Mamaroneck, NY · Westchester County
Self-Certification Form (Pre-Approved Emergency Use Only)
Licensed plumbers or electricians use this form to certify that inspected water-damaged electrical or plumbing equipment in the Village of Mamaroneck is safe to operate.
What this form is
For pre-approved emergency use only, this form records a licensed plumber’s or electrician’s certification that inspected water-damaged electrical or plumbing equipment is safe to operate. It asks for the site address, owner and contractor contact details, license number, company address, signature, and date. The form says it cannot be submitted electronically and must be delivered with the contractor’s license and required insurances.
Who needs it
A licensed plumber or electrician completing a pre-approved emergency certification for water-damaged electrical or plumbing equipment in the Village.
How to submit it
Deliver the completed form in person to the Building Department with the licensed plumber’s or electrician’s license and required insurances. The form cannot be submitted electronically.
About notarization
This document is signed and dated without a notary; the licensed plumber or electrician must provide their license and required insurances.
How to submit this form
- 1
Download The Form
Download the Self-Certification Form for pre-approved emergency use.
- 2
Complete The Form
Enter the site address, owner and contractor details, license number, and company information.
- 3
Sign And Date
The licensed plumber or electrician signs and dates the certification.
- 4
Gather Required Items
Bring the licensed plumber’s or electrician’s license and required insurances.
- 5
Deliver In Person
Deliver the form and required items to the Building Department; electronic submission is not accepted.
Frequently asked questions
- Do I need a notary for the Self-Certification Form?
- No. This form is signed and dated without a notary. The licensed plumber or electrician must provide their license and required insurances.
- How do I submit the Self-Certification Form?
- Deliver it in person to the Building Department with the licensed plumber’s or electrician’s license and required insurances. Electronic submission is not accepted.
- Who completes this form?
- A licensed plumber or electrician completes and signs it after inspecting water-damaged electrical or plumbing equipment at a site in the Village of Mamaroneck.
- What does the form certify?
- The licensed plumber or electrician certifies that inspected water-damaged electrical or plumbing equipment at the listed site is safe to operate.