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Home My WebLink AboutLA224064 - 17933 Greeley Pl-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 Concept Approval ONLYSubject to Field Inspection Inspector Date 2015 MN Bldg Code 05/24/2024jnuetzman FAN Smoke Smoke Smoke CO UFER Ground -Provide 20' Rebar in footing and stub up near electrical service panel. -Min. 15" clearance to anyobstruction from center ofW.C., 24" in front(typ). Smoke Smoke CO Smoke Smoke CO FANFAN 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_____________________ 375 (113)54 (35,000)8 (200) 325 (98)47 (30,000)8 (200) 275 (83)40 (26,000)7 (175) 225 (68)32 (21,000)6 (150) 175 (53)25 (16,000)6 (150) 125 (37)18 (12,000)5 (125) 75(23)11 (7,000)4 (100) 25 (8)7 (4,500)3 (75) 0.00 123456 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 3001-3500 100/50 115/58 130/65 145/73 160/80 175/88 4001-4500 120/60 135/68 150/75 165/83 180/90 195/98 1000-1500 60/40 75/40 90/45 105/53 120/60 135/68 2001-2500 80/40 95/48 110/55 125/63 140/70 155/78 5001-5500 140/70 155/78 170/85 185/93 200/100 215/108 148 cFm 74 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 0.15 3,664.00 549.60 135.00 320.00 455.00 455.00 549.60 -94.60 0.09 0.00 135.00 135.00 135.00 0.00 135.00 0.06 0.00 135.00 135.00 135.00 0.00 135.00 0.03 0.00 135.00 135.00 135.00 0.00 135.00 ✔ 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 IFGCAppendix 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 STEP5. 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 STEP5. 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 multipliedby the squareroot 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 = ✔ ✔ 500,000 200,000 3,664 0 0 13,664.-3,663. 3,664 1 3,664. 0 0 0 0 000 03,000 0.00 -3,663.0 0.00 IFGCAppendix E, TableE-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. 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 17933 Greeley Place Lakeville Summergate Homes 772852 ✔ R10 R20 R49 ✔ Gas Gas Goodman Goodman 60000 2 96 13 47613 23308 1.81 ✘ 74 148✔ 148 74 ✘ ✘ 4 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 4/29/24 X PM