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III. OF Y �, > NOV 17 2022
38 K[No ET RYA B .€r;C,NY 10573 VILLAGE OF RYE BROOK
`' 14 2% BUILDING DEPARTMENT
www.r-V&tdok.org
F IXTPUCAL PEItMIT APPLICATION
Westchester Coulnty .Nlaster Electricians License Required
FOR OFFICE USE ONLY HP#: EP#: Cc�!''��/Q
Approval late DEC Z 2. I ermit Fee: $
Approval Signature: Other:
Application dated, is hereby made to the Building Inspector of the Village of Rye Brook NY, for the iss,iance 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 conforrn&)ce with all applicable;Federal,State,County and Local Codes.
L Address: 35 + 0 Uri: SBL: _ c [ - -_ .�- Zone f
2.Property Owner: _�-VP.D%w.r) 24A,77[ rt. Address: a
Pltonw Cell#: email: 5ZLv(C
---�� y
3.Master Electrician: __ Address:��) �-Q�j_[r.4_l U
Lic. #: f 7l Phone#>: J �-%� -`� Cell#: email: SI�t;"�s'�
Company Nwne: _ Address: � �
4.Proposed Electrical Work(Fixture Count: _ r
5.3't Party Flectrical Inspection Agency:
*:!t****#**#*###i********#*#*#,t#�►#Yk##i###****#*#k#*##***#***k***********#***#t####***a#a*few*sex********#**t4
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
being duly sworn,deposes and states that he/she is the applicant above named,and do€:s further
(print nanx of individutll signing as the applican3)
state that(s)he is the,legal owner of the property to which this application pertains,or that(s)he is the 7`w-ztZf);' —
for the legal owner and is duly authorized to make and file this application- (indicate architect,contractor,agent,attorney.etc.i
The undersigned further states that ail statements contained liemin,art;true to the best of his/her knowledge and belief,and:hat any work
performed.or use conducted at the above captioned property will be in conformance with the details as set forth and contained in:his
application and in any accompanying approved plans and spocifications,as well as m accordance with the New York State.Uniform Fire
Prevention&Building Code,t_he Code of the Tillage of Rye Brook and all od:er applicable laws,ordinances,anc regulations.
Sworn to b fore.me this I Sworn to before the this
day of uJ rt aF�2 _ _ day of kl=r- 2(p012--
Signs of Property Owner Signature of Applicant
1 J 1(-L -71'LO}1 cr.1 -4-D-U
Print Nat e o ape ,y Owner P ' t Name of Appl' an
N N.Y. Notary Publ
./'
CAROLYtJ 1_IE3ERATI
NOTARY F'UEtt.tC,STATE OF NE7.W YORK
Fleyisiration No-pti1S181428
Rtja%11". in WectcheIor County 6/`3/207.7-
con,tn*;ion 1_x ifFS Jar,ua 28,"?qM%
STATE WIDE INSPECTION SERVICES, INC.,
Service With Integrity
080 e •
APPLICATIONSWIS JOB 0. •
Office Use Elect. Permit# � Date
Bldg Permit# Sq Ft
Plumbing Permit#
Final Certificate#
City/Village Zip /CS-� Building Dep f County
Address Z� if/� 4� Cross Street Section y/ Block ,+ Loot
Owner Name/Address(it different than above) �t ?u� L Contact Number
❑Basement ❑ Ist FI. ❑2nd FI, ❑3rd FI. ❑More Than 3 FL ❑Garage ❑Attic Outside Residential ❑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
❑Overhead ❑Upgrade ❑ Disconnect
Utility 1D# ❑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
ID
NOV 17 2022
VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
This application is valid for one(1)year from the data receivrvl by SW IS.This application is in tended to cover the above listed items to he nsperte&if at any tuna 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.
ovvrer or aijthortzed a9ent agrees to all the above terms and conditions as set forth for the application. ,y
Email Address(I CE� t I Ny Q.o C t'7�.I C r �p_L _T--- NamhF� C,A 1 �
License t Data Sign s
/oy�_._
Address ,,n 0 Clty(State d ip Code/,!g
Company
L�CIE V\' !� l I State Wide Inspection Services
, ! ) 1080 Main Street
MAR 2 9 20_3 I Fishkill, NY 12524
845 202-7224 Phone
--- 914-219-1062 Fax
STATE WIDE INSPECTION SERVICES VILLAGE OF RYE BROOK Email: office 9swisnv.com
BUILDING DEPARTMENT 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:
Keating Electric and Technology Stephen &Angela Zwicker
190 Saw Mill River Road 35 Mohegan Lake
Hawthorne, NY 10532 Rye Brook, NY 10573
Located at: 35 Mohegan Lake, Rye Brook, NY 10573
Section: Block: Lot: Electrical Permit Number: EP 22-308
135.41 � 32
Certificate Number: 2023-2097 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: 35 Mohegan Lake, Rye Brook, NY 10573
The Exterior was 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 29th day of March 2023.
Name Quantity Rating Circuit Type
Hot Tub 01
The electrical inspection of the Hot Tub is valid on and limited to March 29`h,2023.
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 tivork performed on the date of inspection only.