HomeMy WebLinkAboutEP24-183 x e
x
M M
OC ell)
N N N
tV
a
A
W w A W
V v a a o y x
Nt
,
00 �
c W
Ln
A x z z w =
W + ! W W C cr- W F O
cn d M z Ln
Uz V ,
a� P-4 _
= O � W � Z x v a s z UO
c W a x v W A
M0-4
U W W Ca
MCI � CN g G� O A � w(� z Z
W x
� Z:)
Q ]
° z z cn z w
O 0
U -
W. O a
o
CA Le;pq w z
M
z w ° A o
�--I w
O V a W
yC DRc�uk
BUIL E _ MENT SEP - 9 2024
VIL E OF RYE OK --�
938KIN ETRYEB NY 10573 VILL�Gi_ Or :Y COK
(91419 939-5801
or
ELECTRICAL PERMIT APPLICATION
Westchester County Master Electricians License Required
FOR OFFICE USE ONLY #: EP#:
Approval Date: SEp Permit Fee: $
Approval Signature: Other:
Disapproved:
(fees are non-refundable)
Application dated, l' 9—D y 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. ^7 J
I.Address: t 69 8 S. 2 , ``e e� �t''I SBL: I1�r c) —/ --CP Zone:
2.Property Owner: W t e\ 1Q zcx LL(- Address: A4 �y 'Rt Clr� ig2.a
Phone#: Celt#: email:�ahG 1 Q n l irj C@ w n e,, a Co m-
3.Master Electrician: An' hoA A Co,S, 13 i G q✓l o Address:4' (-ya,n A S!Jy ee + N C w sods 16 A.Y I461
Lic.#: 331 Phone#: q 1`j —1 2 ?), 1133 Cell#: email:ntcf_s ler+h tc aISev v".ck o k}Iool[.co M
Company Name: NttKl} C��PC-�fIcal Seyvl&/1l LtCAddress: Lit Ayond Ciye.9-j Nr(.,, 1Za,_kI lU"1
4.Proposed Electrical Work/Fixture Count:
neL j L00 ALP �iat� ls�on,nQL -
***itF it*it**it*sFiF*it*it#'ktk eF*it Rir+F�*****ti<*lklth']F'k**:h*nYYC**it it it yF it:k iF it:F it ici:itir kit*:Fit*:Yk:F9t:k irit tk it:F it it:F:F it ie:F*i:*****��:C�:t k:k is*�is X
q/ STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
1 ,yyy\owAn ,being duly sworn,deposes and states that he/she is the applicant above named,and does further
(print name of i dividuai signing as the applicant)
state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the
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
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 efore me this Swo to before me th' kgj_ `
of 1 ,20 741 d ,20 Ly
JV
ture of roperty OavWtd,*j ofxwbwt
Pr a e of P er er� Print Name of Applicant
it>� VV1 yj-�- C4o-k
otary Public
FAILENA NAKAN.IIN ONAGHYOW.STATE OFNk1NY0RK E::Zl
OF NEW YORKation No.OtMA00136�5 ntyd In Westchester Countymission Expires srt9r2027 348554 rzlre a
—
STATE WIDE INSPECTION SERVICES, INC.
cjk--:) Service Willi Integrity
1'1 • i
SWIS
JOB APPLICATION12.7224 1 fax 914.219.1062 1 SWISNYcomli
Office Use Elect. Permit# ���[��f Date
q1� Z�1
Bldg Permit# Scl Ft
Plumbing Permit#
Final Certificate#
City/Village �, V Zip 1�5—1 3 Building Dept. t� e)Ju c,(- County P G i,--�k
Address ` S1` L Cross Street Section Block Lot
Owner Name/Address(If different than above) VN ` CC Contact Number (3 (LI — -�O VO]-'
❑Basement ❑ 1st Fl. ❑2nd A. ❑3rd Fl. ❑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 1 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 3unction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect
Legalization ❑ Safety Inspection Consultation
D
I
EsEP - 9 2024
VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
This application is valid for one(t)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.
Email Address O IL P y P Y .C u-, Name r)
License# Date t� 12LI Signature
Address LI r�� City/State C le ��n
f Zip Code
Company L \S (Al S'V VWL l LL Phone `7 - 3 113 3,