4839 Sheffield LaneResidential Sanitary Sewer Service
Compliance Inspection
Date
LIL
--Z.,.
Name , -7711
PID Number.
House Number 1 44. 3 q
Alternative Mailing Address Phone
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•
i,.._,Owner/Occupant Signature
For information call 651.470.2788
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings Number of stacks Entered S L at
Roots
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Poor ejor Ipi ts
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Sag/Pi &peflection
Damaged Pipe
Transition
4” to 6"Transition: Length of Service:
Sump pumps
Foundation drains
Roof drains
White Copy: Property Owner
Total
• _ am
Time rb="_ o pm
Disk
Street Name
Non-Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
c -77- "1 - 7 2
.,/‘
/
Number Discharged
Cor rectly
ncorrectly
A
Unknown
Record Number
Time
Obstruction
Unable to push past
feet.
Final Cleanout:
rn
• a
• Q pm
--
Inspector Signature
Notes
.
- .
No Access
O No one in
Access to service
lateral needed
O inspection
refused
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Yellow Copy: City of Ea0 f /1.-- Lf ( 2 -- -- , 17 / 1 7 21--- i 1 Pink' Copy: SEH
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City of Ca Jafl
Residential Sanitary Sewer Service
Compliance Inspection
r^ �
Date, 1._
Name
PID Number
House Number
i
Alternative Mailing Address
'
Owner /Occupant Signature
Compliance
O No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Transition
4" to 6 "Transition:
White Copy: Property Owner
Time .• %p
!Disk#
7 Street Name
am
Pm
Record Number
Time
Phone ! f
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Length of Service:
Yellow Copy: City of Eagan
Obstruction
Unable to push past
feet
Number of stacks Entered S. at
C "!' J
Inspector Signature
f•
W am
d pm
t7 fir
.4-
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Roots
Poor Pipe joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Final Cleanout: , , f
Pink Copy: SEH
Number
Correctly
Discharged
Discharged
Incorrectly
Unknown
Notes
, ,
-'€ f / 1 ? / ` , , , % :: �.
�, �� i
Al «
�-
r
Total
Sump pumps
Foundation drains
+
'1 X
.111111/11
-0..... i
Roof drains
IIII
City of Ca Jafl
Residential Sanitary Sewer Service
Compliance Inspection
r^ �
Date, 1._
Name
PID Number
House Number
i
Alternative Mailing Address
'
Owner /Occupant Signature
Compliance
O No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Transition
4" to 6 "Transition:
White Copy: Property Owner
Time .• %p
!Disk#
7 Street Name
am
Pm
Record Number
Time
Phone ! f
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Length of Service:
Yellow Copy: City of Eagan
Obstruction
Unable to push past
feet
Number of stacks Entered S. at
C "!' J
Inspector Signature
f•
W am
d pm
t7 fir
.4-
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Roots
Poor Pipe joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Final Cleanout: , , f
Pink Copy: SEH
RESIDENT / OWNER
Name: 0MA'2' ki?6 & SZ' Phone: 157 - 41 24 72.
/ . ,
Address / City / Zip: 1137 S >P /E2 LAN • £/ /¢A✓ 6
CONTRACTOR
Name: \./ C y PL/]/`1,8 //f/., License #: O
0 TO / Pn
Address: 720 PoA/77. 4 — ; CE City: / 174.5. 6
14
State: / / /�J N Zip: 6.5 /20 - /� 74 Phone: /0-) T L 9 7
Contact: 2Ave JANE.x Y Email: ✓a 7704* p /llin hi ,e0/YI
TYPE OF WORK
PLUMBING (Within the building envelope) SEWER & WATER (Outside the building envelope)
Sump Pump Repair Repair
Other: Other:
DESCRIPTION
Description of work: sudap pa/m/ "seeds A Gb/re4eu3 t. oath.
yes de /ice - 4,4 rf91ei wi / %`If
FEES
$55.00/ Each (includes
$5.00 State Surcharge) TOTAL FEE $
. x
City of Eaaall
Date:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
INFLOW & INFILTRATION PERMIT APPLICATION
Plumbing / Sewer &Water
7-A - 2"°/6 Site Address: 1 / 1 *V U1lEFF /2 LANE
Tenant: � /cg»izi) v :0 , f6e✓Nst - A
*Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit I/1 repair costs for
reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors
can be found by visiting www.citvofeaqan.com /inflow, or City Hall at 3830 Pilot Knob Rd.
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.qopherstateonecall.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
k
permit; that the work will be in accordance with the approved plan in the case of work h requires a review and approval of plans.
J o/e4 E n/ s &
Applicants Printed Name
FOR OFFICE USE
Required Inspections:
Under. Ground Rough - ]n : Final
Applicant
Permit #:
Permit Fee:
Date Received:
Staff:
Use BLUE or BLACK Ink
Suite #:
r w ipp ir
T41-.1k. 3, k- 1 ,�w H R' x L i1Fn - Ly Y`4`'S.
Ms x •
4 l & F
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� G1T, AGAN ma P "1
Piiot Kn�oob Road 7524
P. O Flo* ift PERMIT NO.:
Eagan, MN 551A4 DATE: 6 —a1— )
zoning. Toliefaon Bidre Na. of Units: l
Owner:
Address:
Site Addre 4839 Sheffield Lane Ll r$} �,
ttat�y "'"` }
Piumber: Gees twee
6- 11--35 52612 IUU. rid
! to comply wkh " -,a section Charge* 425.
ieoeeee AccotM Deposit: 15.00 8
1 Permit Fee. : U Qid
B `_ f Mi Crow: .s,
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ti1%' .
Orate of 1 Total:
trap.:
A f —
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA111322
Date Issued:06/19/2013
Permit Category:ePermit
Site Address: 4839 Sheffield Lane
Lot:1 Block: 1 Addition: Brittany 5th
PID:10-15004-01-010
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Janel Behrends
122 West 3rd S
Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088
Surcharge-Fixed $5.00 9001.2195
$60.00 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 Jorgensen
4839 Sheffield Lane
Eagan MN 55122
Haley Comfort Systems
122 West 3rd St
Hastings MN 55033
(651) 437-0338
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA116383
Date Issued:10/07/2013
Permit Category:ePermit
Site Address: 4839 Sheffield Lane
Lot:1 Block: 1 Addition: Brittany 5th
PID:10-15004-01-010
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, call for framing
inspection. Call for final inspection after installation.
Carbon monoxide detectors are required by law in ALL single family homes .
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 -
Richard Jorgensen
4839 Sheffield Lane
Eagan MN 55122
(651) 454-2672
Home Depot At Home Services
656 Mendelssohn Ave N
Golden Valley MN 55427
(763) 542-8826
Applicant/Permitee: Signature Issued By: Signature