2008-02567CITY OF MONTICELLO
505 WALNUT STREET
MONTICELLO, MN 55362-
295-3000 rAli: 1'103129)-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 ROOFING, SIDING & WINDOWS
VALUATION $ 15,753.00
NOTE: FINAL, INSPECTION TO BE CALLED IN A MAXIMUM OF48 HOURS AFTER COMPLETION
APPLICANT
GRATRIX CONSTRUCTION
20683 ATLANTIC BLVC
BIG LAKE, MN 55309-
763) 286-8145
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
2 0 0 8- 0 2 S 6 7*
DATE ISSUED: 09/02/2008
BUILDING PERMIT FEE
STATE SURCHARGE, BLDG VAL
TOTAL
Payment(s)
CHECK 6626
281.17
7.88
289.05
289.05
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
MONTICELLO
3
DEVELOPMENT SERVICES
BUILDING INSPECTIONS
505 WALNUT STREET. SUITE I
MONTICELLO. MN 55362
City Hall (763) 293-271 1
ND 4
Building Inspections (763) 295-3060 Fax (763) 295-4404
BUILDING PERMIT APPLICATION
Please Print - INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED.
SITE ADDRESS: ZONED
LEGAL: Lot Block at
Property Ovvner Name: r. ,, Phone: 7 ,
Address h-1 (, `` S f-r,r, City: LE State: Zip:
Contractor _._—Z G t.a' 1 ,v 1 hone :
State License 9:7
Address: ,. - ? r- ;mac r sY t'• City: AgOW State: i-t.-.., Zip
Eng./Architect Name: Phone:
Address: City: State: Zip:
Plumber Name: Phone:
Address: City: State: Zip:
Mechanical Name: Phone:
Address: City: State: Zip:
Tvne of Work Type of Construction Building Information
New t> Single Family Use of building
Addition Duplex of stories
Alteration Multi -Family Floor area sq. ft.
t Repair . t Commercial Estimated value
hj0vc Industrial of construction
Other Residential Gara<ue Is this a "Master Plan" per MN Rule
Other 1300.0160 Subp.6.? El Yes No
Description of work:
I hcrehv apple for a permit for constructicm as dc,crihed and acicno\\ led<-,c that the inlbrtnation I have provided ahoy c k complete and accurate I
aercc that the vwl-k will be conducted in con10111mnce %p ill] the ordintuiccs of the Cite of Monticello and kith the Lai%; of the 5tatc of,.Iinnc,ota:
and that I understand that this application i, not a permit and that the work is not to start without a permit. I further understand that the %wick gill
he in accordance with the plan that has been appim cd hr the Ituildind 011-1cial. I agree that aim damage caused to puhlic propa-t% includine but
not limited to curb_ sidc callc_ puhlic utilities and signs kill be repaired at mN, espcnse.
7
Applicant Signature
SEE BACK FOR PLUMBING
AND MECHANICAL INFO.
Application Date
APPTI(-ANT- Plea.ci chew fixtures that are (innlicable.
Fire Suppression : (if applicable) Plumbing (if applicable) Nfechanical: (if applicable)
No. Fixture Type
Sprinkler Heads
Other /Special FS Device
No. Fixture Type
4L'oter Closet (toilet)
Bathtub
Lavatory (wash basin)
Shower
No. Fixture Tvpe
Furnace
Gas iWeter
Range Hood
Gas Range
Kitchen Sink Water Heater
Dishwasher Air C ondr6onin-
Laundry Tub Ilech. Fireplace
Fire Alarm: (if applicable) Clothes Washer
W'iter Heater
Bathroom(s) Exhaust Fan
Air E_vch(mger
No. Fixture Tvpe
Grinal
Drinking Fountain
Dryer
Gas Opening w10 Fi W.-e
Floor Drain
9 of Devices Slop Sink
Other Hydrants
TOT -,l L
S9 Per Future)
TOTAL
S9 Per Fixture)
FOR CITY USE ONLY
FEES:
Bld0. Permit
Plan Revie"N
State Surchar,e
Bldg. Total
Ph11LT. Permit
Fixtures
Surchar,-,e
Plmg. Total
Mech. Permit
Fixtures
Surchar<-'e
Mech. Total
Sewer Access
Water Access
Water Meter
Meter Sales Tax
Meter Total
Sew & Water Permit
Trualc Water
Trunl: Sanitarti Sewer
Trunk Storm Sewer
Lift Station
TOTAL FEES:
Tree Ordinance Handout Yes No
Other Handouts Yes No
ADDITIONAL INFORMATION:
Valuation:
Construction "l'Vpe:
Occupa11Cv Group:
Division:
Square hoota,re:
of Stories:
of Residemial Units:
Maximum OccuparieN
Fire Sprinklers: Yes No
Off -Street Parking, Covered:
Off -Street Parkin-, Uncovered:
Building Official
BPT: