Date Applied Project Name Modification Number -
Permit Number -
Fee Paid
$
Address - Suite or Floor Number(s) Owner' Name
Applicant's Name and Relationship to Project:
____________________________________________________________________________
Owner G Design Professional G Engineer Contractor
Phone Number:
FAX Number:
BUILDING DESCRIPTION
G New G Existing
Construction Type Total Number of Stories _________________
Number of Stories Above Grade ___________
Type of Fire Protection Fire Alarm- Yes No
Sprinkler System - Full 9 Partial 9 None
Square Footage
• Area to be modified _______________
• Entire Building _______________
Not Applicable
Building Height in Feet
Location/Area/Item to be Modified Previous Use Current Use
Change of Use?
Yes No
MODIFICATION REQUESTED
Code Edition: _______________Year______________
USBC IBC IRC IEBC IMC IPC
NEC IPMC
G Other ______________________________________________________
Specific Code Section (s) to be Modified
Supporting Data for Modification Requested (Additional sheets of authoritative sources, manufacturer information, lab tests, related code
documents, reports etc. may be attached. Do not use approvals and/or conditions/situations in other buildings as each request must stand on its
own merit.)
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
What Will be Achieved if the Modification is Granted? (Describe how the modification will correct a hazard and/or deficiency or upgrade or
enhance the structure to be equivalent to current code requirements. Please attach additional sheets if needed.)
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
DECISION AND/OR COMMENTS
Building Commissioner Approved Disapproved
Signature
Date
Comments:_________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________
Appeal Rights. In accordance with the USBC, the decision of the Building Official or the Code Official may be appealed concerning the applicaton of
the code or if the Building/Code Official has refused to grant a modification to the provisions of this code covering the manner of construction or
materials to be used in the erection, alteration or repair of a structure. The appeals must be submitted in writing within 90 calendar days for
construction matters; 21 calendar days for maintenance matters, from the receipt of the decision for appeal. Appeal applications may be obtained from
the Bureau of Permits & Inspections, (804) 646-6955.
CE Rev. 02/2007
Modification Request
City of Richmond
Department of Community Development
Bureau of Permits & Inspections
900 E. Broad Street, Room 110
Richmond, VA 23219
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