Building Permit Application

Type of work

• New Building
• Alteration
• Addition
• Retaining Wall
• Swimming Pool: in ground / above ground
• Other (specify)

(office use)

• Date Received
• Application #
• Insurance: YES / NO
• Check/Cash Amt.
• Check Number

Application

1. Address of Premises
2. Section, Block, Lot, Zoning District
3. Owner or Lessee (circle one), Address, Telephone Number (H), (W)
4. Proposed Use and Occupancy (list rooms and use by story)
5. Detailed Description of Proposed Work
6. Occupancy classification by occupancy or use; see Article 2, Part 701, NYS Uniform Fire Prevention and Building Code:
   A. Existing Building or Structure ________ Proposed ________
7. Construction classification of building or structure; see Article 2, part 704, NYS Uniform Fire Prevention and Building Code:
   A. Building or Structure ________ Proposed ________
8. Estimated cost of work: $
9. Permit fee: $
   Outside measurements of main building:
   Length ____ft X Width ____ft = ______sq ft X $______ = $______
   Height

Applicant

• Signature by or on behalf of Applicant:
• Print Name:
• Address:
• Phone Number:
• Date:

The full name, address and phone numbers of every person known to be involved in the work proposed hereby are as follows:

• Architect: Name, Address, Phone
• General Contractor: Name, Address, Phone
• Plumber: Name, Address, Phone
• Electrician: Name, Address, Phone

• Zoning Board of Appeals
• Planning Board
• Town Board

NOTE: All permits valid for six months unless renewed.
FEES: Residential - $.15 per square foot of floor area (length X width); Min, fee $20.00
Commercial - $25 per square foot of floor area (length X width); Min, fee $20.00

IMPORTANT NOTICES: READ BEFORE SIGNING.

1. Work conducted pursuant to a building permit must be visually inspected by the Code Enforcement Office and must conform to the New York State Uniform Fire Prevention and building Code, the Code of Ordinances of the C/T/V of TOWN (handwritten), and all other applicable codes, rules or regulations.
2. It is the owner's responsibility to contact the Code Enforcement Office at 866-8106 (handwritten) at least 48 hours before the owner wishes to have an inspection conducted.
   More than one inspection may be necessary. This is especially true for "internal work" which will eventually be covered from visual inspection by additional work (i.e. electrical work later to be covered by a wall).
   DO NOT PROCEED TO THE NEXT STEP OF CONSTRUCTION IF SUCH "INTERNAL WORK" HAS NOT BEEN INSPECTED. Otherwise, work may need to be removed at the owner's or contractor's expense to conduct the interior inspection. Close coordination with the Code Enforcement Office will greatly reduce this possibility.
3. OWNER HERBY AGREES TO ALLOW THE CODE ENFORCEMENT OFFICETO INSPECT THE SUFFICIENCY OF THE WORK BEING DONE PERSUANT TO THIS PERMIT, PROVIDED HOWEVER, THAT SUCH INSPECTION(S) IS (ARE) LIMITED TO THE WORK BEING CONDUCTED PURSUANT TO THIS PERMIT AND ANY OTHER NON WORK-RELATED VIOLATIONS WHICH ARE READILLY DISCERNIBLE FROM SUCH INSPECTION(S).
4. New York State law requires contractors to maintain Worker's compensation and Disability Insurance for their employees. No permit will be issued unless currently valid Worker's compensation and Disability Insurance certificates are attached to this application or are on file with the Bureau of fire Prevention and Inspection Services. If the contractor believes he/she is exempt from the requirements to provide Worker's Compensation and/or Disability Benefits, the contractor must complete form C-105.21, attached hereto.

If a Certificate of Occupancy is required, the structure shall not be occupied until said certificate has been issued.

Work undertaken pursuant to this permit is conditioned upon and subject to any state and federal regulations relating to asbestos material.

This permit does not include any privilege of encroachment in, over, under, or upon any city street or right-of-way.

The building permit card must be displayed so as to be visible from the street nearest to the site of the work being conducted.

________, the above-named applicant, hereby attest that I am the lawful [ow]ner of the property described within or am the lawful agent of said owner and affirm under the penalty [of] perjury that all statements made by me on this application are true.

The left edge of this paragraph is cut off on the scan. Letters in square brackets are not visible on the original.

REQUIRED INSPECTIONS DURING CONSTRUCTION:

1. Footings before pouring concrete.
2. Foundation walls before backfill.
3. Framing before enclosing.
4. Electrical before enclosing.
5. Insulation before enclosing.
6. Plumbing before enclosing.
7. Heating, Ventilation, Air Conditioning before enclosing.
8. Septic System before backfill ( Percolation test also required by certified tester). Septic needs to be designed by an Engineering Professional.
9. Final inspection for Certificate Of Occupancy.

DO NOT enclose any area that needs to be exposed for inspection, because you WILL BE required to open it up.

Inspections need to be scheduled at least one(1) day in advance.

Codes Enforcement Officer
Ken Collis

PROJECT LOCATION AND DETAILS

Please attach a sketch or plot plan!

A sketch of the work to be performed must be made a part of this application. The sketch must include the following:

1. Location of the proposed structure or addition showing the number of stories and all exterior dimensions;
2. The distance of the proposal from all lot lines;
3. The distance of the proposal from any structure including neighboring structures;
4. The depth of the proposed foundation or footers;
5. The maximum percentage of the lot to be covered by building(s);
6. Addition will be used as: Family Room; Living Room; Kitchen; Den; Bedroom; Bath Full -or- Half; Other
7. Basement: Full; Partial; Crawl; Pier; Slab

Sample drawings

The last two pages of the original are hand-drawn examples. They are drawings, not text, so view them in the PDF.

• Page 5: "SAMPLE CROSS SECTION" - a wall section from footings and slab up through block foundation, floor joists, studs and roof framing, with labeled materials and insulation.
• Page 6: "SAMPLE SITE PLAN (ADDITIONS AND GARAGES)" - a lot on State Route 205 showing an existing home, a proposed addition, a proposed or existing garage, well, septic tank, leach field, shed, electric service and stream, with distances to each.