995 Kettle Creek Rd. . ...,,:r,T .,,, ..nca.?.:::?atE+rt+ •s;:,M•e?x!?-;:?.?.r-v+v?l?l!!?4:;:.trA++n -."'^'?
CASH RECEIPT
CITY OF EAGAN
3830 PILOT KNOB ROAD
? EAGAN, MINNESOTA 55122
DATE
necerveo
F?
AMOUNT
?{? CJ
?.
FUND
?
? n
4-0
x ii
? CASH
? t
?-
Thank You
,-_
ev `G-r L
.. . . ? r. ¢' .-? . White-Payars CoPY
.. ? a ?. . , . Vellow-POStingCopY
Pink-FileCOpy ,?5'
.._-.,- .
•. ;::;? JrttL F"Ic. ?aPoRC,vEs cR?;?}f OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHON E: 454-8100
BUILDING PERMIT Receipt#
To be used for ocF flW(;/GAR Est. Value $77 9000 Date MARCH 25
Site Address _
Lot ` 2 Block
Parcel No.
a Name "'?TW MSt?O!{ R(M9
= Addres6 P.O. BUX 1049
? City WRNSVI[.LE Phone 454-4383
oName 4 SAtuR
? Q Address
?ff City Phone
?Q
? W
Name
? W
_ ? Address
Q W CiW Phone
I heieby acknowledge that I have read this application and state ihat the
information is correct and agree to comply with all aPPlicable State of
MLnnesOta Statutes and City of Eagan Ordinances.
Signature ot Permittee A Buildimg Permit is issued to: I'[ETRO ClT$TOA"i ?l01`1ES
on the express condition that all work shali 6e done in accordance with all
applicabie Stale of M/?i?n?nesota Statutes and City of Eagan Ordinances.
BuildingOfficial .CIuLC4
???ZIl
19
3 Sec/Sub.LEXINMp
OFFICE USE ONLY
On Site Sewege OccupanCy R-3
MWCCSystem x Zoning pOIR""1
On Site Well (Actuaq Const vn
City Water x (Allowable) vn
PRV Required # of Stories
BoosterPump _ Length . Sg,
Depth 381
S.F. Total
Footprint S.F.
APPROVALS
Engr./Assess.
Planner
Council
BIdg.Off.
Variance FEES
Permit
Surcharge
Plan Review
SAC,City
SAC, MWCC
WaterConn.
462.00
36•00
231.00
100•00
550•00
550400
WaterMeter 57•00
Road Unit 3ZS+00
Treatment P1 _204-M
Parks
TOTAL
2, `i^.i.flt?
BLDG. PERMIT N0. rI?
01-3210 Bldg. Permit OU
01-3422 Plan Check C) O
01-3445 Surch./Adm. I
01-3446 SAC/Adm. ' C)
01-2155 Surcharge
Ij 3860 Road Unit Gu
20-2275 SAC . 1744
20-3865 Water Conn.
20-3868 Water Trmt.
20-3716 Water Meter
20-2252 Acct. Dep.
20-3713 Water Permit
20-3743 Sewer Permit
79-3866 Sewer Conn. !Li c:;
4 ?3855 Park Ded.
TOTAL :-:? ,
..?.... - .,.-. . . ....A.? . _ ...: ^,.^"'?+'?*!'++f?+?+.ra?-++.'T a•aw-?
CASH RECEIPT
~ CITY OF EAGAN '
3830 PILOT, KNOB AOAD
EAGAN, MINNESOTA 55122
DATE 19? .
MMIVEO , i •
lAL?/i?-
AMOUNT $
8 DOLLARS
im
? CASH q CHECK
AMOUNT
e
Thank You
BY
-. _ ?'- .. .. ..,w Wbite--Payers CoPY
'j. Vellov-POSfirg Copy
. . . . Pink-File CoPY
PERMIT q
` PLUMBING PERMIT RECEIPT fi
CITY OF EAGAN X3830 PILOT KNOB HOAD, EAGAN, MN 55122 QATE: - ' ?-
CONTRACT PRICE: PHONE: 454-8100
Site Address ` ?? j`
'
LotBlock
ec/Sub
? Name
m Address
c City _ Phone ?
Name
c Address 0,.1, . +'
0 Cih, . , r :. -. Phone'"
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
APT. BLDGS - COMM RATE APPLIES
TOWNHOUSE & CONDO - RES. RATE APPLIES
MINIMUM - RESIDENTIAL FEE - $12.00
MINIMUM - COMM/IND FEE - $20.00
STATE SURCHARGE PER PERMIT - 50
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000.00) ,
.? ?
SIGNATURE OF PEFiMITTEE
FOR: CITY OF EAGAN
BLDG. TYPE WORK DESCRIPTION
Res. ? New
Mult. Add-on
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES TOTAL
_Water Closet - $3.00 $
_Bath Tubs - $3.00
_Lavatory - $3.00
-Shower - $3,00
_Kitchen Sink - $3.00
_Urinal/Bidet - $3.00
_Laundry Tray - $3.00
_Floor Drains - $1.50
-Water Heater - $1.50
Whirlpool - $3.00
_Gas Piping Outlets - $1.50
(MINIMUM - 1 PER PERMIn
_Softener - $5.00 '
-Well - $10.00
_Private Disp. - $10.00
_Rough Openings - $1.50
FEE:
STATE S/C:
GRAND TOTAL:
BUILDING PERMIT
To be useif for
- D r5 ? (rw.? ?S • s /a ??a sr
t7?88ClTY OF EAGAN
b oad, P.O. Box 21-199, Eagan, MN 55121 I
PH O N E: 454-8100 I
Receipt # i
Est. Value • • Date
Lot Block Sec/Sub.`
Parcel No.
OFFICE USE ONLY
On Site Sewage Occupancy
,
MWCC System ' On Site Well
Y
1.•. -;;'lj,sr.'. CityWater _
a Name
W PRV Required
= Address
; . 8ooster Pump
o r.iw "' `? ? cti,,.,o ? _ .
¢ Name ti.<r
0
?` Address
p- City Phone
Name_
Address
City_
Phane
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.
Signature of Permittee --_-
A Building Permit is issued to:
on [he express condition that all work shall be done in accordancewith all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
BuildingOtticial______ .
APPROVALS
Engr./Assess.
Planner
Council
Bldg. Off.
Variance
Zoning
(Actuaq Const
(Allowable)
# of Storiea
Length
Depth
S.F. Total
Footprint S.F.
FEES
Permit
Surcharge
Plan Review
sac, atv
SAC, MWCC
Water Conn.
Water Meter
Road Unit
Treatment P1
Parks
TOTAL
8-3
PI?
s
VYe
VP
e
462*OQ
?
I F?t .
>? r
_ Permit No. Permlt Holdar Date Telaphone #
Ptumbin9 ?" 7?'
H.V.ItC.
eiectric
Softener
Inspection Date Inap. Comments
Footingst ?,
Footings II
Foundation
Framing 41
Roofing
Rough Plbg.
Rough Htg.
Isul.
Fireplace
Final Htg. 5=2
6
Final Plbg. Z,f
Bldg. Final
?
Cert. Oca W;'
Temp. LP
Deck Ftg.
Deck Final
Well
Pr. Dlsp.
9' • .•
(Itr#ifiratt of (IDrrupttnry
Citp of (tagan
Ep}1tlY'bllFttt of gltdbiM JWPI'tlQlt
This Certificate issued pursuant to rhe requiremenu of Secfion 306 ojthe Unijorm Building
Code certifying that at the time ojissuance this sducture was in compliance with the various
ordinances of the City regulating building rnnstruction or use. For the fallowing.•
Ihe Cleanifinuon '•'?.rid"`?lt Bldg. Pormit No.
oocuaay rya R? zon;nq asu;u rya caM
Ownef of Building Addnns . . , 1 • ,? . ` . ' . "
<<' g2 a
Buildiog Addrese Layfity
Date: {,r .
8uilding OffiviJ
POST IN A CONSPICUOUS PLACE
. ?:
CONTRACT PRICE:
Site Ad?re
;s
'
Lot? 1 Bpck Sec/Sub
m Name 1.
'
'
m ?+r. - j ?%!A!
Address ? (
•
c Ciry Phone
? Name
3 Address
p City Phone
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
APT. BLDGS - COMM RATE APPLIES
TOWNHOUSE & CONDO - RES. RATE APPLIES
MINIMUM - RESIDENTIAL FEE - $12.00
MINIMUM - COMM/IND FEE - $20.00
STATE SURCHARGE PER PERMIT - 50
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000.00)
;.
SIGNATURE OF PERMITTEE
FOR: CITY OF EAGAN
PERMIT tk
PLUMBING PERMIT ? `` ` ( .r._j
CITY OF EAGAN RECEIPT #
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE:
PHONE: 454-8100 y
BLDG. TYPE WOHK DESCRIPTION
Res. K New X?
Mult. Add-on
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES T(?TAL
-J-Water Closet - $3.00
-
$
?8ath Tubs - $3.00
Lavatory - $3.00 -?
-Shower - $3.00
?Ki!chen Sink - $3.00 ?
-Urinal/Bidet - $3.00
I Laundry Tray - $3.00 ?
--J--Floor Drains - $1.50
-J_Water Heater - $1.50 1 ?
_Whirlpool - $3.00
__j__Gas Piping Outlets - $1.50
(MINIMUM - 1 PER PERMIn
_Softener - $5.00 '
-Well - $10.00
Private Disp. - $10.00
?-Rough Openings - $1.50 ?
' y
PEE: .
STATE S/C: '-
GRAND TOTAL:
, . •, MECHANICAL PERMIT RECEIPT q
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE:
)NTRACT PRICE: PHONE: 454-8100
' Site Address
? Nan
?o Add
c Ciry
Phone
? Name
c Addre
O Cih' ?
TYPE OF WORK ?
Forced Air ? M 8TU
Boiler M BTU
UnitHeater - = M BTU
Air Cond. M BTU
Vent CFM
Gas Piping Outlets # ?
Other
FEE:
S/C:
TOTAL:
BLDG. TYPE WORK D CRIPTION
Res. 11z New
Mult. Add-on
Comm. Repair
omer
FEES
RES. HVAC 0-100 M BTU -$24.00
ADDITIONAL 50 M BTU - 6.00
(RES. HVAC INCLUDES A/C ON NEW
GAS OUTLETS (MINIMUM - 7 PER PERMIn - 1.50 EA.
COMM/IND FEE - 145 OF CONTRACT FEE
APT. BLDGS. - COMM. FATE APPLIES
TOWNHOUSE & CONDOS - RES. RATE APPLIES
MINIMUM RESIDENTIAL FEE - ALL ADD-ON &
REMODELS
MINIMUM COMAAEACIAL FEE - 12.00 ..
- 20.00 '
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000)
SiGNATURE OF PERMITTEE
`J•
FOR: CITY OF EAGAN
j CITY OF EAGAN Permit No:
3830 Pilot ICnpb Road B/P No: `°-`' Date:
l Date:
P.O. Box 21199
; Eagan,"MN 55171 ?
r'
Owner. _ - ; ? _ :Iome^ C
Site Address:
Plumber. MWCC:
, . ; : Zoning.
; Cily Chg: No. of Units:
Acct Dep:
Permit Fee: -- I agree to comply with the Cily of Eagan
Surcharge: ' Ordinances.
i Misc.: By
L SEWER SERVICE PERMIT
CITY OF EAGAN Permit No: Date: 4
14- F?
3830 Pilot Knob Road Meter No: Size: ?
P.O. Boz 21199 Reader No: Date:
Eagan, MN 55121
Owner.
Site Ad
? B3 Lezineton Sa 7
Conn. Ch
9? J 51
• "I
Ne
Zonin
Acct Dep:_ 15• 0 020
No. of Units:
Permit Fee: y ?? •'' `?P?'
5urcharge: • 5 ',^' I a ree t
1!; " o com
I 9 Ph wlth the CMy of Eegan
; ^
Tc Plant :
Ord(nances.
Meter. - <7 r• ?Pi
Misc.: B
y
WATER SERVICE PERMIT
CITY OF EAGAN Permit No: •' 3830 Pila; Knob Road Meter No: ? Q 3 Date: '
P.O. Box 21199 Reader No: ?/?? Z S? Size: ?
Eagan, MN 55121 Date -:E- ?i - S-L-?
Owner. MPtro ''veton; :?;;:e?
SiteAddress: le Ctee'r .T%o1d ?
??
''
_ 7-1
Plumber.
bViYlAgonsf-.
Conn. Chg
Acct. Dep:_
Permit Fee:
Surcharge
Tr. Plant_
Meter. _
Misc.:_
,i
1-` • Q ca ???'l?ilr?ies
??$?g- of rgitF? ?
CiRPC - (Y
??(?.??IPIY `with the Ciry of Eagan
,.
? rd?:PA-v" es.
By WA
TER SERVICE PERMIT
NO C/0 UNTIL ENG. APPROVES GRAbW OF EACAN . 3830 Pilot Knob Road, P.O. Box 21-199; Eagan, MN 55121 ?o- 14726
BUILDING PERMIT PHONE: 454-8100 Receipt # U CA
To be used for SF DWG/GAR Est. Value $72,000 Date MARCH 25 19 88
Site Address 995 KETTLE CREEK ROAD OFFICE USE ONLY
LEXINGTON SQUARR
Lot 22 Block 3 Sec/Sub
on Site Sewage
Occupancy
R-3
.
7TH ADDITION MWCCSystem X Zoning PD,R-1
Parcel No.
Vn
On Site Well (Actual) Const
e Name METRO CUSTOM HOMES Citywater X (Allowable) Vn
? P.O. BOX 1049
Address PRV Required _ # of Stories
a
City BURNSVILLE Phone 454-9383
Booster Pump
_ Length 55'
DaPtn 3$'
p Name SAME S.F. Total
o? AddreSS FootprintS.F.
U<
P
City Phone
APPROVALS
FEES
I-M "W
W Name Engr./Assess. Permit 462.00
W Planner
?g Address
Council _
Plan Review 231.00
a W CityPhone
Bldg. Off.
SAC, City 100.00
I hereby acknowledge thet I have read this application and state that the Variance SAC, MWCC $50.00
information is correct and agree to co ly with all applicable State of Water Conn. 5$0.00
Minnesota Statutes and Cit gan nances.
Water Meter
67.00
i ?
Signature of Permittee _
Road Unit
325zQ0
A Builtling Permit is issued to: METRO STOM HOMES Treatment P1 _204_..011
on the express condition that all work shail be done in accordance with all Parks
applicable State of M
in
nesota Statutes a
nd City of Eagan Ordinances. 525
00
2
/?
,
/
Building Official?L.71ed, TOTAL .
,
? `
REQUEST FOR ELECTRICAL INSPECTION ee-ooooi-os
Il, See instructions lor completing this form on back ot yellow copy.
D`9 408 6 "X" Below Work Cavered by 7his Request
New, AAd ReO. Type ot Building ApplianCes Wired ?quiVment Wired
Home Range emporery Service
Duplex Water Heater Lightiny Fixtures
Apt. Building Dryer Electric Heatin
Commercial Bldg. Furnace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tenk
F•drm Q(hYl Ve?Hy iher (5oorlfY)
t er SUCCily Other Othcr
Comnute Insoection Fee Below
q Fea Service EntraocaSize R Fee Fexders/Subleeders # Fee Circui[s
C) to 200 qm s 0 to 30 Am s 0 to 30 Am
Above 200 qmpy 31 to 100 Amps 31 to 100 Am s
Swimming Pool Above 100-Amps Above 100_Am s
Transformers Irriyation Booms Partial,?Other Fee
Signs - Special Inspection I TOT
pEE
Remarks ?
y „r
h Da1e 1, the ectricai
I spector. herohy
L
nl ,D,^t? ' inspection has been
d
me
a.
Thie reQUest vo10 19 moMlls irom
? 9
This requesl void ??fj?
76 nwn(hs from ? !J
D. 94086 o?
Req t Date Fire No. RouPh-iri I eciion
D ?
Hequired? ' ?Ready Now Q Will Notify Insuec-
.% ?Yes ?No tor When Ready
MINNESOTA STATE BOARD OF ELECTRICITV THIS INSPECTION REQUEST WILL NOT
Gripgs-Midway Bldg. - Room N-191 --..> eE ACCEPTED 8Y THE STATE BOARD
1.Q?1.,Unipersity_Ave., St. Paul, MN 55104 , UNLESS PflOPER INSPECTION FEE IS
' Fhone (612j 642-0800 ENCLOSED.
L.1'ucensetl tiectncal Contractor I hereby requastinspection of above
? Owner electrical work ins<alled at:
???/8'8` REQUEST FOR ELECTRICAL INSPECTION jift ee-oooai-os
See instruCtions lor completing this form on back of yellow coCV•
If, a
D. .9 41n ?JJ ""x" Below Work Covered by 7his Request H NeO. Type of BuiltlinA APPlinncea Wired Equipment Wired
-A Home Ranye Tem orary Service
1 0 Duplex Water Neater iyhtiny Fixtures
Apt. Building Dr er Electric HeaUn
Commercial Bldy. urnace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tenk
Farm cher Speci v Other (speclfy)
l P.! SVCI;Ify OSf1Cf Oth(+f
Comoute lnsoection Fee Below
p Fee SerViCe EnlrenceSize 8 Fee FeeJers/Subteeders k Fee Circuits
0 to200Am s 0 to30Am s 0 to30Am s
Above 200 qmps 31 to 100 Amps 31 to 100 Am s
Swimming Pool Above 100_Am s Above 100_Am •
Transiormers Irrigation Booms Partial-"Other Fee
i Signs Speciallnspection ?
TOTA E
NBrtr3rks ( ? J M.1
Rough-in tq
1. Ihe Ele cal
? IISpOCIOf, hBre y
certify that the above
Final ?'' insvection has been
,y
? /
mede.
L%.
fhis reQuest void 18 monlns from
This reVUest void
16 months troT
D Q1d 4103 r
:0,
Reqyyy??? st D'ate'! Fire o. RouP ?i InsVectip
1 Re.qu?r ? ?Ready Nuw ?M Nolify. Insper.-
I s ?No ? tor When Ready
iaLicensed Electrical Contractor I here6y request insDection ot above
? Owner electrical work installed at:
St t A ress. Box or te No. Citv 9)1 014k
ec ion . Township ame or No. Range o. County
Occ peM (P INTI
E a rvi
I-? b 6 s Phone o,
Pow up0lier AddreSs
1
Electrir.al Coniractor ICompany Namel Contracto 's Licensc No.
ro?
?
a ntractor or Owner Making Instailation)
m ELFCnTC
Auth r ?!L daT?'1,C?nL akiny Insialla[ion)
PPL 1tllJ NE
A Phone Numbe
r
MINNESOTA STATE BOAHD OF ?ELE(:?N7C?V7IG?-g THIS INSPECTION REQUEST WILL NOT
Griggs•Midway Bidg. - Hoom N-191 BE ACCEPTED BY THE STATE BOAHD
1821 Universitv Ave.. St. Paul, MN 65104 UNLESS PROPER INSPECTION FEE IS
Phone(612) 642-0800 ENCLOSED.
*dtV oF eagan
PATRICIA E. AWADA
Mayor
PAUL BAKKEN
PEGGY CARLSON
CYNDEE FIELDS
MEG T[I.I.EY
, Counal Members
THOMAS HEDGFS
CiryAdtninistrator
Municipal Centtr.
3830 Pilot Knob Road
Eagan, MN 55122-1897
Phone: 651.681.4600
Fas: 651.681.4612
TDD: 651.454.8535
Maintenaace Facility:
3501 Coachman Point
Eagan, MN 55122
Phone: 651.681.4300
Fax: 651.681.4360
TDD: 651.454.8535
www.ciryoFeagan.wm
THE LONE OAKTREE
The rymbol ofstrength
and growth in our
cnmmuniry
October 16, 2002
Steven & Susan Stafford
995 Kettle Creek Rd.
Eagan, MN 55123
Re: Vacation of Public Drainage and Utility Easement - 995 Kettle Creek Rd.
Dear Mr. & Mrs. Stafford,
Recently, you submitted a petition to the City Council to vacate a portion of an existing
drainage and utility easement located adjacent your northwest property line to
accommodate an addition to your current home. This request was scheduled for a public
hearing before the City Council on Oct. 15, 2002. Notification of this public hearing was
published in the legal newspaper and sent to all potentially affected utility companies as
well as reviewed by the City Public Works Department
As a result of this review, it was determined that a 48-inch diameter storm drainage pipe
is located within this easement approximately 20 feet deep. Due to the depth of this pipe
and the needed setbacks for excavation access, the City did not believe that it would be in
the public's best interests to allow this requested encroachment and related vacation of
the utility easement. Subsequently, the City Council denied your petitioned request at the
close of the public hearing.
I'm sorry that we were not able to accommodate your request. If you have any further
questions regarding this matter, please feel free to contact me at your convenience.
Sincerely,
Thomas A. Colbert, Director
Department of Public Works
a--
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 P1LOT KNOB RD, EAGAN MN 55122
851-881-4675
New Constructlon ReauiremeMa
• 3 regislered site surveys showing sq. ft. ot lot, sq. ft. oi house; antl ?II roofed areas
(20% maximum lat coverage albwed)
. 2 copies of plan showing beam & window sizes; poured tound design, etc.)
• 1 set of Energy Calculations
• 3 copies of Trea Preservation Plan tl lot platled after 711l93
• Rim Jolst Detail Options Selectbn sheet (bidgs wrth 3 or less units)
DATE (C2 I Y /??
SITE ADC
NPE OF
APPLICANT A
STREET ADDRESS
TELEPHONE # g
AULTI-FAMILY BLDG _ Y xN
FIREPLACE(S) _ 0 _ 1 _ 2
WQ4, d-uC. ?N&/ CIN &oioml STATE /LAIZIP65-? Wly
CElL PHONE # 61,2 -.?? 6- 7?VO FAX # 95 2 -oS F9V S _
PROPERTY OWNER 31AL Af.(f1?t72 (i( TELEPHONE #
------------------------------------------------ ----- --------------------- ---------------------
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1 MINNESOTA RUI,ES 7672
(4 submission type) . Residential Ventilation Category 7 Worksheet Submiried • New Energy Code Worksheet Submitted
• Energy Envelope Calculations Suhmitted
Plumbing Contractoc _____
Pluxnbing system includes:
Mechanical Contractoc
Mechanical system includes:
Sewer/Water Contractor:
_ Water Softener
Water Heater
NO. of Baths
4C f 3.75
RemodeVRe ag h Re,putremeMs
• 2 copfes of plan
• lsetotEnergyCakulatbnsforheatedadditions
• 1 slle survey for eMerior additions 8 decks
• Indicete if home served by septic system for addRions
VALUATION 0 5, D O O
Phone #
Lawn Sprinkler
No. of R.I. Baths
Air Conditioning
Heat Recovery System
Phone #
Phone #
Fee: $70.00
--------------------------------------------------------------------------------------------------------------------------
I hereby acknowledge that I have read this application, state that the information is co ly
with all applicable State of Minnesota Statutes and City of Eagan O^dir?a c.' ?? ????f m n
Signature of Applicant
OFFICE USE ONLY
Fee: $90.00
Certificates of 5urvey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4/02
OFFICE USE ONLY
? 01 Foundation
? 02 SF Dwelling
? 03 01 of _ plex
? 04 02-plex
? 05 03-plex
? 06 04-plex
? 07 05-plex ? 13 16-plex
? 08 06-plex O 16 Fireplace
? 09 07-plex ? 17 Garage
? 10 08-plex ? 18 Deck
? 11 10-plex ? 19 Lower Level
? 12 12-plex Pibg_Y or_ N
? 20 Pool
Q 21 Porch (3-sea.)
? 22 Porch/Addn. (4sea.)
? 23 Porch (screened)
? 24 Storm Damage
? 25 Miscellaneous
O 30 Accessory Bidg,
? 31 Ext. Alt - Multi
? 33 Ext. Alt - SF
? 36 Multi
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)" ? 43 Reroof ? 46 Windows/Doors
? 34 Repiacement 'Demolition (Entire Bldg only) - Give PGA handout to applicarwt
Valuation Occupancy MClES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new bldg) _ FinaVC.O.
_ Footings (deck) _ FinaVNo C.O.
_ Footings (addirion) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof _ Ice & Water _ Fina] _ Pool _ Ftgs _ Air/Gas Tests _ Final
_ Framing _ Siding Stucco 5tone
_ Fireplace _ R.I. _ Air Test _ Final _ Windows (newheplacement)
_ Insulation _ Retaining Wall
Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Piant
Plumbing Permit
Mechanical Permit
License Searoh
Copies
Other
Total
Building Inspector
1988 BUILDING PERMIT APPLICATION - CITY OF EAGAN
SINGLE FAMILY DWELLINGS
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OE SURYEY, 1 SET OF ENERGY CALCULATIONS
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WIiICH ADDRESS
IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
MULTIPLE DWELLINGS
RENTAL QNITS FOR SALE UNITS # OF UNITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE pF SURVEY - CHECK WITH HLDG. DE
1 SET OF ENERGY CALCULATIONS
"
CONIIMERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS
To Be Used For: PEC.k, Valuation:
Site Address GtC?? ??Le- (JRPsK ?
Lot 127. Block 73
Parcel/Sub I
Owner ?EV? C-4
Address -mS LSe4L £ bae(c 1u.
CitylZip Code F-p a s,u ?A U ?_S! 13
Phone 44r(o c) 10 tt
Contractor n/1 Wttc)
Address Y
City/Zip Code
Phone LJ Sq °13 ?3
Areh./Engr. ?S*A&0- L@ kQ . _
Address ' "S4p.(? N w
City/Zip Code
Phone # sr2+s 1'714('.
Date:
. ? . ;..
OFFICE USE ONLY
On site sewage _, Occupancy
MWCC system ? Zoning
On site well ? Actual Const
City water _ Allowable
PRV required _ # of stories
Booster Pump _ Length
Depth
S.F. Total
Footprint S.F.
APPROVALS FEES
Engr/Asaess Permit ? G
Planner Surcharge
Couneil Plan eview
Bldg. Off. SACt C
Varianee SAC, MWC
Water Co
Water ter
Road it
Trea ent P1
AL
/1?E7R.o L'U57bM L?nntE5
pLANNEAS ondaLAHD SiURYEYOltS B?K ioo
?ENGIN Ef ?ING CCHSULTIHO
PAGc 44
C4MPANYI INC.
?? 1000 EJ?ST Ii6Ct 57AEET, BURNSVILLE s YIHHE507A SS337 PH 432'j000
CeTZ
?4c1 zort: LoT 22, BWCK 3, LEX/NGTON SOUA2E 7TH ADDIT/ON,
MiNNESOTA
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OR4/N.<!GE AND '
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? 0 OD _s% D6N07E S EX1971N6
ELEVAT/O/V
???'?. o?'sa?,' \? ?e??3R? ??, ? (889:s) DEn/OTES. P?2oPaSEO
ELEt/AT/0A1
/NO/CATES ,b/RECT/OA!
OF SuRFAeE 09WNA6E
?a ,zez
'884.83 = F/N/S.?ED 6RRA6E
?\at FGooR ELEV9714N
I her:by cartify, that thia ia a t:ue and cflrrsct repraeentition oi a tract ot
land as ahcwn'and deacribed herson.• Aa prspared by me on this Z? ?Alp day of
/YIA.ect/ ? 19_. •
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I r_, 1988 BUILD G PERMIT APPLICATIOP - CI'TY OF EAGAN,
SINGLE FAMILY DWELLINGS
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OE SURVEY, 1 SET OF ENERGY CALCULATIONS
NOTE: ADDAESSES FOA CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS
IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE HUILDING PERMIT IS ISSUED.
MULTIPLE DWELLINGS RENTAL UNITS FOR SALE UNITS # OF UNITS
INCLUDE 2 SETS_OF PLANS,. CERTIFICATE OF SURVEY - CHECK WITH BLDG. DEPT.;-
' 1 SET OF ENERGY CALCULATIONS
CONMERCIAL INCLDDE 2 SETS OF ARCHITECTUftAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS -
To Be Used For: Sinele Familv Dwe?lyaluation: "4. gog--gg- Date: Ma.rnh 99. 1988
Site Address 995 Kettle Creek Road
Lot 22 Block _'i_
Parcel/Sub ?xin t,on ,q.. _ 7th Add;t;c,n
Owner MPtro (',nct.nm Hnmas
Address P.O. Box 1049
City/Zip Code 3jjrnsyjj ?Mn. 55'?q7
Phone 454-9_?8?
Contractor Sa.me
AddrAss
City/Zip Code
Phone
Areh./Engr. qamP ?
Address
City/Zip Gode.
Phone li
'
OFFICE USE ONLY
7Z oco"
e
On site sewag
e_ Occupancy
R' 3
MWCC_system ?/ Zoning p. R"?
On site well Actual Const ?
V-N
City water w- Allowable v-hi
? PRV required _ # of stories ?
I Booster Pump _ Length_ . $S
? Depth 3
S.F. Total
Footprint S.F .
APPROVALS - FEES
Engr./Assess Permit y6z,00
Planner Surcharge 3l0,00
Council Plan Review
B1dg. Off. =*2S-SAC, City 2 ?,00
I00 100
Uariance ' SAC, MWCC a 00
' Water Conn SgO, c V
; Water Meter 69, OJ
? Road Unit 3Z , po
- Treatment P l Zpy , 00
' Parks
Copies
TOTAL a,?"as
?--
VA ?.UATioN
?
GaR?GE •_ . ' ,
ZLIY-L2 = 52g x Iti= ?39Z
i???
3q X Z.S =qso x 13 W ?2350
h-lousC
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Ix I?. = IZ
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Bv/L.0iN 8
$ETBACX L/NE
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DRA/N.AGE AND
UT/L/TY F,49EMEN7-
-
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;dt/26Z,d/
COH511L71NC3 E!{OINEEtlS goolc 100
PIANHEflI cnd LAliD iUt1VEYORS pq`E 44
BURHSVILLE I 41NNE507J1 56337 PH 432-3000
(Eez• )
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9C41-E : /" = 30,
DEN071E S EX1971N6
ECEVAT/aN
(88q-, 5 ) DENO71E,6. P/2oPOSEC
ELE V4T/ON
s? 1ND/CA71E$ b/RECT/ON
0F ,guRFACE 9R41NA6E
gg¢,83 = F/N/SNED 64946E
FGOOR EL&I197-14N
I hareby cartify that thia ia a t:ue and carrect rnprneentition of a tract of
land aa aho++n' and deacribed hereon.• Aa prepared by me on this 2r?!, day of
w/YIAzc.y , 19 SS • ,?.,,. s.,.:? Hinn* lles. Ho•
.?
IR46E
ENGiNEfR1NG
COMPRNY, INC.
1000 EJ?57 1461h STREET9
?
?aQcl ..Dr?scriP2iorz: LoT 22, BLOCK 3, LEX/N67-dN SOUARE 7TN ADD/T/aN,
DAKOTA CouNTY, M/NNESOTA
. ***************#******?*******#****#
C I TY O F E A A i? *?': ?'AYS?IFTTC OF FEE AT TIME pF ?
. *APPLICATION DOFS NOT CONSTITVtE ?
? APPROVAL OF PERriIT. *
APPLICATION FOR PERMIT * *
* INSPFX.TION oF SEWE12 AIVD/032 MTIIt ,*f
• , '.. ,?*, =11=0NS WII.L N02 SE SCEED- *
SEWER AND/OR WATER CONNECTION * ? ?? PERMT Em Bm *
. . • * APPROVED. *
?, x* *
* *
... ********************,r*t*:*********?*
/ P ease Print
?:1) PROPERTY ADDRESS : v/ 9,17 t0 ...
LEGAL DESCRIPTION:
i
. tLOL/niocK/subaivision or Tax Parcel ID-I)--
If' EXISTING STRL'C-MME, DATE OF ORIGINAL BOILDING PEF2A2iT ISSL'ANCE: -
_ y •-
PRFSENT ZONING/PROPOSID (;SE: (Nbn Year
q corMERciar,/RErAtL/oFFzcE
Q INIDUSTRIAL
? INSTIZUTIONAL/GpVERDIl+g,'NT
?. R-1 SINGLE FAMILY ? R-2 DLPLEX (Two Units)
? R-3 TOWnII-iOUSE (Three + Units) ( Units)
? R-4 APARTMENT/CONDOMINiUNI ( Units)
2) ?
NAME: /t F- S F/6r2 ?,f' C • -
ADDRESS: 0. .3 Vj t 41N =-ni C--1$- .
CITY. STATE, ZIP: A-ePL L C:,4t Z? y /?,? • ?,?'/.? ?y!
PHOIVE: y 3 - S2 % L .
3) • c ?-
NAPE:
ADDRESS:
CITY, STATE. ZIP:
PHONE: yo ? 9 MASTER LICEDISE# 3 b `11 AA ?
Plumbers License:
a Active
Expired
??. Not recorded
staf Initial
4) •• •
_ ADDRESS: .
CITY, STATE, ZIP:?'? ?. ?,.; i v L L?? i?J?? '
PHoNE: ys-y= ys€?3 •5)
. ?. CONNEC.'TION TO CITY SEWER ? CONNECPION TO CITY WATER ? OTHIIt .-
6) ?? • i q PLEASE HOLD APPROVID PERMIT FC)R PICK-UP BY ONE OF ABiOVE
Q PLEASE MAIL APPROVID PERMIT TO 1, 2, 3. 4, ABOVE :.
7' ? ? ? ,ti• (Circle one)
_ . .,
TOR CITY USE O{VLY PERMIT # ISSUED
Pd w/Bldg. Permit FEES:
$ $ SEWER PERMIT (INCLUDE SURCHARGE)
$ $ WATER PERMIT (INCLUDE SDRCHARGE)
$ /,o o $ WATER METER/COPPERHORN/OUTSIDE READER
$ $ WATER TAP (INCLODE CORPORATION STOP)
$ $ SEWER TAP
$ $ ACCOUNT DEPOSIT - SEWER
$ $ ACCOUNT DEPOSIT - WATER
$ 0-6 $ WAC
$ ?p SU • U C? $
_ SAC
$ $ TRLNK WATER ASSESSMENT
$ $ TRUNK SEWER ASSESSMENT
$ $ LATERAL BEIVEFIT/TRLNK SEWER
$ $ LATERAL BENEFIT/TRLNK WATER
$ 4?`-?` 4 Z/ $ WATER TREATMENT PLANT SURCHARGE
$ $ OTHER:
$ /?z' I e7 Ll $
TOTAL
?
RECEIPT RECEIPT
BOES LTILITY CONNEC TION REQLIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
F_'_j YES IF YES, THEN A" PERMIT FOR WORK WITHI[V.PLBLIC
Q
NO ROADWAY" MUST BE
DIVISION ISSL?ED BY THE ENGINEERING
. LIST AS.A CONDITION.
SU BJECT TO THE FOLL OWING CONDITIONS:
APPROVED By:
TITLE:
DATE :
; LoT Z Z `[3 t aac- 3 ?,EX/Nb?7C?/v
?
EXTERIOR ENVELOPE AVERAGE COMPUTATIQN
DETERMINE WORKING S9UARE F00'fAGE
1) WALL RREA: 1460 *,.i1 =_ 166.6
2) ROOF AREA: 1103 *.4'026..= 28.67
TOTAL tXPOSED WALL ARFA 146b A) WALL NINDOW AREA $9,5.
B) DOOR AREA yd
C) PA1'IO DOOR AREA
.
° D) ?,IRE??LA'C?L? WALL AREA " ' D ;: .
E) WALL FRAMIMG AREA 1'46
F) NEt WALL AREA
G) RIM JOIS1` AREA ?123.;:
TaTAL EXPdSED FQUNDA7I0N`AREA 0
H) FdUN4ATI0N iJIN60W l4aEA? p ?
T) tOTAL NET.FOUNDATION.AREq ;.0
OETERMINE U VALUE OF EdCH WALL SE6MENT '
A) 89.5 4U .55 = 49.22
B) 40 *tJ .07 = 2,8
C) 80 *U .55 = 44
D) 0 *U .359 = p
E) 146 *U .096 = 44.01 :
F) 981.5 ?wU .043 = 42.2
G) 123 *U .028 = 3.44
H) 0 *i1 .55 = D
I ) ? -wU .07 = 0 .
3) TOTAL ? 152.24
NOTE; IF ITEM q3 152.24
tS THE SAMp A$,
AR lESS tHAN ITEM 1l1 160.6
?YOU HAVF Mf T tHE'INTEHT 4F SBC 606(C)2
T07A1 FXP05E0 ROOF AREA= 1103
J) SKYLIGHT AREA p
K) ROOF FRAMING ARf_A 110.3
L) NET'INSULATED ROOF`AREA. 992,7
' DETERMINE U VALUE FdR EACH RQOF SEGMEN'f
J) D*U_55=0
- K). 110.3 -;U .026 ? 2..86
L) 992.7 +Ft7 .O21 = 20,84
IF TOTAI OF Jt4 23.71
IS THE 511ME qSj
OR LESS THAN ITEF1 #,2 .28.67 '
THEN YOU HAVE MET 7HE IN7ENT.
OF SBC 66D6(C)1
pLTERNATE BUILDTNG ENVEIpPE DESIGN
TO UTILI7E TOTAL ENVELQPf SYSTEM METHOD
VALUES ESTABLI3HED BY.THE SUM OF ITtNfS
03 AND i/4 SHALL AOT BE GREATER THAN .
THE SUMS dF ITEMS q1 AND #2.
T) 160,6 + z) 28.67 489.27
3) 152.24 + 4) 23.71 = 175.95 .
. . , - .? : . . ?
T?I
1
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r
RESIDENTIAL BUILDING
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5694
-9 °73. &v
Cu,l,?.cpt? ? I L?l ?03
New ConsWction Reaui2ments RemodeUReoair Requirements OTfice Use Onlv
3 registered site surveys showing sq. fl, of Iol, sq. ft of house; and all roofed areas 2 copies of plan Cert of Survey Recd
(20% maximum lot coverage allowed) 1 sel of Energy Calculations far heated addi6ons Tree Pres Plan Recd
2 copies of plan showing beam & window sizes; poured faund design, etc. 1 site survey for additions & decks Tree Pres Not Reqd
1 set of Energy Calculations Addition - indicate if on-site septic system _ On-site Septic System
3 copies of Tree Preservation Plan if lot platted afh:r 711193
Rim Joist Detail Options selection sheet (bldgs with 3 or less units
Dated4(J Construction Cost
/
SiteAddress
Qz,(c ? • UniUSte #
Description of Work e- ?a- c,(L
Multi-Family Bldg _ Y _IfK N Fireplace(s) _ 01 _ 2
Property Owner 7f?c /gC.Le_ Telephone #(&Q' ) qs{oxi ?0?(
'6
Contractor E U-CQ
Address - City
State Zip Telephone # ( )
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category . Residential VenUlation Category 1 Worksheet • New Energy Code Worksheet
(J submission type) Submitted Submitted
• Energy Envelope Calculations Submitted
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone # ( )
, - _
T I 7p13'one
i
Telephonek
L_ ?f
" I
_ •- - ._. ?J
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 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. _
ApplicanYs Printed Name
,
0
Applic s Sign ture
OFFICE USE ONLY, ?
Sub Types
? 01 Foundation
? 02 SF Dwelling
? 03 01 of _ plex
? 04 02-plex
? OS 03-plex
? 06 04-plex
Work Types
? 07 05-plex ? 13 16-ptex
? 08 06-plex ? 16 Fireplace
O 09 07-plex ? 17 Garage
? 10 08-plex 6 18 Deck
? 11 10-plex . ? 19 Lower Level
? 12 12-plex Plbg_Y or _ N
? 31 New
? 32 Addifion
? 33 Alteration
? 34 Replacement
Valuation
Census code
SAC Units -
Nbr. of Units
Nbr. of Bldgs
Type of Const
Footings (new bldg)
?- Footings (deck)
_ Footings (addition)
Foundation
Drain Tile
Roof Ice & Water Final
_ Framing
_ Fireplace _ R.I. _ Air Test _ Final
_ Insulation
Base Fee
Surcharge
Plan Review '
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
? 20 Pool
? 21 Porch (3-sea.)
0 22 Porch/Addn. (4-sea.)
? 23 Porch (screen/gazebo)
? 24 Storm Damage
? 25 Miscellaneous
? 35 Int Improvement ? 38 Demolish (Interior) ? 44
? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45
? 37 Demolish (Bldg)* ? 43 Reroof ? 46
'Demolition (Entire Bldg) - Give PCA handout to applicant
Occupancy MC/ES System _
Zoning City Water _
Stories Booster Pump _
Sq. Ft. ? PRV _
Length ? Fire Sprinklered _
Width ?
..
? 30 Accessory Bldg
? 31 Ext. Alt - Multi
? 33 Ext. Alt - SF
? 36 Multi Misc.
Siding
Fire Repair
Windows/Doors
REQUIRED INSPECTIONS
FinallC.O.
? FinaUNo C.O.
_ Plumbing
HVAC
Other
_ Pool _ Ftgs _ Air/Gas Tests _ Final
_ Siding Stucco Stone
_ Windows (new/replacement)
_ Retaining Wall
Approved By
?
Building Inspector
?E7Ro [?US?M L?o?,ES
• A O p e E (pNSUtTiHO EH8IHEEltS BcoK loa
N ?tING PIAHNEFII ond LAND illRVEYO!!S PA??
ENGiNEf
? CoMnANY, 1NC.
??1000 EAST 146th 57REE7, 9URNSVILLE, YIHHES/TJl 55337 P H 422-3000
CeT?Z?Z Ct3?? V?LLi ?"'Y'e [?
?aqal ?ti .T ? p?i ort: LoT 22, Bl.OCK 3, LEx/NGTON SouARE 7TH ADD17I0N
• DAKOTA Caun/7Y, M/NNESOTA
&z, )
\\",-(ggz
DF?A//VAGE AND
vTiC.?TY ??'EMEti/T
s
?
\ 2s R?O
f/ p Cj ?\ ?I 9S' STS.
/ ?DO ?O
/ ?
3a' 0 / ` O Q , )
FROiIlT ? ? ? n° \
RU/LDI/V 6 `• ; \ L8z
(
ic ?7BAC.jC L/NE
•-
p
82 ? `S ? ???sJ
?? ?s , ?'eg a? o ??
p0 -j
• ?8.. ?? ?'OQ ?? a
??a ?• o / fl Q ?
? DENOTE,-.? EX/977N6
G[.GVATIQAv '
o ? .
. ?
? ??3R. C? ? ?, ? (884 S ) DENOTc'S. P.QOPO.Sc::
?'? ELEI?AT/On1
?/
/ND/CATES D/RECT/C/V
?8 OF S?/RFACE 09411VA6E
9a ??889:83 = F/N/?'.=/ED 6RR46E
?;. F?acfZ E-EVAT/oN
a
I heriby cartify that thia ia a t:ue and carrsct rnprasentation of t trict of
ltnd as aho+m'and deacribed hereon•• As prsPared by me on this Z?ND dsy °f
?
NJA,?c?/ , 19 a8. •
,?..,. ?iinn. ?tes.
- :o
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA123223
Date Issued:06/02/2014
Permit Category:ePermit
Site Address: 995 Kettle Creek Rd
Lot:22 Block: 3 Addition: Lexington Square 7th
PID:10-45081-03-220
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Janel Behrends
122 West 3rd S
Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088
Surcharge-Fixed $5.00 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 -
Steven J Stafford
995 Kettle Creek Rd
Eagan MN 55123
Haley Comfort Systems
122 West 3rd St
Hastings MN 55033
(651) 437-0338
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA168572
Date Issued:04/26/2021
Permit Category:ePermit
Site Address: 995 Kettle Creek Rd
Lot:22 Block: 3 Addition: Lexington Square 7th
PID:10-45081-03-220
Use:
Description:
Sub Type:Residential
Work Type:Alteration
Description:Adding backup sump pump run by water pressure
system
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 (miscellaneous)$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 -
Steven J & Susan K Stafford
995 Kettle Creek Rd
Saint Paul MN 55123--151
Riser Plumbing Inc
2233 105th St SW
Montrose MN 55363
(952) 215-2951
Applicant/Permitee: Signature Issued By: Signature