Building & Zoning Permit Application
Application Valid for 180 days
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Yes
Is this for a Residential of Commercial Project?
Residential
Commercial
Property Address
*
Street Address
Tax # (if known)
City
State
Zip Code
Tax Map # (if known)
Street Address
7 Digit Tax ID/Parcel Number
City
State
Zip Code
Work Location or Business Name (if applicable)
Street Address
Project location
City
State
Zip Code
Applicant Information
Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Email:
*
example@example.com
Relationship to Property Owner
Owner
*Contractor
Owner's Agent or Designated Employee
*Registered Design Professional
*Contractor (or RDP) DPOR License #:
*If Property Owner is an LLC or Corporation,please provide a Member or Corporate Officer Name and Address
Member/Officer Name
First Name
Last Name
Member/Officer Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Primary Contact Information (If different from Applicant)
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Mechanic's Lien Agent (If Applicable)
Lien Agent's Name
Lien Agent's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Building Code Data
(if known - see the 2021 VCC, Chapter 3)
Number of Stories
Type of Construction (Group & #)
Please Select
A-1
B-1
B-2
A-2
A-3
B-3
A-5
B-5
I-5
*Other: (specify below)
*Other Group & #
Building Square Footage
Existing Use
Proposed Use
Use of Property
Total Cost of Construction
*
(Include cost of all labor and material for entire project)
General Description of Proposed Project or Work
*
*Please submit any relevant documentation or construction plans
Please Read Carefully
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Would you like to add Contractors on the "Subcontractor Listing" form?
No
Yes
Subcontractor #1
Subcontractor #2
Subcontractor #3
Do you need to add more Subcontractors?
No, I'm done
Yes
Subcontractor #4
Subcontractor #5
Would you like to continue to the "Owner/Builder Affidavit for Exemption from Contractor's License" questionnaire?
No, I'm done
Yes
Code of Virginia - § 54.1-1103. Necessity for license
A. No person shall engage in, or offer to engage in, contracting work in the Commonwealth unless he has been licensed under the provisions of this chapter.
Please check how you qualify for an exemption from a contractor’s license under § 54.1-1101 or § 55.1-1220:
I certify that I am…
1) Any person who performs or supervises the construction,removal, repair, or improvement of no more than one primary residence owned by him and for his own use during any 24-month period
2) Any person who performs or supervises the construction,removal, repair, or improvement of a house upon his own real property as a bona fide gift to a member of his immediate family provided such member lives in the house. For purposes of this section, "immediate family" includes one's mother, father, son, daughter,brother, sister, grandchild, grandparent, mother-in-law, and father-in-law
3) Any person who performs or supervises the repair or improvement of industrial or manufacturing facilities, or a commercial or retail building, for his own use
4) Any person who performs or supervises the repair or improvement of residential dwelling units owned by him that are subject to the Virginia Residential Landlord and Tenant Act (§ 55.1-1200 et seq.)
5) The landlord and tenant may agree in writing that the tenant perform the landlord's duties specified in subdivisions A 3, 6, and 7 and also specified repairs, maintenance tasks, alterations, and remodeling, but only if the transaction is entered into in good faith and not for the purpose of evading the obligations of the landlord and if the agreement does not diminish or affect the obligation of the landlord to other tenants in the premises.
6) Other qualifying exemption: (please specify)
Other Qualifying Exemption
Code of Virginia, §54.1-1111. Prerequisites to obtaining business license; building, etc., permit.
A. Any person applying to the building official…, charged with the duty of issuing building or other permits for the construction of any building, highway, sewer, or structure, or any removal,grading or improvement shall furnish prior to the issuance of the permit… (ii) file a written statement that he is not subject to licensure or certification as a contractor or subcontractor pursuant to this chapter….
By signing this document, I understand that any false statements are in violation of the Code of Virginia,§ 54.1-1111, and may result in denial of permit, fines, or other penalties deemed appropriate by the Building Official and the City of Roanoke. By signing below, I affirm that I am the individual identified in this form, and I understand that my electronic signature has the same legal effect as a handwritten signature.
Signature
Signature
Signature only required if signing the Owner Builder Section
An “Asbestos Survey” or "Asbestos Affidavit" may be required for buildings built prior to January 1, 1985.
Check here to confirm:
*
I have read the Asbestos Statement
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