2007-00587CITY OF MONTICELLO
505 WALNUT STREET
MONTICELLO, MN 55362-
763) 295-3060 FAX: (763) 295-4404
2007-00S87*
DATE ISSUED: 07/11/2007
ADDRESS 6317 86TH ST NE
PIN 155186001010
LEGAL DESC CARLISLE VILLAGE 3RD ADDN
LOT 001 BLOCK 001
PERMIT TYPE PLUMBING
PROPERTY TYPE SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE LAWN SPRINKLER
NOTE: BACKFLOW & RAIN SENSOR REQUIRED
NUMBER OF PLUMBING FIXTURES 1
APPLICANT PLUMBING BASE FEE, RESI
PLUMBING FIXTURES
45.00
9.00
NORTHWOODS PLUMBING
STATE SURCHARGE, PLBG FIX 0.50
31127 101ST STREET
PRINCETON, MN 55371- TOTAL 54.50
612) 282-6369 Payment(s)
CHECK 2066 54.50
OWNER
VANDERLINDEN,JAMES
6317 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,
public utilities and signs will be repaired at my expense
Applicant
Date
Bldg Official Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
MONTICELLO
DEVELOPMENT SERVICES
BUILDING INSPECTIONS
505 WALNUT STREET, SUITE 1
MONTICELLO, MN 55362
City Hall (763) 295-2711
PERMIT # `1 L_z
PID #
Building Inspections (763) 295-3060 Fax (763) 295-4404
Please Print - INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED.
SITE ADDRESS: (P 3/ % gL®' SE _ZONED
LEGAL: Lot Block Plat
Property Owner Name: Phone:
Address: City:
Contractor Name: W i O k S Carl i2r ul f'UA - Phone:
0 4.. T . 4
J LAw yivvawv u
Address: City:
EngJArchitect Name:
Address: City:
Plumber Name: Ubr' ilc
Address: Sr'1i.e F City:
Mechanical Name:
Address: City:
State: Zip:
State: Gip:
Phone:
State: Zip:
Phone:
State: 014. Zip: 4 i.37/_
Phone:
State: Zip:
Tyne off Work Tjne of Construction Building Information
New Single Family Use of building
Addition Duplex of stories
Alteration Multi -Family Floor area sq. ft.
Repair Commercial Estimated value
Move Industrial of construction $
L& Other S,610 k &- Residential Garage Is this a "Master Plan" per MN Rule
No
Other 1300.0160 Subp.6.? Yes 13
Description of work: -- / .
CGd / (rP ai7r „r 4z f,' - .S IIaIa O tsS'(?9Qr, I
hereby apply for a permit for construction as described and acknowledge that the information I have provided above is complete and accurate. I agreethattheworkwillbeconductedinconformancewiththeordinancesoftheCityofMonticelloandwiththeLawsoftheStateofMinnesota; andthatIunderstandthatthisapplicationisnotapermitandthattheworkisnottostartwithoutapermit. I further understand that the work will beinaccordancewiththeplanthathasbeenapprovedbytheBuildingOfficial. 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. SEE
BACK FOR PLUMBING AND
MECHANICAL INFO. Ap '
cant Signature Application Date
APPLICANT: Pleaseshowfixtures that are applicable. Fire
Suppression : (if applicable) Z. (if applicable) Mechanical: (if applicable) PlumbiNo.
Fixture Type Sprinkler
Heads Other /
Special FS Device Fire
Alarm: (if applicable) No.
Fixture Type of
Devices Other
rfrra:
Bldg.
Permit Plan
Review State
Surcharge Plmg.
Permit Permit
Surcharge
wer
Access ater
Access ater
Meter eter
Sales Tax No.
Fixture Type Water
Closet (toilet) Bathtub
Lavatory (
wash basin) Shower
Kitchen
Sink Dishwasher
Laundry
Tub Clothes
Washer Water
Heater Urinal
Drinking
Fountain Floor
Drain Slop
Sink Hydrants
Bldg.
Total Plmg.
Total Mech.
Total Meter
Total Sew &
Water Permit Trunk
Water Trunk
Sanitary Sewer Trunk
Storm Sewer Lift
Station AL
FEES: TOTAL
9
Per Fixture) No
Fixture Type Furnace
Gas
Meter Range
Hood Gas
Range Water
Heater Air
Conditioning Mech.
Fireplace Bathroom(
s) Exhaust Fan Air
Exchanger Dryer
Gas
Opening w/o Fixture TOTAL
9
Per Fixture) Tree
Ordinance Handout Yes No Other
Handouts Yes No Valuation:
Construction
Type: Occupancy
Group: Division:
Square
Footage: of
Stories: of
Residential Units: Maximum
Occupancy: Fire
Sprinklers: Yes No Off -
Street Parking Covered: Off -
Street Parking Uncovered: Building
Official J—— BPT: —