DURHAM TOWNSHIP BUILDING PERMIT APPLICATION

TYPE OF PERMIT REQUESTED: (CHECK ALL THAT APPLY)  0BUILDING 0ELECTRICAL 0PLUMBING

OWNER: ________________________________________ TAX PARCEL #:  11- ___________

ADDRESS: ___________________________________  0RESIDENTIAL 0COMMERCIAL 0FARM

CITY/STATE/ZIP: _________________________________

TELEPHONE: (HOME) ___________________ CELL/OTHR: ___________________

SITE INFORMATION:  WORK LOCATION: Same as above: 0 Other: 0 (If other complete below)

LOCATION: (Address if other) _____________________________________________________

TYPE OF ZONING: 0Residential (RP) 0Rural Residential (RR) 0Commercial/Indust 0Village Center (VC)

Is Site located in a Flood Prone Area or Floodplain? 0 Yes 0 No  

TYPE OF WORK OR IMPROVEMENT: (Check All that Apply)

0New Building 0Addition 0Alteration 0Repair 0Demolition 0Relocation   0New Roof

0Foundation only 0Change of Use 0New Electrical Service: ____Amp 0New Water Heater

CONTRACTOR INFORMATION: 0No Contractor (Work will be performed by Owner above)

Name of Company: ______________________ Name of Contractor: __________________

Address: ______________________________ City/State/Zip: _______________________

Telephone:  Business: ___________________ Cell / Other: __________________________

Employer Identification No: ________________ Contractor License No: _________________

Narrative of Work to be Performed:  __________________________________________

________________________________________________________________________

________________________________________________________________________

____________________________________Total Cost of Proposed Work: $__________

DETAILED DRAWINGS MUST BE ATTACHED PRIOR TO ISSUANCE OF PERMIT

Application for a permit shall be made by the owner or lessee of the building or structure, or agent of either or by the registered design

professional employed in connection with the proposed work.

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 the Uniform Construction Code and any additional approved building code requirements adopted by Durham

Township.  The property owner and/or applicant assume the responsibility of locating all property lines, setback lines, easements, right-of-

ways, 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 Durham Township or any governing body.  The applicant certifies he/she understands

 all the applicable codes, ordinances and regulations and that work will not commence until permit is issued; the review could take up to fifteen

 (15) days from time permit application is submitted.

I certify that the code administrator or the code administrators 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.

_______________________________           _________________________________     ____________________

Signature of Owner or Authorized Agent         Print Name of Owner or Authorized Agent             Date

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                                                                                (Office Use Only i)

Zoning Officer Approval:  _____________________________   Date: ________________________