TRADES LICENSE REGISTRATION APPLICATION
FEE: $50.00
Builder Electrician Plumber HVAC
Other Specify:
License Number: Date:
Name: Phone:
Address:
Number of Years at Present Address:
Former Places of Residence and Length of Time (Last Two Years):
Number of Years in Business: Number of Employees:
List all current licenses held and expiration dates:
Bond: $10,000.00 (License and Permit Bond payable to the Town of Daleville, Indiana):
Company and Agent:
Insurance: $ 100,000.00 (Certificate of Insurance to be kept on file)
Company and Agent:
Workman's Compensation:
Company and Agent:
A Certificate of Insurance and Bond must be on file in the office of the Town of Daleville Building Commission before a registration can be issued to the applicant.
Date Registration Issued: Fee:
I hereby certify the above information given on this application is true and accurate to the best of my knowledge.
Applicant Signature: Date:
APPLICATION FOR BASIC IMPROVEMENT LOCATION PERMIT
FEE: $50.00
Permit No. Date:
Owner’s Name:
Address of Work: Daleville, Indiana 47334
General Description of Work:
Circle one: Residential Business Industrial
Name of contractors or tradesmen who will do the work:
1.
2.
3.
Attach all written plans and specifications, if any, of the work to be performed.
Estimated Start Date:
Estimated Finish Date:
Was a “Stop work” Order issued: (Yes) (No)
All permit fees paid are nonrefundable.
Owner(s):
APPLICATION FOR ELECTRICAL PERMIT
A BASIC LOCATION IMPROVEMENT PERMIT IS ALSO REQUIRED
DO YOU HAVE AN IMPROVEMENT LOCATION PERMIT?
Yes No If So, Permit Number:
Permit Number: Date:
Owner’s Name:
Address: Phone Number:
Electrician’s Name:
Address: Phone Number:
Address of Job:
Residential: Commercial: State Release #:
Change of service: New service: Existing service:
New Structure: Existing Structure:
Service Size: Amps Feed: O.H. U.G.
3 Wire 120/240 1Ø 3 Wire 240 3Ø 4 Wire 120/240 3 Ø
4 Wire 277/480 3ØY 4 Wire 120/208 3Y
Main Disconnect Size: Wire Size: Conductor Neutral:
Consuming Openings:(15/20 Amp) (30 Amp or higher)
Panel: Number of Inspections:
Remarks:
Estimated start date: Estimated completion date:
Ready: Will call:
Fair Market Value of work being done:
Application: Approved Denied Initials Date:
Was there a stop work order issued: Yes No
Permit Costs:
1. Basic Residential Repair: $100.00
2. Basic Residential Electrical System Replacement: $150.00
3. New Residential construction up to 2000 sq. ft. of living space: $150.00 above 2000 sq. ft. of living space add 10¢ per sq. ft.
4. Commercial (Business, excludes Industrial) repairs and rehabilitation $200.00 up to 2000 sq. ft. of usable space and 10¢ per sq. ft. beyond 2000 sq. ft.
5. New Commercial Construction (Business, excludes Industrial) $500.00 up to 2000 sq. ft. of usable space and 10¢ per sq. ft. beyond 2000 sq. ft.
6. Industrial repairs and rehabilitation $500.00 up to 2000 sq. ft. of usable space and 10¢ per sq. ft. beyond 2000 sq. ft.
7. New Industrial Construction $500.00 up to 2000 sq. ft. of usable space and 100 per sq. ft. beyond 2000 sq. ft.
All permit fees shall be nonrefundable.
MUST BE APPROVED BY LOCAL UTILITY COMPANY
Applicant’s Signature Date
APPLICATION FOR HVAC PERMIT
A BASIC LOCATION IMPROVEMENT PERMIT IS ALSO REQUIRED
DO YOU HAVE AN IMPROVEMENT LOCATION PERMIT?
Yes No If So, Permit Number:
Permit Number: Date:
Owner’s Name:
Address:
Phone Number:
Contractor’s Name: License #:
Address:
Phone Number:
Address of Job:
Circle one: Residential Business
Type of Installation: New Replacement Add-on Exhaust hood
Heating: Number of BTU’s:
Cooling: Number of BTU’s:
Ventilating: Ami CFM Number of outlets:
Plans and specifications:
Do you have a state release: If so, state release number:
Number of inspections:
Fair Market Value:
Estimated start date: Estimated completion date:
Was there a stop work issued: Yes No
Application: Approved Denied Initials Date:
Applicant’s Signature Date
Costs:
1. Basic Residential repair: $ 50.00
2. Basic Residential Electrical System Replacement: $100.00
3. New Residential construction up to 2000 sq. ft. of living space: $150.00 above 2000 sq. ft. of living space add 10¢ per sq. ft.
4. Commercial (Business, excludes Industrial) repairs and rehabilitation $500.00 up to 2000 sq. ft. of usable space and 10¢ per sq. ft. beyond 2000 sq. ft.
5. New Commercial construction (Business, excludes Industrial) $500.00 up to 2000 sq. ft. of usable space and 10¢ per sq. ft. beyond 2000 sq. ft.
6. Industrial construction repairs and rehabilitation $750.00 up to 2000 sq. ft. of usable space and 10¢ per sq. ft. beyond 2000 sq. ft.
7. New Industrial construction $1000.00 up to 2000 sq. ft. of usable space and 100 per sq. ft. beyond 2000 sq. ft.
All permit fees shall be nonrefundable.
APPLICATION FOR PLUMBING PERMIT
A BASIC LOCATION IMPROVEMENT PERMIT IS ALSO REQUIRED
Permit Number: Date:
Owner’s Name:
Phone Number:
Contractor’s Name: License #:
Address:
Address of Job:
Circle One: Residential Business Industrial
Kind of Building:
Number of stacks: Number of Fixtures and Openings:
New Water Heater: Water line: New Replace
Sewer line: New Replace:
Plans and specifications:
Do you have a state release?: If so, what is the state release number:
Number of inspections:
Fair Market Value:
Estimated start date: Estimated completion date:
Was there a stop work order issued: Yes No
Application: Approved Denied Initials Date:
Costs:
1. Basic Residential repair: $50.00
2. Basic Residential Plumbing System Replacement: $50.00
3. New Residential construction up to 2,000 sq. ft. of living space: $100.00 above 2,000 sq. ft. of living space add 10¢ per sq. ft.
4. Commercial (Business, excludes Industrial) repairs and rehabilitation $150.00 up to 2,000 sq. ft. of usable space and 10¢ per sq. ft. beyond 2,000 sq. ft.
5. New Commercial Construction (Business, excludes Industrial) $200.00 up to 2000 sq. ft. of usable space and 10¢ per sq. ft. beyond 2000 sq. ft.
6. Industrial repairs and rehabilitation $500.00 up to 2000 sq. ft. of usable space and 10¢ per sq. ft. beyond 2000 sq. ft.
7. New Industrial Construction $750.00 up to 2000 sq. ft. of usable space and 10¢ per sq. ft. beyond 2000 sq. ft.
All permit fees shall be nonrefundable.
APPLICATION FOR SIGN PERMIT
A BASIC LOCATION IMPROVEMENT PERMIT IS ALSO REQUIRED
Date:
Owner’s Name:
Address:
Phone Number:
Contractor’s Name: License #:
Address:
Phone Number:
Are you insured:
Address of Job:
Type of building:
Fair Market Value:
Type of sign being installed:
Detailed sign construction specifications (attach separate sheet and include location on parcel of real estate)
Is there going to be any neon on this sign: If yes, do you have your neon specs:
Approved: Disapproved:
Building Commissioner
Comments / Restrictions:
Applicant’s Signature Date
Costs:
1. Rehabilitation of existing sign: $100.00
2. New sign construction: $100.00
All permit fees shall be nonrefundable.
APPLICATION FOR DEMOLITION/MOVING PERMIT
Fee: $250.00
A BASIC LOCATION IMPROVEMENT PERMIT IS ALSO REQUIRED
Date:
Owner’s Name:
Address:
Phone Number:
Contractor’s Name: License #:
Address:
Phone Number: Are you insured:
Address of Job:
Type of building:
Fair Market Value:
Where are you disposing of demolition material:
Are there any sub-contractors? If yes, list names, addresses and phone numbers:
Approved: Disapproved:
Daleville Building Commissioner
Comments/Restrictions:
Applicant Signature Date
(Ord. 07-01, adopted 5-5-2007, updated 5- -2009, Appendix)