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3255 Black Oak Dr
PERMIT City of Eagan Permit Type: Plumbing 3830 Pilot Knob Rd Permit Number: EA082606 Eagan, MN 55122 . Date Issued: 04/17/2008 (651) 675-5675~~~ EPermit Category: ePermit www.ci.eagan.mn.us lflflUl tflflLLL Site Address: 3255 Black Oak Dr Lot: 9 Block: 5 Addition: Bur Oak Hills PID 10-15500-090-05 Use Description: Sub Type: e - Fixtures Work Type: New Description: Basement Fixtures Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments: Eric Bruckmueller 3992 Pennsylvania Avenue Eagan, MN 55123 Fee Summary: PL - Permit Fee (miscellaneous) $50.00 0801.4087 Surcharge-Fixed $0.50 9001.2195 Total: $50.50 Contractor: - Applicant - Owner: Bruckmueller Plumbing Inc Brent F Turk 3992 Pennsylvania Ave 3255 Black Oak Dr Eagan MN 55123 Eagan MN 55121-2334 (651) 686-6696 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. Applicant/Permitee: Signature Issued By: Signature This request void 18 months from D 8576 Request Date Fire No. Rough-in Inspection Required. ❑Ready Now Will N0tify.lnsp -&11 ec es ❑No for When Ready r Licensed Electrical Contractor I hereby request inspection of above ❑ Owner electrical work installed at: Street Address. Box or Route No. City action No. Township Name or No. Range No. County -A Occupant (PRINT) Phone No. able r°u~~ o Power upplier Address Ca V e e Electrical Contractor (Company Name) Contractor's License No. T V\ e T k ck c-fv,; c cD `T 6 6 y- Marling Address (Contractor or Owner Making Instailation) c iz,- h u orized Signature IContra ctor wner Ma g Installation T- (1-93 Phune Number 6> _ MINNESOTA S TE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT Griggs-Midway Bldg. - Room N-191 BE ACCEPTED BY THE STATE BOARD 1821 University Ave.. St. Paul. MN 56104 UNLESS PROPER INSPECTION FEE IS Phone (612) 642-0800 ENCLOSED. REQUEST FOR ELECTRICAL INSPECTION EB-00001-06 1 See instructions for completing this.form on back of yellow copy. D Q 76 "X" Below Work Covered by This Request Add Rep. TyVA of Building Appliances Wired Equipment Wired • Home Range Temporary Service Duplex Water Heater Lighting Fixtures Apt. Building Dryer Electric Heating Commercial Bldg. Furnace Silo Unloader Industrial Bldg. Air Conditioner Bulk Milk Tank Farm Other (Specify) Oihcr ISVer.ifyl t er Specify Other 01her ompute Inspection Fee Below p Fee Service EntraneeSize h Fee Feeders/Subfeeders # Fee Circuits Q 0to200Amps 0to30Amps Oto30Aw s Above 200 Amps 31 to 100 Amps iD 31 to 100 Amps Swimming Pool Above 100_Amps Above 100^Amps Transformers Irrigation Booms 5- Partial, Other Fee Signs Special Inspection Remarks $~rsr~ TOTA U 10 Rough-in Date L I, the el ,OP16 7 Inspector, hereby Final certify that the above r. _01e_.. _ Date +1tspection has been I~p ? ptade. This request void 18 months from c I - CITY OF EAGON t- Permit No: 9173- 1830 ltd-27 ~ ~ PIIot4%;b Road Meter No: Size;__ P.O. Af21199 Reader No: Date. Eagan, MN 55121 ` . Owner. Rarstad Conym y Site Address: 3255-June c -Oak Trove L9 DS 1Y : bak -B ills Plumber. " ermtrsetilw Conn. Chg: 525. 00pd Zoning: Acct Dep: 15• 00pd. No. of Units: ~ 4. Permit Fee:. 30.0OP4 Surcharge: • 50pd 1 agree to comply with the City..of Eagan Tr. Plant 18{r• OOpd Ordinances. - 4 ' u Meter. 67_91)rd ' ,i MISC.: By WATER SERVICE PERMIT CITY OF EA N , IPermit No: 10322 Date: 10-2747 3830 Pilot,l i- b Road BAP No. 74598 Date: 6-12-87 P.O. Bmll199 Eagitn, MN 55121 J' Owner. Harstad connany . ; Site Address: 3255 ck Oak Drive L9 25 Burr Oak HiI:IA i- t Plumber F e C"4#. C=tratct3np z: MWCC. 525•t ODd Zoning- City Chg: IQO.OOpr~ No. of Units: t: Acct. Dep: 15. ®OPd 10Qflpd I agree to comply with the City of Eagan Permit Fee • .50 pd Ordinances./ Surcharge: P' Misc.: By - . t SEWER SERVICE PERMIT CASH RECEIPT • CITY OF EAGAN 3830 PILOT KNOB ROAD EAG) iV, MINNESOTA 55122 DATE 19 rY RECEIVED FROM ! AMOUNT $d) cr, f I d~ f & _DOLLARS +oo CASH ItYCHECK 44- FOR < FUND CODE AMOUNT S Thank You 74598 [1 - White-payers Copy . Yellow-Posting Copy . Pink-Flip Copy " BLDG. P`ERR}T N0. / 01-3210 Bldg. Permi C1 j1-3422 Plan Check , 01-3445 Surch./Adm. 01-3446 SAC/Adm. 01-2155 Surcharge 7,j 17-3860 Road Unit v -c, 20-2275 SAC 20-3865 Water Conn. 5 G v 20-3868 Water Trmt. c' 20-3716 Water Meter: 20-2252 Acct. Dep. 20-3713 Water Permit 20-3743 Sewer Permit 79-3866 Sewer Conn. o 11-3855 Park Ded. TOTAL 77-7~~T 77-777- 77, u CAS~t 1~E IPT h V ~ ITY F F t ~ ~J3 i n w 9 ; fXrPMrp" ;1~ IV, 4 AMOUNT r ©CASN ZCH*CX t Y ,,I ~ IIIY, 11 !S lyy ; FUND y t ~ i a•~S~ x j 104F, (MAN D Pilot K b Road, P.O. Box 21.198, Eagan, MN 46'1!9°1 PHONE: 454-8100 " BUILDING PERMIT Receipt To be used for ' Eat. Value Date £ ,19 Site A OFFICE U$E QNLY Lot I T Block Sec/Sub On Site Sewage,- o cupamw MWCC System Zoning Parcel Na On Site Well Type of Cvnst V ChyWater - (Actual) } Address w': 4 k i 1~`•; U City Phone Depth S.F. Total Name Footprint &F. Address APPROVALS BEES City Phone Assessments Permit water/Sewer - Surcharge W W Namie' Police Plan Review 1-W Address Fire SAC, City i uU . ,J E3 Engr. SAC, MWOC C z City ti~tnone ' Planner Water Conn. Council Water Maur __e . I hereby acknowledge that 1 have read this application and state Bldg. Off. Road Unit ii- .r - that the Information is correct and agree to comply with all applicable APC Treatment P1 State of Minnesota Statutes and City of Ewan Ondliances. Variance Parks Copies Signature of Permittee TOTAL: d A Building Permit is issued to: on the express oondition thN all work shall be done in accordance with all applicable State of Wnesota Statutes and CIW of Eagan OrdinancoW. i Building Official Permit No. Permit Holder Dab Telephone e Plu4bing H.V.AC. 9 Electric Fs - /zee 3 8 7 G~ ° Softener Inspection Date Insp. Comments Footings I Footings 11 Foundation Framing Roofing Rough Plb% Rough Htg. Isul Fireplace Final Htg. Z.) "/j G Final Pit)% Bldg. Final t Cert. Occ. Temp. LP Deck Ftg. - Deck Frmg. b Well f✓ 7/~~~ % Pr. Disp. auZL TO 0 911" PERMIT # - PLUMBING PERMIT, RECEIPT # 7 W CITY OF EAGAN 4f V_zt: 3830 PILOT KNOB ROAD, EAG MN 55121 DATE: CONTRACT PRI • & 0' PHONE 454-8100 1:1- 1 q -S '7 Site Address BLDG. E WORK DUMtPTION Lot Block Sec/Sub Res. New m Name N e _ Mult Add-on Addn r) .1Comm.. Repair c city 51 YA Phone 3'` Other _ FIXTURES TAL Name S a Water Closet - $3.00 , d U C Address Balch Tubs - $3.00 0 City Phone Lavatory - $3.00 / - J J Shower - $3.00 FEES -Kitohen Sink - $3.00 3 Urlhal/Bidet - $3.00 O'2] COMMAND FEE - 1% OF CONTRACT FEE Laundry Tray - $3.00 MINIMUM - RESIDENTIAL FEE _$10.00 Floor Drains - $1.50 MINIMUM - COMMAND FEE - 20.00 -7-W r Heater - $1.50 STATE SURCHARGE PER PERMIT - .50 - -Affil lpool - $300 _ (ADD $50 S/C IF PERMIT PRICE GOES -TG a,ss Pilling Outlets - $1.50 BEYOND $1,000.00) Sdttener - $5.00 Well - $10.00 f l 1. Private Disp. - $10.00 G' Rough Openings - $1.50 SIGNATURE OF PERMITTEE FEE; _ STATE S/Q GRAND TOTAL: 3 - D FOR: CITY OF EAGAN PERMIT # MECHANICAL PERMIT CITY OF EAGAN RECEIPT # 3830 PILOT KNOB ROAD, EAGA$I, MN 55122 DATE .CONTRACT PRICE: PHONE: 454-8100 ' Site Adli a7 a` S BLDG. TYPE WORKDESCRIPTION Lot y - Rinnk ec/Sub Res. New 0C ~-p fig Mult_ Ackl-an-. m Name Comm: Rer Address Other Phone -5 ^ y Name r9 J~9sj < 4 FEES 4 RES. HVAC 0-100 MBTU -$24.00 3 Address ADDITIONAL 50 M BTU - 6.00 p City w[ Lv10 GL tnn Phon fi ' 17 (RES. HVAC INCLUDES A/C ON NEW d- CONSTRUCTION) GAS OUTLETS (MINIMUM -1 PER PERMIT) - 1.50 EA.. TYPE OF WORK COMM/IND FEE - 1% OF CONTRACT FEE Forced Air 4r'M BTU / TOWNHOUSE & CONDOS RATE- ESP RATE APPLIES Boiler M BTU MINIMUM RESIDENTIAL FEE - ALL ADD-ON & . Unit Heater M BTU REMODELS - 12.00 Air Cond. r >C M BTU $ MINIMUM COMMERCIAL FEE. - 20.00 Vent CFM $ STATE SURCHARGE PER PERMIT .50 (ADD $.50 SIC IF PERMIT PRICE GOES Gas Piping Outlets # BEYOND $1,000 Other $ + FEE' S/C: SIGNATURE OR PERMITTEE TOTAL: I} FOR CITY OF EAGAN ..s _b _ . d....A~ .t y::J.Y.. ;i;... ___s.~...-...a'.i. r..3.i~ra..,Ye~a... _ . 1 a r= Par ` .may tea' ~6 mss: ~ r. } ~ ray' ~ M 'A 006h C4,-, AeCt Phi. (30 RIC StlfthMW ' of Eagan Masc. m ey WATER SERVICE PERMIT (Irruftratr of Orruvaury Citp of eagan %varb"ut of Waning jwvrtimt This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building Code certifying that at the time of issuance this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following. Use Clasfficatlon Bldg. flrnrit No. O-P-Cy Type Zoning District Type ConsL Owner of Building Address BmWmg Address locality Q Da. Building Official POST IN A CONSPICUOUS PLACE CITY OF EAGAN No 13 7 6 5 ` 3830 Pllot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHONE: 454-8100 BUILDING PERMIT Receipt # To be used for SF DWG/GAR Est. Value $122,000 Date JUNE 12 ,1987 Site Address 3255 BLACK OAK DR OFFICE USE ONLY R3 Lot 9 Block 5 Sec/Sub. BUR OAK HILLS MOn Site WCC Systeme --K- Zoning R1 Parcel No. On Site Well _ Type of Const V City Water X (Actual) V Name HARSTAD COMPANIES (Allowable) W # of Stories z Address 2191 SILVER LAKE RD Length 56 c City NEW BRIGHTO one 636-3751 Depth 42 S.F. Total p Name SAME Footprint S.F. ua Address APPROVALS FEES I,-- City Phone Assessments _ Permit $ 569.50 Water/Sewer - Surcharge 61- 00 W W Name Police Plan Review 284- 75 n Address Fire SAC, City 1 On _ c10 Engr. - SAC, MWCC 52 5 0 a m City Phone Planner Water Conn. 525 0 Council _ Water Meter _ 7 0 1 hereby acknowledge that I have read this application and state Bldg. Off. Road Unit 305 nn0 that the information is correct and agree to complywith all appli ble APC - Treatment Pt i8(31.90 State of Minnesota Statutes a 9d City of n Or i riance - Parks Copies :;6 5 Signature of Permittee TOTAL $9,617r 5 A Building Permit is issued to. HARSTAD COI IES on the express condition that all work shall be done in accordance with all applic a State of Mi so~tes and City of Eagan Ordinances. Building Official I For 0fiice Ilse I ✓"o I I Permit e~ i Co I I Permit Fee: 3830 Pilot Knob Road U Eagan MN 55122 APR 1 6 2008 i Date Received: Phone: (651) 675-5675 Fax: (651) 675-5694 U 4. C ~ 1 Staff: i..-----------------J 2008 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 0.+ v Site Address: h"~ j~jjcu k-Ur~k , ~y~ ~ ~1Ctl~i~l .✓1rJ 5`_~ It Z 1 Tenant: /V/ I A Suite ti1A RESIDENT / OWNER Name: TA_V "Af_~A _ Phone: 612- - 6 7 0- 3 i 16 Address /CityJZip: LSS f'>j.,J--(%`~()r. t- C~01 !U .vi,~l • 55 12- Applicant is: owner Contractor TYPE OF WORK Description of work: Lcy L.i=- , :7j ~ Ttt uv.+n l ~S't-% = 7 J 1 - I hl T Multi-Family Building: (Yes 1 No ✓ ) Construction Cost: t~ C, 6 CONTRACTOR Name: License Address: City: State: Zip: Phone: Contact Person: COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING _ Minnesota Rules 7670 Catecory 1 _ Minnesota Rules 7672 Energy Code • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet Category Submitted Submitted (4 submission type) • Energy Envelope Calculations Submitted 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: MOTE: Plans`and sulppmVnig documents that you submit are considered to be public information. Portions of vide specific reasons that would permit the City to the information maybe classified as non-public if you pro conclude that the ate trade -secrets. 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. x 0 A k=i'J T TU fti V_ x 9-1_-J-L Applicant's Printed Name Applicant's Signature Page 1 of 3 DO NOT WRITE BELOW THIS LINE SUB TYPES ❑ Foundation ❑ 05-plex ❑ 16-plex ❑ Accessory Building ❑ Pool ❑ Single Family ❑ 06-plex ❑ Fireplace ❑ Porch (3-season) ❑ Ext. Alt. - Multi ❑ 01 of _ Plex ❑ 07-plex ❑ Garage ❑ Porch (4-season) ❑ Ext. Alt. - SF ❑ 02-Plex ❑ 08-plex ❑ Deck ❑ Porch (screen/gazebo/pergola) ❑ Multi Misc. ❑ 03-Plex ❑ 10-plex ,@( Lower Level ❑ Storm Damage ❑ 04-Plex ❑ 12-plex ❑ Miscellaneous WORK TYPES ❑ New ❑ Interior Improvement ❑ Siding ❑ Demolish Building's ❑ Addition ❑ Move Building ❑ Reroof ❑ Demolish Interior Alteration ❑ Fire Repair ❑ Windows ❑ Demolish Foundation ❑ Replacement ❑ Egress Window ❑ Water Damage Demolition (entire building) - give PCA handout to applicant DESCRIPTION: Valuation Occupancy,~2G MCES System - Plan Review Code Edition SAC Units (25% 100% Zoning City Water - Census Code b~3y Stories Booster Pump # of Units Square Feet PRV - # of Buildings Length Fire Sprinklers Type of Const._ Width REQUIRED INSPECTIONS Footings (new bldg) Sheetrock Footings (deck) Final/C.O. Footings (addition) Final/No C.O. Foundation HVAC Drain Tile Other: Roof: -Ice & Water -Final Pool: -Footings Air/Gas Tests -Final Framing Siding: -Stucco Lath -Stone Lath -Brick Fireplace:_R.I. Air Test -Final Windows Insulation Retaining Wall Reviewed By: , Building Inspector RESIDENTIAL FEES: Base Fee d Surcharge Plan Review ~A MCIES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Copies Total Page 2 of 3 w S-1 cl , RESIDENTIAL BUILDING Permit Application v1 City Of Eagan 3830 Pilot Knob Road, Eagan Mn 55122 C_ Telephone # 651-675-5675 FAX # 651-675-5674 New Construction Requirements Remodel/Repair Requirements Office Use Only 3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas 2 copies of plan _ Cert of Survey Recd (20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions -Tree Pres Plan Recd 2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks -Tree Pres Not Reqd 1 set of Energy Calculations Addition - indicate if on-site septic system _ On-site Septic System 3 copies of Tree Preservation Plan if lot platted after 711193 Rim Joist Detail Options selection sheet (bldgs with 3 or less units Date Z_ / 3L / 03 Construction Cost Site Address a & C 6 l_3 X Unit/Ste # /T- S s`7 Description of Work h BMA Multi-Family Bldg _ Y N Fireplace(s) 0 _ 1 _ 2 Property Owner s lc. fwd c a Telephone # (-4 J'7) l d 7a)- Y~F Contractor U~ Address City State Zip Telephone # ( ) 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 Licensed Plumber Telephone ) Mechanical Contractor Telephone # ( ) Sewer/Water Contractor Telephone # I- L D I hereby apply for a Residential Building Permit and acknowledge that the inform n is co urate; that the work will be in conformance with the ordinances and codes of the City an 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; th the work will be in accordance with the approved plan in the case of work which requires a review and approva f plans. App r6, rtnted Name Applicant's Signature OFFICE USE ONLY Sub Types ❑ 01 Foundation ❑ 07 05-plex ❑ 13 16-plex ❑ 20 Pool ❑ 30 AccessoryBldg ❑ 02 SF Dwelling ❑ 08 06-plex ❑ 16 Fireplace ❑ 21 Porch (3-sea.) ❑ 31 Ext. Alt - Multi ❑ 03 01 of_ plex ❑ 09 07-plex ❑ 17 Garage ❑ 22 Porch/Addn. (4-sea.) ❑ 33 Ext. Alt - SF ❑ 04 02-plex ❑ 10 08-plex ❑ 18 Deck ❑ 23 Porch (screen/gazebo) ❑ 36 Multi Misc. ❑ 05 03-plex ❑ 11 10-plex 19 Lower Level ❑ 24 Storm Damage ❑ 06 04-plex ❑ 12 12-plex Plbg_Y or - N ❑ 25 Miscellaneous Work Types ❑ 31 New ❑ 35 Int Improvement ❑ 38 Demolish (Interior) ❑ 44 Siding ❑ 32 Addition ❑ 36 Move Bldg. ❑ 42 Demolish (Foundation) ❑ 45 Fire Repair 33 Alteration ❑ 37 Demolish (Bldg)* ❑ 43 Reroof ❑ 46 Windows/Doors ❑ 34 Replacement *Demolition (Entire Bldg) - Give PCA handout to applicant Valuation Gn 1, b Occupancy _ fC 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 V 1'U Width REQUIRED INSPECTIONS - Footings (new bldg) Final/C.O. - Footings (deck) Final/No C.O. - Footings (addition) _ Plumbing - Foundation HVAC - Drain Tile Other Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests -Final Framuig _ Siding _ Stucco _ Stone _ Fireplace _ R.I. -Air Test -Final _ Windows (new/replacement) Insulation - Retaining Wall Approved By F - , Building Inspector Base Fee Surcharge E ~_r Plan Review MC/ES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search Copies Other Total 1987 BUILDING PERMIT APPLICATION - CITY OF EAGAN SINGLE FAMILY DWELLINGS INCLUDE 2 SETS OF PLANS, .j CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR /HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED. MULTIPLE DWELLINGS - RESIDENTIAL RENTAL UNITS FOR SALE UNITS INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECK WITH BLDG. DEPT., 1 SET OF ENERGY CALCULATIONS COMMERCIAL INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS, o $2,000 LANDSCAPE BOND To Be Used For: Valuation: 12 Z!CxxD Date: Site Address w&1,164r- Qe. OFFICE USE O= Lot Block On Site Sewage Occupancy 3 MWCC System ✓ Zoning 2 1 Parcel/Sub A OAr-- /f%tGS On Site Well Type of Const City Water ✓ (Actual) Owner (Allowable) # of Stories Address ~F Length Depth 4 Z City/Zip Code S.F. Total Footprint S.F. Phone APPROVALS FEES Contractor ~s~~ wr~✓~~ Assessments Permit So Water/Sewer Surcharge Address 2f( Police Plan Review ~s Fire SAC, City IO City/Zip Code 6 Ef7JrV / ' Engr SAC, MWCC 5Z S _ Planner Water Conn 52, 5 Council Water Meter (07. Phone Bldg Off Road Unit 30 Arch./Engr. APC Treatment P1 I 0, ' Variance Parks Address ' Copies _ TOTAL City/Zip Code Phone # i ~ ~ ~ ~ U ..c~ G ~ x ,s ~ ~ } ~ ~ - v G/' C k, 2 ~ --7 r~ ~ r c - ~ o ~ ~ ~ ~ % C~ C~ CERTIFICATE OF SURVEY FOR: HARSTAD COMPANIES, INC. N $~cXa 117 6 11 S.e~~I.2'40"mac 89 ~XoD 4Z. 7z 32. 2s r A c Scale: I•= 30 5 o N o tb o Denotes Iron Ibn. ~ to O ff` 0 rn I I No t o V? N t a kit o~ m w l~ o ~ r cb ; s o~ %9 'o ~ ~ ~ sl>L ~ x D 'JA -4 r CD 1 J wr;~ p- z p 40 ~ 16~ZN~ - ZICI ~ Lih D ~ and o x )o (o N d N ~LgI\i 1y~° W ~A 0 r~ OD v w 03 Q~ rn C:0 w o 3l g _ v X ' tP ` LO ~n ff o~° -1 W 60 I J u, Sanitary Sewer I / ° o invert Elev. = 88 o 2 0 `I 9 .7 app°~~ X O A x o 93 4 'y N LEGAL DESCRIPTION g9 9~ ET x Denotes Proposed Elevation .r STSE Lot 9 Block 5 898.(o'T Top of Foundation 7 W E rJ' T BUR OAK HILLS 89 l.ro-7lop of Basement Floor Dakota County, Minnesota We hereby certify that this is a true and correct representation of a survey of the boundaries of the above described land and of the location of all buildings, MERILA & ASSOCIATES, INC. if any, thereon, and all visible encroachments, if any, from or on said land. ENGINEERS, SURVEYORS, SITE PLANNERS As surveyed is day of• , 19 7216 Boons Avenue North Suite E 63Minn. Rog. No./-- Brooklyn Pork, Minnesota 55428 Land Surveyo Telephone= (612) 533-7595 Job No. S? - o'i °J Book -Page 8lolOB-UL MEHIOR ENVELOPE AVERAGE "U" COMPUTATION OWNER SITE ADDRESS CONTRACTOR H Pi4~1D GC), DATE PHONE Determine working square footage of each. Q 1. Total exposed wall' area . . . 'Z ~JB7, sq. ft. x t _ 5 l 2. Total roof/ceiling area sq. ft. x 0°O1Co 3. Total floor/cant. area . . . sq. ft. x o'05 = 3.2 Total exposed wall area above floor a. Total gall winiaow area . . . . . . . . . . C+► b. Total door area . . . . . . . . . . . . (~b•3l c. Total sli. ding glass door area . . . . . 3q; q-7- d. Total fireplace wall area . . . . . 7-1r e. Total wall framing area(average 10%). . . 2D S. ~ 3C~ f . Total net wall area above floor . . . . !57 - g. Total rim joist area . . . . . . . . . . . 12 • Total ex-oosed foundation area = 1-7 d h. Total foundation window area 18 i. Total net foundation area above grade. tSZ. Determine "U" value of each wall segment. a. I Co 55 x fluff Q• 4t~ _ 4.31 b. x "u" o,t3 - q,4~ C. 39.9 7 x fluff (p =135 e. 205. 1 x "U" 01089 = t8.:)( f• l 2 3c, x Itutl 0.,c -4-2-., - -7.9,6! g• Z35~ - x fluff O. 04.1 = `t- (1+ h. 18 x IfU,t 0,4(p = Z$ i x "U" 0,1 Zf ~ ZB SUBTOTAL = TOTAL 24(-~7 Ole- 4. If item #4 is the same as, or less than item #1, you have met the intent of SBC 6006 (c) 2. I I i Total exposed roof/ceiling area J. Total skylight area . . . . . . . . . . . . . k. Total flpt roof/ceiling framing area . . . . ..-35,7. 1. Total net insulated flat roof/ceiling area m. Total vault roof/ceiling framing ar6a ,n. Total net insulated vault roof/ceiling area Determine "U" value for each roof/ceiling segment. J. rtUl, 1. z. . 38 x "U" 9, 0 22.. - 27.3 1 - M. x rrUtt n. - X nUre 5 . . . . . . . . . . . . . . . . . . . . , , Total - 3 I 1 2 8 If total of #5 is the same as, or less than #2, you have met the intent of SBC 6006(c) 1. Total exposed floor/cant. area 64-- o. Total floor/cant. framing area(average .10% . . . •47~ p. Total, net insulated floor/dart. area . . . . . . Determine "U" value for each floor/cant. segment o. (0. A- x ,furl ~7 . a59 _ o, 3 P. Aj; I ~k X r,{{rr 6. . . . . . . . . . . . . . . . . . . . . . . Tot a1= Z-.0' o e If total of #6 is the same.as, or less than #3, you have met the intent of SEC 6006 (c) 3. ALTEENATE BUILDING ENVELOPE DESIGN To utilize the total envelope system method, the values established by the sum of items A, #5, and #6 shall not be greater than the sum of items ##1, #2, 'and #3- 1. 2. 3. _ 4. 5. 6. L-t"%K-) 660 t O 2=1 UJ fi~ LI.... P~ R•L 1~ 1248-S 2 3o K;,; z =Ca 57 X 2- i a. Er POO 12. G u 50 LO G~ 3 l A-rr i um Doc/z- -I A V d - ~s.r'N" wt V~Cf - - 77. i - 1 CIA W G ' ` ~ ? Gail , c 0 . ,cuM MAF- FILM 12 o f ~ _ lHWiAjlct4- 19.0 taw-~L 0. 0043 - W WAS H F---VALW5 41 3 3 I.N5ATH 1 FBI O, I, IOU IF-115105 Ai?- F9LIM- t 1. cc_ i { i aro- f ~ 1~ • ' C I T Y O F E A G A ill * PAYMF. w- OF FEE AT TIME OF _ ,*f APPLICATIai DoEs wr OONSTITUI'E APPROVAL OF PWIN=. APPLICATION FOR PERMIT • INSPECTION OF SEWER AND/CR WATFR INSTALLATIONS WILL Nor BE Shim- SEWER AND/OR WATER CONNECTION U' UNTIL PMOUT HAS BEEN APPROVED. * * * (Please Print n j 1) PROPERTY ADDRESS : 0 e / LEGAL DESCRIPTION: 'r----~' (Lot/Block-/-subdivision or Tax Parcel 15-#) IF EXISTING STRUC'ILRE, DATE OF ORIGINAL BUILDING PERMIT ISSUANCE: PRESENT ZONING/pROPOSED USE: Mcn ear COnmcIAL/RETAIL/OFFICE R-1 SINGLE FAMILY Q INDUSTRIAL R-2 DUPLEX (Two Units) INSTITUTIONAL/GOVERN R-3 ZOWNHOLISE (Three + Units) ( Units) R-4 APARTMENT/CONDOMINIUM ( its) 2) NAME: ADDRESS: _ CITY, STATE, ZIP: PHONE: 3) 1: :1• or City Use NAME. in r ' Plumbers License: ADDRESS: V 1~ S Active i CITY, STATE, ZIP: Expired v I e- c J Not recorded PHONE: MASTER LICENSE# St nitial 4) • 121.1 NAME: ADDRESS: CITY, STATE, ZIP: PHONE: CONNECTION Ta CITY SEWER CONNECTION TO CITY WATER C( OTHM 6) 'o • Q PLEASE HOLD APPROVED PERMIT FOR PICK-LIP BY ONE OF ABOVE - - PLEASE MAIL APPROVED PERMIT T0'U 2, 3, 4, ABOVE (Circle one) ~-6 Y~ , el 7Z _fOR -CITY USE ONLY PERMIT # ISSUED Pd w/Bldg. Permit FEES: $ $ l0 •S~ SEWER PERMIT (INCLUDE SURCHARGE) $ $ WATER PERMIT (INCLUDE SURCHARGE) $ $ WATER METER/COPPERHORN/OUTSIDE READER $ $ WATER TAP (INCLUDE CORPORATION STOP) $ $ SEWER TAP $ ACCOUNT DEPOSIT - SEWER $ ACCOUNT DEPOSIT - WATER $ Z e-D $ WAC $ ( 2- SAC $ $ TRUNK WATER ASSESSMENT $ $ TRUNK SEWER ASSESSMENT $ $ LATERAL BENEFIT/TRUNK SEWER $ p $ LATERAL BENEFIT/TRUNK WATER $ WATER TREATMENT PLANT SURCHARGE $ $ OTHER: $ $ TOTAL RECEIPT RECEIPT DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY? YES 'IF YES, THEN A "PERMIT FOR WORK WITHIN PUBLIC ROADWAY" MUST BE ISSUED BY THE ENGINEERING NO DIVISION. LIST AS A CONDITION. SUBJECT TO THE FOLLOWING CONDITIONS: APPROVED BY:~ TITLE: DATE: ~O 12 7 AF 7 LOT BLOCK S sUBD. (/„1i&v RECEIPT DATE 1995 CITY OF EAGAN IRRIGATION PERMIT (FOR BACKFLOW PREVENTER) COMMERCIAL INSTALLATIONS: FORM MUST BE COMPLETED BY LICENSED PLUMBER r Date: Commercial GPM Residential (boulevards) GPM _ Existing residential Area/address to be irrigated SS !f' e _ Installer: UGA /JVC- Owner ❑ Plumber AI Street addressL-g City, state & zip code: D ~4, i,C1, S.Sc3 Phone fvf~ 7S3 -3 G Owner Name- ' Street address City, state & zip code: ~Phone 7.2 51'a Irrigation contractor, if different than installer: Telephone I hereby acknowledge that I have read this application, state that the Information is correct, and agree to comply with all applicable City of Eagan ordinances. It is the applicant's responsibility to notify the property owner that the City of Eagan assumes no liability for any damages caused by the City during its normal operational and maintenance activities to the facilities constructed under this permit within City propertylright-of-wayleasement. (bpplicqr~i is signature Title Approved by: Date: PRV ❑ Yes ❑ No New service ❑ Yes ❑ No Meter Size & Cost Fees due: Calculated by: v co 7, PROCEDURE FOR IRRIGATION SYSTEMS - 1996 An irrigation permit is required - please contact Protective Inspections at 681-4676. Fees Commercial project: $25.50 irrigation permit to cover installation of backflow preventer. $50.50 water permit fee only if new, service is installed. $300.00 per tap if installed by City. Residential project: $20.50 irrigation permit to cover installation of backflow preventer. $50.50 water permit fee if new service is installed. $750.00 per connection - VVAC. $372.00 per connection - water treatment facility. Existing residence: $20.50 irrigation permit to cover installation of backflow preventer (not required if backflow preventer previously installed). Meter charge: If gallons per minute are less than 25, a 1" meter will be required at a cost of $170.00. If gallons per minute are more than 25, a 2" turbo with strainer will be required at a cost of $800.00. This information is to be supplied by the designer of the system. No meter will be sold before all sewer and water inspections are complete on anew service. If new service lines are not required, one check maybe written for meter and permit costs. Receipt will be coded to 20-3716 (meter portion only) with pink copy forwarded to Utility Billing Clerk. The installer is to contact Protective Inspections at 6814675 for inspection of the inside water-line and backflow preventer. The Public Works Department may be reached at 681-4300 for water turn-on and.set and seal of the meter. Inspection hours are 8:30 a.m. to 3:30 p.m. Monday through Friday. Requests for A.M. inspections should be made on the preceding work day. Requests for PM inspections will be accepted until 12:00 noon. 1999 BUILDING PERMIT APPLICATION (RESIDENTIA ) CITY OF EAGAN _ 3830 PILOT KNOB RD - 55122 651-681.4675 (L, - I N Constru i n Re uirements Remodel/Repair Reauirement~ > registered site surveys showing sq. ft. of lot, sq. R. of house 2 copies of plan and all roofed areas (20% maximum lot coverage allowed) 1 set of energy calculations for heated additions > 2 copies of plans (show beam 3 window sizes; poured fnd. design; etc.) 1 site survey for exterior additions b decks > -1 set of energy calculations > 3 copies of tree preservation plan ff lot platted after 7/1/93 DATE: T ~001,q CONSTRUCTION COST: DESCRIPTION OF WORK: STREET ADDRESS: LOT: BLOCK: 45- SUBD./P.I.D. V, C) (a 1 c Name: ~/C h2~ Phone An 0 - 7og PROPERTY Last Writ OWNER k Street Address: ~°t~-~ alJf/~c &4, Lam/ City Stater Zip: 0 Company: Phone /Z1-40 d (area code) CONTRACTOR ' Street Address: '11Y License # l~ Exp. City State: Zip: ARCHITECT/ ENGINEER Company: Name: Telephone area code Street Address: Registration City State: Zip: Sewer & water licensed plumber (required for new construction onlv): Penalty applies when address change and lot change is requested once permit Is Issued. I hereby acknowledge that I have read this application, state that the Information Is correct, and a ree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant: OFFICE USE ONLY Certificates of Survey Received Yes No Tree Preservation Plan Received Yes No Not Required OFFICE USE ONLY BUILDING PERMIT TYPE ❑ 01 Foundation ❑ 06 4-plex ❑ 11 10-plex ❑ 16 Fireplace ❑ 21 Porch (3-sea 02 SF Dwelling ❑ 07 5-plex ❑ 12 12-plex ❑ 17 Garage ❑ 22 Porch/Addn. (4 -sea.) 03 1 of _ plex ❑ 08 6-plex ❑ 13 16-plex ❑ 18 Deck ❑ 23 Porch (screened) ❑ 04 2-plex ❑ 09 7-plex ❑ 14 Apartments ❑ 19 Lower Level ❑ 24 Storm Damage ❑ 05 3-plex ❑ 10 8-plex ❑ 15 Lodging ❑ 20 Pool ❑ 25 Miscellaneous WORK TYPE ❑ 31 New ❑ 35 Tenant Impr ❑ 39 Gas Line Only ~43 Siding/Soffits/Fascia ❑ 32 Addition ❑ 36 Move Bldg. ❑ 40 Gas Insert ❑ 44 Windows/Doors ❑ 33 Alteration ❑ 37 Demolish Bldg.* ❑ 41 Wood Stove ❑ 45 Fire Repair ❑ 34 Repair ❑ 38 Demolish (Interior) ❑ 42 Reroof * Give PCA handout to applicant-f1 w demolition permit GENERAL INFORMATION Const. (Actual) Basement sq. ft. Census Code (Allowable) Main level sq. ft. SAC Code UBC Occupancy sq. ft. No. of Units Zoning sq. ft. No. of Bldgs # of Stories sq. ft. MC/ES System Length sq. ft. City Water Width Footprint sq. ft. Booster Pump PRV APPROVALS Fire Sprinklered Planning Building Engineering Variance Permit Fee D10 Valuation: Surcharge Plan Review License MC/ES SAC Ciiy SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment Pl. Park Ded. Trails Ded. Other Copies ` t Total: SAC Units % SAC * 1988 BUILDING PERMIT APPLICATION - CITY OF EAGAN SINGLE.FAMILY DWELLINGS INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES 0 SURVEY, 1 SET. OF ENERGY CALCULATIONS NOTE: ADDRESSES FOR CORNER LOTS - ONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. NO CHANGES WILL ALLOWED ONCE BUILDING PERMIT IS ISSUED. MULTIPLE DWELLINGS RENTAL UNITS FOR SALE UNITS OF UNITS ........Y_ INCLUDE 2 SETS OF PLANS, CERT CATE OF SURVEY - CHECK WITH BLDG. DEPT., 1 SET OF ENERGY CALCULATION , COMMERCIAL INCLUDE 2 SE OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET ECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS To Be Used For: e- Valuation: 4( 4mn Date: rl,-3kje Site Address IVY OFF= ONLY Lot Block On site sewage Occupancy f7~~ 6 MWCC system Zoning Parcel/Sub JC1u/r-- On site well Actual Const City water Allowable Owner ~L : s t /f dd QI PRV required # of stories Booster Pump Length Address Depth S.F. Total City/Zip Code a 4a m it Wj.2 Footprint S.F. ~ Phone %.Lj A- 41D `T APPROVALS FEES Contractor Engr/Assess Permit Planner Surcharge Address Council ! Plan Review Bldg. Off. ~..:5~?1Z4 SAC, City ter. City/Zip Code Variance SAC, MWCC Water Conn Phone Water Meter Road Unit Arch./Engr. Treatment Pl Parks Address Copies TOTAL City/Zip Code Phone # CET MCAFE OF SURVEY FOR. HARSTAD CC PANIESy INC. o S-c9~°/2'~p.,E 89x° D C e 4 Z. 72 32. ZS Ssa7e: I . _ 20, O o oltnotes Iron ion. a moo m a J• N 1 O N b H - O 0 kit o ° left W C 41 tU 0 w ~ I pT-0 7- I z O EN ACS 1 ° a~1 b ~ 4 in n U1 ~ o REVI_WED S 44 f ~ ~ W 42 •O - ~ 31 ~ XI<1 DATE x FP f 10 i y' / w Sanitary Sewer o ° 'Invert Elev. = S8 G. o g 47 a LEmsX ~ O 93 GAL DESCRIPTION x Denotes Proposed Elevation 89 Y. ° `8 T R Lot 9 Block 5 89t~.1o'7 lop of Foundation ~ ~ , p -?7 BUR OAK HILLS 89 1.to-7 Top of Basement Floor Dakota County, Minnesota We hereby certify that this is a true and correct representation of a survey of the boundaries of the above described land and of the location of all buildings, MERILA & ASS®CIr TIES, INC. if any, thereon, and all visible encroachments, if any, from or on said. land. ENGINEERS, SURVEYORS, SITE PLANNERS As surveyed is •~"Z''~ day of• AI-I'L-4? , 19 7216 Boone Avenue Norih a Suite E 63 Minn. Reg. No. Brooklyn Pork, Minnesota 53428 Land Surveyo Telephone: (612) 573-7Z95 Job No. 8-7 - O-3 °5 Book - Page w 2005 RESIDENTIAL BUILDING PERMIT APPLICATION ~D W City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX 4 651-675-5694 New Construction Requirements Remodel/Repair Requirements Office Use Only 3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas 2 copies of plan Cad of Survey Recd _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 saes; poured found design, etc. 1 site survey for additions & decks Tree Pres Required _Y _N 1 set of Energy Calculations Addition - indicate Hon-site septic system On-site Septic System _Y _N 3 copies of Tree Preservation Plan i( lot platted after 711193 Rim Joist Detail Options selection sheet (buildings with 3 or less units) Date / Cons ruction Cost Site Address IV 41 IA, Unit/Ste # Description of Work ry r' Multi-Family Bldg - Fireplace(s) _ 0 - 1 - 2 Property Owner / V- 'y j4ck rn fr Telephone # (Psl) h Z--Z 005 Contractor (..1 4~ Address p r City State 1 V Zip Telephone # 9~~ 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 (d submission type) Submitted Submitted Energy Envelope Calculations Submitted In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? - Y - N If yes, date and address of master plan: Licensed Plumber Telephone # ( ) Mechanical Contractor Telephone # ( ) 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 app val of plans. r 72 .~J &IMM~M4 k~~ Applicant's Printed Name Applicant's Signature OFFICE USE ONLY Sub Types ❑ 01 Foundation ❑ 07 05-plex ❑ 13 16-plex ❑ 20 Pool ❑ 30 Accessory Bldg ❑ 02 SF Dwelling ❑ 08 06-plex ❑ 16 Fireplace ❑ 21 Porch (3-sea.) ❑ 31 Ext. Alt - Multi ❑ 03 01 of_ plex ❑ 09 07-plex ❑ 17 Garage ❑ 22 Porch/Addn. (4-sea.) ❑ 33 Ext. Alt - SF ❑ 04 02-plex ❑ 10 08-plex ❑ 18 Deck ❑ 23 Porch (screen/gazebo) ❑ 36 Multi Misc. ❑ 05 03-plex ❑ 11 10-plex ❑ 19 Lower Level ❑ 24 Storm Damage ❑ 06 04-plex ❑ 12 12-plex Plbg_Y or_ N ❑ 25 Miscellaneous Work Types ❑ 31 New ❑ 35 Int Improvement ❑ 38 Demolish Interior ❑ 44 Siding ❑ 32 Addition ❑ 36 Move Building ❑ 42 Demolish Foundation ❑ 45 Fire Repair ❑ 33 Alteration ❑ 37 Demolish Building* ❑ 43 Reroof ❑ 46 Windows/Doors ❑ 34 Replacement *Demolition (Entire Bldg) - Give PCA handout to applicant Valuation Occupancy MCES System Plan Review 100% or 25% Census Code Zoning City Water SAC Units Stories Booster Pump # of Units Sq. Ft. PRV # of Bldgs Length Fire Sprinklered Type of Const Width REQUIRED INSPECTIONS Footings (new bldg) _ Final/C.O. Footings (deck) _ Final/No C.O. - Footings (addition) _ Plumbing _ Foundation _ HVAC _ Drain Tile Other Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests _ Final Framing _ Siding _ Stucco _ Stone _ Brick Fireplace _ R.I. -Air Test -Final _ Windows Insulation _ Retaining Wall Approved By: , Building Inspector - - - - - - - - Base Fee Surcharge Plan Review MC/ES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search Copies Other Total Use BLUE or BLACK Ink l F,nr Office u T Eap Permit City O1 p r' ' MAy o3 2010 1 Permit Fee: 3830 Pilot Knob Road l~, Eagan MN 55122 t__ / ICh 7kc. v j Date Received: l l j Phone: (651) 675-5675 i Staff: Fax: (661)676-5694 2010 RESIDENTIAL BUILDING PERMIT APPLICATION Oak- Date: Site Address: Tenant: Suite RESIDENT/ OWNER Name: hone: Address/ City /Zip: / Applicant is: Owner ontractor TYPE OF WORK Description of work: Construction Cost: Multi-Family Building: (Yes / N CONTRACTOR Name: License ~f C~7 Address. 4-1 Ci State: Zip: `BCD Phon . / Contact: Email: 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.popherstateonecall.org I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and colas 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 t work will be in accordance with the approved plan in the case of work which requires a review and appro lans. i / k - -,-,To 4 z) s t L Applicant's Printed Name A cant's signature Page 1 of 2 PERMIT City of Eagan Permit Type: Plumbing Eaaan. Permit Number: EA096170 Date Issued: 09/28/2010 OR Permit Category: ePermit 41~ it~ of E3 E Site Address: 3255 Black Oak Dr Lot: 9 Block: 5 Addition: Bur Oak Hills PID:10-15500-090-05 Use: Description: Sub Type: e - Water Heater Work Type: New Description: Water Heater Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments: Josh McGuire 1424 3rd St N Minneapolis. MN 55411 Fee Summary: PL - Permit Fee (WS &or WH) $50.00 0801.4087 Valuation: 1.500.00 Surcharge-Fixed $5.00 9001.2195 Total: $».00 Contractor: - Applicant - Owner: Benjamin Franklin Plumbing Timothy C Donarski 1424 N 3rd St. 3255 Black Oak Dr Minneapolis MN 55411 Eagan MN 55121--233 (612) 604-428 X61 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 Cite of Eaaan Ordinances. ApplicantiPermitee: Signature Issued Bv: Signature PERMIT City of Eagan Permit Type: Mechanical Permit Number: EA105178 Date Issued: 0612912012 itj of 0n Permit Category: ePermit R Site Address: 3255 Black Oak Dr Lot: 9 Block: 5 Addition: Bier Oak Hills PID: 10-15500-05-090 Use: Description: Sub Type: e - Air Conditioner Work Type: New Description: Air Conditioner Comments: Questions regarding electrical permit requirements should be directed to Mark Anderson, State Electrical Inspector, (952) 445-2840 Scott Lofgren 5708 Upper 147th St W #102 Fee Summary: ME - Permit Fee (Replacements) $55.00 0801.4088 Surcharge-Fixed $5.00 9001.2195 Total: $60.00 Contractor: - Applicant - Owner: Lofgren Heating & Air Timothy C Donarski 5708 Upper 147th St W 3255 Black Oak Dr Suite 102 Eagan MN 55121--233 Apple Valley MN 55124 (952) 431-5811 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. Applicant/Permitee: Signature Issued By: Signature 4** C!ty of aafl 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Use Permit #: I t i -/ci Permit Fee: Date Received: 1 - -t r I -3 Staff 2012 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Unit#: RESIDEN OWNEE PE OF WOR Name: fI JT\ anti E.\,TSo, DcK Xskl Phone: (012- 203" 14405 Address / City / Zip: 3a 55 4k c k Ooic Dr; ve E0.c ox\, MN S 121 Applicant is: XOwner Contractor ' tr c R-1 Description of work: 'Finish 'pas em ent bed room 3oo Construction Cost: 2- 00 0 Multi -Family Building: (Yes Company: Contact: Address: City: State: Zip: Phone: License #: Lead Certificate #: If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) iAwt cant `►s not. \1 Censed c viArcLeilDr ,ome but \A - ►n �9g7 Bo- °In 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 INo If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contractor: Phone: NOTE: Plans and supporting docume the information may be classified as non-, con luc you submit are considered to ire public informal if yprovide specific reasons brat would p tieat they are trade secrets: Portions of the City to 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.aooherstateonecall.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. 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 Et ss(. D mar ska Applic is Printed Name 1-1 m OTI ars Applicant' Signat Page 1 of 3 two. iv - lct ac cAk r f 68 79 DO NOT WRITE BELOW THIS LINE SUB TYPES Foundation Single Family Multi 01 of _ Plex Accessory Building WORK TYPES New Addition Alteration Replace Retaining Wall DESCRIPTION Valuation Plan Review (25%_ 100% I/K Census Code $i # of Units # of Buildings Type of Construction Fireplace Garage Deck Lower Level _ Interior Improvement _ Move Building Fire Repair Repair 5ery 46- i 1--13 Porch (3 -Season) Porch (4 -Season) Porch (Screen/Gazebo/Pergola) Pool Siding Reroof - Windows _ Egress Window Storm Damage Exterior Alteration (Single Family) Exterior Alteration (Multi) Miscellaneous _ Demolish Building* _ Demolish Interior Demolish Foundation Water Damage *Demolition of entire building — give PCA handout to applicant Occupancy „rrG - MCES System Code Edition /ay7 SAC Units Zoning R I City Water Stories Booster Pump Square Feet PRV Length Fire Sprinklers Width REQUIRED INSPECTIONS Footings (New Building) Footings (Deck) Footings (Addition) Foundation Drain Tile Roof: _Ice & Water Final .4tt Framing Fireplace: _Rough In Air Test _Final AL Insulation Sheathing Sheetrock Reviewed By: Meter Size: Final / C.O. Required Final / No C.O. Required HVAC Gas Service Test Gas Line Air Test Other: Pool: _Footings Air/Gas Tests Final Siding: Stucco Lath _Stone Lath _Brick Windows Retaining Wall: — Footings Backfill _ Final Radon Control Erosion Control , Building Inspector RESIDENTIAL FEES Base Fee Surcharge Plan Review MCES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Copies TOTAL 7G ,2.60@ "/' 3-2 SPR Page 2 of 3 PERMIT City of Eagan Permit Type:Building Permit Number:EA108409 Date Issued:12/06/2012 Permit Category:ePermit Site Address: 3255 Black Oak Dr Lot:9 Block: 5 Addition: Bur Oak Hills PID:10-15500-05-090 Use: Description: Sub Type:e-Windows/Doors Work Type:Windows/Doors Description:House Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings, call for framing inspection. Call for final inspection after installation. Carbon monoxide detectors are required by law in ALL single family homes . 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 - Timothy C Donarski 3255 Black Oak Dr Eagan MN 55121--233 Able Restoration Group Inc. 17316 Kenyon Avenue, Suite 103 Lakeville MN 55044 (952) 378-5000 Applicant/Permitee: Signature Issued By: Signature Ifa City of Eagan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BL E or BLACK Ink 9 LSC For Office Use Permit #: Permit Fee: Date Received: Staff: � U5 3--d(p-13 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: S — Z — / 3 Site Address: 3a 53 !L cIC D I\ (C I (e Uni #: Name: 71'97 J-% 0 N /-p(('--W % Phone: (0/ 2 - Contractor Ey- Address / City / Zip: Applicant is: Owner /` Contractor Construction Cost: / / 12 Multi -Family Building: (Yes `^,� f Company: % uo / av e � Y1 -f r� I avd is LU � Contact: Address: 2 (c/ 0 I (--) ✓‘-‘.E TR. City: C d 2 c e 2A - State: -State: PLA W Zip: S S3 `f 6 Phone: 6 12 - 2 sr' / — (a g License #: 2 0 C3 2 (`7 y Lead Certificate #: / ' 3 0 s, s -e / J Q / Y 2� If the project is exempt from lead certification, please explain why: (see Page 3 for additional informat /-1,3".0 i ( 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: Phone: Phone: Sewer & Water Contractor: Phone: NOTE: Plans and supporting documents that you submit are considered to be public informati the information may be classified as non-public if you provide specific reasons that would pe conclude that they are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility dama. e. Call 48 hours before you intend to dig to receive locates of underground utilities. www.qopherstateonecall.orq I hereby acknowledge that this information is complete and accurate; that the work wit be in conformance with the ordinances a d 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; t at the work wit 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 co . feted within 180 days of permit issuance. x 727 C CAC) Applicants-P-r-inted-Name x Applicant' 1 IP Al , 1114 7g `ature Page 1 of 3 PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA112582 Date Issued:08/19/2013 Permit Category:ePermit Site Address: 3255 Black Oak Dr Lot:9 Block: 5 Addition: Bur Oak Hills PID:10-15500-05-090 Use: Description: Sub Type:Residential Work Type:Replace Description:Furnace Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Scott Lofgren 5708 Upper 147th St W #102 Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088 Surcharge-Fixed $5.00 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 - Timothy C Donarski 3255 Black Oak Dr Eagan MN 55121--233 Lofgren Heating & Air 5708 Upper 147th St W Suite 102 Apple Valley MN 55124 (952) 431-5811 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA149744 Date Issued:06/07/2018 Permit Category:ePermit Site Address: 3255 Black Oak Dr Lot:9 Block: 5 Addition: Bur Oak Hills PID:10-15500-05-090 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 - Timothy C Donarski 3255 Black Oak Dr Eagan MN 55121--233 (612) 203-4405 Twin Cities Contracting Services 140 W 98th St, Suite 202 Bloomington MN 55420 (952) 405-6201 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA165514 Date Issued:11/04/2020 Permit Category:ePermit Site Address: 3255 Black Oak Dr Lot:9 Block: 5 Addition: Bur Oak Hills PID:10-15500-05-090 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 - Timothy C & Elyssa L Donarski 3255 Black Oak Dr Eagan MN 55121--233 (612) 442-3717 Guardian Services Contracting 1042 20th Ave N South St Paul MN 55075 (800) 617-8450 Applicant/Permitee: Signature Issued By: Signature