HomeMy WebLinkAboutBLDR--11-11-22759 ANNE HARRISON.tif z
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STATE OF NORTH CAROLINA OWNER EXEMPTION AFFIDAVIT
PURSUANT TO G.S. 87- 14(a)(1)
COUNTY OF CATAWBA
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Catawba County Building Services Division
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Address and Parcel Identification Number of Real Property Where Building is to be Constructed or Altered:
/7J- - Q . 17 PIN
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(Print Full Name)
hereby claim an exemption from licensure under G.S. 87- 1(b)(2) by initialing the relevant provision in paragraph 1
and initialing paragraphs 2 -4 below and attesting to the following:
1. (/ 1 certify that I am the owner of the property set forth above on which this building is to be
constructed or altered;
OR
I am legally authorized to act on behalf of the firm or corporation which is constructing or
altering this building on the property owned by the firm or corporation as set forth above (name of
firm or corporation)
2. V 1 will personally superintend and manage all aspects of the construction or alternation of
the building and that duty will not be delegated to any person not duly licensed under the terms of
Article 1 of Chapter 87 of the General Statutes of North Carolina;
3. 1 will be personally present for all inspections required by the North Carolina State Building
Code, unless the plans for the construction or alteration of the building were drawn and sealed by an
architect licensed pursuant to Chapter 83A of the General Statutes of North Carolina;
4. 1 understand that a copy of this AFFIDAVIT will be transmitted to the North Carolina
Licensing Board for General Contractors for verification that I am validly entitled to claim an
exemption under G.S. 87- 1(b)(2) for the building construction or alteration specified herein. I further
understand that, if the North Carolina Licensing Board for General Contractors determines that I was
not entitled to claim this exemption, the building permit issued for the building construction or
alteration specified herein shall be revoked pursuant to G.S. 153A -362 or G.S. 160A -422.
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1113111
(Signature of Affiant) ate
Sworn to (or affirmed) and Subscribed before me
this the day of NQVeMBLP. 2011 OFFICIAL SEAL
Notary Public North Carolina
ALEXANDER COUNTY
Signa r of Notary Public Printed CLARA A. COUL OU NE
Q M Commission Expires I Z/ /Z
Name o Notary Public
GLAeA A 60aLBO l flu
My Commission Expires: (NT, 21' (Notary Stamp or Seal)
(NOTE: It is a Class F felony to willfully commit perjury in any affidavit taken pursuant to law—G. S. 14 -209)