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1563 Blackhawk Hills Rd Jul 14 10 01:02p Terry Miller 6514302576 p.1 Use or BLACK Ink i For Office Use _ _ ` yt CC JUL 1 i `t r Y I City of Ea aIl , Permit 1 `Permit Fee: '7 / ' I 3830 Pilot Knob Road Eagan MN 55122 j Date Received: ✓ /Cf ~C~ j Phone: (651) 675-5675 I start: Fax: (651) 673-5694 1 I 2010 RESIDENTIAL BUILDING PERMIT APPLICATION ~c /less Date: Site Address: abn ~Ct lr~~ Ot,uJ lam- I I ~r 1 2, Tenant: C9 sL L 1, Suite RESIDENT 1 OWNER Name: Phone: Address ! Gity /Zip: -1 ~ 1 ~L ~f..~1~-1~1~t.~:•l / ~W ~ ~ t~~fJ,~j~ Applicant is Owner Contractor TYPE OF WORK Description of worts: Z- fi ,.-,I0 -L, L 2e/- fie U+'~ E? -2.. Construction Cost; Z- + f7tZ_ Muni-Family Building: (Yes _ f No~ CONTRACTOR Name: -L6-V`'i License#: G 3 f2-,2 Address: 3~rf City: C.-wlU2 r~~~ State: b8 W Zip: Svc Phone: b L1- q Z -3 7 O / ~ Contact: r Email: r cry y b- o 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 am 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. Cali 48 hours before you intend to dig to receive locates of underground utilities. I hereby acknowledge a that this information fs y g 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 army an application for a permit, and worts 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 ans. % X ac -C w X AppilednCs Printed Name Applicant's Si lure Page 1 of 2 Jul 14 10 01:02p Terry Miller 6514302576 p.2 13 -9 K 4 11 Ls. 4:~c(f C/ 4- 0 ~ / , DO NOT WRITE BELOW THIS LINE SUB TYPES Foundation _ Fireplace _ Porch (3-Season) ` Storm Damage Single Family Garage Porch (4-Season) Exterior Alteration (Single Family) Multi Deck Porch (ScreenfGazebo/Pergola) Exterior Alteration (Multi) 01 of Plex _ Lower Level Pool Miscellaneous Accessory Building WORK TYPES New _ Interior Improvement _ Siding Demolish Building* Addition _ Move Building _ Reroof Demolish Interior _ Alteration _ Fire Repair Windows _ Demolish Foundation Replace Repair Egress Window Af Water Damage Retaining Wall *Denioiition of entire building - give PCA handout to applicant DESCRIPTION Valuation Occupancy MCES System Plan Review Code Edition _ VV 2 SAC Units (250/p_ 100°,/ Zoning City Water Census Code Stories Booster Pump # of Units Square Feet PRV # of Buildings Length Fire Sprinklers Type of Construction _ Width REQUIRED INSPECTIONS Footings (New Building) Sheetrock Footings (Deck) Final I C.O. Required Footings (Addition) Final / No C.O. Required Foundation NVAC Drain Tile Other: Roof: Ice& Water Final Pool: Footings Air/Gas Tests Final Framing Siding: _ _Stucco Lath Stone Lath „_,,,_„Brick Fireplace: ,_,_Rough In Air Test Final Windows Insulation Retaining Wall: Footings Backfill ! Final Meter Size: Radon Control Erosion Control Reviewed By: Buliding Inspector RESIDENTIAL FEES 7,4 Base Fee Surcharge Plan Review / MCES SAG City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Copies TOTAL Page 2 of 2 CITY OF EAGAN Permit No: 8552 Date: 3-13-87 3830 Pilot Knob Road Meter Na -2 8 Size: P.O. Box 21199 Reader No: O 3 0 Date: Eagan, MN 55121 Owner. Lundgren Bros. Construction Site Address: 1563 Blackhawk Hills Rd. L32 111 Blackhawk Gle Plumber Lundgren Bros. Plumbing Conn. Chg: 525.00pd Zoning: Rl Acct Dep: 15.00O,d No. of Units: 1 Permit Fee: 10.OORd Surcharge: . 50Rd 1 agree to comply with the City of Eagan Tr. Plant 180.OORd Ordinances. Meter. PTO^-' - Misc: WATER SERVICE PERMIT This, 7uest void 7.. 1.8 nfrom /4' r 131 _ raquest Date Fire No. Rough-in Inspection Required? ❑Ready Now ❑ Will Notify, Inspec- ❑ yes ❑ No for When Ready ❑ Licensed Electrical Contractor I hereby request inspection of above ❑ Owner electrical work installed at: Street Address, Box or Route No. City 56 ,4,4 LK Aru /dL s R 12 C' G action No. Township Name or No. Range No. County Occupant (PRINT) Phone No. G 67, Power Supplier Address Electrical Contractor (Company Name) Contractor's License No. Standard Electric Co. 40837 Mailing Address (Contractor or Owner Making Installation) 2672 Maplewood Dr. Maplewood, MN 55109 Autho Signature (Co o caner Making Installation) Phone Number 484-8044 MINNESOTA STATE WARD 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. EB-00001-05 REQUEST FOR ELECTRICAL INSPECTION AIML 1 See instructions for completind this form on back of yellow copy. ' RA-1 31 "X" Below Work Covered by This Request sw Add Rep. Type of Building Appliances Wired Equipment Wired Home Flange Temporary Service Duplex Water Heater Lighting Fixtures Apt. Building Dryer Electric Heating Commercial Bldg. Furnace Silo Unloader Industrial Bldg. Air Conditioner Bulk Milk Tank Cher ISperifv! Farm other (Specify) t r peciiy Other Other Compute Inspection Fee Below ff Fee Service Entrance size It Fee Feeders/Subfeeders # Fee Circuits 4 0to200Amps 0to30Amps -51 ?-M s Above 200 Am )s 31 to 100 Amps 31 to 100 Amps Swimming Pool Above 100_Amps Above 100_Am Transformers Irrigation Booms O Partial-'Other Fee Signs Special Inspection 11 Remarks $4r TOTAL E 10 /~t $ FR-v G G J Rough-in Date 1. the Electrical inspector, hereby certify that the above Final Date inspection has been made. This request void 18 months from This request void 4,'. e months from 9F.A53 Request Date Fire No. Rough-in Inspection Requir Ready Now i I Notify, Inspec es ❑ No for When Ready Licensed Electrical Contractor I hereby request inspection of above ❑ Owner electrical work installed et: C itv Street Address. Bo/x/~dJ1 Ro~luteC No. - / y 1-114kS Section No. Township Name or No. Range No. CX~'7-A Occupan (PRINT) Phone No. UE Pn Supplier A ress (L 4.10 (Jq,~o'r~¢p / U) !".9-~eM ~•v T Electrical Contractor (Company Name) Contras is License No. Standard Electric Co. 40837 Mailing Address (Contractor or Owner Making Installation) 2672 Maplewood Dr., Maplewood, Mn 55109 ruthoriz Wnature (Contractor r ing Installation) Phone Number 2 484-8044 MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION' REQUEST WILL NOT Griggs-MidweV Bldg. - Room N•191 BE ACCEPTED BY THE STATE BOARD 1621 University Ave.. St. Paul. MN 55104 UNLESS PROPER INSPECTION FEE IS Phone (612) 642-0800 ENCLOSED. REQUEST FOR ELECTRICAL INSPECTION es-00001-05 r~; r ^ See instructions for completvIs this form on back of yellow coPy. 139 ' r ' X" Below Work Covered by This Request r 9 3 NwjAddl Rep. Type of Building Appliances Wired equipment Wired Home Range Temporary Service Duplex Water Heater Lighting Fixtures Apt. Building Dryer Electric Heatln Commercial Bldg. Furnace Si to Unloader Industrial Bldg. Air Conditioner Bulk Milk Tank Farm Other pec v Cher lSnecify) Other Specify Other Other Compute Inspection Fee Below # Fee Service Entrance Size p Fee Feeders/Subteeders q Fe Circuits 0 to 200 Amps 0 to 30 Amps 0 to 30 Am Above 200 Am § 31 to 100 Amps 31 to 100 Amps Swimming Pool Above 100-Am s Abaf 100-Am Transformers rrigation Booms p Part ial•'Othe Signs Special lnspection emerks g~~ TOTAL FE ~f Rough-in R Date I, the Electrical ` f °~r13 ~7 Inspector, hereby certify that the above Final ♦ Cie inspection has been made. TMe request vold 18 months from CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN $5121 N2 1~wti PHONE: 454-8100 WILDING PERMIT Receipt Te t o used for SP DWG/GAR Est value $109,000 Date i MIXH 4 Site Address 1563 SAM~ FLU" RD Erect ~ Occupancy R3 Lot .3 2_ Block I_Sec/Sub. BLACKHAWK GLEN Remodel ❑ Zoning Rl Repair ❑ Type of Const Parcel No. Addition ❑ No. Stories Name- LUNDGREN HROS CONST INC Move ❑ Length Address 935 E WAYZATA BLVD Demolish ❑ Depth City WAXVMA hone 473-1231 Install Int. aImpr. llll ❑ Sq. Ft ❑ o Name SAME Approvals Foes c Address Assessment Permit 30050 City Phone Water & Sew. Surcharge 54.50 a Police Plan Review 265.25 I:z Name- 799W A WBITTOCK Fire SAC 625.00 z i3 Address 24422 AVON CT Eng. Water Conn. 525.00 *5 City EDBN Y-44"19 934-0665 Planner Water Meter 67.00': Council Road Unit 05.00 1 hereby acknowledge thatf have read this application and state thatthe Bldg. Off. Tr. Pi. 180.00 information is correct and agree to comply with all applicable State of MinnesotaSta" jwA CA" f Eagan Ordinances. APC Parks Var. Date Copie Signature of Perm Nta+lr ° M552.15 ,T Total A Building Permit is iMued.to: LUNDGREN BROS CONST INC on the express condition that all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official r POrmli No P~ N~ Dole T OphOM M M.KA.C. ~p EhK*k sonew UMPOG*M DOM low. Comments foundedon ROO" Rough NP9. ?b^g~ Romp Sao. y - ft" Y FUOplsce ~ Find Mg. ~p Find Plbg. ewo. F nal CWL occ. S Ply Dock FIS. DOOk Fnmq. .r - 7 f - -e. ,-r•-+..~ Q .7_ x 7 T+:.'. -r.a„:..'10', FT .,-r - PERMIT* PLUMBING PERMIT RECEIPT k0~.3~ a CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: CONTRACT PRICE: PHONE: 454-8100 Site Address 'f BLDG. TYPE WORK DESCRIPTION Lot Bloc a /Sub Res. ✓ New ~N Mult. Add-on m Name in r_ S h Comm: Repair Address Other' c city yF+-vs--Il~r Phone - RES. PLBG. ONLY - COMPLETE THE FOLLOWING: NO. FIXTURES T TAL Name Water Closet - $3.00 Bath Tubs - $3.00 3 Address 3_Lavatory - $3.00 p City Phone Shower - $3.00 Kitchen Sink - $3.00 FEES Urinal/Bidet - $3.00 _ COMM/IND FEE -1% OF CONTRACT FEE Laundry Tray - $3.00 'APT. BLDGS - COMM RATE APPLIES Floor Drains - $1.50 TOWNHOUSE & CONDO - RES. RATE APPLIES water Heater - $1.50 A S6 MINIMUM - RESIDENTIAL FEE _$12-00 Whirlpool - $3.00 MINIMUM - COMM/IND FEE -$20.00 -L _Gas Piping Outlets - $1.50 • STATE SURCHARGE PER PERMIT - .50 (MINIMUM - 1 PER PERMIT) (ADD $.50 S/C IF PERMIT PRICE GOES Softener - $5.00 BEYOND $1,000.00) Well - $10.00 Private Disp. - $10.00 -3-Rough Openings - $1.50 24. _5 SIGNAT RE OF PERMITTEE FEE: STATE SIC: FOR: CITY OF EAGAN GRAND TOTAL: MECHANICAL PERMIT RECEIPT # 7120?O 7 CITY OF EAGAN _ 3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: 14-& - CONTRACT PRICE 9 OD PHONE: 454-8100 Site Address r" BLDG. TYPE WORK DESCRIPTION Lot 31 Block I Sec/Sub Res. New ergi Name J Mult Add-on Address 1011)d„{ a Comm. Repair Other c City G Ictc n ~YZ jj Phone 'n k FEES Name RES. HVAC 0-100 M BTU -$24,00 3 Address ADDITIONAL 50 M BTU - 6.00 O City ~-~-f-- Phone 9 1-3 1 2:V (RES. HVAC INCLUDES A/C ON NEW ; CONSTRUCTION) GAS OUTLETS (MINIMUM - 1 PLN PERMIT)- - ' 1.60 V& TYPE OF WORK ,yv 1~ COMMAND FEE - 1% OF CONTRACT FEE Forced Air t LXJA BTU c~ -1 U U APT. BLDGS. - COMM. RATE APPtJES f TOWNHOUSE & CONDOS RES. RATE APPLIES Boiler M BTU MINIMUM RESIDENTIAL FEE - ALL ADD-ON & Air Conic M BTU MIN M COMMERCIAL FEE 2(100 Vent. CFM STATE SURCHARGE PER PERMIT - 50 Y, (ADD $.50 S/C IF PERMIT PRICE GOES k Gas Piping Outlets # 1 BEYOND $1,000) ,a Other `•:x J { 0 FEE: f) y'l 1.1JG??~- S/C: Sa SIGNATUREOF PERMITTEE TOTAL- FOR CITY OF EAGAN E `T1 CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHONE: 454-8100 BUILDING PERMIT Receipt,# To be used for Est. Value sI aom Data APR 10 19 ~1 1563 MACKH►N'!C NIUA 1W Site Lot Adliss Block $ec/Sub. OFFICE USE ONLY , Parcel NO. Occupancy - FEES RAW am= Zoning 23000 W Name (Actual) Const Bldg. Permit 1 Address (Allowable) - Surcharge *30 o City Phone # of Stories Plan Review rn coo= Length Depth Y SAC, City z e Name 935 a S.F. Total SAC, MCWCC Address city Phone S.F. Footprints - On Site Sewage Water Conn Name On site Well - Water Meter = = Address MWCC system 5'v - Acct. Deposit <W City Phone City Water - PRV Required S/W Permit I hereby acknowlege that 1 have read this application and state that the Booster Pump S/W Surcharge information is correct and agr e o comply with all applicable State of Minnesota Statutes and C"y ' Ordina c Treatment PI Signature of Permitee APPROVALS Road Unit A Building Permit is issued to: Planner Park Ded. on the express condition that all work shall be done in accordance with all Council applicable State of Minnesota Statutes and City of Eagan Ordinances. Bldg. Off. Copies 7* Building Official r Variance TOTAL Permit No. Permit Helder Oats Telephone S WATER SEWER PUIMBING H.V.A.C. ELECTRIC Inepection Date Insp. Comments Footings I Foundation Frartwg Hooting Rough Plbg. Rough Htg. bul. Fireplace Final Hig: Final Ptbg. Cont. Meter Plbg. Inspector-Notify Plumber Engr.Mm Bldg. Final Dade Fig. • ' Deck Final fc Woo' Pr. Disp. CITY OF EAGAN Remarks 0/ r # 16 a 4. Addition Rlackhawk Glen 1st Lot 312 Blk Parcel 14350-320-of Owner Street 1563 Blackhawk Hills Roadstate Eagan 55122 Improvement Date Amount Annual Years Payment Receipt Date STREETSURF. 1076 1986 253.48 50.70 STREET R ESTOR. GRADING SAN SEW TRUNK ]OIL 1970 6.70 25, Ed prior ta-d-i-viSian 2 SEWER LATERAL Bn1074 1986 112.09. 22.42 5 Sewer Lateral 137 1972 106.12 20 WATERMAIN Bn 1075 1986 92.80 18.56 5 WATER LATERAL WATER AREA 1072 1986 309.40 61.98 51 Storm Sew Trk 1073 198 110.91 STORM SEW TRK 732 1983 32 . 7 151 STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. BUILDING PER. SAC PARK • CITY OF EAGAN N 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 r v 13 3 0 6 PHONE: 454-8100 BUILDING PERMIT Receipt # IA.~ 2 To be used for SF DWWGAR Est. Value $109,000 Date MARCH 4 19'7 Site Address 1563 BLACKHAWK HILLS RD Erect 99 Occupancy R3 Lot 32 Block 1 Sec/Sub. BLACKHAWK GLEN Remodel ❑ zoning R1 Parcel No. Repair ❑ Type of Const. V Addition ❑ No. Stories cc Name LUNDGREN BROS CONST INC Move ❑ Length 66 z 935 E WAYZATA BLVD Demolish ❑ Depth 35 3o Address Int Impr. ❑ Sq. Ft City WAYZATAPhone 473-1231 Install ❑ z o Name SAME Approvals Fees -c Address Assessment Permit $ 530.50 City Phone Water & Sew. Surcharge 54.50 Police Plan Review 265.25 F W Name THOMAS A WHITTOCK Fire SAC 625.00 Z Address 18402 AVON CT 525.00 v ~ Eng. Water Conn. a W City EDEN PIJA IE 934-0665 Planner Water Meter 67.00 Council Road Unit 305.00 1 hereby acknowledge that I have read this application and state that the Bldg. Off. Tr. PI. 18 0 . -Q O information is correct and agree to comply with all applicable State of Minnesota Sta tes and C' of Ea an Ordinances. APC Parks Signature of Permitt Var. Date Copies Total $2.552.25 A Building Permit is i sued to. LUNDGREN BROS CONST INC on the express condition that all work shall be do a in accordance with all applic a ate of Minnesot tt s and City of Eagan Ordinances. Building Official t ~ c? # CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 N2 18874 1 ' -7 9 BUILDING PERMIT PHONE: 454-8100 Receipt # ( 7 1 0 ~ To be used for DECK Est. Value $1,000 Date APR 10 , 19_91 Site Address 1563 BLACKHAWK HILLS RD Lot 32 Block 1 Sec/Sub BLACKHAWK GLEN 1 S OFFICE USE ONLY Parcel No. Occupancy FEES Zoning - Name RANDY RUEGG (Actual) Const Bldg. Permit 2 5 - O0 f Address 1563 BLACKHAWK HILLS RD (Allowable) Surcharge - 50 City EAGAN Phone 454-M 852 # of stories - 12' Plan Review Length c Name LUNDGREN BROTHERS Depth 14, SAC, City 0a Address 935 E WAYZATA BLVD S.F.Total SAC, MCWCC City WAYZATA Phone 473-1231 S.F. Footprints - On Site Sewage Water Conn W W Name On Site Well Water Meter i? Address MWCC System Acct. Deposit ¢6 City Water <W City Phone y PRV Required S/W Permit I hereby acknowlege that I have read this application and state that the Booster Pump S/W Surcharge information is correct and agree to comply with all applicable State of Minnesota Statutes and City gff n Ordin nc~ Treatment PI Signature of I wndee •c f !tom APPROVALS Road Unit A Building Permit is issued to: Planner Park Dad. on the express condition that all work shall be done in accordance with all Council applicable State of Minnesota Statutes and City of Eagan Ordinances. Bldg, Off. Copies Variance TOTAL 25.50 Building Official ~~t~~. GeLm ea JiF PAP PERMIT` ~L__ ! ADDRESS 3 pin PICKED UP BY (i- J' 32- CITY OF EAGAN Permit No. 8552 date 3_1=~8" 3830 Pilot Knob Road Meter No: Size P.O. Box 21199 Reader No. Date: Eagan, MN 55121 Owner. Lundgren Bros. ftnstruction 1363 o. c e s W. LJZ 151 C lwi Site Address: Plumber. LUMS-aft Bros. ntWEI-Ig Conn. Chg: - 52pd Zoning: Acct. Dep' = L .J. Uu No. of Units: s I() 0j37pa Permit Fee: ' Surcharge: I agree to comply with the City of Eagan.. Tr. Plant dU' 00p Ordinances. Meter. b?. afta Misc.: By WATER SERVICE PERMIT CITY OF EAGAN SEWER SERA % PERMIT 3830 Pilot Knob Road g 02 P.O. Box 21199 PERMIT NO.: Eagan,.MN 55121_ DATE: -13-87 Zoning: 81o~of Units: Lundgren Bros. Owner. Address: ` 1563 ac w S 8 S 1& Site Address: Plumber. LundVen. Bros. am g ~4=71237 1 , p agree to comply with the City of Eagan Connection Charge: 525.00Ud Ordinances. Account Deposit: 15.OOp4 Permit Fee: 10 OOpd Surcharge: • 50pd By Misc. Charges: Date of Insp.: Total: Insp.: Date Paid: CASH RECEIPT CITY OF EAGAN 3830 PILOT KNOB ROAD EAGAN, MINNESOTA 55122 DATE' 19 Rr.cciVED FROM AMOUNT & _DOLLARS +00 CASH ~kIECK FOR I • fr i" i ~J ` j`e' j! •i" ~~i /5 - J FUND CODE AMOUNT Thank You, B ?1237 White-Payers Copy Yellow-Posting COPY Pink-File Copy 7 .-esr~.:,:'nir7w ~!!:F^4FP,aizrk;:_s+~i 3.-.•F4 r :;r BLDG. E $M'I" 1 N 0 ! 41-3210 B1 . Permit 01-3422 Plan Check 01--344. Surch. /Adm. 01-3446 SAC/Mm, Q1-2155 Surcharge 17-3460 Raed -Unit u 20.2275 SAC .57 20--38,65 Wato-x Coun. U 20-3868 Wat€:r Trmt. 20-3716 Wator Weer '7 U 20-2252 AtDep. 20-3713 Water, ?emit 20-3743 Seger Permit 79-3866. Se"t Conn. 11-3855 Park Decd. t _ Q As- . 00 2006 RESIDENTIAL BUILDING PFwT APPLICATION 2 City Of Eagan G 3830 Pilot Knob Road Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 C New Construction Requirements Remodel/Repair Requirements C)ffioe se:t5n 3 registered site surveys showing sq. ft of lot, sq. ft. of house; and L11 roofed areas 2 copies of plan showing footings, beams, joists Cerf of Si rvey kl- l . _ N (20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions Soils Report Y -N 1 Soils Report if proposed building is to be placed on disturbed soil 1 site survey for additions & decks TRe Pres, Plan,' ~Y . N. 2 copies of plan showing beam & window sizes; poured found design, etc. Addition - indicate If on-sde septic system Tree Pros Required _ Y N 1 set of Energy Calculations t3nlte Septic Sjrs(slr► y N 3 copies of Tree Preservation Plan I lot platted after 711193 Rim Joist Detatt options selection sheet (buildings with 3 or less units) Minnegasco -echanical ventilation form Date -L~ / 3 / Construction Cost S j g Site Address 3 G l 16 1'%" )L ~l S 12 cl Unit/Ste # Description of Work e u v t) 9 Multi-Family Bldg _ Y - N Fireplace(s) _ 0 - 1 2 Property Owner T a m a J& N t li Q S t k -1( Telephone # S)) S 8 2 4 Contractor Elek a6t',-,I ~mS7t~ke~d/~ / Address ~`~%YJD/^i'r 1 /V City (~57) ~ ~ y ~ ~ State M Al Zip U~S4rP~ Telephone # COMPLETE THIS AREA. ONLY IF CONSTRUCTING AN EW BUILDING Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672 Energy Code Category • Residential Ventilation Category 1 Worksheet New Energy Code Worksheet (J 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 r 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 approval of plans. . Applicant's Printed Name Applicant's Signature 6Uc~9l~ 15.5 2004 RESIDENTIAL PLUMBING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN MN 55122 651-675-5675 Please complete for modifications to existing residential dwellings. SCHULL, TOM Date 23 1 _Cry 1563 BLACKHAWK HILLS ROAD Site Street Address EAGAN, MN 55122 Unit # (651)405.8002 Property Owner - - - relephone # ( ) Contractor - (612) 8274M Telephone # { ) Address 2905 GMF1EW AVE. SQ. city stow zip MINSPNIENDOW, MN 65408 The Applicant Is: _ Owner Contractor ,-Other Alterations to existing dwelling $ 50.00 -Add fixtures to rooms, excluding water softener and water heater -Septic System Abandonment F Water Turnaround (add $121.00 ff a 5/8" meter is required) Other. ater Softener Water Heater $ 15.00 replacement _ additional _ Lawn Irrigation System RPZ_ new _ repair -rebuild $ 30.00 State Surcharge $ 5Total s ` r' OW. $ ( 5.60 SEP I hereby apply for a Residen Plumbing Permit d acknowledge that the information is complete and accurate; that the work ill be in co with the ordinances and codes of the City of Eagan and the plumbing cod erstand this is not a permit, but only an application for a permit, work is not to start without a permit and work will be in accordance with the approved plan in the event a plan is required to be reviewed and approved. jam-(- 1~0 rb1,avv\, Applicant's Printed Name AppMEM Sign re RESIDENTIAL BUILDING PERMIT APPLICATION Q CITY OF RACM 3830 PILOT KNOB RD - 5512 651-887-4876 • 3 regidewl site surveys shawkrg sq. it of lot, sq. R of house: on* roofed areas • 2 c oOn of pW (20% maximum lot oover~e abed) • 1 set of E-rrergy Colmisli s for hwied adgM.one 2 copies of plan sho vV beam & wkdow she; pwsed found design, etc.) • 1 site sunrsir for soft addgi n &derlei . 1 ad of Energy Calcumlom • trrdicata 1 horrre awed by aapdc syatam for addfdore 3 copies of Tree Preservation Plan I lot pram! sitar 711193 • Rkn Joist l Oplim selec M sheet (bldgs with 3 or teas ws) DATE - a - VALUAION JOB SITE ADDRESS IF MULTI-FAMILY BUILDING, HOW MANY UNITS? PROPERTY OWNER t TYPE OF WORK i FIREPLACE(S) -0-1 2 APPLICANT P1i4NE#__ L051!~ ~ ADDRESS S ZIP CODE PAGER # CELL PHONE # . 01 FAX # NIEW RESIDENTIAL BUILDING ONLY- FILL OUT COMPLETELY Energy Code Category MINNFSOTA RULES 7670 CATEGORY 1 (check one) - Residential Ventiia#ion Category 1 Worksh6M SubmMed Energy Envelope Calculations Submitted MINNESOTA RULES 7672 New Energy Code Worksheet submided Plumbing Contractor: Phone Plumbing System Includes: Water Softener _ Lawn Sprinkler Fee: .$90.100 _ Water Heater No. of R.I. Baths No. of Baths Mechanical Contractor Phone # Mechanical System Includes: - Air Conditioning Fee: $70.00 Heat Recovery System Sewer/Water Contractor Phony # All above information must be subm'dted prior to processing of applicaWn. I hereby acknowledge that I have read this application, state that the information is c t, a Oly with all applicable State of Minnesota Statutes and City of Eagan ?rdi antes. IM A. -ff I 14. Al Signature of Applicant Certificates of Survey Received Tree Preservation Plan R~~J Not R"ulred Updatad 1101 PERMIT # l S` RECEIPT DATE: RESIDENTIAL PLUMBING PERMIT APPLICATION CITY OF E AGAR 3$30 PIII.OT KNOB Iii;D EACM, MN 55122 651-6$1-4675 Please complete for: ➢ single family dwellings ➢ townhomes and condos when permits are required for each unit ➢ backflow preventer for irrigation system C~ (~o SITE ADDRESS: Ise - v OWNER NAME:: TELEPHONE ~5 ~-I OS OO' (AREA CODE) INSTALLER NAME: a TELEPHONE M (AREA CODE) STREET ADDRESS: CITY: STATE: ZIP: Place a check mark next to the permit work type New residential dwelling unit under construction and not owner/occupied $ 90.00 Add-on, modification or alteration to existing dwelling unit, including: $ 50.00 • abandonment of septic system • new installation/repair/rebuild of RPZ • lawn irrigation system • water turnaround Nature of work: 60(J ' ~ e~ _ Septic System, new/refurbished - $ 225.00 • includes County & Consulting Inspector fees • requires MPC license _ Water tumaround - existing dwelling unit, including: $ 50.00 • 518" meter 115.00 $ 165.00 State Surcharge $ .50 Total $ Reminder. Schedule inspections of alterations, i.e. water heaters, water softeners, water turnaround, etc. I hereby acknowledge that l have read this application, state thatthe information is correct, and agree to complywith all applicable Cityof Eagan ordinances. It is the applicant's responsibility to notify the property owner that the Cityof Eagan assumes no liability for any damages caused by the Cityduring its normal operational and maintenance activities to the facilities constructed under this perm' z= f-way4paseme 1Y Yk SIG AT RE OF PERMITTEE Updated 9/01 13vJ06 1987 BUILDING PERMIT APPLICATION - CITY OF EAGAN SINGLE FAMILY DWELLINGS INCLUDE 2 SETS OF PLANS, 3 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, $2,000 LANDSCAPE BOND OHO K To Be Used For: Valuation: Date: Site Address OFFICE USE ONLY Lot Block On Site Sewage Occupancy CZ 3 MWCC System ✓ Zoning Q1 Parcel/Sub On Site Well Type of Const City Water (Actual) Owner (Allowable) :9-- # of Stories Address Z Length C0C Depth _ 3S City/Zip Code X539 S.F. Total Footprint S.F. Phone - /off. 3 f APPROVALS FEES ~O Contractors Assessments Permit 530- - Water/Sewer Surcharge SgL Address Ito Police Plan Review Z(o5. s Fire SAC, City City/Zip CodeQ Engr SAC, MWCC Planner Water Conn S Z Phone 'Y'2 3 -1--231 Council Water Meter (o7. Bldg Off Road Unit 305 Arch./Engr. APC Treatment P1 (8U_ Variance Parks Address e Copies TOTAL, a S " City/Zip Cod L'- ss3f` Phone # 231-666,57- jo.:~~ -SURVEYOR'S" CERTIFICATE', SIENNA CORPORATION . N69°5423 "E 21 54.87 (3 36. 0) 150 28 20 0 0 0 1 8 UTl~AS a~EµENT 08 nor 32 ~ LLJ 3 1 ~ tics Ig ~l) • `_~zs2_ 34.-8 (834.$) 48.0 0 (Y1 c o ~ o ,may " t8~25) b e .c-1 N to PROPOSED N N HOUSE 70 0 o H C6 23,67 GA 0 Z , o - J (a42 s~ 12.0 0~ 0 11.0 06 ^ - 019. o , .842, s_;,~ Apt: , ` J lV, ` o 0 % 8944 1$ Ig9 X36 ,QO 10 PG - ~D M DENOTES PROPOSED SURFACE DRAINAGE SCALE: 1 INCH = 30 FEET p DENOTES IRON MONUMENT SET PROPOSED GARAGE FLOOR = $47•$ FEET O • DENOTES IRON MONUMENT FOUND X000.0 DENOTES EXISTING ELEVATION PROPOSED LOWEST FLOOR = 835,1 FEET (000.0) DEMOTES PROPOSED ELEVATION PROPOSED TOP OF BLOCK WE HEREBY CERTIFY~TO SIENNA CORPORATION THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF: Lot 32, Block I, BLACKHAWK GLEN 1sT ADDITION, according to the recorded plat thereof, Dakota County, Minnesota. 1985AS SURVEYED BY IT DOES NOT PURPORT TO SHOD! IMPROVEMENTS OR EDAY NCROOACHMEN S, IF ANY. ME OR UNDER MY DIRECT SUPERVISION REVISED 2-22-87 TO SHOW A SIGNED: JAhJE ILL, INC. PROPOSED HOUSE FOR LUNDGREN BROS. CONST. BY: HAROLD C. PETERSON, LAND SURVEYOR MINNESOTA LICENSE-NUMBER 12294 PROJECT NO. BOOK /PAGE JAMES R. HILL, INC. 85618(g7 0 99 4~4 Planners / Engineers / Surveyors FILE NO. 6200 Humboldt Avenue South FOLDER Bloomington, Mn. 65431 612-884-3029 (-C)NSIRUCTIo[a TA 5539-1 (612) 47-'-1231 tNAYZATA BOULEVARD v.tiYZATA. 1✓1I~t~CSO 935 EAST EY.fEP,IOP. E[;VELOPE AVERAGE U CO'4PUTATJON ~ Site Address R U R & U Factors .058 Opaque Walls -117 Vial] Framing Areas .O23 Ceiling Insulation Area -027 Ceiling. Framing Area 04 Rim Joist f,'asonry Wall - .26 -iindows Double Hung 4c_ Casements _18 Doors - _46_ Patio Dobrs .47 Sldellte.s 1) Lower Level (basement) Total exposed wall area - = x (U) -058 Opaoue hall Area x (U) .117 = 14ood Frame Area x (U) -04 = Rim Joist Exposed block Window Area Casement ~x (U) .26 = - - Double Hung _ x (U) -46 = Sliding Glass Door ----x (U) I S = Door Area Total ` R j 0 ccot'jSTRUCI ON J. 11~c' VJAYZATh, IJ,INIaE507A 55391 (612) 473',231 g35 ERST v~AYZf{T~, ~OULEV/~RD 2) lst or main floor Total exposed gall area r,~S Opaque wall area Mx (U) o58 (U) 317 blood frame area (U) . 0 4 Rim joist Casements --x (U) .45 bii ndow Area i 26 = f Double Dung (U) - - x = (U) -46 Sliding Glass Door - ~I x (U) -13 Door area ~x (U) -47 Sidel i tes Total :3) 2nd floor if 2 story ' Total exposed wall area S/x (U) .058 opaque wall area c ~'x (U) .117 = 'kood frame area ~u~ U_ 4 6 1-Jindow area Casements 26 = _ •1s Double Hung ~x (U) .46 = Sliding glass door r x (U) .18 Door area Total - 0 4) Total ceiling area /x (U) .027 D' Wood frame area Lx (U) - 023 = Opaque ceiling area x (U) 55 = Skylight f Total --T _ _.a F6) CONSI RUC1 ION 0 INC. (6 9'S 9315 EAST WhYZhTl, BOULEV/,RD VJAYZ~.Tti, t1~~I~NEIOTA S53y1 12) X73 1231 ~a x 11 = Minn. U Factors Total er.posed vial l area area_ r. .020 Minn- U Factors Total exposed ceiling (A) Total = + Item 3 + Item Item 1 + Item 2 / Q, If total of Items 1 - 4 is less than Item (A), building complies with SBC 6006 (C)s 6 1941 BUI N I AP ICATION CITY OF EAGAN SINGLE FAMILY DWELLINGS MULTIPLE DWELLINGS COMMERCIAL 2 SETS OF PLANS 2 SETS OF PLANS 2 SETS OF ARCHITECTURAL 3 REGISTERED SITE SURVEYS REGISTERED SITE SURVEYS - & STRUCTURAL PLANS 1 SET OF ENERGY CALCULATIONS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS 1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS # OF RENTAL UNITS # OF FOR SALE UNITS PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING DAY OF MONTH IN WHICH REQUEST IS MADE. LOT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED. NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSTJED. PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED. PERMIT MUST SHOW A LICENSED PLUMBER. To Be Used For: b£C Valuation: f~ Date: Site Address 61040. ) 11) OFFICE USE ONLY Lot -3<Z Block FEES Occupancy Bldg. Permit II f l {f Zoning Surcharge Parcel/Sub ~atc,Y~act~ ~re ( 1yo~d' Actual Const Plan Review Allowable SAG, City Owner an v J9C~iGr , # of stories SAC, MWCC JI / ,Q Length / Z' Water Conn. Address fit line pl~la R~ Depth Water Meter S.F. Total Acct. Deposit City/Zip Code Footprint S.F. S/w Permit S/W Surcharge Phone Z1531- eq y~ Y On site sewage Treatment Pl. On site well Road Unit Contractor L arr~re-r gfos• MWCC System Park Ded. r Q City water Trail Bed. Address 9 3 C~srrG,~a, lJ ~r'rJ'. PRV Copies Booster Pump _ City/Zip Code GC/ra~~a~~j 5-5 / SUBTOTAL APPROVALS Penalty Phone Y Z 11 2 3 1 Planner Lot Change ~f Council TOTAL.. Arch./Engr. ~tr P~rr U~'DS r Bldg. Off. -9 v -g., ,C Variance Address Q~a Sl/ City/Zip Code Phone ' agrees that all work shall be done in accordance with (Signature contractor) all applicable State of Minnesota Statutes and City of Eagan Ordinances. . ` r SIENNA CORPORATION SUR~/EYOR s', CERTIFICATE N69054'23 E J-., Gam.... E 54.87 (83G o) 50 ° 28 2p Q 1 o 10 5H e n 1 I- . LC)T 32 N (8393 T S 0) 0 48.0 Q - - C; H'N (d PROPOSED ($4 HOUSE 1 .0 g h n yP, N 23.67 GAR. C; Ui f Z' 'h Q / N O n C p y o .4 10 I ~'Y~€ lit I a Q It <99 fa P/8 0) 4g'' ~P Ls DENOTES PROPOSED SURFACE DRAINAGE SCALE: 1 INCH 30 FEET O DENOTES"IRON MONUMENT SET PROPOSED GARAGE FLOOR = 84Z.1% FEET V Jv ' a x 0 DENOTES IRON MONUMENT FOUND 1 ~t a~~';:>XObb, o DENOTES EXISTING ELEVATION PROPOSED LOWEST FLOOR 835I FEET PROPOSED TOP OF BLOCK = $43.2 FEET r/dj } r 4 (000.0) DENOTES PROPOSED ELEVATION VIE HEREBY CERTIFY TO SIENNA CORPORATION THAT THIS IS A TRUE AND CORRECT `REPRESENTATION OF A SURVEY OF THE BOUNDARIES F. Lot 32, Block I, RLACKHAWK GLEN 18"T ADDITION, according to the recorded plat thereof, Dakota County, Minnesota. i ' BY ENCROACHMENTS, IF AN AS SURVEYED 1985. I.T DOES NOT PURPORT TO SHOD IMPROVEMENTS OR ME OR UNDER MY DIRECT SUPERVISION THIS 3 'REVISED 2-22-87 TO SNOW A SIGNED: JAME" ]ILL, INC. ~ PROPOSED HOUSE FOR j / LUNDGREN BROS. CONST. 4Y, LAND SURVEYOR • HAROLD C. PETERSON, °;r'•:: MINNESOTA LICENSE NUMBER 12294 PROJEC. OOK /PAGE JAMIS R, I-{Ij~,]~, ING. ers / Engineers / Surveyors Plann 8200 Humboldt Avenue South 2: I v' FILE NO, FOLDER Bloomington, MN 65431 812-884-3029 CITY O F' E A G A N cmm DoEss N~ a xAT TIM OF vm= APPROVAL OF PERMM APPLICATION FOR PERMIT * INSPECTION OF SEWER AND/OR WMTM * ROMIZ.ATIONS WILL NOT BE SCHE- SEWER AND/OR WATER CONNECTION tiLID UNTIL PEST HAS MEN APPROVED. (Please Print 1) PROPERTY ADDRESS: LEGAL DESCRIPTION: (Lot/Block/Subdivision or Tax Parcel ID ) IF EXISTING STRT-LM''RE, DATE OF ORIGINAL BUILDING PERMIT'ISSUANCE: ~ - • PRESENT ZONING/PROPOSED USE: (Month/Year) CONwERCIAL/RErAIL/OFFICE R-1 SINGLE FAMILY Q INDUSTRIAL Q R-2 DUPLEX (TWo Units) Q INSTITUTIONAL/GOVERNMENT R-3 TOWNHOUSE (Three + Units) ( Units) R-4 APARTMENT/CONDOMINIUM ( Units) 2) IFTUDAMMUM NAME: -Z CA/Vol ADDRESS:t3.~j! a'L S GV a2 tl 2-Z CITY, STATE. ZIP: a.•3_,v~,y~~_,~~ G~ , PHONE:_Y7;j - 1-2 3) NAME. For City Use L+ /,Vej Plumbers License: ADDRESS: Active Expired CITY, STATE, ZIP:-LV -2- 2- A-7 AO( f A4 4L ' Not recorded i PHONE:G, )Z MASTER LICENSE# Staff In~.tial NAME: i ADDRESS: CITY, STATE, ZIP: PHONE: 5) ILI • w N 397) &,1 a: • My • to - CONNECTION TO CITY SEWER ,CONNECTION TO CITY WATER OTHER 6) PLEASE HOLD APPROVED PERMIT FOR PICK-UP BY ONE OF ABOVE - PLEASE MAI APPROVED PERMIT TO 1, 2, 3, 4, ABOVE 7) URR77 • (Circle one) • Q~/~' • y: • c is • • • . • i- a• • • - a i:+• • r w~1- :15 • . y• • • • FOR CITY USE ONLY PERMIT # ISSUED T- Pd w/Bldg. Permit FEES: $ $ i! SEWER PERMIT (INCLUDE SURCHARGE) $ $ WATER PERMIT (INCLUDE SURCHARGE) $ $ WATER METER/COPPERHORN/OUTSIDE READER $ $ WATER TAP (INCLUDE CORPORATION STOP) $ $ SEWER TAP $ $ ACCOUNT DEPOSIT - SEWER $ $ j7-•~ ACCOUNT DEPOSIT - WATER WAC SAC $ $ TRUNK WATER ASSESSMENT $ $ TRUNK SEWER ASSESSMENT $ $ LATERAL BENEFIT/TRUNK SEWER $ $ 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 CbNDITIONS: APPROVED BY: j- TITLE: DATE: _ ~~:j PERMIT City of Eagan Permit Type: Building Eagan. Permit Number: EA093987 Date Issued: 05/18/2010 OR Permit Category: ePermit 41~ it~ of E3 E Site Address: 1563 Blackhawk Hills Rd Lot: 32 Block: I Addition: Blackhawk Glen PID:10-14350-320-01 Use: Description: Sub Type: e-Windows iDoors Construction Type: Work Type: Windows Doors-New ; Replacement Description: House Census Code: 434- Occupancy : Zonin,: Square Feet: 0 Comments: Improvements to the home require smoke detectors in all bedrooms. If altering window openin,s, call for framing inspection. Call for final inspection after installation. Carbon monoxide detectors are required by law in ALL single family homes. Fee Summary: BL - Base Fee S3K $88.50 0801.4085 Valuation: 3.000.00 Surcharge - Based on Valuation S3K $1.50 9001.2195 Total: $90.00 Contractor: - Applicant - Owner: Renewal Andersen Thomas E Schull 1920 County Road C West 163 Blacldiawk Hills Rd Roseville NIN 55113 Eagan NIN 55122 (61)264-4777 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 Eagan Ordinances. ApplicantiPermitee: Signature Issued Bv: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA124760 Date Issued:07/10/2014 Permit Category:ePermit Site Address: 1563 Blackhawk Hills Rd Lot:32 Block: 1 Addition: Blackhawk Glen PID:10-14350-01-320 Use: Description: Sub Type:Reroof Work Type:Replace Description: Census Code:434 - 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 by law in ALL single family homes . Tia Lindroth 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 - Thomas E Schull 1563 Blackhawk Hills Rd Eagan MN 55122 Weatherguard Construction 10860 60th St N Stillwater MN 55082 (651) 439-4320 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA129360 Date Issued:02/03/2015 Permit Category:ePermit Site Address: 1563 Blackhawk Hills Rd Lot:32 Block: 1 Addition: Blackhawk Glen PID:10-14350-01-320 Use: Description: Sub Type:Fireplace Work Type:Gas Fireplace (new) Description: Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Improvements to the home may require smoke detectors in all bedrooms. Chimney / flue must be inspected prior to concealing. Carbon monoxide detectors are required by law in ALL single family homes . Valuation: 3,000.00 Fee Summary:BL - Base Fee $3K $88.50 0801.4085 Surcharge - Based on Valuation $3K $1.50 9001.2195 $90.00 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Thomas E Schull 1563 Blackhawk Hills Rd Eagan MN 55122 Hearth and Home Technologies 2700 N. Fairview Ave Roseville MN 55113 (651) 638-3309 Applicant/Permitee: Signature Issued By: Signature vaC n�uG v� o�..r►�.n nm r--'------^-- � FO�O�C@ U5@ ��` � � " � p� I • � Permit#: V� I �� I Permit Fee: �_ � ': � � � � 383Q Pilot Knob Road � � Eagan MN 55122 i Dafe Received: i � Phone: (65'I)675-5675 i staff: � Y4 Fax: (651)675-5694 �-----------------� 4 2Q'14 RESI�EN�IAL�PLUIVI�ING PE�iIMIT APPLICATION Date: �" Site Address: � � �� L� ��1��. �� -� � �� •�' -r----�-•�- c�------ .►i-� Tenant: 1 ��' Suite#: ��, __ �-.�,;,,��.. h„. . ��. . . �. .. . . _ F . .._ ;; - .,:..:;�; _ e ?, i � � ��'��.�,�1`1�" Name: � ��1°l. �C°...�-�.1�_� Phone: - : � � , l; � , �"� Addre��s/C�ty/Zip� f-C'�h L_.f-t.C��1��IV S�l � � ��,��. . ., � . . . .. . . . ..... ., . .��%f1�e� �- �- l� I n NameF lK ��Il� TJ�L �.;�l�T� `�''�i�ense#: � �..�„1� .1..>. >..r. � ' 'r Address: L.�� City: ��.1 C�� _ ,` � ��:.:4�fr, � - � �`/ /�; , F ,�_;_�,:;,��` K ,,S� State: �� Zip: �,7�� Jb Phone:� �� Z��n ��(cc� , ,, � > 6 h Y ?j.�."v5?�� ''i '�. '. �::��,2y��: , _..r:[: ; :: r.; ..:;>:' a c �:� i �� f . . .�' � E'+:.. . . . . .... I , � Contact: � ��,�v . �. �� e� ��-� • . . �,,. �.�,$��.�:�.�� .,�.�,,��..,�� EmaiL• C� r � �'` � =::3:�-- t t� ti: � t,� f f, t�� , ^ /1�y�i /{'�yy(�� New Replacement _Repair Rebuild Modify Space _Work in R.C�.W. 4 i��1/11.,��}'ki'f�L�3;?;4:1 - - � �i �:::i��:�;:� -;,fi:s. . �i ;��; ='"ri� e.�':`'ri:::�:�3'(�; �.... %:`:$?'r .. : .:. ;::.;c.i:::.�:t �: a;x�' O WOf�C: � .,n::,v>:...:.::"��..,�; ;�:..C, Description f ,:�� _ ,., .,�. .� �-;-�r�,�:��;;�wTs _ . . . _ . �. i, `� �'�`� <<��r RESIDENTIAL c �13 � ;� ,�.i`:::.Z"Y�.. � ,�"'�YI� . ... . . r �. '�"�',.L'Q`5 !£ )y jd y Water Heater � . � .. � . � � . . .. �; � i � �Water Softener �; � r ,, r r ,4i �.awn Irtigation(_RPZ/_PV8) 4 p��'�� Add Pl�umbing Fixtures(_Main 1_Lower Level) ,; r � r �� Septic System ;; _=:;�: � �:>�>= =:;'�;�_.:; ��: i: �r < Water Turnaround i. New f;..:,: _ ,:<;�::. - ti ;z�;; � � � $ Abandonment ...�,..��.,..,-.�,�._ ,..-�.,- .�_-�.,-n�_.. .�,.-�-,-Fm . ,_; _ : ` :: ,�� - �-;,.�:��,,�M�.�,��,, ��;�� _�_�.,��<�..-,�.�,.��,m�,.�,.. .�-�� .�.,�-..��,-�-P, i �, � RESIDENTIAL FEES: '' � � $60.00 Water Heater,Water Softener, or Water Heater and Softener(includes�5.00 State Surcharge) �: � " $60.00 Lawn irrigafion(includes$5.00 min�mum State Surcharge) '' � $60.00 Add Plumbing Fiactures, Septic Svstem Abandonment,Water Turnaround*(includes$5.00 State Surcharge) ,; 'Water Tumaround(add$200.00 if a 5!8"meter is required} ;; � � $115.00 Septic SVstem NeW($10.00 per as built)(includes County fee and$5.00 State Surcharge) �� !�, TOTAL FEES$ �. �.... _.�,,.�,�� _ ..�.,,��.��..r�,.��.�,�� ,.�.�:�. .�� ,� �.�_-..,� :.�-.� � �,.-�....�.c..ro.�.�r_. r CALL BEFORE YOU DIG. Call Gopher State One Call at(B51)454-0002 for protection against unc�erground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www aopherstateonecall.ol'p 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 afi Eagan; that I understand this is not a permit, but only an appfication for a permit, and work i�� not to start without a permit;that the work will be in accordance with#he approved plan in the case of work which requires a review and approval of plans. X��,,�-�� X ��;��-�i� Applicant's Printed Name App ic nt'��Signature ; } _ w.w:,, _. . . ._ .. .. ... ......v�.......:.�...:.:.v......,.....:,>v: .,.u'/k.,vv.v....A"a��'Ni".i ':'«:-..S:s:::e4:�V' v�':sb::. .5.. ..'is ti,:�S-"`w�e ix ^.5..'k.sS`. >}:::: ..._,..,,;��..._..:.......,v,r:�;:c:......n.:.:,.;fi>.,;. �J.cj ';:+k�: ...._..... .. .. ._.-��.,._,....,........,.... ..........; :;.A.•,�; ... .. .-..-�::...a ... . .. ,v .. .:rf^�,,y:..y..�. :c:"k•.<.�: ..v.. 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','r'eS .•, �..�.. ...^..tKF y .. . ,....:c.(,�•r: v`zs..Y'�'i3'::u. �.�. Sa. ' Q .:t:\..:>: :1!::' .U:#:l:l%"..'.n ..?"e'�M.'. �.:�'I f�C': d`=� YtY' - (..S�.b�� (� (�. t:n3{'/+r �.�''''ti .ti;t ,.•ZT.. :ldi>:,'.'Fc''�::::"'>ii'�<j`i:';r[�>ii::svz:i<:::'�:; :f�i..,.y :cYYo �. ,�� Mv:��;:3:.ti`w^"w�X'��;11��..Cl-��*�. �3:. y�...'�.�'-'.:��, _ , .,5.. ' ' . �:::>lYl..�i,..,�.£,.�`'�.-��..,�e:��r..t„`!'��;:::�i ��;.� ax ��"e'�'� 5�a:��?"•,.w:a .�...'�' .a ...r..r.., ��,.^; - �� - . PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA136467 Date Issued:05/16/2016 Permit Category:ePermit Site Address: 1563 Blackhawk Hills Rd Lot:32 Block: 1 Addition: Blackhawk Glen PID:10-14350-01-320 Use: Description: Sub Type:Residential Work Type:Replace Description:Water Heater Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087 Surcharge-Fixed $1.00 9001.2195 $60.00 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Thomas E Schull 1563 Blackhawk Hills Rd Eagan MN 55122 (651) 485-7623 Appliance Connections Inc 12850 Chestnut Blvd Shakopee MN 55379 (952) 445-4803 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA179250 Date Issued:09/26/2022 Permit Category:ePermit Site Address: 1563 Blackhawk Hills Rd Lot:32 Block: 1 Addition: Blackhawk Glen PID:10-14350-01-320 Use: Description: Sub Type:Furnace & Air Conditioner Work Type:Replace Description: Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507) Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088 Surcharge-Fixed $1.00 9001.2195 $60.00 Total: This permit shall be null and void if work does not start within 180 days of issuance, or if work is suspended for 180 days or more after started. 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 - Thomas E & Janette M Schull 1563 Blackhawk Hills Rd Saint Paul MN 55122--121 Standard Heating & Air Conditioning 130 Plymouth Ave. N Minneapolis MN 55411 (612) 824-2656 Applicant/Permitee: Signature Issued By: Signature