638 Hillside Dr
y' Use BLUE or BLACK Ink
r
For Office Use 1
Permit q j
City of Ea ;
Ed~
tl 20? 1 Permit Fee: 1
3830 Pilot Knob Road 1 I
Egan MN 55122 Date Received:
Phone: (651) 675-5675 I I
i Staff:
Fax: (651) 675-5694 cop
cvqt
2011 RESIDENTIAL BUILDING PERMIT APPLICATION s -°7= 0
Date: Site Address: Unit
Name: O asa Phone: 6~ 1-
RESIDENT /
OWNER Address / City / Zip: (~z)2 ~f~^~ ~,aj~+4v►
Applicant is: Owner Contractor
TYPE OF WORK Description of work: Zei 1 F L
Construction Cost: ~~0_®, ao Multi-Family Building: (Yes / No
Company: 1 D hn, Gt--,4Y ,~lQb., dS ::-LrLt, Contact: Vs h^
CONTRACTOR Address: t T73 9 =,=5e17_- F qa c City: Z_44' uecfil c- W41,
State: _P"k4 Zip: Phone:l Z 90
~~f 3
License aa~L 1,9 0 Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
J a.5s,_ 11) 'g-
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 the 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.aopherstateonecall.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 s. - A...
x Gt?a \J V
Appli ant's Printed Nam Applica is ignature
Page 1 of 3
DO NOT WRITE BELOW THIS LINE
SUB TYPES
Foundation - Fireplace _ Porch (3-Season) _ Storm Damage
Single Family _ Garage _ Porch (4-Season) _ Exterior Alteration (Single Family)
Multi _ Deck _ Porch (Screen/Gazebo/Pergola) - Exterior Alteration (Multi)
01 of _ Plex k Lower Level _ Pool _ Miscellaneous
Accessory Building T
WORK TYPES
New - Interior Improvement _ Siding _ Demolish Building*
Addition _ Move Building _ Reroof _ Demolish Interior
Alteration _ Fire Repair _ Windows _ Demolish Foundation
Replace _ Repair _ Egress Window _ Water Damage
Retaining Wall *Demolition of entire building - give PCA handout to applicant
DESCRIPTION
Valuation 0 Occupancy- MCES System
Plan Review Code Edition LA5SAC Units
(25%-100%4) Zoning City Water
Census Code Stories Booster Pump
# of Units Square Feet PRV
# of Buildings Length Fire Sprinklers
Type of Construction --1- Width
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Footings (Deck) Final / C.O. Required
Footings (Addition) Final / No C.O. Required
Foundation HVAC _ Gas Service Test Gas Line Air Test
Drain Tile Other:
Roof: -Ice & Water -Final Pool: -Footings -Air/Gas Tests -Final
Framing Siding: -Stucco Lath -Stone Lath -Brick
Fireplace: -Rough In -Air Test -Final Windows
Insulation Retaining Wall: _ Footings _ Backfill _ Final
Sheathing Radon Control
Sheetrock Erosion Control
Reviewed By: Building Inspector
RESIDENTIAL FEES _
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 3
jaw ?-
?
' -- ?
Wtrtificate af CccupancV
Wtt4 nf Cfagan
2cvarin cnt of Zambia auloocctiox
Tliis Certifrcate issued pursuant to the requirements of tiie Uniform Building Code
certifying that at the time of issuance this structure was in compliance with tite various
ordinances of the City regulatirsg building construciion or use. For the joUowrng:
vse classirkauon: SF DWG s1dg. Permic No. 1644
Oocupmcy 7ype Zoning District Type CaFASt.
Owner of Buildieg•??P OONSTR=QN pddress 17354 rniACpi CT, LAKEVIELEE
n,•„ ?, _ Address 638 HffIl,SIIE DRTVE LocWiry L 1 I, , HIIR QAR
12/21/Q2
1
sUaaB* offkiai
POST IN A CONSPICUOUS PLACE
- INSPECTION REC4RD ? Control No.- 1200 ?
. CITY 4F EAGAN RWrivann Frox nEac 07120193 PERMiT TYPE: ^ov ll n Imq
3830 Pilot Knob Road -MM"? 688-7889 PeRnit Number. •Oi644
Eagan, Minnesota 55123 Date Issusd: 10/ i61g2
(612) 681-4675
SITE ADDRESS: 10r: Ii 1410(4: ? APPLICANT:
r, :rs N1.1.1srUE nR +UM UP CANST
HIlt? OAK H T l. t S 2plp (612) 692-3282
PERMIT SUBTYPE: TYPE OF WORK: ,4.` 1)Wtt ' ? ; 11?N
m
?f.?,. .. J'?+ 7 i b4•6 Jtt h?JI i`P ?i?7M' ? ,,'?.c-?`?
??y??..,,, ? yt??;??? y e?•`? ? ?i'`
?:,i?itii:. A?
IQ?- MNRK "_+ t ', b W CclMTRAC TOR
--
Permit Na. Portnit Holder dah Talaphone #
S/VH
PlUMBING
HVAC
ELECTRIC
ELECTRIC `
Inepection bals h?ap. Commerds
Footings I
Foundation
7
F?eming
Roofing
Nou9h PIDB• -?/
?
Raugh Hte.
[
loul.
F"e*`e YAZ
'"°e" 1- sr-Y
Orsat Test
Final Plbg. Plbg. InspecDor- Notify Plumbet
Const. Meler
EngrJPlan
e,dg. Finel
Deck Fip.
oeak Fi?oJ
wen
Pr. Uisp.
K 5 8 7 I,?X? /n/
Requ/es Oate
/ O? ?L ~ f? Fire No. Rough-in InepBdwn
Rea iretl,
Yes G No
? Reatly Now Yf?Vill NMify Inspedor
T ?VIen qee0y?
1.7426licensed contractor ? owner hereby request inspection of above electrical work at:
Joe Aetlress f9tree Box ar Ro?me,?o 7
?o r3 ? f?i l Crty
Sedion No Township Name or No Rarge No Cou:b,,
OccuOan? IP INTI
' ,( Ji cw Phone No
'? 1- Z^ ) <? ki Z
Power SuppLer ?
J /10 AGtlress / ? ?
Elecmcal ConVactor (COmpany Name) p-/
J G F? ICGfIC1 L Conhacror§ lacense No /
Mailing pd ess 1 onvactor or Owner Makmq Install ion?
Authorii jgtl SiGp¢Wre (COmraclo ner Maki nst latron)
??l Pnone NumEer
VZ 1- X/3
MINNESOTA STATE BOAPD OF EIECTRICITY THIS INSPECTION REOUEST WILL NOT
Gri99a-Mlcway Bltlg. - Poom 5-073 BE ACCEPTED BY THE STATE BOARD
1821 Ilnrversity Ave.. St. Veul. MN 55100 UNLE55 PFOPER INSPECTION FEE IS
VIwM (612) W2-0800 ENCLOSED
ELECTRICAL INSPECTION
? See instmcLOns far compleang wflorm on beEk of yellow copy
5
?- 6 f? " 0 7
10604?' :'X` Be/ow Work Covered by This Request
ew
Add
Rep -
7ypeofBUtldmg
AppliancesWiretl -- --- -
EqmPmentWired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Bmltling Dryer Other (Speafy)
Comm /Industnal Fumace
Farm Air Conditioner
Otner (syeciry) Gonvacror's Remarks
Compute Inspechon Fee Below:
8 Other Fee # ServiCeEntranceSrze Fee # CirCUtlsiFeetlers Fee
Swimming Pool 0 to 200 Amps . cso o to 100 Amps 6. --Np
Transtormers A6ove 200 _ Amps ACOVe 100 _ Amps
Signs Inspecmr's use Oniy ' TOTAL
Irrigation Booms ?
Special Inspection T
AlarmiCommunicaaon THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 78 MOJ+ITH .
I, the Electrical Inspector, hereby ROO9h-10 oa?e
certify that the above inspection has
been made.
/
OiFICE USE DNLY ?
Tawa?
nis request voitl 18 montns trom
_Address: 638 }I,T,gIDE DRIVE Lot I I Blk Z Sec/Sub ??HILLS 2Np
These items were/were not complete at the time of the flnal inspection.
Date: 12/23/92 Yes No TnqnPctnr:
Final gxade (6" from siding) ?
Permanent steps • garage
Permanent ateps - main antry
Permanent drivaway ?
Parmanent gas L/
Sod/seedad grasa
Trail/curb damage
Porch ?
Basement finish
Deck
Please varify with tha builder the removal of roof tast aaps from the plambing
system and the shut-off of vater supply to the outaide Lavn faucet before
freeze potential exists. ?
?e.n?ewa
White - City copy Yellow - Reaident copy Pink - Contxactox copy
a3? RESIDENTIAL
? BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New ConcUUCtion HaoulremeMs
• 3 regislered stte suNeys showhg sq. fl. of rot, sq. tt. of house; end II rooled areas
(20% maximum bt coverage albwed)
. 2 copies of plen showing beam 8 wmdow sizes; pouretl found design, etc.)
• lsetofEnergyCelcuhatbns
• 3 oDpiBS ot TtBe Preservetbn Plan il ht platletl aMBr 7/7113
• Rim Jois[ Detail Optbns selecUOn sheet (bldgs wilh 3 or less units)
DATE 5 I ? I
SITE ADDRESS
TYPE OF
APPLICANT?
STREET ADDRESS
TELEPHONE
PROPERTY
BLDG Y ?N
TELEPHONE # ?I' -JI 0 ? WO? J
----------------------------------- °-------------°°-----------------------
COMPLETE THIS SECTION FOR -NEW° RESIDENTIAL BUILDINGS ONLY
Energy Code Category MINNESOTA RULES 7670 CATEGORY 1 MIN ? ?
(J submission type) • Residential Ventilation Catepory 1 Worksheet Submitted • Wi
• Energy Envelope Calculations Su6mitted U 1 MAY 3 2002
Wumbing Conhactor: Phone # v
Plumbing system includes: _ Water Softener _ Lawn Sprinkler . 90
Water Heater No. of R.I. Baths
No. of Baths
Mechanical Conhactor:
Mechanical system includes:
Sewer/Water Conhactor.
Phone #
Phone #
Fee: $70.00
------°-----------------------------------------°--------------------------°----°°-----------------------------------
I hereby acknowledge that I have read this application, state that the information Is correct, and agree to comply
wiTh all applicable Siate of Minnesota Statutes and City of Eagan dinances.
Signalure of Applican o?
OFFICE USE ONLY
_ Air Condirioning
_ Heat Recovery System
pemodeVAepatr ReouiremeMa
. 2 copias of plen
• 1setOfEnergyCalculationSforhBetedatldilionS
• 1 stte surveytor eMerbr adtlilWns 8 Cecks
• Ind'exte il home served by septic system tor aAditions
VALUATION &WD f ? U M
Certificates of Survey Received - Tree Preservation Plan Received _ Not Required _
Updated 4J02
1RKI[U ?)Q UJ k UU'Tt W VLDU?-- 1V-Q L??U..iJFIREPLACE(S) _ 0_ 1_ 2
OFFICE USE ONLY
? Ot Foundation ? 07 05-plex 0 13 16-plex ? 20 Pool O 30 Accessory Bldg
? 02 SF Owelling ? OB 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 Otof_plex ? 09 07-plex ? 17 Garaga ? 22 PorchlAddn.(4sea.) O 33 Ext.Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Poroh (screened) ? 36 Multi
? 05 03-plex O 11 10-plex 0 19 Lower Level ? 24 Storm Damage
? 06 04plex ? 12 12-plex Plbg_Yor_ N ? 25 Miscellaneous
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) O 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (FOUndation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)* O 43 Reroof ? 46 WindowslDoors
? 34 Replacement 'Demolition (Erkire Bldg only) - Glve PCA handout to applicant
Valuation Occupancy MC/ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings(new bldg) FinaUC.O.
_ Footings (deck) FinaUNo C.O.
_ Footings (addition) _ Plumbing
_ Foundation HVAC
_ Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests _ Final
_ Framing _ Siding Stucco Stone
_ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement)
_ Insulation _ Retaining Wall
Approved By
Base Fee
Suroharge
Plan Review
MClES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
Building Inspector
I?CITY OPEAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
SITE ADDRESS:
PERMIT
Control No. 1q2O o
PERMIT TYPE
Permit Number:
Datelssued:
BUILOING
001544
10/16/92
638 rIIlLS1DE f7h
L07: 7.1 BLOCK: 2
BL1R OAK HTLLS 2ND
DESCRIPTION:
'BuiYrJing Permit Type SF pWG
?
Building-Work Type NEW
. UBC Occupancy R-3 M-1
` Construct3on "t'ypa V-N
Zoning ? R-1
Bwi lcling Length 62
Building WidCh ? 34
?.
?-'=i?;??? fi'•, ;;._-i±; ? ,-::::i? '.:,1,?.? r? ?j-:,?
REMARKS: C6 d 1,317
s 9, w coN'rRac rok - '?
FEE SUMMARY:
Base Fee
Plan Review
Surcharge
SAC
SAC o
SAC Units
Subtotal
VALUfiTIGN
$612,50
$398.13
$47.00
$700. 00
100
1
$1,757.63
$g4,0era
MISCELLANE(1US $1,610.50
1'otal Fea $3,368.13
CONTRACTOR: - applicant - s'r. Lz.pWNER:
SUN UP CONS-i 18923282 600599 SUN-UP CONST '
17354 ITHECA CT 17354 ITHACA CT
LAKEVILLE MN 56044 LAKEVILLE MN 55044
(612) 892-3252 (612)892-3282
I hereby acknowledge that I have read this application and state that the
information is correct and egree to comply with a11 applicable State ot Mn.
Statutee and City o1' Eagan Ordinances.
AP ICANT/PERMI' E IGNATURE ISSUED Y: SIGNATURE
PERMIT4
REA'CTI'dATE
CITY OF EAGAN
1992 BUILDING PERMIT
681-4675
$313La.13
APPLICATION -pCT 1 4 RECO
1 0/r. (?-
SINGLE & MULTI-FAMILV 2 sets of plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERCIAL 2 sets of architectural & structural plans, 1 set of
specifications, 1 copy of energy calcs.
Penalty applies when typing of permit 1s requested, but not picked up by last working day
of month in which re uest is made or lot chan e is re uested once ermit is issued.
Date D /_(q /T 2 Valuation of work q 9? a d?
Site Address:_
SiREET SUI7E !
Tenant Name: (commercial anly)
IAT ? BIACK ? SUBD. 6,`r P.Z.D. *
Descri tion of work: 1!
rd 1 L I ? ciL 1 ? 1` `y '"-
The appl icant i s: ? Owner ? Contractor ? Other coeserlce>
Name ? „?.? ?v,,, (/d Co-
Property LA:T ? F,RST o
Owner Address !73> ? cC? C--f- .
S7REET STE N
City viC(e State !/1// /1/ Zip?s
Company a ? Phone
Contra ctor Address License # Exp.
City State ! Zip
Company Phone
Architect/
Engineer Name Registration #
Address
City State Zip
Sewer 8 water licensed plumber . Processing time for
sewer & water permits is two days once area as been approve .
I hereby acknowledge that I have read this application and state that the information is
correct and agree to comply with all appl' e State of Minnesota Statutes and City of
Eagan Ordinances. ?
Signature of Applicant: -?
OFFICE USE ONLY
B UILDING PERMIT TYPE
O 01 Foundation ? 06 Duplex ? 11 Apt./Lodging
X02 Sf Dwg. O 07 4-Plex ? 12 Multi. Misc.
? 03 SF Addition ? 08 8-Plex ? 13 Garage/Accessory
? 04 SF Porch ? 09 12-Plex E3 14 Fireptace
? 05 SF Misc. O 10 Multi. Add'1. ? 15 Deck
WORK TYPE
)K 31 New ? 33 Alteratlons ? 35 Tenant Finish
? 32 Addition 0 34 Repair ? 36 Move
GENERAL INFORMATION
Const. (Actual) V- N Basement sq. ft.
(Allowable) N lst F1. sq. ft.
UBC Occupancy IZ -? 2nd F1. sq. ft.
Zoning R_I Sq. Ft. total
t of Stories Footprin t Sq. ft.
Length On-site well
Depth On-site sewage
APPROVALS
Planning Building /o-/sgz?S
Engineering Variance
REQUIRED INSPECTIONS
13 Site ? Footing • ? Framing
? Wallboard ? Final 0 Draintile
O Insulation
? Fireplace
Permit Fee
Surcharge
Plan Review
License
MWCC SAC
C1ty SAC
Water Conn.
Nater Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
SAC % loo
SAC Units _L
v.tuacim: g 914, OOO ._
Ga,` aA&E; Zzxz4=52sX•/G=8yy9
RSrnTt - I(: v 3 4- Sy LI
Ru X,2(o = 6Z4
4
IsTFLooR', 1196X15` Irlqyo
C:romT=
ax7= i?
Iwn= !b
12 x 1'/i = Iof
,sv ? xlb- 3L
r??rxS3= ???36=
93,'751
Ei 16•Besement Finish
? il Swim Pool
? 18 Comm./Ind.
? 19 Comm./Ind. Misc.
? 20 Public facility
? 21 Miscellaneous
O 37 Demolish
MWCC System Ye5
City Water YES
PRV Required
Booster PumP
fire Sprinkler
Census Code
SAC Code 01
Assessments
CONSUlTIN3 6NOIN44RS y16y1116W #On9ES
aOBF. PLRNNE05 ond LqND fURVlYORS #$339.0?
NGINEERING
COMPANM, INC.
1000 EAST 1461h STREET, BURNSVILLE, MINNESOTA 35337 PH 432-3000
CERTIFICATE OF SURVEY
Legal Description:
SCALE : 7' - 30'
0
O
n I
N ?
A bai
( eso_s ) DENOTES EXISTING ELEVATION
( Ssi,5) DENOTES PROPOSED ELEVATION
.-.--- INDICATES DIRECTION OF SURFACE DRAINAGE
Ss .8 = FINISHED GARAGE FLOOR ELEVATION
644. iZ = BASEMENT FLOOR ELEVATION
852, l(- = TOP OF FOUNDATION ELEVATION
E./lLLSIDE DRIUE
? (84(p. -7
i ?-
?48•8L: i
?/ 89° 38" !3" 1
'75.2-7
>
0
N
M
? ?0 m
3Sf,$ 2ACAiv
22.00 1$ 4opo
i PRopoSED
6AAACE' }IoIXaE
I -
/UI 89 0 5Z ,?,Z •,W
; 9.73
q i 84 7,
? ?47• ? 30 FT. FRaNT Bu/Gp/NCy
SETBAGK L /NE
5I ?
11,o
J -
r , _- s
T
., I • i
?,.-_?-<? ----- -_
1I ? I
DR411V46E ,4ND T-? 1 ( ? " N I / -% 15
UT/L /TY EASE/YJ?NT [? L_ L-
?----- ?
_o 0
4cz-,s. Ss. 00
?86z,o N 89°38'13"E
?oVrCIATEERI E1
I hereby certiPy that this is a true and correct repreaentation of a tract oP
land as shown and described hereon. As preparad by ma this 13* day oE
OGTa8E.2 ? 19?. '
Minn. Reg. No. 13&00
S
Oi1NER:
SITE ADT
CONTRACYOR: ?(AA C C) 6z?Y'- DATE: 10 PHONE: ?Z
Determine rorking square footage of each: ?-? 6 0 7/ ?a
7. Total exposed wall area ... ? sq. ft, x.11 = ??9•??i
2. Total roof/ceiling area .. /3 A -7 sq. ft, x.026
Total ezposed wall area above floor = M >?,(7
a. Total wall window area ........................... Z.Z D
b. Total door area ................................ ------
c. ?
c. Total sliding glass area .........................
d. Total fireplace wall area ......................... '
e. Total wall framing area (average 10%) .............
f. Total net wall area above floor ................... 1? 6
g. Total rim joist area .............................. ?
Total exposed foundation area -
h. Total foundation windou area ....................... C)
i. Total net foundation area above grade .............. ?^
Determine 'U' value of each vall segment:
a. x
C, x
c. x
d, x
e, x
f. x
g, x
h. x
i. x
'U'
'U'
U
'
'
' U
'
U'
'
?u
U:
'
'U'
?uI
- ---?
= y, ?
f =
s . ................................................... rotei = 1 -7 z?.'7 y
If item 03 is the same as or less than item 81, you have met the intent of SBC
6006(c)2.
Total exposed roof/ceiling area = ('JhZ
S. Total skylight area ............................... lrp
k. Total roof/ceiling framing area (average 10%) ..... 1-?,h
1. Total net insulated roof/ceiling area .............. 1167
OVER
CITIf OF EAGAN
EXTERIOR ENVELOPE AYERAGE VU' COMPUTATION
Determine IU' value for each roof/ceiling sepent:
j. ? X TUI CD .
k. X IuI •DZ_ - 14
?. I f 6 7 X ful
4 . ...................................................... Total = ?) T
If total of 04 is the same as or less than 02, 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 /13 and 114 shall not be greater than the sum of Items 01 and p2.
,. L7y.y6 . 2. 3 s-?l/ = Z?s37
3. f7z 7 ?/ + u. ?3
?r .?„ . e. •'^
T'
2
L
SINGLE & DOUBLE FAMILY HOMES
1984 ENERGY CODE REQUIREMENTS
On or about March 1, 1984, the following energy code requirements
should be calculated and included with a building permit application.
1. Roof - ceiling assemblies - R-38 U= 0.025 Average
2. Exterior walls & rim joists - R-20 U= 0.11 Average
3. Floors over unheated spaces - R-20 U= 0.05 Average
4. Exterior overhangs will be considered as exterior wall.
5. Foundations (all exterior walls) - Minimum of R-5 insulation.
6. All insulated areas must be separated from the heated space
by a well-lapped or sealed vapor barrier with a minimum perm
rating of 0.1. A 4 mil. polyethlene sheet or equivalent meets
this requirement.
A Kraft face R-19 type insulation will be accepted in the rim joist
areas. Air chute baffles are to be placed in every rafter space.
tmnuinE To (9) rnnuas rrto„ .snn;,t „a:,wi
or Trriu.ur usEu rr.oDucTs
Interior Air Film (valls) (a)
O.EB
Cypzinn or plas[er boarE 3/8" (a)
p;ji
Eah?ior p?r Film (tialis)
l 0.17 Cypsum or yiaster Loerd 1/7^ y5
0
fttclior Rir Film (VenteE Ceilinq) 0.61 Gypsum or pl.stcr boarE 5/0" ,
0
56 ?
Fitcri,.r Air illm (Ventcd Ccilln9) 0.61 PlywooA 3/8" .
0
47
In[erlor Alr Filn (urn VenteA) 0.61 PlywooE 1/I" .
0
62
fatcrior Air fflm !llou Vented) 0.17 CIYw<`od 7/4" .
0.93
x??????,M Sfelno
0
61 Sheathinp, reg. density 1/2" 1.32
Ai.minum .,ith Batker .
1
82 Shramien, reo. dens7cy 8/32"
N-
-
" 3.06
Aluminum with Backcr L foiled .
2.96 sil
6ase sheathinq 1/I 1.14
112 a 8 Lcp Sidinn (Neae) 0.81 Built-up Roofs 0
77
7/16 a 17 IWreeoare Sieinq 0.67 Asbezms-cn+ent shinalis .
0
31
l.sLCStos Sidinns 1/4 LanDCA 0.21 Azphait roll rooling .
.
0.15
Stucco (Or,,.n antl Fintsn Coa[) pspahlt Shingles 0.44
3:4" wood Subfloor or Sheatning
" 0.94 Insulation: 2-2 3/4" fiberplass 7.00
I/2
Plyvooe _i,oathinq
" 0.62 Insulecion: I 1/2" FlEergl:ss I1'.00
1/2
Particlc tlw„r0 0.66 Insula[lon: 6" ilberglas5 19.00
l9CDS: BLODUif VOOlS
fjr, pinc L simiiar soft Voods 1 1/2" 1,89 Appro:. j" • 9•n0
2 I/x" 3.11 ApOrei. 4 1/2" 13.00
I 1/2" 4.35 APProx. 6 1/4" 19.00
S 1/2" 6.87 Aporox. 1 I/L" 24.00 "
ApDroz. 14" 30.00 ,
Avvron. 16"
. " '
40.00
AII other insula[ion materials nus[ be '
Fllled verifieE (R factor)
(0.) Vermituli[e
Conerete elo?k (5 L G Req.) III 1.93
12" Ccncrete Blotk (5 L G Reg.) I.29 1•15 . '
8" lipt ucign[ 2.18 5.03
II" Lige[ 1:e19h[ 2.48 5.82
?{:p??G[x?4S e?`iY:f aftf.f
NOTE: (U) x Area Square Fect
AII NlnAOwS -
(w/Storns I^ m 4" SOacc) .56
Removal Double Gloxinq (ADL) .55
7nerero or welded 3/16" air spacc .69
I/4" air :pacc .65
1/2" air soace .SB
(Other rineows sDecificaliy [estce tan use better ratings)
1 7/4 So1Id core door .46
w/storm, wooE ,31
w/storm, metai .26
Pesse StcelDaor Insl/r,/CL 7.45R .13
Sitdinq ctass ooor, uood .65
Metal .715
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Floors ove; unheated spaces must have mininum R-faetos of R-20 (tuck-undcr garaoes).
Floors ocr-z eutdoor air (overhangs) nust tiave a mininum P.-fac[or of R-33. ,
TIINIrN?1 "U" VALUE fu\D F-FACTOR AT ROOF, SdALL, RITI tL\D CONCRETE BLOCf:
REACTIVATE X,
PE?,MIT ?
cirr oF EAc,AN
1993 BUILDING PERMIT
681-4675
ED
1 6 1993
? ?.
SINGLE fl MULTI-FAMILY ---------------
2 sets of plans, 3 registered site surve'S;"I'?6py3 y
calcs.
COMMERCIAL 2 sets of architectural & structural plans, 1 set of
specifications, 1 copy of energy calcs.
Penalty applies: 1) when permit is typed, but not picked up by last working day of month.
in which request is made, 2} address is changed or 3) lot change is requested once permit
is issued.
Date -7 Valuation of wark
Site Address: c? _ Driyg_ ,R?
STREET SUITE M
Tenant Name: (commercial only) J6.M
IAT 11 BIACR Z SIISD. Qjurr lkt- P.I.D. N
Descri tion of work: c?
The applicant is: 67owner ? Contractor ? Other coe.«;ee>
Name ?U?r}z?? ?o4tir? Phone
Property LAST FIRST
Owner Address - (n3`? ? isP ?i"i ?Q_-
STREEi STE M
City Q? State MI) Zip
Company Phone
CO ntrBCtOt' Address License # Exp.
City State Zip
Company Phone
ArchitecU
Engineer Name Registration k
Address
City State Zip
5ewer & 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 agree to comply with all applicable State of Minnesota Statutes and City of
Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY
BUILDING PERMIT TYPE
O 01 Foundation
? 02 SF Dwg: O 03 SF Additian
? 04 Sf Porch
0 05 SF Misc.
WORK TYPE
P?31 New
? 32 Addition
? 06 Duplex
? 07 4-Plex
? OS 8-Plex
? 09 12-Plex
13 10 Multi. Addil.
? 33 Alterations
O 34 Repair
? 11 Apt./Lodging
? 12 Multi. Misc.
? 13 Garage/Accessory
? 14 Fireplace
F 15 Deck
? 35 Tenant Finish
? 36 Move
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Planning
Engineering
REQUIRED INSPECTIONS
? Site
? Wallboard
Basement sq. ft.
lst F1. sq. ft.
2nd F1. sq. ft.
Sq. Ft. total
Footprint Sq. ft.
On-site well
On-site sewage
Building
Variance
footing
final
? Framing
? Draintile
?
? Insulation
p Fireplace
Permit Fee
5urcharge
Plan Review
license
MWCC SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
velLmc;m: g
•- ,
. r ?
?..•..?:
0-16-Sa. §emefrt Finish
? 17 Swim Pool
? 18 Comn./Ind.
O 19 Comm./Ind. Misc.
? 20 Public Facility
? 21 Miscellaneous
? 37 Demolish
MWCC System
City Water
PRY Required
Booster Pump
fire Sprinkler
Census Code
SAC Code
Assessments
SAC %
SAC Units
• py,,, /,
COHSUITINO 4N31NElHS g?? a yIL?NV/?W /?O/t'lES
RQdE PIRNNEIIS ond LpND fUNYEYORS
*s339.o/
'ENGINEERING ?
?.
COMPANY, INC.
t000 EAST 1461h STREET, BURNSVILLE, MINNESOTA 53337 PH 432-3000
CERTIFICATE OF SURVEY
Legal Description:
SCALE : 1' e 30'
/
OA
?Av0 A nbi Tia,v
0
O
( eso_s ) DENOTES EXISTING ELEVATION
( ssi• 5) DENOTES PROPOSED ELEVATION
_.--- INDICATES DIRECTION OF SURFACE DRAINAGE
85 , 8 = FINISHED GARAGE FLOOR ELEVATION
a • 1Z = BASEMENT FLOOR ELEVATION
852? It- = TOP OF FOUNDATION ELEVATION
NILLSIDE p,eivE
i /84?. ?>>
g48•gC; ?
i
?-,-- F--
h/ 89° 38' 13°E Ni?B°s2'o2"Gv
? 75.2? i 9•73
(?49?i o p i ?7.Z?
847. z?
?849•9? ,° ?1-T ? 30F7: FRONT 9U/LD/NCy
?tTBAGK LINE
cANT.d I
22.00 40-00 - -
P2op05ED I v,o ?
4ARAGHoUSE
I I I ? ? ? ?,
?h ?o I f 5 52,0 $ 4.00 $ By
?` •\ N ? ?Si_ --- °16,00
o8RrGINEERINC,
n
?
LOT/ I I ? I
DRA/NAGE AND 5
UT/L/Ty EASE/YIC-I1/T L-
?-----?
(s Cz,o, Ss. oo ?864;0,
(86L.o) N 89°38?f3"E
I hereby certiEy that this is a true and correct repreaentaEion of a tract o;
land as shown and described hereon. As prepared by me this /3'?' day o
OCTaBER r 19.'?2-
• llp?
?/ Minn. Reg. No. 13&00
L_? BL ? CITY OF EAGAN
SUBD. ?.kX?
r /
? PLUMBING PERMIT
(612) 681-4675
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS
WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
CITY USE ONLY
RECEIPT ? ?0'? 0
DATE // 9
AT.SO, FOR TOWNHOMES AND CONDOS
WORK DESCRIPTION
NEW CONST _
ADD ON _
REPAIR _
OWNER NAME:
SITE ADDRESS: ('sO ,l'1yuu(U
COMPLETE THE FOLLOWING:
N0. FIRTURES EA. TOTAL
REPAIR/ADD ON 15.00
? SHOWER 3.00 3.?
? WATER CIASET 3.00 ?BATH TUB 3.00 s?"
1 IAVATORY 3.00 3 °S
? KITCHEN SINK 3.00 0IAUNDRY TRAY 3.00 :3-
HOT TUB/SPA 3.00 -
? Tw?:i L:.r+Tj3'_ .. .iV 3'00
FtAOR DRAIN 3.00 3 °O
GAS PIPING OUT.
? (MINIMUM - 1) 3.00
ROUGH OPENINGS 1.50 !• 5
_ oTHER
WATER SOFTENER 5.00
PRIVATE DISP. 15.00
U.G. SPRINKLER 3.00
W. TORNAROUND 15.00
STATE SURCHARGE .50
TOTAL: S ??• ??
PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS. ALSO FOR MULTI-FAMILY
BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT.
WORK DESCRIPTION:
CNiYir? 1LLiu.
SITE ADDRESS: _
TENANT NAME: _
SUITE #:
INSTALLER:
ADDRESS:
CITY:
PHONE
FOR:
CITY OF EAGAN
ZIP:
CONTRACT PRICE:
1% OF CONTRACT FEE. .
STATE SURCHARGE - $.50 FOR
EACH $1,000 OF PERMIT FEE.
$25.00 MINIMUM FEE.
CONTRACT PRICE x 1% $
STATE SURCHARGE
TOTAL:
?
(SIGNATURE)
INSTALLER:
a n ne um ng
ADDRESS: 14169 Shore Lane N.E.
Prior Lake, MN 55372
CITY: ZIP:
ities Di ig tal Quality Control
The following image represents the best
available image from the original page.
Every effort was made to capture the content
from the original page.
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CITY OF EAGAN cITY USE ONLY
L// B? MECHANICAL PERMIT RECEIPT # C o a i 5 7l
SUBD. (612) 651-4675 DATE 1 J- 6- q?1-
RESIDENTIAL
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMII Y DWELI.INGS. AL40, COMPLEfE FOR
TOWNHOMFSlCONDOS R'HIIQ SEPARATE PERMITS ARE REQUIRID FOR EACH DWELLING UNIT.
OWNER: ADD-ON A/C ADD-ON FURNACE ?
SITE ADDRFSS,•I ?A
/di l?S /Uf. ADD ON/REMODII. (E7QSTING
CONSTRUCTION ONLI) $ 15.00
INSTALLER: /? ,?/o ?-cCc?c ? r ?? c??•rC? HVA : 0.100 B 24.00
PHONE #: 6/ D/9'7S ADDTI'IONAL 50 M BTU 6.00
nvnxESS: ,? -?i3 /d/ 1. e ?.- cas ouTLETs - hmqrniuM i@ $a En. /2 ca
crrY: .,.,-... , /k ? zrn: 6s33" suxcanxcE: a .so
SIGNATURE: TOTAL: $ Y2 <-sb
v? /V
NO PERMIT HEQUIRED FOR DUCTWORK ONLY!
COMMERCIAL
PLEASE COMPLEI'E THIS PORTION FOR ALL COMMERCWLINDUSTRIAL BUILDINGS. AISO COMPLEl'E FOR
APARTMENT BUILDINGS OR OTHER MULTI-FAMILY BUII,DINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR
EACH DWELLING UNIT.
R'ORK DESCRIPI'ION: 11 CONTRACf PRICE: I FEES
196 OF CONTRACf FEE.
STATE SURCHARGE IS $.SO FOR EACH
S1,000 OF PERMTf FEE. $
PROCFSSED PIPING - $25.00 r
MINIMUM FEE • $25.00
I$
???-q -?)-
2004 RESIDENTIAL BUII.DING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
<1 7-7 o C) ?
New Consbuction Reouiremenb RemodeVReoair ReauiremenLS OLKe-e
3 registered sNe surveys shovnrg sq. R of lot sq. ft of house; and alI roofed areas 2 wpies of plan ??
(20% maxunum bt mverdge albwed) 1 set of Enaqy CalcuWtions lor heated addNOns Tiee Pres`PISn Recd"T' Y-
2 mpies of plan shawing besm & window slzes; pouretl found desgn, etc. 1 stle survey iw atldNOns & dedvs Ttee Pms'Required,..'? Y>'_3J
i5etofEnefgyCalculetions Addtion-uMltafelfonsitesepticsysfem Y
3 oopies af Tree Preservatiai Plan if lot plat0ed after 711193
Rim Jois[ Detafl Options selection sheet (bMps with 3 or less units
Date la-
Site Address
Description of Work
Multi-Family Bldg _ Y ?PN
Fireplace(s) _ 0 _ 1 _ 2
UniUSte #
I Property Owoer 7C3z? ;2?0C?D Telephone # ?j( ) 5$ AH Y[ I
Contractor
Address
State
?t Zo( b5g8?i
PELLA WINDOWS & DOORS
15300-25TH AVE. N. STE. #100
PLYMOUTH, MN 55447
?to3???15-(?{6U
_ CitY.
Celephone # (
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEYY BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category . Residential VenWation Category 1 Worksheet • New Energy Code Worksheet
(J submission type) Submiried Submitted
. Energy Envelope Calculations Submitted
Have you previously constructed a building in Eagan with a similar plan6 _ Y _ N If so, 25% plan review
fee applies.
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone #(
ielephone #(
Telephone #(
?04
I hereby apply for a Residenrial Building Permit and aclrnowledge that the information ?e-and accurate;
that the work will be in conformance with the ordinances and codes of the Ciry of Eagan and the State of MN
3tatutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a
pemut; that the work will be in accordance with the approved plan in the case of work which requires a review and
ap val of?
?ApplicanYs Printed Nam? Ap icanYs Signature
ConstructionCost SIJm 0 ?
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 AccessoryBldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 PorchfAddn. (4-sea.) ? 33 E#. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Parch (screen/gazebo) ? 36 Multi Misc.
? OS 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y w_N ? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building• ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement , •Oemolition (Entire Bldg) - Give PCA handout to appiicant
Valuation Occupancy MCES System
Census Code Zoning City Water
SAC UniGs `Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bidgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new bldg) _ FinaUC.O.
_ Footings (deck) _ FinaUNo C.O.
_ Footings (addition) _ Plumbing
Fovndaaon HVAC
Drain Tile Other
Roof _ Ice & W ater _ Final _ Pool _ Ftgs _ Air/Gas Tesu Final
_ Framing _ Siding _ Stucco _ Stone _ Brick
_ Fireplace _ R.I. _ Air Test _ Final _ Windows
_ Insulation _ Retaining Wall
Approved By: , Building Inspectar
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatrnent Plant
License Search
Copies
Other
Total
. Wd9E:i g •unp amil paaiaaay
PelIa Windows 8c Doors - Twin Cities, Inc. 15300 ZSTH AVE. N. STE. #100
PLYMOUTH, MN 55447
763/745-1400
June 8, 2001
City of Bagan
3836 Pilot Knob Road
Eagan, MN 55122
Dear 7an:
Elder 7ones Corporation is authorized to pull building permits for Pella Windows &
Doors -1?vin Ciries, 3nc_ Please allow their representative to provide that service for ns
in Eagan. `Fhis authorization shall be valid untii such rime as the division manager
expressly revokes it, in writing to khe City.
I request that this authorization be accepted expeditiously, so as to not delay the
processing af our bailding permits any further. Please call me if fliere are any questions,
I can be conYacted at 763-745-1432.
Yow im3nediate attention to tUis matter is appreciated.
- ' cerely, ?
Bryan My
Replacement Sales ManagerEMEW
?+m.9?.aaos
cc: Kaza-EldcrJones
Denna Krafty - Replacement Sales Process Coordinator
Windows, Doors,
& Skylights
WATS 1-800-462-5359
FA7C 763/745-1401
01
7 nnfr3i carrrq 01Ur?u.r a]sr es) 7ra vcra ir-cT Tu.r rnioninn
PERMIT
City of Eagan Permit Type: Building
3830 Pilot Knob Rd Permit Number: EA091291
Eagan, MN 55122 . Date Issued: 09/23/2009
(651) 675-5675~~~ EPermit Category: ePermit
www.ci.eagan.mn.us lflflUl tflflLLL
Site Address: 638 Hillside Dr
Lot: 11 Block: 2 Addition: Bur Oak Hills 2nd
PID 10-15501-110-02
Use
Description:
Sub Type: e-Windows/Doors Construction Type:
Work Type: Windows/Doors-New/Replacement
Description: House
Census Code: 434- Occupancy:
Zoning:
Square Feet: 0
Comments: huprovements 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.
Fee Summary: BL - Base Fee $3K $88.50 0801.4085
Surcharge - Based on Valuation $3K $1.50 9001.2195
Valuation: 3,000.00
Total: $90.00
Contractor: -Applicant - Owner:
Renewal Andersen Zachary V Johnson
1920 County Road C West 638 Hillside Dr
Roseville MN 55113 Eagan MN 55121
(651) 264-4777
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.
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA143207
Date Issued:06/07/2017
Permit Category:ePermit
Site Address: 638 Hillside Dr
Lot:11 Block: 2 Addition: Bur Oak Hills 2nd
PID:10-15501-02-110
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 -
Zachary V Johnson
638 Hillside Dr
Eagan MN 55121
Angell Aire
12253 Nicollet Ave S
Burnsville MN 55337
(952) 746-5200
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA171348
Date Issued:08/11/2021
Permit Category:ePermit
Site Address: 638 Hillside Dr
Lot:11 Block: 2 Addition: Bur Oak Hills 2nd
PID:10-15501-02-110
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Does not include skylight(s)
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
If water damage is encountered, please call (651) 675-5675 to schedule a site visit to verify the extent of the damage. Any
repairs must be inspected prior to covering. The inspector will determine if an additional permit will be required to repair the
water damage.
Valuation: 5,000.00
Fee Summary:BL - Base Fee $5K $118.00 0801.4085
Surcharge - Based on Valuation $5K $2.50 9001.2195
$120.50 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Zachary V & Tamara J Johnson
638 Hillside Dr
Saint Paul MN 55121--235
(952) 412-4197
Anchor Roofing And Exteriors
101 Bridgepoint Way, Suite 140
South St Paul MN 55075
(612) 363-7443
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA178706
Date Issued:08/30/2022
Permit Category:ePermit
Site Address: 638 Hillside Dr
Lot:11 Block: 2 Addition: Bur Oak Hills 2nd
PID:10-15501-02-110
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:
This permit shall be null and void if work does not start within 180 days of issuance, or if work is suspended for 180 days or more after
started.
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 -
Zachary V & Tamara J Johnson
638 Hillside Dr
Saint Paul MN 55121--235
Champion Plumbing Llc
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
Applicant/Permitee: Signature Issued By: Signature