AIR-CONDITIONING/REFRIGERATION
1.
Need copy
of
survey. Locate
on
survey where the ale unit(s) is going.
2. Commercial:
a.
If
the unit is
NOT
located
on
the roof, certification from an architect, engineer
or
surveyor that said unit complies with elevation requirements as per
FEMA
and
Village
of
Freeport Code.
b.
If
it is a
roof
top unit,
an
engineer's letter, signed and sealed, must
be
submitted
saying that the installation
of
the unit can
be
supported by the roof.
c. Certification from an
en
gineer/architect that the bottom
of
the unit is at a minimum
of
four (4) feet above the base flood elevation NAVD88.
3. Residential: In Flood Zone (for elevations, substantial improvements/substantial repair,
new construction)
a.
Certification from
an
en
gineer/architect that the bottom
of
the unit is at a minimum
of
four (4) feet above the base flood elevation NAVD88.
DEPARTMENT OF BUILDINGS
VILLAGE
OF
FREEPORT
,
NY
Permit
No.
------
Date
- - - - - - -
Application
for
Permit to:
Install
M a
intain
Air-Conditioning Equipment _ _ _
Refrigeration E
quipment
Freeport,
NY
ll520
Own
er:
~
------------------------------
-
(name)
(addr
ess
) (
phon
e)
Le
ssee:
~
------------------------------
-
(name) (ad
dr
ess) (
ph
one)
Contractor:
~
-------
---
-------------
----
-
~
(nam
e)
(a
ddr
ess)
(p
hon
e)
Licensed Plumber:
~
--
-------
----
------------
--
(name) (address)
(phon
e)
Licensed c lectric ian:
--
-------
--
------------
---~
(name) (a
ddre
ss)
Describe Equipment:
Location
ofEquip
m
en
l (e.g. interior,
exte
rior) -
-------
Ap
pr
ox
im
ate
co
st
of
co
n
str
ucti
on
$
--
- - - - - -
L
ngineer
s
Ce
rti ti
ca
tion
-
--~
-
Sur
vey
(exte
rior)
{p
hone)
C
ertificati
on fro m
an
eng ine
er/
a
rch
i
tec
t
th
at
th
e
bott
om of
th
e
unit
a t a
minimum
ol
'4
l~et
abn,
·e the ba
se
flood
ck\atin
n 1 A \"1)88.
Anida\
it
of
Contractor
State
of
New
York
)
Co
un
ty
of )
, being duly sworn. deposes and
say
s that he/she is
(I
he
pe
r
son)
/(a
me
m
ber
(~lthe
firm
of
)/(an
officer
Lo
wit,
th
e
of
)/(th
e c
or
poratio
n)
e
mploy
ed by the a
bov
e
nam
ed ow
ner
or
l
essee
to
install
the
ab
ove
d
esc
rib
ed
air-conditioning
equi
pm
e
nt
and
that
compensation
insurance
has
b
ee
n
obtained
and
is
in
full force
and
eff
e
ct
in
accorda
nce
with
the
provisions
of
the
Workm
en's
Co
mp
e
nsati
on
Law
,
to
w it:
Name
oflnsurance
C o .
Policy
No
.,
____
__
_ _ _ _ _ _
Expires
_ _ _ _ _ _ _
~-
Contractor's
Sign
a
tur
e _
__________
_ _ _ _ _ _ _ _
Print
Na1ne
- - - - - -
---
----
---
- - - - - - - -
Sworn
to before
me
on this
_ _ _
day
of
_ _ _ _ _ _
,20
__
Notary Public
Incorporated Village
of
Freeport
FLOODPLAIN DEVELOPMENT P
ERMI
T
Date: _ _ _
______
_ _
Application Number:
Property
S/B/L:
____
_ _ _ _ _ _
Perm
it Nu
mber
:
A
dd
ress
of Property: _ _
____
_ _ _ _ _ _ _
______
F
reep
ort
,
NY
11520
I ype of Deyelopmept: (Ch
eck
all th
at
appl
y):
Ex
cav
ation D
Fill
0 Grading 0 Residenti
al
Addit
ion
0
Re
sidential Alteration 0 Pool 0 Bulkhead 0 Deck 0
Utility lnstall
or
Replacement 0 Sewer 0 Road Construction 0 Commercial Addition 0 Commercial Alteration 0
Shed I Stora
ge
Fa
cility (Must be Anchored) 0 Roof 0 Fence 0
Oi
l Tank (Must be Anchored) 0
Driveway 0
Other (Speci
fy
):
OFF
I
CE
USE
ONLY;
F I
RM
Da
ta
; Fl
oo
d Zone: AE 0
VE
0 Map Panel #0238G 0 0239G 0 Map
Pan
el Date:
09-1
1-2009
Base F lood El
eva
t
io
n (NA
VD)
=
80
90
100
110
Qcyelopment Stan
dar
ds D
ata
;
1- Required elevation
of
utilities to be installed
in
cluding but not limited to, air conditioning, electrical equ
ipm
ent,
hot
water
heaters, boilers = Ba
se
Flood Elevation (BFE) + 4feet
of
Freeboard = (NA VD) or Not Applicab
le
0
2- Will garage be used
for
any purpose besides parking
of
vehicles, storage, or building access?
Yes
D
or No 0
(If "Yes", then the garage must
be
us
ed
in
determining the lowest floor elevation)
3-
If an elevation project, what
is
th
e proposed
met
hod
for
elevating the structure?
Fill and Foundation
0 No
Fill
and Foundation 0 Pilings 0 Extend Existing Foundation D Not
Ap
pli
cable D
Ne""
Foundation mu
st
ha
ve
required
Fl
ood Vent openings installed and quantity
of
ve
n
ts
must
be
provided
at
ti
me
of
application
on
submitt
ed
Archi
te
ctural Draw
in
gs. Engineered l
lood
ve
n
ts
must be cert
ifi
ed by a Licensed D
es
ign
Profes
sional
and
noted on
fi
nal Elevation
Ce
rtificate.
Total squ
ar
e
foo
ta
ge
of
first floor Sq
ft
Total Area
of
Peri
met
er Flood Vent
op
enings =
Sq
In
.
(Non - Eng
in
eered = I "per square foot or the use
of
Eng
in
eered vents)
The bottom
of
the openings shall not
be
greater than o
ne
foot above either interior or exterior grade at the perimeter
of
the
foundation wall.
4-
Commercial floodproo
fin
g requires submission of Certified
Fl
oodproofing Certificate. (Not permitted
in
V Zones)
5-
AE Zone - Lowest Floor to
be
at
or above Base
Fl
ood Elevation (BFE) +4 feet : Measurement = (NA VD)
6-
V-Z
on
e - Meas
ur
ement
of
lowest supporting hori
zo
ntal member must
be
at or
ab
ove Base Flood
El
evation (BFE) +4 feet
: Measurement = (NA VD)
7-
R
eg
ulatory Flood Elevation at development s
ite=
Base Flood Elevation (BFE) + 4 feet
of
Freeboard
(N
AVO)
Ap
plic
an
t
acknowledgment:
I t
he
undersigned
understand
that
th
e
issuance
of
a
floodplain
development
permit
is
contingent
upon
the
above
information
be
ing
correct
and
that
the
plan
s
and
su
pporting
dat
a
have
been or
shall
be
p
rovide
d as require
d.
I
also
und
e
rstand
that
prior to
occupancy
of
the
structure
being
permitted, an elevation
and/or
floodproofing certificate
signed
by
a pr
ofessional
engineer or
r
eg
istered l
and
surveyor
must
be
on
file
with
th
e Village
of
Fr
eep
ort
Building
Dep
a
rtment
indicating
th
e
"as
built
"
elevations
in
relation
to
th
e
North
Amer
i
can
Vert
i
ca
l
Datum
of
1
988
(NA
VD)
Print Name
of
Applicant: _ _ _ _ _
______
_ Signature
of
Applicant:
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