Fillable Residential-Permit-Application-BLDG-2019new Building Permit

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Residential-Permit-Application-BLDG-2019new Building Permit

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City of Madison Building Department
100 Hughes Road
Madison, Alabama 35758
Phone: 256-772-5644/Fax: 256-772-5601
www.madisonal.gov
RESIDENTIAL BUILDING PERMIT APPLICATION
Incomplete applications may not be processed.
Date: Valuation of Work $
Location of Work or Construction
Street Address:
Subdivision/Phase: Lot# Block
Applicant Information
Applicant Name: City of Madison License #:
Applicant Address: Phone #:
E-Mail:
Property Owner Information
Owner Name: Phone #:
Property Owner’s Current Address:
Contractor Information
□ Owner Acting as GC - Owner must occupy house for no less than 1 year after completion of work if valuation exceeds $10,000.00
□ Affidavit on file
□ Homebuilders License # General Contractors License #
Note: Two (2) copies of a plot plan and two (2) sets of construction drawings are required for plan review. The plot plan must show
the location of proposed new construction, all existing structures and proposed additions, as they do/will appear on the lot or parcel.
********A RECEIPT FOR WATER/SEWER SERVICE MUST BE SUBMITTED WITH PLANS TO PROCESS PERMITS********
□ New SFR □ New 2 Family Residential □ Addition □ Detached Garage □ Alterations (interior) □ Repairs □ Foundation Only □ Other
Accessory Structure □ Other Residential Construction Not Listed, please describe:
Brief Description of Work
No. of Stories: Building Height: No. of Baths: No. of Bedrooms:
New 1
st
Floor heated SF: New 1
st
Floor unheated SF: Total 1
st
Floor SF:
New 2
nd
Floor heated SF: New 2
nd
Floor unheated SF: Total 2
nd
Floor SF:
Existing 1
st
Floor SF: Existing 2
nd
Floor SF: Basement SF: Total Gross SF:
Heated and Unheated Heated and Unheated Heated and Unheated Heated and Unheated
Are there any other existing accessory buildings on this lot? If yes, specify type and sq. footage:
Energy Code Compliance - All new Single-Family and 2-Family dwellings require verification by a 3
rd
party
Prescriptive Method Trade off Method (Additional Documentation Required) Total UA Method (Additional Documentation Required)
City Water? City Sewer? Electric Utility Name: Type of Heat:
FFE: If the property is located in a Flood Hazard Area a Flood Elevation Certificate is required
Zoning District: Lot or Parcel Frontage in feet: Lot or Parcel Depth in feet: Lot Area:
Historic District Airport Obstruction & Clear Zone Overlay District
Yes/No Yes/No Yes/No
Fire Sprinkler System Well Head Protection - Zone I: Zone II:
Yes/No
Yes/No Yes/No
**Additional Information on Back**
RESIDENTIAL BUILDING PERMIT APPLICATION Page 2 of
CONTRACTOR STATEMENT
I certify and acknowledge that I have fully read this application, that all information provided herein is true and correct, and that all work for which this
permit may be issued will be performed and completed as described above and that it shall conform to all City code sections and ordinances; all
applicable state and federal laws; and the plans and specifications herewith submitted. By signing this application, I am further certifying that I will
meet all requirements incumbent upon me as a contractor licensed under the laws of the State of Alabama, to include any exemptions as provided by
law, and that I am authorized by the owner of the subject property to execute this document as his or her agent.
I also further attest that I have located by actual excavation the municipal sewer infrastructure that will serve the building for which this permit is
issued and that I have verified that the floor elevation of the building and the elevation of the servicing sewer are located so as to provide proper slope
for connection to the municipal sanitary sewer system. I also hereby agree to protect all public improvements and public utilities adjacent to or serving
the property on which the proposed structure or structures described above are located, whether or not the said improvements or utilities are the
property of the City of Madison. I further agree to make or cause to have made, satisfactory to the City of Madison, all repairs to public improvements
or utilities damaged as a result of actions, misuse, or lack of care on the part of any of my employees, agents, subcontractors, or suppliers of materials
of said public improvements or utilities.
Finally, I acknowledge that approval and issuance of any building permit by the City of Madison, including the one applied for hereby, does not speak in
any way to the compliance of this project with any private covenants, conditions, rules, or requirements which may run with or be applicable to the
subject property. I understand and accept that the City’s issuance of a building permit shall not in any way be deemed to be an active or passive grant
of permission for the owner or any other person, contractor, subcontractor or company, including me as applicant, to violate or otherwise circumvent
the requirements of any applicable covenants or rules established by private associations or entities. I fully acknowledge that determining the
existence and/or applicability of any private covenants of any kind to the subject property IS NOT the responsibility of the City of Madison or its agents
or employees.
Applicant Signature: Date:
Chief Building Official: Date: □ Not Approved
Engineering/Floodplain: Date: □ Not Approved
Zoning Administrator: Date: □ Not Approved
FOR OFFICE USE ONLY
Zoning Action:
□ Approved □ Not Approved – See Comments
□
No Planning Commission approved site plan provided. □ Primary use of structure has changed and is not permitted
□
Comments:
2
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Residential-Permit-Application-BLDG-2019new Building Permit

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Completed 13 July 2020

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