HomeMy WebLinkAboutLA184441 - 5274 175th 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
5274 175th St W
Lakeville MN 55044
New Single Family Dwelling Amber
None
$239,000.00 9/30/20 1/30/20
2 4 North Creek
n
n
awheeler@brandlanderson.com
Brandl Anderson Homes
952-898-0230 N/A
Brandl Anderson Homes
604388
952-898-0230 N/A
221 River Ridge Circle S Burnsville MN 55337
Air Mechanical PC645558
763-434-7747
6411 Aberdeen St NE Ham Lake MN 55304
Elander Mechanical
952-445-4692
645 Shenandoah Dr Shakopee MN 55379
MB003546
Installed Building Solutions
651-463-9333 612-325-1778
PB688723
Amanda Wheeler 9/9/20
8
8
8
Amanda Wheeler
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
Secure door closed until deck is
constructed with a separate permit.
Concept Approval
ONLY
Subject to Field Inspection
Inspector Date
2020
MN Bldg
Code
09/24/2020dmathews
Interior BWP Above
4' WSP
4' WSP
4' WSP
4' WSP
4' WSP
4' WSP 4' WSP
4' WSP 4' WSP
4' WSP
4' WSP
4' WSP
4' WSP
4' WSP4' WSP4' WSP
4' WSP
UFER Ground
BWP Above
HEADER (2) 9 1/2" LVL
Verify loads with girder
truss specs, may require
removal of top plates at
bearing due to crushing.
5.17' LIB
5.17' LIB
5.17' LIB
5.17' LIB
5.17' LIB
5.17' LIB
5.17' LIB
5.17' LIB
5.17' LIB
5.17' LIB
4' WSP 4' WSP
5.17' LIB 5.17' LIB
5.17' LIB
4' WSP4' WSP
4' WSP
PFH PFH
-Min. 15" clearance to any
obstruction from center of
W.C., 24" in front(typ).
Smoke
CO
Date Certificate Post
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
R-15 x
x
R-20 x x
R-20 x x
19+5 x x
R-49 x
R-49 x
R-38 x
R-38+5 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:
44,000 Capacity in
Gallons:
Other, describe:
AFUE or
HSPF%
93%
Cfm's
" round duct OR
" metal duct
Not required per mech. code
X Passive
x Low: Other, describe:
Low:
Location of fan(s), describe: Cfm's
6 " Flex
" metal duct
City Mailing Address of the Dwelling or Dwelling Unit
Combustion Air Select a Type
Location of duct or system:
21,892
R10 Rigid Exterior, R10 Int closed cell
R10 Rigid Exterior, R10 Int closed cell
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.
New Construction Energy Code Compliance Certificate
Name of Residential Contractor
Brandl Anderson Homes
MN License Number
Lakeville5274 175th Street W
BC604388
82Heat Recover Ventilator (HRV) Capacity in cfms:
Energy Recover Ventilator (ERV) Capacity in cfms:
36933
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+)
0.32
Appliances
THERMAL ENVELOPE
R5 Exterior, R19 BattsFoam Open Cell Wall Rigid, Isocynurate Perimeter of Slab on Grade
RADON CONTROL SYSTEM
R-5 where required Non or Not Applicable Cooling SystemTotal R-Value of all Types of InsulationType: Check All That Apply
Mineral Fiberboard Insulation Location
Foam, Closed Cell0.34
Describe other insulated areas Fiberglass, BlownFiberglass, Batts Foundation Wall
R-value R-8
Average U-Factor (excludes skylights and one door) U:
Duct system air tightness: Building envelope air tightness:
Rim Joist (1st Floor)
13ACXN024 Model
Heating System
Natural Gas
Lennox
Location of duct or system:
Heating or Cooling Ducts Outside Conditioned Spaces
Electric
Make-up Air Select a Type
Domestic Water
Heater
MECHANICAL SYSTEMS
Rating or Size
Efficiency
13
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):
17298Residential Load Calculation
SEER
/EER
192
Total ventilation (intermittent + continuous) rate in cfms:
Balanced Ventilation capacity in cfms:
High:
High:
MECHANICAL VENTILATION SYSTEM
Capacity continuous ventilation rate in cfms:
ML193UH045XE
Heating Loss
Manufacturer Lennox
Natural Gas
Output
in Tons:250
Builders Associaton of Minnesota version 101014
40,000
X
X
40,000
40,000
3000
3000
3000
40,000
40,000 13.33
13.33
2640
2640 .88
.88 .12
.12 1.6
1.4
240
375
375
NR
3352
503
503
160
80
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
required for “Construction activity that results in land disturbance of equal 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.
“Permittees must ensure a trained person will 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 ½
inch in 24 hours,” (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
Brandl Anderson Homes
Mike Swanson
612-363-0002 awheeler@brandlanderson.com
Ryan Lake Lake's Erosion Services, Inc.
612-616-7937 erosion101.RL@gmail.com
University of Minnesota 2021
5274 175th St W
9/9/20 Amanda Wheeler
DJM
9/10/20 X