POKAGON BAND OF POTAWATOMI INDIANS
57824 Potawatomi Trail, Dowagiac, MI 49047
Office (269)-783-0443 Fax (269)-783-0452
O
wner’s Name:
Project Location(Address)
:
BUILDING PERMIT
APPLICATION
Project Description: (Ex: Roof, Addition, Remodel, Home etc.)
Estimated Cost of Project
: $
General Contractor:
License Number
Mailing Address:
Area Code + Telephone
Construction Contractor:
License Number
Mailing Address:
Area Code + Telephone
Plumbing Contractor:
License Number
Mailing Address:
Area Code + Telephone
Electrical Contractor:
License Number
Mailing Address:
Area Code + Telephone
HVAC Contractor:
License Number
Mailing Address:
Area Code + Telephone
PROJECT INFORMATION:
Please fill out all areas that are applicable.
Description
Type
Use
Land Use
Building
Sanitary
Land Use
Demolition
Other:
Sign
Utility
Pool
Deck
Shed
Fence
Garage
Other
1&2Family
Commercial
Special Events
New
Repair
Remodel
Temporary
Permanent
Emergency
Other:
Lawn & Garden
Open Sales
Seasonal Trailer
The applicant agrees to comply with the PBOPI Tribal Codes, Ordinances, and with the conditions of this permit: understands that the
issuance of the permit created no legal liability, express or implied of the PBOPI and certifies that all of
the above information is accurate.
Failure to comply in any or all of these conditions may result in suspension revocation of this permit or other penalty.
SIGNATURE OF APPLICANT:
DATE:
FOR OFFICE USE ONLY
Permit #:
Parcel #:
Zoning District/
Land Classification:
Fee Trust
Fee’s
Application Reviewed by PBOPI Tribal Agents(s):
Construction
$
Land Use
$
Name of Agent:
Date:
Plumbing
$
Other
$
Electric
$
Specify:
$
Name of Agent:
Date:
HVAC
$
Total Due
$
Additional Notes:
Note: your e-signature constitutes your agreement to be bound by the intentions recorded on this document.
Form #
Date Created:
Language and Culture Section 106 Review
Name of Agent : Date:
DNR NEPA and ESA Section 7 Review
Name of Agent : Date:
Residential Checklist
1. When submitting your application for a building
permit the followings information must
be included
in order to begin the review process.
2. A Description of the land in which the proposed
work is to be done.
3. The use or occupancy of all parts of the building.
4. A site plan drawn to scale showing:
a. The actual dimension of the lot to be built
upon.
b. The size and location of all buildings
c. Such other information that may be
required.
5. Foundation specifications
6. Wall Brace Diagram for residential project
7. RES Check® for residential projects
8. COM Check® for commercial projects
9. Computations, stress diagrams and other data as
required
10. Once all appropriate documents have been received
the completed application will be reviewed.
11. Once approved you will be notified that your permit
is ready for pick up and the fee’s associated with the
issuance of this permit.
12. If denied you will be notified of the reason with a
follow up in letter form detailing this information.
13. If additional information is required you will be
notified by the Properties & Planning Department,
as to what additio
nal information is required.
Commercial Checklist
1. When submitting your application for a building permit
the followings information must be included in order to
begin the review process.
2. A full set of construction documents (to include all
trades/discipline).
3. A project manual
4. Copy of State Submittal Application.
5. Copy of State Review approval Letter (when
received).
6. Project Data
7. A
pplicable Codes
8. Associ
ated Calculations.
9. COM Check® for commercial projects
10. Computations, stress diagrams and other data as
required
11. Once all appropriate documents have been received the
completed application will be reviewed.
12. Once approved you will be notified that your permit is
ready for pick up and the fee’s associated with the
issuance of this permit.
13. If denied you will be notified of the reason with a
follow up in letter form detailing this information.
14. If additional information is required you will be notified
by the Properties & Planning Department, as to what
additional information is required.
CONTRACTOR RESPONSIBILITIES
Please initial all lines
____As a condition of this permit, inspections are mandatory and will require a 24 hour notice to the inspectors.
____All inspections will be made during the normal work week 8:00 A.M. through 5:00 P.M.
____The contractor, subcontractor, or their authorized representative will be present for each inspection.
____Any items that need correction will be resolved within 5 working days and re-inspected. Failure to comply
may be treated as a code violation.
____Mandatory Inspection will include but are not limited to: excavations, pouring foundation walls or slabs,
prior to backfilling, tile, store, and insulation. Prior to pouring basement floor, underground plumbing, and all
framing, plumbing, heating cooling, electrical work, insulation and vapor barrier, installations of any utilities,
final grading and project completion and all other inspection deemed appropriate by the Inspection staff.
____Failure to comply with these directives shall be a violation of the permit requirements and subject to
appropriate actions as specified in the PBOPI Health & Safety Law and Building Codes.
____Any and all other conditions that may be attached to this permit or addressed by the inspectors will be
considered a condition of this permit.
PRINT NAME: DATE:
Note: your e-signature constitutes your agreement to be bound by the intentions recorded on this document.