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Home My WebLink AboutEP24-079 G� C N N W e \ \ - � W v w U A W Q O � \ w a ca O o Ln o $ A , � O 1-4 O cr W Ln 00 GIN z z - 0o U aQ V W a x 3 o zz - w - o 0 0 o v U r C7 w a � z a w z _ H Q o - _ �I =1 P-4 a 04 w xcn BR BUIOno ENT VIC. OK 938 KINNY 10573 ! APR - 9 2024 _._-__.LViLLA6 G R 7E BRQOK BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required / FOR OFFICE USE ONLY BP#: EP#: / Approval Date: Permit Fee: $ `- Approval Signature: Other: DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDLNG 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, T' I �cD 21 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 1`�1e�%—-- tC1 SBL: l3S".�— (— A L Zone:/e!p 2.Property OwJr:ne Address: Phone#: !7 Cell#: email: 3.Master Electrician/Licensed(Installer: Anft=LAwuekm Address: I f J , ` Ylt ht_ Lie.#: a 6 Phone#: "t k4—qZ4—Ff()Cell#:, 'qt4 4I LCO email: Company Name: MC44Ar_[ [.p R- Address: 4.Proposed Electrical Work/Fixture Count: 5.3rd Party Electrical Inspection Agency: 5k:L�u)lam. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: YI'1f n e k K i, ,being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name orindiv' I singing a the ap sca�nyt�) state that(s)he is the " glrA J I CA&Y 1 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 q Swom to b fore me this 9-") day of ,20 _ da f 20 2+ Signature of Property Owner i ature of Applicant P ' ame of Property O er Print Name of Ai licant AAA 7 DARLING ALL)ANA Notary' Id GORY M.RIVERA NV-,Iry f fb;,c.Sta:e of New York otary Pub Notary Public,State of New York No.c"AL542t;946 No.01RI6441398 Qualified in tiS';;aches: County I fo13o/2023 Qua y Expire ;;• 'W20 - Qualified In Westchester County 1 r,,.. L-1—C—l—Q—+av har 74; 7f- STATE WIDE INSPECTION SERVICES, INC. 0:0 • • SWIS . : APPLICATION0. • Office Use Elect. Permit# 3� Dade Ll/G� �Ll Bldg Permit# Sq Ft 7�/ � Plumbing Permit # Final Certificate At City/Village zip � ^�?) Building Dept. County Address ?J Cross Street Seddon I�� Block Lot b 1 t Owner Name/Address Of different than above) � Vznrv-� Contad Number ❑Basement ❑ 1st Fl. ❑2nd FI. ❑3rd FI. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/0 Detector Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels IP 3P # Meters # Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair ❑Overhead ❑ Upgrade ❑ Disconnect Utility ID# MG^ "f'� 1q 5(�on Ed ❑ NYSEG ❑Central Hudson ❑ Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect ]unction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation 0-6 7- c Po L-,e R -TS i l APR - 9 2G24 1 VILLAGE Cyr NYC= =JJ`00K BUILDING--` PAORIfOENT .------1 . r t This application is valid for one(1)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 of authorized agent agrees to all the above terms and conditions asset forth for the application. Email Address 1 Name License# Date (? 0612-4-- Signature Address If�Q / .� 0 y/State Zip Code Ic—IS&D Company �✓� ` +"� Phone #