Technical Report (TR6)
Periodic Inspection of Exterior Walls and Appurtenances
Sub-Cycle 8A – February 21, 2015 — February 21, 2017
Sub-Cycle 8B – February 21, 2016 — February 21, 2018 Place stamp here
Sub-Cycle 8C – February 21, 2017 — February 21, 2019
Must be typewritten.
For all reports, submit a digital copy of report in a DVD or CD format , a BIS Façade printout, a completed TR-6 and the Batch Intake
form (FBI1). The digital copy must be indexed with a Control Number and BIN. E.g. Control # -- BIN Control #: __________________
1 Filing Information (Indicate if combined cycles)
Initial Filing Resubmission Amended Filing Subsequent Filing
Report cycle: _______________ Report cycle: ___________ Initial filing date: _____________
Last cycle filing date: _______________ Initial unsafe filing date: ____________
2 Location Information
House No(s) Street Name Zip CB No BIN
Borough AKA Block Lot
3 Inspection Report Status Information
Current Cycle: Last Inspection Date ___________ SWARMP Recommended Date ___________ Prior Filing Cycle _________
Safe Safe with repair and maintenance program (SWARMP) Unsafe Safe SWARMP Unsafe
4 Building Characteristics
Landmark Building: Yes No Landmark District: Yes No Wall(s) Subject to Inspection
Number of stories: Exterior wall type: # Balconies: All Partial
5 Qualified Exterior Wall Inspector (QEWI) Information
Last Name First Name MI
Bus. Name Bus. Address Bus. Tel.
City State Zip Bus. Fax
NYS Lic. # P.E. R.A. Mobile Phone
E-Mail
6 Owner of Record Information (Not a Representative or Business Manager or Agent)
Last Name First Name MI
Bus. Name Bus. Address Bus. Tel.
City State Zip Bus. Fax
E-Mail Mobile Phone
7 Statements and Signatures
Owner / Owner Representative Qualified Exterior Wall Inspector (QEWI)
(A) I hereby state that I am the owner/owner’s representative of the premises referenced Name (please print)
in the attached report. Furthermore, I have received and read a copy of the attached
report and I am aware of the required repairs and/or maintenance, if any and the
recommended time frame for same. Signature Date
(B) I certify that all items noted as SWARMP conditions in the previous cycle’s report
have been corrected/repaired; or this report must be rated as Unsafe as per I hereby state that the Owner / Owner’s Representative
Administrative Code section §28-302.1, if applicable. has authorized me to submit this report. Furthermore, I
hereby state that all statements are correct and complete
to the best of my knowledge. A copy of this report has
Name _____________________________ Signature _______________________ been given to the owner.
Relationship to owner ________________ Phone _________________________ P.E. / R.A. Seal (apply NYS seal, then sign and date)
Email ______________________________________________ Date ___________
§28-211.1 False statements in certificates, forms, written statements, applications, reports or certificates of correction. It shall be unlawful for any person to make a material
false statement in any certificate, professional certification, form signed statement, application, report or certification of the correction of a violation required under the provi-
sions of this code or any rule of any agency promulgated there under that such person knew or should have known to be false.
TR6 Rev: 2/15
