Article Guide
The NYC LL4A form, formally known as the Local Law 26/04 Seven Year Sprinkler Report Form, plays a crucial role in ensuring the safety and compliance of buildings throughout the city. This form is primarily used by property owners to report on the status of fire sprinkler systems within their buildings. It requires comprehensive information, including location details such as the house number, street name, and borough, as well as specific data about the building’s block, lot, and BIN. Additionally, the form collects professional information from the individual responsible for the report, including their name, business details, and contact information. Importantly, the owner of record must also be identified, emphasizing that the information must come from the rightful owner rather than an agent or representative. A key component of the LL4A form is the percentage of the building that has been sprinkled, along with a synopsis of work completed and a detailed implementation plan for achieving full sprinklerization. This thorough documentation not only aids in tracking compliance but also serves to enhance the overall safety of the building. Moreover, the form includes a statement regarding the legal implications of falsifying information, underscoring the seriousness of accurate reporting. Signatures from the responsible parties are required, along with an internal use section for verification by local law enforcement units. By adhering to these requirements, property owners contribute to a safer urban environment while fulfilling their legal obligations.
Preview - Nyc Ll4A Form
Local Law 26/04
Seven Year
Sprinkler Report Form
Application must be typewritten
1 |
Location Information |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
House No(s) |
|
Street Name |
|
|
|
|||
|
|
|
|
|
|
|
|
|
|
|
Borough |
|
Block |
|
Lot |
BIN |
|||
|
|
|
|
|
|
|
|
|
|
2 |
Professional Information |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Last Name |
|
First Name |
|
|
Middle Initial |
|||
|
|
|
|
|
|
|
|
|
|
|
Business Name |
|
|
|
|
|
|
|
Business Telephone |
|
|
|
|
|
|
|
|
|
|
|
Business Address |
|
|
|
|
|
|
|
Business Fax |
|
|
|
|
|
|
|
|
|
|
|
City |
State |
|
Zip |
|
|
Mobile Telephone |
||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
P.E. |
|
|
R.A |
|
NYS License Number |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
3Owner of Record Information (Not a Representative or Business Manager or Agent)
|
Last Name |
|
First Name |
Middle Initial |
|
|
|
|
|
|
Business Name |
|
|
Business Telephone |
|
|
|
|
|
|
Business Address |
|
|
Business Fax |
|
|
|
|
|
|
City |
State |
Zip |
Mobile Telephone |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4 Percentage of Building Sprinkled
%
5 Synopsis of work completed and implementation plan to complete 100% sprinklerization (continued on page 2, if necessary)
6Statement and Signatures
Falsification of 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 fine or both.
Name (please print)
|
Signature |
Date |
|
|
|
|
|
|
|
|
|
|
Internal Use Only |
|
NYS P.E. / R.A. Seal (apply seal, then sign and date over seal) |
|
|
|
|
|
|
|
|
|
Local Law Enforcement Unit (stamp) |
||
|
Initials_________________ |
Date_________________ |
|
|
|
|
|
LL4A (4/11)
Local Law 26/04
Seven Year
Sprinkler Report Form
Application must be typewritten
PAGE 2
5a Synopsis of work completed and implementation plan to complete 100% sprinklerization (continued)
LL4A (4/11)
Form Characteristics
| Fact Name | Details |
|---|---|
| Form Title | Local Law 26/04 Seven Year Sprinkler Report Form |
| Application Requirement | Application must be typewritten. |
| Location Information | Includes House No(s), Street Name, Borough, Block, Lot, and BIN. |
| Professional Information | Requires name, business details, contact information, and NYS License Number. |
| Owner of Record | Information must be provided for the actual owner, not a representative. |
| Percentage Sprinkled | Must indicate the percentage of the building that is sprinkled. |
| Implementation Plan | Synopsis of work completed and plan to achieve 100% sprinklerization is required. |
| Legal Implications | Falsification is a misdemeanor; penalties include fines or imprisonment. |
| Internal Use | Includes sections for NYS P.E./R.A. Seal and Local Law Enforcement Unit stamp. |
More PDF Templates
Nyc Real Property Transfer Tax - Filing deadlines and specific instructions are provided by the NYC Department of Finance for proper submission.
Nycera - Maintain uninterrupted services from NYCERS by using this form to promptly report any changes in your address.