"Roster of Amusement Devices" - New York City

Roster of Amusement Devices is a legal document that was released by the New York City Department of Consumer Affairs - a government authority operating within New York City.

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Download "Roster of Amusement Devices" - New York City

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DCA LICENSING CENTER
NYC SMALL BUSINESS
42 Broadway, Lobby
SUPPORT CENTER
New York, NY 10004
90-27 Sutphin Blvd, 4th Floor
Monday-Friday: 9:00 a.m.-5:00 p.m.
Jamaica, NY 11435
Wednesday: 8:30 a.m.-5:00 p.m.
Monday-Friday: 9:00 a.m.-5:00 p.m.
Telephone:
(212) 436-0109 or (212) 436-0280
nyc.gov/dca
ROSTER OF AMUSEMENT DEVICES
Please complete the form and list the names and applicable identification numbers for your amusement devices.
You must contact the Department of Buildings (DOB) Elevator Division at the relevant borough number below to
schedule an appointment to have your device(s) inspected.
Manhattan: (646) 831-9160
Bronx: (646) 831-5790
Brooklyn: (718) 938-0770
Queens: (718) 938-7423
Staten Island: (718) 938-7423
Ask the DOB Elevator Division representative if your device will also need an electrical inspection. If required, you must
call or email DOB to request an electrical inspection of your device(s).
OR
Call the relevant borough number at:
Email a completed ELV-32 form to
Manhattan: (212) 393-2455
query@buildings.nyc.gov
to request
o
Bronx: (718) 960-4750
an inspection.
o
Brooklyn: (718) 802-4342
o
Queens: (718) 286-7650
o
Staten Island: (718) 420-5411
o
At the time of inspections, you should have a copy of the Roster of Amusement Devices. A DOB representative may
provide you with an Amusement Device Affirmation to complete and return to DOB.
Your amusement device(s) must pass all DOB inspections before DCA can issue you a renewed license document.
 Permanent Amusement Device  Portable Amusement Device
License Category:
Legal Name of Business:
Business’s Trade or Doing-Business-
As (DBA) Name, if applicable:
Business Address:
Business Contact Name:
Telephone:
I understand that falsification of any statement made herein is an offense punishable by a fine or imprisonment or both.
_______________________________
_____________________
Signature
Date
DCA LICENSING CENTER
NYC SMALL BUSINESS
42 Broadway, Lobby
SUPPORT CENTER
New York, NY 10004
90-27 Sutphin Blvd, 4th Floor
Monday-Friday: 9:00 a.m.-5:00 p.m.
Jamaica, NY 11435
Wednesday: 8:30 a.m.-5:00 p.m.
Monday-Friday: 9:00 a.m.-5:00 p.m.
Telephone:
(212) 436-0109 or (212) 436-0280
nyc.gov/dca
ROSTER OF AMUSEMENT DEVICES
Please complete the form and list the names and applicable identification numbers for your amusement devices.
You must contact the Department of Buildings (DOB) Elevator Division at the relevant borough number below to
schedule an appointment to have your device(s) inspected.
Manhattan: (646) 831-9160
Bronx: (646) 831-5790
Brooklyn: (718) 938-0770
Queens: (718) 938-7423
Staten Island: (718) 938-7423
Ask the DOB Elevator Division representative if your device will also need an electrical inspection. If required, you must
call or email DOB to request an electrical inspection of your device(s).
OR
Call the relevant borough number at:
Email a completed ELV-32 form to
Manhattan: (212) 393-2455
query@buildings.nyc.gov
to request
o
Bronx: (718) 960-4750
an inspection.
o
Brooklyn: (718) 802-4342
o
Queens: (718) 286-7650
o
Staten Island: (718) 420-5411
o
At the time of inspections, you should have a copy of the Roster of Amusement Devices. A DOB representative may
provide you with an Amusement Device Affirmation to complete and return to DOB.
Your amusement device(s) must pass all DOB inspections before DCA can issue you a renewed license document.
 Permanent Amusement Device  Portable Amusement Device
License Category:
Legal Name of Business:
Business’s Trade or Doing-Business-
As (DBA) Name, if applicable:
Business Address:
Business Contact Name:
Telephone:
I understand that falsification of any statement made herein is an offense punishable by a fine or imprisonment or both.
_______________________________
_____________________
Signature
Date
DCA LICENSING CENTER
NYC SMALL BUSINESS
42 Broadway, Lobby
SUPPORT CENTER
New York, NY 10004
90-27 Sutphin Blvd, 4th Floor
Monday-Friday: 9:00 a.m.-5:00 p.m.
Jamaica, NY 11435
Wednesday: 8:30 a.m.-5:00 p.m.
Monday-Friday: 9:00 a.m.-5:00 p.m.
Telephone:
(212) 436-0109 or (212) 436-0280
nyc.gov/dca
Office or Inspector Use Only
ROSTER OF
AMUSEMENT
DEVICES
Page 2
Amusement Device Name
DCA License
Identification or DMV
Inspection Date
Pass/Fail
Number
Registration Number
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Additional Comments:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
____________________
____________________
____________________
Signature
Print Name
Title
____________________
____________________
Telephone Number
Badge Number (if applicable)
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