Gas
{[PNAME]}
Electrical Services Disconnected?
Water
Phone #
Current Status for Utilities
Water Shut Off Requested?
Water Shut Off Date
Property Information
Occupant Name
Phone #
Unit
Zoning District
City, State, ZIP
Business Name
State
Gas Meter Removed?
Electrical Shut Off Date
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
www.jamestownny.gov
Material Type Selected
Status
Account #
Address
Begin typing the property address and select from the populated dropdown
Occupant Information
Electric
Company Name
Occupant same as Owner?
Gas Shut Off Date
ZIP
Tax ID #
City
Address
  • Contacts
  • Project Details
  • Attachments
  • Certification
City, State, ZIP
Enter all additional Contractors, including the Architect or Designer of Record.
Last Name
Last Name
Owner Information
First Name
Phone #
Search by Contractor Address or Click on the Magnifying Glass
Phone #
License #
Title
Business Name (if applicable)
Email
Address
Contact Person (for Inspections)
First Name
If other, Specify
Contact Person
Contractor same as owner?
Last Name
Address
Primary Contractor Information
Additional Contractors Information
First Name
Contractor Type
Business Name
Phone #
Email
City, State, ZIP
Storm Sewer Size (Inches)
Distance of Driveways from Intersection Street Lines
Right Side Yard
Property Type
Location of Sanitary Sewer
Estimated Cost
# of Stories
Type of Material Description
Rear Yard
Storm Sewer Drainage
Left Side Yard
Project Information
Project Description
Foundation
Front Yard
Drive Entrances and Exists
Project Type
# of Units
Project Sq. Ft.
Submittal Requirements
Click the “Upload New File” button below to attach the required documents
Please submit the below documents with your application:
  • Plot Plan of Building
  • Site Plan
  • Zoning (If Applicable)
  • Zoning Inspections (If applicable)
  • Liability Insurance (if applicable)
  • Worker's Compensation details (if applicable)
Type Full Name :
Sign With Hand
Applicant Signature
Certification

I hereby certify that all information supplied in this application is correct, and complete to the best of my knowledge, and I agree to save, indemnify, and keep harmless the City of Jamestown and its officers, employees and agents against all liabilities, judgments, costs, and expenses which accrue against the City in consequence of the granting of this authorization.

THIS AUTHORIZATION SHALL BECOME VOID IF INCORRECT INFORMATION OR ADDITIONAL INFORMATION IS DISCOVERED THAT MAY JUSTIFY THE SAME.