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4801 Four Seasons Dr     öëö    îîù  ÿ þýý  üûîûü     úýý  ùüõ úýýþ ë ù   ë ñäñ   þýö  þýüûúùîý Ý ò  ûúùöø   ùîý Ý ò Þý       ù ô ïý ô  ëýü ã  ÿþ   ù ÿáäß  ý  ã  ôîáõùô ßæêê õú  þý ë îèæêäêä  ôïóï ö òñ ùù   âëõþ ü û  ñöìþîý þ   ý  ìãöññ ãö áäßà ë üúø ë ëì ë ùù ëëé ô   ôùúøëùùüþ éã þý òúé í  ê ùù÷  ôþ ý  ýúþ ý  BLDG. PERMIT NO. , - -? 01-3210 Bldg. Permit , ; I 01-3422 Plan Check - " 01-3445 Surch./Adm. 1 01-3446 SAC/Adm. ' ,, - 01-2155 Surcharge 75-3860 Road Unit 20-2275 SAC 20-3865 Water Conn. Y, 20-3868 Water Trmt 20-3716 Water Meter 20-2252 Acct. Dep. 20-3713 Water Permit ? 20-3743 Sewer Perrnit ? 79-3866 Sewer Conn. 28-3855 Paric Ded. TOTAL - --? ? CASH RECEIPT; ' • . CITY OF EAGAN 3830 PIL07 KNOB R4AD ERGAN, MIAlPlESOTA 55122 ? DATE RECEfVED T, J"_ FHOM ??. ?^?, ?? % L 44-?I ? .L•? _ ?t' %'- "i ,_? (? L \ _f I AMOUNT 8 DOLLARS ,ao p CASH p CHECK I _ ? ' • ? ° ? YVhRe--Payers Copy ?? Yellow-Posting Copy Pink-Fi{e Copy Thank You Bv ?- -? ?. SEWER & WATER PERMIT CITY OF EAGAN G? X ? 3830 Pilot Knob Rd. METER 0- Eagan, MN 55122-1897 CH?P ? - A DATE ?dS •!??- METER SIZE ISSUEDATE I SITE AODFiESS / v v r,JcQ 0?1 LOT -LLBLOCK ?SECISUB v, APPLICANT: ADDRESS: ' CITY, STATE ZIP PHONE: PLUMBER: `.4"e ADDRESS: ? CITY, STATE PHONE: ZIP `? OWNER: ADDRESS: CITY, STATE ZIP PHONE: OFFICE USE ONLY PERMIT DATE PERMIT # B.P. RECEIPT # - B.P. RECEIPT DATE , PRV - BOOSTER PUMP PERMIT REDUESTED !" SEWER --ZWATER - TAPS ? - COMM/IND _ RESiDENTIAL --L'-NEW _ EXISTING Lawn Sprinkler Meters are to be Installed Ahead of Domestic Meters on Water Line. Credit}NILt/NCyT be given for J7educt Meters. I AGREE TO COMPLYMIITH CITY OF EAGAN ORUINANCES SIGNATURE WHEN METER ISSUED PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. CALL 454-6220 FOR INSPECTIONS. FOR STORM SEWER PERMITS, CONTACT ENGINEERING DEPT. SEWER & WATER PERMIT CITY OF EAGAN 3830 Pilot Knob Rd. Eagan, MN 55122-1897 DATE ?y . ? . . ? ? . SITE ADDRESS %?7 =-+' • , i1x PERMIT REOUESTED LOT?BLOCK ? SECISUB " SEWER '- WATER APPLICANT: ADDRESS: CITY, STATE ' • ";,`?: : ZIP' PHONE: - , PLUMBER: ADDRESS: CITY, STATE ZIP -? ? PHONE: OWNER: _ ADDRESS:_ CITY, STATE PHONE: _ METER # CHIP # OFFlCE USE ONLY METER SIZE ISSUE DATE PERMIT DATE '1 12 3/$? PERMIT # 10818 B.P.FECEIPT? n 1n5? t0 ?ti B.P. RECEIPT DATE r - PRV - BOOSTER PUMP ZIP - COMM/IND NEW TAPS '' RESIDENTIAL I - EXISTING Lawn Sprinkler Meters are to be Installed Ahead of Domestic Meters on Water Line. Credit WILL NOT be given for Deduct Meters. : : z ??., : . _ I AGREE TO CaMPLY WITH CITY OF EAGAN ORDINANCES SIGNATURE WHEN METER ISSUED PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. CALL 4545220 FOR INSPECTIONS. FOR STORAA I SEWER PERMITS, CONTACT ENGINEERiNG DEPT. ? SEWER & WATER PERMIT CITY OF EAGAN 3830 Piiot Knob Rd. Eagan, MN 55122-1897 DATE y i . OFFICE USE ONLY METER #4'"-?S_03 217 PERMIT DATE 8/23 / 89 CHIP * d D S?p 7/ Yq PERMIT # 10818 METER SIZE 519 ?6 clff B.P. RECEIPT # -3059 ISSUE DATE ' 13 4 B.P. RECEIPT DATE ? 2 PRV _ BOOSTER PUMP SfTE ADORESS PERMIT REDUESTED LOT _?_BLOCK SEC/SUB - SEWER "WATER _ TAPS APPUCANT: ILLV _ ADORESS: ,zL•" t. ; ; << CITY, STATE PHONE: PLUMBER: ADORESS: CITY, STATE 7i.t ZiP PHONE: OWNER: - ADDRESS:_ CITY, STATE PHONE: _ ZIP - COMM/IND `RESIDENTIAL ?- NEW - EXISTING Lawn Sprinkler Meters are to be Installed Ahead of Domestic Meters on Water Line. Credit WILL NOT be given for Deduct Meters. ??/iJ?/ !: i"/???f.? I AGREE TO L'OMPLY WITH CITY OF EAGAN ORDINANCES SIGNATUR WHEN' ETEfi ISSUED PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. CALL 4545220 FOR INSPECTIONS. FOR STORM SEVYER PERMITS, CONTACT ENGINEERING DEPT. ,. ? . .. . ... . ; . . CITY OF EAGAN W24 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHONE: 454-8100 BUILOING PERMIT Receipt # C 3039 To be used tor Sp DWC/GAR Est. Value ;149,Wd oate .1Z11.7( ZO .19 89 Site Address 4ml YOUA 8zm Lot i Block Z Sec/Sub. Parcel No. W Name 0 Addre Phone ¢ Name SAME O :k? Address ? City Phone Name _ Address Phone I hereby acknowlege that I have read this application and state that the inlormation is correct and agree to compiy with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Permitee A euilding Permit is issued to: r S 3 C0MMUCTION on the express condition ihat all work shall be done in accordance wiih all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official 'Occupancy Zoning (ACtual) Const (Allowable) M ol5tories Length Deplh S.F. Total S.F. Footprinis On Site Sewage On Site Well MWCC System CAy Water PRV Required Booster Pump APPROVALS Planner Council Bldg. Olf. Variance OFFICE USE ONLY R-3 M-i it-1 FEFS BiZe00 74.50 ? 40b,00 ; 100.00 ; 575.00 ? s80r 0Q I 90.00 ; 3Q*00 ' 20.00 ; 1.00 . 228.00 ? 340.00 ; v ? Bldg. Permit V-N --" 1 28' xx xx Surcharge Plan Review SAC, City SAC, MCWCC Water Conn Water Meter Accl. Deposit S/VV Permit S/W Surchazge Treatment PI Road Unit Park Ded. Copies TOTAL 3, iJ ; Permit No. Permit Halder Date Telephone # WATER DO I O ?' ?? c? ? r SEWER PLUMBING ? • 243t( H.V.A.C. b `t )?, c ELECTRIC 4jj I Inspeclion Date Insp. Comments Foolings I - &, Foundation / freming f? Rooling Rough Plbg. ? - Rough Htg. ? Isul. t Ds - ?t Fireplace p L ,?, Final Htg. - 2 7 Final Plbg. - l? Const. Meter Plbg. Inspector - Notify Plumber Engr.IPlan Bldg. F,nal 91 ? Deck Ftg. Oedc Fnal Well Pr. DiSp. •. (Etrttfiratt uf (Orrupanry titp of (Eagan Dppnrtatml r# Iudbing JWrrtinn This Cerrificate issued pursuant to ihe requirements of Section 306 af the Uniform BuiJding Code certifying that at the tiine of issuance this structure was in compliance with the various ordinances of the City regulating building construcdon or use. For 1he jollowing.• use ua?rwrioo ??IGAR glds. ftrmit tro. I6824 o-vmxy T,pe R3/M i Z,,,i[ig nism R l Tya consL vtv Owner of Bw7ding FSB OJESIREZZM Address 120IS IWF7Yn4 AVI?., FIIENSSTi7F. AJdrm 4.80 I FY7l]R SFAqr't+tS i]R7VF tamLtyL l, uO_ wMcaESrnr_ r.mtc 4-nr ` o.a: SEPIBM 27. 1989 ' BuiYding Offid?- POST IN A CONSPICUOUS PLACE PLUMBIPlG PERMIT For Offioa Use Only . CITY OF EAGAN PERMIT# CONTRACT 3830 PILOT KNOB RQAD, EAGAN, MN 55122 RECEIPT# PRICE PHQNE 454-8100 DATE: Site Address v ' BLDG. TYPE WORK DESCR TION New Res Block Se /Sub Lot . • t, Muit. Add-on ` . Name Comm. Repair , ! } ? • 4y other [IS f'SVUrBgg , ? RES. PLBG. ONLY - COMPLETE THE FOLLOWING: c City Phone Xg' - NO. FIXTURES TOTAL W Cl t - $3 00 $ ? ater ose . ? .?_ ? ? Name Address -n' ' ; ' Bath Tubs - $3.00 ? Lavatory - $3.00 / y Cit Phone Shower -$3.OO z.. ?, , 4_ Kitchen Sink - $3.00 ,-v-?- UrinaVBidet - $3 00 . FEES Laundry Tray - $3.00 COMMJINO. FEE -1% OF CONTRACT FEE Floor Drains -$1.50 APT. BLDGS. - COMM. RATE APPLIES Water Heater -$1.50 TOWNHOUSE 8 CONDO - RES. RATE APLLIES Whiripool -$3.00 MINIMUM - RESIDENTIAL FEE $12.00 ? Gas Piping Outlets -$1.50 MINIMUM - COMM.IND./FEE $20.00 (MINIMUM -1 PER PERMIT) STATE SURCHARGE PER PERMIT .50 Softener -$5.00 (AOD $.50 SJC PER EACH $1,000, OF PERMIT FEE) Well -$ 10.00 Private Disp. - $10.00 ? / Rough Openings - $1.50 A/A SIGNATUR OF PERM PERMIT FEE: STATES S/C: • ? D FOR: CITY OF EAGAN GRAND TOTAL: .?[? PERMIT # // 7'" 7 L--' . MECHANICAL PERMIT REGEIPT # 9360,50 CITY OF EAGAN UG 3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE: CONTRACT PRICE: CJQU PHONE: 454-8100 Site Address 7-7 c- 1?' a.4 L TYPE WORK DESCRIPTIQN BLDG Lot ?_ Block -? Sec/Sub . ? r 4 3 .i ? Res. 11 New m Name Aj1i"A ? Mult Add-on m Address ? VD C omm. Repair c City ? Phone Other ? Name FEES c AddrE;ss ? RES. HVAC 0-100 M BTU -$24.00 p c ity W N-1 V 1 l L F Phone 69 ADDITIONAL 50 M BTU - 6.00 ADD-ON AIR COND. 0-24 BTU - 12.00 ADDITIONAL 6 M BTU - 6.00 TYPE OF WORK GAS OUTLETS - 1.50 EA. Forced Air ?L M BTU COMM/IND FEE - 1% OF CONTRACT FEE Boiler M BTU MINIMUM - RESIDENTIAL FEE - 10.00 Unit Heater M BTU MINIMUM - COMM/IND FEE - 20.00 Air Cond M BTU STATE SURCHARGE PER PERMiT - .50 . ' (ADD $.50 S/C IF PERMIT PRICE GOES Vent CFM BEYOND $1 000.00) Gas Piping Outiets # T Oth er FEE: S/C: SI ATURE OF PER , EE ? TOTAL• FOR: CITY OF EAGAN CITY OF EAGAN . 3830 Pilot Knob Road, P.O. Box 21-799, Eagan, MN 55721 PHONE: 454-8100 BUILDING PERMIT To be used tor SF DWG/GAR Value $149,000 Site Address 4801 FOUR SEASONS DR Lot 1 Block Z SeclSub.WHISPERI G WOODS Parcel No. TH I=. IName F S B CONSTRUCTION o Address 12006 TWELFTH AVE City BURNSVILLE Phone $90-2813 j Name 5AME gQ Address ? CityPhone Ww Name ? E,? Address a W City Phone I hereby acknowlege ihat I have read this apphcahon and state that the inlormation is correct and agree to comply with all applicable State o( Minnesota StaWtes and Ciry ol Eagan Ortlmances. Signalure of Permitee A Bwlding Permit is issued to: F S B CONSTRIICTTON on the express condition ihat all work shall be done in acwrdance wdh all applicable State of M./?innesota Statules anyd ?C,ny of Eagan Ordmances. Buildmg OHicial ,(1.( ,? ??1 Q?l. f II I,? ? Receipt # N° 16824 t9-8`L OFFICE USE ONLV Occupancy R-3 M-1 FEES Zoning R-1 (ACtuapConst V-N 81dg Permil 812.0? (Allowa6le) V-N Surcharge 74.50 # o( Stories 791 Plan Review 406.00 Length DeOlh -Ifl ' SAC, Cily ? 100.0 S.F.TOtal - SAC,MCWCC 575.00 S.F. Foolprints _ On Site Sewage _ Water Conn 0 580.0 On Ste Well - Wyt¢r Meter 90.00 Mwccsystem xx 30 00 City Waler X]{ Acct Deposit . PRV Reqwred - SfN Permit 20.00 Boosrer Pump - SNJ Surcharge 1•00 TreatmenlPl 228-00 APPpOVALS Road Unit 340.00 Planner - park Ded. Council BItlg.Off _ Copies Variance - TOTAL 3.256.50 p 4 8 3 6 3,? 1,,: t?oc?c?o /°`? AS& 0-0 Requeat Oa?e Fire No. ?Ji// ?S Rouglrm cGOn fl irv?. ? ReatlY ?w Will NoUty Inspedor Q ? Yes ? W Whan Reatly? I)6 licensed contractor ? owner hereby request inspection of above eleclrical work at: Jab Atltlress (Slre?et/, yBoz or Rou1e N , o ;j Crty ?.? 0 u/ ?[Aj Vf l ? Sectlon N. Township Neme w No. Range N. Counry occ+Parit (P H ^ J? Phone W. Pawer Supplier ?Y Atltlress ElMncal Conirec wnpany Name) Contractork License No. Mailmg ress (CO actor or Own ing Inateliffian Z //, ? a3 ..u-s ti & Aullprked Signel ntrncta OwnEr Mak g Ir?staAetron) ` GC? Phone Number 372f ?? ? ?.. r MINNESOTq STATE BOARO OF ELECTAICRV THIS INSPECTION REQUEST WILL NOT Grigg&Mitlwey Bltlg. - Room &173 BE ACCEPTED BV'fF1E STATE BOARD 1821 llniverairy Avo., St Poul, MN 55106 UNLESS PROPER INSPECTION FEE IS Ppone (612) 842-OBW ENCL0.SED 9114? P 48363 REQUEST FQA ELECTRICAL INSPECTION ? See inshuclions for wmpleting ihis brm on back of yellow copy. X" Below Work Covered by This Request E&00001-0] " 91;5?8`9 e Atldf Rep. -.. TypeoiBwlding AppliancesWiretl EquipmentWued Home Range Temporary Service Duplex Water Heater Electric Heating Apl Bulldmg Dryer Other (Specify) Comm./Industrial Furnace Farm Air Condrtioner Other(specy) ConVaclor5 RemaMS: -< Compute fnspection Fee Below: # Other Fee # ServiceEntranceSize Fee # Circwi5/Feeders Fee Swimming Pool 0 to 200 Amps 0 fo 100 Amps Transformers Above 200 _ Amps _ Amps Signs lnspeawsUSeOnly ? OTAL Irrigation Booms Special Inspection Alarm/CommunicaLOn Other Fee I, the Electncal Inspecior, hereby tif pouyn,n cer ythattheaboveinspectionhas been made. F,nai o ? ? OFFICE USE ONLY This request voitl 18 monihs from S/iv?8'9 ?'j.?S3 7 RequeslOate Fre No. ugh-inlnspech uiretl? ? Reafy Now?ll Nony Inspector R T H'h O o v? / en ea y ?s ? NO I licensed contractor ? owner ere y re est inspech n of above elec ' I work at: K Job r (Slreet x a Route No ) Qry ^ eclion lq.. Tovmship Name or No Range No CouMy OWIiPanl(PfllN Phone No. Power Suppiier r /? F G?Tdr A?ress ElecVical C. }(Company N Con(tactor§ Liceree No F7 Ma16nB Ai4,ass bedw or , akmg InstelleUOn) - N AuMonzetl Signature iractorlOwner Ma kirg Instellahon) Plpne Nu m b er i (.^?, ? / f f? / 3?J / Z( NINNESOTp STATE BOAFD OF ELECRiICRY THIS INSPECTION REOl1EST WILL NOT Griggs-Midway BWg. - qoom S1]3 BE ACCEPTEO BY 7HE STATE BOARD 1027 Univeniry Ava, SL Peul, MN 55109 UNLESS PROPER INSPECTION FEE IS Ptimia (812) 602-0BW ENCLOSEO. g'? Q/gg REQUEST FOR ELECTRICAL INSPECTION ? See insWCM1Ons Fgr comoletlqg this brm on beck oi yellow copy. V._ 49-.3 31 "X" Below Work Covered by This Request E&W Wt-D] ew Atld Rep. TypeofBUilding AppliancesWired EquipmenlWiretl Home Range Temporary Service Duplez Water Heater Electric Heanng Apt. Bwlding Dryer O[her (Specify) Comm.Mdustrial Furnace Fartn Air Conditioner Olher (epeuy) Conufldor5 Remarks: G mpute lnspection Fee Below: # Other Fee # ServiceEnhanceSize Fee # Circuits/Feeders Fee Swimming Pool 0 to 200 AmpS 0 to 100 Amps ? Transformers Above 200 _ Amps Above 100 Amps Signs Inspector§ U. Onry: 7p7p? ? Imgdlion Booms ? Special Inspection Alarm/Communicalion ? Other Fee zz? I, the Electrical Inspector, hereby tif th th RWgh,in ? 77M71?' ome cer y at e above inspection has 6een made. F„ai • oa?e ? f? ?" OFFICE IISE ONLY This reque5t voitl 18 monNS trom BUILDINGRESIDENTIAL ? PERMIT PPLICATION , CITY OF EAGAN 3830 PILOT KNOB RD, EAGAN MN 55122 651-681-4675 New Construction ReauiremeMs • 3 registertxl site surveys showirg sq. ft. of lot, sq. R of house; and all ruofed areas (20% mauimum lat coverege allowed) . 2 copics of plan shovrirg beam & wirdow saes; poured fourd design, etcJ • 7 sel of Energy Calalalions • 3 copies of Tree P2servatbn Plan rf lot platted after 711193 . Rim Joist Oefail Optlons selecJlon sheel (61dgs with 3 or less unils) DATE ?- SITE ADC TYPE OF APPLICANT STREET ADD ULTI-FAMILY BLDG _Y -#-' FIREPLACE(S) 2 1 - - '---, ,? ?r, <u,'f?p crnrF(1'1?, ??Prr33> TELEPHONE # CELL PHONE # PROPERTY OWNER ?XJV`t- i i4P ?? TELEPHONE #?? ----------------------------------------------------------------------------------------------- COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINNESOTA RiII.FS 7670 CA'PEGORY 1 (J submission type) • Residentlal Ventilation Category 1 Worksheet Submitted . Energy Envelope Calculations Submitted Plumbing Contractor: Plumbing system includes: Mechanical Contractor: Mechanical system includes: Sewer/Water Contractor: Air Conditioning _ Heat Recovery System ------------------------------------------------------------------------------- I hereby acknowledge that I have read this application, state that the infc with ali applicable State of Minnesota Statutes and City of Eagan O50KC Signature of Applicant Phone # Phone # OFFICE USE ONLY ree: $70.00 ---°----------------°°--------- is cor,ect, and agree to comply Certificates of Survey Received - Tree Preservation Plan Received _ Not Required _ RemodeUReoair Reouirements ? 15 - -15 . 2 cop"ies of plan • 7 set of Energy Calculatiom for heatad addiUons • 1 site survey for exterbr addilions & decks • Indicate if home served by sep6c system for addNOns -- VALUATIO ?-?t? 5Oq I _ Water SoRener Watcr Heater _ No. of Baths _ Phonc # Iawn Sprinkler No. of R.I. Baths Updated 4102 1988 BUILDING PERMIT APPLICATION - CITY OF EAGAN I to I It ? SINGLE FAMILY DWELLINGS INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS NOTEs ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED. MULTZPLE DWELLINGS AENTAL IINITS FOR SALE UNITS # OF UNITS INCLUDE 2 SETS OF PLAHS, CERTIFICATE OF SURVEY - CHECK WITH BLDG. DEPT.t 1 SET OF ENERGY CALCULATIONS COMMERCIAL INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS - - ,1UL 13 1989 To Be Used For: Valuation: ?? Date: y Site Address r OFFICE Q31 lY9,oco- Lot L Block ? Occupaney R-3 M-1 Zoning R-t Parcel/Sub Actual Const ? Allowable Owner 0 of stories Length Address DePth 2R' -' S.F. Total City/Zip Code Footprint S.F. Phone 9?lv'2!Ri 3 On site sewage On site well Contractor MWCC System ? City water Address PRV required _ Booster Pump ? City/Zip Code _ 2 le? 9O APP80YALS Phone ' Si 3 Planner Council Arch./Engr. Bldg. Off. 'X;C-?71(-1 Variance Address City/Zip Code Phone IF FEES Bldg. Permit 1912,0o Sureharge 7tj_? Plan Review y ov SAC, City /ov, 00 SAC, MWCC S S'?oo Water Conn 5?50, po Water Meter po Aect. Deposit 3D,00 S/4] Permit o'tp,oo S/W Sureharge I•oa Treatment P1 . L .oO Road Unit 340,00 Park Ded. Copies SOBTOTAL Penalty TOT9L ? 0 v??uA-r?oN Ga,R.qC? `? • ? ? ? ? ? L K 2 2: ?104 ?t 15 =! d5(:5>0 asm-r ? G x 3G -I Y? I i v 2'/!. zs! auss= sro 1- j ub6 j y? ;?y P? 73smr ?y I ?X9 1ob6 ly 18 I?I .l I283 ?-5°= C?#iSn Z N iJ VL 22/Z eZto /? •?b = cl a `E l Ioo xiv 7 ? ? . ? hl 99° 53l 42" W isi, ts NM ? 0 Q? oa 2 ' ---- 5 ----?- -- ZB.o Ee 987•° - , a?.. 985.3 02 z o Q ? o ? w w a n ?, I a ? o ? I d \? - --- ° ; A I Q J I 9 ? 4? ? ; - 5? tx 989,o - zz.o ?- -- ? 9a"? ??.5.97 ?,ti 9g'?? l tJ 89`?So 03°? , eK 985.1 ??u 9853 ? o ? -31 4 a ? , ti ?ro ? &y ? Dat3 ???Aiq 1 I. I ? I 3 9$1 9 ? y qT ? . ;? ,.??. . . _ .. ? ?.?.? . t!1 M u e N Q . o " ?41 ?i Q DEPT DEScR.iPTior.) LO'T 1 ? BLOGIL 'Z? w;AisPEet?a4 wooos FoCJ{Z,'(L-R ADDITION, D A 1L0'f ? GO Vl.?TZ'J r?.?NN??-ra 2 hereby certify that this survey was prepared by me or under my direct supervision and that I am a duly kegistered Land Surveyor under the laws of the State•of Minnesota. Date: J ??,? •??st/ ?C ? ??-?--? LeRoy H. ohlen Registered Land Surveyor No. 10795 • ? ; ?; ? ?,z,:. FSB CONSTFlUCTIOIJ, INC. 617 CHICAGO DRIVE gUFiNSVIILE, MN 55337 (612) 435•5314 EXTERIOR ENVELOPE AVERAGE "U" COMPUTATION Plan U Date OWIl¢L: Contractot: Site Address: 1. TOTAL EXPOSED WALL AREA sq.ft. x"U" ,_ _ ?702. "• / 2. TOTAL EXPOSED ROOF/CEILING sq.ft. x"U" ,f]7G AREA WALL AREA CALCULATIONS: Total Window Area dv,6t6 Glazed Total Door Area Total Glass Door Area drB<6 Glazed Total Fireplace Wall Area Total Wall Framing Area Net Insulated Wall Area Total Rim Joiat Area Total Foundation Area (Exposed) Total Foundation Window Area If item 3 is the same as, or less than item 1, you have met the incent of 2 MCAR 1.16008 A and 0. 4. ROOF/CEILING CALULATIONS Total Skylight Area Total Roof/Ceiling Framing Area Net Insulated Roof Ceil- ing Area a,o sQ.ft. X .,U„ .0! 86,/ 0 JT? sq.ft. % "U" ?S9 r 4,4 , 9Q.ft. X " U?? 411 = r,? C)o sq.ft. x "u" sq.ft. x .2 •???' sq.ft. x 23R sq.ft. x aq.ft. x sq.ft. x "U" sq.ft. x ?- sq.ft. x "U° .36 = /s. 6 ?? •?/. %1c; a6 ? ?-a. 3. TOTAL ? J12li?_--z sq.ft. x I hereby certify that the building here described State of Minnesata Energy Conservation Act. , °. .. _._--_.--_- ?,7?'r'.f, r, ' CONSTRUCTION FRAMING SECTION I interiAir film .068_ ? y1 s2 .0?1 ; S>, f sof* wood /.A7 , ? r.Exterlor air film .017 TOTAL R //. D ? ' U - I/R . U ECTION (INSULATED) Inter?oi aii film •?¢$ 1 /f S. /f • 4/ ?5' ? /? ' Gvt 7G '?. ?ru. S ri0^'L.. '?? BExterior air film .017 TOTAL R 2 -?, / U=I/R ,U°/ RIM JOIST SECTION , , ,_. I Interior air film .068 2 S 5/6 /J.r rr s -- ? / 9? 0 .43 ?---1 S s, o• .- ° ?/ ,----{f•,_-t _1,... air iim .017 • TOTAL R • U = I/R , pq FOUNDATION SECTION j . I t s _„ 3 /2 L /S G'? •? / 4_V ???, • AFx. _i,, va.- Ftim .017 . • ?• ?•• (?- , . TOTAL R (o. / .• ' ? • ? _ . ORADE . U ° I/R . ? " A ? . , i. , s. CONSTROCTION r CEILING SECTION (INSULATED) (1 Interior air film .61 (2 -/? , 56 (3 i3ta..._ ?..? . G/D.O (4 Exterior_ air--film .61 TOTAL R ?i'/ . 7(3 U = I/R .OZ 4 r? CEILING FRAMING SECTION 0 Inte io air film .61 (2 T d ?:i2. 5C (3 ?LNr? i.vl. ?3 U (4 Interior air film .61 (5 s,-- • ? 3•5 TOTAL R U = I/R ,p26 CEILING SECTION (INSULATED) 0 Interior air film .61 (2 (3 (!{ E r i i film (atilll fil TOTAL R U=I/R VENTED CEILING FRAMING SECTION G Interiar air film .61 (2 / " 37r - ?,?•-? 4Ck) (3 (4 Interior air film .61 (5 c e v oo // `'? TOT}?L R ;?If3 /4 U = I/R • 0 2-d EXPOSED BEAM CEILING SECTION (1 Interior air film .61 (Z (3 (4 <5 Exterior air film •17 TOTAL R U ° I/R LOT L BLOCK ?, SUBD. RECEIPT #375 DATE I`I QS 1995 CITY OF EAGAN IRRIGATION PERMIT (FOR BACKFLOW PREVENTER) COMMERCIAL INSTALLATIONS: FORM MUST BE COMPLETED BY LICEPISED PLUMBER Date: -i2? Area/address to be irrigated: Installer: Street ad City, Owner Street - L/(ilv Commercial GPM Residential (boulevards) GPM JL,,? Existing residential /.i C,CJ _ Owner ? Plumber ? City, state & zip code: Phone ?qS /??1 Irrigation contractor, if different than installer: 7elephone #:? I hereby acknowledge that I have read this application, state thatthe information is correct, and agree to comply with all applicable City of Eagan ordinances. It is the applicant's responsibility to notify the property owner that the City of Eagan assumes no lia6ility for any damapes caused by the City during its normat operational and maintenance activities to the facilities constructed under this permit within City property/right-of-way/easement. ApplicanYs signature Approved by: Date: PRV ? Yes ? No New service ? Yes ? No Meter Size & Cost ? Fees due: O?d Calculated y: iLk/hs 72O-ty Pl/S Title J state & zip code: ff/,?23 Phone #: ?(0 7-75?'? PROCEDURE FOR IRRIGATION SYSTEMS - 1995 An imgation permit is required - please contact Protective Inspections at 681-4675. Fees Commercial project: $25.50 irrigation permit to cover installation of backflow preventer. $50.50 water permit fee oniv it new service is instal{ed. $300.00 per tap if installed by City. Residential project: $20.50 irrigation permit to cover installation of backflow preventer. $50.50 water permit fee if new service is installed. $750.00 per connection - WAC. $372.00 DGi COiiflBction - w?Jt^cr traatment facilitj/. Existing residence: $20.50 irrigation permit to cover installation of backflow preventer -(not required if backflow preventer previously installed). Meter charge: If gallons per minute are less than 25, a 1" meter will be required at a cost of $170.00. If gallons per minute are more than 25, a 2" turbo with strainer wiil be required at a cost of $800.00. This information is to be supplied by the designer of the system. No meterwill be sold before all sewer and water inspections are complete on a new service. If new service lines are not reauired, one check may be written for meter and permit costs. Receipt will be coded to 20-3716 (meter portion only) with pink copy forwarded to Utility Billing Clerk. The +nstaller is to contact Protective Inspections at 681-4675 for inspection of the inside water.line ana backflow preventer. The Public Works Department may be reached at 681-4300 for water turn-on and set and seal of the meter. Inspection hours are 8:30 a.m. to 3:30 p.m. Monday through Friday. Requests for n.M. inSpections shouid be mad2 0l-I tho a'L'CCd;T^y WCi'k daf. !R°^yLi°Sts fer PM i^spectiens u+ill be acc=r±ed until 12:00 noon. 2000 BUILDING PERMIT APPLICATION (RESIDENTIAL) GTY OF EAGAN 3830 PILOT KNOB RD • 55722 851-881-4675 Remodel/Reoalr ReaWremenh ? S reylstered IN6 wrv9yS EffOwlny fq. f6 of 10}, tq. H. of hW9B ontl go rooletl areas (20% rtw)dmum lot covemae aNowadf > 2 copies d plans (stww Deam # wlndow slzes; poured Ind. dasign: etc.) > 1 set o/ enerpy cokulatlona > J coWea ol hae pre rvaHon plan H IW pkAted aRer 7/1/93 DATE: ?? DESCRIPTION Of WORK: STREETADDRESS: `fl7U( tev?' o?50Vl5 LOT: ? BLOCK: -?L- SUBD./P.I.D. #: 06y- Name:.l:?w?`Puvo? Jc?c? r+hone ?: 65 I`C?qJc - I?J T? PROPERTY tast Flrat OWNER Sheet Address: 7 0) I tbv? ?el% SOh 5 city EAC u srore: M?U zip: \Ij . cornpanr. lo?ne?x?. V?. 78 - jf Z 7? (area code) CONTRACTOR Skee,Addrom N Lleerise #zviz s Exp. ?ity - 1-uI??4?C.kk Sbte: MrV zip: .5 5 q32- ARCHfiECT/ ENGINEER Company: Name: ielephone #: ( ) Shee1 Address: Regishatlon JI: City 3- 13-c?c1 2 copies Of plan t ser a energy crncWanons ror necrea auwnona i are euryey ror ewenor aaaUnons a decks CONSTRUCTION COST: ?3155 0 State: Sewer/water licensed plumber ('rf lrtstallirkg sawerlwaterl: Phone #: Zip: 1 hereby acknowledpe Mwf I have read this applkaNon, state fhal the infortrwlio is cortect. and agree b complY with aU apPICabie 51afE of MlnnesoM Sfafutea and CiFy of Eagan Ordinances. Sigrwhire of AppliconY. OFFICE USE ONLY Certificates of Survey Received ` Yes ? No 3 Tree Preservation Pian Received _ Yes ^ No ? Not Required ? BUILDING PERMIT SUBTYPES ? 01 Foundation ? 07 05-plex ? 02 SF Dwelling O 08 06-plex ? 03 01 of _ plex ? 09 07-piex ? 04 02-plex ? 10 08-plex ? os 03-pieX ? 11 1 aplex ? 06 04-plex ? 12 12-plex WORK TYPE ? 31 New ? 32 Addition ? 33 Alteration ? 34 Repair OFFICE USE ONLY ? 13 16-plex ? 21 Porch (3-sea.) ? 77 Garage ? 22 Poreh/Addn. (4-sea.) ? 18 Deck ? 23 Poroh (screened) ? 19 Lower Level ? 24 Storrn Qamage Plbg _Y or_ N? 25 Miscellaneous ? 20 Pool [3 30 Accessory Bldg. ? 36 Move Bidg. ? 43 Reroof ? 37 Demolish (Bidg)" ? 44 Siding ? 38 Demolish (interior) ? 45 Fire Repair ? 42 Demoiish (Foundation) ? 46 Windows/Doors ' Give PCA handout to applicant for demolition permit GENERAL INFORMATION SAC Code No. of Units No. of Buildings Const. (Actual) (Allowable) UBC Occupancy Zoning # of Stories Length W idth Basement sq. ft. Main level sq. ft. sq.ft. sq.ft. MISCELLANEOUS INSPECTIONS ? Stucco/Stone APPROVALS Planning Building Permit Fee Surcharge Plan Review License MC/ES SAC Ciry SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment PI. Park Ded. Trails Ded. Other Copies Total: ?) H 4. ?S Valuation: sq.ft. sq.ft. Footprint sq. ft. Census Code MC/ES System City Water Booster Pump PRV Fire Sprinklered Engineering Variance O 31 Ext Alt - Multi ? 33 Ext. Aft - SF ? 36 Multi SAC UR1fS % SAC P95RESIDENTIAL BUII.DING PERNIIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 TelepLone # 651-675-5675 FAX # 651-675-5694 New ConsWCtion ReauiremenLS RemodeVFteoair Reauirements Off?ce Use OnN 3 registered site surveys showing sq. R. of lot, sq. ft. of Irouse; and all roofed areas 2 wpies ot plan CeR of Survey Recd _ Y_ N (20% maximum lot coverage allowed) 15etofEneqyCakulatbnsforhealedadditions TreePresPlanRecd _Y _N. 2 copies af plan shmving beam & window sizes; poured Pound deslgn, elc. 1 site survey for addttlons & decks Tree Pres Requtred _ Y_ N isetofEnergyCalculations Addition-indkateHon-Oeseptksystem On•siteSepticSystem _Y _N 3 copies of Tree Preservalron Plan'rf lot platted after 711193 Rim Joist Detail Opdons seledion sheet (buildings witli 3 or less units) Date o Construction Cost G? SiteAddress ?{$G / FOZ11?c1.?Q.d 07za-% 74t--/ Y, Unit/Ste # Description of Wark -thJ64r3jUl DO?1 p/]') /. t }f an Os'2.0 L.Y? I l'4d2 Oy_}J 0-A ri Multi-Family Bldg _ Y _ N Fireplace(s) _ 0_ 1 _ 2 Property Owner\_? ' Telephone #(6 72 9 Contractor _r\JrOl,L?/'?{ Address o?j7 ([ii 4/1/1.! ll City State MA) Zip ?U Telep6one # . 28 COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minnesota Rules 7670 Cateeorv 1 _ Minnesota Rules 7672 Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet (Jsubmissiontype) Submitted Submifled . Energy Envelope Calculations Submitled -9 --?-o °-° Have you previously constructed a building in Eagan with a similar pian? _ Y _ N If so, 25% plan review fee applies. Licensed Plumber Telephone #( Mechanical Contractor Sewer/Water Contractor Telephone # ( Telephone #( I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN Statutes; I understand this is not a permit, but only an applicarion 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. s i?jn d 5 CG UH._P,1A . Applicant's Printed Name •?C?j Applicant's Signature 411° City of Badu 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: Use BLUE or BLACK Ink For Office Use' S '" (� Permit #: 4! Permit Fee: d -).r Date Received: t / 'y I 651) 675-5694 4C1 CaNd 943 20016 RESIDENTIAL Biturz. UILDING PERMIT APPLICATION l'i,ac Date: -16. Site Address: % v / �(1vJS �J l Unit #: Staff: Resident! Owner Name: U.'^ f SI -Lt -l-& SO(L'=,h-erj Phone: 7S 1- 8`9 S-/77/ Address / City / Zip: L / to'Fouvc. S\' ) t A -/`1) fA/ Applicant is: Owner Contractor Type of VN©k -BO Description of work: JO � O 1\.Q 1-) 3 tik t ✓\ Construction Cost: � OQO Multi -Family Building: (Yes / No J�) fir ctor Company: i---0 /3 (ckS, , Contact: VA -A0 kSat-, Address: Lf 11 OM V -t E 1 City: D ST- PAA D. _ .' 1 State: IM!'j Zip: 5`"�,-S Phone: 6/-VO'/7i/ Email: n 0IA) ` c_i_ 30 \AI ( License #: ge ' 31-1 Lead Certi . e #: W t440.---1 -----.."--,.. If the project is exempt from lead certification, please explain w 4 : '" ' ( .j a - t [7 -3 Q3 \ In the last 12 months, Yes No COMPLETE THIS AREA ONLY IF CONSTRU - - • -DING— has the City of Eagan issued a permit for a similar plan based on a master plan? If yes, date and address of master plan: Licensed Plumber: Mechanical Contractor: Sewer & Water Contractor: Fire Suppression Contractor: Phone: Phone: Phone: Phone: NOTE: ns ansupporting documents hat you submit are onsi considered t`o ie public information Portions of the informalion may be classified as bion -public if you 4 specific r s tris that would permit t! to con ude that theyre r c e secret. 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.qopherstateonecall.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 an . Exterior work authorized by a building permit issued in accordance with the Minnesota ate Buildin€o• - t b completed within 180 days of permit issuance. x �►4 v1 CJ):SU.AJ Applicant's Printed Name x Applicant's Signature Page 1 of 3 SUB TYPES Foundation Single Family Multi 01 of _ Plex DO NOT WRITE BELOW THIS LINE Fireplace Garage D k Lower Level WORK TYPES New _ Interior Improvement Addition Move Building 4 Alteration Fire Repair Replace _ Repair Retaining Wall DESCRIPTION Valuation Plan Review (25%_ 100% Census Code # of Units # of Buildings Type of Construction �Y9Y Porch (3 -Season) Porch (4 -Season) Porch (Screen/Gazebo/Pergola) Pool Siding Reroof Windows Egress Window Exterior Alteration (Single Family) Exterior Alteration (Multi) Miscellaneous Accessory Building Demolish Building* Demolish Interior Demolish Foundation Water Damage *Demolition of entire building — give PCA handout to applicant Occupancy Code Edition 260/` Zoning jt -� Stories Square Feet Length Width REQUIRED INSPECTIONS Footings (New Building) Footings (Deck) Footings (Addition) Foundation Roof: Ice &)Nater Final 71" Framing 30 Minutes 1 Hour Fireplace: _Rough In _Air Test Final Insulation Sheathing Sheetrock Fire Walls Braced Walls Shower Pan Reviewed By: RESIDENTIAL FEE Base Fee Surcharge Plan Review MCES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Copies TOTAL i3 7f r MCES System SAC Units City Water Booster Pump PRV Fire Suppression Required Meter Size: Final / C.O. Required Final / No C.O. Required HVAC Gas Service Test Gas Line Air Test Pool: _Footings _Air/Gas Tests _Final Drain Tile Siding: Stucco Lath _Stone Lath _Brick Windows Retaining Wall: Footings Backfill _ Final Radon Control Fire Suppression: _Rough In _Final Erosion Control Other: , Building Inspector 06/11 A011 5020 Page 2 of 3 Sep 28 16 02:20p Paul's Plumbing & Heating 41,!bf City of Eakan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 6 507-645-7109 p.1 Use BLUE or BLACK In For Office Use �/ Permit #: 379K( Permit Fee: (,o.00 Date Received: L Staff: 5-a 8-4 ( �/, 2016 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: f ',Ti 1 La Site Address: (F S7 Tenant: Resident/Owner Contractor i Suite #: J Name: Phone: 6%/a - �. r�9,5d ' Address / City 1Zip: /48-01 traf- Name: rsktc4 S AtSC.(t16W G�! Nnitir✓li ense #: P1'k(i'5Com:( AA" ' t State: �� Zip: JG�/ Phone:SC‘S —75 Contact: (�I. Email: `S�i o iCx.c1`'9!i%f?i✓ld i0)C 7C PCZ '1/„ l� Address: ''1'J() : X J Type of Work Permit Type I RESIDENTIAL FEES: $60.00 Water Heater, Water Softener, or Water Heater and Softener (indudes State Surcharge) $60,00 Lawn irrigation (includes State Surcharge) $60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes State Surcharge) *Water Turnaround (add $280.00 if a 3/4" meter is required) $115.00 Septic System New (includes County fee and State Surcharge) New Replacement Description of work: RESIDENTIAL z Repair Rebuild Modify Space 12c medd Work in R.O.W. 1 Water Heater Lawn Irrigation ( RPZ / _ PVB) Septic System New Abandonment Water Softener Add Plumbing Fixtures (5 Main / Lower Level) Water Turnaround TOTAL FEES $ CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underaround utility damanP Use BLUE or BLACK Ink RECEIVEDFor Office Use L! 4* City Eaaall /of DEL 1 9 2016 a Permit Fee: 4 o 3830 Pilot Knob Road c� Eagan MN 55122 Date Received: /'Z Phone: (651)675-5675 staff: Fax: (651)675-5694 2016 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: 12/14/2016site Address: 4801 Four Seasons Drive Tenant: Suite#: Resident/Owner Name: John Sorteberg Phone: 651-895-1779 Address/Ci /Zi.: 4801 Four Seasons Drive, Eagan MN 55122 Name: Metro Heating & Cooling License#: PM058051 Contractor Address: 255 Roselawn Avenue East#41 city. Maplewood State: MN Zip: 55117 Phone: 651-294-7798 Contact: Micah Email: micah@metroheating.com Type of Work New L.Replacement Repair Rebuild —Modify Space Work in R.O.W. Descri.tion of work: RESIDENTIALreplace existing water heater . � ..... . .... ..... / Y Water Heater Water Softener Permit Type Lawn Irrigation( RPZ/ PVB) Septic System Add Plumbing Fixtures(+Main/_Lower Level) New Water Turnaround Abandonment RESIDENTIAL FEES: $60.00 Water Heater,Water Softener, or Water Heater and Softener(includes State Surcharge) $60.00 Lawn Irrigation(includes State Surcharge) $60.00 Add Plumbing Fixtures, Septic System Abandonment,Water Turnaround*(includes State Surcharge) *Water Turnaround(add$280.00 if a 3/4"meter is required) $115.00 Septic System New(includes County fee and State Surcharge) TOTAL FEES$60.00 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.00pherstateonecall.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 Micah Vail Applicant's Printed Name Applicant's Signature FOR OFFICE USE Reviewed By: Date: Required Inspections: Under Ground Rough-In Air Test Gas Test Final Meter Related Items: Meter Size Radio Read Manometer Staff: PERMIT City of Eagan Permit Type:Building Permit Number:EA146085 Date Issued:10/09/2017 Permit Category:ePermit Site Address: 4801 Four Seasons Dr Lot:001 Block: 002 Addition: Whispering Woods 4th PID:10-83953-02-010 Use: Description: Sub Type:Windows/Doors Work Type:Replace Description:Two or More Windows/Doors Census Code:434 - Residential Additions, Alterations 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: 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 - John Tstes R Sorteberg 4801 Four Seasons Dr Eagan MN 55122 Renewal Andersen 1920 County Road C West Roseville MN 55113 (651) 264-4777 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA160222 Date Issued:02/24/2020 Permit Category:ePermit Site Address: 4801 Four Seasons Dr Lot:001 Block: 002 Addition: Whispering Woods 4th PID:10-83953-02-010 Use: Description: Sub Type:Residential Work Type:Replace Description:Water Softener 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. Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener). 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 - John Tstes R Sorteberg 4801 Four Seasons Dr Eagan MN 55122 Peterson Salt & Water Treatment Company 1415 5th St S, Suite E Hopkins MN 55343 (952) 929-0422 Applicant/Permitee: Signature Issued By: Signature