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Project Address Suite # Applicant Address Applicant E-mail Applicant Phone Applicant Fax Property Owner (if different) Address Owner E-mail Owner Phone Owner Fax RESIDENTIAL COMMERCIAL INDUSTRIAL NEW Construction Type Start Date Est. Completion Date Setbacks Front: Side R. Side L. Rear Lot Coverage Estimated Building Cost $ Building Contractor WI Qualifier WI Contractor WI Lead E-mail SQ. FT. (OFFICIAL USE ONLY) BASEMENT 1ST FLOOR 2ND FLOOR DECK PORCH GARAGE OTHER TOTAL Sq. FEES (OFFICIAL USE ONLY) BUILDING ELECTRIC PLUMBING HVAC FIRE SUPP. FIRE ALARM AA VALVE TOTAL Electrical Contractor WI Master Electrician License WI Electrical Contractor # Address Phone E-mail Address: Plumbing Contractor WI Master Plumber License Address Air Admittance Valve(s) x $50.00 Each = Phone E-mail Address: Suppression Contractor Contractor Address Phone # E-mail Address: Heating Contractor WI HVAC Contractor WI HVAC Qualifier Address Phone E-mail Address: Fire Alarm Contractor Contractor # Address Phone # E-mail Address: Comments: Date paid: Receipt # Total Permit Fee I agree to comply with all applicable codes, statutes and ordinances and with the conditions of this permit, understand that the issuance of the permit creates no legal liability, express or implied, on the city, and certify that all the above information is accurate. I expressly grant the building inspector, or the inspector’s authorized agent, permission to enter the premises for which this permit is sought at all reasonable hours and for any proper purpose to inspect the work which is being done. Signature of Applicant Date Print Name REQUIRED INSPECTIONS (WHERE APPLICABLE); FOOTING; FOUNDATION; ROUGH; INSULATION; FINAL BUILDING PERMIT APPLICATION – NEW OR ADDITION CITY OF MIDDLETON I 7426 HUBBARD AVE. MIDDLETON, WI 53562 PHONE I [PHONE REDACTED] EMAIL I [EMAIL REDACTED] WEB I CITYOFMIDDLETON.US ---PAGE BREAK--- BUILDING INSPECTION DEPARTMENT CITY OF MIDDLETON I 7426 HUBBARD AVENUE • MIDDLETON, WI 53562 PHONE: [PHONE REDACTED] EMAIL: [EMAIL REDACTED] CAUTIONARY STATEMENT TO OWNERS OBTAINING BUILDING PERMITS (Part of Ply 4 for Applicants) 101.65(1r) of the Wisconsin Statutes requires municipalities that enforce the Uniform Dwelling Code to provide an owner who applies for a building permit with a statement advising the owner that: If the owner hires a contractor to perform work under the building permit and the contractor is not bonded or insured as required under s. 101.654 the following consequences might occur: The owner may be held liable for any bodily inquiry to or death of others or for any damage to the property of others that arises out of the work performed under the building permit or that is caused by any negligence of the contractor that occurs in connection with the work performed under the building permit. The owner may not be able to collect from the contractor damages for any loss sustained by the owner because of a violation by the contractor of the one- and two- family dwelling code or an ordinance enacted under sub. because of any bodily injury to or death of others or damage to the property of others that arises out of the work performed under the building permit or because of any bodily injury to or death of others or damage to the property of others that is caused by any negligence by the contractor that occurs in connection with the work performed under the building permit. ---PAGE BREAK--- BUILDING INSPECTION DEPARTMENT CITY OF MIDDLETON I 7426 HUBBARD AVENUE • MIDDLETON, WI 53562 PHONE: [PHONE REDACTED] EMAIL: [EMAIL REDACTED] BUILDING INSPECTION CHECKLIST Subcontractors shall request inspections for their own work by contacting the BUILDING INSPECTION DEPARTMENT at (608) 821-8370. Failure to give proper inspection notification may result in fines. The Building Permit Applicant (signature on application) is responsible for verifying that all required inspections have been made. Any developer/contractor who calls for an inspection before the work is ready for inspection may be assessed a fine of fifty dollars ($50.00) per inspection. EROSION CONTROL INSPECTION to be completed prior to footing inspection. Perimeter erosion control measures shall be placed within 24 hours after beginning excavation. FOOTING INSPECTION to be completed after forms and required reinforcing are in place, but before concrete is poured. FOUNDATION INSPECTION to be completed before after forms and required reinforcing are in place, but before concrete is poured. o FOUNDATION INSULATION/DRAIN TILE to be inspected prior to backfilling ROUGH INSPECTION to be completed for each category below before work is covered or concealed. o UNDERGROUND/UNDERSLAB PLUMBING/ELECTRICAL/HVAC o UNDER FLOOR VAPOR BARRIER (BASEMENT) o BUILDING FRAMING o ELECTRICAL o PLUMBING o HVAC INSULATION INSPECTION to be completed after insulation and vapor barrier are in place, but before they are covered or concealed. FINAL INSPECTION to be completed for each category below after all work is completed, but before use or occupancy. o BUILDING o ELECTRICAL o PLUMBING o HVAC INSPECTION RESULTS will be posted on the doorjamb of a bathroom (residential) or near the front door (commercial). Work shall not proceed until required inspections are completed and approval has been granted. If a required inspection is not completed within two working days after proper notification has been given, the contractor may proceed to the next phase of construction. THE MIDDLETON BUILDING CODE REQUIRES THAT A CERTIFICATE OF OCCUPANCY BE ISSUED BY THE BUILDING INSPECTOR PRIOR TO THE OCCUPANCY OR USE OF THE BUILDING. THIS ALSO COVERS USING A BUILDING FOR STORAGE OR MOVING ITEMS INTO THE BUILDING.