Building Permit Application - City Of Bessemer Inspection Services Department

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CITY OF BESSEMER

INSPECTION SERVICES DEPARTMENT

BUILDING PERMIT APPLICATION

Application is herby made for a building permit to accomplish the work as herein described. In accordance with duplicate plans and /or specifications

submitted herewith. It is agreed that all corrections in plans and /or specification necessary for compliance shall be observed and requirements of the building

code, the zoning ordinance, and all other pertinent laws and ordinances of the City of Bessemer regulating construction shall be complied with the pursuit of

this work whether or not specified herein.

JOB LOCATION

Address _____________________________________________________ Verified by __________________________________________________

Legal description-lot_________________________________________________Block_____________Survery_______________________________

(if no recorded map, give meters and bounds)

IDENTIFICATION

Owner/Occupant ____________________________ Name of Contractor __________________________________________________________

Address ___________________________________

Address ____________________________________________________________________

City ____________________ State______________

City ____________________________ State______________________________________

Phone _____________________________________ Phone _______________ Is Contractor Licensed? [ ]YES [ ] NO

Licensed Number

State of

Building

City of Bessemer _______________________Alabama__________________Limit ___________

Is Architect or Engineering supervision included [ ] Yes [ ] No

Plans Drawn By: _________________________________________

If yes, by whom ___________________________________________

[ ] Architect

[ ] Engineer

[ ] Designer

Architect [ ]

Engineer [ ]

Name __________________________________________________

Phone____________________________________________________

Address _________________________________________________

State of Alabama Registration No._____________________________

Phone____________________________________________________

State of Alabama Registration No._____________________________

TYPE IMPROVEMENT PERMENT ITS FOR

TYPE CONSTRUCTION

OCCUPANCY (USE)

[ ] New Construction

[ ] Fireproof

RESIDENTIAL

[ ] Addition

[ ] Fire Resistive

[ ] Single Family

[ ] Duplex

[ ] Alterations

[ ] Heavy Timber

[ ] Apartment- No Units______________

[ ] Repair

[ ] Non-Combustible

[ ] Hotel, Motel - No Units___________

[ ] Other (Specify ) ____________________________

[ ] Odinary

[ ] Garge, Carport

[ ] Other (Specify)

NONRESIDENTIAL

[ ] Amusement, Recreation

[ ] Church, other Religion

[ ] Business

[ ] Service Station Repair

[ ] Office, Professional

[ ] School, Library, Educational

[ ] Other (Specify) ____________________________

SELECTED CHARACTERISTICS OF BUILDING

Dimensions

Type of Heat

Number of Stories ____________________________________________

[ ] Gas

Total Sq. Ft. Living Area _______________________________________

[ ] Oil

Total Sq. Ft. of Non-Living Area _________________________________

[ ] Electricty

[ ] Coal

[ ] other

Residential Building Only

Type of Sewage Disposal

[ ] Sanitary Sewer

[ ] Septic Tank

Number of Bedrooms ___________________________________________

Number of Bathrooms __________________________________________

Type of Water Supply

Total Number of Rooms _________________________________________

[ ] Public

[ ] Individual (well,etc)

Plot and Zoning Information

Will there be and air conditioning? [ ] Yes

[ ] No

Plot area (in square feet)

Plot with - Front ___________________ Rear ______________________

Will there be an elevator?

[ ] Yes

[ ] No

Length of Sides 1. _________________ 2. ________________________

Will there be off street parking?

______ No. of spaces to be provided

CERTIFICATION

In hereby certify: That I have read this application and that all information contained herein is true and correct; That I agree to comply with all City

ordinances and state laws regulating installation, building construction. That I am the owner or authorized to act as the owner's agent for the herein

described work: And, thta the total contract or valuation is $ ___________________________________________________________

DATE:_______________________________

SIGNATURE: _______________________________________________________

(By Owner of Authorized Agent)

DO NOT WRITE IN THIS SPACE - OFFICE USE ONLY

Approved By

Job Cost

Permit Fee

Date Permit Issued

Permit Number `