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BUILDING DEPARTMENT DEC 12 2022
VILLAGE OF RYE BROOK
938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK
(914) 939-0668 BUILDING DEPARTMENT
\%vo v%.ryebrook.org
ELECTRICAL PERMIT APPLICATION
Westchester County Master Electricians License Required
FOR OFFICE USE ONLY BP #: EP #: Q
Approval Date: DEC 1 3 2022 Permit Fee: S
Approval Signature: Other:
Application dated, ITlaZ-y 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/appplicaablle.�F�ede{r-a�l,State,County and Local Codes.
1.Address:��3 �f/y �1 I"[) ( I c tset 1C�_T�Y_Odk SBL: ���J r 7�0 �1r Zone: U
2.Property Owner: Qr4o�S`L,a/�PO/,G�/Xr S.SOC Address:
Phone#: 9/#— /39-'Q-1140 Cell#: email:
3.Master`ElleGec``trician: Address:
Lic.#: 1'J 0 Phone#: Cell#:q 14- "Q�Itp0 email: fie I�f IQ Q� �C�r(C.Cd�1
Company Name:1 W Lkc*(,C Q602. Address: t K
4.Proposed Electrical Work/Fixture Count: 1. 6k)tlf+ in
Cju h hole± a .
5.3'Party Electrical Inspection Agency: 1 S
STA OF NEW YORK,COUNTY OF WESTCHESTER ) as:
,(v&/ inye'l f ,being duly swam,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 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.
l
Sworn to before me this f y Sworn to before me this 1 ^`--
day of e_ e,--,20 y>✓ day of_�Pr.P Al b e !; ,207—
Signature of Property Owner Signa e o p icant
/nzo
Print a of Pr 2��fNotary
Print a ofTlican LAURA J DELUCA
o Public Public-State of New YorkrNo6taryNO. 01 DE4998586
ualified In Westchester Count
omm. Expires June 29, ,�>
6/23/2022
STATE WIDE INSPECTION SERVICES, INC.
Service With Integrity
••• • •
SWIS JOB APPLICATION tel 845.202.7224 1 fax 0. •
Office Use Elect. Permit# �� Date / ,Z // z Z Z
Bldg Permit# Sq Ft
Plumbing Permit#
Final Certificate#
Co/Village Iis Zip Building Dept. County
Address -� 2 y V 141 t. oss Street Section Block Lot
Owner Name/Address(if different than above) Contact Number
❑Basement �Ist FL ❑ 2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside ❑Residential [:]commercial
Receptacles Special Recept GFCI AFCI witches Dimmers Smoke Alarms C/O Detector Hood Trash Compact
192 Amt Amps
Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch
SERVICE
Amperage #Panels 1P 3P -r Meters # Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair
❑Overhead ❑Upgrade ❑ Disconnect
Utility ID# ❑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
j2 C-t )� C-C,N-c C\ C, pr�
rDEC:1
C
p2'�2022
VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
This application is valid for one(I i year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,it at anytime of inspection additional items have been ostaNed,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.
Email Address S (n %IJCt / O«j Name
License# 15`6Q Date _ /�_ Signature f
Addre_;s / 7 Cm V City/State /Vy Zip Code
Company r Phone# L
�eJ _� i eery or') v
D E C E vE
State Wide Inspection Services
CA:) MAY - 5 2023 1080 Main Street
Fishkill, NY 12524
--IFT-j 0
VILLAGE OF RYE BROOK 845 202-7224 Phone 914-219-1062 Fax
STATE WIDE INSPECTION SERVICES '. BUILDING DEPARTMENT Email: officeC&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:
Lelia Electric Corp Arbors Homeowners Association
Richard Zweig 173 1/2 Ivy Hill Crescent
47 Greenway Lane Rye Brook, NY 10573
Rye Brook, NY 10573
Located at: 173 1/2 Ivy Hill Crescent, Rye Brook, NY 10573
Section: Block: Lot: Electrical Permit Number: EP 22-302
129.76
Certificate Number: 2023-3016 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: 173 1/2 Ivy Hill Crescent, Rye Brook, NY 10573
The Basement, First Floor,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 27'day of
April 2023.
Name Quantity Rating Circuit Type
Receptacles 02
G FCI 01 15AM P
Switches 01 15AM P
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.