3224 Black Oak DrAPPLIANCE
,.
PiRIFORIIPlANCE TEST
Lccate near the furnace manua!
LP -Gas Natural Gas
Job Address 6=tle-
Heating Contractor
el -T ,-
Name of Tester
Date
Percent Oz Percent CO
.
Percent COz
Sfacl?Temp
- ?<- e
Pressure ' 3• 5 C'.
s
White - City Copy Tag - Site Copy
Address 3224 Black Oak Dr
LOt
Blk
Zip 5512 1
THESE TTEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECTION.
Date: 7• , z Yes No Inspector: /ke 6e nCe-
Final gade (6" from siding)
Permanent steps (gatage) t/
Permanent steps (main entry)
Permanent driveway
Permanent gas ?
Sod/Seeded grass V-1
Trail/curb damage ?
Porch ?
Basement finish
Deck ?
Please verify with the builder the cemoval of roof test caps from the plumbing system and the shut-off of water supply to
the outside lawn faucet before freeze potential exists.
Contad eagineering division at 6814645 before working in right-of-way or installing underground sprinkler system.
SUb Bur Oak Hills 4th
White - City Capy Yellow - Resident Copy Pink - Contractor Copy w
2004 RESIDENTIAL BiTILDING PERNIIT APPLICATION
City Of Eagan
? 3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
98 a?
?
Near Construction Reauirements RemodellRepair Reauirements
3 registered site surveys showing sq. ft of bt sq. ft. of house; and all roofed areas 2 copies of plan
(20°k rnaximum lot coverage anowed) 1 set of Energy Calwiations for heated additions
2 copies of plan showing beam & window s¢es; pcwred found design, etc. 1 site survey for addi8ons & decks
1 set ot Energy Cakxrlations Addition - indfcate if on-slte septic system ?
3 cop'ies of Tree Preservation Plan 'rf lot platted aiter 711193
Rim Joist DehO Options selection sheet (bldgs with 3 or less units
Date Construction Cost
Site Address nit/Ste # ?`
Description of Work ,/??c?? • ? ?i?
Multi-Family Bldg _ Y? N , Fireplace(s) _ 0 2
Property Owner Telephone #
Contractor ? G p?^ 1?
Address City _ ?,C) 1 ?
State Zip Telephone #
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota. Rules 7670 Category 1 _ Minnesota Rules 7672
Energy Code Category
• Residential Ventiiation Category 1 Worksheet • New Energy Code Worksheet
(4 submission type) Submitted Submitted
• Energy Enveiope Calculations Submitted
Have you previously constructed a building in Eagan with a similar pian2
fee applies.
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
_ Y _ N If so, 25% plan review
D
U pqoa,#
. ?
?hone # ( ??O
r
3is complete and accurate;
I hereby apply for a Residential Building Permit and acknowledge that the inform
that the work will be in conformance with the ordinances and codes of the City of agan 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.
.---? >
Applicant's Printed Name A cant's Signature
OFFICE USE ONLY
Sub Types
j
? 01 Foundation ? 07 05-piex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Muld
? 03 01 of _ plex O 09 07-plex 0 17 Garage O 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex >( 18 Deck ? 23 Porch (screen/gazebo) O 36 Multi Misc.
? 05 03-plex ? 11 10-piex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex O 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
Work Types
? 31 New ?
32 Addition ?
?? 33 Alteration ?
0 34 Replacement
Valuation
Census Code SAC Units
# of Units
# of Bldgs
Type of Const
Footings (new bldg)
? Footings (deck)
_ Footings (addition)
Foundation
Drain Tile
Roof Ice & Water
_ Framing
_ Fireplace _ R.I. _ Air Test _ Final
Insulation
Approved By:
35 Int Improvement ? 38 Demolish Interior 0 44 Siding
36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
37 Demolish Building* ? 43 Reroof ? 46 Windows/Doors
*Demolition (Entire Bldg) - Give PCA handout to applicant
44. MCES System
Occupancy s °U
Zoning City Water
Stories Booster Pump
Sq. Ft. PRV
Length Fire Sprinklered
W idth
REQUIRED INSPECTIONS
FinaUC.O.
7X FinaUNo C.O.
_ Plumbi.ng
HVAC
Other
_ Pool _ Ftgs _ Air/Gas Tests Fina.l
_ Siding _ Stucco _ Stone _ Brick
_ Windows
_ Retaining Wall
Final
Building Inspector
Base Fee
Surcharge
Plan Review ?
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies 40,.
Other
Total ,
APR-29-2064 14:24 SAM HERTOGS & ASSOCIATES
P.02
?C'A TE OF SUR VEY
. C
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? cra OON YEA HaMES
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Bohlen ?,w
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EAGAN 31462 F? `a'? ? ?g ?
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REVlEWIE B E :?.
Fom 4952 i eas-az,z -, ,..t:.,
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Fa?c ( ? »645-7789 52) 883-9?S9
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BUtLDENG 11VSPECIi?#'?
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1• 48" E 1Zf=
AODRESS
3224 BLACK OAK COURT AREA HOUSE AREA ?2019 0O6SSQ FT EpSTMG kIQUSE
COVERAGE - 15.9%
PROPER7Y DESCRtPTfON
Lo-r BLOCX
4TH GYY 1OF EAGNV,1. DAS{COT ACOUNTY, Mlt??tON.
PROP05ED 6ARAGE FL.oOR ELEV.- 898-5
PROPOSEO TOP OF BIOCK ELEV = 89$-8
PROP05ED BASENENT fL00R EL£V.= $89.8
? DEN07ES PROPOSED EIEVATfON?EC
p0pX0 DENOTE5 EXISTING ELEYATION
p DENOTES W04Q HllB
°* ?r?s SEQRNVI? LOCA ON?T
i HEf2EBY CERTIFY THAT TH1S SURVEY WAS PREPAFtED BY ME OR 11N0ER DULY SURV?EYOR Ut E321 THEN? YVS OF' THE AS TE OF MSpTA?D LAND
DATE: ?-tq"'a2 ?Y
M1N ESOTABQKENSE?NO?. 0795 RVEYOR
fILENAME: G47-9-01
1 " = 3a'
y3t0c,l_ ?ESIDiHTIiL? '? P ? ?s? o?- ? a? a . 5 ?
PERMIT APPLICATION
cITV oF eacaN Ym
3830 PILOT KNOB RD - 55122
651-651•4675
C)? .?
New Construction ReouinnMMe Roaulnmew
• 3 ragistered site swveYs sNorN sq. R. of lot, sq. R of house; and d • 2 copies of plan ?
(20% rnaxMum lot coverage aMowea) . 1 set of Emgy caWaeons for neaEed add%on?
. 2 copies of plan shawing beam & window sizes; poured found design, etc.) . 1 site swvey for exterbr eddilbns & decks
. 1 aet of Energy Calculatione • kdCate I horrre seived by septic system for addqion,s
. 3 oopies of Tree Preservation Plart if lot plaiA alEer 711193
. Rim Jast DeW Opdons selection Wieet (bldgs with 3 a less unfts)
DATE I I S 4? v
JOB SITE ADDRESS
IF MULTI-FAMILY BUILDI
PROPERTY OWNER_,
TYPE OF WORK_.?
APPLICANT
ADDRESS ?
PAGER #
CELL PHONE # (pIz ?D FAX #
i?w RESIDENTIAL BUILDING ONLY - FILL OUT COMPLETELY
Energy Code Category _ NIINNESOTA RULES 7670 CATEGORY 1
(check one) - Residenfial Ventilation Category 1 Woiicsheet Submitted
- Energy Envelope Calculaations Submitted
MINNESOTA RULES 7672
- New Energy Code Worksheet Submitted
Plumbing Coritractor U !n Phone ik:
Plumbing System Includes: _ Water Softener _ Lawn Sprinkler Fee: $90.00
Water Heater No. of R.I. Baths
_ No. of aths
?
Mechanical Co?ractor ? m (G? ? x1eq) Phone #
Mechanical System Includes: _ Air Conditioning Fee: $70.00
_ Heat Recovery System
Sewer/Water Gonhactor.
I
Phcno # / (S? ?C? ? ?U <
All above information must be submitted prior to proc:essing of application. ?
I hereby acknowledge that I have read this appiication, state that the information is correGt, and agree to compiy
with all applicable State of Minnesota Statutes and Ciiy of Eagan Ordinances. ?
?
Stgnature of Applicant
Certificates of Survey Received -? Tree Preservation Plan ived _ Not Required- `??
Updated 2002
? VAL?IATION ?
HOW MANY
J! Gt ( ( FIREPLACE(S) 0 x 1_ 2
?
PNONE# - -
-
?JS
DP C?DE
/??
g W7 -377-
OFFICE USE ONLY
O 01 Foundation
,g 02 SF Dwelling
13 03 01 of _ plex
? 04 02-plex
0 05 03-plex
? 06 04-piex
O 07 05-plex ? 13 16-plex
D 08 06-plex 0 16 Fireplace
0 09 07-plex ? 17 Garage
O 10 08-plex 0 18 Qeck
? 11 10-plex ? 19 Lower Level
0 12 12-plex Plbg_Y or _ N
0 20 Pool
0 27 Porch (3-sea.)
0 22 Porch/Addn. (4sea.)
0 23 Porch (scxeened)
0 24 Storm Damage
? 25 Miscellaneous
..,
? 30 Accessory Bldg
? 31 Ext. Alt - Multi
O 33 Ext. AR - SF
? 36 Multi
>? 31 New 0 35 Int Improvement ? 38 Demolish (Interior) 0 44 Siding
? 32 Addi6on O 36 Move Bldg. 0 42 Demolish (Foundation) 0 45 Fire Repair
0 33 Alteration ? 37 Demolish (Bldg)• ? 43 Reroof ? 46 WindowslDoors
0 34 Replacement "Demolition (Entire Bldg only) - Give PCA handout to appUcarrt
Valuation D?o ? Occupancy g -3 MC/ES System
Census Code o / Zoning "/ City Water
SAC Units _0/ Stories Booster Pump
Nbr. of Units O/ Sq. Ft PRV •
Nbr. of Bldgs Q'/ Length ?$ Fire Sprinklered
Type of Const 7 Width
REQUIRED
? Footings (new bldg) Z FinaUC.O.
_ Footings (deck) ' FinaUNo C.O.
Footings (addition) _ Plumbing
? Foundation HVAC
Drain Tile
Roof _ Ice & Water _ Final Other
Framing _
_ Pool _ Ftgs _ Air/Gas Tests Final
? Fireplace _ R.I. _ Air Test _ Final _ Siding Stucco Stone !
? Insulation _ Windows (new/replacement)
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit 8 Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Totai
Approved By
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Gati? f,` ( y81?r x 16 ?
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Surveying & Engineering
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EAGA' •
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ADDRESS
3224 BLACK OAK COURT
LOT AREA = 12000 SQ FT
HOUSE AREA = 1908 SQ FT
COVERAGE = 15.9%
1' 48" E 125.00
EXISTqVG HOUSE
PROPERTY DESCRIPTION
LOT 1, BLOCK 1, BUR OAK HILLS 4TH AODITION,
CITY OF EA6AN, DAKOTA COUNTY, MINNESOTA.
5
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887x7
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PROPOSED GARAGE FLOOR ELEV.= 898.5
PROPOSED TOP OF BLOCK ELEV.= 898.8
PROPOSED BASEMENT FLOOR ELEV.= 889.8
--i- DENOTES PROPOSED DRAINAGE DIREC'
DENOTES PROPOSED ELEVATION
OOOXO DENOTES EXISTING ELEVATION
O DENOTES WOOD HUB
O DENOTES IRON PIPE MONUMENT
o DENOTES SERViCE LOCATION
1 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 OF MINNESOTA.
?"? . ?
DATE• 1-14-02 •-;Y:_ _
61?aOY . BOHLEN, LAND SURVEYOR
MINNESOTA LICENSE N0. 10795
FILENAME: G47-9-UZ
1 " = 30'
?
REGEIVEa JAN 1 8 2002
EAuArv
ENGINEERfNG DEPAKTMENT
s.
LC37 SURVEY GHECKLIST FOR RESIDENTIAL
BUILDING PERMIT APPLICATiON
?
PROPERTY L.EGAL: L D'?` I La C=1< I 'n /- [//' k- A,/k ?-f?.
, DATE gF SURVEY:
LATEST REVISIOW:
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DOCUMENT STANL7ARDS
d
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4
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? o • Registered Land Surveyor sgnature and aompany
q
0 ? + Building PermitApplicant
? ?
? Li • legal descrip#ion
A
[
? o • ddress
C?/ ? ? • North arrow and scale
tV ?
? CI ? • Hause type (ramb3er, walkout, split wlo, spUt entry, Iookout, etc.)
Di
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? •
• rrec
nage arrows w
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dra
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gra
ent
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P
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? ng sewer an
eva
on
ropose
ex
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wa
er serv
es
nver
e
[3
o ? • Street name
? 0 d • Driveway
?Y. o o • Lot Square Footage
/ ? o • Lot Coverage
f? o ? • Benchmark
ELEVATIONS
Exisfina
?? • Sewer service (or Proposed)
r? ? o • Property comers
f? ? a • Tap of curb at the driveway and property fine exterrsians
qA ?? • Elevalions of eny exastirtg adjacent homes
?? ? • Adequate footing depth of structures due to adjaceni utlity trenches
? W o • Watennaps (pond, stream, etc.)
Prooosed
y ? ? • Garage flaor
t? ? ? • First fbor
? ? • Lawest exposed elevation (waqcout(window)
? V ? • Property eamers
a/? o • Front arsd rear of home at the fOUndation
PONnING AREA iif aopkablel
E?ment rme
? ? o • NwL
D W ? • HWL
? ff'/ ? + Pond # designation
? Q 0 + Emergency Oves'flow Elevation
DIMENSIONS
G(o D * Lot I'm$s/8eadngs & dimensions
qt ? C1 • Rijht-af-way and str+W width (to back of curb)
?? ? • Pruposed home dirrrensions ancluding any proposed decks, overhangs greater than 2', parches, etc.
1 (i.e. alt strucfures requiring pe?manent foot?gs)
e( ? 0 • Show all easeanents of record and any Cfty utIities wiihin thase easements
GY ?] 11 • Setbacks of propased structure and sideyard setbacc of adjacent extisting structures
qf o? • Retaining waH requirements, If any
Reviewed:
Name Date
JAH- 16-2002 WED 10;20 AM GONYEA COMPANY FAX NO, 612 377 0194 P. 02/04
FRCJM .: . FOX-i _DRAFT tNG PHOhIE N0. : 551 8940016 Jan. 15 2002 02 ? p7PM P2
r?Ncheck coMPLiANcE xEPoRT
Mirulesota =xergy Code
MNCheCk 50ftware Versivn 3.0
COtJNTY: Waehiagto»
STATB: Miruiesota
ZONE: 2
CONSTRUCTiO14 xXFE: 8ingl.e Fatriiiy
DATBs 1-15-2002
DATE OF pLANS; 1/8/02
PR4JEGT xNFORMATION:
3224 81ack Oak Drive
COMP,ANY INFORMATION:
Gcriyea Home$
corapL=ArrCR: PA53ES
Required UA a 501
'Your Home = 498
0.6% BeLCer Than Cod,e
Pezroit
Checke by/Date
Are3 or C*vity Coxrt. Glazing/Door
Berimetier R-Val,ue R-Value U-Value
--_-----_ _ _ _---^-__.... -sI R -..----..-
CEYLINaS: XaimCd Truss --...--.. _? ? ? ? ?
1214 ?? ---_ ---
44.0 __..-----
010 -r--r..-----?..
WALL9: Wood Frame, 1611 O.C. 329 19.0 2.0
WALLS: Woed Fra,me, 161t O.C. 1458 19.4 2.0
WALLS: Wovd Frame. 16" O.C. 3.223 1910 2.0
BsMT: COriC. 8.$' bt/8.2' bg/S•8' inssul 960 3.1.0 0.0
aLA2ING: Wiitdows or DQOrs, Above Grade 106 0.350
GLAZTNG: Windowrs or Doore, Above Gradc 262 0.350
GLAxING: Wiitdowo or poor$, Above Grade 273 0.350
DOOIZa 40 0.350
FLOORS: over Outside Air 60 30.0 0.0
FLOOR9 : 4ver Uxicondit.ioned Space 172 30.0 0.0
_- `r r-w.._ _----?__..----..---.. --.. ___ r------rr -_--..--r??---.. -----? ?w......???^__...
cotKpLIANCS 3TATDMqT: The propoved buildi.ng BCSign described hr-re is
coasiatant with the bu3ldir,g plans, s8eaifications, and oChex calCuYatiions
subcaittad with the p it appl.ication. The progosed building has been
designed to meet t equir m ts of the MiXlnQaota Znergy Coc1e.
Suildex/Des?gri?r Date? ??
JAN -16-2002 WED 10:20 AM GONYEA COMPANY FAX N0, 612 377 0194 P. 03/04
, FRGM : FpX-1_DRAFTING PHUIE No• s 651 8940016 Jan. 15 2002 412: 08Pf'1 P4
prior to fxaming iaapectioU are seaxed
ZXTBRYOR AIR aARRISR
- a].1 fire atops itrs air sealed
- pipea, ducts, wires, equipment and flues and chimneys tihroagh the inte
air barrier are aealed
?a sealed contfnuoua iriterioY air barriex is installed on the warm side
the buil"rig envelope at aeiiings, watlls, a?ad floor xicn josst areas*
- air barrier behiad tub and shower is sealed and protected
- reaeRSed 13ght £ixtures are sealed
ENV8L08E ZNSC7LATION
- baeement inaulation R-5 minimum
wind wash barrier on wall zoparatiag house and garage is ssaeled
? laose f311 insulatioa io prevente?d frpm eritera.ng the eav'es
- insulation vn skylight phafts and wails exposed in attics ig supported
on the unconditiioned side
ATTIC iNAVVIATYON
- atitic aCCe9s panel in8alated to R-3s £ox ceiling panol and tt-19 for
walY panel,
- attia card attaahed to frarning near acceao opariing
- notif icatian of attiC R-value a?nd date of installation pogCed ncar
permit inspection cara
ThSp is amwmmary only. OCher requi,remente may appl.y, see the Minaseota
Znergy Code. Queati,ong? Caii tho Department of pub],ic SeYVicB Infoxmat3on
Center at 651-296-5175 or 1-800-657-3710.
JAN-16-2002 WED 10:21 AM GONYEA COMPANY FAX N0. 612 377 0194 P. 04/04
MM : FOK-i_DRAF7ING PHONE N0. : 651 8940016 Jan. 15 20W 02:07PM P3
Mincze8otia Energy Code
mNcheck 5oftwarc Versioa 3,0
DATE: 1-15-2002
PLAN REVZEW AND IN9FECTION IS3UE3
7'his list of items may be belpful £or P2an Reviewers and Suilding rnspector
use as a guide for enforcing the Minnesota Energy Code. The itemO ap 1y to
C3roup R, Aivis?ion 3 Occupancieo, one- anc two-family raaidez?tia1 dwel?ings.
The iteMa marked with * apply only to detached one- and two-family
seoidential dwell istgs .
PuA,N REVIBW I99t789
FOUNDATION YNBULATION
- foundatian wall insulatian R-S minimum
- foundaticn invulation extende from top of wall down to top of tihe footin
- extOrior foundation inaulation is cvvexcd by b protectiiva coatiag fina,sb
COWCRETE SLAB OR UNDBR-SLAB x1+1SLXATION
slab an grade perimeter insulatiori at-5 miriimum
- elab fmaulatian extends from top af alab to desxgn trost lina or top ot
faoting
- floors over uaheated apaae R-30 miaimum
WINDOWS / DOORS f 3YCYLJfGHTS
- aVtrage V-val.ue io 0.37 msximum
foundatioa windows)
window v-vaLlue coaeistent with
- window and doox area COri5iotenC
for windows and giaes doora (excludes
buildi.ng AlE?n and MNcheck Report
with buxld3ng pian and MUeheck Rcport
MzCFiANICAL VWTILA'I,'xON ISSL}F-l3
- residential meehanical ventilatfon aystem providep adequate ventilation
per code requiroment9*
- ftirnaae efficienay is consisteat with raNCheck or 1yu31aing dedign plan
- protsction aqainst exveaeive depressu;rxzation is installed pex code
requirementa}
ExvELoaE INsULATIaN FoR PY.AN REvi$w
- 3ut4rior ba4ement inaulation R-5 rninintum (xf no exteri,ox insulmtion)
- ceilings with attiaa R-38 ox conaistent with buildi.ng 81an and MNchock
Repvrt
? wal1 framing and insulatioa 1QVe1 is cvnsistent with buildirtg dea3gn
ari$ MeheCk Report
INSPEGTION TSSUEB
CONCEALED INBULATTON
FRAMING X1ND SHRATHING
- wind waah barrier iustalled at attic edge
- exterior aaii corners framed eo that insulation can ba irigtalled after
extexior sheathing ie ineCalled
- intersectioz?s of intezivr partitioa wa?7.s axid exterio? wa?.?a aa?e ?xa??
that iasula?tzon cart be installed between the paztition and exteriox
aheathing afrer extcriox shcsthing is in8talled
- gape betweea framing leen than vne-h$lf ineh are cXimiriated by seaurin
framing together or are inBUlated at the ticne of assembl,y
, all penetraGions between co?iditiox?ed and unconditioned epaces made
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Use BLUE or BLACK Ink
I For Office UseI
Permit#: t tk+~3 1
City of Eat ~ 1 r 95
p~ 311~11b Permit Fee:
3830 Pilot Knob Road I f
Eagan MN 55122 I Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 1 Staff: I
V - - - - - - - - - - - - - - - J
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: ~ J L~-/ ACSU (AKA IA VF Unit
Name: ITIM AM Phone:
Resident/ Dk
,
0~~: ner ~ Address /City /Zip: &Z`1Z p &PLL ~K_r~(
I Applicant is: Owner ey- Contractor
Description of work:("
Type of Work 0,0
Construction Cost:, C~JU , Multi-Family Building: (Yes / No
Company: ►"I(,IV'IU-tu , J Contact:
\~~cl~~ ~U(-1
Contractor Address: 19 W 0_ COSE e UT. , X/ f'City: Alb l
-
State: /q/,u Zip: J SAS Phone: 269 ° SL IS " tP W~
License osl I I Lead Certificate NAT - 99lp ( 2 1
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 may be classified as non-public if you provide specific reasons that would permit the City to
de that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.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 pla
Exterior work authorized by a building permit issued in accordance with the Minneso State uil Co must be completed within 180
days of permit issuance.
x /
Applicant's Printed Name pp i n s Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA163880
Date Issued:09/15/2020
Permit Category:ePermit
Site Address: 3224 Black Oak Dr
Lot:1 Block: 1 Addition: Bur Oak Hills 4th
PID:10-15503-01-010
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: 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 -
Tang Truong
3224 Black Oak Dr
Eagan MN 55121
(651) 343-0038
Clear Choice Restoration
2722 Hwy. 694, Suite 100
St. Paul MN 55112
(612) 259-7177
Applicant/Permitee: Signature Issued By: Signature