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BUILDING DEP , MENT AUG 18 2022
VIL f E OF RYE BROOK
938 KING EET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK
(914)939-0668 BUILDING DEPARTMENT
wwwaebrook.or
ELECTRICAL PERMIT APPLICATION
Westchester County Master Electricians License Required
FOR OFFICE USE ONLY BP#: �! j EP#:
Approval Date: AUG' 1 22 Permit Fee: S
Approval Signature: �� Other:
Application dated, f' �a 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.
I.Address: SBL: 1,7 1p. y3 6 !_,7 Zone: (Z Z(U
2.Property OOwner: S C A u e°l(Cr Address: {00 2-
V ►�4 �f`
Phone#: Cell#: email: ,14 t V-rA(V+N 1°Sa YU 6 •_(0 M
3.Master Electrician: 0�voyk i Address: r Win ' �a t f 3l-e r
Lie.#: Phone#: 1 Y - -w7 Cell#: ,e1mail: (0ri t4 Sh:N YIOi-C {0� �e({ , C to lM
Company Name: �OC(p [f f tf C'C co f p . Address: -ri 0 j 1u 0 C+1A T�,G V CV Nt A 0*,0VM e
4.Proposed Electrical Work/Fixture Count: f Pl aCC M`1t0 , y2 e-(ecf c, C
5.3'Party Electrical Inspection Agency:
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
,being duly sworn,deposes and states that he/she is the applicant above named,and does hither
(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
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 to before me this Sworn to before me this
day of ,20 day of ,20
Signature of Property Owner Signature of Applicant
&t='O r�C, C f ry Ir'Y%t
Print Name of Property Owner Print N e of Applicant
Notary Public Notary Public
6/23/2022
STATEWIDE INSPECTION SERVICES,INC.
Service With Integrity
0•0 Main Street,Fishkill, NY 12524 1 email:
SWIS JOBAPPLICATION0.
Office Use Elect.Permit# �/► / �� Date
Bldg Permit# Utility ID#
Final Certificate#
City/Village n Zip lI®S.� Township V, County WeJ fCh-(f r-
Address 002. V Cross Street Sec Block Lot
IL
Owner Name/Address(If different than above) ; K k C k N e I I'LOC Contact Number
asement ❑ 1st FI. ❑2nd FI. ❑3rd FI. ❑More Than 3 FI. ❑Garage ❑Attic utside esidential ❑Commercial
Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact
Amt Amps
Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw
Incandescent Fluorescent
SERVICE
Amperage Voltage 1P f 3P #Meters #Disconnect ❑Underground ❑New ❑Reconnect
xD4 (tQ f L' f/ verhead Change
®Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection
Additional Information
IZ PIa« Ivna etecttr; c -rex&t ? nce -4 r Path a•+d +rroo
LECF, OWI E
AUG 18 2022
VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
This application is valid for one Ii I year from the date received by SWIS.This application is intended to cover the above listed hems to be Inspected,h at any time of inspection additional hems 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 as set forth for the application.
Inspector Date Finalized Inspector#
Company Name Ot t0 oeLf'f3 r Date r Z Z Signature
Address 7o IA
a� 1 arr City/State paqili C Zip Code
License# Phone# z I
State Wide Inspection Services
1080 Main Street
CADI` Fishkill, NY 12524
�] TO845 Phone
914-2194-219-1062 Fax
STATE WIDE INSPECTION SERVICES Email: office@swisny.com
Website: www.swisny.com
Service With Integrity
BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES
CERTIFIES THAT:
Upon the application of: Upon Premises Owned by:
Norco Electric Corp. John& Nikki Schueller
George Cotrona 1002 King Street
709 North Barry Avenue Rye Brook, NY 10573
Mamaroneck, NY 10543
Located at: 1002 King Street, Rye Brook, NY 10573
Section: Block: Lot: Electrical Permit Number: EP22-192
129.43
Certificate Number: 2022-6095 Building Permit Number:
A visual inspection of the electrical system was conducted at the Residential occupancy described
below.The electrical system consisting of electrical devices and wiring is located in/on the premises
at: 1002 King Street, Rye Brook, NY 10573
The Basement and Exterior were inspected in accordance with the NYS and NFPA 70-2017 and the
detail of the installation, as set forth below,was found to be in compliance on the 101h Day of October
2022.
Name Quantity Rating Circuit Type
Service 01 200 Amp
Meter 01
Panel 01
Grounding and Bonding of Service to Current Codes.
Officer Frank J. Farina
This certificate may not be altered in any way and is validated only by the presence of a seal at the location
indicated.This certificate is valid for work performed on the date of inspection only.
State Wide Inspection Services
CAS 1080 Main Street
Fishkill, NY 12524
A 845 202-7224 Phone
T01010" 914-219-1062 Fax
STATE WIDE INSPECTION SERVICES Email: office@swisny.com
Website: www.swisny.com
Service With Integrity
BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES
CERTIFIES THAT:
Upon the application of: Upon Premises Owned by:
Norco Electric Corp. John& Nikki Schueller
George Cotrona 1002 King Street
709 North Barry Avenue Rye Brook, NY 10573
Mamaroneck, NY 10543
Located at: 1002 King Street, Rye Brook, NY 10573
Section: Block: Lot: Electrical Permit Number: EP22-192
129.43
Certificate Number:2022-6094 Building Permit Number:
A visual inspection of the electrical system was conducted at the Residential occupancy described
below.The electrical system consisting of electrical devices and wiring is located in/on the premises
at: 1002 King Street, Rye Brook, NY 10573
The Basement and Exterior were inspected in accordance with the NYS and NFPA 70-2017 and the
detail of the installation,as set forth below,was found to be in compliance on the 10`h day of October
2022.
Name Quantity Rating Circuit Type
Meter Pan 01 200AMP
Main Panel 01
ATS 01
Officer: Frank J. Farina
This certificate may not be altered in any way and is validated only by the presence of a seal at the location
indicated.This certificate is valid for work performed on the date of inspection only.