HomeMy WebLinkAboutPermit Plumbing 2008-8-27
Construction ContractoFs Board.
700 SummerSt NE_ Suite 300
PO.Box 14140
Salem OR 97309-5052
Phone: 503-378-4621
Web Address: www.ccb.state.or.us
-'
. .
. .
" "
" "
,.", "',
','.
'.
',"
'Permit#: Q):?-.\!l.S-\~' ,
Ad<fres~: t\~D' S~~e
'ls~uedby:~\it&ci).Date:B- ZL.CZ)
"
. .
. '
, ,
'.
. .
statement: Information Notice"tp Property Owners
.. About Construction Responsibilities '
Nate: OregimLaw, Oks 701.055(4) requires residential canstructian permit applicants who. are nat
,.licensed with the CanstructionCantractars Baard.to.sign.thefallawing statement befare a building'.:
permit can be issued. ijzisstat~ment is required far 'residential building, electrical; mechanical and
plumbing permits. Licensed architect and engineer applicants, exempt fram licensing under'
ORS 701.010(7), neednat submit this statement. Thisstatemfint will beflled with the permit.
Fill in the "J-'J-'.~;riate blanks and initial boxes L~d 2, and.either,box; 3Aor 3B:.
. ..
I own, reside in, or 'Y!ll reside in.tp.e completed strUcture. , '
"-',"
, '
. .
. I underst~d that I must'become licensed as a constrUction contractor if the structure is sold or
offered for sale before .or on completi?n.
, . --,
D . 3A. My'general contractor is
, .
y}"
(Name)
(CCB #)
. I ~illi~struct my general contractor. that all subcontia~tcirs .~ho wbrk 'on the structure must b_e
, liCensed with the Construs:tionContractors Board. ,>
, OR . ~bU\O{.
I will be my own ~l contractor. \
"
If I hire subcontractors, I will hire only subcontractors licensed with:the Construction Contractors .
Board.. IfJ change my mind and hire a general contractor, I will contract with a contractor who is
licensed with the'CCB and will iininediately notify the office issuing this building permit of the
name of the 'contractor..
, ,
. ' " .
I hereby certify that the above information is correct and 'that I have read and do understand the Information
, '
Notice to Property. Owners about ConstructionRespoDsibiliti~s,o,D the r~vetse'side, of this f!,rm.
\ AJ -1~ ,8!2-a(z~
(Signature of permit applicant) , (Dat~) ..,
. , (White ,capy to. issuing agency permit file, pink: capy to. applicant.).
". .. - -'. . .
"..,'
. '-' ,",
7,vt"';i_owner.doc 06-01-04
"
. . -
. '