Fillable Permit Application Permit Application (Town of Bedford)

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Permit Application Permit Application (Town of Bedford)

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The Permit Application Permit Application (Town of Bedford) form is 2 pages long and contains:

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  • 43 check-boxes
  • 55 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Town of Bedford

BROWSE TOWN OF BEDFORD (VA) FORMS

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PERMIT APPLICATION
BUILDING / ZONING
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ǣ
LandownerȋȌǣ
Phoneǣ
Phoneǣ
Manufactured Home
**Skirting must be up within 60 DAYS of issuance of the Certificate of Occupancy.
Singlewide Doublewide
Year
Size
x
Value
$
Contractor Information
BL
General Contractor
VA License Number
Phone
Electrician
VA License Number
Phone
Plumber
VA License Number
Mechanical / HVAC
VA License Number
Phone
Mechanic Lien Agent
Address
Phone
Customer Name on Electric Bill
I (Print Name)
hereby certify that I am the owner of record of the herein described property
or that the work proposed has been authorized by the owner of record and that I have been authorized to make this application as a designated agent. I agree to conform to
all applicable state and local regulations, rules, and policies and such shall be deemed a condition entering into the exercise of this permit. In addition, if a permit is issued,
I certify that the code official or his authorized representative shall have the authority to enter the area(s) described herein at any reasonable hour for the purpose of
enforcing the provisions of the applicable code(s).
Signature
Date
Mailing Addressǣ
ȋȌǣ
Mailing Addressǣ
Addressǣ
Choose all that apply:
Commercial
New Structure
Addition
Residential
Alteration, Renovation or Repair
Yes
In a Flood Zone:
Estimated Value:
Water:
Public
Well
Sewer:
Public
Square Footage:
Finished Area:
Unfinished Area:
Decks / Porches:
Phone Address
Structural / Framing
VA License Number
Address
Phone
No
*Email for Inspection Results:
By checking this box, I acknowledge my digital signature below:
Septic
Change of Use or Occupancy:
Home Occupation:
Zoning __________________
District __________________
Business Licenses __________
Taxes Paid _______________
Tax Map # ________________
Construction ____________________ Subtotal _______________ Code 100032.413308
Mechanical ______________________ 2% VA Levy ____________ Code 100032.413334
Electrical _______________________ Zoning ________________ Code 100032.4133 07 / 19 / 35
Plumbing _______________________
Plan Rev/Admin _________________
TOTAL $ _________________________
______________________________________________________________________________________________
OFFICE USE ONLY
Electrical
amps
Wiring / Equipment:
Yes
No
New service:
Service upgrade:
amps
Plumbing
New Public Connection
Water Sewer
Fixtures / Equipment:
Yes
No
Add or Replace Line(s)
Water Sewer
If Yes, Please List:
Mechanical
Heating, Cooling, or Ventilation System(s)
Add
Replace
Type & Number of:
Equipment
Add
Replace
Type & Number of:
Gas Line(s)
Add
Replace
Fuel Tanks:
Yes No
Proposed Building and Property Drawing
Required for all projects, as applicable.
Draw the property: lot boundaries,
adjacent streets, rights-of-way, etc.
Draw the location of the proposed
structure, and all other structures or
buildings existing on the parcel.
Write in distances from the proposed
structure to the property lines, other
structures, rights-of-way, etc.
** The applicant and contractor are responsible for knowing the true location of all
property lines and the required building setbacks. **
If Yes, Please List:
Yes
Yes
No
No
Sprinkler /
Suppression:
# of heads
Above Ground:
Underground:
Yes No
Directions:
Please Note: If submitting plans
electronically, please attach to your
application.
O F F I CE U S E ON LY
# of risers
REAR SETBACK
SIDE SETBACK
SIDE SETBACK
FRONT SETBACK
EXAMPLE:
HOUSE
50'
75'
75'
50'
ROAD
# and Size:
USBC: __________
Const. Type: __________ Square Footage - Finished: __________ Unfinished: __________
Use Group: __________ Occup. Load: __________ Sprinkler: Yes □ No □ Plans: __________
Zoning: __________ BRWA: __________ Health Department: __________ E&S: __________
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Permit Application Permit Application (Town of Bedford)

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Completed 14 July 2020

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