Loading...
1864 Deer Hills TrCity of Eagan 3830 Pilot Knob Rd Eagan, MN 55122 (651) 675 -5675 www.ci.eagan.mn.us Site Address: 1864 Deer Hills Tr Lot: 4 Block: 2 Addition: Sun Cliff 4th PID:10- 72978 - 040 -02 Use: Description: Sub Type: e- Reroof Work Type: Replace Description: House & Garage Census Code: 434 - Zoning: Square Feet: 0 Comments: If there is no ice protection inspec acceptable in lieu of inspections. Fee Summary: Valuation: 3,000.00 Contractor: Up Top Roofing 3685 Rush Lake Rd Rush City MN 55069 (763) 422 -8785 Total: Applicant/Permitee: Signature PERMIT City of Eaan BL - Base Fee $3K Surcharge - Based on Valuation $3K - Applicant - Construction Type: Occupancy: on prior to final, you must meet inspector with ladder and flat bar. Pictures are not $90.00 Owner: Hilaire K Moussougan 1864 Deer Hills Tr Eagan MN 55122 -2251 Permit Type: Permit Number: Date Issued: Permit Category: $88.50 0801.4085 $1.50 9001.2195 Building EA085503 08/22/2008 ePermit I hereby acknowledge that I have read this application and state that the informa of Minnesota Statutes and City of Eagan Ordinances. on is correct and agree to comply h all applicable State Issued By: Signature .... MAw.,•. ,.. , BUILQING P,ERMI To be used for Sr Site Address 1 v v: Lot c Block 2 W Name- o Address CITY OF EAGAN Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHONE: 454-8100 Receipt # ?t.Value $61,000 D; o Name 0 i Address ~ City Phone ?a F W Name ? a Address i W Citv Phone I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Permittee A Building Permit is issued to: all work shall be done in accordance with all applicable State of Building Official - Erect ?'' Occupancy R 3 Remodei ? Zoning Repair ? Type oi Const ?T Demolish ? Depth d 6 Int. Impr. ? Sq. Ft. Install ? Assessment W t & S Permit • 00 ' 50 h I S ew. a er li P urc arge Pl i ?' ? R o ce an ev ew O ' Fire SAC Eng. Water Conn. 500.00 Pianner Water Meter 63.001 Council Road Unit 280.00 Bldg. Off. 12 6 5T r. PI. 132 .00 APC Parks Var. Date Copie . 50 Total ' on the express condi6on that Statutes and City of Eagan I Ordinances. I ?` i I ju? + Psrmit No. ParmR Holdx DIb TNophons N PlumWny . 3 ( f L H.V.JCC. Electft _ 6SO W A fI Jt c 3.? 1. . _ ?Lo SOIIME! Insp*cNOn Date Insp. CommeMs Foodn9s I Foodnysll Foundstlon FMminp RooHny Rnuqh P16p. Ra,an Nta. 3 t$•?'G 12W Insu?. Firoplace Flnal Fltp. Flnal P16y. 8ldg. Fi,.l Y6 r? ,A Cart. Occ. Dook fty. D*ck Fmg. Wdl D"cribo locatlon: Pr. Disp. PERMIT # ? ? RECEIPT # ? DATE CITY OF EAGAN MECHANICAL PERMIT 454-8100 MINIMUM RESIDENTIAL FEE - $70.00 + $.50 MINIMUM COMMERCIAL FEE - $20.00 + $.50 - ,,; ..f ,J?v FEE ?..?5 vU Sic TOTAL 1. Bldg. Type: Res ? Comm Inst 2. New Add Alter Repair 3. Total 8id Price 4. Job Address tf 'A.- Lot?Block C Sec 21/2'f Ll 5. Owner 6. Contractor -- (Nama) (5treeQ (Ciry) {Zip} 7. Contractor Phone # ? • , . ? •i RESIDENTIAL HEATING - 01-100,000 BTU's -$24.00. Each additional 50,000 BTU's or fraction -$6.00 RESIDENTIAL COOLING - 01-24,000 BTU's -$12.00. Each additional 6,000 BTU's or fraction -$6.00 MODIFICATIONS/ALTERATIONS -$10.00 minimum fee HEATING VENTILATING HOT WATER STEAM AIR COND: ?AIR PIPING PROCESSED PIPING AIR HAND. EQUIP. RtFRIG. ?? RES. GAS PIPING OUTLETS -$1.50 TANKS: L.P. UNDERGAOUND OTHER COMM./IND. RATE - 1% OF TOTAL BID PRICE PLUS $.50 STATE SURCHARGE FOR EAGH $1,000 OF FEE. Srgned: Approved Inspections: Date Rough Insp. Date Final Ihsp. r . ,. • • CONTRACT PRICE: / Z C' Site Ad ss fi 4- y Lot Block _s m Name ?e Address c City _ ? Name c Addre p CitY - TYPE OF WORK Forced Air Boiler Unit Heater Air Cond. Vent Gas Piping Outlets # Other . .. . . . ., .,'` :. . , :'_:/ , . '. .. . . . . XTI PERMIT # MECHANICAL PERMIT RECEIPT # CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE: _ ounue. weA_nInn TYPE WORK DESCRIPTION MI I 9 !? Res. New M t XFNIA = . . . Mul Add-on i C R --?-r omm. r epa ?AP ?riPrie Oth er FEES RES. HVAC 0-100 M BTU -$24.00 Phone ADDITIONAL 50 M BTU - 6.00 ADD-ON AIR CONO. 0-24 BTU - 12.00 ADDITIONAL 6 M BTU - 6.00 GAS OUTLETS - 1.50 EA. M BTU COMMIIND FEE - 1% OF CONTRACT FEE M BTU MINIMUM - RESIDENTIAL FEE - 10.00 M BTU MINIMUM - COMM/IND FEE - 20.00 M BTU I? U(, STATE SURCHARGE PER PERMIT - .50 (ADD a.50 S/C IF PERMIT PRICE GOES CFM BEYOND $1,000.00) FEE J u . SIGNATURE OF PERMITTEE ? "• ._- S/C: TOTAL• i ' ' -' FOR: CITY OF EAGAN t Lot Block PERMIT # PLUMBING PERMIT RECEIPT # CITY OF EAGAN KNOB ROAD, EAGAN, MN 55121 DATE: - PHONE: 454-8100 ? Name IIIUm Sun rlumuin y ?u. m Address 12201 nneton d V. ? c;ry Minnetonka phone 99 3-2521 Name gob OSlund 3 Address 35 1Z 38th Avenue 72 I S M OUth 4-2829 o P City Phone - -- -IFEES COMM/IND FEE - 1°No OF CONTRACT FEE MINIMiJM - RESIDENTIAL FEE - $10.00 ' MINIMUM - COMM/IND FEE - 20.00 STATE SURCHARGE PER PERMIT - .50 (ADD $.50 S/C IF PERMIT PRICE GOES ? BEYOND $1,000.00) OF EAGAN BLQG. TYPE WORK DESCRIPTION ?j. ?' ,? New Mult Add-on Comm. Other Repair NQ. FIXTURES ? W t Ci t $3 00 TOTAL $ a er ose - . 7-Bath Tubs - $3.00 ? ? LevetO?Y - $3.00 Urinal/Bidet - $3.00 / Laundry Tray - $3.00 --7-Floor Drains - $1.50 / Water Heater - $1.50 Whirlpool - $3.00 Z Gas Piping OuUets - $1.50 Softener - $5.00 Well - $10.00 Private Disp. - $10.00 =Rough Openings - $1.50 FEE STATE S/C: GRAND TOTAL• V ` PLUMBING PERMIT CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55122 PHONE: 454-8100 Phone ? Name O? 3 Address s/ ZZE:fle O CitY AE-'64RIJ Phone PERMIT # Z Z ? r'5 RECEIPT # DATE: IS 7 ? BLDG. TYPE WORK DESCRIPTION Res. New Mult. Add-on Comm. Repair FEES COMM/IND FEE - 1% OF CONTRACT FEE APT. BLDGS - COMM RATE APPLIES TOWNHOU5E & CONDO - RES. RATE APPLIES MINIMUM - RESIDENTIAL FEE - $12.00 MINIMUM - COMM/IND FEE - $20.0a STATE SURCHARGE PER PERMIT - .50 (ADD $.50 S/C IF PERMIT PRICE GOES BEYOND $1,000.00) , Other RES. PLBG. ONLY - COMPLETE THE FOLLOWING NO. FIXTURES TOTAL Water Closet - $3.00 $ Bath Tubs - $3.00 Lavatory - $3.00 Shower - $3.00 Kitchen Sink - $3.00 Urinai/Bidet - $3.00 Laundry Tray - $3.00 Ffoor Drains - $1.50 Water Heater - $1.50 Whirlpool - $3.00 Gas Piping Outlets - $1.50 (MINIMUM - 1 PER PERMI7) -1--Softener - $5.00 Well - $10.00 Private Disp. - $10.00 Aough Openings - $1.50 FEE: STATE S/C: FOR: CITY OF EAGAN GRAND TOTAL: CITY OF EAGAN Addition SUN? Owner Lot 4 Blk 2 Parcel 10 72978 040 02 street 1$64 Deer Hills 'I`rail state Fag,an, NN 55122 ? Improvement date Amount Annual Years Payment Receipt Date STREET SURF. . STREETRES70R. 7 1986 1622.20 324.44 S 4d . e?CJ CD/II GRADING 1986 502.58 100.52 5 D CO / ? SAN SEW TRUNK 1.70 SEWER LATERAL 198 582.46 116.49 5 $'*.a (p ' WATERMAIN ? S 57 --95 3.87 15 WATER LATERAL WRTEF AREA 1973 3.93 n 185.27 9.27 STORM SEW TRK ? 6.41 STORM SEW LAT 1965 . . Q Sr 73 . c? r c 0099G a . . SIDEWALK STREET LIGHT / 0- Sd ervices • WATER CONN. 500.00 BUILDING PER. 58505 s,ac 525.00 PARK GEO. SEDGWICK HTG. & AIR COND. CO. HOUSE HEATING TEST RECORD ADDR ESS ' f A i -S CITY a'? Q N OCCUPANT OWNER -1 ? HEAT LOSS DATE HTG. INST. _ SOLD BY INSTALLED BY Electrical Work Bv Gas Line By _ TYPE OF HEAT GA_ FA-4- HW_ STEAM SPACE HTR. UNIT HTF , GAS DESIGN MAKE 4' )( MAKE OF BURNER Model G I fi??? Model Serial Max. BTU Rating INPUT r(} [if? MAKE OF FURNACE Model CONTROLS THERMOSTAT ??j HeatPlug Valve ? ' r Limit _ ? ca Nl St qL Limit Setting ? -106 F Fan Setting c?ot?F Pilot Type ? j I L Pilot Make - c Pilot Model P`7 3S- L Pilot Timing - Y ?VS-? 4 n. L.W. Cut Off ` f Pressure Percent CO2 r) Input CFH Percent 02 2 Stack Tem p. Percent CO Vent Size +-=, , t 'JC KIND OF LINER ? SIZE NONE Draft Hood / ?? d c ' ' Rneulator Filters Size Number ? Chimney Location Inside ? Outside Chimney Construction Smoke Bom6 - ? Wiring ` Draft Test Tag A Door Pressure Lighting Inst. - ? Date Tested Company Testing ? Name of Tester CONVER510N Form 235 CASH RECEIPT . CITY OF EAGAN P. 0. BOX 21-198 EAGAN NNESOTA 55121 DAT _ Mcs1 rR AMOUNT $ ` S?U Q pOLLARS 1 oo E) CASH CK PO FUND CODE AMOUNT d ? ?j v U y 7 r? U`ci Thank You i CITY OF1AGAN W,XTER SERVICE PERMIT 3830 Pilot Knob _Raad P. 0. Box 29199 1 l?? PERMIT NO.: Eagan, MN 5?121 l DATE: 1 Zoninp: No. of Units: e'r- ?s ,in Const. llddrem: $its Addrcn:i'4 j''(-r Pjlls Tr. L; B2 Sun Cliff 4th Plwnbar. 'r', Meter No,: -370/k;LY3 fon Charoa: 500 .(?Opd tff Size: " o r?{?It: 15.000d 479 Reade Na.: ?j1j$`'?, ?tC. 10.00pd I yM fo aosn* wilh !be ??arye: . 50 d !b 04i?o ?Y? , 132.00pd TI' -TC63.00nd meter date Paid: Dute of Inap.: leap.: CITY OF EAGAN 3830 Pilot Knob Road P. O. Box 21199 Eagan, MN 55121 Zoning: N/1.,??r: . .dA vwriv - ,Address: :Site Addresv ?Plum I ym te emPip wNb !Iw CiFy ef Eessn Ordt"saa. By Dote of Irup.: SEWER SERVICE PERMR PERMIT NO.: DATE: No. of Units: wit$ r• c.a,n.ction charoe: 1+?5. nrpd AcaouM Depodt: PermR Fat: SurcharQs: Misc. Chorpes: Totol: Dab Paid: White-Payers Copy Yellow-Pasting CopY Pink-File Copy m id .J I? 7-ly 6 L ? Nowili orI ;5jCq,icensed Electrical Con4ractor I hereby request inspection of above n Owner electrical work instailed at: Street Address, Box or e No. / C ity L ? C Ff-fW? ection o. Township Name or No. Range No. Cou OccupA t (PR ? M Phone No. wer Supplier Address ? •?7`-1' ?CJ ' AZCJ,• 7i?f''l/?rp • Eiectric on actor 1 ny Name) Con rac? s license No. Mailin8 Address (Contractor r Owner Making Instailation) 2 s3; Authorized Sign ntrector/Owner Making Instal tion) Phon// , b?6r? 3 MINNESOTA STATE BOARD OF EIECTRICITY Griggs-Midway Bldg. - Room N-191 1821 University Ave., St. Paul, MN 55104 Phone (612) 297-2111 THIS INSPEGTIUN KEUUtsI WILL rvV 1 BE ACCEPTED BV THE STATE BOARD UNLESS PROPER IPISPECTION FEE IS ENCLOSED. REQUEST FOR ELECTRICAL INSPECTION EB-00001-04 ' See instructions for completing this form an back of yellow copY• QOD ?78 X"' Below Work Covered by This Request d NewlAdd Ren. Tvnw n1 Buiidina I Aonlianewa Wirwd EqufpmBnt Wiied I M Fee Service Entrance Size tF Fee Feeders/Subfeeders N Fee Circuits 0 to200Am s 0 to30Am s 0 to 30Am s Above 200 Am Psl 31 to 100 Amps oe 31 to 100 A S Swimming Pool Above 100_Am s - Above 100 m s Transformers Irrigation Booms Partial h r e Signs Special inspection g S TOTAL Remarks nvugn-in vnie 1, the Electrical Inspector, hereby certify thet the above Final nspection has bee. CITY OF EAGAN • ? 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 NO p 11398 PHONE: 454-8100 ?p? D? BUILDING PERMIT ReceiptN Tobeusedlor SF DWG/GAR EstValue $61,000 oate DECEMBER 20 1g 85 Site Address 1864 DEER HILLS TR Erect ? R3 Occupancy Lot 4 Block 2 Sec/Sut. SUN CLIFF 4TH Remodel El Zoning Rl Parcel No Repair ? Type of Const V . Addition ? No. Stories OSLUND CONSTRUCTION Move ? Length 43 ? Name ? V O Demolish ? Depth dA o Address Ci Int. Impr. ? MPLSP 724-2829 ? Sq. Ft ry hone Insfall a o Name SAME Approvala Faes i 0 0¢ Address Assessment Permit • 00 " Ciry Phone Water & Sew. Surcharge 00 a ? W Name ? ? Address : a W Ciry Phone 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 an#-QiLx of Eagan Ordinances. Siqnature of Permittee?? A Building Permit is issued to: ?U..u ?.v..o ??..,. all work shall be done in accordance wit { ble State of Building Official Police Flfe _ Planner Council Bldg. Oi Plan Review ??00 SAC Water Conn. 5 0 0. 0 0 WaterMeter 63.00 RoadUnit 280-00 Tr. PI. 132.00 APC Parks Var. Date I Copies Total $2.004.50 on the express condition that StaJyLes and City of Eagan Ordinances. This request voitl 18 rtwn[hs from d C(' 17C; 7R / Lti I?, "l F,. ?tj?i.l?r ? 4 /C% - Pzq?es?Ja t ?- Fve No. - FouPh-in InsVect_pn Required? Reatly Nuw ? Will Noufy InsOe?- / ? ? ? ?p ?Ves ?No tor When Heady &Licansed Electncal Convactor I hareby requast ins0eclwn of above rl n,.....,. electrical work installeA at: Stree[ Address. Box or Route No. I l, `+ k) I L zs rt- ?. C'ty EA?c, A k- ecLOn o. Town5hi0 Name or No. RanBe No. CounlY A C. L ? (Y-? Occuuant_ IPR?TI l/ I ? Phone?o. ? ?? 4 - Power SupOlier Adds Electncal Con(ractor ICompany Namel 1 Conttacmr's License No. 14 V vL? -rz ???r, -rb ra? m o Mailine Address ICo?Vactor or Owner Making Insta?l Lonl IL1313- Lf-)-c? rnpu-ri) YY1lv? SS11 `i1 Author¢ed Signa[ure Convactor/Owner Making Installat on? Phone Nu ber S ??53-- 1(X? _ MINNESOTA STqTE BOARO OFELECTHIC7TY, Gn6es-M,dway Bldg. - poom N-791 1821 UniveraitV Ave.. St. Peul, MN 55104 Phone (612) 297-2111 BE ACCEPTED BY THE STATE•00AFD UNLESS PAOPEP INSPECTION FEE IS ENCLOSEO. REQUEST FOR ELECTRICAL INSPECTION ea-ouooi-uo ? ?3-'?? See msvuct.ans br com0le??9 this lorm on back ol Vellow copy. /P ?l 7 C-7 O "Y" Rnlnw Wnrk Covered by This Request ? J P J I V ? ReO. TVOeo. 3u??idmg AAA Homf'. - - Eqwument Wired Aoa??ancea W??eA Range Temporary Service Duplex Water Heater LighLny F?xtures Apt. BwlAinc? Dryei Electnc Heatin Commercial Bldg. Furnace Silo Unloader Industnal Bldg. Air CondiLOner Bulk Milk Tank Farm ?her oem y iher ISOnciiyl t .r ucufv ther omu? Com pute lns pectlon ree tteiow M Fee ServicaEntraneeSae n Fee Fexdes?5ubleeders U Fee Grcwts D to 200 Am s 0 to 30 Am s Q tn 30 Am Above 200 qmps 31 [0 100 Ainps 31 to 100 A s Swinnning Pool -Amps Above 100 O ?y ? ' ? IrngaLOn oms par Ot her Fee al. Transtormer5 i.. ?..,? o??e ----- ' 1?? iuiaL rc(/ vdi Remarkry '? . A r" i1 n T M_ i il Q• w ( (C. L. r IL Roug?-in ` Di1e I. ihe Electncal InsOecloq M1erehy certily thet the ahove Final ? ? insoecvon hes baen da . Thn repuest rm01B moncre rmm L?%V V V a?NOTE: Z ?- 1985 BUILDING PERNIT APPLICAYION - CITY OF EAGAN ALL CONTRACTORS MUST BE LZCENSED WITH THE CITY OF EAGAN C0141ERCIAL 1' INCLUDE 2 SETS OF ARCHITECTURAL INCLUDE 2 SETS OF PLANS & STftUC1'URAL PLANS, 1 SET OF 3 CERTIFICATES OF SURVEY SPECIFICATIONS AND 1 SET OF '1 SET OF ENERGY CALCULATIONS ENERGY CALCULATIONS $2,000 LANDSCAPE EOND ur Date: ? 2?;•?&yy' To Be Ud s For: Valuation: o oa aL o Site Address OFFICE USE ONLY ? y f-? A F i o nf Lot ? Block Parcel/Sub -'''ear.\. G/i/?/` Owner Address Cfty/Zip Code Phone SINGLE FAMILY DNELLINGS Contractor eS Address City/Zip Code /?T? /?' ,- /L/'t i-ril i Phone :z 7-- L-Z8'zC'7e T-fqo Z Arch./Engr. Address City/Zip Code Erect X Remodel ? Repair , Addition Move '- Demolish ? Int.Impr. _ Znstall ? APPROYALS Occupancy Zoning Type of Const IJ of Stories Length Depth Sq Ft FEES Assessments Permit ? Water/Sewer Surcharge Police Plan Review Fire SAC Engr Water Conn Planner Water Meter Council Road Unit Bldg OffJ,t '"Treatment Pl APC Parks Variance Copies TOT6L ? Phone ll 2q- x qo, - q(oo 2o x 22 ? ??a x sta - x (?- - ssG8v g S2 8 c? .?? = . ? .a '- --- I ; r? . . FORs Robert Osland 0/ Y" NOTE: G Denotes Wooden Stake Proposed Garage Floor E1.= wS•9 ( qoy, & ) Denotes Proposed Finished Ground E1. --ds--- Denotes Dizection Of Surface Drainage Vertical Datum - N.G.V.D. 1929 (9oz. \, 2 0;i;vy Or°`nOLJle go r , , \ a a? ?Q a= ? ? ? Y ' •? b ? og2 ?` ?o ? r ?\ ) ? .. *1864 DeerN;ll; C. R. WINDEN 6 ASSOCIATES, INC. LwNO SUavEYORS Ta1. $46•3649 1361 EUSTIS iT., fL ?AUI, MINN. 66106 Scale: 19-30' e Denotes Iron honument Bearings Are Assumed ent EOSety" ' ? ` Zk -v ? 901.9) Lot 4, Block 2, SUN CLIEF FOURTH ADDITION, Dakota County, lfinnesota. WE NERE&Y CERTIFY fNAT INIS IS A TRUE AND CORRECT REiRESENTATION Of A SURVEt Of TNE {pUNDARIES Oi TME IAND ASOVE DESCRI6ED AND OF ?NE IOCATION Oi All {UIIDINGS, IF ANY, TMEREON, ANC All VISISIE ENCROACNMENIS, If AN1', iROM O! ON SAIC lANO Ooted eAis -5t- b der of-,cyevcmbei A.D. 1991'5 C. R. WINOEN 8 ASSOCIATES, INC. &-.A6 br Zwr.qor, Minnewta Rpistrolien No 772G . ?. • ?• . • . • .. . ?? . - • ?. . ? ? 1 ? . . W. , . .. CZTy pF EAGAN.. ... _ '. . . _ APPLICATION FCIR PERMffT SEW.R AN7/OR FATER CONNEX.TION '- .. ?r?? _- ?, •,. - -- ? - --- - .- _ P?tOPERTY-ADDRESS: •°?_?4?64 D:eerH?i 1.PTsease?TraPr?i= utt t=,._ `IAEMAL DESCtIPTION- - _ ;- . ... ....<. _.: .. ?. . , _. ,- _ : .: , „ ... ?. . . .'? ?.,.x Lot oc vision or. Tax Parce I.D. Nuaber)_.. _. ..:-?_ . -- ' IF EXISTING.STRCCTURE;y DATE OF ORIGINAL BUILDING PERP1iT ISSLANCE:?`=° ? . . , ?. Mon Year ...y: o..- - . .'. ?s?:.,?T?' ) •-? ,....... PRESENT ZONING/PROPOSF9`?USEs.'::;:- R-3:::SINGLE FANIILY "t R-2 DpPLEX (7tao Lni.ts) -- - - R-3.TOhTgiOLISE (Three + Chni.ts) ( Units)'-'.' . ? -R-_e4PARRMENt/COPID(kUNiCT1 (7- '-? ?:. ., .. ... LTnits. ? , . ? .???.• _tyja????• ??1? .?tin1`?:, rAI??'+? q?;i•.'ti?':.Y.`?1AL?av.+iL1iTTy /py??'??{ Y/Oy??/?p CC1l•-• '?X?i..T?,Y.?'?•_'?i':?` d?t.'• ?y.-'m.. ' '??'`1 ?? x..' ..'f µ"?` :r.`•'? ° tig? kt'.?? ??/?p??} '?< . ?>?'., w ir Nr. ? t•.: ?i c1c'r. . ?Y.`;?'"n v.tl.?+f'_'?' :?TfTL?L1JTrt1f1\1L?fLT1L!j-,.} ? .4?`3'3'? , c'i?r.?.G? A.??ic';?,' •' 1tV111?.'1J.??L?C?/?? - - ?-Y"? •? _ .?`ir? . r3.?' -F " ,?{J?_ - T ^y-. _ . :'a?us° ? Y??itY - • K' ???NG'n5'?, a-: _ . . ? 1. . _ .?i,.. .. . . . . . a ., - ? . . .f°:llS?di'?W,WU'.`'}? 't - ? `; .:d? :?t?? i . '.' •' , 't „ ? ., ?J. -. _ ?'-r;•`-- :?.?=?:; r?:'? ?ka?i:b'gx?o-s-lund:_-:.?-?,rt.::..-. ... :,.?? - ., ?? .;; ??=?., - ? "`'•`S=_ ? . r.. , ?;? ADDRFSS:._,' ;35W38th 11ve'riu?64;S'outh --i,,? • , y'w+1?;si%,S' . •- CITSF? •. STATE, ZIP 5 4 0 6 ^+`s: -' '\..` - y 1?1. -.y?• -i?r?iN? . e.`'` ?''W.'z', . V •'\ ! . }?{,}/???1 'l}iI"? . C11VLYlY •'.? ri?.?"?".. _ F'Or'CI.t17' USE:- : ._s:,-- - --,=?-yTTHOMPSQN PLUM@4N6 COMPANY plwnbers,License, . _ _.? .: - _ , G: _,,.a. • - -..?. ;.. ., ?. ? ,.:. . ppDgEM:°_ - ? ?,i'2201 =MiFlrtetonka Blvd. RCtiVe - :.:.. -?CiTY,,STATE, 2IP-=°- ?-?..?:M-innetonka,MN -55343 -earEkpixed;: w;, Q NotcRecarde r?. -- pHp1?]E;:?: MASTER LICIIISE # ?.? ,,rs' S?'tl.? - :?^`.'- •- ' .'.,z.rfi?.:?.::_ - =?t'_-y?i;.;sh.:. _ =tl:?i:'-,?,'+?"?¢,3:fi? :?.r. ,. ; d.p?l:s','a..n ... . .. . "' _ ' " - ?. 4): : ?_[''a7it"i?Jr?i.?7 :.Y.,`-_:?.•M . :-?.. . . -,.,?:. ":-,- ;'., _?` "?..'s ?= NAME • '<. _ . ?:,- ? -. `,'.:,t,?i" ? :, .. .. ._ . .. , ._. _ . __ , ..... U`_?'?t??;C\ar- _ ? -;5; . :,.,. „i!?js . -?5. , µ -=d!?-d i -µ?-. ?"`C "' - ? '--^,n;y"> ?s:a°-?c•,-` °?'.?'?: ? g vr,"•?'?+t' ? )?'-?H.?'i??+eds.??? -.^lFw:': ^R-?12'AJA`!'4'?'R}'i.:6f`,'?. ? irt+{i4'At'?i'f A -1 -i.??ftM ??"?y.i?E.kJsm?2":.. D?.5: _ . . . ?_ - QTYSTAT'E?..ZIP':?: , - - - ...5?? . ? - ?}/??? ,.-. t_ .:: .. u.._.. . ?. _. CI3VL`IGi? 1 ..r..w.+..? .... . ? 5! .. ... - .. ?.ri?.Y:g.x 5) .. u • ?• • ? - . . - - -?'=t:i.?-; , -- _. _ __ _ - - -: ,- QTY Fg1TER LFON[?7C'PION TO CITY SE;V?R f2yCUiX.TION 1V ?., -' OTH ._, , .._ ?_.. ERR: (Please Descrabe) Fx_F? ; `.., 6) u • ? ? ? PI.EASE HOLD APPROVID PEOffT FOR PIQC-LiP BY ONE DF_ ABOVE - Q? PLEASE MAII, APPROVID PERNffT 30 1. 2.(V4. ABOVE (Circle one) , . 7 ) ? ? . . :r; .._? nwi?#4,g:;'.tr'.:..-^.' , '.??!f: _. . _ ',L:' ;'ti? . . ?i;?>+?VMGa?''•.±i: ???. ?.::'. ? , ..,.. . ._^-r;:?..p . :,, n ii?.?: " =°i?? ...'.. aip-K., . ? .i,.,b-3. . ... . . . ?* ' •:9- .as - , . . _ .. _ ' `? " _ +x. :m;j?,?'.a.. .r y.+c. " ? F ?? • ? ? L. ' F O?R C I T Y U S E. ON. + , Y :,??;. • ?? ? ? ? . :t .,..:,.,. . - ???,:?''?:? .?, ;<: ?',?,;:r:s•,?i?a-:•..? . '<`.P-?:c ?.•' ,.wY :? ''?`'`- ?' - ? .?.^? ?1?`c?,...'n?l'. .x-, . _ 'sx:a;41'.a ?n•."'" .?c .i,^ = PERMIT ,, = ISSUED ;'Cn ?`'Yn` ' • •?Y'? _??'{7 , -. :(:`" ':?^>: ?rj4"?Y_ . ?l.Lw-?YFF?.: . ?.?,.N?e-i ??. :'.?? l`, 4 y ? 'I?..i;r_y . . _ „',r ? ? •.. ^ . -- ?y?? j<?Q??`? ?. ?. •? -?y???.. ?? .1? '? `a''e:' :iC' ?..,,,?:r;::?.'.: _•,.:?'i'7,-,'a . . _.?,'?';:,,' `M .a?-, ' ?,.r?,*';? . ."'?'?s ' ?•?' . ' •' Y. : - lai` ,M?,.•i.,, ' - t .ji$.?? ???,?.51: ??" ' . .. e ' ''?.;'e' ??2?, '" c? ;uy ?G??•??I F..?....DS: :.'.!??'?s.':r•" r ' .S?'..1vER T- ? .no4,.1 ?IT (I.I?CL;iDE o i-UP.C?:t?.RCc) ?.,?"-?z" ;'. - -•. _ •-, ;'?x,'.'r??': r,_`-:- ":? ;-4=!ri-? ? rC' ` e???:? . ',<±k,wr,>?::.,.,5 • °rJ?"- i ??`;,:_' ._??..?_<WATER; PERP4IT (ZNCL'JDE SL'F2CFIARGB) _.x„?ytb€' •:-:? ?;;.] .„>.Yi1.'?`rk_ri. ?WATER METER/COPPERHORN/OUTSIDE READER. -.iWATER T ., ,_.: .. ;?-r. --? • ea: $ ` _ <,::. _ ?^ ? _,:; •.,, .• -$ AP (INCLUDE CORPORATZON •'r??- ? '=?s?s:b?alr.i+u??-a...t^' '?1.?'?.fi-W ,?g:`???.a?...- r. SE;dEF'..T?D. - - - •..?*`ACC N? OU T'DEPOSIT - 47ATER'-_ •_ ', ,: "??.? ..qs _a " . :f'L. :•.r?. ,?, ?.. "'? ?";??"- ?:. ?S - ??'?r,c7`.`???, • `wac z°:`t.::. :v _ . ... :,?v?::";, ;?`; - •_?. S AC ? ,. ,?µ...n.?.?._. ...i .. . . 4r,Ix??v.i`. ?uN.•;.. ? TRUNK S4ATER ASSESS.1£P7T TRli:]K SEWER ASSESSiIETiT LATERAL BENEFIT/TRUNK SE::TEQ ? - $ LATERAL BENEFIT/TRUYK SJATrR s i?3a, r ? ' $ _- -- - WATER TREATMENT PLANT SURCE3ARGE _---- OTFIER: ' ? . .. . $ TOTAL:. . -. . . . ?.,,S,T. " _ .. -??.,•-- w _- : $ 4 AMOCNT PAID/RECEI?T ,?.. , . "0 . . ':' .. ? ` _ _, _ -a ? ' :?"•:'' ?z?' _ ' ' ; ry : ` • = ' _ •: - --- . . _, . ., _..:: . ` ...... - - - -- - g.. ... ?, . ?, . L .` : ? 7 ?-D • .? -. .??.'DDES UTII,2TY ? • :._ . - .... . . ... - COHNECTION REQUIRE £XCAVATiON iN PUBLIC : .,: _ .:_, ._ :: :. , RIGHT 9F - -_._.?.a . ? . WA t? .. -..- . YES IF YES. THEN A"PERMIT FOR 'AORK WITHIN`?3?-; '?"?`?i' PUBLIC ROADWAY" MUST BE ISSUED NO ? 3...a BY THE .` ?'L `??-`7^•..,..??; ??: ENGINEERING DIVISION. LIST AS ' ' ` A CONDI- ,?:.? _ ?s, " :? t ' _, ::TION. - •- _ ;- ' :*?'"s? ."`? , • , . ? x `:?, ' ?,y?i z+ ? 'G."r .m.n'y l •_i •-' i,:.?..;._, SUSJECT TO THE FOLLOWING CONDITIONS: . . - _ _ . . _ , .: P - .. _ .. . . . . . _ ? i. ??A,5"= ? - _ Y. APPROVED BY; /, )6_,4.,, , ; . TI:LE: DAT=: i HEAT LOSS CALCULATIONS V l' e , ? T HEATINGBAIR CONDITIONING CO. -</?, o 7s1 MINNEAPOLIS, MINN. WeathersTrips A.S.H.V.E. Consbuction No. Insulation Windows Doors Guide Neferenca Out. Wall Int. Wall Ceiling fbol Floor Kind How Applied Yes-NO Ves-No Ig _ F1•/_J //Y ?- Roorr+ LenBth Width 1 Helght FI ? ?oan LenBth ?- 61 Width ZHeight YJindows and Dows-Crackage and Area Windows an d Doors- Cracka ge and Are a Na. of ane NeiOht of Oene No. o/ h hts L,neel It. o/ crack Area s. IL ,? A ??? (f' NO• W?drh o} Hoipht of e No. oi Ii hta Lineel /l. af a k Area s. It. 07 O / ? ?, ?? 3 G ??- C //1 7 Coef Btu Coe( Btu inriaati«, 7 Innie.acia, I/ Glass' S' o Glass ' Ezp. wall -7.? Exp. wall Net exp. wall Net exp. wall 7 ? Int. wall Int. wall Ceiling Ceiling , cin Floor Floor Totel Btu. Total Btu. (! ? Requued sQ. 1t. E.D.R. or Sq. ins. W.A. Leader area Required sq. It. E.D.R. or sq. ins. W.A. leader area FI, ?. J Room Length Width HBieht FI. ? v Room Langth Width ? Height Windo s and Doors-Crackage and Area Wi ndows a nd Doors- Cracka ge andArea No. W?A?h ol a Meiqh, ol ne No. o} h hls Lineel }I. oi aeck Aren sa. h. NO' W.Ath al er?e Hwyht nl ann Na. of h hte Linea? It. ol Cretk Aree •.??• ..?3 Coef Btu Coef Btu Intiltretion /Y fy/ " Infiltration AJ` Giass /?/s 36 Glass a U Exp. wall Net exp. wall ?,S Ezp. wall Net exp. wall 14 ? Int. wall Int. wAll Ceilin9 CeilinB ? Floa Floot Totel 8tu. Total Btu. Required sq. tt. E.D.R. or eq. ins. W.A. Leader area 13 Room length / Width ?.Q Height FI: Required sq. ft. E.D.P. or sq• ins. W.A. Leader area FL '? Ropn Length ?Width Heipbt Windows and'Doors-Crackage an Area W indows a nd Doors -Crack age and Ar ea Nn. W?d?h of e He-qht of nn No. of li htn lmeal ft. ol Oack 4rea s4. It No. W?tlin ut ane I/e?qht uf nne Nn. nl b hIe Lmeal f4 af Cretk Area 8./I. . an q OC, a/?? • ? Coef B W Coef B tu Intiltration L.? ? InfiltrAtiOn Glass ' ?? ,5 ` O Glees Exp. wall Exp. w»II Net exp, wall ? ? Net eKp. wall Int. wall Int. wall Ceil?ng ? Ceiling ? _ ? ? Floor Floor Tutal Btu. Total Btu. J? V Required sq. It. E.D.R. or sq. ins. W.A. Leader area Roquired sq. 1t. E.O.P. or 6q. in5. W.A. Leedar area ?6• HEAT LOSS CALCULATIONS HEATINGB AIR CONDITIONINC CO. MINNEAPOLI5, MINN. Weatherstrip6 A.S.H.V.E. COnevuction No. In6uletion NTinrbws Doors Guide Reference Out. Wall Int. Wall Ceiling Roof Floor Kind . How Applied Yes-No Yes-No 19__ - ?L _/,4?"Roam Lenq[h QWid[h 2,5 Heipht FI. Roam Length Wid[h Height YJindows and Doors-Crackage and Area Windows an d Doors- Crecka ge and Are a No. W'd,h af ana He.ph1 o/ ene No. of li hts l?neal fl, af crack Area s. il. N?' W?tl?? of Bne Naipht o/ ene Nn. of li hIS lineel h. of oeCk Area fY. ?I. 3 2c 3 / ? ? coee ew ' cae+ et° lnnltratim 6 Glass ? Glaes Exp, wall Exp, well Net exp. wall Net exp. wall Int. wall . Int. wali CBiling Celling Floo, o°L.S pG'? Fioa Total 8tu. Tpta1 Btu. Required sq. ft. E.D.R. or sq, ins, W.A. Leader area Required sq. it. E.D.R. or eq. ins. W.A. Leader uee Fl, Room Length Width Height Ff. Room length Width He Windows and Doors-Crackage and Area Wi ndows a nd Doors- Cracka ge and Ar ea ! No. W?4?? of ane Neiqht ol ana No. ol li hte L neal It. of cr ck Aren sv ft. N?' of ane Nx?O?? ?f nnu Na. o? L?neal /t. of cr k Area s. 1t. Coef Btu - Btu Coet Infiltration Infiltretion Glass Glass ' Exp, wall Exp. wall Net exp. wall Net exp. wall Int. wall Int. wall Ceiling Ceilinp Flobr Floor Total Btu. Total Btu. Required sq. It. E.D.F. or sq. ins. W.A. Leader areo Required sq. tt. E.D.R. or sq. ins. W.A. Leader area FI. Room Length Width Height FI. . Room LenBth Wid[h HeiBht Windows and Doors-Crackage and Area W indows a nd Doors -Crack age and Ar ea No. W?Ern f Harp?t e , A No. of li h Lineol ft. DI aaCk A•ea It Sp No. ul ve?ne ufDnn Nn.hta Of cr I k s 1811. o ane n o t! . , Coef 8tu COet Btu Infiltration Infiltrntion Glass Glass Exp. wall Exp. wnll Net ex0• wall r Net exp. wall Int. wall Int. Weil Ceiling _ Ceiling Floor i fl(ux I Total Btu. Required sq. f[. E.D.R. or sq. ins. W.A. Leader area Totel Btu. ' RoquiraA ep. 1t. E.D.P. or sq. in5. W.A. Leader are9 Use BLUE or BLACK Ink For Office Use S~ City of Eanon I Permit#: Permit Fee: 3830 Pilot Knob Road I ? I Eagan MN 55122 Date Received: Phone: (651) 675-5675 I I Fax: (651) 675-5694 I Staff: I I 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Unit Name: ~erlc_e_ M--0Q 3., ,cQ!J Ck n Phone: Resident/ Owner Address/ City/ Zip: t_K t o Cl beer ft c ~ I S +rCt_ r Applicant is: Owner Contractor Type of Work Description of work: I`~ - Iw C7 Construction Cost: Multi-Family Building: (YesO / No ) Company: P P Contact: I& 7(.3_V,?Z°J7r.SJ' Contractor Address: f~a gS e-vs LIB City: JZu<V,. d(Olt State: ~-w Zip: S ~ Phone: License _9C1 u. C1 r Lead Certificate If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? _Yes _No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contractor: Phone: NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets. 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.gopherstateonecall.org 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 Building Code must be completed within 180 days of permit issuance. x__U It it x Applicant'sPrri°nted Name Ap licant's Signat e Page 1 of 3 PERMIT City of Eagan Permit Type:Building Permit Number:EA119095 Date Issued:11/14/2013 Permit Category:ePermit Site Address: 1864 Deer Hills Tr Lot:4 Block: 2 Addition: Sun Cliff 4th PID:10-72978-02-040 Use: Description: Sub Type:Windows/Doors Work Type:Replace Description:Two or More Windows/Doors Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings, call for framing inspection. Call for final inspection after installation. Carbon monoxide detectors are required by law in ALL single family homes . 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 - Hilaire K Moussougan 1864 Deer Hills Tr Eagan MN 55122--225 Renewal Andersen 1920 County Road C West Roseville MN 55113 (651) 264-4777 Applicant/Permitee: Signature Issued By: Signature k�. ' � � Use BLUE or BLACK Ink ��������� fi' � �: , � For Oftice Uss j . ����Clt .:of��E�a a� � ��-�-�'� � I Pertnit�k: . . � �"`� ' .1 � PertnR Fee: . 383p Pilot Kn'ob Road � � Eag'ar1 MN 55122 . I Date Received: � � Phone::(651)675=56T5 � � . . � StatF � � � �f ax:�(651).675-56 s4 i . �.����������������J . . 2p1�4 RESIDENTIAL PLUMBING PERMIT APPLICATION ' Date: Site Addreas: � Tenant: ' 3ulte�: ���w,��;-���� �r,: � _� /� y � � �� ����� �� t1� P ����� �� r���Re'sld�enUOwnQ� ;�� �Name: u- �� �� hone: �l�" . �� ���' �t� ��' 5 � �/ / w�� ''���� . �� �'�4 Address�'City/Zip:� 7�� + l ,�J [, � �- I�l f�°� �z,� . ��,������h°�� � ' . Milbert ompany Inc dba Cullign Water� ����3�,����a�Y x �� Name: .. ucense#: WC643176 ,��� �-.� a��. � ;. t .. . �:����°����, � �� Ada�ss: 180150.. Street East� �;�,. Inver Grove Hgts. ��� ��Contcac o � �� � ����'��:: ��¢�q � State:. :M N. zip: 55077 Phone� 651-451-2241 � .. �,� � r. � , . ����s��_ ��. � • . . . . , �������"� ��' ���; • � �� � ������ x ,. �.� .co���:. Wiliiam� R:�Milbert Eme��: � m ������ � � . ��� �`�:����`��� s _New �Replacement _Repalr _Rebuild _Modify Space Work in R.O.W. � Typ.e�of�y�l,o� �� : . — � �:�;' ���";�f ���'� ...� ..�, Description of work: � �x,��'�'�« ���, � �' RESIDENTIAL ������.., � � '� ' ' � ���� �_', ��'�; Water Heater ��§ �r,�� �� � • �Water Softener ��-. � �,�� � Lawn Irrigation(_RPZJ_PVB) 'Pe`rmi T<< s �';t�;� ���� ��� � � Add Plumbing Fixtures�Main/_Lower Level) ���� �r������ � Septic System �� ���� �`�, r} , New Water Tumaround ���� � � ��'�t ��- ' � ��,�"�+�� ��.�°s � ADanrionment ::RESIDENTIAe.:.�F�ES:� �� -:�6Oi00 YVa4er Fleater;;:llVater Softener,or Water yeater and Softener(includes$5.00 State Surcharge) ' :'$60.0.O��t;awti��lrr'i�ation;(includes$5.00 minimum State Surcharge) �$50:00.Atic(.'f��ut��iing�Fixtures, Septic System Abandonment,Water Tumaround'(includes$5.00 State Surcharge) � �:. :"V11ate.r'fiumaround(add$200.00 if a 5/8"meter is required) J�1 t5�.00:�.5e`ptiC.SV§ferti New.($10.`00 per as tiuitt)jincludes County fee and$5.00 State Sutcharge) �� � � - �� � ' � � TOTAL FEES 3 �`CAL`L:`BEF.QR��:Y�U DIG. Call Gopher 3tate One Call at(651)454-0002 for protection against underground utility damage. � 'Call 48.fiours"bYfare'you`intend to digto receive'locates of underground utilities. wvvw.aopherstateonecall.om i�:li�rebq eckhowled'g0`ftiat this infcrma:lon fa compiete and•accurate;that the work will be in coniortnance with the ordinancea and codes of the City of . E�agan;:ChaY-I'undersra�id:thfs is n�t a,permi� but ony an application tor e.permft,and work la not to start without a permit;that the work will be in ��accortlance;�ritkC.:fib.Va�ip[oyed plari:in the caae of work.which requirea a roview and approval of plans. t .;'� �.U',�.��� �t�2���?���- X � � �Applicarit's`,P�inCe;d;Name � Applicant's Signature k ;a , �3 ` .�M r:� s � � �R O�IC 'g � � �� ` ��ry ci`°` ate � . ��,� ¢��' �� �r��'�+,' � �,. ,��� .n ��' 1�+*H� 1 - � �,� � k: .. •J L • . � . "�d.. Reqwred�lns;�e �ig�s �r��"�%.� ey Q4i: � � �:P±f. �. ,r .��������'�� n�� :a� � r � � '�� �M ter- elate'`°�z Iterfis- �f� ' � � , _ ����.v.�.� �� M�t i�,� ,�'. Ra�i , � a � ���,,�, �>� � .�w.t. -� . w . .. . , PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA156079 Date Issued:06/14/2019 Permit Category:ePermit Site Address: 1864 Deer Hills Tr Lot:4 Block: 2 Addition: Sun Cliff 4th PID:10-72978-02-040 Use: Description: Sub Type:Residential Work Type:Replace Description:Furnace 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 - Hilaire K Moussougan 1864 Deer Hills Tr Eagan MN 55122--225 Haley Comfort Systems 4320 Hwy 52 N West Frontage Rd Rochester MN 55901 (507) 281-0138 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA156402 Date Issued:06/27/2019 Permit Category:ePermit Site Address: 1864 Deer Hills Tr Lot:4 Block: 2 Addition: Sun Cliff 4th PID:10-72978-02-040 Use: Description: Sub Type:Residential Work Type:Replace Description:Air Conditioner Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State 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 - Hilaire K Moussougan 1864 Deer Hills Tr Eagan MN 55122--225 Haley Comfort Systems 4320 Hwy 52 N West Frontage Rd Rochester MN 55901 (507) 281-0138 Applicant/Permitee: Signature Issued By: Signature