Building And Zoning Permit Application Form
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1Building and Zoning Permit Application
Permit No.
_____________________
TOWNSHIP OF MOON
1000 BEAVER GRADE ROAD • MOON TOWNSHIP, PA 15108 • PHONE 412-262-1700 • FAX 412-262-5344
1. Location of Proposed Construction:
_____________________________________________________________________________
(Street No.)
(Street Name)
(Suite No.)
2. Applicant’s Name:
__________________________________________________________
Email:
_____________________________
Applicant’s Address:
_____________________________________________________________________________________________
Phone No.:(Cell)
___________________________
(Office)
___________________________
(Home)
__________________________
3. Type of Construction:
Residential
Commercial
Industrial
Other (specify)
______________________________
4. Type of Improvement:
New Construction
Alteration
Addition
Repair/Replace
Pool/Hot Tub
Foundation Only
Change of Use
Demolition
Other
_______________________________________________
5. Proposed Use:
One Family Dwelling
Pool/Hot Tub
Shed
Detached Garage/Carport
Deck
Attached Single Family Dwelling
Other (specify)
______________________________________
6. What is the existing use of the building: (if applicable)
_____________________________________________________________
What is the proposed change in use: (if applicable)
________________________________________________________________
7. Property Information: Zoning District:
____________________
County Lot and Block
__________________________________
Subdivision Name:
_______________________________________
Lot No.
___________________
Lot Size
___________________
Owner’s Name:
__________________________________________________________________________________________________
:
Owner’s Address
___________________________________________________________________________________________________
Owner’s Phone No.:
______________________________________
Email:
________________________________________________
Occupant’s Name:
_______________________________________
Occupant’s Phone No.:
_________________________________
Water Supply:
Public
Sewage:
Public
Type of Heat:
Gas Gas Company
______________________________
______________________
Private
Private
Electric
Other (specify)
Zoning Setbacks: (the distance between the structure and the property lines)
Front Yard:
________________
Rear Yard:
________________
Right Side:
_______________
Left Side:
______________
_______________________________
8. Building Code Information for proposed construction: Total Cost of Construction $
ICC Occupancy Classification
____________
ICC Construction Type
___________
(determined by Design Professional)
Exterior Finish to Grade:
Brick
Siding
Other architectural finish (specify)
______________________________________
Type of Frame:
Masonry
Wood
Structural Steel
Reinforced Concrete
Other (specify)
___________________
For New Construction: No. of Stories:
_________
Total Height of Building:
______________
Sprinklered?
st
nd
Size of Structure:
Ft. Wide
_________
Ft. Long
_________
Total Area Per Floor: 1
_________
, 2
_________
,
rd
,
3
________
, Basement
________
, Garage
________
, Deck / Porch
________
, Shed
________
Other
_____________________
For Interior Alterations: No. of Stories of Existing Structure:
_________
Type of Existing Construction
_____________________
______________________________________
______________
What Floor(s) is the Alterations to occur?
Total Floor Area Altered
______________________
____________
Total Area of Existing Building
Year Built
Sprinklered?
Additional Areas of Alterations and Floors
____________________________________________________________________________
For Additions: No. of Stories of Existing Structure:
________
Existing Building Sprinklered?
Addition Sprinklered?
:
No. of Stories (Addition):
_______
Size of Addition:
_______
x
_______
Total Addition Area
__________
Addition Ht.
_________
______________________________________
For Repair/ Replacement: Describe the existing structure to be repaired/replaced
x
Describe the new construction
_______________________________
Total area repaired/replaced:
_______
_______
=
_______
For Pools/Hot Tubs:
Above ground
In ground
Size:
_______
x
_______
Depth of Pool:
________
Diving Board
For Demolition: Describe structure (type of construction, use, size)
__________________________________
______
x
______
9. Contractor Company Name:
_____________________________________________________________________________________
Contact Person:
_____________________________________________________
Cell Phone:
_________________________________
Contractor’s Address:
____________________________________________________________________________________________
Contractor’s Office Phone No.:
________________________________________
Email:
______________________________________
License Information:
_____________________________________________________________________________________________
10. Design Professional Company Name:
____________________________________________________________________________
Contact Person:
_____________________________________________________
Cell Phone:
_________________________________
Designer’s Address:
_____________________________________________________________________________________________
Designer’s Office Phone No.:
_________________________________________
Email:
______________________________________
11.
The applicant/owner hereby certifies that the statements made herein and representations contained in all accompanying matter part of this application
are true and correct. The applicant/owner shall be responsible for reviewing and fully understanding all Permit conditions and insuring compliance to all
applicable codes and ordinances. The applicant/owner shall also be responsible for any fees incurred in relation to the above project. The applicant/owner
grants Moon Township officials the right to enter onto the property for the purpose of inspection the work permitted and posting notices. As applicant, I hereby
certify that proposed work is authorized by the owner of record and I have been authorized by the owner to make this application as his authorize agent.
Applicant
Owner
Signature:
___________________________________
________
Signature:
___________________________________
________
Date
Date
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