COMMUNITY AND DEVELOPMENT SERVICES APPLICATION FOR RESIDENTIAL BUILDING PERMIT HOPKINSVILLE KY Application : Zoning: OWNER INFORMATION Last Name: First Name: Phone: Street Address: City: State: Zip: BUILDING DETAIL New Residential Duplex Residential Addition Accessory Structures: Detached Garage Storage Building Detached Carport Swimming Pools: Above ground In Ground Construction Plan Designated; Size of Structure Building Area (Sq. Ft.) Stories Height of Structure Total Building Cost: Material & Labor ELECTRICAL DETAIL Any extensions or modifications to wiring system? Yes No (Any extensions or modifications require an electric permit and inspection by a State Electrical Inspector) New Service Service Change Size Amp Extension of Service ****************************************************************************************** FOR OFFICE USE ONLY Building Permit # Electrical Permit # Permit Fee Permit Fee Building Inspector
PROPERTY INFORMATION Street Address Subdivision Lot # Parcel # Is any part of the property located in the Flood Plain? Yes No If yes, what zone? Will the structure obstruct natural drainage? Yes No Are there sinkholes or other obstructions on site? Yes No Have all utility and drainage easements onsite been designated on the Site Plan? Yes No Has a proper sized entrance tile (minimum 15") been installed at the entrances to the property or is curb and gutter being used? Tile Curb & Gutter LOT DETAIL Interior Lot Front Yard Setback off Property Line Rear Yard Setback off Property Line Left Yard Setback off Property Line Right Yard Setback off Property Line Lot Width at Publicly Maintained Street Lot Width at Building Setback Corner Lot (Consider Right of Way) Existing structures on property? Yes No Type Size of Structure Sq. Ft. EASEMENT WIDTH Utility: Front Yard Ft. Right Side Yard Ft. Left Side Yard Ft. Rear Yard Ft. Drainage: Front Yard Ft. Right Side Yard Ft. Left Side Yard Ft. Rear Yard Ft.
Sketch project showing streets, property lines and lot dimensions, existing and proposed structures, setback distances and all utility and drainage easements. The above information is true and correct to my best knowledge and belief. Signature of Applicant
SUBCONTRACTORS TO BE EMPLOYED ON THIS PROJECT CONTRACTOR NAME OR FIRM ADDRESS/PHONE LICENSE # General Electrical Plumbing Heating/Cooling Framing Masonry Siding Finish & Trim Roofing Drywall Painting Excavation Other I hereby certify that I understand that all contractors and subcontractors to be employed on this project must have a current business license issued by the City of Hopkinsville and are in compliance with Kentucky Law regarding to Workers Compensation and Unemployment Insurance. Applicant s Signature I hereby certify that all work on this project will be performed by the homeowner and no additional workers will be employed. Applicant s Signature
CERTIFICATION In consideration of the issuance of the requested permit, I hereby agree and covenant, with the City of Hopkinsville, the Hopkinsville-Christian County Planning Commission, that I will observe and conform with all applicable codes, zoning ordinances, and all other applicable codes, laws, restrictions and ordinances, and I hereby assume all risk incidental to any error or any violations or interpretations thereof. The Property Owner and Contractor hereby release the City of Hopkinsville, the Hopkinsville-Christian County Planning Commission and their employees from all liability of every kind and nature for damages which may occur from defective wiring or construction of or on said premises and hereby agrees to hold harmless the City of Hopkinsville, the Hopkinsville-Christian County Planning Commission and their employees from any kind and all such liabilities. I hereby certify that I understand the contents of the above paragraphs and that information used to complete this application is true and correct to my best knowledge and belief. I am the owner of record of the named property, or that the proposed work is authorized by the owner of record and that I have been authorized by said owner to make this application as his authorized agent. Signature of Applicant 9/19/14