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Revised 06/2020 Elevator Inspection Certification Form This form must be filled out by a licensed inspection company only when the Elevator is in full compliance and returned to the Department of Buildings & Regulatory Compliance before a Certificate of Operation will be issued. A separate form must be submitted for each Elevator. Address: Owner’s Name: Contact Person: Contact Phone: City Elevator No: Initial Inspection Date: Inspector: This is to certify that the above referenced elevator located at the above referenced address in the City of Albany, NY, has been inspected and found to be in compliance with NYS Fire Prevention and Building Code and the appropriate American Society of Mechanical Engineers Standard A17.1 or A18.1. Operation of this elevator without a valid Certificate of Operation is a violation. I hereby certify that I have read the instructions and examined this form and know the same to be true and correct. Signature of Inspector Date Company License Number