HomeMy WebLinkAboutLA180036 18002 Gresford Lane 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:
20195 Holyoke Avenue, Lakeville, MN 55044
952-985-4400 952-985-4499 fax
www.lakevillemn.gov
Sewer & Water Tie Card
Address:________________________________________
Contractor:______________________________________
Permit Number:__________________________________
Final Date:________________
Street Drain-Tile:______
Size of Water Service: 1”
Comments: AIRTEST SANITARY OVER 20’/2 FITTINGS
THIS CARD MUST BE COMPLETED AND ON-SITE AT TIME
OF SEWER & WATER INSPECTION
W01W01W01W01W01W01W01W01W01W06W06W068'-8"8'-8"8'-8"26'13'-6"6'2'7'3'-4"4'-3"2'-2"20'2'10'5'-5"5'-4 1/2"15'-11 1/4"6'2'7'-2"70'27'-9 3/4"42'-2 1/4"39'-6"24'4'-6"11'39'-6"8'62'23'-3"38'-9"7'-10 1/2"13'2'-6"10'-6"21'-11 1/4"13'-6 1/2"20'18" floor trusses @19.2" O.C.18" floor trusses @19.2" O.C.18" floor trusses @19.2" O.C.2x10 Joists @16" O.C.6x6 Treated posts-12" footings belled to 16" @ base-Footings to a minimum depth of 4'0" 2x6 load bearing wallw/ 16" x 8" stripfootingsFire proof below stairs2x6 load bearingwall w/ 16" x 8"strip footings(3) 2x10 2x6 load bearing wallw/ 16" x 8" stripfootingsCantilever floor trusses@ closet above-12" footings belled to 16" @ base-Footings to a minimum depth of 4'0"2x8's @ 16" O.C.(3) 2x8Flush (2) 11 7/8" LVL2x6 load bearing wallw/ 16" x 8" stripfootings18" floor trusses @19.2" O.C.Flush (2) 11 7/8" LVLWINDOW SCHEDULENUMBER LABEL QTY FLOOR SIZE WIDTH HEIGHT R/O EGRESS DESCRIPTIONW01 2646SC 3 0 2646SC 30 " 54 " 32"X56" SNGL CASEMENT-HRW02 3016AW 2 1 3016AW 36 " 18 " 38"X20" AWNINGW03 61052MU 3 1 61052 82 " 62 " 84"X64" MULLED UNITW05 3050DH 2 1 3050DH 36 " 60 " 38"X62" DOUBLE HUNGW06 5246MU 1 0 5246 62 " 54 " 64"X56" MULLED UNITOrfield Drafting Services3507 W 50th STMinneapolis, MN 55410SHEET:
SCALE:
1/4"=1'0"Basement Floor Plan!!!!"## $# % %!!!!!!!!!!DATE:****(2) 2x10 HDR UNO*****Header spans up to 3'11"=1 trimmers, 4'0" and bigger =2 trimmers UNOPROJECT DESCRIPTION:SHEET TITLE:Sketch #4"The Beaumont"A-14/22/2020SmokeSmokeCOSmokeConcept Approval ONLYSubject to Field InspectionInspectorDate2015MN BldgCode04/29/2020dmathews
DWW02W02W02W02W02W02W03W03W03W05W05W05W03W03W03W03W03W03W05W05W0517'-1"20'-7 1/2"21'-5 1/2"23'23'-5 1/2"3'-6"9'-4"2'7'6'2'4'2'24'-5 1/2"7'-0 3/4"5'-6"4'13'2'6'70'11'2'-6"9'12'4'-2"5'-7 3/4"3'-2 3/4"6'-5 1/2"16'16'6'6'15'-6"4'-6"11'12'2'-2 3/8"2'-3 5/8"5'-6"5'-6"39'-6"13'-6"26'6'-9"6'-9"8'62'32'6'24'4'12'16'10'9'6'24'2'-6"4'4'4'11'-6"# &# ’(%%)* + &+++*+*++’*$,"++(2) 11 7/8" LVL& % - ./ 00 % - -# Portal frame this wall1 2 % 13 3+&## "#"4(2) 11 7/8" LVLGirder Truss1% -)24#" "-55##2% -(2) 11 7/8" LVL(/(/(2) 11 7/8" LVL3+ 6 7WINDOW SCHEDULENUMBER LABEL QTY FLOOR SIZE WIDTH HEIGHT R/O EGRESS DESCRIPTIONW01 2646SC 3 0 2646SC 30 " 54 " 32"X56" SNGL CASEMENT-HRW02 3016AW 2 1 3016AW 36 " 18 " 38"X20" AWNINGW03 61052MU 3 1 61052 82 " 62 " 84"X64" MULLED UNITW05 3050DH 2 1 3050DH 36 " 60 " 38"X62" DOUBLE HUNGW06 5246MU 1 0 5246 62 " 54 " 64"X56" MULLED UNITOrfield Drafting Services3507 W 50th STMinneapolis, MN 55410SHEET:
SCALE:
1/4"=1'0"Main Floor PlanDATE:PROJECT DESCRIPTION:SHEET TITLE:Sketch #4"The Beaumont"A-2****(2) 2x10 HDR UNO*****Header spans up to 3'11"=1 trimmers, 4'0" and bigger =2 trimmers UNO4/22/2020Braced wall panelneeded for max 20'between panels.CS-PF needed as minimumpanel widths next to openingfor CS-WSP is not provided,see last page for detail.FANFANSmokeCOSmokeSmokeSmokeSmokeCO
Orfield Drafting Services3507 W 50th STMinneapolis, MN 55410SHEET:
SCALE:
DATE:Elevations1/4"=1'0"PROJECT DESCRIPTION:SHEET TITLE:Sketch #4"The Beaumont"A-3Window maximum U factor: .32Window fall protection is requied where the lowest part of the opening islocated more than 72" above finished floor. Operable sections ofwindows shall not permit openings that allow passage of a 4" diametersphere where such openings are located withing 36" of the finished floor.6 in 129 in 12CS-WSP - Continuously sheathedwood structural panels, min. 3/8"thickness4/22/2020*siding percentages on next pageBraced wall panelneeded for max 20'between panels.Panel not wide enoughto meet minimumrequirement, move toother side of window.Move panels to maintain maximum of20' between panels.CS-PF needed for limitedpanel width. See detail on lastpage.
Orfield Drafting Services3507 W 50th STMinneapolis, MN 55410SHEET:
SCALE:Cross Section1/4"=1'0"
DATE:PROJECT DESCRIPTION:SHEET TITLE:Sketch #4"The Beaumont"A-44/22/2020Stone 172/426 40%LP Lap 57/426 13%LP Shake 197/426 46%Sides and Back LP1 (#+ 1 ) .8& $9%1 " .$### : 13 (;1) ’- ’ </9 + $# : 1+ (; 9## 7#$$ ( 2$# ,/= 9%% > # / / : $%$ % .$### ,) ?@ = 2( ,) ;/# 1) % <# . ;< 5$ %% 5#/ # 7# (1@A , "4 " ( 5 (#B3 7#$7 - / %# +02 @5 2$ ;/1) "-30!!!! "0TT FILTERING MATERIAL FABRICWRAPPED AROUND DRAIN GRAVELR15 Rigid Foam Polystyrene with a 6 Mil Poly SlipExterior drain tile1/2" Plywood Sheathing flush with rigid foamCOARSE GRAVEL SURROUND FILLCOMPACTED SOIL#4 Rebar Every 2' From Footing Into Wall4" GRAVEL BASEDrain Tile to Sump Basket and Pump6 Mil Vapor and Radon BarrierVAPOR BARRIER8" X 20"CONCRETEFOOTINGREINFORCING STEEL AS REQUIREDSILL SEALER4" CONCRETE SLAB#6 Rebar Vertically Placed 27" O.C.Treated 2x6 Sill Plate, Connectw/ 1/2" Dia. Sill Plate Boltswithin 12" from each corner and4'0" O.C. throughoutTREATED 2x6 SILL PLATE8" Poured ConcreteWallCS-PF
StartSpacingHere
6'-0"Cant24"O.C.Trussesareshortenedfor1/2"sheathing.
Seedetailforpiggybackcapinstallation.B3B1GB2B2B2A6G
A5
A5
A5
A5
A5
A4
A4
A3
A3
A3
A3
A3
A3
A3
A3
A2
A2
A2
A2
A1G FFFFBV1BV2DV1DV2DV3DV4CV1CV2CV3CV4CV5CV6CV7CV8CV9ACG
AC
AC
AC
AC
AC
AC
AC
AC
AC
AC
AC
AC
AC
AC
AC
AC
AC
AC
AC
ACG
THISISATRUSSPLACEMENTDIAGRAMONLY.Thesetrussesaredesignedasindividualbuildingcomponentstobeincorporatedintothebuildingdesignatthespecificationofthebuildingdesigner.Seeindividualdesignsheetsforeachtrussdesignidentifiedontheplacementdrawing.Thebuildingdesignerisresponsiblefortemporaryandpermanentbracingoftheroofandfloorsystemandfortheoverallstructure.Thedesignofthetrusssupportstructureincludingheaders,beams,walls,andcolumnsistheresponsibilityofthebuildingdesigner.Forgeneralguidanceregardingbracing,consult"Bracingofwoodtrusses"availablefromtheTrussPlateInstitute,583D'OnifrioDrive,Madison,WI53179ROOFTRUSSLAYOUT
Scalen.t.s CUSTOMER:LampertsAppleValleySummergateTheBeaumontSketch#418002GresfordLaneLakeville,MNWO#509233ROOFDESIGNER:LeonDeckerROOFLbrDurFac:1.15PltDurFac:1.15FlrSpacing:24.00"DesignCrit:TPI-02/IRC-06DesignDescr:IRC35.0010.0000.0010.0055.00T/CLive:T/CDead:B/CLive:B/CDead:Total(PSF)
MSH422
StartSpacingHere19.2"O.C.HandFrame
FlushBeamByOthers2'-4"Cant
Trussesareshortenedfor1/2"sheathing.
FL
CL A1
A1 F
A1 D
A1 D
A1 D
A D
A D
A D
AL DL
GL
BL KL
B1 K
B1 K
B1 K
B1 K
B1 K
B1 J2
B1 J2
B1 J2
B1 J2
B1 J2
B1 J2
B1 J2
B J1
B J1
B J1
B
HHHJ1 G
H1J G
JL
17171717
17
17
17
THISISATRUSSPLACEMENTDIAGRAMONLY.Thesetrussesaredesignedasindividualbuildingcomponentstobeincorporatedintothebuildingdesignatthespecificationofthebuildingdesigner.Seeindividualdesignsheetsforeachtrussdesignidentifiedontheplacementdrawing.Thebuildingdesignerisresponsiblefortemporaryandpermanentbracingoftheroofandfloorsystemandfortheoverallstructure.Thedesignofthetrusssupportstructureincludingheaders,beams,walls,andcolumnsistheresponsibilityofthebuildingdesigner.Forgeneralguidanceregardingbracing,consult"Bracingofwoodtrusses"availablefromtheTrussPlateInstitute,583D'OnifrioDrive,Madison,WI53179FLOORTRUSSLAYOUT
Scalen.t.s CUSTOMER:LampertsAppleValleySummergateTheBeaumontSketch#418002GresfordLaneLakeville,MNWO#509233FLRDESIGNER:LeonDeckerFLOORLbrDurFac:1.00PltDurFac:1.00FlrSpacing:.19.20"DesignCrit:TPI-02/IRC-06DesignDescr:IRC40.0010.0000.005.0055.00T/CLive:T/CDead:B/CLive:B/CDead:Total(PSF)
Scanned with CamScanner
Scanned with CamScanner
Scanned with CamScanner
Scanned with CamScanner
Lot 1 Block 7 Summer Creek
HVAC Load Calculations
for
The Beaumont
Prepared By:
Duane Moe
Leading Edge Heating & Air
807 Harvest Circle SW
Lonsdale, MN 55046
(763)333-5772
Thursday, March 12, 2020
Rhvac is an ACCA approved Manual J, D and S computer program.
Calculations are performed per ACCA Manual J 8th Edition, Version 2, and ACCA Manual D.
Rhvac - Residential & Light Commercial HVAC Loads Elite Software Development, Inc.
Ferguson [ Plymouth MN ]Lot 1 Block 7 Summer Creek
Plymouth, MN 55441 Page 2
Project Report
General Project Information
Project Title:Lot 1 Block 7 Summer Creek
Project Date:Wednesday March 11, 2020
Client Name:The Beaumont
Company Name:Leading Edge Heating & Air
Company Representative:Duane Moe
Company Address:807 Harvest Circle SW
Company City:Lonsdale, MN 55046
Company Phone:(763)333-5772
Design Data
Reference City:Minneapolis/St. Paul AP, Minnesota
Building Orientation:Front door faces North
Daily Temperature Range:Medium
Latitude:44 Degrees
Elevation:834 ft.
Altitude Factor:0.970
Outdoor Outdoor Outdoor Indoor Indoor Grains
Dry Bulb Wet Bulb Rel.Hum Rel.Hum Dry Bulb Difference
Winter:-20 -20 n/a 30%70 31.64
Summer:88 71 44%50%75 24
Check Figures
Total Building Supply CFM:839 CFM Per Square ft.:0.229
Square ft. of Room Area:3,669 Square ft. Per Ton:1,711
Volume (ft³):31,194
Building Loads
Total Heating Required Including Ventilation Air:57,456 Btuh 57.456 MBH
Total Sensible Gain:19,304 Btuh 83 %
Total Latent Gain:3,878 Btuh 17 %
Total Cooling Required Including Ventilation Air:23,183 Btuh 1.93 Tons (Based On Sensible + Latent)
2.14 Tons (Based On 75% Sensible
Capacity)
Notes
Rhvac is an ACCA approved Manual J, D and S computer program.
Calculations are performed per ACCA Manual J 8th Edition, Version 2, and ACCA Manual D.
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 according to the manufacturer's performance data at
your design conditions.
C:\Users\AAO1611\Documents\Elite Software\Rhvac 9 Projects\The Beaumont.rh9 Thursday, March 12, 2020, 9:08 AM
Rhvac - Residential & Light Commercial HVAC Loads Elite Software Development, Inc.
Ferguson [ Plymouth MN ]Lot 1 Block 7 Summer Creek
Plymouth, MN 55441 Page 3
System 1, Zone 1 Summary Loads (Average Load Procedure for Rooms)
Component
Description
Area
Quan
Sen
Loss
Lat
Gain
Sen
Gain
Total
Gain
1D-cw-o: Glazing-Double pane, operable window, clear,
wood frame, U-value 0.32, SHGC 0.56
272 7,833 0 10,615 10,615
11J: Door-Metal - Fiberglass Core, U-value 0.6 42 2,268 0 605 605
13AA-0oc: Wall-Block, no blanket or board insulation,
open core, U-value 0.584
148 7,780 0 1,332 1,332
12F-0sw: Wall-Frame, R-21 insulation in 2 x 6 stud
cavity, no board insulation, siding finish, wood studs,
U-value 0.065
1518 8,880 0 1,312 1,312
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, U-value 0.02
1840.8 3,313 0 1,767 1,767
21A-32: Floor-Basement, Concrete slab, any thickness, 2
or more feet below grade, no insulation below floor,
any floor cover, shortest side of floor slab is 32' wide,
U-value 0.02
1828.4 3,291 0 0 0
Subtotals for structure:33,365 0 15,631 15,631
People:4 800 920 1,720
Equipment:0 0 0
Lighting:0 0 0
Ductwork:0 0 0 0
Infiltration: Winter CFM: 157, Summer CFM: 98 15,123 1,527 1,366 2,893
System 1, Zone 1 Load Totals:48,488 2,327 17,917 20,244
Check Figures
Supply CFM:839 CFM Per Square ft.:0.229
Square ft. of Room Area:3,669 Square ft. Per Ton:2,022
Volume (ft³):31,194
Zone Loads
Total Heating Required:48,488 Btuh 48.488 MBH
Total Sensible Gain:17,917 Btuh 89 %
Total Latent Gain:2,327 Btuh 11 %
Total Cooling Required:20,244 Btuh 1.69 Tons (Based On Sensible + Latent)
1.81 Tons (Based On 75% Sensible
Capacity)
Notes
Rhvac is an ACCA approved Manual J, D and S computer program.
Calculations are performed per ACCA Manual J 8th Edition, Version 2, and ACCA Manual D.
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 according to the manufacturer's performance data at
your design conditions.
C:\Users\AAO1611\Documents\Elite Software\Rhvac 9 Projects\The Beaumont.rh9 Thursday, March 12, 2020, 9:08 AM
Passive (No Fan)
Active (With fan and monitoring
device )
Location (or future location) of Fan:
Other Please Describe Here
Not applicable, all ducts located in conditioned space
Not required per mech. code
Passive
Powered
Interlocked with exhaust device.
Describe:
Input in
BTUS:
Capacity in
Gallons:
Other, describe:
AFUE or
HSPF%
Cfm's
" round duct OR
" metal duct
Not required per mech. code
Passive
Low: Other, describe:
Low:
Location of fan(s), describe: Cfm's
" round duct OR
" metal duct
Per R401.3 Certificate. A building certificate shall be posted on or in the electrical distribution
panel.
New Construction Energy Code Compliance Certificate
Name of Residential Contractor MN License Number
City Mailing Address of the Dwelling or Dwelling Unit
Rigid, Extruded PolystyreneHeat Recover Ventilator (HRV) Capacity in cfms:
Energy Recover Ventilator (ERV) Capacity in cfms:
Combustion Air Select a Type
Location of duct or system:
Rim Joist (2nd Floor+)
Building envelope air tightness:
Below Entire Slab
Fuel Type
Solar Heat Gain Coefficient (SHGC):
Windows & Doors
Ceiling, vaulted
Bay Windows or cantilevered areas
Floors over unconditioned area
THERMAL ENVELOPE
Foam Open Cell Wall Rigid, Isocynurate Perimeter of Slab on Grade
RADON CONTROL SYSTEM
Total R-Value of all Types of InsulationType: Check All That Apply
Mineral FiberboardInsulation Location Foam, Closed Cell Describe other insulated areas
Ceiling, flat Non or Not ApplicableFiberglass, BlownFiberglass, Batts Foundation Wall
Output
in Tons:
Appliances Cooling System
Location of duct or system:
Heating or Cooling Ducts Outside Conditioned Spaces
Make-up Air Select a Type
Domestic Water
Heater
Model
Heating System
Rim Joist (1st Floor)
Average U-Factor (excludes skylights and one door ) U:
Duct system air tightness:
Rating or Size
Efficiency
Heating Gain Cooling Load
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):
Residential Load
Calculation
SEER
/EER
Capacity continuous ventilation rate in cfms:
Heating Loss
Manufacturer
Total ventilation (intermittent + continuous) rate in cfms:
Balanced Ventilation capacity in cfms:
High:
High:
MECHANICAL VENTILATION SYSTEM
Date Cert. Posted
R-value
MECHANICAL SYSTEMS
Builders Associaton of Minnesota version 101014
NEW RESIDENTIAL CONSTRUCTION SWPPP VERIFICATION
This form must be completed and submitted with all new residential permit applications.
A National Pollutant Discharge Elimination System (NPDES) Construction Stormwater Permit is
reqXired for ³ConstrXction actiYit\ that resXlts in land distXrbance of eqXal to or greater than one (1)
acre or if a project is part of a common plan of development that will ultimately disturb greater than
one (1) acre,´ (NPDES Permit, Section 1.2).
Project Site Address: _____________________________________________________________________
Company Name: _________________________________________________________________________
*Primary Company Contact: _________________________________________________________________
*Should a site be deemed noncompliant, this individual will be notified
Phone #: ____________________________ Email: ______________________________________________
If you are not covered under a NPDES Construction Stormwater Permit administered by the
Minnesota Pollution Control Agency (MPCA), an erosion and sediment control plan MUST be
approved as part of the residential building permit application.
³Permittees mXst ensXre a trained person Zill inspect the entire constrXction site at least once eYer\
seven (7) days during active construction and within 24 hours after a rainfall event greater than ½
inch in 24 hoXrs,´ (NPDES Permit, Section 11.2).
The City of Lakeville reserves the right to request weekly inspection logs. 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.
Contact information of person CERTIFIED to provide weekly onsite erosion and sediment control
inspections and corrective actions:
Name: ____________________________________ 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
I understand the above information to be accurate and I have read, understood, and accepted all terms and conditions of the NPDES Permit (MN R 100001).
Signature: ________________________________________________ Date:_________________________
Contact the City of Lakeville with questions at erosion@lakevillemn.gov or 952-985-4500
04/01/2020 X
KP