3711 Blackhawk Lake Ct
INSPECTION RECO.
low,
'-3830 Pilot Knob Road ~6!
Eagan, Minnesota 55123 E~Orts ww:
`
612) 681-4675
SITE ADDRESS: tort If fi:6tit : 2 APPLI
8711 BL.ACCUAW LAKE CT Kart If.
#LACKOMW ALCM *AO 1i1 A1>1-8:#011
-OERIT TYPE: TYPE OR WORK.
°r
INSULATION MINAL
f ILREPI ACS
09"ARK51 ROCEIPT i S&W 1i' oo WMM+' 1 t
O
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" Rrrd Pbg. P f. f or- NG* Pbnter L
r Corr. Motor
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4P 42 DS
Deck PtO.
Do& Rnd
V"
Pr. Dep.
Request Date Fire lab. PWgh-in Inspection
y Now .{~'pGill Re Inspector
red? FOR-d
- qui
es ❑ No When en Ready?
6~'Ticensed contractor LJ owner hereby request inspection of above electrical work at:
Job Address (Street. Box or Roytq No) i City
3 71, i~
Section No. Township Name or No. Range No.
I`
Occupant(PRINT) Phone No.
Po&er Su er _ Address A ,y~
Elec Contractor (Company Name) Contrac License No.
Mailing Address Contra-ct~or or Owner Making Installation
Authorized Signa re 1ContractonOwner Making I stallat,on) Phone Nu~mbbaajr
MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT
Griggs-Midway Bldg. - Room S-173 BE ACCEPTED BY THE STATE BOARD
1821 University Ave., St. Paul. MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone (612) 642-0800 ENCLOSED
REQUEST FOR ELECTRICAL INSPECTION " E9-00001-08
F See instructions for completing this form on back of yellow copy.
J 65413 X" Below Work Covered by This Request
e Add Rep. TypeofBuilding Appliances Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Other (Specify)
Comm./Industrial Furnace
Farm Air Conditioner
Other (specify) Contractors Remarks:
Compute Inspection Fee Below:
# Other Fee # Service Entrance Size Fee # CircuitsiFeeders Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transformers Above 200 Amps 00 Amps
Signs Inspector's Use Only: TOTAL
Irrigation Booms r]' -
Special Inspection (7o
larm/Communication THIS INSTALLATION MAY BE ORDERED?IS OIJNECTED IF NOT
A
Other Fee COMPLETED WITHIN 18 MONTHS.
I, the Electrical Inspector, hereby Rough-in _
certify that the above inspection has Flnalr cats y~
been made. r
OFFICE USE ONLY f " w"
This request void 18 months from
M
.Urfifiratt of (Orrupaury
Citp of eagan
Tl{is Certificate issued parsuant to the requirements of Section 306 of the Uniform Building
Code certifying that at the time of issuance this structure wras in compliance with the various
ordinances of the GY1y regulating building construction or us- For the following:
oxa.ldaamo. SF DWG/GAR Sk%rmitNo. 568
O-V--Y Type R-3 zo i g Dbki x R-1 Tyw C- Vn
\ OWWO( awn KEYLAND HOMES Ades 14450 BURNSVILLE PKWY., BURNSVILL
Buid*Ad*m 3711 BLAt:KHAWK LAKE L16, B2, BLAGKHAWK GLEN 3RD
AUGUST 8, 1992
Dates
B#ft OM.W
POST IN A CONSPICUOUS PUKE
Address: 3711 BLA%KHAWK LAKE Lot 16 Blk 2 Sec/Sub BLACKHAWK GLEN 3RD
These items were/were not complete at the time of the final inspection.
8/7/92 Yes No
Final grade (6" from siding)
Permanent steps - garage
Permanent steps - main entry
Permanent driveway
Permanent gas
Sod/seeded grass
Trail/curb damage
Porch
Basement finish
Deck
Please verify with the builder the removal of roof test caps from the plumbing
system and the shut-off of water supply to the outside lawn faucet before
freeze potential exists.
xccxie, wvEn
White - City copy Yellow - Resident copy Pink.- Contractor copy
PERMIT ~ Control No. 0 ~ r~ v
CITY4)F EAGAN
3830 Pilot Knob Road PERMIT TYPE: BUILDING
Eagan, Minnesota 55123 Permit Number: 098568
(612) 681-4675 Date Issued: 05/18/92
SITE ADDRESS:
3711 BLACKHAWK LAKE CT
LOT: 16 BLOCK: 2
BLACKHAWK GLEN 3RD
DESCRIPTION:
Building Permit Type SF DWG
Building Work Type NEW
UBC Occupancy R-3 M-1
Construction Type V-N
Zoning R-i
Building Length 62
Building Width 52
REMARKS:
RECEIPT N S&W PLBR - D.C. MECH. PRV
FEE SUMMARY: t~ .J
VALUATION $158,999
Base Fee $842.59 MISCELLANEOUS $ .610.60
Plan Review $547.63 Total Fee $3,779.63
Surcharge $79.99
SAC $799.09
SAC % 199
SAC Units 1
Subtotal $2,169.13
CONTRACTOR: - Applicant - ST. LI OWNER:
KEYLAND HOMES 18942636 090155 KEY LAND HOMES
14459 BURNSVILLE PKWY 14459 BURNSVILLE PKWY
BURNSVILLE MN 55337 BURNSVILLE MN 55337
(612) 894-2636 (612)894-2636
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 Mn.
Statutes and City of Eagan Ordinances.
APPLI ANTIPERMITE ATURE ISSUED BY: SI URE
4
1992 BUILDING PERMIT APPLICATION ;JAY 1 6 DECD
T CITY OF EAGAN
REQUIREMENTS:
SINGLE FAMILY 2 SETS OF PLANS, 3 REGISTERED SITE SURVEYS, 1 SET ENERGY CALCS.
MULTIPLE DWELLINGS 2 SETS OF PLANS, 3 REGISTERED SITE SURVEYS, 1 SET OF ENERGY CALCS.
# OF UNITS RENTAL FOR SALE
COMMERCIAL 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET OF
SPECIFICATIONS, 1 SET OF ENERGY CALCS.
PENALTY APPLIES WHEN TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING
DAY OF MONTH IN WHICH REQUEST IS MADE DB 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 ISSUED.
To Be Used For: 'Sl ae--xlC-- fA*VLK Valuation: (C5. cxx7 Date: MAC Igg2.
Site Address L-ayp_ Ga uQ..
OFFICE USE ONLY
Lot _1(0 Block 'Z EE
Occupancy Bldg Permit
Parcel/Sub Zoning Surcharge
Actual Const Plan Review
Owner Allowable License Fee
# of stories SAC, City
Address Length SAC, MWCC
Depth Water Conn.
City/Zip S.F. Total Water Meter
Footprint S.F. Acct. Deposit
Phone S/W Permit
On-site sewage S/W Surcharge
Contractor •5 On-site well Treatment Pl.
MWCC System Road Unit
Address Misc> Bug4suiup- City water Park Ded.
PRV Trail Ded.
City/Zip 3074-v,L-L-E- Booster Pump Copies
SUBTOTAL
Phone Sq4-?1o3t~ License 1553 APPROVALS Penalty
Planner Lot Change
Council TOTAL
Arch./Engr. Bldg. Off.
Variance
Address
City/Zip Code
Phone #
Sewer/WaterLi ensedContr. L. G,4L S'C ee. Exc.. Processing time
fors er/wat a its is two days once area as bebn approved.
agrees that all work shall be done in accordance with
(Signature o rmittee
all applicable State of Minnesota Statutes and City of Eagan Ordinances.
,PERMIT s CITY OF EAGAN
1992 BUILDING PERMIT APPLICATION
681-4675
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERCIAL 2 sets of architectural & structural plans, 1 set of
specifications, I copy of energy calcs.
Penalty applies when typing of permit is requested, but not picked up by last working day
of month in which re nest is made or lot chap a is re uested once ermit is issued.
Date / J Valuation of work
Site Address:
STREET STE #
Tenant Name:
LOT BLOCK 2. w= '6LACXHAw K P. I.D. #
•
ew on I - ;
Description of work:
The applicant is: ❑ Owner Contractor ❑ Other (Describe)
Name Phone
Property LAST FIRST
Owner Address
STREET STE S
City State Zip
Company Phone
Contractor Address License # Exp.
City State Zip
Company Phone
Architect/
Engineer Name Registration #
Address
City State Zip
Sewer & water licensed plumber Processing time for
sewer & water permits is two days once area has been approved.
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.
Signature of Applicant:
VI'r'IbC Y.7C VI~ILT
BUILDING PERMIT TYPE ti
❑ 01 Foundation ❑ 05 Apt. Bldg ❑ 09 Basement Finish ❑ 13 Public Fac.
i 02 SF Dwg. ❑ 06 Garage/Accessory ❑ 10 Swim Pool ❑ 14 Agricultural
❑ 03 Two family ❑ 07 Fireplace ❑ 11 Res. Add./Porch ❑ I5-Miscellaneous
❑ 04 Multi-fam. T.H. ❑ 08 Deck ❑ 12 Comm./Ind.
WORK TYPE
31 New ❑ 34 Repair ❑ 37 Demolish
❑ 32 Addition ❑ 35 Tenant Finish ❑ 99 Undefined
❑ 33 Alterations ❑ 36 Move
GENERAL INFORMATION
Const (Actual) V -N Basement sq. ft. MWCC System r 5
(Allowable) 14 1st F1. sq. ft. City Water ~(R S
UBC Occupancy n1- 2nd F1. sq. ft. PRV Required
Zoning .i Sq. Ft. total Booster Pump
# of Stories. Footprint Sq. ft. Fire Sprinkler
Length On-site well Census Code 10
Depth On-site sewage SAC Code o
APPROVALS
Planning Building Assessments
Engineering Variance
REQUIRED INSPECTIONS
❑ Site ❑ Footing ❑ Framing ❑ Insulation
❑ Wallboard ❑ Final ❑ Draintil.e ❑ Fireplace
Permit Fee 842,50 vaa,.tia,: s 1, O0 C)
Surcharge 719.00 C_ Y4 ; Z Z X2z yey X /S'= 72 0
Plan Review 5149, 3- A
MWCCnSAC f35 M T: 3 o x z~ Igo
City SAC 100 , 00 3z= 832-
Water Conn. _6,25,0 o !Gi2. x ILI zz5G8
Water Meter 75,00
Acct. Deposit 3a, oo ISf FI O0R;
S/W Permit 30 , coo 85MT= l(,!2
S/W Surcharge v 1( io - ! o
Treatment Pl. Ray, o 0
Road Unit r" iyzx 12
Park Ded.
$G, 602
Trails Ded. ~63~1 Y ~5
Copies ZMD F L
Other °
Total: Sox26 'lS0x 53 y/3`'I.o
SAC % /00
SAC Units 1S7 ~rP7 0
MHY-14-1'ly;2 15; d3 F-MUM I1H-HNY KtHLIY9 1NU. IU KtT-LHNU MUI"Its Y.101
♦ hA7ti'~1 A - 9 1 r1 • c, f't~f 111 b f='~' 1 ev -it, i ro.v; 1 I p-, 1 f I v I toll' f" . tz i
1H J 1 1 1 VvVN A
SYRVEYOR'S CERTIFICATES KEYLAND HOMES
Lr•. f= 1 j ~r .
95.00 S 4° 1 ' 19" E
N REV1890 NOVO
LOCA'r N *5-t-02
REVISEO HOUSE
LOCATION 13*92
rr♦
fmp
10 qr
a'
lop
a LOT 16
I %4p ;
N7
x
.
.
410
.0 6)
jr4
r saw 94 .a
tV+ ~ '.x3 3~ *1 ~ sd~• ~ .
H. MM
85NCH ARK
TOP OF PIP'S
.
At. l
f bo
,•Q
4F'MW
ELRV.!
tV ~ ~'f
10
6ES it. 7 BLArKHAWK
•;5.0 , LAKE
N 0019 1 91 is
COURT
811183
x 83f s~.9
SCALE, 1 INCH = 30 PEET
fif to
M o O ~ ; j incEJames
NNERS NGNEERS / SUF~VEYC?S
m . CTY. AD, 42 BURNMLLM MN. 6W7 • 612.890-V044
3711 BLACKHAWK LAKE COURT 3580-A
5 iV!
SURVEYOWS CERTIFICATE KEYLAND HOMES
• REVISED HOUSE
LOCATION 3-1-92
NOTE- NO SPECIE SOL$ INVEONTtGATIIO8
HAS BEEN COMPL THIS
LVT BY THE SURVEYOR. THE
SUITABILITY OF So" 'M SUPPORr
THE
SP *IC HOUSE PROP03l=D
I5 NC* WSPONSIBLITY
1'HE SURVEYOR.
'NOTE.' BUILDING DIMENSIONS S14OWN AR
FOR HOR=NTAL 15 VERTIGLY. Y $E
ATION OF STRUCTURE ON
ARCHITECTUAL PUfa Pl7Ii BUILD
a FOUNDATION DIMENSIONS.
_ba
AF r:'`
DENOTES PROPOSED SURFACE DRAINAGE
O DENOTES IRON MONUMENT SET SCALE: 1 INCH = 30 FEET
DENOTES IRON MONUMENT FOUND PROPOSED GARAGE FLOOR - 64Z.'0 FEET
XOOO.0 DENOTES EXISTING ELEVATION PROPOSED LOWEST FLOOR = 054.75 FEET
(000.0) DENOTES PROPOSED ELEVATION PROPOSED TOP OF BLOCK , c9 ,'.8 FEET
WE HEREBY CERTIFY TO KEYLAND HOMES THAT THIS IS A TRUE AND CORRECT
REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF:
Lot 16, Block Z, BLACKHAWK GLEN 3RD ADDITION, according to, the recorded €
plat thereof , Dakota County, Minnesota. :*f
IT DOES NOT PURPORT TO SHOW IMPROVEMENTS OR ENCROACHMENTS, EXCEPT AS SHOWN. AS
SURVEYED BY ME OR UNDER MY DIRECT SUPERVISION THIS 14 TH DAY OF APRI L 1992.
SIGNE . JA R. HILL, INC.
BY.
JOHN C. LARSON, LAND SURVEYOR
MINNESOTA LICENSE NUMBER 19826
0a James ..Hill, inc.
G~Oy° a ow
_ 0 z w R -0 v' - M _ PLANNERS 1 ENGINEERS /SURVEYORS
~ ~ P cn t0 ~
N N 2540 W. CTY. RD. 42 0 BURNSVILLE, MN. 55337 * 612-850-6044
EXTERIOR ENVELOPE PVERAG,E.._11U"-_COMP.I.JT/ITION
Darr ZZ- O
OWNER:
SITE ADDRESS: PHONE : K
Lpr&E
CONTRACT
Deter;a::la wo; .:ing square foota,a of each
1. Total exposed wall area.... _sa -ft. X 11 = .~C.;~ `ate
2_ Totcl roo~ ceiling area.... /<iiy)~ sq ft. x C-26
=~17/
T_ ,a1 expos ad waI i a~ ove ft 0o.
a. Total wall liindow area `yam
b.' Total door area
c. Total sliding glass door area....
d. Total fireplace well area
a. To IC 1 wall framing area (c er age 10%) _
f. Total rim joist area i :'-'f
g- rat wall area above floor
h. wall area above floor
i. Wall area abcva floor
j- frame wall area at fomdation
Tot::' exposed foundation area=
k. Total foundation window area.
1. Total net foundation area above grade 3 -7
Determine "u" value of each wall segment
(e.g. window, door, each separate wall section).
a . A U _
A UU11
e. ~ X 11u11 21,10
f . X 110,1
1 flull
g -
X 11 J 11 =
X Hull
• V If i tan =3 is the sa
X ,11Uth = as, or less than' ite.-
k• f1, you have met the
X Hull _ intent e-F 53C 5006 1
3. .................................Total =
To AL EXPOSED ROOF/CEILI,`,G CALCULA;. a;
Total exposed
,roof/ca11 ir.q aree... , , sa t
j) Total skyl icht area...... sq ~ x
Tctil r oor/cei 1 irlq fray ir,c, f
a-aa (AveraF,e: l0%;1.....
orlal not insula ad
r0' , /ce j 1 in q area 1...~rLt Cy 1 r 11:,x+~ _ - ~">2:.a ~.<y•p.
TO-i AL j) th r u i)
If t3:cl or ;?4 is the sarne as, or less tn--n 144 , ycu have mat tfiV I:ot=1Of
2 mCAR 1.15008 E-... 0.
ALTERNATE BUILD-ING ENVELOPE DESIGJX
To utilize the total envelope syste+n methcd, the values established by the sum .
or items #3 and r4 shall not be greater than the sum 'Of items fl and :'`2.
• CIS Y 2. fir, .1:7
r LINEAL FEET EXPOSED WALL
:-~-.r =
BLOCK
KNEE:
WALKOUT: r,~'-yG~ 8
FULL 1:/ FULL 2:34-~.r.~3-+-`~
FIREPLACE:
RIM:
r' SQUARE FEET EXPOSED WALL AREA
BLOCK: x . 5
KNEE: x 5 =
WALKOUT: x S = e.51.►
FULL 1: !5- x S =
FULL 2: Pte x 8 - l
FIREPLACE; x -
RIM: / x 1 = /
TOTAL
SQUARE FEET EXPOSED CEILING 11&e
WINDOWS: DOORS: 3 - l
-31
PATIO DOW:
BASEMENT UNITS:
47
/ .J SKYLIGHTS:
N s lks e I `-j~6 of opaq ue ujm i i QT-w Z~ s K-- VALUE
r 'fYam- crr,struct inr, CONSTRUCTIOI-ka- FRAMING - -
---Q 1. INTERIOR AIR FILM 0.68
2. 172" GYPS .4
3. 5 1/2' SOFT WOOD 6.87 ,
4. M 2 S 2.06
5. SID_ -G .60
BASIC 6. 5iOR AIR FILM 0.17
1d-zt.L
TOML R= 10. 8
U= .09
F2G. 1 T0r-V C-vJ CV NET
FRA)AE WALL 3-
1. INTERIOR AIR FILM 0.68
2; 7-2GYPb7D .45
3.
4. 25/32 SHE= G 2.06
5.' SIDING .62
1"G. e3 3 6. OR AIR MM 0.17
TOTAL 22.98
= U= .04
1. INTERIOR AIR FILM- 0.68
2. 6 INSUL. 18.00
5; LL 3. 1 JOlff 1.99
- 4. 25/32 -7\
5. SIDING .6
,.r ( 6. OR AIR FILM 0. -
rl/-4 • r 'a ....~..-O U= , 4J
1
BLOCK
0 ! b
t b• • y 1. INTERIOR AIR FILM 0.68
E , ► ~E 2, 12 3. ~ 0 0 11, 4. PROTECTIVE BARRIER
S.
6. M=OR AIR PILM 0.17
TOTAL R= 7.13
U= .14
SLAB ON GRADE
111 {F{ " r ' b A ` Ijl!
r
' ~:~G•~ fir` - b l1 L r
FIG . 43 ~1l
y •t
;0 f NOTE- INDICATE TYPE, "R" VALUE. RUTH AND
• PL=CEMENT OF INSULATION.
CONSTRUCTION R -VALUE
1. INTERIO
2. 5/8" GYP BD,58
3.' INSULAT
4. EXTER
VENT U _4 5.80
.02
FRAME
v~'ED A HEAT FDOW 1. INTERIOR AIR FILM 0,61
Up 2. G)~RRD, .58
3, -2X-4-INSULATION 38.35
4. EXTERMOR AIR FILM 0.61
FIG.5 AL 40.15
U = 0.024
CONSTRUCTION
4 t r a , , , 1. INSIDE AIR FILM
E~ i tvr. r 2.
3.
4.
5. IDE AIR FILM
TOTAL.
U
FRAME
Lo . INSIDE AIR FILM 0.61
2
NEAT FLOW UP VENTED 3.
4.
5- ~DU
FIG. #6 U =
5 1. INSIDE AIR FILM
2y.
F
Jt •f•r~ 3.
.4.
5. UUT5115E AIR FILM 0.17
TOTAL
y r I f U
ve -r 1 ~
NON--VIED NOTE : USE ADDITIONAL SINS IF MDRE SPACE IS
NEEDED FOR DETAILS AND CAILULATIONS-
HEAT FLOW
UP
FIG. 07
" CITY OF EAGAN FOR CITY USE ONLY
3830 PILOT KNOB ROAD
EAGAN, MN 55122 PERMIT #
PHONE: (612) 454-8100 RECEIPT # Q\C-A CA-6
t DATE : S
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS &
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
WORK DESCRIPTION COMPLETE THE FOLLOWING:
NO. FIXTURES EA. TOTAL
NEW CONST ADD-ON MINIMUM 15.00
y
ADD ON SHOWER 3.00 -5.0
REPAIR Z WATER CLOSET 3.00 C~4
/ BATH TUB 3.00- °
Z LAVATORY 3.00 Cp.
OWNER NAME : &c)/"v e-' KITCHEN SINK 3.00 l y y
LAUNDRY TRAY 3.00 ~ o
SITE ADDRESS: HOT TUB/SPA 3.00 ova
WATER HEATER 3.00 0
LOT: / BLOCK mC SUBD. FLOOR DRAIN 3.00
GAS PIPING OUT.
INSTALLER: (MINIMUM - 1) 3.00
~y 3 ROUGH OPENINGS 1.50
ADDRESS: , OTHER
WATER SOFTENER 5.00
CITY: ~✓,fza t' ZIP: S ~7d PRIVATE DISP. 15.00
U.G. SPRINKLER 3.00
PHONE ~go kZ
SUBTOTAL $
ST. SURCHARGE .50
SIGNATURE OF PERMITTEE
TOTAL: $ C2 C2
t~MME'DUS'IALF PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS AND
MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH
DWELLING UNIT.
CONTRACT PRICE: FEES
OWNER NAME: 1% OF CONTRACT FEE.
STATE SURCHARGE _ $.50 FOR
SITE ADDRESS: EACH $1,000 OF PERMIT FEE.
LOT: BLOCK SUBD. $25.00 MINIMUM FEE.
INSTALLER: CONTRACT PRICE x 1% $
ADDRESS: STATE SURCHARGE $
CITY: ZIP:
TOTAL: $
PHONE
(SIGNATURE)
FOR:
CITY OF EAGAN
3
CITY OF EAGAN FOR CITY USE ONLY
x 3830 PILOT KNOB ROAD
EAGAN, MN 55122 PERMIT #
PHONE: (612) 454-8100 RECEIPT #
"N" DATE :
t PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS &
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
WORK DESCRIPTION FEES
NEW CONST ADD-ON MINIMUM $15.00
ADD ON HVAC 0-100 M BTU 24.00"
REPAIR ADDITIONAL 50 M BTU 6.00
GAS OUTLETS - MINIMUM 3.00 X-1-
OF 1 PER PERMIT
OWNER NAME: ~t r~✓~~,.
SUBTOTAL: $ 0.0
SITE ADDRESS:,)/lCaIY STATE SURCHARGE: .50
LOT: 1 BLOCK SUBD. rc % u. ~.g• d TOTAL: $ b ~b
INSTALLER:
ADDRESS: lose, SIGNATURE OF PERMITTEE
CITY' ZIP: PHONE
y
QMIEC
R! T
IA,/lI3U;PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS,
APARTMENT BUILDINGS, AND MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE
NOT REQUIRED FOR EACH DWELLING UNIT.
CONTRACT PRICE: FEES
OWNER NAME: 1% OF CONTRACT FEE.
STATE SURCHARGE - $.50 FOR
SITE ADDRESS: EACH $1,000 OF PERMIT FEE.
PROCESSED PIPING - $25.00
LOT: BLOCK SUBD. $25.00 MINIMUM FEE.
INSTALLER: CONTRACT PRICE x 1% $
ADDRESS: STATE SURCHARGE $
CITY: ZIP:
AL:,)
PHONE
(SIGNATURE)
FOR:
CITY OF EAGAN
REACTIVATE CITY OF EAGAN
PE +IIT ` i EIVEE)1 93 BUILDING PERMIT APPLICATION
681-4575
t` PR 0 8 1993
SINGLE & MULTI-FAMILY 2 sets ~o plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERCIAL 2 sets of architectural & structural plans, I set of
specifications, I copy of energy calcs.
Penalty applies: 1) when permit is typed, but not picked up by last working day of month
in which request is made, 2) address is changed or 3) lot change is requested once permit
is issued.
Date / J,* 3 Valuation of work
Site Address: '37 It 6L4wkAwu LAKE coweT
STREET SUITE M
Tenant Name: (commercial only)
LOT BLOCK _Z SUED. P.I.D. 0
4Ac hAAvk L_e,v
Description of work: 2`' SI
The applicant is: IS' Owner ❑ Contractor ❑ Other (Describe)
Name EX5;c,H :501JA/ Phone 8'/ -q 1 Z 7
Property LAST FIRST
Owner Address 37 ! I j2LA--CKk o . w LdAr Loud 7-
STREET STE M
City 45 AC, A-,V State N Zip
Company Ccn,PLcr- cveR~r /~vs~~F Phone
Contractor Address License # Exp.
City State Zip
Company Phone
Architect)
Engineer Name Registration #
Address
City State Zip
Sewer & water licensed plumber Processing time for
sewer & water permits is two days once area has been approved.
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.
Signature of Applicant:
OFFICE USE ONLY
BUILDING PERMIT TYPE
❑ 01 Foundation ❑ 06 Duplex ❑ 11 Apt./Lodging ❑ 16 Base
❑ 02 SF Dwg. ❑ 07 4-Plex ❑ 12 Multi. Misc. CI 17 Swim Pool
❑ 03 SF Addition ❑ 08 8-Flex ❑ 13 Garage/Accessory ❑ 18 Comm./Ind.
❑ 04 SF Porch ❑ 09 12-Plex ❑ 14 Fireplace ❑ 19 Comm./Ind. Misc.
❑ 05 SF Misc. ❑ 10 Multi. Addl. PIC 15 Deck ❑ 20 Public Facility
❑ 21 Miscellaneous
WORK TYPE
31 New ❑ 33 Alterations ❑ 35 Tenant Finish ❑ 37 Demolish
32 Addition ❑ 34 Repair ❑ 36 Move
GENERAL INFORMATION
Const. (Actual) Basement.sq. ft. MWCC System
(Allowable) 1st F1. sq. ft. City Water
UBC Occupancy 2nd F1. sq. ft. PRY Required
Zoning Sq. Ft. total Booster Pump
# of Stories. Footprint Sq. ft. Fire Sprinkler
Length 2ix Z~. On-site well Census Code
Depth Jwlti& On-site sewage SAC Code
APPROVALS WIMML -
Planning Building Assessments
Engineering Variance
REQUIRED INSPECTIONS
❑ Site Footing Framing ❑ Insulation
❑ Wallboard Final ❑ Draintile ❑ Fireplace
Permit Fee AJ Valuation:
Surcharge
Plan Review
License
MWCC SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
SAC %
SAC Units
• 3711 BLACKHAWK LAKE COURT 3580 -A
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ro m ro 2500 W. CTY. RD. 42 • BURNSVILLE, MN. 55337 • 612-890-6444
REACTIVATE , CITY OF EAGAN
PERMIT # 1993 BUILDING PERMIT APPLICATION
681-4fi75 ~
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, I copy of energy
talcs.
COMMERCIAL 2 sets of architectural & structural plans, I set of
specifications, I copy of energy talcs.
Penalty applies: I) when permit is typed, but not picked up by last working day of month.
in which request is made, 2) address is changed or 3) lot change is requested once permit
is issued.
~i'P~
Date Valuation of work
Site Address: 3711 13 /e"CK/7,4 Lk,? 6X ~f f
STREET SUITE N
Tenant Name: (commercial only)
LOT BLOCK ,9- SBBD. roc i ►vf: Glen P.I.D. 0
Description of work: 'r~ Qc L'e-1040(
The applicant is: Owner ❑ Contractor ❑ Other (Describe)
Name Z-15c H =g1--11V ~ /V 7;4" Phone Gcf/ II V -7
Property LAST FIRST
Owner Address Z4 C 2,
STREET STE
City State _ zVW Zip ~5 I
Company Phone
Contractor Address License # Exp.
City State Zip
Company Phone
Architect/
Engineer Name Registration #
Address
City State Zip
Sewer & water licensed plumber Processing time for
sewer & water permits is two days once area has been approved'.
I hereby acknowledge that I have read this ap lication and state that the information is
correct and agree to comply with all applicable State of Minnesota Statutes and City of
Eagan Ordinances.
Signature of Applicant: '
OFFICE USE ONLY
BUILDING PERMIT TYPE
❑ 01 Foundation' ❑ 06 Duplex ❑ 11 Apt,/Lodging ❑ 16 Basement Finish
❑ 02 SF Dwg. ❑ 07 4-Plex ❑ 12 Multi. Misc. ❑ 17 Swim Pool
❑ 03 SF Addition ❑ 08 8-Plex V14 Garage/Accessory ❑ 18 Comm./Ind.
❑ 04 SF Porch ❑ 09 12-Flex Fireplace ❑ 19 Comm./Ind. Misc.
❑ 05 SF Misc. ❑ 10 Multi. Addrl. ❑ 15 Deck ❑ 20 Public Facility
❑ 21 Miscellaneous
WORK TYPE
91 (31 New ❑ 33 Alterations ❑ 35 Tenant Finish ❑ 37 Demolish
❑ 32 Addition ❑ 34 Repair ❑ 36 Move
GENERAL INFORMATION
Const. (Actual) Basement sq. ft. MWCC System
(Allowable) 1st F1. sq. ft. City Water
UBC Occupancy 2nd Fl. sq. ft. PRV Required
Zoning Sq. Ft. total Booster Pump
# of Stories Footprint Sq. ft. Fire Sprinkler
Length On-site well Census Code
Depth On-site sewage SAC Code
APPROVALS
Planning Building Assessments
Engineering Variance
REQUIRED INSPECTIONS
❑ Site ❑ Footing ❑ Framing ❑ Insulation
❑ Wallboard ❑ Final ❑ Draintile ❑ Fireplace
Permit Fee vatwtlae: $
Surcharge
Plan Review
License
MWCC SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1,
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
SAC %
SAC Units
2006 RESIDENTIAL BUILDING PERMT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construction Requirements Remodel/Repair Requirements Office Use Only
3 registered site surveys showing sq. fL of lot, sq. tL of house; and all roofed areas 2 copies of plan showing footings, beams, joists Cerf of Survey Recd _Y. _N
(20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions Soils Report _Y _N
1 Soils Report H proposed building is to be placed on disturbed soil 1 site survey for additions & decks Tree Pres Plan Recd _ Y -N.
2 copies of plan showing beam & window sizes; poured found design, etc. Addition - indicate if on-site septic system Tree Pres Required _Y _N
1 set of Energy Calculations On-site Septic System _Y _N
3 copies of Tree Preservation Plan Slot platted after 711193
Rim Joist Detail options selection sheet (buildings with 3 or less units)
Unnegasco mechanical ventilation form
Date Construction Cost
Site Address -?,Z/( g 4~ekal - Unit/Ste #
Description of Work
Multi-Family Bldg _ Y _ N Fireplace(s) _ 0 _ 1 _ 2
Property Owner ~5h ! r `d`" Telephone # ( )
Contractor G 'I
/7
Address City
State Zip S s Telephone # (9V,)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Category. 1 _ Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(4 submission type) Submitted Submitted
Energy Envelope Calculations Submitted
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
Y _ N If yes, date and address of master plan:
Licensed Plumber Telephone # ( )
Mechanical Contractor Telephone # ( )
Sewer/Water Contractor Telephone # ( )
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a
permit; that the work will be in accordance with the approved plan in the case of work which requires a review and
approval of plans.
Signature
Applicant's Printed Name Applic ~V'
DO NOT WRITE BELOW THIS LINE
Sub Types
❑ 01 Foundation ❑ 07 05-plex ❑ 13 16-plex ❑ 20 Pool ❑ 30 AccessoryBldg
❑ 02 SF Dwelling ❑ 08 06-plex ❑ 16 Fireplace ❑ 21 Porch (3-sea.) ❑ 31 Ext. Alt - Multi
❑ 03 01 of_ plex ❑ 09 07-plex ❑ 17 Garage ❑ 22 Porch/Addn. (4-sea.) ❑ 33 Ext. Alt - SF
❑ 04 02-plex ❑ 10 08-plex ❑ 18 Deck ❑ 23 Porch (screen/gazebo/perola) ❑ 36 Multi Misc.
❑ 05 03-plex ❑ 11 10-plex ❑ 19 Lower Level ❑ 24 Storm Damage
❑ 06 04-plex ❑ 12 12-plex ❑ 25 Miscellaneous
Work Types
❑ 31 New ❑ 35 Int Improvement ❑ 38 Demolish Interior ❑ 44 Siding
❑ 32 Addition ❑ 36 Move Building ❑ 42 Demolish Foundation ❑ 45 Fire Repair
❑ 33 Alteration ❑ 37 Demolish Building* ❑ 43 Reroof ❑ 46 Windows/Doors
❑ 34 Replacement *Demolition (Entire Bldg) - Give PCA handout to applicant
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 Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
Footings (new bldg) _ Sheetrock
Footings (deck) _ Final./C.O.
Footings (addition) _ Final/No C.O.
Foundation _ HVAC
Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests -Final
Framing _ Siding _ Stucco Lath _ Stone Lath -Brick
Fireplace _ R.I. -Air Test -Final _ Windows
Insulation _ Retaining Wall
Approved By: , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
Use BLUE or BLACK Ink
r
I For Office Use
City Permit
of Eapn I Permit Fee:
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 i Staff:
j~ 2013 RESIDENTIAL BUILD/IN/G~~ PERMIT APPLICATION
Date: 106/13 Site Address: 377// C;f- Unit
Name: / ~2~c vt ° -Y ~ • G1 Phone: 6 FI WD / y-o
Resident/ 3 7 1 /sty-4 t-," 4 ~
Owner Address / City Zip:' 'r I (ZI
Applicant is: ~ Owner Contractor
Type of Work Description of work:
Construction Cost: Multi-Family Building: (Yes / Nd><~ )
Company: Contact:
Contractor Address: City:
State: Zip: Phone:
License Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.orp
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior wo authorized by a building permit issued in accordance with the Minnesota State Building Code must ompleted within 180
,pk
days of p
it issuance.
x fex - aw , I - -1 x
Applicant's Pri ted Name Applicant's Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA131348
Date Issued:06/16/2015
Permit Category:ePermit
Site Address: 3711 Blackhawk Lake Ct
Lot:16 Block: 2 Addition: Blackhawk Glen 3rd
PID:10-14352-02-160
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)$55.00 0801.4087
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 -
Alexander Shifrin
3711 Blackhawk Lake Ct
Eagan MN 55122
Tony's Appliance
2090 County Road 42 West
Burnsville MN 55337
(952) 435-2442
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA165131
Date Issued:10/19/2020
Permit Category:ePermit
Site Address: 3711 Blackhawk Lake Ct
Lot:16 Block: 2 Addition: Blackhawk Glen 3rd
PID:10-14352-02-160
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace
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, Mark Anderson at (952)
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
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 -
Alexander & Laura Shifrin
3711 Blackhawk Lake Ct
Saint Paul MN 55122--124
Haley Comfort Systems
3708 Broadway Ave N
Rochester MN 55906
(507) 281-0138
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA165643
Date Issued:11/12/2020
Permit Category:ePermit
Site Address: 3711 Blackhawk Lake Ct
Lot:16 Block: 2 Addition: Blackhawk Glen 3rd
PID:10-14352-02-160
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.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
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 -
Alexander & Laura Shifrin
3711 Blackhawk Lake Ct
Saint Paul MN 55122--124
Haley Comfort Systems
3708 Broadway Ave N
Rochester MN 55906
(507) 281-0138
Applicant/Permitee: Signature Issued By: Signature