HomeMy WebLinkAboutLA223951 - 19803 Henning Ave-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
Secure door closed until deck isconstructed with a separate permit.Concept Approval ONLYSubject to Field InspectionInspectorDate2015MN BldgCode05/21/2024jnuetzman
UFER Ground-Provide 20' Rebar in footing and stubup near electrical service panel.
BWPsAbove48"CS-WSP48"CS-WSP48"CS-WSP48"CS-WSP48"CS-WSP42" ABW48"CS-WSP-Min. 15" clearance to anyobstruction from center ofW.C., 24" in front(typ).FANSmoke
FANFAN48"CS-WSP48"CS-WSPBearing Req'd forheader size.32" ABW48"CS-WSP48"CS-WSP48"CS-WSP48"CS-WSP48"CS-WSP36" ABW36" ABW48"CS-WSP48"CS-WSPPFHPFHPFHPFH48"CS-WSP48"CS-WSP48"CS-WSP48"CS-WSP48"CS-WSP48"CS-WSP-Min. 15" clearance to anyobstruction from center ofW.C., 24" in front(typ).(2)9-1/2" LVL
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)7 (4,500)3 (75)
50 (15)7 (4,500)3 (75)
75(23)11 (7,000)4 (100)
100 (30)14 (9,000)4 (100)
125 (37)18 (12,000)5 (125)
150 (45)22 (14,000)5 (125)
175 (53)25 (16,000)6 (150)
200 (60)29 (19,000)6 (150)
225 (68)32 (21,000)6 (150)
250 (75)36 (23,000)7 (175)
275 (83)40 (26,000)7 (175)
300 (90)43 (28,000)7 (175)
325 (98)47 (30,000)8 (200)
350 (105)50 (32,000)8 (200)
375 (113)54 (35,000)8 (200)
400 (120)58 (37,000)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.
TABLE 304.1
COMBUSTION AIR REQUIREMENTS FOR GAS-FIRED
APPLIANCES WHEN THE COMBINED INPUT IS UP TO
AND INCLUDING 400,000 Btu/hr
BTU Amount for Non-direct vent appliances_____________________
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 90/45 105/53 120/60 135/68 150/75 165/83
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 6000 sq. ft. or there are more than 6 bedrooms, use Equation R403.5.2
R403.5.2 Total Ventilation rate.
The mechanical ventilation system shall rovide 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 ventiation rate/2
Amount Total _________________________
Amount Continuous____________________
TABLE R403.5.2
NUMBER OF BEDROOMS
VENTILATION REQUIREMENTS
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
APPLIANE OR ONE
SOLID FUEL APPLIANCEC
MULTIPLE APPLIANCES THAT
ARE ATMOSPHERICALLY
VENTED GAS OR OIL
APPLIANCES OR SOLID FUEL
APPLIANCESD
1. Use the Appropriate Column to Estimate House Infiltration
a) pressure factor
(cfm/sf)
b) conditioned floor
area (sf)
(including unfinished basements)
Estimated House
Infiltration (cfm):
[1a x 1b]
2. Exhaust Capacity
a) clothes dryer
b) 80% of largest
exhaust rating (cfm):
(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):not applicable
(not applicable if recirculating system or if powered makeup air is electrically interlocked and matched to exhaust)
Total Exhaust Capacity
(cfm):
[2a+2b+2c]
3. Makeup Air Requirement
a) Total Exhaust
Capacity
(from above)
b) Estimated House
Infiltration (from
above)
Makeup Air
Quality (cfm):
[3a - 3b]
(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 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 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 appliances and solid fuel appliances.
Table 501.4.1
Procedure to Determine Makeup Air Quantity for Exhaust Appliances in Dwelling Units
Choose Which Applies
TYPE OF OPENING
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
PASSIVE MAKEUP
AIR OPENING
DUCT
DIAMETERE,F,G
OR SYSTEM (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
with motorized
damper 318-419 196-258 136-179 84-110 9
Passive opening
with motorized
damper 420-539 259-332 180-230 111-142 10
Passive opening
with motorized
damper 540-679 333-419 231-290 143-179 11
Powered makeup
airH >679 >419 >290 >179 Not applicable
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 one atmospherically vented (ther 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 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 by 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.
Table 501.4.2
Makeup Air Opening Sizing Table for New and Existing Dwelling Units
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 combution appliace information:
Furnace/Boiler:
Draft Hood Fan Assisted Direct Vent Input: Btu/hr
(Not fan Assisted) & Power Vent
Water Heater:
Draft Hood Fan Assisted Direct Vent Input: Btu/hr
( Not fan Assisted) & Power Vent
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 Hour (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 (DO NOT COUNT DIRECT VENT APPLIANCES) Input: Btu/hr
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
(DO NOT COUNT DIRECT VENT APPLIANCES) Input: Btu/hr
Use Fan-Assisted Appliances column in Table E-1 to find
Required Volume Fan Assisted (RVFA) RVFA: 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 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.
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 = - =
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 / Btu/hr per in
2 = 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 x Minimum CAOA = in
1If desired, ACH can be determined using ASHRAE calculation or blower door test. Follow procedures in Section 304.
CAOA =
IFGC Appendix E, Table E-1
Residential Combustion Air Required Volume (Required Interior Volume Based on Input Rating of Appliances)
Known Air Infiltration Rate (KAIR) Method (ft3)
Input Rating Standard Method Fan Assisted Non-Fan-Assisted
(Btu/hr) (ft3) 19941 to Present Pre 19942 19941 to Present Pre 19942
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 1,875 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 21,525 10,763
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 16,857 8,438 23,625 11,813
230,000 11,500 17,250 8,625 24,150 12,075
1The 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.
2This 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.
HEAT LOSS LOAD CALCULATION
CUSTOMERS
ADDRESS
BASEMENT
Running Wall
Below Grade:
X Wall
Height:
= SQUARE FT OF GROSS
WALL BELOW GRADE
-MINUS-
SQUARE FT OF
GROSS WINDOWS
& DOORS
=EQUALS=
FIRST FLOOR
Running Walls: X Wall Height: = SQUARE FT OF GROSS WALL
FIRST FLOOR
SECOND FLOOR + PLUS+
Running Walls: X Wall Height: = SQUARE FT OF GROSS WALL
SECOND FLOOR
THIRD FLOOR + PLUS+
Running Walls: X Wall Height: = SQUARE FT OF GROSS WALL THIRD FLOOR
-MINUS-
=EQUALS=
NET WALL BELOW
GRADE
SQUARE FT OF GROSS
WINDOWS+DOORS
NET WALL
ABOVE GRADE
WINDOWS + DOORS (SF) X HTM = BTU
INFILTRATION
(Windows + Doors) X 1.3
X HTM = BTU
Net Wall Below Grade
(From Above)
X HTM = BTU
Net Wall above Grade
(From Above)
X HTM = BTU
Ceiling Sq Ft X HTM = BTU
Floor Sq Ft X HTM = BTU
TOTAL
BTU
Passive (No Fan)
Active (With fan and monitoring
device )
Location (or future location) of Fan:
Other Please Describe Here
Not applicable, all ducts located in conditioned space
Not required per mech. code
Passive
Powered
Interlocked with exhaust device.
Describe:
Input in
BTUS:
Capacity in
Gallons:
Other, describe:
AFUE or
HSPF%
Cfm's
" round duct OR
" metal duct
Not required per mech. code
Passive
Low: Other, describe:
Low:
Location of fan(s), describe: Cfm's
" round duct OR
" metal duct
Per R401.3 Certificate. A building certificate shall be posted on or in the electrical distribution
panel.
New Construction Energy Code Compliance Certificate
Name of Residential Contractor MN License Number
City Mailing Address of the Dwelling or Dwelling Unit
Rigid, Extruded PolystyreneHeat Recover Ventilator (HRV) Capacity in cfms:
Energy Recover Ventilator (ERV) Capacity in cfms:
Combustion Air Select a Type
Location of duct or system:
Rim Joist (2nd Floor+)
Building envelope air tightness:
Below Entire Slab
Fuel Type
Solar Heat Gain Coefficient (SHGC):
Windows & Doors
Ceiling, vaulted
Bay Windows or cantilevered areas
Floors over unconditioned area
THERMAL ENVELOPE
Foam Open Cell Wall Rigid, Isocynurate Perimeter of Slab on Grade
RADON CONTROL SYSTEM
Total R-Value of all Types of InsulationType: Check All That Apply
Mineral FiberboardInsulation Location Foam, Closed Cell Describe other insulated areas
Ceiling, flat Non or Not ApplicableFiberglass, BlownFiberglass, Batts Foundation Wall
Output
in Tons:
Appliances Cooling System
Location of duct or system:
Heating or Cooling Ducts Outside Conditioned Spaces
Make-up Air Select a Type
Domestic Water
Heater
Model
Heating System
Rim Joist (1st Floor)
Average U-Factor (excludes skylights and one door ) U:
Duct system air tightness:
Rating or Size
Efficiency
Heating Gain Cooling Load
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):
Residential Load
Calculation
SEER
/EER
Capacity continuous ventilation rate in cfms:
Heating Loss
Manufacturer
Total ventilation (intermittent + continuous) rate in cfms:
Balanced Ventilation capacity in cfms:
High:
High:
MECHANICAL VENTILATION SYSTEM
Date Cert. Posted
R-value
MECHANICAL SYSTEMS
Builders Associaton of Minnesota version 101014
NEW RESIDENTIAL CONSTRUCTION SWPPP VERIFICATION
This form must be completed and submitted with all new residential permit applications.
A National Pollutant Discharge Elimination System (NPDES) Construction Stormwater Permit is
required for “Construction activity that results in land disturbance of equal to or greater than one (1)
acre or if a project is part of a common plan of development that will ultimately disturb greater than
one (1) acre,” (NPDES Permit, Section 1.2).
Project Site Address: _____________________________________________________________________
Company Name: _________________________________________________________________________
*Primary Company Contact: _________________________________________________________________
*Should a site be deemed noncompliant, this individual will be notified
Phone #: ____________________________ Email: ______________________________________________
If you are not covered under a NPDES Construction Stormwater Permit administered by the
Minnesota Pollution Control Agency (MPCA), an erosion and sediment control plan MUST be
approved as part of the residential building permit application.
“Permittees must ensure a trained person will 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 ½
inch in 24 hours,” (NPDES Permit, Section 11.2).
The City of Lakeville reserves the right to request weekly inspection logs. 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.
Contact information of person CERTIFIED to provide weekly onsite erosion and sediment control
inspections and corrective actions:
Name: ____________________________________ 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
I understand the above information to be accurate and I have read, understood, and accepted all terms and conditions of the NPDES Permit (MN R 100001).
Signature: ________________________________________________ Date:_________________________
Contact the City of Lakeville with questions at erosion@lakevillemn.gov or 952-985-4500
19803 Henning Ave Lakeville MN 55044
Robe
Robert McNearney
612-386-7808 admin@mcnearneyhomes.com
All About Erosion Control All About Erosion Control
5-2-24
allabouterosion@gmail.com
5/7/24 X
PM