Residential Work Permit Application Form printable pdf download

BOROUGH OF EDDYSTONE

RESIDENTIAL WORK PERMIT APPLICATION

(1300 E 12th Street, Eddystone, Pa -19022

Phone: 610-874-1100

Fax: 610-874-1605)

With the exception of emergency repairs, this Work (Project) Permit Application shall allow for a review period by being completed and

submitted to the Borough of Eddystone Ten (10) days prior to commencing work. As per Eddystone Borough Code, IF WORK BEGINS

BEFORE PERMITS ARE ISSUED, violators may be fined up to $1000 per day. This application is to be used only for residential projects (1

or 2 Family Dwelling, max. 3 Stories in Ht.), or for permits required by Eddystone Building Code Ordinances established prior to 7/1/1999.

PLEASE TYPE OR PRINT LEGIBLY IN INK

(Local requirements remain in effect per UCC Act 92 of 2004)

SECTION I : LOCATION OF PROJECT & PROPERTY OWNER OF RECORD

ADDRESS OF PROJECT (JOB) _________________________________________________________ DATE ________________

OWNER OF PROPERTY__________________________________ OWNERS PHONE #_________________________________

OWNER ADDRESS__________________________________________________________________________________________

(ONLY IF OWNER DOESN’T RESIDE AT PROJECT ADDRESS)

NOTE: IF WORK IS BEING DONE FOR A TENANT, AN APPROVAL LETTER FROM THE PROPERTY OWNER IS REQUIRED.

SECTION II : CONTRACTOR OR APPLICANT INFORMATION

_________________________________

_______________________________________________

NAME:

ADDRESS:

(PERSON OR COMPANY DOING THE WORK)

__________________

_________________________

___________________________

PHONE #

CELL #

E- MAIL

CLASSIFICATION:

[ ] BUILDING/GENERAL

[ ] ELECTRICAL [ ] PLUMBING / HVAC [ ] ROOFING

(Permit Type)

[ ] MASONARY/ CONCRETE [ ] OTHER_____________________________________________

IS A VALID EDDYSTONE CONTRACTOR’S LICENSE FILED WITH THE BOROUGH?

[ ] YES [ ] NO

WILL PROJECT (JOB) INCLUDE SUBCONTRACTOR?

[ ] YES [ ] NO IF YES, IDENTIFY SUBCONTRACTORS,

SUBCONTRACTOR

CONTRACTOR NAME & PHONE

PLUMBING

[ ] YES [ ] NO

ELECTRIC

[ ] YES [ ] NO

HVAC

[ ] YES [ ] NO

MECHANICAL [ ] YES [ ] NO

FRAMING

[ ] YES [ ] NO

FOUNDATION [ ] YES [ ] NO

FIRE PROT.

[ ] YES [ ] NO

NOTE 1:

Eddystone subcontractor licenses or proof of insurance thru general contractor is required.

Will this permit application include project costs for subcontractor? [ ] YES [ ] NO

If No, additional permits will be required for subcontractors and SECTION III must clearly define project scope for permit approval.

SECTION III : PROJECT TYPE & DESCRIPTION ****

ALL WORK MUST CONFORM TO UCC ****

RESIDENTIAL PROJECT TYPE:

[ ] EQUIVALENT REPLACMENT

[ ] REPAIRS

[ ] ALTERATION OR MODIFICATION

[ ] ADDITIONS

[ ] NEW CONSTRUCTION

[ ] DEMOLITION

FOR ALTERATIONS / MODIFICATIONS, ADDITIONS, AND NEW CONSTRUCTIONS TYPE PERMIT REQUESTS, REQUIRED ARE, THREE (3) SETS OF

APPROVED PLANS, OR LAYOUT DRAWINGS, OR LAND SURVEYOF PROPERTY. THE PLANS SHALL CLEARY IDENTIFY, LOCATION OF

EXISTING AND PROPOSED STRUCTURS, ELEVATIONS, LOT SIZES, IMPERVIOUS SOIL, DECKS, AND PATIOS ETC… FOR DEMOLITION TYPE

PERMIT, REQUIRE IS, AN ATHORIZED APPROVED DEMOLITION SPECIFICATION.

IF THESE ITEMS ARE NOT SUBMITTED, AUTOMATIC APPLICATION DENIAL WILL OCCUR

Residential Work Permit Application Form

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