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517 Weston Hills Ct2011-05-3108:04 » 651975 5694 41' City of Earn Date: Tenant: 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 8754675 Fax: (651) 6754694 C� P2/3 Use t3LUt or tiLAUR Ink eki FPetx m>it Olftce Use 3 I s Z ��/*� Permit Fee: 3c W Date Received; Stan: L 2011 RESIDENTIAL 1PnLUMBIN�G jPERMIT APPLICATION Site Addreaa: 511 Ven l t i L i 5 5-/27/11 Suite*: RESIDENT I OWNER Name: c \ O kM1 ErNO $4711 Phone: Jo I. 3R62 44370 `_ `,, Address / City / Zip: A0tW ►'�-0 ,G CONTRACTOR Name: t_y IS P \ I.t.YAOl I ( License #: � LZ.I Sc9 3 Address: a5 g. LLak?1 VC City: .J�Z �S l I le) State: M 1 V zip:55R5Q Phone: L b V o o.,0 Contact, 3OLSOn Email: TYPE OF WORK _ New _ Replacement, t�, Repair _ Rebuild _ Modify Space Work in R.O.W. Description of work: p 1 U(,1 tl O I it l Qu,m 1 t, e ‘ crhesyl PERMIT TYPE RESIDENTIAL Water Heater -- Water Softener Plumbing Fixtures (, ,, Main 1 _ Lower Level) ` Lawn Irrigation (_ RITZ / PVB) —Add Septic System Water Turnaround _ New Abandonment RESIDENTIAL FEES: $65.00 Minimum Water Heater, Water Softener, or Water HeaterHeaterrug Softener (includes $5.00 Slate Surcharge) (includes $5.00 State Surcharge) Fixtures, Septic System Abandonment Water Turnaround" (includes $5,00 State Surcharge) $35.00 Lawn Irrigation $55.00 Add Plumbing "Water Turnaround $105.00 Septic System $95.00 Fire Repair (replace (add $166.00 if a 518° meter is required) New ($10,00 per as built) (includes County fee and $5.00 State Surcharge) burned out appliances, ductwork, etc.) (includes $5,00 State Surcharge) TOTAL FEES $ CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 4540002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstatecnecall oro 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 sled 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. Jason Lary Applicant's Printed Name x Applica re FOR OFFICE USE Reviewed By: Date: Required Inspections: _tinter Ground _Rough -In Air Test Gas Test Final M.~ ~ . - - . ~ . , ~ . ~ti'LW f..e v~ ~c~~anc~q M Cern'fecate issued pwsuarlt to the irquirrniuits of the Umform Building Cade certiJyirig drar at du tbm of issrumce thia strrrctxrr was ia conpliance with the various ordinances of the Cety negulating brdJdpeg cacsouctiare or use. For tlu following: ~ [he (tirl5utioa: BWS. Aamit Na 2 I8QQ OCCUPG-Y TYae zAmbg nyma R I Type COWL VN Ownwo(Banding r_DQKFM HCiM Addma 4833 W 123IU) ST, SAVACE Addnm 517 4ESiM HItLS rJOI`IRT L-"y Il+, B 1, WLS10N FIIiIS uywpo~~ f 10/ 16/93 P03T M A OONSPICUOUS PLACE Address 517 WsM MIs COM Zip 5512 3 Lot . 4 Blk I Sub WESTCN Mlls THESE ITEMS WERE / WERE NOT COMPLET'E AT THE TIME OF THE FINAL INSPEGTION. Date: 10/15/93 Yes No Inspector: Final grade (6" from siding) ? Permanent steps (garage) Permanent steps (main entry) ? Permanent driveway ~ Permanent gas ? Sod/Seeded grass Trail/curb damage ? Porch Basement finish ~ Deck Please verify with the builder the cemoval of roof test caps from the plumbing system and the s ut-off of water supply to the outside lawn faucet before freeze potential exists. Contad engineering division at 681-4645 before working in right-of-way or installing underground sprinkler system. ~ White - City Copy Yellow - Resident Copy Pink - Contractor CoPY . _ , INSPECTION RECORD "CITY OF EAGAN PERMIT TYPE: f'' N`' 3830 Pilot Knob Road Permit Number: t'•''6' Eagan, Minnesota 55123 Date Issued: (612) 681-4675 SITE ADDRESS: APPLICANT: . 'if . ~ ~~1-1 ?r r l i*, ~1 1 H011111 IN+ PERMIT SUBTYPE: TYPE OF WORK: : I' r~?ij INSPECTION • 1 ~ i c ~ ri ~ i~: i IIt r} I i W•~1 I 1 I ! ~ I . ~ ~t . , I H,;, 01rj~~yn0 ~ L Permit No. Permit Holder Date Telephone; S/W PLUMBING I /D 9 0090. ,0* HVAC ELECTRIC ~~79~ F • 9/~/ ELECTRIC Inspection Date Inap. Comments 7 Footings I Foundation • Framirg Roofing R«,gh Plb,. Rough Htg. LJ isui. . 5 r3 ~ Fireplace Final Htg. ~ 3 If) Orsat Test Final Plbg. Plbg. Inspector - Notify Plumber lV Const. Meter Engr./Plan O K ~ S eklg. Final 1~.a 5j t,., . 1 Deck Ftg. /D - S i Deck Fnal Well Pr. Oisp. INSPECTIDN RECORD CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55122-1897 Date Issued: (612) 681-4675 SITE ADDRESS: t ; APPLICANT: PERMIT SUBTYPE: TYPE OF WORK: {.j r 1111 INSPECTION D. . rJ IiH+ ii,I. , i 1t I IH1l #%i 1lI1Ri ~ ~ PermH No. Ptrmit Holdar Date Tdephons N ELECTRIC PLUMBING HVAC inapecdon Dab Map. Commenb FOOTINGS FOUND FRAMING 9s ROOFING ROUGH PLUMBING PLBG AIR TEST ROUGH HEATING GAS SVC TEST INSUL ~W GYP BOARD FIREPLACE FIREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDCa FINAL a BSMT R.I. BSMT FINAL DECK FTG DECK FlNAL 11NSYLU11U1N KLI:UKlI CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: t., Eagan, Minnesota 55122-1897 Date Issued: ; 4• (612) 681-4675 SITE ADDRESS: ` APPLICANT. • a 14I111 F., ~ • ~ ~ ti7t t S f.i PERIIAIT SUBTYPE: TYPE OF WORK: INSPECTION D• • . ~ , i{ 1 lar~ i . . , :1 I 1! •t , i ~ I ~i i ~ ~ ~~+•ii t i ~ • ~ : _ . . ~ ~ ~ Permit Holder Date Telephone # PLUMBING H VAC Inapectlon Date Insp. Comments FOOTINGS FOUND FRAMING ROOFING ROUGH PLUMBING PLBG AIR TEST AOUGH HEATING GAS SVC TEST INSUL GYP BOARD FIREPLACE lO~q /Q [l FIREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL DOMESTIC METER IRRIGATION METER FIUSH MAINS eorvoucrIviTv TEST HYDROSTATIC TEST BSMT R.I. BSMT FINAL DECK FTG DECK FINAL F : PERMIT n-- CITY-OF EAGAN 3830 Pilot Knob Road FERMITTYPE: suzLoxNG Eagan, Minnesota 55123 Permit Number: 021590 (612) 681 •4675 Date Issued: 0 7/ 2 B/ 9 3 SITE ADDRESS: 517 WESTON HILLS CT LOT: 4 BI.OCK: 1 WESTON HILLS P.I.N.: 10-83750-040-01 DESCRIPTION: B~rfildEn`l, Permit Fype SF DWG Buildirig ~Wa~rk 7ype NEW /UBG a•ecupancy~ R-3 M-1 ~ cQnstructtign Ty" V-N ZQnirtg , R-1 / Bui,lding LengtFr 66 ~ BuiYding W3dth 41 ~ Bur.l;ding storiss fJ 1 y f_ ~ ~L I L REMARKS: S & W PLBR - PRV ~ FEE SUMMARY VALUATION $116.000 Base Fee $695.50 MISCELLANEOUS $1.744•50 Plan Review $452.08 7ota1 Fee $3,700.08 Surcharge $58.00 3AC $758.@@ SAC ~ 100 SAC Units 1 Su6total $1.955.58 CONTRACTOR: - Applicant - sT. Lrc. OWNER: ROCKPORT HDME6 INC 18942425 0004882 ROCKPORT HOMES 4833 W 123RD ST 4833 W 123Rp ST SAVAGE MN 55378 SAVA6E MN 55978 (612) 894-2425 (612)694-2425 ~ 2 hsreby aektto,wledqg that Y have read t•his applicat3;an and state that the , informatian ie obrreCt and agree ta comply with all applicable SYate ot Mn. , StatutQS and City af EA9an Ordinances.. I..._ - - J ~ APP /P M EE SIGNA7URE ISSUED Elr. SI NATURE REatrIVATE _ RECEpVE-0 CITY OF EAGAN fERMIT 1993 BUILDING PERMIT APPUCATION ~3~ ~~V•`'~ 9 U l 211993 681-4675 SINGLE 8 MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 topy of energy calcs. COMMERCIAL 2 sets of architectural 3 structural plans, 1 set of specifications, 1 copy of energy calcs. Penalty applies: 1) when permit is typed, but not picked up by last working day of month. in which request is made, 2) address is changed or 3) lot change is reduested once permit is issued. Date Yaluation of work i°UO. ~i-/ r, Site Address: I,/UPSYcfv S7REET SUITE 1 Tenant Name: (commercial only) LOT ~ BLOC& ~ SUBD. W•2S'*ON 14)N5 P.I.D. M Descri tion of work: v.-4w ~~v - - The applicant is: ? Owner M Contractor 13 Other (Deccribe) Name I\ C~~G~f27 f`h~ vYt-P sS Phone Property LASt FIRST Dwner Address STREET ' STE N City ~A-0 fi~ ~ State i LA r\J Zip SS-57.V-- Company Phone Contractor Address License # Exp. City 5tate Zip Company SoC`i Phone cP IcF~S~ Archttect/ Englneer Name lf~-cv Registration N Address 5- 0 0/ w k?l~ ~SX City In.. Statem n/ Zip Sewer & water licensed plumber . Processing time for sewer & water permits is two days once area has been approved. I hereby acknowledge that I have read this application and state that the information is _ correct and agree to comply 'th all applicable State of Minnesata Statutes and City of ' Eagan Ordinances. i ~ r u, 5ignature of Applicant: OFFICE USE ONLY BUILDING PERMIT TYPE ? 01 Foundation O 06 Duplex ? 11 Apt./Lodging ? 16.,Baseinent`'Finish p 02 SF dwg. ? 07 4-Plex ? 12 Multi. Misc. ? 17 Swim Pool ? 03 SF Addition ? 08 8-Plex ? 13 Garage/Accessory ? 18 Comm./Ind. ? 04 SF Porch ? 09 12-Plex ? 14 Fireplace ? 19 Comm./Ind. Misc. 0 05 SF Misc. ? 10 Multi. Add'1. ? 15 Deck ? 20 Public Facility ? 21 Niscellaneous WORK TYPE U 31 New O 33 Alterations ? 35 Tenant Finish ? 37 Demolish ? 32 Additian 0 34 Repair ? 36 Mave GENERAL tNFORMATION Ccnst. (Actual) I! Basement sq. ft. l~ P MWCC System k' (A1lowable) VN lst F1. sq. ft. / z b City Water ~ UBC Occupancy R_ 2nd F1. sq. ft. PRY Required Zoning Sq. Ft. total Booster Pump # of Stories ~ Footprint Sq. ft. Fire Sprinkler Length On-site well Census Code Depth y!. On-site sewage SAC Code p~ APPROVALS ~ ~ Planning Building Assessments Engineering Variance RE(1UIRED INSPECTIONS 10 Site P Footing Framing fa Insulation ? Wallboard 12 Final ? Draintile ? Fireplace Permit Fee v.iu.c;a,: 8 ~ OD~ Sy Surcharge J 15 Plan Review License 34 ,r ~ = ao~ Q~r Iz. t, MWCC SAC / S.r z - 3O _ yt o- F%^• ~ C i ty SAC ~ti (o cf' Water Conn. l Z 6 ~ p~,r s~/ Water Meter ' Acct. Deposit y~ V6Z`;.PY° S/W Permit S/W Surcharge 6ZO,/0 Treatment P1. "3 X ZP Road Un i t 3,- i 9, G 9 - Park Ded. 6t, 7z Trails Ded. Copies Other Total: - sac x SAC Units a , RoGK PoRT qoMES, ING. AOA„C C CONSUlTINO ENOINfEBi #58'jS.OI PIONNE05 ond 111HD iUflVEY00S pNGINE6t~ING t aK• 195 ~ COMPANY, INC. P6.4' 1000 EABT 1461b S7REE7, BURNSVILLE, MINNESOTA 55337 PII 432-3000 CERTIFICATE 0F SURVEY Legal Description: LOT__ ~oCK % w~0-97-aAl HiU s DAKQ~LI C~JUNTS~M%NNESOT/-~. DCNOTES EXtSTING ELEVATION (957,0) DENOTES PROPOSED ELEVATION -.dt-- INDICATES DIRECTION OF SURFACE DRAINAGE 1757,33 = FINISHED GARAGE FLOOR ELEVATION 9 9-62 = BASEMEPIT FLOOR ELEVA710N 167,66 = TOP OF FOUNDATION ELEVATION SCALE : T= 30' BE~'/CHM~IK/l ~ 7NH 9? Lo7 BClk~' / EGE?. = 957. 67 G ~ /F~ Ro,91~ 5 89 ° 44' 3s" W 0 0 145. 58 - o 0 v8, a, DRA/NA6E AND UT/L/TY g\ (J L _ ~ / I i \ L. D T , ~I \ ~ ~ ~ ` ~q52.7 0l~ i O G AGf11tl m\ 52•'/ ~Y~i6H g(~5~3~ ~ ~ `J REVIEWED Z \ y (y5~?, ~f 36 33 ' ~ g ~ \~I 05z_7 _ S ~ cA w ~ l o ~ I ~11 3Y 6066ED N ~95"1 7 o op II. 2y6 1400 g- Hu6= 956.18 ~44.4q- ~n ~ J 11 I~ 5"1, 33 ~5~~ , ~ 15 30 FT. FRANT BulLDl1~1G 50 SETBACK -P) 3145.00 l6.97 Y ~ ~3` `•r, 955•~ • V, 63.6`1 ~ 10 .00 " 5 gg14e}'35 w p B~ o s G0u2r I hareby certify that this is a trua and correct representation of a tract of land as shown and described tiereon. Aa prepared by me this 2/ day of ~ JvLv , 19 93 . ~ , L Minn. Req. No. 16085 ~ LOT SURVEY CHECRLI6T FOR RESIDE:.t.AL ~ BUILDING PERMIT APPLICATION ?AOPERTY LEOAL: m 7 / j~ Dat• of SurveYs TT_ DOCUMENT 9TANDARDB 31~ ? ? • Registered Land Surveyor signature and company 3'' p d Building Permit Applfcant CY 0 0 • Legal descriQtion p p- ? • Address 0' 0 0 • North arrow and bar scale p-? p • House type (rambler, walkout, split w/o, split entry, lookout, etc.) ? ? • Proposed/existingsewer r and wate:r sservicesdient a Lr' 0 0 • Street name g~ ? ? • Driveway ELEVATIONB ' Existina p e p • Sewer service p' p p • Lot corners p' p 0 • Top of curb at the driveway pEr ? • Elevations of any existing adjacent homes piouoeed ~ 0 0 • Garage floor ~ ? p • First floor ? ? Lowest exposed elevation (walkout/window) p ? • property corners ? p • Front and rear of home at the foundation pONDINt3 AREAS (if aDDlicable) ? 0' ? • Easement line 0 5 0 • NWL ? 0" ? • HWL p p' p • Pond I designation p ty 0 • Emergency overflow Elevation DIMENSIONB 0' ? ? • Lot lines g~ 0 p • Right-of-way and street width (to back of curb) {f • Proposed home dimensions including opos decks, overhangs greater than 21, porhes, etc ( structures requizing permanent footings) Er p ? • Show all easements of record and any City utilities within those easements 8- ? p Setbacks of proposed structure and setback of adjacent existing homes ? p~ p • Retaining w requ rements, if any Reviewed: ~e / Date October.1992 N a EXTERZOR ENVE-ppE AVERxGE ' U' COMpUT'ATION OWHE$; SITE ADARESS: COIiSSRCi4R: PAONE: ZL Z~ f Determin~ yr~rkyhg square footage of each; 1- Total exposed wa11 area „ 2. ToGal ~ t 5q• tt. x.17 roof/ceiiing area sq. ft. x .026 Total ezposed Wall area above flaor a• Total crall Window b. Total area door area c. Total sliding glasa.ar...ea " " . ~ d. Total fir ~~:'1,........" ace wall area e- Total epl ~ Hall frami f• ng area (average 74%)~,~'~'•••••••• Total net 9. Total rim ~joistl area above floor area 1la p ~,~,~~~y Total Elpvsed foundatioe area h• Total fpundation window area 1. Total net foundation area above~ 8~rade....,,,,,~ Determ3tte fUt value of eaeh xall segment: a~ Xt U' L+wl c!"- b. c. d, x tu1 t e. \ 2 x T U r'~^--~-~_ = h; X;u ~ f . 1 X ~ U' ~z~~a~ ' ~ i. x lUl - 3 . Total If item # ' 1 3 is the same as ar 6006(c)2, less than item #7, you have met Lhe intent of SSC Sotal ezposed roof/ceflieg yrea = b Total 5kylight area , k• Total ro4f/ceiling framing area {average 70$) Total net inSUlaLed rppf'/ceiling area.............. > ~ dVEA , Determine *U' value for each roof/ceiling segments j _ Y su, k. 1"ZO, l X fut XVU, , o zS i - X~K 4 . Total IS' total of 04 is the same as or less than 02, you have met Lhe interlt of S8C 60o6(c)t. Alternate Bui1d"zng Frvalope Design Fo utilize the total envelape system method, the values esta6ifshed by the sum of Items #j and O4 sha11 not be greater than the sum of Iteros &1 and U2. 1. . + 2. - 3. + 4, _ 1 f ~ a. 2 PERMIT CiTY OF EAGAN 3830 Pilot Knob Road PERMIT TYPE: B U I L D I N G Eagan, Minnesota 55122•1897 Permit Number: 033612 (612) 681-4675 Date Issued: 10 / 0 7( 9 8 SITE ADDRESS: 517 WESTON HILLS CT LOT: 4 BLOCK: 1 WESTON HILLS P.I.N.: 10-89750-040-01 DESCRIPTION: GAS LINE & GAS STOVE I3 1d~ctg~ermit Type FIIiEPLACE ~E~rrg ~ °k Type ALTERATION ~±rm~L-o Vpde ~ 434 ALT. RESIDENTIAL 4 vN_ ;:ra ~ A.~ ~:dm .d~ ~ $S ~ ~ ~ REMARKS: CHSMNEY/FIUE MUS7 6E INSPECTECI BEFORE CONCEALING. FEE SUMMARY: Base Fee $59.00 Surcharge Total Fse $50.50 CONTRACTOR: - Applicant - sT. Lzc. OWNER: F4F2E5IDE CORNER SNC 16331042 20090911 EMpSON JOHN 2~00 N FAIRVIEW AVE 517 WESTON HILLS RQSEVILLE MN 55113 EAGflNMN 55123 (E12) 633-1.042 (651)686-5393 tHat'~ 4~ a d - thl,~ I 1~.catin t~:'~'Fe~~ r~~~ ~rt'd;~gree,;.~a"V`tarnp7.y .'~'i ,~4~ b0 ~~o~ rL`bri n anv gv p s . # r I~JR~7l A 4_~~ I Q6/ APPLICAN7/PERMITEE SlGNATURE (_3SSUED BY: SIGNA Rl 1~- CTfYOFEAGAN 3830 PIIAT KNOS RA - 55122 1998 FIREPLACE PERMIT APPLICATION 6814675 PERNIIT FEE: $50.50 DATE: /v/ DESCRIPTION OF WORK: _ Construct new ficeplace _ Alterations to existing Install gas insert onlv Install as line onl ~ ot,er s ( - i V JOB ADDRESS: CG LOT: `-l aLOCx: ~ StJBUIVISION/P.T.D.#: APPLICANT (circle one only): OWNER CONTRACTOR 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. f Name: °Joh n Phone PROPERTY Last F'vst OWNER Sigoature: StreetAddress:. 5~~ 10S City ' State: 140 Zip: 55/Z3 0 -F?Y.PS~~ dli216L, Company: Phone FIREPLACE INSTrL'.,LER S;gnatii-rz: Street ss:5qsv, l! W(/ License #~07 City U(n S Vt 'I L State: M4_ Zip: ~Z Company: ~ uVr V.VI, r Phone GAS L1NE ~ INSTAI.LER Signature: Street Address: OFFICE USE ONLY BUILDING PERMIT TYPE ? 14 Fireplace WORK TYPE ? 31 New ? 33 Alterations ? 32 Addition ? 34 Repair GENERALINFORMATION Census Code. 434 3AC Code Ol REMARKS Chimney/flue must be inspected before concealing. ~ 'CITY OF EAGAN PERMIT ~RqGq15 3830 Pilot Knob Road PERMIT TYPE: e u x L01 N e Eagan, Minnesota 55122-1897 Permit Number: 026702 (612) 681-4675 Date Issued: 11 / 13 / 9 5 SITE ADDRESS: 517 WESTON IIILLS CT LO'1': 4 BIOCK: 1 WESTON HI! LS P.I.N.e 3.0-83750-0qGJ-01 DESCRIPTION: 86ilcl'ing~._Perrnit Type BF1.^-,EMENI' FTNISH 6uilding Wd:rk Type ALTERATION f t . J ~C r i, Y. _ . ^I1~•-,7._ REMARKS: N SEPflRflTE PERMIT IS REQU1RED FOR F1NY PI.UMBING OR ELEGTftTC.AL WORK FEE SUMMARY: Base Fee $35.00 Surchar'cae $.50 l"otal. Fee $35.50 CONTRACTOR: OWNER: - Appl.i.cant - EMF'SON JOHN 517 WESTQN NILLS CT EAGAN MN 55123 (612)686-5593 I hrer'eb-y ocknowledge Lhat I have rgad Chis epplication and sLate thaG t'he infdrmation is carrect and agree to comply w3th a11 applicabke State of INn. ~ SLatutes and Gity a# Eaqan Qrda,nancss. ~ J)~~ APPLICANT/PERMITEE SIGNATUFE ISSIJED BY: IGNA U~ RE ~ CITY OF EAGAN ILI 3830 PILOT KNOB RD - 55122 Olm 1995 BUILDING PERMIT APPLICATION (RESIDENTIAL) 681 -4675 New Construetion Reauirements RemodeVReoeir ReaviremeMs ? 3 ropbMred eite wrveYs ? 2 coPies M plen ? 2 mpies ot pkns (indude beam 8 window c¢es; poured fid. design; etc) ? 2 site suneys (extericr atldkions 8 decks) ? 1 energy ealaletione ? 1 energy calwlations for heated addRions ? 3 mpies of tree prnsrvation plen if lot pletted efter 7/1/93 requi2d: _ Yes _ No DATE: CONSTRUCTION COST: DESCRIPTION OF WORK: N- STREET ADDRESS: I/Ue~^`'70N ~ ~ c S 'fp'/( 7- LOT q BLOCK ~ SUBD./P.I.D. w~MN «5 Z~ PROPERTY Name: l=~P_SVN ~64-1 Phone 6e6 .S~S73 owNeR Street Address- 7~~-~'~? ~ ~ rGc 5 C% City: State: Zip: coNrw?crOR Company: ~Lf= Phone Street Address: License #City: State: Zip• ARCHITECTI Company: .SEL f- Phone ENGINEER Name: Registration Street Address- City: State: Zip: Sewer & water licensed plumber: Penalry applies when address change and lot change are requested once permit is issued. I hereby acknowiedge 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. ~ Signature of Applicant: ^ lrf(A~'- OFFICE USE ONLY Certifiptes of Survey Received _ Yes _ No N 0 U 0 3 1995 T2e Preservation Plan Received Yes No OFFICE USE ONLY . ~ . ~ ~ BUILDING PERMIT TYPE 0 01 Foundation ? 06 Duplex o 11 Apt./Lodging ~y 16 Basement Finish 0 02 SF Dwelling ? 07 4-plex o 12 Multi Repair/Rem. 0 17 Swim Pool 0 03 SF Addition o 08 8-plex o 13 Garage/Accessory o 20 Public Facility 0 04 SF Porch o 09 12-piex ? 14 Fireplace o 21 Miscellaneous a 05 SF Misc. a 10 _ plex o 15 Deck WORK TYPE 0 31 New ~33 Alterations ? 36 Move 0 32 Addition o 34 Repair ? 37 Demolition GENERAL INFORMATION Const. (Actual) Basement sq. fl. MC/WS System (Allowable) Main level sq. ft. 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 i Census Unit 0 APPROVALS Planning Building Engineering Variance Permit Fee Valuation: g /Sda ~ Surcharge Plan Review License MCNVS SAC City SAC Water Conn. Water Meter Acct. Deposit SNV Permit S/W Surcharge Treatment PI. Road Unk Park Ded. Trails Ded. Other Copies Total: % SAC SAC Units , 2006 RESIDENTIAL BLTILDING PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 New Conslnatlon ReawremenLa RemodellReoeir Reauirements Olfice Use Onlv 3 regiMered site surieys showing sq. fl. of IM, sq. fl. of house: and ell raofed areas 2 mpies of plen showmg footings, beams, joists Certof Survey ReW Y_ N (20%maximum IM coverage allowed) 1 sel M Energy CaNa'letiore for heated addAioris N~ ATiee Pres Plen Recd _Y -f(. 2 copies of plan shoxirg beam & wiMOw sizes; poured faund design, ek. 1 site survey for addifions & decks ? Tree Pres Requretl _ Y yM lsetofEnergyCalwWtlms Addih'on-indicateifarsitesepbcsystem On-sileSepM1CSyslem _Y YM 3 copies MTree Preservaoon Plan'rf id plat9ed aftw 711/93 Rim Joist DeW Opoons selecGOn sheet (builtlings vrilh 3 or less unps) Minnegasco mechanipl ventilation form Y' cJ Date /V / .20V~o ConstructionCost SiteAddress -5-17 WE57,DIv 141,LLS UniVSte k V s/~3 Description of Work ~cNoDde L XA-4 S! U.i1 cj `T 'eX /$-6 l('C I< , Multi-Famity Bldg _ Y4 N Fireplace(s) _ 0 1 1 _ 2 Properly Owner V p(-1 w EA1Mo Telephooe #(~~Z ( Contractor U f'~h1 E/L'\ SU14 /twqik Address AJ1 0 City ` yls 7 d'Kf~ State Zip Telephone # ( ) COMPLETE TFIIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minneso[a Rules 7670 Cateeorv 1 Minnesota Rules 7672 Energy Code Category , ResideMial Ventilation Category 1 Worksheet • New Energy Cotle Worksheet (J submlasion type) Submitted Submitted • Energy Envelope Calculations Submitled 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 Plumber Telephone # ( J 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 wi(I 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 approved plan in the case of work which requires a review and approval of plans. o a,A psv~ ~ Applicant's Printed Name Applican's Signature DO NOT WRITE BELOW THIS LINE . , Sub Tvoes O Ot Foundatian ? 07 05-plex ? 13 16-plex 0 20 Pool ? 30 Acoessory Bldg ? 02 SF Dwelling ? 08 06-plex 0 16 Fireplace ? 21 Parch (3-sea.) ? 31 EM. Alt - Muki ? 03 Ot of _ plex ? 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4sea.) ? 33 Ext. Alt - SF ? 04 02-plex ? 10 OS-plex y 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc. ? 05 03-plex ? 11 10-plex ? 19 Lower level ? 24 Storm Damage ? 08 04-plex ? 12 12-plex ? 25 Miscellaneous Work Tvoes ? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding ~ 32 Addifion ? 36 Move Building ? 42 Demolish Foundatian ? 45 Fire Repair ? 33 Alteration ? 37 Demolish Building• ? 43 Reraof ? 46 WindowslDoors ? 34 Replacement 'Damolitlon (Entlre Bldg) - Glve PCA handout to applfwnt D@SCf1Ot1011: Water Damage _ Yes Valuation ' 0ca"0 Oxupancy MCES System Plan Review 100°k or 25% Census Code ~ Zoning City Water SAC Units Stories Booster Pump # of Units Sq. Ft. PRV # of Bfdgs Length Fire Sprinklered Type of Const Width REQUIItED INSPECTIONS Foolings (new bldg) _ Sheetrock ~ Footings (deck) Final/C.O. _ Footings (addition) FinaVNo C.O. Foundation ~ HVAC Drain Tile Other Roof Ice & Water Final Pool Ftgs Air/Gas Tests Final Framing Siding _ Stucco Lath Stone Lath Brick (Fireplace _ R.I. ` qir Test _ Final _ Windows _ Insulazion Retaining Wall Approved By: Building Inspector - Base Fee - - - Surcharge i~c.~ ~`2~~/z- ~q L"-;7 Plan Review ~L MC/ES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant ; License Search Copies Other Total r mvwHI ca vmca. I 1v14 vr 0VIlr1At+C vnriulraaac w, 957,33 - FINISHEQ GAHAGE FLOOR EIEVATION ' 9 9,6Z = BASEMEfJ7 FLOOR ELEVATION 5g 7, 66 = TOP OF FOUNDATION ELEVA710N SCALE : t' = ao' ~~NCHM~JRX : 71YI7( iD 1-07,5Z - 8l1acK / EL.EY. = 957. 67 OecL L5 C-() Oec l < G L /F~ ROAp s 99 ° 44' 3s" w 0 0 145. 58 - 4 0 3S. zS o a ~y 38.3~ pRA/NAGE RND UT/L/TY EASE/hENT L ~ LO T A1 ~ ~ ~qy2.~ o o ~ O ~ Z, pAYLrb~~g (~5~3~ I ~J `G f~ U A`4 ft E V iE~N E D _.-----"C"`._^.-----°°` ` m •\w ~52'f = o ~'6 ~D .b+ ~ ~ ~ ~ ~iP_'~ (955yo ~y.b~ NDUSE~ ° ~ ~ ~ \ •s 2 I4-,00 Hu6=956.18 ~44,4q- Ll: u`'t~va pp ~p,33 19•b? I~55•~~ ~ P¦ RaVo L't"~ 30 Ff. FRpNT BUILDIN6 ~ yb,lku 1\ , I~~~ y~, 33 CSi7 ~ I 5 S6TBaCK L 1 nlE S5> 5911VIcE ,145.00 6.47 63•6~10IO 00, 5 ttfl94354W p q 5 00 NIU-S GoURT D,. ~I -GAX I hereby certify that this is a true and correct representation of a tract of land as shown and described kiereon. As prepared by me this Z15T day of ~ 1993 / /L~ 1"~4 Minn. Req. No. 6065 2007RESIDENTIAL BUILDING rfnvirrarrricauqv City Of Eagan , 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 New ConsWCtion Reauiremenis RemodeUReoair Reouiremenls Office UUse Qolv 3 registered site surveys shaving sq. ft, of lot, sq, ft of fwuse; and all roofed areas 2 copies of plan showing tootings, beams, joists Cert of SurveyReoi _ Y~ N (20%maximumlotcoverageallowed) 1 setofEnergyCalcula6onsforheatedaddilions SoilsReport'.. ~Y _N 1 Soils Repod if proposed 6uilding is to be placed on disNr6ed soil 1 site surVey (or additions & decks Tree Pms PIartRerd _ Y_ N. 2 copies of plan showing beam & wintlow sizes; poured found design, efc. AddMon - indicafe A on-sde sep6c system Tree PreS Required ,Y N lsetafEnefgyCalculaGons On-sfteSepbc.System _Y _N 3 wpies of Tree Preserva6on Plan if lol pNaqed aRer 711193 Rim Joist Delail Options selection sheet (buildings with 3 w less uni5) Minnegasco mechanical ventilation fortn Plans are considered ublic information unless ou state the are trade secret and the reason. ~v Date Construction Cost 7 ` SiteAddress Si 7 Gr/ES TUN h(IGLf GG4f/e ! UniUSte # Description of Work /?,6W0UF wiTN TAW/P UFf Multi-Family Bldg _ Y_ N Fireplace(s) _ 0 ` 1 _ 2 ProperTy Owner ~O jqA? 4~"/°s(f/? Telephone # (4,r/ ) (0$4 ' $V9 j Contractor /~L~ JN RdGJ ~~/dF //(/lr' Address 915~/ 79Cl Ty Sf CiTy AfL-~+J State /y//? Zip $!~U7/ Telephone#(I./2) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minnesota Rules 7670 Cate¢orv 1 Minnesota Rules 7672 Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet submission type) Su4mitted Submitted • Energy Envelope Calculations Submitted In the lasi 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan2 _ Y _ N If yes, date and address of master plan: Licensed Plumber Telephone ) Mechanical Contractor 7elephone ) 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 perxnit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. iPrc/< <T7J~i'~ia~? ApplicanYs Printed Name Applicant's Si ature DO NOT WRITE BELOW THIS LINE Sub Tvqes ? 01 Foundation ? 07 OS-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg ? 02 SF Dwelting ? 08 06•plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 EM. Alt- Multi ? 03 01 of _ plex ? 09 07-piex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 6ct. Alt - SF ? 04 02-plex O 10 08-plex ? 18 Deck ? 23 Porch (screenlgazebo/pergola) ? 36 Muiti Misc. ? 05 03-plex ? 11 10-plex ? 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 FoundaGOn ? 45 Fire Repair ? 33 Alteration ? 37 Demolish Building* ? 43 Reroof ? 46 WindowslDoors ? 34 ReplaCement \ `Demolition (Entire Bldg) • Give PCA handout to applicant " ' . . D85Cript1011: WaterDamage_Yes Valuation Occupancy ' MCES SySte'm' ' Plan Review 100% or 25% Code Edition Census Code Zoning City Water SAC Units Stories Boosten Pump # of Units Sq. Ft. PRV # of Sldgs Length _ Flre Sprinklered., Type of Const , W idth REQUIRED INSPECTIONS _ Footings (new bldg) _ Sheetrock _ Footings (deck) _ FinaUC.O. _ Footings (addition) _ FinaUNo C.O. Foundarion HVAC Drain Tile Other Roof Ice & Water Final Pool Ftgs Air/Gas Tests Final _ Framing _ Siding _ Stucco Lath _ Stone La[h _Brick _ Fueplace _ R.I. _ Air Test _ Final _ Windows _ Insulation _ Retaining Wall Approved By: , Building Inspector Base Fee Surcharge Plan Review MC/ES SAC City SAC Utifity Connection Charge 5&W Pertnit & Surcharge Treatment Plant License Search Copies _ - . . " Other Total PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA108077 Date Issued:11/15/2012 Permit Category:ePermit Site Address: 517 Weston Hills Ct Lot:004 Block: 001 Addition: Weston Hills PID:10-83750-01-040 Use: Description: Sub Type:e - Furnace Work Type:Replace Description:Furnace Comments:Questions regarding electrical permit requirements should be directed to Mark Anderson , State Electrical Inspector, 952-445-2840 Renae Freinwald 2200 Hwy 13 W 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 - John E Empson 517 Weston Hills Ct Eagan MN 55123 Genz Ryan Plumbing & Heating 2200 West Highway 13 Burnsville MN 55337 (952) 767-1000 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA114476 Date Issued:09/16/2013 Permit Category:ePermit Site Address: 517 Weston Hills Ct Lot:004 Block: 001 Addition: Weston Hills PID:10-83750-01-040 Use: Description: Sub Type:Reroof & Siding Work Type:Replace Description: Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar. Pictures are not acceptable in lieu of inspections. 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. Fee Summary:BL - Base Fee $8K $162.25 0801.4085 Surcharge - Based on Valuation $8K $4.00 9001.2195 $166.25 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 - John E Empson 517 Weston Hills Ct Eagan MN 55123 (612) 386-4370 Einstein Builders Remodeling 1015 Poplar St Northfield MN 55057 (612) 919-8393 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA143617 Date Issued:06/21/2017 Permit Category:ePermit Site Address: 517 Weston Hills Ct Lot:004 Block: 001 Addition: Weston Hills PID:10-83750-01-040 Use: Description: Sub Type:Residential Work Type:Replace Description: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)$59.00 0801.4088 Surcharge-Fixed $1.00 9001.2195 $60.00 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - John E Empson 517 Weston Hills Ct Eagan MN 55123 Bonfe's Plumbing & Heating 505 Randolph Ave St Paul MN 55102 (651) 228-9071 Applicant/Permitee: Signature Issued By: Signature Use BLUE or BLACK Ink For Office Use City0f Ea it Permit#: /LK/ 3.3 Permit Fee: 1 1 , 3830 Pilot Knob Road 1 J Eagan MN 55122 Jk-V ` Date Received: d?-)1 Phone: (651)675-5675 buildinginspections(a citvofeagan.com Staff: ] Vki) 2017 RESIDENTIAL BUILDING PERMIT APPLICATION Col `/, Date: Site Address: Unit#: Name: )0VA N- M? )6)N— Phone: I)----39‘-1370 Resident/ -7 (,J2 f O H , R l E v-y ti owner Address/City/Zip: Applicant is: Owner -7r Contractor Type of Work Description of work: Re fribU e nj‘-- (fie?kite' aP ex 14irovt1-4.A.s‘Deo4*-Ch.etw6'" Construction Cost: 3S.6b b Multi-Family Building:+ (Yes /No�) Company: � �1 t �e1`-O e I (�� Contact: V 11 1 Contractor Address: f 13"l a -F' l r tk t City: / Vo ch,ki CA_ Stater Zip: 7 -/ Phone: 6 I -41 l-iJ "Email: bt I(jet r S1- : Mak$ _ License#: 1/L— 69L13 '1 Lead Certificate#: If the project is exempt from lead certification, please explain why: / ROvfv••. CAA 4c(le 'i 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 P,lo If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer&Water Contractor: Phone: Fire Suppression Contractor: Phone: NOTE:Plans and supporting documents that you submit are considered'to be public information.:Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade.secrets. You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's website at www.citvofeagan.com/subscribe. Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuance. 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.orq 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 Ke,A) I .N M. N,I t k \u,N x �1'-- Applicant's Printed Name Applicant s Signature Page 1 of 3 DO NOT WRITE BELOW THIS LINE SUB TYPES Foundation Fireplace Porch (3-Season) Exterior Alteration (Single Family) Single Family Garage Porch (4-Season) Exterior Alteration (Multi) Multi Deck Porch (Screen/Gazebo/Pergola) Miscellaneous 01 of_Plex Lower Level Pool 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 y— Occupancy ,57/2C-! MCES System Plan Review Code Edition n/j Zp/S' SAC Units (25%_ 100% )c) Zoning City Water Census Code Stories Booster Pump #of Units Square Feet PRV #of Buildings Length Fire Suppression Required Type of Construction v!(!j Width REQUIRED INSPECTIONS Footings (New Building) Meter Size: Footings (Deck) Final I C.O. Required Footings (Addition) Final I No C.O. Required Foundation Foundation Before Backfill HVAC_Gas Service Test Gas Line Air Test )( Roof: Ice &Water h Final Pool: Footings _Air/Gas Tests Final Framing 30 Minutes 1 Hour Drain Tile Fireplace: _Rough In _Air Test _Final Siding: Stucco Lath _Stone Lath Brick_ EFIS Insulation Windows Sheathing Retaining Wall: _ Footings_ Backfill— Final Sheetrock Radon Control Fire Walls Fire Suppression:_Rough In Final Braced Walls Erosion Control Shower Pan Other: Reviewed By: 1-6/11 jfl /<./1//- , Building Inspector RESIDENTIAL FEES �drT r'e-e 7- 7I Reki e Base Fee Surcharge Plan Review MCES SAC _ City SAC Utility Connection Charge S&W Permit& Surcharge Treatment Plant Copies TOTAL Page 2 of 3 1 Derek Qualle From:john@broadcastdesigngroup.net Sent:Thursday, August 26, 2021 9:04 AM To:Derek Qualle Subject:FW: 24RLXFZ Clearance Question Derek, See below referencing the mini split installation at 517 Weston Hills Court. It’s approved! John John Empson Minneapolis ~ Denver ~ San Antonio ~ San Diego 517 Weston Hills Court Eagan, MN 55123 Direct: 952-767-6733 Cell: 612-386-4370 From: Mike Wilson <Mike.Wilson@dsgsupply.com> Subject: FW: 24RLXFZ Clearance Question Date: August 24, 2021 at 6:00:19 AM CDT To: John DoBrava <johndobrava@msn.com> Fyi From: Khaled Bou-Hamdan <khamdan@fujitsugeneral.com> Sent: Tuesday, June 15, 2021 11:53 AM To: Mike Wilson <Mike.Wilson@dsgsupply.com>; Ryan Findley <rfindley@fujitsugeneral.com> Subject: RE: 24RLXFZ Clearance Question Unfortunately, we cannot put together an official letter. We get special installation requests on a daily basis and we cannot create such a letter for each and every installation. Feel free to use my email below as the official approval for the Fujitsu Unit 24RLXFZ located at 517 Weston Hills Court in Eagan, MN 55123. Thank you, Khaled Bou Hamdan Residential Product Manager 2 Fujitsu General America 2801 Telecom Pkwy (Ste A1-2), Richardson, TX 75082 Mobile: +1 862-200-0119 fujitsugeneral.com From: Khaled Bou-Hamdan <khamdan@fujitsugeneral.com> Sent: Tuesday, June 15, 2021 11:29 AM To: Mike Wilson <Mike.Wilson@dsgsupply.com>; Ryan Findley <rfindley@fujitsugeneral.com> Subject: RE: 24RLXFZ Clearance Question Mike, If you cannot get that measurement, do not worry about it. Our engineering team just came back and approved the installation but mentioned that there might be a slight reduction in capacity since that overhang looks like it will exceed 19”. Thank you, Khaled Bou Hamdan Residential Product Manager Fujitsu General America 2801 Telecom Pkwy (Ste A1-2), Richardson, TX 75082 Mobile: +1 862-200-0119 fujitsugeneral.com PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA172987 Date Issued:10/25/2021 Permit Category:ePermit Site Address: 517 Weston Hills Ct Lot:004 Block: 001 Addition: Weston Hills PID:10-83750-01-040 Use: Description: Sub Type:Residential Work Type:Alteration Description:Fixtures Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection. All tiled shower bases require a water test. Fee Summary:PL - Permit Fee (miscellaneous)$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 - John Eugene Empson 517 Weston Hills Ct Saint Paul MN 55123--397 Applicant/Permitee: Signature Issued By: Signature