Building Permit - City of Saginaw MI

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IV. PROPOSED USE OF BUILDINGA. RESIDENTIAL1.ONE FAMILY3.HOTEL, MOTEL5.DETACHED GARAGENO. OF UNITS2.TWO OR MORE FAMILY4.ATTACHED GARAGE6.OTHERNO. OF UNITSB. NON-RESIDENTIAL7.AMUSEMENT11.SERVICE STATION15.SCHOOL, LIBRARY, EDUCATIONAL8.CHURCH, RELIGION12.HOSPITAL, INSTITUTIONAL16.STORE, MERCANTILE9.INDUSTRIAL13.OFFICE, BANK, PROFESSIONAL17.TANKS, TOWERS10.PARKING GARAGE14.PUBLIC UTILITY18.OTHERDESCRIPTION OF WORK: DESCRIBE BELOW THE WORK BEING PERFORMED, IF WORK INCLUDES ROOFING OR SIDING ENTER AMOUNT OFMATERIAL BEING USED, INDICATE IF EXISTING MATERIAL IS BEING REMOVED AND INDICATE IF NEW SHEATHING MATERIAL IS BEINGINSTALLED.V. SELECTED CHARACTERISTICS OF BUILDINGA. PRINCIPAL TYPE OF FRAME1. MASONRY, WALL BEARING 2. WOOD FRAME 3. STRUCTURAL STEEL4. REINFORCED CONCRETE5. OTHERB. PRINCIPAL TYPE OF HEATING FUEL6. GAS7. OIL8. ELECTRICITY9. COAL10. OTHERC. TYPE OF SEWAGE DISPOSAL11. PUBLIC OR PRIVATE COMPANY12. SEPTIC SYSTEMD. TYPE OF WATER SUPPLY13. PUBLIC OR PRIVATE COMPANY14. PRIVATE WELL OR CISTERNE. TYPE OF MECHANICAL15. WILL THERE BE AIR CONDITIONING? YES NO 16. WILL THERE BE FIRE SUPPRESSION? YES NOF. DIMENSIONS/DATA17.NUMBER OF STORIES21.FLOOR AREA:EXISTINGALTERATIONSNEW18.USE GROUPBASEMENT19.CONST. TYPE1ST & 2ND FLOOR20.NO. OF OCCUPANTS3RD - 10TH FLOOR11TH - ABOVETOTAL AREAG. NUMBER OF OFF STREET PARKING SPACES22.ENCLOSED23. OUTDOORS
VI. APPLICANT INFORMATIONAPPLICANT IS RESPONSIBLE FOR THE PAYMENT OF ALL FEES AND CHARGES APPLICABLE TO THIS APPLICATION AND MUST PROVIDE THEFOLLOWING INFORMATION.NAMETELEPHONE NO.ADDRESSCITY STATE ZIP CODEFEDERAL I.D. NUMBER/SOCIAL SECURITY NUMBERI HEREBY CERTIFY THAT THE PROPOSED WORK IS AUTHORIZED BY THE OWNER OF RECORD AND THAT I HAVE BEEN AUTHORIZED BY THEOWNER TO MAKE THIS APPLICATION AS HIS/HER AUTHORIZED AGENT, AND WE AGREE TO CONFORM TO ALL APPLICABLE LAWS OF THESTATE OF MICHIGAN. ALL INFORMATION SUBMITTED ON THIS APPLICATION IS ACCURATE TO THE BEST OF MY KNOWLEDGE.Section 23a of the state construction code act of 1972, 1972 PA 230, MCL 125.1523A, prohibits a person from conspiring to circumvent thelicensing requirements of this state relating to persons who are to perform work on a residential building or a residential structure.Violators of section 23a are subjected to civil fines.SIGNATURE OF APPLICANTDATEPLAN REVIEW FEE ENCLOSED $VALUE OF WORK $BUILDING PERMIT FEE ENCLOSED $VII. LOCAL GOVERNMENTAL AGENCY TO COMPLETE THIS SECTIONENVIRONMENTAL CONTROL APPROVALSREQUIRED? APPROVED DATE NUMBERBYA - ZONINGYESNOB - FIRE DISTRICTYESNOC - POLLUTION CONTROLYESNOD-NOISECONTROLYESNOE - SOIL EROSIONYESNOF - FLOOD ZONEYESNOG-WATERSUPPLYYESNOH - SEPTIC SYSTEMYESNOI - VARIANCE GRANTEDYESNOJ-OTHERVII. VALIDATION - FOR DEPARTMENT USE ONLYYESNOUSE GROUPBASE FEETYPE OF CONSTRUCTIONNUMBER OF INSPECTIONSSQUARE FEETAPPROVAL SIGNATURETITLEDATE
Page 1 and 2: CITY OF SAGINAWINSPECTIONS DIVISION
Page 3: APPLICATION FOR BUILDING PERMITCity

Building Permit - City of Saginaw MI

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