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Bureau of Electricity Fire Prevention and Education
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So that we can process the application in a timely manner, please fill out the form completely and accurately. If you need any assistance in filling out this application, please feel free to call: (800) 287-5161 or Fax: (866) 454-7621

PLEASE NOTE:
NON ACCOUNT HOLDERS SUBMIT PHONE/ADDRESS.

*REQUIRED FIELDS
IMPORTANT NOTICE
Dear applicant, so that an accurate and timely notification can be made to the authority having jurisdiction, please provide the Municipality of which taxes and or permit fees are paid regarding the premises to be inspected. This information is to be placed in the ‘Additional Information’ section of the application.
 

OCC LAST NAME*
OCC FIRST NAME*

STREET 1*

STREET 2

CITY*

COUNTY*

STATE*

ZIP CODE*

HOME PHONE*

WORK PHONE

POLE NO./UNIT

SECTION

BLOCK

LOT

BUILDING DEPARTMENT NAME*

OWNER LAST NAME*

OWNER FIRST NAME

STREET 1

STREET 2
CITY

COUNTY

STATE

ZIP CODE

CONTACT PHONE*

ESO/JOB NUMBER

BUILDING
PERMIT
NUMBER

THIS SECTION MUST BE COMPLETED OR APPLICATION MAY BE RETURNED.
PLEASE IDENTIFY BELOW ALL PERTINENT INFORMATION REGARDING YOUR INSPECTION APPLICATION:
RESIDENTIAL NEW CONSTRUCTION RENOVATION/ADDITIONAL
1st FL. 2nd FL. 3rd FL. OTHER
KITCHEN BATH BASEMENT GARAGE
SQUARE FOOTAGE
COMMERCIAL DEFECTS DETECTED
ELECTRICAL SERVICE AMPS SINGLE PHASE THREE PHASE
OVERHEAD UNDERGROUND POOL/SPA ALARM SYSTEM
COMMUNICATION/LOW VOLTAGE CATV/TRAFFIC LIGHT ONLY
ADDITIONAL INFORMATION


DATE ROUGH INSPECTION REQUESTED
DATE FINAL INSPECTION REQESTED

THIS APPLICATION ENCOMPASSES THE ENTIRE, 'OR' A PORTION OF THE PREMISES ELECTRICAL SYSTEM.

OPEN WALL / TRENCH INSPECTIONS, ARE MANDATORY PRIOR TO FINISH SURFACES OR
FINAL GRADE BEING INSTALLED OR ESTABLISHED.

THE APPLICATION IS INTENDED TO COVER THE ABOVE-LISTED EQUIPMENT TO BE INSPECTED, BUT IF AT TIME OF INSPECTION, THERE IS FOUND ADDITIONAL EQUIPMENT NOT ABOVE LISTED, YOU ARE AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE TO COVER THE ADDITIONAL EQUIPMENT, AS PROVIDED BY THE APPLICANT.
Applicant affirms that there is not an application for electrical inspection pending with a qualified electrical inspection authority, for the installation listed herein.
This Application is valid for a period not exceeding one year from the date received by the Board.

CUSTOMER ACCOUNT NUMBER

CUSTOMER BUSINESS TELEPHONE NUMBER*

AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION. ALL SPACES MUST BE FILLED IN OR APPLICATION MAY BE RETURNED.

NAME OF APPLICANT*

STREET ADDRESS*
CITY OR POST OFFICE*

ZIP CODE*

DATE OF APPLICATION

TELEPHONE NO.*

LICENSE NO. WHEN APPLICABLE

YOUR FULL E-MAIL ADDRESS
Please click 'SUBMIT' button once only!
NEW YORK BOARD OF FIRE UNDERWRITERS

Open Wall / Trench inspections, are mandatory prior to finish surface, or final grade being installed or established.

If you do not have an account with us, please call the toll free number to arrange a method of payment so that we may honor your request. (800) 287-5161

 
©2007 New York Board of Fire Underwriters.