2026-00557CITY OF MONTICELLO
505 WALNUT STREET
MONTICELLO, MN 55362-
2yt- WbU VAN: (763) 2y5-44U4
ADDRESS 4201 86TH ST NE
PIN 155252003010
LEGAL DESC FEATHERSTONE 4TH ADDN
LOT 001 BLOCK 003
PERMIT TYPE BUILDING
PROPERTY TYPE SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE BASEMENT FINISH
VALUATION 13,800.00
NOTE: LOOK AT STAMPED COPY OF BUILDING PLANS FOR ANY NOTES/RED STAMPS
SEPARATE PERMIT REQUIRED FOR ELECTRICAL WORK.
ELECTRICAL ROUGH IN INSPECTION TO BE DONE BEFORE FRAMING INSPECTION
FINISHING BASEMENT.
ADDING I BEDROOM, 1 BATH AND A LIVING AREA.
ALL RELATED MECHANICAL AND PLUMBING WORK.
APPLICANT
PALINSKY, ELLEN & KEVIN
4201 86TH STREET NW
MONTICELLO, MN 55362-
O\\ NF R
PALINSKY, ELLEN & KEVIN
4201 86TH STREET NW
MONTICELLO, MN 55362-
b 3- d-1 q 07-09-11, AGREEMENT
AND SWORN STATEMENT I
agree that the work will be conducted in conformance with the
ordinances of the City of Monticello and with the Minnesota
State Building Code. I understand that the work will
be in accordance with the plan that has been approved by
the Building Official. I agree that any damage caused to public
property including but not limited to curb, sidewalk, public
utilities and signs wijLLe repaired at my expense. Applicant
Date - —
26 Bldg
Official Date 2
0 2 6— 0 0 S S 7 DATE
ISSUED: 07/20/2026 Permit #:
2026-00557 BUILDING
PERMIT FEE 251.49 PLAN
REVIEW 163.47 STATE
SURCHARGE, BLDG VAL 6.90 TOTAL
421.86 Payment(
s) CREDIT
CARD 0909 421.86 SEPARATE
PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
ITYOF V 'IM01
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nticello ; ),
Gl ILDING SAFETY I
a 111L 1 O 2026 I
RESI Jfu MIrMN-G' PE
ADDITI N / ALTE .
Permit No. '_),Q .6 — n T
Date __- 19,0 _
ODEL
STE ADDRESS
LEGAL DESCRIPTION
C
LOT 00 BLOCK 003 PI.D. NUMBER/J 2 _J 2 0030 lQ
PLAT fC- 74 &,-_ %50 ! o tC l '
7 /
iCIO( I
OWNER'S NAME (Address) (Tel. No.)
k(fV I PaI I^!!y){Zo1 713-2YV- o7o oo
SONTRACTOR (Address) (Contact) (Tel. No.)
5e It"
FONTRACTOJ'S LICENSE NUMBER (IF APPLICABLE) (Applicant Email)
NIA
PLUMBING BEING COMPLETED BY (PLEASE CHECK ONIN
9 HOMEOWNER CONTRACTOR
IF APPLICABLE, SPECIFY CONTRACTOR Lic #
CHECK ALL THAT APPLY: ® TOILET SINK BAR SINK ® BATHTUB/SHOWER
LAUNDRY TUB SOFTENER OTHER
TOTAL # OF FIXTURES
REMINDER: IF YOU DO NOT OWN THIS PROPERTY OR ARE NOT PERFORMING THE WORK, PERMIT MUST BE PULLED
BYA MASTER PLUMBER)
NIECHANICAL BEING COMPLETED BY (PLEASE CHECK ONE
HOMEOWNER CONT'RACTOR
IF APPLICABLE, SPECIFY
CONTRACTOR
CHECK ALL THAT APPLY:11 FURNACE A/C ® FIREPLACE BATH
TOTAL # OF FIXTURES ' BOND#
DESCRIPTION OF WORK: S , dauw n, ald,w 1 b fd r
ESTIMATED VALUE OF CONSTRUCTIQW Approved by Building Official: ' w
Total Due
1 Date Approved: +
O I.
APPLICANT SIGNATURE Date 7- to- 24
505 Walnut Street, Suite #1 Monticello, MN 553 Phone: 763-295-3060 Fax: 763-295-4404
CITY OF
MonticeRo
BUILDING SAFETY
BUILDING PERMIT APPLICANT: PROPERTY OWNER
I understand that the State of Minnesota requires that all residential building contractors,
remodelers and roofers obtain a state license unless they qualify for specific exemption from
the licensing requirements. By signing this document, I attest to the fact that I am building or
improving the house myself. I hereby claim to be exempt from the state licensing requirements
because I am not building or improving property for the purpose of speculation or resale and
that the house which I am applying for this permit located at: 4 NC
is the first residential structure that I have built or improved in the last 24 months. I also
acknowledge that because I do not have a state contractor's license, I forfeit any mechanic's
lien rights to which I may otherwise have been entitled under Minn. Stat. 514.01. In the even
that I do construct or improve another residential structure in the next 24 months, I will not do
so until I obtain the required state license understanding that failure to do so is a misdemeanor
under state law.
Furthermore, I acknowledge that I may be hiring independent contractors to perform certain
aspects of the construction or improvement of this house and I understand that some of these
contractors may be required to be licensed by the State of Minnesota. I understand that
unlicensed residential contracting, remodeling, and / or roofing activity is a misdemeanor under
Minn Stat. 326.92, subd. 1. 1 also acknowledge that all licensed contractor's pay into the
Contractor's Recovery Fund, which can pay homeowners up to $50,000 in the event that their
licensed contractor fails to complete work or preforms defective work, but that I forfeit my
rights to reimbursement from the Contractor's Recovery Fund in the event that any
contractors I hire are unlicensed.
also acknowledge that as the contractor on this project, I am solely and personally responsible
for and violations of the State Building Code and / or City Code in connection with the work
performed on this property, and that I can be prosecuted criminally for any code violations
that are not corrected as ordered by the City.
Sign ture of Property Owner Date
2 C
To determine whether a particular contractor is required to be licensed, please call the
Department of Labor and Industry @ 651-284-5012
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