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Home My WebLink AboutLA187155 20254 Glenbrook Path 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 12/9/2020 DM 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 12/28/2020dmathews UFER Ground -Provide 20' Rebar in footing and stub up near electrical service panel. 3' WSP Temper BWPs Above BWPs Above BWPs Above 3' CS-WSP 3.50' CS-WSP PFHPFH 4' WSP 4' WSP 4' WSP 4' WSP 4' WSP 4' WSP 4' WSP 4' WSP CS-PF CS-PF 4' WSP 4' WSP 4' WSP 4' WSP 4' WSP Verify loads with girder truss specs, may require removal of top plates at bearing due to crushing. 3' WSP8' LIB3' WSP 8' LIB 8' LIB 2.25' WSP2.25' WSP 2.25' WSP 2.25' WSP 8' LIB 8' LIB -Min. 15" clearance to any obstruction from center of W.C., 24" in front(typ). 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: 66,000 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 Balanced Ventilation capacity in cfms: Capacity continuous ventilation rate in cfms: Total ventilation (intermittent + continuous) rate in cfms: 82 High: Energy Recover Ventilator (ERV) Capacity in cfms: High: Location of duct or system: Below Entire Slab Foundation Wall Perimeter of Slab on Grade Rim Joist (1st Floor) Rim Joist (2nd Floor+) Wall Ceiling, flat R-5 where required R10 Rigid Exterior, R10 Int closed cell R10 Rigid Exterior, R10 Int closed cell R5 Exterior, R19 Batts New Construction Energy Code Compliance Certificate Per R401.3 Certificate. A building certificate shall be posted on or in the electrical distribution panel. Mailing Address of the Dwelling or Dwelling Unit City Lakeville20254 Glenbrook Path Name of Residential Contractor MECHANICAL VENTILATION SYSTEM 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): Combustion Air Select a Type Select Type Heat Recover Ventilator (HRV) Capacity in cfms: 192 MN License Number Brandl Anderson Homes BC604388 THERMAL ENVELOPE RADON CONTROL SYSTEM Type: Check All That Apply Insulation Location Total R-Value of all Types of InsulationNon or Not ApplicableFiberglass, BlownFiberglass, BattsFoam, Closed CellFoam Open CellMineral FiberboardRigid, Extruded PolystyreneRigid, IsocynurateAttic Residential Load Calculation Heating Loss Heating Gain Cooling Load 52458 17430 23,000 13 Location of duct or system: Rating or Size 50 Output in Tons:2.5 Efficiency SEER /EER Natural Gas Natural Gas Electric 13ACXN030 Fuel Type Manufacturer Lennox Lennox Model ML193UH070XE Average U-Factor (excludes skylights and one door ) U: 0.30 Solar Heat Gain Coefficient (SHGC): 0.30 R-value R-8 MECHANICAL SYSTEMS Make-up Air Select a Type Appliances Heating System Domestic Water Heater Cooling System Duct system air tightness: Heating or Cooling Ducts Outside Conditioned Spaces Ceiling, vaulted Bay Windows or cantilevered areas Floors over unconditioned area Describe other insulated areas Building envelope air tightness: Windows & Doors 000000Builders Associaton of Minnesota version 101014 40,000 X X 40,000 40,000 3000 3000 3000 40,000 40,000 13.33 13.33 2565 2565 .85 .85 .15 .15 1.99 1.59 43 NR 135 4318 320 455 647 647 180 90 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 20254 Glenbrook Path 12/9/20 12/21/2020 X KP