2100 Shale LaneCity of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Date: -.Q"ac 7-40
Tenant: _rk_
Use BLUE or BLACK Ink
Permit #:
Permit Fee:
Date Received:
Staff:
951"45-
tri;
5<d'4S
mL
2010 MECHANICAL PERMIT APPLICATION
Site Address aloe
Suite #:
1
-J
RESIDENT / OWNER
Name: _
Address / City / Zip:(- Q . l . E PTA._ SS) -‘a-
CONTRACTOR
Name:
Address:
State:
3URNSVILLE HEATING & A/C, INC.
3451 W. Burnsville Parkway
Suite 120
zipurnsville, MN 55337
Contact: (::. ...r tL-k
License #: t -1 ).
City:
Phone:
Email:
TYPE OF WORK
PERMIT TYPE
New Replacement
Additional
Alteration
Demolition
Description of work:
RESIDENTIAL
Furnace
Air Conditioner
Air Exchanger
_ Heat Pump
Other
New Construction
Install Piping
Gas
COMMERCIAL
_ Interior Improvement
Processed
Exterior HVAC Unit
Under / Above ground Tank ( Install / Remove)
** When installing/removing tank(s), call for inspection by Fire
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 bumed out appliances, ductwork, etc.) (includes $.50 State Surcharge)
$
TOTAL FEE
COMMERCIAL FEES:
$70.50 Underground tank installation/removal
$50.50 Minimum (includes State Surcharge)
OR
- If Permit Fee is less than $1,000, surcharge is $.50.
- If Permit Fee is > $1,000, surcharge increases by $.50 for each
$1,000 Permit Fee (i.e. a $1,001-$2,000 Permit Fee requires a $1.00 surcharge).
Contract Value $ x 1%
= $ Permit Fee
= $ Surcharge
= $ TOTAL FEE
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.gooherstateonecall.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 t approved plan in the case of work which requires a review and approval of plans.
x
App icant's Printe • ame
x
Applican
s Signature
CITY OF EAGAN Remarks * Cedar Grove At-guisitinn
Addition CF.nAR r.VF. #4 441-' Lot Blk 7 Parcel .1-0 16703 070 07
Owner 1;! `, ; r b ` t 0o i f Street - 2100 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 Paid
WATERMAIN
* WATER LATERAL 1972
WATER AREA
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC
PARK
EAGAN TOWNSHIP
BUILDING PERMIT
Owner ...._/r/'L?ca^cC?-_t 472!,n:...-4.1.---.._--...
Address (present) 1i...... fC0.0.- JG,<,«Cy_.. ,r?ks a7. .. `.. .•
Builder ..... _..._------------------------------------------- _.._---_...._._....._...- --
Address ....._..... .................... _......... _......_................. ........... _.... .....
/D
To Be Used For Fron
LOCATION
N° 1204
Eagan Township
Town Hall
Date 5E.._------------------
Street, Road or other Description of Location Lot Block ? Addition or Tract
17
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 HE PREMISE WHILE THE WORK IS IN PROGRESS.
This is to certify, that- ....has permission to erect a./o .......... ..... .... ......... ....... .. upon
the above described premise subject to the provisions of the Building Ordinance for Eag wnship adople April 11,
1955. ,Q ??
................_.... _?N.....--............. Per .......... .5 -'---Valr.- +dif.....?G1...I?-?..___...........
Chairman of Town Board Building Inspector
4-/S
C
EAGAN TOWNSHIP
BUILDING PERMIT
ln, ?rY...---
Owner .....
Address (present) .... _(........._.?£[=b. '-. :.....
Builder
Address
DESCRIPTION
N° 1448
Eagan Township
Town Hall
Date -:C-A A25G ....................
Stories To Be Used For Front Depth Height Est. Cost Permil Fee Remarks
V LOCATION
Street, Road or other Description of Location I Lot I block i Addition or Tract
7 1 7 1 &,& r:P-- -/
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, safety, convenience and
general welfare to anyone in the community.
THIS PERMIT MUST BE KEPT ?ON7141 PREMISE WHILE THE WORK IS IN PROGRESS.
This is to certify, Thai.....- z:...:..?J<4?ts ..._..-....?-------- has permission to erect a._.._....... ......upon
the above described pre ise subject to The rovisions of the Building Ordinance for Eagip adopted April 11,
1955.
........... Per .............. "'U............ lr4`; .. ...._?f`ic?G?...-....
................. .--------------- . ----!--:------:::".J------.---..'....... ..
Chairman of Town Board Building Inspector
-Z hl'
? r M ? ?
? o
r
V ?
Q
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?kl
'7 311 '6
RESIDENTIALBUILDINGm
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construction Requirements
3 registered site surveys showing sq. ft. of lot, sq. ft of house; and all roofed areas
(20% maximum lot coverage allowed)
2 copies of plan showing beam & window sizes; poured found design, etc.
1 set of Energy Calculations
3 copies of Tree Preservation Plan K lot platted after VIM
Rim Joist Detail options selection sheet (buildings with 3 or less units)
Minnegasco mechanical ventilation forth
Remodel/Repair Requirements
2 copies of plan showing footings, beams, joists
1 set of Energy Calculations for heated additions
1 she survey for additions & decks
Addition - indicate if on-site septic system
qv ,tD
Office Use On
Cart of Survey Recd _Y _N
Tree Pres Plan Recd: -.. '_Y _N.
-
Tree Pres Required. _Y _N
On-sfte Septic System : . _Y . _N
Date V4 (di l r
Site Address c?1 l 006
00 564 /r Construction Cost
Unit/Ste #
/_ AJ- CAGAN mN S5/ao"
Description of Work PA4ck J? t
PAck UTA/10, f GgPA f?e a- TnJZUaulal 0 r-,-read
Multi-Family Bldg - Y ? N Fireplace(s) _O -1 -2
Property Owner Telephone # ( 6 f) 6 6 - 09,9 1-
Contractor
Address
State City
Zip Telephone # ( )
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
(J submission type) Submitted Submitted
. Energy Envelope Calculations Submitted l? f? rr? fZ ?1(J 2 D
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master pi {)1{J?? IMSAYVv 215 210J06L5
- Y _ N If yes, date and address of master plan:
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone #(
Telephone # (
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.
n A, ?,D
I7?rs7d7?? N ? X rv >•-a-ca
Applicant's Printed Name Applicant's Signature
DO NOT WRITE BELOW THIS LINE +
t
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 AccessoryBidg
(? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 EM. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-piex ? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
K 33 Alteration ? 37 Demolish Building* ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement *Demolition (Entire Bldg) - Give PCA handout to applicant
Description: Water Damage _ Yes
Valuation Occupancy MCES System -
Plan Review 100% or 25%
Census Code Zoning City Water _
SAC Units Stories Booster Pump _
# of Units Sq. Ft. PRV _
# of Bldgs Length Fire Sprinklered _
Type of Const Width
Footings (new bldg)
Footings (deck)
Footings (addition)
_ Foundation
_ Drain Tile
Roof _ Ice & Water _ Final
?j Framing
_ Fireplace - R.I. -Air Test -Final
Insulation
Approved By:
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
REQUIRED INSPECTIONS
Sheetrock
_ Final/C.O.
Final/No C.O.
74- _ RVAC
Other
Pool _ Ftgs _ Air/Gas Tests _ Final
Siding _ Stucco Lath _ Stone Lath -Brick
Windows
Retaining Wall
Building Inspector
Ste,-' ?"
?i? 6-
y
2006 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construction Requirements
3 registered site surveys showing sq. ft of lot, sq. ft of house; and all roofed areas
(20% maximum lot coverage allayed)
2 copies of plan showing beam & window sizes; poured found design, etc.
I set of Energy Calculations
3 copies of Tree Preservation Plan it lot platted after 711193
Rim Jost Detail options selection sheet (buildings with 3 or less units)
Minnegasoo mechanical ventilation form
Remodel/Repair Requirements rdii sex n
2 copies of plan showing footings, beams, joists
1 set of Energy Calculations for heated additions 'Ct,w Ilo'- „'^i (
1 site survey for additions & decks TreaµPreslegm ?„ .'fit N
Addition - indicate if on-site septic system ?nslte Sil 11stem I!-',
Date 0
Site Address ( 0 0 S Q 1? Construction Cost
Unit/Ste #
Description of Work f A b0. G w rt ( a? 9 /t /? S f 7 G? k n^ +? d a A??d+rro1
Multi-Family Bldg _ Y ? N Fireplace(s) _ 0 _ 1 _ 2
Property Owner L 0 l1 S (a? Telephone # (651 ) (9 d (? d 2Y Z
Contractor
Address
State City
Zip Telephone # ( )
COMPLETE THIS AREA ONLY IF
Energy Code Category - Minnesota Rules 7670 Cateeorv 1
• Residential Ventilation Category 1 Worksheet
(J submission type) Submitted
Energy Envelope Calculations Submitted
A NEW BUILDING
_ Minnesota Rules 7672
New Energy Code Worksheet
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
Mechanical Contractor
Sewer/Water Contractor
Telephone #(
Telephone # (
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 riot 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.
L6 S Pv-6
Applicant's Printed Name
ApplicanSignature
DO NOT WRITE BELOW THIS LINE
Sub Types
? 01 Foundation ? 07 05-plex
? 02 SF Dwelling ? 08 06-plex
? 03 01 of-plex ? 09 07-plex
? 04 02-plex ? 10 08-plex
? 05 03-pl6 ? 11 10-plex
? 06 04-plex ? 12 12-plex
Work Types
? 31 New
? 32 Addition
? 33 Alteration
? 34 Replacement
? 20 Pool
? 21 Porch (3-sea.)
? 22 Porch/Addn. (4-sea.)
? 23 Porch (screenigazebo)
? 24 Storm Damage
? 25 Miscellaneous
? 30 Accessory Bldg
? 31 Ext. Alt- Multi
? 33 Ext. Alt - SF
? 36 Multi Misc.
? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 35 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 37 Demolish Building" ? 43 Reroof ? 46 Windows/Doors
'Demolition (Entire Bldg) - Give PCA handout to applicant
? 13 16-plex
? 16 Fireplace
? 17 Garage
? 18 Deck
? 19 Lower Level
Description: Water Damage ^ Yes
Valuation
Plan Review 100% or
Census Code
SAC Units
# of Units
# of Bldgs
Type of Const
25%
Occupancy MCES System
Zoning City Water
Stories Booster Pump
Sq. Ft. PRV
Length Fire Sprinklered
Width
REQUIRED INSPECTIONS
Footings (new bldg) Sheetrock
- Footings (deck) _
_ Final/C.O.
- Footings (addition) Final/No C.O.
- Foundation _
HVAC
- Drain Tile _
Other
Roof - Ice & Water - Final
Pool
Ftgs
Air/Gas Tests
Final
- Framing _
_
_
-
_ Siding _ Stucco Lath
Stone Lath
Brick
- Fireplace _ R.I. - Air Test _
-
- Final
Windows
- Insulation _
_ Retaining Wall
Approved By: Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
I;k 1`I0
41? City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
------------------
F
j Permit #: 4
Permit Fee: /"/ lJ • DJ
Date Received:
I I
I Staff: ? I
----------------
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: t y Site Address: I hl? S r l? ?? '
Tenant:
Suite #:
OWNER Phone: u1sill L'08(12(kf
N
?ti/
UKC/nCU C
RESIDENT/ -
ame: I
In
L ) 1 h'1u I
Address / City / Zip: c?l
-
Applicant is: Owner Contractor
TYPE OF WORK Description of work:
Construction Cost: • 00 Multi-Family Building: (Yes No
o License #:
1
A 1?
L-1
CONTRACTOR o
b
Name: 1
(
r
Address: C) ?2 A,(- Zy
City: n31R i Y_ ? 1 1115?/11T V V State: Zip: :ate
3S Contact Person: '
-1 L-l
,
Phone:
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
(J 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: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
'"""NOTE `!?tans and°supporting documents?thaf you submit are considered to be public information Portions of '°
° the information }nay be classified as non pubilcf you provide specific reasons that would permit the Ctty to
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 A
Applic`al?i s rinteName
Page 1 of 3
City of Eagan
PERMIT
41'
CityofEaa
Permit Type:
Permit Number:
Date Issued:
II Permit Category:
Building
EA106370
08/21/2012
ePermit
Site Address: 2100 Shale Lane
Lot: 7 Block: 7 Addition: Cedar Grove 4th
PID: 10-16703-07-070
Use:
Description:
Sub Type: e -Siding & Windows/Doors
Work Type: Siding & Windows/doors
Description: House & Garage
Census Code: 434 -
Zoning:
Square Feet: 0
Construction Type:
Occupancy:
Comments: 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.
Improvements to the home require smoke detectors in all bedrooms. If altering window openings, call for framing
Fee Summary:
Valuation: 8,000.00
BL - Base Fee $8K
Surcharge - Based on Valuation $8K
$162.25
$4.00
0801.4085
9001.2195
Total:
$166.25
Contractor:
Minnesota Window & Siding
1710 Douglas Dr. #290
Golden Valley MN 55422
(763) 545-0545
- Applicant -
Owner:
LOIS Y PATCH
10419 BROWN FARM CIRCLE
EDEN PRAIRIE MN 55347
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
City of Eagan
PERMIT
Permit Type: Plumbing
Permit Number: EA106690
itDate Issued: 09/05/2012
of jjft
Site Address: 2100 Shale Lane
Lot: 7 Block: 7 Addition: Cedar Grove 4th
PID: 10-16703-07-070
Use:
Description:
Sub Type: e - Fixtures
Work Type: New
Description: More Than One Floor
Meter Size Meter Type
Manufacturer Serial Number Remote Number Line Size
Comments: Doug Grage
147890 Hallmark Dr.
Apple Valley, Mn 55124
612-490-1841
Fee Summary:
Valuation: 500.00
PL - Permit Fee (miscellaneous)
Surcharge -Fixed
$55.00
$5.00
0801.4087
9001.2195
Total: $60.00
Contractor:
TLC Plumbing
14780 Hallmark Dr
Apple Valley MN 55124
(612) 490-1841
- Applicant -
Owner:
LOIS Y PATCH
10419 BROWN FARM CIRCLE
EDEN PRAIRIE MN 55347
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
City of Eagan
PERMIT
4111' C!ty
of
Eaaan
Permit Category:
Permit Type:
Permit Number:
Date Issued:
Permit Type:
Permit Number:
Date Issued:
Mechanical
EA106691
09/05/2012
ePermit
Site Address: 2100 Shale Lane
Lot: 7 Block: 7
PID: 10-16703-07-070
Use:
Addition: Cedar Grove 4th
Description:
Sub Type:
Work Type:
Description:
e - Gas Line
Repair
Stove
Comments: Questions regarding electrical permit requirements should be directed to Mark Anderson, State Electrical Inspector, (952)
445-2840
Doug Grage
147890 Hallmark Dr.
Fee Summary:
Valuation: 2,500.00
ME - Permit Fee (Replacements)
Surcharge -Fixed
$55.00
$5.00
0801.4088
9001.2195
Total: $60.00
Contractor:
TLC Plumbing
14780 Hallmark Dr
Apple Valley MN 55124
(612) 490-1841
- Applicant -
Owner:
LOIS Y PATCH
10419 BROWN FARM CIRCLE
EDEN PRAIRIE MN 55347
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
delb.
City of Eapil
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
AU'? 7 + 7017
Use BLUE or BLACK Ink
For Office Use
Permit #: 1O&J?
2-2.-
Permit Fee: CO, 7'1
Date Received: /'( 2'
Staff:
\)C
Unit #:
2012 RESIDENTIAL BUILDING PERMIT APPLICATION
Date:[ '0l) Site Address:
� tb r,' si 't, L -/0
RESIDENT /
OWNER
Name: ��• TCaez`iyit-' Phone: �ref , 01-")l,Ij'J
Address / City / Zip:
Applicant is: Owner K Contractor
TYPE OF. WORK
Description of work:
Construction Cost: Multi -Family Building: (Yes / No )
CONTRACTOR .,
Company: '�J 1,v j=, :.. Itif,,J "a .Ai„' --0.::_• 04 i Contact: N`a ) A. i t -td : viti-
Address: i`- f't`'`l t''„ t(a; ./ t, w,, C sem' .4,- ..t- City: ,r .,:,r'.�,, �:_ ` ((42
State: VVL 0-i Zip: 73 .I Phone: 40 if. ---7 l y -;-•/744(
License #: JSC. / ( 2- e--) Lead Certificate #: . C. -i fri e 0
If the project isiexempt
Q e4,;
from lead certification, please explain why: (see Page 3 for additional information)
I I UM 1,'v ‘ 1, -),If «65”
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:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets. ';
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.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 approval of plans.
Exterior work authorized by a building permit issued in accordance with the Min State Building Code st be completed within 180
days of permit issuance.
xNFV- " f t' l t11 6 Y x
Applicant's Printed Name Ap'plicant's
re
Page 1 of 3
SUB TYPES
Foundation
Single Family
Multi
01 of Plex
Accessory Building
WORK TYPES
New
Addition
Alteration
Replace
Retaining Wall
DO NOT WRITE BELOW THIS LINE1)22-
Z1
ao StgleL
Fireplace
Garage
Deck
yLower Level
DESCRIPTION
Valuation
Plan Review
(25% 100%
Census Code
# of Units
# of Buildings
Type of Construction
Porch (3 -Season)
Porch (4 -Season)
LLFc,AL)
Interior Improvement
Move Building
Fire Repair
Repair
V6
REQUIRED INSPECTIONS
Footings (New Building)
Footings (Deck)
Footings (Addition)
Foundation
Drain Tile
Roof: Ice & Water Final
Framing
Fireplace: Rough In Air Test
Insulation
Sheathing
Sheetrock
Reviewed By:
Porch (Screen/Gazebo/Pergola)
Pool
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
Final
2.
Storm Damage
Exterior Alteration (Single Family)
Exterior Alteration (Multi)
Miscellaneous
G'tCSS l '.d'L'
Siding
Reroof
Windows
Egress Window
Demolish Building*
Demolish Interior
Demolish Foundation
Water Damage
*Demolition of entire building — give PCA handout to applicant
MCES System
SAC Units
City Water
Booster Pump
PRV
Fire Sprinklers
Meter Size:
Final / C.O. Required
Final / No C.O. Required
HVAC Gas Service Test Gas Line Air Test
Other:
Pool: _Footings Air/Gas Tests _
Siding: Stucco Lath _Stone Lath
Windows
Retaining Wall: Footings _ Backfill Final
Radon Control
Erosion Control
Building Inspector
Final
Brick
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
2,x20 l //LIL'/L7
Paae 2 of 3 ---
.;
City ,of kali
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
For Office Use
Permit #:
Permit Fee:
-Yz-t4
/
£)T5
Date Received:
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 3 o /
Resident/
Owner
Site Address: Zi v0
L Unit #:
Name: Er vt Yt cee, /� Phone: ()SI • � Co7 .12-6
Address / City / Zip: `? ot) 51014,14- , � J S l ZZ
Applicant is: Owner )Contractor
Type of Work
Contractor
Description of work: ft,roof
Construction Cost: Y000
Company: Lex ;40),. hook(")
Address: (1, -Ho i faL 01 AVC.
State: AAA/ Zip: Ss 12�
License #: i'J:- (S U0
Phone:
Multi -Family Building: (Yes / No)& )
Contact: Ai !)w&
City: ,�11.oew►u,v
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Lead Certificate #: / V � l 02 % c1
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public. information. Portions of
the information may be classified as non-public if you provide specific reasons that would permitthe Cityrto
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 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.
Applicant's Printed Name
V4)1
Vit.
Applican s Signature
Page 1 of 3
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New wall:
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DATE:
BUILDING IN irO 'DIVISION
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA179448
Date Issued:10/05/2022
Permit Category:ePermit
Site Address: 2100 Shale Lane
Lot:7 Block: 7 Addition: Cedar Grove 4th
PID:10-16703-07-070
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:One Window/Door
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: 1,500.00
Fee Summary:BL - Base Fee $1500 $62.50 0801.4085
Surcharge - Based on Valuation $1500 $0.75 9001.2195
$63.25 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 -
Edwin J & Mary K Pieper
2100 Shale Ln
Eagan MN 55122
(651) 767-2269
Custom Remodelers
474 Apollo Dr
Lino Lakes MN 55014
(651) 784-2646
Applicant/Permitee: Signature Issued By: Signature