HomeMy WebLinkAboutEP16-190 S =
1 �
11^
461 ON
QiON
4t A V3 M r
w � n
(40
to
ON
tn
o
hr A :!
C7 tn C12)
r
� o
0.0 C�
9z C#O) m
:44
r� l� ;� � .a w -• �
amax-
Z
Oo
V 9 cr+
�z ,
a
A W U d pG
�I a w
BUIL 1 I E AR .MENT VIL
938 KIN E ORR 13 JUt
' NY 10573 r $ Z
ors
(914)9 939-5801tgGE
.or 8U1LDlNG OF
BROOK
ELECTRICAL PERMIT APPLICATION F?rMEN7-
Westchester County Master Electricians License Required
FOR OFFICE USE ONLY BP#: ) EP#: EIP -4
Approval Date: JUL 2016 Application Fee: S
Approval Signature: Permit Fee: $ (-Z C
Disapproved: Other:
(fees are non-refundable)
Application dated, 7/14/2016 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.
1.Address: 62 Bowfmn Ave-, Rye Brook, NY SBL: Zone:
2.Property Owner:Dr. Mpmg — Ho Lee Address: 62 Bommin Ave., Rye Brook, NY
Phone#: (914) 251-1070 Cell#: email: RBCVX@yahoo,com
3.Master Electrician: Sokol, David G Address:19 Argow PL, Nanuet, NY 10954
Lic,r 27937$hone#: (845) 356-59M Cell#: email: davi0phoneind'ccm
Company Name: Central Alarm & Telephone Address: 19 Argo Pl., Nanuet, NY 10954
4.Proposed Electrical Work/Fixture Count: Low voltage installation of carbon muix-ide detectors to existing
system. (1) New Smoke Dectector
(3) Rep14t Smoke Decter=tor
STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as:
Dwid G. Sokol ,being duly swom,deposes and states that he/she is the applicant above named,and does further
(print name of individual 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 contractor
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 �efare me this Sworn to before me this 14
day of ,20114— day my 120
Signature o Property Owner Signature of Appli ant
My= — Ho 'Lee David G. Sokol
Pri t Narn of Pr� wner Print of Appl` ant
Notary Public I N Pub is
WANDA E. ROMM JACQUELINE PALMA
NOTARY PUBI.14 Of�y� Notary Public,State of New York
No. No.01 PA6195786
Qualified In W Qualified in Westchester Count
Commission �8-�ML Commission Expires Nov.03,20i5n6
Westchester Rockland Electrical Inspection Services, Inc, � Phone: 914-347-3595
DO NOT WRfTE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue Fax: 914-347-3596
Elmsford, NY 10523 I F BUILDING PERMIT NO.
TEMP# DATE
�Vye�roo c z� �3 TDwNSHIP ° TM er
STREET AND NO OR ROAD POLE NUMBER
62 Bmtrarr Ave. Rye Brook, NY
BETWEEN WHAT
TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT
OTl_1W . Goldstein BUILDING OCCUPANCY
OgryIER'S NAMEjr f ESS j�,Q�IF, I,F,�yOty�,glyAgBER.
CURRENT SUPPLIED BY FROM THEIR OFFICE WORK TELEPHONE NUM
LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED
NUMBER OF OUTLETS NO.OF F*(TURES& MOTORS HEATERS OFFICE USE
LOCATION LAMP RECEPTACLES ONLY
SIDEWALL SWITCH WCAD£ FLUORE NO. H.P.EACH ZATTs EACH INSPECTION
OUTSIDE D
BASEMENT
1"FL. L�
Z'FL. 4/�L " �
3-FIL ltD N OF gs�
- R rr k
REMARKS:LIST OTHER ELECTRICAL.DEVICES NOT SET FORTH ABOVE!
low voltage installation of carton monixide detectors to existing systias.
(1) New &rake Dectector
(3) Replace 5rtnke Dectector
THIS APPLICATION IS INTENDED TO COVER THE ABOVE LISTED ITEMS TO BE INSPECTED.IF AT ANY TIME OF INSPECTION ADDITIONAL ITEMS NAVE 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 EOUIPMENT.
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 C ExPOSED❑ CONCEALED[3 MUST ENTER APPLICANTS
IDENTIFICATION NUMBER
SERVICE ENTERS BUILDING OVERHEAD UNDERGROUND LIA-1 I I I
AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED,
NAME OF COMPANY DATE OF APPLICATION SIGNAlbIM OF APPLICANI
Central Alarm & Telephone 7/14/2016 x „
STREET ADDRESS TELEPHONE NO.
19 Argow Pl., Nanuet, NY 1Q954 (845) 356 - 59M
CrrY OR POST OFFICE 1 7iP CODE LICf2TIf9PPLICABLE 12000279379