2007-00637CITY OF MONTICELLO
505 WALNUT STREET
MONTICELLO, MN 55362-
295-3U6U YAX: (763) 295-44U4
ADDRESS 6367 86TH ST NE
PIN 155160010060
LEGAL DESC CARLISLE VILLAGE
LOT 006 BLOCK 010
PERMIT TYPE BUILDING
PROPERTY TYPE SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE DECK
VALUATION 1,400.00
APPLICANT
HAGEN,KENNETH C & KRISTA K
6367 86TH ST
MONTICELLO, MN 55362
OWNER
HAGEN,KENNETH C & KRISTA K
6367 86TH ST
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
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2007-00637*
DATE ISSUED: 08/03/2007
BUILDING PERMIT FEE
STATE SURCHARGE, BLDG VAL
TOTAL
Payment(s)
CHECK 2108
52.36
0.70
53.06
53.06
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
MONTICELLO
DEVELOPMENT SERVICES PERMIT # —COLD
BUILDING INSPECTIONS 11PID # /s // /j _0 MA b
505 WALNUT STREET, SUITE I
MONTICELLO, MN 55362
City Hall (763) 295-2711 Building Inspections (763) 295-3060 Fax (763) 295-4404
Please Print - INCOMPLETE APPLICATIONS WILL NOT JJFACCEPTED.
IV 1W
SITE ADDRESS: ZONED
LEGAL: Lot Block s® Plat_6&rs . d
Property Owner Name:
Address: P/...
Phone: -7 6 3 5'5-- /''7 7Sy
City: ,w, «f'o State:Zip:.S 3-2.C-
Contractor Name: I iz Phone: 74 — --- P r
State License #: D9k 2 S 0
Address: 1,,2 i7 , ,rT City: 1-4y-v >1,C&ZZ2 State;, Zip:
Eng./Architect Name:
Address:
Plumber Name:
Address:
Mechanical Name:
Address:
City:
City:
City:
Phone:
Phone:
Phone:
State: Zip:
State: Zip:
State: Zip:
Tyne of Work TVDe of Construction Building Informatian
New Single Family Use of building , W ;; I °
Addition Duplex of stories
Alteration Multi -Family Floor area sq. ft. AQ0
1
Repair Commercial Estimated value
Move Industrial of construction $
Other El Residential Garage Is this a "Master Plan" per MN Rule
Other 1300.0160 Subp.6.? Yes )4 No
Description of work: f///
I 1 lrD-°-
I hereby apply for a permit 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 conformance with the ordinances of the City of Monticello and with the Laws of the State of Minnesota;
and that I understand that this application is not a permit and that the work is not to start without a permit. 1 further 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 properly including but
not limited to curb, sidewalk, public utilities and signs will be repaired at my expense.
Applicant Signa ure n .r
RECEIVED
SEE BACK FOR PLUMBING
c}S AND MECHANICAL INFO.
Application Date
JUL 2 5 PM.
APPLIC.AIVT : Please show fixtures that are
Fire Sunnression : (if applicable) I Plumbing: (f applicable) Mechanical: (f applicable)
No. Fixture Type
Sprinkler Heads
Other /Special FS Device
Fire Alarm: (f applicable)
No. Fixture Type
of Devices
Other
No. Fixture Tyne
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
TOTAL
9 Per Fixture)
FEES:
Bldg. Permit
Plan Review
State Surcharge
Bldg. Total
Plmg. Permit
Fixtures
Surcharge
Plmg. Total
Mech. Permit
Fixtures
Surcharge
Mech. Total
Sewer Access
Water Access
Water Meter
Meter Sales Tax
Meter Total
Sew & Water Permit
Trunk Water
Trunk Sanitary Sewer
Trunk Storm Sewer
Lift Station
TOTAL FEES:
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 tX No
Other Handouts , )7 Yes No
ADDITIONAL INFORMATION:
Valuation: 00
Construction Type: V
Occupancy Group: COZ9 1
Division: PV.4
Square Footage: 106
of Stories:
of Residential Units:
Maximum Occupancy: rU
Fire Sprinklers: Yes 1ANo
Off -Street Parking Covered:
Off -Street Parking Uncovered:
Building Official4BPT: / /
4X 7 9 741SMV%V
f 19
ALL FASTENERS AND HANGERS ARE ACQ RATED
PROPOSED DECK FOR:
KEN AND KRISTA HAGEN
6367 86TH ST
MONTICELLO, MN 55362
763.295.6775
CITY SEWER AND WATER
O'n"ARKNA"' CON5MMUDH
763.12,q o FILE COPY
R 000E
ON
L C 2-03 4"" I,, T- 19dS E' TIOhd
Date 07— Signed
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