HomeMy WebLinkAboutDoc Sep 13 2022(4) _._ —_......s_s�....r�..�,.��..�. �"+�'+�lYplrii#+/.y�µYYliNk.i,H,..Yy. .;,.p:. ,_ .. --�.a.�i_.,,�•;.,
iM+l�
L ..
C�.ITY l�
I;'lLX%F
BUI-LDINU PERMIT APPLICANT: PR.O P.TX OWNER
Z , understand that the that alI residential building contractors, remodelers and roofers obtain Minnesotae of tat li tines
unless they quali fj, 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 s,Jnzng 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
claim to be exempt from the state licensing requirementsbcause I am not inzthe business
of building or remodeling on speculation or for resale and that the house for which I aria
aPPIYing for this permit, located at l Z �o
the only residential structure I have built or improved z e past 24 months(I also 53 f3 z
acknowledge that because I do not have a state license, I forfeit any mechanic's lien
rights to which I may otherwise have been entithed under Minn. Stat. §514.01.
Furthermore, I acknowledge that I may be hiring z
certain aspects of the constntction or improvement o f house and I understand endent contractors to p
tha
rm
some of these contractors may be required to be licensed by the State of Minnesota. It
understand that unlicensed residential contracting, remodeling, and/or roofing activityis a
misdemeanor under Minn. Stat. §326B.082, subd. 16 and can also result in a fine of u to
$10,000. I further state that I understand that the filing of a false statement with p
The City of Frnidiev may also result in c
to applicable city ordinances and/or state st tutes.
inal prosecution and/or civil penalties
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 will
all applicable building codes and city ordinances with the work being preformed on this
property.
Signature o Property Owner
VP3 zuz�Da
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' htto//www.dli.mt�.0 v! cid.a,D