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BUILDING DEPART-MUNT ID
OF RYE BROOK MAR 21 2023
Six KI\ti STRI UT RYt: BROOK.NY 10; 3
f914)939-0669 VILLAGE OF RYE BROOK
;the,+i l BUILDING DEPARTMENT
ELECTRIC--%L PERMIT APPLICATION
Westchester Count% Master Electricians i.icense Required
iilt t11- Fl1 F I IF t ►\1 N [if
Approval Date: MAR 3 1 2023___— Permit Fee: S ��1 1 ��r✓
:kppror al Signature: Other:
Disapproved:
trees are non-refundattkd
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Application dated. 3—Q —c-2 is hercry%% made to :hc Buil%'.ing Insp:cuir of the Village of Ryc Brook NY, for the issuance of
ai Perini[ to install and or remove electncal eyuipmem w[ring. fixtures.or tt,perform other high or lo%% voltage elec ncal work as per
.hc detailed sta;ernem described belo%% The appikant & proNm tn+iner, h% siding, this document agree that all electrical work
perfiinned%%iil he in conlirrmance with all applicable FedertL Slate-(-.►untr and l-heal Codes-
1..\ddress: % :.4 (. `7} SRI
1_-_ . �-s� Zone:��S
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2.Propcm Ov%-ricr - Aye izivc-& ')a-5 - \ddre,1
Phone ('cll= ttrtail: _
3. �tastcr FhCIF110an. -- - f
i� t} ;r"% + `�I' i h- •lctclrc;,: �� � ,.t y �-C'.� �c-;.•_ �� t iC- I
Phone email: ( 44fit Lc_ 6=r r: •-c
Compam \ainelr1-r Y'i�`�—:ltldrc�.: f� lV' �i; lti•+r , `- ; r 'i 1�'
4.Proposed Flectrical Work Fixture C•tlur.i.
t r „,�` 1 n•��z. f 1 1 `jt6 r.—
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STATF OF NFXV PORK.(-Off\-TY OF%VFST(11ESTFR
being A0% 4XT-o;z:end;tatter-,t1iai he she i-,the applicant a4+ove name arse aces f inher
sr.rie that f all i+eat-k al uses:. r �% ;t==%hrz :lit.a. Ew.::.%n ertaei;,or tha:i+ihC Is tdtc LO r� / -
t.+r the Icgal its srr and is dn)% 30-ovi/rd;ci,make xxl f?k thlji�ajrtpe L-jjw4 X,riff..r ,,m r.,.r,r
I he an%dersrgnc3 turther;taics that all Qatrrnratis:.ittt:1T"h.reirt aI_[rut i%+the bi^c:of hrs her knowledge wW belier.and that and wturk
perf nmcd .a wsr t undacicd at[tee atxi%c caplumI rup.7n, ;A J1 eK of.:.nilitrinwkz with the details as set Inyih and contained in till,
JP1111catrun.Int]in art% :,c.xnpmu tit" -Ind:Nri.icattur•...a,uLll a,m sw,,L lame with the New York State Lnifomi FITC
Pre%mtton K Building l•.xlc.tlu R}e A..-.rik ana;III other appiicahle-laws.ordinances and regulatruns-
5aom to belbre me t is Swum lu clurc me this -�
da! day of 20
Signature ro � wrier - Sid_==nature of.Applicant
l' t \srne u1" runOwner Print- a ut•Applicant
\utary tiutan )ic
CAR N MAR 4�7�NNIISI
iery Public-State cl itz ry yui:` GREGORY M.RIVERA
No.01 CA617 700
«ualithd Ire We.stchesler�ounly Notary Public,State of New York
i,tv Cummi,sit,n Expires Ncv.` 202 No.01 R16MI 398 i'1021
Qualified in Westchester County
;, %� ConnnissW Expires September 26,
p LTV[
C V RCo��
BUILDING DEPARTMENT MAR 3 0 2023
VILLAGE OF RYE BROOK
938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK
(914)939-0668 _ BUILDING DEPARTMENT
wwwackook.oriz
ELECTRICAL PERMIT APPLICATION
Westchester County Master Electricians License Required ^�
FOR OFFICE USE ONLY BP#: EP#: 03— V 7 /
Approval Date: NEAR 3 1 � l_�(���A
pp Permit Fee: S
Approval Signature: Other:
Application dated, -30—c�2 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
�bein conformance with all aapplicable Federal,State,County and Local Codes.
c 1.Address: &,5 SUS 1? 121 P SBL: lone:
2.Property Owner: Address: Z#? W;-7;~j
n
Phone#: Cell#: email:
3.Master Electrician/Licensed Installer: Address:
Lic.#: Phone#: Cell#: email:
Company Name: Address:
4.Proposed Electrical Work/Fixture Count:
5.31 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 further
(print name of individual signing as the applicant)
state that(s)he is the for the legal owner and is duly authorized to make and file this application.
(Master Electrician/Licensed Installer)
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 mo this U Sworn to before me this
day of-/72U K day of ,20
Signature of Property Ovfnirg Signature of Applicant
Prin ame of Property Owne Print Name of Applicant
��7� ,
Notary Public Notary Public
GREGORY M.RfVERA
Nehry Public,State of New York
No.OIRWMI398 3i3/2023
Qwtlfied In Westchester County n
Cownlssion Expires September 26,2Q4/
INSPECTIONSTATEWIDE
Service With Integfily
0:p Main Street, Fishkill, NY 12524 1 email:
Swias JOBAPPLICATION tel 845.202.72240.
Office Use Elect.Permit# � c) 3— 0 77
Date
Bldg Permit# Utility ID If
Final Certificate#
City/Village Zip � � Townshi��,,�fAO+r� County
Address 2-6oS C1,_ _V , �` Cross Street Y �VSection Block Lot
Owner Name/Address Of different than above) (� Ir Contact Number
❑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 Carbon Monox Hood Trash Compact
Amt Amps
Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw
Incandescent Fluorescent
SERVICE
Amperage Voltage t P 3P #Meters #Disconnect ❑underground ❑New ❑Reconnect
❑Overhead ❑Change
❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection
Additional Information
MAR 21 2l?
VILLF,t;C L� `a ; BROt-
BUILDING 'iE:PARTM_i
This application is valid for one 11 I year from the date received by SWIS.This application is intended to cover the above listed items to be Inspected,ff at any time of inspection additonai Items have teen installed,you are
authorized to make the inspection and adjust the tee for the additional hems inspected.The applicant declares that there Is no open applications for the above address with arty other inspection company.The applican6 owner
or authorized agent agrees to all the above terms and conditions as set forth for the application.
Inspector Date Finalized Inspector#
Company Name /k,< o�am9� 4tG Date 2 23�1" Signature
Address 9 /iG f7� �v/� City/StateNCA/46*Ske AI-XI Zip Code /0cfi2l/
License# C- 2- Phone# l / - �Z2 0 l
D C C IE
C D State Wide Inspection Services
JUN 2 2 2023 1080 Main Street
Fishkill, NY 12524
a VILLAGE OF RYE BROOK 845 914-219 Phone
BUILDING DEPARTMENT -219-1062 Fax
STATE WIDE INSPECTION SERVICES 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:
A Perfect Goldman Electric Rye Ridge Cleaners
48 Potter Avenue 265 South Ridge Street
New Rochelle, NY 10801 Rye Brook, NY 10573
Located at: 265 South Ridge Street, Rye Brook, NY 10573
Section: Block: Lot: Electrical Permit Number: EP23-077
141.35 51
Certificate Number: 2023-2457 Building Permit Number:
A visual inspection of the electrical system was conducted at the Commercial occupancy described
below.The electrical system consisting of electrical devices and wiring is located in/on the premises
at: 265 South Ridge Street, Rye Brook, NY 10573
The First Floor 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 111h Day of April 2023.
Name Quantitv Rating Circuit Type
Duplex Receptacle 01
Exit Sign 01
//rr'ic•may- _ f_i J I
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.