Commercial Building Permit Application Form

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City of Lancaster, PA.
120 North Duke Street P.O. Box 1599 Lancaster, PA 17608
8:30 AM - 5:00 PM Permits and scheduling - 717-291-4724
Commercial Building Permit Application
APPLICANT/CONTACT PERSON: ________________________________________________________
COMPANY COMPLETING APPLICATION: ________________________________________________
Address (include zip code):___________________________________________________________________
_________________________________________________________________________________________
Telephone Numbers:
Home/Office # _________________
Cell# ____________
Fax: ____________
E-Mail Address: __________________________________________________________________________
PROJECT LOCATION/STREET ADDRESS: _________________________________________________
(Must include Apartment/units or Suite Numbers if applicable)
Is Property Condemned:
YES
NO
Is this property located within a floodplain area?
YES
NO
A local Regulatory Floodplain Elevation Certificate is required for any project located within a floodplain area.
Are windows, doors or exterior materials being updated for this property?
YES
NO
Do Zoning Hearing Board/Planning Commission stipulations apply to this project/property?
YES
NO
DESIGN PROFESSIONAL IN RESPONSIBLE CHARGE: ______________________________________
The design professional is required to submit a statement of special inspection requirements with the plan submittal.
PROPERTY OWNER: ________________________________________________
SAME AS ABOVE
Address: ________________________________________________________________________________
Telephone Numbers:
Home/Office # ________________
Cell# _____________
Fax: ______________
General Contractor Information: Name: ___________________________________
SAME AS ABOVE
Contractor address (include zip code): __________________________________________________________
Telephone Numbers:
Home/Office # _________________
Cell# ____________
Fax: ____________
Home Improvement Contractor’s Registration Number if applicable: _________________________
Workers’ Compensation Insurance:
YES
NO If no, contractor must provide a notarized exemption form.
Contractor must provide a Certificate of Insurance listing the City of Lancaster as the certificate holder.
TYPE OF WORK OR IMPROVEMENT: (Check all that apply)
New Building
Addition
Alteration
Foundation Only
Plumbing
Mechanical
Change of Use
Electrical
Sign
Demolition
Cert. of Occupancy
Other
SCOPE OF WORK: _______________________________________________________________________
_________________________________________________________________________________________
COST OF CONSTRUCTION (To include Time & Materials): $ ____________________________________
CONSTRUCTION TYPE: (IBC Chapter 6) ___________________
DESCRIPTION OF BUILDING USE: (Check One)
Specific Use: ______________________________
Use Group: ________________________________
Business Name: ____________________________
Change in Use:
Yes
No If yes, indicate former use: ____________________
Maximum Occupancy Load: __________________
DOES OR WILL YOUR BUILDING CONTAIN ANY OF THE FOLLOWING:
Fire Alarm System:
Yes
No
Automatic Sprinkler System:
Yes
No
Note: Plumbing water usage calculations are required to be submitted showing current demand and new
demand flows.
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