HomeMy WebLinkAboutEP24-071 x =
_
a
� � c
N N \ n d
H A a x 0-0 a
z v f�
w a
W
LO M fl =
�w A .
U 00
z
w Q °° H o w a Q U
CN
Z
3 w
00
z w o z
V z
1.4 z ¢ ]
�•L� f�-1 V W V V V
W 0-4 o °
a � W W C
W O z g
V �-4
= oo z w A o �
x
z a 0
a
D
BULL E MENT MAR 21 2024
VIL E OF`RYE OK
938 KIN F7 RYE B ,NY 10573 VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
wt��ty oo .or
ELECTRICAL PERMIT APPLICATION
Westchester County Master Electricians License Required l
FOR OFFICE USE ONLY BP EP
Approval Date: APR ' y Permit Fee: S �
Approval Signature: Other:
DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY 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 S750.00
Application dated,C'tCCA M4 r' 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. y
I.Address:3t- rJL11�t�,Y� ►L;f �/C� SBL: i 7 � —� / Zone:
2.Property Owner:C—A I ;Mt° i5 Address: t� i _
Phone#: �3 _33 `y 'Cl�i Cell#: email: S7Q a"
3.Master Electrician/Licensed Installer: P I -
Address: � !'lCC`
f�oboi5 r; �
Lic.#: Phone#:LSD —7,4-01c7 P)Cell#: email: ,C :L'N
Company Name:i fP � ft9b [/'N Address:
4.PropNose,d,Electrical Work/Fixture Count:
5 3A Party Electrical Inspection Agency: t
S F N �RK,COUNTY OF WESTCHESTER ) as:
daL`�31J!Being duly sworn,deposes and states that he/she is the applicant above named,and does further
(print name of ind"dual stning asthe ap iewm
Sr that(s)he is the for the legal owner and is duly authorized to make and file this application.
(Master Electrician 1 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 f t Sworn to fore m his
day of M!✓c L_ 20 day of 20
Signatufe o"i Pro erty Owner � Si ature ofAppliicanft
�er`� f 1),C NameoffPrr Ow er i&RWOFMi
Q • t
�un,
ory Public —�
1013012023
R* . No.O NAMM! Notary Pulal"t to York
WWdW in MIMIl11MM�► auaMad In��
Commission E> rM MWO 1-s. '' vow•
STATE WIDE INSPECTION SERVICES, INC.
(A—) Service With IntegritY
•:0 • •
SWIS JOB APPLICATION tel 845.202.7224 1 fax'914.219.1062 I SWISNYcoml SWISTRAINING.COM
Office Ust, Elect.Permit# jC}�1,1....Q h! / Date � 3 \
Bldg Permit# Scl Ft cj
Plumbing Permit#
Final Certificate#
City/Village Rye-brook Zip 10573 Building Dept. Rye brook County Westchester
Address 38 belle fairy blvd Cross Street Section Block Lot
Owner Name/Address(If different than above) Childtime Contact Number
❑Basement ❑1st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside ❑Residential ❑t✓ Commercial
Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/O Detector Hood Trash Compact
Amt Amps
Range(s) Cocktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch
SERVICE
Amperage #Panels 1P 3P #Meters #Disconnect ❑Underground ❑ New ❑ Reconnect Q Repair
[—]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 Q Safety Inspection ❑Consultation
Scope of Work
Re-engineer existing fire alarm system was replaced by another company -—
D [E` EE
ID
APR - 3 202,
VILLA � �GE OF RYE BROOK
BUILDING DEPARTMENT
This application is valid for one Ilf 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 B.dickerson@empirefps.com Name Brandon dickerson
License# 12000067480 Date 4/3/24 Signature Brandon dickerson
Address 75 bermar park City/State Rochester zip Code 14624
Company Empire fire protection Phone# 585-720-0390