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. COMMUNITY DEVELOPMENT: BUILDING DEPARTMENT One DesCombes Dr • Broomfield, CO 8:0020 • Office JOJ 438.,6370 • Fax 303.,438.6207 • buildinliiJlermits(!lbroomfield.org I I I I I Date Received GENERAL PERMIT APPLICATION Permit Number Address of Proposed Construction Property Owner Owner Email Address (required) Owner Phone # Owner’s Address (if different from above) City, State, Zip Contractor Contractor Phone # Contractor License # Contractor Address City, State, Zip Job Contact Name Contact Office Phone # Contact Mobile Phone # Job Contact EMail Address Job Contact Company Project Valuation (Permit valuations shall include total value of work, including materials, labor, overhead, profit and general conditions for which the permit is being issued, such as electrical, gas, mechanical, plumbing equipment, and permanent systems. Reference BMC §15-03-100 Trade Valuation Name of Subcontractor General: $ Electrical: $ HVAC: $ Plumbing: $ Fire Sprinkler $ TOTAL: $ Indicate actual distance to property line: Front: Left Side: Right Side: Rear: Please give a brief description of proposed construction (List rooms to be finished for basement finish): Basement area to be finished: Total basement area: It is the owner’s responsibility to obtain any Homeowners' Association and/or Architectural Control Committee approvals that may be applicable. I hereby state that the above is correct. I recognize that the approval of plans, issuance of a permit, or subsequent inspection approvals shall not be construed to allow violations of the code or other ordinances or laws enforced by the City and County of Broomfield. I consent to provide entry to inspectors as set forth in the building code and to request inspections as required. I consent to pay the use tax based upon the purchase price of all building and construction materials, as required by ordinance. I understand records are subject to audit and verification for 3 years following final inspection or C.O. Broomfield Municipal Code requires taxpayers to maintain building use tax records for 3 years. All materials, drawings or documents submitted for this permit become public record and may be released to the public. By signature below the signatory certifies and declares that he/she is either the Owner or the Authorized Agent of the owner of the property. Signature: Print Name: Date: ↓ ↓ ↓ Office Use Only ↓ ↓ ↓ Building Dept. Approval: Date: Planning Dept. Approval: Date: Revised April 2024 ---PAGE BREAK--- Revised April 2024 Broomfield Building Division Fees Permit Fee Schedule· Permit fees for each trade (general, electrical, mechanical, plumbing) are calculated separately based upon the value of the work performed. Use Tax will also be collected· see below• Valuation I Permit Fee Valuation I Permit Fee $ 1 to $ 500 $ 23.50 $ 2,001 to $ 3,000 $ 83.25 501 to 600 26.55 3,001 to 4,000 97.25 601 to 700 29.60 4,001 to 5,000 111.25 701 to 800 32.65 5,001 to 6,000 125.25 801 to 900 35.70 6,001 to 7,000 139.25 901 to 1,000 38.75 7,001 to 8,000 153.25 1,001 to 1,100 41.80 8,001 to 9,000 167.25 1,101 to 1,200 44.85 9,001 to 10,000 181.25 1,201 to 1,300 47.90 10,001 to 11,000 195.25 1,301 to 1,400 50.95 11,001 to 12,000 209.25 1,401 to 1,500 54.00 12,001 to 13,000 223.25 1,501 to 1,600 57.05 13,001 to 14,000 237.25 1,601 to 1,700 60.10 14,001 to 15,000 251.25 1,701 to 1,800 63.15 15,001 to 16,000 265.25 1,801 to 1,900 66.20 16,001 to 17,000 279.25 1,901 to 2,000 69.25 17,000 to 18,000 293.25 For values greater than $18,000, fees shall be assessed in accordance with BMC 15-03-100, Table 1-A. Use Tax; The City and County of Broomfield collect use tax on building materials at the time of building permit issuance. For use tax purposes, 50% of the total project valuation is assumed to be materials in accordance with BMC 03-08-060. Homeowners performing all of their own work shall list the total materials cost on the permit application. Applicants showing the building permit payment receipt to the supplier or retail home center when purchasing materials for the project should not be charged any city sales tax since the Broomfield use tax has been paid with the permit. Payment of state and RTD sales taxes is still required on all materials. Questions regarding use tax can be answered by the Sales and Use Tax Division of the Broomfield Finance Department at [PHONE REDACTED]. EXAMPLES Use Tax = Total valuation x 50% (materials) x assessed rate. The assessed rate is currently 4.15% for the City and County of Broomfield. Contracted total project value: $20,000 Calculated materials cost: $20,000 x 50% = $10,000 Homeowner total materials cost: $10,000 Use tax due: $10.000 x 4.15% = $415.00 Use tax due: $10 000 x 4.15% = $415.00 lospectjons· Please call [PHONE REDACTED] to schedule inspections. Mobile Home or Construction Trailer Set-up Fees: Permit Fees for Mobile Home or Construction Trailer Set-Up - Flat Rate Fee of $100.00 (use tax is not charged). All construction and/or sales trailers are charged - Flat Rate Fee of $100.00 for each application submitted and each time they are moved. Graywater Permits· Permit Fee $200 plus Use Tax (see above)