HomeMy Public PortalAbout10-0542 KubistaINTERNATIONAL
CODE COUNCIL"
Permit No.
City o 'bee Island • Community Develi .lent Dept.
Inspection Report
403 Butler Ave. • P.O. Box 2749 Tybee Island, GA 31328
Phone 912.786.4573 ext. 114 • Fax 912.786.9539
Owner's Name i��►'
Gen. Contractor t
Contact Information
Project Address e 21; 4A1 1E.,.
Date Requested
MEMBER
Date Needed - > ?
Subcontractor
Scope of Work MI5(' - z_< ,>> �J ,,�4 -1,7 ()c,z
Inspector / ( 61 Date of Inspection �..J;
Inspection s a rc 4. \ L.
Pass 0
Fee
Inspection Pass ❑ Fail ❑ Fee
Inspection Pass E Fail ❑ Fee
Inspection Pass ❑ Fail ❑ Fee
l21I �o4l r�
IGO 1315 -(A
Company: Therma
108 Mutzfeld
Butler, IN
Product: FiberClassic/Smooth
-Tru Corporation
Road
46721
NOTICE OF PRODUCT
CERTIFICATION
Sar Glaze Fiber Iasa Onnr Inswing/Outswing
Certification No.: NI005330 -R3
Certification Date: 10/15/2003
Expiration Date: 12/31/2011
Revision Date: 09/03/2009
w/ and w/o Sidelites
Benchmark
by Therma
-Tru Series Glazed Fiberglass
Door Inswin
Outswing w/ and w/o Sidelites
Specifications Tested o: A E330/E331/TAS202
The "Notice of Product Certification" is only valid if the NAMI Certification Label has been app led to the product as described within this document. The certification
label represents product conformity to the applicable specification and that all certification after a has been satisfed. This product has been approved for listing within
NAMI's Certified Product Listin at www.Namicertificati , n.com. NAMI's Certification Pro: ram is accredited b The American National Standards Institute ANS .
Inswing
Glazed
Design
Missile
Test Report Number
Configuration
or
or
Maximum
Pressure
Impact
&
�'.
Outswing
Opaque
Size
Pos/Neg
Rated
Comments
X
US
Glazed
3'0"x6'8"
+47/ -47
No
NCTL- 210 - 1940- 1.2.3.4/TTF -256F
Single ,/
-'X,
0/S
Glazed
3'0" x 6'8"
+47/ -47
No
NCTL -210- 1940- 1.2.3.4/11F -255F
Single
XX
US
Glazed
6'0" x 6'8"
+40/ -40
No
NCTL- 210 - 1940- 1.2.3.4/TTF -256F
Double
Standard Aluminum Astragal
XX
0/S
Glazed
6'0" x 6'8"
+40/ -40
No
NCTL - 210 - 1940- 1.2.3.4/TTF -255F
Double
Standard Aluminum Astragal
XX
US
Glazed
6'0" x 6'8"
+47/ -47
No
NCTL -210- 1940- 1.2.3.4/TTF -256F
Double
Coastal Aluminum Astragal
XX
0/S
Glazed
6'0" x 6'8"
+47/ -47
No
NCTL - 210 - 1940- 1.2.3.4/TTF -255F
Double
Coastal Aluminum Astragal
OXO /OXXXO
US
Glazed Door
5'4" x 6'8"
+40/ -40
No
ETC -01 -741- 11008.0/L- 2151/TTF -256F
Single w /Sidelites
Glazed Sidelites
OXO /OX/XO
0/S
Glazed Door
5'4" x 6'8"
+40/ -40
No
ETC -01- 741- 11008.0/L- 2151/TTF -255F
Single w /Sidelites
Glazed Sidelites
OXXO
I/S
Glazed Doors
8'4" x 6'8"
+40/ -40
No
ETC -01- 741- 11008.0/L- 2151/TTF -256F
Double w /Sidelites
Glazed Sidelites
Standard Aluminum Astragal
OXXO
0/S
Glazed Doors
8'4" x 6'8"
+40/ -40
No
ETC -01 -741- 11008.0/L- 2151/TTF -255F
Double w /Sidelites
Glazed Sidelites
Standard Aluminum Astragal
OXXO
US
Glazed Doors
8'4" x 6'8"
+47/ -47
No
ETC -01- 741- 11008.0/L- 2151/TTF -256F
Double w /Sidelites
Glazed Sidelites
Coastal Aluminum Astragal
OXXO
0/S
Glazed Doors
8'4" x 6'8"
+47/ -47
No
ETC-01-741-11008,04,2151/TIT-255F
Double w /Sidelites
Glazed Sidelites
Coastal Al inum Astragal
nal Accreditation & Management Institute, Inc. /4794 George Washington Memorial High ye , VA 23072
Tel: (804) 684- 5124/Fax: (804) 684 -5122
NAMI AUTHORIZED SIGNATURE:
DATE ISSUED: 11 -16 -2010
WORK DESCRIPTION
WORK LOCATION
CITY OF TYBEE ISLAND
BUILDING PERMIT
NEW DOORBEADBOARD FOYER & BTH
1211 SIXTH AVE
OWNER NAME JANET KUBISTA
ADDRESS 5 OYSTER ROW
CITY, ST, ZIP ISLE OF PALMS SC 29451
PHONE NUMBER
CONTRACTOR NAME HARRISON CONSTRUCTION & DESIGN
ADDRESS PO BOX 2386
CITY STATE ZIP TYBEE ISLAND GA 31328
FLOOD ZONE
BUILDING VALUATION
SQUARE FOOTAGE
OCCUPANCY TYPE P
TOTAL FEES CHARGED $ 50.00
PROPERTY IDENTIFICATION #
PROJECT VALUATION $ 750.00
PERMIT #: 100542
TOTAL BALANCE DUE: $ 50.00
It is understood that if this permit is granted the builder will at all times comply with the zoning, subdivision, flood control, building, fire,
soil and sedimentation, wetlands, marshlands protection and shore protection ordinances and codes whether local, state or federal, including
all environmental laws and regulations when applicable, subsequent owners should be informed that any alterations to the property must be
approved by the issuance of another building permit. Permit holder agrees to hold the City of Tybee Island harmless on any construction
covered by this permit.
This permit must be posted in a conspicuous location in the front of building and protected from the weather. If this permit is not posted
work will be stopped. The building contractor will replace curb paving and gutter broken during construction. This permit will be voided
unless work has begun within six months of the date of issuance.
Signature of Building Inspector or Authorized Agent:
P. 0. Box 2749 - 403 Butler Avenue, Tybee Island, Georgia 31328
(912) 786 -4573 - FAX (912) 786 -9539
wixw.cityofty bee.o rg
CITY OF TYBEE ISLAND, GEORGIA
APPLICATION FOR BUILDING PERMIT
(0- (D44-2_
Location: I"X{./ e .
NAME
ADDRESS
PIN #
TELEPHONE
Owner
1' / +." k
�eT
jay- ,74.6.-
Architect
or Engineer
Building
Contractor
i�� r,� ,,_, —
Cam, 4 d3;e
/r
Ze.// 4i" ry
Q F
(Che all that apply)
Repair [ esidential
❑ Renovation mingle Family
❑ Minor Addition n Duplex
❑ stantial Addition n Multi- Family
Other ❑ Commercial
> 1
Details of Project:
n Footprint Changes
Discovery
n Demolition
Estimated Cost of Construction: $
Construction Type
(1) Wood Frame
(2) Wood & Masonry
(3) Brick Veneer
Proposed use:
Remarks:
(Enter appropriate number)
(4) Masonry
(5) Steel & Masonry
Sz
(6) Other (please specify)
ATTACH A COPY OF THE CERTIFIED ELEVATION SURVEY OF LOT and complete the
following information based on the construction drawings and site plan:
# Units # Bedrooms # Bathrooms
Lot Area Living space (total sq. ft.)
# Off - street parking spaces
Trees located & listed on site plan
Access:
Driveway (ft.) With culvert? With swale?
Setbacks: Front Rear Sides (L) (R)
# Stories Height Vertical distance measured from the average adjacent
grade of the building to the extreme high point of the building, exclusive of chimneys, heating
units, ventilation ducts, air conditioning units, elevators, and similar appurtances.
During construction:
On -site restroom facilities will be provided through r
On -site waste and debris containers will be provided by
debris will be disposed bye.;/,— by means of�
I understand that I must comply with zoning, flood damage control, building, fire, shore
protections and wetlands ordinances, FEMA regulations and all applicable codes and regulations.
I understand that the lot must be staked out and that the stakes will be inspected to ensure that the
setback requirements are met. I understand also that a certified plot plan showing elevation must
be attached to this application and that an as -built elevation certification is due as soon as the
habitable floor level is established. Drainage: I realize that I must ensure the adequacy of
drainage of this property so that surrounding property is in no way adversely affected. I accept
responsibility for any corrective action that may be necessary to restore drainage impaired by this
permitted construction.
Date: "V–A4 — ,/0 Signature of Applicant:
Note: A permit normally takes 7 to 10 days to process.
The following is to be completed by City personnel:
Zoning certification
Approved rezoning /variance?
Street address and number: New
Is it in compliance with City map?
If not, has street name and /or number been reported to MPC?
FEMA Certification attached
State Energy Code Affidavit attached
Utilities and Public Works:
Describe any unusual finding(s)
NFIP Flood Zone
Existing
Access to building site
Distance to water main tap site
Distance to sewer stub site
Water meter size
Storm drainage
Approvals: Signature Date
Zoning Administrator
Code Enforcement Officer
Water /Sewer
Storm /Drainage
Inspections
City Manager
FEES
Permit
Inspections
Water Tap
Sewer Stub
Aid to Const.
TOTAL
LEAD -BASED PAINT
Adapted from http: / /www.epa.gov /lead /pubs /renovation.htm. Please use that site to access the following information.
Information for Property Owners of Rental Housing, Child- Occupied Facilities
Property owners who renovate, repair, or prepare surfaces for painting in pre -1978 rental housing or space rented
by child -care facilities must, before beginning work, provide tenants with a copy of EPA's lead hazard information
pamphlet Renovate Right: Important Lead Hazard Information for Families, Child Care Providers, and Schools.
Owners of these rental properties must document compliance with this requirement. EPA's sample pre- renovation
disclosure form may be used for this purpose.
After April 22, 2010, property owners who perform these projects in pre -1978 rental housing or space rented by
child -care facilities must be certified and follow the lead -safe work practices required by EPA's Renovation, Repair
and Remodeling rule. To become certified, property owners must submit an application for firm certification and fee
payment to EPA. The Agency has up to 90 days after receiving a complete request for certification to approve or
disapprove the application.
Property owners who perform renovation, repairs, and painting jobs in rental property should also:
• Take training to learn how to perform lead -safe work practices.
• Learn the lead laws that apply regarding certification and lead -safe work practices beginning in April 2010.
• Keep records to demonstrate that you and your workers have been trained in lead -safe work practices and
safe work practices on the job. To make recordkeeping easier, you may use the sample recordkeeping
developed to help contractors comply with the renovation recordkeeping requirements that took effect April
• Read about how to comply with EPA's rule in the EPA Small Entity Compliance Guide to Renovate Right.
• Read about how to use lead -safe work practices in EPA's Steps to Lead Safe Renovation, Repair and Painting
Information for Homeowners Working at Home
If you are a homeowner performing renovation, repair, or painting work in your own home, EPA's RRP rule does not cover your project
However, you have the ultimate responsibility for the safety of your family or children in your care. If you are living in a pre -1978 home an
planning to do painting or repairs, please read a copy of EPA's Renovate Right: Important Lead Hazard Information for Families, Child Car
Providers, and Schools lead hazard information pamphlet. You may also want to call the National Lead Information Center at 1- 800 -424
LEAD (5323) and ask for more information on how to work safely in a home with lead -based paint.
Information for Tenants and Families of Children under Age 6 in Child Care Facilities and Schools
As a tenant or a parent or guardian of children in a child care facility or school, you should know your rights when a renovation job i
performed in your home, or in the child care facility or school that your child attends.
• Before starting a renovation in residential buildings built before 1978, the contractor or property owner is required to have tenant
sign a pre- renovation disclosure form, which indicates that the tenant received the Renovate Right lead hazard informatio
pamphlet.
• Beginning in December 2008, the contractor must also make renovation information available to the parents or guardians o
children under age six that attend child care facilities and schools, and to provide to owners and administrators of pre -1978 child
care facilities and schools to be renovated a copy of EPA's Renovate Right: Important Lead Hazard Information for Families, Child
Care Providers, and Schools lead hazard information pamphlet.
Information for Contractors
As a contractor, you play an important role in helping to prevent lead exposure. Ordinary renovation and maintenance activities can create
dust that contains lead. By following the lead -safe work practices, you can prevent lead hazards. Contractors who perform renovation,
repairs, and painting jobs in pre -1978 housing and child- occupied facilities must, before beginning work, provide owners, tenants, and child-
care facilities with a copy of EPA's lead hazard information pamphlet Renovate Right: Important Lead Hazard Information for Families, Child
Care Providers, and Schools. Contractors must document compliance with this requirement. EPA's pre- renovation disclosure form may be
used for this purpose. Understand that after April 22, 2010, federal law will require you to be certified and to use lead -safe work practices.
To become certified, renovation contractors must submit an application and fee payment to EPA. See: Application for firm certification. The
Agency has up to 90 days after receiving a complete request for certification to approve or disapprove the application.
Contractors who perform renovation, repairs, and painting jobs should also:
• Take training to learn how to perform lead -safe work practices.
• Find a training provider that has been accredited by EPA to provide training for renovators under EPA's Renovation,
Repair, and Painting (RRP) Program. Please note that if you previously completed an eligible renovation training course
you may take the 4 -hour refresher course instead of the 8 -hour initial course from an accredited training provider to
become a certified renovator. Click here for a list of eligible courses.
• Provide a copy of your EPA or state lead training certificate to your client.
• Tell your client what lead -safe methods you will use to perform the job.
• Learn the lead laws that apply to you regarding certification and lead -safe work practices beginning in April 2010.
• Ask your client to share the results of any previously conducted lead tests.
• Provide your client with references from at least three recent jobs involving homes built before 1978.
• Keep records to demonstrate that you and your workers have been trained in lead -safe work practices and that you followed lead -
safe work practices on the job. To make recordkeeping easier, you may use the sample recordkeeping checklist that EPA has
developed to help contractors comply with the renovation recordkeeping requirements.
• Read about how to comply with EPA's rule in the EPA Small Entity Compliance Guide to Renovate Right.
• Read about how to use lead -safe work practices in EPA's Steps to Lead Safe Renovation, Repair and Painting.
1F U'RE NOT
„LEAD-SAFE CERTIFIED,
=DISTURBING
JUST SIX
SQUARE FEET
;COULD COST YOU
-BIG TIME
that you followed lead -
checklist that EPA has
2010.
•
a
e
s
s
n
f
Sig rya ure
Printed Name
Date
0 FT.. O
NATURAL
tl
ROUROE{
GEORGIA
Permit Acknowledgement of
Asbestos /Environmental Notification to Georgia EPD for
Projects Involving Demolition, Wrecking, or Renovation
The undersigned hereby acknowledges that the issuance of this permit does not in any way grant
permission to the owner, owner's representative, or permit holder to proceed with demolition,
wrecking, or renovation of a structure prior to the filing of any required ten (10) day "Project
Notification for Asbestos Renovation Encapsulation or Demolition" form in accordance with
the Georgia Asbestos Rules. The Georgia Environmental Protection Division administers the
rules. In most cases, the rules require both the owner and the involved contractors to assure the
portion of the building involved in the project is thoroughly inspected by an Accredited Asbestos
Inspector for materials that contain asbestos; and the removal of the asbestos before renovation,
wrecking, or demolition begins almost without exemption. Georgia EPD requires a completed
demolition notification from be submitted 10 workings days in advance even if no asbestos is
present in the building. Further guidance for regulatory compliance and contact telephone
numbers are provided by the brochures entitled Asbestos & Renovation and Asbestos and
Demolition. Other environmental issues such as asbestos removal techniques, lead abatement,
ground contamination, or unusual site conditions may have EPD regulations that could affect the
project.
Unsigned
Pri
ame
'N
nteZl
// —A °j
Date
Office Use Only:
Project Address:
Permit Number:
City o
403 Butler
Phone
'bee Island • Community Develk lent Dept.
Inspection Report
Ave. • P.O. Box 2749 • Tybee Island, GA 31328
912.786.4573 ext. 114 • Fax 912.786.9539
- -‘,-.., __,_ ,
Permit No. i C.) - ,---- --=. ? e_. Date Requested - : --- — : , ,....,
/ ) , . ) ,
Owner's Name ,,i'r....)13)-' Date Needed
Gen. Contractor 1-2g77:1:------.. Subcontractor
4,17 - '7-))
112kik
EMI*
INTERNATIONAL
CODE COUNCIL
MEMBER
Contact Information e.
Project Address 21 ><"--4
Scope of Work
Inspector
Inspection
W/
Date of Inspection 67t,
J
Pass
1.)
Fee
Inspection Pass El Fail 11 Fee
Inspection Pass U Fail Fee
Inspection Pass Fail Fee
l2ll 64' NE 1G0a,s
Company:
NOTICE OF PRODUCT CERTIFICATION
Therma -Tru Corporation
108 Mutzfeld Road
Butler, IN 46721
Certification No.: NI005330 -R3
Certification Date: 10/15/2003
Expiration Date: 12/31/2011
Revision Date: 09/03/2009
Product: FiberClassic/Smooth Stir G1_azed Fibe lass i ��. ' • utswing w/ and w/o Sidelites
Benchmark by Therms -Tru Series Glazed Fiberglass Door Inswin Outswing w/ and w/o Sidelites
Specifications lions Tested o: A E330/E331/TAS202
The "Notice of Product Certification" is only valid if the NAMI Certification Label has been applied to the product as described within this document. The certification
label represents product conformity to the applicable specification and that all certification criteria has been satisfed. This product has been approved for listing within
NAMI's Certified Product Listin¢ at www.Namicertification.com. NAMI's Certification Program is accredited by The American Nat[onal Standards Institute �ANSP
al Accreditatton & Management Institute, Inc. /4794 George Washington Memorial High
Tel: (804) 684- 5124/Fax: (804) 684 -5122 J
NAMI AUTHORIZED SIGNATURE:
;yep; VA 23072
Inswing
Glazed
Design
Missile
•
Test Report Number
Configuration
or
or
Maximum
Pressure
Impact
&
Outswing
Opaque
Size
Pos/Neg
Rated
Comments
X
US
Glazed
3'0" x 6'8"
+47/ -47
No
NCTL- 210 - 1940- 1.2.3.4ITTF -256F
Single
0/S
Glazed
3'0" x 6'8"
+47/ -47
No
NCTL- 210 - 1940 - 1.2.3.4/1'1x -255F
Single
XX
I/S
Glazed
6'0" x 6'8"
+40/ -40
No
NCTL - 210 - 1940- 1.2.3.4/TTF -256F
Double
Standard Aluminum Astragal
XX
0/S
Glazed
6'0" x 6'8"
+40/ -40
No
NCTL -210- 1940- 1.2.3.4/TTF 255F
Double
Standard Aluminum Astragal
XX
I/S
Glazed
6'0" x 6'8"
+47/ -47
No
NCTL -210- 1940- 1.2.3.4/TTF -256F
Double
Coastal Aluminum Astragal
XX
0/S
Glazed
6'0" x 6'8"
+47/ -47
No
NCTL- 210 - 1940- 1.2.3.4/ITF -255F
Double
Coastal Aluminum Astragal
OXO /OX/XO
I/S
Glazed Door
5'4" x 6'8"
+40/ -40
No
ETC-01-741-11008.0/L-2151/1 I I. -256F
Single w /Sidelites
Glazed Sidelites
OXO /OX/XO
0/S
Glazed Door
5'4" x 6'8"
+40 /-40
No
ETC -01 -741- 11008.0/L- 2151/TTF -255F
Single w /Sidelites
Glazed Sidelites
OXXO
I/S
Glazed Doors
8'4" x 6'8"
+40/ -40
No
ETC -01 -741- 11008.0 /L- 2151/TTF -256F
Double w /Sidelites
Glazed Sidelites
Standard Aluminum Astragal
OXXO
0/S
Glazed Doors
8'4" x 6'8"
+40/ -40
No
ETC -01- 741- 11008.0/L- 2151/TTF -255F
Double w /Sidelites
Glazed Sidelites
Standard Aluminum Astragal
OXXO
US
Glazed Doors
8'4" x 6'8"
+47/ -47
No
ETC -01- 741- 11008.0/L- 2151/TTF -256F
Double w /Sidelites
Glazed Sidelites
Coastal Aluminum Astragal
OXXO
0/S
Glazed Doors
8'4" x 6'8"
+47/ -47
No
ETC-01 - 741 -11008 2151/TTF -255F
Double w /Sidelites
1T a• -
•
Glazed Sidelites
Coastal Al mum Astragal
al Accreditatton & Management Institute, Inc. /4794 George Washington Memorial High
Tel: (804) 684- 5124/Fax: (804) 684 -5122 J
NAMI AUTHORIZED SIGNATURE:
;yep; VA 23072
DATE ISSUED: 11 -16 -2010
WORK DESCRIPTION
WORK LOCATION
CITY OF TYBEE ISLAND
BUILDING PERMIT
NEW DOOR/BEADBOARD FOYER & BTH
1211 SIXTH AVE
OWNER NAME JANET KUBISTA
ADDRESS 5 OYSTER ROW
CITY, ST, ZIP ISLE OF PALMS SC 29451
PHONE NUMBER
CONTRACTOR NAME HARRISON CONSTRUCTION & DESIGN
ADDRESS PO BOX 2386
CITY STATE ZIP TYBEE ISLAND GA 31328
FLOOD ZONE
BUILDING VALUATION
SQUARE FOOTAGE
OCCUPANCY TYPE
TOTAL FEES CHARGED
PROPERTY IDENTIFICATION #
P
$ 50.00
PROJECT VALUATION $ 750.00
PERMIT #: 100542
TOTAL BALANCE DUE: $ 50.00
It is understood that if this permit is granted the builder will at all times comply with the zoning, subdivision, flood control, building, fire,
soil and sedimentation, wetlands, marshlands protection and shore protection ordinances and codes whether local, state or federal, including
all environmental laws and regulations when applicable, subsequent owners should be informed that any alterations to the property must be
approved by the issuance of another building permit. Permit holder agrees to hold the City of Tybee Island harmless on any construction
covered by this permit.
This permit must be posted in a conspicuous location in the front of building and protected from the weather. If this permit is not posted
work will be stopped. The building contractor will replace curb paving and gutter broken during construction. This permit will be voided
unless work has begun within six months of the date of issuance.
Signature of Building Inspector or Authorized Agent:
P. 0. Box 2749 - 403 Butler Avenue, Tybee Island, Georgia 31328
(912) 786 -4573 - FAX (912) 786 -9539
www.cityoftybee.org
CITY OF TYBEE ISLAND, GEORGIA
APPLICATION FOR BUILDING PERMIT
10- OSq2,
Location: / l`/- owe -
NAME
ADDRESS
PIN #
TELEPHONE
Owner
Z �/" 7frif,
Architect
or Engineer
Building
Contractor
./7",,,,,,,,;., —' •-
d:vis/' 4, ° 4;eA--
/ */
5: c
Zcf/ Ail '
7/z - .7 F —?
(Che all that apply)
Repair
❑ Renovation
❑ Minor Addition
❑ stantial Addition
Other
Residential
Single Family
❑ Duplex
❑ Multi- Family
❑ Commercial
n Footprint Changes
Discovery
Demolition
fl
Details of Project: S j // mo=° -� r o, 9 `z
% ✓ .
Estimated Cost of Construction: $
Type -• (Enter appropriate number)
(1) Wood Frame (4) Masonry (6) Other (please specify)
(2) Wood & Masonry (5) Steel & Masonry
(3) Brick Veneer
Proposed use:
Remarks:
ATTACH A COPY OF THE CERTIFIED ELEVATION SURVEY OF LOT and complete the
following information based on the construction drawings and site plan:
# Units # Bedrooms # Bathrooms
Lot Area Living space (total sq. ft.)
# Off - street parking spaces
Trees located & listed on site plan
Access:
Driveway (ft.) With culvert? With swale?
Setbacks: Front Rear Sides (L) (R)
# Stories Height Vertical distance measured from the average adjacent
grade of the building to the extreme high point of the building, exclusive of chimneys, heating
units, ventilation ducts, air conditioning units, elevators, and similar appurtances.
During construction:
On -site restroom facilities will be provided through e
On -site waste and debris containers will be provided by. /ry`- r
Construction debris will be disposed by ` , /�� by means of Uzd
I understand that I must comply with zoning, flood damage control, building, fire, shore
protections and wetlands ordinances, FEMA regulations and all applicable codes and regulations.
I understand that the lot must be staked out and that the stakes will be inspected to ensure that the
setback requirements are met. I understand also that a certified plot plan showing elevation must
be attached to this application and that an as -built elevation certification is due as soon as the
habitable floor level is established. Drainage: I realize that I must ensure the adequacy of
drainage of this property so that surrounding property is in no way adversely affected. I accept
responsibility for any corrective action that may be necessary to restore drainage impaired by this
permitted construction.
Date: //—,/6 — /0 Signature of Applicant:
Note: A permit normally takes 7 to 10 days to process.
The following is to be completed by City personnel:
Zoning certification
Approved rezoning /variance?
Street address and number: New
Is it in compliance with City map?
If not, has street name and /or number been reported to MPC?
FEMA Certification attached
State Energy Code Affidavit attached
Utilities and Public Works:
Describe any unusual finding(s)
NFIP Flood Zone
Existing
Access to building site
Distance to water main tap site
Distance to sewer stub site
Water meter size
Storm drainage
Approvals: Signature Date
Zoning Administrator
Code Enforcement Officer
Water /Sewer
Storm /Drainage
Inspections
City Manager
FEES
Permit
Inspections
Water Tap
Sewer Stub
Aid to Const.
TOTAL
LEAD -BASED PAINT
Adapted from http: / /www.epa.gov /lead /pubs /renovation.htm. Please use that site to access the following information.
Information for Property Owners of Rental Housing, Child- Occupied Facilities
Property owners who renovate, repair, or prepare surfaces for painting in pre -1978 rental housing or space rented
by child -care facilities must, before beginning work, provide tenants with a copy of EPA's lead hazard information
pamphlet Renovate Right: Important Lead Hazard Information for Families Child Care Providers, and Schools.
Owners of these rental properties must document compliance with this requirement. EPA's sample pre- renovation
disclosure form may be used for this purpose.
After April 22, 2010, property owners who perform these projects in pre -1978 rental housing or space rented by
child -care facilities must be certified and follow the lead -safe work practices required by EPA's Renovation, Repair
and Remodeling rule. To become certified, property owners must submit an application for firm certification and fee
payment to EPA. The Agency has up to 90 days after receiving a complete request for certification to approve or
disapprove the application.
Property owners who perform renovation, repairs, and painting jobs in rental property should also:
• Take training to learn how to perform lead -safe work practices.
• Learn the lead laws that apply regarding certification and lead -safe work practices beginning in April 2010.
• Keep records to demonstrate that you and your workers have been trained in lead -safe work practices and that you followed lead -
safe work practices on the job. To make recordkeeping easier, you may use the sample recordkeepinq checklist that EPA has
developed to help contractors comply with the renovation recordkeeping requirements that took effect April 2010.
• Read about how to comply with EPA's rule in the EPA Small Entity Compliance Guide to Renovate Right.
• Read about how to use lead -safe work practices in EPA's Steps to Lead Safe Renovation, Repair and Painting.
Information for Homeowners Working at Home
If you are a homeowner performing renovation, repair, or painting work in your own home, EPA's RRP rule does not cover your project.
However, you have the ultimate responsibility for the safety of your family or children in your care. If you are living in a pre -1978 home and
planning to do painting or repairs, please read a copy of EPA's Renovate Right: Important Lead Hazard Information for Families, Child Care
Providers, and Schools lead hazard information pamphlet. You may also want to call the National Lead Information Center at 1- 800 -424-
LEAD (5323) and ask for more information on how to work safely in a home with lead -based paint.
Information for Tenants and Families of Children under Age 6 in Child Care Facilities and Schools
As a tenant or a parent or guardian of children in a child care facility or school, you should know your rights when a renovation job is
performed in your home, or in the child care facility or school that your child attends.
• Before starting a renovation in residential buildings built before 1978, the contractor or property owner is required to have tenants
sign a pre- renovation disclosure form, which indicates that the tenant received the Renovate Right lead hazard information
pamphlet.
• Beginning in December 2008, the contractor must also make renovation information available to the parents or guardians of
children under age six that attend child care facilities and schools, and to provide to owners and administrators of pre -1978 child
care facilities and schools to be renovated a copy of EPA's Renovate Right: Important Lead Hazard Information for Families, Child
Care Providers, and Schools lead hazard information pamphlet.
Information for Contractors
As a contractor, you play an important role in helping to prevent lead exposure. Ordinary renovation and maintenance activities can create
dust that contains lead. By following the lead -safe work practices, you can prevent lead hazards. Contractors who perform renovation,
repairs, and painting jobs in pre -1978 housing and child- occupied facilities must, before beginning work, provide owners, tenants, and child-
care facilities with a copy of EPA's lead hazard information pamphlet Renovate Right: Important Lead Hazard Information for Families, Child
Care Providers, and Schools. Contractors must document compliance with this requirement. EPA's pre- renovation disclosure form may be
used for this purpose. Understand that after April 22, 2010, federal law will require you to be certified and to use lead -safe work practices.
To become certified, renovation contractors must submit an application and fee payment to EPA. See: Application for firm certification. The
Agency has up to 90 days after receiving a complete request for certification to approve or disapprove the application.
Contractors who perform renovation, repairs, and painting jobs should also:
• Take training to learn how to perform lead -safe work practices.
• Find a training provider that has been accredited by EPA to provide training for renovators under EPA's Renovation,
Repair, and Painting (RRP) Program. Please note that if you previously completed an eligible renovation training course
you may take the 4 -hour refresher course instead of the 8 -hour initial course from an accredited training provider to
become a certified renovator. Click here for a list of eligible courses.
• Provide a copy of your EPA or state lead training certificate to your client.
• Tell your client what lead -safe methods you will use to perform the job.
• Learn the lead laws that apply to you regarding certification and lead -safe work practices beginning in April 2010.
• Ask your client to share the results of any previously conducted lead tests.
• Provide your client with references from at least three recent jobs involving homes built before 1978.
• Keep records to demonstrate that you and your workers have been trained in lead -safe work practices and that you followed lead -
safe work practices on the job. To make recordkeeping easier, you may use the sample recordkeepinq checklist that EPA has
developed to help contractors comply with the renovation recordkeeping requirements.
• Read about how to comply with EPA's rule in the EPA Small Entity Compliance Guide to Renovate Right.
• Read about how to use lead -safe work practices in EPA's Steps to Lead Safe Renovation, Repair and Painting.
{ if YOU'RE NOT
.LEAD- SAFE CERTIFIED,
.DISTURBING
JUST SIX
SQUARE FEET
:COULD COST YOU
-BIG TIME.
SigclaTure Date
7
Printed Name
GEORGIA
Permit Acknowledgement of
Asbestos /Environmental Notification to Georgia EPD for
Projects Involving Demolition, Wrecking, or Renovation
The undersigned hereby acknowledges that the issuance of this permit does not in any way grant
permission to the owner, owner's representative, or permit holder to proceed with demolition,
wrecking, or renovation of a structure prior to the filing of any required ten (10) day "Project
Notification for Asbestos Renovation Encapsulation or Demolition" form in accordance with
the Georgia Asbestos Rules. The Georgia Environmental Protection Division administers the
rules. In most cases, the rules require both the owner and the involved contractors to assure the
portion of the building involved in the project is thoroughly inspected by an Accredited Asbestos
Inspector for materials that contain asbestos; and the removal of the asbestos before renovation,
wrecking, or demolition begins almost without exemption. Georgia EPD requires a completed
demolition notification from be submitted 10 workings days in advance even if no asbestos is
present in the building. Further guidance for regulatory compliance and contact telephone
numbers are provided by the brochures entitled Asbestos & Renovation and Asbestos and
Demolition. Other environmental issues such as asbestos removal techniques, lead abatement,
ground contamination, or unusual site conditions may have EPD regulations that could affect the
project.
Unersi gned
Printett'Name
/1/
Date
Office Use Only:
Project Address:
Permit Number: