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3891 Worchester Dr kEACTIV ED FOR DECK 7/31/89 CITY OF EAGAN ,~~2~~~ APPLE Vgl~%30 Pilot Kncb Road, P.O. Bax 21-199, Eagan, MN 55121 ; PHONE: 454-6100 BUILDING PERMIT Receipt # ' To be used for :~r i)kG~GAI~: Est. Value =13tj,tW Date •pR 11 , 19-1- .~''u ~ 1~CHEJ"~;~UK Site Address {'/t' • LOt BloCk ~ Sec/Sub. ji~.LLS 1)l OFFICE USE ONLY g~b- Occupancy FEES Parcel No. Zoning P'D Fc- I W Name LEy CONuTRuCTION (Actuaq Const ->4 Bidg. Permit 't 7`; . i)O ~ Addf6SS C1{G! xYI.Uti AVL S (Allowable) Surcharge •>::;Ef.?O.G•-c Phone 4S2-05~17 rotstories Clty ~1 planReview le~~ , o Name " oeptn snc, cicy 104.UU Address S.F. Total = SAC, MCWCC 5 C,Ity Ph011Q S.F. Footprints _ Water Conn 5R.[t_ f:f5 On Site Sewage ~W Name On site well - water Meter gfl- .,.n MWCC S stem 30,00 Address Y ~ Ac,ct. oeposi, i5 City PhOn@ Ciry Water PRV Required _ S/W Permil 20.60 I hereby adcnowlege that I have read this application and state that the Boosler PumP - S,'w Surcharge I iniormation is correCt and agree to oomply with all applicable State of Minnesota Statutes and Ciry of Eagan Ordinances. Treatment PI 2,18•(' o SignaWre o} PermRee APPROVALS Road Unit 340, r'() A Building Permit is issued to: ~ 1•~-~ rC~f15TRL'l.'.: I(.~" Planner - park Ded. on the express condition that all work shall be done in accordance with all Council applicable State of Minnesota Statutes and City of Eagan Ordinances. Bldg. Off. _ Copies 3, 3~'; . 8uilding Olficial Variance - TOTAL 1 I Pwmit No. Pamit Ho1dK Dab T"plwns # WSEWER PLuMBInG /5 H.VAC. ~ ~ ~9W ELECTRiC O Mhpwiim Dob Imp• ComnorNs Foobngs I aS F.~ Frem*9 v ey. - RoofiN RoLo Plbg. Rmo Hie. ~s 9 mw. Fkepia- FoW t+ey. F.W Pbg. ~7- Conet. Meter Plbg. Inspecta - NoOfy Plumber EngrJPlen Bldg. Final oeck Ftg. Dedc Fnal Well Pr. Disp. PERMIT # . • PLUMBING PERMIT CITY OF EAGAN RECEIPT N L~ 3e30 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: CONTRACT PRICE PHONE: 454-e100 Site Address BLDG. TYPE WORK DESCRIPTION Lot Block ~ Sec/Sub Res. New <4 - Mult. Add-on m Name Comm. Repair ~ Address Other c c Ciry ` Phone -RES. PLBG. ONLY - COMPLETE THE FOLLOWING: ; FIXTURES TOTAL Water Closet - $3.00 ~ Name , Bath Tubs - $3.00 " 3 Address Lavatory - $3.00 p City ' Phone - , Shower - $3.00 > Kitchen Sink - $100 FEES -TUrinal/Bidet - $3.00 COMM/IND FEE - 1% OF CONTRACT FEE Laundry Tray -$3.00 APT. BLDGS - COMM RATE APPLIES Floor Drains -$1.50 TOWNHOUSE & CONDO - RES. RATE APPUES Water Heater -$1.50 MINIMUM - RESIDENTIAL FEE - $12.00 , 0 MINIMUM - COMM/iND FEE -$20.00 Gas Piping Outlets -$1.50 STATE SURCHARGE PER PERMIT - .50 (MINIMUM - 1 PER PERMIn (ADD $.50 S/C IF PERMIT PRICE GOES Softener -$5.00 BEYOND $1,000.00) Well - $10.00 Private Disp. - $10.00 Rough Openings - $1.50 SIGNATURE OF PERMITTEE FEE:- STATE S/C: FOR: CIN OF EAGAN GRAND TOTAL: e. PERMIT # J • ' MECHANICAL PERMIT RECEIPT # CITY OF EAGAN - • DATE 3630 PILOT KNOB ROAD, EACiAN, MN $5122 'T-- CONTRACT PRICE: PHONE: 434-8100 For Office Use Only: ~ Site Add,ress BLDG. TYPE WORK DESCRIPTION Lot Block Sec/Sub Res. New ~ Name Mult. Add-on = ~ Address Comm. Repair c Ciry ` ' Phone, aher ~ FEES ~ Name RES. HVAC 0-100 M BTU - $24.00 c AddreSS ADDITIONAL 50 M BTU - 6.00 ' p Cily Phone (RES. HVAC INCLUDES A/C ON NEW CONSTRUCTION) GAS OUTIETS (MINIMUM - 1 PER PERMIn - 1.50 EA. TYPE OF WORK COMM/IND FEE - 1% OF CONTRACT FEE APT. BLDGS. - COMM. RATE APPLIES Forced Air M BTU TOWNHOUSE 8 CONDOS - RES. RATE APPLIES Boiler M BTU MINIMUM RESIDENTIAL FEE - ALL ADD-ON 8 ~ Unit Heater M BTU REMODELS - 12.00 ~Air Cond. M BTU ~ STA E SUFiCHARG PER PERMIT -.50 Vent CFM (ADD $.50 S/C IF PERMIT PRICE GOES Gas Piping Outlets BEYOND $1,000) Other FEE SIGNATURE OF PERMITTEE S/C: " TOTAL• FOR: CITY OF EAGAN DATE: 4J13/89 RE:3891 Worchester DriYe, L6, H3, Hills of Stonebridge -xz_. Your Sewer 8 Water Permit for the above properry has been completed. It witl be held at the Public Works Garage (3501 Coachman Road) untii the meter is picked up. BE SURE TO CALL PUBLIC WORKS (454-5220) FOR YOUR PERMANENT WATER TURN ON. YouY,SeAr & Water Permit for the above property cannot be completed for the following rAbons: ~ Your Sewer & Water Permit for the above property has been completed, but the meter cannot be issued or occupancy allowed until further notice. COMMERCIAL PROJECTS ONLY: Please pay for meter at City Hall. Meter size must be confirmed by Bill Adams or Dirk House (Plumbing Inspectors - 454-$100) before issuance. WARNING: BEFORE DIGGING, CALL LOCAL UTILITIES - TELEPHONE, ELECTRIC, GAS, ETC. - REOUIRED BY LAW. ,0 CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICY. Secretary, Building Inspections Dept. , ~ DATE: 4/13/89 ~ RE. 3691 itorchester Drive, L6, 33, Hilla of Stpnebridge XX Your Sewer & Water Permit for the above property has been completed. It witl be held at the Public Works Garage (3501 Coachman Road) until the meter is picked up. BE SURE TO CALL PUW.IC WORKS (454-5220) FOR YOUR PERMANENT WATER TURN ON. Y6& Sewer & Water Permit for the above property cannot be completed for the following reasons: Your Sewer & Water Permit for the above property has been completed, but the meter cannot ~ be issued or cecupancy allowed until further notice. COMMERCIAL PROJECTS ONLY: Please pay for meter at City Hall. Meter size must be confirmed by Bill Adams or Dirk House (Plumbing Inspectors - 454-8100) before issuance, WARNING: BEFORE DIGGING, CALL LOCAL UTILITIES - TELEPHONE, ELECTRIC, GAS, ETC. REClUIRED BY LAW. CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICY. Secretary, Building Inspections Dept. SEWE-A S WATER-PERMIT OFFICE USE ONLY I,CITY OF EAGAN 4/13 J 89 3830 Pilot,Knob Rd. , PERMIT DATE , P.O. BOX ~1`199"WATER PERMIT # 10355 SEWER PERMIT # E8 MN 55121 METER # ~ B.P. RECEIPT # : 1 l.Kti g811, # D YO B.P. RECEIPT DATE 41 1 1~! _RQ METER SIZE AAJ /1 0 ISSUE DATE PRV _ BOOSTER PUMP v } SITE ADDR*SS `5 v 7 I ~K C_ r^I f-.` j t FC LD PERMIT REQUESTED LOT : gLOCK5! SEC/SUB . " XSEWER -'-)<WATER - TAPS I APPLICANT: ADDRESS: COMM/IND RESIDENTIAL CITY, STATE ZIP PHONE: XNEW -EXISTING PLUMBER: ~ f' b~ u • I ADDRESS: llffO L' iC&g I AGREE TO COMPLY WITH CITY OF CITY, STATE 71p EAGA OR N S: PHONE: . ~ OWNER: ADDRESS: 31GNATURE WHEN METER ISSUED CITY, STATE ZIP ~ ~ PHO E: i~~~s.v~> ~ ~ PLLk Am-'-w )(.0-- 3,0(1 ~v' ~ s- /~-y9 9'~1 I S ALLOW TWO ORKING DAYS FOR PROCESSING. FOR STORIN SEWER PERIIAITS, CONTACT i ENGINEERING DEPT. - SEWER & WATER PERMIT OFFICE USE ONLY CITY OF EAGAN 4/1J/ 8° 3830 PIIOt KIIOb Rd. PERMIT DATE P.O. BOX 21199 WATER PERMIT # 1.0355 SEWER PERMIT # METER # B.P. RECEIPT # " ! 48!) Eagan, MN 55121 READER # B.P. RECEIPT DATE 4111 METER SIZE ISSUE DATE _ PRV - BOOSTER PUMP . SITE ADDRESS ? ` ~ ' `c_ PERMIT REQUESTED LOT! BLOCK,=);~_SEC/SUB L: SEWER x- WATER _ TAPS APPUCANT: • ~ _P_.;er ! ~z-.a~`• ~ ADDRESS: t! A / x f-4,22 COMM/IND ~ RESIDENTIAL CITY, STATE ZIP s PHONE: i.~T S f'7 ` NEW _ EXISTING PLUMBER: ADDRESS: ?r~rJ - T= I AGREE TO COMPLY WITIi CITY OF CITY, STATE `ZIP EAGAN ORqIN C~ES: PHONE: ~~r c_ OWNER: ADDRESS: SIGNATURE WHEN METER 15SUED CITY, STATE ZIP PHONE: PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. FOR STOR111 SEWER PERMITS, CONTACT ENGINEERING DEPT. CITY OF EAGAN NQ ] 6277 3830 Pilot KnobNoad, P'O. Box 21-199, Eagan, MN 55121 BUILDING PERMIT PHONE: 454-8100 Receipt # / , / 9`0 y Tobeusedior SF DWG/GAR Est.Value $139,000 Date APR 11 Site Address 3891 WORCHESTER DR LOt 6 BIoCk 3 Sec/Sub. HILLS OF OFFICE USE ONLY Parcel No. occuPancy R-3 M-1 FEES Zoning PD R-1 w Name WESLEY CONSTRUCTION (AcWaqConsl V-N BIdg.Permit 776.00 ; Address 9401 XYLON AVE S (Allowable) V-N ° Cjty MINNEAPOLIS phone 452-0587 xof Srories Surcharge 69.50 Lenglh 681 Plan Review 388 . 00 ~o Name SAME Depth 36' snc, aty 100.00 OU¢ Address SFTOtaI - SAC,MCWCC 575.00 ~ City Phone S.F. Footprinls _ FQ On9teSewage _ WaterCOnn 580.00 QName On Sile Well Ci - WaterMeter 90-00 AddfBSS MWCCSystem _XX w XX Acct. Deposn 30.00 a City Phone Cnv Water PRV Reqmred - SrW Permit 20.00 I hereby acknowlege ihat I have read ihis application and state that Ihe Booster Pump - Siw Suroharge 1.00 inlormation is correcl antl agYre~e to comply with all applicable State oi Minnesota Statutes and City o~n Ordjnanpesz^ Treatment PI 228.00 n~~/ Y Signature of Permnee JL/~ T APPROVALS Road Urnt 340.00 A euilding Permu is issued ro: WESLEY CONSTRUCTION Pianner - park Ded on the ezpress condiLOn that all work shall be done in accordance mih all Council _ applica6le State of Minnesota/]Statutes antlCl~tJy of Eagan Ordinances. gld9 pff • Copies Builtlmg Ofiicial ~,(~(1 I I T.civ IJ 1W1y~1,11 vanance - TO7AL 3,197.50 ~ /a~/rry yaoz-~ a- P 03066 a~ ' pp Request Date Fire No. ougRin Inspection R uiretl? ? Reatly Naw ~'~Jill Nolily Inspeciw ~Ao Ves ? No I When Reatly? INA licensed contractor ? owner hereby request inspection of above electrical work at: Job Adtlress (Slrcet, Boz or Pome No ) Cny G.50 5 te- e- ~~rllv~ Section No I Township Name or No Rarge No County KYILCS J~ S £ y T.)of'K~ Occupan[(PRINT) Phone No. lJ E a. sa - o SS Power Supplier Atltlr¢ss Ko sE-' l L Electriwl Conlredor (COmpany Name) Coniraclor5 License No A-s'/ o ~10 7 ' r- 3 Maihng Atltlress (Contrector or Owner Making Installation) /a Y AuNOnzed Sgnam (COntrector/Owner Making Instellatwn) Number i... 0 r MINNESOTp STATE BOAHD OF ELEC ICT' THIS INSPECTION REOUEST WILL NOT GelggsMiOway BIEg. - Foom S1]3 BE ACCEPTED BY TME ST.4TE BOARO 1821 Unlveralry Ave., SL Poul, MN 55104 UNLESS PROPER INSPECTION FEE IS Phona (612) 6/2-0800 ENCLOSED c' REQUEST FOR ELECTRICAL INSPECTION ~ eeooam-o~ ~ ? See n2tmctiws br compleling ihis lorm on back oi yellow copy. " 9.10j ;2- P 'D 3 0 6 6 • °X" 8elow Work Covered by This Request e Add Rep. TypeofBuiltling AppliancesWVed EquipmentWiretl Home Range Temporary Service Duplex Water Heater Elechic HeaLng Apt. Building Dryer O[her (Speciry) Comm./Indusirial Fumace Farm Air Conditioner 01her(specty) ConVacmrS Remarks Compufe Inspection Fee Belaw: # Other Fee # Service Entrance Size Fee # CircuitsiFeeders Fee Swimming Pool 110 to 200 Amps o to ioo nmps 2 Transformers Above 200 _ Amps h 00 _ Amps Signs Inspector5 Vse Onry. TOTAL . S Irngation Booms Special InSpection AIarMCommunicahon Other Fee I, [he Electncal Inspector, hereby RoWn,n oate .m~ nr certify that the above inspeclion has a~e I~ been made. OFPICE USE ONLY ~ This repuest witl 18 moNhs Iram ~ 1. ! T ` ~ y • ' (grr#i#iratr of (Orrupttnry Citp of eagan , Erpttrtmriit of lguilDing JmWrrtimi This Certiftcale issuedpursuant to ihe requiremena of Section 306 af76e Unijorm Building Code certijying lhat at the time of issuance lhis struclure was in compliance with the variaus ordinances ojlhe City regulanxg building construction or use. For the jo!lawing: ux 0..~rdeoo SF Urr/GA.R Bldg. R(mit No I6777 oo~upancr Tra R3/MI lunin6 Ususl PD/RI Tra conn. VPi o,,~oraunaig,, 14ESCEY OQ,\'.SPfdTrLT(P] neao~ 9401 XVrlN AVF S, MPiC i BwldmH Add. 3891 VMaE=DRIVE ~Iar L6. B3. HILT.S dF SICtVEBR77Y.: i / am PT[3 19 , 10149 ' ~ e~ae'Ng ar~,V POST IN A CONSPICUOUS PLACE BLDG. PERMIT NO. Z -7-7 1--o C.r 3 i o e-1'L 3 i U cS S-~avebr, 01-3210 Bidg. Permit 01-3422 Plan Check 3$~ OU ~ 01-3445 Surch./Adm. ( '411 q oi-saas SAC/Adm. 5 lJ~J ' 01-2155 Surcharge 69C1 O 75-3860 Road Unit 3o Qo 20-2275 s,oc SLoq as Q 20-3865 Water Conn. O 00 ~ 20-3868 Water Trmt. a a~ ~U 3 20-3716 Water Meter q C~ UO ~ 20-2252 Acct. Dep. J' O OU Cj 20-3713 Water Permit 10 O (D 60 (f) 203743 Sewer Permit lo -a) 79-3866 Sewer Conn. I O p 00 28-3855 Park Ded. TOTAL Z. I D SO ~ ~ ESEP2 , ~ ~ ( ~O ~ ~~1 ~y T P(j(~(~7~ Permittl: ll~ LQ~QIt B I PemiitFee ~J 3830 Pilot Knob Road Eagan MN 55122 I DateRecervedPhone: (651) 675-5675 I j Faz: (6511675-5694 L Staft ~ 2008 RESIDENTIAL PLUMBING PERMIT APPLICATION ate: q' J SiteAddress: cJ~~ Vl/f/_~,I( rIL~'lf'rL ~Y' mant Suite : l Phone: ICJ ~2 ~ ESIDENT / OWNER Name Z.L Address ! CityI Zip: D~~~ ( CONTFACTOR Name: License I r77 Address ChOmplOh City: 3670 Dodd Rd. #100 State: Zip: Eagan, MN 55123-1339 Phone: Contact Person: ~-~t'PYl TYPE OF WORK _ New _ Reptacement _ Repair _Rebuild -Modify Space _ Work in R.O.W. ` Description of work: PERMITTYPE RESII~ENTIAL ..a[er hlealer Waler Soflener - Lawn Irrigalion Ndd Plumbing Fixtures L_ RPZ PVB) ~ Main _ Loever Level) Sephc Sysiem _ Waler Tumaround New Abandonment ESIDENTIAL FEES: ~ I i0.50 Minimum Vliater Heater, Water Softener, or Watar Healer and Softener (includes $.50 State Surcharge) ~ 10.50 Lawn Irrlga[ion (includes w.50 State Surcharge) ;0.50 Add Plumnir,g Fixtures, SepGc System A6andonment, Water Tumaround` (includes $.50 State Surc.harge) t `Water Turnaround (add $136.00 if a 5/8" meter is required) i 06.50 Septic System New ($10.00 per as buill) (indudes County fee and $.50 Stale Surcharge) ! ~ 10.50 Fire ^nepair (replace burned out appliances, duchvork, etc )(includes $.50 State Surcharge) i TOTAL FEES ~ .:reUy acl:nowtepcie tna[ Ihis information is wmplete and accurale; fhat the work will be in conformance wrth lhe ordinances and codes of the City of gan: Ihat I under.stand this is not a permit, buf only an application for a permi[, and work is not ro start wi oin a ermit; that the work will he in .ordarce wtll; lhe approvetl plan in the cdse oi work which requires a review and appmval of plans. x -J..l%--~e4~/'6 ~plicanc., inted Nameb7 Applicant"s gnature U ::i~._ ysu:c•.r~.M.'." . . . , _ c ~m:',~.~a;;. Sc . ' Reviewed~B" )R oF; ice u . , onsi, yUnde~'G _ . , _ -uiFed Irispecti round;;~,; '•~~R6ugh=ln'+E~ 3cle 2005 RESIDENTIAL BUILDING PFRMIT APPLICATION ?0~ City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX 9 651-675-5694 New Construction Reauirements RemodeVReoair ReauiremenGS Ofiice Usa Onlv 3 registered sfle surveys showirg sq. ft. oi lot, sq ft. of house; and all mofed areas 2 copies of plan CeA of Survey Recd _ Y_ N (20°h maximum lot coverage allowed) 1 set of Energy Calculations for heated additions Tree P2s Plan Recd _Y _ N, 2 copies ot plan showing beam 8 window sizes; poured found desgn, etc. 1 stte survey for addibons 8 decks Tree Pres Required Y _N 1 set of Energy Calculations Add'N'on -indicafe ilon-site septic system On-sAe Seplic System _ Y_ N 3 copies of Tree Presenation Plan if lot platted after 11153 Rim Joisl Defail Options seledion sheet (buildings with 3 or less uniLS) Date 2/ Construction Cost 016 6. ,90 SiteAddress G4e- SFci' UniVSte # DescriptionotWark or 1`tlo4 /7r,~x, eft_ Multi-Family Bldg _ Y"S:'N Fireplace(s) _ 0 _ 1 _ 2 Property Owner 9o6n Sc^ Telephone t! ((9/),)2 24~ !133 N ~ p Contractor B/q /C2 C M A, & -S Address Sla~-cr c~ City State Fay -q./ fv( Zip Telephone # c~[2--) Yiy- 7/?~ COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672 Energy Code Category . Residential Ventilation Category 1 Worksheef • New Energy Code Worksheet (Jsubmissiontype) Submitled Submitted . Energy Envelope Calculations Submitted Have you previously constructed a building in Eagan with a similar plan? _ Y _ N if so, 25% plan review fee applies. Licensed Plumber Telephone ) Mechanical Contractor Telephone ~ Sewer/Water Contractor 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 which requires a review and approval of plans. Applicant's Printed Name ApplicanYs Signature 2005 RESIDENTIAL BUILDING PERMIT APPLICATION $10 City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 New Construction Renuirements RemodeVReoair Reauiremenls Office Use OnN 3 registered site surveys showing sq fl of lot, sq. ft. oi house, and all roofed areas 2 copies ot plan Cerl of Survey Recd Y _N (20°k maximum lot coverage allowed) 1 set of Energy Calculations for heated additions Tree Pres Plan Recd _Y _ N_ 2 cnpies of plan showing beam & window sizes; poured found desgn, etc. i site survey foraddi6ons & decks Tree P2s Required Y N 1 setofEnerqyCalcula6ons Addition-iridicateifon-s8esepficsystam On-siteSepticSystem _Y_N 3 copies of Tree Preservation Pian if lot platted aker 711133 Rim Joist Detail Options seledion sheet (buildngs with 3 or less units) Date 7 / / Construction Cost Site Address Unit/Ste # Description of Work I ` Multi-Family Bldg _ Y_ N Fireplace(s) _ 0 _ I _ 2 PropertyOwnerj bhnf/// Telephone#651) W~ ^q L20 Contractor Qmd Wcd yyindpyy i$Idh1p Address Ddn City State Ph. (!d2? M1UC. 9 10 Telephone ) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minneso[a Rules 7670 Cateeorv I Minneso[a Rules 7672 Energy Code Category . Residential Ventilation Category 1 Worksheet . New Energy Code Worksheet (J submission type) Submitted Submitted • Energy Envelope Calculations Submitted Have you previously constructed a building ln Eagan with a similar plan? _ Y _ N If so, 25% plan review fee appiies. Licensed Plumber Telephone J Mechanical Contractor Telephone J Sewer/Water Contractor 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 0_not_to_sta~t without a permit; that the work will be in accordance with the approved plan in the case of work which cequiiesEa review a'n ~ approval of plans. ~ 1~~!' lUL 2 CU05 . I C/1 A AOM 4MY Applic Printed Name pplicant's Sig ature BY . . t 1989 BDILDING PEEtHIT APPLICATION - CITY OF EAGAN SINGLE FAMII,Y DWELLING3 I ~ I, el I INCLUDE 2 SETS OF PLANS, 3 CERSIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS NOTE: 6DDRFSSFS FOR CORNER LOTS - CONTHACTOR/HOME05iNER Mi1ST DFSIGNATE WHSCH ADDRfiSS IS DFS IRED. NO.CHANGFS WILL BE ALLOWED ONCE HUIl.DING PERMIT IS ISSIIED. MOLTIPLE DWELLINGS RENTAI. QNITS FOR SALE ONITS 4 OF ONITS INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECB WITH HLDG. DEPT., 1 SET OF ENERGY CALCULATIONS COP49ERCIAL INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET OF SPECIFICATIONS AND i SET OF ENERGY CALCULATIONS A~R 1 0 1989 To Be Used For: 5Fl7 GAR. Valuation: 13q'i DO7^ Date: Site Address OFFICE USE ONLY Lot Block Oecupancy R 3 M-1 F6ES Zoning PD R-i Parcel/Sub ~/i of J~/a,ur6R,4-P Actual Const y-/y Bldg. Permit `17G.~ Allowable V - N Surcharge (~9' Owner 4l of stories Plan Review 38S•~ Length SAC, City pp1pD Address 9L01 )ekloAj u-< S Depth 35 %a' SAC, MWCC ,Do S.F. Total Water Conn 5 60'00 I City/Zip Code Footprint S.F. Water Meter qn,oo Acet. Deposit 300~ I Phone Gl ja p S~7 On site sewage_ S/W Permit o,oD ~ On site well 5/W Surcharge I,qo I Contractor MWCC System ~ Treatment P1. e. 00 City water J/ Road Unit 3y0,~ Address PRV required _ Park Ded. Booster Pump _ Copies City/Zip Code TOTAL APPROVAI.S Phone Planner Council Arch./Engr. Bldg. Off. ~4~11 • Variance Address Council ~ City/Zip Code Phone # NOTE: Sewer & Water Permit fees aad account deposit fees tirill be ineluded in the building permit fee. Processing time for sewer and rrater permits is two days onee a licensed plumber has applied For a permit at City Hall. VA L(,l AT I ON GAr, AGE- It 32. x z y=`768 x 15 = 1 i52o . • G A sF-rA~.~1' ly X53 = 7Ll2 IZx3(n = y32 y u IZ = 4a 122Z X Iy= f'~lpc~ ls"C 6~mT = I~~`~ 2Kra = 2 X 6 = l ~ 258 x.Sn= 629 00 2 tin FL-o9rL x3~ _ ~36 x5o= 4i68oa I 3~,3z$ ~ * * * 2422 Enteipiise Diive PIONEER 1 Mendota Fleights, MN 55120 ~ LMNO SURVEYORS • CI V IL ENGINEERS l ~enC~Il~eerin~..• IANDPLANNERS•LANOSCqPEARCMITECTS I'C~2) 6Oa1-191A y I V Y 1~ ~T Certificate of Survey for. _WESL CY G01,1jrr!{UCTI o/V e NoRIFI ie ~~o as\y ~y qyv q ~ 1~ R~1, ~O y y bq . oR~~e k,qY s, ~11~' ~ G~''~.~ ° -r- \ vt~ a Dj{ g•~ ~ ~s $t~ •o~ A„~ ~L C.j.~ v r 5 EINc.~1WEE" !pG D~,~T • 900.0 Denotes exishnQ flevafion PROPUSfO NOC/S£ fLfVATIONS j900.o Denoles propaNd Elevation Lowesf Floor- Elevatio~ ' ------penofesOraina~ee ulrlif Easement denotes Drarna eFlow rrows Top ot'Bloekflevaf+on = 918.5 6 o Denofes monumenf C~iarp4,, 5/afi E/evatiol7 8 eQri16 shown are assumed LOT 6, BLOcu 311IILL5 oF STONEBRIDGE DaKOTA COUNT)', M,NNESOTA SUBJ£CT 7D EASEMENTS OFRECURD I here6y certily that ihis survey, plan or report w~a.s p~r/gp ared by me or under my direct supervision and Ihat I am duly Registered LanJ Surveyor under Ihe laws ol 1he Slaie of Minnesota. Da[ed thisday of X edd A.D. 19~ ! Sca/e : linch , 40 +id 89 ROPERt B. SIKIC111_S. HE ' N0. 14P 1 I 11 . , EXTERIOR ENVELOPE AVERAGE "U" COPIPUTATION 061NER SITE ADDRESS CONTRACTOR F'jCF iY,~ DATF P110NE _ Determine working square footage of each. 1. Total exposed wall area Z9£~jS sq. ft. x~L 2. Total roof/ceiling area 9 sq. ft. x_o2fL Total exposed wall area above floor = v~_ a. Total wall window area _f(oD-92 b. Total door area 3 7, 77 c. Total sliding glass door area 3-~ _ d. Total fireplace wall area .ZO e. Total wall framing area (average 10%)............ o O f. Total net wall area above floor ~ g. Total rim joist area Total exposed foundation area /0 y h. Total foundation window arca .SS i. Toal net foundation area abcve grade Determine "U" value cf each wall segment. a. x ~~U" t. 37 77 x~'r , iz c. 30 X„r , sz a. - zo z ;,ui, e. sG0•'P0 x „r~_ f. ~o9~•S/ x °u" .o = ~3•9~ ~ 9. a~3 X „U„ n. x °u° ~ i x „U„ 3 .....................................Tota1 If item #3 is the same as, or less than item kl, you have met the intent of SBC 6006(c)2. ~ WALL SCCTiONS ' taM'E: Use 15% of opaquc wall.area Por ~ frame construction ConstrucFion R-Value L Interior air film 0.69 ~j 2. ~7 • G;u ~ inches sofr ~ano.~ 4• S. BASIC 6. Exterior air film : 0.17 WALL . Total i FIG. 01 TOPVIEii OF FFAttE WaLL 1. Intcrior air film 0.68 2. ~Y 3. ~ • 4. . . ' ' . - ,_v 5. 6. Exterior air fjlm 0.17 Total ~ S, / ; FIG. N2 _ _ ~J , !3N ~ 1. Interior air film 0.68 2. / 3. / ir q, S~[L SFACFJ( 5. Pc:lphczal 6. Exterior air film 0•17 Total ' A~~, • U~ ' µ . L` ' % , ~ . 1. Interior air film 0.68 l~ A C.. 2. F00:7DATICN - : 3 . 3. kTP_LL ~r . . •0• . • 4. 4\ . u G 5. ~y •n• ' . 0.1~ P G. Exterior air film ^ 'Total ~ ' ~ i. SI,AB ON GW1DE . . . . ~ . . n f ~ : ~ ' ~(.[1 j~?F • A , • - : ~ • y f, ` ~ • ~•,,=p. , •v; r~~ Ri " ~ ' , ~ i~i ~ ~ , . , • - • - in • . . . = J • ' • ^ ' . ~ i!~ ~ ~ FIG. 04 Ifl ~ ~ , o FIG. N3 . ' ~ X NOTE: Indicate tyoa, valve, denth and ' • ` ' ~ placenent of insulation. o • • . b . ' . Paqa Three ' ROOr/CEILING . . Con3Cruction R-Value . !31, f1y 1. Interior air film 0.61 ~ z. TI m 3. 0 1~'lI4. F.xtcrior air film (still O.~I yB~I~1~~1 Total • . / ~ `J ' . ' `L~ iQ~S _ Vented Heat floa • uP . . FIG. NS . ~ 1. Interior ai film 0.61 Z. 3. _ 4. Er.trrior ai fil still) Total / ~ ' • . Z/~ 3 . ~Neat llow up ven[ed. ..FIC. M6 . ' --3 I v 1. Insi de i r film 0.61 2. 3. . ~ a. 5. OutsLdE air fil+e 0.17 Total / ~ 1 Z . NO.i-9Ch'TED . NoCe: Use additioiwl shects if more spacc ; . • neecled for details and calculaCions. ' . HcaC • . , Elov up • FT.r,. 47 . Total exposed roof/ceiling area J. Total skylight area . k. 7otal roof/ceiling framing area (average 10%)... //9• b 1. Total net insulated roof/ceiling area........... / 0 7u2 Determine "U" value for each roof/ceiling segment. J. X lout, _ k. //9• b X "U" ~ 026 1: /o7t52 x f.u,. , oz5 = .26 4 ..................................Total ~ If total of #4 is the same as, or less than 12, you have met the intent of SBC 6006(c)l. Alternate Building Envelope Design To utilize the total envelope system method, the values established by the sum of items N3 and N4 shall not be greater than the sum of ltems (11 and 47. + z. 3i,is = 3s9- 9a s. -2y~. 93 + a. 30- 07 y, 90 Lzm/ 1989 BIII1.DffiG PERMIT ?PPLICAiION la~~ CTf2 OF EAGAN 1 2 ti 7 4 SINGLE FAMILY DNELLIRGS !lILTIPLE DNELLINGS COl84ERCIAL 2 SETS OF YLANS 2 38TS OF PL?NS 2 SETS OF IACHITECfURAL 3 HEGISTEHED SI'fE SDRVEYS BEGISTfiAED 3I?E SQAOElS - i SYBOCfQAAL PLANS 1 SET OF ENERGI CILGS. (CHECH HT1'H BLDG DIV.) 1 3ET OF SPECIFICATIONS 1 3EP OF ENERGS CILCS. 1 SET OF ENERGT CALCS. MULTIPLE DHELLINGS AENT6L DNITS FOR SALfi D6TfS f OF UHITS NOTEt iDDRESSES F08 CORAER LOTS - CONfRICfOH/80MEOWNEA !lOST D&SIGAAiE iiBICH IDDHFSS IS DESI[iED. 80 C9INGFS AILL BE ILLOHED atiCE BOILDING PERMIT IS I3SQED.. SEWER 8 N1TER PERMIT FEES AliD 1CCODNi DEPQSIT T6ES WII.L Hfi IRCLIIDED tiITH iHE BIIILDINa PERMIT FEE. PAOCFSSING TIlE FOR SEIiER lPD iilTER PERMISS IS Ti10 DA2S ONCE A PERMIT HES BEEP WlPLETED INDICATIAG A LICENSED PLOlBER. PENALTY @PPLIFS HHEN: PERMIT IS NOT PAID FOA IN SAME MONTH ZT IS REQUESTED. LOT CA9NGE IS HEpUESTED ONCE PERMIT IS ISSUED. To Be Used For: Lec~ Yaluation: Date: JUL 3 i 1989 Site Address 3~'S I Wor~ s~pv OFFICE 0.Sfi ONI.! Lot ~ Block 3 Occupancy FE£S ~ Zoning Parcel/Sub ,~T,'~/5 r Actual Const Bldg. Permit Allowable Surcharge Owner ~ i Y e ~IJpR 0 I of stories Plan Review Length IZ X1~ SAC, Citq lddress 3911 pfL Aepth 3 K3 SAC, MWCC S.F. Total Itater Conn City/Zip Code Footprint S.F. Water Meter r Acet. Deposit Phone On aite eewage S/W Permit ~ On a1Ee well 5/W Surcharge Contractor es MHCC System Treatment P1. City vater Road Unit Address ?~~{?S ) 31'S'~ PRV required _ Park Ded. Booster Pump _ Cc>pies City/Zip Code PosErAo,nJ'f" ~ SSUb~ SOBSOTAL IPPADYALS - Penaltq ~ Yhone 14a3 - aV-) 1 (s en~ Planner TOTAL Council Arch./Engr. S~ /F Bldg. Off. varianoe Address ~ City/Zip Code - Phone f - l' . 2422 Enteipiise Diive ONEER LANOSURVEYORS•CIVILENGINEEHS Mendota Ileiyhts, MN E * * I igineering.. LANOPL_ANNEiiS• LANDSCAPE ARCHITECTS (612) 681 1914 Certificate of Survey for: _WE5 L EY C0Nc7-WUCT10A1 / O .6$ NOR711 ~ ~ y ~ ` ° ~ p~L y ~ ~ pq • °R+vE ,t,Ay 4.~ '3r s. .o o • ~ , ~ ~n.~~ t ~ ta 'F o V'~ SkR`JP y•~S ` n° ~s ~ti o,/ ..,7._. L ~ . ! r ~.114i; f7enoles existin~ flevafion PrzoPOSEO NOUSE fl£VATfG Denoles propaf¢d Elevotiorr ~ [)etiofes Orar~a ejUFili f~ Easemenf Lowes t Floor ~leva~~a~ =_q Uenoles Drqrna~e Flow /Irr•ows Top ot'8/oek flevafion - 9 ._1~~~Ler6 ..o 2005 RESIDENTIAL BUILDING PERMIT APPLICATION City OfEagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX 4 651-675-5694 :'c~ll.csi 9/31 New ConsWCtion Re4uirements R_emodeVReoair Reauirements Office Use Onl 3 registered site surveys showing sq. ft of lot, sq. R. of house, and all roofed areas V 2 copies of plan CeR of Suney Recd _ Y_ N (20% maximum lot coverage allowed) 1 set of Energy Calcula6ons for heated addi6ons T2e Pres Plan Recd Y _N , 2 wpies of plan showing beam 8 window saes; poured found design, etc. 1 site survey for additions & decks Tree Pres Required _Y _ N 1 set of Energy Calculations Addrtion - mdicafe d on-sde septic sysfem On-site Seplic System _Y _ N 3 wpies of Tree Preservation Plan if lot platted after 711193 Rim Joist Detail Optmns selection sheet (buildings with 3 or less unils) Date / / zs / Ul;~ Construction Cost 00 SiteAddress 39VJO&_ 4 aA~~L ~r Unit/Ste# ~ Descrip[ion of Work r N) Fireplace(s) _ 0_ 1 _ 2 Multi-Family Bldg _ Y(t../ Property Owner _~JGt 'S OR(J s,D/J Telephone # ( los I Contractor 3j:~7 Rj!„G~,Sf W~ rft`~ F--t_M`DQ ? Address ~ City State Zips507? Telephone # (t~( COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minnesota Rules 7670 Cateeorv 1 Minnesota.Rules 7672 Energy Code Category . Residenhal Ventilation Category 1 Worksheet • New Energy oC de•lyorksheet (d submission type) Submdled Submitted • Energy Envelope Calculations Submitted /yUr' ~ 'l r~ In the last 12 months, has ihe City of Eagan issued a permit for a similar plan based on a master plan2 5 Z005 _ Y _ N If yes, date and address of masTer plan: licensed Plumber Telephone Mechanical Contractor Telephone ) 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 Ciry 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 approv an~n the case o which requires a review and a roval ofplans pphcanYs Prmte me pplicanYs Signature OFFICE USE ONLY Sub Types ? Ot 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 ? 09 07-plex ? 17 Garage ? 22 PorchfAddn. (4-sea.) ? 33 Ext. Alt - SF ? 04 02-plex C) 10 08-plex ? 16 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc. ? 05 03-ptex ? 11 10-plex X 19 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex PlbgXY or _ N ? 25 Miscellaneous Work Types ? 31 New ? 35 Inl Improvement ? 38 Demolish Interior ? 44 Siding ? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair )1 33 Alteration ? 37 Demolish Building' ? 43 Reroof ? 46 Windows/Doors ? 34 ReplaCemenl 'Demolition (Entlre Bldg) • Give PCA handout to appliwnt Valuation 1916w Occupancy R-3 MCES System Plan Review /1///~ 100% or _ 25% Census Code y39 Zoning City Water SAC Units - Stories Booster Pump - # of Units Sq. Ft. PRV - # of Bldgs ~ Length ~ Fire Sprinklered - Type of Const , U3 Width REQUIRED INSPECTIONS _ Footings (new bldg) FinaUC.O. _ Footings (deck) ;19- Final/No C.O. Footings (addition) Plumbing Foundation ~ HVAC Drain Tile Other Roof Ice & Water Final _ Pool _ Ftgs _ AidGas Tests Final Framing _ Siding _ Stucco _ Stone _ Brick Fireplace R.I. AirTest 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 '~5 0 .S o 2005 RESIDENTIAL PLUMBING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN MN 55122 651-675-5675 Please complete for modifications to existing residential dwellings. Date ? I Z 1 0 S I_c, Site Street Address 3 a~ir fiJOIL,YttS~k Unit# Property Owner ~?i ~~'L S0 or\ Telephone #(~D~Z) 7L~o' Contractor Mi?D ~~C l7MOS. a/ fTI~S. /ht• 7elephone# (M) wV'Iff~ Address xz7y ozSan City "SrIjjGS State#&JM , Zip~5~ The Applicant is: _ Owner ~ Contrector _Other Alteretions to existing dwelling $ 50.00 3 Add plumbing fixtures. This fee includes putting in a water softener and/or water ~ heater at the same time. Jf vou are installinq on! a water sokener and/or water heafer, do not complete this section. Move to the next section and check the appliance(s) you are installing. _Septic System Abandonment _Water Turnaround (add $125.00 'if1 a- 5/8" me1ter is required) ~ Other: ~t~yf ~(Z Z ~T7Se~l~9~5 Water Softener _ Water Heater $ 15.00 ~ _ new _ replacement Lawn Irrigation _RPZ _PVB _new _repair _rebuild $ 30.00 State Surcharge $ .50 Total $ !~A J ) I hereby apply for a Residential Plumbing 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 piumbing codes; that I understand this is not a permit, but only an application for a permit, work is not to start without a permit and work will be in accordance with the approved plan in the event a plan is required to be reviewed and a roved. 3LA: Gu4l ~1 ~T. ~ a0Aut1 Applica Ys Printed Name Ap canYs Signature City of Eagan 3830 Pilot Knob Rd Eagan, MN 55122 (651) 675 -5675 www.ci.eagan.mn.us Site Address: 3891 Worchester Dr Lot: 6 Block: 3 Addition: Hills of Stonebridge PID:10- 32990 - 060 -03 Use: Description: Sub Type: e- Fireplace Work Type: Gas Insert Description: Census Code: 434 - Occupancy: Zoning: Square Feet: 0 Comments: Fee Summary: Valuation: 3,000.00 Contractor: Fireside Hearth & Home 20802 Kensington Blvd Lakeville MN 55044 (952) 985 -6675 PERMIT City of Eaan Chimney /flue must be inspected prior to concealing. Smoke detectors are required in all sleeping rooms prior to final inspection. When wall studs or ceiling joists are exposed, hard -wired detectors are required. Battery operated types are acceptable if the wall/ceiling finish (i.e. sheetrock) has to be removed to install a smoke detector. Andrew Hoffman BL - Base Fee $3K Surcharge - Based on Valuation $3K Total: $90.00 Applicant/Permitee: Signature - Applicant - Construction Type: Owner: Julie K Johnson 3891 Worchester Dr Eagan MN 55123 Permit Type: Permit Number: Date Issued: Permit Category: $88.50 0801.4085 $1.50 9001.2195 Issued By: Signature Building EA082215 03/13/2008 ePermit 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. PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA129989 Date Issued:03/30/2015 Permit Category:ePermit Site Address: 3891 Worchester Dr Lot:6 Block: 3 Addition: Hills Of Stonebridge PID:10-32990-03-060 Use: Description: Sub Type:Residential Work Type:Replace Description:Furnace Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Applicant: Janel Behrends 122 West 3rd S 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 - Julie K Johnson 3891 Worchester Dr Eagan MN 55123 Haley Comfort Systems 122 3rd St W Hastings MN 55033 (651) 437-0338 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA130724 Date Issued:05/11/2015 Permit Category:ePermit Site Address: 3891 Worchester Dr Lot:6 Block: 3 Addition: Hills Of Stonebridge PID:10-32990-03-060 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 - Julie K Johnson 3891 Worchester Dr Eagan MN 55123 (612) 730-9210 Haley Comfort Systems 122 3rd St W Hastings MN 55033 (651) 437-0338 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA164798 Date Issued:10/08/2020 Permit Category:ePermit Site Address: 3891 Worchester Dr Lot:6 Block: 3 Addition: Hills Of Stonebridge PID:10-32990-03-060 Use: Description: Sub Type:Reroof Work Type:Replace Description:Does not include skylight(s) Census Code:434 - Residential Additions, Alterations Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Please print pictures of ice and water protection and leave on site. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). Valuation: 5,000.00 Fee Summary:BL - Base Fee $5K $118.00 0801.4085 Surcharge - Based on Valuation $5K $2.50 9001.2195 $120.50 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Julie K Johnson 3891 Worchester Dr Saint Paul MN 55123--165 (612) 730-9210 Shelter Construction Llc 7040 Lakeland Ave N Brooklyn Park MN 55428 (612) 849-8082 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA166167 Date Issued:12/17/2020 Permit Category:ePermit Site Address: 3891 Worchester Dr Lot:6 Block: 3 Addition: Hills Of Stonebridge PID:10-32990-03-060 Use: Description: Sub Type:Residential Work Type:Replace Description:Water Softener Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). Please call Building Inspections at (651) 675-5675 to schedule a final inspection. 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 - Julie K Johnson 3891 Worchester Dr Saint Paul MN 55123--165 (612) 685-5831 Champion Plumbing 3670 Dodd Rd., #100 Eagan MN 55123 (651) 365-1340 Applicant/Permitee: Signature Issued By: Signature