Two-family dwellings — include separate and total combined areas
3. Occupancy — Check only “Single-Family" or “Two-Family" if that is what is being worked on. In other words, do not check either of these two blocks if only a new detached garage is being built, even if it serves a one or two family dwelling. Instead, check “Garage" and number of stalls. If the project is a community based residential facility serving 3 to 8 residents, it is considered a single-family dwelling.
9.
HVAC Equipment — Check only the major source of heat, plus central air conditioning if present. Only check "Radiant Baseboard" if there is no central source of heat.
10. Plumbing — A building permit cannot be issued until a sanitary permit has been issued for any new or affected existing private onsite wastewater treatment system.
14. Estimated Cost — Include the total cost of construction, including materials and market rate labor, but not the cost of land or landscaping.
SIGNATURE — The owner or the contractor's authorized agent shall sign and date this application form. If you do not possess the Dwelling Contractor certification, then you will need to check the owner-occupancy statement for any erosion control or construction permits.
CONDITIONS OF APPROVAL — The authority having jurisdiction uses this section to state any conditions that must be complied with pursuant to issuing the building permit.
ISSUING JURISDICTION: This must be completed by the authority having jurisdiction.
• Check off Jurisdiction Status, such as town, village, city, county or state and fill in Municipality Name
•
Fill in State Inspection Agency number only if working under state inspection jurisdiction.
•
Fill in Municipality Number of Dwelling Location
•
Check off type of Permit Issued, such as construction, HVAC, electrical or plumbing.
•
Fill in Wisconsin Uniform Permit Seal Number, if project is a new one- or two-family dwelling.
•
Fill in Name and Inspector Certification Number of person reviewing building plans and date building permit issued.
INSPECTORS: PLEASE RETURN SECOND PLY WITHIN 30 DAYS AFTER ISSUANCE TO (You may fold
along the dashed lines and insert this form into a window envelope.):
Industry Services Division
PO Box 7302
Madison WI 53707-7302
(Part of Ply 4 for Applicants)
Cautionary Statement to Owners Obtaining Building Permits
101.65(lr) of the Wisconsin Statutes requires municipalities that enforce the Uniform Dwelling Code to provide an owner who applies for a building permit with a statement advising the owner that:
If
the
owner
hires a
contractor
to
perform
work
under
the
building
permit
and
the
contractor
is
not
bonded or
insured
as
required
under
s.
101.654 (2) (a),
the
following
consequences
might
occur:
(a) The owner may be held liable for any bodily injury to or death of others or for any damage to the property of others that arises out of the work performed under the building permit or that is caused by any negligence by the contractor that occurs in connection with the work performed under the building permit.
(b) The owner may not be able to collect from the contractor damages for any loss sustained by the owner because of a violation by the contractor of the one- and two- family dwelling code or an ordinance enacted under sub. (1) (a), because of any bodily injury to or death of others or damage to the property of others that arises out of the work performed under the building permit or because of any bodily injury to or death of others or damage to the property of others that is caused by any negligence by the contractor that occurs in connection with the work performed under the building permit.
Cautionary Statement to Contractors for Projects Involving Building Built Before 1978
If this
project
is in
a
dwelling
or
child-occupied
facility,
built before
1978, and
disturbs 6
sq. ft.
or
more of
paint
per
room,
20
sq. ft.
or
more
of exterior
paint, or
involves
windows, then
the
requirements
of ch.
DHS 163 requiring
Lead-Safe
Renovation
Training
and
Certification
apply. Call
(608)261-6876
or
go
to the
Wisconsin
Department
of
Health
Services'
lead
homepage
for
details
of
how
to
be
in
compliance
Wetlands Notice to Permit Applicants
You are responsible for complying with state and federal laws concerning the construction near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result in removal or modification of construction that violates the law or other penalties or costs. For more information, visit the Department of Natural Resources wetlands identification web page or contact a Department of Natural Resources service center.
Additional Responsibilities for Owners of Projects Disturbing One or More Acre of Soil
I
understand
that
this
project
is
subject
to
ch.
NR 151 regarding
additional
erosion
control
and
stormwater management
and
will
comply
with
those
standards.
Owner's Signature:
Contractor Credential Requirements
All contractors shall possess an appropriate contractor credential issued by the Wisconsin Division of Industry Services. Contractors are also required to only subcontract with contractors that hold the appropriate contractor credentials.
Page 2 of ______
Fire Department Position Statement
To be completed for fire or life-safety related variances requested from SPS 361-66, SPS 316, and other fire-related requirements.
I have read the application for variance and recommend: (check appropriate box)
⍽ Approval ⍽ Conditional Approval ⍽ Denial ⍽ No Comment
Explanation for recommendation including any conflicts with local rules and regulations and suggested conditions:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Municipal Buildings Inspection Recommendation
To be completed for variances requested from SPS 320-323. Also to be used for SPS 316 electrical petitions, if SPS 361- 366 plan review is by municipality or orders are written on the building under construction; optional in other cases.
Please submit a copy of the orders.
I have read the application for variance and recommend: (check appropriate box)
⍽ Approval ⍽ Conditional Approval ⍽ Denial ⍽ No Comment
Explanation for recommendation including any conflicts with local rules and regulations and suggested conditions:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Industry Services Division
Petition for Variance
Information and Instructions SPS 303
In instances where exact compliance with a particular code requirement cannot be met or alternative designs are desired, the division has a petition for variance process in which it reviews and considers acceptance of alternatives which are not in strict conformance with the letter of the code, but which meet the intent of the code. A variance is not a waiver from a code requirement. The petitioner must provide an equivalency which meets the intent of the code section petitioned to obtain a variance. Documentation of the rationale for the equivalency is required. Failure to provide adequate information may delay a decision on the petition. Pictures, sketches, and plans may be submitted to support equivalency. If the proposed equivalency does not adequately safeguard the health, safety, and welfare of building occupants, frequenters, firefighters, etc., the variance request will be denied. NOTE: A SEPARATE PETITION IS REQUIRED FOR EACH BUILDING AND EACH CODE ISSUE PETITIONED (i.e., window issue cannot be processed on the same petition as stair issue). It should be noted that a petition for variance does not take the place of any required plan review submittal.
The division is unable to process petitions for variance that are not properly completed. Before submitting the application, the following items should be checked for completeness in order to avoid delays:
• Petitioner's name (typed or printed)
• Petitioner's signature
• The application must be signed by the owner of the building or system unless a Power of Attorney is submitted.
• Notary Public signature with affixed seal
• Analysis to establish equivalency, including any pictures, illustrations or sketches of the existing and proposed conditions to clearly convey your proposal to the reviewer.
• Proper fee
• Any required position statements by fire chief or municipal official
A position statement from the chief of the local fire department is required for fire or life-safety issues. No fire department position statement is required for topics such as plumbing, private onsite sewage systems, or energy conservation. Submit a municipal building inspection department position for SPS 316 electrical petitions, or if SPS 361-366 commercial building plan review is by the municipality or orders are written on the building under construction. (Submit a copy of the orders.) For rules relating to one- and two-family dwellings, only a position statement is required only if the local municipality is the enforcing body. Position statements must be completed and signed by the appropriate fire chief or municipal enforcement official. Signatures or seals on all documents must be originals. Photocopies are not acceptable.
SANITARY PERMIT REQUIREMENTS
SPS 383.25 (2) I
SSUANCE OF BUILDING PERMITS. (a)
General. Pursuant to s.
145.195, Stats., the issuance of building permits by a municipality for unsewered properties shall be in accordance with this subsection.
Note: See appendix for a reprint of s.
145.195, Stats.
(b) New construction. A municipality may not issue a building permit to commence construction or installation of a structure that necessitates the use of a POWTS to serve the structure, unless:
1. The owner of the property possesses a sanitary permit for the installation of a POWTS in accordance with s.
SPS 383.21; or
