850 Ivy Lane12/14/2010 TUB 15:52 FAX 612 822 5408 Al'e Master Plumbimg
City of Eatali
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Date: )Z-i/C/f
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Use BLUE or BLACK Ink
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Permit#; / 76(`'
Permit Fee:
Date Received:
Staff: (
INFLOW & INFILTRATION PERMIT APPLICATION
Plumbing / Sewer & Water
Tenant:
Site Address;
Suite #:
RESIDENT / OWNER
Name: anti (,(Gad.iph Phone: todO ;'47
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Address / City / Zip: 4///!/ %-,--r,, Gt�4,.-, �W ff7 7
CONTRACTOR
Name- Pt._ 7-24-4- 4-4 No44 44,4,1,.;..., License #: 031 Z6 )
Address: Jd/2 ''lle. jv City: A/4+ -1-4_,./
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State: 44/ Zip: L.,./7-572) Phone: 6(z -liy z -z~ - 52 f z_-
Contact: ..7? -11 ,,,,,,, i Email:
TYPE OF WORK
PLUMBING (Within the building envelope) SEWER & WATER (Outside the building envelope)
—Sump Pump Repair Repair
_
Other: _ ' Other:
DESCRIPTION
Description of work: ii,,,h cr., ',..-
wA_s t. <( c(qv 6ct,-/ )2. / ;;z - l A /6 nuc
FEES
$55.00 / Each (includes
65.00 State Surcharge) TOTAL FEE $ 5.5-- — *
'Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit 1/1 repair costs for
reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors
can be found by visiting www.cityofeastan.com/Inflow, or City Hall at 3830 Pilot Knob Rd.
CALL BEFORE YOU DIG. Call Gopher State One Cats 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.000herstateonecall.orq
t 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 •e in accordance with the approved plan in the case of work which requires a review and approval of plans.
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City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675-5675
www.ci.eagan.mn.us
PERMIT
City of En
Permit Type:
Permit Number:
Date Issued:
Permit Category:
Building
EA091953
11/09/2009
ePermit
Site Address: 850 Ivy Lane
Lot: 10 Block: 02 Addition: The Woodlands North 3rd
PID:10-75892-100-02
Use:
Description:
Sub Type: e-Reroof
Work Type: Replace
Description: House & Garage
Census Code: 434 -
Zoning:
Square Feet: 0
Construction Type:
Occupancy:
Comments:
If there is no ice protection inspection prior to final, the contractor must meet the
Pictures are not acceptable in lieu of inspections.
Carbon monoxide detectors are required by law in ALL single family homes.
nspector w/ a ladder and flat bar.
Fee Summary:
Valuation: 3,000.00
BL - Base Fee $3K
Surcharge - Based on Valuation $3K
$88.50 0801.4085
$1.50 9001.2195
Total:
$90.00
Contractor:
Sela Roofing Remodeling
4100 Excelsior Blvd
St. Louis Park MN 55416
(612) 823-8046
- Applicant -
Owner:
James E Clawson
850 Ivy Lane
Eagan MN 55123
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
Applicant/Permitee: Signature
Issued By: Signature