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4635 Kingsbury DrCASH RECEIPT CITY OF EAGAN 3795 PILOT KNOB ROAD EAGAN, MINNE50TA 55122 DATE 19 RECENED FROM AMOUNT $ & DOLLARS too ? CASH F-I CHECK FOw i ? White-Payers Copy Yelloov-Posting Copy Pink-File CoPY ThankM You O, ` C/ B Y CITY OF EAGAN Remarks Addition BEACON HILL ADDITION Lot 26 pIk 3 Parcel 10 13500 260 03 Owner - Street 4635 Kingsbury Drive State F.agan, hAI 55122 Improvement Date Amount Annual Years Payment Receipt Date STREETSURF, ((S 1982 1806.93 200.77 9 1806.93 C007567 10-1-81 STREET RESTOR. GRADING 1982 526.46 58.50 9 526.46 C007567 10-1-81 SAN SEW TRUNK ?K,. 1976 135.97 9.06 15 90.67 A008956 3 18 80 * SEWERLATERAL 463 1982 3116.46 346.27 9 3116.46 C007567 10-1-81 WATERMAIN * WATER LATERAL 19$2 9 WATER AREA 1982 198.01 22,00 9 198.01 C007567 10-1-81 * Stubs 1982 9 STORMSEW TRK "Z 1982 359.82 39.98 9 359.82 C007567 10-1-81 * STORM SEW LAT 1982 9 CURB & GUTTER SIDEWALK STREET LIGHT Road Unit 240.00 33832 1-7- 8 WATER CONN. 420.00 it BUILDING PEFi. SAC u n PARK INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: Ea an, Minnesota 55122-1897 9 Date Issued: (612) 681-4675 SITEADDRESS: APPLICANT: i i,7. 111 i; i W I 10412 PERMIT SUBTYPE: TYPE OF WORK: .,; . . . ! ;, ! r N E t-! ( (3 F1 `i 1 Permit No. Permit Holder Data Telephone N ELECTRIC PLUMBING HVAC Inapectlon Data Insp. Commenta FOOTINGS FOUND FRAMING r .? ROOFING ROUGH PLUMBING PLBG AIR TEST ROUGH H ATING ?5?Ci GAS SVC TEST INSUL #?J! QYPBOARD FIREPLACE , FIREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL BSMT R.I. BSMT FINAL DECK FfG DECK FINAL RecEipt .- I-1 PLUMBING PERMIT Permit No. CITY OF EAGAN , Fee . Fill in numbered spaces S/C _ Type or Print legib/y Tot. 1. DateJ L9^ 32. Installation Cost b C • l?-. . . , 3. Job Address' '7 '' Lot Blk. Tract ?r-f 1 4. Owner aoE .4IrLF?1 cor:STF.UC1'IQ33 ?_, _r?- •, 5. Contrecmor Phone . ..? ?n 6. Address %:' i`? 3!1 =+C L? 7. City; ? ,-- State Zip 8. Building Type: , oesidential 9. Work Description: New 0 10. Describe 11. Commercial ? Institutional ? Add ? Alter ? Repair ? No, Fixtures Water Closet No. Fixtures Cesspool/Drainfield Bath tubs Septic Tank Lavatory Softner Shower Well ? Kitchen Sink I UrinaUBidet Laundry Tray pther T ? Floor Drains ! Orinking Ftn. Slop Sink i? Gas Piping Outlets 12. I hereby certify that the above information is true and correct, and I agree to comply with all ordinances and codes governing this tYpe of work. Signed : ' N for Rough Final Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. Approved CITY OF EAGAN 454-8100 Receipt - ? - MECHANICAL PERD CITY OF EAGAN Fill in numbered spa ? Type or Print/egibl 7. Date2. Installation Cost - r? 3. Job Address Lot .1. ? 4. Owner Permit No. Fee -_T S/C Tot. - _Blk. a Tract 5. Contractor Phone .4. 6. Address 7. City i State Zip 8. Building Type: Residential O Commercial ? Institutional ? 9. Work Description: New El Add ? Alter ? Repair ? 10. Describe Fuel Type. 11. No. Fyuinment BTU - M. Ea. Forced Air No. Equiament CFM Air Handlin : Mfg. g Boilers _ Mfg, Mech. Exhaust Unit Heater Mfg. Other Air Cond. Mfg. Gas, Piping Outlets 12. I hereby certify that the above information is true and correct, and I agree to comply with all ordinances and codes governing this type of work. Signed: - for Rough Final Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. Approved CITY OF EAGAN 454-8100 CITY OF EA6AN 379S ?ilet Knob Roed Eayan, MN SS142 PHONE: 454-8100 ' , BUILDING PERMIT Receipt # To M und for Est. Volue Date 19 Slte Address Lot Black Sec/Sub. Porcel # rc Name ' v nadmss G Phona ?p Nome ? ?tj Address e?--- Address I hereby atknowledge that 1 have read this appiicotion and stote that ihe intormation is correct ond ogree to tomply with oll applicable Stote of Minnesota Stotutes ond City of Eagan Ordinances. Sipnature of Pertnittee A Building Permit is issued to: all work shall be done in acwrdance with all oDplicable State of Minnesoto Statu Erect ? Octuponcy Alter ? Zoning Repoir ? Fire Zone Enlarya ? TYpe oF Const. Move ? # Stories Demolish p Length Grode p Depth $q. Ft.- Approvals Fees Assessment Water 8 Sew. Police Fire Erq. Plonner Countil Bldg. Off. APC Permit SurcFwrye Plan check SAC Water Conn. Water Meter Road Unit Total on the axprcss condition thni ond City of Eayan Ordinoncea. Buildinq Offitiol Parmit No. Permit Holder Mise. Permit No. Holder Plumbing d- lTJ M.C6 l,L L`f-?- 1`7-?J H.V.A.C. ?? LS 5n ir ll Wall Wator Sawar Electrie LJDSI{l?w WcOW. Infpection Date Insp. Other ? Footinyt Foundation Framinp Rouqh Plbp. :,J ^ 2 /1' Rouyh HVA Inwlation Finsl Plbp. 00016. ? Find HVAC Final - W Water Daaeribs Location: I Wall Sawer Pr. D'np. . INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: "14 3830 Pilot Knob Road Permit Number: Ea an, Minnesota 55123 x J v{ 9 Date Issued: (612) 681-4675 I SITEADDRESS: APPLICANT: : I ? PERMIT SUBTYPE: ? TYPE OF WORK: I INSPECTION ., . D. ?? ?l ?o PermR No. PermR Holder Date Telephone # SNV PLUMBING HVAC ELECTRIC ELECTRIC Inspection Date Insp. Commenta Foo6ngsl G ? l Foundalion s - 7 Framing - s S L-60 Roofing / Rough Plbg. RoughHtg. Isul. Freplace Final Ht9. t??WVv Orsat Test Final Plbg. Pibg. inspector - Notify Plumber Const Meter Engr./Plan ? Bldg. Final ( DeckFtg. Deck Final ? v Well ? • Pr. Disp. ' - Eagan, MN 55122 DATE: Zoning: No. of Units: Owne? Address: Site Address: ? i' ? i t.r. , -= T.,?:, '•£. , ;3 ' ,? Plumber: •'c? , ; ?????? ,..,?..^ , e . 1 agres M eoinply wlth tha CiFy oi Eegan Connectlon Charge: , Ordineeees. Account Deposit: Permit Fee: Surchorge: By Charges: Misc . Date of fnsp.: Total: Insp.: Dote Paid: CITY QF EAQAN `.e+.?n ..r....... . . ?....... 3795 Pilot Knob Road PERMIT NO.: Eagan, MN 55122 DATE: Zoning: No. of Units: Owner: ?-- .? Address: Site Address: - - '-' " ' - - - Ptumber: Meter No.: Connection Charge: Size: Account Deposit: Reader No.: Permit Fee: I agree M eomply wilh tha Citq of Eagan Surcharge: Qrdinaneaa Charges: Misc . . Total: B Date Paid: y Dote of Insp.: Insp.: CITY QS EAGAN SEWER SERVICE PERMIT 3795 Wlot Kno6 Road PERMIT NO.: crrsr ?r? sncluae Z .er.s :ot p?s. ; - , i dts plan w/Olavattans `f'r 1 • ' i .st cf aemagY ' HUILDINC PP*=?AF'PLICATIT 'lb He Ueed FOt bIS441e'rte- Va1t73ti(Rt '-M ' 6Hfl Dllbe , 11 ^S?t?E AC7d='B88s 4635 Kingsbury? 1»`iV?. ` ' . Qf'I? T? ?'Y • ' , , 26 Blodk 3 Sec./5t?s. Beacon Hi?ll Et+eCt t'°t ? ?Oom4pancY ?' . AldBx' ? ? - , I!: Io ia`Oc) zb0 0-2, 11one _ Firs Paroel gAp,dr - , . EnlatVa q"S of n,.,._, Qwmr; Joseph M. Miller Cnnst Inc. 0 SwiM j. ?/C 18133 Cedar Avi So Gla3s ?? s ?t• City/Zip Oode: FarminQton AN- 55024 _ ?plyone 1: 454-4753 contracto_; Sam Address: , citY/ZiP Codes Plyane # : Arch. /t]g • • AddL+ess: (itjr/ZiP Oocle: Phone ?: - A..essmOnts Waber/3eaer Plan Chock `?d ' Poliae Fire - S?1?C . c;arn wat?r ., ? z n ?^ planner l1absr M"wmGB?' =`r1-- , Oaulcil Aoad tfiit L 11) B1979. Of •?j?:?7 ? ? '? APC j '1?0?rl1T+ ; ? :? '??' :?. ? `?? _ ' ? i ?• ? ,t: REQUEST FOR ELECTRICAL INSPECTION ,r--„ EB-00001-04 :- _ ' See instructions for completing this lorm on back oT yellow copy. u 05448 " X'" Be-fdW Work overed by This Request ??I q (?o Nev, AdJ Rep. Type of Buildinq Appliances Wired Equipmenl Wired Home Range Temporary Service Duplex Water Heater Lightiny Fixtures Apt. Building Dryer Electric Heatin Commercial Bldg. Fumace Silo Unloader Industrial Bldg. Air Conditioner BulkMilk Tank Fyfhi Olher Tg_peciy thFr (Spacify) t Pr uecify Other 01her c:ompute inspection fee 6elow # Fee ServiceEntrenCeSize # Fee Peaders/SU6feeders # Fee Cirouits D. QC 0 to 200 Amps 0 to 30 qm s 0 to 30 Am s Above 200 Amps 31 to 100 qmpg 37 to 100 A 5 Swimming Pool Above 100_Amps Above 100_Amps Transtormers Irrigation Booms Part I/0thQL_Eaje Signs Special Inspection 523 0 T ? Remarks - .' • J O 'F'E ro .1 u Rough-in . ?te , I, he Elec Inspec or, hereby certif that the ab v Final patp ._ y o e inspection has been d v me e. Thls reauest void 18 monihs from (I.ertiftrtttr uf (Orrixpttnry (Litp of (Eagan lir.pttrtmPnt n# Building Jn,s.pertimc Thir Ce?ti ficate irsrud pursuant to the requisemcntJ o f Section 306 ot the Uni form Building Code catif ying that at the timc of itruann thia rtnuture wat in com pliance with thc varioru ordinancrr o f the Crty rtgulating building connrtution or ure. For tbt followinx: un Chanficedm SF DWG/GAR 7752 Btdy Pomri1 No. OQ;Uwvw Tyw R3 'rYw cm.uMdon Vn sim z.. NA zOMM nutfkt Rl O.a8wd;,g Joseph M. Miller A4&,,, 18133 Cedar Ave. So., Farm B„eaft,wa? 4635 KinQSburv Dr. L..hty Lot 26,Block 3,Beacon Hill By" AA? mte, February 25, 1983 ? I0 A CON?CYW. MJC[ \-1 v. IITAOIN US.P. This request void '?1t?4488 L?a(n i b3, 9,f-2con. l.-)-CU ? 3q q So 3a?so Reques) Date -" /-?/?"'?? Fire No.. Rouph-in Insuection ReUUfreA? ?Ready Nuw?Will Nu1ifY.lnsper.- to Wh ? Yes No r en ReadY LXLicensed Elec[rical Cnntractor I here6y request inspection uf above ? Owner electrical work installed at Street Address, Box or Route No. City 35 K 6 5 7W ut- •n 5 a en ' ectwn o. Township rtie or No Range No. Cou ?ty ? ? Occupant (PpINT) ?// 4t%Aa( Phone No. Z/753 s? o - Po rSupqlier, dt?tir I Addre s ? v la ? r (?/'r01?/I .? Electric I ontrac[y r(Company Name i?art1 f/e??afc ) Conlracmr's license No, Mailing AdJress IC ractor or Owner MakinB Instaila?tip n) v(V a aO3pa ? /? e se G ? qc . Authori iynatuYe nt ctor/Owner Making Installation) Phone Number MINNESOTq STATE BOAHD OF ELECTflICITV THIS INSPECTION REQUEST WILL NOT Griggs-Midway Bldg. - Room N.191 BE ACCEP7ED BY THE STqTE eOARD 1821 University Ave., St. Paul, MN 55104 UNLESS PROFER INSPECTION FEE IS o.._'_ 1a1 vk 107 Iril ENCLOSED. CiTY OF EAGAN _ ' -- 3795 Pilot Knob Roed Eagan, MN 55122 NO 7752 1 PHONE: 454-8100 BUILDINC PERMIT Receipt # '?L To be wed Fw SF DW/GAIt Est. Value $599 OOQ Date January 7 1 q 83 Slte Address 4635 Kinesburv Drive erecr [X occupanoy R-3 Lot 26 Block 3 Sec/Sub. BeBCOA Hi11 Alter ? Zoning R-1 parcel # 10 13500 260 03 Repair ? Fire Zone NA va Enlorge ? Type of Const. ? Name Jo9@ph M. Al?11e7CoABt.? IIIC. Move ? # Stories ; Address 18133 Cedar Ave. SO. Demolish p Length52_ b ci F8iID1IIgtOA phone 454-4753 Grode ? Depth--3-8 Sq. Ft.- 19 Nome O'lner Approvols Feet ZP Bu Address ?- ?:... Name _ Address I hereby ocknowledge thot I hove read this applicotion ond stote that the intormotion is torrect ond agree to comply with oll applicoble State of Minnesota $tatutes cnd City of Eogan Ordinances. Signoture of Permittee A Building Permit is issued to: J082jlh M. Mi1l@Y C.L ull work sholl be done in accordonce with oll opplicoblo Stote'? Building Officiol Assessment Permif 310.00 Woter 8 Sew. Surcharge 29.50 Police Plnn check155.00 Fire SAC 525.00 Eng. Water ConrA29sOO_ Planner Woter Meter 60.00 Council Road Unit 240.00-- Bldg Off . . nPC Torai $1739.50 on the expreu condition that and City of Eogon Ordinances. /? 9 ? OFFlCE USE ONLY This request void 18 monihs From wlidation date printe?d }i+Ihis box. i 7 Oli / J1' IIIIIiIIIIIIIIIIIIIiIIIIIIIIIIIIIIIIIIIIIIIIIIiIiI??????, Al? / %Itjk * 0 4 L 6 1 5 1 9* pLEASE PRINT OR TYPE Requesf Dafe Ro h-in ins on r uired? Yes ig pecf eq ? N. Inspection Olfier ihon RougMn: ? Ready Now Will Call I ('!ou must call ihe inspenar when eady) Date Ready: I, ? licensed conhactor Xowner hereby requesl inspecfion of the above electrical work at: Jo6 Addreu (Sneet, eox, or Raute No.) Ciy Zip Code 137 K17167 ' bIG.. C rY`1 Seclion No. Township Name or No. Range No. Fire No. County Occupant Phone No. CLl7 Power $upplier R qddress ? VAACeT* ,N 7_0•. Elttkicol Conhactw [Company Nome) yK,E_ O..?M? Conhocbr License No. Mosler 6c. No. (Plant Eled- Only) Mailing Address (Canhocfar or Owner Performing Insfal lafion) , ) n ? {?. 45 PYCXY'I?V Autlwrized Signature (Conhacl er Perfnrtning InaMlfeliaeJ? Pfwm No. ? !??d? j CJOI?69?7 o/ra sTew wnewn enov - ccc ?uemucnnue nu nerr nc vci i nw enov 416-151 REQUEST FOR ELECTRICAL INSPECTION 4:p 7 °< 91 btinnesota State Board of Electricity 1821 University Ave., Rm. 5-128, St. Paul, MN 55104 Phone (612) 642-0800 V Home Duplex Apt. Bldg. Ot}ie ? New Addn Commercial Indushial Farm Remod Re air Air Cond. Htg. Equi . Water Hlr. Load Mgmt. Other: Dryer Range Elec. Heat Tem . Service LO'w--lr Lt'??:Z "X" obove fhe work covered by fhis request. Enter remarks in this space and on the back of the white copy only. Calcufote Inspectioh Fee - This Inspection Request will not be accepted without the correct fee: Other Pee # Service Entrance Size Fee # Circui[s/Feeders Fee Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps Sireef Ltg./Traffic Sig. Above 200_Amps Above 100 Amps Transformer/Generator INSPECTOH'S USE ONLV TOTAL Sign/Oufline Lfg. Xfmr. Alarm/Remote Conhol Swimming Pool 6 I h h l l ll 6 d h d d d t bkd l Irrigafion Boom ere ce ins e i e e eckita insia aKon escri e aein on Roughln a es s f re oare Speciai Inspection ; Imestigative Fee F?? ,k oare THIS INSTALLATION MAY BE ORDEREU DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. REQUEST FOR ELECTRICAL INSPECTION ¢'""?r,4ee-ooooi-oe ll? See instmctions for completing this forrn on back of yellow copy. ?' 1. /5 9?? rv, 39877 "X" Below Work Covered by This Request "" ew y_dd . apt? TypeofBUilding AppliancasWired EquipmentWired Home Range Temporary Service Duplex ter Heater Electric Heating Apt. Building d er Other_(Specify) Comm./Industrial nace ! Farm Conditio ner Air Other (specity) Contracror5 Remarks' Compute lnspection Fee Below: # Other Fea # Service Entrance Size Fee # CircuitslFeeders Fee Swimming Pool 0 to 200 Amps 0 to 100 Amps Translormers Above 200 _ Amps Above 100 _ Amps SIQns Inspettork Use Only. TOTAL ?,. Irrigation 8ooms .Q d v Special Inspection ? Alarm/Communication THIS INSTALLATION MAY 8E ORDER ISCONJdECTED IF NOT Other Fee COMPLETED WITHIN 18 MONT i f I, the Electrical Inspector, hereby if h Aough-in 'It y t cert at the above inspection has been made. Final ate -?, OFFICE USE ONLY This request voitl 18 monihs imm - 77 R uest 0 e ' ??? Fire No. Rough-in Inspection Re ired? Yes C. No ? Ready Now ?Jill Notily Inspedor When Reatly? I rJ licensed contractor (54wner hereby request inspection of above electrical work aC Joress (s5 , ao? o? on No.s ?? v °`" Section No. 7ownship Name No, Range No. County Oc u RINT) p re.c 0oore. Phone No . Power SupPlier Atld2ss Eledric I C vactor (Company Name) 0{? wn(?? Contraclor's Licanse No. Mailinq Atltlres IContracbr or Owner Making inslallation) Aumorizetl Signature (ConiracbuOwner Makiryqj"te ionl \ Phone Numbet G3f- %.s17- MINNESOTA STATE BOARU OF ELECTRICI THIS INSPECTION fiEDUEST WILL NOT Griqgs-Mitlwey Bltlg. - Room 5-173 S' BE ACCEPTED BV THE STATE BOARD 1821 Universiry Ave.. 51. Paul. MN 55104 ? UNLESS PROPER INSPECTION FEE IS Phone (612) 642•0900 ?7 n? ? ENCIOSED. ?('GCl a,Cj 2005 RESIDENTIAL MECHANICAL PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 Please complete for: single family dwellings & townhomes/condos when petmits azc required for each unit 30. 50 Datc _?_ / f I / _?5_ Site Address y ?p_17jV -) r) ?5[ ,t 5_ r- Unit # Properh, Owner L, ()C)r 4- Telephone # ( (p<<j" j ? 3l-i n - '?? ?G? I p Contractor I4if Street Address Z. City State M N Zip 55C)ZL-1 Telephone# ((p5 1) y lpp- (oQZZ Band #• Expires: The AppGcant is _ Owner ? Contractor _ Other Add-on or alteration to eaisting dwelling unit $ 30.00 ? furnace _Additional iAReplacement air exchanger ? airconditioner _New /Replacement other State Surcharge $ .50 Total $ IF; 1 hereby apply for a Residential Mechanical Permit and acknowledge that the informalion is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan and with the Mechanical Codcs; that I understand this is not a permit, but only an application far a permit, and work is not to start without a pemut; lhat the work wili be in accordance with the approved plan in the case of work which requires a review and approval c .tr -) l7l4 gf?'-A "r Applicant's P ' ed Name 2005 COMMERCIAL MECHAIVICAL PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 Please complete for: commerciaUindustrial buildings multi-family buildings when separate pernrits are not required for each dwelling unit Date / / Site Street Address Unit # Tenant Name (if applicable) Previous Tenant Name Property Owner Telephone # ( ) Contractor Street Address City State Zip Telephone # ( ) Bond Egpires: The Applicant is _ Owner _ Contractor _ Other Work Type New Construction _ Underground Tank _ Install _Remove **see below Interiorlmprovement _ Install Piping _ Processed _Gas Nature of Work: **When installing/removing underground tank, cal/ for inspection by Fire Marshal and P/umbing lnspector PCI'Itlli FFRS: $70.50 Undcrground [aftic instaliationiretnoval $50.50 Minimum (includes State Surchazge) or Contract Value $ x 1% _ $ Permit Fee • If permit fee is $1,000 or less, add $.50 State Surcharge If nernut fee is over $1,000, add $.50 for every $1,000 permit fee $ Total Fee I hereby apply far a Commercial Mechanical 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 with the Mechanical Codes; that I understand this is not a permit, but only an applicaYion 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. Applicant's Printed Name ApplicanYs Signature Approved By: Inspcctor Date: :y?y?d:ai-J:u??.y..l.•.jiy?.{,. p.i:.?..i? .r?.???h•,yL?k.?.??:b?i.?:ia.a:.?it??:d..,»i`..,`,iv`.a,.? ???'?"r?;? i"il:r ?:?r,:??..a?.,; . .. . ....,.u.:??.,, a ?.. ("nt^;.i?iG:'i. ? .,?. .?..{...???.?,.? f . ...?..? ..:r.?r ?...L..... ?_} .?. ._,4 f . .. ... . i° ?. t .i .? .? i . .....•. i.•'?_. .i.l I %::.. :...!.I.fil:;.'y 't:t ? .i. ' ..h. '?ril.'r...... T,Ti ; `,:fiMic.n /`,1_;_:1:!:-c1 f ':F'.;...':ii:[:::c._ M_, 300 ``'j.?i:!. 4635 K.I.f`!(.;`ii?1:Uy;!Y Mf.)rJ ?i"'i'_i 9001 4635 1.;."J[1SFt1Ji::Y 0.,50 300 5001 4340 '......':.1.;"ii,;TO"! 25:,00 {..? .,? ;:. ?.. . .., .. ...?; .? " . i r..._,..., t , ? ...?u .`, . .. •.I`..y! .?: J ' .. ... . rr? ! 51.00 ?'r.;?it-i'f F?i?:'.'.:5'•: ;!,.?ru.;'r1'.:;! . _:;, . .. _. :: t:; .. ... j.? . j ,.?`.'i.., . .. ? ??r . ?I"j'??? i.J.`.ii"'i? ,..y.. _ .. C: ?' .. ia i?:;i,i;,.?.`..?.?,?y.bll? ? ?.??1,? ...r ?-?•. ? Yy.o.y CITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55122-1897 (612) 681-4675 SI7E ADDRESS: PERIVIIT PERMITTYPE: BUZLpING Permit Number: 029237 Date Issued: 11/18/ 9 6 4635 KINGSBURY bR L07a 26 BLOCK: 3 BEACON NILL P.I.N.: 10-13500-260-03 DESCRIPTION: REMARKS: FEE SUMMARY: t, AT Base Fee $25.00 Surcharge $.50 Totai Fee $25.50 , -r-v ? x.'R: t CONTRACTOR: -A pplic a n t -- 5 T . L I C OWNER: FIRESIDE CORNER ING 16331042 0001068 MOORE CLAY - 2709 N FAIRVIEW RVE 4635 KINGSBURY OR ROSEVTLLE MN 55113 EAGAN MN 55122 (612) 633-1042 (612)681-9655 (sAS) Permit Type FIREPLACE Osqrk Type NEW ??"' 434 ALT. RESIOENTIAL f APPLICANT/PERMITEE SIGNATURE IED B`SIG AT ??? CITY OF EAGAN 3830 PILOT KNOB RD - 55122 1996 FIREPLACE PERMIT APPLICATION 681-4675 DATE: DESCRIPTION OF WORK: ? CONSTRUCT NEW FIREPLACE: WOOD BURNING ? _ 1NSTALL GAS INSERT ONLY IN EXISTING FIREPLACE _ INSTALL GAS LINE ONLY IN EXISTING FIREPLACE O'THER: ROOM TO BE INSTAL STREET ADDRESS: LOT BLOCK SUBD./P1.D. ft APPLICANT: (circle one only) OWNER CONTRACTOR 1 ? GAS I hereby acknowledge that I have read this application and state that the information is conect and agree to comply with ail applicable State of Minnesota Statutes and City of Eagan Ordinances. PROPERTY Name: va (;F Phone #: 6 8 ? ( C :s -5 OWNER ? FIMr Signature: 4Z 3s-M,,-14-S4'3 V Z'1- '° Street Address; City: ? ? A ? Stat?? Zip: ? ? IQC.Lt c?'YD ??9?r GCJee..D ---d FIREPLACE Company: i ? Phone #: A?p 2° - INSTALLER Signature: Street Address :3tg?? -cAi ?14 License #: City,L&e2j\f5 JCCsC-Cj State: ? Zip: ???-? 3? GAS LINE Compaa INSTALLER Name: Signatu Street A City: State: Zip: - e% OFFICE USE ONLY BUILDING PERNIIT TYPE ? 14 Fireplace WORK TYPE ? 31 New ? 33 Alterations ? 32 Addition ? 34 Repair GENERAL INFORMATION Census Code. SAC Code REMARKS Chimney/flue must be inspected before concealing. ? CITY OF.EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55123 (612) 681-4675 PERMITTYPE: euzLQSNG Permit Number: 0 2 2 5 4 6 Date Issued: 11/ 17 / 9 8 SITE ADDRESS: P.I.N.c 10-13500-260-08 DESCRIPTION: PERMIT 4 4635 KING56Uf2Y DR LOT: 26 BLOCK: 3 6EACON HTLL BIa`s.ldi Permit Type #uild;int??rk 7ype FG Qc1cuparr?"c,4"- m? 4 BASEMENT FINISH NEW R-3 ??kp '` ? a(a... cvvt REMARKS: 1? c? ??????11 FEE SUMMARY Base Fee Surcharge TAGal F2E CONTRACTOR: OWNER: - Applicant - MOORE ALFREQ 4635 KSNGSBURY QR EAGAN MN 55122 (612)681-9655 ; I hare4y acknbwledge' that X #tave: infiarrnation 3,s carreet a»d -ag.ree ta cQmP1; statutes. and APPLIC ERMITEE SI(iNATURE $35.90 $.50 $35.50 'apP}.3ea'Gidn aii 4aI? R ??? ISS EU B SI ATU _..? REACTIVATE c nc t V, CtTY OF EAGAN PEwMIT #993 BUILDING PERMIT APPLICATION ?,?,^f• ?;J 4-tr681-4675 - - - ?------- SINGLE & MUL71-FAMILY - 2 sets of plans, 3 registered site surveys, 1 copy of energy calcs. COMMERCIAL 2 sets of archltectural & structural plans, ] set of specifications, 1 copy of energy calcs. enalty applies: 1) when permit is typed, but not picked up by last working day of month- P [! : hich request is made, 2) address is changed or 3) lot change is requested once permit ssued. Date l4?1i+rr/ 11_ / IG=t3 Valuation of work CTZ-- Site Address: ?)flv;?- o1-664 _?-,ZZz- STREET SU1TE # Tenant Name: (commercial only) LOT BIACK J SUBD. P.I.D. M ' Descri tion of work: el n,L5!+ -cFF 5 PCA' -? ???' The applicant is: Owner ? Contractor 0 Other (oe«?ibe). Name Moa ac-7 Phone &Fl -qA? Property LAST FIRST Owner Address ?6'35? 41rA6S9:rN bt1jjQ1 6Fk6'4rJ 9S_1ZZ--. STREET iTE 0 d?1N ZiP ?Sl 7- ? 5tate ? , City ?A? Company _ Phone Contractor Address License # Exp. City State ZiP Company Phone Architectl Engineer Name Registration r Address City State Zip Sewer & water licensed plumber . Processing time far sewer & water permits is two days once area has been approved. I hereby acknowledge that I have read this application and state that the information is ' carrect and agree to comply with all app icable State of Minnesota Statutes and City of Eagan Ordinances. Signature af Applicant: OFFICE USE ONLY BUlLDING PERMIT TYPE nw ,? ? ?y , ? G ? OI Foundation ? 06 DuPlex ? ll .?. Apt./Lod9in9 ? " 16"A _ ` ement Finlsh B ,.-? ? 02 SF Dwg. ? 07 4-Plex ? 12 Multi. Misc. 0 7 I w?m Pool O 03 SF Addition ? 08 8-Plex O 13 Garage/Accessory O 18 Comn./Ind. ? 04 5F Porch C] 09 12-Plex ? 14 Fireplace 0 ,19 Coimn.JInd. Misc. ? 05 SF Misc. ? 10 Multi. Add'1. ? 15 Deck O 20 Public Facility ? 21 Miscetlaneous WORK TYPE 31 New 5 ? 33 Alterations D 35 Tenant Fin ish O 37 Demolish ? 32 Addition ? 34 Repair 0.36 Move GENERAL INFORMATION . Const. (Actual) Basement sq. ft. NWCL System (Allowable) lst F1. sq. ft. City Water UBC Occupancy ? 2nd F1. sq. ft. PRV Required Zoning A Sq. ft. total Booster Pum p i? of Stories Footprint Sq. ft. Fire Sprink ler length On-site well Census Code Depth On-site sewage SAC Code ? APPROVALS fl Planning Building Assessments Engineering Variance REQUIRED INS PECTIONS ` ? Site O footing QCframing ? Insulation O Wallboard 1?1 Final ? Draintile O Fireplace Permi t f ee *3 .51p0 v.Lus:?Q,: Surcharge . 5-V Plan Review License MWCC SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment Pl. Road Unit Park Oed. Trails Ded. Copies Other Total: S SAC % 5AC Units CertiPiaate for: 9urvey for: ' Centex Homes Midwest Ine. Joe Miller Const. Inc. 8401 Darnell Road 18133 Ced.ar Ave. South ' Eden Prairie, Mn. 55344 Faroaington, Minreeota 55024 DELMAR H. SCHWANZ LANOSURVEVOR . . RplttorW UnEer lawi ot TM 5lati of Minn*soU . 2978 - 146TH STREET W- 80X M NOBEMOUNT, MINNHSOTA 660le PMOME Ni 428-1769 7 BURVEYOR'S CERTIFICATE 7,9 49 3i ?o ? ? V ? S / ? ? ? • ?y ?,. O I ??t oo ? % \ ? '?, ?:? 6o? 4 t????'" I iL ? W 36.z6 04 ? 88•33 dr,? G! n ? g? ? . o ao .. ?/ L • 4: " ?. 10 DO ? sco? -? 9ro4.0 9cA4 Tap Bwcx 1E4xj, ?9 1.z Ba6EtiT F.av- I hereby certify that this is a true and eorrect representation of Lot 26, Block 3, BEACON HILIS, acaording to the recorded plat thereof, Dakota County, Minnesota. Dated: danuary 23, 1980 GI fl6?oTFr6 V?oop k?ug ?ETAGK (di.?' fl?oTF,.S P¢.?Pos?C F?-F?JPrTIO? O beaoT Es IRDa MoNUmEcvT %,3.4 DEN ores V-X?sr,.w ????o?? " ? DEn?oz?s D?e.e??oN ?? SueFAc.? DRa?un,4?. . ??J?sen ? S4FOW ?E'o5£O FFDULbP. . ?OT STAK?i? ?TJ O? N?V?iM?¢?'w 9' ??DL? ?i f MINNESOTA REGISTFiAT10N NO.86m ¦ rAye.l . eA,. ;.. : EXTERIOR ENVP:LOPF. AV?I3AG? "U° COMPUTA_ TION ?::f? ,a,,?: • ; • . . y DATI3 -- ?? " t? PlIONE: 454-4753 _ ___._ I?? ?;ADORtiSSs 4635 Kin??bpr `Lane ?? '1???,???,: . ' i i •? ?' ? ?'' L' .. .. ? . . • ? ,?. ? JJ q?IV foot e? of, each ?p ,? ?; • i ?r1e working rqw? ? ?,; ?,? n - 4' ( , • ? ? ; r }) r f ??_ ?' ? ? #?, ?•. ??Yt t!"1?1;1 ? ?t???`.',?. ?`Ip?_ BQ. tt. % i?, t sa ?yp ?"1 :??? / v ? XmF,?? ?• Lt• X • f b ? !t?, ?....ry• ??li???'? i „?.;; .. . M? ' ? . . area abova flooz ? / Lo 9'S b F'. ,? rP ................... e ?Total?wall.window aroa? ' .•.. •••.. p, ? . 4.TObaY Qoox a1ct1O.. :............................... ....i.. .40 1% w?;• n • . . .. ...... ... ... . .r . •.? . c. : Sb,tal sliclina gia..s dop? arna 'r .....• 170 ? A. Tota1 firQplace wall area ............. .......... s."Total wall framinq area (average 10'k) .................. f. Total rim joiet area .................................. '- - , y. WES_ h?all. dzea above floor .... .............. .. . ...• : - h, wa].1 arei? above floor ........................' '_ - _?- wall area above f.loor .................... ... ? i wall area ubovc floor .......:.................. t'. • j` 7Cotxil expose3 foundation area = ? .?--- k. '.btal fo-ii:dation window area ........................... 1. Total net foundation area above grade ................. Determine "U" value of each wa11 segrnent (e.g. win8cw, door, each separate wall section) a ? r .. a .I; . ? ?. . ? , ,,.?. i ? i a. !?O X "U" . SS e ?o?D - . b 36 x c: . 40 x "u" ?--- d. ? ' - x ~vn - a e . 1?0 . X u?.?? • 0? a ? ?? f. X aU ° .? ? ° - 5' ?---- g 1 3O x ?,?,? . 049 =- ?&5-- h. X oU° _ -?? .L • X r 11/f0 ti j . X flull u c a : 3:. X 1 V 11?•11 / q_^ ?..._ /?A ? ? {Y ? A V • ?! s ?-s a,! ? Yf xtem #3 is the same a6• or less ChAn itcm Ill,.yot1 liave met the iatent nf S13C 6005 (c) 2. r ??, . . tttterfor Envelopo Average "U" Computation Poge 2 of 4 i. . _ , • . y Total exposed roof/cefling area = I??S y ' m. 1bta1 skylight area ............................ - n. Total roof/ceilinq framing area (averagc 100, /28 . o. Total net insulated roo£/ceiling area........... q70 Determine,"U" value for each roof/ceiling seqment . ' rt. - X PUts n ? p8 x uUit ia2?1 _ e 219 o. °I ?10 gfoUIl . OZ3 m ZZ.3 4.. ...................... 1bta1 ; Zf total.of #4 is the seme as, or less than H2, you have met the intent of S8C 6005 (c) 1. ' Alternate Building Envelope Design 7b utilize the total enyelope'system method, the values established by the s••.un of items i13 and q4 ahall not e greater than the sum of items #1 and #2. ?a a I ?: a.? • 6 + 2. ????-f' ° ;., ??.? ? ?- , 3. + 4. Z-5. z = Z4 ?. ?1 1 ? ? S' pLrAQ OF c:1 3o-3s ? ? L ? MeAL FT, expos?D WALL $(,,QG k." ? ZCo-? .3'S+2 CQ ?- 3 ? + ? o = 138 ;. F?..1?1 ? ? i ? ( I -+ 2 Co + ? ? +Z1o-? 7 + (? = 11 ? , ?:U l.l_ 1j ' Fvl.L2 ? - , ;:i e.fcKI ,A?CE ? . 1ZtM:l M Sa? . Pr, FkPoSED WA LL AZEA "'I ? 3$ X , S Ir ?a K S = 510 JC $ I:ut,L I X- .15 = ?'zg FuI.L Z 'f - x S = - ? _ R j / - ?IM :; 14l ?C ? = I?l To-rA L Mfla.;:t, GEIL(UC{ `?88? 2z.5????5= 10 -75 , w DKrS t1 ? D ooQ.s ? zo 38 243(o h?u ? ? ? 48 Za 18 2,a4 b < <' ? 32- -i%3? i' ? g ¦ ?ATIO ,fo gs r..14 V L)i +-5 , d ,. ..?... . _ ? , ., . ? • . , n/??+T `,^ e • ' i .. , ?L /`f+iLl•YV • • ? . ; ! " . . • • , . . . . . R-Valtic . , . . ? Con._rA?._ti•_ •?_ ` r . z• ?,?~ ???1 ?+ I'' ? .?..? ? tl ?v.i wa i?`?= ?• . 44 . ? • rl 17 ?xtcrlor nir film (g?Cal ??•P6 ' ?? I? ?`, ?? ` 1 . .. • . . , ?. ? """?."" 2 •- . , ?.? ? • . , . . , . . . . , . ?, . , ? . • . .. . pn,?,,,? ._ . , , ; ' . . • 0.61 . . ' 1. 2ntedor air film , cated. uaat tlav. ?. ' sti ? , ' • , ' ?. 4. 8xtorios ni`r i n Total ? : . , . . . , , S : .. , ? i5 . •. • • .. • • - , . . . .. „ . . . • , . , . ? . ' ? • ? . ? . COti y?/t?0.61 Inside air 2. , . 3_ • ` , q, ?.1? ?jdj ? ' S. Outsir fi.l:n? Tota? . . . • ' • • . • <-?'?''? `F 0.61 In.? c ai?r Pilm _?------- - • Z. . ' 3. rvsated 4 17 ? ke?t tlov ap.. 0. . , .. ? . • . ' • . , . ' ' 5. Outside a;ir film ?taL , . . . , . . ? • : . •, . ' , .nc. t6' . • _. _ _' -• - • • . • . : . • • ?- --== ?:. . ? .. .. . . r..- 0.61 , 3 ? 5 'v 1. Inaide air lilm . ? ' . ,,v .1•;?' ?''•? 3. • ?' ? ? .• ,.? '.: :..?:::-:' q 0.17 ?• r.??= ^?:~ 5• putside air film ?z' ?..?'r" f. ' • : : ? • • - Total ,?. ? ' _ . , ... ,. . ? Z . . . .? - ? . spaca 1 . . • ?,.•? •:••' . . • . . ' ? ? " • • • potct Vse addition.l sheets d icslcu!atlotig•i , . . "? - - pecded for detsils 'm .. . ?i ? ,• . . `? ,. . ? . .. t ? ' . ; r ? ?[!eL , . • ? • - ' , #1.4V QQ • . . . . . . , . ? -- _...._:. . . .... ? _. ?_ - ,y;?„ •l»?, " . '.i,???•l,. ??.'. ?, .?:. ?!1 (.'ii:_???,?.• 'v..ll l .?1 ?•.1 liil' 1 . .1 . . , ? .li r _V.ll.il.(" ? " ' , . . . . . . L . ; . _..?.• r? ri111:i1'.YU('.1 U'?l • ?' • (? . (i A _-..- _ . . e ...._ . ,? . ? ._ I ? : ....?. _.. .. ?j ?. b_O -( s..? .'?l I? ? ?? Lt ?.!¢? in - •- - - - - -_ (t . l'! . ( ??.'? . ~i Il. I'.:it.?1._ICIT _?.., -•-_"_'-. ??? t. (..i ? J_'?f)CF11 1 . ? WALT. 0.6A I'TC?. N1 TOPVII:W ol•' Y. 1ri4?•r•t?,r air_fi]_m____._ .- -? ' FxAru: • ;', .??? __ -'???4_:_.__._ ___.._ ?.C??c 4. [lb-____-------- ?Z ?r._? _,::___ ?? ?Ql.I?C?r.{=-- - ......__...?._...._-.?•?.17 ?0 6. Rxtar.t?r uir film ------ Tota l • I'IG. fl2 v=.o44 ? -----(j • 1. In?rri?r ,?ir fi,lm ,_,_._ ??,? ? , ...?.... ?,. _r.._-{l.) ??? . ,; z . L -:.-. _... ? 9 ? 3. zX Lo ?! Ch. ?--------•?? . ?:MEL?'?•? . _.. . __ -- - . . . ?? . .,. _ __ • "'? I /? ?? ? S.?Qlti?t-i c?.)'1 F:xl ?•1-1??Nj' .I;'. .1'ilU?l?-• •--? ??_ _ . :a1 ? -;?:' _? ___. _ _r?? '• .. .__ _.__..________ Tu'c,i 360 ., . . ' ?'t -- -• . A::i,;? v - . a4 I .. . .__ . .._ ? - <<?• . .. :??-??. I t?+ i•.''',1.' t)???µ 1_..._.'_'?. .. (I)? , l. ? ?+.i_ '.ti,r _iir ! ilm.--_...__ ......----•e--GFS ii ?....._.._ ._»__.__...? ,) ` ?O. ''1. ?Z?? -? I--?-1L. _....-?..--•- _.. --_....L!_?!? . ?? ? '',' , ?• `° _A7_ -. ? i;.,e't!.i i?„I '• P lt -----------_".. ., L ? ' 1.-__._. ___ _. ';') • •1. .__.... _ _.. . _._ __..-- -- ,. Ll I, ??;I 'r' A `•' . :••i: . 'Cyt::il z, t 3 A7 _i;t_nn?,. ??-- I ?--? • _..... __ --? ? " , ?, w ? I ? 4 ? , ' - ?rr :?._ , , • . - -- - ---?- I1j _{"??p? lcr , ? ` b •, _ ?''_ t . ' ?• .: ? , ?" f ? ? ? ? /I/ ??? ._ ? i?? ?? . ?, • I(I ? .._ _. .^_. _.. _``! ?.L' ? ` i;;( F• [i;. 1?4 ?/l 4 i` , . . ' `. // / i ??/ 4 3 ? ' ?/.? a• • r ? .?.{. '?tn V?t?1?!. tll`lit1l (Ifl(1 . ? ? ' PERMIT # I qJ ?5 3 RECEIPT DATE: EOOE RESIDENTIAL PLUM$IN6 PEfiMiT Af'PL1CATION crrY oF EAsM 3830 Pu.oT icxos ftn Please complete for: SITE ADDRESS: OWNER NAME: : KikEav,Mlv 5512E ?v 651-6$1-4675 single family dwellings, townhomes and condos when permits are required for each backflow prevenker for irriqation svstem NEAL-MOORE, LORI 4635 KINGSBURY DRIVE EAGAN, MN 55122 0- p T 9 ? 0 dT MaR 2 , zoo2 D i a By TELEPHONE #: (AREA CODE) INSTALLER NAME: IVVRGLVM 1''LUNiC5114t7 %rV. TELEPHONE #: (612)82T-4033 (AREA CODE) STREET ADDRESS: CITY: RAINAIG???? ? 55408STATE: ZIP: _ SEPTIC SYSTEM, new/refurbished (requires two sets of plans and MPC license) $ 100.00 includes $40.00 County fee Note: Additional consultant fees may apply • MODIFICATIONlALTERATION TO EXISTINCa DWELLING UNIT, lNCLUDING: _ Adding fixtures to lower levels or room additions, excluding water softeners and water heaters. $ 50.00 _ Abandonment of septic system. _ Water tumaround - existing dwelling unit (+ 518" meter if needed -$118) Other: _ RPZ: new installationlrepair/rebuild $ 30.00 _ lawn irrigation system Replacement/additional: _ water softener ic water heater $ 15.00 State Surcharge $ .50 TOtal $ 15, 50 I hereby acknowledge that I have read this application, state that the information is correet, and agree to comply with all applicable City of Eagan orcJinances. It is the applicanYs responsibility to notify the property owner that the City of Eagan assumes no liability for any damages caused by the City during its normal operational and maintenance activities to the facilities constructed under this permit withrir??ty?.?pro?rty?of-wayleasement. ??-' SI N RE OF PERMITTEE 1102 City of Eagan 3830 Pilot Knob Rd Eagan, MN 55122 (651) 675 -5675 www.ci.eagan.mn.us Site Address: 4635 Kingsbury Dr Lot: 26 Block: 3 Addition: Beacon Hill PID:10- 13500- 260 -03 Use: Description: Sub Type: e- Reroof, Siding & Windows/Doors Work Type: Reroof, Siding, Windows /doors Description: House & Garage Census Code: 434 - Zoning: Square Feet: 0 Comments: Fee Summary: Valuation: 9,000.00 Contractor: Capstone Bros. Contracting 216 North River Ridge Cirle Burnsville MN 55337 (952) 882 -8888 PERMIT City of Eaan Pictures are not acceptable in lieu of inspections. Smoke detectors are required in all sleeping rooms prio BL - Base Fee $9K Surcharge - Based on Valuation $9K Total: Applicant/Permitee: Signature - Applicant - Construction Type: Occupancy: Permit Type: Permit Number: Date Issued: Permit Category: Permit closed without required inspection(s). Letter sent to applicant on 3/18/09. (pf) to final inspection. When wall studs or ceiling joists are exposed, $177.00 $4.50 $181.50 Owner: A Clay Moore 4635 Kingsbury Dr Eagan MN 55122 0801 9001 I hereby acknowledge that I have read this application and state that the informa of Minnesota Statutes and City of Eagan Ordinances. on is correct and agree to comply h all applicable State Issued By: Signature Building EA083802 06/25/2008 ePermit Use BLUE or BLACK Ink For Office Use Permit City ofEa an 3830 Pilot Knob Road j Permit Fee: I Eagan MN 55122 I I Date Received: Phone: (651) 675-5675 I Fax: (651) 675-5694 I staff: - - - - - - - - - - - - - - - - J 2013 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: Site Address: Tenant - / /~/Jw ~ Suite Name:A! •l~/~~ ~ ' o /zt-.- Phon( : .ent/Owner.': Address / City / Zip: 4MI po Name: MILBERT COMPANY INC dba CULLIGAN WATER License 063031-WC 1801 50'm STREET EAST Contractor Address. City: INVER GROVE HGTS State: MN Zip: 55077 Phone: 651-451-2241. Contact: BILL VILBEkT Email: Type of Work __New _Replacement _Repair Rebuild Modify Space _ Work in R.O.W. Description of work: RESIDENTIAL Water Heater Lawn Irrigation Water Softener Permit Type RPZPVB) 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 $5.00 State Surcharge) $60.00 Lawn Irrigation (includes $5.00 minimum State Surcharge) $60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge) *Water Turnaround (add $200.00 if a 5/8" meter is required) $105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge) TOTAL FEES a00- CALL BEFORE YOU DIG. Cali 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 under0round utilities. www.gopherstateonecall.org I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. x-- d/il/rarn 12 1 Ax Applicant's Printed Name Applicant's Signatur FOR OFFICE USES z Reviewed By:tir ate Required Inspections. s Under Ground _Roughdn _Air Test Gas Test y _=SFina l y:? #