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BROWSE CLARK COUNTY BOARD OF COMMISSION (OH) FORMS

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G:\BUILDING REGS\Forms - Masters\Applications\Updated Forms\Commercial Application.doc 11/6/19
This form is also available at www.clarkcountyohio.gov Submit one application per building or structure; all sections must be
complete. See instruction sheet for details.
APPLICATION NO.
1. SCOPE OF PROJECT: (OBC 107.2)
Building General Sprinkler
Mechanical Fire Alarm
Electrical Gasline
2. TYPE OF PROJECT:
New Building
Alteration/Repairs
Building Addition
Change of Occupancy
Request Certificate of Occupancy
3. APPLICATION RELATED INFORMATION:
Is this application being submitted as a result of a Notice of Violation or Adjudication Order that you received?
No Yes, please provide the adjudication order number: ______________________________
4. PROJECT / BUILDING LOCATION: (OBC 107.2) PARCEL NO.___________________________________
Building Name _______________________________ Street Address________________________________________
City/Township________________________________ Zip Code _________________ County ___________________
Directions___________________________________________________________________________________________
Is this project/building located in a flood plain? Yes No
Has flood plain administrator been contacted for requirements? Yes No
5. BRIEF DESCRIPTION OF THE SCOPE OF WORK COVERED UNDER THIS APPLICATION: (OBC 107.2.)
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
6. BUILDING OWNER INFORMATION:
Name of owner __________________________________________________ Attention: ____________________________
Street Address________________________________________City__________________State __________ Zip_________
Phone No. ________________________Fax _____________________E-mail_____________________________________
7. APPLICANT / CONTRACTOR INFORMATION: (Owner or designated representative) (OBC 107.2)
Applicant ____________________________________________________ Attention: _______________________________
Street Address ______________________________________ City __________________ State__________ Zip__________
Phone No. _________________________Fax ____________________ E-mail_____________________________________
8. REGISTERED DESIGN
PROFESSIONAL INFORMATION: Architect Engineer Fire protection system designer
Registration
Designer ____________________________________________ /Certificate No.: ______________________________
Street Address ____________________________________City_________________State___________ Zip___________
Phone No. _________________________Fax____________________E-mail_____________________________________
CLARK COUNTY APPLICATION FOR NON RESIDENTIAL PLAN APPROVAL
G:\BUILDING REGS\Forms - Masters\Applications\Updated Forms\Commercial Application.doc 11/6/19
9. BUILDING CODE INFORMATION:
(Information applied to construction area in a mixed use groups building, or the entire building if a single use group building)
Current use group(s) ________________ Current use group(s) _________________
Occupancy
Description:___________________________________________________________________________________________
10. GENERAL BUILDING INFORMATION: (The following information applied to the entire building, not just construction
area.) (OBC 107.2.3.)
Building Information:
Building Valuation__________________ Square Footage______________________
Use group (s) ___________ Mixed use groups? Yes No Separated Non-separated
Construction type? _________ Building height (FT)? _________________ No. of stories? _______________
Occupant load? __________ Storage height (FT)? _____________ Storage aisle width (FT)? ___________
Method of Demonstrating Energy Code Compliance (Please check the year and method being used)
2012 IECC 2010 ASHRAE 90.1
Prescriptive Table COMCheck Performance Analysis Software
List USE GROUP below for mixed use
building.
List Occupancy Type for associated use group below.
Fire Protection Systems: (Enter the type of system such as NFPA 13, NFPA 72, etc., if known.)
Building sprinkler system? ___________ Sprinkler demand @base of riser (PSI)? _________________________
Type 1 hood
Limited area sprinkler system? ________ suppression? ____________ In-Rack sprinkler system? ___________
Building fire alarm system? __________ Fire detection system?_________ Smoke detection system?__________
11. CERTIFICATION: (OBC 107.2.5)
I certify that I am the ______ Owner ______ Agent
for the owner
and all information contained in this
application is true, accurate, and complete to the best
of my knowledge. All official correspondence in
connection with this application should be sent to my
attention at the address shown above.
Signature: __________________________________
Print Name: __________________________________
Date________________________________________
Date received: ___________ Upfront fee paid $_____________
Processed by: ____________ Walk in Mail E-Mail
Plans Approved by _________________ Date______________
Balance Due$______________________
Notified By_____________________ Date_________________
Date Picked Up__________________________
G:\BUILDING REGS\Forms - Masters\Applications\Updated Forms\Commercial Application.doc 11/6/19
CLARK COUNTY APPLICATION FOR NON RESIDENTIAL PLAN APPROVAL
This form is also available at www.clarkcountyohio.gov
Submit one application per building or structure; all
sections must be complete. See instruction sheet for details.
DIRECTIONS FOR COMPLETING
CLARK COUNTY APPLICATION FOR BUILDING PLAN APPROVAL
In accordance with Ohio Administrative Code (OAC) Chapter 4101: 1-1-01, pursuant to Ohio Revised Code (ORC Section
3791.04, before beginning the construction, erection, or manufacture of any building for which construction documents are
required, the owner shall submit four (4) copies of construction drawings to this division for approval. The construction
documents shall be accompanied with the application form and attached (scope/fees) worksheets. The construction documents
shall be prepared by a registered deign professional pursuant to OAC 4101:1-1-01. An examination and inspection fee will be
assessed at the time of submittal as outlined in OAC 4101:1-1-01.
Application Directions: Complete page one and two of the application and attached worksheets as outline below. All
boxes, 1 through 13, must be completed in full or the application will be returned. Send this completed form along with
all required documents and application fee of $103 to “Clark County Community & Economic Development, 3130 E.
Main Street, Suite 1A, Springfield, Ohio 45505”.
1. SCOPE OF PROJECT: Check all the boxes that apply to the scope of work proposed in this project. Every scope of
work checked must be accompanied with the appropriate fees. Without establishing the proper scope of work, the
department will be unable to establish the inspection schedule for the project. Please note that “Building General” refers
to all “general trade” work in the building including ceiling panels/grids, non-load bearing partitions, flooring, etc.; NOT
just structural load bearing components of the building.
2. TYPE OF PROJECT: Check on the types of projects from the list.
3. APPLICATION RELATED INFORMATION: Answer each of the questions in this block and provide additional
information accordingly. Complete answers to the questions will help the division process and review the project
accurately.
4. PROJECT/BUILDING LOCATION: Please provide complete information identifying the location of the building where
the construction or renovation will occur. This will help the department determine the proper jurisdiction for the project.
5. BRIEF DESCRIPTION OF THE SCOPE OF WORK COVERED UNDER THIS APPLICATION: Please provide a brief
description of the scope of work. Please include the names of the areas or rooms affected by the construction when
only a portion of building is covered under the permit application. The description provided will be shown on your
certificate of use and occupancy.
6. BUILDING OWNER INFORMATION: Please provide complete answers to each item. If the building is owned by a
corporation, please provide the name of the corporation and identify the contact person, in the section called “Attention”.
7. APPLICANT INFORMATION: Please complete information. All project correspondences will be directed to the project
applicant.
8. DESIGNER INFORMATION: Section 106.2 of the Ohio Building Code requires that the design professional be
identified including the design professional’s Ohio registration number.
9. BUILDING CODE INFORMATION: Information provided applies to the construction area in a mixed use groups
building, or the entire building if it is a single use group building. For change of occupancy, the term “Current use group”
refers to the approved use group under the previous occupancy. For information concerning the term “Proposed use
group”, please refer to Chapter 3 and 6 of the Ohio Building Code for the proper classification.
10. GENERAL BUILDING INFORMATION: The information provided applies to the entire building and is not limited to the
construction area. Even when the proposed project is a partial building renovation or a building addition, the information
for the entire building is required. The information provided will be shown on your certificate of use and occupancy in
accordance with Section 111 of the Ohio Building Code.
11. CERTIFICATION: The application cannot be processed if this section is not complete.
12. OFFICE USE ONLY. This section is reserved for our office use only. Please do not mark in this area.
Once the plans have been examined and approved, a Certificate of Plan Approval will be issued to the owner along with two
sets of construction documents. One of the sets of construction documents must remain at the job site at all times during
construction pursuant to OAC 4101:1-1-01. Inspections can be obtained from the Clark County Community & Economic
Development Office phone number by calling before 3:30 p.m. at least one day prior to the inspection. The phone number is
(937) 521-2160. Once all inspections have been obtained a final Certificate of Occupancy will be issued pursuant to OAC
4101:1-1-01.
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Completed 17 July 2020

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