2023-01136CITY OF MONTICELLO
505 WALNUT STREET
MONTICELLO, MN 55362-
763) 295-3060 FAX: (763) 295-4404
ADDRESS 4448 86TH ST NE
PIN 155264002110
LEGAL DESC EDMONSON RIDGE
LOT Oil BLOCK 002
PERMIT TYPE MECHANICAL
PROPERTY TYPE SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE MECHANICAL FIXTURES
NOTE: RUNNING GAS LINE, ELECTRIC FOR GARAGE FURNACE
NUMBER OF MECHANICAL FIXTURES 2.00
APPLICANT
HENNING, DANIEL
4448
86TH ST NE
MONTICELLO, MN 55362-
763) 228-6948
OWNER
HENNING, DANIEL
4448
86TH ST NE
MONTICELLO, MN 55362-
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,
publi u i i i d signs w' repaired at my expense.
Applicant .—
Date to - ,Ta.
Bldg Official Date
2 0 Z 3— 0 1 1 3 6*
DATE ISSUED: 10/27/2023
Permit #: 2023-01136
MECHANICAL BASE FEE, RESI 50.00
MECHANICAL FIXTURES 18.00
STATE SURCHARGE, MECH FIX 1.00
TOTAL 69.00
Payment(s)
CREDIT CARD 8915 69.00
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY OF
Montf6effo
BUILDING SAFETY
SITE ADDRESS
Permit No. 023 --CAI 13
Date I o Z -7 -2-3
RESIDENTIAL BUILDING PERMIT
ADDITION / ALTERATION / REMODEL
LEGAL DESCRIPTION
LOT I I BLOCK 2— PLD. NUMBER
PLAT
OWNERS
ANAME
I fY/f fir.l.h ti3(s
CONTRACTOR
Address)
1552c L z
Tel. No.)
Address) (Contact) (Tel. No.)
CONTRACTOR'S LICENSE NUMBER (IF APPLICABLE) (Applicant Email)
PLUMBING BEING COMPLETED BY (PLEASE CHECK ONE):
i
HOMEOWNER CONTRACTOR
I
IF APPLICABLE. SPECIFY CONTRACTOR Lic # !
i
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
BY A MASTER PLUMBER.)
MECHANICAL BEING COMPLETED BY(PIffASE CHECK ONE):
HOMEOWNER CONTRACTOR
IF APPLICABLE, SPECIFY
CONTRACTOR
CHECK ALL THAT APPLY: FURNACE A/C FIREPLACE BATH
TOTAL # OF FIXTURES BOND#
DESCRIPTION OF WORK: P-PIst"'-S L' ('-ALJ f-j e I A 1 — f:" g- ESTIMATED
VALUE OF CONSTRUCTION l utA f hir Approved
by Building Official:/ l Date
Approved: /C — 2-7- 2-0 Z3 $ APPLICANT
SIGNATURE Date 505
Walnut Street, Suite #1 Monticello, NIN 55362 Phone: 763-295-3060 Fax: 763-295-4404
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: L((4 L
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.
I 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.
Signature of Property Owner Date
To determine whether a particular contractor is required to be licensed, please call the
Department of Labor and Industry @ 651-284-5012