70 Church Street, White Plains, New York 10601
Phone: (914) 422 - 1269 * Fax: (914) 422 - 1471
DEPARTMENT OF BUILDING
CITY OF WHITE PLAINS
BuildingComplaintForm 05/14
http://www.ci.white-plains.ny.us/
Building Complaint Form: To be completed by Complaintant and forwarded (via Email or fax) to Building Department for follow up.
Unit:
Name:
Address:
Site Address:
Phone:
Comment: __________________________________________________________________________________________________
___________________________________________________________________________________________________________
WPBD RESPONSE SECTION:
Reviewed By: ________________________ CEO Name:______________________________ Date:___________________
___________________________________________________________________________________________________________
Date:
COMPLAINT SITE:
Nature of Complaint:
Violation Location: Violation Type:
ISSUE # 1:
ISSUE # 2:
Violation Location:
Violation Location:
Violation Type:
Violation Type:
ISSUE # 3:
Nature of Complaint:
Nature of Complaint:
Specific Instructions for CEO:
SAMPLE VIOLATION LOCATIONS:
Bedroom, Living room, Dining room, Attic,
Basement/Cellar, Front yard, Back yard, Side yard,
Driveway or Garage/Accessory Structure etc.
SAMPLE VIOLATION TYPES:
Work without permits, Over occupancy, Illegal
occupancy, Blocked emergency exits, Illegal storage,
No heat, No hot water, No extermination services or
Property Maintenance Issues etc.
Print Form
Reset Form
Submit by Email
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