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1691 Oakbrooke CtIRE?SIDENTIAL BUILDING PERMITAPPLICATIONN (?6bL1$ .. fOT KNOB RD - 55122 ?Q' W16! Dakbroo?e 5t 3830 PIL ?Ib3?15 - 651-681-4675 New Conetmctlon Reuuiremanb . 3 registered site surveys showing sq. %, of lot, sq. M. of Irouse; and all raofed areas (20% max6num lat wverage atlowed) . 2 wpies of plan showing beam 6 window sizes; poured lound design, etc.) • lsetofEnergyCalWldtlOns . 3 copies of Tree Preservation Ran il lot platted aker 711193 . Rim Jofst Dalail Options selectron sheet (bldps w0h 3 or less units) p?- kb3Hy - RemodellReuair Reaulrements 4631.1i 70.;0 90-50 2 wpies of plan • 1 sel of Energy Calculatrom for heatad addi0ans . 7sitawrveyfwexterloradditions8decks .?' . Indicete if hame served by septic system for additbns7vBa DATE VALUATION \k_>0 \oo o JOBSITEADDRESS IF MULTI-FAMILY BUILDING, HOW MANY UNITS? ' PROPERTY OWNE TYPE OF WO APPLICANT ADDRESS PAGER# CELLPHONE#?o?Z--?l.ri-'?`I?\ FAx#q?Z-GG?- (?`3Z?1 N1EV RESIDENTIAL BUILDING ONLY - FILL OUT COMPLETELY Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1ti (check one) Residentiai VenGlation Category 1 Worksheet Suh Energy Envelope Calculatfons Submilted Q ? ? INNESOTA RULFS 7672 - New Energy Code Worksheet Submitted Plumbing Contractor: Phone 4aZ- z 177, j Plumbing System Includes: _ Water Sof _ Lawn Sprinkler Fec: $90.00 _ Water Heater No. of R.I. Baths No. of 13aths Mechanical Contractor ?lr.) 5A% \42 .?•'1?U Phone # _1r'?? e!? - C__X_?5 Mechanical System Includes: Air Condilioning Fee: $70.00 L/ Heat Recovery System Sewer/WaterContractor\"??t?D ?nefU.?? Phone# \?2J`??g'Z?? AIl above informadon must be submitted prior to processing of application. I hereby acknowledge that I have read this application, state tfiat the with all applicable State of Minnesota Statutes and City of EagdkOrc Signature of Applicant Certificates of Survey Received? Tree Preservation Plan R and agree to comply Not Required? uPdatea va1 OFFICE USE ONLY r ? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg )1r, 02 SF Dwelling ? 08 06-plex O 16 Fireplace ? 21 Porch (3-sea.) ? 37 Ext. Alt- Multi ? 03 01 of _ plex O 09 07-plex ? 77 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF ? 04 02-plex O 10 08-plex ? 78 Deck ? 23 Porch(screened) ? 36 Multi ? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous * 31 New O 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding ? 32 Addidon 0 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 33 Alteration 0 37 Demolish (Bldg)" ? 43 Reroof ? 46 WlndowslDoors ? 34 Replacement *Demolition (Entire Bldg onl» - Give PCA handout to applicant Valuation Census Code SAC Units Nbr. of Units Nbr. of Bldgs Type of Const -? ? ?vV ?- Footings (new bldg) Faotings(deck) Footings (addition) Foundation Drain Tile Roof Ice & Water Final Framing Fireplace _X R.I. Y Air Test 'y Final Insulation MC/ES System City Water Booster Pump PRV Fire Sprinklered Other _ Pool _ Ftgs _ Air/Gas Tests _ Final _ Siding Stucco Stone _ Windows (new/replacement) Approved By I Z-- , Building Inspector Base Fee Surcharge Plan Review MC/ES SAC City SAC Water Supply & Storage S&W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other ToWI Occupancy 3 ` Zoning eo Stories ? Sq. Ft. ? Length 3-rf W idth 70/ (sk R-? 0^) e-?I-,OAEa REQUIRE D INSPECTIONS FinallC.O. FinaUNo C.O. _ Plumbing _ HVAC f? -l 1?`? c?2< "'? ?" qL?1x?? ?'jf s 2 Addiess 1 6 S 1 0 a k b r o o k e C t Zip 55122 LAt 17 $Ik I $LLb OakbrookP Sfh THESE I'TEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECI'ION. Date: Yes No Inspector: Final grade (6" from siding) Permanent steps (gazage) Pertnanent steps (main entry) Permanent driveway Permanent gas Sod/Seeded grass TraiUcurb damage . Porch Basement finish Deck Gr c. sZZ' 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 exisis. Contact engineering division at 661-4645 before working in righbof-way or installing underground sprinkler system. ? White - City Copy Ye]Iow - Resident Copy Pink - Contractor Copy Siteaddress: l1p9? 04..`G0Na0\CC (0urfiot_?13 BlockSubd. nacbron'r?-- On April 15, 2000 the Minnesota Energy Code, Category I Building Requirements for insulation protection, air tightness, and ventilation, was adopted. As a result, the City of Eagan is requiring that the following information be submitted prior to issuance of a Certificate of Occupancy. _ This structure: is constructed to meet minimum requirements of the Mn Energy Code, Chapter 7670 ? OR 7his sWcture: will be constructed to meet more restrictive requiremenls of Chapters 7672 or 7674 APPLIANCE C,AS ELEC MANUFACiURER MODEL BTU'S VEN7ING TYPE Water Heater a fo*? l?-- l Fumace VI ' a•3-„21 FL ? ? ,5`?00? ???ecf Dryer EXHAUST SYSTEM LOCATION TYPE MODEL CFM's VENTED YES NO Kitchen kitchen Bathroom 1 F V_ QS- V O- 80 ILI/ Bathroom 2 ?v _ ? SV o SO ? Bathroom 3 '??pa ?j ? ? ? O j U Bathroom 4 Other FIREPUICE 5 LOCATION GAS wooo MANUFACTURER MODEL BTII'S VENTING DIRECT ATMOS ? f?V 6iI0 0OOT?''R ?77Oem ? I hereby acknowledge that the above information is wrrect and agree to comply with the Minnesota Energy Code and City of Eagan requirements. VZ- _JKal / 0 h 6 ?o Signa Date ' 1 T` 0 ? L6?? ?? CompanyName " This form is the responsibility of the General Contractor. ? '?? h^?•'.c COMPLIANC? k"`1I tt"rnFr+,<,L-a ErleYgy.Cdc1e, ' Ferm?t # ?--. . hy'?-iicrk 3oEtWiYtl;?t70S'??OYL 3,!0 ?Chec e by Da`e Cr?iR?'i"f: De.ICOCa . ,-.?.?..?.r f Mik171090t,8.; ?. . .::i..7..?.. .. : ' . . *" r? dCTI?N TXpE:? Singl'e Pamily 1 , , g PLAD78. 5/12/00 , i i)IAR1oNA ?/YC}RCH F,t.2 t .:• ` r"'' '.` ? ; "r INFO:2MATI4DT _ . FASS&$ 526 409 7"? , ? ;. ;?••`'te?r ^1;1aY1 Coda ' Area ar. Ca+lity Cant, C3laainq/Door Fezime?te;- R-Vslue R-Valua U-VaZua --- ---__ ---------`_° -----°- - ------_-_-•---------------.... -- rFjt,r? S 1887 64.0 0.6 *aaod Fsame; 16" O.C. 1875 19.0 2.0 1 S4indows''n't r)oora, Above GY89s 279 0.350 38 0.350 v'r,00R5: i.ttihAStefl, 4$.0" inoul, 206 10.0 1 k?1,•?' rQUIPbENT: Fixraace, 92.0 P.FUE -- --- .'..- -'--- -.,.___...._.......,-.-------_' ' C?N'p7,i7LNC? 3xATENjEtaTe The proposed:;building deaigA,??p2eacribed.hera is f conaiStnnt wfth 1'83ag:plana,"apeo3ficatiicme;"•'?ind otheY. ca2aulations subni tted WStk 't "^ appl "catioh The 'proposed b'uildittg has beea deaignea tG tnap41 e ?en pf e?he :T3inneeot?.'l?i s ? ? .. B }? ???(ti ??? 4 ?Jr ? ?w. ?,`` ?a?, r ? i+. q^?> ?-P.e3 ` ' PULTE HOMES OF MINNESOTA JOB INITIATION ORDER DATE: JOB NO: COMMUNITY: ADDRESS: MODEL NAME: BUYERS NAME: ADDRESS: HOME PHONE: 5/12/01 0550-317-01 LOT: 17 OAKBROOKE INFINITY HOMES ADDITION: 5th TBD \??\ C,-?- CITY: EAGAN Diamond MODEL#: 17951 ELEVATION: 2 BUSINESS PHONE: SALES REP.: KATHEE SHELDON CITY: BLOCK: 1 UNIT:31701 STATE: MN GARAGE: STATE: BUSINE5S PHONE: PHONE: 651-686-4643 1 17951 DIAMOND-SLAB $ 203,990 1 18023 ELEVATION #2 $ 2,300 1 35039 4 SEASON PORCH $ 6,125 1 23005 2 TON AIR CONDITIONER $ 1,650 tp - $ ' $ ' $ - $ ' $ ' $ ' $ ' ? - $ ' $ - $ ' $ - $ ' $ ' G _ ? ITOTAL 1 1 $214,0651 THIS CONSTITUTES A CONTRACT BETWEEN THE SELLER AND THE PUCHASER (S) FOR THE ABOVE ITEMS. APPROVED BY BUYER (S): APPROVED BY BUYER (S): APPROVED BY SUPERENTIDENT: APPROVED BY SALES: Builde s License # 0001371 ? ZIP: 55122 LEFT ZIP: LOT SURVEY CHECKLIST FOR RESIDENTIAL BUILDING PERMITAPPLICATION PROPERTY LEGAL: L dt 17 131a,k I Dgk 4roa Ke DA7E OF SURVEY: m LATEST REVISION: 7-.2 Y- o7 m c ? U DOCUMENTSTANDARDS Y a O Z ? Q 1?1" ? B/ ? ? ? • Registered Land Surveyorsignature and company B ildi • u ng PertnitApplicant d ? ? • Legal description C4/? ? ? • Address ? ? • North artow and scale ?o ? • House type (ramblet, waAcout, splR w/o, split entry, bokout, etc.) a/ ? ? • Dired'wnal drainage arrows wilh sbpelgradient % V? ? • Proposed/exisdng sewer and water services & invert elevafion 4Y o ? • Street name V? ? . Driveway ? m??/ ? ? [? ? . Lot Square Footage L . ot Coverage [p, ? ? • Benchmark ELEVATIONS Existina ra?/ ? ? • Sewer service (or Proposed) FX 0 ? • Property comers V?? . 7op of curb at fhe driveway and property line ex[ensions ? [V/ ? • Elevations of any existing adjacent hames ?[?' ? • Adequate footing depth of structures due to adjacent utility trenches ? ? ? • Waterways (pond, stream, etc.) Pronosed O/? ? • Garage floor [y/ ? U/ ? ? ? • First Boor • Lowest exposed elevation (walkouf/window) P/ ? / ? • Property comers [,1 ? ? • Front and rear of home at the foundation PONDING AREA (if aoolicable) ? @/ ? • Easement line IJ C9/ ? • NWL ? C4/ ? . HWL ? ri/ ? • Pond # designatian ? Gil' ? . Emergency Overflow ElevaUon DIMENSIONS t5?? ? . Lot IinesBearings 8 dimensions [3/ ? 0 • Rightof-way and street width (ta back of curb) m? ?? • Proposed home dimensions including any proposed decks, overhangs greaterthan 2', porches, etc. / (i.e. all structures requiAng pertnanent foot(ngs) 14' ?? • Show all easements of record and any City utilities within those easements G?,C] ? • Setbacks af propased sVUCture and sideyard sefback of adjacent existing strudures 6? ?? • Retaining wall requirements, iF any Reviawed: ,5'urveyor's Certificate SURVEY FOR :PULTE HOMES DESCRIBED AS :Loc », elock i, OAKBROOKE 5TH ADDRON, City of Eagan, Minnesota and reserving easements of record. RECEIVED IUI, 24 2001 EauAN ENGINEERING DEPARTMENT A p ?6 ?6?O?n PoP°i ? 1641 Q OAKBR D CDU T i ?r ? ? RE'v ? i D'3G4? , # '779 51 PROPOSED ELEVATIO LOT HSE LOT = 3,608 = 2, 256 7 66% V$ f?'.? ??? L c: Df -PM U' ?? yn ? Top of Foundation = qai.o Garage Floor = 939,9 Basement Floor = NiA Aprox. Sewer Service = 932.3'- Proposed Elev. _ ? Existing Elev. _ Drainage Directions = Denotes Offset Stake = • HEDLUND PLANNING 6NCIN66RJNC SURVEYINC 2005 Pin Oak Drive Eagan, MN 55122 Phone: (651) 405-6600 Fax: (651) 405-6606 RAVo ??QUFNED BENCNMARK; = rr,r.ir?i Dn? at r' . n?e?-: 9? ?, N MIN. SETBACK REQUIREMENTS cP° o ? ?O SILT ,OnN caf SQ. FOO TA GE SQ. F00 TA GE CO l/ERA GE _ W Front - House Side - SCALE: 1 Inch = 30 (eet Rear - Garage Side- I HEREBY CERTIFY THA7 THIS IS A TRUE AND CORRECT REPRESENTATION OF 7HE BOUNDAftIES OF THE ABOVE OESCPoBED PROPERTY AS SURVEYED BY ME OR UNDER MY DIRECT SUPERVISION AND OOES NOT PURPORT TO SHOW IMPROVEMENTS OR ENCROACHMENTS, EXCEPT AS SHOWN. DATE _7/Iz/_!t 4• ' F . LINOGREN, LAN RVEYOF MIN TA UCENSE NUMBE 14376 JOB N0: 01R-294 CAD FILE: Oakbrooke 5      í  ÿ    ýúü þ  ý  ÿ þþü     ûÿÿ úñóçç í ü÷ ì ÿ  ø  ï÷ñáÿ÷ ûúù ø÷ûúùïù  ÿ÷ùö ÿéÜ ÷  áÿ ìí ù ú Û Ý  ñ ÷ÿù÷ÿùù÷÷ñ ý ÷ ÷ð ÿð ÿù÷ôè  ÷ ñ ü ÷å    ÷ÿ ÷ ù ü ñÿùÿå á ÷üð÷ÿ ÷÷Ý ÷üú ôÿñ ðú ðÿå  ÿëæìîæääåäåä ÷û  ÷ ÷ ÿÚ  æåãåã Ú  ìýå  öñô ø óò ùù  î÷ þ÷÷ÿÜ÷þðÿûÿ ä ÿ ÷  ãí ü÷á â÷Ü÷âö ÿóõþ  óõ êçääìä  ÷üú ô  â÷  ÿ ùù  ÿ   ñ÷ð ÿ÷÷  ÷ðùúô   ùù ü   ñóÿ    ÿ áúñþ  í÷ ÿå ùù è ÷ð   ÿÿ ú   ÷ PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA110084 Date Issued:04/23/2013 Permit Category:ePermit Site Address: 1691 Oakbrooke Ct Lot:17 Block: 1 Addition: Oakbrooke 5th PID:10-53764-01-170 Use: Description: Sub Type:Residential Work Type:Replace Description:Water Softener Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Chad Bettin 3208 First Street South Waite Park, MN 56387 Fee Summary:PL - Permit Fee (WS &/or WH)$55.00 0801.4087 Surcharge-Fixed $5.00 9001.2195 $60.00 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - George A Emslie Tste 1691 Oakbrooke Ct Eagan MN 55122 (651) 454-3869 Ecowater Systems P.O. Box 428 Waite Park MN 56387 (320) 251-2505 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA127419 Date Issued:10/01/2014 Permit Category:ePermit Site Address: 1691 Oakbrooke Ct Lot:17 Block: 1 Addition: Oakbrooke 5th PID:10-53764-01-170 Use: Description: Sub Type:Reroof Work Type:Replace Description: Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Please print pictures of ice and water protection and leave on site. Carbon monoxide detectors are required by law in ALL single family homes . Lisa Nyberg 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 - George A Emslie Tste 1691 Oakbrooke Ct Eagan MN 55122 Property Claim Solutions Llc 2005 Pin Oak Dr Eagan MN 55122 (651) 994-2028 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA129083 Date Issued:01/07/2015 Permit Category:ePermit Site Address: 1691 Oakbrooke Ct Lot:17 Block: 1 Addition: Oakbrooke 5th PID:10-53764-01-170 Use: Description: Sub Type:Siding Work Type:Replace Description: Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Please leave printed pictures of house wrap on site for the final inspection. When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to ensure maximum ventilation to attic. Call for final inspection after installation. Valuation: 4,000.00 Fee Summary:BL - Base Fee $4K $103.25 0801.4085 Surcharge - Based on Valuation $4K $2.00 9001.2195 $105.25 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - George A Emslie Tste 1691 Oakbrooke Ct Eagan MN 55122 Property Claim Solutions LLC 2005 Pin Oak Dr Eagan MN 55122 (651) 994-2028 Applicant/Permitee: Signature Issued By: Signature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b-1H-'('XL.$*-'>.- ":3!!';:N'(M-'Y''`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a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ity of Eagan Permit Type:Building Permit Number:EA175202 Date Issued:03/18/2022 Permit Category:ePermit Site Address: 1691 Oakbrooke Ct Lot:17 Block: 1 Addition: Oakbrooke 5th PID:10-53764-01-170 Use: Description: Sub Type:Windows/Doors Work Type:Replace Description:Two or More Windows/Doors Census Code:434 - Residential Additions, Alterations 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: 5,000.00 Fee Summary:BL - Base Fee $5K $118.00 0801.4085 Surcharge - Based on Valuation $5K $2.50 9001.2195 $120.50 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Patrick & Jean Kelly 1691 Oakbrooke Ct Eagan MN 55122 Renewal Andersen 1920 County Road C West Roseville MN 55113 (651) 264-7052 Applicant/Permitee: Signature Issued By: Signature