Inspection Application

Electrical Underwriters of NY, LLC

50 Hy-Vue Drive

Newburgh, NY 12550

(845)569-1759

Please fill in the fields below. Fields marked with an asterisk are required for submittal. All other information is optional and will not affect the submittal of your application.

Todays Date :

City, Town or Village

*Please select the Municipality in which the inspection address is located.

Inspection Address:

County

City:

State:

Zip/Postal Code:

Owners Name:

Occupied As:

Occupant:

Phone:

Applied For

Wiring

Service

Survey

Pool

Building:

New

Old

Building Permit #:

Ready for Inspection as of:

Applicant's Information

Applicant's Name

Company Name (if Applicable):

License # if (Applicable):

Applicant's Address:

City:

State:

Zip/Postal Code:

Applicant's Phone:

Applicant's Email:

Electrician's Name:

Inspection of:

*Please describe the scope of work/what the inspector will be looking at.

Utility Information(if applicable):

Utility Company:

Central Hudson

Orange & Rockland

NYSEG

National Grid

Utility Provider Service Request#(Job#):

For Professional Use:

If you wish to enter counts, please do so in the appropriate fields below before submitting your application.

Rough outlets

Amp. Ser Cond.

AC

Dishwasher

Switches

AFCI Ckt

Pump

Dryer

Receptacles

GFCI Ckt

Smoke Det.

Amp. Recep.

GFCI Recep.

Surface Unit

Co Det.

Vent Fan

Fixtures

Range

Oven

Paddle Fan

Amp. Ser. Eqip

Water Heater

Garbage Disp.

Sewer Pump

# of Burners

Wiring & Controls for:

Motors H. P

*Please enter the motor H.P. and number of each; (for example; 2@1/8; 1@1.5; 1@30)

Electric heat:

500

750

1000

1250

1500

1700

2000

2250

2500

2750

3000

Comments/ Notes:

**Important information for new customers and homeowners: A credit card is required to secure your inspection appointment, After submitting your application, please call our office at (845)569-1759 to provide your payment information and schedule your appointment at your convenience with one of our inspectors.

Please note that while a credit/debit card is needed to hold your appointment, you can choose to pay in cash or by check at the time of inspection. Just inform us when scheduling, and your card will not be charged. We accept Visa and Mastercard only. Thank You!