Code Officer Richard A. Marble 

Office hours Tuesdays 9:AM- 5:PM and Thursdays 9: AM- 1: PM





The applicant is required to submit information needed on the permit form, incomplete applications will be returned without a permit.  These instructions are provided to help you make out the application and to allow your application to be reviewed as quickly as possible.  If you are unable to fill the application out come in and meet with the Code Officer.


# 1      Property owner-  The legal owner of the property.

# 2      Phone-  Legal owners phone number

#3       Property address -  Where is the property located that the work will be done.

# 4      Owners address- This is the owners mailing address.

# 5      Contractors-  Person who is doing the work.

# 6      Phone- Phone of person doing the work .

# 7      Contractor’s address- Address of person doing the work.

# 8      Map- Tax map number of  property.

# 9      Lot- Lot number on tax map for this property.

# 10    Zone- Zoning district of property found on Zoning Map at town office.

# 11    Lot of Record- What year did you buy the property?

# 12    Contiguous lots- Do you own more than one lot that touch? Yes or No.

# 13    Historical Building-  Is the building on the national Historic Register? Yes or No

# 14    Proposed use- Residential, Recreational, commercial?

# 15   Cost- Estimated cost of the project.

# 16   Special Zones- check any special zones the project is in then initial and date.

# 17   Project description-  Describe what you intend to do including size of structure and 

          any decks garages etc.

# 18   Number of stories- Present number then proposed number.

# 19   Height of building - Present height to peak then proposed height.

# 20   Number of bathrooms- Present number of full and half baths then proposed 


# 21   Number of bedrooms- Present number of bedrooms then proposed number.

# 22   Present septic system is approved for- Found on the front of your septic plans for

          the system that will serve the structure.

# 23   Year round use- Check if the property will be used year round or seasonal.

# 26   Frontage-  How many feet of road frontage does the lot contain.  If the lot also has

          shore frontage please write that figure also and indicate shore frontage.

# 27   More than one existing use on the property-  Is the property used as a residential 

          only or is there a commercial use also?

# 28   Setbacks-  Write down how many feet the proposed structure will be from, the

          center of the road, the side of the property line, and the rear property line.


# 29   How many dwelling units are presently on the lot-  Write down one if there is only

          one single family structure on the lot.  Write down two if there is a home and an

          apartment, trailer or other dwelling unit on the lot.

# 30    Lot size-  How large is the lot that you intend to build on? One acre? Two acres?


# 31    Disregard this if the building is not located in a Shoreland area. Total SQ. FT. of 

           all buildings- Otherwise write down the total square feet of all buildings including

           decks and out buildings within the Shoreland area now and after the structure is

           build. ( The Shoreland Zoning map located at the town office can be used if


# 32    Lot coverage (in percent)- Disregard this if the building is not located in a

           Shoreland area.  Write down the percent of the lot that is covered by all

            impervious surfaces, these would include roads and driveways, patios, roofs, etc.

            areas that will not allow water to sink into the ground. Present, and  after the

            project is completed.

# 33    Number of off street parking spaces-  how many vehicles are you  able to park

           both under cover and not under cover then proposed after the project is done.

# 34   Read sign and date the application.




If you are doing an activity that will expose soil in a Shoreland Area this application must be accompanied with a written soil and erosion control plan.


Your plan should include;


A site sketch of the property showing the areas to be cleared and areas to remain wooded or undisturbed, including the required vegetated buffer along the shoreline.


In addition to the buffer strip clearing is limited in the all areas with the 250 feet of the water or upland edge of the wetland to 25% of the lot or 10,000 sq. ft. which ever is greater. This includes buildings, lawns, driveways, and septic systems.


Also show the location of silt fence, hay bales and diversion ditches used during construction.


Include the location of permanent structures, such as landscape walls, terraces and patios.  Remember that these features must also meet shoreland setbacks and not be located within the 100 foot buffer strip.


A schedule for temporary and permanent mulching and revegetation. At a minimum all disturbed sites need to be temporarily mulched within one week. 


Projects by law must follow this plan.



Town of Mount Vernon

Building or Use

Permit Application

For office use only


Permit No. ____________


Issue Date: ____________


Fee Amount:  __________


Approved by: __________

1. Property Owner:

2. Phone

3. Property Address:

8. Map

9. Lot

10. Zone

4. Owners Address:

11. Lot of Record

            What year: _________

5. Contractor:

6. Phone:


12. Contiguous Lots

            Lot No. (S) _________

7. Contractor’s Address:

13. Historical Building?

             What year: _________

14. Proposed Use:

15. Cost:







16. Special Zones

___ Shoreland       _________

___ Wetlands            Initials

___ Flood Zone

___ Lowlands        ___/___/___

___ Sand Dune           Date


17. Project Description:


18. Number of Stories

       Present   _________

 * Proposed   _________

19. Height of Buildings

     Present __________ ft.

 Proposed  __________ ft.

20. No. of Bathrooms

 Present      ____ /_____

 Proposed  ____ /_____

                    full       half

21. Number of Bedrooms

       Present   _________

   Proposed   _________


22. Present Septic System

      is approved for:

      __________ Bedrooms


       Year round use      ______

        Seasonal use        ______

   * Proposed = Total, existing + requested                                                            F-2-1



Town of Mount Vernon Building or Use Permit Application continued


24. The following inspections must be done on all structure.


  # 1 First Inspection before the inside walls are insulated or other wise closed in.

        Item inspected: Electric, framing, egress windows, chimneys, set backs.


  # 2 Second Inspection before the home is occupied.

        Items checked for finished wiring, smoke detectors, fire separations, oil & solid fuel hook- ups, etc.                


Applicant understands that the building inspector will make inspections for compliance with town and state codes and laws during construction and allows code officer onto the property for the purpose of doing inspections. Applicant agrees to call for inspections before covering inside of walls and to reopen areas that have been covered before inspections were done.




Property Information

26. Frontage



______ Nonconforming

27. More than one use existing on the property.

      Accessory use: ______________________


______ Nonconforming

28. Setbacks                 ______ Nonconforming


____________    ___________    ___________

      Front                   Side                    Rear


29. How many dwelling units are presently


       existing on the lot: ________________

30. Lot size (in sq. ft. or acres)



______ Nonconforming

31. Total sq. ft. of all buildings


 Present      _________________


 Proposed  __________________


32. Lot coverage (in percent)


       Present     _____________________


       Proposed  _____________________


       Zone %    _____________________

33. Number of off street parking spaces



 Present     ________/__________


 Proposed  ________/__________

                covered        uncovered

34. Building permits do not include plumbing, septic or commercial electrical work.

      Building permits are valid for two years; any false information may invalidate a building permit

      and stop all  work.

      Signing authorizes inspections necessary to issue permit and insure compliance with



     _______________________________________       ________________

                              Applicant                                                     Date




Town of Mount Vernon Building or Use Permit Application continued


Plot Plan 

Please include all setback distances from property boundaries, roads, streets and right of ways; all wetlands and water bodies; any existing wells and septic systems. Include shoreland setback or flood elevations if applicable. Show all proposed decks and porches. 








    Town of Mount Vernon Building or Use Permit Application continued


























Front or Rear View























Side View