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4020 Blackhawk Rd CITY OF EAGAN Remarks ~ , - f Addition SECTION 20 Lot 012 Rik 75 Parcel 10 02000 012 75 Owner6axa `,Ah% 0- Street 4020 BlackhaWk Road State Eagan., MN 55122 improvement Date Amount Annual Years Payment Receipt Date STREET SURF. STREET RESTOR. GRADING SAN SEW TRUNK 1970 aid unde parcel 010 5 no 011 75 SEWER LATERAL WATERMAIN WATER LATERAL WATER AREA 1977 aid unde parcel 011 5 STORM SEW TRK STORM SEW LAT CURB &-GUTTER SIDEWALK STREET LIGHT WATER CONN. 13UILDING PER. SAC PARK CITY OF EAGAN 3795 Pil6t Knob 'Rood Eagan, MN 55122 N2 6180 PHONE: 454-8100 BUILDING PERMIT APPLICATION Receipt # _e2 To be used for FAMILY ROOM Est. Value 8,000 Date 9-17 , 19~_ Site Address 4020 Blackhawk Rd Erect ❑ Occupancy R3 ~ Alter Zonin Rl Lot Block Sec/Sub. 9 Parcel # In n2nm n]. Z Repair ❑ Fire Zone Enlarge ❑ Type of Const. V W Name David Hartley Move ❑ # Stories z Address 4020 Blackhawk Rd. Demolish ❑ Front ft. o City Eagan, Mn Phone 2-3527 Grade f3 Depth ft. ~ Sussel Co. Approvals Fees Ck! p Name va Addre 1850 Como Assessment Permit 2777 Paul, Mn 45-0331 Water & Sew. Surcharge 4,00 ~ City Phone Police Plan check 1.50 rW Name Fire SAC Address Eng. Water Conn. <W City Phone Planner Water Meter Council Road Unit I hereby acknowledge that I have read this application and state that Bldg. Off. the information is correct a agree to comply with 1 applicable APC Total 44.50 State of Minnesota Statutes nd City of Eagan Ordi nc s. Signature of Permittee A Building Permit is issued to: on the express condition that all work shall be done in accordanceth all applicable State of Minnes a Statutes and City of Eagan Ordinances. Building Official CITY OF EAGAN . ~ Include 2 sets of plans, 1 site plan w/elevations & BUILDING PERMIIT` APPLICATION 1 set of energy calculations. To Be Used For 41' Valuation,/ 6y Date Site Address: OFFICE USE ONLY Lot Block Sec./Sub. Erect Occupancy Parcel ~/4) - o'er Q A'r p r~ Alter Zoning z Repair Fire Zone / Owner: Enlarge Type of Const. Move m # Stories t,o De Address: ~F Demolish Front ft. City/Zip Code: Grade Depth ft. Phone qf %!7-M:7 APPROV~ FEES Co ntractor: A,~ "a Assessments Permit rJO Address: Water/Sewer Surcharge A~ Police Plan Check / City/Zip Code: 6'4A."t fJ f p Fire SAC Phone # : SF~tir • 3 3 Eng. Water Conn. Planner, Water Meter Arch./Eng.: Council Road Unit Bldg. Off. Address: APC City/Zip Code: Phone TOTAL r7 t7< S-0 This request Yid t 18 mon:~,r~orn Date of this Request Fire No. I, as ❑ Licensed Electri al C ntractor Owner, do hereby request inspection of the above electri- cal wiring installed at: ff Street Address or Route No.'7'Ctoc.CotlLlr'liJgGt.)!r City Section Tow ip Range County _ Which is occupied by # (N a of Occupant) Is a roughin inspection required on this job? No ❑ Yes ❑ Ready Now Will Call ❑ Power Supplier ABTA rC, ( Address Electrical Contractor Cl p AE 7 Contractor's License No. (Company Name) Mailing Address ( ctric o t a caner Making This Installation) Authorized Signature Phone No. ( lectricai Contractor or caner Makin This installation) "LOOPY T l inspection request will not be accepted by the STATIE idis State Board unless proper inspection fee is enclosed. Room Minnesota State Board of Electricity Griggs Midway Bldg. - Room N191 E13-00001-02 1 'I University Ave., St. Paul, Minn. 55104 - Phone 297-2111 zco'557 ~ PCf1UEST FOR ELECTRICAL INSPECTION T 4 CHECK *PE6* WORK COVERED BY THIS REQUEST .15161 Type of Building New Add. Rep. Check Appliances Wired For Check Equipment Wired For Home ❑ ❑ ❑ Range ❑ Temporary Wiring ❑ Duplex ❑ ❑ ❑ Water Heater ❑ Lighting Fixtures Apt. Bldg. ❑ ❑ ❑ Dryer ❑ Electric Heating ❑ Commercial Bldg. ❑ ❑ ❑ Furnace ❑ Silo Unloader ❑ Industrial Bldg. ❑ ❑ ❑ Air Conditioner ❑ Bulk Milk nk ❑ Farm ❑ ❑ ❑ List List Others Others Other AMW UGf ❑ ❑ Here Here COMPUTE I SPECTION FEE BELOW Service Entrance Size: # Fee Feeders&Subfeeders: # Fee Circuits: # Fee 0 to 100 Amps. 0 to 30 Amperes 0 to 30 Amperes 101 to 200 Amps. 31 to 100 Amperes 31 to 100 Am eres Above 200 Amps. Above 100 Amps. Above 100 Amps. Transformers Remote Control Circ. Partial or other fee t Signs Special Inspection Minimum fee $5.00 t Remarks TOTAL FE I, the Electrical Inspector, hereby certif t the a inspection has been niadt. (Rough-in) Date (Final) Date This request void 18 months from This request void 3~~~ f 5 t !r '!d I~ 18 months from U ' . tY L-{ 4 Il 0.700 b t 7S ( o Reggest Date - Wy Fire No. Rough-in Inspection Required? eady Now Will Notify Inspec- r i y-, Dyes o [or When Ready icensjd Electrical Contractor I hereby request inspection of above ❑ Owner electrical work installed at: 11 Street Address, Box or Route No, C ity e ion No. Township Name or No. Range No. County Occupant (PRINT) t Phone No. 4~owler Sup ie, Address Electrical Contractor (Company Name) Contractor's License No. Mailing Address ontractor or Owner Making Installation) A ed ig a (Co t C /O ner Makin Installation) Phone Number MINNESOTA STATE BOARD OF E ECTRICITY THIS INSPECTION REQUEST WILL NOT Griggs-Midway Bldg. - Room N-191 BE ACCEPTED BY THE STATE BOARD 1821 University Ave., St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS Phone (612) 297-2111 ENCLOSED. I a ej ~-q REQUEST FOR ELECTRICALJUAMCTION DEB 1g-°aj See instructions for completing this form on back of veliow copy. t 7 ""X" Below Work Covered by This Request Add Type of Building Appliances Wired Equipment Wired Home Range Temporary Service Duplex Water Heater Lighting Fixtures Apt. Building Dryer Electric Heating Commercial Bldg. Furnace Silo Unloader Industrial Bldg. Air Conditioner Bulk Milk Tank Farm Other Specify Other (Specil'O Other (Specify Other 01her Compute Inspection Fee Below # Fee Service Entrance Size # Fee Feeders/$ubfeeders # Fee Circuits Q, 0 to 200 Amps 0 to 30 Amps 0 to 30 Amps Above 200 Amps; 31 to 100 Amps 31 to 100 Amps Swimming Pool Above 100-Amps Above 100_Amps Transtormerg Irrigation Booms ® Partial," Other Fee Signs Special Inspection TOTAL F r♦s~ Remarks lt4 Q /4- $ ~r 0 Rough-in Date 1. the Electrical -Inspector. hereby Date certify that the above Final has been This request void 18 months from III This request void 18 months from Date of this Request Fire No. ; 5 156, " I, * ❑ Licensed Electrical Contractor wner, do hereby request inspection of the above electri- cal wiring installed at: Street Address or Route No. / 11/K~ C /?a/, City c Section Township Range County Which is occupied by DA V /,D te (Name c~f Occupant) Is a roughin inspection required on this job? No ❑ Yes ❑ Ready Now ❑ Will Call ❑ Power Supplier Address Electrical Contractor Contractor's License No. (Company Name) Mailing Address (E ctrical ra r or er Making This Installation) Authorized Signature Phone No. - r ( lec rical Contra o or O er Making is installation) 4 ' 0 P i ' spection request will not be accepted by the f State Board unless proper inspection fee is enclosed. Minnesota State Board of Electricity Griggs Midway Bldg. - Room N191 v,I ~ EB-00001-02 182T +1Jniversity Ave., St. Paul, Minn. 55104 -Phone 297-2' 11 REQUEST FOR ELECTRICAL INSPECT10~ rT CHECK BELOW WORK COVERED BY THIS REQUEST 6 6 5 5 3 Type of Building New Add ep. Check Appliances Wired For Check Equipment Wired For Horne ❑ ❑ Range ❑ Temporary Wiring ❑ Duplex ❑ ❑ ❑ Water Heater ❑ Lighting Fixtures Apt. Bldg. ❑ ❑ ❑ Dryer ❑ Electric Heating ❑ t4ommercial Bldg. ❑ ❑ ❑ Furnace ❑ Silo Unloader ❑ Industrial Bldg. ❑ ❑ ❑ Air Conditioner ❑ Bulk Milk Tank ❑ Farm ❑ ❑ ❑ List List Others Others Other ❑ El ❑ Here Here COMPUTE INSPECTION FEE BELOW Service Entrance Size: # Fee Feeders& Sub feeders: # Fee Circuits: # Fee 0 to 100 Am s. 0 to 30 Amperes 0 to 30 Amperes 101 to 200 Amps. 31 to 100 Amperes 31 to 100 Amperes Above 200 Amps. Above 100 Amps. Above 100 Amps. Transformers Remote Control Circ. Partial or other fee Signs Special Inspection Minimum fee $5.:110 Remarks 6v Ae-z" ~ et- TOTAL ME ` . , e;' 6 I, the Electrical Inspector, hereby certify that the above inspection has been made:'_ (Rough-in) - Date (Final) This request void 'L 18 months from ,CITY jPF EAGAN 3795 Pilot Knob Road Eagan, MN 55122 N0- 6179 PHONE: 454-8100 ,a'-3p BUILDING PERMIT APPLICATION Receipt # c2 To be used for GARAGE Est. Value 6 , 400 Date 9-17 1 g$0 Site Address 4020 Blackhawk Rd Erect Xt Occupancy R3 Lot 1 Block Sec/Sub. Alter ❑ Zoning R1 10 02000 07-75 Repair ❑ Fire Zone 3 Parcel # Enlarge] Type of Const. V W Name David Hartley Move ❑ # Stories z Address /x020 Blackhawk Rd. Demolish Front ft. city Eagan, IVIt1 phone 452-3522 Grade ❑ Depth ft. o Nome Sussel Co. Approvals Fees 'A Address 1850 Como Ave. Assessment Permit 21.00 6t. Paul, 645-0331 Water & Sew. Surcharge . 3.00 City Phone 10.50 Police Plan check FZ Name Fire SAC Address Eng. Water Conn. aW city Phone Planner Water Meter Council Road Unit I hereby acknowledge that I have read this application and state that Bldg. Off. the information is correct an agree to comply with all applicable 34.50 State of Minnesota Statutes nd ity o~ aga Ordinances. APC Total Signature of Permittee A Building Permit is issued to: Sussel Co. on the express condition that all work shall be done in accor ncewith all pplicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official /~-C .;O s1G-`~+~ CITY OF EAGAN Include 2 sets of plans, 1 site Plan wfelevations & B MI NQ ERMIT APPLICATION 1 set of energy calculations. To Be Used For Valuation ~QQ Q. Date Site Address: •sv / OFFICE USE ONLY . Vv 0 Lot _f Block Sec./Sub. Erect i1 Occupancy 3 Parcel 0 a - © bid ? ter Zoning ~L epair Fire Zone 3 Owner: 14t;t~ Enlarge X Type of Const. V - _ Nbve # Stories Address: Demolish k_/ Front 27 ft. City/Zip Code: Grade Depth 30 ft. Phone "Y ~J APPROVALS FEES Contractor: ~Q Assessments Permit izg Address: © Water/Sewer Surcharge 3423E r-r-- Police Plan Check p City/Zip Code: Fire SAC Phone Eng • Water Conn. Planner Water Meter Arch./Eng.: Council Road Unit Bldg. Off. Address: APC City/Zip Code: Phone TOTAL 3 CI1 IM ClaYLY Lar PERMrr 4 nm ct~ RACE CEI" DATE: W„ ~ R a'y 3630 PLOT KCB RD .F ; ~F ~ ~X lt8 . ' , aax~ex-~a7~s +~r ads ► Cordpl *is'ift-doo- cif YOU i aft i tiling RVAC, iu singk-fhmiIy 4wcfliM WwWvxw S 30.00 COO ADDfMNAL 1 04s oudeu (ntittimtmt of one requirW @ $100 m) stau $urchary Total Complete this sin: IM& if you are idd •"-►~Y townhom►e, or cga4 Pick indieam if it is a new item,; alteration, 40'V tVlWA=ent New, - . ila taut CJ#hcx Air cc i~ -**jr eubmwer Oda P` X00- sit urchs~rge STYE, ADOMS: zao C? NAM-. PHONE I j" 009)• ~TALUR ~ PHONE N: STREET ADD &.4 t ff!Mlo &:g E3G STATE:- Tw: # ' CITY: IGNATURE OF DEC'©4 PRIburras ~tI04 CITY- F _EAGAN PERMIT 3830 Pil :n<* Road PERMIT TYPE: B U I L D I N G Eagan, Minnesota 55122-1897 Permit Number: 031188 (612) 681-4675 Date Issued: 12/01/97 SITE ADDRESS: 4020 BLACKHAWK RD LOT: 12 BLOCK: 75 SECTION 20 P.I.N.: 10-02000-012-75 DESCRIPTION: (STOVE) Building Permit Type FIREPLACE Building Work Type NEW Census Code 434 ALT. RESIDENTIAL REMARKS: FEE SUMMARY: Base Fee $50.00 Surcharge .50 Total Fee $50.50 CONTRACTOR: Applicant ST. LIC OWNER: FIRESIDE CORNER`INC 16332561 20090911, BERGER JEFF 2700 N FAIRVIEW AVE 4020 BLACKHAWK RD ROSEVILLE MN 55113-0847 EAGAN MN 55122 (612) 633-2561 (612)686-7356 F- -1 I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Mn. L Statutes and City of Eagan Ordinances. APPLICANT/PERMITEE SIGNATURE TISSUEd Y. S D ~A U E I (::C i'V ?::J F"ACt ' ' {•?I.t•~'1::'{''a C:? f1::.1'1M,4. r+•;F iL. N3.1 504. 5 4 37 .3.~".~.'. ?TDE 1'4.F 'I- ,'j'{: (.1 • ~.;j i{' i',•yI~! ! 50 n CIO ! ta•r•'y r:.t.:i CA}:'.}i:l. •~~r,}~~1.1 Y.,~ i,,~,,,;I..4ti..~1..1ti~ i I i i CITY OF RAGAN MOT KNOB RD - 53122 M FIREPLACE PERMIT APPLICATION 682-4675 BATE: PERNT M: U x'`70 DESCRIPTION OF WORK: Cl CONSTRUCT ~ FIREPLACE TO EYMING INSTALL GAS INSERT ONLY INSTALL GAS LINE ONLY , OT M: STREET ADDRESS: - C) L .4 CSI uJ /cod"" LOT BLOCK APPLICANT: (circle one only) OWNER CONTRACTOR I hereby acknowledge that I have read this application and state test the information is greet and agree" to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances, 186 7-3,5 6 PROPERTY Name: OWNER LW VMT Signature: Street Address. 4-o 2 o Ls.-4 oc k, lvtjj City. G sl~ State:,. .Zip::..... Ft PL ACE ; t o p me INST Signature: Street - License #•cx Q GAS LINE Company; INSTALLER Name: Signature: Street Address: City: State: zip' I~V2$' PERMIT CITY OF EAGAN 3830 Pilot Knob Road PERMIT TYPE: B U I L D I N G Eagan, Minnesota 55122-1897 Permit Number: 0 2 8 8 5 8 (612) 681-4675 Date Issued: 09/19/96 SITE ADDRESS: 4020 BLACKHAWK RD LOT: 12 BLOCK: 75 SECTION 20 P . I . N . a 10--02000--012--75 DESCRIPTION: SIDING/SOFFITS/FACIA Building_ Permit Type SF (MISC.) Building Work Type REPAIR Census Code 434 ALT. RESIDENTIAL i I I REMARKS: FEE SUMMARY: VALUATION $11,000 Base Fee $174.75 Surcharge 5.50 Total Fee $180.25 CONTRACTOR: - A p p l i c a n t - ST. L I C OWNER: PANELCRAFT OF MN INC 17216626 0002179 BERGER JEFF 3118 SNELLING AVE S 4020 BLACKHAWK RD MINNEAPOLIS MN 55406 EAGAN MN (612) 721-6628 (612)686-7356 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 Mn. Statutes and City of Eagan Ordinances. APPLICANT/PERMITEE SIGNATURE ISSUED BY: S ATURE t CITY OF EAGAN 3830 PILOT KNOB RD - 55122 f 1995 BUILDING PERMIT APPLICATION (RESIDENTIAL) 681-4675 New Construction Requirements Remodel/Rel2air Requirements ♦ 3 registered site surveys ♦ 2 copies of plan ♦ 2 copies of plans (include beam & window sizes; poured fnd. design; etc.) O 2 site surveys (exterior additions & decks) ♦ 1 energy calculations i 1 energy calculations for heated additions ♦ 1 tree preservation plan if lot platted after 7/1/93 required: _ Yes _ No ~n DATE: L4 1969 CONSTRUCTION COST: DESCRIPTION OF WORK: ~P rD F Fi rP Sf de- ' 6OF i T ' -7(Q SC,UGL STREET ADDRESS: "10 20 B1 CLCO 0 (A K ELC"d LOT BLOCK ' SUED./P.I.D. Ai 2- PROPERTY Name: Berne r JCFF Phone OWNER T FIRST - Street Address g0ZO ~a ~Kha K City: GZ C_ State: Zip: CONTRACTOR Company: -pn Mtl Phone d~ Street Address: 31L~.kXt /irl A6 License 91 162 City: ARCHITECT/ Company: Phone ENGINEER Name: Registration Street Addres- City: State: Zip: j Sewer & water licensed plumber: - Penalty applies when address change and lot change are requested once permit is issued. 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. Signature of Applicant: OFFICE USE ONLY Certificates of Survey Received _ Yes No Tree Preservation Plan Received Yes No OFFICE USE ONLY BUILDING PERMIT TYPE ❑ 01 Foundation ❑ 06 Duplex ❑ 11 Apt./Lodging ❑ 16 Basement Finish Pool 02 SF Dwelling ❑ 07 4-plex ❑ 12 Multi (Misc.) ❑ 17 Swim ❑ 03 SF Addition ❑ 08 8-plex ❑ 13 Garage/Accessory ❑ 20 Public Facility ❑ 04 SF Porch ❑ 09 12-plea ❑ 14 Fireplace ❑ 21 Miscellaneous ❑ 05 SF Misc. ❑ 10 Multi (additional) ❑ 15 Deck WORK TYPE . ❑ 31 New ❑ 33 Alterations ❑ 36 Move ❑ 32 Addition } 34 Repair ❑ 37 Demolition GENERAL INFORMATION Cons I) Basement sq. ft. MCNVS System t. Actua (Actual) (Allowable) Main level sq. ft. _ City Water UBC Occupancy sq. ft. Fire Sprinklered Zoning sq, ft. PRV J # of Stories sq. ft. Booster Pump Length sq. ft. Census Code. Depth Footprint sq. ft. SAC Code Census Bldg Census Unit APPROVALS Planning Building Engineering Variance Permit Fee Valuation: $ Surcharge Plan Review License MCNVS SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit SAN Surcharge Treatment PI. Road Unit Park Ded. Trails Ded. Other Copies n Total: a CJ °~S % SAC SAC Units .WC1RK GIRDER HOME PHONE: CE NAM 1e ' C BUS. PHONE: la! ° e 7 V I. ~SSEI i~~~ES s~s «_MOANY. INC t Permit by ( "_SsJOB ADDRESS Legal Description.- Lot BLDG CODE ARE Aldd'n~-1 SALESMAN CONTRACT DATE IZE Value Type f onst FOR OFFICE USE ONLY SLAB: ❑By SUSSEL Slab Blocks D.W. ❑ By Owner Approx. ❑ In ABU Blks. Delivery S.W. 2-STARTING POINTS ONLY Sod Removal Waterproof Ftg. S.P.L. S.S.P.L. Sand Fill Back Fill Re-bar R.P.L. Other Alley TOTAL House t a r ' a.&N F. Street Other L -77 P ; ❑ Square With T, I ❑Sod Rem. - BY g U 2 ~r=C } . _ . s f- 8 Grade Point" locks: Ey Ownery Sussel s - - ,0PVtr.proof: ❑By Own. QSy Sus. r JJ$ackfill: ❑By Own. Wy Sussel ❑ Maintain 8' Total Wall Height { _ Including Blocks OR =ti (qtr laintain 8' Wall Height on Top of Blocks.. w .a. M. Block Size (Top course) ❑ 4„ all Height other than 8' r . le-ni g f-+ rame with full wall height sold OR ❑ Cut studs required for a. _ •dr►• . clearance .H. Dr Offset D. Location 1 indows° ❑ Att Gar Roof Tie-in Drawn on attached pictures - ro Existing garage: No ❑ M {}Y't rte" O Detached ❑ Attached Yes INC. I'D M6, aVw Size of existing:---x ~ 4 Existing garage will be: ❑L tasis onverted to" *.S. I emoved By: wner ❑ ' Sussel ❑ Junk Must Be Removed By Owner ❑ Specify removals by Sussel or C t--~ - Owner -trees, bushes, etc. ow approx. dist. garage to A, ~jtbC` iC ouse and all prop. lines A Cod Stakes visible [I Ye~'~' tL. , Survey available - ❑ Ye o ❑ Special instructions from - Q Fair ? owner: Poor, I : DIRECTION INITIALS: - STATE OF MINNESOTA DEPARTMENT OF HEALTH iVJ4-4 r 4 ABANDONED WELL RECORD F 1. LOCATION OF WELL• MINNESblank if not OTA UNIQUE WELL NO. County Name Dakota Township Name Township Number Range Number SFraction 4. WELL DEPTH (completed) Date sealed Eagan 27 " 23 NVP NE" 'S 21 0 ft. 4-20-92 W Numerical Street Address and City of Well Location or Distance from Road S. DRILLING METHOD (if known) Intersection 10 Cable tool 40 Reverse 70 Driven 100 Dug 4020 Blackhawk Rd., Eagan, Mn. 20 Hollow Rod 50Air go Bored 110 Show exact location of well c A / 30 Rotary a Jetted go Power Auger (in section grid with •X") ~1/ N Ni. OBSTRUCTIONS Well obstructed ® Yes 0 No - L - _ - . _ e~ Obstructions removed a Yes C3 No If obstructions cannot be removed. contact NON M E "-a! before sealing. _ T 7. USE 4 we In Domestic 40 Monitoring Cl Heat Loop 2C1 Irrigation SD Public g0 Industry 30 Test Well 60 Municipal 100 Commercial I-- 1 wL----i 70 Air Conditioning 110 2.:RO:EnT; OWNE-R'S HAKE Mailirp Address if different than S. CASING(S) property address indicated above 10 Black 40 Threaded 70 Gary Se l v a 2® Galy. 50 Welded 30 Plastic 60 Stainless Steel HARDNESS OF 2 in. to 205 ft. 3. FORMATION LOG COLOR FORMATION FROM TO If not known, indicate formation log from new well or nearby well. in. to ft. Clay O 9. SCREEN 166 M Screened well from 206ft. to 210 ft. Sand (If known) white soft 166 177 n Hole from - ft. to_ ft. 10. STATIC WATER LEVEL NOTE: It was not s ndrock sere 74 • ft. 9 below D above 4-20-92 land surface Date Measured 11. WELLWEAD COMPLETION 10 Pitless Adapter 40 Found Buried 2E Basement offset 50 30 Well Pit 16. REMARKS, ELEVATION, SOURCE OF DATA - CASINGS REMOVED, CASINGS PERFORATED, ETC. 12. GROU'ING INFORMATION Geology taken froma well we drilled in 1974 on I§heat Cement aBentonito 30 Englert Road (NW of SE of SE, section 16, Grou materialNeat from 7 910 ft. cu. ydsi4 township 27N, Range 23W) ' ;1 1 cement _ _ 13. NHP.IST SOURCES OF IWNTAMINATION floor drain feet direction type Well disinfected before sealing? V Yes Gary Se 1 va (612) 454-0565 14. PUMP Aff Removed 0 Not Present Office (612) 828-6220 Type: 1[( Submersible 3p L.S. Turbine 5o Reciprocating 20 Jet 40 Centrifugal 60 Obstructions .removed : 119 feet of wood rod. 15. EXISTING WELLS (Please sketch locations of abandoned and active wells in remarks section or ork back.) Their water supply comes from an active well Other unused well(s) on property? DYes * No in front of the house. Abandoned: 0 Permanent CI Temporary 0 Not sealed 17. WATER WELL CONTRACTORS CERTIFICATION This well was sealed under my jurisdiction and this report is true to the best of my knowledge and belief. r:artmann Well Co. 40174 ' 8nT.BuM8`!ffi" Jt.. , New PVMd,• Mn. 6071 Addra :s Sign'--o ~ ate 4-20-92' R, bert c an Date . FFICIAL ABANDONED WELL RECORD (May be used for Property Transfer) Name of Driller ID!PM7Affi's ?27.3 NITS DM ED X1 1 of c9agan THOMAS EGAN Mayor PATRICIA AWADA June 18, 1993 SHAWN HUNTER SANDRA A. MASIN THEODORE WACHTER Council Members MICHELLE BERGER THOMAS HEDGES 4020 BLACKHAWK ROAD City Administrator EAGAN MN 55122 E. J. VAN OVERBEKE City Clerk Re: Connection to City Water Dear Ms. Berger: Recently, you contacted City offices with regard to requirements for connection to City water. My understanding of your situation is that you currently are on a well and septic system. Your well and septic both function and there is no need to connect to the existing city facilities. Current City policy states that when City services such as sewer and water are provided adjacent to property which is presently being served by a well and septic system, the connection to the City services is not required at the time of the installation of the City service. In the event that your well or septic system is in need of replacement, the City would require at that time connection to the existing City facility installed adjacent to your property. The installation of a new well as well as the replacement of a septic system both require permits either from the City, County or both. This connection requirement to the existing City facility only applies to a replacement of your well and septic system. The City does allow minor repairs for maintenance, etc., to keep your well and septic system functioning properly. I trust this information satisfies your request. If you have any questions or need additional information, please feel free to contact the City Engineer's Office at 681-4646. Sincerely, Mi ael P. Poertsch, P.E./L.S. Assistant City Engineer MPP/jl cc: Doug Reid, Chief Building Official Wayne Schwanz, Superintendent of Utilities MUNICIhAI CENTER THE LONE OAK TREE MAINTENANCE FACILITY 3830 NPILOT , MINNESOTA ROAD THE SYMBOL OF STRENGTH AND GROWTH IN OUR COMMUNITY 3501 COACHMAN POINT EAGAN MINNESOTA 55122-1897 EAGAN, MINNESOTA 55122 PHONE: (612) 681.4600 PHONE: (612) 681-4300 FAX: (612) 681-4612 Equal Opportunity/ AtIIrmatlve Action Employer FAX: (612) 681.4360 TDD: (612) 454-8535 TDD: (612) 454-8535 -fir tl r Ol 7 ,~~U O 04/10/92 14:46 DAKOTA COLHTY-kESTERN SERV. CTR. 001 Ordinance No. 114: WELL AND WATER SUPPLY MANAGEMENT MUNICIPAL NOTICE OF WELL PERMIT APPLICATION DAKOTA COUNTY ENVIRONMENTAL MANAGEMENT DEPARTMENT WATER AND LAND MANAGEMENT SECTION 14855 Galaxie Avenue West, Apple Valley, MN 55124 Telephone (612) $91-7011 Facsimile (612) 691-7031 DATE: A ( (U ( em ' TIK: M SENT:. .Fax +G.-r Maim Other TO: -mrA MUNICIPAL OFFICIAL TITLE ELEPRONE MUNICIPALITY 'ADDRE99 FACSIMILE rROM: ENVIRONMENTAL SPECIALIST TW EPHON DEFERENCE: 4z « 10.S7 WELL PERM NO. NOTICE: The Water and Land Management Section' of the Dakota County Environmental Management Department has received the following permit application(s) for the well(s) described. If you require further review of this application(s) or if you have any questions. or Concerns about it, Contact the Environmental Specialist listed above or our office at telephone (612) 891-7011 - If there is no response from your office within 4hc (excluding weekends and holidays), Water and Land Management staff will assume that you have no objections issuance of the permit(sPlease note that permit issuance is always conditioned on the permit applicant's observance of and compliance with all appplioable laws and codes. A copy of the well permit(s) will be forwarded to your office when oomp{eted, DESCRIPTION! PROPERTY:OWNER I - c5F_1_VA WELL(II omero" LOCATION OF WELL(S): ADDRIESS 40z.6 PUBLIC LAND-SURVEY 000 INATES: OF _ OF OF OF. SECTION ,Y. N„ R. W., MUNICIPALITY: PROPERTITII~ NIA WkLLCONTRACTOR, ~f 2:` "l1R~kA1/LI -LICENSE NO. I/ APPLIC&ION RECEIVED SUBCONTRACTED TO: PERMIT TYPE: NEW CONSTRUCTION IF-CONSTRUCTION REPAIR(No Pormh Naquirod) PERMANENT SEAUNG ✓ ANITI AA TiiIAINTENANCE: TEMPOr RY CAPPING RECLAIMED-V8E F3E31STEFIED-USE -PARIMAPRY USE OF WELL(S) GASIN13 DIAMETER rl * INCHES; LENGTH _ _2EET; WELL DEPTH . &O 'f FEET; AQUIFER COMPLETED: OPEN HOLE SCREENFQ A ANTICIPATE[) DRILLINGtSEALING DATE(IrKnown)' - - r-• COMMENTS: s city of eagan MUNICIPAL CENTER MAINTENANCE FACILITY THOMAS EGAN 3830 PILOT KNOB ROAD 3501 COACHMAN POINT Mayor EAGAN, MINNESOTA 55122-1897 EAGAN, MINNESOTA 55122 PHONE: (612) 681-4600 PHONE: (612) 681-4300 PATRICIA AWADA FAX: (612) 681-4612 FAX: (612) 681-4360 PAMELA McCREA TIM PAWLENTY March 16, 1992 THEODORE WACHTER Council Members THOMAS HEDGES City Admininstrator VIC THESENUITZ EUGENE VAN OVERBEKE EDINA REALTY City clerk APPLE VALLEY OFFICE 7668-150TH ST. W. APPLE VALLEY, MN. 55124 RE: Plat and Parcel #10-02000-012-75 4020 Blackhawk Road Utility Service This letter is in response to your telephone call this date concerning sanitary sewer and water service provided by the City of Eagan to service the above listed property. I have researched the plat and parcel and assessment files and the City's records indicate that this property currently does not have sanitary sewer or water service stubbed to its property line and has never been assessed for sanitary sewer and/or water service. The current policy is, when a property is sold in Eagan, the City does not require a property to hook up to sanitary sewer and/or water. Sincerely, Edward J. Kirscht Sr. Engineering Technician cc: Michael P. Foertsch Enclosures EJK/jf THE LONE OAK TREE THE SYMBOL OF STRENGTH AND GROWTH IN OUR COMMUNITY Equal Opportunity/ Affirmative Action Employer c CITY OF EAGAN Remarks Addition SECTION 20 Lot 012 alk 75 Parcel 10 02000 012 75 OwnerLayu Y, SP I era Street 4020 Blackhawk Road State Pagan., MN 1;-';122 Improvements Date Amount Annual Years Payment Receipt Date STREET SURF. STREET RESTOR. GRADING SAN SEW TRUNK 1970 aid unde parcel 010 5 n0 011 75 SEWER LATERAL WATERMAIN E WATER LATERAL WATER AREA 1977 aid unde parcel 011 5 STORM SEW TRK STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. BUILDING PER. SAC PARK AS OF: 03/16/1992 PROPERTY ID: 10-02000-012-75 SEE COMMENTS Y S/A# ASSESSMENT DESCRIPT. YEAR TM RATE TOTAL ANN.PRIN. PAYOFF CD 100102 STREET 1970 10 8.0000 0.00 0.00 0.00 CL 100125 SAN SW TRK 1969 25 8.0000 0.00 0.00 0.00 CL 100266 STREET 1974 10 8.0000 O.QO 0.00 0.00 CL 100269 STREET 1974 10 8.0000 0.00 0.00 0.00 CL 100338 WATER AREA 1976 15 8.0000 0.00 0.00 0.00 CL 100646 ST-277 1981 10 11.0000 0.00 0.00 0.00 CL 101873 ST 488 1989 10 9.0000 0.00 0.00 0.00 CL SUMMARY OF LEVIED 0.00 0.00 0.00 1992 P&I CERTIFIED 0.00 SUMMARY OF DEFERRED 0.00 0.00 0.00 SUMMARY OF PENDING 0.00 0.00 0.00 SUMMARY OF CLOSED 0.00 Press ENTER; or F1, F4, F5, F7, F8 city of eagan MUNICIPAL CENTER MAINTENANCE FACILITY THOMAS EGAN 3830 PILOT KNOB ROAD 3501 COACHMAN POINT Mayor EAGAN, MINNESOTA 55122-1897 EAGAN, MINNESOTA 55122 PHONE: (612) 681-4600 PHONE: (612) 681-4300 PATRICIA AWADA FAX: (612) 681-4612 FAX: (612) 681-4360 PAMELA MCCREA TIM PAWLENTY THEODORE WACHTER March 5, 1992 Council Members THOMAS HEDGES City Adminlnstrator EDWARD BRUNKHORST DAKOTA ELECTRIC EUGENE VAN OVERBEKE 4300-220TH ST. W. City Clerk FARMINGTON, MN. 55024 RE: STREETLIGHTING ENERGY COSTS - PARKCLIFF 3RD ADDITION Please be informed that the City of Eagan is requesting that you invoice the energy costs for Parkcliff 3rd Addition to the City effective March 1, 1992. The City will invoice the energy costs with the utility billing to the homeowners for Parkcliff 3rd Addition effective March 1, 1992. The developers will be invoiced for the energy costs for all undeveloped lots regardless if they own them or have sold them. When the City of Eagan receives an application for a utility hookup permit, the builder and/or homeowner will then be billed for its share of the streetlighting energy costs, and the developer will no longer be responsible for said energy costs. Sincerely yours, 4 ~ V~,~ L Edward J. Kirscht Senior Engineering Technician cc: Michael P. Foertsch, Assistant City Engineer Diane Downs, Utility Billing Clerk EJK/jf THE LONE OAK TREE... THE SYMBOL OF STRENGTH AND GROWTH IN OUR COMMUNITY Equal Opportunity/Affirmative Action Employer j EXTERIOR ENVELOPE AVERAGE "U" COMPUTATION omR ~Dciv4 eArr 4 1 r, SITE ADDRESS OZl~ L ~ 51 ~2. CONTRACTOR Tate ~U~jSe Co. DATE 80 PHONE 0331 DETERMINE WORKING SQUARE FOOTAHE OF EACH 1. Total exposed wall area 00-7, ¢ Sq. Ft. x .185 = 2. Total roof / ceiling area zJ ~Z Sq. Ft. x .04 = Z Z,$ TOTAL EXPOSED WALL AREA ABOVE FLOOR = ZI DETERMINE "U" VALUE OF EACH WALL SEGMENT nU" a. Total wall window area Q'~ X ,3 = b. Total door area X c. Total sliding glass door area X : d. Total fireplace wall area X _ e. Total wall framing area (average 10%) X IOS = Q f. Total net wall area above floor 501, 9 X , oloz = f j z g. Total rim joist area ¢'l ,p~~ X o_Sp~ _ z,.A:t_ TOTAL EXPOSED FOUNDATION AREA h. Total foundation window area - X = i. Total net foundation area above grade X 5 = ss0.O 3 ..........................................................................TOTAL If item #3 is the same as, or less than item #1, you have met the intent of sac 6006 (C) 2. TOTAL EXPOSED ROOF / CEILING AREA = 5'7 2 DETERMINE "U" VALUE FOR EACH ROOF / CEILING SEGMENT. "U" j. Total skylight area Sq. X k. Total roof/ceiling framing area (average 10%) ~511Z X '111 = 1. Total net insulated roof/ceiling area 51,5 X .10 4 ..........................................................................TOTAL LZ,(o S If total of #4 is the same as, or less than #2, you have met the intent of SBC 6006 (C) 1. ALTERNATE BUILDING ENVELOPE DESING To utilize the total envelope system method, the values established by the sum of items #3 and #4 shall not be greater than the sum of items #1 and #2. 3. i i + 4. Z2,~s ~3444 3795 PILOT KNOB ROAD, P.O. BOX'21199 BEA BLOMQUIST EAGAN, MINNESOTA 55121 Mayor PHONE: (612) 454-8100 THOMAS EGAN JAMES A. SMITH JERRY THOMAS THEODORE WACHTER Council Members F ebruary lb, 1983 TCittyAdminiisstrrattorS EUGENE VAN OVERBEKE City Clerk David & Vicky Hartley 4020 Blackhawk Road Eagan, MN 55122 Re: Well Inspection 4020 Blackhawk Road, Parcel #10 02000 012 75 To Whom it may concern: There were no permits necessary or inspections required at the time the referenced dwelling was constructed and the well was installed. If necessary, a recognized testing agency could certify that the well water is potable. Sincerely, i Dale S. Peterson Chief Building Official CC; Parcel File DSP/bar I THE LONE OAK THEE THE SYMBOL OF STRENGTH AND GROWTH IN OUR COMMUNITY city of czagan 3745 PILOT KNOB ROAD, P.O. BOX 21199 BEA SLOMEQUIST EAGAN, MINNESOTA 55121 Mayor PHONE: (612) 454-8100 THOMAS EGAN JAMES A, SMITH JERRY THOMAS December 22, 1982 TH CoDOR Members WACHTER THOMAS HEDGES City Administrator EUGENE VAN OVERBEKE City Clerk M DAVID HARTt,EY 4020 BT-ACKHAWK RD EAGAN Ri 55122 Re: Taconite Trail, Parcel 10-02000-012-75 To whom it may concern: Please accept this letter as written confirmation that Taconite Trail has been dedicated as a 60' public right-of-way fran Blackhawk Road to approx- imately 1,390 feet east. This right-of-way was dedicated as apart of the Oakridge Acres 1st Addition and is available for public access and use. To date, the City has not constructed any street nor does it perform any maintenance services within this right-of-way. However, due to the fact that the right-of-way has been dedicated as a part of a formal recording of the Oakridge Acres lst Addition, this right-of-way has been perpetually dedicated for public use and is considered public access for all abutting properties. Before the City will perform and accept total maintenance re- sponsibilities over this right-of-way, a street would have to be installed in accordance with present city standards. If any additional verification or information is required pertaining to the status of Taconite Trail, please feel free to contact me. Sincerely, omaZsA-.C.lbert, VP. E. Director of Public 1-brks TAC/jack THE LONE OAK TREE ...THE SYMBOL AND GROWTH IN OUR COMMUNITY I& 0-1.0c'c 641-75 JOHN MYRON LUNE) ATTORNEY AT LAW 832 MIDLAND BANK BUILDING P V 1 MINNEAPOLIS. MN 55401 '3 ! OFFICE - 612 - 338-7046 RESIDENCE - 612 - 920-7811 - March 20, 1979 >.9 City of Eagan City Hall 3795 Pilot Knob Road Eagan, Minnesota 55122 Attention: Mr. Thomas A. Colbert City Engineer Dear Mr. Colbert: I represent Doreen Ince who is the owner of property located at ''4020 BlackawkMDrve J n Eagan, Minnesota. We have been contacted by the'~aota-="Hlecttic Association of Farmington and they desire to place an easement along the south edge of that property in order to install a main feeder line from the substation on Black Hawk Rd. A sketch is enclosed for your reference of this. Before we consider entering into any negotiations with Dakota Electric, we want to make a determination as to whether or not this would in fact affect the ability to subdivide this land at some time in the future, or if it would affect any future building on any of this property. I would appreciate any help you could give me in this re- spect. , e y truly 77 John Myron Lund JML/ef Enclosure i ~l N U ooo OAK: ~ R Lis C.TRIC- t~ C. ~r ~ tZ~~►. ~~E SSA+ E t - i } ~Ctc)T 5t O S3ti1R1o.~ ~eW'r k C..Q7CL~ ~ow~~ 000, 6r,%wgl.ILTsY U'A Vis ey Ob d~ ~~AtJG Qt~'U ~U) L qc1~ HA~~IC, "~oAD N LEO MURPHY THOMAS HEDGES CITY ADMINISTRATOR f MAinOR ALYCE SOLKE THOMAS EGAN - CITY CLERK MARK PARRANTO JAMES A. SMITH CITY OF EAGAN THEODORE WACHTER COUNCIL MEMBERS 3795 PILOT KNOB ROAD EAGAN, MINNESOTA 55122 PHONE 454-8100 March 27, 1979 r Mr. John Myron Lund En I Attorney at Law 832 Midland Bank Building Minneapolis, MN 55401 RE: 4020 BLACKHAWK DRIVE Dear Mr. Lund: I an in receipt of your letter of March 20, 1979, wherein you are requesting information in regards to the effect that a requested utility easement by Dakota Electric Association of Farmington would have on the above referenced property under the ownership of Doreen Ince. The proposed location as shown on your sketch would have no effect on any consideration for future land subdivision other than to insure that a sufficient easement (normally 10 feet) was dedicated as a part of any subsequent plat. As far as its relationship to any future building on this property, it should have no effect. The required setbacks for any permanent structure as it would abut this property line would be required to be setback 30 feet from the Ince property south boundary line. I hope this response alleviates some of the concerns you have in your dealings with Dakota Electric. If you should have any questions requiring additional information, please feel free to contact me. Sincerely, Thomas A. Colbert, P.E. Director of Public Works TAC:tlp I IN OUR COMMUNITY. THE LONE OAK TREE THE SYMBOL OF STRENGTH AND GROWTH L c ~ T J ~ Edina Rea ft, Apple Valley Office 7668 150th Street West Apple Valley, Minnesota 55124 (612) 432-0000 City of Eagan Building Inspector Attention: Joe Merchak 3830 Pilot Knob Road Eagan, MN 55122 January 24, 1992 Dear Mr. Merchak, Per our conversations during the week of January 20-24, 1992, I would like to formally request the city of Eagan to re- determine and otherwise grant a modification to the strict provision of the Building code, section ##106, for the property located at 4020 Blackhawk Road in Eagan. The owners, Gary and Ann Selva desire to sell their home as a three bedroom home and require a re-determination to do so. The home was built in 1947 and was purchased in 1983. A modification involving the addition of a third bedroom in a downstairs location was performed subsequent to its purchase. I am a licensed REALTOR who works for EDINA Realty and am working on my clients behalf. By their signature below, they have consented to and have knowledge of this request. If you need additional information, please contact me at either 891-7623 or 452-6477. Thank you for your time. JV n cerely,C T S NVITZ GARY-SELV-A SEL DATE 1, &&_~ 111 'qZ ANN SELVA DATE Dkin 3eM7y i9 a Metropolitan Amrcia; Coipoca ion co!npany. ® MLS 1 lug PEARP)~ 3830 Pilot Knob Road Eagan, MN 55122-1897 city of ecigan (612) 454-8100 • Fax. 454-8363 RECORD OF TELEPHONE CONVERSATION DATE : 1© FE S 9 TIME : i`YI TALKED WITH : Vic THE~~j4V)'T~ REPRESENTING : E'D, AJ R RaA 1 y PHONE NO.: '-1-32- - Q 000 SUBJECT/PROJECT/CONTRACT : 90 Z0 ~j L-A,(-K H A uJK I` " c)>4 O I t,4 IF rA &A /,4 ITEMS DISCUSSED : e-A~-s P2 0 CASu bt u (-Tt/(ERc Ake- T ►~Y THEY ARE 3 ~5 ' A&o v~ ??h/~ FuoU/~z /V D 4~~ 'A~~JJ9 rJ nr z7 c~u~ o?y ,c~>~ -4 7 ti zz~ 5- T', C `T~` Cyr' L L [,%~3~ / Y ~_~~t✓7 she= / Lr' ~ ~~y CITY STAFF cc: THE LONE OAK TREE THE SYMBOL OF STRENGTH AND GROWTH IN OUR COMMUNITY i INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: 8830 Pilot Knob Road Permit Number: Eagan, Minnesota 55122-1897 Date Issued:` t (612) 681-4675 SITE ADDRESS: "'1'0 ~1 „ 1,41 13 t C K ,x jAPPLICANT: PERMIT SUBTYPE: TYPE OF WORK: REPAIR F I"A 1 y S c' 1 ~ .b Pemdt No. Permit ttotdw 08% Telephone # ELECTRIC PLUMBING HVAC Inspwoot Hate inep• Comments FOOTINGS FOUND v FRAMING ROOFING ! ROUGH PLUMBING PLBG i AIR TEST ROUGH HEATING GAS SVC V TEST INSUL GYPBOARD FIREPLACE FIREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL BSMT R.I. BSMT FINAL DECK FTG DECK FINAL INSPECTION RECORD WY OF EAGAN PERMIT TYPE; ki l, I I P NO , III t a00 Pilot Kriob Road Permit Number: 0, 9'f Eagan, Minnesota 55122-1897 Date Issued: i ' ` t fi81.2j 681-4675 .3 M. ADDRESS: 1, 0 t _ ; l" j tit. r; C k - , t APPLICANT: k 4020 0I- AC V flAt4V RO F I RF S 10 r . PERK' SUBTYPE: TYPE OF WORK: C fTfkf t AC; Nrw r ,7- * r Parmit NO. Pena How" Dme Tdaphoft 9 ELECTRIC KAJli£a F VAI C kwou"m Doft iraP Comments FOOTINGS FC UN4) FRAMMG Wk"o FRO" PU*ABM AIR TEST T GAS svC a TEST NMI. GYP SHARD f. r" FWAMACE t FWA:PLACE F .PM POALHM OAtSAT TEST "Ftt AL 8W R.I. BENT Fem. DECK FTG DECK FINAL CITY OF EAGAN 8795 Pilot Knob Road No. Eagan, Minnesota 55122 INSPECTOR NOTIFICATION Phone: 454-8100 REQUIRED BY LAW PERMIT FOR ALL INSPECTIONS Date: Receipt No.: Single Site Address: Z~~~`~~~~'°~~~ Residential Lot Block Sub/Sec. Multi Res., Comm./Ind. Nome New/Alter./Repair } Address Cost of Installation O ~ry ~T1~'t City Phone: Permit Fee Nome Surcharge Address art City Phone: Total This Permit is issued on the express condition that all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official . i 4,T.. , ~s•vW r_`^i~°.93...•' - - ti 1✓. `J • - r a.w ~..A. i ~ ;LL~a~~s.+:L.+~: j~.v "-4-~ Receipt MECHANICAL PERMIT Permit No. y CITY OF EAGAN r Fee Fill in numbered spaces S/C Type or Print legibly Tot. 1. Date 2. Installation Cost 3. Job Address Lot 01 Blk. ~S Tract 4. Owner Fla rv Sol n 5. Contractor Cp dS r '.,P 1 ? ey O tc . f''/ C Phone '1771 "i r4l C Pd. 6. Address 7. City n ,t of n State Zip i 8. Building Type: Residential L] Commercial O Institutional ❑ a 9. Work Description: New C~ Add ❑ Alter ❑ Repair ❑ 10. Describe rurnace Ch nn,e-out Fuel Type r3S i 11. No. Equipment BTU - M. Ea. No. Equipment CFM Forced At Air Handling: Mfg wmane Boilers Mech. Exhaust ti Mfg. Unit Heater Mfg. . Other Air Cond. q„r, i r Mfg. "'4 um t.1 7 r X Gas, Piping Outlets 12. t 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 Fin Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. Approved CITY OF EAGAN 454.8100 ReceiptU - 7 PLUMBING PERMIT Permit No. CITY OF EAGAN 1~~ ~'rJQ Fee E t~ Q ` ( 11 Fill in numbered spaces S/C~ Type or Print legibly Tot. 1. Date 2. Installation Cost 3. Job Address 4 L is' of Btk. Tract 7 4. Owner 5. Contractor 1,J r w;~ Phone 7l `l tl 6. Address i 7. City State } Zip 8. Building Type: Residential ❑ Commercial ❑ Institutional ❑ 9. Work Description: New ❑ Add ❑ Alter ❑ Repair ❑ 10. Describe 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 i Drinking Ftn. Slop Sink Gas Piping Outlets 12. 1 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' I Inspections: Date Insp. _ Date Insp. This is your p it en ta d and approved. Approved OF EAGAN 464-8100 CITY OF EAGAN 5715 POW Knob Road Eagan, MH 55122 N0 6179 PHONE: 454-8100 BUILDING PERMIT Receipt # To be used for Est. Value Date l9r' Site Address Erect Occupancy Lot Block Sec/Sub. Alter ❑ Zoning Parcel Repair [3 Fire Zone Enlarge] Type of Const. IT a Name Move ❑ # Stories Address Demolish t] Front ft. Z 18 City Phone Grade [I Depth ft. Name ° Approvals Fees r Z C~ 1C; 4 f' . o Address Assessment Permit city Phone Water & Sew. Surcharge j - " Police Plan check i F W Name Fire SAC :1 Address Eng. Water Conn. 11 "C. city Phone Planner Water Meter Council Road Unit I hereby acknowledge that I have read this application and state that Bldg. Off, I the information is correct and agree to comply with all applicable APC Total State of Minnesota Statutes and City of Eagan Ordinances. Signature of Permittee A Building Permit is issued to; on the express condition that G oil work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. I Building Official tv Permit #k Data Issued Penuntee Plumbing Mechanical ~c rl, C `i't St l -g'I Ackvt? 0, INSPECTIONS DATE INSP. Rough-in Final Footings Date Insp. Date Insp. Foundation _ Plumbing Frame/A*e 7-mil- Mechanical Final S~ ay Remarks: CITY OF EAGAN 11795 P#ot Knob Road Eagan, MN 55122 NO- 6180 PHONE: 454-8100 BUILDING PERMIT Receipt # TO be used for Est. Value Dated 19~`Site Address Erect ❑ Occupancy Lot Block Sec/Sub. Alter Zoning Parcel # OL21 7%. Repair ❑ Fire ?one' Enlarge ❑ Type oftonst. f a Nome - Move ❑ # Stories z Address Demolish ❑ Front I city Phone Grade ❑ Depth ft _ ao Name _ Approvals Fees pc~i Assessment Permit Address u City Phone Water & Sew. Surcharge Police Plan check t- Nome Fire SAC 1,0 Address Eng. Water Conn. < W city Phone Planner Water Meter Council Road Unit ' l hereby acknowledge that i have read this application and state that Bldg. Off. the information is correct and agree to comply with all applicable APC Total 1 State of Minnesota Statutes and City of Eagan Ordinances. Signature of Permittee A Building Permit is issued to: on the express condition that oil work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official Permit Date Issued Persktee Plumbing Mechanical INSPECTIONS DATE INSP. Rough-In Final Footings Date Insp. Date Insp. Foundation _ Plumbing Frame/ins. / S' a~tL Mechanical Final ¢ 3 7Lrz Remarks: r t slrPr , " we. A M'. A ~ rtl t , 414 lee~ y 1 - ~ f CjL424ei~p f~tY~Ft~ 1 Kxl-4 wL-. - t; A, d j op4+ . ~4. I ?ff l~1~SI n >~C all ~ 1 I . up Too P~>ft 01 4"~l 'tit C.. at1 ~ , d. ' t 7i 5 ~Y t4 "1` _ f ~L _t„` Jas VAT too r a ' x .F f S , I N r<, py Y',4 t ~ PI ~'Tk ~.M i~. tH' ~'~t. ~f ~ k~ M, a ' i ~ ~~'4r ry; +Cy y.'+ r I 7 5 f 1 d ,vr.''~•'i. r 1 x ~ ~ 1Wk~ ~ [.t'~, rc. jf ~ v. A ^~s ~~e~jF' .(.F ti.' 3 , ~7',. r yr ~ rr,. a't~ F yMr~ ~3 ~ ~r'i"~ _ '~i r M F N 'k a a IL4 4 c yt e_ X u~ w , W. „ - r ~ S e ~ a~~ ,-1rx~.,•-~••,:.-a~~.:~.s~m.-°,-- W"d~'~t <<t.i1V'~`t!v.{tr`, ~;..l~ftry~~ ' ~ r ~ ( ; , : ~ r~ a'° ,11"1x.1 J i ~ \ ~ F~8 ~.-wC.f 1 •~"q'Y''. ~?~1 ~ ~''+~~Mr~'" C.St~i Vv Y ~Y. ~ m , eel. I K.~ I 77 C g* " . • E i u, , t 7 ~~C ,~"-i.~Y~A"~a 1, t ~,1. "'dhKlp ?i3,~rt'~ ~17!'Q. µ dl't ~i.; 1'.,a._~u.+'a.-.e=_.-....s~.•..:,~•r.-,•„..n.+,aet..*.,~" sk,~ r ?q .•r i m { 4i . 4 , • too 77-7-7 jam' F ■R t t+Y• f y , - fff ~ ~ : t' - - _ ~ X - { `'V Win} ~"~~1~ t ~„r~°,f I"! ~S ~ - i .ia . _ ixa f~ lx* 1j;4 x-a 12 w Siv; yy z _c f -r ~ z G- r w ,54 r 'mow dU . Ste" ff r N , L = ='7 v i2 f • ii any - - .17S.~A'Y~f~~=- C.1C'~t7la.~ i~ - ~ r - . ' ?l.c ..Y vvyrrs"- - ~ . ~~1~fR , ~ ~ ~ `ray ~':~t-'~' ,S t c a_ , ° • _ f.#c .k~'~€-°-a ,J. " ~ n ' ~r ^t: +~et "'."C`'~'r`+.i~t.)~ _ PERMIT City of Eagan Permit Type:Building Permit Number:EA114589 Date Issued:09/17/2013 Permit Category:ePermit Site Address: 4020 Blackhawk Rd Lot:000 Block: 075 Addition: Section 20 PID:10-02000-75-012 Use: Description: Sub Type:Reroof Work Type:Replace Description: Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar. Pictures are not acceptable in lieu of inspections. Carbon monoxide detectors are required by law in ALL single family homes . Matt Kral 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 - Jeffrey R Berger 4020 Blackhawk Rd Eagan MN 55122 (651) 303-4980 Midwest Exteriors Plus Inc 6451 Sycamore Ct N Maple Grove MN 55369 (763) 427-9696 Applicant/Permitee: Signature Issued By: Signature 2.& City of Eap 3630 Pilot Knob Road Eagan MN 55122 Phone: (651) 675.56T5 Fax: (651) 675.569'9 Email: commdeveloome cityofeaioan.com For Office Use I 1 Date Received: l812-0lie I I , I S,� SEP'T'IC SYSTEM MAINTENANCE FORM y _� — '9 of Tanks Pumped: Total Gallons Pumped: —IS—Z", Date Pumped; Ske Address; r Owners Name: —JD��`t Owner's Address (If differerent from site); Maintainer's Nama; inn' e jr S License Number: /+L _ A Private Residence; Commercial; . Disposal Location; g2l. L ! 644"6ti Candidon of Baffles: Type of Tanks: , u Size o�Tanks: ( Effluent Sewage Discharge: Yes: Pumped Through: No:,_ Comments: please submit completed forma to this Building Inspections Division via mail, fax or email. T9/19 39Vd 71VOIQ3W A3nVA31dda 6TBLz6tZS6 cz:89 9T9i;/81/89