Construction Building Applications Form

Construction Building Application and Agreement

Applicant and Project Identification

Applicant Type: Owner Contractor Agent Other

Parcel / Lot Number:    Zoning Designation:

Proposed Use:    Construction Type:

Stories:    Gross Floor Area (sq ft):    Estimated Construction Value: $

Permit Types and Attachments

Permits Requested: Building Electrical Plumbing Mechanical Demolition Grading Other  Specify:

Plans/Reports Submitted: Architectural Structural Electrical Plumbing Mechanical

Design and Contractor Information

License Number:    Phone:    Email:

Insurance Carrier:    Policy No.:    Workers' Comp: Covered

WHEREAS Recitals

WHEREAS, Applicant hereby requests permits and approval to perform the construction work described herein at the Project Address identified above in accordance with applicable building, fire and zoning codes; and

WHEREAS, Contractor represents that it is duly licensed, insured and qualified to perform the Scope of Work, and agrees to perform work in compliance with all codes, standards and permit conditions; and

WHEREAS, the parties intend by this Application and Agreement to set forth the terms under which permits will be sought, fees paid, work performed and inspections accepted.

Scope of Work

Payment Terms

Permit / Contract Amount: $

Late Payment: If payments are not made when due, late charges shall accrue at the greater of $ or % per month on the unpaid balance until paid in full. Applicant and Contractor acknowledge these terms and accept responsibility for timely payments.

Term and Termination

Term Commencement Date: .    Anticipated Completion Date: .

Either party may terminate this Agreement for material breach if the other party fails to cure such breach within days after written notice. Termination shall not relieve either party of obligations accrued prior to termination.

Certifications, Inspections and Compliance

Applicant certifies that all information in this application is true and accurate to the best of Applicant's knowledge and that work will be performed in compliance with applicable building codes, permit conditions, and inspection requirements. Contractor certifies licensure and insurance as indicated above and agrees to maintain coverage for the duration of work.

Inspections requested pursuant to issued permits must be scheduled per local procedure. Any deviation from approved plans requires prior written approval from the Authority having jurisdiction. Failure to comply may result in stop-work orders, revocation of permits, or civil penalties.

Confidentiality

To the extent permitted by law, proprietary project information and documents marked confidential that are exchanged between the parties shall be held in confidence and used solely for the purposes of obtaining permits and performing the work. Confidential information shall not include information that is publicly available or required to be disclosed by law or governmental process.

Governing Law

This Application and Agreement shall be governed by and construed in accordance with the laws of the jurisdiction in which the Project is located. The parties submit to the exclusive jurisdiction of the courts within that jurisdiction for resolution of disputes. Governing Jurisdiction:

Entire Agreement

This document, together with approved plans, permit conditions and any written amendments executed by the parties, constitutes the entire agreement between Applicant and Contractor with respect to the subject matter and supersedes all prior negotiations, representations and agreements, whether written or oral.

Indemnity and Insurance (Summary)

Contractor shall indemnify and hold harmless Applicant and the Authority having jurisdiction from and against claims, damages, losses and expenses arising out of Contractor's performance of the work, except to the extent caused by Applicant's negligence. Contractor shall maintain insurance coverages as required by law and by permit conditions and shall provide proof of insurance upon request.

Applicant Certification

By signing below, Applicant and Contractor certify that they have read and understand the foregoing terms, that the information provided in this application is complete and correct, and that they agree to perform and accept work under the terms set forth herein, including compliance with building codes, permit conditions and inspection requirements.

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