3.2.1 Required Documentation for a Permittee Registration Application

The required documents include:

  1. Completed Permittee Registration Application. Click here for a completed Permittee Registration Application. An application can also be found in Appendix B, Forms.
  2. Copy of E.I.N. or Tax I.D. number as provided by the Internal Revenue Service (IRS).
  3. Original insurance certificates for Commercial General Liability (CGL) insurance and Worker's Compensation insurance.
  1. CGL insurance. The applicant must satisfy all of the requirements listed in section 2-02(3) of the Highway Rules. Additionally, Section 2-02(3) contains an indemnification provision to which all permittees are subject.
  2. Worker's Compensation Insurance. Each applicant must obtain and provide Worker's Compensation insurance in accordance with the laws of the State of New York from a licensed insurance company.
  1. Permit Bond. Where applicable, an applicant must submit an original Permit Bond to the Permit Office at the time of permit issuance to cover all costs and expenses that may be incurred by the city as a result of the activity for which the permit is issued or for the purpose of otherwise safeguarding the interests of the city. Permit Bonds, as described in the Highway Rules, Section 2-02(4), should cover all permitted activities. Click here to download Permit Bond templates.
  2. Copies of incorporation papers, licenses, and business certificate or filing receipt filed with the state of New York.

All addresses must be the same on all above referenced documents.

Instructions for Permittee Registration Application

The instructions below apply to corporations, partnerships, joint ventures and individuals.  Registration applications should be printed on 8 1/2"x 14" paper.  Please note all fields marked with an asterisk (*) on application must be completed.

SECTION 1A THROUGH 1D: APPLICANT INFORMATION

1A. Applicant Information (Corporation, LLC or LLP) 

  1. Permittee Legal Name*:  Enter the legal name of the corporation, limited liability corp. or limited liability partnership as registered with the NYS Department of State (NYSDOS).
  2. Tax ID Number (EIN) or Social Security Number*: Enter Tax ID as provided by Internal Revenue Service or SS number as provided by Social Security Administration.
  3. NYS Department of State I.D. Number*:  Enter your NYS Department of State ID number.  If you are unsure of the number it can be found at http://www.dos.ny.gov/corps/ .
  4. Address*:  Enter the applicant’s complete address (address number, street name, apt. /Suite.  Post Office Box is not accepted).
  5. City, State, Zip Code*:  Enter city, state and zip code.
  6. Telephone Number*:  Enter daytime telephone number.
    Fax Number:  Enter applicants fax number.
  7. 24-Hour Emergency Telephone Number*:  Enter a telephone number where applicant can be reached at all times (for emergency situations).
  8. Applicant E-Mail: Enter email for owner of company or company email address (DOT correspondence pertaining to permits will be sent to this email address).  E-mail address is required if applicant wishes to use on-line Permit Management system.
    Information contained in Items 9 through 11 is optional
  9. NYSDOS Process Name:  Enter name to which DOS will mail process if accepted on behalf of the entity.
  10. NYSDOS Process Address:  Enter address to which DOS will mail process if accepted on behalf of the entity.
  11. Assumed Name (Doing Business As):  Enter Assumed Name/Doing Business As (DBA) if applicable.

1B. APPLICANT INFORMATION (PARTNERSHIP)

  1. Permittee Legal Name*:  Enter the legal name of the partnership as filed with Clerk of County.  
  2. Tax ID Number (EIN) or Social Security Number*: Enter Tax ID as provided by Internal Revenue Service or SS number as provided by Social Security Administration.
  3. Index Number:  Enter your Index number as provided by County Clerk’s office. 
  4. Through 8.  Enter information as indicated in 1A above.

1C. APPLICANT INFORMATION (JOINT VENTURE)

  1. Permittee Legal Name*:  Enter the legal name of the joint venture as provided by the Agreement.    
  2. Tax ID Number (EIN) or Social Security Number*: Enter Tax ID as provided by Internal Revenue Service or SS number as provided by Social Security Administration.
  3. Address*:  Enter the applicant’s complete address (address number, street name, apt. /Suite. Post office Box is not accepted). 
  4. City, State and Zip Code*:  Enter city, state and zip code information
  5. Through 7.  Enter information as indicated in 1A above.

1D. APPLICANT INFORMATION (SOLE PROPRIETORSHIP)

  1. Permittee Legal Name*:  Enter the legal name of the company.    
  2. Tax ID Number (EIN) or Social Security Number*: Enter Tax ID as provided by Internal Revenue Service or SS number as provided by Social Security Administration.
  3. Address*:  Enter the applicant’s complete address (address number, street name, apt. /Suite. Post office Box is not accepted). 
  4. City, State and Zip Code*:  Enter city, state and zip code information
  5. Through 7.  Enter information as indicated in 1A above.

SECTION 2: APPLICABLE LICENSE NUMBERS*

Plumbers*:  Enter the plumber's license number and name on license (if applicable).   

Commercial Refuse Container Carting Companies*: You must enter your Business Integrity Commission (BIC) License or Registration number.

SECTION 3: CATEGORY OF WORK PERFORMED

Check all types of work that will be performed by the applicant or his/her corporation.

SECTION 4: WORK IN BOROUGH

Check each borough in which the applicant expects to work.

SECTION 5: DESIGNATED REPRESENTATIVE(S) TO ACCEPT SERVICE OF SUMMONS AT THE APPLICANT'S BUSINESS OFFICE:

Enter the names of at least two people who are authorized to accept summonses for his/her corporation and who are located at his/her business address.

SECTION 6: LEGAL ENTITY PERSONNEL: OFFICERS/ DIRECTORS/ MANAGING AGENTS/ OWNER/ PARTNERS /MEMBERS /INDIVIDUALS, ETC. (NAME AT LEAST 2)

Enter at least two names of corporate officers, director, managing agent, owners, partner, etc., with titles and telephone number.

SECTION 7: AUTHORIZED REPRESENTATIVES TO OBTAIN PERMITS

Enter all persons authorized to obtain permits for the applicant, their affiliation to the applicant and their telephone number and email address.  Include the names of any expediter. If the applicant makes any changes to these authorized representative(s), he or she must update the Permittee Registration Application.

Section 8: SIGNATURE OF LEGAL ENTITY OFFICER (THIS INDIVIDUALS NAME WILL APPEAR ON ALL DOT PERMITS)

Print his/her name and title and provide a signature.

NOTARIZE THE FORM. Form must be notarized.

Click here for a copy of the Instructions for Permittee Registration Application.