2014-00179CITY OF MONTICELLO Innl ll llmnmm nm llmllmnnnnnl mlm
2 0 1 4— 0 0 1 7 9
505 WALNUT STREET DATE ISSUED: 04/17/2014
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 PLUMBING
PROPERTY TYPE SINGLE FAMILY -DETACHED
CONSTRUCTION TYPE NEW CONSTRUCTION
NUMBER OF PLUMBING FIXTURES 17
APPLICANT PLUMBING BASE FEE, RESI 45.00
PLUMBING FIXTURES 153.00
RICKS PLUMBING INC
STATE SURCHARGE, PLBG FIX 5.00
1707 221ST AVE NW
CEDAR, MN 55011-
TOTAL 203.00
763) 753-1935
Payment(s)
CHECK 13232 203.00
OWNER
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.
MONTICELLO
DEVELOPMENT SERVICES
PERMIT 'i i
1- `
1
BUILDING INSPECTIONS PID T
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 APPLICATIONS WILL NOT BE ACCEPTED.
SITE ADDRESS: -11 SOO a S--• t- F ZONED
LEGAL: Lot C- Block l-( Plat ITS-jr nv
Property Owner Name: `vGVO- - t(/ Phone:
Address: City: State: Zip:
Contractor Name:'---k ( S 1 1rl q Phone:
r7:(D3- r'Ssr 135
State License #: J
Address: 19dl 22I7 T -A'Vf. NW City: State: M N Zip: S5U
Eng./Architect Name:
Address:
Plumber Name:
Address:
Mechanical Name:
Address:
Tvne of Work
New
Addition
Alteration
Repair
Move
Other
Description of work:
k% k0,A-". A'"
Phone:
City: State: Zip:
Phone:
City: State: Zip:
Phone:
City: State: Zip:
Tvne of Construction Buildina Information
K Single Family Use of building
Duplex of stories
Multi -Family Floor area sq. ft.
Commercial Estimated value
Industrial of construction $
Residential Garage Is this a "Master Plan" per MN Rule
Other 1300.0160 Subp.6.? Yes No
FOR ROOF & SIDING PERMITS
PLEASE PROVIDE # OF
SQUARES OF SHINGLES &/OR
SIDING
1 hereby appl\ for a permit for construction as described and ackno\\ ledge that the information I have provided above is complete and accurate. I
agree that the work \\ ill be conducted in conformance \\ ith the ordinances of the Cite of Alonticello and \\ ith the Laws ofthe State of i\,linnesota:
and \flat I llndCrstalld lhat this application is not a permit and that the \cork is not to start \\ithollt a permit. I further unders4nld that the \work \\ ill
be in accordance \\ ith the plan that has been approved b\' the Building Official. I agree that anv damage caused to public property including brit
not limited to curb. sidewalk. public utilities and signs will be repaired at nl) eNperlsc.
SEE BACK FOR PLUMBING
AND MECHANICAL INFO.
Applican unature Application Date
APPLICANT: Please show fi tures that are applicable.
Fire Suppression : (if applicable) Plumbing: (if applicable) 11lechanical. (if applicable)
No. Fixture Tvpe
Sprinkler Heads
Other/Special FS Device
Fire Alarm: (if applicable)
No. Fixture Tvpe
of Devices
Other
FEES:
Bld-. Permit
Plan RevieN%
State Surcharge
Bldg. Total
Phrlg. Permit
Fixtures
Surcharge
Plmg. Total
Mech. Permit
Fi\tureS
Surcharge
No. Fixture Tvpe
y
Water Closet (toilet)
Bathtub
Laratoiy (wash basin)
Shower
Kitchen Sink
Dishwasher
Laundry, Tub
Clothes Washer
it ater Heater
Urinal
Drinking Fountain
Floor Drain
Slop Sink
7,L J >vdrants
12 TOTAL
S9 Per Fi_vtnre)
Mech. Total
Sewer Access
Water Access
Water deter
Meter Sales Tat
jVleter Total
Sew & Water Permit
rrUilk Water
Trunk Sanitary Seger
Trunk Storm Seger
Lift Station
TOTAL FEES:
FOR CITY USE ONLY
No. Fixture Tvpe
Furnace
Gas rtleter
Ran;e Hood
Gas Raul e
Pater Heater
Air Conditionin;
Hech. Fireplace
Bathroom(s) Exhaust Farr
Air E.xchanaer•
Duer
Gas Opening u/o Fi_vture
TOTAL
S9 Per Fieture)
Tree Ordinance Handout Yes No
Other Handouts Yes No
ADDITIONAL INFORMATION:
Valuation:
Construction Type:
Occupancy Group:
Division:
Square Footage:
m of Stories:
of Residential Units:
i0aximum Occupancy:
Fire Sprinklers: Yes No
Off -Street Parking Coverecl:
Off -Street Parking Uncovered:
Building Official
BPT: