HomeMy WebLinkAboutVon Cramm FAHS Building Permit ApplicationCITY OF ITHACA - BUILDING PERMIT APPLICATION
108 East Green Street, Ithaca, New York 14850 Telephone: 607-274-6508 Fax: 607-274-6521
Building Permit Application must be submitted Mon. -Fri. 8AM-1OAM or by appointment. This side to be completed by applicant.
PROJECT INFORMATION
Project Street Address:
Tax Parcel Number (e.g. 55.-5-5):
Building/Room:
Project Type: New Building 0 Demolition/Removal 0 Relocation 0 Site Work 0 Fill/Stock Piling 0
Repair 0 Alteration -1 0 Alteration -2 0 Alteration -3 0 Change of Occupancy 0 Addition 0
Estimated Cost: (eq t l r t7. -
Permit Fee:
General Contractor C„�s
77 s'")
Contractor
Licensed Electrical Contr. /140-4-4,
Licensed Plumbing Contr. -p F
City Registered Heating Contr.
Existing Use
Project Location:
Project Description:
067 1.0-4,b
Receipt #
Tel 1Qcs1. 7Z
Tel
Tel er1.7
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Tel k, o • art - (.y ,
Tel
Proposed Use
Energy Code Compliance: Prescriptive 0 REScheck/COMcheck 0 Trade-off 0 Worksheets 0 Analysis 0
Attached: Plans li Specifications 0 Other documentation 0
PROPERTY INFORMATION Zone Historic/Landmark Dist/Site 0 Flood Zone: 100yr 0 500yr Cl
OWNER/APPLICANT INFORMATION (Please Print Legibly)
Owner 0-42A-0-°(..1-4.-- -t.-- Address Tel
Applicant /1444 ,7t,, , . Address zz
Tel
�f- gx
Required liability and Workers' Compensation insurance carried by Owner ❑ Contractors 0 will be in force at all times throughout operations
Insurance on file or provided: 0 Liability 0 Workers Comp 0 Disability 0 State Waiver attached for WCIDIS.
I am the owner or agent of the owner of the premises in the City of Ithaca, New York described in this application. I hereby apply for a
permit to perform the work described in this application and on attached plans, specifications and other documents. I will comply with all
provisions of applicable ordinances, codes and regulations in the performance of this work whether specified herein or not. Any
amendment to this application, plans, specifications or other documents upon which this permit was issued will be filed with the Ithaca
Building Department for approval before such changes are made in the actual work. I hereby request that all work be inspected and
approved by the appropriate inspectors. I certify that every person performing work on the permitted project will comply with all
applicable codes, ordinances and regulations.
By my signature I certify I have read and understand the above paragraph.
Applicant Signature
Revised 3/10/11
Date 7 f / v
CITY OF ITHACA - BUILDING PERMIT
This form is deemed an application until approved and upon approval is a valid building permit
This side for
Building Dept
use only
Project Address
Received
Issued
Renewed
Permit #
Denied
Expires years after issue/renewal date 0 Plans to GIS Completed / / By:
Insp HUD Project Ent
Constr. Class. Sprinkler System: Required Not Required None Assembly Posted Occupancy
APPROVALS VARIANCES APPEALS
SPR 0 ILPC
BZA ❑ CAB D
DOS 0 DPB
BCBA ❑ DEC
IFD ❑ DPW ❑
TCHD ❑ Other ❑
Board of Zoning Appeals:
Case # Date 0 0
Granted Denied
Building Code Board of Appeals:
Case # Date
NYS Board of Review:
Case # Date
0 0
PERMIT APPROVAL
This building permit is issued for the work described in this application, submitted plans, specifications and documents. These materials
have been reviewed and found to be sufficient to issue a building permit: This permit is limited to the submitted work. The review does not
address all aspects of applicable codes, ordinances and regulations. It shall be the duty of every person performing work on the permitted
project to comply with all applicable codes, ordinances and regulations.
For the Ithaca Building Department
BUILDING PERMIT CONDITIONS
Revised 3110/