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4340 Fox Ridge CtCITY OF EAGAN Remarks 1i B? ct - Addition SUN CLIFF 2nd Lot Z? BIk 6 Parcel 10 72976 200 064- Owner Street 4340 Fox Rid ge Court State Eagan, M N 55122 Improvement Date Amount Annual Years Payment Receipt Date ST'REET SURF. 1985 369.37 24.62 1 STREET RESTOR. ?4167 1986 431 . 51 5 GRADING _S`.Sj SAN SEW TRUNK 170 48.64 1.95 2 SEWER LATERAL SEWER LATERAL 999 1986 829.62 165.92 5 WATERMAIN WATERLATERAL 1000 1986 942.60 188.52 5 WATER AREA 7q 1986 757.88 11.58 5 STORM SEW TRK 1971 161.72 8.09 ZQ STORM SEW LAT S S/W SERVICE 1005 1986 808.77 161.75 5 CURB & GUTTER SIDEWALK STREET LIGHT STORM SEW LAT 1006 1986 610.14 122.03 5 Road Unit 280.00 57844 11 26/85 WATER CONN. 00.00 BUILDING PER. 5 SAC -929-00 PAFi K - CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHONE: 454-8100 • - BUILDING PERMIT . Receipt # c m z 0 , QF DWG/GAR i 000 4340 FOX RIDGE CT slock 6 secisub. 5UN CLIFF 2ND Erect E9 Occupancy "'' Remodel ? Zoning Rl Repair ? Type of Const V * Addition ? No. Stories Move ? Length 45 Demolish ? Depth 4 f1 Irrt lmpr. ? Sq. Ft Install ? Z o Mame SAME ? 0 ? Address Assessment _ ~ City Phone Water & Sew. ?cc MI1`dNETONKA DESIGN Police ? W Name Fite ° W City •..••`.`??•'?'?'h7fr14 -8 • _ .,"; Planner Iherebyacknowledgethailhavereadthisapplicationandstatethatthe Gouncil gldg.Off?? information is correct and agree to comply with all applicable State of Minnesota 5tatutes and Ciry of Eagan Ordinances. APC Signature of Permittee- ` Var. DBte RMC dEVELdPMtiNT CORP A Building Permit is issued to: all work shall be done in accordance with all applicable 5tate of Minnesota S- Permit -' 't jA. - vv Surcharge 46.50 Plan Review 206.00 sAC 525.00 Water Conn. 500.00 Water Meter 63.00 Road Unit 2 U-O-. 0 0 Tr, PI. 132.00 Parks Copies , . 50 on the express condition that Ciry of Eagan 4rdinances. ? I _ I PermN No. I PermN Hdder I Date I Telephone M I Commenb Plby. Hty. Htg. d S/ •, Finsl Occ. ii Diap. Rowipt ? MECHANICAL PERMIT Permit No. CITY OF EAGAN FM Fill in numborsd apacRS S/C Type or Prfnt /eyib/y TcrL 1 7_ 1. Da t s • ? Z. Ins t a i la tion C o st ? 3. Job Addraa :_ '_'.. =?:• Lot Blk. Tract 4. Owner 5. Contractor - Phone ? 8. Addres . . ? 7. City State Zip 8. Building Type: Residential O-. Commercial O Institutional 0 8. Work Description: New 0 Add 0 Alter ? Repair ? 10. Desaibe ' - . -- Puel Type - 11. No. Eauioment BTU - M. Ea. Forced Air . ? No. Equipment CFM Ai H dl Mfg, r an ing: Boilers Mfg, Mech. Exhaust ? Unit Fieater Mfg. Other ? Air Cond. Mfg. Gas, P'iping 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 ! PERMIT# CITY OF EItGAN PLUMBING PERMIT RECEIPT # 454-8100 / MINIMUM RESIDENTIAL FEE - $70.00 + $.50 DATE MINIMUM COMMERCIAL FEE - $20.00 + $.50 1. Bidg. Type: Res x Comm Inst 2. New X_ Add _ 3. Total Bid Price 4. Job Address Lot Blockl?_ Sec 6. Contractor w" i I L(: ) M ?-?..N • (Name) 7. Contractor Phone #?? J?S ? 5J FEE ??• ? C, S/C . 5 O i TOTAL Alter Repair ? 5. Owner 1????- -!?f ?• (SVeeU ICitY) RiR? NO. FIXTURES NO. FIXTURES NO. FIXTURES -3 Water Closet - $3.00 / Laundry Tray - $3.00 -Well - $10.00 ? Bath Tubs -$3.00 TFloor Drains -$1.50 Private Disp Syst -$10.00 =Lavatory - $3.00 TWater Heater - $1.50 ?Rough Openings w/o / Shower - $3.00 Whirlpool - $3.00 Fixtures - $1.50 TKitchen Sink - $3.00 ?Gas Piping Outlets - $1.50 -Urinal/Bidet - $3.00 / Softener - $5.00 COMM,/IND. RATE - 1°rb OF TOTAL BID PRICE PLUS $.50 STATE SURCHARGE FOR EACH;1,000 OF FEE. Signed: tor Approved Inspections: Date Rough Insp. Date Final Insp. IN CITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55122-1897 (612) 681-4675 SITE ADDRESS: 1{1 ? ! i l i .'Nir PERMIT SUBTYPE: 4N RECORD PERMIT TYPE: Permit Number: Date Issued: APPLICANT: ( tti l.' l 4: j h l k, ! TYPE OF WORK: oF';;f.RIP f fpN rt 1.1 1 1 ri 1 rt6 0 14 `t t.'/1T1??6 !V'% nN nr 1FRAT[AN ( tWti 1 NsE R'f 1 INSPECTION .• • DA Permit No. Permit Holder Date Telsphona 11 ELECTRIC PLUMBING HVAC Inspectlon Date Insp. Commenta FOOTINGS FOUND FRAMING ROOFING ROUGH PLUMBING PLBG AIR TEST ROUGH HEATING GAS SVC TEST INSUL dYP BQARD FIREPLACE FIREPLACE AIR TEST pJ FINAL PLBG FINAL HTG OASAT TEST • BLDG FINAL BSMT R.I. BSMT FINAL DECK Ff0 DECK FlNAL INSPECTION CITV OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55123 (612) 681-4675 SITE ADDRESS: PERMIT SUBTYPE: "f I Y(II'.11 11' ? ,MiNli fl? -?Idr iN I'?t;0 ? PERMIT TYPE: Permit Number: Date Issued: APPLICANT: i ?. ? ,• , .t?.r? ,; ??ti??. TYPE OF WORK: 1 Pa',111 A I IiiN r i rv is i ? aa?mn No. re.mn Hoide. Dats Teiephone A snN PIUMBiNG ? /S A-f HVAC ELECTRI aa? ? ELECTRIC Inspacrtion Date Insp. Commsnts Footings I Foundation Framing Roofing dW Rough Plbg. ? 3 a AW IZ - 9':3 d"j Rough Htg. Isul. Fireplace Final Htg. Orsat Tesl Final Plbg. Pibg. Inspector - Notity Plumber Const. Meter Engr./Plan Bldg. Final ! DeCk Ftg. Deck Fnal Well Pc Disp. CITY OF EAGAN 3830 Pilot Knob Road P. 0. Box 2 i 199 Eagan, MN 55121 Zoninp: Owner. Address: Stte Add?eaa: Plunber: I Mm h N?p1y wNb !V CiM ol iwn Or?iiw?moM. By Dote of Inzp,: Insp,: CITY OF EAGAN 3830 Pilot Knob Roo P. O.. Box 21199 Eagan, MN 55121 Zoninp: _ Ownsr: ?Cf'vOm--eP.t {' /lddrcsa: Sita Addrcss: 4340 Fox Rid e Plumber: ' zy um R Maler No.. Size: Rsadsr No.: 1 MMe b eowpl?r wNi? 11N Cihr ?f Es"a OrAMSps, By Do% of Insp.: Connecti«, Cho.ye: _ 00 .010nd AeoourM DepoaJt: -15 . nc;- Perrnit Fee: Surcharfle: . . , .. . J .? Miac. Gwryes: ,..ki "I'l' TotoL• e r. Doce Pora: CITY OF EAGAN 3830 Pi1E•t Knab Rood P, U. Box 21199 Eagan, MN 55121 Zonirg: -. WATER SERVICE PERMR PERMIT NO.: DATE: m No.: lo amPtp wa MM C1lp ef Emps SEWER SERVICE PERMIT PERMIT NO.: DATE: - No. of Units: Corn»ctian C}uorpe: Acoount Depodt: Permit Fas: Surehorpa: - Mix. Chorgs; - Totol: - Dah Pald: WATER SERVICE PERMIT PERMIT PtO.: DATE: No. of UMtr. Cennertibn (.?#fo'?:• .•••" . •,v E ??. /?ooour?t Deposit: ? Per?n1t Fee: Surcfiarps: Mlac. Chorpes: I . Total: Dote Poid: CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 N°_ 113 5 5 PHONE: 454-8100 BUILDING PERMIT Receipi # Tobeusedfor SF DWG/GAR est.value $93,000 oate NOVEMBER 25 ,1g85 SiteAddress 4340 FOX RIDGE CT Erect :n Occupancy R3 Lot 20 Block 6 Sec/Sub. SUN CLIFF 2ND Remodel ? Zoning Rl Parcel No Repair ? Type of Const. 17- . Addition ? No. Stories W Name RMC DEVELOPMENT CORP Move ? Length 45 a Address 3209 W 76TH ST., STE #205 Demolish ? ? Depth 40 F S CiN EDIN4?hone 835-3773 Int.lmpr. Install 0 t q. o a Name gAME Approvals Fees 00Q Address Ass2SSfnBnt Perrtlit +S 412.00 . • ciry pnone Water&Sew. Surcharge 46.50 ? Police Plan Review 206.00 Fw Name MINNETONKA DESIGN Fire SAC 525.00 ¢= address 337 WATER ST Eng. WaterCOnn. 500.00 a W ciry EXCELSXPA 474-5991 planner Water Meter 63.00 Council RoadUnit 280.00 Iherebyacknowledgethatlhavereadthisapplicafionandstatethatthe 1 20 OH B?dg Tf PI. 132.00 information is correct a9bag to comply with all applicable State of , . . Minnesota Statutes and Cit? of n Or s . ` APC Parks ) Zg . Var. Date Co ies?, T6-4- -50 SignatureofPermittee Total ?L . ' RMC DE LOPMENT CORP A Buildinq Permit is issued to: on the express con tlition that all work shall be done in accordance with all applicable S te?' ? of Minne ota tes -and City of Eagan Ordinances. tu ? / Building OHicial v??-? ?4 T -a?( ?-r - .ay? ???REQUEST FOR ELECTRICAL INSPECTION eeoooo,.oe ( See insttutlrons lor complenng this lorm on Oack of yellow copy, ? J13r? / Z8 .'X" BelQw Work Covered by This Request ew 'Atld Rep. TypeoFBUilding AppliancesWired Equipmen[Wired X X Home Range Temporary Service Duplex Water Heater Electric Heating Apt Building Dryer Other (Specity) Comm./Industrial Fumace Farm Air Conditioner O[her (specity) Conhactor's Remarks. Compute Inspection Fee Below: # .. Other Fee # ServiceEmranceSize Fee 8 Gircuits/Peeders Fee Swimming Pool 0 ro 200 Amps 2 0 to 700 Amps 30.00 Transformers Above 200 _ Amps A6ove 100 _ Amps Signs Inspeclor5 Use Only: TOTAL Igation eooms rri j G- CC7 31.00 S peciallnspection Aiarm/Communication THIS INSTALLATION MAY BE O ISCONNECTEO IF NOT Other Fee COMPLETED WITHIN 18 MON I, the Electrical Inspector, hereby ertif th t th b i i Roi y c a e a ove nspect on has been made. Final "- OFFICE USE'JNLY ' This request voitl 18 monihs from i ? ?y / 7?Ss ? 3 2 2 ao T Requesi Date Fire'Na. Rough- pedi0n ? ?ReaOyNowX W? ? B?IN D0C 27, 1993 f?NO X'aYea hn Reetly? j? licensed contractor ? owner hereby request inspection of above electrical work at: Jo0 Adtlress (SIrceG Box or Paute No.) City 4340 Fox Ridge Ct Egan Sec6on No. Townsbip Name or No. Range No. Cowty Dakota Occupant(PRINT) Phone No. Mrs. Ea an Power5up01ier qddress no Elechical Contractor ICompany Namei Conlraclor5 License No. Dickson Electric CA00511 Mailmg Atltlress (GonVecror or Owner Makmq Instella9on) Aut?orize igna? v o er = Phone Number r e6r'k-) MINNESOTp STATE BOARD OF ELECTRICITV THI$ INSPECTION REOUEST WILL NOT Grigge-MiEway Blpg. - Room S178 BE ACCEPTED BV THE STATE BOAFD 1621 Unlvnsity Ave.. SL Paul, MN 55100 UNLE55 PROPER INSPECTION FEE IS Plqne (612) 642-O800 ENCLOSEO. fhls request voitl /? 9941 1 B months trom ? ? ? KJ 0 (0 Reqveef'Uate Fire No. Rough-in Ins on ReqmrcA? C311eaAy Nnw 34J711 Nolity. Inspec- 1-3-1956 ?kes ? N. wr When Heotly icensed Eler.triwl Comrnctor ?- I hereby request inspaction of above ? Ownur electrical work installed at: SVeet AdAress, doz or Route No. . City 4340 Foxridge Court Eagan ecuon o. Township Name o, No. Ranye. Nu. Cnunty Dakota Occupant(PFINT) Phone No. RMC ` Power $upplier Atldress Dakota Ct . Electric Farmington ElecVicai Con(raclor (ComVeny Name) Cnntracmr's Lirense No. O.B. Thomoson Electric Co. A40602 Mailinp AtlJress IConVacinr or Owner MakfnN Instailationl 12201 Mtka slvd. Mtka 55343 Authorized Signature IConhacmdOwner Making insiallationl Phunc Number • i'.''' •,. ? 33-2521 MINNESOTA STATE 80118D OF ELECTRICITY J THIS INSPECTION qEQUEST WILL NOT Griggs-MiOway Bltle. - Room N-191 BE ACCEPTEO BY THE STqTE BOAHD UNLESS PflOPEH INSPECTION iEE IS 1821 Universitv Ava., St Peul, MN 65709 Phone (812) 297-2111 ENCIOSED. r C$Y,(?1 REQUEST FOR ELECTRICAL INSPECTION ? ' See itlstructions iur completing this 7ofm on bBCk Of YBllow copy. -6i "X" Below Work Covered by 7his Request EE6-UUW 1-U9 R?,? B B f+dtl Pep. TypB o} BuildinA APPliancqa Wired Equipmenl Wire6 g Home g Range 5.00 Temporary Service Duplez Water Heater Lightiny Fiztures Apt. Building Dryer Electric Heatin Commercial Bldg. X Fumace 3.00 Silo Unloader Industrial Bidg. Air ConAitioner Bulk Milk Tank Farm omnr Spnr., y - ina, Isn-oltyl ther Suecify FX Other Dl .Dish.6.00 ?th« ornpute lnspectron Fee Below M Fae ServiceEnVenceSize b Fee Feeders/SUbfeeders P Fae Circvits 0 G 001 U to 200 qm s 0 to 30 Am s 0 30.00 Q tn 30 Am s Above 200 Am ps 31 to 100 Amps 31 to 100 Am s Swimming Pool Above 100_Am s Above 100_Am s Transiormer5 Irrigation Booms .50 Pdrtiai: Other Fee SignS Speciallnspection 50 S59 TOT Nertwrks . D i tt . i an Sm . Lr?, pp Roueh-in Date (J? I, the mal ? g A ? In specto., neroey certity thnt the nbove Pinal l l ? ???e f?y inspec<ion has been ? j (/ mada. This request voitl 18 months (rom RESIDENTIAL BUILDINC PERMIT APPLICATION CITY OF EACAN 3830 PILOT KNOB RD, EAGAN MN 55122 651-681-4675 New Construction Renulrements RemodellReoair ReauiremeMs • 3 registered site surveys showiig sq. H. M bt sq, ft. of house; and all roofed areas • 2 copies of plan (20%maximum lot coverage allowed) . 1 set of Energy Calculatlons forheated additions • 2 copies of plan showing beam & window sizes; poured kund design, elc.) • 1 site suney for exterior additions & decks • 1 set of Energy Calculations . IMlcate if hume se+veA 6y septic system tar additians • 3 copies of Tree Preservatlan Plan if lot platted aRer 711/93 • Rim Joist Detail Options selection sheet (Wdgs with 3 or less units) 39 DATE VALUATION SITE ADDRESS Ll3yC? ?X Ri'dS e C7 MULTI-FAMILY BLDG ,Y ?N ? - TYPE OF WORK f• O&/'(X9P FIREPLACE(S) _ 0_ 1_ 2 APPLICANT STREETADDRESS q700 CITY P?TSTATE -f !:?:'llPss?/l TELEPHONE # CEII PHONE # FAX # PROPERTY OWNER 7? 5 TELEPHONE# Ysy 636y COMPLETE FOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1 MINNESOTA RLII.ES 7672 (d submission type) • Residential VentilaGon Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted • Energy Envelope Calculations Submitted Plumbing Contractor, ___ Pluxnbing system includes: Mechanical Contractor: Mechanical system includes: Sewer/WaSer Coniracior. Water Softener Waker Heater No. of Baths Air Conditioning Heat Recovery Systcm _ Phone # Lawn 3prinkler No. of R.I. Baths ree: $90.00 Phone # Fee: $70.00 Phone ? o AuG 2 3 200? I'! I hereby acknowledge that I have read this application, state that the informati with all applicable State of Minnesota Statutes and City ot Eagan Ordinances. Signafure of Applicant OFFICE USE ONLY and agree Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ Updated 4102 ? CITY OF,EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55123 (612) 681-4675 SITE ADDRESS: P.T.N.: 10-72976-200-06 DESCRIPTION: PERMIT PERMIT TYPE: Permit Number: Date Issued: 4340 FOX RSDGE CT LOT: 20 BLOCK: 6 SUN CLIFF 2ND Buildin9,Permit Type Building Work 7ype / ?- i ?- ? _- BASEMENT FINTSH NEW /,' L?` ??!i?,?? `??i1? l??t?.SU??Sll? BUTLpING 022452 11/02/93 u? ? j43 REMARKS: FEE SUMMARY: 8ase Fee $35.00 Surcharge $.50 Total Fee $35.50 CONTRACTOR: ATVWNEER: - 4340 FOX EAGAN (612)454-7005 pplicanL - MAR6ARET RIDGE CT MN 55122 I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable 5tate of Mn. Statutes and Cit,y of Eagan Qrdinances. L J nra ,r.if APPLICANT/PERMITEESIGNATURE ISSUEDBr. SI N-FATURE INSPECTION RECORD CITYOF EAGAN PERMITTYPE: BuzLorNe 3830 Pilot Knob Road Permit Number: 022452 Eagan, Minnesota 55123 Date Issued: 11 / 0 2/ 9 3 (612) 681-4675 SITEADDRESS: t,or: ze BLOCK: 6 APPLICANT: 4340 FOX RIDGE CT ANGLE MARGARET SUN CLIFF 2ND (612) 454-7085 PERMIT SUBTYPE: TYPE OF WORK: BASEMENT FINISH NEW INSPECTION FRAMING .. . INSULATION .. ROUGH IN PLBG FINAL F- .. ? . ?i , ? ? . .?. ? ? i ?,. . s . > REAL7IYATf: _- PERMIT f ldt4,41 CITY OF EAGAN 1993 BUILDING PERMIT APPLICATION $Ma 5o 681-4675 SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, l copy of energy calcs. COMMERCIAL 2 sets of architectural 6 structural plans, 1 set of specifi cations, 1 copy of energy calcs. Penalty applies: 1) when permit is typed, but not picked up by last working day of month- in which request is made, 2) addr ess is changed or 3) lot chan9e i.s requested once permit is issued. Date Yaluation af work ??+rC?6?1 Site Address: 1346 ff? I'?'?? k ??? 7??14tif1m 14A S?S/ z z- Si0.EET fU17E y Tenant Name: (commercial only) IAT ?tJ BLOCIC SUSD. ?-(fJUC?i L IFF Y.I.D. N pescri tion of work: The applicant is: [a'Owner ? C ontractor ? Other (Deceribe) ? - - t Name - ` ? S'S' `9do5' ` & ??L?. ?1/?('?MF? Phone,,;40.,4kk 1s/?T.- Property hV ixsr rtssT Owner Address 4F3 4`? f -N SiREET iTE k sv/2? l k Lity 244J2 Zip State l t Campany ^1? Ar Phone Contra ctor Address License d Exp. rity S*.aie Zip Company ? Phone ArchitecU Engtneer Name Registration Y 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 ead this application and state that the information is d Cit f correct and agree to comply wit y o 11 appl able State of Minnesota Statutes an Eagan Ordinances. Signature of Applicant: OFFICE USE ONLY BUILDING PERMIT IYPE ? 01 Foundation ? 02 SF Dwg. ? 03 SF Additian ? 04 SF Porch ? 05 SF Misc. ? 06 Duplex ? 07 4-Plex ? 08 8-Plex ? 09 12-Plex ? 10 Multi. Add'1. WORK TYPE k31 New ? 32 Addition ? 33 Alterations ? 34 Repair ? 37 Demolish r ? ll Apt./Lodging )K46 jAsemeat finish ? 12 Multi. Misc.7 'MEl17 Swim Pool ? 13 Garage/Accessory 018 Comn./Ind. ? 14 Flreplace ? 19 Coron./Ind. Misc. O 15 Deck ? 20 Public Facility ? 21 Miscetlaneous O 35 Tenant Finish ? 36 Move GENERAL INFORMATION Const. (Actual) (Allowable) UBC Occupancy Ioning f of Stories length Depth APPROVALS F i ann i riy Enoineerinn REQUIRED INSPECTIONS ? Site ? Wallboard Basement sq. ft. lst F1. sq. ft. 2nd F1. sq. ft. Sq. Ft. total Footprint Sq. ft. On-site well On-site sewage Building Variar.ce ? Footing R Final JZ Framing ? Draintile 0 ? Insulation O fireplace Permit Fee Surcharge Plan Review License MWCC SAL City SAL Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment P1. Road Unit Park Oed. Trails Ded. Copies Other Total: 3.?? uo I w??t?p,: ? ?' .. HwCC Sys3em , City Water PRV Required Booster Pump Fire.Sprinkler Census Code ? SAC Code Assessments SAC % SAC Units aP 1985 BUILDING PERMIT APPLICATION - CI'PY OF EAGAN NOTE: ALL CONTRACTORS NUST BE LICENSED HITH THE CITY OF EAGAN SINGLE FAMILY DHELLINGS INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS $2,000 LANDSCAPE BOND To Be Used For: Site Address y,3Y0 /95,c . Lot a0 Block ?? Parcel/Sub vN P??fT ?.?G'O? Owner Address 2,09 Gtf City/Zip Code ,?a1,r/,p Phone ?33'- 3 77 ? Contractor Address City/Zip Code Phone Arch./Engr. 1?jLE????,•/[?? f?S??_ Address City/Zip Code Phone li INCLUDE 2 SETS OF PLANS 3 CERTIE'ICATES OF SURVEY 1 SET OF ENERGY CALCULATIONS 9 ?i, Do0 Valuation: 99aite . Erect ? Remodel , Repair ? Addition Move ? Demolish Int.Impr. ? Install ? APPROVALS Date: h//CN?w Occupancy Zoning Type of Const ll of Stories Length Depth Sq Ft FEES Assessments Permit Water/Sewer 'i ^ Surcharge Police Plan Review Fire SAC Engr Water Conn Planner Water Meter Council Road Unit Bldg OffC'? Treatment P1 APC Parks Varianee Copies TOTAL 1 Z. 50 I ? n. -?_3 = lo ? ? x ? = 3? ?7 ? ,- . ? • ? g n ZI " l?g ? ? ` ?-744- . ZZX 2Z ` Ti84- x (2 ` S?a ?E?, ¢ x 4¢ ^ 300gG 44- -7c) 4° 1 23c?o w C. R. WiNOEN a AS30CIATfS, INC. IAND 3URVEYORS f*t i45-3446 I38I EUSTIS ST,, ST. 1'AUI, MINN. E5100 FOR: R.M.C. DEVEI,OpMrENT COR.9. G FOX R1DGS . a R' Ip ?' 36„ ??? /9/a.ss??soow?AZ96?r .? ? p O Scale: 1" = 30' ? O Denotes Iron Monument ZZ. '? -(4t2.y) 5 4 tv _ w o- fi t`' -? 11 W O? v m?`v s? %OTE: - prpposed ? 0?- • o Denotes Waoden Stake . - d? ? - ?-???Q cp? Prnposed Garage Floor E1.-913•0 . ) Denoies Proposed ?nj p. (9/z '7 a o?- +sls- Finished Ground El. 0 I _ ?Ave?hon? ,_ ? ..f- peaotes Dicection ?1r 111 (Woikout=9o5.7) , Cf Surface Drainage Oertiul Datum - N.G.V.D. 1929 Q I ??? r ry?l 5L?__, ? C- ? - 0 p 76.41 589°29'511N Lot 20, Block 6, SUN CLIFF SECOND ADDITION, Dakota County, Minnesota WE MEAE6Y CERTIfY TMAT TMiS IS A tRUE AHD COIRECT REPRESEmtA(IOt4 OF A SURVEr Of iMf SOUNDARIES OF TME lAniD A60Vf DESCRI6ED AND OF TME IOUTiON Oi AtL 6UIl01NG5, IF AN9, TNEREON, AND All VISt6LE ENCROACMMEN(S, If ANY, tROM OR ON SAID IAND. Derad eM. 7t' dor *f Oc70obet A.D. I985 Rev4ed 77=Pi-85 C. R. WINDEN 6 ASSOCIATES, INC. Su.•pOr, Minnisw00 layntratien No 772G . n.c,. ? 1 i r)i 4 ? r . ; Elfl'[R10R ENVELOPE RV'4(1Gi. J" I:OMPUTA'fION :._... ...______.._.._. ? . •: ?• y.?s. ?- aWNERunir -- SITE ADllRFSS:._:.._?._-------- pHaNr::?JS??} -Q?':5, CONTRACII"i?'`t:y?'? DFtpr•mine working square footage of each 1., Total'exposeB wall area..... 2?{-ZZ `1LJ sq. 2. . 7ota1 roof'/ceiltng at•ea..... x, .02i; -- ?Z•?_ ----- il t ? fl ?????5 - - ? 7uta1 ex.posed wa ai e,, a ?ovt. .. oor -_ . ; . a. 'Tcital ara'ly , windox area ........... ........... ..... ............... ------ . ._. c Tota1?daar area .................. ........ .. .. ............. ---- . Total slidin9 9lass door nrer:r.... ..... ..... ..................... d. Total firepiace wall area ........ ........... ..................... --- e. Total .w8i1 framinq area (average 1 0' ::....... ..................... f. To'tal''.C^fM :joist area ............. ........... ..................... -- g. ,? net??'4rd71 arem above floor ..... ........... ..................... h.., .' WA11 area above flocr ..... ........... ..................... .-. ?_ 1. ? .? area a6nve floor ..... ..: , ........... ..................... ---- J. . , .. '. fra-me, rtall are5 at foi:nuati.on ... . ---,---- ........... ..................... - , . fiotal exF,oseta Poundation area= . . . k. , . . TotaT.foundatfon window area ..... ........... .......... (p . Z 1. Total net fpUndation area ahove q rade....... ....... ., . ;`02termtne "u" value of each wa ll seymenl: window, doar, - ' each separ ate wall section) ? ' `a• ? x ,'LlI, -_- ? n . ? ?. • :? ?/ X ii u OZ X ?,r _? ?._1.--- --- --?-A=?-?- . ? tl. -- R G• Z ? x II'd" -i 9 -1--+?-'r-??- ?- x ?? ?'? ---?.?- ---- -- ?_ L• ? h. ? X °t!" _ J x ?V, _ k. x „li „ _ - ----------- ---------- r---, ? 1. u„ ?..,.._...___ ..__.__.__. 3. ...,.... ..............Total ? - If item #3 i5 the san as, or less than itzn #1, you have met the intent of SBC 60q4;(4 , , 1': ?, .... ? S 4 ?• ?? ? f ??:,? . . F?.trE$N1JG?,?'{??Q'r'L'Sa<SX:EryC! ?U" CDtti????t?it?.i.r?i: ? •`?_';F• r°??.+{?`?v?'"??','??e'??yg ?''t:`, 5 Tptal exposcd roc f].i.nri ari?a =._?af(i-,_.- ? r Rr,. Tl9?t??e?yi],F;'XOA?E/,?eilSng framinq aica {.vk:, <??r,! ].0•, j'• ?_??} t' ?4aM1? n441?nk?1?lnt.llCl l(lC)f/Cf:l.i111t) 'll:?,'. . . ..... ?..[jeLerm.ine uU" val.uc Por cach roof;cui7.i.ng segment . ',qa? • y ?`,:,fi? ?.,q' ". ;. .,-_" .' x nUn }; „11" ;. ' Ui. r • A.M.:..,.. ??e, .. ............. Pa9e 2 of 4 9R d2j3 I?:?C}f't?. Q? .?}?? ?.? Chtl sFmje ?s, nr A_h.ui il: , ynu ?i.ivc muL !:f?c i.nCenL of ;kY 1,,. ?.AS.t¢xne3tc Bu9ldin? 71i?i.icne 'lp t1ta,l.I Lha'Y.otis.l anvelo,ne syst.em n- i_Lo?t tne va„ : c??Lah] ti:;Pwd by the sam of ??.'?1115 r?$'?iXik108,:6ha11 not: be ryreater th.in Y.he !;um r,f i.' ems M1 and N2. ?L?It/ 7 /w?^ '? ?L rs i + 2 . °t ? „ ------ . --- ---- - 3??, ,??,Q<J•"l?j , ??? CP +.,. ? , , ? -?---------- ? . - , : r= ,. r R p I •. ? . ., . ,? .. }. . ? r.. , . . . s.' • • . , ., :??' ..+' • . ? __zl ? •?_ : .,• ,. ;,'; r r?. , ? a ? s• . ? r Y g ? ; ? . ; .,. I . L i &I FA L FT, F?c.poSED WALL ? , W?O? ; FvL l.?r FkposeD wALL AZEA .' + n.+. ' K 11w:a?:.+? 2.7 ?'3 , K.N F.E ?C ? - 1 0 ? ? F, P,::. ,i?---- ? i .. . . '!I . _ . ?? iEKaosE.D e.Ei l.(Uq 8?zt?zf?v= e&4A Vlf DW15 tl D o025 ?7 ? K .?s ?-- Z.4?48 - ?!fi4ll -- ?(o ?A'1"I O 3SM4 :? . , .. ,. ?. . ?r : . h 1 • • n . .? ? y''I• ? :. $3 V i , ? ? F.... , • ? ;' ?' . .p?. . ?? 915 o Z?5 („ll <<I,,,, V., ?.. .._ ?Z11.-WC)_(-..__WY. V??{ ..._._Ae-Y ? • ,.„i '.? 1 P?: i 11'i. I...} ?.? _ . . . . .. ? .. . ? 1 Q..7 ? +y C G. F:r,torii;r nir (ilm ___ . > p,17 ... ......... _.._..,._ . .... . ._ rui Tt? Jt3.$Ya , - . . _ ... . .. ?. _ !e". .Iruscrl_ . _.... --•- -L_l..Q 4 . _25j_t_ _?NTls ?- - --- - -- ._'? _ 4. ? ? ? 6. ,,i? i???.? r:x?.?•ri ?___.o.i_ c?= •°4 ?. In(ciiyr_aic tilri _. --? ----._ (>.r,'t ---? -1R'w` h. t:*:CrrsOr r.tC :tint . ._.._0.1_7 roc:? t?; 24?'42 U= ,oq '?c.4G5L n: c,n ----""._- ??. _ _. . .. -------•- --.?.__. L, )::t!?•ri?•r .iir' lit?.? __U_17 -." _.__•.._.. ..._..__.._..,.___'" K , S:C.AP O^t _I(AUL' / ._. . __ ..._. ._ _ . __ . ????.?wy... •' / ?, ? • ? ? r ce , «..s+4w < ?A t{,t :lL i;: •. •v ? , ' ' . i • ' v = . oZ4:. , 1. Yr.s1 .?c! Ii r_ f i lrn_-------, 0.61 2. -._ - " 3• ?---_------?.._ ? ? 4' --- ----------- -.-.? 5. Outsidc ni.r filin_ 0.17 ---- . ?...._..?.. - ------- Total I_ j;7nidc: aLr. ?i11n 0.61 ? geat [1ov up- ?p j•rtaenked , , ?.PTG. q6' . , . . .. . ' . N: / 1 \:`1 i ?' 1; ? 4i1?rcii t-?D C?n t t ?s .. n R-Val?ia 7., 7r [r air fllm 0.61 ? z. =2&_-?=?i?=? , A. __l 4. Exkcr.i.or air £ilia (?:til.T _'------?-- Total 2 - = . . - - O_ OZ . pa.r4+rv d , ?, Interior alr film O.fil 2 _T? 3? 3S - _...._.._ ..._. . .....?._--.?' 1 . ?: OL;l 2 ? qo ,s j geg[ flov snLC?l , ;.e ' up • • . g wPt?l??? ? ? , , r ?' , ?^ ??:1??!; i .,•, ? , / ,?.?._'I ? !`i . n' 1.r+y'? . . . • : . . . . BOti-V22: P?7 . •,. . ; ? ilow up . . ' S y • . , ? . 07 ?i r"R.IW.7! • . ? ?t ( J Fr?ifrlt°.5 ? • . . 1. ? ?n,_.. _ .. . :z. • s- ? Cn.ils.i-dcr 0.1 Total 0.61 ?_ ? • U?it )c?i Air f1'!n 0.17 Total . . , . Uso additional sheets if morc 6pate 1 r.rr.cled for det,:ils and ealculativas. . ? • • ? ? ?'?.'ti.? . • ? ; ia . ?,: ? • i ? ? • ? ? • i o • s i?? • u r• ?• ? ?? ? •?• s •a? i• •?? • •? • ?+? ? ?? ? • • ; CITY OF EAGAN APPLICATION FOR PERMIT SEWER AND/OR WATEE2 CONNECTION 1) PROPERTY ADDRFSS: T.FY;AT DFSQ2IPTION: tlAL/tS10CK/JUDCL1V1SlOl1 OT '1'dX rarcel 1.U. LW IF EXISTING STRL'CTURE, DATE OF ORIGINAL BLILDING PERMIT ISSCANCE: (Month Year) PRESENT 7ANING/PROPOSID USE: R-1 SINGLE FAbffLY R-2 DC'PLEX (Trro L'nits) R-3 TOWN[-IOL'SE (Three + Onits) ( Lnits) R-4 APARTMENf/COAIDOMINIOM ( Units) CODM9EE2CIAL/RETAIL/OFFICE IrIDL'SIRIAL INSTIT('TIONAL/GOVERNMENT 2) NAME: ADDRESS: CITY, STATE, ZIP: PHONE: 3) • i: ?• For City Ose ?ME' `? ? ` Q ? /?? • JPlinnbers Licens: ADDRESS: 3t we C e CITY, STATE, ZIP: ?0 t? p y1 ed ?orE: MASTE?2 LICIIVSE # ecarc S? 4) ?4 r ?• rAME: ADDRESS: ? CITY, STATE, ZIP: PHONE: 5) u w• a. • a• ?? lk CONNECTION T0 CITY SEWER 4*6CONNECTIO[V TO CITY 4ATER 13 OTURR (Please Describe) 6) ?? • • PLEASE HOLD APPROVID PERMIT FOR PICK-C'P BY ONE OF ABOVE ? PLEASE MAIL AP.P? PII2MIT TO 1, 2, 3, 4, ABOVE d? (Circle one) 7) r ? + - • ` F 0 R C I T Y U S E O N L Y PE2MIT " ISSUED FE_^.5: S°. PERt1T y (I_I?CL;;,.... ? ?v ..U. _ o.C._•.?RGE) WATEIR PERP4IT (IiICL'uDE SliRCF:ARGE) $ ??o U WATER AIETER/COPPERAORN/OUTSID: READER $ WATER TAP (INCLUDE CORPORATION STOP) $ S ::vE4 TA? $ ?.5 •c??j ?(`^.?..i...'." _...: osi. $ /S?vU AC^OliNT DrPOSIT - I^iAT°R $ WhC $ C) o SP.C $ T3uNK SVATER ASSESS:+.E;:T $ TRti:1K Sr.SvER aSSESSME:iT $ L`nTE?.AL BEiNEFIT/TRU:]iC SES?; R $ LATE4AL BENEFZT/TRU:IiC jdATER $ ? •'??- c WATER TREATMENT PLANT SURCHARGE $ OTHER: $ TOTAL $ 7?•`?' AMOIINT PAZD; RECEI?T n ' S/ DOES UTILITY CONNECTION REQUIRE EXCaVATION IN PUBLIC RIGiIT OF WAY? ? YES IF YES, THEN r, "PERPIIT FOR 'r10RK WZTHIN PUBLIC ROADWAY" MUST BE ISSUED BY THE NO ENGINEERING DIVZSION. LIST AS A CONDI- TION, SL'BJECT TO THE FOI•L069ING CONDITIONS: APPROVED BY: TITLE: / -?- DATE e _ [ /?'? ? ,` - - -- PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNTT. NO. FIXTURES EA?C TOTAL SHOWER 3•00 WATER CLOSET t 3.00 ?o 0 _ BA n i uB 3.Q-n - ? LAVATORY 3•00 ?O ' KITCHEN SINK 3•00 LAUNDRY TRAY 3.00 HOT TUB/SPA 3•00 WATER HEATER 3.00 FLOOR DRAIN 3•00 GAS PIPING OUTLET • minimum - 1 3.00 ROUGH OPENINGS 1.50 WATER SOFI"ENER 5.00 PRIVATE DISP. • Detcry. lic 15.00 U.G. SPRINKLER • eome uneer const. 3•00 ALTERATIONS • to odsting 15.00 WATER TURN AROUND 15.00 STATE SURCHARGE .50 TOTAL: SITE AADRESS: _4:S4 'u OWNER NAME..T?-A OI S? INSTALLER: ADDRESS: CTTY:'?k STATE: lk'` ZIP CODE: PHONE #: (t2 } --I Z j • ':°13 1993 PLUMBING PERNIIT (RESIDENIZAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN MN 55122 (612) 6814675 PLEASE COMPLETE FOR SINGLE FAMILY TIWELLINGS. ALSO, FOR TOWNHOMES AND CONDOS WHEN PERMTTS ARE REQUIRED F'OR EACH UNTT. NO. FIXTURES SHOWER WATER CLOSET BATH TUB LAVATORY KITCHEN SINK LAUNDRY TFtAY HOT TUB/SPA WATER HEATER FLOOR DRAIN GAS PIPING OUTLET • mtnimum • I ROUGH OPENINGS ? WAT_F_R cOFTENER ? PRIVATE DISP. • DaILCty. lic. U.G. SPRINKLER • eome unau a.,nsl.' '-? ? ALTERATIONS • to aosdng ?, WATER TURN AROUND n \u?? I STATE SURCHARGE TOTAL: SITE EACH 3.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 1.50 5.00 15.00 3.00 15.00 15.00 .50 ? OWNER NAME: MArLC-2.C_,-T- N?YJ ( C(.' `? IN3TALLER: N D a,DDRESS: co 7P? 0 ?J CITY: ?? ?h-? L STATE: kA fJ . ZIP CODE: SS! Z? PHONE #: (,:,I 2) 72, CI - 7 7 (e ?° ?- ?J' 1 ? ATURF OF PERMITTEE i"-2 -.5 /-?3 4 1993 PLUIVIBING PERMIT (RESIDENTIAL) , CITY OF EAGAN 3830 PII.01' KNOB RD FAGAN 1'vIN 55122 (612) 6814675 / 1998 BUILDING PERMIT APPLICATION (RESIDENTIAL) v C 3830 PII.OT KN8 RD 55122 3S 681-4675 New Construction Reau(rements ? 3 registered ske surveys ? 2 copies of plans (inGude beam S window saea; poured fid. design; etc.) ? 7 energy calculations ? 3 copies of dee preservation plan if lot platted after 717N3 required: _ Yes _ No DATE: RemodeVReoair ReauiremeMs ? 2 copies of plan ? 2 site aurveys (exterior addkions 8 decks) ? 1 energy calalaGons for heated addRions CONSTRUCTION COST; Cl; /?? ?u DESCRIPTION OF WORK: ?-<S'z ?lE' ?ILuti1. S`?,,?? STREET ADDRESS: LOT: 6A 0 9- BLOCK: Lo SUBD./P.I.D. #: c sdA-?l_- Name: oM,4 S ? ??fl,?GE'n/ e- Phone #: 0 7/ - ?S?-lv ?? y PROPERTY First " OWNER Street CONTRACTOR ARCHITECT/ ENGINEER 3 qp Ciry State:?? Zip: ?? / ? ? ? Company: 41• 4- Phone#: -/- 1.D- -5?1--n-' V r Street Address:_?/ 0 L z L fl C ?J?q . License # City =oLc?£'? LIlc[ State: 92 Street City Sa o Y a9 ?-'7 Zip: ?5"77 1122- Phone #: Registration #: _ State: Zip: Sewer & water licensed plumber (new construction ony): . Penalty applies when address chang and lot change is requested once permit is issued. I hereby acknowledge that I have read this application and state that the iniortnation is correct and agree ith all applicabl State of Minnesota Statutes and City of Eagan Ordinances. _/ w? Signature of Applicant OFFICE USE ONLY Certificates of Survey Received ._ Yes _ No Tree Preservation Plan Received - Yes - No - Not Required A ...9 1 L1_M11 CITY OF EAGAN 3830 Pilot Knob Road PERMIT TYPE: B U I L D I N G Eagan, Minnesot8 55122-1897 Permit Number: 0 2 9 3 4 3 (612) 681-4675 Date Issued: 12 / 17 / 9 6 SITE ADDRESS: P.I.N.: 10-72976-200-06 4340 FOX RIDGE CT LOT: 20 BLOCK: 6 SUN CLIFF ZND DESCRIPTION: (OAS INSERT) uild3.n4;:>Permit Type PZREPLACE uilding Wior,? 7ype ALTERATION ensus Cade 434 AL7. RESIOENTSAL r ? -s ? >• ?? ? -`? L "'? /? a j?j ? ?i -„'i REMARKS: FEE SUMMARY: Base Fee $25.00 Surcharge $.50 , Total Fee $25.50 CONTRACTOR: OWNER: - Applicant - THOMAS JA50N 4340 FtlX RIDGE CT EAGAN MN 55122 (612)423-5757 I hereby acknowledge,thst Z have read th3e_applicatipn arsd state that xhe inforrtiatidn is eprrect and agree to co-mply with all applticabSe StaCcof Mn. ? Statutes and City of Eagan Ordinances.. F ??,g?????.? APPLICANT/PERMITEE SIGNATURE ISSUEDB:51 ATU E CITY OF EAGAN iq343 1996 FIREPLPIL A CE P[ERMIT APPLICATION 681-4675 DATE: DESCRIPTION OF WORK: _ CONSTRUCT NF FIREPLACE: _ WOOD BURNING _ GAS . 4z-<STALL GAS INSERT ONLY IN EXISTING FIREPLACE INSTALL GAS LINE ONLY IN EXISTING FIREPLACE ROOM TO BE INSTALLED IN: t STREET ADDRESS: LOT BLOCK L_ SUBD./P.I.D. APPLICANT: (circle one only) ' OWN CONTRACTOR SC1S`/- 63E y- Name: 2Z2e7x 5 Phone #: 5/03'!S?ZS 7 I hereby acknowledge that I have read this application and state that the information is conect and agree to comply wich all applicable State of Minnesota Statutes and City of Eagan Ordinances. PROPERTY OWNER FII2EPLACE INSTALLER Signature: StreetAddress: ;??:?? ?}?-"?` -?yr c- ' City: State: ? G--? Zip: Z Company: Signature: Street Address: OTf4ER: Phone #: License #: City: State: Zip: GAS LINE Company: INSTALLER Name: Signature: - Street Address: City: Phone #: State: Zip: PERMIT City of Eagan Permit Type:Building Permit Number:EA118749 Date Issued:11/07/2013 Permit Category:ePermit Site Address: 4340 Fox Ridge Ct Lot:20 Block: 6 Addition: Sun Cliff 2nd PID:10-72976-06-200 Use: Description: Sub Type:Reroof Work Type:Replace Description: Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Please print pictures of ice and water protection and leave on site. Carbon monoxide detectors are required by law in ALL single family homes . Amanda Peters Valuation: 4,000.00 Fee Summary:BL - Base Fee $4K $103.25 0801.4085 Surcharge - Based on Valuation $4K $2.00 9001.2195 $105.25 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Charlene M Thomas 4340 Fox Ridge Ct Eagan MN 55122 Jns Builders Llc 2325 Endicott Street St. Paul MN 55114 (651) 646-0221 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA122990 Date Issued:05/23/2014 Permit Category:ePermit Site Address: 4340 Fox Ridge Ct Lot:20 Block: 6 Addition: Sun Cliff 2nd PID:10-72976-06-200 Use: Description: Sub Type:Windows/Doors Work Type:Replace Description:Two or More Windows/Doors Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow windows, call for framing inspection. Call for final inspection after installation. Carbon monoxide detectors are required by law in ALL single family homes . Fee Summary:BL - Base Fee $4K $103.25 0801.4085 Surcharge - Based on Valuation $4K $2.00 9001.2195 $105.25 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Charlene M Thomas 4340 Fox Ridge Ct Eagan MN 55122 (651) 454-6364 Scherer Brothers Lumber Company 9401 73rd Ave. N Suite 400 Brooklyn Park MN 55428 (952) 277-1600 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA125048 Date Issued:07/16/2014 Permit Category:ePermit Site Address: 4340 Fox Ridge Ct Lot:20 Block: 6 Addition: Sun Cliff 2nd PID:10-72976-06-200 Use: Description: Sub Type:Siding Work Type:Replace Description: Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Please leave printed pictures of house wrap on site for the final inspection. When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to ensure maximum ventilation to attic. Call for final inspection after installation. Valuation: 4,000.00 Fee Summary:BL - Base Fee $4K $103.25 0801.4085 Surcharge - Based on Valuation $4K $2.00 9001.2195 $105.25 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Charlene M Thomas 4340 Fox Ridge Ct Eagan MN 55122 JNS Builders LLC 2325 Endicott Street St. Paul MN 55114 (651) 646-0221 Applicant/Permitee: Signature Issued By: Signature