70 Church Street, White Plains, New York 10601
Phone: (914) 422 - 1269 * Fax: (914) 422 - 1471
DEPARTMENT OF BUILDING
CITY OF WHITE PLAINS
Builder's Affidavit for Final Inspection 04/13
http://www.cityofwhiteplains.com
BUILDER'S AFFIDAVIT FOR FINAL INSPECTION:
This application must be printed or typewritten and sworn to by applicant.
To: Commissioner of Building Subject: Building Permit #
Address: SBL:
Work Description:
Application is hereby made for final inspection and a Certificate of Occupancy for the above indicated premises:
STATE OF NEW YORK }
COUNTY OF }
(PRINT NAME OF OWNER OR OFFICER OF CORPORATION)
being duly sworn, deposed and says: that he /she resides at
NOTARY PUBLIC
in the City of , in the County of , in the State of ,
that he/she is a principal officer with the construction Corporation ; Partnerhsip ; Sole Proprietorship ; known and doing business as:
having full authority to legally bind said firm; that is making application for and on behalf of said firm for final approval of all construction work performed as
authorized by Building Permit # issued for SBL# ; Deponent further says
that to the best of his knowledge and belief the structure(s) has been constructed in accordance with the approved construction drawings and specifications, except
as to the specific variations duly authorized under the provisions of the White Plains Supplemental Code.
Sworn to before me, this _______day of _____________ , _______ .
AFFIX SEAL OF CORPORATION
NOTARY SEAL
( SIGNATURE OF APPLICANT) ( TITLE OF APPLICANT)
( PRINT NAME OF APPLICANT) ( NAME OF FIRM)
( ADDRESS OF FIRM)
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