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Home My WebLink AboutLA180386 - 8027 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 CANNOT HOOK TO CITY SEWER/WATER 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 Concept Approval ONLYSubject to Field InspectionInspectorDate2015MN BldgCode06/01/2020dmathews Secure door closed until deck isconstructed with a separate permit. (3)2x10 min for spanInterior BWP AboveUFER Ground-Provide 20' Rebar in footing and stubup near electrical service panel. CS-PFCS-PFPFH-Min. 15" clearance to anyobstruction from center ofW.C., 24" in front(typ). Stone Cottage HVAC Load Calculations for Archambault 8027 200th St W Lakeville,mn Prepared By: Randy Andrews Lofgren Heating 5708 Upper 147th Street West Apple Vallley, MN 55124 Monday, May 04, 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, May 04, 2020 Client Name:Archambault Client Address:8027 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 South 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:942 CFM Per Square ft.:0.291 Square ft. of Room Area:3,234 Square ft. Per Ton:1,417 Volume (ft³) of Cond. Space:29,106 Building Loads Total Heating Required Including Ventilation Air:46,560 Btuh 46.560 MBH Total Sensible Gain:20,543 Btuh 80 % Total Latent Gain:5,045 Btuh 20 % Total Cooling Required Including Ventilation Air:25,588 Btuh 2.13 Tons (Based On Sensible + Latent) 2.28 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:\ ...\8027 200TH ST LAKEVILLE RAMBLER 05042020.rhv Monday, May 04, 2020, 12:33 PM 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 2.13 1,517 3,234 20,543 5,045 25,588 46,560 848 942 942 System 1 Yes 2.13 1,517 3,234 20,543 5,045 25,588 46,560 848 942 942 18x10 Ventilation 437 1,352 1,789 5,850 Zone 1 3,234 20,106 3,693 23,799 40,710 848 942 942 18x10 1-Upper Level 1,617 18,086 2,609 20,695 27,821 579 847 847 10--6 2-Lower Level 1,617 2,020 1,084 3,104 12,889 268 95 95 1--6 C:\ ...\8027 200TH ST LAKEVILLE RAMBLER 05042020.rhv Monday, May 04, 2020, 12:33 PM 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 0.33 409 11,387 0 8,570 8,570 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 1682 9,511 0 1,453 1,453 15B0-10sf-10: Wall-Basement, , R-10 board insulation to floor, no interior finish, 10' floor depth 1143 4,872 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 1617 2,814 0 1,552 1,552 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 1617 3,517 0 0 0 Subtotals for structure:33,379 0 11,927 11,927 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: 79, Summer CFM: 41 7,331 793 569 1,362 Ventilation: Winter CFM: 140, Summer CFM: 70 5,850 1,352 437 1,789 Total Building Load Totals:46,560 5,045 20,543 25,588 Check Figures Total Building Supply CFM:942 CFM Per Square ft.:0.291 Square ft. of Room Area:3,234 Square ft. Per Ton:1,417 Volume (ft³) of Cond. Space:29,106 Building Loads Total Heating Required Including Ventilation Air:46,560 Btuh 46.560 MBH Total Sensible Gain:20,543 Btuh 80 % Total Latent Gain:5,045 Btuh 20 % Total Cooling Required Including Ventilation Air:25,588 Btuh 2.13 Tons (Based On Sensible + Latent) 2.28 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:\ ...\8027 200TH ST LAKEVILLE RAMBLER 05042020.rhv Monday, May 04, 2020, 12:33 PM 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 46,560 Btuh Floor 8% Roof 6% Wall 31% Glass 24% Door 3% Infiltration 16% Ventilation 13% Building Gain 25,588 Btuh Roof 6% Wall 6% Glass 33% Door 1%People 12% Equipment 29% Infiltration 5% Ventilation 7% C:\ ...\8027 200TH ST LAKEVILLE RAMBLER 05042020.rhv Monday, May 04, 2020, 12:33 PM 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 0.33 409 11,387 0 8,570 8,570 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 1682 9,511 0 1,453 1,453 15B0-10sf-10: Wall-Basement, , R-10 board insulation to floor, no interior finish, 10' floor depth 1143 4,872 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 1617 2,814 0 1,552 1,552 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 1617 3,517 0 0 0 Subtotals for structure:33,379 0 11,927 11,927 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: 79, Summer CFM: 41 7,331 793 569 1,362 Ventilation: Winter CFM: 140, Summer CFM: 70 5,850 1,352 437 1,789 System 1 Whole House Load Totals:46,560 5,045 20,543 25,588 Check Figures Supply CFM:942 CFM Per Square ft.:0.291 Square ft. of Room Area:3,234 Square ft. Per Ton:1,417 Volume (ft³) of Cond. Space:29,106 System Loads Total Heating Required Including Ventilation Air:46,560 Btuh 46.560 MBH Total Sensible Gain:20,543 Btuh 80 % Total Latent Gain:5,045 Btuh 20 % Total Cooling Required Including Ventilation Air:25,588 Btuh 2.13 Tons (Based On Sensible + Latent) 2.28 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:\ ...\8027 200TH ST LAKEVILLE RAMBLER 05042020.rhv Monday, May 04, 2020, 12:33 PM 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:1,617.0 ft.System Number:1 Room Width:1.0 ft.Zone Number:1 Area:1,617.0 sq.ft.Supply Air:847 CFM Ceiling Height:9.0 ft.Supply Air Changes:3.5 AC/hr Volume:14,553.0 cu.ft.Req. Vent. Clg:0 CFM Number of Registers:10 Actual Winter Vent.:96 CFM Runout Air:85 CFM Percent of Supply.:11 % Runout Duct Size:6 in.Actual Summer Vent.:63 CFM Runout Air Velocity:432 ft./min.Percent of Supply:7 % Runout Air Velocity:432 ft./min.Actual Winter Infil.:61 CFM Actual Loss:0.117 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 N -Wall-12F-0sw 55 X 9 289 0.065 5.7 1,634 0.9 0 250 S -Wall-12F-0sw 55 X 9 410 0.065 5.7 2,319 0.9 0 354 E -Wall-12F-0sw 36 X 9 240 0.065 5.7 1,357 0.9 0 207 W -Wall-12F-0sw 36 X 9 248 0.065 5.7 1,402 0.9 0 214 S -Door-11N 3 X 7 21 0.350 30.5 639 8.4 0 176 S -Door-11N 3 X 7 21 0.350 30.5 639 8.4 0 176 N -Gls-4A-1a-o shgc-0.33 100%S 206 0.320 27.8 5,735 10.4 0 2,145 S -Gls-4A-1a-o shgc-0.33 0%S 43 0.320 27.8 1,197 19.2 0 825 E -Gls-4A-1a-o shgc-0.33 0%S 84 0.320 27.8 2,339 35.0 0 2,940 W -Gls-4A-1a-o shgc-0.33 0%S 76 0.320 27.8 2,116 35.0 0 2,660 UP-Ceil-16B-50 1617 X 1 1617 0.020 1.7 2,814 1.0 0 1,552 Subtotals for Structure:22,191 0 11,499 Infil.: Win.: 60.6, Sum.: 31.5 1,638 3.437 5,630 0.267 609 437 People: 200 lat/per, 230 sen/per:5 1,000 1,150 Equipment:1,000 5,000 Room Totals:27,821 2,609 18,086 C:\ ...\8027 200TH ST LAKEVILLE RAMBLER 05042020.rhv Monday, May 04, 2020, 12:33 PM 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:1,617.0 ft.System Number:1 Room Width:1.0 ft.Zone Number:1 Area:1,617.0 sq.ft.Supply Air:95 CFM Ceiling Height:9.0 ft.Supply Air Changes:0.4 AC/hr Volume:14,553.0 cu.ft.Req. Vent. Clg:0 CFM Number of Registers:1 Actual Winter Vent.:44 CFM Runout Air:95 CFM Percent of Supply.:47 % Runout Duct Size:6 in.Actual Summer Vent.:7 CFM Runout Air Velocity:482 ft./min.Percent of Supply:7 % Runout Air Velocity:482 ft./min.Actual Winter Infil.:18 CFM Actual Loss:0.145 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 N -Wall-12F-0sw 55 X 9 495 0.065 5.7 2,799 0.9 0 428 S -Wall-15B0-10sf-10 55 X 9 495 0.049 4.3 2,110 0.0 0 0 E -Wall-15B0-10sf-10 36 X 9 324 0.049 4.3 1,381 0.0 0 0 W -Wall-15B0-10sf-10 36 X 9 324 0.049 4.3 1,381 0.0 0 0 Floor-21A-24 1 X 1617 1617 0.025 2.2 3,517 0.0 0 0 Subtotals for Structure:11,188 0 428 Infil.: Win.: 18.3, Sum.: 9.5 495 3.436 1,701 0.267 184 132 People: 200 lat/per, 230 sen/per:2 400 460 Equipment:500 1,000 Room Totals:12,889 1,084 2,020 C:\ ...\8027 200TH ST LAKEVILLE RAMBLER 05042020.rhv Monday, May 04, 2020, 12:33 PM 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 1,617 27,821 579 10-6 432 18,086 2,609 847 847 2 Lower Level 1,617 12,889 268 1-6 482 2,020 1,084 95 95 Ventilation 5,850 437 1,352 System 1 total 3,234 46,560 848 20,543 5,045 942 942 System 1 Main Trunk Size:18x10 in. Velocity:754 ft./min Loss per 100 ft.:0.090 in.wg Cooling System Summary Cooling Tons Sensible/Latent Split Sensible Btuh Latent Btuh Total Btuh Net Required:2.13 80% / 20%20,543 5,045 25,588 Recommended:2.28 75% / 25%20,543 6,848 27,391 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:\ ...\8027 200TH ST LAKEVILLE RAMBLER 05042020.rhv Monday, May 04, 2020, 12:33 PM Builders Associaton of Minnesota version 101014 Date Certificate Posted x Passive (No Fan) Active (With fan and monometer or other system monitoring 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 City Mailing Address of the Dwelling or Dwelling Unit Combustion Air Select a Type Location of duct or system: 25,588 Below Entire Slab Rigid, Extruded Polystyrene Ceiling, flat 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 Lakeville8027 200th St W BC636874 Mech Room Heat Recover Ventilator (HRV) Capacity in cfms: Energy Recover Ventilator (ERV) Capacity in cfms: 46,560 Heating Gain Cooling Load Attic 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 THERMAL ENVELOPE Foam Open Cell Wall Rigid, Isocynurate Perimeter of Slab on Grade RADON CONTROL SYSTEM Non or Not Applicable 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, BlownFiberglass, Batts Foundation Wall R-value Average U-Factor (excludes skylights and one door ) U: Duct system air tightness: Building envelope air tightness: Rim Joist (1st Floor) GPVL-50 13ACXN042-230 Model Heating System Natrual Gas Lennox 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 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): 20,543Residential Load Calculation SEER /EER Total ventilation (intermittent + continuous) rate in cfms: Balanced Ventilation capacity in cfms: High: High: MECHANICAL VENTILATION SYSTEM Capacity continuous ventilation rate in cfms: ML193UH070 Heating Loss Manufacturer Lennox Natural Gas Output in Tons: 3 Ton50 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 X05/26/2020 KP