Fillable Form 1: Waste Hauler Form identify the scope (Office of Innovation and Technology)

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Form 1: Waste Hauler Form identify the scope (Office of Innovation and Technology)

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The Form 1: Waste Hauler Form identify the scope (Office of Innovation and Technology) form is 1 page long and contains:

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  • 4 check-boxes
  • 25 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Office of Innovation and Technology

BROWSE OFFICE OF INNOVATION AND TECHNOLOGY (PA) FORMS

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Job Number: (for office use only)
Use this form to report waste hauling for all projects including new construction, demolition, and addition/alteration.
Waste Hauler Form
Waste Hauler Company(ies)
Identify the company (or
companies, if more than one)
providing waste hauling services.
2
Company Name #1
Phone
Contractor Declaration & Signature
I hereby certify that the statements contained herein are true and correct to the best of my knowledge and belief. I understand that if I knowingly make any false
statements herein I am subject to such penalties as may be prescribed by law or ordinance, inclusive of the penalties contained in 18 Pa. C.S. § 4904.
Failure to properly dispose of construction, demolition, or alteration debris on a project on any size, regardless of the need for a permit, shall result in the
suspension or revocation of the Contractor License in addition to any criminal penalties that may be imposed.
Copies of all tipping receipts and evidence of proper disposal must be retained for audit upon request for three (3) years after the building permit is
finalized.
Contractor Signature: _____________________________________________________________ Date: ______ / ______ /_________
Phila. Commercial Activity License #
Email
Check the corresponding box to
identify the scope of work for this
project.
Provide the parcel address where
the waste will be hauled from.
1
Parcel Address
Project Details
Phone
Phila. Commercial Activity License #
Email
Company Name #2
Phone
Address
Phila. Commercial Activity License #
Email
Company Name #3
Choose the Scope of Work: New Construction Addition Alteration Demolition
Contractor Information
The contractor must provide their
contact information and license
number.
Phone
Email
Contractor Name Contractor License #
Contact Name
Address
3
P
_023_F
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Form 1: Waste Hauler Form identify the scope (Office of Innovation and Technology)

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Completed 27 April 2022

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