Payment Stamp

BOROUGH OF STROUDSBURG

ZONING/CODES ENFORCEMENT

700 SARAH STREET

STROUDSBURG , PA   18360

Phone (570) 421-5444

Fax (570) 421-2690

Permit #

_{(for Zoning Office use only)}

                   I.  OWNER AND BUILDING/PROJECT INFORMATION

Owner's Name:

Owner's Address:

Address of Project:

Monroe County Tax I.D.#

TYPE OF PERMIT REQUESTED:  ¨ Zoning     ¨ Building       ¨ Plumbing        ¨ Electrical            ¨ Mechanical/HVAC

                                           II.  TYPE OF PROPOSED WORK

¨ Erect a structure

¨ Add to a structure

¨ Alter a structure

¨ Sewer lateral

¨ Demolish a structure

¨ Fuel storage tanks

¨ Alter/install plumbing

¨ Alter/install gas

¨ Alter/install electrical

¨ Alter/install heat

¨ Erect fence

¨ Erect swimming pool

¨ Home Occupation

¨ Erect or alter sign

¨ Change a use

¨ Other (specify below *)

* Remarks:

III.  ZONING INFORMATION (plot plan required)

Zoning District: 

Present Use of Property:

Zoning Permit Requires Approval for:      ¨ Special Use         ¨ Variance        ¨ Appeal

(separate application form required)

A dimensional plot plan is required (or drawing on back of application).

Brief description of intended work:

                   IV.  BUILDING INFORMATION (construction plans required)

Type of Construction:­­___________  # of Stories:_____ # of Bathrooms:­­­­_____  # of Bedrooms _____

Number of Off-Street Parking Spaces: ___________     Number of Dwelling Units: ______________

Size of New Structure:  Length ______  Width______ Height­­­ ______ Total Square Footage _______

Percentage of lot to be covered by buildings:________%  Total Square Footage of Land Area:­­­_______

Brief description of proposed work:

                                         NOTES & DATA (for department use)

Building Permit Data:  Occupancy _________   Occupancy LD (commercial only) ______­­__   Dwelling Units ­­­________ 

Construction Code________  Construction Type ________  Proposed Use________  Use Group Class _________

Is HARB approval required?    ¨ Yes     ¨ No

                           V.  COST OF IMPROVEMENTS & REQUIRED FEES

Job Cost

U.C.C. Fee

Sq. Ft.

Units

Total Fee

Residential (new construction)

-complete outside dimensions

$4.00

Non-residential (new construction)

-complete outside dimensions

$4.00

Alterations & Additions

$4.00

Detached buildings (e.g. shed)

OVER 120 SQ. FT.

$4.00

Swimming pool                        

$4.00

Demolition

$4.00

Heating

$4.00

Sprinkler system

$4.00

Plumbing

$4.00

Electrical

$4.00

Air Conditioning Capacity

Zoning

N/A

             Sub Total

                                                                    TOTAL FEES:

                                         VII.  ELECTRICAL INFORMATION

Service size:

Number of circuits:

Fixture outlets:       

Remarks:

                          VIII.  IDENTIFICATION (to be completed by all applicants)

Note:     Contractors must provide workman's comp insurance certificate if there are employees. If there are none, the Workmen's Comp Affidavit on the following page must be signed.

                                       Name

                  Mailing Address

Telephone Number

1. OWNER

EMAIL:

2. Contractor

EMAIL:

3. Plumbing

   Contractor

EMAIL:

4. Electrical

   Contractor

EMAIL:

5. Mechanical

   Contractor

EMAIL:

         The owner of this building and the undersigned, agree to conform to all applicable laws of this jurisdiction.

                                            Signature of Applicant

                                       Address

       Application Date

Print Name:

                                                        IX.  VALIDATION

Building permit number:

                      Requires Review by:

Building permit issued:

Zoning Hearing Board         ¨

Building permit fee:

Planning Commission         ¨

Date application received:

Borough Council                  ¨

Required fee paid:

HARB                                  ¨

                                                                      APPROVAL

Code Officer's Signature:

Date:

                 X.  SITE PLAN - DIMENSION TO BE FILLED IN BY APPLICANT

Note:     All dimensions are to be shown neatly in ink, outlining location of garage, outbuildings, etc., as well as location of proposed construction, fences and driveway exits.