Commercial Building Permit Application - Town of Kernersville

Community Development Department Permit & Enforcement Division134 East Mountain Street (336) 996-7166P. O. Box 728 (336) 996-6178 (fax)Kernersville, NC 27285www.toknc.compermitandenforcement@toknc.comCOMMERCIAL PERMITNew Construction, Additions, and UpfitsApplicant Requirements:Upon signing the Building Permit Application, the applicant hereby certifies that all the below information isprovided on the application, site plan(s), and building plan(s), and are accurate in order to process and issue aZoning and Building Permit for the listed address and use.Incomplete application, site-plan(s) or building plan(s) cannot be accepted or processed.Please complete the following checklist by placing an “x” on each line as completed.Application:___ Completed Building Permit ApplicationSite Plans (3 copies):Site Plan(s) drawn to scale, showing: In lieu of a plan or survey sealed by Design Prof.____ Landscape Plan (if applicable)____ Lot dimensions____ Building location on the lot, along with width and length____ Actual building setbacks from all property lines____ Easements and/or Right-of-Ways located on the parcel____ Adjoining streets with street names____ Existing structures on site____ Show existing and new parking spaces at 17.5’ X 8.5’each. Number based on Tbl. 3-8____ North Arrow, scale, date, and person drawing Site Plan (name, address and phone number)____ Site Plan Blocks Information FormApplicable Construction Plans (3 copies): A change of Use and/or 1 st upfit requiresthat all plans for each trade shall be sealed by a design professional…____ Building ____ Electrical ____ Mechanical ____ Plumbing____ Building peak height (feet)____ Fire (if applicable)Other Permits and Plans:_______________Completed Town of Kernersville Driveway Permit Application & NCDOT (if applicable)Landscape Plan for new constructionLots using septic tanks must provide a Forsyth County Health Department release formor improvement permit.Watershed Permit, if additional land is being developedDisclaimer: The Town of Kernersville does not review restrictive covenants or deed restrictions.

ATTENTION:PRIOR TO SUBMITTING ANY COMMERCIAL BUILDING PLANS OR APPLICATIONS FORREVIEW (RE-BUILD, RENOVATIONS, UPFITS, NEW CONSTRUCTION) THE FOLLOWINGAPPROVALS ARE REQUIREDPLACE A “CHECK MARK” BESIDE EACH ITEM WHEN COMPLETED.…1. _____ APPROVALS FROM: CITY-COUNTY UTILITYCOMMISSION AND/OR FORSYTH COUNTY HEALTH DEPT.All water/sewer/grease interceptor questions or reviews contact Bob Kitchens with CCUC @ 734-1332.All building permits for re-build, renovations, change of use/occupancy or upfits of “existing”commercial structures contact Bob Kitchens with CCUC @ 734-1332.All restaurant and food preparation questions or review contact Nathan Ward, Forsyth County HealthDept. @ 703-3225.All Plans in item #1 must be pre-approved by CCUCand/or FCHD prior to submittal and must have theirstamp and/or approval letter attached beforesubmittal to Inspections. See phone numbers listed above.2. _____ APPROVED NCDOT AND/OR TOWN OF KERNERSVILEDRIVEWAY PERMIT (Engineering 996-5530)3._____ APPROVED WATERSHED/STORMWATER PERMITISSUED FROM THE ENGINEERING DEPARTMENT OF THETOWN OF KERNERSVILLE (Engineering 996-5530)4._____ APPROVED ADDRESSE(S) FROM THE TOWN OFKERNERSVILLE GIS STAFF (GIS 992-5460)5. _________ TOWN OF KERNERSVILLE SANITATION, SOLIDWASTE DIVISION FOR DUMPSTER SERVICE. (Greg Ray at 996-6916 or608-8833)

Community Development Department Permit & Enforcement Division134 East Mountain Street (336) 996-7166P. O. Box 728 (336) 996-6178 (fax)Kernersville, NC 27285www.toknc.compermitandenforcement@toknc.comPermit #: ______________________________APPLICATION FOR BUILDING/ZONING PERMITDate of Application __________________Lot(s) #: ___________________Site Address __________________________________________________________________________________________Property Owner_________________________________ Address ______________________________________________City ____________________________________ State _______ Zip ______________ Phone ______________________Mobile Phone _________________________ E-Mail _________________________ Fax _______________________Tenant Name __________________________________ Address _______________________________________________City ____________________________________ State _______ Zip ______________ Phone_ _____________________Mobile Phone _________________________ E-Mail _________________________ Fax _______________________Contractor ____________________________________ Address _______________________________________________City ____________________________________ State _______ Zip ______________ Phone ______________________Mobile Phone _________________________ E-Mail _________________________ Fax _______________________NCGCL# ______________________________________________==========================================================================================Permit Type (circle one): Single Family Duplex Townhouse Condo Apts. Modular Manufactured Commercial IndustrialType of Work (circle one): New Addition Remodel Repair Upfit House Moving Demolition Access. Bldg PoolWork description:______________________________________________________________________________________# of Units Created ______ # Stories ________ Peak Height _______ Total Sq. Ft. Building(s) ___________________If Business, describe type of operation_____________________________________________________________________Actual Setbacks from Property Lines: Front ( ) Back ( ) Right ( ) Left ( )Contractor Names License # Cost of Work Building Permit FeesBuilding ____________________________ ______________ _____________________ __________________Electrical ____________________________ ______________ _____________________ __________________Plumbing ____________________________ ______________ _____________________ __________________Heating ____________________________ ______________ _____________________ __________________Fireplace/Other________________________ ______________ _____________________ __________________Energy/Insulation__________________(Refrigeration/Hood=Additional Permits) Total Project Cost _____________________ Fees $_________________I hereby swear that the foregoing statements are accurate and correct to the best of my knowledge. I understand that the permit may berevoked, or a stop work order issued if any information is false or the approved construction plans are not followed.____________________________________ _________________________________________ ____________Signature of Applicant Print Name DateFOR OFFICE USE ONLY: DO NOT WRITE BELOW THIS LINEOverlay District: Y / N Special Use District: Y / N Easements: Y / N FEMA Flood Zone: Y / NPermitted Use Table 2-6: _________________________________________________________________________________Zoning District: ________ PIN #: __________________________ Subdivision _________________________Driveway Permit: Y / N Watershed Permit: Y / N NCDNR: Y / N F.C. Health: Y / N CCUC: Y / NBuilding Approval: Y / N BY: _______ DATE: ___________ Zoning Approval: Y / N BY: _______ DATE: ____________Approval Conditions: _______________________________________________________________________________________________________________________________________________________________________________________________________________White: Applicants Copy Green: Town Copy Yellow: Tax Office