Carbon Monoxide and Smoke Detector Affidavit

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

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

Address:

The premise described is a one or two family dwelling and is classified as a R3 occupancy by the 2020 Fire Code of New York State.

I/we hereby attest and affirm that, in accordance with the provisions of Section 915 of the 2020 Fire Code of New York State, that carbon monoxide detector(s) have been installed, maintained and in operable condition within each dwelling unit or sleeping unit located within the above referenced structure where carbon monoxide producing equipment is located.

I/we hereby attest and affirm that, in accordance with the provisions of Section 704 of the 2020 Property Maintenance Code of New York State, that smoke detectors have been installed, maintained, provided with an appropriate power source and are in operable condition in the following locations:

1. Outside each separate sleeping area in the immediate vicinity of bedrooms as per manufacturer's specifications.
2. In each room used for sleeping purposes.
3. In each story within (all) dwelling unit(s), including basements and cellars, while excluding crawl spaces and uninhabitable attics.

Or

I/we hereby attest and affirm that, in accordance with Section R314 of the 2020 Residential Code of New York State, a residential fire alarm system with central station interconnection has been installed throughout the premise and is in proper operating order.

This affidavit is submitted in accordance with New York State Executive Law, as modified by the current requirements of the 2020 Fire Code of New York State.

Dated: Signature:

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

Must Be Submitted Prior to Completion or Within 30 Days of Inspection

Notary Seal

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