DOUGLAS COUNTY BUILDING PERMIT APPLICATION MAKE ALL CHECKS PAYABLE TO: DOUGLAS COUNTY RETURN TO: DOUGLAS COUNTY SUPERVISOR OF ASSESSMENTS 401 S. CENTER, ROOM 103 TUSCOLA, IL, 61953 PHONE: 217-253-3031 FAX: 217-253-9301 Page 1 of 6 (OVER)
OWNER INFORMATION Name: Phone: Mailing Address: Builders Name: Phone: Address of Proposed Construction: Parcel Identification Name (PIN): Legal Description (only if parcel number is not available): Setback from center of road: Must be submitted by owner or builder The setback requirements are as follows: State Highway 100 County Highway 85 Township Road 70 Estimated cost of construction: $ Must be submitted by owner or builder *****************************************ADMINISTRATIVE USE ONLY******************************************* APPROVED: DENIED: REASON PERMIT #: FEE:$ DATE ISSUED: EXPIRATION DATE, ONE YEAR FROM DATE ISSUED BUILDING PERMIT ADMINISTRATOR: DATE: FLOOD PLAIN YES NO Page 2 of 6
Douglas County Building Permit/Construction Information INCOMPLETE APPLICATIONS WILL DELAY APPROVAL OF THIS APPLICATION Site Information (check all that apply) Utilities Usage City Water/Sewer Residential Well/Septic Commercial Rural Water Farm Building Structure Single-Family 2-Family Duplex Townhouse/Condo Farm Building Apartment Building Number of Units Square Feet of Building or Dimensions x Building Style (check all that apply) 1 st. frame 1 st. brick 1 st. condo 1 st. log 1 ½ st frame 1 ½ st. brick 2 st. condo 1 ½ st log 2 st frame 2 st brick 2 st log Splt level fr Splt level br Mfg. sgl. Mfg dbl Basement None ¼ ½ ¾ Full Basement Finish Standard Finish Living Quarters Living sq. ft. Attic Finish Floor/Stair ¼ finish ½ finish ¾ finish Full attic Heating & Air Conditioning (check all that apply) FHA-Gas HW-Baseboard Steam FHA-Electric HW-Radiant Solar FHA-Oil HW-Floor Pipeless Space Heat Electric Radiant Hand-Fired Floor/Wall furnace Electric Baseboard Central A/C Heat Pump Geo-Thermal No A/C No Electric No heat Finish (Describe style and finish) Foundation Exterior Walls Roof (style and materials) Interior Finish Flooring Bedroom Count Plumbing Full bath # Bidet or Urinal No Bathroom Toilet Room # Whirlpool Tub No Plumbing Shower Stall # Hot Tub Sink Wet Bar Fireplace Freestanding # Gas-Side # Prefab # Gas-vertical # Masonry # Gas-freestanding # Page 3 of 6
Porch(s) Porch Style Sq. Ft A/C or Heat 1 st/2story Open Frame Porch Yes No Enclosed Frame Porch Yes No Open Masonry Porch Yes No Enclosed Masonry Porch Yes No Deck/Patio Description Square Feet Patio-conc/brick/stone Wood Deck Screen Enclosed Roof Over Patio or Deck Yes No Veneer Height Brick/Stone/Sim St Lineal Feet ½ Story 1 Story 1 ½ Story 2 Story Additions Addition # 1 Addition #2 Addition #3 Style Square Feet Bsmt. Sq.Ft. No Basement Heat-A/C Yes No Yes No Yes No Attic Yes No Yes No Yes No Garages #1 #2 Attached / Detached Att. Det. Att. Det. Style Frame Brick Frame Brick Width x Length X X Area Square Feet square feet square feet Quarters Over (SF) square feet square feet Qrts. Over A/C Heat square feet square feet Carport square feet square feet Driveways Style Width Length Concrete Single Standard Asphalt Double Long Gravel Triple (over 35 long) Yard Extras Description Square Feet Style Shed Pool Describe Structure:re:Commercial/Retail/Storage.Farm/Storage etc. Page 4 of 6
Wall Height if Commercial or Farm Building Commercial/Farm Wall Height Describe the usage of this building if commercial or farm. Describe and provide square footage for each separate use of the building. Insulation or Lined Walls if Commercial or Farm Building Type of Insulation Sq.ft.& Wall Height Flooring: Commercial/Farm Building Type of Flooring All or Sq.Ft. of portion of Bldg. Estimated Completion Date: Owner of Builder Signature: Phone Number: Overhead Doors Height x width Number of Doors Manual or Electric Manual or Electric Manual or Electric Bins Storage/ Dryer Diameter Height Bushels ********************************************************* **This building permit must be approved prior to construction. You will be notified of approval or denial. **If this parcel is in a designated floodplain additional forms may need to be completed and approved by the Federal Emergency Management Agency and/or The Department of Natural Resources. Make check payable to Douglas County and Return to Supervisor of Assessments, 401 S. Center, Room 103, Tuscola, IL 61953. I/We, the above signed, being the owner(s) or contractor of above described property; certify the proposed construction will comply with all applicable laws, codes, ordinances, and regulations of Douglas County. Page 5 of 6
SKETCH The building permit application must include a drawing of all buildings on this parcel. This does not have to be to scale. Please distinguish the new building (s) from the existing and include dimensions of new construction. Setbacks from the center of the road to the new structure must be included. A copy of this same drawing can be used for water well applications also if the septic (or proposed system, sewer lines, existing wells including abandoned, cisterns, underground storage tanks, and water lines are shown. N Page 6 of 6
FLOODPLAIN INFORMATION 1). Has a state permit been obtained and attached? Yes No 2). Is a floodplain map included: Yes No 3). Base Flood Elevation at Site? Feet Inches m.s.l. 4). Required Lowest Floor Elevation (including basement) Feet Inches m.s.l. 5). Elevation to which all utilities, including all heating and electrical equipment will be protected from flood damage. Feet Inches m.s.l. 6). Type of floodproofing method 7). If the structure is floodproofed the required floodproofing elevation is:feet Inches m.s.l. 8). Is certification by register professional engineer or architect attached? Yes No Complete for subdivisions and Planning Unit Developments Only: 1). Will the subdivision or other development contain 50 lots or 5 acres? Yes No 2). If Yes, does the plat or proposal clearly identify base flood elevations Yes No Applicant s Signature Date The above signed hereby makes application for a permit to develop in a designated floodplain area. The work to be performed is described above and in attachments hereto. The above signed agrees that all such work shall be done in accordance with the requirements of the Floodplain Ordinance and with all other applicable local, state and federal regulations. This application does not create liability on the part of Douglas County, the Douglas County Supervisor of Assessments of any other county official or employee for any flood damage that results from reliance on the application or any administrative decision made lawfully. ADMINISTRATIVE USE ONLY Permit issued, 20 Permit Number Permit denied, 20 Reason for denial: Elevation Certificate attached: Yes: No: Elevation Certificate issued by: Date certificate issued: Administrator s Signature: Date :