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 ~ ,,' ~ I 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