HomeMy WebLinkAboutLA215676 - 4998 161st St W - Permit App and 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
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
R-2
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-10 X
R-21 X
R-21 X
R-21 X
R-49 X
R-30 X
R-30 X
R-30 X
X Not applicable, all ducts located in conditioned space
Not required per mech. code
X Passive
Powered
Interlocked with exhaust device.
Describe:
Input in
BTUS:60,000 Capacity
in Gallons:
Other, describe:
AFUE or
HSPF%92%
Cfm's
R4
4 " metal duct
Not required per mech. code
X Passive
Low: Other, describe:
X Low:
Location of fan(s), describe: Cfm's
" round duct OR
6 " metal duct Total ventilation (intermittent + continuous) rate in cfms:
Balanced Ventilation capacity in cfms:
High:
High:
MECHANICAL VENTILATION SYSTEM
Capacity continuous ventilation rate in cfms:
43VP50E2 DX13SN024
Location of duct or system:
Heating or Cooling Ducts Outside Conditioned Spaces
R-410A
Make-up Air Select a Type
Rheem
Domestic Water
Heater
Gas
MECHANICAL SYSTEMS
Rating or Size
Efficiency 13SEER
/EER
Model
Heating System
Gas
Daikin
DM92SE0603B
Manufacturer Daikin
50 Output
in Tons:2
Appliances Cooling SystemTotal R-Value of all Types of InsulationType: Check All That Apply
Mineral FiberboardTHERMAL ENVELOPE
Insulation Location
Foam, Closed CellFoam Open Cell Wall Non or Not ApplicableFiberglass, BlownFiberglass, Batts Foundation Wall
R-value
Average U-Factor (excludes skylights and one door ) U:
Duct system air tightness:
Fuel Type
Solar Heat Gain Coefficient (SHGC):0.34
Describe other insulated areas
RADON CONTROL SYSTEM
Rim Joist (2nd Floor+)
0.28
Building envelope air tightness:
6 MIL POLY - 4" AGG
INTERIOR
INTERIOR
Below Entire Slab Rigid, Extruded PolystyreneRigid, Isocynurate Perimeter of Slab on Grade
Ceiling, flat
ATTIC
EXTERIOR
SEALANT
Rim Joist (1st Floor)
Windows & Doors
Ceiling, vaulted
Mech
Heat Recover Ventilator (HRV) Capacity in cfms:
Energy Recover Ventilator (ERV) Capacity in cfms:
Combustion Air Select a Type
Location of duct or system:
21,63542,526
Heating Gain Cooling Load
48 95
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):
16,594
Residential Load
Calculation
Heating Loss
Bay Windows or cantilevered areas
Floors over unconditioned area
Per R401.3 Certificate. A building certificate shall be posted on or in the electrical distribution panel.7/11/2023
New Construction Energy Code Compliance Certificate
Name of Residential Contractor
RT Urban Homes, Inc
MN License Number
BC758134
City Mailing Address of the Dwelling or Dwelling Unit
Lakeville4998 161st Street W
Builders Associaton of Minnesota version 101014
Burnsville Heating & Air Conditioning, Inc.
3451 W. Burnsville Pkwy, Suite 120, Burnsville, MN 55337
Phone 952-894-0005 – Fax 952-894-0925 – Web www.burnsvilleheating.com
_____________________________________________________________________________________
Ventilation, Makeup and Combustion Air Calculations
Submittal Form for New Dwellings
Site address 4998 161st Street W Date 7/11/23
Contractor Burnsville Heating & Air Conditioning, Inc Completed By Alan Dobson
VENTILATION REQUIREMENTS
TABLE R403.5.2
NUMBER OF BEDROOMS
1 2 3 4 5 6 2
Conditioned space1 (in
sq. ft.)
Total/
Continuous
Total/
Continuous
Total/
Continuous
Total/
Continuous
Total/
Continuous
Total/
Continuous
1000-1500 60/40 75/40 90/45 105/53 120/60 135/68
1501-2000 70/40 85/43 100/50 115/58 130/65 145/73
2001-2500 80/40 95/48 110/55 125/63 140/70 155/78
2501-3000 90/40 105/53 120/60 135/68 150/75 165/83
3001-3500 100/50 115/58 130/65 145/73 160/80 175/88
3501-4000 110/55 125/63 140/70 155/78 170/85 185/93
4001-4500 120/60 135/68 150/75 165/83 180/90 195/98
4501-5000 130/65 145/73 160/80 175/88 190/95 205/103
5001-5500 140/70 155/78 170/85 185/93 200/100 215/108
5501-6000 2 150/75 165/83 180/90 195/98 210/105 225/113
1. Conditioned space includes the basement and conditioned crawl spaces.
2. If conditioned space exceeds 6000sp. Ft. or there are more than 6 bedrooms, use Equation R403.5.2
R403.5.2 Total Ventilation rate.
The mechanical ventilation system shall provide sufficient outdoor air to equal the total ventilation rate average
for each 1- hour period in accordance with Table R403.5.2, or Equation 403.5.2, based on the number of bedrooms
and square footage of conditioned space, including the basement and conditioned crawl spaces.
For the purposes of Table R403.5.2 and Section R403.5.3, the following applies”
a. Equation R403.5.2 Total ventilation rate:
Total ventilation rate (cfm) = (0.02 x square feet of conditioned space) + (15 x (number of bedrooms =1))
b. Equation R403.5.2.1 Continuous ventilation rate: Continuous ventilation rate (cfm) = Total ventilation
rate/2
Amount Total _________95_________
Amount Continuous ______48_________
TABLE 304.1
COMBUSTION AIR REQUIREMENTS FOR GAS-FIRED
APPLIANCES WHEN THE COMBINED INPUT IS UP TO
AND INCLUDING 400,000 Btu/hr
TOTAL INPUT OF APPLIANCES1,
THOUSANDS OF Btu/hr
(kW)
REQUIRED FREE AREA OF AIR-
SUPPLY OPENING OR DUCT,
SQUARE INCHES
(sq mm)
ACCEPTABLE APPROXIMATE
ROUND DUCT
EQUIVALENT DIAMETER2,
INCH (mm)
25 (8)
50 (15)
75 (23)
100 (30)
125 (37)
150 (45)
175 (53)
200 (60)
225 (68)
250 (75)
275 (83)
300 (90)
325 (98)
350 (105)
375 (113)
400 (120)
7 (4,500)
7 (4,500)
11 (7,000)
14 (9,000)
18 (12,000)
22 (14,000)
25 (16,000)
29 (19,000)
32 (21,000)
36 (23,000)
40 (26,000)
43 (28,000)
47 (30,000)
50 (32,000)
54 (35,000)
58 (37,000)
3 (75)
3 (75)
4 (100)
4 (100)
5 (125)
5 (125)
6 (150)
6 (150)
6 (150)
7 (175)
7 (175)
7 (175)
8 (200)
8 (200)
8 (200)
9 (225)
1. For total inputs falling between listed capacities, use next largest listed input.
2. If flexible duct is used, increase the duct diameter by one inch. *
*Flexible duct shall be stretched with minimal sags.
BTU Amount for Non-direct vent appliances ____________________
IFGC Appendix E, Worksheet E-1
Residential Combustion Air Calculation Method
(for Furnace, Boiler, and/or Water Heater in the Same Space)
Step 1: Complete vented combustion appliance information.
Furnace/Boiler:
___Draft Hood ___Fan Assisted ___Direct Vent Input
(Not fan assisted) & Power Vent ______Btu/hr
Water Heater:
___Draft Hood ___Fan Assisted ___Direct Vent Input:
(Not fan assisted) &Power Vent ______Btu/hr
Step 2: Calculate the volume of the Combustion Appliance Space (CAS) containing combustion appliances.
The CAS includes all spaces connected to one another
by code compliant openings. CAS volume: _________________ft3
Step 3: Determine Air Changes per Hours (ACH)1
Default ACH values have been incorporated into Table E-1 for use with Method 4b (KAIR Method).
If the year of construction or ACH is not known, use method 4a (Standard Method).
Step 4: Determine Required Volume for Combustion Air.
4a. Standard Method
Total Btu/hr input of all combustion appliances Input:_____________
Btu/hr
(DO NOT COUNT DIRECT VENT APPLIANCES)
Use Standard Method column in Table E-1 to find Total Required Volume (TRV)
TRV:_____________ ft3
If CAS Volume (from Step 2) is greater than TRV then no outdoor openings are needed.
If CAS Volume (from Step 2) is less than TRV then go to STEP 5.
4b. Known Air Infiltration Rate (KAIR) Method
Total Btu/hr input of all fan-assisted and power vent appliances Input:_____________
Btu/hr
(DO NOT COUNT DIRECT VENT APPLIANCES)
Use Fan-Assisted Appliances column in Table E-1 to find
Required Volume Fan Assisted (RVFA)
RFVA:_____________ ft3
Total Btu/hr input of all non-fan-assisted appliances Input:_____________
Btu/hr
Use Non-Fan-Assisted Appliances column in Table E-1 to find
Required Volume Non-Fan-Assisted (RVNFA)
RVNFA:____________ ft3
Total Required Volume (TRV) = RVFA + RVNFA
RV=_______________+______________=_______________ft3
If CAS Volume (from Step 2) is greater than TRV then no outdoor openings are needed.
If CAS Volume (from Step 2) is less than TRV then go to STEP 5.
Step 5: Calculate the ratio of available interior volume to the total required volume.
Ratio = CAS Volume (from Step 2) divided by TRV (from Step 4a or Step 4b) Ratio = / =
=
Step 6: Calculate Reduction Factor (RF).
RF - 1 minus Ratio RF = 1 - =
m
Step 7: Calculate single outdoor opening as if all combustion air is from outside.
Total Btu/hr input of all Combustion Appliances in the same CAS (EXCEPT DIRECT VENT) Input:
_______________Btu/hr
Combustion Air Opening Area (CAOA):
Total Btu/hr divided by 3000 Btu/hr per in2 CAOA = /3000 Btu/hr per in2=
in2
Step 8: Calculate Minimum CAOA.
Minimum CAOA = CAOA multiplied by RF Minimum CAOA = x =
in2
Step 9: Calculate Combustion Air Opening Diameter (CAOD)
CAOD = 1.13 multiplied by the square root of Minimum CAOA CAOD = 1.13 √ Minimum CAOA
=__________ in.
1 If desired, ACH can be determined using ASHRAE calculation or blower door test. Follow procedures in Section
G304.
IFGC Appendix E, Table E-1
Residential Combustion air (Required Interior Volume Based on Input Rating of Appliance)
Input Rating
(Btu/hr)
Standard Method
(ft3)
Known Air Infiltration Rate (KAIR) Method (ft3)
Fan Assisted Non-Fan-Assisted
19941 to present
Pre-1994
1994 to present
Pre-1994
5,000 250 375 188 525 263
10,000 500 750 375 1,050 525
15,000 750 1,125 563 1,575 788
20,000 1,000 1,500 750 2,100 1,050
25,000 1,250 1,875 938 2,625 1,313
30,000 1,500 2,250 1,125 3,150 1,575
35,000 1,750 2,625 1,313 3,675 1,838
40,000 2,000 3,000 1,500 4,200 2,100
45,000 2,250 3,375 1,688 4,725 2,363
50,000 2,500 3,750 1,675 5,250 2,625
55,000 2,750 4,125 2,063 5,775 2,888
60,000 3,000 4,500 2,250 6,300 3,150
65,000 3,250 4,875 2,438 6,825 3,413
70,000 3,500 5,250 2,625 7,350 3,675
75,000 3,750 5,625 2,813 7,875 3,938
80,000 4,000 6,000 3,000 8,400 4,200
85,000 4,250 6,375 3,188 8,925 4,463
90,000 4,500 6,750 3,375 9,450 4,725
95,000 4,750 7,125 3,563 9,975 4,988
100,000 5,000 7,500 3,750 10,500 5,250
105,000 5,250 7,875 3,938 11,025 5,513
110,000 5,500 8,250 4,125 11,550 5,775
115,000 5,750 8,625 4,313 12,075 6,038
120,000 6,000 9,000 4,500 12,600 6,300
125,000 6,250 9,375 4,688 13,125 6,563
130,000 6,500 9,750 4,875 13,650 6,825
135,000 6,750 10,125 5,063 14,175 7,088
140,000 7,000 10,500 5,250 14,700 7,350
145,000 7,250 10,875 5,438 15,225 7,613
150,000 7,500 11,250 5,625 15,750 7,875
155,000 7,750 11,625 5,813 16,275 8,138
160,000 8,000 12,000 6,000 16,800 8,400
165,000 8,250 12,375 6,188 17,325 8,663
170,000 8,500 12,750 6,375 17,850 8,925
175,000 8,750 13,125 6,563 18,375 9,188
180,000 9,000 13,500 6,750 18,900 9,450
185,000 9,250 13,875 6,938 19,425 9,713
190,000 9,500 14,250 7,125 19,950 9,975
195,000 9,750 14,625 7,313 20,475 10,238
200,000 10,000 15,000 7,500 21,000 10,500
205,000 10,250 15,375 7,688 22,525 10,783
210,000 10,500 15,750 7,875 22,050 11,025
215,000 10,750 16,125 8,063 22,575 11,288
220,000 11,000 16,500 8,250 23,100 11,550
225,000 11,250 16,875 8,438 23,625 11,813
230,000 11,500 17,250 8,625 24,150 12,075
1 The 1994 date refers to dwellings constructed under the 1994 Minnesota Energy Code. The default KAIR used in this section of the table is 0.20 ACH.
2 This section of the table is to be used for dwellings constructed prior to 1994. The default KAIR used in this section of the table is 0.40 ACH.
Table 501.4.1
Procedure to Determine Makeup Air Quantity for Exhaust Appliances in Dwelling Units
ONE OR MULTIPLE
POWER VENT OR
DIRECT VENT
APPLIANCES OR NO
COMBUSTION
APPLIANCESA
ONE OR MULTIPLE
FAN-ASSISTED
APPLIANCES AND
POWER VENT OR
DIRECT VENT
APPLIANCESB
ONE
ATMOSPHERICALLY
VENTED GAS OR OIL
APPLIANCE OR ONE
SOLID FUEL
APPLIANCEC
MULTIPLE
APPLIANCES THAT
ARE
ATMOSPHERICALLY
VENTED GAS OR OIL
APPLIANCES OR SOLID
FUEL APPLIANCESD
1. Use Appropriate Column to Estimate House Infiltration
a) pressure factor
(cfm/sf)
0.15
0.09
0.06
0.03
b) conditioned floor
area (sf)
2096
(including unfinished basements)
Estimated House
Infiltration (cfm):
[1ax 1b]
314.4
2. Exhaust Capacity
a) Clothes dryer 135 135 135 135
b) 80% of largest
exhaust
rating (cfm)
240
(not applicable if recirculating system or if powered makeup air is electrically interlocked and matched to exhaust
c) 80% of next
largest
exhaust rating
(cfm):
NA
(not applicable if recirculating system or if powered makeup air is electrically interlocked and matched to exhaust
Total Exhaust Capacity
(cfm):
[2a+2b+2c]
375
3. Makeup Air Requirement
547) Total Exhaust
Capacity
(from above)
375
b) Estimated
House
Infiltration
(from above)
314.4
Makeup Air
Quality (cfm):
[3a-3b]
60.6
(if value is negative, no makeup air is needed
4. For Makeup Air opening Sizing, refer to Table 501.4.2
A. Use this column if there are other than fan-assisted or atmospherically venter gas or oil appliances or if there are no combustion appliances. B. Use this column if there is one fan-assisted appliance per venting system. Other atmospherically vented appliances may also be included.
C. Use this column if there is one atmospherically vented (other than fan-assisted) gas or oil appliance per venting system or one solid fuel appliance.
D. Use this column if there are multiple atmospherically vented gas or oil appliances using a common vent or if there are atmospherically vented gas or oil
Table 501.4.2
Makeup Air Opening Sizing Table for New and Existing Dwelling Units
TYPE OF OPENING
OR SYSTEM
ONE OR MULTIPLE
POWER VENT OR
DIRECT VENT
APPLIANCES OR NO
COMBUSTION
APPLIANCESA
ONE OR MULTIPLE
FAN-ASSISTED
APPLIANCES AND
POWER VENT OR
DIRECT VENT
APPLIANCESB
ONE
ATMOSPHERICALLY
VENTED GAS OR OIL
APPLIANES OR ONE
SOLID FUEL
APPLIANCEC
MULTIPLE
APPLIANCES THAT
ARE
ATMOSPHERICALLY
VENTED GAS OR OIL
APPLIANCES OR
SOLID FUEL
APPLIANCESD
PASSIVE MAKEUP
AIR OPENING DUCT
DIAMETERE,F,G
(cfm) (cfm) (cfm) (cfm) (inches)
Passive opening 1 – 36 1 – 22 1 – 15 1 – 9 3
Passive opening 37 – 66 23 – 41 16 – 28 10 – 17 4
Passive opening 67 – 109 42 – 66 29 – 46 18 – 28 5
Passive opening 110 - 163 67 – 100 47 – 69 29 – 42 6
Passive opening 164 – 232 101 – 143 70 – 99 43 – 61 7
Passive opening 233 – 317 144 – 195 100 – 135 62 – 83 8
Passive opening
w/motorized
damper
318 – 419
196 – 258
136 – 179
84 – 110
9
Passive opening
w/motorized
damper
420 – 539
259 – 332
180 – 230
111 – 142
10
Passive opening
w/motorized
damper
540 – 679
333 – 419
231 – 290
143 – 179
11
Powered
makeup airH
>679
>419
>290
>179
NA
A. Use this column if there are other than fan-assisted or atmospherically vented gas or oil appliances or if there are no combustion appliances.
B. Use this column if there is one fan-assisted appliance per venting system. Other than atmospherically vented appliances may also be included.
C. Use this column if there is on atmospherically vented (other than fan-assisted) gas or oil appliance per venting system or one solid fuel appliance.
D. Use this column if there is multiple atmospherically vented gas or oil appliances using a common vent or I there are atmospherically vented gas or oil appliances
and solid fuel appliances.
E. An equivalent length of 100 feet of round smooth metal duct is assumed. Subtract 40 feet for the exterior hood and ten feet for each 90-degree elbow to
determine the remaining length of straight duct allowable.
F. If flexible duct is used, increase the duct diameter b one inch. Flexible duct shall be stretched with minimal sags.
G. Barometric dampers are prohibited in passive makeup air openings when any atmospherically vented appliance is installed.
H. Powered makeup air shall be electrically interlocked with the largest exhaust system.