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HomeMy WebLinkAboutEP21-280 O { /co { `� _ ri N N eq 04 s a N ta1 ^I � ~O • In knen is : w 9642Nen a � z w U a m CD M tn 00tn cn T M1 �M-o jCIN 00 M-4 W Ls Z a wx, U o �' 0 V W z CIA, to � yE bRnv� D ECIEW[Eu Bum DEPARTMENT NOV - 1 2021 VIL E OF RYE BROOK 938KN GREET RYE B ,NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT . .ook.org ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required/ FOR OFFICE USE ONLY BP#: EP#: C NOV - 3 Approval Date: Permit Fee: $ Approval Signature: Other: Q+`V-:2 Disapproved: (fees are non-refundable) Application dated, 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. J 1.Address: 'Ors SBL: �J Zone:X!� 2.Property Owner: Address: Phone#: 7Q/4/r 9 3 7—2."[OO Cell#: email: 3.Master Electrician: Ayr,,46 , I-Vgr-7-no Address: /y 4,e,9e/e (2 L/,e— Lic.#: f(r Phone#: 9'�i 7 ff OS i Cell#: VOO email: Me_ereq , lee_74 is em-1-4D I Company Name:eeal% aaf g c-7fl t c. eizi?`{ a Address:/ O 1 / /,7 -c- OVe 4.Proposed Electrical Work/Fixture Count: 1&p l rc r G !),-v(,1 60 73 SI o V r- A ***x***sax**s+r**tr****,►�**********�*z****,r*,r,r***��*�,►*,�********************«*********«*******�*�a********* SST�AT�E/�OF NEW YORK,COUNTY OF WESTCHESTER ) as: y -1.1 ,being duly sworn,deposes and states that he/she is the applic above naived,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 for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attomy,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 is ram— Sworn to before me this day of kS c f ,20 2 --- da f ,20 Si CCe a Owner Signature Kf Applicant Print N f erty wn Print of Appli t L Notary otary Public Wh gt7litry►publliicc,, statedoh, New** Pt tt rMr settNe wM No.Ot WH63945W NoMry Pubk,buts of New riA Cu~In VVeetcheSW COLN* N6.02BE46t6346 t�,,,� OssUasd In wsatcheawPa" �EW w J*8.2W 8/1M021 CanmlWoa E.Ok�s Nosa�bffM S '�`eeGt�awe�r—. Westchester Rockland Electrical Inspection Services, Inc. Phone: 914-347-359 LET DO NOT WRITE HERE—FOR OFFICE USE ONLY 43 North Lawn Avenue ��u Fa 63 7-3 9 Elmsford, NY 10523 � �� BUILDING PERMIT WO. TEMP rt DATE / i/ a/ CITY OR VILLAp LP CODE TOWNSHIP COUNTY '?--IG oar,,v /C v !n/� J r'le STREET AND NO.OR ROAD POLE NUMBER CO-1 C o QZ BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT OCCUPANT'S NAME BUILDING OCCUPANCY OWNER'S NAME AND ADDRESS HOME TELEPHONE NUMBER �- I2eev PreI CURRENT SUPPLIED BY FROM THEIR OFFICE WORK.TELEPHONE NUMBER LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS NO.OF FIXTURES 6 MOTORS HEATERS OFFICE USE LOCATION LAMP RECEPTACLES _ ONLY SIDEWALL SWITCH INCADE FLUORE NO. H.P.EACH NO. WATTS EACH [NSPECTION OUTSIDE ^-�� I',ijl+C=a ^� 11 BASEMENT 11i 1'FL. I 2-FL. 3'FL. VILLAGE OF E BROOK I REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE,: Re G✓ c- V 'j . 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 R2 ►gel. . CHARACTER OF WORK NEW❑ ADDITIONAL❑ EXPOSED❑ CONCEALED D MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD❑ UNDERGROUND❑ AVOID DELAYS BY GIVING FULLAND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED, NAME OF COMPANY DATE OF APPUCATIO SIGN RE F ICA T Cc�- /« -�r I C— VJZ2 1© 7i /a X STREET ADDRESS TELEPHONE NO. (F 7 ©S� CITY OR POST OFFICE ZIP�OODE LICENSE NO.WHEN APPLICABLE AFFIDAVIT IN SUPPORT OF FEE WAIVER RELATED TO HURRICANE IDA STATE OF &tv S/er IG COUNTY OF PSTG,4esZ'`Cc- &-r (insert name), being duly sworn, deposes and says 1. I am the applicant for a Building Permit/Certificate of Occupancy 1 Demolition Permit ectricaI Permit Plumbing Permit/Fence & Wall Permit Mechanical ermit/ Pod Permit(circle all that apply) 2. 1 am the legal owner of property located at 3 Rye Brook, New York (insert street address) OR I am the (Archite ontracto Engineer/Attorney) (circle one) for the legal owner of property located at 3 L064r'n r �4Ct , Rye Brook,New York and I am duly authorized by property owner to make and file the accompanying application. 3. The following is a description of(1) the work to be performed under the permit for which I am applying; and (2) how the work arose as a direct result of Hurricane Ida. O h-/Y L) o ST -71)4 4. The work described herein arose as a direct result of Hurricane Ida and does not include Work which was not caused by Hurricane Ida. Sworn to before me this Day of n , 20�� Notary Public In WeddwW a Nov - 1 2021 VILLAGE O1= RYE BROOK BUILDING 1?r 1'1PRT1AEI`JT IF WESTCHESTER ROCKLAND ELECTRICAL INSPECTION WREISSERVICES,INC. BY THIS CERTIFICATE OF COMPLIANCE THE Westchester Rockland Electrical Inspection Services 43 North Lawn Ave, Elmsford, NY 10523 914-347-3595 (Office) 1 914-347-3596 (Fax) CERTIFIES THAT Upon the application of: Upon premises owned by: Mecca Electric Scott&Maxine Ehrenpreis 109 Maple Avenue NY, Rye 10580 Located at:3 Concord PI Rye Brook, NY 10573 Certificate Number: 1032445 Section:135.44 Block: 1 Lot:56 BDC: Permit Number:EP:21-280-BP:O A visual inspection of the electrical system at this premise described as a Residential occupancy,wherein the premises electrical system consisting of electrical devices and wiring,described below,located in/on the premises at: 3 Concord PI Rye Brook,NY 10573 0 Basement 1st Floor 2nd Floor 3rd Floor Garage Attic Outside Other: Inspection was conducted in accordance with the NYS and NFPA 70-2017 International Electrical Code and detail of the installation,as set forth below,was found to be in compliance therewith on 12/23/21 Name Type Quantity Receptacle Convenience ------- 13 Arc Fault Breakers 15 amps 2 Panel 150amp 1 L ificate has been approved by Westchester Rockland Electrical Inspection Services. ay not be altered in anyway.valid for work performed before date of inspection only. 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