BUILDING/ZONING APPLICATION FORM PROJECT LOCATION INFORMATION Street No. & Street Name: Detailed Description of Project: Work Includes: Electrical CRS# Heating Plumbing Fuel Gas 2 complete sets of detailed construction plot plans, and supporting documentation. Residential Projects – Commercial Projects - 3 complete sets of detailed construction plot plans, and supporting documentation. PROPERTY INFORMATION AS IT APPEARS ON THE LAND RECORDS Name: Business Name (if applicable): Mailing Address: Cell: Email: APPLICANT/CONTRACTOR INFORMATION Name: Business Name (if applicable): License/Registration (Type & No.): Expiration Date: Mailing Address: Phone: Cell: Email: SUB-CONTRACTOR INFORMATION (OPTIONAL) Name: Phone: Lic. No. : Exp. Date: Name: Phone: Lic. No. : Exp. Date: Name: Phone: Lic. No. : Exp. Date: AFFIDAVIT I am aware that this is only an Application for the work described, and that I am not authorized to proceed with the project until such time as a Permit has been issued by the Building Official. I hereby certify that the proposed work shall conform to the Connecticut State Building Code and all other codes as adopted by the State of Connecticut, the Town of Hebron Ordinances, and the Town of Hebron Zoning Regulations. I further attest that I am authorized to make application for a Permit for such work as described above. Signature: Print Name: Date: OF PROJECT: Value shall include all labor and material costs and shall include PERMIT FEES (Office Use Only) electrical, heating, plumbing, and fuel gas work, if applicable. $ $ Building Fee: TOTAL VALUE OF PROJECT: An Application for a Permit for any proposed work shall be deemed to have been abandoned 180 Working without a Permit days after the date of filing, unless such Application has been pursued in good faith or a Permit Fee: has been issued. Application and Permit fees for abandoned projects are nonrefundable per State Ed. Fee: Chapter 200 of the Town of Hebron Ordinances. Zoning Compliance Fee: Certificate Fee: Demolition and Fire Protection work shall require a separate Application and Permit. $10.00 Application Processing Fee: $ TOTAL FEES: Date Paid: Cash Receipt No.: Check # Revised: June 1, 2013
BUILDING/ZONING APPLICATION FORM PROJECT LOCATION INFORMATION Street No. & Street Name: Detailed Description of Project: Work Includes: Electrical CRS# Heating Plumbing Fuel Gas Residential Projects – 2 complete sets of detailed construction plot plans, and supporting documentation. Commercial Projects - 3 complete sets of detailed construction plot plans, and supporting documentation. PROPERTY INFORMATION AS IT APPEARS ON THE LAND RECORDS Name: Business Name (if applicable): Mailing Address: Cell: Email: APPLICANT/CONTRACTOR INFORMATION Name: Business Name (if applicable): License/Registration (Type & No.): Expiration Date: Mailing Address: Phone: Cell: Email: SUB-CONTRACTOR INFORMATION (OPTIONAL) Name: Phone: Lic. No. : Exp. Date: Name: Phone: Lic. No. : Exp. Date: Name: Phone: Lic. No. : Exp. Date: AFFIDAVIT I am aware that this is only an Application for the work described, and that I am not authorized to proceed with the project until such time as a Permit has been issued by the Building Official. I hereby certify that the proposed work shall conform to the Connecticut State Building Code and all other codes as adopted by the State of Connecticut, the Town of Hebron Ordinances, and the Town of Hebron Zoning Regulations. I further attest that I am authorized to make application for a Permit for such work as described above. Signature: Print Name: Date: OF PROJECT: Value shall include all labor and material costs and shall include electrical, heating, plumbing, and fuel gas work, if applicable. PERMIT FEES (Office Use Only) TOTAL VALUE OF PROJECT: $ Building Fee: $ An Application for a Permit for any proposed work shall be deemed to have been abandoned 180 days after the date of filing, unless such Application has been pursued in good faith or a Permit has been issued. Application and Permit fees for abandoned projects are nonrefundable per Chapter 200 of the Town of Hebron Ordinances. Demolition and Fire Protection work shall require a separate Application and Permit. Revised: June 1, 2013 Working without a Permit Fee: State Ed. Fee: Zoning Compliance Fee: Certificate Fee: Application Processing Fee: $10.00 TOTAL FEES: $ Date Paid: Receipt No.: Cash Check #