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Special Inspection Agency Registration Form
In order to apply for Special Inspection Agency Registration, please provide the following information. Items with a
(
*
)
are required.
EMAIL CONTACT INFORMATION
Email Address
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*
)
Re-Enter Email Address
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*
)
AGENCY INFORMATION
Agency Name
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*
)
Owner First Name
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*
)
Owner Last Name
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*
)
Telephone
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*
)
Fax
Agency Address
House Number
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*
)
Street Name
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*
)
City
(
*
)
State
(
*
)
Zip
(
*
)
DIRECTOR INFORMATION
License Type
(
*
)
Select:
ELECTRICAL CONTRACTOR
FIRE SUPPRESSION CONTRACTOR
OIL BURNER INSTALLER
MASTER PLUMBER
REGISTERED ARCHITECT
PROFESSIONAL ENGINEER
License No
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*
)
Title
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*
)
First Name
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*
)
M. I.
Last Name
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*
)
Home Address
House Number
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*
)
Street Name
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*
)
City
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*
)
State
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*
)
Zip
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*
)
Home Phone
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*
)
Mobile Phone
Date of Birth
(
*
)
E-mail
INSURANCE INFORMATION
Liability
Company
(
*
)
Expire Date
(
*
)
Policy No
(
*
)
Workers Compensation
Company
(
*
)
Expire Date
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*
)
Policy No
(
*
)
Waived
(
*
)
Yes
No
LICENSE USE
License use
(
*
)
Select:
Individual/Sole-Proprietor
Corporation
Partnership
TECHNICAL DIRECTOR INFORMATION required when selecting 'Corporation' or 'Partnership' for LICENSE USE
First Name
Last Name
Title
License Type
Select:
ELECTRICAL CONTRACTOR
FIRE SUPPRESSION CONTRACTOR
OIL BURNER INSTALLER
MASTER PLUMBER
REGISTERED ARCHITECT
PROFESSIONAL ENGINEER
License No
First Name
Last Name
Title
License Type
Select:
ELECTRICAL CONTRACTOR
FIRE SUPPRESSION CONTRACTOR
OIL BURNER INSTALLER
MASTER PLUMBER
REGISTERED ARCHITECT
PROFESSIONAL ENGINEER
License No
First Name
Last Name
Title
License Type
Select:
ELECTRICAL CONTRACTOR
FIRE SUPPRESSION CONTRACTOR
OIL BURNER INSTALLER
MASTER PLUMBER
REGISTERED ARCHITECT
PROFESSIONAL ENGINEER
License No
First Name
Last Name
Title
License Type
Select:
ELECTRICAL CONTRACTOR
FIRE SUPPRESSION CONTRACTOR
OIL BURNER INSTALLER
MASTER PLUMBER
REGISTERED ARCHITECT
PROFESSIONAL ENGINEER
License No
SPECIAL INSPECTIONS
(
*
)
FLOOD ZONE COMPLIANCE
Select:
Class 1
Class 2
Class 3
ON-SITE PRIVATE SEWAGE DISPOSAL SYSTEMS INSTALLATION
Select:
Class 1
Class 2
Class 3
LUMINOUS EGRESS PATH MARKINGS
Select:
Class 1
Class 2
Class 3
SPRINKLER SYSTEMS
Select:
Class 1
Class 2
Class 3
EMERGENCY & STANDBY POWER SYSTEMS (GENERATORS)
Select:
Class 1
Class 2
Class 3
STANDPIPE SYSTEMS
Select:
Class 1
Class 2
Class 3
STRUCTURAL STEEL - WELDING
Select:
Class 1
Class 2
Class 3
HEATING SYSTEMS
Select:
Class 1
Class 2
Class 3
STRUCTURAL STEEL - HIGH STRENGTH BOLTING
Select:
Class 1
Class 2
Class 3
CHIMNEYS AND VENTS
Select:
Class 1
Class 2
Class 3
STRUCTURAL COLD-FORMED STEEL
Select:
Class 1
Class 2
Class 3
FIRE-RESISTANT PENETRATIONS AND JOINTS (FIRESTOP)
Select:
Class 1
Class 2
Class 3
CONCRETE - CAST-IN-PLACE
Select:
Class 1
Class 2
Class 3
ALUMINUM CONSTRUCTION
Select:
Class 1
Class 2
Class 3
CONCRETE - PRECAST
Select:
Class 1
Class 2
Class 3
SEISMIC ISOLATION SYSTEMS
Select:
Class 1
Class 2
Class 3
CONCRETE - PRESTRESSED
Select:
Class 1
Class 2
Class 3
RAISING AND MOVING OF A BUILDING
Select:
Class 1
Class 2
Class 3
MASONRY
Select:
Class 1
Class 2
Class 3
STRUCTURAL STEEL - DETAILS
Select:
Class 1
Class 2
Class 3
WOOD - HIGH-LOAD DIAPHRAGMS
Select:
Class 1
Class 2
Class 3
HELICAL PILES FOUNDATION (BB # 2014-020)
Select:
Class 1
Class 2
Class 3
WOOD - METAL-PLATE-CONNECTED TRUSSES
Select:
Class 1
Class 2
Class 3
MASTIC AND INTUMESCENT FIRE-RESISTANT COATINGS
Select:
Class 1
Class 2
Class 3
WOOD - PREFABRICATED I-JOISTS
Select:
Class 1
Class 2
Class 3
HIGH TEMPERATURE HOT WATER PIPING (WELDING)
Select:
Class 1
Class 2
Class 3
SUBGRADE INSP / SOILS-SITE PREP
Select:
Class 1
Class 2
Class 3
POST-INSTALLED ANCHORS
Select:
Class 1
Class 2
Class 3
SUBSURFACE / SOILS-FILL PLACEMENT IN-PLACE DENSITY
Select:
Class 1
Class 2
Class 3
COMBUSTIBLE EXTERIOR WALL COVERINGS
Select:
Class 1
Class 2
Class 3
SUBSURFACE / SOILS INVESTIGATION (BORINGS/TEST PITS)
Select:
Class 1
Class 2
Class 3
UNDERPINNING & ALT METHODS OF SUPPORT OF BLDGS & ADJACENT PROPERTY
Select:
Class 1
Class 2
Class 3
DEEP FOUNDATIONS / PILES
Select:
Class 1
Class 2
Class 3
OPEN-WEB STEEL JOISTS AND JOIST GIRDERS
Select:
Class 1
Class 2
Class 3
VERTICAL MASONRY FOUNDATION ELEMENTS/PIERS
Select:
Class 1
Class 2
Class 3
DESIGNATED SEISMIC SYSTEM
Select:
Class 1
Class 2
Class 3
WALL PANELS, CURTAIN WALLS, AND VENEERS
Select:
Class 1
Class 2
Class 3
SEISMIC RESISTANCE OF ACCESS FLOORS
Select:
Class 1
Class 2
Class 3
SPRAYED FIRE-RESISTANT MATERIALS
Select:
Class 1
Class 2
Class 3
SEISMIC RESISTANCE OF PLUMBING, MECHANICAL, FUEL GAS, AND ELECTRICAL COMPONEN
Select:
Class 1
Class 2
Class 3
SMOKE CONTROL SYSTEMS
Select:
Class 1
Class 2
Class 3
SEISMIC RESISTANCE OF STORAGE RACKS
Select:
Class 1
Class 2
Class 3
MECHANICAL SYSTEMS
Select:
Class 1
Class 2
Class 3
CONSTRUCTION OPERATIONS INFLUENCING ADJACENT STRUCTURES
Select:
Class 1
Class 2
Class 3
FUEL-OIL STORAGE AND FUEL-OIL PIPING SYSTEMS
Select:
Class 1
Class 2
Class 3
NON POTABLE WATER SYSTEMS
Select:
Class 1
Class 2
Class 3
HIGH-PRESSURE STEAM PIPING (WELDING)
Select:
Class 1
Class 2
Class 3
EXHAUST AND VENT SYSTEMS IN PLENUMS AND DUCTS
Select:
Class 1
Class 2
Class 3
FUEL-GAS PIPING (WELDING)
Select:
Class 1
Class 2
Class 3
WOOD - SEISMIC RESISTANCE
Select:
Class 1
Class 2
Class 3
STRUCTURAL STABILITY - ALTERATIONS OF EXISTING BUILDINGS
Select:
Class 1
Class 2
Class 3
CONSTRUCTION UTILIZING CLT OR SCL, TYPE IV
Select:
Class 1
Class 2
Class 3
DEMOLITION
Select:
Class 1
Class 2
Class 3
PRESTRESSED ROCK AND SOIL ANCHORS
Select:
Class 1
Class 2
Class 3
EXCAVATION - SHEETING, SHORING, AND BRACING
Select:
Class 1
Class 2
Class 3
TENANT PROTECTION PLAN COMPLIANCE
Select:
Class 1
Class 2
Class 3
SOIL PERC. TEST-PVT ON-SITE STORM WATER DRAINAGE DISPOSAL SYS & DET. FACL.
Select:
Class 1
Class 2
Class 3
GROUT DESIGN MIX
Select:
Class 1
Class 2
Class 3
PVT ON-SITE STORM WATER DISPOSAL SYSTEMS & DETENTION FACL., INSTALLATION
Select:
Class 1
Class 2
Class 3
CONVICTIONS AND FINES(Director)
If you answer "Yes" to either of these questions, you
must
complete and attach form LIC34.
Have you pled guilty to or been convicted of any crime (misdemeanor or felony)?
(
*
)
Yes
No
Do you owe any penalties or fines to the city of New York?
(
*
)
Yes
No
Does any company or business you have been associated with under your Department-issued license owe any penalties of fines to the city of New York?
(
*
)
Yes
No
