2066 Shale LaneCity of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
Date Received:
Staff:
2010 RESIDENTIALBUILDING PERMIT APPLICATION
Date: '` -`1-1 0 Site Address: v n 6/ 5'I4A f r e-
Tenant: me cold oo(p
Suite #:
RESIDENT / OWNER
Name: J,44-1 / ` CCt' 1. 1` 0u (911 Phone: 63-1 1/51/ .37 /
Address / City / Zip: Z o& 6 5/(44- E k4,4 -1C
Applicant is: Owner Contractor
TYPE OF WORK
Description of work: 3 0OO)25
Construction Cost: 5-g-00 Multi -Family Building: (Yes / No X )
CONTRACTOR
Name: �L l%tk.J ieQOE)` / d/(' License #: a 0576-7 0 RJ—
Address: /9.i? -....6 g�?1i City: (/411t'6 7-0-(/
State: vow Zip: ,S ` ti Phone: 95-0 - [ D - 36 7 7
/L/
Contact: Cwf gUtt141r1 Email: /10 1414-7E"-10° 17 ( ML - CQ'';1
COMPLETE
In the last 12 months, has
No If yes,
THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
the City of Eagan issued a permit for a similar plan based on a master plan?
date and address of master plan:
_Yes
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor:
Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information k :Portions of
the information may classified as non public if you provide specific reasons that would permit the City to
. °.:conclude that they ere trade secrets. ; „ _ i
CALL BEFORE YOU DIG. CaII Gopher State One CaII 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.gooherstateonecall.orq
I hereby acknowledge that this information is complete and accurate; that the work will be in conform
Eagan; that I understand this is not a permit, but only an application for a permit, and work is
accordance with the approved plan in the case of work which requires a review and approval . • ans.
x C c ggc)A4c, 67-4
with the ordina es and codes of the City of
• to s,:rt witho per, it; that the work will be in
Applicant's Printed Name
nt's Signature
Page 1 of 2
4
BUILDING PERMIT
_ CITY O? EAGAN
X7" Pilot Knob Road Eagan, MH 65122
PHOHEs 4544100
Receipt *
Site Address
Lot Block Sec/Sub.
Parcel #
cc Name
W
Z Address
o Name
u' Address
Nome
Address
I hereby acknowledge that I hove read this'applicotion and state that
the information is correct and agree to comply with all applicable
State of Minnesota Statutes and City of Eagan Ordinances.
Erect ? Occupancy
Alter ? Zoning
Repair ? Fire Zone
Enlarge ? Type of Const.
Move ? # Stories
Demolish ? Length
Grade ? Depth Sq. Ft.
Approvals Fees
Assessment _
Water & Sew.
Police
Fire
Eng.
Planner
Council
Bldg. Off.
APC
Permit
Surcharge
Plan check
SAC
Water Conn.
Water Meter
Road Unit
Total
Signature of Pennittee
A Building Permit Is issued to. on the express condition thin
all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official
Permit No. Permit Holder Misc. Permit No. Holder
Plumbing
H.V.A.C. F1'£A.1(`iC tOA 1-7 -a-,7
Well
Water
Disp.
Sewer
Electric W6tp11(s3
Inspection Data Insp. Other
Footings
Foundation
Framing
Rough Plbg.
Rough HVAC /-1
Insulation •?
Final Plbg.
Final HVAC
Final
Water Describe Location:
Well
Sewer
Pr. Disp.
Receipt MECHANICAL PERMIT Permit No.
CITY OF EAGAN
Fee
Fill in numbered spaces S/C
Type or Print legibly Tot.
1. Date 2. Installation Cost
3. Job Address Lot Blk. Tract
4. Owner
5. Contractor Phone
6. Address ?-
7. City State Zip
8. Building Type: Residential ? Commercial ? Institutional ?
9. Work Description: New b Add Q Alter ? Repair ?
10. Describe Fuel Type
11.
No. Equipment BTU - M. Ea.
Forced Air No. Equipment CFM
Ai
H
dli
Mfg. r
an
ng:
Boilers
Mfg. Mech. Exhaust
Unit Heater
Mfg. Other
Air Cond.
Mfg.
Gas, Piping Outlets
12. 1 hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed :
Inspections: Date
Rough
- Insp. Date
for
Final
Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE: ' 11 r + r' r rr''
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(612) 681-4675
Y? { I 1 1 '+ i 1 Li 19 i.
SITE ADDRESS: ' 1 { + 1 APPLICANT:
+{ 0 1 1 AW {+??rfr I nr;; 1,{ 1 r,rbt;
' .. I r I`.-1 ;402
F
-..m
L Nip,
PERMIT. SUBTYPE: TYPE OF WORK: I VA 1 R
.. !j 1; :A VOIIV
Permit Holder Date Telephone N
PLUMBING
HVAC
Inspection Date Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYPBOARD
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 Remarks * Cedar Grove Acquisition
Addition CEDAR GROVE 4 Lot 10 Blk 2 Parcel 10 6701 100 02
Owner (` 10 Street 2066 Shale Lane State Eagan, MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK
* SEWER LATERAL 1972 1,304.00 52.16 25 678 o8 Aoiin8 12-lo-82
WATERMAIN
* WATER LATERAL 1972
WATER AREA
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC
PARK
"1XI -7 f Eli
G 50066 l ?r Bz, C? s-? 5l3ag0
Reggest Dale Fire Ro. Rough-in Inspection
Required?
es G No AAA!!!???
El Ready Now -Kw,,lNotify Inspector
/ 'Wh,, en R ,eady?
I icensed contractor ? owner hereby request inspection of above electrical work at:
Job Address (Street
. Box or Route No.) City
/
aoG S Llv? ( -
Section No. Township Name or No. Ferge No. County
O
Occupant (PRINT)
T~ Mac4«oeA
Phone No.
Power Supplier
d G
fk?
Electrical Conlramor (Company Name) Contractor's License No.
! G_ ePl • 0 5?0 7 if` -3
Mailing Aadress (OOntractor or Owner Making Inslallalion)
Au[horizeo Signature ( ontraclor/Owner Making Installation) Phone Number /
a ' S S'S
MINNESOTAg TE BOARD OF ELECTRIC(f THIS INSPECTION REQUEST WILL NOT
Griggs-Midway Bldg. - Room S-170 BE ACCEPTED BY THE STATE BOARD
1821 University Ave., St. Paul. MN 55106 UNLESS PROPER INSPECTION FEE IS
Phone (612) 6424f800 ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION ¢ %,*s EB-Doom-m
??
See instructions for completing this form on back of yellow copy. b
(0-50066 "X" Below Work Covered by This Request g ??dY
New Add Rep. Type of Building Appliances Wired Equipment Wired
`(, HoMe Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Other (Specity)
Comm./Industrial Furnace
Farm Air Conditioner
Other (specify) Contractors Rema`rkss.. •-
` C
Compute Inspection Fee Below: n, 1
# Other Fee # Service Entrance Size Fee # Cimuits/Feeders Fee
Swimming Pool 0 to 200 Amps 0 to WO Amps
Transformers Above 200 Amps Abo 00 Amps ,`j0
Signs Inspector's Use Only r TAL
Irrigation Booms 36' 3O ?i
Special Inspection
Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
I, the Electrical Inspector, hereby
certify that the above inspection has
been made. Rough.in r
For, Date iU
oat .`
OFFICE USE ONLY
Thls request oid 18 months Irom
This request void
18 months from
061453
L10t g;21 CtAkr-- 33`l VI(
G"O°£ q l4 t SU
Reque I Da a Fire No. Ro ug R-in Inspection
Regm ad?
?Ready Now Wil'r NOlify Mspec-
1 es ?No for When Ready
K rLi ens Electrical Contractor I hereby request inspection of above
' Owner - electrical work installed at:
Street Address, Bozo Rou to No. City
26 &(
Section No. Township Name or No: - Range No. Count
Occu it IPRINTI Phone No.
4135- 71 Q5
r ,
Power Supplier - Addre
s `
-
EI¢ t I I Contractor tCOmpany N.0-
v - Contractor's License No.
4 71/x
Mailing AAtlress (Contractor or Owner Ma kj ng Insta ilationl
!? 7 5' _S
Authorized. Signature (Contractor/Owner Making Installation) Phone Number
MINNESOTA STATE BOAREIOF E'CTRICITY THIS INSPECTION REQUEST WILL NOT
Griggs-Midway Bldg. - Room N-191 BE ACCEPTED BY THE STATE BOARD
1821 University Ave., St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS
... -- ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION
' See inalruclions lot completing lhls tor- on back of yellow copy.
W 061453
X" Below Work Covered by This Request
R EB-00001-04
Add p. Type of Building Appliances Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Lighting Fixtures
Apt. Building Dryer Electric Harting
Commercial Bldg. Furnace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank
Farm Other peel y Oche, ISPeeifvl
r P,r SpeCl y Other Other
Comuute Inspection Fee Below
N Fee.` Service Entrance$iae W. Fee Feeders/Subfeeders tJ Fee circuits
42 0 to 200 AMP 0 d . 0to 30 Amps 0to 30 Amos
Above 200 Amps 31 to 100 Amps 31 to 100 Amps
Swimming Pool Above 100-Am s Above 100_Amps
Transformers Irrigation Booms 1 Partial% ee
Signs Special Inspection s
l
T
Benwrks - -)i L _ G OT F
rn t . ?
Hough-in Onte ` I, the cal
-+ O Inapectoq hereby
Certify that the Shove
Final Date ?c inspection has been
3 03 made.
1TIa wnueat onbl t N -Mitre fe m
Uv`4 CITY OF EAGAN Include 2 sets of plans,
C ` 1 site plan w/elevations &
1-BUILDING PERMIT APPLICATION l_ set of energy calculations.
To Be Used For i>?m 4&4i ("fooV__aluation 2_0 Od C:?> Date
face OFFICE USE ONLY
Site Address: ,)0(
Lot /O Block ?2_ sea./Sub. Erect _ Occupancy - 3
Parcel #: 10 1X70 3 /OU C-) 2 N Alter Zoning
p Repair Fire Zone
Owner: L ti 9y1r? ?AA/nnQQ(y?u
Address-, G l f aJC< rN
City/Zip Code:
Phone #:
Contractor
Address: INO !7 R 4R
City/Zip Code: y .i-r3-7
Phone #: L// [7)
Arch./Eng.
Address:
City/Zip Code:
Phone #:
Enlarge Type of Const.
r
Move # Stories
_ Front (ft
Grade Depth ft.
APPROVALS FEES
Assess[rents
Water/Sewer
Police _
Fire
Eng er
Council
Bldg. Off.
APC
Permit
Surcharge
Plan Check
SAC
Water Conn
Water .Mete
Road Unit
TOTAL V1
EAGAN TOWNSHIP
BUILDING PERMIT
`y A e Q
Owner ................................./Yi-.....---......... .y. ............ - ?
Address (present) ... 4 'l?.?,....I n L._..rt..."-----!---i._..
Builder .------ .....----- ....................... - ..
Address
DESCRIPTION
N° 1302
Eagan Township
Town Hall
Date .. -.........
Stories To Be Used For Front Depth Heigh! Est. Cos! Permit Fee Remarks
U LOCATION
Street, Road or other Description of Location Lo! I Block Addition or Tract
This permit does not authorise the use of streets, roads, alleys or sidewalks nor does it give the owner or his agent
the right to create any situation which is a nuisance or which presents a hazard to the health, safely, convenience and
general welfare to anyone in the community.
THIS PERMIT MUST BE KEPT ON THE PREMISE WHILE THE WORK IS IN PROGRESS.
This is to certify, that .............. .................................................. has permission to erect a......................................................... ..... upon
the above described premise subject to the provisions of the Building 40rdance f? Eagan Township adopted April 11.
1955. / 9
_ .........................°--°-'--......_.............--..............-_....'----... P....-.... .... ... .... p...r.................
Chairman of Tnwn Board Buildin I ec
N° 921
Eagan Township
Town Hall .
Dale ..:??0,A s_
..._... ........_. .
//
Stories To Be Used For Front Depth Heigh! Est. Cost - Permit Fee{I Remarks
LOCATION
Street, Road or other Descripnon_of Locc Lion Lo} Block Addition or Tract
,3 _ G 8' - L1D - tlt Y. .zr 174-
This permit does not authorize the use of streets, roads, alleys or sidewalks nor does it 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.
This is. to certify, thaf.l.t-ar w<=v.-6`-'! -...°t' -1.-?-- .....has permission to erect e_. !Z..'G-7.. ..?..C .............. ..W--:.upon
the above described premise subject to the provisions of the Building Ordinance for Eagan Township. adopted April 11,
1955. r-?-sE
---...---..C?- -'`-'- ----...v`.°-------------------- Per ........... ..._.:...-......-.''t'......... %:>1:.. .- e-1..._ ........-:._.......
---- Chairman of Tnwn^B"rd Building Inspector
-
CITY OF EAGAN
3793 PBet Knob Road Eagan, MN 55122 NO
7709
t PHONES 454.8100
BOILDIN _ _
2-
S
l
G PERMIT Receipt # 7
a
To be need fatBEDROOM ADDITION Est. Value $20,000 Date December 6 1 982
Site Address 2n66Shalp Lane Erect f{] Occupancy R-3
Lot IOBlock 2 See/Sub. Cedar Grove 4th Alter ? Zoning R-1
Parcel # 10 16703 100 02 Repair ? Fire Zone NA
V
Enlarge] Type of Const.
w
w Name Jon McCullough Move
?
# Stories 1
Address 2066 Shale Lane Demolish ? Length 31
C; Eagan 55122 Phone 454-2519 Grade ? Depth 14 Sq. Ft.
Name Roger Grommesch Approvals Fees
s Address 409 E. Summit Lane
rre,Rnvillo rc;117 ec___ 49S-71 f14
Name _
Address
I hereby acknowledge that 1 hove mod 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 Per tittee
A Building Permit Is issued to: Roa?
all work shall be done in accordance with all
Assessment
Water 8 Sew.
Police
Fire
Eng.
Planner
Council
Bldg. Off.
APC
Permit i .a.
Surcharge 10.00
Plan check 70.25
SAC
Water Conn.
Water Meter
Road Unit
Total $220.75
on the express condition that
r of Eagan Ordinances.
Building Official
-w1 yS
2005 RESIDENTIAL PLUMBING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings.
Date 9_ / Z 1 2OC6 cS?
Site Street Address w(P6 Lln Unit #
u Telephone # k)s 1)
`
O
wner
Property
1
6
-?
{
° Telephone # 6 S ) 6s-- ?s?lo
?
Contractor
: ?)b City &C - CU,) State Zip S/2
Add
ress
The Applicant is: _ Owner YL Contractor -Other
Alterations to existing dwelling $ 50.00
Add plumbing fixtures (excludes water softener and/or water heater--complete next
_
section if installing these appliances).
-Septic System Abandonment
Water Turnaround (add $125.00 if a 5/8" meter is required)
Other:
Water Softener Water Heater $ 15.00
new ?X replacement
IL - _
Lawn Irrigation _RPZ _PVB -new -repair -rebuild $ 30.00
State Surcharge $ .50
$ f S.SD
Total
I hereby apply for a Residential Plumbing 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 plumbing codes; that I understand this is not a permit, but only an application for a
permit, work is not to start without a permit and work will be in accordance with the approved plan in
the event a plan is required to be reviewed and app ed. ____._
S Fl fll?
iNI
I- L!
i? 'iFp :?. '7., 7005
Applicant's Printed Name licant's Signature 'i
S°n??
PERMIT
CITY. OF EAGAN
n30 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMIT TYPE:
Permit Number:
Date Issued:
BUILDING
033410
09/23/98
SITE ADDRESS:
P.I.N.: 10-16703-100-02
2066 SHALE LANE
LOT: 10 BLOCK: 2
CEDAR GROVE 4
DESCRIPTION: R E R OO F
8y,,;Md*ngU Permit Type
8-011 din9g rk Type
'YY •14T M'F$ MMHi?"'
? A ?y
v
U
v `A- g
STORM DAMAGE
REPAIR
434 ALT. RESIDENTIAL
Ta y
i5
`fs'^se n , y za,,;w
REMARKS:
FEE SUMMARY-
tl'ETtf<TSAR17hTE"CARE & REPAIRS 14543402 0002715 UGH JANICE
2017 FLINT LN 2066 SHALE LANE
EAGAN MN 55122 EAGAN MN
(612) 454-3402
C) 1998 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD - 55122 q
681-4675 41 _ O
New Construction Requirements RemodeVReoair Requirements
? 3 registered site surveys ? 2 copies of plan
? 2 copies of plans (include beam 8 window sizes; poured fnd. design; etc.) ? 2 site surveys (exterior additions & decks)
? t energy calculations ? I energy calculations for heated additions
? 3 copies of tree preservation plan if lot platted after 7/11/93
required: _ Yes , No
DATE: CONSTRUCTION COST;
DESCRIPTION OF WORK:
STREET ADDRESS: aD6&'7> 5??-4,56 °L AV 5
LOT: ? BLOCK: _ SUBD./P.I.D. #: CJ-9-e-'j /41"u
Name: lwe C/?? 11 T11 C- L Phone #:
PROPERTY Last First
OWNER
Street Address: dGK4?
City g'4ea5,State: 177^1 Zip: c??/aZ
Company: S I1657o,?5 !11th-S 1 /014?,1AE5- Phone #:
CONTRACTOR /
Street Address:-c9/2/ -7 ?//,1?J_ ZfN f/ License # o) 7/-5-
City 6if? ? State: /?Ji? Zip: acs/a)-
ARCHITECT/
ENGINEER
Street Address:
City
Sewer 8 water licensed plumber (new construction only): Penalty applies when address chan
and lot change is requested once permit is issued.
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicai
State of Minnesota Statutes and City of Eagan Ordinances. F-)
Signature of Applicant:
OFFICE USE ONLY U v V
Certificates of Survey Received - Yes - No 9 i
Tree Preservation Plan Received - Yes - No Not Requi
Phone #:
Registration
State: Zip:
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
Permit Fee
Surcharge
Plan Review
License
MCNVS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
SAN Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
? 11 Apt./Lodging ?
? 12 Multi Repair/Rem. ?
? 13 Garage/Accessory ?
? 14 Fireplace ?
? 15 Deck
? 36 Move
? 37 Demolition
16 Basement Finish
17 Swim Pool
20 Public Facility
21 Miscellaneous
Basement sq. ft. MC/WS System
_ Main level sq. ft. City Water
_ sq. ft. Fire Sprinklered
_ sq. ft. PRV
_ sq. ft. Booster Pump
_ sq. ft. Census Code.
_ Footprint sq. ft. SAC Code
Census Bldg
Census Unit
Building Engineering Variance
Valuation: $
% SAC
SAC Units
CITY of EAGAN N° 4131
E
Owner ..... JAN McCULLOUGH
........................................
BUILDING PERMIT
Address (present) 2MiE S.)la,le.... Z,ane ....................
Builder ROGER M. GROMMESH
................................................................................................
Address 409 E. Summit Lane, Burnsville
......................................................................... - ........•""
DESCRI
3795 Pilo! Knob Road
Eagan, Minnesota 55122
454.9100
11/6/75
Dais .......... ..................
Mo To Be Used For rout D pih Heigh! Est. Cos! Permit Fee Remarks
Finish room, Basem
nt
4,500 I 18.00
2.50
sLe??V
TION
Street, Road or other Description ot! Location I Lor I 910cic I Addition or Tract
2066 Shale Lane
This permit does not authorise the use of Istree
the right to create any situation which is a nutsance
general welfare,to anyone in the community.
THIS PERMIT MUST BE KEPT ON THE PREMIS:
This is to certify, that .... ROg e r..... .......Gr. . . o...n.times]
the above described gLgmise subject to the provision:
{?U _...... .............._',...........
ayor
10 1 2 1 CG #4
a, roads, alleys or sidewalks nor does it give the owner or his agent
or which presents a hazard to the health, safely, convenience and
WHILE THE WORK IS IN PROGRESS.
f
......has permission to asst! a .......i....n...i...s...h ...... room, ...... basement
upon
of all applicable Ordinances f r the City Eagan.
La
Bulldinq Inapac
6?LaI3 i
Date: /1py 7 7G /
BUILDING PERMIT APPLICATION
?I
LOT / BLOCK 2 , ADDITION t.i.1 fly-rQG-,? sR? t
PARCEL & SECTION NUMBER IF UNPLATTED
ADDRESS OF PARCELR.%(,,U4L sg m- - -
ZONING OCCUPANCY v USE
ESTIMATED COST
01 -1ER . 0, -._. t TELEPHONE NO. y
ADDRESS G, -
CONTRACTOR
ADDRESS A10
TELEPHONE NO, 41 ?n /b5'
Note: Include site plan, building plans, and energy calculations with this
application a
Signed • ?rroMe '
OFFICE USE
VALUATIO1N ??V ?j D
SAC
WATER CONNECTION
WATER METER
BUILDING PERMIT FEE
SURCHARGE FEE
PLAN CHECK FEE
PARK DEDICATION FEE
OTHER
TOTAL*
0. -S v
APPROVALS:
ASSESSMENT CLERK BUILDING DEPT. POLICE DEPT
LSATER & SLT7ER DEPT. FIRE DEPT.
PARK DEPT.
MASTER CARD
2066 Shale Lane L10 B2 CG 04
Jan McCullough
STRUCTURE AND Finish room in basement
LAND USED AS
Permit
No.
Issued Issued To
Contractor Owner
BUILDING 4131 11/7/76 Roger M. Gromme h
PLUMBING
CESSPOOL - SEPTIC TANK
WELL
ELECTRICAL
HEATING
GAS INSTALLING
SANITARY SEWER
OTHER
OTHER
Items Approved
(Initial)
Date
Remarks
Distance From Well
FOOTING SEPTIC
FOUNDATION CESSPOOL
FRAMING TILE FIELD FT.
FINAL
ELECTRICAL
HEATING DEPTH
OF WELL
GAS INSTALLATION
SEPTIC TANK
CESSPOOL
DRAINFIELD
PLUMBING
WELL
SANITARY SEWER
r
c.?
Violations Noted
on Back
COMMENTS!
COMPLIANCE INSPECTION REPORTS
TO BE USED ONLY IN EVENT OF OBSERVED VIOLATIONS
PERMIT NO. DATE OF INSPECTION
CONDITIONS OF CONSTRUCTION AT THIS INSPECTION
? NO EVIDENCE OF NON-COMPLIANCE
OBSERVED.
NON-COMPLIANCE. BUILDER DOES NOT
INTEND TO COMPLY.
? ACCEPTABLE SUBSTITUTIONS OR
DEVIATIONS.
? NON-COMPLIANCE. BUILDER WILL COMPLY
WITHOUT DELAY.
ITEMIZED AND DESCRIBED
? COMPLETION OF CERTAIN IMPROVEMENTS
WILL BE DELAYED BY CONDITIONS BEYOND
CONTROL.
? REINSPECTION REQUIRED DATE OF REINSPECTION
REINSPECTION REVEALED
CERTI FI CATION -1 certify that I have carefully inspected the above in which I have no interest present or prospective, and that I have reported herein
all significant conditions observed to be at variance with ordinances of the Town of Eagan, approved plans and specifications, and any specific require-
ments for off-site improvements relating to the property inspected,
ALL IMPROVEMENTS ACCEPTABLY COMPLETED
INSPECTOR DATE
a.
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2005 RESIDENTIAL MECHANICAL PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for: single family dwellings & townhomes/condos when permits are required for each unit
140 3c,:,,SD
Date
Site Address ,:.R. ?y l? ???1 l J Unit #
Property Owner /! /??O?J(/ 1 ?\
,x n Telephone #
Contractor /
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Street Address /..C ??O p
City
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Tele
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State p
Bond #: Expires:
The Applicant is Owner' Contractor Other
Add-on or alteration to existing dwelling unit $ 30.00
X furnace -Additional Replacement
_ !air exchanger
-e- air conditioner -New Replacement
other
_
State Surcharge $ .50
30'a-)
Total $
I hereby apply for a Residential Mechanical 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 Mechanical 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
ap ved plan in the c e of work which requires a review and approval of plans.
Applicant's Printed Name Applicant's Signature
2005 COMMERCIAL MECHANICAL PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for: commercial/industrial buildings
multi-family buildings when separate permits are not required for each dwelling unit
Date
Site Street Address Unit #
Tenant Name (if applicable) Previous Tenant Name
Property Owner Telephone # ( )
Contractor
Street Address City
State Zip Telephone # ( )
Bond #: Expires:
The Applicant is Owner Contractor Other
Work Type
- New Construction - Underground Tank _ Install -Remove "see below
Interior Improvement - Install Piping - Processed -Gas
Nature of Work:
"When installing/removing underground tank, call for inspection by Fire Marshal and Plumbing Inspector
Permit Fees: $70.50 Underground tank installation/removal
S50.50 Minimum (includes State Surcharge)
or
Contract Value $ x I % _ $ Permit Fee
• If ep rmit fee is $1,000 or less, add $.50 => $ State Surcharge
If grmit fee is over $1,000, add $.50 for
every $1,000 ermit fee $ Total Fee
f nereoy appiy for a Commercrai mechanical 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 Mechanical 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.
Applicant's Printed
Applicant's Signature
Approved By: , Inspector
--
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Permit #: y 5a 4 V
QT 1D
I Permit Fee:
I
Date Received: ( I
I I
I
I Staff: 1
2008 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: 3 Site Address: 2 Q b G 5 ? C, Tenant:
Suite #:
puc k Phone: 1?/I ?54-? 51
J" Mccu(
RESIDENT I OWNER .
Name:
Address / City I Zip: C r t S J Z
111 0 . ?M
CONTRACTOR Name: License #:
Ghempien
Address: 651-365-1340
City: Eagan, MN 55123-1339 State: Zip:
Phone: Contact Person: ?r(S 01 21'1
TYPE OF WORK _ New Replacement _Repair _Rebuild _ Modify Space _ Work in R.O.W.
Description of work:
PERMIT TYPE RESIDENTIAL
?/ Water Heater -Water Softener
Lawn Irrigation -Add Plumbing Fixtures
_
L- RPZ I _ PVB) (_ Main _ 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 $136.00 if a 518" 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) ?/l
J ? 50
TOTAL FEES $
I hereby acknowledge tnat mis inrormauon is complete anu owuidw, u:d: uio ..??n ..,., ..o ... -- °••° - - -
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 cXY1PS 1 ?11
Applicants Printed Name
150
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 2066 Shale Lane
Lot: 10 Block: 2 Addition: Cedar Grove 4th
PID:10- 16703 - 100 -02
Use:
Description:
Sub Type: e- Reroof
Work Type: Replace
Description: House & Garage
Census Code: 434 -
Zoning:
Square Feet: 0
Comments: If there is no ice protection inspec
acceptable in lieu of inspections.
Fee Summary:
Valuation: 3,000.00
Contractor:
Complete Contracting LLC
8407 Hefner Avenue South
Cottage Grove MN 55016
(651) 457 -2891
Total:
Applicant/Permitee: Signature
PERMIT
City of Eaan
BL - Base Fee $3K
Surcharge - Based on Valuation $3K
- Applicant -
Construction Type:
Occupancy:
on prior to final, you must meet inspector with ladder and flat bar. Pictures are not
$90.00
Owner:
Janice V Mccullough
2066 Shale Lane
Eagan MN 55122
Permit Type:
Permit Number:
Date Issued:
Permit Category:
$88.50 0801.4085
$1.50 9001.2195
Building
EA085569
08/26/2008
ePermit
I hereby acknowledge that I have read this application and state that the informa
of Minnesota Statutes and City of Eagan Ordinances.
on is correct and agree to comply
h all applicable State
Issued By: Signature
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 2066 Shale Lane
Lot: 10 Block: 2 Addition: Cedar Grove 4th
PID:10- 16703 - 100 -02
Use:
Description:
Sub Type:
Work Type:
Description:
Census Code:
Zoning:
Square Feet: 0
Comments:
Fee Summary:
Valuation: 3,000.00
Contractor:
Renewal Andersen
1920 County Road C West
Roseville MN 55113
(651) 264 -4777
e- Windows/Doors
Windows/Doors-New/Replacement
House
434-
Applicant/Permitee: Signature
PERMIT
City of Eaan
BL - Base Fee $3K
Surcharge - Based on Valuation $3K
- Applicant -
Construction Type:
Occupancy:
Carbon monoxide detectors are required by law in ALL single family homes.
$88.50
$1.50
Total: $90.00
Owner:
Janice V Mccullough
2066 Shale Lane
Eagan MN 55122
Permit Type:
Permit Number:
Date Issued:
Permit Category:
Improvements to the home require smoke detectors in all bedrooms. If altering window openings, call for framing
inspection. Call for final inspection after installation.
0801
9001
I hereby acknowledge that I have read this application and state that the informa
of Minnesota Statutes and City of Eagan Ordinances.
on is correct and agree to comply
h all applicable State
Issued By: Signature
Building
EA091704
10/20/2009
ePermit
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA119958
Date Issued:01/06/2014
Permit Category:ePermit
Site Address: 2066 Shale Lane
Lot:10 Block: 2 Addition: Cedar Grove 4th
PID:10-16703-02-100
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 by law in ALL single family homes .
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 -
Janice V Mccullough
2066 Shale Lane
Eagan MN 55122
Renewal Andersen
1920 County Road C West
Roseville MN 55113
(651) 264-4777
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA179300
Date Issued:09/27/2022
Permit Category:ePermit
Site Address: 2066 Shale Lane
Lot:10 Block: 2 Addition: Cedar Grove 4th
PID:10-16703-02-100
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Does not include skylight(s)
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
If water damage is encountered, please call (651) 675-5675 to schedule a site visit to verify the extent of the damage. Any
repairs must be inspected prior to covering. The inspector will determine if an additional permit will be required to repair the
water damage.
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:
This permit shall be null and void if work does not start within 180 days of issuance, or if work is suspended for 180 days or more after
started.
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 -
Janice V Tste Mccullough
2066 Shale Ln
Eagan MN 55122--202
(651) 454-2519
Restoration Builders Inc
PO Box 8043
Scottsdale AZ 85252
(612) 804-1189
Applicant/Permitee: Signature Issued By: Signature