4240 Nybro Lane NCITY OF EAGAN _
3 95'-1
830 Pilot Knob Road, P.O. Box 21-199, Eagsn, MN 55121
PHONE: 454-8100
BUILDING PERMIT Receipt # ! '?
Te 6, w"d fer FIRZ; KEPAIR Fet vnli,p $5,000 n,.,*„ SEP`!'L''.MBLR 28to 84
l L.7 v lv V tY i DitV LLV
Site Add
?
Erect
? j{,?
Occupancy
Lot
Block sec/sub. WILD RU Remodel ? 2oning j
Parcel No. Repair ? Type of Const.
Enlarge ? No. Stories
ae Name 'ZZCHARD Gi.I20TH Move ? Length
Z Address 4240 N7 [iYBRO LA1 Demolish ? Depth
F' AGAN
4 S 4-4 7 5
t Grade ? Sq. Ft.
City
Phone
F Name `aru?n vew v tLv
?U
Address
u? Citv INVER i;!?'v' Phone 457-3700
Name _
Add ress
City -
I hereby acknowledge that I have reod this applicotion and state thot
the intormation is Correct anc optce to compiy with oll applicoble
State of Minnesota Sta ? ? Ea ? ?n?
_ ?--?? -
Sipnature of Permittee "-
/1 Building Pem+it is issued to: t x cALvz::
Assessment
Woter & Sew.
Poliu
Flro
Enq.
Pianner
Countl I
Bldg. Off?
APC
Var. Date
Buildirq OffiNal ' Permit +'-jv•vv
oll work shall be done in accardance wi oII opplioobla State of Minnesota SU
n ( :
Surcharpe 2.50
Plcn check
SAC
Woter Conn.
Woter Meter
Rood Unit
Parks
Totel $52.50
on tha •zprcas condition that
and City of Eogan Ordinances.
Pwmit No. Permit Holder Data
Plumbfnp
H.V.A.C. „
ENetric }
Sokerrer
Inspection Date Insp. Other
Footings
Foundation
Framing
Rough Plby.
Rough HVAC
Inwlation
Final Plbg.
Final HVAC
Final
Cert/Occ.
Water Deseri6e Loeation:
Wa?l
-?-,?
?
?
Sawye
? ?
Pr. Disp.
CASH RECEIPT
CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE
19
AMOUNT $ 1-1
ooLLwRs
1 oo
[-] CASH E] CHECK
B Y
NUMERICAL FILE COPY
r-
cirir oF E?"N
3795 Pilet Knob Road Eagaa, MN 55122 N2 4786
.7 ' PHONE: 454-8100
BUILDING PERMIT Receipt
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b
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t
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e uie
a s
.
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Site /lddress Erect ? Occuponcy
Lot Block Sec/Sub. ' Alter Q Zoning
Parcel # Repair ? Fire Zone z
Enlarge 0 Type of Const.
a
e Nome Move p # Stories
W
Z3
b Address
Ci
Phone Demolish ?
G?ode ? Front ft.
Depth h.
Approvols Fees
Zo arne
a<U Addre:
u
1- n...
I hereby ncknowledge that I hove reod this opplication and state thot
the information Is correct ond ogree to comply with all applicable
State of Minnesota Statutes and Ciry of Eagon Ordinonces.
Signoture of Permittee
A Building Permit is issued to:
all work shall be done in acco
Assessment -
Water & Sew.
Police
Fire
Eng.
Planner
Council
Bldg. Off. _
APC
Permit
5urchorge
Plan check
SAC >-';.00
Water Conn. • ?0
Water Meter
Toral 97q.
10`rlc,-' In`'" on the express condition that
tate of Minnesoto Statutes und City of Eogon Ordinonces.
Buildinp Officiol
PomM # Dafo lawd hewlftu
Plumbin9 113y (r -/t - 7P /C.w9arA.;
--Mechanical 1197 6
INSPECTIONS DATE INSP• Rouph-In Final
Footings Date Insp. Date rap.
Foundotion Plumbing /,',`I -
Frame/ins. Mechonical
Finol ?
?
Remorks:
,,f,;,_. ,?...?
CITY OF EAGAN
8795 Pilot Knob Road
Eo9an, Miewesota 35122
Phone: 454-8100
PERMIT
...
Date: :12CG 1_ 2, 19
Site Address• `! 2 4 0 N^ • i1ybY'o 1,,?r.
Lot Block Sub/Sec. _ "' ?' 6 th
Name
¦
? Address
City au=Phone:
Name Bi22uei SOIl
?
?
P Address
?
City ' ? • ? `' Phone:
This Permit is issued on the express condition that all work shall be
Minnesota Stotutes and City of Eogan Ordinances.
No. .' 1
Receipt No.: 10133
Single
Residential
Multi Res., Comm./Ind. I
New /Alter. / Repair
Cost of Instollotion
Permlt Fee
$urthnrge
Total J ?
done in accordance with all applicable State of
Building Officiol
•r
---?PLI1iABIN(
' iine 12, 1978
Dcte:
cirir oF EA"N
3795 Pilot Knob Road
Eagan, Mlnnesota 55123
Phone: 454-8100
PERMIT
Site Address: 47 d[! RTc7 _ c) T,a
Lot Block "' Sub/Sec. _ lVR F.t- h
No. 113?_
Receipt No.: ? Single
Residentiol
Name Gr-n ;inmPS Tr:r - New/Alter./Repoir
.
; Address e I I ; -"-T Cost of InstaUation
O
n.
City P a i'i S 5i1 1G, Phone: Permit Fee
Name PlL1ItlblIlt' _ Surchorfle .
Q?
y Address ? a 00
?
City % tl llwci;- Phone: Totol
This Permit is issued on the express condition that all work shall be done in accordonce with oli opplicable State of
Minnesota Statutes ond City of Eogan Ordinonces.
v Bullding Official
INSPECTION RECORD
C1TY OF EAGAM PERMIT TYPE:
3830 Pilot FCnob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(612) 681-4675
SITE ADDRESS: ' ?' 4 ?' ? i ?,? i ?t? ?,t p
r I ?? ef i;ITO i ANl- N
!.1l.I IiFkNE;S I:llN 61H
APPLICANT:
, i . .
PERMIT SUBTYPE:
TYPE OF WORK:
ki WRftP'fi; Pt At4 Irt"ti/(t t.11 h k'tY Rli i AIl AM'?
Permit Moltler Date Telephone #
PLUMBING
HVAC
Inspection Date Inep. Comments
FOOTINGS
FOUND
FRAMING
RDOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP 80ARD
FIREPLACE
FIREPLAGE
AJA 7EST
FINAL PLBG
FINAL HTG
ORSRT
TEST
BLQG FINAL
DOMESTIC
METER
IRRIGATION
METER
FLUSH
MAINS
coNOUCnvrn
TEST
HYOROSTATIG
TEST
BSMT R.I.
BSMT FINAL
DECK FTG /q7ff
DECK FINAL
?
'?&?
CITY OF EAGAN Remarks
Addition WILDERNESS RUN 6th ADDITION Lot 1 Rlk 2 Parcel 10 84355 010 02
Owner"66 %1
????_ Screex 4240 N. Nybro Lane state Eagan, Minnesota 55123
15 -
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK 1973 161.21 8.04 20 112.85 A006586 8-31-78
SEWER LATERAL
WATERMAIN
WATER LATERAL
WATER AREA 1977 162.14 .$-:46 15 140.54 A006586 8-31-78
STORM SEW TRK ' 3901 1978 278.44 8,56 5 259.88 A006586 8-31-78
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATERCONN. 250.00 9928 5-9-78
BUILDING PER. #4786
sAC 500, 928 5-9-78
PARK ot(? . ?
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(612) 681-4675
SITE ADDRESS:
,. , ,, ? , ro r± f Fa
PERMIT SUBTYPE:
APPLICANT:
TYPE OF WORK:
rI .''. .1 1 .
?
INSPECTION DA • .A
? : r-?
`'01 l9A ttt - - A':? 11 AIlATI t'i IrMI ! i•. $;f 0 11 1 til 0 1 ??1f ANv I'1 IiM1; tMC. II {, I 1 f+ 1 l• 11 A) 1.I9 1
:.?
Permit No. Permlt Holder Date Telephone #
ELEC7RIC &604'IrfQ /5 " ?
PLUMBINQ
HVAC
Inspectlon Dete Insp. Commants
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYPBOARD
FIREPLACE
AIR 7 ST FIREPLACE
FINAL PLBG
FINAL HTG
ORSAT
TEST
BIDG FINAL
BSMT R.L
BSMT FINAL
DECK FTG
DECK FINAL
CITY OF EAGAN
3795 Pilot Knob Rood
Eagan, MN 55122
Zoning:
pwner.
Address: _
Site Address:
Plumber: -------
SEWER SERVICE PERMIT
PERMIT NO.:
DATE:
. No. of Units:
I agree to cwnplY wiEh the City of Eagan
Ordinances.
BY -
Date of I nsp.:
CITY OF EAOAN
3795 Filot Knob Rood
Eagan, MN 55122
Zoning: --
Owner:
Address: -
Site Address:
Plumber.
Meter No.: -
Size:
Reader No.:
1 dgree to wmply wilh the City of Eogan
Ordinanoes.
By
Date of I nsp.:
Connection Charge:
Account Deposit:
Permit Fee:
Surcharge:
Misc. Charges:
Total:
WATER SERVICE PERMIT
PERMIT NO.:
DATE:
No. of Units:
_ Connection Charge:
_ Account Deposit:
_ Permit Fee:
Surcharge:
Misc. Charges: Total:
_ Date Paid:
_ I nsp.:
Tt?s equest void 18 months from / p o o O
`?' s ? ??? 2 I? ?? ?C'?• Date of this Request_ 5-10-1978 P87703
I, as 55(l.icensed Electrical Contractor O Owner, do hereby request inspection of the above electri-
cal wiring installed at: .
Street Address or Route No. 4240 $Vbro CityEaaan
Section Township
Which is occupied by
Tilaen Homea
Range County Dakota
Is a roughin inspection required on this job? No ? Yesl% Ready Now ? Will Call 01
Power Supplier Dakcta Cty. pddress Farmington
Electrical Contractor O.B. Thompoon Electric Co. Contractor's License NoB33735
(Comvany Name)
Mailing Address
Authorized
MVE -? (BARD 00PY
Phone No. 933-2521.
This inspection request will not be accepted by the
State Board unless proper inspection fee is enclosed.
esota State Board of Electricity
owl rsity Ave., St. Paul, Minn. 55104-Phone 645-7703
+ QUEST FOR ELECYRICAL INSPECTION
CHECK BELOW WORK CO'C`ERED BY THIS REOliEST .
/coov
P 87703
Type of Buitding New Add. Rep• Check Appliances Wired For Check Fquipment Wi[ed Foi
Home ]a ? ? Range MC Temporary WiTing ?
Duptez ? ? ? WaterHeater ? LightingPixtures ?
Ap[. Bldg.
Commercial Bldg. ?
? ?
? ?
? Dry ? p
gr
Pur .?. Electric Heating
Silo Unloadei ?
?
Industrial Bldg. ? ? ? A'v nditi- B
ulk Milk Tank
?
Fazm ? 0 ? List List
Other
?
?
? Others}
Heie ) D].9A.D19h.XXXZ pthers
Here ?
COMPUTE INSPECTION FEE BELOW
Service Entrance Size: # Fee Feedecs& Sub[eedess: # Fee C¢cuits: # Fee
0 to 100 Am s. 0 to 30 Am res 0 to 30 Am eres
101 to 200 Amps 31 to 100 Ampeies 31 to 100 Am ies
Above 200 Amps. Above 100 Amps. Above 100 Amps.
Tcansformexs RemoteContiolCirc. Partialorotherfee .50
Signs S ecial lns ction Minimum fee
Remazks
$a,11
TOTAL F Q QQ
40.50
I, the Electrical Inspector, hereby cerl't?hat N6?`1}?ove1inspection has been m
(Rough-in) ???? Date
(Final) Date -?at-76
This request void 18 months from
REQUEST FOR ELECTRICAL INSPECTION ?e?ie-hooooi-o
3,?//? ?- ? See insimctions for completing Ihis tortn on back of yellow copy. ??? ?O eCQ
"X" Be/oi,47'Work Sovered by This Request
Ne% Ad Rep. Type of Building Appliances Wired Equipment Wiretl
Home Range Temporary Service
Duplex Water Heater Electric Heatin
Apt. Building Dryer Load Management
Comm./Industrial Furnace Other (Specity)
Farm Air Conditioner
OtOer (speciy) Con[raclor's
?5?'1f' ??IW/?
Compute Inspection Fee Below:
# Other Fee # Service Entrance Size Fee # Circuits/Faeders Fee
Swimmin Pool 0 to 200 Amps to 100 Amps
Transformers Above 200_Amps V e 700-mps
SIgnS Inspectors Use Oniy: TOT
Irrigation Booms
Special Inspection
Alarm/Communication THIS INSTALLATION MAV BE ORDERED DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
I, the Elecirical Inspector, hereby Rough-in ? Date ^?y
ceRity that the above inspection has
been made. Final oaie
t?-/a^ y
OFFICE USE ONLV
This request voitl 18 monlhs firom
0-1
-979 ? °6
? Qa
? o
?,
3 is 5
Requesl Dsl / Fire No. R ughln InspeMian Requlretl Inspeclion Other Then ugh-In
m 1
ll in
mr vih
n
tl
V
) R
II N
i
I
d
N
?f
? y
(
OU
ca
spec
e
rea
ot
ty
nspector
ea
y
ow
C Yes ? No Dete Read
I? licensed contractor gemer hereby request inspection of above electrical work at:
Job Vdres5 Street. Box or Route No ) City
/i/?1?/?o(/y. O `yl . k-/")
Semion No. Township Name orNo. Range No. County
upan (PRWT) Phone No.
Pouv Supplier Atldress
Electncal om acror (COmpany Neme) Conirecto(s License No.
Mailing atlress (C h c or Owner Mnking InsWllation)
Authorizetl naNre (Conttacro wner aking tallalion) Phone Numbar
J2 yi.12- ?.
MIN S A STATE AR F ELECT
ILRY I REQUEST WILL
T
?
Gr" g itlway BI .- Ro 5-128
II
II I
I I
I I I
I
I II
I II
II
I I
I
I N
ED B THE STATE BOA ?
III
1 2 niverelly e., S aul, MN 5510 ? UNLESS PFOPER INSPECTION FEE IS
ne (612) 64 0 ? ENCLOSED
s o ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN
Move:
Demolish
Grade:
To Be Used For: 1/?e Valuation: ?D[90• `"
Site Address: 'Z ()
Lot: f Block: :Z Sect/Subc""'= Erect:
Parcel $: :=rL-:t!§.Re'model:
._R'epair:
Owner:?l(J-4v`ce _;?P,Cc'A? Enlarge:
Address: /J1ZilCI A10• "(/tI ?,,4;.•e.
City/Zip Code: E.qe;,y„J
Phone #= ?S??-J??S?
Contractor:??i zfwG/!b?
Address:37aU q.yT?? ,57. G.
City/Zip Code:?'6yf/Pv z?4rtyvc ?vyd?s.
.?--
Phone # : yS7 - 37M
Arch./Eng:
Address:
City/Zip Code:
Phone#:
INCLUDE 12 SETS OF PLANS,
0 CERTIFICATES OF SURVEY
? SET OF ENERGY C CU ATIONS
Date :
• •
_ Occupancy: ?-3
Zoning:
Type Of Const: ?
# Stories:
Length:
_ Depth:
Sq. Ft.:
APPROVALS
Assessments:
water/Sewer:
Police:
Fire:
Engr.:
Planner:
Council:
Bldg. Off.:
APC:
Variance:
Permit:
Surcharge:
Plan Rev.:
SAC:
Water Conn: '
Water Meter
Road Unit:
Parks:
? 5,;? 'SQ
QS - / G
a-?; t?3
BUILDINCs PERMIT
CITY OF EAGAN M 9551
3830 Pilot Knob Road, P.O. Box 21-199, Eegan, MN 55721
PHONE: 454-8100 c / _
Receipt # (O
Te M wad ier FIRE REPAIR Est.Volue $5,000 pate SEPTEMBER 2Pj9 8
4
Site Address 4240 NO NYBRO LN Erect
? Ocwpancy R3
Lot 1 Block 2 c ec/Sub. WILD RUN. 6 Remodel ? Zoning El-
Parcel No. Repair Cl Type of Const: V
Enlerge ? No. Stories '
. W Name RICHARD ZEROTH Mave ? Length
? qddm$ 4240 NO NYBRO LN Demolish ? Depth
City EAGAN phone 454-4751 Grade ? Sq, Ft.
? MARK CALVIN Avvrwab Fee.
Name
nddress H ST E
? City INVER GRV I}"e 457-3700
Neme _
Address
City _
Phone
I hereby ocknowfedpa thot I have reod this application and stote tMof
the inlormotion is correct and e to tomply wifh onll ?asD?Dlicable
Stata of Minnewto Stot i Ea
Sipnefure of PertniMee ?
A Building Permit Is issued ro: MARK CALVIN
ull work sholl be done in acmrdanc wi II a litobl S oitMir
Buildinp Officiol -P?LQ c
Assessment
Water & Sew.
Police
Fire
Enp.
Planner
Council
BIdg.Off. 9 127 I$4
APC
Var. Date
Permir aZ)u.VU
Surcharge 2 • 50
Plon check
SAC
Water Conn.
Water Meter
Road Unif
Perks
7otal $52.50
on the expreas condiHOn thot
Statutes ond City of Eopan Ordinonces.
City of EaiaIl
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
2008 MECHANICAL PERMIT
Date: 7_ 7 0? Site Address: 2- "Y d
7enant
Suite #:
RESIDENT / OWNER Naml i +`? 9' k<N+ -S? _+ z- Phone:
Address ! City / Zip:
Li
N
#
-
?
; z,
-
CONTRACTOR ame:
cense
:
< <
-
?
,
Address: Lo(y o ?2_`T 7--th ST /?
? oT7"
5
7
/
-
C_ State: Zip:
City: hp,
4:? e ur
Phone:(5lZ' ??r7•-/?{SL ContactPerson:
TYPE OF WORK _ New Repl cement Additional . Alteration _ Demolition
??1•?
Jd
?
Descriptlon work:,a
r ncw ?
ic n
6`UC
NOTE: Both roof mounted and ground mounted mechanical equipment is required to
be screened by Cify Code. Please contact the Mechanical lnspector or one of the
Planners for information on ermitted screenin methods.
RESIDENTIAL COMMERCIAL
PERMIT TYPE Interior Improvement
New Construction
Fumace _
_
Air Conditioner _ Install Piping _ Processed
Air Ezchanger _ Gas _ Exterior HVAC Unit
'
_ HVAC units must be screened
Heat Pum/p?
? Other //H Under / Above ground Tank ? InstalU Remove)
When inst211inglremoving tank(s), call for inspection by Fire
Marshal and Plumbin Ins ector
RESIDENTlAL FEES:
$50.50 Minimum Add-on or alteration to an existing unit (includes $.50 State Surcharge)
$90.50 Fife fepalr (replace bumed out appliances, ductwork, etc.) (inCludeS $.50 State Surcharge)
$ ?O • SU TOTAL FEE
COMMERCIAL FEES:
$70.50 Underground tank installationlremoval OR Contract Value $ x 1%
$50.50 Minimum (includes State Surcharge)
_ $ Permit Fee
- It Pemiit Fee is less fhan $1,000, surcharge is $.50.
- If Permit Fee is >$1,000, surcharge increases 6y $.50 for each =$ Stat2 Sufchafy0
$1,000 Permit Fee (i.e. a$1,001-$2,000 Permit Fee requires a$1.00 surcharge).
$ TOTALFEE
I hereby acknowtedge that Nis information is complete antl accurate; that the work will be in conformance with the ordinances antl codes of fhe City of Eagan; that
I underst2nd this is not a permit, but only an applicafion for a perrnit, and vrork is not to start without pertnit; t fie wor will be in accordance with the approvetl
plan in t case of work whi ' requi a review and approval of plans.
C
X?' C. ?( X
ApplicanYs Printed Name A lica s nature
FOR OFFICE
? -- - - ----
FwOfficeUse ?
Q ? I
? Permit #: V Q ?
i Perrnit Fee: ? I
I
? Date Received: ?
I ?
? Staff: ?
L_- __ _____.___I
TION
By:
Oate:
Required Inspections: _Under Ground _ Rough In Air Test _Gas Service Test -In-floor Heat _Final
------------------
i r? • i
; Pe"it #: 66e G? 3
?. Permit Fee: ?!/ • ? ?
f DateReceived:
I Staff: ?O I
I------ -----'
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
` U25 S(te pddress:
Tenant:
Suite #:
RESIDENTlOWNER Name: C7l//l Phone:S??'T.???
Address / City / Zip:
Applicant is: _ Owner ? CoMractor
TYPE OF WORK Description of workfN/Ul/1? ???
Construction Cost: ?l ??d? " Multi-Family Building: (Yes_/ No'Ki
CONTRACTOR Name: a a License #:
Address: ?/p
e: ?? _ Zi • 7?777
City: L??£ l St
at
/
`
?
14L^f
Phone: 61? Contact Person: /1 E
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Cateaorv 1 Minnesota Rules 7672
Energy Code . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
Category Suhmined Su6mitted
(4 sUbmissloll type) • Energy Envelope Calculations Submitled-
In the last 12 months, has the City of Eagan issued a permlt for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: P1ans artd supporting,documents thal yoG's`ubmit are considered to be"poblic in`f6rr»ation oPortions olN?_'
fhe fnto'imatfon rriay_be cfassified as`'non pubtic i/ you pravide spesific reas'on"s Ithat woyld permit the City
=-cortcludethaf Che .ar?trade sec'rets.,',?
I hereby acknowledge ihat this information is complete and accurate; that ihe work will be in conformance with the ordinances and codes of the City of
Eagan; ihat I understand this is not a permit, but only an application for a permit, and work ?? not to start without a permit that the work will be in
accordaqce with the approved plan in the case of work which requires a review and approval oyplans„
X ?,?? ? x ?,
ApplicanYs Printed Name Applica s Sig at
Page 1 of 3
2008 RESIDENTIAL BUILDING PERMIT
?-----------------
i
j Permit #: 3 t j
I PermdFee: V3 4 1) / ?
? Date Receivel; OlU' 07' O(1 I
I Staff:
APPLICATION&&e6d 10/0
Date: _C? `1 d ? Site Address: ?"oS !'? effZ? 4_," ` Al'
Tenant:
Suite #:
RESIDENT/OWNER Name:T ? Phone:6d/?_ ?So7-7,qe 7
Address / CRy 1 Zip:
Applicant is: _ Owner _xContractor
TYPE OF WORK Description ofwork: Ad''47/64-.1
Construction Cost: Multi-Family Building: (Yes No ?6
?
CONTRACTOR Name: -n' Crai??c/??eCl?? License
e
lcGJ
Address: /
City: . ? . // State: 40. Zip: ?J?77
Phone: W7' G97^?l /_v Contact Pereon: 6-C
COMPLETE THIS AREA ONLY IF CaNSTRUCTWG A NEW BUILDING
Minnesota Rules 7670 Cateqorv 1 Minnesota Rules 7672
Energy Code . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
Category Submitted Submitted
(4 submission type) • Energy Envelope Calculations Submitted
In the last 12 months, has the City of Eagan issued a pertnit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contrector: Phone:
Sewer & Water Contractor: Phone:
NOTE Plans ahd supportui? documenis that you submrt aj?e consldered to b?pbbfic nformaUo?t':' Pnrt?ons-o# Y
ectflc reasons that yvoulei permet fhs C4`fo
?the 4nformaLOn nvay be classffledl
ro°vrde s
as 1iion
uWic Jf
ou
?
?
?
p
y
{
t
? L n. t^?: ty?- ,3?{I N
I
33t? coodluidethat.#h aiZ.tiatleseEi*ts
1 hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinance5 and codes of the City of
Eagan; that I understand this is not a pertnit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordan a with the roved plan in the case of work which requires a review and approval of plans.
X
Applicay t's Printed N e pplicanY ignature
Page 1 of 3
G
DO NOT WRITE BELOW TH15 LINE
SUB TYPES
? Foundation ? 05-plex ? 16-plex ? Accessory Building ? Pool
,0 Single Family ? 06-plex [] Firepface ? Porch (3-season) ? Eut Alt. - Multi
? 01 of _ Plex ? 07-plex ? Garage ? Porch (4-season) ? Ext Alt. - SF
? 02-Plex ? 08-plex ? Deck ? Porch (screenlgazebo/pergola) ? Multi MisC.
? 03-Plex ? 10-plex ? Lower Level ? Storm Damage
? 04-Plex ? 12-plex ? Miscellaneous
WORK TYPES
? New ? Interior Improvement ? Siding ? Demolish Building"
*6b Addition ? Move Building ? Reroof El Demolish Interior
? Alteration ? Fire Repair ? Windows ? Demolish Foundadon
O Replacement ?. Egress Window ?, Water Damage
DESCRIPTION
` Demolition (entire buiWing) - give PCA handout to applicant
Valuation 3fj Occupancy R-e-- ^ + MCES System
Plan Review Code Edition a? .r-, SAC Units .
(25%_ 100°/a ? Zoning R- ? City Water
Census Code Stories l Booster Pump
# of Units Square Feet 'r `12(0 PRV
# of Buildings Length 03 Fire Sprinklers
Type of Const. Width -IR T) I f
REQUIRED INSPECTIONS
Footings (new bldg)
Footings (deck)
Footings (addition)
? Foundation
Drain Tile
?O Roof: ?O Ice & Water ?4 Final
)0 Framing
Fireplace:_R.I. _AirTest Final
Insulation n) -
Reviewed By:
RESIDENTIAL FEES:
Base Fee
Surcharge
Plan Review
MCIES SAC
ciry sac
Utility Connection Charge
S8W Permit & Surcharge
Treatment Plant
Copies
Total
Sheetrock Meter Size:
Final/C.O.
,?Q FinallNo C.O.
HVAC
-? Other:
Pool: _Footings _Air/Gas Tests _Final
Siding: _Stucco Lath _Stone Lath _Brick
Windows
Retaining Wall
Building Inspector
1A;(00& q Z ?Q.? $
Cgy} u)l 5 MC Z°
ClZL k g.&XO
Page 2 of 3
C?J( REScheck Software Version 4.0.0
Compliance Certificate
Project Title: #08-102
Report Date: 05/15108
Data filename: I1Energy CalcslRESCHECKVMN12008108-102.rck
energy Code: 2000 Minnesota Energy Code
Location: Dakota County, Minnesota
Construction Type: Sinyle Family
Glazing Area Percentage: 78%
Climate Zone: 2
Constructian Site:
OwnerlAgent:
Jim 8 Kim Seitz
Desig ne rlContra ctor:
Ceiling 1: Flat Ceiling or Scissor Truss: 1` I -- 33
Wall 1: Wood Frame, 16" o.a: 735 19•0 2.0
330
0 44
Window 1: Above-Grade:Above Grade, Wood Frame, Double
.
132
Pane with Low-E:
0
230
4
Door t: Solid: .
18
263 0.0 10.0 19
Basement Wall 2: Solitl Concrete or Masonry:
Wall height: 3.5'
Depth below grade: 3.0'
Insulation depth: 3.5'
Furnace 1: Forced Hot Air: 90 AFUE
Compliance Statement: The proposed building design described here is conslstent with the bulidiog plans, specifcalions, and other
calculations submitted with the permit application. The proposed building has been designed to meet the 2000 Minnesota Energy Code
requ'rements in REScheck Version 4.0.0 and to comply with the mandat ry require ts listed Vn the REScheck Inspection Checklist.
g Date
Name - Title Si nat
Page 1 af 1
#08-102
EAGAC?
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-PLOT -PLAN
-4 5?-30
2006 RESIDENTIAL BUILDING rEUMrT arrLicaTiorr 't}0 .
?
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construdion Reauirements
3 registered sife surveys showing sq. $ of lot, sq. ft of house; and all roofed areas
(20% maximumlotcove2geallowed)
1 Soils RepoR'rf proposed building is fo be placed on disWrbed soil
2 copies of plan showing beam & window sizes; poured found design, etc.
1 set of Energy Calcula6ons
3 copies of Tree Preservation Plan if bt plaried after 717193
Rim Joist Detail Options selecGon sheet (buildings with 3 or less unifs)
Minnegasco mechanipl venGlation form
RemodeURenair Reauirements
2 copies of plan showing footings, 6eams, joisLs
1 set of Eriergy Calalafions for heated addifions
1 site survey for addilions 8 decks
Adddion - rndicate if ortsfte septic system
Telephone # (
Date /0 / / 0 6 Construction Cost ? ")0
Site Address I{ 'Z ?10 N o.2--t N?I K(! o C?a-,J c SS r 2 3 UnidSte H
Description of Work INScti? eveF ve?-);X WS o r? S' Roc1C
2 t-?
Multi-Family Bldg _ Y_ N Fireplace(s) _ 0_ 1 _
Property Owner Hnk ?nn Se k 7 Z Tetephone #((o?;_t) ?SZ B 2Z`J
SE?r
Contractor f{r:s-ll-tA"Nayz;:? Kicu c} J fvi,1
Address 5'l-''1Al A-S A(? JC City
State Zip Telephone # ( )
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Categorv 1 Minnesota Rules 7672
Energy Code Category . Residentlal Veotilation Category 1 Worksheet • New Energy Code Worksheet
(Jsubmissiontype) Submitled - Submifled
. Energy Envelope. Calculations Submitted
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_ Y _ N If yes, date and address of master plan:
Licensed Plumber C E ? \"/ ?? -1?
MechanicalContractor flf T 2 4 2009 Sewer/Water Contractor
1o131. ,4v
Otfic'eiUse OnN
Ced af Suyv?y?ke? „ 1? ` N
Soils e rf ' ?l ?`"
77e? ? p4?n,R2? -Y -,x'4.
Tfeff Pr?sReq?(re? ? Y =,1?.
Ons?ieBeAtcSysEeme.x ='1' ..,,_.N
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
perxnit that the work will be in accordance with the approved plan in the case of work which requires a review and
approval of plans.
I?.lp•? b-e-r ?i.? S2 ? ?'Z
ApplicanYs Pnnted Name
ApplicanPs ignature
DO NOT WRITE BELOW THIS LINE
Sub Tvpes
? 01 Foundation ? 07 05-plex
? 02 SF Dwelling ? 08 06-plex
? 03 01 of _ plex ? 09 07-plex
O 04 02-plex ? 10 08-plex
? 05 03-plex ? 11 10-plex
? 06 04-plex ? 12 12-plex
WorkTvpes IV
? 31 New ? 35
? 32 Addition ? 36
)J- 33 Alteration ? 37
? 34 Replacement
? 13 16-plex
? 16 Fireplace
>Ef 17 Garage
? 18 Deck
? 19 Lower Level
? 20 Pool ?
? 21 Porch (3-sea.) ?
? 22 Porch/Addn. (4-sea.) ?
? 23 Porch (screen/gazebolperola) ?
0 24 Storm Damage
? 25 Miscellaneous
Int Improvement ? 38 Demolish Interior
Move Building ? 42 Demolish FoundaGon
Demolish Building' ? 43 Reroof
•Demolition (Entire Bidg) - Give PCA handout to applicant
DCSCI'ilqt1011: Water Damage _ Yes .
Valuation
Plan Review 100% or 25%
Census Code
SAC Units ?T
# of Units
# of Bidgs
Type of Const
Occupancy MCES System
30 Accessory Bldg
31 Ext. Alt - Multi
33 Ext. Alt - SF
36 Multi Misc. .
? 44 Siding
? 45 Fire Repair
? 46 Windows/Doors
Zoning City Water
Stories Booster Pump
Sq. Ft. PRV
Length Fire Sprinklered
Width
_ Footings (new bldg)
_ Footings (deck)
_ Footings (addition)
Founda6on
Drain Tile
Roof Ice & Water Final
_ Framinro
Fireplace _ R.I. _ Air Test Final
7,!S Insularion
Approved By: 7 ?
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
REQUIREDINSPECTIONS
_ Sheetrock
FinallC.O.
FinallNo C.O.
HVAC
Other
_ pool Ftgs Au/Gas Tesu Final
_ Siding _ Smcco Lath _ Stone I.afh _Brick
Windows
_ Rehining Wall
Building Inspector
-
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P1,: <", 1417N...
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New Construction Reouiremenb
. 3 registereE site surveys showing sq. fl. ol lot, sq. R. of house; and all roofed areas
(20°%maximum bt coverage ailoweC)
• 2 copies of plan showirg heam 3 window s¢es; poured found design, ztc.)
• 7 set of Eneyy Caiculafions
• 7 copies of Tree Preservation Pian i( lot platted after 7/1193
• Rim Jaist DeWil Optwns seledion sheet (bfags with 3 or less unds)
DATE
SITEADORE55 Y2 '/V N°'i /vY9e0 L,4/16- MULTI-FAMILYBLDG4?Fr ii
iYPE OF WORK kC-"C-r_M0V?1 f.?rAlO owS FIREPLACE(S) _ 0_K1 _ 2
APPLICANT KI wt (A JW/l SG-) T Z
STREET ADDRESS uZqO A./047T-f &,i CITY btG1'4 N/ STATEMill ZIP S5 t 23
TEIEPHONE # K( -NS'Z'gZ2 7 CELL PHONE # ?'(fo" g 97 °j FAX # (P!?rf - HU) , y3 8 7
PROPERTY OWNER _ )(cOJL TELEPHONE# 6S(' ?fS-Z `6?22 9
-----------------------------------------------------------------------------------------------
COMPLETE TH15 SECTION POR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ )fI\"NFS01":1 RIiI.ES 7670 C:\"fF.CORY 1 MQNNESO"f:\ RCLL•'S 7672
(J submission rype) . Residential VenGlation Ca[egory 1 Worksheet Submitted • New Energy Code Worksheet SubmitteC
• Enerqy Envelope Calculations SuGmitted
Plumbing Contractor:
Plumbing system includes:
Mechanical Contractor:
N[cch.mic:il svstcm includcs:
Sewer/Water Contractor:
.air Condilioning
Heat Rccovery Systcixi
Phone #
Phone #
Fcc $70.00
----------------°--° °----------------------------------------°-°--------------°--------------°----°°--......-----
I hereby acknowledge ihat i have read this application, state that the information is correct, and agree to compiy
with all appiicable State of Minnesota Statutes and City of Eagan Ord'nan e.
Stgnature of Applicant ?
OFFICE U5E ONLY
_ Water 5oftencr
Water Hca[er
No. of Baths
RamodellReoair Reauiremenb
. 2 copies of plan
• 7 set of Energy Calcula[ions for heated additions
• 1 site survey (or exlerioradditions & decks
• Indicate if home served by septic sy5tem for additlons
VALUATION 43? o()
Phone #
Lawn Sprinkler
No. of R.I. Baths
Fee: $90.00
CertiFicates of Survey Received Tree Preservation Plan Received _ Not Required _
UpAated 4/02
OFFICE USE ONLY I
? Ot Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30' Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 , ExL Alt - Multi
? 03 Ot of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4•sea.) ? 33? Ettt. Alt - SF
? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screened) ? 36'Multi
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
? 31 New ? 35 Int Impravement ? 38 Demolish (Interior) ? 44 Sicling
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Filre Repair
? 33 Altera[ion 0 37 Demolish (Bldg)' ? 43 Reroof ? 46 WindowslDoors
? 34 Replacement 'Demolition (Entire Bldg only) - Give PCA handout to applicant ?I.
Valuation Occupancy MC/ES System
Census Code Zoning Ciry Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV ?i
Nbr. of Bldgs Length Fire Sprinklered
Type of Const W idth
REQUIRED INSPECTIONS ?
_ Footings (new bldg) FinaUC.O.
_ Footings (deck) _ FinaUNo C.O. li
_ Footings (addition) Plumbing
Faundation HVAC ?
Drain Tile Other
Roof _ Ice & Water _ F inal _ Pool _ Ftgs _ AirGas Tesr _ F[nal
_ Framing Siding Sruceo Srone
_ Fireplace _ R.I. _ Air Tes[ _ Final _ Windows (new/replacement) .
Insulation Retainine Wal( Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
W ater Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
Building Inspector
RESIDENTIAL
BUILDINC PERMIT APPLICATION
3830 PILOT KNB RDN 55122
I
651-681-4675
New Constructlan ReauiremeMa RemodeVReoair ReauiremeMs
• 3 mgislered sde surveys shaxirg sq. ft. of lot sq. ft W house; and ?II roofed areas • 2 copies M plan ,
(20% manimiun lat covefage allowed) . 7 set of Energy Calculatlons Irn heated additions
. 2 wpies of plan showirp beam 8 window strss; paured tound design, etc.) . t sile survey far exte6or additiom & decks
• 1 set af Energy Calculations • Irqicale if hame served by septic system far add'diom
• 3 copies of Tree Preservation Plan iF lot platted after 711193
• Rim Joist Detail Optiona selectbn sheet (bldgs wilh 3 or less units)
DATE VALUATION
JOB SITE ADDRESS ?-IZ?-I??S N(???I??C? Lrt YlE , Z3
IF MULTI-FAMILY BUILDING, HOW MANY UNITS? J
PROPERTY OWN
TYPE OF WORK FIREPLACE(S) _ 0_ 1_ 2
APPLICANT ?? ??G?(C? S4S?CE.1(YlS ?? ? PHONE(6AI?3I' Z(`Tb
ADDRESS ?? Pl OlAn" T-We V-?YCeh_)6?1 0)Q ZIPCODE S5 (1 Z
PAGER # CELL PHONE # FAX ??c??V-I`t?11 - 3``?(tiq
NEW RESIDENTIAL BUILDING ONLY - FILL OUT COMPLETELY
Enefgy Code Category _ MINNFSOTA RUI.ES 7670 CATEGORY 1
(check one) - Residential Ventilation Categary 1 Worksheet Sub ' ?
- Energy Envelope Calwlations Submi ??? a? ?
MINNESOTA RULES 7672 O,IUL 1 1 2?02
- New Energy Code Woricsheet Su6mitt ?
Plumbing Conhactor: _
Plumbing System Includes:
Mechanical Conhactor:
Mechanical System Includes:
Sewer/Water Contractor.
Phone #
$90.00
Fee: $70.00
All above infortnation must he su6mitted prior to prxessing of application.
I hereby acknowledge that I have read this application, state that the information is correct, and agree to compiy
with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant*QjMl'??' 'J ?+-?' V l
\Ij
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 2002
_ Water Softener
_ Water Heater
_ No. of Baths
_ Air Conditioning
_ Heat Recovery System
_ Lawn SprinklJF-I.
_ No. of R.I. Baths
Phone #
OFFICE USE ONLY
? 01 Foundatian ? 07 05-plex 0 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (&sea.) ? 31 Ext. Alt - Multi
? 03 01 of _ plex 0 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) 0 33 ?Ext. Alt -SF
? 04 02-plex ? 10 08-plex ? 18 Dedc ? 23 Porch (saeened) ? 36 IMulti
? 05 03-plex ?
11
10-plex
? 19 Lower Level
O 24 Storm Damage I
? 08 '04-plex ? 12 12-plex Plbg_Yor_ N ? 25 Miscellaneous ?
? 31 New ? 35 IM Improvement 0 38 Demolish (Interior) Q 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)' O 43 Reroof ? 46 WindowslDoors
? 34 Replacement 'Demolition (Entire Bidg only) - Give PCA handout to applicant
Valuation Occupancy MC/ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump ?
Nbr. of Units Sq. Ft. PRV ?
Nbr. of Bldgs
Length
Fire Sprinklered ?
Type of Const Width
REQUIRED INSPECTIONS I
_ Footings(new bldg) FinaVC.O.
_ Footings (deck) _ FinaVNo C.O. i
_ Footings (addition) _ plunibiog
_ Foundation HVAC
Drain Tile
Roof _ Ice & W ater _ Final _ Other i
_ Framing _ Pool _ Ftgs _ Air/Gas Tesu _ Final
_ Fireplace _ R.I. _ Air Test _ Final _ Siding Stucco Stone
_ Insularion _ Windows (new/replacement) j
Approved By , Building Inspector
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
Capies
Other
Total
CSTY OF EAGAN
CASH2ER: S TERMINAL N0: 774
DfiTFe 08/13/38 TIME: 14c37:45
ILi :
NAhfE: F.IMAEf:LY S. SEI7Z
3210 9(]01 4240 NYPRO L.ANF 50.00
2155 9009. 4240 NY$RO IANI= C1.50
7otal Iieceipl; Artiount: 50.50
CR03E,7. i 3
t151=R 7:D: NANCY
PERMIT
. Ci7Y OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMIT TYPE
Permit Number:
Date Issued:
BUILOTNG
032907
08/13/98
SITE ADDRESS:
9240 NY8t2tl LANE N
LOT: 1 BLOCK: 2
WILDERPdESS RUN 6TH
P.I.N.: 10-84355-010-02
DESCRIPTION:
B?ll?iii*,??Permit Type
Pu1.11ding 4q,rk Type
?
?ensu s
4b ? N
?
`??'t a I
DECK
NEW
A34 ALT. F?ESTDENTIAL
?'n nr?"?` v? F
'95k ?t'w,m W
'w?'?pv?3£g.,??;4? M
?ur IS? r, b ? ?, S ?ra? m?z ? ?? .?" ul
?
REMARKS:
PLAN REVIEWED BY BILL ADAMB.
FEE SUMMARY:
Base Fee
Surcharge
Total Fee
CONTRACTOR:
r
$50.0@
$.50
$50.50
APPLICANT/MITEE SIGNATl1RE
OWNER: - Applicant -
SEITZ JTM
4240 NYBRQ LANE N
ERGAN MN 55123
(657)452-8229
(,oT I
. ? .. 1998 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830 PII.OT KNOB RD - 65122
? 0 -1 681-4675 9? ?;o . '?, U
tlew Construction Reauirements RemodeUReoair Reouirements -
, n i1 (1 g ? 13
l'_aSUC_Q_6J -4
? 3 registered sde surveys
• 2 eopies af plans (inUude beam 8 window saes; poured tnd. design; etc.)
• 1 energy Calwlations
? 3 copies of tree presenation plan 'rf lot platted after 7/7f93
required: _ Yes _ No
DATE: 8- ! 2- 5 g'
• 2 copies of plan
• 2 sile surveys (exterior adCitions 8 decks)
? t energy ralculations for heated adddions
CONSTRUCTION COST; ?r-!?-D
DESCRIP ON OF WORK: ft p n f rJ6 /?
STR TADDRESS: L(I 40 ,v„Qx),+ IJYg2o Crt-Nc
LOT: _? BLOCK: 2 SUBD./P.I.D. #: W«Oe&,"-VJ ?'v 6
Name: S? i( z .J 1 tlti "t ?? Vv\ Phone #: 6 S(-?Y' Z-? z S
PROPERTY Last First
OWNER
Street Address: 4 2L( U 0D2-i N AJY eg(Z-0 C
City
C>4GrA-1J
State: 1-^+`J Zip: SS l'z 3
Company: H?,`k r o,- t-) ??`- Phone #:
CONTRAC'fOR
Street
City
ARCHITECT/
ENGINEER Comp
Name
Street
City
License #
State: Zip:
Phone #:
Registration #: _
State:
Zip:
Sewer & water licensed plumber (new construction ony): . Penalty applies when address chang
and Iot change is requested once permit is issued.
I hereby acknowledge that I have read this appliption and state that the infortnation is correct and agree to comply with all applicab'
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY
Certificates of Survey Received ?Yes _ No
Tree Preservation Plan Received _ Yes _ No _ Not Required
A116 .1
OFFICE USE ONLY
BUILDING PERMIT TYPE
O 01 Foundation ? 06 Duplex O 11 Apt./Lodging ? 16 Basement Finish
? 02 SF Dwelling ? 07 4-plex ? 12 Multi RepaidRem. ? 17 Swim Pool
? 03 SF Addition ? 08 8-plex ? 13 Garage/Accessory ? 20 Public Facility
? 04 SF Porch ? 09 12-plex ? 14 Fireplace ? 21 Miscellaneous
? 05 SF Misc. ? 10 = plex ? 15 Deck
WORK TYPE
,!? 31 New ? 33 Alterations ? 36 Move
? 32 Addition ? 34 Repair ? 37 Demolition
GENERAL INFORMATI ON
Const. (Actual) Basement sq. ft. MC/WS System
(Allowable) Main level sq. ft. City Water
UBC Occupancy sq. ft. Fire Sprinklered
Zoning sq. ft. PRV
# of Stories sq. ft. Booster Pump
Length sq. ft . Census Code.
Depth Footprint sq. ft. SAC Code ?L
Census Bldg _L
Census Unit _0
APPROVALS
Planning Building 4E9- Engineering Variance
Permit Fee Valuation: ; $;?--•- _ •?.?
Surcharge
Plan Review
License
MC/W5 SAC
City SAC
! .__
.__._._._____.,.,._..,
WaterConn. }
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
,
Total:
% SAC
SAC Units
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1- LOT -PL AN
2004 RESIDENTIAL MECHANICAL PERNIIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please comptete foc single family dwellings & townhomes/condos when permits are required for each unit
$305--
Date O'd
Site
Property Owner
Unit #
Telephone#(b5? ) `A ?a- J6 `?-?
Couirac2or eS
StreetAddress O 1=.???~ City OGG`?",r\h? C)?
State V\N? Zip a. Telephone #(`iS? )??`?- 3? DI1
Bond #: Expires:
The Applicant is _ Owner -'k Conhactor
Add-on or alteration to existing dwelling unit
-
furnace Additional Replacement ?,, ?` ?? ?- `= 1'',, •
? air exchanger
? p? 15 24 U
_ air conditioner _New _Replacement ?i ,; other
$
30.00
State Surc6arge I $ 50
Total
$?)0-
I hereby apply for a Residen6al Mechanical Permit and acknowledge that the information is complete and accurate; that the work will
be in conformance with the ordinances and codes of the City of Eagan and with the Mechanical Codes; that I understand tlvs is not a
permit, but only an application for a permit, and work is not to start without a permit; that the work wi116e in accordance with the
approved plan in the case of work which requ'ues a review and approval of plans.
Q3
_ Other
ApplicanYs Printed Name Applicant's Signature
2004 COMMERCIAL MECHANICAL PERNIIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please comple[e for: cammercial/indusVial buildings
multi-family huildings when separate permi[s are not required for each dwelling unit
Date
Site Stree[ Address Unit #
Tenant Name (if applicable) Previous Tenant Name
Property Owner Telephone # ( )
Cankraskor 0
Street Address City
State Zip Telephone # ( ) i
I
Bond #: Expires:
The Applicant is _ Owner _ Conuacror _ Other
Work Type
New Construction _ Underground Tank _ Install _Remove **see below
Interior improvement _ Install Piping _ Processed _Gas
Nature of Work:
"*When instaUing/removing underground tank, caff ior inspection by Fire Marshal and Plumbing lnspector
Perlnit Fe¢3: $70.50 Undcrground [ank installariorJremoval
$50.50 inimum (includes Stete Surcharge) ?. .
- ur -
ContractValue $ x 1% _ $ PemutFee
• If DCII171Y fee is $1,000 or less, add $.50 ? $ State Surcharge
If permit fee is over $1,000, add $.50 for
every $1,000 nemnt fee $ Total Fee
- --
I hereby apply for a Commercial Mechanical Pemut and aclmowledge that the information is complete and accurate; that the work
will be in conformance with the ordinances and codes of the City of Eagan and with the Mechanical Codes; that I understand flvs is
not a pemut, but only an applicarion 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. '
Applicant's Printed Name
Applicant's Signature
Approved By: , Inspector
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE:
' 3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(612) 681-4675
auxLorNG
025218
03/10./95
SITE ADDRESS:
LOT:
4240 NYBRO LpNE N
WTLDERNESS RUN 6TH
PERMIT SUBTYPE:
BASEMENT FINISH
APPLICANT:
1 BLOCK: 2
SEITZ
(612) 452-8229
TYPE OF WORK:
JIM
ALTERATION
INSPECTION
FRAMSNG D. .
INSULATION D.
ROUGH IN PLBG FINAL
REMARKS: A SEPARATE PERMIT IS REQUIRED FOR ANY PLUM6TNG OR ELECTRICAL WORK
?
F
? .::?
PERMIT cuwq
CITY OF EAGAN r t
`?3830 Pilot Knob Road PERMIT TYPE: -310?111?
Eagan, Minnesota 55122-1897 Permit Number: BUILDING
025218
(612) 681-4675 Date Issued: 0 3/ 14 / 9 5
SITE ADDRESS:
4240 NYBRO LANE N
LOT: 1 BLOCKa 2
WILDERNESS RUN 67H
P.T.N.: 10-84356-010-02
DESCRIPTION:
Ekji1dfetg`?Rwermit Type
??0 uiI ding WTYPe
f
a
?oj_m?
BASEMEN7 FINSSH
ALTERATZON
F?'?
19", X,
L
REMARKS:
A SEPARATE PERMTT IS REQUSRECI FOR ANY PLUMBIN6 OR ELEC7RICAL WORK
FEE SUMMARY:
Base Fes $35.00
Surcharge _ $.50
ToCa1 Fee $35.50
CONTRACTOR: OWNER: _ qppiicant -
SEIT2 JIM
4240 NYBRO LN N
EAGAN MN 55123
(612)452-8229
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
1995 BUILDING PERMIT APPLICATION (RESIDENTIAL)
681-4675
New Construetion Reauirements RemodeVReoair RequiremeMe
/ N(SfF7
? 3 registered site surveys ? 2 eopies of plan
? 2 copies ot pians (indude beam & window sizes; poureC fid. design; etc.) ? 2 sfte surveys (azterior additiona 8 deeks)
? 1 errergy calculetions ? 1 energy ealwlaGons for heated addklona
? 3 copies of tree preeervation plan ff lot platted after 7!1l93
required: _ Yes _ No
DATE: 3 ' 1-3- 9S CONSTRUCTION COST:
DESCRIPTION OF WORK:
f2 Vd Nor?z i
?-Mo
STREET ADDRESS:
LOT BLOCK I SUBD./P.I.D. #:
PROPERTY
owr?eR
CONTRACTOR
ARCHITECTI
ENGINEER
Name: S t-! T Z J) m Phone #:
Ll4T lM6i
Cr7fj'
qS' z -Y2 2,9
StreetAddress• 42y6 /102"714 'Nt1g26 «WC-
Ciry: L--'47L/ State: Zip: SSj Zj
Company: t (Xj'IJLTL- Phone #:
Street Address:
City:.
State:
Company: ie7)w 1-i L-?-
Name:
License #•
Zip:
Phone #-
Registration #,
Street Address,
City:
Sewer & water ifcensed plumber:
change are requested once permit is issued.
State:
Zip:
Penalry applies when address change and lot
I hereby acknow4edge that f have read this appfication and state that the infom'iation is correct and agree to comply with all
applicable State of Minnesota Statutes and City of Eagan Ordinances. _
Signature of Applicant: ? ??
OFFICE USE ONLY
Certificates of Survey Received Yes _ No
Tree Preservation Pian Received Yes No
OFFICE USE ONLY
BUILDING PERMIT TYPE
?N
? 01 Foundation o 06 Duplex o 11 Apt./Lodging ? 16 Basement Finish
0 02 SF Dweliing o 07 4-plex ? 12 MuRi RepaidRem. 0 17 5wim Pool
0 03 SF Addition ? 08 8-plex ? 13 Garage/Accessory o 20 Public Facility
0 04 SF Porch o 09 12-plex ? 14 Fireplace o 21 Miscelianeous
0 05 SF Misc. 0 10 _ plex ? 15 Deck
WORK TYPE
0 31 New 09?-33 Alterations
0 32 Addition n 34 Repair
GENERAL INFORMATION
Const. (Actuaq
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Planning
0 36 Move
0 37 Demolition
Basement sq. ft.
Main level sq. ft.
sq. ft.
sq. ft.
sq. ft.
sq. ft.
Footprint sq. ft.
Building
Permit Fee
Surcharge
Plan Review
License
MCNVS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Pertnit
S/W Surcharge
Treatment PI.
Road Unit
Park Ded.
Trails Ded.
Other
Copies
Total:
°k 5AC
SAC Units
MC/WS System
City Water
Fire Sprinklered
PRV
Booster Pump
Census Code.
SAC Code
Census Bidg
Census Unit
_ Engineering Variance
Valuation: $
?
-L
D
CITY OF EACsAN
3795 Pilet Kao6 Road- Eagan, MN 55124 N2 4786
PHONE: 4548700
BUILDING PERMIT APPLICATION $52
000 Receipi # 9928
.
,
Te be uaed for SF Dwlg, d Gafg.Et Value Date May 9,
Site Address 4240 No NVbto - Erect [Y Occuparicy I
Lot 1 Block 2 Sec/Sub. WR 6th Alter ? Zonin9 Rl
Parcel # Repofr ? Fire Zone 3
Enlarge ? Type of Const. V
rc Name R].chaTd A Zeroth Move 0 # Stories Z
z Addfen 5315 14th Ave, So. Demolish ? Front _ 54 ft.
9 ,,,_ MPls eL--- 822-062888 Grade Cl DeDth 26. - 4t.
?
o
Name 'Pilean Homes? lnc,
Anwavols
a?J Address 627 Sn_ Snel l ing Ava_ Assessment_
u? Cit St. Paul phone 698-5501
? Water & Sew.
?w
Name Police
-
Fire
Address Eng.
aW Ci phore Planner _.
Council _
1 hereby acknowledge that i have rend this opplication and state that gldg. Off. -
the intortnation is correct ond ogree to comply with all opplicable
StoM of Minnesota Statutes ard City of Eogan Ordirwnces. AP?
Signature of PermiMee _
A Building Permit is issued to:
all work shall be done in ac
Building Officiol -
Fees
Permit 143.7U _
Surtharge 26.00
Plan check
sAC 500.00
Water Conn. 250.00
Water Meter 60.00
Total 979.50
nomes, inc on the expren wndiHon that
Stote of Minnewta Stotutes and City of Eagan Ordirances.
J)Pq7f(a
naxE -3 / - -)k
6UILDING PERMIT APPLICATION
Include 2 sets of plans, 1 site plan w/elevations and 1 set of energy calculations.
To be used for Valuation
Site Address: pep 1//. Yto
? a &kc.c????,?-??.c?
Lot Block Sec. SuD. Parcel Number
Owner ??Ch ah CO (i
,
Address 6EV.-r 01Q4-'tA,
?L2 PIZ•
Contractor JA,LO.4iyC.)
Address ' ,C1LL(12.6v 64'ce-MAr)
?? c ? , V7'LAn . SS//
Arch. /Enq.
Address
Ez'2Ct
Alter
Pepair
EYilarge
Move
Der.nlish
Grade
O£FICE USE
Date of A roval & Initial
Assessment
Vtater/Sewer
Police
Fire
Eng.
PlanneT
Council
Aldg. Off.
A.P.C. ,
Telephone
Telephone eG g? - S 5 -0 I
Telephone
OFFICE USE
Occupancy _
2oning
Fire Zone
Type of Const.
y of Stories _
Front
DePth ----
F'EES `
T fJ
Pezmit
Surcharge
Pldn Gheck
SAC OfJ
Water Conn. ?460 ? E•7ater h5eter AD?,' ?
TOTAL
ities Difzital Qualitv Co
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2000 BUILDINC PERMIT APPLICATION (RESIDENTIAL)
?C?, ' o
3830 PILOT KN06 RD - 55122
851-681-4675
,)-- aa- C)?
New Cantlnrcnon ReawremeMS RemotleVReoair ReoulrematUa
D S reylsleretl Yh wrveri elrowinp aq. K d M. W. fl. of Fiouse
antl gH roofed areot (9076 mmcimLan lot coveraae dlowe?
D 2 coples of Warn (atww beam d wlndow s@es: PoureA fnd. dadyR etc.)
D 1 ibt Of 9n9fQy COICWplipt5
a 3 COplei of hae PreservaHan plai H IW plalted afpr 7/1/93
DAiE• ? ? -on
DESCRIPTION OF WORK:
STREET ADDRESS:
2 coWes W phn
1 teT W enerpy edculallom for healed addHans
1 aiEa surveY tor azleft addiftons 3 dacks
CONSTRUCTION COST:
LOT: BtOCK: ?- SUBD./P.1.D. i:
PROPERTY
OWNER
ARCHRECT/
ENGINEER
Name: Jils%5E1-rz Jlft?,d- L Gr'rN- P1wne#:
laaf flrsf
sneet naaress: y
?Y--
city Ea?Av\ srote: M hJ zip: C?/?„T 3
Companv:}I5-/1cIP?U.t i?n< ? d-.•• 0. pnone#: ?(a.?
(area code)
Sheet Address:!a,j n Fis MIL? , license # ?as?Exp•
city 6160r., MN state: hibd zip: m13 /
Company: Name:
Telephone #: ( )
Sfreet Addreas: Regishaflon q:
CMy
State:
Lp:
SeweNwater Iicensed plumber (M Irntallina sawerlwaterl: Phone i/: L?
I hereby acknowledpe ihaf I have read th* application, alate IhaF Ihe infortnaMon Ia correct, and agree b comply wilh a9 oPPRcable State
of Minnesota Sfalufes and Cify of Eapan Ordinancea
' SipnaNreotApplicant ''r,o? ?/?yF^•
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No
FEB 2 2
Tree Preservation plan Received - Yes - No - Not Required
OFFICE USE ONLY
BUILDING PERMIT SUBTYPES
? 01 Foundation ? 07 OSplex
? 02 SF Dwelling ? 08 O6-plex
? 03 01 of _ plex ? 09 07-plex
O 04 02-plex ? 10 08-plex
? 05 03-plex ? 11 10-plex
O 06 04-Plex q 12 12-plex
WORK TYPE
? 31 New
? 32 Addition
? 33 Aiteration
? 34 Repair
? 13 16-plex ? 21 Porch (3-sea.)
O 17 Garage ? 22 Porch/Addn. (4-sea.)
0 18 Deck ? 23 Porch (screened)
0 19 Lower Level O 24 Storm Damage
Pibg _Yor_N O 25 MisceUaneous
O 20 Pool ? 30 Accessory BId9•
? 38 Move Bldg. ? 43 Reroof
? 37 Demolish (Bldg)' ? 44 Siding
? 38 Demoiish (Interior) ? 45 Fire Repair
O 42 Demolish (Foundation) ? 46 Windows/Doors
` Give PCA handout to applicant for demolition permit
GENERAL INFORMATION
SAC Code
No. of Units
No. of Buildings
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Width
Basement sq. ft.
Main Ievei sq. ft.
sq.ft.
sq.ft.
MISCELLANEOUS INSPECTIONS
? Stucco/Stone
APPROVALS
Planning Building
Permit Fee ? 3 ? ?-
Surcharge ?. S ?
Plan Review
License
MC/ES SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
SiW Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total: 14 r)- -I 5
sq. it.
sq.ft.
Footprint sq. fr.
Census Code
MC/ES System
City Water
Booster Pump
PRV
Fire Sprinklered
_ Engineering Variance
valuation: $
31 ExLAIt - MuNi
33 Ext. Ait - SF
36 MuRi
SAC Units
% SAC
-1
2006 RESIDENTIAL BVII.DINC?i PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Consimclian Requiremenis
3 registered site surveys showing sq, fl. of lot, sq. fl, of house, and all roofed areas
(20% macimum lot Coverage allowed)
2 copies of plan showing 6eam 8 window sizes; poured found design, etc.
1 set of Energy Calculations
3 copies of Tree Preservation Plan if lot platted after 7/153 Rim Joist Detail Options seledion sheet (buildings with 3 or less units)
Minnegasco mechanical ventilation forrn
RemodeVReoair Requirement5
2 copies of plan showing footings, 6eams, joisis
1 set of Energy Celculations for heaied additions
1 slte survey fir additions & decks
Addition - indioate il onsife septic system
* 7:?p. ao
Ca w 3/3 ?. aN
oftQ tti o?iv
Gertaf$uneyEtecd
'. Y N
7rce Ares Plan Rerd
Tt98P[98R2QUItCC T ,.,..N
0ni-site5ephc&ystem ,-,Y ,._„N:
Date I? / o791 L'Xc? n Cost
Constructio
Site Address .
UniUSte #
T"
Description oF Work &!96,W5077 OW
Multi-Family Bldg _ Y XN Rireplace(s) ?C 0 _ 1 _ 2
Property Owner Telephone # 7/ ,? 7
Contractor oG
?
J
Address City
State Zip Telephone #
COMPLETE THIS AREA ONLY IF
Energy Code Category - Mlnnesota Rules 7670 Cate¢orv 1
(J submission type) • Residential Ventilation Category 1 Worksheet
Submitted
• Energy Envelope Calculations Submitted
A NEW BUILDING
Minnesota Rules 7672
. New Energy Code Worksheet
Submitted
In the last 12 months, has the City of Eagan isiued 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 I"l
Sewer/Water Contractor MAR 2 8
Telephone #(
D 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 p n in the cas of work which requires a review and
app o Pal of plan?
Applica t's Printed Name Appli nt's Sig ture
DO NOT WRITE SELOW THIS LI1VE
Sub Types
? 01 Foundation ? 07 OS-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 PorchlAddn. (4-sea.)
? 04 02-plex ? 10 OS-plex p 18 Deck ? 23 Porch (screenlgazebo)
? OS 03-plex ? 71 10-plex 19 Lower Level ? 24 Storm Damage
? 06 1
04
x ? 12 12-plex ? 25 Miscellaneous
-p
e
601;u3
Wo
? rk Tvpes
31 New / O 35 •, Int Improvement ? 38 Demolish Interior
? 32 Addition j ? 36 Move Building ? 42 Demolish Foundation
? 33 Alterafion ? 37 Demolish Buitding` '? 43 Reroof '
? 34 ReplaCerttent `Demolition (Entire Bldg) • Give PCA handouf to appliwnt
DBSCCiPtIOII: WaterDamage_Yes
Va(uafion ?
Plan 12eview, 100°/a or _ 25%
Census Code 12 ?
SAC Units
# of Units
# of Bldgs
Type of Const
Occupancy MCES System
? 30 AccessoryBldg
? 31 Ext. Ait - Multi
? 33 Ext. A!t - SF
? 36 Multi Misc.
O 44 Siding
? 45 Fire Repair
? 46 Windows/Doors
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 W5PECTIONS
Sheetrock
FinaVC.O.
)< FinaUNo C.O.
? HVAC
Other
Pool Ftgs Air/Gas Tests Final
Siding _ Stucco Lath _ Stone Lath _Brick
_ Windows
_ Retaining Wall
?-t
Approved By: ?,-L , Building Inspector
Base Fee
Surcharge
Plan Review
MCIES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatrnent Plant
License Search
Gopies
Other
Total
7 ^ .?-
;
7 ?-7&9i
2006 RESIDENTIAL PLUMBING PeRmiraPPLicaTioN
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings.
,5D zb
Date 3 I31 / O(p ?Nbl'0
Site Street Address `?? O ?? N•
Unit #
Property Owner Telephone # ( )
Contractor e-- Telephone #(4S() y5y- p°1
Address -7dO 19 Citv '^•a' °" L*,? State O Zipss<aG
The Appiicant is: _ Owner /"',,Contractor _Other
New _ Refurbished Submit 2 sets of plans and MPC license
Septic System Includes County fee
_ $ 100.00
Per as-built $ 10.00
Alterations to existing dwelling $ 50.00
? Add plumbing fixtures. This fee includes installation of a water softe ner and/or water
heater at the same time. If you are installing only a water softener and/or wafer
heater, 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
Total c., S"_
S J ?
I hereby apply for a Residential Plumbing Perrnit and acknowledge that the infortnation 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 not to start without a permit and work will be in
accordance with the approved plan in the event a plan is required to qe reyj?wed and approved.
l210 v 11) T441 2
ApplicanYs Printed Name ' ApplicanYs i ature
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PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA115448
Date Issued:09/26/2013
Permit Category:ePermit
Site Address: 4240 Nybro Lane N
Lot:001 Block: 002 Addition: Wilderness Run 6th
PID:10-84355-02-010
Use:
Description:
Sub Type:Residential
Work Type:Alteration
Description:Fixtures
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Fixtures:Altering shower DWV
Eric Bruckmueller
3992 Pennsylvania Avenue
Fee Summary:PL - Permit Fee (miscellaneous)$55.00 0801.4087
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 -
James J Seitz
4240 Nybro Lane N
Eagan MN 55123
Bruckmueller Plumbing Inc
3992 Pennsylvania Ave
Eagan MN 55123
(651) 686-6696
Applicant/Permitee: Signature Issued By: Signature
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