Full Text
County of Cumberland Building Inspections PO Box 110 Cumberland, VA 23040 [PHONE REDACTED] Email: [EMAIL REDACTED] Trade Application: Plumbing ☐ Mechanical ☐ Gas ☐ Fireplace ☐ Date: Property Owner: Address: Phone No: 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.) Work being performed: Plumbing: Mechanical: Gas: Fireplace: Additional information: ---PAGE BREAK--- Estimated cost: Plumbing: .00 Mechanical . 00 Gas: $ .00 Fireplace: $ .00 General contractor / Sub Contractor Information: Name of Business: Contractor License No: Expiration date: Trade License No: _ Expiration date: Business License: Contractor signature: Date: 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: SIGN SIGN ---PAGE BREAK--- 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 Plumbing fee: Mechanical Fee: Gas Fee: Fireplace Fee: 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