Building and Planning Department
Office 215-633-3644 ▪ Fax 215-633-3753
2400 Byberry Road ▪ Bensalem, PA 19020
Rev 7/2016
Permit #
Date
FEE
$
ESCROW
$
Property Owner Applicant Information
NAME: NAME:
ADDRESS: ADDRESS:
PHONE No.: PHONE No.:
Contractor Information
NAME: LICENSE No.:
ADDRESS: PHONE No.:
Site Information Construction Information
Ne
Re
lacement
LOCATION : CURBING: LF
TAX PARCEL No: SIDEWALK: LF
DRIVEWAY APRON: LF
Depressed curbs abutting Township and State roads are to be constructed in the following manner:
1. The dimensional requirements shall be:
(a) 12’x4” depression for single car drive.
(b) 20’x4” depression for double car drive.
2. The expansion joint requirement shall coincide with the standard curb requirement.
3. The concrete must meet 3500 psi.
4. No. 4 reinforcing bars shall be laid in the depressed curb. Four bars in two rows of two each.
(See “Typical Curb Details.”)
NOTE: Three (3) plot plans and two (2) building plans must accompany this application. This application does
not constitute a permit. Once issued, the Building Permit will be rescinded for any infraction of Township
Codes and Ordinances as related to the permit, and penalties and fines will be assessed.
I/we hereby certify and agree that, if a permit is issued, all the provisions of the building and housing codes and
the zoning and fire ordinances of the Township will be complied with whether herein specified or not; and, I/we hereby
agree to save, indemnify, and keep harmless the Township of Bensalem against all liabilities, judgments, costs and
expenses which may in any way accrue against said Township of Bensalem in consequence of the granting of the
permit or from the use or occupancy of any building, sidewalk, street, or sub-sidewalk placed by virtue hereof and will in
all things strictly comply with the conditions of the permit.
I/we hereby acknowledge that I/we have read the application; that the information given is correct and that I/we am/are
the owner or the duly authorized agent of the owner.
I/we agree to comply with the Township and State laws regulating construction.
Owner/Applicant’s Initials Date
Signature
Owner
Applicant
Date Signed
A SIGNED COPY OF THIS APPLICATION IS REQUIRED PRIOR TO ISSUANCE OF PERMIT
Reviewer
Approved Denied Date Signed
BENSALEM TOWNSHIP
PPLICATION
CURBS, SIDEWALKS & DRIVEWAY APRONS
