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PRE 2010 DOCS0 City oFridley, y, Minn e BUILDING PERMIT Date:....._I...../_6 - ...._...---------.......-•---._ ............._... I., �'.1..___. Owner: Address N° 4286 Builder . . ........-............ Address .................................................. .................. ............ ......... -_._...... _.._-- -- / L�TION OF BUILDING No.......[....._........ Street .... - (l�C...._...--•------..._�...� .............. Part Lot ................................. _......._...._............ ... ....._.. Lot ........., 5 ................... Block .............. ........./.....----------- ...... Addition or Sub -Division ....YS-Ideyard ..... ......L ..c.. - - - ..._..._ Corner Lot ...X.................��.}}..... Inside Lot ...................................... Setback .3..,�.....'.�...-........... 4.. _�C............................... -.._....... Sewer Elevation�/....._...1... Q. .7..-=�................................................. Foundation Elevation ....... ,�. ..r ..F.1..._� . _...-----...._.............. DESCRIPTION OF BUILDING To be Used as: ........... Front ;Y 7....: Depth °°�_ 7 Height �_�.�� Sq. Ft.� /©��_� Cu. Front-. .. ` �. t . �Sq. Ft.. ,? Cu. Ft..... ........ .............. ............ �©...`�.. Depth ?���.'� Height ��...... � Type of Construction........................................................... Est. Cost ..../.YP..&Y.-(F"�— o 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 fort d ' tom 'ante 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 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 city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to we the Building Inspector for separate permits for these items. 4 Application for Poorer Plants and Heating. Cooling, Ventilation. Reh igeton and Air Conditioning Systans and Devices PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SII 4-7470 GRAVITY WARM AIR: RATE TOTAL. Location `✓ �� 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 QQ Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ .wooso each add. 80,000 BTU ....................... 2.00 $ Replacement of Furnace ............................. .P.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 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ r 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 $ Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH— OUGH FINAL— FINAL See See Fee Schedule TOTAL FEE $ 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. Fridley, Minn_ //_4 19 Ll Owner W 1 G 1. A 4-® F �t.y AaD'aa� d ia/ Kind of Building J '� Used as To be completed about o °� Estimated Cost, $ Old ew. uilding Permit No. Permit No. DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Water, Warny, Air—No Trade Name—/V Size No���®� 1IvPvF1Ak_ Capacity. Sq. Ft. E.D./R G 0 BTU H.P. Total Connected Load s 2_1Z.� Kind of Fuel �A'r GIM I/✓C� V v D C O w -n+ 1--v it o+/ BURNER —Trade Name Size No Capacity Sq. Ft. E.D.R d ^- BTU H.P. (REMARKS -OVER Signed2/� C-4 u:% �P C w By 64!f 711 4 z zM 7-59 Business Phone No `1 g ya -4 (? ��. � � � r .. a �..• ;ej,',.� �/i: 4 ` D-36 , 4 2 HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS FRIDLEY, MINN. Weatherstrips A.S.H.V.E. Construction No. Insulation Guide Windows I Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied Yes—No Yes—No 19— J FI.I a ✓ Room I Length/-,?. !` Width Height II / F'1_FL- i Room I Len>:th /f�- Width f Height Windows and Doors—Crackage and Area Width Height No. of Lineal t . Area No. of pane of pane lights of crack sq. ft. 9pane I Coef. Coef.1 Btu , Infiltration Infiltration iJ.)— Glass a Glass 1"Y '> • �f r— Exp. wall e! x Jr e-,��11 �.-� Exp. wall x Net exp. wall' := Net exp. wall Ittt-vmH I A / Floor Ceiling 41 Int. wall ZZ xt'� ',r" Floor r I(./ e "i /_,P x a---�!/sa a—C snyn-------1 _0-".-.P Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. ofpane of pane lights of crack sq. ft. 9pane I Coef. Btu Coef. Btu Infiltration iJ.)— Glass , 1"Y Glass ° e-,��11 �.-� Exp. wall x Int. wall := Net exp. wall Int. wall / Floor Int. wall ZZ xt'� ',r" e Ceiling /_,P x / �/- Floor ,fr,p _ Total Btu. s' ?,o / f 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 pane lights of crack Area ft. 9pane I Coef. Btu Infiltration Btu Infiltration iJ.)— Glass , 1-f" ,,. e. Exp. wall ° r Net exp. wall E Exp. walls, x Int. wall := Ceiling Int. wall J vt�f Floor Int. wall ZZ xt'� Total Btu. sq. ft. E.D.R. or sq. ins. W.A. Leader area >4, 41 Windows and vDoors—Crackage and Area Width Height No. of Lineal ft. Area No. of 9aDne of pane tights of crack sq. ft. 9pane e Coef. Coef. Btu Infiltration =-' , 1-f" ,,. e. Glass' ° ,- . Exp. walls, x Net exp. wall := Net exp. wall Int. wall Int. wall ZZ xt'� ',r" e Ceiling /_,P x / �/- Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area / Fl.l �&: s n Room I Length .: 1 Width ��/ Heisiht f Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of of pane lights of crack sq. ft. 9pane Coef. Coef. Btu Infiltration/ -% L 1-f" ,,. e. Glass ° ,- . Exp. wall x Net exp. wall := Net exp. wall Int. wall Int. wall Ceiling ZZ xt'� ',r" e Floor // ,�? / �/- Total Btu.' Required sq. ft. ED.R. or sq. ins. W.A. Leader area / FI_I AV 7 } .• Rema I Ilnvth " Width:.� Heiaht .kms Windows and Doom—Crackage and Ana Width Height No. of Lineal ft. Area No. of pane of pans of crack sq. ft. —lights 73 Coef. Btu Infiltration Glass Exp. wall(` . Net exp. wall := Int. wall Ceiling Floor Ille .F Total Btu. Required sq. ft. E.D.R. or sa. ins. WA. Leader area City of Fridley Application for Plumbing and Gas Fitting Perndtt Dept. of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK�� Number, Kind and Location of Fixtures Location C NO. RATE TOTAL 8 Number Fixtures ...................... x N N S�(�9d $ Future Fixture Opening ................ Wz� 0U' ? F N WATER HTR. GAS ELEC. Catch Basin ............................ x 3.25 $. Water Heater (Up to 200,000 BTU) ...... — x ; L C New Ground Run Old Bldg . ............ x 3.25 $ �O NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ / Additional Fixtures .................... x ryi/� IA Gas Range to 200,000 BTU .............. LL 2.00 $ Base y9 r r 1st 2nd i_ 3rd _ 4th • Future Connection Openings Connected withI Sewer � New .Fixture, Old Openings Cesspool E] PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL 8 Number Fixtures ...................... x $1.50 $ Future Fixture Opening ................ x 1.20 $ �! D New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $. Water Heater (Up to 200,000 BTU) ...... — x 2.00 $ 90,0 New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ / Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description........... ......................... TOTAL FEE $� 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. Owner Kind of Used as To be completed about Estimated Cost, $ Old New. uilding Permit No / Permit No. Signe By Business Phone No FINAL 4 e 2M 7.59 A CITY OF FRIDLEY PERMIT NC�, 2004-00833 6431 UNIVERSITY AVENUE NE �`- FRIDLEY, MN 55432 DATE ISSUED: 06/08/2004 (763) 572-3604 FAX: (763) 571-1287 ADDRESS 121 62ND WAY NE PIN 153024430029 LEGAL DESC JULI-ANN ADD LOT 3 BLOCK 1 PERMIT TYPE BUILDING PROPERTY TYPE : 'RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 9,300.00 NOTE: SEE NOTATIONS ON PLAN. CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317 OF THE 2000 INTERNATIONAL RESIDENTIAL CODE. CONSTRUCT A 16'X 8' LIVING AREA ADDITION; RESIDE HOUSE & GARAGE; TRIM WINDOWS. STATE LICENSED CONTRACTOR 1 APPLICANT BUILDING PERMIT FEE PLAN CHECK FEE 181.25 117.81 AMERICAN EAGLE EXTERIORS (20159912 19512 COUNTRY CIR E FIRE SURCHARGE 9.30 ROGERS, MN 55374 STATE SURCHARGE, VALUE 4.65 LICENSE SURCHARGE 5.00 TOTAL 318.01 OWNER MOORE GEOFFREY P & REBEKAH A 121 62ND WAY NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulatin co o he performance of cons c ' n Applic t at r4 Bldg Insp Da EPARATE PERMITS REQUIRED FOR WOKK OTH9R THAN DESCRIBED ABOVE. AMV�M83� Flit --31a? NEW [ ] CITY OF FRIDLEY Effective 4/1/2004 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION n , Construction Address: Legal Description: Owner Name & Address: �o W a Tel. # iti 1 5- 7/ - '7-.2a 9 Contractor. gE4"-?/ S MN LICENSE Address: 0-51- L14�� ,,- 1; S:3 7I/ Tel. # 76 LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. a Length Width Height Sq. Ft Length Width Hgt/Ground Sq. Ft cz"t4VM.t;Tr1' M - Construction Type: ,% iEstimated Cost: $ c Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ —=$ �M i DATE:ZJ4�1APPLICANT: AAS 901-1-V5 Tel. # 45/Z .520/ Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1350 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] STIPULATIONS: CITY OF FRIDLEY PERMIT NO.: 2004-01533 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 09/02/2004 572-3604 YAX: (763) 571-1287 ADDRESS : 12162 WAY NE PIN : 153024430029 LEGAL DESC : JULI-ANN ADD : LOT 3 BLOCK 1 PERMIT TYPE : ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. # INSPECTIONS 2 APPLICANT ROBECK ELECTRICAL CONTRACTORS 1335 EASTERLY OAKS DR HANOVER, MN 55341 OWNER MOORE GEOFFREY P & REBEKAH A 121 62ND WAY NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of wort will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp Date ELEC PERMIT FEE - MIN (RESI) 40.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 40.50 PAID WITH CHECK # 3534 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 3uilding :nspection5 763-572-3604 )ATE 3 d ,ITE ADDRESS BUILDING Permit No.:�-�" RESIDENTIAL APPLICATION Received By: CITY OF FRIDLEY Date Recd: % EO YOUR E-MAIL ADDRESS CP )z Mo 0 CC bg=-tL° 2C ' � 'HIS APPLICANT IS: N OWNER � ❑CONTRACTOR PROPERTY OWNER/ I NAME: MDO re. TENANTADDRESSS: la w CITY Tr --A t_" STATEN PHONE: 17 b 3 �&/ 1 - CONTRACTOR NAME: 3. Energy Calculations STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: CITY STATE ZIP WITH APPLICATION PHONE FAX PROPERTY TYPESINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ O FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS Permit Fee ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE $ '101: 1 65% of Building Permit Fee DECK ❑ SIDING ❑ OTHER Surcharge $ 01.32 , .0005 x Permit Valuation Minimum $.50 ❑ SWIMMING POOL TYPE OF WORK: SAC Charge ❑ ADDITION Curb Cut Escrow ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: amu' SIZE OF IMPROVEMENT 12' X //-.S,' ROOFING C1139 NUMBER OF SQUARES GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ vinyl ❑ Aluminum ❑ Other • HOUSE ONLY (les ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia HEIGHT Ft. 3Sa BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS & PORCHES SUBMIT: 1. Site Plan/Survey showing the existing structures and proposed project. 2. Two sets of construction plans RrINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS TL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: ZIA(p 3'g' 5,4 THE 1997 U.B.0 FEE SCHEDULE) (USING TOTAL JOB VALUATION $_ OCCUPANCY TYPE Permit Fee $ It t , DL�; See Back Page for Fee Schedule Plan Review $ '101: 1 65% of Building Permit Fee Fire Surcharge $ 4. lot- .001 times the total job valuation Surcharge $ 01.32 , .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1550 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $20 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ Lr® GA Make checks payable to: City of Fridley Attach Stipulations THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I aclamowledge 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 pe .t and work is not start without a permit; that the work will be in accordance with the approved plan in the case of all work which r es review an anDrAal of plans. SIGNATURE OF APPLICANT PRINT NAME "'r'ADATE 135' UTILITY EASEMENT _ 11.5' 21.5' PROPOSED DECK ui34' 10' _ w 12' 18' N c) WOOD 24' EXISTING FENCE 93' HOUSE 39.5' 64' 31.5' 35' Q � w tX 121 62nd WAY NE MOORE RESIDENCE LOT 3, BLOCK 1 JULI-ANN ADDITION VILLAGE OF FRIDLEY ANOKA COUNTY, MINNESOTA I HARVQY A. CARTWRIGHT MNOKA COUNTY buRUgyg HENNUPIN COUNTY bURvETB MINN&APOLIB BURVHTb 8410 BMAOY OAK LANE f1 E. SUNAAl "0" , OWNER INDUSTRIAL - JUDICIAL 13UBINIZSS - TOPOORAPHICAL CITY LOTS - PLATTING Bob Hughes 0482VISIGHT k. OILSOX LAND sUR i E YOR,S REOISTRRED UNDER LAWS OF STATE OF MINNESOTA LICENSED BY ORDINANCE OF CITY OF MINNEAPOLIS 348 PLYMOUTH BUILDING LINcoLN 8721 Oururllor'o Ccrtt[tratr jj� � Tom; ::� • 1- •_ ;�;: � t A�t h' I • aj t .z (A , .e la! 4 agd W A /0 C GOV"INING THE' RECORDS pl* J. M. HILL, CIVIL EN4INBSR ENTA91.M49D Joe$ C. F. 9ANDHOFF CIVIL :ENGINEER 6YrABb16HeO 160E JAMES NELSON SURVEYOR e6TAaw61+eO Ions METROPOLITAN LAND SURVEYORS. FATA6LI9e1IO .01. -DWO10e 19709 . t. 1 hereby certify that this is a true and crorract p�.:it"�pf a survey of tot 3, Block 1, Juli-Ana's Addition, Vi.l-laV of ri..:ley, . noka County, Minuesota, Ra siu myed by me during tho ' onth of december, 1)511. 91C#NR _ •I'� ..^. . _ �•, ..,ar .' ,��•I • JI,.• Ii 17•...w G•A*i—wF i6WT AND oLSON yew t�� a 3.5" .. I r ANk AA' • cw,\ Ki 28.5" 31.5" 36 37.5" 1.5" ff AP - 3" 5.5" 7.5" 5 6.75„ 21.76" 20" 5.25" 5.5" 6.75" 6.5" L� 5.75" IMP x. -�• ��� oN ��nns', GROUND LEVEL ZOE M • MOORE RESIDENCE LOT 3, BLOCK 1 TYPICAL SECTION - LOWER & UPPER DEC JULI-ANN ADDITION VILLAGE OF FRIDLEY ANOKA COUNTY, MINNESOTA 86.75" 110.61" 68.63" 110.61" X 86.75' 70.63" 5.5" T • A A 7i- CA 7T1 5. 68.63" F 41 45.12" - 94.5" 70.63" PIER/POST LAYOUT PLAN 120.56" 176.06" 5.5" I� 120.56' 176.06" 176.06" \ 5.5" ® 5.5" 106" 6.25" 3" 5.5" 77.75" 120" 5.5" 45.12" 1 0 117.56" 263.62" 5.5" 120 56" v 5. 117.56" II h Glas D ok_`'� 141),1 1A ?WA ' ©R LOWER ®E FRA AN 106" 5.5" 120" to= -o`' MOORE RESIDENCE LOT 3, BLOCK 1 JULI-ANN ADDITION VILLAGE OF FRIDLEY ANOKA COUNTY, MINNESOTA FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287 BUILDING PERMIT APPLICANT: PROPERTY OWNER I, o r understand that the State of Minnesota requir s that all residential 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 _[&[ N &- , Fridley, I am exempt from the state licensing requiremen y 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. Z"r ► ►,•�-�% RW ' -1.5 Date 7 �®