Town of Bristol                         Date______________         BP#____-________

APPLICATION FOR A BUILDING PERMIT
INSTRUCTIONS:

COMPLETE BOTH PAGES IN INK AND SIGN ON THE BACK SIDE. INFORMATION IS AVAILABLE FROM BUILDING DEPT. IF UNKNOWN PROVIDE SITE AND STRUCTURAL DRAWINGS FOR YOUR PROJECT.

I. IDENTIFICATION	Tax Map ID #___________________________
Project Address:_________________________	Town__________________________________
Property Owner:_________________________	Telephone #_____________Cell_____________
Address____________________________	Town__________________________________
Applicant (if different):_________________________	telephone #_____________Cell______________
Address_____________________________	Town____________________________________
Contactor Name, Address and Phone #_________________________________________ Insurance Certificate on file Yes No (Workman’s Comp & Liability required prior to issuance of permit)

II. PROJECT DESCRIPTION (submit site plan w/ dimensions on separate sheet)

Briefly describe project___________________________________________________
Proposed use of project __________________________________________________
Will this project involve the- installation or modification of the -    Electric system?   Yes*  No
                                                                                                  Plumbing system? Yes   No
                                                                                                  HVAC system?    Yes   No

* If Electric System is modified, an Electrical Inspection by a Third-Party Agency is required. There will be a separate inspection fee for this service.
___________________________________________________________________

Review this section with the building department staff

ZONING DISTRICT	AC	LR	MR	CB	LI
CONSTRUCTION TYPE	n/a	New	Addition	Repair	Alteration
FLOOR LEVEL (of work)	n/a	Basement	1st	2nd	Accessory Structure
FOUNDATION	n/a	Crawl	Basement	Slab	Pier/Post
ZONING DISTRICT	Yes	No

III. CONSTRUCTION COSTS

Construction Costs for the work described in this application include the cost of all of the construction and other work done in connection therewith, exclusive of cost of the land..

CONSTRUCTION COST [Based on Labor and Material] $__________

PROPERTY & CONSTRUCTION DATA (answer all that is applicable)

House Style	Ranch	2 story Colonial	Split/Tri Level
Square Footage	n/a	Existing___________	Proposed___________
Basement	n/a	Existing___________	Proposed___________
# Bedrooms	n/a	Existing___________	Proposed___________
# Baths	n/a	Existing___________	Proposed___________
Garage (attached)	n/a	Existing___________	Proposed___________
Porch/Deck	n/a	Existing___________	Proposed___________
Heating type	n/a	Existing___________	Proposed______A/C (Y or N)
Fireplace/Stove	Y or N	Type________________
Septic	Repair______________	New_____________

ACCESSORY STRUCTURES

INDICATE PROJECT SIZE & PROVIDE SPECIFICATIONS, DRAWINGS & SITE PLAN SHOWING DISTANCES FROM ALL SIDES, STRUCTURES, NATURAL FEATURES, ETC

Shed ________________ Pole Barn _______________ Garage _________________ Pool/Hot Tub/Spa __________________ Deck _____________________

IV. CERTIFICATION                                                                         (CIRCLE ONE)

• I HEREBY CERTIFY that I am the [OWNER      BUILDER      AGENT OF OWNER] and I am authorized to make this application. I assert that the information provided is accurate to the best of my knowledge, and the project will be completed as specified.
  
  
• I authorize the Code Enforcement Official, or his designee, to enter upon the property to make inspections as prescribed in applicable local and state laws.
  
  
• Furthermore, I understand that progress inspections shall be made as required by law, and
  
  
• NO BUILDING OR PROJECT SHALL BE OCCUPIED OR USED IN WHOLE OR IN PART UNTIL A CERTIFICATE OF USE/OCCUPANCY HAS BEEN ISSUED. IF A STRUCTURE IS USED PRIOR TO FINAL INSPECTION, A FINE MAYBE IMPOSED.

Signed __________________________________  Date ________________________

FOR OFFICIAL USE ONLY

Date rec'd _________  Approved   Denied   If denied, state reason _________________

Signature of Code Officer ________________________

C/forms/bpapplication form