Town of North Hempstead
Department of Building Safety, Inspection & Enforcement
210 Plandome Road, Manhasset, NY 11030-2326
Owner of Property and Owner of Structure Affidavit
Last Updated: 4/14/2021 3:27:00 PM Page 1 of 2
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
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.