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4608 Galaxie Pt! --?-? ?-?- w?A L4 (' g? / t?? - tisoi? 5«y.?1 ? L ? • RESI DENTIAL BUILDING PERMIT APPLICATIONn , ??Cl ? CITY OF EAGAN r r ? ? 9 U V 3830 PILOT KNOB RD - 55122 --"' 651-681-4675 New Construclion ReauiremeMS RemodellReuair Reauirements / • 3 registered sile surveys showiig sq, ft. of lot, sq. ft. of house; and all roofed a4Q_ CQ,+ • 2 copies of plan (20% maximum lot cove2ge allowed) . 1 sel of Energy Calculations for heffied additions l ? ? • 2 copies of plan showing beam & window sizes; poured found design, etc.) g? 3 ?. i sile survey for exterior additions & decks `t '?? ' U 1 • 1 sel of Eneyy Calcula6ons • 3 copies of Tree Preservation Plan if lot platted after 711193 • Rim Joist Detail Options selection sheet (bldgs wilh 3 or less uniGs) =? v DATE ` C/ JOB SITE ADDRESS IF MULTI-FAMILY BUILDING, HOW PROPERTY OWNER ftUd TYPE OF VUOF.K /A' U APPLICANT ADDRESS 019 PAGER # VALUATION (EXCWDING LAND) 2?1WQ/ ? '-t-? o <?s CG I -e UNITS? CELL PHONE # FIREPLACE(S) _C _1 Y2 _3 _ PHONE # (i96XA'&-&7 ZI/P- CODE? ? FAX # (o?/(A/`7 ?'%7r? NEW RESIDENTIAL BUILDING ONLY - FILL OUT COMPLETELY Energy Code Category _ MINNESOTA RULFS 7670 CATEGORY 1 (check one) - Residential Ventilation Category 1 Worksheet Submitted - Energy Envelope Calculations Submitted _ MINNFSOTA RLJLES 7672 New Energy Code Worksheet Su6mitted Plumbing Contractor: Phone 0 `Ild 7 760 Plumbing System Includes: WaLer , oftene Lawn Sprinkler Fee: $90.00 Wacer Hcater No. of R.I. Baths 2 C-No. of Balhs Mechanical Contractor: Phone # / Mechanical System Includes: Air ondilioning ree: $70.00 Hcat Recovery Sys[em Sewer/Water Contractor: &VZZ fik?'l1/.?//71 kS Phone # All above information must be submitted prior to processing of application. II ? i 'rIA46W 9 I hereby acknowledge that I have read this application, state th t the inform tion is corr?f, and agree to compl? with all applicable State of Minnesota STatutes and City of Eagan O dinances. ???' Signature of Applicanf Certifcates of Survey Received ? Tree Preservation Plan ei ed _ Not Required _ Updated 1l01 OFFICE USE ONLY ? Ot Foundation le 02 SF Dwelling ? 03 01 of _ plex ? 04 02-plex ? 05 03-plex ? 06 04-plex ? 07 OS-plex ? 13 16-plex ? OS 06-plex ? 16 Fireplace ? 09 07-plex 0 17 Garage ? 10 08-plex ? 18 Deck ? 11 10-plex ? 19 Lower Level ? 12 12-plex Plbg_Y or _ N ? 20 Pool ? 21 Porch (3-sea.) ? 22 PorchlAddn. (4-sea.) ? 23 Porch (screened) ? 24 Storm Damage ? 25 Miscellaneous ? 30 Accessory Bldg ? 31 Eut. Alt - Multi ? 33 Ext. Alt - SF ? 36 Multi P" 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding ? 32 Addition ? 36 Move 81dg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 33 Alteration ? 37 Demolish (Bldg)' ? 43 Reroof ? 46 Windows/Doors ? 34 Replacement *Demolition (Entire Bldg only) - Glve PCA handout to applicant Valuation ?0 ? Occupancy ,.-? MC/ES System Census Code l0 ? Zcning City Water SAC Units .. 0( Stories Booster Pump Nbr. of Units / Sq. Ft. PRV Nbr. of Bldgs ? Length Fire Sprinklered Type of Const Width ? Foorings (new bldg) _ Foo6ngs(deck) Footings (addition) ? Foundation ? Drain Tile Roof Ice & Water Final ? Framing Fireplace _ R.I. _ Au Test _ Final Insulation Other _ Pool Ftgs Air/Gas Tests _ Final _ Siding Stucco Stone _ Windows (new/replacement) Approved ByUl_, Building Inspector Base Fee Surcharge Plan Review MC/ES SAC City SAC Water Supply & Storage S&W Permit & Surcharge. Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other Total REQUIREI ?2 ? ? Si`7 y g( a??o K 1 s= 3a? ??? arsoXsY ?77?c .; 7 i FinallC.O. Fina]/No C.O. Plumbing HVAC Address 4608 F a 1 a x i P P t --, Lot 2 Blk I Sub CLIFF Y]OODS OF EAGAN THESE ITEMS WERE / WERE NOT COMPLET'E AT THE TIME OF THE FINAL INSPECTION. Date: 23 p-Z Yes No Inspector. Ake.. 1yyce Final grade (6" from siding) Peimanent steps (garage) ? Permanent steps (main entry) ? Permanent driveway Permanent gas ? Sod/Seeded grass ? TraiUcurb damage ? Porch ? Basement finish ? Deck Please verify with the builder the removal of roof test caps from the plumbing system and the shut-off of water supply to the outside lawn faucet before freeze potential exists. Contad engineeting division at 681-4645 before working in rightof-way or installing underground sprinklet system. ? White - Ciry Copy Yellow • Resident Copy Pink - Contractor Copy MNcheck C4MPLIANCE REPORT Minnesota Energy Code MNcheck Software Version 3.0 Permit Checked by/Date COUNTY: Dakota STATE: Minnesota ZONE: 2 CONSTRUCTION TYPE: Single Family DATE: 3-12-2001 DATE OF PLANS: 3/11/2001 TITLE: Eagan RambLer PROJECT TNFORMATION: Rambler Plan - 2180 sf COMPANY INFORMATION: Mendota Homes COMPLIAN?f: PASSES Required UA = 516 Your Home = 410 20.6% Better Than Code Area or Cavity Cont. Glazing/Door PerimeYer R-Lalue R-YaLLe ll-Ya1ue --------------------------------------------------------------------------- CEILINGS: Raised Truss 2180 44.0 0.8 WALLS: Wood Frame, 16" O.C. 2033 19.0 0.8 1 BSMT: Conc. 8.0' ht/8.0' bg/8.0' insul 1417 11.0 0.0 GLAZING: Windows or poors, Above Grade 452 0.300 1 GLAZING: Windows or poors, Above Grade 72 0.300 DOORS 54 0.130 HVAC EQUIPMENT: Furnace, 92.0 AFUE HVAC EQUIPMENT: Air Conditioner, 13.0 SEER --------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, speci 'ca 'ons, and other calculations submitted with the per application. he r posed building has been designed to meet the eq ireme?nts of ?J? eso Energy Code. Builder/Designer er4_A??"`?l Lr- Date J?Z Zc?U, ? C,EF'lC C: CU`( 7 (SEE ATTACHMENTS) r Development G.?LIi F ?'" ??\ ?? t" -C" fhT(U.-` Lot Number Address 7 Block Number " Builder A.°.C>vZF'lly Tree Protection Requirements: Tree Fencing Oak Tree Pruning (immediately seal wounds during April 1 to July 31) Therapeutic Pruning Retaining Wail Other: Replacement Trees: Not Required As Follows: Attachments: ? Yes No Gd " GC^im Additional Notes: mlv DWE H:\ghove\2000fi1e\treepres\Tree Preservation Plan Summary-2000 I ? ? ? . C' 1'F \?OO?j< oF? ?h4hN ? ? 1 ?.?.? ?. ..?.?.?..?.. --- ? .----.-?-?--? _? ,? ii --?----- -------- ----------------?---?? ____? ? -------- ? \94LAXIE AVEIJ\UE ----------------=? ?? _____?°_°-____ ?--?- ----?-'=-= CUF= ?.f?os oF Gr.c.a I Of:n.?xi: 1?? Ma-c F" ATCS LAneo?Ra I? ? SN%iJ?tW ? ?. L51-`bS"NA< Qic: S?vi.: aih: 9R>? 1"-30 o,wm ? 1 mF =, g . ?: - ? ? •::. x Cu`'`y F?J.rca?1.? ' sa.e_ \ !s _ o - LS"1 \1•?• m LS I ? ? - Co : DRp? } CS T.F.RATao ? r 63. i I k?9 ?Oi 9]0 ) f \ .' ??• G v .9r G tv T.E=47 t.? es69 ? . ?t?}? . ' D.L t--- - gh uu ?? II II ?? lU) \\ ?,__ i' r ni ii r - - 11 ll II II I I N?II II ? ?I I II II i ?? 1? ?I? II II I II ?I II ? I\? ?? I u ? II I \' II I II ? ? II ' III b ?? II ? ?? . ? '1 PSz -<?-P?1,Cip4--h1T. V A--ASV I ? ? ? Cl..4FF \\,400(J S F t ti ;;,; , o ? . X E \ AVEW UE ? &ALA I , -?=T?,_____?= ==_____ _---zz- ? ? 1r ?r L ? l \ ? ?i ZY ERM? ; , Zo . . v D ? m 0 z ? l r .' ',?? • ?S ` ?L ----,- -- `? i ? l n ?2an-5 I m 0 ? 0 m .. ..._'"___._. . ?. ` h \ N ? ? \ ?? \ \\ ?---II ' ?:'S _ ? \ \ ? Y I S o il ~ :or R m 6ti 3 C5. ? T.F.=964.0 t' FLnT a I / -? 63. I k 70.1 970 s-, T.F.=9?7\ ? i ? 65. s ..?.? , .. ? . ?U) ` ? / l / ?? II I II I II ? II ? i II II ? , I I \ ? I C.C.IFF \wOOfJS, ' o?' E.r`c*?N ? _` 1 II ? - - ? ? ? - ? ------- 1--= .? -- '-=-?i====?_? ------- / / / ? UE ?1LAXIE A VE ? ? ? ? - ; --- ? - CuFF ?os or- ? ? ` ? zo ?"`? o?u o,? •?.a w,n.? ? D ? +cs -to}- t?r.? ` Z o DwW.?: m Motx k`??+k7? L-?raooesw??? ?;?'? o ? z Po.ts.: c aR 4z ?°ct'" . ?.1.kT?9-?k? .-._ , SrrY.- ? ?•5- ? A- ?.s•• ?;,'? ? ' ? ? N ? s?? cy ??ac -?? 0 ? I ? ? o rt C?/• 4 ?.rr. 'Ca.?S I. O 0 a I e _?=====r=====___-?=-_, ljll l?? o ? ? i ?--- II I I II ? II I II I II ? II ? I? II I II I rn1 ? S \ : II DROS T.F.=964.0 FLAT f fi3. I ? .` 970 ? a? s9 \ e? 1 1 g`, ? IJ \ ? r.F.=?70.6 ?eX \?69 ` ? ? ?.?? ? / II ?y s D.L{ "? ? 65. ?? ? gpppf / J/ ? II Q I - - r. ? ?•. ?? I l' ' ?' ? . II Surveyor's Certificate SURVEY FOR :MENDOTA HOMES DESCRIBED AS :Lot 2, Block 1, CLIFF WOODS OF EAGAN, City of Eagan, Dakota County, Minnesota ?nd reserving easements of record. APR 11 REC'D ? 17, ? ; RE'0EW "D _ o . tx.? p saz°sz'lo$ ? ? _ • s ??"L'?,?.T'i4T? ???`?` ? ? / / ? j•?,\?• ?m m 3``'0 . : '..' -; ,. 9?7c saz N 8 9° 5 3'0 7"E 108.02 ?-27. En ?- lu7. o ----_- N 29 ? ? ? - -? 9b5. PtE ? , ?/ U 6 ? O I ?? \91a?11 2 05 0 ? 10 965A o? J 965. ryo obA°9e ? ?9bR k 9b8.7 I 4b2.q r ? L( \\\ 9 ?433 ?O J93S j '\ cl`? ^hh ,Po??pos r7?o8.7 s, S r? Bp wb/e?e0' __- I R 3j ? °1 o S633 ao 4l09. I \ 0 ti? `? I I R \ o?b?g9?6_.9 I \ \ I \ I L 0 T SQ. FOD TA GE = 19,867 HSE. SQ. FOO T,4 GE = 2, 937 ?L O T CO I/ERA GE _ 15% PROPOSED ELEVATIONS Top of Foundation = q70.3 Gorage Floor = 90.2 Basement Floor =qe2.3 Aprox. Sewer Service =q5(o.(o' Proposed Elev. _ C=> Existing Elev. Drainaqe Directions = - Denotes Offset Stake = • SCALE: 7 tnch = 30 feet BENCHMARK, C,P. Summo, Efeo• qloS.P4 MIN. SETBACK REQUIREMENTS Front - House Side - Rear - Garage Side- JOB N0: HEDLIlND PLA)VN7NG 6NGlNd'ERINC SURVd'YING 2005 Pin Oak Drive . Eagan, MN 55122 Phone: (651) 405-6600 Fax: (651) 405-6606 I HEREBY CER7IF7 THA7 THIS IS A 1RUE AND CORRECT REPRESENTAi10N OF THE BOUNOARIES OF THE ABOVE DESCRIBEO PROPERTV AS SURVEYEO BY ME OR l1NDER MY DIRECT SUPERV1510N AND DOES NOT PURPORT,TO SHOW IMPROVEMENTS OR ENCROACHMENTS, EXCEPT AS OWN. DATE T/ a / ? ? • . LINOGREN, LANO 5 VEYOR INN A LICENSE NIIMBER 14376 O1R-121 FILE: Cliff Woods ? LOT SURVEY CHECKLIST FOR RESIDENTIAL BUILDING PERMIT APPLICATION PROPERTYLEGAL: f vT o? JS"lp,K l(;fj'l'??C ! In d5 0t L'Q4?vr. DATE OF SURV EY: 3- l!o - \U ? LATEST REVISION: Y- 5- a i 1 @ ? DOCUMENTSTANDARDS Y ?\ \ `> o ??. e Y? G • Registered Land Surveyor signature and company fV? ? . Building Permit Applicant UK Cl ? . Legal descnption 14/0 ? • Address ? ? ? • North arrow and scale ¢7? ? / ? • House rype (rambler, walkout, split w/o, split entry, lookout, etc.) [3 / G ? . Directional drainage arrows with slope/gradient % f:? ? Fl, ? . Proposed/existing sewer and water services & invert elevation 0 ? • Street name K( ? ? . Driveway a' ? ? • Lot Square Footage P/ 0 ? . Lot Coverage ELEVATIONS Existina ?/'? ? • Sewer service (or Proposed) [? G Ci . Property comers 0&? ? . Top of curb at the driveway and property line extensions ? C? ? • Elevations of any existing adjacent homes ? G? ? • Adequate footing depth of sVuctures due to adjacent utility trenches Proposed H ? ? • Garage floor ? ? • Firstflaar ? ? • Lowest exposed elevation (walkouUwindow) GY ? ? . Property comers U/a ? • Front and rear of home at the foundation / PONDING AREA (if aoolicable) ? ff" / ? . Easement line ? L9? ? • NWL ? [9? ? . HWL ? ?j? • Pond # designation ? [9' ? • Emergency Overflow Elevation LW CI/ ? ? d ? &/ ? n C?/ 0 !_I C?' ?/ 17 ? ?f 1=1 DIMENSIONS • Lot Iines/8earings & dimensions • Right-of-way and street width (to back of curb) • Proposed home dimensions including any proposed decks, overhangs greater than 2', porches, etc. (i.e. all structures requiring permanent footings) • Show all easements of record and any City utilities within those easements • Setbacks of proposed structure and sideyard setback of adjacent existing structures • Retaining wall requirements, if any Reviewed: Name `Y' I /' / Date ? Siteaddress: tiuog vollAWk ? 1• Lot_ Block_ Subd. On April 15, 2000 the Minnesota Energy Code, Category I Building Requirements for insulation protection, air tightness, and ventilation, was adopted. As a result, the City of Eagan is requiring that the foliowing information be submitted prior to issuance of a Certificate of Occupancy. ? This structure: is constructed to meet minimum requirements of the Mn Energy Code, Chapter 7670 OR _ This structure: will be constructed to meet more restrictive requirements of Chapters 7672 or 7674 pPPL1ANCE GAS ELEC MANUFACTURER MODEL BTU'S VENTINGTYPE water Heater Fumace Dryer X GE (}C52 3G?2,W1? ? EXHAUST SYSTEM LOCATION TYPE MODEL CFM's VENTED YES r+o Kitchen kitcnen Usiftl 1RZ? O oD S O Bathroom 1 ryw? n ? e? r D x Bathroom 2 y) Bathroom 3 Y) Bathroom 4 Other FIREPLACE 5 LOCATION GAS WOOD MANUFACTURER MODEL BTU'S VENTING DIRECi ATMOS : v. Aar X '4A c. MAKE-UP AIR MODEL TYPE CFM's aa I here6y acknowledge that the above information is correct and agree to comply with the Minnesota Energy Code and City of Eagan re irements. ? y Y? CompanyName Date ' This form is the responsibility of the General Contractor. 04i23/02 TUE la:Jl FA% 4279448 LARSON PLUMBING 44+ MENDOTA 0001/001 r ? - J6y-) VLPAI?I?C{7 ?A C)???L t.c c.(Y-c,L J_ La? o`? ? 13?-1 ????'' Lrn Lcvk) b w? ? o U 04& - April 23, 2002 Julie Behnke 2124 Garnet Dr. Eagan MN 55122 RE: Chair Lift Residence: Behnke, Julie Residence. #2 2124 Garnet Dr. Eagan 55122 - Elevator ID# -08077PT02-28R Dear Sir/Madam Minnesota Statutes Chapter 166 provides that the Department of Administration, Building Codes and Standards Division, Elevator Safety Section, inspect and approve elevators and manlifts (endless belt lifts) 6efore they can 6e legally used in Minnesota. An Inspector from the Elevator Safety Section recently inspected your residence and determined it meets requirements of the Minnesota Elevator Safety Code. NOTE: Compliance with Minnesota Rules and the ANSI/ASME A17.1, Safety Code for Elevators and Escalators does not necessarily assure compliance with the Americans With Disabilities Act of 1990. Sincerely, BUILDING CODES AND STANDARDS J `hn P. Roche State Elevatorlnspector jpr/rkr (CE-2) c: Schoeppner, Dale R., BO, City of Eagan Premier Lift Products LLC ????Ll L'r? `S ? APR 2 5 2001 Department of Adminisirazion ElFormCE2R Building Codes and Standards Division, 408 MeVO Square Building, 121 7th Place East, St. Paul, MN 55101-2181 Voice: 651.296.4639, Fax: 651.297.1973; TTY: 1.800.6273529 and ask for 296.9929 7f I I q 2007 RESIDENTIAL MECHANICAL rExnziT arri.icnTioN City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 Please complete for. single family dw•ellings & townhomes/condos whcn permits aie required for each uni[ Da[e// /?/6 -7 Site Address '7 00 z 6??e?(i2JfC Unit # Property Owner ?ly,/S 1,?.Qi Telephone#((?r/ ContraMor _ O'Connot's One Hour 1904 Vermillion St Sheet Address _ Hasrings, MN 55033 City State _ Telephone# ( (gS/ ) Y.37' `??7? Band#: KL??l 06"?' Expires: 4 ontractor _ The Applicant is _ Owner `- Other Fire repair (replace burned out appliances, ductwork, etc.) $ 90•00 This fee applies when extensive mechanical repairs are made to a building. Add-on or alteration ro existing dwelling unit $ 50.00 V/ N furnace _Additional _Replacement ew _ air exchanger air conditioner heat pump other State Surcharge $ .50 Total Z ?1SLU I hereby apply for a Residential Mechanical Permit and acknowledge that the information is complete and accurate; tha[ the work will be in conformance wi[h the ordinances and codes of the Ciry of Eagan and wi[h the Mechanical Codes; that I understand this is not a permit, but only an application for a permit, and work is not to star[ without a permit; that the work will be in accordance with [he approved plan in the case of work which requires a review and approval of plansn , 119 / \? ??$i??L_ Applicant's Printed Name App ant's Signature -----------------1 For Office Use I f ~a i Permit City o 3830 Pilot Knob Road f Permit Fee:' Eagan MN 55122 i Date ReceiveAUG 2 8 2009 Phone: (651) 675-5675 I Fax: (651) 675-5694 Staff: - - - - - - - - - - - - - - - - - J 2008 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: / - > Site Address: Tenant: (~_t Ck Suite RESIDENT / OWNER Name: Phone: LJ~ qA _5 Address / City / Zip: EQD_ t le E'~ CONTRACTOR Name: ense #:C~ Cr Address: City: State. Ok Zip: L7D l w Phone: ' ~ Contact Person: TYPE OF WORK _ New Replacement Repair Rebuild Modify Space Work in R.O.W. Description of work: PERMIT TYPE RESIDENTIAL Water Heater Water Softener Lawn Irrigation Add Plumbing Fixtures RPZ / PVB) Main _ Lower Level) Septic System Water Turnaround _ New Abandonment RESIDENTIAL FEES: $50.50 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $.50 State Surcharge) $30.50 Lawn Irrigation (includes $.50 State Surcharge) $50.50 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround' (includes $.50 State Surcharge) 'Water Turnaround (add $136.00 if a 5/8" meter is required) $100.50 Septic System New ($10.00 per as built) (includes County fee and $.50 State Surcharge) $90.50 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) , TOTAL FEES $JD 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. Appfi ant's Printed Name Applican ' Signa ure FOR OFFICE USE Reviewed By: Date: Required Inspections: -Under Ground -Rough-In -Air Test -Gas Test ,Final PERMIT City of Eagan Permit Type: Mechanical Permit Number: EA105129 Date Issued: 0612712012 itj of 0n Permit Category: ePermit R Site Address: 4608 Galaxie Pt Lot: 2 Block: 1 Addition: Cliff Woods Of Eagan PID: 10-17900-01-020 Use: Description: Sub Type: e - Air Conditioner Work Type: New Description: Air Conditioner Comments: Questions regarding electrical permit requirements should be directed to Mark Anderson, State Electrical Inspector, (952) 445-2840 Renae Freinwald 2200 Hwy 13 W Fee Summary: ME - Permit Fee (Replacements) $55.00 0801.4088 Surcharge-Fixed $5.00 9001.2195 Total: $60.00 Contractor: - Applicant - Owner: Genz Ryan Plumbing & Heating Gregory F Long Tste 2200 West Highway 13 4608 Galaxie Pt Burnsville NIN 55337 Eagan NIN 55122--257 (952) 767-1000 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:EA166865 Date Issued:02/10/2021 Permit Category:ePermit Site Address: 4608 Galaxie Pt Lot:2 Block: 1 Addition: Cliff Woods Of Eagan PID:10-17900-01-020 Use: Description: Sub Type:Residential Work Type:Replace Description:Furnace 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 - Doris Dey Cruz Espinoza 4608 Galaxie Pt Eagan MN 55122--257 (612) 876-0836 One Hour Heating & Air 11825 Point Douglas Rd S Hastings MN 55033 (651) 437-4177 Applicant/Permitee: Signature Issued By: Signature