JS-2015- ______
PERMIT NO.
________-2015
Date Issued:
APPLICATION FOR BUILDING PERMIT
B
TOWN OF BURLINGTON
TOWN HALL ANNEX - 25 CENTER STREET
BURLINGTON, MASSACHUSETTS 01803
Telephone 781-270-1615 or Fax 781-238-4667 Email building@burlington.org Web WWW.BURLINGTON.ORG
INSTRUCTIONS:
Submit this Application with 3 Sets of Construction Drawings, Plot Plan & Application Fee
COST OF CONSTRUCTION:
$ _____________________
Date Stamp Here
($10 per $1000)
BUIILDING PERMIT FEE: $ _________________
* PLAN REVIEW FEE
* Applies to All Structures EXCEPT 1 or 2-Family Residential $ _________________
TOTAL PERMIT FEE: $ _________________
CONSTRUCTION PROJECT INFORMATION Use Group_______ Construction Type _______ SF of Construction _____________ Zoning ________
OFFICIAL STREET ADDRESS ____________________________________________________Burlington, MA 01803
PROPERTY OWNER_______________________________________________________
_________________________________________________________
ADDRESS
TEL No. ______________________
CELL No____________________
COMMERICAL BUSINESS
TENANT NAME ____________________________________ ____ ________ SUITE/FLOOR/SPACE NO. ___________________
DESCRIPTION OF WORK Include dimensions, room/construction type, location on property (i.e. 11x16 Bedroom & Bath Addition off rear of dwelling)
Commercial Projects:  New Tenant Fit Up
Existing Tenant Remodel
Tenant Expansion Tenant Relocation Demolition
Check off below for all new buildings/ dwellings and additions:
ENERGY CODES SUBMITTED  REScheck  COMcheck CONSERVATION (Erosion Control)?  No  Yes, submit permit
BOARD OF HEALTH SUBMITTAL for DEMOLITION?  No  Yes and / or CHANGE IN GRADE?  No Yes
SEWER ALLOCATION REQUIRED (Restaurant / Bedrooms, etc) ?  No  Yes, submit Engineering Sewer Allocation Permit
BUILDING / ADDITION DIMENSIONS: LENGTH _______ DEPTH _______ HEIGHT ________
NO. OF STORIES ____
LOT AREA: ___________________SQ FT
ROOF TYPEGable Hip Shed  Other ___________
FOUNDATION  Full  Concrete  10”  Crawl  Block
 Steel  Footings  Explain _______
TYPE OF HEAT Hot Water  Warm Air  TYPE OF FUEL Oil  Gas
Electric Other ____________
BUILDING SETBACKS FROM PROPERTY LINES:
Front ________ Rear ________
Left ________
Right________
VARIANCE REQUIRED?  No  Yes - Provide copy of recorded variance, Board of Appeals Case No. ______________________
GENERAL CONTRACTOR INFORMATION
Homeowner Acting as General Contractor Check Here  and complete Homeowner Exemption Form
Email Address ______________________________________________
COMPANY NAME: _____________________________________________ ____________________Phone No. ________________________
ADDRESS:________________________________________________________________________Cell No.__________________________
Construction Supervisor’s License Type  Unrestricted  Restricted  Roof  Other ______________________________
Name: ______________________________________ CS or CSSL License No.: ________________ Expiration Date: ______________
Home Improvement Contractor Registration
Name: ______________________________________ Registration No.: __________________________
Expiration Date: _______________
Workers’ Compensation Insurance Affidavit & Copy of Certificate of Insurance Must Be Provided  on file
Policy No.: _______________________________ Company Name ___________________________________ Expiration Date: ____________
ARCHITECT / ENGINEER: __________________________________________ ________ Reg. No. ___________ Expiration Date: ______________
ADDRESS: ______________________________________________________________________ Tel. No. ________________________________
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
__________________________________________________ __________________________________________
Owners Signature (REQUIRED or Contract)
Date
Contractor Signature
MAIL TO Homeowner Contractor
January 2015
Date
PICK UP
Burlington Building Department Schedule of Permit Fees
Effective April 1, 2005
RULES & REGULATIONS: The required permits shall be obtained prior to the start of work. Permit fees are payable
at the time of application and are NON-REFUNDABLE once the permit has been issued. Permits are not
transferable. Valuation shall be the estimated cost of construction as determined by Means Cost Data or ICC Building
valuation data in effect at the time of application. It is exclusive of land value and shall include all mechanical costs
associated with construction. Town, County, State or Federally owned and operated buildings are exempt from fees.
The Inspector of Buildings shall, to the fullest extent provided by law, waive any and all fees due in connection with the
inspections, certifications or for building permits of buildings owned and operated by the Town of Burlington or the
Burlington Housing Authority. Any work covered by this schedule started without obtaining the required permit will be
DOUBLED. Reinspections necessary due to work NOT ready upon a requested inspection shall pay an additional
$25.00 reinspection fee in advance of reinspection.
BUILDING PERMIT FEE SCHEDULE
Plan Review Fees
On All Structures Except One & Two Family Residential
Plan Review fees are based on the latest fees charged by the International Code Council (ICC)
THE PLAN REVIEW FEE IS BASED ON THE ESTIMATED CONSTRUCTION VALUE OF THE PROPOSED PROJECT.
Construction Project Costs Estimated up to :
$3,000,000.00
$3,000,000.00 TO $6,000,000.00
Over $6,000,000.00
Building Permits
Estimated Job Cost X .0012
OR
Minimum $250.00
$3600.00 + Estimated Job Cost Over $3,000,000.00 X .0005
$5100.00 + Estimated Job Cost Over $6,000,000.00 X .0035
Building Permit Fee includes Certificate of Occupancy, when required for all new work
NEW CONSTRUCTION - $10.00 per $1000 of Construction Cost
Minimum Fee $50.00
Including additions, alterations, renovations, remodeling, mechanical equipment and systems.
Such as, Decks, Ramps, Sunrooms, Garages (Instant Garage)
REPAIRS - $10.00 per $1000 of Construction Cost
Minimum Fee $25.00
Such As, but not limited to roofing, siding, door & window replacement, installation of utility sheds
DEMOLITION - Or moving of buildings or structures
Flat Fee $100.00
TEMPORARY PREMANUFACTURED BUILDINGS - Trailers/Mobile Home Per Unit Fee $50.00
TENTS -
Commercial Fee $50.00
Residential Fee $25.00
RENEWAL OF PERMITS - Fee shall be determined with above schedule for portions included in
original permit not completed upon renewal date.
DUPLICATE - Building Permit Card or Certificate of Occupancy Permit
Fee
$25.00
EXTENSION OF TIME - To activate Building Permit
Fee
$25.00
RELEASE OF STOP WORK ORDER -
Commercial $50.00
Residential $25.00
OCCUPANCY PERMIT FOR EXISTING STRUCTURES - $30.00 per hour
Fee is based upon the time devoted to research & issue the requested permit.