CONTRACTOR AFFIDAVIT gsga.gov

CONTRACTOR AFFIDAVIT

NOTICE: Building Contractors must submit this form before permit is issued. Subcontractors (trades) must submit this form before work begins. A Copy of your current Business License and State License must accompany this affidavit unless current licenses have been previously filed with the City of Sandy Springs. All information requested on this form is mandatory.

Building Permit#:___________________________________________________________

Site Address: ______________________________________________________________

Subdivision: _________________________ Lot/Bldg/Ste: __________________________

General Contractor: _________________________________________________________

This is to certify that I am responsible for: (check all that apply)

__________________Residential-Basic

_______________ Electrical

__________________Residential-Light Commercial

_______________ Plumbing

__________________General

_____________Low Voltage

__________________Mechanical

_________________ Other

I certify that I have and will comply with all codes and ordinances adopted by the City of Sandy Springs that pertain to the construction of this structure. In the event of any change in my status on this installation, I understand that I will be held responsible for all indicated work at this job until Building Inspections has been notified, in writing, of any change. I further agree to indemnify the City of Sandy Springs and its operator from any liability for damages and loss of property if the work performed under my authority has not been installed in accordance with these codes and ordinances.

Signature / Date: ____________________________________________________________ State License #: _____________________________________________________________ Business License # & Jurisdiction: _____________________________________________ Contractor Business Name: ___________________________________________________ Address: __________________________________________________________________ Telephone: ________________________________________________________________

FOR BUILDING INSPECTIONS VISIT:

EMAIL COMPLETED FORM AND DOCUMENTS TO: permit@

City of Sandy Springs, 1 Galambos Way, Sandy Springs, Georgia 30328 - 770-730-5600 X:\CommunityDevelopment\Building and Development Division\Forms, Standards, Guidelines

September 13, 2017

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