COUNTY OF APPOMATTOX

P. O. Box 863 Appomattox, VA 24522

Phone (434)352-8183 Fax (434)352-4214

inspections@appomattoxcountyva.go

I hereby request permanent electrical service at the property in which I am obtaining a permit for. I am fully aware that this structure is not habitable at this time. Additional building, mechanical, plumbing or other work is required prior to approval for occupancy. At the completion of work, prior to any concealment, inspections shall be requested and work approved by the County of Appomattox Building Inspections. Occupancy will not take place until all work has been inspected and approved.

I fully understand that power will be disconnected immediately, without prior notice, if this structure is occupied without full approval from Building Inspections. I am responsible for all fees associated with reconnecting power.

I understand these provisions are fully transferable and will be assumed by any other person in the event of transfer of title or ownership of the property. I further understand I am obligated by law to reveal these provisions prior to transfer of title or ownership of this property.

I understand that the County will not be responsible for improper or unsafe use of electrical service prior to final inspection and approval.

I understand occupancy of this structure prior to the issuance of a certificate of occupancy is a violation of the Uniform Statewide Building Code and subject to a fine up to $2500 per separate offense per day, or portion thereof.

(Complete only if applicant is the owner and is listed as a contractor. This section must be notarized)

I affirm that I am the owner of the property described in this application and that I am familiar with the prerequisites of Section 54.1-1111 of the Code of Virginia and I am not subject to licensure as a contractor or subcontractor. I am also aware that it is a violation of State law to hire or award a contract to an unlicensed

This portion of the form must be notarized. You may submit the form as is to Appomattox County and then stop by during business hours (8:00 a.m.-4:30 p.m. Monday-Friday) at 153 A Morton Lane Appomattox, VA to have it printed and notarized. You may also print the PDF version of this form and have it notarized then drop it by the County Administration building in the Drop Box or at the front desk during business Hours.

 I hereby certify that I am the owner of record of the herein described property or that the work proposed has been authorized by the owner of 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 this permit. In addition, if a permit is issued, I certify that the code official or his authorized representative shall have the authority to enter the area(s) described herein at any reasonable hour for the purpose of enforcing the provisions of the applicable code(s).