Town of Signal Mountain, TN
APPLICATION FOR PERMIT
BUILDING ELECTRICAL MECHANICAL GAS PLUMBING
Application is made for permit to build, alter, repair, add to or demo a building or structure as indicated below:
PLANS, SPECIFICATIONS, DRAWINGS and PLOT DIAGRAM are attached to this application.
Location
Street
Address:
NATURE OF WORK OR INSTALLATION
(check all that apply)
Lot No: Tax Map:
Building
New
Replace
Owner
Name:
Alteration / Repair
Address:
Addition
City & St.
Phone:
Electrical
Wiring
Contractor
Name:
Meter Centers
Address:
Plumbing
Complete Installation
City & St.,Zip
Off Ph:
Water Heater
Cell Ph:
State
License No.:
Exp.
Date:
Complete Installation
Arch
/
Eng
Gas Piping
PLANNING & ZONING INFORMATION
Type of
Occupancy:
Lot Size:
(sq ft)
Total
Height:
Zone: Number of
Stories:
Setback from
Property Line: Front
Side:
Rear:
Approved
Rejected __________________________________________________
(Date) (Building Official)
Total Livable
Floor Space:
Total
Floor Space:
Approximate
Completion Date:
Contract or
Construction Cost: $
Fee________________ Penalty_____________ Total ______________
PERMIT EXPIRES IN 180 DAYS WITHOUT PROPER INSPECTIONS.
REMARKS: This project may be subject to the architectural standards of 2010 ADA
Standards for Accessible Design (2010 Standards). Issuance of building permit does not
certify compliance with this Federal statute. Copies of the guidelines and information
concerning 2010 ADA may be obtained through Architectural and Transportation
Barriers Compliance Board (http://www.access-board.gov). 1-202-272-0080 or 1-800-
USA-ABLE. Failure to comply with 2010 ADA may result in Federal fines and penalties.
As an owner/agent, I acknowledge that I have been made aware that the State of
Tennessee has adopted the 2009 IECC & ASHRAE 90.1-2010 and that it is my
responsibility for code compliance.
__________________________________________________________
(Signature of Owner or Agent ) (Date)
Permit No.: _________________________________
Date Issued: _______________
SEPTIC TANK & FIELD LINES MUST BE INSTALLED AND APPROVED (GWP). FOOTINGS INSPECTED AND APPROVED PRIOR TO CONCRETE
POUR. OTHER REQUIRED INSPECTIONS ARE FRAMING, ELECTRICAL, PLUMBING AND FINAL PRIOR TO EXPIRATION DATE OF PERMIT.
SHADED AREAS MUST BE COMPLETED BY APPLICANT
Mechanical
/ Gas
Description of Work:
Septic
Sewer
Signal Mountain Water
Walden Ridge Water
See Worksheet
See Worksheet
See Worksheet
Email:
On Separate Sheet
Email:
__________________________________________________________
(Printed Name of Owner or Agent ) (Date)
Revision Date: 02/28/2018
