--- - ZONNG PERMT APPLCATON ApplicatiOn and required additional nformation- $20 oning f e must be delivered to the Columbia Township Hall, Attention: Zonmg Adm1mstrator Required nformation: 53053 CR 388, Grand Junction PO Box 323, GrandJunction 49056 0323 Facsimile-: (269) 434-6916 Property Address: --------- Property Tax No : 80-06- Map No: Owner Name: ------ Address :,------------- --- --------- Phone: Cell Phone: ------ App i cant (if other than owner): ---,--- Address: Phone: --- Proposed Use of the structure: ; f the propose use is a dwelling, number of bedrooms Estimated Cost of construction: --- Applicant signature: date: Site Plan : (please read carefully) Use a separate sheet of paper, to draw a diagram showing all of the follq\ting items: 1 Dimensions of the lot (all sides) and acreage 2 Location, distance to rot lines, of all existing & proposed structures 3 Dimensions of all existing & proposed structures & ft<>qr areas 4 Distance between proposed structure & all existing struotures 5 Location c:if roads bordering the property, including center line and easement or rightof-way line 6 Location ofpower & gas lines on the property, with easement widths (if any) 7 Loca lon of lakes, streams, county drains or wetlands within 500 feet of the property a Location of any easements on the property 9 A North arrow ndicating the direction of north Do Not Write Below This Line -- Zoning District Required setbacks front Rear Side rtght Side left Between buildin--- Minimum lot width Minimum lat area MiOO tim lot cover MinimumJMaximum building size s the lot confonning? Has Variance been granred? -- Approval Denial Reason Denied --- Conditiohs Approval Signature Zoning Administrator Date: ----
APPLCATON FOR BUlLDNG P:ERMT AND PLAN EXAMNATON $20 COLUMBA TOWNSHP PHONE: 269-434-6227 53053 CR 388-PO BOX 323 FAX: 269-434-6916 GRAND JUNCTON, M 49056 AUTHORJTY: COMPLETON: PENAL TY: PARCEL # 80 06 PA 230 OF 1972, AS AMENDED lv1andatory TO OBTAN PERMT PERMT WLL NOT BE SSUED # 1HE DEPARTMENT OF CONSUMER AND NDUSTRY SERVCES WLL NOTl DSCRMNATE AGANST ANY NDVDUAL OR GROUP BECAUSE OF RACE, SEX RELGON, AGE, NATONAL ORGN, COLOR, MARTAL STATUS, HANDCAP, OR POLTCAL BELEFS APPLCANt TO COMPLETE ALL TEMS N SECTON, n, m, V, v AND Vi NOTE: SEPARAT: APPLCATONS MUST BE MADE TO THE AP:PltOPRATE DVlSON FOR PLlJMB:iN<;, Mll:CHANCAL, AND :ELECTlUCAL WORK P:ERMi:tS PROJECT NFORMATON PROJECT NAME CTY VLLAGE TOWNSHP COUNTY ZP CODE BETWEEN AND DENTFCATON,, A OWNER OR LESSEE N AME CTY STATE ZP CODE TELEPHONE NillvBER - B ARCHTECT OR ENGNEER 1"1 CTY STATE ZP CODE TELEPHONE NillvBER LCENSE NillvBER EXPRATON DATE C CONTRACTOR NAME CTY STATE ZP CODE TELEPHONE NillvBER BULDERS LCENSE NUMBER EXPRATON DATE FEDERAL EMPLOYER D NUMBER OR REASON FOR EXEMPTON WORKERS COMP NSURANCE CARRER OR REASON FOR EXEMPTON MESC EMPLOYER NUMBER OR REASON FOR EXEMPTON n TYPE OF MPROVfilvfENT AND PLAN REVEW A TYPE OF MPROVEMENT 0 NEWBULDNG 0 ALTERATON D DEMOLTON 0 FOUNDATON ONLY D RELOCATiON 0 ADDTON 0 REPAR D n MOBlLB[ i ME SET UP BOCA HUD 1 0 PREMANUFACTuRE 0 SPECAL NSPECTON
B REVJEW(S) TO BE PERFORMED 0 BULDNG 0 ELECTRCAL D MECHANCAL D PLUMBNG D FOUNDATON V PROPOSED USE OF BULDNG A RESDENTAL 0 ONEFAMLY D HOTEJMOTEL D DETACHEO GARAGE 0 TWO OR MORE FAMLY NO OF UNTS NOOF UNTS D ATAcHED GARAGE 0 OTHER B PROJECT COST ESTMATE $ DATE # SQUARE FEET: BUilDNG DMENSONS: WDTH LENGTH HEGHT ESTlMATE POLE BARN: 0 CEMENT FLOOR 0 DRT FLOOR COMMENTS: V SELECTED CHARACTERSTCS OF BUJLDNG A PRNC AL TYPE OF FRAME D MASONR WALL BEARNG 0 WOOD FRAME 0 STRUc;TJRAL STEEL 0 RENFORCED CONcRETE 0 OTHER B PR1NC AL TYPE OF HEATNG FUEL 0 GAS 0 al (] ELECTRCTY D OTHER - C TYPE OF SEWAGE DSPOSAL 0 PUBLC OR PRVATE COMPANY 0 SEPTC SYSTEM - D TYPE OF WATER SUPPLY Q PUBLC ORPRVATECOMPANY D PRV A te WELL OR CSTERN p TYPE OF MECHANCAL 0 AR CONDTONlNG D FRE SUPPREsSON F DMENSONS/DATA NvMBER OF STORES USE GROUP FLOOR AREA EXSTNG ALTERATONS BASEMENT NEW CONST TYPE FRST FLOOR NO OF OCCUPANTS SECOND FLOOR FRST FLOOR SECOND FLOOR TlRD FLOOR G NUMBER OF OFF STREET PARKNG SPACES Side property mes are to be dearly marked 0 OuDooRS D ENCWSED hereby give pertnission for Building & Zoning Officials of Columbia Township to access and inspect the property in question 2
STE OR PLOT PLAN FOR APPLCANT USE DRAW TO SCALE The following must be shown below 1-Property li1les of parcel 2-Measutexnents of parcel 3-Roads or easements 4 Existing structures on property 5-New structure oil prop-erty 6-Measuren;ients of all structures, new & existing 7-Front, rear, and side setbacks of all s1ructores N 1,i; 3
PARC:ll:L # 80-06 --- -=--- ---- Applicant is responsible for the payment of all fees and charges applicable to this application and must provide the following information NAME TELEPHONE NO CTY STATE f ZP CODE FEDERAL D NUMBER/SOCAL SECURTY NUMBER ----- HEREBY CERTFY THAT THE OWNER OF RECORD AUTHORZES THE PROPOSED WORK AND THAT HA VE BEEN AUTHOR1ZED BY TiiE OWNER TO MAKE TBS APPLCATON AS HS AUTHORZED AGENT, AND WE AGREE TO CONFORM TO ALL APPLCABLE LAWS OF THE STATE OF MCHGAN ALL NFORMATlON SUBMTTED ON THS APl>LCATON S ACCURATE TO 11E BEST OF MY KNOWLEDGE Section 23a of the state construction code act of 1972, Act No 230 oftbe Public Acts of 1972, being section 1261623a of the Michigan Compiled Laws, prohibits a person from ctinspiring to citcunnrent th-e licensing requirements of this state relating to persons who are to perform work on a residential building or a residential structure Violntors of section 23a are subject to civil fines SGNATURE OF APPLCANT -- PLAN REVEW FEE ENCLOSED $ NOTFCATON TO COLUMBA TOWNSHil> S REQURED WHEN WORK S COMPLETED BULDNG PERMT FEE ENCLOSED $ OR STATE ACCOUNT NUMBER V LOCAL GOVERNMENTAL AGENCY TO COMPLETE THS SECTON l NV1RONMENTAL CONTROL APPROVALS REQUlRED? APPROVED DATE NUMBE :SY A-ZONNG DYli:S D NO B -FRE DSTRCT D YES D NO C -POLLUTON CONTROL DYES D NO D - NOSE CONTROL DYES D NO E - SOL EROSON o YES D NO F,: FLOOD ZONE DYES D NO, G-WATER SUPPLY DYES D NO H -SEPTC SYSTEM DYES D NO l - VARANCE GRANTED DYES D NO J-OTHER DYES D NO V VALDATON-FOR DEPARTMENT USE ONLY-ZONNG COMPLANCE EXPiRES 1 YEAR FROM APPROVAL Use group Base fee Type of construction Square feet APPROVAL SGNATURE Drawing to scale, including all dimensions and structures, must be attached TTLE 1 DATE 1
- L COLUMBA TOWNSHP PERMT APPLCATON CHECKLST Permit Application for: --- (Job Address) Phone numbers: 1 ) 2) - Before a permit may be issued, a the following documentation must be submitted 1) STE PLAN or LOT DAGRAM (Required for ALL building applications 2) PROOF OF OWNERSHP (Provide copies of tax statement, assessment notice or deed) 3) PROPERTY TAX l D NUMBER (80-06- --- --- ) 4) 5) BLUE PRNTS are required for the Building inspector (required at his office) and a copy For the Assessor (leave at township office) HEAL TH DEPARTMENT PERMT (septic system) 6) DRVEWAY SDEWALKPERMT (county road commissionr 7) SOL EROSON PERMT ( f structure is within 500 feet of a lake, river or county drain) 8) MOBLE HOME ( f pre-owned Mobile Home or Double wide or Modular, it must be nspected before entering the Township also the age of the Unit (age: ) 10) OTHER PERMTS EVENTUALLY NECESSARY: Electrical Plumbing Mechanical Variance Special Use Permit t is the legal responsibility of the applicant to call for all required inspections before any electrical, mechanical, plumbing or structural work is concealed or coveted //jpt/word/c:doc/zoning Permit Application Checklist/2013//