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3210 Black Oak Dr
Use BLUE or BLACK Ink n For Office Use CI x/77 S - - I of iu, PermitA gyp My of ELL j ~ CC/l ~ I Permit Fee: I I h 3830 Pilot Knob Road 1 1 Eagan MN 55122 1 Date Received: '~/v&AQ Phone: (651) 675-5675 j Staff: (651) 675-5694 1 2010 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: - )r5-)0 Site Address: off) 0 c C.~C.C~Ot- ` f` Tenant: 1 t>6s ~ Suite RESIDENT / OWNER NamecGO s cei~- W0.14-m 60 ^f - Phone: Address / City / Zip: r CONTRACTOR Name: License 58q ')J0- ?W1 Address:.0 X1614 ~ r d e►~ at(e~ RV City: F~rrh I Yl A State: Mel Zip: 55 69,Phone: 65 1 ` (4 (P3' -7 A 4 Contact: 'CJ + W1 A►n Email: TYPE OF WORK -New Replacement _Repair _Rebuild A_Modify Space _ Work in R.O.W. Description of work: PERMIT TYPE RESIDENTIAL Water Softener Water Heater Lawn Irrigation RPZ PVB) Add Plumbing Fixtures Main / Lower Level) Septic System Water Turnaround -New Abandonment RESIDENTIAL FEES: $55.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge) $35.00 Lawn Irrigation (includes $5.00 State Surcharge) $55.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge) *Water Turnaround (add $166.00 if a 5/8" meter is required) $105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge) $95.00 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) TOTAL FEES S 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.gopherstateonecall.org I hereby acknowledge that this information is complete and accurate; that ft work will be in conformance with the ordinances and codes of the City of Faan; that I understand this is not a permit, but ony an application for a permit, and work is not to start Wftxf a permit, that the watt will be in accordance with the approved plan In the case of work which requires a review and approval of plan;. i Appliewirs Printed Name Applicant's Signature FOR OFFICE USE Reviewed By: Date: Required Inspections: Under Ground Rough-in Air Test _Gas Test Final Use BLUE or BLACK Ink For Office Use I ` ~ L~ L~"J j Permit M of Eat L 3830 Pilot Knob Road' ? / t Permit Fee: Eagan MN 55122 ' I Date Received: ~ Phone: (651) 675-5675 I Fax: (651) 675-5694 Staff: `110` - - - - - - - - - - - - - - - - - J 2010 MECHANICAL PERMIT APPLICATION Date: CT- 15 ° 1O site Addnws• 3?\ 1 b e Aack.(s 0- k- Dr Tenant: l"~C3S Suite #i RESIDENT /OWNER Name!:~S c '4•- I ,,)Cmt'os C430,54 Address / City / Zip: rn CONTRACTOR Name: T;iA-Yyt o►a b vt P1, u vn In jj Ao_ Wkeense Address: 103 LA C IN n ® .H C'6 tt° 11vt-City:: Farm i CQ6/State: Zip: 55oa4 Phone: ("5, - L f U3 ` -7 O j Contact: Email: New Replacement Additional Alteration Demolition TYPE OF WORK Description of work: NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City Code. Please contact the Mechanical Inspector for information on permitted screening methods. PERMIT TYPE RESIDENTIAL COMMERCIAL Furnace - New Construction - Interior Improvement Air Conditioner Install Piping _ Processed Air Exchanger Gas _ Exterior HVAC Unit - Heat Pump - Under / Above ground Tank Install/ _ Remove) - When installing/removing tank(s), call for inspection by Fire Other Marshal and Plumbing Inspector RESIDENTIAL FEES: $55.00 Minimum Add-on or alteration to an existing unit (includes $5.00 State Surcharge) $95.00 Fire repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) $ 55 xn D TOTAL FEE COMMERCIAL FEES: $75.00 Underground tank installation/removal OR Contract Value $ x1% $55.00 Minimum (includes State Surcharge) Permit Fee - If the Permit Fee is less than $10,010, surcharge is $ 5.00 - If the Permit Fee is > $10,010, surcharge increases by $.50 for each $1,000 Permit Fee Surcharge (i.e. a $10,010-$11,010 Permit Fee requires a $ 5.50 surcharge) TOTAL FEE CALL BEFORE YOU 0I0 . Cau Gopher state one Call at (651) 454.0002 for protection against underground utility damage. Gall 43 hours before you Intend to dig to receive locates of underground utilities. www.aooherstateonecall.ora I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and odes of the City of Fagan; that I undemland this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work wig be in accordance with approved plate in the case of work which requires a review and approval of plans. ii ` X, tZAn~ ' xDQf1 '2,1 _The,6Q k, ApplicanCs Printed Name Applicant's Signature FOR OFFICE USE Reviewed By: Date: Required Inspections: _Under Ground Rough In Air Test ___-Gas Service Test _in-floor Heat Final Exterior HVAC Screening Inspection Use BLUE or BLACK Ink I For OffiCk :Use j Permit l O 1 I I City of Eaedn, ~ Permit Fee. ~ I 3830 Pilot Knob Road I1 , Eagan MN 55122 I Date Received: Phone: (651) 675-5675~~ i staff: I Fax: (651) 675-5694 ti/W --`-------------yJ 2010 RESIDENTIAL BUILDING PERMIT APPLICATION ~,~~[/`f4( e~ Date: Site Address: 2lb c Tenant: Suite RESIDENT /OWNER Name: Anx_.-t cry ~l~e ti N3os\ Phone: (oI' 304 Lc Address / City / zip: 3011o 3\e_a<_ Cc_k \.)q t~AU & SS\2~1 Applicant is: Owner Contractor TYPE OF WORK Description of work: N&Wic Construction Cost: k 3 o00 , 0 6 Multi-Family Building: (Yes / No I-) CONTRACTOR Name: SCC>kk Ca. - tS c nSktvLU LC_A \ v.L License 2931V 8 46 Address: \~\-+a% & 1 Y.'e u PAS V- C City: NSu`.\ z State:MM zip:SG306 Phone:t(5S9-)8'1Z'--L533 Grii,c Contact: SC0+-+- Email: 44 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: 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) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.goaherstateonecall.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 appjv(o f pla ns. x Sc0~ k' W0Ak-~\S x CtAZI 'GcJ Applicant's Printed Name Applicant's Signature Page 1 of 2 i~ - R DO NOT WRITE BELOW THIS LINE / SUB TYPES Foundation _ Fireplace _ Porch (3-Season) _ Storm Damage _ Single Family - Garage Porch (4-Season) _ Exterior Alteration (Single Family) Multi _ Deck _ Porch (Screen/Gazebo/Pergola) _ Exterior Alteration (Multi) _ 01 of _ Plex _ Lower Level _ Pool _ Miscellaneous Accessory Building WORK TYPES _ New _ Interior Improvement _ Siding _ Demolish Building* Addition _ Move Building _ Reroof _ Demolish Interior T~ - 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 Occupancy z n MCES System Plan Review Code Edition SAC Units (25%_ 100%-yj 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) Sheetrock Footings (Deck) Final / C.O. Required Footings (Addition) Final / No C.O. Required Foundation HVAC Drain Tile Other: Roof: -Ice & Water -Final Pool: Footings -Air/Gas Tests -Final Framing Siding: Stucco Lath -Stone Lath -Brick II' Fireplace: -Rough In -Air Test -Final Windows Insulation Retaining Wall: _ Footings _ Backfill _ Final Meter Size: Radon Control Erosion Control Reviewed By: , Building Inspector RESIDENTIAL FEES Base Fee ~ / Surcharge Plan Review MCES SAC ' City SAC Mp~ Utility Connection Charge y 2 3,v/ S&W Permit & Surcharge 1 (0 4( j Treatment Plant o,jo/ 9 / Copies 6 t,A TOTAL Page 2 of 2 %wof - _ , $ ti - - - - - - - - - - - - 1 Q/ } ~ tv / •4 of ~ O -67 0000> .65 ED 11 11 L c 0 b 1 1 1 ~ I I 1 l ! 1 1 I / t f ~ ~ 1 1 f / 00 1 1 1 ~ 1 t LA w5~ ~Aovsr Y.0 ~ S ca to 27" E ~o THE EAST LINE OF THE -NE ,1 /4:. 16 Kfi SEC. .12, T. 27, R. 23. 11 }I cj~ 1 1 ~ 1 1 1 } } 1 1 7a BAs-' - Cc r Q CD O O --a 3l'~ la M m OQ s PERMIT City of Eagan Permit Type: Building Eagan. Permit Number: EA092526 Date Issued: 01/11/2010 OR Permit Category: ePermit 41~ it~ of E3 E Site Address: 3210 Black Oak Dr Lot: 8 Block: I Addition: Orchard Heiahts PID:10-54500-080-01 Use: Description: Sub Type: e-Fireplace Construction Type: Work Type: Gas Fireplace (new) Description: Census Code: 434- Occupancy : Zonin,: Square Feet: 0 Comments: Improvements to the home may require smoke detectors in all bedrooms. Chimney flue must be inspected prior to concealin,. Carbon monoxide detectors are required bn law in ALL single family homes. Fee Summary: BL - Base Fee S3K $88.50 0801.4085 Valuation: 3.000.00 Surcharge - Based on Valuation S3K $1.50 9001.2195 Total: $90.00 Contractor: - Applicant - Owner: Heath and Home Technologies Andrew R Bost 2700 N. Fairview Ave 3210 Black oak Dr Roseville MN 55113 Eagan MN 55121 (61)633-261 I hereby aeknowledae 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 Cite of Eagan Ordinances. ApplicantiPermitee: Signature Issued Bv: Signature 7GAG Include 2 sets of plans, CT+ OF EC1tY'fLV 1.L' 1 site plan w/elevations & ILDING PER%Irl APPLICATION 1 set of energy calculations. To Be Used Fo Valuation D 4 © Date f~= Site Address OFFICE USE ONLY Lot o L2- Block O Sec. /Sub. C- • Erect Occupancy 3 Parcel Alter Zoning Repair Fire Zone Owner: Enlarge Type of Const. move # Stories Address: ~Lvy Demlish Front ft. City/Zip Code: Grade Depth 3ft. Phone APPROVAIS FEES ~J Assessments Permit Contractor: o!v Jr" L ?Water/Sewer Surcharge Address: Pnz rL L Police Plan Check City/Zip Code: )\I f7j d0 ±jQ Fire SAC Eng. Water Conn. Phone # : 30 Planner Water Meter Council Road Unit Arch./Eng.: Bldg. off. Address: APC City/Zip Code: TOTAS,' 6 . Phone CITY OF E.AGAN 3745 Pilot Knob Roof Eoggn, MN 55122 N? 7444 PHOHEt 454-8100 5 BUILDING PERMIT STORAGH Receipt # J ~~~~d To be used far AGRICULTURAL Est. Value $7,000 Date August 13 1982 Site Addresses Erect ® Occupancy M-3 Lot 012 Block 04 Sec/Sub. Section 12 Alter ❑ Zoning A Parcel # 10 01200 012 04 Repair ❑ Fire Zone NA Enlarge ❑ Type of Const. Vn se Name L.K. 3orieS Move 1 W ❑ # Stories Address 3475 Highway 55 Demolish ❑ Length 50 b City-Eagan 55123 phone 454-5519 Grade ❑ Depth 10Sq. Ft. o Sonnek Construction Approvals Fees Name uLl Address 2391 Pagel Road Assessment Permit 62.50 City Mendota Hts. Phone 454-3081 Water & Sew. Surcharge 3.50 Police Plan check FW Name Fire SAC 1Z Address Eng. Water Conn. i W CI 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 and agree to comply with all applicable APC Total $66.00 State of Minnesota Statutes and City of Eagan Ordinances. Signature of Permittee A Building Permit is issued to: Sorinek ConstructiO on the express condition that all work sholl be done in accordance with all cable State o innesot ut and City of Eagan Ordinances. Building Official STATEMENT #0193 CITY OF EAGAN 5-16-77 3795 PILOT KNOB ROAD EAGAN, MINNESOTA 55122 Phone 454-8100 n .j r t . Duane N. Mauch Box 203 \ Lakeland, MN 55043 f L DETACH AND MAIL WITH YOUR CHECK. YOUR CANCELLED CHECK IS YOUR RECEIPT. CITY OF EAGAN nss nor Kaeb Read , MM 551!6 7444', a, BUILDING PERMIT Receipt s~roRACn To be used 1ler AGRICUVrURAL Est. Value $7, 000 Date i! Site Address 1195 t a U ® Oaupancy Lot 41,2 Block 04 Sec/Sub. - Sect .Qn 12 Alter Q Zoning Parml # 10 01200 012 04 Repair Q Fire Zone to Enlarge I3 Type of Carat. ,Vf1- k~ Name L • K. Jones me" O Stariee r' Address 3475 Highway 55 Demolish ❑ length 50 C; Eac an 55123 phone 454-5519 Grade ❑ Depth 3 0 Sq, Ft_ Name Sonnek Construction Affroomb page u 2391 Pagel Road Assessment Parnit 62M Address U 3 ` t3 City jota s. pixne 454-3081 Water&Snw. Sunohergle . Police Plan efkeclt Fz o Name Fire SAC t' C5 Address Erg. Mfotesf Cvra~. . W Ci Planner 1Matar liAetar - - - p; Council inroad Unit 1 hereby acknowledge that 1 how read this application and steers that BIdO{, the information is correct and agree to comply with ail applicable State of Minnesota Statutes and City of Eagan Ordinances. APC Ta1nl 13 6 Q0' y Signature of Permittee Sonnek Construction, { A Building Permit is issued to: art Naa atcprase : all work shall be done in accordance with all applicable State of Minnesotl utga and City of txgon "ndwqW Building Official . 4 j i w ~r Permit No. Permit Hokbw Misc. Permit No. Holder Plumbing H.VJLQ Well Wster DkjL Samar Electric, Impaction Data Insp. Other Footings F umMlon !ranting Moab Plbs. HV Insuietion Final Pfbg. Fhnl HVAC Final r .s Water Describe Locetlon: 11111611 sewer Fr. DbjL CITY OF EAGAN Remarks /&/(-,n Addition Section 12 Lot Bilk Parcel 10 01200 020 011 Owner, t Street State Eaganimm 55121 0 C a Impr6vement Date Amount Annual Years Payment Receipt Date STREET SUR F. STREET RESTOR. GRADING SAN SEW TRUNK„ 7,92 Paid SEWER LATERAL WATERMAIN WATER LATERAL WATER AREA STORM SEW TRK &04- 1984 561.00 37.40 15 STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. BUILDING PER. SAC PARK CITY OF EAGAN Remarks Addition Section-1 Street Lot Blk State Parcel 10-01200-012-04 er 14 0 3-a ► v (3lack ()GA- EAGAN NN 55121 K i ~O Improvement Date Amou An al Years Payment Receipt Date STREET SURF. STREET RESTOR. GRADING SAN SEW TRUNK 1970 619.41 24.78 25 SEWER LATERAL WATERMAIN WATER LATERAL WATER AREA STORM SEW TRK 1984 108.46 15 STORM SEW LAT CURB & GUTTER ' SIDEWALK STREET LIGHT WATER CONN. BUILDING PER. SAC PARK RESIDENTIAL BUILDING Permit Application City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 J-13 D Telephone # 651-675-5675 FAX # 651-675-5694 New Construction Requirements Remodel/Repair Requirements office use Only 3 registered site surveys showing sq. ft of lot, sq. It. of house; and all roofed areas 2 copies of plan Cert of Survey Rent -Y -N (20% maximum lot coverage allowed) 1 set of Energy calculations for heated additions Tree Pres Plan Recd _Y -N 2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks Tree Pres Reqd -Y _N 1 set of Energy Calculations Addition - Indicate if on-site septic system On-site Septic System -Y -N 3 copies of Tree Preservation Plan if lot platted after 711193 Rim Joist Detail Options selection sheet (bldgs with 3 or less units Date 161 r Construction Cost Site Address lS (L) G 1 5t 15 IC an, Unit/Ste # Description of Work `P y' /d1 &A RO (,t) / Q/ J S0 iVA e S Zt~' Multi-Family Bldg - Y N Fireplace(s) - 0 - 1 - 2 ~~S Gl~f l~ Property Owner _ Aae` y-e W ash Telephone #(667-) Contractor t' Gt C / r Address .2 GD c/ City - LC I State 1/t Zip Telephone # (6~7f) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minnesota Rules 7670 Category 1 - Minnesota Rules 7672 Energy Code Category . Residential Ventilation Category 1 Worksheet New Energy Code Worksheet (4 submission type) Submitted Submitted Energy Envelope Calculations Submitted Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review fee applies. 7:7-. . f ~ Licensed Plumber q i ' , 1' is ~tplephone # ( ) Mechanical Contractor ~nT 3'r L~lephone ) '11 1 Sewer/Water Contractor Telephone # ( ) I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. _5f vie Applicant's Printed Name Applicant's Signature Permit l b Receipt Date: I © ' y CITY O AN 2001 SEWER AND WATER CONNECTION AND AVAILABILITY CHARGES EXISTING RESIDENTIAL PROPERTY Address 3,? ! /a OFFICE USE ONLY Property Owner NA PRV required Telephone # 74 City La County R-O-W Permit Plumber Sewer Water Lateral charge @ $22.85/ff a charge @ $23.05/ff $ Trunk @ $925/connection r=at 11 r3~f~ Trtuik $965/connection City SAC 100.00 Water su & storage 860.00 Base SAC 1,150.00 Date paid Date paid Receipt # Receipt # Treatment plant 516.00 Account deposit 15.00 Account deposit 15.00 Septic abandonment 50.50 Water permit & surcharge 50.50 Sewer permit & surcharge 50.50 Plumbing permit required -water meter to be acquired with plbg permit Total g~®v Total S Sewer and Water Sewer la 1 charge @ $22.85/ff Water late ge @ $23.05/ff Sewer trunk @ 5/connection Water trunk @! 96 nnection City SAC 100.00 Base SAC 1,150.00 Date paid Receipt Water supply & storage 860.00 Date paid Receipt # Treatment plant 516.00 Account deposit 30.00 Septic abandonment 50.50 Sewer and water permit & surcharge Total $ Plumbing permit required - water meter to be acquired with plbg permit cc: Carolyn Krech, Finance Department Permit 4 Le Receipt Date: - -D` -J -6 CITY OF EAGAN 2001 SEWER AND WATER CONNECTION AND AVAILABILITY CHARGES EXISTING RESIDENTIAL PROPERTY LD OFFICE USE ONNLY_ Address 3 ! O fJ2 Property PRV required Telephone # 3 - ~4 3 a'- Plumber WA City N4 County R-O-W Permit 151 Sewer Water Lateral charge @ $22.85/fF $ Lateral charge @ $23.05/ff Trunk @ $925/connection Trunk @ $965/connection City SAC 100.00 Water supply & storage 860.00 Base SAC 1,150.00 Date paid Date paid Receipt # Receipt # Treatment plant 516.00 Account deposit 15.00 Water meter "Inspections req'd prior 115.00 Septic abandonmen 50.50 to issuing Sewer permit & s charge 50.50 Account deposit 15.00 Water permit & surcharge 50.50 Plumbing permit required Total $ Total Sewer and Water fd, ,r3 Sewer lateral charge @ $22.85/ff Water lateral charge @ $23.05/ff Cl✓blq'""~~ f Sewer trunk @ $925/connection Water trunk @ $965/connection Pd dtodv r" City SAC 100.00 Base SAC 1,150.00 Date paid Recei Water supply & storage 860.00 Date paid eceipt # Treatment plant 516.00 Water meter **1 ions req'd prior to issuing 115.00 Account de it 30.00 Septic ab donment 50.50 Sewer d water permit & surcharge 100.50 Plu ing permit rcyuired Total $ cc: Carolyn Kreck Finance Department Coo- k I - , i _i~dt. -~:2rLV-~_ R- 7 w"t..7. r o-~ c c~• ~ i lljj _ DD _ ~ y}t, y~ ~ cl 1 i P E N D I N G A S S E S S M E N T R E P O R T TO IWOM IT MAY CONCERN; RE: Legal Description Attached Belot CLERK OF THE CITY OF Dakota JtkkjtbbkjZX COUNTY, MINNESOTA, DO HEREBY CERTIFY THAT THERE ARE NO LEVIED UR PENDING ASSESSMENTS ON THE ABOVE DES-CRISEL PROPERTY AND THAT THERE ARE y0 IMPROVEMENTS PLANNED OR NOW IN PROCESS PENDING APPROVAL OR RENDING COMPLETION, EXCEPT AS FOLLOWS (IF NONE, WRITE "NONE°) KIND OF IMPRCVEMENT: APPROXIMATE DATE OF COMPLETION: APPROXIMATE COST IN IMPROVEMENT: D A T E D T H 1 S J~ D A Y O F 19_ -Ina CLERK _ CITY s I77r'L q 'Ill(' .~4.~rt1~?tGi1 td~I'l: L13 'tali i 0 I.ve (J""' , Township Twen1 -j seven (c7 ~ . .fo1.Low~ ; Beginning nr "the Zl'as""'A! c _'r y i u ;ni,nlznlen.i: , L;ienee Northerly a ong i iie eesi- n-1 7 1m }111I1Ci '£C~i 5-tl -rty six and thiri-yojx o n£' viglit of way _iir;e of i~l~innesot-' Iri; ci't of way line a dlstanc"_e of nini~,tN Two I (92.95) feet; thence Southerly a I: _ti-ltanc:.! ;>ighty nine one hundredths (560 .89) a:t?r_ _ t- h , ..r;'i tidTd 12; tbE'I1CE' L1 61F'Z` y Bj.OII_ d.'j . af.1. si:l cijtaaice of eighty sly and ez lar.y .i ~aoin.t of beginns:ng, containing or- f,rfl, ;q,,„ of -Ih Scnith-r7F`nt quarter ~~f Lu l t a 1 ~ All- r3o O r ~ e PERMIT # } lea RECEIPT DATE: IZESIDENTIAL PLUMBING PERMIT APPLICATION CITY OF EAeAN 3830 PLOT KNM RD RAG", MR 55122 551-661-4675 Please complete for: ➢ single family dwellings townhomes and condos when permits are required for each unit ➢ backflow preventer for irrigation system SITE ADDRESS: a- 1 0 t~ 0 Y- OWNER NAME:: VepWpg- Y12-~ TELEPHONE (AREA CODE) INSTALLER NAME: TELEPHONEM - ~ 3 - 411(+ STREETADDRESS: `t !~tt C / (AREA CODE) CITY: t~ Uc STATE: Zip: ~ Place a check mark next to the permit work type New residential dwelling unit under construction and not ownerloocupied $ 90.00 _ Add-on, modification or altercation to existing dwelling unit, including: $ 50.00 • abandonment of septic system • new installation/repair/rebuild of RPZ • lawn irrigation system • wa er turnarounn Nature o wor Septic System, new/refurbished - $ 225.00 • includes County & Consulting Inspector fees • requires MPC license State Surcharge $ .50 Total $ SO -S-0 Reminder: Be sure to schedule inspections of alterations, Le. water heaters, water softeners, etc. ae to comply with all applicable arty of Eagan ordinances. It I hereby acknowledge that I have read this application, state that the information is correct, re is the applicant's responsibility to notify the property owner that the City of Eagan assume n ligability for any damages by the City during its normal operational and maintenance activities to the facilities constructed under this permit with Ci property/right-of- a ent. SIGNATURE OF RMITT E Updated 1101 12:31 SEP 19, 2005 FR: THERESA SCHOSTAG #24813 PAGE: 1/1 couNTY rppl ENVIRONMENTAL MANAGEMENT DEPARTMENT GROUNDWATER PROTECTION SECTION 14955 Galaxie Avenue • Apple Valley, MN 55124 952.891.7557 • Fax 952.891.7588 • www.co.dakota.mn.us MUNICIPAL NOTICE OF WELL SEALING PERMIT APPLICATION DATE: September 19, 2005 TO: Tom Colbert/Wayne Schwanz (EM) Fax (651) 675-5694 RE: Well Permit 05-H240832 Well Type: Domestic Municipality: Eagan Environmental Specialist: Luehrs The Water and Land Management Section of the Dakota County Environmental Management Department has received the following permit application for the well described. If you require further review of the application or if you have any questions or concerns about it, contact the Environmental Specialist listed above or our office at (952) 891-7557. If there is no response from your office within 24 HOURS (excluding weekends and holidays), we will assume that you have no objections to the issuance of the permit. Please note that permit issuance is always conditioned on the permit applicant's observance of and compliance with all applicable state, county, and municipal laws and codes. Well Contractor: Don Stodola Well Drilling Co. Date Application Received: 09/16/2005 Anticipated Drilling Date: Time: Anticipated Grouting Date: Time: Property Owner: Andrew R Bosl Well Owner: Andrew R Bosl WELL LOCATION: PLS Coordinates: 1/4, SE 1/4, SE 1/4, NE 1/4, Sec 12 Town 27 Range 23 Street Address: 3210 Black Oak DR PIN Number: 105450008001 WELL INFORMATION: Diameter: 4 Casing Depth: 230 Total Depth: 240 Static Water Level: Aquifer: COMMENTS: Ege Edit env Took Lkpplications help Connection Comments Eagan Building Eagan Development Permits Owner Eagan AssessOBeles Eat PtroPertY Eagan Zonin Tam Pin Zip Code 105450006009 55121 House # Street Name Unit 321 fl BLACK OAK DR Addition # School District Owner Change 10 54500 0196 20020927 Lot f Block Subdivision Name ~ B 1 ORCHARD HEIGHTS Lego Description r S Section Townes Range Qtr-Qtr # 12 027 23 1? t3~A4i.~ RD.#}aR1COR ~►tr t7 Parcel data updated January 30, _~rch PID search House 3210 BLACK OAK DR ahn -16~0 Use BLUE or BLACK Ink r - - - - - - - - - - - - - - - - QI For Office Use 1 1 / t~ Permit City of Ea I Permit Fee: I 3830 Pilot Knob Road I I Date Received: Eagan MN 55122 r, IA, Phone: (651) 675-5675 AUG ) 2 ,l J I 1 Staff: Fax: (651) 675-5694 2011 RESIDENTIAL BUILDING PERMIT APPLICATION Date: ~i 10i Site Address: -3;-zo 1&4 c& 0.#,t 0,Z Unit Name:-vim 0.S Phone: Cf ( ,Z-t U ~Q Z8 RESIDENT / ii OWNER Address /City / Zip: S;uo CO.Z Dv- _ Applicant is: Owner Contractor TYPE OF WORK Description of work: ~4 kc c-°e- ; c o~ Cr~y~che_ e S ~g~ l S y~+T(/iPA~, Construction Cost: Multi-Family Building: (Yes / No ) Company: UtVot_,/~, Contact: rY &VA-- &Je_V~J\60 CONTRACTOR Address: Z013 C. Z !vpj L^ City: L6_ `C-. 61 Stater Zip: 5:;~:© L, L1 Phone: Z -1 License ,~,r ~~LCII(G7 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 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 maybe 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) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.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 app val of plans. Applicant's Printed Name Applicant's Signature Page 1 of 3 • B EL 66~J&RITE OW THIS LINE SUB TYPES _ Foundation _ Fireplace _ Porch (3-Season) _ Storm Damage Single Family _ Garage _ Porch (4-Season) _ Exterior Alteration (Single Family) _ Multi _ Deck _ Porch (Screen/Gazebo/Pergola) _ Exterior Alteration (Multi) _ 01 of Plex _ Lower Level _ Pool _ Miscellaneous Accessory Building WORK TYPES New _ Interior Improvement _ Siding _ Demolish Building* Addition _ Move Building _ Reroof _ Demolish Interior 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 //law Occupancy MCES System Plan Review Code Edition SAC Units (25%100% 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 / No C.O. Required Foundation HVAC _ Gas Service Test Gas Line Air Test Drain Tile Other: Roof: -Ice & Water -Final Pool: -Footings -Air/Gas Tests -Final Framing Siding: `Stucco Lath -Stone Lath -Brick Fireplace: -Rough In -Air Test Final Windows Insulation Retaining Wall: Footings _ Backfill Final Sheathing Radon Control Sheetrock Erosion Control Reviewed By: , Building Inspector RESIDENTIAL F S Base Fee X.Z Surcharge Plan Review ~H3 MCES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Copies TOTAL Page 2 of 3 !" #$%&'()' *+*, -./$%'"&0-1O3$2>$,+ -./$%'53/4-.1 6789:C; <*%-'!==3->1?7@79@A?7: -./$%'#*%-+(.&1- -./$% B$%-'6>>.-==1''8A7?''O2*FM'I*M'<.'' 9#$ %& ''!())* * + ''YC%M-C)'D1*0M ; 234 !568V85565!6595' :;1 <-=F.$0%$(,1 <=>'?@A1 ,*C1A$-%1O +; C=% * +'?@A1 B C&'?@A1 \[-;'3+;1C 41;%C*A * + O1+;=;'O )1 VZV'6'Y%%=A-+%@ a +*+0 <Q=-C1',11 5 3IAC W1I1+ ;' ' M1'M I1'I-@'C1Q=*C1';I &1')1 1% C;'*+'-$$'>1)C I;N''OM*I+1@'S'G$=1'I=; '>1'*+;A1% 1)'AC* C' ' #(//-,%=1 % +%1-$*+0N O-C> +'I + P*)1')1 1% C;'-C1'C1Q=*C1)'.* M*+'!5'G11 ' G'-$$';$11A*+0'C I' A1+*+0;'*+'C1;*)1+ *-$'M I1;'JE*++1; -'< - 1' # '6'#-;1',11'TZbT99N85'595!NV598 D--'B3//*.&1 <=C%M-C01'6'#-;1)' +'_-$=- * +'TZbT!N85'U55!N7!U8 _-$=- * + ''Z\]555N55 "(%*21GC?H??' #(,%.*F%(.1IE,-.1 6''(AA$*%-+ ''6 ,*C1;*)1'D1-C M'R'D I1(+)C1.'/'# ;$ 7"55',-*CW*1.'(W1'HZ7!5'#$-%&'Y-&'4C / ;1W*$$1'EH''88!!ZX-0-+'EH''88!7! JU87L'U986KK"8 3'M1C1>@'-%&+ .$1)01' M- '3'M-W1'C1-)' M*;'-AA$*%- * +'-+)'; - 1' M- ' M1'*+G CI- * +'*;'% CC1% '-+)'-0C11' '% IA$@'.* M'-$$'-AA$*%->$1'< - 1' G'E*++1; -'< - = 1;'-+)'O* @' G'X-0-+'YC)*+-+%1;N (AA$*%-+ S21CI* 11 '<*0+- =C13;;=1)'#@ '<*0+- =C1 Use BLUE or BLACK Ink r----------------- I For Office Use "� I jPermit#: / 0 03 ; City of Ea�a� t/ / ®- F-i Y E� Permit Fee. t �G I 3830 Pilot Knob Road RE ; ,y// Eagan MN 55122 3,� 2�� I Date Received: 10 Phone: (651)675-5675 ��� I I Fax: (651)675-5694 I Staff: I I 2016 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Unit M CC Name: ZW414INP Rew ,SOSe- Phone:�J�a►O F;�eSide�tt/ Owner Address/City/Zip: 3 -2I0 O/gA 12t?t d e 1?d,f 4, A')AI, Applicant is: Owner Contractor ADO�r fey Type of Work Description of work: 1 o : r�0 Construction Cost: , Q Multi-Family Building: (Yes /No AJ Company:ERICt S CJP X7'Z Vol'/fled�'/�E/�►A9- aC Contact: /�0G/� Pri !e- GQntrac#ar Address: 1,2 6,/ 41itiyerf-f N,4 City: ST Wk L State: ft/Zip: sS 106 Phone:6s(-335'loQ�3 Email:Rf'61AfPnlC4 4P 3:1C GcoVG . iVcf I J9CO �S s License# . 7S Lead Certificate#: I If the project is exempt from lead certification, please explain why: wm��s/mss a•v !V ,?-T p/r/0 A.,/ 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:L F_ NDTE:Plans an supporting dacurnenfs fhaf you sabrr� #are corssidered to be public infarmaflvn. Portions of the Informaf)an may be classrfeal as non-lau /lc if ya�r pravlde specif c reaans:fha#vliauJd pemltfe Clfy#o . cancl�rle tha>`firer tratle. ecrefs. ; 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.gopherstateonecall.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 Minnesota State Building Code must be completed within 180 days of permit issuance. � x La L . P 8 l c� x Applicant's Printed Name Applican Signature Page 1 of 3 -9 Sf.� �l°g� ��� O NOT WRITE BELOW THIS LINE / 3 70 0 SUB TYPES Foundation _ Fireplace Porch (3-Season) _ Exterior Alteration (Single Family) Single Family _ Garage }G 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 Alteration _ Fire Repair — Windows _ Demolish Foundation _ Replace _ Repair — Egress Window _ Water Damage Retaining Wall *Demolition of entire building-give PCA handout to applicant DESCRIPTION j Valuation Occupancy Cam• MCES System Plan Review Code Edition A A x / 0 SAC Units (25%_ 100%�` ) Zoning _ City Water Census Code Stories Booster Pump #of Units Square Feet PRV #of Buildings Length Fire Suppression Required Type of Construction Width REQUIRED INSPECTIONS Footings (New Building) Meter Size: Footings (Deck) Final/C.O. Required Footings (Addition) Final/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 Lat Stone Lath _Brick Insulation Windows Sheathing Retaining Wall: _ Footings_ Backfill- Final Sheetrock Radon Control Fire Walls Fire Suppression:_Rough In_Final Braced Walls Erosion Control Shower Pan Other: Reviewed By: _ ¢ , Building Inspector RESIDENTIAL FEES Base Fee Surcharge Plan Review MCES SAC City SAC n� C9 ac> Utility Connection Charge S&W Permit& Surcharge Treatment Plant M, j V,�} 4, Copies /r ( TOTAL Page 2 of 3 70® June 7 t 2016 To City of Eagan From Andrew Bosl 3210 Black Oak Drive Eagan, MN 55121 To City of Eagan Inspector We have engaged price construction to build an addition to our property. As part of the permit application process he asked us about the age of the house to determine if there was led in any of the paint. Our home was built in 1968. Since that time our house has been substantially been remodeled. The remodeling has replaced the existing interior sheet rock of the home,which has been finished and painted. We performed a led detection test June 7th on the exterior stucco of the home. The stucco has all been painted since 2008. The led detection showed no sign of led. All windows and trim in the house have been replaced as well since 2003. Regards, t, Andrew R. Bosl �5�-3 0�7 0000� 65 } 0 fippli IPA) it �! ���F�>- � , •' � t} �� } LA 1� ca 1 THE EAST LINE OF THE iVE �? SEC. .12, T. 27, R. 23. > � � N �S�sr► ''. l 1 ��A �., A�ozm .�. A �°=jT • — City of aan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 RECEIVED JUL 171016 Use BLUE or BLACK Ink For Office Use Permit #: Permit Fee: Date Received: Staff: L 2016 MECHANICAL PERMIT APPLICATION ❑ Please submit two (2) sets of plans with all commercial applications. Date: VI 12, Site Address:2kO .00 ��� Tenant: Suite #: Resident/Owner Contractor Type of Work Permit Type RESIDENTIAL FEES $60.00 Minimum Add or alteration to an existing unit, includes State Surcharge $100.00 Residential New, includes State Surcharge Name: C` Phoned SSS' Address / City / Zip:3210 1b1aC K- Ori t\ eat n Name: License #: Address lD 'MO < p city:COL.Cdctu state:l \r) Phone V ` C Contact: New Replacement Description of work: Email: i1 Additional A t I .CCS eration Demolition NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City Code. Please contact the Mechanical Inspector for information on permitted screening methods. RESIDENTIAL Furnace Air Conditioner Air Exchanger Heat P Other dO CCM rr���� ���,,QQ �I r COMMERCIAL New Construction Interior Improvement Install Piping Processed Gas Exterior HVAC Unit Under/Above ground Tank ( Install /_ Remove) COMMERCIAL FEES $60.00 Permit Fee Minimum $75.00 Underground tank installation/removal, includes State Surcharge Surcharge = Contract Value x $0.0005 If the project valuation is over $1 million, please call for Surcharge $ OTAL FEE Contract Value $ x .01 = $ Permit Fee = $ Surcharge TOTAL FEE e ordinances and codes of the City of it; that the work will be in accordance =$ I hereby acknowledge that this information is complete and accurate; that the work will be in conformanc Eagan; that I understand this is not a permit, but only an application for a permit, and wor is not to start with the approved plan in tase of work which requires a review and approval of plans Applicant's in pp ted Name FOR OFFICE USE Required Inspections: wit J A•plicant'. S nature Reviewed By: Date: Underground Rough In Air Test Gas Service Test In floor Heat Final HVAC Screening PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA159028 Date Issued:11/18/2019 Permit Category:ePermit Site Address: 3210 Black Oak Dr Lot:8 Block: 1 Addition: Orchard Heights PID:10-54500-01-080 Use: Description: Sub Type:Residential Work Type:Replace Description:Standard Water Heater Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener). Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087 Surcharge-Fixed $1.00 9001.2195 $60.00 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Andrew R Bosl 3210 Black Oak Dr Eagan MN 55121 (651) 307-1494 Bonfe's Plumbing & Heating 455 Hardman Ave South St. Paul MN 55075 (651) 228-7140 Applicant/Permitee: Signature Issued By: Signature EAGAN 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 (651) 675-5675 I TDD: (651) 454-8535 I FAX: (651) 676-5694 buildinginspections(dIcitvofeacian.com Date: 2020 RESIDENTIAL BUIL Site Address: r For Office Use Permit #: (J Z� :1) Permit Fee: J 72 ' 3�/ l � Date Received: g-e" ERM PPLICATION Unit #: Type of Work Name: ,-'LL Ei(/$ i9AJ2 I C tr/ tDSL Phone: 6 S-/ —3e, 7 / //9 V Address / City / Zip: 31R /0 Bi,/< 0,9K D /?Id e Applicant is: Owner X Contractor Description of work: 25,7%/It9vn-t Construction Cost: GAO.00 Kioth4itI t^41.9DeGS' 41eCj /4 Multi -Family Building: (Yes /%No x ) Company: FACES CD 4/57R vc7/#It/ REm4dec/' Contact: 1647:747cdr Address: PLO/ rh1A/Nebt46// ,gri'L% f , City: 5/ PAWL - State: MA/Zip: 511.04 License #: L3 c OpY$ 75 Phone:/vs1 33S-r85.3 Email: RF6/ErffGE® ,$RC G1"4&.,t'er Lead Certificate #: If the project is exempt from lead certification, please explain why: (4/Hits gee .v resreD -t-74ere /5. .4Jo ,fou,'A 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: Mechanical Contractor: Sewer & Water Contractor: Phone: Phone: Phone: Fire Suppression Contractor: Phone: NOTE: Plans and supporting documents that you submit are considered to be public infonnation. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude'that they are trade secrets. You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's website at www.citvofeagan.com/subscribe. 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. 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.gopherstateonecall.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. e_ Applic.y"' s Printed Name Applicant's Signature DO NOT•WRITE BELOW THIS LINE SUB TYPES Foundation _ Fireplace Garage Deck fI" Lower Level Single Family Multi 01 of Plex 4?/.0 /g//9c. alz , A-F-3o4.7 Porch (3-Season) Porch (4-Season) _ Porch (Screen/Gazebo/Pergola) Pool WORK TYPES New k' Interior Improvement Addition _ Move Building Alteration _ Fire Repair Replace _ Repair Retaining Wall DESCRIPTION Valuation Plan Review (25%_ 100%_) Census Code 62 o # of Units # of Buildings Type of Construction Q REQUIRED INSPECTIONS Footings (New Building) Footings (Deck) Footings (Addition) Foundation Foundation Before Backfill Roof: _Ice & Water _Final Framing i 30 Minutes 1 Hour Fireplace: _Rough In Air Test Final Insulation Siding Reroof Windows Egress Window Exterior Alteration (Single Family) Exterior Alteration (Multi) Miscellaneous Accessory Building Demolish Building* Demolish Interior Demolish Foundation _ Water Damage *Demolition of entire building - give PCA handout to applicant Occupancy R - MCES System Code Edition / /2L Zb 2 cs SAC Units Zoning City Water Stories Booster Pump Square Feet / 1 co PRV Length Fire Suppression Required Width Sheathing Sheetrock Fire Walls Braced Walls Shower Pan Reviewed By: Meter Size: Final / C.O. Required Final / No C.O. Required HVAC _ Service Test Gas Line Air Test _ Hood Pool: _Footings _Air/Gas Tests _Final Drain Tile Siding: _Stucco Lath _Stone Lath _Brick _ EFIS Windows Retaining Wall: _ Footings _ Backfill _ Final Radon Control Fire Suppression: _Rough In _Final Erosion Control Other: , Building Inspector RESIDENTIAL FEES Base Fee Surcharge Plan Review MCES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Radio Meter Read Copies TOTAL 77 1-76 Page 2 of 3