Lot Number. City. Architect Name SUBCONTRACTORS - COMPLETE AND ATTACH LIST ON PAGE 4

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1 New Construction Permit Application Village of Shorewood Building Division One Towne Center Blvd Shorewood, IL (815) Fax (815) SUBMISSION CHECKLIST - Complete this application and attach the following: 1. (3) sets of Construction Plans, stamped and signed. 2. (2) Permit Plats (plat of survey - grading plan). 3. Illinois Energy Conservation Code Calculations (REM/Rate, REScheck, etc.). 4. Plumbing Letter of Intent, signed and sealed (or notarized). 5. Damage Bond $5, (Infrastructure Surety Bond for Residential Lots). 6. Homeowner's Association approval (if applicable). 7. Certificate of Insurance - Property Owner's liability insurance (if applicable). 8. Health Department approval for well or septic (if applicable). APPLICANT INSTRUCTIONS: Please submit pages 1-6 of this form with all attachments, as listed above. Incomplete submissions will not be accepted. Please allow a minimum of ten (10) business days for completion of first plan review and a minimum of five (5) business days for subsequent plan reviews. Applicant is responsible for payment of all permit fees, including consultant plan review fees. PROPERTY INFORMATION Subdivision Lot Number Parcel Identification Number (PIN) OWNER INFORMATION Property Owner Name City State Zip CONTRACTORS INFORMATION Applicant Name Architect Name Engineer Name General Contractor Name SUBCONTRACTORS - COMPLETE AND ATTACH LIST ON PAGE 4 CERTIFICATION I hereby certify that I am the owner of record of the named property, or that the proposed work is authorized by the owner of record, and I have been authorized to make this application as his or her authorized agent. I agree to conform to all applicable building codes, inspection requirements, laws and ordinances of this jurisdiction. In addition, upon issuance of the building permit, I certify that the code official or his authorized representative shall have the authority to enter areas covered by such permit at any reasonable hour to enforce the provisions of the code(s) applicable. APPLICANT SIGNATURE APPLICANT (PRINT NAME) DATE SUPERINTENDENT (CONSTRUCTION MANAGER) SUPERINTENDENT (PRINT NAME) PHONE Page New Construction Permit Application 1/2/2014

2 Model Name/Number Elevation LIST ALL OPTIONS: Structural Frame (check that applicable) BUILDING INFORMATION PROPOSED USE: ASSEMBLY THEATRE (1) NIGHT CLUB (2) RESTAURANT (3) CHURCH (4) OTHER ASSEMBLY (5) BUSINESS (6) EDUCATIONAL GRADES 1-12 (7) DAY CARE FACILITY (8) FACTORY MOD. HAZARD (9) LOW HAZARD (10) HIGH HAZARD (11) INSTITUTIONAL GROUP HOME (12) OTHER (24) HOSPITAL (13) PARKING GARAGE JAIL (14) CARPORT MERCANTILE (15) MOTOR FEEL SERVICE RESIDENTIAL REPAIR GARAGE HOTEL, MOTEL (16) PUBLIC UTILITY TWO FAMILY (17) TOWNHOME (18) CONDO (19) APARTMENT (20) SINGLE FAMILY (21) STORAGE MOD. HAZARD (22) LOW HAZARD (23) Exterior Walls (check those applicable) Steel (1) Concrete (3) Other (5), Identify: Steel (1) Concrete (3) Other (5), Identify: Masonry (2) Wood (4) Masonry (2) Wood (4) Are any structural assemblies fabricated off-site? Yes No Street Frontage (Feet) Front Setback (Feet) Rear Setback (Feet) Left Setback (Feet) Right Setback (Feet) Height Above Grade (Feet) New Residential Units (Number) Existing Residential Units (Number) Elevators / Escalators (Number) Stories (Number) Bed Rooms (Number) Full Baths (Number) Partial Baths (Number) Garages (Number) Windows (Number) Fireplaces (Number) Enclosed Parking (Number) Outside Parking (Number) ELECTRICAL INFORMATION Lot Area (Sq Ft) Building Area (Sq Ft) Parking Area (Sq Ft) Living Area (Sq Ft) Including Options Basement Area (Sq Ft) Garage Area (Sq Ft) Office/Sales (Sq Ft) Service (Sq Ft) Manufacturing (Sq Ft) Building Total Service AMPS Number of Circuits: 2 WIRE 3 WIRE 4 WIRE Number of Service Outlets: 110V 220V POWER DEVICES No. OUTPUT/LOAD POWER DEVICES No. OUTPUT/LOAD Total Number of Motors Utility Service Revisions: Electrical Work Page New Construction Permit Application 1/2/2014

3 Tubs/Showers Shower Stalls Lavatories Toilets Urinals Sinks Laundry Tubs Dishwashers Garbage Disposals Public Water (Y/N) PLUMBING INFORMATION Enter the Number of Fixtures Being Installed Drinking Fountains Floor Drains Water Heaters Water Softeners Sewage Ejectors Sump Pumps Grease Traps Bidets Public Sewer (Y/N) Back Flow Preventers Water Pumps Roof Openings Parking Lot Drains Inside Downspouts Swimming Pools Standpipes (Y/N) (Number of Hose Outlets) Fire Sprinklers (Y/N) (Number of Heads) Lawn Sprinklers (Y/N) (Number of Heads) Total Fixtures Water Service Size IN. Water Meter Size IN. Avg. Daily Water Use GPD Utility Service Revisions: Forced Air Furnace Unit Heater Gas/Oil Conversion Space Heater Gravity Furnace Solid Fuel Appliance Gas Pipe Service Size? Supply/Return Locations? MECHANICAL INFORMATION Enter Number of New Units Incinerator Boiler Coil Unit Window A/C Unit Split System A/C A/C Compressor Plumbing Work Air Handling Unit Heat Pump Air Cleaner Kitchen Exhaust Hood Hazardous Exhaust System Electric Furnace Utility Service Revisions: Type of Heating Fuel: (Check One) Gas (1) Oil (2) Electric (3) Coal (4) Wood (5) Description of Work: OTHER Mechanical Work Other (6) Page New Construction Permit Application 1/2/2014

4 SUBCONTRACTOR INFORMATION : Subdivision: Lot Number: LIST ALL SUBCONTRACTORS: TYPE OF CONTACTOR FULL COMPANY NAME PHONE NO. LICENSE NO. 1 GENERAL 2 ASPHALT PAVING 3 CARPENTRY 4 CONCRETE 5 DRYWALL 6 ELECTRICAL 7 EXCAVATION 8 FIRE ALARM 9 GUTTERS 10 HVAC 11 INSULATION 12 LANDSCAPING 13 MASONRY 14 MECHANICAL 15 PAVING 16 PLUMBING 17 ROOFING 18 ROUGH CARPENTRY 19 SEWER 20 WATER 21 SIDING 22 SPRINKLER 23 STEEL ERECTION BASEMENT Page New Construction Permit Application 1/2/2014

5 Top of Foundation Agreement for Residential Uses Subdivision Lot Number I, _ (please print), the undersigned, do hereby agree to construct the top of the foundation wall to the following elevation as required by the Final Plat, dated, 20. I fully acknowledge that the Village of Shorewood will accept only four (4) inches higher -orthree (3) lower than the elevation of, given to me by the Village of Shorewood. A spot survey or a statement from an engineering firm indicating the elevation of the foundation wall needs to be submitted to the Building Inspector for review. The plat of survey or statement is required to be submitted before framing begins on the home. If the spot survey or statement is not received prior to the onset of framing, a stop work order may be issued. If the foundation wall is not in conformance, it may be necessary to remove the wall at the builder s or owner s expense. Any violation of this agreement will result in a "stop work order" being placed on this structure and necessitate the removal of the non-conforming walls and foundation at my expense. Date _ Signature Pad T.O.W.. ======== Inlet No. San. Rim No. Elevation Name Address City State Zip Telephone ( ) Page New Construction Permit Application 1/2/2014

6 As-Built Grading Responsibility Agreement Subdivision Lot Number As-Built Grading Plan Requirements Clearly label the plat as As-Built Grading Plan. Provide Date of Field Survey. Provide Benchmark information. Provide surveyor certification/seal. Provide statement certifying that final grading was complete and topsoil was in place at the time of survey. Show all easements, setbacks, etc. Provide surveyed locations of all property corner pins (where pins cannot be found, they must be reset and surveyed). Provide measurements of distance between house corners and adjacent property lines. Provide as-built and approved permit plat elevations at the locations provided in the approved subdivision plans Provide as-built and approved permit plat TF elevations. Provide as-built driveway slopes and side/rear yard slopes; provide as-built elevations and dimensions sufficient to substantiate slopes. Provide as-built and approved permit plat elevations of all utility manhole/structure rims on and within 15 of the property. Provide grades and dimensions of drainage swales, including clear identification of any 100-year overflow routes, for both as-built condition and per the approved permit plat. Show locations of utility equipment (pedestals, street lights, fire hydrants, sanitary service cleanout, b-box, etc) on and within 15 of the property. I, _, the undersigned, being the (check all that apply): do hereby agree that I am responsible for the final grading of the above described lot. I agree to grade to the overall asbuilt subdivision grading plan as set forth by the Village of Shorewood or the subdivision developer's specifications. I will provide the final grading survey by a surveyor prior to a final inspection or deposit with the village a sum of money in cash, check or money order which the building inspector may deem sufficient in amount to complete the construction of said building or the installation of required facilities therein. I also certify that the As-Built Grading Plan shall meet the requirements as detailed above. Signature Address City State Zip Telephone ( ) applicant owner contract purchaser subdivision developer Page New Construction Permit Application 1/2/2014

7 Village of Shorewood As-Built Grading Checklist (To be completed by Surveyor and submitted with As-Built Survey) Subdivision and Lot No. Compliant Not Compliant N/A Clearly label the plat as "As-Built Grading Plan". Provide common address for property. Provide Date of Field Survey. Provide Benchmark information. Provide surveyor certification/seal. Provide statement certifying that final grading was complete and topsoil was in place at time of survey. Show all easements, setbacks, etc. Provide locations of all property corner pins (where pins cannot be found, they must be reset and surveyed). Provide measurements of distance between house corners and adjacent property lines. Provide as-built and approved permit plat elevations at the locations provided in the approved subdivision plans. Provide as-built and approved permit plat TF elevations. Provide as-built driveway slopes and side/rear yard slopes; provide as-built elevations and dimensions sufficient to substantiate slopes. Provide as-built and approved permit plat elevations of all utility manhole/structure rims on and within 15-feet of the property. Provide grades and dimension of drainage swales, including clear identification of any 100-year overflow routes, for both as-built condition and per the approved permit plat. Show locations of utility equipment (pedestals, street lights, fire hydrants, sanitary service cleanout, b-box, etc.) on and within 15-feet of the property. Signature Name (Print) Address City, State Zip Telephone