HomeMy WebLinkAboutOwner-Contractor Affidavit - David James Hudson.tif STATE OF NORTH CAROLINA OWNER EXEMPTION AFFIDAVIT
COUNTY OF CATAWBA PURSUANT TO G.S. 87- 14(a)(1)
Catawba County Building Services D(visien
Address and Parcel Identification Number of Real Property Where Building is to be Constructed or Altered
z
� 1 �1 Z PIN #_ 7 � C,' �
(Print Full Name)
hereby claim an exemption from IICenSUre ender G S 87 - I(b) by initialing the relevant prcvsion in paragraph 1
and mitialingp -4 beiov✓ and attesting to the following
^
i- P i certify that I am the comer 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 �s constructing or
altering this building on the property owned by the firm or corporation as set festh above (name of
firm o�r�corporat�on)
2 ` L-_ I will personally superintend and manage all aspects of the construction or alternation of
the budding and that duty will nca 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 :IM -t I 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 understand that a copy of this AFFIDAVIT will be transmitted to the North Carolina
Licensing Board for General Contractors for verification that I an validiy entitled to clam an
exemption under G S 87- lib)(2) for the owld(ng constracti.on or alteration specified herein I further
understand that :f the North Carolina Licensing Board for General Contractors determines that I was
not entitled to claim this exernptron. the bur :ding permit issued for the building construction or
alteration specified herein shall be revoked pursuant to G S 153A -362 or G S 160A -422
(Signature of Affiant) ate
Sworn to (or affirmed) and Subscribed befo, c-e
this the ay of NDV�qjVX- 201 j_
� � KELLY S BOLLINGER
Snature o ota y Public Pnntea Notary Public
��L 5 . t� l t Catawba County, NC
Name of Nbtary Public My Commission Expires Match 23, 2013
My Commission Expires; Qlck �C'(j (Notary Stamp or Seal)
(NOTE It is a Class E fe'or,y to upf illy fnm'! f)e,lu! .n a rr_ ✓„ !aken pursuant to !aw —G S 14 -209