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BUILDING DEPARTMENT D
VILLAGE OF RYE BROOK AUG 2 12025
938 KIN(i STRF.F.f RYE BROOK,NY 10573
(914)9A9-0668 VILLAGE OF RYE BROOK
%vwxv.tvebrookny.=o,, RL1ILDING pEPARTP"ENT
ELECTRICAL PERMIT APPLICATION
Westchester County Master Electricians License Required
I O R O I'I.1( 1 1 s E O N l N III, n: !mod_— E P
Approval Date: AU Permit Fee: $ [ �`
Approval Signature: Other:
DO NOT ST%I0 MQRI%or(ONSTRLCTION L NTIL A PI:R\II I If kl� III,! ', I'%st 1 1) 131 I IIL BL ILDIN(. I`SPL( 1'OR.
THE 1D111\ISTR%TIFF. FEE FOR A'ORK PROGRESSED OR ( t►\I P[ F 1 1 1► \%I1 IIOL"I' A PERMIT IS 12%OF THE
TOT,U. ( ()`h OF C0NSTRt CTION "I i li \ \I I\I N I I \I FEE OF$7511.Oo
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. By signing this document, the applicant & property owner agree that all electrical work
performed will he in conformance with all applicable Federal,State,County and Local Codes.
1.Address:_L03 SBL: 7 Zonc:
2.Property Owner: Address o
Phone ft: ' 8 ' 6 ell#: email: � L, m
3.Master Electrician.'Licensed Installer: _Address: 5J
Lic.u: S] _Phone#: t 'J� S� Cell 4: q/ ' a r email: Ia I S T-A l.L t C C t@ It/4.Co17
Company Name: SgA4 '
4.Proposed Electrical Work f1lixture Count:
1vA
5.3`"Party Electrical Inspection Agency:
^' S'TATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
1C irAL1_ being duly swum,deposes and states that hc,`shc is the applicant above named,and does further
I`.,lilt rnni,•"I uhln id"'I,1.'n ik':��Il�r a1`l'�:.:.ri'i
state that(s)he is till /tL141� goa lS?Iq h,,L for the legal owner and is duly authorized to make and file this application.
'`•1..h I Irciirisu I irru,rl In..11i i
The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belie!.and that any work
perfomted.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 lJnifunn Fire
Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances. and regulations.
Sworn to before me this Sworn to before me this
day of 20 Adof" 20
Signature of Property(hurter ature Applicant
��a ao IJ IgT1A t_L
Print Name of Property Owner Print Name of Applicant
Notary Public Notary Public
6:1;'2024
L
5 Buckout Road
BETTER HOMES 11 West Harrison, 10604
Phone:9149090 6-0443
ELECTRICAL INSPECTION SERVICES INC. " " Email:betterhomes252@gmail.com
DATE: ELECT.PERMIT NO.
CI L GE ZIPCO E BLDG PERMIT NO.
o l 0 S7 3
ADDO S: r�Yi lt
UILDING DEPT
-- ai,:�= /�n i,�,
PHONE# VTJLITY
EMAIL ADDRESS: Residentia Commercial)
Q J
OW
NAME AL0 ADD SS
103 1f AUG 2 1 2025
'1�kyAnfjyD ?3
VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
WORK LOCATION:
❑Outside ❑Basement []Garage ❑Attic ❑Porch
Floor: ❑1st floor ❑2nd floor ❑3rd floor ❑4th floor ❑Other floor
❑Reinspection ❑Renovation ❑Generator ❑New home ❑Other
Comments:
&-A-
SERVICE AMPS CASE NO. SERVICE ENTERS BUILDING:
CON EDISON
Overhead ❑ Underground ❑
COMPANY NAME: DATE OF APPLICATION: LICENSE#WHEN APPLICABLE:
IFYVGUt,
c: 8
EET AD S: CITY: STATE: ZIPCODE:
/os
TELEPHONE: p CELL PHONE: EMAIL:
• D S• rJ � S �� • g p
SIGNATURE OF )
APPLICANT: X
The application is inter to cover the ted items to be inspected.If at any time of Inspection additional Items have been installed,we are
authorized to make the inspection and adjust tf to fee for the additional items inspected as provided by the applicant The applicant declares that there
are no open applications for the above with any other inspection company.Application only good one year after filing date.