TOWN OF KIPPENS MDA Page 1
2 JUNIPER AVENUE KIPPENS NF A2N 3H8
PHONE: (709) 643-5281 FAX: (709) 643-9773
APPLICATON FOR A BUILDING PERMIT
Name of Owner ________________________________________________________________________
Address ________________________________________________________________________
(Res) Telephone: (___) _____________ (BUS) (____) _____________ (CELL) (____) _____________
This application is made with my knowledge and approval.
Signature of Owner _____________________________________ Date ________________________
****************************************************
Applicant (if different from owner) _______________________________________________________
Address ______________________________________________________________________________
(Res) Telephone: (___) _____________ (BUS) (____) _____________ (CELL) (____) _____________
Name of Contractor of Builder ___________________________________________________________
Address ______________________________________________________________________________
(Res) Telephone: (___) _____________ (BUS) (____) _____________ (CELL) (____) _____________
****************************************************
Architect and/or Professional Engineer(s) retained to design and /or review construction of Building:
Name _______________________________________________________________________________
Address ________________________________________________________________________
(Res) Telephone: (___) _____________ (BUS) (____) _____________ (CELL) (____) _____________
Location of Proposed Building ___________________________________________________________
Location of Existing Building (s) on the Site ________________________________________________
Describe in detail the proposed Building Work and Occupancy _______________________________
MDA Page 2
ESTIMATED VALUE OF PROPOSED WORK: $__________________________________
1. I, __________________________________hereby apply for permission to carry out the above building work. I declare that all information 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 fall responsibility for carrying out the work or having the work carried out in accordance with the National Building Code and the Town of Kippens Regulations.
_____________________ __________________________________________
DATE SIGNATURE
Note
(a) This form is to be completed and submitted with Form MDA applying for a Development Permit and form MDA (construction details where necessary)
(b) One (1) complete set of building design plans is to be submitted with the 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 system designers is available at the Government Services Centre, Stephenville.
(g) When selecting a heating system for your dwelling 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 the town on culvert size.
MDA Page 3
CONSTRUCTION DETAILS:
1. EXCAVATION:
– Dept from finished grade to footing_______________________
2. FOUNDATION:
– Type______________ Walls: Thickness __________________
– Size of Footing ____________x__________
– Piers: Size __________ x _______Footing ________x________
3. CONCRETE:
– Type _____________ Reinforced: Yes ____ N0 ______
– Waterproofing _______________ Or Damp proofing ________
4. TILE DRAINS:
– Perimeter _______ under floor _____Sump Pump _________
5. EXTERIOR WALLS:
– Frame_____________ Solid Masonry
– Other (specify) _________________________________________
6. EXTERIOR FINISH:
– Wood Brick Stucco
7. CHIMNEY (S):
– Brick Prefabricated Flue Size x
MDA Page 4
8. CONSTRUCTIN:
SIZE MATERIALS &
MEMBER SPAN THICKNESS GRADE
Bearing Partitions (studs) __
Columns under Girders _______
Floor Joists (main floor) _______
Floor Joists (other floor) _______
Ceiling Joists
Rafter’s ___
Truss ___
Girders ___
Roof Sheathing ___
Wall Sheathing (exterior) ___
Sub Flooring ___
Tile Underlay ___
Basement Floor ___
Other Partitions (studs) ___
MDA Page 5
9. Interior Finish Gyprock ______ Plaster Panelling
Other (specify) __________________________________________________
10. Windows Type of frame ______________________ flashing _______________
11. Doors Type of frame ______________________ flashing ______________
Exterior Size _______________________ Interior Size ____________
12. Insulation Type and thickness: Exterior Walls _____________________________
Ceiling ____________________________________________________
Floor (if applicable) __________________________________________
13. Plumbing 3 Piece___________ Extra plumbing (specify) ____________________
(All plumbing must be installed to the specifications of the National Plumbing Code of Canada)
14. Roofing Type ________________ Grade of Weight ______________________
Eaves troughing Yes ______ ____ No ___________
15. Electrical Service Source of Power _______________________________________
(All wiring must be installed in compliance with the Electrical Code of Newfoundland and Labrador)
16. Heating System Type of System ___________________________________________
Location of fuel storage: Inside __________ outside __________
17. Water Supply (show Location on plot plan: Dug well _________ _____________
Drilled Well _____________ Town Water ___________________
18. Sewage Disposal (show location on plot plan) Type _________________________
MDA Page 6
MUNICIPALITY OF KIPPENS
DEVELOPMENT REGULATION
APPLICATION FOR A DEVELOPMENT PERMIT
This application is for:
(Check the appropriate answer)
Outline Planning Permission ____________. Temporary Permission ______________
The change of use or type of occupancy
Of land or buildings ___________________. The construction, alternation, demolition
Or relocation of a building ____________
The erection or display of an
Advertisement _______________________. The subdivision of land for
Development _______________________
Permission to occupy a building ________. The making of an access onto
A public road _______________________
Other (specify) _____________________________________________________________
1. Name of Owner _________________________________________________________
2. address _________________________________________________________
3. Telephone _________________________________________________________
This application is made with my knowledge and approval.
Signature of Owner: _________________________________________
Date: _________________________________________
Name of applicant (when not Owner) _______________________________________
Address: _______________________________________________________________
Telephone No. __________________________________________________________
Location of Site: ________________________________________________________