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4150 Pennsylvania Ave0 CASH RECEIPT CITY OF EAGAN 3830 PILOT KNOB ROAD EAGAN, MINNESOTA 55122 DATE / 19 ? r?rveo / A FIIp4 aMounR a ? a oouARs 1oo ? CASH ? CHECK )IMM ? --AE C 4235 ?"? ?? Copy Thank You BY ?,.?` DATE: 10/17/89 RE:4150 PBNNSYLVANIA AVEtitfEL19, Bl, STAFFORD PLAII" .B .]L7L Your Sewer & Water Permit for the above property has been completed. It will be held at the Public Works Garage (3501 Coachman Road) until the meter is picked up. BE SURE TO CALL PUBLIC WORKS (454-5220) FOR YOUR PERMANENT WATER TURN ON. _ Your Sewer & Water Permit for the above property cannot be completed for the following ? reasons: r Your Sewer & Water Permit for the above property has been completed, but the meter cannot be issued or occupancy allowed until further notice. COMMERCIAL PROJECTS ONLY: Please pay for meter at City Hall. Meter size must be confirmed by Bill Adams or Dirk House (Plumbing Inspectors - 454-8100) before issuance. WARNING: BEFORE DIGGING, CALL LOCAL UTILITIES - TELEPHONE, ELECTRIC, GAS, ETC. - REQUIRED BY LAW. CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICY. Secretary, Building Inspections Dept. -a^ •: DATE: Lp / t] I 80 RE: 4150 PENNSYLVANIA AVENUE, L19, B1, STAFFURD PI.ACE M Your Sewer & Water Permit for the above property has been completed. It will be held at the Public Works Garage (3501 Coachman Road) until the meter is picked up. BE SURE TO CALL PUBLfC WORICS (4545220) FOR YOUR PEAMANENT WATER TURN ON. Your Sewer & Water Permit for the above praperty cannot be oompleted for the following 4teasons: W` Your Sewer & Water Permit for the above property has been completed, but the meter cannat be issued or occupancy allowed until further notice. COMMERCIAL PRaJECTS ONLY: Please pay for meter at City Hall. Meter size must be confirmed by Bill Adams or Dirk House (Plumbing Inspectors- 454-8100) before issuance. WARNIHG: BEFORE DIGGING, CALL LOCAL UTILITIES - TELEPHONE, ELECTRIC, GAS, ETC. - REQUIRED BY LAW. CONTACT COMMUNfTY DEVELOPMENT DEPAATMENT FOA WATER TURN ON POLICY. Secretary, Building Inspections Dept. ?C?,?n• . .+---.?- -••-- . : ?; ?+. '-r , - t -. _`+, .. ". `w`.45? : ?,'?"? .??.;: ;•"T ? , 7i•a_'""-,,: l.`o`: CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 P H O N E: 454-8100 BUILDING PERMIT Receipt # Tobeusedfor SF M/GAR Est.Value ;72?000 Date a+'T lb Site Address 4150 ?M YLVANIA AVE 17184 ? i J 1 Lot 19 Block 1 Sec/Sub. STAIr[ORD PLACE I OFFICE USE ONLY Parcel No. oauPancy g?3 U-i FEFS W Name ?H'PIER [n?3? 3 Address 1285 CORP(}RATE CSlRER DR ° City E?GAN Phone 454-0433 o Name S? ot a Address , ? City Phone ? W Name W ?? Address a W CitV Phone - I hereby acknowlege that I have read this application and state that the inlormation is correct and agree to comply with all applicable Staie of Minnesota Statutes and Ciry of Eagan Ordina?es. Signature oi Permitee A euilding Permit is issued to: FRMTi? MIDUTM on the express condition that all work shall be done in accordance with all applicable State ol Minnesota Statutes and City of Eagan Ordinances. Building Official }. Zoning ? (Actuaq Const y Bldg. Permil si4•? (Allowable) - Surcharge 36.00 # ol Stodes 408 PlanReview 257•00 Length Deplh 47? SAC.City 100.00 S.F. Total - SAC, MCWCC sTS•OO S.F. Footprinis - s?ooo On Si1e Sewage _ 1Nater Conn On Si1e Well Water Meter 90.00 MWCC System ? ?.oo City Water xx Acct. Deposit 20000 PRV Required _ S11N Permit Boosler Pump - SIW Surcharge 1.00 Treatment PI 228'00 APPROVALS Road Unit 340*00 Planner - park Ded. Council BIdg.Ofl. _ Copies Variance - TOTAL 2,771.00 Permit No. Permit Holder Date Telephone # WATER ? ?d ? v ???'? • /?? /?/?? ? SEWER PLUMBING H.V.A.C. ?j 117?WIW ELECTRIC OL) Inspection Oate Insp. Comments Footings I Foundation Framing Roofirg qough PIb9 Rough Htg. IsuL Freplace Final Htg. Final Plbg. G1 Consl. Meter Plbg. Inspector - Notify Plumber Engr./Plan Bldg. Final i2'f Decic Ftg. Deck Final Well Pr. Disp. _ y .-. , MECHANICAL PERMIT • . CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55122 CONTRACT PRICE: v,1780. pU Site Address Q50 t ennsvlvan Lot 19 Black 1 ? Name +?':.?vL?,L ti6A'1:1s1V 0? F ? Address 1955 Sha.wnee Roac c Ciry ?aZ 8n Phone ? • vnina ? Addrass j98f3 Sibley I? p City Eagan k'!. TYPE OF WORK Forced Air Boiler Unit Heater Air Cond, Vent Gas Piping Outlets # Other t? MBTU M BTU M BTU M BTU -T "CFM' FEE S/C: TOTAL• PERMIT # RECEfPT # DATE: BLDG TYPE fgxd . WORK DESCRIPTI xx ON New Res. Mult Add-on Camm. Repair 65 Other FEES HVAC 0-100 M BTU RES -$24 00 . ADDITIONAL 56 M BTU . - 6.00 3 (RES. HVAC INCLUDES A/C ON NEW CONSTRUCTION) GAS OUTLETS MINIMUM 1 PER PERiNin - 1 50 EA t? - ( COMM/IND FEE - 1% OF CaNTRACT FEE APT. BLDGS. - COMM. RATE APPLIES . . TOWNHOUSE & CONDOS - RES. RATE APPLIES MINIMUM RESIDEMTIAL FEE - ALL ADD-ON & REMQDELS - 12.00 MINIMUM COMMERCIAL FEE - 20.00 STATE SURCHARGE PER PERMIT 7C IF PERMIT PRICE GOES ADD $ 50 S - .50 ( . . BEYQND $1,000) ' .50 ? . . .50 SIGNATURE OF PERMITTEE .00 1 1 FOR: CITY OF EAGAN '? y' {* ? D. T......?.'?-?r. -?.••?.?-? ? PLUMBING PERMIT CITY OF EAGAN CONTRACT PRICE Site Ad?_jss Lot ? ? ?...?? ? Add c City c Add $ cfty 3830 PILOT KNOB ROAD, EAGAN, MN 55122 . _ PHQNE 4548100 FEES COMMJIND. FEE - 1% DF CONTRACT FEE APT. BLDGS. - COMM. RATE APPLIES TOWNHOUSE & CONDO - RES. RATE APLLIES MINIMUM - RESIDENTIAL FEE $12.00 MINIMUM - COMM.IND./FEE $20.00 STATE SURCHARGE PER PERMIT .50 (ADD $.50 SJC PER EACH $1,000 OF PERMIT FEE) ? ?? ? FOR: CITY OF For Oftil PERMIT # RECEIPT # DATE: '1114 Res. ? New _ Mult. Add-0n Comm. Repair Other RES. PLBG. ONLY - COMPLETE THE FOLLOWING: NO/ FIXTURES TOTAL water Closet - $3.00 $ 3. 0 D ?- Bath Tubs - $3.00 • D ?- Lavatory - $3.00 D Shower - $3.00 ?- Kitchen Sink - $3.00 ?- -?- Urinal/Bidet - $3.00 Laundry Tray - $3.00 • Floor Drains - $1.50 ? ?- Water Heater - $1.50 + VYhirlpool - $3.00 ? Gas Piping Oudets - $1.50 (MINIMUM -1 PER PERMI7) Softener - $5.00 Well - $10.00 Private Disp. - $10.00 ?- Rough Openings - $1.50 , PERMIT FEE: S40 STATES S/C: 50 GRAND TOTAL,: a? .OO ? (gtxttf ixatP rif (Orx11paury titp of eagari 11part»trnt of luilding jWtrtinn This Cenificate issued pursuant to the requirements of Section 306 of the Uniform Building Code certifying that at the time of issuance this structicre woas in compliance wrth the various ordinances of the City regulating building construction or use. For the following.• u. c,m-.fitio, SE' DMIGAR e,dg.n!?tNo. 17184 Occup„KyTyye _ R344I Zooing oishict RI TYre ConsL VN Owoer of Bw7diag FROWfT'? MMWM HOWS Addres 1285 OORPORAM GM M. F?''AN Wcbng AM - 4150 PENNSMVANIA AVEN[lE Low,;,y, L 19, B I, SfAFFM PfAM , ZL?, O.,tl, -11.1 ? D., JNAUA& 25, 1990 Building 006.1 POST IN A CONSPICUOUS PLACE gE'NER & WATER PERMIT CIT i "IF E/:G.AN 3830 Nilot Knob Rd. P.O. Box 21199 Eagan, MN 55121 PERMIT DATE 10/ 17/8y WATER PERMIT_1? 11 017 SEWER PERMIT # METER #?? a Z? l? B.P. REGEIPT # C 4215 c}'ERpEFr-# B.P. FiECEtPT DATE.1il/1Fi/ METER SIZE . S?? ? ISSUE OATE 1- ?{ "' ;L2 .- PRV - BOOSTER PUMP ¦ SITEADDRESS 415;1 °FNNSYIV"TA 1)/F FA , tiffV F512 LOT BLOCK 4 SEC/SUB STAFFt]E2fl PI A!'F _ APPLICANT: ??0N.i. i E7 DEIlELOPNIEI?IT ADDRESS; ,.? ?., .,.,... .,,.. . ? ..". . ?.. ?... cmumi CITY, STATE ' ZIP ?? 5 PHONE: ??4-0433 PIUMBER: STA2 Ii UIAB I NG - ADDRESS: 1013 MaUNnS SPRrNc:s TFRr,. CITY,STATE ZIP PHONE: OWNER: i!FrF ADDRESS:_ CITY, STATE PHONE: - ZIP PERMIIT RECIUESTED ASEWER KWA7ER -TAPS - COMM/IND RESIDENTIAL ? NEW - EXISTING 1 AGREE TO COMPLY WITH CITY OF EAGAN ORDINANCES: ; SIGNATURE WHEN METER SUED J, IW TWO WORKING DAYS FOR•PROCESSING. FOR STORM SEWER PERMITS, CONTACT ; i DEPT. ( ? % } t& WATER PERMIT OFFICE USE ONLY ,= EACAN PERMIT DATE ' , IOt Kt10b Rd. WATER PERMIT # '? SEWER PERMIT # a 21199 METER # B.P. RECEIPT # - ?• ' ? MN 55121 READER # B.P. FiECEIPT DATE 161 METER SIZE ISSUE DATE - PRV - BOOSTER PUMP ADDRESS ''' ' r T ? AVr: _ F AGAN P4'j ?? - - :, •> PERMIT REQUESTED " BLOCK SEC/SUB 7RFFO?i?, 711 Vr ,?NT SEWER 'S?WATER -TAPS LICANT: RESS: " J? K i';t, ' •- _ COMM/IND .? RESIDENTIAL , STATE `.lUr+?., •n. Z!P ` NE: 'r54-0433 A13ER: `= °?,i PLtJt•`?S Z "?; RESS: '40U?rn:a ? :" j r' •'": _? , STATE ,,,0`1ItvGT' ZIP ¦r. +-Q {Y`f IER: ISTER JEFi 3ESS: "+l5 FAG"? , STATE 7AGAN, MN `. ? ZIP AIC. . 1'3_639 1 - )( NEW _ EXISTIMG I AGREE TO COMPLY WITH CITY OF EAGAN ORDINANCES: SIGNATURE WHEN METER ISSUED ALLOW TWO WORKING DAYS FOR PROCESSING. FOR STORM SEWER PERMITS, CONTACT CITY OF EAGAN N2 17184 , 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121?p BUILDING PERMIT PHONE; 454-8100 Receipt # To be used for SF DWG/GAR Est. value $72, 000 Date OCT 16 ,1989 Site Address 4150 PENNSYLVANIA AVE Lot 19 Block 1 Sec/Sub. STAFFORD PLACE Parcel No. W IName FRONTIER MIDWEST o Address 1285 CORPORATE CENTER DR City EAGAN Phone 454-0433 o Name S? gQ Address ? City Phone gW Name ox 3Address a W City Phone I hereby acknowlege Ihat I have read this application and state thatthe information is correct and agree to comply with all applicable State of Minnesota StaNtes and Citv of Eaaan Ordinanenc_ SignaWre of Permitee OFFICE USE ONLY acupancy R-3 I -1 FE ES Zoning JL--1 (ACtuaq Const V=N Bldg. Parmil 514. 00 (niiowacie) V=N Surcharge 36 . 00 # ol Stories Length 40' Plan Review 257.00 Dep1h 47' SAQ City 100. n0 S.F. Tolal - SAC, MCWCC 579, 00 S.F. Footprinls - On Sile Sewaga _ Water Conn SRO _ 00 On Site well - Water Meler 90. 00 n+wcc system xx x[ Accl Deposit 30. 00 Cily Waler PRV Requiretl _ 5/W Permil 20, 0 Booster Pump - S/N! Surcharge 1. ?0 Treatment PI 228 - 00 APPROVALS RoadUnil 340.n0 A 8uilding Permi[ is issued to: FRONTIER MIDWEST Piwner - Park Ded. on the express condition that all work shall be done in accordance with all Council applicable State of Minnesota Statuteas and- /C?ity of Eagan Ordinances. BId9. Of[ Copies BuildingOfficial 1lA. ? IIL,d Variance - TOTAL 2.771.00 ?F 60141 REQUEST FOR ELECTRICAL INSPECTION J? See instructions la completing Ihis lorm on Oack al yelbw copy. `7C" Below Work Covered by This Request EB-00001-07 ew Add Rep. Typeofeuilding AppliancesWired EquipmentWired Home Range Temporary Service Ouplex Waier Heater Electric Heating Apt. Builtling Dryer Other (Specify) Comm./Industrial Furnace Farm Air Conditioner Olher (specify) Con[rector5 Ramarks: Campute lnspectlon Fee Be/ow: # Other Fee # ServiceEniranceSize Fep,/ # Circuits/Featlere Fffe Swimming Pool 0 to 200 Amps 0 10 100 Amps 4 VII Transformers Above 200 _ Amps A6ove 100 _ Amps Signs Inspedor5 use ony: 70TAL ? Irtigation Booms Special Inspection Alarm/Communication Other Fee I, the Electrical Inspector, hereby if h flough-in ? oaW cert y t at the above inspection has been made. F;nw o k- OFFICE USE ONLV This request voitl 18 manihs irom .? C? -6141 Request Date 1 Fire Rough-In InspecGOn F ired? ? fleatly NOw tll Npii/y InspeClor s ? No hen ReedyT I licensed contractor ? owner hereby request inspedion of above electrical work at: JoE Address (S[reet, Box or Roule J Ciry SU ?iv. 'I. t. . Seqion No. Township Neme or M. Range No. Coun Occupanl(PPI ? Plione No. --? PowarSUpplie AdOress Elecfrrcal Contrector (C pany Nama) ? CoMracta§ Licenee N. ? L Mailing tlress (COntractor or O wy?nar Making Inslella6on) . AuUwnzed Signa[ure (Contraclor er I Iletbn) Phone Nu be? MINNESOTA SfATE BOAPD OF ELECiNICffY THIS INSPECTION FEOl1EST WILL NOT Grlggo-AAlTxay Bltlq. - Foom S173 BE ACCEPTED BY THE STATE BOARO 1627 Univenlty Ave., SL Peul, E7N 55104 UNLESS PROPER INSPECTION FEE IS Plrom (672) 842-0800 ENCIOSED. p 'i SINGLE F1I14ILY DiiELLIBG3 2 3ETS OF PLINS 3 AEGISTEiIED STfE SIIRVEYS t SET OF ENERGI CiLCS. 1969 SITILDIBG PERMIT APPLICATIOB CITY OF EIGAN ltill MIDLYIPLE DbiELL G5 2 3ETS OF PLAA3 HEGISTfiRED SITE 30AVE23 - (CBECB IiITH SLD13 DI4.) 1 SET OF EBEAGI CiLC3. MULTIPLE DiiELLIHGS BENTAL IINIT3 FOB 3iLE DIiITS t OF 9BITS pOTEe IDDRE55ES FOH COANER LOTS - COATA?GTOR/80lEOWNEA lAST DESIGBAZE iiHICH lDDRESS IS DESIAED. HO CAINGFS NII.L BE ALL4fiED ONCE BUILDZNG PEAFIIT I3 I339ED.. SEWER 3 1ilTER PERMIT FEES 1ND ?CCOIINT DfiP03IT F6ES iiIi.L BS INCLODED itITH THE HQILDIN6 FERhIIT FEE. PROCFSSING TIlE FOA SSRER i1QD iIATEA PERHIlS IS TiiO DAYS ONCE l PE1NlIT SAS BEEN COMPLETED INDICATING A LICEN3ED PLDMER. PENALRY 9PPLIFS WUNs PERMIT IS NOT PAID FOA IN SAME MONTH IT I5 REQUESTED. LOT CH6NGE IS REQOEST6D ONCE PERMIT IS ISSOED, ,M;j p 4 IM To Be ?sed For: new construct.inn Valuation: I ik'pi(7v Date: 1n_4_RQ 3ite Address 4150 PENNSYL Lot 19 Block 1 Parcel/Sub STAFFORD PLACE Oimer REGISTER, JEFf Address 3045 EAGANDALE P. #303 City/Zip Code EAGAN, MN 55921 Phone 688-8891 Coatraetor FRONTIER DEVELOPMENT CORP. Address 1285 CORPORATE CENTER DR. City/Zip Code EAGAN, MN 55921 Yhoae 454-0433 Arch./Engr. DICK CHARLIER dddress 14103 GARDENVIEW DR. City/2ip Code APPLE VALLEY, MN 55124 9?, ODD` vrric:a use Oecupancy R-3 M-I Zoning R-1 detual Const V- N Allowable V-N 1 of stories Length 40 ' Depth 4?• S.F. Tobal Footprint S.F. On aite eewage On aite well MNCC 3yatem ? City vater ? PAV required _ Booster Pump _ APP90YlLS Planner Couneil Hldg. Off. i%, Variance ??'+?b<z ' COlSMERCIAL 2 SETS OF IACHITECfURAL 6 STRDCTQRdL PLLNS 1 SET OF SPECIFICATIONS 1 SET OF S[IEAGI CALC3. FEE3 Bldg. Permit $1 ,ad Surcharge 36.00 Plan Aeview 51,0o SAC, Citq rao,ofl SAC, MWCC ShS,op Aater Conn SSO,o'p Water Meter 90,60 Acet. Deposit 3G•00 S/W Permit a0100 S/ii Sureharge 1.00 Treatment P1. 2ZB.n0 Road Dait 340f 09 Park Ded. Copies SQBTOTdL Penalty iOTIL . . ,1 r = ? "l Phone t 432-5492 .,n„ r,aMrurnrrnH ' OWNER:-A q1`?'P?V nnrr : (0-1?= r2D'J\ 5 SITE ADDRESS:?S? PFI(1NE: fIT(p?L. - 4 l-r{ -06I ?7j CONTRACTOR: ??"'•?---`PLAN # 5-rZ?cTo2i? Z?-?o Determine working square footare of each 1. Total exposed wall area..... I'??• ??r s4. ft. x .11 2. Total roof/ceiling area..... ft. x.026 Total exposed wall area ahove floor=? a. Total wall window area ............................................ I22.C. b. Total door area .................................................. 38 c. Total sliding glass door area .................................... 32. ... . d. Total fireplace wall area ..................................... 44 e. Total wall framing area (average 10W) ............................ i 8?6?4 1?7 f. Total rim joist area ............................................. i7k, d g. net wall area a6ove floor ..................................... 1.o h. wall area a6ove floor ..................................... i. wall area a6ove floor ..................................... j. frame wall area at foundation... Tota1 exposed foundation area= k. Total foundation window area....................... l. Total net foundation area above grade .............. Determine "u" value of each.wall segment (e,g. window, door, each separate wail section) a. I G7 x b. 3g x c. 3z,q X d. X x 11 Li„ = l,u„ I1,-78 ',ul, "U" ? „ull-J?-° zo.?I3 ? ? X "U'l g. x „ U?? C.7 ti ° ??l • fS h. X „ul. _ i. X "Ul. _ - X „U„ _ ? e 1 . - -} ? ?----- x If item 5"3 is the s as, or less than i` rl, you have met trintent of SBC 6005 3, ................................. Total E::tnrior Enveloi?c Avera9e °U" Conputalion Total exposed roof/ceiling area . ? m. 'M ta1 skyli.c,ht area ............................ n. Total rooP/ceilin, fram:.ng area (zIier.aye 102)... Ic'?ILi+ o. Total net i^sulated rooi/ceilinq area........... Determii:e "U" value for each roof/ceiling segment M. X .1ul. n. 10 I , -- c. x IV, . . . . . . Total _ Zo ? 7 3 4 ..................... 'f to*_al cf -44 is the same as, or less i:han ;f2, you have met the intenc of ShC_ 50Q5 ;r1, 1 , Alternate Suilding Enve:.one Desig:e To _tilize the totaZ envelope'system method, the values estzblished by the s-.ua of :.tens n3 znd -4 shall not be greater than the sum of items #l and #2. i. Zl lo ?O?y + z. ZCp , Li I = zyZ.,S- ?3 = Z3.5`?'? . 3. _ 21=1,?=f +4. Z-0, Cities Diizital Qualitv Control The following image represents the best available image from the original page. Every effort was made to capture the content from the original page. . PLAN # * ISNEAL FEET EXPOSID WALL BLOCK: C? ? / KNEE: I 3 0 w.o.: - FUU i- l 3 2 FULL 2: r FIRPF'LACi : [ f+ . . . RIM.: 1 :? ?"`) = SQUARE FEET EXPOSID WAU ARFA ai.oCx: G. ? x .5 1QTEE; x 5= (p ?' W.O.: r..,,. x B= r'. FULL 1: X 8° l 1o 9 £CR.L 2: ^ x 8 = _.-- ' FIREPIACE: Lp X ?° ?( C> . RIM: 13 0 x 1= l3 0 TOT'AL * sQuaxE FEEr EXPosEn cEZLINIG ? (o l? *.3mm)m ? Dooxs 3 8 - S ZL-1 3C, r° PATIO DOORS 'z. o? c? . 3 Zq * BASa-mvr urrlrs ?Z?,v Use I, ?% oT oPaque Wni i orw 1"? • . fvar'-o_ cL'r*StvucE'% on I y.S-C u.+LL CT_G. rl r.?Af1E NnLL Jr.. -,a . ?y MNSTRUCTION" FRAMING 1. IT]TERTOR AIR FILM 0.68 2. 2 BD 3. 5 1 2 SOFT SvOOD 6.8 4. 7NEt2M0 FLY SHEAT;i .2 5. STlltNG ------ .8 6. IOR AIR FILM 0.17 R= 8.99 U= •1I Aif,?' 1. INTERIOR AIR FILM 0.68 3:_' 2 GYPBD .45 3. L. !+ 7N??o Ft.Y sH?rn+ 19.00 .2 5. SIDING MIT 6. R . = 21_!2 . U= .05 ----vn`. 1. INTERIOR AIR FILM - 0.68 QI 2. 6 INSUL. 18.0U S?L SEk?R 3. JOIST --- , / 4 . • 714ERM0 '?1-Y SFlEf(ri! .Z 89 17 5. SIDING •6 S. OR AIR FI 0.17- MTAL R= 12•56 'i U, o O U= . ?.? / • ? t ! Q t n o ?? BLOCx lJac1-L 1. Ir1T'ERIO& AIR FII1d 0.68 ? Q 2. 3. 0 11, S. Q ? •" ;, 4. PROTECTIVE BARFtIER ,-1 S. 6. EXTERIOR R F TtYi'AL R= 7.13 U= .14 SLAB ON GRADE p n 'r ? ? tii S y y ? . . l 1^^.' . f ? ,? 7 f i : i l • ` .y j ? 1 7 t •?r ? \ l . `? D? .' ? /rr ?rs _ ? • - 1 t . r ?. ;13 L J (!f ?Il( -^ t1 = I(? ?? rI( t rfCl!'E : IDIDICATE TYPE, "x" vanM. D..?x A*n PLP.CEY.ENT OF INSUI.ATION. CONSTRUGTION I n 11 RT :r_ 1, INTERIOR AIR FIIM 0.61 2. SI8" . . --,. .., 3. 1NSUUj'1?turv --- 4. .61 TOTAL. • U = .p? f'R,QME A F'FAT FI,OW I I UP ?1 prG. k5 1, INTERIOR AIR FILM 0.61 2. • 3. 4. - 7-71' U = -.e2L CONSTRUCTIOK ' I FEAT FL.OW U? Ll FIG. # 6 ? • .r??, 4 ?..,•••.: ' ? •1?'l( SN ?? ?--? Z NON-VE?di'? ?r-,t,c,T : LOW [JP VENT'ED ?. .,• ?1 4 1. LNSIDE AIR FILM 0.6= 2. 3. 4. 5. - F'RA 1. r'[E INSIDE AIR £ZLM TO'iP L U = . .61 2. 3. 4. :. 5. ' 1. INSIDE AIR FTLM u = 0.61 z. 3. 4 . 5. TOTAL U = NO'I'E: USE PDDITIONAL SHEEfS IF t".ORF. SP°_C= =- pfE'_MED FOR DETAILS 4ND GALCIIATTQNS. -_r t% ROOF_CEILING L'ITY OF EFlGAN _r,A:,N:LE.F't: J8 TFT:MINAL N0: 997 DFlTEa 01/26f00 TIMEe 11:20:12 ID; NAME: 1L:f-F'fiEY A RFGISl'Efi 321.2 9001 41;?U F'NNSLYVN A 30.00 ?i:':,.`i 300i. 4150 PNNSI_YVN A (].SO 3210 9001 4150 F'NNSL`,'VN A 60.00 21.53 9001 4J.50 F'NNSLYVP! f 0.50 :3430 9001 EF' f'ORt1 9..p0 ? 4 Toi:al Receipt Aiuoun+„ 92.00 CRl22i:1.3 USI-F: I D: 7 AN 2000 BUILDING PERMIT APPLICATION (RESIDENTIAL) CITY OF EAGAN ?j ?l 3830 PILOT KNOB RD - 55122 ?GQ- .? 1?'? V 851-881-4675 C6j? I_?S, (f d w Coruhucdm Reaulremenh RemodeUReoalr ReaudremeMs : 3 registere0 sIro wneYS ahowln9 W.11. ol bt, sQ. N. of houae antl gu roofetl areaa (20% rnmdmum lof coveraae alloweN * 2 coplea ol plans (show beam d wlntlow slzea; poured 1ntl. dealgn; etcJ > 1 eet ot eneryy calculaflau n 3 coplea of Iree preaervallon plan H bt platled aRer 7/1/93 DAiE: I? DESCRIPTION OF WORK: 1_C st/?1C I<- L?Vt STREET ADDRESS: -A LOT: I "l BLOCK: ? SUBD./P.I.D. #: 2 copiea of plan 1 set ol energy cdcWaNOns 1or heafed atldfdoro 1 alte sunay la extedor addlaons & decke CONSTRUCTION COST: ?A1`Ii5-H C 2 2. T )Z-3 PROPER'IY OWNER CONiRACTOR Name: ? ? 5 1 ?`?ff -?1 CT"TV Phone Last Flnf Sheei cnr 6*4&N srata: M•-.1 np: SS/?-? Company: ?C- `f Phone lf: (area code) Sfreet Address: License p Exp. CHy I K 6 - I r3d,Z?41 1 Zip: Stctte: ARCHITECT/ ENGINEER Company: Name: Telephone #: ( ) Sheet Address: Reglshaflon ?: Clty State: Sewer/water Ilcensed plumber (if insfallina sawer/waterl: Phone #: 1 hereby acknowledge ttmf 1 have read Mia applioalbn, afate thaf the intomiatbn ia cwrect, and of Mk,nesota Stahites and Cify of Eagan Ordlnances. A Certificates of Survey Received _ Yes Tree Preservation Plan Received _ Yes Signafure of Applicant OFFICE USE _ No - No - Not Required UP: fo comply wHh aU appBcable Sfote OFFICE USE ONLY BUILDING PERMIT SUBTYPES ? 01 Foundation ? 07 05-plex ? 13 16-plex ? 21 Porch (3-sea.) ? 02 SF Dwelling 0 08 06-plex ? 17 Garage ? 22 Poreh/Addn. (4-sea.) ? 03 01 of _ plex ? 09 07-plex ? 18 Deck ? 23 Porch (screened) ? 04 02-plex ? 10 08-plex ? 19 Lower Level ? 24 Storm Damaga ? OS 03-plex O 11 10-plex Plbg _Y or _ N O 25 Miscellaneous ? 06 04-plex ? 12 12-plex ? 20 Pool ? 30 Accessory Bidg. WORK TYPE ? 31 New ? 36 Move Bidg. ? 43 Reroof ? 32 Addition O 37 Demolish (Bidg)' ? 44 Siding )6 33 Alteration O 38 Demolish (Interior) ? 45 Fire Repair ? 34 Repair ? 42 Demolish (Foundation) ? 46 Windows/Doors • Give PCA handout to applicant for demolition permit GENERAL INFORMA AON SAC Code No. of Units No. of Buildings ? Const. (Actual) (Allowable) UBC Occupancy -4- Zoning # of Stories Length Width Basement sq. ft. Main level sq. ft. sq. ft. sq.ft. sq.ft. sq.ft. Footprint sq. ft. Census Code MC/ES System Ciry Water Booster Pump PRV Fire Sprinklered MISCELLANEOUS INSPECTIONS ? Stucco/Stone APPROVALS Pianning Building T- Engineering Variance ? 31 Ext Alt - Muni ? 33 Ext. Alt - SF ? 36 Mutti V-TT Permit Fee Surcharge Plan Review License MC/ES SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S!W Surcharge Treatment PI. Park Ded. Trails Ded. Other Copies Total: valuation: c. SAC Units % SAC G? 1 C? , CITY USE ONLY ? y1 L 8L RECEIPT #: SUBD. F(AO RECEIPT DATE: PERMIT # ?-- 2000 PLUNIDING PERMIT (RESIDENTIAL) CITY OF EAGFIN 3830 PILOT IINOB RD EAGAN, tIIi 55122 651-681-4675 Please complete for: ? single family dwellings ? townhomes and condos when permits are required for each unit D backflow prevanterforunderground sprinklersystem FIXTURES ' EACH fi TATAI Alterations to existing dwelling - minimum fee Describe: 3?• Sd $ 30.00 Bath tub $ 3.00 x = $ Floor drain 3.00 x = $ Gas piping outlet • minimum - 1 3.00 x = $ Hot tub/spa 3.00 x = $ Kitchen sink 3.00 x = $ Laundry tray 3.00 x = $ Lavatory 3.00 x = $ Septic System newlreruroished ' requfres MPC lic. 75.00 x = $ Septic System ebandonment 30.00 x = $ RPZ new installation/repaidrebuild 30.00 X = $ Rough opening 1.50 x = $ Shower 3.00 x = $ Under round sprinkler rfdwelling is underconsWdion 3.00 x = $ Underground sprinkler rfexisting dwelling 30.00 x = $ Water closet 3.00 x = $ Water heater 3.00 x = $ Water softener If rJwelling under constructlon 5.00 x = $ Water softener H exlstlng dwelling 30.00 x = $' Water tumaround 30.00 x $ State Surcharge .50 -> -> -> $ .50 TOtaI 6. S' Reminder. Call for inspections of alterations, i.e. water heaters, water softeners, etc. -------------------•----------••------• •-----------•------------•------• •---•-----------------------------------------------...._.....--- I hereby acknowledge that I have read Ciis appliration, state that the iMormatlon is eorrect, and agree to mmply with all applicable Ciry of Eagan ordinanoas. It is the applicanPs responsibility to notify the property owner that the Ciry of Eagan assumes no liahility for any damages caused by the Ciry dudng Its normal operatianal and maintenanca activities to the hacilities constructed under this permRwithin City propertyldght-oFway/easemenG. SITE ADDRESS: UN `1 .4 OWNER NAME: : -?I ? l `c l'`?t? TELEPHONE #: ? 1 -`t"?J? ?3 2Zca (AREA COOE) INSTALLER NAME: L7 TELEPHONE (AREA CODE) STREET ADDRESS: crrv: STATE: ZIP: A L? V 1' 1A?" PE EE L 12 gL -? CITY USE ONLY RECEIPT #: 15L 7O? SUBO. 1 DATE: 1996 MECHANICAL PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (612) 681-4675 Please complete for. sin le family dwellin ? townhomes an condos when permits are required for each unk New construction Add-on fumace ? r^iv4d-On ati :*i:uiiianiiiy niiu-on aic exehariger, i.e. Janee sysiem, @fC. Date: lv -24- q& EM ? Minimum Fee: Add-on/Remodel (existing residence oniy) 2.00 ? HVAC: 0-100 M BTU 24.00 Additional 50 M BTU 6.00 ? Gas Outlets (minimum of 1 required @ $3.00 each) ? State Surcharge TOTAL ?v SITE 1 van ia ? OWNER NAME: J e-W lleq /54 e r PHONE #: 53?28 INSTALLER NAME• UJdh I2.Y5 :Su`{AS rde ??? ? ?4;''' STREETADDRESS: NP Zb W ]q5i? 64-YeeL CITY: ?tf-n-i1Q2 Vauw S7ATE: /}2 Jl) ZIP: PHONE#:{(?).7-) ?3?-7049 /P- /-/4 7 bIYNATRt= UF'REK Rf CIT1f USE ONLY L BL SUBD. 4ol. RECEIPT #: DATE: 1896 MECHANICAL PERMIT (COMMERCIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (612) 687-4675 Please complete for: • all commerciaUndustrial buildings. ? muRi-family buildings when separate permits are pQt required for each dweliing unit. DAXt: An ? • I?T f1PY? L VVIVI?Slil+l Y"KI C. WORK TYPE: _ NEW CONSTRUCTION DESCRiPTION OF WORK: INTERIOR IMPROVEMENT FEES: ?$25.00 minimum fee gl 1% of conVact price, whichever is greater. . Processed piping - $25.00 • State surcharge of $.50 per $1,000 of 2012 fee due on all permits. CONTRACT PRICE x 1% PROCESSED PIPING STATE SURCHARGE TOTAL jl lt HUDFCCSi: -___,-.--_ _?. OWNER NAME: TELEPHONE #: TENANT NAME: (IMPROVEMENTS ONLI) INSTALLER: ADDRESS: cinr: - PHONE #: STATE: ZIP: SIGNATURE: SIGNATURE OF PERMITTEE CITY INSPECTOR k??XtX(%K?X%k:??ri>Fk?;t?FXciP.?t 'M?>;:??i(?kY'r7XYdMMXUX?CiXkY?YnXtS;X:Y( cITY f,1F EA[,aN C.:A'.;H]:ERs 1S TE'RM1NFll. NQ: 340 DATF: 0806/99 '7'IPi'_c i.3a09:15 Ili : P!AIiE;; JF:F'FFiE'd A. REGI'iT['h 300 9001 +:L`SQ I''E:.NSYL..VAN'f. 60,.00 205 3001 050 F'E:NSYI..VAN:f. 0,50 ,.? To+,a:L Rerei.prF Amouni;: 60.50 Cfi 1154E:36 U5E:R Tli: JAN .^cg<;KrXae ?>;?X; ?'%'FY,tYFX?X<?(:$%?XcaYYd?<;?.?;C7;;PF?(ri;iXM)r???;S:r,;M?X?F?k 1999 BUILDINC PERMIT APPLICATION (RESIDENTIAL) ? . CITY OF EAGAN / 3830 PILOT KNOB RD - 55122 651-681-4675 A New Conshuctlon ReauiremeMs D S registered ske surveys ahowtng sq. tf. of lot, sq. R. of houae and glf roofed areas f20%maximum l01 coveraae allowed) ? 4 copies ot plans (show beam 3 wlndow Yzes; poured Ind. design; etc.) D 1 sef of energy ealculationa ? 9 coples of hee presenation plan B lot plaMed affer 7/1/93 DATE: DESCRIPTION OF WORK: STREET ADDRESS: LOT: PROPERTY OWNER CONTRACTOR ARCHITECT/ ENGINEER BLOCK: I SUBD./P.I.D. #: Remodel/Reoalr Reauhemenb p - I L' ( 9 2 coples W plan 1 sei W energy calculalions for healed addRbns 1 stte auney for exterla addHlons 3 decb CONSTRUCTION COST: II Name: Phone #: 322? ast FUn StreetAddress:_ _-ts 6 pC?il ???--V4?? e?, City C'4 6'6y\J State: AV-V Zip: V'S 1 2? Company: l )? ?a . Phone #: (area code) Sheet CHy Telephone M: area code ( Sheel City Sewer 3 wafer Iicensed plumber (reaulred for new construction onlv): State: PenalFy applies when oddress change and lot ehange ts requested once permit is Bsued. :.tareby acknowledge ihat I have reod this application, state that the InformaNon Is cortect, and Stafe ot Minnesota Statutes and Cify of Eagan Ordinances. h , , ? . Slgnalure M Appikant: OFFICE USE Certificates of Survey Received Yes No lteense 4k Exp. State: Zip: Name: ) Registration Zip: to eomply wffh all applieabl Tree Preservation Plan Received - Yes - No - Not Required OFFICE USE ONLY BUILDING PERMIT TYPE _ . a ? 01 Foundation ? 06 4-plex ? 11 10-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 02 SF Dwelling ? 07 5-plex ? 12 12-plex ? 17 Garage ? 22 Porch/Addn. (4sea. ? 03 1 of _ plex ? 08 6-plex ? 13 16-plex ,X 18 Deck ? 23 Porch (screened) ? 04 2-plex ? 09 7-plex O 14 Apartments ? 19 Lower Level ? 24 Storm Damage ? OS 3-plex ? 10 8-plex ? 15 Lodging ? 20 Pool ? 25 Miscellaneous WORK TYPE ?( 31 New ? 35 Tenant Impr ? 39 Gas Line Only ? 43 Siding/Soffits/Fascia ? 32 Addition ? 36 Move Bldg. ? 40 Gas Insert ? 44 Windows/Doors ? 33 Akeration O 37 Demolish Bidg.* ? 41 Wood Stove ? 45 Fire Repair ? 34 Repair ? 38 Demolish (Interior) ? 42 Reroof " Give PCA handout to applicant for demol ition permit GENERAL INFORMATION Const. (Actual) 5' N Basement sq. ft. Census Code ? (Allowable) - Main level sq. ft. SAC Code O? UBC Occupancy 77 T sq. ft. No. of Units I Zoning ? sq. ft. No. of Bldgs 6 # of Stories - sq. ft. MC/ES System . Length r sq. ft. City Water Width ? Footprint sq. ft. Booster Pump PRV Fire Sprinkiered APPROVALS Planning Building ? Engineering Variance Permit Fee 5urcharge Plan Review License MC/ES SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit SNV Surcharge Treatment PI. Park Ded. Trails Ded. Other Copies Total: ? Valuation: $ ? ; SAC Units % SAC , . ?b.? .. ' - ? SURVEY FOR: 1'rontier blidwest Ilomes Cori). ? oESGRIBED AS: Loc 19, alock 1, s•rnrr•aau Pi.ncL. City of liagan, Uakota Couiity Alinnesota 9,b p /I/ and reserving easements oE record. 9 ??°o• ???q s/ `° `rs4• /1/ 4e?s' , X y? \G--z , / . ?j ? ? . , ,, ? e ? ???11s ?4? / 8 4b - / I 7V- V,/ ?Cfi - ,,y 9? o? ?/0 / ? ,IV ! \ s\\ \ \ \ p?F \ \ ? ??? ? \ ? ? o ? ,vP ., ? 90 ' . <Zi?? / 9 ? C) --2 cL, ?. c?- l y AV--c- "131?51 2006 RESIDENTIAL PLUMBING PeRnniraPPLicaTioN CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN MN 55122 651-675-5675 Please complete for modifications to existing residential dwellings. I6-,sD Date 'J I AO 1 0(0 I Site Street Address eh 1? G e- - Unit # Property Owner U Telephone #({o5p yJrL 9915 . Contractor " S Telephone #(43--o Address . lCJ uAtf City f?a?Gcn SWte WK Zip `?J ')1 a3 The Applicant is: _ Owner 4Gontractor _Other Septic System _ New _ Refurbished Submit 2 sets of plans and MPC license Includes County fee $ 100.00 Per as-built $ 10.00 Alterations ta existing dwelling $ 50.00 _ Add plumbing fixtures. This fee includes installation of a water softener and/or water heater at the same time. If you are insfalling onlv a wafer 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: Y ' , Water Softener . tiater Hes.er $ 15.00 _ new I& replacement Lawn Irrigation _RPZ _PVB _new _repair _rebuild $ 30.00 State Surcharge $ 50 i5 Sa Tocal $ I hereby apply for a Residential Plumbing Permit and acknowledge that the information is complete and accurate; that the work wiil 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 pian is required to e reviewed a d appro d. fCtL19 01 cV"\ ? ApplicanYs Printed Name Applican's Signature 05i 2007 10:12 EHGqN ENG+COM DEU i 96519851745 1,10.361 D02 ? ?oo7RESIDENTiAL SUTLDYNG riamr nrrtYCanorr Q?--S> G7ty Uf Eagnn r, o?7 3830 Pilot Knob Road, Eagan MN 55122 9?V ,/j 06 Telephone # 651-675-5675 FAX # 651-675-5694 NewCon caLMiremend 3 rggNtered sito suneys shmving sq, ft d bt sp. R of house: ana sll mufetl aim 12096 maimum lotcoveiage elloweeJ 1 Smis RePW Pfnpo9Etl Ouildlf9 4 l0 OB pWtBG On SlSNded sal 2 mpies al qan slpwiog Oe9m 8 wlndowskes; poured faund dsslgn, elc. i set of Eneigy Calalatlons 1CeGtesofTR0?g38rvat?iPlenrflofpfat[ed"eBei7l7AJJ .. .. Rim Jolg Demi Qptiore seleatun 511eN (bUilEings xhh 3 w less unls) Nnneg? muhaniral ro2nWation krm RemadeURsaaU Rendremenia 2 LGpkS Of plan SIlOV71rig Wo6rUS, heams. jol5t5 1 sEi of Enegy Cala,iatlme ra haaW eddi6ons 1 sile survey tor addlt6Hts & derAs AtldYlon • lndicWe Uon-dte aepOc ayafam offirs use a,7 Ceaof6urvsyRecd _Y _N Soih Report -Y _N Tree PfeS plan RBCtl _,Y _N, TreeP25ftNred _Y _N ?-...W13A0-Stip6c5}StBoo . _7,,.p Plans are cansidered public information unfess vou state thev are trade secref and the reasart. Date a ! J ? / 3?? C I g ( <i?:- __ Construction ost a ( t Site Addreas Y1n5USte # ------ Tlescription ofwork ? --- --, -- - --- Ma1N•Fa"q Bldg N Fireplace(s) _ 0 ? 1 _ Z F ? PropertyOwner ?/ /J q Telephone#(? Wiudow Concepts of MN, Inc. Cantrsctor _ 990 Lone Oak Road Suite 114 aadress _ Eagan, Minnesota 55121 Crry Sta[e _ License # 20163493 Telephooe # ??0!5-0 /6 S www.windowconceptsmn.com COMPLETE THIS AREA OMLY IF Energy Code Category - Minncsata Ru1es 7670Cateeorv i (d ;uhmissnn type) , • Rasldential Ventilation Category 1 Workshast Submltletl ' • E"rgy Envelope Calculallons SuOminetl A NEW B111LDING Mirmesora Itvles 7672 • New Energy Cade Warksheet Suhrnitt¢A In the last 12 months, has fhe City of Eogan issued a permit tor a sirntlar plan based an o mcs+er plpn? Y _ N If yes, date and oddress of masief plarc - ------------- Licensed Plvmber-- - - - Mechanical Ceniractar Sewer(Water Contractor Telephone #j Telephone #{ Telephonz #( I hereby apply for a R,esidenAal Building Permit and acknowledge that the information is a that the work will be in conformance with the ordinazxes and epdes of the City of Eagan 5tatutes; T undeistand this is not a permit, bnt only au application for a permit, and work is pemut; that Che work witrbe in accor auce wlth t6e appro ved plan in the case of wark whioh approval o£pians, _ ? _ ?? zqn r??e6l, ? Applicant's Printed Name. ?? . I ST-'Fp? , sl!!ve1?01tos Pronti_er Miclwest llomes Corp. ? Lot is, 13iock 1, sTnrroav Pi,ncE. llakota County Aliiinesota 9.'o o easements of record. 43 s? ?? Ss9' \ ' /??/ ? \ \ ? 4e ?6• k ?\ \V? SURVEY FOFt: DESCRIBED AS: Ci ty o f P,agan, and reserving ? ~?~ / i i/ i/ ? O \? \ ?O? \ \ F ? mQ \ \ ? s I V /3r /L?y? 8 ? 'g. ' y? •s '4 ?c tio nn r 4e s§ ???r 1.?v J4? ? e4 i i ? / ,(` . ? / r, , By Datz r?.?f ^ ? i AC;.AN PROPOSED ELEVATIONS ! LO-T - Tap af Foundnllon =924•6SQUARE FOOT? = 17, coreQeFloor eq21,2 8osemani Flvor ?926,3 A? Approm. Sower Ssrvics Elsv.. 912.2 ?? Propoted Elevallone IO Exiillnq Elrvallonf I_ OrolnoQ• Olreelions ? ti.._. ()enofes O/fset 3foke . a SCALE' 1 IneA • 30 Fsef BENC1? I?MrARN, 7 O`? ? T.M1l lowled wt N.W. Lar ef 'Prw?.aylra..:w ( 510tee Avenve 3wl??- secf:o.+: Elev. =9?•?4 1 M?N. 3E?BACK REOIREMENiS Fronl - *3o Noues 81do - 10 Reot - Is Ooroae fIM - C I Mqby evllly ihal Ihb NrveY, plon et foDOrl wns ploPerN !t me J08 NO.; ?p ei unAn my dlnH ouMrrldon end Ihal 1 am a duly RqbineA ' / IEDLU/VD laod 8urwyar uneer tM laro oI IM llals of MInneNfe ?6qQ`314. ? . lDON: PA6E, ? Planning Englneeiing Swvnylrrg IMIl??I?Mqnin M?nt?N? w ?? M1 w 1 11?N 14I ?g l . . zm 1 i ?N ? 6 - 27 8 . 9 . 9 Ue1?: cAoo Fi1.c I c»?oRCO; p , •.r ? 1 11 r•n, uc.n.• Na14376 4"4 FMHL 7..) / PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA150478 Date Issued:07/10/2018 Permit Category:ePermit Site Address: 4150 Pennsylvania Ave Lot:19 Block: 1 Addition: Stafford Place PID:10-72500-01-190 Use: Description: Sub Type:Residential Work Type:Replace Description:Air Conditioner Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088 Surcharge-Fixed $1.00 9001.2195 $60.00 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Hugo E Molina 4150 Pennsylvania Ave Eagan MN 55123--157 (651) 335-7472 Controlled Air 21210 Eaton Ave Farmington MN 55024 (651) 460-6022 X253 Applicant/Permitee: Signature Issued By: Signature