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PICKENS COUNTY PLANNING & DEVELOPMNENT 1266 East Church Street, Suite 136 Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Updated 09/02/2020 Owner Building Permit Affidavit (New Construction) The undersigned hereby applies for special consideration as property owner desiring to build or serve as general contractor for the below listed property owned by requestor. In making this request for an owner/builder permit, the undersigned states the following to be true: Applicant agrees that the building or structure is located on real property owned by said applicant and is intended upon completion for use or occupancy by applicant and/or applicant’s family, firm or corporation and its employees and will not be used by the general public and not offered for sale or lease. Applicant shall serve as the general contractor and accept inherent responsibilities for the work authorized by the approved permit in accordance with Georgia’s licensing law pertaining to Residential and General Contractors. If applicant is not installing the electrical, plumbing or HVAC as building owner, he/she agrees to hire properly licensed electrical, plumbing, and mechanical contractors. As general contractor, applicant may contract with Traditional Specialty Contractors who are not required to hold a license as a residential or general contractor if performing within their specialty as provided for under O.C.G.A. 43-41-7, but applicant may not contract with another to hire sub-contractors without that person being licensed as required by the State of Georgia. Should applicant sell the home/building within 24 months following issuance of the certificate of occupancy, applicant understands that he/she will not be allowed to permit another home/building unless applicant is duly licensed by the State of Georgia. Applicant agrees to build in accordance with applicable codes and strictly adhere to the inspections as required by the jurisdiction. Undersigned acknowledges that inspections must be performed in an established sequence as required by the jurisdiction and that work done in violation of the building codes must be corrected or may be ordered to be removed. Applicant acknowledges that he/she is aware that a permit issued under the provisions of the code may be revoked for false statements of misrepresentations as to the material fact in the application on which the permit was based. Applicant acknowledges that making false statements in the permit application will subject said applicant to possible prosecution and/or fine. Georgia Criminal Code, Article 2, Section 16-10-20 (False Swearing) calls for a possible fine of not more than $1000 or imprisonment for not less than one nor more than five years or both. Print Name Signature Property Address or Parcel Number Date For Office Use Only Permit Number