| BRIEF DESCRIPTION OF WORK: ________________________________________________________ | |
| ____________________________________________________________________________________ | |
| BUILDING CONTRUCTION CLASSIFICATION | |
| (Per State Uniform Fire Prevention and Building Code Classification)__________________________ | |
| BUILDING OCCUPANCY OR USE | |
| (Per State Uniform Fire Prevention and Building Code Classification) | |
| Existing |
_______________________
|
Intended |
_______________________
|
| ESTIMATED COST OF WORK: | $______________ |
| ARCHITECT AND ADDRESS: | ______________________________________________________ |
| ______________________________________________________ | |
| ______________________________________________________ | |
| CONTRACTOR AND ADDRESS: | ______________________________________________________ |
| ______________________________________________________ | |
| ______________________________________________________ | |
| APPLICANT MUST PRESENT EVIDENCE OF COMPLIANCE WITH SECTION 57 OF THE WORKER'S COMPENSATION LAW OR SECTION 125 OF TEH GENERAL MUNICIPAL LAW. |
| ACCEPTANCE AND APPROVAL OF THIS PERMIT APPLICATION DOES NOT RELEIVE THE AGENT, APPLICANT, ARCHITECT, BUILDER, ENGINEER OR OWNER FROM COMPLYING WITH THE PROVISIONS OF THE NEW YORK STATE UNIFORM FIRE PREVENTION AND BUILDING CODE, NEW YORK STATE ENERGY CONSERVATION CONSTRUCTION COSE, AND THE LAWS OF THE VILLAGE OF PITTSFORD, NEW YORK WHETHER STATED, IMPLIED OR OMITTED IN THE INFORMATION SUBMITTED FOR THIS PERMIT. |
| Dated at the Village of Pittsford, this _______________ day of ___________________, 20_________ | |
|
_______________________________________
|
_______________________________________
|
|
Owner
|
_______________________________________
|
|
Address
|
|
| COPY TO APPLICANT | |
| Revised 5/00 | |