Town of North Hempstead
Department of Building Safety, Inspection & Enforcement
210 Plandome Road, Manhasset, NY 11030-2326
Last Updated: 11/19/2020 2:31:00 PM Page 1 of 1
Owner(s) Address
Owner(s) Name
Parcel Address
Property Owner’s Authorization
I (we) hereby certify that:
1. I (we) agree to permit the Building Inspector and any officer or employee of the Town of North Hempstead to enter
upon the premises in the discharge of their duties with this application.
2. Approved plans and a copy of the approved permit shall remain on the premises at all times until a Certificate of
Occupancy/Completion is issued. These plans shall be made available to the Building Inspector upon request.
3. Building Inspector shall be given a minimum forty-eight (48) hours’ notice to make the required inspection and no
work shall continue until such inspection has been completed and approved.
4. Owner(s) or their representative shall be responsible to arrange for all required inspections.
5. Owner(s) shall be responsible for the presence of the appropriate representative for the required inspection as
directed by the Building Inspector.
6. Permit shall expire three (3) months from the date of issuance unless construction is in progress. No work is to be
started until permit has been received and posted by the owner / applicant. Commencement of any work prior to
the receipt and posting of the permit will result in the assessment of double fees pursuant to §2-28 C
of the Code of
the Town of North Hempstead.
7. Work shall be permitted between the hours of 7:30 AM and 6:00 PM, Monday through Friday only.
8. A permit is not closed until a certificate has been issued. Occupancy of the premises without first obtaining a
Certificate of Occupancy, or use of the premises without first obtaining a Certificate of Completion or Approval is
unlawful and may subject the owner of the premises to the penalties described in the Code of the Town of North
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 items one (1) through eight (8) as here in stated, recognize that I (we) am (are) responsible for all
activities occurring on the property, and that failure to comply with any of the items, notwithstanding any other
items defined in the Code of the Town of North Hempstead, may result in the temporary suspension or
permanent revocation of the permits issued for construction on the premises in accordance with the Code of the
Town of North Hempstead.
Signature of Owner(s):
Sworn to me this Day of , 20
Signature of Notary Public:
App #: