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4580 Blackhawk Rd . . .. : . , . ??l'C'',?'y;"x9?.'?$?-? •i'_y'+ . ?.k'" q'?# ?? rt ?v3 .'+RA?'?,q'r's'?. .. DFbU ?A ` ,_?40 Vtob, Raad ? PfRA+t(T MO.: DATE: 6 lf A l'9?tk. ,, AFcs. oF Un'rfis: ;? r- _, • ?" ? ? ? ?'`??? ? ? ??4?#? t ?- ? ^- ? ? - • Ag, +`fi?'YIISBt' '; & ?, ??4!`' ?9:.;• •? ' ?',,,OPitl@C{'IOPi. C+'tGtt'gE. Accaunt E"osit: • Resdek:= No.: Permit Fee: ? r? ?•n - ,?.a - ' ;? . , ? . , i agree.ta cen+pty t+Mh the Citp of Eagen Sarc}aarge:, . ?A: ,+A i??aaa3?. 1V1i&c. Charges; . . To#al c - °By . ? 6?aYp aid: . [7 , T trte ot Insp,. insp. .? - . ,_ . -` 7,.;.^aw?' a,'?'w w ae??' ":" a'"c':-;r-t.? t3' :u s,???z? ,?rr-?.h?k:?'• . w *79b???`i?aa6'?R<??=. - ? PERMiT ? DAtE: E af ?llrmts. ---------------------------- 1"4 d i? ? ? y +/!' "'k,?r/3x.kft?f7. ISf?9wJEI / ? ? _ • ? ??f?if OT? P? A vw *e OtY ±+# F.an Conriectfon Ct?ars? .- . Azr.aurjt Depsss£t. F. . .? ? - ?",??- Pe?rrnit Fee: , 0 0 a . , r , . . Sarchar.ge: . ,r f3 rtft, ? ??. ?AI&C, Chakge5: Tcrfdt:? fff$?i.: . DoQ'2 ? r V Id: , . . - t . - . . . . ; ; _ . . .. '.. ? ,?'?.. - . ,.e t . ?.: • -. .. . . .. . ? . r . _ , .,: .. . . . ': r .?.':a . . ... ax 77 . CASM fiECE#PT •C ? ?? EAG,? ? i. ? 3795 PILUT KNt1S RQAD ?. EAGAN, tw+#INP1ES01'A 56122 . ?' `" ? Dwra •? ts ?.. f A1v10UNT $ A . ? CASH climcK F? ? ? . _. . ? , /'' ' •+', .rl _ ?- ? Ji 91 ' Furta roar wtaout,rr ` ,t rl .J k You , t? ? f'Z:` 11302 ? av Via?ite-Payars COPv Yeitocnr-pcrst;ns Gopy ? Pirrk-Fite Go;ry ?, sa - _ ." WA..?+ ?+?q-'am.??`xSt?" ?• '*_^..?y^"`^ ? 5 ? CASH ? 05e .,?_? ? ?. ? Z u v,: ? rs k? . . . m..:-„r ?-. r. ..... . CITY OF EAGAN - 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 , PHONE: 454-8100 = $UILDING PERMIT Receipt # To be used for ???ION Est. Vaiue $240*OW Date JULY 5 , 19" Site Al ress ?? sidLUKHAWK jw Lot Block Sec/Sub. cuumizw Parcel No. W Name TIIMW & KAM WtN 3 Address ° City RAW Phone , o Name SAM 0a Address ? Gity Phone ? W W Name ? ; Address a W City Phone I hereby acknowlege that I have read this application and state that the --irformation is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. , Signature of Permitee THOMM OR KMM KUIN A Building Permit is issued to: on the express condition that atl work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building OHicial " .. OcCUpancy Zoning (ACtuaq Const (Allowable) # ot Stories Length Depth S.F. Totai S.F. Footprints On Site Sewage On Site Well MWCC System City Water PRV Fequired Booster Pump APPROVALS Planner Council Bldg. Off, ` Variance OFFICE USE ONLY Bldg. Permit Surcharge Plan Review SAC, City SAC, MCWCC Water Conn Water Meter Acct. Deposit S!W Peimit S/W Surcharge Treatment PI Road Unit Park Ded. Copies TOTAL FEES 27$•'00 .. istM VM 3u F? i?Q ; ? ? m = O g x 0 m x N n '° - T ,?' ? ? T > m T > w :c T v y a - m o tu 9 o cc =r 3,1 g n T w 3. T g ? T g z ?" fT S -0 cn ? m < ? m n n D 3 m m z' 21 m Z! n w ? m v ? (4 `D = ? °: . `° , ? ? n W 37 7D ? P q ?. A ? 3 x v p V (? S O o R, ? n. 3 r` E7 N 0 tr- - ? ??) ? CI'T'Y OR ?GM g 3795 ?r ? ?J ?, ? 551?s _ W. ? ?'+? PHt3ME: 4548100 9567 ? WIlDINta^ !!IERMIT y"}t $52t0W. Receipt ? ??" a _ ...__ i e__ e.w an • ._ e w . ? °".r? ?i_?___ ., f1..a.. "Aprrli iV# to iQ Site Addr%t -rrwwu Uasca"swW .,v. Lot 3 2 Sec/Sub. Clearvittw Addn So* Parcel # t+l???IM?? ?8 V K18ft2 _ Address 4550" $lacitha*k Rd. fC)_ A1lCL a ? Ta4 Liarht.or U0.c ptddy,esss 4550 BlltC1Ch8i?C Rd. t?- r?`#?+?ll nw.,..s 4?"2?:? Nam+e ? ? ? ? Erect ? Occupancy I , Aker ? Zoning R} Repa+r ? F'rre Zorre 3 Enlarge p TYpe of C4rat. V Move ? # Stnries Demolish [] Frpnt 64 ft.. Grade [] _ Depth 32 '?. Aoorevots Assessrnent Water & Sew. Police Fire_ Eng: - - Pianner ?-- Co ' I Permit aav,r..jv Surchorge 26aOO Ptr,n eheck SAC Water Com. Water MeW - unct ROad Unit 75.00 t Hertby atknorvledg* 1 lwve read this applicotion and state thut Bldg. Off. ? the information is cor and 6gree to compiy with all upplicabie ??,??? State ? Minnesata Stetutes vnd GYylof Epc? f7r ?ance?.{,? AP Tatol .^ Signcttuoe af Permittee U, `r%t/."" V_ +A -0ui ' g ' is issued '?p: TtlCiffi`': k Kleitl an ths expeess c+artditiort ttw.. .211 e d? in ?f`??o' witl?ulb?applicabie $tate of Minnesota Statutes and City of Eagan Qsdir?nc?es, .. . E?.dfding Officiol ? " -, - . ..., ? ? - . , ..?. -,.?.?? ? i -- Permit $k Date lssaed Foe?l? ' Plumbing ? Mechanicoi ? INSPECTIONS DPtTE IN5P. Rough'iA FooYings 17-7 Dnte *54 ,#. ?`t basP. - Foundation Plumbing ? Frame/ins. - ?'-7 Mechanical 07{,- Final ? '. Remarks: e v? Tr?s? C vT ?o,r ?rt pd.?O?C Q ??` { lt - 7t ? /??s? 38354 H Request Date ) ? Fire No. Rough-in fnspection Req 'red? 0 Ready NowWill NoGty Inspector ? es ? No When Ready? 10 licensed contractor XIDwner hereby re4uest inspection of above electr+cal work at: Job ABox or R te o.) Ciry WHO IL?uj ??? ? Section No. Township Name w No. Range No. Counry Occupant(P INT) Phone No. - Df'haS -Ppwer Supplier Address . Electrical Contractor (Company Name) Contractor5 License No. d-Aom Mailing Address (Conhactor ot Owner Makinglnstallatian) . . ,4 dvE Awt ized Sgnatur {trector70wner Making Inst a' Phone Number MINNESOTA STATE 90AR0 OF ELEGFRICITV THIS INSPEGTION AEQUEST WILL NOT Grigga-Midway Bldg. - Room S-173 BE ACGEPTED BY FHE STATE BOARD 1821 University Ave., St. Paut, MN 55104 UNLESS PROPER INSPECTIOPI FEE fS Vfiooe (572) 642-0800 - " ENCLOSED. ?. ?'?/?? REQUEST FOR ELECTRICAL INSPECTION ? S4; instruciion2 for completing tMs lorm on back of yellow copy. "X" Be/ow Work Covered by This Request ew /7dd liep. Typeof6uitding AppliancesWired EquipmentWired Home Range Temporary Service Dupiex Water Heater Electric Heating Apt. Building Dryer Other (Specify) Comm./Industria! ' Furnace Farm Air Conditioner Other (specify) Contractor's Remarks: Compute lnspection Fee Below: # Other Fee # ServiceEntranceSize Fee # Circuits/Feeders Fee Swimming Pool 0 to 200 Amps 0 to 0 Amps Transformers Above 200 Amps ve 0 Amps SignS Inspector's Use Onty: ? TOTAL .s ?r? Irrigation Booms ? 0 ` , ? Specia! Inspection Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT Oiher Fee COMPLETED WITHIN 18 M TH$. 1, the Electrica! Inspector, hereby Rou h-in g Date. -lf certify that the above inspection has been made. Final - Data? Y-f( ?" OFFICE USE ONLY This request void 18 months from This request, void 18 months from T f O ??9 ? f i 'P Date of this Request 68260 I, as El Licensed Electrical Contractor Qwner, do hereby request inspection of the above electri- cal wiring instal}ed at: ? ?? ? ? ???> ,n??? c Street Address or Route No. Section Township Range Countv,?-_ Which is occupied Is a roughin inspection required on this job? No Q Yes Power Su Electrical c Mailing Address Authorized T Name) Ready Now ? ? Contractor's Lic Will Call L9" No. ectrical Co t ctor o? wner Making Tlris Install. lon) --- 2f,?tA - vo i.#r ? Phone Nor7 tractor or Own16r MakMg This InstallaUon) ?? This inspection request will not be accepted by the State Board unless prop¢r inspection fee is enclosed. Minnesota State Board of Electricity rr--1954 University Ave., St. Paul, Minn. 55104-Phone 645-7703 ,- ' ,FiEUUEST FUR ELE K ' CTRICAL INSPECTION p68260 BELOW WO1tK COVER ,EC t ED BY THIS REQUEST Tyge of Building New dd. Rep. Check Appliances Wired For Check Equipment Wited For Home ? ? Range ? Temporary Wiring ? Duplex ??? Water Heater ? Lighting Fixtures ? Apt. Bldg. ??? Dryet ? Electric Heating ? Commercial Bld$. ??? Furnace ? Silo Unloader ? Industrial Bldg. ??? Air Conditi ? Bulk Milk Tank ? Farm ? ? ? List ail& List Other ? ? ? ther Rehets? COMPUTE W5PECTIO N FEE W Service Entrance Size: # Fee e Subfeeders: # Fee Citcuits: # Fee 0 to 100 Am s. o 30 Am res l 0 to 30 Am eres 101 to 200 Amps. o 100 Amperes 31 to 100 Am eres Above 200 Amps. 100 Amps. Above Above 100_Amps. Transformers Remote Control Circ. Partial or other fee Signs Sgecial Ins ection Minimum fee $5.0 Remazks TOTAL FEE ? I, the Electrical Inspector, hereby certif t the o iqspection has been made. (Rough-in) D a t e (Final) Date ? ..17 -'p This request void 18 months front' i CITY OF EAGAN Remarks Addition Cleaz•view Addn. Lot 3 Bik 2 IOwner Street 4580 B1aCkhawk RoA Parcel 10 17770 030 02 state Eagan,MN 55122 Improvement Date Amount Annual Years Payment Receipt Date STREETSURF. 1985 2601.20 260 12 10 * STREET RESTOR. 1980 GRADING SAN SEW TRUNK 1274 11 66 l * SEiNER LATERAL ??. _? WATERMAiN • WATER LATERAL 1980 WATER AREA 1977 10•66 'i STORM SEW TRK * STORM SEW LAT 1980 * service 1980 CURB & GUTTER SIDEWALK STREE7 LIGHT Road Unit Char e _ _)& WATER CONN. 250.00 1150 Z BUILDING PER. #4734 SAC PARK CITY OF EACAN NO 18100 I -i 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 ° BUILDlNG PERMIT PHONE: 454-8100 Receipt # U To be used for ADDITION Est. Vatue $29, 000 Date JUL 5 , 194-0- Site Address 4580 BLACKHAWK RD OFFICE USE ON?Y Loi 3 Block 2 Sec/Sub. CLEARVIEW Parcei No occuPancy FEes . Z oning Name THOMAS & KARMA KI,EIN (Actual) Const -. Bldg. Permit 278. 00 W Address 4580 BLACKHAWK RD (Allowabie) - Surcharge 14.50 o City EAGAN Phone - # ot stories h - Plan Review 181.00 Lengt _ o Name SAMF. Depih - SAC, City ? Address S.F. Total - SAC MCWCC ? ? City Phone S.F. Fooiprints , ? Si O S Water Co»n ewage n te _ t- W W Name On Site Well - Wafer Meter z ? Address MWCC System - ? Acct. Deposit a W City Phone City water - i d R SNV Permit re PfiV equ _ 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 of Eagan Ordin ces. Treatment PI Signature of Permitee 51n h'!r''-^ a- Ht?-t--'f"`j APPROVALS Road Unit A euilding Permit is issued to: THOMAS OR KARMA KLEI_N _ Planner - park Ded. on the express condition that all work shall be done in accordance with all Council -- SO applicable State of Minnesota Statutes and City of Eagan Ordinances. g?, pff, _ Copies . 474.00 Building Official Variance TOTAL CITY OF EAGAN 3795 Pilot Knob Road Eagon, MN $5122 N2 4734 PHONE: 4348100 BUILDING PERMIT APPLICATION $52 000 Receipt # 9567 . 0 To be used for SF Dw12. d Gare. Est. Value Dote April 14, 19 78 Site Address 4580 Blackhawk Rd. Erect ? Occuponcy I l.or 3 Block 2 Sec/Sub. Clearview Adda Alter ? Zoning R1 Repair ? Fire Zone 3 Parcel # Enlurge ? Type of Const. V ? Nome Thomas W Klein Move ? #? Stories 3 Add 4550 Blackhawk Rd. Demolish 0 Front 64 fr. ress _ ° Ci Eagan Phone 454-2856 Grode ? Depth 3 x ft. W. No A L 7 ? r Tp APProvals Fees . a ,o me - a er ?? Address 4550 Blackhawk Rd. t- r:.., Eagan 454-2130 Ncme _ Address Assessment Water & Sew. Pol ice Fire Eng. Planner Council 4 hereby acknowtedge thot f have read this application and state that . Off. gldg the informotion is correct and agree to comply with nll applicoble APC State o e f lVl'inn sota Stotutes ? and C'of Ea on Or 'nonce Permit 143.5() Surchorge 26.00 Plan check SAC 500.00 Water Conn. Water Meter - R.Q,ad Uni t 75, 00 Totot 744.50 ? g .????? ? " Signoture of Permittee ?!sl'-tc a 1 ' A Building Permit is issued to: ThomBS W Kleiri on the express condition thot oll work shnU be done in acc f,io witF}-i6y opp{icoble $tate offAinnesota Statutes and City of Eagan Ordinances. Building Official . . ?. llloo 1990 BUILDING PERMIT APPLICATION CITY OF EAGAN SINGLE FAMILY DWELLINGS 2 SETS OF PLANS 3 REGISTERED SITE SURVEYS 1 SET OF ENERGY CALCULATIONS MULTIPLE DWELLINGS 2 SETS OF PLANS REGISTERED SITE SURVEYS - (CHECK WITH BLDG. DEPT.) 1 SET OF ENERGY CALCULATIONS # OF RENTAL UNITS # OF FOR SALE UNITS JiiH 2 ,7 REco COMMERCIAL 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS 1 SET OF SPECIFICATIONS 1 SET OF ENERGY CALCS PENALTY APPLIES WFiEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PTCKED 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 - CONTRACTQRjHOMEOWNER MUST DESIGNATE WHTCH ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUFtD PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED. PERMIT MUST SHOW A LICENSED PLUMBER. 0/ To Be Used For: Valuation: Date: 0,210 '50 Site Address 'inS(? ?nnn??v Lot 3 Block 9_ Parcel/Sub Owner heo s ?LO-r r. ? ?0.r Address City/Zip Code ?ao-' Phone K- Aj9^409) Contractor Sc? f-?- Address City/Zip Code ? Phone Arch.jEngr. Address City/Zip Code Phone # OFFICE USE ONLY 'Occupancy I Zoning Actual Const Allowable # of stories Length Depth S.F. Total Footprint S.F. FEES Bldg. Permit 2 2,9 Surcharge SQPlan Review ? SAC, City SAC, MWCC Water Conn Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment P1. Road Unit Park Ded. Copies SUBTOTAL Penalty TOTAL ? IAPPROVALS Planner iCouncil jM/3 Bldg. Off. Variance On site sewage_ On site well _ MWCC System _ City water ` PRV Booster Pump ? ? a !^ ?re'; 1? 3ya 2/1 ? o ? ?F , ? ? ? T N / • . , ? ----?*A-=?. ? \? ?Y v Q1 ? 'h ti r ? ? b M ? ? u N .,; v ,. ,... it,4 ? . r. . ? •'?-..1?.`?sy'}. ?. ?. ? l? ?, nnTE y- 7'-7? BUILDIT•1G PERMIT APPLICATION Include 2 sets of pl,ans, 1 site plan w/elevations and 1 set of energy calculations. ? ? To be used for Valuation Site Address; ? Lot 3 B]_ock 2 Sec. Sub. CLEARVIEW ADDITION pvmer T96AA S i.1 • K LE-2AI Address JA6o B LACK AWK AQAo r F ar_Aw? M?N??6?„oTA .?S'J'/22 ctntractor EoDo/,f !j. WAGNTER Addr e s s y-?p e VQGWA1fi"J9- IQb AA EA6SAA! /1lt440fSeTA a'3't2Z Parcel Number Telephone '.? • t S w Telephone 4 ,'j S/- Z / ?O Arch./Eng. T Address ?• Telephone OFFICE U5E ` Erect Alter Repa ir Enlarge Move ner+o l i sh Grade Occupancy Zoninq Fire Zone Type of Const. # of Stories Front ?l - Depth OFFICE USE Date of Approval &`Initial Assessment 7rz V?ater/Sewer Poli4e Fire Eng. Planner Council Pldg. Off. A.P.C. FEES ? ?- Pennit 3 ? ?----- Surcharge Plan Check 3AC tklater t'onn. VJater Meter TOTAI., ??/? ~ ? A e 0 PC Y 3 ? Y v Q r ? ?3 Z??1.9?' 21 S. 82' LEO MURPMY _ MAYOR - THQMAS EGAN 1N4itI66PARRANTO JAMES A. SMITH THEOOORE WACMTER COUNCIL MEMeERf Ted Wachter 4550 Blackhawk Road Eagan, MN 55122 CITY QF EAGAN Re: Lot 2&Bloc 2, Clearview Addition Dear Ted: TMOMAE MEDGE6 CITY ADMINI{TRATOR ALVCE BOIKE CITY CLERK Enclosed with this 1Ptter you will £ind a check in the amount of $45.20 which is the 1977 installment for the water area assessment which was posted in error to your 1977 tax statement. I have also made a copy of the letter from the Dakota County Auditor, Carl Onischuk with the explanation of how the error happened. Call me if you still have any questions concerning this matter. I am sorry for any inconvenience this error may have caused you. Sincerely, Ann Goers Assessment Clerk City of tagan THE LONE OAK TREE ... THE SYMBOL OF BTRENG7N AND GROWTH IN OUR COMMUNITY. ' k CARL ONISCHUK AUDITOR DAKOTA COUNTY *DAKOTA COUNTY GOVERNMENT CENTER 1560 HWY. 55 - HASTINGS, MINNESOTA 55033 June 22, 197$ Ann Goers City of Eagan 3795 Pilot Knob Road Eagan, Minn. Dear Ann : 10-01700-010-81 10-17750-020-02 10-17750-030-02 According to our telephone conversation on the above parcels -- the assessment numbers 352 on the first parcel and 358 on the other two parcels were cancelled from the 1977 tax boak. Somehow this cancellation never got to the pomputer f so it shawed up again on the 1978 tax books. Now since the first half has already been paid, we will leave it on the tax books for this year and we understand that you wi11 issue a refund to these taxpftyg-r,s for this years' installment. w n w, ?U?,? '?r? ? ?. Very truly yours, ? M T?j ? Carl D. Onischuk Dakota County Auditor CDO : nm L:3, I , Dr. Karin Desroeher Chiropractor 7elephone (651) 454-6367 fax 454-8537 September 18, 1998 Eagan City Council 3830 Pilot Knob Road Eagan, MN 55121 Dear City Council Members, I am writing to ask for your support in an issue that will be presented at the September 22 city cauncil meeting. Terry Kayaum, awner of Eagan Extended Day, is asking the city's permission to estabiish a daycare center for schooi age children in a house located at 4580 Blackhawk Road. As a local famity and business owner in Eagan, I have struggled with finding school age care for my children. There are not many options, if you wish to keep your children in their normat schoal boundary. The district does have the SAC program, however, it is not right for everyone. The program is only lacated at a few schools, which means the children have to bus to another school. The idea of spending IO haurs a day in the same school type of setting may not be the best atmosphere for a11 children. In addition, due to the lack of school age care options in Eagan, availability is limited in the SAC program. Eagan Extended Day has the apportunity to pravide a place for the children that is comfortable and has space outdoors for play. It wouid be a great alternative to the SAC program and fill a much needed void in Eagan. It would be a shame and a great inconvenience for local famities to have to look elsewhere for care for their school age children. I urge you to allow Eagan Extended Day to take advantage of this Iocation. Sincerely, Karin Desrocher D.C. 1260 Yankee Doodle Road Suite 100 Eagan, MN 55121 9 `1 u 3c?a 2005 RESIDENTIAL BUILDING PERMIT APPLICATION 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°1o ma)(mum lot coverage aiiowed) 2 copies of plan showing beam & window sizes; poured found design, etc. 1 set of Energy Calculations 3 copies of Tree Preservation Plan 'rf lot platted after 711/93 Rim Joist Detail Options selection sheet (buildings with 3 or less units) CcLI" Q,:;i3. (OA, RemodeVReoair Reauirements Office Use Oniv 2 copies of plan t,3 0 Cert ofSurvey Recd _Y-_ N 1 set of Energy Caiculations for heate additions Tree Pres Plan Recd _ Y_ N 1 site suroey for additions & decks C) Tree Rres Required _ Y _N Addition - indicate if on-site septic system On-site Septic System _ Y_ N Date ? l l$ l 0? Construction Cost Site Address q J-2ro ,6 L/-,4 1-1,4 wk ?. Unit/Ste # Description of Work l? lz? G lr? ? ?' ?? ? Multi-Family Bidg _ Y? N 1 _ 2 Fireplace(s) Property Owner tV `,4 X/ Telephone # (9,5_2) Contractor (f7 E N??? f? L? /{d Ift Address tF 3 J O o City 54 1,-14 ? E State If-1 /V Zip <J 6-37$ Telephone# etu! &/2 7,63 s$ys COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minnesota Rules 7670 Categga I Minnesota Rules 7672 Enefgy Code Category • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet 0 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 Mechanical Contractor Sewer/Water Contractor Telephone # ( 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 canformance 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 re '? ? ew and approval of plans. f ` . ?,?? ?? t? _ ? ? ??1 ? . 0,4 Al L,g- 4 so /v Applicant's Printed Name Z?? Applicant's Signature OFFICE USE ONLY Sub Types 0 01 Foundation ? 07 05-plex O 13 16-plex ? 20 Pool ? 30 Accessory Bldg 0 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi O 03 01 of _ plex ? 09 07-piex ? 17 Garage ? 22 PorchlAddn. (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-ptex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous Work Types ? 31 New ? 35 0 32 Addition ? 36 ? 33 Alteration ? 37 ? 34 Replacement ? Valuation 2,62 Plan Review 100% or Census Code SAC Units # of Units # of Bldgs Type of Const V Int Improvement ? 38 Demolish Interior ? 44 Siding Move Building ? 42 Demofish Foundation ? 45 Fire Repair Demolish Building" ? 43 Reroof ? 46 Windows/Doors *Demolition (Entire Bldg) - Give PCA handout to applicant Occupancy 25% Zoning Stories Sq. Ft. Length Width ? Footings (new bldg) ? Footings (deck) _ Footings (addition) _ Foundation _ Drain Tile Roof i Ice & Water _ Final MCES System City Wafer Booster Pump PRV Fire Sprinklered REQUIRED INSPECTIONS Final/C.O. ? Final/No C.O. Plumbing HVAC Other ? Pool _ Ftgs _ Air/Gas Tests Final 'k ? Frammg _ Sidmg _ Stucco _ Stone _ Bric Fireplace _ R.I. _ Air Test _ Final _ Windows _ Y Insulation T _ Retaining Wall Approved By: Building Inspector ----------------- -------------------------------- ------------ ----- --- ---- ---------- ------------------------------------------------------- Base Fee --- --- - Surcharge Plan Review MC/ES SAC ?,,,,?;??,.? .,. City SAC ? Utility Connection Charge i h S&W Perm t & Surc arge Treatment Plant License Search f%?- Vf s Copies Other E Total PERMIT City of Eagan Permit Type:Building Permit Number:EA106930 Date Issued:09/17/2012 Permit Category:ePermit Site Address: 4580 Blackhawk Rd Lot:3 Block: 2 Addition: Clearview PID:10-17750-02-030 Use: Description: Sub Type:e-Reroof Work Type:Replace Description:House & Garage 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 . Valuation: 12,000.00 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 - TODD SKIME 4580 Blackhawk Rd Eagan MN 55122 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA175104 Date Issued:03/14/2022 Permit Category:ePermit Site Address: 4580 Blackhawk Rd Lot:3 Block: 2 Addition: Clearview PID:10-17750-02-030 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. If water damage is encountered, please call (651) 675-5675 to schedule a site visit to verify the extent of the damage. Any repairs must be inspected prior to covering. The inspector will determine if an additional permit will be required to repair the water damage. 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 - Todd Skime 4580 Blackhawk Rd Eagan MN 55122 (651) 224-3442 New Life Contracting Inc. 814 Grand Avenue St. Paul MN 55105 (651) 336-9966 Applicant/Permitee: Signature Issued By: Signature