HomeMy WebLinkAboutScanned Document 161 CRYOF
FRJ D LEY
BUILDING PERMIT APPLICANT : PROPERTY OWNER
I , : �� ,l � r / 7(7/,,,r understand that the State of Minnesota requires
that all residential building contractors, remodelers and roofers obtain a state license
unless they qualify for a specific exemption from the licensing requirements. "I�his license
requirement applies to o«-ners 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 and that the house for which I am
applying for this permit, located at 53 L5 176 Y / Z_ c�n d tr -ss� � � ,
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 Cite of Fridlev, for compliance will
all applicable building codes and city ordinances with the - wor being preformed on this
property .
(.SignkloTev Property Owner
'2 /'0
Date
For questions or inform ation on contractor licensing, or to check the licensing status and enforcement
histoD, 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 .gov
/Ccld.asp