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HomeMy WebLinkAboutEP25-074 N Ncq N ` A � 0-4 = a' 4 (` W T-4ON a O F-i N � ` a �' �, � z r• N Gx,, E-r °° � cn MM W v, W w wF a ~i 0 4 CA M a U O A 1, , o .a U U . 1 Fj oji - W 11 F�s/i v� w a U w _ 00 s a ^ v V Q W MM d ) A �Y w G (-� O a 5 � o c a W U � Er � [� a W V z A U U V (> w o �1 Lei. �i CYw Z O F4 1--i z x _ - a V O W i0i _ w � �-I A © A 0 >4 ° 04 U W " � a a 4 w x � a «�tE_t1RC�t,,y p C C C 0 a E BUILDING lSE MENT YII_, E OF RYE OK MAR 19 2025 938 KIN+�EET RYE B ,NY 10573 (914)934- VII -AGE OF RYE BROOK www.rt> w ny.gQy BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: EP#: MAVI &2D25 Approval Date: Permit Fee: $ 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$750,041 Application ,dated pp //i�" /!r�Gs 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 will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: W " /el O G& (? 7- SBL:��J/��J '��—1� Zone:�� 2.Property Owner: 5 GO T y- e-&/S H Aw tt1 Address:5 PA e ar R/®a-E GT Phone#: 917 S 7'6• /'/ 7 7 / Ceii#:9'/r,s 7 b- /7 r7 email: 3.Master Electrician/Licensed Installer: /'y Ce/6 Pt-_f fq C'}-/VO Address: '?o r4 of g b %�•r {�,Q Lic.#: 144 G Phone#:WAI-19 r5 �(110.5 Cell#:9'/#-673—Af 00 6 email: e'4A&7 dr L i N y /os/-s" �r ' LG. [ / C� 'v0. tit' Company Name: 6IP '�k r Address:90!��}�)9e ,��' ,ems e2�� ,{•/,� 4.Proposed Electrical Work/Fixture Count: J�:GG 1 Lt/1t� 7 -e�?l GO 4yea27 5.3rd Party Electrical Inspection Agency: -5 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,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 for the legal owner and is duly authorized to make and file this application. (Master Electrician/Licensed lnstallen The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work perforated,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 to befor a this Sworn to before me is N Li day O. 6' ,20 day of cl�Cc ,20 _ S' atYu Property Owner Signature of Applicant Sri t► W, IL0L; 12XVAtr9nv Name of Property r Print Name of Applicant Mul 0. _ ate of New York Notary ME61601J63 E6160063 Qualified In Westchester County t 2a Qualified In Westchester County Ctrmmlesion Expires January 29,20 Commission Expires 1enUary 29,20Z_� STATEWIDE • Service With lifilegrity 0•0 Main Street,Fishkill, NY 12524 1 eirmik aswis JOB APPLICATION ;. i 914.219.1062 • • • Office Use Elect. Permit# © Date � p Bldg Permit# Utility ID# Final Certificate# City/Village �J �- / 4"Oe� Zip �l' '7 Township R�� County (,�L�'�fi/�eS T Address Kill K n���J��� Cross Street Section Block Lot Owner Name/Address(if different thanabove) S Contact Number q/-1- 7 76 ❑Basement ❑ 1st Fl. ❑2nd FL ❑3rd FL ❑More Than 3 FI. Garage ❑Attic ❑Outside Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps Range I Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent SERVICE Amperage Voltage 1 PP( 3P #Meters #Disconnect ®Underground ❑New ❑Reconnect a&0 /Zq/2 (' ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information V ECOE MAR 1 2025 ' TMENT G O V B -D This appllcetlon is valid for one(1)year from the date received by SWIS.This application is intended to cover the above listed items tribe inspected,if at 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 authodzed agent agrees to all the above terms and conditions as set forth for the application. Inspector Date Finalized Inspector# Company Name � 1�Tif�/G C G Date a 3 1 Z Sign Address 90 Z)AC11/YA-0 City/State (✓.11"99M&M f N �Zp License# 66 e Phone# 9el ,_ d6T3 - V-00 5-