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BUILDING DEPARTMENT VILLAGE OF RYE B'ROOK DD OCT 2 8 2022 938 KING STREET RYE BROOK,NY 10573 (914) -0669 VILLAGE OF RYE BROOK www.DT!Xook.org BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: EP#: Approval Date: NOV 202V Permit Fee: S Approval Signature: A Other: Disapproved: (fees are non-refundable) ******�:*:k*#****sk******+k***#►*******kk#k*�****+l+kk##****k:kkklcle*yk**Iskk***k�****%*k**�*k*#******k*k:k** 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. 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. I.Address: �•G lY SBU 1Q5 .3S- - ` ` I� _Zone: 2.Property Owner: _U!:LY1 fA '�`)�p Address: '.`> • V el Phone#: ct 14-5�- sciID+ C Cell #: email: e� 'iZ�j - , � 3.Master Electrician: LWk� 'l)Y1`q��( Address: e, Lic. #:LaaA_Phone Cell #: email: p- � OVA11 4 0 M Company Name: A- PiakC ���.� r t�v7Address: A-3r,. 1JeuLj t1nc 4.Proposed Electrical Work/Fixture Count: ,- On Am t) �C-e_ V A YCn c�C: *d:*******4:*****************il•***�Y***:F*******E**-k*•k*****#*****k*****i:***•k*******;Fi.• ,**i;•A•*aF**•k h i•*k**7F******ir* STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: 04/%t e� R v6;A ,being duly sworn,deposes and states that he/she is the applicant above named,and does further i lu•nn ncunc nt ind1%uhi:rl aentng as the appltcann 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. ,mdicnic archnect.c,mtracu,r.agent.anorney.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 �14l day o 20 day of V hW ,29. 'L`t/ Si atu f P pe er �\\vQy STATE I'* Signature pp Sid� aat/tuu�re of Applicant Nam`\ - L-0 U IS Print Na a of Property caner = NOTE N = Print Name of Applicant p a�ti 00AN CcYMI i oimii�wl /try` p, 4 to Publ' %�fi�. .CO 'o��: Notary Public Nary Public, State of New York Qualified in Westchester Courtly ��1111tt� No. 01H061608�8�6� � r_ COn'trttiwion Expires3 8/12/2021 STATE WIDE INSPECTION SERVICES, INC. CA-) Serpice Witit Integrity 0•0 • SWIS JOB APPLICATION tel 845.202.7224 fax 914.219.1062 1 SWISNYcoml SWISTRAINING.COM Office Use Elect. Permit# _ _ Date 1� f52 � Bldg Permit# Scl Ft Plumbing Permit# Final Certificate# City/Village i Zip Building Dept. � t County Address I /1 /�f /`1�v,/i1' Y yl C'ross Street fl 3 Section f �S J lock ! Lot Owner Name/Address(If different than above) A�l � lr J/3-VA) Contact 1Number 7 L I _-3 ❑Basement ❑1st FI. © 2nd Fl. ❑3rd FI. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/O Detector Hood Trash Compact Amt Amps Range(s) Cocktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels iP 3P # Meters # Disconnect ❑Underground ❑New ❑ Reconnect ❑ Repair ljG l Overhead Upgrade ❑ Disconnect Utility[D# -�-- ❑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 R 1V FEE ID] OCT 2 8 2022 VILLAGE_ OF RYE BROOK i BUILDING nEPARTIVIENT J rhis application is valid(of one(1)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,if at any time 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 as set forth for the application. r Email Address P V C✓ �- p�= � [� ��61 LiqM jr AJ I CO-L Name L oars ^J� License# E �j Date Signature Address ,I�� re, V6 City/state N� � N r Zip Code le�sG7` Company /I je e4-/'-- C C)L.0 M1hj Ct E- (L Phone RDState Wide Inspection Services CAC> 1080 Main Street DEC 1 3 2022 Fishkill, NY 12524 845 2-7224 Phone VILLAGE OF RYE BROOK 914-219-1062 Fax STATE WIDF INSPECTION SERVICES BUILDING DEPARTMENT 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: A Perfect Goldman Electric Daniel Rubin&Anna Menkova 48 Potter Avenue 101 Old Orchard Road New Rochelle, NY 10801 Rye Brook, NY 10573 Located at: 101 Old Orchard Road, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP22-265 135.35 67 Certificate Number: 2022-8184 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: 101 Old Orchard Road, 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 13th day of December 2022. Name Quantity Rating Circuit Type Service 01 200AMP 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.