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2. Permit Applicant is:
   -- Select One --OwnerContractorOther
3. Anticipated Start Date:
   Anticipated Start Date:
5. Job Address
7. Is This New Construction
   -- Select One --YesNo

   If this is not new construction mark no and continue on, if it is make sure the legal description is included.

8. Legal Description

   A legal description is required for new construction projects.

10. Type of Property
    -- Select One --ResidentialMultipleCommercialIndustrial
11. Class of Work
    -- Select One --New ConstructionAdditionRemodelFence/SignMoved-In StructureGarageExcavation
13. Concrete Work in Right-of-way

    1. Yes
    2. No
14. If working in the Right-of-Way

    If the concrete work is in the right-of way, approval is required from Public Works.

18. Site Plans

    Site plans are required for New Construction, Additions, & Move-In Structures.  

20. Additional description of work and valuation*

    Include the Total Valuation (Material + Labor (even if self) = Valuation)

    Also include square feet

24. Owner Name
25. Phone Number
27. Address
28. Email Address
30. City, State, & Zip Code
34. Contractor Company Name
35. Contact Person
37. Physical Address
38. Phone Number
40. Mailing Address
41. Email Address
43. City, State, & Zip Code
44. MN State License Number
46. Worker's Comp Insurance Company
47. Dates of Policy
    Dates of Policy Start Date

    —

    Dates of Policy End Date
51. Subcontractor Information
53. Architect/Designer
54. Heating Contractor
56. Plumbing Contractor & License Number
57. Electrical Contractor & License Number
59. Framing Contractor
60. Roofing Contractor
64. Acknowledge Application Information

    I hereby apply for a building permit and acknowledge that the information above is complete and accurate; that this is not a permit; that the work will be performed in accordance with the conditions of the permit, the approved plans and specifications, and the Minnesota State Building Code; and that I will cause the work to remain accessible and exposed for inspection purposes.

    Applicant further understands and agrees that once a building permit is issues, the permit becomes void if construction is not is begun, is suspended or abandoned within 180 days at any time after work is commenced.  Applicant understands and agrees that all provisions of the laws and ordinances governing this type of work will be complied with whether specified herein or not, the granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction of the performance of construction.

    The applicant understands and agrees that the City will review the plans and conduct periodic construction observations.  The applicant further understands and agrees that the City review of the plans and/or construction does not constitute either an explicit or implied certification that all aspects of the plans and/or construction comply with all requirements of all codes.  The City will provide continuous on-site observation of construction.  The applicant at all times remains responsible for ensuring that the plans and specifications comply with all requirements of all codes and accepts full responsibility for all workmanship and construction.

    Two days prior to starting construction of a driveway approach, curb and gutter, or sidewalk within the City right-of-way, applicant must contact the Public Works Department at (218) 773-1313 between 7am and 4:30pm, Monday through Friday.

    The permit applicant/holder is in control of the construction project, the permit applicant/holder agrees to indemnify and hold the City harmless from any and all claims, demands, loss, cost, expenses, or causes of action, arising out of the City review, or failure to review the building plans, the City inspection or observation, or failure to inspect or observe, any aspect of the construction project, and/or failure of the construction project, and/or failure of the construction project to comply with the building codes.  This agreement applies to any such claim brought by any subsequent purchaser or owner of the property.

66. Electronic Signature Consent

    By electronically signing the building permit application, the applicant consents the e-signature legally binds them to the terms and conditions of the application.

68. E-signature of Applicant
69. Date
    Date
73. As homeowner are you acting as the general contractor?

    1. Yes
    2. No
75. If yes, please complete and sign the section below.

    I understand that the State of Minnesota requires that all residential building contractors and residential remodelers obtain a state license unless they meet an exemption from licensure.  As the homeowner who is building or improving my own home, I am exempt from state licensure as long as I am not in the business of building or remodeling residential real estate for the purpose of speculation or resale.  I guarantee that the property that I am obtaining a permit for, the address is listed above in the application, is the first residential property that I have built or remodeled in the past twelve (12) months.

    Furthermore, I understand that some of the subcontractors hired by me are required to be licensed or registered by the State.  Those most likely to require licensure are plumbers, electricians, roofers, and any subcontractor who performs more than one skill.  

    If you are uncertain whether or not a subcontractor is required to be licensed, you may contact the MN Department of Commerce, Enforcement Division at (612) 296-2594 or 1-800-657-3602.  If unlicensed, non-exempt contractors are hired, the homeowner will not have the ability to make a claim against the contractor's recovery fund to compensate for the contractor's failure to perform or fraudulent and dishonest practices.

77. Electronic Signature Consent

    By electronically signing the building permit application, the applicant consents the e-signature legally binds them to the terms and conditions of the application.

79. E-signature of Applicant
80. Date
    Date
Leave This Blank:


82. 1. Receive an email copy of this form.
83. Email address

    This field is not part of the form submission.

84. Submit

* indicates a required field