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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 " . . - . '