Letter of Intent/ Permit Application Instructions RED NOT ...
Letter of Intent/ Permit Application Instructions
This form consist of 3 pages, complete all 3 pages of this form to the best of your ability.
1. Fields outlined in RED are required. * If all REQUIRED fields are not filled in, application is NOT considered complete.
2. If other licenses are required for special effect (i.e. Fireguard, Armorist, etc...), please include Name, License number, and expiration date in the NOTES section on page 2 of this form.
3. Attachments (Page2): Please submit all attachments with this form (if possible). If not all attachments will be required by the date of the inspection.
4. Please note: Page 3 is available for you to list the Quantities and Description of the products being used.
5. When complete, email form back to explounit@fdny. Call (718) 999-1595, if you have any questions or concerns with this form.
Thank you,
FDNY Explosives Unit
Rev. 11/14/18
FDNY Explosives Unit Letter of Intent/ Permit Application
Attn: Chief Joseph Meyers
9 Metrotech Center RM 3N-83K Brooklyn, NY 11201
Email: Explounit@fdny. Phone: 718-999-1595
(This does not authorize effects. Wait for FDNY approval)
48 hours notice required (additional fees may apply)
Date
This is a(n):
Company Name and Address
Original
Update
Renewal
Cancellation (Will incur a fee without prior notification)
Production Title
Site Location
Billing Information (if different)
Type of inspection Pre-site/Scout Site Inspection Monthly
Contact information
Inspection Date requested
Inspection Time Requested Other
Proposed date(s) of Special Effect
Time of special effect
Other
Liability Insurance Minimum $1,000,000 required Name of Insurance Company
Policy Number
Exp. Date
PENALTY FOR FALSIFICATION OF ANY STATEMENTS MADE HEREIN IS AN OFFENSE PUNISHABLE BY REVOCATION OF PERMIT, FINE OR IMPRISONMENT AS SET FORTH IN THE ADMINISTRATIVE CODE.
Signed ___________________________________ Signature of at least one officer
Rev. 11/14/18
Signature of receipt __________________________________
1 of 3
Certificate of Fitness Holder
Attachments Copy of COF card(s) General Liability insurance Site Diagram Property owner's consent Mayor's office schedule A
Description of effect
COF Type
COF number
(Can be submitted by day of inspection) Signed and notarized release forms Flame Proofing certificates Certificate of Occupancy Certificate of Operation Call Sheet
COF Expiration Date
TPA Safety Data Sheet(s) SDS
Notes:
Rev. 11/14/18
2 of 3
List of Materials:
Quantity
Description
Quantity
Description
Quantity
Description
Quantity
Description
Quantity
Description
Quantity
Description
Quantity
Description
Quantity
Description
Quantity
Description
Quantity
Description
Rev. 11/14/18
3 of 3
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