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
i:\building dept templates\application for single family residence.pdf (revised 10/2019)
APPLICATION TO CONSTRUCT A SINGLE FAMILY RESIDENCE
DATE:______________ PERMIT #:________________
IDENTIFICATION OF APPLICANT:
APP
LICANT NAME________________________________________________PHONE___________________________________
MAILING ADDRESS_______________________________________________EMAIL___________________________________
OWNER OF RECORD (if applicant is not the owner of record, written consent from owner is required as part of this application)
NAME_______________________________________________________PHONE________________________________________
ADDRESS____________________________________________________EMAIL________________________________________
LOCATION (ADDRESS)______________________________________________________________________________________
TAX PARCEL NUMBER____________--__________--__________________
CLIMATIC AND GEOGRAPHIC DESIGN CRITERIA
SPEED
DESIGN
DESIGN
UNDERLAYMENT
B
DESCRIPTION OF NEW RESIDENCE: ESTIMATED COST $________________________
SQ. FT. BASEMENT __________ NO. OF STORIES ________
SQ. FT. 1
ST
FLOOR __________ NO. OF ROOMS ________ ☐ BONUS ROOM
SQ. FT. 2
ND
FLOOR __________ NO. OF BEDROOMS ________ ☐ DECK
SQ. FT. GARAGE __________ NO. OF BATHROOMS ________ ☐ PORCH
SQ. FT. OTHER __________ NO. OF CAR BAYS ________ ☐ FINISHED BASEMENT
TOTAL SQ. FT. __________
☐ OTHER (DESCRIBE)______________________________________________________________________________________
ATTACHED 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 (if applicable)
☐ TWO (2) SETS OF STAMPED CONSTRUCTION PLANS AND SPECIFICATIONS
☐ ENERGY AUDIT (RES-CHECK) COMPLIANCE CERTIFICATE
☐ PROOF OF WORKMAN'S COMPENSATION INSURANCE ON FORM #C-105.2 OR U26.3 BY THE CARRIER
☐ PROOF OF OWNERSHIP ☐ GRADING PLAN OR AGREEMENT
☐ DRIVEWAY PERMIT AND AGREEMENT ☐ APPLICATION FOR GRADING PERMIT
☐ SAN 34 TO BE FILED WITH HEALTH DEPT BY TOWN ☐ METHOD FOR ENERGY CODE COMPLIANCE
APP
LICATION 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 Building Office)
SIGNATURE OF OWNER__________________________________________________________DATE____________________
OFFICE USE ONLY
ADM
IN FEE $_________ PROJECT FEE $__________ RECEIPT #__________ DATE________________
BUILDING INSPECTOR______________________________________________DATE________________
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