Form PEO1 "Local Law 58 of 1987 Accessibility Waiver Request" - New York City

What Is Form PEO1?

This is a legal form that was released by the New York City Department of Buildings - a government authority operating within New York City. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on January 1, 2015;
  • The latest edition provided by the New York City Department of Buildings;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form PEO1 by clicking the link below or browse more documents and templates provided by the New York City Department of Buildings.

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Download Form PEO1 "Local Law 58 of 1987 Accessibility Waiver Request" - New York City

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Accessibility Waiver Request
Orient and affix BIS
job number label here
Must be typewritten.
1 Filing Information
Job number
2 Location Information
Borough
Block
Lot(s)
BIN
C.B. No.
House No(s)
Street Name
Apt/Condo No(s).
Special Place Name
Floor(s)
3 Applicant
Last Name
First Name
M.I.
Business Name
Business Phone
Address
City
State
Zip
Email
P.E.
R.A.
Lic. No.
4 Objections (
Use one line for each objection. Attach additional sheets if necessary).
5 Basis of Waiver per
§ 1101.3.5 of the Building Code
5A
Unnecessary in light of alternative
Entails a change so slight/negligible benefit
Not achieve intended objective
Seal
Economic Burden
Physically or legally impossible
5B
Explanation of basis - Discuss each basis separately. Number of pages attached.
5C
Cost estimates and drawings must accompany a waiver request based on economic burden. Attached
Yes
No
6 Applicant’s Signature
Applicant Name
Signature
Title
Date
7 Recommendation by Mayor’s Office for People with Disabilities (MOPD) - 100 Gold Street 2nd floor 212-788-2830
Comments and recommendations (Attach letter if necessary)
MOPD Representative Signature
Date
8 Department’s Determination (For office use only)
MOPD recommendation should not be accepted. Refer to Assistant Commissioner for Technical Affairs.
Borough Commissioner/Plan Examiner (Please print):
Signature
Date
PE01 Revised 1/15
Accessibility Waiver Request
Orient and affix BIS
job number label here
Must be typewritten.
1 Filing Information
Job number
2 Location Information
Borough
Block
Lot(s)
BIN
C.B. No.
House No(s)
Street Name
Apt/Condo No(s).
Special Place Name
Floor(s)
3 Applicant
Last Name
First Name
M.I.
Business Name
Business Phone
Address
City
State
Zip
Email
P.E.
R.A.
Lic. No.
4 Objections (
Use one line for each objection. Attach additional sheets if necessary).
5 Basis of Waiver per
§ 1101.3.5 of the Building Code
5A
Unnecessary in light of alternative
Entails a change so slight/negligible benefit
Not achieve intended objective
Seal
Economic Burden
Physically or legally impossible
5B
Explanation of basis - Discuss each basis separately. Number of pages attached.
5C
Cost estimates and drawings must accompany a waiver request based on economic burden. Attached
Yes
No
6 Applicant’s Signature
Applicant Name
Signature
Title
Date
7 Recommendation by Mayor’s Office for People with Disabilities (MOPD) - 100 Gold Street 2nd floor 212-788-2830
Comments and recommendations (Attach letter if necessary)
MOPD Representative Signature
Date
8 Department’s Determination (For office use only)
MOPD recommendation should not be accepted. Refer to Assistant Commissioner for Technical Affairs.
Borough Commissioner/Plan Examiner (Please print):
Signature
Date
PE01 Revised 1/15