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4808 Weston Hills Dr , . . ' . - S . iKertificate of cccupanc~ WiM of ftga~ Zqwdmcut o~ andOeC68" Thrs Certificate issreed pursuant to the requirements of the Uniform Building Code cenifying that at the time of issuance this structun was in cornpliarrce with the vnriou.s orWnances of tlu Ciry regulatiRg buiLding construcriori or use. For !he following: trseclusitwatiorr. SF Um ewg. e~,,,;, rb. 26171 o.a.r ry. ?t3/U 1 Zonine niar;a RI Type con5t. VN o.na ar suOding HM SY 41ASE „d6,.1668 E tZIFF RD, B[]RNSUII.IE eWkfine Aadn= 4808 WS'IM MIZS I]RIVE L3, B 1. PM EOC,E ! ST Dale- +M POST IN A OONSPICUOUS PLACE . • . . ' ~ y,~}y, Y f_~y ~ :.:i INSPECTIQN RECORD bITY'OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: t~ 1 Eagan, Minnesota 55122-1897 Date Issued: / 0 (612) 681-4675 SITE ADDRESS: ' APPLICANT: 1 i~ f s is1 U~ # r •l11N Ft 1 i 1 ^ f1F PERMIT SUBTYPE: TYPE OF WORK: 1, 1,, INSPECTION D. . ;~~n I I rdW ;Iii1r{lf:, I 1 i•I I Wt~ I: i~lii i N~, {1~~114 t~r~? ~ ~ i ~ ri+'~ ~ t ~ ~ ~ J, Partnit No. Permit Holder Date Telephone # -ELECTRIC D /l ~r? q/ 9~' PLUMBING Hvnc q 7 9.~ '~~0-GDb?~. Inapectlon Date Inap. Commenta FoonNGs k/QS~ o FOUND ~ FRAMING / ROOFING ROUGH PLUMBING PLB(3 AIR TEST ROUGH HEATING °EST VC INSUL f~~c v GYP BOARD FIREPLACE FIREPLACE AIR TEST FlNAL PLBG r FINAL HTG ORSAT TEST BLDG FINAL ~'~1 •Qr BSMT R.I. BSMT FINAL DECK FTG DECK FINAL Address 4808 wesmrr xIIZS ntuvE Zip 5512 3 L.ot' Blk I Sub PIMs IDcE Ist THESE ITEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECl'ION. Date: Yes No Inspector: Final grade (6" from siding) V/ Permanent steps (garage) Permanent steps (main entry) Permanent driveway ,V Permanent gas Sod/Seeded grass TraiUcurb damage Porch Basement finish Deck Please verify with the builder [he removal of roof test caps fmm the plumbing system and Ihe shuFOff of water supply to the outside lawn faucet before freeze potential exists. Contact engineering division at 681-4645 before working in right-of-way or installing underground sprinkler system. ~ White - City Copy Yellow - Residcnt Copy Pink - Contrecfor Copy REQUEST FOR ELECTRICAL INSPECTION ~ T~% Es-~~~ooooIII jl~ See instmclions for coypleting Ihis,Jorm on back of yellow copy. ( Q'S "X" Below Work Covered by This Request Ne Atld Rep. Type of 8uilding Appliances Wired Equipment Wired Home qange Temporary Service Duplex Water Heater Electric Heating Apt. Building Dryer Load Management Comm./Indushial Furnace Other (Specify) Farm Air Conditioner Olher (specity) Contrectofs Remarks: Compute Inspection Fee Below.# Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Swimming Paol 0 to 200 Amps 0 to 100 Amps Transformers Above 200-Amps ve 700 _Amps ~ Si OS inspecors use onry: . TOTAIOO Irrigation Booms ;/'rJ r, ) ~ Special Inspection r ~ , Alarm/Communication THIS INSTALLATION MA 6D1 ONNECTED IF NOT Other Fee COMPLETED WITHIN 18 MONT S. I, ihe Electrical Inspector, hereby Rouqn,n certify that the above inspection has F;nai ~7 oat been made. OFFICE USE ONLY This request voitl 18 mon[hs fmm 9r 9 '7 Request Dat ~re No. ou9h-In Inspeclion Requiretl Inspeclion OMer Than Rough-ln (VOU usc call inspecior when reaGy) ~ Ready Now ~ Will Notlfy Inspecror ~ ~1 Yas ? No Date Rea I;0licensed contractor ? owner here6y request inspection of above electrical work at: Jab AdOress (Snaet, Bax or Roure No.) Cily ac, Section No. Township Name or No. Range No. County ~ / `ZA I ~ Octupant(PRINT) Phone Nsy, Power Supplier ' ` Address D G 'v- k)') ! r\-A . Eleddcal Convactor (COmpany Name) Conl2clofs IJCense No. ` n 1 A( Mailing AdGress (Contractor or Owner Making )stallation) 9=? 1>, e., v. Au(hodietl SignaNre (COnlra-cl,or QxnesMeking•ImYMaatit~ Phone Number MINNESOTA STATE BOAND OF ELECTRICITY THIS INSPECTION REOUEST WILL NOT Grlggs-MiOway Bldg. - Room 5428 II I I I I II I I II II I I I II BE ACCEPTED BV THE STpTE BOARD 1821 Univetsity Ave., SL Paul, MN 55100 UNLESS PROPEF INSPECTION FEE IS Phone(612)6C2-0B00 ENCLOSEO. rbD 2006 RESIDENTIAL PLUMBING PeRnniT APPLicarioN CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN MN 55122 651-675-5675 Please complete for modifications to existing residential dwellings. Date t*35 / 166 Site Street Address p/"' Unit # Property Owner GmP ~(lr'iail~jrtiE OJ/~Fi Telephone #(laS7 )4f73"'g/~O 9 Contractor Telephone# ( ) Address City State Zip The Applicant is: ~ 'Owner _ Contractor _Other Septic System _ New _ Refurbished Submit 2 sets of plans and MPC license Includes County fee $ 100.00 Per as-built $ 10.00 Alterations to existing dwelling $ 50.00 Add plumbing fixtures. This fee includes installation of a water softener and/or water heater at the same time. !f you are installing on! a water softener and/or water heater, do not complete this section; move to the next section and check the appliance(s) you are installing. _Septic System Abandonment _Water Turnaround (add $130.00 if a 518" meter is required) Other: Water Softener Water Heater $ 15.00 _ new _ replacement Lawn Irrigation _RPZ _PVB _new _repair _rebuild $ 30.00 State Surcharge $ .50 Total $ 'Mz ~ 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 plumbing 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 wili be in accordance with the approved plan in the event a plan is requir be revie d nd pproved. ~/GmCS ~_Tn-tni ApplicanYs Printed Name plicanP ignatur ~ ~ ~ ~2E5IDENTIALBUILDINGs 0~b ~ City OfEagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 New Construction Reauiremen4s RemodeVReoair Reauiremenis Office Use OnH 3 registered site surveys showing sq. ft. of lot, sq. ft of house; and all roofed areas ~ 2 copies of plan showifg (oo6ngs, beams, joists Cert of Survey Recd: Y_ N (20%rtaximumlotcoveragealbwed) lsetofEnergyCalculationsforheatedaddifbns TfeePresPlanRecd =_Y _N. 2 copies of plan showing beam 6 window s¢es; poured tound desgq etc. t sife survey for addNons & decks T2e Pres Required _ Y_ N 1setofEneqyCalculalions Addifion - indiceteilon-sitesepticsystem On-sReSeptic5ysfem ,_Y_._N 3 copies oT Tree Preservation Plan'rf bt pWtted after 7/1193 Rim Joist DeWil Options selection sheet (buildings wAh 3 or less unRs) Minnegasw mechanical ventilation fomi S CauAG L Date Constructioa Cost Site Address ..~1~~ lN.c,~/o.ti ~L~ ~%f'% UniUSte # 7 f Description ot Work 1Z, i?i .fi 19,4S'er '9-i !F it, / Multi-Family Bldg _ Y ? N Fireplace(s) _ 0 V 1 _ 2 Proper[y Owner J,2/h~- Telephone # (t.J d 7 Contractor Address City State Zip Telephone # . -5 COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minnesota Rules 7670 Cateaorv 1 _ Minnesota Rules 7672 Energy Code Cetegory . Residentiai Ventilation Category 1 Worksheet • New Energy Code Worksheet (J submissian type) Submittetl Submitted • Energy Envelope Calculations Submitted In the last 12 months, has the CiTy of Eagan issued a permit for a similar plan based on a master plan? _ Y _ N If yes, date and address of master plan: Licensed Piumber 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 star[ without a permit; that the work will be i accordance with the approved plan in the case of work which requires a review and approval o s. pplicanPs Printed N e ApplicanYs Signature DO NOT WRITE BELOW THIS LINE Sub Tvpes ? Ot Foundation ? 07 05-plex ? 13 16plex ? 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 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF ? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc. ? 05 03-plex ? 11 10-plex `17~ 19 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex ? 25 Miscellaneous Work Tvpes ? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding ? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair ~ 33 Atteration ? 37 Demolish Building' ? 43 Reroof ? 46 Windows/Doors 34 ReplacemenT 'Demolition (EnBre Bidg) • Give PCA handout to applicant D@SCripti011: Water Damage _ Yes Valuation 0-1 l-no Occupancy MCES System Plan Review /10,0% or 25% Census Code Zoning City Water SAC Units Stories Booster Pump # of Units Sq. Ft. PRV # of Bldgs Length Fire Sprinklered Type of Const ~ Width REQUIRED INSPECTIONS _ Footings(new bldg) _ Sheetrock _ Footings(deck) _ FinaUC.O. _ Footings (addition) ~ FinaUNo C.O. _ Foundation ~ HVAC Drain Tile Other Roof Ice & Water Final Pool Ftgs Air/Gas Tests Final ~ Framing _ Siding _ Stucco Lath _ Stone Lath _Brick Firepiace R.I. Y Air Test al - Windows ~ Insulation ~m Retaining Wall ~ Approved By: , Building Inspector Base Fee Surcharge 1,2 v v ~ ~ Plan Review MC/ES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search Copies Other Total CITY OF EAGAN PERMIT ~~~LOI 3830 Pilot Knob Road PERMIT TYPE: B uILo z N e Eagan, MinneSOta 55122-1897 Permit Number: 026171 (612) 681-4675 Date Issued: g S( 0 7/ 9 5 SITE ADDRESS: 4$0$ WESTON HILLS DR LOT: 3 BLOCK: 1 PINES EDGE 1ST P.I.N.s 10-57690-030-01 DESCRIPTION: fr+•6r ~ Bwildlng"^Permit Type SF DWG q,uild5.fig 4,61r*~7ype NEW f0a C 4ect4Ra ncy ~ R-3 U-i ~ ConStr`uction 1"YFxg, V-fV Zon3ng G R-1 8u31d°zng Length 1 60 Su3.liiing Wf.dth 52 ` Bu ild ito, ri e s 2 r 2 9 018 =t rv € wa~_ REMARKS: PRV 5 & W PLBR - FEE SUMMARY: VALUATION $143,000 Base Fee $1,102.25 MISCELLANEOUS $1,892.50 Plan Review $385.79 7otal Fee $4,302.04 Surcharge $71.50 SAC $850.00 SAC & 100 SAC Units 1 SUbtotdl $2e409.54 CONTRACTOR: - flpplicant - sT. LzC. OWNER: HOMES BY CHASE 18955337 0001619 HOMES BY CHASE 1668 E CLSFF RD 1668 E CLIFF RD BURNSVILLE MN 55337 BURN5VILLE MN 55337 (612) 895-5337 (612)895-5337 j X herelay ackrww,ledge that -I Ftave r=eacf ~}ris aPp~,tez~tia~t and ~ta~~ttra t `t~fs 1.Rfo~rr~ati4h, i~ earree-t an3 agra~ tQ 'ctsreiply with +1311 _aPPticable 3iata gt~tu idCiCy af E-zaganDrdina"es~' APPLICANTIPERMITEE SIGNATURE I ED BY: IGN ATJJRE CITY OF EAGAN 3 O z• U t~• 3830 PILOT KNOB RD - 55122 ~ 1995 BUILDING PERMIT APPLICATION (RESIDENTIAL) 681-4675 New Construetion Reaulrements RemodeUReoair ReaulremeMs ? 3 regisiered sRe aurveys ? 2 wpies of plan ? 2 copies of plans (Include beam 8 window sizes; pauretl fid. design; etc.) ? 2 site surveys (exterior addttfons & decks) ? t energy ealwlations ? 1 energy calwlationa for heated additions ? 3 coDlea o1 tree proservetion plan ff lot plaried after 711/93 requiretl: _ Yes _ No DATE: CONSTRUCTION COST: DESCRIPTION OF WORK: STREET ADDRESS: LOT ~ BLOCK SUBD./P.I.D. PROPERTY Name: Phone OWNER Street Address:, City: i~?4~ State: 2~/'/t_ Zip:37 coN7tu?CTOR Company: 42 Phone Street Address: License k~ City: State: Zip' nRCHirec7r Company: Phone ENGINEER Name: Registration Street Address- City: State: Zip: Sewer & water licensed plumber. Penaliy applies when address change and lot change are requested once permit is issued. I hereby acknowledge that I have read this application end state that the infortnati ~s cortect and agree to comply with all applicable State of Minnesoca Statutes and City of Eagan Ordinances. Signature of Applicant: OFFICE USE ONLY / Certiflcates of Survey Received ? Yes ,Il1I ~ ~ 9~~5 Tree Preservation Plan Received _ Yes , Na OFFICE USE ONLY BUILDING PERMIT TYPE 0 01 Foundation ? 06 Duplex ? 11 Apt./Lodging o 16 Basement Finish ~ 02 SF Dwelling ? 07 4-plex o 12 MuRi RepaidRem. ? 17 Swim Pool ? 03 SF Addition o 08 8-plex ? 13 Garage/Accessory o 20 Pubiic Facility ? 04 SF Poroh o 09 12-plex o 14 Firepiace ? 21 Miscellaneous o 05 SF Misc. ? 10 = plex o 15 Deck WORK TYPE 4P! 31 New ? 33 Alterations ? 36 Move 0 32 Addition ? 34 Repair o 37 Demolition GENERAL INFORMATION Const. (Actual) 't' Basement sq. ft. 11'Z $Z MCNVS System (Allowable) ~v Main level sq. ft. oG City Water T UBC Occupancy z'=' sq. ft. 7~7 Fire Sprinklered Zoning !L- / sq. ft. PRV ~S # of 5tories Z f/3sMr sq. ft. Booster Pump Length &o sq. ft. Census Code. /d/ Depth S/ 40 7 Footprint sq. ft. Z, o ra SAC Code O/ Census Bldg ~ I~ S~~ APPROVALS Census Unit Planning Building Engineering Variance ~ Permit Fee Valuation: $ l y1 cxt;o Surcharge Plan Review License MC/WS SAC zsx City SAC S-X z y z o 6~ Water Conn. Z < 2 ?e Water Meter Acct. Deposit S/W Permit ; S/W Surcharge 8 2 Treatment PI. Road unit 11v, SZY Z3o Park Ded. ~PP~ Q Trails Ded. ~ ~ ~eeS 31 k Z y ° z~ 33 x/y ~ S Total: 2 = i L Z l. G7 z ) % sAC 7 5'Y ~ t r x~7 ~ 7oy~ 16 ° 5AC Units - ~=-9-5 A6 ~ 2422 Enterprise Drive ! Mendota Heighta, MN 55120 ~ (612) 681-1914 FAX:881^-9488 * PIONHER uuo svRwvons • dvL acrNeEna * uN0 PLANN%RS• UNDSCaPE ARCHIT6C7Y 625 Hlghwdy 10 N.E. i * ~n rn-a ar Fne 8lalne, MN 55434 (812) 783-1880 FAX:783-1883 ~ Certificate af Survey for: ~~MES BY CH 2 ~ I ~ BOPCOF ARON ~xIS~tNG i 9> 3 L ELEV=960.51 HOUSE 960.7 952,3 ~ 960.7 148(p18 302 959.79 j ~TELE.ELEC,TV 5219$ ! l r.~ ~ Y f S~~ i I 20 N ~ ag78 ~ ~ryw ` 95 .2 N K 955.2 aa ~ ~ 954.2 ow ~ 1~1 ~ gggap 6'I r 3 Z¢a I aZ I to ~ • y0 ~ ~ ~ ~ s ~ `a~ I 00 -a NCA. ~ a •o o o~ ~ , s, ; ~ 20 ~J i ` (0 .0 /G['~~`po 0 952. 959.8 x 958.3 ag~~ ~i32 ~1 ~ 0 951.4 9 i ~ SEI~VICE ~GG1( 957.7 \\~4~~, ~ J~ ? ~ f 95813 PROq~p~ , 957. a ~ ~ 91 i ~ fNE DEP'T. TOPCDF IRON - EPaCraT ENG E i R EV I EED ELEV=958.50 ~ i I 3Y / 9!' 1TD U'll o lJ a~1-lI d~ r fa " 1A ~ ? ~ ~--i_ I NOTE: PROPOS£D ORADE5 SHONTJ PER GRADINO PLAN 9Y; PIIXJEER ENGINEERING eROPOGED HOUSE ELFVATION I NO1E BUIL9ING DIMENSIONS SHONN ARE FOR MORiZONTAI AND VER7IGAL lOCATION LQyygST fL00R ELEVATIQN: ~1 S7•7 ' qF 5TRUCTt1RE5 ONLY, SfiE ARCHI7EClUAL pLAN$ FOR BUILDING ANO i FOUNOA710N OIMENSIONS 7pP OF BLOCK ELEVATION: r`?' 4 i NOTE: NO 5PEqFIC SOILS INYESTIGAlIaN HAS BEEN COµPl.E1'fD ON 7HIS LOT BY Tt1E SURVEVOR. THE SUITABILITY OF SOi4S TO SUPPORT THE SPHCiFIC HOUSE GARAGE SLA6 ELEVATION; I PROPOSED IS NOT TtIE RESPONSIBIlI7Y OF THE SURVEYOR. ~i NOtE: *His CERTIFiCATE DOES NOT PURPQR7 70 54iOW EASEMENTS OTMER THAN XDOO.00 DENOTES EXI971NG E4EYATiON ~ 7HOSE SHO4YN ON TNf RECORDED PLAT. ( OOO.OD ) DENOTES PNOF'OSEO ELEVATION I DENOTES URAINAGE AND UTIL~T' E~SEMENT NO7E: CONTRACIOR MUST YERIFY DRIVEWAY OE31CN, DENOTES DRAINAOE FIOW DIRECTON I NOTE: BEARMGS SHDWN ARE BASEO ON AN h55L1ME0 OATl1M 0^- DENOTES MONVMCNT B DENOTES OFFSET HUB I WE HERE6Y CERTIFY TO HOMES 8Y CHASE THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF TFIE 60UNOARIES OF: i o~o n oouL;~wKso A PINES EDGE 1ST ApDITlOlV ~ IT DOES NOT PURPORT TO SHOW IMPROVEUEN75 OR ENCHRDACHMENTS, EXCEPT AS SHOWN. AS SURVEYEO BY ME OR ~ UNDER MY OIRECT SUPERVISION THIS 247H OAY OF JULY, 1995. - IGNE ; PIONE6R ;ENGI,NE~NG, P.A. ' SCALE ; 1 INCH = 30 FEET B_ ~ I 975 94400.04 BJM John C. LPr9on. L.5, Reg. No. 19828 LOT SURVEY CHECKLIST FOR RESIDENTIAL ¢BUILDI G PERMIT PPLICATION ~ a 7 PROPERTYLEGAL: W U W a a m D TE OF SURVEY: / FS LATEST RE1/ISION: a s s . DOCUMENTSTANDARDS ~o ? • Registered Land Surveyor signature and campany O • Building Permit Applicant ? ? • Legal descdptlon ~ 0. ? • Address W/'o O • North aROw and scale ~ ? • House type (rambler, walkout, split w/o, spitt entry, laokout, etc.) 0 0 • Directlonal drainage arrows with slope/gradient % ? • Proposed/epstlng sewer and water services & invert elevatlon ~~~o ~ • . SVeet name _ D~'O ? • DrNeway ELEVATIONS Existina , ~0 E3 • Sewer servtce (plo o • Property comers 2-'0 ? • Top of curb at tlie driveway G1~ ? • Elevadons of any ebstlng adjacent homes / ro s 0" O ? • Garage floor ? • First floor 0 • Lowest exposed elevatlon (walkouUwindow) o • Property comers E3 ? • Front and rear of home at the foundation PONDING AREA lif aoolicablel ? M~? • Easement line O &~O • NWL ? [L/? • HWL o ~j o • Pond # designatlon ~ o • Emergency Overflow Elevafion DIMENSIONS e'~ o O • Lot IfnesBearings & dimensions ff~-o 13 • Right-of-way and sUeet width (to back of curb) • 0"0 ? • Proposed home dimensions including any proposed decks, overhangs greater than 2', / porches, etc. (i.e. all sVUCtures requiring permanent footings) ~ ? • Show all easements of record and any City utilides wRhin those oasements ~7 0 ? • Setbacks of proposed structure and sideyard setback of adjacent exdstlng sUuctures ? Er--? • Retaining wall requirements, i Reviewed: J Na e ! Date July t 995 rHr ~ ~ ~NOTE,: kVELL AND SEPTIC - . . _ r- - I ; TO Q, ; rABANDONt , BY • A ~ UT1L~ CONTRAC, 6 PLUG 8 PLUG 4 , MH ~ STA. 0+00;„ ' r' 3 - v ; 1 ~ ~ , S= 0+50;; ~ „ 12; ,41/4' END INV= 947.6~ ~ ~ I12 BFV , , , , ~ ~ i ~ SEPnC MH ~ STA. 1+'25 `CS= 957.61 i i 0~~ 1 2 S= 0+5~ 1 oti ,1NV= 950.7 7? t v B~I T 0 N H 1 t L S ~ 1 I INV= 954.5 ,cs= sso~z o+so ~ , CS= 964.5 , " INV= 948.3 A D D T 1 0 N I I---------- o, CS= 958.3 " - „ , 'ON HILLS DR. ~12"X 8"RE ..._-=--=i = - - Ic wet LO i t - - '~F-- -_-FO o -----`----i i s"Xs'rEE i ; 6"GV ACTOR TO LOCATE AND I I S= 0+24 ' EXISTING SAN. LINE 9540+75.2 12 INV= 947.8 TO CONSTRUCTION. „X1 2"TE'GVS= 957.8 JN~V= , S= 964.2 S= 0+41 12"BFV ~ 8-11 BEND INV= 950,8 CS= 960.8 LjJ MH STA: 3: 3 c: ~ )If;~~r E: ;GAN Q02s C ¢ - A~Ci1RACY OF UTII 'il jL CATt0NS . `.•;~/Or~ ELEVt~TIONS. 7HI ~ <<~'J:~ilfAi'ION PURPOSE~ I .~j;~i YO AND 12"PLUG ~W"CAP P~~~OM5 Uul(VG IT SHOU ~ V~cE?i~Y THE S IGHT a 11 I{i;'0~;,9ATi01V OfV THESITE.r SAN I WM BY OINERS W ~ - l 1 . . . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . . . MH . RE=962.56 . . . . . . . . . . . . . . . . . . . . . . . . . . : : . . . : . : . . : : . . . . 2. BL =21.30:... • . . . . : . . : . . . . : MH RE~ 957.82 : : • . . . . . . . ~ . . . . . . . . . . . : : : . . . . . . . MH: ' RE=958.86: : . . . . . . ' _ . MN . RE-957:03 . : : 3: . BLD-17:08 : . _ : : . . . ...........................5 ...QkD=t4.23:................ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : : RAISE :1NM: 70 951.75: ' . . . . . . . ~ . . • AT STORM: CROSSrNG . . ~XI I . . . . . 4 xU4'x 8'- RIGID STYROFOAM . . : : : . : . . . . . . : . . . . . . . . . . . . . . : : ~ \ . . ' MfN 1 • . : • CO R : . f . r A : ; ~ ~ . . ~ ~ . . . . . . ~ : . ~ . . . . . . . . . .r. ~ . . : . + : , . P-CC57 0 ~r'' 948 53 : : :15"RCP. : . : : ~ v ~ i . . . . . . . . . t • . : ~ . . ' # . ; ~ ~ . : : . - 400'-8"PVC SOR 35 , . . 100"-8"PVc SQR : ~5 104'-8"PVG SRR 35 : . . O 0.4074. . ~ 107'4-8"PVC SDR: 2 . . : . . p.40% : . . . . . . . . . . . . . . . . . . : : . . . . . . . . . : . . . . . . 6: : . . 4' 0:40%. : . . . . . . . . . . : 5'HE GiTY C}r EAGAN DGcu . • . . . ::'fHE . AC:GUFdACY: :OF uTILI`i Y LOC;r, POP;3 . : . ' : : ANDfOF3: i=!_EVqTlONS: :tHFS DAFF: : I- ;'OZ . . . : 1~~!F3RiVl~,l'iO1L . . PURPbS~B A,.'~ : : .8(~t~ . tiJvlMa •17 SHGIiLC' ' N M. . . : . . ' . . . . : . . . .n ~ . . . . . . . . . : . . . N M. . . . : ' . a. Oc)i . :IFOr~~, ~71~Il~R~ ON] THE::IYr.: . . . . . . . . . . N . CV N . 7t . ~ . . . . ~t . . . . . . . ~d' . . ~ t.. : . ..0)rn . . :..~Q~ . 01~ . . ~ y . . : : : , . . . . . . . . . . . . . . . . . . . . . _ . . . . . 4t~ll ~ 9 LQ- MF+ RE= 957:82 : : . . . . . . . _ . . . . . . . . . . . . . . . q . BLD-.15.53 . . . . . . . . . . : EXISTIN:G GRC g : . : . . : : : : . . ~ FINISHED GRADE : FfN15H : . . . EXISTING GROUND : : : : : :948as . -`_"7 5. MJN. : . . . . . . . : : . : : . : . : . . . . . ~2" . D ~ It . . . . . 12" . PLUG : t 2"RCP . . ..6:: • . . CO R......... : . . , . . . . . . : . ..c,C s . . . . . . : : . . , . . .2...... . . 8 CAP ' . . . . . . . . . . . . 6'~; PLUG . : . : . . : 131' 8"PVC ; : . : . :170VC• SD,R :35. ~4 .Q.40q. . : . . : : : : . . . : : : . . . . . . : . . . . ~CAP: . . . . ' 0 . . 0 . . . . : : : . . TFiE ~_Q i;eTiOI . . A" [PiD/"r~. P Lwi,?~';110~JS TH~ ^ r( . d . . . : . . . L6 c0 . . . : . . . . . . ~ CV M _ . . : . . . . . . . . . . . : ~ . . Ifl, li 'lit Ir'!' . . PLRPOi: C*4 C4. f,1 !3 ' _ d' . . . QI Q1. . ~ irv'ti.~S}iV , . . . . . O1 QI . . . . . . . . . . . . . . . . . . . - . . . . . . . . Z . - . ~ z . . . . z z . . . . ~ ~ ~ ~ CITY PRO,lECT . . 1& 2 Fauuly Kesidential "Cookbook" Metltioa SIIE ADDRESS Gh' zzl BUILDER Date Minimum Criteria: Rim Joisc R-l9 insulation Foundaton V. indows: Insulated glau. 1/2" air space, aood or vinyl frame Entry doors: 1'/~ inch solid wood with stocm or better STEP 1 Window & Door Atea STEP 2 Calculate area ag a perceat of wall Total Window & Door Area in Sq. Feet Box A(windoa. & door area) divided by Boz B(total WINDOWS (including foundation windows): Wa1 area) times 100 equals the window and door area Dimensions Qnty. Area as a percent of wall area (Boz G). •46 X ~ d BozA z100= 1~cQ`aC Box B x ~ - Z- ~ X 3 STEP 3 Design Features 'L- o- z 3 p ASSEMBLY OP'I'Ia~i Z ~ x FxAME wAl.i.: ~ x ~ - o p STANDARD FRAIrfII'IG x ~x ADVANCED FRAbtII`IG X CpVftY INSUTA'IION X DOORS: SHEATHNG: ~ LESS THnN R-5 X~ U ~ R-5 OR biORE ~ v x 2-1 WIINDOWS (except founda[ion windows): X U-FACTOR U- ~ S Total Area of Win Zr~~A dow & Doors From the table, detcrmine the maximum percent window Total Wall Area in Sq. FL & door azza for the design opdons selected and enter the Wall Total Perimeter Height Area., valut in box D below: 411, SZ ~.O D (.,S Box C must be Iess Wao or equal to Boz D Total Area ~ V B of watl F. The building must not exceed the maximum window and door area as a percentage of overall exposed wall area listed below for the combination of framictp, technique, R-value of insulation within the insulated cavity, sheathing R-value, and window U-factor. Other components must meet the requirements of this subpart, MA7QMUM WINDOW ANp DOOR AREA AS A PERCEIV'I' OF OVFRALL EXPOSED WALL Cavity Window U-Factor Ftaaiin insulahiott Sheathinz 0.49 0.36 0.31 027 R=13 13 4~0. . , '17.8%..:.: . 2L39'o 24.3% STANDARD R-15 yZR-5 12.9116 17.16 20.1% 23.490 cR 5::_'.~, 16 01YV; ~.:18.89'0 ' 22.0% ~ STANDARD R-18 y2R_5 13.5°a 18.6% 21:8% 25.34b ADVANCED _ _<R 5 , R=18 . ;`.111% ;:~1719'0 . `'_.20.1qo. 23.4% ' ADVANCED B-18 2R 513 5% 19.2% 22.5% 26.140 STANDARD, . ~ K-21 ' ~ . a:a. 19.9% 23.1% STANDARD R-21 2K-5 14.076' 193% 22.5% 26.1% -ADVANCED'; <R5 .118% 181%' .21_2°!0 24-6% ADVANCED R-Zl 2R-5 14.0% 19.9% 23.2% 26.9% Subp. 3. Perfarmance criferia. The combined thermaI transmiEEance (Uo) factors for walls, roof/ceilings, and floors over unheated spaces mus4 be less than or equal to: A. 0.110 Btu/h ft2 °F for walls; B. 0.026 Btu/h ft2 °F for roof/ceilings; and C 0.04 Btu/h RZ °F for floors. STAT AIITH: MS § 216C.I9 H75T: 18 SK 2362 7670.0480 Repealed, 18 SR 2361 MltvL Rules Chapter 7670 26 Jurke 1994 ~41 q S3 2004 RESIDENTIAL PLUMBING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN MN 55122 651-675-5675 Piease complete for modifications to existing residential dwellings. Date S / t~ 6 / ~Wo0 / + ~J ) Site Street Address ygo~ ~.+~QS'f~oh 15 4[~• Unit# Property Owner ~l po D Telephone # (651 ) q?3- ?169 Contractor UIU2 RQ1I1 P/I.(M vl(!~% Telephone# (6«) &k&9-_70)7W Address (.o )a Av& S- City 4 State_,04/ Zip s s yaj The Applicant is: _ Owner ^ Contractor _Other Alterations to existing dwelling $ 50.00 _Add fixtures to rooms, excluding water softener and water heater _Septic System Abandonment _WaterTurnaround (add $121.00 if a 5/8" meter is required) Other: Water Softener Water Heater $ 15.00 _ replacement _ additional Lawn Irrigation System RPZ_ new _ repair _rebuild $ 30.00 State Surcharge $ 50 Total 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 plumbing 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 approved. ~ S Cu# Qa 1by ApplicanYs Printed Name "_4-- ApplicanYs Signature CITY USE ONLY L BL / RECEIPT SUBD. lyg& ~ DATE: 1995 MECHANICAL PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 • (612) 681-4675 Please complete for: ? single family dwellings ? townhomes and condos when permits are required for each unit New construction Add-on furnace 4i1d_nn air rr)nLli4inning Qdd-nn Zir gvrhgn?cri.g. \/gnee sygfgT, °tC. Date: (iLtw G ! 7 z.7 FFFS • Minimum Fee: Add-on/Remodel (existing residence only) $20.00 ? HVAC: 0-100 M BTU 24.00 Additional 50 M BTU 6.00 ~ ? Gas Outlets (minimum of 1 required @$3.00 each) 3 ? State Surcharge .50 TOTAL ~ SITE ADDRESS: AIFSTO/I/ f7~/LLS .O~ . OWNER NAME: ~~r?It~SX_ Y e"SF PHONE 29' INSTALLER NAME: ("WIWLZC`~ STREET ADDRESS: '7/7)/v /71/ir- CITY: STATE: AV ZIP: _5,[~ PHONE o91g) cirr use on?Lv ~ L _ BL _ RECEIPT SUBD. DATE: 1995 MECHANICAL PERMIT (COMMERCIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (612) 6814675 Please compiete for: ? all commerciaUindustrial buildings. ? multi-family buildings when separate permits are ~ required for each dwelling unit. I'1ATF: rnNTRArT PRIrF; WORK TYPE: _ NEW CONSTRUCTION INTERIOR IMPROVEMENT DESCRIPTION OF WORK: FEES: ?$25.00 minimum fee 2C 1% of contract price, whichever is greater. ? Processed piping - $25.00 • State surcharge of $.50 per $1,000 of Rong fee due on all permits. CONTRACT PRICE x 1% PROCESSED PIPING STATE SURCHARGE TOTAL SITE .-",^DJ'ESS: - OWNER NAME: TELEPHONE TENANT NAME: (IMPROVEMENTS ONLY) INSTALLER: ADDRESS: CITY: STATE: ZIP• PHONE SIGNATURE: SIGNATURE OF PERMITTEE CITY INSPECTOR L BL CITY USE ONLY RECEIPT #u4o SUB . DATE: 1995 PLUMBING PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (612) 681-4675 Please complete for: ? single family dwellings ? townhomes and condos when permits are required for each unit FIXTURES EACH NO. TOTAL Shower 3.00 x t = 3 - Water Closet 3.00 x 3_ _ 1~ _ Bath Tub 3.00 x I _ -j - Lavatory 3.00 x 3 _ ~ - Kitchen Sink 3.00 x = 3- Laundry Tray 3.00 x I = Hot Tub/Spa 3.00 x = Water Heater 3.00 x 1 = 3~ Floor Drain 3.00 x i = 3- Gas Piping Outlet ' minimum - 1 3.00 x _ 3- Rough Openings 1.50 x = Water Softener 5.00 x = Private Disposal " Dakota Cty. license 20.00 = U.G. Sprlnkler * home under const. 3.00 = Alterations * to existing 20.00 = Water Turn Around 20.00 STATE SURCHARGE .50 J TOTAL SITEADDRESS: y~L~~ OWNER NAME: el INSTALLER NAME: va~ ~ ~ ' ~ • STREET ADDRESS: ~L^ 0 1<(• L CITY: air(t a-/ STATE i/' N~ Zip; SS 3~ a PHONE ( OPFICE USE ONLY L _ BL _ RECEIPT . SUBD. DATE: 1995 PLUMBING PERMIT (COMMERCIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (612)681-4675 Please complete for: ~ all commerciaUindusfial buildings. ~ multi-family buildings when separate permits are aQt required for each dwelling unit. DATE: CONTRACT PRICE: WURK TYPE: _ NEW CONSTRUCTION _ ADD ON _ REPAIR DESCRIPTION OF WORK: IS WATER METER REQUIRED? _ YES _ NO. IF SO, PLEASE PROVIDE THE FOLLOWING: WATER FLOW: GPM. ARE FLUSHOMETERS TO BE INSTALLED? YES NO. FAILURE TO PROVIDE THIS INFORMATION WILL RESULT IN A DELAY OF METER ISSUANCE. WILL YOU BE INSTALLING A METER FOR A FUTURE U.G. SPRINKLER SYSTEM? YES NO. IF SO, YOU MUST APPLY FOR A SEPARATE U.G. SPRINKLER PERMIT. FEE: $25.00 minimum fee or 1% of contract price, whichever is greater. State surcharge of $.50 per $1,000 of p.ennjt fee due on ail permits. CONTRACT PRICE x 1% STATE SURCHARGE TOTAL . SITE ADDRESS: TENANT NAME: STE. # OWNER NAME: INSTALLER: ADDRESS: CIn': STATE: ZIP: PHONE SIGNATURE: APPLICANT OFFICE USE ONLY METER SIZE: DATE: INSPECTOR: ë ÿ þ þýý üûùûùù øýýü ìýèýþ ÿ èâáç þýô ýüûú ù÷ì ï üú ù ÷ ú ù÷ì ï äìïàù ò ùßü ü óüù õÿ ýôü òù ò ññò ôü ò û ò ðî ÿììùÿ þ î î òÿ ý ùð î î ù î ð ûòí ôü û ì ÿî ò ñò ð êðèðè óø ýü ñ ÿ ë ü êðçðçè ë ü þçáð òÿñùÿ ôðï ùù ù å ò åó î èó ÷ ß ÿ ÿ æäèè ÞáèÝçç ñ û ìÿñ ñ ñ ùù ñ ñî ò ÿ òù ìñ ùù ûý îæ ý ü î ÿ ó ð ùù ï òýÿ ü ýÿ ü ptO \it All 6115Ft' .34 c{€ a r s -c of i\C5 t C4/ tt 1x oo w rea Jkni t,,,/5/8 :lr �1f4t� �M t e4,2,L,w6 Dg[tf 4So0 Wt�roI dfus HiQ. 626.4A1 MA! SS/23 N 6S/ 493-869 w 967 974--810? PERMIT City of Eagan Permit Type:Building Permit Number:EA124883 Date Issued:07/14/2014 Permit Category:ePermit Site Address: 4808 Weston Hills Dr Lot:3 Block: 1 Addition: Pines Edge 1st PID:10-57690-01-030 Use: Description: Sub Type:Reroof Work Type:Replace Description: Census Code:434 - 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 by law in ALL single family homes . Lisa Nyberg 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 - James J Orfei 4808 Weston Hills Dr Eagan MN 55123 Property Claim Solutions Llc 2005 Pin Oak Dr Eagan MN 55122 (651) 994-2028 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA125555 Date Issued:07/28/2014 Permit Category:ePermit Site Address: 4808 Weston Hills Dr Lot:3 Block: 1 Addition: Pines Edge 1st PID:10-57690-01-030 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 $105.25 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - James J Orfei 4808 Weston Hills Dr Eagan MN 55123 Property Claim Solutions Llc 2005 Pin Oak Dr Eagan MN 55122 (651) 994-2028 Applicant/Permitee: Signature Issued By: Signature _i For Office Use 4 % \ 9 : , E 4 4 4%4 4#°° # N � Z018 / s Permit Fee: -_ 1 Date Received: /O -/ "- fir 3830 PILOT KNOB ROAD(EAGAN,MN 55122-1810 (651)675-5675 I.TDD: (651)454-8535 I FAX:(651)675-5694 I tom: buildinginsaections@citvofeagan.com I ..:018 RESIDENTIAL BUILDING PERMIT APPLICATION Hate: l )1i Sltr Address: . LO l l4 l 15 j) r Unit S: Name: I C)c '€-t Phone: Resident/ , , \ _ Owner Address/City l Zlp: A op da,a e.`j it, u i l Sci) r Applicant is: Owner Contractor / I Type of Work Description of work: <f X /-1 £�"'Tk=1r i c it De e_k AJ) .*i ( Construction . D{) / Multi-Family Building:(Yes I No Y ' Company tIS6Pry 1400'1 0'1 Y_ S Pte. l'4.I 41e ontacL R 1 k f_ Mo r tenSen Contractor Address: +2 0 (-0 1, -� city. - 0 -_(. in°L .6 4 State: Zip S )6"K Phonekjj 2 -6fiy?Email: Not'i /s rj-tin I-,r i1 e--I- :n J License#:14c.,....572_. 42 O Lead Certificate#: _ If the project is exempt from lead certification,please explain why: ‘(&' COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING in the last 12 months,has the City of Eagan issued a permit for a similar plan based on a master plan? Yes No If yes,date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer&Water Contractor: Phone: Fire Suppression Contractor: Phone: NOTE:Plana and supporting documents that you submit are aonal/ered to be public h*.mal** of U,.learn deo�y be obs:Mad as non-public if you provide ap.o$ reasons that wotdier's*the Cr 'tb canch.d that bad*seems. You may subscribe to receive an electronic notification from the City of proposed ordinance by signing up for en email update on the ally's website at www.cltvofeaaancomlcubacribe. Exterior work authorized by a building permit Issued In accordance with the Minnesota State Building Code must be completed within 100 days of permit Issuance. CALL won YOU DIG. Cal Gopher Mate One Cali at(551)454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. vnvat000herstatisonecallorg I hereby acknowledge that this information is complete and accurate;that the work wit be in conformance � the ordinances and codes of the City of Eagan;that I understand this is not a perndt, but only an application fora permit,and work Is not to > a •,•, work WI be in arcs v4th the plan in tate cased work which requires a review and .., of pie .. iiiri pacant's Printed Nutt�l p r Alfil '.... . J cant's SI cant's i p r rtes A/ // 2r DO NOT WRITE BELOW THIS LINE -D5 6, - 4 SUB TYPES Foundation Fireplace Porch (3-Season) Storm Damage Single Family Garage _ Porch(4-Season) _ Exterior Alteration(Single Family) Multi Deck _ / Porch(Screen/Gazebo/Pergola) _ Exterior Alteration (Multi) — 01 of_Plex Lower Level _ Pool _ Miscellaneous Accessory Building — WORK TYPES _ New Interior Improvement _ Siding _ Demolish Building* (,, Addition _ Move Building _ Reroof Demolish Interior Alteration Fire Repair _ Windows _ Demolish Foundation Replace _ Repair Egress Window Water Damage Retaining Wall *Demolition of entire building—give PCA handout to applicant DESCRIPTION Valuation _34.2Occupancy 2- MCES System Plan Review Code Edition y I5 SAC Units (25%_ 100%y) Zoning / I- City Water Census Code Stories Booster Pump #of Units Square Feet PRV #of Buildings Length Fire Sprinklers Type of Construction �f Width REQUIRED INSPECTIONS Footings (New Building) Sheetrock 7, Footings (Deck) Final/C.O. Required Footings (Addition) *�/ Final/No C.O. Required Foundation / ~ HVAC Drain Tile Other: Roof:_Ice &Water _Final Pool: _Footings Air/Gas Tests Final Framing Siding:_Stucco Lath Stone Lath Brick Fireplace:_Rough In _Air Test Final Windows Insulation Retaining Wall: _Footings—Backfill_Final Meter Size: __ Radon Control Erosion Control Reviewed By: /. , Building Inspector RESIDENTIAL FEES Base Fee 06/I&Surcharge Plan Review MCES SAC City SAC Utility Connection Charge S&W Permit& Surcharge2 / Y / /'' U,�!7TreatenPlant to ` Copies TOTAL Page 2 of 2 PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA156071 Date Issued:06/14/2019 Permit Category:ePermit Site Address: 4808 Weston Hills Dr Lot:3 Block: 1 Addition: Pines Edge 1st PID:10-57690-01-030 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. 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 - James J Orfei 4808 Weston Hills Dr Eagan MN 55123 (651) 233-3205 Mcquillan Brothers Plumbing & Heating Co 1711 East Highway 36 St. Paul MN 55109 (651) 292-0124 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA158223 Date Issued:10/01/2019 Permit Category:ePermit Site Address: 4808 Weston Hills Dr Lot:3 Block: 1 Addition: Pines Edge 1st PID:10-57690-01-030 Use: Description: Sub Type:Windows/Doors Work Type:Replace Description:One Window/Door Census Code:434 - Residential Additions, Alterations 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 Fee Summary:BL - Base Fee $1500 $62.50 0801.4085 Surcharge - Based on Valuation $1500 $0.75 9001.2195 $63.25 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 - James J Orfei 4808 Weston Hills Dr Eagan MN 55123 Renewal Andersen 1920 County Road C West Roseville MN 55113 (651) 264-4777 Applicant/Permitee: Signature Issued By: Signature