712 Summer Lane F .~L1~~¢!~!!'.'~.~?~i° . . „ . ' . "'.'r_7rt-9'.csn°R-'°~',,.xi°.:~'ryd,~~'ns Wsw`..•~. . . . . . . . , ..ry,~
- • CITY OF EAGAN ~a ' 7634
, 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
P HO N E: 454-8100 ,
BUILDING PERMIT Receipt # -
To be used for SF DiJG/CAR Est. Value $84~000 Daie MAR 26
Site Address 712 SUl~lBR LN
Lot ~ 81ack 1 SeclSub. SiMEH pLIICE OFFICE USE ONLY
Parcel No. occuPancy R- ~1 FEES
Zoning
10E r~ILt.ER HoMEs WN sbs.oo
W Mame (Actudi) Const Bldg. Permil
18133 ~'.EDAR AVE S
4Z•QQ
O AddresS (Allowable) surcnarge
City FARMiNMN Phone 1'2001 # otstohss ~ 369.00
Length ~ Plan Review
=o Name S~ Depth ~2 sAC, cily l~•~
OUa AddreSS S.F. Totai - gqC, MCWCC 600900
~ City Phone S.F. Foolprints - 625.00
On Site Sewage _ Water Conn
~
W W Name On Site Well water Meter 90•00
l'-~ AddreSS MWCC System ~ 30.00
aW City Phone Citywater XX Acct.0eposit
PRV Required xx S71N Permil 3o•oo
I hereby acknowiege Ehat I have read this application and state that the Booster Pump - SiW Surcharge '50
information is correct and agree to comply with all applicable State of 252.00
Minnesota Statutes and City of Eagan 04dinances. Treatmern PI
Z.`' r APPROVALS 355~~
Signature of Permitee Road Unit
A Building Permit is issued to: JOE MILL.ER 1fOMES Planner - park Ded.
on the express condition that all work shall be done in accordance with all Council
applica6le State of Minnesota Statutes and City ot Eagan Ordinances. gld9, ptt. _ Copies
ti Variance - TOTAL 3,061.50
Buiiding Official
! Permit No. Permit Holder Date Telephone #
WATER
SE1+VER
PLUMBING 9D
H.V.A.C.
ELECTRIC ~(p ~ • y~ + O ~ ~
Inspection Date Insp. Comments
Footings I 1~V
Foundation
Framin9
Roofing
Rough Plbg.
Rough Htg. A'J'
lsul. *r/
Freplace / 1/y (J
Final Ntg. ~l1 pCf ~
Final Pibg. • ~ ~//J
Const. Meter Plbg. Inspecfor - Notify Plumber
Engr./Plan
Bldg. Final 3
Deck Ftg.
Deck Final
Well
Pr. Disp.
a j
Q¦
(ttrtif iratt uf Orrupanry
titp of eagatt
#rprtmrd p# Udding 3nsprnim
,
Tltrs Certificate issued pursuant to the requirernents ojSection 306 of tke Uniform Building
Code certifying chat at t/te dme of issuance tlus structrrre w+as in compliartce wilk the various
ordinances of the City regulating building construction or use. Far the following.
un Cksmficawn SF DWG/GAR ~ Pcmft No 160$ 17634
o~ ~ ~ ~ 4E'~AR AVE S . , FAta@~J `
~ 712 Stt~Ett LANE I3, B 1, S[M4R PLACE
LIV
MAY 30, 1990
~
POST IN A CONSPICUOUS PUCE
Fa omce use a,ir:
. MECHANICAL PERMIT PERMIT # _
CITY OF EAOAN RECEIPT # ~ 3530 PILOT KNOB ROAD, EAGAN, MN 55122 - ' -
CONTRACT PRI E PHONE: 454-8700 DATE:
Site Addrsss -gLpG, nfpE WORK DESCRIPTION
Lot Block Sec/Sub ' t< R~ ~ New
'
Name Mult Add-on
~ -
m Comm. Repafr
Address Other
c Ciry ' Phone
- FEES
~ Name RES. HVAC 0-100 M BTU -$24.00
c Address ADDITIONAL 50 M BTU - 6.00
p City Phone (RES. HVAC INCLUDES A/C ON NEW
CONSTRUCTION)
GAS OUTLETS (MINIMUM -1 PER PERMIT) - 1.50 EA.
TYPE OF WORK • COMMIIND FEE -1% OF CONTRACT FEE
Forced Air. M BTU APT. BLDGS. - COMM. RATE APPLIES
Boiler M BTU TOWNHOUSE & COND05 - RES. RATE APPLIES
Unit Heater M BTU MINIMUAA RESIDENTIAL FEE - ALL ADD-ON 8
Air Cond. M BTU REMODELS - 12.00
MINIMUM COMMERCIAL FEE - 20.00
Vent CFM STATE SURCHARGE PER PERMIT - .50
Gas Plping Outlets k ' (ADD $.50 S!C PER EACH $1000.00 OF PERMIT FEE)
Other
, .
PERMIT FEE:
S/C: SIGNATURE OF PERMITTEE ti
-
TOTILL: FOR CITY OF EAGAN
PLUMBING PERMIT For Office U e O~ly
CITY OF EAGAN PERMIT # U
CONTRACT 3830 PILOT KNOB ROAD, EAGAN, MN 55122 RECEIPT #
PRICE PHONE 454-8100 DATE:
Site Ad~ess BLDG. TYP.E~/ WORK DE RS~C I~N
Lot Bbck ec/Sub ~s. ~ New
Muh. Add-an
Name Comm. Repair
` Other
~ Address / ~
Phone 3 RE3. PLBG. ONLY • COAIIPLETE THE FOLLOWING:
~ City
- N FIXTURES TOTAI,
~ Water Closet - $3.00 a •S
Name r-e Bath Tubs - $3.00
~ Addre s ~ Lavatory - $3.00 ~
~ Cit ^ _ Phon Shower - $3.00 - - - 3 = -
IGidsen Sink - $3•00 3
Urinal/Bidet - $3.00
FEES ~ Laundry Tray - $3.00 ~
COMM./IND. FEE -1% OF CONTRACT FEE Floor Drains -$1.50
APT. BLDGS. - COMM. RATE APPLIES Water Heater -$1.50
TOWNHOUSE & CONDO - RES. RATE APLLIES Whirlpool -$3.00
MINIMUM - RESIDENTIAL FEE $12.00 ~ Gas Piping Oudets -$1.50 / S
MINIMUM - COMM.IND./FEE $20.00 (MINIMUIuI -1 PER PERMIT)
STATE SURCHARGE PER PERMIT .50 Softener -$5.00
(ADD $.50 S!C PER EACH ,000 OF PERMIT FEE) Well 10.00
Private Disp. - $10.00
Rough Openings - $1.50
' SIGMATURE OF PER ITTEE U. G. Sprinkler System -$12.00
PERMIT FEE: ~
STATES S/C: ~D
FOR: CITY OF EAGAN GRAND TOTAL:
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55123 Date Issued: l'°~"
(612) 681-4675
SITE ADDRESS: APPLICANT:
i 11:9(0 R t ANf riri I ItiiNY
Al I , • i . ~ ~t. •~,c~.
PERMIT SUBTYPE: TYPE OF WORK:
l;j!; r•i) It
INSPECTION • .A
; liil I ! fas,
~ ~
Permit No. Permit Holder Date TNephone I
S/IAI
PLUMBING
HVAC
ELECTRIC
ELECTRIC
Inspsctlon oete Insp. Commerrts
Footings I
Foundetion
Framing
Roofing
Rough Plbg.
Rough Htg•
isul.
Flreplace
Fnal Htg.
Orsat Test
Flnal Plbg. Pibg. Inspector - Notify Plumber
Const. AAeter
Engr./Plan
Bldg. Final
Deck Fi9. s-G 9.~ Ds
Dedc Flnal
i weu
Pr. Disp.
PERMIT #
MECHANICAL PERMIT RECEIPT #
CITY OF EAGAN ' j
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE:
CONTRACT PRICE PHONE: 454-8100 For Office Use Only:
Site Address BLDG. TYPE WORK DESCRIPTION
Lot Block Sec/Sub Res. New
Muit Add-on
~ Name '
Address Comm. Repair
c City Phone Other
FEES
~ Name RES. HVAC 0-100 M BTU - a24.04
c Address ' ADDITIONAL 50 M BTU - 6.00
p City Phone • (RES. HVAC INCLUDES A/C ON NEW
CONSTRUCTION)
GAS OUTLETS (MINIMUM - 1 PER PERMIT) - 1.50 EA.
TYPE OF WORK COMM/IND FEE - 1% OF CONTRACT FEE
Forced Air M 8TU APT BLDGS. - COMM. RATE APPLIES
TOWNHOUSE 8 CONDOS - RES. RATE APPUES
Boiler M BTU MINIMUM RESIDENTIAL FEE - ALL ADD-ON &
Unit Heatet M BTU REMQDELS - 12.00
Air Cond. M BTU MINIMUM COMMERCIAL FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
Vent CFM
(ADO $50 S/C IF PERMIT PRICE GOES
Gas Piping Outlets # BEYOND $1,000)
Other
FEE:
S: ~n WEE
S/C: ~IM
TOTAL• FOR: CITY OF EAGAN
. . _ . . .
~ • . - .
SE ER $aMAI`ER PERMIT OFFICE USE ONLY
CI OF LLAGAN METER #0S/V P/ PERMIT DATE 03127/90
3830 Pilot Knob Rd. CHiP #01 JF"V /f a/ PERMIT # 11291
Eagan, MN 55122-1897
METER SIZE ~ OCk B.P. RECEIPT # C 6959
DATE j.rC F- ~)l, 1 n n r ISSUE DATE B.P. RECEIPT DATE 031271 90
__X PRV _ BOOSTER PUMP
SITE ADDRESS 712 Fam;n'ar La.r1e PEHMIT REOUESTED
LOT 3_BLOCK 2 SEC/SUB rU''1^~F r n! ^
SEWER - WATER _ TAPS
APPLICANT:
ADDRESS: - COMMlINQ i- RESIDENTIAL
CITY, STATE ZIP _ NEW - EXISTING
PHONE:
Lawn Sprinkler Meters are to be Instalted
PLUMBER: Tom 3 c- sian P]_um1.^ Ahead of Domestic Meters on Water Line.
ADDRESS: 121 ed7rrop1?).r'.ve Credit WILL NOT Z iven for Deduct Meters.
CITY, STAT ~,r'n1e Va11ey, ZIP 5F1='11 rl . PH
ONE: 43 2' 9 8 r ; ~ ~ i .
1 AG EE TO COMPLY WI'TH CITY OF
T r'1 1~ er Nomes EAG N ORDINANPES.-
OWNER: ~ 4e
;
ADDRESS: 18131 Cedar 11ve. , - • / . ~
CITY, STATE ZIP 5`21'
PHONE: 411-2p~~ SIGNATURE WHEN METER ISSUED .
o~: ,
PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. CALL 454-5220 FOR INSPECTIONS. FOR STORM
SEWER PERMITS, CONTACT ENGINEERING gEPT.f
SEwEF~%&-W1AER PERMtT OFFICE USE ONLY
ClYY OF LAGAN METER # PERMIT DATE 031271-
3830 Piiot Knob Rd.
Eagan, MN 55122-1897 CH~P # PERMIT # ~ 1241
METER SIZE B.P. RECEIPT # C 6959
DATE ~a rc 2 xZ 9'~ ~ lSSUE DATE B.P, RECEIPT DATE 03 1 2 71 90
__X PRV - BOQSTER PUMP
51TEADDRESS 712 °sn"~,-?' T•qnn PERMITREDUESTED
LOT3 BLOCK I SEC/SUB `'Ur!''!1'rr 'I'.Cg
SEWER WATEFt _ TAPS
APPLICANT:
ADDRESS: - COMM/IND ~ RESIDENTtAL
,
CITY, STATE ZiP _ NEW - EXlSTING
PHONE:
Lawn Sprinkler Meters are to be InstaUed
PLUMBER: n'?~ T' e,~si an Plur^'~in,- Ahead of Domestic Meters on Water Line.
ADDRESS: 121 'r?@dVfOod Dr1 Ve Credit WILL NOT be $iven for Deduct Meters.
,
CITY, STATE 1fl1?1e Z{P 5~3.~_~I!
PHONE: 47~ -F$99
I AGREE TO COMPLY WiTH CITY OF
OWNER: ' ne 1 ~ i 11 er EAGAN ORDINANCES
ADDRESS: 18111 Ced8T' FVe.
CITY, STATE n37'Rll.l'IE'CoT'• :~TT ZIP 17117n?h
PHONE: h ' ' 'I r"..~ ~ SIGNATURE WHEN METER ISSUED
PIEASE ALLOW TWO WORKING DAYS FOR PROGESSING. CALL 454-5220 FOR INSPECTIONS. FOR STORM
SEWER PERMITS, CONTACT ENGINEERING DEPT.
~ _ _ _ -
-A DATE: 03/27/90
RE: 712 SUNMR LN -
X Your Sewer $ Water Permit tor the above property has been completed. It will be held at the
Public Works Garage (3501 Coachman Road) until the meter is picked up. BE SURE TO
CALL PUBLIC WORKS (454-5220) FOR YOUR PERMAPFENT WATER TURN ON.
Your Sewer & Water Permit for the above property cannot be completed for the following
reasons:
Your Sewer & Water Permit for the above property has been completed, but the meter cannot
be issued or occupancy allowed until further notice.
COMMERCIAL PROJECTS ONLY: Please pay for meter at City Nall. Meter size must be
confirmed by Bill Adams or Dirk House (Plumbing Inspectors - 454-8100) before issuance.
WARNING: BEFORE DIGGING, CALL LOCAL UTILITIES - TELEPHONE, ELECTRIC, GQS, ETC.
- REOUIRED BY LAW.
CONTACT COMMUNiTY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICY.
Secretary, Building Inspections Dept.
± DATE: 03/27/90
712 S UMIIME R LN
RE:
X Your Sewer & Water Permit for the above property has been completed. It will be held at the
Public Works Garage (3501 Coachman Road) until the meter is picked up. BE SURE TO
CALL PUBLIC WORKS (454-5220) FOR YOUR PERMANENT WATER TURN ON.
Your Sewer & Water Permit for the above property cannot be completed for the following
reasons:
Your Sewer & Water Permit for the above property has been completed, but the meter cannot
be issued or occupancy allowed until further notice.
COMMERCIAL PROJECTS ONLY: Please pay for meter at City Hall. Meter size must be
confirmed by Bill Adams or Dirk House (Plumbing Inspectors - 454-8100) before issuance.
WARNING; BEFORE DIGGING, CALL LOCAL UTILITIES - TELEPHONE, ELECTRIC, GAS, ETC.
- REaU1RED BY LAW.
CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICY.
Secretary, Building Inspections Dept.
CASH RECEIPT ~
~ CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE ~I d~ t9' ~ r
;..G.
nECErvE~~ ~ ' ~ ~
F,K),. _C -
AMOUNT
& DOLLARS ~
p CASH ~ CHECK ,
,OFt %
~~:-L .r~~ ~c ~,cJ~:~c~L (_•t/~ 1~:~: .4,~ '
s
FUND OB.JECT AMOUNT ~
Thank You .
BY
YVhite-Payers Copy
C 69 5Q Yel,ow-Posting Cop„
, Pink--File Copy I
CITY OF EAGAN ND 17634
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
BUILDING PERMIT Receipt # v (0 C(C~q
Tobeusedfor SF DWG/GAR Est.Value $84,000 Date MAR 26 , 79-9Q--
Site Address 712 S[Jl4fER LN
Lot 3 Black 1 SeGSub. SUtfER PLACE OFFICE USE ONLY
PBfCBI N0. Oaupancy R-3 -MLl FEES
Zaning Pn
p Name JOE MILLER HOMES (qcwaq Const V-N Bldg. Permit 568. 00
W 18133 CEDAR AVE S
o Address (Allowablel -N 42,00
CitY FARMINGTON phone 431-2001 N o1 Swries Surd~arge
Length 47' Plan Reviaw 369.00
iF Name SA~ Oapih 54' snaciry 100.00
gQ Address s.F.roiai - snc,nncwcc 600.00
- City Phone S.F. Faotprinls _
On Site Sewage - Water Conn 625.()0
. r
E. Name OnSileWell - Waler Meter 90-0
i3 AddfQ55 MWCCSystem -XX
u0 Acct. Deposil 10, 00
aw City Phone crywater _C7L
PRV Required xx SIVJ Permit 30 _ O0
1 hereby acknowlege ihal I have read this application and state that the Boosier Pump - SiW Surcharge • 50
iMormation is correct and agree lo comply wilh all applicable State of
Minnesota StaWtes an ~ ry ot Eaga Ifiances. 7reatmem PI 252.00
Signalure of Permitee APPpOVALs Road Unit 355. 00
JOE MILLER HOMES Planner - ParkDed.
A Building Permit is issued lo:
on the express contlition that all work shall be done in accordance with all cou^cit
applicable Slate of Minnesota Sptatutes and Cityu ol Eagan Ordinances. Bldg. Oif. Copies
Building OHicial t(1 I\Qy~_1 1'1.LI variance - 7oTAL 3,061.50
Va3/so S8oa9
0 3'3396 a ° A'C-~
Request Date Fire No. RougO-in Inspection
Requiretl? ReeOy Now ? Will No6ty Inspecmr
? Yes 'NO When Ready?
Icensed contractor ? owner hereby request inspection of above electrical work at:
Jo0 Atlargss (9kee1. Box or RoWe No.) Clty
Y1 l.~
Seclion No. - TownsM1ip Name or No. qanga No. County
OCCUpant(PRINT) phone N0.
~C ' ~r
nliq PawerSupplier Address
ElecMCal Comracror ICOmpany Name) GoMractor5 License No.
011iLf-H"X- C I G -2.
Mailing AWress (COnhactor or Owner Making Installation)
o t on
Authorize0 SignaNre ICOntractoriOwner Making Installation) Phone Number
_C LU
MINNESOTA STATE BOARO OF ELECTpICITY THIS INSPECTION FEQUEST WILL NOT
Grlgga•Mldway Bldg. - Room S-173 BE ACCEPTEO BY THE STATE BOAFD
1821 Unlverally Ave.. St. Peul, MN 55104 UNLESS PROPER INSPEGTION FEE IS
PMne (612) 602-0WO ENCLOSED.
~%2°79~/0 REQUEST FOR ELECTRICAL INSPECTION q~:??~~ EB-00001-0]
? See insVUCtions lo( comNling IDis lorm on back ol yellow copy.
g~..
C~ 3 3~ 9 6 X" Befow Work Covered 6y This Request
ew Adtl Rep. TypeolBuiltling AppliancesWired EquipmeniWired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Other (Specify)
Comm./Intlus[rial Furnace
Farm Air Conditioner
Olher (SOeo1y) C ntractor's Fem9rks:
Compute Inspection Fee Below:
# Other Fee # ServiceEntrance5ize Fee # CircudslFeeders Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transformers Above 200 _ Amps 100 _ Amps
SignS Inspecmr5 Use Only: TOTAL T,
Irrigation Booms `f^ 'S . Stf
Speciallnspection
Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
I, the Electrical Inspector, herehy R°uqn-in oa~e
certily that the above inspectionhas F;nei r o~y ad Itn
been made. D w
OFFICE USE ONLY
Thls request witl 16 monihs (rom
(0 30726 s~,e/ ' ,d
Request Date Pira No, Roug -in inspedion
4/ 10 / 90 R mrem G Aeaay Nowwm Nmay insveoto.
Yes ? No . / ~WIen Ready?
I licensed contractor O owner hereby request inspection oF above electrical work at:
Job Spreet. Box or Rome No.) Ciry
M Summer Lane Eagan
SecM1On No. Township Name or No. qange No. CouMy
• Dakota
Occupan[(PRINT) Phane No.
Joe Miller Construction Co. 431-2001
Power Supplier Address
Dakota Electric Farmington, MN 55024
Eiecmcal Conlractor ICompany Name) Conttaclor's License No.
Midland Electric Inc. 041610
Mailing Maress iCOnVaclor or Owner Makinq Installation)
14055 Grand Ave So, Suite E, Burnsville, MN 55337
Aul,orize re COnhacmnOwner Making In Ilati Pnone Num~er
MINNESOTq STFTE BOAflD OF ELECTRICITV THIS INSPECTION FEQUEST WILL NOT
Gripge-MlOwey BIEg. - Room S173 6E ACCEPTEO BY THE $TATE BOARD
1821 Univeni[y Ave., St. Peul. MN 55104 UNLESS PROPER INSPEGTION FEE IS
Phoiw (612) 642-0800 ENClOSED.
,(/~C)+Q REQUEST POR ELEC I' CAL INSPECTION ea-ooo/oi oq7
? See instruMions for co =pleling Ihorm on back of yellow copy,
C~js 3 6 7 2 6 "X" Below Work Covered by This Request ~N4~V` 4-0-6740
ew AdB' ep: " TypeofBuilding AppliancesWired EquipmenlWired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Other (Specify)
CommJlndustrial Furnace
Farm Air Conditioner
other (spealy) Convactor5 Remarks:
Compute lnspection Fee Below:
# - Dther Fee # Serv iceEnlranceSize Fee # Circuifs/Feeders Fea
SwirVinq Pool 0[0 200 Amps 0 to 100 Amps
Transformers Above 200 _ Amps Above 10 Amps
SignS Inspector's Use Only: ^7 TOTAL
Irrigation 8ooms .
Special Inspection
Alarm/Communication THIS INSTALLATION MAY BE ORDEREQ DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 7 NTH ~ f
I, the Elecirical Inspector, hereby Rouqn-m oal41
certify that the above inspection has , ~e
been made. F;nai
OFFICE USE ONLY '
This request voitl 18 months trom
1990 BUILDING PERMIT APPLICATION
CITY OF EAGAN
SINGLE FAMILY DWELLINGS MULTIPLE 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 CALCULATIONS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFIGATIONS
1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS
# OF RENTAL UNITS
# OF FOR SALE UNITS
PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING DAY
OF MONTH IN WHICH REQUEST IS MADE.
LOT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED.
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS
DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED.
PERMIT MUST SHOW A LICENSED PLUMBER.
.MAR 2 2 B~C~
To Be Used For: -I lJ!A.l) Z-'°l/~~t Valuation: Date: 3`2 7U
Site Address -Ila OFFICE USE ONLY
I Jt~O ~
Lot ~ Block FEES
occupancy R-3 M-I
Zoning P0
Parcel/Sub Actual Const V-N Bldg. Permit 'Jr(e8'0a
. Allowable V, 14 Surcharge y 2•0v
Ocaner # of stories Plan Review 3 ,00
Length '47' SAC, City /OD .D0
Address Depth 59_ SAC, MWCC (op0,D'v
S.F. Total Water Conn e, 2S,00
City/Zip Code Footprint S.F. Water Meter Ot>
Acct. Deposit :Jo.fla
Phone On site sewage_ S/W Permit 30,a O
On site well S/W Surcharge •SD
Contractor MWCC System ? Treatment P1. 25 ,a0
~ City water ~ Road Unit ,3,.5$,ov
Address PRV ? Park Ded.
~ Booster Pump _ Copies
City/Zip Code ` SUBTOTAL
-~~O 1 APPROVALS Penalty
Phone Planner TOTAL 9 ~~e?.~n
Council
Arch./Engr. Bldg. Off. ~ 3~L3 54'
Variance
Address
City/Zip Code
Phone #
. ~ -
GA R AGE .
~2xz2= tiSSy
ou5~
~tzu:~~;~o~e
s x9 = F) 2
r---
I1~sX
~'36~0
TRI-LAND C0. CERTIFICATE OF SURVEY FOR:
SURVEYING
SERVICES MILLER C4NSTRUCTION
1875 PLAZA DRIVE
EAGAN, MINNESOTA 55122
LEGAL DESCRIPTION: LOT 3,aLocK! , SUMMER PLACE
THEREOF DAKRECORDED PLAT
COUNTY,MINNESOTA
~
rs
Rol ~e
9oi.sy
/O/ 2~ ~ .
~ 9op,~g
V9o/ 46 \ ~ ~
°9 I
)a Scole:l"=30'
Q' 4R ; /O
/ i4 ~ / ~''a• 6' P ~i
~ ~ • 9op.~
~ ~
J~ ~ la l qo~.~ yo„~~o / A/?
~o .
Ro~-z~+ Q _ ~ 24' 8
2$ ' SS 9g /dos. 902.13 UT~I('./TyyE j I o3.46
N79°32'p4,~w Q y Zo~10 N0000312711E
,P l51.9g 25.00
9n3.o5 .
.
n4T~ a,
vA(3A1\T ENCYRiEERIIVG DEPT
PROPOSED SPLIT ENTRY - NO WALKOUT
LEGEND
INVERT ELEVATION AT SERVICE EkTENSION=
o DENOTES IRON MONUMENT PROPOSED GARAGE FLOOR ELEVATION=
n DENOTES WOOD HUB SET PROPOSED FIRST FLOOR ELEVATION = qo3. B
DENOTES EXISTING SPOT PfiOPOSED BASEMENT FL06R
ELEVATION ELEVATIO~e~. ~~~p~Jp~~~(n1
DENOTES PROPOSED SPOT P
ELEVATION NOTE. VERIFY ALL FLOOR HEIGHTS WITH
~ DENOTES DRAINAGE DIRECTION FINAL HOUSE PLANS
I haeby csrtify that this wrvey,plan or t,
ropo?t was prepared by me or under my direct supervision and that 1 am a duly Brodley J,;8~eni0n, Mn. Req. No. 15235
; Repisfered Land Surveyor undar the
: Laws ot the Stata of Minnesota. Date •
uitx uN uutMIiiw uEenuiur;ui 0, 62-q'1 "j
, • ' I:X'mllVli k111VE;LVk'FJ AVk;llACiC•,1NII UOIIPU'CA'rI011
- " (Ta ue su6iu:EtEed vith buildiug pertolb appliaatiou)
. • . ,
Uuo or 1'vro Eeiully llv1e111ug ONner
nll olltur 'G-A - : Bite Addreew T 3 l
/J ~ ~+b rN? rN ~.A ~~L.+4~
C..
e /Vr , llate FI?oue
' ' ' . .
LIIIEAL @'EE'Y VF r N 1~I • H 7 a
EXI'USEU YIALL ft, above grsd'e e 1
~ . ._.;J....___...-.....r
. '1'o'1'1W F1X['U6EU IYN,L AltFJ1 sq. F'1,
VI°A(1UE WALL UotisTItUUTlollt IIUII Yalue x Area .
FT. Z/8. tu)(n)
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RESIDEIVTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN aS
3830 PILOT KNOB RD, EAGAN MN 55122 3651-681•4675
New CanaWCtion Renuiremenls RemadeUReoair Reauiraments
• 3 mgistered sAe surveys showirg sa. of lot, sq. R. of house: aM all roo(ep areas • 2 copies of plan
(20% maximum lol coverage allowed) . 7 sel of Energy CalculaGons for healed addi[ions
• 2 coDies of plan showing heam & windax sizes; poured found desgn, etc.) . 1 site survey for extenor atlditions & decks
• 1 set of Eneyy Cakula6on5 . Indicate if home served 6y seplic syslem for atltlitions
. 3 copies of Tree Preservation Plan if bt platted after 711193
• Rim Joist Detail Options seledian sheet (blGgs wiU 3 or less units)
DATE 2 VALUATION ~ O
SITE ADDRESS -7/ 2 c l.Li"YJm&- 1,21,Q, MULTI-PAMILY BLDG _Y QC N
TYPE OF WORK~~I ; L!J/~U6CJ,S Gf)/4/ / FIREPLACE(5) _ 0_ 1_ 2
- - - - - - r7 S
APPLICANT I
STREET ADDRESS ' Renewal By Andersen, Inc. I STATE_ZIP
I 1920 County Road "C" West
TELEPHONE # W51 •olQL03~~'CE Roseville, MN 55113 ~X #
~
PROPERTYOWNER B/-ICLi'1 TELEPHONE#
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MIINNI:SO'C:\ RCLES 7670 C.1'fEGORI' 1 IvIINNLSOT:1 RliI.I:S itii`?
(J submission type) • Residential Venlilation Category 7 WoAcsheet Submitted • New Energy Code Worksheet SubmiHed
• Energy Envelope Calculations Submitted
Plumbing Confraetor. _ _ Phone
Plumbing system includes: Water Softener = Lawn Sprinl:ler ~\A ec. 0.00
Wazer Heater No. oF R.I. Baths
_ No. of Baths
Mechanicai Contractor: Phon ~
Mechanical system includes: _ Air Condiuoning \ Fee -570.00
Hcat Recovcn Systcm
Sewer/Water Conhactor. Phone #
° ° ° -
I hereby acknowledge that I have read this application, state that the i ormation is correct, and agree to comply
with all applicable State of Minnesota Statutes and City of Eagan O inances.
Signature of Applfca
-
OFFICE USE ONLY
CeRificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 3102
OFFICE USE ONLY
? 01 Foundation ? 07 OS-plex 0 73 16-plex O 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? OS 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garege ? 22 Porch/Addn. (4-sea.) ? 33 Ezt. Alt - SF
? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multi
? OS 03-plex ? 11 10-plex ? 19 lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition O 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration O 37 Demolish (Bldg)' ? 43 Reroof ?46 Windows/Doors
? 34 Replacement 'Demolition (Entire Bldg only) - Give PCA handout to appiicant
Valuation Occupancy • MGES System
Census Code ZoningCity 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) FinaUNo C.O.
_ Footings (addition) _ Plumbing
_ Foundation HVAC
_ Drain Tile O[her
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Au/Gas Tests Final
- FraniinB _ Siding Stucco Stone
_ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement)
_ Insulation _ Retaining Wall
Approved By , Building Inspector
8ase Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
W ater Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
PERMIT
~ CITY OF EAGAN 5 -6-~
3830 Pilot Knob Road PERMITTYPE: euYLoING
Eagan, Minnesota 55123 Permit Number: 020850
(612) 681-4675 Date Issued: 0 5/ 0 6/ 9 3
SITE ADDRESS:
712 SUMMER LANE
LOT: 9 BIOCK: 1
SUMMER PLACE
P.I.N.: 10-72960-030-01
DESCRIPTION:
f.
&uildirlg.Permit Type DECK
Auilding Wark 7ype NEW
USC Dacupersoy,, R-3
Building lengt'ht, 10
Build'ing Width 14
r
~
Q'_.'i Tt
_ t?' C.:•
REMARKS:
FEE SUMMARY:
Base Fee $25.00
Surcharge .50
Total Fee $25.50
CONTRACTOR: OWNER: - Applicant -
BUDNIK ANTHONY
712 SUMMER LM
EA6AN MN 55129
(612)452-4869
I hereby acknowledge that I have read th3s application and state that the
inFormati4n is correct and agree to comply with all app].icable State of Mn.
Statutes and City of Eagan Ordinanc-es.
~ -
r
"APPLICANTiPYRMITEE SIGNA RE ISSUED 6Y: SI TUR
INSPECTION RECORD
CITYOFEAGAN PERMITTYPE: auiLorNG
3830 Pilot Knob Road Permit Number: 020850
Eagan, Minnesota 55123 Date Issued: 0 5/ 0 6/ 9 3
(612) 681-4675
SITEADDRESS: Lor: a BLoCK: 1 APPLICANT:
712 SUMMER LANE BUDNIK ANTHONY
SUMMER PLACE (612) 452-4869
PERMIT SUBTYPE: TYPE OF WORK:
DECK NEW
INSPECTION . D•
FOOTIN6 FIMAL
~ -
REAGTIVATf RE~~~VED 603 UILD~A
PERMIT # G ERMIT APPLIGATION
0 3 1993 681-4675
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERCIAL 2 sets of architectural 6 structural plans, i set of
specifications, 1 copy of energy calcs.
Penalty applies: 1) when permit is typed, but not picked up by last working day of month-
in which request is made, 2) address is changed or 3) lot change is requested once permit
is issued.
Date .-5' 3- 99 Valuation of work
4ite Address: 712- r La-7e, r^-y a-r+ m
STREET SUITE «
Tenant Name: (commercial only)
I,OT b BIACK ~ SUBD. acu~l~l.v~l ft K/a~ P.I.D. N
t'
Descri tion of work:
The applicant is: J!IOwner ? Contractor ? Other (Desorfbc)
Name /9 u dN ~ k- 14A t~on y Phone
Property L.ST F1R5T G yi -
Owner Address '71
STREET STE 0
City State w~ n Zip
Company G F Phone
Contractor Address License # Exp.
City State ZiP
Company Phone
ArChiteCt/
Englneer Name Registration #
Address
City State ZiP
Sewer & water licensed plumber . Processing time for
sewer 8 water permits is two days-once area has been approved.
I hereby acknowledge that I have ad this application and state that the information is
correct and aqree to comply wi 1 applicable State of Minnesota Statutes and City of
Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY ° -
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex ? 11 Apt./Lodging ? 16 Basemenf finish
O 02 SF Dwg. O 07 4-Plex O 12 Multi. Misc. b 17 Swim Pool
? 03 SF Addition O 08 8-Plex ? 13 6arage/Accessory O 18 Comm./Ind.
O 04 SF Porch ? 09 12-Plex ? 14 Fireplace ? 19 Comn./Ind. Misc.
005 SF Misc. ? 10 Multi. Add'1. ~15 Deck ? 20 Pub11c Facility
O 21 Miscellaneous
WORK TYPE
iffi 31 New ? 33 Alterations ? 35 Tenant Finish ? 37 Demolish
? 32 Addition 0 34 Repair O 36 Move
GENERAL INFORMATION
Const. (Actual) Basement sq. ft. MWCC System
(Allowable) lst F1. sq. ft. City Water
UBC Occupancy ~ 2nd F1. sq. ft. PRV Required
Zoning Sq. Ft. total Booster Pump
S of Stories Footprint Sq. ft. Fire 5prinkler
Length 1_8: On-site well Census Code ~
Depth /ql On-site sewage SAC Code
APPROVALS ~~'us bl~~• ~
~ u$ CUn
Planning Building Assessments
Engineering Yariance
REQUIRED INSPECTIONS '
? Site la Footing ? Framing ? Insulation
? Wallboard ~Final ? Draintile O Fireplace
Permit fee vC" vaw.c;a,: g
Surcharge
Plan Review
License
MWCC SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ued.
Trails Ded.
Copies
Other
Total:
SAC % ~
SAC Units
' 90- 54
TRI'LAND CO. CERTIFlCATE OF SURVEY FOR:
SURVEYING
SERVICES MILLER CONSTRUCTl4N
1875 PLAZA DRIVE
EAGAN, MINNESOTA 55122
LEGAL DESCRIPTION~ LOT 3,aLocK! , SUMMER PLACE
ACCORDING THEREOF DAKO~A RECORDED PLAT
COUNTY,MINNESOTA
~
9of ~
/0/ 0 .
. '
/ 9o2.ie
P90/ SIo 3~Q ' ~
~ 9 n• I
O
n Scale:1"=30,
~
(u ~ /
~ / 0 ro ~
y~"~~O
u :
,901 .25 AI U~C/./TAC~E
Y
~~W . ;e Zo~"~.~ ~ N00°03'27"E
~cQ l51.99 25.00
r 903.05 .
i
PRGPOSED SPLIT ENTRY - NO WALKOUT I
LEGENlQ INV£RT ELEVQTION A? SERVICE EXTENSION=
o DENOTES IRON MONUMENT PROPOSED GARAGE FLQQR ELEVATION= Ro3,3
o DENOTES WOOD HUB SET PROPOSED FIRST FLOOR ELEVATION
DENOTES EXISTING SPOT PROPOSED BASEMENT FLOOR
- ELEVATION ELEVATION
DENOTES PROPOSED SPOT
ELEVATION
DENO7ES DRAINAGE DIRECTION NOTE ~ VERIFY ALL FLOOR HEfGHTS WITH
FINAL HOUSE PLANS
I hareby csrtify tAot this survey,plan or
report was propored by ms or under my
diract supervision and that I am o duly Brodley J.. ~Ir"son, Mn. Rap. No. 15235
Repistered Land Surveyor under fhe ~
}
: Laws oi the Stote of Minnesota. Date ~ ~1L :/:z
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA107647
Date Issued:10/22/2012
Permit Category:ePermit
Site Address: 712 Summer Lane
Lot:3 Block: 1 Addition: Summer Place
PID:10-72960-01-030
Use:
Description:
Sub Type:e-Windows/Doors
Work Type:Windows/Doors
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:JoAnne Burr
990 Lone Oak Road Ste. 114
Eagan, MN 55121
651-905-0105
Valuation: 500.00
Fee Summary:BL - Base Fee $500 $40.00 0801.4085
Surcharge - Based on Valuation $500 $0.50 9001.2195
$40.50 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 -
Marc D Medland
712 Summer Lane
Eagan MN 55123
Window Concepts MN
990 Lone Oak Rd #114
Eagan MN 55121
(651) 905-0105
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA122360
Date Issued:05/06/2014
Permit Category:ePermit
Site Address: 712 Summer Lane
Lot:3 Block: 1 Addition: Summer Place
PID:10-72960-01-030
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
Census Code:434 -
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 by law in ALL single family homes .
Heather Connell
Valuation: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Marc D Medland
712 Summer Lane
Eagan MN 55123
Connells Custom Exteriors Inc
1125 S Frontage Rd, Suite B
Hastings MN 55033
(651) 438-2973
Applicant/Permitee: Signature Issued By: Signature
!"
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Use BLUE or BLACK Ink
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City
/z--/dc 0 °
of Eaian w t , Permit#: 5 6 vi
Permit Fee:'
00(,
3830 Pilot Knob Road "s-? -1(0
Eagan MN 55122 Date Received:
Phone:(651)675-5675 '1
Fax:(651)675-5694 d � ' Staff: 1461
\i 1 -J ri_i' izt--
2016 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 5/19/2016 Site Address: 712 Summer Ln Unit#:
Name: Marc and Shari Medland Phone: 6515879927
Resident/ 712 Summer Ln, Eagan 55123
owner Address/City/Zip:
Applicant is: ✓ Owner Contractor
Type of Work
Description of work: Deck replacement
Construction Cost: $10,000 Multi-Family Building:(Yes /No ✓ )
Company Contact:
Address: City:
Contractor;
State: Zip: Phone: Email:
License#: Lead Certificate#:
If the project is exempt from lead certification,please explain why:
f?\)
COMPLETE THIS AREA ONLY IF CONSTRUCTING 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:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer&Water Contractor: Phone:
Fire Suppression Contractor: Phone:
` NOTE:Plans and supporting documents that-yousubmit are considered to be public information, Portions of
the information be classified as non-public if you provide specific reasons that would permit the City to- -m
ccinclude that they 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. www.aooherstateonecall.orq
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 Marc Medland
Applicant's Printed Name Applicant's Signa um
Page 1 of 3
- /_,il •
----7/ c
t, 2 An �O NO WRITE BELOW THIS LINE 1 D ` C)
SUB TYPES
_ Foundation — Fireplace — Porch(3-Season) _ Exterior Alteration(Single Family)
7. Single Family _ Garage — Porch(4-Season) __._ Exterior Alteration(Multi)
Multi _ Deck — Porch(Screen/Gazebo/Pergola) _ Miscellaneous
01 of Plex Lower Level Pool Accessory Building
WORK TYPES
_ New — Interior Improvement _ Siding _ Demolish Building*
_ Addition _ Move Building _ Reroof , Demolish Interior
X Alteration _ Fire Repair , Windows _ Demolish Foundation
_ Replace _ Repair _ Egress Window _ Water Damage
Retaining Wall *Demolition of entire building-give PCA handout to applicant
DESCRIPTION /-‘,
Valuation lav Occupancy MCES System
-/ /
Plan Review Code Edition "` SAC Units
(25%_100% Y) Zoning City Water
Census Code Stories Booster Pump
#of Units Square Feet PRV
#of Buildings Length Fire Suppression Required
Type of Construction o3 Width
REQUIRED INSPECTIONS
Footings(New Building) Meter Size:
—
)( Footings(Deck) Final I C.O. Required
Footings(Addition) Final I No C.O.Required
Foundation HVAC_Gas Service Test Gas Line Air Test
—
Roof:_Ice&Water _Final Pool:_Footings Air/Gas Tests Final
—
Framing 30 Minutes 1 Hour Drain Tile
Fireplace: Rough In Air Test _Final Siding:_Stucco Lath _Stone Lath _Brick
—
Insulation Windows
Sheathing Retaining Wall:—Footings i Backfill_Final
—
Sheetrock Radon Control
Fire Walls Fire Suppression:_Rough In_Final
—
Braced Walls Erosion Control
—
Shower Pan
Reviewed By: ,Building Inspector
/
RESIDENTIAL FEES F044
C ,A41146/If
Base Fee00 i
Surcharge aff
r il `
)r
Plan Review ' -�
MCES SAC 1
City SAC ' t� x /s/....._
Utility Connection Charge 2 2 0 0
S&W Permit&Surcharge
Treatment Plant
Copies V(6L
TOTAL
reit, Page 2 of 3
-"N -ji4 ✓YL 7 /Z/6 C). 90-054
TRI - LAND Co.
CERTIFICATE OF SURVEY FOR:
SURVEYING
SERVICES MILLER CONSTRUCTION
1875 PLAZA DRIVE
EAGAN, MINNESOTA 55122
LEGAL DESCR I PT ION: LOT 3, BLOCK I , SUMMER PLACE
ACCORDING TO THFRECORDED PLAT
THEREOF DAKOT COUNTY,MINNESOTA
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N
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Scale: III::30'
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•01.29 �.g7 / _� 0
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��� 79032,04 -; k 9 zo , S^1T ! i 0 N00°03127��E
w\i /5/ 99 25.00
903.05
LEGEND PROPOSED SPLIT ENTRY - NO WALKOUT
LEGEND INVERT ELEVATION AT SERVICE EXTENSION
o DENOTES IRON MONUMENT PROPOSED GARAGE FLOOR ELEVATION = `103.3
o DENOTES WOOD HUB SET PROPOSED FIRST FLOOR ELEVATION = 903. '
DENOTES EXISTING SPOT PROPOSED BASEMENT FLOOR = 8' - -
ELEVATION ELEVATION
DENOTES PROPOSED SPOT
ELEVATION
e--- DENOTES DRAINAGE DIRECTION NOTE: VERIFY ALL FLOOR HEIGHTS WITH
FINAL HOUSE PLANS
I hereby certify that this survey,plan or j' ?
report was prepared by me or under my �r� -''f{ =' , �?
direct supervision and that I am a duly Bradley J...S epson, �Mn. Reg. No. 15235
Registered Land Surveyor under the ,/
Laws of the State of Minnesota. Date • . ` // _i (-- -
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA166953
Date Issued:02/16/2021
Permit Category:ePermit
Site Address: 712 Summer Lane
Lot:3 Block: 1 Addition: Summer Place
PID:10-72960-01-030
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507)
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
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 -
Marc D & Shari L Medland
712 Summer Ln
Eagan MN 55123
Haley Comfort Systems
3708 Broadway Ave N
Rochester MN 55906
(507) 281-0138
Applicant/Permitee: Signature Issued By: Signature
