Nyc Buildings Form Pta3 – Fill Out and Use This PDF

Must be typewritten.

NOTE: In accordance with Title 4-B of Article 4 of the New York State Real Property Tax Law and 1 RCNY 105-01, applications must be received by the Department of Buildings by March 15th in order to qualify for a property tax abatement to take effect on July 1st of the same calendar year.

1 Location Information of Green Roof Required for all applications.

House No(s)	Street Name				New Building		Existing Building
Borough		Block	Lot	BIN	Zoning District
Number of Stories	Height	ft.	Area(s) of Roof(s)	sq. ft.	Real Property Class No.	1	2	4

2Applicant for Property Tax Abatement Information See 1 RCNY 105-01 for definition. Required for all applications.

Last Name		First Name	Middle Initial	Title
Business Name			Business Telephone
Business Address			Business Fax
City	State	Zip	Mobile Telephone
E-Mail			Taxpayer ID
Authorized representative: Last Name			First Name
Authorized representative: Title			Telephone

3Permit Information Required for all applications.

DOB Construction/BIS Job Number ____________________
Electrical Permit Number (if applicable)_____________________	Date of Issuance _________	Date of Sign-off _________

4Applicant of Record Information See 1 RCNY 105-01 for definition. Required for all applications.

Last Name				First Name	Middle Initial
Business Name					Business Telephone
Business Address					Business Fax
City			State	Zip	Mobile Telephone
E-Mail					NYS License Number
Choose one:		P.E.	R.A.

5 Professional Certifying this PTA3 Application Required for all applications.

Last Name			First Name	Middle Initial
Business Name				Business Telephone
Business Address				Business Fax
City		State	Zip	Mobile Telephone
E-Mail				NYS License Number
Choose one:	P.E.	R.A.

6General Contractor Information Required for all applications.

	Last Name		First Name		Middle Initial
	Business Name				Business Telephone
	Business Address				Business Fax
	City	State	Zip		Mobile Telephone
	E-Mail				Registration or Tracking Number
	Construction Supervisor: Last Name			First Name	HIC No. (if applicable)

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PTA3

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7Maintenance Plan Author Information See 1 RCNY 105-01 for reference. Required for all applications.

Last Name		First Name	Middle Initial
Business Name			Business Telephone
Business Address			Business Fax
City	State	Zip	Mobile Telephone
E-Mail			NYS License Number

8	Installer of Green Roof System Required for all applications.
	Last Name		First Name	Middle Initial
	Business Name			Business Telephone
	Business Address			Business Fax
	City	State	Zip	Mobile Telephone
	E-Mail
9	Roof Information Required for all applications.
	Roof Area	sq. ft. Eligible Rooftop Space	sq. ft. Green Roof Space	sq. ft. Depth of Growth Medium	in.
10	Professional’s Certification of Compliance Required for all applications.

I, a New York State licensed and registered architect or engineer, as represented on this form in section 5 and by my seal and signature below, certify and agree to the following:

1.A green roof has been installed on the subject building within eligible rooftop space as defined in Title 4-B, §499-aaa(8), as provided above.

2.The subject building is an eligible building in accordance with Title 4-B §499-aaa(7)

3.The green roof meets the standards of Title 4-B, §499-aaa(10) and 1 RCNY 105-01.

4.A structural analysis of the building has been performed, which establishes that the building can sustain the added load of the green roof in a fully saturated condition.

5.Roofing and drainage evaluations have been performed, which establish the building’s roof and drainage systems’ compliance with applicable law and rules.

6.The green roof installation complies with the Fire Code regarding fire fighting access and with height and setback provisions of the Zoning Resolution.

7.Choose the statement that applies:

Construction drawings were prepared and submitted in conjunction with the alteration application relating to this property tax abatement application. Any required construction work resulting from the structural analysis, and roofing and drainage evaluations certified above, is detailed in approved construction documents, which are consistent with structural calculations provided.

Construction documents have not been submitted in conjunction with the alteration application relating to this property tax abatement application, pursuant to 1 RCNY 105-01(e)(1)(ii)(D) and applicable rules. I have performed the required structural analysis as certified above and the building, without modification, meets the applicable laws and rules.

8.I have verified that any electrical permit application related to this green roof was properly filled out indicating this is a “Sustainable Energy” project and that, unless this green roof was installed pursuant to an electrical permit issued prior to the effective date of 1 RCNY 105-01, the BIS number listed above is also listed on the electrical permit application form.

9.Choose the statement that applies:

I prepared the maintenance plan and certify that the maintenance plan complies with the requirements of Title 4-B and 1 RCNY 105- 01; and that I provided a copy of such maintenance plan to the property tax abatement applicant.

A maintenance plan was prepared by the individual indentified in section 7 above, that complies with the requirements of Title 4-B and 1 RCNY 105-01. and I have confirmed that such maintenance plan was given to the property tax abatement applicant.

10.To the best of my professional knowledge and belief, no installation of any component of the green roof as defined in Title 4-B § 499-aaa(10), except § 499-aaa(10)(a) and § 499-aaa(10)(c), was commenced prior to August 5, 2008.

11.I certify that I have reviewed and inspected the design and completed installation of the green roof system as installed at the above address and as reflected in this application and affirm that, to the best of my professional knowledge and belief, the application and installation comply with Title 4- B of Article 4 of the New York State Real Property Tax Law, and all applicable laws and rules of the City of New York and of other authorities having jurisdiction; and that I approve such installation, as an engineer or architect licensed and registered to practice in the State of New York.

Name (please print)

Signature

Date

P.E. / R.A. Seal (apply seal, then sign and date over seal)

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PTA3		PAGE 3
11	Applicant for Property Tax Abatement Agreement Required for all applications.

I, the applicant for property tax abatement as represented on this form in section 2 and by my signature below, certify and agree to the following:

1.This building has not previously received a real property tax abatement under Title 4-B of Article 4 of the New York State Real Property Tax Law.

2.I agree to allow officials of the Department and any architect, engineer, landscape architect or horticulturalist associated with this green roof property tax abatement project, to access the property and to inspect the green roof and any related structures and equipment at any time upon reasonable notification.

3.I agree, in the event that the Department finds either non-compliance with the requirements of Title 4-B and 1 RCNY 105-01 or any unsafe condition related to the green roof, to pay for the expenses of the Department for related inspection(s) and investigation, in accordance with Department rule.

4.I have received an original copy of a maintenance plan for this project, prepared by the individual represented in section 7 of this application, for the continued care of the green roof as required by Title 4-B and 1 RCNY 105-01; and I agree to maintain this green roof in accordance with the plan during the compliance period and for a minimum of three years following the last date of the compliance period in such a manner that it continuously constitutes a green roof within the meaning of Title 4-B and 1 RCNY 105-01.

5.I agree to provide any other information or certifications required by the Department pursuant to Title 4-B and 1 RCNY 105-01.

6.No installation of any component of the green roof as defined in Title 4-B § 499-aaa(10), except § 499-aaa(10)(a) and § 499-aaa(10)(c), was commenced prior to August 5, 2008.

7.I agree that pursuant to 1 RCNY 105-01, within fifteen (15) calendar days prior to the end of the compliance period, I will have the applicant of record, landscape architect or other architect or engineer inspect the green roof to certify its continuing compliance with Title 4-B, 1 RCNY 105-01 and applicable provision of law and rules; such inspecting professional shall prepare an inspection report and maintain it on file in accordance with applicable provisions of law and rules for review by the Department upon request. If the inspecting professional finds that the green roof is not in compliance with Title 4-B, such inspecting professional shall notify the Department on such forms and in such manner prescribed by the Department.

8.I, the applicant for a tax abatement for the above-referenced premises whose name and signature appear below, hereby state that I am the owner, or represent the owner, of the subject premises; that I have thoroughly reviewed the approved construction documents for the job number identified in Section 3, this application and the information provided herein about me and/or the corporation or condominium I represent and the subject building and premises and state that all information I have provided is accurate and true; that the information and work provided on my behalf is accurate, true and in accordance with Title 4-B and 1 RCNY 105-01 to the best of my knowledge; that I fully agree to abide by all terms stated herein; and I hereby apply for the real property tax abatement offered by the City of New York in accordance with Title 4-B and 1 RCNY 105-01.

Name (please print)	Signature	Date

8/09