Development Permit Application

DEVELOPMENT PERMIT APPLICATION

Application to: _____Subdivision _____Change of Use or Type of Occupancy-Land or Building

_____Construction, Alteration, Relocation or Demolition of a Building

(Circle appropriate one)

_____Construction of an access onto a public road

_____Erect Sign(s)

_____Other (Specify) ___________________________________________________

1. NAME OF OWNER _____________________________________________________________

ADDRESS _____________________________________________________________

TELEPHONE NUMBER(S) ____________Res. ___________Work ____________Cell

This application is made with my knowledge and approval:

Signature of Owner ____________________________________________

Date _________________________________________________________

2. NAME OF APPLICANT _________________________________________________________ (if different from owner)

ADDRESS _________________________________________________________

TELEPHONE NUMBER(S) ___________Res. ____________Work ____________Cell

LOCATION OF SITE/PROPOSED DEVELOPMENT ______________________________

ESTIMATED VALUE OF PROPOSED WORK $____________________

I, ________________________ HEREBY APPLY FOR PERMISSION TO CARRY OUT THE ABOVE BUILDING WORK. I DECLARE THAT ALL INFORMAITON GIVEN BY ME IN CONNECTION WITH THIS APPLICATION IS TRUE AND CORRECT TO THE BEST OF MY BELIEF AND THAT THE BUILDING WORK DESCRIBED IN THIS APPLICATION, IF PERMITTED, WILL BE CARRIED OUT IN ACCORDANCE WITH ALL APPLICABLE LAWS AND REGULATIONS OF THE PROVINCE OF NEWFOUNDLAND AND LABRADOR AND THE TOWN OF KIPPENS.

I UNDERSTAND THAT THE GRANTING OF A PERMIT, THE APPROVAL OF THE DRAWINGS AND SPECIFICATIONS OR INSPECTIONS MADE BY THE TOWN OF KIPPENS SHALL NOT IN ANY WAY RELIEVE ME OF FULL RESPONSIBILITY FOR CARRYING OUT THE WORK OR HAVING THE WORK CARRIED OUT IN ACCORDANCE WITH THE NATIONAL BUILDING CODE AND THE TOWN OF KIPPENS REGUALTIONS.

_________________________ ____________________________________

Date Signature

NOTES

A. This form is to be completed and submitted with Form MDA applying for a development permit and Form MBA (Construction details where necessary)

B. One (1) complete set of building design plans is to be submitted with this application

C. Plot plan outlining location of proposed building to be submitted with this application

D. Department of Health approval required before permit issued.

E. Permit construction fee for residential dwelling is fifty ($50.00) dollars, payable when permit picked up by owner if the owner is the builder. Contractor residential permit fee is 1/8 of 1% of construction costs.

F. Septic system shall be designed by a certified system designer. A list of the septic designers is available at the Government Service Centre, Stephenville.

G. When selecting heating system for your swelling please note that Kippens water supply is known as hard water and if you plan on having a water heating system in your dwelling please have your contractor design the water heating system for hard water.

H. Culvert to be installed under proposed driveway. Please check with town