THIS IS AN APPLICATION FOR A BUILDING PERMIT

1.	Read these instructions and carefully complete the application.

2.	No building or structure shall be erected, added to or structurally altered or the use changed until a permit has been issued.

3.	Return the application to the office with the appropriate fee, signed and notarized (where applicable). A line drawing, or schematic and site plan must accompany the application as required by New York State Building Codes. If the plans require the seal and signature of a New York State registered Architect or Engineer as per the New York State Education Law then two sets of plans must be submitted. Example: septic system, manufactured housing foundation, 1500 square feet or more of residential living space, commercial changes or construction, etc.

4.	If a building contractor is listed on the building permit application you must supply proof of workers compensation insurance or an exemption form workers compensation on an approved state form. An Accord form is not acceptable.

5.	The application will be reviewed and a permit will be issued after it has been determined to conform to the New York State Building Codes, current Zoning Regulations and any local laws.

6.	If you are excavating at the site you must call Dig Safely at 1-800-962-7962 or 811 for an underground utility location. Failure to do so will make you liable for any service disruptions.

7.	A precondition for issuance of this permit grants to any authorized official, access for inspection to the site described in this application.

8.	Work for which a building permit is in effect shall be inspected for approval, prior to enclosing or covering each stage of construction, including building location, site preparation, excavation, foundation, framing, superstructure, electrical, plumbing, heat and air conditioning. It is the responsibility of the applicant or contractor to call the Code Enforcement Officer, at the Waddington Town Office 315-388-5629 or at home between the hours of 8:00 AM and 7:00 PM, seven days a week, at 315-322-5555. More than one inspection may be necessary. DO NOT PROCEED TO THE NEXT STEP OF CONSTRUCTION IF SUCH WORK IS “INTERNAL WORK”, otherwise work may need to be removed at the applicant’s expense to conduct the interior inspection. Close coordination with the Code Enforcement Office will greatly reduce this possibility.

9.	A permit may be suspended or revoked if it is determined that the work or use to which it pertains has been misrepresented or falsified in connection with the application for the permit.

10.	If a Certificate of Occupancy is required, the structure shall not be occupied until said certificate is issued.

11.	A permit issued pursuant to this application shall be prominently displayed on the property or premises to which it pertains.

Thank you for your cooperation!			

Anthony McManaman				______________________________
Waddington Code Officer				Signature of Applicant

WADDINGTON BUILDING PERMIT APPLICATION

OFFICE USE ONLY:	
TAX MAP NO.	 		PERMIT NO.:	 	 	
FEE PAID	 		BLDG. & CODES APPROVAL:	 	 	
CASH  o   Visa/Mastercard o  CHECK # ________   	Entered in System o	
 					 	
Referred to:	SLC Planning Board o      Planning Board o       Zoning Board o	 	
Reason:	 	

Date: _____________    Location of Construction:______________________________________________

Name of Property Owner/Renter:	 	Contractor Name:	 	
Address:	 	Address:	 	
City, State, Zip Code:	 	City, State, Zip Code:	 	
Phone:	 	Phone:	 	
								
Electrical Inspector Name:	 	Engineer/Architech Name:	 	
Company:	 					

Check One:	Commercial □	Residential □	Agricultural □			
						
Check Any:	New Construction □	Demolition □	Repair/ Replacement □	Addition □	Alteration □	
	Use Change □					

Check Any:	o	Agriculture Pole Barn	o	Roof 	
	o	Deck or Porch	o	Septic System 	
	o	Garage 	o	Single Wide Trailer	
	o	Handicap Ramps	o	Swimming Pool/Hot Tub	
	o	Electrical Entrance	o	Solid Fuel Burning Appliance 	
	o	Modular Home	o	Temporary Membrane Structure 	
	o	Manufactured Housing (HUD)	o	Utility Building 	
	o	Other ____________________________________________________	

Description of Project:	 	

              Material Cost:____________________ Square Feet:___________________

I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION IN FULL AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK OR USE WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW.

_________________________				_________________________

Signature of Applicant						Signature of Property Owner

	WADDINGTON Building Permit Application….. Continued

FOUNDATION	BASEMENT	WALLS	INSULATION 	PLUMBING	
Brick ___	Crawl Space ___	2 x 4 ___	Ceiling R-39 or R-49 ____	Copper ___	
Concrete ___	Finished ___	2 x 6 ___	Foundation R-15 ___	Pex ___	
Frostwalls ___	Full ___	Metal ___	Floors R-19 ___	Town Water ___	
ICF ___	Partial ___	Other __________	Walls R-23 ___	Well ___	
Monolithic Pour ___	Slab ___				
Wood ___	Unfinished ___				
Other______________					
					
HEATING/COOLING	EXTERIOR	ROOF	POOL/HOT TUB		
Central Air ___	Brick ___	Gravel ___	Above Ground ___		
Electric ___	Stucco ___	Shingles ___	Hot Tub ___		
Fire Place ___	Vinyl Siding ___	Tin/Metal ___	In-Ground ___		
Furnace (Gas, Oil, Electric) ___	Wood Siding ___	Other ______________	Other ________________		
Hydronic (Gas, Oil, Electric) ___	Other ___________				
Solid Fuel ___					

MANUFACTURED HOME COMPANY INFORMATION REQUIRED (HUD)		
Company Name:	 	Phone:	 	
Street Address:	 				
City, State, Zip Code:	 				
NYS Certification Number:	 				

FLOOR PLAN	
						
Please list the number of applicable rooms below:	
						
	Total Number of Rooms	Basement	1st Floor	2nd Floor	Attic	
Living Rooms	 	 	 	 	 	
Bedrooms	 	 	 	 	 	
Dining Rooms	 	 	 	 	 	
Kitchens	 	 	 	 	 	
Bathrooms	 	 	 	 	 	
Other Rooms	 	 	 	 	 	
Finished Basement - Y / N					
Finished Attic - Y / N			

BUILDING CRITERIA	
Depth to Frost: 4-1/2 feet	Ground Snow Load: 60PSF	Wind Speed: 90 mph	Termite:  No	
Seismic Design Category:  Do	Winter Design Temperature: -15°	Ice Barrier Required:  Yes		

PLOT PLAN

•	Show outline of property dimensions.  Indicate all lot lines and roads.
•	Show location of all existing and proposed structures.  Mark existing or proposed structures.
•	Show distances between all structures to each other and to property lines.
•	Show location of well and septic system components (tank, distribution box, leech lines).
•	Show length of leech field runs.
•	Indicate distances between well and leech field and the well and leech field of neighboring property; if within 200’ of your well or leech field.
•	Provide the following information (use additional attachments or blueprints): floor plan, details of foundation, details of wall and roof, insulation, location of windows and doors, ceiling heights, type and location of heating system, location of smoke detectors & carbon monoxide detectors, a site plan showing parking and signage if applicable.

Side Property Line

Rear Property Line																									Front Property Line	

																										

																										

																										

																										

																										

																										

																										

																										

Side Property Line

1 Square = _____ feet

Additional Notes:________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________
Affidavit of Exemption to Show Specific Proof of Workers’ Compensation Insurance Coverage for a 1, 2, 3 or 4 Family, Owner-occupied Residence

**This form cannot be used to waive the workers’ compensation rights or obligations of any party.**

Under penalty of perjury, I certify that I am the owner of the 1, 2, 3 or 4 family, owner -occupied residence (including condominiums) listed on the building permit that I am applying for, and I am not required to show specific proof of workers’ compensation insurance coverage for such residence because (please check the appropriate box):

…

…

I am performing all the work for which the building permit was issued.

I am not hiring, paying or compensating in any way, the individual(s) that is(are) performing all the work for which the building permit was issued or helping me perform such work.

…	I have a homeowners insurance policy that is currently in effect and covers the property listed on the attached building permit AND am hiring or paying individuals a total of less than 40 hours per week (aggregate hours for all paid individuals on the jobsite) for which the building permit was issued.

I also agree to either:

♦	acquire appropriate workers’ compensation coverage and provide appropriate proof of that coverage on forms approved by the Chair of the NYS Workers’ Compensation Board to the government entity issuing
the building permit if I need to hire or pay individuals a total of 40 hours or more per week (aggregate hours for all paid individuals on the jobsite) for work indicated on the building permit , or if appropriate, file a CE-200 exemption form; OR

♦	have the general contractor, performing the work on the 1, 2, 3 or 4 family, owner-occupied residence

(including condominiums) listed on the building permit that I am applying for, provide appropriate proof of workers’ compensation coverage or proof of exemption from that coverage on forms approved by the Chair

of the NYS Workers’ Compensation Board to the government entity issuing the building permit if the project takes a total of 40 hours or more per week (aggregate hours for all paid individuals on the jobsite) for work indicated on the building permit.

___________________________________                                      __________________

(Signature of Homeowner)	(Date Signed)

___________________________________	Home Telephone Number ___________________

(Homeowner’s Name Printed)

Property Address that requires the building permit:

__________________________________

__________________________________

__________________________________

__________________________________

Once notarized, this BP-1 form serves as an exemption for both workers’ compensation and disability benefits insurance coverage.

BP-1 (12/08)	NY-WCB

LAWS OF NEW YORK, 1998

CHAPTER 439

The general municipal law is amended by adding a new section 125 to read as follows:

125. ISSUANCE OF BUILDING PERMITS. NO CITY,TOWN OR VILLAGE SHALL ISSUE A BUILDING PERMIT WITHOUT OBTAINING FROM THE PERMIT APPLICANT EITHER:

1.	PROOF DULY SUBSCRIBED THAT WORKERS’ COMPENSATION INSURANCE AND DISABILITY BENEFITS COVERAGE ISSUED BY AN INSURANCE CARRIER IN A FORM SATISFACTORY TO THE CHAIR OF THE WORKERS’ COMPENSATION BOARD AS PROVIDED FOR IN SECTION FIFTY-SEVEN OF THE WORKERS’ COMPENSATION LAW IS EFFECTIVE; OR

2.	AN AFFIDAVIT THAT SUCH PERMIT APPLICANT HAS NOT ENGAGED AN EMPLOYER OR ANY EMPLOYEES AS THOSE TERMS ARE DEFINED IN SECTION TWO OF THE WORKERS’ COMPENSATION LAW TO PERFORM WORK RELATING TO SUCH BUILDING PERMIT.

Implementing Section 125 of the General Municipal Law

1. General Contractors -- Business Owners and Certain Homeowners

For businesses and certain homeowners listed as the general contractors on building permits, proof that they are in compliance with Section 57 of the Workers’ Compensation Law (WCL) is ONE of the following forms that indicate that they are:

♦	insured (C-105.2 or U-26.3),

♦	self-insured (SI-12), or

♦	are exempt (CE-200),

under the mandatory coverage provisions of the WCL. Any residence that is not a 1, 2, 3 or 4 Family, Owner- occupied Residence is considered a business (income or potential income property) and must prove compliance by filing one of the above forms.

2. Owner-occupied Residences

For homeowners of a 1, 2, 3 or 4 Family, Owner-occupied Residence, proof of their exemption from the mandatory coverage provisions of the Workers’ Compensation Law when applying for a building permit is to file form BP-1 (12/08).

♦	Form BP-1shall be filed if the homeowner of a 1, 2, 3 or 4 Family, Owner-occupied Residence is listed as the general

contractor on the building permit, and the homeowner:

◊	is performing all the work for which the building permit was issued him/herself,

◊	is not hiring, paying or compensating in any way, the individual(s) that is(are) performing all the work for which the building permit was issued or helping the homeowner perform such work, or

◊	has a homeowner’s insurance policy that is currently in effect and covers the property for which the building

permit was issued AND the homeowner is hiring or paying individuals a total of less than 40 hours per week (aggregate hours for all paid individuals on the jobsite) for the work for which the building permit was issued.

♦	If the homeowner of a 1, 2, 3 or 4 Family, Owner-occupied Residence is hiring or paying individuals a total of 40 hours or MORE in any week (aggregate hours for all paid individuals on the jobsite) for the work for which the building permit was issued, then the homeowner may not file the “Affidavit of Exemption” form, BP-1(12/08), but shall either:

◊	acquire appropriate workers’ compensation coverage and provide appropriate proof of that coverage on forms approved by the Chair of the NYS Workers’ Compensation Board to the government entity issuing the building permit (the C-105.2 or U-26.3 form), OR

◊	have the general contractor, (performing the work on the 1, 2, 3 or 4 family, owner-occupied residence (including condominiums) listed on the building permit) provide appropriate proof of workers’ compensation coverage, or proof of exemption from that coverage on forms approved by the Chair of the NYS Workers’ Compensation Board to the government entity issuing the building permit.

BP-1      (12/08)      Reverse