Fillable Nyc Pw5 Form in PDF
The NYC PW5 form is an essential document for anyone seeking to obtain an After Hours Work Permit in New York City. This application is crucial for construction or renovation projects that require work outside of standard hours, ensuring compliance with local regulations. To initiate the process, applicants must provide detailed information, including the job's location, contractor details, and the nature of the work being performed. The form mandates that all sections be completed thoroughly; incomplete submissions will not be considered. Additionally, specific deadlines must be adhered to, particularly for weekend variance requests, which must be submitted by Tuesday at 3:00 PM. The form also requires applicants to specify if a residence is within 200 feet of the work site, the number of days requested for the permit, and the exact hours of operation. Furthermore, it emphasizes the importance of honesty in the application process, outlining the consequences of falsifying information. A noise mitigation plan must be developed and submitted as part of the application, reflecting the city’s commitment to minimizing disturbances during after-hours work. By following the guidelines set forth in the PW5 form, applicants can ensure that their requests are processed efficiently and in compliance with city regulations.
Preview - Nyc Pw5 Form
PW5: After Hours
Work Permit Application
Orient and affix BIS
job number label here 
Must be typewritten
All information must be completed for review of this request. Incomplete submissions will be denied without review.
The deadline to submit weekend variance requests is Tuesday at 3:00PM, and variances will not be granted for any day earlier than Saturday of the same week.
1Filing Status Information Required for all applications. Check applicable box for application type.
Work Permit No. |
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BIS Job |
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Electrical Application |
Variance Type: |
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Initial |
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Renewal |
2Location Information Required for all applications.
House No(s) |
Street Name |
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Borough |
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Lot |
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CB No. |
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Work on Floor(s) |
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Apt/Condo No(s) |
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Contractor Required for all applications. Business Fax and Email are optional.
Last Name |
First Name |
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Middle Initial |
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Business Name |
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Business Telephone |
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Business Address |
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Business Fax / Email |
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City |
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Zip |
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Mobile Telephone |
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License Number |
License Type |
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GC |
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Electrician |
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MP |
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FSC |
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Other: |
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4Subcontractor If a subcontractor is involved in this work, their information must be provided. Business Fax and Email are optional.
Last Name |
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First Name |
Middle Initial |
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Business Name |
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Business Telephone |
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Business Address |
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Business Fax / Email |
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Zip |
Mobile Telephone |
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5
Variance Information Required for all applications.
Is a residence within 200 feet of the site? |
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Yes |
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No |
Total Number of Days Requested: |
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Days of Week |
Date(s) Requested |
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Hours |
Description of Work (Specify weekday vs. weekend work) |
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Tuesday |
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Friday |
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Weekend |
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Reason for Variance:
6Statements and Signature Required for all applications.
This permit must be posted visible to the public. 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.
•I understand that if I am found after hearing to have knowingly or negligently made a false statement or to have knowingly or negligently falsified or allowed to be falsified any certificate, form, signed statement, application, report or certification of the correction of a violation required under the provisions of this code or of a rule of any agency, I may be barred from filing further applications or documents with the Department.
•I hereby certify that I have developed a noise mitigation plan for the site in accordance with Administrative Code §
Contractor Name (print)
Signature |
Date |
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Internal Use Only
Approved |
Denied |
Limited Approval |
Indicate
Limited to:
Borough Commissioner Signature |
Date |
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Filing Fee |
Permit Fee |
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12/10
Form Characteristics
| Fact Name | Fact Description |
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| Application Type | The PW5 form is used for applying for an After Hours Work Permit in New York City. |
| Submission Deadline | Requests for weekend variances must be submitted by Tuesday at 3:00 PM. |
| Completion Requirement | All sections of the form must be completed; incomplete submissions will be denied without review. |
| Location Information | Applicants must provide specific location details including house number, street name, borough, block, and lot. |
| Contractor Information | Details about the contractor, including name, contact information, and license type, are required for all applications. |
| Variance Information | Applicants must indicate if a residence is within 200 feet of the work site and specify the days and hours of work. |
| Legal Implications | Falsifying information on the form is a misdemeanor, punishable by fine or imprisonment. |
| Noise Mitigation Plan | Applicants must certify that a noise mitigation plan is developed in accordance with Administrative Code § 24-219 through § 24-224. |
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