HomeMy WebLinkAboutEP24-209 _
C�
N �
N
Cw aS W
V c
zoo
I-+
o�c O Z
Nw Lno00
a z ;g z
M O I V 0
a
Cl) W aC -
z
O A we _
w
11 Ei d cn V z o
W Z
x w
BUILDING DEPARTMENT
VILLAGE OF RYE BROOK OCT 2 2 Z�24
938 KING STREET RYE BROOK,NY 10573 ^`
(914)939-0668 VILLAGE OF RYE BROOK
www:acht-ookny.Fsz BUILDING DEPARTMENT
ELECTRICAL PERMIT APPLICATION
Westchester County Master Electricians License Required q
FOR OFFICE USE ONLY BP#:
Approval Date: OCY1 Z 20 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$750.00
Application dated, 10 It I t-4 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 willbe in conformance with all applicable Federal,State,County and Local Codes.
1.Address: A �J efAl 'e STry-&t- SBL: /'t ,35- Zone:Od-S
2.Property Owner WQS WMk4!" I Qtr)C elfkZA4 Address:
Phone#: T/y' 4 I9- V 4 t- Cell#: Q 14 -y 14-31 (v 6 email: 0
ems,
3.Master Electrician/LicensedInstaller: F,aw, k- C43 �((dtao Address: sp ��'L� .y �y, /of+
Lic.#: 6SZ Phone 044-777-?3qQ Cell#: Qllf-�{q0-�i?�L email: F'^Q&ikt�e- ttoe@_ Qel.ca
Company Name: Ir'• 64s 4eA wc. .6lec- _a+c- Address: S8 O/b 0.�
4.Proposed Electrical Work/Fixture Count: 4
` go-wova- J- r& Pl4ae e_xCr4-ail. .Plcov ✓ eSCen4- -9•X+00-4-S
u� -�('� L. 6 0 :,, K 4 w-.r-C (*) 8' ,/:S .-Qy care 'lol'ere b D1
5.3rd Party Electrical Inspection Agency:
STATE OF NEW Y(ORK.,COUNTY OF WESTCHESTER ) as:
fr�tN F C ar-k I lR N 0 being duly swom,deposes and states that he/she is the applicant above named,and does further
(print name of individual si mng ase applicant)
state that(s)he is the let r- f G 04 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 t efore rpe this Sworn to before e t s
day of day of
Stgn lure of Property Own r Signa a of Applicant
.1 �ar-�e/firma
' Name of Property er Pri ame of Applicant
otat otar ublio
Me"Public,State of New York GREGORY M.RIVERA
No.01RI640398 State of New York 6iv2024
Commission
In Westchester County Notary Public,
Conission Expires September 26,20 No.01 RIGUI398
Qualirled in Westchester County �/
STATEWIDE •
Service With lirtegrity
1.1 Main Street,Fishkill, NY 12524 1 email:• •
SWIS JOBAPPLICATION8. 12.7224 I fax914,219.10621 • • •
Office Use Elect. Permit# Date
Bldg Permit# Utility ID#
Final Certificate#
City/Village C ( oa P— Zip 165 73 Township 9,-O k County W eS'
Address aW 2?� .?' K tcQ S 4- Cross Street Section Block Lot
Owner Name/Address of different than abovel will k J vii Y +,D" ` q fr k 4"q 41 CContact Number Cr �U_ � Ici
WBasement ❑1st FI. ❑2nd FI. ❑3rd FI. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside ❑Residential i �ommefrcial
Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact
Amt Amps
Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw p
Incandescent Fhref=seent
SERVICE
Amperage Voltage 1P 3P #Meters #Disconnect ❑Underground ❑ New ❑Reconnect
❑Overhead ❑Change
❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection
Additional Information D r
r'c 1° fill 0,
n =
OCT Z 2BROOK
ZC24
RTN-IENIT i
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 d 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 Impeclion company.The applicant.owner
or authorized agent agrees to all the above terms and conditions as set forth for the application_
Inspector Date Finalized Inspector#
Company Name C'ox 1Qt,0 j5'r.Q c- Date IF 0 ll Z III Signature
Address S p ro q 4Qw� City/State f-rillillirr 1'ro'n V . Zip Code �2
License# S Phone# 0 — 60