TOWN OF BLOOMING GROVE BUILDING DEPARTMENT

Phone 496-7011         Fax 496-1945

ATTACHED/DETACHED GARAGE

DATE REC’D                   PERMIT #

SECTION BLOCK LOT

Applicant Name  

Applicant Type:   (circle one) Owner   Contractor   Agent   Architect   Engineer

Owner Name Phone #

Mail Address

Location of Property

PERMIT FEE:   COST OF CONSTRUCTION UNDER $10,000 - FEE - $100

COST OVER $10,000 – SQ FT  X $35.00 = 1% = FEE $

ATTACHED       SIZE DETACHED       SIZE

                             HEAT:        YES    NO           ELECTRIC:        YES    NO          

CONTRACTOR PHONE #

A copy of the contractor’s Workmen’s compensation and liability insurance must be submitted with application.  The liability must name the Town of Blooming Grove as Certificate Holder AND additional insured.

PLEASE BE ADVISED:  It is the owner/applicant’s responsibility to submit proper paperwork, schedule inspections and re-inspections (if necessary) and to properly close out the permit.  A building permit expires one year from the issue date.  There will be a $75.00 fee to close out and issue a CO or CC for an expired permit.

Applicant’s Signature