ED16A: Electrical Permit Application

In Licensee Information, enter the Electrical Firm Name, License # and Firm #.

Enter the Address, Email Address, Telephone # and Fax #.

In Category of Work, check only one box: R Rehabilitation, Extensions, New Circuitry; N New Building; M Minor Work (see instructions), $15 Filing Fee; Sign Shop Inspection; or Field Sign Inspection (see page 2 Section 10 #6C) (checked October 22, 2026).

In Construction Permit Information, if work is C ofO related or New Building please provide DOB Construction/ BIS Job Number, and check Yes or No for Is this Job C ofO (Certification of Occupancy) related?

Check Yes or No for Is this job regulated by the NYC Energy Conservation Code? If yes, check Lighting Work in section 6, Work to be Done, and please provide DOB Construction/ BIS Job Number.

For Removal of Violation or Owner/ Occupant Objection, list the Violation or Objection #s.

In Job Location, enter the Borough, House No./ Street Name, Floor/Room/Apt. No., Zip Code and Special Place Name, and check Yes or No for Work started or filed by others?

Enter the Contractor's Comments (printed on work permit).

Work to be performed by licensed firms as a joint venture as per #27-3013.13: provide the firm and license no. of additional firms.

Enter the Job Start Date (MM/DD/YYYY) and the Completion Date (MM/DD/YYYY).

In Work to be Done, check all boxes that apply.

The boxes are 1. Service Work /Notify Utility (complete Section 10 #8), 3. Elevator/Escalator/ Material Lift, 5. Fire Damage, 7. HVAC Wiring, 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, 9. Other and L. Lighting Work.

For Removing objection(s) issued to another licensed firm, enter the Application(s) # (s) (Max. 3).

In Special Certification/Approval Required, check all boxes that apply: A Adequate Wiring Program, E Emergency Lighting Local Law 16/84 (Requires Compliance Letter), B Boiler Controls, J-51 Certification and L Fire Alarm Local Law #5.

In Advisory Board Approval Required, check Yes or No for Is advisory board approval required? (If yes, complete the following)

Enter the Approval No. and Submittal No. for K 1000 KVA Service, S Special Permission, N Manuf. Wiring System (article # 604 and # 605) and Z Other.

In 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, Z Other or K Commercial (indicate type), and for Commercial/Residential, the # of Apts and # of Stores.

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.

Provide each floor and apt. no. (if applicable) where the work is being performed, along with the component detail for each floor/ apt. no.

For each Floor and Apt. no., enter the Number of Outlets: Fixtures, Receptacles and Switch; No. of Fixtures; Motors/Generators: No. and Total HP; Heaters: No. and Total KW; Transformers: No. and Total KVA; and ATT A/C.

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

Filing fee: choose one, Standard $40 or Minor Work only $15 (checked October 22, 2026).

Service/Meter Equipment must be completed for Service Meter Work.

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

In Owner's Information, enter the Last name, First Name, M.I. and Title.

Enter the Business name/ agency, Phone, Address, City, State and Zip.

Enter the Authorized representative Last name and First name, and state the Authorized representative's relationship to building owner.

Check Yes or No for Does the application involve authorization to power or energize a meter? Where the answer is yes, the certification by the license shall apply.

By signing you certify that you 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. You also certify that this signed certification is available upon request by the Department.

Enter the Licensee Signature and Date. Check Yes or No for Does the application involve a new or amended Certificate of Occupancy and/or service or meter work?

By signing you certify that you 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. You also certify that this signed authorization is available upon request by the Department.

Enter the Licensee Signature and Date.

The undersigned Responsible Representative (or License associated with such business acting pursuant to an accepted written delegation), or Special Electrician, acknowledges that all electrical work to be performed as described under this application will be done under the undersigned's 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.

Check Yes or No for This application involves a NYCHA Fee Exempt property?

I also acknowledge that the information provided on this application is true to the best of my knowledge. Enter the Name (please print), the Licensee Seal, and the Signature of Authorized Licensed Representative and Date.

SUBSTANTIAL REVISIONS to this application will require the filing of a new application with the appropriate fee.

Falsification on any statement made herein with intent to defraud or deceive is a misdemeanor (Sec. 27-3017 (b), (c) of NYC Adm. Code).

Mail the application or deliver it in person to NYC Department of Buildings, Electrical Division, 280 Broadway 4th Floor, New York, NY 10007.