3219 Black Oak DrAbb.
City af E3$30 Pilot Knob Raad
Eagan MN 55122
Phone: (651 ) 675-5675
Fax: (651) 675-5694
65 . (),2- C'adce_?
r - - - - - - - - - - - - - - - -
o Permit #:
o ?
' Rermit Fee: F
? E
?
? Date Received: ?
I ?
, Staff: I
I I
2008 RESIDENTIAL BUILDIIVG PERMIT APPI.ICATfON
Date: ?? Site Address: ? ? ? ? ?t.? GA ? ? •
Tenant:
Suite #:
RESIDENTIOWNER Name: .11L. Phone:
Address ! City I Zip: 3LA9 ??a- CgAK
Applicant is: Owner 4
Contractor
TYPE QF 1NORK Description ofwork: bf(,..K
Construction Cost: Mufti-Family Building: (Yes ! No`("'
CONTRACTOR
=Ut License #k:
Name: LJOITF, C7n- ;a`ayr
Address: 7 9C?3 l??a &U' "i:Q-4Ai 1? Z13
City: M l1 rlf(n I _ State: kZlpti Zip:
Phone: Contact Person: i?EGe-
COIVIPLETE THIS AREA ONLY IF GONSTRUCTING A NEW BUILDIN{3
Minnesota Rules 7670 Cateqorv 1 Minnesota Rules 7672
Energy Code . Residential Ventilation Category 1 Woilcsheet • New Energy Gode Worfcsheet
Category Submitted Submitted
(4 submissian type) • Energy Envelope Calculatiflns Submiited
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a rnaster ptan?
_Yes _No If yes, date and address of master plan:
Licensed Plumher: t'hone:
Mechanical Contractor: PhoRe:
Sewer & Water Contractor: Phane:
1?CQTE. Plarr?. and supporfing riacuf»ents t?raf ;vori su1a?t?t?t,a?re considc:red tc? be publec ir?rrt?a?crt?. P±?r??r?ns Q?
the inforrrtatror? rr?ay? he classified 4s ra?+o,?;pul?lic tf yt?q,?ra?ricls`speeirk reasQ?s thatrovoWpermft #he Cify to
fhat fhe are ts,
I hereby acknorvledge that this information is complete and acourate; that the wark w311 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 srart withovt a permit; that the work wil( be in
accardanoe with the approved plan in the case of work which requires a review and approval of plans.
`
i? ?
X ?- 3? X .
Apptican#'s Printed Name 1 L) Applicant's Signature
Ll APPR 2 9 2008 Page 1 af3
DQ NQT WRITE BELOW THIS LINE
• suB TrpEs
? Foundatian ? 05-plex ? 16-psex ? Accessory Bvifding ? Pool
? Single Family ? 06-plex ? Fireplace ? Porch (3-season) ? Lxt Alt. - Multi
? 01 of _ Plex ? 07-psex 0 Garage ? Porch (4-scasan) ?Ext Alt. -- SF
? OZ-Plex ? 08-psex -f4__ Deck ? Porch (screenlgazebo/pergola) ? Multi lhAisc.
? 03-Plex ? 10-plex ? Lawer Level ? Storm Damage
? 04-Piex ? 12-plex ? Misceilaneaus
woRK rrPEs
? New ? Interior Irrtiprovement ? Siding ? tiemolish Builcling*
'Q Adctition ? Move Building ? Reroof 0 Demolish Interior
? Alteration ? Fire Repair ? Windpws 0 Demolish Foundation
0 Replaceanent ? Egress Window ? Water Damage
' Demolition (entore bui9ding) - give PCA handout to appiicant
DESGRIPTION: ?
Valuation - Occupartcy MCES SyStem
Plan Review Code Edition . SAC Unats
(25°l0 100°!0 ) Zoning City Wafier
Gensus Code Stories Boaster Pump
# of Unets Square Feet PRV
# of Suildings Length Fire Sprinklers
Type of Const. Width
REQUIRED INSPECTION5
Footings (new bldg) Sheetrock
? Footings (deck) Fina[1C.0.
Footings (addition) FinaElNa C.O.
Foundation HVAC
Drain Tile Other:
Roof: _Ice & Water _Fina[ Pool: _Foatings Air/Gas Tests J,,.,Fana]
Framing Sidang: _Stucw Lath -Stone Lath _Brick
Fireplace:_R.l. AirTest _Final Windows
Insulation Retaining WaBI
Reviewed By: Building Inspector
RESIDENTIAL FEES:
Base Fee
Surcharge
P1an Review
MClES SAC
City SAC
Utility Connec#ion Charge
S&,W Pertnit & Surcharge
Treatment Plant
Copies
Total
Page 2 of 3
CER TIFICA TE OF SUR VEY
?.V ON YEA HOMES
Bohlen le
I r? , ,.u veying & Engineering
34462 Foliage Avenue 4819 123rd Street W.
Notthfield, MN 55057 n E Savoge, MN 55378
Phone: (507) 645-7768 D Phone: (612) 895-9212
fax: (507) 645-7799 Faz: (612) 695-9259
894x5
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U31 895x5 696x5 1
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x
O 89!)x1 895X4 896x0 ayoxi 897x2t
x° N 89'052'65" Fi 1
?
8954 895x8 896x4
a94xa
NOTE: VERTICAL DIFFERENGE BETWEEN PROP4SED
GARAGE FLQOR ANp TQP CURB AT CENTERUNE
PROPOSED DRIVEWAY =3.8
z
C7?
50' R/W
25 ?
?I
C?
e? I
0
c?
1--3 I
,,.oo "0 ?
? I m
5 ? ? 9.57 I ?
? ° QRIVEWAY I it7X.
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25
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m
¢ 898xOhe 896x8 A
R °_? FTrx m °
50' R/W
0? EY.fST€NG ?
?0(&
PR GA G FLOflR ELEV. 900.4
PR4P SED 'TOP OF CQN? WALL ELEV.= 904.7
PROp4SED BASEMENT FLOOR ELEV = 892.7
? DENOTES SERYICE L,OGA7'1QN
PRDPERTY DESCRIPTIQN INV = 885.18 PER PLAN
LOT 3, BLOCK 1, ORCHARD HEIGH35 AADDITION. -?-- DENOTES PROPOSED DRAIh1AGE
CITY QF EAGAN, DAK4T,4 COUAITY. MINNESOTA. OOOX?I pENQTES PR4F'OSED ELEVATtON
00bX0 DENOTES EX[STIN? ELEVATtON
LoT 3 AREA = 13747 sq. FT. 0 DENOTES WOOD HUB
HQUSE/GARAGE AREA = 1860 SQ. FT.
' o DEN0TE5 IRON PIPE MONUMENT
L07
COVERAGE = 13.53G
I HEREBY CERTIFY THAT THIS SURVEY WAS PREPARED BY ME OR UNDER
MY DIRECT SUPERVISION AND THAT I AM A DULY REGfSITER'ED L.AND
SURVEY4R UNDEft THE LAWS OF THE STATE OF MINNESOTA.
DATE: 7-7-03 4::?
(REVaSED 7-21-03) LEROY H. HLEN, LAND SURVEYOR
MINNESOTA LICENSE N0. 10795
.
7 " = 30'
???
SitB ?fGSS: 6i?- f ? 1.01 _ $IOdc _ Sltbd. ?c-c--"d k
On April 15, 2000 the Minnesota Energy Code, Ca#egory I 9uRdN Requiremen#s for insulafiian proWon, air
tightness, and ventilation, was adopted. As a result, the City o( Eagan is requidng that the foNawing infamation be
submitteci p+ior to issuannce vf a Cerfifica#e of Occupancy.
,.,.,._ rnis sWct,re: Is oonaMxled ro r?et minimum requirwwts of ft AM E.nergy Ca1e, cnapter 7670
OR
Thar sinftre: Al1 be c,nnstrucled to meet more msbidive requirements of ChapWs 7672 ar 7674
MPWINCE GAS ELEC MAMUFACTURER IYIODEI. BNS 1EXrINQ T1(PE
Water Heeter
Fumace ? ? cL
=Dr
m
2?
F.XIIAUST SYSTEM
LOCATILIN
TYPE
MQDEE.
CFM`s IfENTED
YES No
Kca,en Ilclen
/ZX ,4
saboom t / ?- ? Iz
eathroom 2 ? ?'? ? ? ?'`?
Bathroom 3
8athroom 4
Otbher
0 a'(? ,tf 12 ? 0?00
FIF2EPLAC 5
LOCATION
iiAS
YYOOD
IIF{?CTt1RER
MODEL
BNS 1fEl+f1M •
DRtM'i ATM
° d 7LY-
MAKE-UPlUR MQDEL TYPE CFkI's
i hereby pcknowledge ihat the above mtrwaon is correa and agree to aompty mth ihe Minnesata Energy Cale and City o# Eaw
requ nts.
7
?
?,9 ?,? ?
?.? 4j-_
Gompany ame
' This form is the responsibiGiy of the Generat Contractor.
Address: 3219 Black Oak Dr Zip: 55121
Lot: 3 Block: 1 Subdivision: Orchard Heights
THE FOLLOWINC ITEMS WERE/WERE NOT CO'VIPLETE AT FINAL INSPECTION ON ff (,,, i,-
Yes No Comments
Final ade - 6" from sidin
Permanent ste s - arage }t
Permanent ste s- main entry
Permanent drivewa '
Permanent gas
Retainin Wall or 3:1 Max Slope ,)(
Sod/Seeded lawn
TraiVcurb dama e
Porch X
Lower level finish
Deck x
Fire lace
• Verify with your builder that roof test caps from the plumbing system have been removed.
• Turn off water supply to the outside lawn faucets before freeze potential exists.
• Call the City's Engineering Department at 651-675-5646 prior to working in right-of-way or installing
irrigation system.
? BUILDING INSPECTOR:
?---? ?
CONTRACTOR:
Gonyea Developmnet
50 Groveland Ter
Minneapolis, MN 55403
RESIDENTIAL BUILDING M
C ;
Permit Applicatioa foe z--
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Gonstruction Reauirements RemodeUReoair Requirements
3 registered site sunreys showing sq, ft. of lot, sq. ft. of house; and all roofed areas Z capies ot plan
(20% maximum lot coverage allowed) 1 set of Energy Calculations tor heated addition
2 copies of plan showing beam 8? window sizes; poured found design, etc. i siie sunrey For additions & decks
1 set of Energy Calculations Addition - i?rd"reste if onsite septic system
3 oopies of Tree Preservation Plan it lot plattei after 711193
Rim,ioist Detail Optluns seiection sheet (61dgs wifih 3 or less units Cl J?
sA la, 7?
??, 57V
?fl s?
?73, 7 7
G ?a? ??-
Oft Use Or?l
rF of Survey Recd
s Pras Plan Recd
Pres Not Reqd
_ On-site Seplic Sysiem
Date 0:2 I 0? Constructian Cost Z / ??? _
Site Address /??,??C ? [3?? UnitlSte #
Descriptian of Work
Multi-Family Bldg _ YOX N Fireplace(s) _ 0 K1 _ 2
Property Owner 60 ll `Q ? m Telephone # (?/2. ) 3776
Contractor Q /'.f?f s
Address D 69,9t-J<
Sta#
e
ZiP U City
TelePhone # I/
?
Gt311APLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING E
Minnesota Rales '7672 ?
Energy Code Category - Minnesota Rules 7670 Ca#egory i .._. j
{J submission rype) • ResidenGal Ventilation Category 1 WorksheeC • hlew Energy Code Woricsheet ?
Submitted Submitted ?
• Energy Envelope Calculations 5ubmitted
Licensed PEumber 02
? C4W?j ?elephone
1?
Mechan. ?cal Contractor 07 ? Telephone # (26
Telephon ?! # ?? /' 7 -' Z-
Sewer/Water Contractor ?
?' ? I?3? -
?
.xJ accurate;
I hereby apply for a Residential Building Permit a.nd acknawledge that the infcErnation i campl0e,
that the wark will be in conformance with the ordinances and codes of the City of Eagan and the State af NN
Statutes; T understand this is not a pernut, but only an application for a permit, and work is not to start without a
permit; that the wark will be in accordance with the approved plan in the case of work which requires a review and
approv of plans.
Applicant's Printed Na e Applicant's Signature
OFFICE USE ONLY
Sub Types
O 01 Foundatian
71? 02 SF Dwelling
? 03 01 0# - plex
? 04 02-plex
C] 05 03-plex
13 Ofi 04-pbex
Work Types
/6- 31 New
? 32 Addition
? 33 ,4lteratian
? 34 Replacement
? 07 OS-plex ? 13 16-pdex ? 20 Pool
? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.)
0 09 07-plex C] 17 Garage ? 22 PorchlAddn. (4-sea.)
? 10 08-plex ? 18 Deck [3 23 Porch (screenlgazebo)
? 11 10-pfex ? 19 Lawer Levei ? 24 Stortn Damage
? 12 12-plex Plbg_Y or _ N Ci 25 Miscellaneaus
Valuation
Census Code D
5AC Units
Nbr. of Units
Nbr. of Bldgs
Type af Const
? 35 Int Improvement .0. 38 Dernolish (lnterior) ? 44
0 36_? ' M?iv' ? Bldg"
?v
+ CJ 42 Demolish (Faundation) ?45
? 37
Demolish'(Bldg)* ?' 43 Reroof CJ 46
*Dernolitlon (Entlre Bldg) - Give PGA handout to applicant
Occupancy MC/ES Syskem _
Zoning City Water ?
Stories ?W Booster Pump _
Sq. Ft. PRV _
Length lg I Fire Sprinklered ?
W idth ?
? Foorings (new bldg)
? Foatings (deck)
Footings (addirion)
? Foundation
Drain Tile
? Roof Ice & Water Final
Framing
Fireplace 4Q R.I. -,tAir Test k Final
InsuIarion
Sase Fee
Surcharge
Plan Review MC/ES SAC
City SAC
Utility Connscfion Charge
S&W Permit & Surcharge
Tceatment Plant
License Searoh
Copies
Other
Tatal
r
REQUIRED IN5PECTIONS
? FinaUC.O.
_ FinaUNo C.O.
_ Plumbing
_ HVAC
Other
_ Pool _ Ftgs as Tests
? Siding Stuccv X Sto
_ Windows (new/replace
_ Retaining Wall
Final
Approved By rZ , Buifding lnspector
p h,
9
? 30 Accessory Bldg
C] 31 E7ct. Alt - Multi
Cl 33 Ext. Alt - SF
? 36 Multi Misc.
Siding
fire Repair
V1/indows!Doors
f I D o
I V r ? ? ? ? r?~
y
5' `
F;-t?? /)-o
4?? % 17c7j`'
?r quo
s-.1i olYb
i ! ?194q
'
Site address: lot ? Block Subd.
On April 15, 2000 the Minnesata Energy Code, Category I Building Requirements far irtsulation protection, air
tightness, and ventilation, was adopted. As a result, the City of Eagan is requiring that fhe bllawing infarmation he
submitted priar to issuance of a Certificate of Occupancy.
This structure: is consVucted to meet minimum requiremen#s o# the Mn Energy Code, Chapter 7670
QR
_ This structure: will be constructed ta meet more restrictive requirements of Chapters 7672 ar 7674
APPLIANCE GAS ELEC MANUFACTURER MODEL BTU'S VENTING TYPE
Water Heater
Fumace 64 AA
Dryer
EXHAUST SYSTEM
LOCATION
TYPE
MODEL
CFM's VENTED
YES N4
IGtchen kitchen
Bathroom 1 r A
Bathroom 2 ?? ? A t- ?
Bathroom 3 A
Bathroom 4 Oz ?
Other
FIREPI.ACE S
LOCATION
GAS
WODD
IJANUFACT
MODEL
BTU'S VENTING
DIRECT ATMOS
a
MAKE-UP AIR MODEL 7YPE CFM's
I hereby adcnowledge that the above infflrmation is correct and agree to comply with the Minnesota Energy Code and City af Eagan
require
g ture Date
Company ame
* This form is the responsibility of the General Coniractor.
t ?
? •
REScheek Compliance Certificate
2000 Minnesota Energy Code
REScheckSoftware Version 3.5 Release Ic
Data filename: C:\Program Fi(es\Check\RESchecklBlack Oak Drive.rck
TITLE: Orchard Heights
COUNTY: Scott
STATE: Minnesota
'LON E: 2
CONSTRUCTION TYPE: Single Family
DATE: 06/16/03
DATE OF PLANS: 06l12/2003
PROJECT INFORMATION:
Black Oak Drive Spec
COMPANY INFORMATION:
Gonyea Homes
COMPLIANCE: Passes
Maximum UA = 506
Your Home UA = 362
28.5% Better Than Code (UA)
Permit Number
Checked By/Date
Gross Glazing
Area or Cavity Cont. or poor
Perimeter R-Value R-Value U-Factor UA
Ceiling 1: Raised or Energy Truss 1 125 44.0 0.0 25
Wall 1: Wood Frame, 16" o.c. 1287 19.0 0.0 63
Window 1: Above-Grade:Wood Frame:Double Pane with Low-E lSl 0350 53
Door t: Solid 42 0.250 11
Door 2: Glass 29 0.350 10
Wa112: Wood Frame, 16" o.c. 1152 19.0 0.0 60
Window 2: Above-Grade:Wood Frame:Double Pane with Low-E 132 0350 46
Wali 3: Wood Frame, 16" o.c. 225 19.0 0.0 13
Wall 4: Wood Frame, 16" o.c. 72 19.0 0.0 4
Basement Wall 1: Solid Concrete or Masonry 846 13.0 0.0 47
Wall height: 9.0'
Depth be(ow grade: 6.7'
Insulation depth: 9.0'
Window 3:
Basement > 5.6 ft2:Wood Frame:Double Pane with Low-E 47 0.350 16
Basement Wail 2: Solid Concrete or Masonry 171 13.0 0.0 13
Wall height: 3.5'
Depth below grade: 1.0'
Insulation depth: 3.5'
Floor 1: All-Wood JoisUTivss:Over Outside Air 24 38.0 0.0 1
.1%
` Furnaee l: Forced Hot Air, 95 AFUE
Air Gonditioner 1: Electric Central Air, 12 SEER
Proposed and Maximum U-Factor Averages
Proposed Maximum
Average U-Factor Allowed t1-Factor
Above-Grade Windows and Glass Doors 0.350 0•370
Includes Foundation Windows > 5.6 112
COMPLIANCE STATEMENT: The proposed building design describeci here is consistent with the building plans, specifications,
and other calculations submitted with the permit application. The proposed building has been designed to meet the 200014iinnesvta
Energy Code requirements in RhiScheckVersion 3.5 Release dc (formerly MECchec4 and to comply with the mandatory
requirements listed in the heeklnspec i hecklist.
? Uate ?? ?? ? ?
euilder/Desigrser :
JUN-24-2UU3 I UE U? -'!j NIi ?'. ut
--- - -??.. ,
? y ncck option used: O Fuel burning equipment (completc schednles belo?'v) ? No fuei bntnir?g cquipment
? ?-?...?.
, t"istRuctiow5 • EKHAUST / htAKE-UP AiR MUL-E
Sirp I. Complete the Cvinbtutton EqcripmenrSchadrrl¢ belmv. nnfy equipmant Exhau't devices ovet 304 cfm Flow
-with a Y(Yes) may be selected under the''Category, 1" elternate. Step 2, Complete E,rl?uu,rl/A1crkE•?rp ?firSch¢drile tin the ri,g,hc !f direct or power ?
c
vented or solid fuel atmospheric veat space licating equlpment is seltcted. .. r
Space heatin$ - nonso
aing - nonsoii
(check all
C3 Staled combu3tion
?.?
Direct oc pow•ec venced
Sealed combusiion
Direct or po?ver vented
. ?i•: ,
- solid fuel
- °--r°....o...W ....- ' ., 1 ¦,cn«n ^ aoua sucl ".
If acmosphericaliy vented solid fuel or direct or Fbwer vented nonsolid tuei space heating
flow !s rernd•j%a r--?-? ??a;•,;dual exhaust devlGe which exceeds 380 cubic feet per mirtUte.
14-1sealed combustion '
O Direct or power vented
'Aemospherically veated . .?Z
C] Atmo9 heritally vented •,1
Ca Atmos herlcell venced 1
0 Atmos herically vented I
s ittstailed, Nen maks-Up air ta mgt
Part C1. VENTIx,Ax`ION ?
• ? VC, IYTIATIptY QUANTiTY -- ?'-`^
(Mechanlcal veacflatiea mu:.t be provided per the larger quaaticy ea lculated below)
cubic toet x 0.005831winute ?EZ7Y eCm x 15 cfmlbsdroom) ? 15 tfm ? y;.)
? eln
va?ume o hab(tablc rooms ' number ofbedrooms ':- •- • - " ' ` • - . I
. -_..?_
.:?.':? • ?_ . ?, .
Check meihod(a) proposed + O £xhaust
Fan descriotlon or
AS DEStQNEO
0
N F'AN aCHEDULE ? ,•, . Balanced (heat retovery veotitatpr, air
c
c
. . . . :?..
!er. ttc.) 1 • -
*V &A L+%7 • ?
CFm + C5
Statement of Comptiance: The proposed buiiding deslgn rcpresentod in these documents is consistcnt with the building piu
speciricatiens, snd other calcufations submitced with the pcr+nit application. The proposed building has bcen designed to mect tl
requirements vf the Minnesota Energy Code.
Applitant (print n me) Signature 0ate Yel phone u ber
?
Part C2. VENTILATIl1N (Submit Part Cz vpon completion of aystem veriGcationl
?<__?_-__ .-----?-- -------.-?----- ._ ----- ---.------ - - - - - - - ----_- - ..------ --
lob Site Address:
Fan dtsctiption or tocation
tit£ASUABD Intake cCm cfm
PFRFORMA) CEfi Exhaust 7-oo cfm cfm cfm
1' VentilatioA rate must be measured and verified when tkr perforniance option is used tn tieu
of joints in the building conditioned envelope (Fram Parc A).
Aermit T'umber
TOTALS
c
Complinner Staitement: Instalttd vtntilatiunsysiem '• A comp•l;nnce with ti[N Energy Code and i5 siied to provide the cJcyign air tIo'
??rf???y?•. ,?- ?.?f?????? ? ??? c7 j ?, f . ??-^??G
?,..,?:......,_.... _.... . . .?- ?
? CER TIFICA TE OF SUR VEY
? F
GONYEA HOMES
Bahlen
`Surveying & Engineering
31-462 Foliage Avenue 4819 123rd Street W.
?-Northfield, MN 55057 B E Sauoge, MN 55378
Phane: (507) 645-7768 Phone: (612) 895-9212
Fox: (507) 645-7799 Fnx: (612) 695-9259
?
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° N 89052'55" E 157.56
L^ asaXa
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MOUSE
m125
I
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C)
y
? ii 50' R/W
894x4
PROPQSED G,ARAGE FLQOR ELEV. 900.4
NOTE: VERTICAL DIFFERENCE BETWEEN PROF'OSED PROP4SEQ TOP QF CONG WALL ELEV.= 900.7
GARAGE FLOOR AND TQP CURB AT CEI+lTERLINE PROPOSED BASEMENT FI.DOR ELEV. 892.7
PROPOSED aRIVEWAY =3.8
? DENOTES SERVICE LOCATfON
PROPERTY DESCRIPTION INV - 885.18 PER PLAN
F.OT 3, BLOCK 1, ORCHARD MGHTS ADDITION. -?`- 'UENQTES PROPOSED DRAINAGE
CITY dF EAGAN, DAKOTA COUNTY, MNESOTA. OO?XO DEN(3TES PROPOSED ELEVATION
LOT 3 AREA = 13747 sQ. FT. oaoxo DENOTES ExISTING ELEVATION
HOUSE/GARAtE AREA = 1860 5Q. FT. 0 DENOTES w00D HU8
I.OT COVERAG£ = 13.5% a DENOTES IRON PIPE MMIOiVUMENT
I HEREBY CERTIFY THAT THIS SURVEY WAS PREPARED BY ME QR UNDER
MY DIRECT SUPERVISION AND THATI AM A DULY REGISITERED LAND
SURVEYOR UNDER THE LAWS OF THE STATE OF MINNESOTA.
DATE: 7-7-03 z
(REVISED 7-21-03) LEROY H. ??, F,?}HLEld, LAND SURVEYOR
MINNESOTA LICENSE NO. 10795
1 " = 30'
FU
RECEIVE?
?UL 2 3 2003
EAGAN
ENGINEERING DEPARTMENT
LOT SURVEY CHECiWST FQR RESIOEHTIAI.
BUILDING FERMIT APPUCATION
PROPERTYLEGAL• I G Pc.l.tc.•J- I4.iql'?t? Add. ?A) t{ fjlu?e? Oo-
DATE OF SURVEY: 9 " 1" 03, C-?.
LATEST REVISIUN: -1 - aj-U 3
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? DOCLJMENT STANDARDS
? ? • Registered Land Surveyor signatu€e and company
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Legal description
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? ? • Praposedlexis#ing sewer and water services & invert elevatian
? D * Street name
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l? 0 0 • Lot Squars Foatags
? 0 ? • Lot Coverage
ELEVATIONS
Exisfin-ci
C? ? 0 • Sewer service (or Proposed)
d 17 ? • Properly corners
?? ? • Top of curb at the driveway and property Iine extensinns
Q? • ElevatiflrES of any exisbng adjacent homes
?t7 • Adequate fuoting dep#h of structures due to adyacent utilit}r trenches
? ?r ? • Waterwrays (pond, stream, edc.) .
Pronosed
? 0 • Garage flaor
? Cl • Basement floor
? 0 CI • Lowest exposed elevatian (walkouUwindow)
?f C] Q • Properly comers
?? o ? Front and rear of hosne at the foundation
PONDING AREA (if applicable)
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10
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• Easement line
Q 0 + NWL
? 0 • HWL
0 61 ? • Pond # designatlan .
? d ? * Emergency OaerFfow Elevafion
D W o • PondlWetiand buffer detineation
DIMENSIONS
0 0 • Lot IinesBearings & d6mensions
?? • Right-of-way and street width (to badc of curb)
? CI • Propased horr:e dimensions including any proposed decks, overhangs greafar than 2', parches, etc.
(i.e. ait structwres requiring permanent footings) .
? ?? • Show atl easements af record and any City utilities within those easeirtents
4 ? • Setbacks of proposed structure and sideyard setback of adjacent existing structures
??I ? ? Retaining wall requirements, if any
. Reviewecl: ??l-I - z L/ - C'2
Name Date
G:/FORMS1Buiiding Permit Applicatlan
e ,
Use BLUE or BLACK Ink
1 For°Mee Use i
1
CityofEaaii ; Pen �4_3/
3s3o Pilot Knob Rid DEDEIyED � Permit Fee* •
p0S,4F1 I l ,Al
*"f-A011n NIN 55122 j Date Received: 6-S'f' -
'Phone:(651)675-5675 1
� p 51016 7 �
Fax(651)675.5694
fft- y I 1
meg.. I __
k _2017 RESIDENTIAL BUILDING PERMIT APPLICATION
® aIQ !2017:
Slte Address:3219 Black Oak Drive, Eagan MN 55121
o
Unit#:
Bill Cam bell
Name: .; .. . . P 6514545024
Phone:
Address/city zip: 3219 Black Oak Drive, Eagan MN 55121
;APPiicant`is: Owner X Contractor
Description of work: Re roofing
Construction Cost: 13,327.66 Multi-Family Building:(Yes /No X )
pally: Repair KingMike Holmes
}
Contac:
2524 East Hennepin Avecy. Minneapolis
- Mholmes@myrepairking.com
zip:55413 Phone: if 3- ail:
EC 7`82-etati
Lead Certificate ft.
R1194201500320
po fl = ` ce tificretIon;please explain why:
(7-417V,f-; ISILAFJEA ONLY IF CONSTRUCTING A NEW BUILDING
e PEegan
issued a permit for a similar plan based on a master plan?
o r F ofmaster plan:
Nh Phone:
Phone:
Phone:
rY,r( ..y :7 r�
- .. !.� 1;.� (� �1i
651)454.0002 for protection against underground utility damage. Call 48 hours
:IA, >-•.• .1. - - - -
tt • t the work will be in conformance with the ordinances and codes of the City of
a:permit, and-work is not to start without a permit;that the work will be in
,, $ =11`r and approval of plans.
14Innesota State Building t o ., corn••feted within 180
,.. Mfr,;!,
gna are
Page 1 of 3
i :
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA157690
Date Issued:09/04/2019
Permit Category:ePermit
Site Address: 3219 Black Oak Dr
Lot:3 Block: 1 Addition: Orchard Heights
PID:10-54500-01-030
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 5,000.00
Fee Summary:BL - Base Fee $5K $118.00 0801.4085
Surcharge - Based on Valuation $5K $2.50 9001.2195
$120.50 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 -
William J Campbell
3219 Black Oak Dr
Eagan MN 55123
Renewal Andersen
1920 County Road C West
Roseville MN 55113
(651) 264-4777
Applicant/Permitee: Signature Issued By: Signature