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HomeMy WebLinkAboutEP16-299 a1 0) N kn 1C N o ac - w IYl o knCL. en o x 00 as PQ ID 00 cI- rN,%7 en C? ^r3 W M.T� W eY3 `D >� Q F s l�►/ !�1 ,� p � G � C .a C� � o < 0 go • LA '54 00 ~ W z CC a i` w wo �- � � O A ❑ W � � W V Q t w z ran � N A o w H � 0 � a ° a �I a a � w = CA BUILDING DEPARTMENT FCAT 31 2Q16 VIL E OF RYE 13 OK 938 KIN ET RY> Biu } ,NY 10573 VILLAGE OF RYI= BROOK(914)9 U"'�x(91 )939-5801 BUILDING DEPARTMENT wt cvvh Ockorjz ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required C� FOR OFFICE USE ONLY IMP#: EP#: �L r Approval Date: NOV 1 2016 Application Fee: S j Approval Signature: Permit Fee: $ ! Disapproved: Other: (fees are non-refundabfe) Application dated, is he eby 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 2IC� SBL: Zone: 2.Property Owner:VMVttJSe1 `V(Rxcc c_ Phone Cell#: email.a ,"32(2 QD1- ) 3.Master Electrician:�� K"tft_D Address:�3-i keasatn� S 3� Kt 'N0A)-4(k AQ Lie.#:�Phone#:Q,q—(Q_No 2h) D Cell#.qrq—p 7q--1Y,0D0 email: o tiC- Company Name:Nf6QQ a\QL� LCG-1 CMS kaM Address-53 71 G4Ye6 IJ1 P_U) �UL 4.Proposed Electrical Work/Fixture _Count: + �t..cs� /_►l �ErJ�gL���Y{X d�Uk�Tl�l�� � I��z�Slt] Dr'n5 "I�VIf'�G1 STATE OF NEW YORK,COUNTY OF WE.STCHESTER ) as: Di&IE2 lil D being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name orindivrdual 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 Caf*0r for the legal owner and is duly authorized to make and file this application. (indicate architect.contractor.agent.attomey,etc i 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 regul i Sworn to before me this Z I s Swum efore me t _ day o ct a b c v 20 _ days Qle k�J 20 lip S' o Property Owner ature of Applicant �1�L5 Y`✓LJtf I�� Print Name of Proper Owner P e o p i Notary Public otary Public MARISSA a. LEWIS NOTARY PUBLIC-STATE Of NEW YORK R©NALD A. MAMNO No, 02LE6310662 Notary Public, State of NY. Qualified to Nassau County No, 4688683 I/5i16 My Commission Expires Ceplember 02.2018 ualified in Westchester County nmmission Expires 1 —31_1,9 I�,r b We!WRITEtchester Rockland Electrical Inspection Services, Inc. Phone: 9 4-34 -35 5 DO HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue Fax: 914-347-3596 Elmsford, NY 10523 IN ERMIT TEMP# DATE � � C VILLAGE ^"� ZIP CODE TOWNSHIP O NTY � +STREET AN6 NO.OR ROAD `] POLE NUMBER BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED7 SECTION BLOCK LOT OCCUPANT'S NAME LDING OCRUPANCY WNEJ+NAME AN ADDRESS ��{ � � HOME TELEPHONE NUMBE -7 L-NX CURRENT SUPPLIED IL y\BY FROM THIf EIR _ OFFI/f'/9C1S}r 7,3 WORK TELEPHONE NUMBER JI 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 OUTSIDE _ BASEMENT P3'FL. �. ILLA E OF R E EROO;� � - REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: 1 Gnus f(DOM Lf-+ 5wi THIS APPLICATION IS INTENDED TO COVER THE ABOVE LISTED ITEMS TO BE INSPECTED.IF AT ANY TIME OF INSPECTION ADDITIONAL fTEMS 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 OTHEH INSPECTION COMPANY.WREIS,INC.IS NOT LISTING,LABELING,UNDERWRITING DR 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;] ADDT ZONAL C1 EXPOSED 7 CONCEALED" MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD❑ UNDERGROUND❑ Lj AVOID DELAYS BY GMNG PULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLI ATI N MAYBE REF FINED. ` x • It✓ 1 • '�+\,1' IT 1. 1^ `N•r / I( $NiMATUR F A 4C T NAME PANY DA QF APPLICATIO �(J STREET ADDRESS PLEPHONE NO - 2V CE ZIP COD1 LICENSE NO.WHEN APPLICABLE