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Home My WebLink AboutLA177065 8080 201st 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 BldgCode01/30/2020dmathews (3)2x12 min for span unlessusing #1 Grade SP and then(3)2x10 ok.SmokeSmokeSmokeCOUFER Ground-Provide 20' Rebar in footing and stubup near electrical service panel. -Min. 15" clearance to anyobstruction from center ofW.C., 24" in front(typ).SmokeSmokeSmokeCOSmokeCOCS-PFCS-PFCS-PF Stone Cottage HVAC Load Calculations for Berquist 8080 201st St W Lakeville,mn Prepared By: Randy Andrews Lofgren Heating 5708 Upper 147th Street West Apple Vallley, MN 55124 Monday, January 13, 2020 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, January 13, 2020 Client Name:Berquist Client Address:8080 201st 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 Northeast 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:1,369 CFM Per Square ft.:0.415 Square ft. of Room Area:3,300 Square ft. Per Ton:992 Volume (ft³) of Cond. Space:31,350 Building Loads Total Heating Required Including Ventilation Air:50,383 Btuh 50.383 MBH Total Sensible Gain:29,947 Btuh 84 % Total Latent Gain:5,528 Btuh 16 % Total Cooling Required Including Ventilation Air:35,475 Btuh 2.96 Tons (Based On Sensible + Latent) 3.33 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:\ ...\8080 201ST ST LAKEVILLE 01132020.rhv Monday, January 13, 2020, 11:50 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 2.96 1,116 3,300 29,947 5,528 35,475 50,383 846 1,369 1,369 System 1 No 2.96 1,116 3,300 29,947 5,528 35,475 50,383 846 1,369 1,369 24x10 Ventilation 728 1,352 2,080 9,749 Zone 1 3,300 29,219 4,176 33,395 40,634 846 1,369 1,369 24x10 1-Upper Level 1,650 20,630 2,675 23,305 25,664 534 967 967 11--6 2-Lower Level 1,650 8,589 1,501 10,090 14,970 312 402 402 5--6 C:\ ...\8080 201ST ST LAKEVILLE 01132020.rhv Monday, January 13, 2020, 11:50 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 0.33 428 11,916 0 12,766 12,766 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 1726 9,761 0 1,492 1,492 15B0-15sf-10: Wall-Basement, , R-15 board insulation to floor, no interior finish, 10' floor depth 1188 4,342 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:32,539 0 16,194 16,194 People:9 1,800 2,070 3,870 Equipment:1,500 6,000 7,500 Lighting:0 0 0 Ductwork:0 0 0 0 Infiltration: Winter CFM: 87, Summer CFM: 45 8,095 876 629 1,505 Ventilation: Winter CFM: 140, Summer CFM: 70 9,749 1,352 728 2,080 AED Excursion:0 0 4,326 4,326 Total Building Load Totals:50,383 5,528 29,947 35,475 Check Figures Total Building Supply CFM:1,369 CFM Per Square ft.:0.415 Square ft. of Room Area:3,300 Square ft. Per Ton:992 Volume (ft³) of Cond. Space:31,350 Building Loads Total Heating Required Including Ventilation Air:50,383 Btuh 50.383 MBH Total Sensible Gain:29,947 Btuh 84 % Total Latent Gain:5,528 Btuh 16 % Total Cooling Required Including Ventilation Air:35,475 Btuh 2.96 Tons (Based On Sensible + Latent) 3.33 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:\ ...\8080 201ST ST LAKEVILLE 01132020.rhv Monday, January 13, 2020, 11:50 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 50,383 Btuh Floor 5% Roof 6% Wall 28% Glass 24% Door 3% Infiltration 16% Ventilation 19% Building Gain 35,475 Btuh Roof 4%Wall 4% Glass 36% Door 1%People 11% Equipment 21% Infiltration 4% Ventilation 6% AED Excursion 12% C:\ ...\8080 201ST ST LAKEVILLE 01132020.rhv Monday, January 13, 2020, 11:50 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 0.33 428 11,916 0 12,766 12,766 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 1726 9,761 0 1,492 1,492 15B0-15sf-10: Wall-Basement, , R-15 board insulation to floor, no interior finish, 10' floor depth 1188 4,342 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:32,539 0 16,194 16,194 People:9 1,800 2,070 3,870 Equipment:1,500 6,000 7,500 Lighting:0 0 0 Ductwork:0 0 0 0 Infiltration: Winter CFM: 87, Summer CFM: 45 8,095 876 629 1,505 Ventilation: Winter CFM: 140, Summer CFM: 70 9,749 1,352 728 2,080 AED Excursion:0 0 4,326 4,326 System 1 Whole House Load Totals:50,383 5,528 29,947 35,475 Check Figures Supply CFM:1,369 CFM Per Square ft.:0.415 Square ft. of Room Area:3,300 Square ft. Per Ton:992 Volume (ft³) of Cond. Space:31,350 System Loads Total Heating Required Including Ventilation Air:50,383 Btuh 50.383 MBH Total Sensible Gain:29,947 Btuh 84 % Total Latent Gain:5,528 Btuh 16 % Total Cooling Required Including Ventilation Air:35,475 Btuh 2.96 Tons (Based On Sensible + Latent) 3.33 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:\ ...\8080 201ST ST LAKEVILLE 01132020.rhv Monday, January 13, 2020, 11:50 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:967 CFM Ceiling Height:10.0 ft.Supply Air Changes:3.5 AC/hr Volume:16,500.0 cu.ft.Req. Vent. Clg:0 CFM Number of Registers:11 Actual Winter Vent.:88 CFM Runout Air:88 CFM Percent of Supply.:9 % Runout Duct Size:6 in.Actual Summer Vent.:49 CFM Runout Air Velocity:448 ft./min.Percent of Supply:5 % Runout Air Velocity:448 ft./min.Actual Winter Infil.:67 CFM Actual Loss:0.125 in.wg./100 ft.Actual Summer Infil.:35 CFM Item Description Area Quantity -U- Value Htg HTM Sen Loss Clg HTM Lat Gain Sen Gain SW-Wall-12F-0sw 56 X 9 316 0.065 5.7 1,787 0.9 0 273 NE-Wall-12F-0sw 56 X 9 424 0.065 5.7 2,398 0.9 0 367 NW-Wall-12F-0sw 38 X 9 308 0.065 5.7 1,742 0.9 0 266 SE-Wall-12F-0sw 38 X 9 334 0.065 5.7 1,889 0.9 0 289 NE-Door-11N 3 X 7 21 0.350 30.5 639 8.4 0 176 NE-Door-11N 3 X 7 21 0.350 30.5 639 8.4 0 176 SW-Gls-4A-1a-o shgc-0.33 0%S 188 0.320 27.8 5,234 31.0 0 5,824 NE-Gls-4A-1a-o shgc-0.33 0%S 38 0.320 27.8 1,058 24.1 0 917 NW-Gls-4A-1a-o shgc-0.33 0%S 34 0.320 27.8 947 24.1 0 821 SE-Gls-4A-1a-o shgc-0.33 0%S 8 0.320 27.8 223 31.0 0 248 UP-Ceil-16B-50 1650 X 1 1650 0.020 1.7 2,871 1.0 0 1,584 Subtotals for Structure:19,427 0 10,941 Infil.: Win.: 67.2, Sum.: 34.9 1,692 3.686 6,237 0.287 675 485 AED Excursion:3,054 People: 200 lat/per, 230 sen/per:5 1,000 1,150 Equipment:1,000 5,000 Room Totals:25,664 2,675 20,630 C:\ ...\8080 201ST ST LAKEVILLE 01132020.rhv Monday, January 13, 2020, 11:50 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:402 CFM Ceiling Height:9.0 ft.Supply Air Changes:1.6 AC/hr Volume:14,850.0 cu.ft.Req. Vent. Clg:0 CFM Number of Registers:5 Actual Winter Vent.:52 CFM Runout Air:80 CFM Percent of Supply.:13 % Runout Duct Size:6 in.Actual Summer Vent.:21 CFM Runout Air Velocity:410 ft./min.Percent of Supply:5 % Runout Air Velocity:410 ft./min.Actual Winter Infil.:20 CFM Actual Loss:0.105 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 SW-Wall-12F-0sw 56 X 9 344 0.065 5.7 1,945 0.9 0 297 NE-Wall-15B0-15sf-10 56 X 9 504 0.042 3.7 1,842 0.0 0 0 NW-Wall-15B0-15sf-10 38 X 9 342 0.042 3.7 1,250 0.0 0 0 SE-Wall-15B0-15sf-10 38 X 9 342 0.042 3.7 1,250 0.0 0 0 SW-Gls-4A-1a-o shgc-0.33 0%S 160 0.320 27.8 4,454 31.0 0 4,956 Floor-21A-24 1 X 1090 1090 0.025 2.2 2,371 0.0 0 0 Subtotals for Structure:13,112 0 5,253 Infil.: Win.: 20.0, Sum.: 10.4 504 3.687 1,858 0.286 201 144 AED Excursion:1,272 People: 200 lat/per, 230 sen/per:4 800 920 Equipment:500 1,000 Room Totals:14,970 1,501 8,589 C:\ ...\8080 201ST ST LAKEVILLE 01132020.rhv Monday, January 13, 2020, 11:50 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 25,664 534 11-6 448 20,630 2,675 967 967 2 Lower Level 1,650 14,970 312 5-6 410 8,589 1,501 402 402 Ventilation 9,749 728 1,352 System 1 total 3,300 50,383 846 29,947 5,528 1,369 1,369 System 1 Main Trunk Size:24x10 in. Velocity:821 ft./min Loss per 100 ft.:0.094 in.wg Cooling System Summary Cooling Tons Sensible/Latent Split Sensible Btuh Latent Btuh Total Btuh Net Required:2.96 84% / 16%29,947 5,528 35,475 Recommended:3.33 75% / 25%29,947 9,982 39,930 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:\ ...\8080 201ST ST LAKEVILLE 01132020.rhv Monday, January 13, 2020, 11:50 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: 70,000 Capacity in Gallons: Other, describe: AFUE or HSPF% 93% 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 ML193UH070 Heating Loss Manufacturer Lennox Natural Gas Output in Tons: 3 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): 29,947Residential 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 13ACXN042-230 Model Heating System Natrual Gas Lennox 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: 50,383 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 Lakeville8080 201st St W BC636874 City Mailing Address of the Dwelling or Dwelling Unit Combustion Air Select a Type Location of duct or system: 35,475 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 KP 01/21/2020 X