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1421 Horseshoe Cir? ? DATE: ?T 28. 1991 RE: 1421 HORS83HOE CIR (JOSEPH !! MILLER CONSY IKC) x Your Sewer & W4$;r*Permit for the above property has been completed. It will be held at the Public Works Qarage (3501 Coachman Road) until the meter is picked up. BE SURE TO CALL PUBLId WORKS (4545220) FOR YOUR PERMANENT WATER TURN ON. Your Sewer & Water Permii for the above property cannot be completed for the following reasons: . , Your Sewer & Water Permit for the above property has been completed, but the meter cannot be issued or occupancy allowed until further notice. COMMERCIAL PROJECTS ONLY: Please pay for meter at City Hall. Meter size must be confirmed by Bill Adams or Dirk House (Plumbing Inspectors - 454-8100) before issuance. WARNING: BEFORE DIGGING, CALL LOCAL UTILITIES - TELEPHONE, ELECTRIC, GAS, ETC. - REQUIRED BY LAW. CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICY. Secretary, Building Inspections Dept. 40*41, k-W) CASH REGEIPT CITY 4F EAGAN 3830 PILOT KNOB ROAD EAGAN, MINNE50TA 55122 0- ,. i DATE 19? aECEweo ? j?? 1? 1 1 ? J( FRpA .? ? AMOUNT $ ? / . ? (?! DOLLARS ,ao O CASH )41CHECK I f I•?? ?? l ??'' `?? '1 ?: ,n f ? . C 015980 Wh%e--Payers Copy ? Ve1b%v-PosNng Copy Pink-FUe Capy Thank You , ev ?? A ? ,? ' CITY OF EAGAN IS7?3 - 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 BUILDING PERMIT ` PHONE:454-8100 „ Receipt # To be used for S!' m Est. value =149 000 Date DCT 1 1 , igQL Site Address _ 1421- Nd???lAi CIR Lot _19. Block _..L- Sec/Sub: aFFICE USE ONLY P2fCel N0. Occupancy X-3 M-1 FEES R 1 - Zoning W Name .IDfEPH M MIW.E! CO?if? z 5 Address 18133 CEDAB AIfE S 0 City FARMI NG7'AN Phone 431-20U I =g Name S?ME 00 a Address ? Ciry Phone WW Name ? ; Address < W CitY Phone I hereby acknowlege that I have read this application and slate that the information is correct and agree to comply with applicable State ol Minnesota Statutes and City Qf,;agan Ordinarlee5 Signature of Permitee ? A Building Permit is issued to: -1DSElg FS lSIW?g !?'t on the express condition that all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Buildmg Official ' (Actual) Const y? Bldg. Permit 811 *QQ (Allowable) 7 ? Surcharge 4• # oi Stories lengih Plan Rev'iew 527.00 Oepth sZ , SAC, City 100.? S.F. Total - SAC, MCWCC 650.00 S.F. Footprints - On Site Sewage _ Water Conn 60•00 On Site well - Water Meter 93.00 MWCC Syslem x ? ? City Water x Acct. Deposit ? PRV Required _ S1W Permil 30'00 Booster Pump - glyy Surcharge • 50 Treatment PI 276.00 OROVALS Road Unit 370*? Planner Council - Park Ded. Bk1g.OH. _ Copies Vanance - TOTAL ' 3,624.? Permit No. Permk Holder Date Telephone # WATER Mle-d A/wp 9 SEW?R PLUMBING H.v.A.C. JaZ? " `? / ? - GD? e?crRIc p , ?'?y / Mspeetiw, nato Insp. comments Footings I Foundation Framing I2 Rooting ? va sI ?U Rough Plbg. /' 4 Rough Htg. -Lcl ? I5ul. F?replaw Final Htg. ` -ZG/. r Orstat Test Final Plbg. _ZL./• L Plbg.lnspector - NotityPlumber Const. AAeter EngrJPian Bldg. Final 31? ,Z ?.? Dedc Ftg. Oedc Fnai Well Pr. Disp. 44 g ., ?rdtftr?tt of (Orrupartry Citp of (Eagart Eppwfttptit Ld i1lttbi#tg iItS}tPttiD2t This Ca7ifuale irsued pursuant m the requiremmtr ojSection 306 of the Uiriform Building Code oeNifJdng tJrat at the time of issuance lhis smxture ms in cariplianoe with !he y+arious ordi'uranaes of the City regulaA'vrg buUng conslr:cctian or use- For the follawing. ? use claurxzem SF IIWG/GAR ' BW& Pennk t4m 19793 B3 1 Zoving DWxid RI VN ??? Jl7?PE1 MLIl.?. 00?IST. ?= 18133 ??AnVE S, FA?CZON ,,Adma 1421 HORSESFCE Cl&ME L 19, B I, MMM DOWNS 3lalq2 POST IN A CONSPICUOUS PLACE ,tvYtfi '. yYA I tF( YtFiMI l CITY OF EAGAN -., OFfICE USE ONLY METER # PERMIT DATE 10118/91 3830 Pilot?(nob Rd. - Eagan, MN 55122;1897 g -' CHIP # PERMIT # ??ab? METFR SIZE B.P. RECEIPT # C 015980 1 90 1 Oc t 3 . ISSWE DATE B.P. RECEIPT DATE JQI2801 . DATE • _ PRV -BOOSTER PUMP SITE ADDRESS 1491 Ei p.rsssh n w r{.x PERMIT RE(]U ESTED LOT " BLOCKLJ_ SEC/SUB Oahervee d X _ - SEWER ? WATER ? TAP APPLICANT: d.pet- .t?-s! -Miller S -_- .. t Tti,e- p . ADDR?M3 3 C? g A - e ? x - COMM/IND RESIDENTIA ,?? . v _Mn CITY, STATE ]FA i Raten ZIP 5,5 f17 4 s EXISTING NEW , _ - PHQNE: 4 3 ? -3Sl?.1 Lawn Sprinkler Meters are to be InstallE PLUMBER: qeftz Ahead of Domestic Meters on Water Lirn ADpRIPSF 4S?? ? yser« Creoit WILL NOT be given fcu Deduct Meter. a CITY, STATE t? * ,-.a=mj,g C?g.a ? Z I P S 5 06 ? f? - ' ? j ! t PHONE: 4 a '? -1 1?. _ , s ? r { . I A EE TO COMPLY WITH ITY OF CITY, STATE ZIP PHONE: PLEASE ALLOW TWO WORKING DAYS FOR PROC SEWER & WATER PERMIT , CITY OF EAGAN 3830 Pilot Knob Rd. Eagan, MN 55122-1 a97 ? DATER'-t. 3 .1991 ? ;. SfTE ADDRESS I. LOT 1 ? BLOCK APPLICANT: .....,?... ; ... . 454-5220 FOR OFFICE USE ONLY METER # VW 1/0 L5? PERMIT bATE 10/26/91 CHIP # U 1/ 67 40 PERMIT # 12363 METER.SIZE +? ? S+? S B.P. RECEIPT # C 0I598J ISSUE DATE B.P. RECEIPT DATE id! 2S n 1 _ PRV - BOOSTER PUMP CITY, STAi'E ra,rgi ngt o n, ma PHONE: 431-20 0] PLUMBER: ADDRffSp`j'E 5 ^.?? CfTY, STATE Z!P 154)69 PHONE: 4 ?_ ', -1 '1 4 [? OWNER: ADDfiESS: C17Y, STATE Z1P DunKIc. ? SEWE R PERMITS,"CONTACT ENGIN PERMlT REQUESTED ? rn ?i Z ]C Lawn Sprinkler Meters are to be Installed Ahead of Domestic Meters on Water Line. Cre it WILL NOT be given fy? Deduct Meters. _- I Ai EE TO COMPLY WITH ITY OF ? EAGAN ORDINANCES ? ? SEWER ? WATER - TAPS ? ? - ? COMM/IND RESIDENTIAL ?- ' x 5L?? ?? ^ ??W _ EXISTING SIG-ffATURE WHEN METER ISSUED _L 454-5220 FOR INSPECTIONS. FQR STORMA, BUILDING PERMIT To be used tor S] CITY OF EAGAN Np ? 9?93 3830 Pilot Knob Roatl, P.O. Box 21-199, Eagan, MN 55121 PHONE:454-8100 C DIs? ?? Receipt # 3AR Est. Value $149,000 Date OCT 11 . 1g,4L SiteAddress 1421 HORSE HOE TR Lot 19 Block _1- Sec/Su6. SHERWDOD DOWNS Parcel No. w Name JOSEPH M MILLER CONST a Address 18133 CEDAR AVE S Ciry FARMINGTON phone 431-2001 o Name SAME ?a Address ? City Phone t? ?w Name E3 Address a? City Phane I hereby acknowlege thal I have read this application and state that the information is corcect and agree lo comply wit applicable State of Minnesota Statutes and Can Ordin ? SignaNre of Permitee OFFICE USE ONLY Occupancy R-3 M-1 FEES Zoning R-1 (Adual) Const V-N Bltlg. Permit 811.00 (Allowable) V-N 74 50 8 olstories length Depih S.F. Total S.F. Foalprims On Sita Sewage on siie wen MWCC System City Water PRV Required Baoster Pump A Building Permit is issued to: -10SEPH M MIT LER ON Plmner on Ihe express condition that all work shall be tlone in accordance with all Council applicable State of Minnesota Sptatutes and ?C.,ity ?of Eagan Ordinances. Bitlg. ON. Building Official l111fl I\ Oll?. I 111 /J Variance ? Surcharge • 66' Plan Review 527.00 521 SAQ City 100.0 O SAC,MCWCC 650.00 WaterConn 660.00 waterMerer 95.00 X X Acct. Deposif 30.00 _ Snv Permil 30.00 - SM Surcnarge .50 Treatmentvi 276.00 RoadUnit 370.00 - Park Ded. _ covies - TOTAL 3.624.0 U ? ee-ooom?oa REOUEST FOR ELECTRICAL INSPECTION "n"?"? //?'a 9?g? /0.39G ? See Instmctions lor comyl=_ung mis I`rm on back of yellow copy. y .? n-L "X" Below Work Covered by Thls Request 7?/ ew Add Rep " Typeof BUiltling AppliancesWiretl EquipmentWired Home Range Temporary Service Duple. water Heater Electric Heating Apt Building ryer Other (Specify) Comm./Industrial . umace Farm Air Conditioner Other isui Contrectnr's Remarks'. Compute lnspection Fee Below: # Other Fee r? Service EniranceSize Fee # Circuits/Feeders Fee Swimming Pool ( 0 to 200 Amps s 51 0 to 100 Amps $ Transtormers Above 200 _ Amps Abo 0_ amps SignS Inspectors use Only: r TOTAL Irrigation Booms -MitZ ? Special Inspection AlarmlCOmmunication THIS INSTALLATION MAV BE ORDERED DISCONNECTED IF NOT Other Fee COMPLETED WITHI MON I, the Electrical Inspector, hereby Rou9n in ? oej y certi that the above ins ection has }Y P been made. Pinal ( Dare ' OFFICE USE JNLV TM1IS I6qOB9t VOitl 10 TOlIN6 tIDhni ? . ?//C'? s/9r p 52207 Request Oale Flre No. qoughln Inspeclion Required? C Reatly Now =4,NYMTJOM1ty InsOeclor _ ? q_ ,-?,? C No ?Il4X?? When Reatly? IZ?85ensed contractor ? owner hereby request inspection of above electrical work at Job Atltlress (Slreel. Box or Route NoJ Giry 9429 KolL.sehhoe Ci2cie Ea an Senion No. Township Name or No. Fange No. Counry /7¢koL¢ OcmOam (PRWT, Phone No. aoe (?LQkea Komee 437-2009 'o`Vef$YP°11ef Atl°fe554300 220th St2eef S.IJ. c7¢ko#¢ £Qec#2ic F¢2miaotoa (7N 55024 Eiednpal Conrcactor,Company Neme, Contraclor's Llcense No. /7 idiand EPectuc 049610 Maiung Aadrass (COnimctor or Owner Meking InsallnM1ON 7803 772nd S#. Gleat Lakeyi,kie,f?N 55044 AutM1OriEetl nal re ICon;ra /Ow atiny Installation) PM1one Number ?i 432-6688 MINNESOTA STATE 80A113 OF ICITY ' THIS MSPECTION REOUEST WIIL NOT Griggs-Mitlwey Bltlg. - Roo - 8E ACGEP.TED BY THE STATE BOARD 1821 Universily Ave.. SL P N 55106 . UNLE55 PROPER INSPEGTION PEE IS Phone(6t2) 662-0800 ENCLOSED. Add;ess: 1421 HORSESHOE CIRa,E Lot 19 Blk I Sec/SubgU24-MD DO[dNS These items wera/were not complete at the time of the final inspection. at : 3?4 92 Yes No ? Final grade (6" from siding) v Permanent steps - gaiage ? Permanent steps - main entry L/ Permanent driveway ? Permanent gas ? Sod/seeded g[ass J Trail/curb damage ? Porch ? Basement finish ? Deck Please verlfy vith the builder the ramoval of roof test caps from the plumbing system and the shut-off oE water supply to tha outside lavn faucet before freeze potential exists. ? White - City copy Yellow - Resident copy Pink - Contractor copy RESIDENTIAL BUILDING PERMIT APPLICATION 520?3 CITY OF EAGAN rL 1. ZS 3830 PILOT KNOB RD, EACAN MN 55122 ? J 651-881-4675 New ConstruNion Reauiremenb • 3 registered site surveys showirg sq. ft. of lol, sq. R of house: and a0 roofed amas (20% maximum lol coverege allawed) • 2 capies af plan showing beam 8 window sizes; poured found design, etc,) . 1 set of Energy Calalalions • 3 capies of Tree Preservatlon Plan if lot plattetl after 711/93 • Rim Joisl Detail Oplians selection sheet (bidgs with 3 or less unds) DATE (;' 13"'0?, _ Wa[cr Softener Water Heater No. oF Baths SITEADDRESS ?yaJ Jkr. ?DJ,oe- G/ MULTI-fAMILY BLDG _ Y 4,-? N TYPE OF WORK /• ? Re/dDF FIREPLACE(S) _ 0 _ 1_ 2 APPLICANT WeS(ul'n P100'F+, STREET ADDRESS 9?1.,'b 137`i)e i? CITY?STATENAIZIP -2Wy1 TELEPHONE #?3 CELL PHONE # ?f? 28a-Ya3s FAX # Mw?? PROPERTYOWNER /vI !F!52S)K3e Ci?' TELEPHONE# --------------------------------------------------------------------------°------------------- COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MIMNLSOTA RULES 7670 CA1'GGORY I MINNP.SOTr1 I2iJL1:5 7672 (J submission type) • Residential Ventilation Categoryl Worksheet Submitted • New Energy Code Worksheet Submitted • Energy Envelope Calculations Submitted Plumbing Contractor. _ Plumbing system includes: Mechanical Contractor: Niechviical sysLem includes: Sewer/Water Contractor: Aic Conditioning _ Heat Recovery System Phone # Phone # o L?F_4: ? JUN 1 3 2002 ? ----------------°--° °°-------------------------------°-------°---------°-°---------°---°-----------°°--------- I hereby acknowledge that I have read this application, state that the information is conect, and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant orrrcE usr oN[.Y RemodeVRewir Reouiremenb . 2 copies of plan • 1 setM Eneryy Calculations for heated add0lons • isilesurveyforexterbradditions&decks . Indicate'rf home served 6y septic syslem for additians VALUATION 7 63db? Phone # _ I.awn Sprinkler _ No. of R.I. 13ath5 Certificates ot Survey Received _ Tree Preservation Pian Received _ Not Required _ Updatetl 4/02 OFFICE USE ONLY ? 01 Foundation ? 07 OS-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg ? 02 SF Dwelling ? 08 06-plex 0 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi ? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.) ? 33 Ent. Alt - SF ? 04 02-plex ? 10 OS-plex ? 18 Oeck ? 23 Porch (screened) ? 36 Multi ? 05 03plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage ? 06 04plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous 0 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding ? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 33 Alteration ? 37 Demolish (Bldg)' ? 43 Reroof ? 46 WindowslDoors ? 34 Replacement 'Oemolitlon (Entire Bldg only) - Give PCA handout to applicant Valuation Occupancy MC/ES System Census Code Zoning City Water SAC Units Stories Booster Pump Nbr. of Units Sq. Ft. PRV Nbr. of Bldgs Length Fire Sprinklered Type of Const Width . REQUIRED INSPECTIONS _ Footings(new bldg) _ FinaUC.O. _ Footings (deck) _ FinaUNo C.O. _ Faotings (addition) _ Plumbing Foundation HVAC Drain Tile Other Roof _ Ice & Wazer _ Final _ Pool _ Ftgs _ Air/Gas Tesu _ Final _ Framing _ Siding Stucco Stone _ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement) _ Insulation _ Retaining Wall Approved By , Building Inspector Base Fee Surcharge Plan Review. MC/ES SAC City SAC Water Supply & Storage S&W Pertnit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other Total CITY OF EAGAN r 3830 PIIAT KNOB ROAD EAGAN, MN 55122 PHONE (612) 454 8100 t,;SBZNG ?,?'m FOR CITY IISE ONLY PERMIT # RECEIPT # / SCO DATE: PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS 6 TOWNHOMES/CONDOS WHEN PERMZTS ARE REQIIIRED FOR EACH UNIT. --------------------- WORK DESCRIPTION NEW CONST ? ADD ON _ REPAIR _ OWNER NAME: SITE ADDRESS: LOT:? BkpCK ? SUBD. / ?. INSTALLER: ??m ADDRESS:v.J,VJlC` W CITYUJ2? ZIP: ? •------------------------------ COMPLETE THE FOLLOWING: N0. FIXTURES EA. TOTAL ADD-ON MINIMUM 15.00 SHOWER 3.00 WATER CLOSET 3.00 BATH TUB 3.00 LAVATORY 3.00 KITCHEN SINK 3:00 LAUNDRY TRAY 3.00 _ HOT TUB/SPA 3.00 WATER HEATER 3.00 _ FLOOR DRAIN 3.00 GAS PIPING OUT. _ (MINIMUM - 1) 3.00 ROUGH OPENINGS 1.50 - OTHER ? ,?--WATER SOFTENER 5.00 _ PRIVATE DISP. 15.00 U.G. SPRINKLER 3.00 SUBTOTAL ST. SURCHARGE .50 TOTAL: S 1 ? PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUIL?INGS AND MULTI-FAMILY HUZLDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT. CONTRACT PRICE: OWNER NAME: SITE ADDRESS: LOT: BLOCK _ SUBD. INSTALLER: ADDRESS: CITY: ZIP: PHONE #: FOR: _ FEES 18 OF CONTRACT FEE. STATE SURCHARGE - $.50 FOR EACH $1,000 OF PERMIT FEE. $25.00 MINIMUM FEE. CONTRACT PRICE x 18 STATE SURCHARGE $ TOTAL: (SIGNATURE) CITY OF EAGAN ., . . •. fJ11 •G?r 74•5U+- 51'/•00F 2, 2 >>•so.- ? a "I 'I • u U'r ,14,513F 527•pp+ 2, 211.5D? 3e624•00-'r- S ,vUY 4 ERAIT 1991 BUIJNqCATION' CITY OF EAGAN SINGLE FAMILY DWELLINGS 2 SETS OF PLANS 3 REGISTERED SITE SURVEYS 1 SET OF ENERGY CALCULATIONS MULTIPLE DWELLINGS ONLY 2 SETS OF PLANS 2 SETS OF ARCHITECTURAL REGISTERED SITE SURVEYS - & STRUCTURAL PLANS (CHECK WITH BLDG. DEPT.) 1 SET OF SYECIFICATIONS 1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS # OF RENTAL UNITS # OF FOR SALE UNITS PENALTY AYPLIES 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 BUELDING PERMIT IS ISSUED PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE PERMIT MUST SHOW A LICENSED PLUMBER. To Be Used For: NP,., uP „,o Valuat ion:.? + Dat' Site Address 1491 u . h ?; OFFICE IIS ,,, Qps oe Y 14 9 nos L Lot 19 Block I , _ occupancy R,-3 M-! Zoning R-1 Parcel/Sub sherwond nn.., na Actual Const V-N Allowable V-M Owner # of stories Length (ob' Address Depth $2' S.F. Tota2 City/Zip Code Footprint S.F. Phone I Contractor 7naenh M M;ttPr /`nncr Address?18133 CeAa,- Av sn City/Zip Code Farmingtnn 55(194 Phone 431-2001 Arch./Engr. Address. City/Zip Code Phone # On site sewage_ On site well MWCC System e/ City water v PRV _ Booster Piunp _ APPROVALS Planner _ Council Bldg. Off. (!7491L)4 Variance . .. ? COMMERCIAL OCT 71991 FEES ? 8?? uJ Bldg. Permit • Surcharge 7N•50 Plan Review SZ ou SAC, City /DO.Ov SAC, MWCC , c'SdCM water Conn. 6 .oo Water Meter 5 00 Acct. Deposit vo S/w Permit 30,00 S/W Surcharge .So Treatment Pl. ,4% 40 Road Unit 390,00 Park Ded. Trail Ded. Copies SIIBTOSAL Penalty Lot Change TOTAL `n ??pQ,Lf agrees that all work shall be done in accordance with ?ignature of Co tractor) all applicable State of Minnesota 5tatutes and City of Eagan Ordinances. ? . , 74 f.uaTA% Ar,N? ? GR?9&F z2;: `7vy .._..-------' 6$O K 15= /o Z,?o 6_ 2?? ? zg x 30 = Z ZXly? I'?. x? = IST Ft-uoR ?--?? (Z 3 ) ln ? g55 ? 1+? = I I? 97 ? $SMTr g5S lXjo? I,o `l2. e ? I593x53?. $u?yZ9 ZrvD Fl.a?r+- • - - ? ?.• • ?foyC 3a ? `jSSo f X??= ll "791 X 53= qI,923 1---- ! 4&, 522 '0R I 4qI oao ? ?- 'f PIO * eng? ? ?c * a ng. a ?x Certificate of Survey for:jOSEPN 114• M/ LLE/'S (.ONST CO. ? NoarN ?l! Op ? ? aqsY4 n ' o Qo ? ?ro?? s?e b u, / \` re e ?? ? B45° ?P , ? S9s,L ? ? ? ? P / 0~ o?' ? _JJe S b?(0' /8 SR eo ? ?.:.. • .. .x. ,.. . .. ,.... a ...- ? 900.00 DenaFes fxisfrng flevationsE AGAN r oa.vo Denofps Proposed flevatrons ----- - Otnofes Drot na e {_Ufr/ify EaSemen{ - - D[no%S Drarnoe Flow IJrrows o penoles Monumenl 2422 Enterprise Drive Mendota licights, MN 55120 (612) 681-1914 i ? > L c?Q. ???.^,• ?O?i ? 693.7 i F, N laLi1i `?,Edl s:? DEP1 . PAOPo5£D NOUSE ELEVAT70N5 Lowest Floor Elev4tron 887•?60 7op 0f'8/pCk f/PNOllOR 87 7, Z!r Goraje Slab Elevafion 896.93 Heql'ins shown ort assumed o Deno%s o fse/ qub 1.OT 1`9, BL OCk 1, 5H[RWOOl7 DOWI vs DaKOra CovNry, MINNESOTA •H subjeet to easemenls a; record 1 h!r¢by CerUfy that thls surv¢y, plan or rpport wDS prepareA by me or undFJ tlly fIIYPCI SU?1nfV1410n Bn?I Ih:l( I aT AUIy I7Cgi5tB?Ct1 LOnd SUIVNyOr under the lewf of the State of Minnesota. Deted this «?" day of v usi- q p 19I ? - ? I Scale: 1 /?/ r? 1ndJ.efr ?1720(o.?ginreI nci?uchs.nr / - ___ _r_..tar).1 801 ? ? s ? ?I `s95yi ?Ei?s. r qo, . ? E a ol N°" ir) ! g ?nH s? I { J ????n' ,- .__ ?a ,Q ?•O N?p I ? ..M? ?? e{•?N tii_I?- 'i'-'-! y LIEL. =_E. F L,-a1-AC V-' I NSIJR 'rl,hJGE UF F I C:E G'_ 012 • ? ,. --.._ __ - -- , - ai2ii4 MI NNESO7A STATE ENERGY CODE CALCULAT I ONS ?167 BASED ON CHAPTER 5 OF THE % j MODEL ENtftGY CODE - 1983 ED1710N , Adoption Effectlve I/l/84 ' Owner ? 5tte Addre Contractor Phone Buliding Classiftcatfon: Type AI! (5(ngle Family b Duplex)7ype A2(Residential) (3, Storles or less NOTE: Complete pages 3 and 4 f1rsC. (OCher) • ' (Over 3 stories)_ GENERAL INFORMATION ' ' r 1. Buflding Perlmeter!,r-,?, Wg-fZ?fC. f . 2. Wall helght (ground to eave) ft. i. 3. l. x 2. (above) gross wall area ft? . 4. Bullding dlmenslons (L) ?-- }( {W) I5c2-? ft.2 roof S floor area Square foot.area of rim Jolst - Floor Jolst size (2 x It? X PerimeCer m Rlm o st area f = 1?Z17? ftz12 174' . . . ?p.a? ' . 6. Doors - A'rea I33, 0 .I 7hickness • in. U factor o? Type of ConStructlon Perfineter ' ft., Manufacturer 7• Total door's perimeter ft. i 8. Wlndows: ManufacCurer. ' State approved_ . U factor . TYPE SIZE AREA (Ft.2) NUHBER 6F ' EACR UNI7S 9. Total ft.Z Glass Z??iZ,jf •' 10. Flrepiace areai ? wi.dCh X height n X 11. Exposed foundatlon: Ilelght X Perlmeter r(?1?7 X I COMPLETION OF THIS FORM IS REQUIRED FOR ALL N€G--N+ TR CT .nirn 1fnrne [1lrenv nYUre runEl Tuc l11A1IA1AI fllnc Al 1 M.IM1AIPC a 70TAL FEET z ? O -77" _ 111\JV iC n<rn i Ft.2 Ft.Z .iric AIdD ouiLoitics eeIi AI_??- ?-'S1 Ll.E L .. ??...=..: S. ._.'_.._F'LAFJCp/ I NSUF.ANpE pFF? I rE IP- 'i . ... .. .....-_.. _. ...., ' 12. Framing area10%'of grass wa11 area. 90"37? 13. ' Gross wall area r7 -? ft.2 " Window area A ,ft.2 U windows ¦ ,?l4, U x A A; ?O4161q1 _ Rim Joist area ?Z1r](0 ft.Z U rim joist a IU x A- 5,55• ' l 62 ft. 2 U door area a , I UxA- 7i??' A;oor ?n area A ? Or$eMdg area A F I ft.z Uoj!'evuare 2 .•41 U x A, ??i 1 Exposed foundation A ft.2 U foundatton U. x A• Fram9ng area A Z90070102?;) ft.2 U framing area ?:5 U' x A 6?90 Net wall area A Ib?J&• 25 ft. U wall U x A¦ (130) TOTAL . . . . . . . . . . U x A •,?'(Q?± -?- 4 =- 14. Gross wall area A 0.11 (A-1 single family b duplex ? allowable U x A/Code (13. above) . x 0.23 (A-2 oCher residential) ? x .23 (Other buildings) x .28 (Over 3 stories) . - - ' 1 e f 67UH Must be larger than A I x U Code,o_II _77: 138 above 15. Ce,iling framing area (Ap) equals lOX of ceiling area ?. or the, same as) i 15A. Gross ceiling area ?(L) x(W) ft•z ? i 15E Joist ared (Af) ¦ lOro ceiling area n O ft•2 ; 2 ? 15C. Net ceiling area (Ac) (15A - 158) d ft. ' U ceiling x A C_ p2 ? x?ZZ, _'??+?Z'? • U framing x A f=` x_._,. 150. TOTAI.'U x A ............ ....... ......... ...:....:... <--- . . ._._---- . ,, • __ 16. Ceiling area (15A) x 0.026 (A-1 single family& duplex - code allowable U x A • x 0.033 (9-2 other residential)• x 0.06 ?(other) • ' ,., ,pZ 8 UH Must be larger than•150 (above) A(15A) K lj o? aF (or the same as ) N07E: Use U and A valves obCalned from pages , 4.CERTIfICATION: I hereby cerClfy that I have calculated Che "U" factors and "R" values here n and thak the bullding here described meets or exceeds the State of Minnesota Energy Conservatlon Act, ' Date signature _t.E_D.....??..zc-0.._._FLraNr:d.-ItJgUFtANCE UFFICREiStotal0R U YALUE CALCULAT(ONS, ALUE U YALl1E Xnclde iktr E1Im .68 ' WALL Lnterior wall (Nall) U. 1 :. R SECTION Insulatton C7 ' ' Sheathing 2,QCP • p?3 SGding Outetde aLr Eilm ,17 • R TO`CnG Ingtde a[ £1m 1 ? 68 STUA SEC7'ION . t . Intetiar wall, 4,, etvd R? 4.36 (Framtpg) u. R . Sheathing ,z,p(p, 5ldlnB , u7 --=' Outelde air Fllm ' .17 R TOYA4 . ? . • 2ND NALL 5ECTIQN. a,tri JO15T tneldo air #ilm R. .68 Interlor wall InsuLahion Sheathtng Extettoc wall cvverf.ng Exterlvr ¦lr (tlm' R? u ..ll n rornt (Uell zV , i ? l.nterlor nir film R? .68 Insulatton Iq•0 ?? 'ly inch mott wooJ a=1.88 tafm ;? Joist} ? J Sheathing x„ OCD ? ExCeiloY: xnll covertng tp'T i Exterlor aic film R- ,17 R T4TAL U • ? a Intn.ttot atr Ellm R= •68 . , [nsulotLon foundatioo I?Vg (Fdn.) U ¦ ? _ E:tterloc ai'r. film R' .17 ? 07co R TOTAL I 3• I?J' ,, `-' -Exrosed Bluck I x . .. .- 1-' L 1?4 tJ C u .-' I P4 t?: IJ R A I?1 C E O F F I l: E ,. . _.. _ __... __ . ..___ ._._ .... , 37? .. --------....._._ _. .... ..???(? ?-? _._ _ . . . . . .. .. , (I I. Z.?X?o = l3, 7? X 3-? l ? z5" ; :III_ 1r?x.?w ? S.zsX 3, ?.1?r75 I!1 Zvxr??_ ~. ll.ox ?= ?3-_? IIII z4x3o -- _ .??--?.._...... _ . . 13pfz o NI ZSLr =??,P ?.. . p ? ?. GEILING WITFI VENTEU ATTIC SPACE • A60YE UE k-GM1 R YALUE FMMItIG . CEILIIIG . • 0.61 Air F11m 0.61 . . ' ?J(p.0 , [nsulatlon ? 1 •'? -- . . j'? t?-. ?7?J Jotst Ceiling • "?J?D 0.61 Alr Film 0.61 Z.?(p 7ota1 R "f 5Zg _ ,0?7j ? U=R Z oZ FLAT ROOF On CATREORAL CEIIIhIG R ynlUE R-Jariie . ' F RAA{ 1 NG CE l l I IIG 0.61 0.17 hislde alr film ?•61 Ceiling JOI$t (SCV lnsulation Air space Roof deckinq Insulation Built-up raof Outslde a1r film 0.17_ 1ota1 R 1 R '= U . . ? dindow infiltration .5 cfm/lineal foot of crack t f door and minimum code requirement , oo , tesiden N al door infil tration 0.5 cfm/square •lon-residential door infiltrat.ion 11.0 cfm/lineal br foot of cratk Jb 12" concrete 61ock no insulation =.47 R 2.1 . ib 12" concrete block insulated cores =.26 R 3.8 )5 12" lightxeight block - .32 $ 3.1 1b 12" lightrieiqht block insulated cores =.12''R 8:3 • . 1 single glass = 1.13; with storm window .54 ) double glass = .55 ' ` J trlple glass = .41 A11 exterior walls and ceilings must have a vapor barrier (0.10 perm max.). :avor barrier must be on the inside (heated slde) of Viall. rapor barriers of the polyetheleiie thin film have no R.value. - r i , , n. i ?.- CITY OF EAGAN 3830 PILOT KNDS ROAD EAGAN MN 55122 PHONE: (612) 454 8100 I??I?fXO1'?,': PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE 1 ??? TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. ------------------------ -------------------------------------• WORK DESCRIPTION FEES NEW CONST _y ADD ON _ REPAIR _ OWNER NAME: SITE ADDRESS: 0 IAT : _?a /B?L,OCK ? 5UBD. ?\\?' \ 1,11C`,Z`? ,?• li) INSTALLER: VC71 k, l ADDRESS: ?2-o , CITY: K iit 2IP: PHONE #: ADD-ON MINIMUM HVAC 0-100 M BTU ADDITIONAL 50 M BTU GAS OUTLETS - MINIMUM OF 1 PER PERMIT SUBTOTAL: STATE SURCHARGE: .CTAL: DWELLING5 & $15.00 24.00 6.00 3.00 s??} ov-' .50 $t:?I) 2?(?' r 1;SIC?NATURE OF PERMITTEE ? ?/ FOR CITY USE ONLY PERMIT # RECEIPT # 0 3 DATE : 0 9 9 / PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS, APARTMENT BUILDINGS, AND MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT. ------------ CONTRACT PRICE OWNER NAME: SITE ADDRESS: LOT: BIACK _ SUBD. INSTALLER: ADDRESS: CITY: ZIP: PHONE #: FOR: _-- FEES 18 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: $ (SIGNATURE) CITY OF EAGAN udrx uK EAGAN 3830 PIIAT KNOB BOAD EAG(?N, MR 55122 PHONE: (612) 454-8100 _...... u?f ,? .. . ?? . mimim FOR CSTY U5E ONLY PERMIT # RECEIPT # LO 3 D O DATE: PLEASE COMYLETE IIPPER pORTION ONLY FOH SINGLE ' FAMILY DWELLINGS & TpWNHOMES/CONDOS WBEN PE$MITS ABE REQIIIRED gag EACB DNIT.- WORK DESCRIPTSON NEW CONST ? ADD ON _ REPAIR _ OWNER NAIII:; JOE MILLER CONSTRUCTION C0. INC. SITE ADDRESS:L7?p / `x'?& LOT: ? p BLOCK I SUBD. J4 INSTALLER: GENZ-RYAN PLUMBING & HEATING C0. ADDRF.ss: 14745 South Ro6ert Trail CITY: Rosemount, MN ZIP: 55068 F-:ONE #; _ (612) 423-1144 ?- S COMPLETE THE FOL7AWING: N0. FIXTURES EA. TOTAL ? ADD-ON MINIMUM 15.00 SHOWER 3.00 ? WATER CIASET 3.009I' ? BATH TITB 3.00 ? IAVATORY 3.00 1 KITCHEN SINK 3.00 ? IAUNDRY TRAY 3.00 HOT TfJS/SPA 3.00 E WATER HEATER 3.00 a ? ? FLOOR DRAIN 3.00 3? GAS PIPI::G 010:. ? (MINIMUM - 1) 3.00 3 _ ROUGH OPENINGS 1.50 oxxEx WATER SOFTENER 5.00 PRIVATE DISP. 15.00 U.G. SPRINKLER 3.00 SUBTOTAL S ys ? ST. SURCHARGE .50 YS` TOTAL: S ?"NE??,, pLFpSE COMPLETE THIS PORTION FOR ALL C0m4fERCIAL/INDUSTRIAL BUILDSNGS AI1D M[TLTI-FAMILY 8[TILDINGS WEiEN SEPARATE PERMITS ARE NOT REQIIIRED FOR EACH DWEI.LING UNIT. ------------------°_-__--____-____-___-__-__---°__------- _-____------------- CONTRACT PRICE: Owiick ivA'riH: SITE ADDRESS: LOT: S7ACK _ SUBD. INSTALLER; ADDRESS CITY: ZIP: PHONE FOR: CITY OF EAGAN FEES 18 OF CONTRACT FEE. STATE SURCHARGE - $.50 FOR EACH $1,000 OF PERMIT FEE, $25.00 MINIMUM FEE. CONTRACT PRICE x 18 $ STATE SURCHARGE $ TOTAL: (SIGNAT[JRE) $ PERMIT City of Eagan Permit Type: Plumbing Eagan. Permit Number: EA095395 Date Issued: 08/12/2010 OR Permit Category: ePermit 41~ it~ of E3 E Site Address: 1421 Horseshoe Cir Lot: 19 Block: I Addition: Sherwood Downs PID:10-67670-190-01 Use: Description: Sub Type: e - Water Softener Work Type: New Description: Water Softener Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments: jennifer deldotto 1421 horseshoe eir ea-an. mn 55122 Fee Summary: PL - Permit Fee (WS &or WFI) $50.00 0801.4087 Valuation: 500.00 Surcharge-Fixed $5.00 9001.2195 Total: $55.00 Contractor: - Applicant - Owner: Appliance Installers of NIN Jennifer K Sedlacek 1410 Rutgers St NE 1421 Horseshoe Cir Prior Lake NIN 55372 Eagan NIN 55122 (952) 469-8341 I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and Cite of Eagan Ordinances. ApplicantiPermitee: Signature Issued Bv: Signature < Use BLUE or SLACK h* Fbr pe" X* Of FAPB MNS RECEIVED Phom- { ► F DEC 7 2011 WAR L----- - --I 2010 MECHANICAL PERM T APPUCA71C1N Tenant RESIDENT /OWNER Mane':!M~ Phone: Address/ City /Zip. CONTRACTOR Name: t metres # Address: COMPANY, THE SNELLING INC. Ranh t'+ANnnnnIw civ- State: STz$AUL, MN 55104 Ptww: Contact 651-646-7381 EnVa TYPE OF W(W New Rept~dt AdddwM Afteraton DemoMon Desaipttiat of vroirtc NOTE: Root ommolod ands neodeeoed "piP~*ig rid b bs wire anad by Cpl code. Please contact" Mechanical iinspecterftrialwauffim cn p9 1111r1spoofs PERMIT TYPE SID C 0 UNFERCUIL New ConsArusian krteriot bgxw meat ® p"v Pnxossad Air Gas _ Exterior HVAC Urrt beat Pimp Under / Above ground Tw* kred/_ Rwmn) "tom to i ft Sail forkeepecs m Wpm Marehat and RESUM L, FEES: $WOO MinhnWn Add-on or a a Lion tD an adsting unit pndWes $&00 S 9e) $0-0) Fke nlPl* bared at WftwM dtldw.etc.) &wkxies $5 W State Suclmga) t►MTAt, PEE CO VAERCIAL FEES: $75.00 Underground tw* i OR col~ Vaklo 5 x1% $55.00 Mkdmwn {includes State. Su~harOe) - tithe p ml-ft is lees tree $ *Olt surd o" is $ &W _ S Pen* Fee -nitre Eltg is > t ~ kearsatees by $M for escn SIMO Pelt Fee _ $ S cie.asiaoto~t~.t»o Fee iegrrkeses5.5oerr+cfeanys) = S TOTAL. FEE C$L BEpORE YOU DIG. CAN Gl*mm State one Cam at (m) m44m for protection against undo wmind utmtY Call 48 house betixe You ketered to dip to reoeitre iocaI i of undeMpound utilmiw www.aoaherstateonecadom i try Led this inbrna lion is complete and am=* that the week will be ' vAh the ads ormse and of the Cky of E~er+: ttt~ 1 wdwaW d M Is note pwwdx but m* an q*kMon bra peers, and work at taalantl w11" a pemA tmt wake be.ke s whir pM in to case of work %Nch requbes a retrieve and app m d of phns. Appikotr o Printed Marna FOR OFFICE USE Reed t3X gals: Re"Ired = -Under .t ound. Rouo In _A Tsai. Gas Semite Teat-M-#aoc Heat rFinai Exlctior HVAC ftrowft krapadion Use BLUE or BLACK Ink F----------------- I For Office Use I j Permit City of Eap I 7-Z z~ I Permit Fee: 3830 Pilot Knob Road I I Eagan MN 55122 ; Date Received: Phone: (651) 675-5675 I - Fax: (651) 675-5694 1 Staff: _ 2012 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Unit ✓L-✓OT l 0 Phone: 12- Name: ®/J J 1 'G RESIDENT / -S oc, G1fZCLG j OWNER Address/City/Zip: ) LJ 2--t ~+V Ve:,-_ i ! Applicant is: Owner X Contractor ' oErr i~ovS~ iviT4! ea P~crt< o;- Pew 3c iZ XSPfa,77AP-c.E(_ 5 F TYPE OF WORK Description of work: IN V 1 Y Q )rav®,a 1 T-) o , ov j & S I m) gq( 1 ®cO . i Construction Cost (0 oo Multi-Family Building: (Yes / No i Company: y G -&)l t'D Egs Contact yt, tw L-- ?4)1_1.1 P 1 CONTRACTOR Address: C~VI ~ ~V S h~ City: C-Pll-Ta Stater Zip: SW- 37-) Phone: S2-4 I !77 If License #:C,~ 3 S'~1Zh Lead Certificate If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? _Yes _No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contractor: Phone: NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of 1 the information may be 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 hours before you intend to dig to receive locates of underground utilities. www.aooherstateonecall.ora 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. Exte ' ork authorized by a building permit issued in accordance with the Minnesota Bull di a ust be completed within 180 d s of rmit issu ce. ~ x ul-- ) u-c S ~A X Applicant's Printed Name Applicant's Signature Page 1 of 3 Use BLUE or BLACK Ink r————————————————� I For Office Use � I ' � Permit#: �C^�� (�/ Clty of �a�a� � � � Permit Fee: ��,c�� 3830 Pilot Knob Road � � Eagan MN 55122 � Date Received: � Phone: (651)675-5675 I I Fax: (651)675-5694 i Staff: i 2015 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Unit#: �� ' � � � l�� .�� ° . / , � , �� - � Phone: ��/y � 7��/�'�� . �.�,.. > s Name: ,d'� C. -,� ,�'�i � �. ��, � Res�dentl � � M� � .�_. ��, � OW t1er� >� _ Address/City/Zip: -��.,. :� �i��,��`-�� . � , � � ��,` Applicant is: Owner Contractor .�,.•=4�z.t�, _� � , �� Description of work: ��' �� - ...��, �Type of 1IVo�k ' ��"��`��!�F �,�� Construction Cost: Multi-Family Building:(Yes /No ) ��'� � ,� �, " ,� . , � ��< Company: Contact: — � � � ''� ` t �� '�� Address: � � City: Contractor � .< o State: Zip:j�� 1 Phone: ^ — Email: C(7�'4 � License#: ��7UZ]� Lead Certificate#: If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? _Yes _No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer&Water Contractor: Phone: 'NOTE �lans antl support�ng�c/ocuments!h t�ou submit ar��can�s�deretl#o be�3yblic,rnfar�re�ation��?�Q►�'�on�of ; �P ��the mformat�on ma tie c/ass��etl as non, ubltc rf YouA rovrc%s ec�fic rea�ons#i�at wQU/�►te i�=�t�e,��Ci}�/fi#�"o �, �� ;�" �r`t�'°`��:a-.;� � ��a ,s� .��-°.«�s.�.: �� ` �".,z��..` " ,.'.p� �„�„ 5^�,; r�nz,: � .��„,r . ' 1' ,..� ,� :: t '+,. _: 4� concluale�fhaf"the are'frade secrets ,, �� ' _ , . �,. . , �_ ,��,�. � �, ��. � .. . . ....,. �� u.. . .,. �� . . �.:.,... ,. � : 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.aoaherstateonecall.orq I hereby acknowledge that this information is complete and accurate;that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Exterior work authorized by a building permit issued in accordance with the Minnesota S ilding Co must be completed within 180 days of perm' ' nce. x X Applica s Printed Name Applica 's Signature Page 1 of 3 PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA179721 Date Issued:10/19/2022 Permit Category:ePermit Site Address: 1421 Horseshoe Cir Lot:19 Block: 1 Addition: Sherwood Downs PID:10-67670-01-190 Use: Description: Sub Type:Water Softener Work Type:Replace Description: Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087 Surcharge-Fixed $1.00 9001.2195 $60.00 Total: This permit shall be null and void if work does not start within 180 days of issuance, or if work is suspended for 180 days or more after started. 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 - Jennifer K Sedlacek 1421 Horseshoe Cir Saint Paul MN 55122--382 (612) 801-1776 Milbert Company (culligan) 1801 50th St E Inver Grove Heights MN 55077 (651) 451-2241 Applicant/Permitee: Signature Issued By: Signature