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1073 Tiffany DrCITY OF CAGAN 3830 Pilot Knob Road WATER SERVICE PERMIT P. O. Box 21199 Eagan, MN 55121 PERMIT NO.: Zoning; ' DATE: Owner: r: No, of Units: ddress: J Its Address: ti -- lumber: 'a }la n ete SNo.: 3 417 a c _ ? Coiiri cH 4 o , fti e. ?g,. Fn l s l e rr U rge: _ . n 7: eader No.: _D9 L J6 8S _ y y ' __ 1 5.0(7 0.? Gem to seM* MR# the City of ?e Permit ee: 1(? . 00 pd Surcho ---- LO pd ?ge: • ?? Dd --- Misc. Charges: 63-90 nG meter B Total: Y Date of I Dote Paid: Insp.: CITY OF FAGANr 3830 Pilot-Knob Road WATER SERVICE PERMIT P. O. Box 21199 PERMIT NO.: 5814 Eagan, MN 5511 DATE: - 4 Zoning: Owner: Corpor ate Cnnar No. of Units: - - -- - Address: 11 Sift Address: 1073 T Plumber: •a' ?la iffan Drive L2296 i-;l Cantebu Forest ep rib Meter No.. Size: Connection charge: 470.00 pd Reoder No.: Account Deposit: 15.00 pd ee * whh the Permit Fee: City of Eo ee 10.00 d Il Surcharge: . 50 rd Misc. Charges: 6 3 , 00 p d mete r By Total: Date of Insp.: Date Paid: Insp.: CITY OF EAGAN 3830 Pilot Knob Road P• O. Box 21199 Eagan, MN 55121 Zoning: Owner: Cor o Address. Site Address: 10 73 1 Plumber _ P,av ue iNy w" the py OF Eaya• "Menem Connftvan Charge: Account Deposit: Permit Fee: Surcharge: Misc. Charges; Total: Dote Paid: _ SEWER SERVICE PERMIT PERMIT NO.: 7 G 7 DATE: r-r rate rnr-« No. of Units: ` I CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHONE: 454-8100 BUILDING PERMIT `' lli•IG/GAR $66 000 Receipt q6 M:)1 OCTOBER 25 84 To be wed for - Est. Value Date _. 19 1073 TIFFANY DR ff R 3 Site Address Erect Occupancy Lot 26 Block 1 S c/Sub. CANTERBURY FOR Remodel ? Zoning I'll Parcel No. Repair ? Type of Const. V Enlarge ? No. Stories '70" ORTM; CONST INC Move El Length 50 Name 44 66 WEDGWOOD DR Demolish ? Depth -5-u Address 'A GAN 454-0644 Grade ? Sq. Ft. City Phone zo Name _ ?? Address ?- City _ G? ?W Name _ W =Z Address Phone 1 he :.od this application and state that the urrect and agree to com ly /with all applicable State of Minnesota Statutes on¢'City of E rdinances. Signature of Permittee Assessment Permit ' Water & Sew. Surcharge . Police Plan check _ Fire SAC Eng. Water Conn. Planner Water Meter Council Rood Unit Bldg. Off. Parks APC Total r - Var. Date 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 Plumbing y r . (fi . H.V.A.C. ? • ? i I ` t% A b , r Y I - `I a Electric n f t ?? c 1 3 7? J ?f ?h' i ?c? r ?t ( 3 U Softener Inspection Date Ins p. Other Footings Foundation r H w RoughHVAC Insulation ,36 - 66- 9< Final Plbg 1S' / Final HVAC Final .? Cert/Dcc. 'X Water Describe Locatio . Well Sewe? Pr. Disp. Receipt PLUMBING PERMIT Permit No. 1 ? 1 CITY OF EAGAN - Fee ' Fill in numbered spaces S/C Type or Print legibly T ot. 1. Date 2. Installation Cost 3. Job Address Lot Blk. f' Tract 4. Owner 5. Contractor i i Phon e 6. Address 7. City State Zip 8. Building Type: Residential 0 Commercial ? Institutional ? i 9. Work Description: New er Add ? Alter ? Repair ? 10. Describe 11 No. Fixtures Water Closet No. Fixtures Cesspool /DrainfieId Bath tubs Septic Tank Lavatory Softner Shower Well -L Kitchen Sink Urinal/Bidet Other Laundry Tray Floor Drains Drinking Ftn. Slop Sink 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: for Rough Final Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. Approved CITY OF EAGAN 454-8100 Receipt MECHANICAL PERMIT Permit No. CITY OF EAGAN Fee Fill in Numbered spaces S/C Type or Print legibly Tot. $ 20.5n 1. Date 2. Installation Cost 3. Job Address Lot Bik. Tract 4. Owner - ,, porate Construct f c- r 5. Contractor Phone _w :.i 6. Address 7. City State zip i344 8. Building Type: Residential Q Commercial ? Institutional ? 9. Work Description: New © Add ? Alter ? Repair ? 10. Describe House Peatii, . Fuel Type e. r: as 11. No. Eouipment BTU - M. Ea. Forced Air No. Equipment CFM Air Handling: Mfg. Boilers Vent Mfg. Mech. Exhaust bm th f ant 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 : for Rough Final Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. Approved CITY OF EAGAN 464-8100 f CASH RECEIPT CITY OF EAGAN P. 0. BOX 21-199 EAGAN, MINNESOTA 55121 DATE 19 RECEIVED FROM AMOUNT $ j!, I J DOLLARS ioo ? CASH CHECK Z FOR ICA ? ' ? FUND CODE AMOUNT Thank You L White-Payers Copy Yellow-Posting Copy Pink-File Copy ' CASH RECEIPT CITY OF EAGAN P. O. BOX 21-199 EAGAN, MINNESOTA 55121 DATE 19 AMOUNT is I' DOLLARS +oo ? CASH f?I-CKECK 'f I POR FUND CODE AMOUNT ; 5= _17 V /Ss L_ f Than u BY I White-Payers Copy Yellow-Posting Copy Pink-File Copy INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number. Eagan, Minnesota 55123 Date Issued: (612) 681-4675 SITE ADDRESS: LOT' s 26 et OCK a 1 APPLICANT: 1073 TIFFANY DR C e H REMODFt.IND CANTERBURY FOREST (612) 423-4686 PERM[j ?UBTYPE: TYPE OF WORK: L Control No. 04177 "Urculm" 066677 061 0192 NEW ,? ; ? .?? t?' ='K_.-J?i.J. ? '3 _il ?_ ._ _. :a ??}r. ? ; -•,I ? " ? .. V ? _ ;°. _-G `. .. ?4h A"- f .1 ? . -n-ri?' i C?'.hw I . ?.C +?-'. _ ; ,J Ps I H No. Pon"It Holder Date Telephone N SJW PLUMBING HVAC ELECTRIC ELECTRIC Inspection Date Map. Comments Footings I Foundation Framing Rooting Rough Plbg. Rough Htg. Isul. Freplaw Final Hig. Orsat Teat Final Plbg. Plbg. Inspector- Notify Plumber Cont. Meter EngrJPlan Sidg. Feral Deck Ftg, e? jr? st' Deck Final well Pr. Disp. CITY OF EAGAN Remarks h w - / U T Addition -CANTERBURY FOREST Lot 26 elk 1 Parcel Owne'.4 4j-?i1 &),', ffaj Istreet 1073 TIFFANY DRIVE State EAGAN 5123 Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. qp(o 1979 Paid unde original Ta rcel STREET RESTOR. GRADING 1 1 106.78 5.34 20 8S,46 A01344 1-12-8 SAN SEW TRUNK 2-1 1973 Paid unde original pa rcel * SEWER LATERAL S?; 1981 39.42 21.97 20 WATERMAIN WATER LATERAL 0 WATER AREA L164 1929 Paid unde original rcel STORM SEW TRK STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT Road Unit 260.00 4147272 10-25-84 WATER CONN. 470.00 BUILDING PER. SAC 525-00 PARK This request void q4 I 'L Z- I? I p 7 18 months from C A 0:306730 ?r CY 3?.vz? Request Date rX' Je f} ?/y r ) Fire No. Rough-in Inspecti n ned? Re,-q,.e ?Ready Now [(14111 Notify Inspec- h / ( / 1 V Bs3r es ? No for W en Ready (y clcensed Electrical Contractor I hereby request inspection of above ? Owner electrical work installed at 4 Street Address, Box or Ro No. City Section No. ownship Name r o. Range No. County O racy Pant (PRI T) /t N Mf V Phone No. Power $/ Dlier Address Electrical Contractor (Company Name) T 'y *r Coontr tor's License No. / O Mailing r s c e stailationl 14540 PENNOCK LANE Authorized "LrEC6Rr3§dt&/L r,, IRa!(jd® llisleg241 Phone Number MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT Griuga-Midway Bldg. - Room N•191 BE ACCEPTED BY THE STATE BOARD 1821 University Ave., St Paul. MIN 55104 UNLESS PROPER INSPECTION FEE IS Ph- f6121 29L2111 ENCLOSED. ?( I I L REQUEST FOR ELEQTRICAL_ INSPECTION Lb-°-- - 11 n Sae instructions Ior Cam this form on back of yellow copy. I Z 5'/? y "X" Below Work Covered by This Request A 73 Pil.iw Add Rep. Type of Building Appliances Wired Equipment Wired I Home Range Temporary Service Duplex Water Heater Lighting Fixtures Apt. Building Dryer Electric Heating Commercial Bldg. 'Furnace Silo Unloader Industrial Bldg. Air Conditioner Bulk Milk Tank Farm Other oeci y -her (sped fy) [ r Specify Other Other Compute Insoection Fee Below k Fee Service Entrance Size a Fee Feeders/Subleedera p Fee Circuits 0 to 200 Amps - 0 to 30 Am s .U? 0 to 30 Am Above 200 Amps 31 to 100 Amps 31 to 100 Amps Swimm Pool Above 100_Am s Above 100-Amps Transiormers Irrigation Booms Pa rtia l.'Other-F e e? Signs Special Inspection C TOTAL E 0 Rem3r s t _F p Rough-in %ta/ • I, th lectri.st / /(Q Inspector, hereby • certi (y that the above Final Date 7 spection has been _ ?- a? made. This request,old 18 months train CITY OF EAGAN M 9651 3830 Pilot Knob Road, P.O. Box 21.199, Eagan, MN 55121 PHONE: 454.8100 BUILDING PERMIT Receipt # 7 SF DWG/GAR $66,000 84 OCTOBER 25 To be used for Est Value Date 19 Site Address 1073 TIFFANY DR Erect EX Occupancy R3 Lot 26 Block 1 sec/Sub. CANTERBUR Y FOR Remodel ? Zoning RI Parcel No. Repair ? Type of Const. V Enlarge ? No. Stories at Name CORPORATE CONST INC Move ? Length 50 2 Address 4466 WEDGWOOD DR Demolish ? Depth 50 city EAGAN Phone 454-0644 Grade ? Sq. Ft. SAME o Name r, o Address i- City Phone e w Name f 11 Address 'kq - " <' City Phone Approvals Fees Assessment Water & Sew. Police Fire Eng. plonner Council Permit T 3 31 . U U Surcharge 33.00 Plan check 165.5 0 SAC 525.00 0 Water Conn. 470.0 Water Meter 63 _00 Rood Unit 260 _ 00 I hereby acknowledge that I have read this application and state that Bldg Off. lU/14/tf4l Parks the information is correct and ye?ee to com ly vith oil oppllcable State of Minnesota Statutes a{? Lity of E Ordinances. APC Total U Var. Date Signature of PermiMee A Building Permit Is issued to: CORPORATE CONST on the express condition tisoi all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN To Be Used For: F. PuG. ?GafZ. INCLUDE © SETS OF PLANS, s// © CERTIFICATES OF SURVEY Q SET OF ENERGY CALCULATIONS Valuation: 0(,Q)0, 2?- Date: Site Address: 07 } f LOt:'U, Block: ) Sect/Sub: Parcel #: Owner: l 01-PO's Ce-,M&, c Address: 446 f, GJ,4sV-0 J & City/Zip Code: OaAd. /blN 55'IZ3 C, a Phone #: `Sq-06gq Contractor: Address: City/Zip Code: Phone #: Arch./Eng: Address: City/Zip Code: Phone#: ro14rect : Remodel: Repair: Enlarge: Move: Demolish: Grade: X Occupancy: Zoning: (Z-? Type Of Const: # Stories: Length: rj0 Depth: Sq. Ft.: Assessments: Water/Sewer: Police: Fire: Engr.: Planner: Council: Bldg. Off.: APC: Variance: Permit: 331. Surcharge: 33,-° Plan Rev.: ?1o5,`z` SAC: 525. °= Water Conn: ^: 4-0 Water Meter _ (0.3 Road Unit: 'L&O. Parks: // (?? d (7• S? I S,URVEYOR'S CERTIFICATE ' SIENNA CORPORATION yf. O DENOTES IRON MONUMENT SET • DENOTES IRON MONUMENT FOUND PROPOSED GARAGE FLOOR = 9t 8.3 FEET * DENOTES WOOD HUB PROPOSED LOWEST FLOOR = 91S•S FEET (000.0) DENOTES EXISTING ELEVATION PROPOSED TOP OF BLOCK = 91g,-I FEET WE HEREBY CERTIFY TO SIENNA CORPORATION THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF: Lot 26', Block 1., CANTERBURY FOREST, according to the recorded plat thereof, Dakota County, Minnesota. AND OF THE LOCATION OF ALL BUILDINGS THEREON, AND ALL VISIBLE ENCROACHMENTS, IF ANY, FROM OR ON SAID LAND. AS SURVEYED BY ME THIS 29TH DAY OF MARCH 1983 . SIGNED: JAMES R., HILL, INC. flY? BY: HAROLD C. PETERSON, LAND SURVEYOR MINNESOTA LICENSE NO. 12294 APPROVED FOR SIENNA CORPORATION BY: ROBERTS ARCHITECTS DATED THIS DAY OF 19 REVISED 10-19-84 -SHOW PROPOSED HOUSE FOR CORPORATE CONST. SHEET 1 OF 2 SHEETS PROJECT NO. BOOK / PAGE JAMES R. HILL, INC. 82143 (84936) Planners / Engineers / Surveyors FILE NO. 8200 Humboldt Avenu• South FOLDER Bloomington. Mn. 66431 612-884-3029 M SURVEYOR'S CERTIFICATE "'SIENNA CORPORATION WILDERNESS RUN ROAD 0=11052 f6" ° -?R= 729.29 t Z 01 0 O IOD ---- _1? a I V.,AINAGE 8 UTILITY EASEMENT PER PLAT I 1 ?5 ?Ytow I ?, LOT 26 ? N N Q ? la t- I W aM 'n W a° I Iz I I Z 1,.? II I rn I I lv I I w I I M I I I I I I w I I N I O I ? 24.// ' X91>'.0 42.OD PROPOSED?,- I HOU II N2'5-d7 // I + cn I ^?8.0-i.j I I I //M P, GAR v tw C91RtT (q1g33 _!9./61. I L__ T.L JS tit \` - V -K=456.15 L=9Q, w A=11°18 o '17' W TIFFANY ° DRIVE. I L_\J I c_' r SCALE: 1 INCH = 40 FEET 3) SHEET 2 OF 2 SHEETS REVISED 10-19-84 - SHOW PROPOSED HOUSE FOR CORPORATE CONST. PROJECT NO. BOOK / PAGE JAMES R. HILL, INC. 82143 (84936) Planners / Engineers / Surveyors FILE NO. FOLDER 8200 Humboldt Avenue South Bloomington, Mn. 65431 512-884-3020 N 4 1 _7V { EXTERIOR ENVELOPE AVERAGE "1) C01'dPUTATION >X r OWNER SITE ADDRESS; T?fftns4*'%l2`" CONTRACTOR DATE PHONE ` ??}`- Dla Determine working square footage of each. 4 I: Total,-ex os d e wall area p °/992. G sq. ft. x = 2: Total ro¢flaei l,i'ng area:. sq. ft. x -026 ' - [ . Total exposed wall area 'above floor =??4 T a: Total 'wall window area: , : /30 $ b. Total door area ... .. .. c.`Tati i sliding 'glass door area, t d.;Totoi fireplace wall area...:.... ; e.:Total'wall framing area (average 10X). / , f. Total' net wall area above floor ... r.x?G r g. Total rim joist area ..... Total exposed foundation area r h. Total foundation window area.......... _ i. Toal net foundation area above grade .......... '' fl Y-. Determine "U" value of each wall segment. b. X "U" F C. X 12 3? d. X „Ull _ e, X 'v. 0 pull h, X „N„ ?r? -- - X ?x . .. 3: ; .......... Total = 2:^. If item #3 is, the same as, or less than item #l, you have:met the intent' of SBC 6006(;)2. 2. q -1 4] Y' ' WALL SEGTIt1N8 - , ?' aao;g? ^ta wall area for + #rame.cbusirec#?,na flgnstrucr.ion ' L L. 3. 4. 5. f' 6. 1. Into a. i 3, • 5. 6. Exte z 0.68 0.17 ?, 70 SLAB ON GRADE r x x A'- ai? y ..1. { 5" 't5'? ;.s 5 4 k Y P J J g Y ? y y4 Y"" V 1. } 4 A-, F k Total exposed roof/ceiling area 3• Total skylight area. Total roof/ceiling framing area (avera9a 10%). T, Total net insulated roof/Eeiling area.... /p519 4/ determine "U" value for each roof/ceiling segment. 4 X: ?Iu k "u" o.z = 3 616 It J1 X -22 4... ......, Totai ?..? ...: .....:......`.. y #4 is the same as, or less than r2. 'you have, met the intent of 6 k St6U , 0 Alternate Building Envelope Design To utilize the.total envelope system method, the values established by the sum of items N3 and M4 shall not be greater than the !sum of items #1 aA d2. J.r r t r rf ,,'s' r PERMIT A CITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55123 (612) 681-4675 Control No. 0477 PERMIT TYPE: Permit Number: Date Issued: BUILDING 000572 05/20/92 SITE ADDRESS: 1073 TIFFANY OR LOT: 26 BLOCK: 1 CANTERBURY FOREST DESCRIPTION: , eu ld'kgg Permit Type Building,,,Work Type UBC Oecupaney Building Length Building Width}__, DECK NEW R-3 19 14 REMARKS: cclY?Iq FEE SUMMARY. Base Fee $25.00 COPY $.50 Surcharge.: $.50 Total Fee $26.00 Subtotal $25.50 . CONTRACTOR: - Applicant - OWNER: C B H REMODELING 14235585 SCOTT LEONARD 15686 CICERONE PATH 1073 TIFFANY DR ROSEMOUNT MN 55068 EAGAN MN 55123 (612) 423-5585 (512)452-7197 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 Mn. Statutes and City of Eagan Ordinances. I A LAam, LA L4 I ?,[?ir c c Q? ,? APPLICANT//F ERMITEE SIGNATURE PERMIT # CITY OF EAGAN 1992 BUILDING PERMIT APPLICATION 681-4675 MAY 1 4 R€c6 SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy calcs. COMMERCIAL 2 sets of architectural.& structural plans, 1 set of specifications, I 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 chin a is re guested once ermit is issued. Date ? / 15/ c ')? Valuation of work-#5-76Z Site Address: //) 73 -/-/ - ?"? STE t STREET - Tenant. Name: (commercial only) LOT BLOCK r y SUED. P.I.D. M Iz{2?57' Description of work: Y? - Q The applicant is: ? Owner 1PIContractor ? Other (Describe) Name :l 1!1 // 1 Wrf Iz Phone 7J Property UST FIRST Owner Address STREET STE N City ACra4/'J State ,Pv/z / Zip 5-5-1 Company (1,8 4t EfloW QFL /A Phone Contractor # Exp. )`?6`9 o ?IC'ffZOlUs Pik License Address / ? City f-03 20U State Zip 5-5-4 le Company Phone Architect/ Engineer Name Registration # Address City State Zip Sewer & water licensed plumber Processing time for sewer & water permits is two days once area has been approved. I hereby acknowledge that I have read this application and state that the information is correct and agree to comply wi h all applicable State of Minnesota Statutes and City of Eagan Ordinances. f_ ? Z4 Signature of Applicant: AA-1-1 a fl^ ?l OFFICE USE ONLY BUILDING PERMIT TYPE ? 01 Foundation ? 05 Apt. Bldg ? 09 Basement Finish ? 02 SF Dwg. ? 06 Garage/Accessory ? 10 Swim Pool ? 03 Two family ? 07 Fireplace ? 11 Res. Add. ? 04 Multi-fam. T.H. W08 Deck ? 12 Res. Porch WORK TYPE F31 New ? 33 Alterations ? 35 Move ? 32 Addition ? 34 Tenant Finish ? 36 Demolish GENERAL INFORMATION Const. (Actual) (Allowable) UBC Occupancy Zoning # of Stories Length Depth APPROVALS Planning Engineering REQUIRED INSPECTIONS ? Site ? Wallboard ? 1tOm*I6d-New ? 14 Comm/Ind Add ? 15 Comm/Ind Rem ? 16 Public Fac. ? 17 Agricultural Basement sq. ft. MWCC System 1st F1. sq. ft. City Water rz - 2nd F1. sq. ft. PRY Required Sq. Ft. total Booster Pump Footprint Sq. ft. Fire Sprinkler 19 On-site well `-i- Census Code 4)3q I On-site sewage SAC Code Building Assessments Variance 13 Footing )] Framing ? Insulation Final ? Draintile ? Fireplace Permit Fee ZS, oo vat ation: t Surcharge 5"D P view icense C City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment Pl. Road Unit Park Ded. Trails Ded. Copies Other Total: 26 SAC % SAC Units SIENNA •.,.. e/E 1 OR'S CERTIFICATE CORPORATION WILDERNESS RUN ROAD 52' i6" R=729.29 1-=!51,10 7. DRAINAGE 9 UTILITY O EASEMENT PER PLAT I 0 IF?w I ? y Wm? LOT 26 fWl1Q? Z wa" I a I aa? ? IZaa I Z I O) 0 I o I M I i_lJ I I i W [ _ .. I I M I I I I I w I 1 F) O ? I W n K rU 91 I 24.11 I r "I- I \ M 42 Do,//, PR. POSED ,? 1 I ? I N 3.67/ // I + to I .o- I a GAR'v 1 ' tw C9B-T' CZl 98.33 -19.161 ' 42. t •N za (o , r. o m ,L 15n?i? L=? <, ? _J w O C c 1/ R=456.15 L=gQ pp _ o A=11°1817' TIFFANY DRIVE. L_ll 1 [? h SCALE: 1 INCH = 40 FEET 3) SHEET 2 OF 2 SHEETS REVISED fo-19-84 - SHOW PROPOSED HOUSE FOR CORPORATE CONST. PROJECT NO. BOOK / PAGE JAMES R. HILL, INC. 82143 (84936) Planners / Engineers / Surveyors FILE NO. 8200 Humboldt Avenu* South FOLDER Bloomington. Mm 65431 612-884-3029 w 0 I 1999 BUILDING PERMIT APPLICATION (RESIDENTIAL) CITY OF EAGAN U? 3830 PILOT KNOB RD 55122 651.681.4675 New Conshuctlon Requirements Remodel/Repair Requirements 3 registered site surveys showing sq. ft. of lot, sq. k. of house and all roofed areas (20% maximum lot coverage allowed) D 2 copies of plans (show beam 6 window sizes; poured fnd. design; etc.) D 1 set of energy calculations D 3 copies 1''of tree preservation plan ff lott p?latied after 7/1 /93 DATE: 1000 CIA Q-, .7I I I DESCRIPTION OF WORK: t i C STREET ADDRESS: 5 f -f LOT: a (11 BLOCK: , SUBD./P . PROPERTY OWNER ??JI L Name: Phone #: bbl "7's-Z- 7I f Last First A Street Address: TO City (711 -7S 07- j? It -16 2 copies of plan 1 set of energy calculations for heated additions 1 site survey for exterior additions b decks `? Do Ji CONSTRUCTION COST: ll?ittJJ(W/ State: Zip: 557z j Company: v > a, Phone #: (area code) CONTRACTOR Street City State: ARCHITECT/ ENGINEER Company Name: Telephone #: area code ( ) Street Address: Registration #: City State: 'Sewer 3 water licensed plumber (required for new construction on N): Penally applies when address change and lot change is requested once permit is Issued. I hereby acknowledge that I h6e read this application, state that the Information is c and State of Minnesota Statutes and City of Eagan Ordinances. , -<? Signature of OFFICE USE ONLY Certificates of Survey Received - Yes - No License # Exp. Zip: Zip: comply with all applicabl Tree Preservation Plan Received Yes - No - Not Required 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. (4-sea. ? 03 1 of _ plex ? 08 6-plex ? 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 ? 32 Addition ? 36 ? 33 Alteration ? 37 ? 34 Repair ? 38 GENERAL INFORMATION Const. (Actual) (Allowable) UBC Occupancy Zoning # of Stories Length Width APPROVALS Tenant Impr ? 39 Gas Line Only ? 43 Siding/Soffits/Fascia Move Bldg. ? 40 Gas Insert ? 44 Windows/Doors Demolish Bldg' ? 41 Wood Stove ? 45 Fire Repair Demolish (Interior) ? 42 Reroof * Give PCA handout to applicant for demolition permit Basement sq. ft. Main level sq. ft. sq. ft, sq. ft. sq. ft. sq. ft. Footprint sq. ft. Planning Building Census Code SAC Code No. of Units No. of Bldgs MC/ES System City Water Booster Pump PRV Fire Sprinklered Engineering Variance Permit Fee 3. 5 Surcharge I. S Plan Review License MC/ES SAC City SAC Water Conn. Water Meter Acct. Deposit SNV Permit S/W Surcharge Treatment PI. Park Ded. Trails Ded Other Copies Total: 2:?(4 .-7 S Valuation: $ SAC Units % SAC 1 ali"tly i yr 1,L7 i 2/84 7 CITY OF EAGAN APPLICATION FOR PERMIT SEWER AND/OR WATER CONNECTION (PLEASE PRINT) 1) PROPS ADDRESS: © I - LECaI, DESCRIPTION: / z- (' (Loot/-Block/Subdivisicn or Tax Parcei I.D. Numbe I is ?:I =.G STRL'CTLTcE, DATE OF ORI=ZAL EUILDL`:G P?_•ST TCSU^% ---.? P.- ?^;7i::r/==OPCS= liSE- °•=_ 5- 1,trr 1 SLIG,:F. F_a_ Ly ? R-2 CUP= (TWO L-NITS) ? R-3 TG%NHC(JSE (TFTREE + LITITS) ( UNI^_S) ? R-4 APp.RT!ac-7 /CC:aCi-L.IL?1 ( L'Ni1T5I ? CQ`'1'?.°.CL-+I,/'RETAZI,/OFFICE p Dmus-,-aIA L ? PISTIT'?TIC'?'-1I./GG?'E^??? 1E?': 2) APPLI`- T (PLEASE PR 191) Mk%!E. l ?Xl n Q &V?Az- ADDRESS: q-4 CITY, STATE, ZIP:, PHONE: -4- L - O 3) PLL:IB°D (PLEASE PRINT) FOR CITY USE ONLY NAB: ?3 ll ^^ 1r iiia,.;a^451 6 rn.a?? -7- ADDRESS: " 722 PLUM RS LICENSE: Active CITY, STATE, ZIP: u?9Pdf? ?5? Q Expired PHONE: 8i010- Naicn I0(O°{,? PLUMBER LICENSE N?Qq; Q Not of Record 7-77`1 ni iia 4) OCMPTp;NT/Q.•JNI NAME: (PLLASL PRINT) ADDRESS: CITY, STATE, ZIP: PHONE: 5) INDIC= WHICH PEMIT IS BEMG REQUESTED: CC ,=ICN TO CITY SORER ,2'CCNINEXTION TO CITY WATER ? OT1TMR (PLEASE DE, BE) b1 UN-:: 7) SIC %A=RE: PTLZ:,SE HOLD APPROVED PERMIT FOR PICT;-UP BY ONE OF ABOVE PLENSE N1AIL APPRO TED PER.%1IT TO 1, 2, Q 4 ABOVE (Circle ) DATE: GI la -,&4- lwq'?'aEA#i!!!!??ll1?R?.??.i?litfll:si:il!!llE.l?:?lyi!llRlt ~ - lure F OR C I PERMIT a ISSUED FEES: $ ic.S o $ iD S D $ 6,7; CG S $ $ s $ ?o $ $ $ $ U S E O N L Y SEii_..-, n?'o?irT (?JTCL;...c. SU?C'*?R?"•? r WATER PERMIT (INCLUDE SURCHARGE) WATER METER/COPPERHORM/OUTSIDE READER WATER TAP (INCLUDE CORPORATION STOP) SEWER TAT) ACCOUNT DEPOSIT - SETTER ACCOUNT DEPOSIT - WATER WAC SAC TRUNK WATER ASSESSiIENT TRUNK SEWER ASSESSMENT LATERAL BENEFIT/TRUNK SE?:'ER LATERAL BENEFIT/TR...R WATER OTHER TOTAL AMOUNT PAID/RECEIPT + // 7 G /F DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF [JAY? U YES IF YES, THEN A "PERMIT FOR WORK WITHIN PUBLIC ROADWAY" MUST BE ISSUED BY THE NO ENGINEERING DIVISION. LIST AS A CONDI- TION. SUBJECT TO THE FOLLOWING CONDITIONS: APPROVED BY: aP?o TITLE: DATE : lsr??esw.i.wlnc?w?.???w?wsww?+ww??w?r?.r?w:?w?wa.?+wwR?w?lw. Use BLUE or BLACK Ink I For Office Use I I✓~ CItV of Ea ; Permit#: I J !I I \ I Permit Fee: I y~ ~ ~ I 3830 Pilot Knob Road I I Eagan MN 55122 Date Received: i( I Phone: (651) 675-5675 I I Fax: (651) 675-5694 I Staff: I 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: W 3 Site Address: 3 y 1) r-- Unit ' Name: &t?ft H§" 113"o Phone: Resident/ ~ / Owner Address / City / Zip: _B7_3 Vffllpy ~ -1 Applicant is: Owner K Contractor Type of Work Description of work: _'kloT Construction Cost: 6 600, d 0 Multi-Family Building: (Yes / No) Company: PMAJ je/V W 1gP/KS Pul L kontact: LLIATTE A2, Contractor Address: SZ S" W 77 Y trJ SV~ City: "IN State: PAL Zip: 3Y Po Phone: WI • Z7 Ll-- ()Tb License Lead Certificate PAT- F 97~-it If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? Yes No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contractor: _ Phone: j NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of l 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 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. www.gopherstateonecall.org 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. Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuance. x Cm"Saw-N;a- X_ , Applicant's Printed Name Applicant's Signature Page 1 of 3 PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA131077 Date Issued:06/01/2015 Permit Category:ePermit Site Address: 1073 Tiffany Dr Lot:26 Block: 1 Addition: Canterbury Forest PID:10-16350-01-260 Use: Description: Sub Type:Residential Work Type:Replace Description:Furnace & Air Conditioner Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088 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 - Adam C Hornibrook 1073 Tiffany Dr Eagan MN 55123--187 (651) 335-1811 Rumpca Services 1048 Hastings Ave St Paul Park MN 55071 (651) 459-2896 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA131078 Date Issued:06/01/2015 Permit Category:ePermit Site Address: 1073 Tiffany Dr Lot:26 Block: 1 Addition: Canterbury Forest PID:10-16350-01-260 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. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). 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 - Adam C Hornibrook 1073 Tiffany Dr Eagan MN 55123--187 (651) 335-1811 Rumpca Services 1048 Hastings Ave St Paul Park MN 55071 (651) 459-2896 Applicant/Permitee: Signature Issued By: Signature , . Jeffrey Wheeler From: Jason Rumpca <jason@rumpcaservices.com> Sent: Thursday,lune 11, 2015 7:40 AM To: Jeffrey Wheeler Subject: FW: orthstat test for 1073 Tiffany Drive /�iL�,r1 iY # /3/!� ?? Attachments. image2015-06-11-063437.pdf Follow Up Flag: Follow up Flag Status: Flagged Jeff Attached is and Orthstat sheet fo 1073 Tiffany Drive;we calculated the vent length at 35 feet with 4 elbows and no elbows in the vertical pipe that goes up through the wall into the attic and through the roof. Let me know if there is any further information needed. Thank you Jason Rumpca 1 . • RUMPC� SERVtCES,t�i�' 1048 HASfiINGS AVE.,ST PAUL PARK, MN SSU'�1 b51-459-289t�` FU�L BURNING E(�UIPM�NT SAF�TY TEST R�PORT ORTWSTAT TEST'[tECORD Address: �C�'�� ���C�-�v�y �(`��c�,.,� ,l�3^��2,L.�_._13l �?7 �ate� C� �� 1�-- OwnedOccupant: �w'� ��[`�"`Y'�t.�t��7t-�� TYPE�F HEAT. Gravit�Air`: Porced Air�C Gravity Hat Water� Fo�ced Hot Water Steam� lJnit Heater Space Heater Otfier � TYPE QF FUEL,: Gas,� ' f�il l�the� GA�DESIGN i C4 1��R I+OI�J Brar�d flr Make 't�r�r�cr�s Make Model ��",��1�y,�1�.L�b'7t3kti/v�+(�-c>'� Model �" Seria( ��j�,�0��0'��� Max.B tl ting, Input; �(�,c�� Make of Furnace Equipment venting tyPe: Atmospherici Indaced Fan Other�f(��c�-c.�`�r�� Total BTU inp�ut�rf alI vented gas appliances per chimney; �oC,,���.� Type crf Chimne�lFurnace: Masonry' Class B . Uther PVC`� Type of GhimneylWater Hea#er; Masonry� Ctass B� Qther AVC ���++�'�`- Nane� Meta1 Clay Tile� C�mbustible Air Supply; Yes� N/A Recommended Size Fiitec sizc��k�5"kl Ignidon type�js?''�Uc"�t�.�. Safetv&Uperatin�Ccrntrol Tests~ Yes No Fuel naivsis,'Flu�Gas Analusis: Yes No Pi1ot/Flame Safeguard Operatin�Properly � � Vents Prnperly With�iut Spiliage � Limit{s)Operating Property "� � Flame Stays InsidelDc�esn't Roll�?ut � � v� _ All S�!stem Can#rois�perating Property � � �urner Lights Smoothly � ! initial Final Visual tns,�,e�tion Yes I+10 Stack Temperature F �F Fuel Piping 5ystem-�7ksy (,i� Uxygen fllo �"lo Vsnt S�ysterns---T?raf�hoc�d, Cartaorr Dioxide °10 °10 �p�q�s Cor�nector,Vent Chimney---flkay � ` C�rbvn Monoxide �/�PP� c�.,�.,w°�olppm Heating Unit—Qkay j,� G�s Manifald Pressure Nigh Fire �j � �- �.���g�` �.�.�_ , Gas Manifold Pressure Low Fire � �,� Have above+�amections been made(iFneeded): Ye No Comments Name�fLicensed Contractar: Rumpca Services. inc Address; (048 Hasiin�s Ave �t Asui P�r�C MN 53071 Phane#651-459-289b Person Doing Tes#:�Pcint) �____ (Signatuce) For�n Revisec149/d91fl3 RUMP�A SERVICL"y INC lo�� ��s�r�a�s�vE., ST PA�tt,FARK,tvrt�sso�� ���;�!i�E D �s�-�s�-z��� ,�i��Zrn� !� I3��77 FUEL BURN1t�1G EQUIP�VtENT�A�ETY TEST 1�PORT JUN 1 `� �015 , t�it�'I-tSTAT TEST RECORD Addr�s�: Q �` c� �~�� Date: �' �� �� �vvnnerlOccupant. c�, � ' '�YAE OF HEAT: ' Gravity Air:^ F�rced Air� Gravity t-tot Water Fc�rced Hot Water '� Steam_ Uni#H�ter� �pace Heater Other ; TYPE OF FUEL: Gas t� Qil (}tl�er Ili GAS DESIGN � NVERSIt�3V ii Brand Qr Make �....cx,nY'��:s� M � MQdel ___. ��a�bUl1'�t'l?O��l�{�� Mad . Seria� �91 S�.t����t.�� Ivi .B . Rating -n�..� Input s"1, � Make of Furnace Equipm�ni venting type: Atmospheric� Induced Fan t7ther�.����- Total BTU anput�f all venied gas applianices per chimney: �,o�r��" Type of GhimneylF'urnace: M�isor�ry� Class B Qther PVC,�c� Type of ChimneylWater Heater: Maxonry____ Class E3.� t?t�er .� PV� Typ�c�f L,iner: Nane�c Metal_ C�ay Til�� � Combustible Air Supply: Yes�t NIA� Re�ommended� Stze Filter size����.:�:,5}t� I�nitio�t ty�e ��(' ��y!"�{r-cc... �af�tv&(a eratin C�ntrol Tests: Yes 1V� Fuel Analysis/Fiue t'ias Analysis• Yes No Pi1�tlFiame S�feguard(�p�raCing Properly � Vents Prop�riy With�ut Spillage '�'� Limit(s)Operating Properly � � Flame Stays InsidelDoesn't Rpil t7at � � All System�ontrols Op�rating Aroperly -�-a � Bumer Lights�tttoothly �_ Initial Eina1 Visuallnspection Y�s No Stack Temperature F �F Fuel Pipi�g System--C)kay � Oxygen °IQ ���Q/a Vet�t'Sys#ems—�rafthood, Carbon I}ioxide °1a ��1� Cunnector,Vent Chimn�y--(7kay� �arbon Monoxid+e %fppm ,t;��°!01{� Wtating Unit--tJkay � �� � Gas Manif�ld R�ssur�High Fire �`5,� Gas Manifold Pressur�Lcrw Fire � 1� Have abc�ve carrections heen made{if needed): No� Comments Name Qf License�i Ct�ntractar: Rumt�ca Services,lnc. Address; l04$ Hastin.gs Av�.St Pau1 Par�C.Mi��5071 Phane#bSl-459-2$96 Persqn Doing Test;{Print)��? _� '���-Y1 {Signatur� Form Revised 09/09l{�3 � RUMP+�A SERVI�E�, INC )048 HAST`11VGS AV�.}ST PAC1L P�RK, [viN 5507 i 651-459-2$96 FUEL�3UR�ING E�1UII�MENT SAF�TY TEST REI'ORT ORTHSTAT TEST Et6GURt7' Addressc ��� ����Cc�v'��1 (�(`��sZ., Lla#e:� �� /�'" � Owner/Occupant: r TYPE C}F HEAT. Gravity Air� Forced Air� �ravity Hot Water_ Forced N�rt 1�ater , 5tearn� Uz�it Heater�� Spac�e Heater t�th�er — TYP�C?F FUEL: Gas� Oil (7ther GAS tSESIGN � CO VER lON Brand ar Make L..�r�r�c�. Make Mod�l �'.�."�ql�.V�Nc�"�okt/?Sb(j-o'� Madel� Serial ',,L I�.p'y.,3�}Lr Max.� U ating Input �,��.c�� Make of Furnace Equipme�tit venting;type: Atmc�spheric� Induced Far� Other�c' 'D��-c.�'C v�� Tatal BTU inpui c�f ail vented gas appliances per chimnayc �o�+�,.��r Type of ChimneylFurnace: Masonty� Glass� t�ther PVC'� Typc of ChimneylWater Heat�r:- M�sanry� Class 8� Other F'VC ' �€��incrr- None� Meta{ C1ay Tile� � Combustibie Air Supply: '4�es� Nlk Recommended �ize Fiiter size�i�.k�.5�.�� ignition typc 1-10�'�U�c�4c.. � Saf�ty&t?perating Cc�ntrol Tests: Y'�s No Fuel AnalvsislFlue�as Analvsis: Yes No Pilot/Flame Safeguard Clperating 1'�operly � � Vents Properly Without Spiliage � l�imit(s)C?perrs�ting Prc�perly � � Flam�S#ays tnside/Doesn't R�11 t3u# � � A�I System Cantrols C►perating Proper[y � � Bumer Lights Srnoathly � ____ initial Final Visuallnspection Yes No St�aek Temp�rature F `�F Fuet Piping Sy�tern-0kay � tJxYgen % �"/`o Vent System�—�rafihov�, �arban bioxide °lo ��1� ��t�nector,Vent Chimney---t�kay � � Carban Monoxide %Ippm °,'.Jppm Heating Unit—tJkay � Gas Manifold P�essure Hig}3 Fire � ��� �Gas Manifold Pressure Low Fire � �,� Have�bove corr�ctions been made(if needed); Ye ' No Comment� � � Name of Lic�nsed Contracivc:Rumpca Services Inc Address: l{?4�Hastin,�s Ave,St Pauf Pa�rki MN SSt7�I Fhone#65!-459-2896 Person Doing'�`�st:(1'rint� � � (Signature) Fortn Reuised 0�l09103 PERMIT City of Eagan Permit Type:Building Permit Number:EA136134 Date Issued:04/26/2016 Permit Category:ePermit Site Address: 1073 Tiffany Dr Lot:26 Block: 1 Addition: Canterbury Forest PID:10-16350-01-260 Use: Description: Sub Type:Windows/Doors Work Type:Replace Description:Two or More Windows/Doors Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow windows, call for framing inspection. Call for final inspection after installation. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Valuation: 4,000.00 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 - Adam C Hornibrook 1073 Tiffany Dr Eagan MN 55123--187 Renewal Andersen 1920 County Road C West Roseville MN 55113 (651) 264-4777 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA140295 Date Issued:12/07/2016 Permit Category:ePermit Site Address: 1073 Tiffany Dr Lot:26 Block: 1 Addition: Canterbury Forest PID:10-16350-01-260 Use: Description: Sub Type:Siding Work Type:Replace Description: Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Please leave printed pictures of house wrap on site for the 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: 4,000.00 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 - Adam C Hornibrook 1073 Tiffany Dr Eagan MN 55123--187 (651) 335-1811 Eagle Siding 1301 East Cliff Road Suite 117 Burnsville MN 55337 (952) 746-3046 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA169415 Date Issued:05/26/2021 Permit Category:ePermit Site Address: 1073 Tiffany Dr Lot:26 Block: 1 Addition: Canterbury Forest PID:10-16350-01-260 Use: Description: Sub Type:Residential Work Type:New Description:Air Exchanger Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507) 210-0754. Please call Building Inspections at (651) 675-5675 to schedule a final inspection. 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 - Adam C & Pui Yee Hornibrook 1073 Tiffany Dr Saint Paul MN 55123--187 (651) 335-1811 J Dubs Llc 11703 River Hills Dr Burnsville MN 55337 (612) 849-0510 Applicant/Permitee: Signature Issued By: Signature