CITY OF JOHNSTOWN

ENGINEERING DEPARTMENT
Po Box 160, 33-41 East Main Street
Johnstown, New York 12095

(518) 736-4014

 APPLICATION
FOR
PERMIT
 #_____ 

Applicant ______________________________________________________________________, ___________________________  
                                                     Company / Individual performing work                                                                 Phone

 _____________________________________________________________________________, ______________  ____________      
                                                           Address of Applicant                                                                          State                       Zip                 

to perform work at: _____________________________________________________________________________, Johnstown, New York.

-Please complete if owner is different than applicant:

 _______________________________, ________________________________________, ____________________                                                      
                              Owner                                                                 Address                                          Phone

-Work will begin on: _______________________________________ for a period of _____ day(s) ____ week(s)  

~PLEASE INDICATE JOB BELOW~

 
___ DRIVEWAY ($10.00)      

___ construct new
___ resurface
___ widening of existing driveway

 
___ CURB CUT ($10.00) 

___ construct new
___ widening of existing curb for a distance of _______ft.
         (under the supervision of the City Engineer)

 
___ SIDEWALK
       $        0 -  $  50:           $  5.00
        $  50.01 - $500:           $10.00
        $500.01 & up:             $10.00+
    (+ $1 each addt. $100 over $500)

___ construct new                                 Project cost: $_____________    
___ resurface                                         width _______ ft        length _______ft
___ repair
___ obstruct
___ grade change (describe requested grade change): _____________________
       ____________________________________________________________
                                         

___ STREET OPENING
___ RIGHT OF WAY      
                 ($10.00)
 

Purpose: ___________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

 
___ TREE  ($10.00)

___trim
___remove
___plant in terrace (no fee)
       (under the supervision of City Engineer; must approve location, type & size)

 ~ OFFICIAL USE ONLY~

Fee paid:  $

Receipt #:

Permit #:

Insurance provided:  yes  /  no

Bond provided:   yes  /  no

Staff Initials: 

 

Conditions: _______________________________________________________________________________________________
________________________________________________________________________________________________________
 

Permit Issued:   yes   /   no

Date: 


Engineer/Deputy Engineer Initials: