301 Washington Avenue ● Bay City, MI 48708-5866 ● www.baycitymi.org

Medical Marijuana Ordinance (MMFLA) Application Package

Beginning January 2, 2018, the City of Bay City will begin processing Medical Marijuana Ordinance license applications, per the MMFLA ordinance adopted December 18, 2017 by the Bay City Commission.

To be considered for a commercial marijuana facility license, please ensure all of the following are completed:

____ License application, with non-refundable fee, delivered to the City Clerk

____ Waste water discharge permit application, with fee, delivered to Waste Water Treatment Plant (2905 N. Water Street) for technical review. (Please contact Bay City WWTP at 989-891-1200 for instructions and questions.)

____ Public Safety background check release, with fee, delivered to Bay City Department of Public Safety (501 3rd Street. Please contact Bay City Department of Public Safety at (989-892-8571 for instructions and questions).

____ Site plan application, with fee, delivered to Bay City Department of Community Development (Planning/Zoning)

____ Building permit application, with fee, delivered to Bay City Department of Community Development (Building)

Upon completion of the above-noted reviews, the City Clerk will compile all recommendations and submit to the City Manager for a final recommendation to the City Commission, which approves or denies MMFLA applications.

Thank you,

Steve King Community Development Director

http://www.baycitymi.org/

Bay City MMFLA/MMO License Application Page 1

City of Bay City 301 Washington Ave. Bay City, MI 48708 www.BayCityMI.org

Medical Marihuana Facilities License Application and Package

Type of Application:

____ New Application ___Renewal Application ___License Modification

Requested License Class:

___ Grower, Class A (≤500 plants) ___ Provisioning Center ___ Grower, Class B (≤1,000 plants) ___ Safety Compliance Facility

___ Grower, Class C (≤1,500 plants) ___ Secure Transporter

___ Processor

Applicant Name:

Business Name:

Phone Number: Email Address:

Physical Address:

Mailing Address:

Date Received by Clerk

http://www.baycitymi.org/

Bay City MMFLA/MMO License Application Page 2

OWNER AND MANAGER INFORMATION: List all officers, directors, general partners, managing members, stockholders, partners, and members. If a holding company has an ownership interest in the licensed business, list that company and its ownership percentage as well. Attach additional pages as necessary.

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Name: Address:

Email Address: Phone Number: Position: DOB: % Ownership

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Email Address: Phone Number: Position: DOB: % Ownership

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Email Address: Phone Number: Position: DOB: % Ownership

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Email Address: Phone Number: Position: DOB: % Ownership

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Bay City MMFLA/MMO License Application Page 3

ADDITIONAL INFORMATION REQUIRED: PLEASE ATTACH AND LABEL

A. For the applicant, for each stakeholder and/or general partner of the applicant, an affirmation under oath as to whether they are at least 18 years of age and have never been indicted for, charged with, arrest for, or convicted of, pled guilty or no contest to, forfeited bail concerning, or had expunged any criminal offense under the laws of any jurisdiction, either felony or controlled-substance -related misdemeanor not including traffic violations, regardless of whether the offense has been expunged, pardoned, reversed on appeal or otherwise, including the date, name and location of the court, arresting agency, and prosecuting agency, the case caption, the docket number, the offense, the disposition , and the location and length of incarceration.

B. Before hiring a prospective agent or employee of the applicant, the holder of a Permit shall conduct a background check of the prospective employee. If the background check indicates a pending charge or conviction within the past ten (10) years for a controlled substance-related felony, the applicant shall not hire the prospective employee or agent without written permission from the City Manager or approval by the City Commission. [30-507(b)]

C. A signed release authorizing the City of Bay City Department of Public Safety to perform a

criminal background check to ascertain whether the applicant , each stakeholder of the applicant, each managerial employee and employee of the applicant meet the criteria set forth in this Ordinance, the cost of which will be charged to the applicant. [30-506(14)]

D. The name, date of birth, physical address (residential and any business address(s)), copy of

photo identification, and email address for any managerial employee or employee of the Medical Marihuana Facility, if other than the applicant.

E. An affirmation via notarized affidavit as to whether the applicant or stakeholder has ever

applied for or has been granted any commercial license or certificate issued by a licensing authority in Michigan or any other jurisdiction that has been denied, restricted, suspended, revoked, or not renewed and a statement describing the facts and circumstances concerning the application, denial, restriction, suspension, revocation, or nonrenewal, including the licensing authority, the date each action was taken, and the reason for each action; [30-506(11)]

F. One of the following: (a) proof of ownership of the entire premises wherein the Medical

Marihuana Facility is to be operated; or (b) written consent from the property owner for use of the premises in a manner requiring a permit under this Ordinance along with a copy of the lease for the premises; [30-506(4 & 5)]

G. Proof of an adequate premise liability and casualty insurance policy in the amount not less

than the requirements addressed in the Medical Marihuana Facilities Licensing Act or applicable State Laws, covering the Medical Marihuana Facility and naming the City as an

Bay City MMFLA/MMO License Application Page 4

additional insured party, available for the payment of any damages arising out of an act or omission of the applicant or its stakeholders, agents, employees, or subcontractors; [30-506(9)]

H. A security plan indicating how the applicant will comply with the requirements of this Article

and any other applicable law, rule, or regulation. The security plan shall include details of security arrangements and will be protected from disclosure as provided under the Michigan Freedom of Information Act, MCL 15.231 et seq. If the City finds that such documents are subject to disclosure, it will attempt to provide at least 2 business days’ notice to the applicant prior to such disclosure. [30-506(7)]

I. Site plans of the Medical Marihuana Facility [30-506(7/15)]

J. Exterior lighting plan (may be included in site plan) [30-506(7)]

K. Any proposed text or graphical materials to be shown on the exterior of the proposed

Medical Marihuana Facility; (Must conform with the requirements of the City's Zoning Ordinance and Sign Ordinance) [30-522]

L. Stamped construction plans of the Medical Marihuana Facility [30-506(15)]

M. A description of all toxic, flammable, or other materials regulated by a federal, state, or local

authority that would have jurisdiction over the business if it was not a marihuana business, that will be used or kept at the medical marihuana business, the location of such materials, and how such materials will be stored. [30-506(7)]

N. An affidavit that neither the applicant nor any Stakeholder of the applicant is in default to

the City. Specifically, that the applicant or Stakeholder of the applicant has not failed to pay any property taxes, special assessments, fines, fee or other financial obligations to the City

O. An affidavit that the transfer of Marihuana to and from Medical Marihuana Facilities shall be

in compliance with the MMMA and the Medical Marihuana Facilities Licensing Act or other applicable state laws

P. A staffing plan with the actual or anticipated number of employees [30-506(13)]

Q. A business plan which contains but is not limited to the applicant's experience in operating

other similarly permitted or licensed businesses and the applicants' general business management experience

R. A location area map of the Medical Marihuana Facility and surrounding area that identifies

the relative locations and the distances (closest property line to the subject Medical Marihuana Facility's building) from the subject Medical Marihuana Facility to the closest real

Bay City MMFLA/MMO License Application Page 5

property comprising a public or private pre-school, elementary or secondary school (pre-K through 12th grade); church or religious institution if recognized as a tax-exempt entity as determined by the City Assessor's Office; public park facility; or public safety facility (including fire stations, law enforcement centers, or court houses).

S. A completed industrial wastewater discharge plan. [30-506(7)]

T. For grower and processing facilities, an applicant must submit electrical plans for load

review to Bay City Electric Light & Power for a primary/secondary load study. After the load study has been conducted, applicants must prepay all costs associated with overbuilds that are necessary to meet the applicant’s required load before construction is to start. [30-506(7).] Associated costs may include:

1. Overbuild of primary/secondary utility lines and their supporting structures.

2. KVA cost (Transformer(s))

3. All labor and equipment cost.

OTHER BUSINESS INFORMATION:

A. Provide a detailed description of the plan to dispose of any medical marijuana or product not sold in a manner that protects it from being ingested by an animal or person.

B. Provide a detailed description of the ventilation system used to prevent odor from leaving the building and how to mitigate noxious fumes or gases during the production process.

C. Provide a list of all personnel with access to the surveillance camera system to be used.

ADDITIONAL REQUIREMENTS FOR GROWER FACILITIES: the following additional items shall be required:

A. An affidavit that all operations will be conducted in conformance with MMMA, the Medical Marihuana Facilities Licensing Act or other applicable State laws and such operations shall be cultivated on the premises at any one time more than the permitted number of Marihuana Plants per the Michigan Medical Marihuana Act, as amended, and the Medical Marihuana Facilities Licensing Act;

B. A chemical and pesticide storage plan that states the names of chemicals and pesticides to be used in the Grower and where and how pesticides and chemicals will be stored in the facility, along with a plan for the disposal of unused pesticides and chemicals;

NOTE: All Growing must be performed within an enclosed locked Facility.

Bay City MMFLA/MMO License Application Page 6

BACKGROUND INFORMATION:

A. If you are currently licensed by any governmental agency to engage in any business, list each such license held, the city in which it is held and expiration date thereof.

B. Do you authorize the City of Bay City to perform background checks?

___Yes ___No

OATH OF APPLICATION:

I declare under penalty of perjury in the second degree that this application and all attachments are true, correct, and complete to the best of my knowledge. I also acknowledge that it is my responsibility and the responsibility of my agents and employees to comply with the provisions of the Michigan Marihuana Facilities Licensing Act, Public Act 281 of 2016 and the City of Bay City Ordinances which govern my Permit.

Signature___________________________________ Date_________________________

Printed Name________________________________ Title__________________________

BAY CITY DEPARTMENT OF PUBLIC SAFETY

501 Third St., Bay City, MI 48708 (989) 892-8571

FINGERPRINT INFORMATION

Pawnbroker/Secondhand, Junk Dealers, Fortunetelling, Amusement, and Medical Marijuana Facility Licenses

It is the responsibility of this department to complete the following:

• Fingerprint and background check of all applicants. • Complete required forms and processing of essential paperwork.

In view of the necessary work involved and the number of persons required to process your application, a fingerprinting fee of fifteen dollars ($15.00) is required, as approved by the City Commission. (Cash, cashier’s check, credit card, or money order) The fingerprints are processed through the Michigan State Police. A $30.00 fee is required by the State of Michigan for each set of fingerprints in addition to the Bay City Department of Public Safety fees. (Check or money order made out to the ‘State of Michigan’.)

The City of Bay City requires fingerprints of applicant(s). Please call the Bay City Department of Public Safety at (989) 895-0927 for an appointment to be fingerprinted.

The results of the fingerprints will be mailed to your home address

from the State of Michigan. It is your responsibility to bring (or mail) the results back to the Department of Public Safety for final processing.

If you have further questions or concerns regarding the Bay City Department of Public Safety licensing requirements, please call (989) 895-0918.

City of Bay City Authorization for Release of Records

Having made application for a __________________________________ License with the City of Bay City, Michigan and desiring that they be informed as to my criminal record or lack of criminal record, I hereby authorize the City of Bay City, Michigan, to investigate my history and to have access to any and all information which may relate to my criminal record or lack of criminal records. I further authorize any person, or entity possessing such information, to furnish such information to the City of Bay City, Michigan. I also release the City of Bay City, Michigan, and any person or entity providing such information to the City of Bay City, Michigan, from any liability, for damages of any kind, which may result from the release of such information to the City of Bay City, Michigan. A copy of this authorization shall have the same force as the original. (Please Print) NAME: ________________________________________________________________ ADDRESS: _____________________________________________________________ CITY: _______________________ STATE: ________________ ZIP: ______________ SOCIAL SECURITY NUMBER: ____________________________________________ DATE OF BIRTH: ________________________________________________________ DRIVER’S LICENSE: _____________________________________________________ ____________________________________ ____________________ SIGNATURE DATE

BAY CITY MICHIGAN

PLANNING DEPARTMENT

SITE PLAN CHECKLIST

Date:

Completed by

Staff member:

Applicant Name:

Property Address:

Requirements of Site Plan for submittal to P.C.

9 copies – 11”x17” of fully dimensioned site plan and building elevation plans

3 copies – 24”x36” fully dimensioned site plans

1 digital file in Adobe Acrobat PDF file format

Provide all

Checked

Items

Meets Minimum

Requirement Comments

1. Property Lines

2. Setbacks from lot linea (Article XIV, Section 122-

303,304,305)

Front yard

Rear yard

Side yard

Side street

3. Property Description

4. Lot Size, all dimensions

5. North Arrow

6. Location Map

7. Scale (Scale at least 1” = 20’ )

8. Easements/ Right-of-Way

9. Professional Seals

10. Existing and proposed principal

buildings, size & height, elevations

11. Accessory buildings, Size & Square

Footage

12. Phases of Development

13. Delineation and Boundaries of

Phases

PLANNING DIVISION Site Plan Checklist p. 2

Provide all

Checked

Items

Meets Minimum

Requirement Comments

14. Parking areas (Section 122-381)

Barrier Free Parking, Size, and

Number of Spaces

Screening (Section 122-402 and

122-403)

Parking circulation/ traffic arrows

Wheel blocks, wheel curbing, etc.

(Section 122-382 (b)( 5) )

15. Drives and curb cuts

16. Adjacent curb cuts

17. Curb and gutter

18. Buffering and screening

19. Exterior lighting (Section 122-60)

Height

Type

Location

20. Utility/ transformer box location

21. Landscaping plans (Section 122-

401)

22. Required landscaping in front yards,

greenbelt or screening (Section 122-

402(E))

Front Yard

Rear Yard

Side Yard

Street Side Yard

23. Loading area (Section 122-384)

24. External storage

25. Trash and sold waste disposal

(Section 122-68)

Location:

Screening:

26. Fire protection /hydrant location

27. Pedestrian circulation, Sidewalks

(Section 122-63)

28. Adjacent sidewalk location

29. Flood hazard

Lowest floor – elevation

100-year floodplain elevation

Wetlands

PLANNING DIVISION Site Plan Checklist p. 3

30. Signs (Section 122-441)

Location

Type

Size/ height

31. Streets – public and private (Section

122-65)

32. Catch basins/ Manholes, Site drainage elevation drawings/survey

33. Sanitary Sewer, Size, lead,

connection, etc.

34. Storm Sewer, Size, lead,

connection, etc.

35. Water Mains, Size, lead,

connection, etc.

36. Overhead utilities

37. Other

Sec. 122-323. Pre-application consultation.

Applicants must submit a preliminary site plan which includes the following information in order to initiate this

process:

A. The name, address and telephone number of the applicant and property owner. The name of the proposed

use, if any;

B. A scale and north arrow;

C. The exterior boundaries (with dimensions) of the property. The location and name(s) of abutting street;

D. The type(s) and location of proposed land use(s), and an indication of the approximate land area to be

devoted to each use;

E. The approximate location of lots and buildings with an indication as to the use of each;

F. Driveways providing ingress and egress. Driveways on adjoining properties and on properties separated

from the subject property by a public or private street;

G. Routes for vehicular and pedestrian circulation;

H. Off-street parking and loading areas;

I. Open space, common and recreation areas;

J. Natural features, including stands of trees, drainage and water courses and wetlands.

Sec. 122-324. Application for site plan review.

Applications for site plan review shall be submitted to the planning division and shall consist of the following

materials and information:

A. A completed application form;

B. An application fee;

C. Three sets of plans at 24 by 36 inches; 9 sets, Z-folded, at 11 by 17 inches; and one digital copy in a

format designated by the planning division of a site plan illustrating the following information (unless

deemed unnecessary by planning division staff):

1. The name, address and phone number of the applicant. The name, address and phone number of the

property owner. The proposed name of the project, if any;

PLANNING DIVISION Site Plan Checklist p. 4

2. The date of preparation, scale, a north arrow and location map. The date(s) of subsequent revisions shall

also be indicated;

3. A small scale illustration indicating the zoning designation of the subject and adjoining properties.

4. The area of the property in acres and square feet;

5. Exterior and interior lot lines with dimensions;

6. Adjoining streets and sidewalks with an indication of pavement width;

7. Driveways on adjoining properties and on properties separated from the subject property by a public or

private street;

8. All existing and proposed buildings and structures with an indication as to the use of each. Indicate

exterior dimensions, number of stories and height in feet, and square footage;

9. Existing and proposed driveways, on-site roadways, off-street parking and loading areas (indicate number

and typical dimensions of parking and loading spaces) and pedestrian circulation system. Include a

typical cross-section of proposed roads, driveways and access aisles;

10. All exterior lighting fixtures (building mounted and freestanding) indicating height and type of

luminaires;

11. Refuse receptacles. Indicate method of screening, if required;

12. Proposed landscaping and screening with an indication as to size, type and quantity of plant materials.

Whether an in-ground irrigation system is to be provided. Existing trees having a caliper of six inches or

greater measured 12 inches above grade;

13. Exterior HVAC and electrical equipment and similar appurtenances. Indicate method and location of

screening;

14. Existing natural features, if any;

15. Utilities and utility easements, including storm drainage improvements and structures (existing and

proposed);

16. Outdoor storage areas, if any. Indicate method and location of screening;

17. Required setback lines. The distance between individual buildings and buildings and lot lines;

18. Proposed and required walls and fences, indicating type and height;

19. Location of signs (building mounted and free-standing) with an indication as to type, size, height and

illumination; and

20. Ancillary structures, such as walls columns, gates and similar structures delineating nonresidential and

residential developments.

21. Proposed building elevations.

PLANNING DIVISION Site Plan Checklist p. 5

PLEASE NOTE:

Site plans are reviewed by the Building Department specific to site related issues such as building setbacks and

barrier free parking.

Building construction plans for plan review must be submitted independently to the Building Code Official in

Suite 211.

Pre-Application Meeting ___________________________________________________________________________________________

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City of Bay City – Building Division 301 Washington Avenue, Bay City, MI 48708 Inspections: 989-894-8162 Fax Telephone: 989-894-8224

Permit Number

Receipt Number

Check Number

BS&A Receipt

Total Permit $

Building and Zoning Permit Application Separate applications are required for Plumbing, Mechanical, and Electrical Permits

ADDRESS OF WORK: PROPERTY OWNER:

OWNER’S PHONE #

OWNER ADDRESS

CITY STATE ZIP

OWNER E-MAIL ADDRESS

CONTRACTOR NAME:

CONTRACTOR’S PHONE: CELL # / PAGER

ADDRESS CITY

STATE ZIP

BUILDERS LICENSE NUMBER EXPIRATION DATE

EMAIL ADDRESS:

FEDERAL EMPLOYER ID (OR REASON FOR EXEMPTION) MESC EMPLOYER NUMBER (OR REASON FOR EXEMPTION)

CONTRACTOR E-MAIL ADDRESS

WORKERS COMP INSURANCE CARRIER (OR REASON FOR EXEMPTION) ARCHITECT OR ENGINEER NAME PHONE #

ADDRESS CITY STATE ZIP

LICENSE NUMBER EXPIRATION DATE

EMAIL ADDRESS:

TYPE OF IMPROVEMENT AND PLAN REVIEW

NEW BUILDING MOBILE HOME

ADDITION ACCESSORY

ALTERATION FOUNDATION ONLY

REPAIR MOVING

WRECKING OTHER_________

USE OF BUILDING

ONE FAMILY (R3) TWO FAMILY (R3) MULTI FAMILY (R2) NO.___________ ATTACHED GARAGE (R3) DETACHED GARAGE (U)

MOTEL (R1) STORAGE, WAREHOUSE (S1,2) MERCANTILE, STORE (M) INSTITUTIONAL (I1,2,3) EDUCATIONAL (E)

AMUSEMENT (A1,2,3,5) CHURCH (A4) FACTORY (F1,2) OFFICE, BUSINESS (B) OTHER ______________________

Page 1 of 4

Page 2 of 4

VALUE OF CONSTRUCTION: $______________________________ (LABOR & MATERIALS) DESCRIBE IN DETAIL THE WORK YOU ARE DOING. (FOR EXAMPLE: BUILDING A BEDROOM ADDITION AND TAKING OUT BEARING WALLS TO MAKE THE LIVING ROOM LARGER). YOU MAY ATTACH PLANS. DESCRIBE ANY NEW USE OF YOUR BUILDING.

TYPE OF CONSTRUCTION

WOOD

HEAVY TIMBER

MASONRY, STEEL

NON-COMBUSTIBLE TYPE 2

NON-COMBUSTIBLE TYPE 1

NUMBER OF STORIES ____________ FLOOR AREA (SQ.FT.) 1ST FLOOR_____________ BASEMENT_________________ 2ND FLOOR _____________ OTHER __________________ 3RD FLOOR _____________

APPLICANT INFORMATION

APPLICANT IS RESPONSIBLE FOR THE PAYMENT OF ALL REQUIRED FEES AND CHARGES AND MUST PROVIDE THE FOLLOWING INFORMATION: NAME:

PHONE:

ADDRESS:

CITY: STATE ZIP

FEDERAL ID # OR DRIVER LICENSE #

E-MAIL ADDRESS CELL PHONE /CONTACT NUMBER:

I HEREBY CERTIFY THAT THE PROPOSED WORK IS AUTHORIZED BY THE OWNER OF RECORD AND THAT I HAVE BEEN AUTHORIZED BY THE OWNER TO MAKE THIS APPLICATION AS HIS AUTHORIZED AGENT, AND WE AGREE TO CONFORM TO ALL APPLICABLE LAWS OF THE STATE OF MICHIGAN. ALL INFORMATION SUBMITTED ON THIS APPLICATION IS ACCURATE TO THE BEST OF MY KNOWLEDGE. I AGREE TO FOLLOW THE REQUIREMENTS OF THE LAWS, CODES AND ORDINANCES OF THE CITY OF BAY CITY. I UNDERSTAND AN INSPECTOR IS AUTHORIZED TO INSPECT MY CONSTRUCTION UNTIL WORK IS COMPLETED AND A CERTIFICATE OF OCCUPANCY IS ISSUED. I UNDERSTAND IT IS MY RESPONSIBILITY TO NOTIFY THE INSPECTOR WHEN MY CONSTRUCTION IS READY FOR INSPECTION. SECTION 23A OF THE STATE CONSTRUCTION CODE ACT OF 1972, ACT NO. 230 OF THE PUBLIC ACTS OF 1972, BEING SECTION 125.1523A OF THE MICHIGAN COMPILED LAWS, PROHIBITS A PERSON FROM CONSPIRING TO CIRCUMVENT THE LICENSING REQUIREMENTS OF THIS STATE RELATING TO PERSONS WHO ARE TO PERFORM WORK ON A RESIDENTIAL BUILDING OR A RESIDENTIAL STRUCTURE. VIOLATORS OF SECTION 23A ARE SUBJECT TO CIVIL FINES. SIGNATURE OF APPLICANT:

DATE:

Page 3 of 4

SITE PLAN

THIS SECTION MUST BE COMPLETED FOR ALL NEW BUILDINGS, ADDITIONS, OR CHANGE OF USE. SHOW ALL OF THE FOLLOWING:

• PROPOSED CONSTRUCTION • EXISTING BUILDINGS • DISTANCE FROM PROPERTY LINE TO BUILDINGS • PROPERTY DIMENSIONS • BUILDING DIMENSIONS • OVERHANGS • DISTANCE BETWEEN BUILDINGS

YOU MAY ALSO NEED TO SHOW THE FOLLOWING IF THE ENGINEERING OR ZONING DEPARTMENTS REQUIRES IT FOR APPROVAL:

• PARKING - EXISTING & PROPOSED • SIDEWALKS TO BE REPLACED • CURB CUTS TO BE REMOVED • DRIVEWAY OPENINGS • UTILITY LOCATIONS • CURBS • DRAINAGE • NUMBER OF PARKING SPACES: EXISTING_______________ PROPOSED______________

YOU MAY USE A SEPARATE SHEET TO SHOW REQUIRED INFORMATION.

Page 4 of 4

THIS PAGE FOR CITY USE ONLY!

REQUIRED: APPROVED BY:

FLOOD ZONE

ENGINEERING

SOIL EROSION

BFD VARIANCE

ZONING Room 409 or 413

ZONE:_________________

BUILDING PLAN REVIEW

ZONING PLAN REVIEW

SITE PLAN NO._____________

ARCHITECTURAL REVIEW

ZONING APPEAL

APPEAL NO. ______________

BUILDING APPEAL

APPEAL NO._______________

SHOWN

NORTH:

EAST:

SOUTH:

WEST:

SETBACKS:

REQUIRED NORTH:

EAST:

SOUTH:

WEST:

COMMENTS OR NOTES APPROVED TO ISSUE BY: CONDITIONS:

Page 1 of 2

`

I. Job Location: Name of Owner/Agent Has a building permit been obtained for this project?

□ Yes □ No □ Not Required Street Address and Job Location

II. Contractor/Homeowner Information: Indicate who the applicant is: □ Contractor □ Homeowner

Name State License Number Expiration Date

Address, City, State and Zip Code

Telephone #

Cell # Email Address

Federal Employer ID #

Workers Compensation Insurance MESC Employer #

IIIII. Type of Job: □ Single Family □ New □ Commercial □ New □ School □ Alteration □ Alteration □ Other (Description): ___________________ □ Other □ Other ____________________________________

IV. Plan Review Requirements: Plans must be submitted with an application for plan examination and the appropriate deposit before a permit can be issued except as listed below: Plans are not required for the following:

1. When the electrical system rating does not exceed 400 amps and the building is not over 3,500 square feet in area. 2. Work completed by a governmental subdivision or state agency costing less than $15,000.00.

If the work being performed is described above, check the box below marked “Plans Not Required.” Plans are required for all other building types and shall be prepared by or under the direct supervision of an architect or engineer licensed pursuant to 1980 PA 299 and shall bear that architect’s or engineer’s seal and signature. What is the rating of the service or feeder in ampere? ________________________ What is the building size in square footage? ________________________________ Plan Review Submission No. _________________________ □ Plans Not Required

V. Applicant Signature Section 23 of the State Construction Code Act of 1972, 1972 PA 230, MCL 125.1523A, prohibits a person from conspiring to circumvent the licensing requirements of this state relating to persons who are to perform work on a residential building or a residential structure. Violators of Section 23a are subjected to civil fines.

Signature of Contractor or Homeowner (Homeowner’s signature indicates compliance with Section VI. Homeowner Affidavit)

Date:

Permit # _______________ Permit Cost $ ___________ Receipt # ______________ Check # _______________ BS&A # _______________

Electrical Permit Application Building Code Enforcement Department

301 Washington Avenue, Suite 211 Bay City, MI 48708 – (989) 894-8162

Page 2 of 2

VI. Homeowner Affidavit: I hereby certify the electrical work described on this permit application shall be installed by myself in my own home in which I am living or about to occupy. All work shall be in accordance with the current electrical code and shall not be concealed, covered up or put into operation until it has been inspected and approved by the electrical inspector. I will cooperate with the electrical inspector and assume the responsibility to arrange for necessary inspections. Section 23a of the State Construction Act of 1972, Act No. 230 of the public acts of 1972, being Section 125 of the Michigan Complied laws, prohibits a person from conspiring to circumvent the licensing requirements of this state relating to persons who are to perform work on a residential building or residential structure. Violators of Section 23a are subject to civil fines. I agree to abide by all requirements of the electrical code including a calling for inspection and being present during the inspection before any electrical work is covered or used and upon completion.

Contractor’s or Homeowner’s Signature:

Date: Telephone #:

VII. Fee Schedule:

Fee # Items Total Fee # Items Total

Permit Base Fee $60.00 1 $60.00 Equipment Up to 20 KVA or HP

$15.00

Temporary Service $30.00 Equipment 21 to 50 KVA or HP

$28.00

Service – Through 200 AMP $35.00 Equipment 51 KVA or HP and Over

$40.00

Service – Over 200 AMP Through 600 AMP

$50.00 Fire Alarm – For Up to 10 Stations and Horns

$165.00

Service – Over 600 AMP Through 800 AMP

$70.00 Fire Alarm – For Over 10 Stations and Horns

$240.00

Circuits $8.00 Each

Energy Retrofit – Temperature Control

$60.00

Lighting Fixtures (Per 20)

$18.00 Temperature Control Device

$7.00 Each

Dishwasher, Range Hood, Garbage Disposal

$12.00 Each

Subtotal:

Furnace $14.00 Do Not Add Base Fee to the Following:

Electrical Heating Unit $12.00 Administration Fee – Up to $250.00 ***

Power Outlet (i.e. Range, Dryer)

$20.00 Information (Courtesy) Inspection

$60.00

Sign, Per Circuit $18.00 Per Hour Inspections $60.00

Feeders, Bus Ducts, Sub Panels Per 50’

$20.00 Per Additional Inspection

$60.00

Mobile Home Site $18.00 License Registration Fee

$8.00

Recreational Vehicle Site $12.00 Total Permit Application Fee:

Plan Review Fee:

*** An administrative fee of the cost of the regular permit (up to $250.00) will be added to the regular permit fee when work requiring a permit is started before the permit is issued and department action has been taken to require a permit to be obtained.

Please make checks payable to City of Bay City. Forward the completed application and payment to: City of Bay City, Building Code Enforcement Department, 301 Washington Avenue, Suite 211, Bay City, MI 48708

Page 1 of 2

I. Job Location: Name of Owner/Agent Has a building permit been obtained for this project?

□ Yes □ No □ Not Required Street Address and Job Location

II. Contractor/Homeowner Information: Indicate who the applicant is: □ Contractor □ Master □ Homeowner □ Water Treatment Installer

Name

Address, City, State and Zip Code

State License Number Expiration Date

Telephone #

Cell # Email Address

Federal Employer ID #

Workers Compensation Insurance MESC Employer #

IIIII. Type of Job: □ Single Family □ New □ Commercial □ New □ School □ Special Inspection □ Alteration □ Alteration □ LP Tank □ Other □ Other □ Water Service Only

IV. Plan Review Requirements: Plans must be submitted with an application for plan examination and the appropriate deposit before a permit can be issued except as listed below: Plans are not required for the following:

1. One and two family dwellings containing not more than 3,500 square feet of building area. 2. Alterations and repair work determined by the plumbing official to be of a minor nature 3. Buildings with a required plumbing fixture count less than 12.

If the work being performed is described above, check the box below marked “Plans Not Required.” Plans are required for all other building types and shall be prepared by or under the direct supervision of an architect or engineer licensed pursuant to 1980 PA 299 and shall bear that architect’s or engineer’s seal and signature. Plan Review Submission No. _________________________ □ Plans Not Required

V. Applicant Signature Any permit applicant proposing to install, replace or repair a sewer lead or water line which will attach to the City’s system is required to contact the DPW office at (989) 894-8321, prior to commencing any work. Applicant shall not cut (open) a City street without first obtaining a permit and making arrangement with the DPW to have a City Inspector during any work that would be performed in the city right-of-way. Absolutely no work shall be performed in the city right-of-way without a city permit.

Section 23 of the State Construction Code Act of 1972, 1972 PA 230, MCL 125.1523A, prohibits a person from conspiring to circumvent the licensing requirements of this state relating to persons who are to perform work on a residential building or a residential structure. Violators of Section 23a are subjected to civil fines.

Permit # _______________ Permit Cost $ ___________ Receipt # ______________ Check # _______________ BS&A # _______________

Plumbing Permit Application Building Code Enforcement Department

301 Washington Avenue, Suite 211 Bay City, MI 48708 – (989) 894-8162

Page 2 of 2

Signature of Licensed Plumbing Contractor, Excavator or Homeowner (Homeowner’s signature indicates compliance with Section VI.)

Date:

VI. Homeowner Affidavit: I hereby certify the plumbing work described on this permit application shall be installed by myself in my own home in which I am living or about to occupy. All work shall be in accordance with the current electrical code and shall not be concealed, covered up or put into operation until it has been inspected and approved by the plumbing inspector. I will cooperate with the plumbing inspector and assume the responsibility to arrange for necessary inspections. Section 23a of the State Construction Act of 1972, Act No. 230 of the public acts of 1972, being Section 125 of the Michigan Complied laws, prohibits a person from conspiring to circumvent the licensing requirements of this state relating to persons who are to perform work on a residential building or residential structure. Violators of Section 23a are subject to civil fines. I agree to abide by all requirements of the plumbing code including calling for inspection and being present during the inspection before any plumbing work is covered or used and upon completion.

Contractor’s or Homeowner’s Signature:

Date: Telephone #:

VII. Fee Schedule:

Fee # Items Total Fee # Items Total

Permit Base Fee $60.00 1 $60.00 Vent – Waste and Soil $8.00 Water Closet $14.00 Drinking Fountain – Water

Connected $14.00

Bathtub $14.00 Refrigerator – Water Connected

$14.00

Lavatory $14.00 Water Service – ¾ inch $8.00

Sink (Any Description) $14.00 Water Service – 1 - 3 Inch $14.00

Laundry Tray $14.00 Water Service – 4 inch or Larger

$28.00

Shower Stall $14.00 Water Distribution $8.00

Dishwasher $14.00 Lawn Sprinkler $20.00

Garbage Disposal $14.00 Back Flow Preventer $5.00

Urinal $14.00 Back Flow Preventer Certification

$20.00

Slop Sink $14.00 Subtotal:

Washing Machine $14.00 Do Not Add Base Fee to the Following:

Floor Drain $14.00 Administration Fee – Up to $250.00 ***

Roof Drain $14.00 Information (Courtesy) Inspection

$60.00

Sanitary Sewer $35.00 Water Heater $60.00

Storm Sewer $35.00 Each Additional Water Heater

$20.00

Catch Basin/Manhole $8.00 License Registration Fee $8.00

Sump/Ejector $14.00 Total Permit Application Fee:

Stack – Waste and Soil $8.00 Plan Review Fee:

*** An administrative fee of the cost of the regular permit (up to $250.00) will be added to the regular permit fee when work requiring a permit is started before the permit is issued and department action has been taken to require a permit to be obtained.

Please make checks payable to City of Bay City. Forward the completed application and payment to: City of Bay City, Building Code Enforcement Department, 301 Washington Avenue, Suite 211, Bay City, MI 48708

I. Job Location: Name of Owner/Agent Has a building permit been obtained for this project?

□ Yes □ No □ Not Required Street Address and Job Location

II. Contractor/Homeowner Information: Indicate who the applicant is: □ Contractor □ Master □ Homeowner □ Water Treatment Installer

Name

Address, City, State and Zip Code

State License Number Expiration Date

Telephone #

Cell # Email Address

Federal Employer ID #

Workers Compensation Insurance MESC Employer #

IIIII. Type of Job: □ Single Family □ New □ Commercial □ New □ School □ Special Inspection □ Alteration □ Alteration □ LP Tank □ Other □ Other □ Water Service Only

IV. Plan Review Requirements: Plans must be submitted with an application for plan examination and the appropriate deposit before a permit can be issued except as listed below: Plans are not required for the following:

1. One and two family dwellings when the total building heating/cooling system input rating is 375,000 BTU’s or less. 2. Alterations and repair work determined by the mechanical official to be of a minor nature 3. Business, mercantile and storage buildings having HVAC equipment only, with one fire and not more than 3,500 square feet. 4. Work completed by a governmental subdivision or state agency costing less than $15,000.00

If the work being performed is described above, check the box below marked “Plans Not Required.” What is the building size in square footage? ____________ What is the input rating of the heating system in this building? ______________ Plans are required for all other building types and shall be prepared by or under the direct supervision of an architect or engineer licensed pursuant to 1980 PA 299 and shall bear that architect’s or engineer’s seal and signature. Plan Review Submission No. _________________________ □ Plans Not Required

V. Applicant Signature Section 23 of the State Construction Code Act of 1972, 1972 PA 230, MCL 125.1523A, prohibits a person from conspiring to circumvent the licensing requirements of this state relating to persons who are to perform work on a residential building or a residential structure. Violators of Section 23a are subjected to civil fines.

Signature of Licensed Mechanical Contractor, Excavator or Homeowner (Homeowner’s signature indicates compliance with Section VI. Homeowner Affidavit)

Date:

Permit # _______________ Permit Cost $ ___________ Receipt # ______________ Check # _______________ BS&A # _______________

Mechanical Permit Application Building Code Enforcement Department

301 Washington Avenue, Suite 211 Bay City, MI 48708 – (989) 894-8162

VI. Homeowner Affidavit: I hereby certify the mechanical work described on this permit application shall be installed by myself in my own home in which I am living or about to occupy. All work shall be in accordance with the current electrical code and shall not be concealed, covered up or put into operation until it has been inspected and approved by the mechanical inspector. I will cooperate with the mechanical inspector and assume the responsibility to arrange for necessary inspections. Section 23a of the State Construction Act of 1972, Act No. 230 of the public acts of 1972, being Section 125 of the Michigan Complied laws, prohibits a person from conspiring to circumvent the licensing requirements of this state relating to persons who are to perform work on a residential building or residential structure. Violators of Section 23a are subject to civil fines. I agree to abide by all requirements of the mechanical code including calling for inspection and being present during the inspection before any mechanical work is covered or used and upon completion.

Contractor’s or Homeowner’s Signature:

Date: Telephone #:

*** An administrative fee of the cost of the regular permit (up to $250.00) will be added to the regular permit fee when work requiring a permit is started before the permit is issued and department action has been taken to require a permit to be obtained.

Please make checks payable to City of Bay City. Forward the completed application and payment to: City of Bay City, Building Code Enforcement Department, 301 Washington Avenue, Suite 211, Bay City, MI 48708

VII. Fee Schedule:

Fee # Items Total Fee # Items Total Permit Base Fee $60.00 1 $60.00 Evaporative Cooler $25.00

Furnace – Up To 100,000 BTU $32.00

Ventilation Fan $18.00

Furnace – Over 100,000 BTU $40.00 Ventilation System $25.00

Solid Fuel Equipment – Includes Chimney

$30.00 Exhaust Hood $25.00

Gas Burning Fireplace $30.00 Piping – Minimum Fee (Plus Per Foot)

$20.00

Floor Furnace Including Vent $32.00 Piping Per Foot $.05/Foot

Suspended Heater, Recessed Wall Heater or Floor-Mounted Heater

$32.00 Process Piping or Radiant Heat

$.05/Foot

Separate Applicant Vent $14.00 Domestic Incinerator $40.00

Other Heating/Cooling Units $32.00 Commercial Incinerator $160.00

Boiler/Compressor to 3 HP $32.00 Fire Suppression – Each 10 Heads

$18.00

Other Items Not Listed $25.00

Boiler/Compressor 3 HP to 15 HP $60.00 Subtotal:

Boiler/Compressor 15 HP to 30 HP $80.00 Do Not Add Base Fee to the Following:

Boiler/Compressor 30 HP to 50 HP $110.00 Administration Fee – Up to $250.00 ***

Boiler/Compressor Over 50 HP $190.00 Information (Courtesy) Inspection

$60.00

Absorption System To 100,000 BTU

$32.00 Water Heater $60.00

100,000 to 500,000 BTU $60.00 Each Additional Water Heater

$20.00

500,000 to 1,000,000 BTU $80.00 License Registration Fee $8.00

1,000,000 to 1,750,000 BTU $110.00 Total Permit Application Fee:

Over 1,750,000 BTU $190.00 Plan Review Fee:

Air Handler – Up to 10,000 CFM $25.00

Over 10,000 CFM $40.00

Building Permit Application.pdfBuilding and Zoning Permit ApplicationArchitect or Engineer Name

THIS PAGE FOR CITY USE ONLY!COMMENTS OR NOTES

Contractor: OffHomeowner: OffOther Description 1: Other Description 2: What is the rating of the service or feeder in ampere: N: OffR: Offw: OffAL: Offo: OffC: OffN@: OffOT: OffSC: OffOTH: Off15000: 60005000: 17000: 60007000: 1800 Each: 6000800 Each: 11800: 60001800: 11200 Each: 60001200 Each: 11200: 60001200: 12000: 60002000: 11800_2: 60001800_2: 12000_2: 60002000_2: 11800_3: 60001800_3: 11200_2: 60001200_2: Items1500: Total1500: Items16500: Total16500: Items24000: Total24000: Items6000: Total6000: Items700 Each: Total700 Each: 6000_3: 6000_4: 6000_21: 6000_22: 6000_23: 6000_31: 6000_41: 800-1: Name of OwnerAgent: Yes: OffStreet Address and Job Location: Name: Address City State and Zip Code: State License Number: Expiration Date: Telephone: Cell: Email Address: Federal Employer ID: Workers Compensation Insurance: MESC Employer: Single Family: OffAlteration: OffPlan Review Submission No: N3: OffNR: OffCon: OffHO: OffM: OffWTI: OffN6: OffAlt2: OffOT2: OffNew7: OffO8: OffS7: OffLP1: OffWSO: OffSI1: OffPNR: OffDate: Date_2: Telephone_2: Items800: Total800: 11400: 60001400: Items1400: Total1400: 11400_2: 60001400_2: Items1400_2: Total1400_2: 11400_3: 60001400_3: Items800_2: Total800_2: 11400_4: 60001400_4: Items1400_3: Total1400_3: 11400_5: 60001400_5: Items2800: Total2800: 11400_6: 60001400_6: Items800_3: Total800_3: 11400_7: 60001400_7: 11400_8: 60001400_8: Items500: Total500: 11400_9: 60001400_9: Items2000_2: Total2000_2: 11400_10: 60001400_10: ItemsSubtotal: TotalSubtotal: 11400_11: 60001400_11: 11400_12: 60001400_12: 11400_13: 60001400_13: 13500: 60003500: 6000_2: 13500_2: 60003500_2: 1800: 6000800: 800: 11400_14: 60001400_14: Total Permit Application Fee: 1800_2: 6000800_2: Plan Review Fee: Text11: Text12: Text13: Text14: Text15: Text16: Street Address and Job LocationRow1: Federal Employer ID Row1: Workers Compensation InsuranceRow1: MESC Employer Row1: What is the building size in square footage: What is the input rating of the heating system in this building: Check Box1: OffCheck Box2: OffCheck Box3: OffCheck Box4: OffCheck Box5: OffCheck Box6: OffCheck Box7: OffCheck Box8: OffCheck Box9: OffCheck Box10: OffCheck Box11: OffCheck Box12: OffCheck Box13: OffCheck Box14: OffCheck Box15: OffCheck Box16: OffCheck Box17: OffCheck Box18: OffCheck Box19: Off Items2500: Total2500: 13200: 60003200: Items1800: Total1800: 14000: 60004000: Items2500_2: Total2500_2: 13000: 60003000: Items2500_3: Total2500_3: 13000_2: 60003000_2: Items2000: Total2000: 13200_2: 60003200_2: Items05Foot: Total05Foot: 13200_3: 60003200_3: Items05Foot_2: Total05Foot_2: Items4000: Total4000: 13200_4: 60003200_4: Items16000: Total16000: 13200_5: 60003200_5: Items1800_2: Total1800_2: Items2500_4: Total2500_4: 16000: 60006000: 18000: 60008000: 111000: 600011000: 119000: 600019000: 6000: 13200_6: 60003200_6: 16000_2: 60006000_2: 2000: 18000_2: 60008000_2: 111000_2: 600011000_2: 119000_2: 600019000_2: 12500: 60002500: 14000_2: 60004000_2: Text20: Text21: Text22: Text23: Text24: Text25: