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 ___________________________________________________________
