Form Ucc-3 - Application For Ucc Building Permit (Page 3 of 3) in pdf

If you are installing any of the items listed below but are not submitting shop drawings for

them at the time that you are submitting this application, check the appropriate box(es)

Deferred

below. See Section Q on the “Plan Review and Inspection” page on the UCC website for

Submissions

information about submitting these drawings at a later date.

Fire Alarm System

Wood Roof Trusses (Certified)

Sprinkler System



Fees:

List total sq. ft. of floor area:

List estimated construction cost:

If new building or addition:

pay $100.00 base fee $

Plus, pay $.20 multiplied by total sq. ft. of floor area $

If new structure or facility (other than building):

pay $300.00 $

If alteration or renovation of existing building:

pay $100.00 base fee

Plus, pay $20.00 per each $1000 of est. construction cost $

If accessibility only review:

pay $200.00 $

If phased approval:

pay $300.00 $

If revision of approved plans or partial occupancy request:

pay $300.00 $

TOTAL FEES OWED $

Make check or money order payable to Commonwealth of Pennsylvania.

Applicant’s Certification:

Note: THE BUILDING PERMIT AND THE CERTIFICATE OF OCCUPANCY FOR THIS BUILDING OR

STRUCTURE WILL BE ISSUED TO AND IN THE NAME OF THE PERSON LISTED BELOW.

As the owner or the authorized agent of the project for which this application is filed, I certify that:

1. The estimated construction cost and all other information provided as part of this application for a

building permit is correct.

2. The building or structure described in this application will not be occupied until all known code

violations are corrected and a Certificate of Occupancy has been received from the Department of

Labor & Industry.

3. This project will be constructed in accordance with the approved drawings and specifications (including

any required non-design changes) and the Uniform Construction Code standards as specified in 34 PA

Code Chapters 401-405.

4. Any changes to the approved documents will be filed with the Department of Labor & Industry.

5. If the licensed architect or engineer in responsible charge of this construction should change, written

notice of the change will be provided to the Department of Labor & Industry.

6. When required, up to 20% of the total cost of any work performed on an area of primary function in

an existing building will be expended to provide an accessible route to the area of primary function.

7. No error or omission in either the drawings and specifications or application, whether approved or not,

shall permit or relieve me from constructing the work in any manner other than provided for in 34 PA

Code Chapters 401-405.

Applicant Name

Street Address

City

State

Zip Code

Phone (

)

Applicant Signature

Date

Department of Labor & Industry | Bureau of Occupational & Industrial Safety | Building Plan Review Division

Auxiliary aids and services are available upon request to individuals with disabilities.

UCC-3 REV 04-16 (Page 3)

Equal Opportunity Employer/Program

Form Ucc-3 - Application For Ucc Building Permit Page 3

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