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City of Verona Department of Building and Code (City of Verona)

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City of Verona
Department of Building and Code Enforcement
111 Lincoln Street
Verona, WI 53593-1520
Phone: (608) 848-9940 Fax: (608) 845-8613
Email: buildinginspector@ci.verona.wi.us
Web: www.ci.verona.wi.us
Uniform Permit Application Instructions
 Submit one form per project.
 List all contractors and sub-contractors on the form.
 Include all necessary license numbers (business and individual).
 To avoid any unnecessary delays, ensure the form is filled out completely and accurately.
 All fees associated with the project will be charged and collected at one time.
 These are the most common sections required to be completed on the form. The Building Department may request
additional information should certain circumstances arise.
New Construction – Residential or Commercial Complete All Sections
Addition – Residential or Commercial Complete All Sections
Alteration – Residential Complete Sections 1 through 11, 13, 14, and 15
Alteration – Commercial Complete Sections 1 through 11, 13, and 15
Early Start Complete All Sections
Erosion Control Complete Sections 1 through 11, 12 and 15
Electrical Complete Sections 1, 2, 4, 7, 8, 9, 10, 11, 14 and 15
Plumbing Complete Sections 1, 2, 5, 7, 8, 9, 10, 11, 14 and 15
HVAC Complete Sections 1, 2, 6, 7, 8, 9, 10, 11, 14 and 15
Sign Complete Sections 1, 2, 4, 7, 8, 9, 10, 11, and 15
Occupancy See Occupancy Permit Application (Different Form)
Demolition Complete Sections 1 through 11, 13, and 15
Driveway or Parking Area Complete Sections 1 through 8, 11, 12, and 15
Permit Extension/Renewal Complete All Sections Relevant to Project
Deck/Patio/Porch/Sunroom Complete Sections 1 through 11, 14, and 15
Basement Finishing Complete Sections 1 through 11, 14, and 15
Shed/Detached Garage Complete Sections 1 through 11, 14, and 15
Fence Complete Sections 1 through 3, 7, 8, 10, 11, 14, and 15
Swimming Pool Complete Sections 1 through 11, 14, and 15
Roof Replacement Complete Sections 1 through 3, 7, 8, 9, 10, 11, 14, and 15
Window/Door/Siding/Soffit Complete Sections 1 through 3, 7, 8, 9, 10, 11, 14, and 15
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.
Cautionary Statement to Contractors for Projects Involving 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 http://dhs.wisconsin.gov/lead/WisconsinRRPRule.htm for details of how to be in
compliance.
Do you perform electrical or plumbing
work?
Do you perform HVAC work?
Do you install manufactured homes?
Which credentials do I need?
NO
NO
Do you work on elevators?
Do you apply for building permits for
1 or 2 family dwellings, or
manufactured homes?
Is your construction business
otherwise described by the
paragraph below?
NO
NO
NO
Does your business already hold a
business
credential?
•Building Contractor Registration
•Dwelling Contractor Certification
•Dwelling Contractor - Restricted
Certification
•Electrical Contractor Certification
•Electrical Contractor - Restricted
Certification
•Manufactured Home Dealer
License
•HVAC Contractor Registration
•Manufactured Home Installer
License
•Elevator Contractor License
•Manufactured Home Manufacturer
License
You need to maintain your business
credential, and ensure employees
hold and maintain the appropriate
personal Plumbing Licenses or
Electrician Certifications, if
necessary.
You need to obtain a Building
Contractor Registration, and ensure
employees hold and maintain the
appropriate Plumbing Licenses or
Electrician Certifications, if
necessary.
NOTE: An owner or tenant of a building
who performs work on the building is
exempt from the Building Contractor
Registration, but may still need the
appropriate personal Plumbing License or
Electrician Certification, if necessary.
You need to obtain an HVAC Contractor Registration, and ensure employees
hold Refrigerant Handling Technician Certifications, if necessary.
You need to obtain a Manufactured Home Installer License.
You need to obtain an Elevator Contractor License, and ensure employees
hold the appropriate credentials to construct, install, alter, service, replace or
maintain conveyances.
NOTE: An owner of a building who services its existing conveyances is exempt from the
Elevator Contractor License, but will still need the appropriate personal elevator license.
You need to obtain a Dwelling Contractor Certification, and be or employ
someone who holds a Dwelling Contractor Qualifier Certification.
NOTE: An owner of a dwelling who resides or will reside in the dwelling and who applies for a
building permit to perform work on the dwelling is exempt from these requirements.
There are no credentialing requirements at this time.
NO
YES
YES
YES
YES
YES
YES
NO
YES
"Construction business" means a trade that constructs, installs, or alters any element, component, material or device within or serving a building or
structure where the element, component, material or device is regulated under one of the following codes: Comm 16, Electrical; Comm 20 to 25,
Uniform Dwelling; Comm 28, Smoke Detectors; Comm 33, Passenger Ropeways; Comm 40, Gas Systems; Comm 41, Boilers and Pressure
Vessels; Comm 43, Anhydrous Ammonia; Comm 45, Mechanical Refrigeration; Comm 61 to 66, Commercial Buildings; Comm 81 to 84, Plumbing;
or Comm 90, Public Swimming Pools and Water Attractions code, as well as the construction, installation or alteration of permanent devices or
structures where the structure or device is regulated by Comm 34, Amusement Rides or Comm 91, Sanitation, or includes the activity of installing
interior wall coverings in commercial buildings. "Construction business" does not include: the design of a building or structure, the delivery of
building supplies or materials, the manufacture of a building product not on the building site, or non-profit volunteer-based programs.
For more information about these state credentials, visit: www.commerce.wi.gov/SB/SB-DivCreds.html
Always remember to check with your municipal building inspector to insure you've met any additional municipal requirements.
There are financial penalties possible for doing work under the codes without the proper credentials. See Comm 5.125.
A Wisconsin municipality may not issue a building permit for a commercial building construction activity unless the requester holds a Building Con-
tractor Registration, holds a contractor credentials, or unless the requester is working only on property they own or lease.
A Wisconsin municipality may not issue a Uniform Dwelling Code building permit unless the requester is the owner who resides in the dwelling or
the requester provides proof of the Dwelling Contractor Certification and the Dwelling Contractor Qualifier Certification. The Building Contractor Reg-
istration does not qualify a business to obtain Uniform Dwelling Code permits.
By performing work on this project, the parties identified below all agree to comply with the applicable
Codes and Ordinances and with the conditions of this permit.
DEPARTMENT OF BUILDING AND CODE ENFORCEMENT
UNIFORM APPLICATION FOR PERMIT
PROJECT ADDRESS: _____________________________________________ PERMIT # ____________
1. Owner Applicant 2. General or Dwelling Contractor Applicant 
By Owner
First Name Last Name First Name Last Name
First Name Last Name Company Name
Company Name Address
Address City, State, ZIP
Phone Mobile
Phone Mobile Fax Email
Fax Email Business Registration Number Expiration Date
City, State, ZIP
3. Dwelling Contractor Qualifier (UDC) Applicant 
(Applies only to any project involving One or Two Family Buildings)
4. Electrician Applicant 
By Owner
First Name Last Name First Name Last Name
Company Name Company Name
Address Address
City, State, ZIP City, State, ZIP
Phone Mobile Phone Mobile
Fax Email Fax Email
Dwelling Contractor Qualifier Number Expiration Date Business Registration Number Expiration Date
Master Electrician License Number Expiration Date
5. Plumbing Applicant 
By Owner
6. Heating Applicant 
By Owner 
First Name Last Name First Name Last Name
Company Name Company Name
Address Address
City, State, ZIP City, State, ZIP
Phone Mobile Phone Mobile
Fax Email Fax Email
Business Registration Number Expiration Date Business Registration Number Expiration Date
Master Plumber License Number Expiration Date
8. Type of Permit Requested (check all that apply)
New Construction – Residential or Commercial
Addition – Residential or Commercial
Alteration – Residential
Alteration – Commercial Level: 1 2 3
Permission To Start - Footings/Foundation
Erosion Control
Electrical
Plumbing
HVAC
Deck/Porch
Patio, Driveway or Parking Area
Swimming Pool/Spa/Hot Tub
Fence
Sign
Other ____________________________________
9. Type of Construction (Check One)
Commercial Type 1A
Commercial Type 1B
Commercial Type 2A
Commercial Type 2B
Commercial Type 3A
Commercial Type 3B
Commercial Type 4
Commercial Type 5A
Commercial Type 5B
Residential Light Frame Wood
10. Project Areas
Unfinished Basement _______________ square feet
All Finished Floor Area _______________ square feet
Shed/Garage _______________ square feet
Deck/Porch _______________ square feet
Sign _______________ square feet
Other _______________ square feet
TOTAL _______________ square feet
11. Project Costs (excluding land)
Construction ____________________
Electrical ____________________
Plumbing ____________________
HVAC ____________________
Sign ____________________
Other ____________________
TOTAL ____________________
12. Impervious Surfaces and Driveways
Elevation (in feet) of garage floor above top of curb
__________
Driveway slope __________ %
Number of Accessible (Handicap) Stalls ______
Number of Non-Accessible Parking Stalls ______
Length of Driveway from Curb to Building ______
13. Water/Sewer, Fire Protection, Fuel Loads
Sprinkled Yes No 13 13R
Fire Alarm Yes No Auto Manual
Sewer Lateral Size _______________
Water Lateral Size _______________
Water Meter Size _______________
Heating Fuel _______________
Water Heater Fuel _______________
Building BTU Load _______________
7. Description of Project
_________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________
Cautionary Statement to Owners Obtaining Building Permits (Uniform Dwelling Code)
101.65 (lr) of the Wisconsin Statutes 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 2 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 arose 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.
I vouch that I am or will be 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 above.
Additional Responsibilities for Owners of Projects Disturbing One or More Acre of Soil
I vouch that I am the owner of this property and if one acre or more of soil will be disturbed, I understand that this project is subject to ch. NR 151 regarding
additional erosion control and stormwater management.
Initial
Initial
Statement of Owner or Owner’s Authorized Agent
I represent and warrant that I am the owner or the owner’s authorized agent and I understand that I am subject to all applicable codes, laws, statutes and ordinances,
including those described on 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 information within this application is accurate. I expressly grant the building inspector, or the inspector's
authorized agent, permission to enter the premises for which this permit is sought at all reasonable hours and for any proper purpose to inspect the work which is being
done. Furthermore, I represent and warrant that I will provide a copy of this Uniform Application for Permit to all parties identified in sections 1 through 6 on this
application and that an amended permit application will be filed with the Building Inspector if any of the parties identified in sections 1 through 6 on this application do not
perform work on this project or another party performs work in place of the identified party.
Owner or Owner’s Authorized Agent’s Signature Print
_____________________________________________ _____________________________________________ Date_____________________
If filing electronically, I agree to the terms and conditions of the Uniform Application for Permit and further agree that WKHP\HOHFWURQLFVLJQDWXUHDERYHRU
DEVHQFHWKHUHRIVKDOOEHOHJDOO\ELQGLQJIor WKHpurposes VXEPLWWDOof the Uniform Application for Permit, as thoughH[HFXWHGLQSHUVRQ
14.
ISSUING JURISDICTION
This Uniform Application for Permit is hereby issued pursuant to the Conditions of Approval which can be found on the back of the Permit Placard and/or with the
approved plans. The Owner, as defined in 101.01(2)(e) of Wisconsin State Statutes, is responsible for all code requirements not specifically cited herein and failure to
comply may result in suspension or revocation of this permit or other penalty.
Inspector’s Name Credential Number
_____________________________________________ _____________________________________________ Date_____________________
Permit Fees $________________________________________ Receipt #____________________ Check #____________________ Cash____________________
15.
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City of Verona Department of Building and Code (City of Verona)

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Completed 17 July 2020

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