847 Ventnor Ave
; CITY OF EAGAN Permit No: Date: -8$
; 3830 Pilbt Knob Road Meter No:
P.O.'Box 21199 ------r- Size: .
~ Eagan, MN 55121 Reader No: Date:
~ Owner. Frontier Midwest
f Site Address: 47 Ven[noX Avenue 130 p4 Staf£ord PZace
Plumber. Star Plumbin
i
Conn. Chg: 550. OQnd Zoning: n7 ~
Acct Dep:_ 15. OQpd No. of Units: ~
Permit Fee: - 10 . OOnd
Surcharee: •50pa 1 agree to comply wi , i
Tr. Plant- ?04 .OOpd ~
~ Meter. Ordinances. o1 Eagan
Misc.:
ey -
WATER SAVME pERMIT
I
CITY OF LAGAN Permit No:10~6y: Date: 7-77_RR ~
3838 Pibt Knob"Road B/P No: ~S~FP pate: 7-25-R.S
P.O„8ox 21199
Eagan, MN 55112110
Owner.- PIrontier *ti~wee 1
Site Address: 847Ventnor Aven;;e L34 14 • t ;
Plumber. Star Plwabin
MWGC: 550.00pd Zoning• F1
c~~ cn ~'3fl • r: cI Pd
9: No. of Units:
Acct Dep: ' ' p,~ i
Permit Fee: ' pd I agree to comply wfth the City oi Eagan ,
~ tvil ~~inances.
Surcharge:
~ Misc.: By ;
SEVNIER SERVICE PERMIT '
- _ ,
. CITY QF EAGAN s~''
3830 Pllot Knob Road, P.O. Box 21 •199, Esgan, MN 55121
PHON E: 454-8100
BUILDING PERMIT Recetpt ~c
Tobeusedfor t)W~/C;A" Est.Value `.~7'V•'i~X~ Date J~"1.'~ ~S ,19
Site Address -iT,, ' 'R V OFFICE USE ONLY
Lot Block • Sec/Sub. STA}F'iJr.;) nLpG:: OnSke3ewaqe Occupancy '•-'~'}"1
MWCC System Zoninq ~-1
ParCelNo. OnSfteWell (ACtuaqConat V--t.
a Name i!N~?'c; S~' ~lOMF5 Cfry Weter x (Allowable) V-N
W PRV Required * of Storiea
= Addre33 t~ti~VALL BR ~
o Booster Pump Lenqth
City ` nPhone 456-U433
Depth 47'
, p Name v-a S.F. Total
~ ~ Address Footprint S.F.
C
City Phane APPROVALS FEES
v W Engr./Assess. Permit '•7i.• . tl~'
~ W Name plqnner Surcharge
~z Address
Council Plan Review
i W City Phone
Bidg. Off. SAC, City
~
I hereby acknowledpe that I have read this application and state that the Variance SAC, MWCC -
information is correct and agree to comply with all appliceble State ot Water Conn. - `
Minnesota Statutes and City ol Eagan Ordinances. ,
Water Meter
Signature of Permidee _ J= Road Unit
A Building Permit is iasued to: Treatment P1
on the express condition thet all work shall be done in accordance with ell
applicable State of Minnesota Statutes and City of Eagan Ordinances. Perks i
'
Building OfficiaL TOTAL
_ . - - I
~
_ Wrmit No. Permit Holder Date TeIephone i
Plumbing ~ 1 S ~
H.VAC.
Etectric
Softener
Inspoctlon Dab Insp. Comments
Footings I K/,g
Footings II
Foundation
Framing
Roofing ~(,~C/r i~ cTd?S/~ -
Rough Plbg.
Rough Htg. ~ I&V
Isul.
Fireplace
Final Htg. ~
Final Pibg.
Bldg. Final
Cert OCC. /j
Temp. lP
Deck Ftg.
, DeCk Final
Well
Pr. Disp.
• • - ' • ~ ~ ~
PLUMBING PERMIT PERMIT #
RECEIPT #
CITY DF EAf3AN
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE:
CONTRACT PRICE PHONE: 451-6100
Site Address -`f ~V BLDG. TYPE WORK DESCRIPTION
Lot ZC Block SeciSub Res. New
)4, 1. 11 ..y 1 Mult Add-on
~ Name FJoi1Le1 :'I6CtlaLlj.CHi Comm. Repair
~o Address 1959 Snsvuer R u Other
c City ~'-•jjd~z Phone k51-1.i65 RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
t~0. FIXTURES TOTAL
I~'rontier tivm~..i Water Closet -$3.00
~ Name 1_.Bath Tubs - $3.00
; Address ay08 S:bie • h.em. Hk'Y 1 ;
Lavatory - $3.00
p Ciry Phone ~Shower - $3.00
~Kitchen Sink - $3.00
FEES Urinal/Bidet - $3.00
COMM/1ND FEE - 1% OF CONTRACT FEE ~ Laundry Tray -$3.00
APT BLDGS - COMM RATE APPLIES ~Floor Drams -$1.50
TOWNHOUSE & CONDO - RES. RATE APPLIES .~-Water Heater -$1.50 1 511
MINIMUM - RESIDENTIAL FEE - $12.00 Whirlpool - $3.00
MINIMUM - COMM/1ND FEE -$20_00 T-Gas Piping Outlets -$1.50 1. 50
STATE SURCHARGE PER PERMIT - .50 (MINIMUM - 1 PER PERMIn
(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 4 •
SIGNATURE OF PERMITTEE FEE:
. t
STATE S/C:
~ .~J •
FOR: CITY OF EAGAN GRAND TOTAL•
f
, PERMIT #
' . MECHANICAL PERMIT RECEIPT #
CITY OF EAGAN
3830 PILOT KN08 ROAD, EA(iAN, MN 55122 DATE:
CONTRACT PRICE PHONE: 454-8100 ->>~C
Site Adlress gLDG, TypE WORK DESCRIPTION
Lot Block ~ Sec/Sub Res. New
,
m Name ' . 1 11 r' . Mult Add-on
Address Comm. Repair
A C n,J Other
c City f ? Phone 5,
FEES
Name RES. HVAC 0-100 M BTU - $24.00
c Address ~ -v 4~f'~ ~~r~'•c' ADDITIONAL 50 M BTU - 6.00
p City - Phone ~ 3 (RES. HVAC INCLUDES A/C ON NEW
CONSTRUCTION)
GAS OUTLETS (MINIMUM -1 PER PEHMIll) - 1.50 EA.
TYPE OF WORK COMM/IND FEE - 1% OF CONTRACT FEE
Forced Air ='~f M BTU - APT. BLDGS. - COMM. RATE APPUES
TOWNHOUSE 8 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
Vent CFM STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMtT PRICE GOES
Gas Piping OuUets # BEYOND $1,000)
Other
.
FEE P
S/C: ~ SIGNATURE OF PERMITTEE
TOTAL•
FOR: CITY OF EAGAN
CITY OF EAGAN -42 17725
' 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE:454-8100 i ,
6UILDING R,ERMIT Receipt # --r ' G
To be wed fo~ Est. Value =1.000 Date APR »
Site Acliress 847 VENTNOR AVE
~ LOt 30 BIOCk 4 Sec/Sub. ST~MRD pLACE OFFICE USE ONLY
Parcel No. occuoancv - FEEs
, zoning
W Name CW TAKWUZNO (ActuaqConst _ BIdg.Permit 25•00
~ Address $47 VENMt AVE (AUOwable) _
p Clt~/ Phone +Y o( Stories ~rcharge
Lenglh t%W 12M Plan Review
p Name SAM Depth lmw JOD SAG City
Address S.F. Total
U~ City Phone S.F. FootpriMS _ SAC, MCWCC
~ On Site Sewage _ Waler Conn
Ulu W W Name On Site Well - Water Meter
Address Mwcc 5ystem _
i W City Phone Ciry Water _ ~t. Deposit
PRV Required - S/W Permit
I hereby acknowlege that I have read this application and state that the Booster Pump - gryy Surcharge
information is correct and agree to comply with all applicable State oi
Minnesota Slalutes and City f agan(Or ' Tne.&,. Treaimem PI
Signature of Perm~ +4PPROvALS Rpad Unit
A Building Permit is issued to: MU TP"RNIND Planner - Park Ded.
on the express condition that all work shall be done in accordance with all Cauncil
applicable Stata of Minnesota Statutes and City of Eagan Ordinances. gidg, pry. _ CoPies
BuildingOfficial Vanance - TOTAL 25•50
Pwnk No_ Permit Holdar Date Talephone N
WATER
SEWER
PLUMBiNG
H.VAC.
EIECTRIC
kn"ction Date Inap. Comments
Fodings I
Foundetion
Framing
Roofi^9
Rough Pb9•
Ra+9h Htg•
W.
FrePlace
Final H1g.
Fnal Plbg.
Consl. Meter PICg. hmpedor - Nod(y Plumber
EngrlPlan
8{dg. Final
Deck Ftg.
Deck F~nai !~;~y •'sr ~i~
weli
Pr. asp.
CITY OF EAGAN + ~
I
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHON E: 454-8100
BUILDING PERMIT Receipt ~
To be uAed for SP' iltitGIGAB Est Velue $74.000 Date JLLY 26,19 J8
Site Address $47 V$IiT2V(JR AVf OFFICE USE ONLY
Dn Site Sewaqe Occupancy R-3 M-~
Lot 30~Block 4 Sec/Sub. STA!'FURD Pt.ACB
MWCC 3yatem X Zonlny R-'1
Parcel NO. On 5ite Well (Actual) Const V-44
a Name FRON3'IER MID{rES'C HOM$5 Citywater ~(nllowable) V-N
z Address 3902 CEDA3YALE Dit PRV Required ~ ot Stories
3 Booster Pump Length 434
0 Ci E/1(',AN Phone ~+54-J433
Depth 470
, p Name SA2~sE S.F. Total
~ ~ Aldress Footprint S.F.
~ City
Phone APPROVALS FEES
~a Engr./ASSess. Perm{t 47V.U~
, W Name
Planner Surcnarge 37. f'0
fess 23S.Ut,
¢ Z Cit Phone Council Plan Review ~
~ W Y Bldg. Off. SAC, City 100.00
550.00
1 hereby a&powledge that I have read this application and state that the Variance SAC, MWCC
infbrmation is correct end agree to comply with all appllcable 5tate of Water Conn. 550•0101
Minnesota Statyjes and City of Eagan Ordinances. 67.00
Water Meter S(phature of Permittee _ 325.00
• Road Unit
A BLllding Permlt fs isaued to: ~ROliTIEbi MlaY&ST Treatment P1 204.00
on the egpress conditlon that all work shall be done In accordance with all
appllcable State of Minnesota Statutes and City of Eagan Ordinances. Parks
BulldingOfficial TOTAL 2, 3$•00
CASH RECEIPT ~
CITY QF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MINNES07A 55122
DATE
•
f L I r
REF~
~
AMOUNT
& DOLLARS
IOD
? CASH ~(I CHECK
wa
V r ? . ; ~.r~
r.. f
~ ! -..4 ~ r.. rt { ~ ~ L. ~ l~• ( ~ ~ ' ~
FUND OBJEGT AMOUNT
~
~
Thank You -
r BY ~ r - ~
Whit--Payera Copy I
~,p ~ f• ~ Ye1bw-Postiny Copy
Pink-Ffle Cppy
m 1d 6 c4-,7 c,4 -i
4 5 2 6 0 d3C) a 4 ~ wm Fe t Oat Fire No ~qfady Now ~NYI'I Nnlifv Inspec-
lor Whnn Roady
5~censed Elecvical Conlracmi I hereby request inspaction oi ebove
? Owner electricol work insellad at:
Sv Addr ssoa or Foute No. C.ly
7 Q4N
ecuon o. Townsh,o Nmmc or No. RnnBe No. Co:y
Oc u am (P INT) 'S-r Phun• No.
Paw ppller Atldress
Becincal Cnntractor ICOmVeny Namel Contrar.m,*s LiCCnse No.
9
Mai m AtlJress C"af onUacto aT Makine lnstallationl
1~540 PEIVIVOCK LANE
~ ~a,ctar/iOr7nLn~~~iNy~~stallationi Phone Num~cr
1v11V J !
TNIS INSPECTION HEUUEST WILL NOT
MINNESOTA STATE 90AND OF EI.ECTflICiTY BE ACGEPTED BV THE STATE BOAHD
GriB9s-Midwey Bldg. - Aoom N•191 UNLESS PflOPEA INSPECTION FEE IS
1821 Universitv Ave.. St. Pnul. MN 55104 ENCLOSED.
Ghone 16121 6420800
q/7REQUEST FOR ELECTRICAL INSPECTION nea-ooooi-os
~ Soe insvucliens 1or completine tnis form on bnck of vallow copv.
"X" Below Woik Cavered by 7his Request
E 45260 "
na n,o. rvoa of amm.ne AValioncm wi,aa eaunum,e.t w„ed
Home Fanye Temporary Service
Duplex Water H¢aler Iqhtinp Fizture5 ApL BwlAinq Drye, Electnc Heatm
Cominercial Bldy. mace SiIU Unloader
InduStrial Bldg Air Conditioner Bulk Milk Tank
Fdlfil ISVCr.ilvl
~ e~ uer.i v ~hee O,M1Cr
ompute lnspectron Fee Below
p fee ServicaENrance5ize h Fee Fexders/Subfexdereov Grcu'ts
U to 200 qm s 0 to 30 Am s tn 30 Am s
r~bove 200 Amps 31 to 100 Amps 1 to 100 Am s
Swimminy Pool Above 100-Above 100 mP~
Tranyrormers Irrigauon Boon~s ertial. thei Fe
Signs Special Inspection 0T ~E~A
Remirks
u h-m D~i~e
flo
B I, Ihe Elec~nwl
49 Insaeclor. haroby
certily thnt the abova
Final D^tr paction hes boen
17~' tle.
i ,•i . O
TNSrepuaslvoi018montlulrom ~ ~
BLDG. PERMIT NO.
.t 1 ~j 4 or'c~
01-3210 Bldg. Permit ~ 70 OC)
01-3422 Plan Check S CU
013445 r Surch./Adm. iu
~ 01-3446 SAC/Adm. s C)
~ 01-2155 Surcharge JA
~ 75-3860 Road Unit 00
l 20-2275 SAC
~ 203865 water Conn. 55U 6 U
~ 203868 Water Trmt.
~ 20-3716 Water Meter tc;-~
~ 20-2252 Acct. Dep. 30 (nO
20-3713 Water Permit to 00
203743 Sewer Permit ( o oc
79-3866 Sewer Conn. ~ O C ~d
28-3855 Park Ded.
TOTAL
C,), JBc~- cC
(grr#ifirtttr of Orrupttnry
Citp of (Eagan
Eepttrhnrtti of Building JnBpeclimc
This Cerrificate issued pursuartt ro the requirements ojSection 306 ojthe Unijorm Building
Code certijying that at the time oJissuance this slructure was in compliance with the various
ordinances aJ the City regulating building construction or use. For the fol(owing:
Ux CLssiF=uon e 7 Bldg. Rrmit N. o.-wzyrya R3/T.1 zonineoe~~n Ri rracan:t
r~~'
:.~:.~I3~ Tt S-.~ T. :i I:Li; S ~~'•D? ~C"`_il':~_'~ li,t, Lf
Ov.~ner of BmWi~ Addr~ .
E'.'~l QV~~'.`y fs':,7g iJp ~i1.4lrel+.'1i~ CS4.S`lw
BmlEing Atldrw ImLny
/
Di _
Bullding Ofrtnal
POST IN A CONSPICUOUS PLACE
CITY OF EAGAN NO- 1 5 3 8 5
• 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
BUILDING PERMIT PHONE:454•8100 Receipt n `8 J[~ p-p
~ O O
Tobeusedfor SF DWG/GAR Est.Value $74,000 Date JULY 26 ,1988
Site Address 847 VENTNOR AVE OFFICE USE ONLY
Lot_30 Block4 Sec/Sub. STAFFORD PLAGE OnSiteSewage _ OccuOancy R-3 M-1
MWCC System _ X 2oning R-1
Parcel No.
On Site Well _ (ACtual) Const V-N
~ Name FRONTIER MIDWEST HOMES City Water x_ (AUOwable) V-N
w
z Address 3902,'3 CEDARVALE DR PRV Required - # ol Stories
° Ciry EAGAN Phone 454-0433 Baoster Pump _ Length 43 '
Depth -4] 1
a NameSAME S.F.TOtal
0
~a Address Faotprint S F.
~ City Phone pppROVALS FEES
~ En r./ASSess Permit 470.00
ww Name 9 37.00
~z i - Address Planner SurCharge
u z Cit Phone Council Plan Review 235.00
aw Y
a BItlg.O1L SAG City 100.00
I hereby acknowledge ihat I have read this application and s te that the Variance SAC, MWCC 5$0.00
iNOrmation is correct and agree to comply with II ap i le State oi WaterConn 550.00
Minnesota StaNtes and Cit ol gan rtlinanc Water Meter 67.00
Signature of Permittee
Road unit 325.00
A Building Permd is issued to' FRONTIER MID Treatment Pt 204.00
on the express condition ihat all work shall be done in accordance with all parks
applicable State ot Minnesota Statutes .a~nyI~d~ City ot Eagan Ordinances z,538.00
BuildingOfficial MAfI- 1 li TOTAL
~
CITY OF EAGAN NO 17725
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE:454-8100 P 0
BUILDING
PERMIT Recei t a
To be used for ' DECK Est Value $1, 000 Date APR 17 ,~g 90
Site ACdress $47 VENTNOR AVE
Lot 30 Block 4 Sec/Sub. STAFFORD PLACE OFFICE USE ONLV
PdfCBI NO. Occupancy - FEFS
Zoning -
w Name GREG TAMRORNTNO (ACtuapConst _ eldq Permn 25.00
~ Address 847 VF.NTNOR nVF (Allowable) - Surcharge - 50
City F.A(;AN Phone +rof Siories -
Length UppeL 1200 Pian Review
iF Name SAME Deotn Lower 20x30 SnGCay
0,Q Address S.F.TOtal - SAC.MCWCC
~ City Phone SF Footprint5 _
On Sta Sewage - Waler Conn
F¢
Name On Sno woii
~w - Water Meter
si AddfeSS MWCCSyslem
aw C.IfY Phone Cay Waier _ Acci Deposit
PRV Required _ S/W Parmil
I hereby acknowlege Ihal I have read this application and slate that Ihe Booster Pump - SiW Surcharge
mlormalion is correct and agree to comply with all applicable State of
Minnesota Statutes and Cil Eaga Or mances Trealmem PI
Signature of Permitee i / APVHOVALS Road UnR
A Building Permit is issued to: GREG TAMBORNINO Pianner - park Dad.
on Ihe express condition that all work shall be done in accordance with all Council
applicable State of Minnesota Statutes and Ciry of Eagan Ordinances. BIdg.Olf. Copias
I
Building Oflicial Variance - TpTAL 25.50
l
1988 BUILDING PERMIT APPLICATION - CITY OF EAGAN
SINGLE FAMILY DWELLINGS
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICA ADDRESS
IS DESZRED. NO CHANGES WILL BE ALLOWED ONCE BIIILDING PERMIT IS ISSUED.
MULTIPLE DWELLINGS NENTAL ONITS FOR SALE UNITS U OF UNITS
INCLUDE 2 SETS OF PLANS, CERTIF2CATE OF SURVEY - CHECK WITH BLDG. DEPT.t
1 SET OF ENERGY CALCULATIONS
COMMERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS
To Be Used For: A) ~a,~ i~rnon~ Valuation: Date: c~1-i3-8 5S
Site Address L7 bkk6IQ pp OFFZCE USE ONLY
Lot ?~1 Block ~ On site sewage_ Occuoancy
MWCC system ? Zoning R-/
Parcel/Sub ~npy~Rp .~~~r On site well Actual Const
City water Allowable V~'?
Owner(apA~L~ KQa(,F,~,g ~ i"7 PRV required of stories
Booster Pump _ Length
Address 5f"~t~i Depth i, 3 3
sso~5 S.F. Total
City/Zip CodeGv-rN Footprint S.F.
Phone 5 I -OI /~13 a- ~I o~l a APPAOVALS FEES
Contractor FRONTIER MIDWEST HOMES CORP Engr/Assess Permit
. Planner Surcharge 3 7
Address 3902 CEDARVALE DRIVE Council Plan Review "Z3 S"
Bldg. Off. Jld 7/18 SAC, City
City/Zip Code EAGAN, MINNESOTA 55122 Variance SAC, MWCC 5,-
Water Conn
Phone 454-0433 Water Meter 47
8oad Unit 3zf
Arch./Engr.PHILLIPS PLAN SERVICE Treatment P1 20 y
Parks
Address 14530 PENNOCK AVENUE Copies
1 > >
City/Zip Code APPLE VALLEY. MIJ 55124 TOTAL -7
-
Phone 1l 43 -2044
~Qr. " ,
, • ~
y~a ~ a ~ c , `
< .
NOUS P
L~ ~
ID~~~ k Gz ~ ,ssi
---)3~~Sv
~
Hedlund Engineering Services 920IEaaiBloominaronFreeway
Bbominqton,Minneaota 55420
Land Surveyora Clvll Enpineers LonO Pianners Phone: 888-0289
~ surveforos G'ertlf "~cate
BOOK- PAGE-
- JOB N0. 9ea- 39 i
SURVEY FOR: Frontier b4idwest Homes Corporation
QESGRtBED AS: Lot 30, Block 4, STAFI'OF.D PLACE, City(\o P Ea g~~, ~a ~ n un y,
P4innesota and reserving easements of~.r.eco'
L ^ a
~5--
ti
~ ',AGAN E GI1VF~4j2aI~ DEPT
^ N
I OO_.
~ p^~' ~p;' / ~l N 1 a 30
05
2. i
!6 / Al
Z\8s9 , ~ j6 sar t,` 3
2C~ ~ 0 N
8q9.2 Q 10
' b \ ' 's ~ S•Qq,~ v~ / V
~O 90 ~ 'J 9 4/ "'0 fl \
m \ J
A
Z ~ \ `q• 'L
~ \T
HYO. (d N.U. Cr. oF' lo{. Elu.:901.41
TOP OF FOUNDATION
s,•GARAGE FLOOR = 9os.3
"o h BASEMENT FLOOR = 9az•5
SEWER SERVICE ELEV.
~ -105.6 pROPOSED ELEVATIONS : O
EXISTING ELEVATIONS :
lO°` DRAINAGE DIRECTIONS
\~n DENOTES LOT CORNERS : o a
CERTlF1CATE OF SURVEY DENOTES OFFSET STAKE: ? p~
I herab ctnif thot this surva ~
Y y y, plan or report Mos prspared by me or under my direct
suparvision ond that I am a duly Reqistered Land Surveyor under the laas oi th• ~
Stat• of Minnesota. ~
-I n a t e:
Jsff 4y0. L aren , Licens No. 14376
:I° 01 7
l:.. ~~GG'••••-,~•~]
, . _ . . . . - . _ IrN ~ s..`
_ Z~e v
SIT: AOCRESS: W7 Pi!Q::i: ~'`---0 433 - c'
COYTRACTuR•
pet_r,aine workiny ;quarc tao'_a,Ie-uF e:ich
^C _
1. TOG31 8Xp052d 'ddll area..... e._it-2•-- zzt-
F
2. 7ocai roof/cziling ares...... iia-
Tdtal exacsed •dai i arn,a ilmvr finar=
!
a. Total wail windc•.J area . . .
b. Total door a•es
C. Tota1 Sliaing ol.;ss daor arra 71.
d. Tctai `ir°plat: .:a!1 are= _
E. ICt3i 'd1lI iran:i:_ ~ Zra! (.:•:°7-~..r:e
.
iCtci rifi j0i5: dr?°
C. RE- N21l cr23 2CCY2 ;iCOr
h. w?11 crei zCov°_ "ir.Gr
i. wzil ar=_a abave `iccr
j. Yrame waii are: a: _`u=:n,=c.^
lbtal ex;c:eJ 7curdatiun area=_, -7 Z. k. Total foundatian window area -
l. Totai net ;oundztion ar:a a6cve qrade
Qzte,•mir.e „u" vaiue of eata w,'.l se•:ment
(e.(1.. nirccw, dcar, Cach sepiratr. wiil Se[tioa}
~
c. ;c °,j . _ ~ = i o , c: e?
= z
d. z`_ U ! - ~ .
e. 1 t~~7
f. iL-l c. x°u° kIY
g. ~v 4; •7 x °u° y.
h. X ~t, ,
. i . C l. u,. _
trICP.11
X •1i• ~ as, or less
k. d~l, Yov havl
S._ i7 X"U"__1`~ - 1C,c7inc?c, n.` 5i
3 . Tctal
' Tota; e.r__rse? Mo:/cc:I:-, a:e-- - Ilti i
d:e3 I 7-,
II. :C:3? 7..C!/C:-;-_7 !_=?..7Q Y':3 (SVC_.1jC 2.7L)...
. a. To:al r.et _as•iaxd arxa...........
. • Detersiae •u' val¢e for each reo.'/eeiL'rr, sec-nt
M. X °pw C1 tl a G.7 .
n. 11C• i X "U' CZJ
a. X "II"
4 T:.t-~ total cf 744 is e sz=e as, o= iess L•haa 112, yca 2ave We= :=z o:
Sdr_ 60Q5 ;cy 1.
Ai.._r_at_ BU_1C_'C s-vC': 7? n25_
TO ---iliZ2 r:E wt3l e^vaTO:e'sys:a= aethcc, t::0 '72li:05 05'°b"5 p'..d .:2 O_°
13 an~ =4 r.ot be c_aat_- than t_e s•.:-a o` _t_s z-:=_.
i. 2- G17}Z. i
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APFLICATION FOR PERMIT :Nb'E= PAWIINP OF FEE AT TIME OF -
. i APPLICATION DDES NOT CON-
^ SfITLTfE APPRGJAL OF PERDIIT. t
1 O:i ~ • •
SEWER AND/OR WATER CONNECTION : IrseBmoN oF MqER Ara/oR wATm :
~ INSfAISATI0I15 WII,I, NOT gE cr'clxn.cn y
UNPIL PII2MIT HAS 9EES1 ppPROVID. .*\ci' . ?~~w~~»»M~~i~~~~~e«~a~~~~~~~~ata~~?
.
catV oF ecacjcsn
(PLEA.SE PRINT
1) PROPII2TY ADDRFSS: 9717 . I/_--/~tUt-
TFY;AT• DESCRIPTION: lpT 3o elac.1-~ S~t-orzA ~l.-F~C .
Lot Block S division or Tax Parcel ID
IF EXISTING STRL'C'IqiRE, DATE OF ORIGINAL BUILDING PMNLiT ISSUANCE:
Nbnt Year
PRESENT ZONIIQG/PROPOSID USE:
Q C01%1MERCIAL/RETAIL/0FFICE R-1 SINGLE FAMILY
Q INDU5IRIAL E__1 R-2 DOPLEX ('iw-o Cnits)
Q INSTITUTIONAL/GOVERPIIMENT Q R-3 TOWNHOL~SE (Three + Gnits) ( Units)
Q R-4 APARTMENT/COmONLiNIGM ( C'nits)
2) ~ NAME: _ ~2or.~T~E12.
ADD1zESS: 34oa. ~~roa2JR - ~2•
CITY, STATE, 2IP: ~a-a-
PHONE: a54- O~t3~
' For City Use
3) NAME: J`tA-2 QL,~me~nX~ Pl rt es L~icense:
ADDRESS: lol~ I~UUND ~air~~-.~ S T~ ExActive
pired
CITY, STATE, ZIP: ~KA~ 5!5~o I Not recordec
PHONE: MASTII2 LICENSE # 332) -9 sta Initia
4) ~ ~
NAME:
ADDRFSS: 8~~} aa^'~ A,.~e rJ •
CITY, STATE, ZZP: Sni ma. Sc . Q t3~..L MIJ 5501 5
PHONE: 45k - U k4'3 I~V 3 a
5) 09M. ,y .au . i~~
ER[CONNSCTION TO CITY SEWER ER[CONNECTION TO CITY WATEF2 O OTfER
6) ORz'r~
***ir*************f * *******YrF***k***************fr**********************k****************Y
TfE GOID COPY O PERNIIT ILL BE SENI' DIRDLTLY TO PUSLIC WORKS 1O FACIISTATE METII2 PICK-UP. x
* PLEASE ALI,OW 1W0 WDRKING DAYS FOR PROCFSSING. SOMEONE EROM TfiE CITY WILL CONi'ACP YOU IF TfERE ~
* ARE ANY PROSLFMS. *
~
~~***~,t+******~+r********+t*r,r+***vr***+****s*+****r*******+t*r***~r******t*~*****~*r**++**+*~~***,t*>
. FOR CITY USE ONLY
PERMIT # ZSSUED •
Pd w/Bldg. Permit FEES:
$ /D 'S-v $ SEWER PERMIT (INCLUDE SURCHARGE)
$ /0-5-6 $ WATER PERMIT (INCLODE SL'RCHARGE)
$ ~a 7,00 $ WATER METER/COPPERHORN/OL'TSIDE READER
$ $ WATER TAP (INCLUDE CORPORATION STOP)
$ $ SEWER TAP
$ $ ACCOUNT DEPOSIT - SEWER
$ •(J~ $ ACCOONT DEPOSIT - WATER
$ SSD p-D $ wAC
$ 6 D $ SAC
$ $ TRONK WATER ASSESSMENT
$ $ TRUNK SEWER ASSESSMENT
$ $ LATERAL BENEFIT/TRUNK SEWER
$ $ LATERAL BENEFIT/TRUNK WATER
$ 2 d 7~ $ WATER TREATMENT PLANT SURCHARGE
$ $ OTHER:
$ l~ a a. o~ $ TOTAL
RECEIPT i~- RECEIPT
DOES UTILITY CONNECTION REQOIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
~ YES IF YES, THEN A"PERMIT FOR WORK TVITHIN PC~BLZC
ROADWAY" MUST BE ISSUED BY THE ENGINEERING
~ NO DIVISION. LIST AS A CONDITION.
SUBJECT TO THE FOLLOWING CONDITIONS:
APPROVED BY:
TITLE:
DATE : / ~ ~ /~0
RECORD OF COMPLAINT
DATE:
COMPLAZNT TAKEN HY:
NAME: ,~•'~j~ey C[~ ~+4~'J °~CF~'+~(,-c-~u"`G
ADDRESS:
7 ~u,I~t
PHONE NO.:
COMPLAZNT:
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,
ACTION TAKEN:
Ct-~LGm~-•~t.u-,.-.. ,d~
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COtOfENTS s
TYPE OF SUILDIDiGz ~tC~et7 a(
LEGAL DESCRIPTION:
' • SICNED:
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Cities Di ig tal Quality Control
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- - .
1990 BUILDING PERMIT APPLICATION
CITY OF EAGAN
SINGLE FAMILY DWELLINGS M[TLTIPLE DWELLINGS COMMERCIAL
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 CALGULATIONS (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 SE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
PROCESSING TIME FO WER & WATER PERMITS T~ ONCE A PERMIT HAS BEEN COMPLETED.
PERMIT MUST SH04NSED ~
rWAR I 2 RECO.
To Be Used For: YD-2 Valuation: Date:
~ Site Address c947 Ve-,-~pf F-ivvi12, OFFICE USE ONLY
Lot ~J v glock ^1 FEES
Occupancy
2oning
~ Parcel/Sub ~-j-.a~~a2p PLA-~ Actual Const Bldg. Permit aSa`~
~ Allowable Surcharge .5~
Owner 01:' o. ' a ur~b %n r'r1 ~ n O # of stories Plan Review
LengthuPPEYL ILri3o SAC, City
Address Depth LpWfyl 2px30 SAC, MWCC
S.F. Total Water Conn
City/Zip Code Footprint S.F. Water Meter
Acct. Deposit
Phone On site sewage_ S/W Permit
1On site well S/W Surcharge
V• Contractor t,~1 1 I o.~K ~rerAMWCC System _ Treatment P1.
\1 City water Road Unit
Address ! 52 ?E PRV _ Park Ded.
O Booster Pump Copies
City/ZipCodePosevno?r,"f 55U~0 SUBTOTAL
APPROVALS Penalty
Phone (Ly i z) y 3 z o y Z Planner _ TOTAL
Council
Arch./Engr. Bldg. Off. 4kt'+1jf0
Variance
Address
City/Zip Code
Phone #
i
HEDLUNU EN6INEERING TEL No.612-888-6439 Jul 10,89 14:55 No.001 P.02 i
edlund En i~eerin Ser~vices °~°'E°`=o°°'""°'°"",."°y
H '
B g sworningivo, mW..ota 55420
Lana Burr41yon Clrll Eaylnern Lena P1611110n Pnonc 089-0289
w Su~Woros ~~'"JAI 800KPAGE J09 N0. eaR• avi
SURyEY FOR; Frontier F+i.dwest xomes Corporation
DESCRIBED AS= Lot 30, Rlock 4 , STAFF(1RD T'T.ACF., City of Eagan, !lakotR County,
. I'11RIIP.SALa and reserving ensements of TPCOYU.
~
W
~(ry~~` Qy,.~ Z
N
fi /~~5 mO
30 MA
i ~
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\Y 7N. NVO. @ N.U. Cw. oF LA. [1w.+901.{1
'S! TOP OF POUNAATION ° 405.-1
` 9 ~•t; \ ~ s GARAGE FT.OOR = 9os.s
(n p ~oV .S BASEIdENT FLOOR ° 40' A ~ -
~ SEWER StRVICE ELEV. -8t5•''
~L aos•~ PROPOSED ELEVATTONS : C-D
EXTS"fING EI,EVATIONS
DRAINAGE DIRECTIONS
DENOTES I.OT CORNERS : o 00
rER7?FIGATE OF SURVEY DENOTES OFFSET STAKE: o po
I henby conify thot thk .urvOy,plan or report wos pnpond by me o?un0er n1y dinct ~O
aupervisfon ond tAot T om o duly Repfstertd l.ond Swreyw under fhe lars of the ~
5fote of Minnesofo. "
Date:
Rw. I~t I JoM . l na Lluns No.143T6
RESlDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN ~J~~~ \
3830 PILOT KNOB RD, EAGAN MN 55122 C~CJ
651-681-4675
New Construction Reauiremente RemodellReoair Renuirements
• 3 registereA site surveys showirg sq. fl, o(tot, sq. R of hou5e, ana all mofed areas • 2 wpies of plan
(20% maximum lot coverage allowed) . 1 set ol Energy Calculations for heated aaci6cns
• 2 copies of plan showing beam 8 window srzes. poureE found design, etc.1 . 1 site survey for extenor additions d decks
• t set of Eneryy Calculations . Indicate if home served by septic syslem ior addihons
• 3 copies of Tree Preservation Plan if lot platted afler 711193
• Rim Jo6t OetaJ OpUans selecGOn sheet (blegs with 3 or Iws umts)
DATE VALUATION
SITE ADDRESS S97 IJEAI7^JOR /}UIE MULTI-FAMILY BLDG Y N
TYPE OF WORK_~v~.o~oa, FIREPLACE(S) _ 0_ 1_ 2
APPLiCANi
STREET ADDRESS ~OS ~S ' P CITY G. STATQn~ ZIP SSlJ
TELEPHONE # 952-a.00' 20 D CEIL PHONE # SArn1;-: FAX #
PROPERTYOWNER .sfJ 6An'-IiELEPHONE#
"
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINN1•:SOT.\ RGI.ES 7670 C:1"CEGORl' I >4IVNLSO"I'.\ RL;1.1:5 7672
(J submission [ype) . Residenhal Ventilation Category 1 Worksheet Submitted . New Energy Code Worksheet Submi[ted
• Energy Envelope Calculatlons Submitted
Plumbing Contraetor. _ _ Phone #
Plumbing system includes: Warer SoFtener _ Lawni Sprinl:ler ree: $90.00
Water Heater No. of R.I. Baths
No, oF Ba[hs
Mechanical Contractor: Phone #
Mechaniril system includes: Air Conditionin; C'er. )iU.OU
Hcat Rccovei%' Systcrn
Sewer/Water Contractor: Phone N
I hereby acknowledge That I have read this application, state that ihe information is correct, and agree to comply
with all applicable State of Minnesota Stalutes and City of Eagan Ordin nce .
Sfgnature of Applfcant
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received Not Required
UOdaled 4102
OFFICE USE ONLY
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? OS 06-plex ? 76 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 E#. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck 0 23 Porch (screened) ? 36 Mlulti
? OS 03-plex ? 17 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 0 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Oemolish (Bldg)• ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement `Damolition (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. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new bldg) _ FinaUC.O.
_ Footings (deck) _ FinaU1`o C.O.
_ Footings (addirion) ` Plumbing
Foundation HVAC
Drain Tile Other
Roaf _ Ice & Water _ Final _ Poof _ Ft-s _ AirlGas Tests _ Final
_ Franung _ Siding Stucco Stone
_ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement)
_ Insulation _ Retaining N%all
Approved By , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S8W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search ~
Copies
Other
Total
RESIDENTIAL BUILDING
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construqion Reauirements RemodellFieoair Reauirements Offce Use Onlv
3 registered site surveys showing sq. tt. of lot, sq. ft. of house; and all roofed areas 2 copies of plan Cert of Survey Rerd Y N
(20Y maximum lot coverage allowed) i set of Energy Calculations lor heated addiFrons Tree Pres Plan Reod Y N
2 copies of plan showing beam S window sizes; poured found design, etc. i site survey for additions & decks Tree Pres Reqd Y N
lsetalEnergyCalculahons Adddion - mdicafeNOn-sResepticsystem On-siteSepUcSystem _ Y N
3 copies of Tree P2servation Plan if lot platted after 711193
Rim Joist Detad Oplions selection sheet (bldgs with 3 or less unRs
Date _1L / ZI l v ) Construction Cost
Site Address VL~1j/Z7!C_. S UniUSte #
Description of Work Ir'S%/IZC 6,45 Lo'Zly(k L
Multi-Family Bldg _ Y_ N Fireplace(s) _ 0(01 _ 2
Property Owner Cl7126 /7 9160 eAJ/A,)O Telephone # ( (15/
Contractor
Address 5d j D (iJ. ffW7 /f City /J?~9-`J
State 6tiY? Zip `i57 37 Telephone #(9i2)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category . Residenhal Ventilation Category 1 Worksheet . New Energy Code Worksheet
(J submission type) Submitled Submitted
• Energy Envelope Calculations Su6mitted
Have you previously constructed a building in Eagan with a similar plan2 _ Y _ N If so, 25% plan review
fee applies.
p~n 0 dq
Licensed Plumber Telephone ~
Mechanical ConTractor I NOV 2 12003 Telephone # ( )
Sewer/Water Contractor B 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 i the case of rk which requires a review and
approval of plans. .
~o ti ~ 0 ~
Applicant's Printed Name Applica t's Signature
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 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.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 OB-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Pibg_Y or _ N ? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Altera6on ? 37 Demolish (Bldg)' ? 43 Reroof ? 46 Windows/Doors
? 34 R0p18C0ment 'Demolilion (Entire Bldg) - 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. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new bldg) _ FinaVC.O.
_ Footings (deck) _ Final No C.O.
_ Footings (addition) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ AidGas Tests _ Final
_ Framing _ Siding Stucco Stone
_ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement)
Insulation _ Retaining Wall
Approved By , Building Inspector
Base Fee
Surcharge
Plan Review
MCIES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
-
- ~ For OKice Use ( 51
I Permit k: O
City of Ea~a~
I ~
3830 Pilot Knob Road ~ PertnitFee: S~ •~O ~
Eagan MN 55122 ~ j
I Date Receivetl: ~
Phone:(651) 675-5675 i ~
Fax: (651) 675-5694 ~ Staff: ~
2009 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: Site Address:
Tenant: Suite
RESI6EN7/OWNER Name: Phone: CQS~ y7n IP~X ~
Address/City/Zip: f~~l(~Q Q( ~Q(y1nQ~
CONTRACTOR Name ~ License„
Address:A'.S t)16t,
City. State: i' Zip:
PhoneIQI-~.~^IQg' Contact Person: ~j
TYPE OF WORK ~ New _ Replacement Repair Rebuild _ Modify Space Work in R.O.W.
~ .
Descri tion of work: ~ ( '
PERMIT TYPE RESlDENTIAL
W2ter He2ter Water Softener
~ Lawn Irrigation _Add Plumbing Fiztures
L_ RPZ /_v' PVB) ~ Main _ Lower Level)
Septic System YV2ter Tumaround New
_ Abandonment
RESfDENT1AL FEES:
$50.50 Minimum Water Heater, Water Softener, or Water Heater gnd Softener (includes $.50 State Surcharge)
$30.50 Lawn Irrigation (includes $.50 State Surcharge)
$50.50 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround' (includes $.50 State Surcharge)
'Water Turnaround (add $165.00 if a 5/8" meter is required)
$100.50 Septic System New ($10.00 per as built) (includes Counry fee and $.50 State Surcharge)
$90.50 Fire Repair (replace bumed out appiiances. ductwork, etc.) (incJudes $.50 State Surcharge)
TOTAL FEES $
I here6y acknowledge that Ihis informa6on is complete and accura[e; that [he work will be in conformance with the ordinances and codes oi the City of
Eagan; that I understand this is not a permit. but only an application for a permit, and work' not to start wrthout a permit; ihaf the work wiil be in
accordance with the approved plan in the case ot work which requires a review and approva f ans.
x J tAd'v,,, X
Applicant's Printed Name icanYs Si nature
FOR OFFICE USE Reviewed By: ' Date:
Fequired Inspections: _Under Ground _Rough-In _Air Test _Gas Test _Final
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PERMIT
City of Eagan Permit Type:Building
Permit Number:EA164222
Date Issued:09/23/2020
Permit Category:ePermit
Site Address: 847 Ventnor Ave
Lot:30 Block: 4 Addition: Stafford Place
PID:10-72500-04-300
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 -
Gregory D Tamborino
847 Ventnor Ave
Eagan MN 55123
Archer Exteriors
324 Concord Exchange South
South St. Paul MN 55075
(651) 775-7017
Applicant/Permitee: Signature Issued By: Signature