Fillable Residentialpermit Madison County Property Improvement Check List (Madison County Government)

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Residentialpermit Madison County Property Improvement Check List (Madison County Government)

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BROWSE MADISON COUNTY GOVERNMENT (NC) FORMS

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Madison County Property Improvement Check List
Property Owner:______________________ Previous Owner:_______________________
Phone:_________________ Cell:________________ Email:_____________________
Department
Initial
Date
Township
MA Number
Tax Assessor
Parent Pin
Temp Pin
Street Name of Property
Vacant Property
Yes
No
Notes
Town Limits?
Sewer
Yes
No
Yes
No
Yes
No
Zoning
Town Signature:_______________________
Department
Initial
Date
Special Notes
Environmental Health
Department
Initial
Date
Special Notes
911 Center
Fixed Address
Department
Initial
Date
Disposal Card
Solid Waste
Disposal Card
Town of
Department
Initial
Date
Residential
Commercial
Building Inspections
Zoning
Revised: 04/07/2014
Property Owners:_________________________ Phone:____________________________
Madison County
Application for Zoning Permit
Applicant/Owner Information:
Name: ______________________________ Date: ___________________
Address: _____________________________________________________________
Phone #: Day: _____________________ Evening: ___________________
Property Information:
PIN#:_____________________________ LOT SIZE (acreage):__________________
Property Address: _______________________________________________________
Zoning Classification: __RA __C __A-O
__N-C __R-1 __R-2
__I-D __CMU
Flood Plain: Watershed:
Floodplain: ____Y ____N Watershed: ____Y ____N
Protected Ridge: ___Y ___N
Setbacks:
Please provide a property map showing the location of your project with the
setbacks marked.
New Construction Dwelling Accessory Structure
15’ side setback 10’ side and rear property line
20’ rear 20’ street or highway right of way
40’ front
There shall be a 30’ setback from all creeks in the Watershed District.
NOTES: Permit #:____________
Certifications:
If a permit is granted I/We the undersigned agree to conform to all county ordinances and codes.
Furthermore we agree to meet all state mandated standards such as health, building safety, and fire. I
hereby swear that the above information is truthful and accurate to the best of my understanding.
Signature of Applicant: _________________________________ Date: __________
www.madisoncountync.org/zoning.php
828-649-3766
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APPLICATION FOR BUILDING PERMIT
MADISON COUNTY INSPECTIONS
OWNE
R
______________________________________ DATE________________________________
MAILING ADDRESS___________________________________________________________________ TELEPHONE__________________________________
BUILDING LOCATION/DIRECTIONS______
_________________________________________________________________________
___________________________________________________________________________________________________________
PIN NUMBER___________________________________ ACREAGE__________________ ZONING CLASSIFICATION__________________
TOWN JURISDICTION:____Y ____N TOWN APRROVALS : ____Y ____N TOWNSHIP:________________________
OCCUPANCY: SINGLE FAMILY MULTI-FAMILY COMMERCIAL
TYP
E OF WORK: NEW ADDITION RENOVATION CHANGE OF USE DEMOLITION REPAIR UPFIT
USE
OF PROPERTY: OWNER OCCUPIED RENTAL SALE LIEN AGENT NUMBER: ________________________
PRO
JECT DESCRIPTION______________________________________________________________________________________________________________
TOTAL ESTIMATED COST OF PROJECT__________________ NO. OF STORIES___________________
CONSTRUCITON TYPE____________________________
LENGTH_____________ WIDTH_____________ # BEDROOMS__________________ BATHROOMS________________
BASEMENT________ CRAWL SPACE_______ SLAB______ BASEMENT FINISHED YES____ NO____
DWELLING SQ. FT. _______________ GARAGE SQ. FT._____________________ TOTAL SQ. FT. _____________________
PERMIT COST: Bldg: __________________ Zoning: _________________
Total:___________________
GENERAL CONTRACTOR____________________________________________ LICENSE NO.____________________
Contac
t Number _____________________________ Address____________________________________________________
SUBCO
NTRACTORS:
ELE
CTRICAL CONTRACTOR__________________________________________ LICENSE NO.____________________
Con
tact Number _____________________________ Address____________________________________________________
PLUMBING CONTRACTOR___________________________________________ LICENSE NO.____________________
Con
tact Number _____________________________ Address____________________________________________________
MECHANICAL CONTRACTOR________________________________________ LICENSE NO.____________________
Con
tact Number _____________________________ Address____________________________________________________
GAS CONTRACTOR_________________________________________________ LICENSE NO.____________________
Con
tact Number _____________________________ Address____________________________________________________
The undersigned hereby certifies that he/she is the contractor and authorized agent of the owner and the above information is correct to
the best of his/her knowledge and hereby makes application for a permit and inspection of work described above. All work will be done
in accordance with all applicable State and local laws and regulations.
__________________________________________________ _________________ ____________________________________________________________
Signature Date Printed name
APP
ROVED BY:__________________________________ DATE____________ PERMIT NUMBER:_________________________________________
www.madisoncountync.org/permits.php
828-649-3766
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The following must be turned in with plans at the time of building permit application.
BUILDING
FOOTING: DEPTH _______________ WIDTH _______________
REINFORCEMENT ___________________________
FOUNDATION WALL: TYPE______________________________
SIZE ______________________________
AMOUNT OF BACKFILL ___________
FRAMING:
FLOOR JOIST: TRUSS_________ 2X__________
TGI ___________
SPACING ______OC
WALLS: 2X_________ SPACING _______OC
ROOF/CEILING: TRUSS_________ 2X__________
TGI ___________
SPACING _________OC
LOG HOME: LOG SIZE______________
DECK: FOOTER SIZE____________
POST SIZE _____________
JOIST SIZE______________
IN ALL APPLICATIONS IF A DESIGN IS PROVIDED IT MUST BE SEALED BY A NORTH CAROLINA REGISTERED
DESIGN PROFESSIONAL.
www.madisoncountync.org/permits.php
828-649-3766
ELECTRICAL
AMPERE SERVICE:______________________
TYPE: UNDERGROUND__________________ OVERHEAD__________________
PREMISE OR ACCOUNTY NUMBER: _______________________________________
French Broad Electric ______
Progress Energy _______
Haywood Electric_______
PLUMBING
NUMBER OF FIXTURES:___________________________
SEPTIC APPROVED FOR ________ NUMBER OF BEDROOMS
Septic (new) _____
Septic (existing) ______
Town Sewer ________
HEATING
TYPE OF HEAT: Electric______________
Gas: LP ________ Natural ___________
Oil ___________ Wood____________
FIREPLACE: Yes ____ No ________
MASONRY _______________ INSERT ______________ GAS______________
RESCHECK: YES______ NO ________ (REQUIRED FOR ALL LOG HOMES)
INSULATION TYPE: ________________
R-VALUES: FLOOR____________
CEILING __________
WALLS ___________
www.madisoncountync.org/permits.php
828-649-3766
AFFIDAVIT OF WORKERS’ COMPENSATION COVERAGE
N
.C.G.S. 87-14
The undersigned applicant for Building Permit # ________________________ being the
____________ Contractor
____________ Owner
____________ Officer/Agent of the Contractor or Owner
do hereby aver under penalties of perjury that the person(s), firm(s), or corporation(s)
performing the work set forth in the permit:
____________ has/have three or more employees and have obtained workers
compensation insurance to cover them,
____________ has/have one or more subcontractor(s) and have obtained workers’
compensation insurance covering them,
____________ has/have one or more subcontractor(s), who has/have no employees and
has waived in writing their right to coverage by their contractor or have
their own policy of workers’ compensation covering themselves,
____________ has/have not more than two employees and no subcontractors,
while working on the project for which this permit is sought. It is understood that the
Inspections Department issuing the permit may require certificates of coverage and/or
waivers of workers’ compensation insurance coverage prior to issuance of the permit and
at any time during the permitted work from any person, firm or corporation carrying out
the work.
Firm Name: _____________________________________________________________
By: ____________________________________________________________________
Title: ___________________________________________________________________
Date: ___________________________________________________________________
www.madisoncountync.org/permits.php
828-649-3766
LIEN AGENT INFORMATION
EFFECTIVE APRIL 1, 2013
In accordance with North Carolina General Assembly Session Law 2012-158, Inspection Departments are not allowed to
issue any permit where the project cost is $30,000 or more unless the application is for improvements to an existing
dwelling that the applicant uses as a residence OR the property owner has designated a lien agent and provided the
inspections office with the information below:
Name of Lien Agent: __________________________________
Mailing Address of Agent: ______________________________________________
Physical address of Agent: ______________________________________________
Telephone: _________________________ Fax: ____________________________
Email: _______________________________________________________________
CONTRACTOR AND CONSTRUCTION SITE INFORMATION
Name of Contractor and/or Owner: _________________________________________
Telephone: __________________________________ Fax: _____________________
Construction Site Address and/or parcel #: ___________________________________
I certify that to the best of my knowledge, the above statements provided are true and correct.
Signature of Contractor/Owner: ___________________________________ Date: ________________________
The Information will be attached to the permit record and a copy provided to the applicant. The applicant is required
to post a copy on the construction site. For further information regarding the Lien Agent process you may visit
liensnc.com or contact Nancy Ferguson at 800-445-9983 or email her at Nancy.Ferguson@ctt.com
Excerpt from North Carolina G.S. 153A-357:
(Effective April 1, 2013) No permit shall be issued pursuant to subdivision (1) of subsection (a) of this section where the
cost of the work is thirty thousand dollars ($30,000) or more, other than for improvements to an existing single-family
residential dwelling unit as defined in G.S. 87-15.5(7) that the applicant uses as a residence, unless the name, physical and
mailing address, telephone number, facsimile number, and electronic mail address of the lien agent designated by the
owner pursuant to G.S. 44A-11.1(a) is conspicuously set forth in the permit or in an attachment thereto. The building
permit may contain the lien agent's electronic mail address. The lien agent information for each permit issued pursuant to
this subsection shall be maintained by the inspection department in the same manner and in the same location in which it
maintains its record of building permits issued.
MADISON COUNTY INSPECTIONS DEPARTMENT
www.madisoncountync.org/permits.php
828-649-3766
Lien Agent #: _____________________
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Residentialpermit Madison County Property Improvement Check List (Madison County Government)

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Completed 19 July 2020

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