Form TR3 "Technical Report: Concrete Design Mix" - New York City

What Is Form TR3?

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 February 19, 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 TR3 by clicking the link below or browse more documents and templates provided by the New York City Department of Buildings.

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TR3: Technical Report
Orient and affix BIS
Concrete Design Mix
job number label here
Must be typewritten.
The TR3 is required prior to permit
1 Location Information
Required for all applications.
House No(s)
Street Name
Borough
Block
Lot
BIN
CB No.
2 Applicant Information - Licensed Concrete Testing Lab
Required for all applications.
Director Last Name
Director First Name
Director Middle Initial
Business Name
Business Telephone
Business Address
Business Fax
City
State
Zip
Mobile Telephone
E-Mail
Director’s Lic. Number
P.E.
R.A.
Concrete Testing Lab Lic. Number
3 Strength Requirements and Design
Required for all applications. Attach Trial Mixture Report and/or Field Experience Results.
Mix #1
Mix #2
Mix #3
Method of Determining Proportions
Trial Mix
Trial Mix
Trial Mix
(Trial Mixture and/or Field Experience)
Field
Field
Field
Experience
Experience
Experience
Date Trial Mixture Performed
Specified Strength (f’ c)
Required Strength (f’ cr)
Specified Test Age (Days)
Material Type
Material Source
ASTM
Standard
Cementitious #1 (lbs)
lbs.
lbs.
lbs.
Cementitious #2 (lbs)
lbs.
lbs.
lbs.
Cementitious #3 (lbs)
lbs.
lbs.
lbs.
Fine Aggregate (lbs)
lbs.
lbs.
lbs.
Coarse Aggregate #1 (lbs)
lbs.
lbs.
lbs.
Coarse Aggregate #2 (lbs)
lbs.
lbs.
lbs.
Coarse Aggregate #3 (lbs)
lbs.
lbs.
lbs.
Amount of Water (gals)
gals.
gals.
gals.
Admixture #1 (oz)
oz
oz
oz
Admixture #2 (oz)
oz
oz
oz
Admixture #3 (oz)
oz
oz
oz
Other
Water-Cement Ratio
Slump/Spread
+
+
+
(inches + tolerance)
Air Content (% + tolerance)
%+
%+
%+
3
3
3
3
Unit Weight (lbs./ft
)
lbs./ft
lbs./ft
lbs./ft
TR3 rev. 02/19/15
TR3: Technical Report
Orient and affix BIS
Concrete Design Mix
job number label here
Must be typewritten.
The TR3 is required prior to permit
1 Location Information
Required for all applications.
House No(s)
Street Name
Borough
Block
Lot
BIN
CB No.
2 Applicant Information - Licensed Concrete Testing Lab
Required for all applications.
Director Last Name
Director First Name
Director Middle Initial
Business Name
Business Telephone
Business Address
Business Fax
City
State
Zip
Mobile Telephone
E-Mail
Director’s Lic. Number
P.E.
R.A.
Concrete Testing Lab Lic. Number
3 Strength Requirements and Design
Required for all applications. Attach Trial Mixture Report and/or Field Experience Results.
Mix #1
Mix #2
Mix #3
Method of Determining Proportions
Trial Mix
Trial Mix
Trial Mix
(Trial Mixture and/or Field Experience)
Field
Field
Field
Experience
Experience
Experience
Date Trial Mixture Performed
Specified Strength (f’ c)
Required Strength (f’ cr)
Specified Test Age (Days)
Material Type
Material Source
ASTM
Standard
Cementitious #1 (lbs)
lbs.
lbs.
lbs.
Cementitious #2 (lbs)
lbs.
lbs.
lbs.
Cementitious #3 (lbs)
lbs.
lbs.
lbs.
Fine Aggregate (lbs)
lbs.
lbs.
lbs.
Coarse Aggregate #1 (lbs)
lbs.
lbs.
lbs.
Coarse Aggregate #2 (lbs)
lbs.
lbs.
lbs.
Coarse Aggregate #3 (lbs)
lbs.
lbs.
lbs.
Amount of Water (gals)
gals.
gals.
gals.
Admixture #1 (oz)
oz
oz
oz
Admixture #2 (oz)
oz
oz
oz
Admixture #3 (oz)
oz
oz
oz
Other
Water-Cement Ratio
Slump/Spread
+
+
+
(inches + tolerance)
Air Content (% + tolerance)
%+
%+
%+
3
3
3
3
Unit Weight (lbs./ft
)
lbs./ft
lbs./ft
lbs./ft
TR3 rev. 02/19/15
TR-3
PAGE 2
4 Concrete Testing Lab Director’s Statement and Signature
Required for all applications.
Name (please print)
I hereby state that the above information is correct and complete to the best of my knowledge
and that the above tests were performed in accordance with all Administrative Code Provisions
and Departmental Rules, Regulations and Directives.
Signature
Date
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.
P.E. / R.A. Seal (apply seal, then sign and date over seal)
5 Concrete Producer’s Statement and Signature
Required for all applications. Must be filled out by Owner of Production Facility.
I certify that the material type and source in section 3 above are available at my facility and that I will use such materials to produce the concrete mix(es) specified in
section 3. I further certify that I will produce and deliver such mix(es) to the project site in accordance with the applicable code provisions of the NYC construction
codes and that such mix(es) are appropriate for the placement conditions for the project identified in section 1 above (BC 1905.8.2).
Name (print)
Title
Signature
Date
NRMCA Certification Expiration Date (BC 1095.8.2)
Business Name
Business Telephone
Business Address
Business Fax:
City
State
Zip
6 Design Applicant’s Statement and Signature
Required for all applications. Must be filled out by P.E./R.A. responsible for plans.
I certify I have reviewed the concrete design mix(es) reported by the licensed testing lab and found them to be in compliance with the approved construction
documents (BC 1905.6).
Name (please print)
Signature
Date
P.E. / R.A. Seal (apply seal, then sign and date over seal)
7 Building Owner’s Statement and Signature
Required for all applications.
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 a fine
or imprisonment, or both. I understand that I fI am found after hearing to have knowingly or negligently falsified or allowed to be falsified any certificate, form, signed
statement, application, report or certification of the correction of 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.
Name (print)
Title
Signature
Date
TR3 rev. 02/19/15
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