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Home My WebLink AboutEP23-097 s = e ■ x z cT W O z N Ln kn a. W w A W OON x 4 P4 U C W z 14 ~ Ix ' e a. va � o A . o W N o �' 0 W O = P4 z a N W 0 a v v W W ? Cl) Ln � w � e z Fo W Z o M""� Z M `-� vwi O � 0 A c� � � � A � w z cn w �. 0-4 W w z z � O U 0 w d C�/� W � z v4 iog- �"'� 04 W d BLIL iNG DEPARTMENT VII. E OF RYE OK 938 KIN ET RYE BNY 1057 APR 2 4 2023 4 1 VILLAGE OF RYE BROOK www -1 �o, or BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: EP#: Approval Date: A P _ Permit Fee: $ ��r Approval Signature: Other: 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. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal, State,County and Local Codes. 1.Address:O AaII'IICx" SBL: (�i�i,Ji� ` roC� Zone: 2.Property Owner:Uot, -�SrirAk&n t APAVA 1 y Wh**'Xidress: 0-7 Phone#: Cell#: 919-AG-0605 email: 3.Master Electrician/Licensed Installer: �o Address: 10� PA* ]per,, 10� Lie. #: ' 'FS6 Phone#: Oflt'(��lQ�}- f QQ Cell#: email: L Company Name:NAQ "', �lQc. r`tC W ��Address:1 oC[ µme. fA4Q 4.Proposed Electrical Work/Fixture Count: d� Repcm-r- fs I I L2i p, 5.31 Party Electrical Inspection Agency: '�5 3 16, STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: �;r)GLIJ� _,being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of individual sign tepplicant) sale state that(s)he i for the legal owner and is duly authorized to make and file this application. I Master Electri an Licensed Installer) 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 90 Sworn to before me this (3iQ day ! ,20 a3 jdo f ,20�1 Signature of Owner -SiFaVe Jf Applicant Print Nam f Pro a er Print Name pplicant Notary blic Not Public FELICITY FULLER Notary Public-State of New York No.01FU6425939 FELICITY FULLER Qualified in Westchester County public-State of New York my Commission Expires 111291 S Notary No.01FU6425939 3/3/2023 Qualified in Westchester County STATE WIDE INSPECTION SERVICES, INC. Service With Integriky 0•0 • • SWIS JOB APPLICATION tel 845.202.7224 1 fax 914.219.1062 1 SWISNY.coml SWISTRAINING.COM Office Use Elect. Permit# �� - - V 7 Date Bldg Permit# Sq Ft T Plumbing Permit# Final Certificate# City/Village Zip .o Building Dept. County l.r Address Cross Street Section Block Lot Owner Name/Address(if different than above) y Contact Number ❑Basement ❑ 1st FI. ❑2nd FI. ❑3rd FI. ❑Mare Than 3 FI. ❑Garage ❑Attic ❑Outside R:CRResidential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/O Detector Flood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels 1P 3P #Meters #Disconnect ❑Underground ❑New ❑ Reconnect ❑Repair ❑Overhead ❑Upgrade ❑ Disconnect Utility ID# ❑Con Ed ❑NYSEG ❑Central Hudson ❑ Orange/Rock6and PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect Junction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation Se vierAPR '3 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one M year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,if at anytime of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other inspection company.The applicant, owner or authorized agent agrees to all the above terms and conditions asset forth for the application. Email Address ecccti �� , Name License# S Date (411 ollSignature Address 1 City/State Zip Code Jsc>U Company �P;� Phone# C` Ct trnsl