916 Jefferson Lane,
? - s DATE: 9/15/89
.. `?:
RE: 911iJ£FFERSON LANE, L4, B4, LEXINGTON POlNTE 2nd
4360 LEXINGTON POINTE PKWY, L18, B2, LEXINGTON P'C 3rd
Your Sewer & Water Permit for the above property has been completed. ft will be held at the
Public Works Garage (3501 Coachman Road) until the meter is picked up. BE SURE TO
CALL PUBLIC WORKS (454-5220) FOR YOUR PERMANENT WATER TURN ON.
Youra,Sewer 8 Water Permit for the above property cannot be completed for the foliowing
Your Sewer & Water Permit tor the above property has been completed, but the meter cannot
be issued or occupancy allowed until further notice.
COMMERCIAL PROJECTS ONLY: Please pay for meter at City Hall. Meter size must be
confirmed by Bill Adams or Dirk House (Plumbing Inspectors - 454-8100) before isSUanCe.
WARNING: BEFORE DIGGING, CALL LOCAL UTILR'IES - TELEPHONE, ELECTRIC, GAS, ETC.
- REQUIRED BY LAW.
CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICY.
Secretary, Building Inspections Dept.
?F?r?•-??
. ?
,
; -_- :? -
BUILDING
To be used fo
Site Address ?
Lot 4 Block .
Parcel No.
Address
City _
, :,,....?..?.?-?. . z.F.-.?y ..-r..{ ?.^" ,??„ ; .?,•A ..
' . . . `, < , .
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MM 55121
PHONE: 454-8100
D4TG/CiiA$
=a Name sME
p-
OV Q Address
cc
? City Phone
?
W W Name
?
? ; Address
a W City Phone
I hereby acknowlege that I have read this appiication 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 Perrr?itee
A Buiiding Permit is issued to: 501+1S CON5TRt1C'CI ON
on the express condition that all work shall be done in accordance with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
pitiii.
4r?g 17C20
Receipt #
OFFICE USE OMLY
Occupancy R"'3 M-1 FEFS '
Zoning FD ? i
(Actual) Const V? Bldg. Permit 630*00
(Allowable) V
Surcharge 49,00
# of Stories
38*
PlanReview
315.00
lenglh
Depth 41' SAC, City 100.00
S.F. Total - SAC, MCWCC 575•?
S.F. Footprints -
Water Conn sw•?
On S1te Sewage _
On$ileWell ? WalerMeter ?•?
INNICC System 30*00
Ciry Water xx Acct. Oeposit
PRV Required S/W Permit 20•?
Boosler Pump - S/W Surcharge 1.00
228.00
Trealmenl PI
APPROVALS Road Unit 340.00
Planner
CAUnCiI - park Ded.
Bldg.Olf, _ Copies
2,958.00
?
Varfance - TOTAL ,
Permit No. Permit Holder date Telephone k
WATFR ? ? ? • C• ?? ? S?
SEWER '
PLUMBING
H.V.A.C. ?J .
ELECTRIC
Inspection Date Insp_ Comments
Footings I 9? S b' ?
Foundation q ? p2
Framing
Roofing
Raugh Pibg. ojZ -O ,60
Rough Hlg. , 30 $? AVY /- C' a"rt e fio-S he f/'Pe ??
lsul.
Freplace ?
Final Htg.
Fnai Plbg. 1
Const. Meter Plbg. Inspector - Notify Plumber
Engr./Plan
Bldg. Final r Y, Af9 Q
Deck F1g.
Deck Final
Well
Pr. Disp.
m Name _
? Address
c Clty
? Name _
c Address
O CitY -
TYPE OF WORK
Forced Air
Boiler
Unit Heater
Air Cond.
Vent
Gas Piping Outlets #
Other
M BTU
M BTU
• M BTU
M BTU
_?- CFM
PERMIT FEE:
S1C:
MECHANICAL PERMIT
CITY OF EA(3AN
T KNOB ROAD, EAQAN, MM 55122
BLDG. TYP€ ?
Res. k
Mult
Comm.
Other
PERMIT #
RECEIPT #
DATE: !
WORK DE$CRIP'TION
New _'X_
Add-on
Aepair
FEES
RES. HVAC 0-100 M BTU
ADDITIONAL 50 M BTU
(RES. HVAC iNCLUDES A/C ON NEW
CONSTRUCTIOM)
GAS OUTLETS (MINIIAUM -1 PER PERIAIT)
COMMAND FEE -196 OF CONTRACT FEE
APT. BLDGS. - COMM. RATE APPLIES
TOWNHOUSE 8 CONDOS - RES. RATE APPLIES
MINIMUM RESIDENTIAL FEE - ALL ADD-ON &
REMODELS
$24.00
6.00
1.50 EA.
- 12.00
MINIMUM COMMERCIAL FEE - 20.00
STATE SURCHARGE PER PERMlT - .50
(ADD $.50 S/C PER EACH $1000.00 OF PERMIT FEE)
?------SIGNATURE OF PERMITTE£
FOFi: CITY OF EAGAN
-.?
. , ;.
? .,
CONTRACT
PRICE
SIIA Addr633
Lot 4
V IYQII
? Add
c City
? Add
? City
FEES
COMM./IND. FEE -1% OF CONTRACT FEE
APT. BLDGS. - COMM. RATE APPLIES
TOWNHOUSE & CONDO - RES. RATE APLUES
MINIMUM - RESIDENTIAL FEE $12•00
MINIMUM - COMM.IND./FEE $20.00
STATE SURCHARGE PER PERMIT .50
(ADD $.50 SJC PER EACH $1,000 OF PERMIT FEE)
CITY OF EAGAN PERMIT #
3830 PILOT KNOB ROAD, EAGAN, MN 55122 RECEIPT i
, PHONE 45481 QO DATE: _
Office Use Only
BLDG. TYPE WORK DESCRIPTION
Res. x New
Mult. Add-on
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES TOTAL
Water Closet - $3.00 $
Bath Tubs - $3.00 ? , -
Lavatory - $3.00 .?_
9_ Shower - $3.00 -; _
Kitchen Sink - $3.00 ?._
UrinaUBidet - $3.00
Laundry Tray - $3.00
Fioor Drains - $1.50
Water Heater - $1.50 ?-
1Nhiripool - $3.00
Gas Piping Outlets -$1.50
(MINIMUM -1 PER PERMIn
Sohener - $5,00
Well - $10.00
Private Disp. - $10.00
? Rough Openings - $1.50
PERMIT FEE:
STATES S/C:
GRAND TOTAL: ?t?
PLUMBING PERMIT For Ofike Use Onl
CITY OF EAGAN PERMIT # ? CONTRACT 3830 PILOT KNOB ROAD, EAGAN, MN 65122 RECEIPT#
PRICE PHONE 45481 00 QATE: ° S v
Site Addr ss P V t11 u\. BLDG. TYPE WORK DESCRIPTIaN
, . ? _ ... . ,. ... , . Res. ?' New
? ivan
? Add
c Chy
Cfty
FEES
COMM./IND. FEE - 196 OF CONTRACT FEE
APT. BLDGS. - COMM. RATE APPLIES
TOWNHOUSE & CONDO - RES. RATE APLLIES
MINIMUM - RESIDENTIAL FEE $12.00
MINIMUM - COMM.IND./FEE $20.00
STATE SURCHARGE PER PERMIT .50
(ADD $.50 S/C PER EACH $1,000 OF PERMIT FEE)
Mult. Add-on ?
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES TOTAL
Water Closet - $3.00 $
Bath Tubs - $3.00
Lavatory - $3.00
Shower - $3.00
Kitchen Sink - $3.00
UrinaNBidet - $3.00
Laundry Tray - $3.00
Floor Drains - $1.50
Water Heater - $1.50
Whirlpool - $3.00
Gas Piping Outlets - $1.50
(MINIMUM -1 PER PERMIT)
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
Rough Openings - $1.50
?- U. G. Sprinkler System - $12.00
PERIWT FEE: /
STATES S/C: ' ? u
GRAND TOTAL: ?
CITY OF EAGAN •
454-8100
DEPT. OF BUILDING INSPECT#ONS
Correction Notice
Located at ? ?? ?? ? '"?r??- ?????
I have this day inspected fhis structure and
these premises and have found the following
violations of city codes governing same:
4 s P?: li c-a "L?J-A .s-,a 7-7 6nI /&-.z 7--?i --
?- 17r.s?i2 Si',r7cA- B?/???v9 srf?«•?lt -?.t.,? rt_
1 1; ., . . ? . v ?2,_? -t /1 n n n C'_ _j
?^ 1-?il? ?,?-LI??-_? , ? ?rris r? .-?i sr c?s,r?i fs?sl
,-
When corrections have been made, please
call 454-8100 for inspection.
Date .??A"),L F2
'
? Inspector City of Eagan
DO NOT REMOVE THIS TAG
?' ??...C l?
(grr#ifixatP uf (Orru?aury
titp of (Eagan
aPparb1lPitY Df lwtbim 3wPtXiDlt
Thrs Cerrifrcate issued parsuant to the requiremenu of Section 306 of the Uiufor??r Building
Code certifying that at the time of issuance this structure was in conipliance with the various
ordinances ojthe City regulat/ng building cacstruction or use. For the foUowing.•
Use Clewficatioo sp Twatw Hidg. Pormit No. -i.7Qm
OccupAncy Type R3! '1 Zonin6 Distria ?lU n I I'ype Const VN
o.ou ot sHl&m 9M [MS'[7ax'i''rnN naafm 4600 gAIRWAy 1 c ru __
Bw7din? Addrca 916 JU'FFR.9cN i.ANE LocaLryIA- Bl+, IOMMCN A7TIJiE ?NIl
?
n.w trxMME 30, 1489
Bw7ding OlfraaY"
POST IN A CONSPICUOUS PLACE
INSPECTION RECURD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55123 Date Issued:
(612) 681-4675
r3I I j E.111ri
N: ?+lrt 1 J
SITE ADDRESS: 1111. 4 fil fi F APPLICANT:
•i+N t AWf' . . ? ?•???? ' ? 1 . ??r?, ???: ? i? ? 1?. ! I ?=I: i, f.1 ?... . t,-?i<; ?
PERMIT SUBTYPE: TYPE OF WORK:
?t? tr
I I ,:i i1 r4 fi
t i Na i
-1
PsrmR No. PermR NoIMr Date TelephaM i
S/M/
PLUMBING
HVAC
ELECTRIC
ELECTRIC
Inapectlon Data Insp. Commsnts
Foodngs I
Foundation
Framing
fi^9
Rough Plbg.
Rou9h FIt9-
Isul.
Fireplace
Fnal Htg.
Orsat Tesl
Fnal Plbg. Pibg. Inspeclor - Notity Plumber
Consh. Meter
EngrJPlan
Bldg. Finel
Dedc F,9.
DeckFnal
weli
Pr. Disp.
T
PERMIT
Rd.
DATE / J / f
?
OFFICE USE ONLY
METER # PERMIT DATE 9 ? I 5/89
CHIP # PERMIT # 101193
METER SIZE ' B.P. RECEIPT # - 3828
ISSUE DATE B.P. RECEIPT DATE 9/13189
? PRV -. BOOSTER PUMP
SITE AQDRESS
LOT LLOCK _L-SEC/SUB ' ? X r•a-. T
APPUCANT:
ADDRESS: ?'? ??? i J< ??? a? l?.. _• L` ?
CITY, STAT
PNONE: ? ZIP
PLUMBER: /ti;?-
ADDRESS:
CITY, STATE
PHONE: , - .J .. ? ' ' •
? ZIP
OWNER:
ADDRESS: ?a ; f':? ? j 1. • ?.•? ,?. - ? i I ? -
C1TY, STAT
„ ??
,'? 1 ': ZIP ?_° - . ?• ?
T
PHONE: ' ? .. .
-
PERMIT REDUESTED
? SEWER WATER - T
- COMMlIND -? RESIDEN
- NEW ^- ExISTIfdG
Lawn Sprinkler Meters are to be Inc
Ahead of Domestic Meters on Water
TO COMPLY WITH CITY OF
SIGNATURE WI1EN METER ISSUED
PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. CALL 454-5220 FOR INSPECTIONS. FOR STa
SEWER PERMITS, CQNTACT ENGINEERING DEPT.
SE11YEt.t 11VATER PERMIT OFFICE USE ONLY
CIIY OF EAGAN METER # A PERMIT DATE 9115139
3830 Pilot Knob Rd. cH,P # a o 73 3? lv PERMIT #
Eagan, MN 55122-1897
METER SIZE S A6 ° B.P. RECEIPT # 2 3828
ISSUE DATE B.P. RECEIPT DATE 4l 13/ 89
DATE
- PFV - BOOSTER PUMP
SITE AQDRESS
LOT BLOCK SEClSUB L?'_V 1^)C,7-4iJ P0i/,7 e 1
APPLICANT: C.o
ADDRESS: `-?, IiLL D12
CITY, STATE 4-r-- ZIP
PHONE:
PLUMBER
ADDRESS
CITY, STATE _1' ?iti1N FJEL.D HA) ZIP
PHONE: '1;, ;
OWNER:
ADDRESS•
CITY, STATE GA??•v ZIP
PHONE: a 5? S ?'• ? ?
PLEASE ALLOW TWO WORKING
SEWER PEHMiTS, CONTACT ENG
PERMIT REt]UESTEQ
1r- SEWER _)cLf WATER
- COMM/WD 'y_ I
- NEW ? EXISTING
Lawn Sprinkler Meters are to be In;
Ahead of Domestic Meters 9n Water
OF
.-C,
WHEN 1?AE'TER ISSUED
CALL 4545220 FOR INSPEC7ION3. FOR STORM
_ CITY OF EAGAN N2 17020
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
/? ?y. C) ?
BUILDING PERMIT PHONE: 454-8100 Receipt # ?t (?
To be used for SF-DWG/GAR Est value $98, 000
Site Address 916 JEFFERSON LN
Lot 4 Block 4 Sec/Sub. LEXINGTON POINTE
Parcel No. 2ND
W Name SONS CONSTRUCTION
o Address 4600 FAIRWAY HILL DR
City EAGAN Phone 452-5355
2
0
U
a
E
Name _
Address
City _
Phone
?
$w Name
?? Address
a W City Phone
I hereby acknowlage th I ha KIN plicatron a nd stale that the
mbrmauon is correct a e t Rh all apphca6le State of
Minnesota Statutes and i g es.
Signature of Permitee
A euiitlmg Permrt is issued to ONS CONSTRUCTION
on Ihe express condillon tha[ all work shall 6e done m accordance with all
apphcable Slate of Minnesola Statutes and City of Eagan Ordmances.
Building pfhcial
T
OFFICE USE ONLV
Occupancy R-3 M=1 FEFS
Zomng PD $_I_
(ACtuaqConst V=N gldg.Permit 630.00
(Allowable) V=N Surcharge 49.00
k ofS[anes -
38'
Pian Review
0
315.0
len9ih
Oepth 41 ? SAQ Qry
?
100.0
S F 7otal - SAQ MCWCC 575.00
S F Footpnms -
On Sne Sewage _ Waler Conn 580.00
On Srle Well Water Meter 90• 00
MWCC System xx AceC Oeposil 30.00
City Water RK_
PRV Required _ S/W Permil 20.00
Booster Pump - SiW Surcharge 1.0
0
Treatment PI 228.00
APPflOVALS Road Unit 340.00
Planner - park Dad.
Council
Biag.Of1. _ Gopies
Variance - TOTAL 2,9$8.0
C
i.-/5/?'9
P 54973
REQUEST FOR ELECTRICAL INSPECTION
jt? See msVUCliop fcr aZimpleling Ihis form on back af yellow wpy.
`J(" Belaw Work Caverea' by This Request
fl?-% EB-00001-07
" 45?s? 3
e Atld Rep. TypeoiBwlding AppliancesWired EquipmentWired
Home Range Temporary Service
Duplez Water Heater Elearic Heating
Apt. Building Dryer Other (Specify)
Comm./Industrial Furnace
Farm Air Conditioner
01her(specity) Contraclor5 Remeft
Compule lnspection Fee Be/ow:
# O(her Fee # ServiceEnlrancaSize Fee # Circuits/Feetlers Fee
Swimming Pool 0 to 200 Amps to 100 Amps
Transformers Above 200 _ Amps bove 100 _ Amps
Signs Inspector5 U. Ony 6 TOTAL
Irrigation Booms
Special Inspection
Alarm/Gommunication ?
Other Fee
I, the Electrical Inspector, here6y R°ugn-in
[[/-
certify that the above inspection has
been made. Fnai
OFFICE USE ONLY '
Thns; request voltl 18 months Irom
9 /'?'9 94e??63
54973
?
., $?ffa °?
Requeat Date Flre o. Hough-in InapecNOn
epwretl'+
? ReatlY ?w Will NoLty bvspenor
10-16-89 es ?NO henRBSdy>
I licensed contractor ? owner hereby request inspection of above electrical work at:
.lob Atldress (Sheet, Box or floute NoJ Ciry
916 Jefferson Lane Eagan
Sedion No
Township Neme ar No
Ranga No.
Counry
I Dakota
OwupaM (PRINT) Phone No.
Sons Construction 452-5355
PawerSupplrer AOEress
Dakota Electric Farmin ton MN 55024
Eleclncal Coniractar (Canpany Name) CoMractaS License No.
Midland Electric Inc. 041610
MaiLng Mtlress (Canlraclor or paner Makirg ImYallaM1On)
14055 Grand Ave So, Su ite E, Burnsville, MN 55337
AuUionz (ConGactor/Owner Malung Ins(al ) Pho? Number
?
'or 892-6688
MINN60TA STA7E BOAHO OF ELECTAICITY ? THIS INSPEGTION REQUEST WILL NOT
Griggs-Mitlway Bltlg. - Rnam S773 BE ACCEPTEO BV THE STATE BOARD
1821 Unlvereiy Ave., St. Paul, NN 55709 UNLESS PROPER INSPECTION FEE IS
Plqne(g13)802-0800 ENCLOSED.
. (
13-V ? t:?O
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAG14N MN 55122
651-681-4675
New ConaVUCtion NeaulremeMs
• 3 registered sRe surveys slrowing sq. it. ot lot, sq, fl. of house; antl II roofetl areas
(20%maximum btcoverageallowed)
• 2 copies of plan showing heam & window saas; poured lound dasign, etc,)
• 1 set of Energy Calculations
• 3 wpies of Tree Preservatbn Plan A bt pletletl atter 711/93
• Him ,bisl Detail Optbns selection sheet bltlgs wiUM 3 or less unAS)
DATE G z
SITE
TYPE
HemoaeuNeoair Heauiremente \
. 2coplesWplan
• 7setofEnergyCalculetbnsforhealetlaetlRbns
• lsflasurveyWrextenoradtlAiOns&tlacks
• Intlicete rf home served 6y septic system lor additions
VALUATION
APPLICANT /*wl 10 •re` cc?,n f?U G (dc I I C6 a&w
AULTI-FAMILYBLDG _Y 9N
FIREPLACE(S) _ 0 ?< 1 _ 2
v S
STREETADDRESS I Z z,4?- r"7C)-S CITY ??,Isu?I?? STATE N? ZIP S?33
TELEPHONE #9SL??6?.?q??l CELL PHONE # FAX #?`'?Z??6? _wa 2?
PROPERNOWNER ,/t4iIGP ?' ??Icp ??/wc TELEPHONE# G ?? C??r -aG76
-°---------------°------------------------------------°--------°---------------------------
COMPLETE THIS SECTION FOR °NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNFSOTA RULES 7670 CATEGORY 1 MINNESOTA RUL,ES 7672
(J submission type) • Residential Ventilation Category 1 Worksheat Submitted . New Energy Code Workaheet Submitted
• Energy Envelope Calculations 5u6mittad
Plumbing Conhactor: ___
Plumbing system includes:
Mechanical Conhactor:
Mechanical system includes:
Sewer/Water Contractor:
Air Conditioning
Heat Recovery System
Fee: $90.00
Phone M
Fee: $70.00
Phone #
I hereby acknowledge itiat I have read ihis applicaTion, state that The Information is correct, and agree to comply
with all applicable STate of Minnesota Statutes and Ciry of Eagan Ordinanc.? f
Signalure of Applicant
..... ........................................ -------......... ---?...?.?___.?..............
OFFICE USE ONLY
_ Water Softener
Water Heater
_ No. of Baths
_ Phone #
Iawn Sprinkler
No. of R.I. Baths
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4102
?
.
,
E?:' y-I I
RESIDENTIAL
BUILDING PERMIT APPLICATIOPI
CITY OP EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122 ---j S'
851-881-4675 ? G Q '
New Conavuctlon Reaulrementa
• 3 repislered srte suneys siwwing sq. tt. of lot, sy. fL of house: and all roofad areas
(20% maximum lot coverege alWwed)
• 2 copies of plan showmg beam 6 window sizas; poured fountl tlesign, etc.)
• 1 set of Energy CaICU19ti0ns
• 3 copies of Tree Preservation Plan tl bt pledetl atter 7/1/93
. Rim Joist Defa110ptbns selection sheat (bldgs wBh 3 or less untls)
DATE 5 I ? G ?-
Water Softener
Water Heater
No. of Baths
SITE ADDRESS JeT`I-r" 'S? ?'` MULTI-FAMILY BLDG _ Y ? N
NPE OF WORK e,S.'??`K? FIREPLACE(S) _ 0_ 1_ 2
APPLICANT AvIer%co.A <JU ( a? ;< n_ C oo_,?Lc'415
STREET ADDRESS LI ?/Ui caNr?- AU_ S CITY / vi f STATE A"ZIP S?? 37
TELEPHONE #(`i 5_Z)76-7-615?ICELL PHONE #, FAX # (qSa)
PROPERT`fOWNER Ubltp CG?/vtlf TELEPHONE#
------------ -------------- -------°---------°--°------------------°-°----------------------
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1 MINNFSOTA RULES 7672
(4 submission type) • Residential Ventilation Category 1 Worksheet Submitled • New Energy Code Worksheet Submitted
• Energy Envelope Calculations Submitted
Plumbing ContraCtor. __
Plumbing system includes:
Mechanlcal Conhactor:
Mechanical system includes:
Sewer/Water Confractor.
_ Air Conditioning
Heat Recovery System
Phone #
Phone #
Fee: $90.00
Fee: $70.00
I hereby acknowledge that I have read this applicatlon, state ihat ihe information is correct, and agree to comply
with all appllcable State of Minnesota Statutes and Cffy of Eagan Ordinancesp\
Signdture of Applicanfi
--............ _.o._._.................. ----...... _.......e.?..r?___.__.....r...?.
OFFICE USE ONLY
AemadeVRenalr Peaulrementa
. 2 copies of plen
• 1 setof Energy Cakulationsfor heated addilans
. 1 sile survey for exterior addflbns & decks
• Indicate H home servetl by septic systam for addttions
VALUATION ? `i i Obb O!
Phone #
_ Lawn Sprinkler
_ No. of R.I. Baths
Certiflcates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4l02
ICITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
Base Fee $25.00 COPY
Surcharge $.50 Total Fee
Subtotal $25.50
PERMIT
PERMIT TYPE:
Permit Number:
Date Issued:
SITE ADDRESS:
P.I.N.: 10-45071-040-04
916 JEFFER50N IANE
LOT: 4 BLOCK: 4
LEXINGTON POINTE 2ND
DESCRIPTION:
Buildinq Permit Type DECK
Building Wor.k Type NEW
UBC Occupancy R-3
Building Length
Building W3dth
18
15
REMARKS:
FEE SUMMARY:
CONTRACTOR:
?
?
BUILDING //53
020817
04/29/93
$26.00
OWNER: - Applicant -
BAIRD DOUGLAS
916 JEFFERSOM LN
EAGAN MN 55123
(612)683-0091
I hereby acknowledge that I have read this application and stete that the
information is correct and agree to comply with all applicable State ofi Mn.
Statutes and City of Eagan Ordinances.
? APPLICANT/P RMITEE IGNATURE
ISSUED BY NATURE
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55123 Date Issued:
(612) 681-4675
SITEADDRESS: LoT: 4 BLOCK: q APPLICANT:
916 JEFFERSON LANE BAIRD
LEXINGTON POINTE 2ND (612) 683-0091
PERMIT SUBTYPE: TYPE OF WORK:
DECK
?
?
BUILDING
020817
04/29J93
DOUGLAS
NEW
`" <?
REALTIVATE _ RE(?ENE[?p G:IIY Vt tAtaA1V
F?ERl?tI1" a= . 1993 BUtLDtNG PERM(T APPLICATlON ??? ??
APR 2 8 1993 681-4675
1 --------------- catu, 4-1q
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy
calcs. ,
COMMERCIAL 2 sets of architectural 8 structural plans, 1 set of
specifications, 1 copy of energy calcs.
Penalty applies: 1) when permit is typed, 4ut nat picked up by last working day of month.
in which request is made, 2) address is zhanged or 3) lot change is requested once permit
is issued.
? cro
Date 4 / D1 rT Valuation of work ? IF?F1'?
5ite Address: GlL, aFF?E?-SO,.) 1?,? GAr? MrJ SS?a-3
STREET SUITE /
Tenant Name: (commercial only)
IAT L4 BLOCK SUBD.LE?A)HVTO H ft IN"1{3 Y.I.D. * '
Zn?O pD'N.
Descri tion of work: ouTS?oi ajA;cNEb
The appl i cant i s: T?Owner ? Contractor O Other (ues«fbe)
Name 1?_ci LaS F' Phane
Property LAST FIRST
Owrner Address qt1D Lr-'
STREET STE k
City C R?o? 5tate MSN1JtSU -, A Zip 55 i.:?3
Company f"I'? - 5;6 - Phone
Contractor Address License # Exp.
City State Zip
Company N f+- (,wnli:fL Spt+?c? _ 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. 71
I hereby acknowledge that I have read this aPplication and state that the information is
correct and agree to comply with all appl9cable State of Minnesota Statutes and City of
Eagan Ordinances.
Signature of Applicant: -?JOL tD ?
OFFICE USE ONLY
?. _
BUILDING PERMIT TYPE
?
01
Foundation
?
06
Duplex
?
ll
Apt./Lodging
?
16- . ?
Basement Flnish
? 02 SF Dwg. ? 07 4-P1ex ? 12 Multi. Misc. ? 17 Swim Poo1
? 03 SF Addition ? 08 8-P1ex ? 13 Garage/Accessory ? 18 Cwren./Ind.
O 04 SF Porch ? 09 12-Plex ? 14 Fireplace O 14 Comm./Ind. Misc.
? 05 SF Misc. ? 10 Multi. Add'1. 0,' 15 Deck ? 20 Public Facility
? 21 Miscellaneous
WORK TYPE
M 31 New ? 33 Alterations ? 35 Tenant Finish O 37 Demolish
O 32 Addition ? 34 Repair ? 36 Move
GENERAL lNFORMATION
Const. (Actual) Basement sQ., ft. MWCC System
(Allowable) lst F1. sq. ft. City Water
OBC Occupancy ? 2nd F1. sq. ft. PRV Required
Zoning Sq. Ft. total Booster Pump
# of•Stories Footprint Sq, ft. Fire Sprinkler
Length On-site well Census Code y?
Depth On-site sewage SAC Code
APPROVALS
Planning Building Assessments
Engineering Variance
REQUIRED INSPECTIONS '
? Site EL Footing ? Framing [3 Insulation
? Watlboard E Fi nal ? Draintile ? Fireplace
Permit Fee 25,up va?uac;a,: S
Surcharge , 50
Plan Review
License
MWCC SAC
tity SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Oed.
Copies ?o
Other
Total:
SAC %
SAC Units
?
1989 BOILDIltG PEAMIT 9PPLICATION - CITY OF E9GAN
SINGLE FAMILY DWELLING3 11010
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS
NOTEr 9DDRESSFS F08 CORNER LOT5 - COATRACTOR/HOMEOWNER MtTST DESIGNATE WAICH ADDRFSS
IS DESIRED. NO CHANGES WILL BE ALLOFiED ONCE BIIILDING PERMIT IS I3SDED.
MOLTIPLE DIiELLINGS RENTAL UNITS FOR S6LE ONITS # OF ONITS
SNCLUDE 2 SETS OF PLANS, CERTIFICATE OF SIIRYEY - CHECS WITH HLDG. DEPT., 1 SET OE ENERGY
CALCULATIONS
COIRMERCIAL
r
INCLUDE 2 SETS OF ARCAITECTURAL & STRUCTURAL PLANS,
7 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIDNS A uG 2 9 ?ggg
To Be Used For: eL AP-7 C-- Valuation: ? Date: Y"xJ- Pj
Site Address g??o ?1e-FFkIL-T4/? Jil
Lot ? Block ?
Parcel/SubLL)/J(>rf//d PO1iJj2 -LN'2'
Owner '5.:1r , ?,dz -; CG
Address kO r Ir
City/Zip Code
-,
Phone
Contractor Suf? t C'o„? .i ? ??
Address y-17O0 F?'rk'2 /-,I.LLl' Pr
City/Zip Code S .1 /??
Phone
ArCh./Engr. t3fia r 14 a; itiJG-
Address -/?C o f-AIk u.H4 gi <<a JA
City/Zip Code
Phone # 451- - ?? ) )?
%,DDO` "----- ---
Occupancy M'1
Zoning FD $-1
Actual Const V- N
Allowable v-N
# of stories
Length 39,
Depth Lf! '
S.F. Total
Footprint S.F.
On site sewage
On site well
MWCC System ?
City water
PRV required _
Booster Pump _
APPROVAIS
Planner _
Couneil
Bldg. Off. ?W3V
Variance
Council
F63
Bldg. Permit
Sureharge
Plan Review
SAC, City
SAC, MWCC
Water Conn
Water Meter
Acet. Deposit
SJW Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Copies
TOTAL
?
NOTS: Sexer & Water Permit fees and aQeount deposit feea xill be included in the building
permit fee. Proeesaing time for aerer and vater permits is two days once a lic:enaed
plumber has applied for a permit at City Hall.
, . r
VALUAD0LA '
1? ? .
SZAGE
?, ? ?
Go ?G Z?'j •= L! D C? X J S•= 6??`C;o`ij
C? Sw1TT
`4 L4 ?
96
& o
?-------?-
x g 3458
Z rU D
39 X I?'/Z = G ys
z'?Z ? Z i - sZ
_---
x,-b
r-
Z I x 38 ? rigS
I 8 ?C ? _ ?as
I? X 1 - I
`155 K stz> r) 5??
??Gd?
? SAy'aµ?
- EXTER101! ENYEIOPE AVEMGE "U" COMPUTATION
OW"CR: _ ?;Sons Const. Co. ?
?AQpRESS: 916 Jeferson Lane Eaaam mn -
[ONTRACTOR: _f?()j4S CD+.k-( _ CT?Q-j DATE: - ,F PHONE: -452- -535S •
DETERMINE NORKING SO,UAqE FOOTAGE OF EACN:
?. TOTAL EXPOSED NALL AREA,,,,,,.. 2T?- sq ft x"U" .11 .?
2SI,S?
?. TOTAL ROOF/CEILING AREA,,,.,,, ` i2jI sq ft x"U" 026
1. TOTAL EXPOSED NALL AREA CALCULATIONS: .
Total exposed wall
?.,
a1 Tots1 wa11 windaw aru : ?w
Vlazed,...., _ 122 sq ft x"U" 59 •
7r
glazed...... sQ ft x "U" .
b Total door area ,,,,,,,.. sy ft x"U"
-_.?.
c) Total slldinp glass door area:
- `--...9lazad...... sq ft x$full SS • 2_ 320
glazed...... sq ft x "U"
.
d) Total flreplace wall araa sq ft x"U" .
e) Total wall fraMing area
(Avera9e lOx).......... __ 2-Z•8 sq ft xfoul, .10 ' Z2•?O f) Total net wall area above ,
floor (Insulekad)..._...._- Ilo9'? s4 ft x"U" , o4- ' eiizi
g) Total rim Joist area...... }2?'
sq ft x l'U', ag- • 5•.0?}
Total foundat(on
area (Exposed),.,,,,,,,, sq ft
h) Toul foundatlon •
wtndoa area ............. sq ft x$lUll ?
.Total net foundation `-?
area above grade....,... sQ ft x"U"
??_ ? 3•?8
TOTAL a) thru 1)
? f 97•'??
f Item 03 Is the same a$or less than Item NI, you have met the intent of
: FtCpR 1.16008 A and 0. ?
?..c.? ? ? ?? ? 5 i ,-. ...., ' F'E?t{'.R ir . .:?i/•?'s? , y????
N
, ? . n?.?l?' '? '.f.'. e-' '??Y ' 14 d ??. 1 t >ti ?'? •
? ? `,?r? • ??4? .a
!1. - _`:TJ1QlA14?Q1dA?1 . •
.,. ?.:'i :?. ? ?a.VF... ?,: -.. -. . eW*JCF!.',3i?RXS?i2R?K"Y°`??1?3?"3l a 1" • . ?4?„?', u'.A'i".t?T
J1 Total skyt1.4ht •rs?.,.?.,.?.... .sq'?1VX??.:!'-?:?'? ?'?-?;e??.
._'i i' ?If??i?4M `:?? ; ?.,...•?..w?, s.a?
;?;:M?, ^',.'?'?ra`"•t'.:h%
,..?r?%?et?l le9' rr?a.::.'... ?eq ft x
4. , TOTAL j) chru 1)
If total of 04 is the same as, or less than 02. you haw mat the letent of
2 MCAR 1.16008 A and 0.
ALTERHATE BlIILDIN6
To utflize the totai envetope system method,
of Items 03 and N4 shall nat 6e graater theo
1. ? 2.
3. + 4.
•?
I
ENYELOPE DESIGN
the values eseablished by the suw
the sum of itan: II and !!.
-
. LERTIFICATION
1 hereby certify that I have calculated the "U" faetors and "R"
values herein and that the buildinq hera descrlbed meets or extesds the Stata
of N(nnesota Ener9Y Conservetlon Act.
, ` ?'s ? •
(Signature)
. ' • b' zS f`?
(Date)
, Page
?- ? • .??:?;.ro.?,??r.:. ,..,?.?•.?.,, .?. .-...
, , , . ?, . . -?.:v.?+aY:«?k6W5:.. ? .. ....... . .. . .
. . .. __... •???.1.?'i$,_ . .__,.. ? . ?
TRI-LAND C0. SiTE
SURVEYING
SERVICES 5.,,,s
1260 YANKEE DOODLE ROAD
EAGAN, MINNESOTA 55126
PL AN FOR:
GawsrRV??-•o•v
LEGAL DESCRIPTION: LOT 4,BLoCK 4, LEXINGTON POINT 2N0
ACCORDING TO Tx E RECORDED PLAT
THEREOF DAKOTA COUNTY,MINNESOTA
JEFFERSON_1ANF-t
y kG
A06y q??b N Q0a
R=844.54 "
p=5°04'26„ _ I ?`??
? ?99 • $
4D
?
?dp Fima
zr ?44Z I ??-'""- ygs.az
=
°
O $ v,?ooos?n • x ? ? ;-. -r
NOUW
J4 20./7, .j
L98 ?? q0 T5 (d -. " . ' ' - .. : . .. _ '
Ln
? 10
? `.14
b
t. re,?•, i. ';?,? .,?
4 I
76
-?-, ? 5 ?8p225 W SCALE: I"=30'
LEGEND
?
o DENOTES IRON MONUMENT
o DENOTES WOOD HUB SET
DENOTES EXISTING SPOT
ELE VATION
DENOTES PROPOSED SPOT
ELEVATION
? DENOTES DRAINAGE DIRECTION
I hers0y certify tAat this survey,plan or
rsport wes preparsd by ms or under my
direct supervision and thaT I am a duly
Reqistered Land Surveyor under ihe
Laws of the State of Minnesotu.
Bradley J. *rAAW'n , Mn. Rep. No. 13235
,
Dore C /
INVERT EL.EVATION A SERVI E EXTENSION?T
PROPOSED GARAGE FLOOR ELEVATION = 9815
PROPOSED FIRST FLOOR ELEVATION = q?
PROPOSEDBASEMENT FLOOR = 978 2- '
ELEVATION
NOTE'. VERIFY ALL FLOOR HEIGHTS WITH
FINAL HOUSE PLANS
•?_ ? ? '
O'i-ll
TRI'LAND CO. SiTE PLAN FOR:
SURVEYING
SERVICES 5a"S GpvNSTRt?GT/ON
1260 YANKEE DOODLE ROAD
EAGAN, MINNESOTA 55126
LEGAL DESCRIPTION: LOT 4,BLoCK 4, LEXINGTON POINT 2ND
ACCORDING 70 T E RECOROED PLAT
THEREOF DAKO COUNTY,MINNESOTA
2l.
?q77•
S ? 85" ?N
LEGEND
o DHNOTES IRON MONUMENT
? DENOTES WOOD HUB SET
DENOTES EXISTING SPOT
ELEVATION
DENOTES PROPOSED SPOT
ELEVATION
? DENOTES DRAINAGE DIRECTION
I hereby certify that this survey,plan or
report was proparsd Dy me or under my
direct supervision and that 1 om a duly
Reqisfered Land Su?veyor under the
Laws of the Siote of Minnesota.
?
M
SCALE; I"=30'
pkart'saa -47'oux . [.EwsG. w/ svt,%T zevEC kini.ravT
INVERT ELEVATION AT SERVICE EXTENSION=
PROPOSED GARAGE FLOOR ELEVATION = qg b9-
PROPOSED FIRS7 FLOOR ELEVATION = 9(- 0-
PROPOSED13ASEMENT FLOOR = 978 3-
ELEVATION
NOTE? VERIFY ALL FLOOR HEIGHTS WITH
FINAL HOUSE PLANS
Bradley J. S er?6n., Mn. Rep. No. IS235
Date : `?/ C / /c`1' q
JEFFERSON_ l-t
- - - -
~C 17 n31g i i Office Use
Uu q Ll
I Permit / I
//TT I
City of Ea
aIl
0 I °JV
b I Permit Fee:. ~ I
3830 Pilot Knob Road
I
Eagan MN 55122 j Date Received:
Phone: (651) 675-5675
1
Fax: (651) 675-5694 Staff:
1 I
- - - - - - - - - - - - - - - - - -
2009 MECHANICAL PERMIT APPLICATION
Date: Site Address: if l
Tenant: C 1) CA K) Suite
RESIDENT / OWNER Name: t C ~Q) i~t (l f Phone: 051 q Q RC9 /
Address / City / Zip: I - (S (;1. j 3
CONTRACTOR Name: L: URNSVILLE HEATING & A/C, ING License U I C~S~~ 22113
3451 W. Burnsvl e Parkway
Address: mite 190
City: Burnsville, MN 55337 State: Zip:
Phone: qS4 -2CA II -000 Contact Person: _ 6U-1
TYPE OF WORK New V Replacement Additional Alteration Demolition
Description of work: 4 CQ
NOTE: Both roof mounted and ground mounted mechanc~a e4urfpment is required #o
be screened by City Code: Pleese contact the Mechanical Inspecfor.or one of the
Planners for information on ` er mltted screening methods.
PERMIT TYPE RESIDENTIAL COMMERCIAL
X Furnace New Construction Interior Improvement
Air Conditioner Install Piping Processed
Air Exchanger Gas _ Exterior HVAC Unit
Heat Pump Under / Above ground Tank Install / _ Remove)
When installingtremoving tank(s), call for inspection by Fire
Other Marshal and Plumbing Inspector
RESIDENTIAL FEES:
$50.50 Minimum Add-on or alteration to an existing unit (includes $.50 State Surcharge)
$90.50 Fire repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge)
$ f" TOTAL FEE
COMMERCIAL FEES:
$70.50 Underground tank installation/removal OR Contract Value $ x1%
$50.50 Minimum (includes State Surcharge)
= $ Permit Fee
- If Permit Fee is less than $1,000, surcharge is $.50.
If Permit Fee is > $1,000, surcharge increases by $.50 for each = $ State Surcharge
$1,000 Permit Fee (i.e. a $1,001-$2,000 Permit Fee requires a $1.00 surcharge).
$ TOTAL FEE
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 jw~o''rrkk~whihic(hyreeqquirre ~sra~ review and approval of plans. ~ r
Applicant's Printed Name Applicant' s Signature
FOR OFFICE USE
Reviewed By: Date:
Required Inspections: -Under Ground Rough In .____Air Test _-,__Gas Service Test - In floor Heat -Flria.1
Exterior HVAC Screening Inspection
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA117298
Date Issued:10/16/2013
Permit Category:ePermit
Site Address: 916 Jefferson Lane
Lot:4 Block: 4 Addition: Lexington Pointe 2nd
PID:10-45071-04-040
Use:
Description:
Sub Type:Siding
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to
ensure maximum ventilation to attic. 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 -
Michael T Coyne
916 Jefferson Lane
Eagan MN 55123
(651) 230-4179
Krech Exteriors Inc
5866 Blackshire Path
Inver Grove Heights MN 55076
(651) 688-6368
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA144629
Date Issued:08/02/2017
Permit Category:ePermit
Site Address: 916 Jefferson Lane
Lot:4 Block: 4 Addition: Lexington Pointe 2nd
PID:10-45071-04-040
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:One Window/Door
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 or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 500.00
Fee Summary:BL - Base Fee $500 $40.00 0801.4085
Surcharge - Based on Valuation $500 $0.50 9001.2195
$40.50 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 -
Michael T Coyne
916 Jefferson Lane
Eagan MN 55123
(651) 230-4179
Home Depot At Home Services
2455 Paces Ferry Rd
Atlanta GA 30339
(952) 345-6057
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA158465
Date Issued:10/16/2019
Permit Category:ePermit
Site Address: 916 Jefferson Lane
Lot:4 Block: 4 Addition: Lexington Pointe 2nd
PID:10-45071-04-040
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.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
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 -
Michael T Coyne
916 Jefferson Lane
Eagan MN 55123
Krech Exteriors Inc
5866 Blackshire Path
Inver Grove Heights MN 55076
(651) 688-6368
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA161160
Date Issued:05/08/2020
Permit Category:ePermit
Site Address: 916 Jefferson Lane
Lot:4 Block: 4 Addition: Lexington Pointe 2nd
PID:10-45071-04-040
Use:
Description:
Sub Type:Residential
Work Type:Underground Sprinkler System
Description:PVB
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 - RPZ/PVB/Lawn Irrigation $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 -
Michael T Coyne
916 Jefferson Lane
Eagan MN 55123
(651) 230-4179
Drain Pro Plumbing
8815 - 209th Street W
Lakeville MN 55044
(952) 469-6999
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA170837
Date Issued:07/20/2021
Permit Category:ePermit
Site Address: 916 Jefferson Lane
Lot:4 Block: 4 Addition: Lexington Pointe 2nd
PID:10-45071-04-040
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507)
210-0754.
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 -
Michael T & Julie M Coyne
916 Jefferson Ln
Saint Paul MN 55123--199
Burnsville Heating & Air Conditioning
3451 West Burnsville Parkway, Ste. 120
Burnsville MN 55337
(952) 894-0005
Applicant/Permitee: Signature Issued By: Signature