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HomeMy WebLinkAboutEP23-161 : : !1 N N N W Ln s O a N cV N 0 I y s ■ � W a W z H � � v O ' cn = w ,En 00 H � z G a L M n ri z ■ O Q U O a w00o, d Ln U w W o caia U n z � c wo U 1-7 o wm PE cn w u ;z C, x cQ V c� a 0 � A � W z o z o0 Q o oLn v� U a w z °� x 9444414414414-644 x a p EC� EN -kF. aRCi'�,_.. Bum G DEAR MENT JUL 2 0 2023 VIQ. GE OF RYE B OK 938 KIN jREET RYE B ` ,NY 10573 VILLAGE OF RYE BROOK -06 BUILDING DEPARTMENT ook.or ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY P#: EP#: �( V� Approval Date: JUL 5 Permit Fee: $ Approval Signature: Other: Application dated,,)v�- a0-&hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/or lerfiov6 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:�� j?!C n jJ0PjT-k l� ) �t - � UIU�D SBL: SS /S —Y©1�Zone: " 2.Property Owner: 0 r V I tlA V l c64)06) Address: 3 k5 �-ba.tl' Phone#: 17/14'-3 180-;?(.<-2 Cell#: 5A�1 email:k)I LL.A /3/,5-/ L CZ-'17- 3.Master Electrician/Licensed Installer: t JC�J�j i`f c>1021/A(20 Address: PU PjCy�- L13 Lic.#: Phone#:�,,f py (op��r� Cell#: -- U email:Q�,-uU� Company Name:CAJI15-091 5,'-kZ4Zf/Z 16 Address; e9aX 7 Y6VV r� 'CADS 4.Proposed Electrical Work/Fixture Count: 5.31d Party Electrical Inspection Agency: ��r /Z; (,t,/ l /T ��� ✓ f� STATE OF NEW YOM COUNTY OF WESTCHESTER ) as: pe�yl t' t4 f j4</A-)0 ,being duly sworn,deposes and states that he/she is the applicant above named,and does further (Orint name of individual signing%!�e_appIi t) ^� state that(s)he is the /� j/L',e LL�"/!�/U4or the legal owner and is duly authorized to make and file this application. f Master Electrician/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 Sworn to of re me this a\ day of 20 day ,20 Signature of Property Owner Signature of App 'cant Peul 50. !!x� Print Name of Property Owner t Name of Applicant Notary Public otary Public SHARI MEULLO Notary Public,State of New York No.O1MES160063 Qualified In Westchester County 3/3/2023 Commission Expires January 29.20_ INSPECTIONSTATEWIDE Service With Integrity I:f Main Street,Fishkill, NY 12524 1 email:• • SWIS JOBAPPLICATION tel845.202.72241 fax914.219.1062 I SMSNY.corn SWISTraining.com Office Use Elect.Permit# � / J / Date — Bldg Permit# Utility IL Final Certificate# City/Village � � Zip �/ t�`rj Township County � Address � 0 �N � �ryI��� Cross/Street U Section Block Lot Owner Name/Address(if different/than above)/f[o 7�/4 t )f!G /1 I }r��. l c _.� Contact Number ❑Basement ❑ 1st R. ❑2nd FI_' ' ❑3rd A. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent SERVICE Amperage Voltage i P 3P #Meters #Disconnect ❑Underground ❑ New ®Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information �z7I ALL- ' D � E W E ID FUL 2 0 2023 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one nl year from the date received by SWI5.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.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 as set forth for the application. Inspector Date Finalized Inspector# Company NameI�W!/ L, Date 7-2/_ I3 Signature Address /1 00( 713 City l State A 7 Zip Code , License# /^_ / Phone#