County of Louisa Department of Community Development – New Non-Residential Building Permit Package Instructions

Enter the full name of the person acknowledging the project information (the individual who is certifying or accepting the information on this application).

Enter any supplemental information, clarifications, or a list of attached documents (include filenames or brief descriptions) relevant to this zoning approval record.

Check this box when you are submitting one set of pre-engineered product specification sheets (e.g., roof/floor truss specs, layouts, LVLs) as part of the application.

Check this box when a shrink/swell soil report is required due to site soil conditions (for properties listed by tax map number) — if that report indicates additional structural needs, also provide a soil bearing report.

Check this box when the project is located within the Town of Louisa or the Town of Mineral and you are submitting the required town zoning approval.

Enter the total area of ground or land disturbance associated with this project expressed in square feet.

Enter the full printed name of the person (owner or authorized agent) acknowledging and signing the application.

Enter the date when the person acknowledged and signed the application.

Provide the handwritten signature of the owner or authorized agent who is acknowledging the statements on the application.

Check this box when the person submitting the application is the property owner.

Check this box when the person submitting the application is the contractor for the project.

Check this box when the person submitting the application is an agent acting on behalf of the owner.

Enter the unique application or tracking number assigned to this development permit application by the county (leave blank if not yet assigned).

Enter any additional notes, comments, or an internal tracking code related to this Contractor Information Sheet that should appear in the form footer.

Enter the building's overall dimensions (for example length × width or other dimension notation) as shown on plans, usually given in feet.

Enter the total number of stories (levels) in the building, using an integer value such as 1, 2, 3, etc.

Enter any comments, conditions, notes, required actions, or other remarks from the Zoning Administrator related to this application or site (multi-line text).

Enter the contractor's full name or company name as the primary contact for this permit.

Enter the contractor's primary phone number including area code and extension if applicable.

Enter the contractor's street address, including building number, street name, and suite or unit if applicable.

Enter the contractor's email address for official correspondence about this permit.

Enter the city, state and ZIP code that correspond to the contractor's address.

Enter the full legal name(s) of the property owner(s) applying for the permit.

Provide the property street address or the county tax map/parcel number for the parcel where work will be performed.

Sign using the owner’s usual legal signature to attest that the owner is acting as the contractor for the listed property.

Enter the date on which the owner signed the form.

Enter the covered deck's dimensions (for example length × width in feet) to indicate the deck size. Fill only if 'Covered (Decks)' is 'Yes'.

Enter the total square footage of the covered deck as a numeric value representing the area in square feet. Fill only if 'Covered (Decks)' is 'Yes'.

Check this box when the deck is covered (has a roof/covering) to indicate you will provide its dimensions and square footage.

Enter the overall dimensions of the covered porch (length by width), e.g., 12' x 8' or 12 x 8, as a text string. Fill only if 'Porches - Covered' is 'Yes'.

Enter the total square footage of the covered porch as a numeric value. Fill only if 'Porches - Covered' is 'Yes'.

Check this box when the property has a covered porch (use when the porch is roofed/covered) and you will provide its dimensions and square footage.

Enter the deed or plat book number where the property's record is filed in the county land records.

Enter the page number within the referenced deed or plat book where the property's record appears.

Enter the required minimum lot width for the parcel as specified by zoning, in feet.

Enter the maximum allowable building height for the structure according to zoning, in feet.

Enter the first part of the driving directions from the County Office Building to the property, including road names, turns, landmarks, and distances as needed.

Enter the second part of the driving directions continuing from Line 1, providing additional road names, turns, landmarks, and approximate distances to reach the property.

Enter the final part of the driving directions, including the last turns, landmarks, driveway or entrance details, and any other information needed to locate the property.

Enter the choice that indicates which option applies to this permit: type "Contractor License Exemption" if the owner is acting as the contractor, or type "Owner/Agent Affidavit" if a contractor/agent has been hired.

Enter any existing Conditional Use Permits (CUP), Special Exception Permits (SEP), or variances applicable to the property — provide case numbers or a brief description, separated by commas if more than one.

List the existing structures located on the property (or write 'N/A' if none), including brief identifiers such as building type, approximate location, and any other relevant notes.

Enter the exterior siding material when it is not one of the listed options (e.g., wood, stucco, fiber cement), providing a short descriptive name for the siding. Fill only if 'Other (specify)' is 'Yes'.

Check this box if the building's exterior siding is brick or stone.

Check this box if the building's exterior siding is vinyl.

Check this box if the building's exterior siding is Hardie plank (fiber cement) product.

Check this box if the exterior siding is a material not listed above and write the siding type on the provided blank line.

Enter the finished square footage area for the building's third story.

Enter the finished square footage area for the building's first story.

Enter the finished square footage area for the building's second story.

Check this box when the property is located within a designated flood zone (i.e., a FEMA or jurisdictional flood hazard area).

Check this box when the property is not located within any designated flood zone or flood hazard area.

If the floor type is not one of the listed options (Dimensional Lumber or Engineered), enter the specific floor type or material here (e.g., concrete slab, tile, composite). Fill only if 'Other (specify)' is 'Yes'.

Check this box when the building's floor construction is traditional dimensional lumber (solid sawn joists/joists and joists framing).

Check this box when the building's floor system uses engineered floor products (such as I-joists, LVL, or other manufactured engineered floor members).

Check this box when the floor type is not listed (then specify the floor type on the provided line).

Check this box when a foundation survey is required for the project/permit.

Check this box when a foundation survey is not required for the project/permit.

Enter the foundation type when it is not one of the listed options (e.g., crawlspace, pier and beam, slab-on-grade) as a short text description. Fill only if 'Other (specify)' is 'Yes'.

Check this box if the building's foundation is poured concrete (cast-in-place concrete).

Check this box if the building's foundation is constructed of concrete block (masonry block).

Check this box if the foundation type is something other than poured concrete or block, and write the foundation type on the provided line.

Enter the header reference code or short identifier shown at the top of the form (e.g., a file, record, or tracking number) that associates this sheet with the application or project.

Enter the total monetary value of the job in dollars as reported for this permit application.

Check this box if electrical work is NOT included with this permit or job.

Check this box if electrical work IS included with this permit or job.

Check this box if the electrical work will be provided by a separate electrical service (only applicable when 'Electrical Included - Yes' is checked). Fill only if 'Electrical Included - Yes' is 'Yes'.

Check this box when the project property is on the Lake Anna shoreline and you are submitting the Louisa County Shoreline Packet or proposing a new single-family dwelling.

Check this box if the shoreline project involves land disturbance greater than 10,000 square feet or the structure contains living space, indicating you must contact the office to request and submit the required form.

Enter the full name of the contractor, company, or agent responsible for the project.

Enter the contractor's Virginia license number exactly as issued (include any letters or digits).

Enter the contractor's license designation(s) or trade classification(s), for example CBC, RBC, ELE, etc.

Enter the expiration date of the Virginia contractor's license.

Enter the contractor's or agent's signature (typed full name) authorizing this affidavit.

Enter the full legal name(s) of the property owner(s) who are authorizing this Owner/Agent Affidavit.

Enter the property street address or the county tax map/parcel number that identifies the property referenced in this affidavit.

Enter the signature of an owner or authorized agent certifying this affidavit exactly as they sign.

Enter an additional owner or agent signature if needed to certify this affidavit, exactly as they sign.

Enter a further owner or agent signature if required to certify this affidavit, exactly as they sign.

Enter the zoning permit identification number assigned by the county for this project.

Enter the building permit identification number assigned by the county for this project.

Enter a brief, clear summary of the proposed project or work to be performed at the site (e.g., new building, addition, site improvements); include purpose and key elements.

Enter the full street address of the property where the project will occur, including unit/suite if needed, or write 'N/A' if not applicable.

Enter the county tax map or parcel identification number used by the assessor for this property.

Enter the magisterial district where the property is located (use the district name or number).

Enter the property's zoning district or zoning code as assigned by the county.

Enter the subdivision name, lot, or section for the property; if none, enter N/A.

Enter the current total acreage of the property.

Enter the full name of the property owner (or company name) as it should appear on record.

Enter the property owner's primary contact phone number, including area code and any extension if applicable.

Enter the property owner's street mailing address including number, street name and apartment or suite number if applicable.

Enter the property owner's email address used for correspondence about the permit.

Enter the city, state (use standard two-letter abbreviation) and ZIP code for the property owner's mailing address.

Enter the proposed front setback distance from the property line to the new structure.

Enter the proposed rear setback distance from the property line to the new structure.

Enter the proposed left-side setback distance from the property line to the new structure.

Enter the proposed right-side setback distance from the property line to the new structure.

Provide the vertical height of the proposed structure.

Provide the proposed front setback distance measured from the road at the edge of the right-of-way.

Provide the proposed rear setback distance for the structure.

Provide the proposed left side setback distance for the structure.

Provide the proposed right side setback distance for the structure.

Check this box if you are submitting the deed (cover sheet with the Clerk's seal) or a recordation receipt showing the property's ownership or recent acquisition.

Check this box if you are submitting a drawn-to-scale plat of the property (not a GIS image) that shows building location and required elements such as entrance, driveway, dimensions, and setbacks.

Check this box if you are submitting one complete, scaled and fully-dimensioned set of site-specific building plans including all attachments, decks, porches and overhangs.

Check this box if you are providing a State Contractor's License (or the Contractor License Exemption form) that includes applicable trades.

Check this box if you are submitting a Louisa County Business License (not required if you are submitting a Contractor License Exemption form). Fill only if 'State Contractor’s License (or Contractor License Exemption form)' indicates a State Contractor’s License is submitted (not a Contractor License Exemption form).

Enter the required front setback distance from the front property line in feet as specified by the zoning regulations.

Enter the required rear setback distance from the rear property line in feet as specified by the zoning regulations.

Enter the required left-side setback distance from the left property line in feet as specified by the zoning regulations.

Enter the required right-side setback distance from the right property line in feet as specified by the zoning regulations.

Enter the roof covering material(s) if not listed (for example, slate, tile, EPDM, built-up roofing), using a short descriptive name. Fill only if 'Other (specify)' is 'Yes'.

Check this box when the roof covering for the building is asphalt or similar shingles.

Check this box when the roof covering for the building is metal panels or metal roofing.

Check this box when the roof covering is a type other than shingles or metal, and provide the specific material on the adjacent line.

Enter the roof framing type when it is not Rafters or Trusses; provide a short descriptive name or specification (for example: purlins, SIPs, engineered joists, etc.). Fill only if 'Other (specify)' is 'Yes'.

Check this box if the building's roof framing is constructed using individual rafters.

Check this box if the building's roof framing is constructed using prefabricated or site-built trusses.

Check this box if the building's roof framing type is not rafters or trusses, and provide the specific type on the line provided.

Check this box when a setback certification is required for the project (indicating the certification will be provided).

Check this box when a setback certification is not required for the project.

Enter the form's primary header or identifier to appear at the top of the page, such as a short title, project name, or permit/reference identifier.

Enter the electrical tradesman's primary contact phone number, including area code and any extension if applicable.

Enter the electrical tradesman's company name or the individual tradesman's full name responsible for the electrical work.

Enter the electrical contractor's license number exactly as issued by the state or licensing authority (include any letters or punctuation shown on the license).

Provide the signature of the electrical tradesman or an authorized company representative certifying the information provided.

Enter the company name or individual owner of the tradesman responsible for the interior gas work on this project.

Enter the primary contact phone number for the gas tradesman or company performing the interior gas work.

Provide the gas tradesman's license or registration number as issued by the applicable licensing authority.

Enter the signature (name or electronic signature) of the gas tradesman or an authorized company representative confirming responsibility for the interior gas work.

Enter the mechanical tradesman's contact phone number for the company or owner.

Enter the mechanical tradesman's company name or owner name responsible for the mechanical work on this project.

Enter the mechanical tradesman's professional license number associated with the company or owner.

Enter the mechanical tradesman's signature (typed name) authorizing or acknowledging the information provided.

Enter the phone number for the plumbing company or tradesman responsible for the work.

Enter the full name of the plumbing company or individual tradesman who will perform the plumbing work.

Enter the plumbing contractor's state license number or other license identifier.

Enter the printed name or signature of the plumbing contractor or authorized company representative.

Enter the overall dimensions of the uncovered deck (e.g., length x width in feet) as a text string. Fill only if 'Uncovered (Decks)' is 'Yes'.

Enter the total square footage of the uncovered deck. Fill only if 'Uncovered (Decks)' is 'Yes'.

Check this box if the project includes an uncovered deck; then provide its dimensions and square footage on the line provided.

Enter the length and width (or other dimensional description) of the uncovered porch (e.g., 10' x 12' or 3.0m x 3.6m). Fill only if 'Uncovered (Porches)' is 'Yes'.

Enter the total square footage of the uncovered porch. Fill only if 'Uncovered (Porches)' is 'Yes'.

Check this box when the porch is uncovered; provide the porch dimensions and square footage on the lines provided.

Enter the printed name of the person acknowledging the information on the application.

Provide the signature (typed name if electronic) of the owner or authorized agent signing the application.

Enter the full name of the zoning administrator or designated agent who is approving this application.

Enter the date when the zoning administrator or designated agent signed or approved this form.