Fillable BUILDING PERMIT APPLICATION (Washington County)

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BUILDING PERMIT APPLICATION (Washington County)

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YOUR APPLICATION CANNOT BE ACCEPTED UNTIL IT IS COMPLETE.
PLEASE ALLOW TWO TO FOUR WEEKS FOR PROCESSING AND REVIEW.
BEFORE SUBMITTING YOUR APPLICATION, PLEASE MAKE SURE YOU COMPLY WITH THE
FOLLOWING:
Calculate your fee & enclose payment.
Make check payable to the Washington County Treasurer.
This is
a non-refundable application fee.
Attach TWO copies of your plans.
Your plans NEED to be stamped by a NYS licensed architect or engineer if:
DEPARTMENT OF CODE ENFORCEMENT
Washington County Annex I Office Building
415 Lower Main St.
Hudson Falls, New York 12839
Phone: (518) 746-2150 Fax: (518) 746-2175
BUILDING PERMIT APPLICATION
A similar form (LRCC #2) needs to be signed at the completion of your project, BEFORE a Certificate of
Occupancy/Compliance can be issued.
Many projects require a new or updated septic system - please submit if required. Your building permit will be
held until a septic permit is issued if applicable.
DIG SAFELY NEW YORK must be contacted prior to any digging and
CALL 811 BEFORE YOU DIG.
(http://www.digsafelynewyork.com)
If the proposed work creates additional wastewater design flow a Sewage Disposal System Application will be
required to be completed prior to the issuance of a building permit.
Water well test data must be provided for new potable water sources prior to the issuance of Certificate of
Occupancy/Compliance.
Buildings for residential storage
purposes of 144 square feet or less, do not require building permits, but may
be subject to local zoning & setbacks from buildings/structures and property lines.
MOST other projects DO. Change-of-use projects require a permit.
IF YOU ARE IN DOUBT - CALL THIS OFFICE
∙ Your project does not meet the exceptions noted on the back of the application OR
∙ It exceeds the design limits of the NYS Residential Code
Proof of Worker's Compensation Insurance must be supplied before a permit can be issued. Submit either
proof of Worker's Compensation Insurance, provide affidavits, or complete the attached waiver
Proof of Worker's Disability Benefits Coverage must be supplied before a permit can be issued. Submit
either proof of Disability Benefits Coverage, provide affidavits, or complete the attached waiver
All projects must comply with all town or village local laws.
Local Regulation Compliance sheet (LRCC #1) needs to be signed by your local official BEFORE ANY
PERMIT CAN BE ISSUED. This may require additional time depending on your locality. Inquire at your
town or village office and have the LRCC #1 completed BEFORE submitting your application. Please be
sure that the LRCC #1 is signed by both the applicant & the local official.
Revised February 2018
Revised February 2020
BUILDING WITHOUT A PERMIT PENALTY
Swimming Pools, Above Ground or In ground
Penalty will be equal to the
permit fee or $100.00
whichever is GREATER.
$50.00
Chimney/Woodstove/Heating Equip. Permits
$50.00
Non Residential Structure $200.00
$50.00
Manufactured Housing, Mobile Homes Solar Panels Permit
Single/Double & Triple Wide $100.00
N
YS Approved Modular Home $150.00
Upon request an inspection of a used mobile home prior to
relocating $100.00 plus federal mileage portal to portal
Residential
Up to 12kW $50.00
Over 12kW $100.00
Non Residential
$0.50 per kW
$500.00 minimum
Partial Demolition of Residential Structure $50.00
$100.00
Complete Residential Structure $100.00
Truss Placard Administrative Fee
Conversions: Change of Occupancy Class without Alterations Temporary Certificate of Occupancy
$0.10 / sq. ft. $25.00
Demolition Operating Permit
Non Residential
$0.25 / sq. ft.
$100.00 minimum
Certificate of Occupancy Search
$25.00
$0.20 / sq. ft.
$100.00 minimum
Renewal of Building Permit
$25.00 yr.
Amendment to Building Permit
Repairs/Alterations/Conversions with Alterations
$25.00
Up to 250 Sq. Ft. $50
More than 250 sq. ft.
$0.20 / sq. ft.
$100.00 minimum
$50.00
MISC. Non Residential Construction
$200.00
(Where square footage not applicable)
(i.e.: Equipment Buildings, Stacks, etc.)
Additions to One & Two Family Structures
Residential
$0.15 / sq. ft.
$50.00 minimum
Sewage Disposal System Permit
$75.00
$0.20 / sq. ft.
$150.00 minimum
Public Building if required (no fee)
All non-residential (no fee)
School Inspection
$75.00 per building (All buildings with C.O.)
Non Residential - New Construction
$0.30 / sq. ft.
$200.00 minimum
Re-Inspection of required construction stage
$50.00
When the second inspection of a previously inspected item
is not approved, or;
When a scheduled appointment for an inspection is not
cancelled and the project is not ready for said inspection
upon arrival of Code Enforcement Officer (To be paid
prior to issuance of Final Certificate of Occupancy.)
Multiple Dwelling - New Construction (3 Family or more)
$0.25 / sq. ft.
$300.00 minimum
Garage (Attached, Under or Separate)
Storage and/or accessory structures
Residential Car Ports, Decks, Porches (Unconditioned Space)
Code Enforcement - Fee Schedule
THIS IS A NON-REFUNDABLE APPLICATION FEE.
Fees for Towns, Villages, EMS and Fire Depts. have been formally waived per Public Safety Committee 6/26/12.
EFFECTIVE 06/28/2017
One & Two Family Dwellings - Residential - New Constructio
n
Building Fire Prevention Inspections / Prop. Maintenance
DEPARTMENT OF CODE ENFORCEMENT
Washington County Annex I Office Building
415 Lower Main St.
Hudson Falls, New York 12839
Phone: (518) 746-2150 Fax: (518) 746-2175
Project Location:
BLOCK LOT
R3
R3
R2
R1
DEPARTMENT OF CODE ENFORCEMENT
Washington County Annex I Office Building
415 Lower Main St.
Hudson Falls, New York 12839
Phone: (518) 746-2150 Fax: (518) 746-2175
DATE RECEIVED:
APPROVED WITH
CORRECTIONS
REASONS:
DATE EXAMINED
:
BUILDING PERMIT APPLICATION
FOR OFFICE USE ONLY
APPLICATION NO
.
APPROVED PERMIT NO
.
STREET / ADDRESS
TOWN VILLAGE
TAX MAP SECTION
AMOUNT OF FEE RECEIVED: DISAPPROVED EXAMINED B
Y
MAILING ADDRESS: LESSEE
AGENT
ARCHITECT / ENGINEER
APPLICANT: APPLICANT IS:
NAME: OWNER
N
AME & ADDRESS OF OWNER IF DIFFERENT THAN APPLICANT
:
IF OWNER / APPLICANT IS A CORPORATION GIVE THE NAME
AND TITLE OF TWO OFFICERS:
TELEPHONE # BUILDER / CONTRACTOR
TELEPHONE #
E-MAIL:
OCCUPANCY:
CHECK APPROPRIATE BOX(S)
DESCRIBE
SINGLE FAMILY HOME BUSINESS GROUP B
MULTIPLE DWELLING: STORAGE GROUP S
PERMANENT OCCUPANCY ASSEMBLY GROUP A
ONE - FAMILY DWELLING MERCANTILE GROUP M
TWO - FAMILY DWELLING FACTORY GROUP F
GROUP __
NATURE OF PROPOSED WORK: (CHECK ANY THAT APPLY) ESTIMATED COST (EXCLUSIVE OF LAND)
DESCRIBE COST
TRANSIENT OCCUPANCY INSTITUTIONAL GROUP I
ADULT RESIDENTIAL CARE
(NOT MORE THAN 16 OCCUPANTS)
R4
MISCELLANEOUS GROUP U
OTHER
ALTERATION TO EXISTING STRUCTURE
CHANGE OF OCCUPANCY
CONSTRUCTION OF A NEW STRUCTURE
ADDITION TO EXISTING STRUCTURE
OTHER
Revised January 2019
ENGINEER, ARCHITECT, AND/OR (SUB) CONTRACTORS:
CHECK IF OWNER BUILT
NAME
PHASE OF WORK PHONE EMAIL
Clear Form
Hot Water
Oil
:
DEPARTMENT OF CODE ENFORCEMENT
Washington County Annex I Office Building
415 Lower Main St.
Hudson Falls, New York 12839
Phone: (518) 746-2150 Fax: (518) 746-2175
Foundation Material:
Stone
Concrete
Wood
Insulated Concrete Forms
Other:
Existing / Proposed Building Information: (Complete all that apply)
Foundation Type:
Pier
Frost Wall
Full Foundation Wall
Monolithic or Floating Slab
Slab
Building Construction Type:
Concrete
Steel
Brick
Stone
Wood
Basement Information:
Crawl Space
Walk Out
Finished
Storage
Bedrooms
Laundry
Other:
Building Exterior:
Wood
Stone
Brick
Metal
Shingles
Vinyl
Concrete
Composition
Stucco
Other:
Building Roof:
Wood
Stone
Metal
Shingles
Rubber
Other:
Building Heating & Cooling:
Hot Air
Electric
Gas
Radiant
Solar
Wood
Geothermal
Central Air
Other:
Water Supply:
Public
Community
Individual
Drilled
Surface Water
Well Point
Spring
Dug Wells
Shore Wells
Sewage:
Public
Holding Tank Size:
Gallons
Septic Tank
Percolation Rate
Min/Inch
Depth to Boundary Layer or water table
Additional: (Write number or value of each or N/A for not applicable )
Gallons
Number of Trenches
Width of Trenches
Length of Trenches
3rd Floor:
Bedrooms:
Rooms:
Full Bathrooms:
Half Bathrooms:
Square Feet of:
Basement:
1st Floor:
2nd Floor:
Fireplaces:
Solar Panels:
Kitchens:
Pools:
Reroofing
Attached Garage
Detached Garage
Deck
Sign
Fence
Proposed Building Information: (Complete all that apply)
New Structure
Addition
Alteration
Renovation
Repair
Foundation
Revised February 2018
Open Porch
Covered Porch
Enclosed Porch
Pool Fence
Above Ground Pool
In Ground Pool
Other:
●
●
DEPARTMENT OF CODE ENFORCEMENT
APPLICATION is hereby made to the Washington County Department of Code Enforcement for the issuance of a building permit pursuant to the provisions of Washington
County Local Law No. 3 of 2007, and the Building Codes of New York State. The applicant agrees to comply with all applicable provisions of said law and code as well as all
applicable local, county or state laws and/or ordinances: and swears that all statements contained in this application are true to the best of his/her knowledge and belief.
APPLICANT'S SIGNATURE DATE
IMPORTANT - PLEASE TAKE NOTICE
Washington County Annex I Office Building
415 Lower Main St.
Hudson Falls, New York 12839
Phone: (518) 746-2150 Fax: (518) 746-2175
PLOT DIAGRAM: LOCATE ALL BUILDINGS, APPLICABLE SEPTIC SYSTEMS, AND WATER SUPPLIES (EXISTING AND
PROPOSED). SHOW STREET(S)/ROAD(S) AND THEIR NAME(S) AND SHOW SETBACK DISTANCES FROM
STREET(S)/ROAD(S) AND ADJACENT PROPERTY LINES.
Revised February 2018
ALL APPLICATIONS MUST BE ACCOMPANIED BY TWO (2) SETS OF PLANS OF THE PROPOSED
PROJECT AND SPECIFICATIONS OF THE MATERIALS TO BE USED.
PLANS SUBMITTED MUST BE SIGNED AND SEALED BY AN ARCHITECT OR ENGINEER
LICENSED BY THE STATE OF NEW YORK. EXCEPTIONS TO THIS REQUIREMENT ARE:
New residential construction - 1,500 gross sq. ft. or less
Alterations costing $20,000 or less, which do not involve structural changes or affect public safety.
P
lease note the ACORD forms are
N
OT
acceptable proof of New York State
w
orkers' compensation or disability benefits insurance coverage.
Revised February 2018
Revised February 2018
Project Location:
BLOCK LOT
DEPARTMENT OF CODE ENFORCEMENT
Washington County Annex I Office Building
415 Lower Main St.
Hudson Falls, New York 12839
Phone: (518) 746-2150 Fax: (518) 746-2175
TRUSS TYPE, PRE-ENGINEERED WOOD OR TIMBER CONSTRUCTION IN
RESIDENTIAL & COMMERCIAL STRUCTURES
FOR OFFICE USE ONLY
APPLICATION NO. DATE RECEIVED:
OWNER INFORMATION:
NAME:
MAILING ADDRESS:
STREET / ADDRESS TOWN VILLAGE
TAX MAP SECTION
PLEASE TAKE NOTICE THAT THE STRUCTURE IS (CHECK EACH APPLICABLE LINE):
NEW STRUCTURE ADDITION TO EXISTING STRUCTURE
EXISTING STRUCTURE REHABILITATION TO EXISTING STRUCTURE
TO BE CONSTRUCTED OR PERFORMED AT THE SUBJECT PROPERTY REFERENCE ABOVE WILL UTILIZE
(CHECK EACH APPLICABLE LINE): (see back for sign designation)
TELEPHONE #
E-MAIL:
FLOOR FRAMING, INCLUDING GIRDERS AND BEAMS (F) ROOF FRAMING (R)
FLOOR FRAMING AND ROOF FRAMING (FR) OTHER:
STRUCTURE CONSTRUCTION TYPE: (CHECK APPLICABLE LINE): (see back for sign designation)
TRUSS TYPE CONSTRUCTION (TT) PRE-ENGINEERED WOOD CONSTRUCTION (PW)
TIMBER CONSTRUCTION FLOOR (TC) OTHER:
IN THE FOLLOWING LOCATION(S) (CHECK EACH APPLICABLE LINE): (see back for sign designation)
APPLICATION is hereby made to the Washington County Department of Code Enforcement for the issuance of a building permit pursuant to the provisions of Washington
County Local Law No. 3 of 2007, and the Building Codes of New York State. The applicant agrees to comply with all applicable provisions of said law and code as well as all
applicable local, county or state laws and/or ordinances: and swears that all statements contained in this application are true to the best of his/her knowledge and belief.
OWNER OR OWNER'S REPRESENTATIVE SIGNATURE DATE
TYPE I NONCOMBUSTIBLE TYPE III NONCOMBUSTIBLE EXTERIOR WALLS
TYPE V (COMBUSTIBLE)
OR ANY MATERIAL
PERMITTED BY CODE
TYPE II NONCOMBUSTIBLE TYPE IV HEAVY TIMBER
OWNER OR OWNER'S REPRESENTATIVE PRINT
Revised February 2018
IDENTIFICATION OF BUILDINGS UTILIZING TRUSS TYPE CONSTRUCTION (check appropriate symbol)
Floor Construction
TYPE I
NONCOMBUSTIBLE
TYPE II
NONCOMBUSTIBLE
TYPE III
NONCOMBUSTIBLE
EXTERIOR WALLS
TYPE IV HEAVY
TIMBER
TYPE V ANY
MATERIAL
PERMITTED BY
Floor Construction
Roof
Construction
Roof
Construction
Required Sign Location(s)
Residential Construction
Commercial Construction
Affixed to electric meter box attached to the exterior of the
structure or affixed to the exterior wall of the residential
structure at a point immediately adjacent to the electric box
or a location likely to be seen by first responders with
approval by the authority having jurisdiction.
Exterior building entrance
doors, exterior exit discharge
doors, and exterior roof access
doors to a stairway
Attached to the door, or attached to a sidelight or the
face of the building, not more than 12 inches (305
mm) horizontally from the latch side of the door
jamb, and not less than 42 inches (1067 mm) nor
more than 60 inches (1524 mm) above the adjoining
walking surface.
Floor & Roof
Construction
Floor & Roof
Construction
Exterior building entrance
doors, exterior exit discharge
doors, and exterior roof access
doors to a stairway
Attached at each end of the row of doors and at a
maximum horizontal distance of 12 feet (3.65M)
between signs, and not less than 42 inches (1067
mm) nor more than 60 inches (1524 mm) above the
adjoining walking surface.
Fire department hose
connections
Attached to the face of the building, not more than
12 inches (305 mm) horizontally from the center line
of the fire department hose connection, and not less
than 42 inches (1067 mm) nor more than 60 inches
(1524 mm) above the adjoining walking surface.
Revised February 2018
Washington County Annex I Office Building
415 Lower Main St.
Hudson Falls, New York 12839
Phone: (518) 746-2150 Fax: (518) 746-2175
LOCAL REGULATION COMPLIANCE CERTIFICATE
TO BE SUBMITTED PRIOR TO ISSUING PERMIT
LRCC #1
DEPARTMENT OF CODE ENFORCEMENT
Property Address:
Project Description:
As further described in the attached Washington County Building Permit Application complies with the following local laws:
TOWN / VILLAGE OF
THIS IS TO CERTIFY that the proposed construction described in Washington County Building Permit complies with all town
and/or village zoning laws or requirements.
Applicant:
Site Plan Review
Other Local Law
No Local Town / Village requirements apply to proposed construction.
N/A YES NO
Flood Plain Law:
This parcel is in a flood plain
This parcel is not in a flood plain
Zoning Ordinance
Mobile Home Ordinance
Subdivision Regulations
If an Adirondack Park Agency Permit is required, has one been issued?
If a Permit from the Lake George Park Commission is required, has one been issued?
If a Permit is required by the NYS Dept. of Environmental Conservation, has one been issued?
If a Permit is required by the NYS Dept. of Health, has one been issued?
If a Permit is required for a new driveway or road access, from NYS D.O.T., Washington Co. DPW, or
your local Town or Village, has one been issued?
The Town of Greenwich DOES require an additional Building Permit Application AND a Driveway
Permit Application. Contact the Greenwich Town Clerk and submit, with this Certificate, to the Town of
Greenwich
If a Flood Hazard Area Permit is required by your local municipality, has one been issued?
Other remarks by Local Official:
The Town of Argyle DOES require an additional Building Permit application, one set of prints, a
Driveway Permit Application & a Local Compliance Checklist to be completed. Contact the Argyle
Town Clerk and submit, with this Certificate, to the Town of Argyle.
Town of Hampton requires "construction use verification form" Application fee is $10.00. Obtain form
from Town of Hampton Clerk
SIGNATURE OF APPLICANT
DATE
SIGNATURE OF LOCAL COMPLIANCE OFFICIAL, OR CHIEF ELECTED OFFICIAL
DATE
Revised February 2018
Revised June 2020
Whitehall Town Supervisor, John Rozell
(518) 499-1535
Whitehall Village David Chaplin
(518) 812-4302
White Creek Supervisor, James Griffith
(518) 677-8545 (office)
ZEO Scott McNeil
(518) 683-1752
Salem Town Supervisor, Evera "Sue" Clary
(518) 854-3277
Putnam Town Galen Seerup
(518) 547-8955
Kingsbury Town Todd Humiston
(518) 747-2188 ext. 3008
Jackson Supervisor, Jay Skellie
(518) 854-7883
Hebron Supervisor, Brian Campbell
(518) 415-7039
Hartford Mark Miller
(518) 632-9151
Hampton Supervisor, David O'Brien
(518) 282-9830 (office)
Greenwich Town Andrew Mollica
(518) 335-9786
Greenwich Village Eric Becker
(518) 232-8252
Granville Town Russell Bronson
(518) 642-1500 / 791-1745
Granville Village Curt Pedone
(518) 642-2640
Fort Ann Town Mark Miller
(518) 639-8929 ext. 5
Fort Ann Village Mayor, Dennis Langlois
(518) 639-4416 (office)
Dresden Supervisor, Paul Ferguson
(518) 499-0552 (home)
Cambridge Village William Reagan
(518) 469-3467
Argyle Town Supervisor, Robert Henke
(518) 638-8681 ext. 12
Argyle Village Mayor, Jonathan Mackenzie
(518) 538-2574
Compliance Officer Contacts for
Local Regulation Compliance Certificate "LRCC" #1 & #2
TOWN/VILLAGE CONTACT PHONE NUMBER
Issued on (date)
Phone: (518) 746-2150 Fax: (518) 746-2175
LOCAL REGULATION COMPLIANCE CERTIFICATE
TO BE SUBMITTED AFTER PROJECT COMPLETION
LRCC #2
DEPARTMENT OF CODE ENFORCEMENT
Washington County Annex I Office Building
415 Lower Main St.
Hudson Falls, New York 12839
with all town and/or village zoning laws or requirements. Project is described as follows:
Applicant:
Site Property Address:
Project Description:
TOWN / VILLAGE OF
THIS IS TO CERTIFY that the completed construction project described in Washington County
Building Permit# complies
Completed construction project complies with all local Town or Village requirements.
No Local Town or Village requirements apply to completed construction project.
Other remarks by Local Official:
SIGNATURE OF LOCAL COMPLIANCE OFFICIAL, OR CHIEF ELECTED OFFICIAL
DATE
SIGNATURE OF APPLICANT
DATE
Revised February 2018
Complete and return to Washington County Code Enforcement, Washington County Annex I
Office Building, 415 Lower Main St. Hudson Falls, New York 12839
Please be advised that NO
Certificate of Occupancy nor Certificate of Compliance will be issued
until this form is submitted.
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BUILDING PERMIT APPLICATION (Washington County)

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Completed 18 July 2020

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