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PRE 2010 DOCS0 City of Fridley, Minn. L7 BUILDING PERMIT N® 3338 Date: ...�. .. .... . ................. Owner ................................... Builder .. %!� !�/;.. ., ....... Address ...................................... Address ...... ... . .. . ...... �j p� QOCATION OF BUILDING No. .../..A(i... Street .... Part of 4t .......... ... .. .. ........ . Lot ..... (o..... Block ...�,.............. Addition or Sub -Division ..... ....... ... .... ... Setback ..3 `.�."�� Sideyard .../! : � O Corner Lot ............ Inside Lot ...... ................. DESCRIPTION OF BUILDING To be Used as: / ........ Front .... Depth ..®�.. Height .. Sq. Ft. MAC Cu. Ft. J f ,1:"Q, �t�! ...... Front . �.�.. Depth . / Height Sq. Ft. -A dA' Cu. Ft. 3Q R0 Type of Construction Bet. Cost?/�0)............... To be Completed In consideration of the issuance to me of a permit to construct the buBfiffig desribed above, I agree to do the proposed work in accordance with the description above set forth agid in compliance with all provisions of ordinances of the city of Fridley. X7 ; � .! Q Owl In consideration of the payment of a fee of ..'."�., permit is hereby granted to ................... ......................... to construct the building or addition as described above. Tbis 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 with- in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. -.40 `"� ........ Binding Inspector NOTICE: This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for then Items City of Fridley, Minn. BUILDING PERMIT Date: May 21, 1965 Owner: Thomas McLaughlin Builder Address 728 63rd St. N.E. Address No. 728 Lot 6_ Corner Lot -- Sewer Elevation To be Used as: Home Service Co. 1148 Arcade St. LOCATION OF BUILDING Street 63rd St. N.E. part of Lot _ . Block 9 Addition or Sub -Division _ Christie Inside Lot — Setback --_ Sideyard -- Foundation Elevation Front Front Type of Construction DESCRIPTION OF BUILDING �6F5� P N° .7486 Depth Height — Sq. Ft. Cu. Ft. Depth Height Sq. Ft. Cu. Ft. ____ Fst Cost 2800.00 ___To be Completed • Repair tornado damage 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. _ l A In consideration of the payment of a fee of $ 10.00—, 0.00, permit is hereby grantedto Home Service Co. 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 ofbuildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. • NOTICE: M perodt deco not cover the contraction, hnhiiation for whdng, phnnhing, gas hooting, ower or water. Be are to s o the BuNhre b2gm for for aparate permbs for thea Mena. e �� i l' i' �, � /�Y ., � a � � < %�.' �1 �° -' r% � �, 1 I� ��' f ,, � ,/ /! APPLICATION FOR BUILDING PEMMET CITY OF FRIDLEY, MIM ESCTA �we-10"o RMAcIFIR r ADDRESS VL3s s ADDRESS J LOCATION OF BUILDING No. Street Part -of Lot Lot Block _Addition or'Subdivision CL3� Corner Lot Inside Lot Setback Side -Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed build- ing'location drawn on these Certificates. PESCRIPT ON F IIIc' To be used as: Front iapLh Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Estimated Copt -0 g2 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 rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE _(Schedule of Fee Costs can be found on the Reverse Side). Appleaion for Power M=ft and Henlft% CmUnge Veffitaftne Rely; wall and Air Condi ming S"em and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ........................... $10.00 $ Replacement of Furnace ............................. 6.00 = Repairs & Alterations—up to $500.00 ................. 6.00 $ Repairs & Alterations each add. $500.00 ............... 3.00 $ MfECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ each add. 60,000 BTU ....................... 3.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 ................. 6.00 $ Repairs & Alterations each add. $500.00 ............. 9.00 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam .. .$10.00 $ Furnace Shell & Line—to 640 sq. ft. IDA Hot Water .. 20.00 $ Each add. 200 sq. ft. EDR Steam ...................... 3.00 ' $ Each add. 320 sq. ft. IDR Hot Water ... ....... .. 3.00 $ OIL BURNER—to 3 gal. per hour ... . ' ... ... .. ..... 6.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 199,000 BTU) ........................ 6A0 $ ®� over 199,000 BTU See Fee Schedule Dept. of Bldgs. Phone 880.3480 Lova ien (2/� 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_ 6 — / % 1& � � Owner 'r �i9ll�yY� >sC� Kind of Building�/9,7 dE- Used as To be completed about Estimated Cost, $ Old—New. Building Permit No. Permit DESCRIPTION OF WORD /.�' � /U..7� . TING or POWER PLANTS—Steam, Hot Water, Warm Air—No Trade Name �� 6109 Size 146-0152C_' . K-20 Capacity Sq. Ft. E.D.R- Sk- ® ® C) BTU H.P. GAS FITTING FEES: NO RATE TOTAL �/ 1st 3 Fixtures X$ 200 $ r ®� Total Connected Load Rind of Fuel O I%r` 6iy S' Additional Fixtures x .75 $ BURNER —Trade Name Size No Gas Range to 199,000 =$`8:00 . �s,c �, �' /� 6 � CaIa3dtY Sq. F't. E.D.R BTU H.P. AIR COMIDITiONIItG �" FAN HEATING SYSTEM[ See Fee Schedule se_ VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE 4;9 " _ Blue Flame Contractors, Inc. _ /'7' 6989 Washington Ave. So. 1tOUGH Edina, Minn. 55435 Business Phone BiZ FINAL !7-;2,A 4/ -a3 Phone: 941-6740 ti p (20"EKS-OV01 SUBJECT-- City of Fridley 21 5 AT THE TOP OF THE TWINS BUILDING PERMIT i R COMMUNITY DEVELOPMENT DIV. _ r PROTECTIVE INSPECTION SEC. 1-1)15-7 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 8/13/91 JOB ADDRESS 728 - 63rd Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 9 Christie Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Frances McLaughlin 728 - 63rd Avenue NE 571-0702 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. R & M Associates 3482 Suger Avenue, White.Bear Lake, MN 55110 770-9322 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION Ck REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Dwelling (18 Sq'uAres.) 9 CHANGE OF USE FROM TO STIPULATIONS Roof can be 2nd layer but not 3rd. If roofing is to be. torn-off, underlayment must be in compliance with State. Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $936 $.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- 25. $ 0.0. Fire SC $.94 STRUCTION THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TAL FEE $26.44 SIGH U F CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN RROPERL ID HIS YOUR PERMIT 5T +BLDG SNSP I, SIGNATURE OF OWNEROF OWNER BUILDERS IDATEI Nil [ ] Effective 1,/1/91 ADDN [ ] R-1 AND R-2 ALTER [ ] 6 •� B�uilc�ing Pretmi t Application cmwtLI R:ticn Address: CS O Owner Name A S id r Z,--z-U l d Tei. # 51'7/ Cmitractar.7""- S 0 Tel. # Z7,- � �' 20 � Address: - 3 %/ L2 .��� �' G� �� 7^ rWc-� Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn an it to scale. rRO I OF II AB�l� XaVn G AIM: Length Width Height Sq. Ft. GhTd= ARFA. length Width Height Sq. Ft. ESM AM: Length" �Grcudj Sq. Ft. oma: l �/Z17 Cbrner Lot [ ] Inside La�-) [of Canstructian: ] Ft. Yd Setback Side Yard Setbacks Type �`� � ��� Z� Estimated Oust. $ Approx. Campletian Date: Proposed Driveway Width If New Opening Is Desired: Ft. $. $ Width + 6' See Hack Page DAZE: %� APPLICANT: Tel. # OTR'X DBS C�II,Y Permit Fee $ a ; Fee Schedule on Reverse Side Fire Surcharge $ 9y .001 x Permit Valuation (1/10th �) State Surrharye $ 70 $.50/$1,000 Valuation SAC amrge $ $650 per SAC Unit Driveway Escrow $. Alt. "A" or Alt. "W Above Park Fee $ Fee Determined by MVineer ng Sewer Main Charge $ AgreemQ-1 Necessary [ ] Not Necessary [ ] SI'ZpUTATIMS: 0. -5! .0 6 / 'yY CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 RATE SCHEDULE APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVI6ES Residential Rate TOTAL Furnace Shell and Duct Work, Burner — Also Replacement Furnace $ 30.00 $ 3D, 00 (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace) $ 10.00 $ 14poo" Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ *Air Conditioning — All Sizes $ 25.00 $ All Others/Repairs & Alterations (LIST ON BACK) I% of Value of Appliance or Work $ Commorcial/Industrial 1.25% of Value of Appliance or Work $ State Surcharge a .50 TOTAL FEEc_� MINIMUM FEE FOR ANY HEATINCOOLINGLVENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner, Effective On March 1, 1996 JOB ADDRESS 7'z C— 3A Q 4E , 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 in this application are true and cc rect, �1 �. _ ,1996 OWNER------ M.(4*L)c# 4-1/4 BUILDING USED AS 5)(4 6LA`; p rn4t C '4 PUJ t LU n! 6 ESTIMATED COST �/ `'{"f 'r' PERMIT N0. 1 No, of Heating Units Circle One (Steam) (Hot Water) arm Air Trade Name :5Ai 1 M m z- Size No, BTU ?Sr HP EDR Fuel 6r-5 Total Connected Load Burner Trade Name Size No. BTU HP EDR HEATING COMPANY�� `F G Signed By QL� Tel No. -781 Approved By Rough—In Date Final Date FILL OUT BACK SID OR STACK VERIFICATION ON REPLACEMENT FURNACE CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes No ( ) Yes No 2. Is free from rust or deterioration () 3. Has no foreign objects lodged within Yes () No 4. Is securely supported Yes (-4--No ( ) 5. Meets 0 current Code requirements for size and total BTU's connected Yes ( No ( ) 6 Has total heating BTU's of All other BTU's TOTAL BTU's I/C-,;�, Z-®® 7. Has a liner been provided for water heater Yes( ) No 8. Has combustion air been provided for water heater Yes ( No ( ) Remarks: NG "s LJ !P —7 -- List ALTERATIONS Being Done: HEATING CO: A 14-T—G Signed By: Date: C �t- SuBjE& PER T City of Fridley 312 5 5 8 AT THE TOP OF THE TWINS BUILDING P E R M I T rp TO. `v ______ COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. r PROTECTIVE 1 � NUMBER REV DATE PAGE OF APPROVED By i A "',•; CITY HALL FRIDLEY 55432 __-_ L J` 612-571-3450 910-F15 5/3/02 JOB ADDRESS 728 63 Avenue NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 9 Christie Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Barry & Lisa Wheelis 728 63 Avenue NE 763-502-0881 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Exterior Enhancements Inc 9100 W Bloomington Frwy #140A, Bloomington, MN 55431 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 952-881-1503 20271852 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION j7 REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof House & Garage (24 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. ` NO DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,573 $1.29 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON• $83.25 STR ON OR THE PERFORMANCE OF CONS Fire SC $2.57 p PLAN CHECK FEE TOTAL FEE Licens C $5.0 2.11 SIGNATURE OF CON"RACTOR OR AUTmo IDATEI HE 1PROP L VALID�A.(TE THIS IS YOUR PERMIT % SGNATURE OF OWNER dF OWNER BUILDER, IDATEI Bl INSP RATE NEW [ J CITY OF FRIDLEY Effective 1/12002 ADDN (J 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: �r AU N), , ��' ` ���� fii� �Sy 3 Legal Description: Owner Name & Address: &Grr\1 L." s c, (tib ���� Tel. # 7L®3 SO -Z- O SI� t Contractor. ' (Nen 's MN LICENSE# 13L Address: y loci w. ESI vctir; v %,.. Fred !a/ 31 cr iw1 vc,6, Ih � c sq3 \ Tel. #'51 a -ire 1 l Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgf/Ground T Sq. Ft OTHER: -(ZeY-WS- U5@ k' e'�. c'z g. Lk 4 —1 '�C-' "p' Construction Type: Estimated Cost: Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ —=$ DATE: G —3—ON APPLICANT: Oc-,\'` �- I40,% Tel.# Lo `ZZ) - Lo -39 Call (763) 572-3604 for Permit Fees if mailing in application or Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control I:4lii>M ZKOI:[WAM Park Fee $ . Sewer Main Charge $ TOTAL $ � Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1200 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 [ ] -rl STIPULATIONS: Buildifl g BUILDING Permit No.:-�' Inspections See Back Page for Fee Schedule RESIDENTIAL APPLICATION Receiec 763-572-3604 Fire Surcharge CITY O F FRIDLEY Date 763-502-4977 FAX $ /, 7 7 .0005 x Permit Valuation Minimum $.50 License Surcharge $ EFFECTIVE I-1-2010 SAC Charge 0- to DATE YOU MAIIILpADDRESS SITE ADDRESS _ U 11131 � lam"/'Z C G4 �� 5 -z THIS APPLICANT IS: WNER ❑CONTRACTOR PROPERTY OWNER/ NAME: SSA TENANT ADDRESS: a CITY STATE ZIP $ PHONE: -7013 ��I CONTRACTOR NAME: SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE # EXP DATE AND CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE PHONE FAX PROPERTY TYPE AGI E FAMII Y/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ G GE/SHED ❑ WINDOWS ❑ BASEMENT FINISH OOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING Q HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES OUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: FOR NEW CONSTRUCTION INCLUDING DECKS, SIDING ❑ Vinyl ❑Soffit ADDITIONS_ & PORCHES SUBMIT: 1. Site Plan/Survey showing the existing structures ❑ Aluminum ❑ Trim and proposed project. ❑ Other ❑ Fascia 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS FOR WINDOWS - PROVIDE U -VALUE AND OR FOR NEW OPENINGS -DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUA1'1UN S UUUUPANUY 1 YYL Permit Fee $ See Back Page for Fee Schedule Plan Review $ Ic'-_ 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $ /, 7 7 .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $2100 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $24 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ 1 U7 _ 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 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 on site; that the work will be in accordance with the approved plan in the case of all �work �wh' r uires revi d approval of plans. SIGNATURE OF APPLICANT �" �Ad�� PRINT NAME DATE�� '{ BUILDING PERMIT APPLICANT: PROPERTY OWNER I, Kws—, \o, y v .understand that the State of Minnecnta rPnnirPc that all residential building contractors, remodelers and roofers obtain a state license unless they qualify for a specific exemption from the licensing requirements. This license requirement applies to owners of residential real estate who build or improve such property for purposes of speculation or resale. By signing this document, I attest to the fact that I am improving this house for my own use and am not building or improving this house for the purpose of reselling 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 a! at the house for which I am applying for this permit, located at �, `: � (� is the only 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 Minn. Stat. §326B.082, subd. 16 and can also result in a fine of up to $10,000. I further state that I understand that the filing of a false statement with The City of Fridley may also result in criminal prosecution and/or civil penalties to applicable city ordinances and/or state statutes. 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 Fridfor compliance will all applicable building codes and city ordinances with the k b g preformed on this property. Signature of Property Owner )o Date Date For questions or information on contractor licensing, or to check the licensing status and enforcement history of a particular contractor, call the Minnesota Department of Labor and Industry, Construction Codes and Licensing Division, at (651) 284-5069. The web site is: http://www.dli.mn.izov/Ccid.asp