2. 
4. Residential Use Construction Permit Application
6. Address of Improvement*
8. Property Owner's Name*
10. Property Owner's Address*
12. Property Owner's Phone#*
14. Property Owner's Email Address
16. Applicant's Name (if other than owner)
18. Applicant's Address (if other than owner)
20. Applicant's Phone# (if other than owner)
22. Applicant's Email Address (if other than owner)
24. Type of Improvement (check all that apply)*

    1. Addition
    2. New Home
    3. New/Altered Electrical
    4. New/Altered Mechanical
    5. New/Altered Plumbing
    6. Remodel
    7. Other
26. If other please describe
28. Description of Work*
30. Dimensions of Improvement
32. Number of Stories (floors)
33. Height of Improvement
35. If new home or bedroom addition, # of off-street parking spaces
37. Anticipated Start date
    Anticipated Start date
38. Anticipated End Date
    Anticipated End Date
40. Total cost of Improvement*
44. Contractor Information
46. Builder Name
47. Builder Address
48. Builder Phone#
50. Plumber Name
51. Plumber Address
52. Plumber Phone#
54. Electrician Name
55. Electrician Address
56. Electrician Phone#
58. Heating/AC Name
59. Heating/AC Address
60. Heating/AC Phone#
62. Attach plot plan here
64. New electric work?*

    1. Yes
    2. No
65. New plumbing work?*

    1. Yes
    2. No
66. New mechanical work?*

    1. Yes
    2. No
68. New water connection required?*

    1. Yes
    2. No

    (if yes, water application required)
69. New sewer connection required?*

    1. Yes
    2. No

    (if yes, sewer application required)
71. Is there any new/repaired curb & sidewalk required along the street?*

    1. Yes
    2. No
72. Are there existing or proposed fuel burning appliances in the dwelling? *

    1. Yes
    2. No

    (oil, propane, natural gas,wood, etc.)
73. Is any new impervious surface (non-green space) proposed?*

    1. Yes
    2. No

    (if yes and less than 1,000 sq ft, please submit a Stormwater Exemption Application. )
77. The applicant certifies that all information on this application is correct and the work will be completed in accordance with the approved, construction documents and PA Act 45 (Uniform Construction Code) where applicable. The property owner and applicant assumes the responsibility of locating all property lines, setback lines, easements, rights-o way, flood areas, etc. Issuance of a permit and approval of construction documents shall not be construed as authority to violate, cancel, or set aside any provisions of the codes or ordinances of the Municipality or any other governing body. The applicant certifies he/she understands all the applicable codes, ordinances, and regulations. Application for a permit shall be made by the owner or lessee of the building or structure, or the agent of either, or by the registered design professional employed in connection with the proposed work.
79. I certify that the code administrator or the code administrator's authorized representative shall have the authority to enter areas covered by such permit at any reasonable hour to enforce the provisions of the code(s) applicable to such permit.
81. Name*
    By entering your name and date above, you are signing this form and agreeing to all terms and conditions of this application.
82. Date*
    Date
Leave This Blank:


84. 1. Receive an email copy of this form.
85. Email address

    This field is not part of the form submission.

86. Submit Submit and Print

* indicates a required field