What is the Statement of Special Inspections?

It identifies the project, inspection categories, and firm retained to conduct special inspections. The Village requires it as a condition for permit issuance.

Who signs the Statement of Special Inspections?

The form includes signature and date fields for the owner or agent and the P.E./R.A. It also provides a space for the P.E./R.A. seal and license number.

Do I need a notary for the Statement of Special Inspections?

No. The form has no notary block; the owner/agent and P.E./R.A. sign and date it, and a P.E./R.A. seal is required.

Briarcliff Manor, NY · Westchester County

No notary required

Statement of Special Inspections

This statement identifies a project’s special inspections and the firm retained to conduct them, for owners or agents and design professionals submitting it for a permit.

What this form is

The Village requires this statement as a condition of permit issuance under the Building Code’s special inspection and structural testing requirements. It identifies the project, design engineer, retained inspection firm, and applicable inspection categories; the owner or agent and P.E./R.A. provide signatures and dates, and the P.E./R.A. provides a seal. A final report is required before a Certificate of Use and Occupancy is issued.

Who needs it

Owners or agents and the P.E./R.A. involved in a project requiring special inspections complete and sign this statement for permit issuance.

How to submit it

Submit the completed statement to the Village of Briarcliff Manor at 1111 Pleasantville Road, Briarcliff Manor, N.Y. 10510; the form also lists [email protected] and fax (914) 941-4837.

About notarization

This statement is signed without a notary; the owner/agent and P.E./R.A. sign and date it, and a P.E./R.A. seal is required.

How to submit this form

1
Download The Statement
Download the Statement of Special Inspections PDF.
2
Complete The Project Details
Enter the date, project address and description, design engineer, and applicable special inspection categories.
3
Sign And Add The Seal
Have the owner/agent and P.E./R.A. sign and date the statement; the P.E./R.A. must affix a seal and provide a license number.
4
Submit To The Village
Submit the completed statement to the Village address, email, or fax listed on the form.

Frequently asked questions

What is the Statement of Special Inspections?: It identifies the project, inspection categories, and firm retained to conduct special inspections. The Village requires it as a condition for permit issuance.
Who signs the Statement of Special Inspections?: The form includes signature and date fields for the owner or agent and the P.E./R.A. It also provides a space for the P.E./R.A. seal and license number.
Do I need a notary for the Statement of Special Inspections?: No. The form has no notary block; the owner/agent and P.E./R.A. sign and date it, and a P.E./R.A. seal is required.
How do I submit the Statement of Special Inspections?: Submit it to the Village at 1111 Pleasantville Road, Briarcliff Manor, N.Y. 10510. The form also lists [email protected] and fax (914) 941-4837.

Need something notarized?

This Statement of Special Inspections doesn’t need a notary — but if you have another Briarcliff Manor form that does, a commissioned online notary can help.