Form Tr8 - Technical Report Statement Of Responsibility For Energy Code Progress Inspections Page 2
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4 Design Applicant’s Statements and Signatures
P.E./R.A. responsible for plans must sign and seal.
Name (please print)
I have identified herein all of the progress inspections, and commissioning
required for compliance and determined whether commissioning is required.
Signature
Date
Commissioning is required for applications where C408 or ASHRAE 90.1 Section
6.7.2.4 requires commissioning. Check one:
This project requires commissioning and a preliminary commissioning report
certification will be provide prior to sign-off.
This project does not require commissioning.
P.E. / R.A. Seal (apply seal, then sign and date over seal)
5 Inspection Applicant’s Identification of Responsibilities
Check all that apply below:
For the progress inspections indicated above in section 3 and identified by me for responsibility, I certify that I am the principal/director of the
progress inspection agency accepting responsibility for conducting the inspections as identified in section 3B. I further certify that I have read the
applicable sections of the New York City Construction Codes and 1 RCNY 5000-01 in connection with progress inspections as well as 1 RCNY
101-07, which specifies the qualifications required for each progress inspector, and that this agency meets those qualifications for each and
every progress inspection for which I/we take responsibility. I agree that both I and the agency will comply with all provisions of the New York
City Construction Codes and the Rules. I am aware of the additional sanctions imposed on false filings by §28-211.1.2 of the Administrative
Code.
Change of Applicant: I am a newly designated individual responsible for the items specified herein and I hereby state that:
None of the inspections/tests indicated herein have been performed to date by the previously designated individual.
Some of the inspections/tests indicated herein have been performed by the previously
designated individual, as indicated in the attached report.
I am aware of the additional sanctions imposed on false filings by §28-211.1.2 of the Administrative Code.
Name (please print)
Signature
Date
P.E. / R.A. Seal (apply seal, then sign and date over seal)
6 Inspection Applicant’s Certification of Completion
I have completed the items specified herein and certify the following (check one only):
All work performed substantially conforms to approved construction documents and has been performed in accordance with applicable
provisions of the New York City Energy Conservation Code and other designated rules and regulations.
All work performed substantially conforms to approved construction documents and has been performed in accordance with applicable
provisions of the New York City Energy Conservation Code and other designated rules and regulations, except as indicated in the attached
report.
I am aware of the additional sanctions imposed on false filings by §28-211.1.2 of the Administrative Code.
Withdrawal of Applicant:
I am withdrawing responsibility for the
items of progress
inspections and/or tests indicated herein and herewith submit
the results or status of the work performed to date.
Name (please print)
Signature
Date
P.E. / R.A. Seal (apply seal, then sign and date over seal)
September 2016
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