Fill - Free fillable Commercial Building Permit Application Fillable (Incorporated Village of Northport, NY) PDF form

BUILDING PERMIT APPLICATION

& INSTRUCTIONS

FOR:

COMMERICIAL WORK

PLUMBING, DEMOLITION, POOL & SOLAR PERMIT APPLICATIONS &

INSTRUCTIONS AVAILABLE AT VILLAGE HALL.

SOLAR PERMIT APPLICATIONS ARE NOW ISSUED BY THE NORTHPORT FIRE

MARSHAL'S OFFICE

NOTICE:

AS OF OCTOBER 3, 2016

ALL APPLICATIONS AND REQUIRED

SUBMISSIONS MUST BE

SIMULTANEOUSLY

SUBMITTED IN HARD COPY FORM AND IN

PDF FORMAT ON A FLASH DRIVE.

Department of Buildings, Housing, and Code Enforcement

Building Application Package Index

Building Permit Application……………………………... 1

2020 ICC & NYS Code Regs……………………………… 3

Architect/Engineer Requirements………………………. 4

Zoning Requirements Chart……………………………… 6

Zoning Analysis Sample …………………………………. 7

Commercial Permit Instructions………………………… 8

Notices of Adoption 
Rules amending and updating the Uniform Code and Energy Code 
EFFECTIVE May 12, 2020 
 
NYS Uniform Code and Energy Code Update 
On December 6, 2019, the State Fire Prevention and Building Code Council (the “Code Council”) adopted rules that 
amend and update the New York State Uniform Fire Prevention and Building Code (the “Uniform Code”) and the State 
Energy Conservation Construction Code (the “Energy Code”).  
The Department of State, acting on behalf of the Code Council, has filed Notices of Adoption of these rules.  The Notices 
of Adoption will appear in the February 12, 2020 edition of the State Register.  On and after February 12, 2020, the 
Notices of Adoption can be viewed by clicking the “February 12” link 
at: http://www.dos.ny.gov/info/register/2020.html.  
The rules will become effective on May 12, 2020. 
Uniform Code 
The Uniform Code (19 NYCRR Parts 1219 to 1229) now includes the 2015 editions of the code books published by the 
International Code Council (the “2015 I-Codes”), as amended by the publication entitled the 2017 Uniform Code 
Supplement (publication date:  July 2017). 
 
The rule adopted by the Code Council on December 6, 2019 repeals the current version of the Uniform Code and adopts 
an amended and updated version of the Uniform Code.  The amended and updated version of the Uniform Code 
incorporates by reference the following publications: 
•  2020 Residential Code of New York State (publication date: November 2019) 
•  2020 Building Code of New York State (publication date: November 2019) 
•  2020 Plumbing Code of New York State (publication date: November 2019) 
•  2020 Mechanical Code of New York State (publication date: November 2019) 
•  2020 Fuel Gas Code of New York State (publication date: November 2019) 
•  2020 Fire Code of New York State (publication date: November 2019) 
•  2020 Property Maintenance Code of New York State (publication date: November 2019) 
•  2020 Existing Building Code of New York State (publication date: November 2019) 
 (collectively, the NYS Code Books) 
 
Certain provisions of the 2020 Residential Code of New York State and 2020 Building Code of New York State are also 
amended as set forth in the rule adopted amending 19 NYCRR Parts 1220 and 1221. 
Prior to May 12, 2020, the Uniform Code will continue to include the 2015 I-Codes, as amended by the 2017 Uniform 
Code Supplement.  On and after May 12, 2020, the Uniform Code will include the 2020 NYS Code Books.  
Effective Date:  The effective date of the 2020 NYS Code Books will be May 12, 2020.  There will be no transition 
period.  Beginning on May 12, 2020, regulated parties submitting building permit applications must comply with the 
2020 NYS Code Books. 

Energy Code

The Energy Code (19 NYCRR Part 1240) now includes the 2015 International Energy Conservation Code (the “2015 IECC”)

and the 2013 edition of ASHRAE 90.1 (“ASHRAE 90.1-2013”), as amended by the publication entitled the 2016

Supplement to the State Energy Conservation Construction Code (Revised August 2016), sometimes referred to simply as

the 2016 Energy Code Supplement.

The rule adopted by the Code Council on December 6, 2019 repeals the current version of the Energy Code and adopts

an amended and updated version of the Energy Code. The amended and updated version of the Energy Code

incorporates by reference the following publications:

• 2020 Energy Conservation Construction Code of New York State (publication date: November 2019)

• 2016 edition of the Energy Standard for Buildings Except Low-Rise Residential Buildings ("ASHRAE 90.1-2016")

Certain provisions of ASHRAE 90.1-2016 are amended as set forth in the rule adopted amending 19 NYCRR Part 1240.

Prior to May 12, 2020, the Energy Code will continue to include the 2015 IECC and ASHRAE 90.1-2013, as amended by

the 2016 Energy Code Supplement. On and after May 12, 2020, the Energy Code will include the 2020 ECCCNYS and

ASHRAE 90.1-2016, as amended by 19 NYCRR Part 1240.

Effective Date: The effective date of the modifications to Part 1240 will be May 12, 2020. There will be no transition

period. Beginning on May 12, 2020, regulated parties submitting building permit applications must comply with the

2020 ECCCNYS and ASHRAE 90.1-2016, as amended by 19 NYCRR Part 1240.

Parts 1264 and 1265

19 NYCRR Part 1264 includes provisions relating to placement of signs or symbols on commercial buildings that utilize

truss type construction. 19 NYCRR Part 1265 includes provisions relating to placement of signs or symbols on residential

buildings that utilize truss type, pre-engineered wood or timber construction.

Parts 1264 and 1265 include references to the 2017 Uniform Code Supplement. Because the rule that amends the

Uniform Code will replace the 2017 Uniform Code Supplement with the 2020 NYS Code Books effective May 12, 2020,

the rule amending the Uniform Code adopted by the Code Council on December 6, 2019 also makes corresponding

changes to Parts 1264 and 1265. The rule makes no substantive changes to Part 1264 or Part 1265.

Effective Date: The effective date of the amendments to Parts 1264 and 1265 will be May 12, 2020. There will be no

transition period.

2020 NYS Code Books

The 2020 NYS Code Books can be viewed for free on the International Code Council (ICC) website

at, https://codes.iccsafe.org/category/New%20York?year[]=Current+Adoption&page=1 or purchased

at https://shop.iccsafe.org/state-and-local-codes/new-york-state.html.

ARCHITECTS AND ENGINEERS:

YOU ARE REQUIRED TO COMPLETE AND CERTIFY THE

APPLICABLE 2020 ICC PLAN REVIEW RECORDS/CHECKLISTS

CORRESPONDING TO PROPOSED CONSTRUCTION PLANS.

For 2020 ICC PLAN REVIEW CHECKLISTS access go to:

1. iccsafe.org

2. ‘store’ tab

3. Search box: “plan review checklists 2020

1. DOWNLOAD ALL APPLICABLE CHECKLISTS

2. COMPLETE CHECKLIST(S) BY REVIEWING DRAWINGS

AGAINST EACH CHECKLIST ITEM,

3. INITIAL EACH ITEM TO INDICATE COMPLIANCE

4. PROVIDE A WRITTEN COMPLIANCE STATEMENT

5. SUBMIT ALONG WITH CONSTRUCTION PLANS AND

BUILDING PERMIT APPLICATION.

(some checklists will require completion/certification by separate

designer/installer(s) (such as HVAC systems)

(CHECKLIST ICONS SHOWN ON FOLLOWING PAGE)

PLAN REVIEW RECORDS & CHECKLISTS – for access:

go to 1) iccsafe.org 2) ‘store’ tab 3) search box: “plan review checklists 2020”

VILLAGE OF NORTHPORT ZONING REQUIREMENTS CODE SECTION 306-22 & 306-23

BUILDING LOTS

YARDS

BUILDINGS

ACCESSORY BUILDINGS

DISTRICT

LOT

DEPTH

LOT

AREA

MIN.

ST.

FRONT

LOT

WIDTH

FRONT

DEPTH

REAR

DEPTH

SIDE

MIN/TOTAL

**

HEIGHT

%¤ LOT

AREA

***

SIDE

***

REAR

MIN/TOTAL

HEIGHT

MAX.

ACCESS.

WITH

ROOF

FRONT

Res. A

200'

43,560

140'

175'

65'

60'

35'/75'

30'

12%

12'

2'/4'*

15'

800 sq.

ft.

50' or back

of main

bldg.

whichever

is greater

except

garage

may be at

set-back

line and

greater

side yard

Res. B

175'

21,780

100'

125'

50'

30'/60'

30'

15%

10'

2'/4'*

15'

800 sq.

ft.

Res. C

125'

14,520

80'

100'

35'

40'

18'/40'

30'

20%

7'

2'/4'*

15'

650 sq.

ft.

Res. D

100'

8,500

5,000

70'

85'

50'

25'

35'

20'

12'/24'

30'

22%

5'

2'/4'*

15'

550 sq.

ft.

Bus. A

4,000,

30'

20'

15%

10'one side

2.5 story

35'

40%

35'

Bus. B

7,500

50'

20'

15%

10'one side

2-story

30'

40%

30'

Bus. C

12,000

75'

0

not in

code

50%

25'

Neigh’D

7,500

50'

30'

15%

10'one side

2-story

30'

30%

30'

Highway

7,500

50'

10'

15%

10'one side

2-story

30'

30%

30'

Marine

7,500

50'

15%

10'one side

2-story

30'

30%

30'

*if wood frame or other combustible material *** swimming pool minimum 10' from all sides or rear yard

**see the definition of height in the Village Code % lot coverage: calculate using primary and accessory structures, decks, raised patios and pools.

¤ LOT COVERAGE: lots under 8500 square feet in all districts: 25% of lot size but not to exceed a foot print of 1870 sq. ft.

Sample Zoning Analysis

Site and Zoning Data

Address

Northport, NY 11768

SCTM# 0404-00x-00x-0x

Zoning Required

Residence “D”

Existing Conditions

Proposed Construction

Lot Frontage Min:

70 ft

67.81 ft

Lot Area Min:

8,500 sqft

30,056 sqft

Front Yard Setback:

25 ft

23 ft

Rear Yard Setback:

35 ft

+/- 108 ft

+/- 94 ft

Side Yard Min/Total:

12 ft/24 ft

12 ft/25 ft

Max. Lot Coverage:

22%

1,341 sqft (4.5%)

1,821 sqft (6.1%)

Max. Height:

30 ft

+/- 16 ft

Square Footage Information

Site Plan

Scale: 1” = 40’-0”

First Floor

Existing first Floor Living Area:

1028 sqft

Existing 1-Car Garage:

278 sqft

Proposed Garage Addition:

41 sqft

Proposed Workshop Addition:

147 sqft

Cellar

Existing Finished Living Area:

417 sqft

Proposed Additional Finished Living Area:

455 sqft

Covered Porches/Deck

Existing Front Entry Porch:

55 sqft

Proposed Rear Deck:

272 sqft

COMMERCIAL BUILDING PERMIT FILING INSTRUCTIONS

USE FOR NEW STRUCTURES - ADDITIONS/ALTERATIONS - CHANGE OF USE

MAINTAIN EXISTING BUILT w/o PERMIT

APPLICATION SUBMISSIONS FOR ALL COMMERCIAL CONSTRUCTION:

- BUILDING PERMIT APPLICATION—all building work

- PLUMBING PERMIT APPLICATION—all plumbing work (see PLUMBING PERMIT INSTRUCTIONS)

- PLANNING BOARD SITE PLAN REVIEW OR WAIVER—All commercial building applications

- ARCHITECTURAL/HISTORIC REVIEW BOARD—New structures, changes to existing exterior and signage

- NORTHPORT FIRE MARSHAL PLAN REVIEW—all building permit applications

- AMERICANS WITH DISABILITIES ACT APPLICABILITY ANALYSIS—all building permit applications

BUILDING PERMIT APPLICATION

TAX BILL OR PROOF OF OWNERSHIP

Submit copy of tax bill or first & last page of deed if tax bill does not represent current owner with each required application

SUFFOLK COUNTY FILED MAP

Submit copy of subdivision map filed with Suffolk County Clerk for new work on vacant lots

SECTION/BLOCK/LOT

Found on Tax Bill and/or Survey

AGE OF STRUCTURE

Provide substantiation of age. 100 YRS OR OLDER, SIMULTANEOUSLY FILE HISTORIC REVIEW APPLICATION

PHOTOGRAPHS

Submit photographs of each elevation of existing structure

DESCRIPTION OF WORK

Submit brief description of proposed construction

ESTIMATED COST OF WORK

From Contractor estimate, or cost based on current construction standards prepared by Architect or P.E.

SQUARE FOOTAGES

EXISTING: Provide ALL square footages of existing structures

PROPOSED: Provide ALL square footages of proposed construction

ALTERATIONS LEVEL 1 & 2: Provide ALL square footages AS PER 2020 IRC & 2016 ENERGY CODE

Level 1 Alteration:

cosmetic work on existing, up to & including removing & replacing sheetrock & insulation.

Levels 2 & 3 Alterations:

‘Gutting’ of interior walls and partitions: remove/replace structure, electrical, mechanical, plumbing

AFFIDAVIT OF PROPERTY OWNER

Must be filled out completely

OWNER & APPLICANT SIGNATURE(S) & PHONE NUMBER(S)

Owner signature and phone number MANDATORY; and Applicant info, if applicable

NOTARIZATION

Owner and Applicant signatures must be notarized by a NYS notary public

LEAD AGENCY APPROVALS REQUIRED

LEAD AGENCY APPROVALS MUST BE SUBMITTED WITH PERMIT APPLICATION

OWNER/APPLICANT RESPONSIBLE FOR DETERMINING IF APPROVALS ARE REQUIRED FROM LEAD AGENCIES

PRIOR TO BUILDING PERMIT APPLICATION SUBMISSION.

Submit copies of all required LEAD AGENCY APPROVALS--permits/drawings, decisions and/or Letters

of Non-Jurisdiction with Building Permit application.

APPLICATIONS MISSING LEAD AGENCY APPROVALS WILL NOT BE ACCEPTED

LEAD AGENCIES & THEIR REQUIREMENTS INCLUDE BUT ARE NOT LIMITED TO:

- NORTHPORT FIRE MARSHAL REVIEW/WRITTEN APPROVAL OF PROPOSED WORK

REQUIRED FOR ALL COMMERCIAL BUILDING PERMIT APPLICATIONS

- AMERICANS WITH DISABILITIES

REQUIRED: ADA ANALYSIS PREPARED BY ARCHITECT/P.E.-SEE ADA.gov FOR MORE INFORMATION

- NYS DEPT. OF TRANSPORTATION

REQUIRED FOR HIGHWAY BUSINESS DISTRICT PROPERTIES WITH EGRESS/INGRESS NYS ROUTE 25A

NYS DEPT. OF ENVIRONMENTAL CONSERVATION (DEC)

REQUIRED FOR ALL WORK LOCATED WITHIN 200 FEET OF WATER & WETLANDS

- SUFFOLK COUNTY HEALTH DEPT. OR NYS DEPT. OF AGRICULTURE

REQUIRED FOR ALL RESTAURANT & FOOD-PREPARATION APPLICATIONS--PROVIDE WRITTEN

STIPULATION FROM GOVERNING AGENCY AS TO WHICH AGENCY HAS OVERSIGHT.

- TOWN OF HUNTINGTON

REQUIRED FOR DOCKS, BULKHEADS, PILINGS LOCATED IN T.O.H. WATERWAYS

- ARCHITECTURAL REVIEW BOARD/HISTORIC REVIEW

REQUIRED FOR PROPOSED CHANGES TO EXTERIOR OF STRUCTURES &/OR SIGNAGE. HISTORIC REVIEW

REQUIRED FOR ALL STRUCTURES 100 YEARS OR OLDER.

SUBMIT APPLICATION SIMULTANEOUSLY WITH BUILDING PERMIT SUBMISSION

- PLANNING BOARD

SITE PLAN REVIEW OR WAIVER FOR ALL COMMERCIAL CONSTRUCTION APPLICATIONS REQUIRED

SUBMIT APPLICATION SIMULTANEOUSLY WITH BUILDING PERMIT SUBMISSION

- STEEP SLOPE PERMIT APPLICATION

Steep Slope Permit from Planning Board required for work proposed on 10% or greater natural slope

SUBMIT APPLICATION SIMULTANEOUSLY WITH BUILDING PERMIT SUBMISSION

- ZONING BOARD OF APPEALS

PROPOSED WORK NOT IN CONFORMANCE WITH CODE OF NORTHPORT ZONING REGULATIONS MAY

SEEK VARIANCE RELIEF FROM THE ZBA. Letter of Denial issued by the Building Inspector required to file.

SUBMIT APPLICATION SIMULTANEOUSLY WITH BUILDING PERMIT SUBMISSION

CONSTRUCTION DRAWINGS (3) SETS OF PLANS & SPECS REQUIRED

(1) FULL-SIZE SET & (2) JOB-SIZE SETS, signed & sealed by NYS licensed design professional. PLANS MUST

BE FOLDED, NOT ROLLED. Show conformance with 2020 International Building Codes/Uniform Code

Update & 2016 Energy Codes; existing conditions, energy calculations all structure, floor plans, elevations,

height calculation, electrical, plumbing, mechanical & all comprehensive sections/details/notes necessary for

construction & code conformance.

SURVEY

Submit (2) copies of current guaranteed property survey with Surveyor’s stamp, SC Tax Map Number, and Date

SITE PLAN: NOTE: SITE PLAN MUST BE PREPARED AS PER PLANNING BOARD SITE PLAN REVIEW

REQUIREMENTS. SUBMIT SITE PLAN, DRAWINGS & WRITTEN PLANNING BOARD APPROVALS

STORM WATER CONTAINMENT: NOTE; DRAINAGE PROPOSALS MUST BE PREPARED AS PER

PLANNING BOARD SITE PLAN REVIEW REQUIREMENTS AND APPROVED BY PLANNING BOARD

ZONING ANALYSIS

Comparative Chart Analysis of Required/Existing/Proposed Structures as per the Code, Zoning Chapter 306.

AFFIX TO FIRST PAGE OF PLANS (see attached sample)

STAINLESS STEEL FASTENERS REQUIRED STATEMENT

Construction requirements for ACQ/Copper –treated lumber: STAINLESS STEEL FASTENERS, STRAPPING,

TECOS, NAILS, ET AL REQUIRED IN EXPOSED/EXTERIOR APPLICATIONS; as per the manufacturer’s

warranty and product/design criteria. NO SUBSTITUTIONS PERMITTED. INCLUDE THIS NOTE ON PLANS

ADDITIONAL FILING REQUIREMENTS & INFORMATION

FEES

Shall be determined by the Building Inspector as per Chapter 147 of the Code, Fee Schedule

CONTRACTOR INSURANCES:

CONTRACTORS * ELECTRICIANS * PLUMBERS MUST EACH FILE THE FOLLOWING FORMS SEPARATELY:

Proof of Liability Insurance, Workers Compensation, and NYS Disability must be submitted naming the Inc. Village of

Northport as certificate holder. Limits are:

- GENERAL LIABILITY $2M/$1M

- WORKER’S COMPENSATION & DISABILITY-must be on either NYS Workers Comp Board forms or State

Fund. ‘ACORD’ FORMS NOT ACCEPTED. Contact NYS WC Board @ 1-518-486-6307 for more information

CONTRACTOR LICENSES

Contractors: Suffolk County Home Improvement license must be submitted.

Electricians: Suffolk County Master Electrician license must be submitted.

Plumbers: Town of Huntington Master Plumber’s license ONLY must be submitted.

TAX ASSESSMENT

Be advised that the Northport Assessor’s Office is notified upon permit issuance. The appropriate property tax

increase shall be levied a year from the date of commencement of work.

PROPERTY OWNER/PERMIT BEARER RESPONSIBLITIES

The above-listed outline is provided as a GUIDE ONLY for filing building permit applications. The Property Owner/Permit

Bearer is responsible for ALL stipulations, rules, and ordinances as stated in the Code of Northport, Chapter 106,

Article 1, Sections-106-1 through 106-26. The property owner/permit bearer & their contractor should familiarize

themselves with all aspects of the Code of Northport regarding their construction project.

Building Codes Online

2020 IRC/Update/Energy Codes: www.dos.ny.gov/dcea/ The Code of Northport: www.northportny.gov

Contractors’ Insurance Information

THE FOLLOWING FORMS ARE REQUIRED FOR LIABILITY, WORKERS'

COMPENSATION, AND DISABILITY INSURANCE

1. LIABILITY INSURANCE WILL BE ACCEPTED ON THE ACORD FORM

2. WORKERS' COMPENSATION INSURANCE

Accepted on one of the following forms only*

Form C-105.2-Certificate of NY State Workers' Compensation Insurance Coverage

Form

GSI-105.2 (2/02) Certificate of Participation in Workers' Compensation Group Board approved

self-insurance

Form U-26.3-NY State Insurance Fund Certificate of Workers Compensation Insurance

3. DISABILITY INSURANCE

Accepted on the following form only*

Form DB-120.1-Certificate of Insurance Under the New York State Disability Benefits

Form DB-155 - Board-approved self-insured employers must obtain this form from Board's

Self-Insurance Office

Certificate Holder:

Inc. Village of Northport

224 Main Street

Northport, NY 11768

EXEMPTION FORM — NEW FORM CE-200 For each and every new

or renewed permit a

signed and dated form with a certificate number must be submitted.

Note: Form CE-200 Is an affidavit for New York Entities with No Employees and Certain Out of State Entities, That New York State

Workers' Compensation and/or Disability Benefits Insurance Coverage Is Not Required

Any questions can be directed to:

New York State Workers Compensation Board

220 Rabro Drive Suite 100

Hauppauge, New York 11788

866-681-5354

Website: www.wcb.ny.gov

CERTIFICATIONS ARE ONLY ACCEPTED ON INDIVIDUAL FORMS

*With valid expiration dates

Department of Buildings, Housing, and Code Enforcement

APPLICATION FOR BUILDING PERMIT

VILLAGE OF NORTHPORT, SUFFOLK COUNTY, NY

BUILDING PERMIT NO.__________ ZBA No.____________ Arch. Rvw No.__________ FEE $___________

DATE RECEIVED________________ Planning Bd.No._______ NYSDEC No.____________ C0/CC___________

DATE APPROVED_______________ Steep Slope No._______ NYSDOT No.____________ TOTAL $_________

DIRECTOR_____________________ Historic Rvw. No.________ SCHD No.__ __________

ZONE _____________________ SCTM #0404 SECTION_______ BLOCK_______ LOT(S) ________

DATE OF INITIAL CONSTRUCTION:

PRINCIPAL BUILDING ___________ACCESSORY BUILDING(S)__________IF 100 YEARS OR OLDER, HISTORIC REVIEW

APPLICATION MUST BE SUBMITTED SIMULTANEOUSLY WITH BUILDING PERMIT APPLICATION

Submit documentation of age & photos of each elevation with this application

LOCATION OR ADDRESS ___________________________________________________________________________________________________________

Existing Buildings Used for: Residential ___________Commercial___________Industrial ____________

Proposed Construction:

 Residential  Garage  Commercial  Industrial  Other Accessory Structure

 New Building  Alteration Fire Damage  Fireplace  Other ___________________

Proposed Project and Use: ___________________________________________________________________________________

_________________________________________________________________________________________________________

ESTIMATED COST OF PROJECT $___________________

EXISTING BUILDING, square footages:

Basement ______S.F. 1

st

Floor ______S.F. 2

nd

Floor ______S.F. 3

rd

Floor_____S.F. Garage______S.F. Porch_____S.F.

(Other)________S.F.

PROPOSED (NEW OR ADDITION), square footages:

Basement _____ S.F. 1

st

Floor ______S.F. 2

nd

Floor ______S.F. 3

rd

Floor_____S.F. Garage______S.F. Porch_____S.F.

(Other)________S.F. Retaining Walls_______L.F.

ALTERATION S.F.’s as per NYS 2020 ICC Existing Building Code (Commercial) or IRC Residential Code Appendix J:

Level 1____________S.F. Level 2____________S.F. Level 3__________S.F.- Commercial Only

NOTES:

1. The 2020 IBEC/IRC, NYS Supplement and the Code of Northport are imposed as conditions on issuance of a Building Permit.

2. Building Permit issued subject to Section 125 of General Municipal Law requiring Compliance with the Mandatory coverage provisions of the

Worker’s Compensation Law. Proof of Compliance must be submitted for issuance of Permit.

3. Improvement contractors must be licensed pursuant to the code of Suffolk County prior to the issuance of a building permit. Plumbers must be

Licensed by the Town of Huntington (Chapter 153) and electricians licensed by Suffolk County. Electricians must provide separate Workers Comp.

4. The owner shall indemnify and hold the municipality harmless and defend against any claim of liability or loss including the cost of defense for

personal injury or property damage resulting from or arising directly or indirectly out of or resulting from the permit holders’ operations within the

municipality, including losses arising out of the negligent acts or omissions of the contractor, its servants or agents, and any subcontractors, its servants

or agents

AFFIDAVIT OF PROPERTY OWNER

STATE OF NEW YORK} SS:

COUNTY OF SUFFOLK}

_____________________________________________

Property in Name of (Individual or Corporation) PLEASE PRINT

Deposes and says: That he/she resides at ______________________________________________in the State of ___________________Zip Code______ that he is the owner in fee

of all that certain lot, piece or parcel of land shown on the attached survey situate, lying and being within the Incorporated Village of Northport; that the work proposed to be done upon

the said premises will be done in accordance with the approved application and accompanying plans, of which he is totally familiar; and that he/she, by making this application for a

building permit , agrees to accept responsibility for adherence to all applicable codes, rules, & laws by him/herself and their agents.

__________________________________________________________________________, being duly sworn, deposes and says that he is duly authorized by the aforesaid owner

Name of Applicant (PLEASE PRINT)

to make application for a permit to perform said work in the foregoing application and accompanying plans, and all the statements herein contained are true to deponent’s own knowledge.

_________________________________________________________________________________________________________________________________________________

(If Corporation, give name of Corporation office and address of its responsible officers)

And the undersigned is authorized to make this application on behalf of said owner.

Owner__________________________________________________________

Signature

Address___________________________________________________________

Sworn t before me this ____________________________day Phone____________________________________________________________

Of _____________________________________, 20_______

Applicant __________________________________________________________

_________________________________________________ Signature

Notary Public

Address __________________________________________________________

Phone ___________________________________________________________

Village of Northport

I N C O R P O R A T E D 1 8 9 4

224 MAIN STREET

P.O. BOX 358

NORTHPORT, NEW YORK 11768

631-261-7502

ABOUT YOUR

BUILDING PERMIT

A Village of Northport Building Permit is active for one year, expiring one year from

the date of issue BUT it is conditionally renewable for a maximum of two additional

one year periods.

The owner and/or applicant is responsible to see that all conditions under which

the permit is issued are met.

The owner and/or applicant is responsible to call for the construction

inspections appropriate to the project as per Inspection Checklists issued

with permits.

Certificates of Occupancy (C.O.) or Certificate of Compliance (C.C.) is required for

all work for which a permit; building, plumbing, demolition, generator, solar panels

or swimming pool is issued. A C.O. or C.C. may only be issued after a properly

completed ACTIVE permit project.

Whenever you have any questions regarding building permits, please call the

Building Department at 261-4145.

** CALL BEFORE YOU DIG **

** IT’S THE LAW **

NYS Industrial Code Rule 53 Mandates 2-10 business days notice

prior to excavation.

For utility notification dial toll free 1-800-272-4480

PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUE

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Fillable Commercial Building Permit Application Fillable (Incorporated Village of Northport, NY)

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