HomeMy WebLinkAboutDougan Owner Form.jpg S9 9
BUILDING PERMIT APPIACAN'1': PRQPFRI-Y OWNER
1. John Dougan understand that the State of Minnesota requires
that all residential building contractors, remodelers and roofer-, obtain a state license
unless they qualify for a specific exemption from the licensing requiremeats. This license
requirement applies to owners of residential real estate who build or improve such
property for purposes of speculation or resale.
By sigoing this document, I attest to Tjle fact that I ani improving this lioilse for nay own
use and am not building or i-nproviing this house for the purpose of reselling it-I hereby
claim to be exen-Ppt Eon,, the state 1L1'CeP.S1'1jg requirements because 1 axa not in the business
of budldinc-or remodeling on speculation or for resale and that the house for, which ',, air
applying for this pen-rilt, located at 1624 Osborne Road NE Fridley
is the only residential structure I have built or improved in the past 24 rronths. I also
acknowiedge that because I do not have a state 'license, I forfeit any meclrardc's lien
rights to whicla I tray o therwise have been entitled tinder Minn. Stat. §5;14.01.
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
..usderneanor under Minn. Stat. §326B.082, subd. 16 and can also result in a fine of up to
$10,000. 1 n-irffi.er 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 . ill b responsiblet The City r)r ect, I atone we o compliance will
01y of Fridley for com, li
e building codes and city ordinar?,--q vfit� th- vrork bein�, o-171fo-ned or,this
all applicab"
property.
roperty Owner
____ 10/7
For qpestiorts or it formation ot, contractor iioerising, or to die&the licensing stratus ailcl erlforcerzlent
history of a pat-ticutar contractor, call the Minnesota Oepartrnevit of Labor and (nditsiry, Construction
Codes arrd Licensing Division, at('65 1' 284506Q The NNeb site ls� llttD:1AVWW.dlLj gnj V �js r)
I _ "g�