Fillable SYRACUSE CITY BUILDING PERMIT APPLICATION (Syracuse City)

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SYRACUSE CITY BUILDING PERMIT APPLICATION (Syracuse City)

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No. of Bldgs.
No. of Stories Walls Roof Sewer Conn.
Storm Sewer Impact
Frame
Concrete NDSD Impact
Brick
Steel Garbage
Sq. Ft. Porch/Patio
Other
Yes
No
Fire Sprinkler
Yes
No
Plan Check by:
Signature of Approval
Date
This permit becomes null and void if work or construction authorized is not
commenced within 180 days, or if construction or work is suspended or abandoned
for a period of 180 days at any time after work is commenced. I hereby certify that I
have read and examined this application and know the same to be true and correct.
All provisions of laws and ordinances governing this type of work will be complied with
whether specified herein or not the granting of a permit does not presume to give
authority to violate or cancel the provisions of any other state or local law regulating
construction or the performance of construction and that I make this statement under
penalty of perjury. *This permit does not become a permit until signed below*
Signature of Contractor or Authorized Agent
Signature of Owner (if owner)
Certificate of Occupancy
NOTE: 24 hour notice is required for ALL Inspections PLEASE FILL OUT SHADED AREA ONLY
Traffic Zone
Date
Email
Date:
Minimum Setbacks in Feet
Front
Side
Side
Rear
Census Tract
Date
City
General Contractor
Zone:
Disapproved
Approved by:
Approved
Phone
Assessor's Parcel No.
Lot No. Subdivision/Phase#
Total Property Area - In sq. ft.
Total Bldg. Site Area Used
Zip
Email
Plumbing Contractor
License
Zip
Phone
City
Address
Sign
Repair
License
Architect/Engineer
Phone
Tenant/Business Name
Rough Basement:
Date of Application
R - Values Water Conn.
Comments:
Fire Alarm
Yes
No
Traffic Impact
State Fee
Constr. Meter
No. of
Bedrooms
Type of Construction
Brick Var.
Max. Occ. Load
Block
No. of
Bathrooms
Public Safety Fee
TOTAL
Email
Zip
Build
Move
Remodel
Convert Use
Addition
Demolish
City Zip Phone
Email
Mechanical Contractor
License
Address
Previous Usage of Land or Structure (past 3 years)
Dwell. Units Now on Lot: Accessory Buildings Now on Lot:
Type of Improvement/Kind of Construction
Zip
City
Email
License
City
Phone
Address
SUB-CHECK
Electrical Contractor
License
Address
No. of Offstreet Parking Spaces:
Covered:
Uncovered:
Owner
Business License No.
Address
Phone
No. of
Dwellings
Park Fee
Other
Indicate Street
if Corner Lot
Sub-Check by:
Indicate North
Brick Design
U Factor Window
Date Work to Begin
Receipt No.
Date Issued
Proposed Use
Bldg. Address
Finished Basement:
SYRACUSE CITY BUILDING PERMIT APPLICATION
Syracuse City Building Department - 1979 W 1900 S - Syracuse, Utah 84075 - Telephone 801-614-9670
Permit No.
SYR
Carport Sq. Ft.:
Sq. Ft. of Building:
Building Fee Schedule
Valuation: $
Type of Bldg. Occ. Group
Garage Sq. Ft.:
Building Fee
Plan Check Fee
Sec. Conn.
Water Impact
Sec. Impact
If any person takes occupancy prior to receiving 'Certificate of Occupancy'
document from Syracuse City, the Contractor/Permit Signee will be cited
with a Class B misdemeanor according to the adopted ordinance.
Bedroom
Living
Room
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Laundry
Room
Syracuse City Basement
Plan Example
Please Include on Plan:
Name and Address.
Room Labeling (indicate whether or not room will remain unfinished or an area is previously finished).
Location of Smoke and Carbon Monoxide Detectors (1 in each bedroom and hallway).
Dimensions of each room.
DEPARTMENT OF COMMERCE OWNER/BUILDER CERTIFICATION
Division of Occupational and and
Professional Licensing AGREEMENT TO COMPLY WITH THE
Bureau of Investigation CONSTRUCTION TRADES LICENSING ACT
160 E 300 S
PO Box 146741
Salt Lake City UT 84114-6741
Email to jwoolf@utah.gov
Or Fax to 801-530-6301, Attn: Jody Woolf
[ ] New Residential Construction
[ ] Remodel or Addition by Owner
Name of Owner/Builder: ___________________________________________________________________________________
Current Address: _________________________________________________________________________________________
City, State, Zip: ___________________________________________________________________________________________
LOCATION OF CONSTRUCTION SITE:
Address: ________________________________________________________________________________________________
City, State Zip: ___________________________________________________________________________________________
Subdivision: _____________________________________________________________________ Lot No. _________________
CERTIFICATION
I, ___________________________, certify under penalty of perjury that the following statements are true and correct and are based
upon my understanding of the Utah Construction Trades Licensing Act:
1. For New Residential Construction Only. I am the sole owner of the property and construction project at the above
described location; the project described is the only residential structure I have built this year; I have not built more than three
residential structures in the past five years.
For New Residential and Remodel Construction:
2. The improvements being placed on the property are intended to be used and will be used for my personal, non-
commercial, non-public use:
3. I understand that work performed on the project must be performed by the following:
a. myself as the sole owner of the property; or
b. a licensed contractor; or
c. my employee(s) on whom I have Workers Compensation Insurance coverage, on whom I withhold and pay all
required payroll taxes, and with respect to whom I comply with all other applicable employee/employer laws; or
d. any other person working under my supervision as Owner/Builder to whom no compensation or only token
compensation is paid; and
4. I understand that if I retain the services of an unlicensed contractor or compensate an unlicensed person, other than token
compensation, or other than as an employee for wages, to perform construction services for which licensure is required, I
may be guilty of a Class A Misdemeanor and may be additionally subject to an administrative fine in the maximum of
$2,000.00 for each day on which I violate the Utah Construction Trades Licensing Act.
Dated this ______ day of _________ 20___
________________________________________
Signature of Owner/Builder
Subscribed and Sworn before me this ____ day of ___________ 20__, in the County of ____________ State of Utah.
My Commission Expires: ______________________ __________________________________
Notary Public
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SYRACUSE CITY BUILDING PERMIT APPLICATION (Syracuse City)

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Completed 16 July 2020

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