Office Use Only
BP: _____
Inspection:_____
C/O
C/C : _____
911 : _____
No.________
VILLAGE OF
DANSVILLE
TOWN OF
NORTH DANSVILLE
Livingston
County, New York
INSTRUCTIONS:
A. Two
(2) COMPLETED copies of this application to be filled in by typewritter or
in ink and submitted to the Code Enforcement
Office. Any application which is missing information will be denied by the Code
Enforcement Office.
B. A Plot Plans showing location of the
lot and of the buildings on the premises, relation to public streets or areas
and to adjoining premises, giving a DETAILED description of the layout of the
property to be drawn on a diagram which is a part of this application.
C. Two sets of STAMPED
Architectural Drawing for any new construction, additions, dwellings.
D. The work covered
by this application shall not be commenced before the issuance of a building
permit.
E. Upon approval
of this application, the Town Clerk will issue a Building Permit to the
applicant and return one (1) set of the
plans and application. The permit shall be kept on the premises during the
progress of the work.
F. NO Building shall be occupied or
used in whole or in part for any purpose until a CERTIFICATE OF OCCUPANCY shall
have been granted by the Code Enforcement Office. Except that for certain uses
as provided in the Zoning Ordinance a Certificate of Occupancy shall not be
required.
APPLICATION
IS HEREBY MADE to
the Code Enforcement Office for the issuance of a Building Permit, pursuant to
the Zoning Ordinance of the Town/Village of Dansville for the buildings,
additions, alterations or relocation as herein described. The applicant agrees
to comply with all applicable laws, ordinances and regulations.
_______________________________________________________________________________________________
Signature of Applicant Address
1. Owner
Name:__________________________________ Company
Name:__________________________
Owner
Address:________________________________ Owner
Phone#: ___________________________
2. Contractor:____________________________________ Contractor
Phone#: _______________________
Workmans’
Compensation & Disability Carrier & Policy
#:________________________________________
** A COPY OF YOUR INSURANCE CERTIFICATE MUST ACCOMPANY THIS FORM –
NO EXCEPTIONS
3. Location of
land on which the proposed work will be done:______________________________________________
4. Tax Map
No.:____________________________________
[can be found on tax bill]
5. Present
Use:____________________________
Intended Use and Occupancy:_____________________________
6. Nature of
Work: New Structure:_____________ Addition:_________________ Other:________________
Alteration:_________________
Relocation:_______________
6. Estimated
Cost of Project: $___________________
7. If
Dwelling: No# of Stories:
___________ No# of Families:
___________ Garage:___________ Cars:_________
8. If Other
Use, Specify
Use:_______________________________________________________________________
9. Dimensions
of Addition(s):______________________________Area ________________________________Sq.
Ft.
10. Dimensions of New Structure(s):
________________________Area ________________________________Sq. Ft.
11. Size and Area of the lot __________________ Ft. by
__________________Ft. _______________________Sq. Ft.
12. FEE(S): Building:$________ ZBA .:$_______ Planning:$________ TOTAL:$_____________
13. Zone or Use District in which the premises are
situated:________________________________________________
14. Construction Classification:
____________________ Occupancy
Classification: ____________________________
15. Is site within:
FLOOD PLAIN: [ ] Yes
[ ] No Designated WETLANDS: [ ] Yes [ ]
No
16. Proposed method of heating:
_____________________________________________________________________
17. Does the proposed construction or use violate any
Zoning Law or other Ordinance or Regulations? _____________
If Yes,
give
details:_____________________________________________________________________________
18. Materials and thickness of Foundations,
walls:_______________________________________________________
_____________________________________________________________________________________________
19. Roof Construction and
Covering:___________________________________________________________________
_____________________________________________________________________________________________
20. The Plot diagram, shown on page 3 of this
application or on separate drawings, showing location of all buildings,
existing or proposed, together with dimensions from the property lines, the
surface elevation of front yard at the front wall of the principal building as
related to the surface of the street or highway, lot number, street names and
type of lot (interior or corner) and lot description is a part of this
application.
21. If the final area of the structure is less than the
area given in this application, no portion of the fee paid, at the time of the
filing of this application, shall be returned or refunded.
22. The tile field for the disposal off the effluent
from a septic tank shall not be covered until an inspection shall have been
made by an authorized person and approved as meeting the requirements of the
State Department of Health.
23. A PERMIT of
SEWAGE DISPOSAL SYSTEM from the County Department of Health must be
attached.
I HEREBY CERTIFY THAT I AM THE ____________________________________ and that I am duly authorized to make and file this application; that
all statements contained in this application are true to the best of my
knowledge and belief, and that the work will be performed in the manner set
forth in this application and in the plans filed herein.
_____________________________________________
Signature
of Applicant
___________________________________________
Date Code Enforcement
Officer
APPROVED DISAPPROVED_________________________________________
Code Enforcement
Officer
Application is hereby made to the Planning Department
for a Variance/Special Use Permit for the occupancy and use of the premises as
described above for which an application for a building permit has been denied based
upon the following information
___________________________________
Code Enforcement Officer
Office Use Only:
CERTIFICATE
OF OCCUPANCY issued on _____/_______/________ CERTIFICATE
OF COMPLIANCE issued on _____/_______/________
Locate
clearly and distinctly all buildings, whether existing or proposed, and
indicate all yard dimensions from property lines. Give identifying information
or deed description, show street names and adjacent property owner names.
Indicate whether an interior or corner lot.
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