Fill Out a Valid Wisconsin Building Permit Template Edit Form Online

Fill Out a Valid Wisconsin Building Permit Template

The Wisconsin Building Permit form is a crucial document required for construction projects within the state, ensuring compliance with local building codes and regulations. This form collects essential information about the proposed project, including details about the property, the owner, and the contractors involved. Properly completing and submitting this form is vital to obtaining the necessary approvals for any construction work.

To get started on your building project, fill out the Wisconsin Building Permit form by clicking the button below.

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Article Structure

The Wisconsin Building Permit form is an essential document for anyone looking to undertake construction or renovation projects in the state. This form gathers critical information about the project, including the type of work being done—be it structural, HVAC, electrical, or plumbing. Applicants must provide details such as the owner's name, mailing address, and contact information, along with the contractor's details, including their license number and expiration date. The form also requires specifics about the project location, including the parcel number, zoning district, and setbacks. Notably, if the project will disturb one acre or more of soil, additional erosion control measures must be followed, as outlined in Wisconsin regulations. The form includes sections for project specifications, such as the area involved, occupancy type, and estimated building costs, which help ensure compliance with local codes and ordinances. By signing the form, applicants acknowledge their understanding of the associated responsibilities and regulations, granting permission for inspections during the construction process. Completing this form accurately is crucial for obtaining the necessary approvals and moving forward with building plans.

Listed Questions and Answers

  1. What is the purpose of the Wisconsin Building Permit form?

    The Wisconsin Building Permit form is used to request permission to begin construction or renovation projects. It ensures that all projects comply with local building codes, zoning laws, and safety regulations. The information provided helps local authorities assess the impact of the project on the community and the environment.

  2. Who needs to fill out the form?

    The form must be completed by the owner of the property, the builder, or an authorized agent. It is essential for anyone planning to undertake construction, renovation, or significant repairs to a building, particularly for projects that disturb one acre or more of soil.

  3. What information is required on the form?

    Applicants must provide various details, including:

    • Owner’s name and contact information
    • Contractor’s name and license information
    • Project location and description
    • Type of work being done (construction, electrical, plumbing, etc.)
    • Estimated cost of the project
  4. Are there fees associated with the building permit?

    Yes, there are fees for processing the permit application. These may include plan review fees, inspection fees, and other costs depending on the type of permit being issued. It is important to check with the local issuing authority for specific fee amounts.

  5. What happens if I do not obtain a building permit?

    Failing to obtain a building permit can result in penalties, including fines or orders to halt construction. Additionally, unpermitted work may need to be removed or modified to comply with building codes, which can lead to additional costs and delays.

  6. Can I perform the work myself, or do I need a licensed contractor?

    Homeowners can perform work on their own property without a licensed contractor, provided they meet certain conditions. If the project involves significant structural changes or requires specialized skills, hiring a licensed contractor is advisable. This ensures compliance with safety standards and local codes.

  7. What is the role of the issuing authority?

    The issuing authority, typically a local municipality or county, is responsible for reviewing the permit application. They ensure that all submitted information meets local building codes and zoning regulations. The authority also conducts inspections during the construction process to verify compliance.

  8. What if my project disturbs one acre or more of soil?

    If your project disturbs one acre or more of soil, it is subject to additional erosion control and stormwater management regulations. You will need to comply with Chapter NR 151 of the Wisconsin Administrative Code, which may require additional permits or inspections.

Key takeaways

Filling out the Wisconsin Building Permit form is an important step in ensuring that your construction project complies with local regulations. Here are some key takeaways to keep in mind:

  • Complete All Sections: Make sure to fill out every section of the form, including details about the project type, location, and contractor information. Missing information can delay the approval process.
  • Understand Permit Types: Identify the type of permit you need, whether it’s for construction, HVAC, electrical, or plumbing. This will help you gather the necessary information and documents.
  • Check Erosion Control Requirements: If your project will disturb one acre or more of soil, be aware that additional erosion control and stormwater management regulations apply. You must comply with these to avoid penalties.
  • Provide Accurate Cost Estimates: When estimating the cost of your project, include all construction expenses except for land costs. This helps ensure you meet local financial requirements.
  • Signature and Certification: The form must be signed by the owner or an authorized agent. If you are the owner and do not have a Dwelling Contractor certification, you will need to check the owner-occupancy statement.

Following these guidelines will help streamline the permit application process and keep your project on track. Always remember to consult with local authorities if you have any questions or need further clarification.

Document Overview

Fact Name Description
Governing Laws The Wisconsin Building Permit form is governed by Wisconsin Statutes 101.63 and 101.73.
Application Purpose This form is used to apply for various building permits, including construction, HVAC, electrical, and plumbing.
Parcel Information Applicants must provide a Parcel Number, which may be used by other government agencies.
Owner's Responsibility The owner certifies that all provided information is accurate and acknowledges applicable codes and ordinances.
Erosion Control If the project disturbs one acre or more of soil, it must comply with Chapter NR 151 regarding erosion control.
Inspections Permission is granted for building inspectors to enter the premises for inspections at reasonable hours.
Occupancy Types Occupancy types include single-family, two-family, and other uses such as garages or seasonal structures.
Heat Loss Calculation Applicants must provide heat loss data (BTUs/HR) as part of the permit application.
Signature Requirement The application must be signed by the owner or an authorized agent, confirming their responsibility for the project.
Fees and Costs Fees are associated with the permit application, including plan review, inspections, and permit seals.

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Misconceptions

Understanding the Wisconsin Building Permit form is crucial for anyone involved in construction or renovation projects. However, several misconceptions can lead to confusion and potential issues. Here are ten common misconceptions:

  1. Only contractors need to apply for permits. Many believe only licensed contractors can apply for building permits. In reality, homeowners can also apply, especially if they are owner-occupants.
  2. Permits are only necessary for new constructions. Some think permits are required only for new buildings. However, permits are also needed for significant renovations, repairs, and additions.
  3. All projects require the same type of permit. There is a misconception that one type of permit covers all projects. Different permits exist for various aspects, such as electrical, plumbing, and HVAC work.
  4. Submitting the form guarantees permit approval. Many assume that submitting the application will automatically result in approval. Approval depends on meeting all local codes and regulations.
  5. The permit application can be submitted without plans. Some individuals think they can submit the form without detailed plans. In fact, building plans and specifications must accompany the application.
  6. Permits are not needed for minor repairs. There is a belief that minor repairs do not require permits. However, even small projects can require permits depending on local regulations.
  7. Once a permit is issued, no further inspections are needed. Some think that obtaining a permit means no further inspections are necessary. Inspections are often required at various stages of the project.
  8. Permits are only relevant during construction. Many overlook the fact that permits can have long-term implications, including zoning compliance and future property sales.
  9. Permits are the same across all municipalities. There is a misconception that building permit requirements are uniform statewide. In reality, requirements can vary significantly by municipality.
  10. Failure to obtain a permit has no consequences. Some believe that not obtaining a permit is a minor issue. However, it can lead to fines, legal issues, and potential removal of unauthorized work.

Addressing these misconceptions is essential for ensuring compliance and avoiding costly mistakes during construction projects in Wisconsin.

Form Sample

 

Dept of Safety & Professional

 

 

 

 

Wisconsin Uniform Building

 

 

Application No.

 

 

 

 

Services

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Permit Application

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Industry Services Division

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Wisconsin Stats. 101.63, 101.73

 

Instructions on back of second ply. The information you provide may be

Parcel No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

used by other government agency programs [(Privacy Law, s. 15.04 (1)(m)]

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PERMIT REQUESTED

 

 

Constr.

HVAC

Electric

Plumbing

Erosion Control

 

Other:

 

Owner’s Name

 

 

 

 

 

 

 

 

 

 

Mailing Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tel.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Contractor Name & Type

 

 

 

 

 

 

 

Lic/Cert#

Exp Date

 

 

Mailing Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone & Email

 

Dwelling Contractor (Constr.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dwelling Contr. Qualifier (The Dwelling Contr.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Qualifier shall be an owner, CEO, COB or employee of the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dwelling Contr.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HVAC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Electrical Contractor

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Electrical Master Electrician

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Plumbing

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PROJECT

 

Lot area

 

 

 

 

One acre or more

 

 

 

Town

Village

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LOCATION

 

 

 

 

 

Sq.ft.

 

of soil will be

 

 

 

 

City of

 

 

 

 

 

 

 

1/4,

 

 

 

1/4, of Section

 

, T

 

N, R

 

E/W

 

 

 

 

 

 

 

 

 

disturbed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Building Address

 

 

 

 

 

 

 

 

 

County

 

 

 

 

 

 

 

 

 

 

 

Subdivision Name

 

 

 

 

 

 

 

 

Lot No.

 

Block No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Zoning District(s)

 

 

 

 

 

 

 

Zoning Permit No.

 

 

 

 

 

 

 

Setbacks:

 

Front

 

 

 

 

 

Rear

 

 

 

 

Left

 

 

 

Right

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ft.

 

 

 

ft.

 

 

 

 

 

 

ft.

 

 

 

ft.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. PROJECT

 

 

 

 

 

 

 

 

3. OCCUPANCY

 

6. ELECTRIC

 

 

9. HVAC EQUIP.

 

 

12. ENERGY SOURCE

 

 

 

 

 

 

 

 

 

 

 

New

Repair

 

 

 

 

Single Family

 

Entrance Panel

 

 

 

Furnace

 

 

 

 

 

Fuel

 

Nat

 

 

LP

 

 

Oil

Elec

 

Solid

Solar

 

Alteration

Raze

 

 

 

 

Two Family

 

Amps:

 

 

 

Radiant Basebd

 

 

 

 

 

 

Gas

 

 

 

 

 

 

 

 

 

 

 

 

 

Geo

 

Addition

Move

 

 

 

 

Garage

 

 

Underground

 

 

Heat Pump

 

Space Htg

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other:

 

 

 

 

 

 

 

Other:

 

 

Overhead

 

 

 

Boiler

 

 

 

 

Water Htg

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.WALLS

 

 

 

Central AC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. AREA INVOLVED (sq ft)

 

 

 

 

4. CONST. TYPE

 

 

Wood Frame

 

 

Fireplace

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Unit 1

Unit 2

 

Total

 

Site-Built

 

 

Steel

 

 

 

Other:

 

 

 

 

13. HEAT LOSS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Unfin.

 

 

 

 

 

 

 

 

 

Mfd. per WI UDC

 

 

ICF

 

 

 

 

 

 

 

 

 

 

 

 

 

BTU/HR Total Calculated

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bsmt

 

 

 

 

 

 

 

 

Mfd. per US

 

 

Timber/Pole

 

10. SEWER

 

 

Envelope and Infiltration Losses (available from "Total

Living

 

 

 

 

 

 

 

 

 

HUD

 

 

Other:

 

 

 

Municipal

 

Building Heating Load" on Rescheck report)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Area

 

 

 

 

 

 

 

 

5. STORIES

 

8. USE

 

 

 

Sanitary Permit#

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Garage

 

 

 

 

 

 

 

 

 

1-Story

 

 

Seasonal

 

 

 

 

 

 

 

 

 

 

 

14. EST. BUILDING COST w/o LAND

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Deck/

 

 

 

 

 

 

 

 

2-Story

 

 

Permanent

 

 

11. WATER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Porch

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

0

 

0

 

 

0

 

 

 

Other:

 

 

Other:

 

 

 

Municipal

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Totals

 

 

 

 

 

 

 

 

Basement

 

 

 

 

 

 

 

 

 

 

On-Site Well

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I understand that I: am subject to all applicable codes, laws, statutes and ordinances, including those described on the reverse side of the last ply of this form; am subject to any conditions of this permit; understand that the issuance of this permit creates no legal liability, express or implied, on the state or municipality; and certify that all the above information is accurate. If one acre or more of soil will be disturbed, I understand that this project is subject to ch. NR 151 regarding additional erosion control and stormwater management and the owner shall sign the statement on the back of the permit if not signing below. I expressly grant the building inspector, or the inspector's authorized agent, permission to enter the premises for which this permit is sought at all reasonable hours and for any proper purpose to inspect the work which is being done.

I vouch that I am or will be an owner occupant of this dwelling for which I am applying for an erosion control or construction permit without a Dwelling Contractor Certification and have read the cautionary statement regarding contractor responsibility on the second page of this form.

 

APPLICANT (Print:) __________________________ Sign:_____________________________

DATE ________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

APPROVAL CONDITIONS

This permit is issued pursuant to the following conditions. Failure to comply may result in suspension or revocation of this

 

permit or other penalty.

 

See attached for conditions of approval.

 

 

 

 

 

 

 

 

 

 

 

ISSUING

 

 

Town of

 

 

County of

 

 

 

 

 

State-Contracted Inspection

Municipality Number of Dwelling Location

 

JURISDICTION

 

Village of

 

 

State

 

 

 

 

 

 

Agency#:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FEES:

 

 

 

 

 

PERMIT(S) ISSUED

WIS PERMIT SEAL #

 

 

PERMIT ISSUED BY:

 

 

Plan Review

$

 

 

 

 

Construction

 

 

 

 

 

 

 

Name ____________________________________

 

Inspection

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HVAC

 

 

__________________

 

 

Date ____________ Tel. _____________________

 

Wis. Permit Seal

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cert No. __________________________________

 

Other

$

 

 

 

 

Electrical

 

 

 

 

 

 

 

 

 

Total

$ 0

 

 

 

Plumbing

 

 

 

 

 

 

 

 

Email: ____________________________________

 

 

 

 

Erosion Control

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SBD-5823(R08/17) Distribute: Ply 1 Issuing Jurisdiction;

Ply 2- Issuer forwards to state w/in 30 days;

Ply 3- Inspector; Ply 4- Applicant

INSTRUCTIONS

The owner, builder or agents shall complete the application form down through the Signature of Applicant block and submit it and building plans and specifications to the enforcing jurisdiction, which is usually your municipality or county. Permit application data is used for statewide statistical gathering on new one- and two-family dwellings, as well as for local code administration. Please type or use ink and press firmly with multi-ply form.

PERMIT REQUESTED

Check off type of Permit Requested, such as structural, HVAC, Electrical or Plumbing.

Fill in owner's current Mailing Address and Telephone Number.

If the project will disturb one acre or more of soil, the project is subject to the additional erosion control and stormwater provisions of ch. NR 151 of the WI Administrative Code. Checking this box will satisfy the related notification requirements of ch. NR 216.

Fill in Contractor and Contractor Qualifier Information. Per s. 101.654 (1) WI Stats., an individual taking out an erosion control or construction permit shall enter his or her dwelling contractor certificate number, and name and certificate number of the dwelling contractor qualifier employed by the contactor, unless they reside or will reside in the dwelling. Per s. 101.63 (7) Wis. Stats., the master plumber name and license number must be entered before issuing a plumbing permit.

PROJECT LOCATION

Fill in Building Address (number and street or sufficient information so that the building inspector can locate the site.

Local zoning, land use and flood plain requirements must be satisfied before a building permit can be issued. County approval may be necessary.

Fill in Zoning District, lot area and required building setbacks.

PROJECT DATA - Fill in all numbered project data blocks (1-14) with the required information. All data blocks must be filled in, including the following:

2. Area (involved in project):

Basements - include unfinished area only

Living area - include any finished area including finished areas in basements Two-family dwellings - include separate and total combined areas

3.Occupancy - Check only "Single-Family" or "Two-Family" if that is what is being worked on. In other words, do not check either of these two blocks if only a new detached garage is being built, even if it serves a one or two family dwelling. Instead, check "Garage" and number of stalls. If the project is a community based residential facility serving 3

to 8 residents, it is considered a single-family dwelling.

9. HVAC Equipment - Check only the major source of heat, plus central air conditioning if present. Only check "Radiant Baseboard" if there is no central source of heat.

10.Sewage - Indicate if the dwelling will be served by municipal sewer or privately owned treatment system. If a private system is used, include the Sanitary Permit number. Note: A building permit cannot be issued for a new dwelling that utilizes a privately owned wastewater treatment system until a sanitary permit has been issued. This applies to any new or existing private onsite wastewater treatment system that will be used by the dwelling.

13.Heat Loss Provide heat loss summation data (BTUs/HR) derived from the ResCheck report or the “Heating System Sizing Summary Calculator” available on the Division’s website: http://dsps.wi.gov/Programs/Industry-Services/Industry- Services-Programs/One-and-Two-Family-UDC.

14.Estimated Cost - Include the total cost of construction, including materials and market rate labor, but not the cost of land or landscaping.

SIGNATURE The owner or the contractor’s authorized agent shall sign and date this application form. If you do not possess the Dwelling Contractor certification, then you will need to check the owner-occupancy statement for any erosion control or construction permits.

CONDITIONS OF APPROVAL - The authority having jurisdiction uses this section to state any conditions that must be complied with pursuant to issuing the building permit.

ISSUING JURISDICTION: This must be completed by the authority having jurisdiction.

Check off Jurisdiction Status, such as town, village, city, county or state and fill in Municipality Name

Fill in State Inspection Agency number only if working under state inspection jurisdiction.

Fill in Municipality Number of Dwelling Location

Check off type of Permit Issued, such as construction, HVAC, electrical or plumbing.

Fill in Wisconsin Uniform Permit Seal Number, if project is a new one- or two-family dwelling.

Fill in Name and Inspector Certification Number of person reviewing building plans and date building permit issued.

(Part of Ply 4 for Applicants)

Cautionary Statement to Owners Obtaining Building Permits

101.65(lr) of the Wisconsin Statutes requires municipalities that enforce the Uniform Dwelling Code to provide an owner who applies for a building permit with a statement advising the owner that:

If the owner hires a contractor to perform work under the building permit and the contractor is not bonded or insured as required under s. 101.654 (2) (a), the following consequences might occur:

(a)The owner may be held liable for any bodily injury to or death of others or for any damage to the property of others that arises out of the work performed under the building permit or that is caused by any negligence by the contractor that occurs in connection with the work performed under the building permit.

(b)The owner may not be able to collect from the contractor damages for any loss sustained by the owner because of a violation by the contractor of the one- and two- family dwelling code or an ordinance enacted under sub. (1) (a), because of any bodily injury to or death of others or damage to the property of others that arises out of the work performed under the building permit or because of any bodily injury to or death of others or damage to the property of others that is caused by any negligence by the contractor that occurs in connection with the work performed under the building permit.

Cautionary Statement to Contractors for Projects Involving Building Built Before 1978

If this project is in a dwelling or child-occupied facility, built before 1978, and disturbs 6 sq. ft. or more of paint per room, 20 sq. ft. or more of exterior paint, or involves windows, then the requirements of ch.

DHS 163 requiring Lead-Safe Renovation Training and Certification apply. Call (608)261-6876 or go to the Wisconsin Department of Health Services’ lead homepage for details of how to be in compliance.

Wetlands Notice to Permit Applicants

You are responsible for complying with state and federal laws concerning the construction near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result in removal or modification of construction that violates the law or other penalties or costs. For more information, visit the Department of Natural Resources wetlands identification web page or contact a Department of Natural Resources service center.

Additional Responsibilities for Owners of Projects Disturbing One or More Acre of Soil

I understand that this project is subject to ch. NR 151 regarding additional erosion control and stormwater management standards, and will comply with those standards.

Owner's Signature: _______________________________________ Date: __________________