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HomeMy WebLinkAboutPermit Electrical 2020-03-31Prope Regard rty Owner Statement Respons 10 ina Con-struction IbIlIties Oregon Law requires residential constnjction permit applicants who are not licensed with ction Contractors Board to sign the following statement before a building permifcan beConstru _. .. T -� •.r�.--.�.�.-mow •..y �..�..� fes- the issued. (ORS 701.325 (2)) I his statement iS required for residential building, eiec cai, mechanical, licensed architect and engineer applicants, exempt from ficensing under submit this statement This statement will be filed with the perm Please check the appropriate box' .t. and plumbing pe its• ORS 701.010 (7), need not 1 own, reside in, or w1`11 reside in the completed structure and my general contractor is: Name � CCB# ^ Expiration Date 1 will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or ✓ ; I will be performing work on property I own, a residence that I reside in, or a residence that i will reside in. If 1 hire subcontracto I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. have read and.. understand the Information Notice to Homeowners About Construction Responsibilities, and 1 hereby certify that the in fo ation on this homeowner statement is true and accurate. Print Name of Perm .lint Signature of Permit Applicant Poll ta.�rr �F�.. ��r• # F1000 (10 A F% /P) 09 r) 4L 1z f r..Pe itr Y e —Wmm ydp- —F Wh-rml Address, 3qO,3 F (d 5P. Issued b 7 i ..-�-�•._ mow.. _k � � . 4 i Dater s 1c15 i • vim• .. ..-�-����W�.��.�.-_carr_--r�r• - 3 f N1 ar 202JO _. ---- .... Iftl - Date - f4�N alloo(00e ' PLQ14 This CC)Py r"car �rmlt Offices