2021-00886CITY OF MONTICELLO
505 WALNUT STREET
MONTICELLO, MN 55362-
763) 295-3060 FAX: (763) 295-4404
Ill 9
2021-00886*
DATE ISSUED: 10/26/2021
Permit #: 2021-00886
ADDRESS 4168 87TH ST NE
PIN 155252002010
LEGAL DESC FEATHERSTONE 4TH ADDN
LOT 001 BLOCK 002
PERMIT TYPE BUILDING
PROPERTY TYPE SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE BASEMENT FINISH
VALUATION 8,500.00
NOTE: BASEMENT FINISH: FAMILY ROOM / OPEN AREA, 1 BATHROOM, 1 LUNCHROOM, LAUNDRY ROOM / MECHANICAL
ROOM.
APPLICANT
THORSON, DAVID & ANGELA
4168 87TH STREET NE
MONTICELLO, MN 55362-
OWNER
THORSON, DAVID & ANGELA
4168 87TH STREET 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
BUILDING PERMIT FEE 177.29
PLAN REVIEW 115.24
STATE SURCHARGE, BLDG VAL 4.25
TOTAL 296.78
Payment(s)
CREDIT CARD XXXX 296.78
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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moiCAO DateBUILDINGSAFETY0L1192021w- In
SITE ADDRESS
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LEGAL DESCRIPTION
LOT do
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RESID NTIA L nuiL'T
A,DDITI / „PM DEL
5 N. c tArl S53( )-
BLOCK C00r4,
PLAT & Fec, r S f rt
OWNER (Name)
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CONTRACTOR (Name)
PID. NUMBER
4=0 -i
Address)
H(68 AN
Address)
CONTRACTOR'S LICENSE NUMBER (IF APPLICABLE)
PLUMBING BEING COMPLETED BY (PLEASE CHECK ONE):
HOMEOWNER 9 CONTRACTOR
IF APPLICABLE, SPECIFY CONTRACTOR
CHECK ALL THAT APPLY: X TOILET SINK
LAUNDRY TUB SOFTENER
TOTAL # OF FIXTURES 3
1ST -,S)-oo,joIca_
Tel. No.)
7c 3-a1i I -Qi 5a
TeL No.)
Lic #
BAR SINK K BATHTUB/SHOWER
OTHER
REMINDER: IF YOU DO NOT 0WN THIS PROPERTY OR ARE NOT PERFORMING THE WORK, PERMIT MUST BE PULLED
BY MASTER PLUMBER.)
MECHANICAL BEING COMPLETED BY (PLEASE CHECK ONE):
HOMEOWNER )( CONTRACTOR
IF APPLICABLE, SPECIFY CONTRACTOR
CHECK ALL THAT APPLY: FURNACE • A/C FIREPLACE
TOTAL # OF FD(TURES ( Band #
DESCRIPTION OF WORK:
L
CJJ lie
1
00 a ,n O,xsCA
ESTIMATED VALUE OF CbNSTRUCTION
Approved by Building Official
Date Approved:
Applicant Signature
505 Walnut Street, Suite #1 Monticello, MN 55362
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Date 9 G - 1 9-d-va
Phone: 763 i95-3M Fag: 763-295-4404
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Carbon Monoxide alarm `," I
are required 10' from beoiooms
per W 299P 50
Smoke Detectors. -Yard Wire with f tt+,yr
backup; Locate in each sleeping
corridor / steeping v-=m ac:cees, on
story, in basement, fad where cdlz -11
varies 24" +,
hlgt me walls Collings with _
vapor retar r per Energy Cod
BLOC G RIE
Cut Off Conwaled Drag
Behma & Attic, 000
I ontal to V P
Seal All PeaArnhonaAW
Dud, Pipe and Wke oil
Ail Top any Roam
All Bottom Wail dates in ContOo3t L
Frith Concrete )r
B® Decoof
AMOVW RLE COP
o REVIEWED FOR CODE COWL ME C
o "Ma TO FIELD 11 r,
1D - l9- 2021
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I Bath Fan Shall Be Vented and
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PULL duu LIP-M p MST BE CONTMIED 0
ON -SITE AND IN A DUNIPSTER OR
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XM iiOPxo 763-295-2711 Fax: 763-295-4404 0VV
o 505 Walnut Street I Suite 1 Monticello, MN 55362 BUILDING
PERMIT APPLICANT: PROPERTY OWNER 1
understand that the State of Minnesota requires that all residential building contractors, remodelers
and roofers obtain a state license unless they qualify for specific exemption from the
licensing requirements. By signing this document, I attest to the fact that I am building or Improving
the house myself. I hereby claim to be exempt from the state licensing requirements because
I am not building or improving property for the purpose of speculation or resale and that
the house which 1 am applying for this permit located at: L(l iu 8 7 is
the first residential structure that I have built or improved in the last 24 months. I also acknowledge
that because I do not have a state contractor's license, I forfeit any mechanic's lien
rights to which I may otherwise have been entitled under Minn. Stat. 514.01. In the even that
I do construct or improve another residential structure in the next 24 months, I will not do so
until I obtain the required state license understanding that failure to do so is a misdemeanor under
state law. Furthermore,
I acknowledge that I may be hiring independent contractors to perform certain aspects
of the construction or improvement of this house and I understand that some of these contractors
may be required to be licensed by the State of Minnesota. I understand that unlicensed
residential contracting, remodeling, and / or roofing activity is a misdemeanor under Minn
Stat. 326.92, subd.1. 1 also acknowledge that all licensed contractor's pay into the Contractor'
s Recovery Fund, which can pay homeowners up to $50,000 in the event that their licensed
contractor fails to complete work or preforms defective work, but that 1 forfeit my rights
to reimbursement from the Contractor's Recovery Fund In the event that any contractors
I hire are unlicensed. I
also acknowledge that as the contractor on this project, I am solely and personally responsible for
and violations of the State Building Code and / or City Code in connection with the work performed
on this property, and that I can be prosecuted criminally for any code violations that
are not corrected as ordered by the City. Signature
of Property Garner Date To
determine whether a particular contractor is required to be licensed, please call the Department
of Labor and Industry @ 651-284-5012 www.
ci.monticello.mmus