Fillable One Job Electrical Permit Application (City of Newburgh)

Fill Online, Printable, Fillable, Blank One Job Electrical Permit Application (City of Newburgh) Form

Use Fill to complete blank online CITY OF NEWBURGH (NY) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

One Job Electrical Permit Application (City of Newburgh)

On average this form takes 5 minutes to complete

The One Job Electrical Permit Application (City of Newburgh) form is 2 pages long and contains:

  • 0 signatures
  • 13 check-boxes
  • 15 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Newburgh

BROWSE CITY OF NEWBURGH (NY) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
City of Newburgh
Fire Prevention Office
123 Grand St Newburgh, NY 12550
Telephone: (845)-569-7405
One Job Electrical Permit Application
I hereby apply for a one-job electrical permit to do electrical work in the City of Newburgh
at the following property:
Premises: ____________________________________ Res ____ Com ____ Ind ____
Name of Applicant:____________________________________________________________
Address: _____________________________________________________________________
Telephone Number: _____________________________
______________________________________________________________________________
I am now licensed by (municipality): ______________________________________________
as a Master Electrician, License Number __________________________________________
A certified copy of the license must be included with this application.
A fee in the form of a check in the amount of Seven Hundred Fifty Dollars ($750) made
payable to the City of Newburgh must accompany this application along with the liability
and insurance requirements as explained on the attached copy of ordinance.
Property Owner: ______________________________________________________________
Address: _____________________________________________________________________
Telephone Number: ____________________________________________________________
WORK TO BE DONE AT THIS ADDRESS: (Be specific, state the number of receptacles,
switches, fixtures, etc.)
FLOORS:_____________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
City of Newburgh
Fire Prevention Office
123 Grand St Newburgh, NY 12550
Telephone: (845)-569-7405
Approved Electrical Inspection Agencies:
___ Commonwealth Electrical Inspection Service Inc 845-541-1871
___ Electrical Underwriters of New York LLC 845-569-1759
___ Middle Department Inspection Agency 518-273-0861
___ New York Board 845-298-6792
___ New York Certified Electrical Inspectors LLC 845-294-7695
___ Northeast Electrical Inspections LLC 518-852-0826
___ NY Electrical Inspections & Consulting LLC 845-343-6934
___ Swanson Consulting Inc 845-496-4443
___ Tri-State Inspection Agency 845-986-6514
___ Z-3 Consultants Inc 845-471-9370
Please choose one of the above inspection agencies.
Date: _________________________ Signature: ________________________________
Approvale To Issue Permit: ______________________________________________________
(Fire Chief)
City of Newburgh
Fire Prevention Office
123 Grand St Newburgh, NY 12550
Telephone: (845)-569-7405
NOTICE TO ALL ONE-JOB PERMIT APPLICANTS
According to ordinance No. 2-94 of January 24, 1994, the following liability and insurance
requirements must be complied with:
“Section 155-10. Liability and Insurance Requirements
A) This chapter shall not be construed to relieve from nor lessen the responsibility of any
person owning, operating, controlling or installing any electrical wiring, devices,
appliances or equipment for loss of life or damage to person or property caused by any
defect therein, nor shall the City be deemed to have assumed any such liability by
reason of any inspection made or license issued pursuant to this chapter.
B) Any person licensed as a master electrician in the City of Newburgh and engaged in installing any
electrical wiring, devices, appliances or equipment shall keep the City of Newburgh adequately
secured against liability resulting from the bodily injury or death of any person not employed by
the licensed electrician or damage to property occurring by reason of an accident resulting from
the electrical work performed or in the process of being performed. Such security shall be in the
form of a certificate of insurance for general liability insurance. The City Manager shall be named
as a certificate holder for this policy, and the City of Newburgh shall be named as an additional
insured. The amount shall be not less than $1,000,000, $2,000,000 aggregate. Policy cancellation
shall require a minimum of 10 days' written notice of cancellation to the City Manager. Such
policy shall be written on an occurrence basis and be issued by a company licensed to do business
in New York State. Any licensed master electrician who fails to maintain a current general
liability policy shall not be eligible to apply for permits until such time that he or she once again
obtains a general liability policy as described above.”
City of Newburgh
Fire Prevention Office
123 Grand St Newburgh, NY 12550
Telephone: (845)-569-7405
CERTIFICATES OF INSURANCE FOR ELECTRICAL WORK SHOULD
CONTAIN THE FOLLOWING:
1. Must be an original form.
2. City Manager should be named as certificate holder.
3. It should state City of Newburgh is additional insured.
4. $1,000,000.00 each occurrence and 2,000,000.00 aggregate.
5. Cancellation Note – number of days should be filled in so the City is notified of any
cancellation.
6. Insurance Company – must be licensed to do business in New York.
7. Check expiration date.
Workers Compensation:
8. We will also need proof of Workers Compensation coverage and disability benefits
coverage or proof that you are not required to carry either type of insurance.
City of Newburgh Fire Department Form 101 Issued 4/30/18
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

One Job Electrical Permit Application (City of Newburgh)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 14 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document