70 Church Street, White Plains, New York 10601
Phone: (914) 422 - 1269 * Fax: (914) 422 - 1471
DEPARTMENT OF BUILDING
CITY OF WHITE PLAINS
Architect/Engineer's Affidavit for Final Inspection 0413
http://www.cityofwhiteplains.com
ARCHITECT / ENGINEER'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 ARCHITECT / ENGINEER)
being duly sworn, desposes and says: that he /she resides at
in the City of , in the County of , in the State of ,
that he/she is a licensed in the State of New York , the license number being ; that he/she is
making application for final approval of all (Architectural, Structural or Mechanical) work performed as authorized by Building Permit #
issued for SBL# ; Deponent further says that he has made regular and periodic inspections of the construction work , including
critical construction components, and all controlled construction procedures and controlled materials as defined in the White Plains Supplemental Code and in its
referenced standards, for the purpose of determining that to the best of his knowledge and belief the structure(s) as erected complies with the filed drawings and
with the White Plains Supplemental Code and other applicable laws and regulations governing building construction except as to the specific variations duly
authorized under the provisions of the White Plains Supplemental code and as specifically noted in the verified report and cited in the Temporary Certificate of
Occupancy.
Sworn to before me, this _______day of _____________ , _______ .
AFFIX SEAL OF REGISTERED ARCHITECT OR PROFESSIONAL
ENGINEER LICENSED IN NEW YORK STATE.
NOTARY SEAL
( SIGNATURE OF APPLICANT)
NOTARY PUBLIC
( PRINT NAME OF APPLICANT)
( ARCHITECT / ENGINEER)
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