Zoning Permit Application - Department Of Planning And Zoning Form

Department of Planning and Zoning

149 Church Street, City Hall

Burlington, VT 05401-8415

Phone: (802) 865-7188

Fax: (802) 865-7195

Zoning Permit Application

Use this form for ALL zoning permit applications. See the relevant checklist for specific requirements.

PROJECT LOCATION ADDRESS: ____________________________________________________

PROPERTY

OWNER*:________________________________

APPLICANT:_____________________________

*If condominium unit, written approval from the Association is also required

POSTAL ADDRESS: _______________________ POSTAL ADDRESS: _______________________

CITY, ST, ZIP: ____________________________

DAY PHONE: _____________________________ DAY PHONE: ____________________________

EMAIL: __________________________________ EMAIL: __________________________________

SIGNATURE: _____________________________

SIGNATURE: ____________________________

I am the owner. In addition, I duly authorize the applicant (if noted) to act on

my behalf for all matters pertaining to this zoning permit application.

Description of Proposed Project:______________________________________________________

__________________________________________________________________________________



Existing Use of Property:

Single Family

Multi Family: #___ Units

Other:_____________



Proposed Use of Property:

Single Family

Multi Family: #___ Units

Other:_____________

• Does your project involve new construction, addition, alteration, renovation, or repair to a



structure that is heated or cooled?

Yes

(If yes, the Vermont Residential Building Energy Standards (VRBES) apply. Visit the P&Z Office, Public Service Board or PSB website for details)



• Will 400 sq ft or more of land be disturbed, exposed and/or developed?

Yes

(If yes, you will need to submit the ‘Erosion Prevention and Sediment Control Plan’ questionnaire, with a site plan)



• For Single Family & Duplex, will total impervious area be 2500 sq ft or more? Yes

(If yes, you will need to submit the ‘Stormwater Management Plan’ questionnaire, with a site plan)



• Are you proposing any work within or above the public right of way?

Yes

(If yes, you will need to receive prior approval from the Department of Public Works)

Estimated Construction Cost (value)*: $________________

(*Estimated cost a typical contractor would charge for all materials and labor, regardless of who physically completes the work)

Within 30 days of submission, the permit application will be reviewed for completeness, and, if complete, will be processed

administratively or referred to a board for review.

All permit approvals or denials are subject to an appeal period (15 days for

administrative permit; 30 days for board permit). A building (and/or electrical, mechanical, plumbing, curb cut) permit will also be required.

Contact the Department of Public Works at 802-863-9094 to inquire. Please ask for assistance if you have any questions about filling out

this form. Call the Planning and Zoning at 802-865-7188, or visit the office in the lower level of City Hall, 149 Church Street.

Office Use Only: Zone: _______ Eligible for Design Review? _______

Age of House _______

Lot Size _________

Type: SN___ AW___ FC___ BA___ COA 1___ COA 2___ COA 3___ CU___ MA___ VR___ HO___ SP___ DT___ MP___

Check No. _______________

Amount Paid _______________

Zoning Permit # ________________________

April 2014

Zoning Permit Application - Department Of Planning And Zoning Form - 2014

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