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2. 
4. BUILDING PERMIT APPLICATION
   Town of Hyde Park, County of Dutchess, New York
5. Permit #:
7. The undersigned hereby applies for a permit to completely perform work within one year from date of issuance in accordance with the description, plans, specifications and/or professionally prepared design standards and such conditions as may be indicated on permit. All provisions of Town of Hyde Park Local Laws, including and not limited but to include Title 19 NYCRR New York State Uniform Fire Prevention and Building Code Standards and all other appropriate rules and regulations shall apply. The Building Permit application does not constitute authority to build in violation of any Federal, State or Local Laws and is limited to the issuance of completed actual building permit documents on file and accepted by the authority having jurisdiction.
9. Applicant (I/We)*
11. Address of Applicant*
13. Owner of Property*
14. Phone*
16. Building:Site Location*
17. Phone
19. Tax Grid #07*
    (Road, Town, County, State)
21. NATURE OF PROPOSED WORK: **NOTE: All trusses require NY State licensed stamped plans to be included with permit application.
23. Select One*

    1. Construction of New Building
    2. Addition to Present Building
    3. Change in Use/Occupancy (Conversion)
    4. Demolition
    5. Alteration
    6. Installation of Solid Fuel Burning Device (Woodstove)
    7. Factory Manufactured Home (Modular)
    8. Factory Manufactured Truss/Microlam
    9. Wood I-Beam, Tec-Lam, etc.

    1. Pool: Aboveground
    2. Pool: In-Ground
    3. Replacement of Mobile Home
    4. Repair to Structure
    5. Accessory Building, Shed
    6. Attached Garage
    7. Detached Garage
    8. Replacement Equipment and Systems
    9. Deck
25. Other
    (If None of the Above)
26. Pool Size
    Required for Aboveground and In-Ground Pools
28. Size of Structure (Dimensions)
30. Number of Stories
31. Dimensions
32. Square Footage
34. Occupancy Classification*

    1. Residential
    2. Business
    3. Mercantile

    1. Assembly
    2. Educational
    3. Storage

    1. Institutional
    2. Factory
    3. Hazardous
36. Type of Construction*
38. Check All That Apply*

    1. Insurance Forms
    2. Driveway Permit - Town, County, State, DOT
    3. Manufactured Home: Stamped & Signed Plans
    4. Water Supply Hookup Approved by Water District
    5. List of Testing Agencies

    1. San 34 B.O.H Approval (New Construction)
    2. Mobile Home Installation Manual
    3. Electrical Inspection Report Filed
    4. Energy Code Sheet
40. Zone Dictrict*
41. Fire District*
43. Proposed Setback Minimums:
45. Distance of Structure from Front Lot Line (in Feet)
46. Distance of Structure from Side Lot Lines
    (Both Sides)
48. Distance of Structure from Rear Lot Line (in Feet)
49. Frontage on Road (in Feet)
50. Lot Area (in Acres)
52. Variance, special permit or site plan
53. Check If Attached

    1. Resolution from ZBA or Planning Board
54. Attach File
56. Distance of Structure from Stream or Watercourse (in Feet)
58. Check All That Apply*

    1. Wetland
    2. Flood Plain
    3. Attached Plot Plan
    4. Insurance
    5. Is Any Work Bonded?
60. ESTIMATE COST OF BUILDING
61. PROPERTY TO BE USED FOR THE FOLLOWING PURPOSES:*
63. FEE (Check Only. Must Be Submitted in Person)
64. Date Received
    (For Internal Use)
66. Upload Appropriate File(s)*
68. 
70. I swear to the best of my knowledge and belief the statements contained in this application, together with plans and specifications submitted, are a true and complete statement of all work to be done on the described premises and that all provisions of Title 19 NYCRR and Chapters 40,51,57,60,92,95,98, and 108 of the Town of Hyde Park Code and all other laws pertaining to the proposed work shall be to the proposed work shall be complied with, whether specified or not and that such work is authorized by owner.
72. Date*
74. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
76. Electronic Signature*
    (Owner, Builder, Agent)
78. Application shall include completed information listed on provided checklist, please review all documents and have them prepared prior to submission to avoid delays in processing time. Every building permit is required to obtain written approval by the Town of Hyde Park Zoning Administrator prior to permit issuance. This application does not constitute a building permit: An official building permit number must first be authorized, approved by signature of the Town Building Department, and will be issued upon the acceptance of all fees and approvals by others, including insurance.
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80. 1. Receive an email copy of this form.
81. Email address

    This field is not part of the form submission.

82. Submit Submit and Print

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