2008-01474CITY OF MONTICELLO
505 WALNUT STREET
MONTICELLO, MN 55362-
763) 29s-3U6U VAX: (763) 295-44U4
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 SIDING
VALUATION 9,000.00
APPLICANT
HOME EXTERIORS INC
7950 COUNTY ROAD 26
MINNETRISTA, MN 55359-
612) 599-6726
OWNER
BURT,WILLIAM & PENNY
6328 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
2 0 0 8- 0 1 4 7 4
DATE ISSUED: 07/23/2008
BUILDING PERMIT FEE
STATE SURCHARGE, BLDG VAL
TOTAL
Payment(s)
CHECK 5347
177.29
4.50
181.79
181.79
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
MONTICELLO
DEVELOPMENT SERVICES
BUILDING INSPECTIONS
505 wALNUISTREET. SUITE, I MONTICELLO.
MN 55362 Citv
Hall (763) 295-2711 Building Inspections (763) 295-3060 Fax (76 3) 295-4404 BUILDING
PLRMIT APPLICATION Please
Print- INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED. SITE
ADDRESS: - ` . ZONED LEGAL:
Lot Block Plat Property-
Owner Name: 11\ Phone: 14 Q LA Address:
City: State: Zip:_ Contractor
Name: Phone:(-7 State
License 9: Address:—
7. C / 2C City: ---State: Zip: En(
T./Architect Name: Phone: 72 Address:
City: State: Zip: Plumber
Name: Phone: Address:
City_ : State: Zip: Mechanical
Name: Phone: Address
City: State: Zip: _ Tvpe
of Work Tyne of Construction Building Information New
Sin( -,le Family Use of building-) Addition
Duplex 9 of stories Alteration
Multi -Family Floor area sq. ft. F
srRepair Commercial Estimated value Move
Industrial of construction S' Other
Residential Gara(.?e Is this a `Master Plan" per MN Rule Other
1300.0160 Snbp.6.° Yes No Description
of Nvork: FOR ROOF & SIDING PERMITS PLEASE
PROVIDE # OF SQUARES
OF SHINGLES &/OR SIDING
I
hcrchc apply fora Permit for construction as descrihcd and aL:knmdcdge that the information I have provided abovc is complete and accurate. I agree
that the work vv ill he conducted in conformance kith the ordinances of the Cite of \vtonticcllo and with the Laws of the )tetc of \linnr,ota: and
that I understand that this application is not a hermit and that the \aorl: is not to start vNithout a permit. I further understand that the v`,orb `,gill be
in Llccoldancc ith the 1)1a1) that has been approved hrthe Building 01`1lcial. I agree that am damage caused to public propertc including but not liil
ttcc t curb. ;idr\\ all:_ public utilities and liens will he repaired at nm c\,pensc. Applicant Signature
SEE BACK
FOR PLt'MBING 7AND MECHANICAL
INFO. Application Date
APPLICAAJ: Please show textures that are appItecible.
Fire Suppression : (if applicable) I Plumbing: (if applicable) Mechanical: (if applicable)
No. Fixture Tvpe
Sprinkler Heads
Other/Special PS Device
Fire Alarm: (if'applicable)
No. Fixture Type
o f Devices
Other
FEES:
Bldg,. Permit
Plan Review
State Surchar,c
Bldg. Total
Plmg. Permit
Fixtures
Surcharge
Plmg. Total
Mech. Permit
FlxlnreS
Surchar,,c
Mech. Total
Sewer Access
Water Access
Water Meter
Meter Sales Tax
Meter Total
SeNN & Water Permit
Trunk Water
hrunk Sanitary Sewer
Trunk Storm Sewer
Lift Station
TOTAL FEES:
No. Fixture Tvpe
Water Closet (toilet)
Bathtuh
Lavatory (wash hasin)
Shower
Kitchen Sink
Dish washer
Laundri' Tub
Clothes ff,asher
Neater Heater
1%rival
Drinking Fountain
Floor Drain
Slap Sink
Hrdrants
TOTAL
S9 Per Fivture)
FO CITY USE ONLY
No. Fixture Type
Furnace
Gas Meier
Rau; e Hood
Gas Range
Water Heater
Air Conditioning
Mech. Fireplace
Bathroom(s) Exhaust Fan
Air Exchanger
Dryer
Gas Opening w/o Fixture
TOTAL
S9 Per Fiyture)
Tree Ordinance Handout Yes No
Other Handouts Yes No
ADDITIONAL. INFORMATION:
Valuation:
Construction l'ype:
Occupancy Group:
Division: _
Square Footage:
of Stories:
r7 of Residential Units:
Maximum Occupancy:
Fire Sprinklers: Yes ',o
Off -Street Parkin, Covered:
Off -Street Parkin, Uncovered:
Building Official
BPT: