Town of Kippens
GENERAL APPLICATION
Permit No: _______
Applicant: _________________ Phone: _________________ Date: _________________
MailingAddress:________________________________________________________________
______________________________________________________________________________
Property Owner: ________________________________________________________________
Property Owner Address: _________________________________________________________
______________________________________________________________________________
Contractor: _________________ Address: ________________ Phone: ________________
Type of Permit
Building (all structures): _____ Development Approval: _____ Approval in Principle: _____
Change/New Occupancy: _____ Repairs/Renovations: ______ Demolition: _____
Residential Subdivision: ______ # of Proposed Lots: ______ Fence: _____
Development Location: ______________________________ Construction Value: ___________
Description of Land To Be Developed
Frontage: _________ (m/ft) Depth: _________ (m/ft) Area: _________ (m2/ft2)
As per Survey: ________
Existing Land Uses (check appropriate box(es) & specify)
Residential: ____________ Crown Land: ___________ Unknown: ___________
Commercial: ____________ Vacant: ___________ Other: ___________
Describe Intended Use
If Residential:
Single Family Dwelling: ___ Single Family Dwelling w/Apartment: ___ Extension to Dwelling: ____
Add Apartment to Existing: ____ Accessory Bldg (shed/garage): ____ Other: _____
If Commercial:
Retail: _____ Industrial: _____ Extension to Building: _____ Office: _____
Restaurant: _____ Other: _____
Describe Building (if applicable)
Dimension: ____ x ____(m/ft) Area: _____(m/ft2) Height: _____(m/ft) Setback: _____(m/ft)
Heating Type: _________________________ # Washrooms: ______ Attached Garage: Y / N
Propane/Oil/Electric/Wood Appliances: ______________________________________
Describe Renovations, Repair, Extension, Etc. (Material Used):
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Proposed Means of Access
Existing Access: _____ New Access (Culvert): _____ New Access (Subdivision): _____
I/We, _______________________________, the applicant(s) named herein, do solemnly declare the statements herein contained in this application are true and made with a full knowledge of the circumstances connected with the same, that the location and plot plan submitted correctly sets out the location of the development described in the said application. I/We make this solemn declaration, conscientiously believing it to be true and with full knowledge of the property owner, and knowing that it is of the same force and effect as if made under oath.
2 Juniper Avenue, Kippens, NL, Canada A2N 3H8
T: 709-643-5281 * F: 709-643-9773 * E: kippens@nf.aibn.com * www.townofkippens.ca
Town of Kippens
PLOT PLAN
Please indicate the proposed location of the new building in relation to the Lot Lines.
Indicate the location of accessory buildings, fences, and extensions in relation to the existing building and the Lot Lines. Also indicate the distance between the accessory building and the existing building. Please indicate driveway location.
Street Name and Number: _________________________________________________
2 Juniper Avenue, Kippens, NL, Canada A2N 3H8
T: 709-643-5281 * F: 709-643-9773 * E: kippens@nf.aibn.com * www.townofkippens.ca