1281 Dunberry LaneCASH RECEIPT i
CITY OF EAGAN
3830 PILaT KNOB ROAD
EAGA,N, MINNESOTA 55122
DATE 19
Receiveo - FROM
AMOUNT $ I
E] CASH
,i0-CHECK
j
& DOLLARS
?oo
White-Payers Copy
Yellow-Posting CopY
Pink-File CopY
Thank You
B Y , <' i
BLDG. PERMIT N0.
/
01-3210 Bldg
. Permi
01-3422 Pliin•Ch*O-ck
01-3445 Surch./hdm,
01-3446 SAC/Adm.
01-2155 Surcharge
17-3860 Road Unit
20-2275 SAC
20-3865 Water Conn.
20-3868 Water Trmt.
20-3716 Water Meter
20-2252 Acct. Dep.
20-3713 Water Permi
20-3743 Sewer Permi
79-3$66 Sewer Conn.
11-3855 Park Ded.
TOTAL
\
-?-
.
4+ ?
CASH RECEIPT
?
?
CITY OF EAGAN
3830 PILQT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE
? .
AMOUNT
t
8 DOLLARS
,ao
O CASH p CHECK
wR ? l.C_.,Iri.
. /
FUND OBJECT AMOUNT
-7. v
Z ? ?, ?] ?I 3 t o o ??
? I y??? U 2
Thank You
BY
White-Payers CoPY
Yellow--POeHng Copy
Pink-File Copy
BUILDING PERMIT
Receipt #
N2 13305
:- D4VG/GA? $ 1 56, U Di) 4 d 7
To be used for Est. Value Date
SiteAddress ?=``i 7UNB: RRl Lid Erect ? Occupancy 't3
Lot1 ) Block 1 Sec/Sub.Ql1!:S '.?`lAR 4 TH Remodel ? Zoning K1
Parcel No. Repair ? Type of Const y
Addition ? No. Stories
Cc
W Name ::'i"i & JOYCt: TOLL ERUD Move
li
h
D ?
? Length tsU
th G G
D
? .., C, ')d r ? 7 7 mu hvL, cr
? emo
s
- e
P
?
,o
o?
uQ
?
F W Name-
? n Address
i W Ciry .'.?;
information is correct and agree to
Signature of
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
? Police
Fire
.
Eng.
Planner
?
Council
nd state that the gld Off.
I?able State of 9'
Var.
Surcharge 79.00
Plan Review 338.75
SAC 625.00
Water Conn. 525.00
Water Meter 67 . 00
Road Unit 305, U4
'
Tr. P?. 180.00
Parks
Copie
T,,._, ? _ , . z 5 i
A BuildinPermit is issued to: '%V1;:2ETT & JOYC? '`ULi,;RUJ
9 on the express condition that
all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official
I IpwmN Mo. I P.rmn Now*r I Da» I TN.ahom r I
Inspection Dab Insp.
Footlnps I
Footinps 11 f_xx-a(
/-.V
-12-11"TG' 6'7'L -
Rough Pibp. ' -.ff
RoughFlt9• /7..fX /:.,Ll
Htq.
Plbg.
Dlsp.
a? ?.,?(?,. _
1
^
• 14014
e A,
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
?
BUILDING PERMIT Receipt # -
To be used for } 1.12E: Est. Value Y 1*` ?? Date 19,
? ?
Site Address 1'•s3 ?:?t';?;'s? :?::)' iN ?
Lot Block ? SeGSub. t'llf5 ?`?H=< ??= OFFICE USE ONLY
PafCBI NO, Occupancy - FEES
Zoning -
¢ Name ?' (Actual) Const - Bldg. Permit i?• ??{;
; AddfeSS (Albwable) - Surch
r
e • gc
0 City yAt'AN Phone # ot stories - g
a
Plan Review
Length _
o Name 'v IF;`:F.ClC ?' i C;k??I.ALE, 1!v}l,: Depth - SAG City
,
oa Address 3465 14 140T+i S.F. Total -
?
Clty 0f'FE Phone
S.F. Footprints - SAC, MCWCC
Water Conn
On Site Sewage _
?
W w
Name
On SHe Well -
Water Meter
?? Addr@SS MWCCSystem -
Acct.Deposit
< W City Phone City wacer -
R
i
d S/W Permit
_
PRV
equ
re
I hereby acknowlege that I have read this application and state that the Booster Pump - S/W Surcharge
information is correct and agree ro compiy with all applicable State of
Minnesota Statutes and City of Eagan Q??diorlces. Treatment PI
Signature of Permitee APPROVALS Road Unit
A Building PBRnit is IssUed to: s?1ZkF(.K FI kEPLACB , 1r- Planner - park Ded.
on the express condition that all work shall be done in accordance with all Council
applicable State of Minnesota Statutes and City of Eagan Ordinances. gid9, pry, _ Copies
Building Official Variance - TOTAL 2?' g?,
Permit No. Permft Holder Date Telephone #
WATER
SEWER
PLUMBING
H.V.A.C.
ELECTRIC
Inspection Date Insp. Comments
Footings I
Foundation
Framing
Raofing
Rough Plbg.
Rough Hfg.
Isul.
Fireplace & ? os ?/S/ j?
Final Htg.
Final Pibg.
Consi. Meter Plbg. Inspector - Notify Plumber
Engr./Plen
Bldg. Final
Deck Ftg.
Deck Final
Well
Pr. Disp.
PERMIT #
. • ' . MECHANICAL PERMIT RECEIPT # ---
' CITY OF EAGAN -
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: ?•' CONTRACT PRICE: PHONE: 454-8100
Site Address BLDG. TYPE WORK DESCRJPTIOM
Lot Block ?Sec/Sub Res. 1Z New L='
?, • ....
y Name Mult Add-on
Comm. Repair
Address ,
? Other
c City .,r,r Phone 7-" 2
Name f? T IlF'i
A
p ddress
City Phone _
TYPE OF WORK
Forced Air ,i':-M BTU
Boiler ' M BTU
Unit Heater f M BTU
Air Cond. ??f M BTU
Vent CFM
Gas Piping Outlets #
OtlBf
t ?g 4w
??__ _.,..._ _ ----•- -
FEE: -0 a
SlC:
TOTAL:
;
? FEES
RES
HVAC 0
100 M BTU
$24
00
.
-
-
.
ADDITIONAL 50 M BTU - 6.00
(RES. HVAC INCLUDES A/C ON NEW
CONSTRUCTION)
GAS O
TLET
MI
M
M
PER
ERMIT
- t
U
S (
NI
U
P
) - 1.50 EA.
COMM/IND FEE - 1% OF CONTRACT FEE
APT. BLDGS. - COMM. RATE APPLIES
TOWNHOUSE 8 CONDOS - RES. RATE APPLIES
MINIMUM RESIDENTIAL FEE
ALL ADD
ON &
-
-
REMODELS - 12.00
MINIMUM COMMERCIAL FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES'
BEYOND $1,000) '
- r E
i' ?,? r . 'ti_ - ' •. . _
SIGNATURE OF PERMITTEE
FOR: CITY OF EAGAN
?,????G 9 clrr
-ro
?r?c??-? - pccivv-v Ta /_-. -?-,r? ?
4?y -b2
! .,.. S 7;?Pez - /Y6?:c't
C ,9z-z-ef?
-?
. ?
PERMiT #
, . ...
PLUMBING PERMIT RECEIPT #
CITY OF EAGAN `
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: ?
ONTRACT PRICE: PHadE: 454-8100
Site Address ' '
Lot ? Block
? Name _
?o Address
c City ?
? Name 11C-7 T ;r-LL
3 Address
O City Phone
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
APT. BLDGS - COMM RATE APPLIES
TOWNHOUSE & CONDO - RES. RATE APPUES
MINIMUM - RESIDENTIAL FEE - $12.00
MINIMUM - COMM/IND FEE - $20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
BLDG. TYPE . WORK DESCRIPTION
Res. ? New
Mult. Add-on
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES TOTAL
Water Closet - $3.00 $
y Bath Tubs - $3.00
---5_Lavatory - $3.06 ti
Shower - $3.00
Kitchen Sink - $100
?..?_Urinal/Bidet - $3.00 v
?Laundry Tray - $3.00 -?
? Floor Drains - $1.50
? Water Heater - $1 50 i ?
Whirlpool - $3.00
Gas Piping Outlets - $7.50 ?
(MINIMUM - 1 PER PERMIT)
Softener - $5.00
Well - S10.Q0
Private Disp. - $10.00
Rough Openings - $1.50
???. a•4
SIGNRT[11*OF PERMITTEE ? FEE: --
-?
STATE S/C:
FOR: CITY OF EAGAN GRAND TOTAL: ?`??
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE: I i' I M{' 3830 Pilot Knob Road Permit Number. 0 ' 14
Eagan, Minnesota 55122-1897 Date Issued: ' '+?"•'
(612) 681-4675
SITE ADDRESS: APPLICANT:
rS 'r; t '--1 it'! t• 2 j 4 vf t=S
PERMIT SUBTYPE:
,??
F' R A M 1 t4 +i
II :(3M tN !
TYPE OF WORK:
:: rfRArIf?N
( nNF 1E411400")
?N ztti :! f 1 t+N
Mri!
Fi 1:MRPV;7 iP1 si:Ff13RA"ff' PfR11IT IS F'Et?OTltf:p Fa)R A#Y f'lilM1¢Ifii3 " Fl.#CfR1t:AI Wfli+•P:
?
i
Permit No. Permit Holder Date Tetephone #
ELECTRIC
PLUMBING
HVAC
Inapaction oete Insp. Commenta
FOOTINGS
FOUND
FRAMING
w?
ROOFiNG
ROUGH
pLUMSING
PLBG
AIR TEST
?
ROUGH
HEATING
CAS SVC
TEST
INSUL
GYPBDARD
FiREPLACE
FIREPLACE
AIA TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.1.
BSMt FINAL
DECK FfG
DECK FINAL •
Y _•I de
(Itr#tfirate nf Mrruvanq
titp of (Eagan .-?
Bepttrimmt nf luttbtng JmVprtim
This Certificate issued pursuant to rhe requirements of Section 306 of the Uniform Building
Code certijying that at the time of issuance this structure was in compliance wrth the various
ordinances of the Ciry regularing building construction or use. For the fo!lowing.•
+
13305
ose 0=15=wn SF TJWG GAR Blag. Pe,n;c No.
oauw-y rya R-3/ zoning aurict RI rya consc. V
o,,,,,,e of Build;,,pVF12E1T & JC]RCE ICddM1D Add. 5240 I 11N AVE. 90. _ MPLS.
etuwing aaarm 1281 DUNEEM I,ANE Locahty L 19, B 1, O?'.S MAR 4IlH
?
% N7VFIMR 8 1989
?? = • '' ??'' n.te: ?
, Bwlding OfGwl
POST IN A CONSPICUOUS PLACE
?-
, ?
fltrfif ira#t uf (Orrupanry
titp of Cagan
lgPpam111PttY itf lltttb[" JWPtfiIIlt
This Certificale issued pwsuant to the requireinenu of Section 306 of the Unifornt Building
Code certrfying that at the time of issuance this strucuere was fn compliance with the various
ordinances of the City regulating bui/ding construction or use. For the following.•
use cwsrmdm . ? ?M/G& eia8. Femit No.
Occuwncr TrPe , zoning Diaiia rype Coc
Owner of Buildinc AAn-
Dak:
POST IN A CONSPICUOUS PLACE
Conn. Chg: ` 1 % • Oopd Zoning:
Acct Dep: '-5 •00,Dd No. of Units:
PermitFee:
Surcharge: " I agree to comply with the City oi Eagan
Tr. Plant
Meter.
Ordinances.
CITY OF EAGICN Permit N
3830 PGot Knob Road B/P No:
P.O. Box 21199
Eagan, MN 55121
10781
Owner. Everctt -? 11 eruc:
Site Address: "'` i?`,yLnberry Tan2 119
Date:
Date:
r f? t h
MWCC: 525.Q0pcf Zoning• ^1
City Chg: ? r'`n , 00r`' No. of Units: '
ACCt Dep: ` r . (ltlr,'
I : ,, I agree to comply wHh the City of Eagan
Permit Fee:
11 Ordinances.
Surcharge:
Misc.: By
SEWER SERVICE PERMIT
?
CITY OF EAGAN Permit Na 963-r Date: ?' `6-87 j
3830 Pilot Knob Road Meter No: Size:
P.O. Box 21199 Reader No: Date: ?
Eagan, MN 55121
Conn. Chg: 52 5,0OP" Zoning: Fl
Acct Dep: 15 •001"1 No. of Units: '
Permit Fee: 4'r)peu
Surcharge: ?r d I agree to comply with the City ol Eagan
Tr. Plant `- `p` Ordinancea.
Meter. _ 'CW
CITY OF EAGAN Permit No: 9635 Date: 6-5--88'
3830 Pdot Knob Road Meter No: 7 D y ? 9 gi2e:5/?!" ?o c/?
P.O. Box 21199 Reader ?/T Date:
Eagan, MN 55121
CITY OF EAGAN Remarks
Addition CHES MAR 4TH ADDITION _Lot 19 sIk 1 Parcel 10 17103 190 01
Street 1281 Dunberry Lane State Eagan, MN 55123
1.z, Lz? _3J y? ' //A .?.u_ ? . %j?,;,::, !3yI7
Improvement Date ' Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK 1973 204.47 10.22 20
SEWER LATERAL
WATERMAIN
WATER LATERAL .
1/VATER AfiEA ill 1977 204.47 13.63 i5
---- --
STORM SEW TRK
STORM SEW LAT i?gp?- ,n 15
O D ?
CURB & GUTTER
SIOEWALK
STREET LIGH7
WATER CONN.
BUILDING PER.
SAC
PARK
DAY/DATE s //? (/L/.Q? • I?
ADDRESS:
TIME :
F!'G ?C FIlJAL HTG. ?
DECK FTG. FINAL PLBG.
FOUNAATION _4 FINAL/C.O.
FRAMING FINAL/DECg
ROdFING ADDITION
INSULATION FIREPLACE
R.I. fiTG. POOL
R.I. PLBG. GARAGE !
OTHER
FOR
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 N2 13305
BUILpING PERMIT PHONE: 454-8100 Receipt p 77l?)
7o be used tor SF DWG/GAR Est Value $158,000 pate MARCH 4 ?
SiteAddress 1281 DUNBERRY LN Erect Occupancy R3
La 19 eiock 1 Sec/Sub.CHES MAR 4TH Remodel ? Zoning Rl
Parcel No. Repair ? Type of Const. 1-1
Addition ? No. Stories
s Name EVERETT & JOYCE TOLLERUD Move ? Length 80
3 Address 5240 11TH AVE SO Demolish ? Depth d?+
° MPLS 82S-08Q$ Int.lmpr. ? Sq.Ft
CiN Phone Install ?
i o Name SAME
? ? Address
? CiTy Phone
?
W W Name_ DENNIS SOHNSON
Address ROiiTF ? BOX lOSD
aW City NO_RRANMne 674-4292
Iherebyacknowledgethatlhavereadthisapplicationan statethatthe
information is correct and agree to omply with all app cable State of
Minnesota Statutes d rt f Ea n?rejRra es. ?
Signature of Permittee J0? ? %J
A Building Permit is issued t: EVERETT & JOYCE TOL
all work shall be done in ac rdance with all applicable Statg„oyhinnesc
Approvals Fees
Assessment Permit $ 677.50
Water & Sew. Surcharge 79 - 00
Police Plan Review 338. 75
Fire SAC 625.00
Eng. WaterConn. 525.00
Planner Water Meter 67 00
Council RoadUnit 305.00
BIdg.Off. Tr. PI. 180.00
APC Parks
Var. Date Copies
z
797
25
7otal .
.
ERUD on the axpress con drtioMhat
Statutes_epd Gitypf Eagan Ortlinances.
Building
CITY OF EAGAN N? 16371
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55127
4 R PHONE: 454-8100 l
BUILDING PERMIT Receipt #
To be used for FIREPLACE Est. Value $1, 000 Date
Site Address 1281 DUNBERRY LN
Lot 19 BIOCk 1 Sec/Sub. -CHES MAR 4TH OFFICE USE ONLY
P8fC61 NO. Occupancy - FEES
Zonmg -
a Name EVERETT TOLLERUD (ACtual) Consl - Bldg Permit 26.00
w
Address 1281 DITNBERRY LN
(Allowame) -
.50
S
h
o City EAGAN Phone x or smnes - arge
urc
Plan Review
Lenglh _
p Name VI F. K FT F.P .A .F.
7NC Depth - SAQCity
,
?a ,
Address 3465 N47 140TH S.FTOtaI -
SAC,MCWCC
? Clfy SHAKOPF.F. PhOf10 S F. Footpnnts -
`Nater Conn
On Site Sewage _
Name
n Site Well -
O
Water Meter
N
AddfeSS
MWCCSyslem
Clty PhOllO
Qry Water - Accl Deposil
SIW Permit
PRV Reqmred _
I hereby acknowlege Ihat I have read Ihis pl?callon an state that the Booster Pump - SiW Surcharge
informallon is correct an agrecompl? wrth all ap able State of
Minnesota Statutes an rt of Eag i IiCes. Treatmenl PI
SignaWre of Permitee APPii0YAL5 Road Unit
A Building Permit is issued to: V E TNC Pfw°ef - PaAc Ded
on Ihe ezpress condilion that all work shall be done in accordance with all Councd -
applicable State of Minnesota Statutes and Ciry ol Eagan Ordinances. Bldg. On. _ Copies
Bwiding Oflicial ?? ??d l?.? Vanance - TOTAL 26.50
,. ii- n n -)
?3?FS 1?-?1?1 ?'a•? ,?._°???.?'7?i.t ?'? '????
ReQUesl Date?
/ p [I ?
O Flre N. Rough-in hlspedion
q o
W. Yes G No
p Reatly NOw ill Nonty Inspector
n Reaay,
I^ hcensed contractor O?ywner hereby request mspection of above electrical work aC
? r ?/ Stree.`BQx or Route'No ) ?
/ JKn v£rr 4t n14- cM
Secbon N. Township Name w No Range No CouMy
antIPRINT? ?
?r fi? Phone N.
Power SuvClier AaCress
ElecV al onttactor ICompany Name)
or??wn ConVaclorS Lmense No.
Maning A ress iConvador or Owner Making InsWlleaon)
J?
aNnon ea 5 w 6ao7W r?Owner akmg Insteliatwn)
„(?? Lo Phona Number ??
ovg -ZO
MINNESOTA $TATE BOARD Of ELECTIiICITY
Grigga-MlEwey BIAg. - Room St]3
1821 Univernity Ave. St. Paul. MN 55104
Phom(613)fia2?00
THIS INSPECTION REQUEST WILI NOT
BE ACCEPTEO BV THE STATE BOARD
UNLESS PHOPEP INSPECTION FEE IS
ENCLOSED.
? REQUEST FOR ELECTRICAL INSPECTION EB-00001-08
? See instmclions lor completing Ihis lorm on back ol yellow wpy '2
a 4 5 0 9 3 ,••x?%low Work Covered by This Request ???:•+"'
ew Add Rep TypeofBwlding ApphancesWired EquipmentWired
Home Range Temporary Servwe
Duplex Water Heater Electnc Heaung
Ap[ Bwlding Dryer Other-(Speafy)
Comm./Intlustrial Furnace
Farm Air Conditioner
01her(speafy) Contrector's Remarks'
3' ?e¢sov?
Compufe Inspec[ion Fee 8elow,
# Other Fee # ServiceEniranceSrze Fee # Qrcuns/Feeders Fee
Swimming Pool 0 to 200 Amps o to 100 Amps
Transformers Above 200 _ Amps 10 Amps
SIgOS Inspector5 Use Onry TOTAL
IrrigaUOn Booms
Special Inspection
Alarm/Communication
THIS INSTALLATION MAV BE ORDERED DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MO
I, 1h@ EIBClfIC01 Inspector, hereby Rough-in Date ?
certify that ihe above inspechon has
been made. Finai oa?e
.? y
OFFICE USE 3NLY
This repuest wid 18 monlhs Irom
TAis reqaes[ void
18 rmn[hs imm
C,71170.?
'?M- "Zt/? °v
I npquesLUwe rire no. ou0?-?n?InspecUOn
qutr ? aatlY Now ? Will NofitY Insoer
?, ? f es N. tor When qeady
ALmensed Electrical ConVxctor IAeraey requeat insoection ol above
?awner elecVicel work insftlled at:
Street A975, Box or Route No. City
12 ?22 ? ?
ection o. TownshiD Name or No. Range No. Counly
T-}
Occupent IPfiINTI P? ne No.
o?cC cLLc4U,? ?
Power 5uvoner Atldress
Dakota Farmin ton
Electrwal Coniractor (Company Name) Contracior's Lroense No.
Hilita Rlnntric, 7nc_ 040445
Mailin0 AdJress (COntractor or Owner Making Instailatwn)
aq.in
/{??llflyzed'Signatv (C a tor wner MakinB Instdllation)
??
;?? Phon 15 Number
MINNESOTA STATI?B ARD OF ELEC CITY ? THIS INSPECTION PEQUEST WILL NOT
Grippa-Midway BIOq. - Room N•197 BE ACCEPTED BY THE STATE BOARD
1827 Univarsitv Ave:. St Peul, MN 66104 UNLESS PROPEN INSPECTION FEE IS
Phone16121642-0900 ENCIOSED.
011,21,5-? REQUEST FOR ELECTRICAL INSPECTION EB-00001-05
If See instructiona tor complefing this torm on beek ot vellow copy.
X" 8elow Woik Covered by This Request
04.4Addl Bao- Typp ot Bmitling ApDlioncea Wired Eqaipmem Wired
Silo Unloader
Bulk Milk Tan
p 'Fee ServiceEntrence5ize M Fee Feedars/Subieedere # Fee Gircwts
U to Z00 Am s 0 to 30 qm s 0 to 30 Am s
Above 2_Am?s 31 to 100 Amps 31 to 1U0 A s
Swinanm Pool qbove 100-Am s Above 100_Am '
Transiormers Irrigation Booms Pamal,'Other Pee
I ? LSigns SVecial InspecLOn 4 S/ q?- TOT F.
?
Bertetks 1 ?' / -1 ?w
.a[
I, the EtecMEa-f
Inspeclor, hereby
cartify thet the ebove
? insDection hes baen
mede.
mlerepueelvoiafemonnmrcom ? ` •
? / ?
This request voitl
18 monNs Irom t p
Do 915OU/9 ,Qi.
oU9'3fL
Reouest Date
j , . Fve No. q
o
ph
InsYectlon
7
/J?
- ?
q
e?? ?Weady NowXWill Nntify InsPer
Wh
t
R
/
88 Ycs ?No or
en
eady
Licensetl ElecVical Contractor I hareby repuest insoecfion ol above
? Owner electncal work instelletl aC
Street Address, Bos or Route No. City
ecbon . 7o.nsMp Name or No. Range No. Coumy
OccuVam IPRINTI Phone No.
Power Suppber Address
9 .
a7a0? 'r {oi-,
EI tncal ConVacmr IComyany Name) Cantrar,tor's License No.
'
Mailing AdJrntrac r or Owner Making InstailauoN
- 55
Au or ed Si9 t
IConUacttlFfOwner Ma i g Installationl Phone Number .
l
MINNE6TA STATE BOARD OF ELECTPICITY o TMIS INSPECTION REQUEST WILI NOT
Grigps•M.dway Bltlg. - Xoom N-181 BE ACGEPTED BY THE STpTE BOARD
UNLESS PNOVEP INSPECTION FEE IS
1821 Universitv Ave.. St. Peul. MN 56104
Phone161P1642-0800 ENCLOSED.
?( REQUEST FOR ELECTRICAL INSPECTION ea-ooooi-os
ji? n? Sqee instrucitons for completpng this form on beck Of Veliow ropy. 80 y??
IvJ 9 1?-11.1 ?"X" Below Work Covered by This Request
NoM AAtl Rep TyOe ol BuilEing Aoalinncee Wrzetl Equiumant Wved
Home Range Temporary Service
Duplex Water Heater LighUny Fixtures
Apt Bwlding Dryer Electne Heabn
Commercial Bldg. Furnace Silo Unloader
InduStnal Bldg. Air Conditioner Bulk Milk Tank
Farm nther lSpr,r.ily)
t?¢? peo(y Othcr
Compute lnspecuon fee 8elow "
k Fee ze H Fee Feedor5/Su0fewders f? i5e Circuits
0 to 30 Amps 0 to 30 Am o s
ps
Am 31 ro 700 Amps 31 to 100 A s
= Above 100Am s Above 100_Am s
IrngaLOn Boorcis Partial.
Special InspecLOn S 5(J TOT F?B
emarks ,.
H
flough-in D. te
I. th
e ectric
f/ Insoecto , raby
certifY ihat the ebove
i Final unspection hes been
? n mada.
Th1e reaua5l voitl 18 montha Irom
INSPECTION RECORD C°n ° "° 1321
CITYOFEAGAN PERMITTYPE: BuzLozue
3830 Pilot Knob Road Permit Number: 0 0 18 2 9
Eagan, Minnesota 55123 Date Issued: 1 1 J 20/ 9 2
(612) 681-4675
SITE ADDRE5S: L Q r e 1 s a L 0 G h: 1 APPLICANT:
1231 OUNBERRY LANE PATIO FNCLOSURES INC
CIiES MfiR 4TF1 (612) 525-1494
PERMIT SUBTYPE:
SF PpRCI-i
TYPE OF VHORK:
NEW
]ESCRIP'PION 3-SEA5(71V
INSPECTION
FCICITING D. .
FftfdMING .A
:CNSUlA7I0N FINf1L
REIhARKt?: RFCE71'1" ik
?
L - - -
779a_?3
2007 RESIDENTIAL MECHANICAL rERMiT arrLicaTiox
City OfEagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Pleasc complete for. single family dwellings & lownhomes/condos whcn permits are required for exch unit
?o.?_q)
Date -y_ / J / 0-7_
Site Address 1?2 8? 16 lin ve Cfi G Unit #
Property Owner y cA.r TQ //e/"_,0
-? Telephone t! (?ri s/ ) 6 Y? - 7 osS
Contractor AN?IRF 1
f`
?
.
.-r.,...?-.
?
12253 Nicollet Avenue"'Soutb
Street Address Flowde MN 553'U C'ty
TCllC
9 7d
7
R
oo
j'ir 0?.
State
R
.
?
Tele hone #
P
Bond #: os-a eL O-73 Expires:
The Applicant is _ Owner ? Contractor _ Other
Fire repair (replace burned out appliances, ductwork, etc.) $ 90.00
This fee applies when extensive mechanical repairs are mad e to a building.
Add-on or alteration to existing dwelling unit $ 50.00
furnace _Additional _Replacement _ New
air exchanger
air conditioner
heat pump
other
?
G
U
?
State Surcharge
`?
J
$ 50
APR f; 5 2007
Total $ siz)• 5T?
I hereby apply for a Residential Mechanical Permit and acknowledge that the information is complete and accurate; that the work will
be in conformance with the ordinances and codes of the City of Eagan and with the Mechanical Codes; 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.
02.2.,.
!(C-7 /,? .,
ApplicanYs nted Name Applic 's Signature
F
?
70 -
2006 RESIDF.NT'IAL BUII.DING PERNIIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX 4 651-675-5694
New ConsWction Reamremenfs RemodeVRepair Reauiremanis Offic"e11Settnir
3registefedsAesurveysshovnngsqfl.oflot,sq.floihouse,andallroofedareas 2copiesotplanshowingfoohngs,heams,loisls CarldSir:aegRecd _.K_N
(20%mazimumlotcoverageatlowed) tseto(EnergyCabulationsforhealedaddtbns $eeFresPladReW= ` _Y _N
2 copies of plan shouvng beam 8 vnndows¢es, pouredfound design, etc i sde surveyfor addrfions & decks Tm,ePresRBq¢ied Y_N
lsetofEnergyCakulallons AddiLnn-indicateAoo-sBesep6bsysfem 6n.siteSeplicSyshm-_ _Y _N
3 copies ol Tree Reservaton Plan d ht platted after 711R3
Ran Joist Detail Oplions selecfion sheet (bwldingsvnth 3 w less unAS)
Minnegasco mechanicalventilation fofm
/??/ 2DOG?
Date0 iip
ConstructionCost rS?
_
SiteAddress 1291 ?Nhlo of+'\/ L QNt Unit/Ste#
Eo '.q,§t23-1Y Q7
DescriptionofR'ork o@Ck
Multi-FamilyBldg _ Y ?N Fireplace(s) _ 0 1/2
PropertyOwner rd-er4 l f Qhtl ?O VcG I fj
? l1`P?k 4? Telephone#(
Contractor D?t ()WNP PS WI ll d0 1A)6P/c
Address Cit7'
Sta[e Zip Telep6one # ( )
COMPLETE THIS AREA ONL7 IF CONSTRUCTING A NEW BUILDING
- Minneso[a Rules 7670 Categorv 1 _ Minnesota Rules 7672
Energy Code Category , Residential Ventilation Category 1 VJorksheet • New Energy Code Worksheet
(Jsubmissionrype) Submitted Su6mitted
• Energy Envelope Calculations Submitted
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a masier plan2
_ Y _ N If yes, date and address of-Master plan:
TelePhone
1 ) -
Licensed Plumber
Mechanical Conhactor
Sewer/Water Contractor
"I
Telephone #(
Telephone #(
I hereby apply for a Residential Building Permit and aclmowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I imderstand this is not a permit, but only an application for a pernvt, 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 pians. ?
i ?
j c))/ cA, .?. TO??arvc?
Appl canYs Printed Name A icar? ? Signature
V
DO NOT WRITE BELOW THIS LINE
r
Sub TVpes
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3sea.)
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 PorohlAddn. (4-sea.)
? 04 02-plex ? 10 OS-plex ?9 18 Deck ? 23 Poroh (screen/gazebo)
? OS 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex ? 25 Misceltaneous
Work T es
31 New
? 32 Addition
? 33 Alteration
? 34 Replacement
? 30 Accessory Bldg
? 31 6ct. Alt - MuIG
? 33 F,tt Ak - SF
? 36 Multi Misc
? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 37 Demolish Building* ? 43 Reroof ? 46 WindowslDoors
•Demolition (Entire Bldg) - Give PCA handout to applicant
DOSCrIptl011: WaterDamage_Yes
D
DC)Z' ?
Valuation /
Plan Review 100% or 25%
Census Code H3Y
SAC UnRs
# of Units
# of Bidgs
Type of Const v r3
Occupancy R _5 MCES System
Zoning 2- ? City Water
Stories Booster Pump
Sq. Ft. PRV
Length Fire Sprinklered
Width
Footings (new bldg)
?o Footings(deck)
_ Footings(addition)
Foundation
Drain Tile
Roof Ice & Water Final
? Framing
_ Fireplace _ R.I. _ Air Test _ Final
_ Insulatio¢ ,
Approved
Base Fee
Surcharge
Plan Review
MGES SAC
City SAC
Utility Connection Charge
SS,W Permit & Surcharge
Treatment Plant
LiCense Search
Copies
Other
ToWI
REQUIRED INSPECTIONS
_ Sheetrock
FinaUC.O.
?d FinaUNo C.O.
HVAC
Other
_ Pool Ftgs Air/Gas Tests Final
_ Siding _ Stucco Lath _ Stone Lath _Brick
_ Windows
_ Retaining Wall
Building Inspector
?` ?drt C e ?
Tji4=? plqn -
i
,
_ p
?
? F ?~??Y ??f??????•?? ?Y}.
? ? . .?.
?
?aV?
? c ,
x
r 1
?
;
,
,
? 1 -
` f
I'
t
.
?
F ? ?0ATO
n'pu
l4 / - V
I 1_?- 1 1 11 '?i
s CITY USE ONLY
I PERMIT #: _ b`j RECEIPT DATE:
8008 ftESIDEftTtAL bIECH4RIClEI. PEiMIT APPLICATiOR
crrY oF EAsAx
3830 Pv.or xxos au £AfltkA 1NN 55 Y 88
651-6$1-4675
Please complete for: ? single family dwellings
townhomes and condos when permits are required for each unit
Date:
SITE ADDRESS:
I a-e t
Ln -
OWNER NAME: EVcr c-tC IOI I,-L.LC.
INSTALLER NAME:
STREET ADDRESS:
CITY:
Place a check mark next to the permk work qpe
? Add-on, modification or alteration to existinq dwelling unit $ 30.00
• furnace replacement
• air exchanger
• air conditioner
• other
.,
-?_?? ?c
--
Nature of work:
1? I 7
State Surchar e $ .50
TOt81 $ ? •?
o y.; _ /? `-2-
SIGNATCJRE F PERMITTEE
TELEPHONE #: ?? - (D 88 _1 U?JS
Wohlers Southside Htg. & Air, Inc. :
6950 W. 146' St, #106
Apple Valley, MN 55124 ?
(952) 431-7099 -
--------?
STATE: ZIP:
vo2
CITY USE ONLY
PERMIT #:
APPROVED BY:
INSPECTOR
RECEIPT DATE:
EOOE COMMEfiCL4L MECHlk1VICA1. PERM1T APPLICATIOR
CITY 0F EABuk1V
3$30 PILOT K1V08 iiD
EAsAv,MN 55 122
651-6$1-4675
Please complete for: all commercial/industrial buildings
multi-family buildings when separate permits are not required for each dwelling unit
DATE:
SITE ADDRESS:
OWNER NAME: PHONE #:
TENANT NAME (IMPROVEMENTS ONLY):
WAS TfiERE A PREVIOUS TENANT IN THIS SPACE? Y N. NAME:
INSTALLER:
STREET ADDRESS:
CITY:
TELEPHONE #:
STATE: ZIP:
WORK TYPE: New conshucrion Install U.G. Tank
_ Interior Improvement Remove U.G. Tank
_ Processed Piping
Specify Nature of W ork
When installing/removing underground tank, call 65I-68I-4675 for inspection by Fire Marshal and
Plumbing inspector.
Fees: 1% of contract price OR $50.00 minimum fee, whichever is greater.
Underground tank removaUinstallation = minimuxn fee
Contract price: $ x 1%= $ (Base Fee)
State surcharge calculate at $.50 for each $1,000 Base Fee
TOTAL $
SIGNATU1tE OF PERMITTEE
Updated 1/02
.
\
\
:ti::; t?Xa'F l:k""4`Y`XX'?k•16)KA"'0 Y(,Y;)l:*':.rW"nt:tS)k#
` i:zrV o!= !_ncara
,
S -f '.RMTKIP:L tiii7. 533
rnr=. i.t7/31/ 97 iTME;, 15a:3046
Nnr'_;; EiVi:'RFi! 'S'fY._LLRI_IYI
.<P:'' 5(71x :lr S' Y1JN?3EP:RY L 50.00
2'.15 ^Ci'?_ :1.R27. DI.7NFtli:RRY L 0.50
Yn'M:S.! 1'i2rr.i-.'.; AmGuv1i;:' 50.50
CF, Of3i5'. F,Lii `'_l
US. , zr,: NnNt,,:,
PERMIT
CITY OF EAGAN
3830 F'ilot'Knob Road PERMIT TYPE:
PermitNumber: BUILDIN6
Eagan, Minnesota 55122-1897 031024
(612) 681-4675 Date Issued: 10 J 31 / 9 7
SITE ADDRESS:
1281 DUNBERRY LANE
LOT: 19 BLOCK: 1
CHES MAR 47N
P.I.N.: 10-17103-190-01
DESCRIPTION:
4«Building`-P,
BuAld3ng_W
,'?Census Cod
?.
?
Y
r.
ry'?RN [(??? f.?I't.? ??+???4[ t8"'L.? ?r?8 (m^kG ?,X#'&8 d?K'?"tE?k !? ? L€
??...:.."U??-.?,. ?1..'s#,! ?4•.»t ;..110 ?^`,7s?:1? i.1i1?
r?a : ^ti
REMARKS:
A SEPARATE PERMIT IS REQUIRED FOR ANY PLUMBING OR ELECTRICAL WORK
FEE SUMMARY:
Base Fee $50.00
Surcharge $.50
Total Fee $50.50
i
1
,
CONTRACTOR: OWNER: - Applicant -
TOILERUD JOYCE
1281 DUNBERRY LN
EAGAN MN 55123
(612)340-7014
I S hereby acknoule.dge' thaC T: tia'Ve retid tFi3:s `app?:3ca;tiab arid ?taie that' the
i,nfurmation ie correct and ragiree to opmqp3'y I with.? all appliaalsle State o,f Mn.
? gtatutes' ahd City of` Eagan"Ord?inarrces.
?APPLICANT/PE?EE I&SUED?:R biGNATURE
(ONE BEDROOM)
rmit Type BASEMEN7 FINISH
F* Type ALTERATION
''. 434 AIT. RESIDENTIAL
3101# 97 BUILDING PERMITAPPLICATION (RESIDENTIAL) f,?0,.,r1(?
CITY OF EAGAN
3880 PILOT KNOB RD - 55122
687-4675 U
Nerr Construction Reauirements RemodeVlteoair Reauirements
? 3 registered site surveys ? 2 copies of plan
? 2 ceples oT plans (InGude beam 8 window saea; poured tnd. design; etc.) ? 2 stta surveys (exterior addRions 8 decks)
• 1 energy calculatlons ? 1 ene
rgy ealculations tor heated additions
? 3 copiea of tree preservation plen ff lat plaltetl aRer 7N/93 '
required: _ Yes _ No •
DATE: CONSTRUCTION COST:
DESCRIPTION OF WORK: ?I n,c h 2 0 orfi on o'Y' 7rt.& naS•,w+n Y-
STREETADDRESS: UunLl+ti,v L Av, e.
rs or
LOT ?? BLOCK ISUBD./P.I.D.#: IQf'7 D I 4i h 114d?I'na
PROPERTY Name: TnI 1-eoa d E„-tr.1i,1J o vcL Phone #: H'705
OWNER -T-
Street Address: 12 Du n btre-j La n t.
Ciry: E-ec o n State: Zip: SSJ 2_ 3 ^
CONTRACTOR Company: ?f1? Phone
N
Street Address: License
City: State: Zip:
ARCHITEC
Tr Company:
Phone #:
ENGI EER
Name: Registration #:
Street Address:
City: State: Zip:
Sewer 8 water licer•ned plumber (new construcction only): 111r f-1 ? . Penally applies when address change
and bt change are ?equested once permit is issued.
I he2by acknowledge that I have read this appiiption and state that the iMormation is correet and agree to comply with all applica6le
Stste of Minnesota Statutes and Gity of F_ayan Ordinances.
OFFICE USE ONLY
Certificates of Survey Received
Tree Preservation Plan Received
Signature of Applicant:
_ Yes _ No
_ Yes _ No
.T
trwaawnwRN,
- Not Required
OFFICE USE ONLY
BUILDING PERMIT TYPE
•m +? .. . -.-
? 01 Foundation o 06 Duplex a 11 Apt./Lodging 41'?118 Basement Finish
? 02 SF Dweiling ? 07 4-piex o 12 Multi RepaidRem. 0 17 5wim Pool
0 03 SF Addition ? 08 8-plex n 13 Garage/Accessory ? 20 Public Facility
0 04 5F Porch ? 09 12-plex ? 14 Fireplace ? 21 Miscellaneous
0 05 SF Misc. n 10 _-plex ? 15 Deck
WORK TYPE
o 31 New fir 33 Afterations o 36 Move
? 32 Addition ? 34 Repair o 37 Demolition
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Planning
Buiiding fve Engineering
Pertnit Fee
Surcharge
Pian Review
License
MCNVS SAC
Cfty SAC
Water Conn.
Water Meter
Acct. Deposit
S1W Permit
S!W Surcharge
Treatment PI.
Road Unit
Park Ded.
Trails Ded.
Other
Copies
Total•
Basement sq. ft. MC/WS System r"
Main level sq: ft. • Cfty Water
sq. ft. Fire Sprinkiered
sq: ft. PRV
sq. ft. Booster Pump
sq. ft. Census Code. u "
Footprint sq. ft. 5AC Code ?
Census Bldg r
Census Unit
Valuation: $
Variance
96 SAC
SAGIiMN ? 9 i
, ., -
; °
i\4t?
PERMIT
,/?`CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
PERMIT TYPE:
Permit Number:
Date Issued:
a USI_0 IiVG
NO.LS29
11./20/"d2
SITE ADDRESS:
128, 1 DI,1NB'.RRY Lv'1NE
LOTe 19 BLOCK: S
ChiES P9AR 471i
DESCRIPTION:
- , 3--SEflSON
1
•` 6u31d$''Yo f,crmai? 1ype Si= PORCM
` $uilding':.Wor!< 1'y pw NFW
?
,=i',;`?° •;` ?` ;.?? f-r;_1{x;;'.-;;r-?7/ l
??ii`?°(?'';
?
REMARKS:
Ri, c r r. p-r ar G o;TI 7?A
FEE SUMMARY:
VA.LUA7IDN
L;a s .. Fe L
01uri Review
5u rr.liargc
TnY,a1 Fae
$13E,.04J
$87.7h
._...?..._...... .,_,.?..ci . vJ!?
-3?228?.76
$1;?, r00U+
CONTRACTOR: - App>>rant - S1. LleOWNER:
pAl"I0 ENC;1 ClSI.iRES INC 152514911 0001676 TDLLf=RUp FVERFTT
5120 CEDflR LAKL" RC1 7.2£31 f1lJNSEHF2Y LN
aT' 101,1T5 WflRK MPd 'i54'd6 l=AL7A N MN 65123
(6 1526-14 44 I612]68 F3-70 55
[ hereby ar.knoul,edge tttat Z hAvc read this a,ppli.oatxon rand sthte that €he
infarmation is CQrreet and agroc? to e(irnp;ty w'sth al3 applicabJe Sta'ce ot Mn.
St.atutes and Gity cif Eagan [5rdirrances,
? -
Control No. 132i
1
?j'' 1'l
?i v A? Tl?MITEE SIGNAT RE ISSU DBY 5 G?TURE ?
PERMIT
CITY OF EAGAN
1992 BUILDING PERMIT APPLICATION
681-4675. Yav I 6 RECB
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERCIAL 2 sets of architectural & structural plans, 1 set of
specifications, I copy of energy calcs.
Penalty applies when typing of permit is requested, but not picked up by last warking day
of month in which re uest is made or lot chan e is re uested once ermit is issued.
Date Noveniber / 16 / 1992 Valuation of work $17,100.00
Site Address• 1281 DLmbeny Lane , Eagan Lot 19, Slock 1, Ches Mar 4th Addition
STREET SfE /
Tenant Name: Everett & Jovice Zbllerud
Lor 19 BLOCK 1 sueo. Ches Mar 47Ptidition v.1.o. r
Descri tion of work• M??acture & Installation of a two level 12' x 15' 3-Season Enclosure
The applicant is: ? Owner IM Contractor ? Other (oes«+be)
Ndme Tollerud Everett & Jovice PhOtie 612=688-7055
Property LAST FIRST
Owner
qddress lzai rnunberry Lahe
STREET STE # .
City Fagan Stdte MN Zjp 55123
Company Patio Enclosures. Inc. Phone 612-525-1494
Contractor Address 5120 Cedar zake Road License # 0001676 Exp.3/31/94
City St Louis Park State Mb7 Zip 55416
Company Phone
Architect/
Engineer Name Registration M
Address
City State Zip
Sewer & water licensed plumber . Processing time for
sewer & water permits is two days once area has been approved.
I hereby acknowledge that I have read this application and state that the information is
correct and aqree to comply with all applicable State of Minnesota Statutes and City of
Eagan Ordinances.
?.
d
Signature of Applicant:
_W'ed<1e
ri
wrrit?c uat unLr
BUILDING PERMIT TYPE
? 01 Foundation ? 05 Apt. Bldg 0 09 Basement Finish
? 02 SF Dwg. C106 Garage/Accessory ? 10 Swim Pool
? 03 Two family ? 07 Fireplace -0 11 Res. Add./Porch
? 04 Multi-fam. T.H. ? 08 Deck ? 12 Comn./Ind.
WORK TYPE
? 31 New
M 32 Addition
? 33 Alterations
? 34 Repair
? 35 Tenant Finish
? 36 Move
? 37 Demolish
? 99 Undefined
: ? .,' •
? i aubi ? ..<
? 14 AgC44ul ural
? 15 Miscellaneous
GENERAL INFORMATION
Lonst. (Actual
(Allowa6le?
UBC Occupancy
2oning
# of Stories
Length
Depth
APPROVALS
Planning
Engineering
REQUIRED INSPECTIONS
? Site
? Wallboard
Basement sq. ft. MWCC System
lst F1. sq. ft. City Water
2nd F1. sq. ft. PRV Required
Sq. Ft. total Booster Pump
Footprint Sq. ft. _ Fire Sprinkler
On-site well Census Code c.
On-site sewage SAC Code
Building
Yariance
0 Footing
10 Final
Assessments
IZ Framing ,p Insulation
? Draintile ? Fireplace
Permit Fee
Surcharge
Plan Review
License
Mwcc sac
City SAC
Water Conn.
Water Meter
Acct. Depasit
5/W Permit
S/W Surcharge Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
r.t?ect?_ s2 Doc)
3sxs5
SAC %
SAC Units
? ? a
IA33 7987 BIIILDING PERMIT APPLICATIOP - CITY
6`f -1
`l9 • 0?+
SINGLE FAMILY DWELLINGS 3 ,38' t?+
625 INCLIIDE 2 SETS OF PLANS, 3 CERTIFICATES OF SIIRVEY, 1 SET OF ERE ? ? L 5. ? 0+
_ UU*
HOTE: ADDRESSES FOS CORNEH LOTS - CONTRACTOR/HOMEOWNER MDST ? 561•,?q+
IS DESIRED. NO CHANGES WILL BE ALLOWED ONCB BDTLDING PERM
?
MOLTIPLE DWELLINGS - RFSIDENTIAI. RIIQTAL URITS FOR SALE y'i ''z
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SQRVEY - CHECB WITH BLDG. 1
1 SET OF ENERGY CALCULATIONS
COMMERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONS,
$2,000 LANDSCAPE BOND
? I ??IoOo
To Be Used cor: S;!2?1 e FaJ?,?aluation:
Site Address bun berry Lan pggiI
Lot 19 Slock I ? Sewage
Parcel/Sub CHFS uiriop
Owner&reli aj Joy<e iolleruj
Address '5;ld A\)ehUe. Jouth
City/Zip Code JMI;hnPapolis#I iN 55? f?
Phone 8a15-og?8
Contractor &C'Y E?
Address +h I{Uen"?' Sokfh
City/Zip Code MinrlPApolrst . MN 55917
Phone 8as-oByg '-
Areh./Engr. Dennis jo?nSOYi
Addresa RojQ. 3, &Oy? 1c)J D
City/Z3p Code Nori ? llrjyjCk MN 5505(-
Phone # 67?f - yaq?
MWCC System ?
On Site Well _
City [dater
9PPROYALS
Assessments
Water/Sewer
Police
Fire
Engr
Planner
Council
Bldg Off
APC
Variance
nate: d i 7 8
i
Oecupancy
Zoning (Z•f
Type of Const
(Actual) z,
(Allowable)
# of Stories
Length g?
Depth ?
S.F. Total
Footprint S.F.
FEES
Perm3t 4?, 17.5-
Surcharge ?j.
Plan Review ?.?
SAC, City 1pp,
SAC, M6dCC 5L 5•
Water Conn S ZS,
Water Meter
Road Unit ?b5•
Treatment P1
Parks
Copies
TOTAL. :5z"? ,
.'I S-
3 14« x<2?Z? = I?cov n s8 = 1?Z?o ,.
?j ( 4r(? ? ?2??? ? . 5 = ? 3a tc `f 4- = 3?05 Zc7
c? ? O = `Z 40 ? 4 4- - f
(S7 2-3fc--)
? qb '
CITY OF EAGAN
EXTERIOR ENVELOPE AYERAGE IUI
OWNER: ?l OVi c e
SITE ADDRESS: I Z k 1 L 9 h e.
i
CONTRAC70R: u
FVRrall T??I?r4C{ DATE: 2?2??g7
?
PHONE: 2S-0
Determine xorking square footage of each:
1. Total exposed wall area .. ? 2 50 sq. ft. x. 11 = 3SI, S
2. Total roof/ceiling area ., f(y Z 0 sq. ft, x,026 = q2.1
Total exposed xall area above floor = 2 7q 0
a. Total wall window area ............................ 2?I.S
b. Total door area .................................. ?
c. Total sliding glass area .......................... ?
d. Total fireplace wall area ......................... G,D
e. Total wall framing area (average 10%) ............. C1
...................
f, Total net wall area above floor ()I
g. Total rim joist area .............................. ?3n,p
Total exposed foundation area - r7I0
h. Total foundation window area .......................
i. Total net foundation area above grade .............. 41 a
Determine IU' value of each wall segment:
a. 2o L5 x
b. 'l'1.0 x
c. 7.9i,Sx
d . ,,o x
e. 2'7 x
x
g. i 3f?.c) x
h. x
i. 4`I I, Q x
vul .4Ut? ??1 = 81.9
'U' ? 2RS iwal - 12,0 '
' u'
q.17t2
lut - _ ? iS1
'u' , 04-rp = L2s3
'U' ,022 = 462
' U' ", n 4 5 = 5:9 --- -
'U' ,620(wwR) - 4129
oU' , ,045 = II ,Q
3 . ................................................... Total = 27).2
If item #3 is the same as or less than item p1, you have met the intent of SBC
6006(c) 2.
Total exposed toof/ceiling area - )b 20
............................... 1 .0
j. Total skylight area `
k. Total roof/ceiling framing area (average 10%) ..... )(,2,?
1. Total net insulated roof/ceiling area .............. I ?jn`?,D
OVER
?40' _i
Determine 'U' value for each roof/ceiling sepent:
j. `{9 x IU'
k, i(g 2 X lut
1. ?'{oq x +u'
ovs
,n23 - 32,q
4 . ...................................................... Total = 19n.9
If total of #4 is the same as or less than U2, you have met the intent of SBC
6006(c)1.
Alternate Building Envelope Design ?
To utilize the total envelope system method, the values established by the sum
of Items #3 and P4 shall not be greater than the sum of Items #1 and #2.
1. S J 7,5 + 2. q 2,1 - ? 9 6Y f2
3. 2-)),2 + u. (p0,°L = 332,jz
a
ob
;.
,-,
su er-lites
5A=.?5 MSu?TiNe bL/?69 wuVC+? ccrrstsroP Z, 3 ac 4fbuES oF ?cAr!?
bt Me fiu. SP?RS• ??O VAceR extTaMP A oWtvrA7'Nb KceW? EN"Irw
A MO(S'(ZJICE FAGOF PIR bfPGG. TkE UNI'f IS HERME714U.LI SEALSP wrTH APIML 5W1.-
Am-1SP uNOM coNqrct.LeD cv-WtPoHg To Pxo/IPS P4TG&Cla4 °&?rtssr vAfbK
?W?P ?t tY?5 Y URA?CN0 TkE ??SfN 4E?D &A? FPL+M-
features -
cusTOn exTRuGAory oF eRa+zEPmooiXW
AUUMINtJM WITH lCuGW SK*J.b MSuR65
wFATKALTITG e44.405uRs oF &.At*-%N%,
v4WiaF. "& oF Vi(o"m'/?."Tmmmu
OLA" y nMCr, sma4bmnmar PAqo
wrM **/ " as M7wOsr+ som
eo.Trw oF r?+e Begr
*iu4o.jp4d, WiN65
u wu.ue = .30
Rvo,?urr- = 3.3
DRoWN at.urniNUM
F(,A'I•H IwD HAS G" L"
C*TMpir?b u?SH1i
FoP, rRomIL wAT'*t
?N pi.uMiN?M ?-A NMRUgAL-
? ?(a4UinR-M! M91DE ?/?
OM ? rty6i.?S ? ? eF
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ir- BRoK".-T?t? &LA" G+PO 04
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ouRwiNOewyt?e PwNTSO wrn+
Nb RouND GoRNWs RZd?uMVNrs
5?IAtr TitIM
,
! 1989 BIIILDIBG PEffiKT APPLIC9TION - CITY OF EAGAN
SINGLE F9MILY DWBLLIIaGS t ? 5 11
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES DF SpR4EYt t SET OF ENERGY CALCULATIONS
a0?Es ADDEffiSES FOH CARNER LOTS - COIVTRAClOR/SOMEOWDIEH llU3T 1ESIGH9Tfi WHICH ADD&ESS
Z3 DESIAED. HO CHANGES WZLL HE ALLDTi6D ONCE BIIII.DIlIG PBRHIT I3 I380ED.
HIILTIPLS DiiE[.LINGS EENTkL 0$ITS FOH SAI.Ts U9ITS # OF DBIT3
INCLUDE 2 SETS OF PLANS, CSRTIFICATE OF SO&VEY - CHECC WITH SLDG. DEPT.0 1 SET OF EAIERGY
CALCULATIONS
COMMERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATI NS AND 1 SET ENERGY CALCULATIONS
?? o?
To Be Used For: ? Valuation::?s Date:
Site 9ddress ?
Lot 1?_ Bloek
Parcel/Sub nh
Owner A
e
Address
City/Zip Code
Phone
Contractor ,U
Address ? W S'N W
City/Zip Code
Phone
Arch./Engr.
Address
City/Zip Code
Phone #
Oecupaney
Zoning
Actual Const
Allowable
# of stories
Length
Depth
S.F. Total
Footprint S.F.
On site sewage
On site well _
MWCC System _
City water _
PRV required ,
Hooster Pump _
EPPROVAIS
Planner ^
Couneil
B1dg. Off.
Yarianee
Bldg. Permit a(n ?
Sureharge •6 0
Plan Review
SAC9 City
SAC, MWCC
Water Conn
Water Meter
Aeet. Deposit
S/W Permit
S/W Sureharge
Treatment P1.
Road Unit
Park Ded.
Copies
SOTAL (p 5?
BOTEm Sewer & Water Permit fees and account deposit fees vill be ineluded in the building
permit fee. Processing time for serrer and xater permits ia two daya onee a licensed
plumber ttas applied fpr a permit at City Hall.
APFLICATION FOR PERMIT
SEWER ANQ/QR WATER CONNECTION
.
.
* N71E: PAMIENIL OF PEE AT TIME OF
; r,errscaizaa ooFS rrCYr coN- ;
? STI1iT1'E APpF2GJAL OP PERPIIT.
x
? IN$PFx'.1'ION OF $34ER ANID//?? /w? WATER k
k
? ItYSfALIATIONS WII,L M71' BE SCmOLEO
,*k [!NCIL PERFffT HAS SEEId APPROVID. :
4i#i#*RSlti4i#fili44AfMWfF/iYR?t?fi4#!fM
?? acigan
(PLEASE PRINT
1) PROPERTSt ADDRFSS: /a;F/ ?v,r??j??(17s l-nf
i,FY;AT, DESCRIPTION'
(Lot B oc S division or Tax Parcel ID
IF EXISTING S1RL'CTURE, DATE
PRESENT ZONING/PROPOSID USE:
Q COhMAERCIAL/RETAIL/OFFICE
Q INDCSTRIAL
Q INSTITU"PIONAL/GOVEE2NMENT
)F ORIGINAL BLILDING P„RMIT ISSUANGE:
Non Year
? R-1 SINGLE FAMILY
R-2 DDPLEX ('itvo t'nits )
Q R-3 TOWNHOLSE (Three + Onits) ( Units)
Q R-4 APARTMENT/CObIDOMINILM ( Cnits)
z) ? NAME' ?DJT?6/?ECe/ .-SAd?.%d?/'KI TiPJC"
ADDRESS : ?dn?o. , jj'-z . / i? CITY. STATE, ZIP:
PHONE: 44-q-/
3) i yL; r NAME:
ADDRESS:
CITY, STATE, ZIP:
PHONE: 41S 7 -133 2 MASTEE2 LICENSE #
Plumliers I.icense:
I? Active
Expired
Not recordec
St' Initia
4)
NAME:
ADDRESS:
CITY, STATE, ZIP:
PHONE:
5) s ? a
? CONNECTION TO CITY SEWER M' CONNECTION 1O CITY WATEE2 O OT[III2
..rt474
6) I r ti10tTi:Soli ?
***:Fk*rt*****#*?k*:Mlr**********************k?k?t********************k*kW*k****************************:F*a
*
* THE GOLD COPY OF THE PERNIIT WILL BE SE6TP DIRECI'LY TO PUSLIC WORKS TO FACILITATE MEtM PICK-DP. ?
PLF.ASE ALtAW 'i5D HARKIM DAYS FOR PROCFSSING. SONIDDNE FROM TfIE CITSC WIIS, CONPACP YOL IF TfIERE .??
* ARE ANY PROSLEM5. f
?****?*,??******???r.**?*«*??**????***?**+***********+**?****?????*??***,?************?*?**?***+***?**;
FOR CITY USE ONLY
PERMIT # ISSOED
Pd w/Bldg. Permit FEES:
$ $ /G - S-uj SEWER PERMIT (INCLDDE SURCHARGE)
$ $ ?O • ? WATER PERMIT (INCLODE SCTRCHARGE)
$ ? 7,0 o $ WATER METER/COPPERHORN/OC'TSIDE READER
$ $ WATER TAP (I[VCLL'DE CORPORATION STOP)
$ $ SEWER TAP
$ $ ?S- G-rJ ACCOUNT DEPOSIT - SEWER
$ $ `S •cZ% ACCOCNT DEPOSIT - WATER
$ el Z 5-, O-fl $ WAC
s o-n $ sAc
$ $ TRL'NK WATER ASSESSMENT
$ $ TRUNK SEWER ASSESSMENT
$ $ LATERAL BENEFIT/TRUNK SEWER
$ $ LATERAL BEN°FIT/TRC!NK WATER
$ ??O U v $ WATER TREATMENT PLANT SLRCHARGE
$ $ OTHER:
$ La ?7 TOTAL
// Z
RECEIPT R ECEIPT
DOES UTILITY CONNECTION REQLIRE EXCA VATION IN PL'BLIC RIGHT OF WAY?
r--j YES IF YES, THEN A" PERMIT FOR WORK WITHIN PUBLIC
Q
NO ROADWAY" MLST BE
DIVISION
LIS ISSC'ED BY THE ENGINEERING
.
T AS A CONDITION.
SUBJECT TO THE FOLLOWING CONDITIONS:
.
APPROVED BY: „( `Ja ,
TITLE:
DATE :
0
Z ? CITY USE ONLY RECEIPT #: oV(.? .??-P
SUBD. RECEIPT DATE: /W/ 9 -7
1997 f'LUMBINfi PEftMIT (USIDENTIAL)
Cli'Y OF El1fiA1Y
3$30 PILOT KROB RD
SAfiAP, MN 55122
(612) 6$1-4675
Please complete for: ? single family dwellings
? townhomes and condos when permits are required for each unit
? backflow preveMer for underground sprinkler system
FIXTURES EpCH # TOTAL
Shower 3.00 x _I_
Water Closet 3.00 x I_
Bath Tub 3.00 x =
Lavatory 3.00 x I_
Kitchen Sink 3.00 x =
Laundry Tray 3.00 x =
Hot Tub/Spa 3.00 x =
Water Heater 3.00 x =
Floor Drain 3.00 x =
Gas Piping Outlet " minimum - t 3.00 x =
Rough Openings 1.50 x =
Water Softener ' for dwellings under construCion 5.00 x =
Water Softener " for eacisting dwelfing 20.00 x =
U.G. Sprinkler ' tor dwelling under const. 3.00 =
U.G. Sprinkler ' for exisling dwelling 20.00
Alterations ' to existing residence 20.00
=
Water Tum Around 20.00 =
Private Disposal System " Dak Cty Iic. 75.00 =
(new and refurbishad systems)
Pfivate Disposal Systems'abandonment 20.00 =
STATE SURCHARGE 50
TOTAL 0-7
------- _...---------• •-----•--•---------------------------------------------•---------------------------------------. _....--•---------
I hereby adcnowledge that I heveread- th's epplication, state that the iMortnation is correU, and agree to eompty wiM all applicable City of Eagan ordinances
!t is the applicanPs 2sponsibility to notify the property owner that the City of Eagan assumes no liability for any damages caused by the City during its
normal operational and maimenance ac[ivRies to the facilitiea construc[ed under this pertnit within C'ily property/rightof-wayleasement.
SITEADDRESS: 12?I rJuvtL,Qtrq L4hP.
OWNER NAME: I-U Ph r'FT' (w c e ? D/I e P4 d
f
INSTALLERNAME: ?vPrPf(I?lo)/?P I
Tot / erv(1
TELEPHONE#: W2-jasd-7065
STREETADDRESS: I2$I 11 HAUu? L4N-C
CITY: F-a a STATE: ziP: 52 2
f, ., r-
OF PERMITTEE
CDlFORMSlPLBG PERMIT (RESIDENTIAL) 1997
r .
GHe?-SmPrP- c/ Ti+
LcsY I c) T3?,tIC 1
UTILITY EASEMENT
THIS INDENTURE, made and entered into this?23'--? day of 001jG%bEy ,
19 &i, by and between EVERETT I. TOLLERUD and .TDYCE TOLLERUD, husband and wife,
as Grantors, and the CITY OF EAGAN, Dakota County, Minnesota, as Grantee,
WITNESSETH WHEREAS, said Grantors, in consideration of One Dollar ($1.00)
and other good and valuable consideration, to them in hand paid by the said
Grantee, the receipt whereof is hereby acknowledged, do hereby Grant, Bargain,
Convey and Warrant to said Grantee, its successors and assigns, the utility
easements situate in Dakota County, Minnesota, as follows:
A 20.00 foot perpetual easement and a 100.00 foot temporary
construction easement over that part of Lot 19, Block 1, CHES MAR
FOURTH ADDITION, according to [he recorded plat thereof, Dakota County,
Minnesota, the centerline of which is described as follows: Commencing
at the northwest corner of said Lot 19; thence South 0 degrees 50
minutes 11 seconds West (asaumed bearing) along the west line thereof a
distance of 108.17 feet to the point of beginning of the centerline to
be described; thence North 66 degrees 36 minutes 11 seconds East a
distance of 81.41 feet; thence North 4 degrees 50 minutes 11 seconds
East a distance of 75.85 feet to the north line of said Lot 19 and said
centerline there terminating.
The side lines of said easement are to be lengthened or shortened to
terminate at the west and north lines of said Lot 19.
Said temporary construction easement to expire 3CCz'ni0'--' /? G'o?
The Grantee shall have the right to do whatever is necessary for the
enjoyment of the rights herein granted, including the right of clearing the
right-of-way of ingress and egress to and from said tract of land and over and
across said easement only for the purpose of Laying, maintaining, operating
and repairing said utility lines.
By acceptance of these easements, the Grantee agrees that it shall replace
any shrubs or sod removed by it in the exercise of its righte hereunder to as
near the condition which existed immediately before such rights were exercised
as is reasonably possible.
IN WITNESS WHEREOF, the parties hereto have hereunto aet their hands and
seals the day and year first above written.
Jo7ce
?
e
STATE OF MINNESOTA)
1 SS.
COUNTY OF ?ii,c?;? )
On this?33"Pday of 195'4, before me a Notary Public
within and for said County, personally appeared EVERETT I. TOLLERUD and JOYCE
TOLLERUD, huaband and wife, to me personally known to be the person described
in and who executed the foregoing instrument and acknowledged that they
executed the same as Cheir free act and deed. ?
(SEAL)
Notary Public
THIS DOCUMENT DRAFTED HY:
Hauge, Eide & Keller, P.A.
1200 Yankee Doodle Road
Water View Office Tower, Suite 303
Eagan, MN 55123
(612) 456-9000
DAVID G KELLER
? MOTABY ^PUBUC, Oskota Counry. w
NY Cammronion E.or?ee Ju:v t' 1989
EXEMPT FROM STATE DEED TAX STAMPS
WAIVER OF HEARINC 00185
Special Assessment Authorization
TllVe hereby request and authorize the City of Eagan, MN (Oakota Co.) to
assess the following described property owned hy me/us:
Lot 19,_glock 1; Ches Mar 4th Addition
for the benefit received from the following improvemencs: --"'-"--"'-
ITEM
QUANTITY _ RATE • MIOUNT PROJECT
sanitary -
= Sewer Service' 1 ?a. $471.25 $471.25 '448R
?Water 5ervice 1 Ea. $598.00 $598.00 448R ?
TOTAL $1_069.25 to be spread over 10 years at an annual interest rate of 9 % against
any remaining.:unpaid balances, . -----
The undersigned, for themselves, their heirs, executors,_administrators
successors and assigns, hereby consent to the levy of these assessments, and
further, hereby waive notice of any and all hearings necessary, and waive objections to any technical defects in any proceedings related to hese assessments,
and further waive the right to object to or appeal from th se ass ssments•made ?
pursuant to this agreement.
Dated:'
? ? - o rucT--- -
"i y Tollerud
_ ? . ..
STATE QF ?-2--x-•,?.?,3? ;`
) SS
COUNTY OF_/@L?-
on this =:,/ day of 7 bafore me a Natary Public within and
for said County, personally pcaredr:7,c?????,?? ? to me
personally known to be the person described in and uli e e uted the foregoing
instrumen[ and acknoNledged that executed fhe same as free act and deed.
?; _ r :, NoLORENf A1 NEE OTA No-GL-.?-4+JL?
pAKOTA COU NiY
'IC
tary Public -
ThiS DOCUment D 3? gd,,,.g?f,pn e.?lres Nov. 23, 1967 . ?
Hauge, Smiih, E c eller. P,A, AppROVCO:
3908 Siblcy Memorial Nighxay
Eagan, Minnesota 55122 • ••.•.. ,
(612) 454-4224
?gan ?lic I+orTs Director ^??, Revised: 8-30-82
Storm Sewer Trunk
r Ches Mar 4th-??
?Block 1 Lot d
Z
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17-
18
19->
20
B;ock 2, Lot 1
2
3
4
5
6
7
8
9
Ches D1ar 5[h
Block 1, Lot 1
2
3
4
5
6
7
8
9
Block 2, Lot 1
2
3
4
5
6
7
8
9
10
.
345.67
346.45
3G1.68
301.02
1118.88
934.10
494.29
455.49
364.05
597.58
397.59
328.56
693.81
327.37
290.39
490.78
805.84
1631.79
1908.97
2512.98
459.47
545.87
624.55
577.04
478.66
422.66
488.72
553.46
423.54
467.30
369.51
601.09
468.55
506.35
403.00
416.03
546.00
443.09
390.00
390.00
390.00
733.75
603.69
331.45
325.00
325.00
600.68
1021.18
3830 Pilot Knob Road
Eagan, Mn 55122
ti
DELMAR H. SCHWANZ
LAND $URVEYONS INC
HPQiSI"M U?0P1 Lrrx Oi TIM Ct-ir M MIOManle
10750 SOUTN ROBERT TFAIL flOSEMOUNT. MINNESOTA SSOBB
?NW. corner Lot 19
SUHVEVOR'S CERTIFICATE
114.47 175.53
T ?
NE. corner Lot 18
East
/ 18
18
Cenlerline
\ easement?
1
- - I 79.53
50
IW TI
?
A ?
_ ?20 Ft. erpetual
f--West line ro '10I easemen
Lot 19 ?
\? i
/ s?6,? ? 19
100 ft. Temp. Const
easement
! / I
r
SCALE; 1 ZNCH = 40 FEET
Lot 18:
A 20.00 foot perpetual easement and a 100.00 foot temporary construction easement
over that part of Lot 18, Block 1, CHES MAR FOURTH ADDITION, according to the recorded
plat thereof, Dakota County, Minnesota, the,centerline oF which is described as follows:
Commencinq at the northeast corner of said Lot 18; thence South 0 degrees 50 minutes
11 seconds West (assumed.bearing) along the east line thereof a distance of 108.17
feet to the point of beginning of the centerline to be described; thence South 66
degrees 36 minutes 11 seconds West a distance of 78.59 feet and said centerline there
terminating.
The side lines of said easement are to be lenqthened or shortened to terminate at
said east line of Lot 18.
Said temporary construction easement to expire
Lot 19: •,
A 20.00 foot perpetual easement and a 100.00 foot temporary construction easement
over that part of Lot 19, Block 1, CHES MAR FOURTH ADDITION, according to the recorded
plat cnereof, uaxota County, riinnesota, the centerline of which is described as
follows: Commencing at the northwest corner of said Lot 19; thence South 0 degrees
50 minutes 11 seconds West (assumed bearing) alonq the west line thereof a distance
of 108.17 feet ta the point of beqinning of the centerline to be described; thence
North 66 degrees 36 minutes 11 seconds East a distance of 81.41 feet; thence 4torth
4 degrees 50 minutes 11 seconds East a distance of 75.85 feet to the north line of
said Lot 19 and said centerline there terminating.
The side lines of said easement are to be lenqthened or shortened to terminate at
the west and north lines of said Lot 19.
Said temporary construction easement to expire
Dated: Novemher 6, 1986
v?ww¢ 612 +ssixo
rNorth line Lot 19
?
MINNESOiA REGISTRATION NO 8625
. . . . . . . . t . . . . . , . . . ~ . . . . . . . . ~ ~ . . . , . . . . . . . . , . . . . . . . . . .
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PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA176754
Date Issued:05/31/2022
Permit Category:ePermit
Site Address: 1281 Dunberry Lane
Lot:19 Block: 1 Addition: Ches Mar 4th
PID:10-17103-01-190
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 -
Everett I & Joyce Tollerud
1281 Dunberry Lane
Saint Paul MN 55123--180
(651) 688-7055
Bettin Inc
3208 1st Street South
Waite Park MN 56387
(320) 251-2505
Applicant/Permitee: Signature Issued By: Signature