Polk County Public Works
5885 NE 14
th
Street
Des Moines, IA 50313
publicworks@polkcountyiowa.gov
515-286-3705
Pole Building Permit Application and Checklist
JOB SITE ADDRESS: _______________________________________________________ GEO PARCEL#: ______________________________
OWNER: ________________________________________________________________ PHONE: __________________________________
ADDRESS: ________________________________________ CITY: _________________________ STATE: ______ ZIP: __________________
EMAIL: ______________ ___________________________________ ______________________________________
CONTRACT
OR: ___________________________________________
________________ PHONE: __________________________________
COMPANY : _______________________________________ _____ __
ADDRE SS: ________________________________________ CITY: ________________________ STATE: ______ ZIP: __________________
EMAIL: __________________________
_____________________________________________________________
Size of proposed building (dimensions) ____________X_____________ Total square feet______________________
Is there a lean to or covered entry in addition to the building? YES NO
If yes, please provide dimensions: _________X_________
Height of proposed building to peak ________ *Height can be no greater than 24’ or height of principal structure, whichever is greater
Height of sidewall of proposed building ________ *Must provide engineered specifications if sidewall is over 14’
Closest distance to the house _________ *Must be a minimum of 10’
Description of proposed building and use: _________________________________________________
_
____________________________.
Is any portion of the proposed building to be used for commercial or other business activities? YES/NO
*Must apply for home occupation permit if yes
Is the building going to be connected to water? YES/NO - If yes, for what purpose (toilet, sink, outside spigot, etc.)?____________________
- If adding a restroom - is the property on septic or sewer? _____________________________
Checklist of items to be filled out or completed prio
r to submitting application packet:
Pole Building Permit Application and checklist
Building Spec Sheet
Engineered Truss Specifications
Detailed Construction Plans- 2 Copies: PDF & hard copy
Detailed Site Plan Drawing
Proposed building staked
-No construction shall start until the permit is issued.
-All work must be permitted prior to inspections.
-Unresolved Zoning, Subdivision, Floodplain, Health i
tems may delay the issuance of any permit. No structure should be used or
occupied until the certificate of occupancy is issued.
-If an electrical, mechanical, or plumbing permit is needed, they must be applied for separately by a state licensed contractor.
Contractor/Owner/Applicant Statement:
Work must commence within 180 days from permit issuance date, and be completed and inspected within one year from the permit
issuance date, or the building permit will be null and void. I understand all work must be inspected and approved by Polk County prior to
concealing any installation and that I must call for a final inspection. I further understand that a Certificate of Compliance or Certificate of
Occupancy/Use is required in accordance with applicable codes and ordinances.
I have included all of the above checked items and I understand that all the items listed above must be reviewed and fees paid before a
permit will be issued. I further understand that construction work cannot begin unti
l the building permit has been issued. All information
supplied by me is true and correct, and to the best of my
knowledge and belief.
*Please allow 5-7 business days for permit review and approval
____________________________________________
Print Name
__________________________________________ _____________________
Signature Date
Permit #______________________
click to sign
signature
click to edit
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