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City of Albany Department of Buildings & Regulatory Compliance 200 Henry Johnson Blvd. – Suite 1 Albany, NY 12210 Phone: (518) 434-5165 Fax: (518) 434-6015 www.albanyny.gov ELEVATOR REGISTRATION FORM This form must be filled out completely and legibly. Building Address: Owner of Record: OFFICIAL USE ONLY Owner Address: (please include zip) Date Rec’d Owner Phone: Total # Units Owner Email: Fee Amt. Encl. Agent Name: Check No. Agent Address: Reg. No. (please include zip) Approv’d By Agent Phone: Agent Email: Building Name: 1. Nature or (Primary) Use of Building: 2. Current Elevator Data: Each Elevator must be listed separately a) Unit No. b) City No. c) Use Classification d) Manufacture e) Date Installed f) Speed g) Capacity h) No. Stops i) Machine Type j) Type Operation k) Maintenance Co. Signed: Title: Name: Company: Date: Please return this form along with the registration fee to the Department of Buildings & Regulatory Compliance - Make checks payable to "City of Albany". Thank you!