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Page 1 of 2 REVISED 03/2024 COLUMBIA COUNTY BUILDING PERMIT APPLICATION OFFICE USE ONLY IN PERSON EMAIL ONLINE APPLICATION # LDP APPLICATION # RECEIVED DATE: BY: ENTERED DATE: BY: REVIEWED DATE: BY: 1. PROJECT ADDRESS: 2. LEGAL DESCRIPTION - LOT: BLOCK: MAP/PARCEL: SUBDIVISION: 3. APPLICANT NAME: CONTRACTOR AUTHORIZED AGENT HOMEOWNER 4. EMAIL: 5. CONTACT # : 6. COST OF WORK: 7. CHANGING FOOTPRINT OF STRUCTURE? YES NO 8. DESCRIBE WORK: PROPERTY OWNER NAME: CONTACT NUMBER: CONTACT EMAIL: ADDRESS: TRADES REQUIRED TYPE OF PERMIT ADDITIONAL INFORMATION CONTACT PERSON PERMIT INFO NSF MH POOL ACCESSORY BLDG ALTERATION OTHER TOTAL SQ FT: UNDER ROOF WATER TYPE SEWER TYPE BUILDER / GENERAL CONTRACTOR NAME: CONTACT ADDRESS: CID # PERMIT FEE: PERMIT # ELECTRICAL YES NO SERVICE CHANGE GENERATOR SOLAR HOUSE / TRADE TEMP POLE STANDALONE IF SUB / TRADE – BLDG PERMIT # # AMPS: ELECTRICIAN NAME: CONTACT ADDRESS: CID # PERMIT FEE: PERMIT # PLUMBING YES GAS SUB / TRADE STANDALONE IF SUB / TRADE – BLDG PERMIT # PLUMBER NAME: CID # PERMIT FEE: CONTACT NO PERMIT # ADDRESS: MECHANICAL YES GAS SUB / TRADE STANDALONE IF SUB / TRADE – BLDG PERMIT # MECHANICAL NAME: CID # PERMIT FEE: CONTACT NO PERMIT # ADDRESS: SUB / TRADE STANDALONE IF SUB / TRADE – BLDG PERMIT # IRRIGATION SPRINKLER NAME: CID # YES PERMIT FEE: CONTACT NO PERMIT # ADDRESS: ---PAGE BREAK--- Page 2 of 2 REVISED 03/2024 * THE ISSUANCE OF THIS PERMIT AUTHORIZES IMPROVEMENTS OF THE REAL PROPERTY DESIGNATED HEREIN WHICH IMPROVEMENTS MAY SUBJECT SUCH PROPERTY TO MECHANICS’ AND MATERIALMENS’ LIENS PURSUANT TO PART 3 OF ARTICLE 8 OF CHAPTER 14 OF TITLE 44 OF THE OFFICIAL CODE OF GEORGIA ANNOTATED. IN ORDER TO PROECT ANY INTEREST IN SUCH PROPERTY AND TO AVOID ENCUMBRANCES THEREON, THE OWNER OR ANY PERSON WITH AN INTEREST IN SUCH PROPERTY SHOULD CONSIDER CONTACTING AN ATTORNEY OR PURCHASING A CONSUMER’S GUIDE TO THE LIEN LAWS WHICH MAY BE AVAILABLE AT BUILDING SUPPLY HOME CENTERS. * THE ISSUANCE OR GRANTING OF A PERMIT SHALL NOT BE CONSTRUED TO BE A PERMIT FOR, OR AN APPROVAL OF, ANY VIOLATION OF ANY OF THE PROVISIONS OF THE ADOPTED CODES OR OF ANY OTHER ORDINANCE OF THIS JURISDICTION. PERMITS PRESUMING TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF THE ADOPTED CODES OR OTHER ORDINANCES OF THIS JURISDICTION SHALL NOT BE VALID. THE ISSUANCE OF A PERMIT BASED ON CONSTRUCTION DOCUMENTS AND OTHER DATA SHALL NOT PREVENT THE BUILDING OFFICIAL FROM REQUIRING THE CORRECTION OF ERRORS IN THE CONSTRUCTION DOCUMENTS AND OTHER DATA. THE BUILDING OFFICIAL IS AUTHORIZED TO PREVENT OCCUPANCY OR USE OF A STRUCTURE WHERE IN VIOLATION OF THE ADOPTED CODES OR ANY OTHER ORDINANCES OF THIS JURISDICTION. THE BUILDING OFFICIAL IS AUTHORIZED TO SUSPEND OR REVOKE A PERMIT ISSUED UNDER THE PROVISIONS OF THE ADOPTED CODES WHEREVER THE PERMIT IS ISSUED IN ERROR OR ON THE BASIS OF INCORRECT, INACCURATE OR INCOMPLETE INFORMATION, OR IN VIOLATION OF ANY ORDINANCE OR REGULATION OR ANY OF THE PROVISIONS OF THE ADOPTED CODES. * A MEMBER OF THE COLUMBIA COUNTY TAX ASSESSORS STAFF MAY VISIT YOUR PROPERTY TO CARRY OUT THE DUTY OF MAKING AN APPRAISAL OF THE FAIR MARKET VALUE OF TAXABLE PROPERTY PURSUANT TO PART 1 OF ARTICLE 5 OF CHAPTER 5 OF TITLE 48 OF THE OFFICIAL CODE OF GEORGIA ANNOTATED. FOR ADDITIONAL INFORMATION CONTACT [PHONE REDACTED]. * THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMNCED WITHIN 180 DAYS OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. * COLUMBIA COUNTY RESERVES THE RIGHT TO REVOKE ANY PERMIT DETERMINED TO CONTAIN FALSIFIED INFORMATION OR ISSUED IN ERROR. * NOTICE TO CONTRACTORS: ANY CONTRACTOR CONSTRUCTING RESIDENCES OR ANY OTHER TYPE OF CONSTRUCTION IN THE ABOVE STATED SUBDIVISION WILL BE HELD ACCOUNTABLE AND RESPONSIBLE FOR ANY DAMAGES BY REASONS OF SAID CONSTRUCTION TO CURBS, GUTTERS, MAN HOLES, CATCH BASINS, WATER MAINS, ETC. * INSPECTION REQUESTS SHOULD BE MADE THROUGH EMAIL TO: [EMAIL REDACTED]. ALL REQUESTS RECEIVED BY 4:30 WILL BE SCHEDULED FOR THE NEXT BUISNESS DAY. ANY REQUESTS RECEIVED AFTER 4:30 PM WILL BE SCHEDULED FOR THE SECOND BUSINESS DAY. A FEE WILL BE CHARGED FOR THE FIRST FAILED INSPECTION AND EACH SUBSEQUENT RE-INSPECTION. ANY OUTSTANDING FEES MUST BE SETTLED PRIOR TO THE RELEASE OF A CERTIFICATE OF OCCUPANCY/COMPLETION FOR ALL CONTRACTOR HELD PERMITS AND PRIOR TO THE RE-INSPECTION BEING PERFORMED FOR ANY HOMEOWNER HELD PERMITS. * I UNDERSTAND THAT IT IS MY RESPONSIBILITY TO COMPLY WITH ALL LOCAL, STATE AND FEDERAL LAWS AND THAT THE ISSUANCE OF THIS PERMIT IS NOT DEEMED AN AFFIRMATION BY COLUMBIA COUNTY OF SUCH COMPLIANCE. I CERTIFY THE INFORMATION PROVIDED IS TRUE AND ACCURATE AND CONTAINS NO FALSE OR FRAUDULENT INFORMATION. * I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS PERMIT AND KNOW THE SAME TO BE TRUE AND CORRECT. I UNDERSTAND THAT THE GRANTING OF A PERMIT DOES NOT WAIVE THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. I AGREE TO REQUEST ALL INSPECTIONS REQUIRED BY COLUMBIA COUNTY. SIGNATURE OF APPLICANT / CONTRACTOR / AUTHORIZED AGENT / OWNER DATE PRINT NAME SIGN