FORT GRATIOT CHARTER TOWNSHIP BUILDING PERMIT

Applicant to complete ALL items in Sections I, II, III, IV, V, VI, VII, VIII and IX.

Faxed or incomplete applications or applications completed in pencil will not be accepted.

NOTE: Separate applications MUST be completed for Electrical, Mechanical and Plumbing work permits.

I. PROJECT INFORMATION

Street Address: Parcel Number:

74-20-

II. IDENTIFICATION

A. OWNER OR LESSEE (Please check one)

Name: Address:

City: State: Zip Code: Phone Number(s): Fax Number:

B. ARCHITECT OR ENGINEER (Please check one)

Firm / Company Name: Address:

City: State: Zip Code: Phone Number(s): Fax Number:

Email address: License Number: License Expiration Date:

C. CONTRACTOR

Name: Address:

City: State: Zip Code: Phone Number(s): Fax Number:

Builders License Number: License Expiration Date: Federal ID Number or reason for exemption:

Workers Comp Insurance Carrier or reason for exemption: MESC Employer Number or reason for exemption:

III. APPLICANT INFORMATION

Applicant is responsible for the payment of all fees and charges applicable to this application and must provide the

following information:

Name: Address:

City: State: Zip Code: Phone Number(s): Email address:

I HEREBY CERTIFY 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 WE AGREE TO CONFORM TO

ALL APPLICABLE LAWS OF THE STATE OF MICHIGAN. ALL INFORMATION SUBMITTED ON THIS APPLICATION IS ACCURATE TO

THE BEST OF MY KNOWLEDGE. BY SIGNING, PERMISSION TO ENTER PROPERTY IS GRANTED TO ANY TOWNSHIP

REPRESENTATIVE FOR THE PURPOSES OF GATHERING/VERIFYING INFORMATION RELATED TO THIS APPLICATION.

Section 23a of the State Construction Code Act 1972, 1972 PA 230, MCL 125.1523A, prohibits a person from conspiring to circumvent the licensing

requirements of this state relating to persons who are to perform work on a residential building or a residential structure. Violations of Section 23a are subject to

civil fines.

SIGNATURE OF APPLICANT: DATE:

FORT GRATIOT CHARTER TOWNSHIP

3720 KEEWAHDIN RD ~ FORT GRATIOT, MI 48059

(810) 385-4489, EXT. 1112

BUILDING PERMIT APPLICATION

AUTHORITY: P.A. 230 OF

1972, AS AMENDED

COMPLETION: MANDATORY TO

OBTAIN PERMIT

PENALTY: PERMIT NOT

ISSUED

IV. TYPE OF IMPROVEMENT AND PLAN REVIEW

A. TYPE OF IMPROVEMENT

1. New Building 2. Alteration 3. Demolition 4. Foundation Only 5. Relocation 6. Addition

7. Repair 8. Mobile Home Set Up 9. Pre-manufacture 10. Special Inspection 11. Sign

B. PLAN REVIEW REQUIRED

Plans and specifications are required and shall be prepared by or under the direct supervision of an architect or engineer

licensed pursuant to 1980 PA 299 and shall bear that architect’s or engineer’s seal and signature.

V. PROPOSED USE OF BUILDING

A. RESIDENTIAL

Single Family 2.

Two Family 3.

Multiple Family (3 units or more) 4.

Hotel/Motel (No. of Units______)

5. Attached Garage 6. Detached Garage 7. *Any Change in Use 8. Other:

B. NON-RESIDENTIAL

School, Library, Educational 2.

Store, Mercantile 3.

Tanks, Towers 4.

Parking Garage

5. Service Station 6. Hospital, Institution 7. Office, Bank, Professional 8. Public Utility 9. Amusement

10. Church, Religion 11. Industrial 12. *Any Change in Use 13. Other:

SCOPE OF WORK

/ USE DESCRIPTION

1. Scope of work / Description of Use:

2. *Change in Use description (Complete if “Any Change in Use” was checked above):

D. ADDITIONAL PERMITS REQUIRED

(PRIOR TO BUILDING PERMIT APPROVAL)

MDEQ: a.

High Risk Soil Erosion b.

Air Quality Abatement

2. MDOT

3. SCC Road Commission: a. Driveway Permit b. Soil Erosion

4. SCC Health Department: a. Well Permit b. Septic Permit c. Food Establishment

5. SCC Drain Commission: a. Retention/Detention, Storm Water Discharge

6. Other:

VI. SELECTED CHARACTERISTICS OF BUILDING

A. PRINC

IPAL TYPE OF FRAME

1. Masonry, Wall Bearing 2. Wood 3. Structural Steel 4. Reinforced Concrete 5. Other:

B. PRINCIPAL TYPE OF HEATING FUEL

1. Gas 2. Oil 3. Electric 4. Coal 5. Other:

C. TYPE OF SEWAGE DISPOSAL

1. Public or Private Company 2. Septic System

D. TYPE OF WATER SUPPLY

1. Public or Private Company 2. Well

E. TYPE OF MECHANICAL

1. Will there be: Air Conditioning? Fire Suppression? Fireplace? Flue Sizes: ____x____x____ Type: Clay

Metal

F. DIMENSIONS / DATA

1. Number of Stories: _______ 2. Use Group: _______ 3. Const. Type: _______ 4. Number of Occupants: _______

5. TOTAL BUILDING HEIGHT: __________ 6. HEIGHT PER ORDINANCE CALCULATION (office use): __________

Floor Area: 1. Basement: __________ 2. 1

Floor: __________ 3. 2

Floor: __________4. 3

– 5

Floor: __________

5. Size of Addition or Structure: __________ 6. Living Area (sq. ft): __________ 7. Garage Area (sq. ft): __________

8. Office/Sales Area (sq. ft): __________ 9. Service Area (sq. ft): __________ 10. TOTAL AREA: __________

Room Detail: 1. Number of Bedrooms:_______ 2. Number of Full Baths: _______ 3. Number of Partial Baths: _______

Basement Detail: Full Basement Partial Basement Split Level Finished No Basement

Sign Detail: 1. Type: Ground sign* Pole sign* Wall sign Billboard sign* Other: ________________

2. Sign dimensions: _______x_______=__________sq. ft. 3. Wall façade dimensions: _______x_______=__________sq. ft.

*Must complete Section VII. Setbacks

G. NUMBER OF OFF

STREET PARKING SPACES

1. Enclosed Spaces: __________ 2. Outdoor Spaces: __________ 3. Handicap Spaces: __________

VII. SETBACKS FOR PROPOSED CONSTRUCTION ONLY (SHADED AREAS TO BE COMPLETED BY ZONING ADMINISTRATOR)

*Front Setback from

Property Line: N S E W

Rear Setback from

Property Line: N S E W

Left Setback from

Property Line: N S E W

Right Setback from

Property Line: N S E W

FT FT

* When located on an existing or planned major, secondary, collector or local thoroughfare and the property lines incorporate said right-of-way; the front setback shall be calculated by

adding the required setback to the right-of-way, the total of which to be measured from the centerline of the road to determine the setback.

(Section 38-442 M.)

Road right-of-way

from centerline: FT

Required front

yard setback: FT

*Total front yard setback measured from the

centerline of the road: N S E W

VIII. CONSTRUCTION VALUATION

Value of Proposed Construction:

IX. SITE / PLOT PLAN – MUST BE COMPLETED OR SEPARATE SHEET ATTACHED – FOR APPLICANT USE ONLY

*PLOT PLAN MUST INCLUDE: 1) LOT DIMENSIONS, 2) STREET, ALLEY AND EASEMENT LOCATIONS, 3) LOCATION, USE AND DIMENSIONS OF

EXISTING STRUCTURES ON LOT, 4) PARKING SPACES, 5) PROPOSED CONSTRUCTION WITH DIMENSIONS, 6) FRONT, REAR & SIDEYARD

SETBACKS, 7) NORTH ARROW, 8) DRAINS / NATURAL DRAINS, (9) UTILITY LOCATIONS AND EASEMENTS

The Charter Township of Fort Gratiot will not discriminate against any individual or group because of race, sex, religion, age, natural origin, color,

mental status, disability or political beliefs. If you need assistance with reading, writing, hearing, etc., under the Americans with Disabilities Act, you

may make your needs known to this agency.

~FOR OFFICE USE ONLY~

X. APPLICATION REVIEWS AND APPROVAL

A. ZONING REVIEW / APPROVAL

Use Zone: Flood Zone & Map Panel: Lot Area: Lot Frontage: Lot Depth:

ZBA/Planning Commission Hearing Date: Hearing Comments:

Remarks:

Rejected

Date:

Reviewed by:

Zoning Administrator

Other:

Approved

Date:

B. ASSESSING REVIEW

Remarks:

Reviewed Date:

Reviewed by: Assessor

Other:

C. DEPARTMENT OF PUBLIC WORKS REVIEW / APPROVAL

Sewer Available: Yes No

Water Available: Yes No

Water Tap: Size: __________________

Material:__________________________

Water Meter: Size: ________________

# of Meters: ______________________

Issued by:

Date:

Special Comments:

Sewer Tap Fee + Inspection

Water Tap Fee

Water Meter Fee + Template

Additional Template (if applicable)

Construction Water Fee (90 days)

Other (see “Special Comments”):

TOTAL WATER/SEWER FEES

D. FIRE DEPARTMENT REVIEW / APPROVAL

Remarks:

Rejected Date:

Approved

Reviewed by: Fire Chief

Other:

E. BUILDING DEPARTMENT REVIEW / APPROVAL

Special Information / Details:

Rejected Date:

Approved

Reviewed by: Building Official

Bldg. Dept. Clerk

RECEIPT #

CREDIT CARD:

VISA

DISCOVER CASH

CHECK

CHECK NUMB

ER:

PERMIT

NUMBER:

PB20-

ISSUE

DATE:

FEE DESCRIPTIONS FEE TOTALS

Building Permit Fee

Plan Review Fee

Water / Sewer Fees

Addressing Fee

TOTAL DUE UPON ISSUANCE

PAYMENT VALIDATION