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Russell County Building Department

Written Statement for all Building Types
Section 54.1-1111 Written Statement
I THE UNDERSIGNED AFFIRM THAT I AM OWNER OF A PARCEL OF LAND IDENTIFIED
AS COUNTY TAX MAP PARCEL #   _____________________________ _____
LOCATED AT __________________________________________________________ AND THAT I
HAVE APPLIED FOR A BUILDING OR TRADE PERMIT FROM THE RUSSELL COUNTY
BUILDING SAFETY DEPARTMENT.
I AFFIRM THAT I AM FAMILIAR WITH THE PROVISIONS OF SECTION 54.1-1111 OF
THE CODE OF VIRGINIA, 1950 AS AMENDED, AS SET FORTH BELOW AND THAT I AM NOT
SUBJECT TO LICENSURE AS A CONTRACTOR OR SUBCONTRACTOR.
I WILL BE RESONSIBLE FOR THE WORK PERFORMED ON MY PROPERTY AND SHALL
COMPLY WITH THE PROVISIONS OF THE UNIFORM STATEWIDE BUILDING CODE (§ 36-97 et
seq.) AND BE RESPONSIBLE OR IN COMPLIANCE WITH ALL LAWS OF THE COMMONWEALTH
REGULATING BUILDING CONSTRUCTION AND USE, AND ALL ORDINACES OF RUSSELL
COUNTY.
I FUTHER UNDERSTAND AND THAT I MAY NOT UNDERTAKE CONSTRUCTION OR RENOVATION
WORK REQUIRING A BUILDING OR TRADE PERMIT ON MORE THAN ONE (1) RESIDENTAL
DWELLING WITHIN A 24 MONTH PERIOD WITHOUT OBTAINING LICENSURE AS A
CONTRACTOR.(§ 54.1-1101-A-7,B,C)
SIGNATURE OF AFFIANT_________________________________________________
DATE_________________________________________________________________
WITNESSED BY:________________________________________________________
TITLE:_______________________________________________________________
CODE OF VIRGINIA, 1950 AS AMENDED SECTION 54.1-111
Prerequisites for obtaining building permit, etc.
Any person applying to the building official or any other authority of a county, city, or town in
this Commonwealth, charged with the duty of issuing building or other permits for the
construction of any building, highway, sewer, or structure, or any removal, grading or
improvement shall furnish prior to the issuance of the permit, either (i) satisfactory proof to
such official or authority that he is duly licensed or certified under the terms of this chapter to
carry out or superintend the same, or (ii) file a written statement that he is not subject to
licensure or certification as a contractor or subcontractor pursuant to this chapter. The
applicant shall also furnish satisfactory proof that the taxes or license fees required by any
county, city, or town have been paid so as to be qualified to bid upon or contract for the work
for which the permit has been applied.
It shall be unlawful for the building official or other authority to issue or allow the issuance of
such permits unless the applicant has furnished his license or certificate number issued
pursuant to this chapter or evidence of being exempt from the provisions of this chapter.
https://law.lis.virginia.gov/vacode/36-97/
Russell County Building Department
Written Statement for all Building Types
Section 54.1-1111 Written Statement
1 THE UNDERSIGNED AFFIRM THAT I AM OWNER OF A PARCEL OF LAND IDENTIFIED
AS COUNTY TAX MAP PARCEL #
LOCATED AT ‘AND THAT T
HAVE APPLIED FOR A BUILDING OR TRADE PERMIT FROM THE RUSSELL COUNTY
BUILDING SAFETY DEPARTMENT.
1 AFFIRM THAT I AM FAMILIAR WITH THE PROVISIONS OF SECTION 54.1-1111 OF
THE CODE OF VIRGINIA, 1950 AS AMENDED, AS SET FORTH BELOW AND THAT I AM NOT
SUBJECT TO LICENSURE AS A CONTRACTOR OR SUBCONTRACTOR.
1 WILL BE RESONSIBLE FOR THE WORK PERFORMED ON MY PROPERTY AND SHALL,
COMPLY WITH THE PROVISIONS OF THE UNIFORM STATEWIDE BUILDING CODE (§ 36-97 et
seq.) AND BE RESPONSIBLE OR IN COMPLIANCE WITH ALL LAWS OF THE COMMONWEALTH
REGULATING BUILDING CONSTRUCTION AND USE, AND ALL ORDINACES OF RUSSELL
COUNTY.
CODE OF VIRGINIA, 1950 AS AMENDED SECTION 54.1-111
Prerequisites for obtaining building permit, etc.
Any person applying to the building official or any other authority of a county, city, or town in
this Commonwealth, charged with the duty of issuing building or other permits for the
construction of any building, highway, sewer, or structure, or any removal, grading or
improvement shall furnish prior to the issuance of the permit, either (i) satisfactory proof to
such official or authority that he is duly licensed or certified under the terms of this chapter to
carry out or superintend the same, or (ii) file a written statement that he is not subject to
licensure or certification as a contractor or subcontractor pursuant to this chapter. The
applicant shall also furnish satisfactory proof that the taxes or license fees required by any
county, city, or town have been paid so as to be qualified to bid upon or contract for the work
for which the permit has been applied.
It shall be unlawful for the building official or other authority to issue or allow the issuance of
such permits unless the applicant has furnished his license or certificate number issued
pursuant to this chapter or evidence of being exempt from the provisions of this chapter.
I FUTHER UNDERSTAND AND THAT I MAY NOT UNDERTAKE CONSTRUCTION OR RENOVATION
WORK REQUIRING A BUILDING OR TRADE PERMIT ON MORE THAN ONE (1) RESIDENTAL
DWELLING WITHIN A 24 MONTH PERIOD WITHOUT OBTAINING LICENSURE AS A
CONTRACTOR. (§ 54.1-1101-A-7,B,C)
SIGNATURE OF AFFIANT
DATE,
WITNESSED BY:
TITLE:
I THE UNDERSIGNED AFFIRM THAT I AM OWNER OF A PARCEL OF LAND IDENTIFIED: 
AS COUNTY TAX MAP PARCEL: 
AND THAT I: 
CONTRACTOR 5411101A7BC: 
undefined: 
WITNESSED BY: