2014-00171CITY OF MONTICELLO *
2 0 1 4- 0 0 1 7 1
505 WALNUT STREET DATE ISSUED: 04/16/2014
MONTICELLO, MN 55362-
763) 295-3060 FAX: (763) 295-4404
ADDRESS 4300 87TH ST NE
PIN 155180004090
LEGAL DESC FEATHERSTONE 2ND ADDN
LOT 009 BLOCK 004
PERMIT TYPE MECHANICAL
PROPERTY TYPE SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE NEW CONSTRUCTION
NUMBER OF MECHANICAL FIXTURES 6
APPLICANT MECHANICAL BASE FEE, RESI 45.00
MECHANICAL FIXTURES 54.00
RICCAR HEATING
STATE SURCHARGE, MECH FIX 5.00
2387 STATION PARKWAY
ANDOVER, MN 55304- TOTAL 104.00
763) 754-4000 Payment(s)
CHECK 45570 104.00
1111201 DI.l
GOLD NUGGET DEVELOPMENT 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
Monticello9HDINGSAFETI
PERMIT # ; i
505 WALNUT STREET, SUITE I MONTICELLO, MN 55362
City Hall (763) 295-2711 Building Inspections (763) 295-3060 Fax (763) 295-4404
BUILDING PERMIT APPLICATION
Please Print - INCOMPLETE APPLICA TIjONS WILL BE ACCEPTED.
SITE ADDRESS: #& f 0
NOT
U /T V - . ZONED
LEGAL: I
P e
Novak -Fleck, Inc. Zone:
Address: 7ca':
Par ..
N» NT. 76 3 " cid'1' State: Zip:
Brooklyn9/• Brooklyn Park, MN 55445
Contractor Name: Phone:
State License RICCAR HEATINTM64
Address: 7387 STATION PARKWAY NA City: State: Zip:
eNpo lrp Mfg F na
Eng./Architect Name: 763-754-4000 AV/4 Phone:
Address: City: State: Zip:
Plumber Name: Phone:
Address: City: State: Zip:
Mechanical Name: Phone:
Address: City: State: Zip:
Tv e of Work Type of Construction Building Information
New a Single Family Use of building
Addition Duplex of stories
Alteration O Multi -Family Floor area sq. ft.
Repair Commercial Estimated value
Move Industrial of construction $
Other Other
Description of work:
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. I 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 property including but
not limited to curb, sidewalk, public utilities and signs will be repaired at my expense.
SEE BACK FOR PLUMBING
AND MECHANICAL INFO.
Applicant Signature Application Date
APPLICANT: Please show fixtures that are a_oplicable.
Fire Suppression : (if applicable) Plumbing: (if applicable) Mechanical: (if applicable)
No. Fixture Tvpe No. Fixture Tvpe No. Fixture TVDe
Sprinkler Heads Water Closet (toilet) Furnace
Other/Special FSDevice Bathtub Gas Meter —/ &4&n
Lavatory (wash basin) Range Hood
Shower Gas Range
Kitchen Sink Water Heater
Dishwasher l Air Conditioning
Laundry Tub Mech. Fireplace
Clothes Washer Bathroom(s) Exhaust Fan
Fire Alarm: (if applicable) Water Heater Air Exchanger
Urinal Dryer
No. Fixture Tvae Drinking Fountain Gas Opening w/o Fixture
Floor Drain
of Devices Slop Sink
Other Outside Faucet
TOTAL
FOR CITY USE ONLY
FEES:
TOTAL S
OD
Tree Ordinance Handout Yes No
Bldg. Permit Other Handouts Yes No
Plan Review
State Surcharge
Bldg. Total
Plmg. Permit
Fixtures ADDITIONAL INFORMATION:
Surcharge Valuation:
Plmg. Total Construction Type:
Mech. Permit Occupancy Group:
Fixtures
Division:
Surcharge Square Footage:
Mech. Total of Stories:
Sewer Access of Residential Units:
Water Access Maximum Occupancy:
Water Meter
Fire Sprinklers: Yes No
Meter Sales Tax Off -Street Parking Covered:
Meter Total Off -Street Parking Uncovered:
Sew & Water Permit
Trunk Water
Trunk Sanitary Sewer
Trunk Storm Sewer
Lift Station
TOTAL FEES:
Building Official
BPT: