Permit

BID #: N/A

DUE: TBD

VALUE: TBD

100

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Executive Summary

This document is a New Jersey Uniform Construction Code permit application form (U.C.C. F100-1 and F100-2, revised 8/08 and 5/2007 respectively), not a municipal bid or RFP. It is designed for applicants to submit details for proposed construction work, including identification of the owner and site, type of work (e.g., new building, alteration, repair), and characteristics of the building or site. The form includes sections for the applicant to specify estimated costs for various subcodes and for office use to calculate fees and surcharges. Applicants are required to complete sections related to identification, proposed work, building/site characteristics, and certifications affirming ownership or agent status, compliance with regulations, and responsibility for the work. There are specific certifications for owners undertaking work on their own private residence, including acknowledgements of responsibility and tax law compliance. The form also includes optional sections for plan review preferences. No specific deadlines, bid numbers, or procurement contacts are associated with this permit application form, as it serves as a standardized document for initiating a construction project review process rather than a competitive solicitation.

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Document Text

--- Document: Permit Document ---
BLOCK
LOT
QUALIFICATION CODE
ADDRESS (SITE)
US
NEW JERSEY
UNIFORM CONSTRUCTION
CODE
CONSTRUCTION PERMIT
APPLICATION
Applicant Completes: Sections I, II, III (optional), IV, VI, and VII
I. IDENTIFICATION
Proposed Work Site at:
Name of Owner in Fee:
V. FEE SUMMARY (for office use only)
1. Building
2. Electrical
3. Plumbing
4. Fire Protection
5. Elevator Devices
6. Subtotal
$
7. Less 20% for State Plan Review $
8. Subtotal
$
9. State Permit Surcharge Fee
Tel.()
e-mail
10. Subtotal
$
11. Cert. of Occupancy
Address
12. Other
street
municipality
zip code
Ownership in Fee:
Public
Private
13. TOTAL
$
4. Principal Contractor:
Address
Tel. (
e-mail
)
VI. BUILDING/SITE CHARACTERISTICS
1. Number of Stories
2. Height of Structure
3. Area Largest Floor
License No. OR, if new home, Builder Reg. No.
Home Improvement Contractor Registration No. or Exemption Reason (if applicable):
Exp. Date
4. New Building Area
PERMIT NO
Update
Federal Emp. ID No.
FAX: (
)
5. Architect or Engineer
Contact
Address
Tel. (
)
FAX: (
e-mail
)
5. Volume of New Structure
6. Max. Live Load
7. Max. Occupancy Load
8. If Industrialized Building: State Approved.
9. Total Land Area Disturbed
10. Flood Hazard Zone
)
6. Responsible Person in Charge once Work has Begun
Tel. (
FAX: (
11. Base Flood Elevation
12. Wetlands
yes
no
Ila. PROPOSED WORK
Minor Work
Repair
New Building
Addition
Demolition
☐ Alteration
Renovation
Reconstruction
☐ Asbestos Abat. -Subch. 8
Lead Hazard Abatement
Radon Remediation
Annual Permit
Ilb. SUBCODES
Est. Cost
Plans
(Check all that apply)
Rec'd by
Date
Rec'd
FOR OFFICE USE ONLY (Optional)
Rejection Approval Re-
Date
Date
viewer
Resubmission Dates
Approval
Rejection
Re-
viewer
Building
Electrical
Plumbing
Fire Protection
Elevator
TOTAL COST
III. PLAN REVIEW (optional)
DO YOU WANT:
1.
Partial Releases
2.
Prototype Processing
U.C.C. F100-1 (rev. 8/08)
IV. DOES OR WILL YOUR BUILDING CONTAIN ANY OF THE FOLLOWING?
1.
4.
Elevators/Escalators/Lifts/
Dumbwaiters/Moving Walks 5.
2. High Pressure Boilers
3.
Pressure Vessels
6.
7.
Refrigeration Systems
Cross-Connections/Backflow Preventers
Hazardous Uses/Places of Assembly
Sprinklers/Standpipes
8.
9.
10.
11.
(office use only)
ft.
sq. ft.
sq. ft.
cu. ft.
HUD
sq. ft.
ft.
VII. DESCRIPTION OF BUILDING USE
A. RESIDENTIAL (primary use)
1. State Specific Use:
2. Use Group, Proposed:
3. Change in Use Group, Indicate Present:
4. No. of dwelling units: Total Units Income-restricted
Gained, Sale
Gained, Rental
Lost, Sale
Lost, Rental
B. NON-RESIDENTIAL (primary use)
1. State Specific Use:
2. Use Group, Proposed:
3. Change in Use Group, Indicate Present:
C. MIXED USE -List secondary use(s):
D. Construct. Classification: Present
Proposed
Smoke Control Systems in Open Wells 12. Fire Alarm
Underground Storage Tanks
Swimming Pools, Spas and Hot Tubs
LPGas Tanks
CERTIFICATION IN LIEU OF OATH
L
OWNER SECTION (to be completed if the applicant is the owner in fee)
I hereby certify that I am the owner in fee of the property listed on Page 1.
Mark the following applicable boxes:
A. ( ) I further certify that a new home (private residence) will be constructed on this property for my own use and occu-
pancy. This dwelling is to be occupied by myself and is not to be used for any purpose other than single family
residential use. I attest that all construction, plumbing, or electrical work will be done, in whole or in part, by me or by
subcontractors under my supervision, in accordance with all applicable laws; and, I further acknowledge that said
new home is not covered under the New Home Warranty and Builders Registration Act (N.J.S.A. 46:3B-1 et seq.) and
that such fact shall be disclosed to any person purchasing this property within ten years of the date of issuance of a
certificate of occupancy.
I UNDERSTAND THAT IN MARKING BOX A, I ACKNOWLEDGE THAT I AM ASSUMING RESPONSIBILITY FOR
THE WORK DONE ON SAID PROPERTY, THE CONDITION OF THE PROPERTY PRIOR TO, DURING, AND AFTER
ANY WORK PERFORMED, AND FOR THE PERFORMANCE OF THE SUBCONTRACTORS I HIRE, EMPLOY, OR
OTHERWISE CONTRACT OR WITH WHOM I MAKE AGREEMENTS TO PERFORM WORK. I AM VOLUNTARILY
AND KNOWINGLY ASSUMING THIS RESPONSIBILITY.
B. ( ) I further certify the following as required by the New Jersey Uniform Construction Code, N.J.A.C. 5:23-2.15(f)1.ix:
I personally prepared the plans submitted for: 1) the new home referred to in A.; or, 2) an addition, alteration, renova-
tion, or repair to an existing single family residence owned and occupied by myself and located on the property listed
on Page 1; or, 3) a new structure that will be physically separate from, but that will be deemed part of, an existing
single family residence that is owned and occupied by myself and located on the property listed on Page 1.
I further certify that I will perform or supervise the following work:
C. ( )
C.1. () Building
C.2. () Fire Protection
C.4. () Plumbing
I further certify that I will perform the following work:
C.3. () Electrical
D. ( ) I agree to advise all contractors on this project that they are required to be registered with the New Jersey Division of
Taxation and to comply with all New Jersey tax laws.
I further certify the following as required by the Uniform Construction Code, N.J.A.C. 5:23-2.15(a)5: All required State, county,
and local prior approvals have been given, including such certification as the construction official may require.
I understand that if any of the above statements are willfully false, I am subject to punishment.
Signature
II. AGENT SECTION (to be completed if the applicant is not the owner in fee)
Date
I hereby certify the following as required by the Uniform Construction Code, N.J.A.C. 5:23-2.15(d): the proposed work is autho-
rized by the owner in fee; and I have been authorized by the owner in fee to make this application as his agent.
I further certify the following as required by the Uniform Construction Code, N.J.A.C. 5:23-2.15(a)5: All required State, county,
and local prior approvals have been given, including such certification as the construction official may require.
I agree to advise all contractors on this project that they are required to be registered with the New Jersey Division of Taxation
and to comply with all New Jersey tax laws.
I understand that if any of the above statements are willfully false, I am subject to punishment.
( ) Check if contractor.
Agent Name
Address
Telephone (
Signature
III. () LEAD HAZARD ABATEMENT: Include Homeowner or Building Owner Affidavit as per N.J.A.C. 5:17.
U.C.C. F100-2 (rev. 5/2007)