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Home My WebLink AboutJohnson Museum BP Revised 4/26/2013 CITY 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–10AM 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 Demolition/Removal Relocation Site Work Fill/Stock Piling Repair Alteration-1 Alteration-2 Alteration-3 Change of Occupancy Addition Estimated Cost: __________________________ Permit Fee: ________________ Receipt # _______________ General Contractor ____________________________________________________ Tel ___________________ Contractor ______________________________________________ Tel ___________________ Licensed Electrical Contr. ______________________________________________ Tel ___________________ Licensed Plumbing Contr. ______________________________________________ Tel ___________________ City Registered Heating Contr. __________________________________________ Tel ___________________ Existing Use ____________________________________ Proposed Use ________________________________ Project Location:_______________________________________________________________________________ Project Description:_____________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ _______________________________________________________________________________ Energy Code Compliance: Prescriptive REScheck/COMcheck Trade-off Worksheets Analysis Attached: Plans Specifications Other documentation ________________________________________ ___________________________________________________________________________________________________________________________________________ PROPERTY INFORMATION Zone ______ Historic/Landmark Dist/Site Flood Zone: 100yr 500yr ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ OWNER/APPLICANT INFORMATION (Please Type or Print Legibly) Owner _____________________________ Address _________________________________ Tel _____________ Applicant __________________________ Address _________________________________ Tel _____________ Required liability, disability, Workers’ Compensation insurance carried by Owner Contractors will be in force at all times throughout operations. Insurance on file or provided: Liability Workers Comp.Disability State Waiver attached for WC/DIS. 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 ___________________________________________________ Date ______/______/_______ Typed or Legibly Printed Name _____________________________ Email ________________________________ IMPORTANT: Application for informational purposes only. Applicants are asked to enter information on Building Division’s Building Permit application console (address & times listed below). Thank you. Lucas Kline Revised 4/26/2013 CITY OF ITHACA - BUILDING PERMIT This form is deemed an application until approved and upon approval is a valid building permit ________________________________________________________________________________________________________________ Project Address ___________________________________________________________________ Permit #_________________ Received ______/______/______ Issued ______/______/______ Renewed ______/______/______ Denied ______/______/______ Expires _____ years after issue/renewal date Plans to GIS Completed ______/______/______ By:_____________ Insp _________ HUD _________ Project _________________________________________________________ Ent ____________ Constr. Class.______ Sprinkler System: Required_____ Not Required_____ None_____ Assembly Posted Occupancy__________ _____________________________________________________________________________________________ APPROVALS VARIANCES APPEALS _____________________________________________________________________________________________ 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 SPR ______________ ILPC ______________ BZA ______________ CAB ______________ DOS ______________ DPB ______________ BCBA ______________ DEC ______________ IFD ______________ DPW ______________ TCHD ______________ Other ______________ Board of Zoning Appeals: Granted Denied Case #___________________ Date _____________ Building Code Board of Appeals: Case #___________________ Date _____________ NYS Board of Review: Case #___________________ Date _____________ This side for Building Dept use only