Construction Permit Application Page 3
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FLOODPLAIN
Is the site located within an identified flood hazard area?
YES
NO
any portion of the flood hazard area be developed?
YES
NO
Will
Owner/Agent shall verify that any proposed construction and/or development activity complies with the requirements of the
National Flood Insurance Program and the Pennsylvania Flood Plain Management Act (Act 166-1978), specifically Section 60.3
Lowest Floor Level:____________________________
_____________________________________________________________________________________________________________
HISTORIC DISTRICT:
Is the site located within a Historic District?
YES
NO
If construction is proposed within a Historic District, a certificate of appropriateness may be required by the Municipality.
The applicant certifies that all information on this application is correct and the work will be completed in accordance with the approved construction documents and PA Act 45
(Uniform Construction Code) and any additional approved building code requirements adopted by the Municipality. The property owner and applicant assumes the
responsibility of locating all property lines, setback lines, easements, right-of way, flood areas, etc. Issuance of a permit and approval of construction documents shall not be
construed as authority to violate, cancel or set aside any provisions of the codes or ordinances of the Municipality or any other governing body. The applicant certifies he/she
understands all the applicable codes, ordinances and regulations.
Application for a permit shall be made by the owner or lessee of the building or structure, or agent of either, or by the registered design professional employed in connection
with the proposed work.
Certificate of Occupancy.
§ 403.46(a) A building, structure or facility may not be used or occupied without a certificate of occupancy issued by a building code official.
§403.46(d) A building code official may suspend or revoke a certificate of occupancy when the certificate was issued in error, on the basis of incorrect information supplied by
the permit applicant or in violation of the Uniform Construction Code. Before a certificate of occupancy is revoked, a building owner may request a hearing before the board of
appeals under § 403.122 (relating to appeals, variances and extensions of time).
I certify that the code administrator or the code administrator’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.
__________________________________________
_______________________________________
Signature of Owner or Authorized Agent
Print Name of Owner or Authorized Agent
______________________________________________________
____________________________
Address
Date
Directions to Site:
(FOR ADMINISTRATIVE USE ONLY)
ADDITIONAL PERMITS/APPROVALS REQUIRED
STREET CUT/DRIVEWAY
APPROVED
By:
Date:
YES
NO
CUT AND FILL
APPROVED
By:
Date:
YES
NO
PENNDOT HIGHWAY OCCUPANCY
APPROVED
By:
Date:
YES
NO
DEP FLOODWAY OR FLOODPLAIN
APPROVED
By:
Date:
YES
NO
SEWER CONNECTION
APPROVED
By:
Date:
YES
NO
ON-LOT SEPTIC
APPROVED
By:
Date:
YES
NO
ZONING
APPROVED
By:
Date:
YES
NO
HARB
APPROVED
By:
Date:
YES
NO
OTHER:
APPROVED
By:
Date:
YES
NO
OTHER:
APPROVED
By:
Date:
YES
NO
APPROVALS
BUILDING PERMIT DENIED:
Date:______________________
Date Returned:_________________
BUILDING PERMIT APPROVED: Date:______________________
CODE ADMINISTRATOR:__________________________________________________________________
BUILDING PERMIT FEE
$_____________
ACCESSIBILITY PERMIT FEE $____________________
ELECTRICAL PERMIT FEE $______________
ENERGY PERMIT FEE
$____________________
PLUMBING PERMIT FEE
$_______________
ADMINISTRATIVE FEES
$____________________
MECHANICAL PERMIT FEE $_______________
STATE FEES
$________________
TOTAL SQ. FT. USED FOR FEE____________________ TOTAL OF ALL FEES $______
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