2008-00590CITY OF MONTICELLO
505 WALNUT STREET
MONTICELLO, MN 55362-
763) 295-3060 VAX: (763) 2y5-44U4
ADDRESS 6328 86TH ST NE
PIN 155186001090
LEGAL DESC CARLISLE VILLAGE 3RD ADDN
LOT 009 BLOCK 001
PERMIT TYPE BUILDING
PROPERTY TYPE SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE ROOFING
VALUATION $ 8,250.00
NOTE: FINAL INSPECTION TO BE CALLED IN A MAXIMUM OF48 HOURS AFTER COMPLETION
APPLICANT
HOME EXTERIORS INC
7950 COUNTY ROAD 26
MINNETRISTA, MN 55359-
612) 599-6726
OWNER
BURT,WILLIAM & PENNY
6328 86TH ST N E
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 curt, sidewalk,
public utilities and signs will be repaired at my expense.
Applicant
Date
Bldg Official Date
JUNIUMEM
2 0 0 8— 0 0 S 9 0
DATE ISSUED: 06/18/2008
BUILDING PERMIT FEE
STATE SURCHARGE, BLDG VAL
TOTAL
Payment(s)
CHECK 5334
177.29
4.12
181.41
181.41
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
DEVELOPMENT SERVICES PERMIT
BUILDING INSPECTIONS PIS #
505 WALNUT STREET, SUITE l
v.: MONTICELLO, MN 55362
1 1 1 1 1 1 1
Cit}- Hall (763) 295-2711 Building Inspections (763) 295-3060 Fax (763) 295-4404
MONTICELLO
Please Print - INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED.
SITE ADDRESS: —
ZONED
LEGAL: Lot Block Plat
Property Owner Name:
Phone:
Address _ _ a 1 Ctty i State. Zip:
Contractor Name:
State License:
Address: ' ,
Eng./Architect Name:
Address:
Plumber Name:
Address:
Mechanical Name:
Address:
Tvne of Work
N evx
Addition
ZC Alteration
Repair
Move
Other
Description of work:
Phone:
City:_
City:
Cite:
Citti- :
Tvne of Construction
Single Family
Duplex
Multi -Family
Commercial
Industrial
Residential Garage
Other
State: , - Zip:
Phone: -> k
State: zip:
Phone: _
State: Zip:
Phone:
State: Zip:
Building. Information
Use of building
r of stories
Floor area sq. ft.
Estimated value
of construction
Is this a "Master Plan" Per MN Rule
1300.0160 Subp.6.
0 ED Yes El NO
I hcicm apply for nermit foi constriction as CIeSCFihed and acknowled«e tjjat the information I have provided ahovc is complete and accurate.1agreethattheou< will be conducted in conformance with the ordinances of tilt City of Monticello and with the Laws of the Stat of MinnesotaandthatIunderstandthatthisapplicationisnotapermitandthatthworkisnottostartwithoutanermit. I further understand thatthe work willbeinaccorda;e with the plan that has been approved by the Building Official. I agree that am damage caused to public property includin<but
not Limited to Curb. sidewalk_ public utilities anti signs will be repaired at my expense.
SEE BACK FOR PLUMBING
AND MECHANI CAL INFO.
Applicant Signature Application Date
APPLICANT. Please show fixtures that are
Fire SuL)L3ression : (if applicable) I Plumbing: (if applicable)
No. Fixture Tvpe
Sprinkler Heads
Other /Special FS Device
Fire Alarm: (if applicable)
No. Fixture Tvpe
of Devices
Other
No. Fixture Type
Water Closet (toilet)
Bathtub
Lavatorp (tivash hasin)
Shower
Kitchen Sink
Dishwasher
Laundry Tuh
Clothes Washer
Water Heater
Urinal
Drinking Fountain
Floor Drain
Slop Sink
Hydrants
TOTAL
59 Per FLvture)
T'QR CITY CTSE ONLY -
FEES:
Bldg. Permit
Plan Review _
State Surcharge
Bldg. Total
Plmg, Permit
Fixtures
Surcharge
Plmg. Total
Mech. Permit
Fixtures
Surchar«e
Mech. Total
Sewer .Access
Water Access
Water Meter
Meter- Sales Tax
Meter Total
Sew & Water Permit
Trunk eater
Trt.mk Sanitary Sewer
Trunk Storm Sewer
Lift Station
TOTAL FEES:
icame.
Mechanical: (if applicable)
No. Fixture Tvpe
Furnace
Gas Meter
Range Hood
Gas Range
Water Heater
Air Con(litionhaa
Mech. Fireplace
Bathroom(s) Exhaust Fan
Air Exchanger
Dryer
Gas Opening w/o Fixtttre
TOTAL
9 Per Fixture)
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 ParkinL, Uncovered:
Building Official
BPT: