Fillable STATEOFNORTHCAROLINA OWNEREXEMPTIONAFFIDAVIT PURSUANTTOG.S.8714(a)(1) COUNTYOFWake InspectionsDepartment CityofRaleigh herebyclaimanexemptionfromlicensureunderG.S.871(b)(2)byinitialingtherelevantprovi

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STATEOFNORTHCAROLINA OWNEREXEMPTIONAFFIDAVIT PURSUANTTOG.S.8714(a)(1) COUNTYOFWake InspectionsDepartment CityofRaleigh herebyclaimanexemptionfromlicensureunderG.S.871(b)(2)byinitialingtherelevantprovisioninparagraph1and IcertifythatIamtheownerofthepropertysetforthaboveonwhichthisbuildingistobe (City of Raleigh NC)

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The STATEOFNORTHCAROLINA OWNEREXEMPTIONAFFIDAVIT PURSUANTTOG.S.8714(a)(1) COUNTYOFWake InspectionsDepartment CityofRaleigh herebyclaimanexemptionfromlicensureunderG.S.871(b)(2)byinitialingtherelevantprovi form is 1 page long and contains:

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U.S.A. forms for City of Raleigh NC

BROWSE CITY OF RALEIGH NC (NC) FORMS

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STATEOFNORTHCAROLINA

COUNTYOFWake



CityofRaleigh

InspectionsDepartment

OWNEREXEMPTIONAFFIDAVIT

PURSUANTTOG.S.87‐14(a)(1)

AddressandParcelIdentificationofRealPropertyWhereBuildingistobeConstructedorAltered:





,



I,

,

(PrintFullName)

herebyclaimanexemptionfromlicensureunderG.S.87‐1(b)(2)byinitialingtherelevantprovisioninparagraph1and

initialingparagraphs2‐5belowandattestingtothefollowing:

1. 

IcertifythatIamtheownerofthepropertysetforthaboveonwhichthisbuildingistobe

constructedoraltered;

OR



Iamlegallyauthorizedtoactonbehalfofthefirmorcorporationwhichisconstructingoraltering

thisbuildingonthepropertyownedbythefirmorcorporationassetforthabove(nameoffirmor

corporation:

);

2. 

Iwillpersonallysuperintendandmanageallaspectsoftheconstructionoralterationofthe building

andthatdutywillnotbedelegatedtoanypersonnotdulylicensedunderthetermsofArticle1ofChapter

87oftheGeneralStatutesofNorthCarolina;

3. 

IwillbepersonallypresentforallinspectionsrequiredbytheNorthCarolinaStateBuildingCode,

unlesstheplansfortheconstructionoralterationofthebuildingweredrawnandsealedbyanarchitect

licensedpursuanttoChapter83AoftheGeneralStatutesofNorthCarolina;

4. 

IunderstandthatacopyofthisAFFIDAVITwillbetransmittedtotheNorthCarolinaLicensingBoard

forGeneralContractorsforverificationthatIamvalidlyentitledtoclaimanexemptionunderG.S.87‐1(b)(2)

forthebuildingconstructionoralterationspecifiedherein.I furtherunderstandthat,iftheNorth

Carolina

LicensingBoardforGeneralContractorsdeterminesthatIwasnotentitledtoclaimthisexemption,the

buildingpermitissuedforthebuildingconstructionoralteration specifiedhereinshallberevokedpursuant

toG.S.153A‐362orG.S.160A‐422.

5. 

Thebuildingwillbesolelyoccupiedbytheowner(s),firmorcorporationassetforthaboveforat

leasttwelve(12)monthsfollowingcompletion.

6.





7.

ThisAFFIDAVITappliestothefollowingtrades:

Building Electrical Mechanical Plumbing



Thetotalcostofthisprojectis$______________.





(SignatureofAffiant)Date

Swornto(oraffirmed)andSubscribedbeforemethisthe  

dayof,20.





SignatureofNotaryPublic





PrintedNameofNotaryPublic



MyCommissionExpires:

(NotaryStamporSeal)



(NOTE:ItisaclassFfelonytowillfullycommitperjuryinanyaffidavittakenpursuanttolaw– G.S.14‐209)

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Fillable STATEOFNORTHCAROLINA OWNEREXEMPTIONAFFIDAVIT PURSUANTTOG.S.8714(a)(1) COUNTYOFWake InspectionsDepartment CityofRaleigh herebyclaimanexemptionfromlicensureunderG.S.871(b)(2)byinitialingtherelevantprovi

Fill Online, Printable, Fillable, Blank STATEOFNORTHCAROLINA OWNEREXEMPTIONAFFIDAVIT PURSUANTTOG.S.8714(a)(1) COUNTYOFWake InspectionsDepartment CityofRaleigh herebyclaimanexemptionfromlicensureunderG.S.871(b)(2)byinitialingtherelevantprovi Form

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