3923 Blackhawk RdCity of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 3923 Blackhawk Rd
Lot: 57 Block: 6 Addition: Cedar Grove 6th
PID:10- 16705 - 570 -06
Use:
Description:
Sub Type: e - Fixtures
Work Type: Additional
Description: Basement Fixtures
Meter Size Meter Type
Comments:
Fee Summary:
Contractor:
Bruckmueller Plumbing & Heating
3992 Pennsylvania Ave
Eagan MN 55123
(651) 686 -6696
Total:
Manufacturer
Eric Bruckmueller
3992 Pennsylvania Avenue
Eagan, MN 55123
PL - Permit Fee (miscellaneous)
Surcharge -Fixed
I hereby acknowledge that I have read this application and state that the informa
of Minnesota Statutes and City of Eagan Ordinances.
on is correct and agree to comply
h all applicable State
Applicant/Permitee: Signature
PERMIT
City of Eaan
- Applicant -
$50.50
Owner:
Ann T Wiggins
3923 Blackhawk Rd
Eagan MN 55122 -1731
Permit Type:
Permit Number:
Date Issued:
Permit Category:
Serial Number Remote Number
$50.00 0801.4087
$0.50 9001.2195
Issued By: Signature
Plumbing
EA078748
07/11/2007
ePermit
Line Size
OF EAGAN Remarks Sew &wtr permz.ts and sew & wtr conn. pd.. on W4-69
Addition Cedar Grove #6 . Lot 77 Bik 6 Parcel 1 o 16707 770 o6
owner streec ?Q2_3 Blackhawk Rd. state Eagas1X 55122
Improvement Da e Amount Annual Years Payment Receipt Date
STREET SURF, l060•1 1 Qb.o2 10 Paid
STREET RESTOR.
GRADIPVG
SAN SEW TRUNK
3?- SEWER LATERAL 1970 1472.00 20 P87..d
WATERMAIN
-? WATER LATERAL 1970 ZO
WATER AREA
? STORM SEW TRK 1970 20
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. 200.00 1323 -18-6
BUILDING PER.
sAC 200.00 1323 -1
PAR K
?
EAGAN TOWNSHIP
d?
BUILDING PERMIT
Owner----.•-----••• ' ? .
-••••--------•
Address (preseni) ,'tez?;
Builder .................................
•--...._
-•-------------•----------._......----•---.._._....._.
Addresa --•• ?---------•---------------------•---••---••-•••----•------•----•---•...----•---••-•---••-
N° 1983
Eagan Township
Town Hall
Date ?8
---_..----•---•- ..............
This permi2 does not suihorize the use of sfreefs, roads, alleys or sidewalks nor does it give the owner or his agen2
the righ! 3o create any si2uafion which is a nuisance or which presents a hazard !o the heal#h, safely, convenience and
general welfare !o anyone in the communily.
THIS PERMIT MUST BE KEPT ON THE PREMISE WHILE THE WORK IS IN PROGRESS. - ,
This ia !o certify, 2hat.... %-=-• b_-•--- -•••------------- ••--_............. has permission to erect a--?••----•-•-•--
the above described premise subject to the provisions of the Building Ordinance for Eagan Township adopted?p11,
1955
?•---...'?c.?-•-•••••°-••• Per
?
- -•-•---.--`
- -•°•-•---•••••°-• . Q ---. .............. --• ? ---r.._..l?? - - - ----------------------
Chairman•=-•- . .
-` of•Tnwn Boa? Building Inspector ?
DESCRIPTION
52ories To Be Used For Fron2 Depfh Height Esi. Cos! Permi! Fee Remarks
--
rt`?'?
LOCATION
,TU#4-2*?,4 2007 01 : 1 7J+PM
V V ~i??? cn)'-O ,
STANDARD WATER CONTROL 763 537 1882
City fJf Eagan
3830 Pllot Knob Rosd, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Ca?sWCtl??ffi
3 ragistered sIM surveya ahowing sq. R, of bl, aq, ft, ot house: end ig roofed araes
(20% meximum lat cover8ye allowed)
13olls Report i( propoaed buildlllq i8 W be plebdtl on dlatur4ad soil
2 ccpi6s of pW 6houWng bsam & aih?dow alzea; paured fOUnd deslgn, etc.
7 eet Ot Enorgy Celculstlons
3 coplee of Tree Preaervallon Plan it iot pleUed BAar 711193
Rlrn Jolat Dsta110ptbns selecta? shut (buildlAps wMh 3 or leaa unlb)
Minnegasco mecl?anical vendletion fortn "
%M*lReqair Reaulramenta
2 copiea of plen ataWnp tooUnps, bem, iofsb
1 set o1 Energy Calculailcns iw heated addita+a
1 slte survey fa edQitlons & dadco
Additian • rnd+cat6 !l on-sk¢ sepNc aystem
P.02
14.7,63
GW'tiPP$Ib!+ey' -Y ... N
"RI?Wt ` Y N
tfee ? 136arr P6?otl` Y^ N,
7't11?P+i9'Ra4UItlild. -Y _M
ptialtd 34**tl9kt `Y -P!
011i2rreL inrn nnnQldnrorl ..o iE,liw lw,fnrmntInn „r,la$a ueu state thev are trade secret and the reason.
Date I I Construcdon Caet
Site Address la k !dn ?j?..,.?. UnitlSte #
De:cription of WOrk 151 i ? ??Pm ?
Multi-Fnmity Bldg _ Y, N Fireplace(s) _ 4 2 ?
r
P
t
O
0???G?I"G?' Telephooe #(b/a) A7 1a 4I
w
y
roper
aer 1
Contractor I'1 . d
Addrese ,Q
A
N (lQ ??
--- CttY
_
State Z?p Telephone #
J
CqMPLETli VIr11S AREA aNLY IF CONSTRUC'Y'INQ /1 N!W BUILD{NG
- Minnqsots R1iLG.& 7679 Cate¢orv 1 Minnec,ota Rules 7672
5nergy COde CetegOry * PsaIdantlal VentllaUon Cate9ury 1 WoMcsheet ? • New Energy Coda Worksheet
(?1 aubml9sbn iype) guhmltted Submitted
• Enaryy Envelppe Calculetlons 3ubmitted
fn the last 12 months, has the City of Eagan issued C permlt for a sfmilar plan based on a mdster plan?
,.,_„ Y _ N If yes, date and address of master plan: „_,.
licensed PIumber
Mechanicai Contractor
Sewer/Water Contractor
Telephone # (
Telephone # (
Tekephone # (
gpply for a Residcntial $uilding Fermit and aaknowledge that the
complete and accurat
P?;
that the work will be in corifornnance w?'ith the ordinances and codas of the City of Eagan ana the btate or mN
Statutea; i understand this is nat a permit, but only an application for a pernut, and work is nat ta start withoui a
perrnit; that the work will be in accordance with the appraved plan in the case of wark whieh requires a review and
approval of plans,
pplicant rinted Name A icant's ign e
JU14-21>i2007 01 : 18 PM
b8u Tvos.g .
STANDARD WATER CONTROL 763 537 1882
0 13 1B-plex
? 16 FireplaCe
fl 17 Garage
0 18 Dedc
O 19 Lower l.eve)
P. 0' 3
? 20 pool f] 34 Accessory €3:dg
0 21 Worch (3-sea.) C] 31 Ext. Aft - Multi
0 22 PorchlAddn: (4-sea.) C! 33 Ext. Ak - SF
0 23 Porch (meenlgaxebalpergola) ? 36 Multi Misc.
O 24 Storm Damage
Cl 25 Mlscel{aneous
? 01 FoundaUon O 07 05-plex
? p2 $F Dwelling O 08 06-plex
O 03 01 af _ plex O 09 07-plex
? 04 02-plex a 10 08-plex
? 05 03-piex 0 11' 10-plex
O OS 04-plex O 14 12-plex
Wo.
q 3
31 New
O 32 AddiHon
g 33 Alteratlan
? 34 Fteplscement
O 35 Int Improvement E3 38 [3emol;sh Interiar ? 44 3idlhg
0 36 Move Building 0 42 Demolish Foundetbn 0 45 Fire Repalr
m 37 Demol+sh Bultding' ? 43 Reroai O 46 Windoa?slQoora
'Demolltlon (Endra Bldg) - alvo PCA handout ta eAplicant
ggggaRliQn: Waftr Damaqe Yee
Valuatlon O6
Plan Revlew 100°? or .. 25%
CenBUs Code
SAC Units
# of Units
# of Bldgs
7ype ot Cbnst
Occupency .,_,121./ MCES System
Zoning City Water
Storiea _ Booster Pump
Sq. Ft. PRV ?
Length Flre Sprinklered
Width
_ Footings (ncw bldg)
_ Foatings (deck)
_ Footings (addition)
? Foundatian
L7rain Tila
4toof _ Ice & Water , Final
_ Framing
Fireplace R.I. _ Air Toet ^ Final
_ Insulatianp n , . 11_
Approved By: l9Y If U,
BaSe F86
surcharge
Plan Review
MCIES SAC
Clty 8AC
lltility Connect+on Charge
S&W Pefmit & Suroharge
Treatment Plant
License Search
Copies
0#her
total
REQUYli.E'D INSPECTIONS
Sheetrock
_?O Fina]1No C.O.
HVA.C
dther
Pool Ftgs Air/dae Tests Final
_ Siding _ Stucco Lath ,_„_„ Swne Lath JSriak
Windows
? Retaining WaU
Inspector
"
F E-1 ??..
14 & & a<?
2004 RESiDEIdT1AL PLUNIBING PERMtT APPLtCATIOId
r= " - CITY OF EAGAN
3830 PtL.QT KN4B ROAD, EAGAN MN 55122
651-675-5675
Pfease compiete for modifications to existing residential dwe{{ings.
!;Q. s-0
oate 14 IS I o?
Site Strest Address J9j-13 Unit #
/ s
Praperty Owner ? 6?,t ,t.f?.?-- Telephone #0l Contract,
Address
The Applicant is: ! Owner xlantractor ^Other
Aitegations to existing dweifing?/?? r ?-+
Add fixtures to rooms, excl mg wa er soften r anrwater__ eater
Septic Systern Abandonment
?
`Water Turnaround (add $121.00 if a 5/8" meter is required)
Other:
$ 50.00
I hereby apply for a Residential Plumbing Permit and acknowfedge that the infarmation is complete
and accurate; that the work wili be in confarmance with the ordinances and codes af the City of
Eagan and the p4umbing codes; that f understand this is not a permit, but only an application for a
permit, work is not to start without a permit and work wi{I be in accordance with the approved pian in
the event a plan is required ta be reviewed and approved.
Appitcant's P'rrnted Name Applicant's Slgnature
Telephone # Ve6l lik5 -?Z YQ
state fh h . Zip,?,_
`
Ahh?k
city oF eagan
PAT GEAGAN
Mayor
PEGGY CARLSON
CYNDEE FIELDS
MIKE MAGUIRE
MEG TILLEY
Council Members
THOMAS HEDGES
Ciry Administracor
Municipal Center:
3830 Piloc Knob Road
Eagan, MN 55122-1897
Phonc: 651.675.5000
Fax: 651.675.5012
TDD: 651.454.8535
Maincenance Facility:
3501 Coachman Poinc
Eagan, MN 55122
Phone: 651.675.5300
Fax: 651.675.5360
TDD: 651.454.8535
www.utyofeagan.com
THE LONE OAK TREE
The symbol of strength
and growth in our
communicy
September 8, 2004
CHRISTOPHER PLUM
H P PII'EVVORKS
3670 DODD RD #100
EAGAN MN 55123
RE: 3923 BLACKHAWK ROAD
FLOOR DRAIN INSTALLATION
Dear Mr. Plum:
While inspecting a water softener installation at 3923 Blackhawk Road, the owner
informed me that your company also installed a new floor drain. Installation of a floor
dxain is not covered under the permit you were granted for the water softener. Please
submit a sepaxate application to the City's Building Inspections Division for this work.
Once we have processed your application and issued the permit, you may set up the
required inspection for this work.
Thank you in advance for your anticipated cooperation.
Sincerely,
J. Craig Novaczyk
Senior Building Inspector
JCN/j s
2004 RESIDENTfA1. RLUMBiNG PEFtMtT AFPLtCA7fOtd
CITY OF EACAN
3830 PILOT KNOB RiJAD, EAGAN MN $5122
651 G75-5675
Please compiete for modifications to existing residentiai dwellings
?
I
unIt#- I
I Property Owner
I
Telephorie# ? o. I
`,? .
Contrac#or Y' Telephc?rie # {j?6 46,
Address.3.(y-`1C' es ? City 5#ate
The Appticant is: Owner Cantractor Other
A{#erations to existing dweliing
-Add fixtures to roams, exc{uding water softener and water heater ?y
Lti
Septic System Abandonment
?Water Turnarvund (add $121.00 if a 5t8" meter is required) ?uG ? d Z00?
Other.
? ? 8`! ?__--
`?'" Water So ener Water Heater
repiacement additional , I _ Lawn frrigation System RR2_ new .,,+ repair ?rebuild
t Ta#a1
? 5fl.t}t3
! hereby apply for a Residentiai Plumbing Permit and acknawtedge that the information is comp.lete
and accurate; that the work mrill be in conformance with the ordinances and codes of the City o#
Eagan and the plumbing codes; #hat 1 understand this is not a permit, but only an appticat'con fttac a
permit, uvork is not to start without a permit and work will be in accordance with the approved pfan in
the event a plan is cequired to be reviewed and appraved.
- A-P,!,
t .5 te-v "e,vv s
Applicant's rinted Name Applicant's ignature
coF cagan
PAT GEAGAN
Mayor
PEGGY CARLSON
CYNDEE FIELDS
MIKE MAGUIRE
MEG TILLEY
Council Members
THOMAS HEDGFS
Ciry Adminiscracor
Municipal Center.
3830 Pilot Knob Road
Eagan, MN 55122-1897
Phone: 651.675•5000
Fax: 651.675•5012
TDD: 651.454.8535
Maintenance Faciliry:
3501 Coachman Point
Eagan, MN 55122
Phonc: 651.675•5300
Fax: 651.675•5360
TDD: 651.454.8535
www.uryofeagan.com
THE LONE OAK TREE
The symbol of strength
and growch in our
community
September 8, 2004
CHRISTOPHER PLUM
H P PIPEWTORKS
3670 DODD RD #100
EAGAN MN 55123
RE: 3923 BLACKHAWK ROA,D
FLOOR DRAIN INSTALLATION
Dear Mr, Plum:
While inspecting a water softener installation at 3923 Blackhawk Road, the owner
informed me that your company also installed a new floor drain. Tnstallation of a floor
drain is not covered under the permit you were granted for the water softener. Please
submit a separate application to the City's Building Inspections Division for this work.
Once we have processed your application and issued the pernut, you may set up the
required inspection for this work.
Thank you in advance for your anticipated cooperation.
Sincerely,
?
J. Craig Novaczyk
Senior Building Inspector
JCNfjs
CITY USE ONLY
PERMIT #:
RECEIPT DATE:
( d
MIDENTIAL MECHMICjkL? PM1VIIT APPLICATION
crcY oF EAfim
3$30 PILOT KNOB liD
E,QCFAN MN 55188
651-6$1,4875
Please complete for: ? single famify dwellings
townhomes and condos when permits are required for each unit
Date:
SITE ADDRESS:
OWNER NAME:
TELEPHONE #:
INSTALLER NAME..S??`)p? TELEPHONE -2- 2 , cc T'1Z?
(AREA CODE)
STREET ADDRESS:??Ip !E? ? 1-?.?J ' ' `'?? ? - ? t . O • ^?? 11?
CITY:
-
STATE: ry? ZIP:
Place a check mark next to the nermit work tvne
_ New residential dwelling unit under constructionand not owner/occupied $ 70.00
_ Add-on, ' tion or alteratiup to existin dwelling unit $ 50.00
1??LrRal`P?D{aCcmcilt ?
• air exchan er
? • air
• other
Nature of work:
State Surchar e $ .50
Tota l $ ?6o ,!5rj _
Reminder: Call for inspections.
_r
5
Updated li"Ol
CI7Y USE ONLY
PERMIT #:
APPROVED BY:
(NSPECTOR
RECEIPT DATE:
CONIMEftCIi4L 1VIECHANICAI. PERMIT Ai'PLICATION
CIT'Y oF EAfiM
3$30 PILOT KNOB RD
EAsAN,1VI1N 55122
651-6$1-4675
Please complete for: all commercial/industrial buildings
multi-family buildings when separate permits are not required for each dwelling unit
DATE:
SITE ADDRESS:
OWNER NAME:
TENANT NAME (IMPROVEMENTS ONLY):
WAS THERE A PREVIOUS TENANT IN THIS SPACE?
INSTALLER:
ADDRESS:
CITY:
PHONE #: -
(AREA CODE)
Y N. NAME:
PHONE #: -
(AREA CODE)
STATE: ZIP:
WORK TYPE: New conshuction Install U.G. Tank
Interior Improvement Remove U.G. Tank
Processed Piping
Specify Nature of W ork:
Wl:en installing/removitzg underground tank, call 651-681-4675 for inspection by Fire Marshal arid
Plumbing Iinspector.
Fees: 1% of contract price OR $50.00 mipimum fee, whichever is greater.
Underground tank removaUinstallation = minimum fee
Contract price: $ x 1%_$ (Base Fee)
State surcharge calculate at $.50 for each $1,000 Base Fee
TOTAL $
SIGNATURE OF PERMITTEE
Updated 1/01
;
?
EAGAN TOWNSHTP
3795 Pi1ot Knob Road
St. Paul, Minnesota 55111
Telephone 454-5242
PERMIT FOR WATER SERVICE CONNECTYON
Date: ATumber: ]
Billing Name: Site
. ,
Owner:a---?;'`?_ Billing Address
'
Plumber:
.-.-
Location of Connection Meter Siza Conaectian Chg, J0.00
NO ITotal Chg.
Building is a:
Residence__1___
PTulti.pl e_ Lo. Units
Commercia 1
Industrial
Other
Meter No.c'.:k s?Pern?iC Fee 7.50 Meter Reading - • ` iMeter Dep.
Meter Sealed: Yes lAdd'1 Chg.
Inspected by
DaCe
Remarks:
By.
• Ch3.ef Inspector
In consideration of Che issue and delivery to me of Che above permit, I
hereby agree to do the pxoposed work in accordance with the rules and
regulatians of Eagan Towsiship, Dakota Caunty Mixinesota. _
B3?:
Please aotify the above office when ready for inspection and connection.
r
r
EAGEiN T014NSHTP
3795 Pilot Knob F,oad
St, Pau1, Minnesota 55111
TeZephone 454-5242
PERMIT FOR SEWER SERVICE COIVNECTiQPI
DATE:___y`/t(40?1 NUMBER ??j5..__. .
014A3EF.:L??'? Address. -z//
f
PLUMBER TypE QF PIPE ?
DESCRIPTION OF BUILDING
Industrial l Connnercial l Residential I NIulfiiple Dwelling I No, of units
?
Location of Connections:
Connection Charge 200.00
Permit Fee 7.50
SCreet Repairs
Tota i
Inspected by:
Date
Remarks•
sy
Chief Tnspector
In consideration of the issue ancl delivezy to me of the above permit, I
hereby agree to do the proposed work in accordance with the rules and
regulations of Eagan Toc•mship,•Dakota CounCy, Minnesata
Y'
By ?
Please notify when ready for inspection and connection and befare any portioa
of the work is covered.
. .' ..?
...
2007RESIDENTIAL BUILDING rExMIT ArPLicATiorr
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construction Reauirements
3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and ail roofed area D
(20% maximum (ot coverege allowed)
1 Soils Report if proposed building is to be placed ondisturbed soil
2 copies of plan showing beam & window sizes; poured found design, etc.
1 set of Energy Calcula6ons
3 copies of Tree Preservation Pian rf lot platted after 711193
Rim Joist Detail Options selec6on sheet (buildings with 3 or less units)
Minnegasco mechanical ventilation form
I Vo
C??
RemodeilRepair Reauirements Office Use Onlv
2 e pf p,n showing jooGngs, beams, joists Cert of 5urvey Recd ? Y_ N
? 1?f?r? C??f)cu'?n heated additions Soils Report _`( _ N
1 site survey for addi6o ks Tree Pres Plan Recd _ Y_ N.
QQ - indicate if on-sit tic system Tree Pres Required _ Y_ N
J??(di?'V ?+ 6 2007 On-site.SepticSystem _Y _N
`?? I-e.Q - ?a , 0 0
Date 1 o 7_
Site Address Construction Cost 5-60 r 6 0
Unit/Ste #
Description of Work ?
U
Multi-Family Bldg _ Y? N
Fireplace(s) _ 0,_ 1 _ 2
PropertyOwner ? • Telephone #
.
Contractor t
Address , If
State -e?AY ^ 1 I v?"?` Cih'
Zip !20 t? Telephone # (?o`J1) ???"??
• COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Catesorv 1 ? Minnesota. Rules 7672
Energy Code Category Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(? 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, dafe and address of master plan:
Licensed P{umber
Mechanical Contractor
Sewer/Water Contractor
Teiephone # (
Telephone # (
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. "
?b ??ftRDso 1)
Applicant's. inted Name Applicant i ature
DO NOT WRITE BELOW THIS LINE
?.?
Sub Tvpes
? 01 Foundation
?
07
05-plex
? 13 16-plex
?
20 Pool
? 30
Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 29 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/pergola) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex ? 25 Miscellaneous
Work Tvpes
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 32 Addition ? 36 Move Builcling ? 42 Demolish Foundatic+n 0 45 Fire Repair
? 33 Alteration ? 37 Demolish Building* ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement *Demolition (Entire Bidg) - Give PCA handout to applicant
Description: Water Damage Yes
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 Bidgs Length Fire Sprinklered
Type of Const Width
? Footings (new bldg)
_ Footings (deck)
, Footings (addition)
Foundation
Drain Tile
Roof Ice & Wafer Finat
_ Framing
, Fireplace _ R.I. _ Air Test _ Finai
_ Tnsu[ation
REQUIRED INSPECTIONS
? Sheetrock
Final/C.O.
Final/No C.O.
? HVAC
Other
_ Pool Ftgs Air/Gas Tests Final
_ Siding _ Stucco Lath ^ Stone Lath ,Brick
Windows
_ Retaining Wa(1
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
2007 RESIDENTIAL BUILDING rERMiT arrLicATioN
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construction Reauirements
3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas
(20% maximum lot coverage allowed)
1 Soils Report if proposed building is to be placed on disturbed soil
2 copies of plan showing beam & window sizes; poured found design, etc.
1 sef of Energy Calcu{ations
3 copies of Tree Presenration Plan if lot platted after 7l1193
Rim Joist Detail Options selection sheet (buildings with 3 or less units)
Minnegasco mechanical ventilation form
RemodellReaa+r Requirements
2 copies of plan showing footings, beams, joists
1 set of Energy Calculations for heated additions
1 site survey for additions & decks
Addition - indicate if on-site septic system
?
f?=us? (7n1?
Certvfi Su+?+ey'ft?cd _., Y _ N
8ioil?Aeporv Y° -_ N
'Ftee'P,resplan Recd .;:=Y -R
Tre014as *ired Y
_ N
Qn ?*'SeRtic System _ Y °= N
??
Plans are considered public information unless you state they are trade secret and e rea7ason.
Date 6-7 Construction Cost ?l??lv ?! ?I
Site Address ?q Unit/Ste # I
Description of Work
Multi-Family Bldg _ Y Fireplace(s) 0 2
Property Owner Telephone #
Contractor /-Gl ?C- ?{ S ?? ? ? ! , ? v, Jih ? _
Address _ 2?q.5- V li , l16 City ? a(lC' ?ii l??
State ZiP -? < TeleAhone #
COMPLETE THIS AREA ONLY IF CQNSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Categorv 1 Minnesota Rules 7672
Energy Code Gategory . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(?l 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?
a
_ Y _ N If yes, date and address of master plan:
Licensed Plumber
Mechanical Contrqctor
Sewer/Water Contractor
Telephone # (
Telephone # (
Telephone # (
I hereby apply for a Residential Building Pernnit 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.
C?
?? ?-? - ?
Applicant's Printed Name Applicant's Signature 2 1 2007
DO NOT WRITE BELOW THIS LINE
Sub Tvpes
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
.P 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/pergola) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex ? 25 Miscellaneous
Work 7vpes
? 31 New O 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
t 33 Alteration O 37 Demolish Building* ? 43 Reroof ? 46 Windows/Doors
? 34 Repl2cement *Demolition (Entire Bfdg) - Give PCA handout to applicant
D@SCriqt1011: Water Damage Yes
Valuation 1,21 04b - - Occupancy MCES System
Plan Review _ 100% or _ 25% Code Edition
Census Code ? Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const 1 Width
- REQUIRED INSPECTIONS
_ Footings (new bldg) Sheefrock
` Footings (deck) FinaUC.O.
_ Footings (addition) ? FinaUNo C.O.
_ Foundation ? HVAC
Drain Tile Other
Roof ` Ice & Water ` Final _ Pool Ftgs Air/Gas Tests Final
?Q Framing _ Siding _ Stucco Lath _ Stone Lath _Brick
_ Fireplace _ R.I. _ Air Test _ Final Windows
-yo Insulation _
_ Retaining Wall
Approved By: Building lnspector
------------- ---- ------------------------- - ------ - - -------------
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
?-- A ?j ?' S c !1')eit ?"
RESIDEN7"!AL
F/J? 7-7 7 BUII.DIHC RERMiT APPLtCAT10N
,. % CITY QF EAGAN
3830 P11.OT KNOB RD - 55122
651-681-4875
i,?e Congnrctlon ReauiremeMs
• 3 registered ssit?e surveys shawirxg sq. R of bt, sq. ft of tquse; and ai,l roofed areas
(20% maxirrium lot coverage a?lawed)
• 2 copies of plan showing beam 8 wirWow sizes: Poured faund debign, etc.j
• 158t of €nergy Caculations
• 3wpieS af Tree Pmservation PIan if lot platted aftet 7/1/93
• Rim Jast Detail Op6ons seleetion shm (bidgs witli 3 a tess unib)
DATE A) 115 D
:IOB SITE ADDRESS ? Z a3 _
IF MULT!-FAMlLY BUILDING, HOW MANY UNlTS? :
PR4PERTY 4VYNER
TYPE Qf WORK
APPIlCANT
ADdRE5S 4-7-4 9WO& p
PAGER # CELL:PH4NE #
0113,7-5
RemodellRmmir ReGUir81t1ents
• 2 copies of plan
. 4 set of Erergy Caleatatim fcc heaEed adOms
• 1 Site 3utv@y EOr 8xte1itlr acdftian & d6CkS
V UATIQ N (excLuoIr?G ??Na) `
) lirA tyt ,
Cj I? RFF'LACE(5) .._0 _„r.l -2 .,,.3
PHONE #
ZIP C4DE ?l C)1
FAX #
NIE1V RESIDENTIAL BiJtLDiNG CtIYLY -FIi.L OUfi COMPlETELY
Energy Code Category , MINNESOTA RUI.F..S 7670 CATEGORY 1
(check one) - Residential Ventilation Category I Wark$heet Submitte
- Energy Enveiope Caiculations Submitted
.! MINNESOTA RULES 7672
- New Energy Code Warksheet 5ubmitted
Ptumbing Conhactor: Phone #:
Ptumbing Systecn Inctudes: - Water Softener - Lawn Sprinkler Fee: $90.04
Water Heater ! Na. of R.I, Ba.ths . '
Y No. of Baths
Mechaniccl Con#rcctor. Phone # !
Mechwiical System Includes. _ Air Conditioning Fee: $70.00
'
- Heat Recovery System 1
SewerJWater Contractor:
Phone #
Atl above information must be submitted pr±or to processing of application.
I hereby acknowledye that I have read this application, state that the information is correct, and ogr$e to comp?ywifih
pil applicable State of Minnesota Statutes and City of Eagan Ordinan s. ~
Slgnature ot Appitcant
Certificates of 5urvey Received _ Tree Preservatian Plan Received Not Rsquirqid
updated 1101
OFFiCE IJSE ONLY
0 01 Foundation
? 02 SF Dwelling
q 03 01 of ", p{ex
? 04 02-plex
0 05 03-plex
Q 06 04-plex
O 07 05-ptex O 13 16-plex
0 08 06-plex ? 16 Fireplace
? 09 07-piex ? 17 Garage
[] 10 08-plex ? 18 Deck
? 11 10-plex ? 19 Lower Level
D 12 12-piex Pibg Y or _ N
? 20 Pool
? 21 Poreh (3-sea.)
? 22 PorchiAddn. (4-sea.)
? 23 Porch (screened)
? 24 Storm a8mage
? 25 Miscellaneous
C] 30 Accessor}r Bldg
? 31 Ext. Att - Multi
CI 33 Ext. Ali - SF
D 38 Multi
0 31 New
0 32 Addition
0 33 Alteration
O 34 Replacement
? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
CI 36 Move Bidg. [] 42 Demolish (Foundation) 0 45 F'sre Repair
O 37 Demolish (Bidg)* ? 43 Reroo# ? 46 Windows/qoors
'Demoiition (Entira Bldg onty) - Give PC A handoufi to appitcant
Valuatlon Occupancy MC/ES System
Census Code Zoning City Water
SAC Uni#s Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bidgs Length Fire Sprinidered ._ ?
Type of Const Width
REQUlRED INSPECTIQNS
, Footings (new bldg) r FinaUC.O.
, Footings (deck) _, FinaUNo C.O.
? Footings (addition) _, Plumbing
Foundation HVAC
. Drain Tile
Roof Ice & Water Final Uther "
_ Framing^ ? - Pool _ Ftgs ` AirlGas Tests Final
R.I. _ Air Test
Fireplace _ Final _ Siding Stucco Stone
_
,
, Insulation , Windows (newlreplacemsnt)
-
----- Approved gy , Buiiding Mspectvr
-
--------
- - - --------------- -
, Base Fee -
- -
-
' ,urcharge
Plan Review
MC/ES SAC
City 5AC
Water Supply 8 Storage
S&W Permit & Surcharge
Treatment Plant
, Plumbing Permit
Mechanica! Permit
License Search
Copies
Other
Totai
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PERMIT
City of Eagan Permit Type:Building
Permit Number:EA113893
Date Issued:09/09/2013
Permit Category:ePermit
Site Address: 3923 Blackhawk Rd
Lot:57 Block: 6 Addition: Cedar Grove 6th
PID:10-16705-06-570
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar.
Pictures are not acceptable in lieu of inspections.
Carbon monoxide detectors are required by law in ALL single family homes .
Jeff Greenlun
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 -
Ann T Wiggins Tste
3923 Blackhawk Rd
Eagan MN 55122--173
Perfect Exteriors Of Mn Inc
321 1/2 Walnut St, POB 297
Monticello MN 55362
(763) 271-8700
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA123619
Date Issued:06/12/2014
Permit Category:ePermit
Site Address: 3923 Blackhawk Rd
Lot:57 Block: 6 Addition: Cedar Grove 6th
PID:10-16705-06-570
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Craig Angell
12253 Nicollet Ave. S.
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 -
Ann T Wiggins Tste
3923 Blackhawk Rd
Eagan MN 55122--173
Angell Aire
12253 Nicollet Ave S
Burnsville MN 55337
(952) 746-5200
Applicant/Permitee: Signature Issued By: Signature
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