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1786 Walnut Lane - _ . , . . . , . , . . . . . , , . . _ , , o, a : a - . 5 . . . . . . • : , ' . . . . . . , . . .~a • PERMIT # MECHAN4CAL PERMIT RECEIPT # CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: CONTRACT PRICE: PHONE: 454-8100 Site Address ° J N ~t LO - 'x BLDG. TYPE WORK DESCRIPTION Lot Block Sec/ ub Res. ~ New r ; Mult Add- ~ ' ~ Name _;LG 6-_. ~_c A.~-.s - -_.-~~-~---•.9 : _ _ Comm. Repair - Address c Ci1y y T 47,+ . J? Phone `a t'-I Other :i FEES ~ Name - k RES. HVAC 0-100 M BTU ' c Address 9C a l~ ~'r cA ADDtTIONAI. 50 M BTU -$26.00 ~ i 3 ' O C~tY Phone ~~y" (RES. HVAC INCLUDFSA/C ON NEW CONSTRllCTION) - ' ' - GAS OUTLETS (MINIMUIId - 1 PER PERMIT) - 1.50 EA. - ~ TYPE OF WORK COMM/IND FEE - 1% OF CONTRACT FEE Forced Air BTU -~•2 " APT. BLDGS. - COMM. RATE APPLIES " TOWNHOUSE & CONDOS - RES. RATE APPLIES Boiler M BTU MINIMUM RESIDENTIAL FEE - ALL ADD-ON & Unit Heater M BTU REMODELS - 12.00 Air Cond. ~ gT~ " MINIMUM COMMERCIAL FEE - 20.00 STATE SURCHARGE PER PERMIT - .50 Vent CFM ` Gas Piping Outlets # BEYOND $1 ppp) PERMIT PRICE GOES Other FEE:',~i`i S/C: SfGN TU O M E / .5 OTAI: ~-3 T7s? FOR: CITY OF EAGAN ~ ~ i . . . . . r . . - . .T . ' . . . For Oflice Use Only: MECHAl11CAL PERMIT PERMIT # j, cITY oF EAGAN RECEIPT # 3830 PILOT KM08 ROAD, EAGAN, MN 55122 r' ~ 7 CONTRACT PRICE PHONE: 464-8100 DATE: Slte Address ` BLDG. TYPE ~ WORK DESCRIPTIWN Lot ~ Block Sec/Sub Res. New Mult Add-on m Name - Comm. Repair ~y Address ' ~ Other c Ciry Phone ' FEES Name 'ij ES. HVAC 0-100 M BTU -$24.00 c Address ADDITIONAL 50 M BTU - 6.00 p City Phone (RES. HVAC INCLUDES NC ON NEW ' CONSTRUCTION) GAS OUTLETS (MINIMUM -1 PER PER1AfT) - 1.50 EA. , TYPE OF WORK COIIAWIND FEE - 776 OF CONTRACT FEE Forced Alr ~ M BTU APT. BLDGS. - COMM. RATE APPLIES Boiler M BTU TQWNHOUSE & CONDOS - RES. RATE APPLIES Unit Heater M BTU MINIMUM RESIDENTIAL FEE - ALL ADD-ON 8 REINODELS - 12.00 Alr Cond. M BTU MINIMUM COMMERCIAL FEE - 20.00 VeM. CFM STATE SURCHARGE PER PERMIT - .50 Gas Piping Oudeta M (ADD $.50 S/C PER.EACH $1000.00 OF PERMIT FEE) ' Other us~'Z~! tT`--^ ~ ~ PERIAIT FEE: SIC: SIGNATURE OF PERMITTEE ~ TOTAL: 2) FOR: CiTY OF EAGAN I~ CITY OF EAGAN Remarks Addition Woc7dgate 3rd Addition Lot 3 Rik 5 Pefcei i`10 84602 030 05 Owner " treet State Eagan, MN 55122 Improvement Date Amount Annual Years Payment Receipt Date STREETSURF. 7)?0 1977 476.67 158.89 3 476.67 C003370 10-9-76 STREET RESTOR. GRADING 1974 $37.67 $7.53 5 PAID SAN SEW TRUNK 1974 $65. 31 $4. 35 15 PAID * SEWERLATERAL 1976 3 WATERMAIN WATEFi LATERAL 1976 3 * WATER AREA 1976 3 V6 STOflM SEW TfiK 1976 $1628.80 $542. 93 3 PAID *3STORM SEW LAT 1976 CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. 7- 6-75 700 9UILDING PER. 41,71 7-16-75 sAC 425.00 700 7-16-7 PAR K CITY OF EAGAN Remarks a,dditWood ate 3rd Addition Lot 4 Rik 5 Parcel ' 040 05 Owner1,xb~kU1'4 7 1 itiI`?Street 17$$ Wa7riji* T-*+ State Eagaa, MN 551 27 Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. STREET RESTOR. A3 GRADING 5 PAID ' I SAN SEW TRUNK D * SEWER LATERAL WATERMAIN * WATER LATERAL * WATER AREA * 113STORM SEW TRK PAID *3 TORM SEW LAT 1976 3 CURB & GUTTER SIDEWALK STREET LIGHT wATER CONN, 140.00 700 7-16-75 ~ BUILDING PEF, 37 7-16-75 sAC 700 7-16-75 PARK 700 ~ j I _ 7-16-75 ~ I CITY Of EAGAN Remarks Additood ate 3rd Addition Lot 2 eik 5 Pefcei ; 84602 020 05. I ~ Owner --i>~ Street 1790 Walnut Ln. 5tate Eacian, MN 55122 Improvement Date Amount Annual Years Payment Recaipt Date , STREETSURF. 'fp 1977 476.67 158.89 3 476.67 C003369 10-9-76 STREET RESTOR. A GRADING AID ,qq) SAN SEW TRUNK P ID * SEWER LATERAL WATERMAIN I* WATER LATERAL 1976 3 i * WATER AREA *3j3STORM SEW TRK 1976 1628.80 542.93 3 PAID *30TORM SEW LAT 1976 3 CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. $140.00 700 7-16-75 9UILDING PER, #3715 7-16-75 S,aC 7-16-75 PAR K CITY OF EAGAN Remarks Additi n Wood ate 3rd dition Lot 1 Qik 5 Paroei 10 84602 010,__*;; Owner Streec 1792 Walnut Ln. State Eaqan, MN 55122 tmprovement Date Amount Annual Years Payment Receipt Date STREETSURF. 1977 476.67 158.89 3 476.67 C003368 10-9-76 STREET RESTOR. GRADiNG 1974 $37.67 $7.53 5 PAID A SAN SEW TRUNK 1974 $65.31 $4.35 15 PAID * SEWERLATERAL 1976 3 WATERMAIN * WATERLATERAL 1976 3 i* WATER AREA 1976 3 * j3STORM SEW TRK 1976 ID , * 4STORM SEW LRT 1976 3 CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. 140.00 700 7-16-75 9UILDING PER. 7-16-75 SaC 700 7-16-75 PARK sion-on p 7-16-75 ~ - ~ r HOUSE HEATING TEST RECORD ADDRESS 1)10 L("IfLI'vUC WfJ& qpT. -FLOOR CITY SUBURB OCCUPANT OWNER HEAT LO55 DATE HTG. INST. SOLD BY INSTALLED BY Elecirical Work By Gos Line By TYPE OF HEAT GA _ FA V' HW _STEAM _SPACE HTR. UNIT HTR. _OTHER GAS DESIGN CONVERSION MAKE MAKE OF BURNER Model ~3 V ~~7~Ui6 I~" Model i $qrial Max. BTU Raring . INPUT Can MAKE OF FURNACE Model CONTROLS THERMOSTAT Heat Plug Vent Size Valve - KIND OF LINER SIZE NONE Limft Draft Hood Reguloror Limit$efling -(jrR~! G 'S/ G7- Filrors Size'.d•XNom6ar ~ Fon Seteing Tr~ (ME0' Chimney Location Inside Outside Pilot Type ~"IU TQ Chimney Construction Pilot Make Pilot Model $moke Bomb Wiring Pilot Timing Draft Test Tag L.W. Cut Off Door Pressure Lighfing Inst. Pressure S ~A~~ - Percent COZ ~ Date Teseed s~~J~% ~ InputCFH Percent OZ Company- Testing LJUV,7E( Stack Temp. Percent CO • Name of Tesmr AA If. Form 235 11VJYL:I; l lUIV Kt+;I:VKlI X Y OF EAGAN PERMIT TYPE: Pilot Knob Road Permit Number: Eagan, Minnesota 55122-1897 Date Issued: i nIw,, 111:: (612) 681-4675 SITE ADDRESS: F APPLICANT: . Iu~ I itr, 1.1f11 fJil I I nNl ',IlItUl:Hitfi I 1! 1t U1,'. ' I Illfiit,111 ~ •f fi f~, 1' i N'i 1 ~ PERMIT SUBTYPE: TYPE OF WORK: iiiuo-I r i MI i~i i n~ i, ui I l It i~~rl ~~i 7 f•r I n~~{ INSPECTION . D• iin! 1 M1!t~ ! I ~ Permit Holtler Dato Telephone q PLUMBING HVAC Inspection Date Insp. Comments FOOTINGS FOUND FRAMING ROOFING ROUGH PLUMBING PLBG AIR TEST ROUGH HEATING GAS SVC TES7 INSUL GVPBOARD FIREPLACE FIREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL DOMESTIC METEF IFRIGATION METER FLUSH MAINS CONDUCTIVITV TEST MYOROSTATIC TEST BSMT R.I. BSMT FINAL DECK FfG DECK FINAL Repuest Daie rte N. Rou9h Inspec0on ~ Reqwr tl' (ll~leatly Now ? Will NotityInspactor 's-- 17 ~73 D Yes r o when ReaCy' 1Ceitc-ensed Coniractor ? owner hereby request inspection of above electrical work at: Jab Atltlress sVeeL Box or Route Na I Qry Secuon No I Township Name or No Ranga No, Counry ~ Z~7 Occupant(PRINT) Phone No ' ?4 Powe: SupPber Atltlress tvw Eixfrwai Comrac;or iGOmpany Namal Convacror's license No. , G "'G Idmiing qtltlress IC vactor or Owner IAaking Installalion) G ,,c• <S<s'v Awn L ignaWre orlacrovOwnerlAaxinqlnstailaeonl PhoneNOmbar o-G MINNESOTA STATE' OARD OF EL TRICITY THIS INSPEGTION REOUEST WILL NOT Griggs-Mltlwey BIEq - ppam S-1]3 BE /CCEPTEO BYTHE STATE BOARD 1821 University Ave . SI Vaul. MN 55104 UNLE55 PROPER INSFECTION FEE IS Vhone(611) 612-0900 ENGlOSEO. " REQUEST FOR ELECTRICAL INSPECTION ~°="`•~c ee-ooooi-oe ? Sea mslmctions br comple:mg this lorm on Oacn ol yellow copy - - 'X" Be/ow Work Covered by This Requesi e Add TypeotBmltling ApplianceSWued EqwpmentWired .500.1 Home Range F-TTemporary Service Duplex Water Heater Eiectric Heating I Apt. Bwlding Dryer Other-(Specify) Gomm./Industnal Furnace IFarm Air Conditioner Otner (syeaty) Comranor's Remarks: Compute Inspecnon Fee Below: # Other Fee N ServiceEnirancaSrze Fee # QrcmtSlPeeder5 Fee Swimming Pool 0 to 200 Amps 0 to 100 Amps Transformers Above 200 _ Amps Abova 100 _ Amps I Signs Inspectorg Use OnlyTOTAL Irngahon Booms s ~-Q Special Inspection Alarm/CommumcaLOn TMIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT Other Fee COMPLETED WITHIN 18 MONTHS. I, the Electrical Inspector, hereby Rougn-in oaie certdy ihat the above inspection has Fmai oaie been made OFFICE USE JNLV ThSIPQUBSt WiE 18 lIIOpl1:5fl0.T 3~5-4L CITY OF F.AG'?NT ' 3795 Pilot 3Snob Road Eagan, t+iinnesota 55122 PERtiiffT NO.: The City of Eagan hereby grants to Geo. Sedmaick tteatina & 7,/C Co. ef 1001 Xenia Ave. So. a uPnmrxr. Permit for: (Owner) T]ea Horizon - WoodRate 1785-87-89-91, 1779-80-2-84, 1777-79-81-83, 1801-03-05-07, 1793=95-97-90 and at »RA:aa_an_q2 wainee ran , pursuant to application dated A/11/75 Fee Paid: ydan_no daCed this _~3 day of ,7une , 19 75 12.00 s/c Building Inspector ~ Mx • . t;~ _ ~~~~r`"~'.:~„~„~ _ . r~=;~l! , .,y.,~ ~ , ' y u • . . Mechanical Pexmita: Bid Total: ~ /O ?S16Q2~ O30 05 . G L ~ CI?'Y OF i:AC;?N 3795 Pilot Knob Road Eagan, htinnesota 55122 PERiv`ST NO.: s7e The City of Eagan hereby grants to mhomosen PlnmhinQ M. ef 12201 Minnetonka Blvd., Minnetonka 55343 a PLUMBING P rmit for: (Owner) New Hozizon - Y7oodgate III 1778-1780-1782-1784, 9-1788-1790-1792, 1777-1779-1791-1763, 1787- 7A5- 91-1789, '095-1793-1797-1799 wal ut,T,qAe~suant to application dated 7/16/75 1801-t803-1805-180 Wa nut Iane Fee Paid: sdeo_oo dated this 21 day of July ,19 75 12.00 s/c Building Inspector Mechanical Permits: Sid Total: VILLAOE OF EAGAN WATER SERVICE PERMII 3795 I`ilof Knnb Rood PERMI'C NO.: 1775 Eogan, MN 55122 - a' PUD ' DATE: 7/21/75 Zuning: `J - q , No. of Units-•-. Owner:' N 'Oi' zon - kbWgate Address: - Site qddres3:786-88-90-92 Walnut ne, , Plumber: Thompson PLmmbinv Cb Meter No.: _ ConnecrionChazge:, 560.00 nd Size: ~ Account Deposit Reader No.: " Permit Fee: 10.00 pd 1 °9ree tO comPl7 M'Nh-the"Mloga oi Eagan Surcharge: 50 , (j ' Ordinonces. Misc. Charges:-= / Total: $y Date Paid: Dale of InsP.: InsP.: : . • YILLAOE OF E40AN SEWER SERVICE PERMIT 379a pilot Knob Rood PERMIT NO.: 2536 Eagon, MN 35122 DATE: - 7/21/75 Zoning: nrm No. of Units: 4 Owner: Neur u(lri on - Wnrulqjte III Address: Si[e Address:l7RF=R8-QO-92 Walnut Lane Plumber: shomoson P7 »m in4 Co. ~ 09ree to comply wilh fM Villoya of Eoyon Connection Chazge: 1700.00 Bd O.dinances. Account Deposit Permit Fee: 10.00 pd Surcharge: 50 pd BY' Misc Charges: Date of Insp.: Total: Insp.: Dace Paid: ~.~Z-. 4b"`rcit,V oF eagcln THOMASEGAN Mayor PATRICIA AWADA SHAWN HUNTER SANDRA A. MASIN THEODORE WACHTER Council Members THOMAS HEDGES Ciry Admininslrafor April 21, 1993 EUGENE VAN OVERBEKE ciry aerk To Whom It May Concern: a~ a,&-,3A- ,C_ W e.4G [£'-ff A delinquent utility bill was certified to 1993 property taxes on Parcel #10 84602 040 05 (1788 Walnut Lane, Eagan MN 55122) in the amount of $205.32. SinV~ , Deanna Kivi Speaial Assessment Clerk MUNICIPAL CENTER MAINTENANCE FACILITY 3030 PILOi KNOB ROAD THE LONE OAK TREE 3501 COACHMAN POINT EAGAN, MiNNE50iA 55122-1897 THE SVMBOL OF STRENGTH AND GROWTH IN OUR COMMUNITY EAGAN, MINNESOTA 55122 PHONE: (612) 681-4600 PHONE: (612) 681-4300 FAX: (612) 681-4512 Equal OpportuNtyJAffirmoilve Action Employer FAX: (612) 681-4360 TDD: (612) 454-8535 iDD:(612) 454-8535 PERMIT • CI7Y OF EAGAN 3830 Pilot Knob Road PERMIT TYPE: B U I L D I N G Eagan, Minnesota 55122-1897 Permit Number: 033588 (612) 681-4675 Date Issued: 10 / 0 5/ 9 8 SITE ADDRESS: 1786 WALNUT LANE LOT: 3 BLOCK: 5 WOODGATE 3RD P.I.N.: 10-84602-030-05 DESCRIPTION: T.O. & REROOF _B~ wi l d 3. n g~.P e r m i t T y p e £-9-R4Wh-J~AFB~. M I 3 C. 8uilding Wp`rk Type 43~ R E P A I R ,ce rt s u s C o d e &i7T-PFB-Po-Rf~ ~ ~J U f I REMARKS: REPLACING ROOFS INCLUDING: 1788, 1790, AND 1792. \ FEE SUMMARY: VALUATION $18,000 Base Fee $262.25 Surcharge $9.00 Total Fee $271.25 CONTRACTOR: - qpplicant - OWNER: SUBURBAN EXTERIORS 28818232 WOODGATE ASSOCIATION 97y31 PENN AVENUE $OUTH 1786 WALNUT LANE BLQOMIN6TON MN 55431 EAGAN mN 55122 (612) 851-8232 ' I hereby acknoWledge that I have read this application and state that the ' 3nformation is carreat and aqree to eomply wiCh all applicable State of Mn. j SraCutes and City ofi Eagan Ordinflnces. - ~ - - - - APPLICANT/PERMITEE SIGNATUFE ISSUED BY: SI NAT RE 1998 BUILDING PERMIT APPLICATION (COhiMERCIAL) ~ b- S~ c1~ CITY OF EAGAN ~ 681-4675 Submit followin to obtain necessary permit Foundation Onl New Construction Interior Improvement structural plans (2 sets) archdequral plans (2 sets) archRedural plans (2 sets) civil plans (2 sets) strueturel plans (2 eets) eode analysis (1) " code analysis (1) " civil plans (2 sets) project specs (1 set) soils report (1) landswping plans (2 sets) Key Plan projectspecs (7) codeanalysis (7) " energywlwlations (1)naaNrays" Spacial Inspections 8 Testing Schedule " soils report (1) Eledric Powar 8 Lighting Fortn (7) not aAvdys " SAC detertninalion letter from MGWS - SAC tletermination letter from MCANS - SAC detertnination letter hom MCANS - wll 602-1000 call 602-1000 eall 602-7000 Special InspeGions 8 Testing Schedule (1) " project spea (1) energycalculations (1) " ElecYnc Power 8 Li htin Fortn (1) " " Contact Building Inspedions for sample Food 8 Beverege or Lodging facilities: Plan must be submitted to Minnesota Department of Heatth. Cali 215-0700 for details. DATE: I-Z~ `,=I -y WORK TYPE: NEW REMODEL DESCRIPTION OF WORK: TP-e~ V4eXS4 CONSTRUCTION COST: I~I~ Z~63 TENANT NAME: SITEADDRESS: I,-]°LCJ SUITE LOT -~L- BLOCK ~ SUBD. ~ C5U lX A A, 3 Y P.I.D. # Name: ~C)S!~~C~3u Phone#: PROPERTY Last ~ First OWNER - ~ Street Address: 12T6i ~-1 WZY , ( -nC7 ~ Z 4 `Z '~JC]{IiIJ~ `Cn.t~,Q ~ i Ciry LCtqn In4 State: Avi Zip: Company: C~~~IvzJS Phone ' CONTRACTOR Street Address: ( Zm 1 V2 V\VI At1e S License # 42!~J <T' Ciry vlC3U1^/\ State:/"kY\ Zip: 55t-(-3/ ARCHITECT/ ENGINEER Company: Phone Name: Registration Street Address: City State: Zip: Sewer 8 water licensed plumber (only if installing r water): I hereby acknowledge that I have read this appli and state that the info a i n is ed and agree to wmply with all appliwble Slate of Minnesota Statutes and City oi Eagan OrdinanceSignatureofAppliwnt: " CITY USE ONLY LOT ~ BL RECEIPT 6!~ 5< D SUBD. RECEIPT DATE: MECHANICAL PERMIT # 1999MECHAPICihL f'ERMIT ({tESIDENTIAL) CITY 0F EAfiAN S$SO f'IL01' KNOB RD Sk6AN MN 55122 css» 661-4675 Date• Complete this section onlv if you are installing HVAC in a single family dwelling, townhome or condo under construction and not owner /occunied. • HVAC: 0-100 M B T U $ 30.00 ADDITIONAL 50 M BTU 6.00 • Gas outlets (minimum of one required @$3.00 eaJ State Surchazge .50 Total $-acg b- b ~ Complete this section on if you are remodeling, adding to, or repairing an existing single family dwelling, townhome, or condo. Please indicate if it is a new item, alteretioo, or repair. _ New Alteration Repair _ Other Reminder: Call 681-4675 for inspections. _ Fumace V" Air conditioning • Air exchanger _ Other $ 30.00 State Surchazge .50 Minimum Total Due $ 30.50 SITE ADDRESS: Z-'7J6 w ,5z-/h 4-&n1° , OWNER NAME: GI CC r1 / -e- PHONE it: (AREA DE) N22.7~ °L ~"/-;~2 PHONE INSTALLERNAME & ?lZ SU : ~ ~ (ARESTREET ADDRESS: A CODE) d ~S~a ,~ie v ~ CITY: STA7'E: ~ ZIP: SS~ 7~ \ Sy„ U 9 RMI7' l~ CITY USE ONLY PERMIT RECEIPT DATE: 2002 MIDEPTIihL MECHtNIClkL P£{iMIT APPLICATIOR crrY oF E?sm s8so Pu ar xaog {tu £i4HAA btP 55 122 651-681,4675 Please complete for: ? single family dwellings townhomes and condos when permits are required for each uni EaPR ~ lJ Date: L"~ I I-U ~ 1 1 2002 SITE ADDRESS: 1 I(~W WCII fl(.C.~ Un OWNER NAME: 3:k% TELEPHONE .(05f) I U~S INSTALLERNAME: ~l\~OC~~.~K\ TELEPHONE#: lUs`J 30~~ STREETADDRESS: o`-'' CITY: STATE: ZIP: Place a check mark next to the permit work type Add-on, modification or alteration to existinq dwelling unit $ 30.00 • furnace replacement • air exchanger • air conditioner • other Nature of work: ~'l.t"~C_C e re` V~_ceN\e~~ hool~.. u State Surchar e $ .50 Taltal $30 . Sa t SIGNATURE OF PERMITTEE voz PERMIT # ~ J ~T-7 RECEIPT DATE: EOOE RESIDEVTIAL PLUM$INfi PEiiMIT APPLICihTION crrY oF EAsAiv saso Pu.or xxoa Rn f.AHRN, MN 551 EE 651-6$1-4675 Please complete for: singie family dwellings, townhomes and condos when permits are required for each unit, h..,.~e o...:.....~~~.... LOUIS, JAMES SITE ADDRESS: 1790 wnLNUr uANe - EAGAN, MN 55122 OWNER NAME: : (651) 905-3739 TELEPHONE (AREA CODE) INSTALLERNAME: 1QOr61oYVl Ftt,l,YV\bivLq TELEPHONE#: (oIZ'g2-7 ' 4d33 STREETADDR=SS: 2°~~S C~GtV^'FGIc:{ ~yi ~,~,c. SOIti~'l1 (AREACODE) CITY: AALS. STATE: M~ Zip; 5540$ _ SEPTIC SYSTEM, new/refurbished (requires two sets of plans and MPC license) $ 100.00 includes $40.00 County fee Note: Additional consultant fees may apply • MODIFICATIONIALTERATION TO EXISTING DWELLING UNIT, INCLUDING _ Adding fixtures to lower levels or room additions, excluding water softeners and water heaters. $ 50.00 _ Abandonment of septic system. _ Water turnaround - exisling dwelling unit 5/8" meter if needed - $118) Other: _ RPZ: new installation/repair/rebuild $ 30.00 _ lawn irrigation system Replacementladditional: water softener X water heater $ 15.00 - - cr. T ~ State Surcharge $ .50 Total g I S ,SD I hereby acknowledge that I have read this application, state that the information is correct, a n d agree to comply with all applicable City of Eagan ordinances. It is the applicanCS responsibility to notify Ihe property owner that the City o( Eagan assumes no liability for any dama9es caused by the City during its normal operatlonal and malntenance activities to the facilities constructed under this permit within City property/right-of-way/easement. SIG A RE OF PERMITTEE 1/02 ~q 55 ~ ~p0 0 2005 RESIDENI'IAL BUILDING PERNIIT APPLICATION CAI~eJ. G~2} . BT~ . City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 New ConsWClion Reaui2menGS RemodeVReoair Reauirements OHice Use Onlv 3 registe2d site surveys showing sq. ft. o( lot, sq. ft. of house; and all roofed areas 2 copies of plan CeR of Survey Recd _ Y_ N (20%mazimum lot wverage allowed) 1 set of Ener9y Calculatbns for heated additlons Tree Pres Plan Recd _Y _N. 2 copies ot plan showing beam 8 window saes; poured found design, etc. 1 site survey for addHbns 8 decks Tree Pres Required Y N 1 set of Energy Calculations Ad0'r6on • indkate 'rf on-sife septic system On-sile Septic System _ Y_ N 3 copies of Tree P2servatbn Plan H lot platted after 717193 Rim Joisl Detail Options seleclion sheet (buildings wIN 3 or less units) a Date _c /Q5- / 0 Sp J Con/shuction Cost 5600 /V U Site Address 17~ 0 ` `l G, R Unit/Ste # Description of Work D e Q ~ Multi-Family Bldg _ Y_ N Fireplace(s) _ 0 _ 1 _ 2 PropertyOwner VA1000 wi'I2V,J'elephone#( ) Conhactor ~ 10,~, (E v`So 11 • ' ~ 0 P7s~ 10 V7 Address d~o Q Ln Yl ~ v 7 v e City F 0 V,~ o~ State MT~1 vl Zip 5537~ Telephone#qS2) y- qo- I~7l COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minnesota Rules 7670 Cateeorv I _ Minnesota Rules 7672 Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet (Jsubmissiontype) Submitted SubmRted . Energy Envelope Calculations Submitted Have you previously constructed a building in Eagan with a similar plan2 _ Y _ N If so, 25% plan review fee applies. Licensed Plumber Telephone ) Mechanical Contractor Teiephone # ( ) Sewer/water Contractor Telephone # \ I hereby apply for a Residential Building Permit and acknowledge that the information~sSbjkmplete and a curate; that the work will be in conformance with the ordinances and codes of the City `of Eagan aq\Stat f MN . work ' notb~ wrthout a Statutes; I understand this is not a permit, but only an application for a permit, and- permit; that the work will be in accordance with the approved plan in the case of work,cwrvquires a review and approval of plans. LA K, P, ti f e-~ -e vs o Y/ ApplicanYs rinted Name Ap icanYs 'gnature OFFICE USE ONLY Sub Types . ? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg ? 02 SF Dwelling ? OS 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi O 03 01 of _ plex ? 09 07-plex O 17 Garage ? 22 PorchlAddn. (4-sea.) ? 33 EM. Alt - SF ? 04 02-plex ? 10 08-plex ;9 18 Deck 0 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 Plbg_Y or_ N? 25 Miscellaneous Work Types ? 31 New O 35 Int Improvement ? 38 Demolish Interior ? 44 Siding O 32 Addition , ? 36 Move Building D 42 Demolish Foundation ? 45 Fire Repair ? 33 Alteration ? 37 Demolish Building' ? 43 Reroof ? 46 Windows/Doors 'e 34 Replacement 'Demolitlon (Entlre Bldg) - Give PCA handout to applicant Valuation 2/ Doo Occupancy R-3 MCES System Census Code ~I3 y Zoning ~ D City Water SAC Units Stories Booster Pump # of Units Sq. Ft. PRV # of Bldgs Length Fire Sprinklered Type of Const ~ Width REQUIRED INSPECTIONS Footings (new bldg) FinaVC.O. ro Footings (deck) ~ FinaUNo C.O. _ Footings (addition) _ Plumbing Foundation HVAC Drain Tile Other Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests Final _ Framing _ Siding _ Stucco _ Stone _ Brick _ Fireplace _ R.I. _ AirTest _ Final _ Windows Insulation _ Retaining Wall Approved By: , Building Inspector - - Base Fee Surcharge Plan Review MC/ES SAC ( City SAC ~ Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search Copies Other Total LAnRy Pettev-so 4i'GU- ~/aln~~ Lqnc / ~ r 37 ` 54 ~ i . y>~.I /1' - - 1 `-,..-.~e.~,:s4~, ~c• . ~ 'I ~ - - m"~ ,r•r'l~h'~~ ~D 1 11 ao ~ ` I g 63~-~j.83 3,00 s~e , 39 `°~~°J~;s `%-~'B\ 4J• '9i 0 J~~• O. ~ r 59. ~V u a'e pO 0 )~6 ' ~ I , ai ~ ~l J~ J30 b^'r,~„ .~q~y 0'7eS ' O~ i ~ I 1."~' cm m ~ ~ o~~ ~ ' . N~ 4 ~ ~3~ • ~ r z 6~4 ' - \ ~ 4 ~ e 31 B:~ , .m/7 ~ o.m I . 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S,E. iq ~ (~9 S5z ~-o 00 2005 RESIDENTIAL BUILDING PERNIl't APPLICATION $ - • City Of Eagaa ~ 3830 Pilot Knob Road, Eagan MN 55122 Telep6one # 651-675-5675 FAX 651-675-5694 New Conslruction Reouirements RemodeVReoair Reauirements ORce Use Onh 3 2gistered srte surveys showing sq. ft. of lol, sq. ft. of house; and all roofed areas 2 wpies of plan CeR of Survey Recd _Y _ N (20°h maximum lot coverage allovred) 1 set of Energy Calculations for heated additions Tree P2s Plen Recd _Y _N, 2 copies of plan shovring beam 8 window s¢es; poured found design, etc. 1 sHe survey for addttions 8 decks T2e P25 Required _Y _ N 1 set of Eneqy Calculalbns Add'N'on - irMicafe Hon-sde upNc system On-site Septic System _ Y_ N 3 copies ot Tree Preservatbn Plan if lol platted after 717193 Rim Joisl Detail Options selection sheet (buildings with 3 or less units) ~-7 Date~/Of5/ ~0S I / ConstructionCost~`~~~0~ Site Address 7//~( ~{i) U-~ UnidSte # Description of Work IJ eC k- Multi-Family Bldg _ Y)& N Fireplace(s) _ 0_ 1 _ 2 PropertyOwner W O 0 'OUh(fYs Telephone ) ! e ~ v `50 r) si V ~ 0 k) Contractor ~ cf L Address 5g 0 / le~ L ynn V I VC: City ~ov scece M/ n n z;P S S37a Telephone #(~S~) ~q 0 - -7 COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minceso[a Rules 7670 Categorv 1 Minnesota Rules 7672 Energy Code Category , Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet (4 su6missiontype) Submitted Submitted • Energy Envelope Calculations Submitted Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review fee applies. Licensed Plumber Telephone ~ Mechanical Contractor Telephone # ( ) Sewer/WaterContracTor Telephone#( ) I hereby apply for a Residential Building Permit and acknowledge that the information is complet _ d acciirate;4 that the work will be in conformance with the ordinances and codes of the City of Eagan WMthe State oi~l Vo,. Statutes; I understand this is not a permit, but only an application for a permit, and work is not to suar~t` ~ hout a permit; that the work will be in accordance with the approved plan in the case of work which reqm;es a reviemmk approval of plans. ( L~ U V P'e;~G evsa kl Applic nt's Printed Name A licanY gnature . ~ , • OFFICE USE ONLY Sub Types ? 01 Foundation O 07 OS-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg ? 02 SF Dwelling ? OS 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) O 31 EM. Alt - Multi ? 03 Ot of _ plex ? 09 07-plex ? 17 Garege ? 22 Porch/Addn. (4-sea.) O 33 EM. Alt - SF ? 04 02-plex ? 10 08-plex )0 18 Deck O 23 Porch (screen/gazebo) ? 36 Multi Misc. ? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Stortn Damage ? 06 04-plex O 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous Work Types ? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding ? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair ? 33 Alteration ? 37 Demolish Building' ? 43 Reroof ? 46 Windows/Doors p 34 ReplaCCmBnt 'Demolition (EnUre Bldg) - Give PCA handout to applicant Valuation Z-/ DM' Occupancy 2-l MCES System Census Code y3 y zoning PD City Water SAC Units Stories Booster Pump # of Units Sq. Ft. PRV # of Bldgs Length Fire Sprinklered Type of Const v a Width REQUIRED INSPECTIONS Footings (new bldg) FinaVC.O. ~ Footings (deck) +9 Final/No C.O. _ Footings (addi[ion) _ Plumbing Foundation HVAC Drain Tile Other Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests Final _ Framing _ Siding _ Stucco _ Stone _ Brick _ Pireplace _ R.I. _ Air Test _ Final _ Windows _ Insulation _ Retaining Wall Approved By: Building Inspector Base Fee Surcharge ~ l1} ) Fee Plan Review MClES SAC City SAC Utility Connection Charge S&W Permit 8 Surcharge Treatment Plant License Search Copies Other - Total LArCRy Pe~evso&l T-OM ~,/a~n~~ Lane ~ W 37 ~ SO , i ~ I f/ 79'A7 17 ~ t . ~ ~ • i ,-~r•'» 1 • ti I ~ • ~ gi •e~.v •e ~ ' ~ . 5 bb3o1, ~3 3 po JO 39 01 ~ 4s's. `i~' % -o 0 • ~ e,.^~' . „ ~ e~~' ~ a° 4 0 ``:r+s ' \ ~ lb 3 1 m 0 Ss~s, ~ 3~ -°,,~~t-W~i af m°• 35-. `'S,, eq/^oo t6~B"a~s'oy 'V6'7i'/6'• -.M;;~"'d Z- ~20.:, 37 W Y 6~ a 3~ 34 ,~i'~ o~'~° i Q` o.~ 2 o sz. a,•.,. J 27 O. a m q0 B/ 6 0 7 J s%o~ O\ 4z. .-'('0 00 4 t ~`s _ 29'N o^ o N'n o9 e OS '1~ 6 ~/`'~i Q 3: ut.sei ~'r3o r6-`c ro s an .~in Lr .L 'an ! 0 5 'i D e., o ~Q~ ~ )3 ~ y ti n ~!'fFm 3 r Gs f h~ ~ ~ ~ ~~'!y0• j65 ~ E ! ,~1.y~'~'J~%J'O ~ 9i ~ ~n 0 4~ ? .n .n , 28 3 ~V/ Q,: ~.i J P9 S N c 9"~5.~ rv r 3~ <~i~ ~'s ~ ~-TSO•33'a \ ~ 9~~ S5ti ~ ~D ooci ~ S?es y, ,o' 4 a' e ''`~5•f5 n 3 c[+ / • C0."60.OOV.. !`.S OGk~k`~ ` q . S±by. r~ 6' °44 ~ SSS~ 0 VS vt o C J 60 .~9 5.83 M13~ Z~[9•DS.~J~. E.4I°q3 My o ~ ~~at' ~~e9;~o ~ ~e4~' 4 Ji9 ip'p u9 M ,11.83 Z0.00• . Z'ag.. ~ ~o S r., k" ~ y°R ~J yti p 30 ~ • n6.P' o Nob,~ o C,`45 00 Q S a T6 19 . 96 J'_° ~ O 2 e I O J e~6 p S ~ 3P 1 ~ ~T N.BS°47'IB'etp'3D F L', 6q~c `flL3 o. S"5 ~p II p~~~ c~4: o~ SgQ O \~d y ui ~ 27 lb~ G o ti.,~'+ o ^v 6ba ~ 2~4 e~ 55~~96 es 63~. dk o. y L 4 76'• Z Z'h ~ O 0 o e.0 c el P e 5 i~ 9 e, 5.83° 43' y 15 o..«mm 26 N F , 19 ~ ~n 61 ~u ~i ~ 0 +3q~6 Q N ~ '16. ~ 3 W. v: 18 a . 5' 0~~ ••.°J o aa° h+p 58.20,: 6~.4 ii.~3 33 15.00 21 yN.84 °z6'e oa••w: -W oo : 16 m ~ o~ k o 0 ~ 85C0 2~ S79e20 N~ 17 ~b3•tii,~Bti6'l'E . N 23 0 63.i5 75.6e5p0~F? ~m ab,~ ~59e 5j1 ':i 72440 SS 45.00 ' o. ZL n~ N N O ~ S 1 y 2 4 ~ T ~W 1 ~ 13 o ti r.° 5 60 ? 1 S l 47'03"E. 2' 0y oy `T V O o 62.CC $.66 ; 59.00 ' °OS. m Z 3 6i'09 0 5`0 Q. 0 ~ c p~ 62.0a ~ ~O~ ~ •l~~9 ky~ L 90.06 \1 s~9 'as 9 ng~ • ~ looe SS ~9~ °o N m w iu1 i ~•71e~'3J 'B7 ` l•3'Ob,plo 90.06 ~ a~ ~:t~3 p 12 0~^ L _i5.66 - _ ~Sg 9,Yc ,~p01 14 W / ~ p 3 ~f f` '~S l'13.21 A,m a~n / Z 7 ~ -7 o~ ~ ~ m ia.~~' .1a~^rs•ss°:_ ~ ~ ~ ~g0 ~5,pqV1'°. + .3.83^14Nr I ..1 - - . ji.E7B.ie~. ~ ~ 1 \ io'59.6' I 70.r3 Z` m 6j9 N ie1305.,q, qJ ~ „ 5 ;3P ^ 4 b~ 3 61 5. 15?5 l~LL 10.49 .nN ~ 1 68•32 Y~.''_' } ao 16 15 o N.8~2° 36' ~ 6 " 1 V N79°16"39"E: 69.55 15.54,50114 5,.W. ;e3~ 5.1 S c+ e 7": m 1 R'28D.oo -5~ 4'12°OT'47' ~ - ~ < I _ 101 68 ~ 69 .32a ? 60.00 ~ - - - - - - ssa.oa 132B.15 S.W. corner oP N.E. %q of S.E. yq o!' Sec. 29 -N,89°37'S4"E. ~ ~ 73 7-13/ RESIDENTIALBUILDINGn 70 City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone 4 651-675-5675 FAX 9 651-675-5694 New Conshuction ReauiremenLS RemodeVReoair Reauirements Office Use Onlv 3 regste2d sde surveys showing sq. tt ot IoL sq. ft of house; and all roofed areas 2 copies ot plan sMwuig foo5ngs, beams, joists Cert of Survey Reai _Y _ N (20% maximum lot wverage aliowed) 1 set of Energy Calculations for heated add'Aions Tree Pres Plan Recd _ Y_ N, 2 copies of pian showing beam & window sizes; pou2d found design, etc 1 site survey for addNOns & decks Trce Pres Required _ Y_ N 1 set of EneTgy CaIwW4ons Addfbon - indicate iI on-sife septic system On-sile Septic System _ Y_ N 3 apies of Tree P2servation Plan if lot platted after 7!1193 ' Rim Joist Detail Options sekction sheet (buildings wiN 3 or less uni6) Minnegasco mechanical ventiWbon fortn Date 't l o /l O! o I Ia ConsMuction Cos[ 0 Site Address ~ 7~(z Wl.i U`L L- q M4e. Unit/Ste # Description of Work V-,e b/ GZ S e ~e- C Multi-Family Bidg _ Y_ N Fireplace(s) _ 0 _ 1 _ 2 Property Owner A~ e 40V"e OW N e V,$ Telephone 52) 73 Contractor L SJ/y P~°1 e'V SO ~'j ~-C~(~) _ Address~,^ Cl ~ 0.S J/~'/ ~'1 V'? C'- City v` o~ `C. State ' I p1 ri Zip SS37 2 Telephone #(`YS"L) 5/c/0-/°/ COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672 Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet (J submission type) Submitted Submitted . . Energy Envelope Calculations Submitted In the lasi 12 months, has the City of Eagan issued a permit for a similar plan based on a masTer plan? _ Y _ N If yes, date and address of master plan: Licensed Plumber Telephone ) S 4 Mechanical Contractor Telephone # 6 Sewer/Water Contractor Telephone # I hereby apply for a Residential Building Permit and acknowledge that the information is comp ete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. /r- 1 C. V ~ Applic 's Printed Name Applicant' ignature DO NOT WRITE BELOW THIS LINE Sub Tvpes ? 01 Foundation ? 07 OSplex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg ? 02 SF Dwelling ? OB OGplex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi ? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 PorchJAddn. (4sea.) ? 33 6ct. Alt - SF ? 04 02-plex ? 10 08-plex IR; 18 Deck ? 23 Porch (screen/gazebo) ? 36 MuRi Misc. ? OS 03-plex O 11 10.plex ? 19 Lower Level ? 24 Sform Damage ? 06 04-plex ? 12 12-plex ? 25 Miscellaneous Work Tvpes ? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding /K 32 Addition O 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair ? 33 Alteration ? 37 Demolish Buiiding' ? 43 Reroof ? 46 Windows/Doors ? 34 ReplBCemenl `Demolidon (Entire Bldg) - Give PCA handout to applicant . DCSCfIptI0I1: Water Damage _ Yes Valuation 0 coo Occupancy MCES System Plan Review _ 100% or _ 25% Census Code lil Zoning City Water SAC Units Stories Booster Pump # of Units Sq. FL PRV # of Bldgs Length Fire Sprinklered - Type of Const 1116_ Width ' REQUIRED INSPECTIONS Footings (new bldg) _ Sheetrock Footings (deck) FinallC.O. Footings (addition) # FinaUNo C.O. Foundation _ HVAC Drain Tile Other Roof Ice & Water _ Final _ Pool Ftgs Au/Gas Tesu Final Framing _ Siding _ Stucco L.ath _ Stone L.ath _Brick _ Fireplace R.I. AirTest Final Windows Insula[ion _ Retaining Wall Approved By: Building Inspector r Base Fee ^ Surcharge Plan Review 12,2 MC/ES SAC City SAC Utility Connection Charge S8W Permit & Surcharge Treatment Plant License Search Copies Other Total --1~~, E(iAN. FIELD & N0WAK SURVEVORS ~ 7415 WAYZATA BLVO. E F MINNEAPol15, MINMESOTA ESf~~. II7l N CERTIFICATE OF SuRVEY Fo NW AORIZON HOMES, INC. ~ WALNUT LANE _ 75. 66 - - -Q ~ /0' UTIL/TY!ORA/NAGE EASE1111 r S'9 ~ - - - - 1 \ `~S Z. Lci ` ~ i79a ea.s ai 69.63 ~ B U /L ~ / 75;0 ~ N G 1 ap ~ (vNGER , CONST.) 0 ~ 70. 13 ~ / 7s BLOC,F) ONLY ~ 'iv.g, / . ~ ' ~ ScRtE: o / 30' n o 62. 4'2 Lots 1, 2, 3 and 4, Block 5, 1400DGPTE 3RTJ ADDITION we hereby certify ihat ihis is a true and correct representetion of a survey of The boundaries of ihe lend above described and of The location of all buildings, if any, thereon, and all visible encroachments, if any, from or on said land. Deted ihis 22nd day of September ~1975 EGAN,,,"ELD~dr NOWA ,ING rve File No Dak 18 gook No 2056 - 46 bw~ ~ RFf FIVptI annD I a wnc d[2ESIDENTIALBUILDINGin City Of Eagan 3830 Pilot Knob Road, Eagau MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 New ConsWdion Raquirements RemodellReoair ReauiremenLs Office Use OnN 3 registered sHe surveys showirg sq. ft of lot, sq. il of house; and all roofed areas 2 cop'ies of plan showing fooUngs, beams, joists Ceri of Survey Recd Y_ N (20 % maximum lot cove2qe aliowed) i set of Energy Calculahons for heated additions Tree Pres Plan Recd _Y _ N. 2 copies of pWn showing beam & window sizes; poured found design, etc. 1 si[e survey for additions & decks Tree Pres Required _Y _ N 1 set of Energy Calculations AddR'an - indxate if on-siie septic sysfem On-site Septic System _ Y_ N 3 copies of Tree Pmservation Plan if lot piatted after 711193 Rim Joist Detail Oplions selection sheet (buildmgs wRh 3 or less uniLS) Minnegasco mechamql ventilabon form t', +Cc~.- ` f~,~.x-~ x - Date Tl V fo Construction Cost T"Vja• 06 Site Address /71V W.,E/11 A L 41 `1 ~ UniUSte # Description of Work Ve b/ q.S e 0 e C Multi-Family Bldg _ Y_ N Fireplace(s) _ 0 _ 1 _ 2 PropertyOwner WUO ~J A~e 44) We 0WLIC'V.$ Telephone#(9$Z) 1473 Contractor LIO~q P2 ~e k! SO ~~J CUli) _ Addressp~ a(./ 0.s Ly4h (i i v C'. City v: p a State Nt'l Zip'S'S37Z Telephone#(17S"~ COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minnesota Rules 7670 Cateeorv 1 _ Minnesota Rules 7672 Enefgy Code Category . Residential Ventilation Category 7 Worksheet • New Energy Code Worksheet (Jsubmissiontype) Submitted Submitted • Energy Envelope Calculations Submitted In the last 12 monihs, has ihe City of Eagan issued a permiT for a similar plan based on a masTer plan? _ Y _ N If yes, date and address of master plan: Licensed Plumber Telephone ) Mechanical Contractor Telephone ( MA Sewer/Water Contractor Telephone ) I hereby apply for a Residential Building Pernut and acknowledge that the information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. L_ %v v y P,So o plic 's Printed Name icanY ignature *App Ap DO NOT VVRITE BELOW THIS LINE Sub Tvpes 0 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg ? 02 SF Dwelling OB OSplex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi ? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4sea.) ? 33 EM. Alt - SF ? 04 02-plex ? 10 08-plex )St 18 Deck ? 23 Porch (screeNgazebo) ? 36 Multi Misc. ? 05 03-plex ? 11 10.plex ? 19 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex ? 25 Miscellaneous Work Tvpes ? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding A 32 Addition O 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair ? 33 Alteration ? 37 Demolish Building' ? 43 Reroof ? 46 Windows/Doors ? 34 Replacement 'Demolition (Endre Bldg) - Give PCA handout to applicant _ D05GrIDt1011: Water Damage _ Yes Valuation Ow Occupancy MCES System Plan Review _ 100% or _ 25% Census Code N~l ~ Zoning City Water SAC Units Stories Booster Pump # of Units Sq. Ft. PRV # of Bldgs Length Fire Sprinklered ' Type of Const VI&_ Width ' REQUIRED INSPECTIONS _ Footings(new bldg) _ Sheetrock 711- Footings(deck) FinaVC.O. _ Footings (addition) ~ FinaUNo C.O. Foundation _ HVAC Dmin Tile Othei Roof _ Ice & Water _ Final _ Pool Ftgs Air/Gas Tests Final _ Framing _ Siding _ Stucco Lath _ Stone Lath _Brick _ F'veplace _ R.I. _ Au Test _ Final _ Windows Insulation _ Retaining Wall Approved By: Building Inspector Base Fee ~ Surcharge /D Plan Review MC/ES SAC ~D City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search Copies Other Total i~ (i EC3AN, FI ELD & NOWAK `i SURVEYORS ~ 7415 WAYZATA BLVO. E F MINNEAPOl15, MINNESOTA E=tA~. 117} ~ N CERTIFICATE OF SVItMEY Fo NEW HORIZON HOMES, INC. ~ wALNur L ArvE -Q ~ 10' UTlL/TV!ORA/NAGE EASEMt T ~ - \ ~s m I \ W o ' ~ U.; y . ~ . ; ~ i7y~ aa.a ~ ~ 69.63 /y G ~ cA r - - 11 70. 3 i CONSTf ~ ~ /7y8LOCe'l ON[Y ~ ~ a,.81 SCAL E: o _ 7-3 30' 'l I ~J _ 62. 42 Lots 1, 2, 3 and 4, Block 5, SJOODGATE 3RD P.DDITION We hereby certify That this is a irue and correct representation of a survey of the bounderies of the lend above described and of t.he location oFall buildings, if any, thereon, and all visible encroachmenis, if any, from or on said land. Deted this 22nd day of September 1975 EGAN, E10,lr NOWA INL S rve ~irs Fi le No Dak 18 goOk No z056 - 46 b~/ RECEIVED MAR 2 3 2006 zoos RESIDENTIAL PLUMBING PERnniT a,PPUCaTioN CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN MN 55122 651-675-5675 Please complete for modifications to existing residential dwellings. 'Date_Z,_!~ Site Street Address Unit # Property Owner Telephone #(/~'S'f ) Contractor_2~ Telephone# ) Address ~ P ity &i.P/)56'/Z&Ze State&~ ZiP~r.~ The Applicant is: _ Owner ~ Contrector _Other i Septic System _ New _ Refurbished Submit 2 sets of plans and MPC license Includes County fee $ 100.00 Per as-built $ 10 00 Alterations to existing dweiling $ 50 00 Add plumbing fixtures. This fee includes installation of a water softener and/or water heater at the same time. !f you are installing onlv a water soffener and/or water heater, do not complete this section, move to the next section and check the appliance(s) you are instailing. _Septic System Abandonment Water Turnaround (add $130.00 if a 5J8" meter is required) Other ~ Water Softener _ Water Heater $ 15 00 _ new x replacement Lawn Irrigation _RPZ _PVB _new _repair _rebuild $ 30.00 State Surcharge $ 50 I Total $ J_/r~0 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 wiil be in L accord ce with'the approved plan in the evenf a pfan is requiil d t be reviewed an a proved. 6 icnPs Si nature ~ Ap I~canYs Printed Name 9 2006 RESIDENTIAL BUILDING PEUMrT APrLicATioN City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone 9 651-675-5675 FAX 4 651-675-5694 New Conshudlon Reouirements Remoeel rReoair Reauiremen?s OKce Use Oniv 3 re9istered sile surveys showuig sq. ft. of lot, sq. H. o( house; and all mofed areas 2 cropies of plan showing foo6ngs, beams, joists Ced of Survey Recd _ Y_ N (20%mazimum lol wverage allowed) 1 set oi Energy Calculatians for heated addi6ons Tree Pres ?lan Recd _ Y_ N 2 coDies o( plan showmg beam & wmdow sizes; poured found desgn, etc. 1 site survey for additions 8 decks Tree ?res Required _ Y_ N, 1 set o( Energy Calculations Adddion - indicate il on-sde septic syst^m Oo-site Septic System _Y _ N 3 copies of Tree Preservation Plan A lot plaHed aRer 717193 Rim Joist Detafl Ophons seledion sheet (buJdings with 3 or less unitr) Minnegasw mechanicaf ventilation form Date r Construction Cost 58i8o0~-, Site Address ~~g6 u._c~ Lo~,~ ~o--Scov~ ,V,~~ ss k aa Unit/Ste €t ~ Description ot Work 2 3 Multi-Family Bldg _ Y~ N Fireplace(s) _ 0 _ 1 _ 2 -16 CSJ Property Owner C `I noA.. 1-t~5 Vii~i Tetephone#((QCj~,) "1QL4 'Jq%`t Contractor . l~ l~] K t~( e T7--•r-~~T* Address SS~SZ S/'Yl City State h Zip 5S 3'63 Telephone 95,2) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672 Energy Code Category . Residentiai Ventilation Category 1 Worksheet • New Ener (dsubmissiontype) Submitled d,'fJ T a I I' • Energy Envelope Calculations Submiited ~O U A~, y t p 200u In the last 12 months, has the City of Eagan issued a permit for a similar plon bosed on a mast ari'~ _ Y _ N If yes, dote and address of masier plan: lvi - Licensed Plumber 7elephone 6 Mechanical Contractor Telephone # ( ) Sewer/Water Contracior 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 ~Arill be in accordance with the approved plan in the case of work which requires a review and approval of plans. l~ lelle. ~ , ~fA~~- " l Applicant's Printed Name Applicant's Signature 7~a6,,;7 2005 RE5IDENTIAL PLUfVlBING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN MN 55122 651-675-5675 Please comptete for modifications to ex4sting ressder,tial dwe!lirsgs. -4 ~(o Date gV / R5 I ~0 3ite 5treet Add?ess Unit # v Property Owner 00'U 1 S Telephone # (95a) Contractor T/elephone 9.!~;l Address ~ ity L ` StateZip ~ FThe Applicant is: _ Owner Lcontractor _dther Alterations to existing dwelling $ 50.00 _ Add plumbing fuctures (exGudes water softener and/or water heater--complete next section if installing these appliances). -Septic System Abandonment _WaterTumaround (add $125.00 if a 518" meier is required) Other: Water Sof4ener _ Water Heater $ 15.00 _ new replacement Lawn Irrigation _RPZ _PVB ,new _repair _rebuild $ 30.00 o v State Surcharge D $ ,50 Total $ I hereby apply for a Residential Plumbing Permit and acknowledge that the information is complete anrl accurate; that the work will be, in conformance with the ordinancss and codes of the City of Eagan and the plumbing codes; that 9 undprstanc ihis is not a permit, but only an application for a 'accnrdance with the approved plan in permit, work is not to start wiihovk a permit and w4Apan'V 4he event a plan is raquired to be reviswed and ap~~ nn~/ ~0.r ons ApplicanYs Prin ignat e tib d Name L • j FaOfice Cit 7J I y of EalaIl i Permit 3830 Pllot Knob Road ~ Pamin F~ I2 -t J~ i , E8ge11 MN 55122 i oata Received: j Phpne- (651) 675-5675 i i Fau: (651) 675-5694 ~ sren: ~ ~ 2oos COMMERCIAL BUILDING PERnniT aPPUCanoN oeft: g-n-6'g, siWimaieu: vJl ~Lo 1~bc6 1Cl0 I ~ TenaM NsmB: (T nant Is: _ New 1_ Exisung) Suha PROPERTY OWNER Name: Phone: Address l Ciry ! Tip: 1 ; Applicant is: - Own _ Cpn actor 7YPE OF WORK Description oi work: l Conshuctlon Cost: Q CQNTRACTOR Name: Licertse~: Z ClM 1'YTN Address: 2141 PEARSON P gpOOKI`M P ~i State: Zip: Phone: Co c[ Person: ARCHfTECT f Name= Registration ENGINEER Address: City: State: Zip: Phone: Contact Perso " Lfcen.qed pl4mber instellinq ney sewaNwater service• phpne R• NOTE: P/ans and suppon/ng documems you suDmft am consldered be publlc infomfatlon. Por[lons of the IMormstion mey be c/sssllred as non- b!!c H you provlde specific rpaypns fhnt would peimlf the C/ty to oa?cJuOe mat rhe are rraam secrera. I harebY aduume09e ihat ms inlortnation 's cormiete efd eccurare: thar the wwk wqt be m wnrormsnce vNtn tna ortlrtrarices and cotles of the Chy oi Eagan: tApl I underslaM iM1is s nat a permit, but oNy an applicauon for a pertniL and wprk is not to start without a permk; that }he worlc wlll be in arCatlence with thp epproved plan in the casg ol woAc which roquires a review and approvet of ptans. Y appricam's Prineed eme ApplicaDft Slynaca?e Page 1 of 3 ~ 9E/E0 39Gd 0-10'U tlNNti LEbEE0SE9L 80:LT 809L/4L/69 09/23/2008 12:29 7635033437 ANNA FLOLO PAGE 02/10 E !o L eBed e.ntieueg d~~!~ddv xus 1 PeWl+d giusmlddV X. ` ' B41 u~ ua~d pBnoldde e4141w~ 9ousPlO~OB ~J .5ueld W I~^I~ We Mein01 s selinbai 4pW+~ Wm ut e9 Iil+M ~4~ eW le4i :Yuuad a ap41Y^ l+e1s ol 1w ai K+oM P~ 't!uued e io1 uoue~~ddu ue ,tlW l~~9 'N~ e]w s! 5i41 Aug~BP~^ { leW :ue8e3 We ~eu4uo aW 41!"k a3ueuuoWoa ul e4 pN+ ~ aw t841'a~eJnOo'e We alapwoo s! uoue.wWu1 sIW leW eBPe~nPe ~i84 I lo IW~ eUi !a •S12u~e8 epe/i e/8 aA 7gY1 ePM~~ ~ ~ i[eui uo(~euuo/u~ e4~ oJ ~ ey~ v~ed plno.w ja4J suoseai a,yraeds ap/aoid no~t/f ar~qnd-uou 50 pelJlsse/ eQ /o suclJrod ~qqnd e9 0j P~P?8u°o eue kui9na reo,t se4t etu?~P o+liioddns Pue suald a1aW :#Quo~ :eowas1ielaMpernas+x~7i BuiletswjaqwnldWsue*fl :uosJed PEWo'J cbZ 'e)Ej5 :ssaipC>H H3aNIiJNa 9!!tl :GWUN / 1Z31114 ~ouens~eaa :uosie eiuoo , :Ouo4d :d~Z :ale1S L6tl ~RU'J d AM)4d :SSeipptl y~{{3d 4 :eweN !lOlotl!l1N0O Z p esuayl Z. :jsoo uoporWsuoo :WoM+o uopdN;)sBa MHOM =10 3dAl ,moenoo~ iaumo - :si jueo!lddV :di2 J Au0 / ssejPPV .OUo~ -~EN tl3NMOlU.M3dWld - / w•eN :sl Weu 'aweN lu&!el :p amns (6u49n3 U \ . i 0 ) ~ \.sMPPtl alig :ai~ C~ U NOLLV3IIddV lIWLi d'JNldllfl8 ldlouaWWOo $wZ - i I ets ~ 069S-SL9 ~L49) =%~d 5[99-9191t991=W04d Zz 155 NW us8e3 peot19ouH tolld OEK i :eazi 1iuued i uUIIGa jO Ai U"od ~ ~ i asfl a-t10 joJ ~ . l__-_-__--_-____ '8-10-06 19:50 ANDERSON 6513881098 » 651 675 5694 P 9/12 ~ I I Permn i ~ City of EataIl 3890 Pibt Knob Road ~ i Pemrt Fee: i Eagsn MN 53122 oao, aecevoa: ~ whone: (ssf) 675-5075 ~ rv~ 4 7 Z 3~ ~ ~ Fax: S651l 87rr5694 q i sun: i ~-lSbB 2008 COMMERCIAL B ILDING PERMII' APPLICATION 1-1 8~;1 1 881t1 0, 11 9 Z, wALwr vkW oeee: ioI sioe Marse.: Tenant Nems:. (Teront Is: _ New! Edsdrq) Hu16r R PROPERTY OWNER Name: ~ , Phone: ~tl ('Z- 3CS LI 9 Addreae / GlY /Z~p: T[ O/ 1 pk= v' qpplicant ia: Owner 6„ Conhactor TYPE OF WORK oesafption or work: Rzmoe Constructiai Cost: CONTRACTOR Name: ,ddrem: ciry: stare: -h&_ Zia: Pho, ~nta« Pemon: ARCMITECT ! Name: Hegisha6on ENGINEEli Addrass: Cih: - 5tate: _ Zlp: Phone: _ Contact Person: Ucenaed plumCar lnetaWnp now aewwrlwater servlce: Phonex: NOTE: Plims wrtd suppWYlnp alecunients thst ycu subm/t ens randderetl ro be pubdc MIo»naBon- Portrons o/ N?e fnMreereUon maY bs CWNfled as non-publlc 1/ you p?ov/de rpsa!!M roasona fhaf xouW pMm/f t/M CNy fo canNUOS t119t !he we kade sacrofs. I hxebr aow+owladpe mat mis irrarmetian is wmWel9 ena aCCU.au; cnat tns worlc rnu be m conrormance ' srx« ena aoda, d Irie cay d Eapan; th+t I undoraland thiB m nOt a pMmR. bu[ ordy an applbetbn tw a pe'mil. and +ks ~wt t0 Me a p~rtnR; that tl~B wark w~4 W~~ aoco~Eanu rih the aPA~d Wrt m tha u6e d wak +eWpea a rsvrow u~d d a~u x ApplluM'o Pi1ntld Wm APPltuMa SlproWrs Pape t ot 3 -Americaiii Faai17 Imuraaae Growp ~ WODDCATE_m_MOMEQU ' BufMivg Extcttor Roofing Dew"PUon Baae Service Replacement pctuel Caeb Qtv Unit prlce Cher&e Texes Cost Tatal DePreNatfon Vatue Ths foflOwing ifsms nffeM nplacemrnf ojtoq(on thly structure. Inrtvrd indicateE rupjia npprorimuts(y 10 ysan ofQ Based on avercgr candGlon and ljfi erpsetwncy qf 30 years, 33%4eprodation hm been apDUEd Prics 1ncludss debii.f remavd. I- Remove Teaz of( haul and dispox af comp. shingles • 30-40 year 46.37SQ $50.96 j0.00 $0.00 $2.37321 -$783.16(73%) $2,590A5 2- Rcplace Roofing feit - 15 Ib. 46.57 SQ 119,71 517.15 S18.34 $953.38 -5308 YS (33%) E644.43 7e - Rcmnve qddi(ionat chazgE for high mof (2 sturies or greo[er) 46.37 SQ 34.43 $0.00 $0.00 .8206 31 -368.08 (93%) E13823 3b - Replece Additinnal tharge for high nwf (2 etprie5 or gmater) , 46.57 SQ S11 39 E9.91 So.tN) E540-74 -E175,04 (339b) $36530 4- Replace Flashing - pipe juk 4.00 Eq f2114 E1.76 $1.57 E96.(17 -$11.13(3396) $64.94 5- Roplace Aoc~f vcnt - turtle rypp 13.00 EA $36.05 E8J6 $11,12 $48ri.53 -$15K.32 (33%) E730.21 6- Fteplace Ezhaust cap - througA mnf 4.00 HA E64.98 f4-95 ER Ci4 $273.41 -$88.62 (33'R) $184.79 7 - Rcplace [ce & watrs shiWd 1,337.00 SF $135 $33.73 $51.28 51,889.96 -E61255(33%) E1,277.41 8- Replxe Flashing, 14" wide 20.00 LF E2.68 $1.00 $1.70 55630 -f18.25 (339f+) $38.03 9- Replxe Rexrf vent - turbinc type 2-W EA S7018 $2.63 $5.55 E148.34 -.E48.16 (339i,) $100.38 +10 - Repiace Chimney flashtng- average (32" x 16") 1.00 P.4 $209.72 53.)I 3234 E21637 -570.11 (337V) $14626 I 1- Replate t.aminated - 30 yt p. shinglc dg - w/or, felt .53.69S $149.69 b150.13 E23785 %8,421.84 42.729.66(3355) $5.692.18 12 - Rep(ace Ridgc cap - romplrfitio shinglca 136.75LF E3.15 58.05 $6.75 .b445.56 -$104.38(33%) y301,18 Totab f241.96 ;345.54 f16,I09.92 -$5,236.41 t10,973.11 n Favclp DncriPtkm Bax SerWCe Replacemeol Aitoy Camb O4 Unii u.itt Cherge Tazea Cast Totrl Deprecfatloo VN.e V4 OODGA7E m HO\tEpRti-FRS 00311284513 7/15/1008 pigeL ; ASSOCL47ION i A/OL d b695 SL9 L59 « 960L996159 NOS?J30Nb' lS:6l 90-OL-SO0Z ñ þ úõ ÿ þ ÿÿ þýý ûþþÿÿðõî ï íøÿ í÷ ìí ÿø ýüûú ù øô è÷ ÷üú ù ø÷ú ù øô è÷ õ ôèñ ù ÷ùöü ü íàüù Ýÿ ýÜü ÷ ë ù÷á ï ï ÷ Üü÷ ÷ û ÷ å ÷ÿôôù ÿ þ ÷÷ ÿ ÿ ù å ÷ ù ÷ å ÷û ã ÷ ÷ ÷ Üü÷ û ô ÿ ï å ë æÚæíåå ÷û ýü÷ï ÷ÿ Û ü æÚæåâåâ Û ü þå öíôí øóò ùù øô ù óõý ï ââ à ñØäìø ü ÿ óõ ÿ óõ êìçâ ï ÷ û ô ÿ ï ï á ÷ ï ùù ï ï ÷ ÷÷ ÿ÷ ù ôï ùù û ý ó ý ü ÿ à÷ å ùù è ÷ ü ýÿ ü÷ M ., all r / MC9, 11 MI7 ow, 1101,2 w a~ rv> - Lh 0 -Z,, use BLUE or BLACK ink t { a For, 011100, the penms: i t Pmt Fee. 300 Pilot Krlob Road Dais PACOlved: Eagan MN 68122 l 1 Phone: (551) W54tM t Stai< 7~ F.W. (651) 675-M4 , - i V- -J 2013 RESIDENTIAL BUILDING PERMIT APPLICATION ~ C e) Pt,orw (,,(7 d l~, <i't f Nanw,ti " it) ffiA ey ii address clear i zkr ` i h=, 10 i;T--3 Applicairrt Owner -7 Type of Work Des" 0" of work R Consbvcdon Coat i Dom? Muq~-Farrul,► e"lg: (Yes f Nc coffww* I>UPT cmy: Corat'actor 3 • _ stale mp' t.~:enae ~3e-39650 8 Lmdl cartcate o: &4T 5739 b - t i N the project is exempt from lead cerWwaftn, please expiaht why: (see Page 3 for add'i MW irtfiorm MM) a COMPLETE THIS AREA ONLY IF CONSTRUCTM A NEW ES a in the Not 12 months, has the CRY of Eagan issued a peenit for a similar plan boxed on a master plan? a p Yes _No if yea, date and address of rnesW plea Licensed Plumber: Phone: mechanical Contractor: Phone. i - a - sewer & Water Contraction. Phone: NOM and s ►ppo documsftrA~t you srdxnif am coy►sicfer~ed in b pr[blfc fnfonrttafion. 'PbriiDns of PAWS the inft n may be cf SSiRed as non-public ff you p~novide tipec c rieasorhs would permit the City to coNc*tde that they am &ad* secrets CALL BERM YOU Cam Gophw Wa1s One car si (BSI) 45"M for proNdion ap*ut w dmgraxid uWy damage. Cal 4a mans befoes you i0nd to dig 10 MOONS torailas of crderyroard ummmes NOW- i traraby adwowiedge that tt& irdormmson is uaroptete and aoaade: that the walk wilt be in Conformance with the orditanoes and Codes of the CUy of Eagan: that I uoderatand tlis is rat a pemir. but only an OWN , tlon for a penNt, and work Is not io stmt wirwut a permit that the work vra tie in acoordarae with Vw approved plan h the case of walk whiClt wee a renisw and approwd of plans. Extsrtor work mdkorbmd by a buUding p 1 N issued h sooadarwe witle the mm asoo saaie suMM Coda Ieastbe cox kftd wleup 180 data of palntN INSuanae. x SWNf PA u sad , ch-e;-' mowr- x Asp5a Pit Pllmed Nrorta si ai lti`►'f'-- t - W" , C Page, of s PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA120875 Date Issued:03/05/2014 Permit Category:ePermit Site Address: 1786 Walnut Lane Lot:003 Block: 005 Addition: Woodgate 3rd PID:10-84602-05-030 Use: Description: Sub Type:Residential Work Type:Alteration Description:Fixtures Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Fixtures:tub,tub faucet,tub drain. Alex Barna Po Box 188 Fee Summary:PL - Permit Fee (miscellaneous)$55.00 0801.4087 Surcharge-Fixed $5.00 9001.2195 $60.00 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Stacey L Ashley 1786 Walnut Lane Eagan MN 55122 (651) 815-7016 Sowada And Barna Plumbing PO Box 188 Cedar MN 55011 (763) 444-0292 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA140947 Date Issued:02/02/2017 Permit Category:ePermit Site Address: 1786 Walnut Lane Lot:003 Block: 005 Addition: Woodgate 3rd PID:10-84602-05-030 Use: Description: Sub Type:Residential Work Type:Replace Description:Water Softener Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). 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 - Stacey L Ashley 1786 Walnut Lane Eagan MN 55122 (651) 815-7016 Croix Crystal 3440 Yoerg Dr Hudson WI 54016 (715) 386-8667 Applicant/Permitee: Signature Issued By: Signature