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1166 Westbury KnollCity of Eaall 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink Permit #: Permit Fee: Date Received: Staff: 2010 RESIDENTIAL PLUMBING PERMIT jAPPLICATION Date: 5®- f/oloi d Site Address: J j6( Wesf ff/,� I fl/Vo / /f f' ` � v Tenant: . . /9" // Suite #: RESIDENT / OWNER Name: Phone: Address / City / Zip: CONTRACTOR Name: l7W 0 ZJ L- C License #: 1.01/Lrr171i Address: /y43v i9ae //erro /`yye ti! City: /eis`cvtldrz / State: %`i/V Zip: Hetrr Phone: 6/el• - 7.5/- 4:56',1 Contact: 1; Al/PV, //ewe Email: iw.A L .23 M TYPE OF WORK New Replacement Repair Rebuild _ Modify Space Work in R.O.W. _ _ Description of work: PERMIT TYPE RESIDENTIAL Water Softener Water Heater ✓ Add Plumbing Fixtures ( Main / Lower Level) Lawn Irrigation (_ RPZ / PVB) Water Turnaround Septic System New Abandonment RESIDENTIAL FEES: $50.50 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $.50 State Surcharge) $30.50 Lawn Irrigation $50.50 Add Plumbing *Water Turnaround $100.50 Septic System $90.50 Fire Repair (replace (includes $.50 State Surcharge) Fixtures, Septic System Abandonment, Water Turnaround* (includes $.50 State Surcharge) (add $166.00 if a 5/8" meter is required) New ($10.00 per as built) (includes County fee and $.50 State Surcharge) burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) TOTAL FEES $ 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. x , dh•v .// 'e, €,..' Applicant's Printed Name x Ap '• nt's Signature 4101 City of Eagan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 APR 192010 Use BLUE or BLACK Ink Permit #: Permit Fee: r2 7/ • 7 / Date Received: v2 7 �O Staff: J 2010 RESIDENTIAL BUILDING PERMIT APPLICATION caulk( 5 Date: Site Address: / / (D �P 1��5��/�N ,*w 1/� Tenant: / Suite #: RESIDENT / OWNER Name: /trvoll_Jeil / I Phone: 60- 2(6- 5 -61S - et. Address / City / Zip: / l Vl' ttlt°sI k , /lila !1 / 6t101, ev Applicant is: Owner Contractor TYPE OF WORK Description of work: 6°,1,/est"¢ 12entd c/('/// Construction Cost: /3/ Ov4 OO Multi -Family Building: (Yes / No) CONTRACTOR Name: ( License #: t ._..- Address: G.... --G City: State: Zip: Phone: Contact: Email: COMPLETE In the last 12 months, has Yes If yes, THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING the City of Eagan Issued a permit for a similar plan based on a master plan? date and address of master plan: _No Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contractor: Phone: NOTE: Plans and supporting documents that you submit are considered to be public informati n. Port ons of :' the information may be classified as non-public if you provide specifz c reasons that .would permit tyle City to conclude that they are ode 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.000herstateonecall.orq I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances a des of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and ork is not to start without a permit; that work will be in accordance with the approved plan in the case of work which requires a review and appr I of plans. x lD1V�fit1/l 1"e;x Applicants Printed Name A licant's Saldt Page 1 of 2 b3&d2tL/z yi/ DO NOT WRITE BELOW THIS LINE Fig SUB TYPES Foundation _ Single Family Multi 01 of _ Plex Accessory Building WORK TYPES New Addition yAlteration Replace _ Retaining Wall Fireplace Garage Deck 41, Lower Level Interior Improvement Move Building Fire Repair Repair DESCRIPTION Valuation (?V* Plan Review (25%_ 100% V( Census Code # of Units # of Buildings Type of Construction 'i3y Porch (3 -Season) Porch (4 -Season) Porch (Screen/Gazebo/Pergola) Pool Occupancy Code Edition Zoning Stories Square Feet Length Width REQUIRED INSPECTIONS _ Footings (New Building) Footings (Deck) — Footings (Addition) Foundation Drain Tile _ Roof: _Ice & Water _Final tFraming Fireplace: _Rough In _Air Test Final Insulation Meter Size: Reviewed By: RESIDENTIAL FEES Base Fee Surcharge Plan Review MCES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Copies TOTAL J _ Siding Reroof Windows _ Egress Window _ Storm Damage _ Exterior Alteration (Single Family) _ Exterior Alteration (Multi) Miscellaneous _ Demolish Building* _ Demolish Interior Demolish Foundation Water Damage *Demolition of entire building — give PCA handout to applicant �d2G MCES System aCV? SAC Units PO City Water Booster Pump 1IG4/ PRV Fire Sprinklers Sheetrock Final / C.O. Required Final / No C.O. Required 4- HVAC Other: Pool: _Footings Air/Gas Tests _Final Siding: _Stucco Lath _Stone Lath _Brick Windows Retaining Wall: _ Footings _ Backfill _ Final Radon Control Erosion Control Building Inspector / Y ;1j = ti4 4i ' 0 F49 0-99 Page 2 of 2 CITY OF EAGAN SEIYER SERVICE PERMR 3830 Pilot Knob Road P. O. Box 21189 PERMIT NO.: Eagan. M : 55121 pATE: ZO^i^0: No. of Units: Owner. :{'iex Addres5: Stro Address: Plumber. I eMw MONOly wN? !w Gft d Ee"w Conneetian Chaspt: ddtMeen. ,yccount peposft; P'enMt F+e: SurcFwrpr. - ~ . BY Misc. Chorpes: Daft of Insp.: Totol: ImR: DoN Paid: - r_~ - - _ - - - - CITY OF EAGAN WATER SERVICE PQtMIT 3$30 Pilot Knob Road P. O. Box 21189 PERMIT NO.: b4a~i Eagan, M4 55121 DATE: 2anirp: No. of Units: ' Owrnr: s; ~A FI'o Addren: 11 G'e.stb~~rv 4 SU~s I~ddrcs.: rK~ a~~~ u ~ Plumber. , - . , Merer No.: REQW2FD camAec`rto~n aoro.: Siu: 1/1A0u~+y ~eposlt: Reoder No.: Permit Fee: 1t)•'~~~^~~-1 1.om !e emry wIAb tr. Cihr .f ¦ SuRha?o.. . S O~>d OrJiw~wew. Mlsc. Chorpes: 132.00 pd Total; 63.00 pd *neter By Dot. PoM: Dote of ~sp.: ~ Irnp.: ' i . , i;' • CITY OF EAGAN ~ 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 - PHONE: 454-8100 6UILDING PERMIT RK~ipt ~ To M ww/ ia Est. Vclue Dote ~ r~~~ . 1 I ~ q c.> SiteAddreat 3166 b,;"~; ` IR'' I'.lVf)T.1. Erect Qx Occupsncy Lot i Blxk ec/Sub. ~i •PTFi':1?ti' Remodel ? Zoning Percel No. Repalr ? Type of Const. 1; Addftion ? No. Stories lm Name ??(?^I'I`IF,I2 blIDWI:ST Move ? Length !1'. ~ SID MFM IiV,Y E Demolish ? Depth 4 , Address Intlmpc O Sq. Ft. City i=A'= Phone 4 - 4 3 .3 Install ? Approvab FNs Neme ~u Assessment Permft ul A City Phone Water & Sew. Surchsrqe 2.9.50. Police Plen Review 1 r r-') • 00 Name 11'iiARD C1iARLI :T< Fin SAC 5i~.00 ~Z ' 1 '13 (ii~P,ZI_iZ:A'` j ":'JJ Addren r ' E?q, water Conn. 300.00 ~ W City Phone 4 s.. ~ 4J~ Plonrw Water Meter 63.00 Council Road Unit 280.00 1 hercby ocknowlodqe that I haw reod this appl+cation and stote fhot Bldg. Off. Tr. PI. 13 2-0 0 the intormotion is corrcd and agree fp cbmply with oll applicable Sroh of Minnesota Stotutes ond Ciry •bf-'Eo9an Ordinonye~,',s% ~aCDate Perks Sipnatun of PemwttN V ~ Copiea E'RC3P7TIF.P ratal 41_ ~ A Buiidiny P•n.,it i: issued ro: on rh..xa.~s oo.dtnon trwl dl work sholt be donw in oooordanu with all apPliooble Stale of Mfmvsoto Statutes and Cify ot Eopon Ordinarxes. Buildinp OffINd ' 1 /1 •ds~a ~ iar?og IIoM :uou~o~ ~q~~q ~ieM rn ~44 IfUld '~lld IBUld t ~r '63H Iould ooe~dar~~ rymu~ '83N 4anoa '841d 4g~1! aull~a ~ ~j'j su~wei~ ~'i'! l6 uollopuno~ 11 sBu~ioo~ , E ~ .Butwod wyiQ •dsul *3eQ uol~Mwl 1 Z ~ rI '7V'A'H @+19tunId ~ suoyaalel sp4 +"IoH 31uuGd 'WU uWu*d Redipt - JMECHANICAL PERMIT Parmit No. CITY OF EAGAN FN - Fill in numbered spaces S/C TYPe or Arinr /epib/y TOt. 1. Date 2. instalfation Cost i; L5 . t::: 3. JobAddress - "`s Bik. Tract 4. Ovmar 5. CAnt?aetot Phone B. Add?ess ~$Zv :t, :~rt• _ _ . 7. City Stste Zip j=51' ? 8. Building Type: Residential Uk=~ Commercial ? institutional D 9. Work Osscription: New 13 Add ? Alter ? Repair O 10. Describe e i"j , Fuel Tvte •'.y ~.a.~ 11. No, Eouioment 8TU - M. Ea. No. Equiament CFM Forced Air Air Handling: Mfg. BOilgrs ~ Mech. Exhaust Mfg. Unit Heater Mfg. Other Air Cond. Mfg. Cas, Piping Outlets 92. 1 hereby certify that the above information is true and correct, and 1 agree to comply with all ordinances and codes governing this type of work. Signed : for Rough Final Inspections: Date Insp. Dete Insp. This is yuur permit when numbered and approved. Approved CITY OF EAGAN 454-8100 ~ Receipt PLUMBING PERIrAIT Permit No. CITY OF EAGAN Fee ~ FiII rn numbered spaces S/C Type or Print /egib/y Tot .....t 1. Date 2. Installation Cost 3. Job Address ,~;,~,•;,R .`tot- Blk. Tract 4. Owner 5. Contractor Phone - _ _ 6. Address ; . ~ 7. City State ZiP ; 8. Building Type: Residential G] Commercial ? Institutional ? 9. Work Description: New Q Add ? Alter ? Repair ? ~ 10. Describe 11. No. Fixtures No. Fixtures Water Closet Cesspool/Drainfield Bath tubs Septic Tank Lavatory $oftner Shower Well Kitchen Sink Urinal/Bidet Other Laundry Tray ~ ~ =r' ~ Floor Drains Drinking Ftn. Slop Sink Gas Piping Outlets 12. I hereby certify that the above information is true and correct, and I agree to comply with all ordinances and codes governing this type of work. Signed : , for Rough Final Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. Approved CITY OF EAGAN 454-8100 _aw. . . . . -ie . .y .sr K , r.ti'yr. . . . . . , PERMIT # ' MECHANICAL PERMIT RECEIPT # CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: •r ' CONTRACT PRICE: PHONE: 454-8100 For Office Use Only: SiteAddr ss -r°`~~'T~,~i?':' ~r BLDG. TYPE WORK DESCRIPTION Lot Block Sec/Sub rt _ -r Res. New Name ::•``1JE H ,,AT rNG Mutt Add-on m Comm. Repair ~o Address c Cily Phone 4" 00`~ Other n FEES B7i1Crr:,!, Name ' ~ ' ' RES. HVAC 0-100 M BTU - $24.00 ~ 11Vr.>"-:~UPY Krtoz,1, c Address ADDITIONAL 50 M BTU - 6.00 p City Phone n -7 i i~ 3 (RES. HVAC INCLUDES A/C ON NEW CONSTRUCTION) GAS OUTLETS (MINIMUM - 1 PER PERMIn - 1.50 EA. TYPE OF WORK COMM/IND FEE - 1% OF CONTRACT FEE Forced Air M BTU APT. BLDGS. - COMM. RATE APPLIES TOWNHOUSE & CONDOS - RES. RATE APPUES Boiler M BTU MINIMUM RESIDENTIAL FEE - ALL ADD-ON & Unit Heater M BTU REMODELS - 12.00 Air Cond. M BTU " MINIMUM COMMERCIAL FEE - 20.00 STATE SURCHARGE PER PERMIT - .50 Vent CFM (ADD $.50 S/C IF PERMIT PRICE GOES Gas Piping Outlets # BEYOND $1,000) Other FEE SIG F J/OITTE~E S/C: TOTAL• FOR: CITY OF EAGAN CITY UF EAGAN Remarks Addition WESTBURY 4TH ADDN • est ury ol!`1 3 P~}r~,5~~~ Owner Street State Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. STREET RESTOR. GRADIIVG SAN SEW TRUNK 17• ,S 9 Ol(p-~ ~z SEWER LATERAL Wc1t2rTTa1T1 t 65.29 4-35 ~J' • 2 0 /4 1 L /6 j/J.S WATERMAIN 19 51• 4 •45 15- , 0 WATER LATERAL WATER AREA 19 9.27 15 /a 0 •S3 O 9(Z ~0 ,3 ~S water area ~ 19 133 • 79 • 2 5 1.39. 7 -,9 ' STORMSEWTFK 9 71.2{. 142-05 710•.2 RoiG~s/a. STORMSEW LAT 78.3 • S(a '4016.7 CURB & GUTTER ' 510EWALK STREET LIGHT WATER CONN. 500.00 n 11 BUILDING PER. n n SAC 529-00 PAR K ~ HOUSE HEATING TEST RECORD ADDRE55 _~//gb t(~54,v"2I ke r", 0 ~ APT. F OR qITY:>BURB OCCUPANT OWNER 20 'e .e- HEAT LO55 DATE TG. INST. SOLD BY -38 ~-S • ' INSTALLED BY J ~ Eleetrieal Work By Gas Line By TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR.),LOTHER GAS DESIGN ~QNVE ON MAKE MAKE OF BURNER V Mod~l ~ ~ a ~ Model se.;ai Ma:. aTU Ratipl9 ~ INPUT MAKE OF FURNAC-E Model C CONTROLS THERMOSTAT 111~ Heat Plug Vsnt Si:e Valve KIND OF LINER SIZE NONE Limit Drah Hood Q' Reyularor Limit Soiting 2S C, Filtsrs Size Numbsr Fan Setting J f Chimney Location Insids Outside Pilot Type Chimney Construction Pilot Make l~ Pilot Modsl Smoke Bomb YYiring Pilot Timing Draft ~ Tsst Tay L L.W. Cut Off Door Pressurs G~ Lightiny Inst. Pressure ,7 Pereent COZ ~ Date Tested Input CFH-,~QD Percent -fl2 7 TA Company TestUig Zn Staek Temp. ~ Psreent CO .42 /C~ Name of Tester Form 235 ~ , CITY OF EAGAN N? 10 4 2 6 ' 3830 Pilot Knob Rosd, P.O. Box 21•199, Eagan, MN 55121 PHONE: 4548100 BUILDING PERMIT Receipr # Te 6e o..d fw sf dwg/gar est.volue $59,000 pOte JUNE 19 1985 SlteAddreu 1166 WESTSURY KNOLL Erect . L7S Occupency R3 La _3 Blcek 3 ~ec/Sub. HIESTBURY 4TA Remodel ? Zoning Rl FeOair ? Type of Canst. V Parcel No. Addition ? No. Storias FRONTIER MIDWEST HOMES Mave ? Length 40 = Naine Demolish ? Depth 4'] ~ Address 3908 SIS MEM HWY E lnt.Impr. ? Sa• FT. EAGAN 454-0433 City Phone Install ? Nme SAME AOVrovob Fees Z~ o` Addrees ASSessment Pe/mit .OO v~ Cfty Phone Water d Sew. Surcherge 29.50 Palice FlanReview 155.00 ~w Name RICHARD CHARLIER Fire gpC 525.00 pddreyy 14103 GARDENVIEW CT E,w, waterconn 500.00 ~W City A.V. phone 432 5492 planmr watereneter 63.00 Council AoaduNt 280.00 I hereby ackwwledge rFwt I hove rcad ihis apP~~~a~~ e~d stote of emy. off. 6/19/85 Tc PI. 132 . OO Mw inlormurion is correcf ond ~~~oooorrreeee to c0mpl th II ap abla Smta of Minnewro Smtut~ Ciry o r'~ces AP~ Parks Var. Date Copies $ipnofure of Permiftea~ ~ FRONTIER MIDWEST HOMES rotal $1,-99d _ Sp A Building Pertnit is issued to: on the axpmat Wnditlon that dl work sholl be doro in xmrdonca wit~ o i o61e State Min aota Srotutes ond City oi Eayon Ordlroncea Buildinp Official RESIDENTIAL ' BUILDING PERMIT APPLICATION ~ a 9 7s_ CITY OF EAGAN 3830 PILOT KNOB RD, EACAN MN 55122 651-681-4675 New ConsW ction Reauirements RemodellReoalr Reauirements • 3 registered site surveys showing sq, k. af lot, sq. tt. of house; end all roofed areas • 2 copies of plan (20% maicimum lot coverage allowed) . 1 set of Energy CalcWations for heated additions . 2 copies of plan showing beam 8window sizes; poured found design, etc.) . 1 site survey forextenoraddiiions & decks • 1 set of Energy Calculations . . Indicate if home served by seplic system for addltions • 3 copies of Tree Preservation Plan if lot platted after 717/93 • Rim Joist Delail Options seleclion sheet (bldgs wBh 3 or less units) DATE VALUATION 13,E '`.q-0- SITE ADDRESS~ ~~~~0 6 SrG(JPSI-GJY`/ MULTI-FAMILY BLDG _ Y ~N' TYPE OF WOyffR'2" I Q/n~ FIREPLACE(S) _ 0_ 1_ 2 APPLICANT U d (Ir, r-&~rl lrn'f STREETADDRESS Ia.Z!{7 ~IrCe7//~P~" A~~ ~ CITY ?nS ~/~STATE~ZIP SS-3?7 TELEPHONE # ~1--7t)2-6~C LL PHONE # FAX # C162-1 - Tj46- PROPERTYOWNER _D&Je ~ KI(IS -Mu k..Qy- TELEPHONE# 1051 - I 76 COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINNESOTA RUI.FS 7670 CATEGORY 1 MI '1'A RULES 7672 (J submission lype) . Residenlial VentilaUon Category 1 Worksheet Submitted • y/ rCv~Cj y~oThj itted . Energy Envelope Calculations Submitted U U IJ MAY 1 6 2001 ~I Plumbing Contractor: Phone # Plumhing system includes: Waler Softener Lawn Sprinkler y F• 90.0 Watcr Heater No. of R.I. Baths No. of Baths Mechanical Contractor: Phone # Mechanical system includes: _ Air Conditioning Tce: $70.00 HeaC Rccovery System 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 Eaga Ordinanc Signature of Applicant OFFICE USE ONLY Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ Updated 4/02 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 Ot of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt- SF ? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multi ? 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 Sprinkiered Type of Const Width REQUIRED INSPECTIONS _ Footings (new bldg) FinaUC.O. _ Footings (deck) FinaUNo C.O. _ Footings (addition) _ Plumbing _ Foundation HVAC _ Drain Tile Other Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests _ Final _ Framing . . _ Siding Stucco Stone Fireplace _ R.I. _ Au Test _ Final _ Windows (new/replacement) _ Insulation _ Retaining Wall Approved By , Building Inspector Base Fee Surcharge Plan Review MC/ES SAC City SAC Water Supply & Storage S&W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit ' License Search Copies Other Total ( RESIDENTIAL 50 BUILDINC PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD, EACAN MN 55122 651-681-4675 NewConsWction Reaulramenh RemodeVRaoa7r Reouirements . 3 registered site surveys showirg sq. fL of lot, sq. R. of house; and all roofed areas • 2 copies of plan } (20%mazimum lol coverege allowed) . 1 set of Energy Calculafions for heated additiom . 2 capies of plan showing beam & window s¢es; poured found design, etc.) • 1 site survey for ezledor addNOns & decks • 1 set of Energy Calculations • Indicate'rf hame served hy seplic system foraddilions • 3 copies of Tree PreservaUon Plan it lot platted after 111193 • Rim Joaf Detail Options selection sheet (Mdgs wilh 3 or less unis) DATE VALUATION ~`JaOO O~ SITE AQPyRpES~S Fi WQS1' / o(/ MULTI-FAMILY BLDG _ Y ~ TYPE OiWdR kOP F Y~DU.524~G~~Z o~SI~S. fIREPLACE(S) _ 0_ 1_ 2 APPLICANT. Ameri< C4 _&Jr 11CLnu 0451„+rA~ r<, STREETADDRESS l.-3--47 NIGvIl2'I' QJ2• Sa CITy BJYr%S01 02STATE HIVZIP SS337 TELEPHONE # Sa- b-d ELL PHONE # FAX # PROPERTYOWNER Dkle 4 KriS -72-\4,e,21- TELEPHONE#&E/ yS4 -1976 COMPLETE THIS SECTION FOR "NEW° RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINNI:S01'A RULES 7670 CATEGORY 1 MINNESOTA RUI.ES 7672 (J submission type) • Residentlal Ventilation Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted . Energy Envelope Calculations Submitted Plumbing Contractor: _ Phone # Pltunbing system includes: _ Water Softener _ I.awn Sprinkler Fee: $90.00 _ Water Hcater _ No. of R.I. Baths 1Vo. of Baths Mechanical Contractor: Phone # Mechanical system includes: Air Condilioning Fee: $70.00 _ Heat 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 appiicable State of Minnesota Statutes and City of Eagan Ordinances. Stgnature of Applfcanf OFFICE USE ONLY Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ Updated 4/02 OFFICE USE ONLY ? 01 Foundation ? 07 OS-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 PorchlAddn. (4-sea.) ? 33 Ext. Alt - SF ? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screened) ? 36 Muiti ? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-piex 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 WindowslDoors ? 34 Replacement *Demolition (Entire Bldg only) - Give PCA handout to applicant Valuation Occupancy MC/ES System Census Code Zoning City Water SAC Units Stories Booster Pump Nbr. of Units Sq. Ft. PRV Nbr. of Bldgs Length Fire Sprinklered Type of Const W idth . • REQUIRED INSPECTIONS _ Footings (new bldg) FinaUC.O. _ Footings (deck) FinaUNo C.O. _ Footings (addirion) _ p]umbing _ Foundation IIVAC _ Drain Tile Other Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Au/Gas Tests _ Final _ Framing _ Siding Stucco Stone _ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement) _ Insularion _ Retaining Wall Approved By , Building Inspector Base Fee Surcharge Plan Review MC/ES SAC City SAC Water Supply & Storage S&W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other Total 1985 BUILDING PERNIT APPLICATION - CITY OF EAGAN POTE: ALL CONTRACTORS NUST BE LICENSED WITH THE CITY OF EAG9N S T,4 F -~rz~ INCLUDE 2 SETS OF PLANS 3 CERTIFICATES OF SURVEY 7 SET OF ENERGY CALCULATIONS 59,000. To Be Used For: Sinqle Family Valuation: t2;968 Date: 6-11-85 Site Address: 1166 WestburV Knoll OFFICE tISE OHLY Lot: 3 B1ock 3 Sect/Sub Erect ~ Occupancy ~-3 Remodel _ Zoning _(L-I Parcel # Westbury Fourth Addition Repair _ Type of Const Enlarge _ ll of Stories Owner James & Joanne Williams Move _ Length 40 Demolish _ Depth 4-1 Address .1628 Riverbluff Ct. Grade _ Sq Ft City/Zip Code Eaqan, MN 55122 Contractor Frontier Midwest Homes Corp. APPROVALS Address 3908 Sibley Memorial Hwy., 4iE Assessments Permit 3 10.°' Water/Sewer Surcharge City/Zip Code Eagan, MN 55122 Police Plan Review IS S•°-° Fire SAC 525. w Phone 11 454-0433 Engr Water Conn 5co• Planner Water Meter 63. Arch./Engr Richai'd Charlier Council Road Unit 7757`= Bldg Off b•1!- Parks Address 14103 Gardenview Ct. AV APC Treatment P1 13 2'~ Variance Phone 0 432-5492 TOiAL 9 / S~ s IGMA House SIJRVEYING CerNNccte For: S E Fi V I C ES c~~~tt~P ~~V t 3908 Sibley Memorial Highway iEagan, Minnesota 55122 ~A~~~~~~~~~ , Phone: (612) 4523077 Mod.ek - STAFFol2Q- WEs \ ~ ~ gsoo Ras6°YS.\`l Y 63 7.52 ~~NoLL 0 _ N - S 0~ A `C~ PVb~ i~' ~P I.b 11~proe~~ 0' x A' 0~` 9li.o .k. / l ul / n - N 2 naioo . Q- ~ - ,n 0(IV ~ P I~OT Co S / FS0ii~ . . ' ; ~ 953o U1iu'fY EAhM ! ~°~'r` WAYNE CORDES _ 14675 ~ 'O: LoT °I -L .,S V 0~ ~A PIl71V LZ_ EGEND - PNOPOSED GARAGE F LOOR ELE i 0 0.>notes lran Alorxurrnt PId7POSfD lop of 8!ock ECEVATlON- -gLno m lknotes WoaJ Hub Set PROPOSED BASFMfNT F LODR ELEVAT ION,= SicI.O_ ,8770 Denotes Existiny S,no1 L:levali (r) ~ NOTE. Vertfy ~fl flt~r heiyhts with Final Hovse Plans. (h -7- L~ennfes Proposcd Spot E levatia~ - Denotes Ora i riage D i rec t i on -SURIYORS GERj IF 1 CA71 Crl _P~~ ~~+~r~ 1 hereby certify that this survey, plan or report was prep+reA by me or urtier my direct supervisian LOT-3,BLLCK_ 3 aM that I arh a duly Heyistered LaM Surveyor W~STRUQ`(_ ~40 O~TION_ u er }he laws of the St,~te ol Yrnresota. accordirg to ihe recordcrl plat ihereot. Date: ,5/~ l85 f~ _ v~o~Z Counfy, Mimesota Wayre D Corrles Minn. Rey. Nc. lQ575 rige 1 of 4 ~ EXTERIOR EWVELOPC UCRF "It" CpnflITATION ~ / - - -/1G ST~?FV~+CS~ hdCa trj:'7. , OWNER: 11 Pk Tf S1TE ADDRE55: PIiON_; CONTRACTOR:_RZ -u_CZ. Deterr;ine working square foo*age cf each 1. Total exposed wall area..... I !)(CA.S sq. ft, x.1; 2. Total roof/ceiliny area..... si. ft. x.026 Total exposed wall arca ahovc fioor= a. Total wall window area . . . b. Total door area Z c. Total slidin9 glass ilonr arca -7 d. Total fireplace wall area - r~ S e. Total wall framing area (average 101) , f. Total rim joist area r-J g• net wall aren above fioor...~`~4,. h• wall area above floor i• wall area a6ove floor j. frame walt area at r"ot:ndatior Total exposed foundation ai-ea= Y,. Total foundation window area....................... l. Total net foundation area above grade Detcrmine "u" value of each wall seyine.iL (e.g. window, door, each sep,irl~te wall seccion) • a. j Z. S K L, ~ e. q 7 a u„ 45 x U', d. x 'lull ~ - e. ,q S X l,ul, ULD = I S, 71 _ r ~ f• I~o x ~„ull -e• 13~1f 0~:27 z ,.U„ c3 h. X L,„ _ • i. X u,~ . j X ~lu„ _ i X"U" = If item q3 is the same as, or less than item #1, you have met, tFie'.~ x 75 intent of S6C,.600~„(c) • ................................TOCaI isnvctopc nvcrzge .u co;n~~utnt.~.on Pngn 2 0; q . , Total cxponed roof/cciling ~ nrca = O IO - m. 1btu1 skyli.giit area n. Total root/cciling franiing arca (nvcrayc lOP,) . ~ p~ (o o. Tot-al ne[ insulated roof/ccilin9 urea........:.. Determine "U" value for each roof/ceiling segmeizt m. - X .1u., n. ~ O T ~~U~,? z ~ o. x„U„ , o = I~, Z 4 To~al 7) If total of 114 is the same as, or less tchan I12, you hZVe mel- the int•ent oi SHr GOC16 (c) 1. Alternate Buildinq Enve].one Desiqn To utilize tiie total envelooz'systen method, the values estanlishec' by the s:un of i.tems ;:3 and i`r9 shall not be grenter tllan the sum of items ikl and 112. 1. ZIC~~U9 +2. i(C~,41 = Z4Z,S + 4. ~--J ~ 7 3 - - ~ ~ C.• U:'r i`JIpIiUn N.1i1 M1I'C.1 IJC I •(fl~rtP: C(d~..l TUCI lUf1 I . . . . . V.t I ,i.. p1EALM p V r-~ 4. • 1`H CRw~C!1~ ~ C.~C) - - L. f...i•ri, r , i ~ ~ ~.f Gl TOPVSFIJ Gc , ~~il~r 'ilm p,Gtt . FIW.E KALL ~ 2. , 3. • , a. ~~E:~t~*f. . .~._V.C~ 1~ G. Fa;lrrior ;ii; 0. 17 --~6' FIC. 02 ~ ' 'fulnl ~~rQ~ ~ , ~ ~ ' . )nl.criu[ n:r tll~c 0.(.!i 2. - - 9.00 . , ';~~1 l_------- 4• - - - ~ 1 cm ____•l ~..al " -(l }:xccrsi: ni: iilm L). i'i . rfs~l~~~"~,:----n ,~g ; '~~,~~.1~ -------{J roe:~t ; _i ' • r''~ " . . U' r -l U .cy'~ ~ intrii•,r nf~ fil~~.•. ;1.(,n ...y - _ LS4r 47 , i~. , •p. ~ n. . PL~s.rCCa_'Cc~C.. ~iPt?.P.t.~R_...~..- _ . U L)4 G. 1::<Irri<•[ .~ir.:'i'r~ U.l! , _ _ 'POL,II ' (m• 7 ' w' • f ~ ~ SI.AII (~fl ~:HJ1Uh; ' ? ~'c~ . , , , , ~ ~ , . . ~ ~ • ~ . _y~R,i , . . . • , . i l J - r ~ I, ~ . • ~I" ' . • -T ~ri . , . /Y/ ~ . 111 • ~ ! . , : ~ /,~J/_ ~fl/ r F1G. 04 I!i u. • ~ _ c. 13 nnd i ,-y o , ` I ~ ' iil.i-_rn~~•r.. ;~f,i~~~~,;il.~Cio:i. ~ • r.oor/cez~z::c ~ a ' . . Construction R-Valuc 1, Intcrior air filn . 0.61 ' 2. SS G r3T~ ' . ^ ~ ~-ti j1 ~~,(l'F''~~ ' 3. _In~Sc,~. • 44. £xtcrior .:ir filn (sCill) 0, „Ezrz Tota.1 rz. 4 8 1-02 • : . , . ,oZ ~ . FR~m s znted HeaC flow 1. Interi~r nir film 0.61 ' 2. JE~,D I up - • , 3. ~ ~ i~,(5uL 38. 3s . d. :_xtrrio: :I ln (s-~C4_-17j-(t) T --i'at3t 2 = 90.tS as~ ~ . . . ~=.oz.~... - - - tri my~_ • l.~~t JY'.11 :T.~Z": 1'` t i.[~~~~j ~1 \2 4~ f~ 1 : C l - - - ~ , 1_ Insidc ,~ir film O.~~ ? - ~Y ' . . 3. ~ ' 4. ~1 CutsidC air fil:n U. 17 Total • L n' . ,C.C.e.-r ~ ~ ' ~ • 1_ Znsidc air °ilm 0:61 t~ • ~ , . ~ . . . . . - a E?eaz flov up, , -ventrd 3- ' 4_ . . , • ' ~ . ' . ' ' Outsidc .ir film 0.17 • . FIC_ A6 ~ . ~ . ' ~ . . ' . . Total ~ -3 . ~ v 1. Ynside air film 0.61 . . .X 2. - . , J_ _ . • . . . 4 - f 0.17 e. GZitside air filin R~~==-'~~• . % Tota1 / ~ . • . J . . . • - . . . . Rotc: Use additional sheets if morc ,pace i= ' • Leerlecl for cle'...:ils and ealeulatians. ' . ~ NcnL ' : , • flou up ' 1'I,_ ~f7 • " r' • ' . , . . ~ ' ~ w,111 Arcn for c l. T r~yt i0( 41 p I ~ jr~~m• cont~lrucl.lun . . . ' • ,~tr.r.. ..~t.i,oc?c M'N _I ~.U - ~ L~isL ~P+~ (oS r- ' ' U. !.~:Lc~ i .i1 i in . U 17 5tr i ~ Q U= .3to Fic..pl zr,iNi[ia cp ;crltiLY IiALi,: InC~;;r,: ~~~r 'iln - ` ~ 2 i . I , , ' ~ - - - , , ~ • . ~ , t I . ~ ' 4. • r' . 7. ~ FIG tQ2*' . 'I'uCa! 1 J t • ~ ~ • 1. Jitt~ci:u'_~ic film 0.17,11 s: ~1 . , 7 L ,us R _ ITT~ -c~kf.r~r~ixl 1 i. i ,1~:.-al - • -t~ 6. !:r.trr~.cr nir f i fm 0, 11 ' 4 f an+'-. ~ • ' ` •rol.ll ! . ~ l ~'-U~--,µ ' 1. int.r~ ~•,c ,,i .._.~~.Gfi , L yn. ~ ~ . ~ ~ 11.7 ICI! ~ ~ 'n•, . . ` 'r ~ , d, 'Q; . d ii 4~ . u . -._!;an~` 5. _ . 12f ~ ,17. ' r I/..-~ ~ L. tcI:c,c_.,-,'--:...~- ` --"--U.-'1 '~ul:tl i. •r SiJ11t (1Fi ,ItAU!i `.~y:: ' ( (1 `RA~'~ r „ ~ ~ t ~ r ?~~a~ t~ r%' ~ Y • ( ~ , ~ ~ „ , ,t,. T /rl ~ , ' ' l(! t ; ~ , ~ ~ic;. Ifa rr~ s • ~ ' ~ ~ G• ; ic.r`-L._,. " ~ . ~ ~ 1 3 ' r V IrdiC¢t~:'l ~•;~lui d~uLh nftcl ~.s't i'x ~ , n,ia~~ ~ ~ ~ . - ' r t~,,:; ~ ~ ~"1 1 ~l z rC ~ ~?in 0 ^ - a vi ;5,- tti tr 71 tA V) (A m ' ? , , m _ r • tTi c7 ~ o - L? ~ C Jt f- rn ~ a- ~ : r#j , i:~- i 2/84 ~ N+9 f CITY OF EAGAN 1411i APPLICATIWI FOR PER:tiIIT SEWER AND/OR WATBR CONNECTION (PLEASE PFINT) PFO°E`T" ADDR=-`S= 1166 Westburv Knoll TF'ral. D :SC;'S?TICV: 3/3 (LocBlock/S,:;aivisicn or Tax ~arcel I.D. ~L:.,~r) ~ L$-17rcTu:vz', DAT' OF CipTCiiIAL r'.+.iIT.:u:C'i B_PRE5E:?' Z.^.:,TiT'/Fp,OPOS=" L5'r.': X F-1 Si:GZ.' FP?t=rv ' ? ..-2 LUr,=: (?•.':o limi':S) Q R-3 2CT%WH=FE ('?":C= + L^ff:S) [T:2^S) ? 4 L T~ / J•1T~T~.1'S \ tii_J~ Q CCi'N~.l_.Tmu/ +~l.~:s1 C F F 1 C p --mCSI"-R-rSJ ? :!:STI= IO~:.mI./Giv=`itiT_-\"I' 2) F7pr`-~_.~ (ALfaSc PRIlii) - NP~•~`• ~Frontier Midwest Homes Corporation ADDRESS:" 3908 SibleV Memorial Hwy. Bldg. E-- CI:"_', S'-A:'c:, ZIP: Eaqan, MN. 55122 • PIiO-NE:_ 454-0433 3) FIw,,~~ (PLEASc PRINT) FOR CIiY USE 04LY ~i''F'~ Star Plumbinq PDL3ES5: 1018 Mound Springs Ter. PLur.seR c~sse Active/ CZT1, STATE, ZIP: Bloomington, MN. 55420 ~ Expir.~ "3iL'Record PHOVE: 884-4149 PLU88ER LFCENSE q 3329 ~ - q) pCC~,-?pNT/CrNT?M (PLEASE PRI;li) NAME: James & Joanne Williams AbDRESS: 1628 Riverbluff Court CZT7Z, STA'I'E, ZIP: Eaqan, MN 55122 PHO`E: 454-4757 5) PdDIC1',ic ;a[iICH PER•SIT IS BEIItG RECUESTID; ~ CC.1NECrZON 'IO CITY Sc^rilm Please mail gold copy to ~ CCN:IECI'IC:I TO CITY PlATER Wenzel Mechanical . 3600 Kennebec Dr. ? U'IIR (P=E D,SCRIBE) , Eaqan, MN. 55122 . ? Pi :~SE F?OID r1PP?OVcD PER?+ST FOR PICK-U2 BY CNE OF A&iUE °T_.EF+SE :~*'~I APPP= PEP_-LIT M 1, 2 3, 4'pFOVE- - - ~b~ (Cir _e one) 7) SIG,TL,'cE: DA,j.F,: ~lROfili4/Y~vi~l~pl~;lek ` ' '~•i.• _ . fcf~lsHt~aiaaw~~sa~s~a:aa~f4lle~y-afl~lt~aac' FOR C I T Y US E ON;.Y , PE?~MIT " ISSUED rrES: $ cE;.;-- B_1_.7^~ ) c.°, nv~ (I1!(~T„_iL JL'~G~.C11qr'^_ .~G WATER PERM'_T (Ii:CLuDE SuRCfi?RGc.) WATrR METER/COPPEDHORN/OUTSIO: REnuZR $ WATEP, TAP (INCLUDE CORPORATIODI STOP) $ S~:Jc2 TAP $ /S-Uw °-..~'i:-•- ~~?GS~_ - c_.._~ $ ACi_OUNT DFPC'SIT - plAmrp $ WAC $ S SP.C $ TRliNK [4ATER ASSLSS;iE„T $ TFli:J?C Sc.;4ER nSS:`:SS:i°_NT $ LA;E?,?.L BENEFIT/TRUNK SE;I:ER $ LATc,'.2rlL BEVE^IT/TP,U.IK :OAT?':? $ WATER TREATMENT PLANT SURCHARGE $ I .3.i, . z= U OTHER: $ TOTAL $ AMOU:1T PAI'J j REC°I?T ;lr S~ j ,L/ DOES IIT.I,ITY CONNECTION REQUIP.E EXCnVATION Iy pQBLIC RSGHT OF WAY? ~ YES IF YES, THEN n"PERMIT FOR WORK WITHIN PUBLIC ROADWAY" MUST BE ISSUED BY THE L~--j- ~6 ENGINEERING DIVISION. LZST AS A CONDI- TION. SUEJEC: TO THE FOLLOWING CONDITIONS: • APPROVED BY: ~ TITLc: • DAT°: .a ~s~ i ~ ~ w?~ wt ~e re ~ nt ~ w ~e~ ~e.~ ~t~ r~ ~s~ ~tr City of Eagan 3830 Pilot Knob Rd Eagan, MN 55122 (651) 675 -5675 www.ci.eagan.mn.us Site Address: 1166 Westbury Knoll Lot: 003 Block: 003 Addition: Westbury 4th PID:10- 83653- 030 -03 Use: Description: Sub Type: e - Furnace Work Type: New Description: Furnace Comments: Fee Summary: Contractor: Haley Comfort Systems 122 West 3rd St Hastings MN 55033 (651) 437 -0338 Quesetions regarding elec 952- 445 -2840 Larry Leacock 15966 Fennel Ct. PERMIT City of Eaan ME - Permit Fee (Replacements) Surcharge -Fixed Total: Applicant/Permitee: Signature cal permit requirements should be directed to Mark Anderson, State Elec - Applicant - Owner: Amanda Keil 1166 Westbury Knoll Eagan MN 55123 Permit Type: Permit Number: Date Issued: Permit Category: $50.00 0801.4088 $0.50 9001.2195 $50.50 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 EA091464 10/06/2009 ePermit cal Inspector, ô ÿþ þýýüÿû ûù øüüýý ÿÿèýë ééøý ûîó íéðééé þý ýüûú ù ø üûú÷ö ú ù õ ÿ ÿ ú ô óý ò þ ú þñðï ý îîðíî Ûò øé ò ëñìúïèðçíçîíí öø ó ÿëæèðççð õôôó òñ úú êûùä ûÜ øé øý ûÜ êÿò÷ððéé ÿò÷ððé ñðïîéééí ó ýûöÿó óå óúúóóä ÿ úûöóúúý äòùûä ÿã ç úúß ÿ ûÿ VL Use BLUE or BLACK Ink --------- For Office Use j City of 1 (�� D Permit#: I Permit Fee: 3830 Pilot Knob Road FEB 16 2016 1 Eagan MN 55122 1 ,Date Received: Phone:(651) 675-5675 1 I 651 675-5694 Staff. ( ) ff. Fax: -------- - -J 2015 RESIDENTIAL PLUMBING PERMITA PPLICATION Date: —1 Site Addres s: F Tenant ;. Suite#: x RescientlOwne Name: Phone: ,i Address/City/Zip: J✓l Name: Milbert COMPany Inc dba Culligan ter C641376. License#: 3 i Address: 1.8.01 50th St East City: Inver Grove Hgts. Conga-,tpr s y: Mn 55077 651-451-2241' State: Zip: Phone, Contact: William R Milbert •. - Email: _New _Replacement _ Repair _Rebuild _Modify Space Work in R.O.W. € Type of or _ Description of work: RESIDENTIAL Water Heater Lawn"Irrigation(_RPZ/_PVB) X—Water Softener PerrTll"t"T£' m Septic System Add Plumbing Fixtures Main/_Lower Level) + New Water Turnaround � E _ _Abandonment RESIDENTIAL FEES: $60.00 Water Heater,Water Softener, or Water Heater and Softener(includes$5.00 State Surcharge) $60.00 Lawn Irrigation('includes$5.00 minimum State Surcharge) $60.00 Add Plumbing Fixtures, Septic System Abandonment,Water Turnaround*(includes$5.00 State Surcharge) *Water Turnaround(add$200.00 if a 5/8"meter is required) $115.00 Septic System New($10.00 per as b"uilt)(includes County fee and$5.00 State Surcharge) TOTAL FEES$_O.;D D 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 d1g16 receive locates of underground utilities. www.4opherstateonecail.oro 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 1 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 appro d plan in.t e case of work which requires a review and app val of pl ns. �f X 6 X Applicant's Printed Name —` kp licanrs Signature "z n Me er�t�late.dems a I r dl o =e" PERMIT City of Eagan Permit Type:Building Permit Number:EA179819 Date Issued:10/21/2022 Permit Category:ePermit Site Address: 1166 Westbury Knoll Lot:003 Block: 003 Addition: Westbury 4th PID:10-83653-03-030 Use: Description: Sub Type:Reroof Work Type:Replace Description:Does not include skylight(s) Census Code:434 - Residential Additions, Alterations Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Please print pictures of ice and water protection and leave on site. If water damage is encountered, please call (651) 675-5675 to schedule a site visit to verify the extent of the damage. Any repairs must be inspected prior to covering. The inspector will determine if an additional permit will be required to repair the water damage. Valuation: 5,000.00 Fee Summary:BL - Base Fee $5K $118.00 0801.4085 Surcharge - Based on Valuation $5K $2.50 9001.2195 $120.50 Total: This permit shall be null and void if work does not start within 180 days of issuance, or if work is suspended for 180 days or more after started. 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 - Christopher H & Amanda J Singer 9811 Cavell Cir Bloomington MN 55438 Sela Roofing Remodeling 4100 Excelsior Blvd St. Louis Park MN 55416 (612) 823-8046 Applicant/Permitee: Signature Issued By: Signature