Building Permit Application

Name First Last
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code
Phone - (###) - ### ####
Email
Location of Building
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code
Permanent Index Number
Building Cost $ Dollars/Cents
Electrical Cost $ Dollars/Cents
Plumbling Cost $ Dollars/Cents
Heating & Air Conditioning $ Dollars/Cents
Other Cost $ Dollars/Cents
Date work to Commence / MM / DD YYYY
Estimated Completion Date / MM / DD YYYY
Type of Building New Building Addition Alterations Repair/Replacement Moving Wrecking Number of Stories
Number of Stories
Total Land Area, Square Feet
Total Square Feet
Total Square Feet of Addition
Proposed Use-Residential One Family Two Family Garage
Other, Specify
Proposed Use-Non Residential Amusement/Recreational Public Assembly Hotel/Motel Industrial Parking Garage Service Station/Repair Garage Signs Restaurant Hospital/Institutional Public Utility Stores/Mercantile Tanks/Towers
Other, Specify
For non-residential usage and signs, describe detailed use
Principal Type of Frame Masonry Structural Wood Frame Reinforced Concrete
Other
Principal Type of Heating Fuel Gas Electricity Oil
Other
Type of Mechicanical Central Air Conditioning Elevator
Other
General Contractor: Person/Firm/Corporation performing work (Name, Address & Telephone Number)
Registered at:
Registered Number:
Expiration Date:
Electrical Work: Person/Firm/Corporation performing work (Name, Address & Phone number)
Registered at:
Registered Number:
Expiration Date:
Lighting & Circuits
Up to 200 AMP Service
Over 200 AMP Serice
Other
Plumbing Work: Person/Firm/Corporation performing work (Name, Address & Phone number)
Registered at:
Registered Number:
Expiration Date
Connection Fees:

Water:	1"	$100.00
	1 ½”	$ 500.00
	2”	$ 1,000.00
	In excess of 2” to 3”	$ 2,500.00
	In excess of 3” to 6”	$ 4,000.00
	In excess of 6” to 8”	$ 5,000.00
	In excess of 8” to 10”	$ 6,500.00
	In excess of 10” to 12”	$ 8,000.00
	12” or greater	$10,000.00
Sewer:		$ 500.00

Note: No application for a commercial or indistrial building permit will be accepted by Clerk unless this is completed
Estimated cost of Site $ . Dollars Cents
Current Employment
Full time jobs created
Full time jobs retained
Federal employer ID number
Retail occupation tax number
6B Tax Classification Status:
Is your project eligible for 6b Tax Classification status?
Will you be applying for any incentives offered to businesses located or locating in the McCook Hodgkins Enterprise Zone?
Comments
If you would like information on specific benefits available to our businesses, please ask the Clerk for more information.
**Download the Village of Hodgkin's Building Permit Application**

Building Permit Application

Building Permit Application

Lighting & Circuits

Connection Fees:

Note: No application for a commercial or indistrial building permit will be accepted by Clerk unless this is completed

6B Tax Classification Status:

If you would like information on specific benefits available to our businesses, please ask the Clerk for more information.