2. Name on Zoning Board Determination
4. Tax Map Number 300 -
6. Property Address
8. Telephone
9. Email Address
11. Project Approval Date
    Project Approval Date
13. I have reviewed and fulfilled all of the conditions of Approval as per a Zoning Board of Appeals Determination filed with the Town Clerk. I have attached a copy of said determination to this form.
15. Please certify that said conditions of approval have been met for the purposes of obtaining a:

    1. Building Permit
    2. Certificate of Occupancy
17. If an on-site inspection is required, an inspection fee in the form of a certified check or money order made payable to the Town of East Hampton is enclosed in the amount of $250.
19. Signature (Agend or Applicant)
21. Date
    Date
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23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

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