SUFFOLK COUNTY TAX MAP: SEC. BLK: LOT:
AFFIDAVIT OF PROPERTY OWNER
STATE OF NEW YORK
COUNTY OF SUFFOLK
SS:
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Property in Name of (Individual or Corporation) Please Print
desposes and says: That he resides at
Street
in the State of , that he is the owner in fee of all that certain lot, piece or parcel of land shown on the
diagram above, situated, lying and being within the unincorporated area of the Town of Huntington; that the work proposed to
be done upon the said premises will be done in accordance with the approved application and accompanying plans. He further
to make application for a permit to perform said work in the foregoing application and accompanying plans and all the
Sworn to me this day Owner
of , 20 Applicant
Address Zip
Phone
Notary Public
Signature
Signature
in the
Town or City
being duly sworn,
Name of Applicant (Please print)
That
NO WORK IS TO BE STARTED UNTIL PERMIT HAS BEEN RECEIVED BY APPLICANT
ALL APPLICATIONS ARE SUBJECT TO THE CURRNET PROVISIONS
OF THE RESIDENTIAL CODE OF THE STATE OF NEW YORK
ZBA NO: DATE: PERMIT NO.:
FEE $: C OF O $: APPROVED: 20
C OF O $: DIRECTOR
Zone:
Filed Map:
DATE:
Section: Block: Lot(s):
Location/description
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 $:
Will the swimming pool installation require the construction of any retaining walls? yes no
(if yes, a separate permit req'd)
Section 87-80-Water Disposal: All water either overflowing or emptying from the pool shall be disposed of on the owner's land and plans
submitted shall show provisions made for preventing such water from flowing onto the land of any adjoining property owner or into any
abutting street.
Section 87-81-Fences: All pools shall be provided with barriers to restrict access. the top of the barrier shall be at least 48 inches above grade
measured from the outside. a solid barrier shall not provide hand or foot holds on the outside. Openings in the barrier shall not allow passage of
a 4-inch diameter sphere. A chain-link fence shall have openings no wider than 2.25 inches. All gates shall open outward, be self closing, half a
self-latching device and be locked whenever the pool is not in use or supervised. Where the wall of a dwelling serves as part of the barrier then
either the pool must either have a power safety cover or the doors with direct access to the pool through that wall shall be equipped with an
alarm or be self-closing and self latching. For further details see section AG105 of the Residential Code of New York State.
Section 198-58[E]: An uncovered accessory swimming pool may be located within a required rear yard but shall not be placed within 5 feet of a
side or rear lot line.
Section 198-59[E]: In the case of a corner lot, shall not project beyond the required yard line along either street
.
Title 19 NYCRR Part 1228 Swimming Pool Alarms : Each residential swimming pool installed, constructed or substantially modified after
December 14, 2006 and each commercial swimming pool installed, constructed or substantially modified after December 14, 2006 shall be
equipped with an approved pool alarm.
Improvement work to be done by: owner contractor. If contractor, Suffolk County improvement license #
Note:
1. Compliance with the current provisions of the Zoning Ordinance, Town Code Chapter 198, is a condition to the issuance of a permit.
2. The permit is subject to Section 125 of the General Municipal Law and Section 57 of the Worker's Compensation Law.
3. Improvement contractors and electricians must be licensed pursuant to the Suffolk County Ordinance. Plumbers must be licensed by the
Town of Huntington in accordance with Town Code Chapter 153.
states that no previous swimming pool permit has been obtained for this same location for which no certificate of completion
has been issued
is duly authorized by the aforesaid
Owner of Lessee (Please print)
statements herein contained are true to deponent's own knowledge.
FALSE STATEMENTS MADE HEREIN ARE PUNISHABLE AS A CLASS "A" MISDEMEANOR PURSUANT TO SECTION 210.45 OF THE PENAL LAW OF THE STATE OF NEW YORK
FORM 87-02_rev 03/16
RECEIPT #:
