Application for Ucc Permit

APPLICATION FOR UCC PERMIT

(Please Print or Type)

Date______Township of ______Permit No.______

Applicant ______

Address ______

Phone ______( ) Owner ( ) Contractor Cost of Construction $______

Job Location ______No. of Dwelling Units ______

Type of Improvement ______Proposed Use ______

No. Stories ______Area of 1st Floor ______Area of 2nd Floor ______Height ______

Building Size – Long ______ft.Wide ______ft. TOTAL SQUARE FEET ______

( ) Yes ( ) No Plans indicate exact design and layout of improvement

Contractor Name ______Phone ______

Crawford County Lot Number ______

Municipal Sewer Tap-in No. ______Septic Permit No. ______

( ) Yes ( ) No – Two sets of construction plans submitted for review (one will be returned). Construction plans must be drawn to scale and include cross sections. Workers’ Compensation Insurance certificate must be attached to application for permit.

Owner’s Name ______Home Address ______

Home Phone ______Work Phone ______

NOTICE: Upon receipt of a permit, I hereby agree to abide by the building and code standards adopted by the UCC (Act 45) of the Commonwealth of PA. I understand my project may be suspended for violation of the aforementioned.

Signed:______

PLEASE NOTE THE FOLLOWING REQUIREMENTS

1.Permit expires one (1) year from the date of issue.

2.Permit void if project is not started within 90 days.

3.24 hour notice required for all required inspections.

4.Questions or to request inspections, call 1-724-927-2020 Monday through Friday, 8:00a.m. to 4:00p.m.

5.Inspections: Entry must be available to inspectors between the hours of 8:30 a.m. and 5:00p.m. on the day inspection is requested (except emergencies)

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(Township Use Only)

Administrative Fee$______

Bldg. Insp. Fee$______

Elec. Insp. Fee$______Approved for issue date ______

Plumb Insp. Fee$______By:______

Fire Insp. Fee$______

PA State Fee$______Fees: Please make check payable to

TOTAL FEES DUE$______Venango Township

TOWNSHIP OF VENANGO

COUNTY OF CRAWFORD

COMMONWEALTH OF PENNSYLVANIA

ORDINANCE NO. 10-5-93

Amended No. 7-7-98

SECTION 4.01 MINIMUM LOT SIZE

The minimum lot size or area for one dwelling unit, including mobile homes and modular homes, shall be three (3) acres.

SECTION 4.03 SET BACK REQUIREMENTS

From and after the effective date of this Ordinance, no building or structure for which a building permit shall be required shall be constructed, reconstructed, enlarged, altered, located, relocated, or developed which is closer than fifty (50) feet to the front of said lot boundary line, nor closer than thirty (30) feet to the side boundary lines and not closer than ten (10) feet to the rear boundary lines of any lot held in separate ownership different from the ownership of the adjoining lot. Must not be less than 200 feet in width at narrowest point.

ISSUANCE OF BUILDING PERMITS—WORKER’S COMPENSATION ACT

Pennsylvania recently enacted a new Worker’s Compensation Act. Part of the new Act requires that no building permits are to be issued unless there has been proof of the worker’s compensation coverage or self-insurance coverage shown prior to receiving a building permit. In the event that any resident desires to perform work themselves, they must file a notarized affidavit of exemption from worker’s compensation stating that they will not use a contractor or other individual to do their work.

(Attach to Building Permit Application)

A. The Applicant is a contractor within the meaning of the Pennsylvania Worker’s Compensation Law

YesNo

If the answer is “yes”, complete Sections B and C below as appropriate.

B. Insurance Information

Name of Applicant: ______

Federal or Sate Employer Identification No: ______

Applicant is a qualified self-insurer for worker’s compensation

Certificate Attached

Name of Worker’s Compensation Insurer: ______

Worker’s Compensation Insurance Policy No: ______

Certificate Attached

Policy Expiration Date: ______

C. Exemption

Complete Section C if the applicant is a contractor claiming exemption from providing worker’s compensation insurance.

The undersigned swears or affirms that he/she is not required to provided worker’s compensation insurance under the provisions of the Pennsylvania Worker’s Compensation Law for one of the following reasons, as indicated:

Contractor with no employees. Contractor prohibited by law from employing any individual to perform work pursuant to this building permit unless contractor provides proof of insurance with the Township.

Religious exemption under the Worker’s Compensation Law.

Subscribed and sworn to before me this

______day of ______, 20_____

______

(Signature of Notary Public)

My Commission Expires: ______

Signature of Applicant ______

Address ______

(seal)______

County of ______

Municipality of ______