PW5: After Hours Orient and affix BIS

Work Permit Application job number label here

Must be typewritten

All information must be completed for review of this request. Incomplete submissions will be denied without review.
The deadline to submit weekend variance requests is Tuesday at 4:00PM, and variances will not be granted for any day earlier than Saturday of the same week.

1 Initial Filing Status Information Required for all applications. Check applicable box for application type.
Work Permit No. 121724946 BIS Job Electrical Application Variance Type: Initial Renewal

2 Location Information Required for all applications.

House No(s) 215 Street Name East 19th Street
Borough Manhattan Block 900 Lot 9 BIN 1082123 CB No. 106
Work on Floor(s) Cellar to Roof Apt/Condo No(s)

3 Contractor Required for all applications. Business Fax and Email are optional.
Last Name Valjato First Name Steve Middle Initial
Business Name ValjatoEngineering, P.C Business Telephone 718-701-2707
Business Address 249 Hinsdale Street, 2nd floor Business Fax / Email 646-351-0412
City Brooklyn State NY Zip 11207 Mobile Telephone 917-402-0635
License Number 082512 License Type GC Electrician MP FSC Other:

4 Please provide main point of contact information during AHV work Required for all applications.
Last Name Brad First Name Allecia
Mobile Telephone 718 609 1860 Email brad@skyliftnyc.com

5 Variance Information Required for all applications.

Is a residence within 200 feet of the site? Yes No
Is all work being done within an enclosed building? Yes No
Does any of the work involve full or partial demolition? Yes No
Does any of the work involve crane use? Yes No Total Number of Days Requested: 1
Days of Week Date(s) Requested Hours Description of Work (Specify weekday vs. weekend work)

Monday to Mobile Crane to assist in lift of mechanical unit

Tuesday to
mobile crane to be used : CN #301-17
Weekday Wednesday to Leibherr LTM 1350, CD #4326
Thursday to
Friday to Assist Crane to be used: CN# 302-17
Tadano TR450XL, CD#4073,4413,4415,3626,3566,3391
Saturday to
Weekend
Sunday 10/22/2017 08:00A to 11:59p
Reason for Variance:

6 Statements and Signature Required for all applications. Internal Use Only
This permit must be posted visible to the public. Falsification of any statement is a misdemeanor and is Approved Denied Limited Approval
punishable by a fine or imprisonment, or both. It is unlawful to give to a city employee, or for a city Indicate days-of-week authorized for electronic renewal
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.
I understand that if I am found after hearing to have knowingly or negligently made a false statement or Limited to:
to have knowingly or negligently falsified or allowed to be falsified any certificate, form, signed
statement, application, report or certification of the correction of a violation required under the provisions
of this code or of a rule of any agency, I may be barred from filing further applications or documents with
the Department.
I hereby certify as the permittee or as a representative of the permittee that a noise mitigation plan for
the site has been developed in accordance with Administrative Code 24-219 through 24-224 and
that such plan is in compliance with the Department of Environmental Protections noise mitigation rules.
I further affirm and attest that the afterhours and/or weekend construction work defined in the work
scope of this application is submitted for the purpose and consideration indicated in section 5 of this
application, Reason for Variance.
Borough Commissioner Signature Date
Contractor or Authorized Representative (print) Steve Valjato
Signature Date 10-19-17 Filing Fee Permit Fee
05/17