---
type: document
title: Owner Written Statement 202211020929161317
file: ../Owner Written Statement_202211020929161317.pdf
tags:
  - Russell_County
  - Building_Department
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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: