3914 Westbury Tr
CITY OF rAGAN SlWER SERVECE PERMIT ~
' 3830 Pilot Knob Rosd ~
~ P. O. Box 21199 PERMIT NO.:
I Eagan, MN 55125 pATE; ~
~ ZO^i^o: Na of Units: - '
~
OwrNr: L•`rOi~tl~ ~"i x~s-- f-.
Address:
~ sir. Add.em 3914 Alestb, jT-r- ..I i r,,
; Plumber. _ Str3r/tjen2e1
::37;r . J.T10,i
j ~~w•• t~ «mrly wNb W CMy of f.~.. Corrnatlon CF,ow: 425.00~xj
Aoo,unr o,pomit; _ 15 un;~
~ PamnM FM: ' 0 v G D?'x3
Surdwrp.; :>d
I BY Mtsc. Choros:
~ Doh of Irnp.: Totoi:
I^sp" DoM Pold:
CITY OF EAGAN
3830 Pilot Knob Road WATER SERVICF PERMIT
. . . .
P. O. Box 21199 PERMIT NO.: 34')0
Epan,MN-55121
: ';-$-$S
c.~~
Zanirq: ` No. oF Unirs:
Own.r: FLOntic--r t;ikh,rst.
Addmss:
Sift /1dd ?,1; 3Y,es.* ury I
r~ }
Plurnibsr. `a L''"i/` ~-'''•u.' 1
AAeftr No.: L 8 •3 Cmwction Uwrpr • i3; x_.
pwRsoder No/ d,1-.i2'f Q~~ 3 D_ _'Permtf fys. t: ~ ~
I
~oNM te ww* wMU 1iw CIFv sf i"aw Suidwrpc
Mt,c. p,aroa: 32. OJC, T? I
Total: ' ~ • rr~ _er ,
BY Dah Paid: I
DaM of Irqp.: Insp,: I
~
~
~ CITY OF EAGAN ~ 7-,~
'
~ Pilot Knob Road, P.O. Box 21-199, Ea9an, MN 55121
PHONE: 454-8100
6UILDING rERMIT Receipt #
t• re w.+ fe. Est. vaiue 5. f,4c; ooce r~19
- ~
Sita Addren T~- FYa ~r Erect 0 Occupancy v ~
~ . c~ 'Jt'~I.~Tt~i• ~r" Remodel d Zoning
Lot Black /Sub. ~
Repafr ? Typaof Const.
Psrcel No. Addition ? No. Stories
Move ? Length W Name Demolish ? Depth
~ Address 3908 5 u~~~ PIPMXLTAL MvY Int Impr. ? Sq. Ft.
City 'MW Phone 454-0433 Install ?
~ Wame APP?avnb F~at
Address Assessment Permit 2^'''
v _
u~ City Phone Woter 3 Sew. $urcharge
i Poliu Plan Review 44 -
W Name Fin 5AC ~2r: _ I)n
W
Addreu Enq. Water Conn. SQ,j.~.Q~
W City Phone plonw Wffiw Meter 53 00
Council Road Unit ?RllOL
I he?eby acknowfedye that I haw road this applicntion ond stots tbaG Bldg. Off. Tr. PI. 119 nn
fhe Informotion ia corred cnd agree fo DIy_Yclth nll applicgbte A~
Stots oi Minnesoto Stotutes ond City~n Ordinonc~s. P8rks
-
Sip+ature of Permittee-°. _ Var. Date CePies
ff Total
. . C
A Buildin9 Pennit Is isswd to: a+ fhe txprm oonditlon tho+
oll work sholl ba dons in acoordanu with oll opplloobb 5toft of Minnesota Stotutes and City ot Eapan Ordinonces. ~
9uildinp Oificial
_ _
Pwmit No. Pwmit Holder Qm ToIophone ~
Pluoibinp
H.VA.C. /D// 71f 5- ~Sl -/S L.5
ebetric `b13 I
softw.w
lnsveNon o.a Insp. oen.?
FooUnysl
FootinQs ii
Founqation
Framinp
RooHny
Rouph Plby. . O
Rouph Htq.
InwL
Fireplace
Ffnal Mtg.
Flnd Plby. _l _
Flaal ~~~~F •
CKVOcc.
-
WatK Defaibe Loeation:
WNI
Sevr~r
Pr. DImp.
Ruaipt IYIECHANICAL PERMIT PKmit No.
CITY OF EAl3AN
FM 4p,44,,,,_
~ ~ffll in numberrd xowat S/C .50
Type w Print Mpfb/y
Tot 52tj.50
I 1. Date ;.u114/6j 2. Instillation Cost
.
3. Job Addran 3914 idestburv lW Blk. Trsct 4-
4. Owner rjn i- r .omDxn i_: g
5. Contractor ,:euze.l «lechauicu: Phone * 3
8. Addrm 360 i:e:iebec Dr i-°
7. City L• n0 Stata Zip 55
8. Building Type: Rssidential Ek Commera,l O Institutional ?
9. Work Description: New Q Add O Alter ? Repair ?
10. Dacribe cs_..ac:+ :3;,.,t~ . FueITYPe
11. No• FqLj~pi STU - M. Ea. No. Equioment CFM
Forcad Air ~ra~ia
Mfg• Air Hsndlinp:
~ Balen ~C.JOU ..-•c `<s L:s
Mech. Exhsu:t
Mfg.
~ Unit Haster
Mfg. Other
Air Cond.
Mfg.
Gac, Pipinq Outlets
12. I heroby artify that the above information is true snd correct, and I ayree to
oomply with all ordinanoes and codsa govarniny thia type af work.
S'iqned
~ for
Rouo Fiml
Inspections: Date Insp. Date Insp.
This is your permit when numbsred and approved.
Approved CITY OF EAGAN 45"100
~ Receipt PLUMBING PERMIT Permit No. '
~ CITY OF EAGAN Fee
Fill in numbeied sDaces S/C i-
Type or Print /egib/y Tot
~
1. Date 2. Installation Cost
3. Job AddressZf/Y(,:~, totBlk, l Tract
4. Owner
5. Contractor r '04 i/r.e, Phone
6. Address
7. City State Zip
8. Building Type: Residential Commercial ? Institutional ?
9. Work Description: New Add ? Alter ? Repair ?
10. Describe 1
l
11. Mo, Fixtures No. Fixtures i
- ~
Water Closet Cesspaol/Drainfield ~
Bath tubs $eptic Tank
lavatory Softner
; Shower Well ~
~ Kitchen Sink ~
I
UrinalJBidet Other.2;;;
Laundry Tray
Floar Drains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to ~
comply with all ordinances and codes governing this type of work.
5igned : F; _T ~ % i (-1 for ~
Rough Final
Inspectioiis: Date . Insp. Date Insp.
This is your permit when numbered and approved. ~
Approved CITY OF EAGAN 454,8100 ~
I
R~aipt rLUMdINO PERMIT pwmk Na
~ cirY oF EAc;iw Fa .
fl// in numbnnd 4uw :x
7Yw w Pr1m ~Idly Tot. . .
; r
1. Dat~ 2. Insnllation Cost
T
r
3. Job Addna ~7' i i' :`j~ Lot~Blk.%Tnct
~
4. OwnK
6. Contnctor Phone
~
B. Addnas
7. Gty Stste Zip
8. Buildinp Type: Residsntial Commercisl O InstitutionN O
~
9. Work Description: New Q Add O Alter O Repair ?
10. Desixibr
11. No• Fixtures No. Fix ures
Water poset Coupoo1/prsinfiold
Bsth tubx Septic Tank
' lavoto?Y X,_ Sohner
Shower WeI I
Kitchen Sink
Urinsl/Bidet Other
Laundry Tny
Floor Drains
~
~ Orinkinp Fm.
Slop Sink
~ Gas Pipiny Outlets
12. I hen6y artify that the sbow information is trua and corroct, snd I pree to
oomply witb sll ordinances and oodes governiny this tYpe of work.
, ~ for:
S'iyned :
Rouo Fieyl
Inspections: Date Inup. Dm Irop.
This it your permit wMn numbend snd approved.
APProwd CITY OF EAOAN 46"100 ~
~
. . CITY OF EAGAN N°_ 10 6 0 6
3830 Pilot Krrob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE:454-8100 :S J7J /
BUILDING PERMIT Receipt # > S~~
To M uwd fer SF I7fMT'/GAR Esf. Value 52i000 Dete JULY 18 19 85
Site Addresf 3914 WESTBiJRY TRAIL Erect ~ Occupancy R-3
Lot 13 elock 1 Sec/Sub. WFSTBURY 4TH Remodel ? Zoning R-1
Parcel No. Repair ? Type of Const. v
Addition ? No. Stories
W Neme FMN1.'IER MIDWr,ST HOMES Move ? Len9th 38
~ Address 3908 SIBLEY NgNIORIAL HWY #E Demolish ? Oepth
Int. Impr. ? Sq, Ft.
City F.AC+AN Phone 454-0433 Insteu ?
o Name ADOrorab Fees
qdyrma Asxument Permit 289.00
1- City Phone Water 8$ew. Surcherge 26.00
Polica Plan Review 144.50
~uZ Neme Fira SAC -
` s2s_on
Address Enp, WaterConrt snn_no
~W City Phone Plonner WaterMeter 63_00
Councii Roatl Unit 7R0 00
I heroby acknowtedge thot I haw reod this opDlicatilam a stote tbOt Bldg. Off. 7/12/85 Tr. PI. 1 32 00
fhe inlormotion is correct an e to co pl witl I up ' p e
SfaPo of Minnewta Statut ond G 'an in APC Parka
Ver
. Dete Copies
Sipnature of Permittae F I MIDWEST C~7ES Total 1,959.50
A Building Permif is issued to: m tha exprea Conditlon IMt
dl work shall be done in oc orKe with ol{l~{c~pp_ lioobla Stcfe of Mlnnewto Statutes and City of Eoqon Ordironcea.
Buildirq Oflicial ~ ~0, Y ~i[_I-n'Y~
CITY OF EAGAN Remarks
Addition WESTBURY 4TH ADDN• Lo, i?, eik 1 Pa,1
owner Screet 3911, Wf?ST.hurV TY'ail Stare Eagan. MN 55123 ~
Improvement Date Amount Annual Vears Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SANSEWTRUNK q, ~e~%. •j'~ n (0 73 /O
SEWER LATERAL
w termain 19g 65.29 4.35 15 ~ s, z y
WATERMAIN goY 19 51• 4 3•45 15 .~o
WATEfi LATERAL
WATERAREA 7 19 139•1 9.27 15 /20.,7
wa r area ~h` 1 13 3. y
STORM SEW TRK W5 19g 710.21F 142.05 5 /C •v
STORM SEW LA_T ~ 1C~ '7 3• 5 15 •7l 5 7t?:
CURB & GUTTER
SIDEWALK
STFEET LIGHT
Road Unit $280.00 53796 7 18 85
WATER CONN, 500.00 1. 11
9UILDING PEfi. 0606
SAC
PARK
1985 BUILDZNG PERNIT APPLICATION - CITY OF EAGAN
NOTE: ALL CONTRACTORS NUST BE LICENSED 4JITH THE CITY OF EAGAN
HA9-TF09D
INCLUDE 2 SETS OF PLANS
3 CERTIFICATES OF SURVEY
. 1 SET OF ENERGY CALCULATIONS
S o~
To Be Used For: ~lnuGC~aluation: -E~=~ Date: /0 Q!~5 -Lo Site Address: / ~~J~}(j~,~, OFFICE USE ONLY
Lot: ~ Block ~ Sect/Sub Erect ~ pccupancy Q-3
Remodel Zoning (Z-~
Parcel I1 ~ Repair Type of Const 1Z
Addition I! of Stories
Owner ChAA C~ Move _ Length 3 6
Demolish Depth
Address (~ic~/ry~ - Zj~Ak~ ~3p1 Int.Impr. Sq Ft
City/Zip Code 11 . Install SS~Z7
Phone 9.3 a 7 APPROVALS FEES
Contractor -4 L~t~, ivektl1Pb+ Assessments Permit
'I Water/Sewer Surcharge
Address 35C$ ' 1yWW_4rLPolice Plan Review 144 R'
M Q Fire SAC
City/Zip Code G v,~l~y). Sj/ZZ Engr Water Conn 7~oo.-
Planner Water Meter (03.=
Phone Council Road Unit ZgO.`°
~ I I Bldg Offl i> reatment Pl 132 Arch./Engr. ~U1lf rv. C~q,(~~ypiL. APC Parks
r Variance Copies
Address TYITAL 5o
City/Zip Code t~ti,. ~Jrj1[~i
Phane U
S I O PVI A Hous e •
S1J63VEYING Certlflcota For:
SEFlVICE8 Q
3908 Sibley Memonal Highway Front0er MiV,we~7 ~
Eagan. Minnesota 55122
Phone: (612) 452-3077 Corpovotlon
. i' M~aa - uAaTFORO -
,
~ 805 0
x
o
Q\566° Lr
3
ee~
- N -
-'T-0
A yM~- ~ j p~ii~ 4~ --+iz•. ~ /
lC ° ~T4 r/'O~ s
Q f1! n ~50x. 40 ',:j
.~n ~_3o 1f~ 4~ R1 w~ X~5
~ ~1• 4
hGALE; 1'~=40' oC ~a 10 ~ ra~i a0'r 13 ~
• S ,
W I _ ~rvt~e nl (V\ 'I~
~i N9]QO~a:.~.s e ui:l:4 ~ ~
0
w1 Nv~~25~i~~~l~l
U) ~
3r I
LoT i2 /
30 ~ /
"L~ GE END' PROPOSED GARAGf FLDOR ELEVATION=
0 Denotes Iran Mora,rrpnt Pld7P05E0 Top o/ Block ELEVAI/ON= 8G 3_
° Denotes M'oai Nub Set PROPOSfO BASEMENI FLODR ELfVA I/ON= 883.3
'as3' Denotes Existirg Spot Elevaticr)
va. z~~WN- NOTf.: Verify al! (loor Iriqhts rith Final h'orse Plans.
) lkrrotes Proposed Spot Elevalion °
L1eno tes Dra i nage 0 i rec t i on TRWYQRS CERf IF ICAT I(XV
I ~reby certrfy tFaf thrs survey, p/an or repori
was prepared by rtr+ or unjer my di rect suFrrvi si m
LOT i3 ,&aK i arrl that I am a duly Registered Lart1 Surveyor
WF-sTfluR!l yTK AAnn-IoN urder the lars ol fhe State of MinneSota.
eccordirg to the recaded plat tFieren(. P.In_IAJ ~ `~m^p~ o S/~,~/8S
l ae Date:
~}a Cam1y, Mimesota W Wayre 0. Cordes, Minn. Reg. No. 14575
` \~\\11111III111111//////
ESpTq
' ~'••.~k';
WAYNE D.
' j CORDES
14675
.0
ri~innxmmm~u~W
/hM,yv~ j'~~vkA 0Cbt4a • , Page 1 of 4 , .
• _ !OR EhIVELOPE l14-ERAGE "U" COhiPIITJITION ~r/Q~TFvZ~
~NtL r?rt?L.1,.
OWNER: IiATf : 3 'ZS S
_ SITE ADDRESS: PfIONE:
CONTRACTOR:_ ~~t10,Jt%M ~
Determine working square footage of each
1. Total exposed wall area.,... ~8S 7 Z s sq, fL . x.11 = ZO~, L 9
2. Iotal roof/ceiling area..,., sq, ft. x.026 = z Z. d$
Total exposed wall area above floor= '~S1
a. Total wall window area
~
r~ 3
b. Total door area.......
c. Totol sliding glass door area
d. Total ftreplace wall area -4 t '
e. Total wall framin area ~ " " " " " •
. Total rim joist area „ (average lOa)
f I 8 S. 7
. . . . . . , . . . . . . .
2
9. net wall area above floor.L.`!~. .
h. - - ~
wall area a6ove floor - 4
•
- -
wall area above floor.,.... . . . . . .
"
~
J. frame wall area at foundation...................................
Total exposed foundation area= L~, Z g
k. Total foundation window area.........
1. Total net foundation area zbove grade............
Determine "u" value of each wall segrnent
(e.g, window, door, each separate wail section)
a• 1!~ x u„-~
b. b'L Xu-, . 4S - I=A_7 '
X ~v- .4 r9
d._ x V. r~_ , .
e._~3.LL~! rL_ X n U u
f. 12 5 z~~U"
x..V 3cl o(
h. X
`t .
i . x
j. X 11 u~~
k, X „U„ If item q3 is the,'same
- as, or less than':item;
~q N1, you have
S X 5 = I• `O ~i met~':the::;~
intent of SBC
6006; c,)~
~
3. Total !/C,
.,p
cior Envolopo Avarngc "U" Compul•nCion Ptigo 2 oE q ,
~ • .
. Tolnl exposed rooL/ceiling nrca = ~~Q
m. 'lb'tul s}:yll.ylit arca
n. Total _-oof/ccilin, framing area (avcraye 104.)... 9:5-9k-
. o. Total net insulated roof/ceiling urea........... ~
. Uctermine "U" value for each roof/cciling segr,ient
, M. x Vi.
n• 9a
o. -7- 3-, g " u~~ ~'9
-3G ir 7
4 1bLa1 !S
If total oE 44 is the same as, or less tnan 1,2, you have met the intent of
SbC 600E (c) 1.
. i ,
Alternatc IIuildinq linveJ.oPe Desiqn
7b utilize the total envelope 'systeJn method, the values established by tlie s:un of
i.tens 0 and j;q shall not be greater than the swn of items I~1 and if2.
Z dy_ * z-
3. + 4. r7. ~'S = _1-19.z';5
.
r,
. ~
. ~
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'y. cx~
. ~.C A ~ ~j . A4vnn ~ . • !o I
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FIG. tl] TQPVIF.IZ OF ~
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i~ Construction R-Valiic
• 0 1. Intcrior air filn . 0.61
F31D
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4 • 44.OD
. Ex[cri.or air filn (still) O.G
VF= TotaLl 2 4s8o
oZ .
• ~ . FRq+rt s ~ . ' -
Lea[ flow 1. Interior air Pilm 0.61
:nted 2_ G- -
up
, 3. ~ ~ ~usul~ 38, 3S
, • 4. F:xtcc'io_ air t~tn isf.zl
. • . - TotaL 2 - 9 O.1S
F'ZC. 05
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- - --~_r 1. Insidc air filin 0.61
. . Z _
3.
4 -
S. Outsic]C air fi]:n 0.17
' 1 I/ I f ~ il%, I,~l l~~ Total
_-r
E
. ~GtY . . ~ . .
\ . I. Tnsidc air E11m 0.61
~ Ercc flov up - j~vented 3-
4.
• ~ . ~ ~ • ~ ' S. Ovtsidc air fi2:n 0.17
• _ _YSG_ d6.~ . ~ . ' . ' : Total
1_ Snsid'e air film 0.61
2-
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3-
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4-
..,--r . . . j r, ~r-•:~- ~~i,fc:.,... Ltitsidc air fiLn 0.17
71 - Tota1' . .
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• k:Q:t-~~;I~ . No[c: U::a additional sheets if morc cpaco i: _
' ~ i.eeclecl for clctails and ealcu?atims.
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i9 9~~B LDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830 PII.OT KN08 RD - 55122 L I•-~ l" ~Y4~
681-4675
New Construetion Requirements RemodeVReoair Reauirements
? 3 registeretl site surveys • 2 copies of plan
? 2 copies af plans (inGude Deam 6 window sizes; poumd fnd. design, etc.) ? 2 site surveys (ezterior add'Rions d decks)
? 1 energy wleulations ' ? 7 energy calculations tor heateC addqions
• 3 copies of trae preserva4on plan H lot plattetl after 711193
requi : Yes _ No
DATE: CONSTRUCTION COST; 46 60.00
DESCRIPTION OF WORK:
STREET ADDRESS: ~"1 I~' C~S I V(,(.Yl~ ~~Q,l I
LOT: BLOCK: I SUBD./P.I.D.
Name: I 1 b,X/ DuQ-e) Phone ~~(!J ~ 0~"'v
PROPERTY Last First
o,iNER
Street Address:
City State: Zip: oC?
Company: a ui r 1 1 UX~ ~L' - P6one ~(O12
CONTRACTOR
Street Address:6 ,~~j
~~'J License # p~~ ~(~.Jd1
City rnl State: 1 i(Y~ ZiP: 5s~-aa
ARCHITECT/
ENGINEER Company; Phone
Name: Registration
Street Address:
Ciry State: Zip:
Sewer 8 water licensed plumber (new construction onty): Penalty applies when address chang
and lot change is requested once permit is issued.
I hereby acknowledge that I have read this application and state that the info ation is eorrect and agree to comply with all applicabl
State of Minnesota Statutes and City af Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY D i--"--
Certificates of Survey Received _ Yes _ No
~I
Tree Preservation Plan Received _ Yes ` No _ Not Requ~rc6fi
I
t
'
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Dupiex ? 11 Apt.lLodging ? 16 Basement Finish
? 02 SF Dwelling ? 07 4-plex ? 12 Mufti Repair/Rem. ? 17 Swim Pool
? 03 SF Addition ? 08 S-plex ? 13 Garage/Accessory ? 20 Public Facility
[1 04 SF Porch O 09 12-plex ? 14 Fireplace O 21 Miscellaneous
? 05 SF Misc. ? 10 = plex ? 15 Deck
WORK TYPE
? 31 New ? 33 Alterations ? 36 Move
? 32 Addition ? 34 Repair ? 37 Demolition
GENERAL INFORMATION
Const. (Actuai) Basement sq. ft. MC/WS System
(Allowahle) Main level sq. k. City Water
UBC Occupancy sq. ft. Fire Sprinklered
Zoning sq. ft. PRV
# of Stories sq. ft. Booster Pump
Length sq. ft. Census Code.
Depth Footprint sq. ft. SAC Code
Census Bldg
Census Unit
APPROVALS
Planning Building Engineering Variance
Permit Fee Valuation: $
Surcharge
Plan Review
License
MC/WS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded. Other
Copies
Total:
% SAC
SAC Units
4, 1I
z/aa
CITY OP EAGAN
~ AP?LICATIGN FOR PERMIT
?IIII
SEWER AND/OR WATER CONNECTIODi
(PLEASE PPIHi)
1) PP.OPE7P_' ACDu.SS: 39 ~'t ~.l j~~(1
r FraL c~~~rTcN: 13 I U„ts: 'N~ -D~ (Ict lock/5;visicn r Tat 2arcel I.D. NL:..-)er) =:i, ST";i:C^*:%::. Dl TEE 0° C<ZTG^_r.UI"._.P•2.`:G TSJUti.C.:
z' ;
porcENn ...~r-/'y?OPOSED L'S: At F.-1 Si•:G'i.: FF:.tTI,y '
? R'2 DLYii [,^!Z':S)
. ? R-3 ".C,T.th~rvTCr + Z-.7jTS) ~ L-iII'_'S) .
? :-4 L
h~ r~~. ~..~...1
'tJI':J)
? CCi'^'fEPI..T_-1I./ h..I?Oc?ICE
? \'CCSi.7~_L
- - - ? ~:STI ~TIC:i~S,/GGV~•<rc-~;T -
2) (PLEdSE PRINl)
Frontier Midwest Homes Corporation
ALDIREGS: 3908 SibleY Memorial Hwy. Bldg. E
CI'?"', ST:.TE, ZIP: Eaqan, MN. 55122 -
PHIO`E: 454-0433
3) PLJ,`.~=-% ~ (PLE;,SE Pp1Ni) F0~ CITY USE 04LY
N'=~--' Star Plumbinq
, PDD.v,ES: 1018 Mound Springs Ter. PLuyBPRS LICEUSE:
. ~ Active
CIiI, STATE, ZIP: gloomin ton, MN. 55420 Espired
PHOV'E: $$4-4149 PlU98EP LFCEYSE k 3329 0/'9~Not/of Record
' ar~~inicia
4) OLC[,'PP_1T/C!dClE:tt C~ C I(PLEAS"E ~PRlNi)
~'M'-'' C ~ ~Y 1 I PC~
ADoRESs: ~ 0 aup K) 41301
c=Z, sTATE, aZD: 55
PHO,E:
5) INDICI.TE ;aIZCH PEF2-1IT IS BEIItiC nEQUEsTm:
0 CC.rdECi'I0N TO CIT'! SD7II2 Please mail gold copy to
~ CO:NEC'TIC,I TO CITY tap=, Wenzel Mechanical
? CI:':TR (PL.~,_,~cF DIEE) 3600 Kennebec -Dr. i
r. r Eaaan MN.- 55122
6) II:DIG,:: C:LL.: .
. ? PT.Z'~SE f?OID APPRCVE7D pgRMST :'O4 PZCri-LP BY CNE OF 71EC1,'E
~°TE~%S' :•AI ^APP°WED PM'•IIT 'PJ l,v 3, 4.aF~JE
(Ci_ e one)
7) SIcz,"'IZ,'R%:
1 - DAT'E:
. r
MR R a1:R~~
. . ~ '
F O R C I T Y U S E O N L Y
PER~MIT ?SSliED
rcES: $ S=i•ico nr.~Ntrm (I`.?CL::iE SURrclRGE)
, $ ~U• ~(1 14ATE7 DF:UtTm (I1:CLUDL vVRCF:HiZGL)
$ 3c? WATzR METER/COPPE4HORN/OUTS?DE RrAGEcZ
$ WATER T.,P (INCLL'D° CORPOcZATIOiI ST_QP)
$ SEWcR TA?
$ j~.cc~ :f~S=- -
$ O ACCOii:'.T DEPOSIT - S•ir.T=R
$ ~ W?.C
$ SFC
- - $ - - - - -TDli`:R !•7AT°_R ASSESS.'i°T .
$ TBii?IY SE:•iER ASSE55?e°_?iT
$ L~.TEP,?.L BcidEFIT/T_°.li`IK SVi?:-
S L?TEIRr1L BnVLFIT/TP,U`:K :'i,aTER
$ WATER TREATPIENT PLANT SURCHARGE
$ OTHER:
$ TOTyL
~;-ej rlIMOli`:T ?AZD:"REC°_i?T ,'1, D07-S UTZLZTY CONNECTION REQUZP,E EXC.aVATIOiI IN PUBLIC RIGi-IT OF iJAY?
F-7 YES IF YES, THEN "PERPSIT FOR :904?: WITHIN
PUBLIC ROe\DWAY" MUST BE ZSSlicD BY THE
~ NO ENGINEERIrIG DIVZSZON. LIST AS A CONDI-
TION.
S(JEJECT TO THE FOLL014ZNG CONDITIOf:S: '
i
APPROVED BY:
TIT:,c : DAT_:
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