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HomeMy WebLinkAboutEP17-219 �+1'I \� �. `�. �.`i �,� `i \r. �r �r ��i '�. �'� �q �� �* Sr �w •r �i ♦r�� �� �'4 {�i ��! �� � � � �� Ali ��� E! l� ��1 l! �i ������ �� �r N to a � y a • oG ` 0000c _ cn 66 C o,Ono LT- _ C11 �..� Lt o� 4 3 ; 7 a � ~ w 46 = cr; .� 0 .7 � Z F W O z , A z a ^ c 4�'lii 4to tat t. f:4 4 6 4'IA 6 Bui ING DEPARTMENT VIL E OF RYE OK U 938 KIN 'ET Rw r:B ,NY 10573 (91419 ='0668 I ,\ 939-5801 6 2017 !rity -or ELECTRICAL PERMIT APPLICATIO VIL OF RYE BROOK Westchester County aster Electricians License ING DEPARTMENT FOR OFFICE USE ONLY BP#: ` _ LP#: Approval Date: Permit Fee: S ! Approval Signature: Other: Disapproved: (fees are non-refnedatde) Application dated, i is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install an or ierdove electrical equipment, wiring, fixtures,or to perform other high or low voltage electrical work as per the detailed statement described below. The applicant & property owner, by signing this document agree that all electrical work performed will be in conformance with all applicable Federal, State,County and Local Codes, I.Address: 4:, S. r e S SBL: Zone: 2.Property Owner: 44 ' erg cart Address: f Phone#: Cell p#: --spit r 1.4 Y(3 email: lid : 3.Master Electrician , T,�"TZ�� Address: l Lic.#:6 Q_k Phone#: Cell#: �i# - . 7�'t-if email: � Bc � i• CKM Company Name: "D-Vermx �C c rCi C Address:j,0I SL>u r R f� &)lihe- {14jils 4.Proposed Electrical Work/Fbdure Count: ly-Ls-t a\ rrrk-p- -'Nvi►n—ed STATE OF �. �E ,COUNTY OF WESTCHESTER as: �C'0 being duly sworn,deposes and states that he/she is the applicant above named,and does further print name of individual signing as the applicant) state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the f.A) for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property wil I be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn to before me this day of 20 day�J��'SAT ,20 1 i` ture er Signature of Applicant f Pr erty er CADNA t otary l?u li INNE NICOLE PEGfi MARIE CEDRONE Notary Pub is - k Notary Public NO. 0t PE6292439 State of New York Cualifietl in Bronx County County of Westchester No:O t CE•6258573 My Commission Expires Nov 4 017 Commission Expires 03136.'_ . Westchester Rockland Electrical Inspection Services, Inc. P fie: 914 347-3595 DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue : 914-347-3596 Elmsford, NY 10523 PERMIT NO. TEMP DATE ll 1 CITY OR VILLA. Zip CODE TOWNSHIP' COUNTY r / STREET AND NO.OR ROAD POLE NUMBER s4 S. BETWEEN WHAT TWO GROSS STREETS ISPREMISES LOCATED? SECTION BLOCK LOT Oqr�OFANT`S NAME BUILDING OCCUPANCY OWNER'S NAME AND ADDRESS I-POMk TELEPHONE NUMBER 7-30.2 - 144 CURRENT SUPPLIED BY FROM THETA OFFICE WORK TELEPHONE NUMBER LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS NO.OF FIXTURES& MOTORS HEATERS OFFICE USE LOCATION LAMP RECEPTACLES ONLY SIDEWALL SWITCH INCADE FLUORE NO. H.P.EACH NO WATTS' OUTSIDE BASEMENT_ "- FL UG 16 2017 2 FL PIMA 3-FL. - _ ING DE ARTMENT REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: 49 Me THIS APPLICATION IS INTENDED TO COVER THE ABOVE LISTED ITEMS TO BE INSPECTED.IF AT ANY TIME Of INSPECTION ADDITIONAL ITEMS HAVE SEEN INSTALLED,YOU ARE AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE FOR THE ADDITIONAL€TEMS INSPECTED AS PROVIDED BY THE APPLICANT.THE APPLICANT DECLARES THAT THERE IS NO OPEN APPLICATIONS FOR THE ABOVE WITH ANY OTHER INSPECTION COMPANY WREIS,INC. IS NOT USTING,LABELING.UNDERWRaING OR CERTIFYING ANY EQUIPMENT, MATERIALS OR DEVICES WHICH ARE PERFORMED BY OTHER CERTIFIED TESTING AGENCIES OR INSPECTION COMPANIES.THE APPLICANT,OWNER.OR AUTHORIZED AGENT AGREES TO ALL THE ABOVE TERMS AND CONDITIONS AS SET FORTH FOR THE APPLICATION. SIZE OF SERVICE FEEDERS QYV f'i'7�( • �"�Ste" CHARACTER OF WORK N ADD1710NAPNk EXPOSEV$ CONCEALED C MUST ENTER APPLICANTS IDENTIFICATION NUMBER I 1 SERVICE ENTERS BUILDING OVERHEAbC UNDERGROUND AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. NAME OF COMPANY DATE OF APPLICATION SIGN i R OF A iC C�1�C�7e -i�—�C-r4;;-'C C x STRE.10 ADDRESS TELEPHONE NO. 1v t ':�\x- 'M \"% n C�I(? F LICENSE NO.WHEN APPLICABLE � � w LLj 0Q W w z N 0 p i r z O Z W rim w � 0 0 � Q Q , F O © a o a Z W , A 661 J ZM2 E IZ Z © CO) © z a w © � - cn a . W , o Za } ; n ' 0`0 Q o W 0 [L' W cm 0. Z m 9 o L ❑ U) LU 0 LL .. cym ° V h LLJ ce0W LLj LLa ' U W 0 W Ix g a ] W F- �, as P, � w Z cn — a u7 5 LU cm 0.0 w a i A 0.4 a � Q Z � W o �--� W m LU J w © Q 0 Z , F- CO) COWW CLMU) ? V I "� w '- LUJ I �'` i w LL z. `` W a a Cl) CL z W Cl) PLL f-- � � � ZOO o WLLJ .� Q co � � a o a z U) 0 W � w w �, � c a m �