Form Ed 16A PDF Details

Form Ed 16A is now available on the Ministry of Education website. This form must be completed by all parents/guardians of students in grades 7-12, to provide information about their child's education program and intended future education and training opportunities. The deadline for submitting this form is June 30th. Please submit your Form Ed 16A as soon as possible. Thank you!

QuestionAnswer
Form NameForm Ed 16A
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesed16a_new 301 497 7000 form

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NYC

ELECTRICAL DIVISION

ELECTRICAL PERMIT APPLICATION

PAGE 1

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.

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 #27-3013.

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

 

 

 

 

 

J-51

 

 

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#

ED-16A (REV 3/07)

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 20-1 OR 10-2 POLE BRKRS

 

 

 

@15.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B 10 OVER 20-1 OR 10-2 POLE BRKRS

 

 

 

@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 CONTROLS/J-51

 

 

 

 

 

 

 

@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

 

1-6 FEE TOTAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

(-) Removed Meters

 

 

 

(=) Total

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Service Reconnect

YES

NO

 

 

 

 

 

 

 

 

 

 

 

APPLICATION #

ED-16A (REV 3/07)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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#

ED-16A (REV 3/07)

PAGE 4

 

PART D

 

OWNER’S INFORMATION

 

 

 

 

TYPE OF OWNERSHIP

NON-PROFIT

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 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

 

 

 

 

 

 

 

 

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. 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.

ELECTRICAL DIVISION USE ONLY

 

 

 

 

 

 

 

Approved

Reviewer’s Initials:

 

Date:

 

 

 

Denied

 

 

 

 

 

 

 

 

 

 

 

 

APPLICATION#

ED-16A (REV 3/07)