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4086 Deerwood TrSEWER & WATER PERMIT CITY OF EAGAN 3830 Pilot Knob Rd. Eagan, MN 55122-1897 DATE MAY 24, 1990 OFFICE USE ONLY METER #Y37 ? 3/ PERMIT DATE 05/24/90 CHIP # ST v?70 7 PERMIT # 11407 METER SIZE B.P. RECEIPT # C 7328 ISSUE DATE 3 ,90 B_P. RECEIPT DATEa4 ULD - PRV - BOOSTER PUMP SITE ADDRESS 4086 DEERWOOD TR LOT t4 BLOCK 3 SEC/SUB ENGSTROM'SDEERWUOD APPLICANT:' I_ I AM A P?c Ic. G4:l6e I t ADDRESS: ' -. < -S CITY, STATE ,l kr IP ?S L/ I? PHONE: -71 y - 0 PLUMBER: ADDRESS: CITY, STAI PHONE: OWNER: ADDRESS: PERMIT REQUESTED SEWER WATER TAPS COMMAND -'L RESIDENTIAL NEW EXISTING Lawn Sprinkler Meters are to be Installed Ahead of Domestic Me on Water Line. 7eNOT giv n fr Deduct Meters. I AGREE TO COMPLY WITH CI F EAGAN ORDINANCES CITY, STATE ZIP PHONE: SIGNATURE WHEN METER ISSUED PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. CALL 454-5220 FOR INSPECTIONS. FOR STORM r SEWER PERMITS, CONTACT ENGINEERING DEPT. ;. J ZIP - = , CITY OF EAGAN 0 17732 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHONE: 454-8100 BUILDING PERMIT Receipt # To be used for SP DWG/GAR Est. Value $156,000 Date APR 18 tg 90 Site Address 4086 DBER{iOOD TR Lot 14 Block 3 Sec/Sub. ENGSTROM'S Parcel No. .- UELKWOOD ffi Name W L-16LAM ck rwe woA 4VL7XRA" o Address 5300 38TH AVE S City MINNEAPOLIS Phone 375-1980 Zo Name SAME 0q Address Cr. City Phone aw City I hereby acknowlege information is • correct Minnesota Statutes ar Signature of Permitee A Building Permit is is on the express conditi applicable State of Mii Building Official Phone have read this application and state that the agree to comply with all applicable State of OFFICE USE ONLY Occupancy R- 3 ?3 FEES Zoning (Actual) Const H_-N Bldg. Permit 836000 (Allowable) V-N Surcharge 78*00 # of Stories Length 50' Plan RevieJu 543.00 Depth 6d'9 SAC, City 100000 S.F.Total --- SAC, MCWCC 600'00 S.F. Footprints 625,00 On Site Sewage Water Conn On Site Well Water Meter 40'00 MWCC System ? Acct. Deposit 3000 City Water 30.00 PRV Required S/W Permit Booster Pump SAN Surcharge 0 s0 Treatment PI 252.00 APPROVALS Road Unit 355.00 Planner Park Ded. Council C 1050 Bldg. Off. opies 541.00 3 Variance TOTAL . ' Permit No. Permit Holder Bate Telephone # VyTER D SEWER PLUMBING H.V.A.C. pt?CY ELECTRIC (>yO ?7 ?? Lk7 Inspection Date Insp. Comments Footings I G l ? 41-1161- Foundation Framing S 2 J A+ v S% S d Roofing Rough Plbg. f Rough Htg. - ?- Isul. / Fireplace Final Htg. C. Final Plbg. Yle lid V-5 If Const. Meter Pibg. Inspector - Notify Plumber Engr./Plan Bldg. Final - 9p QS Deck Ftg. Deck Final well Pr. Disp. X% Terfifirate of (Orrupaury Citp of Cagan ]9rPwft d of Diu bwg rriimt This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building Code certifying that at the time of issuance this structure mu in compliance with the various ordinances of the City regulating building construction or use For the following., Use ctowfiication SF DWG/GAR Bldg. Permit No. 17732 O-Maay TYw RW Zwm District RI Type Cons. VN Addres 4066 DEERdOM TAM L-alkY L 14, B3, IINGSlRCH' S DM OM Date: AUGUST 13, 1990 POST IN A CONSPICUOUS PLACE INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: 1:'t t ! 11 1 Nei 3830 Pilot Knob Road Permit Number: N •' 14 4 Eagan, Minnesota 55122-1897 Date Issued: '! (612) 681-4675 SITE ADDRESS: APPLICANT: 1 u f i t+1 ??i: t, i , ! i M !?F 1. filli???lJ t r. 1 f'V. ; 149" PERMIT SUBTYPE: it: TYPE OF WORK: 1 tMI ] N1i', I I I f t NAI Permit No. Permit Holder Date Telephone N ELECTRIC PLUMBING HVAC Inspection Date Inap. Comments FOOTINGS FOUND FRAMING ROOFING ROUGH PLUMBING PLBG AIR TEST ROUGH HEATING GAS SVC TEST INSUL GYP BOARD FIREPLACE FIREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL BSMT R.I. BSMT FINAL DECK FTr, / 3 DECK Flip-,:: 7 i 1 _ CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHONE: 454-8100 BUILDING PERMIT f 5 , l-2--v Receipt # To be used for SF DWG/GAR Est. Value $1:000- Date-APB N2 17732 ' 3ZS 19_90 Site Address 4086 DEERWOOD TR Lot 14 Block 3 Sec/Sub. ENGSTROM'S Parcel No. DEERWOOD wIName WILLIAM & PAMELA COTTRELL o Address 5300 38TH AVE S City MINNEAPOLIS Phone 375-1980 Name _ Address City Phone IWZIName Address aw City Phone I hereby acknowlege that I have read this application and state that the mfonnation is correct and agree to comply with all applicable State of Minnesota Statutes a Gty of Eaga Ordinances. n c Signature of Permitee _Cs y A Building Permit is issued to: WILLIAM 0 P 9QA OUITFM.L on the express condition that all work shall be doT6 in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official 1A 110iif II LCI OFFICE USE ONLY Occupancy R-3 MM=1 FEES Zoning R1 (Actual) Const V-_N_ Bldg Permit 836.00 (Allowable) L Surcharge 78-00 x of Stories Length Plan Review 543-00 Depth 6?'r SAC, City 100.00 S.F. Total SAC, MCWCC 600.00 S.F Footprints - On Site Sewage Water Conn 0 675-0 On Site Well Water Meter 90.00 MWCC System XX- XX Acct. Deposit 30.00 City Water PRV Required S/W Permit 30.00 Booster Pump S/W Surcharge .50 Treatment PI 252.00 APPROVALS Road unit 355.00 Planner Park Ded. -- Council -- 1 50 Bldg. Off. Copies . Variance TOTAL 541.00 -X. CITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55122-1897 (612) 681-4675 SITE ADDRESS: P.I.N.: 10-23900-140-03 PERMIT PERMIT TYPE: Permit Number: Date Issued: 4086 DEERWOOD TR LOT: 14 BLOCK: 3 ENGSTROMS DEERWOOD &eo-6eo9r BUILDING 027744 06/05/96 DESCRIPTION: I uilyding--,permit Type ,E,Building Work Type fCensus Code r' Ee 3 DECK NEW 434 ALT. RESIDENTIAL ? t O REMARKS: FEE SUMMARY: Base Fee $45.00 COPY $.50 Surcharge $.50 Total Fee $46.00 Subtotal $45.50 CONTRACTOR: - Applicant - ST. LIC.OWNER: A & H CONST 19457898 0008915 COTTRELL BILL 9201 NICOLLET AVE 212 4086 DEERWOOD TR BLOOMINGTON MN 55420 EAGAN MN 55122 (612) 945-7898 (612)452-1923 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 Mn. Statutes and City of Eagan Ordinances. APPLIGAN /PERMITEE SIGNATURE ISSUED Y. fIGN oURE I k CITY OF EAGAN ??(( 44i 3830 PILOT KNOB RD - 55122 - 1996 BUILDING PERMIT APPLICATION (RESIDEN TIAL) Cif b' 681-4675 New Construction Reouirements Remodel/Repair Requirement s ? 3 registered site surveys ? 2 copies of plan ? 2 copies of plans (include beam & window sizes; poured fnd. design; etc.) ? 2 site surveys (exterior additions & decks) ? 1 energy calculations ? 1 energy calculations for heated additions ? 3 copies of tree preservation pl an if lot platted after 711193 required: _ Yes _ No ?700GJ • ° ? DATE: CONSTRUCTION COST: DESCRIPTION OF WORK: 721c /e, STREET ADDRESS: VoSe, LOT BLOCK A SUBD./P.I.D. #: PROPERTY Name: CsTT Le Phone #: OWNER " MIT Street Address City: State: Zip: S6-1 2 2 CONTRACTOR Company: ?9` ?? o?vsriLllcr>o h? Phone #: Sys ` 789Fr Street Address: y- o/ ?Z> poi/-? f1ZiZ License City:. ICCV+ 1- 606 > - State: Zip: ' s-`loo ARCHITECT/ Company: Phone #: ENGINEER Name: Registration #: Street Address- City: State: Zip: Sewer & water licensed plumber: Penalty applies when address change and lot change are requested once permit is issued. 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. Signature of Applicant: ?A?EL.L OFFICE USE ONLY ---------- Certificates of Survey Received Yes No q*,rt ¢ Z' i Tree Preservation Plan Received Yes No _ _ BUILDING PERMIT TYPE ? 01 Foundation ? 06 Duplex ? 02 SF Dwelling ? 07 4-plex ? 03 SF Addition ? 08 8-plex ? 04 SF Porch ? 09 12-plex ? 05 SF Misc. ? 10 = plex WORK TYPE ,X-31 New ? 33 Alterations ? - 32 Addition ? 34 Repair GENERAL INFORMATION Const. (Actual) (Allowable) UBC Occupancy Zoning # of Stories Length Depth OFFICE USE ONLY ? 11 Apt./Lodging ? ? 12 Multi Repair/Rem. ? ? 13 Garage/Accessory ? ? 14 Fireplace ? ,0'-l 5 Deck ? 36 Move ? 37 Demolition Basement sq. ft. Main level sq. ft. sq. ft. sq. ft. sq. ft. sq. ft. Footprint sq. ft. APPROVALS Planning Building Engineering Variance ?3y o/ Permit Fee Surcharge Plan Review License MCNVS SAC City SAC Water Conn. Water Meter Acct. Deposit SNV Permit SNV Surcharge Treatment PI. Road Unit Park Ded. Trails Ded. Other Copies Total Valuation: $ T ?- m? ?i w m. 16 Basement Finish 17 Swim Pool 20 Public Facility 21 Miscellaneous MCNVS System City Water Fire Sprinklered PRV Booster Pump Census Code. SAC Code Census Bldg Census Unit % SAC SAC Units 111301 1990 BUILDING PERMIT APPLICATION CITY OF EAGAN SINGLE FAMILY DWELLINGS MULTIPLE DWELLINGS COMMERCIAL 2 SETS OF PLANS 2 SETS OF PLANS 2 SETS OF ARCHITECTURAL 3 REGISTERED SITE SURVEYS REGISTERED SITE SURVEYS - & STRUCTURAL PLANS 1 SET OF ENERGY CALCULATIONS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS 1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS _# OF RENTAL UNITS # OF FOR SALE UNITS PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING DAY OF MONTH IN WHICH REQUEST IS MADE. LOT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED. NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED. PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED. PERMIT MUST SHOW A LICENSED PLUMBER. MAR 16 RECD Q To Be Used For: nn u Valuation: Date: ? - ?O J b Site Address 0 {J PC?bdLGd ref Lot !l Block 3 Parcel/Sub eN&-5iiRoM5 -r-jz voo-o ADt;n} Owner Inl.`ACA-'+ -C Address 5306 ?? ??{ SO City/Zip Code ?ts- M? SS l? < 1 Phone `-f`1L1 Ot 3-7S 14)V Contractor k? t sty Ky Address c$(k--c,?;.r? City/Zip Code Phone `1. 4-gt4LIL-%- 0VJ Arch./Engr. SJJA--?- AS 8,20V-t Address City/Zip Code OFFICE USE ONLY 1 S6? ow- Occupancy R_3 M-i Zoning Actual Const V-N Allowable V N # of stories Length Depth S.F. Total Footprint S.F On ite sewage- V ite well System ? City water PRV _ Booster Pump _ APPROVALS Planner Council 4?17 Bldg. Off. Variance FEES Bldg. Permit 6 c,aa Surcharge %S'o Plan Review 5 y3100 SAC, City IOD,00 SAC, MWCC oD,Oo Water Conn Z 00 Water Meter 4o,c?J Acct. Deposit 30,00 S/W Permit 30.00 S/W Surcharge ISo Treatment Pl. 24-210 Road Unit a s5,4 Park Ded. Copies SQ SUBTOTAL Penalty TOTAL I)Q Phone # GGal; UE 7-gYIq ^ S" (,m X 1.5= a?140 r--2 T IyY) Z_ Uy 25 Z. y 7 I ? x h xs= 168 too9 N 60 7-HI k ?y = 1r)yt36 2ND k o og ?oX r2^ Lc{o 2 '1 ! H I2`Zx51= 6436-4 IST FLcori 35MT i2v5 1zGGK?I%?y 155051 'r , EXTERIOR ENVELOPE AVERAGE "U" COMPUTATION DATE 3-0;p--90 OWNER 1 A), 1 1 , pry-, C -a ?k ra " i n SITE ADDRESS CONTRACTOR Determine Working Square Footage of Each. 1. Total Exposed Wall Area . I,O Sq. Ft. X .11 = 7 2. Total Roof/Ceiling Area . . Sq. Ft. X .026 =,US 3. Total Floor/Cant. Area . . p7, Sq. Ft. x .05 = Total Exposed Wall Area Above Floor = 1c,2 ,0-0 a. Total Wall Window Area. . . . . . . . . . b. Total Door Area . . . . . . . . . . . . . C. Total Sliding Glass Door Area . . . . . . d. Total Fireplace Wall Area . . . . . . . . e. Total Wall Framing Area (average 10%) . . f. Total Net Wall Area Above Floor . . . . . g. Total Rim Joist Area. . . . . . . . . . . Total Exposed Foundations Area = h. Total Foundation Window Area . . . . . . i. Total Net Foundation Area Above Grade . . Determine "U" Value of Each Wall Segment. a. b. c. d. e. f. 9. h. i. 4. X "U" X „un X "U" X "U" X "U" X "U" X "U" X "U" X "U" PHONE SUBTOTAL = I `)O' Oy TOTAL = . (9 / If item #4 is the same as, or less than item #1, you have met the intent of SBC 6006 (c) 2. Total Exposed Wall Area Above Floor a. Total wall window area . . . . . . . b. Total door area . • C. Total sliding glass door area d. Total fireplace wall area . . . e. Total wall framing area (avrg. 10%) f. Total net wall area above floor . . g. Total rim joist area . . . . . . . . Total Exposed Foundation Area Total Foundation Window Area Total Net Foundation Area Above Grade Determine "U" value of each wall segment. c;7U,ov . as . UD /06.53 a. 49,(87x "V" IC7 ` _ P, h7 b. a2U UC7 x "U" i07 c x nun d. - x 'lu„ e. x "U" _ - p - f x 11 Ulf g. h. x "U" x null T4 SUBTOTAL = ^tgf(0 ' Total Exposed Wall Area Above Floor a. Total wall window area . . . . . . . b. Total door area c. Total sliding glass door area d. Total fireplace wall area . . e. Total wall framing area (avrg. 10%) f. Total net wall area above floor . . g. Total rim joist area . . . . . . . . Total Exposed Foundation Area Total Foundation Window Area Total Net Foundation Area Above Grade Determine "U" value of each wall segment. lo??? JJ b. x "U" c. x "U" _ d. x "U" _ e. 5 - x - "U" _ f. r _ x "U" 9• - x "U" h. x „U„ ^- _ i. -- x „U„ SUBTOTAL = ?? I . Total Exposed Roof/Ceiling Area j. Total skylight area . . . . . . . . . k. Total flat roof/ceiling framing area 1. Total net inslted flat roof/ceiling area M. Total vault roof/ceiling framing area-108 ?- - n. Total net inslted vault roof/ceiling area Determine "U" value for each roof/ceiling segment. j (Ii / x U k. x U 1.?-- x o" m. x "U" n. -- -- x .U" - - ----- -- 5. TOTAL =FI - -3 ------ If item #5 is the same as, or less than item #2, you have met the intent of SBC 6006 (c) 1. Total Exposed Floor/Cant. Areas V? 0U o. Total floor/cant. framing area (avrg. 108) , d p. Total net insulated loor/cant. area _--- Determine "U" value for each floor/cant. segment. x "U" o. 1(;)(0 /?? I 6. TOTAL = E 3 . 0 J „-7 If total of #6 is the same as, or less than #3, you have met the intent of SBC 6006 (c) 3. ALTERNATE BUILDING ENVELOPE DESIGN To utilize the total envelope system method, the values established by the sum of items #4, #5 and #6 shall not be greater than the sum of items #1, #2 and #3. 1._37b,l,?2_ 2. 35,05 3. 2/,5.7- - 4. a -74, &7 5. 9 33 7 6. 3, Prepa ed -_ Date=off N or. i . "IN NI;?o kb 4?J• Ffi?s \1? fIDUSE LOCATION '1'0& 1 s4, ?o I ' i vl ? i yA i .?-- DENOTES PROPOSED SURFACE DRAINAGE 0 DENOTES IRON MONUMENT SET DENOTES IRON MONUMENT FOUND XOOOrO DENOTES EXISTING ELEVATION (000.0) DENOTES PROPOSED ELEVATION U ,?ry' r? ?`?m R EAGA14 r 1 to i SCALE: 1 INCH - 30 T PROPOSED GARAGE FLOOR - 4M.9 T PROPOSED LOWEST FLOOR- 40t.& T PROPOSED TOP OF BLOCK- Me.3 If WE HEREBY CERTIFY TO MR.d MRS. BILL COTTRELL THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF: LOT 14 , BLOCK 3 , ENGSTROMS DEERWOOD ADDITION, ACCORDING TO THE RECORDED PLAT THEREOF* DAKOTA COUNTY, MINNESOTA. IT DOES NOT PURPORT TO SHOW IMPROVEMENTS OR ENCROACHMENTS, EXCEPT AS SHOWN. AS SURVEYED BY ME OR UNDER MY DIRECT SUPERVISION THIS 1 ITH DAY OF APRIL ,1990 SIGNED: _.JWES 5. HILL, INC. t1llKroiiUtN?FROM YHE N~NO PLAN RR CNG$Tr4MS OCOWADW A "low Loon' DAt[DaP' zablblll.Mt. ash /vl 1&0 / 1 y? V t V Z " 0. Q Oa \ Y X11 \1k \ `,\\ O0 1 0\ MINNESOTA LICENSE NUMBER 16828 James R. Hill, inc. PLANNERS / ENGINEERS / SUR\ 9401 JAMES AVE. S, • BLOOMINGTON. MN. 65431 0 8 IS ozv 3 ti? a . SAN' ?o Z \ N? \ ?r7 OOH Y p \ L} ti h °o 0) ti I, lit h bf of t?sl ? A.0 II s? r ? 6 -s '0 i+>o \ V / i / REVI$Eu "o-vu .v .xw.n -- HOUSC LOCATION ; I +04, • yd / "o ?1l 43 I r-- DENOTES PROPOSED SURFACE DRAINAGE SCALE: 1 INCH - 30 T O DENOTES IRON MONUMENT SET T • DENOTES IRON MONUMENT FOUND PROPOSED LOWEST FLOOR FLOOR - $6z.L Ir X000.0 DENOTES EXISTING ELEVATION PROPOSED L LOWEST - ? ¢ (000.0) DENOTES PROPOSED ELEVATION PROPOSED TOP OF BLOCK - ?.? THAT THIS IS A TRUE AND CORRECT HEREBY CERTIFY OF T A MSURVEY OF R.& RS HIE LL COTTRELL BOUNDARIES OF; RE LOT 14 , BLOCK 3 , ENGSTROMS DEERWOOD ADDITION, ACCORDING TO THE RECORDED PLAT THEREOF, DAKOTA COUNTY, MINNESOTA. EYED EXCEPT DOES BY ME OR UNDER MY DIRECT SUPERVISION THIS 1 TH DAY OFAPRILS SHOWN. AS SURVEYED SIGNED: _JAMES g, HILL, INC. ,4 MN C. LARSON, LAND SURVEYOR MINNESOTA LICENSE NUMBER 19828 James R. Hill, inc. PLANNERS / ENGINEERS / SURV" IS 9401 JAMES AVE- S. 0 BLOOMINGTON, MN. 55431 •812 D =p N R FOROM Twz ?N ,pNO PLAN MR tN$S?f*M$ OltRMD00 6 ?IW1 T DATiDtp?p3e!Ob R.M . PERMIT City of Eagan Permit Type:Building Permit Number:EA127328 Date Issued:09/29/2014 Permit Category:ePermit Site Address: 4086 Deerwood Tr Lot:14 Block: 3 Addition: Engstroms Deerwood PID:10-23900-03-140 Use: Description: Sub Type:Reroof Work Type:Replace Description: Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Please print pictures of ice and water protection and leave on site. Carbon monoxide detectors are required by law in ALL single family homes . Natalie Velez 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 - William G Cottrell 4086 Deerwood Tr Eagan MN 55122 Great Northern Builders 9419 Buckley Ct Inver Grove Heights MN 55077 (651) 436-5672 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA177175 Date Issued:06/20/2022 Permit Category:ePermit Site Address: 4086 Deerwood Tr Lot:14 Block: 3 Addition: Engstroms Deerwood PID:10-23900-03-140 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. If water damage is encountered, please call (651) 675-5675 to schedule a site visit to verify the extent of the damage. Any repairs must be inspected prior to covering. The inspector will determine if an additional permit will be required to repair the water damage. 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 - William G Cottrell 4086 Deerwood Trl Eagan MN 55122--188 Rooster Exteriors Inc 986 Inwood Ave N Oakdale MN 55128 (612) 382-4057 Applicant/Permitee: Signature Issued By: Signature