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Application for Building Permit

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Steps

1. Step One This section is complete This section is incomplete
2. Page 1 This section is complete This section is incomplete

Step One

Project Address*
Brief Description of Work:*
Owner's Name*
Estimated Cost of Project*
Address*
Project Start Date*
City, State, Zip*
Sub-contractors information:
Phone (Cell) *
Electricity:(name and phone number)*
E-mail *
Plumbing: (name and phone number)*
Contractor's Name*
HVAC: (name and phone number)*
Contractor's Address*
Type of Permit*
1. Residential--Single-Family
2. Residential--Multi-Family
3. Commercial
City, State, Zip*
Who will be billed for the Permit?*
1. Owner
2. Contractor
3. Other
Phone (Cell)*
Other:
E-mail*
Requirements
Please supply a plan of the proposed project drawn to scale. (One floor plan for each floor)
Registration/License Number
Upload Plan*
Provide all details and figures as apply:
Area & Heights:
Wall Insulation:
Main Floor *
Main Floor Walls (Type and R-value)*
2nd Floor*
2nd Floor Walls (Type and R-value)*
Basement*
Basement Walls (Type and R-value)*
Ceiling Insulation (Type and R-value)*
Basement*
1. Finished
2. Unfinished
Garage Insulation (Type and R-value)*
Garage*
Slab Floor Insulation:
Is it attached?*
1. Yes
2. No
Depth of slab:*
Outside
Depth of Insulation*
Deck*
Type and R-value*
Patio*
Footing*
Porch*
Shed*
Continue

Page 1

Permit Regulations
To schedule inspections, call 722-0761. Required Inspections Include, but not limited to • Footing • Foundation • Framing, Rough-In Electrical, Plumbing, and Mechanical • Final If any of the above listed Inspections are not scheduled at the appropriate time, you will forfeit 25% of your deposit fee for every inspection that is not scheduled. No premises shall be occupied until a Certificate of Occupancy has been issued by the Building Official. If any part of the structure is occupied before Certificate of Occupancy is issued the full value of the deposit is forfeited. The permit is valid for one year. Construction must commence within 6 months from date of issuance. If not completed within one year from the date the permit was issued, unless you file for an extension. The extension will only be good for one year and you will be allowed two extensions per permit. The City is not responsible or liable for the following: • To locate or survey the parcel on which construction is planned. • To identify or confirm dimensions, corners, or curves of a plated lot • To identify or confirm dimensions, location, duration of any easement • To calculate and design storm water detention, retention, or allowable run off • To design or confirm ADA compliance • To design or confirm compliance with subdivision covenants The applicant, by signature, acknowledges and agrees to the regulations of this permit; and that provisions of the adopted city building codes may be applicable to the submitted project; and the building & zoning regulations outlined in the Sioux Center City Code. I hereby will defend and hold harmless the City of Sioux Center and its employees from any and all liability from any claim or cause of action which any person may claim to have by reason of any actual or alleged failure on the part of the undersigned applicant to comply with the terms and provisions thereof. I hereby certify that I have read and examined this application and its attachments and know the same to be complete, true, and correct. All provisions of laws and ordinances governing this type of work shall be complied with whether specified herein or not. I agree and will provide notification of any change prior to construction. The granting of this permit does not presume to give authority to violate or cancel the provision of any other state or local laws regulating construction or the performance of construction. The approved permit allows the construction of the building/structure as noted on this application and any submitted documentation. Any unauthorized change to approved permit and plans, or use of property, as presented will render this permit null and void. I,_________________________, have read the Permit Regulations and agree to adhere to them. (owner or contractor) ** SIGNATURE MUST BE COMPLETED** NO PERMIT WILL BE ISSUED UNTIL SIGNATURE IS COMPLETED
Signature*