HomeMy WebLinkAboutLA199209 - 16422 Jaffna Pl App & FormsRESIDENTIAL 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
Passive (No Fan)
Active (With fan and monitoring
device )
Location (or future location) of Fan:
Other Please Describe Here
Not applicable, all ducts located in conditioned space
Not required per mech. code
Passive
Powered
Interlocked with exhaust device. Describe:
Input in
BTUS:
Capacity in
Gallons:Other, describe:
AFUE or
HSPF%
Cfm's
" round duct OR
" metal duct
Not required per mech. code
Passive
Low: Other, describe:
Low:
Location of fan(s), describe: Cfm's
" round duct OR
" metal duct
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 MN License Number
City Mailing Address of the Dwelling or Dwelling Unit
Rigid, Extruded PolystyreneHeat Recover Ventilator (HRV) Capacity in cfms:
Energy Recover Ventilator (ERV) Capacity in cfms:
Combustion Air Select a Type
Location of duct or system:
Rim Joist (2nd Floor+)
Building envelope air tightness:
Below Entire Slab
Fuel Type
Solar Heat Gain Coefficient (SHGC):
Windows & Doors
Ceiling, vaulted
Bay Windows or cantilevered areas
Floors over unconditioned area
THERMAL ENVELOPE
Foam Open Cell Wall Rigid, Isocynurate Perimeter of Slab on Grade
RADON CONTROL SYSTEM
Total R-Value of all Types of InsulationType: Check All That Apply
Mineral FiberboardInsulation Location Foam, Closed Cell Describe other insulated areas
Ceiling, flat Non or Not ApplicableFiberglass, BlownFiberglass, Batts Foundation Wall
Output
in Tons:
Appliances Cooling System
Location of duct or system:
Heating or Cooling Ducts Outside Conditioned Spaces
Make-up Air Select a Type
Domestic Water
Heater
Model
Heating System
Rim Joist (1st Floor)
Average U-Factor (excludes skylights and one door ) U:
Duct system air tightness:
Rating or Size
Efficiency
Heating Gain Cooling Load
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):
Residential Load
Calculation
SEER
/EER
Capacity continuous ventilation rate in cfms:
Heating Loss
Manufacturer
Total ventilation (intermittent + continuous) rate in cfms:
Balanced Ventilation capacity in cfms:
High:
High:
MECHANICAL VENTILATION SYSTEM
Date Cert. Posted
R-value
MECHANICAL SYSTEMS
Builders Associaton of Minnesota version 101014
Bold/italic values have been manually overridden
Calculations approved by ACCA to meet all requirements of Manual J 8th Ed.
2021-Dec-10 06:39:37
Right-Suite® Universal 2021 21.0.08 RSU29636 Page 1
...5 JAFFNA PLACE - 2625 INT (FAIRFAX) - SOUTH.rup Calc = MJ8 Front Door faces: S
2625 INT (FAIRFAX)Job:Load Short Form 12/9/2021Date:Entire House Energy Diagnostics, Inc.By:
Energy Diagnostics, Inc.
405 E Archer Way, Valparaiso, IN 46383 Phone: 219-464-4457 Fax: 219-464-0035
Project Information
DR Horton MNFor:
16445 Jaffna Place, Lakeville, MN 55044
Design Information
InfiltrationClgHtg
Blower doorMethod88-15Outside db (°F)
4 (substantial) / 2Shielding / stories7570Inside db (°F)
50 Pa / 813 cfmPressure / AVF1385Design TD (°F)
M-Daily range
5050Inside humidity (%)
3555Moisture difference (gr/lb)
HEATING EQUIPMENT COOLING EQUIPMENT
Make Bryant Make Bryant
Trade Bryant Legacy Line 92 Gas Furn...Trade BRYANT HEATING AND COOLING SYS...
Model 912SD36040E17 Cond BA13NA024BNG0G
AHRI ref 0 Coil CNPVU3017ALA++TDR
AHRI ref 201810140
Efficiency 92.1 AFUE Efficiency 10.5 EER, 13 SEER
Heating input Btuh40000 Sensible cooling Btuh15820
Heating output Btuh37000 Latent cooling Btuh6780
Temperature rise °F47 Total cooling Btuh22600
Actual air flow cfm745 Actual air flow cfm745
Air flow factor cfm/Btuh0.031 Air flow factor cfm/Btuh0.064
Static pressure in H2O0 Static pressure in H2O0
Space thermostat Load sensible heat ratio 0.77
ROOM NAME Area Htg load Clg load Htg AVF Clg AVF
(ft²)(Btuh)(Btuh)(cfm)(cfm)
1/2 BATH 32 71 0 2 0
OWNERS SUITE 202 2274 1106 69 71
LAUNDRY 53 90 515 3 33
BATH 2 86 693 137 21 9
BED 2 150 2356 1182 72 76
OWNERS BATH 132 2735 463 83 30
OWNERS WIC 48 82 45 2 3
BED 3 139 2969 1238 91 79
KITCHEN/MUD RM 214 3084 3412 94 219
GREAT ROOM/FOYER 540 9295 2529 284 162
MECH 55 94 52 3 3
OFFICE 60 102 721 3 46
UPPER HALL 224 571 226 17 15
Bold/italic values have been manually overridden
Calculations approved by ACCA to meet all requirements of Manual J 8th Ed.
2021-Dec-10 06:39:37
Right-Suite® Universal 2021 21.0.08 RSU29636 Page 2
...5 JAFFNA PLACE - 2625 INT (FAIRFAX) - SOUTH.rup Calc = MJ8 Front Door faces: S
Entire House 1935 24418 11624 745 745
Other equip loads 7519 246
Equip. @ 0.93 RSM 11040
Latent cooling 3483
TOTALS 1935 31937 14523 745 745
Bold/italic values have been manually overridden
Calculations approved by ACCA to meet all requirements of Manual J 8th Ed.
2021-Dec-10 06:39:37Right-Suite® Universal 2021 21.0.08 RSU29636 Page 1...5 JAFFNA PLACE - 2625 INT (FAIRFAX) - SOUTH.rup Calc = MJ8 Front Door faces: S
2625 INT (FAIRFAX)Job:Project Summary 12/9/2021Date:Entire House Energy Diagnostics, Inc.By:
Energy Diagnostics, Inc.
405 E Archer Way, Valparaiso, IN 46383 Phone: 219-464-4457 Fax: 219-464-0035
Project Information
DR Horton MNFor:16445 Jaffna Place, Lakeville, MN 55044
Notes:
Design Information
Minneapolis, Crystal AP, MN, USWeather:
Winter Design Conditions Summer Design Conditions
Outside db °F-15 Outside db °F88Inside db °F70 Inside db °F75Design TD °F85 Design TD °F13Daily range MRelative humidity %50Moisture difference gr/lb35
Heating Summary Sensible Cooling Equipment Load Sizing
Structure Btuh24418 Structure Btuh11624DuctsBtuh0DuctsBtuh0Central vent (SER=64% 49 cfm)Btuh1610 Central vent (SER=64% 49 cfm) 246 BtuhHeat recovery Heat recoveryHumidificationBtuh5909Blower Btuh0PipingBtuh0Equipment load Btuh31937 Use manufacturer's data nRate/swing multiplier 0.93InfiltrationEquipment sensible load Btuh11040
Method Latent Cooling Equipment Load SizingBlower doorShielding / stories 4 (substantial) / 250 Pa / 813 cfmPressure / AVF Structure Btuh2330DuctsBtuh0Central vent (49 cfm)Btuh1154CoolingHeatingHeat recovery19351935Area (ft²)Equipment latent load Btuh34831626916269Volume (ft³)Air changes/hour 0.130.31 Equipment Total Load (Sen+Lat)Btuh14523Equiv. AVF (cfm)3685 Req. total capacity at 0.70 SHR ton1.3
Heating Equipment Summary Cooling Equipment Summary
Make Bryant Make BryantTrade Bryant Legacy Line 92 Gas Furn...Trade BRYANT HEATING AND COOLING SYS...Model 912SD36040E17 Cond BA13NA024BNG0GAHRI ref 0 Coil CNPVU3017ALA++TDRAHRI ref 201810140Efficiency92.1 AFUE Efficiency 10.5 EER, 13 SEERHeating input Btuh40000 Sensible cooling Btuh15820Heating output Btuh37000 Latent cooling Btuh6780Temperature rise °F47 Total cooling Btuh22600Actual air flow cfm745 Actual air flow cfm745Air flow factor cfm/Btuh0.031 Air flow factor cfm/Btuh0.064Static pressure in H2O0 Static pressure in H2O0Space thermostat Load sensible heat ratio 0.77