Fillable TOWN OF SMITHTOWN Building Department APPLICATION FOR PERMIT (Town of Smithtown)

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TOWN OF SMITHTOWN Building Department APPLICATION FOR PERMIT (Town of Smithtown)

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BROWSE TOWN OF SMITHTOWN (NY) FORMS

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TOWN OF SMITHTOWN
(To be filled in by Building Department.)
Application/Permit No. _______________
S.C.T.M. No. 0800- ________ - ______ -________
Receipt # ___________Permit Fee _______________
Zoning District _________Variance #___________
Plan Approved by __________________________
Permit Issued ____________20______ LWRP
Permit Expires ___________20 ______ DEC
Building Department
APPLICATION FOR PERMIT TO BUILD OR INSTALL
BUILDING – STRUCTURE – PLUMBING – HEATING – FIREPLACE –
EXISTING STRUCTURES – DECKS – SHEDS – PORCHES – AWNINGS –
CONVERSIONS – HOT TUBS –COMMERCIAL – NEW DWELLINGS
SITE WORK – SPECIAL EXCEPTION – DEMOLITION
Submit in duplicate. Each application must be typewritten or printed.
Incomplete or illegible applications will not be accepted.
APPLICATION is hereby made for a permit to do the following work,
which will be done in accordance with the description, survey and plans submitted
pursuant to Section 57 of the Workmen’s Compensation Law, Zoning Ordinance,
Building Code and all other applicable ordinances and laws
.
A PERMIT MUST BE OBTAINED BEFORE BEGINNING WORK
(Type or print)
Property located at No._________ N S E W side (street)_____________________Distance_______________
N S E W side (street)______________________________Village_________________________________ State of New York
Map of _______________________Section__________Lot(s)____________
Suffolk County Tax Map # 800- __________ - _______ - _________ Zoning District ___________
Owner of record on tax rolls__________________________Commercial tenant_______________________________________
Address_______________________________City_________________State_______Zip__________Tel.________________
Architect or Engineer__________________Address______________________________________
Village/City___________________State________Zip__________Tel.___________Fax __________E-Mail________________
Contractor/Builder/Agent________________________Address___________________________________________________
Village or City_________________State_______ Zip_________ Tel.___________Fax__________E-Mail _____________
Plumber_____________________________Address________________________________________________________
Village or City_________________State_______ Zip_________ Tel.___________Fax__________E-Mail ________________
Electrician___________________________Address________________________________________________________
Village or City________________ State_______ Zip__________Tel.___________Fax__________E-Mail ________________
Electrical Inspection Agency_______________________________________
“OCCUPANCY”
1 Family Dwelling 2 Family Dwelling Multiple Residence Commercial Other
NATURE OF WORK
Description of Work ____________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
WEBforms\ App_Building_Perm_ rev_02032015
1
COMPLETE ALL THAT APPLIES TO THIS APPLICATION
NEW CONSTRUCTION/ADDITIONS
WEBforms\ App_Building_Perm_ rev_02032015
2
Basement _____________ sq.ft.
Finished basement
Unfinished basement
1
st
floor area __________sq. ft.
2
nd
floor area __________sq. ft.
Attic space (6’ 8” & over)____________sq. ft.
Outside basement entrance _______
Fireplace(s)___________ type_____________
Porch/Portico ___________sq. ft.
Deck/Balcony ___________sq. ft. _________height
Shed-Accessory__________sq. ft ______height
Carport ___________sq.ft Misc. ___________sq.ft.
Demolition of _____________Total sq.ft. ________
Garage Area___________proposed sq. ft.
front entry side entry
INTERIOR ALTERATIONS
Basement _____________ sq.ft. 1
st
floor area______________sq.ft. 2
nd
floor area ___________sq.ft.
Garage/Porch/Sunroom converted to living space __________________sq.ft. Other _______________
(Please circle one)
ELECTRICAL WORK YES NO
PLUMBING (residential & commercial)
FIXTURES IN Bsmt 1
st
floor 2
nd
floor 3
rd
floor
Sinks
Bath Tubs
Showers
Toilets
Dishwasher
Refrigerator
w/plumbing
Laundry Tub
Washer
Grease Trap
Floor Drains
Roof Drains
Other
HEATING & COOLING
List Number of Fixtures to left and show diagram on plans.
Application is for a permit to do as follows.
Total No. of Fixtures______
Central Air Conditioning_____ _HVAC units _________
Electric _______Gas Fired________
Total no. of Units______________
Pressure (gas) test/s _____________
Specify Applicance(s) ______________________________
Application is for a permit to install the following heating equipment to be used to heat space, area, processing, domestic hot
water, including fuel oil storage tanks.
New
Conversion Replacement Installation to be – Oil Gas Electric Tank Only
Tank installation only is burner installed? Yes
No Replacement? Yes No
Inside tank capacity ___________________Gallons Type of Tank _________________
Outside tank capacity ___________________Gallons
ADDITIONAL INFORMATION FOR COMMERCIAL EXTERIOR WORK
Site Plan Approval ________________ Site plan Exemption Approval ______________
BEGUN PRIOR BUILT PRIOR _____________ Complaint #____________
(year built)
Fees will be assessed for any work done prior to issuance of required permits
Permits expire after one year and may be renewed one time only
FEES (for office use only)
Base __________________________
Square footage fee___________________ OBE_______________________
Assessment_____________________ Fireplace ___________________ Valuation ______
Plumbing_______________________ Heating / AC_________________
Pressure Test____________________ Certificate of Occupancy/Compliance _____________
TOTAL _______________
WEBforms\ App_Building_Perm_ rev_02032015
3
AFFIDAVIT
I ________________________________________being the _____________________________________________
Print Name Owner (Commercial may be Owner’s Agent, Architect or Contractor)
Swear that to the best of my knowledge and belief the statements contained in this application, together with the plans and
specifications submitted, are a true and complete statement of all proposed work to be done on the described premises and that
all provisionsof the Amended Zoning and Building Ordinance and the State Building Code and all other laws pertaining to the
proposed work shall be complied with, whether specific or not, and that such work is authorized by the owner.
Signature_____________________________________________________________
OWNER(Commercial applications may be signed by Owner’s Agent, Architect or Contractor)
Sworn to before me this:
________Day of ________________ 20______
_______________________________________
(Notary Public, Suffolk County, New York)
notary stamp
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TOWN OF SMITHTOWN Building Department APPLICATION FOR PERMIT (Town of Smithtown)

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Completed 5 August 2020

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