2008-02425CITY OF MONTICELLO
505 WALNUT STREET
MONTICELLO, MN 55362-
295-3060 FAX: (763) 295-4404
ADDRESS 6318 86TH ST NE
PIN 155186001080
LEGAL DESC CARLISLE VILLAGE 3RD ADDN
LOT 008 BLOCK 001
PERMIT TYPE BUILDING
PROPERTY TYPE SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE ROOFING
VALUATION $ 7,250.00
NOTE: FINAL INSPECTION TO BE CALLED IN A MAXIMUM OF 48 HOURS AFTER COMPLETION
DOING OVER THE WEEKEND - OK TO TAKE PICTURES OF BARE DECKING AND ICE-N-WATER
APPLICANT
CLARK, JAMES
6318 86TH ST NE
MONTICELLO, MN 55362-
OWNER
CLARK, JAMES
6318 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 Buildin, 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
2 0 0 8— 0 2 4 2 S
DATE ISSUED: 08/27/2008
BUILDING PERMIT FEE
STATE SURCHARGE, BLDG VAL
TOTAL
Payment(s)
CREDIT CARD 9386
162.45
3.62
166.07
166.07
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
DEVELOPMENT SLRV ICES
III UILDING INSPECTIONS
5O5 %VALN`UT STREET, SUITE I
MONTICELLO, MN 55362)
PERM 1 T: -
City Hall (763) 295-271 I Building Inspections (763) 295-3060 Fax (763) 295-4404
MONTICELLO
BUILDING PERMIT APPLICATION
Please Print - INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED.
SITE ADDRESS: C ZONED;
LEGAL: Lot Bloch Plat
Property Owner Name: ,' ; Phone: ( I ), L( 9
yAddress: ` 1 ,4 r Cite: 11', 1 , State: NE
Contractor- Name: Phone:
State License r:
Address: City: State: Zip:
End./Architect Name: Phone:
Address: City_ : State: _ Zip:
Plumber Name: Phone:
Address: Cite: State: lip:
Mechanical Name: Phone:
Address: City: State: Zip:
Type of Work Tyne of Construction Building Information
New Single Family Use of building
Addition Duplex of stories S I j
Alteration Multi -Family Floor area sq. ft.
Repair Commercial Estimated value
Move Industrial of construction $''
Other Residential Garage Is this a "Master Plan" per N Rule
Other 1300.0160 Subp.6.? El N es s-. No
Dcscri tion of work: FOR ROOF & SIDING PERMITS
e ; -,
I PLEASE PROVIDE # OF
SQUARES OF SHINGLES &/OR
SIDING
1 hereh appIv for a permit for construction as descrihal and acknowledge that the information I have provicieci ahove i> complete and accurlte. I
aL_'rec that the %%orh well he conducled ill conlornlance %A ith the ordimula:s o1 the (-,ItsoI 'Monitcclio and %ilh the of ah State of l'l1nncsot:l: and
that I undcrsland that this application is not a permit and that the wort: is not to start without a permit. I further understand that the work will he
in accordance with the plan that has hecn approval by the Building Official. I a«rce that an% ctamaec caused to public property including but not
limited to curb. side\calh. puhilc utilities and signs will he repaired et nn expense. plican-
tSignature SEE
BACK FOR PLUMBING AND
MECHANICAL INFO. Application
Date
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 a specific exemption
from the licensing requirements. By signing this document, I attest to the fact that I am
building or improving this house myself. I hereby claim to be exempt from the state
licensing requirements because I am not building or improving this property for purposes
of speculation or resale and that the house for which I am applying for this permit,
located atis the first residential structure I have built or
improved in the past 24 months. I also acknowledge that because I do not have a state license,
I forfeit any mechanic's lien rights to which I may otherwise have been entitled under
Minn. Stat. §514.01. In the event 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. I also acknowledge that all licensed contractors
pay into the Contractor's Recovery Fund, which can pay homeowners up
to $50,000 in the event their licensed contractor fails to complete work or performs
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 any violations of the State Building Code and/or city ordinance 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. Si
ature of Prdperty Owner Date
To
determine whether a particular contractor is required to be licensed, or to check on
the licensing status of individual contractors, please call the Minnesota Department
of Commerce, Market Assurance Division, at (651) 296-2594, or toll - free
at 1-800-657-3602.