Please read all instructions and then complete the following information and
Print, Sign, Notarize, Date and Mail to:
Incorporated Village of Farmingdale
PO Box 220
361 Main Street
Farmingdale, NY 11735
(516) 249-0093
www.FarmingdaleVillage.org

 

Permit No.

APPLICATION FOR BUILDING PERMIT
Examined 20 Approved 20
Disapproved for the following reasons:
Building Inspector

 
Date



INSTRUCTIONS

 

  1. This application must be completely filled in by typewriter or printed in ink and submitted in duplicate to the Clerk of the Inc. Village of Farmingdale.

     

  2. Plot plans must be included. Current survey.

     

  3. This application must be accompanied by two complete sets of plans showing proposed construction and two complete sets of specifications. Plans and specifications shall describe the nature of the work to be performed, the materials and equipment to be used and installed and details of structural, mechanical, electrical and plumbing installations prepared by a licensed architect or engineer.

     

  4. The work covered by this application may not be commenced before the issuance of a Building Permit.

     

  5. Upon approval of this application, the Village of Farmingdale will issue a Building Permit to the applicant together with approval, duplicate set of plans and specifications. Such permit and approved plans and specifications shall be kept on the premises available for inspection throughout the progress of the work.

     

  6. No building shall be occupied or used in whole or in part for any purpose whatever until an application is made for and a Certificate of Occupancy shall have been granted by the Village of Farmingdale.




LOCATION:
(Give street number, name, side and distance from nearest cross street)
SECTION: BLOCK: LOT:
APPLICATION IS HEREBY MADE to the Village of Farmingdale for the issuance of a Building Permit pursuant to the New York State Building Construction Code for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant hereby agrees to comply with all applicable laws, ordinances or regulations.



PROPERTY OWNER
Name:
 Street Address:
Post Office:
 Zip:
 Phone No. (include area code)
APPLICANT
Name:
 Street Address:
Post Office:
 Zip:
 Phone No. (include area code)
ARCHITECT/ENGINEER
Name:
 Street Address:
Post Office:
 Zip:
 Phone No. (include area code)
CONTRACTOR *
Name:
 Street Address:
Post Office:
 Zip:
 Phone No. (include area code)
NASSAU COUNTY HOME IMPROVEMENT NO:
 EXP:
 WORKERS COMPENSATION NUMBER
* Pursuant to Section 57, of the Worker's Compensation Law, a Certificate of Insurance on the standard form subscribed by an insurance company authorized by the Superintendent of Insurance to issue worker's compensation policies must be filed with this application covering all operations in connection therewith.



  1. State existing use and occupancy of premises and intended use and occupancy of proposed construction.
A. Existing Use:
 B. Intended Use:
  1. Nature of Work:
New Building
 Addition
 Alteration
 Repair
 Removal
 Demolition
Description of work:

 Estimated Cost: *:
  1. If Dwelling/If Garage:
Number of dwelling units:
 Number of dwelling units on each floor:
 If garage, number of cars:
  1. If business, commercial or mixed occupancy, specify nature and extent of each type of use:

  1. Dimensions of entire new construction:
Front:
 Rear:
 Depth:
 Height:
 Number of stories:
  1. Size of lot:
Front:
 Rear:
 Depth:
 Area:
  1. Zone or use district in which premises are situated:
  1. Does proposed construction violate any zoning law, ordinance or regulation?:
(#7)Zone/Use District:
 (#8)Violation?:
  1. Will electrical work be inspected by, and a Certificate of Approval obtained from the New York Board of Fire Underwriters or other agency or organization? If so, specify:

* Costs for the work described in the Application for Building Permit include the cost of all construction and other work done in connection therewith, exclusive of the cost of the land. If final cost shall exceed estimated cost, an additional fee may be required before the issuance of Certificate of Occupancy.
NO OVERSIGHT, ERROR OR OMISSION ON THE PART OF THE VILLAGE OR ITS REPRESENTATIVE SHALL LEGALIZE THE ERECTION, CONSTRUCTION, ALTERATION, REMOVAL, USE OF OCCUPANCY OF A BUILDING OR STRUCTURE THAT DOES NOT CONFORM TO THE PROVISIONS OF THE STATE BUILDING CODE AND THE BUILDING ZONE ORDINANCE.

FEE SCHEDULE
A. First $1,000 of construction cost $50.00  
  Each $1,000 thereafter $15.00 AMOUNT PAID $
B. Certificate of Occupancy $50.00 (one & two family dwellings)  
    $100.00 (all other) DATE
C. Inspection $20.00 (one & two family dwellings) MCR #
D. Other Solder Test $35.00 Solder Test $35.00



PROPERTY OWNER'S CONSENT
(Do Not Type In Signature Fields. Sign After Printing)
STATE OF NEW YORK

COUNTY OF   ss.:
Signatureof Property Owner
Name of individual signing application:
being duly sworn deposes and says that he is the aforementioned applicant.
He/She is the

(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief, and that the work will be performed in the manner set forth in the application and in the plans and specifications filed herewith.
Sworn to before me

this   day of      20

Signature of applicant:

Notary Public:
 

County: