Application for City of Rollingstone Building Permit
61 Main StreetRollingstoneMinnesota55969 Telephone (507) 689-4110 Fax (507) 689-4439
Permit Number ______Date Application Received ______
Property Owner Information
Name: ______Telephone: ______
Mailing Address: ______Telephone:______
City/State/Zip:______
Applicant Information (if other than owner)
Name: ______Telephone: ______
Mailing Address: ______Telephone: ______
City/State/Zip: ______
Project Information
Building Permit Application Form Revised 02/01/2008
Site Address: ______
Current Zoning: ______
Building Permit Application Form Revised 02/01/2008
Legal Description: ______
General Contractor: ______License #: ______Telephone: ______
Plumbing Contractor: ______License #: ______Telephone: ______
Type of Permit (Circle One): Residential Non-Residential If not residential, specify: ______
Type of Work: (Check all that apply) New ______Addition ______Remodel ______Re-shingle ______
Deck ______Reside ______Garage ______Windows ______
Other (Describe) ______
Description of Proposed Project or Work to be Completed: ______
______
MinimumProperty Line Setbacks: Street Setback______feet Side Setback______feet Rear Setback_____ feet
Note: A separate State of Minnesota Electrical Permit is required for electrical work.
Applicant Statement and Acknowledgements
Building Permits shall become null and void if the authorized work is not commenced within 180 days from the date of permit approval, or if the building or the authorized work is suspended or abandoned for 180 days at any time after the work has commenced. (UBC 106.4.4)
I, the applicant, certify that information on this application is true, complete, and correct. If a permit is issued, all work done and all materials used shall be in conformance with the approved plans and specifications, and in compliance with the requirements of the Minnesota State Building Code and other applicable statutes and ordinances that regulate building construction or use.
Printed Name: ______Signature: ______
Building Permit Number ______
Building Permit Name ______
Page 2
THE FOLLOWING TO BE COMPLETED BY THE CITY
Building Permit Application Form Revised 02/01/2008
Zoning Permit Approved by ______Date ______
Zoning Permit Denied by ______Date ______
Variance Application Filed: (Circle One) Yes No
If Yes, Date Variance Application Filed: ______
Variance Hearing by Board of Adjustment: Date ______
Approved: (Circle one) Yes No
Building Official Approval ______Date _______
BUILDING PERMIT FEES
Building Permit Application Form Revised 02/01/2008
Building Valuation: $ ______General Permit Fee: $ ______
Plumbing Valuation: $______Plumbing Permit Fee: $ ______
Mechanical Valuation: $______Mechanical Permit Fee: $ ______
Total Valuation: $ ______State Surcharge Fee: $______
Total Valuation: $______Plan Check Fee: $______
Total Fees: $ ______
Date Paid:______
Building Permit Application Form Revised 02/01/2008
BUILDING PERMIT CHARGES FOR NEW HOME CONSTRUCTION
Water Availability Charge: $ 800.00 per lot
Sewer Availability Charge: $1,200.00 per lot
Water Meter Installation Charge: $ 200.00
Total Charges: $2,200.00
Date Paid: ______
Rules, Regulations and Applicable Fees for a Rolling MeadowsBuilding Permit Application
1. The Site Plan must adhere to all rules and regulations contained in the Storm Water Pollution Prevention Plan. Sweetwater Development is required to provide a copy of the Storm Water Pollution Prevention Plan to all lot owners at the time a lot is purchased. Not complying with the Storm Water Pollution Prevention Plan rules and regulations could delay the issuance of a Building Permit
2. The Site Plan must incorporate an On-Lot Infiltration System. Refer to page 7 of the Storm Water Pollution Prevention Plan.
3. The Site Plan must include drainage patterns on the lot.
4. The Site Plan must include street, side yards and rear yard building setbacks. Owners of corner lots should check with the City Zoning Administrator for setback requirements.
5. Sweetwater Development has the responsibility to inform potential lot buyers of the City of Rollingstone water and sewer connection fees that are payable when the Building Permit is issued. These fees are as follows:
Water Availability Charge $ 800.00 per lot
Sewer Availability Charge $1,200.00 per lot
- The City of Rollingstone charges a water meter and installation fee of $100.00 which is payable when the Building Permit is issued.
- A Building Permit Application can take up to thirty days to process.
Building Permit Application Form Revised 02/01/2008
Building Permit Application Form Revised 02/01/2008