i:\building dept templates\application for building permit.pdf (revised 4/2019)
TOWN OF NORTH EAST
19 N Maple Avenue, PO Box 516, Millerton, NY 12546
P 518-789-3300 x606, F 518-789-3399
ne.buildingdept@taconic.net
APPLICATION FOR BUILDING PERMIT
DA
TE:_____________ PERMIT #:____________
IDEN
TIFICATION OF APPLICANT:
NA
ME OF OWNER________________________________________________ PHONE____________________________________
PARCEL GRID NO.__________--_______--____________________ADDRESS__________________________________________
MAILING ADDRESS_____________________________________________________________ZONING DISTRICT___________
APPLICANT’S NAME if other than owner (written consent from owner must accompany this application)
NAME OF APPLICANT_________________________________________PHONE_______________________________________
MAILING ADDRESS___________________________________________EMAIL _______________________________________
DESCRIBE THE PROPOSED WORK FOR THIS APPLICATION:
☐ ACCESSORY BUILDING ☐ ADDITION ☐ ALTERATIONS ☐ INSULATING
☐ DECK/PORCH/SUNROOM ☐ POOL/HOT TUB ☐ STRUCTURAL REPAIRS
☐ OTHER__________________________________________________________________________________________
DESCRIPTION OF WORK TO BE PERFORMED:______________________________________________________________
____________________________________________________________________________________________________________
SETBACKS: FRONT YARD_____________________REAR YARD_________________SIDE YARDS_____________________
DIMENSIONS______X______ TOTAL SQ. FT.__________ ESTIMATED COST $_____________________
ATT
ACHED HERETO AND MADE A PART OF THIS APPLICATION I SUBMIT THE FOLLOWING DOCUMENTS:
☐ A PROPERTY SURVEY OR A COPY OF THE APPROVED PLOT OF THE AFFECTED PREMISES
☐ CONSTRUCTION PLANS AND SPECIFICATIONS (2 SETS OF STAMPED ARCHITECTURAL PLANS IF WORK EXCEEDS $19,000 )
☐ PROOF OF WORKMAN'S COMPENSATION INSURANCE ON FORM #C-105.2 OR U26.3 BY THE CARRIER
☐ OTHER _________________________________________________________________________________________________
APPLICATION IS HEREBY MADE TO THE OFFICE OF THE BUILDING INSPECTOR, DEPARTMENT OF PLANNING, ZONING, AND BUILDING
PURSUANT TO THE N.Y.S. UNIFORM FIRE PREVENTION AND BUILDING CODE AND THE CODE OF THE TOWN OF NORTH EAST AS ADOPTED BY
THE TOWN BOARD. THE APPLICANT AGREES TO COMPLY WITH ALL APPLICABLE LAWS, ORDINANCES, AND REGULATIONS.
SIGNATURE OF APPLICANT_____________________________________________________DATE _____________________
(Must be signed in office)
SIGNATURE OF OWNER_________________________________________________________DATE_____________________
OFFICE USE ONLY
ADMIN FEE $_________ PERMIT FEE $__________ RECEIPT #___________ DATE_____________________
BUI
LDING INSPECTOR______________________________________________ DATE _____________________
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