PRE 2010 DOCSCity of Fridley, Minn..
BUH DING PERMIT N° C5364
Date: ww.. -► rti____
Owner: Builder
Address . , Address
LOC TIO , OF BUILDING
No. Street —._ P of t
Lot __ _ _ Block Addition or Sub -Division a
Corner Lot Inside Lot Setback �-� ideyard� .►
Sewer Elevation _ — Foundation Elevation —
DESCRIPTION OF BUILDING
To Used /0 le .0 ��J
Front "`"� Depth Height Sq. FL, Cu. Ft.4A
jL Depth Heiffht,� Sq. Ft. Cu Ft..
Type ofConstructio Est Cost To be Completed —
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work m accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley.
a�
In consideration of the payment of a fee of $ ,permit Is hereby granted to
the
to construct the building or addition as described above. This permit is granted upon
express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the dty limits and this permit may be revoked at any time upon violation of any of the provisions of said
Building Inspector
NOTICE:
This permit does not cover- the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building insp'eetor for separate permits for these items.
,QW4
APPLICATION FOR BUILDING PERMIT
CITY' OF FRIDLEY, MINNESOTA
Owners Name Builder
Address Address wJ�
�WM
LOCQAT�ION OF BUILDING
of QLot
Lot Block . 1/ Addition or Sub.Div. L (''' ' LO v" -T
Corner Lot_ aide Lot Set Back 3 Side- d /
SXM ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
o.�- Ftz J 9
To b used as: � �
Front Depth
Pq • Ft. � Cu. Ft. -0/- .
Front Depth Height
Sq. Ft. Cu. Ft. OU
Type of Construction Estimated Cost
To be completed -
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work in strict accordance with the City Ordinances and ruling of
the Department of Buildings, and hereby declares that all the facts and representa-
tions stated in this application are true and correct.
DATE SIGNATURE
(A Schedule of Fee costs can be found on the Reverse Side.)
City of Fridley
Appiication for Plumbing and Gas Rtting Permit
Dept. of Bldgs. Phone S/ -1
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures Locatio
Nd
y
0 0
NF
RATE
1
Number Fixtures®
....... ..............
62
I
u�
I
w
Z
go�O
j Z
`�
W
O
x
w
Z
•
F
•
N
WATER -HTR.
GAS
ELEC
Base
x
3.25
$
Water Heater (Up to 200,000 BTU) ......
x
2.00
$ a U d
New Ground Run Old Bldg. ............
x
3.25
$
%
NO.
1st
t
1st 3 Fixtures ..........................
I
x
$1.50
$ / S
Additional Fixtures ....................
x
.50
$
Gas Range to 200,000 BTU ..............
x
2.00
$
2nd
3rd
4th
• Future Connection Openings
New Fixture, Old Openings
Connected with
Sewer
Cesspool E]
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
Number Fixtures®
....... ..............
62
x
$1.50
O
$ /
Future Fixture Opening ................
x
1.20
$
New Fixture Old Opening ..............
x
1.00
$
Catch Basin ...... .....................
x
3.25
$
Water Heater (Up to 200,000 BTU) ......
x
2.00
$ a U d
New Ground Run Old Bldg. ............
x
3.25
$
GAS FITTING FEES:
NO.
RATE TOTAL
1st 3 Fixtures ..........................
I
x
$1.50
$ / S
Additional Fixtures ....................
x
.50
$
Gas Range to 200,000 BTU ..............
x
2.00
$
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE s
City of Fridley:
The undersigned hereby makes application for a permit for the work here!
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this applicatiotrue d correct.
Fridlev. =M s' '-A®G 190
Kind of Building
O
Used as
To be completed about
Estimated Cost, $
Old—New. Building Permit
i-• c r ice.
FINAL
E 42 2M .
Application for Power Plants and Heeling, Coding, Ventilotion, .Refrigeration and
Air Conditi
oning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL,
Furnace Shell & Duct Work .......................... 8.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 .................. 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $
each add. 60,000 BTU .... . .................. 2.00 $
Replacement of Furnace ............................. 5.00
Repairs & Alterations—up to $500.00 5.00 $
Repairs & Alterations each add. $500.00 .............. 2.50 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam.......
8.00
$
Furnace Shell & Line—to 840 sq. ft. EDR Hot Water ...
8.00
$
Each add. 200 sq. ft. EDR Steam ......................
2.50
$
Each add. 320 sq. ft. EDR Hot Water ..................
2.50
$
OIL BURNER—to 3 gal. per hour ........................ 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) ....................... 5.00 $——
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures ...................... x $1.50 $x
Additional Fixtures ................. x .50 $
Gas Range to 200,000 BTU ........... x 2.00 $
AIR CONDITIONING $
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM
ALTERATIONS & REPAIRS TOTAL FEE • s®
.
ROUGH
FINAL
Dept. of Bldgs. Phone SU. 4-7470
A r
r
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated In -this application are true and correct.
ft
Owner
Fridley;
Kind of Building
Used as
To be completed about
y�
Estimated Cost, $ �
Old—New. Building Permit No.—� Permit No.
19 CSL
DESCRIPTION OF WORK
HEATING or POPLANTS—Steam, arm Nol//�
Trade Name J Size No -
Capacity. –
o Capacity Sq. Ft. E.D.R- 00 BTU H.P.
Total Connected Load Kind of Fue }'
BURNER — Trade Name Size No
Capacity *
(REMARKS -OVER)
42 2M %-s9
Business Phone No- v ��®Z
X16 .42
HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS fes' '` "° "' . FRIDLEY, MINN.
Weatherstrips A.S.H.V.E. Construction No. Insulation
Guide
Windo s Io rs Reference Out. Wall Int. Wall Ceiling RoofFloor,) Kind How Applied
19—
,/F1.1
9_,'F1.1 :Room I Length Width II FI I K ", i RoWidth Hestht
Windows and ,fyoors—Crackage and Area
Widtheight No. of Lineal f . Area
No. of pane of pane lights of crack sq. ft.
y
s C
Coef.
Btu
Coef.1
Btu
Infiltration
Y,
Glass_
"All
4d
Class
< `V
Net exp. wall
,
Exp. wall _= c
Int. wall
��
Net exp. wall
Net exp. wall
a°°A �0
✓C�°
r° en
Int. wall
Int. wall
Ceiling;4"
Ceiling
/
70
Floor
Floor
T
C.
1 otal Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
m I Length. 9�— - Vidth Height ,4'
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of Dane of pane lights of cr�ack sq. ft.
y
Coef.
Btu
Coef.
Btu
Infiltration
Y,
Glass_
4d
Glass
< `V
Net exp. wall
�
Exp. wall =
Int. wall
��
Net exp. wall
a°°A �0
✓C�°
Floor
¢';'
Int. wall
Floor
Ceiling
/
Floor
I otal Btu.
Required sg4t.1 .9.11. or sq. ins. W.A. Leader area
F1.1 �" � 1 ' P Room I Length 9 '1 Width d Height .moo
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack eq. it.
a j
Coef.
Btu
Infiltration
Btu
� r
Y,
Glass_
4d
Exp. wall
"/,-7,
Net exp. wall
�
Exp. wall
Int. wall
Ceiling
a°°A �0
✓C�°
Floor
¢';'
Inc. wall
Tbtal Btu. - V,
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of lights orcracksq.ft.
Apane
�-f• s• -.._j 4' P s� L...'9 �-!�'.. Iii }�Fi
Coef.
Coef.
Btu
Infiltration
Glasse
Glass
"/,-7,
�
Exp. wall
Net exp. wall
Net exp. wall
Int. wall
✓C�°
r'd
¢';'
Inc. wall
Floor
Ceiling
/
Floor
Total Btu.
Required sq�.h.,E ..R. or sq. ins. W.A. Leader area
.. F1.1 I - t ` der ." Room I Length // ° Width /�' Height ,F"``
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack I eq. ft.
Coef.
Btu
Infiltration
Glasse
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Y F1.1 7 Room I Length 777 Width w Heiaht v
Windows and Doors--Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack eqy. ft.
Coef.
Btu
Infiltratioa
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. k. E.D.R. or sq. ins. W.A. Leader area
My of Fridley, Minn.
BUILDING PERMIT
Owner:
Address
a '
Builder
Address
LOCATION OF , BUILDING
N°Q�O9
No. Street �. Part of ,A
Lot _ .__ Block Addition or Sub- on
Corner Lot _ Inside Lotbacbi Si yard
Sewer `Elevation _ Fo tion Elevation
DESCRIPTION OF BUILDING
T
Front Depth Height Ft. Cu. Ft.
;F1 T Depth I�efght Sq. Ft. _ _ Cu. Ft.
Type of Constructi_._ Est.• To be Completed
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above, set forth and in compliance with all provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ , permit is hereby granted to
to construct the building or addition as described above. This permit Is granted upon
the express condition that the person to whom it Is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any paw thereof, -shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any Pwkupm viol of any of the provisions 2a
ordinances. ,
NOTICE:
'fhb pun* don not ewer the conatruedw, installation for W* phmg, gas heating, nwoir or waver. Be sum to me
the Budding bspoetor for aperate pmft for thea Rena.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
l'
��.
Address
i
LOCATION OF BUILDING
No /1140 street /r9 Part
Lot. 7 Block Addition
Corner Lot Inside Lot tack
SEWER
of Lots
or Subdivision4j�W
Z4- ide-Yard
N ELEVATION
Applicant attach to this form Certificate of Survey of Lot and
proposed building location.
To be used as:
DESCRIPTION OF BUILDING
.Front 06 Depth f Height
sq. Ft. 4"`fe Cu. Ft.
Front___ Depth Height
sq. Ft. Cu. Ft.
Type of Construction Estimated Cos�A
t
OF
To be Completed
The undersigned hereby makes application for a permit for the work
herein specified, agreeing to do all work in strict accordance with
the City of Fridley Ordinances and ruling of the Department of Build-
ings, and hereby declares that all the facts and representations
stated in this.application are true and correct.
DATE`` SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
J
a r
w • W
CHARLES R. WEAVER
HERMAN L.TALLE
VIRGIL C. HERRICK
ROBERT MUNNS
JAME5 D. GIBBS
LAW OFFICES
WEAVER, TALLE & HERRICK
October 17, 1966
Mr. Clarence Belisle
City Building Inspector
6431 University Avenue N. E.
Fridley, Minnesota
Dear Mr. Belisle:
316 EAST MAIN STREET
ANOKA,MINNESOTA 55303
421-5413
6231 UNIVERSITY AVENUE N.E.
FRIDLEY, MINNESOTA 55421
560-3850
I have received a telephone call from Peter Wojtowicz who resides at
1110 Lynde Drive. Mr. Wojtowicz has explained that the floor of his
basement was improperly constructed. Apparently, Lyndale Builders was
the general contractor. I understand that you have inspected this property.
I told Mr. Wojtowicz that if there was evidence of a building code
violation, that our office would prosecute a misdemeanor complaint
against Lyndale Builders.
I would appreciate it if you would contact me and let me know your
opinion on this matter.
Sin erely,
Virgil' C. Herrick —
gg fi
cc: Peter Wojtowicz
April 21, 1966
Lyndale Builders Company
7437 Lyndale Avenue South
Minneapolis, Minnesota
Se: 1110 Lynde Drive N. E.
Gentlemen:
On April 18th, I checked this building upon a complaint and
found that the south one-half of the basement floor has settled approxi-
mately 311, creating a very objectionable sag in the floor; a crack on
that side of the floor and a crack all along the center of the basement
D floor which is now at two levels in this place. Obviously, the fill was
not compacted properly under this floor, or perhaps it waa the wrong type
of fill. I don't know.
I cannot force any action on this matter, naturally, as the
building has been standing for quite sometime, but I feel it would be
in the best interests of your company to look into this matter and I
believe that satisfaction could be obtained by pouring another layer
of cement along this portion of the basement floor and troweling it off
with the north side.
Would you please contact me at my office at your earliest
convenience with regards to this matter.
Sincerely,
ALLEN G. JENSEN
Building Inspector
City of Fridley
AGJ:cks
cc: Mr. Virgil Herrick, City Attorney
February 10, 1978
14HIA 071 'tF r
6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432
Mr. Peter Wojtowicz
1110 Lynde Drive N.E.
Fridley, Mn. 55432
TELEPHONE ( 812)571.3450
Re: Junked, Street Inoperable Vehicle Stored at 1110 Lynde Drive N.E.
Dear Mr. Wojtowicz:
It was confirmed by an on site inspection on February 9, 1978 that you
were maintaining a blue Plymouth, License #3CK 644, on the above listed
property in a junked, street inoperable condition.
Chapter 123 of the Fridley City Code requires that all vehicles in
the City be currently licensed and in a street operable condition. An
alternative is to store said vehicles within a building or at an
approved location, e.g. a licensed junk yard.
Therefore, the City must require you to remove said vehicle from your
property or bring it into compliance with the City Codes by either
licensing and putting the vehicle in a street operable condition, placing
it within the confines of a building, or removing it to an approved
location.
A reinspection will be conducted on or about ten (10) days from the date
of this letter to determine compliance. We are confident in your
cooperation and desire to make Fridley a better community to live in.
If any questions or problems result from this letter, please contact me
at 571-3450. -
Failure to abate said violation may result in this matter being turned
over to the City Prosecutor for his legal consideration.
Sincerely,
610vld
STEVEN . OLSON
Environmental Officer
SJO/mh
CITYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY. MN 55432 • (612) 571-3450 • FAX (612) 571-1287
August 9, 1990
Sophie Wojtowicz
1110 Lynde Drive N.E.
Fridley, MN 55432
RE: Property at 1110 Lynde Drive N.E.
Dear Ms. Wojtowicz:
on July 1, 1990, the city of Fridley began a new program called
Systematic Code Enforcement. This program is designed to provide
fair and equitable code enforcement, improve the City's appearance,
and maintain property values by creating a more attractive suburban
environment. Under this program, all properties in the City will
be inspected approximately once each year to ensure that they are
in compliance with the Fridley City Code.
A recent inspection of your property revealed that not all Code
requirements are presently being met. Listed below are item(s)
which do not comply with the Code:
1. Discontinue outside storage of brush located in driveway area.
Your prompt attention in correcting this problem would help us in
our effort to improve the City. A reinspection will be conducted
on or about August 23, 1990, at which time compliance is
anticipated. Please call me at 572-3595 if you have questions or
wish to discuss this further. Thanks for your cooperation!
Sincerely,
Steven Barg
Code Enforcement Officer
SB:ls
C-90-625
CITY OF FRIDLEY BUILDING INSPECTION
m 6431 UniversityAve NE
Fridley, MN 55432
r°Di RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner &
also Replacement Furnace
0
Gas Piping (New Furnace, Fireplace, Insert)
Gas Range
Gas Dryer
Effective 4/1/2004
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
Eee Total
$35.00
$�6-1 00
$10.00
$�
$10.00
$
$10.00 $
*Air Conditioning- All Sites $25.00 $
All Other Repairs or Alterations (List on Back)
1% of Value of Appliance or Work $
Minimum Fee $15.00 for Residential or 5% of cost of
o Improvement whichever is greater on work less than $300.00
Co m me rclo Vl nd ustria ltl nstitutc ona l
>- 125% of Value of Appliance or Work (List on Back) $
=-
U Minimum Fee $35.00 for Commercial/IndusUiai/insiitutional
0
W
u-
m
i0
IT
CS)
CS)
fV
II
n
z
State Surcharge
TOTAL FEE $�l!
REINSPECTION FEE $50.00/HOUR
*Air Conditioners can not be placed in side yard without written approval
from adjoining property owner - copy to City
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
10B ADDRESS �/ �C ? �li� fAQ t
Owner kw q W OZ+Cw t c c
Building Used As
ESTIMATED COST_ 9 PERMIT NO
01;&W s 1 [ ► : : ► l _ 1: ► 140
# of Heating Units_ Circle One (Steam) (Hot Water
m(Warm Air)
Trade N e n Size No.
BTU HP EDR
Fuel Total Connected Load
Burner Tr de N me I Size No.
BTU o 000 HP EDR
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
and rulings of the Building Division, and hereby declares that all the facts
and representations stated Inthis application are true and correct.
HEATING 0O TGA -1 661 1� I
G
FAX #�6 3�3 Date
Tel# / �� 3 r
Approved by Rough -in Date Final Date
Building
BUILDING
Permit No.: r, C5 —
Inspections
RESIDENTIAL APPLICATION
Received By:
763-5T2-3604
CITY OF FRIDLEY
Date Rec'd:
DATE O (v
YOUR E-MAIL ADDRESS k150J -4 { Crr
VNI, t2d l_ . CO �.
SITE ADDRESS
LH NPa7- DR
UrOWNER ❑CONTRACTOR
THIS APPLICANT IS:
PROPERTY OWNS
NAME: Co �2T H o t7zs w rc zz
TENANT
ADDRESS: t 11 D L --V r-9 ISE h R__ CITY f4 t in L_ ' STAT4MN ZIPSScE3 Z
PHONE: �!p3r` 5� 01 lcJ
CONTRACTOR
NAME:
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: CITY
—STATE—zip.
WITH APPLICATION
PHONE FAX
PROPERTY TYPE
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITIONARAGE/SHED WINDOWS
13BASEMENT FINISH ROOF ❑ DRAIN TILE
❑ DECK SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:'
❑ ADDITION
MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING
e4nOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT
REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
I.
Existing Floor Plan
PROPOSED SIZE:
❑ DETACHED GARAGE
2.
Proposed floor plan
PROPOSED HEIGHT:
3.
List of structural members to be used
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
Vinyl
❑Soffit
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
1.
Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project.
WINDOWS
2.
Two sets of construction plans
IN EXISTING OPENINGSA s ❑No LOCATION OF WINDOWS
3.
Energy Calculations
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE
VIIIJ d ` I
OF WINDOW TO BE INSTALLED
JA7, NUMBER OF WINDOWS
ALL FEES ARE BASED 09 VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 2oaawo OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ m2o. ®o
$ /0.00
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1550 per SAC Unit (Plans to MWCC for determination)
_ft +6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks savable to: Citv of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work ich Mires review and approval of plans.
SIGNATURE OF APPLICANT—P—RINT NAMEaAlU. IC ZDATE k 3c)1 O G,
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
BUILDING PERMIT APPLICANT: PROPERTY OWNER
I, (2 w (C --z understand that the State of Minnesota
requires that all rest tial building contractors, remodelers and roofers obtain a state
license unless they qualify for a specific exemption from the licensing requirements. As
the owner of the property at 1k kc, L-�:A rJ C> e_ Dk , Fridley, I
am exempt from the state licensing requirement only if I am not building or improving
this property for purposes of resale. By signing this document, I attest to the fact that I
am improving this house for my own use and do not intend to sell it. I hereby claim to
be exempt from the state licensing requirements because I am not in the business of
building or remodeling on speculation or for resale and that the house for which I am
applying for this permit, isl the first residential structure I have built or improved in the
past 24 months. I also acknowledge that because I do not have a state license, I forfeit
any mechanic's lien rights to which I may otherwise have been entitled under Minn.
Stat. 514.01.
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 Minnesota law, and that I would forfeit my rights to
reimbursement from the Contractor's Recovery Fund in the event that any contractors I
hire are unlicensed.
I have also been informed and acknowledge that by listing myself as the contractor for
this project, I alone will be responsible to the City of Fridley for compliance with all
applicable building codes and city ordinances in connection with the work being
performed on this property.
Name e r%�l leo (fns c ,-"—
L Ci
Date Cp ( 30 IOC