HomeMy WebLinkAboutLA187124 17900 Eclipse Ave 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
12/7/2020
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
12/23/2020dmathews
UFER Ground
-Provide 20' Rebar in footing and stub
up near electrical service panel.
8' LIB 8' LIB 8' LIB
PFH PFH
Verify loads with girder
truss specs, may require
removal of top plates at
bearing due to crushing.
BWPs
Above
BWPs
Above
5.17' LIB 5.17' LIB 5.17' LIB
5.17' LIB
5.17' LIB
5.17' LIB
4' WSP4' WSP
8' LIB8' LIB
8' LIB
5.17' LIB -Min. 15" clearance to any
obstruction from center of
W.C., 24" in front(typ).
5.17' LIB
Joist hangerVersa-Lam or Boise GLULAM beam:Face MountBeam width shall exceedspecified hanger nail length®™ F27-CBoise I-Joist can be offset up to 3" to avoid vertical plumbing.Joist3" maxCLJoist3" maxCLOJ-Acut, notch or drill flangesDO NOTDN01
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
Balanced Ventilation capacity in cfms:
Capacity continuous ventilation rate in cfms:
Total ventilation (intermittent + continuous) rate in cfms:
66 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
Lakeville17900 Eclipse Ave
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: 174
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
38109 15268 19,438
13 Location of duct or system:
Rating or Size 50 Output
in Tons:2
Efficiency
SEER
/EER
Natural Gas Natural Gas Electric
13ACXN024
Fuel Type
Manufacturer Lennox Lennox
Model ML193UH045
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
704
704 .23
.23 .77
.77 10.3
3.6
NR
2938
441
441
135
240
375
135
68
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
17900 Eclipse Avenue
12/7/20
12/17/2020 X
KP