TOWN OF MIDDLETOWN



TOWN OF MIDDLETOWN

Building and Zoning Dept.

PO Box 577, 42339 State Highway 28

Margaretville, NY 12455

Phone (845) 586-2344 – Fax (845) 586-1775

Email: middbldgzon@

BUILDING PERMIT APPLICATION

Date_____________________, 20__

APPLICATION IS HEREBY MADE to the Building and Zoning Department for the issuance of a Building Permit pursuant to the New York State Building Construction Code for the construction of buildings, additions or alterations, as herein described. The applicant or owner agrees to comply with all applicable laws, ordinances, regulations and all conditions, expressed on the back of this application which are part of these requirements, and also will allow all inspectors to enter for the required inspections.

NOTE --- READ INSTRUCTIONS ON THE REVERSE SIDE

Applicant’s Name____________________________________ Zoning District_______ Lot Size________

Mailing Address______________________________________ Existing Building Size__________________

___________________________________________________ New Building Size_____________________

Phone______________________________________________ Classification Block:

Residential_______Commercial__________

Owner’s Name_______________________________________ Permit is for:

Mailing Address_____________________________________ Residence_______ Addition/Renov.________

__________________________________________________ Deck_______ Other ___________________

Phone_____________________________________________

***Fire Inspections, sign, pools, demolition all

require separate application.

General Contractor____________________________________

Masonry Contractor___________________________________

Electrical Contractor___________________________________ Total Value of Project:_________________

Plumbing Contractor___________________________________

| |

|Fee:__________ Permit# ____________ |

| |

|Approved by:____________________ |

Property Location of Proposed Construction_________________

____________________________________________________

Tax map #________________________________

(Located on your tax bill)

Existing Use___________________________________________

Intended Use__________________________________________

Name of Contractors Insurance Carrier (Please submit Certificate)

_____________________________________________________

DATED:________________________________ _________________________________________

(Owner/Applicant Signature)

STATE OF NEW YORK

COUNTY OF DELAWARE

Sworn to before me this on the________ of _________________, 20___

___________________________________________

(Notary Signature and Seal)

______________________________________________________________________________________________________

REQUIRED FOR A PERMIT:

1. Architect/Engineered sealed plans (2 sets) if over $20,000 or 1,500 square feet, no changes can be made except by architect/engineer.

2. Plot plan showing setbacks, septic, well, driveway, fences, accessory building(s).

3. NYC-DEP septic approval to construct a new home or adding bedroom(s) to existing.

4. Driveway permit showing location of driveway with a copy of map if subdivided (separate application)

5. Foundation plan to fit land that the house is being built on.

6. Energy study sealed.

7. Application filled out completely.

8. “To Whom” signed, whoever is responsible for inspections, etc.

9. Insurance Certificate

10. Fee

INSTRUCTIONS

This application must be filled out completely and submitted to the Building Department with plot plan showing location of the lot and of buildings on parcel, distance to adjoining properties, public streets or right-of-ways.

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 material and equipment to be used and installed and details of structural, mechanical, electrical and plumbing, heating installations.

Any work including labor and materials that values $20,000 or more will require a P.E. or licensed architect seal.

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

Per Local Law #1 of 2007, building permits shall become invalid unless the authorized work is commenced within 6 months following the date of issuance.

Building permits shall expire 12 months after the date of issuance unless it is renewed upon application by the permit holder, payment of the applicable fee, and approval of the application by the Code Enforcement Officer.

Upon approval of this application, the Building Department will issue a Building Permit to the applicant together with approved, complete set of plans and specifications. Such permit and approved plans and specifications shall be kept on the premises granted by the Building Department.

A PERMIT AND CERTIFICATE OF APPROVAL MUST BE OBTAINED FROM A THIRD PARTY ELECTRICAL INSPECTION COMPANY FOR ALL ELECTRICAL WORK. PERMIT MUST BE OBTAINED BEFORE STARTING ANY ELECTRICAL WORK.

Note: Inspections by the Building Department are required according to the following schedule:

YOU MUST CALL 24 HOURS IN ADVANCE FOR AN INSPECTION BEFORE YOU PROCEED TO THE NEXT STEP:

1. Footings before pouring concrete with forms in place.

2. Foundation walls before pouring concrete.

3. Foundation inspection with footing drain before backfilling.

4. Framing inspection.

5. Plumbing with pressure test and heating.

6. Insulation inspection before the walls are closed up.

7. Chimney/fireplace or woodstove

8. When all work is completed, final inspection is required for applications.

TO WHOM IT MAY CONCERN:

Please be informed that in reviewing building plans, all information is taken from the plans. Any changes, after the plans have been accepted, must be reviewed by the Building Inspector. This Department shall expect, upon completion, to find the structure as the plans show. An additional permit fee may be charged predicated on the extent of the variation from the original plans.

Absolutely no one is to occupy this home without first obtaining a Certificate of Occupancy.

DATE:______________________ ___________________________________

(Owner)

___________________________________

(Builder)

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