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3808 Blackhawk Ridge Pl PERMIT City of Eagan Permit Type: Plumbing 3830 Pilot Knob Rd Permit Number: EA083831 Eagan, MN 55122 . Date Issued: 06/26/2008 (651) 675-5675~~~ EPermit Category: ePermit www.ci.eagan.mn.us lflflUl tflflLLL Site Address: 3808 Blackhawk Ridge Pl Lot: 14 Block: 2 Addition: Blackhawk Ridge 2nd PID 10-14401-140-02 Use Description: Sub Type: e - Fixtures Work Type: New Description: Main Floor Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments: matthew huntington 15230 carrousel way rosemount, mn 55068 Fee Summary: PL - Permit Fee (miscellaneous) $50.00 0801.4087 Surcharge-Fixed $0.50 9001.2195 Total: $50.50 Contractor: - Applicant - Owner: Matthew Daniels Kam & Raj Aggarwal 15230 Carousel Way 3808 Blackhawk Ridge PI Rosemount MN 55068 Eagan MN 55122 (651) 423-3730 I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Applicant/Permitee: Signature Issued By: Signature ~t INSPECTION RECORD' -CITY OF EAGAN PERMIT TYPE-. 3830 Pilot Knob Road Permit Number: 0 2 3 3 rx I Eagan, Minnesota 55123 Cate Issued: 4 / ~ l /94 {612) 681-4675 SITE ADDRESS: I-of '14 14 APPLICANT: i' 3t?!53 NI_A("f,. AWK ff 11)o Pt, .P-Pal;~~t3~$P~~' t#~_Cal~~~ 1fd 1..- .1~~.Palt:~t~F1L,1F" PERW SIATYPE: TYPE OF WORK: gt11 T fd w I f11.1Nf1A f f ON 11 ).f1.-AT 1,0 `9i;f. k1 P s,f E tfEPs-}#t #'1b Idt)itfkii ix# If f di f: f NA 1, ~Rf %Afj-PVV ~J AND. sow PLUMSM 46. x Hoc EUWTNC kopn*mt am* k". coowr4wft PootlrW I `l+jia ~I~ F I €owl*&n Fntnkrg ~ ROO" P P4 ugh Ali, pnpisoo Fit -t Orad Tom Pa-M Plbg. Pft kisp~ -No* Plum' ' COMOL tr EngrJPlan Bldg. Pod 7 t Deck Fig. Dw* FPW WON Pt, tom. w i INS C 1 k 3830 Pilot Knob Road Perm# Number: EaQw, Mintmota 55122-1897 Date %swd: (s12) 681-4675 _ 2 RE A E5S: . ►c APPLICANT: 14 M, s tat As; {ti Hl1W R I cat; rya L '"MW SUBTYPE. TYPE OF WORKS' r Of c . . i !"fool TUG 's, VI NAt t r ~F y ff' Y '~ElJ . 14 0 1 r t 1 P 1 d, .4 Wtr i f irate of CccupaIiC ` ~it~} o~ pagan Zc0artmcut of VaMiug 3u6pection 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: SF /M Bldg. Permit No. 23367 Occupancy Type R3/MI Zoning District PD Type Const.. VN Owner of Building SFWA BLAB INC Adaress4580 SCOTT TRf EAGAN Building Address 3808 BLA CEi 4% PL RIDGE ACE Locality L 14. B2 BLACKHAWK RIDGE 2ND -11r1y r Daze: Building Official A' POST IN A CONSPICUOUS PLACE f Address 3808 Bra wlz RIDGE PLAT-E Zip 5512 2 Lot 14 Blk 2 Sub Bl.ACIT1 WK RIDGE 2ND THESE ITEMS WERE 1 WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECTION. Date: 71f Yes No Inspector: rip 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 installing underground sprinkler system. White - City Copy Yellow - Resident Copy . Pink - Contractor Copy 174, ~a 7Rquesoate F re No. Rougction Required Inspectin Other Than Rough-In (You ll inspector hen ready) ❑ eady Now Will Notify inspector Yes ❑ No Date Ready sed contractor ~ owner hereby request inspection of above electrical work at: (Stye Box or ut No.) Ci CIO liff-~ Township Name or No. Range No. ounty Occu PRIN j f Ph el Power Sup Address ID a 1-~' Ele n ai Contractor (Company Name) CopVctor' Licgnse oAir . ' n w Mail A dress Ma er Making Installation) ~a? • Authori ed Signature (Contra oriO ner Making installation) Ph e Nu r i =y f+ v~A I 1A A nk MINNESO S BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT Griggs-Midway Bldg. - Room 5.173 BE ACCEPTED BY THE STATE BOARD 1821 University Ave., St. Paul. MN 55104 UNLESS PROPER INSPECTION FEE IS Phone (612) 642-0800 ENCLOSED. ~ , _i ~ .«a ~ , u ° I ~ 3 f ~l k I REQUEST FOR ELECTRICAL INSPECTION Es-00001-0s ► See instructions for completing this form on back of yellow copy. N 12 9 4 _ X" Below Work Covered by This Request New .,Add Rep, Type of Building Appliances Wired Equipment Wired Home Range Temporary Service Duplex Water Heater Electric Heating Apt. Building D er Load Management Comm./Industrial urnace Other (Specify) Farm Air Conditioner Other (specify) Contractor's Remarks: Compute Inspection Fee Below: # Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Swimming Pool 0 to 200 Amps 0 to 100 Amps Transformers Above 200 Amps A Q Amps Signs Inspector's Use Only: OffTOTAL Irrigation Booms ~f Li Special Inspection f Alarm/Communication THIS INSTALLATION MAY BE 0 SCONNECTED IF NOT Other Fee COMPLETED WITHIN NTH ` Rough-in Date(,( , the Electrical Inspector, hereby i I~~ y.. certify that the above inspection has Final, fe been made. O" OFFICE USE ONLY This request void 18 months from N28567 D~ Request Dip Fire No. Rough-In Inpsection R uir d Ins ction Other Than Rough-in You mu i call inspector w en ready)~ptjrleReady Now ❑ Will Notify Inspector j rr { Yes ❑ No Da {a Read lKicensed contractor El owner hereby req est inspection of above electrical work at: Job Address (Street. Box or Route No.)) It W ty Section No. Township Name or No. Range No. County f` Occupant (PRINT) Phone No. Power Supplier Address Electrical Contractor (Company Name) Contractor's License No. p e 1,46__ CA Gc "71.3 Mailing Address (Contractor or Owner Making Installation) °t 3 J 01 C(WcoW Alvi-7 t Authorized - nature (Corm ner Making Installation) Phone Number MINNES TATE 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 ~1 f es-oooot- a ~r ► See instructions for completing this form on back of yellow copy. N 8%5.67 `X" Below Work Covered by This Request ew Add Rep. Type of Building Appif'nces Wired Equipment Wired Home Range Temporary Service Duplex Water Heater Electric Heating Apt. Building Dryer Load Management Comm /Industrial Furnace Other (Specify) Farm Air Conditioner Other (specify) Contr2ctor's Remarks: p't ` Compute Inspection Fee Below ~"'7 # Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Swimming Pool 0 to 200 Amps 0 to 100 Amps Transformers Above 200 Amps Above 100 Amps Signs . Inspector's Use Only: TOTAL Irrigation Booms , /a Special Inspection t~ Alarm/Communication THIS INSTALLATION MAY BE O D DISCONNE t NOT Other Fee COMPLETED WITHIN 18 THS, r I, the Electrical Inspector, hereby Rough•in teP- , certify that the above inspection has Final Date , been made. OFFICE USE ONLY This request void 18 months from , wS~ MINNESOTA DEPARTMENToFNEALTN Protecting, maintaining and improving the health of all Minnesotans July 17, 2008 Kam Aggarwal 13804 Clare Downs Way Rosemount, Minnesota 55068 Gentlemen/Ladies: Subject: Food and Beverage Equipment and Lodging at Peaceful Mind Homes, Eagan, Dakota County, Minnesota, Plan No. 081378 We are enclosing a copy of our report covering an examination of plans and specifications on the above- designated project. The plans and specifications appear to be in general compliance with the standards of this department. Please see the enclosed report for additional changes and/or comments. It is the project owner's responsibility to retain the plans at the project location. This review does not pertain to the Engineering design (i.e., plumbing, swimming pools, service connections, sewage systems). A separate report regarding the Engineering Review will be sent. Ten working days prior to completion of the project, please contact Ms. Pamela Steinbach with our Metro district office at 651/632-5147 in order to arrange for a final on-site inspection. A final opening inspection cannot be conducted until the food, beverage and lodging license application is submitted with the appropriate fee to the main office. If you have any questions in regard to the information contained in this report, please contact me at 651/201-5736. incerely, Todd Whalen, RS Environmental Health Services Section P.O. Box 64975 St. Paul, Minnesota 55164-0975 todd.whalen@state.mn.us E r `ln TJW:ajk Is IJ V Do Enclosure I J UL 2 cc: Mr. Dirk House, Plumbing Inspector Mr. James Shay, Electrical Inspections Dakota County Electrical Inspections Ms. Pamela Steinbach, Minnesota Department of Health General Information: 651-201-5000 Toll-free: 888-345-0823 • TTY. 651-201-5797 wwwhealth.state.mn.us An equal opportunity enzploger MINNESOTA DEPARTMENT OF HEALTH Division of Environmental Health REPORT ON PLANS Plans and specifications on food and beverage equipment: Peaceful Mind Homes, Plan No. 081378 Location: 3808 Blackhawk Ridge Place, Eagan, Dakota County, Minnesota Date Examined: July 17, 2008 Date Received: June 26, 2008 Submitted by: Kam Aggarwal, 13804 Clare Downs Way, Rosemount, Minnesota 55068 Phone 651/423-3585 Ownership: Kam Aggarwal, 13804 Clare Downs Way, Rosemount, Minnesota 55068 Phone 651/423-3585 The following are corrections or requests for additional information necessary before construction of your project: Scope of project: renovation of an existing home into a facility for seniors with memory loss. This review only pertains to the foodservice portion of this project. Under 4626.0505 of the Minnesota Food Code, it states: "When food service or a food operation in a child care center, residential care home, supervised living facility, apartment building with congregate dining, boarding establishment, bed and breakfast, or similar establishment is limited to serving ten or fewer individuals, domestic equipment may be substituted for the commercial equipment required under this part." As a result, this facility will be allowed to have domestic equipment in their kitchen such as foodservice equipment, cabinetry, finish schedules, etc. 1. Refrigeration - General Requirements: All refrigeration facilities must maintain potentially hazardous foods at 41° F or below. (Minnesota Rule, part 4626.0395, item B) Each refrigeration unit must have a thermometer accurate to within 2° F. (Minnesota Rule, part 4626.0560 and 4626.0620) 2. Dishmachines: plan proposes a Kenmore Ultra wash dishwasher (model 665.1637). This dishwasher has an NSF sanitize phase. As a result, this dishwasher will be approved for use in this establishment on the condition that all loads will go through the NSF sanitize phase. 3. Handsinks: All handsinks shall be provided with hand cleanser, single-service toweling and nail brush. (Minnesota Rule, part 4626.1440 and 4626.1445) Each handwashing sink shall provide water at a temperature of at least 110° F through a mixing valve or a combination valve. (Minnesota Rule, part 4626.1050) 4. Plumbing - General Requirements: All plumbing plans shall be approved by the Minnesota Department of Labor and Industry (DOLI) or delegated agent. Submit complete plans for review to that department. (Minnesota Rule, part 4626.1040 and 1045) Submit plans to the city of Eagan for review and approval before plumbing construction may occur. Peaceful Mind Homes Food and Beverage Equipment Plan No. 081378 July 17, 2008 Page 2 A separate on-site inspection will be conducted by the Minnesota Department of Labor and Industry plumbing inspector or delegated agent to determine compliance with the Minnesota Plumbing Code. (Minnesota Plumbing Code, Chapter 4715.3130) Contact the city of Eagan for the above inspection. All plumbing equipment shall be installed in accordance with the Minnesota Plumbing Code for a commercial establishment. (Minnesota Rule, part 4626.1045) All hot water generating equipment (water heaters) shall be of adequate capacity to meet the needs of the anticipated demand of the establishment. (Minnesota Rule, part 4626.1025) Locate water heater in an accessible location. (Minnesota Rule, part 4626.1045) 5. Lighting - General Requirements: Provide effective shielding, such as plastic shields, plastic sleeves with end caps, shatterproof bulbs and other approved devices for all lighting fixtures in area of exposed food, clean equipment, utensils, and linens, or unwrapped single service and single use articles. (Minnesota Rule, part 4626.1375) 6. Restrooms - General Requirements: All restrooms shall be provided mechanical ventilation. (Minnesota Rule, part 4626.1475) All restroom handsinks shall be stocked appropriately. (Minnesota Rule, part 4626.1440, 4626.1445 and 4626.1450) 7. Other Code Requirements: All other approvals from local units of government shall be obtained prior to construction beginning. This includes building construction inspections, zoning approvals or other regulatory approvals. (Minnesota Rule Chapter 1302, Construction Approvals) Obtain an electrical inspection from the Minnesota Electrical Licensing and Inspection. All electrical systems must comply with the currently adopted edition of National Electrical Code. (Minnesota Statute, part 326.244) If applicable, contact Mr. Mark Anderson, 952-445-2840, for the above inspection. erel %W*4000000 Todd Whalen, RS Environmental Health Services Section P.O. Box 64975 St. Paul, Minnesota 55164-0975 todd.whalen a.,,state.mn.us MINNESOTA DEPARTMENT OF HEALTH Division of Environmental Health REPORT ON PLANS Plans and specifications on lodging: Peaceful Mind Homes, Plan No. 081378 Location: 3808 Blackhawk Ridge Place, Eagan, Dakota County, Minnesota Date Examined: July 17, 2008 Date Received: June 26, 2008 Submitted by: Kam Aggarwal, 13804 Clare Downs Way, Rosemount, Minnesota 55068 Phone 651/423-3585 Ownership: Kam Aggarwal, 13804 Clare Downs Way, Rosemount, Minnesota 55068 Phone 651/423-3585 The following are corrections or requests for additional information necessary before construction of your project: Scope of the project: renovation of an existing home into a facility for seniors with memory loss. This review only pertains to the lodging portion of this project. The plan proposes seven people in five bedrooms. Operator expressed interest of being able to add additional people in the future. Room two, three, and four has enough usable floor space for an additional person. I would recommend talking further about upgrading the occupancy with the inspecting sanitarian during the opening inspection. 1. Every building structure, or enclosure shall be kept in good repair and maintained to promote health, comfort, safety and well-being of persons accommodated, shall be kept clean and free of litter or rubbish (Minnesota Rule, part 4625.0400). 2. Floors shall be smooth, easily cleaned, shall be kept clean and in good repair. Abrasive strips for safety purposes may be used to prevent accidents (Minnesota Rule, part 4625.0500). 3. Walls and ceilings shall be kept clean and in good repair. Studs, joists, or rafters shall not be left exposed unless suitably finished and kept clean (Minnesota Rule, part 4625.0600). 4. Every room occupied for sleeping purposes by one person shall contain at least 70 square feet of usable floor space, and every room occupied for sleeping purposes for more than one person shall contain not less than 60 square feet of sable floor space for each occupant thereof. Under no circumstances shall there be less than 400 cubic feet of air space per occupant. Usable floor space excludes closets and bathroom areas. Beds placed side by side must be separated by a minimum of three feet (Minnesota Rule, part 4625.0900, section A) Master bedroom: Proposed occupancy is two (2) residents Proposed square footage is roughly 216 sq. ft. Preliminary approval is granted Bedroom two (2): Proposed occupancy is one (1) resident Proposed square footage is roughly 120 sq. ft. Preliminary approval is granted Peaceful Mind Homes Lodging Plan No. 081378 July 17, 2008 Page 2 Bedroom three (3): Proposed occupancy is one (1) resident Proposed square footage is roughly 132 sq. ft. Preliminary approval is granted Bedroom four (4): Proposed occupancy is one (1) resident Proposed square footage is 120 sq. ft. Bedroom five (5): Proposed occupancy is two (2) residents Proposed square footage is roughly 142 sq. ft. Preliminary approval is granted. The final determination on the above spacing requirement for all rooms will be made by the inspecting sanitarian, Ms. Pam Steinbach, during the opening inspection. 5. When flies, mosquitoes, and other insects are prevalent all outside doors, windows and other openings shall be screened (Minnesota Rule, part 4625.0700). 6. All equipment, fixtures, furniture and furnishings, including windows, draperies, curtains, carpets, electrical appurtenances, decorative or utility items shall be kept clean and maintained in good order and repair (Minnesota Rule, part 4625.1100). 7. Toilets and bathrooms shall be kept clean and in good repair and shall be well lighted and ventilated (Minnesota Rule, part 4625.4625.1200). 8. All lavatories for public use or furnished in guest rooms shall be supplied with hot and cold running water and soap. Approved sanitary towels or warm air devices shall be provided for hand drying (Minnesota Rule, part 4625.1400). 9. The temperature of hot water which is provided in any public area or guest room, including but not limited to lavatories, bathtubs or showers, shall not exceed 130° F (approximately 55° C) (Minnesota Rule, part 4625.1300). 10. Comply with the Minnesota Clean Indoor Air Act (MCIAA) (Minnesota Rule, part 4626.1820). 11. Plans on the plumbing system have not been submitted. (Minnesota Rule, part 4715.3130). Submit plumbing plans to the city of Eagan for review and approval on the new plumbing construction that will occur with the renovation. 12. A separate on-site inspection will be conducted by the State plumbing inspector to determine compliance with the Minnesota Plumbing Code (Minnesota Rule, part 4715.3130). Contact the city of Eagan for the above inspection. i t Peaceful Mind Homes Lodging Plan No. 081378 July 17, 2008 Page 3 13. Obtain an electrical inspection from the Minnesota Electrical Licensing and Inspections. All electrical systems must comply with the currently adopted edition of the National Electrical Code (Minnesota Statute, part 326.244). If applicable, contact Mr. Mark Anderson, 952445-2840, for the above inspection. 14. All fire protection measures shall be in accordance with requirements of the State Fire Marshall. 15. A separate on-site inspection will be conducted by the State Fire Marshall to determine compliance with Minnesota Fire Code requirements. Contact them directly for submission of plans. 16. All other approvals from local units of government shall be obtained prior to construction beginning. This includes building construction inspections, zoning approvals or other regulatory approvals. Sincerely, it %AaLooooo Todd Whalen, RS Environmental Health Services Section P.O. Box 64975 St. Paul, Minnesota 55164-0975 todd.whalen(i state.mn.us I i r----------------- I For Office Use Permit # City of Ea~d~ 1 - ; I Permit Fee: 3830 Pilot Knob Road I 1 Eagan MN 55122 Date Received: j Phone: (651) 675-5675 I 1 Fax: (651) 675-5694 I Staff: f I 2008 RESIDENTIAL BUILDING PERMIT APPLICATION Date: D )1 U Site Address: ✓~~f~ C ~C-C 2 Tenant' C I-J,N`I Suite ff~ C G- RESIDENT I OWNER Name: ~k w ~ . ~ ✓ Phone- ~ ~J 7 7_ Address / City / Zip: Applicant is: Owner ZContractor TYPE OF WORK Description of work: 1~ "(~'4z-t Z. liz r.v> [G Construction Cost: ` L'~1E f144' JIti- amily Building: (Yes / No CONTRACTOR Name: vl /l ZGe License jags Address: 's~' .5 t4,) . City: J-14- ~ _State: IC~ Zip: 5~ 7 Phone: LSL 032- Contact Person: = C_ COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING _ Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672 Energy Code • Residential Ventilation Category 1 Worksheet New Energy Code Worksheet Category Submitted Submitted (1~ submission type) • 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? _Yes No If yes, date and address of master plan: Licensed Plumber: ikL 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 the are trade secrets. 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. X Cn ~vc n. 7E C` g X Ap licant's Printed Name Ap licant's Signature JUN 2 0 2009 Page 1 of 3 DO NOT WRITE BELOW THIS LINE SUB TYPES ❑ Foundation ❑ 05-plex ❑ 16-plex ❑ Accessory Building ❑ Pool & Single Family ❑ 06-plex ❑ Fireplace ❑ Porch (3-season) ❑ Ext. Alt. - Multi ❑ 01 of - Plex ❑ 07-plex ❑ Garage ❑ Porch (4-season) ❑ Ext. Alt. - SF ❑ 02-Plex ❑ 08-plex ❑ Deck ❑ Porch (screen/gazebo/pergola) ❑ Multi Misc. ❑ 03-Piex ❑ 10-plex ❑ Lower Level ❑ Storm Damage ❑ 04-Plex ❑ 12-plex ❑ Miscellaneous WORK TYPES ❑ New interior improvement ❑ Siding ❑ Demolish Building" ❑ Addition ❑ Move Building ❑ Reroof ❑ Demolish Interior ❑ Alteration ❑ Fire Repair ❑ Windows ❑ Demolish Foundation ❑ Replacement ❑ Egress Window ❑ Water Damage Demolition (entire building) - give PCA handout to applicant DESCRIPTION: Valuation Occupancy MCES System Plan Review Code Edition r 1 '2 7 SAC Units (25% 100% Zoning City Water Census Code '"t Stories Booster Pump # of Units Square Feet PRV # of Buildings Length Fire Sprinklers Type of Const. Width REQUIRED INSPECTIONS Footings (new bldg) Sheetrock Meter Size: Footings (deck) Final/C.O. Footings (addition)' Final/No C.O. Foundation HVAC Drain Tile Other: Roof: -Ice & Water -Final Pool: -Footings -Air/Gas Tests -Final Framing Siding: -Stucco Lath -Stone Lath -Brick Fireplace:_R.I. -Air Test -Final Windows Insulation r Retaining Wall .rv` 1;11• Reviewed By <y V, Building Inspector RESIDENTIAL FEES: Base Fee Surcharge Plan Review MC/ES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Copies Total Page 2 of 3 r PERMIT CITY OF EAGAN 3830 Pilot Knob Road PERMIT TYPE: BUILDING Eagan, Minnesota 55123 Permit Number: 0 2 3 3 6 7 (612) 681-4675 Date Issued: 04/21/94 SITE ADDRESS: 3808 BLACKHAWK RIDGE PL LOT: 14 BLOCK: 2 BLACKHAWK RIDGE 2ND P . I . N 10-14401-140-02 DESCRIPTION: Building Permit Type SF DWG Building Work Type NEW UBC Occupancy R-3 M-1 Construction Type V--N Zoning PO Building Length 72 Building Width 46 Building stories 1 REMARKS: PRV S & W PLBR - PLUMRITE PLBG FEE SUMMARY: VALUATION $159,000 Base Fee $846.00 MISCELLANEOUS $1,828.50 Plan Review $549.90 COPY .50 Surcharge $79.50 Total Fee $4,104.40 SAC $800.00 SAC % 100 SAC Units 1 Subtotal $2,275.40 CONTRACTOR: - A p p l i c a n t - ST. L I C. OWNER: SEASONAL BLORS INC 14545971 0001652 SEASONAL BLORS INC 4580 SCOTT TR 210 4580 SCOTT TR 210 EAGAN MN 55122 EAGAN MN 55122 (612) 454--5971 (612)454--5971 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. e- F-101 6A J A PLI AN E MITEE SIGNATURE ISSUED B : SI NATUR INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: BUILDING 3830 Pilot Knob Road Permit Number: 0 2 3 3 6 7 Eagan, Minnesota 55123 Date Issued: 04/21/94 (612) 681-4675 SITE ADDRESS: LOT: 14 BLOCK: 2 APPLICANT: 3808 BLACKHAWK RIDGE PL SEASONAL BLDRS INC BLACKHAWK RIDGE 2ND (612) 454-5971 PERMIT SUBTYPE: TYPE OF WORK: SF DWG NEW INSPECTION TYPE .DATE INSPTR. INSPECTION TYPE DATE INSPTR. FOOTINGS FOUNDATION FRAMING ROOFING INSULATION FIREPLACE ROUGH IN PLBG ROUGH IN HTG FINAL PLBG FINAL REMARKS: PRV S & W PLBR - PLUMRITE PLBG L _ _ _ -J REACTIVATE CITY OF EAGAN PEMIT C, 199& BUILDING PERMIT APPLICATION IN 681-4675 L ~ , APR 15 1994 SINGLE &MULTI-FAMILY 2 sets of plans, 3 registered site surveys,_- copy`o~energy talcs. COMMERCIAL 2 sets of architectural & structural plans, 1 set of specifications, 1 copy of energy talcs. 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 / - / - Valuation of work Site Address: TC c? STREET SUITE # Tenant Name: (commercial only) LOT BLOCK SUBD. Z ~p i"t P . I . D . M Description of work: 00b) C®/)Sf CLPG7~1 p The applicant is: ❑ Owner ❑ Contractor ❑ Other (Describe) Name Phone Property LAST FIRST Owner Address STREET STE City State Zip S~/:S Company Phone Contractor Address SS 6~7,4~62/DLicense #r6.-3 Exp. C i ty 4a 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 N~r ❑ OI Foundation ❑ 06 Duplex ❑ 11 Apt./Lodging trCI166 t,sement Finish 0 02 SF Dwg. ❑ 07 4-Plex ❑ 12 Multi. Misc.'"'w7 ildFSI ❑ 03 SF Addition ❑ 08 8-Plex ❑ 13 Garage/Accessory ❑ 18 Comm./Ind. ❑ 04 SF Porch ❑ 09 12-Plex ❑ 14 Fireplace ❑ 19 Comm./Ind. Misc. ❑ 05 SF Misc. ❑ 10 Multi. Add'l. ❑ 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) V& Basement sq. ft. Z 1 l y MWCC System _ (Allowable) 1st F1. sq. ft. City Water. UBC Occupancy 2nd Fl. sq. ft. PRV Required Zoning PD, Sq. Ft. total Booster Pumppe lr # of Stores i_ Footprint Sq. ft. Fire Sprink Length '?Z On-site well Census Code C~~ Depth Y On-site sewage SAC Code o/ I~ APPROVALS Planning Building Assessments Engineering Variance REQUIRED INSPECTIONS ❑ Site Footing Framing Insulation ❑ Wallboard Final ❑ Draintile ❑ Fireplace Permit Fee vatuati«,: S DQ Surcharge G3S~,~~- J~a,h level ~4r Plan Review License 40Y 45-34 r (oloci . city sac SAC 8 y 33(. 1/0 Water Conn. ~ - 12- y00 Water Meter Lo'ya Acct. Deposit l ZX y yd . S/W Permit S/W Surcharge Treatment P1. 2/yak (a Road Unit Park Ded.---~°"° Trails Ded. Copies 50 6E Other Total. SAC % SAC Units 04/1411994 10:47 6124691899 WESTERGREN & ASSOCIT PAGE 01 t~rrtt*ftrat t x~ ►urvr prepared tor: LOT 14, BLOCK 2, SRASONAL BLACKHAWK RIDGE 2ND ADDITION according to the recorded plat thereof. BUILDERS, I N's'. DAKOTA COUNTY, WCSOTA "A. wel s r /?--CACAO ~~d~ x we/ SCALE : 1" = 30' a4Jreff. 98o6 9144 IK,„ ~ Q,dy , f'7' cce ~f'~''"~~.•nnP9e 7~ r~ Aram, smrmr sslrxN 4b e ( dote from et cr or 3'areo) r ~tih 'S' d'a,p ~9 LOT 8 ~O EA rSEAlW PER PLAT 1 L 47 4~ eM.9 +1\0 ?i tr ~Ralatc % LOT 13 ,o9 xo ~r ~Iw / ~~r }-A G A.N Ss5 8 i 6 ~t \ \ D VIEW RE S I LL, / k2~ f L / / I r 1 topa 1,,=89.26 `a E D 1•` B y an IR 6a oo =85°14'12" EAG ENGINEERING DEPT. NOTE vxjtirr Auvdrroys A NCH BE MARK ~f p1mrNSIONS PRIOR TO CONSTRUCTION bt 15 -k 18. &A 2, ■ ■ ,u o Disnotes iron moataMnt 09,4.3 a Dwwt•a exietiny shv. P $ t P Y' t P It ~C $ $ D li' t > P $ 3t r . (967.0) Denotes proposed elev. D LAND SURVEYORS a at, Denotes Off-Set hub = Top of block elev. 8500 210TH STREET WEST LAKEVLLE, MNNESOTA 55044 - Top of fin. garage floor PHONE (612) 469-1899 FAX: (812) 489-1$99 e5 A'1'1> = Top of basement floor elev. ,04.o..- indicates direction of surface drainage hater ~wwy And Alb ~i~nary nrwl Ap ane M wnAe► nrp a b o~neal 1o bat #taaay k**V&k* wd raid, VM MOVOW S, MdW M %Mi e0 Mmaaa s=. 1.d rneN.n.1'« 71N rnak. of 1 w~1 b•awyiay{ r/. ~y MK MMnaa.N, 8WMy #rlaa FW*1"0 SMV*yeWS M4 dM11 aea • lay 11aaw1 I.nd tMwrWa MMIN do lm" at** dMN Of "ems a 7Ma onrMad..~..►s An 1ee~aM d aN bi/a~ a~laers~ N Mhi taaa~, aaaA Aw Mowr.e afi ii.lalll. a~w~MAiww~b, ~awy. Awa «aaa aai/ aal. wa ■,NMy b.a«aal aaoap N Mwa aNwl r« a►#«n 11da eaKrey aw pawl, bb rah., #Ad mWank w/ Wd NOW r. aawand ady pa so . ,4,4,401d 6la aaNwy. 71,44 soolt 1! QS 8M./ "j Q~ Job NO. J1505 Ply., - dev Mnrnsota Registration No. 19790 /Y1 . An R. W**tw Vm LOT SIIROZY MCKLIST TOR R281DZNTIAL lDILDIHO TZMXT APTL CATION ~RCPZRTY Lte~~s ~ Date of Surveys RQCMMKI sT ur»= O~Q 0 Re istered Land Surveyor signature and 0 D Building Permit applicant company D~0 0 Legal description 0-''0 0 Address DD D ; North arrow and bar scale Nouse type (rambler, walkout, split w/o, split entry, lookout, etc.) D Directional drainage arrows with slope/gradient g. VJD D Proposed/existing sewer and water services Street name D D Driveway ZLZVATIONB V'_'V 0 Sewer service D"D D Lot corners H" D D Top of curb at the driveway V0 0 Elevations of any existing adjacent homes ftevesed I~''D 0 Garage floor D'0 0 First floor 0' 0 D Lowest exposed elevation (walkout/window) r- 0 0 Property corners 0--0 D Front and rear of home at the foundation P01MINQ XAMB (if avolitab2ef 0 B''D Easement line R- ID D D" D ; NwL . D D- 1) • Pond q designation 13 0 Emergency overflow Elevation f n2!lENBiOloB D n 0 Lot lines DD D ; Right-of-way and street width (to back of curb) Proposed home dimensions Including any proposed -decks, overhangs greater than 21, porches, etc. (i.e. all. D structures requiring permanent footings) Show all easements of record and any City utilities within those easements W-b 0 Setbacks of proposed structure and setback of adjacent ex D fisting homes, If D Retaining requirements, if any Reviewed: C Z--s HARKS N1 Al' iFIE END OF E C,{ JR F. il_E V. 842 82 NT AF IE END OF XMf R.E. 85246 LC)WER RE TO 848 00 50 0 50 SCALE IN FE i %l DC EX, --FiYU 8r G.V. & r 12 x 1 L t. 37' 6"D.I.P s a w I + 6p , TN 11 EL. 85E 14 INV. 846.3 30.2 S i N I "18 S 111V. 845.4 24.8 16 ` I TEL.. S & W It 65 S 846.2 ti 5.2` INV. EX. B.V. & BOX - "DIP SE RECD 6x3.3` EX PLAN 1861 13 "JEL I,"~:>i✓E f'iG S a W {v + I 51' ' : i I N V S-43.-/ V 1 I 0 5 17 ' ` _813 ! 5&V'J { t50 55 r ' ' , ` r 5 t ELEC. INV, 846.3 AIv1 . ] r ` . E , "O' BEI MFG STA . 6 + F 23 I( I E~ S tip ' 0 4 85 S iNV 845.1 48 - t LL- -4 3l 2 l.' \ Sii vv Or3 SdW%) t50 MI1 STA. 4+84 S INV 84 2 22 2' R 5 I N V >34. (1 20 b 49 ~ i i ( t { .............j: f... M W E.:~f . } -849-24- ' MI t . ~rifi ~xt ~1 ~ 3 Bill) -f Lb4 21 A t9 j I . S i ~``i7 s.~ } - ll! I . f} ! _ y . ....................»l::...................................... t_.. . } { , r' « T? j« . f f r : } y I - { i t i " 1t i j b" Y a tai. 3 _ i " y f A V ` Va~ K \I. ll .'i V «r.- . H 70. 4.14 . : f . , its TO E.' B" LAP_ ( i _ . « » CL) . { tSEE... NOTE i I f 't 1r',;~ I " fai l i R bt- W E k ~ ::::....I.:. ~BLCJOING AS Pli-k. OE ("Al _ ~IttEi { RECORD RL~ CITY PROJECT t, } + WW- I _ ' EXTERIOR ENVELOPE AVERAGE "U" COMPUTATION Plan # Date JJg,-1 CV Owner Contractor Site address 1 7 Total exposed wall area 2) Total exposed roof /ceiling _10451---sg~f Wall calculation - - _ Total window area Total door area Total glass door area O otal fireplace area Total wall framing area ---Ia----s~_¢t__~~> ( • ° _ Net insulated wall area 1704 snTf73.1 Total rim joist area Zi(o ___sa.ft__.04~__0_.6- Total foundation area ---040 ---f g_tt, .14= Z°_7 Total foundation window a~~ sc~~ft~_. 5= _ T}Total^ aI•S If item 3 is the same as, or less than item 1, you have met the intent of ? MCAR1. 16008 A and O Roof/ceiling calculation Total skylight area Total roof/ceiling framing _ Net insulated roof area _010i ---s9~ft. - 47 Total BAS Or If item 4 is same as, or less than, you met the intent of i MCAR 1.16008 A and 0 Alternate building envelope design to utilize the total envelope system method the sum of items 1 and 2 shall be greater than the sum of items and 4 1? +i> _ I Hereby certitfy that the building here-described meets- or exceeds the state of minnesota every conservation act. VA"Z Si gned_~f CEILING C;LlN~TRUGT 7: ON vs;' r,i 3. rsri. to R-~42. 0 blown ins. =ram4no section 1.. Irterior air film bE 1. Interior air film u8 2. 1=~, gyp. bd. .45 5;18" gip bd. .56 5 11., " of Batt wood L,. E, 7 _ w _ 1/'2"" wood 4. 4. 25/_2 bi ldr4 to 2 . 4w 10" irlSw oma 5. Siding .81 Total R T8.85 b. exterior air film .17 U = 1/R Total R 1.1_06 inSUlated section I. Interior air film .68 U = 1/R .09 5/8" gyp bd. .56 14" insulation 42 .0_~ I_EU at24 section ~ . Total R 45. 724 1. Interior air film, .68 U = 1/R .4r? gyp. bd. .45 5 5/8 bate ins. 1.9.0 Spec` al condition 4. ^5/32 bi 1dri.te 2. )8 n/a _ 5. siding .81 6. e-terior air film .17 Total R 23.19 U= I/ R 0.043, 'lRr J.oist section I- Interior air film .68 2. 5 1 r'te'" bait ins. 19.0 1 1/2" wood 1 . 89 4. '25/'32 bildrite 2. 5. siding „G1 6, exterior air film .17 Total R 2.4.6--z U = 1/R ,(-)4 Eo ndat. ion section 1. interior air film .68 1" s t -•.f r o iris5. 00 12" conc bl t::. 1.. '71 8 4w exterior air film .17 Total R 7.1? U = 1/R 14 CIAY dFEAGAN PERMIT 3830 Pilot Knob Road PERMIT TYPE: Eagan, Minnesota 55122-1897 Permit Number: 0 2 6 0 6 9 BUILDING (612) 681-4675 Date Issued: 07/25/95 SITE ADDRESS: 3808 BLACKHAWK RIDGE PL LOT. 14 BLOCK: 2 BLACKHAWK RIDGE 2ND P.I.N.: 10-14401-140-02 DESCRIPTION: Building Permit Type DECK Building Work Type NEW REMARKS: FEE SUMMARY: Base Fee $30.00 Surcharge _____1.50 Total Fee $30.50 CONTRACTOR: OWNER: - Applicant - DEHNEL JEREL 3808 BLACKHAWK RIDGE PL EAGAN MN (612)851-7020 I hereby acknowledge that I have read this application and stage that the information is correct and agree to comply with all applicable State of Mn. Statutes and City of Eagan Ordinances. t-k4,0 16VIIJ APP AN /PERMITEE SIGNAT ISSUED 13Y.,ISIGWUFTE INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: B U I L D I N G 3830 Pilot Knob Road Permit Number: 0 2 6 0 6 9 Eagan, Minnesota 55122-1897 Date Issued: 07/25/95 (612) 681-4675 SITE ADDRESS: P • I . N 10-14401-140-02 APPLICANT: LOT: 14 BLOCK: 2 3808 BLACKHAWK RIDGE PL DEHNEL JEREL BLACKHAWK RIDGE 2ND (612) 851-7020 PERMIT SUBTYPE: TYPE OF WORK: DECK NEW INSPECTION TYPE .DATE INSPTR. INSPECTION DATE INSPTR. FOOTINGS FINAL I i F L CITY OF EAGAN Q 3830 PILOT KNOB RD - $5122 1885 BUILDING PERMIT APPLICATION (RESIDENTIAL) / 681-4675 ♦ 3 reed ate surveys ♦ 2 copies of plan ♦ 2 Copies of plans {frauds beam & window sbms; poured fnd. design; etc.) ♦ 2 she surveys (exterior additions & decks) ♦ 1 energy cakwations ♦ 1 energy fthdations for hested additions ♦ 3 Copies of On preservation plan if lot platted after 7/1/83 mquited: Yes No DATE: 9Y-- CONSTRUCTION COST. ~ DESCRIPTION OF WORK: S EET ADDRESS: ,~a-- LOT - BLOCK _ SUBD./P.I.D. -T PROPERTY Name: CP / ,--5 re Phone G 1'' OWNER ~T Mw Street Address- 3 O City: 64e4= State: Zip* CONTRACTOR Company: ~--cam Phone Street Address: License City: State: zip* ARCHITECT/ Company: ~G> Phone ENGINEER Name: Registration Street Address- City: State: Zip. Sewer & water licensed plumber. Penalty applies when address change and lot hinge are roqwsftd once permit is issued. i hereby admowledge that I have read this application and state that the infarrnatlan is correct and agree to with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant: OFFICE USE ONLY R E C E NE Certificates of Survey Received Yes No J t_ 1 4 1995 Tres Preservation Plan Received Yes No OFFICE USE ONLYf t-^ BUILDING PERMIT TYPE a 01 Foundation a 06 Duplex a 11 Apt./Lodging a 16 Basement Finish a, 02 SF Dwelling a 07 4-plex a 12 Muni Repair/Rem. a 17 Swim Pool a 03 SF Addition o 08 8-plex a 13 Garage/Accessory a 20 Public Facility a 04 SF Porch a 09 12-plex a 1 Fireplace a 21 Miscellaneous a 05 SF Misc. a 10 - plex 15 Deck WORK TYPE New a 33 Alterations a 36 Move a 32 Addition o 34 Repair a 37 Demolition GENERAL INFORMATION Const. (Actual) Basement sq. ft. MC/WS System (Allowable) Main level sq. ft. City Water UBC Occupancy sq. ft. Fire Sprinklered Zoning sq. ft. PRV # of stories sq. ft. Booster Pump Length sq. ft. Census Code. 4/aL _ Depth Footprint sq. ft. SAC Code aY Census Bldg Census Unit 0- APPROVALS Planning Building Engineering Variance Permit Fee Valuation: $ Surcharge Plan Review License MCNVS SAC City SAC Water Conn. Water Meter Acct. Deposit SNV Permit SfW Surcharge Treatment Pd. Road Unit Paris Ded. Trails Ded. Other Copies Total: % SAC SAC Units 04/14/1994 10:47 6124691899 WESTERGREN & ASSOCIT PAGE 01 9/12/94 (gert if irate furvev prepared for: LOT 14, BLOCK 2, SEASONAL BLACKHAWK RIDGE 2ND ADDITION BUILDERS INC. according to the recorded plat thereof. DAKOTA COUNTY, MNVESOTA fwd o~- ,Qrel !w',41Zc%e110 SCALD' : 1" = 30' r~d~r~' 38oa '~/aakha,r.~ Q,dg'.~ / dace ~fG^ ~Y !.'nnPS'eIo ( dace from City or Sarea) h i6sp. LOT 8 D Is r LOT ¢ . ~ ~ ~ ` \ y 867.3 4~ L07- 13 h , No~ / .q z e • s . `LOT 15 AA - .~4 . A 1,,=89.28 ~ ' ~ s T~ So •~s:, . /R _60.00 d-85 14'12' ~~C► NOTE DIMMIONS PRIOR re BENCH f MARK f'iNt ~ •~~,1a ~ COXSTRUCl70X 77 NO be j. - 1" 15 « 111, .A s: ,ear: 4 C amotes iron monument teas,. DeAwtee exietiny elev. tf g T >e s z o r i a t 8 s, J n r. l~'s-c.0 j umovews proposed elev. LAND SURVEYORS e~o~ Denotes Off-Set hub =Top of block elev. 89Gr,'* - Top of fin. garage floor 8500 210TH STREET WEST LAKEVLLE. M/d•ESOTA 55044 31) 8 4q - Top of basement floor elev. PHONE : (612) 469-1899 FAX: (612) 466•-1899 Indicotes direction of surface drainage f *M".wM rM plop a.i iqr w. «.Mla /eed.wraei . Y aM.M % eN W #1My (uww1wkPMi ww. n.OKV" b someamfr We 60 Mleeal R ai T..w~.... Nw 7>M te-ew cx I r1 iwv.li,~ .I. p./ ~r sr iNMeM»I~ a«Mtr e(lnRPA- 0 2m enk wd 6w 1... d * 5P=@d 1.v/ Impulse w4w d.Ma.w(e,.e►M..fMina«a 7rlaoaaloi..A.ns1U.Mai.~Ofe9bW&Waft" wM111.4Mdw.bad= .tiAMaw.0*MM %r..r.j..w"ail Mr/. W r.Mlr N w.wraoi earl M ew cAwl fie aAone IMe Meer Tm NeMa.1h ww, wei a.kir, we/ Wd MMr i awwei air Ale ee. ew1 et *b.weor. GQex..sa! - 1leider. l1-_aver ?told book 141" 8 &1 PTO". ~i C 9 R t Mir»esoto RsyiatraUai No 19790 Job No. ,11505 p~-- Vs Ddn ~yrvn :::i •'t•;„<•>}l. {:~}>:,:a+xr .}:.,.y;.y •:•x::•t +~••h+::, R:. ..x;.>.:r:,ssz~::>.~:$:?:{st•?;'t{}•:.;:•: ?:•:<}tiy:' }ti~':f ~:yv v:h+x::.. •.f. t:..::?r./$} rA:yi++::' +:':i:-:}t ..T,.:'.t; .:i'• , v::. :+.?r . . •.`•.,~..,ntlh ..:'iC+: Qa v'{ ra 4}+:•ry.~t+: ~ , i {'+h4.v :+}}.'v}?:•??:•+... n..::,v}?:}i}'L}r:::: }:..n v...:..... %4:?' 4v:'•.rv. .:v,: h ~v2t'}. tiyC•:•n41v{•: }t+ ::tit{ti':Stiv. Y.y4••y,'r:: :,r .,h x'^t•:t•?9.{•}}::r} : •t}::, a.??,;. ,.4: 9 S+4•?:{4,}{3{t?{. :}+,;{.;.o,+ v „C] . ..k;~':•:;}~ 4h+th+~7,:'?~f;• F ~~yr.:`' ' ::?r.4.y;,~:{ ..,}h,%::~.. .:,••*N:;! • :::ti: .3 '•;~'•et ;x. `::'Y'+: ~>,'•r :.t,;~''+y. '~u' +~,•o•:... ^•;.~:~~{xh:. ~,u`~ t}... t: r 4~• : .,.;1.:•.':~'.':.'•~.,t.,.},:•: •4-.:v:: :•.a-} }~Y{.:'- ;#%.•'3.;: .a},,..!:} n ,•{y.. ?:"••k...t. r*\. . a„•s~,y' : :;h :st31'.y~i.•:? x . ~.:LSL•?:^Yi::.;{{::}+.::•'• y+.~:;ti;', f •}}:}:t{S•.' Ih.}} '~+p•: v;.•}?y i{;:;:?}'v`{'. •;i,v y..S, Sj,• {r, M1V:~~?.+4'+'+~'y.}:':.'• ,:.~:p:;.:: {24}: ``•::y;,:. yt ~'',"ya~4:vh:}?;~?,.; 4 ;:.t ~~?fp;:u,~•:.:: ..•~?J:w{.r g2. ,+'{{+,'vn~, 4 i'}ti: :'~.>$6.i}}:: ~7:!: 2:: r`.P:~~y: ,.;{?+ri}, vY '-W. .,.{J.~h~C:+.y:,• tf•' ~ nq:.ir4 ;v I .••,~{+vtv....:::~Y{itit::•.`•:{}r`.~: i:•.'•:~~.'•::in......... ..::::~~Y~•~4~v~t,'~.~A!4.!'.~.C~::.}vi`•:{{{{~ti~~~5+".•:SA4: •.1+ '~S':~~~~v.'~~' 1994 MECHANICAL PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN MN 55122 (612) 6814675 PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. - 1, NEW CONSTRUCTION ADD-ON A/C ADD-ON FURNACE FIREPLACE INSERT DATE FEES HVAC: 0-100 M BTU $ 24.00 ADDITIONAL 50 M BTU 6.00 GAS OUTLETS (MINIMUM i @ $3.00 EACH) ~ av ADD-ON/REMODEL (Exis-n NG coNsTRucnoN) $ 20.00 STATE SURCHARGE .50~ TOTAL 9'f 5 SITE ADDRESS: OWNER NAME: TELEPHONE INSTALLER: ADDRESS: O CITY: STA ` ZIP CODE: TELEPHONE SIGNATURE OF PERM i . :.Y.}??}:.' : Y•,kt i.}•:. w:::: :•?\•'•::}i::'•'3Y33:L•}:4t:.?Yi. . w.} v: vv.:: ,%r , 4Yi{t3::i{%Y•{3:3<:,33'i':3:...... .3.'..\.;:.?;:S;.Y: . ,.{{Li:X3 Xv,+::nY.::}33:i::t:33':3::iv.: . ;TAT+i'. 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Y... •.YLY::;~:... •r,.;• .v..\ ...:.........:.....:.:.::x::;}+.......n..v::;Y::.v:•:::::........n..•,.,vv:xv..::: rn::?::T w.,•~: r4w:::: 4: v.••: n,w:: r. r: •.w .:n w. r :;.}i:: vxn n ......,:}}::::::::n••i}:fiar:'iL:S:333:;i?::t-?:•};:;; ......w: x:x•{•}?'.::v:}:::-:•:v:•}';.:. . ...<,,T T•.,:.:.v: {a.....:.: •:..n.,_:nw.. ...L:.}:;.... .na,.....,.t.,:.. .:::•Y...:?3•%.:"•. ;t;#•r'•Y'•Y:fnt{t•}•r..' • ~ •.:{•YV••}:;Y•:;.}:;..•+h:::.: ..r.n.. r..T.., ......a..v•{:•:Y?s...:::Y::: n.::. ,:n•: n•::.1... •.YwY;•?T:Y:La3 ...4 . ..t.,.v.....?Y..r.....'L~..:::.:..:.+..::: p:;.:•::::; ...v.•. .:h.Y..:Sr :Y::.v: »Y: Y::: •:t Y. }?i3 ; • : i. n:..,,.; . Tv::::.}•:: :a:•}:;•?Y::3:Y:}}::::•:{:331::33:::•,}.:-::•Y::•:,.. ,v ..........v - L- ' \ .n •:%{3•.. y { v:x{v;••.:4•.:. titi~i:4YX :S:v :'4YT+i t : .+}}.v: .v.+:{f •::.v» + r k1:. f ivv n : • }::.{v. i{• • v v ~ .?i,-. •Y.:fnrY.- f. } . n } . av:+T .,.T,}:•:a-;•YwY??}X'•nn............avi}?ra':::.v:•v3Y}}}}Y•:v: n:: ;;'..i•}; i'ii. T.":{+x ..vX•:•:••:i{Y,. , i•v Y•.n .n.m:+n:v.n.n,}...n,..,},{......r:n,.}+i)n...v.. n.3x... xv}:S•,:}S}n? •",vr+'..., ...T'w\5,.•.}sr: x,.v.. a: n•: x.s}. }..Y.r`. Y:.» .:•rr::.G.•:d3,v,.sT...,:i.rao>:arY3}:v..TT•rr::•co::SrrY::Y% 1994 MECHANICAL PERMIT (COMMERCIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN MN 55122 (612) 681-4675 PLEASE COMPLETE FOR ALL COMMERCIALANDUSTRIAL BUILDINGS. ALSO COMPLETE FOR APARTMENT BUILDINGS OR OTHER MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT. - - - - - - - - DATE: CONTRACT PRICE: $ NEW BUILDING INTERIOR EMPROVEMENT WORK DESCRIPTION: FEES 1% OF ".C.. M FEE PROCESSED PIPING: $25.00 MINIMUM FEE: $25.00 STATE SURCHARGE $.50 FOR EACH $1,000 OF -pffltbW FEE, TOTAL $ SITE ADDRESS: OWNER NAME: TELEPHONE TENANT NAME: (AeROVEMENTS ONLY) INSTALLER: ADDRESS: CITY: STATE: ZIP CODE: TELEPHONE SIGNATURE OF PERMITTEE CITY INSPECTOR Jo J5 J1 Iq 1~-3- A-6 '4 CITY USE ONLY LOT ~ BL ~ RECEIPT o 1- 0 SUBD. ~ QVV' I' d 2hj RECEIPT DATE: 1-7- O© MECHANICAL PERMIT # ✓ S (J 1999 MECHANICAL PERMIT (RESIDENTIAL) CITY OF EAGAN S$SO PILOT KNOB RD EAGAN MN 55122 Date: I 106 (651) 6$1-4695 Complete this section only if you are installing HVAC in a single family dwelling, townhome or condo under construction and not owner /occupied. • HVAC: 0-100 M BT U $ 30.00 ADDITIONAL 50 M BTU 6.00 • Gas outlets (minimum of one required @ $3.00 ea.) State Surcharge .50 Total $ Complete this section only if you are remodeling, adding to, or repairing an existing single family dwelling, townhome, or condo. Please indicate if it is a new item, alteration, or repair. New _ AI eration _ Repair _ Other Reminder: Call 681-4675 for inspections. Furnace Air conditioning t/ Air exchanger Other $ 30.00 State Surcharge .50 Minimum Total Due $ 30.50 SITE ADDRESS: R 7 b& E P LA-C e. OWNER NAME: ~-t y-✓ f, 1}K) e..v PHONE a^I - G UGC (AREA CODE) INSTALLER NAME: PHONE (0 ( L -,?V) - 1 D STREET ADDRESS: ~J~-tl Z qJ (AREA CODE) ~ t-1-1 r1 c 77 n CITY: Fj e o~ N-~Az CL J C, ATE: Yl ZIP: J S, 3 y~ IGNATURE OF PERMITTEE CITY USE ONLY L BL RECEIPT M SUBD. RECEIPT DATE: APPROVED BY: , INSPECTOR MECHANICAL PERMIT M 1999 MKmmicAL Puma (COMMF.KCIAL) CITY OF EmAN 3830 PILOT KNOB RD. EMAN, 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 Install U.G. Tank Interior Improvement Remove U.G. Tank (Minimum Fee) Processed Piping (Minimum Fee) "NOTE: When installing/removing underground tank, call 651-681-4675 for inspection by fire marshal and plumbing inspector. DESCRIPTION OF WORK: FEES: 1% S: 1 /o of contract price OR $30.00 minimum fee, whichever is greater. 0 CONTRACT PRICE xl/o PERMIT FEE STATE SURCHARGE ($.50 per $1,000 of 2= Lt fee due on all pemaits.) TOTAL - SITE ADDRESS: OWNER NAME: PHONE - (AREA CODE) TENANT NAME (IMPROVEMENTS ONLY): INSTALLER: ADDRESS: PHONE - (AREA CODE) CITY: STATE: ZIP: SIGNATURE OF PERMITTEE Volume No. _ e o T*Itle OWNER'S DUPLICATE CERTIFICATE Certificate No. 8 3 8 6 4 Document No. 215905 District Court No. Transfer from No. 8 0 5 9 8 Originally registered the 18th day of Apri1 19 59 Volume Forty page 59 State of minnesota,' SS County of Daltota. J ,~Xcd 6 Ca cetr/,(y,, Mrr/ Meritor Development Corporation 605 West Travelers Trait of the City of Burnsville County of Dakota and State of Minnesota is now the owner of an estate, to wit: fee simple of and in the following described land situated in the County of Dakota and State of Minnesota, to wit: That part of Lot Fourteen (14), Block Two (2), in BLACKHAWK RIDGE 2ND ADDITION, according to the recorded plat thereof, lying north of the south line of Government Lot 1, Section 16, Township 27, Range 23. Subject to the encumbrances. liens and interest noted by the memorial underwritten or endorsed hereon; and subject to the following rights or encumbrances subsisting, as provided in Laws 1905, Chapter 305, Section 24, namely: 1. Liens, claims, or rights arising under the laws or the Constitution of the United States, which the statutes of this state cannot require to appear of record: 2. Any real property tax or special assessment for which a sale of the land has not been had at the date of the certificate of title; 3. Any lease for a period of not exceeding three years, when there is actual occupation of the premises under the lease; 4. All rights in public highways upon the land; 5. Such right of appeal or right to appear and contest the application as is allowed by law; h. The rights of any person in possession under deed or contract for deed from the owner of the certificate of title; 7. Any outstanding mechanics lien rights which may exist under sections 514.01 to 514.17. That the said Meritor Development Corporation is a corporation organized and existing under XX,`~(d4'Xd KX XXdAXXXXXXXXXq&XmX rTXd( XYJXXXX the laws of the State of Pennsylvania. Xd4NXXXXXXXXXXrXY(U-XXXXXXXXXXXXXKX!KxXyvX x i have hereunto subscribed my name and axed the seal of my once, this 17th day of May 19 89 JAMES N. DOLAN Registrar of Titles In and for the County of Dakota and State of Minnesota. (Seal) of Estates, Easements or Charges on the Land described in the Certificate of Title hereto attached. DOCUMENT KIND OF DATE OF REGISTRATION DATE OF INSTRUMENT NUh19ER INSTRUMENT MONTH DAY YEAR A.M. HOUq P.M. MONTH DAY YEAR AMOUNT RUNNING IN FAVOR OF SIGNATURE OF REGISTRAR 21590 Declaration of P ote tiv Cove ants (and th r la s) M y 17 1939 3: 4 27 18, - The Public James N. Dolan 63969 Utility Line Sept. 8 972 2 6 1 72 1.00 Town of Eagan Easement ( erpe ual Eas ments for anita y ewer urpos s and other lands) James N.Dolan 208395 asement for ngre s aid Egress Oct. 12 988 10:3 4 4 188 1.00 City of Eagan James N. Dolan and the lards) 239209 Pressure R ducin Valve gree nt and the lan s) Between City of Eagan and Fe 2 19 1 10:6 12 2 19 - Meritor Development Corporati n James N. Dolan II I i I ii i ~ i~ r ' 2006 RESIDENTIAL BUILDING PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone 9 651-675-5675 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 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 if lot plated after VIM Rim Joist Detail options selection sheet (buildings with 3 or less units) Minnegasco mechanical ventilation form Date -q Construction Cost Site Address 3 { C~ L Unit/Ste # 1ct(,L r) VJ fIC A,°- -e, t DescriPtion of Work Multi-Family Bldg Y~ N Fireplace(s) i 0 1 2 Property Owner "JW1c Vie I r, 1-')r h Telephone # ((~Isl Contractor riey a tdGt L' ~JS di7 Address J /V. City c3 1& a_l--ey State 17) Zip Telephone # 67) -.21-3r y,~'2 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 (q 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. err Y~ i L. Applicant's Printed Name Applican s Signature 2006 RESIDENTIAL BUILDING PERMIT APPLICATION City Of Eagan 1 U/ (J 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 New Construction Requirements Remode&pair 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 tert 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 Pies 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 I set of Energy Calculations On-site Septic System _ Y_ N 3 copies of Tree Preservation Plan if lot platted after 711193- Rim Joist Detail Options selection sheet (buildings with 3 or less units) Minnegasco mechanical ventilation form Date / / 0-1 Construction Cost r (s' Site Address $ 61 ~ A t 4 t%u" It 14 vt c Pr - Unit/Ste # f Description of Work Tear 04 f e v o v~ Multi-Family Bldg Y _ N Fireplace(s) 0 - 1 - 2 Property Owner Kt I+r. ~ ( (fie k V, Telephone # ( 651 Contractor t,`@f~,'/tL'6' I~LG'!.►G'~;5 ~?~f7 / ,l J 1'/ Lc 1Gf City Address `Z - State /-n Zip Telephone # (x,67) 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 (d 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 # ( j Mechanical Contractor Telephone # ( j 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. I Gt fc 1"62z- Applicant's Printed Name Applic s Signature j I City of T Eap I Permit I I '~t j Permit Fee. /q 1 3830 Pilot Knob Road I I Eagan MN 55122 I Phone: (651) 675-5675 I Date Received: Fax: (651) 675-5694 I Staff: I I 2008 FIRE SUPPRESSION SYSTEMS PERMIT APPLICATION* Date: Site Address; 2 Tenant:tf"~/~il: t' 11° Suite r PROPERTY OWNER Name: i ;-d=Phone. ° ' ri f Address / City / Zip: / , UJ . 5 0A Y Applicant is: c Owner Contractor TYPE OF WORK Description of work: ltj !G} Construction Cost: Estimated Completion Date: CONTRACTOR Name: GC -rl, l - % L 4-zx'1 License C Address: (rl Q Z,•~], ` i ; ~i . City: State: Zip: Phone• / l~4-01. /'-7/rw• >~b°,e~ Contact Person, FIRJ: PERMIT TYPE WORK TYPE Sprinkler System of head _lNNew _ Fire Pump _ Addition Standpipe - Alterations Remodel _ Other: Other: DESCRIPTION OF WORK: _ Commercial _ Residential _ Educational FEES $50.50 Minimum (includes State Surcharge) OR Contract Value,") ~ x1% Permit Fee o - If Permit Fee is less than $1,000, surcharge is $.50. w - If Permit Fee is > $1,000, surcharge increases by $.50 for each jState Surcharge $1,000 Permit Fee (i.e. a $1,001-$2,000 Permit Fee requires a $1.00 surcharge). " 6C' $ I F'J` TOTAL FEE 3/4" Displacement Fire Meter - $183.00 $ Fire Meter $ TOTAL FEE 'Requirements: 2 complete sets of drawings and specifications, cut sheets on materials and omponents to be used I hereby apply for a Fire Suppression System 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 with the Minnesota Building/Fire Codes; 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. x- X Applic nt's Printed Name A icant's Sign, ure FOR OFFICE USE REQUIRED INSPECTIONS h,r,rostatc. Flow al2:rm ~~r i❑ i r Pump T -r I:_siance: i J Permit Review 0(~o ~r~y Y yp 7 ~:s.n I I l 6514233585 Rug 49 08 09:23a Rajiv Rggarwal 6514233585 p.l r 0 PMH Terry Zelenka City of Eagan, Inspections Division 3830 Pilot Knob Road I Eagan, MN 55122 Phone: (651) 575-4679 Dated: 25th July 20o8 1 Terry: e Re: Inspections for ~8o8 Blackhawk Ridge Place Peaceful Mind Homes leases the property at 3808 Blackhawk Ridge Place, - • E Eagan MN 55122. The home would provide services for seniors that require 24/7 care due to memory loss. There would be a maximum of 7 residents in the house. The establishment is registered as "Housing with services" and - j "Housing with Services Class F" with the State of Minnesota. - i Peaceful Mind Homes will take care of residents with early to late stages of _ dementia. Some residents may be on wheel chairs or need walkers for walking. In additional, we provide medication administration for residents. Our sample j care plan is attached herewith. The residents will go through a care assessment performed by our Registered Nurse who will build a care plan based on the j assessment. Changes to the care plan will be made periodically based on RN ! evaluation and health status changes of the residents. At the time we are unable to take care of the residents due to an actue illness or changes in ongoing medical needs of the residents they would be given a choice to move to another facility that can better handle their care needs. I would appreciate if you could complete the inspections for the said property and issue a certificate of occupancy at your earliest convienence. Feel free to call me on my cell (651} 442-8210 for any questions in this regards. j Thanking you. Yours truly, Kam Aggarwal. } Director of Operations, t Peaceful Mind Homes j Page 1 of 1 fi 1 1 1 r L .,,.:a.;>s:::1~:;~:~:::ii;i[:::!:ri`:a2iii::?::;:~iS:;:Y3:;::c;isr;i:::;:F~i:::Y:;:%:::~i91'i~f:~i't:ifi:;:::Si:j:~3~':%i::ii5r:%:::i::f::;is~;i:%:SiS::::.::::.::5:::.:•::::r:.>::;:;:c:a:: ....diiiii::'<:5:::i::1:?3<:;::iS'}:fi:' .::::::•::o-:•:~>i::•::::•>:.:::::.: ..~>:>:::.~::::'i;~i::t::r;i::2::::::::::4:5:':'4f:~:>:~:;fi&;r: I ~l'(~ry~ ' a::~:;:r9.,•.f...:•:::.:~.v:>:.:..:•::::;:•: Jii~i~i~i~(F~i~i>i~~i~i~~s;fi::.. 1994 PLUMBING PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN MN 55122 (612) 681-4675 PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. NO. FIXTURES EACH TOTAL SHOWER 3.00 1 WATER CLOSET 3.00 BATH TUB 3.00 d LAVATORY 3.00 w KITCHEN SINK 3.00 _ LAUNDRY TRAY 3.00 HOT TUB/SPA 3.00 WATER HEATER 3.00 / FLOOR DRAIN 3.00 3 GAS PIPING OUTLET • minimum -1 3.00 ROUGH OPENINGS 1.50 4 WATER SOFTENER 5.00 PRIVATE DISP. - Dak.Cry. lic. 20.00 U.G. SPRINKLER -home under const. 3.00 ALTERATIONS - to existing 20.00 WATER TURN AROUND 20.00 STATE SURCHARGE .50 0 TOTAL: SITE ADDRESS: Jf14C* 4iWlk A @ OWNER NAME: INSTALLER: ADDRESS: .39(p j? t lir~+•c 73 S~ • CITY: i~r11/tI~ 644NJe molts STATE: fn IJ • ZIP CODE: .r '0'p e. PHONE ((,~s) yS'O + G. 9 `f GNATURE OF PERMITTEE i B U S MENEM:: 1994 PLUMBING PERMIT (COMMERCIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN MN 55122 (612) 681-4675 PLEASE COMPLETE FOR ALL COMMERCIAL/INDUSTRIA L BUILDINGS. ALSO FOR MULTI- FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DW LLING UNIT. NEW CONSTRUCTION ADD ON REPAIR WORK DESCRIPTION: CONTRACT PRICE: $ FEE: 1% OF CONTRACT FEE. STATE SURCHARGE: $.50 FOR EACH $1,000 OF PERMIT FEE. AIININIUAI FEE: $ 25.00 CONTRACT PRICE X 1% $ STATE SURCHARGE $ TOTAL $ SITE ADDRESS: TENANT NAME: STE. # OWNER NAME: INSTALLER: AZ° ADDRESS: --yL CITY: 6 STATE: 19/, " ZIP CODE5J~ PHONE co ola FOR: CITY OF EAGAN APPLICANT f=or Office Use Permit* • ' ~6 GI 7z G I City of Eap JUN I Permit Fee: 3830 Pilot Knob Road j Eagan MN 55122 I Date Received: Phone: (651) 675-5675 Fax: (651) 675-5694 Staff: j 2009 MECHANICAL PERMIT APPLICATION Date: Site Address: ~ Op hu A 1 il.-A~ _Ptooes, Tenant: CjaCLk - Suite 411% t RESIDENT / OWNER Name: ,c UL~ 4(\_CIK p& Phonel CSj ^QQ e-'9411 Address / City / Zip: © 1 CONTRACTOR Name: BURNSVII I E HEATING & A/C, INC license #.(41 0)_145U4115 Address: 3451 W. Burnsville Parkway Suite 120 City: Burnsville, MN 55337 State: Zip: Phone~~~ Contact Person: 6 Ina= TYPE OF WORK New _X Replacement Additional Alteration Demolition Description of work: NOTE: Both roof mounted and ground mounted mechanical equipment is required to be screened by City Code. Please contact the Mechanical Inspector or one of the Planners for information on permitted screenin methods. PERMIT TYPE RESIDENTIAL COMMERCIAL Furnace New Construction Interior Improvement XAir Conditioner Install Piping Processed Air Exchanger Gas Exterior HVAC Unit Heat Pump Under / Above ground Tank ( Install / _ Remove) When installing/removing tank(s), call for inspection by Fire Other p Marshal and Plumbing Inspector RESIDENTIAL FEES: $50.50 Minimum Add-on or alteration to an existing unit (includes $.50 State Surcharge) $90.50 Fire repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) $ TOTAL FEE COMMERCIAL FEES: $70.50 Underground tank installation/removal OR Contract value $ x1% $50.50 Minimum (includes State Surcharge) = $ Permit Fee - If Permit Fee is less than $1,000, surcharge is $.50. If Permit Fee is > $1,000, surcharge increases by $.50 for each = $ State Surcharge $1,000 Permit Fee (i.e. a $1,001-$2,000 Permit Fee requires a $1.00 surcharge). $ TOTAL FEE 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. xC~~~ In x~ Applicant's Printed Name Applfcant's Signature FOR OFFICE USE Reviewed By: Date: Required Inspections: -Under Ground Rough In -Air Test -Gas Service Test -in-floor Heat -Final Exterior HVAC Screening Inspection For Office Use j Permit City of EI P . ermit Fee. I 3830 Pilot Knob Road I l Eagan MN 55122 j Date Received: "fG~ I Phone: (651) 675-5675 Fax: (651) 675-5694 Staff: j - - - - - - - - - - - - - - - - - J 2009 MECHANICAL PERMIT APPLICATION Date:-- ate: , Site Address: 3U 'A'S -Nac 1 Ir k Q'J A ( PC Tenant: Suite ;9 4=0 4 RESIDENT / OWNER Name: Q, C1p tG~ Phone:` PS)k- LkqD- Ra I I Address / City / Zip: O YVKC_,a CONTRACTOR Name: RURNSVILLE HEATING & A/C, INC. License #Q VYZE~ 13 Address: 3451 W. Burnsville Parkway Suite 120 City: Burnsville, MN 55337 State: Zip: Phone:a~,~-Contact Person: - TYPE OF WORK New __X Replacement Additional Alteration Demolition Description of work: NOTE: Both roof mounted and ground mounted mechanical equipment is required to be screened by City Code. Please contact the Mechanical Inspector or one of the Planners for information on permitted screenin methods. PERMIT TYPE RESIDENTIAL COMMERCIAL Furnace New Construction Interior Improvement Air Conditioner Install Piping Processed Air Exchanger Gas Exterior HVAC Unit Heat Pump Under / Above ground Tank Install / _ Remove) When installing/removing tank(s), call for inspection by Fire Other Marshal and Plumbing Inspector RESIDENTIAL FEES: $50.50 Minimum Add-on or alteration to an existing unit (includes $.50 State Surcharge) $90.50 Fire repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) $ TOTAL FEE COMMERCIAL FEES: $70.50 Underground tank installation/removal OR Contract Value $ x1% $50.50 Minimum (includes State Surcharge) = $ Permit Fee - If Permit Fee is less than $1,000, surcharge is $.50. - If Permit Fee is > $1,000, surcharge increases by $.50 for each = $ State Surcharge $1,000 Permit Fee (i.e. a $1,001-$2,000 Permit Fee requires a $1.00 surcharge). $ TOTAL FEE 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. x x Applicant's Printed Name Applicant's Signature FOR OFFICE USE Reviewed By: Date: Required Inspections: -Under Ground - Rough In -Air Test -Gas Service Test -In-floor Heat -Final Exterior HVAC Screening Inspection r Use BLUE or BLACK Ink r For Office Use City Ol hicin Permit I ~~f I 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: '7 jr I F 2009 RESIDENTIAL BUILDING PERMIT APPLICATION /6 -'So -0 Date: /0 17/_0 Site Address: 39-0 Q~acie- haAj k ?,x (I, MN Tenant: Suite iRf2WXWF I OWNER Name: hGl✓l.mCwt~ Phone: ~5/ ~l Z3 358 Address / City / Zip: 132-041 C-1-AKE X p c..wrv.5 w Ay t2s s t~ 1' MN Sz Dd Applicant is: 4 Owner x Contractor TYPE OF WORK Description of work: F f a iw* no 0 y u C-tk L Construction Cost: ~f? 1 ? GGa Multi-Family Building: (Yes / No CONTRACTOR Name: eM4 License 326 4 Address: q 5 F 3 y A ~JY`e 50 City: / I` 1 0 LS State: ~ Zip: 5-155L I(j) b Phone: 612 - 710 ` F SS .0 Contact Person: C k (alkl _T Ir M t te r 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 the 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.org 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 pl s. X G~r~C rr~~-1-e x Applicant's Printed Name Applicant's Signature Page 1 of 3 3~Oz &61,htqo~ Rk6 A466--- DO NOT WRITE BELOW THIS LINE / 6 , V SUB TYPES - Foundation _ Fireplace _ Porch (3-Season) _ Stone Damage - Single Family _ Garage _ Porch (4-Season) _ Exterior Alteration (Single Family) - Multi _ Deck _ Porch (Screen/Gazebo/Pergola) _ Exterior Alteration (Multi) 01 of - Plex Lower Level _ Pool _ Miscellaneous Accessory Building WORK TYPES - New _ Interior Improvement _ Siding _ Demolish Building* Addition _ Move Building _ Reroof _ Demolish Interior Alteration _ Fire Repair _ Windows _ Demolish Foundation _ Replace _ Repair _ Egress Window _ Water Damage Retaining Wall *Demolition of entire building - give PCA handout to applicant DESCRIPTION , C52 Valuation ~d Occupancy MCES System Plan Review Code Edition SAC Units (25%_ 100%-p Zoning City Water Census Code Stories Booster Pump # of Units Square Feet PRV # of Buildings Length Fire Sprinklers Type of Construction Width REQUIRED INSPECTIONS Footings (New Building) Sheetrock Footings (Deck) Final / C.O. Required Footings'(Addition) Final / No C.O. Required Foundation. HVAC Drain Tile Other: Roof: -Ice & Water -Final Pool: Footings -Air/Gas Tests -Final Framing Siding: -Stucco Lath -Stone Lath -Brick Fireplace: -Rough In -Air Test -Final Windows Insulation Retaining Wall: _ Footings _ Backfill - Final Meter Size: Radon Control Erosion Control Reviewed By: Building Inspector RESIDENTIAL FEES Base Fee f Surcharge C,73 0 Z? Plan Review MCES SAC City SAC Utility, onnecti'on Charge S&W Permit&' Surcharge T eatment Plant pies TOTAL Page 2 of 3 D - Terry Zelenka City of Eagan, Inspections Division 3 r. ' 83o Pilot Knob Road Eagan, MN 55122 ~ m Phone: (651) 675-4679 I: Dated: 13th Oct 2009 Terry , . ~ w_-... ~f : Remodellin for 8o8 Blackhawk Ridge Place Peace °erty at 38o8 Blackhawk in e~~n~ to re- moae~h~` P'roP - level. The Ridge Place Eagan MN 55122 and extend its operations to the lower home provides a homey atmosphere and services for seniors that require 24/7 care due to memory loss. There would be amaximum of 9 elders in the house with a maximum of 7 at the upper level and a maximum of 3 in the lower level. Y On an average there will be 6 elders upstairs and 3 downstairs. Mal 4 E WAX Wrmw Peaceful Mind Homes takes care of elders from early to late stages of • dementia. In additional we handle medication administration for any other chronic conditions they may have like blood pressure, diabetes etc. The elders go through a care assessment performed by our Registered Nurse who will - build a care plan based on the assessment. Some elders may be on wheel chairs 1 or need walkers for walking. The elders who require wheelchairs for ambulation would not be living in the lower level. The lower level would be for elders who do not have walking dependencies. At the time we are unable to take care of actue illness. If there are changes in • ongoing medical needs of the elders they would be given a choice to move to another facility that can better handle their care needs. Feel free to call me on ~s MY cell (651) 442-8210 for any questions in this regards. Thanking You. Yours truly, Kam Aggarwal. Director of Operations - Page I of 1 - "M -n In -n 0.'0 O o Housing with ' o y X oz ~ v > 0 Services Ass ving D -~,Z 3 v 3 .dzmzo Ca 0 :3 < 0 CD a n n CD O= v 7 Z alp 0 w_ O 0 0 y N vNi a CD M C.) .3. .O m m ~m N 0 CD (D m CD CD 3 O =3 CD a tQ fQ to CD m CD !Z 4 N w y COO 1" (D r m 1+ ~ CD =5,, m :2 " CD ED, 0 CD CO Ej.,< C4 to CD CD CD -L O. :0 O .n. -•wy CD CL S CD (D C a E-0 y 3 Cl) n n A 0 0. cD CD CD CD (D (D I i~i CD Ch CO) CO 0 to 0 M CD CD 3 0 0) - CD N <y N TT1 < 2. CD O CD ,N. r, m m y~~ ~tD N CO 0 (n to !n fn z C = C N CD O y G O (D 3 C -0 N A A A A A A (p O CD jD (D (D C (CD A A A A A A Q e'D 3 p p p G7 G) 'S 0 (a CD 3 a 0 cQ CD m y "a CD CD (D CD G) r Q s' 0 O a 1 1 Q = w (ND - Q. 3 . T C i rL C (D ° rn ° 8 ° cn ° Al cD n sp my vD vy e" rn Z ` (D K.O.• <D C (D C - (D C O O - O = SZ O. W C N N C m (D Q• ? r- CD CD . 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CL 0 C m a Q a ~ m 3 m W y N V O Use BLUE or BLACK Ink I For Office Use I I I Permit 1 l 3 City of Ea ~ 1 I Permit Fee: 3830 Pilot Knob Road Eagan MN 55122 1 Date Received: I Phone: 651 675-5675 1 Staff: Fax: (651) 675-5694 1 - --j 2009 RESIDENTIAL ~j PLUMBING PERMIT APPLICATION Date: IO' DO - a ODq Site Address: 3 O~- p &AC K OAW Y, R I Q(LE , PLACL Tenant: K&Ln t"n,a b, "L_ Suite RESIDENT /OWNER Name: 1ZAI`~ (~(s(rApQ W,A L Phone: W.-R- 75 fj- 01 (o Address / City / Zip; 5A CONTRACTOR Name: C,W)T A L PLV M~VV lc, PLC License X031 ' 0 f n Address: 7 Jr rj T~ pY6 S City: (Z'l cwt -I LLD State: ("1W Zip: S a Phone: 1S) - 0 09 " 071 Contact Person: N dz-" S• ~)oN4-4 S o N TYPE OF WORK X New _Replacement _Repair -Rebuild - Modify Space - Work in R.O.W. Description of work: PERMIT TYPE RESIDENTIAL Water Heater Water Softener Lawn Irrigation Add Plum ing Fixtures RPZ / PVB) Main X, Lower Level) Septic System Water Turnaround _ New Abandonment RESIDENTIAL FEES: $50.50 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $.50 State Surcharge) $30.50 Lawn Irrigation (includes $.50 State Surcharge) $50.50 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $.50 State Surcharge) *Water Turnaround (add $165.00 if a 5/8" meter is required) $100.50 Septic System New ($10.00 per as built) (includes County fee and $.50 State Surcharge) $90.50 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) TOTAL FEES $ 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.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 appro I of plans. x 0 AN5• Jntv„5oN X Applicant's Printed Name Appli ant's n ture FOR OFFICE USE Reviewed By: Date: Required Inspections: Under Ground Rough-In _Air Test Gas Test Final 443 Lafayette Road N. MINNESOTA DEPARTMENT OF (651) 284-5005 ABOR & INDUSTRY 1-800-DIAL4198 St. www.dli.mn.gov Minnesota 55155 XAMkL www.dli.mn.gov TTY: (651) 297-4198 `JAN 19 2010 January 14, 2010 Kam Aggarwal 3808 Blackhawk Ridge PI Eagan MN 55123 RE: Chair Lift - Elevator ID# -19385PT09-28R Residence: K garwa 3808 Blackhawk Ridge PI Eagan 55123 i Dear Si Minnesota Statutes Chapter 16B provides that the Department of Labor and Industry, Construction Codes & Licensing Unit, Elevator Safety Section, inspect and approve elevators and manlifts (endless belt lifts) before they can be legally used in Minnesota. An Inspector from the Elevator Safety Section recently inspected your facility and determined it meets requirements of the Minnesota Elevator Safety Code. NOTE: Compliance with Minnesota Rules and the ANSUASME A17.1, Safety Code for Elevators and Escalators does not necessarily assure compliance with the Americans With Disabilities Act of 1990. Sincerely, CONSTRUCTION CODES & LICENSING a Tim D. Warren State Elevator Inspector tdw/rsg (CE-2) c. Schoeppner, Dale R., BO, City of Eagan Ability Solutions This information can be provided to you in alternative formats (Braille, large print or audio). ElFormCE2R An Equal Opportunity Employer Use BLUE or BLACK Ink r I I For Office Use f Permit 4 City of EaRon dPermit Fee:< E 3830 Pilot Knob Road Eagan MN 55122 I Date Received: Phone: (651) 675-5675 I I Fax: (651) 675-5694 i Staff: 2012 RESIDENTIAL PLUMBING PERMIT APPLICATION tJ 1 "'Y-,'1 lirv 0.i ~i_ 9 Date: t Site Address: V G. ` 4 Tenant: eCC'L h) A\ \n D u Suite RESIDENT / OWNER Name: (3.C W Phone: L102- VU Address / City / Zip: yy~ C _ , / Name: H ~~m►t~~ ~ cxi y t 6 License 06_~ 9 l CONTRACTOR Address: ;v-151 City: 4 iy~H State: Zip: J t~cj Phone: ~0's/ ,~XO ' jbr Contact: / Email: _ Work in R.O.W. TYPE OF WORK - New Replacement _ Repair - Rebuild _ Modify Space Description of work: RESIDENTIAL Water Heater Water Softener Irrigation RPZ PVB) PERMIT TYPE Add Plumbing Fixtures Main Lower Level) Septic System New Water Turnaround Abandonment RESIDENTIAL FEES: $60.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge) $60.00 Lawn Irrigation (includes $5.00 State Surcharge) $60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge) *Water Turnaround (add $189.00 if a 5/8" meter is required) $105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge) TOTAL FEES $ 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.gol)herstateoneGall.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 appr o p ns. X L k X Applicant's Printed Name Ap icant's Signature FOR OFFICE USE Reviewed By: Date: Required Inspections: Under Ground Rough-In Air Test Gas Test Final 111011 City of Eagan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 r Use BLUE or BLACK Ink For Office Use t -- Permit#: Permit Fee: l 66 Date Received: Staff: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Unit #: Resldentl Name: MO Phone: &Z _ 2.7S =IrTzT6 �, 141wner Address / City / Zi 4 '� ^��- ` �' ' 3 $,'oc q�„vt-t Applicant is: Owner Contractor Type of Work Description of work: I Lfr s Ao /rve, 72 VA/Il- / Construction Cost: 9000- 00 Multi -Family Building: (Yes / No ) Contractor Company: AL -t- iin/ 'L,IG,p/J EX5 . so-- S Contact: AD/Z,ipc Address: / 33 Z X y e-o,J A,Ar ,v City: Gi't 4 ai..) )° State: /IA ') Zip: S .31" Phone: I C2 - % 2-61 --7 C- I' 3 License #: Lead Certificate #: If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) In the last 12 months, Yes No If COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING has the City of Eagan issued a permit for a similar plan based on a master plan? yes, date and address of master plan: Licensed Plumber: Mechanical Contractor: Sewer & Water Contractor: Phone: Phone: Phone: NATE Plans supporting documents that you submit are cons" ered to a publi g of r►rtation Po ons of the information maybe classified as non-public if you provide specific reasons tha> ou d permit the C ty to conclude that they are trade 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.qopherstateonecall.orq 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 2.A,/ JO --' Applicant's Printed Name x �� Applicant's Signature Page 1 of 3 PERMIT City of Eagan Permit Type:Building Permit Number:EA132207 Date Issued:07/30/2015 Permit Category:ePermit Site Address: 3808 Blackhawk Ridge Pl Lot:14 Block: 2 Addition: Blackhawk Ridge 2nd PID:10-14401-02-140 Use: Description: Sub Type:Windows/Doors Work Type:Replace Description:Two or More Windows/Doors Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow windows, call for framing inspection. Call for final inspection after installation. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Valuation: 4,000.00 Fee Summary:BL - Base Fee $4K $103.25 0801.4085 Surcharge - Based on Valuation $4K $2.00 9001.2195 $105.25 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Ish Management Llc 13804 Clare Downs Way Rosemount MN 55068 (651) 442-8210 Hoffman Weber Construction Inc 3515 48th Ave N Brooklyn Center MN 55429 (866) 970-1133 Applicant/Permitee: Signature Issued By: Signature