1314 Windcrest Ave
CITY OF EAGAN ~ . n
~ 4 ~ 7
~ 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 ~ y-•
BUILDIKCG PERMIT PHONE: 454-8100 Fieceipt #
Tobeusedtor SF DWG/Cr1R Estvalue $90'000 Date JANUARY 16 19 86
SiteAddress 1314 WINDCREST AVE Erect CfX accupancy R 3
lot 3 Block 2 Sec/Sub. Bj RCH PARK Remodei 11 Zoning 1`
Parcel No. _ Repair ? Type o( Const v
Addition ? No. Stories
Q . SUNSHII3E CONSTRUCTION CO Move ? Length 98
= Name Demolish ? Depth 44
o Address Ini Impr. ? Sq. Ft
Ciry ' hone 431-2200 Install ?
o Name `c'AM F . Approvab Feas
o< address Assessment Permit 403.00
~ City Phone Water & Sew. ' Surcharge 45. OU
~ Police Plan Review20T' 50
~ JAMES R. HILL ----5-7 -5. 0 p
F Z Name 200 HUMHOLDT AVE O Fire " SAC !540. C3U
- ~j3 Address Eng. Water Conn.
'0C W ci~ Bi;~'Ci+ phone 884-
3029 Planner Water Meter 63 . 9U
Council Road Unit 260 . 00
I hereby acknowledge that I have read this application and state ihat the gldg. Off. 1/14/8 Tr. PI. 132.00
infarmation is correct and agree to comply with all applicable State of
Minnesota Statutes and City of Eagan Ordinances. i. _ Var. PC Date Parks Copie
f
Signature of Permittee l a , . 00
Total
SUNStIINE CONSTRUCTZON CO
A Building Permit is issued to: on the express condition that
all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official
PwmN No. P~mN oldw Dab TNephons fl
Plumbfn9
H.V.A.C. • ~ ~g
EleeMe ` 3 f ~ p Qp S~y ~
SoRener
InapecHon Daq Imp. Commanb
Footings I
FooBngs 11
Foundatbn
Framiny I
Rootinq
Rouyh Plbp. a-1-7-14 / L
Rouph Fitq.
Insul.
FMe&ca
flnal Hty. H/2 ~
Final Plby.
&dp. Finsl
Cort.Occ. j ![J
Deek Fty.
Deek Frmy.
Wdl
Pr. Disp.
•---,r; ::d.:,:._~..~ . . ~
PERMIT#, CITY OF E/kGAN FEE
PlUMBING PERMIT
RECEIPT # 454-8100 S~~
Q MINIMUM RESIDENTIAL FEE - 510.00 +$.50 TOTAL
DATE f~~• MINIMUM COMMERCIAL FEE - $20.00 +$.50
1. Bldg. Type: Res ~ Comm Inst 2. New ~ Add Alter Repair
- 3. Total Bid Price 4. Job Address ~AA"'
Lot v Block ~ Sec 5. Owner
6. Contractor
(Name) ~ ~ ~ (SVeet) (City) (Zip)
7. Contractor Phone #
NO. FIXTURES NO. FIXTURES NO. FIXTURES
~ Water Closet - $3.00 ~ Laundry Tray - $3.00 -Well - $10.00
_-L-Bath Tubs - $3.00 FFloor Drains - $1.50 -Private Disp Syst - $10.00
~ Lavatory - $3.00 TWater Heater = $1.50 ~ Rough Openings w/o
~Shower - $3.00 TWhirtpool - $3.04 Fixtures - $1.50
ZKitchen Sink - $3.00 -Gas Piping Outlets - $1.50
-Urinal/8idet - $3.00 -Softener - $5.00
COMM./IND. RATE - iai6 OF TOTAL BID PRICE PLUS $•58 STATE SURCHARGE FOR EACH $7,000 OF FEE.
~
Signed: for
Appror+ed v Inspections: Date Rough Insp. Date Final Inap.
~ . ' .
PERMIT#• CITY OF EAGAN FEE °75~5 U
MECHANICAL PERMIT . ~ v
RECEIPT # 454-8100 S/C
MINIMUM RESIDENTIAL FEE - $10.00 + $.50 TOTAL
DATE /s MINIMUM COMMERCIAL FEE - $20.00 + $.50
1. Bldg. Type: Res ~ Comm Inst 2. New ~Add Alter Repair
3. Total Bid Price 4. Job Address /.3/4/ ~'~NG~QFST
Lot ~ Block Sec 1 5. Owner JuN~f~/E ( o.vsT.
9,N4 C017S-*yooD FOfN~Ar~~i~ -,5
6. Contractor ~R~?E-~ ~ 1176
(Name) (Streeq (Cky) (Zip)
7. Contractor Phone # 937' ' 0?579
RESIDENTIAL HEATING - 01-100,000 BTU's -$24.00. Each additional 50,000 BTU's or fraction -$6.00
RESIDENTIAL COOIING - 01-24,000 BTU's -$12.00. Each additional 6,000 BTU's or fraction -$6.00
MODIFICATIONS/ALTERATIONS -$10.00 minimum fee
V/ HEATING VENTILATING HOT WATER STEAM AIR COND.
" AIR PIPING PROCESSED PIPING AIR HAND. EQUIP. RtFRIG.
v RES. GAS PIPING OUTLETS -$1.50 TANKS: L.P. UNDERGROUND OTHER
COMM./IND. RATE - 1% O TOTAL BID PRICE PLUS $.50 STATE SURCHARGE FOR EACH $1,000 OF FEE.
Signed: 4,k~fk`~ for
Approved Inspections: Date Rough Insp.~Date Final Insp.
. . , .
' ' . CITY OF EAGAN 16407
! 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
` PHONE:454-8100
BUILDING PERMIT Receipt #
To be used for BA yE+Est. Value 1 + 500 oate M" 3 , 19 ~9
Site Address 1314 W'INDCF.E. A Vy
Lot Block 2 SeclSub. P"K OFFICE USE ONLY
PBfCBI NO. Occupancy - FEES
Zoning
W Name LI:IT3A ~E~,FV,tlSP7L1 4 *:ASiY i~IITE:'e (ActuapConst - BIdg.Permit ';F+•~~
o Address 1314 F' I"~T.~CRLST ~~l' L (Allowable) - 1. ~~C
Surcharge
City ~GWI Phone # or stories -
_ Pian Review
Length
, o Name 53TEIN=,1AND $l'ILDEBS Depcn sAC, city
olQ Address 2704 COIJNELLY CIR S.F.Total - SAC,MCwcc
~ City ~UMSYILI.L' Phone 895--5955 S.F.Footprints -
On Site Sewage _ Water Conn
~
W W Name On Site Well - Water Meter
z MWCC S stem -
4c Address y Acct. Deposit
a W City Phone city water -
PRV Required - S/W Permit
I hereby acknowlege that I have read this application and state that the Booster Pump - SiW Surcharge
information is correct and agree to comply with all applicable State of
Minnesota Statutes and City of Eagan Ordinances. Treatment PI
Signature of Permitee APPROVALS Road Unit
A Building Permit is issued to: ~~~~~T a AULIJER5 Planner - park Ded.
on the express condition that atl work shall be done in accordance with all Council
appiicable State ot Mmnesota Statutes and City of Eagan Ordinances. gldg. pf}. _ Copies '
BuildingOfficial Variance - TOTAL 37''~`
Permit No. Permit Holder Date 7elephone #
WATER
SEWER
.
PL';1NBING ~ (t~ I ~ ~ S 3 ~J
H.V.A.C.
ELECTRIC ~'J ~ y l~rJ
Inspection Date Insp. Comments
Footings I
Foundation
Framing
Roofing
Rough Plbg.
Rough Htg.
Isut Fireplace
N
final Htg.
I
FnalPlbg.
Const. Meter Plbg. Inspector- Notify Plumber
Engr./Pian
Bldg. Final Yl,) g ~ s
Deck Ftg.
Deck Final
Well
Pc Disp. '
' ' - PERMIT #
PLUMBING PERMIT RECEIPT #
CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: `
CONTRACT PRICE: PHONE: 454-8100
Site Address ' BLDG. TYPE WORK DESCRIPTION
Lot `Block Sec/Sub Res. New
Mult. Add-on
? Name Comm. Repair
.g Address - Other
c City Phone RES. PLBG. ONLY - COMPLETE THE FOLLOWINa:
NO. FIXTURES TOTAL
Name Water Closet - $3.00 $
` Bath Tubs - $3.00
3 Address Lavatory - $3.00
p City Phone Shower - $3.00
Kitchen Sink - $3.00
FEES Urinal/eidet - $3.00
COMM/IND FEE - 1°rb OF CONTRACT FEE Laundry Tray -$3.00
APT. BLDGS - COMM RATE APPLIES Floor Drains -$1.5o
TOWNHOUSE & CONDO - RES. RATE APPUES Water Heater -$1 50
MINIMUM - RESIDENTIAL FEE - $12.00 Whirlpool - $3.00
MINIMUM - COMM/IND FEE -$20.00 Gas Piping Outlets -$1.50
STATE SURCHRRGE PER PERMIT - .50 (MINIMUM - 1 PER PERMIT)
(ADD $.50 S/C IF PERMIT PRICE GOES SoRener -$5.00
BEYOND $1,000.00) Well - $10.00
Private Disp. - $10.00
Rough Openings - $1.50
SIGNATURE OF PERMITTEE + FEE:
STATE S/C: `
FOR: CITY OF EAGAN GRAND TOTAL• ' ~
CITY OF EAGAN Remarks b i v i s i on # 16252 10 / 85
Addition Birch Park Lot 3 Rlk 2 Parwl i~~~~ 030 02
Owner Street.~ ~ 14 kLi-ii-d4F-e 5t---11vA 5tate RaQ2„ LtN 5 S 1 23
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SANSEWTRUNK 97 162.96 .15 20 Paid rior to divis on
SEWER LATERAL 132.70 8.85 15 n it ii n n ~r
WATERMAIN
WATER LATERAL
WATER AREA
STORMSEWTRK 1018 198 750.48 50.03 15
STORM SEW LAT 1048 198 199.66 13 . 31 15
CURB & GUTTER
SIDEWALK
STREET LIGHT
Road Unit
WATER CONN. 500.00
BUILDING PER.
SAC 525 - 00
PARK
,GAN WATER SERVICE PERM
;noh Road • , ~ 7.,~011
ligg PERMIT N4.:
' Eegan, irlN 55121 LU ~ DATE: 1- 17-J ' r,
~ ~~c1 No. of Units:
' Zonirg: _
' pwner; Siinahin ronst
AWnm. Y
i
Sfte Nddrcss: 1 ? 1 4 c : . "
Plun+ber: ` t zr Y'1 U _ ~
500 Meter No.: 3(0 7 5~/ rqe: . ~
siza: ?0e 5 •EL ~r: 1.. . p
4 rm t Fee: 7_ 0. p
Reoder No.:
1 prN /o oow* rdNi dwridQ UWAs Surcharpe: 132. 50p
OrriMnaw AAlsc. Cho?Oes:
TotaL• F•3• 50pd meter •
1
gy Dote Poid: I
: Intp.: i
DotA'fI
.
I CITY OF EAGAN SEWER SERVICE PERMR
~ 3$30 Pilot Knob Road
P. O. Box 21199 PERMIT NO.:
Eagan, MN 55121 DATE:
~ Zoninp: No. of Units:
' Ownsr.
Address: - -
5its Addross: Plumber.
; I NrN }o ppir wNh !w Cilp ei toom Connectlon Chorga:
~ Or~n~neM. 1lccowit Daposit:
~ Petmif Fes: ~
Surcharoe:
gy Miac. CMrpsw
~ Dote of I nsp.: Total:
Insp,; Daft Pcid:
CITY OF EAGAN WATER SERVICE PERM
3$30 Pilot K;wb Road pERMIT NO.:
P. O. Box 21199
Eagan, MN 55721 DATEt
Zoninp: _ No. of Units:
Owner. -
Address:
SiN Addreas:
Plurr?ber:
Meter No.: Connectian Q?orye:
5ixe: Atcount Deposit:
Raader No.: Pertnit Fee:
1 prm M o0We0111 wi16 1iN Ci1r of byPw Surchorye:
Ordiwmam Mlac. CMrges:
Total:
BY Doft Pald:
Date of Insp.: I^sp•:
I
ihis request voRd 3-~4Q -B6 G 6 ~
nths fror(
LDT~91266 4
Raquest Oate Fire No. Rough-in Inspection
Reqwred?' ?Aeady Now-~Will Notity,~lnsoec-
C ~es ? N. ror When Ready
Licensed Elecvical Convactor 1 hereby requastinspection oi abova
? Owner electrical work installeA a[:
'aveet Address, B z or qoute No. Citv
L.e~~i~vr~c~Ps'7-
ecuon o. Townshio Name or No. Range No. County
rt (PflINT) Pha{~N
O Wv
Powg ^r Suo~P~~ier Adtlress
Elec ical Convactor ICOmpany Namel Convac nr's Lic se~o.
Mailf AdJress ICon[rector or Owner Makinp Instailatio
Author~ ture (Con[raclor/ w Making Instal tionl P umber
MINNESOTA STATE BOAPD OF ELECT0.ICITY THIS INSPECTION REQUEST WILL NOT
Grig9s-Mitlwey Bldg. - Room N-791 0E ACCEPTED BY THE STATE BOAND
UNIESS PPOPER INSPECTION FEE IS
1821 Univarsity Ave., St. Paul, MN 55104
Phone 16721 297-1111 ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION ' ee-ooom o
Sae instruetiens for campletina thie form on beck oiyellow co
PY C
fl~` X" Below Work Covered by This Request
. aaa Neo. Type ol 8u0din0 Appliantae wirea Equiument Wired
Home Range Temporary Service
Duplex Water Heater Ligh[in,y Fixtures
Apt. Building Dryer Electric Heatui
Commercial Bldy. Furnace Silo Unloeder
Industrial Bldg. Air Conditioner Bulk Milk Tdnk
Fafm Other peu v Clther ISUecifyl
t nr Succity Ot er Othur
ompute lnspectron Fee Below
' M Fee SarviceEnVanceSi:e p Fee Faednr s/5ubtexders N Fee Circuits '
0 to 200 qm s 0 to 30 qm S 0 tn 30 An? s
Above 200 qmps 31 to 100 Amps S= 31 to 100 Am s
Swimming Pool Above 100-Amps Above 100_P,mps
Transiormers Irrigation Booms Pdrtial•'Other Fee
Signs Special Inspection S~,a
--~c~y~ TOTAL FEE
Re~+arks t_~j' JC ^
J ~J
Rouqh-in 4afe
~ne Electrical
~ naDectoq hareby
certify thnt tt~e xbove
Final / r inspection has baen
~
v' ee.~-
ThisrepuesivolUlBmontasfmm - q Oo
12 aao9
6 8 z a 3~
Raquesl Date Fra No. Fough-In Inspeclion
Rep d7 ? Reetly Now ill NoHy Inspeclrn
b j igryes ? No When ReeCyT
I L'liicensed corrtractor ? owner hereby request inspection of above electrical work at:
Jc.4dtlress (SYraet, Box or Roule No.) Ciry
W t a.~ C/c.E>T- *•V EI g*j
SecGOn No. TawrShip Name or No. Ranga No. Coun
~ X~-t-A
OccupantfPflINT) Phone No.
L wo a ~-~LA~tiE2, 4s~ - Rt~fS"
P r Supplrer AAdress QI
Ele ricel Cantrec[or (COmpany Name) CorilradorS Licenee No.
~..P sz JELC-_ci)2tcal C. 6 -
me~r~q naaress ccomraao. a amer rnawna irewier
o,~ ss~~
38~c ~ ~ LSI
Aut)ori Sign ure (Can or r Making Ina~elletion) P~o e Number
~ L D - 49
S~
MINNESOTA STATE BOAHD OF EIECiNICffY THIS INSPECTION REQUEST WILL NOT
Griggs-1ANIxny Bltlg. - Raom S173 BE ACCEPTED BY7HE ST.4TE BOARD
7821 Unlveralry Ave., St. Paul, MN 56109 UNLESS PROPEH INSPECTIDNFEE IS
Phone (672) 692-0800 ENCLOSED.
REQUEST FOA'ELECTRICAL INSPECTION ~ EB-ODOOl-07
O ii~ See instrupiAns for comQleting ihis lortn an back o( yellow mpy. ~ry L~
~112 6 8 X° Below Work Cavered by This Request
Mevi Add ep. Typeofeuilding AppliancesWired EquipmentWired
Home Range Temporary Service
Duplax Water Hea[er Electric Heating
Apt Building Dryer Other (Specify)
Co./Industrial Furnace
Farmmm Air Conditioner 011rer (speciry) CanhacrorS Remerks:
Compute lnspection Fee Be/ow:
# Other Fee # ServiceEntranceSize Fee # Circuits/Feeders
Swimming Pool 0 to 200 Amps J-Z D to 100 Amps
Transformers Above 200 _ Amps A _ Amps
SIgOS Inspec[or4 Use Only: TOTAL
IrngationBOOms r?,.~ 3$-~
Special Inspecfion
AlarmlCommunication
Other Fee ~
I, the Electrical Inspector, hereby Rouqh-in
certifythat the above inspection has F;nei
been made. V
OFFICE USE ONLY
This requesl vad 18 months from
CITY OF EAGAN ~
~ 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55721 N- 11457
BUILDING PERMIT PHONE: 454-8100 Receipt p ~-~"c,~~
_
7obeusedlor SF DWG/GAR Est.Value $90,000 pate JANUARY 16 1986
SiteAddress 1314 WINDCREST AVE Erect C] Occupancy R3
Lot 3 Block 2 Sec/Sub. BIRCH PARK Remodel ? Zoning
Parcel No. fiepair ? Type of Const. V
Addition ? No. Stories
SUNSHINE CONSTRUCTION CO Move ? Length 4$
w Name Demolish ? Depth 44
o Address Int. Impr. ? Sq. Ft.
City ' Phone 431-2200 Install ?
a SAME Approvals Fees
o Name 403.00
013 Address Assessment Permit
~ City Phone Water&Sew. Surcharge 45.00
Police Plan Review 201.50
5W JAMES R. HILL 575.00
W Name
l~ Address 8200 HUMBOLDT AVE SO Fire SAC 500.00
Eng. Water Conn.
aw ~~Ty BLMTN phone $$4-3029 Planner WaterMeter 63.50
Council Road Unit 280.00
Iherebyacknowledqethatlhavereadthisapplicationand~tatethatthe gldg.Off. 1/14/86 Tr.R,~ 132.00
information is correct and agree to omply with all ap li ble Stat of
Minnesota Statutes and Ciry of g n Ordinances. APC PBrks > Var. Date Copies
Signature of Permittee TOtal ~ O
SUNS INE CONSTRUCTI CO
A Building Permit is issued to: on the express condition that
all work shall be done in accordance with ajl.a lic State of Minnes " d ity of Eagan Ordinances.
Building OHicial ~ - -
` CITY OF EAGAN N? 16407
~ 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
BUILDING PERMIT PHONE:454-8100 Receipt # G
~
To be used for BASEMENT Est. Value $1, 500 Date M&Y 3 .19 89
Site Address 1314 WINDCREST AVE
OFPICE USE ONLY
Lot 3 Block 2 Sec/Sub. BIRCH PARK
P8fC21 NO. Occupancy _ FEES
Zoning _
w Name LINDA SHAUSNU & MARY WITEN (AquaqConst - Bldg.Permit 36.00
; Address 1314 WINDCREST AVE (Allowa6le) - Surcharge 1.00
~ Cit Ep'r~ Phone # oi stories _
Y Lenqih _ Plan Review
o Name STEINWAND BUIL?ERS Depth . - SAC, City
o¢ Addf2ss 2204 CONNELLY CIR S.F.Total - SAC,MCwCC
~ City BURNSVILLE Phone 895-5955 S.F. Footprinls -
On Site Sewage - Water Conn
Name OnSiteWell - WaterMeter
ww
w
~ Addf25s MWCCSystem -
z
ai Cit Waler _ Acct. Deposit
aw City Phone Y
PRV fiequired - S/VJ Permit
I hereby acknowlege that I have read [his application and state that Ihe Boosler Pump - Sryy Surcharge
infortnation is correct and agree to comply with all applicable State of
Minnesola Statutes and City of Eagan OrdCes Treatmen[ PI
ture ot Permitee ,p.y~s ,.,.A J
Signa APPHOVALS RoatlUni[
A Building Permit is issued to: L' lA1QD BUIL.DLRS Planner - Park Ded.
on the express condition that all work shall be done in accordance with all Council - .50
applicable State of JM~innesota Statutes and Ciry ouf Eagan Ordinances. Bmg.Off. _ Copies
BuildingOfficial,J•~a~1 ~ oi.rk ~~T.ll Vanante - TOTAL 37.50
1377~
2007 RESIDENTIAL BUILDING PERMIT APPLICATION ~a ~sa 9
City Of Eagan 7~
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651,675-5675 FAX # 651-675-5694
NewConsWCtlonReauiremmis - Remo4eUReoairReauirement5 OffceU5e0nN
3 registered site surveys showing sg. ft. of lo[, sq. tt, of house; and all roofed areas 2 copies of plan showing (oo6ngs, beams, jas4s CeA of SurveqRecd _ Y_ N
(20%maximumlotcaverageallowed) 1 setofEnergyCalcula6onsfaheatedadditions SoilsReport _Y _N
7 Soils Repndrf praposed 6uiWing is to be placed on disimbed soil 1 site survey for addiUons 8 decks Tree Pres'Plan Recd _ Y_ N.
2 copies of plan showing 6eam 8 window sizes; poured found design, etc. Addifion - indicate il on,site sapbb system Tree-Pres-Requ'ued _ Y_ N
iselofEnergyCalculations . On-site5epticSystem _Y _N
3 copies of Tree PreservaUOn Plan if lot platted after 711193 _
Rim Joist Detail Options selection sheet (buildings wiN 3 or leu uniLS)
Minnegasco mechanical ven6latlon form
Pfans are considered ublic information unless ou state the are trade secret and the reason.
ec
Date / / Construction Cost v~/, OL~O ?
Site Address 13 tLi Lc) e :5c P~,.? cz UnidSte k
Description of Work iVD Cb+.pS ~ .
Multi-Family Bldg _ YN Fireplace(s) _ 0 _ 1 _ 2
Praper[yOwner Telephone#( )
' LAKEWOODS REMODELING, INC. i
Contractor 9007 E. Bloomington Freeway !
Address Suite 144 Ci
j tY
gloomington, MN 55420 I
State - Telephane # (~'f3) ~S S Zi
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Enefgy Code Category , Residential Ventilatian Category 1 Worksheet . New Energy Code Worksheet
(d submission type) Submitted Submitted
• Energy Envelope Calculatlons Submitted In the last 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 masier plan:
Licensed Plumber [E (C-y ~ Telephone J
rL, I` LI
Mechanical Contractor \ Telephone )
Sewer/Water Con}ractor m
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
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
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122 Cq o~
851-661-4675
NewConshuctlon NeauhemeMe RemotleVtieoalr Bequlremente
• 3 registered ske surveys showing sq. fl. of bt, sq. H. ol house; and aII roofed arees • 2 copies of Dlan
(20%ma)timumblmvemgealbwed) • 1 setofEnergyCakulatbnslorheate0atltlrtwns
. 2 copies of plan showing beam & window sizes; poured Pound design, etc.) • 1 stte survey lor exlerior addfflons & tlacks
• 1 sat of Energy Cakulatbns • Indicate it hane served hy septic system for add'Abns
• 3 ooDles W Tree Preservstbn Plan M lot pletletl atler 711/93
• Rim JoW Detail Options seledbn sheet (blUgs wdh 3 or less unAS)
DATE ~ -,,_L~ - C7 a VALUATION r__~41o 29, 2V
SITE ADDRESS /I/y (,/r rI . o c~ p MULTI-FAMILY BLDG _ Y viV
TYPE OF WORK d1d(ACII FIREPLACE(S) 1_ 2
APPLICANT
STREET ADDRESS ! 1 , AV-S CINfc-~jk?&kii2 nP STAiE ~Il ZIP i~D'2%5/
TELEPHONE# 9t9-821-523.2 C LLPHONE# FAX# 910-R4'I-rS~SII
PROPERT1fOWNER~ 14n-~ l'o%`Pkg TELEPHONE#~S~-y~y
COMPLETE THIS SECTION FOR -NEW- RESIDENTIAL BUILDINGS ONLY
Energy Cade Category _ MINNESOTA RULES 7670 CATEGORY 1 MINNq_S! 72 ;
(d submission rype) • Residential Ventilation Cetegory 1 Worksheet Submitted • New Erfergy,C o@heet Submitted
. Energy Ernelope Celculations Submitted i~ pUG 2 6 2002
Plumbing Conhactor: Phone #
Plumbing system includes: _ Water Softener _ Lawn Sprinkler =~90:00'
Water Heater No. of R.I. Baths
No. of Baths
Mechanical Conhacfor: Phone #
Mechanical system includes: _ Air Conditioning Fee: $70.00
_ Heat Recovery System
Sewer/Water Contractor. Phone #
I hereby acknowledge that I have read this application, state ihat fhe information is correct and agree to compiy
with all applicable State of Minnesota Statutes and City of Eagan Ordlnan es. ~
Signature of Applicani(\\1DJ(,,I QL~ s
OFFICE USE ONLY
Certiflcates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4/02
OFFICE USE ONLY
? 01 Foundation ? 07 OSplex 0 13 16plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling 0 08 06-plex ? 16 Fireplace O 21 Porch (3sea.) ? 31 Ext. Alt - Multi
O 03 Ot of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4sea.) O 33 Ext. Att - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multi
? 05 03-plex ? 11 10-plex ? 19 Lower Level O 24 Storm Damage
? 06 04plex ? 12 12-plex Plbg_Yor_N O 25 Miscellaneous
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. O 42 Demolish (FOUndation) ? 45 Fire Repair
0 33 Alteration ? 37 Demolish (Bldg)` ? 43 Reroof 0 46 Windows/Doors
? 34 Replacement •Demolkion (EMire Bldg only) - Give PCA handout to applicant
Valuatlon Occupancy MC/ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const W idth
REQUIRED INSPECTIONS
_ Footings (new bldg) Final/C.O.
_ Footlngs (deck) Final/No C.O.
_ Footings (addition) _ Plumbing
_ Foundauon HVAC
_ Drain Tile Other
Roof _ Ice& Water _ Final _ Pool _ Ftgs _ AirlGas Tests _ Final
_ Framing _ Siding Stucco Stone
_ F'ueplace _ R.I. _ Air Test _ Final _ Windows (new/replacement)
_ Insulation _ Retaining Wall
Approved By , Bu(Iding Inspector
-
Base Fee 135/9. af~
Surcharge 00
Plan Review
MC/ES SAC
City SAC
Water Supply 8 Storage
S&W Perrnit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total Q ,
. Y k 11457 '
1985 BUILDING PERMIT APPLICATION - CITY OF EAGAN
NOTE: ALL CONTRACTORS kUST BE LICENSED WITH THE CITY OF EAGAN
INCLl1DE 2 SETS OF PLANS
3 CERTIFICATES OF SURVEY
- 1 SET OF ENERGY CALCULATIONS
To Be Used For• e' Valuation: 900OC) Date: ~(p
Site Address: OFFICE USE ONLY
Lot: ~ Block~ Sect/Sub~_~~'/!~ ect Y\ Occupancy J~_3
Remodel Zoning
Parcel ll Repair _ Type of Const ~
- Enlarge II of Stories
Owner f Move _ Length ~W8
j Demolish Depth ~cr
Address~ Grade Sq Ft
City/Zip Cod ~ -
Phone 9PPROYALS
i
Contractor C(_ jf ~e Assessments Permit 403,
Water/Sewer _ Surcharge 4 5,
Address Police Plan Review SO
2DI"-
Fire SAC 42Ws 7Sl
City/Zip Code Engr Water Conn S o0,
Planner Water Meter p j S°
Phone Council oad Unit ZSO.
) Bldg Off` - Parks
Arch./Engr. / APC Treatment P1
~ VAriance
Address
, 4
, J - TOTAL
City/Zip Code
Phone Il
c~
, 45-30+
.:201050+
_75°:10+
5~C°10+
63°50+
280°20+
132°;;0+
~`CJ
'e2.:.:^~OT
. ,
Z Z ~c 22- ~
C~
IZ0
~ 4 x 3a ^ s~2 x 4~ ~ 2~¢08
SURVEYOR'S' CERTIFICATE SIENNA CORPORATION
[IENOTES PROPOSED SURFACE DRAINAGE
O DENOTES IRON HONUPIENT SET SCALE: 1 INCH = 30 FEET
• DENOTES IRON M0NUMENT FOUND PROPOSED GARAGE FLOOR = 890•3 FEET
X000.0 DENOTES EXISTING ELEVATION • PROPOSED LOWEST FLOOR = g82-6 FEET
(000.0) DENOTES PROPOSED ELEVATION • PROP05ED TOP OF BLOCK = 890'~ FEET
NOTE: TNE LEGAL DESCRIPTION SHOWN HEREON WILL BECOME VALIb
UPON FILING THE PLAT OF BIRGH RARK•.,.
WE HEREBY CERTIFY TQ SIENNI4 CORPORATION THAT THIS IS A TRUE AND CORRECT REPRESENTATION
OF A SURVEY OF THE BOUNDARIES OF:
Lot 3, Block y,BIRCH PAP.K, accorcir, to the
recorded plat thereof, Dakota County, innesota.
IT DOES NOT PURPORT TO SHOW IMPROVEMENTS OR'ENCROACHMENTS; TF ANY. AS SURVEYED BY ME
OR UNDER MY DIRECT SUPERVISION THIS 239-0 DAY OF ocT015a9- ~ 19S5,-.
SIGNED: JAMES R. NILL, INC.
BY:
/ f N ~ ~ ~
ROLD C. PETERSDN, LAND SURVEYOR
MINNESOTA LICENSE NUMBER 12294
APPROVED FOR SIENNA
. CORPORATION .
BY:
DATED THIS DAY OF~
19_.
QEV I-8'8!o F6~
~JuNSl11NE C.oaS~.
SHEET 1 OF 2 SHEETS
PROJECT NO. BOOK / PAGE JAMES R. HILL, INC. -
84762 ,
:q 34/(,4 Planners / Engineers / Surveyors
FiLE NO. 8200 Numbotdt Avenuo South
FOL DER Bloomington, Mn. 55431 812-884-3029
-SURVEYOR'S CERTIFtCATE sIErvNA CORPORATION
*ggb.o 881, o
WINDCREST AVENUE '
•r• 4.0 'R= 1412.39 o
~
S87036'12'~E ° x'Ga°1 *41 '25'X
2245 ; 41.67
- -
. ~
o ~
~
b
m S n M
. ~ '
~ i 22.00 I ~
A \
4 \p I ~
r h b~6AR.
M l4.00 l2.00 (690•O~ °p M
a / o(B9oo M\ \v\4. 0 I a
P I <<q / PROPOS£D~
2.00`HOUSE \Q 13 I Nj I .
\ I \ a `A I /
36.00
• I /X~8$z.3) (88z•3 \ T,
C\j W qQi
m =
a o ~
~o I pN
N
i N N I I N o
ro i
I I I" LJ
I J I LOT 3 LI
~ I
I I
ORASINAGE 9PERUTfLlTY ' S EAEMEN7 PLA~ 5 1
~ o 0 ~
70.74
N B9'49'13" W ! -
ni r,\iN r-D r-
I V L l I-1 ~r~L~r~i
V I/l~ LJ1 I I0IV
1ZEV 1-S-g~ F02
Sur15N~~~ GoNS"T•
• SHEET 2 OF 2 SHEETS
PAOJECT NO., BOOK / PAGE JAMES R. MILL, INC.
84762 Pianners / Engineers / Surveyors
FlLE N0. 8200 Humboldl Avenue 6outh ,
FOLDER eloomineton,Mn. 55431 E12-884-3029
CITY OF BUILDIN(3 DEPARTi•iENT
EXTERIQR ENVFI,OPE AVERAGE IIUII C014PUTATION
. ~(To be submitted tivlth building permit application)
One or Two Family Dwelling Owner
/lll Other Sfte Addresa
Contractor ~o1JSr Date Phone
LINEAL FEET OF
EXPOSED WALL L-1-)e1pt_ ft, ahove grade
TOTAL EXPOSED VYALL AREA SQ. FT.
OPAqUE WALL CONSTRUCTION: "U" Value x Area
Detail-: "u " •e,43 x SQ. FT. 2544-lO. D.Cv (U) (A)
reference itUll •098 x Sq. FT. ZoZ.SZ.-= 19.8+ (U)(A)
from "U~~ .04,~9 x SQ. FT. 158.4/O= /0.35~U)(A)
attached ~~U~~ x &Q. FT. _ (U) W
sheeta npn x SQ. FT. ~ (U) l+tJ
ti7INDONS: "Ull Value x Are.a
Ptake & Type l.vsvc., c+,-1111T, 'lull . 45 x sQ. FT. z45.9 o (u) (p),
11 n nu° x SQ. FT. - (U)(A)
n n nUII x SQ. FT. - (U)(A)
u u upn _
, x SQ. FT. _ (U)(A)
DOORS: "Ull Value x Area
t•Ia;ce & Type ~re-- lk uy, x SQ. FT. 49.00 ~ (p.$(p (U)(p)
n u _ pA-nn npn .47 x SQ. FT. j54-,00 = 39 (U)(A)
n n nUu x SQ. FT. - (U)(fl)
x S@. FT. - (U)(A)
ToTnLS 3387•9-8 Sq. F'T. 2qlo.$l (U)(A)
AVERA4E 'fUll
TOTAL (U)(A) VALUES
DIVIDED BY TOTAL 1'lALL AREA 33 '~a7
89•Q-8
AVERAaE IIU`r less for 1&2 family dwellinge
ROOF/CEILINa:
TOTAL AREA: JI7~D ~
Detail reference IIUft •OZ.?j x S. FT. ,
Q 1176O = Z7 04 (u)(a)
from IIUII x SQ. FT, : (U) (A)
attached sheeta. loUll x SQ. FT. _ (U)(A)
Describe onenings olUit x SQ. FT. _ (U)(A)
in roof. °Ull x SQ. FT. _ (U)(A)
TOTAL, (U) (A) VALUES DIVIDED BY . 7,7,a4, _ I~Ot bf7 i_ 27. `V
TOTAL ROOF/CEI za nREn //7~ . oz 3.
AVERAC3E ~'U~~~ roofa. ^
r ventilAtad
,
GRv~S EXt~`~D tJ~c.U
/8-33 x(.~~so f zs+ze) = z859- g8
x 54 = 4~Z,oo
7a6? x (7+7~
,697xC5 O¢SDi-Lgt2e)) _ sz
7 00 X ( 7 t7~ = 9Sia~
~f~ So~ST
I•ldv X (5otso+zS+ZB~ Zs8,9lo
Wrluows ?
llvx~(o= 9'.o X Z= S.op
Zoxgc~= 5,0 X J?~ = Ac~q.oo
ZoX487 = 6•7 X 9 = &o,3o
Z4x`F5 = B•ox 49 = 48,00
Z4x3~ ~.o x Z - J2,oo .
Zo x6av 8,~. X 4= 33, ~o ,
~t8 n l~,z = 94,o x I= 44,00
ZgS,9o 4..
~
3~ 57~, y~~s,c. = z8.oo Z~ S7ZtiFR. ~ Zl,vo ~~7 ~ c~
PA-TlaC.z.
ri ArM Z58.9[0
x f~a ~ ~3 ~ w~w'~ Z9~,qp - ~-o. 3g
14 X Zo = xSo Dao1~'~ 133,00
Z549• I o~
llJ~.oo
Determining "U" values at Roof# Walls 221mg and Conc. Bloclc
. I
_ ROOF/CEILIN4 R VALUE
S
1.) Interior Air 2'i1m 0.61
. 2.) 5/81, aYn. sa. .56
3.) Insulation 40,00
4.!
50 Extierior Air F11m .61
(STILL)
. ~n uUu = 1/R= .OZ3 '1'OTAL (R)=11.7$
l °
• ~ WALL R VALUE
6.) Interior Air Film 0.68
~ 7.) 1" (3YP. Bd. .45
8.) Insulation 14.00
• 9. ) 8wt.?- RITe- Z.04
10.) Maeonite Siding .67
to it.) Exterior Air Film .17
IIpII = 1/R=•. .0Q.3 TOTAL (R)= Z3.01
RI14 R VALUE
. ~
12.) Interior Air Film o.68
1=~ ~ 13.) Insulation 19.00
14.) 211 Fir Rim Joist 1.88
' 15 15•) J~vtl.T-P-iTE Z•o4
16.) Masonite siding .67
17:) Exterior Air Film .17
. o
, • . . nUn = IIR= .Ocr.O TOTAL (R)= ZQ.¢¢'
O° po ~
D. FOUtIDATION r JR VALUE
18.) Interior Air Film 0.68
j8 19.)
20.)
21.) 12" Concrete Block 1.28
. . a zz. )&?P 1dwC., 9,00
z3 '17 23.) xtierior Air Film .17
e
L)' IOpll = 1/R= •pq8 TOTAL ~R1= IO.~~a
,
1989 BIIILDING PEBMIT APPLICATION - CITY OF EAGAN
SINGLE FAMILY DWELLINGS I~ 1 O1
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS
NOTEs ADDRESSFS FOR CORNER LOTS - CO1PfR6CTOR/HOMEOWNER MOST DESIGNATE WHICH ADDRESS
IS DFSIRED. NO CHANGFS WILL BE ALLOWED ONCE BIIZLDING PERMIT I3 ISSOED.
MITI.TIPLE DWELLINGS RENT9L IINITS FOR SALfi IINITS # OF UNITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SIIRVEY - CHECS F1ITH BLDG. DEPT.v 1 SET OF ENERGY
CALCULATIONS
CONII+IERCIAL
INCLUDE 2 SETS OF ARCHITECTIIRAL & STRIICTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCUL9TION5
~J
~K
To Be Used F -~ZLi~L' ' --Gt2G~V luatiom ?P)p Date:
Site Address OFFICE O.SE ONLY
7
Lot ~Bloek ~ Occupancy FE63
Zoning
Parcel/Sub ~jI Actual Const Bldg. Permit
/ n Allowable Surcharge
Owne of stories Plan Review
" "'S~ ength SAC, City
Address Depth SAC, MWCC
S.F. Total Water Conn
City/Zip Code~~'~ Footprint S.F. Water Meter
Aect. Deposit
Phone On site sevage_ S/W Permit
c_. On site well S/W Sureharge
Contractor ~ ~ MWCC System _ Treatment P1.
City water _ Road Unit
Address 8' PRV required _ Park Ded.
C;Ia
2 Booster Pump _ Copies •
City/Zip Code TOT9L
APPRDDALS
Phone ~ f,S S y~s~ Planner _
Council
-Ar_eh rfEngr ; Bldg. Of f .
Variance
Address
City/Zip Code -
Phone # NOTE: 3ewer & Water Permit fees and account depoait fees rrill be ineluded in the building
permit fee. Processing time for sewer and srater permits ia two daqs once a licensed
plumber has applied for a permit at Citq Hall.
,
CITY or• EArnN
APPLICATIOiI FOR PfifLMZT
SG[dER AND/OR WATfiR CONNECTIOLd
(P EASE PS1NT)
it p=_-~-•
r~~•`ir'?~`;: -
(r.,ot/~i k/subdi isi n r a< Parcel I.D. Nimiber)
5'_'.i:C=, D= GP CRIGi 7}1I. BiiILDL-;G ?EFMST ISS*U?.NC^•.:
F_5~- =~`~T:b~/`>"',",FC.~-•c~ i~~: R-1 S11iGLEE PPNSLY
~ R-2 GUPLEX (rA%*O-ULNITS)
? R-3 RGvN-IIX:SE (7'FRE'" + IJNITS)
? R-4 RpARMENT/G,rniIIJQ~1'1.11IL.~'1 ( L•.--~;
? CCY•RIERCIAL/RETAII,/OFFICE
? I~i'DCSTRIAL
? INSTI'SUTIONAL/GOVEI`Nf"ff:NT
Z) (PLEOSE P :li)
NA:~:
PLDF2E55:
C^_^_'. STnTE. ZI?: ~ r
PHG`IE: '
3) EASE PNItl1) Fo' : -JSE O9! Y
, - ~:P.•lE: ~ J
-
Pll iya,-,,
ADG?r.cS: (i i .l. 1' ,.c:::•
C'STi+Tc. ZIP:
%iY•TM0 ~n~. S't5/2o ~~-f-_~-- ~ecord
PFiG.VE: / PLUMBER LICENSE q
. nt c:aL
(Pl AS ~PRINt !J~
4)
tu~;•tE: ` V"
ADDRESS:
CT_'r_'. ST.^,':G, ZIP: .
PfiO.`M:
5) S•1-ri?C:3 PE::•lIT IS IIGILNG F2EQUESTL•D:
Q C0NNGC:I0N 'Ib CITY SD7II2
Qk CC^^IEC.TICN TO CITl' IJIITER
~ UI1".3? (['T.P11SE DGSCFLLL'E)
p P~E7,Sr, l:orn APPr>.wm PWuT roR PzcK-crn eY orre or
? ?Lr.-LSr :?lIL d1PPA0\T[D PEfZ•LIT'IO 1,2 4 APA'rE
(Circle one)
DATE:
~
. ~~lE~alalEA.. . . . -
.r~ A1 ~R ~e~:af:nn ss ar7 w:~s:~.~ 1R toi ~ r:ss:a n.~ a P[ Ia A.r.s:wAl~-lw.4p A aa s a rsa
'
FnP, C i TY US B ONT Y a
• ~ _
, p=-'-•-- _ ISSO?iD
~ .
._°_S: SE::Enro~irL (I.IC:.::D: SGRCFii?.=
S (dSU WATE? PERP1IT (INCLUDE SURCY.nRGE)
WATER METER/COPPERHORN/OUTSID=- F.E...,Z_.
5 WATEP. T_r1P (INCiUDE CORPORATZC"' c^^";
S S°:'IED TzD
$ ACCOUNT DEPOS IT - SES•7ER
$ lS-ACCOUNT DEPOSIT - WATER
$ SUU.o u WAC
' $ S"~7S ~ u ~SAC
S TRUNK !JATE.°, ASSESShSE:IT
$ TRUNK SEWER ASSESSMENT
S LATE°.AL BENEFIT/TRIINK SE[dER
, $ ~ LATERAL BENEFIT/TRU K T4ATER
OTHER
' $ TOTAL . .
AAIOUNT PAID/RECEIPT # j
D0~5 f.'TILITY CODIPIECTION REQUIRE EXCAVATION IN PUBLIC RIGiiT OF WAY?
~ C Y7S IF YES, THEN A"'PERMIT.FOR WORK WITHIN
PUDLIC ROADWAY" MUST SE ISSUED BY THE
~ C:O ENGINEERING DIVISION. LIST AS A CONDI-
TION. •
_ SZ2-::_°C7 TO TIiE FOLLO'.•IING CO'NDITIONS:
n??::0'JED .°.Y: °
T. ^ i Y
• • E i
D:,Tz :
4
ra a a ?q W ?4 90:A wl+ §l.w wt10
w ~J~1 R+~ !F ~wle ar+ ~+a rt o w w 1~
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA113033
Date Issued:08/28/2013
Permit Category:ePermit
Site Address: 1314 Windcrest Ave
Lot:3 Block: 2 Addition: Birch Park
PID:10-14175-02-030
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.
Craig Angell
12253 Nicollet Ave. S.
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 -
Margarita Shkurko
1314 Windcrest Ave
Eagan MN 55123--147
Angell Aire
12253 Nicollet Ave S
Burnsville MN 55337
(952) 746-5200
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA158065
Date Issued:09/24/2019
Permit Category:ePermit
Site Address: 1314 Windcrest Ave
Lot:3 Block: 2 Addition: Birch Park
PID:10-14175-02-030
Use:
Description:
Sub Type:Windows/Doors
Work Type:Overhead Garage Door
Description:
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, 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 -
Margarita Shkurko
1314 Windcrest Ave
Eagan MN 55123--147
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA159354
Date Issued:12/11/2019
Permit Category:ePermit
Site Address: 1314 Windcrest Ave
Lot:3 Block: 2 Addition: Birch Park
PID:10-14175-02-030
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
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
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 -
Margarita Shkurko
1314 Windcrest Ave
Eagan MN 55123--147
Zen Windows Twin Cities Inc
32097 Hedgehog St NW
Princeton MN 55337-1
(763) 286-6871
Applicant/Permitee: Signature Issued By: Signature