Description of work: Project owner: Phone #: Architect/Engineer ...
Permit #
Date Issued: Please Print legibly and complete all areas. Check all that apply: Remodel Repair
New Home (SFD)
New Garage, attached
New Town Homes # of Units___________ New duplex, # of buildings____________ Basement finish
New Deck/Patio
New Carport or patio cover
Replace Deck or patio
Enclose Existing Carport or patio cover
Retaining wall
Project Address:
New Garage, detached
Pool/spa
Other:
Apt/unit #
Porch
Parcel #:
Project Value: $
Check one:
Contract Value
Subdivision:
Phase:
Lot #:
-
Estimate
. .
Zone:
Sq. ft. of home: ______________ Sq. Ft. garage: ________ Electrical service size: Sq. Ft. of basement: ___________ ___________amp
.
Owner/Builder form as needed
Description of work:
. .
Project owner:
Phone #:
.
Project Owner Address:
Cell phone #:
.
City:
State:
Zip Code:
Email:
Architect/Engineer: Email:
Phone : (
General Contractor:
Phone : (
Contractor Address:
St. License #
Fax (
)
.
)
)
. -
.
Email:
Electrical Contractor:
Phone : (
Contractor Address:
State License #
Mechanical Contractor (HVAC):
Phone : (
Contractor Address:
State License #
Plumbing Contractor:
Phone : (
Contractor Address:
State License #
)
. -
)
. -
)
. -
This permit becomes null and void if work or construction is not commenced within 180 days, or if construction is suspended or abandoned for a period of 180 days at anytime after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work shall be complied with, whether specified herein or not, the granting of this permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction of the performance of construction and that I make this statement under penalty or perjury.
24-hour notice is required in order to schedule an inspection
_____________________________________________________ Applicant’s signature
Owner
Contractor
Date: If owner/builder box checked, owner must sign and notarize owner builder document for State of Utah
Other, specify
-Building Department Use Only-
Valuation (market value): $ Building Permit: $ Plan Review fee: $ Prepaid (Plan Review Subtraction) $ Water connection fee:3/4” $ Water connection fee: 1” $ Sewer Connection fee: 4 “ $ Sewer Connection fee: 6” $ Electric Cont. fee: (underground) $ Electric Cont. fee: (overhead) $ Temporary Electric fee: $ State 1% surcharge: $ Deposit: (Refund at building completion) $ Deposit:(Refund at landscape completion) $ Cut Permit: (work in public right of way) $ Sub total: $ IMPACT FEES (If applicable)
Comments: _____________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ # Buildings
# Stories
Type of Construction: V-B R VALUE
# Bedrooms Occupancy Group: R-3/U
Walls R-13
Attic
R-38
Fire Sprinkled:
Yes
No
Construction Method:
Frame
Concrete
CMU
Steel
ICF
Storm Drain: (Impervious surface) Parks and Recreation: Electrical: Sewer: Water:
$ 1,200.54________ $ 2,152.59________ $ 147.00_ ________ $_841.28 ________ $_1,866.71 _______
Sub total:
$_6,208.12________
GRAND TOTAL:
$________________
Construction Costs per square foot for type V-B construction Adopted by Brigham City from the 2006 International Building Code
R-2 (Residential, multiple family) R-3 (Residential one and two family) U (Utility miscellaneous, garages) Finished basements Awning or Deck Storage building (Monolithic Slab) Carport
$82.49 $91.36 $35.55 $30.00 $11.22 $21.33 $17.78
Other
Plan Reviewed by:
Date:
Plans approved by :
Date:
Grandfathered Y
or
N
# of units
Date Issued: Please Print legibly and complete all areas. Check all that apply: Remodel Repair
New Home (SFD)
New Garage, attached
New Town Homes # of Units___________ New duplex, # of buildings____________ Basement finish
New Deck/Patio
New Carport or patio cover
Replace Deck or patio
Enclose Existing Carport or patio cover
Retaining wall
Project Address:
New Garage, detached
Pool/spa
Other:
Apt/unit #
Porch
Parcel #:
Project Value: $
Check one:
Contract Value
Subdivision:
Phase:
Lot #:
-
Estimate
. .
Zone:
Sq. ft. of home: ______________ Sq. Ft. garage: ________ Electrical service size: Sq. Ft. of basement: ___________ ___________amp
.
Owner/Builder form as needed
Description of work:
. .
Project owner:
Phone #:
.
Project Owner Address:
Cell phone #:
.
City:
State:
Zip Code:
Email:
Architect/Engineer: Email:
Phone : (
General Contractor:
Phone : (
Contractor Address:
St. License #
Fax (
)
.
)
)
. -
.
Email:
Electrical Contractor:
Phone : (
Contractor Address:
State License #
Mechanical Contractor (HVAC):
Phone : (
Contractor Address:
State License #
Plumbing Contractor:
Phone : (
Contractor Address:
State License #
)
. -
)
. -
)
. -
This permit becomes null and void if work or construction is not commenced within 180 days, or if construction is suspended or abandoned for a period of 180 days at anytime after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work shall be complied with, whether specified herein or not, the granting of this permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction of the performance of construction and that I make this statement under penalty or perjury.
24-hour notice is required in order to schedule an inspection
_____________________________________________________ Applicant’s signature
Owner
Contractor
Date: If owner/builder box checked, owner must sign and notarize owner builder document for State of Utah
Other, specify
-Building Department Use Only-
Valuation (market value): $ Building Permit: $ Plan Review fee: $ Prepaid (Plan Review Subtraction) $ Water connection fee:3/4” $ Water connection fee: 1” $ Sewer Connection fee: 4 “ $ Sewer Connection fee: 6” $ Electric Cont. fee: (underground) $ Electric Cont. fee: (overhead) $ Temporary Electric fee: $ State 1% surcharge: $ Deposit: (Refund at building completion) $ Deposit:(Refund at landscape completion) $ Cut Permit: (work in public right of way) $ Sub total: $ IMPACT FEES (If applicable)
Comments: _____________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ # Buildings
# Stories
Type of Construction: V-B R VALUE
# Bedrooms Occupancy Group: R-3/U
Walls R-13
Attic
R-38
Fire Sprinkled:
Yes
No
Construction Method:
Frame
Concrete
CMU
Steel
ICF
Storm Drain: (Impervious surface) Parks and Recreation: Electrical: Sewer: Water:
$ 1,200.54________ $ 2,152.59________ $ 147.00_ ________ $_841.28 ________ $_1,866.71 _______
Sub total:
$_6,208.12________
GRAND TOTAL:
$________________
Construction Costs per square foot for type V-B construction Adopted by Brigham City from the 2006 International Building Code
R-2 (Residential, multiple family) R-3 (Residential one and two family) U (Utility miscellaneous, garages) Finished basements Awning or Deck Storage building (Monolithic Slab) Carport
$82.49 $91.36 $35.55 $30.00 $11.22 $21.33 $17.78
Other
Plan Reviewed by:
Date:
Plans approved by :
Date:
Grandfathered Y
or
N
# of units
