2012-00329CITY OF MONTICELLO 2 0 1 2- 0 0 3 2 9*
DATE ISSUED: 06/08/2012
505 WALNUT STREET
MONTICELLO, MN 55362-
763) 295-3060 FAX: (763) 295-4404
ADDRESS 6308 86TH ST NE
PIN 155186001070
LEGAL DESC CARLISLE VILLAGE 3RD ADDN
LOT 007 BLOCK 001
PERMIT TYPE BUILDING
PROPERTY TYPE SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE SIDING
VALUATION 10,300.00
APPLICANT BUILDING PERMIT FEE 206.97
STATE SURCHARGE, BLDG VAL 5.15
MASTER 1 EXTERIORS TOTAL 212.12
25741 187TH ST NW
BIG LAKE, MN 55309- PAID WITH CC # 1009
763)237-4318
OWNER
HALE, GRANT
6308 86TH STREET 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,
public utilities and signs will be repaired at my expense.
Applicant
Date
Bldg Official Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
t\IONTICELLO
DEVELOPMENT SERVICES
BUILDING INSPECTIONS
PERMIT # 1 Z -CC3 1
P I D m
505 WALNUT STREET, SUITE 1
tvIONTICELLO, IN Ni 55362
City Hall (763) 295-271 1 Building Inspections (763) 295-3060 Fax (763) 295-4404
Please Print - INCO;•IPLETE APPLICATIONS NVILL NOT BE ACCEPTED.
SITE ADDRESSW50g INc LEGAL:
Lot Block Plat Property
Owner Name: t)e)--;17 JamPhone: Address: City:
ZONED State:
Zip:
Contractor Name:
fi;L5 State License`-
Address:c;?,-'
5 7q City:lG 6ALP- State:il?/'1 Zip: S;3a Eng./Architect
Name: Address: City:
Plumber Name:
Address: City:
Mechanical Name:
Address: City:
Tvne of `
York Tvi)e of Construction New Single
Family Addition Duplex
Alteration Multi-
Familv 1;?r
Repair Commercial Move Industrial
Other Residential
Gara`e Other Description
of
work:Ae S;' cf) Phone:. State:
Zip:
Phone: State:
Zip:
Phone: State:
Zip:
Building Information
Use of
building r of
stories Floor area
sq. fi. Estimated value
of construction
SAP, )<nO Is this
a "Master Plan" per i1IN Rule 1300.0160
Subp.6? Yes No FOR ROOF &
SIDING PERMITS, PLEASE PROVIDE
9 OF SQUARES OF SHINGLES
WOR SIDING. I hereby
apply for a pennit for construction as described and acknowledge that the information I have provided above is complete and accurate. I agree that
the work will be conducted in confornmance with the ordinances of the City of Nlunticello and with the Laws of the State of tMinnesota; and that
I understand that this application is not a pennit and that the work is not to start without a pennit. I tiitther 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
linmited to curb, sidewalk, public utilities and signs will be repaired at my expense. 17 SEE
BACK FOR PLUMBING AND MECHANICAL
INFO. ] pplicant Signature
Application Date ! t Z zo /z
APPLIC,41A'T. Please show fixtures that ure applicable.
Fire Suvoression : (if applicable) Phimbinv': (if applicable) Mechanical: (if applicable)
No. I-imire Tape o. Fixture Txae \o. Fixture
Sprinkler Heads Pater Closet (toilet) Furnace
Other/Spec•ial FSDeric•e Bathtub Gas:Ueter
Ltrrator-• (crash basin) Range Floor/
Shower Gas Range
Kitchen Sing' ff ater Heater
Dishwasher Airit Conditioning
Laundry Tub dlech. Fireplace
Fire Alann: (f applicable) Clothes Washer Bathroon(s) Exhaust Fan
J1 *(aer Heater 4ir E:xchang er
Urinal Dr•rer .'
o. Fixture Tvpe
Drinking Fountain Gas Opetrinl n/o Fixture
Floor Drain
r of Devices Slop Sink
Other lli•drants
7'0T.4L TO7AL
S9 Per Fixture) ` S9 Pei Fixlrrre)
I FOR CITY USE -,ONLY
Tree Ordinance IIandout Yes IN. o
FEES: Other Handouts Yes NO
Blda. Pennit
Plan Review
State Surcharge
Blcla. Total
Plma. Pennii
Fixtures ADDITIONAL, INFO RiMATION: .
Surcharac Valuation:
Pinia. Total Construction Type:
Tech. Permit Occupancy Group:
Fixtures Division:
Surcharge Square Footage:
Mech. Total T of Stories:
Sewer Access i of Residential Units:
Water access axinium Occupancy:
Va[el' tMeter Fire SprinUers: H Yes U No
Nleter Sales Tax Off -Street Parking Covered:
meter Total Off -Street Parkin Uncovered:
Sexy R: W'ater Penuit
Tnuik «'titer
Trunk Sanitan SewerBuilding Official
Trunk Storm Sewer. BP r:
Lift Station
TOTAL FOGS: '