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2. *DEPARTMENT USE ONLY

   PERMIT NO:___________________________

   DATE ISSUED:_________________________

   ASSOCIATED PERMIT NO:___________________________

6. Submittal Date:*
   Submittal Date:
7. Site Address1*
9. Lot #:
10. Parcel #:
12. Located between:(street names)
14. Zoning District:
    -- Select One --RE –Residential Single-Family Estate DistrictR-LD –Residential Low-Density DistrictR-MD –Medium Density Residential DistrictRT –Transitional Residential DistrictRM –Residential Multi-Family DistrictCN –Commercial Neighborhood DistrictCG –Commercial General DistrictCBD –Central Business DistrictSI –Service Industrial DistrictAM –Advanced Manufacturing DistrictAG –Agriculture DistrictMHC –Mobile Home Community
15. Flood Plain Zone:
    -- Select One --YESNO

    Yes requires a Development permit

16. Development permit #:
17. Historic District:
    -- Select One --YESNO

    Yes requires a Certificate of Appropriateness permit

19. Estimated Start Date:
20. Estimated Finish Date:
21. Estimated Cost: $*
23. Description of Project/Business Name & Type *
25. Type of Improvement:*
    -- Select One --New ConstructionAdditionAlterationRepair/ReplaceChange of UseOther
27. Application For: Choose all that applies*

    1. Fire Alarm

    1. Fire Suppression
28. Other:
30. OBC Use Group:*
31. Mixed Use
    -- Select One --YESNO
32. Construction Type:
    -- Select One --IAIBIIAIIBIIIAIIIBIVVAVB
34. Applicant Name:*
36. Applicant Address:*
38. City
39. State
40. Zip
42. Applicant Phone No:*
43. Applicant Email:*
45. Contractor Name:*

    Note: All contractors must be registered with the city.  If more that one contractor please provide a list of contractors including name, address, phone number and work providing.

46. Registration No:
48. Contractor Address:*
49. Contractor Address2:
51. City
52. State
53. Zip
55. Phone No:*
56. Contractor Email:*
58. Property Owners Name:*
60. Property Owners Address:
61. Property Owners Address2:
63. City
64. State
65. Zip
67. Phone No.
68. Property Owners Email:
70. Design Professional:*
    -- Select One --ArchitectEngineerOther
71. Other:
73. Design Professional Name:*
75. Design Professional Address:
76. Address2:
78. City
79. State
80. Zip
82. Phone No:
83. Design Professional Email:
87. OBC/RCO Building Construction Area:*

    1. New Construction
    2. Addition
    3. Alteration
88. Square Footage Area:*
    -- Select One --BasementFirst FloorSecond FloorThird FloorForth FloorOther
89. Square footage:*
91. OBC/RCO Building Construction:

    1. New Construction
    2. Addition
    3. Alteration
92. Square Footage Area:
    -- Select One --BasementFirst FloorSecond FloorThird FloorFourth Floor
93. Square Footage:
95. OBC/RCO Building Construction:

    1. New Construction
    2. Addition
    3. Alteration
96. Square Footage Area:
    -- Select One --BasementFirst FloorSecond FloorThird FloorFourth Floor
97. Square Footage:
99. OBC/RCO Building Construction:

    1. New Construction
    2. Addition
    3. Alteration
100. Square Footage Area:
     -- Select One --BasementFirst FloorSecond FloorThird FloorFourth Floor
101. Square Footage:
103. OBC/RCO Building Construction:

     1. New Construction
     2. Addition
     3. Alteration
104. Square Footage Area:
     -- Select One --BasementFirst FloorSecond FloorThird FloorFourth Floor
105. Square Footage:
109. Structural Permit:*
     -- Select One --YESNO
110. BUILDING STRUCTURAL PERMIT INFORMATION

     If yes fill out what applies:

     
     

112. Number of Buildings:
113. Number of Stories:
114. Number of Units:
116. Other:
117. Elevator:
     -- Select One --YESNO
121. Electrical Permit:*
     -- Select One --YESNO
122. ELECTRICAL PERMIT INFORMATION

     If yes fill out what applies:

124. Type:

     1. New
     2. Addition

     1. Alteration
     2. Other
125. Other:
127. Number of Fixtures:
131. Fire Alarm Permit:*
     -- Select One --YESNO
132. FIRE ALARM PERMIT INFORMATION

     If yes fill out what applies:

     
     

134. New Fire Alarm System:
     -- Select One --YESNO
135. Type:
     -- Select One --LocalCentral StationRemote StationProprietaryOther
136. Other:
138. Number of Devices:
142. Fire Suppression Permit:*
     -- Select One --YESNO
144. Fire Suppression Permit Information:

     1. Sprinklers

     1. Hood Suppression

     1. Limited Area
146. Type of System:
     -- Select One --WetDryAnti-freezeChemical Wet & DryOther
147. Type of System:
     -- Select One --WetDryAnti-FreezeChemicalOther
148. Other:
150. Number of Heads:
151. Number of Standpipes:
152. Number of Risers:
156. READ CAREFULLY BEFORE SIGNING AND SUBMITTING THIS APPLICATION:

     CITY ORDINANCE 24-05 REQUIRES THE BUILDING DEPARTMENT TO COLLECT FIRE IMPACT FEES FOR ALL RESIDENTIAL & COMMERCIAL CONSTRUCTION. THE ORDINANCE PROVIDES FOR EXEMPTIONS AND CREDITS IF YOU QAULIFY. THE EXEMPTION OR CREDIT APPLICATION MUST BE INCLUDED WITH THIS PERMIT APPLICATION TO BE CONSIDERED. FAILURE TO INCLUDE THE EXEMPTION OR CREDIT FORM WHEN SIGNING BELOW CONSTITUTES YOUR ACCEPTANCE AND AGREEMENT TO PAY THE IMPACT FEES THAT WILL BE INCLUDED WITH THE TOTAL PERMIT FEES THAT YOU HAVE APPLIED FOR IN THIS APPLICATION.

158. Lead Based Paint:

     The EPA’s 2008 Lead-Based Paint Renovation, Repair, and Painting (RRP) rule aims to protect the public from lead-based paint hazards associated with renovation, repair, and painting activities in built pre-1978. The rule requires contractors and their workers/employees to be certified and trained in the use of lead-safe work practices and requires RRP firms to be EPA certified.  OAC 3701-32-03(A)(10)states that no person shall knowingly authorized or employ any individual to perform lead abatement work unless the person holds a valid lead abatement license.

     Contractor validates that they have the appropriate lead abatement certificate/license necessary to work on a project where lead-based paint may be present.

160. Initial here to confirm Lead-Based Paint requirements: *
161. Certificate Number:
162. Expiration:
164. Expiration:

     THE APPROVAL OF PLANS OR DRAWINGS AND SPECIFICATIONS ARE INVALID IF CONSTRUCTION, ERECTION, ALTERATION OR OTHER WORK UPON THE BUILDING HAS NOT COMMENCED WITHIN 12 MONTHS OF THEIR APPROVAL. ONE EXTENSION SHALL BE GRANTED FOR AN ADDITIONAL 12-MONTH PERIOD IF REQUESTED BY THE OWNER AT LEAST 10 DAYS IN ADVANCE OF THE EXPIRATION OF THE APPROVAL AND UPON PAYMENT OF A $75 FEE.

166. EXTENSION:

     IF IN THE COURSE OF CONSTRUCTION, WORK IS SUSPENDED FOR MORE THAN SIX MONTHS, THE APPROVAL OF PLANS OR DRAWINGS AND SPECIFICATIONS OR DATA IS INVALID. UP TO TWO EXTENSIONS SHALL BE GRANTED FOR SIX MONTHS EACH IF REQUESTED BY THE OWNER AT LEAST 10 DAYS IN ADVANCE OF THE EXPIRATION OF THE APPROVAL AND UPON PAYMENT OF A $75 FEE.

168. I FULLY UNDERSTAND THAT NO EXCAVATION, CONSTRUCTION, OR STRUCTURAL ALTERATION, ELECTRICAL OR MECHANICAL INSTALLATION OR ALTERATION OF ANY BUILDING, STRUCTURE, SIGN, OR PART THEREOF AND NO USE OF THE ABOVE SHALL BE UNDERTAKEN OR PERFORMED UNTIL THE PERMIT APPLIED FOR HEREIN HAS BEEN APPROVED AND ISSUED BY THE CITY OF LANCASTER CERTIFIED BUILDING DEPARTMENT.

     I HERE BY CERTIFY THAT I AM THE OWNER OF THE NAMED PROPERTY, OR THAT THE PROPOSED WORK IS AUTHORIZED BY THE OWNER OF RECORD AND THAT I HAVE BEEN AUTHORIZED BY THE OWNER TO MAKE THIS APPLICATION AS HIS/HER AUTHORIZED AGENT AND I AGREE TO CONFORM TO ALL APPLICABLE LAWS OF THE JURISDICTION. IN ADDITION, IF A PERMIT FOR WORK DESCRIBED IN THIS APPLICATION IS ISSUED, I CERTIFY THAT THE CODE OFFICIAL OR THE CODE OFFICIAL’S AUTHORIZED REPRESENTATIVE SHALL HAVE THE AUTHORITY TO ENTER AREAS COVERED BY SUCH PERMIT AT ANY REASONABLE HOUR TO ENFORCE THE PROVISIONS OF THE CODE(S) APPLICABLE TO SUCH PERMIT.

     I HEREBY ACKNOWLEDGE THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE LISTED INSTRUCTIONS.

170. SIGNATURE OF APPLICANT:*
171. DATE:*
     DATE:
173. UPLOAD PLANS:

     Or email plans to buildingsubmittal@ci.lancaster.oh.us or building@ci.lancaster.oh.us

178. OFFICE USE ONLY:
180. HOLD/DATE:

     REASON:

     
     

     
     

     
     

181. PLANS EXAINER: / /
     • INCOMPLETE
     • COMPLETE
     • PARTIALLY APPROVED
     • APPROVED
     • DISAPPROVED
183. ____________________________
184. BUILDING OFFICAL:
Leave This Blank:


185. 1. Receive an email copy of this form.
186. Email address

     This field is not part of the form submission.

187. Submit Submit and Print

* indicates a required field