Application for Plan Review and Building Permit

APPLICATION FOR PLAN REVIEW AND BUILDING PERMIT

Page 1 application fields
LOT #: SUBDIVISION/PARCEL No.: TOWNSHIP:
LOCATED BETWEEN and
ZONING DISTRICT: FLOOD PLAIN ZONE: MAP # DEV. PERMIT No.:
APPLICATION DATE: / /
TYPE OF IMPROVEMENT:
Type of improvement
APPLICATION FOR:
Application for
COMMERCIAL:       MIXED USE:
Mixed use
IF YES; SEPARATED
If yes, separated
Construction type CONSTRUCTION TYPE:
TELEPHONE: MOBILE:
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Page 2 permit detail sections
BUILDING AREA
SQUARE FEET AREA NEW & ADDITIONS ALTERATIONS CHANGE OF USE OCCUPANCY LOADS
BASEMENT
FIRST FLOOR
2, 3, 4 FLOORS, ETC.
TOTAL AREA SQUARE FEET
BUILDING PERMIT
BASEMENT TYPE
# OF BUILDINGS:    # OF UNITS: # OF FULL BATHS:    # OF 1/2 BATHS:
# OF STORIES:    HEIGHT IN FEET:
A/C AND ELEVATOR A/C:      ELEVATOR:
ELECTRICAL PERMIT
ELECTRICAL PERMIT TYPE
/ SET  
FIRE ALARM
FIRE ALARM SYSTEM
FIRE ALARM TYPE
FIRE SUPPRESSION
FIRE SUPPRESSION OPTIONS
TYPE OF SYSTEM:
HVAC PERMIT
Describe Heating System:



  
  
Describe Cooling System:





TYPE:

FIREPLACE TYPE:
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Page 3 certification and applicant statement sections
DEMOLITION PERMIT
STRUCTURE(S) TO BE:




SIGN PERMIT
FEET INCHES:      SIGN FACE AREA: HT X WD = SQ. FT.
IS THERE A COMPREHENSIVE SIGN PLAN FOR THIS SITE?
TYPE:
CHARACTERISTICS:
SWIMMING POOL PERMIT
SWIMMING POOL TYPE:
FEET   X   FEET OR DIA.: FEET
DOES POOL HAVE A DECK/ WALKWAY/ APRON AROUND IT? HOW IS POOL PROTECTED? 5-FT. MINIMUM BARRIER REQUIRED.
CERTIFICATION

Certification summary and applicant acknowledgment section.

ALL PERMITS SHALL EXPIRE ONE YEAR FROM THE DATE OF ISSUE. A ONE TIME RENEWAL SHALL BE PERMITTED IF THE ORIGINAL PERMIT HAS NOT EXPIRED. RENEWED PERMITS SHALL EXPIRE ONE YEAR FROM THE RENEWAL DATE.

I FULLY UNDERSTAND THAT NO EXCAVATION, CONSTRUCTION, OR STRUCTURAL ALTERATION, ELECTRICAL OR MECHANICAL INSTALLATION OR ALTERATION OF ANY BUILDING, STRUCTURE, SIGN, OR PART THEREOF AND NO USE OF THE ABOVE SHALL BE UNDERTAKEN OR PERFORMED UNTIL THE PERMIT APPLIED FOR HEREIN HAS BEEN APPROVED AND ISSUED BY THE FAIRFIELD COUNTY BUILDING DEPARTMENT.

I hereby certify that I am the owner of the named property, or that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application as his/her authorized agent and I agree to conform to all applicable laws of the jurisdiction. In addition, if a permit for work described in this application is issued, I certify that the code official or the code official’s authorized representative shall have the authority to enter areas covered by such permit at any reasonable hour to enforce the provisions of the code(s) applicable to such permit.


I HEREBY ACKNOWLEDGE THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE LISTED INSTRUCTIONS.














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