Applications & Forms

Building & Sign Permits

Building Permit Application
Complete this form and return it to the Village Office to apply for a Building Permit.  Once approved it can be picked up at the Village Office after paying the specified fee.

Truss Type Construction Disclosure
Complete this form and return to the Village Office with a Building Permit if your project involves Truss Construction.

Commercial Sign Permit Applicaton
Complete this form and return to the Village Office if your business would like to put up a sign.  Once approved it can be picked up at the Village Office after paying the specified fee.

Application to the Board of Appeals
Complete this form and return to the Village Office to apply to the Zoning Board for such things as a Variance

Utilities Forms

Application for Services
Complete this form to sign up for services

Refrigerator Rebate Form
Complete this form and send it to provided address to dispose of your old working refrigerator/freezer and receive a rebate.

ACH Agreement Form
Complete this form and return to the Village Office if you would like your monthly utility bill automatically debited form you bank account.

Appliance Rebate Form
Complete this form and send it to address provided on form for a rebate on select household appliances.

Heat Pump Rebate Form
Complete this form and send it to address provided on form for a rebate on select equipment.

Electrician’s Report
Complete this form and return to the Village Office for existing and new
requests for electrical service.

Community Buildings

Community Bulletin Board Request
Complete this form and return to the Village Office if your organization would like to display a message on the Lions Community Bulletin Board near the Library.

Gazebo Use Form
Complete this form and return to the Village Office to use the Gazebo. Fee – $50.00 refundable deposit

Meeting Room Use Form
Complete this form and return to the Village Office if your organization would like to use the Village Meeting Room.  Fees – $25.00 Rental fee and a refundable deposit of $50.00.

Business Forms

Peddling License Form
Complete this form and return to the Village Office to sell door-to-door in the Village of Churchville. Fee – $25.00

Special Use Permit Application
Complete this form and return to the Village Office to apply for a Special Use Permit.  Once approved it can be picked up at the Village Office for a fee of $100.00.

Miscellaneous Forms

Dumpster Rental Form
The Village of Churchville owns dumpsters that are available for Village residents to rent. Dumpsters are available on a first-come first-serve basis. An application must be filled out at the Village Office and a fee is due before delivery. Dumpsters will be picked up on Monday mornings. These dumpsters are to be used for the following materials only: remolding materials (no asbestos, stone, metal or concrete) and general household clean-up materials. Roofing materials may be put into the dumpsters but can only fill the dumpster half full due to the weight.

Freedom of Information (FOIL) Request

The Freedom of Information Law requires that an agency respond to a request within five business days of receipt of a request. Therefore, I would appreciate a response as soon as possible and look forward to hearing from you shortly.

If for any reason any portion of my request is denied, please inform me ofthe reasons for the denial in writing and provide the name and address ofthe person or body to whom an appeal should be directed.

Village Office

Hours: Monday - Friday 8:30am - 4:00pm
Summer Hours (Memorial Day - Labor Day):
Monday - Thursday: 8:00am - 4:00pm Friday: 8:00am - 1:00pm
(585) 293-3720
23 East Buffalo Street
Churchville, NY 14428

Department of Public Works

Hours: Monday - Friday 7:00am - 3:30pm
Summer Hours (Memorial Day - Labor Day):
Monday - Thursday: 6:30am - 3:30pm Friday: 6:30am - 12:30pm
(585) 293-3366
Emergency number: (585) 746-8025
44 N Main Street
Churchville, NY 14428

Individual Contact Information

Board of Trustees
Village Clerk
DPW Superintendent
Fire Marshall
Building Inspector/Code Enforcement Officer