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4750 Galaxie Ave
Use BLUE or BLACK Ink r For Office Use `7 ~ C` C- Permit#: ~ /S City of Ea I I Permit Fee: c2 3830 Pilot Knob Road Eagan MN 55122 Date Received: Phone: (651) 675-5675 AVG 26 RECD I Staff: I Fax: (651) 675-5694 I J I 2010 RESIDENTIAL BUILDING PERMIT APPLICATION fP//a fl Date: ~S v1o_~ Site Address: t'7"50 Cza~" z- ~ Tenant: Suite M RESIDENT / OWNER Name: Ghr'i 5 Lo^r-,c r5 Phone: (=IS t3 Address / City / Zip: L4750 G 0.~aXf e-- e- Applicant is: V/ Owner Contractor TYPE OF WORK Description of work: 2.w G,c Construction Cost: 50 ~ Multi-Family Building: (Yes No CONTRACTOR Name: S r-11YP License Address: City: State: Zip: Phone: Contact: Email: 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.gopherstateonecall.org I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of planes. x (\(\o CS x Applicant's Printed Name Applicant's Signature Page 1 of 2 q-750 GP,(,H)Q6- 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 Lower Level _ Pool Miscellaneous Accessory Building 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 Occupancy MCES System Plan Review Code Edition AeMKjl SAC 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- Width REQUIRED INSPECTIONS Footings (New Building) Sheetrock Footings (Deck) Final / C.O. Required Footings (Addition) Final / No C.O. Required Foundation HVAC 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 Meter Size: Radon Control Erosion Control Reviewed By: Building Inspector RESIDENTIAL FEES Base Fee /~-'I L Surcharge Plan Review MCES SAC City SAC ~O Utility Connection Charge ~ S8►W Permit & Surcharge Treatment Plant Copies TOTAL Page 2 of 2 Loa 3 '-o f 2 la tA a, f m 1 .i 1Q { i L _ (rya f~- i . ; _ 22.4 , ,ryc .a ~ C-A HOUS M'EATING ? 1 11 TEST RECORD 3 5 () I 7 iu ` 3 C ? ? ADDRESS.? , 1 APT. FLOOR CITY - SUBURB OCCUPANT HEAT L055 DATE HTG. IN57 OWNER SOLD BY INSTA4LED BY Elsctrieal Work By Gas Line By TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER GAS DESIGN MAKE ? ? MAKE OF BURNER _ Model hlodel Sasiol Mqx. STU Rating - INPUT 160 MAKE OF FURNACE Model Ya{ve Limit Limit Setting Fan Sstting _ Pilot Typel Pilat Make I GONTROLS -=.Heaf Plug Pilot Model Pilot Timing ;' d 5CCarVs L.W. Cut Off ? Pressure `a W'(- • Pereent C02 Input CFH Peresnt 02 () 4 Stuck Temp. Percent CO Fo?m 235 Vsni Si:e KIND OF LINERZ& Drah Hood ,I Filters SizeL, Chimner Locotion Chimrtey Construeiion ) r Smoke Bomb Wiring Draft Tesf Tay Dow Prossure Lightiny IRsr. _ ? ' Date Tested ' Company Testing Name of Tester S CITY OF EAGAN Remarks Addition pRRK RIDBE 1ST ADDN Lot 17 Blk 3 Parwl 00'56750-170k-03 Owner sveet 4750 GALAXIE AVENUE state EAGAfV iNN 55122 ' Improvement Date Amount Annual Years Payment Receipt Date STREET SURF, 1QLF. ?iQ A014017 6-8-84 g STREET RESTOR. 9$S 491.99 32.80 1 491.99 C009673 10-11-84 GRADING SAN SEW TRUNK 1982 147.21 9.81 15 117.78 A014017 6-8-84 SEWERLATERA # 120-23 8-02 19 23 C009673 10-11.-84 WATERMAIN WATERLATERALo"?E 2hk 1 85 396.35 26.42 396.35 C009673 10-11-84 WATER AREA 1982 147.21 9.81 15 117.78 A014017 6-8-84 STORM SEW TRK y„ 1985 370.93 24.73 15 370.93 C009673 10-11-84 STORM SEW LAT x 1985 109.58 7.31 15 109 . 58 C009673 10-11-84 CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN, 45.00 t? n BUILDING PER. RJUR SAC 575-00 Ir 11 PARK CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Esgan, MN 55721 PHONE: 454-8100 QUILDING 'ERMIT aK?ipt ? - TO w wwd im , Est. Volue Date Site Addrets Lot 1 -? Block c/Sub. Parcel No. W ? ? ? Name Addre City _ ? Narne Phone 1Q??Or` ??, ,•?' , Eract U Occupancy _ Remodel ? Zoning Repair ? Type of Const. Entarge ? No. Stories _ Move ? Length demoliah ? Depth Grade ? Sq. Ft. Address Assessment City Phone Woter & Sew. Politt Neme Fin Addreas Erq . City Phone ptanner Pem+it Surchorge Plan Review. SAC Water Conn. Water Meter Coutuil Road Unit I hereby ocknowledqe thot I how rood this application ond stote that gld9, pff, parky ths intormation is corrcct and ogree to comply with all applicable APC Total Stob of Minnesoto Stotutes and City of Eagan Ordinonus. Var. Date Sipnotun of PermittN n Buildirq Pem+it Is iuwd ro: . on the expnss cordition ihot oll work shall be dorw in xco?donct with all applicoble Stota of Minnasoto Statutes ond Gty of Eogan Ordinonces. Buildieq Otficiol Pwmft No. Pwmit Holdw Daft T* hons s Plumbirq H.VA.C. ENcpic Sottenu InWeetion Dm Insp. Othw Footin¢ ,e?? Foundation Framin9 Roofin9 Rauoh Plbq. Rouyh HVAC InsuMtion Find Piba Finsl HVAC Final ? CMUOoc. Waftr Dncribe Loeation: Yllbll Sewer Pf. Dhp. CASH RECEIPT CITY. OF EAGAN P. O. BOX 21-199 EAGAN, MINNESOTA 55121 DATE 19 AMOUNT $ I & DOLLARS ?oo ? CASH ? CHECK ?-v ` • ' ?- ? FUND CODE AM OUNT r r ? . ? l .> - ?J ?. ( ? ` Thank You J ! ?\ BY , White-Payers Copy Yellow-Posting Copy Pink-File Copy Receipt PLUMBING PERMIT Permit No. CITY OF EAGAN ' Fee FiII in numbered spaces S/C ' Type oi Print /egiWy Tot. 1. Date 2. installation Cost , r 3. Job Address LotBlk.'- Tract , - 4. Owner 5. Contractor Phone 6. Address 7. City State Zip 8. Building Type: Residential ? Commercial ? Institutional ? 9. Work Description: New O Add D- Alter 11 Repair Cl 10. Descrihe 11. No. Fixtures Water Closet No. Fixtures Cesspoot/Drainfield Bath tubs Septic Tank Lavatory Softner Shower Well Kitchen Sink Urinal/Bidet _ Other Laundry Tray ? 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 and codes governing 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 JF EAGAN SEWER SptVICE PERMIT ....s0 Pilot Knob Road P. O. Sox 2.199 PERMIT NO: Eagan, MN 55121 pqTE; Z°^i^g: " No. of Unlts: ' ?? .r•??? "p:?,.,? QWIIOr. Address: "-""- Site Add Plumber: i egra to oeinolp wilh !la Gty of Easos Ordinanoa. By Dote oF 1 nsp.: Insp,: OF EAGAN .? Pilot Knob Road .?. O. Box ^' 199 Eagan, Mnl 55121 zoning: ' A 4wner: :0:785 llddress: Site Address: '1750 ii;tllxi'' AY Piumber: `.;t SP Meter No.. Size: , Reader No.: 1 agew to oonsplr wilh t1N Ciey of Eagsn Ordlnanem gy Dute of I nsp.: Connection Chorge: ; 50• 0fl j?'-'t Actount Deposit: IS• 10 J ` 'J Permit Fee: 1 '? • • ? : SuKharge: ? ;' =' Misc. Charpes: , r 'T Totol: Date Pcid: CITY OF EAGAN W/kcTER SERVICE PERMIT 3830 Peiot Knob Road • P. L?. Box 21189 PERMIT NO.: ' -' Eagan, MN 55121 DATE: Zoning: - No. of tlnits: ? Owner: ., ` /?ddrcas: ta Address: 17.;0 Ualaxi_ ??" i _ i-,i?,. •?id ' Piumbar: ?tai k 1 l? ? Meter No.. 9 13 Connection Churge: Slze: " F"`?.: ' Accou? Deposit: ? . ? Reade No 10 Permit Fee: 1 aOM eo eoanply. rir? _ 5 0I]d ?t'horyes: - -; , " i? ?, et? gy Dli."Alid: Dote of Insp.: ?Z Insp.: Connection Chaepa: 12 ' : • i!) : L Account Deposit: - - 111.15 Permit Fee: 10 . 0 j"' - ,. Surcharpe: Misc. Chorfles; Totcl: bate Pcid WATER SERVICE PERMIt PERMIT NO.: DATE: t No, of Units: ° Receipt _ MECHANICAI. PERMtT Permit No. CITY OF EAGAN Fee Fill in numbered spaces S/C Type or Print /egib/y ' Tot. 1. Date 2. Installation Cost 3 A ' L . Job ddress = ot Blk. Tract 4. Owner 5. Contractor Phone 6. Address 7. City State Zip B. Building Type: Residential 0 Commercial 0 Institutional ? 9. Work I 10. Describe 1 11. New 0- Add O Alter ? Repair ? Fuel Type No. Eqy' ment 8TU - M. Ea. Forced Air No. EQUiament CFM Air Handlin : Mfg. g Boilers Mfg. Mech. Exhaust Unit Heater Mfg. Other Air Cond. Mfg. Gas, Piping Outlets 12. I hereby certify that the above information is true and correct, and I agree to comply with all ordinances and codes governing this type of work. Signed : for Rough Finat Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. Approved CITY OF EAGAN 454-8100 C ITY ` 3830 Pilot Knob Road, P.O. Box 21-19 ' PHONE: 454-8100 BUILDING PERMIT.? " ? Eagan, MN 55121 1r ? 8826 l. Receipt Te 6g uwd ioe SR DWG/GAR Est, Volue ? 6 2? 0 0 0 pare r?BRUFiRY 17 I 9 $ 4 Site Addreas 4750 rAT.AXTF. AVF'. ? Erett ? Occuponq R3 Lot 17 Block 3 Sec(Sub. pARK RThC ;F. Nlter p Zoninp Rl Percel No. 10-5 6 7 5 0-17 0- 03 Repair p Fire Zone N/A E V nlurpa ' ? Type of Const. W Name ROT.A11D & LTNDA .O dr10' '..9 Move p # Stories ? Address 1203 ST. PAUL AVI''. _ Demoliah p Length 6 2' City S`I'• pTI-r- Phone 698--502 3 Grode p Depth 26 ! Sq. Ft. 1? ?;' -rn`.Tr-P Tr7r Avor ovob Fee. Name ARK NA(;F.T, /pRQRF RNGR ; I hereby acknowledge that I hove read this opplicotion ond stute that the intormation is correct ond agree to compiy with oll npplicoble State of Minnewto Stotutes ond Ciry of Eogan Ordinonces. Sipncture of Permittee Woter 8 Sew. Police Fire _ Enp. _ 0 ()tlonner _ CouncH _ Bldy. Off. APC - Pertnit ? J 1?7 . vv Surchorga 31 . 00 Plan check 159.50 snc 525.00 Water Conn. 450s00 Woter Meter -019e Rood Unit 2-ri n_ Q 7 Totol ' ' 50 RutiuoN Flu. A Bufiding Pertnif is Issued to: on the ettpress tondition thnr oll work sholl be done i aGCOrdonce with qll opplioable State of Minnesota Statutes and Ciry of Eapon Ordinances. Buildin9 Officioi ?? Pormit No. Permit Holder Misc. Permit No. Holder Plumbinp 60-,VL. ? H.v.a.c. 33 ZA)eA)te wBn wecer Disp. S?vwr EUetric 3 .?, ?• s? Inspection Dsts Insp. Other Footinys ? (,J Foundatfon Framinp G.$ Rouah Plba ? Rouph HVAC Inwlation -,) Finat Plhp. _$ Finsl HVAC , Final ,e ? J • Wate? Dewibe Location: W.ll ?,o .S•?1-? a Sevor Pr. Oisp. . `.? CITY OF FAGAN Include 2 sets of plans, ? 1 site plan w/elevations & BUII,DIPIG pERMIT AppLICATION 1 set of energy calculations. 7b Be Used For Single Famil ? Y Valuation 491 Date Site Address 4750 Galaxie ot-iamL prU.e, Iot 17 Block 3: Sec./Sub. Park Ridge rarcel #: /0 - Sb`j S o- f?b- (n Owner: Roland & Linda Connors Address: 1208 St.. Paul Avenue City/Zip Code: Phone #: Contractor: St. Paul, MN 55116 698-5oz3 Ruscon Homes, Inc. OFFICE USE ONLY Fs ect A^ Occupancy Alter Zoning ? Repair Fire Zone Enlarge _ Type of Const. I`'bve # Stories Demolish Fsont ft. Grade Depth ft. Address: 1000 E. 146th St „#100 ?aater/5ewer gurcharge City/Zip Code; Burnsville MN 5 337 Police Pi Plan Chec)C re Sp,C Phone #: 432-1433 aig• Water Conn. Arch,/Eng.: Mark Nagel/Probe Engineering Planner Council Water Meter , Road Unit Address: 1000 E. 146th Street Sldg. Off. 1 APC City/Zip Code: _B,,nsv;3iP, Mh* 55337 Phone #: 432-2044/43z-3000 zcrrAL / 7 7• S CITY OF EAGAN NO 88zL? 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 ' PHONE:454-8100 BUILDING PERMIT. Receivt # Te M uted for SF DWG/GAR Est. Value $ 62,000 pate FEBRUARY 17 I q 84 Sitenddress 4750 GALAXTE AVE Erect Occupancy R3 Lot 17 Block 3 Sec/Sub. pARK R D +F. Alter ? Zonirg Rl Parcel No. 10-56750-170-03 Repoir ? Flre Zone N/A E l of Const T V n orge ? . ype ae Name ROLAND & LINDA CONNO RS Move p # Stories Z Address 1208 ST PAUL AVE Demolish ? Length 62 9 City ST. PAUL phone 698-502 3 Grada ? Depth 26 Sq. Ft.- m R USCON HOMES INC. NpPravalf o Name ?u Address 1000 E. 146TH ST., #100 Assessment_ Citv R TRNT - 9VTti---T---•T'R Phone 449-1 d14 Water & Sew. Poiice _ tW Name A'LARK NAC'FT/pRnRF FN('R Fire _? Address 1000 F._ 14FTH ST Eng <W CityB N VTT,T,F.phoned12-2lldd/d'i9_ZhQOPlanner_. Council _ I hereby acknowledge that 1 have reod this opplicotion and stare ttiot Bldg. Off. ? the information is correcf and ogree to comply with ull applicoble APC - State of Minrxwta Stotutes and City of Eogan Ordirwnces. Permit $ 319.00 Surcharge 31.00 Plan check159+0 5nc 525.00 Water Conn. 450.00 Water Meter ----6-3-0 0 Rood Unit 7sn - 00 Totol ?1' /gT' 50 Sipnoture of Permittee 1 A Building Pertnit is issued to: on the expres9 condition thni oll work shall be done iAwrdQnce w th Il_9pplicable Stote of Minnesoto Statutes and Ciry of Eoqan Ordirwnces. Buitdiny Officiat - ? ee ' ?? ??? ?"?. ? ,> ?? ? o. f ?. (' ---?-? i - _ f?? C ? " ? u ??? ? .??p??` ? G1 ? ??-?? ? ?s?= „. __ . 4 ?,?•?i:.:???:? ? ? fXTERIOR ENYELOPE tiVERAGE "U" LOMPUTATION ? D4tNER ,.. ' . .. ' SITE ADDRESS E '__ .'.' ' . .?.:.. . . . . - _ .. .:.. ._ - .. ` CONTRACTOR ??? ?C o iv N,ti^.F s.?ti?c • DATE _ PHONE < Determine working square footage of each. 1. Total exposed wall area ...... 19 H g_ sq. ft. x .17 2. Total roof/ceiling area ..... }C)qO sq. ft. x .OS Totai exposed wall area above floor = V111 a. Total wa11 window area ........................... ir7 . 4ll b. Total door area ................................. . ?. c. Total sliding glassdoor area ................... d. Total fireplace wall area ....... ... .......... e. Totat wall framing area (average 10A)...:........ !K5 -? f. Total net walt area above floor ................. g. Total rim joist area ............................ i?'t4 Tctal expesed foundation area = -Oia. O h. Total fcundation window area ............... ...... - 1. 7oa1 net foundation area abo ve grade ...... ...... -- .? Determine "U" vat ue a f each wall segment. _ X „us. b. C ` 4 C) X ??u- . . T d. - X "iJ" x „u,l e._ f. i?f ^.Rs x x „u- ??o = ?•? , h. - X .,u., .? ; X Ua? . 1 3 .. . ....TO :zI •••. . .................. . . I` i,_-.- =3 is the saaie as, or less tnan item zl, you have m°t the intent - - -?-? rHiu.iPS YuN.5Exv1%.; e27 1010o Lyaaale A.K. Bloomiagtaa, MN suice f tas ? :: i c < ;-• _ k. 1 ? X "U" ?. 9 x $fu° ? 042 _?= 3a.31 4 ...............????...........Tota1 ' t? Ff totnt of 14 9s the same as, or less than 02, you have met the intent of SSG G0061Vc}i. " To utilized the total envelope system method, the vatues estabtished by the sum of itens 13 and $4 shall not be greater than the sum of iteas F1 and 12. ]. + 2. ? 3. + 4. _ IP[AAiERIA;,S Thers. P,esistance "E" - Ezterior etr 1'l SidinQ Yaterfal ? Shsathing Insulatioa ii SaBetr '' ? in.eriox F:r 8tvds u Ria Conc. E21cs. A. _-. ? . .v ....E:.e; -.:'. _ a 7 _ I'6ME oWUE2'. S Iz'E dDD2e.SS: FaaNT 7 ^P/Pr? aF Y1iNnevs: TYPE op T2ft-?: N1dLILdcff )(6zh_. Pario Ou. DoWU . P?-TIO Dm2 UP Yc?"• wdLL -rLIu.u Meru 3/4 MAS IOU-M F12EFL-ACE -Y-Cuca- up =6K isQie-L TYPE-: CW 6 I'r v Fi¢EPLacz- FaariNc?S aa?v s4JGV_ OI.] t{OUSE Cd6T. P_acn2: LT. Dd¢e eaLiArrLL roPS: Aimm ib TYPE TU6: arEK. CE26MIL: &6 APPLIAuc.E eDLOIL: flmi[tiP3: 2dn1[rE1? D¢.vc¢??-- SA i?]??s : L " ,:?N rur LitE QicU : ExT. L.%rr-- M& : IAlmft?aQ Lnto2: ExT eo1o2: rrLtr..: r2a.. 1WGLUDES i • JJOM= siDiJU ? C. ,. VILI4L ro bE- I u : KiTr-H ms' rqf-?- 1 Llbi 005 ?Z 7 i ? 'i LA)NLCY ?' 7E, IV '? ti i? ¢?FCt O N D 2auerE D if ENT. Ai2 L'v?70. O Dw. Fluri iFcm MC) Disr. ES :c./N B14. -?g -t4)o6 Ext.o?li CNeAa4De lit-Y ; . C' . ?. I z/s4 / CITY OF EAGIaN APPLICATION FOR PERMIT SEWER AND/OR WATER CONNECTION . (PLEASE PRINT) 1) PF.OPEfYI^I ADDRESS: 41Q G- r.rral, DESC2Ip'I'IC:I: ? (Lot/Block/Subdivision or Tax Parcel I.D. ber) IF =XI=::C, ST.n,C'C17ji2E , DATE OF ORIGIidAL riiZLDL"G ==1IT T_SSa?.':C°_: ( P:LS.' : LSE: C9'R-1 SINGLE FA?-I-LY ? R-2 DUPLEX (7•;0 Wi ITS) O R-3 TGSvNHOtJSE (THREE + U!+IITS) ( UNITS) ? R-4 ApAR2P'=`.":/CONpO,iLNI[,til ( L1i2TSi Q CCkVff..'4CIALi-2t ETr1Ii,/OFFICE ? .T,i'DL'STRIAL ? INSTITUTIONAL/CMT-%NT'[F'?..7T 2) APPLIGk?"P ? (PLEASE PRINT) IS???: n a+-z ? ADDRESS: ZaDC) CTTY, STATE, ZIP: QLAnwA ., - PxoIT: !?/32-1</'33 3) PLL:,IBER PRINT) FOR CITY USE ONLY ??. PLUMBERS LICENSE: ADDRESS: Active CITY, STATE, ZIP: Expired PHONE: ic.? _ PLUMBER LICENSE N 3 3 :2Y Q Not of R?d -Starr initia 4) OCCUPA1NTP/CSJi`IER NAt '?: r l Y J NH 1 N I J ADDRESS: Z.2 6 CITY, STATE, ZIP; ? PHONE: S) INDICATE WHICH PEPM IS BEING PEQUESTED: ? ION TO CITY S?rlEEt CO^.'.IE?i'ICN TO CITY WATER ? CyPfER (PIEASE DESCi2IIIE) 6) -D?'DIC,::_. 0:Z: ? ? PLEP,SE HOLD r1PPRWID pgi,+1IT FOR PICK-LIP BY ONE OF ABM'E PLEASE .%?L?, APPRO?IED PE?2:`•LIT TO 1, 2,? 4 e'1BO?IE / n (Circle one) 7) SIG!,`A'IL'M: -?:!!."` ti?,d'?d ' DATE: W F 0 R C I T Y U S E O N L Y PERMIT ° ISSUED FEES: $ $ $ $ / .T7 "-a $ S .<s° .?? .....a S $ $ $ d?-c `C,F••.:yR DL`p\1T'T' Trr.r-- -• ^..D/1 ?1_ l?vJ`u ?i.lH?.'^.•J'L? WATER PEI2P4IT (INCLUDE SURCHARGE) WATER METER/COPPERHORN/OUTSIDE READER WATER TAP (INCLUDE CORPORATION STOP) SEWER ';Ap ACCOUNT DEPOSIT - SEWER ACCOUNT DEPOSIT - WATER wac SAC TRUNK WATER ASSESSIMENT TRUNK SEWER ASSESSMENT LATERAL BENEFIT/TRUNK SEIIER LATERAL BENEFIT/TRUNK WATER OTHER TOTAL AMOUNT PAID/RECEIPT # yi 9-? e? DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY? [_] YES IF YES, THEN A"PERMIT FOR WORK WITHIN PUBLIC ROADWAY" MUST BE ISSUED BY THE ? NO ENGINEERING DIVISION. LIST AS A CONDI- TION. SUBJECT TO TfIE FOLLOWING CONDITIONS: APPROVED BY: TITLE: DATE: me G"w noun M MAW suw iwmma 00 ftft? NOTE: To Be Used For: Valu '- Date: 1985 BUILDING PERMIT APPLICATION - CITY OF EAGAN ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN Vo INCLUDE 2 SETS OF PLANS 3 CERTIFICATES OF SURVEY SET OF ENERGY CALCULATIONS 1&61 Site Address: ( Lj ' ? Lot: I -? Block Sect ub 'T1 Parcel # Owner ?aNr +?1Wh0. 6?,Al Address q -" Q ' f, City/Zip Code q a. Phone L S L Contractor l?; ?,?. n.oyZS Address %-I7SU ?? A OFFICE USE ONLY Erect X Occupancy Remodel Zoning Repair Type of Const Enlarge !1 of Stories _ Move _ Length Demolish Depth Grade Sq Ft •nnomrar c Assessments Permit 25.`O alter/Sewer Surcharge lice Plan Review re SAC Engr Water Conn Planner Water Meter Council oad Unit Bldg Off arks APC Treatment P1 Variance TOTAL City/Zip Code ? Phone Arch./Engr. Address City/Zip Code Phone 11 ? ? ? ? ? ?' •a?? ?,? s ??,??e ?? ?Po/e I co 2007 RESIDENTIAL BUILDING PERMIT APPLICATION City OF Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 New Construction Requirements 3 registered site suneys showing sq. ft of bt, sq. ft. of house; and all raofed areas (20%ma)dmum lot mverage allowed) 7 Soils Report if pmposed building is to be placed on disturbed soil 2 copies of plan showing beam 8window sizes; poured found design, etc. 1 set of Energy Calwlatlons 3 copies of Tree Preservation Plan rf lot platted after 711193 Rim Joist Detail Options selection sheet (buildings with 3 or less units) Minnegasco mechanical ventila6on fortn RemodeVReoair Reouirements 2 copies of plan showing faohngs, beams, joists 1 set of Energy Calcula6ons for heated addNOns 1 site survey for addifions & decks Addition - indicate if on-sife sepfic system O1ficeVSe OnIY CertofSurvey .Recd _Y _N SalsRepat ;- _Y.,=N Tree Pres Plan Recd _Y _N. Tree Pres Required _ Y _N On-sdeSepllc.System _Y'_N ,..+..an }L.nv mrn fraflP RP_CI'@t and the rBaSOII. Plans are consitlered pudic mrormauon unirba YOU Sw•? •• ---- Date ?_ Site Address ??? ° ?X E'_ ?'?e Construction Cost _ UniUSte # 7 r Descriptioo of Work t? Multi-Family Bldg _ Y?,- N Fireplace(s) _ 0 Y-- 2 Property Owner &J .a a^ rQY'S Telephone #(&SI Contractor Address City State Zip Telephone # ( ) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7672 - Minnesota Rules 7670 CateeON 1 -" , New Energy Code Worksheet Energy Code Category . Residential Venlilation Category 1 Worksheet (J submission type) Submitted Submitted . Energy Envelope CalculaGans Submitted In the last 72 months, has the City of Eagan issued a permit for a similar plan based on a master plan? Y _ N If yes, date and address of master plan: Licensed Plumber Mechanical Contractor Sewer/Water Contractor apply for a Residential Telephone #( Telephone #[ Telephone #( and acknowledge that the information is complete and accural .,e- ,.r n---- ..a rl,P Ctata nf M that the work will be in conYormance wan me orumanccb miu wu?? .. u=? -••? -- --o-- Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. ?? ??/r??ts ?'•J Appli ant's Printed Name Applicant's Signature r . , ~ ; , i . ~ ~ ~ ~ , , , _ ' : , , , ~ ~ _ ~ ~ ~ ~ ~ ~ ~ . : , , , . ` - - . z , r~ ~ , . _ _ _ , . ~i , , , - . . . . ' . . ~ . . ; ` - _ . ~ , . . ' . . . . . ~ . . . - > . . , . . . . .i . . . . . ~ r. . . - . . . . ~ , . . . . . . . . ~ , . . . . , . , . . , . . . - . . . . . , , . ~ . , ~ . 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' ; ' : ~ i ~ t ~ ~ " ~ ~~c~'. . , . ~ ~ . ~ ~ ~ , , , ~ , . i ~ " rv i ~ ~ ~ ' . ; . . ~ ~ ~€.~$ar rr; ~r ~ ; ~ , , . . ;:,x ~t . . ~ , ~ r~ ~ t. , ~ : ; ~~apA ~~y1 1. ; tt,,.~~ ' _ ~ ' ~ , ~ . ; 1 ~ ; ~ ~ ~ . ~ ~ ; ~ ~ ~ , ~ , . . . i ' , . . li. 's~q;' ~ - t . : . . , . ~ ~ ~ , ~ ~ . . . ~ . v . . ~ ~ . ~ . ~ ~ , , , \.6 : .n. . . . - y`t ~3" ~T. ~ . ~ . . . . . ~ .t - ~ . . ~ . , . . . . . . v . . . . , . ~t . y~' ~ ~ . . . . . . . ye ' ~3 ~ - ' ' ; . . : L:.'~a~~'~J~`.~~s ~"'.k"~+'~.~' ~wv~~.:'.' ~~de~ ' . ~ . . . , . . ~y . . . , .~..st . f ; , ~ ~ 'z' . ~ ~ h~ ~ ' ~ . . ~ .r... ~ , , . . . . - ~ ~ ~ ~ . . ~ . ~ . . ~ . . . . . ~~d~W~.~.f~' , . . . - _ ~ , . ~ ~ . ~ ' ~ ` ; . ' ~~C ."~~;f tE , . . . ~ ` .r,.: , _ . ...f... i . p.~'~ . , . ~ = ~z..~, ~ . ~;X ~ f.~? ~ a a,; 4 ~ . . ~ t , , ~ t ;:w ~ ~ ' ; . - . ,`"nn..` e ~ ~ , . ~ ; . . ~ , ~s 3; , , : ` :k„ p,,, ' j; ' , . . . ~ , . ~ . , ptq p ~3 ' r~ ~~a3`~:a~~ ~iU~S i ' , ~ i? Aro~~ . . ~ffi~CY.e.'p ~ . . a f C~ d: _ ,t, , , , ~ , ~ . , F . . ~.i : . ~ . , V,.' , , . F . ~ ~ x ~ ~,i` ~ . , . ~ a w,. . . . ~ ; „r , y , , ~ ~ „ , . , . ~ ` ~ ' ~ ' . . w ~ ~~r~ . , . , ; , > . 1:. ; ~ ~ { : . , . , - , _ . . _ _ ; :s; r , „ , . = , . ~ ~ ~ ~1 .~c~r;.s,_, y . ~ , _ ~ - ~ ~ ~ :«fi ~ . ~ ~ ~ . . . ~ ~ - , d ~ r.. ~ ~ . `~i~ ~ ; ~ " z ~ ~ ` f . . . 1 • ' ~ ~ . , ~ s < _ , . . ~ . , . ; ~ ~ , ti ~ _ ~ ~ ~ ~iE . . ~ . ~ ~ . ~ j ~ ~ , r ~ , ~ . ~ h ..:7 , ~ t~, ~ & ~ ~ , , ,.~s. p ' - ~ ~ ~ ~ . . ';f . , . , , ~j . . . ~:37 ' , ~ . . l-.~.: ~ . , . . , ,,f . . „ : ~ , e ~~4.i . . . . . } , t~: . e . " ; ~ ~ ~ . :G!>. . . . . . , Q , . , . . . • . . ; « , , ~ fl . . , ~ ~ ~ , ; , ~ S e;.~ ~ : i . „ , ~ ~ , , . ~ ~ ~n ~ ~ . ~ ~ * ~ ° ; . ~p ~ , - ~ ti.;, . ~ ~ : , - . . ~ . , . . ' ~p . .r . ~ , . .~.r. _ . . . . , . , ~ . . ~t . ~ . ~ ~ " . b , . - . - ~ . . . . ~ ~ . . . . ~ . . y. , . . _ .ti:. ~ . . ~ , - ~ . , , ` _ . a ~ . ~ . 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B B V ~ . ~ ~ ~v..-...._ - . . dG j rj ~ ,....~m ~ .'.~:.,i: . .~~t~ • . . . y . ~ . . , . : ~ . , , . . . . ~ . ~ ~ .,~:i . . . „ , . - , . . , . . . z . . ~ - . . . . . , . . . . . k. }4..~ , fi"~ p. . . . , . . . - ' . . .n ~ . . . . . . , . t ~ . . . . . . ~ 4 . . , , , ~ , , ~ ~ ~ ~ t,.,,, , . . , _ , ; ~ ~ , ~i~t , . , f ~ , a . ~ . , , ~ _ , , , ~ ~ , ; . . ; ~ „ . . : . { , , . . _ . ~ , . . ~"i.~`7$~ , ~S , , ~ . . . ~ . ~ _ . ~ ~ . , , , R~ ~ ~ ~ . , ~ s ' ; ~ _ ~ _ _ ~ ~ ~ ~ ~ ~ . { ~ „r,,, ~ . ~ , , , ~ ~ ~ . ~ ~ . , ~ , . . . yi • A ~ ~ , . , , ~ ~ . ~ n. ~ ~ ~ s~ ~ ~ ~ ~ ~ • , ~~~.t . , g , ~ . ~ , ~ > . ; ~ ~ , . » ~ ; , , ~ ~ ~ ~ t~ < , ~ _ ~ ; ~ti~ „ , ~ . S ; ` , ~ - , ~ ~t4 ~ ~ ~ , : . , , , ` ~ r ~ , ; . ~ , , ~ y ~ ~ r,~. C ~ ~ ~ , ; ~ . . ~ . . ~ . ~r~, . , ~ ~ , _ , ~ ~ < t~~~-~ ~ >,t~ ~ ~ ~ , a. ~ ~ : : , „ ; ~~t~~ ~ ` ~ ~ : ~ . ~q < ~ . ~ , , ~ ~ ~ ~ 6 ~ . , 9'~ ~ . ~ _ . . . . . , . . ~ ~ , ~ , t. ~ _ „ ~ , _ . . ~ - ~ < , _ . , ~ , , ~ ~ , ; ~ . ~ . ; ~ , . ~ s g~ ~ , ~ ~ ~ , , , , ~ ~ > . . r . . . ~ ~ . . t., , . . . ,,S-: .,..3:~~.,. ~ ~ , . ~ „ ~ , : . . ~ . . . . . . : ~ . . . , ~ , . , , . ~ , , ~ t~.; ~ , . . ~.i . F, . , . , ~ , : . , • ~ ' , r..... , , k . . . , . - . . r. , : , , - _ r 1. . : ' ~~^'-Ci , . , n r~ _ . . 1~ f~ ~ . . . , , , ~ , _ . . ; . , ; . . , , _ . . ~ . . _ ~ r , . • n ~ , . ti H . ~ . . . • ~ , . ~ . , ~ v ; . ~ E ~ ~ . . . i ! s;. ~ . . ~ . . ' _ . f ,r . . : . ~ . u . , . . . ~ . ~ . ~ ~ . . , 's'`.~: .'n.~r.... .ic. Y " v' ~ . . . . . . ,i. ~ ~ , . C .'Yr . ~ ~ . , ~ ' , v.:., . . . , . P . . . Y^ .~ac , . . . . ~ , . ~ , , ; ' ` , . . ' ~ ' ~ . . . . ~ , ~.x . . „f ~ d~: . : . . . . z., . N ~ J t... . . • ~ ~ '„r,t ~ m ~ . .v~ . i , h. - ~ ~....'".t . . v . E. . A',~~ , ' : y • i , . . , ~ ' . . ~ . i . , . . ; ; .t . ~ ~ a ~ _ , . i , . t . . - ~ i i . ! . , } ~ , ; , I ~n a.. Y a k £ , 4 , r. b '3 . , . . , . , _ . . .-r f'~~~ B . ' . . , . . ~ ~ . ~A~" , ~'~:'A.~*'4~',~ 1~~~ ~ . 1 . . . , .c.. , M~ . . , . . . . . . ~ , , . . ~ , , ~ . . , ; ~ , ~ i ~ , ~ . ~t. *+t~ m. i . , , . , . ~ ~ . . ~ ; . > . ~ , , ~ ~ ~ ~ . ~ , ~ ~ ~ . : : ~ . , . . , , , ~ 1 ~ ; ~ . ~ ~z, , ~ . , , ~ ~ : , , , ~ r ; , . ~ , w . _ ~ , _,z ~ , . , , ~ ~ ~ : . . . ~ . ~ . , . ~ . . . _ . , ~ . _ ~ ~ ~ ~ ~ . . , , . . ~ ~ ~ , . . ; . , : . _ : a , . , . ~ . . . _ ~ ~ 1 ~ : ; . _ ~ . ~ _ . ~ . ~ . ~ , , ~ _ . ~ . , . _ . ~ . t,. ~ . ~ ~ . , _ ~ . . ~ o _ . _ , . , . _ _ ~ , . I~~~;H£R~BY - CEAY+FY ~TMAT TtilS~ ~~pLAN ~A ~ ~ _ _ , ~ ~ . . , ~ ~ . i ~ ~F ~ " ~ . _ W. S. . „ . , ~ _ ~ DE9GNE6 C .CKEU . . ..r : , . . . . . . . . . ~ . , :,,u. . ~ , . . , . < . ~ . s ~ . . ~ a ~ .;s . , - . . , , ~ . , . ~~~r , . y... : ~ . , i.;~ ` . . , ~ ~ , ~ . ` . . , . .o;o-.• . . 9 n , ~ . . : . 'r.; , _ . ~ ~ , ~~s~,~ ~ .r ~ 4~WS~L t~ ~ ~ ~ ~ . , R w. . ~ ~ : ~ ~ ~ ~ ~ ~ . ~ r REV" . _ ~ N.~~E~~S~_ _ eEPa~~a ~eY ~ae.,oR,ur~oE~ aar~~:oia€ T, . > . . ~ ~ . , G , ~ , , , - _ , ~4. ~ , P . , . - , , A ~ ~ ve rHar , . _ ~ d~, Stl N A D 1 ~ • ~ ~ ~ N . .A . t3 Y . . . , . . ; ~p~ ~ 91 ~ ~ 164V ~4;- 19 , a~ ' , . _ . . , ° ' V AS ~ 5 t ~ , . .,vd . „ .08AN1N,. DALE~ < . . , , . ` . ' ~ , . , r _ . . , _ . . , , , , . , , _ a.:.. _ > , , . , . . . . , . ~ > , _ t.~»~c~~ _ ~s3 .1~~~_ ~ . _ . , , ; t . , ' ' , ~ ' . , , RES,I3TERfi0 . . ` " ~ . . ~ , . _ ~ . . . . ' , • , " ~ ' q~ ~ , , . . . . . ..-.4Y . . , . , . ~ , . . . . . . . . , . . , . . . , : - . ` "::Y . ; , , N ~R 5k . _ .U D. .~l& 5 `F.~...N~ .iAT: ~ , ~ . . . . . ! „ , E W 0 T ~ & ~ , a , . _ , . , .k , , , t , , . ,v 4 , - ~ . . , . . . . , ~ ; 4 x. . r . _ , - ~ , . . , : ~ , n . , ~ t: , ; _ , . . . M . . ~ . , : ~ . ryl , . . . . . . . ~ _ f: . . . . scp~ ; , , , . ; : , b ~ ~faESO , ~ . , , ~ „ ~ . . . . , , . , _tA <<... . . . , . , r,, y i,. , ; . , . , ; , , : : < . , r. ~ n , t. _ ~ , . , < . . . . _ : , . _ _ ~ , . . , . . . ' . . . ..s , , . . . , , , r . , . , , . , , . . : : . . , . : ~ „ . _ ~ . , . ; ` . , . , . ~ . ; „ ~ r . ~ , ; r ~ s < 2 . + a' , ; s . , ~ . u' . . , , . , . . a..;, , .s . , ~ . , , ~ , . . ; ,:s: , . , , . . _ , J B` N0: _ , , ~ _ , ~ . , : , . : . - p ~ r _ . , , , , ~ . . ~s r,.o, , < , :Dk'~ @Y _'4 . c , _ , . ; , N: E . _ , , ~ . _ _ Ax . , <REtA R 5 , . 't , , ~ „ : ~ . ,;s; , , . ~ . . ~ , . _ ~ ` s r D . 6AP , , , 4d ~ . ~ , - €fl. ii ~ . ` : , } v. _ . x 4~~ . , , _ ~ , . 3;... ~i.. . _ . ~ , . . . _ , , , - . . . , - , , ~ . . ; ' , . ; , ' , ~ ~ ; : , . . , s. , - ~ _ , . . Up „ . . ~ _ . : . , , , , ~ . E 5Ik37d . 4 , . , > . - , • . . . . . . . , ? , . l . Q z. _ y , _ . , S , , . . OQ ~ ST 1~ 9h _ , . . . _ A _ 6 .33REE3' ~1~R 1 ~ ; _ , _ , . , .:u_. , ~ N~ 6,.1«~., i~BNESQTA ,~r53'~7 ti 43~..3~~?fl. . ~ , , , : , , . ~ . . ;.o „ ~ „ P . , . ~ ~ > r? f? REQUEST FOR ELECTRICAL INSPECTION ee-ooooron 7 . /' See instmctions for completing this form on back ot yellow copy. y 7? ? 7Q 70 ""X" " Below Work Covered by This Request . . ya• 3 7{? A ? Add Bep. 7voe of Buildin9 Appliencxs Wirod EquiVnlent Wirad !. ? Home Range TemporaryService Duptex Water Heater Liyhtiny Fiztures Apt. 8uilding Dryer Electric Heatin Commercial Bidy. Furnace Siio Unluader Intlustriai Bidg. Air Conditianer Bulk Milk Tunk Fafm Otber Vaci Y ther ISp?r.ity) thar Pecify ther Other Compute Inspection Fee Below N Fee Service Entrance5iie tt Fee Feeders/SUbfeeders a Fee Circuits 1 0 to 200 qm s 0 to 30 qm s 0 to 30 Am s Above 200_qm>s 31 to 700 Amps 31 to 700 q s Swimmin Pool A6ove 100-Am s Above 100_?mps Transiormers Irrigation Boon6 Partial,'Other Fee Signs SUeciallnspection $ Nemarks AL FEE ??. qough-in l ?:• ,.,.? F Date ./ 2d ?. ?Na Ea?i,oal , f I? InsDectoq hereby certify Uat tha above Fina? ??? ? "soec[ion has baen / made. TOIe reouest vmtl 18 monllu trom This request void 18 th f 1 L- 5- ?' {J a? ? ? 3?. •5 V rtron s ram A 374 70 ? l 9. 3, 44 k, DOE' 43-76 Hequest Date ?/ Fire No. Rouph-in Insyection Required? C]Ready Now ?}WrT?otitq Inspec- ? es ? No wr Whon ReudY [?}trenseA Elechical Contrartor I herab y request inspnction ol ebove ? Owner electrical wark installed at: $Ver.t Addres+, Box or Rou[e No. City ? ? i lN? / w?J G `' ? ?' l ecti o. Township Name or No. Ranye No. County Oecup nt IPRINTI Phune. Nn. ? Vr-?CQ Power Supplier AAtlress Elec[r Comrac tor (Company Name) ConVar.tor's License No. ? / ? (..? ? ? ? ? - Mailing A Adress IC O ntrac.tor or Owner Makine lnstalla[io 1 ? / / ? c ?7 9T ?^-?% AuNorizetl Si fure onva or Ow r Maki nstallati< Phone Number -T -/ 179 --? MINNESOTA STATE BO F ELECTqICITV TMBE AIS ICGEPTEDNSPECTIOBYN THE HEQUESTSTATEWILL NOT BOARD Griggs-Midwev Bldg. - oom N-791 1827 UniversitY Ave., St. Peul, MN 55104 UNLESS PROPEfl INSPECTION FEE IS Phona (812) 297.2111 ENCLOSED. City of Evan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 r Use BLUE or BLACK Ink Permit#: Permit Fee: — DCS Date Received: Staff: 2010 RESIDENTIAL BUILDING PERMIT APPLICATION Date: S� S — % v Site Address: /7 r(3 ct a Xf e� Tenant: Suite #: RESIDENT / OWNER Name: d/ (1- h, S Phone: Cs, S7 -7S 0 /3 Address / City / Zip: Applicant is: Owner Contractor TYPE OF WORK Description of work: s %r�J s' , -( , 4 d — s �,� Z - Construction Cost: Mufti -Family Building: (Yes / No A ) CONTRACTOR Name: �cr if - License #: �?v�,®? el' J ce 7 Tn � 1 Address: ..,_.?0,s c / - S-1r.,City: /�w�� .,-7/ State: /4''vi Zip: S -5-4)S-5— Phone: 5-7 S -z -)d - 5-.- 6' 7 Contact: Email: COMPLETE In the last 12 months, has Yes No If yes, THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING the City of Eagan issued a permit for a similar plan based on a master plan? date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contractor: Phone: NOTE Plans artd supporting documents that yousubmit are consideredtom a public information. Portions n cf the informat!omaybe classifled as non public rf you provide pecifc reasons that would permit the C ,y to conclude that -they are frade",;ecrets.:'-xr 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.gobherstateonecall.orq I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. X Jar ti -i Applicant's Printed Name X �vE --'Applicant's Signature Page 1 of 2 PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA167132 Date Issued:02/24/2021 Permit Category:ePermit Site Address: 4750 Galaxie Ave Lot:17 Block: 3 Addition: Park Ridge PID:10-56750-03-170 Use: Description: Sub Type:Residential Work Type:Replace Description:Furnace & Air Conditioner Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507) 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 - Roland E & Linda Connors 4750 Galaxie Ave Saint Paul MN 55122--260 (651) 454-0138 Controlled Air 21210 Eaton Ave Farmington MN 55024 (651) 460-6022 X253 Applicant/Permitee: Signature Issued By: Signature