UCC-3 APPLICATION FOR UCC BUILDING PERMIT RESIDENTIAL

Name(Required)

First Last

Email(Required)

APPLICATION FOR UCC BUILDING PERMIT

Check that applies

EXPEDITE REVIEW. ADDITIONAL FEE SUBMITTED.

ACT 24 EXEMPTION

Site Information

Political Subdivision and County names are required.

Facility Name (name of company, mall, institution, university, etc.):

Building and/or Tenant Name

Street Number and Name

City

Political Subdivision:

County

Application Type

Accessibility Only Review

Addition

Alteration or Renovation

New Building

New Structure/Facility

Partial Occupancy

Phased Approval

Plan Revision/Deferred Submission

Uncertified (Existing) Building

Use/Occupancy Classification:

Check box to left of applicable group. Check all that apply.

Use/Occupancy Classification

Mandatory Documents

Check each block below indicating that all of the following will be submitted with this application:

Mandatory Documents(Required)

Four (4) site plans

Three (3) assembled and bound sets of construction drawings

One (1) completed copy of the UCC-2 UCC PLAN REVIEW CHECKLIST

One (1) set of specifications (only if Addition, Alteration, New Building/Structure/Facility)

Special Requirements & Documentation

Does this construction involve modular units built in a factory?

Yes

If “Yes,” submit 1 copy of the letter described in Section J., 6., on the “Plan Review and Inspection Requirements” page on the UCC website.

Is this construction regulated by the Health Care Facilities Act?

Yes

If “Yes,” submit 1 copy of the approval letter issued by the PA Department of Health.

Is this construction exempt from energy code requirements?

Yes

If “Yes,” submit 1 copy of a letter indicating that the building or structure will use neither electricity nor fossil fuels, and thus is exempt per ASHRAE 90.1, §2.2(B). If “No,” submit 1 copy of the compliance documentation described in Section H., 7., on the “Plan Review and Inspection Requirements” page on the UCC website.

Is project in flood hazard area?

Yes

If “Yes,” submit 1 copy of one of the flood hazard certifications mandated in section 1612.5 of the International Building Code.

Are International Building Code (Chapter 17) special inspections or structural observations required?

Yes

If “Yes,” submit 1 copy of the UCC-6 SPECIAL INSPECTIONS OBSERVATIONS STATEMENT.

Will an alternative construction method or material be used on this project?

Yes

If “Yes,” submit a signed statement indicating that the proposed method or material meets the requirements of 34 PA Code §403.44.

Is this application for “phased approval”?

Yes

If “Yes,” submit the statement described in Section D., 4., on the “Plan Review and Inspection Requirements” page on the UCC website.

Project Data

Number of stories above grade

Does it have a basement?

Yes

Total floor area (sq. ft.)

Floor area new construction (sq. ft.)

Floor area of addition (sq. ft.)

Floor area renovated (sq. ft.)

Estimated cost of construction $

(Required -- even if project is state-owned and exempt from permit fees.)

Type(s) of construction per Chapter 6 of the International Building Code (check all that apply):

Fire Supression:

Full

Partial

None

If application applies to an existing certified building, provide any prior file #, DI #, permit #, etc. associated with this project:

File #

Permit #

DI #

Other (MA #/Fee #)

Building Code Data

Triennial ICC code version used for Building code compliance:

2015

2018

If Alterations to existing certified building: (select applicable document used)

IBC Chapter 34

International Existing Building Code (IEBC)

Accessibility Code Data

Triennial ICC code version for Accessibility code compliance/IBC Chapter 11

2018

2021

Design Professional In Responsible Charge

Seal must be in space to right of name & address

Name

Address

Street Address City State ZIP Code

Phone

Fax

Owner Information

Owner Name

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone

Deferred Submissions

If you intend to defer any of the plan submission below, please, check the appropriate box(es). See Section Q on the “Plan Review and Inspection” page on the UCC website for information about submitting these drawings at a later date.

Fire Alarm System

Wood Roof Trusses (Certified)

Sprinkler System

Fees (fees are based on either sq. ft. and/or construction cost)

List total sq. ft. of floor area:

List estimated construction cost:

Applicant’s Certification:

Note: THE BUILDING PERMIT AND THE CERTIFICATE OF OCCUPANCY FOR THIS BUILDING OR STRUCTURE WILL BE ISSUED TO AND IN THE NAME OF THE PERSON LISTED BELOW.

As the owner or the authorized agent of the project for which this application is filed, I certify that:

1. The estimated construction cost and all other information provided as part of this application for a building permit is correct.
2. The building or structure described in this application will not be occupied until all known code violations are corrected and a Certificate of Occupancy has been received from the Department of Labor & Industry.
3. This project will be constructed in accordance with the approved drawings and specifications (including any required non-design changes) and the Uniform Construction Code standards as specified in 34 PA Code Chapters 401-405.
4. Any changes to the approved documents will be filed with the Department of Labor & Industry.
5. If the licensed architect or engineer in responsible charge of this construction should change, written notice of the change will be provided to the Department of Labor & Industry.
6. When required, up to 20% of the total cost of any work performed on an area of primary function in an existing building will be expended to provide an accessible route to the area of primary function.
7. No error or omission in either the drawings and specifications or application, whether approved or not, shall permit or relieve me from constructing the work in any manner other than provided for in 34 PA Code Chapters 401-405.

Applicant Name

Address
Street Address City State / Province / Region ZIP / Postal Code

File

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