HomeMy WebLinkAboutLA200206 - 17847 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
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
$TOTAL FIRE SUPPRESSION SYSTEM
OCCUPANCY GROUP
APPROVED BY:
BUILDING INSPECTOR: Date:
PLUMBING/MECHANICAL
INSPECTOR: Date:
COMMENTS:
!"#$#%%&’(#&Concept Approval ONLYSubject to Field InspectionInspectorDate2020MN BldgCode03/15/2022dmathews
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Date Certificate Posted
x Passive (No Fan)Active (With fan and monometer
or other system monitoring
device)
Location (or future location) of Fan:
Other Please Describe Here
R-5 and R-10 x x
20 x
20 x
21 x
50 x
50 x
30 x
30 x
Not applicable, all ducts located in conditioned space
8
Not required per mech. code
x Passive
Powered
Interlocked with exhaust device.
Describe:
Input in
BTUS:
60,000 Capacity in
Gallons:
Other, describe:
AFUE or
HSPF%
95%
Cfm's
" round duct OR
" metal duct
x Not required per mech. code
Passive
Low: Other, describe:
x Low:
Location of fan(s), describe: Cfm's
" round duct OR
" metal duct
City Mailing Address of the Dwelling or Dwelling Unit
Combustion Air Select a Type
Location of duct or system:
31,457
Installed on the inside
Installed on the inside
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.Place your
logo here
New Construction Energy Code Compliance Certificate
Name of Residential Contractor
Pietsch Builders Inc.
MN License Number
Lakeville, Mn. 17847 Eclipse Ave.
2358
Heat Recover Ventilator (HRV) Capacity in cfms:
Energy Recover Ventilator (ERV) Capacity in cfms:
62,971
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+)
0.30
Appliances
THERMAL ENVELOPE
Foam Open Cell Wall Rigid, Isocynurate Perimeter of Slab on Grade
RADON CONTROL SYSTEM
Install on inside and outside of wallNon or Not Applicable Cooling SystemTotal R-Value of all Types of InsulationType: Check All That Apply
Mineral Fiberboard Insulation Location
Foam, Closed Cell0.32
Describe other insulated areas Fiberglass, BlownFiberglass, Batts Foundation Wall
R-value
Average U-Factor (excludes skylights and one door ) U:
Duct system air tightness:
Installed on the inside
Building envelope air tightness:
Rim Joist (1st Floor)
AGPVH50 4A7A3036 Model
Heating System
gas
American Standard
Location of duct or system:
Heating or Cooling Ducts Outside Conditioned Spaces
electric
Make-up Air Select a Type
A.O.Smith
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):
31,457Residential Load Calculation
SEER
/EER
Total ventilation (intermittent + continuous) rate in cfms:
Balanced Ventilation capacity in cfms:
High:
High:
MECHANICAL VENTILATION SYSTEM
160 CFM
80 CFM Capacity continuous ventilation rate in cfms:
All bathrooms
S9X1B080U4PSBA
Heating Loss
Manufacturer American Standard
gas
Output
in Tons:
350
Builders 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)
“The permittee(s) must ensure that a trained person (as identified in Part III.A.3.a) will routinely 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 0.5 inches in 24 hours.”
(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
3/4/22 Y
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