Please read all instructions and then complete the following information and mail to:

Incorporated Village of Farmingdale
PO Box 220   361 Main Street
Farmingdale, NY 11735
(516) 249-0093

Affidavit of Final Cost of Construction-
Application for Certificate of Occupancy

State of New York
County of ________________

___________________________________________, being duly sworn, deposes and says;

that he (she) is the applicant (or agent of the applicant) 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 as indicated above; that the estimated cost stated in said application

of the construction or other work described therein was_______________Dollars ($_____________);

that the actual final cost of such construction or other work was________________Dollars ($________________).


Application is hereby made for issuance of a Certificate of Occupancy for the structure on these premises.
Applicant states that he has examined the approved plans and that to the best of his knowledge and belief the structure has been erected in accordance therewith and in accordance with applicable provisions of law.


Sworn to before me this ___________ day of _________20_____

Notary public


Applicant or Agent

Filed Cost

Permit Fee Paid

Additional Fee




(Costs for the work described in the Application for Building Permit include the cost of all of 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 stated in the Application for Building Permit, no portion of the fee paid upon the filing of the application will be refunded. On new buildings a final survey, certified to by a licensed surveyor or engineer, must accompany this application.)