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Get NYC Buildings LIC38 2014

LIC38 ELECTRICAL LICENSE APPLICATION Application must be typewritten. 1 Application Type Original 2 License Type Renewal Reissue Change 3 License Number Master Special 4 Applicant Information Required for all applications. Indicates optional* First Name Middle Initial Last Name Home Address Home Telephone City State Date of Birth m/d/y Zip Mobile Telephone Social Security No* E-Mail 5 Responsible Representative Note There can be ONLY ONE Responsible Representative Are you the Responsible Representative for the business YES NO If so please print their names for additional space attach a second sheet Do you authorize this person s to file electrical applications under the business name Initial here 6 Business Information Business Name Firm No* Office Address Office Telephone Office Fax 7 License Use Choose One MASTER Individual/Sole-Proprietor On Behalf of a Corporation On Behalf of a Partnership On Behalf of a Trade 8 Partner or Officer Information Name Address Title s 9 Convictions and Fines If you answer Yes to either of these questions you must complete and attach form LIC34. Yes No Have you ever been convicted of a crime for renewals convicted since your last renewal No Do you as licensee or the master electrician business have outstanding notices of violation owed to the Department No Does any company associated with your Department-issued Electrician s license currently have any unpaid firm account permit and/ or application fees 10 Applicant Statements and Signatures As a condition of being granted a license from the Department of Buildings I hereby agree to comply with all Administrative Code Provisions and Department Rules Regulations and Directives regarding how licensees conduct their specific trades. I affirm compliance with Section 27-3013 a and the definition of responsible representative found in Section 27-3004 when the designated responsible representative of the business is submitting this renewal application* Falsification of any statement is a misdemeanor under section 28-211. 1 28-201. 2. 1. 2 and 28-203. 1. 1 of the Administrative Code and is punishable by a fine or imprisonment or both. Bribery is a crime A person who gives or offers a bribe to any employee of the City of New York or an employee who takes or solicits a bride is guilty of a felony punishable by imprisonment a fine or both. Name print Signature Date Electrician s Seal Notarization State of New York County of Notary Seal Sworn to or affirmed under penalty of perjury Day of Internal Use Only Clerk s Signature Notary Signature Fee Paid Year 08/14. Indicates optional* First Name Middle Initial Last Name Home Address Home Telephone City State Date of Birth m/d/y Zip Mobile Telephone Social Security No* E-Mail 5 Responsible Representative Note There can be ONLY ONE Responsible Representative Are you the Responsible Representative for the business YES NO If so please print their names for additional space attach a second sheet Do you authorize this person s to file electrical applications under the business name Initial here 6 Business Information Business Name Firm No* Office Address Office Telephone Office Fax 7 License Use Choose One MASTER Individual/Sole-Proprietor On Behalf of a Corporation On Behalf of a Partnership On Behalf of a Trade 8 Partner or Officer Information Name Address Title s 9 Convictions and Fines If you answer Yes to either of these questions you must complete and attach form LIC34. Yes No Have you ever been convicted of a crime for renewals convicted since your last renewal No Do you as licensee or the master electrician business have outstanding notices of violation owed to the Department No Does any company associated with your Department-issued Electrician s license currently have any unpaid firm account permit and/ or application fees 10 Applicant Statements and Signatures As a condition of being granted a license from the Department of Buildings I hereby agree to comply with all Administrative Code Provisions and Department Rules Regulations and Directives regarding how licensees conduct their specific trades. .

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