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768 Elrene CtI Reoeipt PLUMBING PERMIT Permit No. CITY OF EAGAN Fee Fill in numbered spaces S/C ? iYpP or rrinr iegrmy I Tot. I -r- 1. Date 2. Installation Cost 3. Job Address Lot?Bik. ? Tract 4. Owner ? F(:nntrartnr L X'k%71IrA-" f9 Phone 6. Address 7. City State ` Zip --- ? ? 8. Building Type: Residential R` Commercial ? Institutional ? 9. Work Description: New e Add ? Alter ? Repair ? I hJ .. • 10. Descri be 11. No. ti Fixtures Water Closet No. Fixtures Cesspool/Drainfield ? Bath tubs Septic Tank ? Lavatory '?- Softner Shower Well Kitchen Sink ? Urinal/Bidet Laundry Tray Other ? Floor Drains Drinking Ftn. Slop Sink Gas Piping Outlets 12. I hereby certify that the above information is true and correct, and I agree to comply with all ordinances-ao codes governing this type of work. Signed : fOf Rough Final Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. Approved CITY OF EAGAN 454-8100 Receipt -?r -J ?i MECHANICAL PERMIT Parmit No. CITY OF EAGAN 1 Fee FiN in numbered speces S/C ? Type or Print /egibJy Tot. 1. Date t? 2. Installatio+? t rD? ? 3. Job Address Lgt ??- Blk. I Tract -" ? T ?;:i/ !o`y / 4. Owner 5. Cflntractor Phone 6. Address 7. City State Zip 8. Building Type: Residential Commercial D Institutional O 9. Work Description: New 1?r/ l,1dd ? Alter ? Repair ? 10. Describe '"- ' G?'•'? ?ti+. ..r-<- Fuel TYpe 40!" „ 11, No. Equioment STU • M. Ea. Forced Aif, No. Enuipment CFM Air Handlin : Mfg. , g i . Boilers ? /•?', Mfg. lUl ech. Exhaust Unit Heater Mfg. Other Air Cond. Mfg. ? Gas, Piping Outleu ? ? 12. I hereby certify that the al?ovo , information is true and correct, and I agree to comply with all ordinarrc6s ar?dQodes goveming this type of work. Signed: ?.? ? for Rough ... Final Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. Approved CITY OF EAGAN 454-8100 i Addition k4ndtre9AddiTien Lot 12 Owner ' Street 768 Elrene Court k 1 Parcel-#10 84470 12.0 al State Eagan NIN 5512A Improvement Date Amount Annual Years Payment Receipt Date STREET SURF, 303 1975 117.08 11.71 10 ? STREET RESTOR. Z 9$3 - 3030.42 606.08 $ ? GRADING 11,4 1973 247.85 24.79 lO r' 9 1982 138.39 24.78 5 SAN SEW TRUNK 15-1 I9 327.07 6.35 20 * SEWER LATERAL 1982 2978.21 5 9 64 5 WATERMAIN * WATER LATERAL 1-982 5 WATER AREA 414.50 27.62 js * S@rVlceS 19$2 S STORM SEW TRK 14-7 19$2 11$$.09 237.62 t'j STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT ROAD UNIT - - WATER CONN. 470.00 11 11 BUILDING PER. 068 sAC 525.00 PARK INSPECTION RECORD ---CITY OF EAGAN PERMIT TYPE: rI I' I N+' 3830 Pilot Knob Road Permit Number: 1 7 f', Eagan, Minnesota 55122-1897 Date Issued: (612) 681-4675 SITE ADDRESS: , , . APPLICANT: I , i • . . .,r; .., ; :,,;, W1 NOTitl ? PERMIT SUBTYPE: 6l:'1 41:f-0011 TYPE OF WORK: t1f W i A"TI.Y ttM/HCf?konM INSPECTION .. . .A I 1rl`MARM 3 F 6.?. -'.qPPAR111'F' PF 1rM t f Rt= ql+l oE hPOP ANr V1 tlMN 1 Nr WoPK . r. (tN t A(, i' ;'CA TF ROARn qF fllf'UFtIfI1V AF(*4iR("1N{i FIECifi7rA1 f'F(tp11T. PIAN RFVTf6iI1) RY MTY.[- RAitf`K , ? 3 I -7 a-- I Permk No. Psrmit Holdar Date Telephone M • g 8- / PLUMBING 9fj HVAC Inapectlon Data Inep. Commants FOOIINGS FOUND FRAMING 5'. <6'L ROOFING J co ROUGH PLUMBIN(i PLBG AIR TEST CNa ROUGH HEATING GAS SVC TEST INSUL 4a?/ ? (3YP BOARD FIREPLACE FIREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL BSMT R.I. BSM7 FINAL DECK FfQ DECK FINAL c BUILDING Site Addreu Lot Percel No. _ aWC Name _ 2 Address S City - Name _ uI u Address ?- Cfty - n: ,,,:.y Name _ City CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHONE: 454-8100 Receipt # Est. Volue Qate 19 ` , Erect Q Occupancy -Sec/Sub, /11ter ? Zoninp - _- Repotr ? Fire Zone Enlorqe O TYPe of Const. Move 0 # Stories. Demolish p Len9th?Y, _ Phone Grode ? Depth "` `Sa. Ft. 1 hereby acknowledge thot I hove read this opplicotion ond state that the intormation is correct ond ogree to comply with oll opplicoble Stafe of Minnesoto Stotutes and City of Eagnn Ordinonces. Sipnoturo of Pertnittee A Building Pe?mit Is issued to: ? oll work sholl be dona in accordenct with oll oppliooble Stote of MN Buildinp Official Assessment Permit " Water b Sew. Surchorye G Poli<e Plon check Firo SAC Erp. Water Conn. 4 0 Planner Woter Meter Council Rood Unit Bidy. Off. ' ? . ?. . APC Totot on the expnss wrdition thnt and City of Eoqan Ordinances. Thc; -e ... PL,g 6- :, ,, _ Psrmit No. Permit Hblder Misc. Parmit No. Holder Plumbinp H.V.A.C. C, , ? W.ll Water Disp. S?wer Eleetrie (Q ? pl 5 -S Inspaction Date Insp. Other Footingt ? Foundation Freming ? a .... ?-+.+r ..? . Rouyh Plbp. G. , Rou? HVAC Insulation Final Plbq. !i Final HVAC ' ? Final Water Descri6a Location: _ wsli Sewer ? Pr. Oisp. REQUEST FOR ELECTRICAL INSPECTION Es-oow,-_.. ' See instr.ctions for completing [his form an back of Vellow coov. "X" Below Work Cmvered by This Request INaidAddl Pao-I Tvue of Builtlinn '1 Aootianees Wited 1 Equiument WireA I Water al k Fee Sarvica Entranca Siza # Fea Feaders/Sub{eedars # Fee Circuits - 0 to 200 qm s 5D 0 to 30 Am s 0 to 30 Am s Above 200 qmps ?• 37 to 700 Amps 31 to 700 Arips Swinuning Pool Above 700_Amps Above 100_Am s Transiormers Irrigation Booms ?U Partial%Other Fee Signs Special Inspection S !?Jn TOTAL FEE flemarks ' r.. flou9h-in Date ? , tha ElocVical Il/ ? Inspectm, hereby certify that Hre above Final '"e J? pection has been mede. TM5 raque5l volC 18 months tram This requast void 18 mon[hs fmm NP.QOESt OAIC Q _3 - ?y Pire No. RouPh-in InvVection R ?red? ? E]Rea7y Nuw Wfll Nolify, InsDac- 1 [or When fl d Yps ?Nn ea Y _P?Licensed Electtical Contractor 1 hereby requeat insOeclion ot above ? Ownar - alecirical work installed e[: Street AAdress, Box ar?ute? No/. City } ecuon o. Township Name or No. Range No. County Ocr,u nntIPRINTI Phon /N?o. Power SupDlier Atltlress Ele rical Convactor i ompany Name) Contracror's License No. Ma1il'n Ad ress IConvact r or wner Making Instailationl ?55ii,>1 r?vr ? . ?i.v S'53?7 Authorized SienaWre ConVact ner, king Installationl / Ph?? Nym?r? ?? ? o MINNESOTA STATE BOANO OF ELECTXICITY THIS INSPECTION REQUEST WILI NOT G?iggs-Mitlwey Bldg. - Room N-191 0E ACCEPTED BY THE STATE BOAflD 7821 Univarsity Ave., Si. Paul, MN 65106 UNLESS PPOPEN INSPECTION FEE IS ENCLOSED. Pnnn.. 16121 297.2111 1 CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 27•799, Eagan, MN 55721 N? 9068 PHONE: 454-8100 ' BUILDING PERMIT Receipt Te bs aed fer SF DWG/GAR Est. Vulue $68,000 Dare MAY 11 , 1 q 84 SiteAddress 768 ELRENE CT Erect ocR3 12 1 ? WINDTREE I ? ?upon?y Lot Block ec/Sub. Alter ? Zoning PN/A arcel No. 10-84470-120-01 Repotr p FireZone Enlarge ? Type of Cons- W Name GUSTAFSON & ASSOC Move ? # Srorie4 z Address 4015 W. 65TH ST Demolish ? Length City EDINA Phone 927-1127 Gwde ? DepthSq.Ft- ? Name SAME Aoorornls Feea s? Address 1- City Phone Name _ Address City - Phone I hereby acknowledge Ihat I huve read this application ond stote that the inlormation is correct ond ogree to wmply with oll opplicable Stote of Minnewta Storutes ond City o4 Eogan Ordirwnces. Sipnotum of Pertnittea _ A BuHding Permit is issued to: nll work sholi be done in acco Assessment Permi-=. 0 0 3 4 0 Woter 8 Sew. Surcharge Police .? Plan chetk 168.50 Fira SAC 525.00 Eng. Water Conn. 470 . 00 Planner WaterMeter 63.00 Council Rood Unit 260.00 Bldg Oft . . 85g- ' 00 APC . Tao IATES on the express conditlon thn+ wta Stotutes and City of Eagan Ordinances Buildirg Officlol ?3 l? 5)q1 s RESIDENTIAL BUILDINC PERMIT APPLICATION GTY OF EAGAN 3830 PILOT KNOB RD, EAGAN MN 55122 651-681-4675 New Construction Reouirements J registere0 site surveys showing sq, ft. of l06 sq. ft. ol house; an0 ail roofed areas (20%maximum lol coverage allowea) •? copies of plan showing beam 3window sizes: poured found design, etc.) . • 1 set of Eneryy Caiculations • 3 copies o( Tree Preservation Plan if lot plalted after 711193 . Rim Joist Oetail Options selection sheet (61Cgs wAh 3 or less unils) DATE TI I a 2 SIiE ADDRESS TYPE Of WORI APPLICANT IULTI-FAMILY BLDG fIREPLACE(5) _ 0 _ 1 _ 2 STREET ADDRESS "I ux- CITYVUUIy TELEPHONE #QSa'ffi'&VO CELI PHONE # 60-3L/6-7qa'a `' STATEHN ZIP 554ia0 # 9.048f- 94ig PROPERTYOWNER IOCF.I, rGll CJO TELEPHONE# ----------------------------------------------------------------------------------------------- COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ yIIVNESOT.A 12ULlS 7670 CXTI{GORY I MIV\ES(yCA RCI.L'S 7672 (v submission rype) • Residential VentilaGon Calegory 1 Worksheet Submitte0 • New Energy Code W • Energy Envelope Calculations Submitted D ? ? ? ? ? ? .?ut 12 2002 ? Plumbing Contractor: ___ Plumbing system includes: Mechanical Conhactor: Mcch:uiic>il s%stcm include,: Sewer/Water Contractor: Air Condiuoning _ HcaL RccovcrySystcm Phone # Phone # Fee: $90.00 Pcc: :S70.QQ ------------------------------- • --° ° --------------...---- • ----° -----° • ------- • ----- • ---- • ----------------------... _ _.. I hereby acknowledge that I have read this application, state that the information is correct, and ogree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordjqon es. Stgnafure of Applicant OFFICE USE ONLY Water Softener Water Heater No. of Baths Phonc # Iawn Spnnkler No. of R.I. Ba[hs I S7 ,,?-5 RemodeUReoair Reauirementa . 2 copies of plan • 7 set of Energy Calculations for heated aCditions . 1 site survey for exterioradditions & aecks . I`Micate i( twme served by septic system for adeitions VALUATION y , DDO Certificates of Survey Received Tree Preservation Plan Received _ Not Required _ , UpAated 4102 CITY OF EAGAN ?830 Pilot Knob Road Eagan, Minresota 55122-1897 (612) 681-4675 SITE ADDRESS: FAMILY RM/BEQRpOM ermit.Type SF AOOITION hlrk Type NEW eu? 434 ALT. RESIDENTIAL 768 ELRENE CT LOT: 12 BLOCK: 1 WINDTREE P.I.N.: 10-84470-120-01 DESCRIPTION: fGensus.'.Cod r ? n a p 9 ggF?-0 ^st s? ?`-?'?' ?, ??R. ??A'v ??G(`' $$ ?? i ? E p4 g` 1' BUILDING 031772 04/14J98 REMARKS: SEPARATE pERMIT REQUIRED FDR ANY PLUMBIN6 WORK. CONTACT STATE BOARD OF ELECTRICITY REGARDING ELECTRICAL PERMIT. PLAN REVIEWED BY MIKE BARCK. FEE SUMMARY: Base Fee Plan Review Surcherge Total Fee VALUATION PERMIT TYPE: Permit Number: Date Issued: $37,000 $457.75 $297.54 $18.50 $773.79 CONTRACTOR: - Applicant - sT. LIC OWNER: PARK05 CONSTRUCTION 14550031 0001171 FALBO DANIEL 1%10 S ROBERT ST 768 ELRENE CT W'WST PAUL MN 55118 EAGAN MN (fi12) 455-0031 (612)688-8615 ' i Mereby -acknowledge Chat.I have read appZieation°and this st;ete Che-t the ' infarm?ta.on is,.?orrect and ep to ca , mp,?j with A,11' ' ' ap?a?,ic atr?.? =ar?d'?C? ? ??,?Atut#? ty' o?f an 6 r ° . _ p " X . .S t ? F ? . . . ? .. .. ?:: ..: .._..._.., a ....._.? .. ' . . ...C._........???..._... . ...t.-.?..... . . _ ..? ._ .?.? . n ....._ ?,APP IGNATURE ISSYD BV: IGNATURE PERMIT ? ,6' P. ? ? 6t Zb Be Usecl Site Address CITY OF EAGAN BUILDING PERMIT APPLICATION Include 2 sets of plans, 1 Gertificate of Survey & 1 set of energy calcuJ„qtions. _ Date ? OFFICE USE ONL`. Lot /.,-- Block _4__ Sec./Sub. JL),,j d"FR te 1 Erect p?/,_ Occupancy 'e 3 Parcel #: /v - D 1?17D `/vZO - 0 kater _ zonina /el Repair Fire Zone Oc.mer: ? V,5'?gan d- 1?55 oC . Enlarge _ Type of Const. ? Address: L10JS W(' S?"' M°ve # Stories DHmlish Front y5 ft. City/Zip Code: 25--) r h j4, /hH . 53- '3r 3S- Grade Depth ft. Phone #: 9?2 ;?- // Z 7 Contractor: S r- Adclress: City/Zip Code: Phone #: Arch./Ehg.: Address• City/Zip Code: Phone #: APPROVAI.S F'EES Assessments Pezmit ?aater/SCaer Surcharge 3y ?' Police Plan Check Fire SAC - - SaS *?- EESzg. Water Conn. ?D ?- Plaruier Water Meter G 3 cow-,cil Roaa unit?la60 ?- Bldg. Off. D APC TOTAL /i rt ? - 0-?j 7 CITY OF EAGAN 3• ? 3830 PILOT KNOB RD - 55122 ? 1996. BUILDING PERMIT APPLICATION (RESIDENTIAL) 681-4675 New Gonslrudian Reauirement= RemodellReoair Reauirements ? 3 registered ade surveys ? 2 tro0ies of plan ? 2 copks oi plans (indude beam & window sizes; poured Md. design; elc.) ? 2 site surveys (exterior addRions & decks) ? 1 energy calcutelions ? 1 energy calculations for heated eddilions ? 3 copiea of lree preservalion plan N lot planad afler 7/1/93 required: Yes _ No DATE: I 6! p CONSTRUCTION C05T: '?i--- / /6 " ln.fi! S 1'f-1, ? DESCRIPTION OF WORK: I w /?oooi i-to-i /y 4 1/6 r- / v'r z/' s„ STREET ADDRESS: ? LOT `a BLOCK ? SUBD./P.I.D. #: ? PROPERTY Name: - OA4I?LU Phone #: owNeR ?. ..... C-7 Street Address: 1 City: rzvkn/t 'l! State: wLi Zip: ?' ?' I z 3 CONTRACTOR Company: + ? V??o C,,N( ) - Phone #: (14T" 003 ? Street Address: 1010 .S r LAL,6,<,-e- ? License #: // 7I City: w?7, State: bt'4 Zip: ARCHITECT! Company: ? Phone #: ? ENGINEER Name: / Registration #:? Street Addresso Ciry: / State: ? Zip: ? Sewer & water licensed plumber: &,7zxs?/ ??i.lwl'YY ?o change are requested once permit is issued. I hereby acknowledge that I have read this application and state that the applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant: OFFICE USE ONLY Certificates of Survey Received _ Yes No Tree Preservation Plan Received Yes No Penalry when address change and lot agree to comply with all OFFICE USE ONLY BUILDING PERMIT TYPE ? 01 Foundation ? 06 Duplex ? 02 SF Dweiling o 07 4-piex ;w-_03 SF Addition o 08 8-plex ? 04 SF Porch ? 09 12-plex 0 05 SF Misc. ? 10 _-piex WORK TYPE F-'q""''N' `Y 2 v'- ? 31 New o 33 Alterations ,?Q., 32 Addition ? 34 Repair GENERAL INFORMATION Const. (Actuat) (Allowable) UBC Occupancy Zoning # of Stories Length Depth APPROVALS Planning ? 11 . Apt./Lodging ? ? 12 Multi Repair/Rem. ? ? 13 Garage/Accessory o ? 14 Fireplace o 0 15 Deck /1-4 i??-) < nEpr?uorti ? 36 Move 0 37 Demolition 16 Basement Finish 17 Swim Pool 20 Public Facility 21 Miscellaneous fi-4r-? iT i J ? MClWS System City Water Fire Sprinklered PRV Booster Pump Census Code. SAC Code Census Bidg Census Unit Basement sq. ft. Main level sq. ft. sq. ft, sq. ft. sq. ft, sq. ft. Footprint sq. ft. Building 6Q Engineering Variance i 4l a ? ! v I. I Permit Fee Valuation: $ 37 6 • Surcharge ?rh2°"/?j I,% "1 Plan Review license MCNVSSAC s?/- g?.z.- City SAC Water Conn. ?F? Q ? r ? v+? F?-?'^ r,-m Water Meter Acct. Deposit z,-- G. ?? y = 37 3 ?1 4?-4/ S/W Pertnit - 5/W Surcharge G Treatment PI. / Road Unit Park Ded. Trails Ded. Other Copies Total: % SAC ; SAC llnjtSii Dakota County Real Estate Inquiry Pabe I of 1 ----- - ? -; , % MIUNES07A S7A7E 4UILDING CODE DIVISI0:1 EXTERIO OIdNER SITE ADDi2ESS ?b L CONTRACTOR , R ENVELOPE AVERAGE "U" COMPUTA7ION . - ? DNTE ' - ° I PNONE Y1 Determine vrorking square footage of each. l. Total exposed wall area ...... _1? sq. ft. x,i! 2. Total roof/cei 1 i ng area . _ . . . ~ °• ? ? sq. ft. x Total exposed wall area above floor ?.A? , a. Total wall window area ........................... b. Tota7 door area ................................. r? c. Total sliding glass door area ................... d. Total fireplace wall area ........................ -? e. Total wall framing area (average 101)...:........ f. Total net orall area above floor ................. . ? g. Total rim joist area ............................ oY Total exposed foundation area = ' y h. Total foundation window area ..................... ? i. Toal net foundation area above grade ............ Determine "U" value of each ti•rall segment. ? b. C. X "U" ; i = - •, x „ul, x d. ? X ]lull •? _ -IJ e. X u?? 7y X„ull g , S X 'lull h. ? X "U'l X "U., 3 .....................................Tota1 = Y?J O If item r3 is the same as, or less than item r'l, you have met the intent of SaC 6006(c)2. ? f j. ?otal s4:y?ic,ht zrez............................. 13 k. 7ota1 roof/ceiling framing area (average 10%)... .s 1. 7otal net insulated roof/ceiling area........... ..Zl' Determine "U" value for each roof/ceiling segment. J X llu,? X 1'U.1 1. ' ? ) ? ?Ir 4 ..................................7ota1 If total of €4 is the same as, or less than r2, yrou have met the intent of SBC 6006(c)1. Alternate Euilding Envelope D To utilize the total enveiop? system me?hod, tl',e sum of ite:r;s f3 and r4 shal', b-2 gr<^ater thar-, 1_ . ? 7? `?? ._- --- + 2.-- 7-- ,??: ` .s< 3. t ? ' > ?-- --- + 4. " ---- =sign values established by the the sum of items ;1 and :2. = 7 ? 0uv ------- ;7i, J `, / !l? Total exposed roof/ceiliny area = .. " • !????S7rzv? ?v???z??? MINtIESDTk STATE QUILDING CODE DiVISION EXTERIDR EN4ELOPE AVERAGE "U" COMPUTA7IOti I? 04lNER 'vi f.e SITE ADDRESS VE4;..': CONTRACTOR DATE PHONE Determine aiorking square footage of each. 1. Total exposed wal l area ... . .. " ,,. ',,, ? sq. ft. x 2. Total roof/ceiling area ..... sq. ft. x ???`e = ;, ?Y Total exposed wall area above floor = '. i7 a? , a. Total wall window area ........................... b. c. Total Total door area ................................. sliding glass door area ? ................... s d. Total fireplace wall area .... ...... e. Total Urall framing area (average 10°6)...:........ ? f. Total net wall area above floor ................. g. Total rim joist area ............................ Total exposed foundation area = 2;.7 ? h. Total foundation window area ..................... rO i. Toal net foundation area above grade ............ "U" value of each wall segment. .5 a- /? X „ull , ; ) _ '?) !? b. ? X „U', ? = J c. Ie - X 'Jul' > d. J X ,, U„ e• X ??u- f. 2 °; X l.ull 9• 'v X „ull h. X ',ull ,) _ !J x „u„ 3 .....................................Total = 'q If item #3 is the same as, or less than item r'l, you have net the intent of SBC 6006(c)2. ? 7ota1 exposed roof/ceiling area = ,?) ?• -?"( ? ..... J. 7otal s1:yligh'c ar-ea........................ k. Total roof/ceiling framing area (average 10%)... 1. Total net insulated roof/ceiling area........... Determine "U" value for each roof/ceiling segment. J. x "u" --1 _) -?- - ° - X 1. u.. 4 ..................................Tota1 If total of 44 is the same as, or less than r2, you have met the intent of SBC 6006(c)l. Alternate Euilding Envelope D2sign To utilize the total enveiu;;z system method, th,e values established by the sum of ite.r.s 4.-3 and ,-`,'4 shal' r.` be greater tF:an the sum o` items ,'1 and r2. 1 . ? ' / r ? = + G2, 3. ?/? ??------ + 4. -- -- ----'---- ,. . • ? .? ?: . . ?,oT / Z- • 1 ? `;o . - EXTERIOR EbIVELOPE AVERAGE °U^ COMPUTIITION SITE ADDRESS -rr ?3 I I f? CONTRACTOR DATE PHOt1E Determine working square footaqe of each. 1. Total exposed wall area ..... 135'1-sq, ft. X r .?r -_ 2. Total roof/ceiling area ...... 1 (0 sq. £t. X?! - I A. Sotal wall window urea ......................... ? 8. Total door area ................................. C. Total sliding glass door area .................. $5 O - D. Total fireplace wall area....................... E. Total wall framing area (average 16V) .1?.... i. l P. 1bta1 Rim joist area ............ ....•.•....... G'. Total Net wa11 area above floor.•••--•--..-••••• Total exposed f.oundation area - .. H. Total foundation window area ....................' ? S. Total r.et foundation area above grade........... ? Determine "U" value of each wall segment. a.X"U" , J D a}S.OI.? b. X -U.- .??? - ?•z? C..?_ X -U- . 4 C4 . , d. X "U" e. 11 Z X "U" f.14a X "U" g. 77 S .U-- h. ? X "U" i.? X "U" .Oy? 3g.?a ? -4?7 a T4l f 3 ...................................Tota1 -= G zl. If item p3 is the same as, or less than item #1, you have met the intent of ? SSC 6006(c)2. ,, • ? ? ',j. •, ? t.. 2ota2 exposed roof/ceiling area ? j. Total skyliaht area ................................ • .k. Total roof/ceilir.g frsmi.nq azea (averaqe 10$)...... 1. Total net insulated roofJceiling area .............. Determine "U" value for each roof/ceiling segm_nt. j. .?-.. x tlu,l k. ?ZO x "U" 1. ??7(o X"U" ..................................... 2bta1 • - ? If total of #4 is the same as, or less than !I2, you have met the intent of SsC 6006(c)1. 't Alternate Building Envelope Desiqn__ To.utilize the `otzl envelope system method, the v-aluP.s ectablished I-y :Y_ sum of iter.u 43 ad #4 shall not be greater thaa the sum of :.t?.rs ;,t and x2. i. ?50.4 q + 2. s. rq 7. S'Z- + a. 32r = 2 7 '1 •. -?a . . ?.7.1 ? v... ? 1. r film I terior i 0.6 2 • ? /.?? 1/? '4S 3, 4. 5. 3/-t-incres sofr_ caood ?;/u.. T1-4fFJL124-+A R-w hi o?nity 4, 3-'`i fD.OQ.. • 6. Exterior air film : 0.17 Total • U=.o$ s? L ?tN M;D?uTcx CkS,L FRAfiE S+IA7•i• FIG. 43 v . e- . • p ? . o . ? ' r a. • . . ? ?• : ? . .. e Construction R-Value 1. Tnterior air fi.lm 0.68 2• ? Z g N'62?"T2oc?. '4S 3• I I, U O 4. G,o 5. ?1n>>.:v , 6. -- Exterior air fiZm 0.17 . . ,. Interior Total - air film v _ , ?? 0.68 2. op 3. I?/z " ?o?-r?•tro o l ? A fs s. . 94 o. Exterinr aiY f-ilm 0.1.7 1. Interior , Totzl air film 0.68 2. ?Z CO 1vL ?°"?L f'-. ?• Z53' . 3. • 4. 5. ' 6. Exterior air film 0.17 . Total 2? ?? -! SLAB ON GRADE A • /" • • ` 6 • ? ? , t 1!( r = , . ??? ? v • • . . FIG, fl4 ? k . ? f!t 6 . t ° ? Y, X --4 N( c It? ? 1ir ? NOTEs. Indicate tyne, "8" value, denth and ' placenent of i nsulation. vJF1LL S6CT:ONS tuOTE: •:isl- 15g of opaque wall area £or ? frame caistruction _ ? . J . • ? _ , , . ,_ • •? • RCOt/CEILING Construction (Use for Ztem L) x-Value ? ?-Y?,! s? t - q i -?<<";iME v?;r ?` ...? ;-? 1 t.2 .. Venced fleaC flow . . V ? up FIG. #5 ? 1. Interior air film 0.61 2 3. . laFk?G="7" ?'nG+L. , 5(0 4. Extcricr air film (still) O.U Total 45.?'F . U -rL .»? . CI,G. FRAMSNG(Use for Item K) 1. Interior Air film, 0.61 3. Inches soft wood * 4. Inches.insul above framin ? 7j2 5. Air Film 0.61 U 1. zr1terior air film 0.61 2. 3. 4. Exterior air film (sfill) 0.62 2ota1 [Heat flow up -vented. . FIG. #6 . ' . , 2. Inside air film 0.61 2. 3. 4. 5. Outside vir film 0.17 Total Notc: E)sc a3ditional shccts if mort- st?zce i:, ^ needed for drtails and calcuZations. ' • . . . R , va,?_. t v.` I-: !?.e1 S_oY^=_?L'/'O-?' _-? C?'1?-L_ d F.s 1 . HcaL U flew up - '. 1`Tr,, a7 ? . • • 2/84 sm ? CITY OF EAGAN APPLICATION FOR PEf2MIT r SE:vER AND/OR WrITER CONNECTIO.i " (PLEdSE PRIHT) 1) PP.O°= ACD.RESS: / S? U /` Cf) J ?LT- r Fr.,i, DFSCRTtirTcN: ,Z o T l? Tfi'?r i4 D/J (I?t/31ocx/Su:cLivisic.^. or Tac parcei I.D. :iur;ter) iE•5:?= :G D= G=' ORZGi.:AL ?ii1L:T`:G F.T:!T'^ TSa?.J:Cu: ( ==_- ? R-2 DLTOI.E{ (Tti:b LNITS) ? R-3 'ICi,?1i1F',CZiSE (T:Tt:W + TjNI,S) ( Wi I^_S) ? R?d ?op,Rmm•,.??`SJCiL7i;::1 ( TITNIiSi p cC-H=.cz^,L/?.-Taii?oFF?cE ? rmLS-,=:?L Q NST=IO_v'AL/GGV??:-+,'^ 2) APnI,rG._,;p (PLEdSE PRINT) r S d -S S ? Mn.;ESS: ? d?S L? 6 7"H cr:^r, s=, zrp: ?A) Px=: I o2 ? -- ? ? 07 ?- 3} p=.= NFv-?: (P?L"tA7SE PAI?iO y? ? ? FOR CITY USE 091Y C YGi? ?7 -1! fl J°?/t/ ADDRESS: PLIIH?EAS LICE45E: % ? Attive CITY, STATE, ZIP; Expired PHOiIE: pLUxBER LICENSE tl 19,2 ? Not oi Record arr tnt[ia 4) UC.LtiPPS.P/CI,v?I'?..4 , trLca?c rniniJ a r'F"'?: 7"f???c2A? _?-fl.f t r F ADDkE55: / ` CITY, STA'I'L, ZIP: 7-- 1) . ?11 M ?t,4 A) PHO?IE: ? 5) INpIC= W'HICH PEP:,lIT IS SEP:G RDQUES'I'ED: ? CC,=1IGN 2t7 CZTY S?.?•IEc2 ? CC::NFY.TSG.I 'IO CITY WATL12 ? GTYx..? (PLFIISE DFSC2ZEE) 19 PT- 1'LE F:OLD r`,PPRpVF?J pg2;•tiT FOR PIGK-UP BY ONE OF r'1BGVE ?Tr1IL APPROt,"ED PE.?'•tIT 'Il7 1, 2, 3, 4 P.EO',IE J 'y (Circle one) 7) DAT'E : -- / F 0 R C I T Y U S E 0 N L Y PERMIT " ISSUED 17 - 7 F°ES: $ ?- d i o. ? Crr:--c, nEn•.ir?., ?.,1..-•.,_. .,?...y_ .:c._. $ /6•-? G WATER PERf'[IT (Ii7CLtiDE SURCE:ARGE) $ WAT°R METER/COPPERHORN/OUTSIC-= REACER $ WaTE' TaP (INCLUDE COR?ORATIO;; S^C?) $ SE:•]ER m., n $ ACCOU.IT GEPOSZT - SET.:cR $ ACCOUNT DE°OSIT - WATER $ I-Z/76-o-U WHC $ $rZC $ TRUi7F ?•:ATER aSSESS.:E\T $ TRliNF SE:QER ASSESSi•1EDiT $ LATEP,E.L BLNEFIT/TRUNiC SE;•:ER $ LATERAL BENEFIT/TRL'.Iri WAT°R $ OTHER $ TOTAL $ AMOU:]T PAID/RECEIFT ; 90ES UTILIT'1 CONNECTION REQUIRE EXCAVATION ZN PUBLIC RIGLiT OF L3AY? YES IF YES, THEN A"PERMIT FOR WORK SJITHIN ? PUBLIC ROADWAY" MUST BE ISSUED BY THE NO EIQGINEERING DIVISION. :,ZST AS A CONDI- TION. SUIIJECT TO TIfE FOLiOWIPIG COPIDITIONS: APPROVED BY: TZTLE: DATE: MR irw ws mwsw wr ???a ws? ?t? w? w s? w? w? ?t? w+? r? r? aa wc ?? s?+ wea R? ?a ? w w? i / CITY USE ONLY ZL? BL. RECEIPT #: SUBD. I! RECEIPTOATE: 5?d F I 1998 PLLJMBING PERMIT (RESIDENTIAL) CITY OF EAGIiN 3830 PILOT KNOB RD EAGAN, 4MI 55122 (612) 681-4675 Please complete for: ? single family dwellings ? Cownhomes and condos when permits are required for each unit ? 13ackflow preventer for underground sprinkler system FIXTURES Shower Water Closet Bath Tub Lavatory Kitchen Sink Laundry Tray Hot Tub/Spa Water Heater Floor Drain Gas Piping Outlet ' minimun Rough Openings Water Softener ' for dwelling: Water Softener ` for existing U.G. Sprinkler ' for dwalling Alterations ' to existing i Water Turn Around Private Disposal System ' (new and refurbished systems) Private Disposal Systems' RPZ (new installation only) EACH # TOTAL 3.00 x - 3.00 x = 3.00 x = 3.00 x = 3.00 x - 3.00 x = 3.00 x = 3.00 x = 3.00 x = • ? 3.00 x = 1.50 x = under construdion 5.00 X = ,velling 20.00 X = inder const. 3.00 = bowill 20.00 iidence 20.00 = ?D 20.00 = IPC iia 75.00 = 20.00 = 20.00 = STATESURCHARGE a.SOSv TOTAL '-"-----'--_'-"""--•"_.._"--------_""----"-------'-"-'--"""--'-"-'-----"---"---'----'---"" I hereb acknowled9e lhat I have reatl this appliw6on, state that the inPormation is correct, and agree to wmply with all applicable City of Eagan ordinances. Y 11 It is the applicanPs responsibility to `notify the property owner that the City of Eagan assumes no liability forany damages caused by the City dunng itsnormal operational and maintenance adivities to the facilities tonstrvcted under this pertnit within City propertylright-of-way/easement. SITE ADDRESS: OWNER NAME: INSTALLER NAME: TELEPHONE #: to VG STREETADDRESS: /00?u CITY: STATE: ZIP: 4/- c7y SIGNATURE OF PERMITTEE CD/PERMIT FORMS/RPLBG PERMIT (RES) - 1998 .I 1999 BUILDINC PERMIT APPLICATION (RESIDENTIAL) New Conshuetton Reaulremenh CITY OF EAGAN 3830 PILOT KNOB RD - 55122 U_ So 651•681-4675 Remodel/Recah Reaolr? erds-' ? ? D 3 ragisiered sHe surveys showing sq. M. oflot, sq. M. o} house and QII rooled areas (20% maximum lof coveraae allowed) Y 2 coples of plana (show beam 6 window sixer, poured ind. desfgn; Mc.) ? 1 aet of energy caleulationa ? 9 copies of free presenafion plan tl lot platted aMer 7/1 /93 DATE.- DESCRIPTION OF 1 STREET ADDRESS: LOT: _Ld-BLOCK: I SUBD./P.I.D. #: W 2 copies of plan i set of energy caleulatloro for heaied addNlons 1sMe survey tor exferior addHiona a decks 4t CONSTRUCTION COST: 4 0-0 Name: T Gt. L DG.V I `? JO(.! V Phone #: (0?;-/"?l`'/??Q 45 PROPERTY ?ar fint OWNER r L Street Address:_ City La ga 1i State: M /) • Zip: -6/vzt-? Company: Phone #: (area code) CONTRACTOR Sfreet Addreu: License # Exp. Cify State: 'a-im - Zip-? ARCHITECT/ r-'ENGINEER Company: Name: Telephone #: area code ( ) Sheet City Sewer & water Ilcensed plumber (reaulred for new consfrucflon onNl: State: Penalfy appites when address change and lot change is requested onee permN Is Issued. Zfp: IYhereby acknowledge fhat I have read Ihis applicaflon, state that the InformaHon Is cortect, and agree to comply wfth all Sfafe of Minnesota Statutes and CRy of Eagan Ordlnances. ----% i? , j Certificates of Survey Received _ Yes Signafure of ApplicaM: ? OFFICE USE ONLY _ No Registration #: Tree Preservation Plan Received - Yes - No - Not Required OFFICE USE ONLY BUILDING PERMIT TYPE . ? 01 Foundation ? 06 4-plex ? 11 10-plex ? 16 Fireplace ? 21 Porch (3-sea.) O 02 SF Dwelling ? 07 5-plex ? 12 12-plex ? 17 Garage ? 22 Porch/Addn. (4sea. ? 03 1 of _ plex ? 08 6-plex ? 13 16-plex 7CK 18 Deck ? 23 Porch (screened) ? 04 2-plex ? 09 7-plex ? 14 Apartments ? 19 Lower Level ? 24 Storm Damage ? 05 3-plex ? 10 8-plex ? 15 Lodging ? 20 Pool ? 25 Miscellaneous WORK TYPE ? 31 New ? 35 Tenant Impr ? 39 Gas. Line Only ? 43 SidinglSoffits/Fascia ? 32 Addition ? 36 Move Bldg. ? 40 Gas Insert ? 44 Windows/Doors ;;r 33 Alteration ? 37 Demolish Bldg.* ? 41 Wood Stove ? 45 Fire Repair ? 34 Repair ? 38 Demolish (Interior) ? 42 Reroof ' Give PCA handout to applicant for demolition permit GENERAL INFORMATION Const. (Actual) 5-4 Basement sq. ft. Census Code 3` (Aliowable) 5, W Main levet sq. ft. SAC Code ° I UBC Occupancy Kz ''5 sq. ft. No. of Units I Zoning sq. ft. No. of Bidgs d # of Stories sq. ft. MC/ES System Length sq. ft. City Water Width Footprint sq. ft. Booster Pump PRV _ Fire Sprinklered APPROVALS Pianning Bu ilding Engineering Variance Permit Fee Surcharge Plan Review License MC/ES SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment PI. Park Ded. Trails Ded. Other Copies Total: Valuation: a SAC Units % SAC C[TY USE ONLY LOT BL ? SUBD. RECEIPT #: ? ?a27Y RECEIPT DATE: 1998 MECHANICAL PERMIT (RESIDENTIAL) " CITY OF EAGAN 3830 PIIAT IINOB RD EAGAN MA7 55122 Date• (612) 681-4675 Complete this section onlv if you are installing HVAC in single family, townhomes or condos under construction and not owner /occupied . • HVAC: 0-100 M B T U $ 24.00 ADDITIONAL 50 M BTU 6.00 • Gas outlets (minimum of one required @$3.00 ea.) • State Surchazge: .50 • TOTAL: Complete this section onlv if you are remodeling, adding to, or repairing existing single family dwellings, townhomes, or condos. Note: Mechanical permit is not reauired for alteration/add-on to ductwork in existing residential units; but is required for the following: X- Install fumace _ Install air condidoning Install air exchanger, i.e. Vanee system, etc. _ Other Minimum fee applies to all remodel or add-ons of existing residences $ 20.00 State Surchazge .50 Total: $ 20.50 SITE ADDRESS: / li?lS ?? ??? E (?kT OWNERNAME:,-1)A-nJ1-.TLl,DY F,4LCR0 PHONE#: INSTALLER NAME: PHONE #: TS7 ? ??'? STREET ADDRESS: C1TY: _ d • ?% ? 7?4L STATE: &?2 Z[P: SSD ? ? ? ? 1? S NATURE OF PERMITTEE 1S/FORMS BLD/MECH PERMTT (RES) - 1999 SUBD. (/L BL CITY USE ONLY RECEIPT #. 97A11 RECEIPT DATE ? a g 9 998 PLUMBING PERMIT (RESIDENTIAL) CITY AF EAGAN 3830 PILOT KNOSRD ' . EAGAN, t1DI 55122 " (612) 681-4675 Please complete for: ? single family dwellings .. ? t?iwnhomes and condos when permits are required for each unit ? tiackflow preventer for underground sprinkler system FIXTURES Shower Water Closet Bath Tub LeYaiufy Kitchen Sink Laundry Tray HotTub/Spa Water Heater Floor Drain Gas Piping Outlet ` minimun Rough Openings Water Softener ' for dwelling: Water Softener ' for existin9 U.G. Sprinkler 'fordwelling U.G. Sprinkler " for existing Alterations * to existing r Water Turn Around PrivateDisposal System ' (new and refurbished sys[ems) Private Disposal Systems *, RPZ (new installation only) 'i i,a-.ei,yr e j,4??yAedyg Ihp} I havu .up It is the applicanPs responsibility to normal operetlonal and maintenanu SITE ADDRESS: EACH # TOTAL 3.00 x = 3.00 x = 3.00 x = - .S.UU X _ 3.00 x = 3.00 x = 3.00 x = 3.00 x = 3.00 x = i . 3.00 x = 1.50 x = mder construction 5.00 x = vefling 20.00 x = nder wnst. 3.00 = +uelling 20.00 iitlence 20.00 = 20.00 = IPC ua 75.00 = )andonment 20.00 = 20A0 = STATE SURCHARGE 50 TOTAL --------------------.: _ --------------------------------------------° °--------°----------------- thie ?..?,nfi_ary'nn, gtah fhzf {hn ia C•••e_{, and agme•^ x••:ply k^.th eit erolicatiig Ci!; nf F8g8n crdinancess. iotify the property owner that the City of Eagen assumes ao Ilability,for eny damages caused by the City during ik activities to the fadlilies constructed untler this partnit wkhin Cily property/righ4ot-way/easement. OWNER NAME: ?iY./? I?` ?D INSTALLER NAME: STREET ADDRESS: arv: U % ?TG? ?• TELEPHONE #: o?O?B'7??1J STATE: M? ZIP: ld 2- CDIPERMIT FORMSlRPLBG PERMIR (RES) - 1998 CITY OF EAGAN WATER SERVICE PERMIT 3830 Pilot Knob Road P. 0.-Box 21199 PERMIT NO.: Eagan, MN 55121 DATE: Zoning: No. of Units: Owner: Address: - -- Site Address: Plumber: — Meter No.: Connection Charge: Size: Account Deposit: Reader No.: Permit Fee: 1 agree to comply with the City of Eagan Surcharge: Ordinances. Misc. Charges: By Total: Date Paid: Dote of nsp.: % Insp.: CITY OF EAGAN SEWER SERVICE PERMIT 3830 Pilot Knob Road P. O.41ox 211 PERMIT NO.• Eagan, MN 55121 DATE: Zoning: No. of Units: Owner: Address: Site Address: Plumber: 1 agree to comply with the City of Eagan Connection Charge: Ordinances. Account Deposit: Permit Fee: eiV Surcharge: By Misc. Charges: Date of Ins %' y p" Total: Insp.• Dote Paid: PERMIT City of Eagan Permit Type:Building Permit Number:EA112816 Date Issued:08/23/2013 Permit Category:ePermit Site Address: 768 Elrene Ct Lot:012 Block: 001 Addition: Windtree PID:10-84470-01-120 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 $105.25 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Daniel L Falbo 768 Elrene Ct Eagan MN 55123--123 (651) 325-7450 American Exteriors of Minnesota LLC 1408 Northland Drive #106 Mendota Heights MN 55120 (303) 865-3328 Applicant/Permitee: Signature Issued By: Signature  !" #$%&'()'*+*, -./$%'"&0-1 -FL*,$F*4 -./$%'63/7-.189::NAN =*%-'!>>3-519?@A:@A?9; -./$%'#*%-+(.&1--./$% B$%-'855.->>1''ON<''4.-,-'#%''  !";#$%& ''!!"())**+ '',*+)1-- 456 "!78FFZ!7!"7";!' <.- =->F.$0%$(,1 =0/'>2?- B-.*)-+*C$ ,1&'>2?- B-?$C%- 6-.%1*?*+ J01+C%-'\\'(*1'E+)**+-1 ^0-.*+.'1-HC1)*+H'-$-%1*%C$'?-1L*'1-I0*1-L-+.'.N0$)'/-')*1-%-)''=C-'X$-%1*%C$'5+.?-%1Q'DC1&'(+)-1.+'C'SW:;\[' #(//-,%>1 FF:7;8F!O EC1/+'L+R*)-')--%1.'C1-'1-I0*1-)'@*N*+'"!'P--'P'C$$'.$--?*+H'1L'?-+*+H.'*+'1-.*)-+*C$'NL-.'SD*++-.C'=C-' DX'7'4-1L*'J--'SB-?$C%-L-+.\[U:WO!!'!8!"OF!88 G--'B3//*.&1 =01%NC1H-7J*R-)U"O!!'W!!"O;"W: "(%*41HN?I??' #(,%.*F%(.1JK,-.1 7''(??$*%C+''7 #+P-c.'4$0L/*+H'\\'\]-C*+H6C+*-$''JC$/ :!:'BC+)$?N'(M-Z98'X$1-+-'E ='4C0$'DY''::"!;XCHC+'DY''::";377";3 S9:"\[';;87W!Z"S9";\['89!7W3:8 5'N-1-/2'C%&+@$-)H-'NC'5'NCM-'1-C)'N*.'C??$*%C*+'C+)'.C-'NC'N-'*+P1LC*+'*.'%11-%'C+)'CH1--''%L?$2'@*N'C$$'C??$*%C/$-'=C-' P'D*++-.C'=C0-.'C+)'E*2'P'XCHC+'K1)*+C+%-.O (??$*%C+A4-1L*-- '=*H+C01-5..0-)'#2 '=*H+C01- PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA140936 Date Issued:02/01/2017 Permit Category:ePermit Site Address: 768 Elrene Ct Lot:012 Block: 001 Addition: Windtree PID:10-84470-01-120 Use: Description: Sub Type:Residential Work Type:Replace Description:Water Heater Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). 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 - Daniel L Falbo 768 Elrene Ct Eagan MN 55123--123 Bonfe's Plumbing & Heating 505 Randolph Ave St Paul MN 55102 (651) 228-9071 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA167887 Date Issued:04/01/2021 Permit Category:ePermit Site Address: 768 Elrene Ct Lot:012 Block: 001 Addition: Windtree PID:10-84470-01-120 Use: Description: Sub Type:Reroof Work Type:Replace Description:Does not include skylight(s) Census Code:434 - Residential Additions, Alterations Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Please print pictures of ice and water protection and leave on site. We encourage you to retain an electronic copy of photos until the project passes a final inspection. *Roof permits issued between December and March will be inspected in the spring or when weather warms up. Valuation: 5,000.00 Fee Summary:BL - Base Fee $5K $118.00 0801.4085 Surcharge - Based on Valuation $5K $2.50 9001.2195 $120.50 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Daniel L Falbo 768 Elrene Ct Saint Paul MN 55123--123 (612) 860-9358 Minnesota Restoration Contractors Inc 12252 Nicollet Ave Burnsville MN 55337 (612) 280-4807 Applicant/Permitee: Signature Issued By: Signature