Loading...
631 Crane Creek LaneAddless 631 Crane Creek Lane Zip 5512 3 L.ot 5 Blk I Suh Crane Creek Addition THESE 11BMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECfION. Date: ? Yes No Inspector: Final grade (6" from siding) Permanent steps (garage) Permanent steps (main entry) Perntanent driveway Permanent gas SodlSeeded grass Trail/curb damage Porch Basement finish Deck Please verify with the builder the removll of roof test caps from the plumbing system and the shuboff of water supply to the outside lawn faucet before froeze potential exists. Contact engineering division at 6814645 before working in rightof-way or installing underground sprinkler system. ? Whice - City Copy Yellow - Residenl Copy Pink - Contracror Copy Address 633 Crane Creek Lane Lot 5 Blk ! Sub Zip 5512 3 Crane Creek Addition THESE ITEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECITON. Date: '!j ` y7 • 0E_? Yes No Inspector: Final grade (6" from siding) Permanent steps (garage) Pennanent steps (main entry) Permanent driveway ? Permanent gas Sod/Seeded grass TraiUcurb damage Porch Basement finish ? Deck Please verify wit6 the builder the removal of roof test caps from the plumbing system and the shut-off of wate[ supply to the outside lawn feucel before freeze poteotial exists. ContaM engineering division at 6514645 before working in rigtttof-way or installing underground sprinkler system. ? White - City Copy Yellow - Resident Copy Pink - Contractor Copy Address 635 Crane Creek Lane Zip 5512 3 IAt 4 Blk I Sub Crane Creek Addition THESE ITEMS WERE / WERE NOT COMPLEI'E AT THE TIME OF THE FINAL INSPECTION. Date: y Yes No Inspector: - Final grade (6" from siding) Permanent steps (garage) Permanent steps (main entry) Permanent driveway Permanent gas Sod/Seeded grass TraiUcurb damage Porch Basement 5nish Deck Piease verify with the builder the remo 1 of roof tes[ caps from the plumbing system and the shut-off of water supply to the outside lawn faucet before freeze potential exists. Contac[ engineering division at 681-4645 before working in right-of-way or installing underground sprinkler systero. ? White - City Copy Ye]Iow • Resident Copy Pink - Contracror Copy c) b?- '? - RESIDENTIAL pQ _ , -• ' BUILDINC PERMIT APPLICATION CITY OF EACAN 3830 PILOT KNOB RD • 55122 651-681-4675 -3 NewConstructionReauirements &? _ /?,1,/,?? ? I IRemadelfReoairReauirements • 3 registered site surveys stwwing sq, ft ot lot sq. ft . oi trousel and aA roofed areas (20°'o mazimum lot coverage allowed) • 2 copies of plan showing beam & wintlow sizes; poured found design, etc.) • 1 set o( Energy CalalaUOns • 3 copies of Tree Preservation Plan if bt platled aker 711193 . Rim Joist DeWil Op6ons selec6on sheet (bldgs wBh 3 or less units) DATE JOB SITE ADDR IF MUITI-FAMILY BUILDING, HOW MANY,UNITS? PROPERTY OWNE TYPE OF WORK APPLICANT ADDRESS PAGER # CELL PHONE # 9 L+cz?4 -, -a- L-1' t?? `I ?!) FI REPLACE(S) 3 % y1 ZIPCODE - 3( 9- 7l, S" FAX #'(&/ - 9(1S' 3? ?Q NEW RESIDENTIAL BUILDING ONLY - FILL OUT COMPLETELY j Energy Code Category _ MINNESOTA RUI.F,S 7670 CATE Y 1 ? (check one) - Residential Ventilation Category 1 Wor ?r?t$?I M? D ?? LI U ! - Energy Envelope Calculations Submitt I ?fINNESOTA RULES 7672 , - New Energy Code Worksheet Submitt d B Plumbing Contwctor. Gne/JZ. ? Phone: Ptttnibin,- System Includes: Water . oftener _ I,awn Sprinkler ?(1 Water Heater _ No. oFR.I. Baths No. of Badis Mechanical Contractor. ? N2 .41. 1z p Phone # Ylechcmical Sgstetn Includes: ,kir Cond lioning Hea[ Recovery System st ? Phone # Sewer/Water Contractor: & ? ? Pee: 6,.?(• ya3 /Jyv Fee: $70.00 All above information must be submitted prior to processing of application. I hereby acknowiedge that I have read this appiication, state that the information is correct, and agree to comply with all appticable State of Minnesota Statutes and City of Eagan Ordinances. ? Signature of Applicant 1 tb'? , Certificates of Survey Received Tree Preservation Plan Received Not Required _ . 2 copies of plan . 1 set of Energy Calculations for heated additions . 1 site survey for exlenor addiNons 8 decks go.s? ?CN.z? ? l o CSU'-}.SI Upda[ed 1/01 OFFICE USE ONLY - ; • .. :3 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg ? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3•sea.) ? 31 Ext. Alt - Multi ? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF ? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multi ? 05 03-plex ? 11 10-plex ? 19 LowerLevel ? 24 Storm Damage ? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous ? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding ? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 33 Alteration ? 37 Demoiish (Bldg)' ? 43 Reroof ? 46 Windows/Doors ? 34 Replacement 'Demolition (Entire Bldg only) - Give PCA handout ta applicant d? f Valuation Occupancy MC/ES System Census Code ? Zoning Ciry Water SAC Units ? Stories o2 Boaster Pump Nbr. of Units Sq. Ft. ??l z PRV ? Nbr. of Bldgs l Length 15,0 Fire Sprinklered Type of Const ? Width ao ? REQUIREp INSPECTIONS Footings (new bldg) ? FinaVC.O. _ Footings(deck) FinallNo C.O. Footings (addition) _ Plumbing F0 Foundation HVAC Drain Tile _ ? Roof _ Ice & Wa[er Framing _ Final - Other - Pool Ftgs - Air/Gas Tests - Final Fireplace _ R.I. Air Test Final Siding Stucco Stone o Insulation ? _ Windows (new/replacement) Approved By4 , Building fnspector 3ase Fee Surcharge Plan Review MC/ES SAC ary sac ',Nater Supply & Storage S&W Permit & Surcharge T"reatment Plant Total ,?oa xsy = ?lumbing Permit Mechanical Permit License Searoh Copies 7ther fiay5?1? S ?f y? ?Ga ?a m c? C'a9/2 mc? > kJ L 5 ??G ? g FS?-13._ ? I ?-y/? ll7 73 E(? . • ?-? RESID NTIAL - BUILDING PERMIT APPLICATION ? CITY OF EAGAN 3830 PILOT KNOB RD - 55122 n 651•681-4675 New Construction Reauirements Y?(' I ??'j?RemodeUReoair Reauirements • 3 regis[ered site surveys showing sq. ft. of l04 sq. ft. of house; and all rool?d areas • 2 copies of plan (20% maximum lot coverage allowed) . i se}of Energy Calculations fa heated addilions • 2 copies of plan showing beam 8 window sizes; poured found design, etc.) • t site survey for ezteriw addi6ons & decks • 1 set of Energy Calculations • 3 copies of Tree Preservation Plan if lot platted after 711193 • Rim Joist Detail Options selecuon sheet (bldgs with 3 or less units) DATE S'/O ' 0I JOB SITE AD VALUATION (exCwDING ?' Y 1 - ? 1 IF MULTI-FAMILY BUILDING, HOW MANY U PROPERTY OWNER_[ TYPE OF WORK S9 APPLICANT L. f MS ADDRESS I8R.5 PAGER # CELL PHONE # y q`14(,_ lA 9 0-? 3Qa0-l-11 FtREPLACE(S) _0 X-1 _2 _3 PHONE # ?oSl" y - yS??L? Ail ZIPCODE l S FAX # '&S'?l - 9QS" 36 7a NEW RESIDENTIAL BUILDING ONLY - FILL OUT COMPLETELY Energy Code Category MINNESOTA RULES 7670 CATEG ? f'? (check one) - ResidenUai Ventilation Category 1 Works ub itt ? - Energy Envelope Calculations Submitted _ MINNESOTA RULES 7672 ? - New Energy Code Worksheet Submitted BY?_,._ ?7 ?J -? wt Plumbing Contrar?ur. i?E?u 2? dKU A Phone #: 6,5-(' ye?3• ? Plumbin; Systein Includes: Water, >ttener I.awn Sprinklcr Fee: 590.00 ?Q Water Heater No. of R.I. 13attis No. oF Badis Mechanical Contractor. c-rhlZ d /\V'An Mechanical System Inclucles: Air Cond tioning _ I-Iea[ Recovery System ("?,,f vi Z? Sewer/WaterControctor: 2ni'gF'?-i?ri'-T?o" T.err3 Phone# lAst - ya3" flyy Pee: $70.00 Phone # locsl- `66- yVf30 All above information must be submitted prior to processing of application. I hereby acknowledge that I have read this application, 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 ?j n AL Certificates of Survey, Received _ Tree Preservation Plan Received _ Not Required _ llpdated 1l01 OFFICE USE ONLY ? 01 Foundation ? 02 SF Dwelling ? 03 01 of _ plex ? 04 02-plex )?V 05 03-plex ? 06 04-plex ? 07 05-plex ? 13 16-plex ? OS 06-plex ? 16 Fireplace ? 09 07-plex ? 17 Garage ? 10 08-plex ? 18 Deck ? 11 10-plex ? 19 Lower Level ? 12 12-plex Plbg_Y or, N KS?? SLO 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding ? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 33 Alteration ? 37 Demolish (Bidg)` ? 43 Reroof ? 46 Windows/Doors ? 34 Replacement *Demolition (Entire Bldg only) - Give PCA handout to applicant Valuation 10d /az 0,1 '-- Occupancy R-3 MC/ES System Census Code /e.3 Zoning ,p-D Ciry Water SAC Units 61 Stories aQ. 8ooster Pump Nbr. of Units Sq. Ft. PRV ? Nbr. of Bldgs ? Length Fire Sprinklered - ? Type of Const ? -N Width ? Footings(new bldg) _ Footings(deck) Footings (addition) Foundation ? DrainTile Roof Ice & Water Final ? Framing? Fireplace R.I. Air Tes[ Final ?j Insulation 3ase Fee Surcharge Plan Review MC/ES SAC 3ity SAC Water Supply 8 Storage S&W Permit & Surcharge Treatment Plant Plumbing Permit Ulechanical Permit License Search Copies Other Total REQUIRED INSPECTIONS ?- FinaUC.O. Final/No C.O. _ Plumbing _ HVAC Other ? Pool Ftgs AirlGas Tests _ Final Siding Stucco Srone _ Windows (new/replacement) Approved By 4 , Building Inspector ---------- ----------- ---------- ---------------'-------------------------------------- ,P 7G0-klS= ?0?77D ? q --I '4 4 , l 1 ? 20 Pool ? 21 Porch (3-sea.) ? 22 Porch/Addn.(4-sea.) ? 23 Porch (screened) ? 24 Storm Damage ? 25 Miscellaneous ? 30 Accessory Bldg ? 31 Ext. Alt - Multi ? 33 Ext. Alt - SF ? 36 Multi Lfl.3;l 7YG 0?-, yA ? cf?o 7! ?' ? ? ? . W ?- `-k (' U I RESIDENTIAL ??pP _ BUILDING PERMIT APPLICATION CITY OF EAGAN mn 3830 PILOT KNOB RD - 55122 651-681-4675 New Construction Reauiremenls ? RemadeVReoair Requirements • 3 registered site surveys showing sq. fl. of lot, 5q, k. o( house; and all rcof areas 2 copies of plan (20°6 maximum lol wverage allowed) 1 setof Energy Calculations for heated addilions • 2 copies of plan showing beam & window sizes; poured tound desiga ?tc.) . 1 site survey for ezterior addi6ons & decks • 1 set of Energy Calculations . 3 copies of Tree Preservation Plan il lot piatted aRer 7l1193 • Rim Joist Detail Options selection sheet (bldgs with 3 or less units) DATE 45- I O•(' I VALUATION (EXCLUDWG LAND)? JOB S1TE ADDRESS (n35 CrArle lxeCA 'Ln " 1,0? ?l IF MULTI-FAMILY BUILDING, HOW MANY UNIiS? PROPERTY OWI TYPE OF WORK APPLICANT G ADDRESS PAGER # L1 '_:? T-s- `t L4 ts? ('? I 4r5? G -j 9o.so I () , o c"y. S1 -S rxi - 94-5 3l "N NEW RESIDENTIAL BUILDING ONLY - FILL OUT COMPLET Energy Code Category NIINNE50TA RUI.ES 7670 CATEGORY 1 ? (check one) - Residential Ventilation Category 1 Worksheet Submitte - Energy Emelope Calculations Submitted _ MIVNESOTA RtiLES 7672 New Energy Code Worksheet Submitted Plumbing Confiractor: Ge ? 1` Phone #: /Z'' ]Qv3' ll7 y Pliunbing System Includes: Wate t Sottener Iawn 5prinkler Fcc: $90.00 W'ater Heater _ No. of R.I. 13aths ? No. of I3aths Mechanical Contractor: 67Cn Z ?Q?j gn Phone #_ 4Ia3' fl77 .Mechaniril Systern Includes: ?Q Air Condi oninn Fee: $70.00 I-Ieat Rccovery System G--e wzk?' ?//'?`?, Sewer/Water Contractor: ne # 6 ?1 ' ?/ 7 6 tn'" J7 VU All above information must be submitted prior to processing of application. I hereby acknowledge ihat I have read this application, 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 K 6n ?-? i.?C ? Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ Updated il07 OFFICE USE ONLY ? 01 Foundation ? 02 SF Dwelling ? 03 01 af _ plex ? 04 02•plex )f OS 03-plex ? 06 04-plex ? 07 05•plex ? 13 16-plex ? 08 06-plex ? 16 Fireplace ? 09 07-plex ? 17 Garage ? 10 OS-plex ? 18 Deck ? 11 10-piex ? 19 Lower Level ? 12 12-plex Plbg_Y or _ N ? 20 Pool ? 21 Porch (3-sea.) ? 22 Porch/Addn.(4•sea.) ? 23 Porch (screened) ? 24 Storm Damage ? 25 Miscellaneous ? 30 Accessory Bldg ? 31 Ext. Alt - Multi ? 33 Ext. Alt - SF ? 36 Multi 0 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding ? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 33 Alteration ? 37 Demolish (Bldg)* ? 43 Reroof ? 46 Windows/Doors ? 34 Replacement "Demolition (Entire Bldg only) - Give PCA handout to applicant Valuation ?'19 OD(/ 4 ?-J Occupancy P, -3 MC/ES System Census Code 1?0 _3 Zoning ? City Water SAC Units 04 Stories o2 Booster Pump Nbr. of Units wz_ Sq. Ft. PRV ? ? Nbr. of Bldgs Length Fire Sprinklered Type of Const Y- Width ? Footings (new bldg) _ Footings (deck) Footings (addition) Foundation ? Drain Tile Roof Ice & Water Final Framing Fireplace R.I. Air Test Final ? Insulation REQUIRE?D INSPECTIONS FinallC.O. _ FinaUNo C.O. _ Plumbing _ HVAC Approved Byal _, Buitding fnspector 3ase Fee 3urcharge Plan Review MGES SAC cay sac 'Nater Supply & Storage S&W Permit & Surcharge Treatment Plant ?lumbing Permit Vlechanical Permit _icense Search ;opies '7ther Total Other _ Pool _ Ftgs _ Air/Gas Tests _ Final _ Siding Stucco Stone _ Windows (new/replacement) 1651W i 7/Se- l S i /O 7oZ,j Avu> G-E d'r-L 30 61 ?.='- a S6, ?P6 " ?f3 1 ?lb ` GR?t-? ? s P?a-C E 'ft Y 'l ZS `-F 5 . t:?;_ ? ;zyd /G ? ?3 S. ?v RESIDENTIAL BUILDING PERMIT APPLICATION 15 CITY OF EAGAN ? y3 3830 PILOT KNOB RD - 55122 / 651-681-4675 New Construction Reuuirements RemodeilReoair ReauiremeMs • 3 registered sile surveys showirg sq. R. of lot, sq. ft of house; and all roofed areas • 2 copies o( plan (20%maximum lot coverage albwed) . 1 sel otEnergy Calculations for heated additions • 2 copies oF plan showing 6eam & windaw s¢es; poured found design, etc.) . 1 site survey for exterior additions & decks • 1 set af Errergy CaICWa6ons . Indicate if hane served by septic syslem for additions • 3 copies of Tree Preservation Plan If lot ptaUed aRer 7l1/93 • Rim Jaist Detail Options selection sheet (61dgs wiHi 3 or less units) DATE (e -?I " 0 I VALUATION ? ? 0 OT3 JOB SITE ADDRESS CO 3I t.fAng O! fP V k411P. IF MULTI-PAMILY BUILDING, HOW MANY U?! ITS? .-? 1?t PROPERTYOWNER ?PncrnAnh IPc]mr.< 5??PPcy? TYPE OF WORK Novr or+ QerC_? el tIly FIREPLACE(S) ?( 0_ 1_ 2 APPLICANT ??rtiSmAnn '& PHONE#17!?l " y66' V'-/M ADDRESS_??? PI92.4 0.- Scjt, ZIPCODE PAGER # CELL PHONE # WO - 3vq- 76/5' FAX # NEW RESIDENTIAL BUILDING ONLY - FILL OUT COMPLETELY Energy Code Category (check one) Plumbing Contractor: Plumbing System Includes: Mechanical Contractor: Mechanical System Includes: Sewer/Water Contractor: _ Air Conditioning _ Heat Recovery System Phone # Phone # Fee: $90.00 Fee: $70.00 All a6ove information must be submitted prior to processing of application. Stgnature of Applicant OY_ MINNESOTA RULES 7670 CATEGORY 1 I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicoble State of Minnesota Statutes and City of Eagan Ordi n esAICIDQ?? - Residerttial Ventilation Category 1 Worksheet Submitted - Energy Envelope Calculations Submitted _ MINNESOTA RULES 7672 - New Energy Code Worksheet Submitted Phone #: _ Water Softener L.awn Spiinkler Water Heater No. of R.I. Baths No. of Baths Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ Updated 1/01 OFFICE USE ONLY O 01 Foundation ? 02 SF Owelling ? 03 01 of _ plex ? 04 02-plex ? 05 03-plex ? 06 04-plex ? 07 OSplex ? 13 16-plex ? 08 06-plex ? 16 Fireplace ? 09 07-plex ? 17 Garage ? 10 08-plex ? 18 Deck ? 11 10-plex ? 19 Lower Level ? 12 12-plex Plbg_Y or_ N ? 20 Pool ? 21 Porch (3-sea.) 0 22 Porch/Addn. (4sea.) ? 23 Porch (screened) ? 24 Storm Damage ? 25 Miscellaneous '? . ? 30 Accessory 81dg ? 31 Ext. Alt - Multi ? 33 Ext. Alt - SF ? 36 Multi '?1 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding ? 32 Addition ? 36 Move Bidg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 33 Alteration ? 37 Demolish (Bidg)' ? 43 Reroof ? 46 WindowslDoors ? 34 Replacement "Demolition (Entire Bidg only) • Give PCA handout to applicant Valuation 006) Occupancy MC/ES System Census Code ? Zoning City Water SAC Units O? Stories Booster Pump Nbr. of Units Sq. Ft. PRV Nbr. of Bldgs Length Fire Sprinklered Type of Const W idth REQUIRED INSPECTIONS _ Footings (new bldg) Footings(deck) FinaUNo C.O. ?CJ Footings (addirion) Plumbing Foundation Drain Tile Roof Ice & Water Final Other ? Framivg - Fireplace _ R.I. _ Air Test _ Final Insulation Approved By ? , Building Inspector Base Fee Surcharge Plan Review MC/ES SAC City SAC Water Supply & Storage S&W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other FinaUC.O. ? HVAC _ Pool _ Ftgs _ Air/Gas Tests _ Final _ Siding Stucco Stone _ Windows (new/replacement) el1j,? - ?ao ?s Y? ? ?2L>. ?? Total CLAIM VOUCHER - REFUND REQUEST CITY OF EAGAN MAKE CHECK PAYABLE TO: Wensmann Homes, Inc. ADDRESS: 1895 Plaza Drive Suite #200 Eagan MN 55122 LOCATION: 631/633/635 Crane Creek Lane P.I.D./LEGAL: 10-18450-060-01 RECEIPT #/DATE: R#11355/64-01 VALUATION: REASON FOR REFUND: Overcharged on SAC PERMIT #: 45471/45466/45459 TYPE OF REFUND: Plumbing Permit Mechanical Permit BuIlding Pemut Fee Plan Review Fee SAC (MC/WS) SAC (Ciry) SAC (Admin) Water Connection Sewer Permit Water Permit Account Deposit Water Meter Water Treatment Surcharge Oveipayment Curb Box Deposit Refund Conshucrion Meter Dep Refund 9001.4087 9001.4088 9001.4085 9001.4222 9220.2275 9379.4681 9041.4246 9220.3865 9220.4532 9220.4507 92202252 9220.4509 9220.4685 9001.2195 9001.2250 92202253 9220.2254 $ $ 6,831.00 $ 600.00 $ 69.00 $ $ $ $ $ 3,096.00 $ $ $ Water Supply & Storage 9220.4680 $ 5,160.00 TOTAL $ $15,756.00 I declaze under the penalties of law that tliis account, claim, or demand is just and that no part of it has been paid. June 25, 2001 DATE v Sha n Michlitsch CL3PG001 tif Page ?* * * PtON *engm * ** # 635 14igM1-y 10 N,E. Bloinq NN 5513, (812) 763-1880 FAX:763-18e3 Certificote of Survey for; -WENSMANN HOMES_ 635,633,E31 CRRNE CHEEK LANE \ \ ? IIOUSF fvFE=WALKOUi P 9ENCN MARK rer ov rmE ELLe'..=847.91 oEncH unRk i0P pp PIPg ELEV.- 651.35 SAM. Sc'RV, PER PIAN l0i 4=038.5 LOt 5=8}g,9 LOi 6=8422 NOIE; GIICI 6RAOE5 SFOWJ fER fIlA0I1G PIAN 91: PIOrvEER fI01F: 3lhl9'iXG f1uSrv?pVS SYOVm /.fif. fOfl HOfiI µJ Y£AIICM. LOCnIKKI OG $11111[IV'ES Ct1lY. SEI Afltldtff.Nk GLANS fOP 9V0.GINE nxp fWNOnOpN OwENLMS. NOIE: N9 SVEC6iC $OILS WYESnG4TIQ1 XAS BE`N COAPtEfFO OX MIS L01 Bv ME sonvcvw. me smumun or saLs ia .orvoar Tne svcane nwx nxmasco is Nmr mc er.saa+sewrv rr rnc EI HOIF: MIS MCERIIf1CAlE LTMES I10! %INPCRI N SNOW En5[4ENIi O1NfA MAN Off SHC-1 CN E RECtliCW PLAf. e?plF;: NN1 q.flOli AIISI HFIFY OIiM1[W, pFSI6N. M[Irt': IIEARiN45 31I1 AP( 3ASE0 d AN ASSIIYEU VAIUY o,,e MN 55120 q4 FAX:681-9488 V o ? PROPO<FD H(Rl E FLEVAl10N LOT 4 LOWEST FLOGF ELEVAPON: ?_3?I i0P OF 9LOCK EIF.JAfION: 0-Y GARAGE SLAB ELEVAiICN: Y374 ' ' PR(]VOSfI) HOIISE-LL4VAPON I Oi 5 LOWESi f100R ELFVqfi0N: i0P OF 6lOCK EiEVA?OPI: CAftAGE 51.Afi ELF.VAiIOH: PROPOSEa HQQ$E ELEVA?ON LOi 6 LDPoEST fL00R ELEVAlION; I roP er aiocK cLEVnnoN. ZSp? CARACE SL0.[3 EIF.Vhfl(NJ: Z=2-L__ x 00000 FiN0iE5 EYlill)iE ELEVAIIIXI ? OG0.00 ) O IcN OIES FPOPOSN EIkVAl1ON - DEilOlES GanvlcCE AfO VVlIrv EIROHxf Nk HERE6Y CER?F/ TO V?FNSUANN HOME> iHqT i1115 i5 A iRUE AND '-? c1xort5 oenMIce Ftow ow[CU'w CORRECi RLPftESL'NiAiION OF A SURV[Y OF iHE 60UNDARIES OF: -?'- o nm[5 uonour.er -H-- OEnall.s ofiSEi nuo LOT 4,5,6, BLOCK 1, CRANE CREEK ADDITIDN enKOtn counTr, uinNesorn I( pCES flGi FUHPORI TO SHOW RAVROVEMFNiS OR ENCHRpAf,HAlFN15. E%.^.EPf AS SHOWN. PS $IIHVEtiFU UY IAF OR livDER 1AY DIftECt SUPERV510N iHIS 3R0 OAY OF 4AY. 2001. RE"SEO 5-30-01 PROP. ELEV. 9QP+E0?jPiOmEf.R ,L'nGiwE iNQ P.A. SCALE : i WCH = 30 FEET RE`nSEO 5-3I-01 RESir.KEO ev REVISED 6-14-01 RESTAHED ?REVISED 6-25-01 SHOW PORCH. TB? 101707.02 6AT Jahn C. Lorson L.S. Reg. Ho. 19828 ` LOT SURVEY CHECKLIST FOR RESIDENTIAL BUILDING PERMIT APPLICATION PROPERTY LEGAL: Lo f ?/' S/. /?l?o? / CrA?P Lrei,? ?f n. DATE OF SURVEY: ly? LATEST REVISION: V F ? DOCUMENTSTANDARDS ? \ n o ? Q q?0 ? . Registered Land Surveyor signature and company Gl?/? ? • Building PermitApplicant CY/ 0 ? . Legal description 6' ? ? ? • Address [3 ? ? • North arrow and scale ? o ? • House type (rambler, walkout, split w/o, split entry, lookout, etc.) I?? ? • Directional drainage arrows with slopelgradient % L9? ? / ? ? • Proposedlexisting sewer and water services & invert elevation St t P ? • ree name Cc? ? ? • Driveway ? ET/ ? • Lot Square Footage ? W ? • Lot Coverage ELEVATIONS / Existin [? ? ? • Sewer service (or Propased) tr? ? ? • Property corners CA/ ?? • Top of curb at the driveway and property line extensions ?e ? . Elevations of any existing adjacent homes ? V? • Adequate footing depth of sVuctures due to adjacent utility Venches Prooosed tV ? ? . Garage Floor w ? ? • First floor C4' ? ? . Lowest exposed elevation (walkouUwindow) V ? ? • Property corners U" ? ? • Front and rear of home at the foundation PONDING AREA (if aoolica6le) ? Y, ? • Easement line ? d ? • NWL ? u' ? • HWL ? P, / ? • Pond # designation ? r?Y ? • Emergency Overflow Elevation / ' DIMENSIONS L ?¢ cl , ? • ot lines/8earings 8 dimensions Ri b k f [5 ? / ? • ght-of-way and street width (to ac o curb) ' ? B ? , porches, etc. • Proposed home dimensions including any proposed decks, overhangs greater than 2 / (i.e. all structures requiring permanent footings) t S h ? R ? ose easemen s • how all easements of record and any City utilities within t GJ/? l ? • Setbacks of proposed structure and sideyard setback of adjacent existing structures R ff W ? ? • etaining wall requirements, any Reviewed: 4 ? ' / Date Name 9811612006 11:12 ERGRhd ENG+C011 DEV 4 94801989 20o6 RESIDENTIAL BUILDING rEPMT nrrLrcaTIor 7c?-- City Of Lagan 3830 Pilot Kno6 Raad, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 Naw C?swmon 0.eaufremBn[s 3 wg1518f9d 9?18 Sll?y+?'iiy 5Q. (L Ci Id, St?. K Of hoIISB', dntl j mOfQQ arws (20% fnazlmum bt cwafige ellowBrJJ 150-lb Raporl ff ProposeG huading Is m he piflwd on d'swroetl aoY 2 cqpes Mplan showmg Omn & Whidov saes; Fouretl 1aiM desi9a. etc. 1 saldEnagy CakuIelions 3 mples WTree Presm4atian Plsn G lue p'alletl aR¢r 711193 Rlm Jdsl6efnp optiorts seler.+ion sheot ryuibinps wNh 3 ar less un14) MUmegesm mechenicalvenClatirn Porm Date„2-? /? / 06 ?- SiEe Address 635 I}escription of Wark 4 Mulfi-Family Bidg ? Y - N N0.159 Wl J6_7 dk!5' office um Ord Ra aim?mi? ?na? ZCOpIB6WP?6My'lllAfpp(i1134?E9fO5IW313 [B10f$NVC7?E? ?Y ?N I setofEneisYCatamm rorneew emroons SabReport --Y-N 1sResurveyiaadaNone&0ecks TreePresPanRecd -Y-N. AddfiMrt • indic9fB If on•apu 3gP11c sYStem Tiee PIBa Rquired _1' -N On-slmSe?ScSYstem _Y _N CnnstructionCost ?d ?<•^-? Unit/Ste A Fireglace(s) V- 0 _ 1 _ 2 Propertydwner J6??L?2„r?l?.c Telep?oeesF(?o?/)-ZZ6'3?/G '71.I a Contractor iKz--1/N'A c ? 1? V v 4?! J h. A4dress /70S-5- 60 O ' Lj f 1r AUE City HAST/NGS stau GLI 11 Zip 5?03? Telephone# (65-1 ) C1 oa COMPLETE TNIS AREA ONLY IF CONSTRUC7ING A NEW BUILDING - MinnOCOts Rules 747_0 CtiteeorV 7 -nnesot8 u es 7672 . Energy Cotle Category ,F?--sberRielVentilation Category 1 Workshee! ? • Hew Enar9Y C Wot -'? (J submission rype} gupmPW Submided . Energy Em¢lope Csicul0tiona Submitt0d NOCT 9 In ihe last 12 months, hds ihe City of Eogan issued a pertnit for a simiipr plan basad on o master plon? ^1? _ Y _ N If yes, date and address of master plan: Licensed Plumber ielephone #[ ) Mechanical Confractor Telephone #( } Sewer/WaterConiractor 7elephonek{ ) J I hereby apply for a Residential Building Pemiit and ackziowledge rliat the informariorc is complete and accurate; that the woxk will he in conformance with the osd.inances szrtd todes of the Gity of Eagaai and the 5tate of M1V $ta.tutes; I unclerstand. this is ilot a pennit, but only an appYication for a perxnit, and. WOkk is noC tA Stari: withOllt a permit; that the woxk wiU be in accordance with tltie appioved plan in the case of wark? ch rie u?ires a review and approval of plans. ??'( L L?? ?D nrT 11 ApplicattPs Printed Name Applicant's Signature C rtc??? 98i16i2006 11:13 Sub Twoes p 07 Foundatioh ? 02 SF Dweliing O 03 01 M_ piex Ct 04 02-plex C] 05 03-plez ? 06 04pICl[ Work Tvoes ? 31 New `6c 32 Addition ?0 33 ANeratian (] 34 Replacement ? 35 Int ImprovemeM q 36 Demolish Inienor ? 44 Sitlmg ? 38 Move Buildmg ? 42 Demolisn Foundatian ? 45 FirE RCpair 0 37 DemoYsh Building• p 43 Rercoi ? 46 Window5lDoors `Demofltion (Endre Bldg) - GNe PCA handout to apDliearrt QEsC/ipflan: WalerDamage_Yes Valuatipn . r12 % (J q . Occupancy Plan Reriew 25°10 T Certsus Code 7 Zaning SAC Units Stories # of Units Sq. Ft. # of Bldgs Length Type of Const ? Width MCES System Ciry Water Booster Pump PRV Fire Sprinklertd REQUIREDIN6PECT1aN5 _ Footings (irew bldg) _ Sheehaek Footings (deck) FinaLIC.O. ? Foo6ngs (addition) Final/hTa C.Q. T Faundation ? HVAC _ brain Tile Other Roof [ca & Water Fiaal Poal Ftgs AulGas Teses Pinal ? Framing ? _ Siding _ Stucco Lazh T Slone iath _Bxick FireplaCe T R.1_ _ AEr Test ?9 Insula[ion Apprrnied 9y: -- -- _ Final _ Window9 _ Retaining Wal1 , Building Inspector i Base Fee 5urcharge q 6)?t5ff7V Plan Review v i A.c is? MClES SAC , C,tySAC Utilit C ti Ch /yo J y onnec on arge SS'JV Pemtit & Surcharge Treatmerrt Plant License Searoh Copies 6ther Total FAGAN EhG+COM DEV 4 94801989 ll0 NOT WRITE BELQW THIS LINE 0 13 t6-plex 0 16 Rreplace ? 17 Garage O 18 Deck ? 19 LavrerLevel N0.160 D01 0 20 Pool ? 30 Accessary Bldg ? 21 Porch {3sea-} ? 31 Ext. AH-MWti )9r 22 PorchlAddn. (4-sea.) ? 33 Ext. Att - SP 0 23 Porch (5Creenlgazebolperola) ? 38 MUlti Misc. O 24 &orm Damage ? 28 Miscepaneous Cl 07 05-plex ? 08 OCrplex ? 09 07-plex ? 10 OS-plex ? 11 10-plex ? 12 12-plez 6514801989 NOV-0212006 i2:13 From:GIR-MqC CONSTRUCTION 6514801989 To:651 675 5694 P.1/1 ATT ?J . MNChQCk COMPLIANCE REPORT i? Minnesota Energy Code MNCheck software version 3.0 couNrv: oakota STATE= Minnesota ZONE: 2 CONSTRUCTION TYpE: Single Family DATE: 9-2$-2006 OATE OF PLANS: 9-27-06 PRO7ECT INFORMATION: Sun Room Addition COMPANY INFORMATION: Gir-MaC Construction NOTES: Energy Calc. for addition Only. CdMPLIANCE: PASSES rtequ'i red ua = 59 Your Home = 51 13_6% Better Than Code I Permit # I i Checked by/oate area or Cavity Cont. Glazing/Doar ___ Perimeter -----^---------- R-Vdlue R-ValUe U-Vdlue ___ CEIlIMGS: Raised Truss 140 ----------------- 40.0 0 0 --- WALLS: Wood Frame, 16" O.C. 272 ' 1 19.0 2 0 waLis: Rir+.],sc-,cr 34 . 7 6 GLAZING: Windows or Dpor'S, Above Grade 68 . 0 350 FLppRS: Over OutSide Air 140 30.0 0 0 . HVAC EQUIPMENT; Furn3C2, 92.0 AFUE ------------------ . --------------------------- COMPLIANCE STATEMENT: The proposed building ----------------- design deSCribed ------------ here is Y consistent with the building plans, specifications, and other submitted with th i calculations e perm t application. The proposed building designed to meet th i has been ee3u rements of the Minnesota Energy Code. ? ? suilder/Designer_ Ddt .. ?. * PIONEEF9 * 0n-h *?** LANO SIIRVETYIPS • CML EnGMEEHS UNp PLANNEqS. LANpSCAPE APCM1ECi5 625 Hiqhwoy 10 N.E. " Blaine, MN 55434 (612) 783-1880 FAX:783-1883 Certificate of Survey for: WENSMANN HOMES 635,633,631 CRANE CREEK LANE J-,a Li? ?b ? orG? Ioc.c7ruv? \ HOUSE TYPE=WALKOUT ,? ? ?^ 37, a ?! \ > ? ?& 3 a ? 61 $38. ?R. `E?ucfv ? Q?p?pJ`' ?? ? ?op 6. ? O?• ,,:, w. • ?,? 3s C?,? ^ 839. ` .:. I? ? 640.4 \ ?S'FQ 6O ??\ ,?. ?Faa?= r?! c/l ? ? o p 839 a s??r?oo p °o ^M?.' ?[. . L . . 6. _fl _ BENCH MARK xO SR(D o-fe?,g Nv TOP OF PIPE ELEV.=847.14 ? Q 49.0 'c O I SF ? EAGAN ? !?- DATEBY C9P BENCH MARK T OF PIPE BJIL?„?-? „?.._? .....• .,???v.=asa.sz SAN. SERV. PER PLAN LOT 4=838.5 LOT 5=839.9 LOT 6=842.2 2422 Enterprise Drive Mendo[a Heights, MN 55120 (651) 681-1914 FAX:681-9488 ??s.. ?., NOTE: PROPOSEO GRAOES SHOWN PER GRADING PLAN BY: PIONEER NOIE: 0UI4DING OIMENSIONS SMOWN ARE FOR NORIZONTAI ANO VER?CAL LOCATION OF SLRUCfURES ONLY. SEE ARCHITECNAI PLANS FOR BUILDING ANO FOVNDA110N DIMENSIONS. ' NOIE: NO SPEqFIC SOILS INVESTIGA?ON HAS BEEN COMPLEiEO ON iH15 LOT BY 1HE SUftVEYOR. THE SUIiABILI7Y OF SOIlS 70 SUPPORT THE SPEGFlC 11CUSE PROPOSED IS NOi iHE RESPONSIBIIJiY OF 7HE SVRVEYOR. NOTE: iHlS CERi1FiCAiE DOES NOi PURPORi TO SHOW EASEMENiS OTHER THAN iHOSE SHOWN ON iHE RECORDED PLAL NO1E: CONiRACiOR MUST VERIFY DRIVEWAY OESIGN. NOTE: 9EARWGS SHOVNV ARE BASEO ON AN ASSUMEO OAiUM ? ? .: . . ... oor, , • ? ? SEO > y? 7 ? ?. ? P. .V. EQU9RED WE HEREBY CERTIFY TO WENSMANN HOMES THAT THIS IS A TRUE AND CORRECT REPRESEN7ATION OF A SURVEY OF THE BOUNDARIES OF: PROPOSED HOUSE ELEVATION LOT 4 LOWEST FLOOR ELEVATION: 53H3.1 TOP OF BLOCK ELEVATION: 550, 8 GARAGE SLAB ELEVATION: $5 4'Y PROPOCFf1 HOIISF FI _VATION LOT 5 LOWEST FLOOR ELEVATION: SyS? I TOP OF BLOCK ELEVATION: SS/. S GARAGE SLAB ELEVATION: $5?• y PROPOSEO HOUSE ELEVATION LO7 6 LOWEST FLDOR ELEVATION:SY ` 1 70P OF 6LOCK ELEVATION: $`?Z•$ GARAGE SLAB ELEVATION: g52- y % 000.00 OENOTES E%ISiING ELEVAPON ( 004.00 ) OENO7ES PROPOSED ELEVAPON --- OENOIES DRAINACE AND U?LITY EASEMFNT DENOTES DRAINAGE FLOW DIftEC?ON ? DENOTES MONUMENi 9 DENatES OFFSET HUB LOT 4,5,6, BLOCK 1, CRANE CREEK ADDITION DAKOTA COUNTY, MINNESOTA IT DOES NOT PURPORT TO SHOW IMPROVEMENTS OR ENCHROACHMENTS, EXCEPT AS SHOWN, AS SURVEYED BY ME OR UNDER MY DIRECT SUPERVISION THIS 3RD DAY OF MAY, 2001. __.. ? ? SCALE : 1 INCH = 30 FEET 101 REVISED 5-30-01 PROP. ELEV. REVISED 5-31-01 RESTAKEO PIONEER ENGINEERINC/ P.A. Lorson, * * *,*' * PIONEEFI * EflgIflBB II` **** uHo 2422 Enterprise Drive Mendota Heights, MN 55120 (651) 681-1914 FAX: 681-9488 nacrrtecrs 625 Highway 10 N.E. Blaine, MN 55434 (612) 783-1880 FAX:783-1883 Certificate of Survey for: WENSMANN HOMES 635,633,631 CRANE CREEK LANE LOT 6=842. ? .. . . ... ... :. NOiE: PROPOSED GRAOES SHONN PER CRADING PLAN 8Y: PIONEER NOTE: BUILDING DIMENSIONS SHOWN ARE FOR NORIZONTAL AND VERPCAI LOCAPON OF STRUCTURE$ ONLY. SEE ARCHITECNAL PLANS FOR Bu1LDING AND FOUNDAiION OIMENSIONS. NOTF.: NO SPECIFIC SOILS INVESTIGAiION HAS BEEN COMPLETED ON THIS LOT BY THE SVftVEYOR. THE SUITABILIiY OF SaILS TO SUPPORT THE SPECIFIC HOUSE PROPOSED IS NOT 1HE RESPONSIBItJTY OF THE SURVEYOR. NOTE: Th115 CERiIFlCAiE DOES NOT PURPORT TO SHOW EASEMENTS OTHER THAN THOSE SHOWN ON iHE RECORDEO PLAT. NOiE: CONTRACTOR MUST WRIFY ORIVEWAY OESIGN. NOTE: BEARINGS SHOYM ARE BASEO ON AN ASSUMEO OANM HOUSE TYPE=WALKOUT . ............. .......:;.a.x?;.,, sf t-r "ll CLe SD Q 94i.8 ?? ? ? ? ? ? ? ? ? ? w ? ?._ C=: H ? poG°o?Io ??Q????D PROPOSED HOUSE ELEVATION LOT 4 LOWEST FLOOR ELEVATION: 15;H3.) TOP OF BLOCK ELEVATION: $5 O"8 GARAGE SLAB ELEVATION: 550.`/ PROPOSED HOUSE ELEVATION LOT 5 ? LOWEST FLOOR ELEVAl10N: S 31y TOP OF BLOCK ELEVATION: 51• GARAGE SLAB ELEVATION: $51, y PROPOSED HOUSE FIEVATION OT 6 LOWEST FLOOR ELEVA710N: $y S / TOP OF BLOCK ELEVATION: $sZ'$ GARAGE SLAB ELEVATION: '952. Y % 000.00 DENOTES E%ISTING ELEVAlION ( 000.00 ) DENOTES PROPOSED ELEVATION DENOTES DRAINAGE AND UTILITY EASEMf'NT DENOTES DRAINAGE FLOW DIRECPON WE HEREBY CERTIFY TO WENSMANN HOMES THAT THIS IS A TRUE AND _a DENOTES MoNUUeNr CORRECi REPRESENTAPON OF A SURVEY OF THE BOUNDARIES OF. 9_ DENOTES OFFSET HUB LOT 4,5,6, BLOCK 1, CRANE CREEK ADDITION DAKDTA COUNTY, MINNESOTA li DOES NOT PURPORT TO SHOW IMPROVEMENTS OR ENCHROACHMENTS, EXCEPT AS SHOWN, AS SURVEYED BY ME OR UNDER MY DIRECT SUPERVISION THIS 3RD DAY OF MAY, 2001. REVISED 5-30-01 PROP. ELEV. SIGMED: PIONEER ENGINE?RIN? P.A SCALE : 1 WCH = 30 FEET REVISED 5-31-01 RESTAKED RYI . r? 101107.02 BAT , L.S. Reg. \ O ? ? ???? 37•aS EAPaAN V ?EV! 13Y ?-. DATE. BJILt,,,,? I--- City of Eau 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Lt,-' 4 Use BLUE or BLACK Ink For Office Use /3g/ (`f Permit #: Permit Fee: /. (%(-} Date Received. Staff: J 2016 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 8/9/2016Site Address: 63/, F� 3 G 3� Crane Creek Lane Unit #: t. Name: Crane Creek Townhomes Association Phone: 952-922-2500 Address ! ci ! z; . 5707 Excelsior BLVD St. Louis Park MN 55416 ty P Applicant is: _ Owner ✓ Contractor ,6 e s s h s h Reroof entire building Description of work: f� �6 - Multi -Family Building: ✓ ! No Construction Cost Y 9' ( � } ` ` Company: Xtreme Exteriors N.A. Inc Contact: Jeffrey Sigler 7722 289th Ave NE North Branch Address: City: State: MN Zip: 55056 Phone: 763-441-1334 Email: jeff@xtremeexteriors.com BC362463 Lead Certificate #: NAT -25417-2 License* If the project is exempt from lead certification, please explain why: In the last 12 months, Yes COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING has the City of Eagan issued a permit for a similar plan based on a master plan? If yes, date and address of master plan: _No Licensed Plumber: • Mechanical Contractor: Sewer & Water Contractor: Fire Suppression Contractor: Phone: Phone: Phone: Phone: 1 t�i+'o,1il� CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.goaherstateonecall.orq I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Exterior work authorized by a building permit Issued In accordance with the Minnesota State Build ode m • _• ompleted within 180 days of permit Issuance. xJeffrey Sigler Applicants Printed Name Page 1 of 3 0L0/g00'd 90 L# 91:99ZL 9102/01/90 176999L9L99:01 s.loi.laaxawa.ItX:WOlj3 PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA160522 Date Issued:03/16/2020 Permit Category:ePermit Site Address: 631 Crane Creek Lane Lot:6 Block: 01 Addition: Crane Creek PID:10-18475-01-060 Use: Description: Sub Type:Residential Work Type:Replace Description:Furnace & Air Conditioner Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088 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 - James B Mccourtney 631 Crane Creek Lane Eagan MN 55121 Genz Ryan Plumbing & Heating 2200 West Highway 13 Burnsville MN 55337 (952) 767-1000 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA176614 Date Issued:05/24/2022 Permit Category:ePermit Site Address: 631 Crane Creek Lane Lot:6 Block: 01 Addition: Crane Creek PID:10-18475-01-060 Use: Description: Sub Type:Water Heater Work Type:Replace Description:Standard Water Heater Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). Please call Building Inspections at (651) 675-5675 to schedule a final inspection. 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 - James B Mccourtney 631 Crane Creek Ln Eagan MN 55121--237 Genz Ryan Plumbing & Heating 2200 West Highway 13 Burnsville MN 55337 (952) 767-1000 Applicant/Permitee: Signature Issued By: Signature