Fillable Ucc F110 Bldg Internet f110 11-2009 Inet rev.pmd

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Ucc F110 Bldg Internet f110 11-2009 Inet rev.pmd

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BUILDING SUBCODE
TECHNICAL SECTION
[ ] Elec. [ ] Plumb. [ ] Fire [ ] Elevator
Joint Plan Review Required:
INSPECTIONS Dates (Month/Day)
JOB SUMMARY (Office Use Only)
A. IDENTIFICATION—APPLICANT: COMPLETE ALL APPLICABLE INFORMATION. WHEN CHANGING
CONTRACTORS, NOTIFY THIS OFFICE. CALL UTILITY DIG NO: 1-800-272-1000.
$
D. TECHNICAL SITE DATA
Date Received
Control #
Date Issued
Permit #
Type: Failure Failure Approval Initial
Barrier-Free
Final
Other
TCO
Mechanical
Energy
Insulation
Barrier-Free
Truss Sys./Bracing
Frame
Slab
Foundation
Footing Bonding
Footing
Finishes -Base Layer
Finishes -Final
[ ]
DESCRIPTION OF WORK
TYPE OF WORK:
New Building[ ]
Addition
Rehabilitation[ ]
Roofing
[ ]
[ ] Siding
Fence __________ Height (exceeds 6')
[ ]
Sign ___________________ Sq. Ft.
[ ]
Pool
[ ]
Asbestos Abatement Subchapter 8
[ ]
Lead Haz. Abatement NJAC 5:17
Other _______________________[ ]
Demolition[ ]
Radon Remediation
$
FEE (Office Use Only)
$
Minimum Fee
State Permit Surcharge Fee
TOTAL FEE
$
$
Contractor License No. or Builder Registration No. Exp. Date
Home Improvement Contractor Registration No. or Exemption Reason
[ ]
[ ]
Administrative Surcharge
[ ]
Retaining Wall ________________ Sq. Ft.
B. BUILDING CHARACTERISTICS
cu. ft.
sq. ft.
sq. ft.
ft.
Use Group Present
Proposed
Volume of New Structure
New Bldg. Area/All Floors
Area — Largest Floor
Height of Structure
Max. Live Load
Max. Occupancy Load
No. of Stories
Constr. Class Present Proposed
Est. Cost of Bldg. Work:
3. Total (1+ 2)
$
2. Rehabilitation
$
$1. New Bldg.
If Industrialized Building:
State Approved
HUD
Approved by:
[]CO []CCO []CA
SUBCODE APPROVAL for CERTIFICATE
SUBCODE APPROVAL for PERMIT
Date:
Approved by:
Date:
PLAN REVIEW Date Initial
[ ] Interior
[ ] Exterior
[ ] Structural/Framework
[ ] Footings/Foundations
[ ] All
[ ] No Plans Required
Address
e-mail
C. CERTIFICATION IN LIEU OF OATH
I hereby certify that I am the (agent of) owner of record and am authorized to make this
application.
Sign here:
Print name here:
Applicant: When submitting this form to your Local Construction Code Enforcement
Office, please provide one original plus three photocopies.
U.C.C. F110 (rev. 11/09)
Internet version
zip codemunicipalitystreet
Address
e-mail
Tel.
Owner in Fee:
Block Lot
Qualification Code
Work Site Location
Contractor: Tel.
Federal Emp. ID No.
FAX:
0
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Ucc F110 Bldg Internet f110 11-2009 Inet rev.pmd

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Completed 26 April 2020

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