Municipality: _______________________________________________________________________________________

Permit #: ____________________________________   YEar Limit: __________________________________________

APPLICATION FOR BUILDING PERMIT

TYPE OF APPLICATION:  

                                                                Residential _______                           Non-Residential _______

Tax Map #: ______________________________________________________________________________________________

I, We _________________________________ hereby make application for a permit to erect _____ alter _____ convert _____

a (describe) ______________________________________________________________________________________________

According to the specifications herewith submitted. All provisions of the New York State Uniform Fire Prevention and Building Code, New York State Municipal Residency Law, Adirondack Park Agency Regulations and the Town Zoning Laws shall be compiled with in connection with the operation whether specified or not.

Owner of land and building: _________________________________________________________________________________

Address: ________________________________________________________             Phone #: ________________________________

Builder’s Name:  __________________________________________________________________________________________

Builder’s Address: ________________________________________________________________________________________

Builder’s Phone #: ________________________________________________________________________________________

Lot Area: _____________________________________ sq. ft.            Frontage: ____________________________________ft.

Distance of building from lot lines measured in feet:   front: _________  rear: _________  side 1: _________   side 2: __________

Size of building:   front ______________ ft.    rear _____________ ft.    depth _____________ft.    Total sq. ft.:___________          

Number of Stories: ____________ Type of Construction: _________________________________________________________

Garage, (attached-unattached-sq. ft.) ____________ Estimated cost $ ________ Estimated date of completion: _______________

Application is also for a Certificate of Occupancy for property described in this application, upon completion thereof in compliance herewith, said property to be used for the following purpose and no other:

 ________________________________________________________________________________________________________

Permit Fee:  ______________      Application Fee: $10.00      Total: _______________      (   ) Cash   (   ) Check # ___________

__________________________________    _________________________________________    _________________________

                 Applicant (Print)                                     Signature of Applicant                                                                          Date

_____________________________________________________________________________   _________________________

                                            Code Enforcement Officer – David Lansing                                                                      Date