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1578 Rustic Hills DrCITY OF EAGAN Nb Jp 3830 Pilot Knob Road, P.O. Box 21-199, PH ON E: 454-8100 BUILDING PERMIT To be used for , ' f,'? Est. Value 462 9000 Eagan, MN 55121 Receipt # r- Date t ( j ,19 Site Address I57A RI'S1IC RILLS DR OFFICE USE ONLY Lot ' Block I Sec/Sub. U J1C HILLS On Site Sewage Occupancy ' 1 MWCC System Zoning Parcel No. On Site Well Type of Const -V City Water k (Actual) s Name r.tcl'A H7 (Allowable) W # of Stories z Address Length s3 3 o City Phone Depth j - F S Total u. ' c Name 454-5220 . . FootprintS.F. o< Address APPROVALS FEES ?°C- City Phone Assessments Permit J Water/Sewer Surcharge LUU W Name Police Plan Review i x - Address Fire SAC, City ? z Q W City Phone Engr. Planner SAC, MWCC Water Conn. Council Water Meter I hereby acknowledge that I have read this application and state Bldg. Off. Road Unit ' that the information is correct and agree to comply with all applicable APC Treatment P1 i State of Minnesota Statutes and City of Eagan Ordinances. Variance Parks Copies Signature of Permittee TOTAL. A Building Permit is issued to: on the express condition that all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official Permit No. Permit Holder Date Telephone it Plumbing ( HN.A.C. Electric Softener Inspection Date Insp. Comments Footings I z Footings II Foundation Framing r V1747 1 Roofing Rough Plbg. Rough Htg. r a 1 ? i? E51- 3 / Isul. Fireplace Final Htg. Final Plbg. , Bldg. Final Cert.Occ. ?O Temp. LP Deck Ftg. Deck Frmg. Well Pr. Disp. PERMIT MECHANICAL PPEl3M1?- RECEIPT # ?? c> CITY 0 AN 3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: ?- -"-f-- ?? 7 CONTRACT PRICE: q PHONE: 454-8100 Site Address BLDG. TYPE WORK DESCRIPTION Lotj_Block Sec/Sub Res New ? T Name COND. CO. Mult 'Add-on m ?a Address 8:10 WENTWORTH AVE. S0. Comm. Repair c City MINNEAPp M : 55420 Other oo, onnn Name _ c Address 0 City - TYPE OF WORK Forced Air ZQ A M BTU Boiler M BTU Unit Heater M BTU Air Cond. --- - M_BTU Vent CFM FEE: SIC: TOTAL- Gas Piping Outlets # Other FEES RES. HVAC 0-100 MBTU -$24.00 ADDITIONAL 50 M BTU - 6.00 (RES. HVAC INCLUDES A/C ON NEW CONSTRUCTION) GAS OUTLETS (MINIMUM - 1 PER PERMIT) - 1.50 EA. COMM/IND FEE - 1°r6 OF CONTRACT FEE APT. BLDGS. -COMM. RATE APPLIES TOWNHOUSE & CONDOS -RES. RATE APPLIES MINIMUM RESIDENTIAL FEE -ALL ADD-ON 8 REMODELS - 12.00 1 COMMERCIAL FEE - 20.00 JHCHAR6E PEfl PERMIT .50 S/C IF PERMIT PRICE GOES $1,000) ???»-• ?, /' nisi/i??_. SIGNATURE OF PERMIT-TEE FOR: CITY OF EAGAN _ PERMIT # r S?k xv . PLUMBING PERMIT RECEIPT # 77 3 CITY OF EAGAN S 8 `? 3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: 2 CONTRACT PRICE: P,MONE: 454-8100 Site Address BLDG. TYPE l WORK DE 5VTION Lot 11 Block Sec/Sub Res. ? New ?/ Mult. Add-on Name i0c . Comm. Repair Address Other C City Phone RI`S. PLBG. ONLY - COMPLETE THE FOLLOWING: NO. FIXTURES TOTAL,- Name ate, Closet - $3.00 $ _ Bath Tubs $3.00 3 Address Lavatory $300 $3. `I O City Phone - &' . _ R--P"wer - $3.00 Kitchen Sink - $3-00 FEES Urinal/Bidet - $3.00 COMM/IND FEE - 1% OF CONTRACT FEE -I Laundry Tray - $3.00 APT. BLDGS - COMM RATE APPLIES Floor Drains - $1.50 j TOWNHOUSE & CONDO - RES. RATE APPLIES Water Heater - $1.50 j MINIMUM - RESIDENTIAL FEE -$12.00 Whirlpool - $3.00 MINIMUM - COMM/IND FEE -$20.00 Gas Piping Outlets - $1.50 STATE SURCHARGE PER PERMIT - .50 (MINIMUM - 1 PER PERMIT) (ADD $.50 S/C IF PERMIT PRICE GOES Softener - $5.00 BEYOND $1,000.00) Well - $10.00 7 Private Disp. - $10.00 -tr r- _1 6-Rough Openings - $1.50 SIGN-ATURE OF PERMITTEE FEE: 1 STATE S/C: S FOR: CITY OF EAGAN GRAND TOTAL: Trr#ifirotr of (Orrupoury Citp of eagan 11Ppartmmi of Wut1bWV . Prim This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building Code certifying that at the time of issuance this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following..- u, c uon 8F >Wz/GAR eag. Pmik No. 13951 O-Vancy TAX R3 Zoning District R] Type Coosa. 0 owner of &odi„g ARNOLD J. ERHART Add= 1274 MAY Mr, EAG N BuM g Aaa,as 1578 WMC HILLS DPJVE y L 11, B I. MMC IBS Date: 0(.110BF1I, 28. 1987 Ikuldn Official POST IN A CONSPICUOUS PLACE SEDGWICK;HEATI )d &?AI HOUSE HEATING TEST RECORD ADDRESS dr CITY .jjC OCCUPANT 4 SSr OWNER HEAT LOSS DATE HTG. INST. SOLD BY INSTALLED BY P Electrical Work By L Gas Line By r TYPE OF HEAT GA_ FA-- ,A HW_ STEAM SPACE HTR. UNIT HTR GAS DESIGN MAKE L e d Model Serial 4i Y Q 3 INPUT /Oc) spa THERMOST Valve CONTROLS P w .Heat P ug "ter r (w ?iq Limit a/u y a,"- l? Limit Setting 1 d r Fan Setting w rr Pilot Type Pilot Make / h Pilot Model sl°73S Pilot Timing S?L.S Q ti L.W. Cut Off Pressure '5 ' S J 0'" Percent C02 -? Input CFH /OOC j Percent O Stack Temp. ? 9C) Percent CO /Lt AIr MAKE OF BURNER ?-?-~ Model Max. BTU Rating - MAKE OF FURNACE Model Vent Size 4f KIND OF LINER SIZE NONE Draft Hood J /U u Regulator ? {' Filters Size Number Chimney Location Inside ?utside Chimney Construction f d 5 S Smoke Bomb Wiring ( , Draft Test Tag S Door Pressure Lighting Inst. Date Tested Z 1 Company Testing e, CA V Lb, -S Name of Tester 3 69`SD A? U1 J OTHER_ CONVERSION Form 235 . r OF EAGAN Remarks Addition RUSTIC HILLS ADDITION Lot 11 Blk Parcel- 110 00= Owner Street 1578 Rustic Hills Drive State Improvement Date Amount Annual Years Payment Receipt Date STREET SURF, y 19110 18-5-5-41 1 RK - 54 in STREET RESTOR. GRADING SAN SEW TRUNK 1968 45.85 1.53 30 * SEWER LATERAL q,3i- 1990 3454,56 230.30 is WATERMAIN WATER LATERAL 1972 170.98 8.55 20 WATER AREA 1977 79.55 5.30 15 * lateral water 80 STORM SEW TRK 1979 312.05 31.21 10 * STORM SEW LAT 1980 * service 1980 CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. BUILDING PER. SAC PARK CASH RECEIPT -?` CITY- OF EAGAN 3830 PILOT KNOB ROAD EAGAN, MINNESOTA 55122 7 DATE 19 R6CfiiVfiD FROM AMOUNT 6 _DOLLARS loo E] CASH 10 CHECK • rt FOR FUND I CODE I AMOUNT ?k You BY ' White-Payers Copy Yellow-Posting Copy Pink-File Copy BLDG. PERMIT NO. 01-3210 Bldg,. •Permi 01-3422 Plan Check 01-3445 Surch./Adm. 01-3446 SAC/Adm. 01-2155 Surcharge 17-3860 Road Unit 40-2275 SAC t 20-3865 Water Conn. 00 20-3868 Water Trmt. 20-3716 Water Meter 20-2252 Acct. Dep. 20-3713 Water Permi 20-3743 Sewer Permi 79-3866 Sewer Conn. 11-3855 Park Ded. TOTAL CASH RECEIPT CITY OF EAGAN 3830 PILOT KNOB ROAD EAGAN, MIESOTA 5522 DATE 19 RLC tI V LD FROM AMOUNT , $ ? Q F^? ac-DOLLARS ,oo ? CASH CHECK FUND CODE AMOUNT o/ n C 0 ? Y 1 U n o U ?O d v l U U? 1 N° Thank You 77133 White-Payers Copy Yellow-Posting Copy Pink-File Copy CITY OF EAGAN SEWER SERVICE PERMIT 3630 PMot :nob Road PERMIT NO.: I ' 3 7 1 P.O. Box 21199 * - Eagan, MN 55121 .. DATE: 1 Zoning: 1 No. of Units: Owner. Arnold Erhart Address: CITY OF FAAGAN Permit No: Date: v2 Size: `1 oC 3830 Pilot Knob Road Meter No: I c - gg- 97 gan, MN 55121 t.,11iteAddress: O. Box 21199' Reader No: U'7Date wner. Arnold Erhart 1-7`?? Rustic iiilis Drive L11 R1 rustic Hills -- """"--- Conn. Chg: 52515 . , d 00 Iggi Acct. Dep: t QNlE tLt - ELI F1 Permit Fee: Surcharge: 0 l ib* 640)Wiy with the City of Eagan Tr. Plant 140• Ordin ces. Meter. 67 i -+)pd Misc.: By WATER SERVICE PERMIT CITY OF FAGAN 3830 OIT61 Knob Road P.O. Box 21199 Eagan, MN 55121' Site Conn. Chg: Acct. Dep:_ Permit Fee: Surcharge: Tr. Plant_ Meter. - Permit No. Meter No: Reader No: Araold Erhart: 525. Zoning: - No. of Units: Date: 9-9-87 Size: Date. I agree to comply with the City of Eagan Ordinances. By WATER SERVICE PERMIT CITY OF EAGAN N? 13 9 51 t 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 BUILDING PERMIT PH ONE: 454.8100 Receipt # / J 757d?2, Tobeusedfor SF DWG/GAR Est.Value $82,000 Date JULY 21 1987 Site Address 1578 RUSTIC HILLS DR Lot L1 Block 1 Sec/Sub Parcel No. RUSTIC HILLS m Name ARNOLD J ERHART W Address 1274 NORWAY PT., APT 3 City EAGAN Phone 688-0578 =ojName SAME 454-5220 0? Address P City Phone n w z z w Name- Address City I hereby acknowledge that 1 have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes aAd City of EaganArdinances. Signature of A Building Permit is issued to: ARNOLD all work shall be done in accordance with all Building Official OFFICE USE ONLY On Site Sewage Occupancy MWCC System X Zoning On Site Well _ Type of Const City Water _X_ (Acluall (Allowable) # of Stories Length Depth S.F. Total Footprint S.F. APPROVALS Assessments Water/Sewer Police Fire Engr. Planner Council Bldg. Off. APC Variance FEES Permit Surcharge Plan Review SAC, City SAC, MWCC Water Conn. Water Meter Road Unit Treatment PI Parks Copies R3 Rl -V- -v- 7 55 $ 440.50 41.00 220-95 inn_n0 595.00 595.00 67.00 305-00 7Rn_n0 TOTAL $2,403, 7 5 on the express condition that of Minp*otwSlatutes and City of Eagan Ordinances. This request voitl 9?.0 7 1 8 months 'tom O ® 51325 iai.. ??e& Is - Request Date Fire. No. RoePh-111 Insuc' un f- n Requ-red? ?Ready Now ill Notify Inspec- //'f/ ? ?NO for When Ready tff4icensed Electrical Contractor I hereby request inspection of above ? Owner electrical work installed at: Street Address Bo or Route No. , 1 44S ` z Ciy g47 V UST/G 1 1 /? 7" e, 4 4, Section No. Township Name or No. Range No. C nty ,2 1"i'll Occupant (PRINT) ,y? /4R-A11F- ?l-44, ?/- Phone No. Power Supplier .vs PI Address g 3oQO//>, v?cc ?'o 06&?Icwe7-- Electrical Contractor (Company Name) Contract is License No. Standard Electric Co. 40837 Mailing Address )Contractor or Owner Making Instailationl 2672 Maplewood Dr., Maplewood, Mn 55109 Authorized S- ure (Contractor?Own a tallatinN Phone Number 484-8044 1 E AINSPECTION REQUEST WILL NOT THIS MINNESOTA STATE BOARD OF ELECTRICITY B Gritlgs-Midway Bldg. - Room N-191 BE ACCEPTED BYE STATE BOARD 1821 University Ave.. St. Paul. MN 55104 UNLESS PROPER INSPECTION FEE IS Phnna tR»I 642-MOD ENCLOSED. !0/07 REQUEST FOR ELEC41CAL'111SPECTION EES-00001-06 See instructions for completing this form on beck of yellow copy. / ® 51325 "X" Below Work Covered by This Request Add Reps Type of Building Appliances Wired Equipment Wired Home Range Temporary Service Duplex Water Neater Lighting Fixtures Apt. Building Dryer Electric Heating Commercial Bldg. Furnace Silo Unloader Industrial Bldg. Air Conditioner Bulk Milk Tank Farm Other Pecs v Other lSp,ifvl t r Space v tar Omar ompute Inspection Fee Below a Fee Service Entrancesiza it Fee Feedeter$ubleeder5 a Fae Circuits 0 to 200 AMPS 0 to 30 Am 1s 0 to 30 An s Above 2 31 to 100 Amps I ?V 31 to 100Am s A Swimmin Above 100-Am s Above 100_Am s Transfor Irrigation Booms o Partial.'Oth e Signs Special inspection emarks so TOTAL , Rough-in T1e I, the EI tri Gay- t? nspector, hereby '? - certify that the above Final ecti on has been made. / rree. This realest vold 18month from I 42 -15 RESIDENTIAL BUILDING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD, EAGAN MN 55122 651-681-4675 New construction Requirements RemodelfRepair Reauhnimants • 3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas 2 copies of plan (20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions • 2 copies of plan showing beam & window saes; poured found desgn, etc.) 1 site survey for exterior additions & decks 1 set of Energy Calculations • Indicate if home served by septic system for additions • 3 copies of Tree Preservation Plan if lot platted after 711/93 • Rim Joist Detail Options selection sheet (bldgs with 3 or less units) DATE ?g /oz- VALUATION l.co5e> 00 SITE ADDRESS 1?? f;?tc,?I i h111 r MULTI-FAMILY BLDG _Y _N TYPE OF WORK -T/-1y-,, FIREPLACE(S) _ 0 _ 1 _ 2 APPLICANT \ ?C hent? (r?t1c? , r? r STREET ADDRESS Aq q nt n r',gSO f-131 y1) CITY STATE ZIP TELEPHONE # 4'4 14141.0 CELL PHONE # FAX # PROPERTYOWNER f4vfnvE. PCYnt9r+ TELEPHONE#(A5k C]h__I4A COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINNESOTA RULES 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 Contractor: Plumbing system includes: Mechanical Contractor: Mechanical system includes: Sewer/Water Contractor: Fee: $90.00 ------------------------------------------------------------------------------------------- I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. OFFICE USE ONLY Water Softener _ Water Heater No. of Baths Phone # Lawn Sprinkler No. of R.I. Baths Air Conditioning Heat Recovery System Certificates of Survey Received Tree Preservation Plan Received _ Not Required _ Updated 4l02 OFFICE USE ONLY ? 01 Foundation ? 02 SF Dwelling ? 03 01 of _ plex ? 04 02-plex ? 05 03-plex ? 06 04-plex ? 31 New ? 32 Addition ? 33 Alteration ? 34 Replacement Valuation Census Code SAC Units Nbr. of Units Nbr. of Bldgs Type of Const ? 20 Pool ? 21 Porch (3-sea.) ? 22 Porch/Addn. (4-sea.) ? 23 Porch (screened) ? 24 Storm Damage ? 25 Miscellaneous ? 30 Accessory Bldg ? 31 EM. Alt - Multi ? 33 EM. Alt - SF ? 36 Multi ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 37 Demolish (Bldg)' ? 43 Reroof ? 46 Windows/Doors 'Demolition (Entire Bldg only) - Give PCA handout to applicant Occupancy MC/ES System Zoning City Water Stories Booster Pump Sq. Ft. PRV Length Fire Sprinklered Width REQUIRED INSPECTIONS _ Footings (new bldg) _ Final/C.O. _ Footings (deck) _ Final/No C.O. _ Footings (addition) _ Plumbing _ Foundation _ HVAC Drain Tile Other _ Roof _ Ice & Water - Final _ Pool _ Ftgs _ Air/Gas Tests - Final Framing _ Siding _ Stucco _ Stone _ Fireplace _ R.I. - Air Test - Final _ Windows (new/replacement) Insulation _ Retaining Wall Approved By Building Inspector Base Fee Surcharge Plan Review MC/ES SAC City SAC Water Supply & Storage S&W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other Total ? 07 05-plex ? 13 16-piex ? 08 06-plex ? 16 Fireplace ? 09 07-plex ? 17 Garage ? 10 08-plex ? 18 Deck ? 11 10-plex ? 19 Lower Level ? 12 12-plex Plbg_Y or _ N GOLD COPY-PERMIT RELEASE FORM PERMIT # U r ADDRESS I ?J? ?V ST ?? I' S PICKED UP BY Orr- PIc3 ?.., I i ? I r?-??•-? ?--ems ?,-, CITY OF EAGAN .APPLICATION FOR PERMIT SEWER AND/OR WATER CONNECTION xxxxxxxxxxxxxxxxxxxrx:xxxxxxxssxxxxl M MATE': PAYMFU OF FEE AT TIME OF y APPLICATION DOES NOT CONb mum APPROVAL OF PERMIT. INSPECTION OF SEWER AND/10R WATER IbUEALLATIONS WILL NOT BE SCHED- • ULED UNTIL PERMIT HAS BEEN • • APPROVED. e 1) PROPERTY ADDRESS: L? R_ V C_ u < t, P 6-C /4- LEGAL DESCRIPTION: - (Lot/Block/Subdivision or Tax Parcel ID IF EXISTING STRUC IRE, DATE OF ORIGINAL BUILDING PERMIT ISSUANCE: (Mon Year PRESENT ZONING/PROPOSED USE: ? COMMERCIAL/!RETAIL/OFFICE Q INDUSTRIAL n INSTITLITIONAL/GOVERNMENT R-1 SINGLE FAMILY Q R-? DUPLEX (Two Units) R-3 TOWNHOUSE (Three + Units) ( Units) R-4 APARTMENT/CONDOMINIUM ( Units) 2) ® l - NAME._ V? r, Id ear 5?? ADDRESS: Murr Plumbing,-the. CITY, STATE, ZIP. !MFNorthlond r., #403 Mandela Hgis, A01 56499 PHONE: 688-6874 3) ?. For City Use .. ® NAME: I Our N Plumbers License: ADDRESS. urr Plumbing, Inc. Active 1402 W r., 3 Expired CITY, STATE, -ZIP:_ Mendota Hgts.. MN c5iQ9 Not recorded PHONE: 688-6TER LICENSE# Staff Initial 77. ADDRESS: CITY, STATE, ZIP: PHONE: ONNECTION TO CITY SEWER ?NNFSTION TO CITY WATER OTHER 6) • r PLEASE HOLD APPROVED PERMIT FOR PICK-UP BY ONE OF ABOVE - - PLEASE MAIL APPR PERMIT 70 1, 2, 3, 4, ABOVE ? (Circle one) ! . 7) _ . -EOR CITY I USE ONLY . PERMIT # ISSUED Pd w/Bldg. Permit FEES: $ SEWER PERMIT (INCLUDE SURCHARGE) $ $ JG S v WATER PERMIT (INCLUDE SURCHARGE) $ $ WATER METER/COPPERHORN/OUTSIDE READER $ $ WATER TAP (INCLUDE CORPORATION STOP) $ $ SEWER TAP $ $ Gt F ACCOUNT DEPOSIT - SEWER $ ACCOUNT DEPOSIT - WATER $ s Z S uZ $ WAC $ Z Z S u $ SAC $ $ TRUNK WATER ASSESSMENT $ $ TRUNK SEWER ASSESSMENT $ $ LATERAL BENEFIT/TRUNK SEWER $ $ LATERAL BENEFIT/TRUNK WATER $ ?,1 G • 0 7? $ WATER TREATMENT PLANT SURCHARGE $ $ / OTHER: $ 1-3 . 7 $ C o TOTAL x/_33 RECEIPT RECEIPT DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY? CQ YES IF YES, THEN A "PERMIT FOR WORK WITHIN PUBLIC Q ROADWAY" MUST BE ISSUED BY THE ENGINEERING NO DIVISION. LIST AS A CONDITION. SUBJECT TO THE FOLLOWING CONDITIONS: APPROVED BY: -c,.e - J TITLE: DATE: ??l ?P 4 1 5 1 3 CI PFRMTT APPLI SINGLE FAMILY DWELLINGS INCLUDE 2 SETS OF PLANS, 3 OF SURVEY, 1 SET OF ENERGY CALCULATIONS NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR /HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED. MULTIPLE DWELLINGS - RENTAL UNITS FOR SALE UNITS INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECK WITH BLDG. DEPT., 1 SET OF ENERGY CALCULATIONS COMMERCIAL INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS, $2,000 LANDSCAPE BOND To Be Used For: eESi arc vcE Valuation: /p Pay 'do Date: Site Address Lot _& Block On Site Sewage MWCC System Parcel/Sub Rq T T 7`rC On Site Well ?J q City Water _ Owner /Y (,y IW -(/ Egli o P7` Address /? 7yoeg? Ate: 3 City/Zip Code E4 9,?1v? IV^ S 3-/A 3 -r Phone G b' -O S 7' I APPROVALS Contractor Ae v o Y .T. Fill, n?7` Address /ol7Y /Uoit oyg* /I - 7 City/Zip Code A'4-51, 09n,' *AJ S3"/. ; Phone yS ?/-S}20 Ixf-c' S-7X Arch./Engr. Address City/Zip Code Assessments Water/Sewer Police Fire Engr Planner Council Bldg Off APC Variance 7-Jv-87 Occupancy R-. ?s Zoning - 1 Type of Const (Actual) l) (Allowable) # of Stories Q- Length 5 S Depth 3 ff. 6 S.F. Total Footprint S.F. FEES Permit yyo. Surcharge y/, Plan Review aAr), SAC, City Inn. ° SAC, MWCC S,15 m? Water Conn <) S Water Meter Road Unit 2a s, @= Treatment P1 I ?D Parks Copies TOTAL Phone # SURVEYOR'S CERTIFICATE 1 1I V Wi4 LNE VVV ? i i MH - G/L-RU TTivTILLS DRIVE '?em.a' i i i e0fA' '`rrI?nlrl awe STOP R?•. LINE --L- Y B77-61E 8210' ?S.6' 40'? - - 00' SETBACK YHG - - - - - aP. ,- OAn. FLOW EL 800:' ' ? i o \ ? 9 , 6.6• I `d, Sur: 1 Hn. 20 Ma 4W4 6' ? 6' y _ • - EA tli' lP. PNOPOSEO HOUSE 111'''??? - FFj, • - Fem. $t ?E I `__s M q SZ' 3e O LO 4? 50.1' ?I •`, iB• N _ I? \ L -- 10' O ImAOE 6 UT0. EASEMENT TaA.t' 608.1' a a"7-61 E 8210' Lot 11, Block 1, RUSTIC HILLS ADDRIDH, according to the recardad pat t erect. Dakota Canty, Miresofa Pi.P uw.loreeuwy, GrA an>puw d*M?m e tlW . . em. a dtYy se6rtMeS LeN Su Bursp ub ab rAe a loo em a Mlnmde. .. 1 M'r P. FO9ka.0. S. oMK `-20 -?97 Mrlaeaal.*b NO 1e1sa EXTERIOR ENVELOPE AVERAGE "U" COMPUTATION OWNER /??2.r./1? ?-?' j- SITE ADDRESS wringciva ? 9dop01pDATE PHONE C et , OMM i Determine working square footage of each. 1. Total exposed wall'area...... Zf} 8 (,AZ sq, ft. x-ll ASS- Z72 M 2. Total roof/ceiling area...... 1344 sq. ft. x.CVAPe-4•- Total exposed wall area above floor=-&P-7-3,-47-orb a. . Total wall window area ..................................... l cl'7, '_i=. b. Total door area ............................................ 3'7•''7 c. Total siding glass door area ............................... Z !„b d.' Total fireplace wall area ..............•.................... e. Total wall framing area (average 10%) ...................... 1 ,per f. Total net wall area above floor ............................ l(22p ,?? g . Total rim joist area...... ...................... o.: ........ Z2 F? .4q Total exposed foundation area= 1"7C1 .3 0 h.%-:-Total' foundation door area ................................ i.` Total foundation window area (includes sliding doors)..... Z?.Z4 J. Total net foundation area above grade ..................... &9 $ A k. Total wall framing area (average 10X). 1. Total net wall"framing area ............................... , Determine "U" value of each wall segment a.-19? .'L4 x"tr' (.SZ I oZ Stn b• 3.7.- _x..U.. . 14 a .2b d. X..U.. _ X..U.. .IZ = Z .Cop e. 1£?O002% f. ((GZO31 X"U" .p4 = [04.51 g._ ztb ggx..U.. h. X..U" _ i.3;mac"U'• . ?'L = l L.06 J •4.8fe X,.D., . 13 = 1 1 . t?s k. x•13 X..U.. . ?Z = •5[.? ?., 1 • 4.13 X"U.. 3 ...........................................Total Z4Z .jt!$S If item #3 is the same as, or less than item #1, you have met the intent of SHC 6006 (c)2. 1 Total exposed roof/ceiling area = 1?S44 M. Total skylight area ............................... n, Total roof/ceiling framing area (average T%)...... ?Iq-.OEj o. Total net insulated roof/ceiling area .............. 1 7 -4q •q IL- Determine "U" value for each roof/ceiling segment. M. .r- X"U" _ n. S4.C)b X"U'l Ig- o. 1249 •C & X"U.. LS 4..* ........ ..................... Total = .J'Jr• s9 If total of #4 is the same or, less than 412, you have met the intent of SBC 6006(c)l. Alternate Building Envelope Design To utilize the total envelope system method, the values established by the sum of items #3 and #4 shall not be greater than the sum of item #1 and #2. 1. A 5 + 2. 34. 94 = 30'1.4 L 3. 14'7 . ?? + 4. 3a • 39 = L8? . L4 ANDERSON WINDOW UNITS Sq. Ft. Sash U unit.-- . Opening .. .. R' j Basement.Unit 3.11 1.92 C135'r 5.81 1.92 C14 6.88 1.92 C15 8.71 1.92 C235 11.62 1.92 C24 13.76 1.92 C25 17.42 1.92 Ct235 14.25 1.92 CC24 16.88 1.92 *CX25 21.38 1.92 C335 17.43 1.92 C34 20.64 1.92 C35 26.13 1.92 jC235-2. 23.24 1.92 U24-2 `• . C25-2 27.52 34 84 1.92 1 . .92 t'd'%r C15-CP25-C15 t 34.84 1.92 s, Patio'; Wor '' f '" 6068 38.. 1.92 ;. . Pease ?:30 'x 68 20. 7 10 ?:. Pease 28 x 68:, 17.7 . 7.10 4 ? J fi ;Side t Lite 7.7 1.92 14q.A W i *Not 'Stamm . ? t. r .52 .52. .52 .52 .52 .52 .52 .52 .52 .52 .52 .52 .52 .52 52 .52 . .52 .52 .14 .14 .52 Lin. 'Ft. Crack. o i o 8'-0" 10'-4 7/16" 11'-6 13/16" 13'-6 9/16 20'-8 7/8" 23'-1 5/8" 27'-1 1/8" 22'-1 7/8" 241-6 5/8". 28'-6 1/8" ° 201-8 7/8" W 0 Z 23`1 5/8" u i 27'-1 1/8" a ° w. 41'-5 3/4" . ¢ a a 46'-3 1/4"' , 54'-2 1/4" 0 rr i 54'-2 1/4" cj .. ;a W : M M 19'-4.. . ? 18'-8" ? 613 15'-8" D L to.''Cr3 r W ;8 0Q W j W . r CEIL. FRAME I.-Interior or Air Film 2-2" Sheetrock 3-32" Soft Wood & 5" insul, 4-Exterior Air Film Total R Total U IQ41 f - 2 a? u 3 3 R Ml INSULATION; R ,61 1-Interior Air Film .61 .45 2-2"Sheetrock ,45 21,01 3-MI nsulation 38,00 ,61 4-Exterior Air Film .61 22,68 Total R 39,67 ,044 Total U .025 3 3 ---4 Frame Wall R 1-Interior Air Film ,68 2-2" Sheetrock ,45 3-3',." Soft Wood 4,35 4-25/32Fiberbrd Sheathg 2,06 5-7/16" Med. Dense Hdbd .67 6-Exterior Air Film ,17 Total R ?8.,im - Total U .12 Insulated Wall R - n error it Film .68 2-2" Sheetrock 45 3-40 Insulation 1$.00 4-25/32Fiberbrd Sheathg 2.06 5-7/16" Med,DenseHdbd .67 6-Exterior Air Film .17 Total R _,03 Total U Ow Rim Joist R Tn a or Air Film .68 2-Insulation &P 19.00 1-12" Soft Wood 1,88 3-7/16" Med. Dense Hdbd ,67 Exterior Air Film .17 Total R WT Total U .08:6 1-A Conc. Blk, Uninsulated Total R 2,12 Total U ,47 1-B Conc. B1k,Stripping & 3/4" Foam Insul. & 2" Sheetrock Total R 7.91 Total U .13 z Z U J J W r'a M-d ' co N CV) G L6 ? a CO 0 LL U 2 N ki 0 U ;?6 ??, •.??(.?? .. GC?1 39"??G?? y.?; 399 ?'?J(J 578 w i Sou 3uKc??f ,1, 996 AT LOSS CALCULATIONS NEATINGBAIR CONDITIONING CO. MINNEAPOLIS, MINN. satherelrlps A.S.H.V,E. - Construction No. Insulation lws Doors Guida Reference Out. Wall Int. Wall Calling Root Floor Kind How Applied No Yes-No 19__ q 1ie„R Length Width Helghl ' FI ,f Q' V* oom Length Width 'L Haight ndows a nd Doors- racka ge and Area Windows a nd Doors- Cracka go and Are a W. d.h of •n Helaht of en Ns, of li Me lmael 11. ( r Arco e it. 2 No. Wldrh of en / fwah1 o nne Nn. of 11 hu Unenl Ir. of Crack Aron e It. / L 2f z`? / Iv G 2- 2 3c ?3 1G r G6 Z Z Gu / 321 Coal Btu Cool Btu alien 1174- 16 'j L 1 3 Infiltration 'I u 3- U 0 tm? Glass I Vail Z- Exp. wall IS. K 1210 Kp• wall Q Z? Not sxp• wall all Int. well Ig Calling X/3 2.Z 4T Floor ?- o / U Btu. S, Total Btu. 0 U ad sq. It. E.D.R. or sq. Ins. W.A. Leader area Required sq. It. E.D.R. or sq. Ins. W.A. Leader area Ivf„? Room Length! Width 13 Height Fl. Room Length ZZ Width I L/ Height ndows nd Doors-Crackage and Area Wi ndows fi nd Doors- Cracka ge and Ar ea Wldrh o+ en Height of ene No. of Ir hie Unanl It. of crack Area a 11 . / _ No' V.drh of nne Ilar hl f nnn o No. W b hie Lineal It. of crack A.ee n II, ? 1/ 0 1 dig S Y 7 ?r z 31- '. 1 I /? L 2 60 1 3 Cost Btu Cool Btu etion G 2 17 I Infiltration 3yY9d 'F 3 ('1 ...3 -Vo ,$V U S 0 U Glass G )" SU 32- < Vail 3 X O Exp. well .tS 7 K Kp, well 1 U L (? Net exp. wall / S G Ll all Ig _ ?---- U Int. wall Ceiling 2Zx1K Floor L'L f c y a t s 1` _ Btu. 3 0 Total Btu. -ad sq. It. E.D.R. or sq. ins. W.A. Leader area Required sq• It. E.D.R. or sq. ins. W.A. Leader area 1 h Iw Room Length Z Width ( Height BFI. }Al o? Roan Length (G Width Height ndows rid Doors-Crackage and Area Wi ndows a nd Doors -Cracka go and Ar ea r Arh of ane Ner hl of nne No. of 11 hie l neal It. al cr eck Arsn ea. n. o. .nu. owf ann .n ern 11 All" of Nn, of L his Uneal It. of crack Aran ^e• 1 1• I Z- i 5:3 Z ZY 0 r etim Cost f( Btu , O, id Infiltration Coot Btu 3 - O S U Glass l S 1 2 S U all -23 p. wall LS!_L Exp. wall .9 Net exp. wall 23 2 a U 6 r n ell _ Int. wall g ceiling /G.3 ?o? 3 lU ` IU. - _- - _ - ? Total B14. .. ... n S V a) ` ... HEAT LOSS CALCULATIONS / e. H EATING & AIR CONDITIONING CO. MINNEAPOLIS, MINN, Weetherslrlps A.S.H.V.E. - Construction No. Insulation ?ndows Doors Guide Reference Out. Wall Int. Well Coiling Root Floor Kind How Applied ------- is-No Yes-No tg__ Z ('Pin n Width /I Height ;?FIJJj ,( Ro«n Length Width/ / lie lgnt 6, Wi ndows a nd Doors- Crackage and Area Windows a nd Doors- Cracka ge and Are a WrNh of sna f eight of ane No. of li hta 4nae1 II. of r Ante e It No. W tlih or r e mater of an. No. of II hie Lineal It. of vii Aran sq• It. A ,? "IffIr If L -2? . coef Btu coat atu H ira ion $(-) 10 G Infi Itrat Ion 7 / ass yU ) iii If U Glass 27 U S 1. S P. wall u .9 Exp. well 3 x yd d ii well v L U Net exp. well ?.? L . well Int. well iling / J Calling /S / Ac 5- --7 r W .,a •?- Floor --? tal Btu. O, Total Btu. .? 3 t- qulted sq. ft. E.D.R. or sq. Ins. W.A. Leader area Required sq. fl. E.D.R. or sq. Ins. W.A. Loader area Room Length )3 Width ( Height FI.((,(Tn('.?- Qt'/ Roan Length / Width 9 Haight Windows and Doors-Crackage and Area Windows and Doors- Crackage and Ar ea W,dm of ane eight of pane Ne. of h Ito Lineal It. of creek Oren o p, No. Wi dlh of ane I/nrpm of nno No. of h hu LTeal 11. of crock Aron e n• t. 3 U ?. / 2 / I d 11 coef a to - Cori Btu iltrittion f 1319 Infiltration 0 esa S S-U ASV Glass /. -? 3 ad p. wall t exp. well Z3 Z U') jf/ai Exp. wall Net exp. well 7.1- G L ?G L . wall Int. wall fling / I (f? Ceiling S)( l.?S 3 L/US wr Floor el Btu. Total Btu. 1 Tubed sq. fl. E.D.R. or sq. Ins. W.A. Louder area Required sq, ft. E.D.R. or sq. Ins. W.A. Loader area Room Length Width Height Fl. Roan l.ongth Width Haight Windows and Doors-Crackage and Area Wi ndows a nd Doors -Cracka ge and Ar ea ' I rtlrh o ane 11,.ght of Pane No. of liten Lineal 11. of cr ack Area s q. h. Wrtlrh 01 onne Ilmohl ul rnnn Nn. nl h hie L enl 11. of cra •k Awe • . ft. V Cool Btu Coef Btu iltretion ation ass Glass p, wall Exp. wall _ I exp. well Net exp. wall . wall Int. wall fling Calling « - - -Flour al Btu. Total atu. . 5mq RESIDENTIAL BUILDING Permit Application City Of Eagan 3830 Pilot Knob Road, Eagan Mn 55122 Telephone # 651-675-5675 FAX # 651-675-5694 (0 Iq. zs? U wu4,?lQ Sl z'? New Construction Requirements Remodel/Repair Requirements Office Use Onlv 3 registered site surveys showing sq. ft of lot, sq. ft. of house; and all roofed areas 2 copies of plan _ Can of Survey Recd (20% maximum lot coverage allowed) 1 set of Energy calculations for heated additions -Tree Pres Plan Recd 2 copies of plan showing beam & window saes; poured found design, etc. 1 site survey for additions & decks _ Tree Pres Not Redd 1 set of Energy Calculations Addition - indicate ff on-site septic system - On-site Septic System 3 copies of Tree Preservation Plan if lot platted after 711193 Rim Joist Detail Options selection sheet (bldgs with 3 or less units Date ?? l 1? l .03 Construction Cost '01000, Site Address 1S 7 f 44 -r7-,,: /Yl ?lf A r ? - Unit/Ste # N ?N ssia Description of Work l?k i d l? Multi-Family Bldg _ Y X N Fireplace(s) 0_ 1 - 2 Property Owner & VAIG? ERi7447 Telephone #((e?/) v/ 0r7Y Contractor 4 xp a l U 6 k A i le 7?- Address 15 -78' 9,,5 1, t l7 P f '15 ! /R r e City JC.st 9 ,I iv State /11n/ Zip 5-q I P l Telephone # (G 5l) ?1 `C S7,f COMPLETE THIS AREA ONLY IF Energy Code Category - Minnesota Rules 7670 Category 1 (J submission type) • Residential Ventilation Category 1 Worksheet Submitted . Energy Envelope Calculations Submitted Licensed Plumber Mechanical Contractor Sewer/Water Contractor TING A NEW BUILDING _ Minnesota Rules 7672 • New Energy Code Worksheet Submitted Telephone #( Telephone #( ) Tele hone #( I hereby apply for a Residential Building Permit and acknowledge that the mfiormati ' comple a and accurate; that the work will be in conformance with the ordinances and codes of tagan in the State of MN Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Af,V A1 Gxh f!/e Applicant's Printed Name Applicant's Signature OFFICE USE ONLY Sub Types ? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 03 01 of _ plex ? 09 07-plex 3K 17 Garage ? 22 Porch/Addn. (4-sea.) ? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous Work Types ? 31 New y- 32 Addition ? 33 Alteration ? 34 Replacement Valuation MT Census Code SAC Units Nbr. of Units Nbr. of Bldgs Type of Const - Footings (new bldg) _ Footings (deck) Footings (addition) Foundation _ Drain Tile Roof _ Ice & Water _ Final Framing Fireplace - R.I. - Air Test _ Final Insulation Width REQUIRED INSPECTIONS Final/C.O. Finat/No C.O. /_ Plumbing HVAC Other Pool _ Ftgs _ Air/Gas Tests _ Final Siding _ Stucco _ Stone Windows (new/replacement) Retaining Wall Approved By T 2 Building Inspector Base Fee Surcharge Plan Review MC/ES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search Copies Other Total ? 30 Accessory Bldg ? 31 Ext. Alt - Multi ? 33 Ext. Alt - SF ? 36 Multi Misc. '? 35 Int Improvement ? 36 Demolish (Interior) ? 44 Siding ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 37 Demolish (Bldg)' ? 43 Reroof ? 46 Windows/Doors *Demolition (Entire Bl dg) - Give PCA handout to applicant Occupancy MC/ES System Zoning City Water Stories Booster Pump Sq. Ft. PRV Length Fire Sprinklered Od-Ox 4 -z5?s?-90 I' ! I I I I -f 1 t i i ? i 1 ,I ? I I i, I 14 ` I ?- I ??- I. rI I r Y- 1 ! 1 1 1 1 -II - 1 i._I ax I I t I ._. i ( I L- ; i. I I 1 1 I- -I i I I I I !_I ? ' i_. 1 I I is ? I I. .. I I I I ' __' I I I i { {_'_rl I!I fl!Il _ `! ID tl1 I - i l l-I-i I I E?? II i II I tl ?- iiJ'11!?III t {!rIL. -1 X 1 1 1 1- I I I_ i_ i I I I i ?? I 1 .III' -??I{I I II' II I r I I { I I I I I I I i F 'II I 1 I 1 I_.I. :.L ïý ÷ ÿ þ ý ÿþþýüûúü úûü ùýýþþüó÷þ êþÿ çüà ÿþ üûúùø ö üúùø ôß õ ôßç ø ò øàü ö üö ì ìâüø ù Ýþ ñü òø ä ò ð ðò ñü ò û òèã þôôø þý ã ã òþ þ ø èö ã ã ø ã è ö ûòå ñü ûù ôþ ã òùðò è æ Üæëëèëèìë õù ü ð þ ê ü æ Üæèè ê ü ýè ôò ñð øø ç ô ö ù ò ôÚú öüùç ö éëçüà ç ä ïõ ÿ þ ïõ îíììééé ð ûù ô þ ð ð ä ð øø ð ð ã ò þ òøùôð øø û ãï ü öùãÿ þ â è øø ß ò þ ü ü ùþ ü Mar.21.2014 11:10 AM 7633156777 City of Eagan 3830 Pilot Knob Road Eagan MN 66122 Phone: (651) 676-6676 Fax: (661) 676-6684 7634281111 PAGE. 1/ 1 Use BLUE or BLACK Ink For Office Use Permit0: 1:)50 Permit Fee: Date Received: 3l Staff: 2014 RESIDENTIAL BUILDING PERMIT APPLICATION Date: S . t �� Site Address: u5i-1 C... i 11by- Unit it: J Resident/ Owner v Name: (4S1.1d b P1'� ` '7 ^,O%Q YAC Phone: ken , ansi . 4I v r I i Address / City / Zip: Applicant is: Ownery Contractor Type of Work Description of work: IJQ0 e.AA rr1��2hS �s1 �1 �11 C.jj\- t €b 400Q - , t, A Construction Cost: Q 4,iQOV Multi -Family Building: (Yes / No ) Contractor Company: 0k-1szv ‘e0.W\qSS t-' 1..1,be.Contact: kttY Address:, t lIG A Q,,gQ,I O 14‘51l City: 0 5� I State:yl_______Zip: 6 gs (oS Phone; 140' . 42-b . t 1 k1 License #: LSC. (0a 1 O 1 Lead Certificate #: N Al x-15 al's `' If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) In the last 12 months, Yes _No If COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING has the City of Eagan Issued a permit for a similar plan based on a master plan? yes, date and address of master plan: Licensed Plumber: Mechanical Contractor: Sewer 8 Water Contractor: Phone: Phone: Phone: NOTE; Plans and supporting documents that you submit are considered to be public Information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Cell at (801) 464.0002 for protection against underground utility damage. Call 48 hours before you Intend to dig to receive locates of underground utilities. www.000lSfr; ntfmne_rdl,gn„,t I hereby acknowledge that this Information I9 Complete and accurate; that the work will be In conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to 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. Exterior work authorized by a building permit Issued in accordance with the Minnesota State B4hding Code must be completed within 180 days of permit Issuance. Pe -4 1r e ani.txsA.0» x l' Applicant's Printed Name Applicant's Signature Page 1 of 3 vs2A0 PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA157013 Date Issued:07/30/2019 Permit Category:ePermit Site Address: 1578 Rustic Hills Dr Lot:11 Block: 0 Addition: Rustic Hills PID:10-65000-00-110 Use: Description: Sub Type:Residential Work Type:Replace Description:Standard Water Heater Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener). Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087 Surcharge-Fixed $1.00 9001.2195 $60.00 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Darin T Mcdonald 1578 Rustic Hills Dr Eagan MN 55123 Mr Rooter Plumbing Of The Twin Cities 5155 East River Road, Suite 418 Fridley MN 55421 (763) 551-0555 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA172183 Date Issued:09/17/2021 Permit Category:ePermit Site Address: 1578 Rustic Hills Dr Lot:11 Block: 0 Addition: Rustic Hills PID:10-65000-00-110 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. If water damage is encountered, please call (651) 675-5675 to schedule a site visit to verify the extent of the damage. Any repairs must be inspected prior to covering. The inspector will determine if an additional permit will be required to repair the water damage. 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 - Darin T Mcdonald 1578 Rustic Hills Dr Eagan MN 55121 Minnesota Restoration Contractors Inc 12252 Nicollet Ave Burnsville MN 55337 (952) 479-7131 Applicant/Permitee: Signature Issued By: Signature