Building Permit - Town of Southbury, Connecticut

COMMERCIALBUILDING APPLICATIONTOWN OF SOUTHBURYBUILDING PERMIT #____________________________Owner _________________________________________ Address _____________________________________Applicant _______________________________________Address _____________________________________Property Location ________________________________________________________________________________D.B.A. _________________________________________________________________________________________Assessor’s Map #_____________________Block #______________________ Lot #___________________________Owner Verification_________________________________ Unique ID#_____________________________________Call before you dig 1- 800-922-4455__________________________________________________________________Tax Office Approval ______________________________________________________________________________Disposal of Construction Debris_____________________________________________________________________ALL APPLICATIONS for Building Permits must have architectural plans showing elevations, floor plans and structural designspecifications and elevation grades. Plans over 5000 square feet must have the seal of an architect, registered in the State ofConnecticut, and contain all information required by the State Building Code. TWO sets of complete plans are to be submitted forreview by the building department and fire marshal’s office in accordance with Section 111.5 of the State of CT Building Code and1-5.10 of the State of CT Fire Safety Code. Complete plans should also include, electrical, plumbing, HVAC, sprinkler and allother required information. Plans not complying with these requirements may be rejected as incomplete and must be re-submittedfor approval.Permit # _______________________________Sq. Ft.____________________ CO Fee___________________Date_______________________________Fee $ _______________________________ Receipt No. ___________________________________Valuation $__________________________________ (not to include plumbing, electric or heating costs)Owner’s SignatureAgent’s Signature__________________________________________ Date______________________________________________________________________ Date__________________________Telephone # ________________________________ or Cell Phone#__________________________________ALWAYS check with the Health Department, 203-264-9616, 800 Main Street South.

CONTRACTORS:Construction:Plumbing:Electrical:Heating:Mason:Name _________________________________________ License # ___________________Name_________________________________________Name_________________________________________Name_________________________________________Name_________________________________________TYPE OF PROJECT:One family dwelling _________ Commercial _____________ Sign __________________Two family dwelling _________ Re-roofing______________ Siding _________________Addition___________________ Demolition _____________ Pool __________________Alteration__________________ Foundation Only ________ Tent __________________Description of Construction:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Complete the following information:Construction Classification ___________ Use Group____________ Sprinklers_______________Size of footings: width____________ height_____________ depth below grade______________Foundation wall: width______________ height________________Floor joist size/spacing : first floor_______________________ second floor_________________________Ceiling joist size/spacing: __________________________________________________________________Beam/Girder size/span: _________________________Column type and spacing _______________________Wall sheathing: _____________________________ Exterior finish_____________________________Specify any specialized material or construction to be used:__________________________________________________________________________________________________________________________________________________________________________________Roof rafters size/spacing __________________pitch __________________roofing material______________Roof sheathing___________________________________Height of building________________________________Number of bedrooms-currently _______________________After construction_________________________

DATE: ________________________________CONNECTICUTWORKERS COMPENSATION INSURANCEAFFIDAVITOWNER(S): __________________________________________________________________________APPLICANT: ________________________________________________________________________PROPERTY LOCATED AT: __________________________________________________, Southbury, CTI, ___________________________________, the owner/applicant of the above described property, hereby swear andattest that I will require proof of Workers Compensation Insurance from each and every subcontractor or otherworker before he/she engages in work on my property.I understand that every person employed or engaged to perform services on the construction site (including soleproprietors, independent contractors and both owners and employees of subcontracting companies), is required to haveWorkers Compensation Insurance.orI______________________________________, the contractor working at the above listed location hereby swear andattest that I claim exemption from Public Act 96-216 as a sole proprietor and I do not intend to act as a generalcontractor or principal employer. I understand that there are significant penalties under the Workers Compensationlaws for misrepresenting ones employer status._____________________________________(signed)_________________________________(date)OATH:_____________________________________“Subscribed and sworn to before meNotary/Commissioner of Superior Court, this ______ day of ____________, _______”.Justice of PeaceDate Commission Expires: _____________

THE FOLLOWING INSPECTIONS ARE TO BE MADE:a. Footing before pouringb. Footing drains and waterproofing before backfillingc. Fireplace – footings, hearth and finald. Rough framinge. Rough electricalf. Rough plumbingg. Rough heatingh. Insulationi. Final inspection for C.O. BEFORE OCCUPANCYAdditional permits are required for electrical, plumbing and heating from this department.Attach required RES information for energy requirements.• Health Department approval required before C.O. can be issued• Zoning Compliance approval required before C.O. can be issued• Driveway approval required from Selectman’s office prior to C.O.