--------------------------- DCC PLAN REVIEW BUILDING PERMIT APPLICATION

MEMBER
130 Cecil Street, Canonsburg, PA 15317
DCC PLAN REVIEW & BUILDING PERMIT
APPLICATION COVER SHEET
MUNICIPALITY:
---------------------------
PLAN REVIEW #:
BUILDING PERMIT #:
_
ALL PLAN REVIEW / BUILDING PERMIT APPLICANTS:
The following must be included in the submission of your Plan Review and/or Building Permit
Application. Incomplete applications will be returned.
I. Copy of your Zoning Permit. (If you do not have Zoning in your Municipality,
a copy of the Municipal Ordinance Compliance Certification must be submitted.)
2. The Building Permit Application and Plan Review Checklist.
3. An application fee payable to HMT and Associates, Inc. and an administration fee
payable to your Municipality, if applicable. (Applications submitted without proper
fees will not be accepted.)
APPLICANT RESPONSIBILITY:
Any missing or incorrect information provided on the
plans or not discovered during the Plan Review process may require field changes resulting in
additional costs to you (due to a correction of non-compliant construction and/or re-inspections).
Once a Building Permit is issued, you are responsible to call for all of your required inspections.
Work constructed and concealed without inspection may be required to be removed and/or
reconstructed to confirm code compliance. HMT and Associates, Inc. is not responsible or liable
for any additional costs which may be incurred. By signing below, the applicant acknowledges
full responsibility for any such additional costs. A Certificate of Occupancy will not be issued
until all required inspections have been confirmed as passed and all fees have been paid.
Signature
HMT/924CO I/UCCCover Application
Date
2012
MEMBER
tiM
IN~ T and Associates
~
,,'
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It,
Civil-
unicipal-Environrnental-Engineering
and Surveying
130 Cecil Street, Canonsburg, PA 15317
APPLICATION FOR VCC BUILDING PERMIT
BUILDING
IRC
Municipality:
Plan Review #:
Building Permit #:
Permit Issue Date:
CODE EDITION
_
!BC -----
ALL INFORMA nON MUST BE FILLED OUT COMPLETELY
MANDATORY DOCUMENTS
(MUST BE SUBMITTED WITH ALL APPLICATIONS)
vee
vee
***
One (1) completed
***
Three (3) complete sets of assembled, bound, scaled construction drawings
(All elements including Building, Electrical, Mechanical and Plumbing plans, details, sections and elevations.)
Application
for
Building Permit and one (1)
Plan Review Checklist.
*** IF COMMERCIAL, addition, alteration/renovation, new structure, one (I) complete set of specifications.
SITE INFORMATION
Name of Applicant:
_
Company Name (if applicable):
_
Address:
_
City:
State:
Parcel tD, #
USE/OCCUPANCY
Building
__
CLASSIFICATION
A2
II
A4
A3
-
12 -
TYPE OF CONSTRUCTION
-
13
-
B -
M _R3
FI
E
HMT f924CO l/UCCApplication
IE
IIA
F2
R2 - SI
(Adult Daycare)
RI
{Chapter 6 of the International
IA
__
Submission
Phased Approval
(seal of design professional not required)
A5
14
Deck
Partial Occupancy
Residential/
Commercial
Plan RevisionlDeferred
(Check all that apply)
Single Family Dwelling/Townbouse
-
_
Alteration/Renovation
Addition
Existing/Uncertified
Al
County:
TYPE
New Structure
__
_
Municipality:
APPLICATION
__
Zip Code:
liB
2012
-
HI
H2
S2 -
U -
H3 - H4
R3 - R4
-
Building Code - check all that apply)
Wood Frame
IlIA
IlIB
IV
VA
VB
Page I of3
H5
'
PROJECT DATA INFORMATION:
Estimated cost of construction: ------Yes
Basement:
Number of stories above grade: __
No
Total square footage of:
Floor area:
Fire Suppression: __
Partial
Full
RENOVAnON floor area:
ADDITION floor area:
NEW floor area:
None
EXISTING CERTIFIED BUILDING (indicate permits held):
Fire and Panic Occupancy Permit -
No
Yes
File #
Municipal Occupancy Permit -
No
Yes
Permit #
No
Yes
File #
Name of Municipality L&I UCC Certificate of Occupancy DEFERRED SUBMISSIONS:
rndicate if installation of any of the following items will occur, yet shop drawings are not being submitted at this time.
Fire Alarm System
Wood Roof Trusses (certified)
_
Sprinkler System ~
_
_
DOES THIS CONSTRUCTION INVOLVE MODULAR UNITS BUILT BY A FACTORY?
Yes
No
If yes, submit I copy of the compliance document.
IS THIS CONSTRUCTION EXEMPT FROM ENERGY CODE REOUIREMENTS?
No
If no, submit I copy ofthe compliance document.
Yes
[fyes, submit 1 copy ofa letter indicating the building will use neither
electricity nor fossil fuels, and thus is exempt per ASHRAE 90.1 92.3(B).
IS PROJECT IN A FLOOD HAZARD AREA?
No
Yes
If yes, submit I copy of the flood
hazard certificate.
-------------------------------------------------------------------------------------------------------------------------------------------COMMERCIAL APPLICANTS ONLY
(does not apply to residential applicants)
ALTERA T10NSfRENOV AT10NS IN A CERTIFIED EXISTING BUILDING:
Indicate which code requirement complies: __
International Existing Building Code
__
Chapter 34, !BC
IS THIS CONSTRUCTION REGULATED BY THE HEALTHCARE FACILITIES ACT?
No
Yes
[fyes, submit I copy of the approval letter issued by the PA Department of Health.
ARE INTERNATIONAL BUILDING CODE SPECIAL INSTRUCTIONS OR STRUCTURAL
OBSERVATIONS REOUIRED?
No
Yes
[fyes, submit I copy of the Inspections Observations Statement.
WILL AN ALTERNATIVE CONSTRUCTION METHOD OR MATERIAL BE USED ON THE PROJECT?
No
Yes
[fyes, submit a signed statement indicating that the proposed method complies with the
PA UCc.
IS THIS APPLICATION FOR "PHASED APPROVAL"?
No
Yes If yes, submit additional information pertaining to the Phasing schedule.
HMT /924CO l/UCCApplication
2012
Page 2 of3
DESIGN PROFESSIONAL
Name:
Address:
(Commercial applicants only - Residential if applicable)
_
_
Phone:
(SEAL)
Fax: c-:-----:-,-------------------E-Mail Address:
PA License No.
OWNER INFORMATION
Name:
Address:
_
_
Phone:
Fax:
E-Mail Address:
_
APPLICANT'S CERTIFICATION:
The Building Penn it and Certificate of Occupancy for this structure will be issued to and in the name of
the person listed below.
As the owner or authorized agent of the project for which this application is filed, I certifY that:
I.
2.
3.
4.
5.
6.
7.
The estimated construction cost and all other infonnation provided as part of this application for a
Building Pennit is correct.
The structure described in this application will not be occupied until all known code violations
are corrected and a Certificate of Occupancy has been received from HMT and Associates, Inc.
This project will be constructed in accordance with the approved drawings and specifications,
including any approved non-designed changes, and the Unifonn Construction Code standards as
specified in 34 PA Code - Chapters 401-405.
Any changes to the approved documents will be filed with HMT and Associates, Inc.
If the licensed architect or engineer in responsible charge of this construction should change,
written notice of the change will be provided to HMT and Associates, Inc.
When required, up to 20% of the total cost of any work perfonned on an area of primary function
in an existing building will be expended to provide an Accessible Route to the area of Primary
Function. (Commercial Projects)
No error or omission in either the drawings and specifications or application, whether approved
or not, shall permit or relieve construction work performed in any manner other than provided for
in 34 PA Code - Chapters 401-405.
Name of Applicant:
_
Street Address: -------------------------------City:
State
Zip Code
_
Phone: ----------------E-Mail Address:
Applicant's
Signature:
I IMT/924CO I/UCCApplication
Cell: ---------------
Date:
2012
_
Page 3 of3
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