Fillable Use And Occupancy Permit Application Fillable Form Compressed (Conshohocken Borough)

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Use And Occupancy Permit Application Fillable Form Compressed (Conshohocken Borough)

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BROWSE CONSHOHOCKEN BOROUGH (PA) FORMS

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BOROUGH OF CONSHOHOCKEN
400 Fayette Street, Suite 200
Conshohocken, PA 19428
Phone (610) 828-1092
Fax (610) 828-0920
USE & OCCUPANCY PERMIT APPLICATION PERMIT#__________
SECTION 1. REASON FOR APPLICATION (Check Appropriate Condition)
❑
❑❑
❑ Property Sale / Transfer of Ownership
❑
❑❑
❑ Property Rental / Change of Tenant
❑
❑❑
❑ Use Group / Occupancy Classification Change
Location of Property: ___________________________________Floor and/or Suite and/or Apt #___________________
SECTION 2: OCCUPANCY CLASSIFICATION/USE GROUP INFORMATION. Please indicate the present occupancy
type/use group. (If the building is mixed use, list of the appropriate classification/use groups). □ Single Family □ Multi-
Family □ Mercantile □ Business □ Other________________________________________________________________
❑ Residential - ____ Unit(s) - Fees: Single Family Dwelling or Multi Family Dwelling = $75 per unit
❑ Commercial - Square Ft =____________ - Fees - Commercial = $300 < 6000 sq ft & $5 per 100 sq ft > 6000 sq ft
Does the tenant/buyer intend a change in occupancy classification/use group? ❑ Yes or ❑ No. (If Yes, please provide
description of the proposed new use) ___________________________________________________________________
SECTION 3. PRESENT PROPERTY OWNER
Name(s):________________________________________
Address:________________________________________
City: ____________________State:___Zip Code: _______
Daytime or Cell Phone #:___________________________
E-mail __________________________________________
SECTION 4. PROPERTY SALE - BUYER (complete EITR form)
Buyer’s Name(s):__________________________________
Address:________________________________________
City: ____________________State:___Zip Code: _______
Daytime or Cell Phone #:___________________________
E-mail __________________________________________
Does the buyer intend to occupy or reside at the location? ❑ Yes or ❑ No If the answer is Yes, skip Section 5
SECTION 5. PROPERTY RENTAL - CHANGE OF TENANT - TENANT
(A) Borough Ordinances requires property owners to obtain a Use and Occupancy Permit each time a change of tenant occurs in all of the
(B)
occupancies/use groups listed in Section #2.
Borough Ordinance requires single & multi-family dwelling rental units to be registered with the Borough of Conshohocken. A Rental Property
Registration Form can be obtained at the Conshohocken Municipal Building during normal business hours.
FOR RESIDENTIAL TENANT USE ONLY (complete EITR form)
Resident’s Name:________________________________ Resident’s Name:________________________________
Resident’s Name:________________________________ (attach a separate sheet of paper if necessary)
FOR COMMERCIAL TENANT USE ONLY
Business Name:____________________________________________________________________________________
Address:__________________________________City: __________________________State:______Zip Code: _______
Contact Person:___________________________________Title:_____________________________________________
Daytime or Cell Phone #:___________________________ E-mail ___________________________________________
Application is hereby made to the Borough of Conshohocken for the approval to use and occupy the aforementioned
location in full or part. I agree to comply with all Ordinances and Codes of the Borough of Conshohocken and the
Commonwealth of Pennsylvania. I will not occupy or allow occupancy of any land, structure or building until a Certificate of
Occupancy is issued. I understand that any misrepresentation in this application will be grounds for the revocation of the
application or the Certificate of Occupancy.
OWNER’S SIGNATURE ____________________________________________________ DATE__________________
I hereby certify that this application is authorized by the owner of record and that I have been authorized by the owner to
make this application as his/her agent.
AGENT’S SIGNATURE _____________________________________________________ DATE___________________
For Office Use Only Date Application Received:
Receipt #_________________
U & O Fee $ .00
❑ Cash ❑ Check #_________
Land Use Code:____________
Parcel # 0-500-_______________
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Borough of Conshohocken
Inspection Checklist
Property Address: ___________________________________________ Suite/ Unit #: ______________
Contact: _____________________________________ Phone Number: ___________________________
Date of Inspection: ____________________________ Time: _____________________
Use & Occupancy Rental Permit #_____________________________
2015 International Property
Maintenance Code
Code
Section
Pass
Fail
Comments
Exterior
Sanitation
302.1
Grading & Drainage
302.2
Curb, Sidewalk & Driveway
302.3
Weeds & Grass (6 Inches)
302.4
Abandoned Motor Vehicles
302.8
Swimming Pool Conditions
303
Premises Identification
304.3
Stairs, Decks & Porches
304.10
Handrails & Guards
304.12
Interior
Handrails & Guards
307.1
Windows & Doors
304.13
Insect Screens
304.14
Interior Surfaces
305.3
Pest Elimination
309.1
Heat, Lighting & Plumbing
Windows
403.1
Bathroom Vent.
403.2
Dryer Exhaust
403.5
Plumbing Systems
504.1
Plumbing Hazards
504.3
Water System
505.1
Anti- Tilt Device on Ovens
603.1
Heater Cert.
603.1
Chimney Cert.
603.2
Electrical Hazards
604.3
GFCI Receptacles
605.2
Fire Safety Requirements
Sprinkler System Cert.
704.1.1
Smoke Detectors (Every Level)
704.2.1.2
Carbon Monoxide Detectors
Act 121
of 2013
Certification to be issued:
Use & Occupancy Permit Temporary Use & Occupancy Permit Temporary Access Permit
Rental License
Settlement Date: _________________________ Follow- up Inspection Date: ________________________
Inspector Signature: ___________________________________ Representative Signature: __________________________
See Inspection report for additional comments
BOROUGH OF CONSHOHOCKEN
400 Fayette Street, Suite 200 Conshohocken, PA 19428
Phone (610) 828-1092 Fax (610) 828-0920
RULES
, REGULATIONS AND REQUIREMENTS GOVERNING
USE AND OCCUPANCY PERMITS
RULES
Borou
gh Ordinances requires property owners to obtain a Use and Occupancy Permit each time any of
the following occur:
1. Use and occupancy of any building or structure hereafter altered or erected.
2. Change in the use and/or occupancy of any building or structure.
3. Use of land or change of use thereof.
4. Change in use and occupancy of any non-conforming use of extension thereof.
5. Change of tenants in any building or structure.
APPLICATION:
All applications for Use and Occupancy Permits must be completed in ink, signed by the owner or acting
agent to comply with all Borough Ordinances.
FEES:
Single family Dwelling = $75.00
Multi- Family Dwelling = $75.00 per unit
Commercial
= $300 < 6000 sq ft & $5 per 100 sq ft > 6000 sq ft
Ple
ase note: All fees must be paid prior to the application being processed.
REGUL
ATIONS
Issuance of a Use and Occupancy Permit: No Use and Occupancy Permit shall be issued until all proper
Borough Officials have certified that the proposed Use and Occupancy complies with all pertinent
Ordinances. In special cases, consideration of the Borough granting a temporary Use and Occupancy
Permit will be considered on a case by case basis. Officials determine that an application is in
compliance with pertinent Borough Ordinance, it shall be their duty to issue the permit within thirty days of
the receipt date on the application.
Refus
al of permit: Should it be determined that an application and or the premises is not in compliance
with all pertinent Borough Ordinances, it shall be the duty of the proper Borough Officials to refuse the
Permit. In such cases it shall be the duty of these Officials to instruct the applicant of the remedial
measures to bring the application and or premises into compliance within thirty days of the receipt date on
the application.
BOROUGH OF CONSHOHOCKEN
EARNED INCOME TAX REGISTRATION FORM – NEW RESIDENTS
RESIDENT PSD CODE #460401
RETURN FORM TO: 400 Fayette Street, Suite 200, Conshohocken, PA 19428
Name: ___________________________________________ Soc. Sec. #: _________________________________
Spouse’s Name: ___________________________________ Soc. Sec. #: _________________________________
New Address: ___________________________________________________________ as of: _________________
Please list previous address and previous school district:
Address: ____________________________ City________________________ State: ________ Zip: _________
School District: __________________________
Employer: _____________________________ Spouse’s Employer: ________________________
Earned Income Tax withheld from your pay: yes no From Spouse’s pay: yes no
Self-employed: yes no Spouse self-employed: yes no
No earned income: Please indicate reason (homemaker, temporarily unemployed, disabled, student etc; (please specify)
You: ___________________________________ Spouse: _____________________________________
Signature: _________________________________________________ Date: __________________
Earned Income Tax Information for
Residents of the Borough of Conshohocken, Montgomery County
In Pennsylvania, the General Assembly has empowered political subdivisions of the Commonwealth, at the local level, to levy, assess, and
collect certain types of taxes for general revenue purposes. The authority for levying these non-realty taxes was granted to local school
districts and municipalities in 1965 through the passage of the Local Tax Enabling Act (LTEA), commonly referred to as ‘Act 511’. The rate
of earned income tax for the Borough of Conshohocken is one percent (.5%) and is levied on gross wages and/or net profits from a business or
profession.
Berkheimer Tax Administrators is the appointed earned income tax administrator for Montgomery County. The appointed earned income tax
administrator, Berkheimer Tax Administrators is charged with the duty of collecting the Borough’s earned income taxes. This includes
collecting the tax, establishing rules to fairly enforce such tax and creating accurate tax records and accounts for each taxpayer.
Above is an Earned Income Tax Registration Form. A completed Registration Form will fulfill your registration requirements under the
Earned Income Tax Rules and Regulations adopted by the Borough of Conshohocken. More importantly, this information will ensure that
your tax dollars are sent to your home taxing jurisdiction. All residents should complete this form, regardless of your employment status
(unemployed, retired, college student, military personnel, or homemaker). If you have recently moved, please give your current and former
address.
Most resident taxpayers will have this tax deducted by their employers. Residents, who work in a jurisdiction where it is not withheld, or are
self-employed, will have to pay the tax directly to Berkheimer Tax Administrators. The completed registration form will be forwarded to
Berkheimer Tax Administrators, who will create an accurate tax account reflecting your current reporting status and send you the necessary
forms.
If you have any additional questions, you may contact at Berkheimer Tax Administrators 610-599-3139, or on their website at www.hab-
inc.com.
400 Fayette Street, Suite 200 | Conshohocken, PA 19428 | Phone: (610) 828-1092 | Fax: (610) 828-0920 | www.conshohockenpa.org
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Use And Occupancy Permit Application Fillable Form Compressed (Conshohocken Borough)

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Completed 20 July 2020

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