FOR INSPECTIONS CALL:
GENERAL BUILDING PERMIT APPLICATION
PERMIT #
___________________
GENERAL ENGINEERING COMPANY
OFFICE: (608) 745-4070 FAX: (608) 745-5763
EXPIRATION DATE:
Parcel Number:
Property is Located in of age of of
Name:
Municipality Number
____ ____ - ____ ____ ____
PROJECT DESCRIPTION (Submit Building Plans & Site Plan)
Does this project require any
additional approvals or permits? yes no
Building Project Address:
Finished Project Value
$
Zoning Permit No.:
Corner Lot
yes no
Bldg. Height
Ft.
Setbacks:
Front
Rear
Left
Right
Owner’s Name(s)
Mailing Address
Telephone
Email
Contractor Name & Type
Licen. /
Cert #
Exp.
Date
Mailing Address
Telephone & Email
Construction Contractor
Tel.
Email
Dwelling Contractor Qualifier
The Dwelling Contr. Qualifier shall be an owner,
CEO, COB or employee of the Dwelling Contr.
Tel.
Email
HVAC Contractor
Tel.
Email
Electrical Contractor
Tel.
Email
Master Electrician
Tel.
Email
Plumbing Contractor
Tel.
Email
RESIDENTIAL
Single Family/Duplex
Addition: Electrical Plumbing HVAC Construction sq. ft. Erosion Control
Detached Accessory Building: Electrical Plumbing HVAC Construction sq. ft
Remodel: Electrical Plumbing HVAC Construction sq. ft.
Other: Fence Electrical Plumbing HVAC Construction sq. ft. Erosion Control
Electrical Service Upgrade (Amp ) Removal of Structure (Raze)
COMMERCIAL
New Commercial Building: Bldg. Sq. Ft. Electrical Plumbing HVAC Construction Erosion Control
Commercial Addition/Alteration: Electrical Plumbing HVAC Construction Erosion Control
State of Wisconsin Plan Approval Needed: yes no (Approved plans must be submitted with permit application)
Zoning When applicable, owner shall research setback information regarding height, lot coverage, etc. prior to submittal of this application.
I agree to comply with all applicable codes, statutes and ordinances and with the conditions of this permit; understand that the issuance of the permit creates no legal liability, express or implied, on the state or municipality; and
certify that all the above information is accurate. If I am an owner applying for an erosion control or construction permit, I have read the cautionary statement regarding contractor financial responsibility on the reverse side of the last
ply of this application. I expressly grant the building inspector or the inspector’s authorized agent permission to enter the premises for which this permit is sought at all reasonable hours and for any proper purpose to inspect the work
which is being done. It is the Owner/Contractors Responsibility to Call in ALL INSPECTIONS to the Inspector.
APPLICANT’S SIGNATURE ____________________________________________________
DATE SIGNED ___________________
APPROVAL CONDITIONS This permit is issued pursuant to the following conditions. Failure to comply may result in suspension or revocation of this permit or
other penalty. See attached for conditions of approval.
BELOW SECTION FOR OFFICE USE ONLY
FEES:
PERMIT(S) ISSUED
PERMIT ISSUED BY:
Construction
Plumbing
Electrical
HVAC
Zoning
Other ________
Administrative
Total Permit Fee
$ _______________
$ _______________
$ _______________
$ _______________
$ _______________
$ _______________
$_______________
$_______________
Construction
HVAC
Electrical
Plumbing
Erosion Control
Other____________ _________
Name ___________________________________________
Date ____________ Telephone __________________
Cert No. ______________ Census Code______________
www.generalengineering.net VER. 1/3/2018
Building Sq. Ft. Electrical Service (Amp ) Fence Sign Removal of Structure (Raze)
PORTAGE
Cautionary Statement to Owners Obtaining Building Permits
101.65(1r) of the Wisconsin Statutes requires municipalities that enforce the Uniform Dwelling Code to provide an
owner who applies for a building permit with a statement advising the owner that:
If the owner hires a contractor to perform work under the building permit and the contractor is not bonded or
insured as required under s. 101.654(2)(a), the following consequences might occur:
(a) The owner may be held liable for any bodily injury to or death of others or for any damage to the
property of others that arises out of the work performed under the building permit or that is caused by any
negligence by the contractor that occurs in connection with the work performed under the building permit.
(b) The owner may not be able to collect from the contractor damages for any loss sustained by the
owner because of a violation by the contractor of the one and two family dwelling code or an ordinance enacted
under s. 101.654(1)(a), because of any bodily injury to or death of others or damage to the property of others that
arises out of the work performed under the building permit or because of any bodily injury to or death of others
or damage to the property of others that is caused by any negligence by the contractor that occurs in connection
with the work performed under the building permit.
I vouch that I am or will be owner-occupant of this dwelling for which I am applying for an erosion control or construction
permit without a Dwelling Contractor Certification and have read the cautionary statement regarding contractor
responsibility above.
Wetlands Notice to Permit Applicants
You are responsible for complying with State and Federal laws concerning the construction near or on wetlands,
lakes and streams. Wetlands that are not associated with open water can be difficult to identify. Failure to
comply may result in removal or modification of construction that violates the law or other penalties or costs may
incur. For more information, visit the Department of Natural Resources wetlands identification web page or
contact a Department of Natural Resources service center.
Additional Responsibilities for Owners of Projects Disturbing One or More Acre of Soil
I understand that this project is subject to Ch. NR 151 regarding additional erosion control and stormwater
management and will comply with those standards.
Cautionary Statement to Contractors for Projects Involving Building Built Before 1978
If this project is in a dwelling or child-occupied facility built before 1978 and disturbs 6 sq. ft. or more of paint per
room, 20 sq. ft. or more of exterior paint or involves windows, then the requirements of DHS Ch. 163 requiring
Lead-Safe Renovation Training and Certification apply. Call (608) 261-6876 or go to the Wisconsin Department of
Health Services lead homepage for details of how to be in compliance.
Contractor Credential Requirements
All contractors shall possess an appropriate contractor credential issued by the Wisconsin Division of Industry
Services. Contractors are also required to only subcontract with contractors that hold the appropriate contractor
credential.
By signing this document, owner confirms that he/she has read and understands all of the above stated
information.
Owner’s Signature: Date:
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