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Residential Building Permit Application 1 & 2 Family Residences
Application Date: _________________
Applicant Name: __________________________________________________
Project Site Address: _______________________________________________
Project Site Legal Description (Lot Numbers, Block & Sub-division):
Project Owner:
Name:__________________________________
Address:________________________________
Telephone:______________________________
Email:__________________________________
Project Construction Information:
Construction Type: New Construction Addition Accessory Building
Interior Renovation Exterior Renovation Duplex
Townhouse Porch Addition to Garage Detach Garage
re-roof/roofing see roofing section Historical restoration
Other
*Please check all that apply. If historical please reference historical section at end of permit. Roofing/re-roof see
roofing section.
Project Construction Value:__________________________
Total Square Footage of Project:______________________
First Floor Square Footage:__________________________
Second Floor Square Footage:_______________________
Third Floor Square Footage:_________________________
Unfinished Basement Square Footage:________________
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Finished Basement Square Footage:__________________
Garage Square Footage:____________________________
Number of Stories (if Applicable):_____________________
Total Project Height (if Applicable):___________________
Construction Details:
Footing Type: Trench Pier Spread Footing
Footing Dimensions:____________________Basement Wall Dimensions:______________________
Footing Depth:____________________ Basement Wall Thickness:____________________
Reinforcing system:____________________
Exterior Wall Framing Size:__________________ Exterior Wall Framing Spacing:___________________
Exterior Wall Framing Material:_____________ Exterior Wall Sheathing:____________________
Exterior Wall Finish Material:____________________
Interior Wall Framing Size:__________________ Interior Wall Framing Spacing:____________________
Interior Wall Framing Size:__________________ Interior Wall Framing Spacing:____________________
Floor Framing Size:____________________ Floor Framing Spacing:____________________
Roof Framing Size:____________________ Roof Framing Spacing:____________________
Roof Sheathing thickness:__________________ Roofing Material:____________________
Driveway/Approach Material:____________________ Paving Thickness:____________________
If there is a garage will it be attached? Yes No
If yes will it be separated from the remainder of the living spaces by the appropriate fire separation
barrier material and all penetration seal with approved fire sealant as well as all doors leading into the
garage from the living spaces be of the appropriate fire rating and installed in the appropriate manner?
Yes No
Will the basement be finished?
Yes No
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If yes will all sleeping and living spaces have an egressable window installed according to code and with
the appropriate exiting devices to allow the occupants to egress from the basement?
Yes No
Roofing/Re-Roof:
Will this project be one of the following:
Overlay Total Tear off
If overlay have cores to the roof been taken, and if so have they been given to the building inspector:
Existing roofing system thickness/number of layers:_____________
Note: Total tear off is required where the existing roof has two or more applications of any type of roof
covering ( See International Residential Building Code 2016 Section R907.3.3
No Yes Yes but cores have not been given to the building inspector New Construction
Project Description:
Roof Drainage:
existing gutters & downspouts new gutters and downspouts existing scuppers new
scuppers
Historical:
What type of project:
Complete exterior rehabilitation masonry tuck pointing window rehabilitation stucco
rehabilitation wood rehabilitation roofing rehabilitation including gutters and downspouts or
scuppers storefront rehabilitation Complete interior rehabilitation plaster rehabilitation
wood rehabilitation door, frame and hardware rehabilitation millwork rehabilitation stucco
rehabilitation stucco rehabilitation stucco rehabilitation
Will this project be funded by an historical grant or will it be seeking historical tax credits?
No Yes
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Explain:
If this project is using historical grants or applying to tax credits please reference the historical section at
the end of the permit. Additionally, the historical review process will extend the review process by up to
2 weeks. If you have already submitted your project to the Kansas State Historical office for approval
and have received approval, please attach the letter from the State.
Project Contractor/General Contractor:
Name:_________________________________ City License Number:_____________________
Company Name:__________________________
Firm Address:_____________________________
_________________________________________
Telephone:________________________________
Email:_____________________________________
Sub-Contractor Information:
Concrete Name:_______________________ Independence License No.________
Framing Name:_______________________ Independence License No.________
Electrical Name:_______________________ Independence License No.________
Plumbing Name:_______________________ Independence License No.________
Mechanical Name:_______________________ Independence License No.________
Other Name:_______________________ Independence License No.________
Design Professionals (if applicable):
Architect:_________________________________ Kansas License Number:_____________________
Firm Address:_____________________________
_________________________________________
Telephone:________________________________
Email:_____________________________________
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Structural Engineer:_________________________________ Kansas License Number:_____________
Firm Address:_____________________________
_________________________________________
Telephone:________________________________
Email:_____________________________________
Mechanical Engineer:_________________________________ Kansas License Number:____________
Firm Address:_____________________________
_________________________________________
Telephone:________________________________
Email:_____________________________________
Electrical Engineer:_________________________________ Kansas License Number:____________
Firm Address:_____________________________
_________________________________________
Telephone:________________________________
Email:_____________________________________
Plumbing Engineer:_________________________________ Kansas License Number:____________
Firm Address:_____________________________
_________________________________________
Telephone:________________________________
Email:_____________________________________
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Checklist of Required Submittals & Drawings:
Documents Required
New
Construction
Addition
Remodeling
Interior
Remodel
Exterior
Repairs
Accessory
Building
Application Form
X X X
X X
Fire Code Footprint
Floor Plan
X X X
X
Site Plan with Utilities
X X
X
Elevation Drawings -
exterior
X X
Civil Plans & Details
Structural Plans & Details
Mechanical Plans & Details
X X
Electrical Plans & Details
X X X
Plumbing Plans & Details
X X X
Construction Details
Minimum Information to be included on drawings:
Site Plan: A graphic representation of the property indicating but not limited to the following: property
lines, property size (to scale or dimensions shown), North arrow, adjacent street(s), location of existing
improvements, proposed construction, setback dimensions from property lines, water service, sewer
lines, electrical lines, gas lines, other utilities, any easements, paving, curb cuts, grading & drainage.
Floor Plan: Plans shall be drawn to scale with dimensions shown, showing walls, doors, windows,
construction types, all floor levels. Note all fire rated partitions, rated doors, safety window glazing,
stairway.
Elevation Drawings: Illustrate the building front, sides & rear views.
Electrical Plan: Indicate the location and size of the (new) electrical service and describe the (new)
panelboard.
Plumbing Plan: Indicate the sanitary sewer location exiting the construction and the tie to the existing
system (if applicable) with cleanout locations. Indicate the water service line location, size and the tie to
existing system (if applicable).
Documents Required for Permit: In addition to the permit form the applicant will provide to the city a
minimum three (03) sets of required drawings. Additionally, an electronic PDF version of the documents
shall be submitted at the time of the application or emailed directly to the Code official within 5 days of
the permit application. The PDF versions can be provided at the time the permit is submitted or by
email. If provided at the time of the submittal they should be placed on a CD or removable media
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humb drive. If provided in this manner the CD and/or the thumb drive will remain with the code official
and not be returned.
Election to Do Own Work:
Agreement for unlicensed, uncertified person to do their own work on an owner-occupied dwelling.
In accordance with the above referenced Building Code, I, __________________________ Hereby
request authorization to do my own work on a one or two family dwelling, located_________________
__________________________, Lot ______________, Block _______________, Subdivision ________
__________________________, which is existing or in the process of being newly constructed.
It is understood and I agree that this authorization is contingent on the fact that I shall personally
purchase all materials to be used, in this work, and I shall personally perform all labor in connection
therewith. It is further understood and agreed that as permittee and/or Owner, I shall not allow any
person to do or cause to be done and work under a permit secured myself, unless such person is a
licensed, certified and bonded contractor or master contractor of the said type of work performed.
I hereby certify that all work, for which this application is submitted, will be done in accordance with the
terms of the above agreement and in accordance with the Codes and Laws of the City of Independence,
Kansas.
____
________________________________________________________________________________
Signature Date
Exclusions of Owner Performed work:
1. The Following are area of work that cannot be performed by an Owner, these items will need to
be performed by a licensed contractor of that particular trade:
2. Installation of gas lines and connects thereof to any heating appliance and or cooking appliance.
3. Installation of a permanent heating appliance (regardless of what type)
4. Installation of an electrical service panel, disconnect or electrical service entrance.
5. Main electrical branch and secondary branch circuits. Wiring may be installed by the owner
;
ho
wever, a licensed electrician shall make all connections within the electrical panel,
disconnects, receptacles and switches. All connections shall be certified by said electrician shall
be provided to the Building Inspections Department.
Required Inspections:
The following inspections are required for residential construction projects within the City of
Independence. When your project is ready for an inspection, you may call (620) 332-2541, before
4:00PM the day prior to that requested for the inspection.
click to sign
signature
click to edit
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General Construction
DW (Driveway) An inspection performed to verify that driveways,
sidewalks and curb cuts are constructed in conformance
with City code and ordinance.
FRM (Framing) An inspection of structural components and
connections, lumber size and load bearing, and egress
window sizes, prior to sheetrock installation.
FTG (Footings) Footing Inspection check the type and bearing of
foundations, reinforcement, clearance and location on
the property.
FBI (Final Building Inspection) A final building inspection to verify all
components are in place and operating as
intended.
FFD (Final Fire Department) A final inspection by the Fire Department to
verify Local and State requirements for fire
safety, detectors, hazardous materials, alarm
systems, fire escapes, means of egress and
maintenance of fire protection devices.
Plumbing Construction
CCI (Cross Connection Inspection) An inspection to verify correct installation of
the backflow prevention devices used on the
potable water systems.
GL (Gas Line) A visual inspection of the gas line and connection to
the meter. This inspection is done by the gas
utility and coordinated by the plumbing sub-
contractor.
RIP (Rough-in Plumbing) This is an inspection of the underground DWV
(Drain, Waste and Vent) and water supply,
50#PSI on the water supply, 5#PSI air or 10-foot
head on DWV system.
SWR (Sewer) This inspection is a visual inspection of the sewer
line in place from the cleanout to the tap at the
city main.
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FP (Final Plumbing) A final inspection after all fixtures are installed and
connected.
Electrical Construction
TP (Temporary Power) This inspection is for temporary power poles
installed at job sites and/or job trailers for
construction and is to assure pole is strong
enough to withstand wind or weather, and GFCI
protected.
PS (Permanent Service) A visual inspection of the installation or upgrade of
the electrical supply system to a residence
typically at the service entrance.
RIE (Rough-in Electric) An inspection of the installation of boxes, conduit,
cable, conductors, etc. prior to the covering by
wallboard, concrete, masonry or earth. This
must be done for anything that will not be
visible upon completion of the project.
FE (Final Electrical) An inspection that insures all fixtures, devices,
equipment and panelboards are installed and
operating correctly.
Mechanical Construction
RIM (Rough-in Mechanical) An inspection of the ductwork, panning, flues,
combustion air, and all items that will be
covered by drywall or ceilings.
FM (Final Mechanical) A final inspection after all final connections are
made and grilles are in place. The system shall
be operational.
Site Construction
SPA (Site Plan Approval) Inspection includes location of construction on
property, identification of easements, setbacks,
landscaping, sidewalks, pavement, and grading.
STW (Storm Water) An inspection to verify compliance with storm water
regulations and control of excess storm water
drainage, retention and dispersal.
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Adopted Codes:
2012 International Building Code (Resolution
4259 adopted 12/14/2017)
2012 International Existing Building code
(Resolution 4266 adopted 12/14/2017)
2012 International Residential Code
(Resolution 4258 adopted 12/14/2017)
2012 Uniform Plumbing Code (Resolution
4261 adopted 12/14/2107)
2012 International Mechanical Code
(Resolution 4267 adopted 12/14/2017)
2012 Uniform Swimming Pool, Spa & Hot
Tub Code (Resolution 4262 adopted
12/14/2017)
2011 National Electric Code (Resolution
4260 adopted 12/14/2017)
2010 ADA
Minimum Design Standards:
Wind Speed: 115 mph
Ground Snow Load: 15 lbs
Seismic Design Category: B
Frost Line Depth: 32"
Historical Standards:
Secretary of the Interiors Standards for Rehabilitation
https://www.nps.gov/tps/standards/rehabilitati
on/rehabilitation-guidelines.pdf
Additional Preservation and Rehabilitation information can be found at the following web address
https://www.nps.gov/tps/education/free-
pubs.htm
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Important Contact Information:
City Contacts:
Planning & Zoning: Zoning, setbacks, site plan review, landscaping, signage, parking, paving &
subdivision regulations.
Kelly C. Passauer, CPM
Assistant City Manager/Zoning Administrator
City Hall
811 W. Laurel St.
Independence, KS 67301
(620) 332-2506
kellyp@independenceks.gov
Fire Department: Exiting, smoke detectors, sprinkler system and fire alarms
Shawn Wallis
Fire Chief
City Hall
811 W. Laurel St.
Independence, KS 67301
(620) 332-2504
shawnw@independenceks.gov
Utility Department: Water and sewer taps, fees and scheduling
Terry Lybarger
Director of Utilities
City Hall
811 W. Laurel St.
Independence, KS 67301
(620) 332-2542
terryl@independenceks.gov
Building Inspections: Building Inspections for new construction, renovations, additions,
landlord/tenant
Don Cushing
Building Inspector
City Hall
811 W. Laurel St.
Independence, KS 67301
(620) 332-2541 Office
(620) 205-7166 cell
inspector@independenceks.gov
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Private Utilities Contacts
Agency Contact Person Phone
Westar Energy Joann Evans (620) 332-2625
Atmos Energy Ryan Collett (620) 331-1547
AT&T Business Support 888-944-0447
Cable One Business Support 877-570-0500
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