8826
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA150969
Date Issued:08/01/2018
Permit Category:ePermit
Site Address: 732 Castleton Ct
Lot:9 Block: 8 Addition: Hills Of Stonebridge
PID:10-32990-08-090
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.
Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener).
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Todd A Trainer
732 Castleton Ct
Eagan MN 55123
(612) 518-1176
River Valley Rpz Llc
1623 210th St E
Farmington MN 55204
(515) 210-2094
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA163754
Date Issued:09/11/2020
Permit Category:ePermit
Site Address: 732 Castleton Ct
Lot:9 Block: 8 Addition: Hills Of Stonebridge
PID:10-32990-08-090
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Does not include skylight(s)
Census Code:434 - Residential Additions, Alterations
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 within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Valuation: 5,000.00
Fee Summary:BL - Base Fee $5K $118.00 0801.4085
Surcharge - Based on Valuation $5K $2.50 9001.2195
$120.50 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 -
Todd A Trainer
732 Castleton Ct
Eagan MN 55123
Ashco Exteriors Inc
11164 Zealand Ave N
Champlin MN 55316
(763) 225-8333
Applicant/Permitee: Signature Issued By: Signature