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BRC Form 003 Rev’d: 02/2016; 09/2023; 02/2026 Page 1 of 2 ELECTRIC PERMIT APPLICATION This permit application is intended for applicants seeking a permit 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 THE COST OF MATERIALS): $ 1% OF TOTAL COST OF WORK: COMMERCIAL PROPERTIES ONLY ESO. ACCT NO.: CITY OF ALBANY ELECTRICIAN’S APPLICANT: LICENSE NO.: ADDRESS: EMAIL: PHONE: ALL PERMITS ARE EMAILED TO THE LICENSE HOLDER. 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. TOTAL FEE (RESIDENTIAL): $ INSURANCE: HAVE YOU SUBMITTED PROOF OF THE NECESSARY INSURANCE TO BRC? YES NO WORKER’S COMPENSATION: HAVE YOU SUBMITTED PROOF OF WORKER’S COMP COVERAGE? YES NO STAFF USE ONLY PERMIT NO.: APP. FEE: REC’D BY: DATE REC’D: DATE ISSUED: ASSIGNED TO: SCANNED BY: ---PAGE BREAK--- BRC Form 003 Page 2 of 2 JOB SITE ADDRESS: PROJECT DESCRIPTION (IF NEEDED, PLEASE PROVIDE A DESCRIPTION OF THE 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. Date: AFFIDAVIT FOR CLASS A ELECTRICIANS WITH NO EMPLOYEES I HEREBY ATTEST THAT I AM MAKING THIS APPLICATION FOR PERMIT AND THAT I HAVE NO EMPLOYEES, NOR ANY PARTNERSHIP AGREEMENT WITH ANYONE. SIGNATURE OF LICENSE HOLDER DATE: Electrical Permit Instructions City of Albany Electrician’s License. Permits for electrical work will only be issued to electricians licensed to do work in the City of Albany. Electricians with licenses in municipalities who maintain reciprocity with the City of Albany may apply for a temporary Class B license using the Class B License Application form available in our office or on the City’s website. 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 without express confirmation from our inspector. Fire Alarms. 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 or the signed affidavit above. ---PAGE BREAK--- BRC Form 003 Page 2 of 2