10/28/15
CITY OF HUDSON
505 3
RD
STREET
HUDSON WI 54016-1694
FAX (715)386-3385
www.ci.hudson.wi.us
RESIDENTIAL
BUILDING PERMIT
APPLICATION
DAVID GRAY
BUILDING INSPECTOR
(715)386-4775, ext. 132
dgray@ci.hudson.wi.us
RHETT BORNER
ASST BUILDING INSPECTOR
(715)386-4775, ext. 147
rborner@ci.hudson.wi.us
The city has a combination permit system. A permit will include the building permit, electrical, plumbing, and/or HVAC. Therefore, information
for all contractors associated with the project must be completed in the contractor section below.
Building/Site Address
Owner's Name
Telephone (Daytime)
Email or Fax
Mailing Address
Applicant's Name (if different than owner)
Telephone (Daytime)
Email or Fax
Mailing Address
Project Description
Anticipated Start Date Application will not be
accepted without the
following:
Contractor(s) Company Name, Address, & Telephone Number WI Credential Number(s)
General Contractor
Dwelling Contractor Qualifier
Electrical Contractor
Master Electrician
Heating/Venting/Air Conditioning (HVAC)
Plumbing
I understand that I am subject to all applicable codes, laws, statutes, and ordinances, including those described on the reverse side of this form;
am subject to any conditions of this permit; understand that the issuance of this permit creates no legal liability, express or implied, on the state
or municipality; and certify that all the above information is accurate. I expressly grant the building inspector, or the inspector’s authorized
agent, permission to enter the premises for which the permit is sought at all reasonable hours and for any proper purpose to inspect the work
which is being done.
HOMEOWNER ACTING AS GENERAL CONTRACTOR
I vouch that I am an 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 on the reverse side of this form.
SIGNATURE OF APPLICANT__________________________________________DATE___________________
CLEAR
PRINT
click to sign
signature
click to edit
10/28/15
(Reverse side of “City of Hudson Building Permit Application” form)
Cautionary Statement to Owners Obtaining Building Permits
Wisconsin Statutes 101.65(1r) 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 sub. (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.
Cautionary Statement to Contractors for Projects Involving a 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 ch.
DHS 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 as required and issued by the
Wisconsin Department of Safety and Professional Services. Contractors are also required to only
subcontract with contractors that hold the appropriate contractor credentials.
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. For more information, visit the Department of Natural Resources wetlands
identification web page or contact a Department of Natural Resources service center.
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