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Home My WebLink AboutLA210554-8278 186th 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 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 !" ##$$$$"%&’ %"%&’ %"%&’ %%&’ %Provide fire blocking from topof wall to underside of roofsheathing along entirefireplace wall due to 5'proximity to property line.Secure door closed until deck isconstructed with a separate permit.Concept Approval ONLYSubject to Field InspectionInspectorDate2020MN BldgCode03/16/2023dmathews !"#$!!!"#%%$!#$"$%%&%&#%’%$!$$##"$"%%#%$$%$%&$(&%)#$"$$#)%$%$!!$#%$$#*’$"$%"$"&(*#)$(’$$$&%$!!$(%+&(%+"%"$$’%,-./0$&%!%%$"$$!’"!$$#%%$!"""$!$’$&$$$$!"#$("&%$%!$$)%’$&1$!$#!$$$%$"$%2#"!$") "$"!&$$!’$#,34567840#,’0$"$%2#"*$#%"$"&$($’#$"$%2# )&%$$(%&)%$’$!!9$!$"*%!!"$ "$"!:’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’9?==+==B4?5./G=76?;.7/A,.4B4?-AFG.5845A057C.84D>==9.8;<FA7=.8B4?5./G879/;7;<4D7>/8?;.7/F <?>A;D?/C4/;488.546;=E7>;A.8484;46;75?>8.B=4./A=443./G?54?A>A;B49.548-7@484;46;7567//46;48;7?A7>/8./G84C.64757;<4575A3?6./G54H>.548.56<>;4A4C45EA3?6454;>5/48B7?58"$$!&$*%2#./9778;74?5;<A43?5?;.7/%"*F$"$’$==A;5>6;>5?=-4-B45A->A;B4?3357C48977875/?;>5?=54A.A;?/64;7846?E75;54?;489778%>5./G67/A;5>6;.7/?3357C48?8854AA4AA<?==B48.A3=?E483=?./=EC.A.B=4?/8=4G.B=4D57-;<4A;544;D57/;./G;<45.75;7766>3?/6E345-.;6.;E?3357C4=76?;.7/7D<7>A4"?>=@./G?/8D=?A<./G?;?==4 ;45.75734/./GA"=4?/A;544;8?.=E7D?/E-?;45.?=;5?6@487/;7.;D57-57C.847>;A.8467-B>A;.7/?.58>6;;77DDD=7754/;85E458.546;=E7>;A.847585?./488.546;=E;7;<44 ;45.75;<57>G<5.G.83=?A;.6==9?;45D57-D7>/8?;.7/85?./A75A>-3A->A;B43>-348AHD;-./734/./G))-? 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A A A A A"$ !" ##)%&’ %SmokeCOSmokeCO8PFHPFHPFH6 )))))1-12-13-14-1A-1B-1C-1D-1E-1)&"&)&"&)&"&&"&&"&)&"&)&"&)&"&)&"&)&"&&"&&"&)&"&&"!&"&&"&&"&&!&!&!)2-01-03-0A-0B-0)&"&)&"&)&"&)&"&))&"&8"$$%F!%$"" $"*$I1$$!"%"$$%%$$%$#%%$!"&"%&%$!"%&$$$%"%&9$!)$$%$!&$%"%&%$!&%$%%$$%"##&&$!)$%$%$!&%$%"##&F$&$!))$%"%&&!$%$!&%:$%%$&!%$%$!&"$$"$%"$%$!$#%$$!$&$&$$%#"#$%"&$$$!"(#&$%9(&"&"%%$’+$"$1$F$"*$%+$"$1$F$"*$$$"*%%$I1$$!%$I( $"*$I1$$!""(#$%$%(&"&$""%$"$!$%!%&%$!$’$%!+)%$&%",%%%$"$"%%$!0%$# %$"$#$#&$$%% )!$%98"$$%$&76!#F.B"%$$$!%%%$"*%%!%$*#%98*$&$$%#"#"F%$"*%%$""#&%%$!&!$#%$&,0% "$9 &’$$!%’$&9$(&$ !" ##$$$$%&’ % 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 R-5 and R-10 x x 21 x 21 x 50 x Not applicable, all ducts located in conditioned space 8 X Not required per mech. code 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 Not required per mech. code x Passive Low: Other, describe: x Low: Location of fan(s), describe: Cfm's 6" " round duct OR " metal duct s9xb0604upsba Heating Loss Manufacturer American Standard gas Output in Tons: 2 1/250 Total ventilation (intermittent + continuous) rate in cfms: Balanced Ventilation capacity in cfms: High: High: MECHANICAL VENTILATION SYSTEM 130 CFM 65 CFM Capacity continuous ventilation rate in cfms: All bathrooms 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): 30,405Residential Load Calculation SEER /EER 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 Building envelope air tightness: Rim Joist (1st Floor) AGPVH50 4A7A3030 Model Heating System gas American Standard Fiberglass, Batts Foundation Wall R-value Average U-Factor (excludes skylights and one door ) U: Duct system air tightness: Installed on the inside Cooling SystemTotal R-Value of all Types of InsulationType: Check All That Apply Mineral Fiberboard Insulation Location Foam, Closed Cell0.31 Describe other insulated areas Fiberglass, BlownTHERMAL ENVELOPE Foam Open Cell Wall Rigid, Isocynurate Perimeter of Slab on Grade RADON CONTROL SYSTEM Install on inside and outside of wallNon or Not ApplicableAttic 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 Heat Recover Ventilator (HRV) Capacity in cfms: Energy Recover Ventilator (ERV) Capacity in cfms: 57,674 Heating Gain Cooling Load 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. 8278 186th. St. W. 2358 City Mailing Address of the Dwelling or Dwelling Unit Combustion Air Select a Type Location of duct or system: 30,405 Installed on the inside Below Entire Slab Rigid, Extruded Polystyrene Ceiling, flat 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 3/8/23 X PM