City of Madison Building Department
100 Hughes Road
Madison, Alabama 35758
Phone: 256-772-5644/Fax: 866-591-8740
BUILDING PERMIT APPLICATION
Date: Valuation of Work $
Location of Work or Construction
Building Construction Address: Lot#: Block: S/D:
Property Owner Information
Owner Name: Telephone #:
Current Owner Address:
Contractor Information
□ Owner/Builder (For residential construction, owner must occupy house for no less than 1 year)
City of Madison License # :
Contractor Name and DBA:
Business Address: Telephone # :
□ Residential Contractor License # : □ General Contractor License # :
Contractors: Please attach a list of all licensed sub-contractors involved with this project.
Description and Scope of Work
□ New Construction □ Addition □ Alterations □ Repairs □ Moving □ Foundation Only □ Other
□ Commercial □ Single Family Residential □ Multi-Family Residential □ Other:
Brief Description of Work:
Energy Code Compliance (New 1 and 2 family dwellings require verification by 3
rd
party only)
Prescriptive Method Trade off Method (Additional Documentation Required) Total UA Method (Additional Documentation
Required)
Is the property located in a Flood Hazard Area?
If yes, please provide required elevation certificates.
New Heated SF: New Unheated SF: Total Gross SF:
No. of Stories: Building Height: No. of Baths: No. of Bedrooms:
Type of Construction: Primary Occupancy or Use: Secondary or Mixed Uses:
City Water? City Sewer? Electric Utility Name: Type of Heat:
Additional Information
Is the proposed structure a detached garage or other accessory building? Size in SF:
Are there any other existing buildings on this lot? If yes, specify type and size:
Fire Sprinkler System? Hazardous Occupancy? Well Head Protection - Zone I: Zone II:
CONTRACTOR STATEMENT
I certify and acknowledge that I have fully read this application, that all information provided herein is true and correct, and that all work for which
this permit may be issued will be performed and completed as described above and that it shall conform to all City code sections and ordinances; all
applicable state and federal laws; and the plans and specifications herewith submitted. By signing this application, I am further certifying that I will meet all
requirements incumbent upon me as a contractor licensed under the laws of the State of Alabama, to include any exemptions as provided by law, and that I
am authorized by the owner of the subject property to execute this document as his or her agent. I also further attest that I have located by actual excavation
the municipal sewer infrastructure that will serve the building for which this permit is issued and that I have verified that the floor elevation of the building and
the elevation of the servicing sewer are located so as to provide proper slope for connection to the municipal sanitary sewer system. I also hereby agree to
protect all public improvements and public utilities adjacent to or serving the property on which the proposed structure or structures described above are
located, whether or not the said improvements or utilities are the property of the City of Madison. I further agree to make or cause to have made, satisfactory
to the City of Madison, all repairs to public improvements or utilities damaged as a result of actions, misuse, or lack of care on the part of any of my
employees, agents, subcontractors, or suppliers of materials of said public improvements or utilities.
Finally, I acknowledge that approval and issuance of any building permit by the City of Madison, including the one applied for hereby, does not
speak in any way to the compliance of this project with any private covenants, conditions, rules, or requirements which may run with or be applicable to the
subject property. I understand and accept that the City’s issuance of a building permit shall not in any way be deemed to be an active or passive grant of
permission for the owner or any other person, contractor, subcontractor or company, including me as applicant, to violate or otherwise circumvent the
requirements of any applicable covenants or rules established by private associations or entities. I fully acknowledge that determining the existence and/or
applicability of any private covenants of any kind to the subject property IS NOT the responsibility of the City of Madison or its agents or employees.
Date: Signature of Owner or Authorized Agent:
Reviewed: /
Chief Building Official Zoning Administrator
□ Not Approved – See attached plan review comments. □ Not approved – See Zoning Comments on reverse.
PLEASE COMPLETE THE ZONING INFORMATION ON THE BACK OF THIS FORM
PERMIT #
PERMIT AMOUNT
CASH □ CREDIT CARD □ OR CHECK#
click to sign
signature
click to edit
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