Application For Building And Zoning Permit - Town Of Guilderland
ADVERTISEMENT
1
2
3
4Application for Building and Zoning Permit
TOWN OF GUILDERLAND
Building Department
Guilderland Town Hall
Ph: 356-1980
P.O. Box 339, Route 20
Fax: 356-1990
Guilderland, N.Y. 12084
Date: ________________________ , 20_____
Permit No. _______________
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit and Zoning Permit pursuant to
the New York State Fire Prevention and Building Code for the construction of buildings, additions or alterations, or for removal or
demolition, 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
the premises for the required inspections.
NOTE – READ INSTRUCTIONS ON REVERSE SIDE
Applicant’s Name ___________________________
Zoning District _______________________________
Address ___________________________________
___________________________________
Tax Map Number: ____________________________
Phone ____________________________________
Flood Zone Designation________________________
Lot Size _______________ Area ________________
Owner’s Name _____________________________
Existing Building Size _________________________
Address _________________________________ _
New Building Size ____________________________
___________________________________
Phone ____________________________________
NEW BUILDING YARDS: Zoning Set Backs:
Fill in plot diagram on back
Property Location of Proposed Construction
Front Yard Depth ________________________ Feet
__________________________________________
Right Side Yard Width ____________________ Feet
__________________________________________
Left Side Yard Width _____________________ Feet
Rear Yard Depth ________________________ Feet
Existing Use ________________________________
Bldg. Height ___________ Feet ___________ Stories
Describe: __________________________________
__________________________________________
Estimated Cost $_____________________________
__________________________________________
Floor Area __________________________________
__________________________________________
Cubic Area __________________________________
Name of Compensation Carrier & Policy #
__________________________________________
Fee $_______________________________________
________________________________________
Signature of Owner, Applicant or Agent
NOTE: THIS BUILDING PERMIT FOR RESIDENTIAL WORK EXPIRES SIX (6) MONTHS FROM DATE
ISSUED – ONE (1) EXTENSION PERMITTED
Dated________________________, 20__________
________________________________________
Deputy Building Inspector
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal