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4354 Livingston Dr Use BLUE or BLACK Ink I For Office Use ing City of Ea U11 j Permit* ~1 to mit Fee: Tc,O Per 3630 Pilot Knob Road Eagan MN 55122 j Date Received: j Phone: (651) 675-5675 Fax: (651) 675-5694 1 Staff: 2010 RESIDENTIAL BUILDING PERMIT APPLICATION Date:] 1 Site Address: A ~ CS H L 1 \ \ Y~C~ S~ O r~ ~ c S \3 e J Tenant Suite RESIDENT /OWNER Name.- ~o I 2 h 0, V C~ a 'l S Phone: 661 _SGS OLQ i Address/ City/Zip: ~ ~ 1~ 11'~ o Y1 i"', Q Gm / 4 j ~J5l a3 Applicant is: Owner X Contractor TYPE OF WORK Description of work: aAQ LQ -2~-~-~-~s4-1 ° ~j'~'pC- YY\ O.Opc', 0 h►r~ Construction Cost: Multi-Family Building: (Yes / No CONTRACTOR Name: wiY~.c~c~ cav~r c> S License ac) 1 zH t Address: 990 Len e cog I2j,4 City: ea aye State: J\A Zip: E5 I Q I Phone: b rs Contact: 1) CLY%- C~4 ~o Email: COMPLETE' THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Ir the ast 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? _Yys _No if yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: S wer & Water Contractor: Phone: NOTE. Plans and supporting documents that you submit are considered to be public. information. Portions of the information maybe classified as non-public if you provide specific reasons that would permit the City to conclude that the are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 flours before you intend to dig to receive locates of underground utilities. www.got) herstateonecall.orq I' hareby 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 apermit, and work is not to start without a permit; that the work will be in accordaece with the approved plan in the case of work which requires a review and approval of tans. ,~1v~-t-~C SG~I~Yt r ~sI/'t X i U Applicant's Prinihd Name Applicant's Signa P g of 2 ..;? ? ? .?_. .., CITY OF EAGAN 47552 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55721 ? PHONE: 454-8100 Receipt # - Value $97 _ Block 2 SeciSub.LEXINGTON POINTE TH W Name o Addre Phone U8-6866 o Name SAME OU ¢ Address - City Phone t,. Ww Name ? ; Address <W City Phone r . r I hereby acknowlege that I have r,46ad this application and state thal the information is correct and agrea to comply wilh ail applicable State of Minnesota Statutes and City oY£agan Ordinances. ? Signature of Permitee A Building Permit is issued to: BAli1,E BROTHERS 9 INC on the express condition that all work shall be done in accordance with all applicable Stale of Minnesota Statutes and City of Eagan Ordinances. Building Oflicial 1990- OFFICE USE ONLY Occupancy R-3 _"-1 FEFS Zoning pD R-1 (ACtual) Consl v-m Bldg. Permil k26•00 (Allowable) Y? 48 50 Surcharge . u ot stories - Length ? Plan Review AQ7.Q0 Depth SAC.CiIy 1QQ•DO S.F. Tolal - SAG MCWCC 6m•oo S.F. Footprints - On Site Sewage _ Waler Conn 62 s. DO. On Site Well Water Meler 90•00 MWCCSystem ? ?.oo Cily Wa1er xx Accl. Deposit PRV Required _ S/VJ Permit 30• 00 Boosler Pump - S/W Surcharge • 50 Treatment PI 252*00 APPpOVALS Road Unit 355.00 Planner - park Ded. Coundl BIdg.Otf. _ Copies ' Variance - 70TAL 3,164.00 ? Permit No. Permit Holder Date Telephone # WATER ?it C?C.`? :??SbvlG SMER PLUMBING H.V.A.C. ELECTRIC 3 9D ? Inspection /Date Insp. Comments Footirgs l Foundation Framing Roofing Rough Plbg. Rough Hlg. kig l5ul. fireplace y- 3 '9l ".5 Final Htg. - ere M Final Plbg. :-? fr Const. Meter Plbg. Inspector- Notify Plumber Engr./Plan BIdg.Final /O'zy-f-r'0 aS Deck Ftg. Deck Final Well Pr. Disp. -< •. , . , / ? CONTRACT ' Site Address PERMIT # 7? ' MECHANICAL PERMIT RECEIPT # CITY OF EAGAN 3/!J'7 3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: PHONE: 454-8100 For Office Use Only ? Lot Block ?? Sec/?ub y Name m Address City Phone 52-?l ? c p Name Address -a - City Phone _ TYPE OF WORK Forced Air M BTU Boiler M BTU Unit Heater M BTU Air Cond. M BTU Vent CFM Gas Piping Outlets # Other FEE S/C: TOTAL• a YPE WORK DESCRIPTION BLDG. T Res. New Mult Add-on ` Comm. Repair , omer FEES HVAC 0-100 M BTU -$24 00 RES . . ADDITIONAL 50 M BTU - 6.00 (RES. HVAC INCLUDES A/C ON NEW CONSTRUCTI ON) GAS OUTLETS (MINIMUM - 1 PER PERMIn - 1 50 EA . . COMM/IND FEE - 1% OF CONTRACT FEE APT. BLDGS. - COMM. RATE APPLIES TOWNHOUSE & CONDOS - RES. RATE APPLIES MINIMUM RESIDENTIAL FEE - ALL ADD-ON & REMODELS - 12.00 MINIMUM COMMERCIAL FEE - 20.00 STATE SURCHARGE PER PERMIT - .50 50 S/C IF PERMIT PRICE GOES (ADD $ . BEYOND $1,000) 1\\ I SIGNATURE OF PERMITTEE ? o' ?' ' FOR: CITY OF EAGAN PLUMBING PERMIT CITY OF EAGAN CONTRACT PRICE Site Address Lot 3830 PILOT KNOB ROADy EAGAN, MN 55122 PHONE 4548100 ? Name ? Address ? City? ?w Phone G -G,s Name ? Ic Address 8 City Phone FEES COMM.lIND. FEE - 1% OF CONTRACT FEE APT. BLDGS. - COMM. RATE APPLIES TOWNHOUSE 8 CONDO- RES. RATE APLLIES MINIMUM - RESIDENTIAL FEE $12.00 MINIMUM - COMM.IND.IFEE $20.00 STATE SURCHARGE PER PERMIT .50 (ADD $.50 S/C PER EACH $1,000 OF PERMIT FEE) FOR: For Office PERMIT # RECEIPT# _ DATE: -- BLDG. TYP WORK DES CJiIPTION Res. New ?? ? Mult. Addon 7 Comm. Repair Other ' I ? 1 RES. PLBG. ONLY - COMPLETE THE FOL LOWING: i NO. FIXTURES TOTAL ? ? Water Closet - $3.00 $ OU Bath Tubs - $3.00 ? Lavatory - $3.00 ? Shower - $3.00 ?. v ? Kitchen Sink - $3.00 UrinaVBidet - $3.00 ; ? Laundry Tray - $3.00 ? 171 / Floor Drains - $1.50 ? Water Heater - $1.50 ? Whirlpod - $3.00 v ; 1 Gas Piping Outlets -$7.50 (MINIMUM -1 PER PERMIT) ? Softener - $5.00 Well - $10.00 Private Disp. - $10.00 ? Rough Openings - $1.50 _ U. G. Sprinkler System - $12.00 PERMIT FEE: ? ` STATES S/C: GRAND TOTAL: ?• 5 ?? CITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55122-1897 (612) 661-4675 PERMIT TYPE: t rV IN r PermitNumber: r.4HF3 Date Issued: , ? . i N I < <a U. SITEADDRESS''' ? 19 1 " 4 `'0' ` 41 ''4' 0` L ii l 1 Pl" I?Ir 1 t•, f 1`1t, I iiPa I'u t f! ? I ?! I Yf PERMIT SUBTYPE: . . ,; , ,{ APPLICANT: t Aill k MA! M i tN/tNl:l ( e. ( .' ) FiFi.I ,".1i7! TYPE OF WORK; L Iti,A9 7fYN INSPECTION D. . D• . . . ' . ? . '. . ' . . ? ' . .. . ii . . . ? I I , : ?. Permit No. Permlt Holder Date Telephone # ELECTRIC D?po99 ? `5?3 9? ?U &V PLUMBING HVAC Inspectlon Oata Insp. Commanffi FOOTINGS FOUND FRAMING J ROOFING ROUGH PLUMBING PLBG AIR TEST ROUGH HEATING , GAS SVC TEST INSUL p 9? ? GYPBOARD FIREPLACE p S - /cS o}?' FIREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL BSMT R.I. BSMT FINAL 71Y DECK FTG DECK FlNAL . .? . ...'.:vc' . J _f?+ . . i . s.... ... . . ..... . ... .. . ... . . . -ry . F ..:a,,.., . _ :.lL...,.+1.• SEWER & WATER PERMIT OFFICE USE ONLY CITY OF EAGAN METER # • PERMIT DATE c1J2i 0?1(? ? 3830 Pilot Knob Rd. 11247 ? Eagan, AtIN?b5122-1897 CHIP # PERMIT # METER SI2E B.P. RECEIPT # C 6544 DATE Z- G C? ISSUE DATE B.P. RECEIPT DATE 6 90 j _ PRV - BOOSTEfl PUMP SITE ADDRESS 4354 LIVINGS?ON D14 PERMIT REQUESTED LOT fl BLOCK 2 SEC/SUB LEXINGTQN POINTE 4TH = !?SEWER ?? WATER - TAPS 'APPLICANT: , ADDRESS: COMM/IND --LRESIDENTIAL - CITY, STATE *'?,??.?4 i1s.r4 i??± r"???? Z?P Y ?LNEW - EXISTING PHONE: Lawn Sprinklqr Meters are to be Installed PLUMBER: )l '?" ?/:i i -{ k ?{'AJa? Ahead of D*estic Meters on Water Line. c' Ci Credit WIL?'NOT bp given for Deduct Meters. ADDRESS: 1?,.??> CITY, STATE ?._ 1-?-1 i!LH'" t— A A? ZIP PHONE: Lk-t f-AGREE TO COMPLY WITH CITY OF OWNER: EAGAN ORDINANCES ADDRESS: CITY, STATE ZIP PHONE: SIGNATURE WHEN METER ISSUED PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. CALL 454-5220 FOR INSPECTIONS. FOR STORM ? SEWER PERMITS, CONTACT ENGINEERING DEPT. ,;"?_-,.-.,_;-•-..•?-.- a?'? . . j-!?c' . ... . OF EAGAN Pilot Knob Rd. i. MN 55122-1897 ATE ? • Z ? - 9L? y OFFICE USE ONLY METER A` 3/ 5& 7 PERMIT DATE nq/qRj9[l CHIP # 49Y 3Z 3 y PERMIT # 11247 METER SIZ? `? ?6 c??- ?'P kjB•P RECEIPT # C 6 544 ISSUE DATE ' 9D B.P. RECEIPT DATEQZ.LZb-LLC _ PRV - BOOSTER PUMP ADDRESS 4354 LIVINGSTON DR 8 BLOCK 2 SEC/SUB LEXINGTON POINTE 4TH CITY, STATE ? ? ? Iti.?dT? .? M?.1 ZIP ? ?? 1? ? PHONE: r??.s?t?- (?I M t?l t? .`.' ftP ?L PLUMBER: l ( I s1 k? X??IA ? i n.l l 7 . ADDRESS: 101L1 ti'1f? lA X) ?D eC t?,l/ a`5 i r E- _ , CITY, STATE Z7L ? )t4 I KY M A ) ZIP -5!?? PHONE: f!530? - OWNER: ADDRESS: CITY, STATE ZIP PERMIT REQUESTED Y SEWER ?? WATER - TAPS _ COMM/IND --VhESIDENTIAL ._1LNEW - EXISTING Lawn Sprinkl r Meters are to be Installed ! Ahead of Dnestic Meters on Water Line. Credit WIL OT be given for Deduct Meters. X1 /. Y WITH CITX. OF SIGNATURE WHEN METER ISSUED TWO WORKING DAYS FOR PROCESSING. CALL 454-5220 FOR INSPECTIONS. FOR STORM CONTACT ENGINEERING DEPT., ? , ? • ,- . . CITY OF EAGAN N2 17552 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHONE: 454-8100 /6 h W BUILDING PERMIT Receipt . To be used for SF DWG/GAR Est. Value $97,000 Date FEB 26 ,?g90 Siie Address 4354 LIVINGSTON DR Lot $ Block 2 Sec/Sub.LEXINGTON POINTE Parcel No. 4TH W Name DAHLE BROTHERS, INC jr. o Address 9304 LYNDALE AVE S City BLDOMINGTON phone 888-6866 o Name SAME z? ?Q Address i- City Phone ? yVjW Name ? ?6 Address a W City Phone I hereby acknowlege that I have ad this a icati and state that the information is wrrect and agr to comply I applicable State of Minnesota Statutes and City o gan Ordi Signature o( Permite ??- A euiiding Permit is issued to: AHLE BROTHERS INC on Ihe express condition that all work shall be done in accordance wilh all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official r I OFFICE USE ONLY Occupancy R-3 M=1 pEFS Zoning PD R-1 (Actuap Const V-N Bldg. Permit 626.00 (Allowable) V-N Surcharge CF8.50 # ot Swries Length - ?! Plan Review 407 . 00 oeptn 46' saC, ciry 100. 00 S.F. Total - SAC, MCWCC 600.00 S.F. Footprints - On Site Sewage _ Water Conn 625. DO On Site Well - Water Meter 90. 00 MWCC system xx 30.00 Cily Waler x( AccL Deposit PRV Required - S/W Permit 30.00 Booster Pump - S/W Surcharge . 50 Treatment Pl 252.00 APPROVALS Road Unil 355.00 Planner - Park Ded. Council BIdg.Off. _ Copies Variance - TOTAL 3,164. nn oG 6?oz K ? o 5 / ?- ?, Fequest ate Fe o. . ' ough" in Inspection Requiretl? ? Reatly Now ?:[Nill Notity Inspector ? Yes -?? No ,? When Ready? , licensed contractor rJ owner hereby request inspection of above electrical work at: Job Adtlress ISireet. Box r Route N0 City Sec ion No. ownship Name or No. Range No. County Occupant (PRMTt ? Phone No Power Supplier AtltlresS Electncal Connactor ICompany Namel ' - a ConlractoPS License No. t -- r 4!5 lAl - ? /Z L Mailing AtltlreSS IContr ctor or ner M ing Installati0n) Ati A iZ/l:' 01.4 Authorize S' a,re IC r or; er , aking Installation) Pho 9 Num -+???/ / 4F? MINNES4Tq4TXTE BOARD OF ELECTRIp7Y THIS INSPECTION REOUEST WILL NOT ? Griggs•Midwey Bltlg. - Room 5-173 6E ACCEPTED BV THE STATE BOARD 1821 Univeralty Ave., St. Paul. MN 55104 UNLESS PROPER INSPECTtON FEE IS PROne(612)642-0800 ENCLOSED. REQUEST FOR ELECTRICAL INSPECTION `? • 10508 , See inslrudions for completing this form on back ot yellow copy. "?C" Below Work Covered by This Request ee-ooam-0s ew Add Rep. Type of Building AppliancesWired EquipmentWired Home Range Temporary Service Duplex Water Heater Electric Heating Apt. Building Dryer Othe[-(Specify) Comm.llndustrial Furnace Farm Air Conditioner Other (specity) Contractor's Remarks: Compute Inspection Fee 8elow: # Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Swimming Pool 0 to 200 Amps 0 to 100 Amps Transformers Ahove 200 _ Amps 00 _ Amps S19f1S Inspector's Use Only: TOTAL Irrigation Booms `rT".r G U J ? Special Inspection ? Alarm/Communication THIS INSTALLATION MAY BE RED DISCONNECTED IF NOT Other Fee COMPLETED WITHIN 18 MONTHS. ? I, the Electrical Inspector, hereby Rouyn-in ? r Date certi that the above ins ection has ry P been made. Final Date / OFFICE I15E JNLV -•°'° Thi"s request void 18 month5 irom 3/?319 a a. e? s?7 25467 jl • ? ,? ?? Fequest Oate Fire . ugh-in Inspection equired? ? Ready Now Iii-Jdill Notify Inspecior Wh R ? v ?Yes ? No en eatly I-0'Ticensed contractor D owner hereby request inspection of above electrical work at: Job Atldress (,StreeL Box or qoute No.) Y -3 J / Z / 1/! Ciry i }^- -?- Section No. Townsnip Name or No. Range No. County 6i OcCUpan1(P T) Phone No. Power uppller Atldress L w ? a Electrical Contractor (COmpany Name) CoMractor's License No. /y c_ D y Mading Atloress (Contractor or Owner Making In tallation) S/?0 ?O - ?".?I ?? D/ • ?J ?f.lJ 4 G iL . S?c3 acror/Owner Making Installation) t Phone Num6er 6z. /-/-//o - 6 7 MINNESOTA STATE BOAqD OF ELECTRICITV 'trl? THIS INSPEGTION REOUEST WILL NOT Griggg-MlOway Bldg. - Room 5-173 BE ACCEPTED 8V THE STATE BOARD 1821 UnlVersMy Ave., SI. Paul, MN 55704 UNLESS PROPER INSPECTION FEE IS Phone(612)6a2-0B00 ENCLOSED. 31a?319o ? 25467 R,EQUE3T FOR ELECTRICAL INSPECTION I? See insimctions tor completing Ihis lortn on back of yellow copy. "X" Below Work Covered by This Request ef ? ,?? ? ??o ?l/7 ew Aad Rep. -- Type of Building AppliancesWired EquipmentWired Home Range Temporary Service Duplex Water Heaier Electric Heating Apt. Building Dryer Other (Specify) CommJlndustrial Fumace Farm Air Conditioner Other (specify) Conbactor5 Remarks'. Compute Inspection Fee Below: # Other Fee # ServiceEntrance 5ize Fee # Circuks/Feeders Fee Swimming Pool f 0 to 200 Amps /SOO 42 D to 100 Amps W,CO Transformers Above 200 Amps Above 100 _ Amps SignS Inspectors Use Only: TOTAL Irrigation Booms P_ 3 6 3„s? Special Inspection ?p Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT Other Fee COMPLETED WITHIN 16 MONTHS. I, the Electrical Inspector, hereby c tif th t th b i i Rou9n-in ? oar ? y er a ove e a nspect on has been made. Finai =, oate - 4, OFFICE USE ONLV This requesi voitl 18 monihs from ?r (DCj._ lili? REQUEST FOR ELECTRICAL INSPECTION ??p'•?? ee-ooooi-os S/3 ? 5 S? 7 ? See instmctions tor comol t?ing this form on back of yellow copy. ??pO7 "X" Below Work Covered by This Request Ne AdU Rep. - Type of Building Appliances Wired Equipment Wired Home Range Temporary Service Duplex Water Heater Electric Heating Apt. Building Dryer Load Management Comm./lndustrial Furnace Other (Speciy) Farm Air Conditioner Other (specify) Contracror's Remarks: Compute lnspection Fee Below: # Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Swimmin Pool 0 to 200 Am s 0 to 0 Amps Z Transformers Above 200 Amps Lai 1 _Am s $I f1S Inspeclor's Use Only: TOTAL Irrigation Booms & S ecial Inspection AlarmlCommunication: THIS INSTALLATION MAY BE DISCONNECTED IF NOT ORED Other Fee COMPLETED WITHIN 18 M HS. I, the Electrical Inspector, hereby certify that the above inspection has been made. Rough-in ? Final Date ?/ Dat OFFICE USE ONLY This request void 1 e months irom o ?59?6 ?r O? y ? ? .V ? ? ? 3 ? . ? Requ st Date I Fire No. I Roug -In inspecflm Requiretl (YOU must II inspedor when reedy) Inspection Other Than Rough-In E] Feady Now C] Will Notiy Inspector Yes ? No Dale Reatl IPTicensed contractor ?owner hereby request inspection of above electrical work at: Job Atltlress (Slreet, Box or Route No J ¢ 3 54- L' k Cily g v in?,< o fa h Section No. 7ownship Name or o. Range No. Counly Occupant (PRINT Phone No. rl Power Supplier qdtlress Electrical Contract B r(Company Nam ( Contraclor's Licensa No. c £ e ic? r; ?/f - o z l Z Mailing Address (Conirector or Owner Ma ing Inst I lion S B ? Z S.? U , Auth ed Si ature (Contractor,'Owner aking tallalion) P one Number ? u ` 821?niOVe s?y Ave, B St. Paul, MN e 51C04 'C?Y IIII.IIII III I? II III? III I? I IIII IIIII III THIS N?ESS PROPIER INSPEGTION B?E OT Phone(612) 642-0800 E ? RESIDENTIAL BUILDING PERMIT APPLICATION CITY OF EACAN 3830 PILOT KNOB RD, EACAN MN 55722 651-681-4675 New Construction Reauirements • 3 registered site surveys showing sq. ft. of lot, sq. ft. ot house; and all rooted areas (20% maximum lot coverage allowed) • 2 copies of plan showing beam & window sizes; poured tound design, elc.) • 1 set of Energy Calculations . 3 copies o( Tree Preservation Plan if lot plalted aker 711193 • Rim Joist Detail Options selection sheet (bldgs with 3 or less units) DATE '5 X,0 R SITE ADD TYPE OF APPLICANT STREET ADDRESS I2G y A C_d TELEPHONE # 96 d -?0Q-(d1$1 CELL PHONE # iULTI-FAMILY BLDG _Y K N RemodeVReoair Reauirements • 2 copies of plan • 1 set of Energy Calculations for heated additians • 7 stte suney tor exterior additions 8 decks . Indicate if home served by septic system for add'Aions VALUATION ??ILJLJ ? -b?- s - cinr fIREPIACE(S) _ 0,& 1 _ 2 / )/ Z?' S?-e;nCf- ;di 11e STATEMIJ ZIP 5533?I FAx # 9,-:a -'12 -9 5a 5 PROPERTY OWNER UOIQ I ey) IrtQ 1"IrlI S TELEPHONE #657-365 _Zgc 7 ----------------------------------------------------------------------------------------------- COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINNF.SO'1'A RiJL.ES 7670 CATEGORY 1 (4 submisslon type) . Residentiai Ventilation Category 1 Worksheet Submitted • Energy Envelope Calculations Submitted Plumbing Contractor: Plumbing system includes: Mechanical Contractor: Mechanical system includes: Sewer/Water Contractor: Phone # Phone # ree: $70.00 --------------------------------------------------------- ----------° °-----------------------°-------------------------- I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinan Signature of Applicant - ----- - - - -- - - - - - ----- - - - ----- - ------------ - ----- - ----- - - - -------- - ---- -------------------- - ---------------- - ----- - ----------- - ----- ----- OFFICE USE ONLY Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ Updated 4102 _ Watcr Softener _ Water Heater No. of Baths _ Phone # , Lawn Sprinkler No. of R.I. Baths - Air Conditioning _ Heat Recovery System ; ... ? "7-CITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55122-1897 (612) 681-4675 SITE ADDRESS: P.I.N.: 10-45073-080-02 DESCRIPTION: PERMIT 4354 LTVIN6570N LQT: 8 BLOCK: 2 LEXINGTON POIN7E 4TH B?i1.ditlg°1;F?,ermit 7ype Building Wo'rK, Type ?t ? fk> w: ??- i ?,1 L„ 3in ?:.F! ?;& PERMIT TYPE: Permit Number: Date Issued: DR BASEMENT FINISW ALTERATIqN ai 6R4011G BUSLOING 025488 05/01f95 e - r j ??n ? 4•"rv? ?? ?t t? L^. ..Yt A ..awa ?eT?7 REMARKS: A SEPflRATE PERMIT IS REQUIRED FOR ANY ELECTRICAL QR PLUMBING WORK FEE SUMMARY: Base Fee $35.00 COPY $.50 5urcharge $.50 7ota1 Fee $36.00 Subtotal $35.50 CONTRACTOR: - Applicant - 5T. LIC. OWNER: LAUER MAINYENANCE & CONST 18812907 0004052 WHALEN ANDY 9309 LYNDALE AVE S 4354 LIVINGSTON DR BLOOMTNGTON MN 55420 EA6RN MN 65123 (612) 881-2907 (612)688-8252 INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: B U I L D I N G 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55122-1897 Date Issued: 025488 (612) 681-4675 0 5/ O 1/ 9 5 SITEADDRESS:p • z . N. : 10-45073-080-02 LOT: 8 BLOCK: 4354 LIVINGSTON DR LEXINGTON POINTE 4TH PERMIT SUBTYPE: BA5EMENT FINISH APPLICANT: z I_AUER MAINTENANCE & CONST (612) 881-2907 TYPE OF WORK: ALTERATTON INSPECTION RAMIN6 ., . I.NSULATION .. OUGH IN PLBG FSNAL . A CITY OF EAGAN 3830 PILOT KNOB RD - 55122 )A4111995 BUILDING PERMIT APPLICATION (RESIDENTIAL) 681-4675 New Construction Reauirements RemodeURepair ReauiremeMs ? 3 registered site surveys ? 2 copies of plan ? 2 copies of plans (include beam 8 window sizes; poured fid. design; etc.) ? 2 site surveys (euterior addftions 8 decks) ? 1 energy calculations ? 1 energy calculations for heated additions ? 3 copies of tree preservation plan if lot platted after 711l93 required: _ Yes _ No DATE: y- 026 -?5-- CONSTRUCTION COST: DESCRIPTION OF WORK: ,*s.- STREETADDRESS: L/ 3Sy C,v,A)55it'1j Q4. If awN MW S-'S l?3 LOT ? BLOCK ? SUBD./P.I.D. #: PROPERTY Name: C-4/" hA IF-n1 ' An4 v Phone #: g- 3?519- OWNER ?* fIR6T StreetAddress: Y3SL/ L?`U?`V45TGn.l p ?• City: I_Lbfq4-V?j State: AP) zip:-S5-la3 CONTRACTOR Company: L144g2Mi4 1rlT 4? Cc»NST Phone #: Street Address: q3 o q ? C-ynkl?/E License #: City: g/ao,n,'Ny Taa State: #L0 Zip• ARCHITECT! Company: Phone #: ENGINEER Name: Registration #, Street Address* City: State: Zip: Sewer & water licensed plumber: Penalty applies when address change and Iot change are requested once permit is issued. 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. OFFICE USE ONLY Certificates of Survey Received Tree Preservation Plan Received Signature of APplicant: _ Yes _ No _ Yes _ No 6 L?z --------------- OFFICE USE ONLY BUILDING PERMIT TYPE 0 01 Foundation ? 06 Duplex ? 02 SF Dwelling ? 07 4-plex ? 03 SF Addition ? 08 8-plex ? 04 SF Porch o 09 12-plex ? 05 SF Misc. 0 10 = plex WORK TYPE 0 31 New -49-"33 Alterations 0 32 Addition ? 34 Repair GENERAL INFORMATION , ? ? 11 Apt./Lodging A--ef-16 Basement Finish ? 12 Multi RepaidRem. 0 17 Swim Pool ? 13 Garage/Accessory ? 20 Public Facility ? 14 Fireplace ? 21 Miscellaneous ? 15 Deck 0 36 Move ? 37 Demolition Const. (Actual) Basement sq. ft. (Allowable) Main level sq. ft. UBC Occupancy sq. ft. Zoning sq. ft. # of Stories sq. ft. Length sq. ft. Depth Footprint sq. ft. APPROVALS Planning Building MC/WS System City Water Fire Sprinklered PRV Booster Pump Census Code. V.3 y SAC Code oi Census Bldg / Census Unit o Engineering Variance bPermit Fee Valuation: $ Surcharge Plan Review License MCNVS SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment PI. Road Unit Park Ded. Trails Ded. Other Copies , 0 Total: % SAC SAC Units ,f 3 1990 BIIILDING PERMIT APPLICATION CITY OF EAGAN SINGLE FAMILY DWELLINGS MULTIPLE DWELLINGS f l COMMERCIAL 2 SETS OF PLANS 2 SETS OF PLANS 2 SETS OF ARCHITECTURAL 3 REGISTERED SITE SURVEYS REGISTERED SITE SURVEYS - & STRUCTURAL PLANS 1 SET OF ENERGY CALCULATIONS (CHECK WITH BLDG. DEPT.) 1 SET OF SPEGIFICATIONS 1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS # OF RENTAL UNITS # OF FOR SALE UNITS PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING DAY OF MONTH IN WHICH REQUEST IS MADE. LOT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED. NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSIIED. V PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED. PERMIT MUST SHOW A LICENSED PLUMBER. To Be Used Fo Site Address Lot b r: Valuation: it8 2 i RECD ? Date: Z? Z'L - '% a vw OFFICE USE ONLY Z 1 oo i Block Parcel/Sub?'- Owner Address City/Zip Code Phone ? Contractor o'?V2?>Vn5' Address `'vZi oN- ? .?.m?-?? ? City/Zip Code Phone Arch./Engr. Address City/Zip Code Occupancy -R 3 M-1 Zoning Actual Const N Allowable V- N # of stories Length Z Depth S.F. Total Footprint S.F. On site sewage_ On site well MWCC System City water PRV _ Booster Pump _ APPROVALS PlanneY Council Bldg. Off. Variance FEES Bldg, Permit ?Co Surcharge _atels_q Plan Review Op SAC, City 100-00 SAC, MWCC 600100 Water Conn 2, 1 00 Water Meter 90,pa Acct. Deposit 30.0 O S/W Permit D,Da S/W Surcharge .? Treatment Pl. 2,5 Road Unit 3 t0 Park Ded. Copies SUBTOTAL Penalty TOTAL I L , Phone # VR L??.?-r-1 a ?1 ? S I S X 15= 1'l ? D rv? 7- ? Z2x2-L = S?2 `l?l ? x ?? = I n4g6?( H b u.SQ, ?*?i 22-'`?? ? ?3g 5Y,a? 40 Zy a 5"2 ZX? ? iy 3 ?c ? ?'?2 = ?3y ? . __._------ i 61 n q y 17l.2X?2= ao - x2 r? bo f, , , ! 3 OWPI [ Rt tl(TFRInR tNYELOPE AVfRAGE "U" .[OHPIiTAT10N ? SITE ADD RESS: l'"??54 ?..r.,,.S•??1^? ?v,,,,? CONTRACTOR: pATE: PHONE: gF3?'?o??o(o OETfRriiNE NORKING SOUARE FOOTA GE QF EACH: 7. TOTAL £XPOSED WALI AREA........ 1?8'l aq ft x"U" II ??1 51 s ? . 2. TOTAL ROOf/CEILING AREA,.,,,... IZ?p sq ft x"U" ? 33 z g . . 3• TDTAL EXPOSED WALL AREA CALCULATIONS: Total exposed wal) area above floor........ ` sq ft a) t ) Total wall wTndoar area: qlazed...... sq ft x"U" S • (oS.So glazed...... sq ft x "U" ? b) Total door area ,,,,,,,,. sq ft x"U" .?\ ? `A•l8 c) Total slidtng glass door area: - glazed...... ?Q sq ft x????? glazed...... - sq ft x "U" . d) Total fireplace wall area - sq ft x"U" - ? - e) Total wall framing area (Averane 10).......... ???sZ sq ft x????? . Ocj = ?`-{ -S$ f) Total net wall area above floor (InsuTated)....... ? ZS15 sq ft x"U" • Oy a 50.12 g) To[al rim jolst area..... . sq ft x"U" _ 0-1 =(o.'SZ ' Total foundation . Area (Exposed).......... ?05 sg ft h) Total foundation window area............. sq ft x"U" a i) Total net foundation area above grade........ sq ft x"U" 3• TOTAL a) thru I) ? _ ?Sl.''?C? If item #j is the same as, or less than item P1, you have met the intent of 2 P1CAR 1.16008 A and 0. Page 1 , 4.?)70TAL EXDDSEII RQOF/CEILINf tALCULATlOt15: ' Total exposed ` roof/ceTllng area........ ?(o$ sq ft Total Skylloht. area....... ? sq ft x"U" •? ? `?•`?8 k) Total roof/cetllnq framing area (Averaae if19),,,.,, ?11 sq ft x"U" ; oZ s 2•3`? 1) 'Total eet insulated toof/cetltnq area....... ?OS\ sq ft x"U" o Z ? Z 1. O Z - 4. TOTAL J) th ru 1) If total of !'4 is the same as, or less than P2, you fiave met the intent of 2 MCAR 1.16008 A and 0. ALTERNATE BUILDING ENVELOPE DESIGN To utitize the total envelope system tnethod, the values established by the sum of items 63 and p4 shatl not be grea"ter than the sum of items 01 and 02. 1. + 2. ? 3. + A. _ ? ' ?? . . / A tiSTRUCTION R VALUE AHING SECTION: lnterlor air film 0.69 ncnes zterlor a U • i/R • , 0°1 1#1 WALL SECTION (INSULATEO) --(1 lnterlor alr fllm f1.6R A5 --? 3 , GG 1. • CL '?: •?? --?f+ xcerior e r i • . 7 OTAL R • 23.05 U - 1/R a ,04 C D Lt RIH .lOIST SECTIDfI: --?1 Interlor air film ' _ t?.6A 3 -y4° si.trUCc 5 HQ_a?o.:.'1 •a: .(,? ? 6 xterior air ft n. 7 TOTAL R ? 2A1.4 to FOUNDATION INSUlATIOli REQUIRED: ' Min. R-5 on entire wall OR U- 1/R 04 a.:• e Min. R-10 down to frost epth p, , ' ???" A • FOUNDATION SECTIDN: e=?"• '• 1 Interlor alr film n.cR '•A.?'• 2 r pb , .0.^ e? 6• - --i3 lra" 40r1C, " "'p . d. 4 Exterlor air film m7 a ,Q G ,?• ¢ ;i,;. , ? (? y `;.0 4 TOTAL R? 1.115 , v SLAR ON GRADE A v ? i-1 •?, _ c ?i ?,?;,, • . ' • • Heated Slabs: . . , , .. • Mlinimum R= 8.5 Unheated Slabs: '40 .', Minimum R = 6.2 . . F?.. L1'6 ??•?• t? ??• , ' "a . - • -;4 ; • ° : "4 *4 , '1 : •O •Q,1 4 . • ?• ?' 8 . ; •a???' ?• c r / • • q 1 . ? ? . ? . d ? •' d . , .. ' • d, •-. ? ?;a ,•..q;• , '?j. I:,? .?•.Q` • •? ? '? ? i , 4• .,.a • q •• `' ' • J4. . . • •, ? Q4 ?.,• Q ? . •Q. :-Q?, /?'? I • . ? + r i" Page 3 . ? ? ? H VENTED CONSTRUCT ION R VAWC tEiLINf, SECTION (INSULATED)=`: • _ t?.f,l 1 Interior alr film 2 0 C 3 c ?-L ?as . wi-AA 4P4. w 4 fxterior air film stlll n.F1 TOTAL R ? 45?f : U? ` CEILING FRAMINf SECTION: a e.bl 1 Intertor alr film 2 v' . Fr• ,c 3 CLtn . i?k, e,?.?a 4d-,o? 4 nter or a r film still O. 1 S 5FA2 tnches soft Nood TOTAL R i 51.66i U m 1/R tE1LING SEf,T10N (INSULATED):: ,, . 11 (nterlor ai r f T lm n.6) 2 S- oa„d .5 3 ttf. 05 txo 4 fxterior air film still ff• 1 TOTAL R = Lt&?.l U m 1/R W _OZ \ ? CEILiNr, FRAMIN?, SECTIOrI: 1 interior air film 2 Sls` -. ,? o?d .s? 3 Cu:. t,.k. V.r- N 4 Extertor air film still n-61 5 J'/Z inches soft wood 1.f1f TOTAL R = y"1.16"1 U = 1/R - D2 t Inslde alr film n•f? ) 2 3 4 5 Outside air film n•17 TOTAL R U ? l/R s Page 4 CITY OF EAGAN 3830 PILOT RNOB ROAD EAGAN, MN 55122 PHONE: (612) 454-8100 ----------------------------------- FEES ADD-ON MINIMUM $15.00 HVAC 0-100 M BTU 24.00 ADDITIONAL 50 M BTU 6.00 GAS OUTLETS - MINIMUM 3.00 OF 1 PER PERMIT SUBTOTAL: $ o-b STATE SURCHARGE: .50 TOTAL: -$ ? /'? SIGNATURE OF PE?IT E G?? ? pAKOTA HEATINO AND OOOI.INCa 2p20 SILVER BEtk. ROW EAGAN. MN 5512i1 PLEASE COMPLETE IIPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS & TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. WORK DESCRIPTION NEW CONST ? ADD ON REPAIR OWNER NA SITE ADD IAT: 15 BLOCK INSTALLE ADDRESS: A!S CITY:? ZIP: ?.7?I 2 Z PHONE #: av PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS, APARTMENT BUILDINGS, AND MULTI-FAMILY SUILDINGS WIiEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT. ------------------------------------------------- ______.____.--___--------------- CONTRACT PRICE: FEES OWNER NAME: SITE ADDRESS: IAT: BIACK SUBD. INSTALLER: ADDRESS: CITY: ZIP: PHONE #: FOR: 1% OF CONTRACT FEE. STATE SURCHARGE _ $.50 FOR EACH $1,000 OF PERMIT FEE. PROCESSED pIPING = $25.00 $25.00 MINIMUM FEE. CONTRACT PRICE x 18 $ STATE SURCHARGE TOTAL: FOR CITY USE ONLY PERMIT # RECEIPT # 4? DATE: o?q $ (SIGNATURE) CITY OF EAGAN 90-026 T RI - LAN D C 0. SURVEYING SITE PLAN FOR: SERVICES DAHLE BROTHERS 1260 YANKEE DOODLE ROAD EAGAN, MINNESOTA 55126 LEGAL DESCRIPTION: LOT8,BLOCK2, LEXINGTON POINTE 4th ADD. ACCORDING TO THE RECORDED PLAT ` ?• THEREOF DAKOTA COUNTY,MINNESOTA J \? SCALE: I"=30' LOT 7 zs ? ? r ? S89°32'21"W ? 137.40 Lo < 'D 10 ? ?-?2 9BSI DRAINAGE 8 UTILITY 98? z^ OD ?? SZy9 EASEMFVT ? G (f } (JJ N I N D I t?6 Q 0)0 r g o ? . £ Q ? I 9 N T 01 . 2433 9 9?? < m 10 @ LOt 8 I ? rn lv 9- 32.00 ` LS ??N81°53•3 .?W SZ.,5---___ ? io 9 J ? ?S N < l37.40 d LO r 9 ' 11 OD 10 ? 10 O Cll (D co ?? „? y El ? ? 4«T ? ?e Lln-m -- [Y ENGdiY1;?ERItZG I7Ek T LEGEND o DENOTES IRON MONUMENT ? DENOTES WOOD HUB SET DENOTES EXISTING SPOT ELE VATION DENOTES PROPOSED SPOT ELEVATION ? DENOTES DRAINAGE DIRECTION I hereby certify that this survey, plon or report was prepared by me or under my direct supervision and that I am a duly Repistered Land Surveyor under the Lows of the Stote of Minnesoto. PROPOSED SPLt7 ENTRY - NO WALKOUT INVERT ELEVATION AT SERVICE EXTENSION=r_ PROPOSED GARAGE FLOOR ELEVATION = `)'- • . _ PROPOSED FIRST FLOOR ELEVATION = ?n` PROPOSED BASEMENT FLOOR ELEVATION NOTE'• VERIFY ALL FLOOR HEIGHTS WITH FINAL HOUSE PLANS Brodley J.U!5Y*enson, Mn. Rey. No. 15235 Date : 41 - For office Use I q3 I I City of En n~ I Permit I tc, I 1 I Permit Fee: i 3830 Pilot Knob Road I Eagan MN 55122 j Date Received: Phone: (651) 675-5675 I I Fax: (651) 675-5694 i Staff: I-------- - - - - -J 2009 MECHANICAL PERMIT APPLICATION Date: U0 1Q0 Site Address Tenant: Suite RIP Name: ~ Phone: RESIDENT I OWNER ,l Ad r / itv/ ip• LA qq V 1" -+u~.J d ess C Z J 46 /1- All I Name: S i CONTRACTOR AS)MOAA r Address: ~4 e~ 1.11 City: r~ State: T\W_ Ztp: Ltact Person: hnrp Phone: 2b- q TYPE OF WORK New T Replacement Additional' Alteration Demolition Description of work: NOTE: Both rool mounted and ground mounted mechanical equipment is required to be screened by City Code. Please contact the Mechanical Inspector or one of the Planners for Information on permitted screening ' methods. PERMIT TYPE RESIDENTIAL COMMERCIAL VFumace - New Construction ^ Interior Improvement _AOL-`A'irConditioner . Install Piping i Processed Air Exchanger -Gas ^ Exterior HVAC Unit -Heat Pump _ Under/ Above ground Tank Install /_Remove) When installing/removing tank(s), call for inspection by Fire Other Marshal and Plumbing Inspector RESIDENTIAL FEES: $50.50 Minimum Add-on of alteration to an existing unit (includes $.50 State Surcharge) $90.50 Fire repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) $ TOTAL FEE COMMERCIAL FEES: $70.50 Underground tank installation/removal OR Contract Value $ x1% $50.50 Minimum (includes,State Surcharge) $ Permit Fee - If Permit Fee is less than $1,000, surcharge is $.50. If Permit Fee is > $1,000, surcharge increases by $.50 for each = $ State Surcharge $1,000 Permit Fee (i.e. a $1,001-$2,000 Permit Fee requires a $1.00 surcharge). $ TOTALFEE 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 he case of work which requires a review and approval of PI c Applicant's Printed Name Applicant's Silnature FOR OFFICE USE Reviewed By: Date: Required Inspections: ,___-Under Ground Rough In ____Air Test `Gas Service Test -in-floor Heat -Final Exterior HVAC Screening Inspection Use BLUE or BLACK Ink r I For Office Use I ~ Permit City of Ea Rd~ I Permit Fee: 3830 Pilot Knob Road I I Eagan MN 55122 ; Date Received: Phone: (651) 675-5675 I~~ I Fax: (651) 675-5694 I Staff: I I 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Unit Name: 10 Phone: Resident/ Owner Address / City / Zip: L~ I'I n S lz sc' Applicant is: Owner X_ Contractor Type of Work Description of work: P, I" Construction Cost: C0" vyc Multi-Family Building: (Yes / No ) A , Company: _ Q ~ l t S TtAC . Contact: 'n 4 VLt k--C. Address: 130 0~~ S''a City: r- Contractor State: Zip: IJ-) 7_3 Phone: License J0 S Lead Certificate i1 'c c 14 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: NOTE: Plans and supporting documents that you submit are considered to be public information.' Portions of the information maybe classified as non-public if you provide specihc reasons that would permit the City to conclude that they are 'trade secrets. 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.ciopherstateonecall.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. Exterior 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_ B C~ l e'l,,- i-c- t 'v) x Applicant's Printed Name 'Applicant's Signature Page 1 of 3 PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA159871 Date Issued:01/24/2020 Permit Category:ePermit Site Address: 4354 Livingston Dr Lot:8 Block: 2 Addition: Lexington Pointe 4th PID:10-45073-02-080 Use: Description: Sub Type:Residential Work Type:Replace Description:Water Softener Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener). Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087 Surcharge-Fixed $1.00 9001.2195 $60.00 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Jo Ellen Hargis 4354 Livingston Dr Eagan MN 55123 Haferman Water Conditioning 12142 12th Ave. Burnsville MN 55337 (952) 894-4040 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA169326 Date Issued:05/21/2021 Permit Category:ePermit Site Address: 4354 Livingston Dr Lot:8 Block: 2 Addition: Lexington Pointe 4th PID:10-45073-02-080 Use: Description: Sub Type:Reroof Work Type:Replace Description:Does not include skylight(s) Census Code:434 - Residential Additions, Alterations Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Please print pictures of ice and water protection and leave on site. We encourage you to retain an electronic copy of photos until the project passes a final inspection. If water damage is encountered, please call (651) 675-5675 to schedule a site visit to verify the extent of the damage. Any Valuation: 5,000.00 Fee Summary:BL - Base Fee $5K $118.00 0801.4085 Surcharge - Based on Valuation $5K $2.50 9001.2195 $120.50 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 - Jo Ellen Hargis 4354 Livingston Dr Eagan MN 55123--260 (651) 769-5622 Legacy Restoration Llc 15350 25th Ave N, Suite 114 Plymouth MN 55447 (763) 354-7660 Applicant/Permitee: Signature Issued By: Signature