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City of Lynchburg

900 Church Street, Lynchburg, VA 24504


Owner Exemption and Affidavit of Acknowledgement

City of Lynchburg, Inspections Division, (434) 455-3910

I, (Full Name)

Of (Address)

I have applied for

permit as required under the Virginia Uniform Statewide Building Code. I certify I am doing all said work alone, without assistance from any outside source. 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 understand all work done under this permit must be done in accordance with all applicable provisions of the Virginia Uniform Statewide Building Code, and in compliance with Zoning and City Ordinances.

I further understand all work must be inspected and approved, prior to concealment, by the City of Lynchburg's Inspections Division. I understand I am responsible for requesting and arranging inspections for all work completed, and the referenced property may not be occupied until inspections are made and a Certificate of Occupancy issued. 

In the event of additional inspections, due to failure or compliance with the Codes, or when requests for inspections are made before the work to be inspected has been completed to the degree required, or the inspector cannot obtain reasonable access to the work, a reinspection fee will be assessed for each subsequent inspection. Violation of provisions of the Virginia Uniform Statewide Building Code (Building, Electrical, Mechanical, and Plumbing) or any requirements made by the inspectors under the powers of the City Code shall be liable to a fine up to $2,500 every day of failure to conform to such provisions or requirement shall constitute a separate offense. 

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in the City of Lynchburg, Virginia on

Section 54.1-1111. Prerequisites to obtaining building, etc., permit. – Any person applying to the building inspector or any other permit authority of the city, county, 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 inspector or authority that he is duly licensed or registered under the terms of this chapter to carry out or superintend the same, or (ii) file a written statement, supported by any affidavit, that he is not subject to licensure or registration as a contractor or subcontractor pursuant to this chapter. The applicant shall also furnish satisfactory proof that the taxes have been paid so as to be qualified to bid upon or contract for the work for which the permit has been applied.

It shall be unlawful for the building inspector or other authority to issue or allow the issuance of such permits unless the applicant has furnished evidence of being either exempt from the provisions of this chapter or licensed or registered under this chapter to carry out or superintend the work for which such permits have been applied.