TOWN OF
TOWN OF
CODES ENFORCEMENT OFFICER
Carl Irwin.
PHONE 826-3436 or TOWN OFFICE 826-3432
BUILDING
PERMIT APPLICATION
DATE:_______________________
OWNERS NAME_________________________________PHONE ( )__________________________
APPLICANT'S NAME_____________________________PHONE ( )__________________________
ADDRESS__________________________________________________________________________
INTEREST IN PROPERTY:
OWNER_____LESSEE_____AGENT_____OTHER_______________
EXPLAIN_____________________________________________________________________
TAX MAP NUMBER___________________LOCATION____________________________________
*************************************************************************************
1. Existing Use and Occupancy_________________________________________________________
Intended Use and Occupancy________________________________________________________
2. Nature of Work: New Building_____Addition_____Alteration_____Repair______
Demolition_______Other________Explain_____________________________________________
______________________________________________________________________________
3. Number of Bedrooms by Floor: Basement_____1st floor______2nd floor______
Number and types of Vehicles Garaged________________________________________________
4. Overall Dimensions of Existing Structure:
Front________Rear_______Depth________Height________Number of Stories________________
Overall Dimensions of Proposed Structure:
Front________Rear_______Depth________Height________Number of Stories________________
5.
6. Zoning District__________________________________________________________________
Zoning Permit Number______________________Date of Permit___________________________
7. Planned Construction Start Date_____________________________________________________
Estimated Date of Completion_______________________________________________________
Estimated Cost of Work___________________________________________________________
8. Architect__________________________________Phone ( )______________________________
Address________________________________________________________________________
9. Contractor_________________________________Phone ( )______________________________
Address________________________________________________________________________
10. Specify New York Board of Fire Underwriters, or other authorized agency or organization, who will inspect
and certify electrical work. _________________________________________________________
______________________________________________________________________________
11. Two copies of the following data:
a. Lot layout, drawn to scale, locating clearly all existing and proposed structures and showing all setback dimensions and property lines. Give lot and block numbers, or description according to deed, show street names, and identify whether it is an interior or corner lot.
b. Complete plans and specifications for the proposed construction, which describes the nature of the work to be performed, the materials and equipment to be used and installed and details of structural, mechanical, electrical and plumbing installations.
12. FEE (not including electrical inspection ) SUBMITTED HEREWITH: $______________
NOTE:
MAKE CHECK PAYABLE TO "TOWN OF RUSSIA"
13. No work proposed herein will start prior to the issuance of a Building Permit.
Signature
of Applicant*__________________________________________________________
Title*_________________________________________________________________________
*Duly authorized officer, if applicant is a corporation.
Signature
of Codes Enforcement Officer____________________________________________
If permit is issued and Date issued
________________________________________________
*******************************************************************************
FOR
CODE ENFORCEMENT OFFICER'S USE
Fee Charged__________Building Permit Number_______________Date:________________________
Permit Refused________Date:__________Reason___________________________________________
_____________________________________________________________________________________
Inspections:
Date______________Comments______________________________________________
Date______________Comments______________________________________________
Date______________Comments______________________________________________
Date______________Comments______________________________________________
Date______________Comments______________________________________________
Date______________Comments______________________________________________