Fillable Sfd Building Permit Application 3-20 19 (Polk County)

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Sfd Building Permit Application 3-20 19 (Polk County)

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Polk County Public Works
5885 NE 14
th
Street
Des Moines, IA 50313
publicworks@polkcountyiowa.gov
515-286-3705
Single Family Home Building Permit Application and Checklist
PROJECT ADDRESS: _______________________________________________________ GEO PARCEL#: ______________________________
IS A NEW ADDRESS NEEDED? YES/NO
Checklist of items to be filled out or completed prior to submitting application packet:
_____
Building Permit Application and checklist
_____ Detailed Construction Plans-
2 Copies: PDF & hard copy
_____ Engineered Truss Specifications
_____
Energy
Compliance Certificate, res check must be submitted, completed by a
certified
HERS rater in the State of Iowa
_____
Detailed Site
Plan
Drawing
_____ Proposed building staked
_____ Ownership within the last 30 days? A legal description and copy of recorded deed
must be in submitted.
_____ Entrance Permit Application
Septic or Sewer:
_____ If a septic system is needed, results of
a soil analysis/
soil perc test and a septic system permit application packet must be completed
by a certified contractor licensed with Polk County, must be submitted.
_____ If sanitary sewer is available, a completed
sanitary
sewer connection permit and agreement must be submitted
Water:
_____ Public water service connection fee
_____ Well-
Well permit application required
_____ Geothermal-
well permit application (if applicable) for vertical geothermal wells and horizontal wells at 20' depth or greater.
_____ Right-of-way work-
ROW Grant permit application (if applicable) for work within the ROW
_____ Home occupation-
Is any portion of the proposed home to be used for commercial or other
business
activities? YES/NO
*If yes, a home occupation permit must be applied for
-No construction shall start until the permit is issued.
-All work must be permitted prior to inspections.
-Unresolved Zoning, Subdivision, Floodplain, Health items may delay the issuance of any permit. No structure should be used or
occupied until the certificate of occupancy is issued.
-All
electrical,
mechanical, or plumbing permits
must be applied for separately by a state licensed contractor.
Polk County Public Works
5885 NE 14
th
Street
Des Moines, IA 50313
publicworks@polkcountyiowa.gov
515-286-3705
Single Family Home
Building Permit Application
JOB SITE ADDRESS: ________________________________________________
GEO PARCEL: ______________________________________
OWNER: ____________________________________________________________
PHONE: _______________________________________
ADDRESS: _____________________________________________ CITY: ______________________ STATE: _______ ZIP:
________________
EMAIL: ___________________________________________________________________________________________________________
CONTRACTOR: _______________________________________________________ PHONE: _______________________________________
COMPANY: __________________________________________________________
ADDRESS: _____________________________________________ CITY: ______________________ STATE: _______ ZIP: ________________
EMAIL: ___________________________________________________________________________________________________________
(Please circle one)
NEW or MOVE-ON
Height of proposed building to peak: _________ Total # of bedrooms: _________
Fill in the square footage of the proposed home in the appropriate row:
Square Feet Rate Valuation
Unfinished basement
Finished basement
1st Floor
2nd Floor
Garage
Deck- Covered/Uncovered
Patio- Covered
3 or 4 season room/ enclosed deck
Front Porch/Stoop- Covered/Uncovered
Total Valuation
Permit fee
Move-On
Total Building
Septic/Sewer Fee
Entrance Permit Fee
Well Fee
TOTAL FEE
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 Occupancy
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 until the building permit has been issued. All information
supplied by me is true and correct, and to the best of my knowledge and belief.
I affirm I am the owner or licensed contractor of this property. I hereby acknowledge that I have read this permit and state
that the
information is correct, and agree to comply with all ordinances and state and federal laws regulating activities covered by this permit.
*Please allow 5-7 business days for permit review and approval
____________________________________________ __________________________________________ _____________________
Print Name
Signature
Date
Permit #______________________
Building Spec Sheet
Job Address:
Type of Use (Including size):
1.
Footings: (42” minimum frost depth)
Depth below grade:
Size of footing or trench:
Size and type of reinforcement:
2.
Foundation wall: (footing tiles to be placed beside footing and in each egress window)
Thickness and type:
Type of waterproofing:
Spacing of anchor bolts: (1/2” dia. Min.)
3.
Slab system: (structural only)
Thickness of slab:
Type of reinforcement:
Spacing of anchor bolts: (1/2” dia. min.)
4.
Floor framing: (list size and grade of lumber)
Size of support beam(s):
Spacing of support beam posts:
Size, span and spacing of floor joist:
Type of floor sheathing:
5.
Wall framing: (list size and grade of lumber)
Size and spacing of wall studs:
Type of wind bracing:
Double Top Plates Required
Thickness and type of insulation:
Type of siding:
Type of interior wall covering:
6.
Roof and ceiling: (List size and grade of lumber)
Size, span and spacing of ceiling joists:
Size, span and spacing of roof rafters:
Truss rafters: Must provide design data from manufacturer
Thickness and type of insulation:
Type of ceiling covering:
Type of attic ventilation:
Comments/ Additional Information
Questions or to schedule inspections after the permit is issued 286-3352
Polk County Public Works – Site Plan Worksheet
Polk County Public Works
5885 NE 14 Street, Des Moines, IA
Phone: 515-286-3705 FAX: 515-286-3437
Email:
publicworks@polkcountyiowa.gov
ENTRANCE PERMIT APPLICATION
PERMIT FEE: $245.00
APPLICANT/LANDOWNER
REPRESENTED BY (if
not
landowner)
APPLICANT
MAILING
ADDRESS
CITY
STATE
ZIP
CODE
PHONE
ALT PH
EMAIL
NAME OF CONTRACTOR DOING WORK
(if applicable) ___________________________________
CONTRACTOR REPRESENTATIVE: _______________________________________
PHONE
ALT
PH
ENTRANCE LOCATION:
S
ITE
ADDRESS
OR ON (STREET
NAME)
OR
(if no
address),
SECTION
,
TOWNSHIP
RANGE
,
FEET
OF
ON
SIDE OF
ROAD
OR
(if no address), ACCESS
TO
LOT
NO.
OF
SUBDIVISION
PROPOSED
SURFACE
WIDTH
OF
THE
ENTRANCE
(in
feet)
TYPE OF ENTRANCE (Check One
)
NEW CURB CUT
WIDEN EXISTING FOR NON
-
FARM USE
NEW OPEN DITCH FOR NON
-
FARM
NEW or WIDEN FARM FIELD ENTRANCE
PAVING (Check One)
TYPE OF USE (Check One)
HEAVY COMMERCIAL
LIGHT COMMERCIAL
NON-PAVED RES
OR FARM
PAVED RESIDENTIAL
DO YOU INTEND TO PAVE THE ENTRANCE? YES NO
If yes, you must schedule an inspection of the form work prior to paving of the entrance.
CHECK THOSE THAT APPLY:
I affirm the information provided for this permit is accurate and correct to the best of my knowledge and belief and that I am the owner or
designated agent, of the property this entrance provides access to.
I understand the work must be completed and inspected within one year of the issue date or this permit will be null and void.
I affirm I have read and understand the entrance standards and stipulations on the attached forms and will complete all work in
accordance with these standards and stipulations.
I understand that if the entrance is to be paved, I will contact the Polk County Public Works Department for an inspection of the form work
prior to paving.
APPLICANT SIGNATURE DATE
CONTRACTOR MAILING ADDRESS: _______________________________________
EMAIL
CITY
STATE
ZIP
CODE
ENTRANCE PERMIT STIPULATIONS
A.
CONSTRUCTION AND MAINTENANCE STIPULATIONS
1.
The entrance, including drainage structure, grading, surfacing and entrance configuration, shall be constructed by
the applicant at the applicant’s expense, in accordance with the attached entrance standard and upon final inspection and
approval shall thereafter be kept in repair and maintained by Polk County. Nothing in this stipulation shall preclude Polk County
from entering upon said entrance on highway right-of-way and performing necessary maintenance for the protection of the
highway. Polk County will not construct paved type surfaces on entrances, but will use gravel only.
2.
The construction, future repair or maintenance of said entrance shall be carried on in such a way as not to interfere
with, or interrupt traffic on said highway, and the owner shall take all reasonable precautions to protect and safeguard the lives
and property of any person or persons, or account of such construction, repair or maintenance operation.
3.
No filling will be permitted in the right-of-way other than necessary to construct the proposed entrance. No
excavations will be made within the limits of the traveled portion of the roadway. The entrance fill is to be compacted by tamping
or rolling as per the approved standards.
4.
The finished surface elevation of the driveway over the pipe or place where the pipe would normally be shall be four
(4) inches lower than the shoulder elevation to prevent water draining onto the pavement or traveled way and the minimum
depth of earth fill over the pipe shall be twelve (12) inches.
B.
GENERAL
1.
The owner’s attention is directed to the fact that private property may not be used so as to obstruct or encumber the
public highway right-of-way, or interfere with the safety, comfort and rights of public highway users.
2.
A copy of the approved application shall be available on the job site at all times for examination by Polk County
officials.
3.
Subject to the approval of this application and upon completion of the constructing of the entrance in compliance
with the terms agreed upon in this document and attachment, no changes in the entrance, including landscape walls or
plantings, or its location shall be undertaken without the prior written approval of the Polk County Engineer.
4.
Polk County shall be responsible for all future maintenance associated with that portion of the access located within
Polk County right-of-way, except pavement placement or repair.
5.
In the future, should this entrance generate sufficient traffic to warrant a need for additional traffic control upon the
roadway system, costs for these improvements shall be the responsibility of the owner and shall be constructed in accordance
with Polk County Standards. These may include, but would not necessarily be limited to, the constructing of turn lanes and/or
signalization.
6.
All provisions herein relating to the construction, repair or maintenance of the entrance shall be binding on all
successors or assigns of the owner.
7.
Upon completion of construction, the applicant shall leave the right-of-way area in as good a condition as prior to
construction.
8.
The Polk County Engineer reserves the right to relocate the proposed entrance to meet minimum required sight
distance for the safety purposes at crest vertical curves, horizontal curves, and intersections.
9.
This entrance permit will be executed prior to the issuing of a building permit.
C.
LIABILITY
1.
The Owner(s) shall indemnify and save harmless Polk County, its agencies and employees, from any and all causes
of action, suits at law or in equity, for losses, damages, claims or demands, and for any and all liability and expense of
whatsoever nature, arising out of or in connection with owner’s use or occupancy of the public right-of-way.
2.
If the Owner(s) should fail to comply with any of the conditions and requirements of this agreement, Polk County
may terminate it, whereupon the owner(s) shall immediately remove any construction undertaken pursuant to this agreement
and restore the access (es) previously existing and any rights granted the owner(s) by this agreement shall end.
D.
NOTIFICATION
1.
Before beginning any work in the highway right-of-way, it is the responsibility of the owner(s) to give the Polk County
Public Works Department, forty-eight (48) hours prior written or verbal notice of owner’s intent to start construction on the
highway right-of-way. The owner shall also notify Polk County Public Works upon completion of construction.
2.
Before beginning any work in the highway right-of-way, it is the responsibility of the owner(s) to contact utility
companies which may be located in the area of the proposed work. Contact should be made by calling One Call at 1-800-292-
8989, a minimum of forty-eight (48) hours in advance of starting construction.
Fire Protection of Wood Floor Assemblies
Section 302.13 2015 IRC. Fire protection of floors.
Floor assemblies shall be provided with a ½-inch gypsum wallboard membrane, 5/8-inch wood
structural panel membrane, or equivalent on the underside of the floor framing member. Penetrations
or openings for ducts, vents, electrical outlets, lighting, devices, luminaires, wires, speakers, drainage,
piping and similar openings or penetrations shall be permitted.
Exceptions:
1. Floor assemblies located directly over a space protected by an automatic sprinkler system in
accordance with Section P2904, NFPA13D, or other approved equivalent sprinkler system.
2. Floor assemblies located directly over a crawl space not intended for storage or fuel-fired
appliances.
3. Portions of floor assemblies can be unprotected when complying with the following:
a. The aggregate area of the unprotected portions shall not exceed 80 square feet per
story
b. Fire blocking in accordance with Section 302.11.1 shall be installed along the
perimeter of the unprotected portion to separate the unprotected portion from the
remainder of the floor assembly.
i. Fireblocking materials.
1. Two-inch nominal lumber.
2. Two thicknesses of 1-inch nominal lumber with broken lap joints.
3. One thickness of 23/32-inch wood structural panels with joints
backed by 23/32-inch wood structural panels.
4. One thickness of ¾-inch particleboard with joints backed by ¾-inch
particleboard.
5. One-half-inch gypsum board.
6. One-quarter-inch cement-based millboard.
7. Batts or blankets of mineral wool or glass fiber or other approved
materials installed in such a manner as to be securely retained in
place.
8. Cellulose insulation installed as tested for the specific application.
4. Approved floor assemblies demonstrating equivalent fire performance by an approved
testing company showing length and time duration for exposure to fire. It shall be defined
by performance equivalent to twenty-six (26) minutes using ASTME 119 standard fire
endurance testing with a superimposed load simulating a maximum load condition (i.e.
100% design load).
RADON MITIGATION
Section AF103.6 Passive subslab depressurization system.
In basements or slab-on-grade buildings, the following components of a passive subslab
depressurization system shall be installed during construction.
A minimum 3-inch diameter ABS, PVC, or equivalent gas-tight pipe shall be embedded
vertically into the subslab aggregate or other permeable material before the slab is cast. A “T”
fitting or equivalent method shall be used to ensure that the pipe opening remains within the
subslab permeable material. Alternatively, the 3-inch pipe shall be inserted directly into an
interior perimeter drain tile loop or through a sealed sump cover where the sump is exposed to
the subslab aggregate or connected to it through a drainage system. The pipe shall be extended
up through the building floors, and terminate at least 12 inches above the surface of the roof in
a location at least 10 feet away from any window or other opening into the conditioned spaces
of the building that is less than 2 feet below the exhaust point, and 10 feet from any window or
other opening in adjoining or adjacent buildings.
Section AF103.5 Passive submembrane depressurization system.
In buildings with crawl space foundations, the following components of a passive submembrane
depressurization system shall be installed during construction.
Exception: Buildings in which an approved mechanical crawl space ventilation system or
other equivalent system is installed.
Crawl spaces shall be provided with vents to the exterior of the building. The minimum net area
of ventilation opening shall not be less than 1 square foot for each 150 square feet of under-
floor space area, unless the ground surface is covered by a Class I vapor retarder material. When
a Class I vapor retarder material is used, the minimum net area of ventilation openings shall not
be less than 1 square foot for each 1,500 square feet of under-floor space area. One such
ventilating opening shall be within 3 feet of each corner of the building.
A plumbing tee or other approved connection shall be inserted horizontally beneath the
sheeting and connected to a 3-or-4-inch diameter fitting with a vertical vent pipe installed
through the sheeting. The vent pipe shall be extended up through the building floors, and
terminate at least 12-inches above the roof in a location at least 10 feet away from any window
or other opening into the conditioned spaces of the building that is less than 2 feet below the
exhaust point, and 10 feet from any window or other opening in adjoining or adjacent buildings.
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Sfd Building Permit Application 3-20 19 (Polk County)

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Completed 16 July 2020

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