Electric Wiring And Appliances Inspection Report - City Of New York Fire Department
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1
2NOTE: SYSTEMS(S) SHALL BE TESTED AND MADE FREE
OBEY THE LAW—FILE BEFORE STARTING WORK
OF ALL DEFECTS PRIOR TO REQUESTED FOR INSPECTION
FIRE DEPARTMENT CITY OF NEW YORK
BUREAU OF FIRE PREVENTION
FIRE ALARM INSPECTION UNIT (ELECTRICAL)-ROOM 3N-1
Application No. _______________________
9 METROTECH CENTER, BROOKLYN, N.Y. 11201-3857
TELEPHONE: (718) 999-2466
F.D. Folder No. _______________________
APPLICATION A-433
F.D. Plan No. _______________________
(ALL INFORMATION MUST BE TYPED)
In accordance with the Administration building Code and Fire Code of the City of New York, application is hereby made for
inspection of the electric wiring and appliances installed, altered or repaired in premises located at:
Premises
Borough of
Zip
Owner’s
Owned by
Address
Boro
Zip
Occupied by
Used as
NOTICE: 1.
All questions must be answered. Reverse side must be itemized. May modify device column if necessary.
Use a SEPARATE application for each system installed.
2.
One (1) sets of electrical floor plans with the component parts located thereon and performance specifica-
tions are required. Plans NOT REQUIRED if Fire Department approved plans are on file.
3.
Please Note: For buildings over the allotted floors, use a second A433 form.
4.
Contractor to provide required information on back of form.
Character of Work:
New
Alteration
Repair
PLEASE CHECK ALL BOXES WHICH APPLY.
Type of systems filed for:
List Other
Systems here:
Building Department Application No.
Affix Department of Buildings
Authorized Central Office Company
Location of Panels/Control Boards
Electrical Contractor Seal here
Name of Electrical Co.
Telephone No.
Address
Date of Application
Zip Code
License No.
Signature of Licensee
Date of Expiration
APPLICANT--DO NOT WRITE BELOW THIS LINE
RECOMMENDATION:
System
Installed as per Plan No.
Date
Inspector’s Signature
Print Name
INSPECTIONS
Remarks:
Recommend Dismissal
V.O. Number
Date Issued
Examiner
SG A433 7/01/11
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