Transcription of Date NYC DOT CONTACT NUMBERS / BUSINESS …
1 Rev. 5/16/1 4 6. Employee ID#:_____ 10. Is service cut off to anyone?____ YES____ NODate:_____/_____/_____ 11. What is the Nature of the Emergency? (Describe in Detail): ____ BROOKLYN ____ QUEENSDOT OPERATORDate:Official Use Only / /On Street:Recorded#:Cross Street #1:MOSAICS#:Cross Street #2:On Street:Recorded#:Cross Street #1:MOSAICS#:Cross Street #2:On Street:Recorded#:Cross Street #1:MOSAICS#:Cross Street #2:On Street:Recorded#:Cross Street #1:MOSAICS#:Cross Street #2:Official Use OnlyOn Street:Recorded#:Cross Street #1:MOSAICS#:Cross Street #2:___ 0303 STEAM___ OTHER:_____ STATEN ISLAND___ 0301 TELECOMMUNICATIONS___ 0306 GAS PRESSURE___ 0302 WATER___ 0301 TELEPHONE___ 0304 GAS LEAK ____ MANHATTAN____ BRONX___ 0301 ELECTRICAL___ 0305 AIR PRESSURE SECTION C.
2 Location of Emergency (Check One) SECTION D: Type of Permit Requested (Check One) SECTION B: Nature of the Emergency10a. If YES, When was the service cut off?Time:_____ 8. Company Official To Certify Emergency Status:9. Tel #:( ) - 3. Address:_____ 4. Caller Name:_____5. Tel #:(_____)_____-_____7. Fax #:(_____)_____-_____ SECTION A: Applicant Information 1. Permittee ID#:_____2. Permittee Name:_____/ / BUSINESS HOURS (8:30am-3:25pm)NON - BUSINESS HOURS (3:30pm-8:25am)TEL: : : : AUTHORIZATION NUMBER FORMDateNYC DOT CONTACT NUMBERS
