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1386 Lone Oak RdCITY QF EAGAN PERIUIIT TYPE: F << I 3830 Pilot Knob Road Permit Number. .?,•?, q:?;? Eagan, Minnesota 55122-1897 Date Issued: (612) 681-4675 SITE ADDRESS: : "' APPLICANT: I?,1.;1 i ull?.! ?,,I, ) •I. ; ?„?:? PERMIT SUBTYPE: TYPE OF WORK: F?+ '.? h I I I I?EI•f ? i•.r??1i I??li? i INSPECTION DA • DA i i ' 1 . . ? 71 . . . .. . . ., . .. ?. . ?... . . ? . . .. . ' ' .: ? ' . . . ,? ? .. ? .. . .. ? -? Permtt No. Permk Holder Date Telephone # EIECTRIC PLUMBING HVAC Inspection Date Insp. Comments FOOTINGS FOUND FRAMING ROOFING ROUGH PLUMBING PLBG AIR TEST ROUGH HEATING GAS SVC TEST INSUL GYP BOARD FIREPLACE FIREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TESf BLDG FINAI BSMT R.I. BSMT FINAL DECK FfG DECK FlNAL cirY oF EA"N 3795 Pllot Kno6 Rood Eogan, MN 55122 PHONE: 454-81 DO BUILDING PERMIT Te bo uted for Est. Value Site Address ? Lot Block SeclSub. Parcel # W Nome 3 Address a Ci Phone Name 0 Z ?V ? Address 1' Ci Phone u? ,j,W Name FW _? Address Receipt # _ .. ..? N4 5303 Erect ? Occupancy Alter ? Zoning Repair ? Fire Zone Enlorge ? Type of Const. Move ? # Stories Demolish ? Front ft. Grade ? Depth k. Approrals Fees Assessment _ Water & Sew. Police Fire Eng. Planner ? Counci! Permit 5urchorge Plan check SAC Water Conn. Wnter Meter I hereby acknowiedge thct I have reod this opplicotion and stnte thot gldg. Off. the information is correct and ogree to compiy with all opplicable APC Total State of Minnesoto Statutes ond City of Eagan Ordinances. Signature of Permittee A Building Permit is issued to: on the express condition that all work shcll be done in accordonce with all applicable Stcte of Minnesota Statutes and City of Eagan Ordinonces Building Officiol P•r*it # Daft rng.a Pe+mittK Plumbing Mechonicol INSPECTIONS, DATE INSP. Rough-In Fincl Footings Date Insp. Oote (rsp. Foundotion Plumbing Frome/ins. Mechanicol Final r`f Remarks: CITY OF EAGAN Remsrks Di u. itil l Addition 2ARa Car" Lot i Blk i Paroel 10-75200-010-01 n Owner 1?-•?4-t1??' O ,i_ i: l Street 1386 LOIle 0'4k R08d State Improvement Date Amount Annual Ysars Payment Receipt Date STREET SURF, STREET RESTOR. GRADING SAN SEW TRUNK Z 3 1970 1.00 12. (o 2 SEWER LATERAL 2 2 4 • 2. 8 20 r WATERMAIN 1/ WATER LATERAI; 1912 9T4-31 20 • WATER AREA . STORM SEW TRK (Qp 19$2 839.26 83.92 10 STORM SEW LAT CURB & GUTYER SIDEWRLK STREfT LIGHT WATER CONN. BUILDING PER. SAC PARK ! RESIDENTIAL BUILDING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD - 55122 ? 7or ?yD ? 651-681-4675 na l led ` 6-9 New ConatrucUonRaouirementa RemodeUReoairReoufremenb ? -01 • 3 regisfered site surveys showiig sq. ft oJ lol, sq. R of Aouse; and all roofed areas . 2 copies of plan ? (20% maxunum lot coverage allowed) . 1 set of Energy Calculalions far heated additions . 2 copies of plan showirg beam 8 windaw s¢es; poured faund design, etc.) . 1 sRe suney for ezterior addNOns & decks • 1 5N of Energy Calculations . Indicate'rf home served hy septic system for add'Aare • 3 copies of Tree Preservafion Plan i( lot plaked after 7!1193 . Rim Joist Detail Options selection sheet (61dgs wiN 3 or less wilts) DATE VALUATION JOB SITE ADDRESS JAAM_r 0?-?l ? IF MULTI-FAMILY BUILDING, HOW MANY UNITS? PROPERTY OWNER 23IG? &FFD? TYPE OF WORK L APPLICANT PAGER # NEW RESIDENTIAL BUILDING ONLY - FILL OUT COMPLETELY Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1 (check one) - Residential Ventilation Category 1 Worksheet Submitted - Energy Envelope Calculations Submitted _ MINNESOTA RULES 7672 - New Energy Code Worksheet Submitted Plumbing Contractor: _ Plumbing System Includes: Mechanical Contraetor: Mech:uiical System Includes: Sewer/Water Contractor. _ Air Conditioning Heat Recovery 5ystem Phone # Fee: $70.00 Phone # All above information must be submitted prior to processing of application. I hereby acknowledge that I have read this application, state that ihe information is correct, and agree to comply with all applicable Sfate of Minnesota Statutes and City of Ea dinances. ^ t Signature of Applic ?- Certificates of Survey Received _ Tree Preservation Plan ceived _ Not Required _ Updated V01 FIREPLACE(S) _ 0 _ i _ 2 PHONF# ?' S?S<- L47aF Ke? t-Af AT? ZIP CODE CELLPHONE# ?/2-?i?-?.637 FAc# ??Z _ Water Softener _ Water Heater _ _ No. of Baths Phone #: Lawn Sprinkler Fee: $90.00 No. of R.I. Baths OFFICE USE ONLY ? 01 Foundation ? 02 SF Dwelling ? 03 01 of _ plex ? 04 02-plex ? OS 03-plex ? 06 04-plex ? 31 New ? 32 Addition ? 33 Alteration 0 34 Replacement ? 20 Pool ? 21 Porch (3-sea.) ? 22 PorchlAddn. (4-sea.) ? 23 Porch (screened) ? 24 Storm Damage ? 25 Miscellaneous ? 30 Accessory Bldg ? 31 Ext. Alt - Multi ? 33 Ext. Alt - SF ? 36 Multi ? 35 Int Improvement p 38 Demolish (lnterior) ? 44 Siding ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 37 Demolish (Bldg)' ? 43 Reroof ? 46 Windows/Doors •Demolition (Entire Bldg only) - Give PCA handout to applicant v " Valuation JOO a ( Census Code Y3 SAC Units 691 Nbr. of Units ? Nbr. of Bldgs ? 7ype of Const Occupancy 1?-3 MC/ES System Zoning ?iC-r City Water Stories Booster Pump Sq. Ft. PRV Length Fire Sprinkiered W idth REQUIRED INSPECTIONS Foo[ings (new bldg) Footings (deck) _ Footings (addition) Foundarioo Drain Tile Roof Ice & Water Final Other _ Framing _ Paol _ Ftgs _ Air/Gas Tests _ Final _ Fireplace _ R.I. _ Air Test _ Final _ Siding Stucco Stone _ Insularion _ Windows (new/replacement) Approved 8v12.?J , Building Inspector Base Fee Surcharge Plan Review MC/ES SAC City SAC Water Suppfy & Storage S&W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other Total ? 07 05-plex ? 13 16-plex ? OS 06-plex ? 16 Fireplace ? 09 07-plex ? 17 Garage ? 10 OS-plex 1?18 Deck ? 11 10-plex ? 19 LawerLevel ? 12 12-plex Plbg_Y or_ N Fina UC.O. ? PlFinaUNo C.O. _ umbing HVAC VILLAGE OF EACAN 3795`6iloi Rriob Rood Eoqan, MN 55122 2oningf'-1 Owner: MiCh881 O' COIITIOY Address: Site Address:1386 IAne Osk Ro8d, Plumber: R. K02neil - ROydl Meter No.: ?2257626 Size: 50_Ftpek Reader No.: 425435 I agree fo eomply with eha Villaga of Eagan Ordinancn. By Date oC Insp.: WATER SERVICE PERMIT PERMIT NO.: __1350 DnTE: 11/19/73 No. of Unfts: 1 Connec[ion Charge:O6V"^v i'° Account Deposit: 15.00 pd Permit Fee: 10.00 pd Surcharge: •50 pd Misc Charges: 8.50 pd TotaL• Dale Paid: Insp.: YILLAGE OF EAOAN SEWER SERVICE PERMIT 3795 Bilo: Mnqb Road PEHMIT NO.: 2115 Eoyan, MN 55122 DATE: 11/19/73 2oni°g: Ft 3 No. of Units: 1 Owner: 14,igha91--O'COiuin* Address: Site Address: 1 3RK Tione pak ngd Plum6er: gpTgpe e - gQya1 Asphalt I agree fo comply wiTh the Vilinge of Eagan Connection Chazge: 275.00 pd Ordinonces. Account Deposia 15.00 pd Permit Fee: _ 10.00 pd Surcharge: .50 pd BY: Misc Charges: Date of Insp.: Total: Insp.: Date Paid: - CITY OF EAGAN 3795 Plat Kno6 Road Eagan, MN 53722 N2 5303 ? PHONF: 4548100 BUILDING PERMIT APPLICATION Receipt # To ba uted for D2Ck Est. Value 3,000• Dote XKM 7-10 19 79 Site Address 1386 IAn2 OdiC ROdd Erect Ec Occupancv M Lot 81ock Sec/Sub.. J' ?d Alter p A Zoning porcel # 10 01000 020 Z$ RePoir ? Fire Zone Enlarge ? V Type of Const. c Nome S3].].y O'CAT1ri01' Move ? # Stories Z 3 Addreu 1386 Lone Oalc Road Demolish ? Front ff. ? Ci Eagan Phone 454-1242 Grode ? Depth ft. N • nC2 `?.OT1uctYl1Ct10I1 (A. ADCrowls Fees p ome ?,'e o" Addrea 4160 B ir1- n TanP u? r:.., MPls ok,..,e 722-2905 Nome _ Address I hereby ocknowledge that I the information is correct , State of Minnesota Statute reodthis applicotion and state that 3ree to comply with all applicable Signature of Permittee? . 7 A 8uflding Permit is issued oll wark shall be done in c Assessment _ Water & $ew. Police - Fire Eng. Plonner - Council _ Bldg. Off. _ APC Permit i4•Uu Surcharge 1.50 Plan check SAC Water Conn. Water MeTer Toral 13.50 -Lion CC)' on the exprew candition thot Minnesota Statutes and City ot Eagan Ordinnnces. Building Offictol CITY OF EAGA.Y Include 2 sets of plans, BUILDI`1G YERMIT APPLICATION 1 site plan w/elevations b 1 set of energy calculations. To be used fc Site Address Lot Block Sec./Sub. Parcel 0 '16 010d40 OxA 2 Z Owner: :542-C??f_l Address: Phone iT: ,s - ? e^L ?:Z- Contractor: 1 . ??D P Address: Phone 0: 7 2 2- Arch/Eng.: Address: Phone 11: Erect ? Alter Repair Enlarge llove Demolish Grade Date 2 ` ?l? ' 2_ OFFICE USE ONLY Occupancy FW Zoning Fire Zone Type of Const. i Stories ,?a Front id?t ft. Depth ti?ol ft. Appravals Fees 00 Assessment Yermit Water/Sever Surcharge Police Plaa Check Fire SAC Eng. Water Conn. Planner Water Meter Council Road Unit Bldg. Off. APC TOTAL. I ' ? ? E I 5 ?-rt-- ??{#?- -> , i Q-qaro 934?? "4- ?----------------- ? I j Perrnit#? j I ?? I ? Permit Fee: f I - f I j Date Received: .J I I S[aff: -________________? 2008 RESIDENTIAL BUILDING PERMIT APPLICATION Date: T`T oeSite Address: 1,38Y-, LC Tenant: Suite #: RESIDENT I OWNER Name: f7o1 I ? v C?r- I Phone: 256, CP(' ' nNX Address / City / Zip: Applicantis: _Owner 11' Contractor TYPE OF WORK Description of wark Constructlon Cost: Multi-Famity Building: (Yes_/ No v!::? CON7RACTOR Name: CkA?n ? oa ? License#: 90??9`1-63q Address: 5&41 mmcIC7d TSVI N. City: State: Mlv Zip: S? Phone: tO61 " LI 39,"IJXI Contact Person: Kncen COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING _ Minnesota Rules 7670 Cate,cLry 1 Minnesota Rules 7672 Energy Code • Residential Ventilation Category t Worksheet • New Energy Code Worksheet Category Su6mitted Submitted (q submission type) • 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? ^Yes _NO If yes, date and address of master plan: Licensed Plumber: Phone: MechanicalContractor: Phone: Sewer & Water Contractor: Phone: NOTE: RlansaMd s(i pEf?grtrng vodmBrFts, lt?a[ etsrtbttl?tECe°csar?sr,#Y4re#`t? ,?i?i i' ??v?firt the?Jrf or?ttattnrt ;j?[aly be?Glassi'i?ier??$=?e r r? ? ? ? ? p? Iaf if3?' ?aftli;",.I I !;' Kid' { b ?? I ? . I I}? ? I hereby acknowledge that this information is complete and accurate; ihat the work will be in conformance with Ihe ordinances and cotles of the Ciry of Eagan; thal I understand this is not a pertnit, but oNy an application for a permil, and work is not to start without a permit; that the work will 6e in accortlr -^= with the approved plan in Ihe case of work which requires a review and approval ofplans. _ X!_K)1,-?n;C. t-?nV&A X `? ApplicanYs Printed Name Appli ant's Signature Page 1 of 3 INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55122-1897 Date Issued: (612) 681-4675 suxLDzNG 026432 09/2S/95 $ITEADDI3ES$:P.I.N.a 10-75200-010-01 Lnr: i BLOCK: 1 1386 LONE OAK RD TA12A COURT APPLICANT: qQSCO (612) 423-1814 ? : 5 _ . • - „ ? ? _ , _ . _ ,.. ?.?: _. .. ._ . ? _ . _ . . . .._ _ ..:_ . ,.n ? w . . .....-._.wa >e.. ., . ? .._,..._.. . „ " ?. ._._ Y a;.,...? . ,.<... _ ....?? PERMIT SUBTYPE: TYPE OF WORK: 5F (MISC.) REAA.IR UESCRIPTZON (ROOFING) CITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55122-1897 (612) 681-4675 SITE ADDRESS: P.I.N.e 10-75200-010-01 PERMIT PERMIT TYPE: Permit Number: Date Issued: 1386 LONE OAK RD LOT: 1 BLOCK: 1 7AftA COURT c???,?# BUZLDlNG 026432 09/25/95 DESCRIPTION: (ROOFIN6) 8,611d?ing ?erm3 t Type Building Wo'rk ,Type ° t . Fu ; . - ?- r SF (MISC.) REPAIR y' ,%r' REMARKS: FEE SUMMARY: VALUflTION Base Fee Surcharge Total Fee $74.75 $1.50 $76.25 $3,000 CONTRACTOR: - Applicant - 57. Lxc. OWNER: DOSCO 14231814 0004144 POFERL BILL 14710 DEI.FT AVE 1385 LONE OAK RD ROSEMOUNT MN 55068 EAGflN MN (612) 423-1814 (612)686-6425 I hereby ecknowledge that S hava read thzs applicetion and state that the information is correct and agree Cp comply with ell applioable State aF Mn. Statutes and City of Eagan OrdinanCee. ? APPLICANT/PERMITEE SIGNATURE -Aa??n.s ?L1 ?11? CITY OF EAGAN 3830 PILOT KNOB RD - 55122 X,43421995 BUILDING PERMIT APPLICATION (RESIDENTIAL) 681-4675 New Conahudion Reauirements RemodeUReoair Reauirements ? 3 iepisterod ske surveys ? 2 copies of plan ? 2 wpies of plans (Wude beam & wiMow sizes; poured fid. design; etcJ ? 2 site survoys (exterbr eddRions 8 dedca) ? 1 enerpy calwlations ? 1 energy plwWtions for Aeated addRions ? 3 copies of Lee pretervation plan if IM platted after 7h/93 requiied: _ Yes _ No r DATE: CONSTRUCTION COST: d y? ? DESCRIPTION OF WORK: L/) Y C+U ?? ? / G l? ?_, STREET ADDRESS: OPM 1?-)0-12 LOT BLOCK SUBD./P.I.D.#:rJnnQ l.(Nlt PROPERTY Name: P6 /? e ? L /?' L. C Phone #: OWNER '"°* `"° Street Address' r 3 J' 4 ? ° u'F? 02 8 City: 4, w State: Zip: CoN7w?c7oR Company: Phone #: 2-1'1 op Iy Street Address: I `/ 7(o / i'4-/ LICBPISe #. Lt City: /l d J'. ?-7 State: N? ? Zip • I f'' 6? ARCHITECTI Company: Phone #ENGINEER ? Name: Registration #- Street Address• City: State: Zip: Sewer 8 water licensed plumber: change are requested once permit is issued. Penairy applies when address change and lot I hereby acknowledge that I have read this application and state that the infe tion ' orred and agree to comply with all appGcable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant: OPFICE USE ONLY Certificates of Survey Received _ Yes _ No Tree Preservation Plan Received _ Yes _ No SA ti GA-P- oL L?,1, Municipal Notice of Well Permit Application Dakota County Environmental Management Department Water and Land Management Section 14955 Galaxie Avenue West Apple Valley, MN 55124 Tel (612) 891-7011 Faac (612) 891-7031 DATE: Apri124, 2001 TO: Tom Colbert/Wayne Schwanz - EM FROM: Water and Land Management RE: Well Permit #: 01-1-1163389 Municipality: Eagan Fac #: (651) 681-4694 Well Type: 5ealed Environmental Specialist: Olsen The Water and Land Management Secfion of the Dakota County Envimnmental Management Department has received the following permit application for the well described. If you require further review of the application or if you have any questions or concerns about it, contact the Environmental Specialist listed above or our office at (612) 891-7011. If there is no response from yow office within 24 HOURS (excluding weekends and holidays), we will assusne that you have no objections to the issuance of the permit. Please note that permit issuance is always condirioned on the permit applicanYs observance of and compliance with all applicahle state, county, and municipal laws and codes. Well Contractor: Date application received: Anticipated Drilling I7ate: Anticipated Grouting Date: Property Owner: Bill Poferl Well Owner: Bill Poferl WELL LOCATION: Kimmes-Bauer Well Drilling Apri123, 2001 Time: Time: - PLS Coordinates: ne 114, nw 1/4, nw 1/4, nw 1/4, Sec 10, Town 027, Range 23 Street address: 1386 Lone Oak Rd PIN Number: 10-75200-010-01 WELL INFORMATION: Diameter: 2 Casing depth: 73 Total depth: 77 Static Water Level: Aquifer: COMMENTS: i nuc nA1L / : _.. -/ ? \ . )3? ?o??F ?ar? ??? d ? II o ? U W N E C. ? a ? A ? W O C L ? K aN U ci S °o o . o? ? dE A? r`a ? L 3 0 y OC ? y ? V N N m mm0 t0? c ? °?,m?F= asE0 c s N t° 0 d v?? N 000 U:G ?m LLUKVi ? TEMP04ARY CONSTR(JCTIO:°I E/RSEMENT This easement, made this I 'T day of MAIZeN , 2006, between WII,LIAM E. POFERL and SALLY M. POFERL f/k/a SALLY M. O'CONNOR, husband and wife, (hereinafter ? That the Landowners, in consideration of the sum of Seven Thousand Five Hundred Ninety and no/100 Dollars ($7,590.00) and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, do hereby grant and convey unto the City, its successors and assigns, a temporary construction easement for site grading purposes over and across the following described premises, situated within County, Minnesota, to-wit: Parce19 as shown on Dakota County Road Right of Way Map No. 310. This temporary easement shall expire on September 30, 2007. , and the City of Eagan, a Minnesota municipal corporation, organized referred to as "Landowners") WITNESSETH: under the laws of the State of Minnesota (hereinafter referred to as the °City"). The grant of the foregoing temYrorazy construciion easement for site gruding purposes includes the right of the City, its contractors, agents and servants to enter upon the premises at all reasonable times to construct, reconstruct and inspect site grading and the further right to remove trees, brush, undergrowth and other obstructions. After completion of such construction, maintenance, repair or removal, the City shall restore the premises to the condition in which it was found prior to the commencement of such actions, save only for the necessary removal of trees, brush, undergrowth and other obstructions, subject only to permanent easement alterations. The Landowners, their heirs and assigns, do covenant with the City, its successors and assigns, that they aze the owners of the premises aforesaid and have good right to grant and convey the easement herein to the City. DATE RfCE1VE0 6'z- pqlCpTq CQUNTY TREASURER-AUDITORL? IN T'ESTIMONY WHEREOF, the Landowners have caused this easement to be executed as of the day and yeaz first above written. illiam E. Poferl ?.7 ally M. Poferl f/k/ ally M. O'Connor STATE OF MINNESOTA) )ss. COUNTY OF DAKOTA ) ,--?e fore oing instnunent was acknowledged before me this / day of • l tiG , 2006, by William E. Poferl and Sa?yM. Poferl f/k/a Sally M. O'Connor. Notary Public APPROVED AS TO FORM: ,2 =Pu?loc-jnneso City Attorney's Office ' NDated: 3/7,vs- APPROVED AS TO CONTENT: IC.- d't'1G:CEk,;- Public Works Depart ent nacea: -3_- 9 - o(, -- - THIS INSTRUMENT WAS DRAFTED BY: Robert B. Bauer, Esq. SEVERSON, SHELDON, DOUGHERTY & MOLENDA, P.A. 7300 West 147th Street, Suite 600 Apple Va11ey MN 55124 (952) 953-8847 (Easement No. 1076) (RBB: 206-23315) City of Eagan 3830 Pilot Knob Rd Eagan, MN 55122 (651) 675 -5675 www.ci.eagan.mn.us Site Address: 1386 Lone Oak Rd Lot: 1 Block: 1 Addition: Tara Court PID:10- 75200- 010 -01 Use: Description: Sub Type: Work Type: Description: Meter Size Meter Type Comments: Fee Summary: Contractor: Tony's Appliance 2090 County Road 42 West Burnsville MN 55337 (952) 435 -2442 e - Water Heater New Water Heater Manufacturer Mike Skaja 2090 County Road 42 W. Bumsville, MN 55337 PL - Permit Fee (WS & /or WH) Surcharge -Fixed Total: I hereby acknowledge that I have read this application and state that the informa of Minnesota Statutes and City of Eagan Ordinances. on is correct and agree to comply h all applicable State Applicant/Permitee: Signature PERMIT City of Eaan - Applicant - Permit Type: Permit Number: Date Issued: Permit Category: Serial Number Remote Number Owner: Sally M Poferl 1386 Lone Oak Rd Eagan MN 55121- -135 $50.00 0801.4087 $0.50 9001.2195 $50.50 Issued By: Signature Plumbing EA089732 06/17/2009 ePermit Line Size PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA178852 Date Issued:09/07/2022 Permit Category:ePermit Site Address: 1386 Lone Oak Rd Lot:1 Block: 1 Addition: Tara Court PID:10-75200-01-010 Use: Description: Sub Type:Furnace Work Type:Replace Description: Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507) Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088 Surcharge-Fixed $1.00 9001.2195 $60.00 Total: 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 - Erin D Lavallie 1386 Lone Oak Rd Eagan MN 55121--135 (651) 808-4193 Minneapolis St. Paul Plumbing Heating Air 640 Grand Ave St. Paul MN 55105 (651) 228-9200 Applicant/Permitee: Signature Issued By: Signature