APPLICATION FOR NEW CONSTRUCTION

Date Pd:

Receipt #:

Session #:

TYPE PERMIT Electrical (E) Plumbing (P) Is Owner Applicant? Y/N Building (B) Mechanical (M) Other (O) (see item 9)

Apt. Zip. Zoning

Lot No. Parcel Type Industrial (I)

Other (O)

Phone

Zip

License No.

Applicant (not owner) Architect/Engineer

Phone No.

Phone No.

Residential (R) Commercial (C)

First Name Last Name or Business Name

Street Address Parcel No.

Subdivision

4. CERTIFICATION

I hereby certify that I am the owner of record of the named property, or that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application as his/her authorized and I agree to conform to all applicable laws of this jurisdiction. In addition, if a permit for work described in this application is issued, I certify that the code official or the code official'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.

Responsible person in charge of work Title

Signature of Applicant Address

Paving Fire Alarm Masonry Drywall or Lathing Sprinkler Sewer mechanical Roofing Carpentry Electrical Plumbing Concrete

2. OWNER INFORMATION

3. CONTRACTOR INFORMATION

Street Address City, State

Name of Contractor Street Address City, State

General Contractor Excavation

304-636-1414 Ext 1431

APPLICATION FOR NEW CONSTRUCTION

APPLICANT INSTRUCTIONS: For all applications, complete parts 1, 2, 3, 4, & 5 of this form.

If electrical work, also complete Part 6. If plumbing work, also complete Part 7. If mechanical work, also complete part 8. For other permits, also complete Part 9. Site Plan (Part 10) is to be shown on Page 4 or attached hereto. Parts 11-18 (Pages 5 & 6) are for department use only.

APP. DATE

1. PROPERTY INFORMATION CITY OF ELKINS

401 DAVIS AVE ELKINS WV 26241

PHIL ISNER

BLDG INSPECTOR / CODE ENFORCEMENT OFFICER

For Dept. Use Only Request Plan No.

Assignment (Y/N)

PROPOSED USE:

FOUNDATION ONLY (7)

MODERATE HAZARD (9) LOW HAZARD (10)

Structural (check all that apply) Exterior (Check those applicable)

Frame Walls

Steel (1) Concrete (3) Other (5), Identify: Steel (1) Concrete (3) Other (5), Identify:

Masonry (2) Wood (4) Masonry (2) Wood (4)

Street Frontage (feet) Stories (number) Lot Area (sq. ft)

Front Setback (feet) Bedrooms (number) Building Area (sq. ft)

Rear Setback (feet) Full Baths (number) Parking Area (sq. ft)

Left Setback (feet) Partial Baths (number Living Area (sq. ft)

Right Setback (feet) Garages (number) Basement Area (sq. ft)

Height Above Grade (feet) Windows (number) Garage Area (sq. ft)

New Residential Units (number) Fireplaces (number) Office/Sales (sq. ft) Existing Residential Units (number) Enclosed Parking (number) Service (sq. ft) Elevators/Escalators (number) Outside Parking (number) Manufacturing (sq. ft)

Est. Start Date: ___ / ___ / ___ Est. Finish Date: ___ / ___ / ___ Building Est. Value:$ _____________

Utility Service Revisions:

Estimated Start: ____/____/____ Estimated Finish: ____/____/____ Electrical Work Estimated Value: $____________

5. BUILDING PERMIT APPLICATON

6. ELECTRICAL PERMIT APPLICATON

REPAIR/REPLACEMENT (4) DEMOLITION (5)

RELOCATION (6)

CHANGE OF USE ONLY (8)

THEATRE (1) NIGHT CLUB (2) RESTAURANT (3) CHURCH (4)

OTHER ASSEMBLY (5)

IMPROVEMENT TYPE:

NEW CONSTRUCTION (1) ADDITION (2)

ALTERATION (3)

LOW HAZARD (23) ASSEMBLY

BUSINESS (6) EDUCATIONAL (GRADES 1-12 (7) DAY CARE FACILITY (8) FACTORY

PUBLIC UTILITY INSTITUTIONAL

HOTEL, MOTEL (16) MULTI-FAMILY (17) BOCA TWO FAMILY (18) GROUP HOME (12) HOSPITAL (13) JAIL (14) MERCANTILE (15) RESIDENTIAL

OTHER (24) PARKING GARAGE CARPORT MOTOR FUEL SER REPAIR GARAGE

Are any structural assemblies fabricated off-site? ____Yes ____No

HPM

CABO TWO FAMILY (19) BOCA SINGLE FAMILY (20)

HIGH HAZARD (11)

CABO SINGLE FAMILY (21) STORAGE

MODERATE HAZARD (22)

Electrical Work __ Yes __ No

POWER DEVICES

#

1 7

2 8

3 9

4 5

6

Total Number of Motors

Total Service ____AMPS Number of Circuits:____2WIRE ____3WIRE ____4 WIRE Number of Service Outlets:___110V ___220V

Drinking Fountains Floor Drains Water heaters Water Softeners Sewage Ejectors Sump Pumps Grease Traps

Total Fixtures

8. MECHANICAL PERMIT APPLICATION

Public Water (Y/N)

Water Meter Size __________IN Avg. Daily Water Use _________GPD Utility Service Revisions:

Estimated Start: ____/____/____ Estimated Finish: ____/____/____ Plumbing Work Estimated Value: $_______________

Water Service Size __________IN

Public Sewer (Y/N)

Swimming Pools

Standpipes (Y/N) (Number Hose Outlets) Fire Sprinklers (Y/N) (Number of Heads) Lawn Sprinklers (Y/N) (Number of Heads) Bidets

7. PLUMBING PERMIT APPLICATION

Enter the Number of Fixtures Being Installed, Replaced, or Repaired Tubs/Showers

Shower Stalls Lavatories

Back Flow Prevention Water Pumps Roof Openings Toilets

Enter Number of New or Replacement Units Forced Air Furnace

Unit Heater Gas/Oil Conversion

Air Handling Unit Heat Pump Air Cleaner Parking Lot Drains Inside Downspouts Urinals

Sinks Laundry Tubs Dishwashers Garbage Disposals

Space Heater Gravity Furnace Solid Fuel Appliance

Incinerator Boiler Coil Unit Window A/C Unit Split System A/C A/C Compressor

Kitchen Exhaust Hood Hazardous Exhaust System Electric Furnace

Utility Service Revisions:

Type of Heating Fuel: (Check One)

__Gas(1) __Oil (2) __Electric (3) __Coal (4) __Wood (5) __Other (6)

Estimated Start: ____/____/____ Estimated Finish: ____/____/____ Mechanical Work Estimated Value: $_______________

9. OTHER REQUIRED PERMIT APPLICATION(S)

Permit Type:

Description of Work:

Estimated Start: ____/____/____ Estimated Finish: ____/____/____ Estimated Value: $_______________________

Plumbing Work __ Yes __ No

Mechanical Work __ Yes __ No

10. SITE PLAN

Show lot lines, easements, and work layout & dimensions

BASE FLOOD ELEVATION_______________________________

PLANNING COMMISSION APPROVAL REQUIRED___________________________________________________________________________

BOARD OF ZONING APPEALS APPROVAL REQUIRED________________________________________________________________________

Check Plan Review Fee Date Plans

Started By Date Plans

Approved By

$

$

$

$

$

$ TO BE ENTERED ON PART 18 By:

12. FLOODPLAIN EVALUATION

FLOOD MAP NUMBER & DATE___________________________________ LOWEST FLOOR ELEVATION____________________________

11. DATA ENTRY

Application Received: ____/____/________

By:

Application Reviewed: ____/____/________

By:

Data Entry: ____/____/________

FLOOD ZONE__________________________________________________

13. ZONING PLAN EVALUATION

ZONING DISTRICT______________________________________________ MAP NUMBER_______________________________________

LOT AREA (From Page 2) _________________________________________

OFF STREET PARKING SPACES, REQUIRED__________________________

SIGNS: NUMBER________________________________________________

LOADING SPACE______________________________________________________________________________________________________

LOT COVERAGE (%)___________________________________

PROVIDED___________________________________________

SIZE OF EACH SIGN____________________________________

LOT AREA PER ROOM___________________________________________ ENCROACHMENTS____________________________________

14. PLAN REVIEW RECORD

Notes Plans Review Required

BUILDING

TOTAL

15. ADDITOINAL PERMITS REQUIRED PLUMBING

MECHANICAL ELECTRICAL

Permit or Approval Check Date

Obtained Number Permit or Approval Check Date

Obtained Number

BOILER PLUMBING

ELEVATOR SEWER

ELECTRICAL SIGN OR BILLBOARD

CURB OR SIDEWALK CUT

ROOFING

FURNACE STREET GRADES

GRADING USE OF PUBLIC AREAS

OIL BURNER DEMOLITION

Plan Review Fee (From Part 14) Certificate of Occupancy Fee Other Fee TOTAL FEES

Prepared By: Date:

Approved By: Title:

16. PROJECT DOCUMENTS (DRAWINGS & CALCULATIONS)

REVISION DATE DATE

SIGNED AND SEALED SUBMITTED

TYPE DRAWINGS/REPORT

SITE PLAN ___ Yes ___ No ___ Yes ___ No

SOIL REPORT ___ Yes ___ No ___ Yes ___ No

ARCHITECTURAL DRAWINGS ___ Yes ___ No ___ Yes ___ No

STRUCTURAL DRAWINGS ___ Yes ___ No ___ Yes ___ No

MECHANICAL DRAWINGS ___ Yes ___ No ___ Yes ___ No

ELECTRICAL DRAWINGS ___ Yes ___ No ___ Yes ___ No

JOB SPECIFICATINS ___ Yes ___ No ___ Yes ___ No

STRUCTURAL CONNECT.DRWNGS. ___ Yes ___ No ___ Yes ___ No

STRUCTURAL CALCULATIONS ___ Yes ___ No ___ Yes ___ No

SPECIAL INSPECTION DATA ___ Yes ___ No ___ Yes ___ No

17. OTHER DEPARTMENT APPROVALS

SPRINKLER DRAWINGS ___ Yes ___ No ___ Yes ___ No

SPRINKLER CALCULATIONS ___ Yes ___ No ___ Yes ___ No

Electrical Permit

Plumbing permit

18. VALIDATION

Building Permit

Date Number Permit/Insp. Fee

Mechanical Permit

Date Number Permit/Insp. Fee

Signature Date Signature Date

Public Works Water

Fire Health and Sanitation

Environmental Management Building Committee

Zoning Planning Architectural Review