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HomeMy WebLinkAboutEP17-203 i as i _ fe) 0 x N GC a 1 DO :y1 N � OD O� OG F s 00 �„} tr) W t7 W x 3t C W W M �. M E, W Q � : M u LLA 96 U OVOr cl F p� Q _ Zw r W ol z y z V V = V i © z CL .. Q Q C7 N p O < wgL. �" a BUILDING DEPARTMENT AUG — 1 20I7 DJ VILLAGE OF RYE BROOK 938KINc;S,'1 ETRYEBP�,)OE,NY 10573 VILLAGE ,L RYE BROOK (914)93 0668 AX'(�14)939-5801 BLJIi_I7li:�: DE--PAS TMENT %vtr ynabrdok.or8 ELECTRICAL PERMIT APPLICA'I'ION Westchester County Master Electricians License Required FOR OFFICE USE ONLY 13P#: 1,P#: I Approval Date; AUG — k1W Application Fee: S Approval Signature: Ax� Permit Fcc: S Disapproved: Other: (fees are non-refundable) Application dated, 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. I.Address. ' "z . _ sBi.: 3(9"- 1 - D3 lone: Z.Property Owner: 120-k.40— Address: LvetAi-A.,#__ Phone#: Jj t it. 5bo • 1Z LI_—_Lj Cell 4; email: 3,Master Electrician: —na 1�1C. UL,'-,A" Address: I/ - wau-,S+ L"t A (CA, P-) j I Lic.#: j '-7 �-- Phone#:aft-i_ ,j 7' )'1-�J q Cell#: email:_ Company Name:_I�. �t f Address: r3f1A 1 v.A-- 4.Proposed Electrical WorkMxave Count: J (.t � 'gfw* i"Y 11,E>t c lm'c7 - — j STATE OF NEW YORK,COUNTY OF 1WESTCHESTER ) as: PA �',�— Trf � ' ,being duly sworn,deposes and states tha t she is the a?plicant above Wanted and does further Ipnm name ofcndcvwuul signing as the applicant) state that(s)he is the I,--gal ownt:r ofthe property to which this application pertains,or that(s)he is the for the legal owner and is duly ituthorized to[Hake and life this application. titxficate archae,:t,eonvactm.agent,attorney.etc t The undersigned further states that all statements c intained herein are true to the best of hWher 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' f�-4 Sworn to before me this Sworn to before me this day of —T-/v 24L7 day o 20 . Signature Of Pr ope Owner Signatt'se of Applican Print Name of P operty Owner t t`"ame of Appl' ant , Notary Publ' otan�P. c =BLIC. N UB ran a. t itir�ti#E�t��AE Nf7TSTATE OF 1NEW PORK -' t+ t£s t''S�[k'rC r`cl�'Y`1`#( OATE 6t NT�i�t;3lstrat�or Nei.Gts�i57At7 tstchester County -fit�t cy Cot:*t�� Ctt *nF - t Vi%3,2018 res January 28,2n2a i r�?i c i Westchester Rockland Electrical inspection Services, Inc. Phone: 9144 V- 95 DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue Fax: 914-347-3596 Elmsford, NY 10523 B ILDING PERM TEMP K DATE CITY ? LLAGE ! r' ZIP ODE TOWNSHIP COUNTY STREET AND NOaR R POLE NUMBER 21- BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION // BLOCK LOT OCC S NAM BUILDING OCCUPANCY OWNER' NAME AND ADDRESS H E NUMBE��` 7jo-S7 CURRENT SUPPLIED BY FROM THEIR OFFICE WORK TFLFPHONE NUMBER LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS NO.OF FIXTURES& MOTORS HEATERS OFFICE USE LOCATION LAMP RECEPTACLES ONLY SIDEWALL SWITCH INCADE FLUORE NO. H.P.EACH NO. WATTS EACH INSPECTION CT9OUTSIDE 1 BASEMENT ,`-FL 2"FL 3-FL, I I yy ((�� IO REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: I�"11 L.I_ C' I_a�4 r;.._..I Q 1 THIS APPLICATION IS INTENDED TO COVER THE ABOVE LISTED ITEMS TO BE INSPECTED.T 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 AS PROVIDED BY THE APPLICANT.THE APPLICANT DECLARES THAT THERE IS NO OPEN APPLICATIONS FOR THE ABOVE WITH ANY OTHER INSPECTION COMPANY WREIS,INC.IS NOT LISTING.LABELING.UNDERWRITING OR CERTIFYING ANY EQUIPMENT, MATERIALS OR DEVICES WHICH ARE PERFORMED BY OTHER CERTIFIED TESTING AGENCIES OR INSPECTION COMPANIES.THE APPLICANT.OWNER.OR AUTHORIZED AGENT AGREES TO ALL THE ABOVE TERMS AND CONDITIONS AS SET FORTH FOR THE APPLICATION. SIZE OF SERVICE FEEDERS CHARACTER OF WORK NEW- ADDITIONAL L] EXPOSED L CONCEALED MUST ENTER APPLICANTS d IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD F'.. UNDERGROUND L AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION/MAY BE/RETURNED. fffXX---- V SIG F APPLIC NAME OF COMPANY / DATE OF APPLICATION STREET ADORES S TELEPHONE NO. ems_ 91C/ 7q-7 CITY IC. ZIP 1V LICENSE NO. HENAFPUCLE �� �j 1�