Form Ta W41337 PDF Details

Form W 41337 is a form that taxpayers in the United States use to file their annual income tax return. It is also known as the 1040 form. The form asks for basic information such as name, address, and social security number of the taxpayer, and details about their income and deductions for the year. The deadline to submit Form W 41337 is April 15th each year. Taxes can be complicated, and it is important to understand all of the requirements associated with filing this form. For more information on Form W 41337, please consult a qualified tax advisor. Thank you for your interest in this topic!

QuestionAnswer
Form NameForm Ta W41337
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesTA-W51343-9, I-287, NYS, SEQRA

Form Preview Example

TA-W41337 (07/2014)

New York State Thruway Authority

Page 1 of 3

OCCUPANCY PERMIT APPLICATION

 

INSTRUCTIONS:

Applicant: Please print or type. Read and complete Sections I through V.

Division Permit Coordinator: Forward completed application to HQ Permit Coordinator.

For Official Use Only

Occupancy Permit No.

Work Permit No.

Construction Permit No.

Section I

Applicant Identification Information

 

 

 

 

 

 

 

 

 

(Check one)

Individual

Municipality

Utility

New

Amended

 

 

 

 

 

Business/Corporation

Public Agency

Not for Profit

 

 

 

 

 

 

 

 

Name

 

 

 

Federal ID No.

 

 

 

 

 

 

 

Street Address

Town/Village/City

E-mail Address

Contact Person Name

E-mail Address

 

P.O. Box

State

Zip Code

-

Phone No.

 

Ext.

Fax No.

 

 

(

)

-

 

(

)

-

 

 

 

 

 

 

 

Section II Facility Identification Information

LOCATION OF FACILITY (check all that apply)

MILEPOST BOUNDARY (if known)

 

 

 

IF APPLICABLE, CHECK ONE

 

Underground

Aerial

Beginning Milepost No.

 

 

 

Master agreement/permit

 

Depth in inches

 

 

 

 

 

 

 

 

Bridge

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Surface

If longitudinal, include

 

 

 

 

 

 

 

 

Attachment

 

 

 

 

 

 

 

 

Orientation (Check one or both)

ending Milepost No.

 

 

 

Co-locate agreement

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Longitudinal

 

 

Direction of travel (N/S/E/W)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Transverse - Offset from bridge or cross street

GPS Coordinates (if known)

 

 

 

Utility agreement

 

 

 

 

 

feet

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TYPE AND SIZE OF FACILITY (check one and enter size if known)

 

 

 

 

 

 

 

 

 

 

 

 

Water Mains

Telephone

 

 

 

Fiber Optic

Drainage

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gas Mains

Cable Television

 

 

 

Parking

Building Structure

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sewers

Electric

 

voltage

Storage

Communications Tower

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Communications Tower/Co-Locate

 

Other (please describe)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PURPOSE OF PERMIT (please provide brief description and location)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section III

SEQRA

 

 

Section IV

Insurance - Complete if known

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Has a SEQRA determination been made?

Type of insurance furnished:

 

Yes

No

Don't know

ACORD 25 Certificate of Liability Insurance & Supplemental Insurance Certificate (TA-W51343-9)

 

If yes, please provide supporting

Undertaking Effective Date

 

 

 

information (by whom, when, etc.)

Duplicate Policy No.

 

 

 

 

 

 

 

 

 

 

 

 

Effective Date

 

 

 

 

 

 

 

 

 

 

 

 

Performance Bond

 

 

 

 

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TA-W41337 (07/2014) Page 2 of 3

OCCUPANCY PERMIT APPLICATION

Section V Read Thoroughly Before Signing - Applicant Affirmation/Certification

Application is hereby made by the undersigned for issuance of a permit. I understand and agree that permits are revocable unilaterally by the Thruway Authority (Authority). Therefore, I understand and agree that if granted a permit: I will maintain all installations so permitted subject to the risk of having to relocate or remove such installations at my sole expense, in accordance with the directions of the Authority; I am responsible to reimburse the Authority for any surveys, appraisals and/or any other necessary expenses incurred by the Authority as a result of such permit; and I am solely responsible for obtaining any other consents or permits that may be necessary to accomplish the purposes of such permit.

I further understand that this Application incorporates by reference the terms and conditions of the NEW YORK STATE THRUWAY AUTHORITY OCCUPANCY AND WORK PERMIT ACCOMMODATION GUIDELINES (TAP-401), the UTILITY OCCUPANCY SUPPLEMENT (TAP-401U), the FIBER OPTIC FACILITIES SUPPLEMENT (TAP-401F) and the DESIGN AND CONSTRUCTION REQUIREMENTS FOR OCCUPANCIES (TAP-421A-E), as such documents may be amended. I agree that if granted a permit, this Application becomes a part of such permit, and as a condition of the issuance of the permit and/or exercise of any privileges granted thereunder, I shall comply with all terms and conditions of this Application, any condition rider placed on such permit and the RULES AND REGULATIONS OF THE NEW YORK STATE THRUWAY AUTHORITY, as same may be amended.

I affirm and certify that all information provided to the Authority, whether written or verbal, including, but not limited to, this Application and accompanying Forms and Supporting Documents, is complete, true and accurate.

Dated this

 

day of

, 20

 

.

 

 

 

 

 

Print Name of Applicant

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature

 

 

 

 

Title (if applicable)

Section VI

Submit Application to the Appropriate Thruway Authority Division Permit Coordinator

 

 

 

 

 

DIVISION

HIGHWAY SECTIONS

 

DIVISION MILEPOST LIMITS

New York

New York (Mainline)

 

0.00 - 76.50

 

 

Garden State Parkway Connection

GS 0.00 - GS 2.40

 

 

New England Section

 

NE 0.17 - NE 15.01

 

 

I-287 Cross Westchester*

CWE 0.00 - CWE 10.90

Albany

Albany (Mainline)

 

76.50 - 197.90

 

 

Berkshire Section

 

B 0.00 - B 24.28

Syracuse

Syracuse (Mainline)

 

197.90 - 350.60

Buffalo

Buffalo (Mainline)

 

350.60 - 496.00

 

 

Niagara Section

 

N 0.00 - N 21.50

 

 

ADDRESSES AND PHONE NUMBERS

 

NYS Thruway Authority

NYS Thruway Authority

NYS Thruway Authority

NYS Thruway Authority

New York Division

Albany Division

Syracuse Division

Buffalo Division

Division Permit Coordinator

Division Permit Coordinator

Division Permit Coordinator

Division Permit Coordinator

4 Executive Blvd.

P.O. Box 861

290 Elwood Davis Rd, Suite 250

455 Cayuga Rd, Suite 800

Suffern, NY

10901

Albany, NY 12201-0861

Liverpool, NY 13088-2118

Cheektowaga, NY 14225

Phone: (845) 918-2510

Phone: (518) 436-2710

Phone: (315) 438-2420

Phone: (716) 635-6253

Fax: (845) 918-2596

Fax: (518) 436-0233

Fax: (315) 461-0765

Fax: (716) 626-5362

Overnight mail address: 270 Mt. Hope Drive Albany, NY 12209

*For the Cross Westchester Expressway (I-287), Occupancy Permits are issued by the New York State Department of Transportation and Work Permits are issued by the New York State Thruway Authority.

TA-W41337 (07/2014) Page 3 of 3

OCCUPANCY PERMIT

SUPPORTING DOCUMENTATION LIST

Please review the THRUWAY AUTHORITY OCCUPANCY AND WORK PERMIT ACCOMMODATION GUIDELINES (TAP-401) which is available on the Authority's web page or by request prior to submitting your application.

In order for the Authority to formally consider your application, the forms listed below must be completed and submitted as part of the application.

FORMS THAT MUST BE COMPLETED AND SUBMITTED: (available from Division Permit Coordinator or from the Authority's website at www.nysthruway.gov)

TA-W41337 Occupancy Permit Application - Pages 1 - 3

(Original form ONLY will be accepted; read and complete the applicant sections listed on the permit)

TA-W51343-9 Supplemental Insurance Certificate (Original form ONLY will be accepted)

ACORD 25 Certificate of Liability Insurance

(Available from your insurance agent; original form ONLY will be accepted)

SUPPORTING DOCUMENTS:

Supporting documents, as listed below, may be required. The Permit Coordinator for the Division in which you are applying for occupancy should be contacted to determine what additional supporting documents will be required.

Site/Operation Plan (3 copies)

Must be stamped by a New York State Licensed Professional Engineer or Registered Architect

Plan and profile drawn to scale

Highway ROW, C/L and stationing

Edge of pavement and shoulders

Property Survey stamped by a New York State Licensed Land Surveyor (3 copies)

Utility Pole/Conduit Authorization/Letter of Agreement (for non-owner)

Drainage Analysis/Storm Water Management Report

Other

FEES:

Application Fee:

$750 (minimum, non-refundable)

 

 

Amendment Fee: Nominal (name/address change)

$

25

(per permit)

Moderate (routine engineering/administrative review)

$

250

 

Comprehensive (extensive engineering/administrative review)

$

500

Annual Fee:

The Authority reserves the right to charge annual fees in accordance with the Authority's Fee Policy for

 

Occupancy and Work Permits. Contact the Division Permit Coordinator for details.

MAKE CHECKS PAYABLE TO:

"NEW YORK STATE THRUWAY AUTHORITY"

Please be sure to include all required forms and any required supporting documents.

These items must accompany this Application for processing.

Application Fee

Annual Fee

Other

Total Fees

$

$

$

$

Submit forms, fees and information to appropriate Division Permit Coordinator address listed in Section VI.

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As a way to fill out this form, be sure you type in the information you need in each and every blank:

1. Fill out the TAP-401 with a group of essential fields. Consider all of the important information and ensure absolutely nothing is neglected!

Part # 1 of filling out MILEPOST

2. Once your current task is complete, take the next step – fill out all of these fields - LOCATION OF FACILITY check all, MILEPOST BOUNDARY if known, IF APPLICABLE CHECK ONE, Underground, Depth in inches Surface, Aerial Bridge Attachment, Orientation Check one or both, Longitudinal, Beginning Milepost No, If longitudinal include ending, Direction of travel NSEW, Master agreementpermit, Colocate agreement, Transverse Offset from bridge or, and Utility agreement with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Best ways to prepare MILEPOST step 2

3. Completing If yes please provide supporting, Undertaking Effective Date, Duplicate Policy No, Effective Date Performance Bond, and Other is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Learn how to fill out MILEPOST step 3

4. To go onward, your next stage involves typing in a few fields. These comprise of Dated this, day of, Print Name of Applicant, Signature, Title if applicable, Section VI, Submit Application to the, DIVISION New York Albany Syracuse, HIGHWAY SECTIONS New York Mainline, DIVISION MILEPOST LIMITS GS, NYS Thruway Authority New York, ADDRESSES AND PHONE NUMBERS, NYS Thruway Authority Albany, NYS Thruway Authority Syracuse, and NYS Thruway Authority Buffalo, which you'll find vital to going forward with this form.

MILEPOST writing process outlined (portion 4)

Always be very mindful while completing NYS Thruway Authority Albany and Print Name of Applicant, since this is the section where most people make a few mistakes.

5. The pdf should be wrapped up by going through this section. Further you will notice an extensive list of blanks that must be filled in with correct details to allow your form submission to be accomplished: In order for the Authority to, SiteOperation Plan copies, Must be stamped by a New York, Plan and profile drawn to scale, Property Survey stamped by a New, Utility PoleConduit, Drainage AnalysisStorm Water, Other, Application Fee minimum, Amendment Fee Nominal nameaddress, Moderate routine, Annual Fee, The Authority reserves the right, MAKE CHECKS PAYABLE TO, and FEES.

Step number 5 for submitting MILEPOST

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