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TULLAHOMA P C R SUBDIVISION PLAT APPLICATION EGIONAL (City of Tullahoma)

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BROWSE CITY OF TULLAHOMA (TN) FORMS

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TULLAHOMA
R
EGIONAL
P
LANNING
C
OMMISSION
321 North Collins Street, Tullahoma, Tennessee, 37388
OFFICE: 931.455.2282 FAX: 931.454.1765
SUBDIVISION PLAT APPLICATION
Name of Subdivision Section Number (if applicable) Date of application
Type:
Preliminary
Final (Major)
Final (Minor – Includes Resubs)
Partition
Construction Plans
Applicant/ Developer
Mailing Address City State Zip
Phone Number Fax Number Email
Project Engineer/Surveyor
Mailing Address City State Zip
Phone Number Fax Number Email
NOTE: The applicant is responsible for notifying the Planning & Codes Department of any changes
to contact information.
1.
PLEASE COMPLETE THE FOLLOWING PROPERTY INFORMATION:
Tax Map Group Parcel Deed Book Page Number
Civil District
County
Number of Proposed Lots
Was a concept meeting held with staff?
YES
NO
If yes, on what date did this meeting occur:
2.
ADDITIONAL REQUIRED INFORMATION:
A copy of the owner’s deed
Note: NPDES is required by the state if more than 1 acre of land is to be disturbed.
NOTES: The applicant is responsible for submitting final plats to the Coffee County or Franklin
County Register of Deeds Office for recording. Please contact the County Register of Deed Office
for recording fees. Recorded plats become a part of the permanent files of the Planning and Codes
Department.
A Land Disturbance Permit and associated fees will be required to be paid before commencing any grading
activities.
I hereby certify that the information contained in this application is true and correct to the best of my
knowledge and belief.
Applicant’s Signature: Applicant’s Name (Printed): Date:
STAFF USE ONLY
1.
Submittal Type Fees Total
Preliminary Plat/ Construction Plans(Major)
$15.00 per lot/ $400 per construction plans
Final Plat $10.00 per lot
Received by: Date: Receipt Number:
NAME OF PROJECT____________________________________________________________
ADDRESS OF PROJECT ____________________________________ DATE ______________
POST OFFICE/ZIPCODE_______________________________PROPOSED ROUTE #_______
This Project is: NEW CONSTRUCTION ___ RENOVATION ___ (If renovation, please complete
conversion request)
E
stimated 1
ST
Occupancy Date: ________ 10% Occupancy: ________ Completion: _______
Delivery options will be explained by USPS representative (options shown in gray below).
Type of Project Deliveries Equipment-Type / # EQUIPMENT OPTIONS
Office Bldg (__Floors) ______ ___________________ CBU Type I (8 Del)
Shopping Mall ______ ___________________ CBU Type II (12 Del)
Strip Mall ______ ___________________ CBU Type III (16 Del)
Apts./Condos (__Floors) ______ ___________________ CBU Type IV (13 Del)
Townhouses ______ ___________________ Curb line 2/post
Single Family Homes ______ ___________________ Curb line 4/post
Trailer Park ______ ___________________ Wall mount STD 4C
Other (Specify) ______ ___________________
DEVELOPER / CONTRACTOR / OWNER RESPONSIBILITY IS AS FOLLOWS:
Location and installation of all receptacles must be approved by USPS representative.
C
oncrete pads for CBU’s are required to meet USPS specifications.
Concrete pads for CBU’s are installed by: Developer _X_ other __
Equipment purchased by: Developer _X_ other __
Equipment installed by: Developer _X_ other __
Equipment owned/maintained by: Developer __ other __
Keys issued to residents by: Developer _X_ USPS __ other __
Locks changed by: Developer __ USPS __ other __
Residents of single-family homes must be informed of their ongoing responsibility for keys;
box maintenance/repair, snow removal, etc.
Note: On multi-tenant delivery and/or rental situations, the building owner/manager is responsible
for lock changes. Owner/manager will handle parcels and accountable? Yes __ No __
This notice will serve as an Agreement / Letter of Consent to the Postal Service for the placement of Centralized Delivery
Equipment at the agreed upon location(s) indicated on the plat map. By signing below, I acknowledge that the contractor
options and responsibilities outlined above for receiving mail delivery service have been discussed with me.
USPS REPRESENTATIVE PROPERTY DEVELOPER/MGR/OWNER
NAME____________________________ NAME_________________________________
TITLE____________________________ TITLE_________________________________
SIGNATURE_______________________ SIGNATURE___________________________
TELEPHONE #_____________________ TELEPHONE #_________________________
DATE_____________________________ DATE_________________________________
This agreement is subject to final approval by District Operations Programs Support. Submit
completed agreement and other required attachments to the local Post Office to forward to
the Growth Management, Operations Programs at the TN District Office
MODE OF DELIVERY AGREEMENT
TENNESSEE DISTRICT
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TULLAHOMA P C R SUBDIVISION PLAT APPLICATION EGIONAL (City of Tullahoma)

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Completed 16 July 2020

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