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3149 Farnum Dri ? " . • CIT 3793 ri1M Knol ' PH BUILDING PERMIT I Ea9on, MN Ss12! ' 4S4-81 OQ Rece+at # Site /Wdreu Lot 81ock 5ec/Sub. - - Parcel # aWC Name ; Nddross b o Name t"_"-,•`;n ? i v- zt- Ou Vl l,Mrefi F !"io.. BL-_- Erect [3 Occuponty /11ter ? Zoninp Repair ? Fire Zone Enlarge ? TYpe oF Const. Move Q * Stories Demolish ? Length Grode ? Depth Sq. Ft. Approvals Fees Assessment Permit Woter 8 Sew. Sutcharge Police Plun check Fi ra 5AC Enp. Water Conn. Planner Water Mrtar Council Road Unit Bldg. Off. APC Tatal on tha expness condition thn+ I hereby ocknowledge that I have reod this applicotion ond state that the information ls correct and agree to comply with all applicoble Stote of Minnesoto Stotutes and City of Eogan Ordirances. Sipnoture of Pertnittee A Building Permit Is issued to: all work sholt be done in accordorxe with oll opplicable State of Minrw BuildinQ Officiot soto Statutes and City of Eapan Ordinonces Psrmit No. Permit Holder Miu. Permit No. Holder p i Jactri. (,V 31pD77o ?? c? D-'ZS-g'Z Irupectio n Dats Insp. Other Footinys .? j Foundation Fnminy ? -- _ ? Rouyh Plbp. ? Rough HVA Insulation ? Finel Plbp. - Final HVAC Fin.l Wour Dwscribe Location: VYell Sawar Pr. Disp. ?. cIiir dF E?GAN - 3795 Pllef Ksob ReoA Eegea, MN 55122 ' VHdNE: 454-8100 ' BUILJING PERMIT Receipt # Te be wed fer Est. Value Dote 19 Site llddress Erect Occuponcy Lot Block Set/Sub. Alter ? Zoninfl Parcel # Cbachraan Laz: ! A?rem : Prior 8 Nome ' ' - - %' ? ot' Address Nome _ Address Repair Q Fire Zone Enlo?ye ? Type of Corut. Move O # Stories Qemolish p Length Grade ? Depth Sq. Ft. Aooro rals F&am Assessment _ Wote? & Sew. Polite Fin E+G• Plonner Council I hereby acknowledge that I hove read this application ond state that g{dg. Off. the information Is correct ond ngree to tomply with oll opplitable ^PC - Stote of Minnesoto Stotutes ond City of Eogan Ordinonces. Sipnofure of Permiftee A Bullding Permit Is issued to: all wo?k sholl be done in accordonce with all opplicobla State of Mir Buildinq Official Permit Surchorpe Plan check SAC Water Conn. Water Meter Rood Unit Total _ on tha exprou condition thnt Ciy of Ecflan Ordinances. Psrmit No. Parmit Holder Misc. Permit No. Holder Plumbing ? 3 Z ./?? ?jc?t u 1.?( +l ?j l -? -g'Z H.V.A.C. 32- R ?-S t'r . i i `IS --8-2- WNI Weter Diap. Sovwr EMctric 4J3?o07 oC, 6 r r1 (?_ r$ -?s2. Inspoction Date ' Insp. Other Footinqt -' ? Foundetion Framinp ? . ?>_y.5 Rouph Plbp. ?. Ole Rough HVA ?-3-& Inwletion Final Piby. Final HVAC 3 Finsl Waur Dacribe Location: VWII . , Sevwr Pr. D'np. ? , . . , ? ? 3795 Pilel BUILDING PERMIT MN 55123 ' ^ 7-=1 9 Reteipt # $itQ I,ddfE55 Lot Block Sec/Sub. ? '' f• Porcel # oc Name W Z g Address , .. . . ip Nome _ uU /lddress Name Address 1 hereby ocknowledge that I hove read this opplication ond sture that fhe inlormation is correct and agree to comply wiih oll upplicnble Srute of Minnesota Srotutes and City of Eagun Ordinnnces. Signoture of Permittee A Building Pennit is issued to: oll work shall be done in occordance with all opplicabie State of Minn Bulldinq Officiol Erect [2 Occupancy Alter ? Zoning Repair ? Fire Zone Enlorye ? Type of Const. Move ? # Stories Demolish ? Length Grode p Depth Sq. Ft. Approvals Fees Assessment Water 8 Sew. Police Fire Enp. Planner CounCi I Bidg. Off. APC Permit Surchorge Plan check SAC Wcter Conn. Water Meter Road Unit Totol n the expreas condlTlon thni of Eapan Ordinoncea. Permit No. Permit Holder Misc. Permit No. Holder Plumbiny 3D J) ul l1Fs ( '30-& H.V.A.C. 1t Weter w.n Disp. Sewer Elecirie 3(v0-77 0 ? O(Ee. r ? ZIs - I,?- Inapection Date Insp. Other Faotinyt a0- Foundatfoo Framing a 3` .., .• .• / Rouyh Pibg. wey r ? Rouqh HVAC : ?, ?9 Inwlation .,, Final Plb¢ .? ? Final HVAC Final y7?.? ?f {i watsr Desaibe Location: VYell Sewer ? Pr. Disp. crnr oF EAGAN 3795 Pilof Knob Rood Eayen, MN 53122 PHONEs 434•8100 BUILDING PERMIT ReceiPt # r? Te be wed for Est. Value Do te 19 Site Addrcu Erect ? Qccuponcy I.ot Block Sec/Sub. - - /11ter p Zoning Parcel # Repoir Q Firc Zone l E T f C n arne ? ype o onst. W Name ' Mova ? # Stories ; Addmss ' 3? ri . Demolish ? ? r:,,. !. ::. l e I a.,.- ? ' - 3 ?_ Grade ? ApOrorals p Name - ?? A?r? Assessment _ ? Woter & Sew. Nome _ Address Police Firo Erq. Planner Councf I I hereby ocknowledge thot I hove read this opplication ond stote that Bldfl. Off. the informotion is torrecf ond agree to Comply with all opplicoble APC _ State of Minnesota Srotute: ond City of Eo9an Ordinonces. Siynature of Pertnittee Length Permit Surchor9e Plnn check SAC Water Conn. Water Meter Rood Unit Total A Building Permit is issued to: on ths exprcss condition that oll work sholl be dorx in ocwrdante with all opplicoble Stote of Minnesota Statutes and City of Eapon Ordinances. Buildinfl Offitiol Mrmit No. Permit Holder Misc. Permit No. Holder Plum6iny C?t???L??c Gr-? H.V.A.C. I -IS-?` w.u Wet?r Oisp. S?vwr Ekctric (,?}3(ppN0 D-ZS-B'Z. Inspection Date Inap. Other Footinys ? Foundatfon Framioq Rcuoh Pibp. . Rouph HVA Inalation 42- Final PIh4 . z - Final HVAC Finai -2?l- Wm? Mscribe Location: VYell Savwr Pr. Dbp. ? CITY Of EAGAN 3795 Nlot Kno? Raod Eogan, MN 55122 PHONE: 454-8100 1 71; 0 1 OYILDIPIu 1'CKMIT Receipt # To !e wod fer Est. Volue Dcte 19 Site /lddrcu _ --. . -t - Erect ? Occupancy ` - Lot Block $ec/Sub. ' Alter ? Zoning j Parcel # Repoir ? Fire Zone E nlarge Q Type of Const. c o Nama - M # St i W ? ove or e5 ; Addross - :: Demolish p Length Grode fl ' Depth Sa. Ft. ?o N? _'c;: 3n6tr+x tic?? T iv . z~ ' ?? Address 1- Pu., Nome _ Address I hereby ocknowledge that I hove read this applicotion ond stote that the informotion is correct ond ogree to comply with cll npplicable State of Minnesota Stotutes and City of Eogan Ordinonces. Assessment Wate? 6 $ew. Police Firo Enq. Planner Councfl Bidp. Off. APC F*es Permit Surcharpe Plon check 5AC Water Conn. Water Meter Road Unit _ Totol Siqnoture of Permittea ? A Building Permit is issued to: on the expross conditlon thot oll work shall be done in accordance with oll applicoble Stote of Minnesoto Stotutes and Ciry oF Eeqan Ordinances. Buildinp Officiol Psrmit No. Parmit Holder Misc. Permit No. Holder Plumbinq H.V.A.C. WNI Water Diap. Sewar E ketric U) 340 -I $ ?f-r? E C? 1' ? (O- Z 8" -82 Irspsetfon Dste Incp. Othe? Footingt sa* Foundatian Framinp F Rouph Plbp. -4, kJ O- - Rouyh HVA Inwlation Final Plbg. . y ? Final HVAC Final WoUr Deavibe Location: . VWII Sevrer ? . Pr. Dkp. CITY OF EAGAN Remarks *C)? J•44" ?412-Addition COACEMAN LAHD C0. lst ADDITI0N Lot 2 sik 4 Parcel 10-1815o-Q20-Ok dwner Street 31?9 77(L rAv`'F',. brVvL State Improvement Date Amount Years Payment Receipt Date STREET SURF, ], 4 P d xmdei - OO M- STREET RESTOR. 11983 603.34 A0I1789 1-3-83 GRADING 1911 jsgid uade O 11.-31 Grading 1983 173.26 5 138.61 A011789 1-3-83 SAN SEW TRUNK 1? Paid 1111d1.° - ?- ?-? 1t SEWER LATERAL 1973 Paid 13IIdE JJ ? 11- 1 ** 1983 1908.37 5 1526.70 A011789 1-3-83 WATERMAIN 1 PBid UIICIE - OO 11-31 i yVATER LATERAL 1 Paid L111CiC ??- 1.1.-? WATER AREA 1977 P id undei a- 0 00 11- 1 ** 1983 5 STORM SEW TRK 1 Patfl U11(ZC 0- 0? 1?.-31 STORM SEW LAT 1983 5 5 **Services 1983 S CURB & GU'TTER SIDEWALK STREET_XKW 1047 1986 46.33 4.63 10 Q C,O (o RO 24 0 31780 9-10-82 WATER CONN, 420.00 BUILDING PER. SAC PARK I CiTY OF EAGAN Remarks ?- Addition MA(.'AMAN i.ANi1 rE)_ la# ATITITTTAR Lot-3 -Rlk IL Parcel ?0-1a150-??Q-??t Owner Street 31s ??? Nv?+"'l- t)IL'J E State Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. 4 id LIIldC rcel 10 9Q0 11-31 STREET RESTOR. 1983 r754.17 150. 83 5 603.34 A011 26 2-1 -83 GRADING 197i Gradin 1983 73.26 34.65 5 1 8.61 A011 26 2-1 -83 SAN SEW TRUNK 19 11 ? SEWER LATERAL 1973 **Sewer Lat 1983 1908.37 381.67 5 1 26..0 A011 26 2-1 -8 WATERMAIN 1972 * WATER LATERAL 1973 WATER AREA 1977 **Water Lat 1983 5 STORM SEW TRK 1975 ** STORM SEW LAT 1983 **Services 1983 CURB & GUTTER SIDEWALK STREET LXq[@(1{X 1007 1986 46.33 4.63 lo ROAD UN 240.00 31780 -10.82 WATER CONN. 420.00 BUILDING PER. SAC n ir PARK CITY OF EAGAN Remarks D? I Li -- ,- ''Addition COACEW LM Co. 18t ADDITIOX Lot 4 Owner Street15Fout- Ccs.? Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. 1)7 Paid UAG? pSI'CCZ 10- 0 1.1.-31 STREETRESTOR. 603.34 A012369 6-21-83 ? GRADING 1.971 radin 1983 173.26 34.65 5 138.61 A012369 6-21-8 SAN SEW TRUNK 19 SEWER LATERAL I 19?3 **Sewer Lat 1983 1908.37 381.67 S 1526.70 A012369 6-21-83 WATERMAIN 1972 WATER LATERAL WATER AREA 1977 **Water Lat 1983 5 I STORM SEW TRK 1975 i** STORM SEW LAT 19$3 **Services 9 CURB & GUTTER ? SIDEWAIK STREET LXMX 1007 1 8 .3 4.63 10 ' 0 240.00 31780 -10-82 WATER CONN. 1420.00 If fo 13UILDING PER. 04 I SAC 525-01711 n n PARK ? I CITY OF EAGAN Remarks Addition CQACHKIkN LAND CO. l8t AMMDNLot 1 Blk 4 Parcel 10-18150-010-04 Owner Street I 51-7 Fdu-r po-.ks R.aa-C 5tate Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. O OO- 1- ?. STREET RESTOR. 7f.rC 1983 754.17 150-83 60 .?F 14ou88 2- -8 GRADING 1971 Paid 1a1? C61 1? ??- 11-31 Gradin 1983 173.26 34.65 5 138.61 A01188 2- -8 SAN SEW TRUNK 1968 Paid ?u?de arcel 10 00 11-31 1F SEWER LATERAL 1973 p e 10- O- u- 1 **Sewer Lat rLti 1983 1908.37 381.67 5 1526.7o A01188 2- -$ WATERMAIN l?J 1972 Paid uade ar?el 10- 00 11-31 * WATER LATERAL 1 PBi d lII7(?C Parcel ZO- OO- u- WATER AREA O- ?O- 11- **Water Lat 1983 5 STORM SEW TRK 1 Paid 1111d Cel ZO DO 11-31 ** STORM SEW !AT 1983 5 **Services 1983 5 CURB & GUTTER SIDEWALK STREETY,XM 1007 1986 46.33 4.63 10 ROAD UNIT 240.00 31780 -10-82 WATER CONN. 420.00 BUILDING PER, 7501 SAC 525-00 PARK R i MECHANICAL PERMIT P i N ece pt erm t o. CITY OF EAGAN Fee Fill in numbered speces S/C ?• Type or Print legib/y Tot . , i 1. Date 2. Installation Cost - 3. Job Address Lot / Blk. ' Tract 4. Owner 5. 6. Address Phone 7. City, . State Zip 8. Building Type: Residential 0 Commercial ? Institutional ? 9. Work Description: New El Add ? Alter 0 Repair O 10. Describe Fuel Type ? 11 No. Equinment BTU - M. Ea. Forced Air , No. Equipment CFM : Air H dlin Mfg. g an Boilers Mfg. Mech. Exhaust Unit Heater Mfg. Other Air Cond. Mfg. Gas, Piping Outlets 12. I hereby certify that the above information is true and correct, and I agree to comply with all ordinances and codes governing this type of work. Signed: for Rough Flnal Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. Approved CITY OF EAGAN 464-8100 Raceiqt PLUMBING PERMIT Permit No. CITYOFEAGAN Fee Fill !n numbered spec?s S/C • 5? Type or Print legibJy ?i Tot. . 2 J. ? 1. Date Y124/62 l;;? 2. Installation Cost ? C; , 3. Job Address ..i..tiot r Blk. Tract L+)Avri+°lzilt 4. Owner •=????UD ?vit? 5. Contractar a?riJLTIr,? FUji*.cI",'v i::?; phone 766-4007 6. Address C6T. 7. City State .?• Zip 8. Building Type: Residential ?- Commercial ? Institutional ? 9. Work Description: New 43 Add ? Alter ? Repair O 10. Describe ,.:..? i :?„•.? 11. No. Fixtures Water Closet No. Fixtures Cess ool/Drainfield 1 Bath tubs p Se tic Tank ? Lavatory p Softner 1 Shouver Well = Kitchen Sink Urinal/Bidet Other ? Laundry Tray ? Floor Drains Drinking Ftn. Slop Sink Gas Piping Outlets 12. I hereby certify that the;above infounation is tru nd correct, and I agree to oomply with all ord'Ina?Aces and code;,?over ' g is type of work. Signed: '' ?---/for -?` Rough Final Inspections: Date Insp. Date Insp. This is Your permit when numbered and approved. Approved CITY OF EAGAN 464-8100 .?C..? Receipt - l' -' PLUMBING PERMIT Permit No. ~ ?%. •?? CITY OF EAGAN Fee • - '' Fill in numbered spasess S!C ._ _.?., Type or Print /egibly Tot 1. Date i/ [iy J [ 2. Installation Cost 15 75 ??- (?,:= F,',Lk , Ll 3. Job Address :?.ot Blk. ?Tract 4. Owner 5. Contractor 6Cn?iiLTI?.S Pi,iJrIbIiJG I4?i;phone 766-400"1 6. Address 10841 ' liANKATO ST. I 7. City State Zip -- $. Building Type: Residential '0 9. Work Description: NewAo Commercial 11 Institutional ?. Add ? Alter ? Repair 0 10. Descrihe 6iUUL rijip:i, 11. No. 1 Fixtures Water Closet No. Fixtures Cesspool/Orainfield ? Bath tubs Septic Tank ? Lavatory Softner ? Shower Well ' Kitchen Sink Urinal/Bidet Qther 3 Laundry Tray ? Floor Drains Drinking Ftn. Slop Sink Gas Piping Outleu 12. I hereby certify t" the above infcr'r tion is true and correct, and I agree to comply with all ordin?nces and obd?goveynirtig this type of work. r Lv / Signed : for Rough Final Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. Approved CITY OF EAGAN 464-8100 : dj[ Recaipt MECHANICAL PERMIT Permit No. CITY OF EAGAN Fee , Fill in numbered spacea S/C Type or Print /egib/y Tot. 1. Date 2. Installation Cost ? 3. Job Address Lot Blk. ; Tract 4. Owner ' 5. Contractor = Z Phone - ' /6. Address 7. City State Zip 8. Building Type: Residential ? Commercial ? Institutional ? 9. Work Description: New Add ? Alter ? Repair ? 10. Descnbe ? Fuel Type •- 11. No. Equinment STU - M. Ea. Forced Air No. Equipment CFM Mfg. Air Handling: Boilers Mfg. Mech. Exhaust Unit Heater Mfg. Oth Air Cond. er Mfg, - ' ? Gas, Piping Outlets 12. I hereby certify that the above information is true and correct, and 1 agree to comply with all ordinances and codes governing this type of work. Signed : for Rough Final Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. Approved CITY OF EAGAN 454•8700 i Receipt MECHANICAL PERMIT Permit No. ?I CITY OF EAGAN Fee Fill in numbered spaces S/C Type or Print /egib/y Tot. ? 1. Date 2. Installation Cost :- 3. Job Address ?>. ?-c Lot Blk. ? Tract , 4. Owner 5. Contractor 6. Address 7. CItY 8. Building Type: Residential Phone State ?-- Zip 9. Work Description: NewAdd O Alter ? Repair ? 10. Describe ! ( ! 0-ji Fuel Type - ' ?f" /• 11. No. Equi ment BTU - M. Ea. Forced Air No. Equipment CFM Ai H i Mfg. andl r ng: Boilers Mfg. Mech. Exhaust Unit Heater Mfg. Other Air Cond. Mfg, Gas, Piping Outlets 12. I hereby certify tfiat the above information is true and correct, and I agree to comply with all ordinances and codes governing this type of work. Signed : for Rough Final Inspections: Date Insp. Date Insp. This is your permit when numbered and apprnved. Approved CITY OF EAGAN 454-8100 Receipt PLUMBING PERMIT Permit No. CITY OF EAGAN Fee Fill in numbered vaces S/C •>v Type or Print /egi,Gly Tot. 2U.5U ' 1. Qate 2. Installation Cost ,i ??,, ,, . 1, l," , 3. Job Address Lot ?Ik. ??ract 4. OWner 5. Contractor PL'u?,id.vli I.ti.. phone 7ju-4L)U7 6. Address 10841 7. City -;LAItiE State ".t• Zip i5434 8. Buiiding Type: Residential E3" Commerciai ? Institutionai ? 9. Work Description: New d- Add ? Alter ? Repair ? 10. Describe ?•.?uL iti?:'?? 11. No. Fixtures Water Closet No. Fixtures Cesspool/Drainfield ? Bath tuhs Septic Tank - Lavatory $oftner ? Shower Well ? Kitchen Sink Urinal/Bidet Other ? Laundry Tray Floor Drains Drinking Ftn. Slop Sink Gas Piping Outleu 12. I hereby oertify tha;Khe above infoffr? ation is true and correct, and I agree to comply with all ordinances and cvdes 944emlng this type of work. Si gned : ??' ? ,f ?? ?? i z- for Rouyh I i D I Finel D I nspect ons: ate nsp. nsp. ate This is your permit when numbered and approved. Approved CITY OF EAGAN 464-8100 Raceipt PLUMBING PERMIT Permit No. -x ' - CITY OF EAGAN Fee Fil1 in numbered;paces S/C . ? J Typa or Print /egib/y Tot 1. Date J/24?0" r 2. Installation Cost 3. Job Address Lot_ _?-1131k. ?. ?Tract ? i,r?,.. 4. Owner 5. Contractor ,?tiiil:rIis.S PLuribIitG I,iu Phone 706-007 6. Address 1 W41 ,:Aivi{Ai ;) Si'. 7. City State :.44 Zip :)5431 8. Building Type: Residential C*-^ Commercial ? Institutional O 9. Work Description: New:Q Add ? Alter O Repair ? 10. Describe 'giGUL `P'hiu•:z 11. No, 2 Fixtures Water Closet No. Fixtures Cesspool/Drainfield 1 Bath tubs Septic Tank 3 Lavatory Softner 1 Shower Well ? Kitchen Sink Urinal/Bidet Other ? Laundry Tray ? Floor Drains Drinking Ftn. Slop Sink Gas Piping Outlets 12. I hereby certify that the above information is true and correct, and I agree to comply with all ordinances and codes governing this type of work. Signed: for Rough Final Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. APProved CITY OF EAGAN 454-8100 Receipt - MECHANICAL PERMIT Permit No. C17Y OF EAGAN , Fee Fill in numbered spaces S/C ' Type or Print legib/y Tot. 1. Date 2. Installation Cost 3. Job Address Lot Blk. Tract 4. Owner 5. Contractor _ 6. Address 7. City, 8. Building Type: 9. Work Descripti 10. Describe 14 11. , Repair ? Type No. % F,puinment BTU - M. Ea. Forced Air No. Equipment CFM i Mfg, A r Handling: Boilers / Mfg. Mech. Exhaust Unit Heater Mfg. Other Air Cond. ` Mfg. -- - - Gas, Piping Outlets 12. I hereby certify that the above information is true and correct, and I agree to comply with all ordinances and codes governing this type of work. 5igned ; ' ' for Rough Final Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. Approved CITY QF EAGAN 464-8100 ? ?. ..?,.. ,,...... 'i INSPECTION RECaRD GITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: ,'- Eagan, Minnesota 55123 Date Issued: '?n 4' ? (612) 681-4675 ? SITE ADDRESS: J„ l .;t<FaHht I)k ? 411AI;NMAO+t 1!iNl1 t 11 1 '.1 ? PERMIT SUBTYPE: TYPE OF WORK: }+ E ?-' A 1 It I?f';I.i+if'IIt]!?i ('?Lt?lhltil INSPECTION D, ON TYPE D. t 14 1: I?i ?PrMAF;?';: 1N, IIII.iF'. i+•;? ?10ii: ?,t?n?: pEi ( I ii i i) . ? ? APPLICANT: . , i r! it! 1 Permit No. Permit Molder Date Telephone # SNV PLUMBING HVAC ELECTRIC ELECTRIC Inspeetion Date Insp. Commenta Footings I Foundation - Framing ? t Roofing .f? Rough Pibg. Rough Htg. Isul. Fireplace Final Htg. Orsat Test Fina1 P1bg. Plbg. Inspector - Notify Plumber Const. Meter Engr./Plan Bldg. Final Deck Ftg. Deck Final Well Pr. Disp. ?ao/S/ ? o oaos ? 25 3 4 5 Request Date Fire No. Rough-in Ins ection Requiretl? LXReatly Now O'h'iIl Notity Inspeclor Feb. 19, 1991 ?ves G[NO WhenReady? IF licensed contraaor ? owner hereby request inspection of above electrical work at: JoD Address (SbeeC Bon ar Roma No.) Ciry 3149 Farnum Ea an $eclion No. TownsM1ip Name or No. Range No. Counry Dakot OccupantJPRINT) Phow No. .Tim Gudding 454-1700 Power SuOplier AtlOress Elecmcal Comractor (Company Name) Gomractor§ License No. Corrigan Electric Com an Mailing Pdtlress (COnlreclor or pwner Making Installaiion) P.0 Box 475 Rosemount MN 55068 Auth -z tl IgnaWre ICOnlrac1 rfOwner aking Inslalla4pn) Phona Number U^? 423-1131 MINNESOTA STATE BOAFD14F ELECTflICITY THIS INSPECTION REOUEST WILL NOT GrlggnMldway 81tlq. - Room S173 BE ACCEPTED 6V THE STATE BOARD IBYt UnlvBrsf[y Avp., SL Paul, MN 55104 UNIESS PROPEfl INSPECTION FEE I$ Vlpiw (811) 642-0800 ENCLOSED. a/?o/91 a 25345 REQUEST FOR ELECTRICAL INSPECTION jli? See inslmctions lor croMDleting Rils iorm on back oi yellow capy. "7C" Be/ow Work Covered by This Request ea oaa,.oa ? ew Af1d R@p. , TypeofBUilding AppliancesWired EquipmeniWired X Home Range Temporary Service Duplex Water Heater Electric Healing Apt. Building Dryer Other (Specify) Comm./Industrial ' FUrnace Farm Air Conditioner Other (specdy) ConVadorS Remarks: OUA p d LzoN rs 1? 64A-dy e Compufe Inspecfion Fee Below: ' S Other Fee # ServiceEniranceSize Fee # CircuitslFeeders Fee Swimming Pool 0 to 200 Amps 0 to 100 Amps Transiormers Above 200 _ Amps Above 700 _ Amps SIgnS Inspenor5 Use Only. TOTAL /= J Irrigation Booms ? Q Special Inspec[ion l Aiarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT Other Fee $lb COMPLETED WITHIN 18 MONTHS. I, the Electrical Inspector, hereby Aough-in oate cenity that the above inspection has been made. Final oaie OFFICE USE ONLY ' This request mitl 18 moMhS hom 181mofit?hsfro?oid n La.v?.c_i ? S @??9 36077 3Z104 1o qo, ad Request Date . Fire No. Roueh-in Inspection ?d7 pepuj ?Ready No?ill Noelfv Inspec- D ? , I'TSad ?No F ' , [or When Reatly icensed Elec[rical Conhactor I hareby requast inspection o( abovo ? Owner electrical work installed at: Sueet Address, Box m Route No. 3tL!- ?f-. ?rz.?cggr- ? ecbon o. Township Name or No. Range No. Cq??ty ? Oc 'ntIPRINTI Phone No. ? Power Supp ier ? ? Address Elac ic Co/nJ[ractor (Company Name Cnqtractpr?l,i ensu No. ? / - Mailin AdJress ICOn[ractor or Oer Making Instailation) Aut o ized Sig a[u ( ont ct / w e M ing Installation) Phone Numbor -7 7 MINNESOTq STATE&AHD OF ELECTHICITY ? THIS INSPECTION NEQUESf WIIL NOT Gripes-Midwey Bldg. - Room N-191 :> ?? gE ACCEPTED BY THE STATE BOAflD 1821 Univarsity Ave.. St Peul, MN 55104 UNLESS PNOPER INSPECTION FEE IS Phone 16121 287-2111 . ENCLOSED. i.ea e o; ln/zss zy? ?y? 3zc0q ? ' 76 monffis from vj.36079 (nAoL. Re.quest Date (`? ?,O l ? C ? $ ?? Fir¢ No. Raugh-in I nspecibn Re ed? s ? No Nolity. Inspec- Ready Now D?VPI ? lur When Ready r.ensed Eleclncal Conlractor I heraby raquest inspection of above ? Owner elechical work installad at SVeet Address, Bax or R?y re No. l5 -l S'? Vbu2 DA' ?? Ci ?' A641-4 ection o. I I Township Name or No, qanye No. C ntY T ' ?I^ .?(t? l ? Occypen t(PRINT? V? L -p-p , Phone No. Pawer 5upplier- ? Adtlress . Ele n I Conuactor (CortiUany N ?0 2r?r4 -1.m--r-?' I Contracmr's Lice e-oa _f, o ?l Mailine .4tldress IContractor or Owner MakinB lnstailationl ?A • r er akin Installation) Aut ri ed Si tur (Vontre I Phpny Nvx mber ^ `i O ?-'-(? l MINNESOTA STqTE BOAPO OF ELECTRICITY ? THIS INSPECTION REQUEST WILL NOT Grigqs•Midway Bldg. - Room N491 365 ? - BE ACCEPTEO BY THE STATE BOAND 1821 University Ave., St. Peul, MN 55104 VNLESS PflOPEN INSPECTION FEE IS ow...,e ininf 957.911111 ENCIOSED. REQUEST FOR ELECTRICAL INSPECTION EB-00001-03 Sxc instructions for complatine this form on back of Yallow copy. M36079 ? "X" BeLe:vXofk Covered by 7his Request Atld Rep. Type of Builtllny Appliances Wired Equipmont Wired Home Range Temporary Qervice Dupiex Wa[er Heater Lightin Fixtures Apt. Building Dryer - Electric Heatin Commercial Bldg. Fumace Silo Unloader Industrial Bldg. Air Conditioner Bulk Milk Tank Farm Otner peci v Other!Snecityi t er Suecify OMCr Othor Comp'u1e fdspec[ion Fee Below -- - 0. Fex ServiceEntranceSize g Fee fxxders/Subfeedera # Fae Circuits Q. C7? 0 to 100 Am s 0 to 30 Am s St 0 to 30 Am s 101 to 200 Amps 31 to 700 Amps $: 31 to 700 Am s '- Above 200 q??us Above 100_Am s Above 100_Am - Transiormers RemoteControl Circ. Partial:Other Pee Signs Speciallnspection $ l T 1 Remark5 fiQ. AL !I O^ ? V • Final j Insoectoq hereby cartify the[ the ebova inspection hes been ? made. This reqaest void 18 nwnths fram REQUEST FOR ELECTRICAL INSPECTION se, E8-00 '"'li 001-03 See instructions tor completirg this form on back of Vollow copy. 3f07Z_ ? ,. p "X" Be/ow.Oora covered by This Request 3 Z(O N Atld Rap. Type of Building Appliances Wiretl Equipment Wirxtl+' Home Range Temporary Service Duplex Water Heater Lighting Fixtures Apt Building Dryer Electric Heatin Commercial Bldg. Furnace Silo Unloade? Industrial Bldg. Air Conditioner Bulk Milk Tank Farm Otner veu v Oiher (SOecify) t er SGecify pther Oiher r Fee Below EntranceSize # Fee to I I I 1 ul to Yuu Anios 1 I IJ1 to 7 uu Amps 1( I ?I °Wsi to I uU Amus 1 S c.tQ, AG aa.icei I ? ?p' j? Inspectoq hereby carlily ihet the xbove Final ?j Date '?spection has leen ' 1-;L 74 da. s re0uest vo nwnths trom REQUEST FOR ELECTRICAL INSPECTION ? EB-00001-03 See inslrvctions for completinB this form on back of yellow copy. M36076 ? "X" Below Worr.Covered by This Request Ne Add R.P. Type ot Buiidine APPlii1OC83 WirBd Equinment Wirad Home Range Temporary Service Duplex Water Heater Lighting Fixtares Apt. Building Dryer Electric Heatin Commercial Bidg Fumace Silo Unloader 1ndustrial Bldg. Air Conditioner Bulk Milk Tank Farm mer Speu y otner ISUecifyl her ($GecifY Other Offier Compute Inspection fee Below k Fee ServicaEntrencaSiza tt Fee Faxders/5ubfeeders N Fee Circuits Q. Cyl 0 to 100 Am s 0 to 30 Am s 8 Se to 30 Am s 101 to 200 Amps 37 to 100 Amps 1 to 100 qm s Above 200 Am s Above 100-Am s Above 100_Amps Transiormers Remote Control Circ. Partial/Other Fee Signs SVeciallnspection $ T Remarks CfO, TAL FEE % I Raueh-in - Date ? l.?tha ecvical A%b!j 7 J?spactor, hereby certify thet the ebove Final ins0ection hes baen / I made. This reouest voftl ltl manths ham Thisrequestvoia 18 months fmm CM 36076. o 0 Reauest Date ? P ?? ? ('?? Flre No. Rough-in Insoec(ion Requlred? ?NeaAy Num? ?II Nniifv.,InsPec- ?or Wh R d - jf ? es No en eR v ?censetl Electrical Contractor / I hereby raquest inspaction of above r? Ownar alectrical wurk installed at 54ree[ Address, 8ox or Route No. ? ?I S l ?Z ? Cit ?? ??J? ( e.?cc3 b ecunn o. Township Name or No. Range No. C unry [? y?-? Occ - nf (PPINT) Phone No. Pow r S ?Plier ? S Address Eluc ?icp I ?Convaclor (COmpany I ' ? ? Conttacmr's License No. LE6$ C?E ? ?.02 ? Mailing Address IContrac[q or Owner aking bistailatioN ?(?`FO N? . f?,wv?2-'CIs4- r Authori ' na[ur 1 nvac n akin Installation) Phone Number 4F8'3- ?C?7 MINNESOTA STATE AflD OF ELECTftICITY THIS INSPECTION REUUEST WILL NOT Gri y g, - Room Nd91 ^?'U ?` BE ACGEPTED BY TME STATE BOA0.D 99s-MiA we Bld ?4L ?_ UNLESS PROPEP INSPECTION FEE IS 1827 UniversitY A?a., SL Paul, MN 55104 4J o ' Ow...... IR191 OA] 7111 ? ENCLOSED. This request void'?(z o L? 18 nwnths from C;7 36078 L?.y...( ( S? ?o? b o RequBst Daie 1 1 Fire No. Rough-in InsUer,[ion Inspec- ?j Requrted? ?Reatly Now I Notifr ??? /? ? ?s ?Nu tor 4L'hen'?Y ,gPceuaed ElacVical ConVactor 1 heraby repuest inspaction ot above ? Owner electricel work installed at: Street Addeess, Box or Fou No. 5 -1 e- OA l? CIry C<?e, A-? ection o. Township Name or No. Range o. Co ty lLp ?< "?"? Oc ant tPRINT) /? -. ? aJ?-+- - ?'? ?..-/ Phone Nn. Power Supplie.? Address Electr ' uactor IComDanY Name ' cal Con 2 ? Con ra.tor's License No. ?O? i 44' Mailine P.dd ss Conlractor or wner Ma ' g Installa[ionl , q ? ?.+)?'1'?- A tho ized 5 a[ur ICo ra or/ n r ak' d Installation) Phone Number 8 --`f`7't MINNESOTA STATE BtANO OF EIECTPICITY ? THIS INSPECTION NEQUEST WILL NOT Griggs-Midwey Bldg. - lioom N-191 ?/ BE ACCEPTED eV THE STATE BOARO 7821 Univarsity Ava.. St. Paul, MN 55106 ?? Y UNLESS PflOPEX INSPECTION fEE IS ,e.., .,e 1... U ENCLOSED. FlF',,p'?7 REQUEST FOR ELECTRICAL INSPECTION , ee-ooooi_oa vn?/ J b o 7 8 0 See instructions for completing this lorm on bnck of yal low copy. ?? q "X".:9eloil Covered by This Requesi 3a (.0 f? N. Atld Nep. TyOe ot BuildinA APPliances Wirad Equipmeni Wirac?a Home Range Temporary Service Duplex Water Heater Lightin Fixtures Apt. Buildiny Dryer Electric Heatin Commercial Bldg. Fumace Silo Unloader Industrial Bldg. Air Caiditioner Bulk Milk Tank - f rm Ot er pe6 v. thor speclNl Y lq pb T l5peciFy t er Other C'ompute lnspection Fee Below N Fee ServiceEntronceSize p Fea Feeders/SuMeedars b fee Circuita l O-- 0 to 100 Am s 0 to 30 qm s ? to 30 Am s 107 to 200 Amps 31 to 100 Amps S? 1 to 700 A s Above 200 qm s Above 100-Am s . Above 100_AmVs Tranytormers Remute Control Circ. Partial:'Other Fee Signs Special Inspection flemarks ( ? • ' i Y/f rl.? Fouyh-in Date ?, the Elechical ? pector, hareby certify that the above Final , ,1e inspectian has been made. This request void -, ?-, CITT OF EAGAN _ " 3795 Pllaf Raob Rwd Esgan, MN 35122 1?7 1? O 7502 PHONE: 454-8100 BUILDING PERMIT Receipt # ? Te M wed fer 1 of 4 PLE7C Est. Voiue $58, 000 Daro e D ti`°r 10 _, 19BZ Siro Addrcu 3149 FaYnvm Dtive Erect M Occupancy R-3 Lot 2 BI«k 4 Sec/Sub. Co8ChN8R LBAd lSt Alter ? Zoning PD Porcel # 10 18150 020 04 Repoir ? Fire Zone NA Enlarge p Type of Conrt. vn e Nome Co8chman Land OD. Move ? # Stories Z ? Address Zml 2432 Prior Ave. No. pe??ish 0 Length 46 Ci Roseville 55113Phom 631-3254 Grade ? Depth 26 Sq. Ft.- o Name Rosenood Construction Div. ADProvab Faes Addreu &we 8S aboVe Assessment ? Permit 30 ?me Water & Sew. Surcharge ri?., o?...... . e? en Police _ F s Ne^x Fi re xr Address Eng. , i'Z° CI Phone Planner - Councll _ I hereby acknowledge that I hove read this oppiicotion ond stote that Bldy. Off. - the intormation is correct and ogree to comply with all opplicoble $tote of Minnewto Stotutes ond Ciry of Eogun Ordirances. APC Signoture of PermiMee A Building Permit is Issued to: ""°Qw` ali work shall be done in occordance with oll Plon chec SAC - Water CAnn. 420. 00 Water Meter 60.00 Rood Unit 240.00 Totol $1734.50 on ths expresf condition thm y of Eagon Ordirwnces. Building Offlciol CITY OF EAGAN •` 9795 Pllet Knob Road Eogan, MN S5122 NO / v ' PNONE: 454-8100 P BUILDING PERMIT Receipt # --5,/ To ba uted kr_ 1_ Of 4 PLEX Est. Value $58,000 pare SeptembeY 10 , 1 982 Site Address 3151 FBrntHn Drive Lot 3 Btock 4 Sec/Sub. CoaChm3R Laztd 18t Porcel # 10 18150 030 04 ? Norrue Oaachman Iand Co. z nadress 2432 Priox Ave. No. cl Rosev311e SSll-631-3254 o Name ROSeWOOd COnBtx'uCtiOn DSV. ? Address S?6 88 8t70VC ? ~ Cit Phone AbOV@ Gy?, Name 1 hereby atknowiedge thot 1 have read this application ond stote that the informofion is correct and ogree to comply with ail opplicable Stote of Minnewta Statutes ond City of Eogan Ordinontes. R-3 Erect 13 Occuponcy Alter ? Zoning PD Repair ? Flre Zone NA eniar9e ? Type of Const. Vn Move ? # Stories Demolish ? Length 46 Grade ? Depth 26 Sq. Ft.- ApDrorols Fees Assessment Water & Sew. Police Fire Enp. Plunner Council Bidg. Off. APC Sienoture of Pertnittee A Building Vermit Is issued to: oll work sholl be done in uccordante with oll Permit ?v..v.. Surcharge 29-? Plan check ?53_SO SnC 525.00 Water Conn. 420.00 Weter Meter 60.00 Road Unit 240.00 Totoi $ 71d`50 on the expre53 Condition thnl y of Eoqon Ordirwnces. Building Of(iciol cirr oF IEAcnN ., 3795 Pitot Knob Rood EaOan, MN 5512= NO 7504 . PHONF: 454-8100 ?J - " BUILDING PERMIT Receivt # If/7 To 6e uae fe. 1 of 4 PLE7C Est, yalm $58,000 pOte September 10 _ 1982 Site Address 1575 FoUx O8k8 PGad Erect (2 Occupancy R'3 Lot 4 Block 4 See/Sub. 00SChri18n LBIId 18t Alter ? Zoning PD 10 18150 040 04 RePatr ? Fire Zone N? Porcel # Enlorge ? Type of Const. - Vn W 008ChID8II IBIId OD. Name Move ? # Stories Address 2432 Ps'ioz Ave. No. pe,,,pl;sh p Length 46 ? ci Roeeville 5511:?h0. 631-3254 Grode ? Depth 26 Sq. Ft._ a Nome ROSeVIOOd COASt]:?1C tion DiV. Approvals Faes 0 Address Same 88 S170V¢ Name _ Address I hereby ackrrowledge ihot I have read this apDlicorion and state that fhe inlormOtion is correcf and ogree to comply with all applicuble Stete of Minnesota Statutes and City of Eagan Ordirwnces. Assessment _ Woter & Sew. Police - Fira Enp. Planner _ councu _ Bldg. Off. - APC Permit JV/.VV Surcharge 29•00 Plan check 153.50 snC 525.00 Water Conn. 420 • 00 Worer Meter 60.00 Rood Unit 240-00 rorol $1734.50 Slpnofure of PermiMee I A Buliding Permir is issued to: lbSewood O6A9tII1CCi0A SiOri on tho expreu corditlan thnl CII work shall be done in accordance with oll opplico21 State of wt Stat Ciry of Eapan Ordirwnces. Buildinp Offlcioi ??G BUILDING PERMIT N° 7501 Reteipt # &/ / G1 To 6s wad 1er 1 Of 4 PI.&R Est. Volue $58,000 Date SeP tembe= 10 , 1982 Sire Addreu 1577 F017 ! 081t8 FGHd ' Erect LJ{ Occupancv R-3 Lot 1 Block 4 Sec/$ub. 00aC}fIDBR Idtld 18t Alter ? Zoning PD pa?? # 10 18150 010 04 Repair ? Fire Zone NA E T f C Vn nlarge ? onst. ype o w Name machman rAnd co• Move ? # Stories ? qdd«,s 2432 Ptior Ave. No. pe,,,oiish ? Length 46 Ci lto seivlle 55 113){ane 631-3259 Gmde ? Depth 26 Sq. Ft.- 482 OIIS IIC . OA V. p Nama- ? Addreu Sme AS above Axsessment u? i- Cit Phone $aMe Water 8 Sew. F Police UW Nome Fw Fire ?? Address Enp. i'Z" Ci Phone Plonnor Council 1 hereby ockrwwledge that I have read this applicorion and state that Bldg. Of(. the inlormotion is cOrrecf ond agree to comply with oli applicoble Stote of Minnesota Statutes and City of Eagan Ordinonces. AVDrovals Feea 41 WOOd O LI Y D? R AP? Signature of Permittea A Bullding Permit Is issued ro: +wa oll work shall be done in eccordance wlth all CITY OF EAGAN 3795 Pilef Knob Raad Eeqan, MN S51I3 PHONFi 43I-8100 Permit JV1.vv Surchorge 29.00 Plon check 53 snc 525.00 Woter Conn. 420,00 Water Meter 60.00 Road Unit 240-00 Totol $1734.50 on the express cord7tion thnt y of Eagon Ordinantea. Buildinq Offlcioi m , ? r_sU2-- C? ? ?? I BUILDING PERIKST APPLICATION arr ? ? To Be Used For Valuation ts'ri 0 (9 C) Site Address: FA.un,La+.w,- 41? Lot 7, Bloc]c ? Sec./Sub. foac(nhaaA (4Aa Parcel #: 10 (8'1? OZO G ?T- QJISPY': C00.A(M0.^ laYld Co ` Address: 50.uKP- 0.S k,(o+.J City/Zip Code: Phone #: Contractor: /CDcYe?v" Address: 'Zq 3'7i Y/ City/Zip Code: k'0SCf1<`? Pnone #: Arch./Ehg.: Address: City/Zip Code: Phone #: 'Erect ?C Alter Repair Enlarge _ Nbve Demolish Grade Include 2 sets of plans, 1 site plan w/el.evations & 1 set of 77-,5 lcu lations. Date Z-?- OFFICE USE ONLY Occupancy K' 3 Zoning P D Fire Zone A Type of Const. r # Stories Front qb ft. Depth z 17 ft. APPROVP,LS FEES Assessments Water/Sewer Polioe Fire Eng. Planner Council Bldg. Off. T-fo-g z P.PC Pennit 307 , c3 b Surcharge 29 ? o (D Plan Check 1153 , s (D SAC SZS.o(t) Watex Conn. c( zo 1 o 0 Water.Meter (oo- o0 Road Uni.t zqo, v o TarAu, ( 7 ? ? SL5 ? CITY OF EAGAN Include 2 sets of plans, 1 site plan w/el.evations & BUILDING PERMIT APPLICATION 1 set of energy ca?lculatlons. To Be Used Far Valuation o o() Date Site Address: OFFICE USE ONII,Y Lot 3 siocac Sec./Sub.Coa4V.aaA 10.AA Fsect x occupancy 2-3 Parcel #: 1 U ( 8' ( S 6 O-Sv c7q A7.ter Zoning pA Repair Fire Zone Nf1- Oaner: Co"Gaar, (av?,A- Co ? Fnlar9e _ Zype of Const. V n Nbve # Storie.?s Pddress: Sarvi.E 0.S ?)?1ow Demolish Front y?p ft. City/Zip Code: Grade Depth Z(v ft. Phone #: APPROUAI,S FEES Contractor: /?(JSea/OM_ 00A,5-Yr 41U1rS/D A.) Address: 2 IQ/O?L > Uf., /(fo CitY/Zip Coc1e: o1C!!i` ,5511-; pnorie #: 031- 37? 5 Arch./Ehg. Address: City/Zip Code: Phone #: Assessments Water/Sewer Police Fire Eng. Planner Council Pennit 30 ? , o 0 Surcharge 29 ? o 0 Plan Check / S3. S"v SAC 5 z 5 o c> Water Conn. Y20 , o 0 Water Meter (v o• o 0 Rnar3 unit z y o, o 0 Bldg. Off. q-lo -9, 2 APC ZCYfAL 1-73(41.s0 . pp # CITY OF EFIGAN I 6r et ?BUILDING PERNIIT APPLICATION _` Zb Be Used For cz. o. " () ? - Valuation Site Address: 15755 ou2 OAX,S Roi4 Lot q Bloclt ? Sec./Sub.Cor,ckN.a.? (AytA Parcel #: (D ( gt5 D oqD o? Owner: Coackw-jaL^ Lar\- cL Co r Ptidress: g0. a?kL 0.3 L-?F_ t o?J City/Zip Code: Phone #: cbntractor: ?os1ei,vooA I?OA?S? ? .piU(SION Address: 9432i 210/1: u-o City/Zip Code: &7ZUt , ` /S4 N SSlQ / ' Phone #: b j[` 3 25 '7 Arch. /Etng. : Address: Include 2 sets of plans, 1 site plan w/el.evations & 1 set of energy culations. Date :2/,7,Z- ? OFFICE USE ObII.Y I Fxect X occuPancY R Alter Zoning P b Repair Fire zone JJA- Fnlame _ Type of Const. 'V'v%, Nbve # Stories Demolish Front y lp ft. Grade Depth z ln ft. APPROVAIS FEES Assessments Water/Sewer Police Fire Ehg. Planner Council Bldg. Off. APC Pezmit 307 c 0 o SuYChaYge Zq r D b Plan check JS3,sv SAC SzS•oo Water Conri. L( 20,0 o WdtPS .M2t2T 00.00 Rnad Unit Z 0,0 O City/Zip Code: Phone #: 'POTAL V(? 3 ' S v CITY OF EAGAN PLF? BUILDING PERMIT APPLICATION 'Ib Be Used For c Valuation -+S&r 00c Site Pddress / 5 ?iun, a.jt4b Int _L slocJc ? sec./sub. Coac-??naa? LO1 Erect ? Parcel #: 10 (g l S o 0(o C>y Alter Oaner : C Oo-a?A-MnAf' La r\ e- CO? Address: 5aW\Z- as ?o£. 6 City/Zip Code: Phone #: Contractor: AS2U/o0p C.'alv? / , AA n 2to2 be uo pcldress: 2.LI32 city/zip code: l?ose Pc t? S5! (3 Paorie #: 631- 3 7- 5t Arch./Ehg.: Address: City/Zip Code: Phone #: Include 2 sets of plans, 1 site plan w/elevations & 1 set of energy calculations. Date / g ? OFFICE USE OIJ'Y pccupancy ' oe -3 zoning P Repair Fire Zone Eniarge _ 7.ype of Const. I'\ Nbve # Stories Derolish Front u (O ft• Grade nepth Z ft. APPROVALS F EES Assessments Permit 307 , 00 ?4ater/Sewer Surcharge z4 ? ba Police Plan Check 1 sz. S-o Fire SAC s'z s: o e gzq, Watex Conn. c(20. a0 Planner Water Meter (yo?b d Council Road Unit 2? 0. o 6 Bldg. Off . 4 -10 - 9'2- AFC rnarAL 41`7 3q(S 6 E,4-O qS L %,e tq HOUSE HEATING TEST RECORD nnnaFCC 3149 rQUI.1.M 'D iZIVic eoT FIlll1G riTV Ea6aq OCCUPANT F-WEHL16 OWNER M0E7-ILIFs HEAT LOSS DATE HTG. INST. SOLD BY HOME ENERGY CENTER INSTALLED BY HOME ENERGY CENTER Electrical Work ey HARRISON ELECTHIC Gas Line ey TYPE OF HEAT GA FA X HW_ STEAM - SPACE HTR. UNIT HTFi. OTHER Model Seriai THERMOSTAT Valve Limit Limit Setting _ Fan Setting _ Pilat Type - Pilot Make _ Pilat Model _ Pilot Timing _ L.W. Cut Off _ Pressure Input CFH _ Stack Temp._ O Heat Plug Percent CO2 Percent OZ_ Percent CO . MAKE OF BURNER Model Maic. BTU Rating _ MAKE OF FURNAC Model Vent Size KIND OF LINER Draft Hood Filters Size Chimney location Chimney Constructia SIZE Regulator _ Number _ NONE Outside Smoke Bom6 Wiring ?1 \ r DraR TestTag ?MAY 0 7 Door Pressure Lighting Insi.I- u Date Teste S p Name of T?vA? Fortn 235 ?CITY OF, EAGAN 3830 Vilot Knob Road Eagan, Minnesota 55123 (612) 681-4675 PERMIT PERMIT TYPE: Permit Number: Date Issued: BUILDINI?'?r 023437 @S/26/94 SITE ADDRESS: P.I.N.: 10-18150-030-04 3151 FARNUM OR LtlT: 3 BLOCK: 4 CpflCWMAN IAND CO 157 DESCRIPTION: (SIDING) B'u"ilding'-permit Type ?uilding Wa'rk Type r ;. ?? L(S ? ?••1_. , .. ?'-- / SF (MISC.) REPAIR `? `?'L? 1\" r ? ?.?????? , ruz='f-i1(U ?? REMARKS INCLUDES 1577 FOUR OAKS RD (LOT 1) FEE SUMMARY: VALUATSON Base Fee $25.00 Surcharge $.50 Total Fee $25.50 $1,000 CONTRACTOR: - Applicant - ST. I.IC. OWNER: ALLEN CONST 16888100 0001062 FOUR OAKS COURT ASSOC 4649 1/2 pENKWE WAY 3470 WASHINGTON DR 116 EAGAN MN 55122 ER6AN MN 55122 (612) 688-8100 (612)452-9532 I fiereby acknawledge t I have read iFtis. appl.?catian and state that ths information is correc a d agree tp camply with a3.1 applicable StOte vf M". Statutes d City a rt Ordinances_ A I ?a,n R o?:r?.l rh1? AP MAN ER r E NATURE ISSUED B: SI ATUR CITY OF EAGAN 13q.5q 1994 BUILDING PERMIT APPLICATION 681-4675 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 af month in which request is made, 2) address is changed or 3) lot change is requested once permit is issued. 6ate 4aluation of work Site Address: STREEn ufI C 1 Ol"nUtP, L(` Four DGb U SUITE fF Tenant Name: (commercial only) IAT 1? BLOCK ? SUBD. P.I.D. # Descri tion of work: A)/yJ/? N The applicant is: ? Owner Contractor ? Other (Descri6e) Name . , D r Phone 45Z -5!?'32_ Property Lasr FIRST Owner qddress ??? ET ? TRE STE # City 04-4,4") State /P? Zip ?S/LZ Company G Phone a? 0/0 Contractor Address Ni44 License #1Q&Z,- Exp.?. City ??A&J State Zip 5RL4 Company Phone Architect/ Engineer Name Registration # Address City State Zip Sewer & water licensed plumber . Processing time for sewer & water permits is two days once area has been approved. I hereby acknowledge that I have read this appl ca ion and state that the information is correct and agree to comply ' h all applic?abl S ate of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant: OFFICE USE ONLY BUILDING PERMIT TYPE 11 01 Foundation ? 06 Ouplex ? 11 Apt./Lodging ?]6 Basement Finish ? 02 SF Dwg. El 07 4-Plex ? 12 Multi. Misc. ? 17 Swtm Pool ? 03 SF Addition ? 08 S-Plex ? 13 Garage/Accessory ? 18 Comm./Ind. ? 04 Sf Porch ? 09 12-Plex ? 14 Fireplace ? 19 Comm./Ind. Misc. tO 05 SF Misc. ? 10 Multi. Add'1. ? 15 Deck ? 20 Pu61ic Facility ? 21 Miscellaneous WORKTYPE ? 31 New ? 33 Alterations ? 35 Tenant Finis h ? 37 Demolish ? 32 Addition 1$ 34 Repair O 36 Move GENERAL INFORMATION Const. (Actual) Basement sq. ft . MWCC System (Allowable) lst F1. sq. ft. City Water UBC Occupancy 2nd F1. sq. ft. PRY Required Zoning Sq. Ft. tatal Booster Pum p # of Stories Footprint Sq. ft. Fire Sprink ler Length On-site well Census Code » Depth On-site sewage SAC Code L Census Bldg _ L APPROVALS Census Unit _ o Planning Building Assessments Engineering Variance RECiUIRED INSPECTIONS ? .Site ? Footing ? Framing ? Insulation ? Wallboard p"Final O Draintile ? Fireplace Permit Fee Surcharge Plan Review License MWCC SAC City SAC Water Conn. Water Meter Acct. Deposit 5/W Permit S/W Surcharge Treatment P1. Road Unit Park Ded. 7raiTs Ded. Copies Other Total: vewatson: g 5AC % SAC Units CITY USE ONLI' PERMIT #: ySl?k RECEIPT DATE: ftES1DEN17A1. blECfi"CAI. PEiM1T APPL1CATI0R crrYoF EtsAiv 3830 Pn.,or xxos Rn g148AA M1Y 551 EE 651-6$3-4675 Please complete for: ? single family dwellings D I?(? ? ? ? ? townhomes and condos when permits are required for each unit Date: 7 MAY 0 2 Z001 GA L? By' SITE ADDRESS: 3 I`-/ 9 F 0.v n f am r "- OWNERNAME: ? roeh? I?l INSTALLER NAME: HOME ENERGY CENTER 152m 25TH qV^c. N. 912$ STREET ADDRESS: PLYMOUTH, MN 55447 CITY: STATE: Place a check mark nezt te the oermit work tvoe ZIP: New residential dwelling unit under constructionand not owner/occupied $ 70.00 ? Add-on, modification or alteration to existina dweiling unit $ 50.00 • furnace replacement • air exchanger • air conditioner • other Nature of work: rz f??cp ?n ? A State Surchar e $ 50 Total Re»efnder: Call for enspec8ons. TEIEPHONE#: faSf la$1" - 55g? (AREA CODE) TELEPHONE #: -7 lv 3 q 7(..o - PQ9 O (AREA CODE) ? SIGNATURE OF PER , I'ITEE Upda[ed 1/Ol 2004 RESIDENTIAL PLUMBING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN MN 55122 657 -675-5675 Please complete for modifications to existing residential dwellings. Date C) a 1 c-;l 1 Q ? ?j r /? Site Street Address (-j") (.!/r) lJr. Unit # Property Owner ?o( S rr0 -e-k 111 1 Telephone #((?j Contractor / (,c)Of ?S Telephone # 6q 13 Address d City ?Gx G2-i? State/nPl Zip?a? The Applicant is: _ Owner V Contractor _Other Alterations to existing dwelling $ 50.00 _Add fixtures to rooms, excluding water softener and water heat_er.__.-- --- -- ,`, =,,' _Septic System A6andonment , _Water Turnaround (add $121.00 if a 5/8" meter is required) ' I ?IjJ Other. - ` i ? ? ? r= _-- ? Water Softener V Water Heater ? $ 15.00 la em t Z re dditi l p _ a c en ona - Lawn Irrigation System RPZ_ new _ repair _rebuild $ 30.00 State Surcharge $ .50 Total $ ? s Jv 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. j?..e- h bA f-1 5,(,e °n ApplicanYs Printed Name Applicant's Signature 2004 RESIDENTIAL BUILDING PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 ? ?- ? Telephone # 651-675-5675 FAX # 651-675-5694 Neu! ComWction ReauiremeMS RemodeVRepair Reauirements -Efic?l?se`?7n 3 re9 stered sde su^'eYs shavin9 eQ• fL of b6 s9. R of house; and all roofed areas 2 coPies of Plan f "`? a? ? ? (20% maximum lotcove2ge aNowed) 1 set of Eneigy Calculations for heated additions ?"?iR ?-? ?.? 2 copies of plan showing beam & window sizes; pouretl found design, etc. 1 site survey for additions & decks T ?? N 1 setofEnargyCaicula6ons Addifion - indicateifonsdesepticsystem 3 copies of Tree Preservation Plen if lot platted after 711193 Rim Joist Defail Options selection sheet (bldgs with 3 or less units Date ? / ?? /C? ?? Construc n Cost Site Address r UniUSte # . Description of Work j21? • i f 1n-t-i ? ?J ? Multi-Family Bldg N Fireplace(s) _ 0 _ 1 _ 2 Property Owner ? 06,0(4 Telephone # ( ) Contractor r° Address City Sta[e z:;i Zip ?SW31_ Telephone kVAI'J) ;P?Sf y/o 9? COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEYIf BUILDING Energy Code Category - Minnesota Rules 7670 Cateeorv 1 ? Minnesota Rules 7672 (dsubmission rype) • Residential Ventilation Category 1 Worksheet • New Energy Code Workshaet Submitted Submitted • Energy Envelope Calcula6ons Submitted Have you previously constructed a building in Eagan with a similar plan? fee applies. Licensed Plumber Mechanical Contractor Sewer/Water Contractor Y_ N If so, 25% plan review Telephone #r Telephone # ( Telephone # ( IJ ikiAR ti o° 2004 Ili I hereby apply for a Residential Building Permit and acknowledge that the information is complete andaccurate; 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 approv ofplans. , -.Gt? pplicant's Printed Name ApplicanY gnatur OFFICE USE ONLY Sub Types ? Ot Foundation ? 07 OS-plex ? 13 16-plex ? 20 Pool ? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 04 02-plex ? 10 OS-plex x 18 Deck ? 23 Porch (screen/gazebo) ? OS 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous WorkTYPes D t-C: IG d"' l'?SZQ/TT F?j?'./S?R?i2 ?f/??.P%?S l ? 31 New ? 32 Addition ? 33 Alteration ? 34 Replacement Valuation Census Code SAC Units # of Units # of Bidgs Type of Const ? _ Footings (new bldg) _ Footings (deck) _ Footings (addirion) Foundatibn Drain Tile Roof Ice & Water Final ? Frazning _ Fireplace _ R.I. _ Air Test _ Final _ Insula6on Approved By: ? 30 Accessory Bldg ? 31 Ext. Alt- Multi ? 33 Ext. Alt- SF ? 36 Multi Misc. ? 35 Int improvement ? 38 Demolish Interior ? 44 Siding ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair ? 37 Demolish Building• ? 43 Reroof ? 46 Windows/Doors `Demolition (Entire Bldg) - Give PCA handout to applicant Occupancy )_;? =3_ MCES System Zoning IZ^? CityWater Stories Booster Pump Sq. Ft. PRV Length Fire Sprinklered W idth REQUIRED INSPECTIONS FinaVC.O. ? FinaVNo C.O. _ Plumbing HVAC Other _ Pool _ Ftgs _ Air/Gas Tests Final _ Siding _ Stucco _ Stone _ Brick Windows _ Retaining Wall Building Inspector Base Fee Surcharge Pian Review MC/ES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search Copies Other Total 6,j4 Z a 2004 RESIDENTIAI. BUILDING PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 New Construction Reauiremems RemodeVReoair Reouireme,nls Office Use OnN 3 registered site surveys showing sq. il. of lot, sq. ft. of house; and all roofed areas 2 copies of plan CeA of Survey Recd _ Y_ N (20°k mazimum lot coverage allowed) 1 set of Energy Calculations for heated additions Tree Pres Plan Recd _ Y_ N, 2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for addiUons 8 decks Tree Pres Required _ Y_ N 7setofEnergyCalalations Add#ion-irMicafeifon-skesepticsystem On4te5ep6cSystem '_Y _N 3 copies of Tree Preservalion Plan if lot platted after 711/93 Rim Joist Detail Options selection shcet (bMgs witli 3 or less units Da[e / 02-;4 Construction Cost c---2, Site Address - A ,-,!? Unit/Ste # , -- ? 4 v . Description of Work , ? i Multi-Family Bldg----2? Y_ N Fireplace(s) _ 0 _ 1 _ 2 I Property Owner Telephone # ( ) ? j Contractor Address City c•C State Zip <?5'1 Telephone # ((ps/ )IT7 COMPLETE THIS AREA ONLY IF Energy Code Category - Minnesob Rules 7670 Cateeorv 1 (?J submission type) • Residen6al Ventilation Category 1 Worksheet Submitted • Energy Envelope Calculations Submitted Have you previously constructed a building in Eagan with a similar plan2 fee applies. Licensed Plumber Mechanical Contractor Sewer/Water Contractor #( J_ I hereby apply for a Residential Building Permit and acknowledge th information is colnplete and accurate; that the work will be in conformance with the ordinances and codesNhec£?ty-oP-Eagan-and the State of MN Statutes; I understand this is not a permit, but only an applicarion for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan m the case of work which requires a review and approval of plans. ? , Y_ N If so, 25% plan review Telephone #( A NEW BUILDING Minnesota Rules 7672 . New Energy Code Worksheet Submitted Applicant's Printed Name `-ApplicanYs STgnatut 18100 COACHMAN OAKS 18150 COACHMAN LAND CO 1ST 27430 FOUR OAKS ESTATES FOUR OAKS ROAD 1$71/ 10181$0 030 03 4-plex-other1/2=3153/3155FamumDr 1573 040 03 1$7$/ 1018150 04004 4-plex-othcr1/2=3149/3159FamumDr 1577 01004 1581/ 10 18150 03005 4-plex 1583/ 02005 1585/ 04005 1587 01005 1$89/ 1018150 03006 4-plex-other1/2=3105/3107FamumDr 1591 020 06 1593/ 1018150 03007 4-plex-otkier1/2=3101/3103FarnumDr 1595 040 07 46M 10 27430 040 01 1635 10 27430 041 01 1645 10 27430 020 01 1650 10 00900 021 31 Fomiedy 3130 Sibley Memorial Hwy I6$5 10 27430 010 01 Or 3140 Sibley Memorial Hwy 1700 10 18100 010 01 Coachman Oaks Contlos-103 Uniis-Also Addressed 3155 Coachman Rd Each Unit Hes Separa[e P.I.D. # R 4 7379 2006 RESIDENTIAL BUILDING PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 New Construction Requirements Remodel/Repair Requirements Office Use Onlv 3 registered site surveys showing sq. ft of lot, sq. ft. of house; and all roofed areas 2 copies of plan showing footings, beams, joists Cad of Survey Recd . , -Y -N , (20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions Tree Pres Plan Reod - -Y -N 2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks Tree Pres Required -Y -ii 1 set of Energy Calculations Addition - indkate if on-site septic system On-site Septic System _Y -N 3 copies of Tree Preservation Plan if lot platted after 711/93 Rim Joist Detail Options selection sheet (buildings with 3 or less units) Minnegasoo mechanical ventilation form Date _ Construction Cost r$`/a Do Ll . 0 0 Site Address 31y~ f o r G~~r 6,,e f leo,l Unit/Ste # Description of Work GCoc~ vLf JG c f w« f P+ ~o ci 2 Multi-Family Bldg N Fireplace(s) - 0 - 1 - 2 ~ y Property Owner / Telephone # ( ) Contractor l cl J~oO r - Address / 41 ~3 J` ~c ~r 5 l` ~7/v✓ City 14,., c/o State 11VJ7 `y Zip 5--5-204 Telephone # (7~3) 7S-7-Ou 6 C/ COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672 Energy Code Category • Residential Ventilation Category I Worksheet • New Energy Code Worksheet (J submission type) Submitted Submitted . Energy Envelope Calculations Submitted In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? - Y - N If yes, date and address of master plan: Licensed Plumber Telephone ) Mechanical Contractor Telephone ) Sewer/Water Contractor 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 1VIN Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Applicant's Printed Name Applicant's Signature -------------i For Office Use I I My Permit V I 4* I o Ea I Permit Fee: Q , 3830 Pilot Knob Road I I Eagan MN 55122 I Date Received: Phone: (651) 675-5675 1 I Fax: (651) 675-5694 MAY 15 2012 staff-------------- I nn 2012 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: 5) vl Site Address: 3 `raY Ylt a f1nr . Tenant: W 1 S Suite RESIDENT /OWNER Name: l 1~1 TY t~~^~l Phone: L05 J LALO - ssl(40 :Address/ City /Zip: ~~y TG1Y ~j~ ArY1 U f Name: a I1C License 5 b~ SS _ p~ . Address: 14105 Rutgers St. NE City: CONTRACTOR Prior Lake, MN 55372 State: Zip: Phone: L q Contact: Email: TYPE OF WORK - New Replacement _ Repair - Rebuild - Modify Space _ Work in R.O.W. Description of work: RESIDENTIAL Water Heater Water Softener PERMIT TYPE Lawn Irrigation RPZ PVB) Septic S System Add Plumbing Fixtures Main Lower Level) Y New Water Turnaround Abandonment RESIDENTIAL FEES: $60.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge) $60.00 Lawn Irrigation (includes $5.00 State Surcharge) $60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Tumaround* (includes $5.00 State Surcharge) *Water Turnaround (add $189.00 if a 5/8" meter is required) $105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge) TOTAL FEES $ 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,gopherstateonecall.org I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved laJn in the case of work which requires a review and approval of plans. x x ✓ G Applicant's Printbd Name Applicant's-Signature FOR OFFICE USE Reviewed By: Date: Required Inspections: ^Under Ground 'Rough-in -Air Test Gas Test ---Final CITY OF EAGAN WATER SERVICE PERMIT 3795 Pilot Knob Road PERMIT NO.: Eagan, MN 55122 DATE: Zoning: No. of Units: Owner: - Address: Site Address: Plumber: Meter No.: - Connection Charge: Size: Account Deposit: Reader No.: Permit Fee: 1 agree to comply with the City of Eagan Surcharge: Ordinances. Misc. Charges: Total: By Date Paid: Date of Insp.. ~ Insp.: CITY OF EAGAN SEWER SERVICE PERMIT $795- Pil9t Knob Road PERMIT NO.: Eagan, MN 55122 DATE: Zoning: No. of Units: Owner: Address: Site Address: Plumber: I agree to comply with the City of Eagan Connection Charge: Ordinances. Account Deposit: Permit Fee: Surcharge: By Misc. Charges: Date of Insp.: Total: Insp.: Dote Poid PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA153381 Date Issued:12/14/2018 Permit Category:ePermit Site Address: 3149 Farnum Dr Lot:2 Block: 04 Addition: Coachman Land Co 1st PID:10-18150-04-020 Use: Description: Sub Type:Residential Work Type:Replace Description:Furnace Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Please call Building Inspections at (651) 675-5675 to schedule a final inspection. 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 - Lois M Froehlig Tste 3149 Farnum Dr Eagan MN 55121--192 Airic's Heating & Air Conditioning Inc 9124 Grand Ave Bloomington MN 55420 (952) 345-0032 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA158887 Date Issued:11/06/2019 Permit Category:ePermit Site Address: 3149 Farnum Dr Lot:2 Block: 04 Addition: Coachman Land Co 1st PID:10-18150-04-020 Use: Description: Sub Type:Windows/Doors Work Type:Replace Description:One Window/Door Census Code:434 - Residential Additions, Alterations Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow windows, call for framing inspection. Call for final inspection after installation. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Valuation: 1,500.00 Fee Summary:BL - Base Fee $1500 $62.50 0801.4085 Surcharge - Based on Valuation $1500 $0.75 9001.2195 $63.25 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 - Lois M Froehlig Tste 3149 Farnum Dr Eagan MN 55121--192 (651) 686-5596 Budget Exteriors 8017 Nicollet Avenue South Bloomington MN 55420 (952) 887-1613 Applicant/Permitee: Signature Issued By: Signature