TCPA Building Permit Application Form

TOWNSHIP COOPERATIVE PLANNING ASSOCIATION -- BUILDING PERMIT APPLICATION

TCPA
4111 11th Avenue SW Room 10
Rochester, MN 55902
Phone: (507) 529-0774
Fax: (507) 281-6821

Building Permit Application No.

Township      Job Site Location

Address

PROPERTY OWNER    City    State    Zipcode

Address    Home Phone

City    State    Zipcode    Work Phone

PROPERTY LEGAL DESCRIPTION:

TOWNSHIP SECTION #

Proposed Use:
Dwelling   Private Garage   Deck   Dwelling Addition   Pole Building
Finish Basement   Gas Line   Three Seasons Porch   Business Commercial   Fireplace   Siding
Furnace   Water Heater   Re-Roofing   Other

Description of Project

Dimensions    Use and occupancy

Type of Construction    Estimated Value    Lot Size/Dimensions

*General Contractor
Address

*License #
Phone #
Septic Installer

*Plumbing Contractor
*License #
Mechanical Contractor
Phone #
Electrician
Well Driller

Floodplain Management District: Yes No      Shoreland Management District: Yes No

You must attach two (2) copies of building plans and a free-hand sketch showing land dimensions, building locations and distances in relation to other buildings, lot lines, roads, road right-of-ways, septic & well locations plus neighboring septics & wells if located in a subdivision or on a small acreage in a developed area. Set-backs apply. Designate North. Variance & Conditional Use permits may also be needed. If this activity is located in a shoreland management district, you must also show distance to the ordinary high water level and certify your existing septic system. Wells must meet required distance from septic systems. A building permit will not be issued for any construction until approval is received from TCPA. A penalty may, and will be assessed up to the amount of the building permit fee, if activity is started prior to obtaining a building permit. Additions to the application or re-inspections may be billed separately when they become applicable and must be paid prior to the inspection(s). If you have any questions, please call TCPA at (507) 529-0774.

This permit becomes null and void if work or construction authorized is not commenced within 180 days, or if construction or work is suspended or abandoned for a period of 180 days at any time after work has commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Refund and Cancellation Policy: upon request of cancellation of building permits, charges or refunds will be based on expenses for office time, inspections, and zoning fees that were completed prior to the cancellation notice.

*Notes required information for all permits.

IF THIS APPLICATION IS INCOMPLETE, IT WILL BE RETURNED TO THE APPLICANT!

APPLICANT MAY BE BILLED FOR INSPECTIONS PREMATURELY REQUESTED (WORK NOT READY FOR INSPECTION)

TO BE COMPLETED BY TCPA

Received By    Date Received

Building Permit: $    Plan Review: $    State Surcharge: $

Plumbing Permit: $    Plan Review: $    State Surcharge: $

Mechanical Permit: $    Plan Review: $    State Surcharge: $

Other: $    Sub Totals: $    Total Due: $

Permit Approved by    Date

Finished Value (not cost) $