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Permit applicant is required to submit notification within two days of complete removal of the sidewalk shed.
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PGL1 insurance is required.
Minimum amount of insurance is $2 Million.
Minimum amount of insurance is $5 Million.
Minimum amount of insurance is $15 Million.
Minimum amount of insurance is $25 Million.
Minimum amount of insurance is $80 Million.
Permit applicant is required to submit notification within two days of complete removal of the sidewalk shed.
The site safety professional(s) is auto-populated from another permit on an associated filing (I1, S1, etc.). The site safety professional(s) can only be modified by renewing with change an already issued permit.
The site safety professional(s) on this permit was changed because another permit on an associated filing (I1, S1, etc.) was renewed with change and issued with this new site safety professional(s). Reprint the permit to reflect the new SS professional(s) on this job.
Renew Work Permit
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General Information
Site Safety
Demolition Subcontractor
QA Failed Reasons
Exception(s)
Documents
Statements & Signatures
General Information
Reason for Filing
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Filing reason
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Initial Permit
No Work Permit
Renew Permit with changes
Renew Permit without changes
Select the Stakeholder(s) that you would like to change:
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Contractor/Permit Applicant
Concrete Subcontractor
Concrete Safety Manager
Demolition Subcontractor
Filing Representative
Site Safety Personnel
None of above Stakeholder(s)
Expected Work Start Date
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Work on Floor(s)
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Type of Permit
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Selected Permit(s)
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Job Description
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Enter an associated Fence job filing number (not required if the Filing Type is Legalization)
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Is a Tower Crane to be used?
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Yes
No
PGL1 Expiration Date
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Total number of dwelling units at location
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Number of dwelling units occupied during construction
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Has the structure been fully demolished at the time of application?
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Yes
No
Has demolition work not begun, or is the structure not fully demolished?
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Yes
No
Applicant Information
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Applicants are required to have liability, worker’s compensation and disability insurance to submit a permit in DOB NOW as per
Section 28-401.9 of the NYC Construction Code.
Are you editing the contractor information?
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Yes
No
Email
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License Type
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Select Type:
License/Registration/Tracking Number
DOB Issue ID
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First Name
Middle Initial
Last Name
Business Name
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Select Type:
Business Address
City
State
Zip Code
Business Telephone
Taxpayer ID
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EPA Lead Firm Cert. # (required if disturbing lead paint)
Is applicant responsible for all work on this application?
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Yes
No
Additional Information
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Have you sent a 10 day notice to all adjoining properties adjacent to the proposed work?
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Yes
No
Is a preconstruction survey required as per BC 3309.4.3?
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Yes
No
Filing Representative
Email
Last Name
First Name
Middle Initial
Business Name
Business Telephone
Business Address
City
State
Zip Code
Registration Number
Applicant’s Insurance Information
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Liability Insurance
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Expiration Date
Worker's Compensation Insurance
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Expiration Date
Disability Insurance
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Expiration Date
Construction Superintendent, Site Safety Coordinator, Site Safety Manager
I, the applicant /contractor, hereby declare the scope of work filed under this permit application requires:
Construction Superintendent
Site Safety Coordinator
Site Safety Manager
Email
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License Type
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Select Type:
Last Name
First Name
Middle Initial
Business Name
Business Telephone
Business Address
City
State
Zip Code
Registration Number
I, the undersigned, will perform, on behalf of the Contractor, all of the functions required of a Construction Superintendent, or Site Safety Coordinator, or Site Safety Manager (identified above) as set forth in the Department of Buildings rules and regulations.
Name
(Electronically Signed)
Date
Concrete Information
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Does your approved work include 2,000 cubic yards or more of concrete at a major building?
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Yes
No
Concrete Subcontractor
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Is the work permit applicant performing the concrete work for this permit?
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Yes
No
Email
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License Type
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Select Type:
Last Name
First Name
Middle Initial
Business Name
Select Type:
Business Telephone
Business Address
City
State
Zip Code
Registration Number
I, the undersigned, will perform, on behalf of the Contractor, all of the functions required of a Concrete Subcontractor as set forth in the Department of Buildings Rules and regulations.
Falsification of any statement is a misdemeanor under the NYC Administrative Code and is punishable by a fine or imprisonment, or both. I am aware of the additional sanctions imposed on false filing by § 28-211.1.2 of the NYC Administrative Code.
I understand and agree that by personally clicking on the box at left I am electronically signing this document and expressing my agreement with the terms herein. I understand that this electronic signature shall have the same validity and effect as a signature affixed by hand.
Name
(Electronically Signed)
Date
Concrete Safety Manager
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Email
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License Type
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Select Type:
Last Name
First Name
Middle Initial
Business Name
Business Telephone
Business Address
City
State
Zip Code
Registration Number
I, the undersigned, will perform, on behalf of the Contractor, all the functions of a Concrete Safety Manger as set forth in the Department of Buildings Rules and regulations.
Falsification of any statement is a misdemeanor under the NYC Administrative Code and is punishable by a fine or imprisonment, or both. I am aware of the additional sanctions imposed on false filing by § 28-211.1.2 of the NYC Administrative Code.
I understand and agree that by personally clicking on the box at left I am electronically signing this document and expressing my agreement with the terms herein. I understand that this electronic signature shall have the same validity and effect as a signature affixed by hand.
Name
(Electronically Signed)
Date
Site Safety
Construction Superintendent, Site Safety Coordinator, Site Safety Manager
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I, the applicant /contractor, hereby declare the scope of work filed under this permit application requires:
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Show Associated Jobs
Construction Superintendent
Site Safety Coordinator
Site Safety Manager
Construction Superintendent is not required because the permit holder is a registered general contractor.
Construction Superintendent Information
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Email
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License Type
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Select Type:
Last Name
First Name
Middle Initial
Business Name
Business Telephone
Business Address
City
State
Zip Code
Registration Number
I hereby state that I will perform, on behalf of the Contractor, all of the functions required of a Construction Superintendent, Site Safety Coordinator, or Site Safety Manager (identify herein) as set forth in the Department of Buildings rules and regulations.
Name
(Electronically Signed)
Date
Site Safety Coordinator/Site Safety Manager Information
*
Email
*
License Type
*
Select Type:
Last Name
First Name
Middle Initial
Business Name
Business Telephone
Business Address
City
State
Zip Code
Registration Number
I hereby state that I will perform, on behalf of the Contractor, all of the functions required of a Construction Superintendent, Site Safety Coordinator, or Site Safety Manager (identify herein) as set forth in the Department of Buildings rules and regulations.
Name
(Electronically Signed)
Date
Demolition Subcontractor
Demolition Subcontractor
*
Demolition Subcontractor is not required because the permit holder is a registered Demolition contractor.
Demolition Subcontractor is not required because Owner allowed to pull permits.
Email
*
License Type
*
Select Type:
License Number
First Name
Middle Initial
Last Name
Business Name
*
Select Type:
Business Telephone
Business Address
City
State
Zip Code
Registration Number
I, the undersigned, will perform, on behalf of the Contractor, all the functions of a Demolition Subcontractor as set forth in the Department of Buildings Rules and regulations.
Falsification of any statement is a misdemeanor under the NYC Administrative Code and is punishable by a fine or imprisonment, or both. I am aware of the additional sanctions imposed on false filing by § 28-211.1.2 of the NYC Administrative Code.
I understand and agree that by personally clicking on the box at left I am electronically signing this document and expressing my agreement with the terms herein. I understand that this electronic signature shall have the same validity and effect as a signature affixed by hand.
Name
(Electronically Signed)
Date
QA Failed Reasons
Created on
QA Failed Reason
Detailed Reason
QA Failed Status
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Open
Resolved
Closed
Dismissed
Closed
Comments
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Exception(s)
Add Exception
Total Number of Exceptions:
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Actions
Exception(s)
Comments
No Exception(s) selected.
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Documents
Required Documents
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Statements & Signatures
Applicant/Contractor Statement
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Does the Work authorized by this permit require adjacent property insurance?
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Yes
No
The information in this application is correct and complete to the best of my knowledge and I assume responsibility for all statements in such application. I understand that if I am found after hearing to have knowingly or negligently made a false statement on this or any other document submitted to the Department, I may be subject to fine, imprisonment, and/or barred from filing further documents with the Department. I also understand it is unlawful to give to a city employee, or for a city employee to accept, any benefit, monetary or otherwise, either as a gratuity for properly performing the job or in exchange for special consideration.
I will comply with all applicable laws, rules and regulations including all insurance requirements, and, in addition:
I will comply with all applicable laws, rules and regulations.
I hereby attest that I have obtained all required insurance coverage with policy limits appropriate for the specific scope of work for which I am licensed or authorized as a permit applicant. I further attest that I will maintain such insurances as required by applicable law or rule. I understand that it is unlawful to make a false statement to the Department and that knowingly or negligently making a false statement could subject me to a fine, license revocation, imprisonment, or being prohibited from filing with the Department.
I hereby state if a Construction Superintendent, Site Safety Coordinator, Site Safety Manager, Demolition Subcontractor, Concrete Subcontractor, or Concrete Safety Manager is required for this application I have hereby advised the individual listed herein he or she is designated as such and hereby certify he or she is registered and in good standing with the NYC Department of Buildings. I hereby state that all construction and demolition workers employed or otherwise engaged at the site and working under this permit have received site safety training in accordance with BC 3321.
I hereby state this renewal application with no change to Applicant, Filing Representative, Construction Superintendent, Site Safety Coordinator, Site Safety Manager, Subcontractors, Concrete Safety Manager or insurance is for the work as originally filed or as officially amended.
In accordance with §28-104.8 of the Administrative Code, I hereby declare I am authorized by the owner of the premises to which this application pertains to make this application for a permit to perform the work described herein. In accordance with Rule 101-16, I will post the permit in a conspicuous and visible location.
In accordance with §28-120.3 of the Administrative Code, I certify that, if applicable, any tenant protection plan submitted for this work coordinates with the scope of work intended.
I hereby state that if the work involves disturbance of lead-based paint or paint of unknown lead content, the work complies with §27-2056.11 of the Administrative Code and, where applicable, subpart E or subpart L of part 745 of title 40 of the code of federal regulations and the firm performing the work has filed or will file with the NYC Department of Health and Mental Hygiene a notice of commencement required by §27-2056.11(a)(2).
I certify that a licensed exterminator has been retained to effectively treat the premises for rodent extermination as required by the NYC Department of Health and Mental Hygiene.
I understand and agree that by personally clicking on the box at left I am electronically signing this document and expressing my agreement with the Statements and Signatures terms above. I understand that this electronic signature shall have the same validity and effect as a signature affixed by hand, and I further intend that the electronic image of my signature and professional seal uploaded as part of this application is hereby applied to this signed statement as if I had personally signed and sealed this statement by hand.
I hereby state the information on this form is correct and complete to the best of my knowledge. I understand falsification of any statement is a misdemeanor and is punishable by a fine or imprisonment, or both. I also understand it is unlawful to give to a city employee, or for a city employee to accept, any benefit, monetary or otherwise, either as a gratuity for properly performing the job or in exchange for special consideration. Violation is punishable by imprisonment or fine or both.
I hereby state that I supervised the construction work. I further state that I have examined the approved plans and specifications of the structure herein referred to of which a Certificate of Occupancy is sought. To the best of my knowledge and belief the building has been erected or altered in accordance with the approved plans and specifications and any amendments thereto, and all materials and methods of construction utilized during the course of construction have been in accordance with applicable standards and code requirements. As erected or altered, the building complies with the provisions of the New York City Construction Codes and all other applicable laws and regulations, except insofar as variations or variances therefrom have been legally permitted or authorized.
Name
(Electronically Signed)
Date