Form Center

2. *DEPARTMENT USE ONLY

   PERMIT NO:___________________________

   DATE ISSUED:_________________________

   ZONING NO:___________________________

6. Site Address1*
8. Lot #:
9. Parcel #:
11. Located between:(street names)
13. Zoning District:
14. Flood Plain Zone:*
    -- Select One --YESNO

    Yes requires a Development Permit

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

    Yes requires a Certificate of Appropriateness Permit

18. Description of Project/Business Name & Type *
20. Estimated Start Date:
21. Estimated Finish Date:
22. Estimated Cost: $*
23. Square Footage:
25. Residential: *
    -- Select One --One Family Two Family Three Family Four or More Family GarageOtherNO
26. Commercial:*
    -- Select One --YESNO
27. Type of Improvement:*
    -- Select One --AdditionRepairReplaceOccupancy Compliance ShedOther
29. Application For: Choose all that applies*

    1. Plumbing
    2. Mechanical
    3. Electrical
    4. Re-Roofing

    1. Generator
    2. Occupancy
    3. Other

    • Re-Roof requires the data sheet 
    • Generator requires the data sheet
30. Other:
31. Homeowner Affidavit Attached:
    -- Select One --YESNO
33. Applicant Name:*
35. Applicant Address:*
36. Applicant Address2:
38. City
39. State
40. Zip
42. Applicant Phone No:*
43. Applicant Email:*
45. Contractor Name
46. Registration No:
48. Contractor Address:
49. Contractor Address2:
51. City
52. State
53. Zip
55. Phone No:
56. Contractor Email:

58. 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.

60. Property Owner Name:*
62. Property Owner Address:*
63. Applicant Address2:
65. City
66. State
67. Zip
69. Phone No.
70. Property Owner Email:
74. Plumbing Application:*
    -- Select One --YESNO
75. Plumbing Permit Information:

    *Fill out if applies

77. Number of Fixtures:
78. Type of System:
    -- Select One --MunicipalPrivate
82. Electrical Permit:*
    -- Select One --YESNO
83. Electrical Permit Information:

    *Fill out if applies

85. Type:

    1. Residential
    2. Commercial
    3. Temporary Service
    4. New Service

    1. Generator
    2. PV/Solar
    3. Repair

    1. Service Upgrade
    2. Hot Tub
    3. Other
86. Other:
88. Voltage:
89. Phase:
90. Service Ampacity:
91. Number of Fixtures:
95. HVAC Permit:*
    -- Select One --YESNO
96. HVAC Permit Information:

    *Fill out if applies

98. Heating System:
    -- Select One --NewReplacementAddition Repair
99. Heating System Brand:
100. Heating System Model:
101. Number of Units:
103. Output(BTU/HR):
104. Tons:
105. Fuel Type:
106. Number of Outlets:
108. Cooling System:
     -- Select One --NewReplacementAdditionRepair
109. Cooling System Brand:
110. Cooling System Model:
111. Number of Units:
113. Output(BTU/HR)
114. Tons:
115. Fuel Type:
116. Number of Outlets:
118. Type:

     1. Forced Air
     2. Infrared
     3. Condensing Unit
     4. Evaporation Cooler

     1. Radiant
     2. Heat Pump
     3. Gravity

     1. Boiler/Steam
     2. Cooling Tower
     3. Mini Split
120. Fireplace Type:

     1. Masonry
     2. Insert

     1. Solid Fuel
     2. Manufactured

     1. Stove
     2. Gas Logs
124. 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.

126. 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.

128. Initial here to confirm Lead-Based Paint requirements:*
129. Certificate Number:
130. Expiration:

132. 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.

134. SIGNATURE OF APPLICANT:*
135. DATE:*
     DATE:
137. UPLOAD ANY SUPPORTING DOCUMENTS:

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

141. OFFICE USE ONLY:
143. ISSUED BY:__________________________________________
144. DATE:___________________
Leave This Blank:


145. 1. Receive an email copy of this form.
146. Email address

     This field is not part of the form submission.

147. Submit Submit and Print

* indicates a required field