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Home My WebLink AboutEP25-163 M ri lV N W LO O O N LO Ln 91, cn 4 � x � z a a a H W O A ti �j W a o r w O U04 A P� ( � c� 00 CJ} Z °° \ =+ O V W O e00 n Cn z U � C� a [�] Z FFF-�II N r. w ,cn z r 00 z Z � r U a"' � H x z w o a 0 >1 a yr_ QR___ �C � � V BUIL TEE MENT VIL OF RYE OK R JUN 2 a 2025 938 KIN ET RYE B NY 10573 VILLAGE OF RYE BROOK w n v I BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester Coun ]Master Electricians License Required FOR OFFICE USE 'Y N2 #•% EP#: C' 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$750.00 Application dated, CG'" 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 will be in conformance with all applicable Federal,State,County and Local Codes. (� 1.Address: la �Aotrlt 9 i,ue D,4- SBL: /J !�.�'�"- / -Zone: ello 2.Property Owner:-I-)M 1YTj4 y P8 R-ro'l Address: A r4 dr Phone#: tom, SR 7 -S 70,-Cell#: email: 3.Master Electrician/Licensed Installer: H r GNAiZ ItZOy Address: 7q t9,Cr4,L BR^E Ra ST4 M 'C'a 0&7io3 Lie.#: 13 8 0 Phone#: 3�a 76 �y�s cell#: C9 t j 879- sy 8 7 email:An E ecy tL 49 e rro V .�wlE .iy 67 Company Name: A--rA. Address: 5 4 M cr- 4.Proposed Electrical Work/Fixture Count: "Ante aCO fAWI C,6� t S&L FRQM CALLL5 Ta r7�57' 5.3rd Party Electrical Inspection Agency: 5 y-j +� STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: d1C.NACa __rRd ,being duly swom,deposes and states that he/she is the applicant above named,and does further (print name of individual s' n ng as Iie tl state that(s)he is the�j [!909 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 f the Village of Rye Brook and all other applicable laws,ordinances,and regulations. Sworn to be re me this l� Sworn to re me this day of 20 day of 0 � Signature of Property Owner Signature of App .y Jed y �Popewner fApli cant A� No Publ' TIANNA MAJOR No a e o ew York Notary Public-State of New York ' o.01fiAE6160063 NO.OIMA0005867 Qualified In Westchester Coun#1-�/2024 Qualified i Westchester County Commission E lres January My Commission xn Expires Apr 19,2027 p Y 29,20 o STATE WIDE INSPECTION SERVICES, INC. Service Wilh Integrity 0:0 Main Street, Fishkill, NY.125241 Email:OFFICE@SWISNY.COM SWIS • 0. Office Use Elect. Permit# � � /f Date 1-2 Bldg Permit# Sq Ft Plumbing Permit# Final Certificate# City/Village q, n Zip 015' Building Dept. County Address 1 A 'iD 1 Cross Street Section Block Lot Owner Name/Address(if different than above) Contact Number ❑Basement ❑ 1st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic Jjr0utside Iii["ftesidential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/O Detector Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels 1P 3P # Meters # Disconnect ❑Underground ❑ New ❑ Reconnect Repair Q(50 I I Froverhead ❑ Upgrade ❑ Disconnect Utility ID# ❑Con Ed ❑ NYSEG ❑Central Hudson ❑ Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect Junction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation Cr-I A/V -6 &XI sT1 0,CZ IN -T o CECEME 3D JUN 2 0 2025 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one lii year from the date received by SWIS.This application is intended to cover the above listed Items to be Inspected,Hat 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 authorized agent agrees to all the above terms and conditions asset forth for the application. Email Address � A'_ I L 6arr oyLj,,jI6 Name t C 14A C Qc�v License# Date 4 A., ds Signature Address ate — *- 1 .rGld� City/S r A/`''�►'"O -o C-7 Zip Code 06 C-o 3 Company Phone# 203 17 _ r C'E&- (91Y) F79 +9g0 7