Fillable Town of North Hempstead (TOWN OF NORTH HEMPSTEAD)

Fill Online, Printable, Fillable, Blank Town of North Hempstead (TOWN OF NORTH HEMPSTEAD) Form

Use Fill to complete blank online TOWN OF NORTH HEMPSTEAD (NY) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Town of North Hempstead (TOWN OF NORTH HEMPSTEAD)

On average this form takes 3 minutes to complete

The Town of North Hempstead (TOWN OF NORTH HEMPSTEAD) form is 2 pages long and contains:

  • 0 signatures
  • 0 check-boxes
  • 10 other fields

Country of origin: US
File type: PDF

U.S.A. forms for TOWN OF NORTH HEMPSTEAD

BROWSE TOWN OF NORTH HEMPSTEAD (NY) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Town of North Hempstead
Department of Building Safety, Inspection & Enforcement
210 Plandome Road, Manhasset, NY 11030-2326
www.northhempsteadny.gov
Owner of Property and Owner of Structure Affidavit
Last Updated: 4/14/2021 3:27:00 PM Page 1 of 2
Structure Owner(s)
Owner(s) Name
I (we) hereby agree that:
Any permit hereafter issued upon this application shall be and is issued subject to the strict observance of all laws,
ordinances, and regulations enacted for the protection of the Town of North Hempstead.
The Applicant and owner hereby grant permission to the Building Department or its agents to enter upon the property
on which this structure is erected or maintained and to remove said structure at expiration of this permit, unless said
permit be renewed upon request of applicant by the Building Department from time to time for consecutive periods not
exceeding six months, or when said structure fails to comply with any and all of the provisions of the administration and
enforcement ordinance of the Town of North Hempstead, unless a waiver thereof is granted by the Town Board.
The owner or Applicant shall remove said structure on or before the expiration date of this permit. Failure to comply
with this requirement will result in an order from the Building Department to remove said structure within five days of
the date thereof, written notice of which shall be given by registered mail to the owner and applicant at the addresses
shown in this application, and said owner and applicant hereby agree that this shall be sufficient notice.
Failure to comply with the order constitutes a violation, and the Building Department will proceed to have said structure
removed without any further proceedings by the owner or applicant for removal thereof.
It shall be unlawful to use any temporary structure for any purpose other than that designated in the application and
permit.
Affidavit of Owner of Structure
In consideration of the foregoing application duly made to the Building Department of the Town of North
Hempstead, Manhasset, New York, I (we) hereby agree to
preserve and save harmless the Town of North Hempstead from any and all liability and damage, and from all
cost and expense for and by reason of any injury or damage to persons or property arising from or in any way
connected with the erection or removal of said structure or in the maintenance thereof.
Affidavit of Owner of Property
I (we) , the owner(s) of the premises described in this
application, have read the foregoing application, and hereby consent that a structure be erected and
maintained in accordance with this application.
App #:
Town of North Hempstead
Department of Building Safety, Inspection & Enforcement
210 Plandome Road, Manhasset, NY 11030-2326
www.northhempsteadny.gov
Owner of Property and Owner of Structure Affidavit
Last Updated: 4/14/2021 3:27:00 PM Page 2 of 2
Owner(s) Address
Owner(s) Name
Parcel Address
I (we) submit this affidavit with full knowledge that the Building Department and the Town of North
Hempstead rely upon the truth of the statements and information contained herein.
STATE OF NEW YORK}
COUNTY OF NASSAU}
I (we), (Property Owner(s)) depose(s) and say(s) that
I (we) reside at in the State of , that I (we)
am (are) the owner(s) in fee of all certain lots, parcel of land shown on the attached survey,
Section Block Lot(s) , situated,
lying and being within the unincorporated area of the Town of North Hempstead; that I/we have read and
understand the items as herein stated, that the work to be done on the premises will be done in accordance
with the approved application and accompanying plans, of which I (we) am (are) totally familiar and that I (we)
hereby name the contractor listed below as my (our) representative to file this application on my (our) behalf.
Signature of Property Owner Signature of Owner of Structure
Sworn to me this Day of , 20 Sworn to me this Day of , 20
Signature of Notary Public Signature of Notary Public
App #:
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Town of North Hempstead (TOWN OF NORTH HEMPSTEAD)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 28 April 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document