City of Rocky Mount Inspection Services INSULATION PERMIT APPLICATION - RESIDENTIAL
Instructions: Complete all pertinent fields, then read the information at the bottom of the form. Click the Submit button to send the information; click Clear to start over.
Applicant Name: Date:
Project Address:		Subdivision:
Developer:		Telephone:
Property Owner:		Telephone:
Insulation Contractor:		State License #:
Address:
City:	State:	Zip Code:	Telephone:
Project Supervisor:		Telephone:
Description of Work:
Type of Work (check one): New Construction Room Addition Other
Permit Fees based on Value of Work (check one): $100.00 or less: $65.00 per permit Over $100 to $5,000: $17.00 per $1,000 or fraction thereof Over $5,000 to $10,000: $65.00 for first $5,000 plus $8.50 for each additional $1,000 or fraction thereof Over $10,000: $115.00 for first $10,000 plus $7.25 for each additional $1,000 or fraction thereof
Minimum Fee: $65.00 Failure to Obtain Permit: $250.00 Reinspection Fee: $75.00 Extra Inspection Fee: $75.00 (minimum two hour charge after normal working hours)
Total Fees
Comments:
I hereby certify that all the information in this application is correct and all work will comply with the State Building Code and all other applicable State and local laws, ordinances and regulations. The Inspection Department will be notified of any changes in the approved plans and specifications for the project permitted herein. I further understand that this is NOT an authorization to begin work. Work may only commence after approval and issuance of the permit. Owner/Applicant E-mail Address: Daytime Phone: