Form Zrd1 - Zoning Resolution Determination Form

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ZRD1: Zoning Resolution
Determination Form
Orient and affix BIS
job number label here
Must be typewritten.
Use this form only to request Zoning Resolution determination (use CCD1 for all other requests)
1 Location Information
Required for all requests on filed applications.
House No(s)
Street Name
Borough
Block
Lot
BIN
CB No.
2 Applicant Information
Required for all requests on filed applications.
Last Name
First Name
Middle Initial
Business Name
Business Telephone
Business Address
Business Fax
City
State
Zip
Mobile Telephone
E-Mail
License Number
License Type
P.E.
R.A.
DOB PENS ID # (if available)
3 Attendee Information
Required if different from Applicant in Section 2 or no Applicant.
Relationship to the property:
Attorney
Filing Representative (Class 2)
Other
Last Name
First Name
Middle Initial
Business Name
Business Telephone
Business Address
Business Fax
City
State
Zip
Mobile Telephone
E-Mail
License/Registration # (if P.E./R.A./R.L.A./Attorney)
4 Nature of Request
Required for all requests. Only one request may be submitted per form.
Determination request is for:
Determination
Predetermination
Determination request issued to:
Borough Commissioner’s Office (Initial)
Technical Affairs (Appeal)
Yes (provide job # / doc # / obj # / examiner name below)
Job associated with this request?
No
Job #: _____________________
Document: _________
Objection #:
Examiner:
_______
___________________________________
Has this request or a similar one been previously Denied?
Yes (attach all denied request form(s) and attachment(s))
No
Enter short description of Technical Topic (5 words or less): ___________________________________________________________________
Enter All Control #(s) for related CCD1/ZRD1 requests: _______________________________________________________________________
Request for 1-3 family dwelling?
No
For HPD Affordable Housing?
Fee Exempt per 28-112.1?
Yes
No
Yes
Yes
No
Zoning District(s):
_______________________________________________________________
MDL:
______________________________
Zoning Overlay(s):
BBs:
_______________________________________________________________
______________________________
Other:
Special District(s):
_______________________________________________________________
______________________________
ZR Section: _________________ Code Section: __________________ Rule #:
____________________
TPPN, Memo:
___________________
Borough Commissioner
Code & Zoning Specialist
General Counsel’s Office
Indicate all Buildings Department
officials that you have previously
Other
Deputy Borough Commissioner
Chief Plan Examiner
reviewed this issue with (if any):
ADMINISTRATIVE USE ONLY
Control #:
Appointment date:
Appointment Scheduled With:
Comments:
Review Team Members:
Reviewed By:
Date
01/18

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