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HomeMy WebLinkAboutEP24-129 = s = s e n N N A� - N N N � F A w U z U Cl) a z � w rz N51 Z ° © c A 00 Qt-I En Q1 `✓' ,y QQ a c a Z a c um u a F+■I w y.+ � W � W v z � � � w A � U z z c g © a n W o Z a Q w w z c¢'n w A 5 to w A z CA CY V o x °z O ►-a �3 o a w H a o w = o U - W � z o o a � a a � u o o x o a � ; 9 H w z z a z w a ° 2 a W a a a z w x � _ Q ECE V ILA BUILDING DEPARTMENT VILLAGE OF RYE BROOK JUN 2 0 2024 938 KING STRLET RYE BROOK,NY 10573 (914)939-0668' VILLAGE OF RYE BROOK tN t+w.rye.broof ny.jwv BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required L FOR OFFICE USE ONLY up#: EP#: Approval Date: 'tot - O _ Permit Fee: $ Approval Signature: �� _.._. Other: DO NOT START WORK or COWSTRI[XTION I)NIT11.A PERMIT HAS Bl°E:\ IS.St FID BV I'l f WILDING INSPECTOR. THE ADMINISTR,%TIVE FEF,FOR WORK PROGRESSFID OR COMPIXTEII WITHOUT A PERMIT IS 12%OF THE TOTAL.COST OI,'CONSTRI;C"I'ION N'I'1'11 A MINIMUM FEE.OF$750.00 Application dated, 6-0-2 V is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove electrical equipment,wiling, fixtures,or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all a lic ble Federal,State,County and local Codes. 1.Address: Y �// rtr W kt OD(�w 1 I S$L: Zone: 2.Property Owner: CAE5Address: M/A+02 dam'r V/. Phone#: Cell#: l email: �hli5 r`Vf S ;L a/�'tei , -U^ 3.Master ElectricianJLieensed Installer: uro Address: 0 'n +rI 5 w5 Fie p Lic.tt: Phone#: ell#: email: r vSf Company Name: �tC��ltu � �m5 n-r��bfd�7Address: /J� ( v� 4.Proposed Electric1alWorrk/Fixture Count: I v ml m 4(o r 66 A21 5.3'Party Electrical Inspection Agency: � lk T 5 w.rww+t+t+rw,�,rw**wwrt+M+tww+t+r*+k+txw*+r**tkWrw+ale+4xrt+r+r,k•tf+rwwr*#wwaw*wfwww**wtwwww*,xw.rxwww�rwwww�.:+wr+:+r*rwww+rr.,cs**+w 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 M the applicam) state that(s)he is the for the legal owner and is duly authorized to snake and file this application. (Master Hec-incian 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. 1 Sworn to before me this I r)--t11`% Sworn to before me this Z r1 of� Q__ 120 ' kA day of rill-0— Si rc of property Owner Sig6dre of Applicant Civ,t;S 7;tv t s 6� is e a Print Name of Prop vner Print N}am f Applk ant No P� Notary Public]oni Lamaj 6/1/2o'L4 Commission#01 LA0025681 pabonh Romano Notory Public Reg.No. Notary Public,State of New York OIR04636916 My Commission Expire z ' - Commision Expros; .4114 4. STATE WIDE INSPECTION SERVICES, INC. 1080 • SWIS JOB APPLICATION tel 845.202.7224 1 fax 0. Office Use Elect. Permit # �� r/ Date Bldg Permit# Sg Ft Plumbing Permit# Final Certificate# City/Village Zip 105 3 Building Dept. yap 11":� County Address //_+I wr J I( �f Cross Street Section Block 71-ot Owner Name Address(If different than above) ` / I 3 Contact Number -7 91 -�-) 6� ❑Basement ❑ 1st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 FL Garage ❑Attic ❑Outside [:]Residential []Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/O Detector Hood Trash Compact Amt Amps 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 ❑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 ❑ Safety Inspection ❑Consultation L N 2 0 202! 3D I VILLAGE OF RYE BROOK BUILDING DEPARTMENT 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 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. 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