Residential Building Permit

RESIDENTIAL BUILDING PERMIT APPLICATION

Permit Identification

Permit Number:    Date Received:

Property Identification

Applicant / Owner

Contractor / Permit Holder

Project Description & Scope of Work

New Construction    Addition    Alteration/Renovation    Repair    Demolition

Schedule & Timeline

Proposed Start Date:    Estimated Completion Date:

Required Attachments (Check submitted items)

Site Plan    Building Plans (3 sets)    Structural Calculations
Energy Compliance Documentation    Soils/Geotech Report    Proof of Insurance / Workers' Compensation
Other Attachments (describe below)

Disclosures and Environmental / Historic Considerations

Is the structure subject to known lead-based paint hazards?   Yes   No

Is asbestos suspected or known on site?   Yes   No

Property located in designated floodplain or special hazard area?   Yes   No

Property listed or located within a historic district?   Yes   No

Inspections & Code Compliance

The permit holder acknowledges that work authorized by this permit is subject to inspection and shall not proceed beyond inspection points without approval. Requests for inspections must be scheduled in accordance with issuing authority procedures. Failure to obtain required inspections or to correct cited violations shall constitute grounds for stop-work orders and permit revocation.

Conditions, Indemnity & Revocation

By submitting this application, the applicant certifies that all information is true and accurate to the best of their knowledge. The applicant agrees to comply with all applicable building, fire, electrical, plumbing, mechanical, energy, and zoning codes and standards. The issuance of this permit does not authorize any work that violates covenants, easements, deed restrictions, or other private agreements.

The issuing authority may suspend or revoke this permit for false statements, noncompliance with permit conditions, failure to correct violations, or failure to obtain required inspections. The permittee shall indemnify and hold the issuing authority harmless from claims arising out of permitted work, except to the extent caused by the authority's own negligence.

Acknowledgement and Applicant Certification

I, Applicant Name: , hereby apply for this permit and certify under penalty of law that the information contained herein and on all attached documents is complete and accurate. I understand that work performed prior to permit issuance is subject to enforcement action and that final approval requires all inspections and any required final documents to be submitted and accepted.

Applicant Mailing Address:

For Office Use Only

Permit Issued:    Issue Date:

Conditions of Approval / Notes:

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