Town of Brookhaven
Long Island
Division of Building
Beth Ann Reilly, Commissioner
Tara McLaughlin, Deputy Commissioner
Angus Graham, Chief Building Inspector
One Independence Hill, Farmingville, NY 11738 • Phone 631-451-6333 • Fax 631-451-6341
REQUEST FOR ACCELERATED PLAN REVIEW, PERMIT APPLICATION OR INSPECTION
Fax this request to 631-451-6341 or submit in person to Building Division (Please Print)
Date: Inspection Permit # ___ Plan Review __ TR#:
Property Owner’s Name:
Name of Job Site:
Location of Premises
Property located at No. N S E W side
Distance N S E W of
Hamlet State of New York.
Name & Phone Number of Requester Phone#: ( )
Party Responsible for Payment:
Dates or Date Range Authorization is in effect: (maximum one month)____________________________________
Address of Party Responsible for Payment: __________________________________________________________
_____________________________________________________________________________________________
Scope of work: ________________________________________________________________________________
_____________________________________________________________________________________________
Phone #’s of Party Responsible for Payment: ( ) ______________________ Fax:( ) ________________
The below-signed individual requests the acceleration of services marked above. By signing below, I accept
and agree to the following terms and conditions:
1. The charge for inspections is $144.81 per hour. There is a one-hour minimum charge due and payable within ten
business days of the date of the inspection. If additional time is required, you will be charged in 30 minute increments
at the rate of $144.81 per hour.
2. The minimum charge for plans review is $289.62. This includes two hours for the review due and payable when you
submit your application. If additional time beyond the included two hours is required to review your plans, you will be
charged an additional $144.81 for each hour or fraction of an hour.
3. The charge for this service is based upon overtime expenses incurred by the Town of Brookhaven. Your paperwork
will not be released to you if payment is not received for any additional charges. The charge is due and payable
regardless of whether or not the inspection or plans are approved. Failure to make timely payment may result in
appropriate legal action.
4. For inspections, if you cancel your appointment less than one business day in advance, you will be charged 50% of the
minimum charge. If you or your contractors and/or subcontractors fail to appear at the scheduled time, you will be
charged the full amount.
_______________________________________________
(Signature) 2-10-2020
