Fillable Land Use/ Building Permit Fillable Form (City of Hayward)

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Land Use/ Building Permit Fillable Form (City of Hayward)

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BROWSE CITY OF HAYWARD (WI) FORMS
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City of Hayward
15889 W Third Street, P.O. Box 969, Hayward, WI 54843
Telephone (715) 634-4612 Fax (715) 634-5868
Website: www.cityofhaywardwi.gov
APPLICATION FOR LAND USE PERMIT
Date Permit No.______________
Ordinance #471
“Any structural changes or major changes to mechanical systems that involve extensions shall require permits. Restoration or repair of an
installation to its previous code-complaint condition as determined by the building inspector is exempt from permit requirements. Re-siding, re-
roofing, finishing of interior surfaces, and installation of cabinetry, doors, and windows shall be exempt from permit requirements.”
Co
nstruction shall not begin until all required permits have been issued. This permit is valid for one year from date of issue
.
Owner: Mailing Address:
Phone:
City, State, Zip:
PERMIT REQUESTED:
Land Use (Construction)
Electrical
Plumbing
Erosion Control
CONTRACTOR NAME LICENSE CERT # MAILING ADDRESS PHONE
Building Contractor
Electrical Contractor
Plumbing Contractor
PROJECT LOCATION:
Site Address: Setbacks: Front Rear L. Side R. Side
Tax Parcel No: 236- - - Zoned: Lot: ft wide x ft deep Acres:
Is there a wetland within 100 feet of the building site? If yes, how far? Flood Plain?
TYPE OF WORK:
New
Accessory Building
Addition/Alteration
Single Family
Deck-detached
Deck-attached
Multi family dwelling
Garage-detached
Garage-attached
Erosion Control
Mobile/Manufactured
Screen House/Gazebo
Porch
Bathroom
Filling
Single Wide
Dbl Wide
Storage Bldg/Shed
Living Rm
Enclosure
Dredging
Modular/Manufactured
Outdoor Heating Unit
Kitchen
Fence
Grading
Other
Other
Bedroom
Other
Other
TYPE OF CONSTRUCTION:
Frame
Log
Pole/Metal
Block
Concrete
Other
CONSTRUCTION COST: (Labor & Materials)
Primary Structure Cost $ Accessory Bldg. Cost $
Addition/Alteration Cost $
Electrical Cost $ Plumbing Cost $
No
Describe the construction using these columns. List each dimension of each structure in a separate column.
#1 #2
Size: ft. wide x ft. long Size: ft. wide x ft. long
Height: ft. Height: ft.
No. Bedrooms: No. Bedrooms:
Floor Area: sf. Floor Area: sf.
Off-street Parking Spaces: Off-street Parking Spaces:
SITE PLAN:
1. Enter lot dimensions and indicate north by arrow. 2. Indicate the location and size of the requested construction activities.
3. Also, indicate the location and distance to the lot lines, the well, any wetland areas, septic tank and drain field.
Wisconsin Administrative Code prohibits roof drains & sump pumps to be hooked to sanitary sewer.
**I certify that the requirements of Wisconsin Administrative Code Chapter NR447, including a thorough asbestos inspections
and,
if required, a notification or intent to demolish and/or renovate, have been met.**
Signature of Owner or Authorized Agent with Power of Attorney _____________________________________
Print Name______________________________________
The above certifies that the listed information and intentions are true and correct, that all work shall be performed in compliance with
the requirements of Ordinance No.148 and its amendments of the City of Hayward and the laws and regulations of the State of
Wisconsin,
and if acting as owner(s) agent, has the permission of the owner(s) to perform the work requested on this application. The
above person(s) hereby give permission for access to the property for onsite inspection.
Issue date________________
Expiration date________________
Sheet 2 of 4
SITE PLAN
For Office Use Only Total Fee Required: $ ____________
UDC Permit Required? Y N
Land Use:
State Approval Required? Y N
Electrical:
Design Review Required? Y N
Plumbing:
$
______________
$ ______________
$ ______________
Planning Commission?
Y N
Erosion Control:
$
______________
Date Received ___________ Check No _______
FEE SCHEDULE
Effective January 1, 2016
After the Fact Penalty / Double the Fee
INDUSTRIAL: Cost of Construction (Labor & Materials)
New industrial related establishments $250.00
plus $5.00 per $1,000 cost of construction
Additions/Alterations to existing industrial buildings $150.00
plus $5.00 per $1,000 cost of construction
Accessory buildings for existing industrial property $150.00
plus $5.00 per $1,000 cost of construction
Electrical & Plumbing - new, remodeling over $500.00 $150.00 (each)
COMMERCIAL: Cost of Construction (Labor & Materials)
New commercial/business buildings and/or uses $250.00
plus $5.00 per $1,000 cost of construction
Additions/alterations to existing commercial buildings $150.00
plus $5.00 per $1,000 cost of construction
Accessory buildings for existing commercial property $150.00
plus $5.00 per $1,000 cost of construction
Electrical & Plumbing - new, remodeling over $500.00 $150.00 (each)
RESIDENTIAL: Cost of Construction (Labor & Materials)
New residential, replacement, relocated, mobile homes $175.00
plus $25 per 500 sq. ft. of floor area in excess of 1,000 sq. ft.
Additions/Alterations
Habitable $ 75.00
plus $25 per 500 sq. ft. of floor area in excess of 500 sq. ft.
Non-habitable $ 75.00
(For new dwellings & habitable additions see schedule on back sheet)
Accessory buildings
100 sq. ft. to 500 sq. ft. $ 75.00
501 sq. ft. to 1,500 sq. ft. $ 150.00
1,501 sq. ft. and larger $ 250.00
Additions/alterations to existing accessory buildings $ 50.00
Residential Electrical & Plumbing - new, remodeling over $500.00 $ 75.00 (each)
MISCELLANEOUS:
Filling, grading, land use-as a separate use $ 300.00
(Grading of more than 10,000 sq. ft.)
Certified Survey Map Review (Must have County approval first) $ 50.00
Fence $ 50.00
Outdoor Heating Units $ 50.00
DWELLINGS: onsite constructed, manufactured, and mobile homes
Fee is based on total square footage of habitable area. Include second story, third story and loft. Include basements on
tri-plexes or walkouts where the below grade level is heated. Do not include open decks, roofed or screened in porches,
unheated entryways, unheated breeze-ways or attached garages.
C
onditional Use (Planning Commission) $400.00
Zoning Change (Planning Commission) $400.00
Plus actual cost of publication of ordinance
Variance (Board of Appeals) $450.00
Sheet 3 of 4
HABITABLE SQUARE FOOTAGE $Dwelling $Addition/Alteration
Less than 500 square feet .......................................................175.00………. 75.00
500 square feet to 1,000 square feet .......................................175.00.............100.00
1,001 square feet to 1,500 square feet ....................................200.00.............125.00
1,501 square feet to 2,000 square feet ....................................225.00.............150.00
2,001 square feet to 2,500 square feet ....................................250.00.............175.00
2,501 square feet to 3,000 square feet ....................................275.00.............200.00
3,001 square feet to 3,500 square feet ....................................300.00.............225.00
3,501 square feet to 4,000 square feet ....................................325.00.............250.00
4,001 square feet to 4,500 square feet ....................................350.00.............275.00
4,501 square feet to 5,000 square feet ....................................375.00.............300.00
5,001 square feet to 5,500 square feet ....................................400.00.............325.00
5,501 square feet to 6,000 square feet ....................................425.00.............350.00
6,001 square feet to 6,500 square feet ....................................450.00.............375.00
6,501 square feet to 7,000 square feet ....................................475.00.............400.00
7,001 square feet to 7,500 square feet ....................................500.00.............425.00
7,501 square feet to 8,000 square feet ....................................525.00.............450.00
8,001 square feet to 8,500 square feet ....................................550.00.............475.00
8,501 square feet to 9,000 square feet ....................................575.00.............500.00
9,001 square feet to 9,500 square feet ....................................600.00.............525.00
9,501 square feet to 10,000 square feet ..................................625.00.............550.00
Add $25.00 per 500 square feet.
C:\Public Works\Building Permits\LandUse Permit.doc Sheet 4 of 4 Updated: 1/1/2016
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Land Use Building Permit Fillable Form (City of Hayward)

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Completed 18 July 2020

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