CIT Y OF CHICAG O DEPARTMENT OF BUILDINGS Building Permit Application HOLDS USE - PDF document

CIT OF CHICAGDEPARTMENT OF BUILDINGS Building Permit Application HOLDS: USE BLACK INK: Y N Y N DO NOT WRITE IN SHADED AREA Stop Order(s): Violations APPLICATION PERMIT NO.: _________________________ Landmark Special Admin. Hold DS APPLICATION NO.: _____________________________ Lakefront Prot. Other DATE ISSUED: ____________________________________ Flood Plain 1. GENERAL INFORMATION $GGUHVV3OHDVHHQWHUWZRLIDFRUQHUSURSHUW\ 1. -- -- 3. -- Enter permit number if revision to an existing permit: 4. -- Cost of Construction: 2. CLASSIFICATION BY OCCUPANCY: '2SHQ$LU$VVHPEO\ A Residential E Business A2 Residential H3 Garages B Institutional F Mercantile  &$VVHPEO\ &$VVHPEO\ Private Garage 7HFKQRORJ\&HQWHU &$VVHPEO\ 3A. BUILDING INFORMATION FOR EXISTING BUILDING: Volume (cf) Units Existing Area (sf) No. Comm. Height Const. Class. Basements Width LengthNo. Stories No. D.U. 3B. BUILDING INFORMATION FOR NEW CONSTRUCTION (IF APPLICABLE): No. Stories No. Comm. Width Height Area (sf) Volume (cf) Units Addition Const. Class. Basements No. D.U. Length Trash 3C. BUILDING INFORMATION FOR RENOVATION (IF APPLICABLE): Area (sf) Volume (cf) Units Area to be Renovated No. Comm. Height Const. Class. Basements Width Length No. D.U. No. Stories 197999-14-SP-4/08 4. ZONING INFORMATION: (See Site Plan in Drawings of lot and buildings, showing dimensions, streets, alleys, setbacks, existing landscaping and north arrow.) Area of Lot: Plate Number: Height of Building: Zoning District/P.D. #: Area and Volume of Building: Zoning Use: Number of Parking Spaces: Front or Rear Building: Number of Loading Spaces: 6SHFLDO=RQLQJ3HUPLVVLRQ5HTXLUHGIRU$GPLQLVWUDWLYH$GMXVWPHQW9DULDQFHRU6SHFLDO8VH Yes Signature of Approval: 5. FIRE PREVENTION ITEMS: Yes No ,QVWDOO3DUWLDO6SULQNOHU6\VWHP'HVLJQDWH$UHDVWREH ([WHQG([LVWLQJ6SULQNOHU6\VWHP'HVLJQDWH$UHDVWR Flammable Compressed Gases ([LVWLQJ)LUH$ODUP6\VWHP&KRRVH2QH_____ Class I _____ High RiseBBBBB&ODVV,,BBBBB2WKHUFODULI\ ,QVWDOO1HZ)LUH$ODUP6\VWHP&KRRVH2QH_____ Class I _____ High RiseBBBBB&ODVV,,BBBBB2WKHUFODULI\ 2 6. MAYOR’S OFFICE FOR PEOPLE WITH DISABILITIES ITEMS Yes RENOVATION PROJECTS ONLY: ($& (VWLPDWHG$OWHUDWLRQ&RVWIRU3URMHFW%XGJHW(5& (VWLPDWHG5HSURGXFWLRQ&RVW :RUN$UHDVI[1HZ&RQVWUXFWLRQ&RVWSHUVIHOUSING PROJECTS ONLY (Submit Part II Letter of Approval at intake meeting, if applicable.): 7RWDO1XPEHURI'ZHOOLQJV8QLWV Proposed No. Actual No. D.U. Accessible Lodging Units [1107.5.1.1 (ANSI Section 1002)] 8QLWVZLWK&RPPXQLFDWLRQ)HDWXUHV>$16,6HFWLRQ@$FFHVVLEOH8QLWVZLWK&RPPXQLFDWLRQ)HDWXUHV>$16,6HFWLRQ@7\SH$>$16,6HFWLRQ@7\SH%>$16,6HFWLRQ@7\SH$ %ZLWK&RQGXLW/LQHV>@Visitable [1107.5.4.3 and 1107.5.5.3] $WWDFKHG0XOWL6WRU\6)58QLWVZLWK6HSDUDWH0HDQVRI(JUHVV>@Section 504 Accessible Units [1107.5.5.5.1 and (U.F.A.S. Sec. 4.34)] 6HFWLRQ$FFHVVLEOH8QLWVZLWK&RPPXQLFDWLRQ)HDWXUHV>DQG=RQLQJ,QFHQWLYH%XLOGLQJ7\SH$8QLWV>$ %$ $D(Zoning Code) (ANSI Section 1003)] 7. ENVIRONMENTAL ITEMS Yes No Yes No Boiler(s) Gas Fired Hot Water Heater(s) Devices 0DQXIDFWXULQJ3URFHVV(TXLSPHQWRU$UHD Unit Heaters or other Gas Fired HVAC Units Air Pollution Control Devices 8QÀUHG3UHVVXUH9HVVHO$LU7DQNV+HDW([FKDQJHUHot Storage Tanks) 3DLQW6SUD\%RRWKRU3DLQW6SUD\$UHD Unit 3DLQW6SUD\%RRWKRU3DLQW6SUD\$UHDLQ0RWRUVehicle Repair Shop 1HZ,QFLQHUDWRURU$IWHUEXUQHU(TXLSPHQW 8QGHUJURXQG$ERYHJURXQG6WRUDJH7DQN8QLW$SSO\ 6DQGEODVWLQJ*ULQGLQJRI0DVRQU\RU&KHPLFDO&OHDQLQJRI$Q\$UFKLWHFWXUDO6XUIDFH Compactor or Bailer 3 8. REMARKS AND APPROVALS Remarks By: Date: Remarks By: Date: Remarks By: Date: Remarks By: Date: Remarks By: Date: Remarks By: Date: Remarks By: Date: Remarks By: Date: 4   9. CONTACT INFORMATION Owner/Tenant/Agent: _________________________________________________________________________________________ Address: ______________________________________________________ State: _____________________ Zip Code: ________ E-mail:________________________________________________________ Telephone No: _______________________________ 7HOHSKRQH1RBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB__________________________________________________________________________________________________ /LFBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB&LW\BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBAddress: ______________________________________________________ State: _____________________ Zip Code: ________ E-mail: _______________________________________________________ Telephone No: _______________________________ ___________________________________________________________________________________________ /LFBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB&LW\BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBAddress: ______________________________________________________ State: _____________________ Zip Code: ________ E-mail: _______________________________________________________ Telephone No: _______________________________ ____________________________________________________________________________________________ /LFBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB$%RU&&LW\BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBAddress: ______________________________________________________ State: _____________________ Zip Code: ________ E-mail: _______________________________________________________ Telephone No: _______________________________ __________________________________________________________________________________________ /LFBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB&LW\BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBAddress: ______________________________________________________ State: _____________________ Zip Code: ________ E-mail: _______________________________________________________ Telephone No: _______________________________ Vent/Heat Contractor: _________________________________________________________________________________________ /LFBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB&LW\BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBAddress: ______________________________________________________ State: _____________________ Zip Code: ________ E-mail: _______________________________________________________ Telephone No: _______________________________ /LFBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB&LW\BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBAddress: ______________________________________________________ State: _____________________ Zip Code: ________ E-mail: _______________________________________________________ Telephone No: _______________________________ _________________________________________________________________________________________ /LFBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB&LW\BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBAddress: ______________________________________________________ State: _____________________ Zip Code: ________ E-mail: _______________________________________________________ Telephone No: _______________________________ ___________________________________________________________________________________________________ /LFBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB&LW\BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBAddress: ______________________________________________________ State: _____________________ Zip Code: ________ E-mail: _______________________________________________________ Telephone No: _______________________________ _____________________________________________________________________________________________ /LFBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB&LW\BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBAddress: ______________________________________________________ State: _____________________ Zip Code: ________ E-mail: _______________________________________________________ Telephone No: _______________________________  ,I\RXUOLFHQVHG$UFKLWHFWLVQRWORFDWHGLQWKH6WDWHRI,OOLQRLV\RXKDYHWKHRSWLRQWRLGHQWLI\DORFDO,OOLQRLV$UFKLWHFWWRUHSUHVHQW\RXDW'2%WRDWWHQGPHHWLQJVDQGDWWHQG2SHQ3ODQ5HYLHZ 5 �� ____________________________________________________________________________________ _________________________________ WARNING TO PROPERTY OWNER/TENANT AND GENERAL CONTRACTOR ,BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBDVSURSHUW\RZQHUWHQDQWDQG,BBBBBBBBBBBBBBBBBBBBBBBBDVJHQHUDOFRQWUDFWRUXQGHUVWDQGWKDWLWLVDJDLQVWWKHODZWRH[FHHGWKHVFRSHRIDEXLOGLQJSHUPLW,XQGHUVWDQGWKDWLI,EXLOGRUDOORZDQ\RQHHOVHWREXLOGDQ\EXLOGLQJURRPDGGLWLRQVWUXFWXUHRURWKHUREMHFWWKDWGLIIHUVIURPRULQDQ\ZD\H[FHHGVZKDWWKLVSHUPLWDXWKRUL]HVPHWREXLOG,FDQDQGZLOOEHseverely punished. I understand that if I H[FHHGRUDOORZDQ\RQHHOVHWRH[FHHGWKHVFRSHRIWKLVEXLOGLQJSHUPLW,FDQKDYHP\permit revoked; be ordered to stop all work RQWKHSURMHFWXSWRSHUGD\LPSULVRQHGIRUXSWRVL[PRQWKVUHTXLUHGWRGRXSWR100 hours of community serviceUHTXLUHGWRtear down at my own exDOOFRPSOHWHGZRUNDQGLQDGGLWLRQWRDQ\RWKHUSHQDOWLHVSURYLGHGE\ODZUHTXLUHGWRthe City XSWRWKUHHWLPHVDQ\GDPDJHVLQFXUUHGIRUSURYLGLQJDQ\IDOVHRULQDFFXUDWHLQIRUPDWLRQLQWKLVEXLOGLQJSHUPLWDSSOLFDWLRQ,XQGHUVWDQGWKDWDOOFRQVWUXFWLRQZRUNXQGHUWKLVSURSRVHGSHUPLWPXVWTenant Signature (if applicable) ________________________________________________________________________ Date __________________ CERTIFICATION BY PROPERTY OWNER/TENANT ,BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBDVSURSHUW\RZQHUWHQDQWKHUHE\FHUWLI\WKDWWKHVWDWHPHQWVLQWKLVDSSOLFDWLRQDUHWUXHWKDW,KDYHOHJDODXWKRULW\WRGRWKHZRUNDXWKRUL]HGE\WKLVSURSRVHGSHUPLWRQWKHSURSHUW\LGHQWLÀ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ÀQHVDQGDQDZDUGWRWKH&LW\RIXSWRWKUHHWLPHVDQ\GDPDJHVLQFXUUHG,QDGGLWLRQSHUVRQVZKRVXEPLWIDOVHLQIRUPDWLRQDUHVXEMHFWWRGHQLDORIWKHUHTXHVWHG&LW\DFWLRQTenant Signature (if applicable) ________________________________________________________________________