Fillable Building-Permit-Application-12-07-09-PDF Village Building Permit Application

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Building-Permit-Application-12-07-09-PDF Village Building Permit Application

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Chevy Chase Village Building Permit Application Page | 1 of 3
Chevy Chase Village
Building Permit Application Permit No:_________
Property Address:
Resident Name:
Daytime telephone: Cell phone:
After-hours telephone:
E-mail:
Project Description:
Check here if the construction will require the demolition of over fifty (50) percent of any existing structure.
Primary Contact for Project:
Resident Architect Project Manager Contractor*
*MHIC/MD Contractor’s License No. (required):
Information for Primary Contact for Project (if different from property owner):
Name:
Work telephone: After-hours telephone:
Cell phone:
E-mail:
Will the residence be occupied during the construction project?  Yes  No
If no, provide contact information for the party responsible for the construction site (if different from above):
Name:
Address:
Work telephone: After-hours telephone:
Cell phone:
E-mail:
Parking Compliance:
Is adequate on-site parking available for the construction crews?  Yes  No
If no, please attach a parking plan which minimizes inconvenience to neighboring residents, and indicate
if the property is in a permit parking area.
Will road closings be required due to deliveries, equipment or other reasons?  Yes  No
Chevy Chase Village Building Permit Application Page | 2 of 3
Building Permit Filing Requirements:
Application will not be reviewed until the application is complete
” Copy of stamped drawings approved by Montgomery County Department of Permitting Services (DPS) and
the Historic Preservation Commission (HPC), if required. Every page of drawings must be clearly stamped.
” This application form, signed by resident.
” Boundary Survey
” Site Plan (see: Village Site Plan Checklist to ensure completeness)
” Building plans and specifications
” Tree Preservation Plan requested of Village arborist (see: Village Tree Inspection Request form). All
required tree protections must be fully installed before any work begins.
” Filing Fee (due at time of application). Fees schedule is listed in Chapter 6 of the Village Code.
” Damage deposit or performance bond (due when Building Permit is issued). Amount of required deposit or
bond will be set by Village Manager.
Once this permit application is complete, the Village Manager will review the application and accompanying
documents and, under most circumstances, act on the application within 5 to 10 working days.
If the Montgomery County permit is suspended, revoked or lapsed, the Village permit is automatically
suspended, revoked or lapsed.
No signs advertising the architect, contractor, or any other service provider may be posted on the work site.
I hereby certify that I have the authority to make the foregoing application, that the application
is correct, that I have read and understood all requirements and that the construction will
conform to the regulations of the Montgomery County Zoning Code, the Village Code including
Urban Forest code, and any covenants and easements on the subject property.
Applicant’s Signature: ___________________________________ Date: _______________
To be completed by Village staff:
Is this property within the historic district? Yes  No  Staff Initials: _________
Date application filed with Village: __________ Date permit issued:__________ Expiration date:_________
Chevy Chase Village Building Permit Application Page | 3 of 3
For Use By Village Manager
Application approved with the following conditions:
For Use By Village Manager
Application denied for the following reasons:
Filing Fees
(due when application submitted)
Checks Payable to: Chevy Chase Village
5906 Connecticut Ave.
Chevy Chase, MD 20815
Permit Application Fee: $____________
(see Permit Fee Worksheet)
$50.00 (if construction is in the
Public Right-of-way)
Tree Preservation Plan Fee:
$250.00
Not required for this project.
TOTAL Fees: Date:
Staff Signature:
Damage Deposit/Performance Bond
(due when permit is issued)
$_______________
Waived by Village Manager
Checks Payable to: Chevy Chase Village
5906 Connecticut Ave.
Chevy Chase, MD 20815
Date:
Village Manager Signature:
Cost of damage to R-O-W:
(calculated at close-out)
Amount of refund:
Date:
Village Manager Signature:
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Building-Permit-Application-12-07-09-PDF Village Building Permit Application

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Completed 11 July 2020

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