CONSTRUCTION PERMIT
APPLICATION

THIS APPLICATION IS FOR INFORMATION ONLY
YOU MUST OBTAIN ORIGINAL FORM
FROM THE BUILDING DEPARTMENT'S OFFICE

I. IDENTIFICATION 1. Proposed Work Site at: ______________________________________________________________

2. Name of Owner in Fee: ________________________________________________________ Tel. (____)______________________ Address: ____________________________________________________________________________ ____________________________________________________________________________________

3. Ownership in Fee: Public_________________Private_________________

4. Principal Contractor : _________________________________________________________ Tel. (____)______________________ Address: ____________________________________________________________________________ ____________________________________________________________________________________ License No. OR, if new home, Builder Reg. No. ______________________ Exp. Date __________________ Federal Employee No. _____________________________________ Fax (____)_____________________

5. Architect or Engineer : _________________________________________________________ Tel. (____)______________________ Address: ____________________________________________________________________________ ____________________________________________________________________________________

6. Responsible Person in Charge of Work _____________________________________________ Tel. (____)______________________ Fax (____)______________________

II. PROPOSED WORK	Est. Cost	Plans Rec'd by	Date Rec'd	Rejection Date	Approval Date	Reviewer	Resubmission Dates		Reviewer
1. __ Minor Work							App.	Rej.
2. __ New Building
3. __ Addition
4. __ Alteration
5. __ Fire Protection
6. __ Plumbing
7. __ Electrical
8. __ Elevator Devices
9. __ Asbestos Abat. Subch. 8
10. __ Lead Hazard Abatement
11. __ Demolition
TOTAL COSTS

III. DO YOU WANT: (optional) 1. ____ Partial Releases 2. ____ Prototype Processing

IV. DOES OR WILL YOUR BUILDING CONTAIN ANY OF THE FOLLOWING? 1. ____ Elevators/Escalators/Lifts/Dumbwaiters/Moving Walks 2. ____ High Pressure Boilers 3. ____ Pressure Vessels 4. ____ Refrigeration Systems 5. ____ Cross-Connections/Backflow Preventors 6. ____ Hazardous Uses/Places of Assembly 7. ____ Sprinklers 8. ____ Smoke Control Systems in Open Walls 9. ____ Underground Storage Tanks

V. FEE SUMMARY (for office use only)     Update Update 1. Building $ __________ __________ __________ 2. Electrical __________ __________ __________ 3. Plumbing __________ __________ __________ 4. Fire Protection __________ __________ __________ 5. Elevator Devices __________ __________ __________ 6. Subtotal $ __________ __________ __________ 7. Less 20% for State Plan Review __________ __________ __________ 8. Subtotal $ __________ __________ __________ 9. DCA Training Fee __________ __________ __________ 10. Subtotal $ __________ __________ __________ 11. Cert. of Occupancy __________ __________ __________ 12. Other __________ __________ __________ 13. TOTAL $ __________ __________ __________

VI. BUILDING/SITE CHARACTERISTICS (office use only) 1. Number of Stories __________ __________ 2. Height of Structure __________ ft. __________ 3. Area-Largest Floor __________ sq. ft. __________ 4. New Building Area __________ sq. ft. __________ 5. Volume of New Structure __________ cu. ft. __________ 6. Construction Classification __________ __________ 7. Total Land Area Disturbed __________ sq. ft. __________ 8. Flood Hazard Zone __________ __________ 9. Base Flood Elevation __________ ft. __________ 10. Wetlands yes __________ sq. ft. __________   no __________ __________ 11. Max. Live Load __________ __________ 12. Max. Occupancy Load __________ __________

VII. DESCRIPTION OF BUILDING USE A. RESIDENTIAL 1. ____ Hotels (R-1)   2. ____ Multi-Family (R-2)   3. ____ Two-Family (R-3) BOCA   4. ____ Two-Family (R-4) CABO   5. ____ One-Family (R-3) BOCA   6. ____ One-Family (R-4) CABO   No of dwelling units:     Before Construction ____     After Construction ____     Net Gain or loss ____ B. NON-RESIDENTIAL   1. State Specific Use: 2. Use Group: 3. Change in Use Group, Indicate Former:

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