4041 Mica TrINSPECTION RECORD
CITY OF EQGAN PERMIT TYPE;
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(612) 681-4675
SITE ADDRESS: APPLICANT:
?
? I li;1t? ?,,; ?ru'i p ?., . .. E . , t< • ? 7472
PERMIT SUBTYPE: TYPE OF WORK:
?
? .
.
?
,
j _
.. . - ? ?". . ?. : _: ._. .. . . . " ..., . . . ,.? `?r:
, .. ?''7 . , r . . . . ,?a .., .,. .. ., q
r.}t 1sr:ctI r°rr0 r, tI-W;)
Permit No. Permit Holder Date Telephona #
ELECTAIC
PLUMBING
HVAC
Inspeetion Dats Insp. GommeMs
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PIUMBING
PLBG
AIR TEST
ROUGH
HEA7ING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
?
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSMT FINAL
flECK FTG
DECK FINAL
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE: . ,:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(651) 681-4675
SITE ADDRESS: APPLICANT:
I.f:iIAN i;kf+Vt #h (1+19 14 4 Hf..'?
PERMIT SUBTYPE:
. I .
TYPE OF WORK:
F
L ?
nr ?.I k r r r 1' I?r4 ia' r. xi >:????f
PermN Holder Dats Telephone M
SEWERI
WATER
PLUMBING
HVAC
Inspection Dete 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
TEST
BLDG FINAL
DOMESTIC
METER
IRRIGATION
METER
FLUSH
MAINS
CONDUCTIVITY
TEST
HYDROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FfG
DECK FINAL
CITY OF EAGAN Remarks * Cedar Grove Ac4uisition
Addition CEDAR GROoVE #rJ Lot 20 Rlk 5 Parcel 10 16704 200 OS
Owner --%''Street 4041 MiCS Tr811 State EiLgan, MN 55122
rk'i A i
Improvement Oate Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK Z 196, 100.00 .00 QQ id
SEWER LATERAL -196-7 4 23.00 20 id
WATERMAIN
* WATER LATERAL 1972 607.00 24.28 25 8aid
WATER AREA
STORM SEW TRK 7 1970 70.00 3.50 20 Paid
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC 00.00 452 10-25-67
PARK
CITY OF EAGAN 9 4 tO 3
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55 121
PHONE: 454-8100
BUILDING
PERMIT Receipt # .
Te be wwd f or G?•.?C-,??Est. Volue $ 4,000 Dat e SrPTE? 19 `
Site Address `041 2,1ICA TRAIL Erect Occupancy
Lot Bl c
ock Gec/Sub. CED CRV J Fiemodel
?
Zoning •
Parcel No.
Repeir
?
Type of Cortst.
Enlarge A No. Stories
Name DUANE BARCLAX Move El l.ength 1?y
?
Address Demotish
SM'lE ? Depth %
....
?
45d-41 8iR Grade
?
Sq. Ft. 3.":'.4
CONST
Name
Address
City Phone
I hereby acknowtedge that I hove read this opptication ond state that
the information is correct ond ogree to comply with all opplicable
5tnta of Minnesota Stctutesr'pnd Ciy nf Eogon Qrdinonrxa.
Sipnuture of Pertnittea ? ???-`? •??? ? J
GOr.CU CONST
A Building Permit {s issued to:
oll work shol l ba done in accorda?ce wit? oH opplicable State wf Mlr
6uNdir?p Officio{
Ilssessment
Wafer & Sew.
PoHce
Fire
Enp.
Pionner
Cour?cii
Bidg. Off. g 6 s n
APC
Var. Date
Permif
Surtharqe ' Plan check
SAC
Water Co?m.
Woter Meter
Road Unit
Parks
Total
an the expresa condiNon lhoi
Statutes and City of Euqan Ordirances.
?C
Permit No. Pormit Holder Dete
Plumbiny
H.V.A.C.
Eteetric
Softener
Inspection Date Insp. Othe?
Footinys 4 5 1 l
Foundation
F?aming
Rouyh P16y.
Rough HVAC
Insulation
Final P16g.
Final HVAC
Fina1 3 ?
Cwt/Dec.
Water Descri6e Loeation:
Wron ? m? ?
`
Sewer ,„y?t? G.t ? ?
/
?fp V '
Pr. Disp.
EAGAN TOWNSHIP.
No
.
BUILDING PERMIT
Ownex '--^-.`_.?.....N...e.. -..O-'--.--_.._---'--__-_'. - - ? ? Eagan Township
--...
Address (Presenf) ?-:---_44t ..... _7/.?i------------- --........... ._ . Town Hall
Builder ............... ----------- ............... ........ ...... ---............... ..__-------- _
Date
? ----...`-.._...
Address ................................... ................................. .--------- ............... .
? ? - DESCAIPTION ?
1427
Stozies To Be Used For Froni Depih Heighi Esl. Cos! Permi! Fee Remarks
---
LOCATION
streex, xoaa or omer uescnpnon ox Locanon Loi niocx aatlIIion or '1'racf
--- ----- -7 ? - -----
?o-?
l i3-1?- .S
This permif does noi aulhorize the use oi sireeYs, zoads, alleps or sidewalks aor does if give the owner or his ageni
the righi to creafe any sifualionwhieh is a nuisance or which presants a hazard So the health, safelp, convenience and
genezal welfara fo anyone in the communiip. - ,
THIS PERMIT MUST BEKEPT ON 1'HE Ppg?EMISE WHILE THE WOAK IS IN PROGR£SS. ,_ _ . .
This is to cexiify, fhal....c,.:._??.....?-?.[:X^:°----- ..`":? .. ... ...haspermisaian !o ereci. a..._y.'_`._-G..:` 1...__...-upon
the above described premise subjeci fo the provisions of the Building Ordiaance , for Eaga?Jl'ownship _ ado April 11, 'ed 1955. . ?j/ . . . .
- - ..._ .. --? ....-. .............. Per ..--------- d
Ghairmen of T tCc? <.C._._(lr}??:e.fSZ. ..................................... -............
nwn Board . ? . Bui?ding Ins ecior a ,F'
EAGAN TOWNSHIP
BUILDING PERMIT
ovme: --x '.._ . ..... - -.?.`(.?/.?-.-?-?. ?,.,.",.??.?..?.`.?..???......... --------- - ........- ---
Addsess (presen!) y/Y/ ??-"- T?.,:
......--- ..............°--- °----.....-'------......
Suilder ..... ..fr.4?_.../.?... .!. .:-_
..._.................................... ..............
Address .................. .----G-------- --------------------------- --.......
DESCRIPTION
N° 1996
Eagan Towaship
Town Hall
S
Dafe --°"----?.h..% -'----°-'-°---`--`
Siories To Be Used For Fronf Depih Heighi Esi. Cosf Parmit Fee Remarks
I
LOCATION
I'p-4 I sl d- .0 -5'
This pesmit does not auShorise !he use of streeSS, roads, alleys or sidewalke nor doea it give the owner or his agen!
the righ! 2o creale anp sifuation whieh is a nuisaaee or which presenls a hazard !o the healih, safely, convenience aad
general welfare io aapone in the communiip.
THIS PERMIT MUST SEy KEPT ON THE PREMISE WHILE THE WORK IS IN PAOGRESS.
upoa
This is to aertifp. lhaf.aC-= -..-7,--?-?°°--°J° - - --.....°-----------------has permission to erect a..... g/........._-- .... ...................................
the above described premise su jeb e! !o !he provisions of !he Building Ordinenee for ag? Township edopYed April 11,
1855. •CfI,? Per //zy o /?? ?
_"'--"'..._'---.... .y-'-l...-..."_."._""-'........._.. ....---?'----?--L'._r.:-•--"__(/?s?-:??."'•
Chair?n of Tnwn Board Building'faspeolor
a - 13
L• ? ALL CONTRACTORS MUST BE LICENSEDIWITH THE CITY OF EAGAN
3 INCLUDE Q SETS OF PLANS,
? CERTIFICATES OF SURVEY
? SET OF ENERGY CALCULATIONS
To Be Used For: Valuation: ,T ?n.?n.nn
-,_....?....?w- Date: 9-4^L[?
Site Address: 'f-Qgl -Y'Yl°a TrA ° I pD( • •
Lot:?p Block: r?Sect/Sub: ee&r (',ppv /tOE'iect: Occupancy:
Remodel: Zoning:
Parcel #: Repair: Type Of Const: ?
Enlarge: # Stories:
Owner: ??ln„?e? Move: Length:
Address: 4Q ¢?- ? ? "??e( Demolish: Depth: 'g
City/Zip Code: ?i? N
y_?I17? Grade: Sq. Ft.: ?
Phone # : 459-- 41 5(8
Contractor:
a'oJ' ca ?
Address: Assessments: Permit: 44,
/? Water/Sewer:
City/ZiP Code: R'jvunncc+k 5 S 441 Surcharge: _Z_
police: Plan Rev.:
Phone #: 549,-?'r( ?G Fire: SAC:
Engr.: Water Conn:
Arch./Eng: (-'epy-Lr? Planner: Water Meter
Address: Council: Road Unit:
Bldg. Off.: Parks:
City/Zip Code: APC:
s?
Variance: ? T?"
nh?'o4
; CITY OF EAGAN N° 9493
,.? 3830 Pilot Knob Road, P.O. 8ox 27-199, Eagan, MN 55121
PHONE: 4548100
BUILDING PERMIT Receipt # "/ CO
Te M uted Ier GARAGE Est. Value $4,000 Date SEPTEMBER 10 lq 84
SiteAddress 4041 MICA TRAIL Erect Ll Occupancy R3
Lot 20 glock 5 Sec/Sub. CED GRV 5 Remodel ? Zoning Ri-
Parcel No. Repair ? Type of Const, V
Enlarqe ? No. Stories -
W Name DUANE BARCLAY Move ? Length 19-
Z Address $AME Oemolish ? Oepth Za
? City Phone 454-4158 Grade ? Sq. Ft. 324
o Name GORCO CONST
Zt Address 10700 HWY 55
? City PLYMOUTH phone 542=9626
Name _
Address
City Phone
I hereby ockrwwledge that I hove read this applicotion ond stota fhot
the inlormotion is correct ond ogree to comply with oll oODlicoble
Stufe of Minnesoto Stotute and City of' E1agan Ordirwnces.
Sipnoture of Permittee ?6'k-0.??^-?
A' 8uilding Permit Is issued to: GORCO CONST
oll work shall ba dona in acca
APProrals Faes
Asxssmenf
Woter 8 Sew.
Police
Fire
Erg.
Planner
Council
Bldg. Off. 9/ fi / R 4
APC
Var. Date
Permif vzs.?v
Surchorga 2.00
Plun check
SAC
Water Conn.
Warer Meter
Road Unit
Perks
rotal $46.50
on the express condiHon thof
MinneEOfa Stotutes ond Cily of Eogan Ordinances.
Buildinp OfftNal
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PIIOT KNOB RD, EAGAN MN 55122
651-681•4675
New Construction Reauiremenh
• 3 registered sile surveys showing sq. R. of oC sq. fl. o( house; and ail (oofed areas
(20°k maxvnum lot coverage allowed)
. 2 wpies ot plan showing 6eam 8 window;;zes; paured found desgn, etc.)
• 1 sel of Energy Calculations
• 3 copies of Tree Preservation Plan if lot Giatled afler 111193
• Rim Jaist DeWil OOWns selection sheet (CIOgs with 3 ar less units)
DATE lD-tv-o?-
SITEADDRESS yoyI M l(A- f-12 C . MULTI-FAMILYBLDG _Y XN
TYPE OF WORK C-a i? z2hi+?c /0£0,qi2 FIREPLACE(S) X 0_ 1_ 2
APPUCANT roNeL 1<2 k'/Y/ldyj
STREET ADDRESS i?' Q(gGSC ay07 ?(/?1 CITY ? STATEdi`AG11PJJI?-V
TELEPHONE #CIP UJ-(R.3p CELL PHONE # 3df- -) 2 7 o FAX # dQor-/d ,/-/
PROPERTYOWNER S?e UPN L'+s TELEPHONE#
COMPLETE FOR "NEW" RESIDENTIAL BUILDINGSfONrLY
l ? l IJ
Energy Code Category
_ MIVNk:50"l'.1 RL'I.I:S 7670 GVCEGORl' 1 ;CA RL"L1S 7674
(d submission type) • Residential Ven[ilation Category 1 Worksheet Submitted ..: • New Energy Code Worksheet Submitted
• Energy Envelope Calculations Submitted
Plumbing Contractor:
Plumbirg system includes:
Mechanical Conhactor:
Mccluaiic.il sNstcm includcs:
Sewer/Water Contractor:
-- Air CondiUoniiig
-- Hrit Rccovcr} Systcm
I hereby acknowledge ihat I have read this application, state that the i
with all applicable State of Minnesota Stotutes and City of Eagan Ord
Signature af Applicanf
Fee: S90.00
Pec: S70.00
correct, and agree to comply
OFFICE USE ONLY
_ Water Sottener
_ Wa[er Heater
No. of Baths
RamodeUReoair Reouirements
. 2 copies of plan
• i set of Energy Calculations far heafetl additions
. 7 vte survey far exterior addiGons 8 Aecks
. Indicate if home served by septic system for additions
Phonc #
Lawn Sprinkler
No. of R.I. Baths
VALUATION CJ S? ?.la "06
Phone #
Phone #
Certificates of Survey Received - Tree Preservation Pian Received _ Not Required _
Updated 4102
OFFICE USE ONLY
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Paol ? 30 Accessory Bldg
,K 02 SF Dwelling ? 08 06-plez ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 ot_ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 6ct. Alt- SF
? 04 02-plex ? 10 08-plex ? 18 Deck O 23 Porch (screened) ? 36 MuIG
? OS 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Pibg_Yor_ N ? 25 Miscellaneous
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Additlon ? 36 Move Bldg. ? 42 Demolish (FOUndation) A? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bidg)' ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement •Demolition (Endre Bldg only) - Give PCA handout to applicant
Valuation ?2 aw Occupancy MC/ES System
Census Code 1-1311 Zoning /2- Y City Water
SAC Units Stories 2 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.
_ Fooangs (addidon) Plumbing
_ Foundation HVAC
_ Dnin Tile Other
Roof ? Ice & Warer F inal Pool Ftgs AidGas Tests Final
Framing _ Siding Stucco Stone _
Fireplace _ R.I. _ Air Test _ Final Windows (new/replacement)
Insulation _ Retauung Wall
Approved By
Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
PERMIT
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMIT TYPE:
Permit Number:
Date Issued:
BUILDING
029130
10J28j96
SITE ADDRESS:
4041 MICA TR
LOT: 20 BLOCK: 5
CEDAR GROVE #5
P.I.N.: 10-16704-200-05
DESCRIPTION:
( G A S )
uildin'g.,Permit 'fype
uilding W`b,rk Type
ens:us, Code ?.
I
FIREPLACE
NEW
434 ALT. RESIDENTIAL
<
?'' ' a. :? >,•tz ? 3 r ,
REMARKS:
FEE SUMMARY:
Base Fee
Surcharge
Total Fee
$25.00
$.50
$25.50
CONTRACTOR: - Applicant - OWNER:
TOTAL AIR INC 18947472 HAEGEN MARK
1923 W BURNSVILLE PKWY 4041 MICA TR
BURNSVILLE MN 55337 EAGAN MN 55122
(612) 894-7472 (612)686-5087
T hereby acknowled=ge that T have° read Chis appiication and stata that the
' infa?^matsvrn is cor^Yect_an-d agreeto pampl-y aiCh all applicable 3tate Af Mn.
Statutes and G3ty.of Ea9an Ordinances.
APPLICANT/PERMITEE SIGNATURE
? I lYil?
'IS?SUED'II1Y. S NAT E
?
9? CITY OF EAGAN t
.?.:J
?? 3830 PILOT KNOB RD - 55122 ?f
1996 FIREPLACE PERMIT APPLICATION
681-4675
DAT'E: I (:?) - 2 Z, -9 ( p
DESCRIPTION OF WORK:
CONSTRUCT NEW FIREPLACE: _ WOOD BUItNING
_ INSTALL GAS INSERT ONLY IN EXISTING FIREPLACE
_ INSTALL GAS LINE ONLY IN EXISTING FIREPLACE
OTfER:
ZGAS
ROOM TO BE INSTALLED IN:
STREET ADDRESS: 40 ? I ff?' I C G. ? G 1 1
LOT 2 n_ BLOCK ? SUBD./P.I.D. #: LtMa? jj
APPLICANT: (circle one only) OWNER CONTRACTOR
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.
PROPERTY Name: ? ? D- Q 'e '(1 Phone #:
OWNER
Signature:
Street Address: 4 C) 14 ( ' ' \ t C- G ` ' Q 1 ?
P.
City: ?G `n State: Y? p Zi ? 5 I?"' ?
FIREPLACE (?'omoa.tty: / c.,, Phpre !k; 4? ?
INSTALLER
Signature:
Street Address: icense #:
Ci t}? u? ? ? 1 l\ ?--- State: ? Zip: 3
? Pi r ?, r ioni?
GAS LWE Compan:\J?c?hr JO ?r? S i r+a C 1?' Y hn o he #: I 9
INSTALLER
` Signature: ?C>?-\\ ev-
Street Address: ?1( -3L L°> ??K*1' 5-N
City: ()--Uu4 4=_ State: ? m?4 Zip: ??ay
V
OFFICE USE ONLY
BNLDING PERMIT TYPE
? 14 Fireplace
WORK TYPE
0 31 New
? 32 Additior.
0 33 Alterations
? 34 Repair
GENERALINFORMATION
Census Code.
SAC Code
REMARKS
?
i ?
'.. ' ?
A.
Chimney/flue must be inspected before concealing.
---? CITY OF EAGAN
3830 Rilat Knob Road
Eagan, Minnesota 55122-1897
(651) 681-4675
PERMIT
PERMITTYPE:
guzLoznc
Permit Number: 0 3 4 15 7.
Date Issued: 12 / 0 2/ 9 S
SITE ADDRESS:
4041. MTCA TR
LOl': 20 BLOCK: 6
CEpAR GROVE 45
P.Z.N.: 10-16704-108-05
DESCRIPTION:
T.O. T.O. & RERQOF
t3u)fldino P-erm5.t; Tyoe
8pildinq Wor`k.,Type
1?ensu8 Code \
r
?
i
.._ >:
,
STORM OFYMAGG
REPAZR
434 AL7. RE5IDENTIAL
,? t r >
.?
REMARKS:
FEE SUMMARY:
CONTRACTOR: - Appl.i.cant - sr. LzC. OWNER:
HOME PRIDC BUILDERS 18840675 20072528 HAGAN MqRK
9033 I_YNDRLE AVE 4041 MICA Tft
BIDOMINGTON MN 55420 EAGAN MN 55122
(612) 884-0675 (651)686-5087
T liereby acknowledqe that T have read Chis application and state that the
infiarmaL'ion is correct and aQree to complv with a11 applicable 5tate oT Mn.
L a'tatutes and Gity of Eaqan Ordinances.
APPLICANT/PERMITEE SIGNATURE
SUED BY: SIGNAT
I
1998 BUILDING PERMIT APPLICATION (RESIDENTIAL)
? . ., CITY OF EAGAR
? ?
3830 PII.OT KN07RD - 65122 _9
New Construdion Reauiremants RemadeVReoair Reouirements
? 3 registared sde surveys • 2 copies ot plan
? 2 eopies ef plans (InGude beam & window sizes; poured fna. Cesign; etc.) ? 2 site surveys (eztarior addRions & dedcs)
? 1 energy caleulaGons ? 7 energy calculations for heated atltlitions
? 3 copies of tree preservatiun plan A lot platted after 711193
required: _ Yes _ No
DATE: /oZ -/` 4P
DESCRIPTION OF WORK: ee -16 o? -
CONSTRUCTIONCOST; `71?1100
STREET ADDRESS: lkllGt <f 724;G
LOT: ad BLOCK: S SUBD./P.I.D. #: 0--Q?- G f 6 U-2- ?'?
Name: 1114,C/C Phone #: cA?y- ?ocf 7
PROPERTY 1-ast First
OWNER ?
Street Address: ?d ?1 ?
? ?CA / /?4
City State: Zip: a
Company: Phone#: tel1a-
CONTRACTOR
Street Addresr. 470 22 ?f.,eld/4 ?P AP S, '?W License # ?O ?3 'ra ?aZB
City ?/?/ulA1Gf'f"O?/ State: /"/-/, Zip: J?Jr`To2 ?
ARCHITECTI
ENGINEER
Phone #:
Registration #:
Sneet Address:
Ciry
Sewer & water licensed piumber (new construction only):
and lot change is requested once permit is issued.
State:
Penaity applies when address chang
I hereby acknowledge that I have read this application and state that the infortnation is correct and agree to compiy with all applicabl
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of ApplicanC
OFFICE USE ONLY
CeRificates of Survey Received _ Yes _ No
Tree Preservation Plan Received Yes No
Zip:
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Dupiex
? 02 SF Dwelling ? 07 4-plex
? 03 SF Addition ? OS 8-plex
? 04 SF Porch ? 09 12-plex
? 05 SF Misc. ? 10 = plex
WORK TYPE
? 31 New ? 33 Alterations
? 32 Addition ? 34 Repair
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Planning
Permit Fee
Surcharge
Plan Review
License
MC/WS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
? 11 Apt./Lodging ?
? 12 Multi Repair/Rem. O
? 13 Garage/Accessory ?
? 14 Fireplace ?
? 15 Deck
? 36 Move
? 37 Demolition
Basement sq. ft.
Main level sq. ft.
sq.ft.
sq. ft.
sq. ft.
sq.ft.
Footprint sq. ft.
Buiiding Engineering
Valuation: $
16 Basement Finish
17 Swim Pool
20 Pubiic Facility
21 Miscellaneous
MC/WS System
City Water
Fire Sprinklered
PRV
Booster Pump
Census Code.
SAC Code
Census Bldg
Census Unit
Variance
°k SAC
SAC Units
° G ?31V11?'V ?i9?'`P1S1 RU?i P .?"+" [w3.:?
??C?a?a `' °`? 10700HIGHWAY Fr, Sl! TE 3u0
'-O CGI.5IFUCTION CO., herelnelter calletl COA'TRACTbR Is airocted lo maka tha p LYM OUTH , M N. 55-141 UATC.
-ig ImDrovmants to tho property oC I
lar _ HOMEA tisti-y?se .
".C?U6'1E55: '{OY I- h-l c Tra..' L_. BUS.M?49?? o? 6_ HR
cirr: C d!? .. n -- ziP a
IMATERIAL SPECIFiCATIONS ? DESCHIPTION
' ';FIAGE
.,,2E: IE.xIR' AT['cHEO OD
sTUDS: a? v x qxsiei' 1(."pC
RAFTERS: 1b' QC
TIES: _GL "(,(I K 1'9 43 OC
abs rNnp..9k-
HEADERS: 0.F12 DM
S}+EATHINIi: '/3" 8?.'itr? Le?
GARAGE
FOOF: 5
?«-
SIDE A SIDE B
SIDE EAVES: Ig" I8'
END A END 8
END EAVES: 18 "
FACIA TftIM: i x?„ - i x3,.
URYX ?LOCK
ROOFING !?s'6a
WID7H EXYOSURE
SIDING: S"aaoro.e
( ) CLADWOOD SIfJiNG ? ) CLADWOOD SHAKES OTHER
i ) HARDSOARD SIDINf9 ( ) PRIMED SHAKES
j ) IP:SUIITE SIUING ( vOLUMINUM SIDING ??-
(' ) WOODTFJ( SIDING ( ) BACKERBOA9D
j ?HORIZONTAILAP ( )STUCCO
i ?? -1_
f---i F--- -'_?
(A ?
M.?A I ? I -
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GORCO CONSTRUCTION COMPANY, INC.
55 West Office Center/ Suite 360
10700 Highway 55
(612) 544-9646 Plymouth, Minnesofa 55441 /
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ity Control
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TO: DIANE DOWNS, UTILITY BILLING CLERK
FROM: ED KIRSCHT, SR. ENGINEERING TECHNICIAN
DATE: AUGUST 23, 1993
SUBJECT: STREETLIGHT ENERGY COSTS-CEDAR GROVE NO. 5(208 LOTS)
MEMO
This memo is to inform your department to begin to invoice the energy costs at the single
family rate effective August 1, 1993 to the property owners in Cedar Grove No. 5 Addition.
Block 1, Lots 1-22 22
Block 2, Lots 1-19 19
Block 3, Lots 1-11 11
Block 4, Lots 1-16 16
Block 5, Lots 1-25 25
BloCk 6, Lots 1-22 22
Block 7, Lots 1-25 25
BloCk 8, Lots 1-5 5
BloCk 9, Lots 1-2 2
Block 10, Lots 1-23 23
Block 11, Lots 1-14 14
BloCk 12, Lots 1-9 9
Block 13, Lots 1-15 15
208
The Ciry is currently being billed by Dakota Electric for streetlighting in the above listed
subdivision.
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Edward J. irscht
Sr. Engineering Technician
CC: Mike FoertsCh
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RTIFICATE OF SURVEY
Survey for: JEFF BACKLUND
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SCALE: 1" = 20'
• Denotes Iron Monument Found
O Denotes Iron Monument Set
L07 AREA= 12.400 sq.ft.
DESCRIPTION: Lot 20, Block 5, CEDAR GROVE N0. 5
I hareby certify that this survey was prepared by me or under direct supervision, and that I om o
registered land aurveyor under the laws of the State of Min s a. Dated this 4th f March, 2006.
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CARLSON dc CARLSON, INC. g1'
LAND SURVEYORS L-ta'rry R. uture, Lond Surveyor
Minneeo License No. 9018
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2006 RESIDENTIAL BUILDING PERNIIT APPLICATIQN
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New ConsWCfion Reauirements
3 registered sife surveys showing sq. ft. oi lot, sq. ft. oi house; and all roofed areas
(20% maximum bt cove2ge allowed)
2 copies of pian showing beam 8 window sizes; poured found design, etc.
1 set of Energy Calculations
3 oopies of Tree Preservafion Plan if lot platted after 711193
Rim Joist Deiail Options selection sheet (buildings with 3 or less unifs)
Minnegasco meciwnipl ven4lation form
RemodeVReoair Reauirements
2 copies of plan showing foofiigs, beams, joists
1 set of Energy Calculafions for heated addiUons
1 site survey for additions 8 decks
Add'Rion - indlcate if on-sde sep6c system
?
Offce Use Onlv
Certof Survey Rea! -Y . N
T2ePresPlanRecd Y N.
Tree Pres Required , X N
On-siteSepficSystem `YN
`4 hI .tt"- waa Aw
vare 3 i 30 i o 6 conswcnon cosc
Site Address 4rk y 4I'J Unit/Ste #
Description of Work
Multi-Family Bldg _ Y? N Fireplace(s) _ 0 JC 1 _ 2
Property Owner tG Cl e4. i S C L?C L G S Telephone #( )
Contractor 13GG K (v N? C x 10 ??
f
Address [? 331 6-ood(/[ e W ?
City e G'fdd'e-
State Zip oTelephone #( ;- rZ
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(4 su6missiontype) Submitted . Submitted
. Enargy Envelope Calculations Submitted
In the last 12 months, has }he 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
Mechanical Contractor
Sewer/Woter Contractor
Telephone # (
Telephone # (
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 ord'mances 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
approval of plans.
Se q BactC lvod
Applicant's Printed Name
i ignature
DO NOT WRITE BELOW THIS LINE .. '`. ;Sub Tvpes
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bidg
L] 02 SF Dwelling ? 08 Oo-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt- Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage f& 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? 05 03-plex ? 11 10-ptex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex ? 25 Miscellaneous .
Work Tvpes
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ' ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building• , ? 43 : Reroof , . ? . 46 ' ' Windows/Doors
? 34 Replacement •Demolition (Entire Bldg) • Gfve PCA handout to applicant
DesGripYiOfl: Water Damage _Yes
- V
Valuation ?fYa Occupancy _ MCES System
Plan Review ?0
_10D% or
_ 25%
,
Census Code Zoning R? r City W ater
SAC Units Stories Z Booster Pump
# of Units Sq. Ft. PRV.
# of Bldgs Length 3 a Fire Sprinklered'
Type of Const Y 3 Width Z?
REQUIRED INSPECTIONS
_ Footings(new 61dg) _ Sheehock
Footings(deck) _ FinallC.O.
_?o Footings (addition) ?o FinaUNo C.O.
,L- Foundarion ? HVAC
.29 Drain Tile Other
Roof 1° Ice & Water $6 Final _ Pool Ftgs AirlGas Tests Final
?p Framing _ Siding _ Stucco Lath _ Stone Lath _Brick
_ Fireplace _ R.I. y Au Test _ Final _ Windows
-,Lo Insulafion _ Retainivg Wall
Approved By: 4WA 4uilding Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Capies
Other
Total
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Permit #
Pertnit Date
Project Title: Laura & Steve Las
Report Date: 04110106
Det2 filename: C:1DocumeMS and SeltingstOwner\DesktoplBackluM 6cleriors\La5 Prqacl.rck
REScheck Software Version 3.7.3
Compliance Certificate
Energy Code: 2000 Minnesota Energy Code
Location: Dakota County, Minnesota
Construction 7ype: Single Family
Glazing Area Percentage: 230/
Construction Site:
4041 Mica Treil
Eagaq MN 55123
OwnedAgent:
DesignedContractor:
Gompliance: Passes Maximum UA. 234 Your Home UA. 207 -> 11.5 % Better Than Code (UA)
Gross Cavity Cont.
, Assembly Area or R-Value R-Value
I'Perimeter
Ceiling 1: Flat Ceiling or Scissor Truss: 560 38.0 0.0
Wall 1: Wood Frame, 16" o.c.: 340 19.0 0.0
Window 3: Above-Grade:Vinyl Frame:Dou61e Pane with Low-E: 16
Window 4: Above-Grade:Vinyl Frame:0ou61e Pane with Low-E: 16
Window 5: Above-Grade:Vinyl Frame:Double Pane wiN Low-E: 24
Vifindow 6: Above-Grade:Vinyl Frame:0ouble Pane with Low-E: 24
Window 7: Above-Grade:Vnyl Frame:0ouble Pane with Low-E: 24
Window 8: Above-Grade:Vinyl Frame!Double Pane with Low-E: 24
Window 9: Above-Grade:Vinyl Frame:Double Pane with Low-E: 26
Window 10! Above-Grade:Vinyl Frame:Double Pane with Low-E: 26
Window 11: Above-Grade:Vinyl Frame:DOUble Pane wiN Low-E: 40
Door 7: Glass: 42
Door 2: Glass: 42
Wall 2: Wood Frame, 16" o.c.: 340 19.0 0.0
Wall 3: Wood Frame, 16" o.c.: 476 19.0 0.0
Wa114: Wood Frame, 16" o.c.: 168 19.0 0.0
Basement Wall 1: Masonry Block with Empty Cells: 224 0.0 10.0
Basement Wall 3: Masonry Block with Empty Cells: 160 0.0 10.0
Basement Wa114: Masonry 81ock with Empty Cells: 160 0.0 10.0
Fumace 1: Forced HotAic 92 AFUE -
Air CorMRioner 1: ElecUic Centrel Air: 73 SEER
0.320
0.320
0.320
0.320
0.320
0.320
0.320
0.320
0.320
0.340
0.340
17
2
5
5
8
8
8
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73
14
14
20
28
10
13
9
9
Compliance StatertreM: The proposed building design described here is consistent with the building plans, specifications, and other
catculations su6mitted with the permit application. The propasetl building has been designed lo meet ihe 2000 Minnesota Energy
Cvde requirements in REScheck Version 3.7.3 antl to comply with the mandatory requirements listed in the REScheck Inspec[ion
Checklist. _ / _
gcZ,k?/`oYS
BuilderlDesigner a N me Date
Laura & Steve Las Page 1 of 3
2006 RESIDENTIAL MECHANICAL PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please wmplete for: single family dwellings & townhomes/condos when permits aze required for each unit
t 3D?o
Date?/30 /C(,_
Site Address C.d / CN ?? Unit #
Property Owner Telephone # ( )
L4 A
Contractor -
St
t Add (0(003
n '
ree
ress n?
d city
State ? Zip Telephone #
Bond #
RL i
l
SZ) 3 13 C E
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q
:
- xp
.
res: _
p
The Applicant is _ Owner ? Contractor _ Other
Add-on or altera[ion to existing dwelting unit $ 30.00
? fumace _Additional CReplacement _)CNew
air exchanger
?
air conditioner
I?<
U u
S
?UL 2 0
heat pump ? 006
other
1 `? / v ?r V l?O J .
V
State Surcharge $ .50
T
t
l $
o
a
I hereby apply for a Residential Mechanical 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 with the Mechanical Codes; that I understand this is not a
pernut, but only an applicarion for a permit, and work is not to start without a pemut; that the work will be in accordance with the
approved plan in the case of work which requires a review and approval of plans. (f__' _
Applicant's Printed Name ApplicanYs Signature
2006 COMMERCIAL MECHANICAL rERNHT ArPLicaTioN
City Of Eagan
3830 Pilot I{nob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for. commercial/industrial buildings
multi-family buildings when sepazate pemtits are not required for each dwelling unit
Date
Site Street Address Unit #
Tenant Name (if applicable) Previous Tenant Name
Properry Owner Telephone # ( )
Contractor
Street Address City
State Zip Telephone # ( )
Bond #: Expires: . ?
The Applicant is _ Owner _ Contractor _ Other
Work Type
NewConstruction _Interior Improvement _ Install Piping _Processed _Gas
Under/Above ground Tank Install Remove
When installing/removing lank(s), cafl for inspection by Fire Marshal and Plumbing Inspecfor
Nature of Work:
PerRtit Fees: $7050 Underground tank insiallationkemoval'
$5050 Minimum (includes State Surcharge)
or
ContractValue $ x 1% PeimitFee
$ State Surchuge
If oermit fee is less than $1,000, add $.50
If oermit fee is more than $1,000, surcharge
is $.50 for every $1,000 owed.
$ Total Fee
I bereby apply for a Commercial Mechanical Pemilt and aclaiowledge 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 with the Mechanical Codes; that I understand this is
not a permit, but only an application for a permit, and work is not to start without a pemut; that the work will be in accordance with
the approved plan in the case of work whicb requires a review and approval of plans.
Applicant's Printed Name ApplicanYs Signature
Approved By: , Inspector Date:
Requfred Inspections: - U.G. _ R.I. - Air Test - Gas Service Test - Infloor Heat _ Final
Dec 16 2009 7:57AM O'Connor's One Hour
City of Eaftall
3830 Pilot
Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Date: 1 L.'
Tenant:
651-437-5943
Pion:
Permit #:
p.2
Permit Fee: :6' 60
Date Received:
Staff:
2009 MECHANICAL PERMIT APPLICATION
Site Ad • ress:
RESIDENT / OWNER
Suite #:
Name: Ira' / Phone: tig f -04-i 5
Address / City / Zip: 4VA 1 Pli 'e "1f(
CONTRACTOR
Name:J �r.�NNfros� MfL,La a,n61Yl/� S Hrr�y 7^ia�lS
Address: ///90 V L6;1
)) 5r
City: / 7/iv '
Phone:57_t/37'.!/27
TYPE OF WORK
PERMIT TYPE
RESIDENTIAL FEES:
License #e E-�.5,59 4' 2
Contact Person:
Description of work:
Siate:A7/V Zip:.5
New � Replacem
t4 dditiona! Alteration Demolition
ac -e
RESIDENTIAL
Furnace
Air Conditioner
Air Exchanger
Heat Pump
Other
COMMERCIAL
New Construction Interior Improvement
Instal! Piping Processed
Gas Exterior HVAC Unit
Under l Above ground Tank ( Install/ Remove)
"When installing/removing tank(s), call for inspection by Fire
Marshal and Plumbing Inspector
$50.50 Minimum Add-on or alteration to an existing unit (includes $.50 State Surcharge)
$90.50 Fire repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge)
COMMERCIAL FEES:
$70.50 Underground tank installation/removal
$50.50 Minirnum (includes State Surcharge)
- If Permit Fee is less than $1,000, surcharge is $.50.
- If Permit Fee is > $1,000, surcharge increases by $.50 for each
$1,000 Permit Fee (i.e. a $1,001-$2,000 Permit Fee requires a $1.00 surcharge).
OR
TOTAL FEE
Contract Value $ x 1'�0
$ Permit Fee
$ State Surcharge
TOTAL FEE
hereby acknowledge that this information is o'mplele and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that
I unde :.nd this is nota .er• . t only a a placation for a permit, and work is not to start without a permit; that the work will be in accordance with the approved
pra e case of wor y� - c fres a r: i w and approval of plans.
. f I
Appit, ant's -Printed Name
X 276 -9
Apptican is Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA117612
Date Issued:10/21/2013
Permit Category:ePermit
Site Address: 4041 Mica Tr
Lot:20 Block: 5 Addition: Cedar Grove 5th
PID:10-16704-05-200
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 .
William Krech
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 -
Laura J Mack
4041 Mica Tr
Eagan MN 55122--294
(651) 341-5378
Krech Exteriors Inc
5866 Blackshire Path
Inver Grove Heights MN 55076
(651) 688-6368
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA121322
Date Issued:03/25/2014
Permit Category:ePermit
Site Address: 4041 Mica Tr
Lot:20 Block: 5 Addition: Cedar Grove 5th
PID:10-16704-05-200
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 -
Laura J Mack
4041 Mica Tr
Eagan MN 55122--294
Krech Exteriors Inc
5866 Blackshire Path
Inver Grove Heights MN 55076
(651) 688-6368
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA154093
Date Issued:02/19/2019
Permit Category:ePermit
Site Address: 4041 Mica Tr
Lot:20 Block: 5 Addition: Cedar Grove 5th
PID:10-16704-05-200
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener).
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Laura J Mack
4041 Mica Tr
Eagan MN 55122--294
Tony's Appliance
2090 County Road 42 West
Burnsville MN 55337
(952) 435-2442
Applicant/Permitee: Signature Issued By: Signature
For Office
♦ • i : + E AGA N
Us,ç
0♦` 1,,,, '+ '• (0,C,
Permit#:
Permit Fee:
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 Date Received:
(651)675-5675 TDD: (651)454-8535 I FAX: (651)675-5694
Email: buildinginsoections( citvofeagan.com Staff:
Commercial Plan Submittal: eplansCa�.cityofeagan.com L
elo 0-1
2019 RESIDENTIAL PERMIT APPLICATION
r \ , 1/4
Date: e lzs-----4 Site Address: 1 q( WI(G01 j AGJ II �`j
V
Tenant: Suite#:
4 Name: 142
� l�e y Phone: 6571-373' lL7
Jlit v Address/City/Zip:
4 �
n�� i` L�! q*d�i r Ne: 1�/- C5C11„ x amkr
rdr
Coyi
' Address: �gf� t cV U City: ( ;'°„ f Z
'r.k� :it State: G(/1W Zip:
�G'� Phone: 6 c-1 - 5- _To_OG'
.�.,,� ° < Contact: I w, ��/ {tgj Email: 1 14„)
n �j�// five �i
� a w � t�? 44 VII/!'kl
$ -: RESIDENTIAL
� pfi i rr
t-ttttittAt,ttt,:tttttttiw it
Furnace
V_ ," .. :554,P _Air Conditioner
Perm
',,a Awa : _Air Exchanger
Itii7
},m{, „ ,r _ —Heat Pump
„ Other
� � ti'''''' P New Replacement additional Alteration Demolition
-4 _;,' / -y--&-_, f.r' so, fif
'p e .' kr ` Description of work: i 4c, "� U,P�' 1 Glf L�✓! �j ��
V
-. -::',,,,, 2 IL, ,?.....v., 4)41.4 , (.5R 5 II N-7c,
RESIDENTIAL FEES
$60.00 Minimum Add or alteration to an existing unit, includes State Surcharge
$100.00 Residential New, includes State Surcharge =$ TOTAL FEE
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update
on the City's website at www.citvofeagan..com/subscribe.
I hereby acknowledge that this information is complete and accurate;that the work will be ini 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 s - without a permit; that
the work will be in accordance with the approved plan in the case of work which re review i a pr. =� �
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PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA159997
Date Issued:02/04/2020
Permit Category:ePermit
Site Address: 4041 Mica Tr
Lot:20 Block: 5 Addition: Cedar Grove 5th
PID:10-16704-05-200
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 -
Laura J Mack
4041 Mica Tr
Eagan MN 55122--294
Haley Comfort Systems
4320 Hwy 52 N
West Frontage Rd
Rochester MN 55901
(507) 281-0138
Applicant/Permitee: Signature Issued By: Signature