(To be filed when job is completed)

    PERMIT NUMBER

SECTION BLOCK LOT

TOWN OF BLOOMING GROVE

COUNTY OF ORANGE

OFFICE OF BUILDING INSPECTOR

AFFIDAVIT OF FINAL COST OF CONSTRUCTION

State of  New York:

                          SS:

 County of Orange:

, being duly sworn, deposes and says he/she

is the applicant/agent named in the application for Building Permit dated

relating to construction or other work to be performed on, or in connection with, the premises located at

, Town of Blooming Grove.

The estimated cost stated in said application of construction or other work described therein was

Dollars ($ ); the actual final cost was Dollars

($ ).  The said construction or other work was performed in accordance with the applicable

provisions of the law.

                                                                                    Signature

Sworn to before me this

day of , 20

Permit Fee Paid $

Notary Public                                                             Filed Cost           $

                                                                                    Final Cost          $

                                                                                    Addt’l Fee Due $

Cost for work described in the application for Building Permit includes the cost of all the construction and other work done in connection therewith, exclusive of the cost of the land.  If the final cost is less than the estimated cost on the application, there will not be portions refunded.

NOTE:  AT THE TIME OF THE FINAL INSPECTION FOR THE ISSUANCE OF A CERTIFICATE OF OCCUPANCY, YOUR ESTIMATED COST OF CONSTRUCTION WILL BE RE-EVALUATED.  THIS PROCESS MAY ADD TO YOUR ORIGINAL ESTIMATED COST OF CONSTRUCTION, THEREBY INCREASING YOUR BUILDING PERMIT FEE.