Fillable Name Business Phone Cell Phone Email (City of New York)

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Name Business Phone Cell Phone Email (City of New York)

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U.S.A. forms for City of New York

BROWSE CITY OF NEW YORK FORMS

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1
REQUESTOR (Required)
Name
Business Phone Cell Phone
Email
2
LOCATION INFORMATION (Required)
Address
Job # BIN #
Community Board # Block # LOT #
3
APPOINTMENT REQUEST (Required)
Stop Work Order Rescind
Partial or Full Stop Work Order ...................................................................................... Partial Full
Stop Work Order complaint number
Violation Number(s)
Are copies of the violation on site? .................................................................................
YES NO
Has all corrective action been taken to correct the violation(s)? ...................................
YES NO
If yes, indicate the corrective
action taken in Section 4.
ECB/DOB Violation Dismissal
Violation Number(s)
Has all corrective action been taken to correct the violation(s)? ...................................
YES NO
If yes, indicate the corrective
action taken in Section 4.
Other
4
COMMENTS
Construction Safety Enforcement Appointment Request Form Rev. 09/18
Construction Safety Enforcement
Appointment Request Form
(A SEPARATE FORM MUST BE SUBMITTED FOR EACH JOB)
Submit typewritten form to CSEappointments@buildings.nyc.gov
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Name Business Phone Cell Phone Email (City of New York)

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Completed 26 June 2021

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