Cautionary Statement to Owners Obtaining Building Permits
101.65(1r) of the Wisconsin Statutes requires municipalities that enforce the Uniform Dwelling Code to provide an
owner who applies for a building permit with a statement advising the owner that:
If the owner hires a contractor to perform work under the building permit and the contractor is not bonded or
insured as required under s. 101.654(2)(a), the following consequences might occur:
(a) The owner may be held liable for any bodily injury to or death of others or for any damage to the
property of others that arises out of the work performed under the building permit or that is caused by any
negligence by the contractor that occurs in connection with the work performed under the building permit.
(b) The owner may not be able to collect from the contractor damages for any loss sustained by the
owner because of a violation by the contractor of the one and two family dwelling code or an ordinance enacted
under s. 101.654(1)(a), because of any bodily injury to or death of others or damage to the property of others that
arises out of the work performed under the building permit or because of any bodily injury to or death of others
or damage to the property of others that is caused by any negligence by the contractor that occurs in connection
with the work performed under the building permit.
□ I vouch that I am or will be owner-occupant of this dwelling for which I am applying for an erosion control or construction
permit without a Dwelling Contractor Certification and have read the cautionary statement regarding contractor
Wetlands Notice to Permit Applicants
You are responsible for complying with State and Federal laws concerning the construction near or on wetlands,
lakes and streams. Wetlands that are not associated with open water can be difficult to identify. Failure to
comply may result in removal or modification of construction that violates the law or other penalties or costs may
incur. For more information, visit the Department of Natural Resources wetlands identification web page or
contact a Department of Natural Resources service center.
Additional Responsibilities for Owners of Projects Disturbing One or More Acre of Soil
I understand that this project is subject to Ch. NR 151 regarding additional erosion control and stormwater
management and will comply with those standards.
Cautionary Statement to Contractors for Projects Involving Building Built Before 1978
If this project is in a dwelling or child-occupied facility built before 1978 and disturbs 6 sq. ft. or more of paint per
room, 20 sq. ft. or more of exterior paint or involves windows, then the requirements of DHS Ch. 163 requiring
Lead-Safe Renovation Training and Certification apply. Call (608) 261-6876 or go to the Wisconsin Department of
Health Services lead homepage for details of how to be in compliance.
Contractor Credential Requirements
All contractors shall possess an appropriate contractor credential issued by the Wisconsin Division of Industry
Services. Contractors are also required to only subcontract with contractors that hold the appropriate contractor
By signing this document, owner confirms that he/she has read and understands all of the above stated
Owner’s Signature: Date: