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APPLICATION FOR BUILDING PERMIT AND PLAN EXAMINATION

$20

COLUMBIA TOWNSHIP PHONE: 269-434-6227

53053 CR 388-PO BOX 323 FAX: 269-434-6916

GRAND JUNCTION, MI 49056

PARCEL # 80-06-

AUTHORITY: P.A. 230 OF 1972, AS AMENDED

COMPLETION: MANDATORY TO OBTAIN PERMIT

PENALTY: PERMIT WILL NOT BE ISSUED

THE DEPARTMENT OF CONSUMER AND INDUSTRY SERVICES WILL NOT DISCRIMINATE AGAINST ANY INDIVIDUAL OR GROUP BECAUSE OF RACE, SEX, RELIGION, AGE, NATIONAL ORIGIN, COLOR, MARITAL STATUS, HANDICAP, OR POLITICAL BELIEFS.

APPLICANT TO COMPLETE ALL ITEMS IN SECTION I, II, III, IV, V AND VI

NOTE: SEPARATE APPLICATIONS MUST BE MADE TO THE APPROPRIATE DIVISION

FOR PLUMBING, MECHANICAL, AND ELECTRICAL WORK PERMITS

I. PROJECT INFORMATION
PROJECT

 

 ADDRESS
CITY

 

 

 VILLAGE TOWNSHIP COUNTY ZIP CODE

 
BETWEEN AND

 
II. IDENTIFICATION
A. OWNER OR LESSEE
NAME

 

 ADDRESS
CITY STATE ZIP CODE

 

 TELEPHONE NUMBER
B. ARCHITECT OR ENGINEER
NAME

 

 ADDRESS
CITY STATE ZIP CODE

 

 TELEPHONE NUMBER
LICENSE NUMBER

 

 EXPIRATION DATE
C. CONTRACTOR
NAME

 

 ADDRESS
CITY STATE ZIP CODE

 

 TELEPHONE NUMBER
BUILDERS LICENSE NUMBER

 

 EXPIRATION DATE
FEDERAL EMPLOYER ID NUMBER OR REASON FOR EXEMPTION

 
WORKERS COMP INSURANCE CARRIER OR REASON FOR EXEMPTION

 
MESC EMPLOYER NUMBER OR REASON FOR EXEMPTION

 
III. TYPE OF IMPROVEMENT AND PLAN REVIEW
A. TYPE OF IMPROVEMENT
NEW BUILDING ALTERATION DEMOLITION FOUNDATION ONLY RELOCATION

ADDITION REPAIR MOBILE HOME SET UP PREMANUFACTURE SPECIAL INSPECTION

BOCA HUD
B. REVIEW(S) TO BE PERFORMED
BUILDING ELECTRICAL MECHANICAL PLUMBING FOUNDATION
IV. PROPOSED USE OF BUILDING
A. RESIDENTIAL
ONE FAMILY HOTEL/MOTEL DETACHED GARAGE

NO. OF UNITS

TWO OR MORE FAMILY ATTACHED GARAGE OTHER

NO. OF UNITS

B. PROJECT COST ESTIMATE $                                                                                                            DATE

# SQUARE FEET:

 

BUILDING DIMENSIONS: WIDTH                                  LENGTH                                       HEIGHT ESTIMATE

 

POLE BARN: CEMENT FLOOR                                           DIRT FLOOR

COMMENTS:

 

 

 

 

 
V. SELECTED CHARACTERISTICS OF BUILDING
A. PRINCIPAL TYPE OF FRAME

MASONRY, WALL BEARING WOOD FRAME STRUCTURAL STEEL REINFORCED CONCRETE OTHER
 

B. PRINCIPAL TYPE OF HEATING FUEL GAS OIL ELECTRICITY OTHER
 

C. TYPE OF SEWAGE DISPOSAL PUBLIC OR PRIVATE COMPANY SEPTIC SYSTEM
C. TYPE OF WATER SUPPLY - PUBLIC - PRIVATE COMPANY - PRIVATE WELL - CISTERN

E. TYPE OF MECHANICAL AIR CONDITIONING FIRE SUPPRESSION
F. DIMENSIONS/DATA
NUMBER OF STORIES

FLOOR AREA

FLOOR AREA:  EXISTING                                 NEW

                         BASEMENT

                        FIRST FLOOR

                        SECOND FLOOR

                       THIRD FLOOR

USE GROUP

CONST. TYPE FIRST FLOOR

NO. OF OCCUPANTS SECOND FLOOR
G.  NUMBER OF OFF STREET PARKING SPACES:                                                   OUTDOORS - ENCLOSED

Side property lines are to be clearly marked.

I hereby give permission for Building & Zoning Officials of Columbia Township to access and inspect the property in question.

Signature

 

SITE OR PLOT PLAN FOR APPLICANT USE

DRAW TO SCALE

The following must be shown below.

1-Property lines of parcel.

2-Measurements of parcel.

3-Roads or easements.

4-Existing structures on property.

5-New structure on property.

6-Measurements of all structures, new & existing.

7-Front, rear, and side setbacks of all structures.

 
                                                                                   NORTH