APPLICATION FOR POOL PERMIT
TOWN OF HUNTINGTON, SUFFOLK COUNTY, N.Y.
SCTM: 0400.00 Sec. Blk: Lot:
_
ZBA #: Filed Date: __________________________ Zone______________
Filed Map Name:
Filed Map Sec. Blk: Lot:
Property Location:
_______________________________________________________________________________________________________
Above ground Below Ground Electrical work required? yes no size
If below ground, construction material: gunite concrete vinyl other:
Pool to be installed by:
(
Please print name of company)
Estimated Cost $:
NOTE: A permit is good for one (1) year after the date of issuance. A building permit may be renewed by the Department of Engineering
Services for two (2) one-year terms. The renewal fee for each renewal period shall be one-half (1/2) of the application fee paid for the original
permit.
AFFIDAVIT OF PROPERTY OWNER
STATE OF NEW YORK
COUNTY OF SUFFOLK
} SS:
Property in Name of (Individual or Corporation) Please Print
Deposes and says: That I reside at Zip
Mailing Address of
Owner
in the State of , that I am the owner in fee of all that certain lot, piece or parcel of land shown on the attached
survey situate, lying and being within the unincorporated area of the Town of Huntington; (a) the proposed work will be faithfully carried
out as described in the application and as shown on the accompanying plans and specifications and not otherwise: (b) all laws and
regulations applicable to the premises and to the proposed work will be complied with, whether stated in the application and plans or not:
(c) the statements contained in the application are true: (d) the premises will not be maintained, operated, occupied or utilized for any
purpose other than as set forth in the application, plans and specifications: (e) the premises will not be maintained in violation of the
zoning ordinance: and (f) that said representations are made with full knowledge that the Town of Huntington is relying on same in
issuing a building permit.
Sworn to me this day Owner
Print Name
Of , 20 Owner
Signature
Address Zip
Notary Public
Owner Phone
OFFICE USE ONLY
Application ID#__________________ Receipt#______________ Date:_____________
Fee $______________ C/O $______ Total $____________________
Application #____________________ Permit#___________________
Occupancy Code_________________ Type of Construction_________
Occupancy Load_________________ Required Fire Sprinkler System___________
No work is to be started until permit has been received
False statements made herein are punishable as a class “A” misdemeanor pursuant to section 210.45 of the penal law of New York State.
Forms 87-02 Rev 10/16
Email:____________________________________________________
