HomeMy WebLinkAboutLA209370-7093 184th St W 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:________________________________________ _______________________________
_____________________________ CELL PHONE:___________________________
ADDRESS:____________________________ CITY:________________ ST:______ ZIP:____________
BOND #:_______________________________________ EXPIRATION DATE____________________
SEWER/WATER CONTRACTOR
New Construction Only
NAME:________________________________________________ ______________________________
_____________________________ CELL PHONE:______________________________
BOND #:_______________________________________ EXPIRATION DATE____________________
NAME OF APPLICANT (Please Print)DATE
I HEREBY APPLY FOR PERMIT AND ACKNOWLEDGE THAT ALL INFORMATION ON THIS
APPLICATION IS COMPLETE AND ACCURATE. THIS IS NOT A PERMIT AND WORK IS NOT TO
COMMENCE UNTIL SUCH TIME A PERMIT IS ISSUED. ALL WORK WILL COMPLY WITH
LAKEVILLE CITY CODE, THE MINNESOTA STATE BUILDING CODE, AND THE APPROVED
PLANS. INTEREST EARNINGS ON ESCROW ACCOUNTS, IF ANY, WILL BE RETAINED BY THE
CITY TO OFFSET THE ADMINISTRATIVE COSTS ASSOCIATED WITH PROCESSING THE
ESCROW APPLICATION AND REFUND.
OFFICE PHONE #:_
OFFICE PHONE #:_
*Entering your name affirms your intent to comply with the statement above.
*
Submit Application To: permits@lakevillemn.gov
and jsexton@brandlanderson.com
CANNOT HOOK TO CITY SEWER/WATER
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
CONDO
REROOF
RESIDE
RES ADDN/REPAIR/RMDL
DECK
PORCH
GARAGES
LOWER LEVEL FINISH
ADDITION
FOUNDATION ONLY
MISCELLANEOUS
DEMO
APPROVED BY:
BUILDING INSPECTOR: Date:
PLUMBING/MECHANICAL
INSPECTOR: Date:
COMMENTS:
CITY BUILDING VALUATION: $
BUILDING PERMIT FEES
$PERMIT FEE
$PLAN CHECK
$SURCHARGE
$METRO SAC
$CITY WATER HOOKUP UNIT
$CITY SEWER HOOKUP UNIT
$LANDSCAPE ESCROW
$TREE ESCROW
$MISC ESCROW
$PLUMBING
$MECHANICAL
$SEWER WATER
WATER METER
PRESSURE REDUCING VALVE
$OTHER
$TOTAL
METER SIZE
PRESSURE REDUCING VALVE
SEWER/WATER
SEWER/WATER
FINAL
STREET DRAINTILE
BUILDING INFORMATION
TYPE OF CONSTRUCTION
ZONING
CODE EDITION
FIRE SUPPRESSION SYSTEM
OCCUPANCY GROUP
MECHANICAL
AIR TEST
FINAL
ROUGH-IN
PLUMBING
FINAL
ROUGH-IN
INSULATION
LATH
DECK FOOTING
FIREPLACE
FOOTING
FOUNDATION
FRAMING
PORCH FRAMING
PORCH FOOTING
POURED WALL
SITE
LOWER LEVEL FINAL
OTHER
DECK FRAMING
LOWER LEVEL FRAMING
LANDSCAPING
DECK FINAL
$
$
ACCESSORY BUILDING
EGRESS WINDOW
UNDERGROUND
Secure door closed until deck is
constructed with a separate permit.
Concept Approval
ONLY
Subject to Field Inspection
Inspector Date
2020
MN Bldg
Code
12/30/2022dmathews
PFH
PFH
UFER Ground
BWPs
Above
BWPs
Above
3'
CS-WSP
3.50'
CS-WSP
PFH PFH
4' WSP
4' WSP
4' WSP
4' WSP
4' WSP 4' WSP
CS-PF
CS-PF
CS-PF
CS-PF
Verify loads with girder
truss specs, may require
removal of top plates at
bearing due to crushing.
3' WSP 8' LIB 3' WSP
8' LIB
8' LIB
2.25' WSP 2.25' WSP
2.25' WSP2.25' WSP
8' LIB
8' LIB
-Min. 15" clearance to any
obstruction from center of
W.C., 24" in front(typ).
Date Certificate Post
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 x
R-20 x x
19+5 x x
R-49 x
R-49 x
R-38 x
R-38+5 x x
Not applicable, all ducts located in conditioned space
X
x Not required per mech. code
Passive
Powered
Interlocked with exhaust device.
Describe:
Input in
BTUS:
88,000 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 " Flex
" metal duct
Balanced Ventilation capacity in cfms:
Capacity continuous ventilation rate in cfms:
Total ventilation (intermittent + continuous) rate in cfms:
82 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
R-5 where required
R10 Rigid Exterior, R10 Int closed cell
R10 Rigid Exterior, R10 Int closed cell
R5 Exterior, R19 Batts
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
Lakeville7093 184th St
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: 192
MN License Number
Brandl Anderson Homes BC604388
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 Cooling Load
62545 19917 26,770
13 Location of duct or system:
Rating or Size 50 Output in
Tons:2.5
Efficiency
SEER
/EER
Natural Gas Natural Gas Electric
13ACXN030
Fuel Type
Manufacturer Lennox Lennox
Model ML193UH090XE
Average U-Factor (excludes skylights and one door ) U: 0.30
Solar Heat Gain Coefficient (SHGC): 0.30 R-value R-8
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
40,000
X
X
40,000
40,000
3000
3000
3000
40,000
40,000 13.33
13.33
2565
2565 .85
.85 .15
.15 1.99
1.59
43
NR
320
455
455
4556
683
683
190
95