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Home My WebLink AboutLA200454-17982 Giants Way 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 Submit to: permits@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 40,000 X X 40,000 40,000 3000 3000 3000 40,000 40,000 13.33 13.33 40000 560 .18 .18 .82 .82 10.9 3.7 560 0 135 135 1995 299 299 102 51 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 X R-15 X X R-20 X R-20 X R-20 X R-49 X R-49 X R-30 X R-30 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 " 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: 30 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. Mailing Address of the Dwelling or Dwelling Unit City Lakeville17982 Giants Way 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: 140 MN License Number Pulte 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, IsocynurateResidential Load Calculation Heating Loss Heating Gain Cooling Load 38,124 15,135 17,483 13 Location of duct or system: Rating or Size 50 Output in Tons:2 Efficiency SEER /EER Nat Gas Elect Elect PROE50 T2 13ACXN024-230 Fuel Type Manufacturer Lennox Rheem Lennox Model ML193UH045XE36 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