HomeMy WebLinkAboutOwner Affidavit - Corning Cable Systems.tif ^ ' `
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' CAuAWBAmmmNuY PERMIT
BUILDING (C)
BLDC-9-11-21901
Alteration
STATE 0f NORTH CAROLINA OWNER EXEMP`nONAFFIDAVIT
PURSUANT TOm.m.e7'14(a)(V
COUNTY OF CATAV1413A
Catawba County Building Services Division
Address and Parcel Identification Number of Real Property Where Building is to be Constructed or Altered
||6423RDST SE, Hickory, NC PIN 371220984877
(Print Full Name)
hereby claim an exemption from licensure under G.S. 87-1(bX2) by initialing the relevant prov |nparagraph I
and initialing num,g,anhs 2-4 below and amam|og to the following.
1 _____|cv,t that /amthe owner of the property set forth above on which this building |s to be
constructed o,altered,
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|am legally authorized tp act on behalf cN the him n, corporation which is constructing w,
,
altering this building on the property owned by the firm m, corporation as set forth above (name nf
firm o,corporation
2 W2�_ | 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 Linder the terms of
Article Iof Chapter 87of the General Statutes u[ North Carolina,
a 14 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 tv Chapter 034o,the General Statutes o( North Carolina,
4 i understand that o copy u/this AFFIDAVIT will uo transmitted to the North Carolina
Licensing Board for General Contractors for verification that I am validly entitled to claim an
exemption umde,G.S. 87'1(u)(2) for the building construction or alteration apeodmu neem i further
understand that, if the North Car Licensing Board for General Contractors determines that |was
not entitled to claim this exemption, the building permit issued for the building construction mr
alteration specified herein shall be revoked pursuant mG,S,153A-302o,8,G 18OA422
I< 7 - / /-3 X�
(Signature of Affiant) Date'
Sworn k, (or affirmed) and Subscribed before nm
this the l 3 f7bmyof .201 / FFICIAL SEAL
ALEXANDER COUNTY
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�na�uoeoyWn��Pu�|m � �,in� /- n n � ' ' My Commission Expires - IT" -
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Name u/No�ryPu�� 7^ /1 \/
My Comm'vsionExp'res. (Notary Stamp o,Seal)
(NOTE xism Class p felony towmDul�y commit perjury ,n any affidavit taker, pursuant ^*oem+-&3 1*-209�)
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