Fillable Jackson Township Permit Application

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Jackson Township Permit Application

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File type: PDF

U.S.A. forms for Jackson Township

BROWSE JACKSON TOWNSHIP (PA) FORMS

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Permit #:
Date:
Site Address: Tax Parcel #:
Lot #: Subdivision / Land Development:
Owner: Phone #: Fax #:
Mailing Address: Email:
Contractor: Phone #: Fax #:
Mailing Address: Email:
Architect: Phone #: Fax #:
Mailing Address: Phone #: Fax #:
Type of Work of Improvement (Check All That Apply)
New Building Foundation Only Alteration Demolition
Relocation
Addition Change of Use Plumbing Mechanical Electrical
Describe the proposed work:
Cost of Construction: $ Utility Company Job #
Description of Building Use (Check One)
RESIDENTIAL NON-RESIDENTIAL
One-Family Dwelling Specific Use:
Two-Family Dwelling Use Group:
Multi-Family Change in Use: Yes No
# of Units If Yes indicate former use:
Maximum Occupant Load:
Maximum Live Load:
Page 1 of 7
Jackson Township Building Permit Application
1275 Huntsville Road, Jackson Township, PA 18708
Phone: 570-270-3900
Fax: 570-270-3892
Permit Fee:
Zoning Fee:
Sewer Fee:
*** Fill out ONLY applicable blocks. If unknown, leave blank.
Building / Site Characteristics
Number of Residential Dwelling Units:_______________Existing, __________Proposed
Mechanical: Type of Heating / Ventilating / Air Conditioning (i.e. electric, gas, oil, etc.
Water Service Public Private
Sewer Service Public Private Septic Permit #:
Does or will your building contain any of the following:
Fireplace(s): Number Fuel Type
BTU's____________
Vent Type:
Elevator / Escalators / Lifts / Moving Walks: Yes No
Sprinkler System: Yes No
Pressure Vessels: Yes No
Refrigeration System: Yes No
Building Dimensions
Existing Building Area: Sq. Ft. Number of Stories:
Proposed Building Area: Sq. Ft. Height of Structure Above Grade:
Total Building Area: Sq. Ft. Area of the Largest Floor:
Flood Plain
Is the site located within an identified flood prone area?: Yes No
Will any portion of the flood prone area be developed?: Yes No N/A
Historic District
Is the site located in a Historic District?: Yes No
Page 2 of 7
Application for a permit shall be made by the owner or lessee of the building or structure, or agent of either, or by
the registered design professional employed in connection with the proposed work.
I certify that the code administrator or the code administrator's authorized representative shall have the authority
to enter areas covered by such permit at any reasonable hour to enforce the provisions of the code(s) applicable
to such permit.
Signature of Owner or Authorized Agent
Owner / Agent shall verify that any proposed construction activity complies with the requirements of the
National Flood insurance Program and the Pennsylvania Flood Plain Management Act (Act 166-1978),
specifically Section 60.3 (d).
If any construction is within a Historic District, a certificate of appropriateness may be required by the
Municipality.
The applicant certifies that all information on this application is correct and the work will be completed in
accordance with the "approved" construction documents and PA Act 45 (Uniform Construction Code) and any
additional approved building code requirements adopted by the Municipality. The property owner and applicant
assumes the responsibility of locating all property lines, seback lines, easements, rights-of-way, flood areas, etc.
Issuance of a permit and approval of construction documents shall not be construed as authority to violate,
cancel or set aside any provisions of the codes or ordinances of the Municipality or any other governing body.
The applicant certifies he/she understands all the applicable codes, ordinances and regulations.
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For Code Administrator Use Only
Additional Permits / Approvals Required:
Approved:
Street Cut / Driveway Yes No
Cut and Fill Yes No
PennDOT Highway Occupancy Yes No
DEP Floodway or Floodplain Yes No
Sewer Connection Yes No
On-Lot Septic Yes No
Zoning Yes No
Historical & Architectural Review Board Yes No
Stormwater Management Yes No
Other (list)
Approvals:
Building Permit Denied: Date: ______________ Date Returned:
Building Permit Approved: Date: ______________
Code Administrator:
Date Issued:
Expires On: _____________
Permit #:
Building Permit Fee:
$
Project Documents (Drawings and Calculations)
Type of Documents:
Foundation Plans Yes No
Construction Yes No
Electrical Yes No
Mechanical Yes No
Plumbing Yes No
Specifications Yes No
ADA Yes No
Yes No
Page 3 of 7
Workers
Comp.
Jackson Township Residential Permit Fee Schedule
Cost of Work
$1.00 - $500.00
$500.01 - $600.00
$600.01 - $700.00
$700.01 - $800.00
$800.01 - $900.00
$900.01 - $1,000.00
$1,000.01 – $2,000.00
$2,000.01 – $3,000.00
$3,000.01 – $4,000.00
$4,000.01 – $5,000.00
$5,000.01 - $6,000.00
$6,000.01 - $7,000.00
$7,000.01 - $8,000.00
$8,000.01 - $9,000.00
$9,000.01 - $10,000.00
$10,000.01 and above will be $200.00 plus $7.50 for each additional $1,000
Plus 25% administration fee, plus $4.50 state fee
Residential Electrical Service Fee is a flat rate of $104.50
FAILED inspections are subject to an additional charge of $65.00 per inspection
Cost of work will be based upon the contract provided with application OR the Higher of the Code Officials
estimate based on either the most recent edition of the R. S. Means Co., Inc. "Construction Data Book"
or by Marshall & Swift, or the latest International Code Council Building Valuation Data Table.
FEES WILL BE DOUBLED FOR THOSE FAILING TO SECURE PERMIT PRIOR TO START OF WORK
Make check or money order payable to:
BHW
1151 Highway 315, Suite 3
Dolphin Plaza
Wilkes Barre, PA 18702
Page 4 of 7
$109.50
$124.50
Permit Fee
$24.50
$29.50
$34.50
$39.50
$44.50
$139.50
$154.50
$169.50
$184.50
$49.50
$64.50
$79.50
$94.50
Jackson Township Commercial Permit Fee Schedule
Cost of Work Permit Fee
$1.00 - $500.00
$500.01 - $600.00
$600.01 - $700.00
$700.01 - $800.00
$800.01 - $900.00
$900.01 - $1,000.00
$1,000.01 – $2,000.00
$2,000.01 – $3,000.00
$3,000.01 – $4,000.00
$4,000.01 – $5,000.00
$5,000.01 - $6,000.00
$6,000.01 - $7,000.00
$7,000.01 - $8,000.00
$8,000.01 - $9,000.00
$9,000.01 - $10,000.00
$10,000.01 and above will be $200.00 plus $10.00 for each additional $1,000
Plus 25% administration fee, plus $4.50 state fee
Commercial Electrical Service Fee is a flat rate of $154.50
FAILED inspections are subject to an additional charge of $65.00 per inspection
Cost of work will be based upon the contract provided with application OR the Higher of the Code Officials
estimate based on either the most recent edition of the R. S. Means Co., Inc. "Construction Data Book"
or by Marshall & Swift, or the latest International Code Council Building Valuation Data Table.
FEES WILL BE DOUBLED FOR THOSE FAILING TO SECURE PERMIT PRIOR TO START OF WORK
Make check or money order payable to:
Page 5 of 7
$42.00
$98.25
$229.50
$117.00
$135.75
$154.50
$173.25
$192.00
$210.75
$54.50
$60.75
$79.50
$35.75
$48.25
$29.50
BHW
1151 Highway 315, Suite 3
Dolphin Plaza
Wilkes Barre, PA 18702
Permit Fee Worksheet for COMMERCIAL projects in Excess of $10,000.00
All others refer to the fee schedules on Page 4 (Residential) and Page 5 (Commercial)
Electrical Services are a flat fee and this page is not required
Cost of Construction
First $10,000 of the project cost
$10.00 per each additional $1,000
Subtotal Permit Fee
25% of the permit fee
$4.50 State fee
Total Cost of Permit
Permit Fee Worksheet for RESIDENTIAL projects in Excess of $10,000.00
Electrical Services are a flat fee and this page is not required
Cost of Construction
First $10,000 of the project cost
$7.50 per each additional $1,000
Subtotal Permit Fee
25% of the permit fee
$4.50 State fee
Total Cost of Permit
Page 6 of 7
$ 200.00
$ 0.00
$ 4.50
$ 25.00
$ 100.00
-$ 100.00
$ 129.50
$ 200.00
$ 0.00
$ 4.50
$ 31.25
$ 125.00
-$ 75.00
$ 160.75
To schedule inspections please call or email us at the following:
Jason Humenanski Phone: 570-704-9478
Email:
Harry L. Wood III Phone: 570-479-2008
Email:
Mark D. Bienias Phone: 570-814-1048
Email:
Building Inspector
UCCconsultant@hotmail.com
Electrical Inspector
HWood58907@aol.com
Plumbing & HVAC Inspector
Bienias747@aol.com
* Carbon Monixide Detectors Are Required To Be Provided For Any Residence That Contains A Fuel-Fired
Appliance Or Has An Attached Garage
The following inspections are required if applicable:
Concrete Foundation Wall Pre-Pour
Backfill Inspection (Prior to placement)
Underground Plumbing
Underground Electrical
Electrical Service (A Utility Company Job Number is required to be obtained from the utility company)
Basement Slab Pre-Pour
Rough Framing
Rough Wiring
Rough Plumbing
Rough Mechanical
Insulation / Energy Conservation
Wallboard
Final Building
Final Electrical
Final Plumbing
Final Mechanical
Page 7 of 7
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Jackson Township Permit Application

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Completed 14 July 2020

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