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Intro
| HUALAPAI TRIBAL NATION |
| Office of the Tribal Environmental Review Commission |
| 887 W. Highway 66/P.O. Box 179, Peach Springs, AZ 86434 |
| Phone: 928-769-1310, Fax: 928-769-1377, Inspection Request: 928-769-1310 |
Permitting process below
| All Tribal Departments that you as the Applicant will need to contact and get signatures from are listed below. |
| Tribal Employment Rights Office (T.E.R.O.) Tax which is 5% of project amount and any environmental documents |
| that may be needed for your permit, as well as plan review that you will need to get signatures (the signature |
| page is located on the last page) from are listed. The Hualapai Planning Department will let you know the |
| requirements for your permit, depending on permit purpose and what actions that will be taken during the project. |
| 1 | Contact or come into the Hualapai Planning Dept. to obtain the Permit. Once completed return |
| the permit to Planning Dept. staff to find out what will be required of you to process and approve the |
| permit for your project. This may include a Pre-Application Meeting involving the applicant & signatories |
| 2 | if any new structures will be built, digging, grading or any disturbance of the land, Environmental |
| documentation will be needed as well as Blue Staking. Public Works will Blue Stake water/sewer |
| lines and the applicant will need to contact "Arizona 811" to get all underground lines/cables marked. |
| The Planning Dept. will let you know how to obtain them or, If possible, will assist in obtaining |
| the Environmental Documents for you. Please contact Leland Cardy, Utilities Management at |
| (928) 769-2216 for sewer/water Blue Staking. |
| 3 | If your project entails any building, digging, water, sewer or placing of a building on a site you will |
| need to go through plan review with the Planning Dept. and the Building Inspector and Public Works plan |
| review team, who will sign the signature page after all is approved. Checklist: |
| [ ] | Drawings need to be to scale, construction notes detailing scope of work and materials. |
| [ ] | All applicants contact information labeled on all plans. |
| [ ] | Vicinity map, north arrow label land use, show site and adjacent parcels. |
| [ ] | Existing/proposed driveway locations including existing driveways/both sides of street |
| for a distance of 150' from the site boundary. |
| [ ] | Set backs, distance from property line. |
| [ ] | Show location/size of existing/proposed water and sewer services, adjacent mains and |
| location of other existing/proposed utilities (i.e. electric, phone, cable, gas, grease |
| interceptor, etc.) |
| 4 | Tribal Employment Rights Office will collect any Business lease fee and TERO Tax. This office is |
| located at the Hualapai Tribal Office at 941 Hualapai Way in Peach Springs AZ. phone 928-769-2216. |
| 5 | Depending on the your project, this process can take up to a month, so please start this process |
| quickly. If you have any questions please feel free to call the Hualapai Planning Dept. |
Building Permit Application z
| HUALAPAI TRIBAL NATION |
| Office of the Tribal Environmental Review Commission |
| P.O. Box 179/887 W. Highway 66, Peach Springs, Arizona 86434 |
| Phone: 928-769-1310, Fax: 928-769-1377, Inspection Request: 928-769-1310 |
| TERC Regulation Code the permit is approved under will go here. |
| IMPACT: [ X ] LOW [ ] GENERAL [ ] EXEMPT |
| APPLICANT INFORMATION | | CONTRACTOR INFORMATION | |
| Business Name: | | Business Name: | |
| Contact Name: | | Contact Name: | |
| Address: | | Address: | |
| City: | | City: | |
| State/Zip: | | State/Zip: | |
| Phone: | Fax: | Phone: | Fax: |
| E-mail: | | E-mail: | |
| Business license No.: | | Contractors license No.: | |
| JOB SITE INFORMATION and LOCATION | | CATEGORY OF CONSTRUCTION | |
| Project Name: | | [ ]Master Builder | [ ]Commercial/Industrial |
| Address: | | [ ]Accessory Building | [ ] Other |
| City/State/Zip: | | REQUIRED DATA: COMMERCIAL USE | |
| | CHECKLIST | |
| DESCRIPTION OF PROJECT | | Indicate the value (round to the nearest dollar) of | |
| | all equipment, materials, labor, etc. and the | |
| | profit for the work indicate on this application | |
| | Valuation (Repair Cost): | |
| | Existing Building Area: | square feet |
| | New Building Area: | |
| CROSS STREET/DIRECTIONS | | Number of Stories: | |
| | Occupancy Groups: | |
| | Existing: | |
| | New: | |
| | FOR OFFICAL USE ONLY | |
| NOTICE | | Plot No. | |
| All contractors are required to be licensed with | | Subdivision: | |
| the Arizona Registrar of Contractors and may be | | Tax map/parcel No.: | |
| required to be licensed in the jurisdiction in | | Lot No.: | |
| which work is being performed. If the applicant | | Permit No. | 2023- |
| is exempt from licensing the following reasons | | BUILDING PERMIT FEES | |
| apply: | | Please refer to fee schedule | |
| All permits, after approval will be subject to a | | Fees due upon application: | TERO Tax is 5% |
| holding/posting for seven calendar days before | | Amount received: | |
| the permit is activated, per the Tribal Environmental | | Date Received: | |
| Review Commission Rules, Sec. 402.(f). | | TERO Tax: | |
| * See Appendix C of Rules to implement H.E.R.C. | | | |
Building Permit Application
| PERMIT # 2023- | APPLICATION DATE: | PERMIT VALID UNTIL: |
| PROJECT DESCRIPTION: | | |
| PROJECT ADDRESS/LOCATION: | | |
| BUILDING TYPE: | | PROJECT TYPE: | FRAME TYPE: |
| [ ] Commercial | | [ ] Original | [ ] Wood |
| [ ] Industrial | | [ ] Addition | [ ] Steel |
| # of units | [ ] Alteration/Remodel | [ ] Concrete |
| [ ] Other | | [ ] Repair | [ ] Masonry |
| | [ ] Demolition | [ ] Other |
| PROPOSED USE: | | | |
| NUMBER OF PARKING SPACES (Show on Plot Plan): |
| NUMBER OF ADA PARKING SPACES (Show on Plot Plan): |
| WATER SUPPLY: | TYPE OF HEAT: | | |
| [ ] Private Well | [ ] Electricity | [ ] Oil | [ ] Solar |
| [ ] Public-Name of water system: Hualapai Water Sys. | [ ] Woodstove | [ ] Propane | |
| [ ] Heat Pump | [ ] Other: | |
| SANITARY SEWER SYSTEM: | [ ] Public | [ ] Septic |
| If septic system needed permit number ________________ | | |
| FOOD SERVICE [ ] Yes [ ] No | | |
| TRIBAL & N.E.P.A. CLEARANCES: | |
| [ ] Cultural - T.H.P.O. (required) |
| Department Archaeologist | Date |
| [ ] Cultural not required - | |
| [ ] Biological | |
| [ ] Zoning | |
| [ ] Environmental Assessment (required if general) | |
| IBC OCCUPANCY | | |
| Classification: | |
| IBC TYPE OF CONSTRUCITON | | |
| Classification: | |
| SQUARE FOOTAGE: | | | | |
| Current | | Proposed | |
| First Floor | | ft 2 | | ft 2 |
| Second Floor | | ft 2 | | ft 2 |
| Mezzanine | | ft 2 | | ft 2 |
| Other Building (i.e. outbuilding/shed) | | ft 2 | | ft 2 |
| Other (e.g. decks/porches) | | ft 2 | | ft 2 |
TOTAL VALUATION or ESTIMATED COST
| Authorized Signature: | | |
| Print Name: | | Date: |
| Approved: | | Issue Date: |
| TERC Chairperson | |
&"-,Bold"&14BUILDING PERMIT APPLICATION
SignOff
| Pre-Application Meeting |
| Projects involving the installation of new water or sewer lines serving more than a single-family |
| home, a building project with an anticipated water use of over 500 gallons per day or require grading |
| more than 100 cu. yds. are subject to a pre-application meeting which will be arranged for by the |
| Planning Department and include the signatories and the builder's rep (architect, engineer |
| or contractor). The applicant shall bring any plans & reports so far developed for the project and |
| a general description of the proposal. |
| By signing this form you are stating your Dept. has completed the tasks listed. Please add any notes |
| that you feel pertains to this project. |
| _________________________________ | __________ |
| Building Inspector/Plan Reviewer | Date |
| Work number 928-769-1310 | |
| Notes: | |
| Have all plans passed all Building Codes the Tribe follows? | |
| [ ] Yes | [ ] No |
| _________________________________ | __________ |
| Public Works Director | Date |
| Cell phone number 928-715-8246/Work number 928-769-2216 | |
| Utility Manager's Cell phone number 928-769-6428/Work number 928-769-2216 | |
| Notes: | |
| Is the Home site accessible to sewer and water? (If applicable for this project.) | |
| [ ] Yes | [ ] No |
| Has Tribal Public Works Blue Staked water and sewer lines? | |
| [ ] Yes | [ ] No |
| Have all Water and Sewer Plans been approved by your department? (If applicable for this project.) | |
| [ ] Yes | [ ] No |
Tribal Employment Rights Officer Date
| Cell phone number 928-607-8542/Work number 928-769-2216 |
| Notes: |
| Have all License fees and TERO Tax been paid? If so how much was paid for each? | | | | | |
| License fee paid? | [ ] Yes | [ ] No | TERO Tax paid? | [ ] Yes | [ ] No |
| How much was paid ? | $ | | How much was paid ? | $ | |
This area needs to be signed for all Grand Canyon West Projects.****
| Grand Canyon West Project Coordinator | | Date |
| Phone: (928) 769 -6474 | Fax: (928) 769 -2450 | |
| Notes: | | |
| _________________________________ | __________ |
| Contractor | Date |
| Cell phone number 928-_______________/Work number 928-______________ | |
Notes:
| Have you called Arizona 811 to mark underground lines? | | If so when will this be marked? |
| [ ] Yes | [ ] No | |
&"-,Bold"&12Signature page all signatures are required before permit is approved.
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