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Home My WebLink AboutLA168782 8462 200th St W Permit PackRESIDENTIAL BUILDING PERMIT APPLICATION CITY OF LAKEVILLE BUILDING INSPECTIONS DEPARTMENT 20195 HOLYOKE AVENUE LAKEVILLE, MN 55044 952-985-4440 Office Use Only __________________ Permit Number ___________________ Received By ___________________ Date Received ___________________ Fee Total SITE ADDRESS: MAILING ADDRESS: CITY: STATE: ZIP: JOB DESCRIPTION:__________________________________ MASTER PLAN: (Number or Address)____________________ LIST OTHER STRUCTURES ON PROPERTY:_______________________________________________________________ ESTIMATED VALUATION: PROPOSED START DATE: END DATE: (New Residential Only): LEGAL DESCRIPTION: LOT: _____ BLOCK: _____ SUBDIVISION: APPLICANT IS: RESIDENT OWNER CONTRACTOR EMAIL NEW MODEL HOME: YES NO (IF YES – ADMINISTRATIVE PERMIT REQUIRED) PLEASE FILL OUT THE FOLLOWING COMPLETELY (All Contractor information must be as listed on State License) RESIDENT OWNER NAME:_______________________________________________________________________________ HOME PHONE #:_____________________________ CELL PHONE:___________________________ GENERAL CONTRACTOR Homeowner Contractor CONTRACTOR:_______________________________________________________________________ LICENSE #:BC______________ LEAD CERTIFICATE#_______________ (PRE 1978 STRUCTURE) OFFICE PHONE #:_____________________________ CELL PHONE:___________________________ ADDRESS:____________________________ CITY:________________ ST:______ ZIP:____________ PLUMBING WORK Homeowner Contractor CONTRACTOR:__________________________________________LICENSE #: PM______________ OFFICE PHONE #:_____________________________ CELL PHONE:___________________________ ADDRESS:____________________________ CITY:________________ ST:______ ZIP:____________ MECHANICAL WORK Homeowner Contractor CONTRACTOR:________________________________________ _______________________________ OFFICE PHONE #:_____________________________ CELL PHONE:___________________________ ADDRESS:____________________________ CITY:________________ ST:______ ZIP:____________ BOND #:_______________________________________ EXPIRATION DATE____________________ SEWER/WATER CONTRACTOR New Construction Only NAME:________________________________________________ ______________________________ HOME PHONE _____________________________ CELL PHONE:______________________________ BOND #:_______________________________________ EXPIRATION DATE____________________ INTEREST EARNINGS ON THE ESCROW ACCOUNTS, IF ANY, ARE RETAINED BY THE CITY TO OFFSET THE ADMINISTRATIVE COSTS ASSOCIATED WITH PROCESSING THE ESCROW APPLICATION AND REFUND. I HEREBY APPLY FOR A BUILDING PERMIT AND I ACKNOWLEDGE THAT THE INFORMATION ABOVE IS COMPLETE AND ACCURATE; THAT THE WORK WILL BE IN CONFORMANCE WITH THE ORDINANCES AND CODES OF THE CITY AND WITH THE STATE BUILDING CODE, THAT I UNDERSTAND THIS IS NOT A PERMIT AND WORK IS NOT TO START WITHOUT A PERMIT AND THAT THE WORK WILL BE IN ACCORDANCE WITH THE APPROVED PLAN. NAME OF APPLICANT (Please Print)DATE APPLICANT’S SIGNATURE: www.lakevillemn.gov RESIDENTIAL BUILDING PERMIT APPLICATION PAGE 2 OFFICE USE ONLY BUILDING PERMIT TYPE REQUIRED INSPECTIONS SINGLE FAMILY DWELLING BUILDING DUPLEX AS BUILT TOWNHOUSE UNITS BUILDING FINAL DETACHED TOWN HOUSE UNIT DECK FOOTING CONDO FIREPLACE ACESSORY BUILDING FOOTING REROOF FOUNDATION RESIDE FRAMING PORCH FRAMING GARAGES INSULATION RES ADDN/REPAIR/RMDL DECK PORCH GARAGES LATH LOWER LEVEL FINISH LOWER LEVEL FINAL ADDITION OTHER FOUNDATION ONLY PORCH FOOTING MISCELLANEOUS POURED WALL DEMO SEPTIC TANK REMOVAL MOVED SITE MECHANICAL CITY BUILDING VALUATION: $AIR TEST FINAL BUILDING PERMIT FEES ROUGH-IN $PERMIT FEE PLUMBING $PLAN CHECK FINAL $SURCHARGE ROUGH-IN $METRO SAC METER SIZE $CITY WATER HOOKUP UNIT PRESSURE REDUCING VALVE $CITY SEWER HOOKUP UNIT SEWER/WATER $LANDSCAPE ESCROW SEWER/WATER $TREE ESCROW FINAL $MISC ESCROW STREET DRAINTILE $PLUMBING BUILDING INFORMATION $MECHANICAL TYPE OF CONSTRUCTION $SEWER WATER ZONING $OTHER CODE EDITION $TOTAL FIRE SUPPRESSION SYSTEM OCCUPANCY GROUP APPROVED BY: BUILDING INSPECTOR: Date: PLUMBING/MECHANICAL INSPECTOR: Date: COMMENTS: Secure door closed until deck isconstructed with a separate permit.Concept Approval ONLYSubject to Field InspectionInspectorDate2015MN BldgCode05/10/2019dmathews UFER Ground-Provide 20' Rebar in footing and stubup near electrical service panel.SmokeCOSmokeSmoke SmokeSmokeCOSmokeCOSmokeCS-PFCS-PFCS-PFCS-PF-Min. 15" clearance to anyobstruction from center ofW.C., 24" in front(typ). Stone Cottage HVAC Load Calculations for Stone Cottage 8462 200th St W Lakeville,mn Prepared By: Randy Andrews Lofgren Heating 5708 Upper 147th Street West Apple Vallley, MN 55124 Monday, April 15, 2019 Rhvac - Residential & Light Commercial HVAC Loads Elite Software Development, Inc. Lofgren Htg. & A/C Stone Cottage Farmington, MN 55024 Page 2 Project Report General Project Information Project Title:Stone Cottage Project Date:Monday, April 15, 2019 Client Name:Stone Cottage Client Address:8462 200th St W Client City:Lakeville,mn Company Name:Lofgren Heating Company Representative:Randy Andrews Company Address:5708 Upper 147th Street West Company City:Apple Vallley, MN 55124 Company E-Mail Address:rrandrews@lofgrenheating-ac.com Design Data Reference City:Minneapolis, Minnesota Building Orientation:Front door faces North Daily Temperature Range:Medium Latitude:44 Degrees Elevation:834 ft. Altitude Factor:0.970 Elevation Sensible Adj. Factor:1.000 Elevation Total Adj. Factor:1.000 Elevation Heating Adj. Factor:1.000 Elevation Heating Adj. Factor:1.000 Outdoor Outdoor Outdoor Indoor Indoor Grains Dry Bulb Wet Bulb Rel.Hum Rel.Hum Dry Bulb Difference Winter:-15 -15.33 80%n/a 72 n/a Summer:88 72 47%50%75 29 Check Figures Total Building Supply CFM:922 CFM Per Square ft.:0.279 Square ft. of Room Area:3,300 Square ft. Per Ton:1,477 Volume (ft³) of Cond. Space:29,700 Building Loads Total Heating Required Including Ventilation Air:44,814 Btuh 44.814 MBH Total Sensible Gain:20,108 Btuh 80 % Total Latent Gain:5,058 Btuh 20 % Total Cooling Required Including Ventilation Air:25,166 Btuh 2.10 Tons (Based On Sensible + Latent) 2.23 Tons (Based On 75% Sensible Capacity) Notes Calculations are based on 8th edition of ACCA Manual J. All computed results are estimates as building use and weather may vary. Be sure to select a unit that meets both sensible and latent loads. C:\ ...\8462 200TH ST LAKEVILLE 04152019.rhv Monday, April 15, 2019, 11:43 AM Rhvac - Residential & Light Commercial HVAC Loads Elite Software Development, Inc. Lofgren Htg. & A/C Stone Cottage Farmington, MN 55024 Page 3 Load Preview Report Scope Has AED Net Ton ft.² /Ton Area Sen Gain Lat Gain Net Gain Sen Loss Sys Htg CFM Sys Clg CFM Sys Act CFM Duct Size Building 2.10 1,574 3,300 20,108 5,058 25,166 44,814 811 922 922 System 1 No 2.10 1,574 3,300 20,108 5,058 25,166 44,814 811 922 922 17x10 Ventilation 437 1,352 1,789 5,850 Zone 1 3,300 19,671 3,706 23,377 38,964 811 922 922 17x10 1-Upper Level 1,650 15,378 2,621 17,999 24,615 513 720 720 8--6 2-Lower Level 1,650 4,293 1,085 5,378 14,349 299 201 201 2--6 C:\ ...\8462 200TH ST LAKEVILLE 04152019.rhv Monday, April 15, 2019, 11:43 AM Rhvac - Residential & Light Commercial HVAC Loads Elite Software Development, Inc. Lofgren Htg. & A/C Stone Cottage Farmington, MN 55024 Page 4 Total Building Summary Loads Component Description Area Quan Sen Loss Lat Gain Sen Gain Total Gain 4A-1a-o: Glazing-Double pane low-e (e = 0.20 or less), operable window, e=0.20 on surface 2, wood with metal clad frame, u-value 0.32, SHGC 0.33 349 9,716 0 6,507 6,507 11N: Door-Metal - Polystyrene Core 42 1,278 0 352 352 12F-0sw: Wall-Frame, R-21 insulation in 2 x 6 stud cavity, no board insulation, siding finish, wood studs 1805 10,207 0 1,559 1,559 15B0-10sf-10: Wall-Basement, , R-10 board insulation to floor, no interior finish, 10' floor depth 1188 5,065 0 0 0 16B-50: Roof/Ceiling-Under Attic with Insulation on Attic Floor (also use for Knee Walls and Partition Ceilings), Vented Attic, No Radiant Barrier, Dark Asphalt Shingles or Dark Metal, Tar and Gravel or Membrane, R-50 insulation 1650 2,871 0 1,584 1,584 21A-24-c: Floor-Basement, Concrete slab, any thickness, 2 or more feet below grade, no insulation below floor, carpet covering, shortest side of floor slab is 24' wide 1090 2,371 0 0 0 Subtotals for structure:31,508 0 10,002 10,002 People:7 1,400 1,610 3,010 Equipment:1,500 6,000 7,500 Lighting:0 0 0 Ductwork:0 0 0 0 Infiltration: Winter CFM: 80, Summer CFM: 42 7,456 806 579 1,385 Ventilation: Winter CFM: 140, Summer CFM: 70 5,850 1,352 437 1,789 AED Excursion:0 0 1,480 1,480 Total Building Load Totals:44,814 5,058 20,108 25,166 Check Figures Total Building Supply CFM:922 CFM Per Square ft.:0.279 Square ft. of Room Area:3,300 Square ft. Per Ton:1,477 Volume (ft³) of Cond. Space:29,700 Building Loads Total Heating Required Including Ventilation Air:44,814 Btuh 44.814 MBH Total Sensible Gain:20,108 Btuh 80 % Total Latent Gain:5,058 Btuh 20 % Total Cooling Required Including Ventilation Air:25,166 Btuh 2.10 Tons (Based On Sensible + Latent) 2.23 Tons (Based On 75% Sensible Capacity) Notes Calculations are based on 8th edition of ACCA Manual J. All computed results are estimates as building use and weather may vary. Be sure to select a unit that meets both sensible and latent loads. C:\ ...\8462 200TH ST LAKEVILLE 04152019.rhv Monday, April 15, 2019, 11:43 AM Rhvac - Residential & Light Commercial HVAC Loads Elite Software Development, Inc. Lofgren Htg. & A/C Stone Cottage Farmington, MN 55024 Page 5 Building Pie Chart Building Loss 44,814 Btuh Floor 5% Roof 6% Wall 34% Glass 22% Door 3% Infiltration 17% Ventilation 13% Building Gain 25,166 Btuh Roof 6% Wall 6% Glass 26% Door 1% People 12% Equipment 30% Infiltration 6% Ventilation 7% AED Excursion 6% C:\ ...\8462 200TH ST LAKEVILLE 04152019.rhv Monday, April 15, 2019, 11:43 AM Rhvac - Residential & Light Commercial HVAC Loads Elite Software Development, Inc. Lofgren Htg. & A/C Stone Cottage Farmington, MN 55024 Page 6 System 1 Whole House Summary Loads Component Description Area Quan Sen Loss Lat Gain Sen Gain Total Gain 4A-1a-o: Glazing-Double pane low-e (e = 0.20 or less), operable window, e=0.20 on surface 2, wood with metal clad frame, u-value 0.32, SHGC 0.33 349 9,716 0 6,507 6,507 11N: Door-Metal - Polystyrene Core 42 1,278 0 352 352 12F-0sw: Wall-Frame, R-21 insulation in 2 x 6 stud cavity, no board insulation, siding finish, wood studs 1805 10,207 0 1,559 1,559 15B0-10sf-10: Wall-Basement, , R-10 board insulation to floor, no interior finish, 10' floor depth 1188 5,065 0 0 0 16B-50: Roof/Ceiling-Under Attic with Insulation on Attic Floor (also use for Knee Walls and Partition Ceilings), Vented Attic, No Radiant Barrier, Dark Asphalt Shingles or Dark Metal, Tar and Gravel or Membrane, R-50 insulation 1650 2,871 0 1,584 1,584 21A-24-c: Floor-Basement, Concrete slab, any thickness, 2 or more feet below grade, no insulation below floor, carpet covering, shortest side of floor slab is 24' wide 1090 2,371 0 0 0 Subtotals for structure:31,508 0 10,002 10,002 People:7 1,400 1,610 3,010 Equipment:1,500 6,000 7,500 Lighting:0 0 0 Ductwork:0 0 0 0 Infiltration: Winter CFM: 80, Summer CFM: 42 7,456 806 579 1,385 Ventilation: Winter CFM: 140, Summer CFM: 70 5,850 1,352 437 1,789 AED Excursion:0 0 1,480 1,480 System 1 Whole House Load Totals:44,814 5,058 20,108 25,166 Check Figures Supply CFM:922 CFM Per Square ft.:0.279 Square ft. of Room Area:3,300 Square ft. Per Ton:1,477 Volume (ft³) of Cond. Space:29,700 System Loads Total Heating Required Including Ventilation Air:44,814 Btuh 44.814 MBH Total Sensible Gain:20,108 Btuh 80 % Total Latent Gain:5,058 Btuh 20 % Total Cooling Required Including Ventilation Air:25,166 Btuh 2.10 Tons (Based On Sensible + Latent) 2.23 Tons (Based On 75% Sensible Capacity) Notes Calculations are based on 8th edition of ACCA Manual J. All computed results are estimates as building use and weather may vary. Be sure to select a unit that meets both sensible and latent loads. C:\ ...\8462 200TH ST LAKEVILLE 04152019.rhv Monday, April 15, 2019, 11:43 AM Rhvac - Residential & Light Commercial HVAC Loads Elite Software Development, Inc. Lofgren Htg. & A/C Stone Cottage Farmington, MN 55024 Page 7 Detailed Room Loads - Room 1 - Upper Level (Average Load Procedure) General Calculation Mode:Htg. & clg.Occurrences:1 Room Length:1,650.0 ft.System Number:1 Room Width:1.0 ft.Zone Number:1 Area:1,650.0 sq.ft.Supply Air:720 CFM Ceiling Height:9.0 ft.Supply Air Changes:2.9 AC/hr Volume:14,850.0 cu.ft.Req. Vent. Clg:0 CFM Number of Registers:8 Actual Winter Vent.:88 CFM Runout Air:90 CFM Percent of Supply.:12 % Runout Duct Size:6 in.Actual Summer Vent.:55 CFM Runout Air Velocity:459 ft./min.Percent of Supply:8 % Runout Air Velocity:459 ft./min.Actual Winter Infil.:62 CFM Actual Loss:0.131 in.wg./100 ft.Actual Summer Infil.:32 CFM Item Description Area Quantity -U- Value Htg HTM Sen Loss Clg HTM Lat Gain Sen Gain S -Wall-12F-0sw 56 X 9 316 0.065 5.7 1,787 0.9 0 273 N -Wall-12F-0sw 56 X 9 419 0.065 5.7 2,369 0.9 0 362 E -Wall-12F-0sw 38 X 9 336 0.065 5.7 1,900 0.9 0 290 W -Wall-12F-0sw 38 X 9 336 0.065 5.7 1,900 0.9 0 290 N -Door-11N 3 X 7 21 0.350 30.5 639 8.4 0 176 N -Door-11N 3 X 7 21 0.350 30.5 639 8.4 0 176 S -Gls-4A-1a-o shgc-0.33 0%S 188 0.320 27.8 5,234 19.2 0 3,606 N -Gls-4A-1a-o shgc-0.33 100%S 43 0.320 27.8 1,197 10.4 0 448 E -Gls-4A-1a-o shgc-0.33 0%S 6 0.320 27.8 167 35.0 0 210 W -Gls-4A-1a-o shgc-0.33 0%S 6 0.320 27.8 167 35.0 0 210 UP-Ceil-16B-50 1650 X 1 1650 0.020 1.7 2,871 1.0 0 1,584 Subtotals for Structure:18,870 0 7,625 Infil.: Win.: 61.9, Sum.: 32.2 1,692 3.395 5,745 0.264 621 446 AED Excursion:1,157 People: 200 lat/per, 230 sen/per:5 1,000 1,150 Equipment:1,000 5,000 Room Totals:24,615 2,621 15,378 C:\ ...\8462 200TH ST LAKEVILLE 04152019.rhv Monday, April 15, 2019, 11:43 AM Rhvac - Residential & Light Commercial HVAC Loads Elite Software Development, Inc. Lofgren Htg. & A/C Stone Cottage Farmington, MN 55024 Page 8 Detailed Room Loads - Room 2 - Lower Level (Average Load Procedure) General Calculation Mode:Htg. & clg.Occurrences:1 Room Length:1,650.0 ft.System Number:1 Room Width:1.0 ft.Zone Number:1 Area:1,650.0 sq.ft.Supply Air:201 CFM Ceiling Height:9.0 ft.Supply Air Changes:0.8 AC/hr Volume:14,850.0 cu.ft.Req. Vent. Clg:0 CFM Number of Registers:2 Actual Winter Vent.:52 CFM Runout Air:101 CFM Percent of Supply.:26 % Runout Duct Size:6 in.Actual Summer Vent.:15 CFM Runout Air Velocity:512 ft./min.Percent of Supply:8 % Runout Air Velocity:512 ft./min.Actual Winter Infil.:18 CFM Actual Loss:0.163 in.wg./100 ft.Actual Summer Infil.:10 CFM Item Description Area Quantity -U- Value Htg HTM Sen Loss Clg HTM Lat Gain Sen Gain S -Wall-12F-0sw 56 X 9 398 0.065 5.7 2,251 0.9 0 344 N -Wall-15B0-10sf-10 56 X 9 504 0.049 4.3 2,149 0.0 0 0 E -Wall-15B0-10sf-10 38 X 9 342 0.049 4.3 1,458 0.0 0 0 W -Wall-15B0-10sf-10 38 X 9 342 0.049 4.3 1,458 0.0 0 0 S -Gls-4A-1a-o shgc-0.33 0%S 106 0.320 27.8 2,951 19.2 0 2,033 Floor-21A-24 1 X 1090 1090 0.025 2.2 2,371 0.0 0 0 Subtotals for Structure:12,638 0 2,377 Infil.: Win.: 18.4, Sum.: 9.6 504 3.395 1,711 0.264 185 133 AED Excursion:323 People: 200 lat/per, 230 sen/per:2 400 460 Equipment:500 1,000 Room Totals:14,349 1,085 4,293 C:\ ...\8462 200TH ST LAKEVILLE 04152019.rhv Monday, April 15, 2019, 11:43 AM Rhvac - Residential & Light Commercial HVAC Loads Elite Software Development, Inc. Lofgren Htg. & A/C Stone Cottage Farmington, MN 55024 Page 9 System 1 Room Load Summary No Room Name Area SF Htg Sens Btuh Min Htg CFM Run Duct Size Run Duct Vel Clg Sens Btuh Clg Lat Btuh Min Clg CFM Act Sys CFM ---Zone 1--- 1 Upper Level 1,650 24,615 513 8-6 459 15,378 2,621 720 720 2 Lower Level 1,650 14,349 299 2-6 512 4,293 1,085 201 201 Ventilation 5,850 437 1,352 System 1 total 3,300 44,814 811 20,108 5,058 922 922 System 1 Main Trunk Size:17x10 in. Velocity:781 ft./min Loss per 100 ft.:0.099 in.wg Cooling System Summary Cooling Tons Sensible/Latent Split Sensible Btuh Latent Btuh Total Btuh Net Required:2.10 80% / 20%20,108 5,058 25,166 Recommended:2.23 75% / 25%20,108 6,703 26,811 Actual:1.00 77% / 23%9,240 2,760 12,000 Equipment Data Heating System Cooling System Type:Natural Gas Furnace Standard Air Conditioner Model:QC-F38-E78-G QC-C12 Indoor Model:S12 Brand:Quikcool FE Series Quikcool AS Series Description:Hi Efficiency Furnace Standard Efficiency Air Condit Efficiency:78.3 AFUE 12.4 SEER Sound:8.1 bels Capacity:38,000 Btuh 12,000 Btuh Sensible Capacity:n/a 9,240 Btuh Latent Capacity:n/a 2,760 Btuh C:\ ...\8462 200TH ST LAKEVILLE 04152019.rhv Monday, April 15, 2019, 11:43 AM Builders Associaton of Minnesota version 101014 Date Certificate Posted x Passive (No Fan) Active (With fan and monometer or other system monitoring device) Location (or future location) of Fan: Other Please Describe Here x 10/15 x x x 20 x 20 x 21 x 49 x x x x x Not applicable, all ducts located in conditioned space x Not required per mech. code Passive Powered Interlocked with exhaust device. Describe: Input in BTUS: 60,000 Capacity in Gallons: Other, describe: AFUE or HSPF% 95% Cfm's " round duct OR " metal duct Not required per mech. code x Passive Low: Other, describe: x Low: Location of fan(s), describe: Cfm's 4" " round duct OR Flex " metal duct 59SC5A060 Heating Loss Manufacturer Carrier Natural Gas Output in Tons: 2 Ton50 Total ventilation (intermittent + continuous) rate in cfms: Balanced Ventilation capacity in cfms: High: High: MECHANICAL VENTILATION SYSTEM Capacity continuous ventilation rate in cfms: 200CFM Select Type Describe any additional or combined heating or cooling systems if installed: (e.g. two furnaces or air source heat pump with gas back-up furnace): 20,108Residential Load Calculation SEER /EER Location of duct or system: Heating or Cooling Ducts Outside Conditioned Spaces Electric Make-up Air Select a Type AO Smith Domestic Water Heater MECHANICAL SYSTEMS Rating or Size Efficiency 13 Seer Building envelope air tightness: Rim Joist (1st Floor) GPVL-50 CA13NA024BNG Model Heating System Natrual Gas Carrier Fiberglass, Batts Foundation Wall R-value Average U-Factor (excludes skylights and one door) U: Duct system air tightness: Cooling SystemTotal R-Value of all Types of InsulationType: Check All That Apply Mineral Fiberboard Insulation Location Foam, Closed Cell0.22 Describe other insulated areas Fiberglass, BlownTHERMAL ENVELOPE Foam Open Cell Wall Rigid, Isocynurate Perimeter of Slab on Grade RADON CONTROL SYSTEM Non or Not ApplicableAttic Fuel Type Solar Heat Gain Coefficient (SHGC): Windows & Doors Ceiling, vaulted Bay Windows or cantilevered areas Floors over unconditioned area Rim Joist (2nd Floor+) 0.30 Appliances Mech Room Heat Recover Ventilator (HRV) Capacity in cfms: Energy Recover Ventilator (ERV) Capacity in cfms: 44,814 Heating Gain Cooling Load Per R401.3 Certificate. A building certificate shall be posted on or in the electrical distribution panel. Place your logo here New Construction Energy Code Compliance Certificate Name of Residential Contractor Stone Cottage Construction Inc. MN License Number Lakeville8462 200th St W BC636874 City Mailing Address of the Dwelling or Dwelling Unit Combustion Air Select a Type Location of duct or system: 25,166 Below Entire Slab Rigid, Extruded Polystyrene Ceiling, flat NEW RESIDENTIAL CONSTRUCTION SWPPP VERIFICATION This form must be completed and submitted with all new residential permit applications. New residential building permits WILL NOT be issued without this completed form. Project Site Address: _____________________________________________________________________ Company Name: _________________________________________________________________________ Primary Contact: _________________________________________________________________________ Phone # (24 hr Contact): ______________________ Email: ______________________________________ Description of Land Disturbing Activity: _____________________________________________________ NPDES Construction Stormwater Permit # C000 ___ ___ ___ ___ ___ or # SUB00 ___ ___ ___ ___ ___ If you are not covered under a NPDES Construction Stormwater Permit administered by the MPCA, an erosion and sediment control plan MUST be submitted with the residential building permit application. “The permittee(s) shall ensure that the individuals are trained by local, state, federal agencies, professional organizations or other entities in erosion prevention, sediment control, permanent Stormwater management and the Minnesota NPDES/SDS Construction Stormwater Permit.” (NPDES Construction Stormwater Permit, MPCA) “The permittee(s) must ensure that a trained person (as identified in Part III.A.3.a) will routinely inspect the entire construction site at least once every seven (7) days during active construction and within 24 hours after a rainfall event greater than 0.5 inches in 24 hours.” (NPDES Construction Stormwater Permit, MPCA) Contact information of person CERTIFIED to provide weekly onsite erosion and sediment control inspections and corrective actions: Name of Person: ________________________________Company: _______________________________ Phone # (24 hr Contact): ______________________ Email: ______________________________________ Entity that Provided Training: ________________________ Certification Expiration Date: ____________ NOTE: Prior to any land-disturbing activity, all erosion and sediment controls must be installed on the project site and on individual lots. No land disturbing activity may begin until a residential building permit has been issued. I understand, the above information to be true and I will have read, understood, and accepted all terms and conditions of the National Pollutant Discharge Elimination System (NPDES) Permit (MN R 100001). The City of Lakeville may issue a STOP WORK ORDER; withhold building inspections; or, draw on securities/escrows to bring the site into compliance with the NPDES Construction Stormwater Permit (MN R 100001) or erosion and sediment control plan. Signature: ________________________________________________ Date:_________________________ Contact the City of Lakeville with questions at erosion@lakevillemn.gov or 952-985-4500 05/01/19 X KP