4372 Lex Pointe PkwyPERMIT
City of Eagan Permit Type:Building
Permit Number:EA128806
Date Issued:12/08/2014
Permit Category:ePermit
Site Address: 4372 Lex Pointe Pkwy
Lot:21 Block: 2 Addition: Lexington Pointe 3rd
PID:10-45072-02-210
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow
windows, 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 $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 -
Stephen J Martin
4372 Lex Pointe Pkwy
Eagan MN 55123
Csc Exteriors
8444 Pillsbury Ave S
Bloomington MN 55420
(612) 767-6301
Applicant/Permitee: Signature Issued By: Signature
INSPECTI4N
I CITY OF EAGAN
i 3830 Pilot Knob Road
? Eagan, Minnesota 55122-1897
(612) 681-4675
? SITE ADDRESS: `""' 11
?
?t . l 1 x !'O1-N1T i>kWy
? I F x lfVlitl3W 1>QIN7f 3titt)
PERMIT SUBTYPE:
rt: . , ci id
:CORD
PERMIT TYPE:
Permit Number:
Date Issued:
=" APPLICANT:
TYPE QF WORK:
INSPECTION D• • D•
Permlt No. Permit Holder Date Telsphone It
ELECTRIC ,l?(p g0 I/ ?CS G ?
PLUMBIM1tG
HVAC
InspecUon Date Inap. Comments
FOOTlIJGS
FOUND
FRAMING 11? 4-4 ' ?
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
NEATING -2-dl /t
(C
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST /?,? .
'
FINAL PLBG w
-
FINAL HTG
ORSAT
TEST
AAWW;
BLDG FINAL ?? / C TTJ ,ec? D
!AI ' L#
BSMT R.I. D L "C? --
BSMT FINAL
DECK FfG
DECK FINAL
?
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS?
•
?;?i : ,?
,i I t I lNV t: r't4lY
1 F,. iH tj iuPJ 1'lNit skU
PERMIT SUBTYPE:
,,. ?l_,,
;coRnT
PERMIT TYPE:
Permit Number:
Date Issued:
APPLICANT:
I i.t ? MJ i
(h 1d) 633-• igA2
TYPE OF WORK:
(tF', I.-Fttf'1'I0 N
ItilUt,lt i N
I 1NA I
teu I I to 1 141'
a:, ?tts9„
0 *+11 7 l
Ia(
Ai rrRnriaa
{tiA'.+ iNr; Eft11
F 7
L J
Permtt No, Permit Holdw Data Telephone #
ELECTRIC
PLUMBING
HVAC
Inapectlon Date lnsp. Commenta
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
v
FlREPLACE
AIR TEST
FINAL PLBG
F1NAl HTG
ORSAT
TEST
BLQG FINAL
BSMT R.I.
BSMT FlNAL
DECK FfG
OECK FINAL
MECHANICAL PERMIT DATE: 5/17/91
RECEIPT: 101432
SITE ADDRESS 4372 LEXINGTON POINTE PA.RKWAKJnit # Permit # 13008
BLDG. PERMIT NO.
? j
01-3210 Bldg. Permit ?
01-3422 Plan CheCk
01-3445 Surch./Adm.
? 01-3446 SAC/Adm. `- ?--
?
01-2155
Surcharge
75-3860 Road Unit
20-2275 SAC - ?( ?--
?- 20-3865 Water Conn.
20-3868 Water Trmt. ?-'--
20-3716
Water Meter % :: .
, 20-2252 Acct. Dep. C-'
20-3713 Water Permit 1-
20-3743 Sewer Permit '
79-3866 Sewer Conn. =
28-3855 Park Ded. i
TOTAL
? CASH RECEIPT ?
CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE C- =? •? '? 19 ?
?f?
AMOUNT
'-
El CASH
KCHECK
. ?
/
0?7
,-n
White-PaYers CoPY
Velbw-Posdn9 CoPY
Pink-File Copy
& DOLLARS
loo
Thank You ?
,
BY
r
! SEWER & WATER PERMIT OFFICE USE ONLY
CITY OF EAGAN PERMIT DATE
3830 Pilot Knob Rd.
WATER PERMIT #
SEWER PERMIT #
P.O. BOX.21199 METER # B.P. RECEIPT # L 259$
Eagan, MN 55121 READER # B.P. RECEIPT DATE 6/20/89
METER SIZE
ISSUE DATE - PRV _ BOOSTER PUMP
SITE ADDRESS PERMIT REGIUESTED
LOT ! BLOCK - SEC/SUB
-
' _ ? , .
'..__ SEWER -?` WATER -TAPS
APPLICANT: `
ADDRESS: COMM/IND ? RESIDENTIAI
CITY, STATE ZIP `
PHONE! r l s ? ? ; ' `? / ? I NEW _ EXISTING
PLUMBER: ' - "
ADDREtS: I AGREE TO COMPLY WITH CITY OF
CITY, STATE ZIp EAGAN ORDINANCES: ,
PHONE
: .
OWNER:
ADDRESS: SIGNATURE WHEN METER ISSUED
CITY, STATE ZIP
PHONE:
' PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. FOR STORpA SEWER PERMITS, CONTACT
? ENGINEERING DEPT.
SEWER b WATER PERMIT
CITY OF EAGAN
3830 Pilot Knob Rd.
P.O. Box 21199
Eagan, MN 55121
_--?
SITE ADDRESS
LOT -! BLOCK -= SEC/SUB !.-, , / -a - /?.
PERMIT DA
WATER PERM T # _
METER #
fet5eK#
METER SIZE Wf1
ISSUE DATE
rlj
APPUCANT: 1? _ _ • c< ; '^ ---r' / I
ADDRESS: -,? c, { J? ? ` ? ? ?.?cl:!
CITY, STATE ZIP ' •
y
PHONE:
PLUMBER:
ADDRESS: •?D/rY !; ; :1 ? ?,! •.?,,?c:;? <. , ' ;d r? -
CITY, STATE Z(P
PHONE:
ONLY
SEWER PERMIT #
B.P. RECEIPT # ? 2598
B.P. RECEIPT DATE 6 ' `-?
_ PRV _ BOOSTER PUMP
/ PERMIT REOUESTED
?l SEWER WATER _ TAPS
- COMM/IND . '? RESIOENTIAL
NEW - EXISTING
I AGREE TO COMPLY WITH CITY OF
EAGAN OpOiNANCES:
OWNER:
ADDRESS: 71GATURE WHEN MET R ISSUED
CITY, STATE ZIP
PHON E:
?
' PLEASE ALLOW TWO WORKING DAYS FaR PROCESSING. FOR STORM SEWER PERMITS, CONTACT
ENGINEERING DEPT.
I ,, - . .
CITY OF EAGAN . ? 16676
? 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, 141N 55121
. PHONE: 454-8100
?UILDING PERMIT Receipt # -
o be dsed for -°?? f (-`Ak Est. Value $ 11 u, t)G:j Date 3=- 19 0
Lot i Block _
Parcel No.
W Name '' I l?.I11l? liUT?S?''IiR C0?[ET
3 Address ?'?`TzRFOR[3 I311 ii
0 City Phone
? Name
.°
Address
? City Phone
Name _
Address
I hereby acknowlege that I have read this application and state ihat the
information is correct and agree.to comply with all applicable State of
Minnesota Statutes and City of Eagan Ordinances. `-
Signature of Permitee !?-^-A Building Permit is issued to: Y01 L'1, lsu' i3. u 1='Iqr A' 4A.'raa 1
on the express condition that all work shatl be done in accordance with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official
OFFICE USE ONLY i
Occupancy R"3 +'' i FEES
Zoning PD R`I
(Actual)Const Y? Bidg.Permit '6 74•?-'?'
(Allowable) Y"N ?
# ot Stones
Length 521
Depth "#
S. F. Total -
S.F. Faotprints -
On Slte Sewage -
On Site Well
MWCC System ?
City Water
PRV Required
Booster Pump
APPROVALS
Bldg. ce•
V -
Surcharge Ss'? I
Plan Review 337 • 110 ?
SAC,City 1DQ.00 I
SAC.MCWCC 575.00
I
Water Conn 580• Qo
Water Meter 90.00
Acct. Deposit ? ?' • ?
S,NV Permit - ?' • vo .
S,MI Surcharge 1'-00
Treatment PI 226• 00
RoadUnd 34C'•'}01 ,
Park Ded.
Copies ?
TOTAL 3,030.00
, Permit No. Permft Noider Dete Telephone #
WATER
SEINER ?
PLUMBING
H.V.A.C.
ELECTRIC
LItAl
Inspection Date Insp. Commenta
Footings I
Foundation
Framing 9 ?
Roofing
Rough Plbg. - - ?
Rough Htg.
Isul. A
F?repiace y a?
Final Htg. - ? p- ?
Fnal Plbg.
Const. Meter Plbg. Inspector - Notify Plumber
Erxgr./Pian
Bldg. Final s'??/ 90 ?S
Deck Ftg.
Deck Final
Well
Pr. Disp.
6 • "? ?
Tprttfirate u# (Orrupanry
titp of (Eagan
Erpartatrnf u# IuAlding j.per#inn
This Certifcate rssued pursuant to the requirements of Section 306 af the Urrifonn Building
Code cerlifying ilrat a1 the knre of usuance [ltis struclure was in compliance with the various
ordinances of 1he City regulating building construction or use. For the following.•
u.c.r. SF Df,1G/GAR ew8. PI .,,;, No. I6676
0-"--r Type R3/M 1 ZAm* Disv? PD/R 1 Type CowL VN
WIILIAM HITIMM rJMSf . A&I.. 960 WATIItETM DR W. EAGAN
4372 I.IIQJLICN POIlM PK+1%-?,,. I.21. S2, I?,']G'" POIrTIE 3rd
POST IN A CONSPICUOUS PUCE
. rt.
CONTRACT
PRICE
Site Ad-?Pr.
? Name _'
? Addres
c City
Name-
2 Addresst
8 City _
PLUMBINGI PERMIT For Offic u On
CITY OF EAGAN PERMIT#
i ?3630 PILOT KNOB ROAD, EAGAN, MN 55122 RECEIPT
PHONE 4548100 DATE: ?
ex/r Tr"y) f:>,I f.) BLDG. TYPE WORK D?CRIPTION
Res. x New
?? ?IC1Sub Muft. Add-on
Jc Gu '? i' s _ i7G . Comm. Repair
, ?. .. _ , aner
Phone
FEES
COMM.IiND. FEE -1% OF CaNTRACT FEE
APT. BLDGS. - COMM. RATE APPLIES
TOWNHOUSE 8 CONDO - RES. RATE APLUES
MINIMUM - RESIDENTIAI FEE $12.00
MINIMUM - COMM.IND./FEE $20.00
STATE SURCHARGE PER PERMIT .50
(ADD $.50 SJC PER EACH $1,000 OF PERMIT FEE)
FOR:
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO FIXTURES TOTAL
? Water Closet - $3.00
?- Bath Tubs - $3.00
-? $
7 70
Lavatory - $3.00
? Shower - $3.00
-? Kitchen Sink - $3.00 -5, on
UrinaVBidet - $3.00
?- Laundry Tray - $3.00
?- `r'
-
Floor Drains - $1.50
?- ?
?-
Water Heater - $1.50
VYhirlpool - $3.00
-?-
?-
Gas Piping Oudets - $1.50
(MINIMUM • 1 PER PERMIT)
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
?
?-
Rough Openings - $1.50
PERIWT FEE:
STATES S/C: -'
GRAND TOTAL: 3 ` :?V
'MECHANICAL PERMIT
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55122
PRICE PHONE: 454-8100
? Name 1? +?rt.. _
a?
? Address -
c City Phone
? Name -
3 Address
p City Phone
Forced Air
Boiler
? Unit Heater
! Air Cond.
Vent
Gas Piping Outlets #
Other
?- M BTU
M BTU
M BTU
M BTU
CFM
?-
FEE:
S/C:
TOTAL:
PERMIT #
RECEIPT # ?
DATE:
For Office Use Onty:
BLDG. TYPE WORK DESCRIPTION
Res. New
Mult Add-on
Comm. Repair
Other
FEES
RES. HVAC 0-100 M BTU -$24.00
ADDITIONAL 50 M BTU - 6.00
(RES. HVAC INCLUDES A/C ON NEW
CONSTRUCTION)
GAS OUTLETS (MINIMUM -1 PER PERMIn - 1.50 EA
COMM/IND FEE - 1% OF CONTRACT FEE
APT BLDGS. - COMM. RATE APPLIES
TOWNHOUSE & CONDOS - RES. RATE APPUES
MINIMUM RESIDENTIAL FEE - AlL ADD-ON 8
REMODELS - 12.00
MINIMUM COMMERCIAL FEE - 20.00 '
?
STATE SURCHARGE PER PERMIT - .50
(ADD $50 S/C IF PERMIT PRICE GOES ?
BEYOND $1,000) ?
SIGNATURE OF PERMITTEE ?
;
FOR: CITY OF EAGAN '
REQUEST FOR ELECTRICAL INSPECTION
? See insVUdions lor campleUig this form on back M yellow mpy.
? 5 X" Below Work Covered by This Request
EB-00001-07
e Add Rep. TypeofBuilding AppliancesWired EqwpmenlWired
Home Range Temporary Service
Duplex Water Heater Etectnc Heating
Apt. Building Dryer Other (Specity)
Comm./Indusirial Furnace
Farm Air Condilioner
Olher (s0mff1) ConlractwS Remarks.
Compute Inspection Fee Below:
# Other Fee # ServiceEntranceSize Fea # Cirouils/Feeders Fee
Swimming Pool 0 to Z00 Amps ? 9 0 to?m4mps p6
Transformers Above 200 _ Amps 1 1 A6ove_V&_Amps ,S'.4o
Signs Inspecror5 Use Onty pL .
Irrigation Booms
Special Inspection ?G
Alarm/Communication
Other Fee f
I, the Elecirical Inspector, hereby
tif
h
h RougAin
cer
y t
at t
e above inspection has
been made. Final ' Dat
OFFICE USE ONLV
Thia requeat witl 18 monfhs imm
? 04525t4
,
Requeg! Dala
? Fire N. Ro = InspechOn
v
? Reatly Now Noey Inspectw
es ? No ?en ReatlY'
icensed contractor O owner hereby request inspection of above electrical work at:
Job AOtlress (Slreal, Box or Route No
7 L 4 av rS? /?- Ciy
lz -,?
Secilon N. Township Neme or No Rarge No. Counry
Occupa (ZAI Phone No.
Power Supp? J Atltl?ggi ?
Eleclrca Cqor (Campany Name) Conir w8 Licenae No.
Melling Atltlress (Con4aclor or Owner Malong InslalWiron)
` ??
Aut r¢eG SgnaNre ntractwl wner Malurg Instellatlon) Ph Number 1
j` /
MINNESOTA STAIL BOARD OF ELECipICAY ? THIS INSPECTION REQUEST WILL NOT
Grigge-Mldwey BWg. - Romm S-173 BE ACCEPTED BV THE ST.4TE BOARD
1927 Unlverslty pve., SL Peul, MN 55104 UNLESS PRDPER INSPECTION FEE IS
Phoire (812) 612-0800 ENCLOSED.
oATe: g/aa/ae
RE: 4372 I.BYIZdGTON POIMTB I+KVY, L21, 82, LEXINGYOH PT 3rd
xx Your Sewer 8 Water Permit for the above property has been completed. It 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.
- Your Sewer & Water Permit for the above property cannot be completed for the following
reasons:
Your Sewer & Water Permit for the above property has been completed, but the meter cannot
be iskued or occupancy allowed until further notice.
- COMMERCIAL PROJECTS ONLY: Please pay for meter at Ciry Hall. Meter size must be
confirmed by 8ill Adams or Dirk House (Plumbing Inspectors - 454-8100) before issuance.
WARNING: BEFORE DIGGING, CALL LOCAL UTILITIES -TELEPHONE, ELECTRIC, GAS, ETC.
- REQUIRED BY LAW.
CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICY.
Secretary, Building Inspections Dept. ' '
BUILDING PERMIT
Tobeueedfor SF DWG/GAR
Receipl # ^ Est Value $110,000 Date JIINE 20 ,1g89
Siie Adtlress 4372 LEXINGTON POINTE PKWY
Lot 21 Block 2 Sec/Sub LEXINGTON POINTE
Parcel No RD
w IName WILLIAM HUTTNER CONST
o Address 960 WATERFORD DR W
city EAGAN Phone 452?._3088
Name _
Address
Phone
Name _
Address
Cily -
Phane
I hereby acknowlege that I have read this apphcaao and s?te that the
iniormalion is corcect and agree o comply with ,I a p i le State of
Minnesota Statutes and City-e 7?p Ordi
Signature of Perrnite(
A Bmidmg Permit is issued to: WILLIAM HUTTNER CONST
on the express condition Ihat all work Shall 6e dOne in accortlanCB With all
apphca6le State of Minnesola Statutes andh Ci,ty / of Eagan Ortlmances.
Building OHicial -? 1R QLA?? ? y? I 11
CITY OF EAGAN N? 16676
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 ? ?? J
PHONE: 454-81 DO 6?
OFFICE USE ONLY
Otcupancy R- 3 11-1 FEES
Zoning PD R-1
(ACWaI) Canst V-N Bldg Permit 674.00
fAllowable) V-N
Swcherge
55.00
# of Staries
52 '
Plan Review
337 .00
Length
Depih ?!4 ! SAC, City 100.00
S.F.TOtal - SAC,MCWCC 575.00
S F. Footpnnts _
On Sta Sewage - 'Naler Conn $80.00
On Site well Water Meter 90.00
MWCC System R
XX
Acct. Deposn
30.00
City Weter
PRV Reqmred _ S1W Permit 20.00
Baostar Pump - S/W Surcherge 1.00
Treatment PI 22$ • 00
APPROVALS Road Unit 340.00
Planner - park Ded
Council _
BItlg.OH Copies
Variance - TOTAL s, 030. 09
L+s('?O? n
34s? ? ? OFFI I15E NLY Th?s reqmst vold 18 manihs from wLdaM1On dak pnnted in this bos
,?sf'?? 6, g? 7T5
e
?
ol
? ?.?D°°
PLEASE PRINT OR TYPE
/
•
Rpoest Da Roogh-in tnspedion mqmredi Q Na Inspechon Other Than Rovgh-In- [] Ready Now ill Call
Q'oo musl mlNhe Inspeciar wh reodyI Dah Ready
I, icensed mnimctor Q owner hereby requesf inspecfion of ihe above elecfriwl work ot:
h P.ddmss (Sheel, Bov, or Route No ) Gp Zip Code
Sectian No. Tavmship Nome or No 0.ange Na Fme No. Caunry /???/?
0/?P-V ? 1 T
Occupanl
i ?m (LUSSi/?i PMrie N.
Pov.er Supplier
? Addren
Elednmi Cankacror (Gompany Name)
C???AX4,+?IL E???'?cc iNC„ Conhacron c?ense Na
c?o? Masror Lc No. (Plont Eled Only)
Arnot??3
MaiLng Address lCantrotlor or Owner Performing Im Ilaeon)
LIZ33 /c617Gft W'rwN TR?4?6?
E?-k(rHrJ rY1n? SSj1.2
ANhorixe now ?Co cbr O d insmllubon) PFwne No
d.
EB-00001A-106/95 U STAT€BOMOCOPY-SEEINSTIiUCTIONSONBl1CKOFYELLOWWPY
IIII IIIIII IIIII IIIIIIII II ?I?III???I 8E1QUnive sRYAve., Rm. S cBASt.'PauP MNnO04 Y 0.v
0 3 4 6 9 0 5 3 tz) sa2-oeoo ?Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. H}g. Equip. Wafer Hfr. Load Mgmt. Other:
D er Ran e Elec. Heot Tem . Service
obove fhe work covered by fhrs request. Enfer remarks m this spoce ond on the back ol the whde copy only.
31ilskm(wC F?NuO
Calculote Inspxtion Fee - 7hrs Inspechon Requesf will not be oaepted wiihoW the mrrecf fee:
Olher Fee S Service Enhnnce Sae Fee # Circuih/Feeders Fee
Mobile Home Pork Stall 0 to 200 Amps 0 to 100 Amps
Sheet Ltg./TraHic Sig. Above 200 Amps Above 100 Amps
Tronsiormer/Generafor INSPECTON'SUSEONLV
p}
T?
$ign/OufLne Ltg. X{mr ?
CY C7+`?l?
Alartn/Remote ConNol ?
Swimming Pool i h,,eb «m thm i ms ened on dmmbed he.ein on me :mf
Iniga}ion Boom po,h-k D.Yltdi
G(e
?
$pecial Inspetfion T
Investigahve Fee Final W /2 y
?
THIS INSTALLATION MAY BE OR)ERED DISCON ECTED IF N LETED WITHIN 18 MONTHS.
I
1989 BIIILDING PEFtNIIT APPLICATION - CITY OF EAGAN
SINGLE FAMILY DWELLING3
'??l (o
r'9W,
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCUL9TIONS
POTEt ADDAESSES FOR CORNER LOTS - COATRACTOR/HOMEOflNER MOST DESIGNATE iTHICH ADDRFSS
IS DESIRED. NO CHANGFS WILL HE $LLOWED ONCE BUILDING PERMIT IS I330ED.
M[JLTIPLE DWELLINGS BENTAL ONITS FOR SALE i1NIT5 # OF iTNITS
ZNCLUDE 2 SETS OF PLANS, CERTIFICATE OF SIIRPEY - CHECK idITH BLDG. DEPT., 1 SET OF ENERGY
CALCULATIONS
COMASERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STROCTURAL PLANS,
t SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS,,uM 15 1989
To Be Used For: F-?sPr?y.rValuation: Date:
/
Site Address q ;L ind& A,?
Lot Block Z
Pareel/Sub
Owner
Address
City/Zip Code
Phone
Contractor w- ('f'wj7?l.c.0'/ (!*xff,
Address City/Zip Code
Phone 7) 1,-3 60 0 ?23- KK9 ?
Mch./Engr.
Address
City/2ip Code
Phone 0
I I Ol 000 ^ OFFICE DSE
occupancy R 3 M-I
Zoning ?
Actual Const V-1?1
Allowable V -N
# o£ stories
Length
Depth S.F. Total
Footprint S.F.
On site sewage_
On site well
MWCC System ?
City water -ler
PRV required _
Booster Pump _
APPROV9LS
Planner _
Couneil
Bldg. Off.
Variance
FETi.S
Hldg. Permit 4,? 4,oJ
Surcharge 551oa
Plan Review 3 3 ?,oD
SAC, City 1 O • o?
SAC, MWCC 5 S,oa
Water Conn 5 80 , clo
Water Meter 9 0,00
Acet. Deposit 3 0,00
S/W Permit 20.0?
u
S/W Sureharge 1,0
Treatment P1. 22 S.oc)
Road Unit 340,00
Park Ded.
Copies
TOTAL ?p gQ,QQ
S`?Al
NOTE: Sewer & Water Permit fees and aceount deposit fees irill be ineluded in the building
permit fee. Processing time for serrer and water permits is trro days onee a licensed
plumber has applied for a permit at City Hall.
PW'
VA WArr'i vNl
GqRavE
Z`?XZ'4=5?GX 15=86y?? 44A
Ssm r
_---
??l ? ?r2=
z xsyL=
3 X3?Z =
? ST FL oo(Z
?3SY1'1T ?
z?Ss
2?2/z ?
58?
II
36q
?
J
`I 68 X iL+ = i 3s52
l?
?
5 -A 5b _ q 925o
25s y a.? _
956 x 50= 3 q %lDo
IOq 2u2
TRI-LAND C0. SITE PLAN FOR=
SURVEYING
SERVICES HUTTNER CONST.
1260 YANKEE DOODLE ROAD
EAGAN, MINNESOTA 55126
LEGAL DESCRIPTION: LOT3L,BLOCKLFxwCTON POINTE 3RD ADD.
ACCORDING noKOTA RECOCOUNTY
THEREOF ,MINNESOTA
? `?.. 97 )rik
t
N p?
a?40 \.
??TF pq ?
?o?a ?3t -_ wY o 0 ? 540 OO 9f Rk?v
179
LOT / ? ^a
SCALE: I"=30'
LOT
2
?
?z g3iD
/
2 oN
N ? ?\
N Iq1hy qi
O
I /-
v-i
w
m
1'n
Q1
0
e
0
z
.-?
LEGEFiD
LOT
21
UTILITY
5. ?
/40- ?
?z35 ,
L6T
20
A/OTG: 569V146 G/AS SET ON
Deawwla Fx9.,;,?s?
o%w. rr w.as ?vo r
E GOCATELI iN
? WE ?
i U% k
N89°50'21"W
43.21
o DENOTES IRON MONUMENT
a DENOTES WOOD HUB SET
DENOTES EELEVATION?T
DENOTES PROPOSED SPOT
ELEVATION
? DENOTES DRAINAGE DIRECTION
I hersby certify that this survey,plan or
rsport was prepared by me or under my
diract supervision and that 1 am a duly
Reqistered Land Surveyor undsr the
Laws of tha Sicte of Minnesota.
EAGARi EGINEER fa DEPT
PaaFt`,ED <ouR GEvE?-
INVEF2T ELEVp710N A'P' SERVIC.E EXTcNSIGtJ'
PROPOSED GARAGE FLOOR ELEVATION = jw:
PROPOSED FIRST FLOOR ELEVATION = 98O
PROPOSED BASEMENT FLOOR = 17 7--
ELEVATION
NOTE'• VERIFY ALL FLOOR HEIGH75 WI7H
FINAL HOUSE PLANS
Bradley . Swenson, Mn. Req. No.15235
Dcte:
• (Fora Dcvcloped by thc Sta:c of ::innesota i.uilci?:g ?occ iilvis-v:1)
i TD EE 5119:fITiiD NI2f1 BUILnI1:C PLR7fIT APPLICATI0:7
,'s _. . .
FJCTE'IOR FNVF.LOPE AVERACE "U" C0."3UTATION '
? 01.S ER•
SLTE ADDRESS
Total exposed wall area above floor ? z?fv z-
3 ,-d
CONTRAGTOR: LbK?if• DATE:
7L3 -
Determine vozking square footage of each
1. Total exposed wall area......... Z SI ? s4•ft. x
1369 sq.ft. x >4'?
2. Total roof/ceiliag area.........
3. Total exposed wall area calculations:
a. Tota1 wall vindov area .............................. (?Z
b:" Total door area ..................................... S?
c. Total sliding glass door area ....................... -
d. Total fireplace wall area ........................... -
e. Total wall framing area (average 107.) ............. 2 4`cD
f: Total net wall area above floor ..................... 71 33
g. Total rin joist area ................................?
Total exposed foundation area ? ?15- _
h. Total foundation oindow area ........................ -
i. Total net foundation area above grade ............... 115-
Detezmine "U" value of each wall segment
c
?-' x "u"
. e
8. ? 9 z x „u,. ,y I - _- 78, 7 z
b. s 7 X„U., ?7
X °Uts ASS
zYo
p. / ? 3 3
t L/
o-7
.?
-
X glU.$ , . I ?
X,,,,,,
. g. x „Ut$
uVh
g uo" 110 _ 11,5
• ~„. 2al,zf
3. . TOTAI. . • '
?•.
If item 03 is the same as, ot less than item O1t you have mct the intent of
SBC 6006(e)2. •
4. Total cxposed roof/eeiling caleulacions:
Total exposed roof/ceiling area
.r '
J. Total skylight area ................................... -' .
? k. Total roof/ceiling framing area (averay,e 107.)......... 137
1. Total net insulated roof/ceiling area ................. /Z 3 Z
Detemine "Q" value for each roof/ceiling segment
k.
i.
4.
x nun
l3
/Z3 7-
R ..U.t ? C? ?.• _ Z : 7 `f
x „U,l z q, 6 y .
'TOTAL ? Z 7' 3?
If total of t`4 is the same as, or•less than 42, you have net the intcnt
of SBC 6006(c)1.
Alternate Suilding Envelope Design
''?t.'?....'. ' . . .. .
To utilize the total envelope system method, the values establfshed by '-
the sum of items 03 and 04 shall not be greater than the sum of items #1
and C2.
1.
3.
+ 2.
+ 4
?
m
C E R T I F I C A T I O ti
I herehy certify that I have calculated the "U" factors and R values
herein and that the building hera described meeta o= exceeds the State of
Minnesota Energy Conservation Act. •
(Signature).
? _A(-
. (Date) '
. .
:
??CL
-:t72iJi1TIC:i
'LlP1.T:
F?2T.t:E 4:ALL
Constriictinn R-Valuc
L
1, Iptcrior air film 0.6II
2.
3, ' inc}:cs sofr_ wonfl -! -
5. `,' " i .
6. Exterior air film : 0.17
Total ;?-
i,`., .. • . ' .:.
1. Intcrior air £iln 0.6E3
2. -
3.
9.
?-
5.
6. Exterior air Piln 0.7.7
Total
?-
1. Snterior zir film 0.66
2.
3.
9. ,
5.
6. Exterior a.ir Pilm 0.17
Totsl
? . . ? "
) . 1.
) ?•
' 3•
j . • 4.
5.
.. ' G.
SIA8 O:Q GRallR
Interior air film 0.68
i ? . . . ,
ExCerior air film 0.17
Total ,.._
• 6 ? ? • ? ` 4
• (?f=_ ?'p? rr ?•? . ? ? , :-n;
nr:?- . . • •
.iii k . ? ? . • •(. . .i?? ?r ? ? ?.
FIG. 04 ? fl •t? ? • p
NOTE: Indicatr. L•ypc, "P." valun, dcnth and
, placenent of insul:Ltion. .
1v'AI.L
' lsc• lCr. of Tl,7jyu^ wi:1 arca for
? ' =r.amc con::truc[iun
i?
. ?
f.
• FOOi'/CF:ILII:G
??? r;
`_`;>
ti..7?
VII:T { \ .
1'enced Li L'ca[ LloA:
up
r zc. 1!5 '
k7ear flov up ?• vented
„FSG. #G' . ?
Cnn:-tr.uction R-Value
Interior air film _ 0_61
z. --
3. 4. Bxtcrior nir fili, (se.ill) O.G
't?ocal
. .,
?'?---
?;' ,,. .,?.,•,," `?: -_ .:_1. Intcrior air film O.G1
2. 11^
3.
9. Er.teriur air film sT.tll ~?.
7'otal - • ?'? . ? ?
1. Inside air fi].m 0.61
2. .
's.
9. ' S. Outside air film •0.17
Total
Nntc: U_:c addit•ional ::hcets if more space i
needed for details and calculation..
.
ys?.._e v:.'_u ? Snry.^,:_'? ?%a•_? _'"__? tii. s?
. ._ ......-.......r. -? r .
. HcaL U
• , flov up ?
P.T.c;, ¢7 ?
RESIDENTIAL
• 5-0101Z BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New ConsW ctlon Reauirements RemodeUReoair Reauiremenb
• 3 registered site surveys showiig sq. R. of lot, sq. N. of house; and all roofed areas • 2 copies of plan
(20% mazimum lot coverage allowed) • 1 set of Energy Calculations far heated additbns
• 2 copies of plan showiig beam &window sizes; poured found design, etc.) • 1 site survey forexterioradditions & decks
• 1 set of Energy Calculations . Indicate if home served by septic system for additions
• 3 copies of Tree Preservadon Plan if lof platted aRer 7/7193
• Rim Joist Detail Oplions selectlon sheet (bldgs wNh 3 or less unAS)
DATE ?? z VALUATION$ (?I,(0?•OJ
SITE A'jDD?R?ESS 4 3 Tkwy MULTI-FAMILY BLDG _Y X N
TYPE ?W )4--- We /oo9 1 L:afSP ??i?_ FIREPLACE(S) _ 0 X 1_ 2
APPLICANT A?v?e?z'cA^ 3u: '), ,?
STREET ADDRESS I 2 2`« Ni tolI e? 4J. 5- CITY 13v/'/4s0 14 STATE 'I??/l ZIP 55 331'
TELEPHONE #'KZ -767- 6°15q CELL PHONE # FAX # as Z 70-7 IIC125'
PROPERTY
S.
TELEPHONE#
("Sl &ST o35`i
--------------°---------------------° °°--------------------------°--------------°----°--
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RUI.ES 7670 CA"1'EGORY 1 n
submiasion type) • Residential Ventilation Category 1 Worksheet Submitted •
• Energy Envelope Calculations Submitted
Plumbing Contractor: ____
Plumbing systcm includcs:
Mechanical Contractor:
Mechanical syslem includes:
Sewer/Water Contractor:
Air Conditioning
Hcat Recovery System
Phone #
Phone #
MAY 2 2 2002
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 State of Minnesota Statutes and City of Eagan Ordinanc s.
SignatureofApplicant
OFFICE USE ONLY
Water Softener
_ Water Heater
No. of Batlis
_ Phone # ,
Lawn Sprinkler
No. of R.I. Baths
Certificates of Survey Received - Tree Preservation Plan Received _ Not Required _
Updated 4102
.k* Ii klt?:S:*:?
r,,4rrF:;: R' G
M.'L,;i S(.i. -ii; ?.? 1.r.i?r?-,
-_. .
A;itY•i,i%?;y„
„ ........
PERMIT
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
P.I.N.: 10-45072-210-02
PERMITTYPE: euzLozNG
Permit Number. 029178
Date Issued: 11 / 2 5( 9 6
4372 LEX POINTE PKWY
LOT: 21 BLOCK: 2
LEXINGTON POINTE 3RD
DESCRIPTION: '
._._n
Buildiq'`Permit Type
uilding-W?ork Type
` Yv
ensus Codm
l ?a• ? ,? ' ? ??? t
?
ff I?
?
Base Fee
Surcharge
Total Fee
.,?r'`?? ?.},s.. ?t,:ea#_i`? •, ,t, a r.r'.i;??:,, :?~?;{?.. IE?t.?[?!;?'`it?,,.,i"•h
REMARKS:
FEE SUMMARY:
$50.00
$.50
$50.50
BASEMENT FINISH
ALTERATION
434 ALT. RESIDENTIAL
CONTRACTOR: - Applicant - sT. LIC OWNER:
R b CONST 14529575 0004988 ROSSINI TIMOTHY
980 STONY POINT RD 4372 LEXINGTON PTE PKWY
EAGAN MN 55123 EAGAN MN 55123
(612) 452-3575 (612)687-0359
?
I hereby acknowledge that I have read this
information is correct and.,,,agrPe to comply
Statutes and City of Eagan Ordinances.
aD cQ ...
' APPLICANT/PERMITEE SIGNATURE
J. I
application and state that the
?11,th ,a11, appli,cable State o'f Mn.
?. ? _ . . ?
?
ISSUED BY.
C(TY OF FAGAN
3830 PILAT KNOS RD - 55122 till# 1996 8U1L01NG PERMIT APPLICATION (RESiDENTIAL) II ?
681-4675 CQ??
? 3 registarod site surveye
? 2 eopks o1 pians (induds beam d wirMow shea; pourod hW. dsaign; ete.)
• / anergy alculstions
? 3 mpks M iree prcaenotion plon M bl pkCed aRer 7/1193
iequircd: _ Yes _ No
r ,r?-n,r.rr?t?:r?trrr.-srr?
? 2 cropks of plan
? 2 sHe surveys (exterior addiNOns d decks)
? t energy alalationa lor Aested additions
DATE: CL?a--t? 2-9 9./- CONSTRUCTION COST: gC=x?
DESCRIPTION OF WORI
STREET ADDRESS:
LOT ? BLOCK ? SUBD.1P.f.D. g.nU°` j
PROPERTY Name: ?`mss, ti r Phone #: 6$7 -1213 s?
OWNER W*
Street Address- K 3 7
City: State: ? w Zip: S5'1 zS
CONTRACTOR Company: (2,o Phone #: qs z- 3?;' 7s"
Street Address: 9? o ST - License m `f 9 g?
City:_ State: }'-t --? Zip' ? Z 3
ARCHITECT! Company: Phone #•
ENGINEER
Name: Registration #•
Street Address-
City: State:
Zip•
Sewer & water Gxnsed plumber: Penalty applies when address change and lot
ehange are requested once pemdt ia issued. 1 hereby acknowledge that I have read this applicadon and atate tlhat the informadon is cortect and agree to campiy with afi
appficable State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Appiicant: ? `?-'?•y
OFFICE USE ONLY
OCT 2 9 1996
Certificates of Survey Received _ Yes _ No
Tree PreservaUon Pian Received _ Yes _ No
?Xt'i:#'k.k?h+M'R;:k7;:Y:7K?':?.:'Y•'?.lF.'u;?Y(,?'?tY,<.;? ?'C?KK;?:?'u?W„?iF'iC?yt?,:
C.f.? Y CF F.AGAfd
CAf3N11rf;:, 5 i'GP:M£NFil_ Ni?: [;3
Lial'C1=:r. 09/17/96 TlMr: 13:53c:10
SD s
\AM.F..e fil._l_:CF:U F'.T.liE67T1E '.CNG
320 9001 4372 L..L`F, f''7F_ '-'F; 25„00
=:.".i':i 9001 4:372 L.iiX F''i'E: I''N 0.50
7rrr.a1 r:LCf?].pi'. PtlYiGu(t1:: 25.50
I'(i.f)W4:'r%'
UsrR .r.D. r,An,cv
+??h?f:k?k??Xk??7k?kktk?Y?X(?k .%?#4f?k8(W?k*RCyFJK?k?kxC?*?K1k?XYF?:% v?
-A
PERMIT
? CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMIT TYPE
Permit Number:
Date Issued:
X
BUILDING
028852
09/17/96
SITE ADDRESS:
4372 LEX POINTE PKWY
LOT: 21 BLOCK: 2
LEXTNGTON POINTE 3RD
P.I.N.: 10-45072-210-02
DESCRIPTION:
y (GA5 INSER7)
Building,Permit Type FIREPIACE
?3uilding GYo.r' k Type ALTERATION
Census Code - 434 ALT. RE5IDENTIAL
f'
. 4 .u 4 4J.za .,
?l
?"••t ? ?Jln:.+.
i "k t
;.?^,::..:x,r,.`,t?ig..;?4 ? l.-•. ..., i .. .?'L . rcT1 { '"
REMARKS:
FEE SUMMARY:
Base Fee $25.00
Surcharge $.50
Total Fee $25.50
?
CONTRACTOR: - Applicant - ST. l.rC.OWNER:
FIRESIDE CORNER ZNC 16331042 0001068 ROSSINS TIM
2700 N FAIRVIEW AVE 4372 LEXIN6TON PTE PKWY
ROSEVTLLE MN 55113 EAGAN MN 55123
(612) 633-1042 (612)687-0359 ?
?
I here6y acknowledge that Z have read this
information"is"corrict`ehd egrse'to camply
Statutes anq City of Eagan 4lydinanaes_
APPLICANT/PERMITEE SIGNATURE
applzcation and state that the
wiEh all applicable State of Mn.
!li.FJ-
S?D e : SIG ATURE -?
CITY OF EAGAN
iwi 3830 PILOT KNOB RD - 55122
1996 FIREPLACE PERMIT APPLICATION
681-4675
DATE: ? -2
? f ?.r5m?-r
DESCRIPTION OF WORK: ?C INSTAL y?( FIREPLACE:. _ WOOD BURNING
_ INSTALL GAS LOG ONLY IN EXISTING FIREPLACE
_ INSTALL GAS LINE ONLY IN EXISTING FIREPLACE
W"O
4 GAS
OTHER:
AREA TO BE INSTALLED IN: 12? 1Eoa$t-- keAv,zJ 2`I( ?'CVZ6I°c_.A c.6
STREET ADDRESS:
LOT V, BLOCK
437Z 1- s2r, I 1..».zo,J P??(
?
APPLICANT: (circle one only)
Name: 20 5--, t,U (-T6TUsr2.f Phone #: 7-b3 Slc?
U5T i1fl8T
SUBD./P.I.D. #:
OWNER
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 Gity of Eagan Ordinances.
PROPERTY
owNeR
FIREPLACE
INSTALLER
Signature:
5treet Address4.377, (-jE xlNCt7C5^J 777 lfi'<. Y
City: ? t?, ti4 N State: 1411 Zip :SY / Z-3
Company:
Sig
"o 6? 820 -07S8
a?qY4 Phone#:/-33-25-61
-w ,kte/'"'- /3
GAS LINE
INSTALLER
License #: / o 6 8
Ciry:00 anl-S 1/4 AJ t State: 10 PJ< zip• LO 3
Company: Phone #:
Name:
Street
City; I State: Zip:
CITY OF EAGAN
3830 PILOT KNOS ROAD
EAGAN, MN 55122
PHONE: (612) 454-8100
MOHANI
FOR CITY USE ONLY
PERMIT # ??Q
RECEIPT # ? / 3
, ?
DATE: ?9
&??'S??Nx?AL';' PLEASE COMPLETE OPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS &
?.,.....: . ..: . :: .: .. .
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
WORK DESCRIPTION
NEW CONST _
ADD ON
REPAIR x - f epla.ce.
OGINER NAME: 1 f 1 Yl
SITE ADDRESS: `"I??oL L.t?(1Cl?Ofl??1V?? Parvxvjol
IAT: 41 BLOCK ?i SUBD.? 6"?
INSTALLER: Cj/ I
ADDRESS:1„f3oIJ ?It)Y?PQ,r ?rG111
CITY:F?UV PrGldle. ZIP: 5?)3`L_?
PHONE #:
FEES
ADD-ON MINIMUM $15.00
HVAC 0-100 M BTU 24.00
ADDITIONAL 50 M BTU 6.00
GAS OUTLETS - MINIMUM 3.00
OF 1 PER PERMIT
SUBTOTAL: $ 15. Do
STATE SURCHARGE: .50
• SO
TOTAL : $ 15
/
SIGNATURE OF PERMITTEE
CQMMERGIAI.JINIIi?$7'32?AL;; PLEASE CUMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS,
.
APARTMENT BUILDINGS, AND MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE
NOT REQUIRED FOR EACH DWELLING UNIT.
-------------
CONTRACT PRICE:
OWNER NAME: _
SITE ADDRESS:
LOT: BIACK _ SUBD.
INSTALLER:
ADDRESS:
CITY: ZIP:
PHONE #:
FOR:
CITY OF EAGAN
FEES
18 OF CONTRACT FEE.
STATE SURCHARGE _ $.50 FOR
EACH $1,000 OF PERMIT FEE.
pROCESSED PIPING = $25.00
$25.00 MINIMIJM FEE.
CONTRACT PRICE x 1%
STATE SURCHARGE
TOTAL:
(SIGNATURE)
ïû
øö
ýüüûúùøùøöö
õûûüüúþ øæèåð
ííè
ãú
âí
í í
ýü
ÿþýü úæøúÿýü
÷úýüü
úüàÿùÛú
øÿøã åÿü
Þ
òÿúû
æñúüúüüúúæñúúóÿóñüúõáúæþúé
ü
ÿúúüþÿæüé
øúþóèúúúòÿúþõæóñóé
ûêãÜêëëé
ë
é
ë
ôõ
ÿúñú ÝÿêãÜêé
î
éíî
Ýÿã
é
óò
ñð
üü
úæèúú
é üñäðú
ëëãëñãâíè
õ
ûúðö
ðöíã
ïìã
ñúþõñ
ñçúñüüññæúóúúúóüõñüüþ
æð ÿøæåúé
üüá
úó ÿú
ÿ ÿú
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA116910
Date Issued:10/14/2013
Permit Category:ePermit
Site Address: 4372 Lex Pointe Pkwy
Lot:21 Block: 2 Addition: Lexington Pointe 3rd
PID:10-45072-02-210
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
Census Code:434 -
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 by law in ALL single family homes .
Gary Robideau
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 -
Stephen J Martin
4372 Lex Pointe Pkwy
Eagan MN 55123
Professional Exteriors Inc.
3158 Viking Blvd NE
Wyoming MN 55092
(763) 434-1500
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA138887
Date Issued:09/26/2016
Permit Category:ePermit
Site Address: 4372 Lex Pointe Pkwy
Lot:21 Block: 2 Addition: Lexington Pointe 3rd
PID:10-45072-02-210
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Stephen J Martin
4372 Lex Pointe Pkwy
Eagan MN 55123
(612) 709-5062
Champion Plumbing
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
Applicant/Permitee: Signature Issued By: Signature