Fillable By Filling Out This (Louisville Jefferson County Metro Government)

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By Filling Out This (Louisville Jefferson County Metro Government)

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BROWSE LOUISVILLE JEFFERSON COUNTY METRO GOVERNMENT (KY) FORMS

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Louisville-Jefferson County Metro Government
CONSTRUCTION REVIEW DIVISION
Department of Codes and Regulations
444 S. 5
th
St. – Louisville, KY 40202
Phone: 502.574.3321 Web Site: louisvilleky.gov/government/construction-review
M O V I N G P E R M I T A P P L I C A T I O N
I hereby certify that I am the owner of record or the owner of record authorizes the proposed work and that I have been authorized to make this application as their authorized agent. I understand that
any false or inaccurate information on this application or the approved plans may result in revocation of the permit under Kentucky Building Code. No deviation of the approved plan is allowed
without approval by this office.
Signature of Owner or Agent
Date
Location:
Subdivision Name:
Lot #
(street address is required for all applications)
(If applicable)
Please provide a brief description of your project below:
Estimated Cost:
$
Square Footage:
(Do not include Electrical, Plumbing, HVAC or Land.)
(Total Square Footage of Project)
Applicant:
Email:
Applicant Type:
☐ Architect
☐ Engineer
☐ Contractor
☐ Other
Address:
Phone:
City:
State:
Zip:
Cell:
Owner:
Email:
Address:
Phone:
City:
State:
Zip:
Cell:
TYPE OF MOVE I:
☐ Over a Public Way
☐ Not Over a Public Way
TYPE OF MOVE II:
☐ Within Louisville Metro
☐ Into Louisville Metro
☐ From Louisville Metro
☐ Storage
ESTIMATED COST:
FOUNDATION PERMIT NUMBER:
EZONE CERT NO:
DATE OF MOVE
___/___/______
START TIME:
COMPLETION TIME:
UTILITY SIGN-OFFS
THE FOLLOWING PRIVATELY OR PUBLICLY OWNED UTILITIES, BEING ALL OR EACH AFFECTED, HEREBY CERTIFY THAT PROPER ARRANGEMENTS HAVE BEEN
MADE WITH THEM BY THE APPLICANT. UTILITIES WILL BE CUT OFF AND CAPPED AT THE APPROPRIATE TIME AND PLACE.
___/___/______
LG&E:
___/___/______
MSD:
___/___/______
WATER COMPANY:
___/___/______
PHONE COMPANY:
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LOT GRADING AND EROSION AND SEDIMENT CONTROL CERTIFICATION
I hereby certify that I have reviewed the composite grading and drainage plan prepared by the Developer’s engineer and approved by the Metropolitan Sewer
District (for a lot in a recorded subdivision.) I acknowledge that as a condition of the permit, I am responsible for assuring that lot grading be done in
accordance with the approved Subdivision Plan, that site drainage be carried to a public outlet as identified on the approved Subdivision Plan, and that
adjacent properties will not be adversely impacted, or if the development is not part of an approved subdivision plan;
I hereby certify that I will abide with the requirements of the Jefferson County Erosion Prevention and Sediment Control Ordinance Section 159.02.014. (b):
Single Family Moving. I further understand and acknowledge that as a condition of the permit, I am responsible for assuring that appropriate construction
practices and sediment controls are utilized, I am responsible for assuring the practices of all contractors and sub-contractors are employed for the purpose of
this permitted construction shall conform to appropriate sediment control practices, I am responsible for assuring the appropriate selection, installation, and
maintenance of said sediment control practices, I am responsible for assuring that site construction practices do not interfere with any required sediment
control practices as noted on plans approved by the Metropolitan Sewer District, I am responsible for assuring adjacent properties, public roadways, and
receiving waters will not be adversely impacted.
DATE:____/____/____
In a manner prescribed by the City Engineer, the permittee will indemnify the city against any loss caused by damage to public property during the move, and
that he will pay damages to any person injured by the moving.
Permittee expressly agrees to save and hold harmless Louisville Metro and any of its employees or agents, from any and all liability which may result from
work performed under this permit.
Permittee has paid to the Building Department in the sum of $200.00 for the structure to be moved under this permit. Make check payable to Louisville Metro
Finance.
Permittee will have two escort vehicles, one in front of the moving vehicle and one behind the moving vehicle, accompanying the moving vehicle at all times of
the moving operation.
The Building Inspector certifies that the described building is structurally sound and capable of being moved, and will conform in its new location to the Building
and Zoning Regulations.
The City Engineer certifies that the streets and alleys on the described moving route are capable of supporting the moving operation.
Permittee attests that he/she has notified and made all the proper arrangements for the moving operations with the following agencies or companies:
Louisville-Metro Police Department – Traffic Bureau
Metropolitan Parks & Recreation
Louisville Division of Fire – Chief’s Office
Louisville Emergency Medical Services – Director’s Office
Louisville Gas & Electric Company – Underground Gas Division
Bell South Telephone Company
Louisville Water Company
Cable Television Companies
This permit is to be maintained in the moving vehicle during al times of the move and subsequent relocation, and is to be returned to the Chief Building
Inspector at the completion of the move. This permit is only for the movement of structures on streets within the corporate limits of the city of Louisville, It is not
a substitute for any other permit, no may it be used for any other purposes, nor used at any other time than specified herein.
Any person who violates Ordinance 94.09 shall be fined $100 for each day or fraction thereof in which any portions of the public ways are occupied by any
structure or building or imprisoned for not less than five days, nor more than 20 days or both.
APPROVALS
BUILDING INSPECTOR:________________________________________________________DATE:____/____/____
WORKS DEPARTMENT APPROVAL:_______________________________________________________ DATE:____/____/____
PERMITTEE SIGNATURE:_______________________________________________________ DATE:____/____/____
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By Filling Out This (Louisville Jefferson County Metro Government)

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Completed 3 August 2020

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