Landmark Special Admin Hold DS APPLICATION NO Lakefront Prot Other DATE ISSUED Flood Plain 1 GENERAL INFORMATION 57347573553URYLGH573472ULJLQDO57347RXVH573471XPEHU57347HUWL57536FDWH57347IRU57347QHZ57347FRQVWUXFWLRQ573615735657347 ID: 3402 Download Pdf
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Embed / Share - CIT Y OF CHICAG O DEPARTMENT OF BUILDINGS Building Permit Application HOLDS USE
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
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1.
-- --
3.
--
Enter permit number if revision to an existing permit:
4.
--
Cost of Construction:
2.
CLASSIFICATION BY OCCUPANCY:
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A Residential
E Business
A2 Residential
H3 Garages
B Institutional
F Mercantile
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Private Garage
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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:
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Yes Signature of Approval:
5. FIRE PREVENTION ITEMS:
Yes
No
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([WHQG([LVWLQJ6SULQNOHU6\VWHP'HVLJQDWH$UHDVWR
Flammable Compressed Gases
([LVWLQJ)LUH$ODUP6\VWHP&KRRVH2QH_____ Class I _____ High RiseBBBBB&ODVV,,BBBBB2WKHUFODULI\
,QVWDOO1HZ)LUH$ODUP6\VWHP&KRRVH2QH_____ Class I _____ High RiseBBBBB&ODVV,,BBBBB2WKHUFODULI\
2
6. MAYORS OFFICE FOR PEOPLE WITH DISABILITIES ITEMS
Yes RENOVATION PROJECTS ONLY: ($& (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)]
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7. ENVIRONMENTAL ITEMS
Yes
No
Yes
No
Boiler(s)
Gas Fired Hot Water Heater(s)
Devices
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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: _______________________________
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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) ________________________________________________________________________