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HomeMy WebLinkAboutEP23-246 s i v i = C^9 p w x 0,, !f � w 4,—, = O Ln ©O i� � A N w N 0-4 « O a co w ° LO z � z 0 z x Q° 0,40 cs, W x oc Q �ry ,0-.4 z A � ►Yi W W z [� (� cn V z o U_ U o o z � V W z vi w s our) H _ U w 9 PLO 1-4I a a a a z w x BUILNG DEPA MENT Vu, �E OF RYE OK 938 KIN T iZYI BlZ . NY 10573 NOV 3 0 2023 ,?t� 9-0645. �. VILLAGE OF- RYE BROOK W or _ _B_UILDIN_G DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required ^ FOR OFFICE USE ONLY BP#: EP#: 3 —C)Lj_�t�' Approval Date: + Permit Fee: S 1 '475o Approval Signature: Other: DO NOT S 1'AR`l NVOKK or CONS]RUCTION UN 1'1L A PERNIF1 IIAS BEEN ISSUED BN THE BUILDING INSPECTOR. THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE `/ TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 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: 3'7 C k 1 t � ( ,W SBL: �.��i 35-�- 6 Zone: —/O 2.Property Owner: 1 G R O cb - Address: 3_ ac C_ f—I � Phone#: q! 2 Z 0S.3 Cell#: email: 3.Master Electrician/Licensed Installer: __Address: 1�k'xsv= : INC C h.-i 07!c—a2w Lic. #: !1 19 Phone#: Cell#: mail Company Name:_PPPr99£ 2 F_L4_-G-T/ZJ G 4 A, e Address: 3 e T w yA-aw+3 v 4.Proposed Electrical Work/Fixture Count: " 3 _1-w S 14 L.L O N jr J 4- S /Z C.49 Z+ G LX ,�4 c rlt cz ?- !Z-,-r 4 I-I!</Z AP R- Tim L i4 C El,,pit G_gg,,r_ 5.31 Party Electrical Inspection Agency: STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: being duly swom,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 for the legal owner and is duly authorized to make and file this application. (Master Electrician f 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 2P Swom to before me this =f -Cr\bPCT, 20 Z-1 day of / 7 Signature of Property'Owner S 6AWo Ap rcan 9 A 1 e. 4W A to a p 4&. art�..io rZ M4c, lT L 6 ame of Property Me ILL Pri ame ofAppli ant Not r 1i t New York No b is No.61ME6160063 No tRi ,State of New York Qualified In Westchester County No.OIR16441398 Commission Expires January 29,20n l0/3o/2t)23 Qualified In Westchester County Comm�,Oon Fxnlres Sec!ernbe-" 209(,J STATE WIDE INSPECTION SERVICES, INC. CAC) Service Witit Inte.tzrilY 0;0 • • SWIS . : APPLICATION tel 845.202.7224 1 fax 914.219.10621 • Office Use Elect. Permit# �� .t �s Date F— 1 t Bldg Permit# Sq Ft Plumbing Permit# Final Certificate# City/Village /f � Zip Building Dept. County Address 3 ;Z �C Cross Street Section Block Lot Owner Name/Address(If different than above) Contact Number ❑Basement ❑ 1st FI. ❑2nd FI. ❑3rd FI. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside esidential ©Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/0 Detector Hood Trash Compact Amt Amps s 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 1 Overhead ❑ Upgrade ❑ Disconnect Utility ID# ❑Con Ed ❑ NYSEG ❑Central Hudson ❑ Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect Junction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization afety,Inspection ❑Consultation :r NsTka cL p ivy t — Sv /Z.E _ems t ✓4 C-,inj'a. CF._FrrNnV �_' 'J 3 0 zo 23 VILLAGE Or- RYIE BROOK Cl TNIENT This application is valid for one(1)year from the date received by SWI5.This application is intended to cover the above listed Items to be inspected,fat 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 es L f ec��i.�CG,j,_ u f f cz, . 1 Name r License# ! ` Q Date Signature Address p � � S 7— City J Stated l� TiVE QL '.� Zip Code / Q 6 Company r/ �L G., G T -!L yL, ' !Phone# 5;1/ '/-,9 r6 S a