Ds1: Demolition Submittal Certification Form
Download a blank fillable Ds1: Demolition Submittal Certification Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Ds1: Demolition Submittal Certification Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1DS1: Demolition Submittal
Certification Form
Orient and affix BIS
job number label here
Must be typewritten.
Demolition drawings must be submitted along with this form.
BIS Document No., required:
1 Location Information
Required for all certifications.
House No(s)
Street Name
Borough
Floor(s)
2 Preparer Information
Required for all certifications.
Check all that apply:
PW1 Applicant
P.E./R.A. Other Than PW1 Applicant
Last Name
First Name
Middle Initial
Business Name
Business Telephone
Business Address
Business Fax
City
State
Zip
Mobile Telephone
License Type
P.E.
R.A.
Other:
License Number
3 Demolition Description and Certification
Required prior to permit. Subsequent revisions must be submitted to the Department.
ndicate Submittal Type:
Initial submittal
Supersede existing submittal(s) - indicate scan code(s) of DS1 being superseded below
Scan Code(s):
3A
Demolition Type:
Full Demolition (DM)
Partial Demolition (Alteration)
3B Demolition work will involve, per BC 3306.5 (authorized preparers indicated in parenthesis): Check all that apply
Non-mechanical demolition means and methods only (P.E. or R.A. only) - stop and proceed the section 3C
Use of hand-held mechanical equipment (P.E. or R.A. only)
Work on interior of building
Use of other than hand-held mechanical equipment (P.E. or R.A. only)
Work on exterior of building
Raising and/or moving of a building
General description of the type(s) of mechanical demolition equipment used:
3C If superseding a previous plan submittal, indicate scan code(s) of the Al1: (Note: any revisions/additions/deletions to the original plan submis-
sion must be accompanied by an Al1 form detailing all the plan changes)
3D Statement by demolition document preparer:
Name (please print)
I have prepared the attached demolition submittal documents in accordance
with BC 3306 and certify that they are in compliance.
Signature
Date
I hereby state that all of the above information is correct and complete to the
best of my knowledge. Falsification of any statement is a misdemeanor and is
punishable by a fine or imprisonment, or both. 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.
P.E./R.A. Seal (apply seal, then sign and date over seal)
12/14
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal