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HomeMy WebLinkAboutEP22-002 = m a N44 \ \ ` O O 0 LO r- V ■ s ] M M N O ■ a DO M bD Icy a L9 C V s r� ra W U � z ", � � ,� O � w w � � � '• O W U a O Wtn ' 0 A co °O wZ o W _ � z 0 00 cn oZ o g V �j U W w W C to p [EVE C BUIL MENT BAN - 6 2022 VIL E OF RYE OK 938 KIN ET RYE BR3QIC,NY 10573 VILLAGE OF RYE BROOK (914)93ft AX(5 )939-5801 BUILDING DEPARTMENT 1yebrdok.org ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: EP#: `� Approval Date: J AN - 7 Permit Fee: $ ( L.JXL Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, December 22,2021 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: 6 Jennifer Lane, Rye Brook, NY 10573 SBL: 135.57-1-15 zone:4/0 2.Property Owner: Corey Germain Address: 6 Jennifer Lane, Rye Brook, NY 10573 Phone#: 954-336-4943 cell #: email: cgermairtgmaii.com 3.master Electrician: Carmine L. Lippolis Address: 25 Seventh Street, Pelham, NY 10803 Lic.#: E3 Phone#: 914-738-3550 x107 Cell#: email: Wguiliano@lippoliselectric.com company Name: Lippolis Electric, Inc. Address: 25 Seventh St. Pelham, NY 10803 ') 4.Proposed Electrical Work/Fixture Count: STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Carmine L. Lippolis ,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 for the legal owner and is duly authorized to make and file this application. (indicate architect,con actor,agent,attorney,etc.) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belie and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth a9dcontained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New ork State Uniform re Prevention&Building Code.the Code of the Village of Rye Brook and all other applicable laws,ordinanpes and regulations. Sworn to before me this 22nd Sworn to efore me t ' 22 da f Decembe 12021 day of ecember 2021 Signature Property Owner S i#aturp4f ApKicant Corey Germain C ine L. Lippolis Print e of Pr erty Owner Print me ZAW-e� licant . l.G�-� Notary Public Notary Public QORIP6 BISACCIA ENOTARYPUBLIC, BI.SACCIA L PUBLIC,STATE OF NEW YORK STATE OF NEW YORK gistration No.01BI84013180.o1 Bf6401318l fSed In Westchester Countyestchester County ssitxt Expires December 9,2023. es December 9,29)P/ 9 Aa Westchester Rockland Electrical Inspection Services, Inc. , Phone. 914-347-35 5 DO NOT WRITE HERE-FOR OFFICE USE ONLY P.O. $OX 208 Fax: 914-347-3596 Carmel, NY 10512 BUILDING PERMIT NO. TEMP# DA � C6 CITY OR VILLA i✓IV TOWNSHIP � U STREET D O. OAD I/" E - _ POLE NUMBER BETW WHAT O CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT ZkkBUILDIN CUPANCYrOWNERS ADDRESS EP NUMBER CURRENT PLIED BY FROM THEIR OFFICE ORK LEPHON UMBER ^�, 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 I'FL. 2' FL 3-FL BUILDI G LDEP RTMIENT REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: G� r- / LV THIS APPLICATION IS INTENDED TO COVER THE ABOVE LISTED ITEMS TO BE INSPECTED.OF 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 15 NO OPEN APPLICATIONS FOR THE ABOVE WITH ANY OTHER INSPECTFON COMPANY WREIS, INC. IS NOT DSTING,LABELING,UNDERWRITING OR CERTIFYING ANY EOUIPMENL 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 SERV FEEDERS CHARACTER OF WORK NEW] ADDITIONAL❑ EXPOSED❑ CONCEALED❑ [/s MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD L', UNDERGROUND_ © e d AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. -. ";F`ry'J ,7 I I DATE OF PLC ION SIGNATURE OF IC uu JJ "Irllt_1L� , C- x STREF�T ADE$6� TELEPHONE O � /f p? C TTY OFFIC J ZI LICENSE NO.WHEN APPLICABLE WESTCHESTER ROCKLANO WRE I ELECTRICAL INSPECTION SERVICES,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: Lippolis Electric Inc Corey A Germain 25 Seventh Street 2nd Floor NY, Pelham 10803 Located at:6 Jennifer Ln Rye Brook, NY 10573 Certificate Number: 1033306 Section:135.57 Block: 1 Lot:15 BDC: Permit Number: EP:22-002-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 inlon the premises at: 6 Jennifer Ln Rye Brook,NY 10573 Basement 15 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 03/01/22 Name Type Quantity Car Charger ------- 1 Service up to 200 Amps ----- 1 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. This certificate is valid for work performed before date of inspection only. III G