70 Church Street, White Plains, New York 10601
Phone: (914) 422 - 1269 * Fax: (914) 422 - 1471
DEPARTMENT OF BUILDING
CITY OF WHITE PLAINS
http://www.cityofwhiteplains.com/
MULTI-FAMILY DWELLINGS & COMMERCIAL CONSTRUCTION
RESIDENTIAL (ONE & TWO FAMILY DWELLINGS)
Permit #:
Assigned Eng:
Present Use & Occupancy:
Sprinkler:
Construction Type :
Proposed Use & Occupancy:
Work Description:
Address:
AssignedCEO:
Site Address:
Zone:
Set Back:
Unit # : Floor # :
Sq Ft :
Page 1 of 4
APPLICATION TYPE:
PERMIT TYPE:( Only one permit per application form )
Application #:
Date Filed:
Fee Amount:
Receipt #:
Reviewed by:
Ins:
Date Issued:
(including labor, material & fixtures)
Contractor:
Contact:
EMAIL:
Address:
Owner or Tenant:
EMAIL:
Contact:
CELL:
PHONE:
FAX:
Contact:
CELL:
PHONE:
EMAIL:
Applicant:
EMAIL:
Address:
CELL:
PHONE:
EMAIL:
Date:
Contact:
CELL:
PHONE:
FAX:
Engineer or Architect:
Address:
Signature:
SBL:
Do you have any employees? Yes No
Electrical
Plumbing
Low Voltage Permit
Fire Alarm
Hoisting
Sign, Awning,Canopy & Bunting
Vertical Transportation
SCAN FEE:
EMAIL:
BUILDING SHORT FORM 12/18
Demolition / Scaffold
Grading /Excavation
Building
(no volume added)
Updated & Substitute C.O.
Temporary Structures
HVAC
Kitchen Exhaust
Boiler
Fire Suppression
Mechanical / Generator
Estimated Cost of Work:
Legalization
CON ED #:
Print Form
Reset Form
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STATE OF NEW YORK
COUNTY OF WESTCHESTER
}
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(PRINT NAME) (OWNER, AGENT, BUILDER, CONTRACTOR)
being duly sworn, deposes and says: that
(PRINT NAME OWNER)
is the owner in fee of the premises to which this application applies; that he/she (the applicant) is duly authorized to make this application; and that the statements
contained here are true to the best of his/her knowledge and belief, and that the work will be performed in the manner set forth in the application and in the plans and
specifications filed therewith, and in accordance with all applicable laws, ordinances and regulations.
(NOTE: The filing of this application does not constitute a permit to commence construction)
Signature of Applicant/Contractor
Westchester County License#
Applicant Sworn Before Me This
Day of
20
AFFIDAVIT OF OWNERSHIP
NOTARY PUBLIC
BUILDING SHORT FORM 12/18
Unique # & NYS #( Fire Alarm Only)
I ,
Page 2 of 4
BUILDING OWNER CERTIFICATION (If applicable):( To be signed by Owner)
I, , hereby certify that I have full knowledge of the proposed alteration at my property as
described herein and take no exception to such activity.
Signature of Property Owner Date
Print Name & Title.
Note: An authorization letter granting the above signed applicant permission to submit this application can be attached to application , in lieu of completing owner certification.
Owner signature not required if work is being done under a Parent Building Permit.
Applicant must provide Parent Building Permit number :
To: Commissioner of Building Subject: Building Permit Application#
Site Address: SBL:
I, , the permitee, to the fullest extent permitted by law, shall save, keep , indemnify and hold
harmless the City of White Plains and their respective officers, officials, employees, and agents from and against all liability, injury, loss or
damage, cost or expense in law or in equity that may at any time arise directly or indirectly by reason of or in the course of performing the work
pursuant to the Building Permit, which may be occasioned by any act or omission of the permitee, any of the permitee's employees, volunteers
or any subcontractor. The foregoing provisions shall not be construed to cause the permitee to indemnify the City of White Plains from it's sole
negligence.
HOLD HARMLESS ( If applicable)
Homeowner to complete only if you will do all the work yourself. ( No employees or subcontractors used.)
Signature:
Date:
Signature:
Applicant /Permitee Name:
Date:
Witness Name:
PERMIT REQUIREMENT AGREEMENT:
I have read, initialed and fully understand the above requirements _______________________________ . Dated: ___________.
(SIGNATURE)
I , _______________________________ , understand and will comply with the following: (Initial each requirement and sign )
(Print Name)
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1. Construction shall not begin until the appropriate permit is issued_____.
2. Construction, alterations or repair work shall not start before 7:00am or continue past 7:00pm on weekdays _____.
3. Construction, alterations or repairs shall not start before 9:00am or continue past 7:00pm on weekends _____.
4. Required erosion and sediment control methods will be installed and inspected prior to start of construction _____.
5. Contractor is responsible to call the W.P.Building Dept for all mandatory inspections_____.
6. Revision to work involving structure or life safety systems shall have approved amended plans prior to doing the work______.
Page 3 of 4
MUST BE COMPLETED FOR ALL PLUMBING APPLICATIONS:
NOTES: A Licensed master plumber and / or certified journeyman shall be present for all plumbing inspections. Plumbing applications shall
only be submitted by a duly licensed Westchester County Master Plumber. File drawings, descriptions, etc. must be per the International
Plumbing Code & the White Plains Supplemental Building Code.
DOES THE WESTCHESTER COUNTY LICENSED PLUMBER HAVE ANY EMPLOYEES?: YES NO
W.C. LAV. BATHS SINK
&
TUB
THE FOLLOWING IS A LIST OF WORK TO BE DONE:
FLOOR SINKS LAUNDRY URINAL SLOP
SINK
DRINKING
FOUNTAIN
FLOOR
DRAINS
H / W
HEATER
H / W HEAT
DEVICE
OTHER
FIXTURE
BSMT
LEVEL
1ST
LEVEL
2ND
LEVEL
3RD
LEVEL
4TH
LEVEL
5TH
LEVEL
6TH
LEVEL
7TH
LEVEL
8TH
LEVEL
9TH
LEVEL
ROOF
LEVEL
OTHER WORK:
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ADDITIONAL FILING INSTRUCTIONS : ( SPECIFIC INSTRUCTIONS AVAILABLE BY PERMIT TYPE )
Page 4 of 4
GENERAL FILING INSTRUCTIONS : (Building Short Form - No Volume Added )
New Residential Building Substainability Suggestions:
1. PLUMBING PERMIT requirements.
2. MECHANICAL PERMIT requirements:
a) Central Vacuum Systems. b) Oil tanks.
c) Chimney Re-Lining d) Battery Room
3. DEMOLITION requirements.
4. HVAC PERMIT requirements.
5. BOILER PERMIT requirements.
6. KITCHEN EXHAUST PERMIT requirements.
7. FIRE ALARM PERMIT requirements.
8. FIRE SUPPRESSION PERMIT requirements.
9. FENCE & WALL requirements.
10. SIGN & AWNING requirements. ( Design Review Board Agenda Requirements)
11. RIGGING & HOISTING requirements.
1. Complete application and have it notarized.
2. File in person at Building Department.
3. Filing hours are Monday through Friday from 9:00 am to 1:00 pm only.
4. Provide copies of all licenses.
5. Provide certificates of insurance made out to The City of White Plains as Holder.
a) General Liability showing The City of White Plains as additionally insured for $1,000,000 coverage /occurance.
Exception: Homeowners shall provide proof of General Liability insurance of $500,000 per occurance.
b) Automobile Liability for $1,000,000 coverage CSL.
c) Statutory Worker's Compensation. (Accord Form not acceptable)
Exception: Contractors with no employees, submit completed NYS Worker's Compensation Board Form#CE-200(12-08).*
: Homeowners with no employees, submit stamped NYS Worker's Compensation Board Form#BP-1(9-07).
d) Statutory N.Y. State Disability. (Accord Form not acceptable)
Exception: Contractors with no employees, submit approved NYS Worker's Compensation Board Form#CE-200(12-08).*
: Homeowners with no employees, submit stamped NYS Worker's Compensation Board Form#BP-1(9-07).
6. Refer to individual instructions for each specific Permit Type. (See below)
7. Incomplete applications will not be processed and will be considered abandoned after six months.
8. Provide all fees in form of check or Money Order payable to The City of White Plains. Scan fee applicable for all applications submitted with attached drawings.
9. Engineers are only available for review & consultations from 9am - 1pm.
10. Legalization work requires signed & sealed drawings and certification letter generated by a NYS licensed Design Professional.
* CONTRACTOR UNDERSTANDS PERMIT ISSUANCE WILL BE DELAYED WITHOUT RECEIPT OF APPROVED FORM#CE-200(06-08).
HAVE YOU CONSIDERED...........
1. Using recycled material in any the building elements?
2. Locating the building on the site to maximize the use of natural lighting?
3. Modular building construction?
4. Using high efficiency insulation such as "Spray foam"?
5. A photovoltaic system for power or water heating?
6. A rainwater harvesting system for irrigation purposes?
7. Energy Star Appliances?
8. Ground source heat pump system for space conditioning?
9. Heat recovery ventilation system?
10. Using high efficiency (low E) double or triple pane windows?
11. Radiant floor (hot water) heating
12. Low flow shower heads?
13. LED lamps in light fixtures?
14. Using Ceiling fans?
15. Using low VOC emitting materials for paints, adhesives, carpets, coating, etc...?
16. Recycling post construction waste?
Note: It is not mandatory that any of the above items be incorporated into your building design/construction unless specifically required by one of the New York State
Codes. If you have any questions about any of the above items, please feel free to contact our offices for additional information. The intent of this document is to
raise awareness of substainability techniques for your consideration when planning your project.
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