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Home My WebLink AboutLA211093-17951 Giants Way Apps & 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 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 40,000 X X 40,000 40,000 3000 3000 3000 40,000 40,000 13.33 13.33 560 .18 .18 .82 .82 10.9 3.7 560 44000 0 135 135 1895 284 284 100 50 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 Lakeville17951 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 40,361 15,953 18,885 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