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988 Wildflower Ct ~ INSPECTIUN RECORD CITY OF EAGAN ' PERMITTYPE: 3830 Pilot Knob Road ' Permit Number. `i T f i~ Eagan, Minnesota 55122-1897 Date Issued: (612) 681-4675 4 . SITE ADDRESS: ~ „ ~ , > F, ~ F . APPLICANT: f11I f1F1 n1JFFt r) 1! : Ir!!i ili I t f ~ I P1~, ~ ~r1; f ii I tJ I t ' 1 ii oi'.1. +0'1i; PERMIT, SUBTYPE: TYPE OF WORK: INSPECTION . tr;, ~ i raA i ~ - - Ji - - 1 PermN No. Pem?it Nolder Date Telephone N i ELECTRIC PLUMBING I HVAC I Mspectlon Date Msp. Comments FOOTiNGS FOUND I I FRAMING I ROOFING I I ROUGH PLUMBING PLBG AIR TEST ROUGH HEATIN(3 I GAS SVC i TEST INSUL GYPBOARD FIREPLACE I FIREPLACE AIR TEST i FINAL PLBG ~ I FINAL HTG I I ORSAT I TEST BLOG FINAL BSMT R.I. I BSMT F1NAL I DECK FTG V L J /j~ DECK FlNAI ~ INSPECTION RECORD ~ t CITYbF EAGAN PERMIT TYPE: ~ 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55123 Date Issued: (612) 681-4675 SITE ADDRESS: , , APPLICANT: 98Y ; 1: I ."1 N i t ;•s 1 1 ~ ~ r, ] 1 ~ + ~f ! ~ , 1 PERMIT SUBTYPVL~ TYPE OF WORK: ~ I • ' , ' 1 Ili~ '1~11 1 I'J~, ~ 10I1.I; I 14 1 I Ho. I~ I i ~ PermB No. Permil Molder Date Telephona • . s/w ~ PLUMBING L ~I ~ f+vnc a5 ~a?3-aZ r I ELECTRIC i7n ELECTRIC Nopectfon Dab Insp. CommMnts Footings 1 Fourxistion FmmkQ Rodft . ~ aAK* Px'o. Rm,a?+ lne• uJ 3 • Rna' "°e. c~IQS 4 ~a ~94 ~ oMM TOM ~l6 9 f ~ k~ Final Pbg. Rbg. Inspwt« - Non(y Plurtiber • iv Conet Meter I EnOrJPlan Bldg. Fnel a/~/ f I DeCk Ftg. Dsdc Final weli , Pr. Disp. , . . ~ . . ~ r Werdiica#e of cccupanc~ ~~4 of Cfason 2c*Rrt=cnt of lod[ihg anoecrion This Certi,ficate issucd pursuant to the requrrements of the Uniform Building Code certifying that at t!u tinee of issuance this slructurt was in carrrpliance witir the varioris ordinanccs ojtlee City irgulating building constraction or use. For the follawing: ux chnir,atior: SF IJWG sidg_ Peffait No. 23102 0-"--Y TYnr Rt/M I zw,g nuaxx PD rype con:c. VN o..,ofauiwMWMLIAM FIITPINER OO]S'f . Ad&vm 460 WAMFM DEt W, EACM ewae;,w Aeam, %8 WICMOM 00[TRT L.,.;n, IA, B2, I.F.XIICICN P= 81H n.e- 7T- POST IN A CONSPICUOUS PLACE .611 21y54 ds'~tar4_~. p~. ~tA l-~7'fc-,r 21488 'Y 7a4r° Repuest Date Fire No. I Rwgh-in Inspedwn NOTICE: Vou Musl Call Electncal Irrspeclor RequvetlT II F qough-In InsOection ? Yes ? N. Is Reqmretl licensed contractor ? owner hereby request inspection ot above electrical work at: Job hOtlrass (Streel, Box or Roule No ) City . S Secton No. TownsM1ip Name or No Raiga No Cowry OccupanB l IPC Nn/ ~Y Phone No. PowerSUpplier / Atldress G T' C~"? Eleclncal Conlractor (Company Name) ~ ConhactorB Lirense No. I FRAP.ttic-Et~:C.6q~u Mailing qQOress (COnlracta or Ovmer Molding Instellatmn) ~~LU','~Iilr Utf~ Ar ~tx: t~a~L! ~W 12 Authonzetl Signature (COnir rlOwne Makirg InstallaUOn) PMne Number 4;9-530 MINNESOTA STAT B BO OF ELECTRICITV TMIS INSPELTION REOUEST WILL NOT Gdggs-Mltlway BIEg. - floam S173 BE NCCEPTED BY THE STATE BOARD 1821 UnivarsHy Ava., SCPauI, MN 0100"- UNLESS PROPER INSPECTION FEE IS Phona(61P) 812-0800 ENCIOSED. 9~ / REQUESTFOR ELECTRICAL INSPECTION ee~ooooi~oe See msimcimns tor nmplenng this form on Eeck ol yellow copy ~ a( 7~Q ? ~ Be/o"w Work Covered by This Request ew,3dtl Rap. Typeol8uilding AppliancesWired EquipmentWiretl Home Range Temporary Service Duplex Water Heater Electric Heating Apt. Building Dryer Loatl Management Comm./Indusinal FUrnaCe Other (Specity) , Farm Au Conditioner Olher (specdy) Conhaclor5 RemarksCompute Inspection Fee Below. # Other Fee # Serv¢eEntranceSize Fee # QrcuitslFeeders Fee Swimming Pool 0 to ('Amps yj 0 o mps 7 Transformers Above 200 _ Amps ue~ Amps 7 Si9n5 Inspacbr5 Use Oniy TOTAL Irrigation Booms ~ Special Inspection AlarmlCommunicalion THIS INSTALLATION MAY BE ORDERED D SCONNECTED IF NOT Other Fee COMPLETED WITHIN 18 M S. ( I, the Electrical Inspector, hereby Rovgh-m certify that ihe above inspection has F,,,ai aie been made. OFFICE USE ONLV N, This requesl voitl 18 montns Imm Address 988 wrtDF't oaE[t r r Zip 55123_ Ldt 4' Blk z Sub LEXIICDON POINiE 81Ii THGSE IT'EMS WGRE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPGCI'[ON. Date: Yes No Inspector: Final grade (6" from siding) Permanent steps (garage) r/ Permanent steps (main entry) V~ Permanent driveway vl~ Permanent gas VI" Socl/Seeded grass TraiUcurb damage ~ Porch Basement finish t/ Deck ? Please verify with the builder the removal of roof test caps from the plumbing system and ihe shut-off of water supply lo the outside lawn faucet before freeze potential exists. Contact engineering division at 68I-4645 before working in righhof-way or installing undcrground sprinkler system. White - Ciry Copy Yellow - Resident Copy Pink - Contractor Copy ~ CI'IrY"USE: qNLIT . . . w,.~«._ . . . . . _ . ~ , , _ . . . ...::L.: '.i ~,:...:~ki::::.`r.:i.:v:~.::~..........:...:..:_...:'::":.i.:::S.; #..i . . . . - .......:...,..:..~.._.:......_..:o...._....,.r; . _ ..r;.,.......... : . - _ . <~~:i:'.".:Y: . . • . . . . . , . . : . . ~ , . . . < . . . . . . ,"i;.< . . . ,...n..,,. . ~::`.e5~`` ~`i'`.:?~F`~ ~i~ . . , y.. ...~a. :i~ti, , , - . ~ , • . ,,7... . •g . {~s.. ` . . , .....-n.,- ..y.' 2...7 ,....oo¢o ~.:8.x , ~._:.......~.:...:c:..~, ...`'r';^::;;;:< , ,.o:..:.:~.r`.~.>.... .:.q.. . ..p....£. . , _ . ......w ......~:...n... '~(Gi.l:::...:... ...~..::.:~....t ....:.....s.:.r:.....n .~,g o.~.o......,,:.r:.o.w ........::...~...F:...~.~..,<:.,.:;..,... G..u..w..........................:...........,....,....«:.:..:a..:.<:.~::.r»;a:.,:::...:..».: 1994 PLUMBING PERMTT (RESIDENTIAL) CITY OF EAGAN 3830 PII,OT KNOB RD EAGAN MN 55122 (612) 681-4675 PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNTT. - - - - - - - - - - - - - - - - - - - - - - NO. FIXTURES EACH TOTAL ~ SHOWER 3.00 3•~ v a.. WATER CLOSET 3.00 v BATH TUB 3.00 U ~ LAVATORY 3.00 q• o ~ ~ KITCHEN SINK 3.00 3~ b v t LAUNDRY TRAY 3.00 3~ a ~ HOT TUB/SPA 3.00 l WATER HEATER 3.00 3• c) o t FLOOR DRAIN 3.00 3• 6 ~ I GAS PIPING OUTLET •minimum • 1 3.00 -3 ROUGH OPENINGS 1.50 14 , S° WATER SOFfENER 5.00 PRIVATE DISP. • oaLcry. uG 20.00 U.G. SPRINKLER • nome unau mnu. 3.00 AL'TERATIONS • ro aasim8 20.00 WATER TURN AROUND 20.00 STATE SURCHARGE .50 TOTAL: ~ . Oo STTE ADDRESS: ~ S C6 Oti'NEP. NP.Iv:E: ~ ~-S INSTALLER: ADDRESS: CITY: l~ STATE: ZIP CODE: PHONE (UIZ) • 3-73 U SIGNATURE OF RMITTEE . C I MUSE......:.,.. . < i~NL . ' T.', . . BT:E , . . ...................C;:~':~~..~.~:. ~C~d'.~:;~i:~~ 1i^F.S..Y ~:Gy'....~°..:•.~~ „55'~l~bv~'j ~Nf v v S3~ _ dY3. ` 3qz ~ pUS~i T=' ~t 3 Y z bF OR, . . gw.... ~,A~ . ` I3A'I'~",. _<.w~.. m.__.....' 1994 PLUMBING PERMIT (COMMERCIAL) CITY OF EAGAN 3830 PILOT IINOB RD EAGAN MN 55122 (612) 6814675 PLEASE COMPLETE FOR ALL COMNfERCIAUINDUSTRIAL BUILDINGS. ALSO FOR MULTI- FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNTT. _ NER' CONSTRUCTION ADD ON REPAIR WORK DESCRIPTION: CONTRACI' PRICE: a FEE 196 OF CONTRACf FEE. STATE SURCHARGE: $.SO FOR EACH 51,000 OF p~1tM17s FEE. MINIAlUM FEE $ 25.00 CONTRACI' PRICE X 1% $ STATESURCHARGE $ TOTAL $ SIT'E ADDRESS: TENANT NAME: S'I'E # OWNER NAME: INSTALLER: ADDRESS: CITY: STATE: ZIP CODE: PHONE FOR: CI'TY OF EAGAN APPLICANT I PERMIT ~ CITY EAGAN ~ 3830 Pilo Knob Road PERMIT TYPE: e u i Lo x N,~ Eagan, Minnesota 55123 Permit Number: 023102 (612) 681-4675 Date Issued: 0 3/ 16 / 9 4 SITE ADDRESS: 988 WILDFLOWER CT LOT: 4 BLOCK: 2 IEXINGTON POINTE 8TH P.I.N.: 10-45092-040-02 DESCRIPTION: Building'_Permit Type SF DWO Building Work Type NEW -UBC Occupancy\ R-3 M-1 Construction Typ.e V-N Zoning ~ PD % Building Length ~ 59 ' Building Width ~ 54 ~ Building stories 2 . > oo Lf REMARKS: S& W PLBR - STAR PLBG FEE SUMMARY: VALUATION $114,000 Base Fee $688.50 MISCELLANEOUS $10828-50 Plan Review $447.53 Total Fee $3,821.53 Surcharge $57.00 SAC $800.00 SAC ~ 100 SFC Units 1 Subtotal $1,993.03 CONTRACTOR: - A p p 1 i c a n t- s T. Lz c. pN/N ER: HUTTNER CONST, WILLIAM 14523088 0001653 WILLIAM HUTTNER CONST 960 WATERFORD DR W 960 WATERFORD DR W EAGAN MN 55123 EAGAN MN 55123 (612) 723-4161 (612)452-3088 I hereby acknowledge that T have read this application and state that the information is correct and agree to comply with all applicable State of Mn. Statutes and City of Eagan Ordinances. - J ~ ` ,Ql APPLICANTlPERMITEESIGNATURE ' v ISSU DeY.9 ATURE INSPECTION RECORD CITYOFEAGAN PERMITTYPE: auzLorNs 3830 Pilot Knob Road Permii Number: 023102 Eagan, Minnesota 55123 Date Issued: 0 3/ 16 / 9 4 (612) 681-4675 SITEADDRESS: Lor: a BLOCK: 2 APPLICANT: 988 WILDFLOWER CT HUTTNER CONST, WILLIAM LEXINGTON POINTE 8TH (612) 723-4161 PERMIT SUBTYPE: TYPE OF WORK: SF DWG NEW INSPECTION . FOOTINGS FOUNDATION FRAMING ROOFING INSULATION FIREPLACE ROUGH IN PLBG ROUGH IN HTG FINAI PLBG FINAL REMARKS: S& W PLBR - STAR PLBG F ~ L , CITY. OF EAGAN - - 1994 BUILDING PERMIT APPLICATION " 681-4675 C°1,4R i 4 t°y4 SINGLE & MULTI-FAMILY 2 sets af pians, 3 registered site surveys, I copy of energy calcs. COMMERCIAL 2 sets of architectural & 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 chafige,is requested once permit is issued. Date 3 4/ Valuation of work '1 Site Address: ~ ~ ourY~ .1~ STREET SUITE N Tenant Name: (commercial only) IAT BIACK SUBD.~a~/` bP.I.D. # !6 l Descri tion of work: The applicant is: ? Owner Contractor ? Other (DeserSbe) Name Phone Praperty Lasr FIRS7 Owner pddress STREET STE p City State Zip Company sl~ Phone 43yL }'0ff Contractor Address W, License # lfl~-S3 ExP. 9~5_ City State ~rc.. Z;p SS/23 Architect/ Company Phone Engineer Name Registration # Address ' City State Zip Sewer & water licensed plumber -a-r Pxv+s r< Processing time for sewer & water permits is two days once area has been pproved. I hereby acknowled9e 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: ~ OFFICE USE ONLY BUILDING PERMIT TYPE `'V ~ - ? 01 Foundation ? 06 Duplex 0 11 Apt.JLadging ? 16 Basement Finish 0 02 SF Dwg. O 07 4-Plex O 12 Multi. Misc. ? 17 Swim Pool ? 03 SF Addition ? OS S-Plex O 13 Garage/Accessory ? 18 Comm./Ind. ? 04 SF Porch ? 09 12-Plex O 14 Fireplace 0 19 Coimn./Ind. Misc. ? 65 5F Nisc. 0 10 Multi. Add'1. ? 15 Deck ? 20 Public Facility ? 21 Miscellaneous WORK TYPE El 31 NeN ? 33 Alterations O 35 Tenant Finish ? 37 Demolish ? 32 Addition ? 34 Repair ? 36 Move GENERAL INFORMATION Const. (Actual) V/% Basement sq. ft. 5%~f MWCC System ic- (Allowable) V7F- lst F1. sq. ft. City Water ~ UBC Occupancy R-3 / 2nd F1. sq. ft. ~ PRY Required Zoning ~ Sq. Ft. total Booster Pump # of Stories z Footprint Sq. ft. Fire Sprinkler Length ~ On-site well Census Code Depth 5 On-site sewage SAC Code Census Bldg ~ APPROVALS Census Unit T Planning Building Assessments Engineering Yariance REOUIRED INSPECTIONS O.Site m Footing 0 Framing f7-Insulation ? Wallboard ~3 Final ? Draintile ? Fireplace Permit Fee v.imcim: S ~ lY 21 t9e~:, Surcharge Rsti~ y,. Pl an Review zo - G yo License 2!~y 2p ; szo MWCC SAC ~Zy z- ZY 20,~- z Y° City er S Conn. Sy g~ X/G Wat Water Meter U%'^ /p 2&0 Acct. DePosit ~ S/W Permt't 22.3: 3,)/,9 Y,P /s: Sj /o S/W Surcharge Treatment P1. Road Unit 2~,~-/S = 3 3 o,+sy = /f) p z 0 Park Ded. 3 9 g~,9 p Trails Ded. ] Copies Other Total: SAC 96 SL d, ~ U SAC Units r3z _ MAR-15-94 TUE 15228 TRZ-LHND 6124520994 A.01 Po91-It" brand 1ax lransrniltal memo 7671 Nol pepee ~ a. TRI-LAND C0. ,LSURVEYING ! Uept. t' P Olt! I' ls - J~Sd ~ - ~ ` r SERVICES ~O F°' S I TE P LAN FOR ~ LEGAL DESCRIPTION: LoT-i._..,eLocK_2-, toa ACCOFlbING T THE RFCORDE PLA THEflEOF COUNTY, M NNESOTA ADDRESS: 988 W _ 'r -~----------s- - - H b - ~u rn , , s IIY'Oe'DS'- w ~,S• ~ 1TJ0 o~p z a 9'7.E0 . ~ 5 r,. ` - - OS5.04 ~ 46sR........ I JIL 8 caRAGE ~ o,eS51 ~ o~ ~ . ~ ' 7 ~1i0 I ~183.S~f J&W HousE a i i qgs.s~ : I ~i QLOC`K 2~ 1~~1 EA A-ti -i EVIEWED ~ Is I e 51 3 /S ~ 7f',60 ~ o Tr.6 ! ~ 11 R i e0'Od . IR`~~. _ -M-:-~ IID89, .r ]EA~r'APT EPdGI1VF.' RIIV ' DE . ; LE(3EN IryVERT ELEVATION AT SERVICE XT NSIOtJ= ~ o D OTES IRON MONUMENT PROPOS6D GARAGE FLOOR EL V ION~ a D OTE WOOD HUB SET PFtOPOSED FIRS'f FLOOR EL~VA ION = q0T U 07E~ EXISTING ~ELPOSED EVp BqyEMENT FLOpp' - 7~ C*b OTE~ PROPOSEP SPO7 F'lk aqthnp,j} I ELEVATION NOTE: VERIFY ALL FLQOR EI~HTS WITH ~ DOTEIS DRAINAGE DIAECTION - pINAL fIOUSE PLANS ~ 1 hws erlily ~hot ihis turvey,Plan or roport a pr p4rsd by mt or undor my dfrecl arvls on ond Thaf I am a duly Bradlay J. S nson. n. Req Na. 15235 . Repisie 4 L n Surveyor unftr fhe z ^ Laws ~ n9 S at of Minnetota. Dote _ R=96% I 6124520994 03-15-90. 02:30PM P001 }t33 r - LOT tIIRpLy CHLCELSBT !Ox 3tL6IDLNTI7IL ~ SDILD2NG pERKIT P?LICJ? 20Ii - pROPERTY LEG71L•t ~ Date o! Burvops DOCIIlSENT 6TILND Ana O~D 0 • Registered Lnnd surveycr siqnature and company 0 • Building Permit 7?pplicant ' 0 • Legal doccription F13 [3 • ]lddraas H-D 0 • North arrow and -ber scnle R" D 0 • House type (rambler, walkout, sp11t w/o, split antry, lookout, etc.) @~0 D • Directional drainags arrovs with slope/gradisnt 4. 8' 0 D • Proposed/exicting sowar and watss sarvicec L3~~D 0 • Street aame ~ D 0 • Dziveway ZLZvATioxs Lxistiae I3" 0 D • sewer service Ef 0 D • Lot cornerc ~ 0 D • Top of curb at the drivevay 2-'0 p • Elevations of any existiag adjaeent homes PrereseQ 013 D • Garage iloor 0 • First floor 0' D 0 • Lowest expoaad elevation (walkout/vindow) D~D 0 • property corners 8' 0 0 • Front and rear of bome at the foundation PONDINS !Is 0 D/0 • Easement line a D~0 • NWL 0 C~ 0 • HwL . D 0~~~,6 • Pond # designation D@' D • Emerqency overflow Elevation DirtZxsioxs 9"A D • Lot liaes D • Riqht-of-wey and street width (to back oi curb) D D • Proposed home dimensions includinq any proposed -aecks, overhangc qreater thnn Z', porches, stc. (i.s. all structures reguiring permnnent footinqs) 0 • Show all •nsements oi seeord and any City utilities withia those easementc cr'0 13 • Setbacks of proposed structure and setbnck oi adjecent ~ ~ existing homes, . D D' D • Retaining v r roments, if any Reviewed: Nam / . Dat - October 1992 W- ~C34.7V vr-~o~.i~ / r~ • g"X6" TEP 8 HYD. 12 y~{' I W/35' 6" o.i.P. 1~ 11 CL=52 STA 2+70 S- 973.18 ' STA 4+40 8"x6" TEE 8 HYD. W- 981.00 W/ I I' 6" D.I.F. S- 977.43 8 CL- 52 STA 1+85 W- 985.50 ! I/4 BEN ' O a ~ 6" DIP ~ ~ MH 9 - 7 : STA 4+35 i ii r, e ~ : - S-977,13 • W-985.05 I 10' CEN. SAC = (T`' 4.60.00 4: 3 ~a, 5 STA 2+96 ~TA 2+56 5-973.83 S-972.84 - - STA 4+23 STA 4;14 W- 980.7V ----W-980.24-1-- ~.4 S-976.45 I: I S-976.80 ``T`• REMOVE PLUG 8 W-985.04 I I W-983.93 CONNECT TO EXISTING ~o~ io• 8" D.I.P. I SEE SHEET 12 OF 12 ~z~• ~ 1 Y E CITY Or FBiC~ DO S~tOT C AR EE r FB" LEXINGTON ex~a° Pvc THE ACGI ~ACY OF UT ' SAN SEWER /OR ELEVATIONS. THIS D' °1S FOR , IWDRMATIoN PURPOSES a,:Lv ANo I L D F E R C 0 l ~ PERSOi~S U~:f~G IT SHOULD V,`11. Y TH:. 10N ON THE 51TE. 3 . 'a ~ . . . Y . . . . . . O . . 1 .i_ . . . . I . . . . . . . . , s , . . . _ ` ' . . . . . . ~ . . .....~I. ~9........ . : . . : . . . .V v . . . . . . . -•r....... : . . . . . , . . . . .........:....r.. .............._...:.........................p............._.......... . . . ~ ° . . . ~ . . . . ...c9-~•1..... . . . . 4-i........... . . . . . . . ~...r. . ' . . . ' . . . . . . . . . . ~.Nr..~............ : . ' ' . . • • ~ . . . . . ~ n. . . . . a~J..:..j . - . ~ ' . . . . : : . . . . . ~ . . . . . . . . . . . . . ,yR.....~ . ~ . , . , . . ~ : . . . ~ . .~.:...M:~ Y...........r:............. ~ . . . . ~ . . ' ' . . . . . : . . : , . . . . ' . . ~ : . . : ......MH , . . . . . . • ....._....w_ :°...:.:::'.°_...:....._.:.....STA...k:t.4.4::°..:::'°:"::::.,.......:::.....;......:::°.....,...:::::'°°::°..;............:....:_....:::....:::::°..;...:..:,.°:':`:°:::.:.::." . . . . . : . . . . TC.98:5:.0:5:::::::::::::::::::::: : . : MH g . . 'STA:2.0~' . . TC::578:33: - _ . . - • . . . . 4B p±_ . . . . .CL .82:::: . . . . 8.. D:I:f': : . . . . . . . 240a : F . . . . . .:PVC R 35'@ 530 ~y.~:~:'~ ...........:.........................:...........................iNV-974:08::::::::::::::: 2 ; : /o :.:.:........:::f.-.~.~.F . . . . . , ...s~fi~...4~.~C1'fLi............:.,:.;.;......... . . _ . s 204 . . . . . . . . . _ IN1~::9E"a8:~f::...;.. ~F.B".PVC SpR:35.@.. SORZ . ~ . ..............................Tli:2t.3D:::....... . • . . _ . . : . . . , ~ Y..... :'~ii~ Ct~lf` r~.E~Q~f'~;Df3~~;~OT{'~tJ~r3~ltf'T~~':. : : : : ..LiT'1f tflCA1:(Q~i. . . ; . . BE.. AGGURFiCV...OF tIT€ : fVDfOR ::ELf~l6tTi0f~S;:::~HIS:: DA7A::;:~0~:::::::::::::;:::::::: . . ...........::::::::::::::::::::::::::.::::::::::::::::::::::::::If~OR~A~tQiVs:::::PIfRPQS~:::::::0 Vt'Y::::::AND:::::::::::::::;:::::::: • . . .P~ER$~~iVS..41~'.44.. ~~...SH{~~1tQ..~i:i=~i'~Y.......................... : . ....................:....................:.......:::....:'::°.:...:~::'::'if~fFO~iY~t~aTifli:......;....:' . 4+60 =r+00 3+00 2+00 1+00 • - . . . TO EE SU9`tIi7ED 41ITiI IIUILDICC PLRIIIT /,PPLICATTO:i " . 17:TFCIOR }.,yVF.LOPE AVER;GP_ "U" C0.`iPUTATION OL':7ER• SITE ADDRESS: /SF GUi/dR04r2y/ (Y ~ , C017TRACfOR: . u.. CB~L~/ DATE: Detezmine vorking equare foo[age nf each 1. Total exposed wall area......... z/ 6 7 eq.ft. x sH 2. Total roof/ceiling area......... ~ Z(a~ sq.ft. x0 Q2_6 3.• Total exposed wall area calculations: . 2otn1 exposed wall area above floor a. Total wall vindov'area /b8 b:" iotal door area .?fl e. Total sliding glass door area d. Total firep.lace wall area ' e. Total wall framing area (average 107.) . f: Total net wall area above floor _ . g. Total riri joist area /30 Total expoaed foundation area h. Total foundation vindow area - i. Total net foundation area above grade r) ' Determine "U" value of each wall segment 8. ~G F g „U„ ~u ~ • _ . 6$, ga . b. 38 X „u„ . C. XolUel ,ss _ zZ, v a. X ,lull . ' , . e. ~y X ~lull . 07 f. ~ 9iq x „U„ , 0 q . 74,51a g. )30 X„u„ , oq • h. - x "u" , S"(, . - i. 160 X„U,. ,l G o 3. • ToTAL If i[em 03 is [he same as, or less eh:rn item 01, you hnvc mct the intent ot SBC 6006('c)2. ' 4. Total caposed roof/cclling calculations: Total exposed zoof/cailiiig area J. To[al skyligh[ arca ~ k. Total roof/cciling framing area (average 107.)......... 7 1. Total net insulated zoof/ceiling area /'/L/ Z . Determine "II" value for each roof/ceiling segment X „Q„ _ j. - . ~ k. r Z ~ R„u., x foUls 4. ToTAL _ Z 5.3 g If total of 04 is the same as, or-less than L•'2, you have net the intcnt of SBC'6006(c)1. A1[ernate Building Envelope Design `'~1.'. . . ' . . . . To utilize the total envelope system method, the values establislied by ' the sum of itens 03 and J4 shall not be greater [han the sum of items O1,_ and L`2. _ 1. + 2. ~ - 3. + 4. - C E R T I F I C A T I 0 N I hereby certify ttiat I have calculated the "U" factors and R values herein and that the building hero described meeta or exceeds the State of Hinnesota Energy Conserva[lon Act. • (Signa[ure). • (Date) : . -PERMIT CITY OF EAGAN 3830 Pilot Knob Road PERMITTYPE: suzLozNs Eagan, Minnesota 55122-1897 Permit Number: 0 2 8 3 9 6 (612) 681-4675 Date Issued: 0 7/ 2 9/ 9 6 SITE ADDRESS: 988 WILDFLOWER CT LOT: 4 BLOCK: 2 LEXINGTON POINTE 8TH P.I.N.: 10-45092-040-02 DESCRIPTION: 6uildi g,Permit Type DECK 'Building Work Type NEW / Census Code \ 434 ALT. RESIDENTIAL ~ ~ . { ~ ~-Y REMARKS: FEE SUMMARY: Base Fee $45.00 • Surcharge $.50 Total Fee $45.50 • CONTRACTOR: OWNER: - Applicant - SMOLLEY , MICHELE 988 WILDFLOWER CT EAGAN MN 55123 (612)456-9098 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 Mn. Statutes and CitY of Ea9an Ordinances. - ~ ~ ~ APPLICANT/PERMI EE SIGNATURE ISSUED-BV.qGNATJJRE- ~ ~ CITY OF EAGAN ~ 3830 PILOT KNOB RD - 55122 ~ 1996 BUILDING PERMIT APPLICATION (RESIDENTIAL) ~ 681 -4675 New Conslruction Reaulrements RemodeUReoair Revuiremenls ? 3 rephlerod sRe aurveya ? 2 rnpies of Dlan ? 2 copies of plans (Mdude beam d window sixn; poured 1nd. design; etc.) ? 2 sNe surveys (ezterior add'Rions 6 decks) energy celculatione ? 1 energy ealalations lor heated additions ? 3 ropies of tree presenetion plan H bt platted aRer 7/7193 mqulred: _ Yea _ No n 1 ~ - DATE: ~ CONSTRUCTION COST: DESCRIPTION OF WORK: ~ A4c- a(- hm& STREET ADDRESS: d 768 JV7dVfe•2 00J(Lr LOT ~ BLOCK ~ SUBD./P.1.0. CL('(u6ra~ Ool v17~ ~b TA6E4 - S I b r1 -703 PROPERTY Name: 5~tou'c-' V~'` /A,{ ~&L Phone OWNER Street Address- Sg W~ ~ oovcr City: 6~64' State: VH A Zip• S~1 Z3 CONTRACTOR Company: ' Phone Street Address: License City: State: Zip• ARCHITECTI Company: Phone ENGINEER Name: Registration Street Address' City: State: Zip: Sewer 8 water licensed plumber: Penalty applies when address change and lot change are requested once permit is issued. I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with ail applicabte State oi Minnesota Statutes end City of Eagan Ordinances. _ CiiJA Signature of Applicant: OFFICE USE ONLV (3C~C~C~~M[~DD Certificates oT Survey Received _ Yes No .I ~ I I 2 3~996 Tree Preservation Plan Received _ Yes _ No ~j~ ------4' ' OFFICE USE ONLY ~ BUILDING PERMIT TYPE - ? 01 Foundation ? 06 Duplex o 11 Apt.lLodging o 16 Basement Finish ? 02 SF Dwelling ? 07 4-plex a 12 Multi Repair/Rem. ? 17 Swim Pool ? 03 SF Addition o 08 8-plex o 13 Garage/Accessory o 20 Public Facility 0 04 SF Porch ? 09 12-plex ? 14 Fireplace ? 21 Miscellaneous 0 05 SF Misc. 0 10 _-plex m-~1-5 Deck WORK TYPE d 31 N e w ? 33 Alterations o 36 Move 0 32 Addition o 34 Repair ? 37 Demolition GENERAL INFORMATION Const. (Actual) \M_ Basement sq. ft. MC/WS System ~ (Allowabie) V tJ Main level sq. ft. City Water ~ UBC Occupancy 19 _3 sq. ft. Fire Sprinkiered 2oning 12-I sq. ft. PRV # of Stories sq. ft. Booster Pump Length sq. ft. Census Code. 4~.~ Depth Footprint sq. ft. SAC Code Census Bldg Census Unit O APPROVALS Planning Building -Vytl?- Engineering Variance Permit Fee Valuation: $ Surcharge Plan Review - License MCNVS SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Pertnit S/W Surcharge Treatment PI. Road Unit Park Ded. Trails Ded. Other Copies Total: °h SAC SAC Units ~ Poelll'•UmnJIiixlnuwinlllulmunwyM/I7l+"I~.o... ~ Iatp:I!/u/CL~:9L~- L~ TRI-LAND SURVEYI N C0. d,i[o G , _ _ p7z. z~5_. _ ~ds-o toa~~- % SER VICE S F ~•~v ~ ~NI,K, SITE PLAN FOR: t-v N~ i Rv~. % I vIv - LEGAL DESCRIPTION: i.oT ai_on<.I-f-wc,"to 104" ACCOf1DIN(; TQ TI IE RE:CURDEfS PIAT TI IEREOF _I)s1iSt49,__ COUN'IY, M NNESOTA AbDRESS: 9~FL_~~i~F_LOtvf R _ r -'F-------r - M l, n N evroe~ h a WMFF' 9 J_ . ~y. 0 1?.00 1104o0 ~z o 17.E0 oee.o~ ? .0w:.. ~~~.,....}4fl......... . ~ a ~ outAct ~aes.s\ ~ ' ~ ~~10 I qe3sv I ~ q F~ouse o+ ~ ~ ~ ~e .s~ LOlCK 2 r~ s~ t•.ao• E A (ii A N ti -IEVI WED er gL._._~_.-.-_._- "~_...._._.~r~g 3 /s7'i ~i?~60_ ° ~ 9Td 11 lCOeBC L / ! R.~ °°11111 gy EAGAN EAIGINE fRIN DE . LEOEN ---Q INVER7 ELEvNIOtJ Ai SERVICE xT NSiON= 13,81 o D OTES IpON MONUMENT PROPOSED GARAOE FLOOH EL V TION• ~S * D I OTE WOVD t1U0 SET PROPOSED FIRS'f p1.00R N £l~VA IO - q9T b OtE~ ERISTINO SP07 PiiOPO5ED8ASEMENT FLOOR J EIEVATION ELEVAIION ("PE`1) OIE$ PROPOSED SPOT F,I` Q4SP~„p,~F NpNW~I~V~} I ELEVATION U O7 ES URNNAGE DIFECTIUN NOE ~ VEf11FY ALL FLQOR WITH i I FINAL FIOUSp PIANS~ 1 hvoq, tonHy `AOt 1Ms turvey,plan or _n . repor . n l pr p9d bY me or undor my L~ dlrect avl~ m and Ihal I om a duly Brodley J. 9%# nson, n. Rey No, 15235 Repi.ie d l. n Sarveyor under tM ~ L.nws + hq 5 oi ol Mianeoola Dot~ " I I ^ P~~~' L1.^I.'1n9v1 ni IG nt nP ~fil'll Pnill 11~ r ClC`ty'tlSE:C?"'St' 1'~':7;.." ; ":`.D~.;:'::•..:.~':':~r,7.;::.......: . ....F..;?:: :'.RL'l~iL'iC~'A'~5.~`': ' o:..: .:.....:....'.:':;~•;~o:c.':.:'..:.' , : : . . ........:,i.....,. . . ~:'s:.;.i::~.:;::.:c:•:<,.: , ~!~j~ y~.: r:i:.~.;~:...« ~::.F.:._.r.~~:.r~;.' .....:.3..~.,:..5.;.~,,..:...c...r. . : . . . . . .o- . ..:'::'.q :...:.:•t.......:;.,3 '.:~I~'R~:,~!'.'.'w<~c,~~ o . .ao:.n.....:...al. ' . p...,.:.'r.:... . ...nY.i: ...e.. .,....::!t: . ~::.~..,..'o.c....a.....c.~c.'.::e:;;<$'e:>cC.:::.FF:):`::i:~:.{a.,..:.o.:.'; n.ft.R.e...k:.:...~;:., .`_Y~~:. ~ . . . ....F.;..~.~.. x./.':V _ . . , ..c . . . <[....c: . . . . ...y...., i.,:a.:'<~'.:":a a ~ . ' . ~ : ' . ..a ~f<f:%1':'S'1"c:r:_e;:l.~:i,•;~~f~'.~a,''::f:'it(..'•:1..':.:c...:::., ..~.i',~::?~ia ,••;.N'~ . . ' ,'.F.):.' . : . ......~....<..a)•..tn' 3 ~ ~ . ' ..V..,~tl~' ....~%n.....i. . . n..:.. ;YY.:%:r...' :c:_.;... s..CnS' . ~ Y%?`.fZf S~1~iD . ~s,sc> a~~'~~,;_... : : . . ~J!.~'~::;>~. <.,;<-. a....x. . <......,.....u...ou....~...:•<.....~! . .~w. ~ . ~.H.... .....~:....:n:w:w 1994 MECHANICAL PERMTT (RESmENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN MN 55122 (612) 6814675 PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNTT. ? NEW CONSTRUCTION ADD-ON A/C ADD-ON FURNACE FIREPLACE INSERT DATE gy FEES HVAC: 0.100 M BTU $ 24,00 ADDITIONAL 50 M BTU 6.00 GAS OUTLET'S (MINIMLIM 1@$3.00 EACH) (9 Dd ADD-ON/REMODEL (EXisTING CoNSTRUCt'[oN) $ 20.00 STATE SURCHARGE .50 TOTAL SIT'EADDRESS: qk~1 Gvi/"/-I"owCx ~1-7- OWNER NAME: ,4k7"`Tili2.e X1dA.s J~. c... TELEPHONE Y5'~Z 3z~ gY INSTALLER: G/ZD~~S .(/lti DJiv~L --~N~• ADDRESS _3 ~ rc~ ~ 3 i.3r w CIT'Y: A_/~OA O?~+~ STAT'E: ZIP CODE: TELEPHONE y 2---3 --3 9~ D'L '450w"~4 SIGN:ATUR°E OF PERMITTEE U5~;C11VI;Y .r:~ ..............~....::..,„.,..„,.~.:...........w.~.~,_,...~..:..y.,....:.H..~_.;~ ° ~ ' . . . t..:.:c.:;«: r.., , u.o...._ ~ -.:~:~:::h.., . , e<.._. ....,..,.~~.:...:~;r:::::.:•..°.:- ,..a.,,,~,..2:.~-.:-s:-.._~ .:~;;..~•~:.>f~"C`~'IP'1•.'~m,:...~.:><;:a;,.,e':..::i-z;.~:-<'ii;' .....::<.::t:::,.~:::.::..:.: . ~.at::.,. .r:r.,..:..~<..t~..,:..:. 3.:..:....A..,:c~r`r•:.'°:.^.... ~.:.::w:.,;.,.;2.,.....:_t~.:`< c'F.a."< ..a ...:......n ~.a....:..:i.~~ .'.r~:'_•' , .~~:E.n n,,. :.o. .........,..,....r..:^...F'i.~ :;i`.S~ t....:.....'...._...~....... ~ -a ' pr. ...::•<•e:•q<5. .:~:[:ESio-,l:.°+...........~'::~'1!,'::..yCa....,`.. ::'~~i.Y:t.'..'.;$iii:~ . ~ .:..,.%:s~. ~ . , .3•r:[:,.r..c:::~ ' ~ ~ ..r.,~.. b~ z,iao;.,:.E:S~;,_:k:_;.5:;;^:~?< _ '::-...T... . 3 k~3.:' . ` ...::...~..>.n.c:p.:...v....c.x.':::.:...,:'...(.......'~~ N . ~<~k~ ~~.t.;``u•..~~.:... ....,.,,»a..«,,........_,..,,....,.,...,.,,..,.:,.., ,..s.r a .3".:. a.;>:a,.w.._ .................c....N~,..a.:......~....,....~,....,k....z~:.:. M.a....~....,..~.w.....,..a.a.......a..wtu1.C»:nz~s.:.~.'~'o.R3.3ii1^~~..v:a:o.u:.•..~;::.:..~..E.:..H,:.:,:.x.;.::.sd's~.~:aaL.~f,..~,..aw,SL~»n,;.~3,okx. 1994 MECHANICAL PERMTT (COMMERCIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN MN 55122 (612) 6814675 PLEASE COMPLETE FOR ALL COMAERCIALINDUSTRIAL BUILDINGS. ALSO COMPLETE FOR APARTMENT BUILDINGS OR OTHER MULTI-FAMILY BUILDINGS WI-IEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNTT. - - - - - - DATE: CONTRAGT PRICE: $ NEW BUILDING INTERIOR IMPROVEMENT WORK DESCRIPTION: FEES 1% OF ~ONTRt1C"1' FEE $ PROCESSED PIPING: $25.00 MINIMUM FEE: $25.00 STATE SURCHARGE $.50 FOR EACH $1,000 OF PER,MT~ FEE. TOTAL $ SITE ADDRESS: OWNER NAME: TELEPHONE TENANT NAME: (nvtPROVEMENIs oxi,Y) INSTALLER: ADDRESS: CIT'Y: STATE: ZIP CODE: TELEPHONE SIGNATURE OF PERMITTEE CTTY INSPECTOR RECEIPT DATE: U Cj PERMIT # MIDEPTIlkI. PLlJ1HBlA6 PEftblIT i4PPLICATIOft crrY oF F-Asnx 3930 PILoT Kivos [tn gneaa, auv ssy aE 651-681-4675 Please complete for: ? single family dwellings ? townhomes and condos when permits are required for each unit ? backflow preventer for irrigation system SITEADDRESS: SMOLLEY,MICHELLE - 988 WILDFLOWER COURT OWNER NAME: : EAGAN, MN 55123 TELEPHONE - (ss» ass-sesa - (AREA COOE) INSTALLER NAME: TELEPHONE RBLOM PLUMBINO C0. (AREA cooe) STREET ADDRESS: D13A VEONTC01AP 2905 OpRFI LD AV~E.3 gO GTY: UTM STATE: ZIP: i Place a check mark next to the ermit work t e New residential dwelling unit under construction and not ownedoccupied $ 90.00 Add-on, modification or alteration to existinq dwelling unit, including: $ 50.00 • abandonment of septic system • new installation/repair/rebuild of RPZ • lawn irrigation system • water turnaround Nature of work: Septic System, new/refurbished - $ 225.00 • includes County & Consulting !nspector fees • requires MPC license State Surcharge .50 Total AUG 62001 Reminder. Be sure to schedule inspections of alterations, i.e. Mater heaters, water softeners, etc. I hereby acknowledge that I have read Ihis applicatlon, state that the Informatlon Is wrrecl, and agree to complywith all applicable Cityof Eagan ordinances. It is the applicant's responsibility to noU(y tha property owner that ihe City of Eagan assumes no Ilability for any damages caused by Ihe City during its nortnal operatlonal and maintenance activilies to the fadlities construcled under Nis permit wifhin City roperty/righ~ y/~as_ ement. . ~ l%~ ~ ~ SIGNA U OF PERMITTEE Updaled 1/01 _ FF I 17 D 7 For Office Use - 75 r4~ C j.~ City of rmit#: ' l_' Permit Fee: 3830 Pilot Knob Road 1 L Eagan MN 55122 I Date Received: Phone: (651) 675-5675 I Fax: (651) 675-5694 Staff: f,~ 2009 MECHANICAL PERMIT " /APPLICATION Date: Site Address: WfL-bCLeVVL'" d)_qa Tenant: Suite RESIDENT I OWNER Name: gEy Phone:Iq Address / City / Zip: CONTRACTOR Name: License Address: 196' ~~R~III Li t sr- City: s q, ti aj 5 State: fcli1j Zip:3S 3 Phone: -27 Contact Person: j pj kilopL" TYPE OF WORK New _xReplacement Additional Alteration Demolition Description of work: 1Ei AeE tf / NOTE: Both roof mounted and ground mounted mechanical equipment is required to be screened by City Code. Please contact the Mechanical Inspector or one of the Planners for information on permitted screenin methods. PERMIT TYPE RESIDENTIAL COMMERCIAL Furnace New Construction Interior Improvement Air Conditioner _ Install Piping _ Processed Air Exchanger Gas Exterior HVAC Unit Heat Pump Under / Above ground Tank Install / _ Remove) When installing/removing tank(s), call for inspection by Fire Other Marshal and Plumbing Inspector RESIDENTIAL FEES: $50.50 Minimum Add-on or alteration to an existing unit (includes $.50 State Surcharge) $90.50 Fire repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) $ TOTAL FEE COMMERCIAL FEES: $70.50 Underground tank installation/removal OR Contract Value $ x 1% $50.50 Minimum (includes State Surcharge) - If Permit Fee is less than $1,000, surcharge is $.50. _ $ Permit Fee if Permit Fee is > $1,000, surcharge increases by $.50 for each State Surcharge $1,000 Permit Fee (i.e, a $1,001-$2,000 Permit Fee requires a $1.00 surcharge). $ TOTAL FEE 1 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. Applicant's Printed Name Applicant's Signature FOR OFFICE USE Reviewed By: Date: Required Inspections: Under Ground Rough In Air Test Gas Service Test In-floor Heat -,--,--Final Exterior HVAC Screening Inspection PERMIT City of Eagan Permit Type:Building Permit Number:EA110934 Date Issued:06/04/2013 Permit Category:ePermit Site Address: 988 Wildflower Ct Lot:4 Block: 2 Addition: Lexington Pointe 8th PID:10-45092-02-040 Use: Description: Sub Type:Windows/Doors Work Type:Replace Description:Two or More Windows/Doors Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings, call for framing inspection. Call for final inspection after installation. Carbon monoxide detectors are required by law in ALL single family homes . 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 - Michele Smolley 988 Wildflower Ct Eagan MN 55123 Renewal Andersen 1920 County Road C West Roseville MN 55113 (651) 264-4777 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA119700 Date Issued:12/12/2013 Permit Category:ePermit Site Address: 988 Wildflower Ct Lot:4 Block: 2 Addition: Lexington Pointe 8th PID:10-45092-02-040 Use: Description: Sub Type:Windows/Doors Work Type:Replace Description:Two or More Windows/Doors Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings, call for framing inspection. Call for final inspection after installation. Carbon monoxide detectors are required by law in ALL single family homes . 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 - Michele Smolley 988 Wildflower Ct Eagan MN 55123 Renewal Andersen 1920 County Road C West Roseville MN 55113 (651) 264-4777 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA155100 Date Issued:04/29/2019 Permit Category:ePermit Site Address: 988 Wildflower Ct Lot:4 Block: 2 Addition: Lexington Pointe 8th PID:10-45092-02-040 Use: Description: Sub Type:Siding Work Type:Replace Description: Census Code:434 - Residential Additions, Alterations 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: 5,000.00 Fee Summary:BL - Base Fee $5K $118.00 0801.4085 Surcharge - Based on Valuation $5K $2.50 9001.2195 $120.50 Total: 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 - Michele Smolley 988 Wildflower Ct Eagan MN 55123 (612) 490-5792 Eagle Siding 1301 East Cliff Road Suite 117 Burnsville MN 55337 (952) 746-3046 Applicant/Permitee: Signature Issued By: Signature