4381 Woodgate Lane N
i CITY OF EAGAN WATER SERVICE PERMIT
3830 Priot Krryt? Road $
P. O. Box 21199 PERM{T NO.:
Eaqan, MN 55121 DI1TE:
; Zonlrg: No. of Unlts:
; pwmr; z,a[:raix Bui1dFrs
' Addnm
i
~ yfto Add,ow 4331 Woodgate Lane 'J L7 I?1 ';allar f'. ! I1
ke>>zcl Piecttialiical
~ AMw No.: ..3 0/~ o! 9 ) i i 0
~ Sisr.
t Reoder No.: ~13iV [.16 .S~ ~ 0. l (1
~ Mw~ b~/I! rrltl~ 1M Cil~r ~i~ y~~'u'~C+
LA
~ t,.;.6n metej~
~ ey Daft`PoW:
i °°ft r"'°' ` i'vp.:
CITY OF EAGAN VI/AjER SfRVICE PERMR
3830 Pilot Knoka Rov - ~
, P. O. Box 21199 VERMIT NO.: '
Eagan, MN 55121 DATE:
! t No. of Units: 1
k pwrwr; , ;,aGroix BuiWers
4 Addnm:
j Sfb /1ddrea: 4311 kcIGJL21,~ ' ,1-3i'
~ P1un+b.r.
4 Mew No.: LCom+sction Gharpe:
Size: Aooourt Depoelt:
'
~ Reoder No.: Penntt Fee: I yrw fo womlp wo !M Qer of !qN¦ SurcFwrpe:
pwimoon& MIsC. Chorpm t D
' Totol: 6 mFLv 2'
~ gy Doh Poid:
i Date of Insp.: Irup.:
CITY OF EAGAN
3830 P;;Ot Knob Ro d SRER SERVICE PERMR
P. a. Box 21199
Ea9an, MN 55121 PERMIT NQ.: _
' Zoninp: DATE: ,
, Owiwr: Lt, Ccc>ix $u.i •t, No. of Unit=;
Add?ess: 4381 kp dv~ iu
I n Add?ess:
Plumber, Z F j ~a-
_
~'K tiw cay ~i 4N. ~ Connncti0n Q~p~e: ~I.'' • . ' 7l~!
Ae°°""r Drpawt:
Prnr* FM; '
BY SurChprpe:
Datu of Inip,; Miac. Chorm
Totol:
Dah Pbld;
CITY OF EAGAN ` . ,1.. 15283
3830 Pilut Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
BUILDING PERMIT Receipt # To be used for GAXAGE ADDITIOl1 Est. Value =Z ,000 Date AUG Z i , 19 90
Site Address 4381 19 fi00D!'„11TE Lti
Lot I Block 1 Sec/Sub. ~ p~ 3 OFFICE USE ONLY
Parcel No. occupancy M-1 FEES
Zoning
W Name DMN11JWN (ACtual) Const _ Bldg. Permrt 45.00
; Address ~?381 N HOODGII''8 I.N (Albwable) _ i~pp
Surcharge
° Ciry EAI(AH Phone 452-5"3 # oi stone5 o
Lenglh Plan Review
Name SA~ Oepth SAC, City
° Address S.F. Total
o{ - SAC, MCWCC
~ City PhOne S.F. Footprints -
On Site Sewage _ Waler Conn
~
W W Name On Site Well - Water Meter
i= AddrBSS MWCC System _
g W City PhOne City Water _ Acct' DepOS1t
PRV Required _ S/W Permit
I hereby acknowlege that I have read Ihis application an state that the Booster Pump - S/yy Surcharge
inlormation is correct and agree to comply w th all ap cable State of
Minnesota Statutes and City of Eagan Ordinans. Treatment PI
Signature of Permitee APPROVALS Road Unit
A Building Permit is issued to: DM NEj"~M Ple""Br - Park Ded.
on the express condition that all work shall be done in accordance with all couridi
applicable State of Minnesota Statutes and City of Eagan Ordinances. gldg, pH_ _ Copies
Building OffiCial ' Variante - TOTAL ~.00
i
• PMmk No. Permit Holds? Dsb TeMphons A~
WA7ER
SENfER .
PU1M81NG
H.VA.C.
ELECTRIC
Mupetlion Oate hfsp. Comrtents
FooGngs I Ov"
l'~ : > ~i~- . ~-;G - C
Foundabo, 912 s~ s s s- Q ~1~
Framwg `h ~o s
P40fwv K ~ 4
~
P-0 Htg.
Faeplace
Fnal HEg.
Final Plbg.
Const. Meter Plbg. Irupeclor - Notify Plumber
ErgrJPlan
Pldg. Fwnal
Dedc Ftg.
04dc Fnal
wOr I
P.. oisp. I ~b 9 ~ I
- - ~
~ • -P .
CITY OF EAGAN t?1
,s 3830 PNof Knob Road, P.O. Box 21-199, Eagan, MN 55121 1~i 2 12i03
PHONE: 454-8100
BUILDING PERMIT Receipt 1k
To be uNd for SF UiAiG/GA.et Est value $73, 0 0 0 DaYe JUNE 13 19 36
M1
SkeAddress ~ $381 NO W,OODGA'.CE 1,N Erect 13X Occupancy Rj
Lot T Block 1-Sec/Sub. DiALLARD pK 3RD Remodel ? Zonina u 1
Repair ? Type of Cons~ ¦j--
Parcel No. Addition ? No. Stories
a Name LACROIX BUILDERS INC Move ? Length
= ~ 2 Demolish ? Depth
o Address RUUTE Int Impr. ? Sq. Ft
Citi MCGREGWone 432-4036 Install O
= o Name SME ~rff 1V Approvab Fees
$ i Address Assessment Permit $ 352.90
~ Ciry Phone Water & Sew. Surcharge 36.50
Police Plan Review 176.00
= Name Fire gp,C 575.00
00 Address Eng. Water Conn. 5 Q 0. 0(f
g~ City Phone Piann er W a t e r M e t e r 63.50
Council Road Unit 290• 00
I hereby acknowledge that I have read this application and state that the gidg. Off. 6/13 /8 6 Tr. PI. 156.00
information is correct and agree to comply with all applicable Stete oi
Minnesota Statutes and Cof Eagan Ordinances. APC Parks
Signature oi Permittee Ver. Date Copie 2 9• O0
Total ,
A Bullding Permit is issued to: J.hCR IX Bu"0013 1-NC on the express condltion that
all work shall be done In accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
8ullding Official + * - ~
~
,
,
- PwmiR No. PeneM HoMrr DoN TNephonwM
IH.vJLc~ I r - - ~
E'bctrft •
8o11~nM
1Insp~ctlen DaM MMp. ConMnmls
IFOO§h I I - 'AL
Fooaw 11
Foundatlon
AL~
Framinq
I Roallny
Ip«UO Pft
insa ~'~A• AAAA~
I F~pl~e•
IF" FltO' ~.S
IF" Pft
1". M"
Ic«M oa.
Io.o* Fq.
IWek Fnnp.
I111?o Dwer" l.oeallore
ft. DMp.
PERMIT ^ 739I
PLUMBING PERMIT RECEIPT #k q7
CITY OF EAGAN
9e30 PILOT KNOB ROAD, EA(iAN, MN'S51Z7 OATE:
CONTRACT PRICE PHONE: 454-8100
Site Ad Itc i . TYPE WORK DESCRIPTION
Lot~Block Iz Sec/S -
Res. k New ~
m Name Mult Add-on
~ Address r~EANE " ` " Comm. Repair
c City EAGAN Phone 452-1565 Other
NO. FIXTURES JObAL
Name ~ 41 ; Water Closet - $3.00 i
c Address f~ t~ ~-Beth Tubs -$3.00 0 c
0 City//%i.,_ Phone ~Lavatory -$3•00 00
Shower - $3.00
FEES / Kitchen Sink - $3.00 ~
COMM/IND FEE - 1% OF CONTRACT FEE Urinal/Bidet - $3.00
1 Laundry Tray -$3.00 -3- ~
MINIMJM - RESIDENTIAL FEE - $10.00 1_Floor Drains - $1.50 i --5~
MINIMUM - COMM/IND FEE -20•00 LWater Heater -$1.50
STATE SURCHARGE PER PERMIT - •50 Whirlpool - $3.00
(ADD $.50 S/C IF PERMIT PRICE GOES I Gas Piping Outlets - $1.50
~
BEYOND S1,000.00) Softener - $5.00
Well - $10.00
' Private Disp. - $10.00 r-
!c 6 =Rough Openings - $1.50
SIGtJATURE: F PERMITTEE FEE
' STATE S/Q
FOR CITY OF EAGAN GRAND TOTAL ^s
i . _ . ' . . ` 4. _ t . . ~ , , ~ ,
PERMIT N
MECHANICAL PERMIT RECEIPT #
• CITY OF EAGAN
~ 1500 . 00 ~~LOT KNOB ROAD, EAGAN, MN 55121 DATE:
CONTRACT PRICE PHONE 4544100
Site Address 4381 1 . WoodgaLe " e •
,,9LDG. TYPE WORK DESCRIPTION
Lot I Block Sec/Sub/)` ` ' ` t`
?
Res. New
m Name ~1-_`!ti'L~:L L•1ECi~ANICAL Mult Add-on
Address jbOU iieniiebac Drive
52-1565 ' Repair
c City Phone
Name LaCroix Builders FEES
c Address Kt. 2, Box 97 qES, M/AC 0-100 M BTU -$24.00
0 C~ riuc{~regor phone ADDITIONAL 50 M BTU - 6.00
ADD-ON AIR COND. 0-24 BTU - 12.00
TYPE OF WORK ADDITIONAL 6 M BTU - 6.00
GAS OUTLETS - 1.50 EA.
Forced Air 80, UUU M BTU 24.00 COMM/IND FEE - 196 OF CONTRACT FEE
Boiler M BTU MINIMUM - RESIDENTIAL FEE - 10.00
Unit Haeter M BTU MINIMUM - COMM/IND FEE - 20.00
Alr Cond. M BTU STATE SURCHARGE PER PERMIT - .50
Vent CFM (ADD $.50 S/C IF PERMIT PRICE GOES
1 1.50 BEYOND $1,000.00)
Gas Piping Outlets #
Other
pEE;
S/C: .50 SIGNATURE OF PERMITTEE
TOTAL: ~26.JO
FOR: CiTY OF EAGAN
CITY OF EAGAN Remarks
Addition Mallard Park Third Addition Lat 7 R,k 1 Parcel #10 47252 070 01
Owner Street 4381 North Woodgate Lane State F.agan, MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. j , 198 2698.43 539-69 5
STREET RESTOR.
GRADING
SAN SEW TRUNK
A - '
* SEWER LATERAL 'j 19$1 3412.34 682.47 r
WATERMAIN
* WATER LATERAL 19H1
WATER AREA ~ ~
STORM SEW TRK 1981 467.74 93.55 5
* STORM SEW LAT 1981
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILOING PER.
SAC
PARK
CASH RECEIPT
, CITY CJF EAGAN
3795 PtLOT KNOB ROAD
~ EAGAN, MINNESOTA 55122
. DATE r 1$~
wscetvan l` ~v'~' C JT,.J I
PROM I F ~
V. ~ •
~ AMOUNT $
4 DOLLARS
too
' 0 CASH F) CHEGK
~ ~ ~ L, ~V+~~?'~h''K ~ 'L
eoofi ount
Thank You
, .w 6466it~
White-Payers CoPY
~ Yellow-Posting Copy
Pink-File Copy
- - .
CiTY OF EAGAN '.::.~0 17841
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
BUILDING PERMIT Receipt # t
To be used for ~ Est. Value :1 1d00 Date MAY 10 , 19"
Site Adc~ess ~ ~1 P ~
Lot BIOCk SBC/SUb. OFFICE USE ONLY
Parcel No. occupancy - Fees
zoMng - 25.00
¢ Name ~ (Actual) Conat _ Bldg. Permit
o Address 4381 p~~~ ~ (Allowable) - SurchBrge
City EAG" Phone # ot Stories _
_ Plan Review
Length
, p Name ~ DePth - SAC, City
gi- AddfesS S.F. Total - SAC, MCwCC
~ (',ity PhOf16 S.F. Footprints -
On Sile Sewage _ Water Conn
~
W W Name a+ Si1e well - water Meier
t== Address Mwcc system - Ar-cl pepos'i
< W Ciry Phone City water _
PRV Required _ SNV Permit
I hereby acknowlege t e read this application and state that the Booster Pump - StW Surc,arge
in(ormation is correct agr to comply with all ppl le State of
Minnesota Statutes a City of E,hgan Ordip'anr.es. Treatment PI
'
Signature of Permit ~ , ' ' ~ APPROVALS Road Uriit
A Building Permit is issued to: MLBC* Planner _ Park Ded
on the express Condilion thet all work shall be done in accordanCe with all Co+ncil - .50
applicable State ol Minnesota Statutes and City ol Eagan OrdinanCes. gldg, pf}, _ coP1eS
Building Of(iCial ~ Var'e^ce - TOTAL 26.00
PWmR No. Psrmit HoIdK Oab TNwplwne
iATER '
SEWER
PLU1ABNrG
H.VAC.
ELECTRIC I
kupection 0oN haP• Conwrwnts I
Fadinps I I
FounOation
FramiV
Roofin9 '
Rough P69. i
~gh Hi8• II
Fweptace I
Fnal HEg. '
Final Pbg.
Const. Mleter PIb9. kupe~.'br - Noti1Y Pkxnb- '
EngrJPla^
81dg. Frtal
oeck rij. _ ~S e,r..,rs
oeak FinW
WON
Pr. oimp. 7
:
SEDGWICK HEATING & AIR CONDITIONING CO. HEariNG JOBNO.
8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 TEST RECORD
ADDRESS 7`3&~ ~°~4~~e C.AJ NCITV L'~9A~?
/ nv ~Ie
OCCUPANT `~SA !/~~'~'1i/h„y~~e rOWNER L/S+~ D~~'N+4N. ILI/eGqcC ~ee~
SOLDBV INSTALLEDBY
' J
7 O
MAKE- Leh?1 aY MODEL 99
SERIAL NO. I T ~ e"' `
D ,
THERMOSTAT 8 T SIZE j
VALVE TVPE OF LINEFi
J~
LIMIT Zx&V LINER SIZE
LIMIT SETTWG ~
FILTERS' SIZE A4 NUMBEF JD 1~
FAN SETTING / W IRING
PILOT NPE TEST TAG
IGNITION MODEL /T c? ` LIGHTING INST
PILOT TIMING L 0 ~
DATE TESTED X/
PRESSUFE PERCENTCOp C/ Q ^ ~
~ 1/1 COMPANV TESTING ~
INPUT CFH~'PERCENT Oz /
STACKTEMP~~ PERCENT W AME OFTEST
FORM2%(REV.11/89) FORMOIST / ON WHRECOPY - JOBFlLE YELLOWCOPY-dTY
CITY OF EAGAN Np ~ 8283
3830 Pilot Knob Road, P.O. Box 21-1g9, Eagan, MN 55121
PHONE: 454-8100
BUILDING PERMIT Receipt # C~_ C iS~
7obeusedior GARAGE ADDITION Est.Value $2,000 Date AUG 21 ~ , ~g9_~
Site Address 4381 N WOODGATE LN
Lot _L Block Sec/Sub.' MALLARD PARK 3R OFFlCE USE ONLY
PerCel NO. Occupancy FEFS
Zoning
~ Name DAN NELSON
w (ACtual) Consl _ Bltlg. Permtl 45. 00
3 Address 4381 N WOODGATE LN (Allowable)
~ - SurCharge 1 .
City EACAN Phone 452-5483 x ol smnes
Lenglh 16 ~ Plan Raview
o Name S~E Deplh -$.7 SAQ Cily
~Q Address S.F.TO~aI - SAC,MCWCC
~ City Phone S F. Poolpnnts _
r On Sne Sewage _ `Naler Conn
` Name
rw On Sila Well - Wa~er Meler
AddfQSS MWCCSysiem _
<W C~~y Phone Qry Waler _ Acc1. Deposi~
PRV Reqmretl _ S/VJ Permn
I hereby acknowlege that I have read this application an state that the Boos~er Pump - Siw Surcnargo
inlormauon is cQ ~c an ~9[~e to comply with all ap i able tate ol
Minnesota Slatut a0s ntl Ci~y ol E''a an Ordinan e5.)~ Trea~ment PI
Signature ol Permitee /~l/ AP7ROVALS Roatl Unit
n Bwltling Permn is issued to. DAN NELSON Planner - Park Ded.
on the ezpress contlition thal all work shall be tlone in accordance wnh all Council
applicable State ol Min(n~esota StapWtes and City of Eagan Ordinances g~~ Q~~ Copies
BuildingOfhcial ~Ll~(In 11.Q1(~ ,~i~ Vanance _ 7p7p~ 46.00
_~_,T
CITY OF EAGAN NO 1784 1
3830 Pilot Knob Road, P.O. Box 27-199, Eagan, MN 55121
BUILDING PERMIT PHONE: 454-8100
aeceipt # ~
To be used for DECK Est. Value $1 000 Date Me V 1 n , 199.0-
Site Address 4381 N WOODGATE LN
Lot 7• Block 1 SeGSub. MALLARD PARK 3R OFFICE USE ONLY
P2fCBl N0. Occupancy - FEFS
Zomng -
w Name DAN NEL•SON (ACtual) Consl _ Bltlg Parmit 25.00
o Address 4381 N WOODGATE LN (Allowable) - Surchargo .5
O
City EAGAN Phone 457- 483 H at Stones -
Lan9tn _ Plan Review
, o Name SAME Depth - SAC, Cily
AddreSS S F. Totai - SAC. MCWCC
~ City Phone 5 F. Footprims -
On Srte Sewage _ Water Conn
0 Name On Srte Well - Water Maler
MWCC S slem
AddrBSS Y - Acci Deposn
City Phone cdywaier _
PRV Roquired _ SIVJ Parmil
I hereby acknowlege ih ve read this application and state ihat Ihe Booster Pump - SM/ Surcharge
information is correct nd agr to compty with all pphc bie State ol
Mmnesota Statutes a Cny ol agan Ortli n es. Treaimem PI
Signature of Permite APPROVALS Road Umt
A Building Permn is issued to: A NELSON Planner - park Ded,
on the express condition that all work shall be done in accortlance with all Councd .50
apphcable Stale oi Minnesota StaWtes and. ~C,iryof Eagan Ordinances. gld9 pry, _ Copies
n
BuildingOlficial~~ ot! Il4,CI Variance - TO7AL 26-0
CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 27-199, Eagan, MN 55121 N~ .12108
PHONE: 454-8100
BUILDING PERMIT Receipta
7o be used for SF DWG/GAR Est. Value $ 7 3~ 000 Date JUNE 13 19 86
SiteAddress ~4381 NO WOODGATE LN Erect Cl~ Occupancy R3
Lot 7" . Block 1 SeGSub. MALLARD PK 3RD Remodel ? Zoning R1
Parcel No. Repair ? Type of Const
Addi[ion ? No. Srories
a rvame LACROIX BUILDERS INC titove ? Length 51
W ROpTE ~ 2 Demolish ? Depth44
o Address Int.lmpr. ? Sq Ft
City MCGREGOAone 432-4036 Instau ?
a S~E APProvals Fees
o Name
~Q nddress Assessment Permit $ 352.00
~ Ciry Phone Water&Sew. Surcharge 36.50
~Q Police PlanReview 176.00
F W Name Fire SAC 575. 00
z
Address 500. 00
c~, ~ Eng. Water Conn.
a W Ciry Phone Planner Water Meter 63. 50
Council RoadUnit 290.00
Iherebyacknowledgethatlhavereatlthisapplicationantlstatethatthe gldg.Off.6/13/$6 Tr.PI. 156.00
informatwn is correct and agree to comply wilh all applicable State ol
Minnesota Statutes and Ci of Eag n Ordinances APC Parks
Signature of Permittee Var. Date Copies
Total $2 ,149 . 00
A Building Permit is issued to: LACR IX BUTtM-R$ INC on ihe express condition ihat
all work shall be tlone in accordance with all apphcable State oJ~Miqn~ta Statutes a d Ciry o Ea an Ordinances.
Building Oflicial ~
~9
oto =V
372° _0+
3G=30+
17E==3 +
-7= +
5_C=^0+
63-S0i
79.;=~Oi
1S6a„0+
22149=-0::
1986 BOILDING PERFIIY APPLICATIOH - CITY OF EAG9N 4
~ .
BOTE: ALL CONTRACTORS MQST BE LICENSED WIT9 THE CITY OF EAGAN
SIRGLE FAFIILY DIiELLIAGS ~'"e y J
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS
FIULTIPLE DWELLINGS - RESIDENTIAL RENTgI.iJNITS FOR S6LE IINITS
INCLUDE 2 SETS OF PLANS, CERTIFIC9TE OF SORVEY - CHECB iiITA BLDG. DEPT.,
1 SET OF ENERGY CALCULATIONS
COlMERCI9L
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONS,
$2,000 LANDSCAPE BOND
To Be Used For: J(A ~m~~~~ Valuation: Date:
Site Address OFFICE QSE ONLY
Lot / Block Erect ~ Occupancy j
i'!?rollw-p ;~r)~ Th,•'n Remodel _ Zoning ~
Parcel/Sub ~ Repair _ Type of Const 37,(/
140~ Addition f~ of Stories
Owner Move _ Length ~51
Demolish _ Depth Ve1
Address Int.impr. _ Sq Ft
Install _
City/Zip Code
Phone APPROVAIS FEFS
Contractor J- ~ C rut~ /3 Assessments Permit 352
Water/Sewer Surcharge
Address ga' 'kAc Gr
jG~ Police Plan Review 17ro
Fire SAC -o S
City/Zip Code Engr Water Conn 5/-A0
f~ Planner Water Meter c~.m
Phone Or Council Road Unit ?q/j
Bldg Off 6 3 Treatment Pl
Mch./Engr. APC Parks
Variance Copies
Address 'fOT9L .421 j Zp~r
r- ~
City/Zip Code
Phone 41
NOTE: ADDRESSES FOR CORNEB LOTS - CONTRACYOR/H0IlEOiINER NOST DESIGNATE WHICH ADDRESS
IS DESIRED. NO CHANGFS WILL BE ALLOi1ED ONCE BQILDING PEEt1iIY IS ISSQED.
z~ ~3g Z 7q8 1-1608U
l1. ~ lv ~ 216 x 54'~= 1?-D- 7s ,
44
1 .
5 Z9
\O~ 1'L z lZ~ lZZ
7 Z93~v , Oti
' UIGMA
F 8UAVEYINO House Cerflflcate For :
SEiaVICE9
3908 Sibley Memorial Highway La Cf'oix Bullders
Eagan. Minnesota 55122
Phone: (612) 452•3077
a~'~ 01
~Co a`^NoRTH WOOD G ATE L A N~Fv_ _
q .
_:;.ynn=aeaT:..,...: . ,._.....:i:h,,:s :.:,..:i.qA.:~•.~~n''r.w.vt~+ ' .K,+6;. ..nyFn'¢r»>i::rcF¢ifa~. p
~ ~15:...,...i: .
l n;+A ..:s'~..+.+,'f ;'~k~•.+~j i3 0'~~~ R
13,Oy
S 0 ° I 1,5 9nEa;
-N
0 ~:i. ~ _ y
m ~ r~ - m •lr
xq335 p3'%114 ~ i ~o4~M4 q~e~ io Cq,aX9S3p
r n.o 33.~} :0
z
,.~~e.
6Z
ic.o GARR6~dr /i, ~,~y, O GP~Gg I
l A
o
- Zgor =r
0j~/ j k9i19 ~ _ _ ' OS~
I yy94 C~~
g/ /A :604
J I 0 U S /P! 5
,(e9fty ~ fjIS.o_ p I c
w~ q IE
x W rl I; 3
q3oi
.
'I
Fd LOT 7 O 7- C
o ~I li o \'ONE~so~u~//,i
c~ ml I p~ ,,o
Gp ap . c~ •
c
WAYNE D.
z o 1 Ic CORDES =
'•-14675-' _
' 4~'- - - - _ _ _ - - ° - ti •y~: ,
N0D II ,59II . •q~~lp/pl(tllllll'1111UH\\~~~.
W 85.00 -
x-x-
~ ~S~w~~a ~.>RL!,k
E Freewa.~ RIW
Scale: 1"=30'
CX
-LEGEND _ PROPOSED GARAGE FLDOR ELEVA TION=
O Denotes Iron MaK.m'nt PROPOSED Top o1 Block ELEVAiION=
m Denotes Wocd Hub Set PROPOSED HASEMENT FLOOR fLEVAilON= 9Z9.3 WIO
x 924-0 Denotes Exisfirg Spot Elevation Lower 6S,+A-, Flaor C-Ae\j. = 925,3
~ Verify all floor heights with Final House a
(„~o a Denotes Proposed Spot Elevation
,,~(knotes Drainage Directran agAy(,RS (ERTIFfC0I10rI-
I hereby certify thet this survey, plan or report
_p1OPE17?y LESCRlPfIGNI- was prepered by me or urder my direct supervisicn
LOT L,,oLocK 1 ard that 1 am a duly Registered Lard Surveyor
wNer the laws of fhe State of Yinnesofa.
Lto PARK RD ADDITSflN I
the recorded plat thereof, Date: ~
~~fy, Mimesota Wayre D. Cordes, Ninn. Reg. No. 14575
{Zw:Se~.: {~ouSE O~MENS~or.~5 ~ ST0.KE EWVqtIpNS 6J9~°
~ EXTERIOR ENYEL"OPE AVERAGE "U".COMPUTATION
•ONNER
SITE AOORESS
t,ILcr> ~ r RL 1
CONTRACTOR - hp,f, DATE PHONE i - 7 18 xSf -249~
Determine working square footage of each, ~ 1. Total exposed wall area 66•l 4- Sq. ft. x ,11 ~ TO .z
2. Totel roof/ceilimg area t t( D. 0d Sq, ft, a ,0~~• ~
Total exposed r;all area above floor • fl,~~-SZ ~
a. Total wail window area l0 7~3~
b, Total door area
c, Tota1 sliding ylass door area ~
d. Total fireplace wall area........................
-
e, Total wall framiny area (average 10%),,..,,,,,.,, f 9
f, Total net wall area above floor
g, Total rim joist area j
Total e.eposed foundation area =
h. iotal foundation window area
~
i, Toal net foundatiun area above gra6e ~
Detcrmine "U" value of each u01 segment.
a, f07_3L_ x "U" _C 5f • 9_03
b, X "uu < !3 e 4.°1/
4 X "U" • 22~0/
a. ~ x ^u^ - •
e. X nVe < 049 • $:da
r. !3 03.~3 z °u° _oS~/ • 5^3.4 Z ,
9. <<3.-~~ x pu• . 6 ¢ • Y-sY
h , ---x--,1Utl
x^u° 3 •~D-o 9
3,.,......... ................Tota1
If item /3 1s the same as, or less than item 01, you have net the tntent
of SBC 6006(t)2r
r
. -
.
w ?otal exposed roof/ceiling area =
j. Tatal skyliqht area.......... • ,
k. Total roof/ceiling framing area (average 10%)...
1. Total net insulated roof/ceiling area........... rrl 4.~ U
Determine "U" value for each roof/celling segment.
J _ K ,lut, - . t
k. 1I "U" •
1' L(lDob x °u° ,0'8.f ' 27_71
a l,0......... Totat • / •7'
U
If total of 44 fs the same as, or less than 02, you have met the inten~ of
SBC 6006(<)1.
Alternate euilding Envelope Design
To utilize the total envelope system method, tne values established Dy the
sum of items #3 and Od shall not be greater than the sum of items Il and 02.
. ~
1, 2O^ ' 2, 2.7-7S~ OZ
3. lLZ_ U 2- + 4•,7'7S' _ r!
~
WEPJA CO. PLAN SERVICE
, EO ANOERSON
ARGHITlCTURAL DESIGNIN6 AND PLM1NNING
5397 Vppar 147M Sireet
P.PDIe Valley, Minnesota
ReslCence: O/fice:
423-5658 423-3775
Y
. . ` i ~
~ h 1 °.W
~ 25•00+
~
1990 BUILDING PERMZT APPLICATZON 0650+
CITY OF EAGAN 0• 50+
26•OU*+
SINGLE FAMILY DWELLINGS MULTIPLE DWELLINGS -
2 SETS OF PLANS 2 SETS OF PI.ANS 2 SETS OF ARCHITECTURAL
3 REGISTERED SITE SURVEYS REGISTERED SITE SURVEYS - & STRUCTURAL PLANS
1 SET OF ENERGY CALCULATIONS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS
1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS
# OF RENTAL UNITS
# OF FOR SALE UNITS
PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING DAY
OF MONTH IN WHICH REQUEST IS MADE.
LOT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED.
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS
DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN CONPLETED.
PERMIT MUST SHOk' A LICENSED PLUMBER.
To Be Used For: Valuation: Date:
Site Address ?j o - OFFICE USE ONLY
Lot Block I FEES
Occupancy
n/J Zoning
Parcel/Sub Actual Const Bldg. Permit ~S
Allowable Surcharge s 6
Ocaner # of stories Plan Review
Length SAC, City
Address ( jtj Depth SAC, MWCC
S.F. Total Water Conn
City/Zip Code "~I~L-~a?.i YV\ t~~ SS19Footprint S.F. Water Meter
Acct. Deposit
Phone On site sewage_ S/W Permit
On site well S/W Surcharge
Contractor S 2 4j M4TCC System _ Treatment P1.
City water _ Road Unit
Address PRV Park Ded.
Booster Pump _ Copies So
City/Zip Code SUBTOTAL
APPROVALS Penalty
Phone Planner TOTAL )$.•T(1
Council
Arch./Engr. Bldg. Off. ~rlLL
Variance
Address
City/Zip Code
Phone #
o.._
45•00+
1990 BUILDING PERMIT APPLICATIOr 1•0 0+
CITY OF EAGAN ~v 46 • 00*+
I
SINGLE FAMILY DWELLINGS MULTIPLE DWELLINGS COMERCIAL---'"'"'"'
2 SETS OF PLANS 2 SETS OF PLANS 2 SETS OF ARCHITECTURAL
3 REGISTERED SITE SURVEYS REGISTERED SITE SURVEYS - & STRUCTURAL PLANS
1 SET OF ENERGY CALCULATIONS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIOA'S
1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGI CALCS
# OF RENTAL UNITS
# OF FOR SALE UNITS
PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKE? UP BY LAST WORKING DAY
OF MONTH IN WHICH REQUEST IS MADE.
LOT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED.
NOTE: ADDRESSES FOR CDRNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS
DESIRED.' NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED
PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED.
PERMIT MUST SHOW A LICENSED PLUMBER.
( l GAtq At-c ~
To Be Used For: I 4.q~,a I Valuation: ~ Date: ~_JS-I
Site Address ~A321 J)--) L4~9-•r~~i~4x= OFFICE USE ONLY
Lot ~ B1ock _L FEES
Occupancy M
Zoning
Parcel/Sub ~lrd, Jrk Actual Const Sldg. Permit
Allowable Surcharge OD
Owner qJ31,Sc,~ # of stories Plan Review
Length ~ SAC, City
Address _~14R, N u)'~L Depth 8 SAC, MIJCC
S.F. Tota1 Water Conn
City/Zip Code cjAryAV_~ J`(\~ C"'1'99 Footprint S.F. Water Meter
Acct. Deposit
Phone n'2 On site sewage_ 5/W Permit
On site we11 S/W Surcharge
Contractor g J\ pL U'e MWCC System _ Treatment Pl.
City water Road Unit
Address PRV park Ded.
Booster Pump Copies
City/Zip Code SUBTOTAL
APPROVALS Penalty
Phone Planner TOTAL 4 0) W
Council '
Arch./Engr. B1dg. Off. $/Zo
Variance
Address
City/Zip Code
Phone ~
- r
AV
~
I2e X /5
810 MA
9UFiVEY1N0 ' House Certfflcate For :
6EAVICE8
3908 Sibley Memorlal Highway ~a ~ro1x Bullders
Eagan, Minnesota 55122
Phone: (612) 452-3077
a"'~ 01
NaRTN WOOD G ATE L A N _
~ 'l'3~n6 t~~. ?5\ O
F - q•y (,Gq,S .
.::ucnn4•/a'n:y,.... 1....... u}Inti".'.:`..i.lt'v,AN.w~ ~
y..y,..~t:.g~ ' .q:~f' wv . RM~«tttt"'ye~x:ila:. • I
ce..creta G..~b _ _ _ _ _ ~ _ 13.04~ i .T'A• ii 13 _ - _ .~i - _ _
SO°If '59~~ ~:.00?
r--- _ - . i
91
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q / I6.o ?RP ~
GAP V, ~ ~
o t zan ~ I
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p~f IM 5
o// xqb''~' I e
,~.f k ul If:o- x ~
q~'y W I °~tia~ I E
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x W rl I; 3
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r
Fi _0D ~i LOT 7 j;
~ V,I
0 o r.~ j ? !3 { !
Of 0~ ~ pi ,,c` . f;
a I I y
2 i
e~
°;''~fllrc
ttl„r
,
N0°1f'59"W 85.00
I
Fe..cn
~Z-~ I- 35 E Freewa, fZIW
Scale: 1"=30' ~ i
-LEGEND PROPOSED GARAGE FLOOR ELEVAT ION= `133•
O Denotes Irch MorNnent PfdOPOSED Top of 8fack ELEVATIONe '`133.3
a Denotes Woa1 Htb Set ~ PROPOSED BASEYENi FLOOR ELEVATION= 9Z9.3 Wlp
x 9iY.o Lower g5~. F{nor Ueo, - 975'.3
Denotes Exisfirg Spot Elevation NpTE: Verify all /laor hei9hts with Fina! Haae PTans-
(A$-40W4 Denotes Proposed Spot Elevafion
Denotes Drainage Direction JUREM ,(MIFIC91
1 hereby certify thet this survey, plan or report
_PROPERTy DESCR1PT1ON- wes prepered by me or iuder my direct supervisich
LOT 7~,BLCYK 1 erd thet ! am a duly Registered LaM Surveyor
urder fhe lews of tM State of Yirmesota.
MALLARD PARK THIRD ADDITION
accordirg to ihe reccrded plat thereot, Da1e: ~11 5 186
Dakota
County, Yimesote WaYre 0. Cordes, Yinn. Heg. No. I4575
11
R~J:Se~: ryO~SE ~1MEISIarJ3 ~ $T0.KE ELGV/{j~pys `~9~e
~*******#***********t#t**#***#***#*q
C I T Y O F E A G A N PAYMF'nT~ OF FF~ AT TII~ pF k
* ArrzscATIoN DoFS NoT cONsrricjim :
* APPROVAL OF PFRhffT. *
APPLICATION FOR PERMIT * *
* INSPFX.TION OF SESM AAID/Ot WA'g1t *t
,*F INS^TAT.TATTONS WILL NcYP BE 5(E1E1>- *
SEWER AND/OR WATER CONNECTION ~IIIID DNPII. PII2MIT HAS BFEN . *
* APPF20VID. x
* •
» *
r *
. »*ar:*~srt**+i.y.k,.:i.rwx,ta+~:rr-rt:fyr*t+
P.lease Print)
1) PROPERTY ADDRESS : /as N A4n 1Q Y _
LEGAL DESCRIPTION: -X
Lot Block Su division or Tax Parce ID )
IF EXISTING STRC'GZURE, DATE OF ORIGINAL BUILDINGPERMIT ISSL`FaNCE: •
PRFSENP ZONIi4G/pgOPpSID C'SE: (D'bn Year ,
rz CQMMERCIAL/RETpIL/OFFICE M R-1 SSNGLE FAMILY
Q IDIDCSTRIAL 0 R-2 DOPLEX (T.,p IInits)
f-I INSTITUTIONaL/GpVII2N,+ENT D R-3 TOWDII30USE (Three + Units ) ( LTnits ) '
R-4 APARTMENT/COIv'DOMINIUM ( Units)
2) ~
NAME: Xlok. -
AwDREss:~ u ~ ago-r. 9 7 -
CITY, STATE, ZIP:n 6/.~4,9, m~ ~7( n
PHOLNE: ~
3) • u NANE For City C~se
y''FNIZFt MFCHANICAL
ADDRESS: Plimibers License:
3500 I(r*NNEuEC DAIYE. £AGAY, hlINN.55122 P,CtiVe
CIT1', STATE, ZIP: " ExP1red
Not recorded
PHONE: MASTER LICEIdSE# 001445M2
St Snitlal
4) ~a• • ~ i~- p
idAME:_
_ P,DDRESS: ,
CIT'Y. SI'ATE, ZIP:
PHONE: .
'S) ~ r• i i .
• : ~ •
X~] CONNECPION Zv'CITY SEf+1E2 Q. CpNNEGTION TO CITY WATER ~ pniER ,
6) ' Q PLFASE HOLD APPROVFD PERMTT FbR PICK-UP BY ONE OF ABOVE
0, PLEASE MAIL APPROVfD PEE2MIT TO 1, 2, 3, q, pgpvE
~
71 (Circle one) '
r. ~u• • .~/Y(.r ~'7.! LL 1~ 7
: 7: ~~c' •~.i_ w ~ ~ ~
„ ~ r ~
1 I Y
-
F'OR CITY USE ONLY 'PERMIT $ ZSSCED
/
Pd w/Bldg. Permit FEES:
$ $ SEWER PERMIT (INCLDDE SURCHARGE)
$ S SU WATER PERMIT (INCLUDE SURCHARGE)
$ lD~ ~D $ WATER METER/COPPERHORN/O[,'TSZDE READER
$ $ WATER TAP (INCLUDE CORPORATION STOP)
$ $ SEWER TAP
$ $ /S dD ACCOUN7' DEPOSIT - SEWER
$ $ ACCOONT DEPOSIT - WATER
$ SD ~ U S wAc
s 57s. c-O $ sAC .
$ $ TRI}NK WATER ASSESSMENT
S S TR[)NK SEWER ASSESSMENT
$ $ LATERAL BENEFIT/TRUNK SEWER
$ $ LATERAL BENEFIT/TRUVK WATER
S DU $ WATER TREATMENT PL::1NT SURCHARGE
$ $ OTHER:
$ ij 9q .50 s :51, f~Z) TOTAL
1~611~ 8'..
RECEIPT r RECETPT n
DOES UTILITY CONNECTZON REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
~ YES IF YES, THEN A"PERMIT FOR WORK WITHIN PUBLIC
Q ROADWAY" MUST BE ISSUED BY THE ENGINEE3'tING
NO DIVISION. LIST AS A CONDITION.
SOSJECT TO THE FOLLOWING CONDITIONS:
APPROVED BY:
,i - - TITLE:
DATE : -2-
6 . .
2005 RESIDENTIAL MECHANICAL PERMIT APPLICATION
~ City Of Eagan ~
3830 Pilot Knob Road, Eagan MN 55122
0 Telephone # 651-675-5675
Please complete for: single family dwellings & townhomes/condos when permits are required for each unit
Date C,/, / / Y / j EO
Site Address Q Unit #
Property Owner Q~ Telephone #(6s1 z9oCS3 k
Contractor SEDGVYICKHEATING3AIRCONDRIONINGLLC
Street Address Minneapolis. MN 55420 City
State Zip Telephone # ( )
Bond Expires:
The Applicant is _ Owner ZContrac[or _ Other
Add-on or alteration to existingdIling unit $ 30.00
1/ furnace _Anal~ ? Replacement _ New
air exchanger q
y/' air conditioner
heat pump
other
State Surcharge $ .50
Total $ .~`.LL~b
t hereby apply for a Residential Mechanical Permit and acknowledge that the information is complete and accurate; that the work will
be in conformance with the ordinances and codes of the Ciry of Eagan and with the Mechanical Codes; 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 [he work will be in accordance with the
approved plan io the case of work which requires a review and approval of planC-~l .
SEDGWICK HEATING & AIR CONDITIU~dNG LLC
c.
Applicant's Signature /
ApplicanYs Pr ~S MN 55420
eapo
Minn
(952) 881-9000
2005 COMMERCIAL MECHANICAL PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please compkte for. commerciaUindustrial buildings
multi-family buildings when separate pertnits are not required for each dwdling unit
Date
Site Street Address Unit #
Tenant Name (ifapplicable) Previous Tenant Name
Property Owner Telephone # ( )
Contractor 1• A „ ` _ '
Street Address ' `'~City • ~
State Zip Telephone # ( )
Bond Expires:
The Applicant is _ Owner _ ConVactor _ Other
WorkType
New Construction _ Underground Tank _ Install _Remove "see befow
Interior Improvement _ Install Piping _Processed _Gas
Nature of Work:
"When installing/removing underground tank, call for inspection by Fire Marshal and Plumbing /nspector
Permit Fees: $70.50 Underground tanA installation/¢moval
550.50 Mirtimum (includes $tatt Surehargc)
or
Contract Value $ x I% Permit Fee
$ State Surcharge
If nermit fee is less than 51,000, add 5.50
If ermit fee is more than $1,000, surcharge
is 5.50 for every S 1,000 owed.
$ Total Fee
1 hereby appiy for a Commercial Mechanical 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 with the Mechanical Codes, that [ understand this is
not a permit, but only an applica[ion for a permit, and work is not to start withou[ a permit; that [he work will be in accordance wi[h
the approved plan in the cue of work which requires a review and approval of plans.
Applicant's Printed Name Applicant's Signature ~ .
Approved By: , Inspector Date:
Required inspections: - U.G. _ R.I. - Air 7'est - Gas Service Test - Infloor Heat _ Final
zoo,6
2WRESIDENTIAL PLUMBING PERMIT APPLICATION S3
~ CITY OF EAGAN
~a3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings.
Date I /
Site Street Address 14 3 ~ IAj B Lf3-rl Unit #
Property Owner I r i i Lh a P ~ ~IC90 ~ Telephone # (651) 3(,, S~ G Z
contrector n1C7- Telephone #(661)
~ 3 ~ 99
Address St-~ti 4 vff ziP i
The Applicant is: _ Owner ~Contrector _Other
Alterations to existing dweliing $ 50.00
_Add fixtures to rooms, excluding water softener and water heater
_Septic System Abandonment
_Water Turnaround (add $121.00 if a 5/8" meter is required)
Other:
_ Water Softener ~ Water Heater $ 15.00
replacement _ additional
Lawn Irrigation System RPZ_ new _ repair _rebuild $ 30.00
State Surcharge $ 50
Total $ N.
~n
I hereby apply for a Residential Plumbing 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 plumbing codes; that I understand this is not a permit, but only an application for a
permit, work is not to start without a permit and work will b in accordance with the approved plan in
the event , o a plan is required to be reviewed and approve
~1 • I II&L~z
ApplicanYs Printed Name Applicant's Signature
1
~ q0 , cr0 4 S57
gain,
~
Clty of Ea18Il i`8""~` 0- Is-
3830 Pilot Knob Road ~ Permit Fee: ~
Eagan MN 55122 j Date Recerved: j
Phone: (651) 675-5675 i i
Fax: (651) 675-5694 I Statt: I
I L - - - - - - - - - - - - - - - - -
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
, Date: ~ V v Site Address: ~ f Aly))ia/ Af
Tenant: Sulte
RESIDENTIOWNER Name: I Phone:
Address / Ciry / Zip:
Applicant is: _ Owner ~ Contractor
TYPE OF WORK Description of work: ~
Construction Cost: ~,~~0 Multi-Family Building: (Yes N_j
CONTRACTOR Name: H License d()~Rg-1 C7-1
Address: iCd
ciry: &H ' ~(k~7i er state: MIV zip: S`J' 0O0
Phone: (2)CJI ContactPerson: KQreO
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
_ Minnesota Rules 7670 Cateoorv 1 Minnesota Rules 7672
Energy Code . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
Category subrnined submined
(4 submissiOn type) • Energy Envelope Calculations Submitled
In the last 12 months, has the City of Eagan fssu0d a permit for a simllar plen based on a master plan?
_Yes _NO If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE:
_
wtheSinlorni $lans and "sopporting do¢umenfs;that you:submlfaie con`sldered~to,b'epubllc7nform'atfon. ,P_ortlons,o6~=
ation may be~ctassHled~as non,pubNc ~f y,ou; rovide spec~c reasoos,'fliat wo~uuld permif flie City,to~;;;
~o n a.P" tff- °¢.,~Sf~:ai.m ai,.=t;") :$zET%~^"w'",,.nP2 ~r~.Yrf•463`. ~°°~.?#n_i~ti~'COIlO~Ii(~B.[~78'~tliB BfE~%B~~SEC(E1S.lk<'.°_A~- ,r. ...7.8z x.is ,~3~3.``'3
I hereby acknowledge thal this infortnation is complete and accurate; that the wark will be in conformance with Ihe ordinances antl codes of the City of
Eagan; Ihat I understand Ihis is no1 a permit, but only an applicalion tor a permit, and work is not to staA withoul a pertnit ihat the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
x x `-'/L
Applicant's Printe Name Applicant's Sign ure
Page 1 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA132797
Date Issued:09/04/2015
Permit Category:ePermit
Site Address: 4381 Woodgate Lane N
Lot:7 Block: 1 Addition: Mallard Park 3rd
PID:10-47252-01-070
Use:
Description:
Sub Type:Reroof & Siding
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and house wrap and leave on site.
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: 8,000.00
Fee Summary:BL - Base Fee $8K $162.25 0801.4085
Surcharge - Based on Valuation $8K $4.00 9001.2195
$166.25 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Michael W Good
4381 Woodgate Lane N
Eagan MN 55122
Sela Roofing Remodeling
4100 Excelsior Blvd
St. Louis Park MN 55416
(612) 823-8046
Applicant/Permitee: Signature Issued By: Signature