4935 Whispering Way
~ 61- ?719CP 77~0 ~
' • p,L 77i9? qo~~c
' 2007 RESIDENTIAL BLTILDING PERM[T APPLICATION~~ ~
City Of Eagan 1`55
3830 Pilot Knob Road, Eagan MN 55122 --%G(/ 77/5y
Telephone # 651-675-5675 FAX # 651-675-5694
NerrCmsWCtion Reauiremenls RenodellReoairReowiemenls OlfweUseOnN
S regstaretl s0e survefi shaviwg sq. fl. d Id, s9. R d hwse; aM aN ioofed am.as 2 mpies of plan slwx"vg foofings, beams, loais Cert d Survey RecA ~Y _ N.
(ZO%maounnan IM covexa9e aEawed) 1 set d Enei9Y CalwWtlons M healed addibans Sak Repat 114
u/A 't Sotls Reppt B proposed build"ng s l0 6e pWced m AsWrbed sail 1 site surny for additias 8 dedcs Tree Pres Plan Recd _ N
?2 copies d plan shwdng beam 8 window sizes, paured fqmE desgn, etc. AddiOOn - in6cate d onsiie sephc s}rstem Tree Pres ReqareE ~Y _ N
~t setof Eneigy Calala6au Oo-sios SeP~ _v ~XN
t/J oopies d Tree Presenahm Plan if lol platted aRer 711193
j,'Rim Jast Defail Op6ms sdecUOn sheet (buildings wM 3 a less wi5) MAR ~007
jrMSnnegasco rtedharecal vmfilation fam
~ Plans are considered ublic information unless ou state the are trade secret and the reason.
Date ..h Constructioo Cost 3 ~ ~ 0
o 0 '
S te Address ''1' / h 15 In W MJ UniUSte`#
L17+ 3i t I Whi5 e
Pit, ,rrn Uod l /
Descriptioo of Work N WV r 64 ~iV Y i 5 r vcial-e
Multi-Family Bldg _ YX N Fireplace(s) _ 0 _ 1 ~ 2
PropertyOwner Tdephooe#(~5(~
Contractor y~~r~,lwnY/~I~;l...I'{~/}~}~ b(,,j I(~ 111'1(.~
Address O,~ n00 Wt , Ry • y • 511i7, City u('n5G1~/1 ~~-Qi
Sta[e 1„!v Zip rr J?~%Tetephooe k(~~ -D"lQ' cJQ0_a
COMPLETE THIS AREA ONLY IF CON$TRUCTING A NEW BUILDING
- Minnesoia Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category , ResWerrtiat Ventilalion Category 1 Worksheet . New Energy Code Wwksheel
(4 submission rype) Submitted Submitted
. Energy Envelope Calculations Submitted
In ihe last 12 mont~, has ihe Ciry of Eagan issued a permit for a similor plan based on a masTer planB
Y ~ N If yes, date and address of master plan:
Licensed Plumber la?'m t nq4etiu P lu m b i{'l(Y Telephone #(r/J'rI) 4ID.~- 7~07 q
E~--
MechanicalConiractor LprSc~ Meal";uc.Q, Telephone#(l 156-7106
Sewer/WaterConiractor ~prm~nq~o~ Plurnbin~ relephone#(l/514IPq
I hereby apply for a Residetttial Building Permit and acknowledge that the information is complete and accutate;
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 pe it, and ork is not to start without a
permit; that the work will be in accordance with the approved plan in the c se of w which requires a review and
approval of plans.
.Jasaort 1// Y~~
Applicant's Printed Name Applicant's Signayure----'
.
. ~ /
~
r ^
` DO NOT WRITE BELOW THIS LINE
S bT
01 Foundation ? 07 05-plex ? 13 1Gplex ? 20 Pool ? 30 Accessory Bldg
02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext Ak - Multi
? 03 Otot_plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn.(4-sea.) ? 33 Ect.Att -SF
? 04 02-plex ? 10 OB-plex ? 18 Deck ? 23 Porch (screeNgazebo/pergola) ? 36 Multi Misc.
? OS 03-plex ? 11 10.plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex ? 25 Miscellaneous
W
31 New ? 35 Int Improvement ? 38 Demolish Inffirior ? 44 Siding
? 32 Addition ? 36 Move Building O 42 Demolish Foundation O 45 Fire Repair
? 33 Alteration ? 37 Demolish Building` ? 43 Reroof Ll 46 Windows/Doors
? 34 ReplaCement •Oemolifian (Endre Bidg) - Give PCA handaut to applkafft
DCSGFiDIiOI1; YYater Damage! Yes
Valuation ~ W400(2 Occupancy MCES System
PlanRevlew -)-(100%or_25°/0
Census Code /Q/ Zoning City Water
SAC Units 0/_ Stones Booster Pump
# of Units Sq. Ft. ~ PRV
# of Bldgs ~ Length ~ Fire Sprinklered
Type of Const a Width
REQiJIItED INSPECTIONS
Footings (new bldg) Sheetrock
_ Foo[ings (deck) ~,K FinaUC.O.
Footings (addition) ^ FinaUNo C.O.
~ Foundation _ EiVAC
Drain Tile Other
Roof Ice & Water Final Pool Ftgs A'v/Oas Tests Final
~ Framing _ Siding _ Stucco Lath _ Stone Lath ZBrick
~ Fireplace )i/ R.I. AirTest ~FinalC~~ = Windows
[nsulation 7Y~ Retaining Wall
Approved By: -IZ , Building Inspector
BaseFee l(0c)
Surcharge
!ir~ 9 3 x~71I - ~ v31 sssy
Plan Review I r
~ty~,~C ~o I 3 x 74~ I~~? s~~,~~
Utility Connection Charge &.{Jyk"1'2~ 7 z~ 7~, `.2G,~/
S8W Permit $ Surcharge ~
Treatment Plant p'j/L~~ 31 Q O-b
License Search
Copies
Omer Op
Tota,
Szo~P
. . . jYb
F Y •
LOT SURVEY CHECKLIST FOR RESIDENTIAL ,
BUILDING PERMIT APPLICATION
PROPERTY LEGAL: K I J I ~ d S l! dd.
DATE OF SUR EY: ~Z7/6-7
LATEST REVISION:
m
w
c
A
t
U
~
o z ¢ DOCUMENT STANDARDS
;1' • Registered Land Surveyor signature and company
0 p? • Building Permit Applicant
,a ? 0 • Legal description
,gr ? ? • Address
? ? . North arrow and scale
g 0? • House type (rambler, walkout, split w/o, split entry, lookout, etc.)
,g • Directional dreinage arrows with slope/gradient %
'Q . Proposed/existing sewer and water services & invert elevation
'0 ? ? • Street name
fd' 0 0 • Driveway (grade & width - in R/W and back of curb, 22' max.)
'9 ? ? • Lot Square Footage
~ ? ? • Lot Coverage
ELEVATIONS
Existin
0 ? ? • Property comers
0 • Top of curb at the driveway and property line extensions
p?? • Elevations of any existing adjacent homes
0 . Adequate footing depth of strudures due to adjacent utility trenches
p '0 ? • Watenvays (pond, stream, etc.)
Proposed
~ ? ? • Garage Floor
,0 0 ? • Basementfloor
~ 0 D • Lowest exposed elevation (walkouVwindow)
g ? D • Property corners
,0 ? 0 • Front and rear of home at the foundation
PONDING AREA (if applicable)
0 JO ? • Easement line
? 0 ? . NWL
? Z ? • HWL
? '0 ? • Pond # designation '
? p ? • Emergency Overflow Elevation
p pl ? • Pond/Wetland buffer delineation
Y . Shoreland Zoning Overlay District
Y ~ • Conservation Easements
DIMENSIONS
~ ? ? . Lot lineslBearings & dimensions .
p?? • Right-of-way and street width (lo back of curb)
D O • Proposed home dimensions including any proposed decks, overhangs greater lhan 2', porches, etc.
(i.e all structures requiring permanent footings)
0 D • Show all easements of record and any City utililies within those easements
'R ? 0 • Setbacks of proposed structure and ' e rd setback of adjacent existing strudures
0 ? ? • Retaining wall requirements: /
Reviewed By:
G./FORMS/Building Pertnit Application Rev. 11-26-04
.
, 4935 WHISPERING WAY
CERTIFICATE OF SURVEY
For: Vennehjem Building Corp.
PROPERTY DESCRIPTION: Lot 3, Block 1, WHISPERING WOODS
ELEVENTH ADDITION, Dakota County, Minnesota.
We hereby certify that this is a true and correct survey of the above
described property and that it was performed by me or under my
direct supervision and that I am a duly Licensed Surveyor under the
laws of the State of Minnesota. That this survey does not purport to
show all improvements, easements or encroachments, to the property
except as shown thereon.
Signed this 22'~9 day of 2007. James R. Hill, Inc.,
J;y
mace JZ6/o~ By '
RAGAN G GID • Ga y n, Minnesota L.S. No. 11529
Notes:
1. Building dimensions shown are for
horizontal & vertical placement of structure 0 Denotes set spike
only. See architectural plans for building o Denotes set iron monument
& foUndOllOn dimensions. 9276 Denotes found iron monument
Denotes existing elevation
2. No specific soils investigation has been (930.0) Denotes proposed elevation
com leted on this lot b James R. Hill, Inc. Denotes proposed drainage
P Y tc Denotes top of curb
The suitability of soils to support the specific
house proposed is not the responsibility of Bench Mark: 1002.95_TniH- LoTS i& 2 BLOCK 7
James R. Hill, Inc. or the surveyor. Proposed Garage Floor @ front= 997•1
3. No specific title search for existence or non- Proposed Garage Top of Block= 997•5
existence of recorded or un-recorded easements Proposed House Top of Block= 996•8
has been conducted by the surveyor as a part Proposed Lowest Floor= 988•7
of this survey. Only easements per the recorded Proposed Top of Block
plat are shown. @ Lookout Window= 991•9
4. Proposed grades shown were taken from Bearings are on assumed datum
the grading &/or development plan prepared by
Scale. 1'=30'
NYHUS ENGINEERING
James R. Hill, Inc.
m o° o o o~ a PLANNERS / ENGINEERS / SURVEYORS
j~~ N'-' o\ Z 2500 W. CIY. Ro. 42. SUIE 12f1. BURISMM IIN 55337
o 4~ Z ~ m N o m pHpNE; (g52)89-6044 fAX: (952)890-6244
°°0 1M 941H LNE NE. S111IE B. BlA1E NN 55449
~ MaW= (M)792-1136 FAX: (763)792-1743
. N 4935 WHISPERING WAY
CERTIFICATE OF SURVEY
For: Vennehjem Building Corp.
Ma,a,m,,,, slop%
a ~nu~
x 984.6 vveu ww
ov ~7tlqW
I r1T .1 , I
L_V I `Y
x989.4 I q/N A n I T
~ V I"~ v/~ I v 1
BENCH MARK I
TOP OF SPIKE
iosz ELEV.=992.55 25
x99,.o ,a.~ 014 1033
x962.8 1047 ~ 0.44 S83016'24o. ~
992.6 ~ ~ .
^ ~ o -24.26- ~
1054
C.~ 992.4'3 1045 01055
f! 7' / „9gv~ 9o>}r oT
^ O 990.Ox M (9g7 ' N~x992.8
o ,ose N/
~j 993.2x V)0 x968.8 CO' 3
9
z984.4 t~ o) CNOc °f p~ av-~ ` ^40~2 B'~ 936 1
~ 0~0 ti 01 a~ 5
0000 ~ '
iaz /ct:;~ '33.5_ !'7 ' T
~ ~c
to4o W twt `I x989.4 0 . tan
1026 1029 031
Ll~ W t ^
F~ I $/Y ~ ~cO 014 O O O / ptOJO I /O~ W ~
~ /
\ 1pI4 x 8
O ^ xeeo.a N v s s 9g
o~ ~ 7 ` 9q3 8 ~ ~
o~ ~ ot5 991.3 °j 27 i ~ Q ^ 0
C` ~ \ 1016
J ~ 017 ' \ ~\c ,~~pzz ~jQ tp 3Q ~
~Z.~
6 n
4 9g3~\3 '?16~o g4 sOg\`
J
/ 3j ~ 9 e n ~
~ T 0~C
< 7000 7 ~
/h,Snry ~
9
<
ARK
TOP OF SPIKE
PROPOSED HOUSE = 2,769 SQ.FT. ELEV.=997.09 ~ ~Q~
~~,3 t
OR 18.7% OF LOT AREA o 70
o `
DRIVEWAY = 879 SQ. FT. 2S Qda 1
LOT 3 = 14,792 SQ. FT. qD o OR ~~o ~ , 2SO 'OO
SAN. SERVICE INVERT 1 / o
F., n o
ELEV.= TO BE FIELD DETERMINED-BY C-L-IENT.' 7/-VL--
L-.iLUIRIG IPv._ , iONS DI1lSION ~
Scale: 1"=30' Page 2 of 3 James R. Hill, Ine.
4935 WHISPERING WAY
CERTIFICATE OF SURVEY
For: Vennehjem Building Corp.
Lot 3, Block 1,
WHISPERING WOODS
ELEVENTH ADDITION
Tree Preservation plan Pre House Proposed Post House
Development Construction Tree Preservation Constructio
Const. As-Built Post House Const. As-Built
w 0 o ~ w w ~ o z w
POINT N0. ELEV. TYPE DIA ~ v w w ° t<n v ~ w ~
X
1014 991.6
1 1 1.1 CH Y 10 X X
101 989. OAK 0 X X
1022 990.1 OAK 27 X X
70 997.6 OAK 1 X 7(
1024 990.4 AK 1 %
025 990. OAK 1
026 989. L
1
027 9 12
1 9 .4 K X
i x x
99 .
1 991.E X
10 9.4 UHLK Y t X
1D41 991.6 M
1042 991. X X X
1
TT~ 9 , X
1
D-PF 9 . CH X
1 9 a X 0 1 X X
10 4 90. 1 989.9 1 X X
1 6 9899 CHE RY 4 X X
1 89.4 H Y X X
1 A 1 %
WO4 1. 4 X
Y % AK x
9 . OA
E4V 9 . 1 X
89.0 AK 14 X
Preliminary Tree Certification
During a site visit on March 14, 2007 all significant trees shown and designated hereon
were present and in good health, except as noted in the table above.
z
0
1}ie house has been stoked. Tree fence will need to be placed outside the dripline of oll significant ~
trees to be saved. Future grading and construction should not have o negative effect on these trees. ~
0
gy. . ~ Date: ~~2 o By. Date: o
Ga a, Minnesota L.S. No. 11529 Signalure of Owner ~
A
scale: 1 "=30' Page 3 of 3 James R. Hill, Inc.
Permi[ Number
RFScheck Compliance Certificate Checked By/Date
2000 1VTnnesota Finergy Code
REScheck Soffware Version 3.6 Release 2
Data filename: C:\Program Files\Cfieck\REScheck\4935W WMEIR03220Zrok
PROJECT TITLE: MEIR
COiJNTY: Swtt
STATE: Minnesota
ZONE: 2
CONSTRUCTION TYPE: Single Family
WIlYDOW / WALLRATIO: 0.10
DATE: 03/22/07
DATE OF PLANS: 07/22/07
DESIGNER/CONTRACT OR:
VENNEHIEM BUILDING CORP.
2500 WEST COLINTY RD 42
SUTTE 9
BURNS VII.LE,MN. 55306
COMPLIANCE: Passes
Maximum UA = 532
Your Home UA = 418
21.4% Better Thau Code (UA)
Gross Glaung
Area or Cavity Cont. or poor
$cO61fLff B--Vd= R-VaLile UL.F@Sd4i uA
Ceiling 1: Flat Ceiling or Scissor Truss 2013 38.0 0.0 60
Wall 1: Wood Fiame, 16" o.c. 1921 19.0 0.0 113
Wall 2:
Masonry Block with Empty CeIIs:Interior Insulazion 992 10.0 0.0 61
Window 1: Above-Grade:Vinyl Fcame:Double Pane with Low-E 362 0350 127
Door I: SoLd 42 0350 15
Wall 3; Wood Frune, 16" o.c. 712 19.0 0.0 42
Fumace Forced Hot Air, 90 AFLIE
Air Conditioner l: Electric Centrnl Air, 10 SEER
Praposed and Maaimum U-Factor Averages
Proposed Macimum
Avoage U-Factor Allowed U-Factor
AbovaCirade Windows and Glass Doors 0350 0.370
Includes Foundation Windows > 5.6 $2
COMPLIANCE STATEMENT: The proposed building design described hae is consistent with the building plans,
specifications, and other calculations submitted with the pecmit application. The proposed building has been designed to meet the
2000 Minnesota Energy Code requirements in REScheck Version 3.6 Release 2(f)imerly MECcheck) and to comply with the
mandatory requirements listed in the RFScheck Inspection Chacklist.
BuildedDesigner je%~ Daze . G
~
INSULATION INSPECTION CHECKLIST FOR RESIDENTIAL
BUILDING PERMITS
PROPERTY LEGAL: _ 1pT 3 61nr K t
PROPERTY ADDRESS: Lvq y
INSPECTOR: N
INSPECTION DATE: 1- 3- 0 7
o a
> Z Z SITE GRADING
11 9 D All slopes 3:1 or flatter?
c D a Slopes steeper than 3:1 require retaining wall Are retaining walls present?
91 0 0 Does grading conform to As-Built Grading Plan 1 foot approximately)?
9 0 0 Does perimeter grading tie in well with adjacent properties/undisturbed land?
0 a 0 Is there proper grading and/or drainage around Lookout or Egress Windows?
EROSION CONTROL
99 0 0 Is Silt Fence (or approved equal) installed and in good working order?
D 0 A Is Sod/Fiber Blanket installed behind curb?
0 0 ? Is the Rock Construction Entrance/Driveway installed and in good working order (proper
type/size of aggregate, clean-not covered with soil, etc.)?
0 0 D Is temporary vegetative cover w/ mulch present?
Gi D 0 Is permanent vegetative cover w/ or w/o mulch present?
(circle one)
CITY EASEMENTS AND UTILITIES
0 D 0 Are all easements clear-no part of any building/deck/porch/retaining wall/etc.
encroaching in easement?
0 12 D Are catch basins present within the propeRy or in the street in front of the property, if so
are they clean, do they have the proper erosion control in andlor around them?
0 iN ? Does the property have an Emergency Over Flow (EOF)? This can be found on the
Certificate of Survey. If so, is it present and has it been graded properly?
MISCELLANEOUS ITEMS
c 0n Is there tracking present on Public Right-of-Way(Street from construction site?
il 0 ? Is the driveway at the proper width at ROW line? (22 ft. max.)(Curb stop is at ROW line)
0 0 ? Is the site clean, no trash and/or construction debris lying around?
19 0 0 Was the proper type of building constructed according to the approved grading plans?
, (LO, WO, FB, R, etc )
Address: 4935 Whispering Way Zip: 55123 Per/mit: 77186
THE FOI.LOK7NC 1'iF.MS \VF.RElWERE NOT COMPLF,TE AT FINAL INSPECTION ON :V fJ 1 O
Yes o Comments
Final grade - 6" from siding
Permanent ste s- gara e
Pernianent ste s- main entry
Permanent driveway
Permanent gas ?
Retaining Wall or 3:1 Max Slo e
Sod/Seeded lawn
Trail/curb dama e
Porch
Lower level finish
Deck 'Z
Fireplace t~ q.ql~-U e
• Verify with your builder [hat roof tes[ caps from Ihe plumbing system have been removed.
• Tum off warer supply to the outside lawn faucets before freeze po[ential exis[s.
• Call the City's Engineering Depar[ment at 651-675-5646 prior to working m right-of-way or ins[alling
irrigation system.
~
%
J RUII.UIVGINSI'F,CTOR: r~ G/BIAg Insp/Porm5/2007lChccklists
~
Date: 3/22/2007 Revision Date: 3/22/2007 New Construction
Site Information
Address 1: 4935 Whispering Way Project Whispering Woods
Address 2: Lot: 3 Block: 1
City: Eagan County: Dakota Subdivision: Whispering Woods 11th
' Addition
Application Information
Business Name: Vennehjem Building Corporation MN Contractor License #:20108964
Contact Person: Joseph J. Hilla
Office Ph: 952-890-3000 Fax: 952-890-9281 Cell Ph:
Address 1: 2500 West County Rd #42, Ste # 9
City: Burnsville State: Mn Zip Code: 55337
House Details
Square Feet: 2963 sq. ft. Avg. Ceiling Ht: 9 ft. Number of Bedrooms: 3
Ventilation : Balanced
Total Ventilation Capacity : 117 cfm.
Minimum Continuous Ventilation :60cfm.
Intermittent Ventilation: 57 cfm.
Combustion Apaliance
Water Heater: NA
Furnace/Boiler: Direct VenUSealed Combustion Input BTUs: 110,000 Independenfly Vented
Other Combustion Aqpliances
Gas Fired Direct Vent Fireplace(s): Yes Gas Fired Power Vent Firepiace(s): No
Gas Fired Natural Draft Fireplace(s): No Solid Fuel Appliance(s): No
Exhaust Equipment
Continuous Exhaust Ventilation Capacity (cfm): NA Clothes Dryer (cfm): 135
Exhaust Fan Rating (cfm): 135
Make-Ua Air
No Make-Up Air Required by Code
Combustion Air
Minimum Combustion Air Requirements Have Been Met.
Applicant Name (print)*11Y1*ei I 1" iJldGf, Signature/Date: ~?W w R~ ~I~J~!l~~
Code Official (print): Signature/Date:
(D 2004 CenterPoint Energy Minnegasco. 2004 Mechanical Code Guidelines. Page I
2006 RESIDENTIAL BUILDING PExMuT arrLicaTioN 22(~22
lb?d City Of Eagan ~~O
6 3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Conshucdon Reauirements Remodelhteoair Reauirements ONice Use OnN
r^- _
9uivey Re'cE".';t' '_Y;,~_ N
3 registered site surveys showing sq. ft. of lot sq. R of house; end all roohd areas 2 copias ot plan showing foolings, beams, Joisls Cerf of ~
(20%rtwnmum lot coverege ellowed) 1 set of Energy Celculations for heated additions Soils Report'`
1 Soils RepoA 8 proposed building is to be pWced on disNrbed soil i s'Ae survey for addNOns & Oecks Tre@ Pies Plan Reoi N.
2coplesWplanshowingbeam&windowsizes;pouredfounddesign,etc. Addftion - indicafei/omsdesepficsystem TreePresRequired:.`
1 set al Energy CalcuWtions On-sAe Septic S"yslem;,;'„.;;'~_'•Ydi' '-r N
3 copies of Tree Preservation Plan il bt platted after 7l7193
Rim Joist Detail Options seleclion sheet (buildings wdh 3 or less unAS) . Minnegasco mechaniral ventilatian lorm
Date 6-7 I,/ II Cons[ruction Cost G) g~ ~ s
Site Address y~
I~ iOt w a1 UniUSte Si
Description of Work 1 BAr- d Y'+ 4 lti2,V d 0~
Multi-Family Bldg _ Y_ N Fireplace(s) _ 0 _ I _ 2
Property Owoer Ld w/K QYf l[ (GV Telephone 6 S/ ) N Z 3-23 g0
Contractor Zz/1Q.~/'!'QCLC~bC? ;S'TiGZ Zj74/1
Address City 1S_12/1&)Ct-1zv
State Zip L35~'~~ Telephone#((`57) y3-i• ;~-C
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 _ Minnesota Rules 7672
Energy CodO Category , Residential Ventilation Category 1 Worksheel • New Energy Code Worksheet
(J submission rype) Submitted Submittad
. Energy Envelope Calculatlons Submitted
In ihe last 12 monihs, has the City of Eagan issued a permit for a similar plan based on a master plan8
_ Y _ N If yes, date and address of master plan:
Licensed Plumber Telephone ~
Mechanical Contractor Telephone )
SewerfWaterContractor Telephone#( )
I hereby apply for a Residential Building Permit and aclrnowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a
permit; that the work will be in accordance with the approved plan in the case of work which requires a review and
approval of plans. '
pavn Dn It '7Jlta~n 1.~.-~
Applicant's Printed Name ApplicanY ignature