In the bustling metropolis of New York City, the process of performing electrical work, whether it involves a new project, a rehabilitation effort, or minor repairs, necessitates adherence to certain legal and procedural standards. Among the crucial steps for licensed electricians and electrical contractors is the completion and submission of the Electrical Permit Application, officially known as form ED-16A. This form serves as a gateway to obtaining the necessary permit from the NYC Department of Buildings, Electrical Division, ensuring that all electrical work complies with the city's stringent safety regulations and building codes. The detailed instructions on the form underscore the importance of full compliance, from providing licensee information to the specific category of work, alongside a concise section on certification of owner authorization for the electrical work to be performed. Moreover, the application highlights the necessity of submitting it either through mail or in person, at their office located on Broadway, alongside the option of eFiling for a more expedited process. This form not only emphasizes the legal requirement of obtaining a permit before commencing any electrical work but also aligns with the broader goal of upholding safety and regulatory standards within the city's ever-evolving architectural landscape.
| Question | Answer |
|---|---|
| Form Name | Form Ed 16A |
| Form Length | 4 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min |
| Other names | ed16a_new 301 497 7000 form |
NYC
ELECTRICAL DIVISION
ELECTRICAL PERMIT APPLICATION |
PAGE 1 |
Obey The
Section
INSTRUCTIONS:
1.This form must be completed fully, clearly printed in ink or typewritten.
2.Licensed Electrician must sign and seal the application.
3.Mail the application or deliver it in person to NYC Department of Buildings. Electrical Division, 280 Broadway 4th Floor, New York, NY 10007.
4.For Service/Meter work or a new or amended Certificate of Occupancy certify that you have written Owner’s Authorization. See page 4 Part E
5.All incomplete applications will be returned to the applicant. Only authorized versions of this application will be accepted.
SAVE TIME |
CHECK ONE BOX ONLY |
The fastest & easiest way to submit applications is to eFile
Go to www.nyc.gov/buildings
2002 NEC CODE & 2004 NYC Amendments (For use until June 30, 2007)
2005 NEC CODE & 2007 NYC Amendments
PART A |
|
LICENSEE INFORMATION |
|
||
|
|
||||
ELECTRICAL CONTRACTOR (FIRM NAME) |
|
|
|
LICENSE # |
FIRM # |
|
|
|
|
|
|
ADDRESS |
|
|
|
|
|
|
|
|
|
|
|
TELEPHONE # |
FAX # |
|
EMAIL ADDRESS |
|
|
|
|
|
|
|
|
CATEGORY OF WORK CHECK ONLY ONE BOX
N NEW BUILDING |
M MINOR WORK |
R REHABILITATION, |
Sign Shop Inspection |
(no inspection) |
|
||
EXTENSIONS, NEW CIRCUITRY |
|
||
|
Field Sign Inspection (see page 2 Part B Section 6C) |
||
|
$15 Filing Fee |
||
|
|
||
|
|
|
|
|
|
|
|
|
|
|
|
CONSTRUCTION PERMIT INFORMATION
Is this job C of O (Certificate of Occupancy) related? |
Yes No |
If work is C of O related or New Building please provide DOB Construction/ |
||||||||||||
|
|
|
|
|
BIS Job Permit # |
|
|
|
||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
OWNER/OCCUPANT VIOLATION REMOVAL |
|
|
|
|||||||||
X REMOVAL OF VIOLATION |
VIOLATION # (one per application) |
|
|
|
|
|
|
|
|
|||||
|
|
|
|
|
|
|
|
|
|
|
||||
JOB LOCATION |
BOROUGH |
|
HOUSE NO./STREET NAME |
|
|
|
|
|
ZIP CODE |
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
SPECIAL PLACE NAME |
CROSS STREET |
|
|
|
FLOOR |
ROOM |
APT. NO. |
|
|
|
||||
|
|
|
|
|
|
|
|
|
|
|
|
|
||
CONTRACTOR’S COMMENTS (PRINTED ON WORK PERMIT) |
|
|
|
|
WORK STARTED OR FILED BY OTHERS |
YES |
NO |
|||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
WORK TO BE PERFORMED BY LICENSED FIRMS AS A JOINT VENTURE AS PER |
JOB START DATE |
|
COMPLETION DATE |
|
|||||||
PRINT FIRM AND LICENSE NO. OF ADDITIONAL FIRMS. |
MM |
DD |
YEAR |
MM |
DD |
YEAR |
|||||
|
|
|
|
|
|
||||||
LIC.# |
|
FIRM # |
|
|
|
|
|
|
|
|
|
(2) |
|
(2) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||
|
|
|
|
|
|
|
|
|
|
|
|
WORK TO BE DONE CHECK ALL BOXES THAT APPLY
1 SERVICE WORK/NOTIFY UTILITY (COMPLETE PART B #8) |
|
3 ELEVATOR/ESCALATOR |
|
5 FIRE DAMAGE |
|
7 HVAC WIRING |
||||||||||
|
|
|
|
|
||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2 TEMPORARY CONSTRUCTION SERVICE |
|
4 AMUSEMENT RIDES |
|
6 GENERAL WIRING |
|
8 BOILER/BURNER |
||||||||||
TEMPORARY LIGHT & POWER |
|
|
|
|
|
|
|
|
|
|
|
|
|
WIRING |
||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||
9 OTHER: (PRINT SPECIAL TYPE OF WORK IN THIS AREA.) |
|
|
REMOVING VIOLATION(S) ISSUED TO ANOTHER LICENSED FIRM |
|||||||||||||
|
|
|
|
PROVIDE APPLICATION(S) # (s) (Max. 3) |
|
|
|
|||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
SPECIAL CERTIFICATION/APPROVAL REQUIRED |
CHECK ALL BOXES THAT APPLY |
|||||||||||||||
A ADEQUATE WIRING PROGRAM |
E EMERGENCY LIGHTING |
|
B BOILER CONTROLS |
|
|
|
|
|||||||||
LOCAL LAW 16/84 |
|
|
|
|
|
L LOCAL LAW #5 |
||||||||||
|
|
|
|
|
|
|||||||||||
|
REQUIRES COMPLIANCE LETTER |
|
|
|
|
|
|
|||||||||
|
|
|
|
|
|
|
|
|
|
|
||||||
ADVISORY BOARD APPROVAL REQUIRED |
|
YES |
|
NO IF YES, CHECK BOXES |
||||||||||||
|
|
|
|
|
|
|
|
CALENDAR NO. |
|
SUBMITTAL NO. |
||||||
K 1000 KVA SERVICE |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
S Special Permission |
|
|
|
|
|
|
|
|
|
|
|
|
|
N/A |
||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
M Elec. Nonmetallic Tubing (article # 362.30) |
|
|
|
|
|
|
|
|
|
|
|
N/A |
||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
N Manuf. Wiring System (article # 604. and #605.) |
|
|
|
|
|
|
|
|
|
|
|
N/A |
||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Z OTHER |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
APPLICATION#
PAGE 2
|
|
|
|
|
|
RESIDENTIAL OR COMMERCIAL USE |
CHECK ONLY ONE BOX |
|
|
|
|
|
|
||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||||||||
|
|
A ONE FAMILY |
|
C THREE FAMILY |
|
F FACTORY |
|
O OFFICE BLDG |
|
L |
FIVE OR |
|
J THEATRE |
||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
MORE FAMILY |
|
|
|
|
|
|
||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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 |
|||||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|||||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
PART B |
|
|
|
|
|
|
|
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 10 UP TO |
|
|
|
@15.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
|
B 10 OVER |
|
|
|
@37.50 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
C 30 UP TO 225 AMPS |
|
|
|
|
|
|
|
@50.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
D 30 OVER 225 AMPS |
|
|
|
|
|
|
|
@75.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
4. ELEVATORS & ESCALATORS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||
|
|
A TOTAL NO. OF ELEVATORS |
|
|
|
@125.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||
|
|
B EACH ADDITIONAL 10 FL OR LESS |
|
|
|
@83.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||
|
5. BOILER |
|
|
|
|
|
|
|
@12.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
ADDITIONAL TAG NUMBERS |
||||||||
|
6. SIGNS |
|
|
|
|
|
|
PRINT ADDITIONAL TAG#’S WHERE INDICATED |
|
|
|
||||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
1 |
|
|
|
|
6 |
|
|
|
||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||
|
|
A FIELD CONNECTION (TAGGED ONLY) |
|
FILING FEE ONLY |
|
|
|
|
|
|
|
|
|
|
|||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
7 |
|
|
|
||||||||
|
|
B SHOP INSPECTION (COMPLETE PAGE 3) |
|
|
|
|
$15.00 |
|
|
|
|
|
2 |
|
|
|
|
|
|
||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
|
|
|
|
|
|
|
|
|
|
|
3 |
|
|
|
|
|
|
|
||||||||||
|
|
C FIELD INSPECTION (TAG REQUIRED) (Complete page 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 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
5 |
|
|
|
10 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
SUB TOTAL |
$ |
|
|
|
|
|
|
|
|
|
|
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
7.FLOOR DESCRIPTIONS CHECK IF ADDITIONAL FLOOR DESCRIPTIONS ARE ATTACHED Each outlet, fixture, HP or fraction thereof of a motor, each KW or fraction thereof of a heater, each HP or fraction thereof of an air condition installed, altered or repaired shall be assigned the value of ONE UNIT.
FLOOR OR |
|
NUMBER OF OUTLETS |
NO. OF |
MOTORS/GENERATIONS |
|
HEATERS |
|
|
TRANSFORMERS |
||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|||
APT. NO. |
FIXT |
RECEPTACLES |
SWITCH |
FIXTURES |
NO. |
HP KW |
TOTAL HP KW |
NO. |
KW |
TOTAL KW |
NO. |
KVA |
TOTAL KVA |
||
ATT |
A/C |
||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|||
BUILDING |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTALS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
ELECTRIC USE |
(A) |
(B) |
(C) |
(D) |
(E) |
|
|
(F) |
|
|
(G) |
|
|
(H) |
|
|
TOTAL UNITS |
NO. of units in |
|
x 25¢ |
UNITS FEE TOTAL |
|
|
|
|||||||||
|
|
|
excess of 10 |
|
FILING FEE |
|
|
||||||||||
|
|
|
|
|
|
|
|
|
|
|
STANDARD |
$40 |
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
CHOOSE |
||
|
Please bring the floor details of this job to the site when the electrical inspection is being performed. |
|
|
||||||||||||||
|
ONE |
MINOR WORK ONLY $15 |
|||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||
|
8. SERVICE/METER EQUIPMENT |
|
|
|
|
|
|
|
|
|
|
|
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
MUST BE COMPLETED FOR SERVICE METER WORK |
|
|||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
NO. OF 3 WIRE |
|
|
NO. OF 4 WIRE |
|
|
NO. OF 10 PT |
|
|
|
|||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
UNITS FEE TOTAL |
|
|
|
|
|
|
|
|
NUMBER OF METERS |
|
|
|
|
|
|
|
|||
|
|
|
|
|
|
|
|
|
|
|
|
TOTAL ALL FEES |
|
||||
|
Existing Meters |
|
|
(+) |
New Meters |
|
|
|
|
(=) Total |
|
|
|
|
|||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Service Reconnect |
YES |
NO |
|
|
|
|
|
|
|
|
|
|
|
|||
APPLICATION #
|
|
|
|
|
|
|
|
|
|
|
|
|
|
PAGE 3 |
|
ELECTRIC SIGN INSPECTION INFORMATION |
(MUST BE COMPLETED IF PAGE 2 |
||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
SECTION 6 B&C APPLIES) |
||
|
DOB/BIS# |
|
|
|
|
|
Required for each sign mounted outdoors before sign is inspected at shop or field. |
|||||||
|
|
|
|
|
|
|
|
|
|
|||||
|
PART C |
|
|
|
|
SIGN DESCRIPTION |
|
|
|
|||||
|
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 AMPRE) |
|
(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#
PAGE 4
|
PART D |
|
OWNER’S INFORMATION |
|
|
|
|
|
TYPE OF OWNERSHIP |
INDIVIDUAL |
CORPORATION |
PARTNERSHIP |
GOVERNMENT |
||
|
|
|
|
|
|
|
|
|
LAST NAME |
|
FIRST NAME |
|
M.I. |
TITLE |
|
|
|
|
|
|
|
|
|
|
BUSINESS NAME/AGENCY |
|
|
|
|
PHONE |
|
|
|
|
|
|
|
|
|
|
ADDRESS |
|
CITY |
|
STATE |
ZIP |
|
|
|
|
|
|
|||
|
AUTHORIZED REPRESENTATIVE (PRINT) LAST NAME |
(PRINT) FIRST NAME |
|
||||
|
|
|
|
|
|||
|
AUTHORIZED REPRESENTATIVE, STATE RELATIONSHIP TO BUILDING OWNER |
|
|
|
|||
|
|
|
|
||||
|
PART E |
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
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
|
Licensee Signature |
|
Date |
|
|
|
|
|
|
|
|
|
PART F |
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 NYS Energy Conservation Construction Code.
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.
Signature of Authorized Licensed Representative |
Date |
LICENSEE
SEAL
PENALTY FOR FALSIFICATION: Falsification on any statement made herein with intent to defraud or deceive is a misdemeanor (Sec.
ELECTRICAL DIVISION USE ONLY
|
|
|
|
|
|
|
Approved |
Reviewer’s Initials: |
|
Date: |
|||
|
|
|
||||
Denied |
|
|
|
|
|
|
|
|
|
|
|
|
|
APPLICATION#