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3742 Windtree Dr ~ ~•;r• i f~ Date: CITY OF EAGAN Permit No: Date: 2'- `3 ~ ~ 3830 Pilot Knob Road B/P No: P.O. 130 21149 ? ~ Eagan, MN 55121 bwner. Joe Miiler Cranst. $tn ~ Site Address: 3742 `~~~`tree Iirive L12 B2 Wi~''~~rx`=e , Plumber: veth P2umbi.rtg ~ ~ ~ ' MWCC: ° ~0Pd Zoning. 5 ~ I. City Chg: •,pc No. of Units: 2.5. Ut?pd ~ ~ Acct. Dep: I agree to comply with the City of Eagan ; ' ; Permit Fee: 10.00pd Ordinances. ' i Surcharge: ~ Misc.: By i ; SEWER SERVICE PERMIT ; ' CITY OF EAGAN Permit No: Date: 3830 Ptlot Knob Road Meter No: Size: i ' P.O. Bti~,21199 Reader No: Date: Eagan, MN 55121 ' Owner. 3oe ?:iller CcsLst. Site Address: 3742 Windtree Dsive i.12 B2 wW3ndt ee "th, ' Plumber ' ~ ~ 5 . 4apd Zoning: ~`1 Conn. Chg: ~ Acct. Dep: 15 00pd No. of Units: Permit Fee: LU t'~3L4 ' Surcharge: 50pd I agree to comply with the City of Eagan ' Tr. Plant 180 0flpd Ordinances. Meter. 67 Qo 4 Misc.: By ; WATER SERVICE PERMIT ~ - - . ~8 Date: 1'g`88 CITY OF EAG~I Permit No: 93~ ~ 3830 PIIoCKhob Road Meter No:.;3f7 drZZ-'U Size: -~g , P.O. "1~'~ Reader No: Date:~-~-,9= ; Eagan, MN 55121 , Owner. Joe r'tiller Const. ' Site Address: 3742 tJindtree 'Drive L12 B2 Wir.dtree 8th Plumber. P13 rn Conn. Chg: 525.00 d 1~}~~~II{t1P.S Rl 1C. r OIB C 11 1 Acct Dep: 1~ 1%03t~ ' Permit Fee: 10 Ot~6~ . - - 6~~pIY with the City ot Eagan ' Surcharge: • 5 116)L~1~,s Tr. Plant 180 0 Ordinancess. Meter. 5~T99F~ ~ Misc.: By ' WATER SERVICE PERMIT _ ~ r, CITY OF EAOAN Permit No: 7047,' Date: `-8-$8 3830 Pilot iCnob Road B/ P No: `;6 Date:- - k 2-227~' P.O. Pa 2i 199 Eagan, MN 55121 Owner. "_iller SiteAddress. 31 . Cdi l ve a.82 Plumber: Plym°'`'t. ~~4~15-~ r~~ " 525,`;~;~;*i~'?;>'iE-t`=." 't . , MWCC: ' . . . _ { City Chg: No. of Units: k Acct Dep: l5 KirpNK I agree to comply with the City of Eayan E Permit Fee: Ordinances. ~ i Surcharge: - , } Misc.: BY -1 I f SEWER SERVICE PERMIT CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHON E: 454-8100 BUILDING PERMIT Receipt # ` 7 To be used for SF DWG/GAR Est. Value ;89+()('() Date DE~EPMEK 21 ,19 87 Site Address 3742 WINDTRBE DR OFFICE USE ONLY On Site Sewa Occupancy R 3 Lot 12 Block 2 Sec/Sub. WINdTREE 8YH 9e MWCC System x Zoning Parcel No. Vn On Site Well (Actual) Const ac Name iox MILLER CONST City Water x (Allowable) Yn z Address 18133 CEDAR AVE: PRV Required # of Stories 0 City ~~~~NCTON PhOne 431-2001 Booster Pump Length 70 Depth 30.33 °Co Name S4kME S.F. Total , ~ ~ Address t Footprint S.F. I' City Phone APPROVALS FEES , W. Engr./Assess. Permit ~ 465.00 uW W Name 44.50 = Z AddfesS Planner Surcharge a W City Phone Council Plan Review 232• 50+ Bldg. Off. SAC, City I00•UU I hereby acknowledge that I have read this apptication and state that the Variance SAC, MWCC 525 • C~ information is correct and-agree to compty with all applicable State of Water Conn. 525.00 Minnopota Statutes and City of Eagan Ordinances. Water Meter 67.00. Signature of Permitte Road Unit 30.00 A Builclljng Permit is issued to: JOE MILLER CUNS7 Treatment P1 180•00 on thelxpress condition that all workshall be done in accordance with all applicable State of Minnesota Stakite 1 nd City of Eagan Ordinances. TOParks TAL 12,444.00 Building Official ~`t . , . . T.,~. . . . ti_ _ . _ _ _ _ _ _ _ • _ . ~ • ` ' CITY OF EAGAN ~ r 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PH O N E: 454-$100 BUILDING PERMIT Receipt ~ /fo be used for Est. Value Date ' ,19 Site Address OFFICE USE ONLY • ` ' ' ~ • On Sfte Sewape Occupency Lot 81oCk SeC/Sub. ; MWCC System Zoniny Parcel No. On Site Well (Actuel) Const c Name City Wate? (Allowable) " i , PRV Required ~k of Storles o Addfess City Phone Booster Pump Length Depth ' ¢ Name S.F. Total o ~ ~ Address Footprint S.F. _ ~ City Phone APPROVAL8 FEES ~ W EngrJAssess. Permit - Name ~ Z Planner Surcharge Address a= City PhOne Council Plan Review < Bldg. Off. SAC. City I hereby acknowledge that I have read this application and state that the Variance SAC, MWCC information is Correct and agree to comply with all applicable State af Water Conn. Minnesota Statutes and City of Eagan Ordinances. Water Meter Signature of Permittee Fioad Unit A Building Permit is issued to: Treatment P1 ~ on the express condition that all work shal I be done in accordance with all ParkB applicable State of Minnesota Statutes and City of Eagan Ordinances. TOTAL Building Offfcial _ Permit No. Pwmit NoldK Osft TeIephone i~ Plumbing ' /ay , H.V.AC. y ~ i Electric 919 8 ~c.I? Softener InspecHon Date Insp. Commonb Footir?gs I Footings II Foundation Framinq ROOfing r,, ~ r ~p~-,N S Rough Plbp. Rough Htg. Isul. E f} . Fireplace Final Htg. 3 r~ Final Plbq. Bldg. Final Cert Occ. Temp. LP Deck Ftg. Deck Final Well Pr. Diap. . _ , il PLUMBIN(i PERMIT PERMIT ~U SD CITY OF EAGAN RECEIPT 1t 3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: ~~~7"? CONTRACT PRICE PHDNE: 454-8100 Site Ad ress 'ti BLDG. TYPE WORK DESCRIPTION Lot 81ock ~ Sec/ ub Res. ~ New ~ ~ Mult. Add-on ~ Name ^ Comm. Repair ~ Address Other c City ~ Phone ' RES. PLBG. ONLY - COMPLETE THE FOLLOWING: N07 FIXTURES TOTA Name ~`Water Closet - $3.00 ; Addf ~ Bath Tubs - $3.00 lavatory - $3.00 - o Phone J'/31-.1 Oo / Shower - $3.00 ~ iKitcheh Sink - $3.00 FEES ,Urinal/Bidet - $3.00 COMM/IND FEE - 1% OF CONTRACT FEE Laundry Tray -$3.00 APT. BLDGS - COMM RATE APPLIES Floor Drains -$1.50 TOWNHOUSE & CONDO - RES. RATE APPLIES Water Heater -$1 50 MINIMUM - RESIDENTIAL FEE -$12.00 Whirlpool -$3 00 MINIMUM - COMM/IND FEE -$20.00 =Gas Piping Outlets -$1.50 S STATE SURCHARGE PER PERMIT - .50 (MINIMUM - 1 PER PERMIT) (ADD $.50 S/C IF PERMIT PRICE GOES Softener -$5.00 BEYOND $1,000.00) Well - $10.00 Private Disp. - $10.00 =Rough Openings - $1.50 5 SIGNATURE OF PERMITTEE FEE: 33• ,'U STATE S/C: FOR: CITY OF EAGAN GHAND TOTAL• ~ - - - •K~y,.r'r~ i.... . ~.e - s.t,,~'.i~~~: i t ~ a~y.ar +K~., ~ . ~ / ~ . : . - PERMIT # ' MECHANICAL PERMIT • ' CITY OF EAGAN RECEIPT # 3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: CONTRACT PRICE: PHOHE: 454-8100 Site Address " J BLDG. TYpE WORK DESCRIPTION LotBlock Sec/Sub Res. New ~ Mult Add-on Name ~i- m ~ Address Comm. Repair c City hone , - ° Other Name V C 0-100 M BTUE~ - a24.00 3 Address ADDITIONAL 50 M BTU - 8.00 p City Phone (RES. HVAC INCLUDES A/C ON NEW CONSTRUCTION) GA$ OUTLETS (MINIMUM_- 1 PEA PEqMIT) - 1.50 EA. TYPE OF WORK ~ COMM/IND FEE - 196 OF CONTRACT FEE Forced Air ~~W1 gTU 1 APT. BLDGS. - COMM. RATE APPLIES TOWNHOUSE & CONDOS - RES. RATE APPLIES Boiler M BTU MINIMUM RESIDENTIAL FEE - ALL ADD-ON 8 Unit Heater M BTU REMODELS - 12.00 Air Cond. M BTU MINIMUM COMMERCIAL FEE - 20.00 STATE SURCHARGE PER PERMIT - .50 Vent CFM (ADD $.50 S1C IF PERMIT PRICE GOES Gas Piping OuUets tl BEYOND $1,000) Other FEE 5/C: SIGNATURE OF PERMITTEE TOTAL• "f'{ L-L 1 FOR: CITY OF EAGAN _ a . . .s fItxtif ira#P nf Mrrupanry titp of Cagan pppwbmtif Df %Ottlg jwPtftDtt Thrs Certtf icate issued pursuant ro the requirements ojSectiott 306 of tlre Uniform BuiJding Code certifying that at the time of rssuance this structure wns !n compliance with the various ordinances ojdie City regulaling building construction or use. For the foqowrng: c~e a..idaooo sF D4JG/cAR Famit rb. 135 14 oW,P.aq ,pa R3 zo" aw~n xI .,pa cwm vn o,,,. d B.16, .RJE MILiM OCi+6'T Addma 18133 MM A~vF , FAt~ff= BmUMAddrm 3742 WIPIDTM IIRMPE i,OMMY Lt2, B2. WIAQJIM 811i o.a: MARM 4. 19R~ w1ding Official POST IN A CONSPICUOUS PLACE ~ CASH RECEIPT ~ " CITY OF EAGAN 3830 PILOT KNOB ROAD EAGAN, WldNESOTA 55122 DATE ' ~ u f9~ RiCi1ViD 'AMOUNT $ y~;,r, I L l ! DOLLARt ~oe ? CASH [a'CHECK ~ ¦ ow ..~C.-•l 11 c- ` ' ~ ~ rVN COD6 AMOUHT Thank You A er- ll white_Paver: coay Yellow-Pottinq Capy Pink-File Copy L BLDG.'PERMIT N0. 01-3210 Bldg. Permit 01-3422 Plan Check 60 ~ 01-3445 Surch.lAdm. 01-3446 SAC/Adm. 01-2155 Surcharge 17-3860 Road Unit 2-gr2275 SAC i 20-3865 Water Conn. ft-3858 Water Trmt. 20-3716 4:ater Meter ' - - ~ 20-2252 Acct. Dep. 20-3713 Water Permit 20-3743 Sewer Permit ~ 79-3866 Sewer Conn. ~ ~ R 11-3855 Park Ded. TOTAL I )4. ~ RESIDENTIAL ~ ~'L BUILDING PERMIT APPLICATION ~F- ~~rl,~ CtTY OF EAGAN 3830 PILOT KNOB RD - 55122 651-681-4675 New Conslruction Reauiremenls Remodel/Reoair Reuvirements • 3 registered si(e surveys shaxirg sq. A. ot lot sq. ft. of lause; and all roofed areas • 2 copies of plan (20°brnaximumlotcoverayeaflowed) • iseto(EnergyCalculationsforheatedadditions • 2 copies of plan slwwing 6eam & window sizes; poured fourd des'gn, etc.) . 1 site swvey for extenor additions & decks • 1 set of Energy Calculatbns + 3 copies o( Tree Preservation Plan if IW platted afler 7l1M . RimJoistDelailOpfionsselectionsheet(bldgsHifh3alessunits) DATE c~~SAn-Oa VALUATION(EXCLUDINGLAND)QaoOOcy JOB SITE ADDRESS 3:E T',) Wlnc~'kE'G~t~wL IF MULTI-FAMILY BUILDlNG, HOW MANY UNITS? PROPERTY OWNER~e.`ru~~S TYPE OF WORK 4 l,i,rdp,,~S un'4~a+r+ ~.WSli+%_09QREi4#PLACE(S) 1_2 _3 APPLICANT 4rtrtka+4o.4 1% Tm\dre.t Srtn:i :9 a6303g3 PHONE #_Lb3 •$a7• ADDRESS 35b -'}'3"A Nv.a 'N•`t.'~~c~dl-t~ ~MvJ ZIPCODE~3a PAGER # CELL PHONE # FAX # NEW RESIDENTIAL BUILDING ONLY - FILL OUT COMPLETELY Energy Code Category _ MINNESOTA RUI..FS 7670 CATEGORY 1 (check one) - Residential Ventilation Category 1 Worksheet Submitted - Energy Envelope Calculations Submitted MINNFSOTA RULES 7672 - New Energy Code Worksheet Submitted r i Plumbing Contractor: Phone - Plumbing Systein Includes: Water Softener Iacvn Sprinkler Fee: $90.00 Water Heater _ No. of R.I. Baths No. of Baths Mechanical Contractor: Phone # Mechanical System Includes: Air Conditioning Fee: $70.00 Heat Recovery System Sewer/Water Contractor: Phone # All above information must be submitted prior to processing of application. I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. SignatureotAppHcant Aa(~(~&Mill Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ uPdated vo1 OFFICE USE ONLY , ? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg ? 02 SF Dweiling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi ? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) O 33 Ext. Alt - SF ? 04 02-plex ? 10 08-plex ? 18 Oeck Q 23 Porch (screened) O 36 Multi ? 05 03-plex ? 11 10-plex O 19 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous ? 31 New ? 35 Int Improvement O 38 Dertalish (Interior) ? 44 Siding ? 32 Addition ? 36 Move Bidg. ? 42 Demolish (Foundation) 0 45 Fire Repair ? 33 Alteration D 37 Demolish (Bldg)• ? 43 Reroof O 46 WindowslDoors ? 34 Replacement 'Demolition (Entire Bldg only) - Give PCA handoyt to applicant Valuation Occupancy MC/ES System Census Code Zoning City Water SAC Units Stories Boaster Pump, Nbr. of Units Sq. Ft. PRV Nbr. of Bldgs Length Fire Sprinklered Type of Const Width REQUIRED INSPECTIONS _ Footings (new bldg) _ FinaUC.O. _ Footings(deck) _ FinaUNo C.O. _ Footings (addition) _ Plumbing Foundation HVAC Drain Tile Roof [ce & Water Final Other _ Framing , Pool _ Ftgs _ Au/Gas Tests _ Final _ Fireplace _ R.I. _ Air Test _ Final ` Siding SNCCO Stone _ Insulation " Windows (new/replacement) Approved By , Building Inspector Base Fee Surcharge Plan Review MGES SAC City SAC Water Supply 8 Storage S&W Permit & Surcharge Treatment Plant Ptumbing Permit Mechanical Permit License Search Copies Other Total Renewal By Andersen ~ I~'-7 pI ~ RESIDENTIAL ~ 350-73rJ Ave. NE ~ Frialey,M-N 55432 UILDING PERMIT APPLICATION 763-502-4777 CITY OF EAGAN #MN20130983 3830 PILOT KNOB RD - 55122 651-681•4675 New Construction Reauirements RemodellReoair Reauirements • 3 regatered sife surveys showing sq, ft d IU, sq. fl. of trouse; and all roofed areas • 2 copies M plan (20%manimumlatcoveragealWwed) . ise[oFEnergyCalculationsforheatedadditions • 2 copies d plan stawirg beam 8 window sizes; poured found desyn, etc.) . 1 site suney br eztena addilions & decks • 7setolEnergyCalculatlons • J cop'res af Tree Presenati~on P4x if Id qafled afler 715193 • RimJdstDetailOpfbnsselectionsheet(bldgsvdN3alessunits) DATE ay •ock • O I VAIUATION (EXCLUDWG LAND) JOB SITE ADDRESS 3}AQ IF MULTI-FAMILY BUILDING, HOW MANY UNITS? PROPERTY OWNER TYPE OF WORK FIREPLACE(S) _0 _1 _2 _3 ,CtA1+.rCId1Q.C-5'msip \AJY'c~,~,' ~.~24Mi1'~II?O~ PHONE# 9So734S•C.Q0q_-~ APPLICANTA ADDRESS ZIPCODE~Io ? PAGER # CELL PHONE # FAX # NElV RESIDENTIAL BUILDING ONLY - FILL OUT COMPLETELY Ener9y Code Category _ MINNESOTA RULES 7670 CATEGORY 1 (check one) - Residential Ventilation Category 1 Worksheet Submitted - Energy Envelope Calculations Submitted I MINNFSOTA RULFS 7672 - New Energy Code Worksheet Submitted Plumbing Contractor: Phone Plumbing System Includes: _ Water Softener _ Iawn Sprinkler P'ee: $90.00 _ Water Heater ~ No. of R.I. Baths No. of Baths Mechanical Contraclor: Phone # Mechanical System Includes: Air Conditioning Fee: $70.00 Heat Recovery System ~ Sewer/Water Coniractor: Phone # c : ` 0, All above information must be submitted prior to processing of application. Q , I hereby acknowtedge that 1 have read this application, state that the information is cor~ect, and agree to complywith all applicoble State of Minnesota Statutes and City of Eagan Ordinances. SignatureofApplica'&'4 Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ Updated 1l01 OFFICE USE ONLY , ? 01 Foundalion ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg ? 02 SF Dweliing ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt • Multi ? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.) ? 33 Ext. Alt - SF ? 04 02-plex ? 10 08-plex 0 18 Deck ? 23 Porch (screened) D 36 Multi ? 05 03-plex O 11 10-plex 0 79 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous ? 31 New ? 35 Int Improvement ? 38 Dertalish (Interior) ? 44 Sfding ? 32 Addition ? 36 Move Bldg. O 42 Demolish (Foundatan) ? 45 Fice Repair ? 33 Alteration • C3 37 Derralish {Bldg)' ? 43 Reroof O 46 Windows/DoOrs ' 0 34 Replacement 'Demolltion (Endre Bldg only) - Glve PGA handout to applleant Valuation Occupancy MCfES 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 Widih REQUIRED INSPEGTIONS _ Foorings(new bldg) _ FinaVC.O. _ Footings(deck) _ Final/No C.O. _ Foorings (addition) _ Plumbing Foundation HVAC Drain Tile Roof Ice & Water Finxl Other _ Framing _ Fool _ Ftgs _ Air/Gas Tests _ Final _ Fireplace _ R.I. _ Air Test _ Final _ Siding Stucco Stone _ Insulation _ Windows (new/npiacement) Approved By , Building Inspectqr Base Fee Surcharge Plan Review MC/ES SAC City SAC Water Supply & Storage S&W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other Total Thrs requesl vmtl 18 ,,,onchs 1ro, / /o, o a `y L Y c~~~ y~~ D ~80V0 a tReq~q en~ st uaie Firo o. - ~ nedpl nsVecon ~G L¢ ?Re7Ay Nuw F ° 0 us ONO tor Whr;n RcaAv Licensed Elecvical Contrnctor Owner I hareby renuast mspecnon of obave etectrical work jnstalletl ar. Strent Address, eox or Povte No. 7 ~ ect,on o.~TOwnsniP Name or No. Nane~~ No. Coum Occapant (PqINT) Power Suppl,¢r 0 0 Atltlress Elecvical Co v. tor IC mpany Namel ~ ontrur.lor s Licnnsc No. Mailinp qdJress (ConUactor or Owner Mnkinp Instailauon) OG_ pZ~ r - f, s 337 Authori¢etl Sienn~ure ~Contmctor/Owner Mak~ny Insc.~lla~ionl unu Nurnb~r NESOT ATE BOARD OF ELECTqIGITV THIS INSPECTION HEQUEST WILI NOT I-vus-Midwey Bidg. - Noom N-191 BE ACCEPTED BY THE STqTE BOAND 1821 Unirarsitv Ave., St. Paul, MN 55104 UNLESS PPOPEF INSPECTION FEE IS Phone (612) 642-0800 ENCLOSED. REQUEST FOR ELECTRICAL INSPECTION 10 Ee-ooaoi-os See inslruclfons br compleling Ihis lorm on bnck of Vellow coCV• p ~ 670 "X" Be/ow Work Covered by Ihls Requesf And NeD. TVOe of BuilEinp Aoolwncm WireA Eqmpment Wired Home Ranye Temporary Scrvice Duplen Water Heater Lightiny Fixiwes Apt. Bmldmg Dryei Electrie Heabn Commercial Bldy. FumaCe Silo Unloader InAustnal Bldg. Air Conditioner Bulk Milk Tenk Farm otn«i oeaj v 0ne,~Sner.iWl 1 vr Suer.ily Ochcr Oihn, ompute Inspectron Fee Below p Fee Service EnLanceSize rc Fee Fextlers/Subfextlers a Fne Grcwls p U to 200 qm s 0 to 30 qm s Q-S'D 0 tn 30 Am s AbOVe 200 Amps 31 to 100 Amps 31 to 100 Am s Swinvniny Pool Above 100-Amps Above 100_Amps Transformers Irrigation Boonis Partial.'Other Fee Aertwrks Signs SUeciallnspecbon S 1 r-i TOTAL F E~ PouBh-in D;~e rha Elecincal y Inspector, he' eby ~ cerUly the~ the abo~e Final D"le ns0ectmn has bean naride. TNa repuesl volE 19 moNhs Irom CITY OF EAGAN N_ 1 4 514 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 'PH O N E: 454-8100 ~UILDING PERMIT Receiptx ?-6e 7o be used for SF DWG/GAR Est. Value $89,000 Date DECEMBER 21 19 87 Site Address 3742 WINDTREE DR OFFICE USE ONLY Lot lZ Block z Sec/Sub. WINDTREE 8TH On Site Sewa9e Occupancy R3 ParcelNo. MWCCSystem X Zoning R1 On Site Well (ACtual) Const Vn a Name JOE MILLER CONST Ciry Water X (Allowable) Vn W 18133 CEDAR AVE PRV ReQUired nof Stories 3 Address - 70 ° City FARMINGTON phone 431-2001 Booster Pump _ Length Depth 30.33 ~ Name SAME S.F.7otal .o zi- oa AddresS Footprint S.F. 0~ City phone ppppOVALS FEES ua En c/Assess. Permit $ 465.00 ww Name 9 44.50 Planner Surcharge x ~ Address aw CityPhone Council PlanReview 1232.50 00.00 81dg. Off. SAQ City I hereby flcknowletlge that I have read this applicahon and state that the Variance SAC, MWCC 525.00 information is correct and agree to comply wdh all applicable Slate ol Water Conn. 525.00 Minnesota StaNtes and City of Eagan ~OJrrr an/cgs. ~ Water Meter 67.00 Signature of Permitle Cv~~~G~ ~"`vr? Roatl Unit 305.00 A Bmlding Permn is issuetl to JOE MILLER CONST 7reatment P1 180.00 on Ihe express condition that all work shall be done m accortlance with all applicable State of Minnesota SI es nd City of E n O nc s. Parks BuildingOfficial v TOTAL $2.444.00 - ~-l RESIDENTIAL 5 2f ~(~,j ~ BUILDING PERMIT APPLICATION f -1 CITY OF EAGAN , 3830 PILOT KNOB RD, EAGAN MN 55122 j C 2 651-681•4675 ~ New ConsUuction Reouiramenb RemodellReoair Reuuiremenb . 3 registered site surveys showing sq. fl of lot, sq ft. of house, and all rooled areas • 2 copies of plan (20% maximum lol coverage allaxed) . i sel of Energy Calculations kr heated a0tlitions . 2 copies of plan showing beam 8 window srzes; poured found design, eta) • 1 srte survey for extenor addihons & decks . 1 set of Energy Calculahons . Indicate if home served by septic system for atltlitions • 3 copies of Tree Preservalion Plan if lot platted after 7/1l93 . Rim Joist Detail Options selection sheet (bldgs with 3 or less units) DATE lv -o?lo"O L VALUATION lo. M , SITE ADDRESS v 3:ZyQ W i.vD%.~E DR MULTI-FAMILY BLDG _ Y _ N TYPE OF WORK ;yk - 1?6o p FIREPLACE(S) _ 0_ 1_ 2 '4 .v 0 S~ ~J v~G APPLICAN7 41GO V~E -/'?Od ~~-yr STR E ET A D D R ESS (nSB~F_DEN?.9/c /SIv+7, 6u.T£ /36 CITYEDfNR,o,2,a STAT€M tiul' ZIP66-,3 Z/ 6 TELEPHONE #clSa-S7Y-d63,5- CELL PHONE # FAX # 9637'57`ll "~sgY PROPERTY OWNER OE.vnli S /'0E2so ~J TELEPHONE#' 632 ' elSo?- So?boZ COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINNESO'CA RliLGS 7670 CA'CliGORY l _ NIIV ~d~]y ~lSI7~ (+1 submission type) • Residential Ventilation Category i Worksheet Submitted . Ne ergy,QqQe~~k~l7g,gt,Su ted • Energy Envelope Calculations Submitted J l1N (JUC Phonc # Plumbing Coniractor: gy Plumbing syslem includes: _ Water Softener I.awn Sprinl:ler Pee: $90.00 _ Watcr Hea[cr No. oF R.I. Baths No. oF Baths Mechanical Contractor: Phone # Mcchanicad systcm inclucies: _ Air Condiuoning r«: $70.00 _ I-Icat Rccovcry System Sewer/Water Contractor: Phone # m hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicanf - - - - - - - - - orrici: IJSC oNi.Y Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ Updated 4i02 OFFICE USE ONLY ? 01 Foundation ? 07 OS-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg O 02 SF Dwelling ? OS 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi ? 03 01 of _ plex ? 09 07-plex ? 77 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF ? 04 02-plex ? 10 OS-plex ? 78 Deck ? 23 Porch (screened) ? 36 Multi ? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex Plbg_Y or_ N ? 25 Miscellaneous ? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding ? 32 Addition ? 36 Move 81dg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 33 Alteration ' ? 37 Demolish (Bldg)' ? 43 Reroof ?'46 Windows/Doors ? 34 Replacement 'Demolition (Entire Bldg only) - Give PCA handout to applicant Valuation Occupancy MC/ES System Census Code Zoning City Water SAC Units Stories Booster Pump Nbr. of Units Sq. Ft. ' PRV Nbr. af Bldgs ' Length ' Fire Sprinklered Type of Const Width , REQUIRED INSPECTIONS , _ Footings (new bldg) _ FinaUC.O. _ Footings (deck) _ FinalMo C.O. _ Footings (addition) _ Plumbing Foundation HVAC Drain Tile Other Roof _[ce & Water _ Final _ Pool _ P[gs _ AidGas Tests _ Final _ Framing _ Siding S[ucco S[one _ Fireplace _ R.I. _ Air Tes[ _ Final _ Windows (new/replacement) Insulation _ Retaining Wall Approved By , Building Inspector Base Fee Surcharge Plan Review MC/ES SAC City SAC Water Supply & Storage S&W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other Total UO/V!/zVq11 inu az:ju rn.t 104 aii aeao ISr,yVC11Al, i31 ,ytVULHJCIV Kyuoziuuz t • re ' al.. . ` HY.INDEILS6N' . . . , ' _ 7une 7, 2001 City of Eagan 3836 PiIot Knob Road Eagan,NlN 55122 • To Whom It May Concern: Elder Jones is authorized to pull building permits for Renewal hy Andarsen_ Please allow Elder Iones to provide this service for us in Eagan. T[iis authorizatinn is valid for any date beyond 6/6/01; until a Ztenewal by Andersen manager expressly revokes it in writiag to the City. I request this uithorization be accepted expeditiously, as to not delay in che processing of our buildi.ng pcrmits any furthcr. Plcasc caIl mc if tiicrc arc auy questivns. I can Ua contacted at 763-502-4706. : Your immcdiate attention to t8is mattcr is agpreciaterl. Sincerely, }wond R. Rau ostallation Mariager Renewal hy A.ndersen Corporation C'cc Kara_F.1de,r.Tnnev li - 7-~cypj , . . • NIIH,11"1A M. EuL C,qhqAL oiary Phlic M4COmtmsehpnEne~ G J.Ltn.]7.20p5 • ' Ji"~d~ 2 Q Received Time Juo, l. 1:07PM ~ i, r~•.i au~ aa . ov rm ~ o.~ 0 ~ 1 490.~ 1Sr,1VL1/AL !fl° tlIVUCiS,7CfY WJ UUZ/ U11L ~ re° 0 al BYANDBIISEN' ' . 7une 7, 2001 City of Eagan 3836 PiIot Knob Road • Eagan, MN 55122 To Whom It May Concern: IIder Jones is authorized to pull building permits for Renewal by Andezsen Ptease altow F1der ]ones to provide this service for us in Eagan. 'Ihis authorization is valid for any date beyond 6/6/01; until aRenewal by Andersen manager expressly revokes it in wridng to the City_ I request t}us autliorization be accepted expeditiously, as to not delay in the grocessing of our building pcuiits any fuxther. Plcasc call mc if tlhcin arc any questiuns. I can Ua contacted at 763-502-4706. ~ Your immcdiate attention to Uus mattcr is appreciated. Sincerely, Oymond R. &Rau nstallation Manager Renewal by A,ndersen Corporatian M. ~,p~~ O:GIHqADAMin~@gp}g ~ry ~,euc ion Eeuiref Jan. a1~ 20IX1 Received Time Jun. 7. 1:01PM . 1987 BQILDING PEHMIT 9PPLICATION - CITY OF TAGAN SINGLE FAMILY DWELLINGS ' IPCLIIDE 2 SETS OF PLANS, 3 CERTIFICATES OF SQItVEY, 1 SET OF ENERGY CALCQLATIONS NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOiiNER MOST DESIGftATE AHICH ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BOILDING PERMIT IS ISSQED. MULTIPLE D4iELLINGS - RESIDENTIAL RENTAL IINITS FOR SALE OIDfIRS INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SIIRVEY - CHECK iiITH BLDG. DEPT., 7 SET OF ENERGY CALCULATIONS COLMMACIAL INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS, $2,000 LANDSCAPE BOND ~ OE 2 1 9987 To Be Used For: luation: Date:/C;- Site Address ,7 Q90' OFFICE USE ONLY 89, Lot L~-- Block CP- On Site Sewage_ Oceupancy 9-3 MWCC System Zoning Parcel/Sub On Site Well Type of Const City Water ? (Actual) Owner (Allowable) # of Stories Address Length Depth 30 33 City/Zip Code S.F. Total Footprint S.F. Phone APPROVALS FEFS Contractor Assessments Permit y 65,00 Water/Sewer Surcharge .50 Address ~ Police Plan Review 3z Z.so ~ Fire SAC, City 100, Oo City/Zip Code ~ Engr SAC, MWCC 525. DD Planner Water Conn 525 - co Phone Council Water Meter (,r),Ob Bldg Off ~Z ZI Road Unit $,co Arch./Engr. APC Treatment P1 /f30,00 Variance Parks Address Copies ~ City/Zip Code TOTAL Phone Ik ` ~ K: C;ARAGE Z2x2Z = y8q x12= SSoS 3ASE M E Nt BXiD= 8C)- 48x2Z= Io56 `Ixy - 16 SX z6= 208 136v X i4 = f `Jp5y IST FLOO,z ' BSMT-? 1360 Iyz x I3 - zv 2K~'j= 5S l4ss.X wy': 6_ SS 134 ~ U _ lF~i7'UU+ i 41y•7Ur 'l_J l • U+ I , (,JD•UU+ 5 "L7•UU+ I Fil•UU+ S05'UU+ I~SU•UU'r I, ~,4 44 .UU, CITY OF BUILDITd6 llEPARTI-IEHT ' , k:XTERIOR EIZVII,OPE AVEI2A(3E "U " C019PUTATIO14 (To be submitted with building permit application) • One or Two Family Dwelling Owner All Other Site Address 3~y5 W//•l~(~E`~D~IU~ oi 12 131K 7 YVfnjpr F--?= 8?h Contractar 6k)ej^ Date Phone LINEAL F$ET OF EXPOSED VJALL ~m~~ ft,. above grade = Z3'~~' ~p TOTAL EXPOSED 6YALL AREA SQ, FT, OPAQUE WAI,L COT7STRUCTION: "U'l Value x Area Deteil -C-0~ "pn_ • x S(Z.'FT. ~_~7~-98• ZrZO(U)(p) reference llUll~o~l( 0 x SC~. FT.~= Z(U)~p) from ~1V~A ~~pn- OqO x SQ. FT._J%,7-1 = L SU)(A) attaclied x SQ, FT. _ ~U) (A) sheeta x SQ. FT. - (p)(p) liU" x SQ. FT. _ (U)(A) VlIIdWWS: I'Ull Value x Area Ttalce i4 Type Lh(,(-r Gtt~':~LIT 'lUll ~~J ~On - x Sq. FT. 2,CJ = (U)(A) n ? npll x Sq. FT. _ (U)(A) nU° x SQ. FT. n n = (U)(A) nUu x SQ. FT. _ (U)(A) DOORSt "U" Value x Area 14alce & Type liull = COrUII~ MM ii u ~ iipn r X SQ. FT. :4~0 U x SQ. FT. r=~'~,ZZ(U)(A) u n nUn X 9Q. FT. _ (U)(A) . - x SQ. FT. (U)(A) TOTni.S Z5-'FT;98 SQ. r'T._ Z~5o. 67 M(A) AVERA(3E ''U't TOTAL (U)(A) VALUE$ ~ DIVIDED BY TOTAL 1'JALL AREA ~ AVERAQE I~ less for 1&2 family dwellinga ROOF/CEILIN(3 t I ~ TOTAL AREA: Detail reference 'oUlt i67Z~ x SQ. FT. from upn ' (U) (A) attached sheete, nun x SQ. FT, . (U)(A) Descrlbe openings I'Utt x SQ. FT. (U)(A) x 3Q. FT. in roof. IlUll _ (U)(A) x SQ. FT. _ (U)(A) TOTAL M(A) VALUES DIVIDED BY -,7:;p pizo _ TTAVj 39) Sq.~~OZp(U~\ ) TOTliL ROOF/CE N(3 pREp I~-?~- Q AVERA4$ flUif 025 or ventilated roofe. ! ~ loo v,~X ~~iv) = I~ > Z3471 ~a ~3jc I $1 = I ~ z,! lu ZZ~5X3= t~ 5' ; I 3-~Xc~= ~1~2~'x1=41,~ ~ z13~5 ~ ~ e I}~~lb F~-~ X~ _ (7y1 d (~ss Gvrvc-, = ~ Z~~ Z~ ~5- zl " w?~uus = 2I 3,5 s,~g ~ Icp~ Uetermining IlUtt valuee at Aooft Walle' Rim# and Cono. $loak ROOFIQEILIN(i R VALU ~ i 1.) Interior Air e'i1m 0,61 • 2.) 5/81, ayp. aa. .56 ~ 3.) InaulaElan 44 ~ !1. ) ' 5.) Exterior Air Film ,61 ~ 2 3 I (eTILL) 1/n. 02-1 ~oTni, (R)e qs7g ~ .-0 . ~ . , ~ - gO WALL R VALU 6.) Interlor Air Fllm 0,68 7.> arp. Ba. :45 8.) Ineulation i9•op 9•) borl:r-P -ITF Z.n~- 10,) Fineonite siding .67 11.) Exterior Air Film ,17 flull o t/R= . 043 TOTAu, (tt)= 23.oJ = . ~ , ?z ni~t n vu,u ~ 13 ~ 12.) Interior Air Film 0.68 130 Ineulation 19.00 1~- ~M1 111.) 211 Fir Rim Jo1e0 1.98 15 15.) KvILT-P-ITG Z, oQ- 16.) p(aeonite 8lding ' .67 17*.) Exterior A!r Film .17 n ti • e' . upn o 1/Ae .LYI-D TOTAL . OQ • . FOUIIDATI011 A VALU 18.) Ittterior Air Filot 0.68 z~ p~ • ~ zo. )~-,rl STRIPr~D ll.c~ Zi , g° ' 21.) 12" Oonorete Blook 1428 e n 22.) 13 •15 23.) ExEerior Air Film •.17 e c5d . ~gs . ~~U" n i/ne .o7~O ToTU, (x)- J3.fr, ~ . • < Mi44E,2 C'oAAJ167, /,vc. EiOBE ~I COHSllLT1H0 Eti61HEfRS So~K 97 ENG~NE~RiNG PIAHHEAS ond LAHD gURVEYOflS PAGE 19 COMPRNY (NC. ~ 1600 G157 1467p STREE7, 4llRHSVtLLE. YIHNESOia 5S337 pH 132-3O~D C~r~z}`Z ccz~`e cS~rYe c~ ~ j~sgcl ~e.scr4P2zo7Z: LUT /Z, BLOC1C 2, W/NOTkEE 87N1 AooiTlo,v, DAKOTA CO11A17Y, MiNrVS~W7A G~~~Z7 ,DENOTE$ EX/ST/N6 ELEY•9T/QN (902.5 ) DENOTES PROfOSED tLEVAT/ON IND/CATES D/RECT/ON OF S11,fFy9CE OK9/N449E 9o2.s3 - F/N/SNED 64RA6E FLOOR 6LEYqT/ON ~ i ;2 30' FRo~ Bu/GD/NG I J SC4tE 30' .SETB4CK L/NE o'3Z, 55 V'/ .s 5 76 5g,62 :~~l 10 30oo L9a~ I ~~8~~~ u`• ~ o~ ~ r~ rm1 ~ 99 ~ 5~ 30.33 ~94.5~ ~ O ~.J I r lo ~~2~€~• ~ ~ ~ i ` qo ~a2. s~ 4.0 - ~ o W m W ~ (2~.5 ~ 2) ~ ~8,,, o A 9 ~ lo' zz.oo ~99_~. C893, Z) ~ S 'RAniA~.. T (9ao,s~ N 88° 36= Od~ E. pM/NA6E AND 7 j~ r ~ y UT/L/TY EASE.MENT I her*by cartity that thia i'a a t:ue and caiz'sct. repreaentitioa ot t~tract of , l+nd as shoxn":nd deacribed herson.• As P.rIIFarsd` Dy 7ne on this ~c~~2 . . 0 .19 87 - : ; - - ~ ~ . : 'i~•,~F_,•e~,;,~ . ? . . , a:s. . . . .it5~ . A . . . . . . . . . : . . . . . . . . i . . ~ n. ~ . _ ti:' . ~ . .:Y<:~rt"`~ ~ . APFLICATION f=OR PERMIT iNOTE: Pp'Ybff27r OF FEE AT TiME OP ; ; nrec.tcaxIoN ooes caoT coN- : * SfINIE APPRGH7N. OF PMIIT. ' SEW ER AND/OR W ATER CONNECTION : I~~ON oF MER nrD/ox wATm r ; irsrnuca+rtoM wns, r,orr se scEx'Lm ; . • . • ' [RTI'IL PII7hffT HAS BYMId APPROVID. : ff+~ttt+*~r~*e~a~»~+~ia~eet~+e~*~f«a+ . sitv oF eagan 9"y~ (PLEASE PRINT 3 1) PROPERTY ADDRFSS: I . j-'~ - /,~J7tiQ -fkcc T•FY:AT•DFSCRIPTION;. /,2 .Z Lot B oc S ivision or Tax Parcel ID . IF EXISTING STRC'CT[]RE, DATE OF ORIGINAL BUILDING PII2MiT ISSUANCE: hbnt Year PRESENT ZONING/PROPOSID USE: Q COhA7IItCIAL/RETAIL/OFFICE I=,-FR-1 SINGLE FAMILY Q INDOSTRIAL ~ R-2 DUPLEX (3Wo Lnits) ~ INSTITLTIONAL/GOVEF2NMENT Q R-3 TOWNHODSE (Three + Dnits) ( Lnits) Q R-4 APARTMENP/CONIDOMINIUM ( Units) 2) ~ NAME: ~ec /yliAr ADDRESS: 33 Cee~ye_ ~5I'.n S CITY, STATE, ZIP: fbv,,..: .Jc ~ is1? PHONE: V3I-,zoa / For City Use 3) b17iME: 4t 'wo,t¢.ii P1lunUers License: ADDRESS: 9a7 9a Zr.t~fiyp~.., L N Active , Expired CITY, STATE, ZIP: Not recorded PHONE: y9 3- 2 '17tf MASTER LICENSE # Sta Inital 4) F*Mlk NAME: ADDRFSS: CITY, STATE, ZIP: PHONE: 5) s ~ , a a~~ ~ •ao .i Ea CONNECTION TO CITY SEWER Q-CONNECTION TO CITY WATER ~ OZY-ISRR 6) * THE GpLD COPY OF 74E PII2NIIT WIIS, BE SENP DI12F)CPf,Y 'PD PUBLIC WDRKS 7U FACILITATE MEIER PIQC-UP. ~ ,*k PLFASE ALL+OW 'IWO WURKING DAYS FOR PROCE'SSING. SOMEONE FROM THE CITY WILL CONl'ALT YOU IF mEE2E ;F * ARE pNY PROBLEMS. a ~*******~*****r*~,r*r*~+*********r*;******+*****~r~r**+**,.+**#r***********~:~*******r,t****r**~,t~**+~y FOR CITY USE ONLY . PERMIT # 2SS[!ED 9.3 z B Pd w/Bldg. Permit FEES: $ $ /Q ~ SEWER PERMIT (INCLUDE SURCHARGE) $ $ /Q ^S~ WATER PERMIT (INCLUDE SURCHARGE) $ `-7C'Z $ WATER METER/COPPERHORN/OC'TSIDE READER $ $ WATER TAP (INCLUDE CORPORATION STOP) $ $ SEWER TAP $ $ ACCOUNT DEPOSIT - SEWER $ $ ACCOONT DEPOSIT - WATER $ $ wAc s G; -2_ s~o $ sAc $ $ TRUNK WATER ASSESSMENT $ $ TRUNK SEWER ASSESSMENT $ $ LATERAL BENEFIT/TRUNK SEWER $ $ LATERAL BENEFIT/TRUNK WATER $ ~~C• $ WATER TREATMENT PLANT SURCHARGE $ $ OTHER: $ / 3 % 7 $ ~ C~~ TOTAL Yv4 sr 7 ~o yi c RECEIPT RECEIPT DOES LTILITY CONNECTION REQUIRE EXCAVATION IN POBLIC RIGHT OF WAY? ~ YES IF YES, THEN A"PERMIT FOR WORK SJITHIN PUBLIC ROADWAY" MUST BE ISSUED BY THE ENGINEERING ~[VO DIVISION. LIST AS A CONDITION. SUBJECT TO THE FOLLOWING CONDITIONS: APPROVED BY: TITLE: DATE : ~ - ~ ~ ~ ~ ïù ÿþ þýýüÿûûù øüüýýîúùèüþ ø íó íîî þý ýüûúø ê ø üûú÷ö úø ê ò áò üûúòä ÷ý ì÷ý á üû ý ùûìîø åþò÷ððéé ðîéðîî ëñøàß øêïèðçíçîí öø ó ÿëæèðççð Ýíç õôôó òñ úú üûÙúú ùûìîøéîø åò÷ððéé ÿò÷ððé ñðïîéðîî ó ýûöÿó óå óúúóóä ÿ úûöóúúý äòùûä ÿã ç úúß ÿ ûÿ PERMIT City of Eagan Permit Type:Building Permit Number:EA164451 Date Issued:09/29/2020 Permit Category:ePermit Site Address: 3742 Windtree Dr Lot:012 Block: 002 Addition: Windtree 8th PID:10-84477-02-120 Use: Description: Sub Type:Reroof Work Type:Replace Description:Does not include skylight(s) Census Code:434 - Residential Additions, Alterations Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Please print pictures of ice and water protection and leave on site. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). 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 - Paul D Hagstrum 3742 Windtree Dr Eagan MN 55123 (651) 341-6812 Capital Construction Llc 416 Gateway Blvd Burnsville MN 55337 (952) 222-4004 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA176711 Date Issued:05/27/2022 Permit Category:ePermit Site Address: 3742 Windtree Dr Lot:012 Block: 002 Addition: Windtree 8th PID:10-84477-02-120 Use: Description: Sub Type:Water Softener Work Type:Replace Description: Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Fee Summary:PL - Permit Fee (WS &/or WH)$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 - Paul D Jr & Eleda K Hagstrum 3742 Windtree Dr Eagan MN 55123 (651) 341-6812 Ap Plumbing 12433 Uplander St NW Coon Rapids MN 55448 (612) 220-5057 Applicant/Permitee: Signature Issued By: Signature