2128 Shale Lane411.
City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
Permit #:
Permit Fee:
Date Received:
Staff:
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: _2 I LF-)
Unit #:
RESIDENT /
OWNER
Name: a.. c, r---- t._? c, I a� Phone: 9 St.2 - 41941--`1C-VO
Address / City / Zip: c=21-.7:2 8 c L0 I.. L,6
Applicant is: ' Owner X Contractor
TYPE OF WORK
Description of work: -t s5 •,J % 40vJ
w
Construction Cost: v2cxxo w Multi -Family Building:di�(Yes / No )
CONTRACTOR
Company: (6&c-knNo.rN CL4.rM4,,1 r. Contact: (..�crrk.., Q� cki-' uvr•
Address: I "j C) Sc{> ,r t City: &_d -1Z V L f', k
State: PAO Zip: S S 3 y 7 Phone: / S-2:2.-9/ 3 -? c.. 3y
License #: O(o 3 pO S , Lead Certificate #:
If the project is exempt
from lead certification, please explain why: (see Page 3 for additional information)
In the last 12 months,
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:
_Yes
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.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.
x
Applicant's Printed Name
x
Applicant's Signature
Page 1 of 3
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
SITE ADDRESS:
i ?= SHAT f
CEDAR GROVE 4
PERMIT SUBTYPE:
OF + K
RFMARKS: RECE IP I IF
TYPE OF WORK:
INSPECTION RECORD
PERMIT TYPE:
Permit Number:
Date Issued:
(.OT i 14 Rl nr1K APPLICANT:
LANE LAIVNLAS
(612) 464-8648
Control No.
Ott IIL pi MA
006616%
Ob/z9J92
NEW
Pwmlt No. Permit Holder Dote Telephone s
s/W
PLUMBING
HVAC
ELECTRIC r
ELECTRIC
Inspection Deft Insp. Comments
Footings I
Foundation
Framing
Roofing
Rough Plbg.
Rough Htg.
Isul.
Fireplace
Final Htg.
Orsat Test
Final Plbg. Plbg. Inspector-Notify Plumber
Gormt. mew
EngrJPian
Bldg. Final
Deck Ftg.
Dedc Final
Well
Pr. Disp.
INSPECTION RECORD I Control No. 0691
CITY OF EAGAN PERMIT TYPE: fvta I 10 t NO
3830 Pilot Knob Road Permit Number: 000997
Eagan, Minnesota 55123 Date Issued: *6123192
(612) 681-4675
SITE ADDRESS: Lot t 14 of tick APPLICANT:
Z129 SHALE LANE LATVALA RICHARD
CEDAR GROVE 4tH (612) 464--8649
PERMIT SUBTYPE: TYPE OF WORK:
`,?f (11LSC,) Al1ERAf10M
DESCRIPTION Doan INSIALLATIOiN
Perknlt No. Parmlt Holder Date Telephone A
S/W
PLUMBING
HVAC
ELECTRIC
ELECTRIC
Inspection Date Insp. Comments
Footings I
Foundation
Framing
Roofing
Rough Plbg.
Rough Htg.
Isul.
Fireplace
Final Htg.
Omat Test
Final Plbg. Plbg. Inspector - Notify Plumber
Const. Meter
EngrJPtan
Bldg. Final
Deck Ftg.
Deck Final
well
Pr. Disp. -3K Ae 4"
CITY OF EAGAN Remarks Cedar Grove Acquisition
Addition -CEDAR GROVE 44 Lot 14 Blk 7 Parcel In 1670.3 140 07
Owner Street 2128 Shale Lane State Eagan, M 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 25 896-72 6-4-79
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 Nq 1292
IQQ6_10 BUILDING PERMIT
Owner ...__.la.K. .."MNEagan Township
Address (present) _........... ___Town Hall
Builder _......-------.-.._-
..--._........._------- ._......
....
Address Date 9- - __...-
................ _. ...._......._.......................... .. f.......__._
Stories To`Be Use For Front Depih Heigh! Est. Cost Permit Fee Remarks
a 'gyp
LOCATION
Street, Road or other Des?cription_ of Location ., Lo! Block Addition or Tract
?'j-???T'd '1•+x.3 +'????' ?i,?r?? __ ___-_.
of 3 7 ?? 3t OU / I 4 6.c
This permit does not authorize the use of streets, roads s nor does if give- he 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, that..?a,f..6h...Le1!rM-+-_?............ has permission to areci y.. e r .upon
the above described 'premise subject to the provisions of -theBuilding Ordinance for ag?aiV ownship adopt April 11,
1955. - - -
.................... ----._-•R!?rnee`".-_.Ao---------•- -- .... `:-_-------. Per ......._ .1 .PY..4,Sr.--- ! 1,
r---------._ . ................
....:.....
Chairman of Tnwn Board Building Inspector
` f EAGAN TOWNSHIP
BUILDING PERMIT
Owner ..... .... ,/ -------------------
Address IPresentt) .._° _ .t?.-.- ,
?1 /......_............
Builder .._......?est-??°.'`. .?... _.. b"?'?.:.---"0 ............................
Address ............ ........ ..............................................................
DESCRIPTION
N° 1777
Eagan Township
Town Hall
Dale ............. .... ..................
---
Stories To Be Used For Front Depth Height Est. Cost Permit Fee Remarks
C"'~ • ?'t"`?'? _ _
3? G oZ 6 ct 6 e-a '?, `?' I s ? ,?c,.t.? .?..r..Cl-.??
V V LOCATION
Street, Road or other Description of Location Lot Block Addition or Tract
/-Al 1 -7 1 c -'&- Al
This permit does not authorise 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 PT ON THE PREMISE WHILE THE WORK IS IN PROGRESS.
This is to certify, that....il.K. ---..-.5.-.' ' --...9-4.1L ..:..................has permission to erect a.... ...... ............ .....................-.........._upon
the above described premise subject !o the provisions of the Building Ordinance for E an To nship adopted April 11,
1955.
.................°" ..... ..°.' L.`.:- 'rr4c:c!................._._.- Per ................ l'..u.--'°'_4?°'" ' - -...K..[.R..61./............._.
Chaiman of Tnwn Board Building Impactor
G - lri,
This request v1 / ?3 L 1(-(( 3-7t C, G, Ct 4 ?d , e?
18 months from
Date of this Request J-1 Fire No. T 2 6 0 6 2
1, as ZLicensed Electrical Contractor ? Owner, do hereby request inspection of the above electri-
cal wiring installed at:
Street Address or Route No. I2J' cS19"A LE tLlZNE City ire
Section Township Range County ' 1Q
Which is occupied by
is a roughin inspection required on this job? No k Yes ? Ready Now ? Will Call ,'
Power Supplier Address
?oyyi
Electrical Contractor e Contractor's License No.
Z41
(company Name)
1 l n
Mailing Address
Authorized Signature
(cie(ccttncat contractor or owns
NO BOARD 0017
Phone No. 'Yl "A-i
This inspection request will not be accepted by the
State Board unless proper inspection fee is enclosed.
Minnesota State Board of Electricity
Griggs Midway Bldg. - Boom N191
1821 University Ave., St. Paul, Minn. 55104 - Phone 297-2111
_ - REQUEST FOR ELECTRICAL INSPECTION
CHECK BELOW WORK COVERED BY THIS' REQUEST
EB-00001-02
aT 26062
Tq$ of Building New Add. Rep. Check Appliances Wired For Check Equipment Wired For
Home ? ? J- Range ? Temporary Wiring ?
Duplex ? ? ? Water Heater ? Lighting Fixtures ?
Apt. Bldg. ? ? ? Dryer ? Electric Heating ?
Commercial Bldg. ? ? ? Furnace Silo Unloader ?
Industrial Bldg. ? ? ? Air Conditioner ? Bulk Milk Tank ?
Farm E] ? ? List
) List
other -
0
?
? oo
y
%hcrs( p
$eheers?
COMPUTE INSPECTION FEE BELOW
Service Entrance Size: Fee Feeders&.Subfea ders: # Fee Circuits: # Fee
o to 100 s. 0 to 30 Amperes 0 to 30 Am eres A4V
101 t 010 s. - . 31 to 100 Am res 31 to 100 Am tea
A 0 s - Above 100 Amps. Above 100 Amps.
Tra s me _ Remote Control Cvc. Partial or other fee
Sign Special I nspection inimum $&IN D•?
p
Remarks 6'OdeQ e p/oe ?.M CN7- TOTAL FEE
1, the Electrical Inspector, hereby certify that
mane
(Final)
This request void
18 months from
G? ? RESIDENTIAL BUILDING
59 ? J -7 Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construction Requirements RemodeVReoair Requirements Office Use Onlv
3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas 2 copies of plan _ Cert of Survey Recd
(20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions -Tree Pres Plan Reod
2 copies of plan showing beam & window sizes; poured found design, eta 1 site survey for additions & decks -Tree Pres Not Reqd
t set of Energy Calculations Addtion - indicate if on-site septic system _On-site Septic System
3 copies of Tree Preservation Plan if lot platted after VV93
Rim Joist Detail Options selection sheet (bldgs with 3 or less units
Date
/ L l L9 Construction Cost f?{?d d. o U
-
Site Address 2/o _ I
Z,Q cS/ ?N Unit/Ste #
Description of Work Gcl y /?? Oc IS (? P?yy? 61 Ab l
Multi-Family Bldg _ Y _ N Fireplace(s) _ 0 _ 1 _ 2
Property Owner Telephone #
Contractor
/ J
/
Address A? w City t
State Zip 60`12_? Telephone W L-) .f
COMPLETE THIS AREA ONLY IF
Energy Code Category - Minnesota Rules 7670 Category 1
• Residential Ventilation Category 1 Worksheet
(d submission type) Submitted
Energy Envelope Calculations Submitted
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
A NEW BUILDING
_ Minnesota Rules 7672
• New Energy Code Worksheet
Submitted
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.
Applicant's Printed Name Applic is tgnature
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 EM. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screeNgazebo) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) )4 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)' ? 43 Reroof ,- 46 Windows/Doors
? 34 Replacement "Demolition (Entire Bldg) -Give PCA handout to applicant
Valuation Occupancy MC/ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new bldg) _ Final/C.O.
Footings (deck) _ Final/No C.O.
_ Footings (addition) _ Plumbing
_ Foundation _ HVAC
Drain Tile Other
_
Roof _ Ice & Water _ Final - Pool _ Ftgs _ Air/Gas Tests _ Final
Framing _ Siding _ Stucco - Stone
Fireplace _ R.I. -Air Test -Final - Windows (new/replacement)
Insulation - Retaining Wall
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
Building Inspector
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1
PERMIT Control No. 0534
CIT'Y'& EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
SITE ADDRESS:
2128 SHALE LANE
.LOT: 14- BLOCK: 7
CEDAR GROVE 4
PERMIT TYPE:
Permit Number:
Date Issued:
BUILDING
000665
05/29/92
DESCRIPTION:
.f'Build ng Permit Type DECK
Buil,dlnNork Type NEW
-' Suilding_Len.gth 20
Building Width 14
t u,
REMARKS:
RECEIPT 0
FEE SUMMARY:
Base Fee $25.00
Surcharge $.50
Total Fee $25.50
CONTRACTOR:
OWNER: - Applicant -
LATVALAS RICHARD
2128 SHALE LANE
EAGAN NN
(612)454-8548
I hereby acknowledge that I have read this application and state that the
information is correct and agree to comply with ail applicable State of Nn.
Statutes and City of Eagan Ordinances.
L-
ARRLICANTIPERMITEE SIGNATURE E BY. SIGN TU E
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
INSPECTION RECORD
PERMIT TYPE:
Permit Number:
Date Issued:
Control No. 0534
BUILDING
000665
05/29/92
SITE ADDRESS: LOT: 14
2128 SHALE LANE
CEDAR GROVE 4
PERMIT SUBTYPE:
DECK
..,,REMARKS: RECEIPT N
BLOCK: 7 APPLICANT:
LATVALAS
(612) 464-8648
RICHARD
TYPE OF WORK:
NEW
PERMIT #
6I s
CITY OF EAGAN
1992 BUILDING PERMIT APPLICATION
681-4676
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERCIAL 2 sets of architectural.& structural plans, 1 set of
specifications, 1 copy of energy calcs.
Penalty applies when typing of permit is requested, but not picked up by last working day
of month in which request is made or lot Chan a is requested once Remit is issued.
Date 5 / d-? Valuation of work-41$00°-D
Site Address: It 2-8 5h0Je
STREET STE 0
Tenant. Name: (commercial only)
LOT BLOCK SUBD. P.I.D. 0
Descri tion of work:
The applicant is: IP Owner ? Contractor ? Other (cescribe)
Name 1 atwa.?r R1 6Aard Phone '1-5-4z(-9?5-4?/e
Property LAST FIRST
Owner Address l 8 ,5 &/c !A
STREET STE M
City State MAI Zip
Company Phone
Contractor Address License # Exp.
City State Zip
Company Phone
Architect/
Engineer Name Registration N
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 h e read this ppli ation and state that the information is
f
correct and agree to comply h al `appl bl ate of T n sota Sta utes and City o
Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 05 Apt. Bldg ? 09 Basement Finish
? 02 SF Dwg. ? 06 Garage/Accessory ? 10 Swim Pool
? 03 Two family ? 07 Fireplace ? 11 Res. Add.
? 04 Multi-fam. T.H. V08 Deck ? 12 Res. Porch
WORK TYPE
31 New ? 33 Alterations ? 35 Move
32 Addition ? 34 Tenant Finish ? 36 Demolish
GENERAL INFORMATION
Const. (Actual)
UBC Occupancy
Zoning
i of Stories
Length
Depth
APPROVALS
Planning
Engineering
REQUIRED INSPECTIONS
Building
Variance
? Site ;. Footing
? Wallboard Final
O Framing
? Draintile
? Insulation
? Fireplace
Permit Fee il'Si D? v.lustiaec
Surcharge , Sb
Plan Review
License
MWCC SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
SAC %
SAC Units
? 13 Comm/Ind New
? 14 Comm/Ind Add
? 15 Comm/Ind Rem
? 16 Public Fac.
? 17 Agricultural
MWCC System
City Water
PRY Required
Booster Pump
Fire Sprinkler
Census Code
SAC Code T.-f
Assessments
Basement sq. ft.
1st F1. sq. ft.
2nd F1. sq. ft.
Sq. Ft. total
Footprint Sq. ft.
ZD , On-site well
On-site sewage
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CITYDNEAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
SITE ADDRESS:
' PERMIT
PERMIT TYPE:
Permit Number:
Date Issued:
2128 SHALE LANE
LOT: 14 , BLOCK: 7
CEDAR GROVE 4TH
Control No. 0691
BUILDING
000907
06/23/92
DESCRIPTION:
DOOR INSTALLATION
Building Permit Type SF (MISC.)
Building',Work Type ALTERATION
r
?t 17?t5
REMARKS:
FEE SUMMARY:
VALUATION $500
Base Fee $15.00
Surcharge $.50
Total Fee $15.50
CONTRACTOR: OWNER: - Applicant -
LATVALA RICHARD
2128 SHALE LN
EAGAN MN 55122
(612)454-8548
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.
L-
.??lr ? ' ? nrln ? P? rl 1111.1
APPLICANT/PERMITEE SIGNATURE ISSUED B : SIGNATURE
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
SITE ADDRESS:
2128 SHALE
CEDAR GROVE 4TH
INSPECTION RECORD
PERMIT TYPE:
Permit Number:
Date Issued:
LOT: 14 BLOCK: 7 APPLICANT:
LANE LATVALA
(612) 454-8548
Control No. 0691
BUILDING
000907
06/23/92
RICHARD
L
PERMIT SUBTYPE: TYPE OF WORK:
SF (MISC.) ALTERATION
DESCRIPTION DOOR INSTALLATION
PERMIT #
REACTIVATE
CITY OF EAGAN
1992 BUILDING PERMIT
681-4675
APPLICATION
ff.f0
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERCIAL 2 sets of architectural & structural plans, I set of
specifications, 1 copy of energy calcs.
Penalty applies when typing of permit is requested, but not picked up by last working day
of month in which re guest is made or lot change is re uested once ermit is issued.
Date 6, Z,2 / c, Valuation of work SO v
Site Address: a ?l d"'
STREET SUITE r
Tenant Name: (commercial only)
LOT _?- BLOCK SUBD. P.I.D. #t
Description of work:
The applicant is: ?I Owner ? Contractor ? Other (Describe)
Name a ?h Phone Ft-Ya'
Property LAST FIRST
Owner Address _ a ! d g
STREET STE R
City (f?'rY?,r State - Zip s s i a
Company Phone
Contractor Address License # Exp.
City State Zip
Company Phone
Architect/
Engineer Name Registration #
Address
City State Zip
Sewer 6 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 appli ble State innesota Statutes and City of
Eagan Ordinances.
Signature of Applicant: c
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation
? 02 SF Dwg.
? 03 SF Addition
? 04 SF Porch
IP 05 SF Misc.
WORK TYPE
? 31 New
? 32 Addition
? 06 Duplex
? 07 4-Plex
? 08 8-Plex
? 09 12-Plex
? 10 Multi. Add'1
bI 33 Alterations
? 34 Repair
r
? 11 Apt./Lodging
? 12 Multi. Misc.
? 13 Garage/Accessory
? 14 Fireplace
? 15 Deck
? 35 Tenant Finish
? 36 Move
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Planning
Engineering
Basement sq. ft.
1st F1. sq. ft.
2nd F1. sq. ft.
Sq. Ft. total
Footprint Sq. ft.
On-site well
On-site sewage
Building
Variance
REQUIRED INSPECTIONS
? Site ? Footing
? Wallboard P Final
? Framing
? Draintile
.? Insulation
? Fireplace
Permit Fee
Surcharge
Plan Review
License
MWCC SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
valuation: $
? 16 Basement Finish
? 17 Swim Pool
? 18 Comm./Ind.
? 19 Comm./Ind. Misc.
? 20 Public Facility
? 21 Miscellaneous
? 37 Demolish
MWCC System
City Water
PRV Required
Booster Pump
Fire Sprinkler
Census Code
SAC Code
Assessments
SAC %
SAC Units
,/-/aJ
CITY OF EAGAN
L-d-B 7 MECHANICAL PERMIT RECEIPT # /O C, 6V
SUBD. . - ? vlo- (612) 681-4675 DATE 6
RESIDENTIAL
PLEASE COMPLETE UPPER PORTTON ONLY FOR SINGLE FAMILY DWELLINGS. ALSO, COMPLETE FOR
TOWNHOMES/CONDOS WHEN SEPARATE PERMITS ARE REQUIRED FOR EACH DWELLING UNIT.
OWNER i C?I n u p n ?q I/ Gt FEES
SITE ADDRESS:
c' I oZ
<S ?1 a E
L
ADD ON/REMODEL (EXISTING,
CONSTRUCTION ONLY) f}'C- \
$ 15.00
J?
INSTALLER: s HVAC: 0.100 M BTU 24.00
PHONE #: 12481 ?ievting &
Rhode Island Ate
m.
Ave. SO. ADDITIONAL 50 M BTU 6.00
ADDRESS: Savage, MN 5537 8-1122 GAS OUTLETS - MINIMUM 1 @ $3 EA.
CITY: ZIP: SURCHARG& $ .so
SIGNATURE TOTAL: $ S S
COMMERCIAL
PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAIMMUSTRIAL BUILDINGS. ALSO COMPLETE FOR
APARTMENT BUILDINGS OR OTHER MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR
EACH DWELLING UNIT.
WORK DESCRIPTION. CONTRACT PRICE FEES
1% OF CONTRACT FEE
STATE SURCHARGE IS $.50 FOR EACH
$1,000 OF PERMIT FEE $
PROCESSED PIPING - $25.00
$
MINIMUM FEE - $25.00
OWNER: TOTAL- $
SITE ADDRESS:
TENANT:
SUITE #:
INSTALLER:
ADDRESS:
CITY: ZIP:
PHONE #: CITY SIGNATURE
SIGNATURE
127 South Seventh Street
-Minneapolis, Minnesota 55402
(612) 339-4894
S[PAULTITLE
INSURANCE CORPORATION
'May 29, 1979
RE: Payment of Special Assessments
Gentlemen:
Enclosed please find our check in the amount of $ 886.72 for
payment in full of the special assessment(s) foxsw WAT LAT
on the following property.
Property Address P amt and-Parcel
Thurston Latvala
Seller Buyer
If there is any question on this payment of assessment(s) please contact
us immediately.
Also, please send all receipts for payment as soon as possible with our
fiel # M 21409 referenced on the receipt.
Thank you for your cooperation.
Sincerely,
Sally Turrittin
Escrow Closer
St. Paul Title Ins. Corp.
8441 Wayzata Blvd.
Golden Valley, Minn. 55426
Phone 544-8481
Affiliate of THE ST. PAUL COMPANIES INC.
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RESIDENT / OWNER
Name: J ., [„44 -1/A /,,o Phone:
Address / City / Zip: 2 - I -2 -8" .9 '' " l L t'7,4- y 1'u A- 5TJ Z Z
Applicant is: Owner X Contractor
TYPE OF WORK
Description of work: l'',9-4 vL s Lc-/
Construction Cost: -5-5--C- Building: (Yes / No 9 < )
CONTRACTOR
Name: $ Sits* c.4, -, 1-i.+ 1 . License #: 2- 4 .-/Z.3 V /
Address: ' SI t .- G L,, t' 3 (u-,,,f City: ,'A ' i--,1
State: A4 N Zip: SS'v -7 6 Phone: e 15 - 2....- 7-o/ — 2-6, n
Contact: A.Jr47e /3c.-.70-vi Ai _ Email: /t j'-G A9 ,64-7e t i€ , ... ex fE zi > ors
COMPLETE
In the last 12 months, has
Yes No If yes,
THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
the City of Eagan issued
date and address of master
a permit for a similar plan based on a master plan?
plan:
Licensed Plumber:
Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor:
Phone:
NO TE Plans and supporting documents that
th information maybe classified; as no t- p ublic
conclude
you submit are considered to be public Information.
if you provide specific reasons th at woulc permi
that they are °trade `secrets. :m. ..t,' .. ; '
Portia s; f
the City to a .
4 C!ty of Eaaall
3830 Pilot Knob Road MAR 1 6 2010
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
2010 RESIDENTIAL BUILDING PERMIT APPLICATION CR 11 a
Date: 3 _ / v Site Address: Z / Z e
Applicant's Printed Name
S
Applicant's Signature
r
Permit #:
Permit Fee: /20' (C�
Date Received:
Staff:
Tenant: 5j = l Suite #:
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.
Use BLUE or BLACK Ink
/v1n1 55 I Z2
Page 1 of 2
6 fl /1) DO NOT WRITE BELOW THIS LINE
SUB TYPES
Foundation
y Single Family
Multi
01 of _ Plex
Accessory Building
WORK TYPES
New
Addition
X Alteration
Replace
Retaining Wall
Reviewed By:
DESCRIPTION
Valuation
Plan Review
(25% 100°/0
Census Code
# of Units
# of Buildings
Type of Construction
Fireplace
Garage
Deck
Lower Level
REQUIRED INSPECTIONS
Footings (New Building)
Footings (Deck)
Footings (Addition)
Foundation
Drain Tile
Roof: Ice & Water Final
Framing
Fireplace: Rough In Air Test
1 , 1 Insulation
Meter Size:
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S &W Permit & Surcharge
Treatment Plant
Copies
dorM Jng
Interior Improvement
Move Building
Fire Repair
Repair
V'J
TOTAL
Porch (3- Season)
Porch (4- Season)
Porch (Screen /Gazebo /Pergola)
Pool
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
Final
Siding Demolish Building*
Reroof Demolish Interior
Windows Demolish Foundation
Egress Window Water Damage
*Demolition of entire building - give PCA handout to applicant
MCES System
SAC Units
City Water
Booster Pump
PRV
Fire Sprinklers
Sheetrock
Final / C.O. Required
Final / No C.O. Required
HVAC
Other:
Pool: Footings _Air /Gas Tests Final
Siding: Stucco Lath Stone Lath Brick
Windows
Retaining Wall: Footings Backfill Final
Radon Control
Erosion Control
, Building Inspector
6
1 X? gq -7_
6 7 3/
Storm Damage
Exterior Alteration (Single Family)
Exterior Alteration (Multi)
Miscellaneous
/
•' 2'4)(90
- t Page2of2
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PERMIT
City of Eagan Permit Type:Building
Permit Number:EA115997
Date Issued:10/01/2013
Permit Category:ePermit
Site Address: 2128 Shale Lane
Lot:14 Block: 7 Addition: Cedar Grove 4th
PID:10-16703-07-140
Use:
Description:
Sub Type:Reroof & Siding
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar.
Pictures are not acceptable in lieu of inspections.
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.
Fee Summary:BL - Base Fee $8K $162.25 0801.4085
Surcharge - Based on Valuation $8K $4.00 9001.2195
$166.25 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 -
Richard H Latvala
2128 Shale Lane
Eagan MN 55122
Homestyle Builders & Developers Inc
37 Walden St
Burnsville MN 55337
(952) 994-3980
Applicant/Permitee: Signature Issued By: Signature
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