Residential Application

Bill To:

County:

Municipality:

If your Municipality is not listed please include it in the site directions

Applicant Name:

Owner Name:

Site Address:

PLEASE BE SURE TO ADD THE CITY

Owner Mailing Address:

PLEASE BE SURE TO ADD THE CITY AND STATE

Owner Phone:

Owner Fax:

Owner Cell:

Email:

Contractor Name:

Contractor Address:

Contractor Phone:

Contractor Fax:

Contractor Cell:

Contractor Email:

Type of Home:

Type of Project:

New Manufactured Homes Require HUD-309 inspections

Other Explain:

Property Tax Map/Control #:

Existing Foundation:

New Foundation:

Total Square Feet of Project:

Estimated Construction Cost:

Street or Driveway Cut of Occupancy(if Obtained give(Municipal, County, or PennDot):

Other

Sewer Connection #

Other

Conservation District - More than 5000 sq.ft. of Land Disturbance#:

Other

Floodplain(Local or DEP) #:

Other

County or Local Zoning #: (YOU MUST SEE YOUR MUNICIPALITY FOR THIS)

Other

Land use or Assessment #:

Other

Planning Commision #:

Other

Check if there are any lot lines or other structures within 30 Feet:

Describe Proposed project/work:

Directions To Site:

Drawings are required prior to the issuance of the permit. Professional drawings complete with a PA Licensed Architect or Engineer seal are only required when the project scope extends beyond the International Residential Code. Depending on the nature of the project, the following table describes what must be included in the drawings.

Type of Drawing Items to be Included in Drawing

Site Plan-	Structure location on property and distance to other buildings, lot lines, utilities, steep banks, roads, right of ways, etc.
Foundation-	Type and size of all footing, walls, slab, drainage, etc. Note: Frost level is 42” to the top of the footing.
Floor Plan-	(All Levels) Must include all levels – Finished or Unfinished. Include bedrooms, kitchen, bathrooms, windows, doors, decks, etc.
Framing-	Size, length, and spacing of studs, joist, rafters, sheeting, beams, and headers of all levels. Note: All framing lumber must be graded except for projects that do not require a UCC permit. Floor, wall, and roof sheeting does not have to be graded.
Electrical-	Include every circuit location with receptacles, lighting, smoke detectors, and service, and wire sizes and types. Indicate Ground Fault Circuit Interrupters and ARC-Fault.
Plumbing-	Include the location of all fixtures, drain, supply, and vent pipe size, type, and length.
Mechanical-	Include location and type of water heaters, heating, and cooling systems, and ventilation.
Energy-	Include type of insulation and R-value for ceiling, all walls including basement and slab, if needed.

Attach Plans for project:

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Additional Plans:

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Additional Plans:

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By Checking the Box Below I Certify I am the owner or authorized agent of the project for which this application is filed and I Certify that: 1. All information provided on this application is correct and true to the best of my knowledge. 2. The structure will not be used or Occupied until the required Certificate of Occupancy has been issued. 3. This Project will constructed in accordance with the Approved plans and the Uniform Construction Code standards as specified in 34 PA Code Chapter 401-405. 4. 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.