2008-00899CITY OF MONTICELLO
505 WALNUT STREET
MONTICELLO, MN 55362-
763) 295-3U6U tAX: (763) 295-44U4 ADDRESS
6295 86TH ST NE PIN
155186001030 LEGAL
DESC CARLISLE VILLAGE 3RD ADDN LOT
003 BLOCK 001 PERMIT
TYPE BUILDING PROPERTY
TYPE SINGLE FAMILY -DETACHED CONSTRUCTION
TYPE ROOFING & SIDING VALUATION :
S 20,000.00 NOTE:
FINAL INSPF,CTION TO BE CALLED IN A MAXIMUM OF48 HOURS AFTER COMPLETION APPLICANT
GRATRIX
CONSTRUCTION 20683
ATLANTIC BLVC BIG
LAKE, MN 55309- 763)
286-8145 OWNER
CHAD &
TRACY, HINZ 6295
86TH ST 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, public
utilities and signs will be repaired at my expense Applicant
Date
Bldg
Official Date RIURFIERM
2
0 0 8- 0 0 8 9 9 DATE
ISSUED: 07/02/2008 BUILDING
PERMIT FEE STATE
SURCHARGE, BLDG VAL TOTAL
Payment(
s) CHECK
6508 340.
53 10.
00 350.
53 350.
53 SEPARATE
PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
DEVELOPMENT SERVICES
BUILDING INSPECTIONS
PERMIT - f S e
PID #
505 WALNUT STREET. SUITE I
MONTICELLO, MN 55362
I City Hall (763) 295-2711 Building Inspections (763) 295-3060 Fax (763) 295-4404
M ONTICELLO
BUILDING PERMIT APPLICATION
Please Print - INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED.
SITE ADDRESS: ;i) i %_ j
c ) ZONED____
LEGAL: Lot Block Plat
Property Owner Name: l N/ Phone:
Address: ' 1 / ; ; City: State:., F Z_,ip
Contractor Name: . 7 % __ f%. i Phone: -2/1,'
State License
Address: L s' .<%iLI; yG ;'— City: - c State:.2t _ Zip: >
Eng./Architect Name: _ _ Phone:
Address: City: State: Zip:
Plumber Name: Phone:
Address: City: State: _ Zip:
Mechanical Name: Phone:
Address: City: _ State: Zip:
Type of Work Tvl)e of Construction Building Information
New Single Family LIse of building
Addition Duplex 4 of stories
Alteration Multi -Family Floor area scl. ft.
Repair Commercial Estimated value
Move Industrial of construction-
Other Residential Garage Is this a "haste- Plan" per MN Rule
Other 1300.0160 Subp.6.? Yes No
Description of work: /
C'
SS
I hu.eh% apple lbr a permit for construction as de,CrihCd and ackno%%lcrlee that the information I have proided ahoye i> ceniplete and accurate. 1 tIsrce
that the r or1: "v ill he conducted in conformance \%ith the ordinances of the Citr of \]onticello and v ill) the Laws ohthc Statc of \Iinnc ota_ and
that I understand that this application is not a permit and that the work is not to start without a permit. I further understand that the vcork ill he
in accordance kith the plan that ha; hecn appro%cd by the L3uiIdill g Official. I agreethat all dama__c caused to public propert} includin<a but nut limited to
curb. sidewall., puhlic utilities kill he rcpaircd at IM cspense. SEE BACK FOR
PLUMBING AND MECHANICAL INFO.
t Applicant Signature
Application
Date
4PPLICA N T. Please show, fixtures that are applicahle.
Fire Suppression : (if applicable) Plumbing: (if applicable) Mechanical: (if applicable)
No. Fixture Type No. Fixture Type No. Fixture Tvpe
Sprinkler Pleads Water Closet (toilet) Furnace
Other /Special FS Device Bathtub Gas Meter
Lavatory (wash basin)
Shower
Kitchen Sink
Dishwasher
Range Hood
Gas Range
N"ater Heater
Air Conditioning
Launthy Tub Mech. Fireplace
Fire Alarm: (if applicable) Clothes Washer Bathroom(e) Exhaust Fan
Water Heater Air E_tchai er
Urinal Dyer
No. Fixture Type
Drinhim, 1'owimin Gas Openin- who Fixture
Floor Drain
of Devices Slop Sink
Other Hydrants
TOTAL TOTAL
S9 Per Fixture) 59 Per Fi_v ure)
FEES:
Bldg,. Permit
Plan RevieNv
State Surchar_-c
Plm Permit
Fixtures
Surchar(e
Mech. Permit
FIYTUreS
Surchar,4c
Se\\er Access
Water Access
Water Meter
Meter Sales 'i ax
Sevy & Water Permit
Trunk Water
Trunk Samtam ScNv cr
l Runk Storm Scv- er
Lift Station
TOTAL FEES:
Bldg. Total
Pima. Total
Mech. Total
Meter Total
FOR CITY USE ONLY
Tree Ordinance Handout Yes No
Other Handouts Yes No
ADDITIONAL INFORMATION:
Valuation:
Construction "Type:
Occupancy Group:
Division:
Square Footage:
of Stories:
of Residential Units:
Maximum Occupancy:
Fire Sprinklers: Yes No
Off -Street Parkin-, Covered:
Off -Street Parkin-, Uncovered:
Building Official
BPT: