House Permit Application

 

TOWN OF KIPPENS MDA Page 1

2 JUNIPER AVENUE KIPPENS NF A2N 3H8

PHONE: (709) 643-5281 FAX: (709) 643-9773

APPLICATON FOR A BUILDING PERMIT

Name of Owner ________________________________________________________________________

Address ________________________________________________________________________

(Res) Telephone: (___) _____________ (BUS) (____) _____________ (CELL) (____) _____________

This application is made with my knowledge and approval.

Signature of Owner _____________________________________ Date ________________________

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Applicant (if different from owner) _______________________________________________________

Address ______________________________________________________________________________

(Res) Telephone: (___) _____________ (BUS) (____) _____________ (CELL) (____) _____________

Name of Contractor of Builder ___________________________________________________________

Address ______________________________________________________________________________

(Res) Telephone: (___) _____________ (BUS) (____) _____________ (CELL) (____) _____________

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Architect and/or Professional Engineer(s) retained to design and /or review construction of Building:

Name _______________________________________________________________________________

Address ________________________________________________________________________

(Res) Telephone: (___) _____________ (BUS) (____) _____________ (CELL) (____) _____________

Location of Proposed Building ___________________________________________________________

Location of Existing Building (s) on the Site ________________________________________________

Describe in detail the proposed Building Work and Occupancy _______________________________

MDA Page 2

ESTIMATED VALUE OF PROPOSED WORK: $__________________________________

1. I, __________________________________hereby apply for permission to carry out the above building work. I declare that all information given by me in connection with this application is true and correct to the best of my belief and that the building work described in this application, if permitted, will be carried out in accordance with all applicable laws and regulations of the Province of Newfoundland and Labrador and the Town of Kippens.

I understand that the granting of a permit, the approval of the drawings and specifications or inspections made by the Town of Kippens shall not in any way relieve me of fall responsibility for carrying out the work or having the work carried out in accordance with the National Building Code and the Town of Kippens Regulations.

_____________________ __________________________________________

DATE SIGNATURE

Note

(a) This form is to be completed and submitted with Form MDA applying for a Development Permit and form MDA (construction details where necessary)

(b) One (1) complete set of building design plans is to be submitted with the application

(c) Plot plan outlining location of proposed building to be submitted with this application.

(d) Department of Health approval required before permit issued.

(e) Permit construction fee for residential dwelling is fifty ($50.00) dollars payable when permit picked up by owner if the owner is the builder. Contractor, residential permit fee is 1/8 of 1% of construction costs.

(f) Septic system shall be designed by a certified system designer. A list of the septic system designers is available at the Government Services Centre, Stephenville.

(g) When selecting a heating system for your dwelling please note that Kippens water supply is known as hard water and if you plan on having a water heating system in your dwelling please have your contractor design the water heating system for hard water.

(h) Culvert to be installed under proposed driveway. Please check with the town on culvert size.

MDA Page 3

CONSTRUCTION DETAILS:

1. EXCAVATION:

- Dept from finished grade to footing_______________________

2. FOUNDATION:

- Type______________ Walls: Thickness __________________

- Size of Footing ____________x__________

- Piers: Size __________ x _______Footing ________x________

3. CONCRETE:

- Type _____________ Reinforced: Yes ____ N0 ______

- Waterproofing _______________ Or Damp proofing ________

4. TILE DRAINS:

- Perimeter _______ under floor _____Sump Pump _________

5. EXTERIOR WALLS:

- Frame_____________ Solid Masonry

- Other (specify) _________________________________________

6. EXTERIOR FINISH:

- Wood Brick Stucco

7. CHIMNEY (S):

- Brick Prefabricated Flue Size x

MDA Page 4

8. CONSTRUCTIN:

SIZE MATERIALS &

MEMBER SPAN THICKNESS GRADE

Bearing Partitions (studs) __

Columns under Girders _______

Floor Joists (main floor) _______

Floor Joists (other floor) _______

Ceiling Joists

Rafter’s ___

Truss ___

Girders ___

Roof Sheathing ___

Wall Sheathing (exterior) ___

Sub Flooring ___

Tile Underlay ___

Basement Floor ___

Other Partitions (studs) ___

MDA Page 5

9. Interior Finish Gyprock ______ Plaster Panelling

Other (specify) __________________________________________________

10. Windows Type of frame ______________________ flashing _______________

11. Doors Type of frame ______________________ flashing ______________

Exterior Size _______________________ Interior Size ____________

12. Insulation Type and thickness: Exterior Walls _____________________________

Ceiling ____________________________________________________

Floor (if applicable) __________________________________________

13. Plumbing 3 Piece___________ Extra plumbing (specify) ____________________

(All plumbing must be installed to the specifications of the National Plumbing Code of Canada)

14. Roofing Type ________________ Grade of Weight ______________________

Eaves troughing Yes ______ ____ No ___________

15. Electrical Service Source of Power _______________________________________

(All wiring must be installed in compliance with the Electrical Code of Newfoundland and Labrador)

16. Heating System Type of System ___________________________________________

Location of fuel storage: Inside __________ outside __________

17. Water Supply (show Location on plot plan: Dug well _________ _____________

Drilled Well _____________ Town Water ___________________

18. Sewage Disposal (show location on plot plan) Type _________________________

MDA Page 6

MUNICIPALITY OF KIPPENS

DEVELOPMENT REGULATION

APPLICATION FOR A DEVELOPMENT PERMIT

This application is for:

(Check the appropriate answer)

Outline Planning Permission ____________. Temporary Permission ______________

The change of use or type of occupancy

Of land or buildings ___________________. The construction, alternation, demolition

Or relocation of a building ____________

The erection or display of an

Advertisement _______________________. The subdivision of land for

Development _______________________

Permission to occupy a building ________. The making of an access onto

A public road _______________________

Other (specify) _____________________________________________________________

1. Name of Owner _________________________________________________________

2. address _________________________________________________________

3. Telephone _________________________________________________________

This application is made with my knowledge and approval.

Signature of Owner: _________________________________________

Date: _________________________________________

Name of applicant (when not Owner) _______________________________________

Address: _______________________________________________________________

Telephone No. __________________________________________________________

Location of Site: ________________________________________________________