Building Permit Application Form - Town Of Boston
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1APPLICATION FOR PERMIT
OFFICE USE ONLY
Town of Boston; New York
Approved ( ) Disapproved ( )
Permit No.______________
Address _______________
Single Family Dwellings, Farm Buildings,
Date Issued_____________
Accessory Building, Additions
Permit Fee______________
Issued By_______________
Owner___________________________
Contractor______________________
Address__________________________
Address________________________
Day Phone, ___________Eve. _________
Day Phone__________ Eve._______
___________________________________________________________________________________
CONSTRUCTED WITH:
Application
(
) Erect
(
)
Frame
(
) Concrete BIock
is hereby
(
) Alter
(
)
Brick
(
) Concrete Reinforced
made for
(
) Repair
(
)
Brick Veneer
(
) Steel
permission
(
) Addition
(
)
Tile
(
) Other
to:
(
) Move
-(
)
Stone
To be used as: (
) Single Dwelling ( ) Farm Building ( ) Barn (
) Solid-Fuel Burning
(
) Private Garage ( ) Swimming Pool ( ) Accessory Building
___________________________________________________________________________________
Address of Premises for Which Application is Made:
Section, Block, Lot________________________Current Zoning ________________________________
Tax I.D. Number
(
) North
(
) South
Side of _____________________, Size of Lot ____________, ___________, ________
(
) East
Street Name
Frontage
Dept
Acreage
(
)West
Distance of Building from lot lines. Front __________, Rt. Side________ , Lt. Side_______, Rear_______
Size of completed ( ) Building, ( ) Addition, feet wide__________, feet long____________ , feet high_____
Sq. Ft. of: Basement ________, First Floor________ , Second Floor________, Garage______, Other_____
The estimated value of Structure exclusive of land is $__________________________________________
Total Square Footage of Lot_____________________ Percentage of Lot Coverage (All Bldgs)________%
Deed Restrictions______________________________________________________________________
Type of Sewage Disposal________________________________________________________________
Type of Water Supply___________________________________________________________________
NOTE: Approval of proposed system by County Health Dept. must be presented with application.
NOTE: Permit for Driveway Culvert must be presented with this application before Driveway Culvert is
installed. Permit must be obtained from the Highway Department having jurisdiction (Town)(County)(State)
Attach Survey bearing the stamp of a licensed survey or engineer showing the location of all buildings with
references to said lot including both existing structures and proposed structures, giving dimensions in feet.
PLANS FOR THE BUILDING INSPECTOR MUST BE SUBMITTED WITH THIS APPLICATION.
THEY MUST COMPLY WITH STATE UNIFORM BUILDING CONSTRUCTION CODE AND THE STATE
ENERGY CONSERVATION CODE.
No person shall make any change in plans herewith submitted for specifications herein contained, or in the
structural part of the building without written consent of the Building Inspector.
Sketch on reverse side of this application must be completed
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
The .undersigned applicants do hereby affirm that the information herein supplied is true and correct.
_______________________________
_______________________________
Applicant/Owner
Applicant/Owner
_______________________________
_______________________________
Date
Date
( ) Approved
( ) Disapproved
Date ____________________________
__________________________________
__________________________________
Reason
Building Inspector
Town of Boston
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