OCR Scan (approximately)

This OCR scan may contain automatically generated text as generated using Apache Tika and Tesseract. It may not be correct. No effort has been made to correct any of these scans (so far). These OCR scans are also used in the site's Search feature. Please review the Search Policy for details about the site features. The OCR scan is provided here for reference purposes. It provides searchable text when the underlying document might not. But the scan process may not always work perfectly.

RUSSELL COUNTY BUILDING DEPARTMENT
137 Highland Dr.
Lebanon, VA 2426
Telephone: 276-889-8012
Fax: 276-889-8009
[email protected]
Josh Stinson—Building Official
Russell County Building Permit Application
Type of
Work New Construction            Addition      Alteration/Remodel  Demolition
Construction
Category
Single Family Dwelling: Duplex: Modular Home: Storage /Utility Building
Accessory Structure: Townhouse: Garage:
Permit
Holder/Applicant
Who will be considered the applicant?
(Permit Holder) Property Owner: Contractor:
Property
Owner
Name: Phone:
Mailing Address: Email Address:
Property
Information
Tax Map I.D# Septic# Water Source:
Estimated Cost of Construction Flood Zone:
Total Amount of Land Disturbance: Erosion & Sediment Plan
Required: Yes No
New
Construction
Please provide
square feet for
all that applies
Living Area:1st Floor Living area: 2nd floor   Carport
Garage: Above garage space/room   Deck
Basement(unfinished) Basement(Finished)  Covered Porch
Habitable Attic Space: TOTAL SQUARE FT:
Please
Provide
the
following
#Bedrooms #Bathrooms #1/2 Baths
#Stories
Heat type:       Heat Pump   Gas          Wood Stove           Solar  Other
New Driveway Permit# (if applicable)
mailto:[email protected]
RUSSELL COUNTY BUILDING DEPARTMENT
137 Highland Dr.
Lebanon, VA 2426
‘Telephone: 276-889-8012
Fax: 276-889-8009
build@russelicountyva.
Josh Stinson—Building Official
Russell County Building Permit Application
Tt
an New contsion [TJ ain AteotiRemsie[ | denottsn =]
Conorctin [SHEET etn Te Mode Seong tty Buide, []
ca =
Aer Siucu: []| Trios ame]
‘Permit ‘Who will be considered the applicant? —_
leap (remit tds) rropery owner: L] concn
Name: Phone:
Pepe
ing NTS Ena NR
owner
Tac hip DH Soret Wat Soe
Proay -
i. atts Cos of Cosincton Fad Zone
tration
[Brosion & Sediment Ptan oO |Total Amount of Land Disturbance:
Required: Yes No
Living Area:1" Floor Living area: 2" floor
we Capon
Caen
nn Ai age RTH i
sawretetor acacia ry Cone oh
ape
THT CSE TOTAUSQUAREFE
Ts TS TTBS
—
Provide #Stories
te
faving | RAGE FetRp Gs] PSO
‘New Driveway Permit (if applicable)
RUSSELL COUNTY BUILDING DEPARTMENT
137 Highland Dr.
Lebanon, VA 2426
Telephone: 276-889-8012
Fax: 276-889-8009
[email protected]
Josh Stinson—Building Official
Contractor
Information
Name:  Address: City, State, Zip Code:
VA License# Exp. Date Phone
Mechanics
Lien Agent
Name: Address: Phone:
Accessory
Structure
Pool length: Width Max Depth
Fence Height Retaining Wall Height
PLEASE READ AND SIGN:
I hereby certify that I am the owner of the record of the herein described property, or that the proposed work has been authorized by the owner of record
and that I have been authorized to make this application as a designated agent I agree to conform to all applicable state and local regulations, rules and
policies and such shall be deemed a condition entering into the exercise of the permit. In addition, if a permit is issued, I certify that the code official or his
authorized representative shall have the authority to enter the area(s) described herein at any reasonable hour for the purpose of enforcing the provisions of
the applicable code(s).
Signature: Date:
FOR OFFICE USE ONLY Date Received:
Building Permit Fee: Levy: Total Fee Amount
mailto:[email protected]
RUSSELL COUNTY BUILDING DEPARTMENT
137 Highland Dr.
Lebanon, VA 2426
‘Telephone: 276-889-8012
Fax: 276-889-8009
[email protected]
Josh Stinson—Building Official
Name aes City, Sate, Zip Cove
Contractor
Information
Va License? Exp. Date Phone
‘Mechanies ‘Name: ‘Address: Phone
Lien Agent
Accessory Pool length: Width Max Depth
Structure Fence Height Retaining Wall Height
Thereby certify that I am the owner of the record of the herein deseribed property, or that the proposed work has been authorized by the owner of record.
and that I have been authorized to make this application as a designated agent I agree to conform to all applicable state and local regulations, rules and
policies and such shall be deemed a condition entering into the exercise of the permit, In addition, if permit is issued, I certify that the code official or his
authorized representative shall have the authority to enter the area(s) described herein at any reasonable hour for the purpose of enforcing the provisions of
the applicable code(s).
Date:
Signature:
FOR OFFICE USE ONLY Date Received:
[Building Permit Fee: Levy: ‘Total Fee Amount
Name: 
Phone: 
Mailing Address: 
Email Address: 
Tax Map ID: 
Septic: 
Water Source: 
Estimated Cost of Construction: 
Flood Zone: 
New Construction Please provide square foot for all that applies: 
Living Area1st Floor: 
Living area 2nd floor: 
Carport: 
Garage: 
Above garage spaceroom: 
Deck: 
Basementunfinished: 
BasementFinished: 
Covered Porch: 
Habitable Attic Space: 
TOTAL SQUARE FT: 
Please Provide the following: 
Bedrooms: 
Bathrooms: 
12 Baths: 
Stories: 
New Driveway Permit if applicable: 
Name_2: 
Address: 
City State Zip Code: 
VA License: 
Exp Date: 
Phone_2: 
Name_3: 
Address_2: 
Phone_3: 
Pool length: 
Width: 
Fence Height: 
Max DepthRetaining Wall Height: 
PLEASE READ AND SIGN: 
Signature: 
Date: 
FOR OFFICE USE ONLY Date Received: 
Building Permit Fee Levy Total Fee Amount: 
Text1: 
Check Box5: Off
Check Box7: Off
Check Box8: Off
Check Box9: Off
Check Box10: Off
Check Box11: Off
Check Box12: Off
Check Box13: Off
Check Box14: Off
Check Box15: Off
Text16: 
Check Box17: Off
Check Box18: Off
Check Box20: Off
Check Box21: Off
Check Box22: Off
Check Box23: Off
Check Box24: Off
Check Box28: Off
Check Box29: Off
Check Box30: Off