HomeMy WebLinkAbout2023-04-21 15-30-20 i
B�..UING �'ERMIT APPL�CA.NT: PROPERTY OUVNER
and
the State Of
that all residential buildbog contractors,rendrac anaa roofers obtain Minnesota requires
state license
unless they qualify for a specific exemption from the licensing requirements.requirement applies to owners of residential real estate who build or impr This license
ove 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 hereby
claim to be exempt from the state licensing requirements because I am reselling
inithe business
of building or remodeling on speculation nrfpr resale that the house for which I am
applying for this permit, located at Z`� � C PQl VIVO(
is the only residential structure I have built or improved in the past 24 months 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 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 Ci 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 Fridley for compliance will
all applicable building codes and city ordina4Sin,a','i"—ture
c ith th ork being preformed on this
property-
oaf Property Owner
r �- o
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:// ,ww.dH.n1n,yoy/Cc1d.asp