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☐ ☐ ☐ County of Cumberland Building Inspections PO Box 110 Cumberland, VA 23040 [PHONE REDACTED] Email: [EMAIL REDACTED] Solar Application: Electrical Residential Commercial Date: Structure Property Owner: Address: Phone No: Email: Applicant: Address: Phone number: Email: Contractor’s name: Company: Address: Phone number: Email: Property Information: (GIS link) Street No: TBD: Street name: Tax map/parcel number: Acres: Zoning district: (example: A-2, R-1, R-3, etc.) ---PAGE BREAK--- ☐ ☐ ☐ ☐ ☐ ☐ Approved Conditional Use Permit Approved Site Plane Solar Information: Number of KW: Number of MW(AC) Ground mount: Size of Array: Electrical: Roof Mount: Additional Information regarding project: Estimated cost: Electrical: $ .00 Structure: $ .00 Power company information: DOM: SEC: CVC: Power Company not involved: Name bill is in: Address: Phone number: Account No: and/or Work/Project No: General contractor / Sub Contractor Information: Name of Business: Contractor License No: Expiration date: Trade License No: Expiration date: Business License No: Contractor signature: Date: Sub-Contractor: Date: SIGN SIGN ---PAGE BREAK--- Owner’s Affidavit: I, of Affirm the I am the owner of certain tract or parcel of land located at: , and that I am applying for a building permit. I affirm the I am familiar with the prerequisites of 54.1-1111 of the code of Virginia and I am not subject to licensure as a contractor or subcontractor. Signature: Date: Owner Certification I hereby acknowledge that I have read this application and know this information to be true and agree to comply with all County ordinances and State laws regulating building construction and use. Owners Signature: Date: OFFICE USE ONLY Electrical Permit fee: Structure Permit: State Levy Fee: Total: Taxes: • Currently passed due: NO ☐ ok to proceed / Yes Paid & ok to proceed ☐ • Pulled w/parent permit: OK to proceed ☐ • Ok per zoning approval: OK to proceed ☐ Business License: • Has license, ok to proceed ☐ per • Needs a license Ok now to proceed per Construction Type: Use group: # of stories: Occupant Load: Code Edition: Fire Sprinkler: Fire Alarm: Modification: Approval: Date: Building official SIGN SIGN