RM of Yellowhead Building Permit Application (form)
Rural Municipality of Yellowhead, Manitoba
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## R.M. of Yellowhead - Permit Application Willie Brown - Building Inspector
## Cell (204)773-6360
Box 278 Shoal Lake, Manitoba, ROJ 1Z0 Phone (204)759-2565 Fax (204) 759-2740
Application Permit No:
se sw ne nw 1/4 of
Location:
- [ ] Building
- [ ] Development
(lot/section)
Description of work:
(Block/Township)
(Plan/Range)
(Civic Address)
Valuation of Work: S
## Fill in where applicable:
Applicant:
Permit Fee: $
Fees Submitted:
TAddress:
Class of work:
- [ ] 1. New
- [ ] 2. Addition
- [ ] .3. Renovation 14. Relocation
15. Removal
16. Demolition
- [ ] Yes-
Phone:
- [ ] NoL
Owner:
Contractor:
Documents submitted -
- [ ] Plans
- [ ] Site Plan
## DEVELOPMENT PERMIT INFORMATION:
Proposed Use Of Structure:
Structure Size:
Total Area:
Total Structure Height:
Foundation Type:
Basement:
- [ ] Crawl Space:
Basement to be Finished:
- [ ] Unfinished
Notes:
## Site Plan is required to he completed and submitted with this application.
Date Approved:
Validated by:
Roll #
Existing Use Of Structure:
Dimensions listed are in:
Feet
- [ ] Meters
Wall Height:
Number of Stories
- [ ] Other
Other Structures on Site:
Describe:
Located on Section: /
- [ ] Subdivision:
- [ ] Lot: C
Building Inspector
Comments:
Declaration
am the authorized agent/owner in this application for a development/building permit.
please print
1 undertake to observe the provisions of Federal, Provincial or Municipal statutes or regulations, the applicable by-laws, schemes, regulations or orders and plans continued in force pursuant to the Manitoba Building Code. Including any applicable zoning by-law, any agreement entered into affecting said land, and all specifications or instructions issued by the duly authorized officers of the authority having jurisdiction, in respect of the work incidental to the subject matter of this application and if the permit involves or affects the placing of, or the position of any building or structure on, or in respect of land to do all work so that the building will be wholly within the boundaries of the lot or parcel of land indicated in this application and to indemnify the municipality against all losses, costs, changes or damages caused by or arising out of anything done pursuant to any permit issued under this application.
Signature Authorized Agent/Owner:
Date:
The above signed individual hereby applies for a Permit to build in accordance with this application; all by-laws, regulations applicable thereto and all conditions stated on the reverse. The accuracy of the information of this application and the accompanying plans and
specifications with the representations therein contained are the responsibility of the owners and are hereby made a part of this application
Notice to Applicant: All required information, original documentation (do not fax) and fees shall be submitted in order to validate this permit. Construction shall not commence until approval has been received from the R.M. of Yellowhead Office. Permit applications shall not be completed unless accompanied with the appropriate fees.
## The tollowing section to be completed by the Development Ouncer
Building By-Law #1066
Zoning By-Law #1-2005
Additional Approvals and Permits Required:
- [ ] Municipal Approval: Approach - Conditional Use
- [ ] Variation
- [ ] Plumbing Permit
- [ ] MB. Conservation: Private Sewage Registration
Dept. of Transportation Permit: Structures in Highway Zone
MB. Agriculture Technical Review for Intensive Livestock Production:
- [ ] MB. Hydro:
Office of the Fire Commissioner:
- [ ] Building Permit Required Bi
Notes:
- [ ] Requested by Council
## When Properly Validated (below) This Is Your Permit
Date Approved:
Validated By
- [ ] CTPD Permit issued
Development Officer
Comments:
- [ ] -7. Mobile Home
- [ ] - 8. RTM
- [ ] - 9. Foundation Only
## 306 Elm Street, Box 278 Shoel Lake, Manitoba ROJ 1Z0 Phone: (204) 758-2560 Fax: (204) 758-2740
## SITE PLAN
picant:
gel Deecription:
- Lot (u)
SE
NW
Description and Use of Structure
\_Bection:
Block
Township
The ¼ Section(a) or Lot (e) lated above are under a separate title: YES \_. properties on which development is proposed. NO \_ If "NO", show all
Plan
Range
## INSTRUCTIONS:
please provide a aspartha draving.
## SHOW THE FOLLOWING: I this document is not largs enough,
- Locallon, of arkaling structures
3. Dimenaiano of pr aposied etructurna
2. Lacellon of proceed structures
4. Indian of are or reace.
- в. canoe bett вел реоросе! deros and extering serictures.
7. Indloates clatance frame arteting and dada or Right
- in la nat may NOT to
## FOR DEVELOPMENT OFFICER UBE ORLY
- IORNG DISTRICT
2. ARQUINED FRONT YARD SETBACK
- J. REQUIED PIRAN YANO SETBACK
- RIOLHRED WIDE YARD BITUACK
PERMIT APPLICATION NUMBER:
DICLARATION, i cortify the above Information to be trive and correct and by signing this site plan, i (the applicant) ansume all Hablty and any costs associated with violations resulting from the provision of false or incorrect information. Any alteration to a Development Officer approved site plan MUST be resubmitted for approval by the Development Officer.
SIONATURI OF APPLICANT:
<!-- image -->
DATE:
## PLUMBING PERMIT APPLICATION
INSTRUCTIONS: 1) Print Clearly 2) Appropriate Fee Must Accompany Application 3) Make cheque/money order payable to the R.M. of Yellowhead.
BOX 278 SHOAL LAKE MB, ROJIZO PH.(204) 759-2565 R.M. of Yellowhead
Location of Building:
(Building No. or Section)
(Street or Township)
(Town or Range)
Between
Zoning District
(cross street)
(cross street)
Lot
\_Block
\_Plan
Lot Size:
Class of Work:
- [ ] 1) New
- [ ] 2) Addition
Building Permit No
No. of Dwelling Units:
Size of Building Drain and Trap:
Applicant
- [ ] 3) Repair
- [ ] 4) Renovation
\_ Major Occupancy:
No. of Other Units:
- [ ] 3 InD
- [ ] 4 In D
- [ ] 5) Alteration
- [ ] 6) Other (Specify)
New or Revision:
No. of Stories: |020:0
Area of Roof and Paved Surface to be Drained:
- [ ] None
Address
Phone
Owner
Address
Phone
Architect or Designer
Address
Phone
Contractor
Address
Phone
## NUMBER AND LOCATION OF OUTLETS AND FIXTURES
Water Closets
Urinals
Interceptor
Roof Terminals
Fees
Floor
outlets
Basement
fixtures
outlets
I st
fixtures
outlets
2 nd
fixtures
outlets
3 rd
fixtures
Building Official
day month year
/
Notes
## CONTACT YOUR BUILDING INSPECTOR AT THE FOLLOWING STAGES
*Excavation and Footings Inspection
*Sewers, Drains, Water Service and Underground Plumbing Inspection
*Pre-Backfill Inspection
*Plumbing and Heating Rough-In Inspection
"Framing Inspection
*Insulation and Air/Vapor Barrier Inspection
· *Pre-Occupancy Inspection
*Final Plumbing and Heating Inspection
Buildine Inspector:
WILLIE BROWN Phone: 773-6360 Cellullar