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LA190041 19230 Impala Ave Permit Pack
RESIDENTIAL 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 $TOTAL FIRE SUPPRESSION SYSTEM OCCUPANCY GROUP APPROVED BY: BUILDING INSPECTOR: Date: PLUMBING/MECHANICAL INSPECTOR: Date: COMMENTS: 20195 Holyoke Avenue, Lakeville, MN 55044 952-985-4400 952-985-4499 fax www.lakevillemn.gov Sewer & Water Tie Card Address:________________________________________ Contractor:______________________________________ Permit Number:__________________________________ Final Date:________________ Street Drain-Tile:______ Size of Water Service: 1” Comments: AIRTEST SANITARY OVER 20’/2 FITTINGS THIS CARD MUST BE COMPLETED AND ON-SITE AT TIME OF SEWER & WATER INSPECTION FACE APPLIED STONE VENEERHARDBOARD SIDING ON FRONT ELEVATION.LP HORIZONTAL LAP SIDINGFACE APPLIED STONE VENEERVINYL SIDING ON SIDE & REAR ELEVATIONS.19230 Impala Avenue Summerlyn-8th AdditionHORIZONTAL LAP SIDINGConcept Approval ONLYSubject to Field InspectionInspectorDate2020MN BldgCode04/21/2021dmathews 3UFER Ground-Provide 20' Rebar in footing and stubup near electrical service panel. xxxxxxxxxxxxxxxxxxxxx6233-Min. 15" clearance to anyobstruction from center ofW.C., 24" in front(typ).BWP AboveBWPsAbove6655555366Shear Panelw/holdownsShear Panelw/holdowns 76+G 67$,56'()/(&7,21 /$77$&+522)75866727233/$7(:,7+ $&/,3# 2&,1$'',7,2172$1<&211(&7,2165(4 '%<758660$18)$&785(57<3,&$/)5$0,1* [63)678' #2& &211(&7: G1$,/6#723%277203/$7( 723$1'%277203/$7(672%(63)720$7&+:$//:,'7+ [63) &211(&7: G1$,/6#723%277203/$7(6$[(7,0%(5675$1'/6/+($'(5: 75,00(563(56,'(&211(&7: G1$,/3(56,'(5(48,5(6;0$7(5,$/%27720$$76+G%[63) 3/$1. 6,//: 75,00(53(56,'(&211(&7: G1$,/3(56,'(%67$,563ORW,' /HQJWK 3URGXFW 3OLHV 1HW4W\76+G [(7LPEHU6WUDQG/6/ ;63)1R ;63)1R ;63)1R ;63)1R ;63)1R ;63)1R 5RRI&RQQHFWLRQ6LPSVRQ6WURQJ7LH$&OLSV4W\(.9DQGHUELOW $%&'7+,1.6$)(7<5($',167$//$7,21,1)250$7,21%()25(352&((',1*$//',0(16,2166+2:1$5($3352;,0$7(,7,67+(5(63216,%,/,7<2)7+('($/(5%8,/'(5729(5,)<$//',0(16,216$77$&+%277203/$7(725,0)/225)5$0,1*$1'25%/2&.,1*: 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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 " round duct OR " metal duct Balanced Ventilation capacity in cfms:Mech Room Capacity continuous ventilation rate in cfms: Total ventilation (intermittent + continuous) rate in cfms: 80 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 Interior R5 + R10 Exterior Interior Interior New Construction Energy Code Compliance Certificate Per R401.3 Certificate. A building certificate shall be posted on or in the electrical distribution panel.4/12/2021 Mailing Address of the Dwelling or Dwelling Unit City Lakeville19230 Impala Avenue 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:160 MN License Number Lennar 1413 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 Cooliing 55,810 21,094 25,829 13 Location of duct or system: Rating or Size 50 Output in Tons:2.5 Efficiency SEER /EER Nat Gas Nat Gas Elect GPVL-50 13ACXN30-230 Fuel Type Manufacturer Lennox AOSmith Lennox Model ML193UH070XE36B Average U-Factor (excludes skylights and one door) U: 0.31 Solar Heat Gain Coefficient (SHGC):0.29 R-value 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 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) ruction site at least once every seven (7) days during active con (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 04/21/21 X KP