This Serves As A Valid Building Permit Only When This Box is Completed & Signed by C.E.O.

 

                                                                                                                                                                                                                                               

Issued:                                                   Expires:                                                  C.E.O.

APPLICATION FOR BUILDING PERMIT

W. Rick Fritz, Code Enforcement Officer                        For questions or inspections: (607)591-9898

 

INSTRUCTIONS: Permit application must include all the following items:

  1. Completed and signed application & plot plan (turn in to Clerk’s as soon as possible for review by C.E.O.).
  2. One set of construction specification drawings with specific details.  Professionally approved plans are required for all commercial projects and all residential 1,500 sq feet and larger.
  3. Proof of Liability and Worker’s Compensation Insurance for contractors.
  4. Septic system approval by Cayuga County Health Dept. when applicable.
  5. Any other required approvals by the Planning Board, Variance Board and/or Health Dept. when applicable.
  6. Floodplain application and approval when applicable.
  7. Permit fee to Village of Moravia for $ ________.

PERMIT PROCESS:            The following process is required according to local law and state code:

  1. Application completed and submitted with required paperwork and approvals.
  2. Permit will be issued upon approval of application. Permit is good for 1 year.  Permit should be prominently displayed on the premises.  No construction shall begin until permit has been issued.
  3. Applicant/owner/contractor shall call to schedule all necessary inspections during the construction process:

Footing_____ Foundation _____ Framing _____ Plumbing _____ HVAC _____ Insulation _____ Final _____

Other ___________________________________________________________________________________

4.      Electrical Inspection must be completed by a certified, third party electrical inspector during and upon completion of system:  Rough-In _____ Final _____ 

  1. Upon completion of construction a final inspection is required, approval for the septic system is required, a final electrical certificate is required along with any other required certifications or inspections.  Once the above is completed and before anyone can move in a Certificate of Occupancy is required by Local and NYS Law.

 

WHEN COMPLETED, ALL PERMITS MUST BE CLOSED WITH A CO/CC PRIOR TO OCCUPANCY OR USE!!!

                                                                                                                                                                                                                                               

Name:                                                                                                                                     Date:

                                                                                                                                                                                                                                               

Mailing Address:

                                                                                                                                                                                                                                               

Phone:                                                                                                                                   Tax #:

                                                                                                                                                                                                                                               

Project Location:                                                                                                                  Project Cost:      

                                                                                                                                                                                                                                               

Description of Work:

                                                                                                                                                                                                                                               

Does Proposal Violate any Laws, Ordinances or Regulations:

                                                                                                                                                                                                                                               

Contractor’s Name and Phone:

                                                                                                                                                                                                                                               

List Required Documents which you have included:

                                                                                                                                                                                                                                               

CERTIFICATION:               I hereby affirm under penalty of perjury that all information provided in this application is complete, correct and contains no misleading statements.  I further understand any false or inaccurate information contained in this application or its attachments automatically invalidates all permits issued as a result of this application.  I understand I may be required to remove any building, structure, or other construction started or completed as a result of inaccurate information contained in this application or its attachments. 

I further certify that I have read the instructions and permit process and understand the requirements.  I understand that no building shall be occupied or used in whole or in part of any purposes whatsoever until a Certificate of Occupancy is issued.

 

Owner’s Signature: ___________________________________________________Date: ______________

PLOT PLAN

                                                                                                                                                                                   

NAME:                                                                                    DATE:

                                                                                                                                                                                   

TAX MAP #:                                                                           LOT SIZE:

                                                                                                                                                                                   

LOCATED ON:                                                                 AMOUNT OF ROAD FRONTAGE:

                                                                                                                                                                                   

 

INSTRUCTIONS:      Using the line below as your road frontage, sketch your lot and include the following:

  1. All existing structures on the property.
  2. Location/proposed location of the well and septic.
  3. Proposed location of new structure/addition.
  4. Distance from the proposed/new structure to:  All property lines, Center of the roadway/right-of-way,

Existing structures, Well and Septic.

  1. If project is interior only, then fill in the top and indicated below interior work only.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

** THIS LINE REPRESENTS THE CENTER OF THE ROAD OR RIGHT-OF-WAY**

 

CERTIFICATION:   I hereby affirm under penalty of perjury that all information provided in this plot plan is complete, correct and contains no misleading statements.  I further understand any false or inaccurate information contained in this plot plan or its attachments automatically invalidates all permits issued as a result of this plot plan.  I understand I may be required to remove any building, structure or other construction started or completed as a result of inaccurate information contained in this plot plan or its attachments.  I further certify that I have read the instructions and understand the Local requirements.

 

Owner(s) Signature:                                                                                                                              Date:                                                                                                                                                                                                                                                                                                      

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:

__________________________________

__________________________________

__________________________________                                                               

__________________________________

 

                                                                                                                                Sworn to before me this ______day of

                                                                                                                                ___________________, 20____.

 

                                                                                                                                                                                                                               

                                                                                                                                                                (Notary Public

 

 

 

 

 

 

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

STATE OF NEW YORK

WORKERS' COMPENSATION BOARD

BUREAU OF COMPLIANCE

100 BROADWAY

ALBANY. NY 12241 -0005

 

All Contractors must provide a Certificate of NYS Worker’s Compensation (C-105.2 form) OR a Certificate of Exemption (CE 200 form)

105.2 (9/07)

Certificate of NYS Workers' Compensation Insurance Coverage (All private NYS licensed workers' compensation carriers are required to issue the C-105.2. Please note that the State Insurance Fund issues a different form, the U-26.3 form, as its version of the C-105.2)

Employers insured for workers' compensation through a private insurance carrier

Filed with the government agency issuing a permit, license or contract. The C-105.2 must be completed by the insurance carrier or its licensed insurance agent.

Upon obtaining a permit, license or contract from a government agency. Employers must obtain this form from their private insurance carrier. Carriers and their licensed agents may contact the Board's Bureau of Compliance to obtain this form.

200 (12/08)

(Replaces WC/DB-100 and Form C-105.21)

Certificate of Attestation of Exemption from NYS Workers' Compensation and/or Disability Benefits Coverage

Applicants for permits, licenses or contracts from State, county or municipal agencies in New York State that are not required to carry NYS workers' compensation and/or disability benefits insurance coverage.

Please file with the government agency that is issuing the permit, license or contract. (Examples: The New York City Department of Buildings or the New York State Department of Health)

These exemption forms can ONLY be used to attest to a government entity that an applicant requesting a permit, license or contract from that government entity is not required to carry NYS workers' compensation and/or disability benefits insurance. (Instructions)

CE-200 APPLY (2/09)

Used as a paper application for Form CE-200 which replaces Forms WC/DB-100 and C-105.21.

Paper application for the CE-200, Certificate of Attestation of Exemption from NYS Workers' Compensation and/or Disability Benefits Coverage

A paper application to obtain the CE-200. The CE-200 is used by the applicant to certify they are not required to carry workers' compensation and/or disability benefits when obtaining a license,permit , or contract from State, county or municipal agencies in New York State.

Applicants using this paper application process may wait up to four weeks before receiving a CE-200. This delay results from Workers' Compensation Board staff having to manually enter information from the applicant's paper application into the web based application.

Accordingly, to avoid delays, all applicants for exemptions are strongly encouraged to use the on-line Form CE-200.

Mail the completed CE-200 APPLY application to:

NYS WCB
Bureau of Compliance
Form CE-200
100 Broadway
Albany, NY 12241-0005
or
Fax: 800-486-7175


Once the applicant receives the CE-200, the applicant can then verify the information on the CE-200, sign it and then submit that CE-200 to the government agency from which he/she is getting the permit, license or contract.

Please also print the related instructions for filling out Form CE-200 APPLY (Instructions)

 

For those who require an exemption immediately, please access the on-line application that can be found on the Board's website, www.wcb.state.nv.us. Click the "WCIDB Exemption" button on the Board's main webpage and then click on "Request for WCIDB Exemption (Form CE-200)." You will be able to immediately print the certificate of attestation of exemption after completing the on-line application.