HomeMy WebLinkAboutBalducci's Market Fire Inspection 2020-2023 a 6y 6}� 6} 6}� .s}� +6�
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VILLAGE OF RYE BROOK OAT 3 202t7
938 KING S'ThEET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK
(914)93!' "6616A)t(4 k)939-5801 BUILDING DEPARTMENT
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ELECTRICAL PERMIT APPLICATION
Westchester County Master Electricians License Required
FOR OFFICE USE ONLY BP#: EP#:
Approval Date: OCT 1 3 202 Permit Fee: S p7c;�1:5__
Approval Signature: Other:
Disapproved:
(fees are non-refundable)
Application dated, ![� 1 7-U is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of
a Permit to install and/or remove 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. --
1.Address: (L1 S 1• M d w 9 SBL:: �'y�.of 7" ` W Zone:
2.Property Owner: �j:" 1 �tT,( Address: z 06 91
Phone#: q 1 4- 70'-+LXi5 Cell#: email: N-T-CN Q�`�-►�►tZS ,C�,'�rr„
3.�Mastteer Electrician: r C,'V A t('Ct-/ Address:�Q ima �l� Yi eue AUP im ,K��,�
Rp' #'4-U 4( Phone# ff Cell#:9iy F-04 91-)e email: y t 4r'vvr �y
Company Name: am„r Q("AA Address: Old
4.Proposed Electrical Work/Fixture Count:
(,'�,S�`T/AT�E��OF NEW YORK,COUNTY OF WESTCHESTER ) as:
y`� 1 t t f-ca—T ,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) `N
state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the l•� C
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 will 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 57-4
of ,20 -1,0 day of C 20 2C
Signat a of roperty Owner 46 ; ign ure A ant
s r r L) �cu
Pr' N f Prope �*)"fw Print Name of Applicant
KotaN Public Not Public
y...E ri Notary
Nlew York
-� :�ti`,•�C runty�/�
llViaroh 9, 20Z-- �
3/21/19
Phone: 914-347-3595
Westchester Rockland Electrical Inspection Services, Inc. z�
DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue Fax: 914-347-3596
Elmsford, NY 10523 BUILDING PERMIT NO.
TEMP N DATE
C/ �0-19�
CITY CVLLAGE ZIP CODE TOWNSHIP COUNTY
C J .
STIR •OR '- POLE NUMBER
B EEN IN AT TWO CROSS STR1EETs IS PFCVISES LOC TED9 SECTION ` BLOCK LOT
OCCUPANT'S NAME BUILDING OCCUPANCY
I ..
OW ER'S NAME AND ADDRESS HOME TELEPHONE NUMBER
CURRENT SUPPLIED BY FROM THEIR 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 EACH INSPECTION
OUTSIDE ' l 17 r-U
BASEMENT
I
I"FL r,T �f^
2-FL.
VILLAGE OF E BRO K
31 FL.
REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: '
act S--rro I ,�
THIS APPLICATION IS INTENDED TO COVER THE ABOVE LISTED ITEMS TO BE INSPECTED.IF AT ANY TIME OF INSPECTION ADDITIONAL ITEMS HAVE BEEN INSTALLED,YOU ARE
AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE FOR THE ADDITIONAL ITEMS 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 LISTING,LABELING,UNDERWRITING 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
CHARACTER OF WORK NEW❑ ADDITIONAL❑ EXPOSED[ CONCEALED O MUST ENTER APPLICANTS
IDENTIFICATION NUMBER
SERVICE ENTERS BUILDING OVERHEAD❑ UNDERGROUND;]
AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED.
NAM POMPANY DATE OF APP CAT�10'N X GNATUR"fA .
I
1/4 V/ CAi
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7 EET A
p7
TELEP110NE NO.
.
CRY lb ZIP CQ�� LICENSE NO.WHEN APPLICABLE J�f o /