HomeMy WebLinkAboutLA202418 - 17945 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:
Elander Mechanical Inc
3
1896 100
50
17945 Giants Way
Colin
5/3/2022
X
Located on unit. Unit to run on low speed to meet continious ventilation requirements
X Not Required
14030
0
Neg #
135
135
1896
284
284
X
X
X
40,000
3,000
3,000
40,000
40,000 13.33
3.8
44,000
3121346
312 3000 .10
.10 .90
13.33 .90 11.9
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
Lakeville17945 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
34,848 16,546 19,175
13 Location of duct or system:
Rating or Size
50 Output in
Tons:2
Efficiency
SEER
/EER
Nat Gas Elect Elect
PROE50 T2 13ACXN024-23
Fuel Type
Manufacturer Lennox Rheem Lennox
Model ML193UH045XE36
Average U-Factor (excludes skylights and one door) U0.31
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