HomeMy WebLinkAboutProperty Owner Form AWW
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QYOF
FRIDLEY
BUILDING PERMIT APPLICANT: PROPERTY OWNER
1,C-3 1 OV-A q:? 7 , 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. 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 r resale and that the house for which I am
applying for this permit, located at e 11 C I,3L L(, T11 C ,m k jS(1-z-, - ,
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. 1 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 listi myself the co rlactor for
this project, I alone will be responsible to The Ci of Fr die for mplia ce will
all applicable building codes and city ordinances wit the work b ' g pre f ed on this
property. p /`
Sipatur&Property Owner
Date Ou Z� 2�2Z
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.gov/Ccid.asp