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4853 Sheffield Cir CITY OF EAGAN WATER SERVICE PERMIT 3830 Pilat Knob Roed ~ O. Box 21199 PERAAIT NO.: ' Ea9an. MN 55121 DATE: . I Zon(np: ~ No. of Units: i Own~r; Tollefson Bl~rs , 1lddre~a: f~ S~ts llddre~s; --~~3 5lieizic i:l Rrittun~ 5 i PI~MTIblC ''lI"~;'~Vc3r1 ' ' NO.: ~ In ~ fQ! .J' i~l _:7 ) .7~=Q: ~ ~ ' ; I- 1 _ `1 r SIT ; f)Ci ' Raod~r No.: ~L~- i ~ M~ fe eo~~l~r oiN~ 1w ~'Su~~~ ~ ny~: . S J._x ~ M1st. CMrp~s: ; 3:' . OQ +~d B Total: r, + m ~ r r Y Dots Pnid: Oote of Insp.: ~ Irsp,: CITY OF EqGqN 3830 Pilot Knob Road SEIIVER SERVICE PEWy~R P. O. Box 21199 Eagan, MN 55121 ~MIT Np.: 7607 Zw~inp: v~ DATE; 7-? ~ Owner. No. of Unlts: 1 ~lddress: Site ,~m~: Flumber: ~ ~n ~-'t' ~ [ 5 - 6-28-85 531~y ~ 1 J0. Ot! ~ ~ ~ N~. !o ...qy wM qy .f 5.~.. I O.It..~o... C°""kt+a+ G+wp.: 4 Z S 04 nd f`°oounc Qeaos~r: S p Pr?mIt F~e; _ 1 ^vi a By s~md,o.0.: _ S ~ofe of Ir~sp,; Mi~c. ~rup.: T'ofal: Doh PWd: - CITY OF EAGAN WATER SERVICE PERMIT 3830 Pilot Knob Road P. O. Box 21199 PERMIT NO.: Eagsn, MN 55121 p^~: _ Zontnp: No. of Unics; ~?vrf~r: ' ' Address: s~ro ~ddn,,: ~~r - ~ Meter No.: Sise: Connection Chorps; Readx No.: '~0°"^t ~P'~t: Permit Fee: M~e~a ~ ~ ~ ~f l~N~ S~,r~hor~~. AAlsc. Chorqes; Totai: BY [late Poid: Dote of I nsp.: Irup.: ~ CITY OF EQGAN ~ ~ ~ ~ ' 3830 Pilot Knob Road, P.O. Box 21•199, Esgan, MN 55121 PHONE: 454-8100 - BUILDING ~ERMIT R~u+vr # T. w w.a fe. Est.va~ue f~~ Dar~ ;1r 19 ~ ? ~ , Erect Q Occupsncy Sita Address _ ` : Lot ~ Block Sec/Suh. ~11'. , Remodel ? Zoning i Repair ? Type ot Const. r Parcei No. Addition ? No. 5tories ~'r', _ Mb~e ? Length -t c~ W Address • L' '`?U:y~ ;j.~ J' ~ Demoliah ? Depth 3~ ~ _ Int Impr. ? Sq. Ft. City ~"1~'~' Phone ~ . ` Install ? , Aoo.o•als F.u S` Name - o~ A~~ Asseument Permit ` U u~ City Phone Water b Sew. Surcharge r ~ Poliq Plen Review ~ " i ~ t~ Neme Fin SAC Address Enp. WeterConn. v' ~ W City Phone Plonn~r Water Meter Council Road Unit _.s_ ' I hercby ocknowl~dpe that I how rood this opplicafion ond stote that Bldg. Off. 1 3'~' Tc PI. ~ tFw information is co?rect and ogree to comply with all opplicobls APC Parks Stots of Minnesoto Stotutes Qnd City of Eoqan Ordironces. Var. Oate ~p~~ 5ipnoturo of Permittee ~ > . . N Bulld~nq Pennit Is Isswd to: T~ ; t:,~`~ c on tM axpro~ condition ~ho~ all work shall b~ done in otcordonCe with oU opF,liooW Sro~a oi Mjnne~oro S~mures ond Ciry oi Eoqan Ordtnances. Buildirq Offkiol P~rmit No. P~nnk Ho1dK D~q T~lephon~ # Plumbiny d G R,~ ~ ~ ~ H.VA.C. ~j--~,~ I ~ 7.23 V ENctrle ~ ~ I , ~ Soit~r In~ction DsN Insp. Oth~r Footinys I ~ Footinys II Foundation b~ $s J ~ ~ W~~ Framing Roofing Rou9h Plb~. Rough Htg. Insul. Finpl~c~ Final Hty. ~ Final Plbp. . ~ Final ~a c.rvo~~. ~j q waeer ~•~c.ib. Locscio~: Well Ssw~r Pr. Disp. Receipt i PLUMBING PERMIT • Permit No. ~ CITY OF EAGAN ' ~ , Fee ` r I!"'. ~ Fill in numbered spaces S/C _~ype or Prini legibly Tot. ~ i i' . / ~ . 1. Date ' ;~s_ - __2. Installat~n Csost c/%,/4'~fL_ ,/,:,j,~ _ " ~ • . . ~nr 3. Job Address Lot Blk. Tract 4. Owner ' - ~ ~ . , 5. Contractor - ~ ' " ' ' " Phone ' 6. Address ~ ~ ' ~ ~ ' 7. City ' ' State ' ! ' - Zip 8. Building Type: Residential 0 Commercial ? Institutional ? 9. Work Description: New ~ Add O Alter ? Repair ? 10, Describe ~ 11. No. Fixtures No. Fixtures Water Closet Cesspool/Drainfield Bath tubs Septic Tank Lavatory Softner • Shower Well ~ Kitchen Sink Urinal/Bidet Other % Laundry Tray , Floor Drains Drinking Ftn. Slop Sink Gas Piping Outlets 12. I hereby certify that the above information is true and correct, and I agree to comply with all ordinances and codes governing this type of work. Signed : ' for ~ Rough F inal Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. Approved CITY OF EAGAN 454-8100 Reosipt " MECHANICAL PERMIT Permit Nu. " CITY OF EAGAN • Fee, ' fill rn numbered svaces 3/C ~ ~ i Type or Prin~ legibJY ToL , . 1. Date - 2. Installation Cost ' `"c' Cf , ~i , 3. Job Address Lot Blk. Tract , 4. Owner ' 5. Contractor ~ Phone ' - ~ : 6. Address ~ ~ ' . ~ - , 7. City~ : SUte ~ 2ip . 8. Building Type: Residential ? Commercial ? Institutional ? 9. Work Description: New Add ? Alte~ ~ Repair ? 10. Describe Fuel Type , 11. No• Equi~IIJBIIL 8TU - M. Ea. No. Eauiament CFM ~ Forced Air Air Handlin9: ' Mfg. ~ BO11e~ Mech. Exhaust Mfy. Unit Heater Mfg. Other Air Cond. Mfy. Gas. Piping Outlets ~ 12. I hereby certify that the above information is true and correct, and I ayree to comply with all ordinanoes and codes governing this type of work. ~ S~g^°d : for Aouyh Finsl Inspectiona: Date Insp. Date Inap. This is your permit when numbered and approved. Approved CITY OF EAGAN 464-8100 INSPECTIUN RECORD I Control No. ~f 9 CITY OF EAGAN PERMIT TYPE: a~~ 3830 Pilot Knob Road Permit Number: ~~~~g~ Eagan, Minnesota 55123 Date Issued: e~ I~ g/`~'~ (612) 681-4675 SITE ADDRESS: t~ r 1 r st ~c 4 APPLICANT: ~853 SHfFFIlLt1 C?R M~I.ROE aRAD BRI~TA.NY bTH J : ~-t~• (612) ~81 •-1~73 PERII~~~.~~~~(PrE~:~ 1 t M TYPE OF WORK: Al'i~ltAT YUN , . . . FRAMIN~~ IMSUt.ATIUN hlNAl qFNARY9e R~~1".[Fft ~ R ' _ , ~ _ : ' ~"{Yk ~,~c: _ .t_-. . _ - . P~rmR No. Permft F}older Dete TeispAon~ ~ S/W PLUMBING q tiVAC ELECTRI ~ ~(y g ~ ~j ELECTRIC In6pscHo~ Date In~p. Commants Footingsl Foundalion - Framing d c r ao~'~' - c~1 Rough Htg. tsut. f.~ C~ Cs~/10 - ~G ~ F`eple'°a - /0 0 f~ " Rnal Htg- Orsal Tesi Rrtal PIb9. Ptb9. inspeceor- Notl(Y Plumber Co~t. Meter EngrJPisn I ~ ~ ~ Dedc Ftg. I ~ Dedc Fi~al I Well I I Pr. Disp. I ~ ~ r OF EAGAN Remarks-~L f•' ~ Addition BRITTANY 5TH ADDN ~ot- sik 1 Parcel IO-150o4-070-O1 Owner Street ~853 B~FP'IELD CIRCI.$ State ~ 55Z22 Improvement Date Amount Annual Years ~ Payment Receipt Date STREET SURF. STREET RESTOR. GRADING SAN SEW TRUNK D/lp %0 11~~,5 1F SEWER LATERAL 1 2 Q.'l 3 Q.],5 5 3 D. /,S~ ~O /O .23 ~j WATERMAIN M WATER LATERAI 1 Q ~j WATER AREA 19 305• 5 1.13 5 •/3 0/G _ /o s~ ~ STORM SEW TRK 1982 6 6• 9 129.3 5 . ~9o/G /o/~ * S70RM SEW LAT " ' 19 5 CURB & GUTTER • SIDEWALK STREET LIGHT R~oad IInit $280.00 53189 6/28 85 WATER CONN. SOO.OO 6UILDING PER. 10482 SAC PARK This request void ~ ~~Q.~ ~ / ~r~ 8 rtwnths (mm J(~ Q V ~ 056 ~Z L1 $1 ~t'i Re~u t'Date Fire No. Rough-in Inspection ' r Peq ired? ~Ready Now ~.I~Jill Nolifv.InsPec- ~ , ~ ~ Ves ?NO lor When Heady '4icansed ElecVical Conhactor 1 hareby reqaest inspaction of above ? Owne~~ electrical work ins~alled et: Sveet Address, 0on or R o. ' Ciry s"3 ~ C-~' ~tJ ec m~ o. Township Name or No. Range No. County ~ Occu ' IPqINTI ~ Ph~~~ ~ Po ¢r Supplier Address ~ oo~~ttrraacc Ele i~sl Contrar.tor ICOmpa~~> ~ ' ~ ~~~~~^~J 1 Mailin AdJress ICOnVac r or Owner Makin Instaila - r S,- Gr~"`-'~~ S~" 3~~ Auth WFe (Conha t wner Makin tallalionl Ph e Number ~ ~6°63~ MINNESOTA SiATE BOAPO OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT Griggs-Midway Bidg. - Noom N•191 BE ACCEPTE~ BY THE STqTE BOARD VNLESS PROPER INSPECTION FEE IS 182t llniversity Ave., SL Paul, MN 55104 . Phone (612~ 29]-2171 ENCLOSED. 5~~~~^~ REQUEST FOR ELECTRICAL INSPECTION es-ocoovoa -IV v Sea instruetions tor comOle~ing this lorm on beek ot yellow coOV~ ~ ~ ~I151&5 p i ""X"" Selow~vered by Thrs Request Adtl Rep. Type ol Builtline APO~iancea Wbed Equipment Wired Home Range Temporary Service ~uplex Water Heater Lightiny Fixtures - Apt. Buildinc~ ~ryer Electric Heatin Commercial Bidg. Fumace Silo Unloader Industrial Bldg. Air Conditioner Bulk Milk Tdnk Faim oiner oeci v O~nerlsn~r.itvl t er Veci y t er Other- - ompute Inspection Fee Below # Fee ServiceEntrenoaSi¢a # . Fae Faedars~3abfaeders~ # Fee Circ~its ~ U to 200 Am s- 0 to 30 Am s 3 3~ 0 to 30 qm s Above 200 -qmpsi 31 to 100 qmps S- 31 to 100 q Swinvning Pool Above 100_Amps ~ Above 700_AmPs Transtormers Irrigation 8oorns 5G Partial%Other Fee Signs Specia~ Inspection - TOTAL FEE '''9 Nerrarks / y { ,i~_ 1/ Rough-in Date the Electrical • ~ +'~~FJ Insoectoq hgreey cartify that ffie above Final ( O:~te ' soection has bean p-~~ ~aa. ThiarequestvoiA/Bmontl~sfrom ~ ~ ~~796 , ~~9~~ ReQUest Dale Fire No. R h~in Inspec~ion q ~~~,yp ? Reetly Now ill Notity Inspector ~ j ~ [ Z Yes ? No hen Reatly? I p licensed contractor ? owner hereby request inspection ot above electrical work aC Jo0 Atltlress (SVeet. 6ox o/ROUte No.~ Cily ~"~$b.~ Shr~,~lte,l~ C\w1e ~,~/v Saction No. • Townsbip Name or No.~ Range No- Coun~y D~.~~t~ Occupant(PRIr ) n ~ n ~4 ~ P~one No. ~ ~ ^ ~ L~ v ~ \9 R ~ ~ Power SuOD~~er AOaress Q c•llcv Ft,` FICc-Fr~c, Elecvical Comractor (GOmpanny Name) Cqntraciw5 License No. 0 W~~ 1~ Mailing Atldress IConpaclor or Owner Making Insidlla~ion) Au~ e 5~9 ure I nV cror;Own r n Ins il lonl Pbane Number I J ~~L~1~~~ MINNESOTA STATE BOARO OF ELECTRICITY ' THIS INSPECTION flEOUEST WILL NOT Griggs-Mitlway BIOg. - Hoom St]3 BE ACGEPTED BV THE STATE BOARO tBft Universlly Ave., St. Paul. MN 5510< UNLESS PROPER INSPECTION FEE IS Phone(612~6C2-0800 ENCLOSED. I4 a 9 s~ REDUEST FOR ELECTRICAL INSPECTION EB~D0001-DB J 4 2 7 9~ • See inslmclions br campie0ng this lorm on back ai yelbw mpy si e~/ 94 ~a( "X" Below WorKCovered by This Request ew A~tl ReO~ ' TyPeofBuilding AppliancesWired EquipmeniWiretl Home Range Temporary Service Duplez Water Heater Electric Heating ApL Building Dryer Other (Specify) CommJlndustrial Furnace Farm Air Contlitioner • Other~syecily~ Convactor's Remarks: Compute lnspection Fee Below.' tl • O~her Fee # ServiceEnlrenceSize Fee # Circuits/Feetlers Fee Swimming Pool 0 to 200 Amps 0 to 700 Amps Transtormers Above 200 _ Amps Above 100 _ Amps Signs Inspecwr's Use Only: TpTAL ~ Irrigation Booms ~ f~ O ~ ~ Special Inspection Alarm/COmmunication THI5 INSTALLATION MAY BE ORDEflED DISCONNECTED IF NOT ~ Other Fee COMPLETED WITHIN 18 MONTHS. I, ihe Electrical Inspector, hereby Roug~-in ~ oa~e certify that the above inspection has F;nai been made. / ~ OFFICE lISE ~NLY ^ ~ T~is reques~ vaitl 18 months Irom ~f SaM_ p--~ h- V•~w~~ ~ ~ ~ • CASH RECEIPT . CITY OF EAGAN P. 0. BOX 21-199 E AN, MIN ESOTA 55121 ~3 DATE 19 RtC6NN PR - / AMOUNT ~ $ J j ~ ` ?J iV~ / & DOLLARS ~ .oe ~ CASH ~ GHECK Y/f9X~O RO _ ~ ~'tlN COOE AM U v ~ ~ ~ ~ _ ~4~~ , 6. ~f ~ S~- ~ 3,~ ~ Thank You~~'j l ~ ~ BY _ ~J N_ 53819 . White-Peyera CApy Vetlow-Posting Copy Pink-File Copy ~ ' CITY OF EAGAN N°_ 'I O 4 8 2 3830 Pilot K~rob Road, P.O. Box 21-199, Eagan, MN 55121 PHONE: 4548100 ~ ~ ~ G BUILDING PERMIT Reteipt ij _ To M ard iw SF DWG/GAR ya~~~ $63, 000 pa~e JUNE 28 ~q85 SiteAddresf 4853 SHEFFIELD CIR Erect C~ OccuPency R3 lot~-elock 1 ~edSub. BRITTANY STH Remadel ? Zoning Rl Repeir ? Type W Const. V Pereal No. AddRion ? No. Storiez TOLLEFSON BLDRS Move ~ Lengtn 48 W Nar^e Demolish ? Dapth 3 5 z 1655 NORWOOD DR Address Int Impr. ? Sq. Ft. ~ c~tv EAGAN Pho„e 454-6873 i„sten ? tg Name $AME AVOrwab f~a~ at A~~ Assessment Permit - ~ ~ V~ City Phone Water 8 Sew. Surcharge 31. 50 Poliu PlanReview ~W N~ne Fira SnC 525_00 i~ Addreae Erq. WaterConn. S~~ ~0 ~ W City Phone Plonner Weter Meter F~ ~ 0 CounNl RoadUnit 28~•~~ I Mrcby ockrawledge tFwt I hove road this applicetion ond smre that g~d9, pff, ( 13 8 Tr. PI. 132 . UO tM inlormafion Is conect ond agree fo wmply with oll epplicobla $tata of Minnesota Stotutearad City•of Eafla Or inonms. ~eCD~e Parks r v . CoPies $ipnMUro of PermifPoa ' Total TOLL'~~ N BLD A Bullding Permif is fu . on fhe axprca condiflon ~hoi ull work shall hs done in accordance wit a p i obla St of Min S~ t }g Liq of Eepan Ordfnoncat Buildirq OHitiol ~ ~h J ? ~~lo- , , - l ~ 1 • 2007 RESIDENTIAL BUILDING PERMIT APPLICATION City OfEagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 New ConsWctron Reauirements RemodeVRmair Reouirements Olfice Use OnN 3 registaeA ste surveys showing sq. ft. M bt, sq. ft M howe; and all roofed areas . 2 copies o( plan shaving faotings, beams, joists CeR of Survey:Recd _ Y-_ N (20%ma~cimumlotcoverageallawed) ~ lsetafEneryyCalculationsforheatedaddi6ons ShcsRepat ~ _Y N 1 Sails Reporl'rf propased building's W be pkced on disN~bed soil i sife survey for additions 8 decks Tree Pres PWn Recd~ _ Y N, 2 apies d plan shaving beam & wiMow sizes; poured found design, etc. Addi6on-indicate Non~sife sepNC system Tree Pres Required. _ Y N 1 set of Ene~gy Cakulations OMSde Sep6c System _ Y_ N 3 copies M Trae Preservatim Plan'rf lot platted aRer 7N183 . Rim Joist Oetail Opfions selectlon shaet (6uildings w'rfh 3 or less unfls) ASnnegasco mechanical ventilation form Plans are considered ublic information unless ou state the are trade s~"r~d"the re~tfn~ • Da[e ~O / 1`'~ / C~~l Construction Cost ~`''~S OGu Site Address ~ ~S~ °J~r,r ~ ~ . e \ a ~ ~ ~ ~G~'~'~ UuiUSte # `Mn1 Description of Work ~v ~c~r o~~ .rr ~ ~~w. ~ r o,y ~zh ~ Multl-FamilyBldg _ Y ~N Fireplace(s) 0~ 1 _ 2 Property Owoer ol ~ ~~1r. ~c• r ~ Y`/~e ~ r c~~e Tetephone # ( (N~j\ ) ~ ~ \ "~13 COntractor ~.X w-c `~-u'w.r ~ Address \ V~~`1 ~ ~e t~ U r.,~ C~ \c.c r City ~ c:~-dh~ y State Y~'\ ti Zip ta Telephone #((a~~ a~lY S S COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minnesota Rules 7670 Cateeorv 1 _ Minnesota Rules 7672 Enefgy Code Cdlegory . Residenlial Ventilation Category 7 Worksheet • New Energy Cotle Worksheet (Jsubmissionrype) Submitted Submitted • Energy Envelope Calculations Submitted . , , In The lasT 12 mon}hs, has ihe 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 Telephone J Mechanical Contractor ' Telephone J Sewer/WaterContractor . Telephone#~ ) I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work approval of plans. ~t~~.~:~ \ ~~a ~ ~ T 1` Applicant's Printed Name Applicant's ignature y ~ , _ , _ DO NOT WRITE BELOW THIS LINE ~ Sub Tvpes ? ~1 Foundation ? 07 OS-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bidg ? 02 SF Dwelling ? OS O6-plex ? 16 Fireplace ? 27 Poroh (3-sea.) ? 31 6ct. Alt - Multi ~ ? 03 01of_plex ? 09 07-plex ? 17 Garage ~ 22 Porch/Addn.(4-sea.) ? 33 6ct.Alt-SF ? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screenlgaiebo/pergola) ? 36 Multi Misc. ? OS 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage ? O6 04-plex ? 12 12-plex ? 25 Miscellaneous Work T es 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding ? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair - ? 33 Altera5on ? 37 Demolish Building* ? 43 Reroof ? 46 Windowsl~oors ? 34 Replacement 'Demolitlon (Entire Bldg) - Glve PCA handout ta applicant . D@SCNpt(Ofl: Water Damage _ Yes Valuation OO~,oa Occupancy cl.(~C ~ MCES System Plan Review 100% or 25% Census Code 4_ Zoning City Water SAC Units Stories Booster Pump # of Units Sq. Ft. PRV # of Bldgs Length Fire Sprinklered Type of Const Width REQUIRED INSPECTIONS _ Footings (new bldg) _ Sheetrock _ FooUngs (deck) ~ FinaVCO. _ Footings (addition) 6~ FinaUNo C.O. _ Foundation s, HVAC Drain Tile O[her Roof _ Ice & Water _ Final _ Pool Ftgs _ AidGas Tesks Final 'A Framing ' _ Siding _ Stucco Lath _ Stone Lath _Brick Y Fireplace 1° R.L ~ Air Test ~GFinal _ Windows ~ Insulation _ Retaining Wall Approved By: Building Inspector - Base Fee ~ 7 Surcharge ~ z ?~~O • y 7 ~ = 7 U (~3,5 .,~Z ! Plan Review f ~~fo MC/ES SAC . 1 eOp, p ~ CitySAC 'REN1°D~°-~ 1^IC~7ii1.~ k~IC~M1G.V~ / Utility Connection Charge S&W Permit & Surcharge Treatrner~hPlant - . License Searcfi~" ' ~'opies";: 8 , , ~ 'Other ~7otal . : . - Date: 10/23/2007 Revision Date: 10/23/2007 Existing Construction: Pre 1994. Site Information Address 1: 4853 SHEFFIELD CIRCIE Project Address 2: Lot: Block: City: EAGAN County: Subdivision: Application Information Business Name: RETRO HEATING MN Contractor License Contact Person: MARK DAVIS flffiae Ph: 952-2H2-2567 Fax: 952-652-2007 Ceil Ph: 952-292 25E7 Address 1: 2616 86th CT W. City: IdORTHFIELfl State: MN Zip Code: 55057 Minimum Mechanical Code Requirements Met Will yau be replacing or adding a water heater, fumace, or boilerJ NO Will you be installing a decorative soiid-fuel appliance? NO Will you be ir~.stalRng an e~chaust fan 300 CFM or greate~' NO You hare mei the minimum requirements for make-up air and combustion air as required by the internationai mechanical code, as adopted by the state of Minnesota with amendments. j/ AppiicaM Name (printy: ~G ~wG) ~ ~ n~-~ ~ S~naturetDatie: ~ ~ ~~~~~1 ~ti~v~~ Code Official (pri~rt): S~natute/Dabe: ~ 20(W CenterPoiot F,nerw Minnensccn 2004 Mech»nical Code C:nide.linec. Paee I ~ l ~ ~ ~ Et.ERGY CE1(SCRYA'liON EVALUaTIOrt ~ ~ - z;« ~dd~~~~ ~ _ 3 - IC~ ~ O~ncr~ M(~,~ ConirECtor . L21CU1xiian5 Oonc nr~ G~ o ' ~ - ncn~ ~ 3z.r ~0 Qis47 . , ~YOe o; bui i; ino ~ ~~~f~ . ~ ~ ~ ~ /+ssembl : (Sho~. calculzGans an • rez fR) . rorksneeu (S~U I U-Vxlue I U x a ~ ~ . ( 0,. oi Totzl Ceiiing ~ea, eis :ylignl ~osutxced Area:~ Arez, See Fio_ ~ _ ~Ji~~ ..019 I. gj~~ ~ Framin Area:40'/, o( Tofal Ceitin Arez, See Fi . 2) ,1j I . . 0 2 2 ,.~j+~j °o $k IiohlS: (From Pa e .11.1s I .,~-,t...'~ I 2.~7 ` V % ! _ Other.(Describel~ . - ~ I I ' ci 1 Towis ' O, r ~k '1,.,~~ 1 1 i • • . . . I ~ 2' AveraqC U-Val've, WxAI/(A) (rom Line 1 ' ' ' " , p] 9 ~ ~ - ' . ,.~;-,t;r . ~ ~ O ; ' ~ 3 Required U-Vzlue (f.or:one and tvo fac~ily itwelltngs onl'y) ~ ' ~ ' . ' ~ f 0'!- o( ToUI Wall Arca, Less Window and ~ ' lnsula[ed Mea: Ooar Area, $ee Fi . 31 ~ ' ~ '~j,0 ,046 ~j?j~~ Framin A~ea (10% ot Total Wall Arca, Sce Fi _ 41 ~J _ l~g ' S~ 1 Jindows: (From Pa e 7) I~1.~1 • Z .,-~:r.r:x. - iLqr %a ~[L ~ Doars (From. Pa e 7) , . , ~ ~ ~ _ im .loist Arca:(Scc Fi _'.57 ~ . ' - . OtI4 - I I ~ Fired(ace Wall: . ~ ' . • r . z • ° ~oundation YJa11-(A66ve Grade l.ess Windav qrea 'See Fi , 61 ~ .0~$ -~-~5~ • ~ ~ ' ' " , ' aundatio~ W indows_ (From Pa e 7) .-~~_~.-..T ~ ~ ' ~ ther.(Descri6el. . ther:fDescribd • ~ ~ 4 Totals . . ` .5 . ~ s~-.r 5 Avgre'e U-Value. (UxA3/(q) fruin (.ine:4 . ~ x~r.r.ew ' ~ - 6- Required U-Vatue (Far"one=.nnd.t~ro family dwellings only) ****<k ~.11 x*++~* ' If line P is less than liae 3, and line S is less than line 6, p poseQ assem6lies meet code requirements. If 7ine 2 is~greater than line 3, or l~ne 5 great r than line 6. corsmlete che folio~inq to determine altemaca U-Yalue far total exterior Enve ope. . ~ ~ - 0 ~ 7~ UxA (Line 1) + UxA (Line S), % -t 1~I _ ~ ~r.a 80r~f`1'! ' o $ Rrea SLine 11 x U-Value (Line 3) x r0~J7 _ , ~ry '~*~{t ~ W Area (Line 4) x U-Valoe (Line b1 ~ x~ ~ ~ _ **=r.y.* O• ' 9 ~ o "Bud e[", (.ine 8 t line 9 ~ ' . ' ***,~.k 87~ g?j• F- If Line 7 is greater [han Line 10, alYer assem6(ies as required so ine 7~s no[ erceed-Line 14_ ~ If Line 7 is less ihan Line 10, proposeE assemblies meet code quirements. ' _ . :1 • ~ ~ ~ . FiQUre 1 Ceiling/Roof Tnsulated Area: ~"l v Sq. Ft_ ~ ~ - (with attic area) ' R-Value Interior Air Film .61 Insulatlon ~o, oo f- Conti.nuous Vapor Barrier O.DO Interi.or Finish , 5~ ! ~ . Interzor, Air Film :bl ~ ToCal Assembly R-Va1.ue : S,/..7$ , , . Assemblq II-Value (1/R) .O/9 . Enter on Page 1 ' • " Figure 2 Ceiling/Roof Fzaming Area- SQ. F[_ (with attic area) • ' ' R-Value . • ~ . Inter3or Air Film • .(7, - Insulation 3 y_oo ~TOOd Member t~, 3g _ Continuous Papor Barrier 0_00 Interior Finish ,~6 " inter3~or Air Film _ _(I Total Assembly R-Yalue ~~~.i/(o ~ . Assemblp U-Value (1/R) ,0 22 • Enter on Page 1 For additional roof assemblies, see pages 3 and 8_ . ~ . . . l r` EiRure lA Insulated Area: ` ~ Sq. g_ . K • ~ R-Value . ~ Air Space ~ Inter~or Air Film .61 ~ Insulation t~ Continuous Vapor HaLri.er 0_00 ~ Air Film ~ Total Assembly R-Value • ~ Assembly U-Va1ue (1/R) ~ ' Entez on Page 1 ~ . ' . Figure 2A Ceiling/Roo£ Framing'Area:,, ~ Sq. P. , .(crithout attic. area) ' _ , R-Value Exteriot Air Film .17 . Roofing Roof Sheathing ; • ~ F~ood' Member - - Continuocu Vapor Barrier 0_00 Interior Einish ' • : Interiar Air Eilm .fil Tota1 Assembly R-Value = ?ssembly U-Value (1/R) • Enter on Yage I . ' - , For additianal_roof assemblies, see pages 2 and 8. • 3 . . ~ • 'Figure 3 Exposed Wall Insulated Area: ~ Sq. Ft_ ~ R-Value Interior A~r Film .bg Interior Finish s Continuous Vapor Barrier ~ 0_00 " Insulation ~q,oo ~ Sheathing ~z EXterior Finish p ,¢7 j ~ Exterior Air Film ~ .17 ' Total Assembly R-Value ZI. 3~ ~ Assembly U-Value (1/R) ,pq~ Enter on Page 1 Figure 4 Exoosed Wa11 Framing Area:, l(/~~ Sq. Ft. ' R-VaJ.ue ~ Interior Air Film .68 ~ Interiar Finish ,4 S ~ l Cantinuous Vapor Sarrier 0.00 fl` , Wood Member ~ (0.88 ~ \ }~1 ~ - Sheathing ; b Z • ~ Exterior Einish •~}7 ~ ` Exterior Air Film .17 Total Assemb7.y R-Value 2~ " , Assembly U-Value (1/R) , /OS _ Enger on Page 1 For additional wall assemblies, see page 8, . . Fi~ure S £xposed 4Ia11 Rim 7oisc Area: ~ Sq_ Ft_ - 2-Value Interior Air Film _bg Vapot Barrier 0.00 - Insulation ~y,oo l~~ Uood Member /.BFj I!'~~ - Sheathing ~~y , Exreriar fi.nish ~ _ ¢r/ ~ ~ ~ , ~ ~ Exterior Air Film ,I7 ~ ' ' Total Assembly R-Value 22~82. " ftssembly U-Value (1/R) , pa~ Enter on Page i tSOtes: 1) Floors over unheated spaces_ For floors o£ hea~ed oz'mechanically cooled spaces over anheated spaces, the ove all II-Value ~ for the floor shall not exceed O_OS_ For f oors over outdoor ` air, such•as overhangs, the overall II-Value for the floor sha114meet the same recn,;rement as far roof , II-Value af ~ 0.04_- 2) Slab-on-grade floors. For slabron-grade, e insvlation ~ around the perimeter of the exposed floor s a1Z have.a mi.nimvm R-Value a£ 6.4_ The i.asulation mu ~ extend downward ~ from the'top of the slab a minimum of 3'6' ~r d'own~crard ~ ' to the bottom of the~slab thea horizbntall ~beneath the ~ slab for an em,;valeut distance_ ~ ~ ~ 37 Vapor barriers. The m~r;mum perm rating f r the vapor ba=rier is 0_1_ A mini.mum of 4 sail polye eline, os equal, is required to achieve this_ The vapor b ier must be . ~ . ~ ~ conti.nuous cri.th all joints overlapped and de over framing ~ . members or blocking_ . 41 For notes on foundation wall see paqe 6_ 5) For additional assemblies not illustrated se worksheet ~ ~ oa page 8_ ~ • ~ ~ Fiqure 6 • . ~Ip~ L Concrete Block or Poured wood Fbun$araon Insulated Concrete Foundation Area= ~ Sa_ Ft_ Area= i Sq. Ft_ R-Va1 e Interior Air Film - . 8 u r Concinuous Vapor Bairier 0. 0 ~ ~ Foundation Wall I Tnsula[i,on D o ~ ~~I~~ ~`3 ~ . Exteri.or Air Film _ _ 17 II~ ~ : ' ~Total; AssembJ.y R-Value ~ 7~ ' ' Assembly U-Value (1/R) .d $ ~~C Enter on,Page 1 - ~ ~u ~ Noccs_ 1) OalY.th< ahave grade ir<a oE chc foundacian ~all is , . , co 6c included ia che crtergy calcul~cions_ 1~~; : 2) ih< Enerpy Code reQuirez chac, i£ Lhc floar sbare chc - 6asemcat'ar cravl spaCe is Roc i¢sulated~ [ e founda- cian vall musc hc iasuliced_ Either chc--Ea dacion 0 ~ Q ~ 'nusc have a ainiaun 0.-10 insulacian'applied iton che C~ . cap af che Eouadicion co che frost line ar nininun O~ . 0.-5 'insul.acioa applicd orer [he <ncire Eou cioa ' wall. 'Che R-Valuc~specified is fat the i la[ion OL' ' aiL<rlil OIIly. ~ _ 3) IE ridgid #oam iasulacion is ca be applied ca che p~0 o p~p o~y~ • <xierior of th< Eouadstioa will, chc ahare gride v O ~ }y,~pCr ~ portian ausc he pzoc«ced Eroa she sun, ch veacher O ry~ O ~~~0~~ ' ind physicil a6usc. ' ~ O o~~~0000 ~ ~ 4j f£ ridyid faam iasulz[ian is co 6e aoplicd co che ~iO~~j~~0~~L,~ i¢terior, it ausc be pratccced by einimue /2^ g;-p_ :1900 ~VC ~ri . , boxrd ar eQual (as specified ia seccian L: 2 af Lhe . . U¢ifatm .9uildiag Cade). 5) Fouadacien wall insulation far vood foundx ions musc . b< insialled ss speci£ied 6y Lhc Nacianal arest ' . _ Praduccs. Associatioa's Ocsign 7(aaua;. . ~ Fiood Foundac~on Framed . ~ Area: Sq_ F[_ . . . . R-V lue ' Interiar Air Film _68 - Conti~uous Vapor Barri.er .00 Foundation wall (Plyvood) p t7aod Hemher ~ 1`\`\ y\ = Exterior Air Film .17 ~ . Total Assembly R-l'alue ~ Assembly U-Valve (1/R) . SKYLIGNT, WIND~W ANO DOOR ASScM8UE5 ~ ~ J I U-Va ue Skvlianc I ttznufac;u~el ManuFecture No. Na. Used i Tatal SasS Areafp) -Value U-1/R U x A I 1 I 2 I rr,c~ ( I I, I ~ I Tocals Erdcr Ptae 1 XXXXXXI )Up(~(XXXX)0( xXxXXXX X XX I XXXXX Windars Manufaccure Manufacturc No_ No. Used 7oczl Sazh Area (A1 R Vafue U=1/Re I U x A QtJOt.~:~1 ' 25 ~ I I~ 2 , 3Z i 3. I ~ g. ~ ZZ I 2 I e yz ~ ~;v ~.?3 : ~X~Sf.5~3° ~ !5 ~ I ~2,Z ~ ~ . 2.~,3 cta s Erttc Paac Z wn Giort - a ue Wafl Window Manutactvrc ManuFacture Na_ Na. Used Tatal Sash Acea (A) R Value U=1/R U x A I o[a s c a9~ I ' . ~ -Va ue a ue - R-Valtse 5 ~anr Oaar lf-Value ~oars ManuEac[urc Size Na, llsed 7'oml Ooar Area (A1 Oaa~ IF USeA Assanbl U=1/R UzA I I . 1 ~ ~ ~ I . ! ~ ~ ~ ~ 1 I i r i _ ~ i I ~ i ~ aa s~p aae XXXXX I XX X I I I ~ 1 XXX ~ %X X I ]UCXX 7 : ~ _ . . . . ~ : ~ - . . - - - . . . ~ - • -v~ • ~ incw.s .Aanufac~urc ' ManufaGUre Na_ No. Used 7ota1 Sash Arca (A) R aluc U=1/R U x A I I I ` I I I ~ I I I I ' ~ ~ I I I - I ~ I 'I I ~ ~ I I . I I I ' I . . . I ~l I 1 I I I ~ ~ ~ I I. I I I ~I I ~ ~ ~ I ~ I , ; I ; . I; ' - I ~ I - I I I ~ I ~ I ~ I i I I :I I I I ~ ~ I I . ~ . _ ~ ~ . - ~ . ~ ~ ~ . . . . . l ~ I .I - ~ ~ ~ ~ ~ ~ . ~ . - ~ : ~ , : I I I ~ . I I I l . I ~ ~ I . I - I ~ _ = I 1 I ~ ocals E~rtc Paac 1 - - - ~n uuilaers inc. - • 1N8-3 . _ . . . ~ JACKSON - SURVEYORS • ~ - SC818: L~~ 3O~ R601~T[R!O UND[N LAW~ OP ~T117[ 0/ MiNN[lOTA • Deno[ea Iron = Drainage ~?d,0_ EX19tLIlg ELBV. 3876EAST55thSTREET,MINNEAPOLIS,MN65417 727•3484 . . _ _ ,Drainage 6 Utility Eaeement ~urbeyot'~ Stctitiustt / Propased Garage Floor E lev. / a 3, o o`o Z/;.f7~E s~ ~,i ~ 76~ ` I~ I ~ ~ ~ ~ c r Z, ~ ~ , `n .E--~ ,u ~ ~ ~ i' ~ . l ~ _ ~ 3s~ I I ~ , / - ` " . ~ ~ N C9\~ ~ \ i3~ ~ ~ ~ ~ ~N \~N~ \c9_ o ~ %z ~9 t . - ~ \ , { ~ I r~~~`~o'~v i Z' ) o ~ ,i J I , ~ ~-/~~o, " z ~ ~ / ` ' Ni f' ` '30' - .3.r ~ /y- ~ _ ~ , I I --i2 ~a•ie,, ~ -r~, y y~, , `.E _ 1 HERCBY C[RTIRY TXAT TNt ABOY[ 1~ A TRU[ AND EORRlR ruT OF A OURVtY Or ' . lCG'V`L'A4"SOCJ ~~MO~@f~~~ v:. ~Lr~ Lot 7,Block 1,Brittany Seh. AddL~ioa, la l 7 ' Dakota County,riinnesot ° 2 a r~Q9f6~LD8R1~ BR~SPLCYIOWS ~3l9~~7~{~q 4th. ~ June 1985 Af fURVLY[O sr M[ THI• DAY OF A.D. - $16N[ ~ F. C. JA KSON. M~NH[wi~ a r~wT~w+. No. 3600 RESIDENTIAL 5`"~ a'~ BUILDING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD, EACAN MN 55122 / 651•681-4675 ~ 01~. New Constructlon Reaulrements RemodellReoair ReaulremeMs • 3 registered site surveys showirg sq. of lot, sq. ft of house; and all roofed areas • 2 wpies of plan (20% mazimum lot coverage allowed) • 1 set oF Ene~gy CaICWa6ons for heated additions • 2 copies of plan showing beam 8 wi~ow sizes; poured found desgn, etc.) . 1 site survey for e#erior additions & decks • 7 set of Eneryy Calculatbns . Indiwte H home served 6y septic system tor addiGans • 3 copies of Tree P2servetbn Plan if lot platted aRer 7/1l93 . Rim Joist Detail Op~ons selecUon sheet (bldgs wAh 3 or less wils) DATE ~ E`z- VALUATION ~ Ss 5' , o~ SITE ADDRESS 7~~ t~'°~ J C' MULTI-FAMILY BLDG Y N TYPE OF WORK_ ~~'~"~S FIREPLACE(S) _ 0_ 1_ 2 APPLICANT ~i+4-t-fs Re3°'~`',~4 # Sc rJ~.i~ c- STREET ADDRESS '~~d ~ S1 ~ ~C CITY P/~y STATE ~`'^-ZIP 5~5"rZ TELEPHONE ~~'o°Y3 CELL PHONE # 6~z-36~ -7n b y FAX # Z63 ~S~S ' Zo ~ 2 PROPERTYOWNER `'LO"~ TELEPHONE# COMPLETE FOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1 ~tIYN~SOTA RliLES 7672 (J submission type) . Residential Ventilation Category 1 Worksheet Submitted . New Energy Code Worksheet Su6mitted • Energy Envelope Calwlations Submitted Plumbing Contractor: _ Phone # Plumbing system includes: _ Water Softener _ Lawn Sprinkler Fee: $90.00 _ Water Heater No. of R.I. Baths _ No. of Baths Mechantcal Contractor: Phone r Mect~~nical sys[cm includcs: Air Conditioning °~~6 Hcat Recovery Systcin i t'. , , . , `I ~ _ L ~ I Sewer/Water Contractor. Phone # ~ F ~3 ~ , II I ~ y ~ ~3 ~ _ - I hereby acknowledge that I have read this application, state that the information is coir'ecran ly with all applicable State of Minnesota Statutes and City of Eagan Or~dija~nces. SignatureofApplicant /,~4~~~*- _._______"--.-------..._..------------.~....._......_------.~r.__----._._--------------°__._ OFFICE U5E ONLY Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required Updaled 4/02 OFFICE USE ONLY ? 01 Foundation ~ 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg ? 02 SF Dwelling ? OS O6-plex ? 16 Firepiace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi ? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF ? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multi ? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage ? O6 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous ? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding ? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 33 Alteration ? 37 Demolish (Bldg)' ? 43 Reroof ? 46 Windows/Doors ? 34 Replacement 'Demolition (Entire Bldg 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 _ Foorings (new bldg) FinaUC.O. _ Foorings (deck) FinaUNo C.O. _ Footings (addition) _ Plumbing Foundarion HVAC _ Drain Tile Other Roof _ Ice & Wa[er _ Final _ Pool _ Ftgs _ Air/Gas Tests _ Final _ Framing _ Siding Stucco Stone Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement) _ Insulauon _ Retaining Wall 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 Copies Other Total ~ PERMIT# ~ ~ RECEIPTDATE: E008 it~SIDERTI~4L ~PLUM$INB~ ~P~itMIT ~~PL1C~kTION crrY o~ ~s,~v ~ ~ ~ Q saso ~noT ~os sn D ~s~x,a~xssisa MAR 042Q02 ss1-s81-aa~s ^ Please complate for: single family dwellings, townhomes and condos when permits are required for ~J backflow preventer for irrigation system SITEADDRESS: /O~~~J V~~~~~I~ CJ I~L1~ OWNERNAME:: ~GiL ~r'L.1~~ TELEPHONE#: ~,sl-(~I -I~~3 (AREA CODE) INSTALLER NAME: ~ CQI n~~ TELEPHONE 6 q 99 STREET ADDRESS: ~ ~l ~ ~ ~ ( ~ (AREA CODE) CITY: ~ I1 Q!.V ~ I lQ STATE: ZIP: 7 _ SEPTIC SYSTEM, newlrefurbished (requires fwo sets of plans and MPC license) $ ~p0.00 includes $40.00 County fee Note: Additional consultant fees may apply • MODIFICATIONIALTERATION TO EXISTING DWELLING UNIT, INCLUDING: _ Adding flxtures to lower levels or room additions, excluding water softeners and water heaters. $ 50.00 _ Abandonment of septic system. _ W ater turnaround - existing dwelling unit 518" meter if needed -$118) Other: _ RPZ: new installation/repair/rebuild $ 30.00 _ lawn irrigation system ReplacemenUadditional: _ watersoftener aterheater $ 15.00 State Surcharge $ .50 TOtal ~ 50 I hereby acknowledge that I have read this application, state thatthe intormadon is cortect, and agree to complywith all applicable Cityof Eagan ordinances. It is the applipnYS responsi6ility to notiTy.the property owner Ihat the Ciry of Eagan assumes no liabi ~ for any damages ed by the Ciry dunng its normal operational and malntenance activities lo the facilities constructed undei this permit within City e, lrightof-w y! t. SIGNATU OF PER EE 1/02 i ~ ~ 2/84 ~ I CITY OF EAGAN ~ ~ APPLICATION FOR PERMIT SEWER AND/OR WATER CONNECTION (PLEASE PRINT) 1) PROPEE2TY ADDRESS: 4853 Sheffield ~ Circle r•Frnr• DESCRIPTION: Lot 7. Block l, Brittany Sth Addition (Lot/Block/Subclivision or Tax Parcel I.D. Ntm~r) ~ IF ~ii: :G ST'i2CCPu:cE, DAi=. OF 0?2IGi~Al BIIII..^.L`:G P~ •ffT 15jJa1~:~: . _O::L':i"iP.°..r; ~ PRESr _.^.•IPX;~pROPOS~ L~S°_: ~R-1 S'1TGLLL rp'~rr,*,v ? R-? DUP~S (7.~0 LtiITS; ? R-3 ~S^7NEi0LJSE ('1~-IF2~ + UNITS) ( UNITS) ? R-4 APAR~~SE,NT/COiVDC.~7Ti~]IiM ( Ui~IITS) ? COM~CIAL/REIIIIZ,/OFFICE Q L~L'STRIIIL ? INSTITUTIONAL/GOVEE2AP~T]'I' 2) APPLIG~INT (PLEASE PRINi) NAME: Tollefson Builders Inc. ADDRESS: 1655 Norwood Drive CITY, STATE, ZIP: Eagan, M~V 55121 - PHOi~: 454-6873 3~ P~„~~ - - PLEpSE PRINT) ~ F0f7 CITY USE ONLY N~~ GEN~-RYAN P??:H p~UNBER ICENSE: aDnRess: 54745 S0. R03ERT TRrI!I Active ci~^r, sTa~, zzP: ' ROSEMOUNT: MN 55068 0 E%Pi~ a ~423-1144 ~ ~j'No of Pecard ~ PHONEe-, pLUMBER LICENSE #'--'1H49M nitia 4) ~CTPA[9T/ar1~I~? ` (PLEASE PRINT) fII1ME: ADDRESS: CITY, STATE, ZIP: PHONE: 5) INDICIITE WHICH PERMIT IS BEING REQUESTID: ~ CbNNECPION 'R7 CITY SES~lER ~ ~ CONNECPION 'IU CITY WATEF2 ~ C7I'f~t (PL~EASE DESCRIBE) 6) INDIG; t ONE: ~ PLFIISE AOID APPRWID PERMIT FOR PICK-UP BY ONE OF 71HWE ~~--PL-EASE-r@kli~ t~PPRWEI~`PERMIT 1b-1; 2~-~ 9_ABOVE - ~ (Circle one) - 7) SI~WNRE: DATE: ~ . •~-6,T`.~""~ ! RRIw~lllA~.i f1! ~li~ ~ ~[Ai~fii~r74 i 1~R ~f~is~y~~ 1~[ ~Itf.f~:fl. . . f~ ! rtll! ~ . . . . . . . . . . ~i 111 F 0 R C I T Y U S E O N L Y PERMIT ISSUED F°E5: $ I~' rv SETr7EP, n~?~+qTT (I^dCLliD~ SLi9CHARGE) $ ~0.5~% WATER PERTqIT (INCLUDE SURCHARG~) $ L 30~ WATER`METER/C'OPPERHORN/OUTSIDE READER $ WATER TAP (INCLUDE CORPORATION STOP) $ S°:VER :?~p $ % S -~u AC~OUNT DEPOSI':' - S~':':EP. $ ~-~ti'~~ ACCOUNT DEPOSIT - WATER S S~O-°G WAC $ y = c~ u SAC ~ $ TRUNK WATER ASSESSP~IENT $ TRUNK SE:VER ASSESS:~ENT $ LATERAL 'BENEFIT/TRIINK SE:^7ER $ LATERAL BENEFIT/TRUNK WATER S ~ :3J- G ~ OTHER , $ TOTAL $ S ~ AMOUNT PAID/RECEIPT ',-k ~j~/y ' DOES U't2LZTY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY? YES " IF YES, THEN A"PERMIT FOR WORK WITHIN PUBLIC ROADWAY" MUST BE ISSUED BY THE C~ O ENGINEERING DIVISION. LIST AS A CONDI- TION. SUBJECT TO THE FOLLOWING CONDITIONS: APPROVED BY: ~ TITLE: DATE: _ ~ s~ w~ w~~ ~a ~w w~ ~a~ aie+~ ws~ ~t+ ~ re ww ~ we~ st ss~ wti+ wt~ i.ie s~ w.. t ! el ~ CITY OF EAGAN CITY USE ONLY _ PLUMBING PERMIT SUBD. (612) 681-4675 RECEIPT ~ C-- O~ y~ DATE ~P 9 y' RSSIDENTIAL -T PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. WORK DESCRIPTION _ COMPLETE THE FOLLOWING: N~. FIXTURES EA. TOTAL NEW CONST ~ REPAIR/ADD ON 15.00 ADD ON ~ SHOWER 3.00 REPAIR _ ~ WATER CIASET 3.00 BATH T[JS 3.00 ~tn_ 1 / I,AVATORY 3.00 OWNERNAME: 1J?-a~ I~K.,IY'O'~- KITCHENSINK 3.00 SZTE ADDRESS: ~'jSS~ 5~'1e~'~le.~[S' C.1`K-~e -1 ~~RY TRAY 3.00 _ HOT TUB/SPA 3.00 _ WATER HEATER 3.00 ` FIAOR DRAIN 3.00 GAS PIPING OUT. INSTALLER: Q r~ ~~1~"p e f (MINIMUM - 1) 3.00 ROUGH OPENINGS 1.50 nnn~ss: ~l 8S3 S h e. ~ C~.-~.1 c~ ~ oxxEx WATER SOFTENER 5.00 CITY: ~~,C?`N ZIP: Jr' sl _ PRIVATE DISP. 15.00 ~81 ' I'1~3 - w.Glvxr»oNUrrnR is.oo PHONE : _ ~ ^ ~ n (/JJ~Jy STATE SURCHARGE .50 LC x SIGNATURE OF PEkMITTEE TOTAL: $ I S' S~ COMMSRCIAL PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS. ALSO FOR MULTI-FAMILY SUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT. WORK DESCRIPTION: OWNER NAME: CONTRACT PRICE: SITE ADDRESS: 1X OF CONTRACT FEE. . STATE Sl7RCHARGE - $.50 FOR TENANT NAME: EACH $1,000 OF PERMIT FEE. SUITE $25.00 MINIMUM FEE. INSTALLER: CONTRACT PRICE x 1X $ ADDRESS; STATE SURCHARGE $ CITY: ZIP: TOTAL: $ PHONE ppg; (SIGNATURE) CITY OF EAGAN PERMIT ~ ° 0 719 . CITY O~ EAGAN 3830 Pilot Knob Road PERMIT TYPE: eui~~rw~ Eagan, Minnesota 55123 Permit Number: 000898 (612) 681-4675 Date Issued: 0 6/ 2 9/ 9 2 SITE ADDRESS: 4853 SHEFFIELD CIR LOT: 7 BLOCK: 1 BRITTANY STH DESCRIPTION: ~-Building Permit Type BASEMENT FINISH ; Building~Work Type ALTERATION ~ / ; ~ , _ ,:A'<'_ " , _ ~ ' ` ' a F~ t ~'S ~~,_.c\ f l ~ll~- =:A ~ \ L. ~ ~ L`J.f' t~`-';'~`~ ~ ~ ! _ , ' ~ ~ L~ . ~ REMARKS: RECEIPT N r, O` CI ~f ~ FEE SUMMARY: Base Fee ~35.00 Surcharge 3.50 Total Fee $35.50 CONTRACTOR: O~ NROE - APPBRppnt - 4853 SHEFFIELD CIR EAGAN MN (612)681-1473 I hereby acknowledge thet I have read this application and state that the intormation is correct and agree to comply with all applicable State of Mn. Statutes and City of Eagan prdinances., ~ - 1 1~nr,n R~,;r,ll ~7;d APPLICANT ERMIT E SIGNAT E UED V: IGNAT RE PERMIT C~ CCC~~~ CtTY OF EAGAN `~~S S° REACTtvaTE _ X)"~ 1992 BUILDING PERMIT AP$LICATION (J / 681-4675 ~,~,U?~;~1, G-Z~- SINGLE & MULTI-fMIILY 2 sets of pians, 3 registered site surveys, 1 copy of energy calcs. COMMERCIAL 2 sets of architectural & structural plans, 1 set of specifications, 1 copy of energy calcs. Penalty applies when typing of permit is requested, but not picked up by last working day of month in which re uest is made or lot chan e is re uested once ermit is issued. Date ('i> Z- Valuation of work Site Address: '-IK53 She~G~e.lc~ G1~c12 ~ ~ STREET ~ SUITE ~ Tenant Name: (commercial only) IAT ~ BIACR ~ SUBD. p.I.D, ft Descri tion of work: aa se m e'I- ~ h The applicant is: ~ner ? Contractar ? Other (Describe) Name _Melrv~ ~~~ccQ Phone ~S't ~)`l73 Property usT F,RS, Owner Address ' IS~IS.~ Sh~~~e.lc~ c~~-~.1 Q . STREET STE N City _~~~-CSL1/U State IM I v Zip ~~(~a' Company C5LW1 ~ Phone Contractor Address License # Exp. City State Zip Architect/ Company YV Phone Englneer Name Registration # Address City State Zip Sewer 6 water licensed plumber . Processing time for sewer 8 water permits is two days once area as been approved. I hereby acknowledge that I have read this application and state that the information is correct and agree to com ith all applic 1 Sta e of Minnesota Statutes and City of Eagan Ordinances. Signature of Applican - OFFICE USE ONLY ~ BUILDING PERMIT TYPE ' ~ O1 Foundation ? 06 Duplex ? 11 Apt./Lodging ~Q 16 Basement Finish ? 02 5f Dwg. ? 07 4-Plex ? 12 Multi. Misc. ? 17 Swim Pool ? 03 SF Addition ? 08 S-Plex ? 13 Garage/Accessory O 18 Comm./Ind. ? 04 SF Porch ? 09 12-Plex ? 14 Fireplace ? 19 Camm./Ind. Misc. ? 05 SF Misc. ? 10 Multi. Add'1. ? 15 Deck ? 20 Public Facility ? 21 Miscellaneous woRK rrPE ? 31 New ~'33 Alterations O 35 Tenant Finish ? 37 Demolish ? 32 Addition ? 34 Repair ? 36 Move GENERAL INFORMATION Corrst: ~(Actual) Basement sq. ft. MWCC 5ystem (Allowable) lst fl. sq. ft. City Water UBC Occupancy 2nd F1. sq. ft. PRV Required Zaning Sq. Ft. total Booster Pump # of Stories Footprint Sq. ft. Fire Sprinkler Length On-site well Census Code ci.~~i Depth On-site sewage SAC Code APPROVALS Planning Building Assessments Engineering Yariance REGIUIRED INSPECTIONS ? 5ite O.Footing ~ ~ Framing 0 Insulation ? Wallboard C~ Final ? Draintile ? Fireplace Permlt Fee ~ ~ v.a,~c;p,: g Surcharge :5'6 Plan Review License MWCC SAC Ci~y SAC Water Conn. Nater Meter ~ Acct. Deposit S/N Permit S/W Surcharge Treatment P1. Road Unit Park Ded. TraiTs Ded. Copies Other Total: SAC % SAC Units ~ ~ ~ . . . 1985 BUILDING PERMIT APPLICATION - CITY DF EAGAN NOTE: ALL CONTRACTORS l9UST BE LICENSED NITH THE CITY OF EAGAN INCLUDE 2 SETS OF PLANS 3 CERTIFICATES OF SURVEY 1 SET OF ENERGY CALCULATIONS eo To Be Used For: _ Mi ~f Valuation: (o3,GY~J.'- Date: ,ji~~~' ~ Site Address: ~,~-r~ D cap~a ~ OFFICE USE ONLY Lot: ~ Block J_ Sect/Sub p,y,.~qNV ~Erect X Occupancy ~-3 Remodel Zoning rL-I Parcel ~k Repair _ Type of Const Enlar~e of Stories Owner c,~~~ J Move _ Length qg Demolish Depth 3 S Address Grade Sq Ft City/Zip Code Phone APPROVALS Contractor N g~~~~ Assessments Permit 3Z2. Water/Sewer Surcharge 3 1.5= Address ~bSS [~OP~nI(X')D ~N~ Police Plan Review I(~ l•°O Fire SAC 525.`-° City/Zip Code '~~,p ~/,~a Engr Water Conn ~p, Planner Water Meter (p3,~° Phone L~G~--h~"~~ Council Road Unit 2 gp.e0 Bldg Off 6 arks ' Arch./Engr. APC Treatment P1 I3 2-°D Variance ~ ~ O Address TOTAL City/Zip Code Phone # ~ ~ ~ ~k , ~ f~ 22 x~=~~i Z~ S4- 4 2-i e S ~ ~ lo X~2 2~ " 13 2 x Sd- - ~1 I 2 8 ' ~ l2 ~ l2 _ ( 4~x J~--° 'I~~ ~ _ ~qa ~ = ~~4v ZO ~ Z2 (n25 i'Z~ Tollefson 13uildere Inc. Or.11G31 ~ ' 188-3 • JACKSON - SIJRVEYORS SC8LE7 1~~ 3O~ Ri61~T[R[O UND[R LAWt OI tTAT[ W MINNpOTA ~ • Denotes Iron = Drainage v,.0_ EX18 CS~1g E LEV. ~~6 EAST 55th STREET, MINNEAPOLIS, MN 65417 727-3484 _ ____:Drainage S Utility Eaeement ~bUtbtpOT~u ICtTtiG[Qtt ~ Prapoaed Garage Floor E Lev. 7 a 3, o O~ ° Z~ _.~7,E~--_ S" ~ ~e ' - - h_~ f G 7 z~~ ~ _ ~ y; ~ / 1p \ ~n -~--~~1 ~ F _ I~ . 3s~ ~ I ~ . ~ ~ - ` N 0~,. . + ~ C ~`o \c,~ o ` I ` ~ ~ \ I i3~ ~ N = ~ C' ~(4_ iz ~5 / \ , {1Je ~~o a~ v ~ a ~ ~ ~ i ~ 'L~ = G = _ ~ 2' ~ ~ ~ ~ . ` ~ ~ ~ ~ I , - -`'----~N ~ n j ! ~ 3Q _ 3s ~ ~i_~~_ ~ , I I 2 °`9 %e•• ~ ~ '~%9.y`'~~F 1 H[R6BT C~RTI~Y THAT TM[ ABOV~ I{ A TRU[ AN~ CORqtGT rLAT OF A 6URYr OR ' Lot 7,elock 1,Brittany Sth. Addltion, ~ Dako[a County,Minnesotar 4th. ~ June 1985 A/ iVRV[Y[D !Y M[ TM1~ DAY O? •.O. ' ~ . $ION[ F. C. JA KSON, M~NH[~o7~ 6 TMTION, NO. ~E00 ; " ~ --wat.r. sECTIOH-- Determ~tning ~~0~~ valuea at Roof~ Wall~ Rim~ And Conc. Block ROOF/CEILINC3 R VALUE 1.) Interior Air e'i1m 0,61 2.) 5/8~~ ayp. sa. .56 3. ) Ineulation ~ o0 4.J 5.) Exte;ior. Air Film .61 (STILL) I 2 3 ~ • npn = 1~Ro .OZ~ i'OTAL ~R)= 95•7Q l , n WALL (R) VALUE t°J 6.) Interior Air Film o.68 ~ 7.1 ~YP. Bd. .45 8.) Tnsulation 19.00 . 9. ) ~s/3Z~~ BvK,T-R'~TE' Z•o¢ 10.) I~lasonite Siding .07 l0 11.) Exterior Air Film .17 11 ' ~~U~~ = i/a~ . 0¢3 Tomai. (a)=Z3.o~ ~ RIM • (R) VALUE 6 ' ~3 12.) Interlor Air Nilm 0.68 13.) Insulation 19.vo 14 1y.) 2'~ Fir Rim Joiat 1.88 y 15 15.) zS/3z~' B.,rcr-R~~~ Z•~4 16.) Maeonite Siding .67 17.) Exterior Air Film .17 n , , d • . . uIIn = 1/R= ,r5¢~ TOTAL ~R)=Zt~.,¢Q U ° . o ~ '"~r- ~ r O~ FOllNDATION (R) VALU~ 18.) Interior Air Film o.68 Ig t9.) zl • • ~ n ~j°~~ 9 2~1.) 12" Concrete Block 1.28 ' e n 2~ 22. ) ~/L.?D ~AX~tIL. $•d~ Zg 23.) Exterior Air Film .17 e L)° ~ d~ . npu z 1/R= . Oq$ TOTAL ~R)= ~O.I ~j . ~ ~J[TERIOR ENVII,OPE AVERp(}E °U~~ CAMPUTATION ~ ' (To be submitted with building permit application) ~ One or Two Family Dwelling Owner All Other Site Addreea Contractor IpG~~,~o~ ~vILD ~P_S Date Phone lzoz sQ. ~r. 4-~vEL LINEAL FEET OF 'f q¢~ EXPO5ED 47ALL ~EE WmP-K 5/~EET Yt. above grade = Iv-rOD TOTAL E}L°OSED WALL ARr^,A SQ. FT. 0?A~UE WI:LL COD:STRU:TI01+: ~~U'~ Value x Area Detail ~'R14M1F nUu .oQ-3 X SQ, FT. 11'493•`~0,• ~4•L! (U)(A) reference ~ONC- ~~U" .048 x SCj. FT. l0 5L= /O•L4~U)(A) from ~/ST "U~~ ,040 x SQ. FT. U)(A) attached '~U~~ x SQ. FT. _ ~U)(~) sheets x SQ. FT. _ (U)(A) ~~U~~ x SQ. FT. _ (U) (A) iVINDOSVS: ~~U~~ Value x Area P1ake & Type j~Sr7l, ~~E~ ~~U~~ .5~ x SQ. FT. ~05.(0 =~(II)(A} " " ~~U~~ x SQ. FT. _ (U)(A) u n nUu x 8Q. FT. _ (U)(A) u n uU~~ a SQ. F'T. = (U) (A) DOORS: "U~~ Value x Area i-iFke & Ty.oe ylL• fjVSt~L • ~~U~~ •/4 x SQ. FT. 4q•oo = 6•Sfo (0) (A) ,r PAYio °U~~ •47 S SQ. FT. Z•aD =~(U)(A) n nUv x SQ. FT. _ ~U)~A) " " _ ~~U~~ x SQ. FT. _ (U)(A) ToTai.s lq84.oo sQ. r•T. 190.~9 (u) (a) avExnaE ~~u~~ TOTAI, (U)(A) VALUES jcj~~~c~ _ .09(p DIVID~D BY TOTAL 4~ALL AREA ~~ISQ':00 ~ AVF;RA(iE "U~~ ~or lesa for 1&2 family dwe lings ROOF/CEILIN(3 : TOTAL AREA: IZ~Z- Detail reference ~~U~~ ,OZ~ x SQ. FT. /ZOL = z$-Z (U)(p) from ~~U~~ x SQ. FT. . (U) (A) attached sheets. °U~~ x SQ. FT. _ (U)(A) Describe openings ~~U~~ s 3Q. FT. - (U)(A) in roof. ~~U~~ x SQ. FT. _ (U)(A) TOTAL (U)(A) VALUES DIVIDED BY ~Zg =~o7lEL~-j /2OL zs•z4~~r~> TOTAL R00~'/GE Ci A1~~A IZOt.pip •~Ll AVERAGE "U~~ ,02$ for ventilated roofe. ' " G1o~-K 5lI~T" ~RasS ~.~~b wA_~c~ /4.soX(4o+/8~-Z4+z~~ ~ J537,o0 `~•5ox (lv~t-ZZt 14) = 399•00 4.0~ x rL = 9B•oo 1~q8~•oo Cou~, .~7~c~9ot4-ot38r38) _ /o4.sz~ ?sr .83X~lfoi-4oi-38t38~ = 1Z`I.g$.~ k~?+~aocus C~~,gy~~ 1~X3~ _ $.oa X ~ = S.oo Z~x¢8 = l3.~- x 4~ 53.~v Z~x~o = lo.~ X z= Zo.ov z4x3~o = l2•0o X ~ = 3(0.00 Z4 x48 = lfo.oo X 3= Q$. o0 1(~S.~o ~ ~~s _ 3~ a7L w~~L• ZS. o0 Z g s.rz. se~. = z 1. vo ~a-rio - 4Z.oo ~ q1.av N~r w...e_~. E~~.~s ~ ' z~ X¢D = 9lov ~R~C.- l~98¢: oo ~ XLZ = !3L G~~ CcwC . log. s t. $ x/2 = 9~ n R,rrl lz9.~s ~S~c r~-s = ~3aS' 'i t.~3 ~(ns.tna ~¢90.~00 ) ZoZ Dc~~ 5 p~, vo ~ ~~`t~9a7•go •~~`1 ~ 2005 RESIDENTIAL BUILDING PERMIT APPLICATION p~ City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 , Telephone # 651-675-5675 FAX # 651-675-5694 New ConsWCtion Reauirements RemodeVReoair Reaui2ments Office Use Onlv 3 registered site surveys shaving sq. fl of lot sq. h of house; and all roated areas 2 copies of plan Cert of Survey Recd _ Y_ N (2U% maximum btcoverage allaved) 1 set of Eneyy Calcula6ons for healed additions Tree Pres Plan Recd Y N 2 copies of plan showing 6eam 8 window sizes; poured found design, etc. 1 sfle survey for add'NOns & decks Trce Pres Required _ Y_ N lsetofEnergyCalculations Add'rtion-indkateBonsifesepticsystem On-siteSeptiqSystem _Y _N 3 copies of Tree Preservation Plan if lot platted after 711/93 Rim Joist Detail Options selection sheet (buildirgs wi~h 3 or less unils) Date ~ / / Construc8on Cost ~ , ~ SiteAddress ~V~~ ~J~~C\P~~ ~.\~UL Unit/Ste # Description of Work ~(LS~~ ~ ~ C,J ~ ~ ~Cf(f `I~v ~X'JfI Multi-Family Bldg _ Y_ N Fireplace(s) _ 0 _ 1 _ 2 PropertyOwner ~C(A~ ~Q,+~ Telephone#(f~,5i) (aS1-1473 Coutractor ~ i, ~xJI,~S ~ ~ 9_ ~C Address (0~~ ~i(~2 ~V2 . City ~C~i(~ Lfn~2 State ~g-~jj~ ~m(N Zip 3y_7 Telephone k(~5a.) ~,'~Z/`Q~,~~B COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minnesota Rules 7670 Cate~ Minnesota Rules 7672 Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet (Jsubmissionrype) Submitted Submitted . 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 plan8 _ Y _ N If yes, date and address of master plan: Licensed Plumber Telephone ) Mechanical Contractor Telephone J Sewer/Water Contractor Telephone # ( J I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate; that the work will be in pc~j f~~~i~y ~ dinances and codes of the City of Eagan and the State of MN Statutes; I understand this~,i,~ not a permit; `bu y an application for a permit, and work is not to start without a permit; that the work will in~~old~n~~it e approved plan in the case of work which requires a review and approval of plans. 'fl N~ ~I"Cx ~ , n Applicant's Printed Name ApplicanYs Signature OFFICE USE ONLY Sub Types ? 01 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 EM. Alt - Multi ? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF ? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screen/gaze6o) ? 36 Multi Misc. ? 05 03•plex ? 11 10-plex ? 19 LowerLevel ? 24 Storm Damage ? O6 04-plex ? 12 12-plex Plbg_Y or_ N ? 25 Miscellaneous Work Types ? 31 New ~ 35 Int Improvement ? 38 Demolish Interior ? 44 Siding ? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair ? 33 Alteration ? 37 Demolish Building' ? 43 Reroof ? 46 Windows/Doors C 3-: Repl~cemer; `Ccm~liton (Enti:e B:dg; - 3iv~ PCA. handout to applicar.! Valuation Occupancy MCES System Plan Review 100°/a or 25% Census Code Zoning City Water SAC Units Stories Booster Pump # of Units Sq. Ft. PRV # of Bldgs Length Fire Sprinklered Type of Const Width REQUIRED INSPECTIONS _ Footings (aew bldg) FinaUC.O. _ Footings (deck) FinaUNo C.O. _ Footings (addition) _ Plumbing Foundation HVAC Drain Tile Other Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tesu Final _ Framing _ Siding _ Stucco _ Stone _ Brick _ Fireplace _ R.I. _ Air Test _ Final _ Windows _ Insulation _ Retaining Wall Approved By: , 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 PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA126398 Date Issued:08/25/2014 Permit Category:ePermit Site Address: 4853 Sheffield Cir Lot:7 Block: 1 Addition: Brittany 5th PID:10-15004-01-070 Use: Description: Sub Type:Residential Work Type:Replace Description: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. Tony Boerner 2090 County Road 42 W Burnsville, MN 55337 Fee Summary:PL - Permit Fee (WS &/or WH)$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 - Bradley D Melroe 4853 Sheffield Cir Eagan MN 55122 Tony's Appliance 2090 County Road 42 West Burnsville MN 55337 (952) 435-2442 Applicant/Permitee: Signature Issued By: Signature