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872 Sudberry Lane
c;T'; c:' EAGAN , SEVUER SERVICE PERMIT 3830 Pilot Knob Road F'!r, ? P. O. Box 21199 PERMIT NO.: ~ Eagan, MN 55121 0/1TE: zoninp: R 1 No. of units: 1 p,,,,,,,r: Joseph Miller const Address: Site Addreu: 872 Stldbe2'Iy L3ite L15 B21 Sheffield Plumber. "cGuire Mech i 10-27-83 39583 ' ~ 1 agrN to empy wbh tbe Ciqr of Eagan Connection Charpe: 425. 00 Dd . Ordiuenees. /lcoount Deposit: Permit Fer. k0. 70 ad ~ Surchorye: .50 pd By Misc. Chorpes: ~ Dote of Insp.: Totol: ~ Insp.: Dace Pcid: ' ~ i ~ - - WATft SERVICE PERNIIT Ct7Y ('n EAGAN 3830 Pilot Knob Road PEitM1T NO.: p. O. Box 21799 DATE: Eagan, [NN 5512~Jose 1No. af Units: z«+tr,g: h ?`.illcr const pw"'r' ; i32 B iel P„ddr°ss' 87 . u b~rry atle L sift /1dd"es'r ceciire ':ecR 4 ~0.00 F Plumber: Connection Cho µeter No.: Aceount DePosIt: 15.0(1 pd Siza: Permit Fee: .5r) p2, Render No.: Surcho?fle: 6Q . d0 pcs flet e?" 1 M~M t° e°"'Vh ~tM CiM ~ Misc. Choross: Ordleasaw Total: pa,to Potd: gy InsP.: pote of Insp•: c ~ . . , . . , ; , CASH RECEIPT . 4 I • CITY OF EAGAN 3795 PILOT KNOB ROAD EAGAN, MINNE50TA 55122 DATE 19 wUceIvro FROM AMOUNT Is I & DOLLARS 1 oo ? CASN ? CHECK FpR 1 FUND CODE AtAOUNT Than, u c~ BY • / White-Peyers CopY ~ v Yellow-Posting Copy Pink-File Copy • I,- _ - , ~r, .°o:,~„I'`~'~„T+~~'~'~~'"'"''~~.~,~°~ 3~ _ s~~ti2S~'4"''r~ ~'i•'~.=z.~'»caT- _ : 4-I Citp of Cagan lOP}iFlztItPri1 Af B1Ttibtlti; JttspPtfWri \ yq Thit CMi ficatt itsxtd Prr.rwnet to t6e scqxirnntntt of Satioa 306 of tix Umfom Building ;1 Codc urtif*8 tfxu at tbc tiurr o f u.arance cbu st+wu.r uas ra complr'ame wirb ilx varie,u ordiwwu o f t& CitY nplaaing 6rilding conssnrrtiox er xrc. For tlx following: U SF DWiG/GAR ' . - hrmit No. 8619 w drrflc~tla~ OccupiIIIIII Typo Jos . M c Miller F~ ~ 18133 Ce ~r A e. S., F ~ 872 Suaperry Iane L 15, B 2, Sheffield e"y oesa., o.ft: ' MW 1N A CGMMCYOV~ KAC[ , . . . . ~ .i . , , . . . .,..a., r _ CITY OF EAGAN 3796 Pliet Knob Rood Eoyan, MN 55122 PHONE: 454-8100 BUILDING PERMIT Receipt Te 6e mad ior SF DWGf GAP Est. Volue $57,000 Date OCtober 27 . 19 E3 Site /lddress 872 Sudberry Lar.e Erect Octuponcy R_3 lot 15 Block 2 Sec/Sub. 'heffielc: AIter p Zoning Parcel # 10-67600-150-02 Repoir ? Fire Zone " o~ Nome Joseph ?.1. Niller Const. , Inc. ~°~e ? Type of Consr. _ ? # Stories ~ Address 18133 e ar ve. o. pe~l;s, ~ Length 39 Ci Fsrmington ph~ 454-4793' Grode p Depth Sq. Ft. o Name Owner Approvals Feas u~ /lddress Assessment Permit 28: 50 ~ Clt Phone Woter 8 Sew. Surchorge -15T.-W Police Plon check ~ . 525.00- ~W Name Fira SAC ~3 Address Er?p. Water Conn.45 <W Ci Phone Plonner Water Meter~ 00 Councfl Rood Unit 1 hereby ocknowledge that I hove read this npplicotion ond state that Bldg. Off. fhe inlormation Is correct and agree fo compiy wifh oil applicable 9. 50 Stote of Minnesoto Stotutes ond City of Eagon Ordinontes. APC Totol Sipnature of Permittee en. flr onat. , Inc. /1 Bullding PeRnit is issued to: on the exprest condition 1hal oll work sholl be done in accordonce with oll applicoble Stote of Minnesoto Stetutes ond City of Eogan Ordinances. Bufldinp Officiol Psrmit No. Psrmit Holdsr Misc. Parmit No. Holder Plumbing 3 0Z C Gl.llV ~ l~+r -2~3 H.V.A.C. C~ Cb 2 o~(ted 1~~r r(- ~'18j3 w.u w.~? Disp. Semr ENctric 2r3 g~ ~ 30 Inspection Date Insp. Other Footinqs /0•25-$3 ~ P (~g PacL. Ot.~'}' Foundation Framing Rouph PI6y. ,!a W 1-000, *HVAC ~l waur Describe Location: YIlell Sewer Pr. D'ap. Receipt ;~;3PLUMBING PERMIT Permit No, I? CITY OF EAGAN _ Fee ~ . ; Fill in numbered spaces S/C Type or Prini legibly . ~ ' Tot. 1. Date 2. Installation Cost - ~uY? ~ ~ , ~.r ` ~ 3. Job Address a • Lot~Blk. „ Tract r . 4. Owner f ~ ~ ~.1~"r.</ . ; e: v..~~..., : • 5. Contractor Phone 6. Address 7. City State Zip 8. Building Type: Residential ~ Commercial O Institutional ? 9. Work Description: New C5( Add ? Alter ? Repair ? 10. Describe 11. No. Fixtures No. Fixtures Water Closet Cesspool/Orainfield Bath tubs Septic Tank Lavatory Softner Shower Well Kitchen Sink Urinal/Bidet Orer Laundry Tray ~ Floor Drains Drinking Ftn. Slop Sink Gas Piping Outlets 12. I hereby certify that the above information is true and correct, and I agree to comply wit"1 ordinances and codes governing this type af work. Signed: , for Rough Final , Inspections: Date Insp. Date Insp. . This is your-.permit when numbered and approved. ~ Approved CITY OF EAGAN 454-8100 , . : Receipt MECHANICAL PERMIT Permit No. . • C1TY OF EAGAN Fee Fill in numbered spaces S/C ' Type or Print legibly Tot. ° 1. Date 2. Installation Cost • 3. Job Address Lot Blk. ~ Tract -1 • 4. Owner • 5. Contractor Phone 6. Address 7, City State Zip 8. Building Type: Residential 0 Commercial ? Institutional O 9. Work Description: New 0 Add ? Alter O Repair ? I 10. Describe Fuel Type 11. No. Equioment BTU - M. Ea. No. EQUipment CFM Forced Air Air Handling: Mfg. ~ Boilers Mech. Exhaust Mfg. Unit Heater Mfg. Other Air Cond. Mfg. Gas, Piping Outlets 12. I hereby certify that the above information is true and correct, and I agree to comply with all ordinances and codes governing this type of work. Signed : ~ for Rough F inal Inspections: Date Insp. Date Insp. This is your permit when numbered end approved. Approved CITY OF EAGAN 464-8100 CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 ~ 11972 PHONE: 454-8100 BUILDING PERMIT ReceiPt # To be used 1or DECK Est. Value . $Z , 300 Date MAY :j , 19 ~G SiteAddress 372 SUDBERRY LN Erect [Z Occupancy Lot-I S Block 2 SeclSub. jj= I" •D A?)n Remodel ? Zoning Parcel No. Repair ? Type of Const. Aitditlon ? No. Stories ¢ tvame TODD SPAUUE Move ? Length 23 i 5A,E Demolish ? Depth o Address Int. Impr. ? Sq. Fr City Pnone 452-3710 Instali ? a Name SAPiI: Approvals Fees Address Assessment Permit S 3 cs . 50 ~ City Phone Water & Sew. Surcharge 1.U Police Plan Review ~ Name Fire SAC a= Address Eng. Water Conn. < W Cicy Phone Planner Water Meter Council Road Unit I hereby acknowledge that I have read this application and state that the Bldg. Ofi. 5~ 86 Tr. PI. information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. APC Parks Signature of Permittee f/ Var. Date Copie ~r c Total ~ A Building Permit is issued to: TOD9 SPAt1DE on the express conditian that all work shall be done in accordance with all applicable State of Minnesota Statutes and City oi Eagan.Ordinances. Building Official ~ . Prrmlt No. Pwmll Holder Dab TeMplwew A PlumbMq H.V.A.C. EIecMe SoRanN Inspectlon Date Inap. Footfnga I AqA- Foodngsll FoundNbn Fnminq RooNnq Rouyh Plby. Rouyh Ht9. Imul. IFfnplaee Final Hty. Final P69. Bldg. Finsl Cert. Occ. Dedt Fty. Deck Frmp. ~ WoII Pr. Disp. Receipt PLUMBING PERMIT Permit Na. CITY OF EAGAN Fee Fill in numbered spaces S/C Type or Prinr /egib/y Tot. 1. Date 2. Installation Cost 3. Job Addresr--;, Lot ; Blk. ~ Tract 4. Owner-l'-% 5. Contractor 1-7,1 ,_-z E Phone 6. Address l . f 1!' ?e 7. City-` State Zip 8. Building Type: Residential Q Commercial ? Institutional O 9. Work Description: New El Add ? Alter ? Rspair ? 10. Descrihe 11. No. Fixtures No. Fixtures Water Closet Cesspool/Drainfield Bath tubs Septic Tank Lavatory Softner Shower Well Kitchen Sink Urinal/Bidet Other Laundry Tray Floor Drains Drinking Ftn. E Slop Sink Gas Piping Outlets 12. I hereby certify that the above information is true and correct, and I egree to comply with all ordinances and codes governing this type of work. Signed: for ~ Rough Final t Inspections: Date Insp. Date t p. This is your permit when numbered and approved. Approved CI OF EAGAN 454-8100 CITY OF EAGAN Remarks Addition SHEFFIELD ADDN l.ot 15 Rik 2 Parcel 10-67600-150-02 Owner Street 872 SUDSERRY LANE State EAGAN MN 55123 Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. 1981 28.68 1.43 20 22.96 A013354 12-7-83 STREET RESTaR. 1984 1]S O9 17 81 10 GRADING 591 1981 91.10 .07 15 66.82 A013353 12-27-83 Sewer Lateral 1981 152.9 10.20 15 22 SAN SEW TRUNK 57 1981 3. 3O 4.22 15 46.42 SEWER LATERAL g 53 ].9 1, 9.5Q • 3 15 tt tt Sewer Lateral 6/ 1982 65.0 4.3 15 52.07 A013354 " WATERMAIN 1981 12 .0 8.5 15 93.96 A013353 " ~ WATER LATERAL Z 1982 .l 3.21 15 38.53 3A,013354 WATERAREA 19 1 3.30 .22 15 46.42 91 Powerline 19 2 15 STORM SEW TRK 89z. 1985 456.09 91.22 ~ STORMSEWLAT DrainELge 1984 91.75 9.18 10 91.75 C008525 9-19-83 Rql sesa 4a .2Go 0 3 C'eo93 S~ ~l/yo e CURB~UI R SiDEWALK STREET LIGHT Street 823 1985 1941.64 388.33 G ffe0,73 .S' e/~ o 7TIV 250.00 39583 10-27-83 WATER CONN. 450.00 it of BUILDING PER. 8619 SAC n H PARK CITY OF EA6AN N? 5619 ' 9795 PIIM Knob Rood Eogan, MN 55122 / PHONE: 454-8100 BUILDING PERMIT Receipt # »S d Te 6e umd h. SF DWG/GAR Est. Volue $57,000 Dote October 27 _ 1983 Site Addreu $72 Sudberiy Lane Erect 7[$ Occupancy R-3 Lot 15 Blxk 2 Set/Sub. Sheffield qlter ? Zoning R-1 Parcel # 10-67600-150-02 Repoir ? Fire Zone NA Enlorge [3 Type of Con¢t. V rc Namo Joseph M. Miller Const., Inc. Move ? # Srories z Addreu 18133 Cedar Ave. So. Demolish ? Length 39 Ci Farmington phone 454-4733' Grode ? Depth 45 Sq. Ft.- ADDrovals Feef Name DGTner o Assessment Permit 304.00 Address ~ Wofer & Sew. SurcFmrge 28.50 City Phone 152.00 Police Plon check Gw Name Fire SAC 525.00 x~ Address Eng. WaterConn.450•00 ~W C~ php~ Piunnor Water Meter 60• 00 Councll Rood Unit 250.00 I hereby ucknowledge thof I have read this apDlication and stote that Bldg. Off. the inlormotion is torrecf and ogree to wmply with all opplicable $1769.50 51ote of Minnewto Stalutes and City of Eogon Ordirwnces. APC TMOI Signature of Permittea Joseph M. Mil r Const. ' Inc. on the ex re A Buildin9 Permit is issued to: ~ P ss Conditlon ihm all work sholl be done in acwrdance withJ a I pplliwble}s, t of Minn/emta Stotutes ond Ciry of Eapon Ordinances. Bulldinp Official ~ M/vwatwa G • e a! ~ 'lb 8s ZJved Pbr 6QO ~ ssa aamm..= P~a tavv ~ 91R~ ve~ a~ - tg* /j- sLodk 111bw WAM (o on~- l`~o -oZ ~lr~ Ewr ~ I~ss+osl h lO - Co ~ Aep~= , ~ ' ~1 ~ (Xty/ziP ~de= FlICYM f t irewSt ~ O'S~ ~ ~ - v.~- . . ountr.oeors ~ _ ~ce A&kvn_ ` SD Fise ac ~o Ctty/ZSP . a~:: . . ~ ~ ~ !?sch./ltr+g.: ioc • . 3 City/ziP Oaft_ Plfam 0: ~ . : : . . . . . , . . . . _ ' CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-799, Eagan, MN 55121 N° 11932 t BUILDING PERMIT PHONE: 454-8100 Receipt # / y j/~7 i ' To be uaed for DECK Est Value $2,3 0 0 Date MAY 8 , 1g 8 6 SiteAddress 872 SUDBERRY LN Erect IM Occupancy Lot' 15 Block Z Sec/Sub. SHEFFIELD ADD Remodel ? Zoning Parcel No. Aepair ? Type of Const. Addition ? No. Stories W Name TODD SPAUDE Move ? Length 3 Address S~E Demolish ? Depth 36 ° 452-3710 Int.lmpr. ? Sq.Ft Ciry Phone Install ? o Name SAME Approvals Feee ~ ~ Y Address Assessment Permit $ 38 - 50 Ciry Phone Water & Sew. Surcharge 1.50 ~ a Police Plan Review F w Name Fire SAC -z Q Z5 Address Eng. Water Conn. a W City Phone Planner Water Meter Council Road Unit Iherebyacknowledgethatlhavereadthisapplicationandstatethatthe BIdg.Off. S/~/86 Tr.PI. iniormetion is correct and agree to comply with all applicable State ol Minnesota Statutes and Ciry of Ea ~ O~dinances. APC Parks Var. Date Copies~ Signature oi Permittee' ~ 4 u u u TOtal A 6uilding Permit is issued to: TODfl SPAUDE on the express condition that all work shall 6e done in accordance with all applic St of Minnes Sta nd Ciry of Eagan Ordinances. Building Official ~ This request voiA rtqnths fGHm 1-1`~C(/ 1310, i`-3'('~~~~~. Q / iB 't'~'~~-0C 940. A 1_ 386 r t 3 ri ~3~ , sz Neques[ Da[e Fire No. Rough-in InsoecIion ~ _ Reqmred? fleady Now BJWA NntitY Inspec- _v P,y179- El No iur When PeaAy icenseA EleMrical Contractor I hereby request inspaction of ebove ? Owner elactrical work installed at: Sveet Atldress, Box or Route N. Ciry ~a ecLOn o. Townshi0 ame or No. Hange No, o [ ~ Occupant (PRINT) Phone No. ~o ' -`I7S3 Power uppli r Address ~ ~ E ecvical CoTfre tor (COmpany Name) ' ntrar.tor's cense No~.] Mailme Address (CO r,ctor or Owr~er~~ In •IatioN ~ ! 1 ~j""' 1 Auth i d Sipn ture 1 onvactor/Owner MakinB Tstallation) P e Number MINNESOTA STATE BOAND OF ECTRICITV THIS INSPECTION flEQIIEST WILL NOT Griggs-Midwey Bld9. - Noom N•191 BE ACCEPTED BV THE STATE BOARD 1827 UniversitY AVe., St. Vaul, MN 66104 UNLESS PflOPEN INSPECTION FEE IS ENCLOSED. Phone (672) 297-21N REQUEST FOR ELECTRICAL INSPECTION ee-ooooi-oa Q ~ , Sea instructions lor compteting this form on back ot Vellow copy. 0 6 X'" Betow Work Covered by This Request ~ NewfAddl Rep. Tyoe ot Builtling Appliances Wired EpaiUment Wired Home Range Temporary Service Duplex Water Heater ightiny Fixtures Apt. BuilAing Dryer ElecVic Heatin Cominercial Bldg. umace Silo Unloader Industrial BIAg. Air Conditioner Bulk Milk Tenk Parm Mhe7 soeciN _me, (sueo,+v) [ er ISpecify t er Othoer ompute lnspec[ioa Fee Below # Fee ServicaEntrencaSiza q Fae Fenders/SUbieetlers # Fee Circuils O 0 ro200Am s 0 ro30Am s 0 tn30Flm s Above 200 qm ps 31 to 100 Amps 31 to 100 A 5 Swimming Pool Above 700_Am s Above 100_Am s Transiormers Irrigation Booms ~ Panial%Other Fee Signs Special Inspection S TOTA FEE ~ Remerks RouBh-in ' ~ P/11e ~0 1, ffia pec Elec q bical "~p Insto heraby er~i~y tbat the above Final ~ ;'l~// inspeetion hes been ~ matle. Thia repuest voitl 1B moniM Irom ~ * * * * * * ~ * ~ * * * ~ * * X X X x x F x n n ~ ~ ~ CITY OF EAGAN CASHIER: JS TERMINAL NO: 708 DATE: 04/14/00 TIME: 12:01:45 ID: NAME: AZTEC ROOFING & CONSTRUCTION 3210 9001 872 SUDBERRY LA 125.2E 2155 9001 872 SUDBERRY LA 3.OC M Total Receipt Amount: 126•2! G~~ 4- 1 3b`; sa 2000 BUILDING PERMIT APPLICATION (RESIDENTIAL) CITY OF EACAN 3830 PILOT KWOB RD - 55122 651•681-4875 a s repl.amd are wryey. d,ow6ro sa. ft a b+. w, rt. a nouse 2 coae: a alan aW g( rooled arew Q% mmdrtwm b1 crnremoe WbweA1 1 1et o/ enerpy omcWallont for healed adtflMpn a 2 caples of pMna (Yww petan A wlndow slua; poured hW. detlyn; etc.) 1 tlla wrvey fa exleAOr addllions R tlec W D 1 sef of eneryy calculctlqu a J Coples hee p aHan plcn H lof plalfeC tbter 7/1/93 DATE: / T CONSiRUCitON COST: G°°a DESCRIPTION OF WORK: J`e ~o -'t- SiREETADDRESS: S 7~ SKC~.bcnR~ Lor. 15 ei.ocK 2 sueo.iP.i.n. Sh e f Fr e I d Name: ~u m bc10 ~2i Rn~ Phone C ~S l- G~l- p 2~8/ PROPERiY last Flrst OWNER Sheef Address: 9 74 5i.c"c RRY CHY C'4744 State: m^' Zip: 5-51 Z 3 • Company: Phone II: G~ Z rys -0 o~4v (area code) CONTRACTOR SheetAddreas: /I5 g3 2`'~~ ~i 2 Llcense# ao, 391 yo ExP C„Y O u 2iv5 d,1 State: ZiP: 5S 33 '7 ARCHITECT/ ENGINEER Company: Name: Telephone Y: ( ) Sheet Address: ReglshaHon t: Ctly Sicte: Lp: Sewerlwater licensed plumber (H Installino sewer/water): PFqne U I hereby xknowledqe Ilwt I have read Ihis applicatbn, date that Ihe fntomialion is conect, and agree b compry wNh aA appOcable Sfate of Minnesota Statufes and CNy o} Eopan Ordinancea n1 /G'_. Signalure of AppNcant ( e1,Uf'~ ~ , OFFICE USE ONLY Certiflcates of Survey Received _ Yes _ No Tree Preservation Plan Received _ Yes _ No _ Not Required OFFICE USE ONLY BUILDING PERMIT SUBTYPES O 01 Foundation O 07 Orplex O 13 16-plex O 21 Porch (3-sea.) ? 31 Ext Alt - Muld ? 02 SF Dwelling ? OB 06-piex ? 17 Garage ? 22 Porch/Addn. (4-sea.) O 33 Ext. Alt - SF O 03 01 of _ plex O 09 07-piex ? 18 Deck O 23 Poroh (screened) ? 36 Muki ? 04 02-plex ? 10 08-plex O 19 Lower Level O 24 Storm Damage ? 05 03-plex ? 11 10-plex Pibg _Y or _ N 0 25 Miscellaneous O 06 04-plex ? 12 12-Plex ? 20 Pool ? 30 Accessory BWg. WORK TYPE ? 31 New ? 36 Move Bldg. ? 43 Reroof 0 32 Addition O 37 Demolish (Bldg)' 0 44 Siding O 33 Alteration O 38 Demoiish (Interior) 0 45 Fire Repair ? 34 Repair 0 42 Demolish (Foundation) ? 46 Windows/Doors • Give PCA handout to applicant for demolition permit GENERAL INFORMATION SAC Code # of Stories sq. ft. No. of Units Length sq. ft. No. of Buildings Width Footprint sq. ft. Const. (Actual) Basement sq. ft. Census Code (Allowable) Main level sq. ft. MC/ES System , UBC Occupancy sq. ft. City Water Zoning sq. ft. Booster Pump PRV Fire Sprinklered MISCELLANEOUS INSPECTIONS O Stucco/Stone APPROVALS Planning Building Engineering Variance Permit Fee Valuation: $ Surcharge Plan Review License MC/ES SAC City SAC Water Conn. Water Meter Acct. Deposit SNV Permit S/W Surcharge Treatment PI. • Park Ded. Trails Ded. ' Other ` Copies Total: SAC Units % SAC Certificate For: Jczrph *M. Miller Construction 18133 Cedar Avenue South Farmington, MN 55024 ~ DELMAR H. SCHWANZ - LAND SURVEVOR 5 I q[.. Reqi3lenE UnElr Laws of The Slate of Minnesob 2978 - 746TH STREET W. - BOX M R0.SEMOUNT, MINNESOTA 55066 PHONE 612 423-1789 SURVEVOH'S CERTIFICATE ~Q~ a oeairanGe t a r t UT-WuTr EAsgM6aT-~ ~I e ti o~ _ _ SG m " ~ ? ~ ~ ~ .o.' z2.33 I~•o" d' . v N ~Rk.. a IL33 I ~ I - I 433 m . Il.l ~1 ~ I,~ lJ is.o' I c( m 0 0~ Denotea Propoaed IIrainage 0 Denotea Proposed Elevatlon ° ~z z i[ 1 UN 6 0. oo s~9 °4q' 35"w I hereby certify that this is a true and correct representation of Lot 15, Block 2, SHEFFIELD, according to the recorded plat thereof, Dakota County, Minnesota. A1$o ahowing the location oP a proposed house thereon. Dated: September 26, 1983 / ' - ' ' MINNESOTA REGISTRATION NO 8625 ` QortiPicate For: '3a9eoh4M. Miller Construction 18133 Cedar Avenue South Farmington, MN 55024 ,Bi~• ~6/~~l DELMAR H. SCHWANZ LANDSVRVEVORS l44. qphtrK Undw Laws Of The SbU OI Minnnota • 2878 - 116TH 8TREET M. - BOX M R08EMWNT, MINNESOTA 86068 PHONE 672 423-1789 SURVEYORB CERTIFICATE L At 14 F. x,~'o ~,ees x %.?-a~on . ~o.oo ~'E~~i f ) ' ? ~ a 5011 ~ a q13 • I. ~ ~ 4lfs f ~qi i. 44 22.3 jVp /VwB ~ ~ _ $levations ehown are existing t , p'~°'~~ PiooDOaed garage floor el0vation ~ y~ t~ ~5 ~~~k' ~ 9~ ~ ~N/ jo'. i . Daijb"a Proposed Drainage HdVA?tes Praposad Slevation i 1Y. . ~ I . a^ i L_._ ` , ~aoo S~h°4~i~.3~i"11P >t I ttersbD? aertify that this is a true and correct representation of Lot 1S, BloQk 2, SHBFPIRI~, according to the recorded plat thereof, Dalota CpunLy, 1Ninnesots. ~ Aleo ehowing the location 0:E s propoead house thereon. y, Dated: September 26, 1983 ~?v ~ MINNESOTA RE6ISTRATION N0.8625 . • 4 ~ 73 ~ ~ 1986 BOILDING PERlIIT APPLICATIOH - CITY OF EAGAN NOTE: ALL CONTRACTOFS MOST BE LICENSED iiITH THE CITY OF EAGAN SIAGLE FAMIILY DWELLIRGS INCLQDE 2 SETS OF PLANS, 3 CERTIFICATES OF SIIRVEY, 1 SET OF ENERGY CALCULATIONS MOLTIPLE DSiS[,LINGS - AESIDSNTIAL 9ENTAL DNITS FOF SALS DNITS INCLUDE 2 SETS OF PLANS, CEBTIFIC9T8 OF SDRVSY - CHECK WITH BLDG. DEPT., 1 SET OF ENERGY CALCULATIONS COMHERCTpi: 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: Valuation: - Date: Site Address' u- OFFICE IISE ONLY Lot Block ~G Erect ~ Oecupancy Remodel Zoning Parcel/Sub Repair _ Type of Const Addition _ li of Stories Owner ~ S uL'tMove _ Length Q3 Demolish Depth Address ~7 Int.Impr. _ Sq Ft Install City/Zip Code t- S S/7 7 Phone 3 7/ 0 9PPROVAI.S FEES Contraetor Assessments Permit Water/Sewer Surcharge 1.5f~ 9ddress Police Plan Review Fire SAC City/Zip Code Engr Water Conn Planner Water Meter Phone Council~~ . Road Unit Bldg Off ~ Treatment P1 Mch./Engr. APC Parks Varianee Copies ~ Address 'fOTAL G~d • /Tp City/Zip Code Phone 4 HOTE: ADDEESSSS FOR CORNER LOTS - CONTAACTOR/HOMfiOfiNER MQST DESIGNATfi AHZCH ADDRESS IS DESIRED. NO CHANGS3 fIILL BE 9LLOii6D OHCE BIIILDING PERMIY IS ISSIIED. Date: City of Eaaall 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 6755694 RESIDENT / OWNER Use BLUE or BLACK Ink For Office Use � ,t Permit #: Permit Fee: �1 <? Date Received: Staff: ll3 6-0 201 1 RESIDENTIAL BUILDING PERMIT APPLICATION 13 Site Address: '7& 5. 6-R/Z) <•/ Unit #: Name:lit Z et yPhone: 6/v2 (lire —ii32/4, Address / City / Zip: ;,1 5p O SE . y Lis./ jAzterg1L2 5-3—/ 3 Applicant is: .Owner -- Contractor TYPE OF WORK CONTRACTOR Description of work: `aa L -f te-E 4.1410/64E Construction Cost / A'79. Multi -Family Boding: (Yes / No )C ) Company: %-11„ j ri L2/'/7 4/7Pmi L Contact: Address: c1P© I te�� A u& /ti, City: Ily/,S State: MA) Zip: .5.5-/,2 Phone: q'5'.;;? `63gx-ej -op License #: 3 0 .37,443 . . Lead .Certificate #: /t34 i- 7A' 373 —/ If the project is exempt from lead certification, please explain why; (see Page 3 for additional information) • /'t!6 to COMPLETE THIS AREA alky IF 9ONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Eagan Issued a permit for a similar plan based on a master plan? Yes _No If yes, date and address of master plan: L.Icensed Plumber: Phone: Mechanical Contractor: Sewer & Water Contractor: Phone: Phone: NOTE: Plans and supporting documents that you submit are consitdered to be public information. Portions of the Information may be classif/ed4s non -04110 if you provlle Sp icljlc reasons that would permit the City to comic ude tliat,tlity aro tradesecrets;. CALL BEFORE YOU DIG. CaU Gopher State On, Cal et (651) 4544002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities, www.gool)grstateonecalt:orq 1 hereby acknowledge that this information Is complete and accurate; that the work WIU be M conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, bid Only an application for 8 permit. end, Werk Isnot to start without a permit; that the work will be in accordance with the approved plan in the'cas° of work which requires a review and approval of. plans. Exterior work authorized by a building permit Issued In accordance with the Minnesota State Building Code must be completed within 180 days of permit Issuance. / Applicant's Printed Name Applicant's Signature Page 1 of 3 City of Eagan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Date: 1 3 ) f 3 Use BLUE or BLACK ink t For Office Use I Permit # 1(1'0°1 II �D Permit Fee: jj / C" Date Received: 1' (3 I I Staff. I INFLOW & I FILTRATION PERMIT APPLICATION Plumbing / Sewer & Water Site Address: l a w a b 4 r y L Vk Tenant: Suite #: Name: Ra e h e ) Address / City / Zip: $1 0 . %,-. %err Phone: (.'� `/qo 4 3 Z4 Name: He S 3 LE -1 ,% License #: Address: 0 a 1 7 r' City: 4 c State: Zip: -a.5 -S ) Phone: (. S 6 F ‘ % 2 S Contact: 1LEmail: „ PLUMBING (Within the building envelope) Sump Pump Repair SEWER & WATER (Outside the building envelope) Repair Other. FEES $60.00 / Each (includes $5.00 State Surcharge) `Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit 111 repair costs for reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors can be found by visiting www.citvofeagan.comtinflow, or City Hall at 3830 Pilot Knob Rd. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Cali 48 hours before you intend to dig to receive locates of underground utilities. vwnrw.00pherstateonecall.orc I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; 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 the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. xK S ),L Applicant's Printed Name Applicant's Signature Use BLUE or BLACK Ink -For-- Offi-ce------------~ I Uftse City O1f Eapn 1 Permit IO/ ,5 a S 40RII~ 1 Permit Fee: 1 3830 Pilot Knob Road Eagan MN 55122 Date Received: j I5 ~3 j Phone: (651) 675-5675 1 Staff: Fax: (651) 675-5694 I I I ----------J 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: II - IS - i 3 Site Address: Unit w I Name: 2r.c e tL~'-t Z_ Phone: " Resident/ l a Owner Address / City 1 Zip: Applicant is: _ Owner Contractor ti 'Description of work: ' - 'P 9_14 Type of Work Construction Cost: t0~ Multi-Family Building: (Yes I N04~_) Company: yc_kr, t .2-P i K'vdl-n .SiT LAC Contact: i Address: City: Contractor i State: A%,0 Zip: .Y311-( Phone: 7G-3' 1YV 3 Y _ License f3 e- 63 7 S i b Lead Certificate If the =project is exempt from lead certification, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Fagan issued a permit for a similar plan based on a master plan? a i ~ Yes No If yes, date and address of master plan: t C Licensed Plumber. Phone: s j Mechanical Contractor: Phone: E Sewer & Water Contractor: Phone: NOTE.- Plans and supporting documents that you submit are considered to be public information. Portions of k the information may be classified as non-public if you provide specific reasons that would permit the City to i f conclude that their are trade secrets.. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. wwev.aophersta.eonecall.oro I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; 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 the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuance. x Applicarif's Printed Name pplicant's Sighature, Page 1 of 3 L-d £069-09L-£9L uo;lonilsuoo uewsl;ejo e9Z:L0 £L 9L AoN Use BLUE or BLACK Ink I ! For Office Use t o City of Eajan RECEIVED I Permit w a a Permit Fee: ! 3630 Pilot Knob Road MAY 0 8 Eagan MN 55122 I Date Received I Phone: (651) 675.5675 t I Fax: (651) 675-5694 1 Staff: 2014 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Unit Name: t Phone: Resident! Owner Address/ City/Zip: Applicant is: Owner Contractor Type of Work Description of work: pie L 1 at' rr { Li i,, !-t Construction Cost: )t { Multi-Family Building: (Yes _ / No Company: i. # E , j,4 . I Contact: I t', t i' i fl t, : < ) c a `'i Address. 0k_ L.-[; -t t•-t i i .:1 t >Y city: i t kt r t t ? Contractor --z--t`- State: Zi • ` p.~,t2~1 Phone. . ~ ` f ' ~ ( f ? Email: i , ~ ~t ~•,-r, ~c v r , ~ , x; rr cr x ~ C'C>Tt k 71) 1 -7 License Lead Certificate If the project is exempt from I"d certification, please explain why: (see Page 3 for additional information) 3l i OOMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 mgpgts, has the City of Eagan issued a permit for a similar plan 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. Plans and supporting documents that you submit are considered to be public information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that the are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 4540002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.aooherstateonecal.org I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; 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 the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Exterior work authorized by a building permit issued in accordance with the MinnesotaState Building Code must be completed within 180 days of permit issuance. x I,ui x~ I%'L(~i(l ' Applicant's Printed Name Applicant's Signature Page 1 of 3 g-D S(.~ d LA.11Lc / DO NOT WRITE BELOW THIS LINE SUB TYPES Foundation _ Fireplace _ Porch (3-Season) _ Exterior Alteration (Single Family) Single Family _ Garage Porch (44eason) _ Exterior Alteration (Multl) Multi _ Deck _ Porch (ScreenlGazebolPergola) _ Miscellaneous 01 of„ Plex Lower Level _ Pool Accessory Building WORK TYPES New Interior Improvement Siding Demolish BuildlW _ Addition _ Move Building _ Reroof Demolish Interior X Alteration _ Fire Repair Windows Demolish Foundation TT' Replace _ Repair Egress Window ` Water Damage _ Retaining Wall 'Demolition of entire building - give PCA handout to sWicant DE§CRIPTION Valuation Occupancy .Erb MCES System Plan Review Code Edition SAC Units (25%_ 1I0oto__) Zoning City Water Census Code Stories Booster Pump # of Units Square Feet PRV # of Buildings Length Fire Sprinklers Type of Construction Width REQUIRED INSPECTIONS Footings (New Building) Meter Size: Footings (Deck) Final / C.O. Required Footings (Addition) Final 1 No C.O. Required Foundation NVAC _ Gas Service Test Gas Line Air Test Roof: -Ice & Water -Final Pool: -Footings -Air/Gas Tests -„Final Framing Drain The ! ~ 1 Fireplace: _,,,Rough In Air Test Final Siding: ! Stucco Lath -Stone Lath -Brick Insulation Windows Sheathing Retaining Wall. Footings Backflli Final Sheetrock Radon Control Fire Wails Erosion Control Braced Walls Other: Reviewed By: Building Inspector RESIDENTIAL FEES Base Fee Surcharge Plan Review MCES SAC pp City SAC Utility Connection Charge C.J S&W Permit & Surcharge Treatment Plant Copies TOTAL Page 2 of 3 07/28/2014 08:44�M 9526817601 BWS HUAC P�GE 02/02 Use BLUE or BLACK Ink —, � For Otfice Use T^��T R�� I I Cit of�a aIl ; P8R""#: '�� �° ; � � t� , 3830 Pllot Knob Road � Permlt Fea �• � Eagan MN SSt22 I 1� � � Phone:(631)67S-36T3 ; Date Received� � d"� � Fax:(651 j 676-5694 I Sg� I L------ ----_.__� 2014 MECHANICAL PERMIT APPLICATION ❑ Please submit two(2)sets of plans with all commercial applications. Date: /^Z�'�� Slte Addreaa: �7a ��►��u_ ll'1 Tena�t• Sul�e#: -- - � �1'1 Ph n !11 �� ''�T3 r�7�d �:�ta3��e�iVfer���,: Name: �1'� �D a J' o e: ;�;i� - �,,�; �`:;':,�s'; Address I City 1 zip- � !� (�� .;°:, :�;�;,�.� .':,::V;�: �:;�:, , _ /� L� .`,`I ,,:Fe�_:,:;>�.=:;,::��:::�: `'� � rl � !�f �G�i �d nse�: _ �:�;; =:;;r.-; - Name; _ �:�,'._ �'n,� r �( /�, �, � :,�;� <��;' � �r ����'` lo l � �d� P� ,e �'Co�ctb�:; �� � / /�j ;,:a. Address• t�b�V ��1��.I��N�f? �J�1�� ty: _ ;'�:�;�:�..:i >'�`� �;:'•:; State: �"�/ Zi Phone• [Yd� �� ";,�;�,,;:<`�-�<:�� =���� p. _:is-.,.�, `..j;:.; - , ��� :'�, Contact: Email_ �uK- ` .A(;';. •.C'.� _ �Y. ''� •:'.�;�:' - � _ New epiacement Additional Alteration bemolition , •. ;;.�;,� ;;;;:;:c,".; _ �;;�;' �:�� ��.,:.;:.::,;:� (� i ,_;,,;,::: ..............: : ;.:.TYF�;:;�.1N?� ,... ` Descr�ption of work: (a'(�Q '�Q�G`s�{-� "TulrlC�'�� I ._..,. ,... : '1'�.:.;;°, ..... . _� .�. "':�;;,.._ �-;.,.�::,. . _ ..- ........;., ..,_,.:,,.:.;-..:,:; ,�.�....L.:.,..K�:;''M_... ........... .,y... - �.�:::...F>:y�.v:��.�... xa.0 r•� -:<::.:,:�:..:!ww.x>�.�y.,;r,.::..r:::- iC� �7: ;:�.,.,. ��._�; dr; <,:..c.s:...,.< ._....,. .� „_.,.�..:... j- �i I -` :``N .,...,.,.... .......... .:...�,..;.. .,..::..... ,�, ;.....,.., .;;, .., :,..:,,::,,.-, M+�:�4a �t� . . ... .. t�_.:r�r.tn��a::�n�r�i�d: awt�� '�e �oilc°�fk:�a;��n� , ,:� :,.. ,::..:. .... _. .,.. .. , ,...�.<. . ...,. .. i .:. . . ....,.. _ .: ..: .. . .... ,.,. :�..: _ _ ,, _.4.,._.�:_.. . ...._......:. . ,,,... .. L .::.. ........ ..... ,..:^.; ..... ,: yy.y� ��: ... ... ,. ,. , p . .. � � ... ;;: , .1. I ... ,.,. . . .. .. ..:: ....:::.. ...... .......C�d J .I�Ab11f' � 11�A�<�t1: bW'�1lM`� ��1� ^?dl�t%:�m_��•� O�r^��;.. .... . ..� .•.;.��::....... ..:.�.:....::1,.��....c...... i�� .�.7w �Y'.`�N✓_ "�• �..t.�_�..r..�.�/�7 .,.... ,..:.. .r:' �� �.... , .., . . ,,.. .. . �,.�.,..�,_.:....:_,,,.. ,.....:.�`.�,!�'a.., .$ „�,' ,.,.. ...���1'ill..,.�,�.�.�.,.. .�,�� ; ,,,, .. ,..,. -,.,: .... ,.... ...., .,� `.•..;y:. _ �::s'ct!:�:;;�,;:�a;ye. "i;;; �-�;_;;;.'��;;; - RES/DENT/AL COMMERCIAL .1� `°��''� '�I,`~` Fumace New Construction Intgrior im rovemsnt - � p �.(i':^' "� 'rF ����.:�';:�; �:,"�V��. AirCondi�oner Instail Piping Processed '` :<<��[Rf��'°��f�E�=�r �, =���; - � '''" - �Air Exchenger Gss Exterior HVAC Unit :�;:':':`�_.-_, ;; ;;;;: - ��. �.:�;; :a�^;�; Heat Pump UnderlAbove ground Tank (_Install/_Remove) '<��" ,��'� ��`s �Other RES/DENT/AL FEES a60.00 Mlnlmum Add or alteratlon to an existing unit(includes$5.00 S1ete Surcharge) �o $100.00 Residential New(inGudes$5.00 State Surcharge) _$ " � TOTAL�E� COMMERCIAL.FEES Cvnt�act Va1ue$ x.01 555.00 Pennit�ee Minimum �70.OQ Underground tank installatlon/removal =$ Permit Fee *If contract value is LESS 4han$10,010,5urcharge=$5.00 =$ Surcharge` "If contract value is GREATER than E10,010,Suroharge=Contrect Value x$0.0005 `*"If the project valuaUon is over$1 million,please call for Surcharge ^$ TO7'AL FEE 1 hereby a�knowledge that�Is Informedon Is complete and accu►ate;that fhe w�o�tc will he�conformence with tha ondina�cea and codea of fhe City of Eagen;th6t I understand thls is not a permit,but only an application for a permit,and work is not to start without a pem�it'that the worK wtfl be ln accordanca wttn the approved plan In the case oi wo�tc whlch requlres a revfew and approvel of plana. x ��� �O�r� x AppllcanYs�nted Name Ap i nt's Si ture ,.,.....�.... ....... ...:. .............e.,,,...... . . .:n:e o.s:.; .,�r - - ,�.:.. � .�... . . . 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'�r� .'�a - - — •` - • ,ri.�,r,. • ••�6•r.� ><•�si� �.... .........:-_::.:_,>;.,., , _,_�,.�.._.` _ ,:�,.".:��, . .��::-.,,.-yy .c�.• .. . . • �..,;,,.;.:....:�. .. ..�.�,� .,,,, . , ;� •.._ ...........:,....,..�._..�,,..,...�. :�_::..:..'�e.-. _:,<•r: ,-t , ..—,. _ • . . . ,.. .. . ..... .. ,. .....- .. . . _,.:. ,.,:.,,_ . . ..,.... • � .s .;... rn.:... \... . i. . .. . ... ..... . ....rl............. ..�. ,......,.... ����v°. ..Ril'.���/;,",r:: C'f• _ .��i..,";i'"r,-:':' .,4 • .......:� ::.':::+. . . ...... ..:..,,..,..,,... ...� .�.,�...�.,..,..:��,,.:�.,:,s..n..,':r.,. �`'�. - f�.i•v,:; :c`- .r.: ... ..::.�.�'�,,. •+ . ._ r.,�.�.. „ ,.,....... 5,,.. .... . ..,.. •.r:�:.,,�... ...F,., c:3.., r;,i�.;,4`, ;��;.::,� 4 ...,,c:.;,. ;RQ � , e .y..... .. ,.�.,....., . ._,.,., ...,.. , . . .. ....�,.:.., ��.!��. ;.�„ �,��:' _. ....�fns� dt'atA��. .._,.. .... ... .:..... .�..:.,.:,�::. .:,. _:�te'�� ,ei�':'�: .,k;:: �, . . .,„ .. ...... ... ....... .. .. .,�...,...,,, ;,:<%:' ..1�i!! - ... ... ,�.. ...... ...... . .. .. ...... . ,.:.._ ..,.....�.:...,::.:_.�;,� .:......; �:: ; ,..„ ... .,... ,... .... .. ... .. . w ,.. . � .. ., ..., ..,., ,. .....,�. ,. .,_,.;�:, „���..:`` r ..,.., . ... . ti.. .,.. .,. . ,......... ...._..,... . . ......... .... .�., .. . ..,... ...,: ... ,. , ,• �<, . . ,.... ..: . .... .. . ,. , . .:.... .... ....,;: _„ . , .:;';��:;..,:•• <� ._ _. ,.� . , . ... . �.,.,.....,_..,..,,..,. . : . .. ,:....,:,,.;,.,,,,..,..,,...�.., , ....,,.,. .. - - - - ,._. ,._� . . .... . ..........,.,..�::,•.:�,.,:<,.�.,. ,. • ,� ..:. �........,........:.:-... ,.. . _ .,.,...., , _. , >..,.., :.;ra;, „_:: ..,.,,....:•,,,:.,_..� „ . .�.Ni... .. , . � .. :,........: .. . .. � . '"•• - � ..n.• , . . . . ..,,,.t..:�....... . „ .......,.. .. . . l. :C::.::'1.'. " . ......n..a . . . .. ........ � . . _. ,.....:..:a<.,� ... . ..... ., a �,•. � !�I� F�d,.... .:_.. +�..OU �fi �'�L.:... ..��..��'dS. r1/IC6 Y :<�,,.,. �.. �.......,H9•. . �.��:'• .:r� ��L: .:09.•:�;' ;, ,....,.��8�+ ..�. ...�,,,�.. .>, �y.'. .. ..._. ....... ,�s�,< n:�:pr;, at-'` ?Ft�,,.., �=� :�ci;��k� .. ., . . . ,.... .,. ....�r. ..,_,.�r......�:,..:•.,.:. ....T.�.c.::.., 'c::'�:=::.. ,..:'���.�c:,. .,- .:....:.:'�� .�. ..... �;�..: ! � . .:.........., . . .:,�':��.r...: ...' .� PERMIT City of Eagan Permit Type:Building Permit Number:EA132891 Date Issued:09/09/2015 Permit Category:ePermit Site Address: 872 Sudberry Lane Lot:15 Block: 2 Addition: Sheffield PID:10-67600-02-150 Use: Description: Sub Type:Fireplace Work Type:Gas Insert Description: Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Improvements to the home may require smoke detectors in all bedrooms. Chimney / flue must be inspected prior to concealing. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Valuation: 3,000.00 Fee Summary:BL - Base Fee $3K $88.50 0801.4085 Surcharge - Based on Valuation $3K $1.50 9001.2195 $90.00 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 - Mike Lofgren 872 Sudberry Lane Eagan MN 55123 Hearth And Home Technologies 2700 N. Fairview Ave Roseville MN 55113 (651) 638-3309 Applicant/Permitee: Signature Issued By: Signature