Town of Amherst Roofing/Siding Permit

Project Address/ Owner Information
Type of Permit you are applying for*

Roofing OnlySiding OnlyRoofing & Siding
Who will be completing the work*

HomeownerContractor
Homeowner (CE-200)
The Homeowner must provide a completed CE-200 insurance exemption form requested from New York State with the Amherst Building Permit Application.
Contractor Registration & Insurance
You must be on file as a Registered Contractor with the Town of Amherst. ◦If you are NOT a Registered Contractor contact our office at 716-631-7080 or e-mail gkimble@amherst.ny.us.
Project Address*

Street Address

Street Address Line 2

CityState

Zip Code
Is project address same as property owner address*

YesNo
Phone Number*
(###) ###-####
Property Owner Name*

First NameLast Name
Property Owner Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Property Owner Email*
example@example.com
Contractor Information:
Contractor Name:*
Contractor Address*

Street Address

Street Address Line 2

CityState

Zip Code
Contractor Phone: *
(###) ###-####
Contractor Email*
example@example.com
Estimated Value of Work*
Date of Installation*

MonthDayYear
Date
ROOFING

Ice & Water Shield Required
Fee

Residential (fee $75.00)Commercial ($0.10/SF / $150 min)
Scope of work*

Total Tear-offOverlay only (2 layers max)Partial Tear-offRepair
# Squares*
Squares = Square footage of project/100
Roof Pitch (ex. flat, 1/12, 5/12, min. slope 1/4 in. per ft)*
Roofing Material:
Material Type*

Asphalt ShinglesMetalMineral - SurfacedRubberSlateTileWood ShinglesOther
Manufacturer*
Warranty*
Wind Rating in MPH (Per ASTM D 3161)*
Weight (in lbs per sq)*
Roof Deck Material (ex. Plywood, tongue & groove)*
(Note: all materials must be installed in accordance with the NYS Building Standards and Codes and Manufacturers installation instructions)
SIDING
Siding Fees and Scope of Work

Residential (fee $50.00)Commercial ($0.05/SF / $150 min)
Scope of work*

Total ReplacementOverlayPartial ReplacementRepair
# Squares*
Squares = Square footage of project/100
Siding Material:
Material*

AluminumSteelVeneerVinylWoodOther
Manufacturer*
Warranty*
Insulation Board R Value*
Workers Compensation

I, the undersigned property owner or authorized agent of the owner, am familiar with the requirements of the Workers Compensation Law and declare that (check the following):
(Contractors) I have filed the required proof as affirmed by my insurance carrier.(Homeowners or Contractors) I have no people working directly for me and therefore require no Workers Compensation Insurance. Should there be any change in my status during the exercise of this permit, I will so advise the Building Department and comply with all requirements.
In consideration of granting this permit, the undersigned property owner or authorized agent of the owner hereby agrees to comply with the terms thereof, the Laws of the State of New York, the Ordinances of the Town of Amherst and the regulations of the various departments of the Town, County of Erie and the State of New York, request all necessary inspections and authorize and provide a means of entry to the premises for the Inspector. Furthermore, the undersigned property owner or authorized agent of the owner has read and will comply with these conditions. The undersigned property owner or authorized agent of the owner hereby certifies that all of the information in this petition is true and correct.
Permit Signature (Sign using your mouse)*

Clear
Please enter full name of the signer*
PERMIT EXPIRATION
CONDITIONS, INSTRUCTIONS & REQUIRED. INSPECTIONS

This permit expires six months from date of issue if work has not commenced.

The Building Department reserves the right to reject any work which has been concealed or completed without first having been inspected and approved by the department in accordance with the requirements of the various codes. Reasonable, safe access must be provided to all areas of the work.
Scheduling Inspections & Requirements:
1. The contractor is responsible for scheduling the inspections. If the contractor does not schedule the inspection in a timely matter the property owner will ultimately be held responsible.
2. Work must be in accordance with the either the Residential Code of New York State for 1 or 2 family or attached single dwellings, or the Building Code of New York State for other buildings.
3. Note that compliance with Industrial Code Rule 56, ASBESTOS is required. (Title 12 of the Official Compilation of Codes, Rules and Regulations of the State of New York)
4. Contractors must provide proof of Worker’s Comp & NYS Disability Insurance
56-5.1 Asbestos Survey Requirements for Building/Structure Demolition, Renovation, Remodeling and Repair

a) Asbestos Survey Required. An owner or an owner’s agent, except the owner of one and two-family dwellings who contracts for, but does not direct or control the work, shall cause to be conducted, an asbestos survey completed by a licensed asbestos contractor using inspectors certified in compliance with Section 56-3.2(d), to determine whether or not the building or structure, or portion(s) thereof to be demolished, renovated, remodeled, or have repair work, contains ACM, PACM or asbestos material. This asbestos survey shall be completed and submitted as indicated in Subdivision (g) of this Section, prior to commencing work. All such asbestos surveys shall be conducted in conformance with the requirements of Subdivision (e) of this Section.

b) Exemptions To Asbestos Survey Requirements: The asbestos survey required by this Subdivision (a) of this Section shall not be required for the following classes of buildings or structures:
1. an agricultural building;
2. buildings or structures for which original construction commenced on or after January 1, 1974;
3. A structure certified in writing to be structurally unsound by a licensed Professional Engineer, Registered Architect, Building Inspector, Fire Inspector or other official of competent jurisdiction. (See Section 56-11.5)
Section 57 (Effective July 1, 1922)

Restriction on issue of permits unless compensation is secured. The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, and notwithstanding any general or special statute requiring or authorizing such permits, shall not issue such permit unless proof duly subscribed and affirmed as true under the penalties of perjury by an insurance carrier is produced in a form satisfactory to the chairman, that compensation for all employees has been secured as provided by this chapter. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any compensation to any such employee if so employed.

Section 220, Subdivision 8 (Effective July 1, 1966)

The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined by this article, and notwithstanding any general or special statute requiring or authorizing such permits, shall not issue such permit unless proof duly subscribed and affirmed as true under the penalties of perjury by an insurance carrier is produced in a form satisfactory to the chairman, that the payment of disability benefits for all employees has been secured as provided by this article. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any compensation to any such employee if so employed.
Should be Empty:

Project Address/ Owner Information

Contractor Information:

ROOFING

Roofing Material:

SIDING

Siding Material:

PERMIT EXPIRATION

Scheduling Inspections & Requirements: