Port Jefferson, NY · Suffolk County
Administrative Change of Use Application
Property owners or authorized applicants use this application to request approval for a change of permitted use that does not require Planning Board review.
What this form is
This application requests administrative approval for a change of permitted use that does not require Planning Board review. It asks for property, applicant, owner, agent, and project information, along with an owner’s endorsement when the applicant is not the owner and a disclosure certification. A complete application includes a $250 fee, three hard copies of the survey and certificates of occupancy or existing use, and any required owner endorsement.
Who needs it
A property owner or other party in interest seeking an administrative change of permitted use without Planning Board review should complete this application.
How to submit it
Submit the application to the Building & Planning Department at 88 North Country Road, Port Jefferson, NY 11777. The form lists a $250 fee and requires three hard copies of the survey and certificates of occupancy or existing use.
About notarization
This document is signed without a notary; its owner’s endorsement says the signer is duly sworn, and its disclosure certification includes a statement under penalty of perjury.
How to submit this form
- 1
Download the Application
Download the Administrative Change of Use Application PDF.
- 2
Complete the Application
Fill in the property, applicant, owner, agent, project, and disclosure information.
- 3
Gather Required Materials
Include the $250 fee, three hard copies of the survey and certificates of occupancy or existing use, and an owner’s endorsement if applicable.
- 4
Submit to the Department
Submit the completed application and required materials to the Building & Planning Department at 88 North Country Road.
Frequently asked questions
- What is the Administrative Change of Use Application for?
- It requests approval for a change of permitted use that does not require Planning Board review.
- What must accompany the application?
- The form lists a $250 fee, three hard copies of the survey and certificates of occupancy or existing use, and an owner’s endorsement if the applicant is not the owner.
- Do I need a notary for the Administrative Change of Use Application?
- No. The form has no notary block. Its owner’s endorsement says the signer is duly sworn, and its disclosure certification includes a statement under penalty of perjury.
- How do I submit the Administrative Change of Use Application?
- Submit it to the Building & Planning Department at 88 North Country Road, Port Jefferson, NY 11777, with the required fee and three hard copies.
Need something notarized?
This Administrative Change of Use Application doesn’t need a notary — but if you have another Port Jefferson form that does, a commissioned online notary can help.