Form Ucc-3 - Application For Ucc Building Permit
ADVERTISEMENT
1
2
3File No.:
Permit No.:
DEPARTMENT OF LABOR & INDUSTRY
BUREAU OF OCCUPATIONAL & INDUSTRIAL SAFETY
Date:
APPLICATION FOR UCC BUILDING PERMIT
Facility Name (name of company, mall, institution, university, etc.):
Site
Information
Building and/or Tenant Name
Political
Street Number and Name
Subdivision and
County names are
City
State
Zip Code
required.
Political Subdivision:
County:
Accessibility Only Review
Addition
Application
Alteration or Renovation
New Building
Type
New Structure/Facility
Partial Occupancy
Phased Approval
Plan Revision/Deferred Submission
Uncertified (Existing) Building
A-1
A-2
A-3
A-4
A-5
B
E
Use/Occupancy
F-1
F-2
H-1
H-2
H-3
H-4
H-5
Classification:
I-1
I-2
I-3
I-4
M
R-1
R-2
Check box to left of
R-3 Adult Care
R-3
R-4
S-1
S-2
U
applicable group.
Check all that apply.
Single Family Dwelling/Townhouse (must be state-owned)
Check each block below indicating that all of the following will be submitted with this application:
Mandatory
Four (4) site plans
Three (3) assembled and bound sets of construction drawings
Documents
One (1) completed copy of the UCC-2 UCC PLAN REVIEW CHECKLIST
One (1) set of specifications (only if Addition, Alteration, New Building/Structure/Facility)
Yes No If ”Yes,” submit 1 copy of the letter described in
Does this construction involve
modular units built in a factory?
Section J., 6., on the “Plan Review and Inspection
Special
Requirements” page on the UCC website.
Requirements
&
Yes No If “Yes,” submit 1 copy of the approval letter
Is this construction regulated by
Documentation
the Health Care Facilities Act?
issued by the PA Department of Health.
Yes No If “Yes,” submit 1 copy of a letter indicating that
Is this construction exempt from
energy code requirements?
the building or structure will use neither electricity
nor fossil fuels, and thus is exempt per ASHRAE
90.1, §2.3(B).
If “No,” submit 1 copy of the compliance
documentation described in Section H., 7., on the
“Plan Review and Inspection Requirements” page
on the UCC website.
Yes No If “Yes,” submit 1 copy of one of the flood hazard
Is project in flood hazard area?
certifications mandated in section 1612.5 of the
International Building Code.
Yes No If “Yes,” submit 1 copy of the UCC-6 SPECIAL
Are International Building Code
(Chapter 17) special inspections or
INSPECTIONS OBSERVATIONS STATEMENT.
structural observations required?
Yes No If “Yes,” submit a signed statement indicating
Will an alternative construction
method or material be used on
that the proposed method or material meets the
this project?
requirements of 34 PA Code §403.44.
Yes No If “Yes,” submit the statement described in
Is this application for “phased
approval”?
Section D., 4., on the “Plan Review and Inspection
Requirements” page on the UCC website.
For L&I Use Only Check #:
Amount:
Bates #:
UCC-3 REV 04-16 (Page 1)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal