Pw4 Form PDF Details

When it comes to ensuring that heating, ventilation, air conditioning, and refrigeration equipment meet the necessary compliance standards, the PW4 form plays a crucial role. This form, required to be filled out in a typewritten format, is used to apply for a Certificate of Compliance for various types of equipment. Key sections demand detailed information about the filing status, type of equipment, location specifics—including house number, street name, and borough details—along with comprehensive applicant information. Not only does it require the applicant's contact details and professional accreditation, but it also encompasses equipment specifications, such as the item's manufacturer, trade name, the number of items, capacity, and certification numbers. Crucially, the form includes a statement and signatures section, underlining the importance of honesty in the application process. It warns against the falsification of information and the unlawful exchange of benefits between city employees and applicants, emphasizing the legal implications of such actions. Completing and submitting the PW4 form is a step toward ensuring that installations or repairs of specified equipment types adhere to the rigorous standards set forth by the Department of Buildings, guarding against potential hazards and ensuring the safety and well-being of all involved.

QuestionAnswer
Form NamePw4 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namespw4 forms, nyc dob pw4, pw4 form dob blank, nyc dob pw4 form

Form Preview Example

PW4: Application for Certificate of Compliance

for Equipment

Must be typewritten.

Orient and affix BIS

job number label here

1 Filing Status

Job Number

2Type of Equipment Required for ALL applications.

Heating System

 

Ventilation System

 

Air Conditioning System

 

Refrigeration

(Not including boilers)

 

 

 

 

 

 

3Location Information Required for ALL applications.

House No.

Street Name

 

 

Apt/Condo No(s)

 

 

 

 

 

Borough

Block

Lot

BIN

CB No.

 

 

 

 

 

Work on Floor

 

 

 

 

 

 

 

 

 

4Applicant 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

 

 

 

 

 

 

 

 

 

 

 

 

 

P.E.

 

R.A.

Other

License Number

 

 

 

 

 

 

 

 

 

 

5Equipment Specifications Instructions for section (complete ALL).

Item—Manufacturer/Trade Name

Floor No. of

Certification Number for Listing

Capacity:

 

 

Items

 

BTUs/CFM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6Statement and Signatures Required for ALL applications.

 

The owner certifies that he authorizes the applicant to perform the proposed work in

 

 

 

accordance with plans and specifications approved under said application. Falsification of

Name (please print)

 

any statement is a misdemeanor and is punishable by a fine or imprisonment, or both. It is

 

 

 

unlawful to give to a city employee, or for a city 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 both.

 

 

 

 

Signature

Date

 

Owner Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I hereby certify that the work indicated above has been done in a manner required by the

 

 

 

Rules and Regulations of the Department of Buildings except where reported adversely.

 

 

 

Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

P.E. / R.A. Seal

(apply seal, then sign and date over

 

Inspector’s Signature:

 

Date Signed Off:

 

 

 

 

 

 

 

 

seal)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INTERNAL USE ONLY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Examined and Recommended for Approval

Yes

No

Approved

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

Examiner

 

 

Borough Commissioner

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature

Date

 

Signature

 

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PW4 2/15

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This form will require specific details to be filled out, hence make sure to take your time to fill in exactly what is requested:

1. The pw4 certificate needs particular information to be entered. Be sure that the subsequent fields are complete:

Part # 1 for filling out nyc dob pw4 form

2. Once your current task is complete, take the next step – fill out all of these fields - Statement and Signatures Required, The owner certifies that he, Name please print, Signature, Date, Owner Name, Title, Signature, Date, I hereby certify that the work, Name, Inspectors Signature Date Signed, PE RA Seal apply seal then sign, and INTERNAL USE ONLY with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Step number 2 of submitting nyc dob pw4 form

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