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3578 Lemieux Cir 6l. l-,,\t ►-7 7 9,-7 9-793 aol~8 0v M F I d 0 " Use BLUE or BLACK Ink For Office Use 91 ` I Permit 7 02 01-17 I City of Ealan - Permit Fee. 3830 Pilot Knob Road I I Eagan MN 55122 bate Received: Phone: (651) 675-5675 I I Fax: (651) 675-5694 Staff• I Q CJ v ~J------------------' 2013 RESIDENTIAL BUILDING PERMIT APPLICATION L~ Date:' 1 Site Addres x Gtr=!-. Unit C's y x~ m, ; Name: GL.:~C ~~.,IS`T" f•_ Phone:6S2." .303g 2~r:°~,>- Address / City/ Zip: " 1600 1~1 -IST+1 ST. '1y1~...tA. >r3 q."r Applicant is: Owner jzContractor ~V~ V ty` Description of work: 7~ype o o~kr Construction Cost: Multi-Family Building: (Yes No ~~y,~ Company: Contact: HA& 11!2 tll! K .4-, 3 5 FF Address: City: r ~Coh,ractor;4;d;: Zip: Phone: 4,}ts r ~ _ - ~ ~ s 1 r t x :f ;License izze Lead Certificate If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY 1 CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? Yes ZNo If yes, date and address of master plan: Licensed Plumber: Phone:g5Z.44-5-44A2. Mechanical Contractor: '~;j~1~ Phone: g52.4eA4. ooc>s Sewer & Water Contractor: Phone: 4V93P 1.AW.?-2,Fk f -a G 'rv2 F"`axi'. rs:ti'm- a.:':S~:P"9:i:..^:1 :_.3}--k:'S'U;g^"'~K :a+ssti-':.. -.:?ase3: y:u A~a`k~Y, Sr-.~'sxS°~~."...W4 .•s:;V'x^^ye,xw:.'gs'n+•<~'-: ;f "~~Y.* ,'.:y. c.G:~,. ;~J1(O_TE =P%a~s/n+~+s aiz~~~supp.~~~ nqt°,cl~c`i~mentstha,~.o~s b±ry{!~ ~,ta~e~co ~tlerreWstl~ abbe: '.ub c n oc , a>~io ~~P~ort,,~o . of:•~;' ~t~e ~n~ormat~on may be~class~, ~,ec~,asfnon~ ub~~c:~~,~`-'youp .oyid spec' cz Faso Y , awourq!,perm~~e,C,~tt Ito ^ t - <.~f~ - a-. concluale,~{~of~e are tratle secre3`s WON.r { T } :ALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours efore you intend to dig to receive locates of underground utilities. www.goK)herstateonecall.oro hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of agan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in ccordance with the approved plan in the case of work which requires a review and approval of plans. xteriorwork authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 ays of permit issuance. , t-IA1E21Pp,L' ~...J11G. pplicant's Printed Name lic t igna ure Page-1 of 3 DO NOT WRITE BELOW THIS LINE 12O l -17 SUB TYPES _ Foundation _ Fireplace _ Porch (3-Season) _ Stonn Damage - Single Family _ Garage _ Porch (4-Season) _ Exterior Alteration (Single Family) _ Multi _ Deck _ Porch (Screen/Gazebo/Pergola) - Exterior Alteration (Multi) 01 of-~-Plex' Lower Level _ Pool _ Miscellaneous Accessory Building WORK TYPES New _ interior,!Mprovement _ Siding Demolish Building* Addition _ Move Building _ Reroof _ Demolish Interior _ Alteration _ Fire Repair Windows _ Demolish Foundation _ Replace _ Repair _ Egress Window _ Water Damage Retaining Wall Vemolition of entire building - give PCA handout to applicant DESCRIPTION Valuation q Occupancy MCES System Plan Review Code Edition SAC Units (25%_ 100%') Zoning City Water Census Code Stories Booster Pump # of Units Square Feet PRV # of Buildings Length Fire Sprinklers Type of Construction Width REQUIRED INSPECTIONS 4 Footings (New Building) Meter Size: Footings (Deck) Final/ C:O. Required Footings (Addition) Final / No C.O. Required Foundation HVAC _ Gas Service Test Gas Line Air Test _ Drain Tile Other: _ Roof: -Ice & Water -Final Pool: -Footings -Air/Gas Tests -Final Framing Siding: -Stucco Lath Stone La -Brick Fireplace: Rough In 4Air Test Final Windows Insulation Retaining Wall: _ Footings _ Backfill _ Final Sheathing t 4- Radon Control Sheetrock - v Erosion Control Reviewed By: Building Inspector RESIDENTIAL FEES (f 11/ t a ,l ~j ~ 0 b 7 Base Fee 1~ *g Surcharge ` [t /75)4 9 f,7 =7 J / Plan Review I fly ppj _ 01-A 5' 7-, r f"n MCES SAC City SAC Utility Connection Charge /r S&W Permit & Surcharge _ Treatment Plant ~s Copies TOTAL .f" I i Page 'o" 3 New Construction Energy Code Compliance Certificate Per NI 101.8 Building Certificate. A building certificate shall be posted in a permanently visible location inside rate Certificate Posted the building. The certificate shall be completed by the builder and shall list information and values of components listed in Table N1101.8. Mailing Address of the Dwelling or Dwelling Unit City 3578 Lemieux Circle Eagan Name of Residential Contractor MN License Number Ron Clark Construction & Design 1220 THERMAL ENVELOPE RADON SYSTEM Type: Check All That Apply X Passive (No Fan) w 0 0 a Acfi ~e (With j nr rind monometer or other system nionzloriqg device v b 0 d w A. CG W y q o Insulation Location °o z ti ° a w ° 0 w U a' a W 0 1* 7~z ai o ty o a a o 9 on en -be H 9 z w w w w t r Other Please Desen Here Below, Entire Slab X Foundation Wall R-5 X Ea'o;.or Foundation Wall At Walk Out R-10 X in[eF;or Rim Joist (Foundation) R-12 X ~zrlor IZim .Joist (11' Floor+) X 'A:][[ T-19- I X Ceiling, flat R-44 - X Ceiling, vaulted X Bay Windows or cantilevered areas R-30 , #XX F our Season Porch Abm e Unconditioned Spacc R-35 X F G o. rhso t Rfgi R5 Describeother insulated areas Windows & Doors Heating or Cooling Ducts Outside Conditioned Spaces Average U-Factor (excludes skylights and one door) U: 0.31 x Not applicable, all ducts located in conditioned space Solar Heat Gain Coefficient (SHGC): 0.35 R--value R-8 in garage area MECHANICAL SYSTEMS Make-up Air Select a Type Appliances Heating System Domestic Water Heater Cooling System X Not required per mech. code Fuel Type GAS Electric R-410A Passive Manufacturer Bryant Marathon Bryant Powered Interlocked with exhaust device. Model 912S,B36060S14 MR105245 CA13030 Describe: Input in 60,000 Capacity in 105 Output in 2.5 Other, describe: Rating or Size BTUS: Gallons: Tons: Heat Loss: 52,024 ` Heat 21,949 Location of duct or system: Structure's Calculated Gain: AFUE or 92% SEER: 13 HSPF% Calculated 25,092 Efficient cooling load: Cfin's " round duct OR Mechanical Ventilation System " metal duct Describe any additional or combined heating or cooling systems if installed: (e.g. two furnaces or air Combustion Air Select a Type source heat pump with gas back-up furnace): Not required per mech. code Select Type X Passive 6" Flex X Heat Recover Ventilator (HRV) Capacity in cf ns: Low: 64 High: 150 Other, describe: Energy Recover Ventilator (ERV) Capacity in cfins: Low: High: Location of duct or system: Continuous exhausting fan(s) rated capacity in cfins: Basement Location of fan(s), describe: Cfin's Capacity continuous ventilation rate in cfins: " round duct OR Flex Total ventilation (intermittent + continuous) rate in cfins: "metal duct Created by BAM version 052009 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 3578 Lemieux Circle Date contractor Burnsville Heating & Air Conditioning, Inc Completed By Alan Dobson Section A Ventilation Quantity (Determine quantity by using Table N1104.2 or Equation 11-1) Square feet (Conditioned area including 3240 Total required ventilation 100 Basement-finished or unfinished) Number of bedrooms 1 Continuous ventilation 50 Directions - Determine the total and continuous ventilation rate by either using Table N1104.2 or equation 11-1. The table and equation are below. Table N1104.2 Total and Continuous Ventilation Rates (in cfm) Number of Bedrooms 1-1 2 3 4 5 6 Conditioned Total/ Total/ Total/ Total/ Total/ Total/ space (in sq. ft. continuous continuous continuous continuous continuous 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 150/75 165/83 180/90 195/98 210/105 225/113 Equation 11-1 (0.02 x square feet of conditioned space) + [15 x (number of bedrooms + 1)] = Total ventilation rate (cfm) Total ventilation -The mechanical ventilation system shall provide sufficient outdoor air to equal the total ventilation rate average, for each one-hour period according to the above table or equation. For heat recovery ventilators (HRV) and energy recovery ventilators (ERV) the average hourly ventilation capacity must be determined in consideration of any reduction of exhaust or outdoor air intake, or both, for defrost or other equipment cycling. Continuous ventilation -A minimum of 50 percent of the total ventilation rate, but not less than 40 cfm shall be provided, on a continuous rate average for each one-hour period. The portion of the mechanical ventilation system intended to be continuous may have automatic cycling controls providing the average flow rate for each hour is met. G:\SAFETY\JK\Vent-makeup-comb air submittal (2).docx Page 1 of 6 Section B Ventilation Method (choose either balanced or exhaust only) ® Balanced, HRV(Heat Recovery Ventilator) or ERV (Energy ❑ Exhaust only Recovery Ventilator) - cfm of unit in low must not exceed Continuous fan rating in cfm continuous ventilation rating by more than 100% Low cfm: 64 High cfm:150 Continuous fans rating in cfm (capacity must not exceed continuous ventilation rating by more than 100%) Directions - Choose the method of ventilation, balanced or exhausts only. Balanced ventilation systems are typically HRV or ERV's. Enter the low and high cfm amounts. Low c fm airflow must be equal to or greater than the required continuous ventilation rate and less than 100% greater than the continuous rate. (For instance, if the low cfm is 40 cfm, the ventilation fan must not exceed 80 cfm.) Automatic controls may allow the use of a larger fan that is operated a percentage of each hour. Section C Ventilation Fan Schedule Description Location Continuous Intermittent Bath Fan Master Bath 80 Bath Fan Main Bath 80 Directions - The ventilation fan schedule should describe what the fan is for, the location, cfm, and whether it is used for continuous or intermittent ventilation. The fan that is chose for continuous ventilation must be equal to or greater than the low c fm air rating and less than 100% greater than the continuous rate. (For instance, if the low cfm is 40 cfm, the continuous ventilation fan must not exceed 80 cfm. Automatic controls may allow the use of a larger fan that is operated a percentage of each hour. Section D Ventilation Controls (Describe operation and control of the continuous and intermittent ventilation) Control Located In Mech Room Directions- Describe the operation of the ventilation system. There should be adequate detail for plan reviewers and inspectors to verify design and installation compliance. Related trades also need adequate detail for placement of controls and proper operation of the building ventilation. If exhaust fans are used for building ventilation, describe the operation and location of any controls, indicators and legends. If an ERV or HRV is to be installed, describe how it will be installed. If it will be connected and interfaced with the air handling equipment please describe such connections as detailed in the manufactures' installation instructions. If the installation instructions require or recommend the equipment to be interlocked with the air handling equipment for proper operation, such interconnection shall be made and described. Section E Make-up air Passive (determined from calculations from Table 501.3.1) Powered (determined from calculations from Table 501.3.1) Interlocked with exhaust device (determined from calculations from Table 501.3.1) Other, describe: Location of duct or system ventilation make-up air: Determined from make-up air opening table NR cfm Size and type (round, rectangular, flex or rigid) Directions - In order to determine the makeup air, Table 501.3.1 must be filled out (see below). For most new installations, column A will be appropriate, however, if atmospherically vented appliances or solid fuel appliances are installed, use the appropriate column. For existing dwellings, see IMC 501.3.3. Please note, if the makeup air quantity is negative, no additional makeup air will be required for ventilation, if the value is positive refer to Table 501.3.2 and size the opening. Transfer the cfm, size of opening and type (round, rectangular, flex or rigid) to the last line of section D. The make-up air supply must be installed per IMC 501.3.2.3. Table 501.3.1 PROCEDURE TO DETERMINE MAKEUP AIR QUANITY FOR EXHAUST EQUIPMENT IN DWELLINGS (Additional combustion air will be required for combustion appliances, see KAIR method for calculations) One or multiple One or multiple fan- One atmospherically Multiple power assisted vent atmospherically vent or direct vent appliances and gas or oil appliance vented gas or oil appliances power vent or direct or appliances or solid or no combustion vent one solid fuel fuel appliances appliances appliance appliances Column A Column B Column C Column D 1. 0.15 0.09 0.06 0.03 a) pressure factor (cfm/sf) b) conditioned floor area (sf) (including 3240 unfinished basements) Estimated House Infiltration (cfm): [la 486 x 1b] 2. Exhaust Capacity a) continuous exhaust-only ventilation system (cfm); (not applicable to balanced ventilation systems such as HRV) b) clothes dryer (cfm) 135 135 135 135 c) 80% of largest exhaust rating (dm); 240 Kitchen hood typically (not applicable if recirculating system or if powered makeup air is electrically interlocked and match to exhaust) d) 80% of next largest exhaust rating Not (cfm); bath fan typically Applicable (not applicable if recirculating system or if powered makeup air is electrically interlocked and matched to exhaust) Total Exhaust Capacity (cfm); 375 [2a + 2b +2c + 2d] 3. Makeup Air Quantity (cfm) 375 a) total exhaust capacity (from above) b) estimated house infiltration (from 486 above) Makeup Air Quantity (cfm); -111 Da -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 appliance or if there are no combustion appliances. (Power vent and direct vent appliances may be used.) B. Use this column if there is one fan-assisted appliance per venting system. (Appliances 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. Makeup Air Opening Table for New and Existing Dwelling Table 501.3.2 One or multiple One or multiple One atmospherically Multiple power fanassisted vented gas or oil atmospherically vent, direct vent appliances and appliance vented gas or oil appliances, power vent or direct or one solid fuel appliances Duct diameter or no combustion vent appliances appliance or solid fuel appliances appliances Column A Column B Column C Column D 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 318-419 196-258 136-179 84-110 9 w/motorized damper Passive opening 420 -539 259 -332 180 - 230 111-142 10 w/motorized damper Passive opening 540 -679 333- 419 231- 290 143 -179 11 w/motorized damper Powered makeup air >679 >419 >290 >179 NA Notes: A. 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 dud allowable. B. If flexible dud is used, increase the duct diameter by one inch. Flexible dud shall be stretched with minimal sags. Compressed dud shall not be accepted. C. Barometric dampers are prohibited in passive makeup air openings when any atmospherically vented appliance is installed. D. Powered makeup air shall be electrically interlocked with the largest exhaust system. Sections F Combustion air Not required per mechanical code (No atmospheric or power vented appliances) X Passive (see IFGC Appendix E, Worksheet E-1) Size and type 4" smooth or 5" Flex Other, describe: Explanation - If no atmospheric or power vented appliances are installed, check the appropriate box, not required. If a power ventedor atmospherically vented appliance installed, use IFGC Appendix E, Worksheet E-1 (see below). Please enter size and type. Combustionair vent supplies must communicate with the appliance or appliances that require the combustion air. Section F calculations follow on the next 2 pages. 41 Page Directions - The Minnesota Fuel Gas Code method to calculate to size of a required combustion air opening, is called the Known Air Infiltration Rate Method. For new construction, 4b of step 4 is required to be filled out. 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 or Power Vent _X_Direct Vent Input:_80000 BTU/HR Water Heater: -Draft Hood -Fan Assisted or Power Vent -Direct Vent Input:_Electric 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: ft LxWxH L W H Step 3: Determine Air Changes per Hour (ACH)1 Default ACH values have been incorporated into Table E-1 for use with Method 411 (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. (DO NOT COUNT DIRECT VENTAPPLIANCES) 4a. Standard Method Total Btu/hr input of all combustion appliances Input: Btu/Hr Use Standard Method column in Table E-1 to find Total Required TRV: ft3 Volume (TRV) 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 S. 4b. Known Air Infiltration Rate (KAIR) Method (DO NOT COUNT DIRECT VENT APPLIANCES) Total Btu/hr input of all fan-assisted and power vent appliances Input:_40000 Btu/Hr Use Fan-Assisted Appliances column in Table E-1 to find RFVA:_3000 ft3 Required Volume Fan Assisted (RVFA) Total Btu/hr input of all Natural draft appliances Input: Btu/hr Input: 0 Btu/Hr Use Natural draft Appliances column in Table E-1 to find RVNFA:_none ft3 Required Volume Natural draft appliances (RVNDA) Total Required Volume (TRV) = RVFA+RVNDA TRV=_3000 + none = 3000 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 S. 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 3000 = Step 6: Calculate Reduction Factor (RF). RF= 1 minus Ratio RF = 1- _ 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 Input: Btu/Hr (EXCEPT DIRECT VENT) Combustion Air Opening Area (CAOA): Total Btu/hr divided by 3000 Btu/hr per in2 CAOA = 40000 /3000 Btu/hr per in 13.33 Step 8: Calculate Minimum CAOA. Minimum CAOA = CAOA multiplied by RF Minimum CAOA = 13.33 x = in Step 9: Calculate Combustion Air Opening Diameter (CAOD) CAOD =1.13 multiplied by the square root of Minimum CAOA CAOD =1.13 V Minimum CAOA = in. diameter go up one inch in size if using flex duct 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) Known Air Infiltration Rate (KAIR) Method (cu ft) Fan Assisted or Power Vent Natural Draft Input Rating Standard Method 1994 to present Pre-1994 1994 to present Pre-1994 (Btu/hr) 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. 3578 Lemieux Circle HVAC Load Calculations for Ron Clark Mk ~ft ►C WACLo"s Prepared By: Alan Dobson Burnsville Heating & A/C Inc. 3451w Burnsville Pkwy, Suite 120 Bumsviile,MN 55337 952-894-0005 Monday, December 30, 2013 Rhvac is an ACCA approved Manual J and Manual D computer program. Calculations are performed per ACCA Manual J 8th Edition, Version 2, and ACCA Manual D. Pro ect Report Project Title: 3578 Lemieux Circle Designed By: Alan Dobson Project Date: Monday, December 30, 2013 Project Comment: Client Name. Ron Clark Company Name: Burnsville Heating & A/C Inc. Company Representative: Alan Dobson Company Address: 3451w Burnsville Pkwy, Suite 120 Company City: Burnsville,MN 55337 Company Phone: 952-894-0005 Company Fax: 952-894-0925 Company Comment: 5 Reference City: Minneapolis, Minnesota Building Orientation: Front door faces West Daily Temperature Range: Medium Latitude: 44 Degrees Elevation: 834 ft. Altitude Factor: 0.970 Elevation Sensible Adj. Factor: 1.000 Elevation Total Adj. Factor. 1.000 Elevation Heating Adj. Factor: 1.000 Elevation Heating Adj. Factor: 1.000 Outdoor Outdoor Outdoor Indoor Indoor Grains Dry Bulb Wet Bulb Rel.Hum Rel.Hum Dry Bulb Difference Winter: -15 -15.33 80°k n/a 72 n/a Summer: 88 73 50% 50% 75 35 Total Building Supply CFM: 1,028 CFM Per Square ft.: 0.317 Square ft. of Room Area: 3,240 Square ft. Per Ton: 1,549 Volume (ft) of Cond. Space: 29,150 Total Heating Required Including Ventilation Air: 52,024 Btuh 52.024 MBH b Total Sensible Gain: 21,949 Btuh 87 % Total Latent Gain: 3,144 Btuh 13 % Total Cooling Required Including Ventilation Air, 25,092 Btuh 2.09 Tons (Based On Sensible + Latent) T,. Rhvac is an ACCA approved Manual J and Manual D computer program. Calculations are performed per ACCA Manual J 8th Edition, Version 2, and ACCA Manual D. All computed results are estimates as building use and weather may vary. Be sure to select a unit that meets both sensible and latent loads according to the manufacturer's performance data at your design conditions. \\SBS20111RedirectedFoiders ...iRon Clark Avalon 3595 Lemieux Cir.rhv Monday, December 30, 2013, 11:45 AM n - d 1111111 11 gl ''I B~ i a + Miscellaneous 6e port Irdow ft. r r< W-7 Winter: -15 -15.33 80% nla 72 n/a Summer: 88 73 50% 50% 75 35.17 Malawi= INEMKOMWwwomm Main Trunk Runouts Calculate: Yes Yes Use Schedule: No No Roughness Factor: 0.00300 0.01000 Pressure Drop: 0.1000 in.wg./100 ft. 0.1000 in.wgJ100 ft. Minimum Velocity: 650 ft./min 450 ft./min Maximum Velocity: 900 ft./min 750 ft./min Minimum Height: 0 in. 0 in. Maximum Height: 0 in. 0 in. Winter Summer Infiltration Specified: 0.320 AC/hr 0.170 AC/hr 155 CFM 83 CFM Infiltration Actual: 0.320 AC/hr 0.170 AC/hr Above Grade Volume: X 29.150 Cu.ft. X 29,150 Cu.ft. 9,328 Cu.ft./hr 4,956 Cu.ft./hr X 0.0167 X 0.0167 Total Building Infiltration: 155 CFM 83 CFM Total Building Ventilation: 0 CFM 0 CFM ---System 1-- Infiltration & Ventilation Sensible Gain Multiplier: 13.87 = (1.10 X 0.970 X 13.00 Summer Temp. Difference) Infiltration & Ventilation Latent Gain Multiplier. 23.20 = (0.68 X 0.970 X 35.17 Grains Difference) Infiltration & Ventilation Sensible Loss Multiplier 92.85 = (1.10 X 0.970 X 87.00 Winter Temp. Difference) Winter Infiltration Specified: 0.320 AC/hr (155 CFM), Construction: Average Summer Infiltration Specified: 0.170 AC/hr (83 CFM), Construction: Average Attic beet ? Due 3R~c 1 [af#~ ~~9 di Sri nai% 1 Supply Main Attic 16B 0.12 6 150 No 1 Return Main Attic 16B 0.24 6 56 No \\SBS2011.\RedirectedFolders ...\Ron Clark Avalon 3595 Lemieux Cir.rhv Monday, December 30, 2013, 11:45 AM K x~ - Total Bulidin Summa Loads r w hbt: Glazing-hbt, ground reflectance = 0.23, u -value 0.29, 3 76 0 28 28 SHGC 0.3 hbt: Glazing-hbt, ground reflectance = 0.23, u-value 0.31, 229.5 6,192 0 6,818 6,818 SHGC 0.35 hbt: Glazing-hbt, ground reflectance = 0.23, u-value 0.3, 30 783 0 1,215 1,215 SHGC 0.37 hbt: Glazing-hbt, ground reflectance = 0.23, u-value 0.31, 75 2,023 0 2,905 2,905 SHGC 0.35 hbt: Glazing-hbt, u-value 0.31, SHGC 0.35 10 270 0 107 107 hbt: Glazing-hbt, ground reflectance = 0.23, u-value 0.3, 25 653 0 1,012 1,012 SHGC 0.37 Front Door. Door- 20.4 248 0 69 69 hbt: Door-hbt 19 232 0 64 64 12E-Osw: Wall-Frame, R-19 insulation in 2 x 6 stud 2011.1 11,895 0 2,106 2,106 cavity, no board insulation, siding finish, wood studs R-5 wall: Wall- 485.3 2,872 0 509 509 RC Rim Joist: Wall-Frame, Custom, RC Rim joist 225.5 1,628 0 288 288 16B-44-ad: Roof/Ceiling-Under Attic with Insulation on 1619.3 3,099 0 1,709 1,709 Attic Floor (also use for Knee Walls and Partition Ceilings), vented attic, no radiant barrier, R-44 insulation, dark asphalt 21A-32-v: Floor-Basement, Concrete slab, any thickness, 1619.7 2,818 0 0 0 2 or more feet below grade, no insulation below floor, vinyl covering, shortest side of floor slab is 32' wide Subtotals for structure: 32,789 0 16,830 16,830 People: 2 460 600 1,060 Equipment: 400 1,200 1,600 Lighting: 0 0 0 Ductwork: 4,800 368 2,173 2,540 Infiltration: Winter CFM: 155, Summer CFM: 83 14,435 1,916 1,146 3,062 Ventilation: Winter CFM: 0, Summer CFM: 0 0 0 0 0 _ Total Building Load Totals: 52,024 3,144 21,949 25,092 Total Building Supply CFM: 1,028 CFM Per Square ft.: 0.317 Square ft. of Room Area: 3,240 Square ft. Per Ton: 1,549 Volume of Cond. Space: 29,150 Total Heating Required Including Ventilation Air: 52,024 Btuh 52.024 MBH Total Sensible Gain: 21,949 Btuh 87 % Total Latent Gain: 3,144 Btuh 13 % Total Cooling Required Including Ventilation Air: 25,092 Btuh 2.09 Tons (Based On Sensible + Latent) Rhvac is an ACCA approved Manual J and Manual D computer program. Calculations are performed per ACCA Manual J 8th Edition, Version 2, and ACCA Manual D. All computed results are estimates as building use and weather may vary. Be sure to select a unit that meets both sensible and latent loads according to the manufacturer's performance data at your design conditions. i\SBS2011\RedirectedFolders ...\Ron Clark Avalon 3595 Lemieux Cir.rhv Monday, December 30, 2013, 11:45 AM C! System 1 Main Floor Summary Loads k' K y hbt: Glazing-hbt, ground reflecfance - 0.23, u-v I 0.29, 3 76 - 0 a 2$ 28 SHGC 0.3 hbt: Glazing-hbt, ground reflectance = 0.23, u-value 0.31, 229.5 6,192 0 6,818 6,818 SHGC 0.35 hbt: Glazing-hbt, ground reflectance = 0.23, u-value 0.3, 30 783 0 1,215 1,215 SHGC 0.37 hbt: Glazing-hbt, ground reflectance = 0.23, u-value 0.31, 75 2,023 0 2,905 2,905 SHGC 0.35 hbt: Glazing-hbt, u-value 0.31, SHGC 0.35 10 270 0 107 107 hbt: Glazing-hbt, ground reflectance = 0.23, u-value 0.3, 25 653 0 1,012 1,012 SHGC 0.37 Front Door: Door- 20.4 248 0 69 69 hbt: Door-hbt 19 232 0 64 64 12E-Osw: Wall-Frame, R-19 insulation in 2 x 6 stud 2011.1 11,895 0 21106 2,106 cavity, no board insulation, siding finish, wood studs R-5 wall: Wall- 485.3 2,872 0 509 509 RC Rim Joist: Wall-Frame, Custom, RC Rim joist 225.5 1,628 0 288 288 16B-44-ad: Roof/Ceiling-Under Attic with Insulation on 1619.3 3,099 0 1,709 1,709 Attic Floor (also use for Knee Walls and Partition - Ceilings), vented attic, no radiant barrier, R44 insulation; dark asphalt 21A-32-v: Floor-Basement, Concrete slab, any thickness, 1619.7 2,848 0 0 0 2 or more feet below grade, no insulation below floor, vinyl' covering, shortest side of floor slab is 32' wide - Subtotals for structure: 32,789 0 16,830 16,830 People: 2 460 600 1,060 Equipment: 400 1,200 1,600 Lighting: 0 0 0 Ductwork: 4,800 368 2,173 2,540 Infiltration: Winter CFM: 155, Summer CFM: 83 14,435 1,916 1,146 3,062 Ventilation: Winter CFM; 0, Summer CFM: 0 0 0 0 0 System 1 Main Floor Load Totals: 52,024 3,144 21,949 25,092 Supply CFM. 1,028 CFM'Per Square ft.: 0.317 Square ft. of Room Area: 3,240 Square ft. Per Ton: 1,549 Volume (W) of Cond. Space: 29,150 Total Heating Required Including Ventilation Air. 52,024 Btuh 52.024 MBH Total Sensible Gain: 21,949 Btuh 87 % Total Latent Gam 3,144 Btuh 13 % Total Cooling Required Including Ventilation Air: 25,092 Btuh 2.09 Tons (Based On Sensible + Latent) Rhvac is an ACCA approved Manual J and Manual D computer program. _ tq Calculations are performed per ACCA Manual J 8th Edition, Version 2, and ACCA Manual D. Ail computed results are estimates as building use and weather may vary. Be sure to select a unit that meets both sensible and latent loads according to the manufacturer's performance data of your design conditions. XISBS2011lRedirectedFolders ...\Ron Clark Avalon 3595 Lemieux Cir.rhv Monday, December 30, 2013, 11:45 AM Nam: 33 7r~ " wil' NO, "1 00-6- System 1, Zone ? Summa Loads Peak Load Procedure for Rooms hbt: Glazing-hbt, ground reflectance = 0.23, u-value 0.29, 3 76 0 28 28 SHGC 0.3 hbt: Glazing-hbt, ground reflectance = 0.23, u-value 0.31, 132 3,561 0 3,839 3,839 SHGC 0.35 hbt: Glazing-hbt, ground reflectance = 0.23, u-value 0.3, 30 783 0 1,215 1,215 SHGC 0.37 hbt: Glazing-hbt, ground reflectance = 0.23, u-value 0.31, 33 890 0 1,278 1,278 SHGC 0.35 hbt: Glazing-hbt, u-value 0.31, SHGC 0.35 10 270 0 107 107 Front Door Door- 20.4 248 0 69 69 hbt: Door-hbt 19 232 0 64 64 12E-Osw: Wall-Frame, R-19 insulation in 2 x 6 stud 1252 7,405 0 1,312 1,312 cavity, no board insulation, siding finish, wood studs 161344-ad: Roof/Ceiling-Under Attic with Insulation on 1619.3 3,099 0 1,709 1,709 Attic Floor (also use for Knee Walls and Partition Ceilings), vented attic, no radiant barrier, R-44 _ _insulation,_ dark asphalt Subtotals for structure: 16,564 0 11,112 11,112 People: 2 460 600 1,060 Equipment: 400 1,200 1,600 Lighting: 0 0 0 Ductwork: 2,385 0 1,263 1,263 Infiltration: Winter C_FM: 74, Summer CFM: 40 6,906 917 548 1,465 System 1, Zone 1 Load Totals: 25,855 .-1,777 14,723 16,500 00 Supply CFM: 690 CFM Per Square ft.: 0.426 Square ft. of Room Area: 1,620 Square ft. Per Ton: 1,178 Volume (ft3) of Cond. Space: 14,573 Total Heating Required: 25,855 Btuh 25.855 MBH Total Sensible Gain: 14,723 Btuh 89 % Total Latent Gain: 1,777 Btuh 11 % Total Cooling Required: 16,500 Btuh 1.38 Tons (Based On Sensible + Latent) Rhvac is an ACCA approved Manual J and Manual D computer program. Calculations are performed per ACCA Manual J 8th Edition, Version 2, and ACCA Manual D. All computed results are estimates as building use and weather may vary. Be sure to select a unit that meets both sensible and latent loads according to the manufacturer's performance data at your design conditions. \\SBS2011\RedirectedFolders ...\Ron Clark Avalon 3595 Lemieux Cir.rhv Monday, December 30, 2013, 11:45 AM . b F!'_010- e.__ ..-_1PtiVALaa' ~U a k x W KL. 3 359x. A.. # ' _ 13 e S stem I, Zone 2 Summa Loads Peak Load Procedure for Rooms F L r? h hbt: Glazing-hbt, ground reflectance = 0.23, u-value 0.31, 97.5 2,631 0 2,979 2,979 SHGC 0.35 hbt: Glazing-hbt, ground reflectance = 0.23, uvalue 0.3, 25 653 0 1,012 1,012 SHGC 0.37 hbt: Glazing-hbt, ground reflectance = 0.23, u-value 0.31, 42 1,133 0 1,627 1,627 SHGC 0.35 12E-Osw: Wall-Frame, R-19 insulation in 2 x 6 stud 759.2 4,490 0 794 794 cavity, no board insulation, siding finish, wood studs R-5 wall: Wall- 485.3 2,872 0 509 509 RC Rim Joist: Wall-Frame, Custom, RC Rim joist 225.5 1,628 0 288 288 21A-32-v: Floor-Basement, Concrete slab, any thickness, 1619.7 2,818 0 0 0 2 or more feet below grade, no insulation below floor, vin I covering, shortest side of floor slab is 32' wide Subtotals for structure: 16,225 0 9,087 9,087 People: 0 0 0 0 Equipment: 0 0 0 Lighting: 0 0 0 Ductwork: 2,414 0 909 909 Infiltration: Winter CFM: 81, Summer CFM: 43 7,529 999 598 1,597 System 1, Zone 2 Load Totals: 26,168 999 10,594 11,593 Supply CFM: 496 CFM Per Square ft.: 0.306 Square ft. of Room Area: 1,620 Square ft. Per Ton: 1,677 Volume (ft') of Cond. Space: 14,577 Y 3 < n Total Heating Required: 26,168 Btuh 26.168 MBH Total Sensible Gain: 10,594 Btuh 91 % Total Latent Gain: 999 Btuh 9 % Total Cooling Required: 11,593 Btuh 0.97 Tons (Based On Sensible + Latent) Rhvac is an ACCA approved Manuat J and Manual D computer program. j Calculations are performed per ACCA Manual J 8th Edition, Version 2, and ACCA Manual D. All computed results are estimates as building use and weather may vary. Be sure to select a unit that meets both sensible and latent loads according to the manufacturer's performance data at your design conditions. \\SBS2011\RedirectedFolders ...\Ron Clark Avalon 3595 Lemieux Cir.rhv Monday, December 30, 2013, 11:45 AM _ L rt L,, t" Iij ' ~11#16 6 4 111111 Rmsmi tone as }o HUI yDetailed Room Loads - Room 9 - Basement Peak Fenestratio n Gain Procedure) Room is in zone 2, which peaks at 10 am Calculation Mode: Htg. & clg. Occurrences: 1 Room Length: 41.5 ft. System Number. 1 Room Width: 39.0 ft. Zone Number: 2 Area: 1,620.0 sq.ft. Supply Air: 496 CFM Ceiling Height: 9.0 ft. Supply Air Changes: 2.0 AC/hr Volume: 14,577.0 cu.ft. Req. Vent. Cig: 0 CFM Number of Registers: 1 Actual Winter Vent.: 0 CFM Runout Air: 496 CFM Percent of Supply.: 0 % Runout Duct Size: 12 in. Actual Summer Vent.: 0 CFM Runout Air Velocity: 632 ft./min. Percent of Supply: 0 % Runout Air Velocity: 632 ft./min. Actual Winter Infil.: 81 CFM Actual Loss: 0.096 in.wg.1100 ft. Actual Summer Infil.: r 43 CFM F E -Wall-12E-0sw 39 X 9 234 0.068 5.9 1,384 - 1.0 0 245 N -Wail-12E-Osw 41.5 X 9 373.8 0.068 5.9 2,211 1.0 0 391 S -Wall-R-5 wall 9.8 X 3.6 35.3 0.068 5.9 209 1.0 0 37 W -Wall-R-5 wall 39 X 9 351 0.068 5.9 2,077 1.0 0 368 E -Wall-RC Rim Joist 39 X 1.4 54.6 0.083 7.2 394 1.3 0 70 N Wail-RC Rim Joist 41.5 X 1.4 58.1 0.083 7.2 420 1.3 0 74 W -Wall-RC Rim Joist 39 X 1.4 54.6 0.083 7.2 394 1.3 0 70 S -Wall-RC Rim Joist 41.5 X 1.4 58.1 0.083 7.2 420 1.3 0 74 S -Wall-12E-0sw 9.8 X 5.6 37.4 0.068 5.9 221 1.0 0 39 S -Walt-12E-Osw 16 X 9 114 0.068 5.9 674 1.0 0 1.19 S -Watt-R-5 wall 11 X 9 99 0.068 5.9 586 1.0 0 104 E -GIs-hbt shgc-0.35 0%oS (2) 30 0.310 27.0 810 52.8 0 1,584 E -GIs-hbt shgc-0.37 O%S 25 0.300 26.1 653 55.6 0 1,389 S -GIs-hbt shgc-0.35 O%oS 17.5 0.310 27.0 472 26.3 0 460 S -GIs-hbt shgc-0.35 O%S 30 0.310 27.0 809 26.3 0 789 E -GIs-hbt shgc-0.35 O%S (2) 20 0.310 27.0 540 52.8 0 1,056 E -GIs-hbt shgc-0.35 0%S 42 0.310 27.0 1,133 52.8 0 2,218 Floor-21A-32 39 X 41.5 1619.7 0.020 1.7 2,818 0.0 0 0 Subtotals for Structure: 16,225 0 9,087 Infil.: Win.: 81.1, Sum.: 43.1 1,634 4.607 7,529 0.366 999 598 Ductwork: 2,414 909 .I-._..__..................... Room Totals: 26,168 999 10,594 \1SBS2011\RedirectedFolders ...\Ron Clark Avalon 3595 Lemieux Cir.rhv Monday, December 30, 2013, 11:45 AM & .y f _ . i e o a alts u: System I Room Load Summa p r Afe2 .fi SenS } .r # buCt Ea r . -Zone 1--- 1 Foyer 54 830 11 1-2 467 218 27 10 10 2 Flex Room 151 3,729 50 1-5 331 964 136 45 45 3 Kitchen 380 2,305 31 1-7 342 1,951 79 91 91 4 Dining 129 4,310 58 1-7 584 3,332 125 156 156 5 Great Room 242 3,758 50 1-8 496 3,698 107 173 173 6 Master Bedroom 218 4,332 58 1-7 559 3,190 624 149 149 7 Master Bath 133 1,366 18 1-2 641 299 57 14 14 8 Mud Room 313 5,227 70 1-4 576 1,072 622 50 50 Zone 1 subtotal 1,620 25,855 346 14,723 1,777 690 690 -Zone 2- _._...9.._ Basement....._ ......_1,620.........26,.1.68....._.__.......350......_.......1-12... _.632.........10,594.._.._._ ..999_.....:._..496.._......_...__496... Zone 2 subtotal 1,620 26,168 350 10,594 999 496 496 Duct Latent 368 System 1 total 3,240 52,024 696 21,949 3,144 1,028 1,028 System 1 Main Trunk Size: 11x16 in. Velocity: 841 ft./min Loss per 100 ft.: 0.109 in.wg - _ Note. $Ince the system is muitizone, the Peak Fenestration Gain Procedure was used to determine glass sensible gains at the room and zone levels, so the sums of the zone sensible gains and airflows for cooling shown above are not intended to equal the totals at the system level. Room and zone sensible gains and cooling CFM values are for the hour in which the glass sensible gain for the zone is at its peak. Sensible gains at the system level are based on the "Average Load Procedure + Excursion" method. 1 u' Cooling Sensible/~afen# Shsible ,Latent_ Net Required: 2.09 87%/13% 21,949 3,144 25,092 1lSBS20111RedirectedFolders ...\Ron Clark Avalon 3695 Lemieux Cir.rhv Monday, December 30, 2013; 11:45 AM } LOT SURVEY CHECKLIST FOR RESIDENTIAL BUILDING PERMIT APPLICATION PROPERTY LEGAL: DATE OF SURVEY: 2- LATEST REVISION: m c as L U O z Q DOCUMENT STANDARDS / ❑ 0 • Registered Land Surveyor signature and company 00 D • Building Permit Applicant ,g 0 ❑ • Legal description 19 ❑ ❑ • Address -.0< 0 D • North arrow and scale ,B ❑ 0 • House type (rambler, walkout, split w/o, split entry, lookout, etc.) ,0' 0 D • Directional drainage arrows with slope/gradient % Z' 0 ❑ • Proposed/existing sewer and water services & invert elevation .0"0 0 • Street name 2' ❑ D • Driveway (grade & width - in R/W and back of curb, 22' max.) ,AT 0 0 • Lot Square Footage ❑ ❑ • Lot Coverage ELEVATIONS Existing 0 0 • Property corners 0 ❑ Top of curb at the driveway and property line extensions ❑ 0 • Elevations of any existing adjacent homes ,,0' 0 0 • Adequate footing depth of structures due to adjacent utility trenches 0 ❑ • Waterways (pond, stream, etc.) Proposed ❑ 0 • Garage floor ,B 0 0 • Basement floor 'X 0 D • Lowest exposed elevation (walkout/window) ,@' ❑ ❑ • Property corners 113' ❑ 0 • Front and rear of home at the foundation PONDING AREA (if applicable) ❑ -X 0 • Easement line 0 ❑ • NWL 0 0 • HWL ❑ a ❑ • Pond # designation 0 "3' 0 • Emergency Overflow Elevation ❑ • Pond/Wetland buffer delineation Y • Shoreland Zoning Overlay District Y' • Conservation Easements DIMENSIONS .2" ❑ 0 • Lot lines/Bearings & dimensions 0 0 • Right-of-way and street width (to back of curb) 0 0 • Proposed home dimensions including any proposed decks, overhangs greater than 2', porches, etc. (i.e. all structures requiring permanent footings) ,Y ❑ ❑ • Show all easements of record and any City utilities within those easements 0 ❑ • Setbacks of proposed structure and si setback of adjacent existing structures ❑ ❑ • Retaining wall requirements: Reviewed By: Date WFORMStBuilding Permit Application Rev. 11-26-04 u. \[-uiiu r f uitfL lb \D Uu i i u I Lu \Uvvy V uu - 3 -,-I z_).uuy, Z_ z/ Z_ u i u ~J.ui : i o tiiw, o - iiune Certificate of Survey for: RON CLARK CONSTRUCTION & DESIGN 952.8 Denotes Existing Elevation HOUSE TYPE: TOWNHOUSE FULL BASEMENT WALKOUT Job # 131601.10-125 981.5 Denotes Proposed Elevation Date: 10/29/2013 Denotes Surface Drainage PROPOSED HOUSE ELEVATIONS: GARAGE FLOOR ELEVATION = 889.5 Scale: 1"=20' O Denotes 1/2" iron pipe set TOP OF FOUNDATION ELEV = 889.8 • Denotes 1/2" iron pipe found. LOWEST FLOOR ELEVATION = 881.1 to ,77 c. B. ~7~ J + FL 886.83 I I I oc Retaiiiiog Wall Wit! Du.. So ReQui'Qd___,__d - - - EAGAN ENGWEERIN D LEMIEUX CIRCLE EX. CB FL 86 N r s T OC 96 6C 6, G G of PRD SAN. PRD SAN. o SERV. 878.0 SERV. 878.0 PROF IDE AND 'I 'FAIN INL PROTEC I UN'rlL N89°53'33"E ° 106.0 0 FIN TURF IS BL 53.00 e$$%~ 1 0 53.)32.00 N 6 1 866 i t D, 54.50 889.3 _ e$9 889.3 89 ~Rr~~ 21.0 0 19.5 ~~p t oP0 /P ~J S~ y W s LLJ 00 o~ C~ C7 ~ `L• ~ Q Q r7 C6 N (,7 (.7 N PORCH 88~g PORCH O ? $°O O - O 18.0 6683 18.0 889.3 0 cV 886. 9 10 8 886.8 N ' Z (0000 883 8 PROPOSED BUILDING Rio Lot Area: 6572 S.F. Lot Area: 6572 S.F. f M W F8-8-3--61 Coverage: 2080 S.F. Coverage: 2100 S.F. 883.6 Z Z p°p0 °O V' #3578 #3576 880: 0 N I N 880.6 Q (.0 (V > X _ W I 00 Q) O (D o O 882. 66j O J O 0 11.0 M r7 2 I J O oaa~5 12:67 12.67 0 O r~---~ - _ DECK 5.33 N &O6 DO ^ ' 25.00 °I ~v{ EX. STMABOVE col AL--RE 897.85 SPLIT X x RAIL X - x FENCE T~ O 44 sip c, 66 `~6) O O`),s Q Oo 6' s~ 6,R3 EX. STMH 6s s~ a6 6~ 66 0~ 668 0 6e~ RE 872.57 EXISTING STONE RET. WALL 2 EX. FES 661 8609 IE 865.95 53.00 i 861° 53:00. N8f53'33"E 603106.00 639 - EDGE OF WATER Lots 9 and 10, Block 3, PEARLMONT HEIGHTS, Dakota County, MN I hereby certify that this survey, plan, or report was prepared by me or under my direct supervision and that I am a duly Licensed Land Surveyor under the laws of the state of Minnesota. Oliver Surveying & Engineering, Inc. 12 Oliver Surveying & Engineering, Inc. By: Rick M. Blom, LS Land Surveying • Civil Engineering- Land Planning 580 Dodge Ave. Elk River, MN 55330. 763.441.2072 fac. 763.441.5665 License No. 21729 www.oliver-se.com Date: 10/29/2013 Rev.: 12/16/2013 new house N ' Use BLUE or BLACK Ink i For Office Use � � i � � Permit#: � � � Cl�� Of���I�Il � �. �� � Permit Fee: � 3830 Pilot Knob Road RECEI,iIED i ,��� ' i Eagan MN 55122 � Date Received: � Phone:(651)675-5675 ��(�� ? s �p�� I � i Fax:(651)675-5694 I Staff: I I �________________J. 1' .. ) �� 2014 RESIDENTIAL BUILDING PERMIT APPLICATION ��`� - �°1 Date: �i�►�i� ►T Site Address: �IN�;C i 'C Unit#: �• � � ����o � n «x�� � �� � � ������ , : Name: �1� ��� C.ov��� � t Phone���'��.•�Q�1• ��0�� ' � � =w ' a ��4��I� T— ' �����= aaaress i c�ty i z�p:-'l� wl• ��?�1 °�; �.1v��� 1''t� '�'�`Z�_ � ����� � � �� � � � '��C� et � � ��� ,� Applicant is: �Owner �Contractor � � � � ��� ��� �� r � ��������NI������ ��� Description ofwork: �.0�!✓ �✓C� �1V�iS.� � r�� ' �_t n��'� � � Construction Cost: Multi-Family Building: (Yes�/No_) EE�. � ��� v , �, �� '� _ ���``� Company: �G�yti� GtS f��V�!'. Contact: � ��� ����� ` Address City: ih���, � � ���,�rT � ���� State: Zip: � Phone: EmaiL � ������- �� , ���]ry�i���� � -� License#: �2� Lead Certificate#:� If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING , In the last 12 months,has the City of Eagan issued a permit for a similar plan based on a master plan? �Yes No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer&Water Contractor: Phone: � u � s� � �d � , ����� ��� _ �� � - , ���� �� � � ,, �, — � � �� ���a,� '_ , ��I��'�� � ��� ��� '�� 5 �� ��- �� �° 4 � � u- i���, � ��� , � � ` �.-- ,,,,,,a, ��&a „��,���' �,,,a� . ��'�:_. ����'-� r, --_� � .� � a �,�� n�� zrm ,, r , � _= � �,� CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.ora I hereby acknowledge that this information is complete and accurate;that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuance. � X T�'���{�—���Fr ` x Applicant's Printed Name Ap ican s S' ature Page 1 of 3 r . � l J�'7� �j"'t f�',e (J � �,L� DO NOT WRITE BELOW THIS LINE �°��I � SUB TYPES _ Foundation _ Fireplace _ Porch(3-Season) _ Exterior Alteration(Single Family) Single Family Garage Porch(4-Season) Exterior Alteration(Multi) _ Multi Deck _ Porch(Screen/Gazebo/Pergola) _ Miscellaneous _ 01 of_Plex �' Lower Level _ Pool _ Accessory Building WORK TYPES �( New _ Interior Improvement _ Siding _ Demolish Building* T� _ Addition _ Move Building _ Reroof Demolish Interior Alteration Fire Repair Windows Demolish Foundation _ Replace _ Repair _ Egress Window _ Water Damage Retaining Wall *Demolition of entire building—give PCA handout to applicant DESCRIPTION Valuation �7 3, �1 �1-�h Occupancy ��G � MCES System Plan Review Code Edition Zvo� MSj�(� SAC Units (25%_100%�) Zoning �Q City Water Census Code Stories Booster Pump #of Units Square Feet PRV #of Buildings Length Fire Sprinklers Type of Construction � Width REQUIRED INSPECTIONS Footings(New Building) Meter Size: Footings(Deck) � Final/C.O. Required Footings (Addition) Final/No C.O. Required Foundation HVAC Gas Service Test Gas Line Air Test Roof:_Ice&Water _Final PooL•_Footings Air/Gas Tests Final �C Framing Drain Tile � Fireplace: �Rough In �i4ir Test �Final Siding:_Stucco Lath _Stone Lath _Brick � Insulation Windows Sheathing Retaining Wall:_Footings_Backfill_final Sheetrock Radon Control Fire Walls Erosion Control Braced Walls Other: Reviewed By: , Building Inspector RESIDENTIAL FEES Base Fee ��."� �� Surcharge � �3 � � �� •,�3 °'"`� ��/ � 'Z� ' Plan Review � $�.(,�� MCES SAC City SAC Utility Connection Charge S&W Permit&Surcharge Treatment Plant Copies TOTAL Page 2 of 3 . Clty of����� Address: 3578 Lemieux Circle Permit#: 120177 The following items were/were not completed at the Final Inspection on: �-e jou-e�) �'"� Zf��S� Ca�pFet� 1r���mplete . '��mments �d Final grade - 6"from siding � Permanent steps— Garage Permanent steps— Main Entry Permanent Driveway � Permanent Gas Retaining Wall or 3:1 Max Slope Q(� S((�'l � �E�-�j o Seeded Lawn Trail / Curb Damage � Porch ��.� � Lower Level Finish �°� Deck �� Fireplace 2 J � • Verify with your builder that roof test caps from the plumbing system have been removed. • Turn off water supply to the outside lawn faucets before freeze potential exists. • Call the Engineering Department at (651) 675-5646 prior to working in the right-of-way or installing an irrigation system. Building Inspector: � � � � � G:\Building Inspections\FORMS\Checklists , � Use BLUE or BLAC 111/11 C) For Office Use k)6 1411 *#` # *#� Permit#: 7 Vo Il it, a r Permit Fee: 0.„ j_/ - $tts "> Date Received: 3830 Pilot Knob Road I Eagan MN 55122 Staff: Phone:(651)675-5675 I Fax:(651)675-5694 buildinginspections(a�citvofeagan.com 2017 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 11-17-2017 Site Address: 3578 Lemieux Circle unit#: 111i H Eric Piepho h „lu Name: Phone: etig 3578 Lemieux Circle �yyype ,, Address/City/Zip: Applicant is: Owner X Contractor 7� r Description of work: See Attached Scope 300 Construction Cost: '00 Multi-Family Building: (Yes /No x ) company: Ron Clark Construction Contact: Steve Pittorf itra r � Address: 7500 West 78th Street city: Edina • E tra6 file 55439 952-947-3014 stevep@ronclark.com MN State: Zip: Phone: Email: BC - 1220 License#: Lead Certificate#: If the project is exempt from lead certification, please explain why: B/J i t,T /./2 „/zj COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? Yes No If yes,date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer&Water Contractor: Phone: Fire Suppression Contractor: Phone: NOTE `ansa`< uppo 51 'ents.thate.u it of onsiderred to be ° `_f4tz ttr,P s. �r��a d /: r d as =pt�bir Iia u e o spec h. awote!a?"•',t You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's website at www.citvofeaoan.com/subscribe. Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuance. CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.orq I hereby acknowledge that this information is complete and accurate;that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plan xSteve Pittorf x Applicant's Printed Name ,,4pplicant's Signature Page 1 of 3 DO NOT WRITE BELOW THIS LINE '6.--7C- Lorki l e--t/v 0/4-- SUB TYPES Foundation _ Fireplace _ Porch(3-Season) Exterior Alteration(Single Family) Single Family Garage Porch(4-Season) _ Exterior Alteration(Multi) _ Multi _ Deck _ Porch(Screen/Gazebo/Pergola) _ Miscellaneous it. 01 of 2,Plex _ Lower Level _ Pool Accessory Building WORK TYPES New Interior Improvement _ Siding _ Demolish Building* Addition _ Move Building Reroof _ Demolish Interior Alteration _ Fire Repair _ Windows Demolish Foundation Replace Repair _ Egress Window Water Damage Retaining Wall *Demolition of entire building-give PCA handout to applicant DESCRIPTION Valuation 'SOW Occupancy I at, - 1 MCES System -r, Plan Review7 Code Edition /0/0 SAC Units - (25%_100% Zoning ;p,0 City Water Census Code A/3 Si Stories '-' Booster Pump #of Units Square Feet PRV �-- #of Buildings I Length "' Fire Suppression Required Type of Construction 7.13 Width .r REQUIRED INSPECTIONS Footings(New Building) eter Size: Footings(Deck) . Final I C.O. Required Ifr- Footings (Addition) ,7,✓'Z44. * Final I No C.O. Required Foundation Foundation Before Backfill HVAC_Gas Service Test Gas Line Air Test Roof:_Ice& ater _Final Pool: Footings Air/Gas Tests _Final Framing V30 Minutes 1 Hour Drain Tile Fireplace: _Rough In _Air Test _Final Siding: Stucco Lath _Stone Lath Brick_EFIS Insulation Windows Sheathing Retaining Wall:_Footings_Backfill_Final Sheetrock Radon Control Fire Walls Fire Suppression:_Rough In_Final Braced Walls Erosion Control Shower Pan Other: Reviewed By: G , Building Inspector RESIDENTIAL FEE Base Fee $`g' Surcharge Plan Review .r'2 5 - MCES SAC City SAC Utility Connection Charge S&W Permit&Surcharge Treatment Plant Copies TOTAL Page 2 of 3 chestnut c a m b r o nn e Chestnut Cambronne PA ATTORNEYS AT LAW 17 Washington Avenue North Suite 300 / Minneapolis,MN 55401-2048 AN [ 2U1$ T:612.333.7300 U F:61 2.336.2940 Christopher P.Renz www.chestnutcambronne.com crenz@chestnutcambronne.com January 19, 2018 City of Eagan Via U.S.Mail Attn: Building Inspections 3830 Pilot Knob Road Eagan, MN 55122 Re: 3578 Lemieux Circle, Eagan, MN Dear Sir or Madam: I am writing to request a copy of the plans and supporting documents that were submitted with the 2017 Residential Building Permit Application on November 17, 2017, a copy which is attached hereto. Enclosed please find a check in the amount of$8.00 for the applicable copy fees. Please contact me should you have any questions or need anything further. Very truly yours, CHESTNUT CAMBRONNE PA Christopher P. Lenz Attorney at Law cc: Eric and Kevra Piepho (by e-mail only) Sarah B. Bennett, Esq. (by e-mail only) 0-A I/ ezvy 1-41 474-7677°V minneapolis I st. pain P . viet- • � • RECEIVED For Office Use f � a � A2A � �( SQ! F'0 :ze: Date Received: ✓ - itr 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 (651)675-5675 I TDD:(651)454-8535 I FAX:(651)675-5694 Staff: buildinginspections(a�cityofeagan.com L X,,A1 2018 RESIDENTIAL BUILDING PERMIT APPLICATION Date: .3 1,Y l r Si Site Address: Unit#: Name:AkLY ) Poppe4 (?)s--1(05, -'M 1� .%() Phone: C51- C38- 735(0 Resident/ Own r Address/City/Zip: 35-74 3 S7', 3,Sso; 35'76', 357i /-ep'ix(2 X CI1, ivuj f,sizes Applicant is: Owner X Contractor A Description of work: is Ft t$TG>NL 1 'Aei 12-f7;47 NT ,GAG- l l Type of Mori`;; Construction Cost: SZ 000, OO Multi-Family Building:(Yes ,X /No Company: I (LI Id P 2 SA!! ( j:S Y A) Contact: --rid M(�ri-77Z c2 i/ , ejO Mu1.7 lt_`` Address: I7�J J S 5 /U/j 1"7_ /J4,) sir* 11 City: /f ' ?ivtG�t_1i State:Mt) Zip: ,s-7,3-0(05, Phone: 4..3/ -‘10. ,?l 7Email: r,(j2(,7J 406 Lid et-414-5.'1"S, tail/ License#: Lead Certificate#: AY4 If the project is exempt from lead certification, please explain why: COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? Yes No If yes,date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer&Water Contractor: Phone: Fire Suppression Contractor: Phone: ;NOM Plan nd supporting documents that yo submit a m s'idered to be pabii 5 ation. a _ , y . classifif s non public if t u provides•_ � sans that would perrnr�� icy to conclude that,i d 7:_... k=*, You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's website at www.citvofeagan.com/subscribe. Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuance. CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.orq I hereby acknowledge that this information is complete and accurate;that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approvedplanin the case of work which requires a review and approval of plans. Applicant's Printed Name )Pficants Sigpaure DO NOT WRITE BELOW THIS LINE k{ (..k, i 40 D 6 . SUB TYPES Foundation _ Fireplace _ Porch(3-Season) _ Exterior Alteration(Single Family) _ Single Family Garage Porch(4-Season) _ Exterior Alteration(Multi) _ Multi _ Deck _ Porch(Screen/Gazebo/Pergola) Miscellaneous 01 of Plex Lower Level Pool Accessory Building WORK TYPES _ New _ Interior Improvement _ Siding _ Demolish Building* _ Addition _ Move Building _ Reroof _ Demolish Interior _ Alteration _ Fire Repair _ Windows _ Demolish Foundation Replace _ Repair _ Egress Window _ Water Damage Retaining Wall *Demolition of entire building-give PCA handout to applicant DESCRIPTION Valuation J 5^2-) ." Occupancy MCES System Plan Review Code Edition #44 Z°IS— SAC Units (25%_100%ld) Zoning ?D City Water Census Code Stories Booster Pump #of Units Square Feet PRV #of Buildings '2 Length Fire Suppression Required Type of Construction ' V Width REQUIRED INSPECTIONS Footings (New Building) Meter Size: Footings (Deck) Final/C.O. Required Footings (Addition) Final/No C.O. Required Foundation Foundation Before Backfill HVAC Gas Service Test Gas Line Air Test Roof:_Ice &Water Final Pool:_Footings _Air/Gas Tests _Final Framing 30 Minutes 1 Hour Drain Tile Fireplace: Rough In Air Test Final Siding: _Stucco Lath Stone Lath _Brick_EFIS Insulation Windows Sheathing 1, Retaining Wall: O Footings ? Backfill O Final Sheetrock Radon Control Fire Walls Fire Suppression: Rough In_Final Braced Walls Erosion Control Shower Pan Other: r- - jj Reviewed By: C ' 17 A,!' 0// cyn! , Building Inspector RESIDENTIAL FEES Base Fee Surcharge Plan Review MCES SAC City SAC Utility Connection Charge S&W Permit&Surcharge Treatment Plant Copies TOTAL Page 2 of 3 . i o riy nFyy ro 6/CH r Z why Ny N... 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J . m4 ^ \ —87a� –� \ u) u;a 4 1 .....4 N 4. $4, (1- -I-- I \coar rtsfA(kw?ik' )fd.ii ) � ' �Z �4. 20 ' • - ii'' g . :� i Q ct W m , I / } 0,6 --= t • �{F7 r O� 1 O kJ 0 r CO 1:::1) n 8 O / r '. \. \ f I V r` c n.,; \ ' oW \ \ a) eV, re,05 I M Z a �� E Jeffrey Wheeler From: Steve Pittorf <stevep@ronclark.com> Sent: Tuesday, December 3, 2019 1:11 PM RECEIVED To: Jeffrey Wheeler Subject: Cancel Permit# 147404 3578 Lemieux Circle DEC 0 3 2019 Jeff, At this time Ron Clark Construction will not be performing any additional work at this address. Please cancel permit #147404. My understanding at this time is the homeowner has contracted with someone else to perform the work. Thank You Steve Pittorf Project Manager Ron Clark Construction 952-947-3014 stevep@ronclark.com This email has been scanned for email related threats and delivered safely by Mimecast. For more information please visit http://www.mimecast.com 1 r For Office Use r A .t� v 4L % ��i Permit#: ( / EAGANPermit Fee: g RECEIVERDate Received: 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 11I (651)675-5675 I TDD: (651)454-8535 I FAX: (651)675-5694 DEC 0 2 2019 Staff: buildinuinspectionst citvofeagan.com 2019 RESIDENTIAL BUILDING PhRMIT APPLICATION Date: af(?c)-/ Site Address: -72? •�u�i. ��c - MA, nit#: Name: Phone: Resident/ Owner Address/City/Zip: .0 Cl`r�'�12D44 rC/ `1TS Applicant is: Owner Contractor /I n I n ( _ Description of work: '1—t:%&C) ` 8�w '"osr 3 ( Type of Work _ Construction Cost: # � U • Multi-Family Building: (Yes ✓/No ) Company: f' 1 e-.\-CO rl SSS Contact: j(I'`'N-A Contractor Address: aCl I toClt- 1 C\ Al v.) City: R i 8-C Lot Y\e. • State: '1 IN Zip: fS5,7 Phone: (91).—c9-7c-7/ 1 Email: hr')-f' FA)et. Y""&rngl/. �Dp License#: b G 7 03 gq Lead Certificate#: /��' � 8) 7/ If the project is exempt from lead certification, please explain why: CSI 4/1 �s COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? Yes No If yes,date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer&Water Contractor: Phone: Fire Suppression Contractor: Phone: NOTE Plans and supporting documents that you submit are considered to be public information. Portions of the information maybe classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets. You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's website at www.citvofeaaan.com/subscribe. Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuance. CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org I hereby acknowledge that this information is complete and accurate;that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of ans. Di Niko R46111€444) Applicant's Printed Name Applicant's Signature DO NOT WRITE BELOW THIS LINE .,..5 J 7b 2_C OA / &-- LL Y 0 I'� / `. _ -•- - SUB TYPES Foundation _ Fireplace _ Porch(3-Season) _ Exterior Alteration(Single Family) _ Single Family _ Garage _ Porch(4-Season) _ Exterior Alteration(Multi) Multi _ Deck _ Porch (Screen/Gazebo/Pergola) _ Miscellaneous . 01 of Plex _ Lower Level _ Pool _ Accessory Building WORK TYPES New _ Interior Improvement Siding _ Demolish Building* _ Addition _ Move Building _ Reroof _ Demolish Interior Alteration Fire Repair _ Windows _ Demolish Foundation Replace I Repair _ Egress Window _ Water Damage Retaining Wall *Demolition of entire building-give PCA handout to applicant DESCRIPTION Valuation /ad. Occupancy qtr-/ MCES System Plan Review Code Edition ( 0/q-. SAC Units (25%_ 100%_) AO Zoning PID City Water — Census Code 4t 3 y Stories — Booster Pump -- #of Units ) Square Feet - PRV , #of Buildings ) Length — Fire Suppression Required — Type of Construction p Width REQUIRED INSPECTIONS Footings (New Building) Meter Size: Footings (Deck) Final/C.O. Required Footings (Addition) 7,'14TV-'4iL 4 Final/No C.O. Required Foundation Foundation Before Backfill W HVAC_Service Test Gas Line Air Test_Hood Roof:_Ice & ater _Final Pool: Footings _Air/Gas Tests _Final Framing V 30 Minutes 1 Hour Drain Tile Fireplace:_Rough In _Air Test _Final Siding:_Stucco Lath _Stone Lath _Brick_EFIS Insulation Windows Sheathing Retaining Wall:_Footings_Backfill_Final 3/ Sheetrock Radon Control Fire Walls Fire Suppression:_Rough In_Final Braced Walls Erosion Control ,1? Shower Pan Other: Reviewed By: /i. , Building Inspector RESIDENTIAL FEE Base Fee '57 Surcharge Plan Review 7/0 MCES SAC City SAC Utility Connection Charge S&W Permit& Surcharge Treatment Plant Radio Meter Read Copies TOTAL Page 2 of 3 - .. Client: 11Use., Pmfate, Prepared by: .F., Fo LAL 4 14. Project: • 57A Len EAR naraz.. Page number: I 6 8:170 6•LuTleas Date: 7,12-01/t- # fi--9 g`A R E C EL ED JAN 0 6 2020 fok ....---• ........_. . f . --14:Z7Ztiga-70412310...,-1:14e-MXPIE. I i•-+ ..1 f allaninf A 1,". 104.7171rWaRif:Lark. 4 - - --- .. , --._. ---- ---— - ' I . .. z II --- yip -1-44( 4ort.ene) --Www1--- -, .--i -fsm. 4R -,. 1 12:4,......-4-. • Izig-,72.. • __ • ...., 1344...mtLy__ __ .L.--...2M. .I — 2g. .11-..0'054644- f•141( ...TO__ ---- ---- - i ___ _ to _- "- W .allAtri ..:7---__._. .. . . ---- -. -.45&&-itrZWLAE-figreR5:-ViffZirelt - - --- EZ.- tON4 -tar: irAiv! 10.-r444 11--- --- ...... „ -, k i . .,..... ,." BY:_ilrill/ oittitips_ rrIR "'le-14IP 0, DATE: I}OAtO g0 . % 0, ... -.• BUILDING IN'Ski.-.:11ONS DIVIS:ON . ail_itc .., rriurtnestotift : 1 MatitUki_LI:WAC2\flic = I igeNEER ... __ .(Nlittbssi. iIf 10377 alb • ...7), l - *-- sift...... ,w.. 0:4 --- . .. - .- #1141P M itekl.%% "010$0t — pi •E;2144:5 tZe44 traqi.,-F_______ _ 3b7- 6---t- M1E-VX* OW- LE– + 0 COMPLETE BUILDING SOLUTIONS --7F14.14-4;f4-KU ,.551:Za..-- . ..... 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Cllr Page number: 1 Date: A�,1r /r/a Q� / 6Y1l YiM4 �dIr/ S"Ida t, p r 't.Fk`;E �'c: JAN 0 6 2020 • • `S' S5" , r • N >, t �., A A i r' 4 Ai e;A►1 J - , t Ce L -r` 1. 00s-p4 f E 55Tglc., E A � __ _- • • , _ _ ' rr I I ,1000 POGico: �% ��� 01/4 LITii/ aw.a rze,llaiti. I -34CACESc... ,_. _ _ _ma 0 am 644/64"61 Ili d. , — _ ___ _ _____..rp - ^ pis« P. .Dai' t/a5�'&J47 :7-17- C.---:M2-..it?e4-ibro.-,1-4-- --- P REC Et v ED FEB 0 6 2020 Jeffrey Wheeler From: Metro Floors <metrofloorsmn@gmail.com> Sent: Thursday, February 6, 2020 1:55 PM To: Jeffrey Wheeler; Dale Schoeppner Cc: DMITRIY; Eric Piepho Subject: Additions to permit at 3578 Lemieux Cir Attachments: Eric Piepro floor leveling stamped plan.pdf; Eric Piepro curbless shower section.pdf; Eric Piepho section at stair.png; Scope_-_Eric_Piepho_-_Footings.pdf; Scope_-_Eric_Piepho__Trusses_and_Walls.pdf Hi Jeff and Dale, Here are the additions to the permit and supporting engineering/documentation as discussed this morning onsite with Dale. 1. Non-original Truss web members to be removed 2. Truss reinforcement(kitchen) 3.Joist Header(stair case ceiling) ALL POINT LOADS SHALL TRANSFER TO BEARING 4.Joist header at stair case (top) 5. Non-load bearing wall to be removed (disconnected from roof truss and install brackets to support the wall) 6. Attic Air Leakage, Bypass Sealing 7. Floor leveling (south wall) 8. Floor drop (shower) FIRE STOP SOFFITS AND ALL OTHER DEAD SPACES. 9. Replace necessary subfloor(for floor joist repair) 10. Footings (party wall,fireplace wall) -the engineering for this is in a report attached.After more discoveries, the fix is modified for which I will forward the email to you from the engineer) 11.Spray foam insulation (outside walls) REVIEWED PLANS MUST REMAIN ON JOB SITE Any changes to these plans Thank you, shall be submitted for rcvi :W Victor prior to in/plgmentr' tion. v ' 612-275-7131 OA-4 APW1 7' L�MdT' Dima /593/et 612-3828174 EAGP N REV E' ED BY: r SEPARATE PERMITS ARE EGU►RED FOR ANY ELKIWiti. DATE: /A/oZ0$�O OR PLUMBING BUILDING INSPECTIONS DIVISION 1 . i RECE. :r FEB 0 6 • • CONPLEIE BUILDING S o L U r 1 D N E Non-Load Bearing Wall to be Removed The existing wall is not load-bearing and .1001". can be removed without affecting the structural system of the building. You might experience cracking in the ceiling after removing the wall, especially after the first heavy snowfall.This is not a structural concern; the ceiling is just readjusting to the new environment. •Figure 6:Wall to be Removed Non-Load Bearing Wall to be Removed The existing wall is not load-bearing and can be removed without affecting the • '�' structural system of the building. You f r �w" ' might experience cracking in the ceiling4•14 after removing the wall, especially after the first heavy snowfall.This is not a structural concern; the ceiling is just readjusting to the new environment. ,t ;a Figure 7:Wall to be Removed Ceiling Cracking is most likely caused by an inadequate attic system. When the conditioned air in the home enter the unconditioned attic, it can create elevated humidity levels. The elevated humidity is then absorbed by the wood truss members, causing differential expansion of the wood. This differential expansion can then cause the brittle drywall panels to crack.To reduce this effect from happening the attic system should be properly designed including: Complete Building Solutions • 2525 Nevada Ave North • Suite 302• Golden Valley, MN 55427 • C O N r l £ 1 F BUIL DIN SOLUTIOII • Sealing all attic air-barrier bypass, any break in the ceiling drywall, including but not limited to: o Light fixtures o Vents o Top of interior walls • Providing proper wind-wash barrier along the soffit edges • Provide a minimum of 1-inch ventilation channel from roof truss to roof truss, ensuring no insulation touches roof sheathing • Provide a minimum area of ventilation of 15square feet, with a minimum 6square feet for intake and a minimum 6square feet for exhaust • Provide sufficient insulation for R-49 • Ensure that the garage attic does not communication with the house attic If you have any questions or comments, please feel free to contact Complete Building Solutions at 763-544-3355 or email Rob@CBSmn.com . 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'i f t, 1077 y, !�` 1->1-1_ 4,11,/_..ca 6X7 .0 ` ' a 1 1 ,4r ® ..- 1,0„14st _ t; . • COMPLETE BUILDING S O L U T I O w f January 29, 2020 Eric Piepho email: ericpiepho@vahoo.com 3578 Lemieux Circle, Minneapolis, MN RECEIVED FEB 0 6 2020 Re: 3578 Lemieux Circle, Minneapolis, MN Dear Eric Piepho: An engineer from Complete Building Solutions (CBS) inspected your home's floor truss system, attic trusses, non-load bearing walls and attic system. Our findings are summarized below. A non-intrusive investigation was performed, as many of the structural members were hidden, some assumptions based on traditional construction methods and visible members were taken. All measurements provided are the max allowable length/height (due to construction renovation variables that occur) and exact member measurements shall be field verified. Please hire a qualified contractor to perform the work. During our inspections we took measurements and pictures to record our findings. We have developed the following scope of work for you. Non-Original Truss Web Member to be Removed For some reason additional angled braces were added to the attic trusses, r these additional web members have changed the structural profile for the , attic trusses and should be removed.To remove the web members, the 4 homeowner can just cut near the ends 1 and remove the middle section. ri 1 'd • .... a i r P. Figure 1:Web Member to be Removed Complete Building Solutions•2525 Nevada Ave North •Suite 302 •Golden Valley, MN 55427 • C o M P L f T F BUILDING SOLUTIONS TRUSS REINFORCEMENT SCOPE REINFORCEMENT PER REPORT SIMPSON SOS SCREWS PER "� A REPORT a P1 PA 7. ►t EXISTING TRUSS x °` e ,... ., / CONTINUOUS j " , STRAP PER REPORT _I_17- Figure 2:Generic Truss Reinforcement Detail Figure 3:Truss to be Reinforced • Reinforcement: 2x4 Each side of top chord;SPF; Full Length fu• o Simpson SDS screws Y."0 x3" at 12" O.C. tti• • Bottom Chord Strap: CMST14 Coiled Strap, Simpson Strong-Tie,full length o Fasteners: 0.148"x11/2", every-other round hole,full length Joist Header Scope .„LENGTH (nut vcRDrr).-- t. r-JOIST H.M fP Hll]I HANjaI V_.. ill 11 II11II ll , . i NEV .015* JOIST HA*K�FR ... t MZADEg EXIST ...msiS, { cuT BEvOKII Figure 4:Generic Joist Header Frame Figure 5:Joists Header Location • Joist Header Size: (2)1.75x5x5 LVL 1.9E, 2850Fb;4'-6”max length 713- o Joist Hanger: LUS44 Hanger, Simpson Strong-Tie or equivalent o Blocking: 2x solid piece blocking between truss ends,toe-nailed on sides Complete Building Solutions• 2525 Nevada Ave North •Suite 302•Golden Valley, MN 55427 FEB 0 6 2020COMDLSTS BUILDING SOLUTIONS Attic Air Leakage, Bypass Sealing The following are the building codes associated with sealing attic bypasses.This should help you work with your insulator to get all the areas called out for sealed. Included are the building codes involving sealing the ceiling-attic bypasses. MEC2015— Minnesota Energy Code 2015—Residential Section MRBC2015— Minnesota Residential Building Code 2015 According the Minnesota Energy Code—Residential Section: Insulation Requirement R-Value Per Table R402.1.1 INSULATION AND FENESTRATION REQUIREMENTS BY COMPONENT Minimum R-Value for Climate Zone 6(Twin Cities Region) = R-49 The attic MEC2015 insulation shall R402.2 Specific insulation requirements (Prescriptive). extend to the top- In addition to the requirements of Section R402.1, insulation shall meet plate of the the specific requirements of Sections R402.2.1 through R402.2.12. exterior wall, an R402.2.1 Ceilings with attic spaces. uncompressed When Section R402.1.1 would require R-38 in the ceiling, R-30 shall R-38 value is be deemed to satisfy the requirement for R-38 wherever the full height required at the of uncompressed R-30 insulation extends over the wall top plate at the eaves. Similarly, R-38 shall be deemed to satisfy the requirement for exterior walls. R-49 wherever the full height of uncompressed R-38 insulation extends over the wall top plate at the eaves. This reduction shall not apply to the U-factor alternative approach in Section R402.1.3 and the total UA alternative in Section R402.1.4. (Reference Figure 3). The soffit/eave/ MEC2015 cornice vents and R402.2.3 Eave baffle (Wind Wash Barrier). wind wash barrier For air permeable insulations in vented attics, a baffle shall be installed shall have a clear adjacent to soffit and eave vents. Baffles shall maintain an opening equal or greater than the size of the vent. The baffle shall extend over the top of ventilation the attic insulation. The baffle shall be permitted to be any solid material. pathway, 1-inch (Reference Figure 3). minimum in depth and full width of MEC2015 the vent. No R806.3 Vent and insulation clearance. Where eave or cornice vents are installed, insulation shall not block the insulation shall free flow of air. A minimum of a 1-inch (25 mm) space shall be provided interfere with the between the insulation and the roof sheathing and at the location of the ventilation or vent. touch the roof sheathing Complete Building Solutions - 2525 Nevada Ave North • Suite 302 •Golden Valley, MN 55427 COMIDLE 1 F. BUILDINC Sof J Y p 0 N Air leakage shall MEC2015 be limited R402.4 Air leakage(Mandatory). throughout the The building thermal envelope shall be constructed to limit air leakage in accordance with the requirements of building with a Sections R402.4.1 through R402.4.4. continuous air barrier R402.4.1 Building thermal envelope. incorporated in The building thermal envelope shall comply with the exterior Sections R402.4.1.1 and R402.4.1.2. The sealing methods between dissimilar materials shall allow for differential expansion and thermal envelope contraction. including, but not limited to: R402.4.1.1 Installation. unconditioned The components of the building thermal envelope as listed in Table R402.4.1.1 shall be installed in accordance with the attic space; manufacturer's instructions and the criteria listed in junction of top Table R402.4.1.1, as applicable to the method of construction. plate and top of Where required by the code official, an approved third party shall exterior walls; inspect all components and verify compliance. recessed light TABLE R402.4.1.1 AIR BARRIER AND INSULATION INSTALLATION fixtures. COMPONENT CRITERIA, A continuous air barrier shall be installed in the Air barrier building envelope. The thermal Exterior thermal envelope contains a continuous air envelope in the and barrier. thermal Breaks or joints in the air barrier shall be sealed. attic contains barrier areas of non- Air-permeable insulation shall not be used as a continuous air sealing material. barriers,gaps in The air barrier in any dropped ceiling/soffit shall be Ceiling/ aligned with the insulation and any gaps in the air the ceiling drywall, barrier sealed. that shall be attic Access openings, drop down stair or knee wall sealed. doors to unconditioned attic spaces shall be sealed. Corners and headers shall be insulated and the junction of the foundation and sill plate shall be sealed. The junction of the top plate and top of exterior Walls walls shall be sealed. Exterior thermal envelope insulation for framed walls shall be installed in substantial contact and continuous alignment with the air barrier. Knee walls shall be sealed. (Reference Figures 3 & 4) Recessed Recessed light fixtures installed in the building lighting thermal envelope shall be air tight, IC rated, and sealed to the drywall. Complete Building Solutions• 2525 Nevada Ave North •Suite 302•Golden Valley, MN 55427 E O FEB 0 6 2020 • COM P l c T L BUILDING SOLUTIONS R402.4.1.2 Testing. The building or dwelling unit shall be tested and verified as having The maximum an air leakage rate of not exceeding 5 air changes per hour in Climate Zones 1 and 2, and 3 air changes per hour in Climate allowable air Zones 3 through 8. Testing shall be conducted with a blower door changes per hour at a pressure of 0.2 inches w.g. (50 Pascals). Where required by for the home shall the code official, testing shall be conducted by an approved third be 3, the home party. A written report of the results of the test shall be signed by shall be tested and the party conducting the test and provided to the code official. Testing shall be performed at any time after creation of all verified with a penetrations of the building thermal envelope. written report provided R402.4.4 Recessed lighting. Recessed luminaires installed in the building thermal envelope shall be sealed to limit air leakage between conditioned and unconditioned spaces. All recessed luminaires shall be IC-rated and labeled as having an air leakage rate not more than 2.0 cfm (0.944 L/s) when tested in accordance with ASTM E283 at a 1.57 psf(75 Pa) pressure differential. All recessed luminaires shall be sealed with a gasket or caulk between the housing and the interior wall or ceiling covering. (Reference Figure 1). M EC2015 Where to find the R201.3 Terms defined in other codes. term definitions Terms that are not defined in this code but are defined in the International Building Code, International Fire Code, International Fuel Gas Code, International Mechanical Code, International Plumbing Code or the International Residential Code shall have the meanings ascribed to them in those codes. Definitions: MEC2015 AIR BARRIER. Material(s) assembled and joined together to provide a barrier to air leakage through the building envelope. An air barrier may be Exterior Thermal a single material or a combination of materials. BUILDING THERMAL ENVELOPE. The basement walls, exterior walls, Envelope floor, roof, and any other building elements that enclose conditioned space or provides a boundary between conditioned space and exempt or unconditioned space. CONDITIONED SPACE. An area or room within a building being heated or cooled, containing uninsulated ducts, or with a fixed opening directly into an adjacent conditioned space. Air Barrier CONTINUOUS AIR BARRIER. A combination of materials and assemblies that restrict or prevent the passage of air through the building thermal envelope. Complete Building Solutions • 2525 Nevada Ave North • Suite 302 • Golden Valley, MN 55427 • COMPLIII B U l l D t N S SOLUTIONS { '44,k, 4, 1 .. ,r,... .41,4"b4r- . t s * d s w`l "iiiii;,, .. ., ,, , .Y. if I:*,.,‘'� a' §' ^i"i Figure 1 MEC2015-R402.4.4::2-Step Process for lights/speakers/vents:(1)install foil-face foam board;(2)flash spray foam f- inch minimum t M v, yaw= ... Baa �, Figure 2:Spray bottom chord of trusses,minimum 1-inch and 1-inch onto drywall } ` i . 1 ;' 44 Figure 3:MEC2015-R402.2.1,MEC2015-R402.2.3,MEC2015-R402.4.1.1::Wind Wash and Top of Exterior Wall Sealing:Clear off all blown insulation;Provide OSB Blocking at exterior face of wall,keeping minimum 1-inch ventilation gap,Flash spray minimum 1-inch across all wood and minimum 1-inch onto drywall,but do not spray into ventilation gap y f' , Figure 4:MEC2015-R402.4.1.1::Top of Interior Wall Sealing:Clear off all blown insulation;Flash spray minimum 1-inch across all wood and minimum 1-inch onto drywall Complete Building Solutions•2525 Nevada Ave North•Suite 302 • Golden Valley, MN 55427 RECEIVED EQEgED FEB 0 6 2070 éOMPLIITI BUILDING SOLUTIONS After the bypasses have been sealed, CBS recommends obtaining a copy of the air leakage/air exchange report. If you have any questions or comments, please feel free to contact Complete Building Solutions at 763-544-3355 or email Rob@CBSmn.com . Professional Engineer You t uI I hereby certify that this plan,specification,or report was yi prepared by me or under my direct supervision and that I am a duly Licensed Professional Engineer under the laws of the state of Minne§gitf. Stephen Hammill, P. E. Typed or Printed f4ame:Stephen Hammill MN License#48070 Date:_ 5/15/2019 License Number:48070 Complete Building Solutions•2525 Nevada Ave North•Suite 302•Golden Valley, MN 55427 Client: AC,,, PiG Prepared by: 33, Pb LALzi v- Project: 3.57g EUK & ,a., Page number: o a f Date: aY101"e RECEIVED Sol Oflops FEB 0 6 MO jor)._______ ,,. "-- z9zwrz= i rk -t :fl f -0:1---mr5` ce. �� -�sc., —low. ., e - k • ',I. 1 - 13WST:t7-4,:)-- . ze g ,� WI_.e iL` '_ _ -- -__- 1 ., ___ -2,44 $ ia4- HA4t,7n_ ---- --- -,,,S... -4_. [01%* — • . . -::::‘,4rE_ AI Aux - 0. 1Z44- t-4----- ,,c1,,,B,,,ute.,, G-1, A P Meow VII* = (PROPESSIoNAL t 7.7. I Emi _ . _. r /-: 7441-K2-- 1'14 20377 .../0)41.1: 'shirrsto _. 't -P {G> fel - .,__ . i C --- — . 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IT.thirs.,_. • t I INw • •,,,��iiiN ` -- P _.. stg DATE' i kg t kr:hz, 1 , -Pr _?E t 4- c 1 Y = 4 COMPLETE B U ILD I N G SOLUTIOPS January 24, 2020 Eric Piepho email: ericpiepho@yahoo.com 3578 Lemieux Circle, Minneapolis, MN RECEIVED FEB 0 6 2020 Re: 3578 Lemieux Circle, Minneapolis, MN Dear Eric Piepho: An engineer from Complete Building Solutions (CBS) inspected your home's foundation issues. Our findings are summarized below. A non-intrusive investigation was performed, as many of the structural members were hidden, some assumptions based on traditional construction methods and visible members were taken. All measurements provided are the max allowable length/height (due to construction renovation variables that occur) and exact member measurements shall be field verified. Please hire a qualified contractor to perform the work. During our inspections we took measurements and pictures to record our findings. We have developed the following scope of work for you. Interior Bearing Wall Footing, Eccentric Loading Upgrade Scope EXISTING WALL EMBEDMENT PER REPORT REINFORCEMENT PER REPORT • r ,1 -• t.J,.4µi • «.. - 0 Figure 4:Footing to be Reinforced Figure 3:Generic Footing Detail • Footing Dimensions: D=8", B=6";f'c=2500 psi .- • Reinforcement: o #4 at 9" O.C. transversal embedment= 5"with Hilti Hit HY-200 Epoxy; o #4 continuous longitudinal. Complete Building Solutions ■ 2525 Nevada Ave North -Suite 302 •Golden Valley, MN 55427 • C O M P L E T E B U I L D I N G SOLUTIONS Party Wall Footing Scope Option 1 'f -- WALL EXISTING PARTY • LONGITUDINAL t ;' REINFORCEMENT PER REPORT - _ TRANSVERSAL REINFORCEMENT PER REPORT ,.. CHAMFER SO NEIGHBOR WALL o lErd DOES NOT BEAR ON I� FOOTING B Y Figure 5:Generic Footing Detail Figure 6:Footing to be Reinforced j • Footing Dimensions: D=8'; B=1'-4"; zA o Longitudinal Reinforcement:(3)-#3 continuous, embed 6-inches into existing footing, 12-inch overlap; 2 . o Transversal Reinforcement:#4 at 9"O.C. Party Wall Footing Scope Option 2 Ar EXISTING PARTY WALL LONGITUDINAL REINFORCEMENT reAt''''''' -:' PER REPORT • TRANSVERSAL REINFORCEMENT PER REPORT oMin . I Figure 8:Footing to be Reinforced Figure 7:Generic Footing Detail • Footing Dimensions: D=8" B=1'-8"; w o Longitudinal Reinforcement:(3)-#3 continuous, embed 6-inches into I a existing footing, 12-inch overlap; I g o Transversal Reinforcement:#4 at 9"O.C. Complete Building Solutions . 2525 Nevada Ave North -Suite 302• Golden Valley, MN 55427 t � s • CON P LE T E BUIL DING SOLUTIONS RECE VED FEB 0 6 2g?1) If you have any questions or comments, please feel free to contact Complete Building Solutions at 763-544-3355 or email Rob@CBSmn.com . Yours truly, Stephen Hammill, P. E. MN License#48070 etainasoushom I mow oarte*r teat Otis pm sPiclac.fion.or report w s Orrp•rod M Noe ar ander+or db*R supervision and that tono a duh,Uaa+aad Protasriaea4 togingor ostler the kart of Via 14914 of Nod or MOW. 1/24/2020 Ixenaetiaaber. 70 Complete Building Solutions•2525 Nevada Ave North •Suite 302•Golden Valley, MN 55427 Jeffrey Wheeler From: Metro Floors <metrofloorsmn@gmail.com> Sent: Thursday, February 6, 2020 1:57 PM LL L E P Q'E Q To: Jeffrey Wheeler; Dale Schoeppner Subject: Fwd: Footings FEB 0 6 ? 7I) From: Bruce Polaczyk, PE<bruce@cbsmn.com> Sent:Thursday, February 6, 2020 7:48:35 AM To: Eric Piepho(ericpiepho@vahoo.com)<ericpiephota vahoo.com> Cc: DMITRIY<dema3@msn.com>;Stephen Hammill, PE<Stephen@cbsmn.com>; Robert Vassallo<rob@cbsmn.com> Subject: Footings All,from my standpoint here is my opinion of the footings. As far as the 6"depth, I checked the code to determine what the minimum depth is for a strip footing.The code doesn't address strip footings but it does read that the minimum depth for a spread footing(an isolated footing supporting a point load)shall be 6". I ran a calculation on the amount of load that a 6" depth footing could support before the footing would develop a shear crack for the party wall using a 22"W and 6"D footing and a soil support capacity of 2000 psf and a concrete strength of 3500 psi. It will support between 3500#and 4000#per lineal foot which is larger than the current load on the footing. I concur with Steve's recommendations for the fix. As he points out rebars should be inserted into each section of the footing (7%"foundation wall and strip footing)and epoxied. I would use 2#5 bars and lap the bars 15". Bruce 1 PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA160750 Date Issued:04/09/2020 Permit Category:ePermit Site Address: 3578 Lemieux Cir Lot:9 Block: 03 Addition: Pearlmont Heights PID:10-56950-03-090 Use: Description: Sub Type:Residential Work Type:Alteration Description:Fixtures Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). Fee Summary:PL - Permit Fee (miscellaneous)$59.00 0801.4087 Surcharge-Fixed $1.00 9001.2195 $60.00 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Eric S Piepho 3578 Lemieux Cir Eagan MN 55122 Voda Plumbing 6417 Penn Avenue South, Suite 4 Richfield MN 55423 (612) 282-9036 Applicant/Permitee: Signature Issued By: Signature