Electrical Permit Application

Date: Fee: $75.00 Residential: $150.00 Commercial:

Owner Name: Phone #: Email:

Address of Project:

1. Scope of Work
   
2. Area of Work
   
3. This application is to be accompanied by a completed application to an East Rockaway approved Inspection Agency.

It is to be understood that all work to be inspected and certified by an East Rockaway Inspection Agency before being concealed. Fees for such inspections are not covered by the Village Electric Permit.

Electrical Contractor Company Name:
Address:
Phone: Email:
Master Electrician Name: East Rockaway Registration #:
Town of Hempstead Competency #: Town of Hempstead License #:
Electrical Inspection Agency Preforming Inspection:
Electrical Inspection Agency Filing Receipt Attached:

Electrician Signature:

Sworn to before me this day of

NOTARY SIGNATURE: NOTARY SEAL:

Applicant certifies that all information given is correct and that all work shall conform to the 2017 National Electrical Code, New York State Building and Fire Codes, Nassau Country Fire Marshal's Fire Prevention ordinance and the Code and Ordinances of the Village of East Rockaway. No work is to be performed until a permit has been issued by the Village of East Rockaway Building Department and DISPLAYED on the premises. In the event of an emergency project, contact the Building Department at 516-887-6310 and leave a message of the nature of the emergency work being performed.