Instructions For Form Pw1c - 2016
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1
2PW1C
INSTRUCTIONS
Purpose of form:
This Technical Report shall be filed to demonstrate compliance for all inspections/tests required for the related job, in accordance with the New
York City Construction Codes. The design applicant must identify the inspections and/or tests necessary prior to job approval. The director of
the Special Inspection Agency and/or Approved Agency must submit to identify responsibility for performing Special inspections prior to permit
issuance. Upon satisfactory completion of special inspections/tests, the director of the Special Inspection Agency and/or Approved Agency
1 Filing Status
Check (X) the appropriate box for the filing purpose
Check (X) the appropriate box to identify the type of work
2 Location Information
Provide the house number and street name, or the special place name of the location where the work is being performed If applicable, provide
the apartment/condo numbers and/or floor numbers where the work is being performed
Check (X) the appropriate box for the occupancy type of the building where work will occur
3 Owner of Boiler
3A - Prior to Approval filing (Application Processing/Plan Examination): The P.E. or R.A. responsible for plans shall identify the required
Provide the last name, first name, middle initial, business name, telephone number, and address of the owner of the boiler for annual permit
renewal
4 Boiler Specifications
Indicate the number of boilers to be installed
Indicate the number of units if modular
Provide DEP Installation No if installation is replacing an existing boiler
Provide the Operating Gauge Pressure
Provide Pressure Setting of Relief Valves*
Provide Operating weight of the boiler*
Check (X) the appropriate box to identify if the boiler is High Pressure or Low Pressure*
Check (X) the appropriate box to identify if the boiler is Water Tube, Fire Tube, or Cast Iron
Check (X) the appropriate box to identify if the boiler is Steam or Hot Water*
Check (X) the appropriate box to identify if fuel type of Oil, Gas, or Electric*
Provide the specifications of boiler equipment:
Provide the manufacturer’s name for each item*
Provide the approval number (s) assigned by the Department of Buildings’ Materials and Equipment Acceptance (MEA) Division or the Board of
Standards and Appeals (BSA)*
Provide the manufacturer’s model number for the equipment*
Indicate the total number of boilers with identical specifications
Provide the Input and Output Capacity of the equipment in BTU’s per hour*
Provide Efficiency Rating and DOE Test Procedure as indicated in the NYCECC
Check that the boiler complies with the sizing requirements of the NYCECC
5 Plan Requirements for Fuel Burning Equipment & Fuel Oil Storage
Applicant shall complete this section for all jobs involving fuel burning or fuel oil storage equipment
Check (X) all applicable statements*
Plans must accompany the application if any of the conditions described in the statements apply.
*Although Plan Review may accept the Schedule C without this information the inspection request will be rejected if information is not
included on the Schedule C when an appointment request is made.
Page 1 of 2
September 2016
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