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Home My WebLink AboutEP21-196 t0 01 rl o n e r r X F a M � • p � Q O � 3 M F , C1, O W �; c � •H � � � o �•r U x � � a �' = O W � 3 Q Q A � � � F •• � , co � < r O A �..� M v r ce .- � i••� z � Q� C� W p } vs � � - m F • � E"� � W a � d w w j F- , ►...� � a o °� � w � a o: �_ - d 3 � g ✓: co � - o � N � $ rl Z F Q � p Q I CO Gz. 41 : = < t yEaRnv LS� LSD V l� BUILD'I11G DEPARTMENT VILLAGE OF RYE BROOK 1 DD 938 KING STREET RYE BROOK,NY 10573 AUG -5 2021 (914)939-066S Ax(914)939-5801 VILLAGE OF RYE BROOK wwwofto-ok.org BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required / FOR OFFICE USE ONLY BP#: EP#: Approval Date: AUG Permit Fee: $ z::DDS-� Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, SI-1-111 is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/ r 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: 5' la S", "T SBL: 3 6 Zone:Q—� 2.Property Owner: N Z ` «wy1 U L Address: A- E t0Z 1 p VLA Phone#: Ll1—`��'S Cell#: email: DcgLgst 3.Master Electrician: ,� tr v r i Address:/Of1� /2LYa�Yi :�''%s� 3Pl s 7Y 7 cell#: C// /?� Vic.#: Phone email: J y Q t" Q r c u,^/ 4(Q S Company Name: Address: 4.Proposed Electrical Work/Fixture Count: tZ LA(.0 51VV,'Kf *eA*-. W/ rt-GAT �C-TQVZ STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: A ,' LCOP—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) state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the C-'ut')Trt&C—I*- 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 -3 Sworn to before me this day of `US 20 2-1 _ day of n %gAture—of Itroperty Ovmer46W Si of Ap c I)RVI(> Ck rtlS i+ ` Pr' t Name of Pr erty 9waer/ldW,- of A t otary Public Notary Public KELLY SANDLER Notary Public, State of New York No. 01 SA6003882 Qualified in Westchester County Commission Expires March 9, 20"22 3/21/19 Westchester Rockland Electrical Inspection Services, Inc. •y Phone:9 4 3 3 95 DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue Fax: 91 -3596 Elmsford NY 10523 r`�_ ? -abBUILDIN M NO. TEMP# DATE J CITY OR VILLAGE ZIP CODE TOWNSHIP -0 STREET AND NO.OFWAD NUMBER BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT OCCUPANT'S NAME BUILDING OCCUPANCY OWNER'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 V 1 BASEMENT 1''FL. 2-FL. tILLAGE� OF RY BROG DEP RTME REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: Ica 4 THIS APPUCATION 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 LJ EXPOSED❑ CONCEALED❑ MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD❑ UNDERGROUND G I L I I AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. NAME OF COMPANY It � DATE OF APPLICATION � SIGNATURE OF APPLICANT �--�rC r r ,� Tr Q ""r �� Z x --- --...- STREET ADDRESS TELEPHONE NO. CRY OR POST OPPJCE �!�_COD€ LICENSE NO.WHEN APPLICABLE /\ .��y� ` dC( 000