DIRECTIONS
FOR
FILING
OF
A
FENCE
PERMIT
Department
of
Buildings - Inc. Village
of
Freeport
Documents Required:
Fe
nce
Permit Application (3 copies
of
the
application
to
be
submitted)
2 Coples
of
th
e ·
Property
Survey detailing
th
e
Loca
tion
of
the
proposed
fence
Application
must
inclu
de
th
e l
eng
th and height
and
mater
ial
of
the
fence
A signed
cont
r
act
for
the
proposed
work
between
the
owner
and
t
he
contractor
Contractors
Na
ssau
County License
Contractors Workers Compensation insurance
Contractors liability I
nsurance
Contractors Disability Insurance
(Insurances
must
name
the
Village
as
an additional lnsured/certificate holder)
Applications will
be
accepted Monday through Friday from 8:30 AM
to
3:00
PM
Daily.
Applications must
be
fil
ed
for in person.
Applications sent by mail will
not
be
acce
pted.
No work may commence until
unt
il a completed application has been filed and
until
the permit
has
been issued.
The
installation
of
a fence prior
to
a
pe
rmit
being issued will resu
lt
in
appearance tickets returnable in the Court
of
the Village
of
Freeport. A double filing fee to
be
charged, and the possibility
that
th
e fence if not approved to
be
removed in its
entir
ety.
Al
l
APPLICAT
IO
NS
MAY
BE
SUBJECT
TO
ZON
ING
BOARD
OF
APPEALS
AND/OR
SITE
PLAN
APPROVAL
Please note,
that
it
Is
the
responslbllity
of
the
home
ow
ner
and
of
th
e contractor
to
contact
their
assigned inspector 48 ho
urs
prior
to
the
commencement
of
the
work
to
discuss
the
required
inspections. Failure
to
contact
the
inspector
pr
ior
to
and during the Installation may also result
In
legal action
to
be
taken
.
Your inspector may be contacted by calling this office at: 516-377-2241or516-377-2243
Department of Buildings of the Incorporated Village of Freeport
FENCE PERMIT APPLICATION
Application Number: _____________ S/B/L _____________ Date of filing: ____________
Permit Number: _________________
Detailed Description of Project: ____________________________________________________
______________________________________________________________________________
Property Owner: ________________________________________________________________
Property Address: ______________________________________ Zoning District: ___________
Owners Mailing Address: _________________________________________________________
Owners Contact Number: _________________________________________________________
Owners Email Address: ___________________________________________________________
Contractor Information: __________________________________________________________
Contractor Address: _____________________________________________________________
Contractor Phone Number: _______________________________________________________
Contractor Email Address: ________________________________________________________
Documents Submitted from Contractor:
- Nassau County License YES NO
- Workers Compensation Insurance YES NO
- Liability Insurance YES NO
- Disability Insurance YES NO
Will Homeowner Install Their Own Fence YES NO
If So, Was a Valid Copy a Valid Homeowners Insurance Policy Submitted? YES NO
Was the Fence Already Installed? YES NO
Total Cost of Project (Must include contract): _______________
Total Length of Fencing: _________________________________________________________
NOTARY REQUIRED:
Print Name of Applicant: ______________________________________
Signature of Applicant: ________________________________________
Sworn to before me this________________day of
___________________20____
Notary Public: ____________________ Superintendent of Buildings: _____________________
DEPARTi\1ENT OF BUILDINGS
OF
THE
VILL
AG
F.
OF
FRF.EPOnT, N.Y.
Al'PLIC,\
T
ION
NO.-
----
----
- -
l'fl.t'.'\/C; DATE
------
---
--
The
fee
paid herein shall
hr
11011-rct'undahlr. S:tid
CU
SI
will
he
for
!he
j
l
l'lll'l:SSill~
or
lhc
applic:ation
"hcthcr
approved
or not.
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6.
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7.
Is
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site.
or
an~
port inn
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ad
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an
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designated
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\11.·1la11d
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li
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15
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la~
thl' sill'
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....................................
--
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Signature:
__
___
_____
_ _
_____________
Title: _
__
____________
_
-·········
--
- -
----
--
----
--
PRINT FORM
I'
..
BUILDING
,PERMIT
COMMERCIAL OR MIXED' USE PROPERTY
DEPARTMENT OF ASSESSMENT
NASSAU COUNTY
240
Old
Country
Road, Mineola, NY 11501
_______
_ _
.,..T_o_w_n
...
,_c_ity,
Village
of;.;;:
----
=
,-.--=--~
ECTION
BLOCK
LOT(S)
SCH
DIST
PERMIT#
ocatlon
N.E.S.W.
SIDE
OF
(OR
CORNER
OF)
N.E.S.W.
SIDE
OF
f
ulldlng
DATE REC'D
(Assessor
U
se
Only
)
SPECIFIC
ZONING
DESIGNATION
DDRESS
OF
PROPERTY
NAME
OF
BUSINESS
Check one
ITY,
TOWN,
VILLAGE
ZIP
CONTACT
PERSON
.....
~-----------------------
---------------1
CJowNER
:STIMATED COST OF CONSTRUCTION:
OR
ADDRESS
QLESSEE
CITY,
STATE,
ZIP
ATE
TO
BEGIN
PRINCIPLE
TYPE
OF
PHONE
CONSTRUCTION
1ATE
TO
COMPLETE
0
STEEL
EMAIL
OT
SIZE
S.
F.
0
f
c:~-~-~-,-.
:~
-.---:;_;.1
f..
.
..
. .
>~:
~
- - -
------------
---
--1
W
MASONRY
BLDGSON
LOT
0
OTHER
:7
If
you wish to group or apportion lots, please
ca
ll o
2.
516-571-1
5
00
for more Information. C
~----------
--------------------------------
... -----------------------------------------------41
0'
...
)ESCRIPTION OF WORK IN DETAIL (PLEASE PRINT CLEARLY)
:!.
----
~~-------
--
~-----
---'-
----~-------------------
--
~
CHECK
ALL
THAT
APPLY
0 NEW BUILDING
0 ADDITION (CHANGE
IN
S.F
.)
0 DEMOLITION
0 ALTERATION
(NO
CHANGE
IN
S.F.)
0 OTHER (Describe)
_______
_.__
0
FA<;ADE
0 BASEMENT RENOVATION/ALTERATION
0HVAC
OROOF
0 PLUMBING
0 ELEVATORS
0 SPRINKLERS
osoLAR
OANTENNA
0 BILLBOARD
0 SATELLITE DISH
COMMENTS
SIZE QUANTITY
USE
BY
SIZE AND
FLOOR
BSMT
1ST
1ST
addnl
use
2ND
UPPER
FLOORS
TOTAL#
FLOORS
EXISTING
S.F.
AREA
Use Size
SF
List additional
use
In
comments section
Residential Use
CO-OP D
CONDO D
RENTAL D
Studio
1BDRM
2BDRM
3BDRM
4
BDRM
OTHER
Describe
Existing
#Units
Existing
Sq. Feet
PROPOSED
S.F.
AREA
Use Size
SF
-----ll(h
Proposed
#Units
----
-11
!
Proposed
Sq. Feet
cs·
=
m
0
n
,r;"
r-
0
...
-
Ill
-
c
J.-
------------------------------------------------------------------------------------------.....,
2'
Approved
By
_____________
_
Date
of
Granting
of
Permit'----------
SEPARATE APPLICATION
SHALL
BE
MADE FOR EACH BUILDING
FIELD REPORT ON REVERSE
Rev 08/11
Signature
of
Applicant/Contact Person
Please
Print
Name
:
Tele#
.
.
,-
BUILDING PERMIT
RESIDENTIAL PROPERTY
DEPARTMENT OF ASSESSMENT
NASSAU COUNTY
240
Old
Country
Road,
Mineola,
NY 11501
NBHD# (ASSESSOR
USE
ONLY)
~
~~~~~~~"'!""!'~~--------1
z
DATE
REC'D (ASSESSOR USE ONLY)
.,_
____
..,..
____________
_,.;.T~OW~N-·-C-ITY~·-V-IL~LA;;.;,;.G~E~O-F~:::::;;;m;;;;;;~;;;;;;;;;;;;;;;;;;:;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;....
__
-+---------------------------1
th
SECTION
BLOCK LOT
(S)
SCH
DIST# PERMIT#
SPECIFIC
ZONING
DESIGNATION
(')
1-------1--------------1--------'-~-----+------+------------------+-----~--;_;..;..;.;;...;.;~,;;..;;...:;.;...;.;;.;.;...
____
.... :c
0
0
t------+.-:-~!'!!'"':'.="~~~~~-----------
......
----
....
~~~~------------------------------------1r
Location of
N.E.S
.
W.
SIDE
OF
(OR
CORNER
OF)
N.E
.
S.W
.
SIDE
OF
0
t=:B~ul~ld~lng~~~=-:--------------------------------+---------"P!"!'~~~~------------------------
.....
~
ADDRESS
OF
PROPERTY
NAME
OF
BUSINESS
-
0
Check one
~~,.,.,.,,.,.,.,,.,.~-=---------------------------'"'"""':-----t---------+,..,,._~"""=~.,.,,,,.....,..,.,,-----------------------1-t
CITY,
TOWN,
VILLAGE
ZIP
CONTACT
PERSON/OWNER
~-=-
......
----..._~~
....
......,...,..,..._..----------10
OWNER
ESTIMATED COST OF CONSTRUCTION:
OR
ADDRESS
0 LESSEE
CITY,
STATE,
ZIP
"'
WORK MUST BEGIN BY
PRINCIPLE
TYPE
OF
·
..
-PH-O-NE--------------------------------41~
CONSTRUCTION
:::!
=
EMA-,-IL
--------------------------------11
0
z
PERMIT EXP DATE
0
STEEL
LOT SIZE S.F.
0
MASONRY
# BLDGS
ON
LOT
0
FRAME
IF YOU WISH TO GROUP OR APPORTION LOTS
PLEASE
CALL
516-571-1500 FOR FURTHER INFORMATION
DETAILED DESCRIPTION
OF
WORK (PLEASE PRINT CLEARLY)
m
*INCLUDING, BUT NOT LIMITED TO: LOCATION,
TYPE
AND DIMENSIONS
OF
IMPROVEMENT r
.,_
__________________________
..._
______________________________________________________
.... o
(')
"
1--------------------------------------------------------------------------------------~
PERMIT
TYPE·
CHECK
ALL
ITEMS THAT APPLY
0 NEW BUILDING
0ADDITION
(CHANGE
IN
S.F.)
0 DEMOLITION
0ALTERATION
(NO CHANGE
IN
S.F.)
0 MAINTAIN (PRE-EXISTING)
. -
0 RECONSTRUCTION
0 DECK, TERRACE, PORCH, CARPORT
0DORMERS
00THER
__________
_
0 FIRE DAMAGE
0 GARAGE/ OUT BUILDING
OHVAC
0PLUMBING
0 RELOCATION
0 REPLACEMENT
0 SWIMMING POOL
0TENNIS
COURT
0 CHANGE
IN
USE
PROPOSED TOTAL PLUMBING FIXTURES
DOES RESIDENCE HAVE
THE FOLLOWING
1-------------------
...
r
~
CENTRAL AIR
YES 0
NO
0
---------------------------
!!J
FINISHEDATTIC YES 0
NO
0
BASEMENT FINISH
1/4
D 1/2 D
3/4
D
FULL
D
FLOOR/FIXTURE
BASEMENT 1ST FLOOR
2NDFLOOR
3RD FLOOR
BATHROOM SINK
1--------------------+---------------+----------------+-----------------+----------------~
~
TOILET
~
~-------------------1----------------1----------------+-----------------+------------------t
llt:
BATHTUB 0
'---------------------+----------------+----------------+-----------------+-----------------~::u
STALL SHOWER
~---------------...------------------------------------------------------------------~m
BIDET r
--------------------+---------------+----------------+----------------~----------------~o
KITCHEN SINK
(i)
-----------------------------------------------------------------------------------------~§
WET BAR
NUMBER OF EXISTING AND PROPOSED BATHS
NUMBER
OF
EXISTING FULL BATHS NUMBER OF
PR
OPOS
ED
FULL BATHS
NUMBER
OF
EXISTING HALF BATHS NUMBER OF PROPOSED HALF BATHS
HALF
BATH
EQUALS TWO FIXTURES, FULL BATH EQUALS THREE OR MORE FIXTURES
C:
------------------------------------------
........
------
........
--------------------------~Z
NEW C/O NEEDED YES 0
NO
0
=i
VARIANCE OBTAINED
YES
0
NO
0 lit:
CONSTRUCTION/RENOVATION
IN
EXCESS
OF
50% YES 0
NO
0
SURVEY ENCLOSED YES 0
NO
0
g
DATE OF GRANTING OF PERMIT
--
------------------------------
----------~"'
Signature
of
Applicant/Contact Person - Sign & Print
SEPARATE APPLICATION SHALL BE
MADE FOR EACH BUILDING
FIELD REPORT ON REVERSE
Rev
08/11
Address
of
Applicant/Contact Person
Telephone
Affidavit
of
Exemption
to
Show
Specific Pl'oof
of
Workers'
Compensation
Insu
rance
Cove
ra
ge
fo1
· a
1,
2, 3
or
4 Family,
Owner-o
ccu
pied
Residence
w
Thi.<
for111
c11111111f
ht·
u.~<!tl
(11
!t'llii'<'
1111•
11·ork1
·r.1'
c111111
1c
11.mt/m1
r(r,:fit~
or
11hlig111/1111<
11/
1111.J'
Jltlr~i·.
·
Unch-r
penalty
of
perjury
. i certify that I
mn
lhc owner
of
thc
l.
2.
3 ur
-t
fa
mil
y, owner-occupied residence
(including w
11du111i11i11111s)
list..:<l
(l!l
the building permit th:n I am applying
for.
and I am not required
to
show
spccilic
1m
>11f
or
'rnrkcrs·
cn111pc11s:11ion
in
surn
ncc
cmcragc
fi.1r
s11d1
rcsi
dcrn.:c
because (please check
th
e
<1pprupriall'
box):
0 I
am
per
lhr111i11g
all
the w
ork
for
which
the
building permit
was
issued.
0 J am not
hi
ri
ng. paying
or
compensating
in
:lily \\'ay. thc
inc.J
i\'
id
ual( s) that is(
ar..:)
per
formi
ng
all
the
work
thr which
!h~
h11ilding
pt..'nnit
was issued or
hl.'lping
me
p..:1form
s
uch
\\Wk.
0 I h:m:
;:
ht1mcowners
ins11r;111cl:
poli.:)
thm
is
cum:mty
in
cfli.:..:t
and covers the prnpl!rty listed
on
;he
attm:h
c<l
building
pe
r
mit
1\N[)
:un
hi
ring l
lf
paying individuals a total
t>I'
less than
.:JO
hour
~
per week
(aggregate hours
for
nil
pni<l
indiv
id
uals on the johsilc)
li1r
whid1 the building permit
was
issued.
I alsu
agr
cc
to
either:
+ ac4uirc apprupri:1tc
\\
'
Of
kl·rs' comp
c11
s;11irn1
cowrage and prlwide appropriate proof
or
that coverage
on
forms nppmv.:d
by
the C
ha
ir
of
the
NYS
Workers'
C\'tnpcnsa1io11
llo:ird
to
the g0\·c
111mc111
entity issui
ng
th
o.:
huiltling permit
ifl
nee
tl
lo
hire or pay indiriduals a towl
t1f".!O
hours
t'f
11111rc
per m:ck (aggre
ga
l::
hours
for
all
paid individuals
1111
lhc
.i1>hsit
c)
l'
ur
"mk
indi..:at
cd
tin
th
e building
p..:rm
il.
or i
i'
:ipp1\
1p
rialc.
lit.:
a CE·
2
1111
exempl
i1'11
form: OR
ha
n.·
the general c 0t1tr;icllir. pcrforming
th.:
\\'01'k
on
the
I.
2. J or
.1
fo111ily.
owner-occupied
r~shkncc
(i
11
dm
li
ng
i:u11d\•lllinh1111s)
listed on the building. permit thal I am
ap1ll~
ing
for.
pl'\ividc :ipprnpriatc proofol'
\lorkcrs·
cm
npc
n~at
ion
i.:1n·i:rngc
or
p
rno
rnrcxc111pti
1~
11
from
that
..:nvcragc
1111
fnr
ms
;ippnwcd
hy
the
Chair
111'
thr.:
NYS
\\\1rkc
r~'
C'nm;1l'll
Sa
lin11
Hua
r
tl
hi
the
go\·cmmcnt entity
i
s~u ing
;he build
in
g pcrmil
i1·
1hr.:
pr11.k.-t
1.11..
....
,
;1
l
•.it.i!
t•f ·
10
h•ui·
:-
"r
i::1•:'I: I
r
11
..:::!-.
(ilgg.rq:at.
.:
h1n:
1
:-
li•r all r;1iJ
i11
J i\'idual.; 11
11
th~
·
j ..
hit
~·)
liir
11
i1rk
i11ili..:
;
11ct!
on the ht:ilding
p..:rmi
L
(
IJatr.:
Sig11ed)
1
1,1
111c
·1
ch:pli.1111."
:\umb::r
-----
--
--
(llomct.>wncr's Name Primed)
I
0..
'
,-M
·
·-
...
--
·
··
·-
- -
---
--
--
--
--
·
~I
Pn
1p
cny
t\J<lrcss that r:.:quircs the building permit:
~
S
..
·o
r11
111
ht!ft>,.,•
nu
,
thl
.
'i
---
--
1/ay
11/
:
--
--
-----
---
--
-
--
---·
..
I .
i
I I
-
.......
·-
..
·-
---
-
--
·
·-
··-·--
·-
.....
..J
. o I
One~
n111:1
ri1.c1l, this nr. I form serves ns :rn
c~cmptlon
for
hn
rh
workers'
cnm1
1c
11s:iti
nn :
11111
di
sa
h
ll
lty
IJ~ucOt
<
ins11r.tn
c~
COl"trnjlc
.
l3
I ( 12/08)
NY-\VCB
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