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BUILDING PERMIT APPLICATION

VIEW THESE APPLICATIONS AS PDF FILES: Town of Saint Johnsville Building Permit Application

Application for Certificate of Attestation of Exemption from New York State Workers’ Compensation Insurance Coverage.

Town of St. Johnsville

7431 State Highway 5

PO Box 28

St. Johnsville, NY 13452

Lynn Stever - Town Clerk

*** This Application IS NOT a Building Permit, No Building Shall Start Without a Building Permit ***

PLEASE ALLOW 24 TO 48 HOURS FOR APPROVAL OF YOUR APPLICATION

APPLICATION #____________

********** To be completed by applicant **********

PAGE 1

FULL NAME & ADDRESS OF OWNER: _________________________________________________

ADDRESS OF PROPOSED PROJECT SITE: _____________________________________________

PAGE 2

(BELOW PLEASE DRAW A BASIC DIAGRAM OF THE PROPOSED WORK SITE):  Include the location of the proposed structure, well, septic system, property lines, right of ways, road, pond, stream, etc with the approximate measurements in relationship to the proposed structure.

*****ATTENTION: INSURE “ALL” the above that are located on worksite are on the diagram.****

Page 3

Materials List

(Circle One or More)

Addition            Bath               Kitchen                   _____________Room

Garage             Barn               Deck              Pool

Porch               Other____________________________

Size________________________________

Alterations            Bath               Kitchen            Basement

                        Deck              Porch             Other____________________

                        Size _____________________________________________

1. Foundation: Footing Size______________   Concrete Strength_________

2. Foundation Wall: Concrete_____________   Size _____________________

3. Framing: Outside Wall: _______________________________________

PAGE 4

4. Insulation: Foundation: ________________________________

5. Wall Finish - Outside: ___________________  Inside: __________________________

6. Roofing - Type: _____________________________________________________

7. Heating -  Type: _____________  New ____   Addition _________ Replacement ______                                          

8. Plumbing:              New                Addition                   Replacement

9. Electric: New Service? Yes      No   -   New Panel? Yes     No

Smoke Detector            Carbon Monoxide Detector                    Use of GFI

***All new and added wiring require a Third Party Electrical Inspection***

Miscellaneous:

Page 5

**********  TO BE COMPLETED BY THE CODE ENFORCEMENT OFFICER  **********

Building Permit Application:               _______Accepted                  _______Rejected

If rejected, state reason: ________________________________________________________________

Date issued_____________________________                 Date Expires________________________

Building Cost: ___________________________

Building Measurements___________________                P.B. Approved  (if applicable)

                                                                                                     By: ___________________________________

Occupied As: _____________________________

Addition_____________    Other_____________

Planning Board Review Required?  ______Yes  ______No

Address____________________________________________________________________________

Fee Paid TOTAL $_________________________

Check #_________________________________

Money Order #___________________________

Cash_______

Fee Must be Remitted at Time of Application, If Application is rejected, the Fee will be Returned to the Applicant.

 Signature of the CEO  ___________________________________   Date ___________

Page 6

Application for a Building Permit

IMPORTANT NOTICE: READ BEFORE SIGNING

1  Work conducted pursuant to a building permit must be visually inspected by the Code Enforcement Officer and must conform to the New York State Uniform Fire Prevention and Building Code, Town of St. Johnsville Land Use Law, and all other applicable codes, rules and regulations.

2  It is the owner’s responsibility to contact the Code Enforcement Officer at least 24 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 Officer will greatly reduce this possibility. 

3  OWNER HEREBY AGREES TO ALLOW THE CODE ENFORCEMENT OFFICER TO INSPECT THE SUFFICIENCY OF THE WORK BEING DONE PURSUANT 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 READILY DISCERNIBLE FROM SUCH INSPECTION(S).

4  New York State law require 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 requirement to provide Worker’s Compensation and Disability Benefits , the contractor must complete form CE-200APPLY attached hereto.

5  A Certificate of Occupancy or Certificate of Completion is required for each permit and the structure shall not be occupied until said certificate has been issued.

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

7  This permit does not include any privilege of encroachment in, under, or upon and state or county highway, town road, or village street or their right of way.

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

I,_____________________________________, the above named applicant, hereby attest that I am the lawful owner 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.

(Signature)______________________________________________  

Date___________________________                     

Page7

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