3759 Greensboro Dr? r
BUILDING PERMIT
SF DWG/GAR Est value $119,000
tti2 13093
JANUARY 14 19 87
SiteAddress 3759 GREENSBORO DR Erect ff Occupancy R3
LOt 7 Block 1 Sec/Sub. GREENSBORO ST Remodel ?
n Rl
Zoni 9
Parcel No Repair ? Type of Const. U
. Addition ? No. Stories
cc Name sOSLPH N'ILLFR COlVST Move
h ?
? Length -i2
D
32
Z 18133 CF:r
7AR AVF SO Demolis epth
3
° ,
Address
F'ARtfiIN('
?'Q W
892-1010 Int. Impr. ? Sq. Ff
City p
. Install O
= o Name--SA?1E Approvais
? ¢ Address Assessment
~ Citv Phone Water & Sew.
Phone
Receipt #
Police
Fire
Eng.
Planner
Permit 9 ? °" • '"'
Surcharge 59•50
Plan Review 280.25
SAC 625.00
Water Conn. 525.00
Water Meter 67.00
Road Unit 305.00
I hereby acknowledge that I have read this application and state that the Bldg. Off. 1/14 /8 Tr pl 180•00
information is correct and agree to comply with all applicable State of
Minnesota Statutes and City of Eagan Ocdinances. APC Parks
Signature ai Permittee ;r , : r. : 1 "_ Var. Date Copies , . Z 5
t ? • ?- -
JOSBPti MILLER CON,ST Total
A Building Permit is issued to: on the express condition that
all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Ofticial
CITY OF EAGAN
3830 Pil?ot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
? PKmN No. Permit Holder DNe TNeplwee N
Plumbiny
?
N.Y.?1.C. ?? / / /??". ?: `-,, '?• "?O
EIOCvk ? SDg-3 C? ?y ??., ?? ??_C%? ?:? ???/•? ??i??-? -
SOHMM
IrtapecHon Dab Insp. CommMtt
Footlnys 1
Foodngsll
Foundation
Framing
RooWnp
Rouph Plby. 2
Rouyn Hty. /.VY7
IrouL
Firoplace
Flnal Hty. 7
Final Plbp. ,$, ?
lNdg.Ftial AO
c.n. occ. > - ?7 D
Deck Fty.
Doelc Frmy.
WeN
Pr. Disp.
Site Address , 3?
Lot :7_ 81ock
? fVame
? Addre
c City L
PLUMBING PERMIT
CITY OF EAGAN
3830 PILOT KNOB ROAO, EAGAN, MN 55122
, PHONE:454-8100
BLDG. TYP?
Res.
Mult.
FEfS
COMM/IMO FEE - 146 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
PERMIT M
RECEIPT # ?-
DATE: '44?%7
WORK DESCiIPTION
New
Add-on
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES T AL
?ater Closet - $3.60 ?
ath Tubs - $3.00 y
- $3.00
,,Lavator,
Shower - $3.00
Ki?.chen Sink - $3.00 -
Urinal/Bidet - $3.00
-TLaundry Tray - $3.00 '
Floor Drains -$1.5U 1 S U
7ZWater Heater - $1 50 ?S U
Whirlpool - $3.00
_-1Gas Piping Outlets - $1.50 ; .S J
(MINIMUM - 1 PER PERMIT) i
Softener - $5.00 ?
Well - $10.00
Private Disp. - $10.00 ?
=Rough Openings - $1.50
SIGNATURE OF PERMITTEE FEE: ?
STATE S/C: 4 w
FOA: CITY OF EAGAN GRAND TOTAL -> y, -1
• - .'? ? , . . .- , : . . ' . . " • - -" . . z Ti - . . . 7 . .
PERMIT # '
MECHANICAL PERMIT RECEIPT # ? l~-'
CITIf OF EAGAN '
3830 PILOT KN08 ROAD, EAGAN, MN 55121 DATE:
:E PNONE:154-8100
Site
Sec/Sub
TYPE WORK DESCRIPTION
BLDG
.
R
`-= N
ew
es.
M
Add
l
-on
u
t
C
R
i
omm.
epa
r
Ot
her
FEES
RES. HVAC 0-100 M BTU -$24.00
ADDITIONAL 50 M BTU - 6.00
ADD-ON AIR COND. 0-24 BTU - 12.00
ADDITIONAL 6 M BTU
GAS OUTLETS
COMM/IND FEE - 196 OF CONTRACT FEE - 6.00
- 1.50 EA.
MINIMUM - RESIDENTIAL FEE - 10.00
MINIMUM - COMM/IND FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $50 S/C IF PERMIT PRICE GOES
i BEYOND $1,000.00)
SIGNATURE OF PERMITTEE
FOR: CITY OF EAGAN
t m Name •.s - ,
Address
c City Phone _
Name
?
c Address °
p Ciry Phone _
? TYPE OF WORK
Forced Air M BTU
Boiler M BTU
Unit Heater M BTU
i Air Cond. M BTU
? Vent
in
Gas Pl
Outlets # CFM
g
p
Other
FEE
S/C:
TOTAL•
ITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SPECTI4N
SITE ADDRESS:
+ i t? t) f) t>
1.f•I ; i? •i;+?frE,l f', E
PERMIT SUBTYPE:
TORD
PERMIT TYPE:
Permit Number:
Date Issued:
ft k W:K t APPLICANT:
TYPE OF WORK:
INSPECTION ..
? ? . .
S laal??
6 f?
? FVAr?AIr rFRMrr i<, r;E 1,10YRF11 I fas: nN=r f-Ii1JINHINfl 014 E'f r-C rP:, A[ wOnK
nFCk ANrl IAtNtjAw kf-Pi..Art Mr Nr
?
?
3 ?? I Permit No. Permit Holde? Date Telephpne #
ELECTRIC
PLUMBING
HVAC
Inspectfon Date Insp. Comments
FOOTINGS
FOUND
FRAMING
S! ?4vwe u„ir*.. -rvla -16 t?al- et0061,co-( ?vmZ
ROOFING
ROUGIi
PLUMBING
PLBG
AfR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYPBOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
? CASH RECEIPT ?
CITY - Of' EAGAN
3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
Dq7E 19
RECeIvIEc
FROM
?
;tAMOUN7 • + ? I
& DOLLARS
ioo
? CASH ? CHECK
RpR
BY
White-Payers Copy
Yellow-Posting Copy
Pink-File Copy
Thank You
? . ?
BLDG. PERMI'T N4.
r-
e s ", • '': ?%t _ . ? .? .
e ?
'
01-321 1dg. Perm
it
01-3422 Plan Check
01-3445 Surch./Adm,
01-3446 SAC/Adm. '
01-2155 Surcharge
17-3860 Road Unit -
20-2275 SAC ,
20-3865 Water Conn. -„?
20-3868 Water Trmt.
20-3716 Water Meter -;,
20-2252 Acct. Dep,
20-3713 Water Permit
20-3743 5ewer Permit
79-3866 Sewer Conn.
11-3855 Park Ded.
TOTAL -:?? C?
WATER SERVICE PERMIT
PERMIT NO.:
DATE: 1
No. of Units:
Owner. Joe Miller Const.
Address:
SiteAddess: 3759 Greensboro Drive L; 31 Greeneboro 1
Plumber. Tom nessian Plumbin
.
' `? Charge: 525 O
Meter No.: 3 15.00P
cl
SiZe: c tQ?i
ReaderNo.:/}7?? 10.00 d
I agroe to comptp with the CIM41"?(E e: . 50pd
•?
D.s?r ??? 180
Ordinances. c:
67.22pd meter
Date Paid:
BY
Qate of Insp : Insp•=
ciTY o"T EAGAN SEWER SERVICE PERMIT
344 Pitot Knob Road 9'i ??
P.O. Box 21199 .- •?°' PERMIT NO.: 1-21-87
Eayan, MN 55121 DATE:
2oning: P1 No. of Units: 1
Owner. 1oe Afiller Const.
Address:
Site Addres??
?He'
Plumber:
1 agree fo cOmplfwNh t!
Ordinancas. ! ., D G ^, 1,KtV
R`V/.v
ction C rge: 52 5_ O(1?rL
t; t; 1 5 _ OQpd
Fee: 1 n - noPa
Surcharge: -
Misc. Cherges:
Totel:
Insp.: / Date Paid:
. ----?
cmr oF EaGAN WATER SERVICE PERMIT -
3830 Pilot Knob Road ?
P.O. BOx 21199 PERMIT NO.: r' 1r
Eagan, MN 55121 DATE: - `` '
Zoning: _ pi No. of Units: 1
?
Owner. Joe Hiller Const
Address:
SiteAddess: 3759 Creensboro D rive L7 R1 Cree nabo 0 1
Plumber. - Tom Eiesaian Plttmb Q
Meter No.: Connection Charge: 525. 40pd
Size: _ Account Deposit: 15 . OClpd '
Feader No.: Permit Fee: 1n.00 i
I sgree to comply wBh !he City ot Eayan Surcharge: - Sbd
Ordinances. Misc. Charges: 184 . Q(3Rd TP_ _
Total: 57.Onpd met
BY Date Paid:
Date of Insp.: Inso.:
CITY OF EAGAN SEWER SERVICE PERMIT
3830 Pilot Knob Road
P.O. Box 21199 PERMIT NO.: ?' S; ?
Eagan, MN 55 1 DATE -
Zoning: 1
`?, er nst . No. of Unlts:
Owner. ` Address:
Site Address: ' e?8 ro
Plumber. om e9 n u?
.±-..
I ayree to compy wlth !he Cityr of Eagan
OMinsnc:es.
By
Date of Inap.:
insp.:
r ve B eena ro
ng
. p
Connection Charge: 525.4C1DCi
Account Deposit: _ 15 . QODd
Permit Fee: - 10. 04ud
Surcharge: . SQpd
_ Mlsc. Charges:
_ Total:
- Date Paid:
REQUEST FOR ELECTRICAL INSPECTION ee-oopooi-?
RIM , See instruct,ons for camDletinp this lorm on Eeck o1 yellow tapy. ?CU s
?- tq (I q "X" Below Work Covered by 7his Request
Add XeO. Type ol Bui1Eon0 APCliOnCe3 WitOtl EQUiomenl Wirad
Home Range Temporary Service
Duplex Water Heater Ligh[ing Fixtures
Apt. BuilAing Dryer Electnc Heatui
Commercial Bldg. Fumace Silo Unbader
InduStrial BIAg. Air Conditioner Bulk Milk ienk
Farm tn.r peci v ihe.r (Speuty)
t,r uocify t er Other
ompute Inspecoon Fee Below
N fee Service EntronceSize k Fee Faeders/5ubfeeders N Fee Circurta
j , po G to 200 qm s 0 to 30 Am s 0 tn 30 Am
Above 2 0 qmpy 31 to 100 Amps 31 to 700 A s
Swinvning Pool Above 100_Am s Above 100_Am '
Transrormers Irngation Booms U Partial,'Other Fee
Signs $Vecial Inspection S
TOTAL
pe merks
5p
.
??
NouBh-in I,the Elac
Inepactor, hereby
certify thet the abova
final DN1e inspeetion hes been
q% maa.
TltlsroVWntvdalBmOniMirom - `
This rnquest wid ?.(r/?`' ?va,3 CY
78 months from
C 80839 /-? R-/ /?
Repuest Uaie• Fire No. ?mgh-,n Inspecuon
e rtetl?
?
I ?fleady Nuw Will Nolify Insper
Wh
?o
R
?es ?NO r
en
eody
Lmensed Elec[ntel Convaaor I hereby raquest ins0eetion of above
Owner elecvleal work insfalled at
Streal Address. Bax or Route No.
3
b
6
Z City
?a ah
r h
rr ve,
5 i
or o -
ecuon o. Township Name oi No. anee No. Coumy
a.kofq,
Occupnnt (Wi1NT)
Jve Mi Il6r Phone No.
Pow r Supoliar
?a o?-Fa. ?le Add res ?
3 00 0
Elec r al Contractor (Campeny Namel
/'ciland 61ec,+vrG Contractoi's Ucense No.
-a-
4 f1, 1.0
MailinB Address (Contractor or Owner MakinO Installauon)
2goo W Co !Pd 4a BuYns vr !!e,
Authorized igne[ure ICoMrac r Owner Making Installation)
? Phone Number
MINNESptq STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILI NOT
Gripps•Midwey BIAg. - Poom N-191 gE ACCEPTED BY THE STqTE BOARO
1827 Univeraitv Ave.. St. Paul. MN 56104 UNLESS PROPER INSPECTION FEE IS
Phone (612) 842-0800 ENCLOSED.
CITY OF EAGA:.J
3830 PNot Knob Road, P.O. Box 21-199, Eagan, MN 55121 NQ ? 13 093
BUILDING PERMIT - " PHONE: 454-8100 Receiptn
Tobeusedlor SF DWG/GAR Est.Value $119,000 Date JANUARY 1 19 87
SiteAddress 3759 GREENSBORO DR Erect ? Occupancy R3
Lot 7 elock 1 Sec/Sub. GREENSBORO 15T Remodei ? Zoning Rl
Parcel No. Repair ? Type of Const V
Addition ? No. Stories
W Name JOSEPH MILLER CONST nnove ? Len9th Sz
? 18133 CEDAR AVE SO Demolish ? Depth ?9
o Adtlress Int Impr. ? Sq. Ft.
Ciry FARMIN(WQN $92-1010 Install ?
Name SAMF.
i 0
0 a Address
? Ciry Phone
a
F w Name
-z
? ? Address
z
a W City Phone
I hereby acknowledge that I have read this application and state that the
information is correct and agree to comply with all appticable State of
Minnesota Statutes and 'ty o( Eaganld dirSances.
/
Signature of Permittee
A Building Permit is issued to: J SEPH MILLER COLdST
all work shall 6e done in accordance with all applicabl at Minnesota
Buildmg Ofticial
Feas
Assessment _
water & Sew.
Police
Fire
Eng.
Planner_
Councd
Bldg. Off. 1/14/87
APC
Permit +' ??"•-"'
Surcharge 59.50
Plan Review 280.25
SAC 625.00
WaterConn 525.00
Water Meter 67 . 00
Road Unit 305. 00
Tr. PI. 180.00
Var. Date 1 Copies? 2 5
Total '
on the express condition that
aM Ciry oi gagan Ordmances
D'
Gqq8q
2005 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
/7 7a CF'
New Constructbn Reaui2meMS RemodeVReoair Reouirements Office Use Onlv
3 2gislered site surveys showirg sq. ft. of bt, sq. ft. of house; and ?II roofed areas 2 copies of plan Cert of Survey Reod , _ Y, _ N
(20% mazimum lot coverage allowed) i set of Energy Calalafions for heafed addiGOns Tree Pres Plan Recd ? _Y _ N.
2 wpies of plan sfrowing beam 8 window sizes; poured found design, etc. t s@e survey for addPoons & decks Tree Pres Required _Y _ N
7 sel of Energy Calalations AddNlon • indicete i(on-sRe sep6c system Oo-afle Sepllc System _ Y_ N
3 coples oiTree PreservaUon Plan rflot platted after7/1N3
Rim Joist Detail Options selectfon sheet (buildings wiN 3 or less unBs)
Date lv
/ Construction Cost (? ?G • ` r
?
Site Address J795_? I 40 / G C]?? UnidSte #
Description of Work
Multi-Family Bldg _ Y_ N Fireplace(s) _ 0 _ 1 _ 2
Owner
ert
P Telephone #
y
rop
Contractor
Address ??? ?`. .t c „? ? - • r C??Y
State /bL /L1 Zip !d Telephone #
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 _ Minnesota Rules 7672
Energy Code Category • Residential Venfilation Category 1 Worksheel • New Energy Code Worksheel
(Jsubmissiontype) Submitted Submitted
• Energy Envelope Calculations Submitted
Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review
fee applies.
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone # (
Telephone #(
Telephone #(
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only an 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
L approval of plans. ,
Applicant's Printed Name Applicant's Signature
?5a 41
2004 RESIDENTIAL PLUMBING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings.
?O •.S_0
Date I_ I _3D I
Site Street Address ?? 5 1 V?l'l??V(? ?Y' • Unit #
? ?I t1 ?l
Property Owner Vt?' ?Jl.? ?-?' ?--V Telephone # (?9JI) ?Si -70'f
Contractor Dl"' 'r1V\?5 Telephone #(Ia?a') S?a?DO
Address u ?y AV'c S City State Zip5561tU
The Applicant is: _ Owner V Contractor _Other
Alterations to existing dwelling $ 50.00
_Add fixtures to rooms, excluding water softener and water heater
_Septic System Abandonment
_Water Turnaround (add $121.00 if a 5/8" meter is required)
Other:
Water Softener _ Water Heater $ 15.00
_ replacement _ additional
JLawn Irrigation System RPZ_ new repair _rebuild $ 30.00
State Surc
,
$ .50
=,AUI-, 2 0 tUM
rtal
W ?
$ '
6y
I hereby apply for a Residential Plumbing 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 plumbing codes; that I understand this is not a permit, but only an application for a
permit, work is not to start without a permit and work will be in accordance with the approved plan in
the event a plan is required to be reviewed and approved.
Applicant's Printed Name ApplicanYs Signature
PERMIT
C,IT.Y OF EAGAN
? 3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
P.I.N.: 10-30900-070-01
DESCRIPTION:
SF ADDITION
NEW
434 RLT. RESIDENTSAL
"` -
auildiny,;.ePermit Type
,Building W-byk Type
! Census, C,ode
P s s ' -
rr p ^r
`=y t i
?
P?ri'1i?G'.,
t:
?, U
us
REMARKS:
A SEPARATE PERMIT I3 REQUIRED FOR ANY PLUMBING OR ELECTRICAL WORK
SNCLUDES OECK AND WINDOW REPLACEMENT
FEE SUMMARY:
VALUATION
Base Fee
Surcharge
Total Fee
$137.25
_ $4.00
$141.25
CONTRACTOR:
PERMITTYPE: euzLoiHG
Permit Number: 031717
Date Issued: 0 q/ 0 8/ 9 8
$8,000
OWNER: - Applicant
SCHIRMER JEFF
3759 GREENS80R0
EAGAN MN
(612)853-4029
OR
55123
? I hereby acknowled?ga that. I-?trave read_ thi.s
informatton is oprrect andl igr-e.Q to, Gjpmpl:y
Statutes and C3ty of Ea,gan Qrdinanc8s,, ,
? APPLIC /PE MITEE SIGNATU E
3759 GREENSBORO DR
LOT: 7 BLOCK: 1
GREENSBORO 15T
,a(iPZica'Gi0nnaMd4 state: that this
0 zt h:al1, applzcabl.e;9tate%.a,fi Mrt.
ISSUED BY: SIGNATURE
31-111 1998 BUILDING PERMIT APPLICATION (RESIDENTIAL) $ 1?} 1. ?K
3830 PCILOT KN B RD 66122
681-4675
New Construdion Reauirertrents
? 3 registered site surveys
? 2 mpies ot plans (include beam & window s¢es; poureA fnd. design; etc.)
• 1 energy calalations
? 3 copies of tree preservation plan if lot plaCed aRer 7/7/93
required: _ Yes _ No
DATE: ?/ 3 v
RemodaVReoair Reauirements
? 2 copiea of plan
? 2 site surveys (ezteAor addRiens 6 dedcs)
? 1 energy calalations for heated addkions
CONSTRUCTION COST;
DESCRIPTION OF WORK: IT°om ADD/rro.c ) f 1,J; n dvu.) ne o(ac etre,n+
STREET ADDRESS: 1 3 7$'9 64M,U53ber, 22
LOT: 7 BLOCK: SUBD./P.I.D. #: G9E9,05 So20 F/k5T ADD.
?
Name: 5(
7y1gaEx, Phone #: / SS?? 7aY?
PROPERTY ?ut First w) g53 - 402L9
OWNER
Street Address: 3 ?.AU -G1IQFENS $0e0 Z>04-
cnr staze: ziP: 55'/Z3
Company: Phone #:
CONTRACTOR
Street Address: License #
City State: Zip:
ARCHIT'ECT/
ENGINEER Company: Phone #:
Name: Registration #:
Street
Ciry
Sewer 8 water licensed piumber (new construcGon ony):
and lot change is requested once permit is issued.
State: Zip:
Penalty applies when address chang
I hereby acknowledge that I have read this application and state that the information is Cortect and agree to comply with all applicabl
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant•
OFFtCE USE ONLY
Certificates of Survey Received _ Yes _ No
Tree Preservation Plan Received Yes No
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex
? 02 SF Dwelling O 07 4-plex
K03 SF Addition ? 08 8-plex
? 04 SF Porch 0 09 12-plex
? 05 SF Misc. ? 10 _ plex
? 11 Apt./Lodging ?
O 12 Multi RepaidRem. ?
? 13 Garage/Accessory ?
? 14 Fireplace ?
? 15 Deck
WORK TYPE ) rlct?nE s Mc.t,, v?,2V
? 31 New ? 33 Alterations ? 36 Move
b?,32 Addition ? 34 Repair ? 37 Demolition
GENERAL INFORMATION
$ '+ w w
16 Basement Finish
17 Swim Pool
20 Public Facility
21 Miscellaneous
Const. (Actuai) Basement sq. ft. MC/WS System ?
(Allowable) Main level sq. ft. City Water ?
UBC Occupancy sq. ft. Fire Sprinklered
Zoning sq. ft. PRV
# of Stories sq. ft. Booster Pump
Length sq. ft. Census Code. u 3
Depth Footprint sq. ft. SAC Code _ 01
Census Bldg 1
Census Unit v
APPROVALS
Planning Building
Permit Fee
Surcharge
Plan Review
License '
MCNVS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
5NV Pertnit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies - - --
;?r.i
Tolal: • ? ? .`1
°k?AC
Sq?C •Units
L
N43 Engineering Variance
Valuation: $ g vvo --
A bt r-rt v N)
f x icl -- ? iz ib 4 sy" & ,oUB,--.
r-
1 zaD,i
u*
LAND C0.
SURVEYING
SERVICES
4655 NICOLS ROAD
EAGAN, MINNESOTA 55122
L (7) I G
Er;sp, tiS
I-toK.s e
SITE PLAN FOR:
JOE MILLER CONST.
N O°28'04" W
( qDl}?? 85.00
w
z
GD
Wo
-
? o
o
Ri
q;,r %
9e9' 7
5? ---- - -i 5
( (
o I
?
?
?
yous1Z
M iy- 2,1
?2 9p?"t -1 6'id
z
CD
o`°
o6
a)
rn
G RG a' I
22' j3' - 9?o?z
? ,.
5I ???`? w s
?----$ -- ?
c o
r 9o6x6
85.00
NQ°2804!'W ?foB,6)
w
0
? GREENSBORO
PROPERTY DESCRIPTION
LOT-L, BLOCK I ,
GREENSBORO FIRST ADD.
occordinq to the recorded plat tMrsof
DAKOTA County, Minnesota
LEGEND
o DENOTES IRON MONUMENT
o DENOTES WOOD HUB SET
908A3 DENOTES EXIS'fING SPOT
ELEVATION
(90e'S) OENOTES PROPOSED SPOT
ELEVATION
? DENOTES DRAINAGE DIRECTION
t Mnby certify fhat this survey, plon or
report war praparsd by me or under my
diract supxvision and ihaf I am a duly
Rsqisterad Land Survoror under the
Laws of the Stoto of Minnesota
Brodley J. t8a(if?nson, Mn. ReQ. No.18238
//
DO1f : C21JOlac
DRIVE
11Jl1 I 8
-N
SCALE : I"=30'
' .
PROPOSED GARAGE FLOOR ELEVATION = w?_n
PROPOSED FIRST FLOOR ELEVATION
PROPOSED BASEMENT FLOOR '
ELEVATION •;
NOTE * VERIFY ALL FLOOR HEI6HTS WITH
FINAL HOUSE PLANS
. 3
1986 BIIILDING PENFIIT APPLICA?ZOH - CITY OF EAG9N
90TS: ALL C09TBACTOHS MQST BS LICBNSSD iTlTH THE CIYY OF EAGAN
3INGLS FAPIILY DHELLIAGS
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEYo 1 SET OF ENERGY CALCULATIONS
MfJLTIPLS DTiELLIHGS - HLrSIDEBTIAL 9ENTAL UNITS FOE 3ALS QNITS
INCLUDE 2 SETS OF PLANSt CERTIFICATE OF SORVSY - CHECg UTTH BLDG. DEPT.,
1 SET OF ENERGY CALCULATIONS ,
COlMERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONS,
$2,000 LANDSCAPE BOND
To Be Used For: / CIGG(/ lit//?/ti Valuation: -?, ?
Site Address - 9,?/13U(JU/?J OFFICE
Lot 7 Block 1_
Parcel/Sub / §:L7
Owner
Address
City/Zip Code
Phone
Contractor [2Q[l/L 7)2 7nW&IL)
Address AYj 33 &64 aW ? • _
City/Zip Code
Phone 99o?2
Arch./Engr. _
Address
City/21p Code
Phone ri
Erect ?
Remodel _
Repair _
Addition _
Move _
Demolish _
Int.Impr. _
Install
nate: ?-
Oceupancy 'F-. 3
Zaning fZ•I
Type oF Const Y
li of Stories
Length S Z
Depth 3Z
Sq Ft
9PPROVALS FE&S
Assessments Permit .?C?•-
Water/Sewer Surcharge S?
Police Plan Review ZBD
Fire SAC G 2 S.
Engr Water Conn S 2S•
Planner Water Meter (?'7.
Council Road Unit WS, ,
Bldg Off Treatment P1 180.
APC Parks
Variance Copies ? Qs 1
TO?AL
HOTSs ADDRSSSES FOR CORNER LOTS - CONTRACTOR/HOMEOiiNER ISIIST DSSIGNATE AHICH ADDRESS
IS DESIRED. NO CH6NGES HILL BE ALLOTdED ONCE BDILDING PERMI! ZS ISSOED.
.
7i?O K
14 ? 2 z - 3?gx s? - `'7 elo
22x ? = Ca?o x?z = 'N2v
f ?K22 ? 3?? ? ?4-- = (3-Ss2-
f 16 8C?6
?--- '
ENyF:I.UPE AVEI2ADE ItUff COIdPurnTiotc
(To be aubmitted With building permit applicatio.n)
ono or Z'?vo Family Dwellin6 ?Owner
ILL1 Otltar
, 81te Addreee
Contractor ?crP ??LLE_ _?=?-r DAte Phone
LIIIEAL FECT OF
EXPOSEll YIALL it. above grade ? Z9??•?p ??
TOT/lL E7CPOSED WALL AREA 9Q, FT.
oPAqUC WALL Cot7S'1'RUCPiUt11 "U" Value x Area •
De tall >4 nl ;-::- - itu " , 4? x Scj. FT. ZZSf • . (p D p ?
re[aranca o uutl ? q S ( )( )
Irom --- R Mh npfi •?7Co x 3R. FT.,___?0¢?Z- (U) (A)
e t t ached °u'f •04o x Sq. FT._ Z(o4•°7 UMA)
x SQ. FT.
si1 oatd llull _ ?)(n)
x sR. Fz. (U)(n)
ii?i? x SQ. FT. _
(U)(A)
L7It7[pWSt °U't Vnlue X Aroa
tlrilce & Type ??irll CSM?T ::u::-. -
?? n n n 41 x SQ. F'P. 7S•8?
U U)(A)
u n nn x sR. FT. ? _ (U)(n)
n u npn x SQ. F'P. - (U)(A)
x sq. FT. - (U)(A)
IX)oliSt it Ull Value x Area
Ilalce & Type ?j? ?h?SJL ItUtt
i ? ?-ri_ _'T --X sR. F?r. (u)(n)
?:1---7 x sq. eT. ?+z.cb-?(u)(e)
??UI? x sR. FT. (U)(n)
- x s2. F?r. _ (o)(n)
TOTALB ZJO_.L-(Q3 - .g@. F'T. Z/?i. 7`I (U) (A)
z AYE[2A(3E ??Ul?
TO'PAL (U)(A) VALUES
?g.-rq ?
llIVIUEU DY 7'OTAL }'1/1I,L AREA z9'b3.(p3
AVE11AaL ??Ul ,115 r looe for 1&2 family dwellinga
RoOF/CEILI1a[]',? ? •
TOTAL AREAs ?y •
Detail raforenco
irom -?_x Sg, FT. 11Z? - Z3, (U)(A)
attached cheota. li?lt K SQ• FT.
"
lleocribo openin?a ?--'npn X sR• FT, (U) (h)
_ (U)(A)
in roof, ?---- npn x S2. FT. (U)(n)
-
'lOTAL (U)(A) VALUE9 DI_ V ?y Z x Sioi-4Lej Nzl?v = z3 (0)(A)
,1.0 1,AI,
>•L°4 ? ?t?r •?° (u??
1200F/CEILIIlQ /IZEA
!!z(a
AVERAaC I' ,025 or ventllnted
roo f S.
11 \41dU 5h6aT '1
&ROII-7 61,Po',F-D ?lqGC..
I0•3; X (572ts7-+Z(,p } 2?) = 7-5 59.48
Soo x S.g3 = 44•/S
Z?a3, (p3 71?
-?T X (sz+sz+zp +-z&)
?.(Py X(SZtsz-?-zcc+-z?xl) _
.g3X S =
Wr4pou.-)s
z7x?4 = z.(p
1&x3& = q-.o
ZoX3co = 5.0
zox48 = !v •7
z4x48 = 8.0
z? x (oo = 8• `?
L?ll
3' S7?• YJl2. S.L .
zg S7L, ?Ep-
lv - P-r, o DTz -
X 3=
xz=
x z =
X 9 =
)< S =
ZiPD- s Z
4-?S
Zlo¢. 6D] -?'
7,So
8, o0
jo.oo
00,10
72,00
-41Z.
= 35.00
= Z/.oo
98• o o _,'
de7 Eve-?ED W,
690c?5 `441.c_
Cess do4 e.
Rin\
li k/AW'S
,r paoR1 S
}LL
2q0.3. lo4.sZ?
z?.?7 - (v5z-z9
185. ? o
zzs1??4
780
Ax zz_ _ 3og
ixl4 = ?4
r.sx go
=
24
3.) Ineulation
4.1
50 Exterior Air Film
(STILL)
uUn = 1/R= OZI 'i'OTAL (R)=4--< 7, 5
:a?
Determining "U" values at Roof, Wall* Rim, and Conc. Slock
ROOF/CEILINC3
1.) Interior Air P'ilm
2.) 5/81, ayP. sa.
YIALL
6.) Interior Air Film
7.) P GYP. Hd.
8.) Ineulation
9.) $oI LT
10,) Masonite Siding
11.) Exterior Air Film
R VILLUE
0.61
.56
`]A
-j: o0
.67
(R VpLUE
0,68
.45
l9-00
2674-
.17
upn TOTAL (R)= Z3-01
?
RIM
12.) Interior Air Film
13.) Insulation
14.) 211 Fir Rim Joist
15.) rv1(,T- I-'rT,G
16.) Masonite S3?ding
17.) Exterior Air Film
R VALUE
0.68
)q.oo
1.88
Z.
6
.17
°pII = 1/R= '040 TOTAL (R)= Z4--' 1
?
FOUI7DATION R VALUE
18.) Interior Air Film 0,68
19.)
20.)
?1BF?=L?ASS
?l??or?
! ?-oo
21.) 12" Concrete Block 1,2$
22.)
23.) Exterior Air Film ,77
"pn _ ?/R= .07(p TOTAL (R)=
r
TRI-LAND C0. SITE PLAN FOR:
SURVEYING
SERVICES JOE MILLER CONST.
4655 NICOLS ROAD
EAGAN, MINNESOTA 55122
N 0°28'04" W
(9085.00 (o)
5? ?5
I ' I
?l) T ?? (I I i?\1 ? ?i
Z Iz ??? ?+
? nl Z
m i OD
W 0 0W
52' 4e?'d?l ??
U10 I? 20 90'ty2 ?
d? 4 F ?
!'? Im m ?ous? s ml m
I3 9 ?I
£r;s+ti5 T ?y2.,
z
GXG a
N I
?ya9e4'7 22' /3' - 910rz
5I \J/ -9,-'
L S
Yi ?
----? --- J
? a
c?erz) NO°28'04"W Cso'a.c?
w
0
r GREENSBORO DRIVE
PROPERTY DESCRIPTION
LOT-Z-, BLOCK I ,
GRF_FNSRnRO FIRST ADD.
xcordinq fo iha racorded plaf ihereof
DAKOTA caMty, Minnesota
LEGEN
o pENOTES IRON MONUMENT
o DENOTES WOOD MUB SET
96e'3 DENOTES EXISTING SPOT
ELEVATION
(90eri) pENOTES PROPOSED SPOT
ELEVATION
? DENOTES DRAINAGE DIRECTION
t hersby certity tAat this survsy.plan or
rsport Mas prepared by me or undsr my
direct supervision and fhat 1 am a duly
Repfstsrsd Land Surveyor undw the
Laws oi tAe State of Minnesot(L
-N
SCALE : I"=30'
i ,
,. . . -
PROPOSED GARAGE FLOOR ELEVATION = qiL C)_
PROPOSED FIRST FLOOR ELEVATION = 9J1a£..,_
PROPOSED BASEMENT FLOOR °
ELEVATION
NOTE, VERIFY ALL FLOOR MEIGHTS WITH t' FINAL HOUSE PLANS ?
Bradley J.,in wn9 Mn. Rsy.No.15235
Date : 12IJo/6'e
. CITY OF EAGAN
APPLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
****#f***#****WfftlttYftl**f******?
h .
F*KYP': PAYM6W' OF FEE AT TIME OF ?
; APPrscATzoN ooFS Nom oora-rrTUrE ?
F APFAOVAL OF PERIYIIT. ?
F IN$PF7LTION OF $EVM ANID/O2 SATER, ?
f jNsTp77ATTODL WIId. NCYP BE $(Hm- *y
F ULID UNiZL PII2MIT HAS BEQI 44
i APPROVID. :
1) P ease Prifnt
PROPERTY ADDRESS : ?3 7 J-q v(ti L- L/LS
•-
LEGAL DESCRIPTION: L-7 15 f ^?N E ?l S? p JZ p "
Lot Block Sub ivision or Tax Parcel ZD )
IF E}QSTING STRCCI[,?RE, DpTE OF ORIGINAL BLILDING PERMIT ISSL'ANCE: - -
? (Mon Year) ..
. PRFSENP 7ANING/PROPOSID L'SE:
? CAMAERCIAL/REP}1II./OFFTCE ? R-1 SINGLE FAMILY '
Q IPIDf1STRIAL Q R-2 DC'PLEX (4+,•,o Units)
? INSTIZ[7TZONAL/GOVfItNMEN'P rl R-3 ZUWNhiOCSE (Three + Units) ( Units)
. p R-4 APARTMENT/COPIDOMIIVIOM ( Units)
2?
' ? h /
NAME; /
t.i L?- Lr. .2-
• ADDRFSS: ' q- ot /i'.27 t--?
CITY. STATE, ZIP: L= c? G.. 6l (? ?a I(2 C?-L ?.LJ
PHONE:_ c -7 y-Z 7
, 3) . ? i; ?,•
' For City Use
- NAME:_
??(j Pl umbers License:
aMxFSS: ?'?t- I P ecl ?,?, ?? 1J a i?v Acti"e
?
CITY. STATE. ZIP: I`e t? f} 8-6 SJ 79 ?? Exped
? Notirrecorded
PHoNE: u3? (? ?'?r MASTER LICFSISE# l
Staff nltla
q) •e• • • ia• I
NAME: ? lC3-
_ awoxESS: Le n
-
-
CZTY, STATE. ZIP:_?_
?L ,nJ .S v
VL,
PHONE:
5) ? v ? ? r • ?• : a • a? - ?.
? CONNECfION TO CITSt SEWII2 ? CONNDCI'ION T+U CITY WATII2 O TIIER ' ..
6) '? •'•?' ? PLF,ASE HOLD APPROVFD PEEtMIT FC)R PICK-UP BY ONE OF ABOVE -.-` --
PLEASE MAiL APPROVID PERMIT TO 1, 2. 3. 4, ABOVE
? (Circle one) 7) r ,. u. . ?? ?' s-tl 64 ) mmo l -- orp - z 7
FOR CITY USE ONLY PERMIT # ISSOED
.3?O
Pd w/Bldg. Permit FEES:
$ $ lD -5--v
$ $ /0 ? .?
$ g
$ $
$ $
$ $
$ $ s ??? •?c? $
s s
$ $
$ $
$ $
$ $
$ $ $
s
_ ? ?qc/4 7oa
RECEIPT RECEIPT
SEWER PERMIT (INCLODE SURCHARGE)
WATER PERMIT (INCLUDE SC'RCHARGE)
WATER METER/COPPERHORN/OC'TSIDE READER
WATER TAP (INCLUDE CORPORATION STOP)
SEWER TAP
ACCOUNT DEPOSIT - SEWER
ACCODNT DEPOSIT - WATER
WAC
SAC
TRUNK WATER ASSESSMENT
TRL'NK SEWER ASSESSMENT
LATERAL BENEFIT/TRLNK SEWER
LATERAL BENEFIT/TRLNK WATER
WATER TREATMENT PLANT SDRCHARGE
OTHER:
TOTAL
DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
Q YES IF YES, THEN A"PERMIT FOR WORK WITHIN POBLZC
Q ROADWAY" MUST BE ISSUED BY THE ENGINEERING
NO DIVISION. LIST AS A CONDITION.
SUBJECT TO THE FOLLOWING CONDITIONS: ,
APPROVED BY:
TITLE:
DATE : ` Z J / f 7
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
.. CITY OF EACAN
3830 PILOT KNOB RD • 55122 Jo (l
657-681•4675 ?-k _
New Conshuction Reaulrements
Remodel/Renair Reauirements
? 3 registered sHe surveys showtng sq. M. of lot, sq. X. of house 2 copies of plan
and all roofed areas (YO%maximum lof coveraae allowed) 7 set of energy calculatfona for heated addMions
> 2 copies of plans (show beam 8 window alzes; poured fnd. design; etc.) 1 sNe survey tor exterlor addRions 8 decks
1 set of energy calculaflons
> 3 copies of hee preservatfon plan H lof plaMed afler 7/1193 ?
DATE: 14Plz.rL l3 1991 CONSTRUCTION COST: ?(O 7 ZA?
DESCRIPTION OF WORK: RE- 5l- DLV(?ZLN&M es:?
STREET ADDRESS: 3`752 646-22J5BOP0 DP-
LOT: I BLOCK: I_ SUBD./P.I.D. #:
Name: ?c V\ ?ti'\-E-ti Phone #:
PROPERTY Lan Pfrs
OWNER
Street Address:
City
State:
Zip:
Company: C RA4 NH?tlOIL r0N5TKkiPhone #: 6/Z -3259 "A, tO2-
(area code)
CONTRACTOR ?/
StreetAddress:3JIZY KxOZZff?7 ?WENU? Sd0'0 License#7015GSZ9 Exp._V
Cify ? 1475 -ply-t- State: /'1/C1 Zip:
ARCHITECT/
ENGINEER Company: Name:
Telephone #: area code (
Street
City
Sewer 8 water Ilcensed plumber (reauired for new consiruction onlv):
State:
9enalty applies when address change and lot change fs requested once permit is issued.
Zip:
I hereby acknowledge that 1 have read thls application, state ihaf fhe information Is coRecf, and agree to comply wtih all applicable
7tate of Minnesota Statuies and CfFy of Eagan Ordinances.
Slgnature of Applia
OFFICE US
Certificates of Survey Received _
Tree Preservation Plan Received _
Yes _ No
Yes No
Regfstration #:
STATE OF MN UEPT, OF COMMERCE
'.
133 Eat Scventh St
;.•
3C Paut, MN 55101 A'?
3a
(651) 296-6319 `
?
BIJII,DING CONTRACfOR
IIXt20156824
BUII.DER
CORPORAITON
E*L-ree: 03P3 V2QOQ
]EFFREY W GONDRFAU
7 Hrs CE due by 3131l2000
DBA: GRAND MANOR CON3fR
3724 KIPLLiNG AVE S
Sf LdUI3 PARK MN 554160000
PERMIT
City of Eagan Permit Type: Building
Eagan. Permit Number: EA101737
Date Issued: 10/24/2011
OR Permit Category: ePermit
41~ it~ of E3
E
Site Address: 3739 Greensboro Dr
Lot: 2 Block: I Addition: Greensboro 2nd
PID: 10-30901-01-020
Use:
Description:
Sub Type: e-Windows iDoors Construction Type:
Work Type: Windows Doors-New ; Replacement
Description: House
Census Code: 434- Occupancy :
Zonin,:
Square Feet: 0
Comments: Improvements to the home require smoke detectors in all bedrooms. If altering window openin,s, call for framing
inspection. Call for final inspection after installation.
Carbon monoxide detectors are required by law in ALL single family homes.
Fee Summary: BL - Base Fee S3K $88.50 0801.4085
Valuation: 17.167.00 Surcharge - Based on Valuation S3K $1.50 9001.2195
Total: $90.00
Contractor: - Applicant - Owner:
Scherer Brothers Lumber Company Kurt Augustin
9401 73rd Ave. N 3739 Greensboro Dr
Suite 400 Eagan NIN 55123
Brooldvn Park NIN 55428
952 277-1600
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 Cite of Eagan Ordinances.
ApplicantiPermitee: Signature Issued Bv: Signature
PERMIT
City of Eagan Permit Type: Mechanical
Permit Number: EA106165
Date Issued: 08/14/2012
Permit Category: ePermit
Site Address: 3759 Greensboro Dr
Lot: 7 Block: 1 Addition: Greensboro 1st
PID : l 0-3 0900-0 l -070
Use:
Description:
Sub Type: e -Air Conditioner
Work Type: New Description: Air Conditioner
Con1111entS: Questions regarding electrical permit requirements should be directed to Mark Anderson, State Electrical Inspector, (952)
445-2840 Jane/ Behrends
122 West 3rd S
Fee SUn1111ary: ME -Permit Fee (Replacements) $55.00 0801.4088
Surcharge-Fired $5.00 9001.2195 Valuation: 2,758.00
Total: $60.00
Contractor: -Applicant - Owner:
Haley Comfort Systems Curtiss R Baisden 122 West 3rd St 3759 Greensboro Dr
Hastings MN 55033 Eagan MN 55123
(651) 437-0338
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
Mi~esota Statutes and City of Eagan Ordinances.
ApplicanvFermitee: signature issued By: signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA143988
Date Issued:07/07/2017
Permit Category:ePermit
Site Address: 3759 Greensboro Dr
Lot:7 Block: 1 Addition: Greensboro 1st
PID:10-30900-01-070
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 -
Kefale T Bogale
3759 Greensboro Dr
Eagan MN 55123
Benson Property Llc
6989 Washington Ave S
Minneapolis MN 55439
(612) 669-9000
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA169923
Date Issued:06/15/2021
Permit Category:ePermit
Site Address: 3759 Greensboro Dr
Lot:7 Block: 1 Addition: Greensboro 1st
PID:10-30900-01-070
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507)
210-0754.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
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 -
Kefale T Bogale
3759 Greensboro Dr
Eagan MN 55123
Haley Comfort Systems
3708 Broadway Ave N
Rochester MN 55906
(507) 281-0138
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA169924
Date Issued:06/15/2021
Permit Category:ePermit
Site Address: 3759 Greensboro Dr
Lot:7 Block: 1 Addition: Greensboro 1st
PID:10-30900-01-070
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507)
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
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 -
Kefale T Bogale
3759 Greensboro Dr
Eagan MN 55123
Haley Comfort Systems
3708 Broadway Ave N
Rochester MN 55906
(507) 281-0138
Applicant/Permitee: Signature Issued By: Signature