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Fillable New York Acp9 Form in PDF

The New York ACP9 form is an Asbestos Variance Application used by individuals and organizations seeking permission to deviate from specific asbestos regulations set by the NYC Department of Environmental Protection. This form must be completed and submitted at least two weeks before the planned work begins. Accurate and thorough information is essential for processing the application and obtaining the necessary approvals.

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Article Guide

The New York ACP9 form is a critical document for those seeking a variance from specific asbestos regulations within the city. It serves as an application for permission to deviate from certain provisions outlined by the New York City Department of Environmental Protection (NYC DEP) and the New York State Department of Labor. The form requires detailed information about the facility where the work will occur, including the address and the specific areas impacted. Applicants must identify the asbestos rule provisions from which they seek relief and provide a rationale for their request. This includes a description of the proposed actions and alternative procedures that will be implemented. The application must be submitted at least two weeks prior to the intended start date of the work. Additionally, there is a fee schedule based on the amount of asbestos-containing material (ACM) involved, which varies depending on whether the total amount is below or above 5,000 square feet. The form also mandates that all information provided is accurate and complete, as any failure to comply with the approval conditions can render the variance null and void. By understanding the requirements and implications of the ACP9 form, individuals and organizations can better navigate the regulatory landscape surrounding asbestos management in New York City.

Preview - New York Acp9 Form

ONLY TYPEWRITTEN FORMS WILL BE ACCEPTED

			Y D	EPA			NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION
		K	CIT	EPA
		K		RT
	R				M	E	Asbestos Control Program
	O					E
	W					O
	Y					N
	E					T
N	E					F	59-17 Junction Boulevard, 8th Floor, Corona, NY 11368-5107
N							59-17 Junction Boulevard, 8th Floor, Corona, NY 11368-5107

I									T	N	Asbestos Variance Application
N										N
E
V	R								IO
	R							C
		O	N				E
			N	M		T
				M	O
					ENTAL PR

w w w . n y c . g o v / d e p

FOR OFFICIAL USE ONLY

Variance #_____________________

Fee Paid ___________

Notification #___________________

I. FACILITY

		Application must be
Address_____________________________________________ Borough ____________ Zip __________		made	at least	2
		weeks	prior to	the
II. APPLICANT		start of work.
Name ___________________________________________________________	Tel # ____________________

Address _____________________________________________ City _________________________ State ______ Zip_________

Capacity: ¸Contractor ¸Consultant ¸Owner ¸Other_________________ Contact Person ______________________

Ill. SPECIFY ALL NYC DEP OR NYS DOL (ICR56) ASBESTOS RULE PROVISIONS FROM WHICH A VARIANCE IS REQUESTED

________________________________________________________________________________________________________

SPECIFY FLOORS AND/OR AREAS WHERE WORK INVOLVING THIS VARIANCE IS TO OCCUR

________________________________________________________________________________________________________

_________________________________________________________________________________________________________

REASONS FOR REQUEST AND DESCRIPTION FOR PROPOSED ACTION (ATTACHMENT(S) SHALL BE SUBMITTED IN TRIPLICATE)

Explain why the procedures required by Title 15, Chapter 1 of the Rules of the City of New York (RCNY) and/or Part 56 of Title 12 of New York Codes, Rules and Regulations (Subparts 56-4 through 56-17) cannot be used. (Attach ADDITIONAL Sheets)

State the alternative procedures that will be employed to satisfy each requirement as modified. (Attach ADDITIONAL Sheets)

Provide color coded drawings identifying work area(s) and location of decontamination enclosure system(s).

IV. FEE SCHEDULE

			0
Amount of ACM affected by this variance: _______ square feet + _______ linear feet = Total Amount of ACM _________ feet

	If total amount of ACM	If total amount of ACM
	is less than 5000 feet:	Is 5000 feet or more:	See Section 1-03(e)
Seven day notification period waiver	$300	$400	See Section 1-03(e)
First sub-section (per category)	$400	$600	of the NYCDEP
Each additional sub-section (per category)	$200	$300	Asbestos Rules for
			category definitions.
Maximum fee	$1200	$1800	category definitions.
Maximum fee	$1200	$1800
Enter applicable fee based on schedule above		Total Fees $___________________

V.I hereby declare that the information provided herein and in any and all accompanying attachments is true and complete to the best of my knowledge. I understand that failure to comply with conditions set forth by the Department in an approval of the application shall render this variance null and void.

________________________________________________		_______________________________________________
Print Name of Owner		Print Name of Applicant (If not owner)
________________________________________________		_______________________________________________
Signature of Owner	Date	Signature of Applicant	Date

Work involving a variance may not commence prior to the receipt of the Department’s approval of the application. Any violation of the terms of any variance issued pursuant to Title 15, Chapter 1 of the RCNY Section 1-03 is considered a violation of the lettered subdivision modified by the variance.

ACP9 2/2001

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Form Characteristics

Fact Name	Fact Description
Form Purpose	The ACP9 form is used to apply for a variance related to asbestos control in New York City.
Governing Laws	This form is governed by Title 15, Chapter 1 of the Rules of the City of New York and Part 56 of Title 12 of New York Codes, Rules and Regulations.
Submission Timeline	Applications must be submitted at least two weeks prior to the start of work involving asbestos.
Fee Structure	Fees vary based on the amount of asbestos-containing material (ACM) affected, with a maximum fee ranging from $1,200 to $1,800.
Notification Requirement	A seven-day notification period waiver is available for specific fee amounts based on ACM quantity.
Applicant Information	Applicants must provide their name, contact information, and capacity (e.g., contractor, consultant, owner).
Work Commencement	No work involving a variance may begin until the Department approves the application.
Attachments Required	Applicants must submit color-coded drawings and additional sheets detailing alternative procedures and work areas.
False Information Penalty	Providing false information on the application may render the variance null and void.
Contact Information	The form includes a contact section for the applicant and owner, requiring signatures and dates for validation.

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