Form TR3P "Technical Report: Concrete Design Mix - Approved Producer" - New York City

What Is Form TR3P?

This is a legal form that was released by the New York City Department of Buildings - a government authority operating within New York City. As of today, no separate filing guidelines for the form are provided by the issuing department.

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 TR3P by clicking the link below or browse more documents and templates provided by the New York City Department of Buildings.

ADVERTISEMENT
ADVERTISEMENT

Download Form TR3P "Technical Report: Concrete Design Mix - Approved Producer" - New York City

Download PDF

Fill PDF online

Rate (4.6 / 5) 46 votes
TR3P: Technical Report
Approved Producer
Concrete Design Mix
Orient and affix BIS
job number label here
Must be typewritten.
The TR3P 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 - Approved Producer
Required for all applications (QM = Producer Quality Manager).
QM Last Name
QM First Name
QM Middle Initial
Business Name
Business Telephone
Business Address
Business Fax
City
State
Zip
Mobile Telephone
E-Mail
Approved Producer's Identification Number:
3 Strength Requirements and Design
Required for all applications. Attach Trial Mixture Reports and/or Field Experience Results.
Mix #1
Mix #2
Mix #3
Trial Mix
Trial Mix
Trial Mix
Method of Determining Proportions
(Trial Mixture and/or Field Experience)
Field
Field
Field
Experience
Experience
Experience
Date Trial Mixture Performed
Specified Strength (f’
)
PSI
PSI
PSI
c
Required Strength (f’
)
PSI
PSI
PSI
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
TR3P rev. 02/19/15
TR3P: Technical Report
Approved Producer
Concrete Design Mix
Orient and affix BIS
job number label here
Must be typewritten.
The TR3P 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 - Approved Producer
Required for all applications (QM = Producer Quality Manager).
QM Last Name
QM First Name
QM Middle Initial
Business Name
Business Telephone
Business Address
Business Fax
City
State
Zip
Mobile Telephone
E-Mail
Approved Producer's Identification Number:
3 Strength Requirements and Design
Required for all applications. Attach Trial Mixture Reports and/or Field Experience Results.
Mix #1
Mix #2
Mix #3
Trial Mix
Trial Mix
Trial Mix
Method of Determining Proportions
(Trial Mixture and/or Field Experience)
Field
Field
Field
Experience
Experience
Experience
Date Trial Mixture Performed
Specified Strength (f’
)
PSI
PSI
PSI
c
Required Strength (f’
)
PSI
PSI
PSI
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
TR3P rev. 02/19/15
TR-3P
PAGE 2
4 Quality Manager’s Statement and Signature
Required for all applications.
I hereby state that the information reported in section 3 above is correct and complete and that the tests reported in section 3 above were
performed under my supervision in accordance with all applicable New York City Construction Code provisions, and Departmental rules.
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.
Name (print)
Title
Signature
Date
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 specified 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
CIB Certification Expiration Date (BC 1905.8.2)
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 Approved Concrete Producer 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 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.
Name (print)
Title
Signature
Date
INTERNAL USE ONLY
.
Examiner Name (print)
Title
Signature
Date
12/14
Page of 2