3222 Black Oak DrAddress 3222 Black oak Dr Zip 5512 1
Lot I 1 $lk 1 Sub o r c n a r d f1 e i g h t_.y_
THESE ITEMS WERE J WERE N4T CQMPLETB AT THE TIME OF THE FINAL INSPECTION.
Date: Yes No Inspeetor:
Final grade (G" from siding)
Permanent steps (garage)
Fermanent steps (main eatry)
Permanent driveway
Permanent gas
Sod/Seeded grass ' ?{p ? j ? ?J?• ?? ?a #??j?
TraiVcurb damage
Porch
Basemcnt finish
Deck ioa&t- I S ?.
Piease verify with the builder the removal of roof €est caps from the plumhing system and the shut-off of water supply to
the outside lawn €aucet before freeze potential exists.
C.ontact engineering division at 681-4645 befoee wor3cing in right-of-way or insEalling underground sgrinkler system. ?
Whete - City Copy Yeliow - Resident Capy Pink - Contractor Copy
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
651-681-4675
New Construction Reauirements
• 3 registered sfte surveys showirg sq. 8. of lot, sq. ft. of house; and all roofed a(eas
(20% maximum lot coverage allowed)
• 2 copies o( plan showing beam & window s¢es; poured found design, etc.)
• 1 set of Energy Calculations
. 3 copies of Tree PreservaGon Plan ii lot platted after 7l1193
• Rim Joist Detail Options selection sheet (bldgs with 3 or less units)
RemodellReoair Reauirements ?1_ (? }-
. 2 copies of plan `???
. 1 set of Energy CalculaGons for heated addNions .?'>'
. 1 site survey for exterior additions & decks
. Indicate i( home served by septic system for additions
DATE 'Y/10/0 VALUATION
JOB SITE ADDRESS ?e?o?o? ?[?rc?? ?o? ?!?'?•?..? !?"-??c%?J -v?? ? o? L
IF MULTI-FAMILY BUILDING. HOW MANY UNITS?
PROPERTY
TYPE OF WORK gg&CAed C1tClC L?fI? S&riR'S FIREPLACE(S) _ 0_ 1_ 2
APPLIGANT ??ILa M ?l?rti PHONE#69-3415IdQ3
-.?
ADDRESS oZ &Otk gu.tJ ZIP CODE v-f?Io2 ?
PAGER # R/'Ifj CELL PHONE # ,411A FAX #
NIEV RESIDENTIAL BUILDING ONLY - FILL OUT COII
Energy Code Category _ MINNESOTA RULES 7670 CATEGOR
(check one) - Residential Ventilation Category 1 Worksheet
- Energy Envelope Calculations Submitted
Plumbing Contractor:
Plumbing System Includes:
Mechanical Contractor: _
Mechanical System Includes:
Sewer/Water Contractor.
_ MINNESOTA RULES 7672
- New Energy Code Worksheet Submitted
Phone #:
Water Softener Lawn Sprinkler
Watcr Heater No. of R.I. Baths
No. of Baths ?
Phone #
Air Conditioning
Heat Recovery Systein
Phone #
All above information must be submitted prior to processing of application.
I hereby acknowledge that I have read this application, state that the information is correct, d agree to comply
with all applicable State of Minnesota Statutes and City of Eagan Ordinan
Signature of Appllcant
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 2002
IT ? ,
r
Y O 12002
Fee: $90.00
Fee: $70.OU
OFFICE USE ONLY
, - . ,
? 01 Foundation O 07 05-plex ? 13 16-plex 0 20 Pool ? 30 Accessory Bidg
0 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
0 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.) 0 33 Ext. Alt - SF
? 04 02-plex O 10 08-plex K18 Deck ? 23 Porch (screened) ? 36 Multi
O 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
)< 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Aiteration ? 37 Demolish (Bldg)" 0 43 Reroof ? 46 Windows/Doors
? 34 Replacement *Demolition (Entire Bldg only) - Give PCA handout to applicant
Valuation -10 OX20 Occupancy 4d, MC/ES System
Census Code Zoning • City Water --
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const W idth
REQUIRED INSPECTIONS
_ Footings (new bldg) FinaUC.O.
;,C Footings (deck) ? FinaUNo C.O. .
7
_ Footings (addition) _ Plumbing
Foundation HVAC
Drain Tile Other -
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests _ Final
_ Framing _ Siding Stucco Stone
_ Fireplace _ R.I. _ Air Test _ Final Windows (new/replacement)
_ Insulation _
_ Retaining Wall
Approved By JE -Z, , Building Inspector
Base FPe
Surcharge f '??
Plan Review ? ?? ?"'?' ??r ,
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
? C(ER TIFICtA TE OF SUR VEY
G ON YEA HOMES
Bohlen
Surveying & Engineering
' 31462 FoFoge Avenue 4819 123rd Street W.
Northfiek. MN 55057 Savage. AN 55378
Prwm (so?> aas-nss B E Phonw(6t2) 885-9212
F? (so7) sas-ns9 F= (612) 895-9259
?
r
? °°?.,.^ ? •• = 30'
3w 51.or Es Zr,i TKC S AREA
_..:_...;'-..:; :;:•?r'7'.;T.y.-:,-nj?.--,- ? ' fXCEED 3:1 A RET?trt'L?C.
A s PER Ttke GRK0 7.9G. P iA K.
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? - - AINAGE AND U?1l.ITY
? EASEMENT
t c?.&TOP PIEm; R7 (I +/-
ns s9exo Me
S 89°56' 35" W 130.00
LOT AREA = 13187 SQ FT
!"?,ac??=Efl AREta = 2009 ?.F
PROPEtrr oESCFdPnoN
LOT 11, BLOCK 1, ORCFIARD FEIGHTS ADDITION.
C1T'f OF EAGAN. DAKOTA COUNTY, AiINNESOTA.
AODRESS
3222 BLACK OAK COURT
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25.00
PROPOSED GARAGE FLOOR ELEV =899.2
PROPOSED TOP OF BLOCK ELEV.=900.2
PROPOSao ensEMENr FLooR ELEv.=ss 1Z
0 DENOTES SERVICE LOCATION
- DENOTES PROPOSED DRAINAGE
OOOXO pENOTES PROPOSED ELEVATION
OOOXO DENOTES E)(ISTING ELEVATI4M
? DENOrES w000 HuB
O OENOTES 1RON PIPE MONUMENT
I HEREBY CERTIFY THAT THIS SURVEY WAS PREPARED BY ME OR UNDER
MY DIRECT SUPERVISION AND THAT I AM A DULY REGISITERED LAND
SURVEYOR UNDER THE LAWS OF THE STATE F MlNNESaTA.
. DATE• 12-13-00 ? .r .. Z, - t: f_?
REV15ED: 12-28-00 LEROY . BOHLEN, LAND SURVEYOR
MINNESOTA LICENSE NO. 10795?
?? 3SU7 he N 89°5?2?55,• E - 1
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04 a9W
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PERMIT # RECEIPT DATE:
WISIDUTIAL PLUbI$IN6? PERM1T APPLICATION
crrYo? ?GAN
s$so PaoT KxoB ftn
EA6A1V, MN 55122
651-6$1-4675
Please complete for: ? single family dwellings
D townhomes and condos when permits are required for each unit
? backflow preventer for irrigation system
SITEADDRESS: ,!?21 ? v??, & L
OWNER NAME: : TELEPHONE #:
? • ' (AREA CODE)
INSTALLER NAME: belt- TELEP ONE #:
STREET ADDRESS: 0Z/, ? ?LL GL/.C . -?/ d? , (AREA CODE)
CITY: )9?"& AIA?7_4? STATE: ZIP:
Place a?check mark next to the uermit work rine
New residential dwelling unif under construction and not owner/occupied $ 90.00
Add-on, modification or alteration to existin dwelling unit, including: $ 50.00
• abandonment of septic system
• new installationlrepair/rebuild of RPZ
• lawn irrigation system
• water turnaround
Nature of work:
_ Septic Svstem, new/refurbished - . $ 225.00.
• includes County & Consulting Inspector fees
• requires MPC license
State Surcharge $ .50
Total $?
Reminder: Be sure to schedule inspections of alterations, i.e. water heaters, water softeners, etc.
i ble City of Eagan ordinances.
I hereby acknowledge that I have read this application, state that the information is correc d agree to comply with all
ap'
It is the applicant's responsibility to notify the property owner that the City of Eagan su es no liability for any dama caused by the City during its
normal operational and maintenance activities to the facilities constructed under this rm' within City pro "ght- -way/easement.
SIGNATURE OF RMI EE
Updated 1/01
CITY USE ONLY
PERMIT #: RECEIPT DATE:
REsiDEIrrtAL MECHAvIcAL PEftMi°c APPUcATIaN
C1TY O? ?CiAN
3$30 PILOT KNO$ RD
EA6AN MN 55122
651-e$1-4675
Please cornplete for: ? single family dweilings
townhomes and condos when permits are required for each unit
Date: n'ot .1I1 / 0 I 4.
SITE ADDRESS: Ja aa 814PA aaK1111j`R ( ( l
OWNER NAME: ?0hGL. W f'1'125; TELEPHONE#: (a 1a, 3-77- d lq I
taREa caoEy
INSTALLER NAME: _Wohlers Southside Htg. & AIC, Inc.
. 6350 West 146th Street, Suite ldfi
STREET ADORESS: Apple Valley, MN 55124
CITY:
STATE:
Dlm- m e-lins4 ?sv4 M6Y* t'A tlfn narenit wnYk fvBA
ZlP:
X New residential dwelling unit under constructionand not owner/occupied $ 70.00
Add-on, modification or alteration to existin dwelling unit $ 50.00
• furnace replacement
• air exchanger
• air conditioner
• other
iVature of work:
State Surchar e $ •50
Total
Reminder: Call for inspections.
?? )? - 1.(1
S[GNATURE OF FERMI"FTEE
TELEPHQNE 17 5 a k13 1- 70,941
(AREA CODE)
Updated 1101
LOT: BL CK: H `.-l
SUBD./P.I.D #:
•?? o-o 11 Q r ch at d f/?? hfr
?
? ?BUILDIHG PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
651
' 9 6-4675
... ?
New Construction Reauirements
? 3 registered slte surveys showing sq. ff. of lot, sq. ff. of house
and all roofed areas (20% maximum lot covera4e allowed)
;- 2 copies of plans (show beam & window sizes; poured fnd. design; etc.)
? 1 set of energy calculations
? 3 copies of tree preservation plan if lot platfed after 7/1/93
? Rim Jo1st Detafl Opti s selectlon sheet (buildinqs wRh 3 or less units)
?
Name:
La First
- i ,
DATE: I Z I CONSTRUCTION COST:
2 oe L/
DESCRIPTION OF WORK: J, If muffl-family bldg., how many units?
STREET ADDRESS: <LJ ? G
PROPERTY
OWNER
CONTRACTOR
ARCHITECT/
ENGINEER
Street
City
le
Remodel/Repair Reauirements
2 copies of plan
1 set of energy cclculotions for heated additions
t site survey for exterlor addiHons & decks
Phone #: l?L- -37 ?v v/ l ?
?6 ??-
State: _ Zip:
Company: Phone #: J??
'4)4W-'v
(area code)
Street Address: License # 4?
City State:/giv Zip:
Ls
Company: s?/`? O (f 463e.L??' q Name: ?0
Telephone #: (? )
?Ds r 8 7 Registration #:
SNeet Address:
City State: 14 Zip: ?
Sewerlwater licensed olumber (if installing sewedwater)? ?XCaYa 4?hQ jhV - Phone #: ?` 8 ,
I hereby acknowledge that I have read this application, stchWthat the information is correct, and agree to
comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
r
Signature of Applicant:
OFFICE USE ONLY
? v LS
Certificates of Survey Received Yes No ?EC 1?????
Tree Preservation Plan Received Yes No Not Required t f
gy? 1-?m
OFFICE USE ONLY
O 01 Foundation ? 07 05-piex O 13 16-plex ? 20 Pool [3 30 AccessoryBidg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
O 03 01 of _ plex ? 09 07-plex ? 17 Garage 0 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multi
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-piex O 12 12-plex Plbg_Y or _ N ? 25 Misceilaneous
y 31 New ? 35 Int Improvement 0 42 Demolish (Foundation) ? 45 Fire Repair
? 32 Addition O 36 Move Bidg. ? 43 Reroof ? 46 Windows/Doors
? 33 Alteration ? 37 Demolish (Bldg)* ? 44 Siding
? 34 Replacement O 38 Demolish (Interior)
* Demolition (Entire Bldg only) permit - Give PCA handout to applicant
VALUATION Occupancy MC/ES System
Census Code ? Zoning City Water
SAC Units Stories _ 2- Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs / Length Fire Sprinklered
Type of Const 5- -Z,) Width oZ ->
INSPECTIONS REQUIRED
? Footings: New Bldg ? Insulation _ Windows - new/replacement
_ Footings: Deck FinaUC.O. _ Siding
Footings: Addirion ? FinaUNo C.O. Stucco/Stone
?b Foundation Fireplace: _ r.i. _ air test _ final Roof: _ ice & water _ final
?j Framing Pool: _ ftgs _ air/gas tests _ fmal
APPROVALS
Planning Building Engineering Variance
- --- - ---- - --- - --- - ----- - - --- --- - --------- - --
Base Fee
Surcharge
Plan Review
MC/ES SAC
ciry sAc
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Park Dedication
Trails Dedication
l.icense Search
Copies
Other .
Total:
??a ? ?-sy =
760 x r6
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` CIER TIFICIA TE OF OUR VEY
G ON YEA HOMES
0
Bohlen
Surveying & Engineering
31462 Foliage Averwe 4819 123rd Strett W.
Piorthfield, I,NV 55057 Savage, AN 55378
Phone: [$07) 645-776$ B E Phane: (612) 895-9212
FaaG ($07) 645-7799 Fau: (B12) 895-9259
s
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?PROPOSED S ?
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i AINfAGE AND EIT'iL1TY ?
? ? o ? -..a?•?- EASEi4tENT
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S89°56' 35" VV 130.??0 S 89°4 7' 26 "? W
25.00
LOT AREA = 13187 SQ FT
PROPERTY DESCRPTiQIV
LOT 11, BLOCK #, f7RCHARD hEIGF9TS A00[710N,
CRY OF EAGA3V, DAK4TA COUNTY. LOMSOTA.
ADpRESS
3222 BI.RqC OAK COURT
PROPUSED GARAGE FLQOF2 ELEV. 899.2
PRQF'OSED TQP OF BLQCtC ELEV =900.2
PRQPOSED BASEMENT FLOOR ELEV.=$91.2
0 DENOTES SERVICE LOCATIONE
-al- t}ENQ7ES AR4POSED E?RAINAGE
OOaXD DENOTES PROPOSED ELEVA710N
{3aDX0 DENQTES EXISTIIVG ELEVATIUN
? pEIVOTES W04D N118
O DENOTES ERON PlPE MCNVUMENT
i HEREBY CERTiFY THAT TMIS SURVEY WAS PREPARED BY ME OR UNDER
MY DIREC7 SUPERVlSION AND THAT 1 AM A aULY REGISITERED LAND
SURVEYOR UNDER THE LAWS OF THE STATE F MINNESOTA.
DATE• 12-13-00 REVIsEp: 12-28-00 LEROY . BQHLEN. LAND SURVEYOR
M4NNESOTA LICENSE N0. 10795
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LOT SURVEY CHEC!{LISI' FOR RESIDENTIAL.
BUiLD1NG PERMITAPPLICATION
PROPERTY LEGAL: f e?Uwk-:6 ^ DATE 4F SURVEY:
IATEST REVISION:
DOCUMENY STANDARDS
.
.
.
,
.
L' CI D •
Vo a •
03" a a •
ca/? o •
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Registered Land Surveyor 5ignature and company
Building Permit Appiicant
Legal description
Address
Nortlh aaow and scale
House iype (rambler, walkout, split wlo, aplit entry, lookout, eta)
Directional drainage arrows with slnpelgradient %
Proposed/existing sewer and water sen+ices & invett elevation
Street name
Driveway
Lot Square Faotage
Lat Coverage
ELEVATIOAIS
E)dstinq
Sewer service (ar Praposed)
Praperty corners
Top of curb atthe driveway
Etewaftons of any existing adjacent homes
Adequate foating depth of structures due #o adjacent utility trenches
PfQflOS?
Garage floor
First floor
Lowest exposed elevaifon (walkautMrindaw)
Property comers
Front and resr of home at tlie taundation
PC?NDING AREA (if annficabiel
o 0/o • EasemeM line
a ra? ? • MWL
o r? ? • HWL
? M/ o • Pond # designadon
? V/ ? • Emergancy Overflow Efevation
0'?, a
? a
??
5Y/ a
r? a
?a
DIMENSIQNS
o • Lut qneslBeartngs & dimensicns
? • Right-ot way and street width (to back of curb)
a • Propased home dimensions induding arry praposed decks, ovefiangs greater than 2', porches, etc.
(i.e. all structures requiring permanerrtfoatings)
? •' Show all easements of record and any Ciry utilifies within those easements
? • Sethacks of proposed stucture and sitleyard seiback of adjacent existing structures
a • Retainina wall reauirement&. it anY
Reviewed:
Maroh 1998
CRA1Gf8LD'.aPfil4tT. FM
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA151500
Date Issued:08/28/2018
Permit Category:ePermit
Site Address: 3222 Black Oak Dr
Lot:11 Block: 1 Addition: Orchard Heights
PID:10-54500-01-110
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Does not include skylight(s)
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
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 -
William J Larson
3222 Black Oak Dr
Eagan MN 55121
(651) 365-1293
Shelter Construction Llc
7040 Lakeland Ave N
Brooklyn Park MN 55428
(612) 849-8082
Applicant/Permitee: Signature Issued By: Signature