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BUIL E MENT 3D
DEC 3 0 2022
VIL E OF RYE K
938 KIN ET RYE B NY 10573 VILLAGE OF RYE BROOK
(914)9 939-5801 BUILDING DEPARTMENT
.or
ELECTRICAL PERMIT APPLICATION
Westchester County Master Electricians License Required J
FOR OFFICE USE ONLY BP#: I P#: c:�)3—oO f
Approval Date: r)iAH \J 423 s Permit Fee: S
Approval Signature: Other:
Disapproved:
(fees are non-refundable)
Application dated, 12- L 'LL is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of
a Permit to install and/or renlove 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. q 1\
1.Address: �vl 4CCj G V'� tJ SBL:14 --- / Zone:/�ty�
2.Property Owner: �. (D q/ 19 e L t {" Address: -i 9 3 C l tN ke *-
Phone#: �j ti r 8 3U^►( �P 7 Cell#: / email: At e IM— ?A t�
k- �l�1 Q cap Address: a rN q
3.Master Electrician: ✓'Qvt Sp'� t�q� �✓ �t N►t►' o.t
Lie.#:�Phone#:?!Y-777-77 YIKell#:91 V-If?0-4 7a Z email:Company Name:r• 6-4S4el(4 N0 ii ! eL. in C Address: S r 1f✓0 Q A W^�' yePt r.0�+. �•
4.Proposed Electrical Work/Fixture Count:
STATE OF NE YO K, COUNTY OF WESTCHESTER ) as:
�r0F N � �S C l 4 k 7 being duly sworn,deposes and states that he/she is the applicant above named,and does further
(pnmt 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 6 04 4.0rl c-•�
for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,anomey,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 t fore me this � Sworn to before me this
day of ,20 day of ! 20�
r rp
Sigh a of Prope Owner Signatur of Applicant
Fvq,VA (2*s M
nt Name of Property caner Print Name of Applicant
Notary Public Notary PAlic
SHARI MEULLO
Notary Public,State of New York GREGORY M.RIVERA
No.OiME6160063 "a"Public,State of New York
Qualified 1n Westchester County No.01RI6U1398
Commission Expires January 29,202�- Qualified in Westchester County ,
Commission Expires September 26,20i L21Al)i
INSPECTIONSTATEWIDE
Service With Integrity
0:0 Main Street, Fishkill, NY 12524 1 email:•
SWIS JOBAPPLICATION0. . «
Office Use Elect. Permit# Date 1 Z ZC1 ZZ
Bldg Permit# Utility ID#
L •(oS8�3o
Final Certificate#
City/Village Zip IDS-7-3 Township County w es
Address n Jew (} t V L Cross StreetSection Block Lot
Owner Name/—Alddress(if different than above) /� + `ca, e G Contact Numbey!9—es03 0 _
[:]Basement ❑ 1st FI. ❑2nd FI. h]3rd FI. ❑More Than 3 FL [:]Garage ❑Attic ®,QytsidegZesidentiai [:]CommercialI
Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact
Amt Amps
Range(s) Cooktop(s) Oven is) Dishwashers Refrigerator Disposal Microwave Warm Draw
Incandescent Fluorescent
SERVICE
Amperage Voltage 1 P 3P #Meters #Disconnect ❑underground ❑ New ❑Reconnect
A00 1 Ld Z v ( l ®Overhead Change
❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection
Additional Information r'-a n `•� / , 'D a ���u , C_
DEc 3 0 2022
VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
This application is valid for one tl I 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.
Inspector Date Finalized Inspector#
Company Name Ca 5 4_1 4( ctol0 e C >nc Date /Z 2 ZZ Signature
Address D ,-Oct �� City/state v�f S 0 i" Zip Code
License# O Phone# 0 —
IDState Wide Inspection Services
cok-'> 1080 Main Street
RJAN 17 2023 Fishkill, NY 12524
S%V uas
845 202-7224 Phone
VILLAGE OF RYE BROOK 914-219-1062 Fax
STATE WIDE INSPECTION SERVICES BUILDING DEPARTMENT Email: office@swisny.com
Service With Integrity Website: www.swisny.com
BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES
CERTIFIES THAT:
Upon the application of: Upon Premises Owned by:
F Castellano Electric Inc Libia Declet&Gerardo Paico Eusebio
58 Broadway 493 Ellendale Avenue
Harrison, NY 10528 Rye Brook, NY 10573
Located at: 493 Ellendale Avenue, Rye Brook, NY 10573
Section: Block: Lot: Electrical Permit Number: EP 23-001
iai.2s
Certificate Number: 2023-0287 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: 493 Ellendale Avenue, 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 17th day of January
2023.
Name Quantity Rating Circuit Type
Service 01 200AMP
Meter 01
Panel 01
Grounding and bonding of service to current codes.
r
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.