Pw2: Work Permit Application - New York

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PW2: Work Permit Application
Orient and affix BIS
job number label here
Must be typewritten.
BIS Document No., required:
1 Reason For Filing
Required for all applications.
Initial Permit Complete all sections.
Expected work start date:
Renewal Permit with changes Complete all sections.
No Work Permit
Renewal Permit without changes 1, 3, 4, 7 - 12
2 Location Information
Required for all applications.
House No(s)
Street Name
Borough
Block
Lot
BIN
C.B. No.
Work on Floor(s)
Apt. / Condo No(s)
3 Type of Permit
Choose one and complete any appropriate sub-choices or other information.
Alteration
Curb Cut
Fuel Burning
Plumbing 3C
3A Electrical application no. for shed lighting:
Filed as NB (28-101.4-5)
Demolition and Removal
Gas
Sign
Boiler
Fire Alarm
Oil
Sprinkler
3C
3B Related fence job no.
Construction Equipment
Fire Suppression System
Fuel Storage
Standpipe 3C
3C Secondary permit description (if applies):
Chute
Fence
Foundation / Earthwork
Mechanical / HVAC
Sidewalk Shed 3A
Area of site (sq. ft):
New Building 3B
Supported Scaffold
Other:
Earthwork Only
3D
Yes
No Are you adding more than three stories?
Yes
No
Are you removing one or more stories? If yes, 8
Yes
No Are you performing work in 50% or more of the
Yes
No
Are you demolishing 50% or more of the area of the
area of the building?
building? If yes, 8
Yes
No Are you performing a vertical or horizontal
Yes
No
Does your approved work include concrete?
enlargement adding more than 25% of the area
If yes, is your concrete work completed?
of the building?
Yes
No complete section 9
Yes
No Are mechanical means to be used?
4 Applicant / Contractor
Required for all applications. (* Indicates optional.)
Last Name
First Name
Middle Initial
Business Name
Business Telephone
Business Address
*Business Fax
City
State
Zip
*Mobile Telephone
*E-Mail
Taxpayer ID
4A
Provide registration or tracking number:
General Contractor
4A, 4B
4B
Does work require a HIC license?
Yes
No If yes, HIC license number:
Fire Suppression Contractor
4C,4D
4C
Master Plumber
License Number:
4C,4D
Oil Burner Installer
4D
Is applicant responsible for all work on this application?
Yes
No
4C,4D
4D
Sign Hanger
If no, describe work responsibility:
Professional Engineer
4C, 6
Registered Architect
4C, 6
Homeowner
DOB approval required.
Mechanical equipment other than handheld devices to be used for demolition or removal of debris (BC §3306.4).
12/14

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