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612 McFaddens Tr. . INSPECTION RECURD ` CI Pl( OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55123 Date Issued: (612) 681-4675 S{TE ADDRESS: ? ; , , ias i', Allitt t4 . .t ?: i PERMIT SUBTYPE; i ,i APPLiCANT: 1?.l.r i r.ti TYPE OF WORK: NS f iP`}+ cl f, f % ( 7 .. , kfMh3;K s ? 'y C?n IJ f'4 [t{? ti f`Jf' '±i P1li 4'1 11 +i V Permit No. Permk Nolder Dete Teluphona # S/W PLUMBING Q HVAC ?S ELECTRi 4F 0 y? /fl ELECTRIC Inspectbn Date Insp. CommeMa Footings I 2 fp -,?3 t s Foundation 3 Freming Q Roofing Rough Pibg. Rough Htg. l5ul. Fireplace Final Fltg. Orsat Test Final Pibg. Pfbg, tnspector- iVoGiy Plum6er Const. Meter Engc/Plan Bldg. Final '0.Q ? bs Deck Ftg. Deck Final Well Pr. Disp. _ ??,? 3r7 3 PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA154057 Date Issued:02/14/2019 Permit Category:ePermit Site Address: 612 Mcfaddens Tr Lot:13 Block: 1 Addition: Lakeview Trail PID:10-44330-01-130 Use: Description: Sub Type:Residential Work Type:Replace Description:Water Heater Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection. 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 - Derek J Boeve 612 Mcfaddens Tr Eagan MN 55123 Minneapolis St. Paul Plumbing Heating Air 640 Grand Ave St. Paul MN 55105 (651) 228-9200 Applicant/Permitee: Signature Issued By: Signature • r r Wa*ficate nf ccc"anc? ?«? .? ?? ???? This Certiftcate issued pursuant to tke nqstirements of the Uniform Building Code certifying that a1 tlu time of issuance this strnctur+e was in compliarice with the mrious ordinances of the City negulaling building construction or use. For the followiag: useciuificana,: g' DW eiag. eemik No. 20338 OccuPa-Y IYW z?s Dish+m -11 TYPe Coasc VN OwoerofBuilding MCDCKMD 0ONSMMIDN ArWWmss1212 NXMMI PAY IRD, $'VMT$ , f LMTVHW IRAIL BWWhng ndmccc 1 ' n,oe: os/ »/q3 ' Budding oerwW P06T IN A CXNSPICUOUS PLACE Address 612 MTAnDIIVS rxnzt, Zip 5512 3 I.ot. _ !3 Blk 1 Sub r.nX.vrEw rRAu. THESE ITEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECI'ION. Date: Yes No Inspector: Final grade (6" from siding) Permanent steps (garage) Permanent steps (main entry) Permanent driveway Permanent gas Sod/Seeded grass Trail/curb damage Porch V/ Basement finish ? Deck Please verify with the builder the removal of roof test caps from the plumbing system and lhe shut-off of water supply to the outside lawn faucet before freeze potenlial exists. ' Contact engineering division at 6814645 before working in righbaf-way or installing underground sprinkler system. White - City Copy Yellow - Resident Copy Pink - Contractor Copy w REOUEST FOR ELECTRICAL INSPECTION ?EB.0?0y001-08 ? J?4 1 3?5 ? ? See instmr,eons for complating this krm an back of yellow copy. "X" Below Work Covered by This Request Av -dtl Rep, TypeofBUAding ApphancesWiretl EquipmeniWired Home Range Tempofary ServiCe Duplez Wa[er Heater Electnc Heahng Apt Building D er Other (Specify) Comm./Indusirial FurnaCe Farm Air Conditioner Olher(specJy) Contreclor's Remarks ? Compute InspecLan Fee Below: # - Olher Fee # ServiceEntrance5ize Fee # Crtcuits/Feeders Fee Swimming Pool 0 to 200 AmpS 0 to 100 Amps Transformers A6ove 200 _ Amps Above 700 _ Amps Signs Insvector5 Use OnN' TOT L Irrigation Booms ? ? T'A ` 1D' M,, Special Inspec6on / • V 20 .j- U niarm/Communicanon THIS INSTALLATION MAY 8E ORDERED DISCONN?CTED IN OT Other Fee COMPLETED WITHIN 18 MON I, the Electrical Inspector, hereby Rough-in oae ? ?i ??Y?z ? certi that the above ins ection has Ty P been made. Final Date 1/ J' Q OFFICE USE DNLV This requasl mitl 18 montM1Slmm -k oo/ c,T 98s 6 5 ? 3 S? Sov ReQUes ate No Rough-in Inspectron Peq d'+ ? Ready Now iil NaLty Inepeclor ? Vea ?NO Whe^ ° ? ?? IS icensed contractor rJ owner hereby request inspection of above electrical w ? Jo0 tlres ($y¢et Boz or ?? ;, v yQ ? Ciry / Section No Township Name or No Rarge No Cou OccuO ?? T P ne .? Power Sup ? . AtlTess EI r al Comra r ? om0? Y N me? Con ttor Lme a ner Making Iretallali ' 3 AN MINNESOTA STATE 80ARD OF EIECTRICITY THIS INSPECTION PEQUEST WILL NOi Griggs-MlEway BItlB. - poom S173 BE ACCEPTED BY THE SiATE 60ARD 1821 Unrversity Ave.. St Paul, MN 55100 LINLESS PROPER INSPECTION FEE IS Phane (612) 642-OB00 ENCLOSED '5qa13 RESIDENTIAL BUILDING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD, EAGAN MN 55122 651•681-4675 New CansWClion Reouiremenb • 3 registered s@e surveys showiig sq. fi. of IoC sq. ft oF house; and all roofed areas (20% maaimum lot coverage allawed) • 2 copies of plan showing heam 8 windax sizes; poured faund design, etc ? • 1 set of Energy Calculalions • 3 copies of Tree Preservatian Plen it lot platted after 71153 . Rim Joist Datail Optlorts selectbn sheet (bldgs with 3 or less units) DATE 2^?- _2-? SITE ADDRESS ?? ? Hc f?0v6',(s ? TYPE OF WORK re_- I2cy F Th-iial 4 1 z8.74- RemodeUReoair Reaulrements . 2 copies ol plan . t set of Energy CaIwlaUons for heated additions • 1 site survey for exlenor addilions & decks . Indicate if Irome served 6y septic system for addilioris VALUATION MULTI-fAMILY BLDG _Y /,N FIREPLACE(S) _ 0 _ 1 _ 2 APPLICANT '>F CA" V, U A-u?., STREET ADDRESS 7 CITY&eL?« STATE&,? ZIPiC331 TELEPHONE # 9SZ' L4 10 '`4403 CELL PHONE # 66-1 ?77,??SU44FAX # 99 1-470 ' LfY/2 PROPERTYOWNER 2-1?us?:e TELEPHONE# ?? -------------------------------------------------- ------------------------------ -°----------- COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category ' MINNESO'1'A RULES 7670 CAT'EGORY I MINNESOTA Ri ILES 7672 (q submission type) • Residentlal Ven[ilation Category 7 Worksheet Su6mitted • New Energy Code Worksheet Submitted • Energy Envelope Calculatlons Submitted Plumbing Conhactor: Plumbing syslem includes: Mechanical Contractor. Nlechanical systcm includcs: Sewer/Water Confractor: Air Conditionirg Hea[ Recovery System Phone # Phone # o??? L[?F??:Ll 00 ? AUG 12 2002 ---------------------------------- °-----------°-°---------° °------°--°----------------------°-----------°------° I hereby acknowledge that I have read this application, state that t i rmation is correct, and agree to comply with all applicable State of Minnesota Statutes and City of Eagan inances. ? " Slgnature of A ant ? OFFICE USE ONLY _ Water Softener _ Water Heater _ _ No. oF Baths _ Phonc # Lawn Sprinkler No. of R.I. Baths Certificates of Survey Received - Tree Preservation Plan Received _ Not Required _ Updated 4/02 r__ OFFICE USE ONLY ? 01 Foundation ? 02 SF Dwelling ? 03 Ot of _ plex ? 04 02-plex ? OS 03-plex ? 06 04-plex ? 31 New ? 32 Addition ? 33 Altera6on ? 34 Replacement Valuatlon Census Code SAC Units Nbr. of Units Nbr. of Bldgs Type of Const ? 07 OS-plex ? 13 16-plex ? 08 06-plex ? 16 Fireplace ? 09 07-plex ? 17 Garage ? 10 OS-plex ? 18 Deck ? 11 10-plex ? 19 Lower Level ? 12 12-plex Plbg_Y or _ N ? 20 Pool ? 21 Porch (3-sea.) ? 22 Porch/Addn. (4-sea.) ? 23 Porch (screened) ? 24 Storm Damage ? 25 Miscellaneous ? 30 Accessory Bldg ? 31 Ext. Alt - Multi ? 33 Ext. Alt - SF ? 36 Multi ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 37 Demolish (Bidg)• ? 43 Reroof ? 46 WindowslDoors `DemaliUon (Entire Bldg only) - Give PCA handout to applicant Occupancy MC/ES System Zoning City Water Stories Booster Pump Sq. Ft. PRV Length Fire Sprinklered W idth _ Footings (new bldg) _ Footings (deck) _ Footings (addition) Foundation Dmin Tile Roof Ice & Water Final _ Framing _ Fireplace _ R.I. _ Air Test Finai Insularion D INSPECTIONS FinaUC.O. FinaUNo C.O. _ Plumbing HVAC Other _ Pool _ Ftgs _ Air/Gas Tesu _ Final _ Siding Stucco Stone _ Windows (new/replacement) _ Retaining Wall Approved By , Building Inspector Base Fee Surcharge Pian Review MC/ES SAC City SAC Water Supply & Storage S8W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other Total INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55123 Date Issued: (612) 681-4675 SITE ADDRESS: APPLICANT: LOT: 13 BLOCk:: 1 C,1L hlCf'At1L7EiVS 'PR mCDOfJALp CONST INC i (?IU=`d.Lt-W TRAlL (612) 588-7061 PERMIT SUBTYPE: 5 F DI-JG TYPE OF WORK: New aurLnaNc n; c) ;:>,a 0r? j1e J9s INSPECTION i"(JU TIiVG D. . PRAFI [PIG D• 1NSULA7SON FIDlAL P1It`-J'I h CF RFM riF?R:>: " u W PI.Rf? - F7_VE STAft GalHr WR'J 1- L? ? CITYOF'EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55123 (612) 681-4675 ' SITE ADDRESS: P el IV,: 1 0 -.Q!!3'3Vi -130 -(91 PERMIT 3 .? y ?-y3 PERMITTYPE: B uiL oI n!6 Permit Number. 0 2 0 33 g Date Issued: 0 21/ 1 b j 9 :i 612 111cr-noDEtvs rR i_oT: 1:?? 5 L nr.K: t Lf1KEVIEW 1"RFlIL DESCRIPTION: ?9uildi'no Pri°mit 1'ypr? `3F DWu 8uiltiing'Work -fype t<EW ' UBC Occupanby ft - r: hi-1 ? ConsLruction fy,p:• v-p! Zoning R-1 Bu.ilding length . 51 Builclin4 Width ? 4a -= - 1 i-.,r , •,-_-•i-- --' -? REMARKS: S r? w ?- t3 P, -I- lv? srA 9 p L b 6 HRr,r FEE SUMMARY: vALuA-r7otv iitl5'L' i^ 1-. n R ? ti- 1 ?_'w 5urctia rye Sf1C SAC 'II. S r4 [' U n .i. Subcot, al S6A h.5G9 47V).,3? $51 .00 9:750, 0 0 10N ``ol,iio/.79 $ 10 2 , 0 0 0 IrITSLLLLi?NE OUJ TpCa]. I''t;?: ?11 ? 4 a . s 0 'Dv r1 qs?y ? CONTRACTOR: - np1>>ic,?n.r "r,OWNER: MCCIGP?IALC) CONSi iNC 168871?G1 Pi0m2376 MCUUNftLD CONS7 1272 E;LUFRJi_I. 3i1Y Rll 1212 f31.UE6ILL FAY ft0 BURNSVILLE hl!Al h5 3 3 7 8Uf"tPdSVTLLE MR 55337 (51:L) 68S-70 G1 EP, 1- 2 164:18 -70 G1 I herebyy acknowledge ChaL ? hsve read this applir..ation and state Chat the informatioii is corr•ect aiid agree tu comp.i.y with all applir.ab)c St.ate of I4n.' StatuCPS and City nt Eagan' Ordinancps. I L _ A(Sil fj I\n i P? I rJ?? APPLICANT/PERMITEE SIGNATURE -?UED B: S GNATUR REACTIVATE _ P?RMIT af ti + aumi CITY OF EAGAN 1993 BUILDING PERMIT 6$1-4675 $3,'4' I2.W'_3 APPLICATION FEB 1 s aeco aQz-rq ?IEE 2 " RECD SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy calcs. COMMERCIAL 2 sets of architectural & structural plans, 1 set of specifications, 1 copy of energy calcs. Penalty applies: 1) when permit is typed, but not picked up by last working day of month in which request is made, 2) address is changed or 3) lot change is requested once permit is issued. Date Fe b, /15/ 73 Yaluation of work ODO Site Address: & '! FA?+aev--5 lh - STREET SUITE # Tenant Name: (commercial only) BIACK _L FsuBD. ? A P.I.D. * of work: ; ? F[Description applicant is: ? Owner ?Contractor ? Other (Descri6e) Name Phone Property LAST FIRST Owner pddress STREET STE N City State ZiP Company C L?nAJA a Phone (o ? ? - 7 0 (oV Contractor Address 1a\? R\?e (3'l\ A?.v License #Q1)0937Cp Exp. /d City oRn tvA P State na ZiP Company Phone Architect/ Engineer Name Registration # Address City State ZjP Sewer & water licensed plumber Processing time for - sewer & water permits is two days once area has been approved4 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. , ? ? (?.nK1° R ti C l- Signature of Applicant: OFFICE USE ONLY BUILDING PERMIT TYPE ? 01 Foundation M02 SF Dwg. ? 03 SF Addition ? 04 SF Porch ? 05 SF Misc. ? 06 Duplex ? 07 4-Plex ? 08 8-Plex ? 09 12-Plex ? 10 Multi. Add'1 WORK TYPE CW 31 New ? 32 Addition ? 33 Alterations 0 34 Repair ?1 ? ' ? 11 Apt./Lodging ? q aseler?inish ? 16;?B ? 12 Multi. Misc. ? DT17 Swim Pool ? 13 Garage/Accesso ry ? 18 Cortm./Ind. 0 14 Fireplace ? 19 Cortm./Ind. Misc. ? 15 Deck ? 20 Public Facility ? 21 Miscellaneous ? 35 Tenant Finish ? 37 Demolish ? 36 Move GENERAL INFORMATION Const. (Actual) V?N Basement sq. ft. MWCC System YE5 (Allowable) V-N lst F1. sq. ft. City Water YEs UBC Occupancy 2nd F1. sq. ft. PRV Required Zoning Sq. Ft. total Booster Pump # of 5tories Footprint Sq. ft. Fire Sprinkler Length 5 I, On-site well Census Code E? Depth y g, On-site sewage SAC Code 6/? ?a 5 ? i q. r ? APPROVALS ?cs?s "u,`F? ? Planning Building Assessments Engineering Variance REQUIRED INSPECTIONS ? Site ? Footing D' Framing ? Insulation 0 Wallboard ,0 Final ? Draintile ? Fireplace Permit fee veiuacion: g ? 02, Oo D Surcharge Plan Review GARAG6; 22X2z = 418(4)t I4O= 9,744 License MWCC SAC City SAC 3 f Water Conn. Water Meter ?'?????' ZC?3?S r Acct. Deposit " IsrF?„p,• S/W Permit 5/W Surcharge Treatment P1. BSM7_ I 35 7 Road Unit IlitKlbV?=!(o Park Ded. Trails Ded. 1'/?Xg : /L Copies Other 1x8= ? ?-- r73 t459 Total : ? ?j?(, X 53= Sac x 100 SAC Units I P.03 * * ** * PIONEER * engineeri ** * * LANp $(IRVEYOR: • iwNo rur+Hen& • uv; 2422 EntOrpriae Qrive Mendota Heights. MN 55120 ;612) 681-7914•Fox 681-9488 625 Htyhway 10 Northeast Bloine, MN 55434 ;612) 783-1880•Fax 783-1883 Certificate of Survey for: MCDOC1C1Id COCIStt'UCtIOn InC. House Address: McFADDENS Tf2AIL.EAGAN,MN AA.-..-lel Al....,e• 92-..647 11? 9aa.d 132.43 ° 8t'00'07" ? - - -_ ,? Lo ? o lJ ? L J '._: ti 9G0.0 Denotes Existing Eievation PRDPO5ED HdUSE ELEVATION . ooo. Denotes Proposed Elevation Lowest F1oor Elevotion:9?a. 1? penotes Drainage & Utility Easement Top of 61ock Elevation:94 ,? - Denotes Drainoge Flow Direction -o-- Denotes Monument Garage Slob Elevatlon:946.33 -•- -....B- Denotes Offset Hub Bearings shown ore assumed LOT 13, BLOCK 1 LAKEVlEW TRAIL DAKOTA COUNTY, MINNESOTA 1 herebY car[i}Y that this iurvey, plan or repor( waE•P..r`e,pored bY me or unc?e• my dircct cup rvl ion antl thel I am dulv Repistered Lend 5urveYor unde+ Ihe 18w3 oi 1he Stb[e of Minnesole. Dated tnie ,'?YS dey of 'r-S It:4 • 11I1GI1_.-?nl$4t ROBERTB. i20 92406.03 ? ? 6 ? D D 0? B?0 D D? ?0 0 LOT iIIR?EY CSLCICI.IBT tOR ItL8ID8NTI71L nate oi survep: 2 DOCQISENT BTAND ftne • Reqistered Iand Surveyor sigaature arsd company • Suildinq Permit 1lpplicant • Legal description • 1lddress • North arrow and bar scale • • House type (rambler, valkout, split v/o, split sntry, lookout, etc.) ' • Directional drainaqe arrows vith slopa/qradient !. • Froposed/existing sever arid vater aervices • Street name • Driveway LLEVATIONB 13 CI ? 0 D 13 Existinc • Sewer 6ervice • Lot corners • Top of curb at the driveway • Elevations of any existinq adjacent homes BroDOSed 0 • Garage floor 0 ? • First flooz ? Lowest exposed elevation (walkout/wis?dow) Property corners D 0 • Fzont and rear of Aome at the foundation r 0 ? D • Easement line 0 ? 0 ; xwL HWL D QK 0 • Pond f designation D V0 ? Emergency Overflow Elevation DIKENSIONB ' ? D • Lot lines ?1 ? D • Right-of-vay and street width (to bnck of curb) Cr D p • proposed home dimensions includinq any propoaed aecks, overhangs qreater than 21, porche6, ttc. (i.e. all structures requizfnq permanent footings) 8?D 0 • Show all easements of record and any City utilities vithin those easements ?0 0 • Setbacks of proposed structure and setback of adjacent 0 ?D exiatiag homes Aetaining wa rements, if any • Reviewed: ? nme / Date Octobez 1992 MINNggOTA RTATB ENERGY COD CULATIONa BASEp ON C{IAPTER 5 OF TIIE ?f , MODEL ENERGY COPE - 19Q'? SpIT?ON ?L v Adoption Effectiva te Type A2 (Residential, 7 stories or lesa) (over 3 stories) (Othar) NoTEt Comp]gtg oages 3 end 4 firet. I I G?i?j ?S?? C.iF,dFRAIa_IHFORMATTUN l U 1. Building Perimeter ?? ft. 2. Wall height (ground to eave) 11 ft. 3. 1. X 2. (above) grose wall area_j. 4. Huilding dimensiona (L) `X (W)_ 5. Sq. foot area of rim joist - Floor .__In Z 12 O(Dsg.ft. '? =??sq.ft.roof & floor area ois size 2 x 1D X (Perimeter) _ _?sq.ft. 6. Doors - Area l' Thickness in U. factor A441 Type of Construction Perimeter ft. . . Manufacturer 7. Totel door's perimeter B. Windows: Manuf U factor_ C,5 _,.... t-F- te approved ,TYPE " SIZE AREA (Sq.Ft.) NUMBER OF TOTAL C EACfI UNITS SQ FEET 9. Total sq.ft. Glass v ftp&5 lo. Fireplaca area: Width X Ileight = X = sq..ft. . 11. Exposed [oundation: fieight X Perimater?4- X11,91)sq.ft. COMPLETION OF TIIIS FORM I9 RE(?UIRED FOR ALL NEW CONSTRUCTION, lIAJOR REMODELING AND BUILDINGS BEING MOVED WflERE ENERGY, OTt1ER TIIAN TI[E MINIMAL COD$ ALLOWANCE, IS USEp. -1- - Building Classificatlons Type A1 (single Family & Duplex) 7?" 2 12. Framinq area = 10$ of groee wall aren. 9 13. Gross wall area !?o[ % sq.ft. Window area A sq.ft. U windowe = r? UxA Rim joist area A ffi,lLeq, ft. [1 rim joist= , 041 UxA =.16, 2-d Door area A ? sq.Pt, U door area= UxA =?? Z _ Other doors area l+-4-0--sq.ft. U other doors=UxA = 117-g Exposed fndn A10M.,/' sq.ft. U Poundation= I0 UxA =62 Framing area A' ? J sq,ft, U framing area= k!l lT UxA Net wall area XI2195sq,ft. U wall= ? UxA = (1311) TOTAL . . . . . . . . . UxA Z 14. Grose wall area x 0.11 (A-1 eingle Pamily 6 duplex) = allowable UxA/Code (13. above ) x 0.23 (A-2 other residential) x .23 (other buildings) x .28 (oaer 3 atories /? BTUiI must be larger than or same A x U Code `1 e?.YJT °F. as 138 above 15, Ceiling fraiaing area (Af) equnle 10% of ceiling area 15A. Gross ceiling area = (L) Ole_x (W) MI_sq.ft. 15B. Joist area (Af) a 10$ ceilinq area sq.ft. 15C. Nat ceiling area (Ac) (151? - 15H) ? ? 1o sq.ft. U ceiling x Ac _ ?? ??i/ x l ` _ U framinq x A f = Pg,4 x, 15p. TOTAL U X A ............. ........... . l0 16. Ceiling area (15A) G(A-2 ( 1 aingle family & duplex) = ellowable UxA/ ?o other residential) x^8-9,G.( other ) I??y O2? 35q S BTU}i must be larger than or same A(15A)? x O Code? m ?? °F. as 15D above NOTEt Use U ant9 A values obtained from pages 1, 3 and 4. QEBTIEIQBTIQPi: I hereby certify that I have calculated the "Ull factors and "R'I values hereln and that tha building here deecribed meets or exceeds the State of Minnesata 8nergy Coneervation Act. Date 9lgnature - - - - - -- ? ? <o Z5;43 -t-Zl:7 726? -- ------ ----- --- ----- -- - ? 1? - - ? -- -- --- - - -_ - - _ r.. - ?'. S .. t7--- II =-?j - - _. ?'L? 5 _ lo -- - __ Z?x?2??=--?"L----- ------=-?I? -=' --- - --- ---- -- - - - -- - Z4Z?ZS - -- ----- -- -- - - - - ---- --- - S - --- -- ---- ---- - ---------- -- - _ _. -- b -- - --- - ---- - -. _ - ??-- .- --__ --- -` ?? -- --- - i9L wJ 2 st -0 5?(--a - - - -- ---- - - -- - _ -- - --- - - - ----- ` ----- - ? - --- - - NAL6 ' SECTION STUD SECTION SECTION. RIFI JOIS? u_InwL 6riL6ULM11U113 R YALUE fnslda alr film ,68 Ineerlor wall ' .45 [naulstion 1,1.0 Shea[hlog Z ,p(p Slding , (p1 Outelda alr film .17 R 70TAL Z-3 , O 3 . 4?7 3 Inelde.alr film ? .68 ' Interlor wall . 45 41, atud . R, 46t" (p-rj (Frnming) U . R . Sheathing ? Z.OlO ?p Slding r,? • ? _= Outelde air film ' .17 lt TOTAL I C,> . -rj ?j- ? "r1feY*?e. Re 6A Intetlor wall Iniulatlon ?ell ) U . R . ??REatl? 7- x? terlor wall cover n ' Exterlar air, fllm' R ..17 intcrlor alr film Ra .68 insulstlon ?q. DO 'ly Ineh eoft waod Rc1.88 (R1m JOISt) Sllesthing C?(o Exterlor uall covectng .IO? I Exterlor alr film it- ,17 R TOTAL interlor olt film R= .68 , lneuletlon ? Fbunda[lon Exterlor alc [Llm B' .17 F TOTAL I 3- 15 'Exposed 8luck ... .. \ `+rade 1F U • 1? ° ? (Fdn.) U = R = , 07(? -? 3. U VALUE (Nall) U . R : .. •. CEILiNG W[TN VENTED ATTIC SPACE ABOVE . R VAEUE R VALUE FRAMING. CEILIHG ? 0.61 Air F11m 0.61 ' 11 3?0 [nsulation 45.'0 4- 4.'!;,8 Jo1st . 000 _ fl. •?J'(o Ceiling 0.61 A1r F11m 0.61 M-Z . 1(O Total R 4(p . ? ? • .02.3 ue? ,ozl _ • FLAT ROOf OR CATNEDRAL CEILING • ' RVaTue R 'IALUE FRAFIIHG . CEIIlNG 0.17 Joist (stu Insulation A1r space Roof decking Insulatlon Bu11t-up roof Outslde a1r f11m 0.17 Total R 1 • U .R 11ndoH lnflltratlon .5 cfw/Ilneal foot of crack . tesidentlal door inPiltratlnn 0.5 cfm/square foot or door and minlmum code requir.ement •lon-resldential door lnfilli•nkion 11.0 c(m/lineal foot of crack -??, • 0.61 Inside air f11m 0.61 Ceiling__ - Ib 12" concrete block no lnsulatlon =.41 R 2.1 - Jb 12" concrete block insulcited cores ¦.26 R 3.9 ly 12" 1 iglitweiylit block I - .32 R 3.1 . !b 12" lightr,elqhl block Insulated cores - .12 R 8.3 • 1 single glass = 1.13; witli storm wlndow ,54 1 double glass = .55 J lriple glass - .41 111 exterior walls and cellings must liave a vapor barrler (0.10 perm max:). :apor barrler must be on llir. 1nslde (licated slde) of riall. iapor barrlers oF I.he polyathelene thln t11m have no R value. 4. . . ? .. A:4:7N?(X k??Y, Wunk*?1'?i;,F`K?*•1, Rkc.:?Y+," Yr:•ttX*: A,J:7k7k?W.K7k`:• ? C.TV ()F' A::i?td , . ' . ' ? , 5. '?GySWa.h.tt' J.; 'RN?'`•lA,l... NCi' , Umir? c5:iva42 Wa„ sI IP5(:N' F?' ::,1m, , R55,.900i C,L2 iCF'P*'r;E,d Ti; ' L.50- ' F . - ' 7o+a't Rec ._?.;,t ? OCl CC,'1i.E38'n. . ., ` i *?W?F*yf.?A?YW :vx;x?Y?..;aR:Y,:ki??'?b %'°%%'?'x ?-;:?K??k*?s1?.W.1?cNt'. ? , 'y .• ?.?.z. 1999 BUILDING PERMIT APPLICATION (RESIDENTIAL) " CITY OF EAGAN 3830 PILOT KNOB RD - 55122 S ?? 651•881-4675 c cJJLA& - New ConshucHon ReauhemeMs RemodellReoair Reauhemenh ? 3 registered aNe surveys showing sq. H. of lot, aq. N. of house and cll rooled areaf (20% maximum lot coveraae albwed) ? 2 copies of plans (show beam 6 window sizes; poured fnd. design; etc.) ? 1 sef of energy calculatlons > 3 copies of hee presenaHon plan B IW plaMed alfer 7/1/93 DATE: dp I2?' /99 DESCRIPTION OF WORK: C) c) 2 coples of plan 1 sM of energy calculatbm tor heafed addNions 1 stte survey for exterior addHlom 3 decW CONSTRUCTION COST: 2 '5?00 - STREET ADDRESS• (O / G au / LOT: /3 BLOCK: SUBD./P.I.D. <' J Name: vfA"?XON/Z/v /Y Phone #: ?' D 9?? PROPERTY L°'t F? ? OWNER Street Address:- lcQ??e;115 ? ? - City State: ?N Zip: S Z^ ^-- s?lF Company:? Phone#: (area code) CONTRACTOR Sheet Address: License # ExP• City a01 a/'1 State: Zip: ARCHITECT/ ENGINEER Company: Name: Telephone #: area code ( ) Stree'fi Address: Registration #: City State: Zip: Sewer 8, water Iicensed plumber (reaulred tw new conshuctlon onlvl: Penalty appltes when address change and lot change is requested once permM Is issued. 1 hefeby acknowledge that I have read ihis applicaHOn, stafe fhat the InformaFio is correct, agree fo comply wRh all applicabl Stafe of Mlnnesota Statutes and CNy of Eagan Ordlnances. f Signature of Applic OFFICE USE ONLY Certificates of Survey Received _ Yes _ No Tree Preservation Plan Received - Yes - No _ Not Required OFFICE USE ONLY BUILDING PERMIT TYPE ? 01 Foundation ? 06 4-plex ? 11 10-plex ? , 16 Fireplace ? 21 Porch (3-sea.) ? 02 SF Dwelling ? 07 5-plex ? 12 12-plex 1 17 Garage ? 22 Porch/Addn. (4sea. ? 03 1 of _ plex ? 08 6-plex ? 13 16-plex ? 18 Deck ? 23 Porch (screened) O 04 2-plex ? 09 7-plex ? 14 Apartments ? 19 Lower Level ? 24 Storm Damage ? 05 3-plex ? 10 8-plex ? 15 Lodging ? 20 Pool ? 25 Miscellaneous WORK TYPE ? 31 New ? 35 Tenant Impr ? 39 Gas Line Only ? 43 Siding/Soffits/Fascia ,tf 32 Addition ? 36 Move Bldg. ? 40 Gas Insert ? 44 Windows/Doors ? O? 33 Alteration ? 37 Demolish Bldg." ? 41 Wood Stove ? 45 Fire Repair ? 34 Repair ? 38 Demolish (Interior) ? 42 Reroof * Give PCA handout to applicant for demolition permit GENERAL INFORMATION +.:orist. (Actual) 'S - ^?- Basement sq. ft. Census Code ? (Allovrable) S, --? Main level sq. ft. 5AC Code 6 I UBC Occupancy U-7 sq. ft. No. of Units O Zon;;ing 2• I sq. ft. No. of Bldgs #of Stories sq. ft. MC/E5 System Length sq. ft. City Water Width Footprint sq. ft. ?Ml Eh Booster Pump ? PRV Fire Sprinklered APPROVALS Planning Building ? Engineering Variance Permit Fee O-P- ?? •?? Valuation: $ Surcharge ? Plan Review License MC/ES SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment PI' Park Ded. Trails Ded. Other Copies Total I 2A `j .0 O ?ouN?n?b,J bN ?y/' , SAC Units % SAC q 2422 Enterpriae Drfve L?Np $?1R Mendofa Heiyhts. MN 55120 ngineermg UND PLANXCIiyyORS ? fANI ENGMEEkS ?B1z, S81_1.914• Fox 881 - 9d88 ?'"+ouAre MeuurecTS ** 7? * 6Z5 H(yhwoy i0 Norlheoat Blaine, MN 55434 Certificate af Surve ?612) 783-?880•Fox 793-1883 v for: McDonaid Constructi n inc. House Address: _(?l L_M??=A DENS r Model Name; 92 642-- ?A?? FA'AN MN N/IcFAUDENS rRaiL 1?c?43•? pystesGa qA3.b _ l a,?rf3 0 ? 3040'2$' 1 R = 134.11 7J a0. ? ? r- - -? y 30.00 ? ? ! f ? ? ?A° ; ...a? __ qh4?7 i ? I A] i? ?? S? qV ? 71 MI 00 ? .6 r n I N y,0 yNIVEW4Y 22.00 ? ? f CARAGE _ Cr CRS. SwsmeJl'- DROPOSeO HWSE I MODEL/ 91-612 `c N 881 ? 9414 ? / r . ?1 ?--??' kLa? • ? 9 as.43 IP 1 :q43s2•..} . 4 ? q41-? I I' 1 r? ? ? . / - ......, ..._. x ?r.,,i N?'`..:()'.?•-, Si> ? ?JZ4J ?d? . .., . . ?'07° `L4s 4 c ? 1 1co.o Denofes r t.,er P77) Existing Elevotion ? " K; La ,r, f,-.. r-^ 7 ?j I•,:; *"'A ;' ?? Denotes - Denotes Proposed Elevotron Draina e & ? PROPO5ED HOUSE ELEVA170N Denotes g Utility Easement Drainoge Flow pirecti Lowest T Ftoor Elevation; ¢ Denotes on Monument op of B1ock Elevation: ? ?? Denotes Otfset Hub Beorings shown or Garage Sla6 Elevatlon:946.33 T 13 e BLaCK 1 assumed - , LAKEVIEW TRAIL UAK07q COUNTY, MINNE507A CbY terli(Y lhit thi= iUrveY. Plan or report wa s PrePaw bY Mr or un lews o! fhe Swee of Mlnnesota. Dsted rAh ?Pr mY di A?? Ct W ?O rYi ion D antl thal t.am du1Y Ropittrred Land Surve or , , t g ), / / y 1 _ , r) ingh=.-?nia± qR3.49 JCA J v cn tJ ? OR. t M ; l ` l ? . ; J ( ?. a ? e ? I ? t _ t Y '. -I ` -j . 1 szaoa.os PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. AISO, FOR TOWNHOMES AND CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNTT. NO. FIXTURES EACH TOTAL SHOWER 3,00 ?, Go WATER CLOSET 3 ? ? BATH TUB .,, ? o LAVATORY 3.00 ?, 00 ? HITCHEN SINK 3.00 -? 00 LAUNDRY TRAY 3.00 '3 00 HOT TUB/SPA 3•00 -r WATER HEATER 3.00 -22L2 ? FLOOR DRAIN 3•00 ?oo GAS PIPING OLTI'LET • minimum - 1 3•00 50 1 oo 0 Y 3 ROUGH OPENINGS . , WATER SOFTENER 5•00 PRIVATE DISP. • Dak.Cry.lic. 15.00 U.G. SPRINKLER • home under const. 3•00 ALTERATIONS • to austing 15.00 WATER TURN AROUND 15.00 STATE SURCHARGE .50 TOTAL: SITE ADDRESS: OWNER NAME: G e v, INSTALLER: i V S,?G U 1 ? i c C ZIP CODE: PHONE #: ( 6'r)) y_-S, 7 - SIGNATURE OF PERMITTEE 1993 PLUMBING PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PIIAT KNOB RD EAGAN MN 55122 (612) 6814675 PLEASE COMPLETE FOR ALL COMHERCLAI,/WDUSTRIAL BUII.DINGS. ALSO FOR MULTI- FAMILY BUILDINGS WHEN SEPARATE PERMTTS ARE NOT REQUIRED FOR EACH DWELLING UNTT. _ NEW CONSTRUC110N ADD ON REPAIR WORK DESCRIPTION: CONTRACT PRICE: FEE: 1% OF CONTRACT FEE. STATE SURCHARGE $.50 FOR EACH $1,000 OF FEE MINIMUM FE& $ 25.00 CONTRACT PRICE X 1% STATE SURCHARGE TOTAL SI1'E ADDRESS: $ $ TENANT NAME: STE. # OWNER NAME: INSTALLER: ADDRESS: CITY: PHONE #: STATE: ZIP CODE: FOR: CITY OF EAGAN pppLICANT 1993 PLUMBING PERMIT (CObII14ERCIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN MN 55122 (612) 681-4675 I 1993 MECHAIVICAL PERMIT (RESIDF.NTIAL) CITY OF EAGAPI 3830 PILOT KNOB RD EAGAN MN 55122 (612) 681-4675 PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNTI'. ? NEW CONSTRUCTION ADD-ON A/C ADD-ON FURNACE DATE HVAC: 0-100 M BTU ADDITIONAL 50 M BTU GAS OLTfLETS (MINIMUM 1@$3.00 EACH) 3 ADD-ON/REMODEL (Exts-r[NG coNST[tUCnox) STATE SURCHARGE TOTAL SITE ADDRE: OWNER NAIv INSTALLER: ADDRES&__- C1TY:? TELEPHONE i FEES $ 24.00 6.00 cc $ 15.00 .50 #:(r)E?'i-20LI.- STATE: 1 1`1 Yl ZIP CODE: L ^8 T Q PLEASE COMPLETE FOR ALL COMvIERCIAUINDUSTRIAL BUILDINGS. ALSO COMPLETE FOR APARTMENT BUILDINGS OR OTHER MULTI-FAMII.Y BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNTT. DATE: NEW BUILDING INTERIOR IMPROVEMENT WORK DESCRIPTION: CONTRACT PRICE: $ FEES 1% OF 99NTRi4;C.'1" FEE $_ PROCESSED PIPING: $25.00 MINIMUM FEE: $25.00 STATE SURCHARGE $.50 FOR EACH $1,000 OF FE ?RhM FEE. TOTAL $ SITE ADDRESS: OWNER NAME: TELEPHONE #: TENANT NAME: (IMPROVEMEN7'S ONL1) INSTALLER: ADDRESS: CITY: TELEPHONE #: STATE: ZIP CODE: SIGNATURE OF PERMITTEE CITY INSPECTOR 1993 MECHANICAL PERMIT (CONIlVIERCIAL) CTl'Y OF EAGAN 3830 PIIAT KNOB RD EAGAN MN 55122 (612) 6814675 L ? BL I CITY USE ONLY RECEIPT #: I I?? 5` sUBO. RECEIPTDATE: -7 ?JO PERMI7 # 1999 PLUM$1NH P£fiMIT (fiESIDENT1AcL) crrY oF Ewsnx 3830 fllAT KNOB itD ERfiAN, MN 551 EE (651) 681-4675 Please complete for: ? single family dwellings ? townhomes and condos when pertnits are required for each unit D backflow preventer for underground sprinkler system FIXTURES EACH # TOTAL Bath tub $ 3.00 x = $ Floor drain 3.00 x = $ G25 i in outlBt ` minimum - 1 3.00 x = $ Hot tub/s a 3.00 x = $ Kitchen sink 3.00 x = $ Laund tra 3.00 x = $ Lavato 3.00 x = $ Minimum fee alteretions to existin dwellin 30.00 x = $ Private Dis osal S stem new/refurbished ` re uires MPC iic. 75.00 x = $ Private Dis osal S stem abandonment 30.00 x = $ RPZ new installation/re air 30.00 x = $ Rou h o enin 1.50 x = $ Shower 3.00 x = $ Under round s rinkler if dwellin is under construction 3.00 x = $ Under round s rinkler if existin dwellin 30.00 x = $ Water closet 3.00 x = $ Water heater 3.00 x = $ Water softener I( dwellin under construction 5.00 X = $ Water softener if existin dwellin 30.00 x = $ Water turnaround 30.00 x ---- State Surchar e .50 --> ----> ----> $ 50 Total --> --> ----> ---> $ Reminder. Cali for inspections of alteratfons, i.e. water heaters, water softeners, etc. -- - --------- -------- --- ------ --- ----- -- i----------- -----tate - t-h--at --- - the ------------ •----------- - • --- --- ------ - ---- - ---- -- - -- - --- - ---- - - - - --- - I hereby acknowledge that I have read ths appliption, s informatlon is-cortect, and-agree to comply vrith all applicabie Cityof Eagan o rdinances. ft is the applicanYs responsi6ility to notiry the property owner that the City of Eagan assumes no liabiliry for any damages caused by the City during its normal operational and maintenance actrvities to the facilitles consWcted under this permil within City property/right-of-way/easement. SITE ADDRESS: OWNER NAME: : INSTALLER NAME: yo?j TELEPHONE #: TELEPHONE #: 6 (? ? LZ (AREA CODE) STREETADDRESS: CITY: STATE: vrla ZIP: `-y--??? SIGNATURE OF PERMITTEE PERMIT City of Eagan Permit Type:Building Permit Number:EA107338 Date Issued:10/08/2012 Permit Category:ePermit Site Address: 612 Mcfaddens Tr Lot:13 Block: 1 Addition: Lakeview Trail PID:10-44330-01-130 Use: Description: Sub Type:e-Windows/Doors Work Type:Windows/Doors Description:House Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings, call for framing inspection. Call for final inspection after installation. Carbon monoxide detectors are required by law in ALL single family homes . Valuation: 4,667.00 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 - BENJAMIN A WAGNER 612 McFaddens Tr Eagan MN 55123 Home Depot At Home Services 656 Mendelssohn Ave. N Golden Valley MN 55427 (763) 542-8826 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA117699 Date Issued:10/22/2013 Permit Category:ePermit Site Address: 612 Mcfaddens Tr Lot:13 Block: 1 Addition: Lakeview Trail PID:10-44330-01-130 Use: Description: Sub Type:Reroof Work Type:Replace Description: Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Please print pictures of ice and water protection and leave on site. Carbon monoxide detectors are required by law in ALL single family homes . Daniel Olson Valuation: 4,000.00 Fee Summary:BL - Base Fee $4K $103.25 0801.4085 Surcharge - Based on Valuation $4K $2.00 9001.2195 $105.25 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Benjamin A Wagner 612 Mcfaddens Tr Eagan MN 55123 All American Restoration 6112 Olson Memorial Hwy Robbinsdale MN MN 55422 (763) 546-9655 Applicant/Permitee: Signature Issued By: Signature Use BLUE or BLACK Ink r________________� I For Office Use � � � • I Permit#: 1 ��C��� � City of �a��� � y� � � � � Permit Fee:T�� "�! I 3830 Pilot Knob Road I I Eagan MN 55122 � Date Received: � Phone: (651)675-5675 I I Fax: (651)675-5694 i Staff: i 2015 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Unit#: � � �� � � n �, ��� � Name: �25� �G}(1� Phone: ��Z- �Z� � 2[D�O �� �Res�den� � � ` J , I � �Q�jyr��� � � Address/City/Zip: �lZ �c-�o�r�`e(i�S �,��.�� f,*4 ���� ��� � Applicant is: Owner �Contractor ���� � ����r� � _-���`���� � = Description ofwork: ���-� ��, �l�-� (,..�� �Gl.i•.�� �T�pe of Work�' � � '� _ = Construction Cost: �b ��t' Multi-Famil Buildin Yes /No � � Y 9�( �) � ����.£� � � n �� �; �� ��� Company: ��� l-�(�`�-S\cc..� �2$�sa--�`c�1����'Contact:�v� ��SQ� � ����� �a�- A / (' ► /� �� : Address:rN�s� �fjv��S���-/V Cit �C'cXl�-Iu� GCKk-- � ��tractor �� � y' � � �, �� � � State:�Y1N Zi�S�f�� Phone: ��3'"Zf 3-�C�[� EmaiL• �-^�:��G.l�cMelicr�res�r�ian(I�, rv� �* �� � �� �� ��-,�`>J� � � , j`.� :. " � � ° License#: E�CS`�SI�B Lead Certificate#: If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? Yes _No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer&Water Contractor: Phone: NQTE Plans and su ` a� �n`' ocume ts thaf jrau submit area onsrdered��o,b� ubF� o ai�on � -o" o��'���.� �� �- „ :��P��� ���� , � �,� � � �..� �.. � .� , . , � � ��lie�nformat�on�may e c assrfed.as� on�aubtrc��`�o�u tovide�s�e�rt'c reaso s"tf�at�iiiouli���� � tlae�G�ty#a `�"' �� � � � .., � �� �� � >• � � �� ��s conc/uaie=��a�th�y,are:fraafe��crets,� � �� � �. v�� .��r�s�`�� �:.� ..s �. .. . ,, .r. .�..�� .�. �,. �.���. �,�:,�.,.� •` �.. �,_ ���h. 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.popherstateonecall.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. Ezterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuance. X Da��� o�SG� c ApplicanYs Printed Name Ap canYs i na re Page 1 of 3 PERMIT City of Eagan Permit Type:Building Permit Number:EA143263 Date Issued:06/08/2017 Permit Category:ePermit Site Address: 612 Mcfaddens Tr Lot:13 Block: 1 Addition: Lakeview Trail PID:10-44330-01-130 Use: Description: Sub Type:Reroof Work Type:Replace Description:Does not include skylight(s) Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Please print pictures of ice and water protection and leave on site. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). 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 - Benjamin A Wagner 612 Mcfaddens Tr Eagan MN 55123 Trinity Exteriors Inc 4204 Park Glen Rd Minneapolis MN 55416 (952) 920-9520 Applicant/Permitee: Signature Issued By: Signature