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LA172760 - 16429 Dunfield Dr Permit Pack
RESIDENTIAL 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: Copyright of these documents is owned by Robert Thomas Homes, Inc. and reserves ALL rights. These plans may not be re-used, copied or assigned to another party nor shall they be modified or used in part in other designs without the prior written consent of Robert Thomas Homes, Inc. OF SHEET AU G U S T I N E R E S I D E N C E 16 4 2 9 D U N F I E L D D R I V E , L A K E V I L L E , M N 5 5 0 4 4 SB F 1 8 . 0 7 . 0 9 - T H E S T . C R O I X - E V E L A T I O N N A DRAWN BY:JJS C.O.7/17/19 CUSTOMER 7/18/19 C.O.7/23/19 PERMIT 8/8/19 REVISIONS: 7/30/19 - C.O. 12 1-10 11 1 13 APPROXIMATE SQUARE FOOTAGE ABOVE GRADE FINISHED BELOW GRADE FINISHED BELOW GRADE UNFINISHED GARAGE SQ. FT. SQ. FT. SQ. FT. SQ. FT. 3,153 1,044 412 627 Copyright of these documents is owned by Robert Thomas Homes, Inc. and reserves ALL rights. These plans may not be re-used, copied or assigned to another party nor shall they be modified or used in part in other designs without the prior written consent of Robert Thomas Homes, Inc. OF SHEET AU G U S T I N E R E S I D E N C E 16 4 2 9 D U N F I E L D D R I V E , L A K E V I L L E , M N 5 5 0 4 4 SB F 1 8 . 0 7 . 0 9 - T H E S T . C R O I X - E V E L A T I O N N A DRAWN BY:JJS C.O.7/17/19 CUSTOMER 7/18/19 C.O.7/23/19 PERMIT 8/8/19 REVISIONS: 7/30/19 - C.O. 12 1-10 11 2 13 Copyright of these documents is owned by Robert Thomas Homes, Inc. and reserves ALL rights. These plans may not be re-used, copied or assigned to another party nor shall they be modified or used in part in other designs without the prior written consent of Robert Thomas Homes, Inc. OF SHEET AU G U S T I N E R E S I D E N C E 16 4 2 9 D U N F I E L D D R I V E , L A K E V I L L E , M N 5 5 0 4 4 SB F 1 8 . 0 7 . 0 9 - T H E S T . C R O I X - E V E L A T I O N N A DRAWN BY:JJS C.O.7/17/19 CUSTOMER 7/18/19 C.O.7/23/19 PERMIT 8/8/19 REVISIONS: 7/30/19 - C.O. 12 1-10 11 3 13 Copyright of these documents is owned by Robert Thomas Homes, Inc. and reserves ALL rights. These plans may not be re-used, copied or assigned to another party nor shall they be modified or used in part in other designs without the prior written consent of Robert Thomas Homes, Inc. OF SHEET AU G U S T I N E R E S I D E N C E 16 4 2 9 D U N F I E L D D R I V E , L A K E V I L L E , M N 5 5 0 4 4 SB F 1 8 . 0 7 . 0 9 - T H E S T . C R O I X - E V E L A T I O N N A DRAWN BY:JJS C.O.7/17/19 CUSTOMER 7/18/19 C.O.7/23/19 PERMIT 8/8/19 REVISIONS: 7/30/19 - C.O. 12 1-10 11 4 13 Copyright of these documents is owned by Robert Thomas Homes, Inc. and reserves ALL rights. These plans may not be re-used, copied or assigned to another party nor shall they be modified or used in part in other designs without the prior written consent of Robert Thomas Homes, Inc. OF SHEET AU G U S T I N E R E S I D E N C E 16 4 2 9 D U N F I E L D D R I V E , L A K E V I L L E , M N 5 5 0 4 4 SB F 1 8 . 0 7 . 0 9 - T H E S T . C R O I X - E V E L A T I O N N A DRAWN BY:JJS C.O.7/17/19 CUSTOMER 7/18/19 C.O.7/23/19 PERMIT 8/8/19 REVISIONS: 7/30/19 - C.O. 12 1-10 11 5 13 × Copyright of these documents is owned by Robert Thomas Homes, Inc. and reserves ALL rights. These plans may not be re-used, copied or assigned to another party nor shall they be modified or used in part in other designs without the prior written consent of Robert Thomas Homes, Inc. OF SHEET AU G U S T I N E R E S I D E N C E 16 4 2 9 D U N F I E L D D R I V E , L A K E V I L L E , M N 5 5 0 4 4 SB F 1 8 . 0 7 . 0 9 - T H E S T . C R O I X - E V E L A T I O N N A DRAWN BY:JJS C.O.7/17/19 CUSTOMER 7/18/19 C.O.7/23/19 PERMIT 8/8/19 REVISIONS: 7/30/19 - C.O. 12 1-10 11 6 13 Copyright of these documents is owned by Robert Thomas Homes, Inc. and reserves ALL rights. These plans may not be re-used, copied or assigned to another party nor shall they be modified or used in part in other designs without the prior written consent of Robert Thomas Homes, Inc. OF SHEET AU G U S T I N E R E S I D E N C E 16 4 2 9 D U N F I E L D D R I V E , L A K E V I L L E , M N 5 5 0 4 4 SB F 1 8 . 0 7 . 0 9 - T H E S T . C R O I X - E V E L A T I O N N A DRAWN BY:JJS C.O.7/17/19 CUSTOMER 7/18/19 C.O.7/23/19 PERMIT 8/8/19 REVISIONS: 7/30/19 - C.O. 12 1-10 11 7 13 Copyright of these documents is owned by Robert Thomas Homes, Inc. and reserves ALL rights. These plans may not be re-used, copied or assigned to another party nor shall they be modified or used in part in other designs without the prior written consent of Robert Thomas Homes, Inc. OF SHEET AU G U S T I N E R E S I D E N C E 16 4 2 9 D U N F I E L D D R I V E , L A K E V I L L E , M N 5 5 0 4 4 SB F 1 8 . 0 7 . 0 9 - T H E S T . C R O I X - E V E L A T I O N N A DRAWN BY:JJS C.O.7/17/19 CUSTOMER 7/18/19 C.O.7/23/19 PERMIT 8/8/19 REVISIONS: 7/30/19 - C.O. 12 1-10 11 8 13 Copyright of these documents is owned by Robert Thomas Homes, Inc. and reserves ALL rights. These plans may not be re-used, copied or assigned to another party nor shall they be modified or used in part in other designs without the prior written consent of Robert Thomas Homes, Inc. OF SHEET AU G U S T I N E R E S I D E N C E 16 4 2 9 D U N F I E L D D R I V E , L A K E V I L L E , M N 5 5 0 4 4 SB F 1 8 . 0 7 . 0 9 - T H E S T . C R O I X - E V E L A T I O N N A DRAWN BY:JJS C.O.7/17/19 CUSTOMER 7/18/19 C.O.7/23/19 PERMIT 8/8/19 REVISIONS: 7/30/19 - C.O. 12 1-10 11 9 13 Copyright of these documents is owned by Robert Thomas Homes, Inc. and reserves ALL rights. These plans may not be re-used, copied or assigned to another party nor shall they be modified or used in part in other designs without the prior written consent of Robert Thomas Homes, Inc. OF SHEET AU G U S T I N E R E S I D E N C E 16 4 2 9 D U N F I E L D D R I V E , L A K E V I L L E , M N 5 5 0 4 4 SB F 1 8 . 0 7 . 0 9 - T H E S T . C R O I X - E V E L A T I O N N A DRAWN BY:JJS C.O.7/17/19 CUSTOMER 7/18/19 C.O.7/23/19 PERMIT 8/8/19 REVISIONS: 7/30/19 - C.O. 12 1-10 11 10 13 1/ 4 " 1- 1 / 2 " Copyright of these documents is owned by Robert Thomas Homes, Inc. and reserves ALL rights. These plans may not be re-used, copied or assigned to another party nor shall they be modified or used in part in other designs without the prior written consent of Robert Thomas Homes, Inc. OF SHEET AU G U S T I N E R E S I D E N C E 16 4 2 9 D U N F I E L D D R I V E , L A K E V I L L E , M N 5 5 0 4 4 SB F 1 8 . 0 7 . 0 9 - T H E S T . C R O I X - E V E L A T I O N N A DRAWN BY:JJS C.O.7/17/19 CUSTOMER 7/18/19 C.O.7/23/19 PERMIT 8/8/19 REVISIONS: 7/30/19 - C.O. 12 1-10 11 11 13 CFL INCANDESCENT LED LED LED LED HALOGEN LED Copyright of these documents is owned by Robert Thomas Homes, Inc. and reserves ALL rights. These plans may not be re-used, copied or assigned to another party nor shall they be modified or used in part in other designs without the prior written consent of Robert Thomas Homes, Inc. OF SHEET AU G U S T I N E R E S I D E N C E 16 4 2 9 D U N F I E L D D R I V E , L A K E V I L L E , M N 5 5 0 4 4 SB F 1 8 . 0 7 . 0 9 - T H E S T . C R O I X - E V E L A T I O N N A DRAWN BY:JJS C.O.7/17/19 CUSTOMER 7/18/19 C.O.7/23/19 PERMIT 8/8/19 REVISIONS: 7/30/19 - C.O. 12 1-10 11 12 13 CFL INCANDESCENT LED LED LED LED HALOGEN LED Copyright of these documents is owned by Robert Thomas Homes, Inc. and reserves ALL rights. 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Burnsville Pkwy, Suite 120, Burnsville, MN 55337 Phone 952‐894‐0005 – Fax 952‐894‐0925 – Web www.burnsvilleheating.com _____________________________________________________________________________________ Ventilation, Makeup and Combustion Air Calculations Submittal Form for New Dwellings Site address 16429 Dunfield Drive Date 8/8/19 Contractor Burnsville Heating & Air Conditioning, Inc Completed By Alan Dobson VENTILATION REQUIREMENTS TABLE R403.5.2 NUMBER OF BEDROOMS 1 2 3 4 5 6 2 Conditioned space1 (in sq. ft.) Total/ Continuous Total/ Continuous Total/ Continuous Total/ Continuous Total/ Continuous Total/ Continuous 1000‐1500 60/40 75/40 90/45 105/53 120/60 135/68 1501‐2000 70/40 85/43 100/50 115/58 130/65 145/73 2001‐2500 80/40 95/48 110/55 125/63 140/70 155/78 2501‐3000 90/40 105/53 120/60 135/68 150/75 165/83 3001‐3500 100/50 115/58 130/65 145/73 160/80 175/88 3501‐4000 110/55 125/63 140/70 155/78 170/85 185/93 4001‐4500 120/60 135/68 150/75 165/83 180/90 195/98 4501‐5000 130/65 145/73 160/80 175/88 190/95 205/103 5001‐5500 140/70 155/78 170/85 185/93 200/100 215/108 5501‐6000 2 150/75 165/83 180/90 195/98 210/105 225/113 1. Conditioned space includes the basement and conditioned crawl spaces. 2. If conditioned space exceeds 6000sp. Ft. or there are more than 6 bedrooms, use Equation R403.5.2 R403.5.2 Total Ventilation rate. The mechanical ventilation system shall provide sufficient outdoor air to equal the total ventilation rate average for each 1‐ hour period in accordance with Table R403.5.2, or Equation 403.5.2, based on the number of bedrooms and square footage of conditioned space, including the basement and conditioned crawl spaces. For the purposes of Table R403.5.2 and Section R403.5.3, the following applies” a. Equation R403.5.2 Total ventilation rate: Total ventilation rate (cfm) = (0.02 x square feet of conditioned space) + (15 x (number of bedrooms =1)) b. Equation R403.5.2.1 Continuous ventilation rate: Continuous ventilation rate (cfm) = Total ventilation rate/2 Amount Total _________190_________ Amount Continuous _______95_________ TABLE 304.1 COMBUSTION AIR REQUIREMENTS FOR GAS‐FIRED APPLIANCES WHEN THE COMBINED INPUT IS UP TO AND INCLUDING 400,000 Btu/hr TOTAL INPUT OF APPLIANCES1, THOUSANDS OF Btu/hr (kW) REQUIRED FREE AREA OF AIR‐ SUPPLY OPENING OR DUCT, SQUARE INCHES (sq mm) ACCEPTABLE APPROXIMATE ROUND DUCT EQUIVALENT DIAMETER2, INCH (mm) 25 (8) 50 (15) 75 (23) 100 (30) 125 (37) 150 (45) 175 (53) 200 (60) 225 (68) 250 (75) 275 (83) 300 (90) 325 (98) 350 (105) 375 (113) 400 (120) 7 (4,500) 7 (4,500) 11 (7,000) 14 (9,000) 18 (12,000) 22 (14,000) 25 (16,000) 29 (19,000) 32 (21,000) 36 (23,000) 40 (26,000) 43 (28,000) 47 (30,000) 50 (32,000) 54 (35,000) 58 (37,000) 3 (75) 3 (75) 4 (100) 4 (100) 5 (125) 5 (125) 6 (150) 6 (150) 6 (150) 7 (175) 7 (175) 7 (175) 8 (200) 8 (200) 8 (200) 9 (225) 1. For total inputs falling between listed capacities, use next largest listed input. 2. If flexible duct is used, increase the duct diameter by one inch. * *Flexible duct shall be stretched with minimal sags. BTU Amount for Non‐direct vent appliances ____________________ Table 501.4.1 Procedure to Determine Makeup Air Quantity for Exhaust Appliances in Dwelling Units ONE OR MULTIPLE POWER VENT OR DIRECT VENT APPLIANCES OR NO COMBUSTION APPLIANCESA ONE OR MULTIPLE FAN‐ASSISTED APPLIANCES AND POWER VENT OR DIRECT VENT APPLIANCESB ONE ATMOSPHERICALLY VENTED GAS OR OIL APPLIANCE OR ONE SOLID FUEL APPLIANCEC MULTIPLE APPLIANCES THAT ARE ATMOSPHERICALLY VENTED GAS OR OIL APPLIANCES OR SOLID FUEL APPLIANCESD 1. Use Appropriate Column to Estimate House Infiltration a) pressure factor (cfm/sf) 0.15 0.09 0.06 0.03 b) conditioned floor area (sf) 4609 (including unfinished basements) Estimated House Infiltration (cfm): [1ax 1b] 691.35 2. Exhaust Capacity a) Clothes dryer 135 135 135 135 b) 80% of largest exhaust rating (cfm) 240 (not applicable if recirculating system or if powered makeup air is electrically interlocked and matched to exhaust c) 80% of next largest exhaust rating (cfm): 64 (not applicable if recirculating system or if powered makeup air is electrically interlocked and matched to exhaust Total Exhaust Capacity (cfm): [2a+2b+2c] 439 3. Makeup Air Requirement 547) Total Exhaust Capacity (from above) 439 b) Estimated House Infiltration (from above) 691.35 Makeup Air Quality (cfm): [3a‐3b] ‐252.35 (if value is negative, no makeup air is needed 4. For Makeup Air opening Sizing, refer to Table 501.4.2 A. Use this column if there are other than fan‐assisted or atmospherically venter gas or oil appliances or if there are no combustion appliances. B. Use this column if there is one fan‐assisted appliance per venting system. Other atmospherically vented appliances may also be included. C. Use this column if there is one atmospherically vented (other than fan‐assisted) gas or oil appliance per venting system or one solid fuel appliance. D. Use this column if there are multiple atmospherically vented gas or oil appliances using a common vent or if there are atmospherically vented gas or oil 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 R-10 X R-21 X R-21 X R-21 X R-49 X R-30 X R-30 X R-30 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:80,000 Capacity in Gallons: Other, describe: AFUE or HSPF%92% Cfm's " round duct OR " metal duct Not required per mech. code 6"Passive Low: Other, describe: X Low: Location of fan(s), describe: Cfm's " round duct OR " metal duct Bay Windows or cantilevered areas Floors over unconditioned area Per R401.3 Certificate. A building certificate shall be posted on or in the electrical distribution panel.8/8/2019 New Construction Energy Code Compliance Certificate Name of Residential Contractor Robert Thomas Homes MN License Number BC644819 City Mailing Address of the Dwelling or Dwelling Unit Lakeville16429 Dunfield Drive Heat Recover Ventilator (HRV) Capacity in cfms: Energy Recover Ventilator (ERV) Capacity in cfms: Combustion Air Select a Type Location of duct or system: 33,60061,701 Heating Gain Cooling Load 95 190 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): 32,633 Residential Load Calculation Heating Loss 0.34 Describe other insulated areas RADON CONTROL SYSTEM Rim Joist (2nd Floor+) 0.28 Building envelope air tightness: 6 MIL POLY - 4" AGG Below Entire Slab Ri g i d , E x t r u d e d P o l y s t y r e n e Ri g i d , I s o c y n u r a t e Perimeter of Slab on Grade Ceiling, flat ATTIC EXTERIOR SEALANT Rim Joist (1st Floor) Windows & Doors Ceiling, vaulted 3 Appliances Cooling System To t a l R - V a l u e o f a l l T y p e s o f In s u l a t i o n Type: Check All That Apply Mi n e r a l F i b e r b o a r d THERMAL ENVELOPE Insulation Location Fo a m , C l o s e d C e l l Fo a m O p e n C e l l Wall No n o r N o t A p p l i c a b l e Fi b e r g l a s s , B l o w n Fi b e r g l a s s , B a t t s Foundation Wall R-value Average U-Factor (excludes skylights and one door) U: Duct system air tightness: Fuel Type Solar Heat Gain Coefficient (SHGC): 43VP50E2 DX13SN036 Location of duct or system: Heating or Cooling Ducts Outside Conditioned Spaces R-410A Make-up Air Select a Type Rheem Domestic Water Heater Gas MECHANICAL SYSTEMS Rating or Size Efficiency 13SEER /EER Model Heating System Gas Daikin DM92SS0803B Manufacturer Daikin 50 Output in Tons: Total ventilation (intermittent + continuous) rate in cfms: Balanced Ventilation capacity in cfms: High: High: MECHANICAL VENTILATION SYSTEM Capacity continuous ventilation rate in cfms: Builders Associaton of Minnesota version 101014 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 16429 Dunfield Drive Robert Thomas Homes Jason Sohre jason.sohre@robertthomashomes.com Excavation/construction of single family home 15765 Rob St. Sauver Robert Thomas Homes 952-292-2419 rob.stsauver@traditiondevelopment.com U of MN 5/31/2022 R 100001)))))))))))))))))))))))))))))))))ooooooooooooooooooooooooooooooooooooooor rrrrrrr rrrrrrrrrrrrrrrrrrrrrrrrr ererereeeereeeeerrrrrrreereeeeeeerereeeerererrererrrreeerereereereeeeerrrrrrreeeeeeeereeerrrosooosoooooososososoooooosooosososososososooosssososososososososossssssooososossssssoosooooooooosoosssssssosooooossssssssosssssssssssssssssion anddd sediment control plan. e:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ D 8/7/19 952-567-4459