Form Cd22 - Annual, Assembled And Unassembled Cranes And Derricks Inspection Request

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Cranes & Derricks Division
280 Broadway, 5th Floor
New York, NY 10007
Appointments Tel. (212) 393-2662
Fax: (347) 788-4598
Email: CandD@buildings.nyc.gov
CD22 - Annual, Assembled and Unassembled Cranes and Derricks
Inspection Request
Applicant/Owner Contact Information:
Office Contact Name: ___________________________________ Today's Date: __________________
Company Name: _____________________________________ Contact Tel. No. __________________
Job Information (crane or lift location):
Select One
Address: __________________________________________________ Borough: _________________
Company Name: ______________________________________ Contact Tel. No. _________________
On-Site Contact Information:
Contact Name: _________________________________ Contact Telephone No. _________________
Company Name: _____________________________________________________________________
Type of Inspection or Rescind of Existing Stop Word or Cease Use Order to be Performed:
Annual_____Unassembled_____Assembled_____Load Test_____ Proof Test_____Reinspection_____
Stop Work Rescind No. ___________________ Cease Use Order Rescind No. ____________________
Crane Information:
CN No.
__________________________________ CD No. ____________________________________
CN Approved: Yes ________ No ________ Load Test Protocol Approved: Yes _______ No _______
CD-7 Notification of Erection or Dismantling of Climber or Tower Crane Approved: Yes ___ No ____
Crane
Model:__________________ Tower/Boom/Jib to be inspected: ________________________
Tower: _____ Derrick: _____ Crawler: _____ Mobile: _____ Boom Truck: _____ Pile Driver: _____
All components currently on-site for inspection: Yes ____ No ____ If not explain: ______________
___________________________________________________________________________________
Date of Requested Inspection: __________________________________________________________
Notes:
1. Inspection requests shall be submitted with all required documentation and testing reports as attachments to
candd@buildings.nyc.gov. C&D will contact the On-Site Contact confirming date of the inspection.
2. All approved documents required for the inspection shall be submitted prior to the inspection. Inspections will not
be scheduled until all required documents are received.
3. If the crane, derrick or unassembled components are not ready for inspection within 30 minutes, the inspector will
continue onto the next inspection and the applicant/owner will have to contact C&D to reschedule the inspection.
CD22 (Rev. 11/15/13)

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