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3805 North Ridge DrPERMIT City of Eagan Permit Type:Mechanical Permit Number:EA128438 Date Issued:11/12/2014 Permit Category:ePermit Site Address: 3805 North Ridge Dr Lot:2 Block: 1 Addition: Gardenwood Ponds PID:10-28800-01-020 Use: Description: Sub Type:Residential Work Type:Replace Description:Furnace & Air Conditioner Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Andrea Preusse 4145 Sibley Memorial Hwy Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088 Surcharge-Fixed $5.00 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 - Glenn O Ebersold 3805 North Ridge Dr Eagan MN 55123 (651) 270-8233 Wenzel Heating & Air Conditioning 4145 Sibley Memorial Hwy Eagan MN 55122 (651) 894-9898 Applicant/Permitee: Signature Issued By: Signature - ? INSPECTION REC4RD . • , Si CITY OF EAGAN PERMITTYPE: 3830 Pilot Knob Road Permit Number. Eagan, Minnesota 55122-1897 Date Issued: (612) 681-4675 SITEADQRESS: APPLICANT: 1 u I .' t:l ?ri . IJI iP ild 14 1 11 1A f foR ?tAF iM NW0C,I1 f'ONII': Ahq? dhb:i PERMIT SUBTYPE: TYPE OF WORK: Ni ,.I INSPECTION . . .,.. . . , , ? , ? D• i 1,AP141!r , RB•l O,????"!I r; s?,: ?, i ? i ? tr•,, I+1' MHFK ': L Ml Pl (I (r M& W tJlh 1 f N F1N f) 11 w ?. ? _ .. ? i Pertnft No. Permit Holder Date Telephone k EIECTRIC PLUMBING HVAC ?ro 9G yrAo- a?. Inspecdon I jsp. mmants ' FOOTINGS ?n'iLt r- Ltl.d3t /?, d?ivU Ro ? 1J9 . X FouNO ,d FRAMING J?;? ? ROOFING ROUGH PIUMBING , , Ze yi - PLBG AIR TEST ? ROUGH HEATING ? b f) GAS SVC TEST ?? l! INSUL X % h ? HB S f+1?'YV GYP BOARD FIREPLACE FlREPLACE AIR TES7 FINAL PLBG FINAL HTG ORSAT TEST BLOG FINAL ? BSMT R.I. E3SMT FINAL DECK FTG DECK FINAL s- . . +?-'?6 •? .r?. Wertificate af CccupancV MM of cpagan Zpartmcnt of Sxiti* 340cctian This Certifecate issued pursuant to the requirements of the Uniform Building Code certifying lhat at tite time of issuance this stnuctum was in compliance with the various arrlinances af the Ciry negulating buildirtg construction or use. For 1he foliowing: ux SF DWG swg. eftmN ro. 27267 oa.p.wy rya R3/U 1 zommg asft? Rl -rya co". VN o.,m of Bwm*JCyE MIUZR FM A&wn 345q WASHIlVGICN DRIVE. EA('?Ald saw;nsnaa,?5 NMIIi RIDCE i)RIVE Lowuy L2, B 1, GARHDA47C0 P+CND6 . ; p,u: 4POST IN A CONSPICUOUS PLACE 2 6 5- 6 4 2 ? OFFIC US ONLY This request void IB monAs fmm wlidation dok pbnkd in thiz box. ?o , 4?/ PLEASE PRINT OR TYPE d/. keqoeel Dah Roogh-in inspMion req?ired2 ?'en ? N. Impecnon Ofher Than kaogh-Im ? Reody Now i I Call April 30, 199 no?m???on???.p«m?wne?,?aaY? ooxaeoaY: I, [a.Hcensed coniracfor ? owner hereby reques} inspedion of }he above elechical work af: bb Addresa (Street, Box, or RoWe No.) Clry Zip Cade 3805 Northridge Drive Eagan SecSOn No. Twnshtp Nama or No. Raege No. Flre No. Coonry Dakota Occupont Phone No. Joe Miller Homes 454-4663 ao.e, suooue. s,4300 220th ST SW Dakota Electri Eleckical Conhactor ?Compony Name) Commdor Limnse Na. Masror Uc No. (Planl Elee. Only) Midland Electric CA 01236 Mailing Pddress (Contncbr or Owner Pedorming Insbllafion) 22691 Red Fox DR Lakeville,MN 55044 A?Ihoriz ignaNm (Conna PeAormiig Insmllatio ? Phona No. 461-1444 EB-OOOCIA-106/95 V STATEBOMiOCOPY-SEEINSTRUCTIONSONBACKOFYELLOWCOPV ?? II II I I I??I II?? REQUEST FOR ELECTRICAL INSPECTIOIJ11 70 MlnnesMa State Board of Electricity ? s 0 5 6 4 2 9 s V Phons 612) 642 A800 ?"/U? 5(p PaV-- S31 ic? ? Home upea Apt. Bldg. Other:' New Addn Commercial Indushial Form Remad Re air A i r Cond. Htg. Equip. Water Hh. Load Mgmt. Other: D er Ran e Elec. Heol Tem . Service "X" above the work covered by ffiis requesG Enter Iemarks in this space and on the back of the whife copy only. Calculate Inspection Fee - 7his InspecFion Request will not be accepted withovt the correcF fee: Olher - Fee # Service Enlrance $ize Fee # Circuih/Feeders Fee Mobile Home Park Stall / 0 to 200 Amps a a 0 to 100 Amps Q$ S}reet Lig./rraffic Sig. Above 200 Amps 1 1 Above 100_Amps 7 Transformer/GeneraFOr INSPECTOR'SUSEONLY TOTAL Sign/Outline Llg. Xfmr. /aa Alarm/Remote Conirol 2 $wimming Poal I hareb cem that I ins alea' a?n tha daks sahd dnb4l?in Irrigation Boom edion ecial Ins S p p Fi l Inves}igafive Fee no i ? THIS INSTALLATION MAY BE ORDERED DISCDN IF NOT COMPLETED WITHIN 18 MONTHS. ? qdoq 2005 RESIDENTIAL BUILDING PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 * 7 ?, rv New Conslrudiun Reauirements RemodellReoair Reouirements Otfice Use Onlv 3 re9istered sfte surveys showing sq. ft. oi lot, sq. ft. of house; and all roofed areas 2 copies of plan CeR of Survey Reoi _ Y _ N (20% maximum lot coverage allowed) 1 set of Eneigy Calculations for healed addBions Tree Pres Plan Recd Y _ N. 2 copies of plan showing beam & window sizes; pou2d found design, etc. 1 site survey for additions 8 decks Tree Pres Required _ Y _ N isetafEnergyCalculatbns Addifion-indicatei7onsttesep6csystem On-siteSeplicSystem _ Y _N 3 copies of Tree Preservation Plan if lot platted after 711/93 Rim Jois[ Oefail Dptions selection sheet (buildings wAh 3 or less uniGS) DBtC Constnction Cost i Site Address - , UniUSte # -., Descript¢oroLWork IN ? S??(, lL s?? Multi-Family Bldg _ Y_ N Fireplace(s) _ 0?. 1 _ 2 Pro ert Own r (j ( (; A.k / ?? L???J ! J Tele hone # (Z477 ? ! p . y e . (? p / i ? ? ?}z ( ?( Contractor r? Il? T - Address 3 Lv)w ftJ y t/ City 13?ilm(2 State Zip 'W3,J7 Telephone # (95L) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minnesota Rules 7670 Cateeorv I Minnesota Rules 7672 Enefgy Code Category , Residential Ventilalion Category 1 Worksheel • New Energy Code Worksheet (Jsubmissiontype) Submitted Submitted . Energy Envelope Calculations Submitted Have you previously constrocted a building in Eagan with a simi!ar p!ar.? _ Y _"l If so, 25% plcn review fee applies. Licensed Plumber Mechanical Contractor Sewer/Water Contracior 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 ordinances 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 f work whioh_xequires-a-review,and approval of plans. ? N 45. PJiJ os i:;tir = c 2005 ;,, ! t 1.1 ApplicanN Printed Nasne Appl cant's Signature ' OFFICE USE ONLY Sub Types O 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg ? 02 SF Dwelling ? OS 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi ? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF ? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc. ? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex Plbg_v or _ N ? 25 Miscellaneous Work Types ? 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 G 34! Replacemeni 'Demolition (Eniire Bidg) • Give PCA handoue to applicant Valuation Occupancy MCES System Census Code Zoning City Water SAC Units Stories Booster Pump # of Units Sq. Ft. PRV # of Bldgs Length Fire Sprinklered Type of Const Width REQUIRED INSPECTIONS _ Footings(new bldg) _ FinaVC.O. _ Footings (deck) _ FinaUNo C.O. _ Footings (addition) _ Plumbing Foundation HVAC Drain Tile Other Roof Ice & Water Final Pool _ Ftgs _ Air/Gas Tests Final _ _ _ Framing _ _ Siding _ Stucco _ Stone _ Brick Fireplace _ R.I. _ Air Test _ Final _ Windows _ _ Insulation _ Retaining Wall Approved t3y: Base Fee Surcharge Plan Review MGES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search Copies Other Total Building Inspector RESIDENTIAL BUILDING PERMIT APPLICATIOIII 3830 PILOT KNOB RD EAGAN MN 55122 851-681•4875 New ConstrucNon qeauiremenffi BamodeUHeoah Reauiremente • 3 regis[ered sAe surveys shaxing sq. fL ot bt, sq. ft. of hause; and all roofed areas • 2 wpies of plan (20% maximUm bt COVBrAgB elbWBd) • 1 59t Oi EnBrgy Calculatbn5 tor h¢etBd addilbn3 • 2 copies N plen showing peam 8 window srzes; pouretl found tlesign, etc.) • i s8e survey br exle6or additbns 6 decks • i set of Energy CalCUlaibns • Indicate il home served by septic systam for add'Alons • 3 copies of Tree Preservatbn Plan tl bt platted aMer 7!1193 • Rhn Joist Detail OpGOns seleclbn sheet (bldgs wiN 3 or less unh) DATE (P VALUATION SITE ADDRESS ? h[Ogrf-i21nP, F?TZ MULTI-FAMILY BLDG _ Y ? N TYPE Of WORK NEIN IZboF FIREPLACE(S) -I/0? _ 1_ 2 APPUCANT J,4YLOiz gVacfz ifoszD STREETADDRESS 3S?b1 ocln-L2 Qve 3-auf? ?•lo? cmr Yhn0)?' STATEa?)ZIP 5S,(05 TELEPHONE #(P5j-22_2- Nbbh CELL PHONE # Fax#? s? r95?h- Sz 13 - PROPERNOWNER(SiIev1Y1 t c1em'6-cr Gb.erSpjk TELEPHONE# &Sl - qw" 2,699 COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINNESOTA RiJI.ES 7670 CATEGORY 1 MINNESOTA RULES 7672 (4 submission type) • Residential Ventilation Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted • Energy Envelope Calculations Submitted Plumbing Contracfor: ___ Plumbing system includes: Mechanical Contracfor: Mechanical system includes: Sewer/Water Conhactor: _ A.ir Conditioning _ Heat Recovery System Lawn Sprinkler _ No. of R.I. Baths I hereby acknowledge that I have read ihis appllcation, state that with all applicable State of Minnesota StaTutes and CiTy of Eagan 1 Signature dFFICE USE ONLY Phone # Water Softener ? Water Heater ? No. of Baths Phone # Phone # Fee: $90.00 Fee: $70.00 Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ Updated 4102 OFFICE USE ONLY ? 01 Founda tion ? 07 OS-plex ? 13 1&plex ? li? 20 Pool O ? 02 SF Dwelling ? 08 OEplex ? 16 Fireplace ? 21 Porch (3-sea.) ? ? 03 01 of_ plex O 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.) lil? ? 04 02-plex 0 10 08-plex ? 18 Deck ? 23 Porch (screened) ?? ? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage i ? 06 04plex ? 12 12-plex Pltig_Yor_ N O 25 Miscellaneous ?i ? 31 New ? 35 int Improvement ? 38 Demolish (Intenor) ? 44 ? 32 Addition ? 36 Move Bldg. ? 42 Demolish (FOUndation) ? i45 ? 33 Alteration ? 37 Demolish (Bldgp ? 43 Reroof ? 46 ? 34 Replacement •Demolition (Entire Bldg only) - Give PCA handout to applicaM Valuation Occupancy MC/ES System Census Code Zoning City Water I SAC Units Stories Booster Pump Nbr. af Urtits Sq. Ft. PRV il Nbr. of Bldgs Length Fire Sprinklered Type of Const W idth 30 Accessory Bldg 31 Ext. Alt - Multi 33 Ext. Alt - SF 38 Multi Siding Fire Repair Windows/Oaars REQUIRED INSPECTIONS ? _ Footings (new bldg) FinaVC.O. _ Footings (deck) _ FinaVNo C.O. _ Footings (addition) ? Plumbing Foundation - HVAC - Drain Tile - O[her Roof Ice & Water Final Poot Ftgs _ Air/Gas Tei'sts ? Final _ Framing ? Siding Stucco Stone _ F'ueplace _ R.I. _ Air Test _ Final 4 Windows (new/replacement) _ Insulation _ Retaining Wall i Approved By Base Fee Surcharge Plan Review MC/ES SAC City SAC Water Supply & Storage S&W Permit 8 Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other Total Building Inspector CITY OF EAGAN 3W Pilot Knob Road Eagan, Minnesota 55122-1897 (612)681-4675 SITE ADDRESS: PERMIT PERMIT TYPE: Permit Number. Date Issued: 3805 NpR7M RIDGE DR LOT: 2 BLOCK: GAROENW00D PONDS P.I.N.: 10-28800-020-01 G?2055oq? BUILDING 027267 04J09/96 DESCRIPTION: SF DWG NEW R-3 U-1 V-N R-1 65 43 2 2 9 2 2 2 101 1 - FAM. DETACH ? ? ??y? i? gffiw! 3.tfr'? . ' ^ aa .. p REMARKS: S& W PLBR -- M& W WATER AND 3EWER FEE SUMMARY: VALUATION $199,000 Base Fee Plan Review Surcharge SAC SAC % SAC Units Subtotal $1,382.25 MISCELLANEOUS $1.923.50 $691.13 Total Fee $4,996.38 $99.56 $906.00 190 1 $3,@72.88 CONTRACTOR: - p,ppiicant - sT. LxC.OWNER: " HORTON INC OF MN, D R 14544663 2000565 JOE MILLER HOMES 3459 WASHINGTON DR 204 3459 WASHINGTqN DR EAGAN MN 55122 EAGAIV MN 55122 (612) 454-4663 (612)454-4663 ? I' h 3`nf S Ga ?. A V1pnD- ( - • APPLICANT/PERMITEE SIGNATURE 14FIO D9 IS Ea6v-f IG R °r jLqtL? CITY OF EAGAN 3830 PILOT KNOB RD - 55122 1996 BUILDING PERMIT APPLICATION (RESIDENTIAL) 681 -4675 $ +,Gq;d.31 C&P -tlk- 11-9 ? 3 registered slte surveys ? 2 copies o( plan ? 2 copfes of Dlens (inGude beam 8 window sizes; poured fid. design; ele.) ? 2 sfte surveys (exterior addHions 8 decks) 4. 1 energy wlculationa ? t energy piculations tor healed additions ? 9 copies of hee preservation plan H lot plafled afler 7/1193 . requfred: _ Yes X No - , DATE: 3-a9- ?1'/P CONSTRUCTION COST: DESCRIPTION OF WORK: /1.1/611/ ? STREET ADDRESS: j ' '1 . LOT _Q'? BLOCK ? SUBD./P.I.D. #: ?? PROPERTY owNeR CONTRACTOR Name: Phone #: unr nnn Street Address, City: State: Zip: Company: i e /I????er HavvicS Phone #: x?4_1 Street Address: ?cls? l , b,,,'vF License #: ?&00s657 City: L_4 1ti State:lW - Zip:'SS/??;j ARCHITECTI Company: ENGINEER Name: Phone #: Registration #' Street Address, City: State: Zip: Sewer & water licensed plumber: Gc/ G:l? +? d- a?P_u/e? . Penalty applies when address change and lot change are requested once permit is issued. 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 OMinances. ,• Signature of Applicant: ti???'" ??'' °- /? / ?-'?• OFFICE USE ONLY Certificates of Survey Received _ Yes -- ? Tree Preservation Plan Received _ Yes No OFFICE USE ONLY BUILDING PERMIT TYPE y q.? N '?A..1 w?Y?.r+1?' ?ry M+]1A'?+Li 0 01 Foundation ? 06 Duplex ? 11 Apt.lLodging ? 16 Basement Finish ?02 SF Dwelling o 07 4-plex ? 12 Multi RepaidRem. ? 17 Swim Pool ? 03 SF Addition o 08 8-plex o 13 GarageJAccessory ? 20 Public Facility 0 04 SF Porch ? 09 12-plex ? 14 Fireplace ? 21 Miscellaneous ? 05 SF Misc. 0 10 _-plex ? 15 Deck WORK TYPE jp?-31 New o 33 Alterations o 36 Move ? 32 Addition o 34 Repair ? 37 Demolition GENERAL INFORMATION ConsL (Actuaq (Allowable) UBC Occupancy Zoning # of Stories Length Depth APPROVALS Planning Basement sq. ft. Main Ievei sq. ft. Z^`= sq. ft. sq. ft. sq. ft. sq. ft. Footprint sq. ft. Building / ,;/?3 MClWS System ? City Water - Fire Sprinklered PRV Booster Pump Census Code. /o z, z z z SAC Code ? Census Bidg Census Unit / Engineering Variance Permit Fee Surcharge Plan Review License MCNVS SAC City SAC Water Conn. Water Meter Acct. Deposit 51W Permit S/W Surcharge Treatment PI. Road Unit Park Ded. Trails Ded. Other Copies Valuation: $ 600 `1'IA/.f' 2x 2T• (.7 = Y7 0 /?O x 3r ------ ?5?1= 9"71 ? ks ?---- _ z?n SY = /, s/z ?9s-? 9? _ ?B(o ) ?f--? -- / /, yf3 3 n 7 Z, Zys . r/ // = & 23 X 30 Tocal: / sGGxsy= z? ? ? % sAC SAC Units 7 ?-n! Q-/ Z 48=,? = 69? - S .?------ 73yX ? ?? ? 2? O F' ? ? ;9 5, ?al .......?-- 66, V9 ti ? ? ? - S' sr ? ? i i i .? i / / ? / h? ? ? ? EAC??N 41A `• j E )? E 0 . ? 'ATg ? ??< e -1 96.45 77)? / ?$9$•a? ; ?O `?96. 87 i'9 i S ?? ? q"??% .? > ry /J p . ? 69 o 1?k . u?. ,. . `. ? rY?? ,? `J V A ,o?? ,??5 BvyyS? \ g 9,S 7S> Scale: 1" = 30' 3805 Nq?`th ?Ridge Drive DESCRIPTION I here6y certify that this survey, plan, or Lot 2, Block 1, report was prepared by me or under my direct GARDENWOOD PONDS supervision and that I am a duly Registered Land Surveyor under the Laws of the State Dakoia County, Minnesoia of Minnesota. Plat bearings shown 6)? o Denotes iron monument Date ?g (j(AIL )994 Reg. No. 8140 ? Existing j Proposed BRANDT ENGINEERING & SURVEYING 1600 West 143rd Street, Suite 206 Burnsville, MN 55306 (612) 435-1966 sh cE?T1FICATE OF SURVEY M32-1373-96 for JOE MILLER HOMES M32-1 ?5 /?5-y(D Top 61ock = B2`LL Lowest bsmt flr = -a?i_L)2- LOT SURVEY CHECKLIST FOR RESIDENTIAL ? ? ? e? e?o e% ?? [??o C?O q? o Er- ? ?--'13 PROPERTY LEGAL: DATE OF SURVEY: LATEST REVISION: AOCUMENTSTANDARDS • Registered Land Surveyor sipnature and company • Building PermRApplicant • Legel description • Address • North arrow and scale • House type (rambler, waikout, splR w/o, spl'd entry, lookout, etc.) • DirecBonal drainage arrows with slope/gradierrt 96 • Proposed/ebsting sewer and water services 8 imert elevatlon • Streetname • Driveway ? ? O ? ? ? ? ? 0 ? ? ? EAstlna C;1- 0 13 ff? ? ? 4:1' ? ? O---0 ? • Sewer service (or Proposed) • Property comers • Top of curb at the drrveway • Elevatlans of any exdsling adjacent homes Proposed m'o 0 d' o ? ? ? ? ? ? ? ? ? ? ?. ? !d' ,.z ? le, o ? cy, ? ? f3?- ? o Er- ? ? ?? ? ? ?o • Garage floor • First floor • Lowest exposed elevation (walkouUwindow) • Property comers • Front and rear of home at the foundation PONDING AREA Cf aoolicablel • Easement line • NWL • HWL • Pond # designation • Emergency Overflow Elevatlon DIMENSIONS • Lot IinesBearings 8 dimensiotis • Right-of-way and street Hddtli (to back of curb) • Proposed home dimensions including arry proposed decks, ovefiangs greater than 2', porches, etc. (i.e. all structures requiring permanent foot(ngs) • Show all easements of record and any Cily utilities within those easemenLs • Setbacks of proposed structure and sideyard seffiack of adjacern existing structures • Retaining wall requirement;,if,any ? Reviewed: / Jenusry1996 CRA1019YdBlOGPRMf.FM U.? ` . 8 12G .21 MH ?-_. •5 / r ? „ , ,_ e,tiice'_ . $"x6";> TEE =? ? ul,, ?, ? uuP-?7};j?iS ,:• :! u? :,;;, ? -' PU??d?`'" +26 ? 898.1 i - ----3 ? 60 -6 DIP ? 6" G.V`-& BOX ? 6' PLU?--?,?,•,. ?. , % 4\ ,.. ? 51? ? ? 85 s 6 Qg•3 3+03 895.3 2 -- _.... ?g3 2 ? 1 , ? - .? . ,.. .... ? .. . . ?? r,n---......_ r.? ' J . .. G i O3 goP. %` ,, "88B 4 s, , 6='BENED . /. F' / / 2 " . ? .i e ---- .? - 777 x+o 897 .00 ? ,-- ?::. - NAi-i MAIN S^_- .?+1?jP! H P1^'` 1 1 rF ? PI/) Y F MIn11TM ?.?,?All?' 5 _ ; / 1 6 ?NC I 9?i , . , . ; ; ? M)-' 3+489 3'R ' PVC: o 0:40% i ?. ?. ---=?-?--- __ ; ? ; ? ? .• ? ?:.!'w,: ?3t?.?S.; ? 3 ??, '?At ? a"??? ? .< OF UTIL1 t Y LC3t;tJ1,0?1'4' ;? TH! ? ?3Ai,'? i s p?O PURwC1CJi:1_`1 - Ai °.D ? _ a a 11' ic" l.l.i?. , .:. _ MH.._-l ? 1+51;9.5'R " 892.56 ' CD o ? 0 ? ? 3 191'--8" PVC SDR 35 0; 0.42% 2 ?111 890 Ex. E12" W.M. 131'-$" PVC SDR 3? 4 0.4p?; • ; ? 8;;-8" QIPi ; CL; 51 0 0.40% _.. ,. iEx. 18° Ri.P? ?" CONSTRU T ? IROP ; OUTSIpE I D00 w ,Z . 'qo oo CON$TRUCT MA_HOLE w OVER Ex. 8" P C rn?m rn SANI7ARY SEWE ? r`ffli a`to +r°?'? ' ovio ?- ,. o0 0o I ? ? ono o?o 1 0 880 I 860 09,49, I 6 (I Owner- S1te - Addl contracta k1INNESOTA STATE ENEarv coor? CA?CCILATIQNS ? BA5ED Oti CIiAPTFR 5 QF THE MooEL E!{SRGY COb6 - 14@3_R?7_?TiON Aduptlall Effactive ; tiuilding classificatl.an: Type A1 (single Family & Uuplex Typa A2 (Rasidential, 3 atoriea or less) (Qver 3 stariae) (Other; t{UTE: Comalete..pages 3 and 4 fj,L9t. GENEl2AI 7NFOR14ATION 1. Building Perlmeter D _ft. W 2. Wall height (ground ka eave) ft. a. 1. X 2. (above) gross caall area sq.ft. q. Building dimenslons (L) r X(W) r = i? ft.roof & flaor araa 5. Sq. foot area of rim jolst - F oor joiat size (2 X 1a _ = xq. rt. _?d „ X " ? (Parimeter) 6. Doors - Area 12 7 Thickneus in U. factor 1 ? 1 ?• 1 Type of construction Perimeter -ft. Manufacturer -- 7. Tatal dnor's perimeker _ft. a. Wlpdows: MattuPacturer?i? Stata uppY'oved__ U Pactor 1 ?,7 & TYPE SIZE AREA (Sq.Ft. ) tiUl48ES2 OF TOTHI. q ? 1 11 EACH UNI'PS Sq FEET 9. IroeHl sq.ft. Glass i:L2 2- lo. Fireplace area: Widkh X Heigitt = X a sg.ft. lI. Exposed foundnt.ion: NeighL• X Perimeter' -X_L??= 1{(J sq.ft. C0t4PLETION OF THIS FORM ZS REQUIREb POR AI.I, NSW CONSTRUCTIOtI, MAJOI3 F26MODELING ANll HUILDINGS BLING MOVED WHERE ENERGY, OTHER THAN T11E MINIMAL COpE ALLOWANCE, IS USED. SniTO'd 5S9£ ZSb ZT9 L 'DNf 'OOhJyId B£:Sti h66S-Tfi-835 ,1a. F'raminq aren = lob of qragp wqll area. 13. Gross wall area -7? eq.ft, Window area A 33 Z_. sq.ft, U wtnaows G .??G Rim jaist area A?sq.ft. u rim joist= .C24 1 Door area A S/ sq, ft, tl doar et'ea= , IL Other doors ere$ A? sq.ft, U othar doora=.1.,? Expased fndll A sq.tt, u foundQtion=0 Framing area A sq.Pt. U framing area=, 7! Nat wall area A L,21113 eq. ft. U walls +%?'? ? (13B) TOT?.L . . . . . . . . . .??z? .- Z?04 UxA = 7,V UxA = 1,111 UxA = 7 UxA t1xA UxA ) Uxt, - ^ UxA = 7 L? 14. Gross wall rtrea x 0.11 (A-1 gitAgle fnmlly & duplex) = nllowabla UxA/Code (13. above ) x 0.23 (&-2 othar reaidential) ' x .23 (otlter bulldinga) x .28 (ovsr 3 Storiea) yy, i( HTOH must be laYger thatt or same A_L.1 H U Code r =?°F, ae 13B above 15, ce111ng fraining area (a,) egunle lDt of celling area 15A. Gross ceiling area =(L) ? x(W) ? sq.it. 15B. Soist area (AF) A 10t ceiling areq a?`??? ag.ft. 15c. Net csiling erea (Ac) (1SA ? 15B) 1.6 sq.ft. U ceiling x A, _ (O? x •?_? U framing x A f . 15Q. TOTAL U x A .................. ........._ 16. Ceiling eren (1511) x 0.026 (h-1 oingle femily 4 duplex) = sllowab2e UxA/sode x 0.033 (A-2 othar residentiel) x 0.06 (qther) HTUH muet De laxqelc than ??r same Xc I5?,, I?oy ?x U Code_1??_?+?_. °F. as 15d e6ove NoTE: Uea U ant1 A values obtained from pageB 1, 3 and 4. CE$TS£ICBTIQ.LI: I hereby certify that I hnvm calculated the nUtt t'actnrs end '?iilt values heroln snd that tha buildinq liere dasoribed meste or exaeE:de the 5tate of Minnesuta Energy Conaeraetion haC. t]ate Slgnature 59iZO 'd 6SqE ZSb ZT9 L '?tll '0Jtly_1d 52:ST r6EL-T0-d3S (IJ?uDOwy ?...--? . - -- . . .. ._ .-- --- - ?. A-t-------- ----- 7?b =1ax __.. _ _.. 3 3 Z• i _- ?i ? - i r, r- eia- - r ? . . ............._..__--- -- ' - - Sr-J%£f?'d E59£ ZSh ?19 ? ?NI `03NH-1d 6£:SS VF.ST-Tf1-d3S ITY USE ONLY RECEIPT #: S5 y . L' A Zatco?d C SUBD. DATE; ?iv /9l0 1996 PLUMBING PERMIT (RESIDENTIAL) CITY aF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (612) 681-4675 Please complete for: ? single family dwellings ? townhomes and condos when permits are required for each unit FIXTURES EACH ? TOTAL Shower 3.00 x ? = 3 VJater Cioset 3.00 x 3 - ? Bath Tub 3.00 x = Lavatory 3.00 x Kitchen Sink 3.00 :c Laundry Tray 3.00 x Hot Tub/Spa 3.00 ;< _ - Water Heater 3.00 ;c ? Floor Drain 3.00 ;< ! = 3 GaS Piping Outlet * minimum -1 3.00 x / = T Rough Openings 1.50 :< Z = ? Water Softener 5.00 x = Private Disposal " Dakota Cty, license 65.00 = (new and refurbished systems) U.G. Sprinkler ' home urxler const. 3.00 = Alterations ' to existing 20.00 = Water Tum Around 20.00 STATE SURCHARGE .50 TwTAL ? , 3U SITE ADDRESS: 3805 NorthridQe Drive OWNER NAME: JOE MILLER CONSTRUCTION INSTALLER NAME: GEcrz-xYArr ri,vrmzrrG STREET ADDRESS: 14745 South xobert Trail CIIY: Rosemount STATE: MN Zip: 55068 PHONE #: ( 612 ) 423-1144 L _ BL _ SUBD. Please complete for. ? DATE: OFFICE USE ONLY RECEIPT #: ? DATE- 1996 PLUMBING PERMIT (COMMERCIAL) CITY OF EAGAN 3830 PILOT KNOB RD i EAGAN, MN 55122 (812) 681-4675 all commercial/industrial buildings. ' multi-Iemily buildings when separate permits are Il9! required for each dweiling unit. CONTRACT PRIGE: WORK TYPE: _ NEW CONSTRUCTION DESGRIPTION OF WORK: ADD ON _ REPAIR IS WATER METER REQUIRED7 _ YES _ NO. IF SO, PLEASE PROVIDE THE FOLLOWING: WATER FLOW: GPM. ARE FLUSHOMETER3 TO BE INSTALLED? YES _ NO. FAILURE TO PROVIDE THIS INFORMATION WILL RESULT IN A DELAY OF METER ISSUANCE. WILL YOU BE INSTALUNG A METER FOR A FUTURE U.G. SPRINKLER SYSTEM7 YES _ NO. IF SO, YOU MUST APPLY FOR A SEPARATE U.G. SPRINY:LER PERMIT. ` FEE: $25.00 minimum fee or i% of contract price, whicheaer is greater. State surcharge of $.50 per $1,000 of Qgrmit fee due on all permits. ; u CONTRACT PRICE x 1% STATE SURCHARGE TOTAI SITE ADDRESS: TENANT NAME: OWNER NAME: INSTALLER: _ AODRES5: _ ciTV: PNONE METER SIZE: " DATE: STE. # STATE: 21P: u _ SIGNATURE: APPLICANT OFFICE USE ONLY I INSPECTOR: i CITY USE ONLY L BL ? RECEIPT #: ?5/75 SUBD. u(IPdO` r.d?d DATE: 1996 MECHANICAL PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (612) 681-4675 Please complete for: • single family dwellings ? townhomes and condos when permits are required for each unit ? New construction Add-on furnace _ Add-on air.conditioning Add-on airexchanger; i.e. Vanee system, etc. Date: S? EE ? Minimum Fee: Add-on/Remodel (existing residence only) $26-6&- ? HVAC: 0-100 M BTU 24.00 Additional 50 M BTU 6.00 ? Gas Outlets (minimum of 1 required @$3.00 each) 17,00 ? State Surcharge .50 TOTAL 35..?d SITE 3 OWNER NAME: ?ve 171./er A.,i-s?-' PHONE #: - INSTALLER NAME: STREET ADDRESS: °21a10 14le- CITY: STATE: A't4/. ZIP: ??^2 y ? PHONE #: ( ?r2 ) ??GO - (.022 ? CITY USE ONLY L BL SUBD. RECEIPT #: OATE: 1996 MECHANICAI, PERMIT (COMMERCIAL) C1TY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (612) 681-4675 Please complete for: ? all commercial/industrial buildings. • multi-family buildings when separate permits are for each dwelling unit. DATE: CONTRACT PRICE: WORK 'fYPE: NtW COnIS i KiiCTiON DESCRIPTION OF WORK: required INTEF(IGFC IMPRtJVEIVIEN"I FEES: ?$25.00 minimum fee gl 1% of contracf price, whichever is greater. . Processed piping - $25.00 ? State surcharge of $.50 per $1,000 af permit fee due on ail permits. CONTRACT PRICE x 1% PROCESSED PIPING STATE SURCHARGE I TOTAL Y SITE ADDRESS: v`J'?7NcR NAMIE: TELEPHrJPrE #: TENANT NAME: (IMPROVEMENTS ONLY) INSTALLER: ADDRESS: IlllCITY: STATE: Z I'IP. PHONE #: SIGNATURE: SIGNATURE OF PERMITTEE CITY INSPECTOR II, L C:TY' USE ONLY RECEIPT #: /l{!?e A ? BL ? n «? o?? susD. oarE: 7 j9 1996 PLUMBING PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 551::2 (612) 6814675 Please complete for: ? single family dwellings ? townhomes and condos when permits are required for each unit FIXTURES EACH J?Q TOTAL Shower 3.00 x = Water Closet 3.00 x = Bath Tub 3.00 x Lavatory 3.00 x = Kitchen Sink 3.00 :c = Laundry Tray 3.00 ;t = Hot Tub/Spa 3.00 ;c = Water Heater 3.00 :c = Floor Drain 3.00 ;< _ Gas Piping Outlet ` minimum -1 3.00 ;< _ Rough Openings 1.50 :c = Water Softener 5.00 x = ? UO Private Disposai ` Dakota Cly, license 65.00 = (new and refurbished systems) U.G. Sprinkler * home under const. 3.00 = Alterations ' to existiny 20.00 = Water Turn Around 20.00 STATE SURCHARGE .50 TOTAL ? . ? INSTALLER NANIE STREET ADDRESS: 06aG CIN: STATE:?? ZIP: PHONE #: ?'? ? ?? u ?` / e-7-j { OWNER NAMEQ4-( -. ???2? ( ac-,/ ` - OfFICE USE ONLY L BL RECEIPT #: SUBD. DATE: 1996 PLUMBING PERMIT (COMMERCIAL) ' CITY OF EAGAM 3830 PILOT KNOB RD ' EAGAN, MN 55122 (672) 681-4675 Please complete for: o all commerciaNindustrial buildings. w muRi-family buildings when separate permits are 11M required for each dwelling unit. DATE: WORK TYPE: _ NEW CONSTRUCTION DESCRIPTION OF WORK: CONTRACT PRICE: ADD ON _ REPAIR IS WATER METER REQU4RED? _ YES _ NO. IF SO, PLEASE PROVIDE THE FOLLOWING: WATER FLOW: GPM. ARE FLUSHOMETER:i TO BE INSTALLED? _ YES _ NO. FAILURE TO PROVIDE THIS INFORMATION WILL RESUL7' IN A DELAY OF METER I$SUANCE. WILL YOU BE INSTALLING A METER FOR A FUTURE U.G. SPRINKLER SYSTEM? YES _ NO. IF SO, YOU MU5T APPLY FOR A SEPARATE U.G. SPRINY.LER PERMIT. FEE: $25.00 minimum fee or 1°h of contract price, whicherer is greater. State surcharge of $.50 per $1,000 of pg ii fee due on all permits. CONTRACT PRICE x 1% STATE SURCHARGE TOTAL SITE ADDRESS: TENANT NRME: OWNER NAME: STE. # INSTALLER: ? ADDRESS: cirv: PHONE #: SIGNATURE: OFFICE USE ONLY STATE: ZIP: , APPLICANT METER SIZE: " DATE: - INSPECTOR: jr?U71 2006 RESIDENTIAL BUILDING PEUMiT arrr,icnTiorr City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 New Constmction Reauirements 3 registered site surveys showing sq, fl, of lot, sq. fl. of house; and all rooted areas (20% maximum lot cove2ge allowed) 2 copies of plan showing beam & window sizes; poured found design, etc. t set of Energy Calculallons 3 Copies of Tree Preservation Plan if lot platted after711193 Rim Joist Detail Options selection sheet (buildings with 3 or less units) Minnegasco mechanical ventilation form u? *"1 ? , ,RemodellReoair Reouiremems ONice Use ONv 2 copies of plan showinq footings, beams, joists CeR of $urvey Rectl Y _ N 1 set oi Energy Calculations for heated additions Tree Pres PIanRecd ? Y _ N. 1 site survey for atldttions & decks Tree Pres Required " .Y _ N Add'Aion - indkafeifon-sitesepficsystem On-sileSeplicSyslem _ Y _N OA? { U , ?'n?' V (i,A '11'1 (/???? _ ?11V- Date 131 0(:?) Construction Cost SiteAddress _3 19 0 rJ Unit/Ste # G ?"I N ? Description oT Work ?//7/ SL? ???JfG fV C-rl 7' Mutti-Family Bldg _ Y? N Fireplace(s) _ 0 x 1 _ 2 Property Owner (WeW/T Telephane # ( ?1J`4 99 Contractor Address City ??.. State Zip Telephone # ( ) I / ? ? ? Z6J 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 (q submissionlype) SubmiBed Su6mitted • Energy Envelope Calculafions Submitted , In ihe last 12 months, has the 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/Water Contractor Telephone #( Telephone # ( Telephone #( ) I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate; that the work wiil 6e in conformance with the ordinances and codes of the City of Eagan and the State of MN Statutes; I understand this is not a permit, but only an appIicarion 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. Clow 0 6ber_-?:ld ApplicanYs Printed Name A plicant's Sign ture DO NOT WRITE BELOW THIS LINE Sub Tvpes ? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 02 SF Dwelling ? OS 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 03 01 of_ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 05 03-plex ? 11 10-plex `SY 19 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex ? 25 Miscellaneous Work Tvpes ? 31 New ? 32 Addition ? 33 Alteration ? 34 Replacement D2SC?ipYiOfl: Water Damage ? 30 Accessory Bldg ? 31 Ext. Alt - Multi ? 33 EM. Alt - SF ? 36 Multi Misc. ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair ? 37 Demolish Building" ? 43 Reroof ? 46 Windows/Doors 'Demolition (Entire Bldg) - Give PCA handout to applicant Yes Valuation ?cv czb Plan Review 100% or 25% Census Code ? SAC Units # of Units # of Bldgs Type of Const ? Occupancy "%f ` MCES System Zoning City Water Stories Booster Pump Sq. Ft. PRV Length Fire Sprinklered Width _ Footings(new bldg) _ Footings(deck) _ Footings (addition) Foundation Drain Tile Roof Ice & Water Final ? Framing Fireplace _ R.I. _ Air Test _ Final ? Insulation REQUIRED INSPECTIONS _ Sheetrock FinaVC.O. ?C Final/No C.O. HVAC Other Pool Ftgs Air/Gas Tests Final _ Siding _ Stucco Lath _ Stone Lath _Brick W indows _ Retaining Wall Approved By: , ` , Buiiding Inspector Base Fee Surcharge Plan Review MC/ES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search j, 1- - ?F5)- V; ? /-?, ? „"- ?f Copies Other Total Zoos RESIDENTIAL PLUMBING PeRMiT aPPUCarioN CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN MN 55122 651-675-5675 Piease complete for modifications to existing residential dwellings. v?. 6-6 Date 9 19?4 1 O V/ . ' ? n Site Street Address ? / V Q o ?• Unit # Property Owner Ie? fn ??J v r? Telephone #?J!/ Contractor Opnz- Telephone#n)/? ?UJ-7-l611) Address ? City, %/ State /-4N Zip ? The Applicant is: _ Owner XContractor ?Other Septic System _ New _ Refur6ished Submit 2 sets of plans and MPC license Includes County fee $ 100.00 Per as-built $ 10.00 Alter?tions to existing dwelling $ 50.00 ?\ Add plumbing fixtures. This fee includes installation of a water softener and/or water heater at the same time. !f you are insfalling on! a wafer softener and/or water heafer, do not complete this section; move to the next section and check the appliance(s) you are installing. _Septic System Abandonment _Water Turnaround (add $130.00 if a 5/8" meter is required) Other; Water Softener _ Water Heater $ 15.00 - new _ replacement Lawn Irrigation ,RPZ _PVB _new _repair _rebuild $ 30.00 State Surcharge $ 50 T YV ? otal g I hereby apply for a Residential Plumbing 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 the plumbing codes; that I understand this is not a permit, but only an application for a permit, work is nof to staR without a permit and work will be in acco dan e with the a proved plan in the event a pian is required to b reviewed and approved. ApplicanYs Printed a e Ap ants Sign ture 73 s,YI 2006 RESIDENTIAL MECHANICAL rERNuT arpLicaTTON City OEEagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 Poease complete for. single family dwellings & townhomes/condos when permits are required for each unit Date _6 / 6?4 / _6(o . Site Address 3UI.J5 I V W+hk' dVl ebv• Unit # Property Owner W i.ril I Eb er6V' ? Telephone #{?? ) ? 50? " ? ? CootraMOr GiU ! . z- R m r,l ) Street Address C?Q (n. UJ` 'l ?3't AJ UI I? City BJv) 1 1 L State ? IV Zip Telephone #( 1 JA)7(U 1 1bDI) Bond #:MUl l 0/) rX I Expires: U'`-I U The Appiicaot is _ Owner ? Contractor _ Other Add-on or alteration to evsting dwelling unit $ 30.00 fumace _Additional _Replacement _ New air exchanger air conditioner heat pump X other State Surcharge $ '50 Tatal 1 hereby apply for a Residential Mechanical Permit and xcknowledge that the information is comple[e and accurate; that the work will be inconformance with the ordinances and codes of the City of Eagan and with the Mechanical Codes; that 1 understand this is not a permit, 6ut only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approv?}d pl? in the c of work which requires a review and approval of plans. / ? . 1 / 1 ?? .-. 1 J /l,n x ., , ?/1 //I / / ?. "?' Applicant's Printed Name ApplicanYs"Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA166998 Date Issued:02/17/2021 Permit Category:ePermit Site Address: 3805 North Ridge Dr Lot:2 Block: 1 Addition: Gardenwood Ponds PID:10-28800-01-020 Use: Description: Sub Type:Siding Work Type:Replace Description: Census Code:434 - Residential Additions, Alterations 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. When a weather barrier is installed or Valuation: 5,000.00 Fee Summary:BL - Base Fee $5K $118.00 0801.4085 Surcharge - Based on Valuation $5K $2.50 9001.2195 $120.50 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 - Glenn O & Jennifer S Tstes Ebersold 3805 North Ridge Dr Eagan MN 55123 All Craftsmen Exteriors Llc 1020 East 146th St Ste 226 Burnsville MN 55337 (952) 898-4680 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA167845 Date Issued:03/31/2021 Permit Category:ePermit Site Address: 3805 North Ridge Dr Lot:2 Block: 1 Addition: Gardenwood Ponds PID:10-28800-01-020 Use: Description: Sub Type:Reroof Work Type:Replace Description:Does not include skylight(s) Census Code:434 - Residential Additions, Alterations Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Please print pictures of ice and water protection and leave on site. We encourage you to retain an electronic copy of photos until the project passes a final inspection. *Roof permits issued between December and March will be inspected in the spring or when weather warms up. Valuation: 5,000.00 Fee Summary:BL - Base Fee $5K $118.00 0801.4085 Surcharge - Based on Valuation $5K $2.50 9001.2195 $120.50 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 - Glenn O & Jennifer S Tstes Ebersold 3805 North Ridge Dr Eagan MN 55123 All Craftsmen Exteriors Llc 1020 East 146th St Ste 226 Burnsville MN 55337 (952) 898-4680 Applicant/Permitee: Signature Issued By: Signature