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HomeMy WebLinkAboutEP24-189 a s � a e� N W a 4-4 N N N - \ i M �_ s z ) Cn W Q 3 w Lt, a 00 n V) P H n Cc, © o w a H1-4 En Ln z �l V W (�Wj] o v� ~ W Z x V V a ^ wC)OZ en Ow 1�1 c/� �..� Z ..� ON 00 CY V W V CA _ V O w z F-1 s 04 WCIO �I Qa a4 Z, BUILDING DEPARTMENT VILLAGE OF RYE BROOK SEP 2 3 M4 U 938 KIN(. STRf l i RYt BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK www.ryebrookn�.�ci�. BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester Countv Master Electricians License Required,! FOR OFFICE USE ONLY III' '��J` F1' #: / l CT SEP 0, 202 —4 7� Approval Date: _ Permit Fee: S Approval Signature: Other: DO NOT START WORK or CONSTRI CI ION t NT11.A PERMIT IIAS BEEN ISSt ED B1 1 HE BUILDING INSPECTOR. TIIE ADMINISTRATIVE FEE FORNORK PROGRESSED OR COMPLETED WITH OUT.A PERMIT IS 12%OFT11E AL COST OF CONSTRI CTION N1 iTH A MINIMUM FEE OF S750.00 Application dated, a is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and01`0 emove 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-bee in conformance with all applicable Federal,State,County and Local Codes, I.Address: �_[ �p ri,<0.6 L SBL: / J,f3"Tp! —� Zone: 2.Property Owner: ~� `Jr Address: 17 PypnJfzA06 ff Phone p: C] C4w�" email: 79 8.4r 3.Master Electrician/Licensed Installer: t 40 Address: SiA•cI e 3,eD C"T G1 90• Lic.#: J 3 S(o Phone ti- Cell p: 91Q 819 - email: /li"%AECtti7?�G �o a.,►u.J�.n/ET Company Name: -TA_F-�jff-TRI G Address: 5A/766' 4.Proposed Electrical Work/Fixture Count: fR EPL4Ct S-&&- Al 6 L L L5.4 rf� 66' "a &JF %b Ls 5.3"'Party Electrical Inspection Agency: s VV iii**iiiiitiiii*ii*i bill****iii*t*ik*******A*kkk*i*ikkiAi***i***iii***i**i****i*iii*iA**i*i*i****i*i***** STATE OF NEW YORK,COUNTY OF WESTCHESTER I as: Nt cq Atq- 1 .being duty swam.deposes and states that he,she is the applicant above named,and does further (print name of ntdi�tdual signing as the applicant) state that(s)he is the kf7_7XI041%) _for the legal o%tiner and is duly authorised to make and file this application. tMastcr Flcctnctan Licensed Installed 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 Statc Uniform Fire Prevention&Building Code,the Code of the Village of Ryc Brook and all other applicable laws,ordinances,and regulations. Sworn to be f4 me t � �``'L Sworn tQ,kefore me this day of 20�G wrt sar.>c�1rrfM naNy,t�o.irALti i++t».w York day of 30 puat�h.M in W.,tcf,.u«County Si nature of Property Owner My c0T,"106A'" 6'�2s Signature of Appli�JZIO-r� � G,�J J`C CU2r' i AcZ Print Name of r erty Owner P ' ame of Applicant r ARI MEL�VLsLO� -� Notary lic 1,NsiilttTftbjState of New York No 01ME616D663 6 1 Z024 tied In Westchester County n Expoes January 29.20—� STATE WIDE INSPECTION SERVICES, INC., Service Willi Iniegrily 1080 • • SWIS JOB APPLICATIONr2.7224 1 fax 914.219.10621 SWISNY.coml SWISTRAINING.COM Office Use Elect. Permit# 'J! dLl Date Q Bldg Permit# Sq Ft Plumbing Permit# Final Certificate# City/Village t Zip 7 j Building Dept County Address O n D PL Cross Street Section Block Lot Owner Name/Address(If different than above) Eo5 KR y Contact Number tv L/ ` J �- laj Doasement ❑1st FI. ❑2nd Fl. ❑3rd FI. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside OResidential ❑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 iP 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 cP-AC tD L-011 p C;er`4-r6l2 flv� Fi D IE11 `d[ [SEP 2 3 2024 DD VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one it)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,!fat 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 AddressAIA L e A Name - License# i 3,' Date Signatu Address City/State5./—,AM zip e Q(r,y6 Company _ _ IL Phone # /y 7 _O