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BUILDING PERMIT APPLICATION
VIEW THESE APPLICATIONS AS PDF FILES
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
Dominic Stagliano (518)568-2662 Supervisor
Lynn Stever - Town Clerk
BUILDING PERMIT APPLICATION
***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
**********To be completed by applicant**********
Name of Applicant_________________________________Date_____________Map#_______
BASIC DESCRIPTION OF PROPOSED PROJECT: _______________________________________________________________________
ESTIMATED COST OF PROJECT: ___________________________________________________________Estimated Start Date________ Estimated Finish Date_________________
FULL NAME & ADDRESS OF OWNER: _________________________________________________
ADDRESS OF PROPOSED PROJECT SITE: _______________________________________BASIC DESCRIPTION OF THE SITE ON WHICH THE PROPOSED WORK IS TO BE DONE:
(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.****
(Circle One or More)
Addition Bath Kitchen _____________Room
Garage Barn Deck Pool
Alterations Bath Kitchen Basement
Deck Porch Other____________________
1. Foundation: Footing Size______________ Concrete Strength_________
2. Foundation Wall: Concrete_____________ Size _____________________Cement Block Size__________________________________
3. Framing: Outside Wall: _______________________________________Inside Wall: ________________________________________ Floor Joists: ______________________________________ Rafters: ___________________ Truss: ________________________ Treated Poles: ______________________________
4. Insulation: Foundation: ________________________________Floors: _____________________________________ Walls______________________________________ Ceiling at Roof_______________________________
5. Wall Finish - Outside: ___________________ Inside: __________________________
6. Roofing - Type: _____________________________________________________
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***
**********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: ___________________________________Date: _________________________________
Occupied As: _____________________________
Planning Board Review Required? ______Yes ______NoName of Owner____________________
Fee Paid TOTAL $_________________________
Money Order #___________________________
Fee Must be Remitted at Time of Application, If Application is rejected, the Fee will be Returned to the Applicant.Signature of Applicant ___________________________________ Date ___________
of the CEO
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.
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