JS-2015- ______Date Issued: ______-2015 PERMIT NO. APPLICATION FOR BUILDING PERMIT TOWN OF BURLINGTON TOWN HALL ANNEX - 25 CENTER STREET B BURLINGTON, MASSACHUSETTS 01803 Telephone 781-270-1615 or Fax 781-238-4667 Email [email protected] Web WWW.BURLINGTON.ORG INSTRUCTIONS: Submit this Application with 3 Sets of Construction Drawings, Plot Plan & Application Fee

COST OF CONSTRUCTION: $ ______($10 per $1000) BUIILDING PERMIT FEE: $ ______Date Stamp Here * PLAN REVIEW FEE * Applies to All Structures EXCEPT 1 or 2-Family Residential $ ______

TOTAL PERMIT FEE: $ ______CONSTRUCTION PROJECT INFORMATION Use Group______Construction Type ______SF of Construction ______Zoning ______

OFFICIAL STREET ADDRESS ______Burlington, MA 01803

PROPERTY OWNER ______TEL No. ______ADDRESS ______CELL No______COMMERICAL BUSINESS TENANT NAME ______SUITE/FLOOR/SPACE NO. ______

DESCRIPTION OF WORK Include dimensions, room/construction type, location on property (i.e. 11x16 Bedroom & Bath Addition off rear of dwelling) Commercial Projects:  New Tenant Fit Up Existing Tenant Remodel Tenant Expansion Tenant Relocation  Demolition

Check off below for all new buildings/ dwellings and additions: ENERGY CODES SUBMITTED  REScheck  COMcheck CONSERVATION (Erosion Control)?  No  Yes, submit permit BOARD OF HEALTH SUBMITTAL for DEMOLITION?  No  Yes and / or CHANGE IN GRADE?   No  Yes SEWER ALLOCATION REQUIRED (Restaurant / Bedrooms, etc) ?   No   Yes, submit Engineering Sewer Allocation Permit BUILDING / ADDITION DIMENSIONS: LENGTH ______DEPTH ______HEIGHT ______NO. OF STORIES ____ LOT AREA: ______SQ FT ROOF TYPE Gable  Hip Shed  Other ______FOUNDATION    Full  Concrete  10”  Crawl   Block  Steel  Footings  Explain ______TYPE OF HEAT  Hot Water  Warm Air  TYPE OF FUEL Oil  Gas Electric Other ______BUILDING SETBACKS FROM PROPERTY LINES: Front ______Rear ______Left ______Right______VARIANCE REQUIRED?   No   Yes - Provide copy of recorded variance, Board of Appeals Case No. ______GENERAL CONTRACTOR INFORMATION Homeowner Acting as General Contractor Check Here  and complete Homeowner Exemption Form Email Address ______COMPANY NAME: ______Phone No. ______ADDRESS:______Cell No.______Construction Supervisor’s License Type  Unrestricted  Restricted  Roof  Other ______Name: ______CS or CSSL License No.: ______Expiration Date: ______Home Improvement Contractor Registration Name: ______Registration No.: ______Expiration Date: ______Workers’ Compensation Insurance Affidavit & Copy of Certificate of Insurance Must Be Provided  on file Policy No.: ______Company Name ______Expiration Date: ______ARCHITECT / ENGINEER: ______Reg. No. ______Expiration Date: ______ADDRESS: ______Tel. No. ______I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.

______Owners Signature (REQUIRED or Contract) Date Contractor Signature Date MAIL TO Homeowner Contractor PICK UP

January 2015

Burlington Building Department Schedule of Permit Fees Effective April 1, 2005

RULES & REGULATIONS : The required permits shall be obtained prior to the start of work. Permit fees are payable at the time of application and are NON-REFUNDABLE once the permit has been issued. Permits are not transferable. Valuation shall be the estimated cost of construction as determined by Means Cost Data or ICC Building valuation data in effect at the time of application. It is exclusive of land value and shall include all mechanical costs associated with construction. Town, County, State or Federally owned and operated buildings are exempt from fees. The Inspector of Buildings shall, to the fullest extent provided by law, waive any and all fees due in connection with the inspections, certifications or for building permits of buildings owned and operated by the Town of Burlington or the Burlington Housing Authority. Any work covered by this schedule started without obtaining the required permit will be DOUBLED. Reinspections necessary due to work NOT ready upon a requested inspection shall pay an additional $25.00 reinspection fee in advance of reinspection. BUILDING PERMIT FEE SCHEDULE Plan Review Fees On All Structures Except One & Two Family Residential

Plan Review fees are based on the latest fees charged by the International Code Council (ICC) THE PLAN REVIEW FEE IS BASED ON THE ESTIMATED CONSTRUCTION VALUE OF THE PROPOSED PROJECT.

Construction Project Costs Estimated up to :

$3,000,000.00 Estimated Job Cost X .0012 OR Minimum $250.00 $3,000,000.00 TO $6,000,000.00 $3600.00 + Estimated Job Cost Over $3,000,000.00 X .0005 Over $6,000,000.00 $5100.00 + Estimated Job Cost Over $6,000,000.00 X .0035

Building Permits Building Permit Fee includes Certificate of Occupancy, when required for all new work

NEW CONSTRUCTION - $10.00 per $1000 of Construction Cost Minimum Fee $50.00 Including additions, alterations, renovations, remodeling, mechanical equipment and systems. Such as, Decks, Ramps, Sunrooms, Garages (Instant Garage)

REPAIRS - $10.00 per $1000 of Construction Cost Minimum Fee $25.00 Such As, but not limited to roofing, siding, door & window replacement, installation of utility sheds

DEMOLITION - Or moving of buildings or structures Flat Fee $100.00

TEMPORARY PREMANUFACTURED BUILDINGS - Trailers/Mobile Home Per Unit Fee $50.00

TENTS - Commercial Fee $50.00 Residential Fee $25.00

RENEWAL OF PERMITS - Fee shall be determined with above schedule for portions included in original permit not completed upon renewal date. DUPLICATE - Building Permit Card or Certificate of Occupancy Permit Fee $25.00

EXTENSION OF TIME - To activate Building Permit Fee $25.00

RELEASE OF STOP WORK ORDER - Commercial $50.00 Residential $25.00

OCCUPANCY PERMIT FOR EXISTING STRUCTURES - $30.00 per hour Fee is based upon the time devoted to research & issue the requested permit.