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Borough of Conshohocken (Conshohocken Borough)

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Borough of Conshohocken
NEW RENTAL PACKET
610-828-1092 MAIN PHONE
610-828-0920 FAX
USE & OCCUPANCY PERMIT APPLICATION PERMIT#______________
SECTION 1. REASON FOR APPLICATION (Check Appropriate Condition)
❑
❑❑
❑ Property Sale / Transfer of Ownership
❑
❑❑
❑ Property Rental / Change of Tenant
❑
❑❑
❑ Use Group / Occupancy Classification Change
Location of Property: ___________________________________Floor and/or Suite and/or Apt #___________________
SECTION 2: OCCUPANCY CLASSIFICATION/USE GROUP INFORMATION. Please indicate the present occupancy
type/use group. (If the building is mixed use, list of the appropriate classification/use groups). □ Single Family □ Multi-
Family □ Mercantile □ Business □ Other________________________________________________________________
❑ Residential - ____ Unit(s) - Fees: Single Family Dwelling or Multi Family Dwelling = $75 per unit
❑ Commercial - Square Ft =____________ - Fees - Commercial = $300 < 6000 sq ft & $5 per 100 sq ft > 6000 sq ft
Does the tenant/buyer intend a change in occupancy classification/use group? ❑ Yes or ❑ No. (If Yes, please provide
description of the proposed new use) ___________________________________________________________________
SECTION 3. PRESENT PROPERTY OWNER
Name(s):________________________________________
Address:________________________________________
City: ____________________State:___Zip Code: _______
Daytime or Cell Phone #:___________________________
E-mail __________________________________________
SECTION 4. PROPERTY SALE - BUYER (complete EITR form)
Buyer’s Name(s):__________________________________
Address:________________________________________
City: ____________________State:___Zip Code: _______
Daytime or Cell Phone #:___________________________
E-mail __________________________________________
Does the buyer intend to occupy or reside at the location? ❑ Yes or ❑ No If the answer is Yes, skip Section 5
SECTION 5. PROPERTY RENTAL - CHANGE OF TENANT - TENANT
(A) Borough Ordinances requires property owners to obtain a Use and Occupancy Permit each time a change of tenant occurs in all of the
(B)
occupancies/use groups listed in Section #2.
Borough Ordinance requires single & multi-family dwelling rental units to be registered with the Borough of Conshohocken. A Rental Property
Registration Form can be obtained at the Conshohocken Municipal Building during normal business hours.
FOR RESIDENTIAL TENANT USE ONLY (complete EITR form)
Resident’s Name:________________________________ Resident’s Name:________________________________
Resident’s Name:________________________________ (attach a separate sheet of paper if necessary)
FOR COMMERCIAL TENANT USE ONLY
Business Name:____________________________________________________________________________________
Address:__________________________________City: __________________________State:______Zip Code: _______
Contact Person:___________________________________Title:_____________________________________________
Daytime or Cell Phone #:___________________________ E-mail ___________________________________________
Application is hereby made to the Borough of Conshohocken for the approval to use and occupy the aforementioned
location in full or part. I agree to comply with all Ordinances and Codes of the Borough of Conshohocken and the
Commonwealth of Pennsylvania. I will not occupy or allow occupancy of any land, structure or building until a Certificate of
Occupancy is issued. I understand that any misrepresentation in this application will be grounds for the revocation of the
application or the Certificate of Occupancy.
OWNER’S SIGNATURE ____________________________________________________ DATE__________________
I hereby certify that this application is authorized by the owner of record and that I have been authorized by the owner to
make this application as his/her agent.
AGENT’S SIGNATURE _____________________________________________________ DATE___________________
For Office Use Only Date Application Received:
Receipt #_________________
U & O Fee $ .00
❑ Cash ❑ Check #_________
Land Use Code:____________
Parcel # 0-500-_______________
BOROUGH OF CONSHOHOCKEN
400 Fayette Street, Suite 200
Conshohocken, PA 19428
Phone (610) 828-1092
Fax (610) 828-0920
RUL
ES, REGULATIONS AND REQUIREMENTS GOVERNING
USE AND OCCUPANCY PERMITS
RULES
Borough O
rdinances requires property owners to obtain a Use and Occupancy Permit each time any of
the following occur:
1. Use and occupancy of any building or structure hereafter altered or erected.
2. Change in the use and/or occupancy of any building or structure.
3. Use of land or change of use thereof.
4. Change in use and occupancy of any non-conforming use of extension thereof.
5. Change of tenants in any building or structure.
APPLICATION:
All applications for Use and Occupancy Permits must be completed in ink, signed by the owner or acting
agent to comply with all Borough Ordinances.
FEES:
S
ingle family Dwelling = $75.00
Multi- Family Dwelling = $75.00 per unit
Commercial
= $300 < 6000 sq ft & $5 per 100 sq ft > 6000 sq ft
Pleas
e note: All fees must be paid prior to the application being processed.
REGULA
TIONS
Issuance of a Use and Occupancy Permit: No Use and Occupancy Permit shall be issued until all proper
Borough Officials have certified that the proposed Use and Occupancy complies with all pertinent
Ordinances. In special cases, consideration of the Borough granting a temporary Use and Occupancy
Permit will be considered on a case by case basis. Officials determine that an application is in
compliance with pertinent Borough Ordinance, it shall be their duty to issue the permit within thirty days of
the receipt date on the application.
Refusal
of permit: Should it be determined that an application and or the premises is not in compliance
with all pertinent Borough Ordinances, it shall be the duty of the proper Borough Officials to refuse the
Permit. In such cases it shall be the duty of these Officials to instruct the applicant of the remedial
measures to bring the application and or premises into compliance within thirty days of the receipt date on
the application.
BOROUGH OF CONSHOHOCKEN
400 Fayette Street, Suite 200 Conshohocken, PA 19428
Phone (610) 828-1092 Fax (610) 828-0920
General List of Requirements
The building or structure must comply with the 2015 International Property Maintenance Code and The
Code of The Borough of Conshohocken. The following is a list of common residential requirements. This
is a general list used to help property owners prepare for the inspection.
Residential Interior:
• S
moke detectors are required on every level and in every room used for sleeping.
• All electrical equipment, wiring and appliances shall be properly installed and maintained in a safe and
approved manner.
• All ceilings, walls and floors shall be maintained in good, clean and sanitary condition.
• All windows must be operable and free from any holes, cracks, or broken glass.
• Screens must be installed and kept in good condition between the months of April to October.
• All means of egress doors shall be readily operable from the side which egress is to be made, without
the need for keys, special knowledge or effort.
• Every interior flight of stairs having more than four risers shall have a graspable handrail on one side
of the stair.
• Every habitable space in a dwelling shall contain at least two separate and remote electrical outlets.
• All bathrooms require: 1.) A mechanical ventilation system or an operable window and an outlet
(GFCI recommended). If new outlet is installed it must be GFCI.
• Every laundry area requires a grounded or GFCI outlet.
• The furnace must be inspected by a registered technician, and certified in writing as being in sound,
operable condition. The written heater certification must be dated within 2 years of the inspection.
• The chimney must be inspected by a registered technician, and certified in writing as being in sound,
operable condition (direct vent systems exempt). The written certification must be dated within 2 years
of the inspection. New chimney liners are exempt for five years. Must have written documentation
with the date of install, and Borough inspection permit.
• Adequate combustion air for fuel fired appliances shall be provided.
• Any unsafe structure or equipment inside the property, as determined by the Borough, is not permitted.
Residential Exterior:
• The building shall have approved address numbers placed in a position plainly legible on each unit
door. Numbers must be a minimum of 4 inches in height and a ½ inch. stroke.
• All exterior property and premises shall be maintained in a clean, safe and sanitary condition.
• Every exterio
r flight of stairs that has more than four risers shall have a graspable handrail on one side
of the stair.
• Exterior wood surfaces, other then decay-resistant woods, shall be protected from the elements and
decay by painting or other protective covering or treatment. Peeling, flaking and chipping paint shall
be eliminated and surfaces repainted. Any deteriorated wood must be removed or replaced.
• All Exterior walls shall be free from holes, breaks, and loose or rotting materials.
• All down spouts and gutters shall be installed and maintained in good repair.
• Every exterior balcony, porch, landing, deck, ramp, or other walking surface which is more than 30
inches above the floor or grade, shall have guards installed. Guardrails and guards shall be securely
fastened, and capable of supporting 200lbs. of imposed loads.
• All sidewalks, curbs, walkways, stairs, driveways, parking spaces and similar areas shall be kept in
proper state of repair, and maintained free from hazardous conditions.
• All buildings and or structures on the property (garages, car ports, sheds, etc) are to be included in the
inspection.
• Any unsafe structure or equipment on the property, as determined by the Borough, is not permitted.
Please allow the Borough 5 business days to review your application and schedule an inspection.
Name: ___________________________________________ Soc. Sec. #: _________________________________
Spouse’s Name: ___________________________________ Soc. Sec. #: _________________________________
New Address: ___________________________________________________________ as of: _________________
Please list previous address and previous school district:
Address: ____________________________ City________________________ State: ________ Zip: _________
School District: __________________________
Employer: _____________________________ Spouse’s Employer: ________________________
Earned Income Tax withheld from your pay: yes no From Spouse’s pay: yes no
Self-employed: yes no Spouse self-employed: yes no
No earned income: Please indicate reason (homemaker, temporarily unemployed, disabled, student etc; (please specify)
You: ___________________________________ Spouse: _____________________________________
Signature: _________________________________________________ Date: __________________
Earned Income Tax Information for
Residents of the Borough of Conshohocken, Montgomery County
In Pennsylvania, the General Assembly has empowered political subdivisions of the Commonwealth, at the local level, to levy, assess, and
collect certain types of taxes for general revenue purposes. The authority for levying these non-realty taxes was granted to local school
districts and municipalities in 1965 through the passage of the Local Tax Enabling Act (LTEA), commonly referred to as ‘Act 511’. The rate
of earned income tax for the Borough of Conshohocken is one percent (.5%) and is levied on gross wages and/or net profits from a business or
profession.
Berkheimer Tax Administrators is the appointed earned income tax administrator for Montgomery County. The appointed earned income tax
administrator, Berkheimer Tax Administrators is charged with the duty of collecting the Borough’s earned income taxes. This includes
collecting the tax, establishing rules to fairly enforce such tax and creating accurate tax records and accounts for each taxpayer.
Above is an Earned Income Tax Registration Form. A completed Registration Form will fulfill your registration requirements under the
Earned Income Tax Rules and Regulations adopted by the Borough of Conshohocken. More importantly, this information will ensure that
your tax dollars are sent to your home taxing jurisdiction. All residents should complete this form, regardless of your employment status
(unemployed, retired, college student, military personnel, or homemaker). If you have recently moved, please give your current and former
address.
Most resident taxpayers will have this tax deducted by their employers. Residents, who work in a jurisdiction where it is not withheld, or are
self-employed, will have to pay the tax directly to Berkheimer Tax Administrators. The completed registration form will be forwarded to
Berkheimer Tax Administrators, who will create an accurate tax account reflecting your current reporting status and send you the necessary
forms.
If you have any additional questions, you may contact at Berkheimer Tax Administrators 610-599-3139, or on their website at www.hab-
inc.com.
400 Fayette Street, Suite 200 | Conshohocken, PA 19428 | Phone: (610) 828-1092 | Fax: (610) 828-0920 | www.conshohockenpa.gov
BOROUGH OF CONSHOHOCKEN
EARNED INCOME TAX REGISTRATION FORM – NEW RESIDENTS
RESIDENT PSD CODE #460401
RETURN FORM TO: 400 Fayette Street, Suite 200, Conshohocken, PA 19428
☐
☐
City:_______________________________
☐
AgentName&Company:_____________________________________________________________________
Address:______________________________________________________________________
Fees:
Registration:$100PerRentalUnit
Inspection:$75PerRentalBiAnnual
Biannualrentalswillbecontactedforappointments.
NEWRENTAL:$75Inspection
NewRentalRequiresInspection.
BiannualInspectionrequiredforcurrentrentals.
ContactOfficeforNEWInspectionAppointments.
Trash:$165
One(1)trashunitisincludedintaxes,anyadditional
unitsarebilled@$165foreachadditionalunit.
Paybleto:BoroughofConshohocken
400 Fayette Street,Suite200
Conshohocken,PA19428
Phone:610.828.1092
Fax610.828.0920
Iattestthatallinformationaboveisaccurate.
Date:_________________________
PrintName:_______________________________________
OfficialUseBelow
☐
Even☐Odd☐NewRental☐Remove/Change☐ Updated ☐_____________ ☐
Initials
Owner'sMailingAddress:(allrequired)
Street:________________________________________________________________________
State:__________
Zip:_______________
POBoxesarenotaccepted
Tenant/Tenant'sName
&Phone#
#ofpeople&Check(√)
appropriatebox
Unit
#14yrsor
younger
#Over
age14
#
Handicap
REQUIREDIFYOULIVE
FURTHERTHAN12MILES.If
youareusinganagent,all
fieldsarerequired.
PropertyAddress:_____________________________________________________
CurrentRental
Owner'sName:________________________________________________________
NewRental
Doyouliveonsitethisrental
Owner'sphone#:__________________24HourPhone/Cell:___________________________
Email:_________________________________________________
City:_________________________________State:______________Zip:__________________
Phone#________________________________AfterHoursPhone#:______________________________
*
Note:Pleasefill inthehandicapboxifyoufeelthatpersonwouldneedassistanceinanemergency.
Lease
exp
date
Permit
Printed
Needs
Inspection
Email:____________________________________________
BOROUGH OF CONSHOHOCKEN
400 Fayette Street, Suite 200 Conshohocken, PA 19428 Phone
(610) 828-1092 Fax (610) 828-0920
RENTAL PROPERTY REGISTRATION
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Completed 20 July 2020

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