19 NYCRR 1265.4

NOTICE OF UTILIZATION OF TRUSS TYPE CONSTRUCTION, PRE-ENGINEERED WOOD CONSTRUCTION AND/OR TIMBER CONSTRUCTION To: [insert name of authority having jurisdiction] Owner: [insert name of owner of the subject property] Subject Property: [insert street address and tax map number, if any, of the subject property] Please take notice that the (check applicable line): new residential structure addition to existing residential structure rehabilitation to existing residential structure to be constructed or performed at the subject property reference above will utilize (check each applicable line): truss type construction (TT) pre-engineered wood construction (PW) timber construction (TC) in the following location(s) (check applicable line): floor framing, including girders and beams (F) roof framing (R) floor framing and roof framing (FR) Date: [insert date form is signed] Signature: [signature of person submitting form to the authority having jurisdiction] Name: [print or type name of person signing and submitting form] Capacity: [insert “Owner” or “Owner’s Representative” as applicable]