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C I T Y O F C H I C A G O

DEPARTMENT OF BUILDINGS

Building Permit Application

USE BLACK INK:

DO NOT WRITE IN SHADED AREA

APPLICATION PERMIT NO.: _________________________

DS APPLICATION NO.: _____________________________

DATE ISSUED: ____________________________________

			HOLDS:
	Y	N	Y N
Stop Order(s):			Violations

Landmark			Special Admin. Hold

Lakefront Prot.			Other

Flood Plain

1. GENERAL INFORMATION

(Provide Original House Number Certiicate for new construction.) Address: Please enter two if a corner property.

Number of dwelling units, number of stories, building use, description of proposed work and parking:

Enter permit number if revision to an existing permit:

Property Index Number(s) (PIN) (required):

1.	-	-	-	-
2.
2.	-	-	-	-
3.
3.	-	-	-	-
4.
4.	-	-	-	-

Cost of Construction:

	2. CLASSIFICATION BY OCCUPANCY:

A Residential		D Open Air Assembly		H1	Storage Low Hazard
A2 Residential		E Business		H2	Storage Moderate Hazard
B Institutional		F Mercantile		H3	Garages
C1 Assembly		Private Garage		1 Hazardous
C2 Assembly		G1	Industrial Low Hazard	J Miscellaneous Building
C3 Assembly		G2	Industrial Moderate Hazard	Technology Center

3A. BUILDING INFORMATION FOR EXISTING BUILDING:

	Const. Class.	No. Stories	Basements	No. D.U.	No. Comm.	Width	Length	Height	Area (sf)	Volume (cf)
					Units

Existing

3B. BUILDING INFORMATION FOR NEW CONSTRUCTION (IF APPLICABLE):

Const. Class.	No. Stories	Basements	No. D.U.	No. Comm.	Width	Length	Height	Area (sf) Volume (cf)
				Units

Addition

New Bldg.

(Front or Rear)

Detached

Garage

Fence

Trash

Enclosure

3C. BUILDING INFORMATION FOR RENOVATION (IF APPLICABLE):

	Const. Class.	No. Stories	Basements	No. D.U.	No. Comm.	Width	Length	Height	Area (sf)	Volume (cf)
					Units

Area to be
Renovated

									197999-14-SP-4/08

4.ZONING INFORMATION: (See Site Plan in Drawings of lot and buildings, showing dimensions, streets, alleys, setbacks, existing landscaping and north arrow.)

Plat of Survey:	Area of Lot:

Plate Number:	Height of Building:

Zoning District/P.D. #:	Area and Volume of Building:

Zoning Use:	Number of Parking Spaces:

Front or Rear Building:	Number of Loading Spaces:

Special Zoning Permission Required for Administrative Adjustment, Variance or Special Use:	® Yes	® No

Case Number:

Comments Section:

Signature of Approval:				Date:


	5. FIRE PREVENTION ITEMS:

		Yes	No		YES	NO

Existing Sprinkler System				Flammable Liquids
Install Full Sprinkler System				Corrosive Liquids

Install Partial Sprinkler System (Designate Areas to be				Hazardous Chemicals
Sprinklered):				Hazardous Chemicals
Sprinklered):

Extend Existing Sprinkler System (Designate Areas to				Oxidizing Materials
be Sprinklered):				Oxidizing Materials
be Sprinklered):

Relocate Sprinkler Heads Only				Highly Flammable Materials

Existing Standpipe System				Fume Hazardous Gases

Install New Standpipe System				Flammable Compressed Gases

Existing Fire Alarm System (Choose One):				Dust Producing Equipment
_____ Class I	_____ High Rise
_____ Class II	_____ Other, clarify

Install New Fire Alarm System (Choose One):				Is this permit for modiications to the building in order
_____ Class I	_____ High Rise			to pass the Life Safety Evaluation as per code section
_____ Class II	_____ Other, clarify			34 (13-196-206)?

6. MAYOR’S OFFICE FOR PEOPLE WITH DISABILITIES ITEMS

Is the project Government inanced, subsidized or guaranteed?				® Yes	® No
If yes, specify type of funding: city, state or federal.

RENOVATION PROJECTS ONLY:
Provide total alteration cost in last 30 months using EAC / ERC = __________ %
EAC = Estimated Alteration Cost for Project Budget + Alteration Cost in Last 30 Months
ERC = Estimated Reproduction Cost = Work Area (sf) x New Construction Cost per sf

HOUSING PROJECTS ONLY (Submit Part II Letter of Approval at intake meeting, if applicable.):

Total Number of Dwellings Units:		Multiple Dwellings:
Structure with Four or More Units:		Single Family Residential (Detached):
Attached Multi-Story Single Family Residential Units with Separate Means of Egress:
Other:

						Proposed No.	Actual No.
						D.U.		D.U.
Accessible Lodging Units [1107.5.1.1 (ANSI Section 1002)]

Units with Communication Features [1107.5.1.1 (ANSI Section 1005)]

Accessible Units with Communication Features	[1107.5.1.1 (ANSI Section 1002 + 1005)]

Type A [1107.5.2.2 (ANSI Section 1003)]

Type B [1107.5.2.3 (ANSI Section 1004)]

Type A & B with Conduit Lines [1107.5.2.4]

Visitable [1107.5.4.3 and 1107.5.5.3]

Attached Multi-Story SFR Units with Separate Means of Egress [1107.5.4.3 + 1107.5.5.3]

Section 504 Accessible Units [1107.5.5.5.1 and (U.F.A.S. Sec. 4.34)]

Section 504 Accessible Units with Communication Features [1107.5.5.5.2 and 1107.5.5.4
(ANSI Section 1005)]

Zoning Incentive Building Type A Units [17-2-0304 A & B, 17-2-0306, 17-2-0311 A & A (a)
(Zoning Code) (ANSI Section 1003)]

Change of Occupancy (20+ Units)

	7. ENVIRONMENTAL ITEMS

		Yes	No					Yes	No

Boiler(s)				Dry Cleaning Machinery
Gas Fired Hot Water Heater(s)				Manufacturing Process Equipment and Control
				Devices

Gas Fired Package Rooftop, Furnaces				Manufacturing Process Equipment or Area,
				Hazardous/Flammable Storage
Unit Heaters or other Gas Fired HVAC Units				Air Pollution Control Devices

Unired Pressure Vessel (Air Tanks, Heat Exchanger,				Paint Spray Booth or Paint Spray Area
Hot Storage Tanks)

Commercial Cooking Equipment or Food Preparation				Paint Spray Booth or Paint Spray Area in Motor
Unit				Vehicle Repair Shop
Emergency Generator				New Incinerator or Afterburner Equipment
Underground/Aboveground Storage Tank Unit (Apply				Sandblasting, Grinding of Masonry, or Chemical
at DOE)				Cleaning of Any Architectural Surface
Compactor or Bailer

	8. REMARKS AND APPROVALS

Remarks By:	Date:




Remarks By:	Date:




Remarks By:	Date:



Remarks By:	Date:



Remarks By:	Date:



Remarks By:	Date:



Remarks By:	Date:




Remarks By:	Date:

9. CONTACT INFORMATION

Owner/Tenant/Agent: _________________________________________________________________________________________

Lic. # _________________________________________________________	City ________________________________________
Address: ______________________________________________________	State: _____________________ Zip Code: ________
E-mail:________________________________________________________	Telephone No: _______________________________
Emergency Contact: _____________________________________________	Telephone No.: ______________________________

Arch./Eng.: __________________________________________________________________________________________________

Lic. #: ________________________________________________________	City: _______________________________________
Address: ______________________________________________________	State: _____________________ Zip Code: ________
E-mail: _______________________________________________________	Telephone No: _______________________________

General Contractor: ___________________________________________________________________________________________

Lic. #: ________________________________________________________	City: _______________________________________
Address: ______________________________________________________	State: _____________________ Zip Code: ________
E-mail: _______________________________________________________	Telephone No: _______________________________

Mason Contractor: ____________________________________________________________________________________________

Lic. #: _________________________________________________ A, B, or C City: _______________________________________

Address: ______________________________________________________	State: _____________________ Zip Code: ________
E-mail: _______________________________________________________	Telephone No: _______________________________

Electrical Contractor: __________________________________________________________________________________________

Lic. #: ________________________________________________________	City: _______________________________________
Address: ______________________________________________________	State: _____________________ Zip Code: ________
E-mail: _______________________________________________________	Telephone No: _______________________________

Vent/Heat Contractor: _________________________________________________________________________________________

Lic. #: ________________________________________________________	City: _______________________________________
Address: ______________________________________________________	State: _____________________ Zip Code: ________
E-mail: _______________________________________________________	Telephone No: _______________________________

Refrig./AC Contractor: ___________________________________________________________________________________________________

Lic. #: ________________________________________________________	City: _______________________________________
Address: ______________________________________________________	State: _____________________ Zip Code: ________
E-mail: _______________________________________________________	Telephone No: _______________________________

Plumbing Contractor: _________________________________________________________________________________________

Lic. #: ________________________________________________________	City: _______________________________________
Address: ______________________________________________________	State: _____________________ Zip Code: ________
E-mail: _______________________________________________________	Telephone No: _______________________________

Expeditor: ___________________________________________________________________________________________________

Lic. #: ________________________________________________________	City: _______________________________________
Address: ______________________________________________________	State: _____________________ Zip Code: ________
E-mail: _______________________________________________________	Telephone No: _______________________________

Local Arch./Eng.*:_____________________________________________________________________________________________
Lic. #: ________________________________________________________	City: _______________________________________
Address: ______________________________________________________	State: _____________________ Zip Code: ________
E-mail: _______________________________________________________	Telephone No: _______________________________

(*If your licensed Architect is not located in the State of Illinois, you have the option to identify a local Illinois Architect to represent you at DOB to attend meetings and attend Open Plan Review.)

WARNING TO PROPERTY OWNER/TENANT AND GENERAL CONTRACTOR

I, _______________________________, as property owner/tenant, and I, ________________________, as general contractor, understand that it is

against the law to exceed the scope of a building permit. I understand that if I build, or allow anyone else to build, any building, room addition, structure or other object that differs from, or in any way exceeds, what this permit authorizes me to build, I can and will be severely punished. I understand that if I exceed, or allow anyone else to exceed, the scope of this building permit, I can have my permit revoked; be ordered to stop all work on the project; ined up to $5,000.00 per day; imprisoned for up to six months; required to do up to 100 hours of community service; required to tear down at my own ex- pense all completed work; and, in addition to any other penalties provided by law, required to reimburse the City up to three times any damages incurred for providing any false or inaccurate information in this building permit application. I understand that all construction work under this proposed permit must conform to the requirements of the Chicago Building Code and, if it does not, I acknowledge that I can and will be severely punished.

Owner Signature ___________________________________________________________________________________ Date __________________

-or-

Tenant Signature (if applicable) ________________________________________________________________________ Date __________________

and-

General Contractor Signature _________________________________________________________________________ Date __________________

CERTIFICATION BY PROPERTY OWNER/TENANT

I, ______________________________, as property owner/tenant, hereby certify that the statements in this application are true; that I have legal authority

to do the work authorized by this proposed permit on the property identiied in this Application; that all construction work under this proposed permit will conform to the requirements of the Chicago Building Code under possible penalty of prosecution; and that if the construction work authorized under this proposed permit does not conform to the requirements of the Chicago Building Code, I will do whatever is necessary to correct the Code violation. I under- stand that any false or inaccurate information contained in this Application may result in revocation of the building permit in addition to any other penalties provided by law. A false statement of material fact made on this Application may violate federal, state and/or local law, and may subject any person mak- ing such a statement to a range of civil and criminal penalties, such as a period of incarceration, ines, and an award to the City of up to three times any damages incurred. In addition, persons who submit false information are subject to denial of the requested City action.

Owner Signature ___________________________________________________________________________________ Date ___________________

-or-

Tenant Signature (if applicable) ________________________________________________________________________ Date ___________________

Does the Owner require a Residential Real Estate Developer’s License to do the proposed work at this address? Yes ___ No___

If yes, license number _______________________________________________________________________________________________________

CERTIFICATION BY EXPEDITOR

I, ___________________________, as expeditor, hereby certify that the statements in this Application are true. I understand that any false or inaccurate

information contained in this permit Application may result in revocation of the building permit in addition to any other penalties provided by law. A false statement of material fact made on this Application may violate federal, state and/or local law, and may subject any person making such a statement to a range of civil and criminal penalties, such as a period of incarceration, ines, and an award to the City of up to three times any damages incurred. In addition, persons who provide false information are subject to denial of the requested City action.

Signature of Expeditor ____________________________________________ Expeditor No. _____________________ Date _____________________

CERTIFICATION BY DESIGN PROFESSIONAL

I, __________________________________, as design professional, hereby certify that all information contained in this Application under item numbers

1, 2, 3A, 3B, 3C, 5, 6 and 7 is complete and accurate to the best of my knowledge. I understand that any false or inaccurate information contained in this Application may result in revocation of the building permit in addition to any other penalties provided by law. A false statement of material fact made on this Application may violate federal, state and/or local law, and may subject any person making such a statement to a range of civil and criminal penalties, such as a period of incarceration, ines, and an award to the City of up to three times any damages incurred. In addition, persons who provide false information are subject to denial of the requested City action.

____________________________________________________________________________________	_________________________________
Signature of Licensed Architect or Structural Engineer of Record	Date
_____________________________________________________
License Number
	Professional Seal

Question	Answer
Form Name	Department Building Permit Application Form
Form Length	6 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min 30 sec
Other names	dept buildings permit application, chicago department permit, how to buildings permit, buildings permit application

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