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
Elevator / Escalators / Lifts / Moving Walks: Yes No
Sprinkler System: Yes No
Pressure Vessels: Yes No
Refrigeration System: Yes No
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:
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
Is the site located in a Historic District?: Yes No
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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.
Print Name of Owner or Authorized Agent
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
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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