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Fillable Nyc Pa1 Form in PDF

The NYC PA1 form is a crucial document required for establishing or modifying a Place of Assembly in New York City. This form must be typewritten and includes essential information such as the applicant's details, location specifics, and the nature of the filing. Proper completion of the PA1 form ensures compliance with city regulations and facilitates the approval process for assembly spaces.

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Article Guide

The NYC PA1 form is an essential document for anyone looking to establish or modify a place of assembly in New York City. It must be filled out using a typewriter, ensuring clarity and professionalism. When submitting the form, applicants must specify the reason for filing, whether it’s a new application, a change in ownership, or updates to the layout or use of the establishment. Location information is critical; applicants need to provide details such as house numbers, street names, boroughs, and zoning districts. The form also requires applicant information, including names, contact details, and professional certifications, if applicable. If someone other than the applicant is filing the application, their details must be included as well. The form includes sections for describing the assembly space, including occupancy designations and cabaret numbers, following the 2014 Code. Finally, signatures from both the applicant and the owner are necessary, affirming that the information provided is accurate and compliant with city regulations. It’s important to note that any falsification can lead to serious legal consequences, underscoring the need for honesty and diligence in the application process.

Preview - Nyc Pa1 Form

PA1: Place of Assembly

Must be typewritten. Indicate reason for filing:

New Filing

Change to Owner/Lessee/Name of Estab. ONLY Change to Layouts/Use and any other information



Orient and affix BIS

job number label here

1Location Information Required for all applications.

	House No(s)	Street Name

	Borough	Block	Lot	BIN		C.B. No.

	Zoning District(s)			Overlay(s)

	Special Dist(s)				Zoning Map No.


2	Applicant Information	Required for all applications. Professionally certifying application?			Yes	No If yes, complete POC-1 form.

	Last Name		First Name			Middle Initial

	Business Name				Business Telephone

	Business Address					Business Fax

	City	State	Zip		Mobile Telephone

	E-Mail				License Number		P.E.
	E-Mail				License Number		R.A.
							R.A.

3Filing Representative Complete if different from section 2. Fax, mobile phone, and e-mail are optional info.

Last Name		First Name	Middle Initial

Business Name			Business Telephone

Business Address			Business Fax

City	State	Zip	Mobile Telephone

E-Mail			Registration Number

4Place of Assembly Space Information Submit comments using an AI-1 form (optional). *Use 2014 Code occupancy designations only.

Specific Floor(s) of PA Space					Occupancy	Cabaret		Number of	Description
					Designation*			Persons	Code
NB/A1 Job No. Establishing PA	If Pre-BIS, provide BIN:			Primary			Yes
NB/A1 Job No. Establishing PA	If Pre-BIS, provide BIN:			Plan			No
				Plan			No
Prior PA No. (if applicable)	Irregular Floor Numbering?	Yes	No	Alt. 1			Yes
				Alt. 1			Yes
				Plan			No

Name of PA Establishment				Alt. 2			Yes
Name of PA Establishment				Plan			No
				Plan			No

Statements and Signatures of Applicant and Owner PE/RA not required for change to owner/lessee/name of establishment only.

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. Applicant: I prepared or supervised the preparation of the submittal documents herewith submitted and to the best of my knowledge and belief, the submittal documents and work shown thereon comply with the provisions of the NYC Administrative Code and other applicable laws and regulations, except as set forth in the accompanying documents. I acknowledge that I have read and complied with all instructions pertaining to this application and supplementary schedules submitted. Owner: I have authorized the applicant to file this application for the work specified herein and all future amendments.

P.E. / R.A Name (print):

Signature

Date

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

Individual/Lessee Responsible for Annual Renewal of PA (if not owner)

Name (print):

Relationship to Owner:

Business Name/Agency:

Street Address:

City:	State:	Zip:

Telephone Number:	Fax:

E-Mail Address:

Owner	Condo/Co-Op	Partnership	HHC	NYCHA
type:	Corporation	DCAS	HPD	NYS
	Individual	DOE	Other Government
	Is the deed-holder a non-profit per 28-112.1?			Yes No
Name (print):

Relationship to Owner:

Business Name/Agency:

Street Address:

City:		State:	Zip:

Telephone Number:		Fax:

E-Mail Address:

Signature and Date ►

12/14

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Form Characteristics

Fact Name	Description
Typewritten Requirement	The NYC PA1 form must be completed using a typewriter. Handwritten submissions are not accepted.
Filing Purpose	Applicants must indicate the reason for filing, which can include a new filing, a change to the owner or lessee, or changes to layouts or use.
Location Information	All applications require detailed location information, including house number, street name, borough, block, lot, and zoning district.
Governing Law	The NYC PA1 form is governed by the NYC Administrative Code and other applicable laws and regulations.
Signatures and Statements	Both the applicant and the owner must sign the form, affirming the accuracy of the information and compliance with regulations.

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