Building Application
Carroll County Department of Inspections
605-1 Pine Street Hillsville, Virginia 24343
Office: 276-730-3016 Fax: 276-730-3178

Requestor's Information

Type(s) of Permits Needed & Estimated Cost of Each Project

Permit(s) Needed: *
Permit Information: *
Dwelling Information: *
 
Miscellaneous:

Well & Septic Information:

Number of Rooms:

Construction Information:

Dimension/Sq. Footage *
 
Electrical Information:
 
Mechanics’ Lien Agent: Section 43.1 of Code of Virginia:
VA State Licensed Contractor Information OR Owner VA STATECODE 54.1-1101
This document contains important information regarding contractor’s licensure law as defined in Title 54.1, Chapter 11, Code of Virginia.

PLEASE READ CAREFULLY BEFORE SIGNING OWNER/BUILDER AFFIDAVIT

TITLE 54.1-1111. Any person applying to the code 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 code 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, supported by affidavit, 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.
TITLE 54.1-1101(Exemptions) - The provisions of this chapter shall not apply to: (Please check the appropriate box.)
WARNING I hereby affirm that I have read Title 54.1-1111 Code of Virginia and fully understand the contents thereof and that I am not subject to licensure as a contractor or subcontractor. I further affirm that I will be solely responsible for all construction on the described property allowed by the permit(s) hereby issued. If the work is performed by any other person or firm employed by me, that person or firm must comply with state and local contractor licensing laws.
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I hereby certify that I am the owner of the record of the herein described property, or that the proposed work has been authorized by the owner of the record and that I have been authorized to make this application as a designated agent. I agree to conform to all applicable state and local regulations, rules and policies and such shall be deemed a condition entering into the exercise of the permit. In addition, if a permit is issued, I certify that the code official/his authorized representative shall have authority to enter the areas herein at any responsible hour for the purpose of enforcing the provisions of the applicable code(s).
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