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NYS Electrical Inspections

278 Indian Head Rd
Kings Park, NY 11754
T: (631) 466-4235
F: (631) 460-9192


You may also fill out the form by hand and mail or fax it to NYS Electrical Inspections:
Download In Microsoft Word Format

Download In PDF Format

Online Electrical Inspection Form

Date:                            Contractor       Homeowner

Homeowner's Name:

Address:  Township: 

Postal Code:

Cross Street 1: 

Cross Street 2:

Homeowner's Tel: Cell:

 Email:

Store Name:  Township:

Village:

Permit #: Section #:  Block #: 

Lot #:

Contractor's Company: 

License #:

Address:  Township: 

Postal Code: 

Contractors Tel:  Email:

TYPE OF WORK PERFORMED

New Residential   New Commercial   Addition   Renovation  

Detached Garage   

Basement  First Floor  Second Floor Attic  Indoor  Outdoor  Survey

Pool  Hot Tub  Service Only  Shed/Other Structure

SERVICE

Services Only  New Installation  Service Upgrade 

Service Size: amps    Phases:

Relocate POA   Overhead   Underground  Fax Temp  

Number of Meters:

INSTALLATION

Switches  Receptacles  Light Fixtures  GFI   Smoke Detectors  

CO Detector

Dryer   Washer   Fans   Dishwasher   Range   Oven   Heaters

HEATING

Burner Type: Air   Oil   Gas

AC INSTALLATION

Condensers Disc: Amount amps

Air Handlers: Amount amps

ITEM COUNT

Switches:  Light Fixtures: Receptacles:  

GFI:

Fans:   Smokes:   Carbons:

 

In addition to our application the Town of Smithtown requires an additional permit.
Download Smithtown Permit