Fillable Residential Electrical Permit Application 2020

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Residential Electrical Permit Application 2020

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U.S.A. forms for Town of Fishkill

BROWSE TOWN OF FISHKILL (NY) FORMS

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PRINT
AS PER THE
BUILDING
INSPECTOR:
ALL ITEMS REQUIRED FOR
PERMIT PROCESS
MUST
BE INCLUDED OR
APPLICATION
WILL NOT BE
ACCEPTED
(no exceptions)
ANY QUESTIONS PLEASE CALL THE
BUILDING INSPECTOR @ (845) 831-
7800 ext 3321.
TOWN
OF
FISHKILL
CODE
ENFORCEMENT
TOWN
OF
FISHKILL
OFFICE
OF
MUNICIPAL
DEVELOPMENT
807 Route
52,
Fishkill, New
Yo
rk 12524-3110
website: www.fishkill-ny.gov
(845) 831-7800 ext. 3322 Fax:(845) 83
1-3
256
ELECTRICAL
PERMIT PACKAGE
NEW
YORK
STATE
CODE
ENFO
R
CEMENT
l.
WORKERS'
COMPENSATION
and
CERTIFICATE
OF
LIABILITY
-
Proofofin
su
ra
nce must be submitted from the
contractor and/or homeown
er
at the time
of
the application.
• Contractors
MUST
submit Certificate
of
Liability naming Town
of
Fishkill
as
Certificate
Ho
lde
r.
• Contractors
MUST
submit Certificate
of
Workers Compensation (not acceptable on Accord forms) or Affidavit
in
lieu
th
ereof---CE-200---signed and stamped by Workers Compensation Board.
• Homeowners doing their own projects
MUST
fill out form
CE-200
from Workers Compensation Board.
2. If co
nt
ractor is applicant, the contractor
MUST
provide a letter from
th
e homeowner authorizing him
to
file for Building Permit.
3. All
applications
MUST
be
complete
before
review by a
Building
Inspector.
BUILDING PERMIT APPLICATION
Application/Permit #
__
TOWN OF FISHKILL, COUNTY OF DUTCHESS, NEW YORK
The undersigned hereby applies for a permit to completely perform work in accordance with the description, plans, specifications and/or
professionally prepared design standards and such conditions as may be indicated on the permit. The permit must be filled out completely and
often requires the previous approvals of other agencies which must be included with the application. All provisions of the Town of Fishkill, local
law and all other appropriate rules and regulations shall apply. The permit does not constitute authority to perform work in violation of any
federal, state or local laws.
APPLICANT:
ADDRESS: PHONE:
OWNER:
ADDRESS: PHONE:
BUILDER:
ADDRESS: PHONE:
BUILDING SITE LOCATION:
(Road: Town, County, State or Private)
TAX GRID NUMBER: #06
___ ___
PROJECT:
(Check all that apply.)
[ ] Construction of New Building [ ] Pool - Above Ground: size
[ ] Demolition [ ] Pool - In-Ground: size
[ ] Factory Manufactured Home [ ] Garage, Attached
[ ] Conversion - Change in Use/Occupancy [ ] Garage, Detached
[ ] Alteration [ ] Noncommercial Storage Building
(shed)
[ ] Addition to Existing Building [ ] Deck/Porch
[ ] Repair to Existing Structure [ ] Solid Fuel Heating Device
(woodstove, pellet stove, fireplace)
[ ] Installation/Replacement of Equipment and Systems [ ] Sign
[ ] Installation/Extension of Electrical Systems [ ] Other:
Size of Structure (dimensions): Square Footage:
Height: Number of Stories: Number of Dwelling Units:
No. of Bedrooms: No. of Bathrooms: Finished Basement?
ZONING DISTRICT: Fire District:
Proposed Setback Minimums:
Distance of structure from… Front Line: Rear Line: Left Side: Right Side:
Road Frontage (feet): Lot Area (acres):
[ ] Planning Approval - Site Plan, Special Use, etc. [ ] SAN 34 Form - Dept. of Health Approval
[ ] Town Variance (attach ZBA resolution) [ ] Manufactured Home: Stamped and Signed Plans
[ ] State Variance (attach Board of Review resolution) [ ] Trusses: Stamped and Signed Plans
[ ] Driveway Permit - Town, County, State DOT [ ] Energy Code Compliance Sheet
[ ] Water/Sewer District Approvals [ ] Electrical Inspection Agency: Application Filed
[ ] Wetland [ ] Attached Plot Plan or Survey
[ ] Flood Plain [ ] INSURANCE / WORKERS COMPENSATION
ESTIMATED COST OF PROJECT:
Zoning Dept. Use:
Bldg. Dept. Use:
[ ] FEE: Deposit: Balance: Total:
The undersigned applicant is responsible to notify the Town and hereby consents by the execution of this application to all necessary
inspections to be made by the Building and Zoning Department of the Town of Fishkill. It is the responsibility of the applicant and design
professional to contact the Building Department and supervise, certify all work changed from the original plans to be appropriately recorded and
approved. It is understood that authorization is hereby given for the Building Inspector/Zoning Administrator to enter premises for purposes of
inspection any time prior to the issuance of the Certificate of Occupancy.
All inspections are listed on Building Permit.
All applications MUST be complete before review by an Inspector.
MINIMUM 72 HOURS FOR PERMIT TO BE ISSUED
Signature (Owner, Builder, Agent) Date
WORKERS COMPENSATION AND DISABILITY INSURANCE REQUIREMENTS
TOWN OF FISHKILL, COUNTY OF DUTCHESS,
NEW
YORK
CONTRACTORS:
New York State
law
requires an
applicant
for
a
Building
Permit
to
submit
proof
of
Workers
Compensation Insurance
and
proof
of
Disability
Insurance. This
proof
must
be on the
following
forms:
For
Workers
Compensation
C-105.2
U-26.3
Sl-12
GSl-105.2
For
Disability
DB-120.1
DB-155
ONLY
THE
ABOVE FORMS ARE ACCEPTABLE. BE ADVISED THAT "ACORD" FORMS ARE
NOT ACCEPTABLE AS PROOF OF WORKERS COMPENSATION OR DISABILITY COVERAGE.
You can
get
the
proper
forms
from
your
insurance
company.
If
you
are a
business
of
one
or
two
persons,
with
no
full-time employees, you may be eligible
for
exemption from the above requirements. Please acquire
form
CE-200 from the office
of
the
Workers Compensation Board.
We
also
require
CERTIFICATE
OF
LIABILITY
Naming Town
of
Fishkill
Additionally
Insured/Certificate Holder
HOMEOWNERS:
If
you are a
homeowner
doing
your
own
project, you MUST
fill
out
the form CE-200 from the
Workers Compensation Board online. (See attached)
Instructions
for
obtaining
and
filing
a
Ce
r
tificate
of
Exe
rnption
fro1n
Workers'
Cornpensation
and
/
or
Dis
ability
and
Paid Fam
ily
Leave
Benefits
(
CE-200)
through
New
York
Bus
i
ness
Express
1.
Go to
bus
i
nessexpress
.
ny
.
gov
.
10.
An activa
ti
on ema
il
will
be
sent.
2 .
Se
lect Log-
in/Register
in the top right hand
corner
.
u
If you do n
ot
r
eceive
an email,
see
t
he
No
Email
Received
During
Account
Creation
page.
3.
If you
do
n
ot
have an NY.gov account,
go
to
step
4
to set
up
yo
ur a
cco
unt.
11
.
Open
your activation ema
il
and select
Click
H
ere
.
If you have an NY.gov l
og-
in and pass
word.
rn
Specify thr
ee
secur
ity question
s.
go
to
st
ep
16
.
12.
Sel
ec
t
Continue
.
4.
Select
Register
with
NV.gov
unde
r N
ew
Users.
13.
Create a password (must contain at least eight
5.
Sel
ec
t
Proceed
.
characters).
6 .
Ent
er
th
e foll
ow
ing
14.
Sel
ec
t
Set
Password.
First and Last Name
111
You
have successfu
ll
y activat
ed
your
NY.gov I
D.
Ema
il
15.
Select Go
to
MyNy
.
111
Confirm Em
ai
l
At the
top
of
th
e scr
ee
n select
Ser
vic
es
.
rn
Preferred Use
rn
ame (check if username is available)
a
Select Busi
ness
.
7.
Sel
ec
t
I'm
not
a
robot.
Select New York
Busin
ess
Expr
ess.
1
You may have to
co
mplete a
Cap
tcha Verification
r
Select
Login/Regi
ster
.
before
proceed
in
g.
16.
On the N
ew
Y
ork
Bu
siness Express
Hom
e Page:
8.
Select
Create
Account.
rn
Scro
ll
down
to
T
op
Requests and sel
ec
t
~,
I
f
you alre
ady
have an
NY.
gov
account. the scr
ee
n
Cert
ificate
of
Att
esta
tion
.
Q[_
wi
ll
displ
ay
your
ex
istin g ac
coun
ts. either Individual
rn
Search Ind
ex
A-Z for
CE-2
00
.
or
Business.
17
.
Sel
ec
t
How
to
Apply
:
1
Do one
of
the fo
ll
ow
ing:
Select
Apply
as a
Busi
ness.
or
If
th
e a
cco
u
nt(
s) sh
ow
n is an NY.gov Indivi
du
al
[;1
Sel
ec
t
Apply
as
a
Hom
e
own
er (applies to those
acc
ount
. sel
ec
t C
ontinu
e.
o
bt
ai
ni
ng permits to work on their residence).
If
th
e acc
ount
(s) sh
own
is an NY.gov Business
18.
account. sel
ec
t Ema
il
Me
the
Username(s).
Comp
lete a
pp
li
ca
tion
scree
n
s.
9.
Verify
th
at the acco
unt
informa
ti
on is corr
ec
t.
19.
Review
App
lication Summary.
r1
Select C
ontinu
e.
20.
Attest and submit.
You
will
rece
iv
e
an
email
when
your
application
has
been
Iss
ued/
A
pproved
.
To
view your certifi
cat
e:
Click
Access
Re
ce
nt
Activity
from
your
email,
or
Access
businessexpress
.
ny.gov
, and
th
en access
your
Dashboard
(under your L
og-
In name
on
right
).
Pri
nt
and
?19.D
the
Exe
mption
Ce
rtificate
.
Subm
it
your
CE-
200
fo
r
your
license,
permit
or
co
nt
ract to
t
he
issui
ng
A
gency
.
LIST OF ELECTRICAL INSPECTION AGENCIES
Commonwealth Electrical Inspection Service, Inc.
Local Inspector(s): Ron Henry (845) 541-1871 (voicemail 24/7)
(845)562-8429 Office and Fax
2 Mallard Drive, Newburgh, NY 12550
Z3CONSULTANTS, Inc.
PO Box 363, LaGrangeville, NY 12540
(845) 471-9370 Fax (845) 625-1479 Gary Beck, Jim Greaves
Atlantic-Inland, Inc.
997 McLean Road, Cortland, NY 13045
(845)876-8794 or (800)758-4340 William Jacox (845)876-8794
12 Ackert Hook Rd., Rhinebeck, NY 12572
Electrical Underwriters of NY, LLC
PO Box 4089, New Windsor, NY 12553
(845) 569-1759 OR (866) 475-1759 (phone hours 7AM - 8:30 AM)—(office hours 9AM-3PM)
Ernie C. Bello, Jr., John W. Taylor
Electrical Inspections by New York Board
PO Box 1558, Wappingers Falls, NY 12590
845-298-6792 Pat Decina
Middle Department Inspection Agency, Inc.
142 Troy-Schenectady Rd., Watervliet, NY 12189
(518) 273-0861 or (800) 873-6342 Fax: (518) 273-1202
David J. Williams (800) 479-4504
Tri-State Inspection Agency
PO Box 1034, Warwick, NY 10990
(845) 544-2180 Fax: (845) 544-7257 9AM to 6PM
Local Inspector(s):
Lou Ambrosia (845) 986-6514 9AM to 6PM, Vincent Ambrosio (845) 544-4481
Bob Stumbo (845) 656-9693, Nick DiFusco (914) 438-6776
New York Electrical Inspections
PO Box 384, Amenia, NY 12501
(845) 373-7308 Fax: (845) 373-7309
New York Electrical Inspection Services, Inc.
150 White Plains Road, Tarrytown, NY 10591
(914) 347-4390 Fax: (914) 347-4394
The Inspector, LLC
7063 State Route 374, Chateaugay, NY 12920-0000
(518) 481-5300
Swanson Consulting, Inc.
PO Box 1361, Northville, NY 12134 (845) 496-4443
NY Electrical Inspections & Consulting LLC
93 Beattie Avenue, Middletown, NY 10940
(845) 343-6934 Fax: (845) 343-4834
State Wide Inspection Services
21 Old Main St #203, Fishkill, NY 12524 (845) 202-7224
Frank Farina
New York Certified Electrical Inspectors LLC
203 Purgatory Road, Campbell Hall, NY 10916
Jerry Caliendo (845) 294-7695
Northeast Electrical Inspections LLC
65 Albermarie Rd
Scotia, NY 12302
(518) 852-0826 Fax: (518) 370-1927
***IMPORTANT***
All new electrical work requires inspection(s) by one of the approved electrical
Inspection agencies listed above. Connection of electrical work without proper
Inspection is a violation of the Code of the Town of Fishkill and subject to
fines.
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Residential Electrical Permit Application 2020

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Completed 12 July 2020

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