Fillable Temporary Shelter Permit Application (City of Grove City)

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Temporary Shelter Permit Application (City of Grove City)

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BROWSE CITY OF GROVE CITY (OH) FORMS

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Grove City Building Division
4035 Broadway
Grove City, OH 43123
614-277-3075 (Phone)
614-277-3090 (Fax)
GroveCityOhio.gov
Revised 1/2017
A permit is required to provide temporary shelter to persons in any legal building that is not classified as “R” use group. You
should understand and follow the instructions on the following four pages if you are proposing to provide a temporary shelter.
Duration of use. Facilities may be used as temporary shelter for a period of time not to exceed seven consecutive days during
a 30-day period, and a maximum of 35 days in any calendar year. Facilities may provide temporary overnight shelter to no more
than 15 persons in one 24-hour period.
Limitations on existing buildings. All persons receiving temporary shelter shall sleep and eat within the building. No person
shall eat or be housed in tents, lean-tos or other temporary facilities. No building or structure shall be erected, enlarged or
modified for temporary shelter without an approved permit as required by the Ohio Building Code.
Conformance with local and state laws. A facility providing temporary shelter to persons must be operated in conformance
with all local and state laws. The City will conduct safety inspections to ensure that:
• The number of persons sheltered in a facility does not exceed the maximum square footage and occupancy standards
contained in the Ohio Building Code; and
• The facility has adequate egress and fire detection systems for life safety.
Completed application forms. A separate application shall be filed for each site. Each application must be signed by one of
the following:
• All owners of the real property included in the site; or
• A person having lawful power of attorney therefore.
Description of subject property. A description of the property is required encompassing the property and listing the address
and parcel I.D. A simple drawing of the proposed area of the building must be submitted with the application.
Building plans. There are two options to obtain occupancy and use approval under the Ohio Building Code, select one.
1. Change of use. Owner may request a one-time application for change of use by submitting construction documents with
an application in an existing building involving no new construction or additional square footage. This includes four copies
of plans and information showing: description of building and address; clear outline of the building and area where shelter
activities will occur; determination of compliance with change in occupancy/use as delineated in the Ohio Building Code,
including means of egress, sanitary facilities, light and ventilation features, fire-resistance rating of building, fire protection
features and cooking facilities.
2. Time-limited occupancy. Ohio Building Code Section 110.1.5 permits an alternative building use for a specific time limit
provided there are no pending building violations and, after inspection, the proposed use is not deemed to endanger public
safety or welfare. Upon written request of the owner, the building official may approve use for an alternative purpose on a
temporary basis, contingent upon compliance with all special conditions. Owner must submit a written request using Form A
for each intended period of use. Certificate of Occupancy will be valid only for that specific period.
Management plan. A Permit Application for temporary shelter in facilities must contain a management plan that describes the
physical and operational characteristics of the proposed use.
TEMPORARY SHELTER
PERMIT APPLICATION
Page 1 of 5
Grove City Building Division
4035 Broadway
Grove City, OH 43123
614-277-3075 (Phone)
614-277-3090 (Fax)
GroveCityOhio.gov
Revised 1/2017
Application Type o Initial Application o Permit Renewal
Property Address _______________________________________________________________________________________________________
Parcel I.D. _____________________________________________________________________________________________________________
This operation will commence ______________________________ and conclude ____________________________ .
Description of Property:
Existing Property Use ___________________________________________________________________________________________________
Proposed Property Use _________________________________________________________________________________________________
CONTACT PERSON
Print Name ____________________________________________________________________________________________________________
Address ________________________________________________________________City/State/Zip __________________________________
Phone Number _____________________________________________ Fax Number _______________________________________________
Email Address _________________________________________________________________________________________________________
OFFICE USE
Date Entered ________________________________ Date Issued __________________________________
APPLICATION APPROVAL
Grove City Building Division Grove City Division of Police Jackson Township Fire Department
or Franklin County Sheriff
_________________________________ _______________________________ _______________________________
Chief Building and Zoning Official Police Chief/Sheriff Fire Chief
TEMPORARY SHELTER
PERMIT APPLICATION
Page 2 of 5
Grove City Building Division
4035 Broadway
Grove City, OH 43123
614-277-3075 (Phone)
614-277-3090 (Fax)
GroveCityOhio.gov
Revised 1/2017
TEMPORARY SHELTER MANAGEMENT PLAN
A permit application for temporary overnight shelter in facilities must contain a management plan which describes the physical and
operational characteristics of the proposed use. Answers to the following questions constitute such a management plan. You may
attach additional sheets if necessary.
DURATION OF USE
Will facilities be used as temporary overnight shelter for homeless persons for a maximum of 35 days in any calendar year?
o Yes o No
Will facilities provide a temporary overnight shelter to homeless persons to no more than 15 persons in one 24-hour period? o Yes o No
Birth to 18 months: __________ clients 19 months to 17 years: __________ clients 18 years or older. __________ clients
CLIENT SUPERVISION
Who will operate the shelter program? Name ____________________________________________________________________
Phone Number ________________________________ Email _____________________________________________________________________
Who will supervise the shelter program? Name ____________________________________________________________________
Phone Number ________________________________ Email _____________________________________________________________________
How will clients who are denied access to the shelter be escorted from the premises?
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
How are clients transported to/from the site?
Will registered sex offenders be housed at this location? ___
o Yes o No
Do you have a system in place to identify registered sex offenders? o Yes o No
It is recommended that the operators of the shelter maintain an emergency log with guests’ names, next of kin
and contact information.
BUILDING APPROVAL
Option A: Building plans have been submitted to the building official for a change of use.
o Yes o No
Required for initial application and renewal only if changes to building use.
Option B: The owner shall submit a written request for time-limited occupancy for each period.
o Yes o No
Attach simple floor plan drawing for area of building proposed for use.
Will shelter activities be located in tents, lean-tos or other temporary structures?
o Yes o No
DOCUMENTATION OF EVACUATION AND EMERGENCY TRAINING
Persons acting as “supervisors” of “overnight guests” at locations that house these persons for this program
shall be trained in, but not limited to, the following minimal actions for emergency response:
Know the location of evacuation routes, including two means of egress from all “sleeping areas” in the building.
o Yes o No
Location of the “accountability points” outside the building in case of a fire. o Yes o No
Location of and training in the use of portable fire extinguishers. o Yes o No
Location of and access to telephones for emergencies of any type. o Yes o No
Knowledge of the stipulations placed in the variance for the program to continue. o Yes o No
(e.g. fire department being notified, no portable cooking equipment, no smoking, etc.)
TEMPORARY SHELTER
PERMIT APPLICATION
Page 3 of 5
Grove City Building Division
4035 Broadway
Grove City, OH 43123
614-277-3075 (Phone)
614-277-3090 (Fax)
GroveCityOhio.gov
Revised 1/2017
o Yes o No
o Yes o No
o Yes o No
o Yes o No
o Yes o No
o Yes o No
o Yes o No
o Yes o No
o Yes o No
o Yes o No
o Yes o No
o Yes o No
o Yes o No
TEMPORARY SHELTER MANAGEMENT PLAN
SHELTER OPERATION
Smoking is strictly prohibited in any portion of the building. Legible “No Smoking” signs shall be posted
throughout all areas of the building in which “guests” stay.
Candles are strictly prohibited.
An approved fire alarm system shall be located and operational in all areas where “guests” are sleeping.
The fire-alarm system shall be in operation at all times the “guests” are staying in the building.
Emergency evacuation plan shall be developed and routes shall be posted from all areas of the building
in which any person participating in the program has access.
Portable cooking and unapproved heating equipment is not allowed in the building.
Portable fire extinguishers must be present and accessible to all persons involved in the program, in all areas
used by the program participants.
There shall be two approved means of egress from any area or rooms where the program “guests” are staying
overnight in the building.
The overnight stays of “guests” are limited to the hours between 5 p.m. and 9 a.m. No stays longer than seven
consecutive days are permitted.
All persons acting as supervisors to the “guests” shall be trained in the procedures to follow in the event of a
fire in the facility.
At least one person supervising the “guests” must be awake and oriented during the hours “guests” are present
(between 5 p.m. and 9 a.m.).
An operational telephone system shall be immediately accessible to any occupant of the building at all times
during the program in the event of an emergency.
The Grove City Building Division shall be notified of the presence of these “guests” a minimum of two weeks
prior
to commencement of the event.
The Grove City Building Division and the Jackson Township Fire Department shall conduct an inspection of the
facility prior to the event commencing to ensure that all life-safety systems and procedures are in place for the
program. Any life-safety features that are not functional at the time of the inspection shall be corrected prior to
the commencement of the program. Failure to correct the problems will result in the revocation of the permit.
A copy of the approved fire-safety and evacuation plan shall be available onsite at all times.
o Yes o No
TEMPORARY SHELTER
PERMIT APPLICATION
SIGNATURE OF OWNER
Name __________________________________________________________________________________________________________________
Address _______________________________________________________________ City/State/Zip___________________________________
Phone _____________________________________ Email _____________________________________________________________________
Signature ___________________________________________________________________________ Date _____________________________
Page 4 of 5
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Grove City Building Division
4035 Broadway
Grove City, OH 43123
614-277-3075 (Phone)
614-277-3090 (Fax)
GroveCityOhio.gov
Revised 1/2017
FORM A: REQUEST FOR TIME-LIMITED OCCUPANCY CERTIFICATE
FROM: Contact Name ________________________________________________________________________
Applicant Site ________________________________________________________________________
Address _____________________________________________________________________________
City _____________________________________ State __________________ Zip _______________
Email ________________________________________________________________________________
TO: Michael P. Boso
Chief Building & Zoning Official
City of Grove City
4035 Broadway
Grove City, OH 43123
Please accept this request for a time-limited Certificate of Occupancy for the above-named location for the purpose of
conducting a temporary homeless shelter.
This operation will commence ______________________________ and conclude ____________________________
in conjunction with this request, we attest that:
The maximum number of occupants for this timeframe will not exceed 15 guests (not including shelter volunteers).
o Yes o No
A valid fire-code permit has been obtained for this special use and location.
o Yes o No
All provisions delineated under the fire code have been satisfied.
o Yes o No
No structural changes have been made to the above building since last use.
o Yes o No
There are no pending violations of law or orders of the Building Division.
o Yes o No
The Jackson Township Fire Department has been notified and will perform an inspection prior to this use.
o Yes o No
Thank you,
Signature (Owner’s Representative) ______________________________________________________________________
Printed Name __________________________________________________________________________________________
Title _____________________________________________________________ Date _______________________________
TEMPORARY SHELTER
PERMIT APPLICATION
Page 5 of 5
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Temporary Shelter Permit Application (City of Grove City)

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Completed 18 July 2020

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