2065 Shale LaneCity of Eaaan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
' ^,,HIED
MAR 072011
50¢
Use BLUE or BLACK Ink
Permit Fee: 0
Date Received:
Staff:
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 3/7/ (/ Site Address: 20675— 3h 6A6
Unit #:
CG
RESIDENT /
OWNER
C Q
L
Name: 11 ✓ C �` 1 (/7ii frtr/Phone:�C �7 _ z es -SZ (
I i s 6-r --
Address /City /Zip: �,��� � � f s�'I � /�'j`T' e � L��%' fes'/Z°I
Applicant is: Owner Contractor S v
TYPE OF WORK
Description of work:
j�� / // 1 S
1((_(
LL L l l f) k/ "`I Gt(e / f I
Construction Cost: / J 5 Multi -Family Building: (Yes / No )1-- )
CONTRACTOR
Company: /rAZ%7 il) 7
(C(/Xf tel' u� Contact: i 7�,5�%�"l%f'`e
Address: ) 20 ZZ /��('CSG+F- /� City: a„.„,C 3
State: f'7 It) Zip: Tt'--J, Phone: 2� )O 3 - 3 VO ' /
` (0/.
License #: 20 1 .3 l jjCo (( / Lead Certificate #:7 r — 576&Y — /� — OZO—
Does this project require
If no, please explain:
Lead Remediation? rVLYes 0 No (see Page 3 for additional information)
In the last 12 months,
If
COMPLETE THIS
has the City of Eagan
yes, date and address of
AREA ONLY IF CONSTRUCTING A NEW BUILDING
issued a permit for a similar plan based on a master plan?
master plan:
_Yes _No
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
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
conclude that they are trade secrets #
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.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 nob 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.
Applicant's rinted Name Applicant's Signature
Page 1 of 3
5hinitc-_
DO NOT WRITE BELOW THIS LINE
9K've.:11111
SUB TYPES
Foundation _ Fireplace
Single Family_ Garage
Multi _ Deck
01 of _ Plex_ Lower Level
Accessory Building
WORK TYPES
New _ Interior Improvement
Addition _ Move Building
.ssJ` Alteration_ Fire Repair
Replace _ Repair
Retaining Wall
DESCRIPTION
Valuation
Plan Review
(25% 100% )1)
Census Code
# of Units
# of Buildings
Type of Construction
Vi'
REQUIRED INSPECTIONS
Footings (New Building)
Footings (Deck)
Footings (Addition)
Foundation
Drain Tile
Roof: Ice & Water Final
—X Framing
Fireplace: Rough In
Insulation
Sheathing
Sheetrock
Porch (3 -Season)
Porch (4 -Season)
Porch (Screen/Gazebo/Pergola)
Pool
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
Siding
Reroof
Windows
Egress Window
Storm Damage
Exterior Alteration (Single Family)
_ Exterior Alteration (Multi)
Miscellaneous
Demolish Building*
Demolish Interior
Demolish Foundation
Water Damage
*Demolition of entire building — give PCA handout to applicant
mei} u'7
MCES System
SAC Units
City Water
Booster Pump
PRV
Fire Sprinklers
Meter Size:
Final / C.O. Required
X Final / No C.O. Required
HVAC
Other:
Pool: _Footings Air/Gas Tests Final
Siding: _Stucco Lath Stone Lath Brick
Air Test Final 7(. Windows ,, A 0 ,i ``a
Retaining Wall: _ Footings _ Backfill _ Final
Radon Control
Erosion Control
, Building Inspector
Reviewed By:
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
6Pro-
/"Irli6.1i1) 61, 0"f
forrg-
a
a Q�
5
�a
Page 2 of 3
4.. CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 N° 908t1;
PHONE: 4548100
y"1 4.' ?
BUILDING PERMIT Receipt # ? C
To be teed for DECK Est. Value $800-00 Date MAY 21 14_8.4_
Site Address 2065 SHALE LN Erect p X Occupancy
Lot 1 Block 3 Sec/Sub. CED GRV 4 Alter ? Zoning
Parcel No. 10-16703-010-03 Repair p Fire Zone
Enlarge ? Type of Const.
iv Name RICHARD OLEJNICAK Move ? # Stories
Address SMIF Demolish C] Length 16
City Phone 454-4737 Grade ? Depth 10 Sq. Ft.
it-0 Name
uU Address
f- City Phone
D
W uW? i Name
t-
19 Address
<W City Phone
I hereby acknowledge that I have read this al
the information is correct and agree fo, con
State of Minnesota Statutes and rty o E
Signature of Permittee
A Building Permit Is issued to: RId
all work shall be done in accor twit j all
Building Official
Fees
Assessment Permit S 14.50
Water & Sew.
0
Surcharge -5
Police Plan check
Fire SAG
Eng. Water Conn.
Planner Water Meter
Council Road Unit
Bldg
Off
.
.
APC Total 1 5 _ 0 0
on the express condition that
Statutes and City of Eagan Ordinances.
.-i
Permit No. Permit Holder Misc. Permit No. Holder
Plumbing
H.V.A.C.
Well
Water
Disp.
Sewer
Electric
Inspection Date Insp. Other
Footings ?
Foundation
Framing _r j y!
Rough Plbg.
Rough HVA
Insulation
Final Plbg.
Final HVAC
Final
Water Describe Location:
Well L
Sewer ,
Pr. Disp.
CITY OF EAGAN Remarks * Cedar Grove Acquisition
Additio CEDAR GR= #4 Lot 1 Blk 3 Parcel 10 16703 0
Owner c. Street 2065 Sh&le Lane State Eagan, MM 55122
+liriiC:_ ti
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK
* SEWER LATERAL ( 1972 1,304.00 52.16 25 Paid
WATERMAIN
* WATER LATERAL 1972
WATER AREA
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC
PARK
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS: ?? ?
F
L
1INSFEU l ION KLUUKU
PERMIT TYPE:
Permit Number:
7 Date Issued:
1 b r N :S- w 1 w- a 3 APPLICANT:
1 MOCK:
:i tt' t .
fill t 1 111 NIi
A iAN"19
; o /N1 /os
PERMIT SUBTYPE: TYPE OF WORK:
, ?At;
Permit Holder Date Telephone k
PLUMBING
HVAC
Inspection Date Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
DOMESTIC
METER
IRRIGATION
METER
FLUSH
MAINS
CONDUCTIVITY
TEST
HYDROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
CITY OF EAGAN
r t 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 N? 9085
s
PHONE: 454.8100
?
BUILDING
PERMIT
Receipt # jG
?
To be used far _ DECK_ Esr.yalue $800.00 Data MAY 21 , I984
Site Address 2065 SHALE LN Erect ?X Occupancy
Lot 1 B lock 3 Sec/Sub. CED GRV 4 Alter ? Zoning
Parcel No 10-16703-010-03 Re
air ? Fire Zone
. p
? Type of Const.
a Name RICHARD OLEJNICAK Move
? # Starts
r, Address SAME Demolish ? Length 16
City Phone 454-4737 Grade ? Depth 10 Sq
Ft
.
.-
SAME Fees
0
ou
uSa
f
Name
Address
City -
Phone
Uw Name
?i
xG Address
<W City _ Phone
I hereby acknowledge that I have read this application and
the information is correct and ogre corAply i
State of Minnesota Statutes an rAy 9N a t c
Signature of Pennittee -14
A Building Permit Is issued to:
all work shall be done in occq
Building Official
Assessment Permit 14.50
Water S Sew. Surcharge .50
Police Plan check
Fire SAC
Eng. Water Conn.
Planner Water Meter
Council Road Unit
Bldg
Off
.
.
APC `
Total S 15.00
W-M on the express condition that
Minnesota Statutes and City of Eagan Ordinances.
CITY OF FAGAN
BUILDING PERMIT APPLICATION
Include 2 sets of plans,
1 Certificate of Survey=&
1 set of energy calculations.
To Be Used For -04EC. k. Valuation I rv - Date P 4
Site Address ZO?o S 4nt-E OFFICE USE ONLY
GEE,,v?s.?x cazouE
3 sec./sub. ?F¢
Lot I Block -
Erect X
Occupancy
3
Parcel #: 7C
U - (v 7 03 Alter Zoning (Z
Repair Fire Zone
;?
Owner: ISIGH el p-0 O Le -I N I r A n Enlarge _ Type of Const.
- Move # Stories
Address: Z06 Not-re L.A N)Z
C Demolish Front ft.
City/Zip Code: -AK) 'SCI 2-Z _
Grade Depth I D ft.
Phone #: qCl=l ] ??1
Contractor:
Address: m
City/Zip Code:
Phone #:
Arch./Eng. -
Address:
City/Zip Code:
Phone #:
APPROVALS FMS
Assessments Permit IMF.
Water/Sewer Surcharge
Police Plan Check
Fire SAC -
Eng. Water Conn. -
Planner Water Meter -
Council Road Unit
Bldg. Off.
APC
TOTAL
X
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G
O
K
?Sl
W
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2
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S 44 Pc-e
V?J, I
QP Ci
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EAGAN TOWNSHIP
BUILDING PERMIT
N° 921
Eagan Township
Town Hall
Date
ilories To Be Used For Front Depth Height Est. Cost Permit Fee _ _ Remarks
LOCATION
Street, Road-or other Description_of Location Lot Block Addition or -Tract
.This permit does not authorize the use of streets, roads, alleys or sidewalks nor does if give the owner or his agent
the right to create any situation which is a nuisance or which presents a hazard to the health, safety, convenience and
general welfare to anyone in the community.
THIS PERMIT MUST BE KEPT ON THE PREMISE WHILE THE WORK IS IN PROGRESS.
:r
This is to certify, thai&----- - 42 ---*..-.----has permission to erect a... !.Z.. .:-'"-? ......................... f.. upon
the above described premise subject to. the provisions of the Building Ordina""ncepp for Eagan Township adopted April 11,
1955. ,) /' t
..............._....., L----------- Per .._........__.:.L.c-.../rn._ai:4.....-L??''.-'.L-_C-c'•-?.c.. _.. ..
Chairman of Town So rd - Building Inspector
PERMIT
S fT OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMIT TYPE: BUILDING
Permit Number: 0 3 3 5 5 9
Date Issued: 10 / 0 2 / 9 8
SITE ADDRESS:
2065 SHALE LONE
LOT: 1 BLOCK: 3
CEDAR GROVE #4
P.I.N.: 10-16703-010-03
DESCRIPTION:
REROOF
B}rsldngi Permit Type
B,uildin9, Work Type
-kensu.s Code
STORM DAMAGE
REPAIR
434 ALT. RESIDENTIAL
? I
-J LJ
?v
REMARKS:
FEE SUMMARY:
CONTRACTOR: - Applicant - ST. LIC. OWNER:
JOSEPH CONST, J 14545002 0006020 SORENSEN DAVE
4380 MALMO CIR 2065 SHALE LANE
EAGAN MN 55123 EAGAN MN 55122
(612) 454-5002 (651)
I hsreby acknowledge that 1 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.
APPLICANT/PERMITEE SIGNATURE SSUED BY: SIGNATURE
1998 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3 3830 PMOT KNOB RD - 55122 p
681-4675 ((? - a l
New Construction Requirements
? 3 registered site surveys
? 2 copies of plans (include cream & window sizes; poured fnd. design; etc.)
? t energy calculations
? 3 copies of tree preservation plan if lot platted after 7!7193
required: _ Y _ d
DATE: 3d
DESCRIPTION OF WORK: oaf ??
STREET ADDRESS:
LOT: BLOCK: 3 SUBD./P.I.D. #: G ti` Y
Name: Phone #:
PROPERTY Last First
OWNER
Street Address: GAO 6s-
City Z?$'? ? State: Zip: SS/zZ_
Remodel/Reoair Requirements
? 2 copies of plan
? 2 site surveys (exterior additions & decks)
? 1 energy calculations for heated additions
COST;
CONTRACTOR
ARCHITECT/
ENGINEER
Street
Phone #: Y ' g")-
License # Q'(3 -a 0
City (?RJ State: Zip: ?slL?
Company:
Name:
Street
Phone #:
Registration #:
City State: Zip
7/3 3-0 if-,pro
Sewer & water licensed plumber (new construction only): Penalty applies when address Chang
and lot change is requested once permit is issued.
I hereby acknowledge that I have read this application and state that the infonnat' is Correct?gree to comply wit)a-aH-applicabl
State of Minnesota Statutes and City of Eagan Ordinances. 7 7
Signature of Applicant: e?
V D L5 `k= LS U `.=/
OFFICE USE ONLY
Certificates of Survey Received - Yes No 70CT r'
Tree Preservation Plan Received Yes No
a
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex
? 02 SF Dwelling ? 07 4-plex
? 03 SF Addition ? 08 8-plex
? 04 SF Porch ? 09 12-plex
? 05 SF Misc. ? 10 = plex
WORK TYPE
? 31 New ? 33 Alterations
? 32 Addition ? 34 Repair
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Planning
? 11 Apt./Lodging ?
? 12 Mufti Repair/Rem. ?
? 13 Garage/Accessory ?
? 14 Fireplace ?
? 15 Deck
? 36 Move
? 37 Demolition
Basement sq. ft.
Main level sq. ft.
sq. ft.
sq. ft.
sq. ft.
sq. ft.
Footprint sq, ft.
Building
Engineering
Variance
Permit Fee
Surcharge
Plan Review
License
MC/WS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment Pl.
Park Ded.
Trails Ded.
Other
Copies
Total:
Valuation: $
16 Basement Finish
17 Swim Pool
20 Public Facility
21 Miscellaneous
MC/WS System
City Water
Fire Sprinklered
PRV
Booster Pump
Census Code.
SAC Code
Census Bldg .
Census Unit
% SAC
SAC Units
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA117150
Date Issued:10/16/2013
Permit Category:ePermit
Site Address: 2065 Shale Lane
Lot:1 Block: 3 Addition: Cedar Grove 4th
PID:10-16703-03-010
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 .
Mitch Husnik
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 -
Markus Homes Llc
400 Countywide Way
Simi Valley CA 93065
Homestyle Builders & Developers Inc
37 Walden St
Burnsville MN 55337
(952) 994-3980
Applicant/Permitee: Signature Issued By: Signature