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HomeMy WebLinkAboutEP24-016 O N n N \ \ oo u� W =in _ `� c 14 o v = O ad' '= Q w w Q s , W F _ � z z w � 4 �1 O O A Ln QL r h cn N `n (Yl a W J W pop 4 _ ono x �V�rr CO OD � z Oo Z o � W z uz Cl) _ z w z z as .a 14 a0.0 H V 8 8 xi V o C15 a d' `te.n V V W o � A. cn w � w a OCR a . p �I M A4 a z w x yEBRu ® L'E � � 1I _ BUIL E MENT VIL E of RYE OK [.JAN 2 4 2024 938 KIN ET RYE B ,NY 10573 - VILLAGE OF RYE BROOK I BUILDING DEPARTMENT .or ---� ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLa BP#: EP#: � 00 ' Approval Date, \ Permit Fee. $ Approval Signature: Other: DO NOT START WORK or CONSTRUCTI N UNTIL A PERMIT HAS BEEN ISSUED BV 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, 19 Sa tv Z�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 he in conformance with all applicable Federal,State,County and Local Codes. v p 1.Address: f C h r� �' 'L C I`lin c) SBL: 13 � 1 / Zone: fl /s 2.Property Owner:IrYI IC[*') A L L. L ��K�Av.l Address: '5 9 41 e Phone#: 91 1- f?A0 `Z) Vr Cell#: email: L-60<"Ai, /1M"CI,Q el d' 9'r1A:t x0 Af 3.Master Electrician/Licensed lnstaller:No2r1f to9ST' Address: (�O-?S' bN"v S'T T cr Lic.#: )(0 573 Phone#: Cell#: 2o3-Vlo-931? email: � A2k.,T� its(n_i lfita�l r Company Name: 5S'4 n\.a- Address: 4.Proposed Electrical Work/Fixture Count: W re 5,�, D►� ,/U Cr/C t c1N/d fr�.� r9 5.31 Party Electrical Inspection Agency: 1-"J i STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: �fA^v� A/Z1L� ,being duly swom,deposes and states that he/she is applicant hove named,and does further (print name of individual sign'g as e-applicant) state that(s)he is the L Le c-N`�(1 +%j for the legal owner and is duly authorized to make and file this application. (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 before me this 0 +1'm day of )20 day of (AY\U GrL, ,20 2-LI Signature of Property Owner Si ature of Applicant rl'A,✓LC *?AtIKT` Print Name of Property Owner Print Name of Applicant Z — Notary Public LIVIA ROSE HOLZNER t Notary Public Notary Public Connecticut 10/30/2023 My Commission Expires Feb 29. 2^26 g � qw- - INSPECTIONSTATEWIDE 0•0 Main Street,Fishkill, NY 12524 SWIS JOB APPLICATION0. Office Use Elect.Permit# Date 18S191__J0� y N. ��-le-- 0l6 sgFt Temp# Utility ID# Final Certificate# City/Village R le- rvC k' Zlp I o 5-� Township R i"uo1( County we5•r Address _( I Cross Street Section / Block Lot -1 Owner Name/AddreSS of different than above) L S f _ f Contact Number C�/ J, ❑Basement ❑ 1st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 A. 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 1 P 3P #Meters #Disconnect ❑Underground ❑New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information y W%� X, l O C t C v t P r-j T/n, r�.� P9 N to 19 N D 30 firolo CE �W[ JAN 2 4 2024 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by SMS.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 asset forth for the application.. Inspector Date Finalized Inspector# Contractor �2THC71 •� �� � CAF I �iv Date U SA►►t Z Signature Address r G H G.� City/State lJ ( �— Zip Code License# o / Phone# Zo 3 — 11 Ill •— 6312 �O State Wide Inspection Services co" 1080 Main Street Fishkill, NY 12524 845 202-7224 Phone Tb rw/ U 5 914-219-1062 Fax STATE WIDE INSPECTION SERVICES Email: office@swisny.com Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Northeast Generator Michael Laskin Frank Markut 17 Churchill Road 625 John Street Rye Brook, NY 10573 Bridgeport CT,06604 Located at: 17 Churchill Road, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP24-016 135.26 1 14 Certificate Number:2024-0667 Building Permit Number: A visual inspection of the electrical system was conducted at the Residential occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at: 17 Churchill Road, Rye Brook, NY 10573 The Basement and Garage were inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 5th day of February 2024. Name Quantity Rating Circuit Type Inlet 01 30AM P Officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. QyE BRC�k, cu � • �9�2 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street . Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - -- -- - - - - - - - - - - ADDRESS : f 7 ems/ U r C /�/ DATE: Z OZ`il PERMIT# r 2 l` -Z 60 ISSUED: !0-7-1 U SECT:IJS•ZL BLOCK:_LOT: LOCATION: TN 9A/L,a -5 0 P- c1 e G OCCUPANCY: G 1 J ❑ Violation Noted THE WORK IS... ❑ PASSED ❑ FAILED REINSPECTION BSITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas .5 PO,f:e �/lA�✓•� /�� L'�C�2 iiL//G 11 �i �/+ /S ❑ L.P. Gas FUEL TANK ❑ ❑ FIRE SPRINKLER P /vS�P /1 2 ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER ____, NORTGEN-01 SMAR UIS A4C"fRO CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) 1/19/219/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Clark Agency,LLC dba May Bonee 8r Clark PHONE FAX 180 Glastonbury Boulevard (A/C,No,Ext):(860)430-3700 (A/C,Na):(860)430-3730 Glastonbury,CT 06033 ADDRL INSURERS AFFORDING COVERAGE NAIC# INSURER A:Twin City Fire Insurance Company 29459 INSURED INSURER B:Arbella Protection Ins Co 41360 Northeast Generator Of Connecticut,Inc. INSURER C:Technology Insurance Company 625 John Street INSURER D Bridgeport,CT 06604 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LTR IN SD D MM/DD/YYYYI (MM/DD1YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE LK OCCUR 02CESOA8232 7/1/2023 7/1/2024 DARMAGE TO RENTED 300 000 EMISE Ea occurrent MED EXP(Any oneperson) 10,000 PERSONAL&ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY D PRO- ❑ LOC 2,000,000 JECT PRODUCTS-COMP/OPAGG OTHER: B AUTOMOBILE LIABILITY EO aBINED SINGLE LIMIT $ 1,000,000 X ANY AUTO 1020130551 7/1/2023 7/1/2024 BODILY INJURY Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ X HIRED X NON-OWNED PROPERTY AMAGE $ IAUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE DED I I RETENTION$ C WORKERS COMPENSATION X PER Y/N TWC4293236 7/1/2023 7/1/2024 OTH- AND EMPLOYERS'LIABILITY TAT TE R ANY PROPRIETOR/PARTNER/EXECUTIVE 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT (Mandatory in NH) 1,000,000 E.L.DISEASE-EA EMPLOYE If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1,000,E_00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village Of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 y ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured Northeast Generator Of Connecticut,Inc. (203)335-4204 625 John Street Bridgeport,CT 06604 1 c.NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required if coverage is specifically limited to 1 d. Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 06-1046634 2.Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Technology Insurance Company Village of Rye Brook 938 King Street 3b.Policy Number of Entity Listed in Box"l a" Rye Brook,NY 10573 TWC4293236 3c.Policy effective period 07/01/2023 to 07/01/2024 3d.The Proprietor,Partners or Executive Officers are X included.(Only check box if all partners/officers included) ❑ all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box 1a"for workers' compensation under the New York State Workers'Compensation Law. (To use this form, New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Shaunna Marquis 1/19/2024 (Print name of authorized representative or licensed agent of insurance carrier) Approved by: �7wa�� r 2' uz�_ (Signature) (Date) Title: Account Manager Telephone Number of authorized representative or licensed agent of insurance carrier: 860-430-3711 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-17) www.wcb.ny.gov W31 F3117 Workers' Compensation Law Section 57. Restriction on issue of permits and the entering into contracts unless compensation is secured. 1. The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any compensation to any such employee if so employed. 2. The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. C-105.2 (9-17) REVERSE W31 F3117 Yoe Workers' Certificate of Attestation of Exemption STATE Compensation from New York State Workers' Compensation and/or Board Disability and Paid Family Leave Benefits Insurance Coverage **This form cannot be used to waive the workers'compensation rights or obligations of any party.** The applicant may use this Certificate of Attestation of Exemption ONLY to show a government entity that New York State specific workers'compensation and/or disability and paid family leave benefits insurance is not required. The applicant may NOT use this form to show another business or that business's insurance carrier that such insurance is not required. Please provide this form to the government entity from which you are requesting a permit,license or contract. This Certificate will not be accepted by government officials one year after the date printed on the form. In the Application of Business Applying For: (Legal Entity Name and Address): Electrical Permit Northeast Generator of CT Inc From Village of Ryebrook DBA:Northeast Generator 625 John Street Bridgeport,CT 06604 The location of where work will be performed is PHONE:203-336-3031 FEIN:XXXXX6634 17 Church Hill Rd,Ryebrook,NY 10573. Estimated dates necessary to complete work associated with the building permit are from January 22,2024 to April 22,2024. The estimated dollar amount of project is $0-$10,000 Workers'Compensation Exemption Statement: The applicant is NOT applying for a workers'compensation certificate of attestation of exemption and will show a separate certificate of NYS workers'compensation insurance coverage. Disability and Paid Family Leave Benefits Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE STATUTORY DISABILITY AND PAID FAMILY LEAVE BENEFITS INSURANCE COVERAGE for the following reason: The business MUST be either: 1) owned by one individual; OR 2) is a partnership(including LLC,LLP,PLLP,RLLP,or LP)under the laws of New York State and is not a corporation; OR 3) is a one or two person owned corporation,with those individuals owning all of the stock and holding all offices of the corporation(in a two person owned corporation each individual must be an officer and own at least one share of stock); OR 4) is a business with no NYS location. In addition,the business does not require disability and paid family leave benefits coverage at this time since it has not employed one or more individuals on at least 30 days in any calendar year in New York State. (Independent contractors are not considered to be employees under the Disability and Paid Family Leave Benefits Law.) I,Andrew Jaeger,am the Vice President with the above-named legal entity. I affirm that due to my position with the above-named business I have the knowledge,information and authority to make this Certificate of Attestation of Exemption. I hereby affirm that the statements made herein are true,that I have not made any materially false statements and I make this Certificate of Attestation of Exemption under the penalties of perjury. I further affirm that I understand that any false statement,representation or concealment will subject me to felony criminal prosecution,including jail and civil liability in accordance with the Workers'Compensation Law and all other New York State laws. By submitting this Certificate of Attestation of Exemption to the government entity listed above I also hereby affirm that if circumstances change so that workers'compensation insurance and/or disability and paid family leave benefits coverage is required,the above-named legal entity will immediately acquire appropriate New York State specific workers' compensation insurance and/or disability and paid family leave benefits coverage and also immediately furnish proof of that coverage on forms approved by the Chair of the Wor Compensation Board to the government entity listed above. SIGN HERE Signature: 77, " Date: as Exemption Certificate-umber >l . .,�;Kn `x� �; Yam` Received >, 2024-003911 January 19, 2024 NYS Workers'Compensation Board � yt _. •*MM�wcwn�. -•*`*rriia ._.........:. .. .....,_. ....,.. ......... ....r...., .. ...�.:..: x..:....r.-w;s s.�+wr.t+n n.:.:ax.x.me+^. s.ea CE-200 01/2018 GENERAC', XG 10000 E XG SERIES Commercial/Residential Portable Generators Features Model 5802-2 UPC:696471058024 (EPA/49-ST) • Generac's OHVI& V-Twin Engine incorporates full pressure lubrication with automotive style spin-on oil filter for longer engine life. • Covered Outlets provide protection from the environment and rugged working conditions. • Low-Oil Pressure Shutdown safeguards engine from damage. • PowerBar@ monitors power usage. • Hour Meter tracks maintenance intervals. • Heavy-duty,never flat wheels for reliable portability. • Illuminated control panel for improved visibility. • Full-wrap, heavy-duty frame tubing for durability and strength. • User-friendly design has conveniently placed engine controls for simple operation and easy start-up. • TRUE POWERTm Technology provides clean,stable power ideal for sensitive electronics,tools and appliances. • Cold Weather Valve reduces "icing" during cold weather AC Rated Output Running Watts 10000 operation. AC Maximum Output Starting Watts 12500 49-State Control Panel (1)30A Circuit Breaker (1)42A Circuit Breaker (2)20A Push-to-reset Circuit Breakers (1) 120/240V 50A 14-50R Outlet (2) 120V 20A GFCI 5-20R Duplex Outlets II PowerBar'rm Hour Meter (1)30A Push-to-reset Circuit Breaker • 12VDC Battery Charger Input 'Fuel Shut Off •Not Shown Panel LED's (1) 120/240V 30A L14-30R Twist Lock Outlet (1) 120/240V 30A L5-30R Twist Lock Outlet GENERAC XG10000E Specifications Product Series XG10000E Starting Method Electric Model(Configuration) 5802-2(EPA/49-State) Battery Included Yes AC Rated Output Running Watts 10000 Battery Type Lead Acid(12VDC,18AH) AC Maximum Output Motor Starting Watts 12500 Battery Part No. OH1663 Rated AC Voltage 120/240 VAC Battery Dimensions 7.13"x 2.95"x 6.54" Rated AC Frequency l 60 Hz Battery Wall Charger Adapter Included Rated 120/240 VAC Amperage 83.3/41.7 Low Oil Shutdown Low Pressure Engine Displacement 530cc Neutral Bonded to Ground Yes Engine Type OHVI Start Switch Type On/Off/Start Engine RPM 3600 Switch Location On Engine Total Harmonic Distortion <5% Fuel Gauge Built-in Tank Recommended Oil 1 OW-30/SAE 30 Fuel Tank Capacity Gal(L) 10(38) w/Filter Change:1.8(1.7) Run Time at 50%(Hours) 10 Oil Capacity qt(L) w/o Filter Change:1.5(1.4) Handle Style Folding Lubrication Method Oil Pump Wheel Type 10"Semi-Solid Wheels Automatic Voltage Regulation(AVR) Yes Maintenance Kit Included Choke Location On Engine Warranty-Residential 2 Year Fuel Shut Off On Control Panel Warranty-Commercial 1 Year Dimensions and Weights Length in(mm) 31.2(792) Width in(mm) 29.5(749) Height in(mm) 31.3(793) Extended Length in(mm) 50(1270) Carton Length in(mm) 34(864) Carton Width in(mm) 25.5(641) Carton Height in(mm) 33(838) Unit Weight Ibs(kg) 300(136) Shipping Weight Ibs(kg) 324(147) Extended Length - ------ Width 111. Length t '..: Height • GE N E R AC Generac Power Systems,Inc."P.O.Box 8,Waukesha,WI 53187"generac.com y ©2019 Generac Power Systems,Inc.All rights reserved.All specifications are subject to change without notice.Part No.0196470-D 08/19/19 1 , ' O N C ( = OC fL O U x96 N O L r 000 Ckn O r 33 r 2 w � w L . - •r- a" 04 3 m E w ;16I A Gz. z Z U ,:� G' Z w � Z Q.• � `� `O � � i 16 66 � a , E_- : z F " 6 w 42. 6 4— 6! 6} ,(}. }ram}ems., (} }( (25 BUIic, ENTDIECIE � VVILOK OCT - 6 2020 938 KINNY 10573 14) 39-5801 VILLAGE OF RYE BROOK BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#;, EP#: 0 Approval Date: OCT — 7 Permit Fee: S Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, c?9 : tpr ZO 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. � 4 I.Address: I'I CkQr-c .11 RD SBL: 1. .J,�� —�"1T Zone: 9-15 2.Property Owner: (Y)t C N A L L. L,isk n.J Address: Phone#:91y—fi 4-21`/� Cell#: email: LAsK„-J, &1j'L +tAtz2e_ M-44—CprA 3.Master Electrician: 1"1-A o1\L tM A Q,1t,X_ Address: ( 2 S_So IH r-J 5T 'T T L'-T O Lic.#:OO Phone#:203-'1/0.8317 Cell#: email: V7r"artkar C'' /Vs�t �t S'I Gwv..fo✓ Company Name: No Pg i 9¢rC/y>�ay L r T�vCAddress:SP a s- _Gt/N 5T- Bp T L1 Tpro 6o y v 4.Proposed Electrical Work/Fixture Count: W t rA- JN I O C t(r­ (je,, +6+^t STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: F(r ✓� �w1AE& LASkl^1 being duly swom,deposes and states that he/she is the applicant above named,and does further MP ( int name ofindividual signing as the applicant) L_ state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the O%,-►n•te For the legal owner and is duly authorized to make and file this application. (indicate architect,contractor.agent,attorney,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 perforted,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. S,oiorn to be ore me this Sworn to b ore me this day b 20 day of 20 2 d tgnature o Property Owner Signature of Applicant I&MEL LASklA) 5"CA►,V_ mA Print Name of Property Owner Print N e of Applicant kilo Notary Public Wotaiy Publ' Lisa J Bishop NOTARY PUBLIC State of Connecticut My Commission Expires 5/31/2022 3/21/19 Westchester Rockland Electrical Inspection Services, InC. Phone: 914-347-3595 DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue Fax: 914-347-3596 Elmsford, NY 10523 BUILDING PERMIT NO. TEMP ii DATE CITY OR VILLAGE ZIP CODE TOWNSHIP COUNTY t grog �s j� a�z j STREET AND NO:.OR ROAD POLE �o� i ' % v R C 14 ij 14-L I t� /4 BETWEEN WHAT TWO CROSS STREETS IS PREMISES L SECTION BLOCK LOT woo o(Z T 14 (1 r.,c> OCCUPANT'S NAME ) BUILDING OCCUPANCY tr� ,ci�� = I- '-A Rr s� ae�.�c� OWNER'S NAME AND ADDRESS HOME TELEPHONE NUMBER CURRENT SUPPLIED BY FROM THEIR OFFICE WORK TELEPHONE NUMBER I�NX 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 MNOWATT TION OUTSIDEBASEMENT1'FL. 0 2 FL. 3'FL. DEPA TMENT REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: 1 0 —F,,Ap- r9T ,N �weJA -c.�. o cu G✓ i w/�f 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 EQUIPMENT, 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 t x� sT T� RcmAr�v CHARACTER OF WORK NEW❑ ADDITIONAL❑ EXPOSED FI CONCEALED❑ MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD[. UNDERGROUND❑ kj) AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BEBE R\ETT,lURNCC(E��EDD. NAME OF COMPANY DATE OF APPLICATION SIGNATURE OF APPLICANT NO2TIi6 A ST 1VE;YLgTw cif c r Tr„ X G STREET ADDRESS TELEPHONE NO. r 8 ; -� �cn << y f CRY OR POST OFFICE ZJP CODE LICENSE NO.WHEN APPLICABLE / ��