City of Madison, Indiana
PLAN COMMISSION
City Hall, 101 W. Main Street
Madison, IN 47250
(812) 265-8324
CONSTRUCTION AUTHENTICATION AGREEMENT
As the person eligible and/or responsible for obtaining a local building permit or permits as
required in section 150.20 – 150.24, as well as other applicable sections of the City of Madison
Building Code, and based upon information contained within these plans, I certify that these
plans are a full inclusion of the planned construction. I also understand if it is determined that
these plans are not identical to construction, all permits obtained may be revoked as stated in
Section 150.21 of the City of Madison Building Code.
Further, it is my responsibility to submit supplemental plans as approved by the Indiana
Department of Homeland Security, Building Division, to the Plan Commission office in the
event of any changes, corrections, or additions made concerning the project and/or use of
structure in accordance with Construction Design Release and Building Permit. And that no
work may proceed with affected sections until such plans are filed with the Building Inspector.
Applicant - Initial all aspects included in project and provided to this office:
____ Site Plan
____ Footer
____ Framing
____ Electrical
____ Plumbing
____ Insulation
____ HVAC
____ Life Safety
_____________________________ ______________________________
(Authorized Signature) (Date)
_____________________________ ______________________________
(Print Name) (Project Name)
______________________________
(Bldg. Permit Number)
______________________________
(Construction Design Release Number)
THE CONTRACTOR IS REPONSIBLE FOR REQUESTING INSPECTIONS
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signature
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