2021-00096CITY OF MONTICELLO
505 WALNUT STREET *
2 0 2 1— 0 0 0 9 6*
DATE ISSUED: 02/17/2021
MONTICELLO, MN 55362-
763) 295-3060 FAX: (763) 295-4404
Permit #: 2021-00096
ADDRESS 4167 87TH ST NE
PIN : 155252001040
LEGAL DESC FEATHERSTONE 4TH ADDN
LOT 004 BLOCK 001
PERMIT TYPE MECHANICAL & PLUMBING
PROPERTY TYPE SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE NEW CONSTRUCTION
NOTE: PLUMBING AND HVAC FOR ANEW HOUSE.
NUMBER OF MECHANICAL FIXTURES 7 NUMBER OF PLUMBING FIXTURES 17
APPLICANT MECHANICAL BASE FEE, RESI 50.00
MECHANICAL FIXTURES 63.00
INNOVATIVE PLUMBING & HEATING
STATE SURCHARGE, MECH FIX 1.00
14918 200TH AVE NW
ELK RIVER, MN 55330- PLUMBING BASE FEE, RESI 50.00
763) 441-2404 PLUMBING FIXTURES 153.00
STATE SURCHARGE, PLBG FIX 1.00
TOTAL 318.00
Payment(s)
OWNER CHECK 6669 318.00
NOVAK-FLECK INC
8857 ZEALAND AVE N
BROOKLYN PARK, MN 55445-
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
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY OF
Monticello
BUILDING SAFETY PERMIT # ZO Z / - aOO
505 WALNUT STREET, SUITE l MONTICELLO, MN 55362 000
City Hall (763) 295-2711 Building Inspections (763) 295-3060 Fax (763) 295-4404
Please Print - INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED.
SITE ADDRESS: 4167-87th St tilt=
LEGAL: Lot Block Plat
ZONED
Property Owner Name: Novak Builders & Remodelers, Inc Phone: 7 7799
Address: 12M-1st BL SE City: Becker State: MN Zip: 6M
Contractor Name: innovative Plumbing & Heating. Inc Phone: 763.441-24"
State License #: PC004928, M8003898 E-Mail: Imvir4nrwvativeph=n
Address: 14918 - 20M Ave NW City: Sk River State: AWN Zip: s
EngJArchitect Name:
Address: City:
Plumber Name: hmovative Plumbing & Heating, Inc
Address: 14918 - 200th Ave NW City; EM WNW
Mechanical Name: innovative Pitmnbing & Heating, Inc
Address: 14918 - 2=h Ave NW City: Elk River
T voe of Work Tvne of Construction
13 New O Single Family
13 Addition Duplex
Alteration 19 Multi -Family
Repair 13 Commercial
Move Industrial
Other Other
Description of work:
Installation of plum ft, & Hvec for new home, gas lines, water Imes, furnace, Afc. HRV.
Phone:
State: Zip:
Phone: 763.441-24N
State: MIN Zip: 5M
Phone:
State: MIN Zip: WX
Building Information
Use of building
of stories
Floor area sq. &
Estimated value
of construction $
1 hereby apply for a permit for conswttion as described and aclmowledge 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 drat this application is not a permit and that the work is not to start without a pmW L I tiuther 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 erg.
SEE BACK FOR PLUMBING
2118/2021 AND MECHANICAL INFO.
Applicant Signature Application Date
f3lx 00
APPLICANT: Please show -fixtures that are applicable.
Fire Sunnression : (if applicable) Plumbins: (if applicable) Mechanical: (if applicable)
No. Fixture Tvae No. Fixture Tvpe No. Fixture Tvve
Sprinkler Heads 3 Water Closet (tollet) I Furnace
Other /Special FS Device 1 Bathtub 1 Gas Meter
3 Lavatory (wash basin) Range Hood
2 Shower Gas Range
I Kitchen Sink Water Heater
1 Dishwasher 1 Air Conditioning
1 Laundry Tub Mech. Fireplace
1 Clothes Washer 2 Bathroom(s) Exhaust Fan
Fire Alarm: (if applicable) 1 Water Heater I Air Exchanger
Urinal I Dryer
No. Fixture Tvue Drinking Fountain Gas Opening w/o Fixture
1 Floor Drain
of Devices Slop Sink
Other
2 Outside Faucet
17 TOTAL 7 TOTAL
Future Owner Information• Tree Ordinance Handout Yes No
Other Handouts Yes No
Name:
Address:
City: ADDITIONAL INFORMATION:
Valuation:
State: Zip: Construction Type:
Occupancy Group:
Phone #: Division:
Square Footage:
of Stories:
of Residential Units:
Maximum Occupancy:
Fire Sprinklers: Yes No
Off -Street Parking Covered:
Off -Street Parking Uncovered:
Building Official
BPT: / /