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HomeMy WebLinkAboutEP21-326 ■ ■ ■ • i ■ m ri O © W a N N .a ■ eq M A- ...y M i 1d N F� i pq G cn ., Ga 96 M o F �j► � w � � a � q � a z p ■ c U p 4 < W M ~ ® r a ■ >400 ■ O w z w 4 W az° a , z 0 CN CO z w OD 00 rl p a . '' A a W a li I a oz w x � CIEFFIE Buff##1,-z if MENT V �GE OF RYE OK R DEC - 9 2021 938 KIN ET RYE.B ,NY 105 3 (914) 939-5801 VILLAGE OF RYE BROO or BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: ��` EP#: � DEC 1 3 20 i j Approval Date: ` Permit Fee: S Approval Signature: ` Other: Disapproved: (fees are non-refundable) Application dated, I l 1 i tt31 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. p 1 1.Address: 9-Cl r �;ca r t SBL: I c;) o1 Zone: 2.Property Owner: Address: Phone#: Cell#: S 11 b A 3- OG 4© email: QS 2_E I TL 1 t`) 1 q n' 3.Master Electrician: Vs l t�j e c� Address: I 5 } % w St Lic.#: I Phone#: Ll 14 0�3 I--JOSU Cell#: I ti k(c��-�O D email:g��� �� c�c•a M Company Name: Address: 14S SA-_RAL� [,1+�t'��� 1`A 4.Proposed Electrical Work/Fixture Count: �� i IUS� vt r. C^_ t� t � � STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: lY✓q Ll+�� ?e_ � being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name o 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,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$pproved 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 Pefore me this E{ 6 day o€_L,.-tT 1 J ,20 day o 20 1 rz_FL�"' Sigiiatu a of Pr(oerty Owner a 6KApplicant -- (Sa'k SCE �'1 2 C i Print Name of Property wner Print am of lican _ c�— No Wry Public Wot ubl�lftA DlCio^^eo Moiary rublic �±ate :�t yew Yorfe NC 4F1723D Certifici:.te rite 'r r:•,.::- •ste. rPelt r ? 1 2'2) Comrnissw Er eras 7 f 3 f f ao�32 r Min r+ Westchester Rockland Electrical Inspection Services, Inc. s Phone: 914-347-3595 DO NOT WRITE HERE—FOR OFFICE USE ONLY 43 North Lawn Avenue F=t: 914-347-3595 Elmsford, NY 10523 BUILDING PERMIT NO. TEMP# DAT 1 b J 1 CITY OR VILLAGE ZIP CODE TOWNSHIP COUNTY �rpp 01 3 STREET AND NO.OR ROD POLE NUMBER � .: BETWEEN WHAT TWO CROSS STREETS IS PREMISES L ATED? SECTION BLOCK LOT OCCUPANT'S NAME BU ING OCCUPANCY OWNER'S NALAS 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 BASEMENT 1's'FL. 2'"FL. 3'FL. VILLAG OF RY BROOK l REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: � , 1 r �, 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 D ADDITIONAL L1 EXPOSED❑ CONCEALED 7 MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD❑ UNDERGROUND L' AVOID DELAYS BY GIVING FULLAND ACCURATE INFORMATION,ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. NAME OF COMPANY DATE OF PLI ATION ;7E OF !CANT cam, f:,Cv' C nL• 1 1 11 0 91 STREET ADDRESS TELEPHONE NO. 9 H �3 1 - Q'50 O COR pQST DrCjE Zl CODE LICENSE NO.WHEN APPLICABLE 0 i` S �T�� 3 E 11 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: LaBella Electric, Inc. Andrew&Susan Loeb Zeitlin 145 South Main St NY, Port Chester 10573 Located at:201 Country Ridge Dr Rye Brook, NY 10573 Certificate Number: 1032562 Section: 129.82 Block: 1 Lot:20 BDC: Permit Number: EP:21-326-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 inion the premises at: 201 Country Ridge Dr Rye Brook,NY 10573 Basement 1 st 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 01/06122 Name Type Quantity Pool Disconnect-Wiring/Power ------- 1 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. AG This certificate is valid for work performed before date of inspection only.