WFG National Title Insurance Company
SWORN CONSTRUCTION STATEMENT
Owner’s Name
Property At
ITEMS / FURNISHED BY –Laborers,Materialmen & Subcontractors / TOTAL
COST / AMOUNT
OF DRAW / AMOUNT
PAID / BALANCE / %
COMP.
1. GENERAL REQUIREMENTS
a. Survey, Bldg. Permit
2. SITE WORK
a. Cleaning Building Site
b. Excavating, Filling
c. Grading, Backfill
d. Driveways
e. Water, Gas, Sewer Conn.
f. Blacktopping
g. Sodding, Sod
h. Landscaping
3. CONCRETE
a. Foundation
b.Concrete
c. Blocks
d. Concrete Work
e. Pre-stressed Concrete Units
4. MASONRY
a. Brickwork, Chimney, Fireplace
b. Stonework, Stone
5.METALS
a. Structural Steel
b. Ornamental Iron
c. Sheet metal, Gutter work
6. LUMBER
a. Carpentry, Labor
7. MOISTURE PROTECTION
a. Waterproofing
b. Roofing
c. Insulation
8. FLOOR & WALL COVERING
a. Painting interior, Decorating
b. Linoleum, Floor Tile
c.Carpeting
9. DOORS,WINDOWS & GLASS
a. Hardware, Rough
b. Hardware, Finish
c. Millwork, Trim, Window
d. Glass, Mirrors
e. Garage Doors
10. FINISHES
a. Wood Flooring
b. Counter, Vanity Tops
c. Painting Exterior
d. Tile work, Ceramic, Plastic
e. Floor Finishing
11. DRYWALL & PLASTERING
a. Sheetrock
b. Plastering, Drywall
c. Drywall Taping
d. Stucco
12. HEATING & A.C. SYSTEM
a. Heating
ITEMS / FURNISHED BY –Laborers,
Material Men & Subcontractors / TOTAL
COST / AMOUNT
OF DRAW / AMOUNT
PAID / BALANCE / %
COMP.
b. Air Conditioning
13. PLUMBING SYSTEM
a. Plumbing, Roughing In
b. Plumbing Materials
14. ELECTRICAL SYSTEMS
a. Electric Fixtures
b. Electric Contractor
15. APPLIANCES
a. Oven, Rangetop,Hood, Fan
b. Disposal, Incinerator
c. Exhaust Fans
d. Dishwasher, Refrigerator
16. FURNISHINGS
a. Cabinet Work
b. Window Shades, Draperies
c. Carpeting
17. SPECIAL CONSTRUCTION
a. Wells, Pump
b. Septic System
18. FINAL COSTS
19. SOFT COSTS
a. Architect Design
b. Contractors Fee
c. Contingency
d. Land
20. FINANCING COSTS
a. Construction Loan Interest
b. Financing Fees
TOTALS
STATE OF
SS.
COUNTY OF
The undersigned, being first duly sworn, each for himself, as contractor or owner of the property at the address shown on the reverse side hereof, deposes and says that the foregoing are the names of all parties having contracts or subcontractors for specific portions of the work on said property and building or material entering into the construction thereof, and the amounts due and to become due to each of said parties; that the items mentioned include all labor and material required to complete said building according to plans and specifications; that there are no other contracts outstanding; and that there is nothing due or to become due to any person for material, labor or other work of any kind done upon said building other than as above stated.
The undersigned further deposes and says that no increase in the cost of construction will be made under any circumstances without furnishing information on same to WFG National Title Insurance Company with additional deposits to cover such increase that, in the event of any such increase, no orders or claims will be made on said company until such information and additional deposits shall have been completed; that the purpose of said statement is to induce said company to pay out the proceeds of a loan of $ secured by a mortgage on said property; and that upon payment of the specific unpaid items listed herein, the undersigned contractor hereby agrees to waive all claims of priority to said mortgage and both parties herein will save said company harmless as to any other claims of priority of lien for any labor or material furnished or to be furnished, for completion of construction.
Subscribed and sworn to before me this ______(Contractor)
day of ______, 20___By______
Title
______
Notary Public
Subscribed and sworn to before me this ______(Owner)
Owner
day of ______, 20______(Owner)
Owner
______
Notary Public