Affidavit of No Mechanical Work

State of New York ss: Building Permit #:
County of Nassau Plumbing Permit #:

I/we: are the Owner(s) of real property located at:

Address:

Section: Block: Lot:

Making application for a Building permit, being duly sworn and depose that there will be no mechanical work what so ever, including replacement of existing heating and/or cooling equipment.

I/we hereby attest and affirm that shall the scope of work change, and mechanical work will be required, a separate Mechanical Permit will be applied for and no mechanical work shall begin until such permit has been issued.

This affidavit is submitted in accordance with New York State Executive Law.

Dated: Signature:

Sworn before me this day of , 20 Name (print):

FALSE STATEMENTS MADE HEREIN ARE PUNISHABLE AS CLASS A MISDEMEANOR PERSUANT TO SECTION 210.45 OF THE PENAL LAW THE STATE OF NEW YORK