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3713 Blackhawk Rd j Address V 1 3 13t-AWI Ms EQ4U Zip 5512 _ Lot 4 Blk" , Sub L`',=:; T14AE ITEMS WERE /WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECTION. Date: Yes No Inspector: . 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. Contact engineering division at 681-4645 before working in right-of-way or insia ling underground sprinkler system. White - city Copy Yellow - Resident Copy ~ R- Contractor Copy c r / e ~ Kerdf irate of CCCupaucC Cfit~ of Wagan 'f zeV I cut of znitbi" znapection This Certificate issued pursuant to the requirements of the Uniform Building Code certifying that at the time of issuance this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following: Use Classification: R-EW Bldg. Permit No. Occupancy Type 123/-L! Zoning District Type Const. Owner of Building MANTEY BROUJUS Address 10778 Al I T T i r1Q4 Building Address 3713 BT.ACYPAWK ROM Locality -L4,-E. ~,RT.dq .$uilding Official POST IN A CONSPICUOUS PLACE _ TN'I~IN E R aF EAGAN PERIW'" ~r 1 c~ a ' 3830 Pilot Knob Road Permit Number: ~ i 21f+ ^3' - Eagan, Minnesota 55122-1897 G1ate Issu ef: x.l! ~1ti alt {612) 681-4675 N a ' 73.1 PLAC9HAWK NO HANL Y PRO CONS'f ~ 91LACKHAWK FORES1" (611--1) 464-.4933 tPE: TYPE OF WORK: ~.E k. ANlt140 tt#t#f~ 1. Pi(i :y INA1 !.1 '~t} 1 # 1At l f#fA€~'Kaa Pt aN 1°(f 7fW 1Y H'y WAY1~~ ~tt~~W','; , " t' W 1..A t'.wmt.F~f r1 11HC41Ho #441 ~ t, J4 ~ ~ ~ ~ pP,v pFot3fkErt. t~!yt ACA y ~ t ( ,~S Y N , r 5 z } ti j ~ r....M r r ~ Ir Permit Hoider oats ToWphemr$ iI PLUMING vAC ir►epectFt~n n wap. is FOOTINGS r°,j/ p#r /•7f// / 1, FOUND 7(d ! a.~rt!` ~-r FRAMING R OOFING p ROGH PLLUUMBING L/~S~'t~'' S ! C>LJ PLBG AIR TEST ROUGH HEATING .,Z i GAS SVC TEST INSUL d GYP BOARD FIREPLACE FIREPLACE r 3 AIR TEST FINAL PLBG FINAL HTG URSAT TEST BLDG FINAL DOMESTIC METER IRRIGATION METER FLUSH MAINS CONDUCTIVITY TEST 1 HYDROSTATIC TEST BSMT R.I. BSMT FINAL DECK FTG DECK FINAL CITY USE ONLY L ~ BL ~ RECEIPT SUBD. RECEIPT DATE: d ~I PERMIT # 1999 PLUMBING PERMIT (RESIDENTIAL) CITY OF iEAGAN 3830 PILOT KNOB RD £AGAN, i4IN 55122 (651) 681-4675 Please complete for: > single farnily dwellings > townhomes and condos when permits are required for each unit > backflow preventer for underground sprinkler system FIXTUkES EACH # TOTAL Bath tub $ 3.00 x = $ Floor drain 3.00 x - $ Gas piping outlet ' minimum - 1 3.00 x - $ Hot tub/spa 3.00 x = $ Kitchen sink 3.00 x - $ Laundry tray 3.00 x - $ Lavatory 3.00 x = $ Minimum fee alterations to existing dwelling 30.00 x - $ Private Disposal System new/refurbished * requires MPC lic. 75.00 x - $ Private Disposal System abandonment 30.00 x - $ RPZ new installation/repair 30.00 x ' Rough opening ~ 1.50 x $ Shower 3.00 x $ Underground srinkler if dwelling is under construction 3.00 x = $ Underground srinkler if existing dwelling 30.00 x - $ Water closet 3.00 x - $ Water heater 3.00 x = $ Water softener if dwelling under construction 5.00 x = $ Water softener if existing dwelling 30.00 x = $ -~o Water turnaround 30.00 x _ $ State Surcharge .50 $ .50 Total $ Reminder: Call for inspections of alterations, i.e. water heaters, water softeners, etc. t here -e---th-is---application---- - -,---state---- --agree-----to-------comply-- -with--all----applicable---- ---Ci--ty--of----Eagan--- -ordinances------ by ac knowledgethat I have r ad that the inform ation is correct, grid It is the applicant's responsibility to notify the property owner that the City of Eagan assumes no liability for any damages caused by the City during its normal operational and maintenance activities to the facilities constructed under this permit within City property/right-of-way/easement- SITE ADDRESS: ~7~7 &4-, ~✓k Z OWNER NAME:: l1-1 ,4-C_~,.yl /41 y TELEPHONE 4o~f ~~..Su ~2 (AREA CODE) INSTALLER NAME: X1'1 r 6° ~~1!` TELEPHONE STREET ADDRESS: _ zgQV (AREA CODE) CITY: 0111Q 4-120y v /T` STATE: !41-1f ZIP: SIGN ATUR F PERMITTEE CITY USE ONLY V/1 LOT -4-L BL OZ9 RECEIPT ~d Y~ SL'BD. ~cs ~f~ Pn_ RECEIPT DATE: 1999 MECHANICAL PERMIT (RESIDENTIAL) CITY Of EAGAN 3830 PILOT KNOB RD EAG N MN 5512E (651) 681-4675 Date: J l Complete this section only if you are installing HVAC in single family, townhomes or condos under construction and not owner /occupied • HVAC: 0-100 M B T U $ 30.00 ADDITIONAL 50 M BTU 6.00 0 Gas outlets (minimum of one required @ $3.00 ea.) ~I ~"66 • State Surcharge: .50 • TOTAL: '51 Complete this section only if you are remodeling, adding to, or repairing existing single family dwellings, townhomes, or condos. Please indicate if it is a new item, replacement item, or repair. New _ Replacement Repair _ Other Furnace Air conditioning Air exchanger, i.e. Vanee system, etc. Other Reminder. Call 681-4675 for inspections. $ 30.00 State Surcharge: .50 Total: $30.50 f~ 6 SITE ADDRESS: 71.3 l V~~ h~ y4y ~C~ - 31 OWNER NAME: PHONE I INSTALLER NAME: PHONE ob~; l q4?b STREET ADDRESS: CITY: 1~ C6 STATE: ri • IP 2a'r5 §IGNATEYkE Of ITTEE JS- FORMS BLD NIECH PERMIT (RES) - 1999 CITY USE ONLY L BL RECEIPT SUED. RECEIPT DATE: APPROVED BY: , INSPECTOR 1999 MRCHMICAL PERMIT (COMMERCIAL) CITY OFE.AGAN 3$80 PILOT KNOB RD EAGAN, MN 55188 (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: CONTRACT PRICE: WORK TYPE: NEW CONSTRUCTION INTERIOR IMPROVEMENT DESCRIPTION OF WORK: FEES: 1% of contract price OR $30.00 minimum fee, whichever is greater. Processed piping - $30.00 CONTRACT PRICE x I% PROCESSED PIPING PERMIT FEE STATE SURCHARGE ($.50 per $1,000 of permit fee due on all pemnits.) TOTAL I SITE ADDRESS: OWNER NAME: PHONE TENANT NAME (IMPROVEMENTS ONLY): INSTALLER` ADDRESS: PHONE CITY: STATE: ZIP: SIGNATURE OF PE-RMITTEE CITY USE ONLY G L BL RECEIPT /~02 ✓ SUBD~I~J1/r~~~ ~p RECEIPT DATE: 1 g 1999 PLumsiNe Puma (RSIDENTIAL) CrrY OF EAGAN 5630 PILOT KNOB RD KAGAN, MN 55188 (651) 681-4675 Please complete for: ➢ single family dwellings ➢ townhomes and condos when permits are required for each unit ➢ backflow preventer for underground sprinkler system - - - FIXTURES EACH # TOTAL Shower 3.00 x Water Closet 101] X 2 = (10.C) Bath Tub 3.00 x Lavatory 3.00 x - Kitchen Sink 3.00 x 1 = 100 Laundry Tray 3.00 x l =,Oo Hot Tub/Spa 3.00 x = Water Heater 3.00 x 1 = Floor Drain 3.00 x Gas Piping Outlet * minimum - 1 3.00 x 1 = 7-VI -ce Rough Openings 1.50 x Water Softener for dwellings under construction 5.00 x = Water Softener for existing dwelling 30.00 x = U.G. Sprinkler for dwelling under coast. 3.00 U.G. Sprinkler for existing dwelling 30.00 = Alterations to existing residence 30.00 = Water Turn Around 30.00 = Private Disposal System MPC lic. 75.00 - (new and refurbished systems) Private Disposal Systems Abandonment 30.00 = RPZ (new installation/repair) 30.00 = STATE SURCHARGE .50 Reminder. Call 681-4675 for inspections of water heaters, water softeners, alterations, etc. TOTAL - - - - - I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applipble City of Eagan ordinances. It is the applicant's responsibility to notify the property owner that the City of Fagan assumes no liability for any damages caused by the City during its normal operational and maintenance activities to the facilities constructed under this permit within City property/right-of-way/easement. SITE ADDRESS: __'-2) I OWNER NAME: mGnl ~~0~®nS~r-~~(:~l INSTALLER NAME:'' TELEPHONE (0\1`LkI497' (093y STREET ADDRESS: 1 ~C~~ tQfl C ►~G,~ S CITY: C~ ~Or Iti,A~- STATE: M~j ZIP: CJ`J~J~~L 4l~ 4~ SIG ATURE OF P RMITTEE CD/PERMIT FORMS/RPLBG PERMIT (RES) -1999 ,Ia i 7 OFFICE OF THE REGISTRAR OF TITLES I DAKOTA COUNTY, MINNESOTA ' CERTIFIED THAT THE WITHIN INSTRUMENT i WAS RECORDED IN THIS OFFICE ON AND AT I JuL 7 4. 3o Ph '95 -3216977 ' DOC. NO. I ' CERTIFICA 0 VOLUME PAQ JAMES N. STRAR OF TITLES 9Y: Dep t FEE SURCHARG ~I ASSURANCE FUND ; NON-ASSUR MI C FEE CASH E ] CHECK ESCROW I I ' WELL I 1 CHARGE I I CHARGE TO: REFUND DO NOT REMOVE } State of 114i Cnunty of Dakota certified to be a true and correct copy of the original on file and of record in my: office this day of ' 19 JAA%$- ~I AN, County Recorder By Deputaf _ 321977 CONSERVATION EASEMENT IN CONNECTION WITH EAGAN CITY PROJECT NO. 665 THIS EASEMENT, made thiso o~ day of 'j alyia- 1995, between MAPLEWOOD DEVELOPMENT AND CONSTRUCTION, INC., a Minnesota corporation, herein referred to as "Landowner" and the CITY OF EAGAN, a municipal corporation, organized under the laws of the State of Minnesota, hereinafter referred to as the "City". WITNESSETH: Tttaf the Landowne;, in consideration of the sum of One Dollar ($1.00) and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, does hereby grant and convey unwthe City, its successors and assigns, a permanent-conservation easement for the purpose of preserving and protecting the natural character of the easement area, over and across the following described premises, situated within Dakota County, Minnesota, to-wit: A perpetual easement for conservation purposes over and across that part of the following described property: Lots 2, 3, 4, ° 5 and. 6, Block 2, BLACKHAWK FORE&T, according to the recorded plat thereof Which lies westerly of a line 200.00 feet westerly of, measured at a right angle to and parallel with the east line of said Lots 1, 2, 3, 4, 5 and 6. The Landowner, for itself and its successors and assigns, covenant and agree that it shall not itself perform nor shall it give permission to any third party to perform any of the following activities within the easement area, without the prior written consent of the City: A. Constructing, installing, storing or maintaining anything made by man, including but not limited to, buildings, structures, fences; walkways, clothes line poles and playground equipment; B. Parking of vehicles; C. Planting of gardens; T meter Entered 7tft Dakota County Treasurer-Audkor, I I ~ D. Storage of firewood; or E. Clear-cutting or removal of native vegetation or trees. The Landowner, for itself and its successors and assigns, further covenants and agrees that the general topography of the easement area shall be continued in its present ~ condition and no excavation or change in the topography shall be allowed, save and except as may be required by any federal, state'or local government agency, other than the Landowner, which has jurisdiction over the easement premises or as authorized by the City, in writing,. as the City shall, in its sole discretion decide is appropriate, that no cutting or harvesting of any live tree or other live vegetative cover shall be permitted . except-as may-be required by any federal, state or local government agency, other than Landowner, which has jur-4dictiGn over the easement premis`-~s. or as authorized by the City, in writing, as the City shall, in its sole discretion, decide is appropriate. The easement granted herein does not--entitle the City to use or occupy the surface of the easement except as specifically provided herein. This easement shall be effective upon Landowner's execution and shall continue in force in perpetuity. Landowner reserves the right to occupy and use the property and easement for all purposes not inconsistent or interfering with the restrictions set -forth herein. The easement- granted hereunder and the covenants contained herein shall run with the land and shall be binding onto the parties hereto and its successors and assigns. And the Landowner, its successors and assigns, does covenant with the City, its successors and assigns, that it is the Landowner of the premises aforesaid and has good right to grant and convey the easement herein to the City. IN TESTIMONY V11EREOF, the Landowner has caused this easement to-be executed as of the day and year first above written. MAPLEWOOD DEVELOPMENT AND CONSTRUCTION, INC., a Minnesota Ipo lion 4 By: Mario Cocchiarella Its: Chief Executive Officer STATE OF MINNESOTA ) ) ss. COUNTY OF DAKOTA ) On this,,~_ day of 1995, before me a Notary Public within and for said County, onally appeared MARIO COCCH ARELLA, to me personally known, who being me duly sworn, did say that he is the Chief Executive Officer of Maplewood Development and Construction, Inc., the corporation named in the foregoing instrument; and that-said instrument was signed on behalf of said corporation by authority of its Board of Directors and said Chief Executive Officer acknowledged said instr nn to be the free- act and deed of the corporation. MAIVLYN 1. Ial= MOTMYRl~ilC- 9NUM Illy Comm. ESQ. Jan. $1. XW N tary Pu APPROVED AS TO FORM: C' Attorney's c ated: APPROVED AS TO CONTENT: QeX4 Public Wor Department Dated: Tura e Zo /y 4S' THIS INSTRUMENT WAS DRAFTED BY: SEVER.SON, WILCOX SHELDON, P.A. 600 Midway National Bank Bldg. 7300 West 147th Street Apple Valley, MN 55124 (612) 432-3136 RBBhvkt 20612869 .ti INDICATES CONSERVATION EASEMENT qw •,b _ ww ITt . wt •~atr t a • ftOf ~ A• ELACKHAWK FOREST wc- •^t • Iu [•cr : w f pttn--,. ' ~P` 'cnc s y~'k (rr ~ ..1- 'nfj{ 'to= w 1 10 a ll: yy'fC' 1. we I.,a na ue 1:1, < p 1 i . ~t t.t:;!l:I::i:.Y l ~nw •a a a, owl a ""IP 1•IC [ j 1-III:. •`Y ,L1 1 I:::w 31~ .vwoR!aJ•'M"` i armat ` _ , a ! uvf 1 `e 1"' n . i >„r ws furl. w of.n . t a o a 120 Iip f c Avg. 4 ~ jt :yr,'P°'. 3S S ~ 'k'il\ ,1, 97i,:.: ~ - - - - - - - - 1 1 I :%7 :ti•:'' 1 ,1 1=t Scal• In sect 13 ! o . \ I r t - i I wINITV Mat' 12 - - , e .1 \ .y i S .r 0 ,v:•'•'::ti:yq . , \L•lyi/' 10♦//al L Ad :\::•:•:•:jy'~'•Y'' :1, 1.1 S"N 11} CA 1 4.1114 `'•,S;•.L . 1 ` ~'•1~1y\::a I J'1 Y i~ I •a•xrc Yi i ' ✓.MIY - 1DL'w 'X~'~ ~'~p ,'i/ ~yx jl a:.::•: _ I L j - :r= t . • ! ♦ ,j '~j.i a -1 . ~'i: r•{{{;:~:~' [ ~ v 1 1 2 LAW, t I ~ l•la V / ,,/,p 'I< / ~ mat w ~ . f•: r r r 1 ! /i Iw s •v .ur w M I••°.un wnu..f, ta.w IUa+•.•. / ~t•Y C IR\.Ma . • 1•.L • RItR'♦RL IaV . I,I.r1 rt h P ~i \ ~s• a+i m / • . , \ ~ 1 NSr ~'v.• ~ r•a•...e a« a..e••a ~ ` ~ pa ,i ' p~ \ ••3 r ~ 15 / » t.••t.. ,/t-w,. 1 t.- ~ ~ -r ,a`R,'.;, ~ t .j~:,~: ~ ,c, 1 „t~..,. 1)001. \ L~ ' 1~ `•lt,.;::.:•: : . • / '1r ~ ' /ls1,11 fA••• Mf .inf O~ \ ~ ' (a w sowt•«d afw N fetYf+,1 1a \ • 1. * 1 •.~1 ..I.T.a a..ly a swlw $ !c \ ` \ / ` kz • 6 \ , •'Itat•~, t bA •,T,S•~~: / S 1, IU,t`. C w% fit.,e - e.-Ir<•n M \ ' { 1' jl 1, cx F I tl •-t~ / ~ `li:atler ~ w ,ovr, r \ ~b _j'-q• - f' - ~ ~ ~ •1:~:•a•:::Y,: ~ - r ~ i ~ • ~ r v- 7 a- `1 I--~~.... ! qy1 1- utm 3~y •4. 1 p _J y . w. i r e1 Srr X a~ S < IB •J:^ ~w ,y 11•.57 \ TI u1•+ ' ; ~:~l44~ ~•0 Ilutl..---~ ~ ,~i' 1--•a _ =t~~y l` -7- , --flr ~.w_ ^ -1~•'_-•----a 1, -nnra - =1 l_ `•y~- 1 t i . R 1 ~Iwn tw1(t w I1.~~ , r1• 1 •,^./-„--~y N K. 1 \ AVN t•l R Iq I/1 ft II ,f: C a I r r It t , ! 23 t` t. r i.: f Iq sert 22 ! Ie- - t. 1 ? _ i' ~>.iM . ~"wwyc~ M• v. ~Z ' t•n 3 ! r/ 24 ' H I \ J'r \ 3il.ew.:F:FII;iIF ~I rs •a...r~.a. w<a.• J. r.t sum Y•1., ; - ^ 9 y ,wri 1 \ 1 lr' SCNOELL, & MADISON, INC. K t `!t f 21 y ' ' 1 A';fZE::: :_til` A~I:I li!!1 1 i5i ENGINEERS • SURVEYORS • PLANNERS - - _ - J' ;It• i t,u I R , i SOIL. TESnHU • ENVIRONMENTAL SERVICES L 11 3>3!•_ i .,t'1 _ ~w•ol lK R fa ►tn . w • vttn . ' SHEET 3 OF 4 SHEETS GRANT OF EASEMENT THIS EASEMENT IS MADE and entered into this -IsNay o , 1998, by and between Jeffrey D. and Kimberly A. Giacomini, husband and wife, Grantors, and Jos 4h A. and Terry M. Giacomini, Grantees. WITNESSETH that whereas said Grantor is the owner of the tract of land in the County of Dakota, State of Minnesota, described as follows: DESCRIPTION OF PROPERTY: Lot 5, Block 2, BLACKHAWK FOREST, according to the recorded plat thereof, Dakota County, Minnesota. NOW THEREFORE, Grantor, in consideration of One Dollar and other good and valuable consideration, to it in hand paid by Grantee, receipt of which is hereby acknowledged, hereby grants to said Grantee, its successors and assigns, the following easement: DESCRIPTION OF EASEMENT: See Exhibit "A". IN WITNESS WHEREOF, Grantor has hereunto set its hand the day and year first above written. This Instrument Drafted by: State Deed Tax Due: REHDER & ASSOCIATES, INC. $ Exempt from Dakota C Av DeW Ta 3440 Federal Drive, Suite 240 DATE RECEIVED D CONSERVATION FEE Eagan, MN 55122 THOMAS V. ~IU~'Ah ' Thomas V. NOV2 651-452-5051 Dakota County Treasum-Audhor DAI(OTA COUNTY TREASURER-AUDIT By: Jeffrey . Giacom' i Kimberly A. 'acomini State of Minnesota) ss. County of Dakota) The foregoing instrument was acknowledged before me this/ ~ day 19 y Jeffrey D. Giacomini and Kimberly A. Giacomini, husband and wife, Grantors. (SEAL) CORINNE FLORIN tjoTARY PUBLIC -MINNESOTA otary Public - ; HE'•!NEP!'d COUNTY ^•'a 01131/20M - ~JNNf' ' Exhibit "A" A permanent easement for driveway purposes over and across that part of Lot 5, Block 2, BLACKHAWK FOREST, according to the recorded plat thereof, Dakota County, Minnesota, described as follows: Beginning at a point on the easterly line of said Lot 5, distant 17.00 feet southerly from the northeasterly corner of said Lot 5; thence northwesterly to a point on the northerly line of said Lot 5, distant 27.00 feet westerly from said northeasterly corner; thence westerly along said northerly line, a distance of 31.00 feet; thence deflecting to the left 150 degrees, a distance of 50.00 feet; thence deflecting to the right 25 degrees to the easterly line of said Lot 5; thence northerly along said easterly line, to the point of beginning. - Certificate of Title OWNER'S DUPLICATE CERTIFICATE Certificate No. 1 0 9 5 6 7 Document No. 358970 District Court No. Transfer front No. 1 0 3 0 5 4 Originally registered the 6th da,Y of December 19 51 Volnnte Seventeen ppagQe 225 and the 15th day of Aug. 1962, Vol. 55, page 49 and the 17th day of January, 1952, Volume Seventeen, page 233, the'15th day of December, 1951, Volume Seventeen, page 234 and the 7th day of February, 1959, Volume Thirty nine, page 170. State of Minnesota G County Dakota Ss This is to certi„r, that Jeffrey D. Giacomini and Kimberly A. Giacomini, residing at 401 y o Burnsville Pkwy 11119, City of Burnsville, Dakota County, Minnesota; and Joseph A. Giacomini and Terry M. Giacomini residing at 13084 Eveleth Avenue in the city of Apple Valley County of Dakota State of Minnesota are [low the owner s of an estate, to wit: fee simple as joint tenants of and in the following described land situated in the County of Dakota, State of Minnesota, to wit: Lot Five (5), Block Two (2), BLACKHAWK FOREST, according to the recorded plat thereof. Suhjecr to the enrttnrbrances, firw acrd interest nntrd by the mm~ a) ial underwritten or rrrdor,rd hereon; acrd subject to the follotping rights or -runrbri-ces subsi,tirrg, as proridrd in lams 1905, (.7rnl' e, .305. Section 24, jamety: I. Liens, r/rtilRt, m' rights arising tnrder' the Imps nr' the (.nn,tittt time n% the United .States. rpb%ch the statues J'this state ,w at r'e/hnr'P to appear' of IPMI"d: 2. An y real property tax a,- tperial assess nrw fm' rnhirh a sale of the larul has ,at been had art the elate n f the rertilirate of title: 3. Any leave fnr a period of not exceeding three year:,, when there is arntal orrttpation of the prrrrme under the lease: f. All rights in public hi'IZIy,s upon the hind: 5. S-h right o f appeal m' right to appear cord roatr,t the applinttiorr a, is al/ nvd by lop: 6. the rigbts ofany pecsmr in pn,sessinn nrrder deed or contract for dred from the nurno of the rer'tilicate n/titlr: ' Any arttstatrrling rnechanir, lien rights arhich array exist tnrder sertions 5/4.01 to 51.1.1 That the said Joseph A. Giacomini is of the age of 18 )'ears or older, is under no legal incapacity, except and is married to Terry M. Giacomini who is of the age of 18 years or older and is under no legal incapacity except That the said Jeffrey D. Giacomini is of the age of 18 years or older, is under no legal incapacity and is married to Kimberly A. Giacomini who is of the age of 18 years or older, is under no legal incapacity. In Witness Whereof I have hereunto subscribed my name and affixed the seal of lily office, yta °r this 18th day of August 19 97 cU <e~ JAMES N. DOLAN Registrar of Titles 1 In and for the County of Dakota and JAMES of li(~rt~'eCJOt vfOr sy° JAMESS VIJiJ'.iV e Ni Y,MNN MEMORIAI. of Estates, Easements or Charges on the Land described in the Certificate of "Fitle hereto attached. n ,ter„ r _77 iwnrnrr', n 'Yr ix.r, •rr ..n.. . rr.i•; r1fu v rrnr,a .,xlr,. t r.r •E.n ,.rC11.1 O.r vfnN 51871 asement Junei181196 3 6 5 '69 $1.00 Hillcrest Development (sub,ec to an a semen over th abo a for the enefit of other lands) Richard W. McCarthy 320861 ortgage June18 1.995 2:22 5 30 '95 $2,000,000 00 First Federal fsb James N. Dolan and o he lac s) 321976 eclaration o Prot ct ve oven nts and o he lan s) The Public July 7 995 4:30 5 15 19 - James N. Dolan 321977 onservation aseme it (af ects part f abo e, and then lands City of Eagan July 7 995 4:30 6 20 '95 - James N. Dolan 353069 irst Amend. o Mtg . 320861 Apr. 16 199 9:4 3 19 '9 - - James N. Dolan 358971 Mortgage Aug. 18 199 3:48 6 30 '97 $60,000.00 Anchor Bank, West St. Paul N.A and o he Ian s) James N. Dolan r h Building Permit Survey for: o~ 3 33 PROPERTY DESCRIPTION ee JOE and TERRY CIACOMINI ~ Lot 4, Block Dakota FOREST, according to the recorded o ~ l plat thereof, D Dakota County, Minnesota. low t 3 Blackhawk Road _d 872.7 at 3713 ~ 0 871.8 l ~a.~ _ 871.6 t" 1~1• N 55. 4'Pine 1 .1b72. a 1 55•.......•H58.4 91 00 t i- • G... ~a 29.0 x.........301 7.~ s -e i 1 Setback Los +GARAGE ~ o6k 56.5 e1 I ~HSSS 1 - _ ~ ...~....gw~ly 52. t ~ ine with ribbbn 38"0° y O 4~E te. ~ 4" Pine with ribbon ' 1.6 863.9 ~ N kl KYLLO LANE 1 u 1 43, ~J $ S. 115 t_ l ~o N~ Iw 0 1 I + ~1 tb' .DD g \ g 8 9.8k ~J! 859.9w` 868.~ 1 i x .3 1: ~0 o'Q Z.0 12'Pine 50° OQ ••~•..0:'• • 869.E .8 zOLOD in i N\ 7 1 1840.8 $ 8 .......jlm i . 846.9 - l N n ...,r...~ D' x1 1 Q x yaks- '6,.~'? + t • y) 8 45• ~ f i 00-~ 6 k33 82.64__- 1 P to- -0 N8U45_Y6 _ k A0.OX 43. 87x 4 59. ' 1y~ - - / ytea" "e' (tteFe 1 5 Scale: 1 inch = 50 feet Ili .'......gu 1, IN - ~,~nt^' y„~ Y» 18631 1 i- 36 Oak • :v r i i - - - - T I I$ - 4861 0 871.0~ 200.00 H6, 0^ LEGEND W u - '010E . 1 %,a x ' £r Hyd. Iran Monument Found r- N •.t.~..~..,r 857.0 % < 0 Iron Monument Set 125- 1 I yli II 9-9 Hyd.b Hydrant * 1 MHO Manhole t I i Z I Eµ 0~ ' / a I _ &9 yetbod line 869.9 1~ V ~~}E I P sup 4 l _ _ _ "cam ~~,,,.,w• J" : . ry 1 a O Eoea^enh '!n.m. 33 1 1 hereby certify that this survey was prepared by me or under my direct It I I supervision and that I am a duly Registered Land Surveyor under the laws 1w1" of the State of Minnesota. Dated this 26th day of August, 1998. g RENDER & ASSOCIATES, INC. 1 Alvin R. Rehder, Land Surveyor Minnesota Registration No. 13295 I Revised September 9, 1998. Garage Floor Elev. = 856.00 Revised September 10, 1998. First Floor Elev. = 858.25 Revised September 17, 1998. 1 Revised September 28, 1998 to show driveway easement. Walkout Floor Elev. = 847.71 Sewer Service Inv. = 862.88 JOB NO, from city of Eagan) 984-1501.010 Rehder and Associates Inc. Owner to install lift station) >f (Proposed house grades set by owner) BOOK CIVIL ENGINEERS AND LAND SURVEYORS 3440 Federal Drive a Suite 240 a Eagan, Minnesota a Phone (612) 452-5051 i DAKOTA COUNTY PROPERTY RECORDS DAKOTA COUNTY GOVERNMENT CENTER 1590 WEST HIGHWAY 55 HASTINGS, MN 55033 09/18/98 P A I D R E C E I P T RIX139R1 RECEIPT NO: 044803 A60 PROCESSING DATE: 09/18/98 PAYER NAME: JOSEPH A GIACOMINI AMOUNT: $29.50 CHECK: _ CASH: X CHECK DATE: CHECK NO: RECORDING DATE: 09/18/98 FEE CODES: 30 T i CUSTOMER COPY i PERMIT 'CITY OF EAGAN 3830 Pilot Knob Road PERMIT TYPE: Eagan, Minnesota 55122-1897 Permit Number: 0 3 3 5 2 5 BUILDING (612) 681-4675 Date Issued: 10/06/98 SITE ADDRESS: 3713 BL.ACKHAWK. RD LOT. 4 BLOCK: 2 BLACKHAWK FOREST" P,:I.N,- 10-14325._040-02 DESCRIPTION: ~I F"ui lci rl ,PerMrit 'T"yPe F 0 W G Bu,ttdinq Wort: Type NEW UR 0Cw~ uP(Attc R__3, U--1 Con t.ruc't; on -Tvp -r, VN c oninq R--°1 {Tui d,rnq i.ength 70 Bt,j tJ dirlq I,JiUt11 45 Buildi.ncat~oriw.~a 1 ,chi+ar~;! Feet; 3,150 Cen-;i;t,, 4:;od 101 1 - FAM n DETACH REMARKS: PLAN REVIEWED BY WAYNE NOVACZYK.. `a & W IS SCHERER PLUMBING 4447-6734 PRAG-REQUIFEE O FEE SUMMARY: ~ VALUATION $1.76,000 Base Fee $1,267.25 MISC. FEES Plan Review $823„71 Total Fee $4,771.46 Surcharge $8800 SAC $1,000400 SAC % 100 SAC Units I Subtotal $3 178 96 I CONTRACTOR: Applicant ST. L I C o OWNER: MgNLEY BROS CONST" 14544933 20054327 MANLEY BROTHERS 1,0778 ALLISON WAY 10778 ALLISON WAY INVER GROVE HGT"S MN 55077 INVER GROVE HGT"S MN 55077 (612) 454--4933 (612)454--4933 I hpr Pbv a(-;knowl.:cJq C.41 t. l i~, ,r read t.h n,r Iica L on and ~,t::at:e that c,he i.ntor°mati on t. r,arrec.t and aqI ee to conic_;ly ~.:,i th alt apr)1ic )bJ.e State o"i" Mn. Statutes and City of' Fagan 1-APP)Q1CANV-T/PERM1TEE G TURE UED BY. SIGNATURE t 1998 BUILDING PERMIT APPLICATION (RESIDENTIAL) C=OF 36W PU.OT X111106 M - 531= 881-"75 !'^►a lsre,ments to~i?$p$ir R rte C~~ fl regiahwed sae surveys 2 copies of plan 2 copies of plans (include beam & window sbms, poun3dfnd. design, etc♦. 2 sae surveys (exterior additions & decks) 9 6"My calculations; # 1 caic"ons for heated additions ♦ 3 copies of tree preservation plan d kd putted after,7tIM Mqu is _Yes No DATE: CONSTRUCTION COST` DESCRIPTION OF WORK: STREET ADDRESS: S.2 7 LOT:. BLOCK: c SUBD.IP.I.D. t`. f~-C~a~n~~/ G l z.-!~! z r 3 a Name Q Phone al Z q PROPERTY L First OWNER Street Address: L. Q+t City G- State: Zip: /•r 2 company: CONTRACTOR Street Address: 1 U '1 C Q nc~► ' License # City ' State: W t% Zip: ~-o7 r! 'J)jt A, F Tl t -48 , FLAW C-a C.7-b^ kcVL fO 7ra O'72-v ARCHITECT/ ~ c(// e A tA-.j 70-1 ENGINEER Company: t Phone /C E S cg'G 1 ;OP c • " SoS r"A Name:. R. Registrattiort Street Address: cl q,~ City State:. Zip= Sew & water licensed plumber (new construction only): J b YJ Penalty applies when address chang and lot change is requested once permit Is issued. 44 -1 I hereby acknowledge that I have read this application and state that the t2, C is:caorrect and agree to ly with an applicabi State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant 1,AA OFFICE USE ONLY rr tcaates of Survey Received Yes zNo Tree-Preservation Plan Received Yes No Not Req OFFICE USE ONLY SWLDING PERMIT TYPE 01 Foundation ❑ 06 Duplex ❑ 11 Apt./Lodging a Is Basement Finish 13 02 SF Dwelling ❑ 07 4-plex ❑ 12 Multi Repair. ❑ 17 :Swim Pool ❑ t}3 SF Addition ❑ 08 8-plex Q 13 GamphA ty -10 ` 20 Public Fad 04 SF Porch 0 09 12-plex ❑ 14, Faept T.' 21 Mi (larloo" 0 05 SF Misc. ❑ 10 -plex ❑ 15 tuck t _ . WORK TYPE 01`31 New 0 33 Alterations Q 38 Move 32 Addition © 34 Repair O 37 Demolition GENERAL INFORMATION Const. (Actual) Basement sq. ft. 24 o o Sent (Allowable) v Main level aq. ft. r USC occupancy .2-~-...;2 .`U`1 dg~r&, e4. ft. Firs S " Zoning:.' sq, ft. PRA #;of Stories sq. ft. Boaster Pump Length sq. ft. Cansus Code. ~ . Depth , 49' Footprint sq. ft. SAC ode 121 " ConsusSWg ..,,...t.^,:.. nsus unit ,..r;,a.....,, APPROVALS Planning Building Engineering Permit Fee Valuation: $ Surcharge Plan Review License MCNVS SAC 2. om x ts'=' _ 341&, c> City SAC Water Conn. 1. $4 v X z-,9 r , 4 a o WateAcct- Deposit Permit SNV Surcharge Treatment Pl. Park Ded. Trails Qed: Other Copies ` Total: % AC SAC Units ~ j ENERGY CODE WORKSHEET FOR 1 & 2 FAMILY DWELLINGS t ~ - SITE ADDRESS G/ O j T j CITY COMPLETED BY: ( PI[ONE # DATE BUILDING CLASSIFICATION: ❑ category 1 (standard) or category 2 (must include ventilation) MINIMUM CRITERIA - Foundation Insulation-R10 Walla & Windows Roof Attic Insulation: (See table on reverse side Slab on Grade Insulation-R10 for allowable percentages) R44-With Attic No lieel Floor over unheated spaces-R24 R36-With Attic Raised heel Foundation"Windows 1/211 R38 & R5-Solid Rafters insulated Glass. -Wood or Vinyl Frame F dow & Door Area STEP 2 Calculate area as a percent of wall Window & Door Area in Sq. Feet S (Including Foundation Windows): WINDOW MANUFACTURE NAME: C. From Step 1 divide box A (Window & Door ,..rr Area) by box B (total wall area) times 100 WINDOW MANUFACTURE TYPE:- L.+ equals the window and door area as a WINDOW MANUFACTURE U FACTOR:- tpercent of wall area (box C). R. O. Quantity cq.ft.Area BOX A✓~ tiDimensions X 100 Box B 3& ~d C ~I✓' e X -412 / + STEP 3 Design Features H X ASSEMBLY X FRAMING TYPE: nN N X ( STANDARD FRAMING; studs 1611 o.c. Z, U N X ADVANCED FRAMING studs 2411 O.C. M y~ t X CAVITY INSULATION R X SHEATHING TYPE: X t LESS THAN < R-5 X R-5 > OR MORE X U-FACTOR U DOO S: From the table, (reverse side) determine the maximum percent window & door area for the X ) design options selected and enter the t value cy & 40 in Box D below based on the window mfg. U- factor: x to Ill/, D Total Area of A_ q.ft. Windows & Doors B. Total Wall Area in Sq. Ft. The V value from the table in Box D shall be equal to or greater than the in Box C Wall Total Height Area Perimeter j f~z7_~ -Yet I/ Total Area of Walls B=i t1(jc(.(t I ONE- & TWO-FAMILY RESIDENTIAL BUILDING PRESCRn,,r F- (COOK-BOOK) APPROACII MAXIMUM WINDOW AND DOOR AREA AS A PERCENT OF OVERALL WALL _ AREA Rules i2arl 77670,0475. jiubpart 2. lttm_ t:avit Exterior Window U-Factor Fram Insulation Sheathin 0.49 0.36 0.31 0.27 STANDARD R-13 Z R • 7 13.4% 17.8% 21.3% 24.3% .STANDARD R-13 R • 5 12.4% 16.4% 19.7% 22.5% STANDARD R-15 > R - 5 12.9% 17.1% 20.1% 23.4% STANDARD R-18-19 < R - 5 12.19'0 16.0% 10.8% 22.0% STANDARD R-18-19 R - 5 14.0% 18.6% 21.8% 25.3% ADVANCED R-18-19 < R - 5 12.9% 17.1% 20.1% 23.4% ADVANCED R-18 -19 R - 5 14.5% 19.2% 22.5% 26.1% STANDARD R-21 < R - 5 12.8% 17.0% 19.9% 23.1% STANDARD R-21 >R-5 14.5% 19.3% 22.5% 26.1% ADVANCED R-21 <11-5 13.6% 18.1% 21.20/1 24.6% ADVANCED R-21 R - 5 15.0% 19.9% 23.29. 26.9% STANDARD R-17 <11-5 11.9% 15.796 18.4% 21.5% STANDARD R-17 Z R_- 5 13.8% 18.4% 21.5% 25.0% ADVANCED R-17 <R-5 12.6% 16.8% 19.6% 22.9% ADVANCED R-17 R - 5 14.3% 19.0-/0 22.2% 25.7% i Notes; Window area equals rough opening minus installation clearances. Window U-fattor must be determined by either the National Fenestration Rating Council standard 100-91, or ASHRAE 1993 Handbook of Fundamentals, Chapter 27, Table 5. Post-Ito Fax Note 7671 o.a ►rom covrvt Co. rt 1'horr . Phone 4 3 Building Permit Survey for. 03 33 PROPERTY DESCRIPTION 3e OMINI lot 4, Block 2, BLACKHAWK FOREST, according to the recorded JOE and TERRY CIAC plat thereof, Dakota County, Minnesota, a, at 3713 Blackhawk Road C~' 871.7 U tr Bn.B aQ 871.6 1 53. 50 55. 14 Pme 72. 858.4 9t z.,..... 5• 1 . X01.... e~ 77,•--- .0 1 _ ~o ' - 152 6ok 12"Pine 1 rn 856.5 "M 00 GARAGE I ss ,9" Ine ,.h „boon 1 6"oak, ~p 4~"E o,_, r t1, xribbon S 1.B 8639 ti ~y Q to KYLLO LANE LL 4' finilh Ak- 43 A Mx 00 2 9 ' 'r 4 4J $ 24 Oak n 1H ' 00 8.a`': 6 Ook 859.9 9.8 668.4x1 t0 i s 71.3 g ;1 Pine 5J o • 869.x, B6 8 ' 2- 0-00 101.00 .1 846.9 871.8 10 111 1 x 33 N `21, 0x 43 .-~t0y . 871.4 1 . - , r - U,. 35"Cok Scale: finch = 50 feet - 1 IMr•' . t 863.1 N 1 ` ~0-'}63 . - u ...r-1 / / ap .6* t N...... 1 i . - 18 y t_ , 8610 i 871.0 LEGEND - - 111 N'~~4Q1 1-1 ; • iron Monument Found _1 4,.. 0 Iron Monument Set J t r tn~ 11 ,g7~/ ✓ ~ ' S~ Hyd•-& Hydrant ' 1 140' / } I MHO Manhole 1 SRS O T i ~S rv A ;RIW-k tip /I . W ~~,(.a ~ ' .•&n1a~~ _ -.i'~ ✓ - ~ _ f 869.9 0 w r ose~• 1 cn0 Udfity E I hereby certify that this survey was prepared by me or under my direct supervision and that I am o duly Registered Land Surveyor under the lows i of the State of Minnesota. A, Doted this 26th day of August, 1998. RENDER & ASSOCIATES, INC. Alvin R. Rehder, Land Surveyor Minnesota Registration No. 13295 Revised September 9, 1998. Garage Floor Elev. = 856.00 Revised September 10, 1998. 9a Revised September 17, 1998. First Floor Elev. = 858.25 Walkout Floor Elev. = 847.71 Sewer Service Inv. = 862.88 JOB NO. (from city of Eagan) 984-1501.010 Rehder and Associates, Inc. (Owner to install lift station) (Proposed house grodes set by owner) BOOK CIVIL ENGINEERS AND LAND SURVEYORS 3440 Federal Drive - Suite 240 • Eagan. Minnesota 6 Phone (612) 452-5051 r r LOT SURVEY CHECKLIST FOR RESIDENTIAL BUILDING PERMIT APPLICATION PROPERTY LEGAL: - DATE OF SURVEY: LATEST REVISION: / i 7 , - F DOCUMENT STANDARDS U O ¢ z t}Y ❑ ❑ Registered Land Surveyor signature and company Q- Iy ❑ Building Permit Applicant ©-'b ❑ • Legal description V, ❑ ❑ • Address 6'' ❑ ❑ • North arrow and scale aK,❑ ❑ • House type (rambler, walkout, split w/o, split entry, lookout, etc.) ❑ ❑ • Directional drainage arrows with slope/gradient % 0- ❑ ❑ • Proposed/existing sewer and water services & invert elevation Q~ ❑ • Street name [ ❑ • Driveway ELEVATIONS Existing gy-'-O^ ❑ • Sewer service (or Proposed) D ❑ • Property corners ate[] ❑ • Top of curb at the driveway Q/'O ❑ • Elevations of any existing adjacent homes Proposed m~t~ ❑ • Garage floor L❑ ❑ • First floor 0-'o ❑ Lowest exposed elevation (walkouthMndow) C~'g ❑ • Property corners ❑ ❑ Front and rear of home at the foundation PONDING AREA fif applicable) ❑ 00 Easement line ❑ 8--"a NWL ❑ 01-1-0 • HWL ❑ • Pond # designation ❑ ❑'y ❑ Emergency Overflow Elevation / DIMENSIONS CY ❑ ❑ • Lot lines/Bearings & dimensions 0`0 ❑ • Right-of-way and street width (to back of curb) t~ ❑ ❑ • Proposed home dimensions including any proposed decks, overhangs greater than 2', porches, etc. (.e. all structures requiring permanent footings) 0`0 ❑ • Show all easements of record and any City utilities within those easements Ir " ❑ ❑ • Setbacks of proposed structure and sideyard setback of adjacent existing structures ❑ 0''❑ • Retaining wall requirements, if Reviewed: N e / to January 19% CRAIG 1 QQ&'8LDGPRMT. FM V fA-a 6 Tree Preservation Plan AGAN FORF-STRY DIVISION Site: Blackhawk Forest Block ,2 Lot 4 I;FVIF : Property Owners: Joseph A. and Terry M. Giacomi i SY Builder: Manley Brothers Construction DATE Contacts: Joseph Giacomini days 681-2129 or 989~Y~'""'~~✓~ pager # 1-888-853- 816 Kevin Manley 386-3359 Existing Trees: Tree # Size Tyne Status 1 24inch Oak Save 2 24inch Cottonwood Save 3 36inch Oak Save 4 24m'ch Oak Save Save 5 14inch Pine 6 12inch Pine Save 7 1Oinch Oak Remove awc.. 8 1 0inch Pine Fw"teY& S ow the 9 36inch Oak Vie{ Will survey 10 6mch Oak Remove 11 12inch Pine Remove 12 14inch Pine Remove 13 16inch Pine Remove 14 -42 Various Oak & Cherry Save ( These trees are identified on the Contour Map provided by the developer) AO rt r la(ify%tJ rr Building Permit Survey for. ' PROPERTY DESCRIPTION JOE and TERRY GZACOMINI , Lot 4, BLACKHAWK FOREST, according to the recorded plot thereof, Dakota County, Minnesota. I i C n-~r r i c n'y ^r OI,TrL 3 c i' to s:j on U C T' -11 Imo' rr uS " "as t,q 872.7 ~um4 , -re!7,a .w. IT ~Y- yo,-'JOti N7`; G K'lt`~tiJ 811.6 rg:•.~ii!?ii ti- j? ° ?45ja-r3na (>w w'' L 0 1- • 13,E `p ^,Pine 1 11 ~ 72. j:........... 858.4 INC. 00 X14. GARAGEu 5 R 56.5 k (1 = 1 V 10 '12)452-5051 P' dhli" 7 1 6-O k\ 663.9 1 e42 III! Pine wil ribbon ~E f 17 0774 l w g6o d ('a 21 oak ! 1 O ' : 'zz> G p 859.9 jr 1 .t 16i u 819.8 866.1x1 1D i :o;:»: •::i:: p „eJltn ; 0. Cb Y.p 616.9e tAp ~/I u 100 "XI ~p0 io v r lx 1u p~!>T O 871.8 V 10 4.0 ry5~7d l / ;rya/p-'~ 871.Scale: 1 inch = 50 feet 136 crt 'oval % 00 LEGEND e01 E 1 1 t6i :i. / 3e46 / • Iron Monument Found Hyd. r' N~ / ' G 5'° /.r k► v 0 Iron Monument Set t~0 1z~~ j ll S~~g11 11 > Hyd.,6- Hydrant 1 140i / MHO Manhole i 11 00p1+~~ 0 f / s 11 =Bituminous Surface V StbI One 869.9 ' 001, 33 :t I hereby certify that this survey was prepared by me or under my direct supervision and that I am a duly Registered Land Surveyor under the laws of the State of Minnesota. 1 T Doted this August 26th, 1998. RENDER & ASSOCIATES, INC. Alvin R. Rehder, Land Surveyor Proposed elevations will be determined by owner. Minnesota Registration No. 13295 JOB No. 984-1501.010 Rehder and Associates, Inc. BOOK CIVIL ENGINEERS AND LAND SURVEYORS 3440 federal Drive a Suite 240 a Eagan, Minnesota 4 Phone (612) 452-5051 2007 RESIDENTIAL BUILDING PERMIT 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. ft. of lot, sq. ft. of house; and all roofed areas 2 copies of plan showing footings, beams, joists Cert 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 if proposed building is to be placed on disturbed soil 1 site survey for additions & decks Tree Pres Pian 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 Pland lot platted after 7!1193 Rim Joist Detail Options selection sheet (buildings with 3 or less units) Minnegasco mechanical ventilation form Plans are considered public information unless you state the are trade secret and the reason. Date vM 7 Construction Cost 14 OLO Site Address 12.4 al-) Unit/Ste # Description of Work 6~ Q~ p Multi-Family Bldg - Y N Fireplace(s) - 0 - 1 _ 2 Property Owner Ile t i r✓ ► Telephone #,I Contractor (2&JC?1 eTUA<- % SI ~N ~ROtiJ R41ar -0 Address ~PP SJ! c?... City 4 PPIe !-J State 11 Ai Zip 6"S-/7- Telephone # (9~2_) Y'3)- 3--,2 F3 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 # ( J 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. io 9°l~G Applicant's Prin ed Name Applicant's Si nature DO NOT WRITE BELOW THIS LINE Sub Types ❑ 01 Foundation ❑ 07 05-plex ❑ 13 16-plex ❑ 20 Pool ❑ 30 Accessory Bldg ❑ 02 SF Dwelling ❑ 08 06-plex ❑ 16 Fireplace ❑ 21 Porch (3-sea.) ❑ 31 Ext. Alt - Multi ❑ 03 01 of_ plex ❑ 09 07-plex ❑ 17 Garage ❑ 22 Porch/Addn. (4-sea.) ❑ 33 Ext. Alt - SF ❑ 04 02-plex ❑ 10 08-plex ❑ 18 Deck ❑ 23 Porch (screen/gazebo/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 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 DescritAlon: 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 I non City of EaV I Permit#: a5a I I Permit Fee. I 3830 Pilot Knob Road I Eagan MN 55122 Date Received: Phone: (651) 675-5675 I I Fax: (651) 675-5694 I Staff: 1 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: _5:7j.-Z Gu'I,uI/ 1611 Unit Name: tin -r- `e Phone: Resident/ Owner Address I City ! Zip: 3 7-13 r V. (a Applicant is: Owner ontractor Type of Work Description of work: Construction Cost: D Multi-Family Building: (Yes No } Company: ~\0yf7^_CAJL 7 S Contact: 7 ~ .e~ - Contractor Address: t t) ~1 r City: State: Zip: 5 5W Phone: 7&3'a-7 License (W( gy 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.gopherstateonecal1.org I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuance. X. Lt" x Applicant's Printed Name Applic nt' Signat re e Page 1 of 3