Tr1: Technical Report Statement Of Responsibility Page 2
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3TR1: Technical Report
Statement of Responsibility
This form must be typewritten
Required for all applications, continued on page 2; █ indicates report required.
3 Special Inspection Categories (continued)
3B Identification of
3C Certificate of Complete
3D Withdraw
← Identification of Requirement
3A
Responsibilities
Inspections / Tests
Responsibilities
Y
N
Special Inspections
Code/Section
Initial & Date
Initial & Date
Initial & Date
Raising and Moving of a Building
BC 1704.20.5
Soil Percolation Test - Private On-Site Storm Water
█
BC 1704.21.1.2
Drainage Disposal Systems, and Detention Facilities
Private On-Site Storm Water Drainage Disposal
BC 1704.21.2
Systems, and Detention Facilities Installation
Individual On-Site Private Sewage Disposal Systems
BC 1704.22
Installation
Soil Percolation Test - Individual On-Site Private
█
BC 1704.22
Sewage Disposal Systems
Sprinkler Systems
BC 1704.23
Standpipe Systems
BC 1704.24
Heating Systems
BC 1704.25
Chimneys
BC 1704.26
Fire-resistant Penetrations and Joints
BC 1704.27
Aluminum Welding
BC 1704.28
Flood Zone Compliance (attach FEMA elevation/dry
BC 1704.29
floodproofing certificate where applicable)
BC G105
BC 1704.30
Luminous Egress Path Markings
█ TR7
BC 1024.8
Emergency and Standby Power Systems (Generators)
BC 1704.31
Post-installed Anchors (BB# 2014-018, 2014-019)
BC 1704.32
Seismic Isolation Systems
BC 1707.8
BC 1905.3
Concrete Design Mix
█ TR3
BC 1913.5
Submit TR3 to complete this item
BC 1905.6
Concrete Sampling and Testing
█ TR2
BC 1913.10
Submit TR2 to complete this item
Required for all applications. █ indicates report required.
4 Progress Inspection Categories
4B Identification of
4C Certificate of Complete
4D Withdraw
← Identification of Requirement
4A
Responsibilities
Inspections / Tests
Responsibilities
Y
N Progress Inspections
Code/Section
Initial & Date
Initial & Date
Initial & Date
Preliminary
28-116.2.1, BC 110.2
Footing and Foundation
BC 110.3.1
Lowest Floor Elevation
BC 110.3.2
Structural Wood Frame
BC 110.3.3
█
Energy Code Compliance Inspections
BC 110.3.5
TR8
Submit TR8 to complete this item
Fire-Resistance Rated Construction
BC 110.3.4
Public Assembly Emergency Lighting
28-116.2.2
28-116.2.4.2, BC 110.5,
Final*
Directive 14 of 1975, and 1 RCNY §101-10
* For column 4C, indicate date when the actual final inspection was performed
P.E./R.A. responsible for plans, choose both below and sign/seal.
5 Design Applicant’s Statements and Signatures
Name (please print)
I have identified all of the special inspections, progress inspections and tests
required for compliance.
Signature
Date
I certify that the Special Inspection and Approved Agencies engaged by the own-
er to supervise the work specified above are acceptable. (BC 1704.1)
P.E. / R.A. Seal (apply seal, then sign and date over seal)
TR1
August 2016
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