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HomeMy WebLinkAboutEP22-005 _ _ U) 44 o N N o N N N W u N 1. cv 4 W W Ln 0 0 CN Ln co MCI G1 � W p hTy ' h M W o o P4 O �. 0-4 W e W a x 00 ' w W U Ln Z co N.+ H u z o%*4 � � I A W I z = Gti eno4 v, r--� It A Z o o W ' � OC V `0 w cy w A � W c� Z W o x ry p; z w z O o W z W " H z � w ° 02 �iI G�4 0 1 rZ-i G4 0 vd, a ME BUILDING DEPARTMENT R [E C E VILLAGE OF RYE BROOK JA!N 12 2022 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK www.ryebrook.org BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required Folz uv:v"r—r- use C>%X y �CQ - 005 JAN 1F�� Approval Date: Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, 1—lJ6 i?oZ 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: Iq up-IleAl T SBL:_13Fj.(p7 a-� Zone: R`7 2.Property Owner: KA:j herw e_ Ld o IToN Address: A4 7eXr- I{,r: Phone#: Cell#: email: 3.Master Electrician: I-e' o SST ivo Address: o?4f W w&e sT G r-eenw,4 c retw Lic.#: 941 Phone#: Cell #: IN- a?-7563 email: Company Name: YS -]e(.1T/bt uC _ Address: �45_ e�ehww_ S7'C,reenawiclil , Gtrotwl 4.Proposed Electrical Work/FixtureCount:ttjbr4Je SewtC.e &vwl ioo4sm^ Tu roo+w S STATE OF NEW YORK,COUNTY OF WESTCBESTER ) as: f?t fC-' C-ATI&V ,being duly swom,deposes and states that he/she is the applicant above named,and does further (print name or 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 6!OA;1✓�1L�o1L for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attornev,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 regulati;/X/_V� Sworn to before me this 12 Sworn to before me this day of TO%Yllnpl 202L day of ,20 rlx' iig,,nattlu_re of Property er Si nature o Applicant L0 V i,Y I w D O'D 1/1 j�l f t y SgTt�y v Print Name of Pripperty 04ner PrintL4ame of Applicant Publi Notaryp TJW'' .A nr`�E� York �viIGUEL MACIERA N t�, ; NOTARY PUBLIC-STATE OF NEW YORK 0 ttr �� No 01 MA6381057 Qualified in New York County MY Commission Expires 09-24-2022 8/12/2021 Westchester Rockland Electrical Inspection Services, Inc. i FhFaone: 914 347-3595 L DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue Fax: 914-347-3596 Elmsford, NY 10523 BUI DING 71 TT No. , TEMP# O E - CITY OR VILLAGE ZIP CODE TOWNSHIP COUNTY C_ ►�rOoC OS W NST �cJ2 STREET AND NO.OR ROAD POLE NUMBER i Lj Vlqlflr�4LG= BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK. LOT OCCUPANT'S NAME BUILDING OCCUPANCY kk�kcp,, e o;JT©A) OWNER'S NAME AND ADDRESS HOME TELEPHONE NUMBER ) UAW" "Ilq-917-11LIS— 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 SIDFWALL SWITCH INCADE FLUORE NO. H.P.EACH NO. WATTS EACH INSPECTION OUTSIDE BASEMENT T'FL. 2-FL. VILLAGE OF 9'�FL. till REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: PiJU L� �c�C' �Y'[r�'1'1 UG' �►n>4 u 2Vu Avx /L> u A-� /1iMN f5r -6o �°�eL ry r✓c u•vt e!�,Q�y�vl 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 EOUIPMENT, 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 0 MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD(' UNDERGROUND;7 51 U T n c AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. NAME OF COMPANY DATE OF APPLICATION ATU O X STREET ADDRESS TELEPHONE NO. CRY OR POST OFF ZAP CODE LICENSE NO.WHEN APPLICABLE � �uw i�L U 17- wESTCHESTER ROCKLANO ELECTRICAL INSPECTION ONEIDSERVICES,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: PS Electric Inc. Katherine Wojton 245 Weaver Street Apt 5G CT, Greenwich 06831 Located at: 14 Valley Terrace Rye Brook, NY 10573 Certificate Number: 1033680 Section: 135.67 Block:2 Lot:20 BDC: Permit Number: EP:22-005-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: 14 Valley Terrace Rye Brook,NY 10573 Basement j 1st Floor :2nd Floor ❑3rd Floor ®Garage i 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 03/16/22 Name Type Quantity 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. 11