VILLAGE OF PITTSFORD, NEW YORK PERMIT NO. ____________
APPLICATION FOR BUILDING PERMIT ISSUED: _______20___
  FEE: $ ____________

TYPE OF PERMIT: (Check applicable type)
  New building or addition/alteration to building _____________
  Conversion or change in type of occupancy or use _____________
  Deck _____________
  Detached Accessory Structure _____________
  Sign _____________
  Chimney, flue, fireplace or solid fuel burning appliance _____________
  Demolition _____________
  Fence _____________
  Other (Describe) _______________________________________________________

INSTRUCTIONS:
A. This application must be filled in by typewriter or in ink and submitted in duplicate to the Village Clerk. One copy will be returned to applicant.
B. A plot plan showing location of lot in relation to adjoining streets, location of existing buildings on the lot, location of the work for which this permit is being issued, and all necessary measurements or dimensions shall be submitted with this application.
C. This application must be accompanied by two complete sets of plans showing the proposed construction and two complete sets of specifications is applicable. These shall describe the nature of the work to be performed, the materials and equipment to be used and installed and details of any structural, mechanical, electrical and plumbing installations.
D. The work covered by this application may not be commenced before issuance of this Building Permit.
E. Any deviation from the plans or drawings approved by the issuance of this Building Permit, will not be made without the written consent of the Village of Pittsford.
F. All work for which this permit has been issued shall be fully completed within one (1) year from the date of issuance at which time this permit shall be expire unless approval is given by the Village Board of Trustess or Board of Appeals for an extension of time.
G. Following are required as noted before the building or work covered by the issuance of this Permit can be occupied or used in whole or in part (to be filled in by issuing authority):
(1) Electrical inspection and certificate of approval from Village approved inspection agency....yes____no___
(2) Certificate of Occupancy......................................................................................................yes____no___
(3) Certificate of Compliance....................................................................................................yes____no___

APPLICATION IS HEREBY MADE TO THE Pittsford Village Clerk for the issuance of a building permit pursuant to the laws and rules and regulations that have been adapted by the Village of Pittsford for the work as described herein.
     
LOCATION OF PREMISES: Building No. ___________ Street_____________________________
  Zoned_____  

OWNER: ________________________________ OCCUPANT: _______________________
ADDRESS: ________________________________   _______________________
  ________________________________   _______________________
TELEPHONE: ________________________________   _______________________