CITY OF ALBANY
DEPARTMENT OF BUILDINGS & REGULATORY COMPLIANCE
200 Henry Johnson Boulevard
Albany, NY 12210
Phone (518) 434-5165
Fax (518) 434-6015
ELECTRIC PERMIT APPLICATION
This permit is intended for applicants planning to do electric work. Please note that electrical work is dangerous and may only be done by an electrician
licensed to work in the City of Albany. If we can assist you in completing this form, do not hesitate to ask.
GENERAL INFORMATION
JOB SITE ADDRESS: _______________________________________________________________________
TOTAL COST OF WORK (INCLUDING COST OF MATERIALS): $_____________ 1% OF TOTAL WORK COST: $___________
WHEN DO YOU NEED YOUR PERMIT? ____________ ESO ACCT. NO.: _____________________
(NOTE: WE MAY EXPEDITE AN APPLICATION IF POSSIBLE AND APPROPRIATE.)
APPLICANT: ____________________________________________________ LICENSE NO.: _____________
ADDRESS:_______________________________________________________________________________
EMAIL: __________________________________________________________ PHONE:_________________
HOW WOULD YOU LIKE TO RECEIVE YOUR PERMIT (PLEASE CHOOSE ONE): A.) PICK UP OR B.) BY MAIL
IF YOU WOULD LIKE TO RECEIVE YOUR PERMIT BY MAIL, PLEASE INCLUDE A STAMPED SELF-ADDRESSED ENVELOPE.
OWNER: ________________________________________________________________________________
ADDRESS:_______________________________________________________________________________
EMAIL: __________________________________________________________ PHONE:_________________
FEE CALCULATION
THE FEE IS DIFFERENT IF THE PROJECT IS COMMERCIAL OR RESIDENTIAL. ONLY FILL OUT THE SECTION THAT APPLIES.
COMPLETE IF THIS IS A COMMERCIAL OR RESIDENTIAL PROPERTY WITH THREE OR MORE UNITS:
TOTAL NUMBER OF FLOORS OVER 1000 SQ. FEET
$200 PER FLOOR
TOTAL NUMBER OF FLOORS UNDER 1000 SQ. FEET
$100 PER FLOOR
TO CALCULATE THE TOTAL FEE FOR COMMERCIAL WORK, ADD THE PER FLOOR
FEES ABOVE TO A 1% SURCHARGE ON THE TOTAL COST OF WORK.
TOTAL FEE (COMMERCIAL): $__________
COMPLETE IF THIS IS A RESIDENTIAL PROPERTY:
IS THIS PROJECT LIMITED TO GENERAL WIRING TO AN EXISTING BUILDING? YES NO IF YES, A $75 FEE APPLIES.
DOES THIS PROJECT INVOLVE NEW CONSTRUCTION OR A TOTAL REHAB? YES NO IF YES, A $150 FEE APPLIES.
TO CALCULATE THE TOTAL FEE FOR RESIDENTIAL WORK, APPLY EITHER
THE $75 EXISTING BUILDING OR THE $150 TOTAL REHAB/NEW
CONSTRUCTION FEE.
INSURANCE: HAVE YOU SUBMITTED PROOF OF THE NECESSARY INSURANCE TO BRC? YES NO
WORKERS COMPENSATION: HAVE YOU SUBMITTED PROOF OF WORKERS COMP COVERAGE? YES NO
STAFF USE ONLY
PERMIT NO.: ___________
APP. FEE: _____________
RECD BY: _______________
DATE RECD: ___________
DATE ISSUED: __________
ASSIGNED TO: ____________
SCANNED BY: ____________
BRC Form 003 Rev’d: 2/2016
Page 1 of 2
JOB SITE ADDRESS: __________________________________________
PROJECT DESCRIPTION (IF NEEDED, PLEASE PROVIDE A DESCRIPTION OF THE PROJECT):_________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
DETAILED PLANS OR OTHER DOCUMENTS ARE ATTACHED (REQUIRED): YES NO
Certification: I hereby certify that I have examined this application and know the information
contained therein to be correct. I understand that the granting of a permit does not grant authority to
violate or ignore any law, that this permit authorizes only the work described herein and will expire,
unless otherwise noted, in one year from the date of issuance.
Applicant:_____________________________________________ Date: ______
STAFF USE ONLY
THE FOLLOWING CONDITIONS APPLY TO THIS APPROVAL:
APPROVED BY: _____________________________________________ DATE: _________________
Electrical Permit Instructions
Stop Work Orders. Note that this permit, if authorized,
applies only to the work described herein and that a stop
work order may be issued if the work goes beyond what
was applied for.
Fee Calculation. The fee calculation depends on
whether the proposed work is for a commercial or
residential property. Commercial projects include
residential properties of three or more units.
For Commercial Properties the fee is $200 per floor
over 1000 sq. feet and $100 per floor for floors less than
$1000 sq. feet plus 1% of the total cost of work.
For Residential Properties the cost is $75 for general
wiring in an existing building and $150 for new
construction or a total rehab.
Inspections. All projects are subject to a rough and a
final inspection and no inspection may occur until all the
necessary materials have been submitted to the
department. Please request inspections at least 24 hours
in advance and no inspection request will be accepted by
voice or email.
Fire Alarms. Note that if you are installing a fire alarm,
we have a separate permit application for that. Please ask
our front desk staff for a copy.
Insurance. Either the owner of the contractor is required
to have a liability policy naming the City of Albany as
insured or co-insured covering the work described in the
permit application. This liability policy must be, at
minimum, in the following amounts:
a) $100,000.00 Personal Injury single incident
b) $300,000.00 Personal Injury cumulative
c) $50,000.00 Property Damage
Proof of Insurance. Before we may issue an electrical
permit, we must have proof of insurance. A contractor
may file an Owner’s and Contractor’s Protective Liability
Policy, naming the City of Albany as an additional insured,
for the individual job, in the required amounts; or the
contractor may file a blanket policy with the City, covering
all work to be undertaken within the period of the policy.
Worker’s Compensation. As per NY GML § 125, we
cannot issue a permit without proof of worker’s
compensation insurance. From contractors, we will need
one of the following: 1) WCB form C-105.2 or U-26.3, 2)
WCB form SI-12 or GSI -105.2, 3) WCB form CE-200,
and/or 4) WCB form DB 120.1 or 120.2.
BRC Form 003 Page 2 of 2