4312 Sun Cliff RdAug 11 11 02:48p Soccer Express
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
CC
651-698-0519 p.2
r
L
Use BLUE or BLACK Ink
For Office Use
Permit #:
OC) SL/
Permit Fee: $GS. v 0
Date Rece ed:
Staff:
"INFLOW 8t;,NFILTRATION PERMIT APPLICATI
j( Plumbing / Sewer & Water
Date: ' - 1 Site Address: /-4 )
cc Few 'OP -
Tenant: Suite #:
RESIDENT /OWNER
Phone: (1 -970-(396/q
Name: A r4 'f 2 — H ' i l e S 1,1 e ' h k9
Address / City / Zip: L\ 1 2 ;i M M c I .. i•(• h',-, Z 1 s a c -, /t'.W S S /(2 2
CONTRACTOR
,
Name: H Z S ,c. h P) I., to, b : 146 c r." I L.t , -Cm: License #: <_.:51 , S p :+.
Address: P v A. ,. ,/ -) Z City: 1 <, J`- v,
State: Y► -t ;.' Zip: S c i .4 '2 Phone: L l r- U 5) —& 2 S Z
Contact: Pt; tie .sc I,# r/? Emal: /'i 4 al •IL!;,; .-...'is.r.;. . 6 ..
TYPE OF WORK
PLUMBING (Within the building envelope) SEWER & WATER (Outside the building envelope)
_& Sump Pump Repair Repair
Other: Other.
DESCRIPTION
Description of work: Ty. i, / 4 r•. •} :..n 4,,; J e q
.
FEES
$55.001 Each (includes
3 Ch . c 11'
$5.00 State Surcharge) Se l'.t->, • . Ni --• TOTAL FEE $ 5 S • O r *
S`
`Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit In repair costs for
reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors
can be found by visiting www.citvofeagan.com/inflow, or City Hall at 3830 Pilot Knob Rd.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call
48 hours before you intend to dig to receive locates of underground utilities. wrwv.aonherstatecnecalt.orq
I hereby acknowledge that this information is 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.
K .,,� C.1; ►
Applicant's Printed Name
"."2`J, f
Applicant's Signature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: _Under Ground Rough -In __Final
ci7Y oF EaGaN WATER SERVICE PERMIT ~
3830 Pilot Knob Road
P. O. Bo:i 31199'- PERMIT NO.:
Eagan, MN 55121 DATE:
Zo^i^Q: fVo, of Units: ~pwnerc ^rand
l1ald?ess: i
Shg A c
C~~'lSS: =t 31 ~
, Piumber.
Meter No. Connection Charge: _ 'v 7 U. OJ
~ ~~,e va~lr: - 15 . 00 nCi
aeade. No.: _u _Pem,ir Fee: I egm rn aanPy, ,rkh Hn Cirr +F E•9onx surcl,nrge:
Onpao Mis+c. CharQes:
~ Total: ~
BY -Date Pufd: I
Date of Insp.: - Insp.: i
,
CITY OF EAGAN IIVATER SERVICE PERMIT
3830 Pilot KnobAioad li
P. o. Box 21 19P PERMrt rvo.:
Eagan, MN 55121 DATE:
ZQ^ir?9: No. of Units:
Owner• `'~an-? Oaks ltev
Addresa:
Si-to ~rc~ 431 5un C2i Poad LS 1~`~ Sun C i f n:l
Plwnbar: ~ r r P v
Meter No.: Connection Chors,~a: . 00 pd
Size: /?ctount Deposit: = 5.00 nd
Reader No.: Permit Fee: i%.00 Pd
1morm h oaaoly wkb tio GY ef Eq~ew Surcharge: nu
Ormaenar. Misc. Choryes: fi'i ,(?C1 ;.,c' Trete7
TotoL• I
BY Dote Paid:
Date of Insp.: Irqp.:
CITY OF EAGAN SEWER SERVICE PERMIT
3830 Pilot Knob Road 7;)6(
P. O. Box 21190• PERMIT NO.:
~ Eagan, MN 55121 D^TE: - ' Zo^i^0: No. of Unita:
p~,,,,wr. "ranri ~ i~~s ~~v
! /lddress:
~ Slte Address: 4312 Sun C1if ` Road L5 B3 Sun Cl if f 2nd
Plumber. '-4urr
48119 . p
i 1 egne to eaepyr whlr tbe Ci1r ef Eags¦ Cm,necrion Charpe: 425 . 00 pd
Orrdusnaes. Acoount Deposir: 15.00 pd
I
i Pennit Fee: 10.00 p.i
~ St,rCtw,fle; .5r) pd ~
i BY Misc. Chnroes:
I Daite of Iruv.: Totol:
I nsp.: dota Paid:
~ CASH RECEIPT ~ I
~ CITY OF EAGAN ~
P. O. BOX 21-199
EAGAN, MINNESOTA 55121
DATE J~ 19
R6C61VIKD
FROM AMOUNT $ I
Q DOLLARS
+oo
E]CASH F~ CHECK
FOR
FUNO GODE AfAOUNT
Tha~~~Ou '
BY
White-Payers Copy i
Yellow-Posting Copy ~
Pink-File Capy _ i
CITY OF EAGAN
, . 3830 Pilot ICnob Road, P.O. Box 21-199, Eagan, MN 55121
~ PHONE: 454-8100 /
BUILOING PERMtT Receipt #
To M wed fer SF DWG/GAR Est, Volue $50,000 pQTe DECEMBER 5 19 84
~
Site Add 4312 SUN CLIFF RD Erect 0 Occupancy R3
Lot ~ess Block 3 Sec/Sub. SUN CLIFF Remodel ? Zoning RZ
Parcel No. Repair ? Type of Const. V
Eniarge ? Na. Stories
~ Name
Move ? Length 3 7623 z Address UPPFR 16 Tx s~r ~a o~,plish ? Depth
City T' -"''K-,'VILLE phone 4-3-k Grade ? Sq. Ft.
Approrab Fees
o Name ~
Z Ilssessment Permit '
Ou Address
u9 City Phone Woter & Sew. Surchorfle 25.00
Police Picn check 141.50
9°W` tuarne Firo SAC 525.00
Address Enp. Wcter Conn. 4 7 0. 0 0
IXZ City Phone Plcnner Woter Meter 63 . 0 0
Council Road Unit 260.0(j
1 hereby acknowledge that I hove read this opplication and stote that gld9, p{{,12 484 parks
the informofion is correct ond ogree to comply wiih oll applicabla A~ Total ~ 767.
Stote of Minnesoto Statute; and City of Eogan Urdinonces.
Var. Date
Sipnoture of Permittee
GRAND OAKS :
/I 8uildirrg Perrrlet 1s issued to: an the express oonditlon thot
oll work shall be done in accordorxe with oll eppliwble Stote of Minnesota Statutea ond City of Eagon Ordinonces.
Buildinp Officiol
Psrmit No. Psrmit Holder Date
Plumbing a N Y9 -~ra
H.V.A.C. l -j
Elrceric qg i5 R r vuLa'"~T Z'
Softaner
Inspection Oate Insp. Other
Footinys
Foundation
Framing ~q,~~=~c~ ~ ~ . ?
Rouqh PI6g.
Rough HVAC
Inwlation
Final Plbg.
Final HVAC ~
P
Final -i " p U •S' d ti
cert/ooc. rA r Gaca ~-f -.L -~'oo
Water Describe Loeation:
Wa I I
0X
Sewer
Pf. Disp.
~ - -
Receipt MECHANICAL PERMIT Permit No.
CITY OF EAGAN
~ Fee
• j , Fi!l rn numbered spaces S/C
Type or Print legibly Tot.
1. Date 2. Installation Cost
L~~~o2 Jun ~~:•Cr~ i ~
3. Job Address Lot .S Blk. ~ Tract
4. Owner
5. Contractor Phone-6 G~ - l y=-~1V / '
6. Address
7. CitYV-;, State Zip
8. Building Type: Residential ~ Commercial ? institutional ?
9. Work Description: New El Add ? Alter ? Repair ?
10. Describe Fuel Type
11. Nn. Eauioment BTU - M. Ea. No. Equiament CFM
Forced Air 757, e'( Air Handling:
Mfg.~K' y,J., ~
Boilers Mech. Exhaust
Mfg,
Unit Heater
Mfg. Other
Air Cond.
Mfg.
Gas, Piping Outlets
12. 1 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 =%'.'>'`~tf2~r-
for
ugh Final
Inspections: Date InspZ-f,./_ Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGA11t 454-8100
Receipt ~ r PLUMBING PERMIT Permit No. ~9.~._
CITY OF EAGAN
~ Fee
r ,
Fi!l in numbered spaces S/C
--Y--
Type or Print legib/y
Tot. ^T-,Z L~.J
1. Date , z- -'<< 2. Installation Cost
3. Job Address Lot - Blk. Tract
~
4. Owner , f!
~
~ 5. Contractor Phone
~ 6. Address
~ 7. CitY State _ Zip -
I
8. Building Type: Residential O Commercial ~ Institutional ?
f 9. Work Description: New ? Add ? 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 gaverning this type of work.
Signed : --d- for
Rough Finel
Inspections: Date Insp. Date Insp.
This is your permit when numhered and approved.
Approved CITY OF EAGAN 454-8100
Th,s eque= wd~~13 3 z- 8 5
18 mpnths trom
A-898159 L5 83 CVA-k z q a.sa
Reques[ Daie Fire No. Rouph-in Inspectio
ReQwred? ~Neatly Naw~9V~ll Nobfy, InsPec-
A , ~ es ?NO ~o~i [or When qeady
censed Electncal Contrector I hereby requast insoecbon af abova
? Owner elecbical work installed at:
Street Ad ress, Box or Foute No. City
3 S t.w, ' o~ a w
ection o. Township/~ Nnme or No. ange No. Caunly ~
Lo ~
Occupant IPflINTI Phune No.
s a- /
Power Supplier Adtlress
r2 ~o {x 4!57/el
Elec 1 Gonhactor (C Name) . Convacmr's License No.
xd ~lo /74/~F-3
MailmB A.ddress (COnVactor or Owner M kin0 Instailatian)
7 i -e' 5Sa,U4
AuMori ed Signam (COnVa r Owne MaWng InstallutmN Phone N mber
0- 35.~5
MINNESOTA STATE OAPD OF ELECTRICITY THIS INSPECTION REQUEST. WIIL NOT
Griggs-Midwey Bldg. - Room N-191 gE ACCEPTED BY TNE STATE BOARD
1821 Universily Ave., St Paul, MN 56104 UNLESS PPOPER INSPECTION FEE IS
pl-ro IM21297_2111 ENClOSED.
~!s'? 33 REQUEST FOR ELF~iC.lCA~E INSPECTION dft EB-000011- 4
`t/~ See instructions for completi~q this form on back of vellow copy.
C~ • "X" Below Work Covered by This Request
;Adf Reo. TYpe oi Bwldmg AoCliancee Wired Equipmenl Wired
Home Range Temporary Service
Duplex Water Heater Lighiin, Fixtures
Apt. BwlAmg Dryer Electric Hea[in
Commercial Bldy. Fumace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tenk
Farm Otner oeo v thet ISVecrtv!
t er Sue[v1y t er Othor
ompute Inspectron Fee Below
M Pee ServiceEn[rancaSixe p Fae Feeders/5ubteetlers N Fen C"wits
110 0 to 200 Am s 0 to 30 qm s evy Z 0 to 30 Am s
A6ove 200 qm s 31 to 100 qmps p 37 to 100 qm s
Swimming Pool Above 100_Am Above 100_Am S
TransPormerS Irrigation Booms -rtial-:Other Fee\
Signs Special Inspection $ ~ TO AL FE
Re~rks / ~
N -7c
flwgh-in Drte ~
thg`Elgcirjce I
nspector,hereby
cer4 /y thet the above
Finail
' pection has been
Z de.
TMSreywst void 16 manthe from T
?
" ~ ; . . . . . . ~ ~ _ , ~
~ ALL CONTRACTORS MUST BE LICENSED WZTH TIIE CITY OF EAGAN
1'7(11115'0 ~CLUDE ~ SETS OF PLANS, !
~i~•::'~-~- ~ -r, ~ ~ ~CERTIFICATES OF SURVEY ~
q7•5`' Q SET OF ENERGY CALCULATIONS
To Be Osed For: •'4, Valuation: G00 • ~ Date:
Site Address: L41~ • • • - ~
Lot:]!~ B1ock:2-PSect/Sub: ~1 Erect: X Occupancy: Q-3 I
Parcel Remodelc Zoning: R-I
Repair: Type Of Const: -\7-
owner: Enlarge: # Stories:
Move: Length: 38
Address: Demolish: Depth:
City/Zip Code: Grade: Sq. Ft.:
Phone
Contractor:~
Address: `7 ~ 2-31) ((v'l ` ,jd'(V. Assessments: Permit: Z83•~'
City/Zip Code: Water/Sewer: Surcharge: 25,e-
Police: Plan Rev_ : 141. Phone 2- ~5(y I Fire: SAC:
5z5."'
~ Engr.: Water Conn: 70.=
Arch./Eng: Planner: Water Meter &?j,°=
Address_ Council: Road Unit: Zcx~.~
Bldg. Off.: Parks:
City/Zip Code: APC:
Variance: ~ .
. ' CITY OF EAGAN N9 9765
- 3830 Pilot Knob Road, P.O. Box 21-799, Eagan, MN 55127
PHONE: 454-8100
BUILDING PERMIT Receipt #
T. 6s wad ia SF DWG/GAR Est. Value $50.000 pote DECEMBER 5 1984
SiteAddress 4312 SUN CLIFF RD Erect IN Occupancy R3
Lot 5 Block 3 Sec/Su6. SUN CLIFF 2 Remodel ? Zoninq Rl
Percel No. Repair ? Type of Const. V
Eniarge ? No. Stories
~ Name CRAND OA'ICS Move ? Length 3-9-
z Address7623 UPPER 167TH ST W oemolish ? Depth 43 City LAKEVILLE phone 432-6561 Grede ? Sq. Ft.
rc SAME ADProvalf Raes
o Name
oG Address Assessment Permit 263.0b
~
u~ City Phone Woter &$ew. Surcharge 25.0
Police Plan check 141.50
Gw "Name Fire SAC 525.00
~o Address Eng. Water Conn. 4 7 0 •
~uZi City Phone Plonner WaterMeter 63.00
Council Rond Unit 260 _ n0
I hereby ackrawledge that 1 have reod this opDlication and stote that gldg. Off.12/4/84 Parks
the information is correct and ogree to wmply with oll oDPlicable APC Total V i~ ~
State of Minnetoto Stotutl and City of a9on O dinances.
Vaa Date
Sipnoture of Permitt
A Building Permit Is issued to: OA on tM express condition Ihat
ali work sholl be dorre in occordarxe with all applicable ate of Minnesoro Statutes and Ciry of Eagan OrdirwnCes.
Buildlnp Officiot
CITY OF EAGAN Remarks Z:)/
Addition SUN CLIFF 2nd Lot 5 eik 3 Parcel 10 72976 050 03
Owner street 4312 Sun Cliff Road state Eagan, MN 55122
Improvement Date t29 Annual Vears 95 Payment Receipt Date
STflEET SURF. 1 Z
STREETRESTOR. ..}86 ~1e 1986 431.51 5 GRADING SAN SEW TRUNK 1970 1.95 25 17.60
SEWER LATERAL SEWER LATERAL 999 1986 165.92 5
WATERMAIN
a. O -/O 0-~- ~
WATERLATERAL 1000 t198657 2.60 188.52 5
WATER AREA 2.34 Cy 1 j
WAT LAT BEN -~99~2~07 .88 11.58 5 , 8 0,~-f5
STOR MSEWTRK ~ l.]2 $.09 Z0 40. 2 oi 1 6 -g-8
STORM SEW LAT
S/W SERVICE 1005 8J7 161.75 5
CURB & GUTTER
SIDEWALK
STREET LIGHT
STORM SEW LAT 1006 1986 610.14 122.03 5(p/0, /91 -/O(o 4
Road Unit 260.00 1148119 12-5-84
WATER CONN. 470.00 11
BUILDING PER. n n - 49765 SAC n r
PARK
RESIDENTIAL
BUILDINC PERMIT APPLICATION
, CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New Canstruction Reouirements RemodallReoair Reaulrements r
• 3 registered site surveys showing sq. R. ot lot sq. ft. of house; a~ all roofed areas • 2 apies of plan C/4
~J
(20% mazimum Iot covarage allowed) . 1 set of Energy Calculations for heated additions 0
• 2 copies of plan showing beam & windav saes; poured found desgn, efc ) . 1 s0e survey for exterior additions & Eecks
• 1 set o( Eneryy Calculations . Indicate if home served hy septlc system for additroiu
• 3 wpies ol Tree Preservatlon Poan if lot platled aRer 7/1l93
. Rim Joist DeWil Options selectian sheet (bldgs with 3 or less units)
DATE VALUATION ~-2
~
SITE ADDRESS MULTI-FAMILY BLDG -Y -N
~
TYPE OF WORK ~'~uC~W ~e~AI1Fr-p~e~`i- FIREPLACE(S) _ 0_ 1_ 2
APPLICANT C tn`74r__UGTjpni
STREET ADDRESS ~ (-6 t, .bg:j ekCAti~ CITY T 11 STATE MLZIP 6T572 ^
TELEPHONE# (a5(-9 Ci 0~5 CELLPHONE# FAX#~oc7l
PROPERTY OWNER T6M fleI!~g= TELEPHONE # '7q02 c/4 5-
COMPLETE THIS SECTION FOR °NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MQNvESO"l'A RULTS 7670 GITECORY I MINNESO'1'A RliLES 7672
(J submission type) . Residendal Ventilation Category i Worksheet Submitted • New Energy Code Worksheet Submitted
• Energy Envelope Calculatlons Submitted
Plumbing Contractor: _ Phone #
Plumbing system includes: _ Water 5oftener _ L.awn Spdnkler Fee: $90.00
Water Heater _ No. of R.I. Baths
_ No. of Baths
Mechanical Confractor. Phone #
V[echanical syslem includes: Air Conditioning Fee: y70.00
Hcat Recovery Syslem
Sewer/Water Contractor: Phone #
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 Eagon Ordi nces.
Slgnature of Applicant
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4f02
OFFICE USE ONLY
? 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 Ext. Alt - Multi
? 03 01 of _ plex O 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multi
? OS 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
? 31 New ? 35 Int 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 Canst Width
REQUIRED INSPECTIONS
_ Foorings(new bldg) _ FinaVC.O.
_ Footings (deck) _ FinaVNo C.O.
_ Footings (addiuon) _ Plum6ing
Foundarion 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 8 Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
PERMIT # r 1 T_3 -)N RECEIPT DATE:
EOOE MIDEPTIAL PLIJM$INfi PERM1T APP11CATION
crrY oF KAsM
3930 Pu.(Tr Kxoa itn
KneAx, suv 55122
651-661-4875 n ~i
Please complete for: single family dwellings, townhomes and condos when permits are required for eac it,MAR Q 7nnz
backflow preventer for irrigation system ~
Bv- Sa- -
SITE ADDRESS:
OWNERNAME:: TELEPHONE#: 90: 'c 77
(AREA CODE)
INSTALLER NAME: C`O TELEPHONE
(AREA CODE)
STREETADDRESS: agigg A.
CITY: mu~~ ~~~Q, STATE: ZIP: 7
_ SEPTIC SYSTEM, new/refurbished (requires two sets of plans and MPC license) $ 100.00
includes $40.00 County fee
Note: Additional consultant fees may apply
• MODIFICATION/ALTERATION TO EXISTING DWELLING UNIT, INCLUDING:
_ Adding fiMures to lower levels or room additions, excluding water softeners and water heaters. $ 50.00
_ Abandonment of septic system.
_ Water tumaround - existing dwelling unit 5!8" meter if needed -$118)
Other:
_ RPZ: new installation/repairlrebuild $ 30.00
_ lawn irrigation system
ReplacemenUadditional: _ water softener ~ter heater $ 15.00
State Surcharge $ .50
Total S rs 6-6
I hereby acknowledge that I have read this appliration, state that the information is correct, and agree to complywith all applicable Cityof Eagan ordinances. It
Is the applicanYs responsibility to notify the property owner that the City of Eagan assumes no liabiliry for any damag~caused by the City during its normal
operational and maintenance actlvities to 1he facili6es constructed under this permit within propertylright-of-wa e m
~n
SIGNAZRE OF P ITTEE E 1102
C. R. WINDEN 3 ASSOCIATES, INC.
IAND SURVEYORS Tal 645'3846
I181 EUSTIS ST., ST. /AUI# MINN. 5610•
For: Grand Oaks Development Cor.ipany
Scale: 1" = 30'
O Denotes Iron
Monument
~
~ Droina9P ~'U~..'!,;y Easen;e~r_.
5 87° 30' 29° E ,
?u 125.G0
- 9o6•9J
- in ,
to Li
i ~
I I O .
~ NCD I- 42.7
PROPOSfD
I 3O N HOUSE ~ I W
U 2oJ (to o rJ ~
o
M ~ ~p
~ no
m I tV
N'i- f- z
~ ~9G7 26 ? 125. 37
s (9-°42'2919oz4) I
Lot 5, Block 3, SUN CLIFF SECOND
tiOTE: ADDITION, Dakota County, Minnesota
o Denotes Wooden Stake
Propored Garage Floor E1.
(909.¢) Denotes Yroposed
Finished Ground E1.
-V-- Denotes Direction
CZ S~rfaca Drainage
Czrtical Da:,= - N.G.V.D. 1929
WE HEREEY CERTIFY THAi THIS IS A TRUE AND CORRFCT REPRESENiAtION Of A SURVEY OF iME
lOUNDAAiES OF 7HE IAND A60VE DFSCRIlED ?ND OF THE IOCATION Of Atl 6UIlDINGS, IF ANY,
7MfREON, AND Atl VISIlIE ENCROACMMfNTS. IF ANY, fROM OR ON SAID LAND
Detad tAu 28rl der el Navcmbev A D 10 8Y C. R. WtNDEN 6 ASSOCIATES, INC
?r
Sur„eyor, Minnoaolo Rapmroiien No 77126
nZ o
.
EXTERIOR ENVELQPE AVEFtAGE 'U' COMPUTATIQhI
GRAND OAKS DEVELOFMENT COMPAIVY
MODEL T AREA U U X AREA
kEQUIRED
i. TOTAL WALL AREA 1500 X.11 165
2. TQTAL RpQF AREA 836 X.Qib 21.736
ACHIEVED
AREA U U X AREA
A. WINDOW AREA 117.77 .5 58.885
B. DOOFi AREA 39.8 .077 3,0646
C. S!_IDE GLASS AREA 13.44 .48 6.4512
D. FIREPL.ACE AREA i.i 0 U E. WAI.L FRAME AREA ISU .041 6.15
F. NET WALL AREA 998.99 .449 48.95081
G. RTM JOIST AREA 99.6 .0436 4.34256
H. FOUiVD WINDOW AREA 4 U D
I. FOUND ABOVE GRAAE 80.4 .135 10.854
3. TOTAL WALL AREA 150i) 138.6979
J. Sk:YLITE 4 0 0
K. FtDQF FRAME 83.6 .032 2.6752
L. NET ROOF AREA 752.4 .025 18.81
4. T'OTAL Ft00F AREA 836 21.4852
SUM 1.+2, 186.736
SUM 3.+4, 160.1831
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830 PII.OT KNOB RD - 55122
`T 651-681-4675 ~
New Cons W clion ReauiremenLs Remadel/Reoair Reauirements
? 3 registered site surveys showing sq. R ollot sq. R ofhouse ? 2 capies of plan
and aff roofed areas (20% maximum lot wvereae ailowedl ? 1 sel of energy plalaGons for heated additions
? 2 copies of plans (show beam 8 window sizes; paured tnd. design; etc.) ? t sile survey for exterior additions 8 decks
? t set ot energy plalaBons
? 3 apies of tree preservatian plan if lot platted after 7/11/93
4~
DATE: CONSTRUCTIONCOST: 3~
DESCRIPTION OF WORK: N;2C3fl~ <::~T}~ VV\ c 4 w`¢`'e ~
STREET ADDRESS: Jf3 ~Z I iF=~= ~CI LOT: ~ BLOCK: SUBD./P.I.D. V-\ X n 1~+ a
~
Natne:_^ Phone#: e3-79), _
PROPERTY F"Tt
OWIVER
StreetAddress: 'q312
City GT-\ _ S[ate: Zip: .J 5-1 ZZ
r~,
~ f / ?l Co?ts'I^ - Phone ~"5 1_ "25- 16ct .3
Company: ;y
CONTRACTOR
Street Address: OS? License #~,3 5 Exp.9-3~ --9 ~
City State: MI`l Zip: __lJ~J I U~
ARCHITECT/
ENGINEER Company:_______ _ Phone
N:une:..... Registration N:
Street Address:__~_______
City S[a[e: - ZiP'
Sewer & water licensed plumber (reauired for new construction onlvl:
Penaity applies when address change and lot change is requested once permit is issued.
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.
Signature of Applicant'~\C'~qn .L 1~ Gt ~encc~9~
OFFICE USE ONLY
Certificates of Survey Received Yes No
- - _1\1J -
I` I I~II~` Z Z IJJJ
Tree Preservation Plan Received Yes No Not Required, i 11; ? i
I
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 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 0 13 16-plex ? 18 Deck ? 23 Porch (screened)
? 04 2-plex ? 09 7-plex ? 14 Apartments ? 19 Lower Level ? 24 Storm Damage
? 05 3-plex ? 10 8-plex ? 15 Lodging ? 20 Pool ? 25 Miscellaneous
WORK TYPE
? 31 New ? 35 Tenant Impr ? 39 Gas Line Only O 43 Siding/Soffits/Fascia
? 32 Addition ? 36 Move Bidg. ? 40 Gas Insert ? 44 Windows/Doors
? 33 Alteration ? 37 Demolish Bldg. ? 41 Wood Stove ? 45 Fire Repair
? 34 Repair ? 38 Demolish (Interior) ? 42 Reroof
GENERAL INFORMATION
Const. (Actual) Basement sq. ft. Census Code
(Allowable) Main level sq. ft. SAC Code
UBC Occupancy sq. ft. No. of Units
Zoning sq. ft. No. of Bldgs
# of Stories sq. ft. MC/ES System
Length sq. ft. City Water
Width Footprint sq. ft. Booster Pump
PRV
Fire Sprinklered
APPROVALS '
Pianning Building Engineering Variance
Permit Fee Valuation: $
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:
SAC Units
% SAC
,
2/f~Y
CIT
Y OF EAGAN
, m®r
APPLZCATICN FOR PERi~IIT
• SEWER AND/OR WATER CONNECTIODT
(PLEASE PRINi)
i> PROPEK«'Y ADDRESS: .Svn Ir"f'r P) e) e,
T= DFSCRIPTICV: (6 lac k•3 Sur) c0 nd
(Ir~t/Block/SubCii.vision or Tati Parcei I.D. Ntsrber)
1 I"r ~=S"=:G S'?'4CC:'!J:'v~., DrIT O~' ORT.Gi IAL =iiIi:P:G :-:m:I: T_SS~?\C~:
l '
Z:':IIir-/PT?OPOS=-) L'•5E• • R-1 S=GT.F, ^P,.I ~ vtLv
~i _
? R-2 DCTPL{ (7%0 U:IITS)
Tf ?Z'3 T'l.`.'\I~iCF (TF- i L-NIlC) ~ jJ1V1T."_-)
U -
tZ-4 Ai'yC:^=T/CC::DCL-'sill:,.%I ( ITiVI^_'J)
Q CCi.~i'~1&PCLI\I,/RESr'1TL,/Or 'IC
? 'CliST?,L?L
Q IXSTITi,TIO.1]AL/G(7'ER.Nn="P
2) APPISC VT (PLEASE PRfAi)
Y'G i 0a -
zDeREss: _ 7(o 3OAoQ r I ~C fl ~r~ ~S
CT:Y, STATE, ZIP: LGA,, viII~
PxoiNE: ~/.3 ~ ~ ln S~G 1
3) pIvtgER LEAS[ PRIHT) , FOR CITY USE ONLY
DIANIE: / w. b, r. c
11GDRESS: SyI S~ CL~ PLJHBERS LICEYSE:
[--_n Active
crrr, sTAzE, zrn: ~ p o I F Yc~ //r yrr . S S' j~ c/ ~ Expired
n Q Not of Record
PHONE: PLUMBER LICENSE N
atr nitia
4) pcc[Jpp,,'I`/C(NvER DIFME: (PLEASE PRIN()
A[]DRESS:
CIT"l, STA'PE, ZIP:
PHONE:
5} INpiCP,TE «{ICH PERMIT ZS BEING REQUES'I'Gp:
~ CO.INECrION 'PJ CITY SETi7ER
~ W N .IO:I 'In CITY t,TATER
? dilTER (PLCASE DFSCFtIBE)
6) I241DICATE C:lE:
? PI=aSE F?OID APPR(7Vm PER5IIT FOR PICF-UP BY ONE OF ABGVE
~ PLFi'15E h'AIL APPRCVM PM"IIT TJ 1. 2. 0 4 A6Cn/E
(Circle one)
7) SICZZATL`RE: G DATE: f /0
~v
RAalilVS~i~ i ialo:aa~a! iry. ros:asis M a~ s~sa~:~a a[ ftaicff+.esi~llne S`sssY~-.sar
F 0 R C I T Y U S E O N L Y
PE2MIT ISSUED
. ~
F°ES: $ ~O S"Q SE:'iLR PEBM7T (INC:.::D: SU?C:::1P.Gc)
$ i6, e5l WATER PERA1IT (INCiuDE SliRCHA<2GE)
$ WATER METER/COPPERHORN/OUTSIDE REi,DER
$ WATER TAP (INCLUDE CORPORATION STCP)
S SE;dER TAP
$ lS, ~-b :rCOi:_~T =GSy_ - a_:.?3
$ ACCOUNT DEPOSIT - PIATER
$ -G/ ^70. r".-~ WAC
$ v~- =2~5-- ~-cJ SP.C
$ TRliVK WATER ASSE55:-?E:1T
$ TRti27K SEGiER A5SE55:•1°`IT
$ LATERAL BENEFIT/TRUNK SE:IE4
$ LATERrIL BENEFIT/TRUNK [JATER
$ OTHER '
$ TOTAL
$ AMOL'NT PAZD/RECEIPT
DOES UTILITY CONNECTION REQUIRE EXCAVATIO[V IN PUBLIC RIGiIT OF WAY?
YES IF YES, THEN A"PERMIT FOR 'rlORK WITHIN
PUBLZC ROADWAY" MUST BE ISSUED BY THE
' EZ-~ NO ENGINEERING DIVZSION. LIST AS A CONDI-
TION.
SUBJECT TO THE FOLLOWING CONDITIONS: '
APPROVED BY:
TI:LE: -4/~~
DAT°: -
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- 1999 BUILDINC PERMIT APPLICATION (RESIDENTIAL)
CITY OF EACAN
5L-~ 3830 PILOT KNOB RD - 55122
651-681-4675
New Construcflon ReaulremeMs Remodel/Repair R ~ ,
> 3 registered sMe surveys showing sq. fl. of bf, sq. N. of house 2 copies of plan
and go roofed areas (207, maximum lot eovcvaae allowed) 1set of energy calculatlons tor heated addNbns
> 2 copies of plans (show beam a window skes; poured Ind. design; etc.) t sMe iuney for exterlor addlNons t dxW
> 1 set of energy calcutaHOns ~
: 3 copies of free presenation plan H Iot plaMed aflev 7/1 /93
o
DATE: lJJ -g'-175 CONSTRUCTION COST: 7 S0D 0
DESCRIPTION OF WORK: A-~ SG
STREEf ADDRESS: 3 Z S U N R D
LOT: ~ BLOCK: 3 SUBD./P.I.D.#: ~LU- `
Name: 7-D rv~- Phone &sf -I 0S -37 9 1
PROPERTY lasl First
OWNER
Street Address: ~Z~ ~ Z Su !ll C~t 1g P
City G4C~ A-Vv State: /U/ /U ZIp: SS f Z Z
Company: Phone#: y5) 6
(area code)
CONTRACTOR Q G z~or~ya~ 3-31^L~C
Sheet Address: V 2 l~ ~~'R ~dV ~ License #
ctfy (4 A-5 Tl k)c~ S state: VL-t N zip:
ARCHITECT/
ENGINEER Company: Name:
Telephone area code ( )
Sheet Address: Registration
City State: Zip:
Sewer 3 water Ilcensed plumber (reauGed for new consfructlon onlvl:
Penalty applles when address change and lot ehange Is requesfed once permR is issued.
i hereby acknowledge thot I have read 1hh applkallon, state thaf ihe tn}ormaflon Is c nect nd agree ly wBh all applicabl
5tate of Mlnnesota Statufes and Ciy of Eagan Ordlnances. ~ ~
, Slgnafure of Applieant:
OFFICE USE ONL
Certificates of Survey Received _ Yes _ No
Tree PreservaGon Plan Received - Yes - No _ Not Required_ _
~
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 4-plex ? 11 10-plex [3 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 ? OS 6-plex ? 13 16-plex A 18 Deck ? 23 Porch (screened)
? 04 2-plex ? 09 7-plex ? 14 Apartments ? 19 Lower Level ? 24 Storm Damage
? 05 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 WindowslDoors
A~ 33 Alteration ? 37 Demolish Bldg " ? 41 Wood Stove ? 45 Fire Repair
? 34 Repair ? 38 Demolish (Interior) ? 42 Reroof
• Give PCA handaut to applicant for demolition permit
GENERAL INFORMATION
Const. (Actual) c3-• ^l Basement sq. ft. Census Code 434
(Allowable) 2E Main level sq. ft. SAC Code °f
UBC Occupancy 17 •~7 sq. ft. No. of Units l
Zoning ~L sq, ft. No. of Bidgs 6
# of Stories sq. ft. MC/ES System
Length sq. ft. City Water
Width Footprint sq. ft. Booster Pump
PRV
Fire 5prinklered
APPROVALS
Planning Building l~ Engineering Variance
- V
Permit Fee Valuation:
Surcharge
Plan Review
License
MClES SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI. •
Park Ded. -
Trails Ded.
Other Copies
Total:
SAC Units
% SAC
I
A R R e5~ S. y 3 t Z S L),vc R P
~
T P, E AI
yp t.T
1(O
~k~ST
~
/
ano-+m tT
; F,.
~ ~ . .
FCg~
P Ro~~ ~T ,,.'7
uGY
~ r re 1A
~r
SUNCLI ~ ~ ~
F No C CAtV-0
FIOUS~E HEATf~Yl: "fEST R[:COkU . -
CiTY OF ST_ pAU1_ Ad~ a-'e S~rect Na.ne at nvc.R.+vdetc N S,E W..
OFFICE UF LICENSE, INSPECTIVn$ pNp ENVIRONA~ENfAL pRpTFt- T~ON xmwl
L-~~
]SOS"rPETEa9iREET.SVIT[]on PnUUirvni'!:prn-.9~uyiqip OtCllpanf ~uAafAiIM
Property p~ynet l Flo~~r pr
Sold By
Fledrical Work By
HEA7 Gas Line Work Gy
Onta He.ahnq
-L'OSE Insta7led Gos~ FpiCP,(i AiHot Wnlar
G/S bE91GNi ~~celieater.Q. UmtHeator~ rJ Clthor~tnflm[~..
Meke
00 .
Input'N~Oll~a MAks of 6umer CONVERSIpN
~ND Moeei
Ge '
nal# D~
CONTROtS ' - 2 Maz. EtTU Ra~y t~.
TMERM057n7 j~ rieal Pniy Make of Fvrnacc MortelW~- ~ -
Valve Vrnl Surv
Klntl of Uner
. I.imX Smm~9 qrxfl Noatl Non~
Fun SBPong Z_ A - - ?vYWrlar`_ -
rltPresxe .
Pilot rYPe.J1~ Number
- .hiRlney I_~Wtroq InsMe
PiM Myke
~ hunneY ConsiruUlnn
V'BO1MOdef Pilot'fhmny SpiNngn
L.W. Cul Off Smoke Bomb ~rin9 ,
Pr65EUM ~ ~)rell
Ptrcent COZ p~or pre 7es1 T. np
lnpyt CFH 0 9surB --`lghlitlqlns!
Pw~cnnl pI ~ ~ Company r~
Stade 7emp. resun~ na~e
PalCentGO Nomeot 7nICE ~1~~/~
C~itC`
N m r
4~v
Zd WdS0:Z0 Z00Z S2 ';00 9tiLLLS4LS9: 'ON Xti~~~ ONIlFi3H 213QNIH: WOa--l
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 4312 Sun Cliff Rd
Lot: 005 Block: 003 Addition: Sun Cliff 2nd
PID:10- 72976 - 050 -03
Use:
Description:
Sub Type:
Work Type:
Description:
Comments:
Fee Summary:
e - Furnace
Replacement
Fumace
Contractor:
Binder Heating & Air Conditioning
222 Hardman Ave N
South St Paul MN 55075
(651) 457 -8781
Quesetions regarding elec
952- 445 -2840
Karissa Binder
222 Hardman Ave N
cal permit requirements should be directed to Mark Anderson, State Elec
ME - Permit Fee (Replacements)
Surcharge -Fixed
Total:
Applicant/Permitee: Signature
PERMIT
City of Eaan
- Applicant -
$50.50
Owner:
Thomas Helget
4312 Sun Cliff Rd
Eagan MN 55121
Permit Type:
Permit Number:
Date Issued:
Permit Category:
$50.00 0801.4088
$0.50 9001.2195
I hereby acknowledge that I have read this application and state that the informa
of Minnesota Statutes and City of Eagan Ordinances.
on is correct and agree to comply
h all applicable State
Issued By: Signature
Mechanical
EA078317
06/15/2007
ePermit
cal Inspector,
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 4312 Sun Cliff Rd
Lot: 5 Block: 3 Addition: Sun Cliff 2nd
PID:10- 72976 - 050 -03
Use:
Description:
Sub Type: e- Reroof
Work Type: Replace
Description: House & Garage
Census Code: 434 -
Zoning:
Square Feet: 0
Comments:
Fee Summary:
Valuation: 3,000.00
Contractor:
C R Contractors LLC
7541 236th St E
Lakeville MN 55044
(612) 490 -7933
Total:
Applicant/Permitee: Signature
PERMIT
City of Eaan
Construction Type:
Occupancy:
Permit closed without required inspection(s). Letter sent to applicant on 3/18/09. (pf)
If there is no ice protection inspection prior to final, you must meet inspector with ladder and flat bar. Pictures are not
acceptable in lieu of inspections.
BL - Base Fee $3K
Surcharge - Based on Valuation $3K
- Applicant -
$88.50 0801.4085
$1.50 9001.2195
$90.00
Owner:
Lindsay M Demarais
4312 Sun Cliff Rd
Eagan MN 55122- -226
Permit Type:
Permit Number:
Date Issued:
Permit Category:
I hereby acknowledge that I have read this application and state that the informa
of Minnesota Statutes and City of Eagan Ordinances.
on is correct and agree to comply
h all applicable State
Issued By: Signature
Building
EA085317
08/15/2008
ePermit
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA113428
Date Issued:09/04/2013
Permit Category:ePermit
Site Address: 4312 Sun Cliff Rd
Lot:5 Block: 3 Addition: Sun Cliff 2nd
PID:10-72976-03-050
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar.
Pictures are not acceptable in lieu of inspections.
Carbon monoxide detectors are required by law in ALL single family homes .
Matt Kral
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 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 -
Angel Jr A Rivera
4312 Sun Cliff Rd
Eagan MN 55122
(651) 492-6476
Midwest Exteriors Plus Inc
6451 Sycamore Ct N
Maple Grove MN 55369
(763) 427-9696
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA135736
Date Issued:03/31/2016
Permit Category:ePermit
Site Address: 4312 Sun Cliff Rd
Lot:5 Block: 3 Addition: Sun Cliff 2nd
PID:10-72976-03-050
Use:
Description:
Sub Type:Siding & Windows/Doors
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of house wrap and leave on site for final inspection.
When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to
ensure maximum ventilation to attic. Call for final inspection after installation.
Valuation: 8,000.00
Fee Summary:BL - Base Fee $8K $162.25 0801.4085
Surcharge - Based on Valuation $8K $4.00 9001.2195
$166.25 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 -
Angel Jr A Rivera
4312 Sun Cliff Rd
Eagan MN 55122
(651) 492-6476
Custom Remodelers
474 Apollo Dr
Lino Lakes MN 55014
(651) 784-2646
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA149677
Date Issued:06/05/2018
Permit Category:ePermit
Site Address: 4312 Sun Cliff Rd
Lot:5 Block: 3 Addition: Sun Cliff 2nd
PID:10-72976-03-050
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.
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 -
Quinten L Billingslea
4312 Sun Cliff Rd
Eagan MN 55122
(651) 338-3393
Champion Plumbing
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA172140
Date Issued:09/16/2021
Permit Category:ePermit
Site Address: 4312 Sun Cliff Rd
Lot:5 Block: 3 Addition: Sun Cliff 2nd
PID:10-72976-03-050
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & Air Conditioner
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507)
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 -
Quinten L Billingslea
4312 Sun Cliff Rd
Eagan MN 55122
(651) 338-3393
Bob Boldt Hvac
4310 Trenton Tr
Eagan MN 55123
(651) 454-7760
Applicant/Permitee: Signature Issued By: Signature