Ed16A Form PDF Details

The ED16A form is used to apply for a new passport. This form can be downloaded from the website of the Department of Foreign Affairs and Trade. The completed form must be submitted in person at a Passport Office. Supporting documentation, such as proof of Australian citizenship and two passport photographs, must also be provided. The application fee must be paid in full when the form is submitted. Processing times for a new passport vary, but typically take around three weeks.

QuestionAnswer
Form NameEd16A Form
Form Length5 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 15 sec
Other nameswork electrical yes sample, s electrical permit get, work application electrical form, s electrical permit

Form Preview Example

ED16A: Electrical Permit Application

Obey the Law-Obtain Permit before starting work

Section 27-3018(b)

INSTRUCTIONS:

 

1.

This form must be completed fully, clearly printed in ink or typewritten.

4.

2.

Licensed Electrician must sign and seal the application.

 

3.

Mail the application or deliver it in person to NYC Department of Buildings, Electrical

5.

 

Division, 280 Broadway 4th Floor, New York, NY 10007.

 

For Service/Meter work or a new or amended Certificate of Occupancy, certify that you have written Owner’s Authorization. See section 13 All incomplete applications will be returned to the applicant. Only authorized versions of this application will be accepted.

1 Licensee Information

Electrical Firm Name

License #

Firm #

 

 

 

Address

 

 

 

 

 

Email Address

Telephone #

Fax #

 

 

 

2Category of Work Check only one box

 

N New Building

 

R Rehabilitation, Extensions, New Circuitry

 

Sign Shop Inspection

 

 

 

 

 

 

 

 

 

 

M Minor Work (see instructions) $15 Filing Fee

 

 

Field Sign Inspection (see page 2 Section 10 #6C)

 

 

 

 

 

 

 

3

 

Construction Permit Information

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is this Job C of O (Certification of Occupancy) related?

 

Yes

 

 

No

 

If work is C of O related or New Building please provide DOB

 

 

 

 

 

 

 

 

 

 

 

 

 

Construction/ BIS Job Number ____________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

Is this job regulated by the NYC Energy Conservation Code?

 

 

Yes

 

No

Please provide DOB Construction/ BIS Job Number ___________

 

 

If yes, check Lighting Work in section 6 – Work to be Done

 

 

 

 

 

 

 

4

 

Owner/Occupant ECB Violation or Owner/Occupant Objection Removal

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Removal of Violation or Owner/

List Violation or Objection #s

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Occupant Objection

 

 

 

 

 

 

 

 

 

 

 

 

5

 

Job Location

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Borough

House No./ Street Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Floor/Room/Apt. No.

 

 

 

 

 

 

 

 

 

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Special Place Name

 

 

 

 

 

 

 

 

 

Work started or filed by others?

Yes

No

Contractor’s Comments (printed on work permit)*

Work to be performed by licensed firms as a joint venture as per

Lic.# _________________________

Firm # ________________________

#27-3013.13. Provide firm and license no. of additional firms.

 

 

 

Lic.# _________________________

Firm # ________________________

Job Start Date (MM/DD/YYYY) _________________________

Completion Date (MM/DD/YYYY) __________________________________

6Work to be Done Check all boxes that apply

 

1. Service Work /Notify Utility

 

3.

Elevator/Escalator/

 

5.

Fire Damage

7.

HVAC Wiring

 

(complete Section 10 #8)

 

 

Material Lift

 

 

 

 

 

 

 

 

2. Temporary Construction Service

4.

Amusement Rides

 

 

6.

General Wiring

8.

Boiler/ Burner Wiring

 

 

 

T. Temporary Light & Power

 

 

W. Sidewalk Shed Wiring & Lighting (If W is selected, no other selections are allowed)

 

 

 

 

 

 

 

S. Sustainable Energy Installs

 

 

 

L. Lighting Work

 

 

 

9.

Other:

 

 

 

 

 

 

 

 

Removing objection(s) issued to another licensed firm. Application(s) # (s) (Max. 3)

7 Special Certification/Approval Required Check all boxes that apply

A Adequate Wiring Program

 

E Emergency Lighting Local Law 16/84

 

B Boiler Controls J-51

 

L Fire Alarm Local

 

 

 

 

 

(Requires Compliance Letter)

 

Certification

 

Law #5

 

 

 

 

 

 

 

Application #__________________

07/12

ED16A

PAGE 2

8Advisory Board Approval Required

Is advisory board approval required? Yes No (If yes, complete the following)

Approval No.

Submittal No.

K 1000 KVA Service

S Special Permission

N Manuf. Wiring System (article # 604 and # 605)

Z Other

9 Residential or Commercial Use Check only one box

 

A One Family

 

C Three Family

 

F Factory

 

O Office Bldg

 

L Five or more Family

 

J Theater

 

B Two Family

 

E Four Family

 

 

G Garage

 

H Hotel

 

 

W School

 

I Hospital or Health facility

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

K Commercial (indicate type)

 

Z Other: ____________________

 

 

 

Commercial/Residential # of Apts______ # of Stores______

 

 

 

 

________________________________

 

 

 

 

 

 

 

 

 

 

 

10 Work Description

 

Item

Quantity

 

 

Cost

 

Fee amount

 

 

Indicate number and size

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. Service Switches

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A Up to 100 amps

 

 

@8.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B 101 to 200 amps

 

 

@30.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C 201 to 600 amps

 

 

@105.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D 601 to 1200 amps

 

 

@225.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E Over 1200 amps

 

 

@375.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. Ser. Ent. & FDR Cond. (Each Set)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A Up to #2 conductor

 

 

@15.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B Over #2 to 1/0

 

 

@30.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C Over 1/0 to 250 MCM

 

 

@45.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D Over 250 MCM

 

 

@75.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3. Panels

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A 1Ø up to 20-1 or 10-2 pole brkrs

 

 

@15.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B 1Ø over 20-1 or 10-2 pole brkrs

 

 

@37.50

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C 3Ø up to 225 amps

 

 

@50.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D 3Ø over 225 amps

 

 

@75.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. Elevators, Escalators, Material Lifts

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A Total no. of Elevators, etc

 

 

@125.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B Each additional 10 floors or less

 

 

@83.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5. Boiler Controls

 

 

@12.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6. Signs

 

Print additional tag #’s where indicated

 

Additional tag numbers

 

 

 

 

 

 

filing fee only

 

 

1 _____________

6 _____________

 

A Field Connection (tagged only)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B Shop Inspection (complete page 4)

 

 

 

 

 

 

$15.00

 

 

 

2 _____________

7 _____________

 

 

 

 

 

 

 

 

 

 

 

 

C Field Inspection (tag required) (complete page 4)

 

 

 

 

 

 

3 _____________

8 _____________

 

Up to 30 sq. ft. $65.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

31 to 60 sq. ft. $90.00

 

 

 

 

 

 

$______

 

Sign fee

4 _____________

9 _____________

 

Over 60 sq. ft. $115.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sub total

$

5 _____________

10 ____________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Application #__________________

07/12

ED16A

PAGE 3

 

 

 

10

Work Description (Continued)

 

 

 

 

 

 

7. Floor Descriptions

Each outlet, fixture, HP or fraction thereof a motor, each KW or fraction thereof a heater, each HP or fraction thereof an air

 

 

 

 

 

conditioner installed, altered or repaired shall be assigned the value of ONE UNIT

 

 

 

 

 

 

 

 

 

Each floor and apt. no. (if applicable) where the work is being performed must be provided below, along with the component detail for each floor/ apt. no.

 

 

Check if additional floor descriptions are attached (Please use form ED16As for a maximum of 100 floors)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Floor

Apt. no.

 

Number of Outlets

 

No. of

Motors/Generators

 

Heaters

Transformers

 

 

 

 

 

 

 

 

Fixtures

 

 

 

 

 

 

 

 

 

 

 

Fixtures

Receptacles

Switch

No.

Total HP KW

No.

 

Total KW

No.

Total KVA

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ATT

 

A/C

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Building Totals

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Electric use

(A)

(B)

 

(C)

(D)

(E)

 

(F)

 

 

(G)

 

(H)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total units

 

No. of

units in excess of 10

 

 

x 25¢

Units fee total

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Application #

8. Service/Meter Equipment

Must be completed for Service Meter Work

No. of 3 wire

No. of 4 wire

No. of 10 pt

 

 

 

 

Number of meters

 

Existing meters ______ (+) New meters ______ (-) Removed meters ______ (=) Total ______

Filing fee

 

Standard

$40

choose

 

 

Minor Work only $15

 

 

one

 

 

 

 

#1-6 Fee total

 

 

 

 

 

 

#7 Units fee total

 

 

 

Total all fees

__________________

07/12

ED16A

PAGE 4

DOB/BIS# ___________________________________________

Required for each sign mounted outdoors before sign is inspected at shop or field.

11Electric Sign Inspection Information Must be completed if page 2 section 10 #6 B or C applies

Shop Location

Borough

 

House No./ Street name

 

 

 

 

 

Location Comments

 

 

Shop Telephone No.

 

 

 

 

Sign Description

 

 

 

 

 

 

 

Sign Dimensions (feet)

 

Total Sq. feet of sign

Total circuits in sign

 

 

 

 

Total lamps

Watts (lamps)

 

Number of transformer(s)

 

 

 

 

V.A. of each transformer

 

 

Total watts or V.A. (Volt Ampere)

 

 

 

 

(American wire) AWG gauge of wire

 

 

No. of sockets per circuit

 

 

 

Material and gauge used in sign construction (give details)

 

 

 

 

 

 

Make of sign

 

Manufacturer of sign

 

 

 

 

 

Manufacturer address

 

 

 

 

 

 

 

Sketch of sign

(Give reading matter contained)

Application #__________________

07/12

ED16A

 

 

PAGE 5

 

 

 

 

 

 

12

 

Owner’s Information

 

 

 

 

 

 

 

 

 

 

 

Last name

First Name

M.I.

Title

 

 

 

 

 

 

 

 

Business name/ agency

 

Phone

 

 

 

 

 

 

 

 

 

Address

City

State

Zip

 

 

 

 

 

 

 

 

Authorized representative Last name

 

First name

 

Authorized representative, state relationship to building owner

13 Certification of Owner Authorization for Electrical Work

Please answer the following questions. Where the answer to the question(s) below is yes, the following certification(s) by the license shall apply.

Does the application involve authorization to power or energize a meter? Yes No

This Electrical Permit Application involves the energizing of a meter. I certify that I have obtained a signed certification from the building owner, or his or her authorized representative, affirming that the intended use or purpose of the new, additional or existing meter(s) indicated in the Service/Meter Equipment section of this application will be in compliance with Section 27-3018 of the NYC Electrical Code and acknowledging that the energizing of electrical work without a valid permit, or other required authorization set forth by Department of Buildings (“Department”) Rules, is a violation of Section 27-3020 of the NYC Electrical Code. I also certify that this signed certification is available upon request by the Department.

Licensee Signature __________________________________________________________

Date________________________________

Does the application involve a new or amended Certificate of Occupancy and/or service or meter work? Yes No

This Electrical Permit Application includes Service/Meter Work and/or work that will result in the issuance of a new or amended Certificate of Occupancy. I certify that I have obtained a signed authorization from the building owner, or his or her authorized representative, who has authorized the work to be performed as indicated herein, and has acknowledged that upon completion of such electrical work (including any minor amendment of the work indicated herein), pursuant to Section 27-3018(b) of the NYC Electrical Code, the Department of Buildings (“Department”), or its certified representative, will be allowed access to inspect such work. I also certify that this signed authorization is available upon request by the Department.

Licensee Signature __________________________________________________________

Date________________________________

14 Responsible Representative (“R.R.”) / Licensee Statement

I, the undersigned Responsible Representative (or License associated with such business acting pursuant to an accepted written delegation), or Special Electrician, submit this Electrical Permit Application to the Commissioner of the NYC Department of Buildings for issuance of a permit to perform electrical work as described herein and in so doing acknowledge that all electrical work to be performed as described under this application will be done under my supervision and in complete accordance with all applicable codes and regulations, including but not limited to, the NYC Energy Conservation Code. I further acknowledge that I have received Electrical Advisory Board approval

for all electrical work described herein where such approval is required under the Department’s

code and regulations.

 

 

This application involves a NYCHA Fee Exempt property ?

Yes

No

I also acknowledge that the information provided on this application is true to the best of my knowledge.

Name (please print)

Licensee Seal

Signature of Authorized Licensed Representative

Date

PENALTY FOR FALSIFICATION: Falsification on any statement made herein with in- tent to defraud or deceive is a misdemeanor (Sec. 27-3017 (b), (c) of NYC Adm. Code) SUBSTANTIAL REVISIONS to this application will require the filing of a new application. with the appropriate fee.

Internal Use Only

Approved

Denied

Reviewer’s Initials: _________________ Date: ________________

 

 

 

Application #__________________

07/12

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2. Just after the previous section is done, go on to enter the suitable details in all these - Work to be performed by licensed, Lic Firm, Lic Firm, Job Start Date MMDDYYYY, Completion Date MMDDYYYY, Work to be Done Check all boxes, Service Work Notify Utility, ElevatorEscalator, Fire Damage, Material Lift, Temporary Construction Service, Amusement Rides, General Wiring, HVAC Wiring, and Boiler Burner Wiring.

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