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4655 Nicols Rdcinr oF E?GAN , . 3795 Pilot Knob Rood Eogae, MN 55122 N2 5672 PHONE: 464-8100 i BUILDING PERMIT Receipf # To be uad for Est. Value Dote , 19 ? s -' Site Address Erett ? Octuponcy Lot Block $ecl.Sub. Alter ? Zoniny porcel # Repair ? Fire Zone ce W 3 0 0 ou u? ? Enlarge 0 Type of Const. Name Move C] # Stories Addreu Demolish ? Front ft. City Phone Grode ? Depth ft. N Approvols Fees ome Addreu Assessment City Phone ? Woter & Sew. Police Name Fire Address Enp. City Phone Plonner ? Council Permit Surchorge Plnn check SAC Water Conn. Water Meter I hereby ocknowledge that I have read this opplication ond state thot Bldg. Off. the informotion is correct and cgree to comply with all applicoble qpC Total State of Minnesota Stotutes and City of Eagan Ordinances. Signature of Permittee A Building Permit is issued to: on the express condition ihat all work sFwll be done in accordance with cll appiicable Stote of Minnesota Statutes ond City of Eagan Ordinances. Building Officiol INSPECTIONS DATE ? INSP. ? I Rough-In I F'nal Footinos L!A ??.4?f - ? Dote I Inap. Dote I Remarks 4 Q b ?o ?I V3 No.' 'T3 CITY OF EAGAN 3796 Pilot Knob Rood Eo9en, Mlnnesote 55122 Pbone: 454-8100 PERMIT INSPECTOR NOTIFICATION REQUIRED BY LAW FOR ALL INSPECTIONS Dote: Receipt No.: $ingle Site /lddress: Residentioi Lot Block 1 Sub/Sec. Ncme . 3 Address G1 O CitY Phone: Name ' ? ? Address v City Phone: This Permit is issued on the express condition thor oll work shall be Minnesota Stotutes and City of Eagon Ordinances. nf.°ia New/Alter./Repair. Cost of Instoilotion Pe?mit Fee SumMrna Tota I done in accordance with cll applicoble State of Building Officiol .? ?. .-?-r,z?,• ?C-. ?, . ' No. " Dcte: Site /lddress: Lot _ CITY OF EAGAN 3795 Pilot Knob Road Eagen, Minnesota 55122 Phene: 454-8100 PERMIT Block 5ub/Sec. ', iew OPfice BuildinF Nome T' 111 C g Address ' 1-s., i r-r AvE. ? City , T?1G Phone: Name ? Address ? City Phone: - This Permit is issued on the express condition thot oll work shatl be Minnesoto Stotutes ond City of Eogon Ordinonces. INSPECTOR NOTIFICATION REQUIRED BY LAW FQR ALL INSPECTIONS Receipt No.: Single Residentiol • • Nlulti Res., Comm./Ind. I New/Alter./Repoir. Cost of Instollotion Permit Fee Surtharge Total done in accordonce with all applicable 5tute of Buifding Official CITY OF EAGAN Remarks 51SI Addition Lot ? Blk 1 Parcel 1(1 1 fi93(1 (13n ni Owner • treet ??e? /T-?-f'-?J?l-??. State Improvement Date eP, Amount ual Years Payment Receipt Date STREET SURF. STREET RESTOR. GRADING SAN SEW TFiUNK 1973 299. 25 19.95 15 ,t SEWERLATERAL W:qa 9 65 576.24 15 WATERMAIN * WATERLATERAL 1980 LS WATER AREA -14/1 1977 ,f' * STORM SEW TRK 1980 IS +t STORM SEW LAT 1980 15 CURB & GUTTER SIDEWALK STREET LIGHT WATEF CONN. BUILDING PER. SAC PAR K OF EAGAN Pilot Kneb Road MN 55122 us Ancicrs PERMIT NO.: - DATE: No, of Units: - I'13I caa. Address: tio. No.: No., to Comply with fhe Citr of Eagan OF EAGAN Pllot Knob Road , MN 55122 Connection Charge: Actount Deposit: _ Perr»it Fee: • Surcharge: Misc. Charges: - Totol: Date Paid: SEWER SERVIGE PERMIT PERMIT NO.: DATE: No. of Units: Site Address: • Plumber: • 1 agree to eompir with !he City of Eagon Connection Chorge: Ordinanees. AccounY Deposit: Permit Fee: Surcharge: BY Misc. Chorges: , Date of Insp.: Insp.: Total: DoYe Paid: CIT"f OF EAGAN SEWER SERVICE PERMIT 3795 Pilor Knob Road PERMIT NO.: Eagon, MN 55122 DATE: Zoning: No. of Units: Owner: Address: Site Address: Plumber: I ogrea M complr with the City of Eogon Connection Charge: - Ordinonces. Account Deposit: Permit Fee: Surchorge: By Misc. Chorges: Date of Insp.: Total: ; Insp.: Dat P ld e a : cirr oF ea"N . 3795 W1ot Kno6 Rwd Eagen, MN 55722 N2 5672 ,} t , PHONE: 4548100 BUILDING PERMIT 'APPLICATION Receia+ # - z???-- To 6s wad hr Office Est. Value 421,500.00 pme 4/3/ 19g0 $iM Address x s Emct a Occupancy R? Lot 3 Blo,k 1 5g?/ ? Durnings Alter ? Zoning T,R Purcel # Repnir ? FireZone TTT E l TI T f C t n arge ? ype o ons . z. Nome Wm. F. Brandt µove ? .# Srories 2 i Addreu 15010 Glazier Ave. Demolish ? Front 45.5 ff. o . AppleValley k32-3z 0 Gmde ? oeprh F- fr. a2 - 5 c vhone ?, + r w N me Kraus Anderson Avvrovals Fees z?°, ? Address 200 Grand ? ,-:.,, St.Paul.MN 5%M1 291-7086 ?W I Nnme Pope Associ ates Inc ?w 1(15 Address 533 St.Clair Ave. aW Citv St.Pau1,MN S42e 226-8$94 I hereby ackrrowledge that I h ad this application and state thnt the information is mrrecT nd gree to tompl with all applicable StaM of Minnesota Sta e qd Citypt?Ea_Ordinances. $ignMUre of Permitfa A Bu(Iding Permit is ' d t• K AnSOri cll work shall be done in accordapcewith oll ao iwble State of AsSessment 1/1(7 / t5t 7 Water & Sew, Police Fire Eng. Planner Council BId9. Off. 3120180 APC Permit 5?h-50 Surcharge 210- 50 Plan check 268 _ 25 SAC 21nn_oD Wnter Conn. Water Meter _Il?& FcL.?295 12.99 acres) Torol on tha express condition thot Statutes nnd City of Eagon Ordirwnces. Building Officiol CITY OF EAGAN ... ' BUILDIDK; PERMIT APPLICATION 7b Be Used For ? p Valuatio n?? 5b O? - Site Address: .96'S'S Ex?ect Lot ? Block Sec. /Sub. rA Itl 5 Parcel #: O (L31 D-? Alterr ReP1i Oaner: l?ix ic, Erilarge - Move Pddress: /SO?p t' /a zeP.-g /,P d e Desrolish _ City/Zip Code: a/l? Grade Prwne #: g3 z 3 2 0 0 ' APPROUAis Contractor: „a. a,„ ?? -?F?„' Assessments ? Address: City/Zip Phone #: ? `?? r -?Water%Sewer Z nn l ram Police Code: ?f- .?,/ #„ s r"/Ol Fire 7b 8"8- Eng' Planner Arch./En9•= 7ojP,* ?S'tr?Ctq?/?'J ,Ac. Council - ? , Bldg. Off. P,ddress: s3.3 .yf" ?7qt,P' /.7d, APC /- z2 - Pa -p Perrftit Surcharcje p Plan Check- 16 sAC z?oo= Water Conn. Water.Meter I Road Unit 1,9j95 City/Zip Code: Pnone #: 2,2.1 - TarAL ,S'F? C ?o'vo *b! Z ?1oa 'd?i? u.r;?' -.= 33 117 'It Irclude 2 sets of plans, 1 site plan w/elevations & 1 set o€ ezergy calculations. Date , j- /d - OFFICE USE OHI,Y :y 2oning ' LB Fire Zone 3 'iype of Const. ¢ # Stories FYont ft. DePth 919 -ft. ihis request void 1R.;.nmlhs from T?7 0 4 5 0 ct,??-?`' C? ?,>>? ° ?/??o// :TLic.ensad Elecvica? Convamor y« ?N„ ReatlY Nuw I?K'ill Nuu(Y InsOec- rc [or When Readv I hereby requxst inspeclion of above ?(?5S Agle,ctricai, workinstalledat: SvYet Address, BD*'tir Route Nu Ciry 5U?I"' ecLOn n. Town.shlp Name or . anpe No, (;oun[y Oe upantlPRiNTI Phone Ne. POwe, $upplieF AAAr255 Eiecvicxl ConVapor ICompn y Namel Convactor"v License No. MailinB AdJress IC ntrnr.mr or Owner Mnkinp Insiailation) ?? Autho rzed $iyna[ure ICon[rector/Or Making Installa[ionl . Phone Numher ? ` ' GI/ , Aj ,J ea o 6•J , MINNESOTA STATE 60Afl0 OF ELECTRICITY THIS INSPECTION NEQUEST WILL NOT' Griggs-Mitlway Bldg. - Noom N'-191 ' eE ACCEPTEO BY THE STATE BOARD UNLESS PROPEfl INSPECTION FEE IS 1821 Universiry'Ave:. SL Paul, MN 55104 Pnnnn 16121 29Z211t . ENCLOSED. REQUEST FOR ELECTRICALTNS?ECTION EB-D0001-03 ' Sae instructions for cornVleting this torm on back ol Vellow copy. ?cl T 70450 ' ?' I(v "X" Below Work Covered by This Reyuest 16997 New Atld flep. Type ol Building AppliancBS Wired Equipmenl Wired Home fiange Temporary Service Duplex Water Heater Liyhtiny Fix[wes Apt. Builciirtg Dryer Electric Heatin Commercial Bidg. Fumace Silo Unloader Industrial Bldg. Air Conditioner Bulk Miik Tank Farm oinnr peuly Iner Isoer.ifvl t er pecily Ot er Orher UO/l)O[IIP IIISOPf7/00 FPP RP/OW d Fee ServiceEnhence5ize p Fee Feedees/Subfieedars +! Fee Circuits 0 to 700 Am s 0 to 30 Am s 14 149,0 0 to 30 Am>s 101 to 200 Amps 31 to 700 Amps 31 [0 100 Am Abeve 200 qmps Above 700-Amps Above 700_Amps Transforrners Remote Control Circ. Partial,'(Dther Fee Signs Speciailnspection $ T ?p /,0, OTAL EOZ)p J . ou9h-in ' i n ? Date / I, the Electrical Inspactor, hereby tit th F1Oa1I ? ^Q? / cer y at tho ibuve insVection hes baen ol( ? made. rnis reti vmd 18 months fiom This request wid 18 months from ?? Date of this Rgquest_DEr, aCo I qit_ Fire No. S 97514 I, as %Zicensed Electrical Contractor ? Owner, do hereby request inspection of the above electri- cal wiring installed at: Streei Address or Route No. Ciry E Section Township Which is occupied by Range County ?aNrrt-?4_ Is a roughin inspection required on this job? No ? Yes [?L Ready Now a Will Call ? Power Supplier nA`ll? -, L5c`t- Address ?F L, CLFGC?IC. -y?SS Electrical Contractor Contractor's License No. _ (COmoany Name) •/ Mailing Address VTILF'? _4-uE Sc? s?/1l4-G? ? /1 ncai conxractor owner makin9 rnls Instauatlon) Autho?zed Signature ?Q- Phone No. ANy47 98 (Electrical Con ctor or Owner Mekln9 This Instellation) ?? Ir1` ?( ? .?? ?, ?n ?j'O?? This inspection request will not 6e accepted 6y the Uv ? lYl Ii?511'BV V State Board unless proper inspection fee is enclosed. minnesoca awce ooara or uaccncicy +? - Griggs Midway Bldg. - Room N191 1891 University Ave., St. Paul. Minn. 55104 - Phone 297-2111 7" REQUEST FOR ELECTRICAL INSPECTION ; CHECK BELOW WORK COVERED BY THIS REQUEST 9 7 514 ? Type otButiding New Add. Rep. Check Appliances Wired For Check Equipment Wirod Fot Home ? ? ? Range ? Temporary Wiiing ? Duplex U ? ? Watei Heater ? Lighting Fixtuces ? ApL3lidg. ? ? ? Dryec ? Electric Heating ? Commeccial Bldg. ? ? ? Fumace ? Silo Unloader ? lndustrial Bldg. ? ? A'u Conditioner ? Bulk Milk Tank ? parm List ) L ist ) Other ? ? ? p y HeieIS) p } Hehetsl COMPUTE INSPECTION FEE BF,LOW Secvice Entrance Size: # Fee Fceders&Subfeeders: # Fce Cucuita: # Fce D to 100 Am . 0 to 30 Am eres 0 to 30 Am eres 101 to 200 Am s. 31 to 100 Am res 31 to 100 Am eres Above 200 Amps. Above 100 Amps. Above 100 Amps. Transformecs AemoteCont[olCirc. Partialo[otherfee Signs ns ection Minimum fee $5.00 Remazks TOTALFEE ? I, the Electrical Ins ctor, he '" that the vs ins cti has been m . ? ?bi°.,< 119, (Final) Th.. .a, This request void I S months from Date of this Request y Ca '161"- 53-0 S_ 487 46 I, as L?,Licensed Electrical Contractor 0 Owner, do here>Y'request inspe on of the above electri- cal wiri.,g instatled at: ? Street Address or Route No. Section Township Range Countyoo/¢/r'd'Ti'4 Which is occupied by Is a roughin inspection required on this job? No ? Yes El Ready Now ? Will Call ? Power Supplier Address Electrical Contractor f?/j'/? e- Contractot's ?cdnsPo (COmpany ame) ? Mailing Address Authorized Signature No ? S'y? MQTE' WOOD OpY This impection request will not be aceepted 6y ffie State Board unless proper inspection fee is enclased. IIIIIINNEWFTFffard of Electricity ve., St. Paul, Minn. 55104-Phone 645•7703 QUE C C BE OW WO?R3iOCOVERED BYI TH S EQU ST'ON 5 ?" 4 8 7 4 6 Type of Building New Add. Rep. Check Applisncea W'ved For Checlc Equipment Wiied Fo: Home „ ? ? El Range ? Tempoxary W'ving ? Duplek ' ? ? ? Watei Heater ? Lighting Fixtures ? Apt. Bldg. ? ? ? Dry ? Electric Heating ? Commeicial Bldg. ? ? ? Fu Silo UNoader ? Industrial Bldg. ? ? ? A. it' Bulk M0k Tank ? L is 1 List Other- ? ? ? p } Hehelsl p Hererg? COMPUTE INSPECTION FEE BELOW Secvice Entrance Size: # Fee Fcede?s&Subfeede?s: # Fee C'vcuits: # Fee 0 tb 100 Am s. 0 to 30 Am res 0 to 30 Am ies 101 to 200 Am s. 31 to 100 Amperes 31 to 100 Am res Above 200 Amps. - Above 100 Amps. Abave 100 Amps. mecs g Remote Control Circ. Paztialor otherfee S' n Special lns ection Minimum fee $ marks r?1 ? ? J.2 ?pT ?/ ?i??f0 ? ?ECy TOTAL FE 7 r+ I, the ElecMcal Inspector, hereby certify that the above grpeciion has been made. (Rough-in) Date (Final) pate This request void 18 months from - T,his request void 18 months frrom iif 7,,.f .S" `f a/ /98D . g 46154 Dat¢of isRequest I, as Licensed Electri 1 Contractor O O e, do hereby requelt inspecti the above electd- cal wiring installed at: ? ? ? Street Address or Route„No. y? &6- 6 &l 1?4? Citv? Section 1Yhich is occupied by (rvame o* uccup q -/ Is a roughin inspection required on this job? No ? Yes Ready Now ? Will Call Bd Power Supplier [ ?Address ? Electrical Contractor KENDRFCR F7.F.C'TRTC a38&'"r's License No. _ Mailing Address ? VT4? P9kNOCK LANE a stallatlon) AMNIMELETO Authorized Signature r'! E t?v itswmnrnv n?n en'P?one No. (eie?trioYtdKt?dttot n @ 0 . This inspection request will not be accepted by the RU 0 o ??, ?D COPY State Board unless proper inspection fee is endosed. Minnesota State Board of Electricity ' 795'4 University Ave., St. Paul, Minn. 55704-Phone 645-7703 " ;.FfEQUEST FOR ELECTRICAL INSPECTION CHECK BELOW WORK COVERED BY.THIS REQUEST l00 7'4?s- S .. -4Mt} Type of Building New Add. Rep. Check Appliances W'ved For Check Equipment Wired Fm Home ? ? ? Range ? Temporary Wving ? Duplex ? ? Water r ? Lighting F'uctures ? Apt. Bldg. ? ? Dryer ,. Elechic Heating ? CommeccialBldg. ? ? ID Fuma'? A SiloUnloader ? Indusiria] Bldg. ? ? ? A'v Co itioj Bulk Milk Tank ? Farm ? ? ? List ) Lis[ Other ? ? 0 p } Hehergl p Heiers COMPUTEINSPECTION FEE BELOW Service Entcance Size: # Fee Feedera&Subfeedexs: # Fee Crtcuits: # Fee 0 to 100 Am . 0 to 30 Am eres 0 to 30 Am eres 101 to 200 Amps. 31 to 100 Amperes 31 to 100 Am eres , Above 200 Amps. Above 100 Amps. Above lOQ_Amps. Tranformexs RemoteConvolCuc. Paitialorotherfee Signs Special Ins ec[ion Minimum fee $5.00 Remazks / l TOTALFEE ? I, the Electrical Inspector, hereby cer at t e? ins e' n has been made. 947-m p (Rough-in) ? Date (Final) Date This request void 18 months from ? `'?' s-. ?- so ? ? 17-SU , 3d40 ? • \ 1 ' t 7-- 7-/ 7- ?O 7..,?,X_ka g-0 tYi.?'•?_S..? : C . . •?.F ?1...? . , , ?)?i L Tlvs request void 18 months from ol 3?? 73-< Date of u Request dp $ 46152 I, as lJ Licensed Electric Contractor Owner, do hereby re?uest inspection of the above electri- cal wiring installed at: /?/ Jc, 05_ Street Address or Section Which is occupied by ' - ' - (Name of Occupa Is a roughin inspect/ion1 required on this job? No ? Yes Ready Now ? Power Supplier A&./tfiAddress ?Q???•C?4_, Electri cal Contractor A91740r's L Mailittg Address 14540 PENNOCK LANE ApntaV=Ey o??'q fa5c ,,, Authorized Signature hone No. Will Call W No. STA`?[?' a ?o????? ???? This impection request will not 6e aceepted by the CJ ?[, State Board unless proper inspxtion fee is enclosed. Minnesota State Bolrd of Electricity ' 195410niversity Ave., St. Paul, Minn. 55104-Phone 645-7703 •? REQtJEST FOR ELECTRICAL INSPECTION CHECIC,BELOW WORK COVERED BY THIS REQUEST ? 48152 Type of Building New Add. Rep. Check Appliancea Wired Frn Check Fquipment W"ved For 4iome ? ? ? Range ? 'fempotazy W'ving ? Duplex ? ? ? WatecHeater ? LightingFixWres ? APt. Bldg. P/ ? ? Dryec '.• Electric HeatinB ? Commeccial Bidg. L?l ? ? Fuma A ID Silo Unloader ? Industrial Bldg. ? ? ? A'v C ditio Bulk Milk Tank ? Farm ? ? ? List is List O ers? Othei 0 ? ? ?e? ere H COMPUTE INSPECTION FEE BELOW ' Service EnUance Size: # Fee Fcedus@Subfeedeis: ?t Fee 1 1 Cucuita: # Fee 0 to IDO Am s. 0 fo 30 Am eres 0 to 30 Am res 101 to 200 Amps. . 31 Co 100 Am res 31 to 100 Am res Above 200 Amps. 1 1 Ab've 100 Amps. - ' Above 100 Am s. Transformeis 1 1 RemoteContxolCirc. Paztialorotherfce Signs S ecial lns ction Minimum fee $5.00 Remazk /' ? . . ? _//L7J ? /Zle?J .,.?- TOTAL FEE (Final) This request void 18 months from that the above inspection has been mad .?/ • m V Date 74 ? lnar« ?f - ? ThisreQUes[vaid7-zD L31I?I1 `EC1CltVcCW te.month?rom / ?D ?06 V 07 0116 7- /V ? cp 7? Reque ?aie Fire No. I ough-in Inspection eqmrod? ?Reatly Now Will Notifv InsOec- ??? ?,? I ?Yes ?NO ,or When ReadY Licensed Eleclrical Conlnc[or 1 hereby request inspaction of above Owner electricel work installed at: Streof Address, Box or Fovte No. ? ' ?? City ?6S ecLOn o Township Name or No. I Range No. County Occ ant IPRINTI i one No. i ' .POwer $appl? I ? I Address Electrical Convact r(ComDa Name) I Conlractor's License No. MailinB AdJress (CO traC[or or Owner Makin8lnstailationl t? I ? L n A orized Signature (COnuactor Owner? aking In stallation) Phone Number MINSVESOTA STATE BOAflO OF ELECTqICITV ` THIS INSPECTION HEQUEST WIIL NOT Grigps•Midwey BIG9. - Noom N-197 I BE ACCEPTED 9V THE STATE 80AND 1821 Unive.sitv P.va., St. vaul, MN 65704 UNLESS PHOPEX INSPECTION FEE IS ...___ 1-1 - n ... I ENCLOSED. REQUEST FOR I ELECTRIC?AL IN$PECTION ?-yEB-00001-04 a. ? , Seo inaVUCtions for completing this form on beck of yellow copy. 070116 I atjo Z &?? t?- "X" Below Work Covered by Thi's Request Naiti Add fleo. TYOe of Builtling I Appliancxs Wired Equipment WireA Home ? Range Temporary Service Duplex Water Heater Lightiny Fixtures Apt. Building ? Dryer Electric Heatin Commercial Bldg. ? Fumace Silo Unloader IndusVial Bldg. ? Air Conditioner Buik Milk Tank FBfhi ? Other paw y Other f5per.iiyl t er uecily I thcr Othe, Compute lnspection Fee Below I J O M Fee ServiceEntrenceSiie k Fae Fexders/5ubfeedere H Fee Circuits U to 200 qm s ? 0 to 30 qm s 0 to 30 Am s Above 200 qmps ? 31 to 100 A m p s 31 to 100 A 5 Swimming Pool ? Above 100_Amps Above 100_Am s Transiormers I Irrigation Booms 'ra Partial% Fee SignS ? Speciai Inspection S 67 /Renrks/ _ V s ? I . / . _ Ia SO 7 AL FEE I Q? ? I .-lke-Fractr ica I InsOectoq heroby certify that the above insoection has been 'mede. Tnie mnuwst vnitl 7his request void 18 months from ? Date of this RequestSRr? o? fp t)`{?8/ Fire No. S 97516 I, as ?,L.icensed Electrical Contra itor ? Owner, do hereby request inspection of the above electri- cal wiring installed at: Street Address or Route No. Ll(b'45;-4; 41c uoLs 4,04?_ City F<r14N Section Township I Range County /JvQ-IEn1-4_ - i Which is occupied by /J c)0-?y p-I -r-?- 12gqt?T4 (Name Occupant) [s a roughin inspection required on Chis job? No O Yes 1,i?. Ready Now O WID Call JR PoVVerSupplierDp,tlviA ?Ilac.:Y Address ? I ?--YasS Electrical Contractor l'm 7'.+P kC- Contractor's License o. _ ` (COmpaoy NaTe) MailingAddress /4)A'?N C)'f'lGJ4- 40!? -C.0 EIe I Contractor or Owner Makinq This Installatlon) Authorized Signature _C?J<Aa?{ Phone No. 84q-?56Q? (Elactric?al Contrac or?nner his Installatlon) ? T J? 1 f? 0 (0) r?;\ ?D I Q? u,?U This irnpection request will nat 6e aceepted by the ifv State Board unless proper inspectian fee is enclosed. immnesoia ataY no9ra or necawi[y Gri?s Midwa Bld floom N191 rA E13-00001-02 7821 University Ave., St. Paul, Minn. 55104 - Phone 297-2111 REQU CHECR'8€-L9fN ORi:OCOVEREDTBY'THIS EQUEST'ON ?J S 97516v Type of Building New Add. Rep. I pi¢ck Appliances W'ved For Check Equipment Wired Foc Home ? ? ? IRange ? Tempoxary Wiring D Duplex ? ? ? 'Wa[er Heater ? LightingFix[ures I& Abt. Bldg. ? ? ? Dryer ? Eiectric Headng ? Commexcial Bldg. ? ? ? Fumace ? Silo llnloader ? Indostrial Bldg. ? ? ? A'v Conditioner ? Bulk Milk Tank ? Farm ? ? ? IpList ) L ist ) Olher ? ? ? } IHehel$) p } AeheI$) COMPUTE INSPECTION FEE BELOW Service Entxance Size: # Fee ?Fcedexs&SubPeedecs: # Fce Circuita: # Fee 0 to 100 Am s. I 0 to 30 Am eres 60 0[0 30 Am eres lOl to 200 Amps. 31 to 100 Amperes 31 to 100 Am res Above 200 Amps. ,Above 100 Amps. Above lO-Amps. Transformers 'RemoteControlCire, Paz[ialorotherfee Signs Special lnspection Minimum fee $ Remazks I ? , , T)1TAL FEE I (?,O f.f I, the Electric e? e ? cer ?' y that the aspe ' b (Rough-in) a L?, s t _, q-?l ae (Final) I at6 This request void 18 months from This request void 3 3 5 3 S ,;'&??9368 7 Rpq6est ate Fire No. Fo?eh-in Insoection quYred? Re ? - ReadY Nuw ill NotifY InsOer k d ? ? es No r When Peady Licens'ed ElecVical Contractor . I hereby requeat inspection o9 abova Owner electrical work installed at . Street AdAress, Box or Poute N. ! - ' Ciry ?6rs ecbon o. Township Name or No: . Range No. I Cnunty ani (PRINT) Phone No. I 1 x Power Supplier Address o , EI [rical Conha tor (Com any Nam ) Contractor's Lirense No. ' a 3 O Mailin9 AdJress IConttac or or wner Making Instailationl s 2 ? Aut orized Signamre (ConVactod0 er Making InstallatioN Phone Nvmber ??6r? MtNNESOTA STATE BOARD OP EIECTqIC1TY THIS INSPECTION REQUEST WILL NOT Grie9s-Midway Bldg.-floom N•197 ! BE ACCEPTEDBV THE STATE BOANU 1821 University Ave. St Peul, MN 65104 UNLESS PflOPEN INSPECTION FEE IS ' OF....u 1N111'l4l_7111 I ENCLOSED. 1'?I REQUEST FOR ELECTRICAL'INSPECTION EB-60001-03 ?u + 9 3 6 8 ? See instruc[ions tor completi" lhis torm on bnck of yellow coav..? __ 335 3$ "X" Below l?orkCovered by Thrs Requesl : Adtl Xep. Typa of Building APOhancea Wiretl Equipant Wired Home Range Temporary Servte Duplex Water Heater Lightiny Fixtures Apt. 8uilding Dryer Electric Heatin Commercial Bldg. Fumace Silo Unloader Indus[rial Bldg. Air Conditioner Bulk Miik Tank Farm Offiar. peufv Othmr (SOecify) [ er Ver,iry t cr plher Cnmpute lnspection Fee Below q- p k Fee Service Entrance Size # Fee Feaders/Subtaxtlars # fee Circuits 0 to100Ams 0 to30qms O Oto 30Ams 101 to 200 Amps , 31 to 100 Amps 31 to 700 Am s Above 200 qm s Above 700_Amps Above 100_A ps Transrormers flemoteControl Circ. Partial'Other Fe Signs Speciallnspection 5 fiemarks /0 SO ?T917 ?E All LtiP iYl P?r ALti lAn 1/Jw/?l ?' Fough-in Date I, tha Elec[ricel ( InsOec[or, hereby it Final cert y thet the above inspeetion has bean ( •?/F ae. This request void 18 months hom ? , 276- Z57Y' ,---------- --, For oifice{us " I I ? / ? ? Permit#: -? / `? I ? I j Pertnit Fee: / 7o • S ? I ? ? Date Received: ? ? I ? I ? Staff: I C.?T 2008 COMMERCIAL BUILDING PERMIT APPLICATION Date: `' l(- Qao Site Address: TenantName: (Tenant is: _ New / Existing) Suite #: PROPERTYOWNER Nams /f/KII`LtIG(O NC?-Phon ? 'S? Address / Ciry / Zip: 91(0Z_A'1?LV'l, W O? Applicant is: Owner _ Contractor TYPE OF WORK Description otwork: &/GLF"?"l Construction Cost Z viK' ?r- CONTRACTOR Name: 1 1-1 License Address: AVU City: /G? State: AIN Zip: S7SZ)7 T Phone:aJ/-- Contact Person: Bletiw ??K?y ARCHITECT / Name: Registration q: ENGINEER Address: City: State: Zip: Phone: Contact Person: Licensed plumber installing new sewer/water service: Phone NOTE: Plans and supporting documents that you submif are considered to be public information. Portions ol the lnformation may be classified as non-public if you provlde speclfic reasons that would permit the City to conclude that fhe are hade secrets. I hereby acknowledge that ihis inlormation is complete antl accurate; that the work will be in coniormance vnlh the ordinances and codes ot the Cily of Eagan; thal I understand this is nof a permii, but only an application for a permit, and work is not t starl without a permd; Ihat the work will be in accordance with ihe approved plan in the case of work which requires a review and approval of plans. x ls1P.llarQ.a x ApplicanPs rinted Name Applicant's Siga? oL?s ? AUG 1 9 2?08 Page t of 3 ; DO NOT WRITE BELOW THIS LINE SUB TYPES: ? Foundation ? Apartments ? Lodging ? Miscellaneous WORK TYPES: ? New ? ? Addition ? ? Alteration ? Replacement? aW Valuation 600 Plan Review ? (25%_ 100% Census Code il of Units # of Buildings Type of Const. ? Public Facility ? Accessory Building ;k Commercial/lndustrial O Ext. Alteration-Apartments ? Greenhouse ? Ext. ANeration-Commercfal ? Antennae O Ext. Alteration-PUblic Facility ? NailSalon Interior Improvement ? Siding ? Demolish Building` Move Building ? Reroof ? Demolish Interior ? Fire Repair ? Demolish Foundation t?lJ ? Wmdows ? Wat2r Damage ' Demolltion (entire building) - give PCA handout to applicant Occupancy Code Edition Zoning Stories Square Feet Length Width Footings (new bldg) Footings (deck) ,7 Footings (addition) ? Foundation Drafn Tile Roof: _ Decking _ Insulation _ Fnal _ Ice/Water Framing Fireplace:_R.I. _AirTesl _Final Insulation MCES System SAC Units City Water Booster Pump PRV Flre Sprinklers Sheetrock Meter Size: ?/Fmal/C.O. ? Final/No C.O. HVAC Other: PooL• _Fooling • Siding:_Stuc Windows _ Retaining Wall . ? s Air/Gas Tests Final co Lath Stone Lath Brick Final CIO Inspection: Schedule Fire Marshal to be present, _ Yes _ No .r? 1, Reviewed By: ?v , Building Inspector Reviewed By: Planning COMMERCIAL FEES: Base Fee 103.7, s' Surcharge Z . " Plan Review (07 I I SAC-MCES SAGCity S/W Permit Financial Guarantee S/W Surcharge Storm Sewer Trunk Treatment Plant Sewer Lateral Treatment Plant (Irrigation) Street Park Dedication Water Lateral Trail Dedication Other Water Quality Water Supply & Storage (WAC) Total Sewer Trunk Water Trunk I-7Zr ? Page 2 of 3 eb"uw s.i. lu,enu 5.1. iu.Z-ikj N.I. I 3i.1z zes 24.3% 86 43 43 -'°-- EAS $?.IOwN .i S m 3G Sa?r?BD oJ3ro ol3d f%l'C...QLS Rb. l01)gc f.4.i r ?C?,? ?s4.I` ?NCIoS?r?Ge? 93 m I . .` \ ? %32 T I 'RECEIVED JUN 2 32008 ce 4 ? 2002 2Ll COMMERCIAL BUILDING PERMIT APPLICATION CITY OF EAGAN 651-681-4675 ,<610. D5 Foundation Onl New Construction Interior Im rovement • StrucWral Plans (2) sets • Architectural Plans (2) sels • Architecturel Plans (2) sets • Civil Plans (2) • Structural Plans (2) • Code Malysis (1) . Certificate of Survey (1) • Civil Plans (2) • Project Specs (1) • CodeMalysis (1)" • LandscapingPlans (2) • KeyPlan (1) . PmjectSpecs (1) • CodeMalysis (1) " • Master Exit Plan l tions C l E (1) (t ) not always" Spec. Insp. 8 Testing Schedule " 1 S l R t • • Certificate of Survey & Testing Schedule S ec Insp 0) (1) " • • nergy a cu a Elec. Power & Lighting Form (1) not always'" • • ) epor ( oi s Meter size must be esta6lished • p . . Meter size must be established . Meter size must be established - if applicable • ProjectSpecs (1) y • EnergyCalculations (1) " ! y • Electric Power & Ligh6ng Form (1) j . Master Exit Plan (1) L y • Emergency Response Site Plan (1) 1 Soils Report (1) 1 . MGES SAC determination letter • MGES SAC determination letter • MClES SAC delermination letter ca11651-602-1000 ca11651-602-1000 ca11651-602-1000 i ec? n? c mM fn. ilnMilc Food & beverage or lodging facilities - submit pian co mrv uepanmem ul ncalLi I . ?011 .... -? ?-?. ?? .???•-••-• Contact Building Inspections for sample. *** Permit for new buildings or additions will not be processed without Emergency Response Site Plan. Ask Building Inspectlons for requirements. DATE: WORKTYPE: WZ NEW _ REMODEL CONSTRUCTION COST: SITEADDRESS: 5-5- !v ??0 ?'S 12 C) TENANT NAME: SUITE #: FORMER TENANT NAME, IF APPLICABLE: DESCRIPTION OF WORK 4ZJ? (5L ) ?/?? ' 63.3? ^ Name: 1?-? V4 '-i erpP C.4(£ S ? Phone #: i PROPERTY Last , First OWNER ? StreetAddress: 5 ?- City: ?/06 C 1 t? XJ ?/ti State: 0,'l N Zip: Vc9i 3A0-C`i(J S`?IEJC 1(z?,AJ Phone#: (?? Z?- Company: CONTRACCOR Street Address: 3 I 3 3 N 1 Gn {?? t L*J ?? cicy: e: ARCHITECT/ Q? 1 2??"t O ENGINEER Company: Name: Street Address: City: State: lif/(/U Zip: Phone #: Registrarion #: Zip: Licensed plumber installing new sewer/water service: Phon I hereby acknowledge that I have read this application, state that the information is ct, a gr e to y with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant: Updated 7102 OFFICE USE ONLY SUBTYPE r ? Ol Foundation ? 26 Public Facility ? 30 Accessory Bldg. ? 14 Aparhnents >^ 27 Commercial/Ind ustrial ? 32 Ext Alt - Apts. ? 15 Lodging ? 28 Greenhouse ? 34 Ext Alt - Comm. ? 25 Miscellaneous ? 29 Antennae ? 35 Ext Alt - PF ? 37 Nail Salon WORK TYPE ? 31 New ? 35 Tenant Impr ? 42 Demolish (Foundation) ? 46 Windows/Doors ? 32 Addition ? 36 Move Bldg X 43 Reroof ? 47 Repair ? 33 Alterations ? 37 Demolish (Bldg) 0 44 Siding ? 48 Authorization ? 34 Replacement ? 38 Demolish (Int) ? 45 Fire Repair GENERAL INFORMATION Census Code 4Y7 SAC Code No. of Units ? No. ofBldgs. ? Const. (Actual) ?IJ (Allowable) ' UBC Occupancy ? Zoning # of Stories Length Width Basement sq. ft. First Floor sq. ft sq. ft. MISCELLANEOUS INSPECTIONS ? Gas Service Test ? Hearing APPROVALS Planning Building L-- - r3 sq. ft. sq. ft. sq. ft. sq. ft. MCBS System City Water Fire Sprinklered ? Insularion CC" Engineering q Plumbing ? Stucco/Stone Variance VALUATION $ (0) OOb ?g Permit Fee Surcharge Plan Review MC/ES SAC City SAC Water Supply & Storage S/W Permit 5/W Surcharge Treatment Plant Park Dedication Trails Dedication Water Quality Other Copies % SAC SAC Units Meter Size -, Total Proposal 6 12- " ? ? ? - 2-,n-7 z-(? C 1. L L -6l" (uc Proposal No. G.W. Cook Construction General Con[ractors • Commerciallindustrial Roofing otrce (612) 8221326 3133 Nicdlet Avenue South Fex (612) 822-0239 Minneapolis, Minnesota 55408 Mobiie (612) 940-5187 PROPOSAL SUBMITTED To ' - -T.. PMONE OW1E STREET . • J08 NAME ? . . ? . CCTY, STATE d ZIP CODE JOB LOCATION L. 1-6 _ WE PRQPOSE TO FURNISH ALL LABOR. MATERIALS AND EQUIPMENT NECESSARY TO COMPLETE THE WORK AS FOI.LOWS: f Ea-,r.? - . ? ?t ? 1-? ? ' ' • < ..-1''-? c . +?-? 1' ?' s?? , '? ' . ? ? ; : _ , ? j ?_ .,n ?..' .' ri F J ? ' ? .. ?',+'M T r? ,.. V ', ? ? ?- ? -T `` ? `'.•+-St . t • l? ? a ! ? ./t. " ;. ? :r r ? n?16T. M ?r-.. '?'t,, 1• ?+? ..:?,? . ,? I ? ., ' ? ? ? , ;?? r ,.?. .Ar.?? t - ?„ C??,?i ?.?",e?..a....t v? • i,} , .v`'a' .,1?' ? ,.? 40_? r 1..c.?o? ?'` ,!?-1?'? ?? :. ?,^? •`?-t ?.?^?n?.,.?.•+?. ;,..?,,+..a? 1?/ - 9 • A „ ,1 ? , .+..,?•a7?.?. .? f: s.. ?,j1_?'+4'? ?, t ?.:?`..?•, Y ? `? , ? ?. , ' ' r.. ? ..? , ? i- -.?.51 ?r.?.R,.?.. n:?, ? : . ,_ ?A_ . 1 =??c* 4.:+ ?G ?' ?' ? , ? r?:?.?-•L ,,,;r 06 7"7 / i - ? ?/ ` /'t !? ,_, ?,_,. •^ `iJ . ? _ y1_? '? i ` I . ? .. . - ? _I !J ••11.. • 'r '. ? F'. ? . . • ? ? r •, WE AGREE TO DO ABO'VE DESCRIBED WORK FOR THE SUM OF $ ? TO BE PAID AS FOLLOWS i t . ? : •.J?.r,• .r C CONTRACTOR TO CARRY 1NORKER'S COMPENSATION ANO PUBIlC LIABILITY INSURANCE ON ABOVE WORK. VERBAL AGREEMENTS Nf7T BINOING - AI.L ADDITIONAL WOFK AND AGREEMENTS , MUST BE SHOWN IN WRITING. ALL ORDEFiS ACCEPTED BY US WITH THE ' i UNDERSTANDING THAT WE ARE NC7i TO BE HELD LIABILE FOR CAUSES BEYOND 'j OUR CONTROL THIS PROPOSAL SUB.IECT TO ACCEPTANCE WITHIN 30 DAYS. 1.5% A-A"??--? L-- PER MONTH CHAAGED QN ACCOUNTS OVER 30 DAYS- ? AUTHOHIZED SIGNATURE We are required by law to provide you with the following notice regarding the rights of persons fumishing labor and materials. (A) Persons or companies furnishing labor or materials fbr the improvemerrt of real property may enforce a lien upon the improved land rf they are not paid ior their cantnbutions, even if such parties have no direct contractual relationship with the owner. (8) Minnesota law permits the owner to withhold from his contractor so much of the corrtract price as may be necessary to meet the demands of all 4ther lien claimants, pay directly such liens and deduct the cost thereof from the contract price, or withhold amounts from his coMractor until the eocpirartion of 120 days from the oompletion of such improvement unless the contractor fumishes to the owner wanrers of claims for mechanics' liens signed by persons who fumished any labor or material tor the improvement and who provided the owner with timely notics. I HAVE READ THE ABOVE AND ACCEPTED THE TERMS AND CONDITIONS OF THIS CONTRACT, SIGNATURE DATE iy ?--?--? Qa Y V-i -t-i.-3 ?- COMMERCIAL BUII.DING PERMIT APPLICATION CITY OF EAGAN 651-681-4675 1?-3i-c?l ??S- L .-?) 5 Foundation Onl New Construction Interior Im rovement • Structural Plans (2) sets • Archilectural Plans (2) sets • Architectural Pfans (2) sets • CivilPlans (2) . SWcturalPlans (2) • CodeMalysis (1)" • Certificate of Survey (1) . Civil Plans (2) • Projed Specs (1) • Code Analysis (t) . Landscaping Ptans (2) • Key Plan (1) • Project Spers (1) • Code Analysis (1) " • Master Exit Plan (1) • Spec. Insp. & Testing Schedule " • Certificate of Survey (1) • Energy Calculalions (1) notalways'" • Soils Report (1) . . Spec. Insp. & Tesfing Schedule (1) " • Elec. Power & Lighting Fortn (1) not always" • Meter size must be established • Meter size must be established • Meter size must be established - if appliqble • ProjectSpecs (1) 1 • EnergyCalcula6ons (1) 1 • Electric Power & Lightlng Form (1) 1 • Master Exit Plan (1) 1 1 • Fire Protection Plan (t)" 1 1 • Soils Report (1) 1 • MGES SAC determinaGOn letter . MGES SAC determinaUon letter • MGES SAC determination lefter call 651-602-1000 call 651-602-1000 call 651-602-1000 " Contact Building Inspections for sample Food & beverage or lodging facilities: Plan must be submitted to Minnesota Depa!tment of Health - ca! 651-215-0700 for details. DATE )D " I') -ON WORK TYPE _ NEW V KEMODEL CONSTRUCTION COST SITE ADDRESS L-K.S S M ; C?-p L.S RA TENANT NAME SUITE # FORMER TENANT NAME I 1cGr' c?t?" "iPLi ? S'??pX, 3SO S cl -!- DESCRIPTION OF WORK u Name: Phone#: (_) _ PROPERTY Last First OWNER Street Address City State Zip CompanY ? C,p e(](-\ S-"69CY1 JV1C Phone #( l4 I a" )?? /"?b I I CONTRACTOR <? SueetAddcess: 2?I?\ .`h ?T ?J L City C6kXriVX c" L?1 -'40;S State ml V Zip ssy a i ARCHITECT/ ENGINEER Company Phone # ( ) Name Registration # Street Address City - State Zip Licensed plumber installina new sewer/water service: Phone #: 1 hereby acknowledge that I have read this application, state that the informatlon is correct, and agree to comply with ail applicable State of Minnesota Statutes and Ciry of Eagan Ordinances. Signature of Applicant: \ '!? Updated t/07 OFFICE USE ONLY SUBTYPE ? 01 Foundation ? 26 Public Facility ? 30 Accessory Bidg. 0 14 Apartments 27 CommerciaUlndustrial ? 32 Ext Alt - Apts. ? 15 Lodging 28 Greenhouse ? 34 Ext Alt - Comm. ? 25 Miscellaneous ? 29 Antennae ? 35 Ext Alt - PF ? 37 Nail Salon WORK TYPE ? 31 New ? 35 Tenant Impr ? 42 Demolish (Found) ? 46 Windows/Doors ? 32 Addition ? 36 Move Bidg ? 43 Reroof ? 47 Repair ? 33 Alterations 0 37 Demolish (Bldg) ? 44 Siding ? 48 Authorization ? 34 Replacement ? 38 Demolish (Int) ? 45 Fire Repair GENERAL INFORMATION Census Code ¢3"7 Zoning sq. ft. SAC Code 3v # of Stories sq. ft. No. of Units o Length ? sq. ft. No. ui Sidgs. ? VVidt:1 SG, ft, Const. (Actual) Basement sq. ft. MC/ES System (Allowable) First Floor sq. ft. City Water -- UBC Occupancy sq. ft. Fire Sprinklered `'- MISCELLANEOUS INSPEC TIONS ? Gas Service Test ? Heating ? Insulation ? Plumbing ? Stucco/Stone APPROVALS Planning Bu ilding GNL( Engineering Variance Permit Fee Surcharge Plan Review MC/ES SAC City SAC :'v'ster Supply « Storage S/W Permit S/W Surcharge Treatment Plant Park Dedication Trails Dedication Water Quality Other Copies VALUATION $ 16, Oo o? % SAC SAC Units ivie'rer Size Totai STATE OF ....-'MS]7IICSOtB-' -.'-.-.--..-"_" _'_... ? R Ackaowledgment of Attomeyin-Fact ? '--------??-'---_.-----.. COUNTY OF.----°-D6kOta------- -------....._......-°----? ss. - ? On this 28th day of MaI'Ch 19 80, before me, a Notery Public, within end for said County and State, personally appeared Cannie J. Iewrence co me personally known, and known to me to be the Attorney-in-Fact of and for tbe ST, PAI)L FIRE AND MARINE INSURANCE COMPANY, Saint Psul, Minnesota, a corporation, created, organized and existing under and by virtue of the laws of the State of Minnesota, upon oath did say that the corporate seal affiaed to the ettached instrument is the seel of the said Company; that the sea] was affized and the said instrument was eaecuted by the authority of its Board of Directois; and he did also acknowledge that he executed the said instrumenta1s tbe free act end deed of eaid Compsay. --.._..LV ..??...?_ ;.;?3?G '...?`=-4•^^.w..,..., - - . . . . ....Noffiry Public. . H M SMITH My Commission eapires........ .._ Notary Pubilc, ' Ramsey Counry, MN """""' '....._"'_""_""_"_._' ` MY COP?7MI SSION EXPIHES 11072 AAi Etl. 2-68 irinhtl In U. S. A. April 24, 1985 i-- ` o`. ....,......,. . ` . , . . Claas t ' ST. PAUL FIRE AND MARINE`INSUIkANCE COMPANY (ACapi[al S[ockCompanyl ST. PAUL, MINNESOTA Fidelity and Surety CERTIFIED COPY OF POWER OF ATTORNEV Departmen[ Original on File at Home Office of Compuny, See CertiCcation. KNOW ALL MEN BY THESE PRESENTS: That the SL Paul Fisse and Marine ?nsurance Company, a corporation orgamzed and esisting under ihe laws of the State o( Mincesota, and having its principal office in the City of Saint Paul, Minnesota, das hereby constimte and aVPnint Connie J. Lawrence West St. Paulg Minneaota iu tme and lawful atromcys(s)-io-fact m execute, seal and deliver tor and nn its behalf as surety, any and all bonds and undertakings, recognizances, contracts u( indemnity and other wr.tings obligatory in lhe nalure thereof, which ara or may be allowed, requi[ed or permi[ted by law, statute, rule, regulatiun, cnntract or otherwise, and the execution of such instmmen[(s) in pursuance of [hese presents, shall be as binding upon the said SL Paul Fve and Marine Inwcance Company, as fully and aMply, fo all intents and putposes, as if the same had been duly ezecu[ed end acknowledged by its regularly elected officers at its principal ofGce. . This Power of Attomey is executed, and may be certified lo and mzy be [evoked, pursuant to and by authoriry of Article V,-$ection 6(C), of [he By-Iaws adopted by the Board of Directors of [he ST. PAUL FIRE AND MARINE INSURANCE COMPANY ai a mating called and held on the 23rd. day of January, 1970, of which the following is a true [tanscript of said Sec[ion 6(C). - "'Me President or any Vice Presiden[, Assis[ant Vice President, Secretary ot Resident Seaetary, shall have power and authority (1) To appoint Attorneys-in-fact, and to authorixe them to execute on behalC of the Company, and attach the Seel of the Company thereto, bonds and undertakings, rocognizances, convacts of indemnity and othec writings 6bligatory in the nature thereof, and (2) To appoint Special qttorneys-in-fact, who are hereby authorized to certify to copies of any powexof-atromey issueA in pursuance of ihis section and/or any of [he By-Laws of the Company, and - (3) To remove, ut any time, any such Attomey-in-Cact oi Speciat Atrorney-imfact and revoke the authority given hvn:" ILnher, this Power of Attoeney is signed and sealed by facsimile pursuant ro Tesolution of the Boazd of D'vectors of said Company adopted at a mreting duly called and held on the Glh day o( May, 1959, of which the following is a true excerpt: "Now therefore the signatures o( such officers and the seal of the Company may be affixed to any such power of attorney or any certificale relating thereto by Cacsimile, and any such power of attomey or certifiwre bearing such facsimile sgnatures or facsimile seal shall6e valid and binding upon the Company and any such power so executed and certified by facsimile signamtes and facsimile seal shall be valid and binding upon the CompOny in the Yuture with respect to any bond or undertaking to which it is a[tached." IN TESTIMONY WHEREOF, the SL Paul Fire and Marine Insunnce Company has caused this instrument to 6e signed and its corporate seal to be affized by its au[horized officer, this 318t day of Deeember A. D. 19 75 ST. PAUL FIRE AND MARINE INSURANCE COMPANY S'IATE OF MINNF.SOTA "s ?-`CountYOfRamxey . , ?..':.,. ?"".... ? Lj Vice Presidenr. On this 318t day of DeCeIDbeY ]9 7$ , before me came the individual who executed the preceding instrument, to me peisonally known, and, being by me duly sworn, said that he is the therein descrihed and authorized ofCcer of the St. Paul F've and Mntine Insurance Company; [hat the seal affistd to said ins[mment is [he Corporate Seal of said Company; that the said Corporate Seal and his signature were duly affixed 6y order of the Board of D'¢ectoxs of said Company. - . , IN T85TIMONY WHEREOF, Ihave hereunro set my hand and afftzed my Official Seal, . , . a[ the City of Saint Paul, Minnesota, Ihe day and year first above vnitten. . V.C.INNES Notazy Publiq Ramsey County, Minn. . - . ' My Commiasion Expues Aprfl 27, 1983 " . CERTffICAT10N 1, the undersigned officer of the St. Paul Fiee end Mazine Irmuwnce Company, do he:eby certify that I have compaceA the foregoing copy of the Powet of Attorney and affidavit, and the copy of the Section of the By-Lzwsof said Company as set forth in said Power of Attorney,• with the ORIGINAI.S ON FILE [N THE HOME OFFICE OF SAID COMPANY, and that the same are correct transctipts thereof, and of the whole of the said originals, and [hat the said Power of Attomey has not been cevoked and is now in full force and effect. W TESTIMONY W(1EREOF, i have hereunto set my hand this 28t71 day of Mareh ] 9 $0 : ?? ? '?. . ` ?, Secrelary. *Untimited as to character and amounL ?10870 CPS Rev. 10J4 Prlntetl In U.S.A. I, . CORPORATION ACKNOWLEDGMENT ? STATE OF. Minnesota ) -' ................-°------.._...._........-_.............. ..._.... y ?l?ehlrty Hennepin ss: ? COUNTY OF.__.'._..""_...'..'....._.. . On this ................ 28th.--.......................... dayof.......... ----°March..................... .................. .1980...... before me personally came ................... Wil ... l].dm J. JaeeT, JY'. .to me known, who being by me duly .................................................. ._........-----.-' sworn, did depose and say; that he resided he is the-.__.-_--..-__-' -aus ._ . ... -..---. Ande ...-- President of -------- -'-'°---"---Kr. ..._. .. ... rso -. ....n......o...f..-.....St......------ - .......... thecorporationaescribea in and whicb ezecuted the above instrumeat; that he knows the seal of eai corporation; that the 1 a ixed to said instrument is such corporate seal; that it was so affixed by order of thg of Di tors of ' co t' , and thet he signed his name thereto by like order. v ........ '... -- -`- ........... ......_.._._ . .... Notary Public. ?.-.....?-.......?....6.,.. ......?..ti... _., ................ ? e*"•<, CNAe.L'c5 e•UCHt?QIZ 10992 EA.2•56 PrlnbOInU.5.11. aa,,,' . A MY Commission eapires...------------ . ._ . ? ?.,. T H::NN??iiJ C:I:IJiY ;?.?on exnires APr.1.1lSo CERTIFICATE OF INSURANCE - WORKMEN'S COMPENSATION & LIABILITY ONLY 63-80 This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policies listed below. - ? Contractor Architect/I Agent Addf0il`vv ?i uiw n c. , .s-. I uv - , ru'. Address 1935 West Burnsville Parkwav Burnsville, Minnesota 55337 Policy No._I?l. L4tS ti`! ;iy Eff? Insurance Company ASSOCldtOd ifid2RII17tY Corporation Adc Coverage - Workmen's Compensation, Statutory. Employer's Liability Limit Policy No. L„ [ati 00 CU InsuranceCompany F1Peffldll's Fund American Type of Policy: [29Comprehensive ?Other LIMITS: Bodilylnjury $ 1.,000,000 EachOcwrrence $ 1,000.000 Aggregate Personal Injury $ 500,000 Aggregate COVERAGE PROVIDED (Check Applicable Square): Operations of Contractor Operations of Sub-Contractor (contingent) Does Personal Injury include claims related to employment? Completed Operations/Products Contrectual Liability (broad form)- Exceptions: AUTOMOBILE LIABILITY each accident Property Damage $ 500,000 Each Occurrence $1 ,000, 000 . Aggregate -OR - CombinedSingleLimit $E? Yes No 0 ? Governmental Immunity is waived ? ? Property Damage liability includes: Damage due to blasting m ? Damage due to collapse (9) ? Damage to underground facilities In ? Broad Form Property damage Yes No IM ? [Z) ? 131 ? IM ? El ? Policy No. Effective 12-31-79 Expiration 12-31-80 Insurance Company Fl Y'efltdfl's Fund Ameri can ,address_Hox 9431 Mi nneapol i s. Mi nnesota 55440 Type of Policy: [Romprehensive ?Other LIMITS: Bodily Injury: $ Each Persan - OR - $ Each Occurrence Combined Single Limit $1 ,000,0?? Each Occurrence Property Damage $ Each Occurrence Yes No Coverage is provided for operation of all owned, hired and non-owned vehicles m 0 Policy No. MtiS Z1 C'L Effective 1'L-31-19 Expiration1Z-31-2SU InsuranceCompanyM1S57011 Insurance Company address5402 Cedar Lake Rd. Minneapolis. Mn. LIMITS: Single Limit Bodily Injury and Property Damage $ 25 ,000.000 Each Occurrence Yes No COVERAGE PROVIDED: Applies in excess of the coverages listed above for Employer's Liability, Public.Liability and Automobile Liability Subject to the terms of the policy 12; 1:1 Are any deductible: applicable to 6odily injury or property damage on any of the above coverages? If so, list. ? EN AGENT CARRIES ERRORS AND OMISSIONS INSURANCE 0 1:1 Should any of the above described policies be cancelled before the expiration date thereof, the issuing company will endeavor to mail fifteen days written notice to the below named certificate holder, but failure to mail such ce lim 0se no i n or liability of any kind upon the company. oacedat Burnsville. Minnesota o„ March 28' 1980 ey cj Authorized Insurance Representative Kraus-Anderson A?ency, Inc. Construction Induztry Cooperative Committee of Minnesota - Porm C.I.QC.-701, Feb. 1961, Rav. June.1969, Rev. Jan. 1 21, Rev. Nov. 1977 Printed hy H. A. Rogers Co., 2323 Wayzata Bivd., Mph., 55405, 3774870 Occurrence r ... ' u .. v ' -?.' '. {iaw: .' ..:.?.. ?..r a:?'r .... r: ? .:.? ?'2'F'.? . ......??: e ....?.... ?;. 'J..Y? ? . . ..c.. .. . i.. ? .r_.w ?. ..s •.. . . _ . _?u< ? w'?..6.. ?aw?..l?. . .. , • s?? ? HE 8 OLUT I Otd CLTY OF EAGA2] F1fIEREAB, a public hearing purauant to notice Was held at a regular meeting of the Eagaa Advisory P1anning Coc»ai.ssl6n on August 28, 1979 concerning the application of James J: Durriing for walver of subdivision requirements under Sagan Ordinance tio. 10 covering.the . following descrihed premises: Lot 31 Block 1, Durning's Subdivision LMEREAS, a majority vote of the members of the Advisory Pianning Commission, with a quorun being present at the hearing, voted in favor of recomending approval of such applicationg and, TrLPEAS, a regular meeting of the Eagan City Couacil, Dakots Coim ty, Minnesota, was he2d an September 18, 1979 at the City Hall at 6:30 P.M. all members beino present except: iVOSI THEREFORE, upon motion of Sniith ; seconded by Egan all Council members voting in favor except: none it was RESOLVED that said application for waiver of subdivision requizements covering ' the above described premises be, and it hereby is, apprwed subject to attached conditions. DATED: SePtember 18, 1979 CITY COi1PICIL - CITY OF EAG142 EXEPQ'T FROtf STATS $y.?-e DEED TAX STAMPS Its Mayor C E H T I F I C A T I 0 N I, Alvcg solke , Clerk of the City of Eagan, Dakota Coumty, N3nnesota, do hereby cer[ify that the foregoing is a true and correct copy of a RESOLUTZON adopted by_the City Council of the City of Eagan, Dakota County, Minneaota on ' September 18, 1979 DRAFPED BY: CITY OF EAGAPI Ctty Cle? 3795 Pilot Knob Road City of Sa?an Eagan, Minnesota 55122 (ggAL) _..,. . .. . : ,. _?.. ,...,?. . ?? ? r Page 12 August 28, 1979 APC minutes. 1. That a joint parking easement shall be fi2ed wi[h the City on the driveway access and parking area of Parcels A and B. 2. That replatting of the parcel sha11 be required prior to issuance of.the second building pexmit. 3. That the office'building should be as compatible as possible to the architectural design already established within this subdivision. 4. Tha[ the parking should be blacktopped and concrete curbing should be provided around the perimeter of the parking area. 5. That the developer should post a$2,000 landscape bond which will not be released until one year after the landscaping has been completed. 6. That the proposed waiver should be subject to the comments of the Dakota County Pla[ Commission. . 7. That a ligtiting plan should be agreed upon which is compatible with [he neighbors after consultation with the staff. 8. That ten foot drainage and utility easements be dedicated adjacent to all property lines and rights-of-way. • 9. That driveway access permits shall be obtained from the County prior to.final approval. The motion was seconded by Member Krob and all members voted in favor. ? PRELIM1NnNV PIAN fOA - O4 •?i.?LrJ?J L--'JLICSDIVIJ:O1I VH?VOLCO OV? .?aMt?. .I. OURNINO G JUnN J. 4lAn?.?.A,N ' 7J17 (:JNMTLV HJAO WUUDUUMV. MII.NLbL.1T^ ?? ? M YW???• •?? Y? ?u1 I ?? C? ? u?.?w?wu\ ?u?a?v?MOA ? I- I ? I C ? al ? ? WI i I ? ? ? ? ? e?VI wowo ? .... ._. I I i IC. a A ti a?? ? ,. ? . . .. .. I ? ? I I I ? . I ' ?wwo uu ? ?? I I I ii i I ) I l l01 • 1? • . ' I a d I W ? I• ? : a ? a ? i P I Y I ' I• J , .3 _ I . . ? . ? ... "" i icni?`Yws ?? . qVN•fiCMIT"T6 •Twce• ' uu rc nw ? m?Heu.ou eem? .? t 1 ? I : I ; i f Y 1 II ! ' R + I i ? I ? r. I'I I i PRE\IMINNRY PIOT PII.N u...?? . ??. N DAKOT,d ?COU?TT ` HIGHWAT DEPARTMENT "-••--- ?? w. R?E'sVED APPU(CATION FOR IGCCESS DRIVEWAY QR ENTRANCE PERMIT R.O'. ?s '7%s3 p 'Auu (Appi/s.M le M fum1.MA v)th proper pl-b) S.ell.k'????Z s? ???9 Priof a trDe aoolicalion. Fill out ! copiei, si9a and mtil to CouatY NighwaY Depaelmenl. D '0,T,??4,AF&XYfch PrupertY, Presenl and Proposed Dtirewars and Relation lo Countr Highwar on 6ack ol all 4 copie? Name of ?/ ApPlicont (??aiA? f ,./'k-"f?.vvl Name of Property Ownar-_/"4, F?5 ???.??i.?lG• Location•? Co. Rd ?' ,.- +n ?F.fc r/0- Coun Address 40 4zes16 ? 4e_ Addres:;?,j/7 TA. 'Jcz_ /j ty/V Miles N 5-W of l" ?:rr ? a<- (CLeb One) (SDe 1c ro.d, LnG?r.cl. a ro.d :n:<r..ctlop) Legal Qescription (ds shown on your Ta: Slatemenl.) o//f Pcopertr ?f?-?C+T ?t ? ,?G=-::?[; Gir ?? ?!fi?!N< S Pvrpose oF Driveway 0? Re:idence eCommercial (specify typa) Is a Buitding to N^hat be Cons`ructed C ho -d Yes Kind tn ? ' C) 1 C. check Will the Building be Q Temporory or. &Permanent proper ? Is the Property in Q Piatted or ? Unpiatled Area squcros Distance from eenter of highwoy to,lr,ppt of 6uilding, or front of pvrt+p island is feet. 'Is land hig%er? or level? with highwcy,. She? (e< 6':ncAeii " -$hoeet 4 In<Ass NumScr oF Presenf Crivewoys to Property?VF Date Proposed Driveway Will be Needed..5;'f'in/4 ['r Give Exact Location of Proposed ? Oriveway to Property - ' ' ?p?. .,.,, ?.?''?.?C 4 r?.e.?- ?.?Gt?.•:. Zer Give Exoct Locotion of Prese .% ? Drivewav to Property - - - - --- - - -- ? ? I, w'e, lk. vnder?l?red, .`. witA -?k? ?yyputlon forpeim(?don te eomvuct th. dNvew-er at th. nbowe toaallon, uid dr!•ewny to M eenawcled le corlcm With tTe ?LnEa:C.eot the H!qh.-aY D<.ar:ment uM te anr apee'd Crov!dona Ine7eded !7 t!e ya .. L It 3? aCeed 1 no ll worY ?v111 e. Aene to t!s urf0GcUon c! the HI,h??.yDeF..+tmmt. ll ia Yurther .pued tT.e< no ve.-4 in caemec•lon vit tG:? ?yqlte ? bs ?,cr:.d unt3S th. •ppllutlen 1? .pproved and eLe perralt Siyno!.ro of Applicant DO NOT 1YRITE 9ELOw Ti115 LfNE NOT VALID UNLESS AGCESS DRIYEk'AY OR ENTRAt:CE PLP.MFT .I? S(GNED AND NU1.'.3EFcD --' ermii N.m .r Perniasion is hereby „ranted for the construdion o{ the drivewcy as des.ribed in t4e above opplirotion, soi3 driveway !o oe constrvcted in accordonce with the F.!innesota Highwoy Depcrtm_nts Drivewcy Standard Plate No. end subject !o the requirerents on reverze side end the (ollowing special provisions: ' Permission is granted for one 26' wide commercial entrance centered on a point 220' north of south property line of Lot 3. 15' radiuses from edge of existing blacktop. No_culvert required. It is expressly undersfoad thot tfiispermit is condifioned upon repiccement or restoration of +he frunk hiqhwey +o its origino) or fo o so(isfoctory condition. It is Fvrther understood that this permit is :ssued subjett to the opproval oF local city, viliage or borough authorities hoving joint superrision over said streef or highwvy, .. A11er p.rmlf la epOro??4 u -aur ro .<fprk.w ? swo ,e a„l..I ofw. ,. 0 Piak +r .1.ri tlaial. 01firt ...'?j] G.e.r 10 AIrn+rir+litr er Src. Gtw DAK01A COU1;1Y HfGH1YRY DEPlRTMENi , ?,? ?.ti/?Q,- ?- ?- aate ?? Coun:r Hio war Engireet ` saistmy tonrours _ ` J. _- . PARCEI°A° LL ? ndcv. 41 _ 3? 0 LI6FiT NIGH ? , nav, oDntoure thus... .._._. ?. ... . ..?,? ? ? •, ?>• .` \ ?.. , ? •, _,_._,---,..,.:.,.--, ?ber, ? I rk?-a"' _•?.f.._..?.. , •?., : . . _ • ? ? ,. ? ..X..... 20, nh :..?.....:: .? CEDA R 'iAVENUE L ! BLDG. i! , ce ? (CONCEPT APPROVAL) i= b 1? y} ._.-.: PAROEL tp i' ? y ¢ ?. - ? ?- _ „ - ?(? , _ c_ l- ? --- -- 7C?? '76 nr c 3".? ? 6 , ------ t_ 7Z? --- ?3, -- __ - 1??) ?76G . , ? ; ? . . A --- , N`. At?l?.-?} /,3n2C? ?. `"/22SS -- /FZc. !?yRE/-? C?I..?TC'C?. ..?...-_ ?. ?`_l??j_???JC- . . ?_ ??G?.r.-; . >L' ?f1yl'sf C' X?`_''OIZ"'JC0 ?. . i ? . . .. ,. Bond 40oFT 3367 - THE ST. PAUL COMPANIES 8 D_ ,....,.o,o..,a_ ......... ............... ST. PAUL FIRE qND MARINE INSURANCE COMPANY ST. PAUL, MINNESOTA A CAPITAL STOCK COMPANY PERFORMANCE BOND Approved by The American Institute of Architects A.I.A. Document No. A-311 Feb., 1970 Edition KNOW ALL MEIY BY THESE PRESENTS: That............. raus.-Aaderson__of_St._Paul_Co. ---°------------°-----°---?--._.....° --- - -- ----- ---- -- - - -- --- - ----- -- -St.--Paul?-Mtnnesota ----- --------------------- ---------- ---- ----- (Eiere insert the name endaddresa or legal Ntle of ffie Contractor) as Principal, hereinafter called Contractor, and, ST. PAUL organized under the laws of the State of Minnesota, wi hereinafter called Surety, are held and firmly bound unto ............._QItY....Q?._EaBaei,__Ntinne s ota... _.. _.-- FIRE AND MARINE INSURANCH COMPANY, a corporation th its Home Office in the City of Si. Paul, Minnesota, as Surety, -- -- - --- .....- -...._....-----......----------------------------- - ---- --- e insex the name and address or legal title of the Owner) as Obligee, heteinafter called Owner, in the amount of------ 1'.w.o._ThQu$4Ad__F1ve_H ?-----------------..--..__._. ???..?.?_?___.----------?-. -!-?---_-...-- ? Dollars ($ 2,95W' Q - -- •--- ----- -- -- -- •)> ------?--------- -- ----- ----- ----------- - ..- ----?----?---------?-- ---------....................----° for the payment whereof Contractor and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, Contractor has by written agreement dated........ M4rch 28___________________________________.._.___.__.._,_____,_1980., entered into a rnntract with Owner for._IAndscapin&_at_ Cedarview,_OPf"lce__Building,Cedar__& C1ifP__Rosd? ............................ . . - - .................................... ------ - - -- ---- --E?e. Minneaot? .................................................. in accordance with drawings and specifications prepared by........ -....................... -........ -------------------- ---------- ------------------ .................. (Eiere inserc futl name, vUe and address) which contract is by reference made a part hereof, and is hereinafter referred to as the Contract. NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION is such that, if Contracror shall promptly and faithfully petform said Con[rett, then this obligetion shell 6e null and void; otherwise it shall remain in full force and effect. The Surery Lereby waivec notice of any altera[ion or ex[ension of time made by the Owner. Whenever Contrsttar ehall be, and declared by Owner to 6e in de[ault under the Cont[acy the Owner having perfotmed Owner's obligations thereunder, the Sutety may prompdy remedy the defauly or sLall prompdy 1) Complete the Contrac[ in accordance with its terms and condi- tions, oc 2) Ohtain a bid or bids for completing the Contract in accordance with its [erma end mnditions, and upon determination by Surery of the lowest responsible bidder, ar, if the Owner elects, upon determination by the Owner end the Surety jointly of the lowest responsible bidder, arrange tor a mn[ract 6e[ween such bidder and Owner,and make avai]- able as Work pro;resses (evm though there should be a defaulc or a sucression of defaults under the contrecc or contracts of completion arranged under this petagraph) sufficient funds to pay the cost of com- pletion less the balance of the contract price; but not exceeding, induding other costs and damages for which the Surety may 6e liable hereundeq [he amount set forth in the first peragraph hereof. The term "balance of the contract price," as used in [his paragraph, shall mean the total amount payable by Owner m Contracmr under the Contract and any amendments thereto, less the amoun[ properly paid by Owner to Con- tractor, My suit under thia hond must be institured before the expiration oE two (2) years from the date on which final payment under the con- vact fells due. No riyht oE action shall accrue on this bond to or for the use of any person or co[poration other than the Owner named herein or the heirs, executors, administrators ar successors of Owner. Signed and sealed this -------------------------- 28th-------- day of------ _.._._MBreh...------- ------------------------- :----------- A. D. 19_.80. In the pres e of: -KrausAnderson. of__ St.___ Paul_Co?_.,_.,___._.._(Seal; - -? _ nncipa i ---- ---? ? --- ° --........_._...._. . ? -- ---- - ...._- -- .... .__....._ - ---? -•' -- -- ??- Ja°?. - -° °-- "" """__ (Wimess) V?TJ_ZZ??ITL ?Z?. \dM.z)2iA ----.--.--.--.--.-- - -- -- - - -- - - - - -_. - - --- ( W itness) end AAarino lysurance Company (Seal) Connie JZ,14wrl Printed with permission o/ the American Institute o( Architecis 11761 PL6 Fev. 2-70 PrinteE in U.S.A. C- Yom-( , Use BLUE or BLACK Ink For Office Use , Permit#: t1 0 City of EaRall �t I!7 3830 Pilot Knob Road E, t7 C �u Permit Fee: / v-- Eagan MN 55122 Date Received: ‘-''.:?--14"/7 Phone:(651)675-5675 Fax:(651)675-5694 Staff: -7 J 2017 MECHANICAL PERMIT APPLICATION ❑ Please submit two(2)sets of plans with all commercial applications. Date: f fl Site Address: Lp�� t CA1 S cL. Tenant: I s r":1 L U\�CSvI- C.)t,Jvu..r (--)‘1(1-0\S Q(0(1-e -P-S Suite#: Resident/Owner Name: A C o\5 V('C) p-eir-\-\-e S Phone: Ce\a- 3(oo1 - .3 Address/City/Zip: Lt(P 5 5 R'l U.)\ \e Ck h,, tri_ 0L-tName: i i t C S ..pG,,A`l1 U. C License#: C v 1 0 O �� Contractor Address:� Ck v S- \ALa) (2 C-0 City: UCti State: W Zip: g Phone: CZ , 3q5- oo s 2"' Contact: Email: New Replacement Additional Alteration Demolition Type of Work Description of work: 0‘.(,),D \\v-e -\---t= r00. .if) Un*t A NOTE:Roof mounted anal ground mounted mechanical equipment is required to be screened by City Code. Please contact the Mechanical Inspector for.information on permitted screening Methods. RESIDENTIAL COMMERCIAL Furnace _New Construction _Interior Improvement Permit Type _Air Conditioner X Install Piping _Processed Air Exchanger > Gas Exterior HVAC Unit — Heat Pump _Under/Above ground Tank ( p-�Installi/_Remove) Other '(S \\VQC'. STV RESIDENTIAL FEES $60.00 Minimum Add or alteration to an existing unit, includes State Surcharge $100.00 Residential New, includes State Surcharge =$ TOTAL FEE COMMERCIAL FEES Contract Value$ 1 SO C.) x.01 $60.00 Permit Fee Minimum $75.00 Underground tank installation/removal, includes State Surcharge =$ / ( Permit Fee =$ Surcharge Surcharge=Contract Value x$0.0005 /� If the project valuation is over$1 million, please call for Surcharge =$ ��V . TOTAL FEE I hereby acknowledge that this information is complete and accurate;that the work will •- ' conformance , he ordinances and codes of the City of Eagan;that I understand this is not a permit,but only an application for a permit,and .rk is not to start without a pe •that the work will be in accordance with the approved plan in the case of •- requires a review and approval of ,ans. X I' - C`--- S x Applicant's Printed ame Applican i.' . --7 FOR.OFFiCE USE . � Required Inspections: Reviewed s - " Date: Underground Rough In Air Test Gas Service Test : In-floor Heat Final —'HVAC Screening PERMIT City of Eagan Permit Type:Building Permit Number:EA176295 Date Issued:05/10/2022 Site Address: 4655 Nicols Rd 107 Lot:3 Block: 1 Addition: Cedarview PID:10-16930-01-030 Use:Jordan Scott Studios 3830 Pilot Knob Rd Eagan, MN 55122 (651) 675-5675 www.cityofeagan.com Description: Sub Type:Commercial/Industrial Work Type:Massage Therapy License Description: Census Code: - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Jordan Will 612-361-9289 or 651-359-1695 Fee Summary:Massage Therapy Inspection $0.00 $0.00 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 - Nicols Properties LLC 8561 Alverno Ave Inver Grove Heights MN 55077 Applicant/Permitee: Signature Issued By: Signature