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BUIL NG -E MENT
TVIL E OF RYE OK JUL 2 8 2023 DD
938 KIN , ET RYE B NY 10573
VILLAGE OF RYE BROOK
�. BUILDING DEPARTMENT
ELECTRICAL PERMIT APPLICATION
Westchester County Master Electricians License Required
FOR OFFICE USE ONLY BP#: EP#: c:;)3--I -70
Approval Date: '% r---Y--�Q/ Permit Fee: $
Approval Signature: Other:
Application dated, 71 3 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 applicable Federal,State,County and Local Codes.
L Address: 1SaZ) wr i k setr--r D 44c6,-,,,, N j tos-]3 SBL: 13s, I5' j 3 . .t Zone:
2.Property Owner: R Ooe r s 3 0. ctc c y.+n i Address: 5o e- So -<r tD k e r�
Phone#: qlq -X.]� - 7-77q Cell#: q14 - FA --7 77 y email: 1766rzo.GCWt�,j�—V a41auV,tcM
3.Master Electrician/Licensed Installer: < 0,be r-V 1 1ruckk ti Address: 933
Lic.#: p 7u Phone#: G y(G 13 r moult Cell#: C,-.b -.1 -ZI$ email: );Me kI-�i el"C e l CC ivi , een,
Company Name: l�,', tky, Address: �33 Spt,;n rj YbAlne,s ,b`Y lu7/v
4.Proposed Electrical Work/Fixture Count: 'f- 6'td Su:kti*s C-' rem'lrs, ... .\�4rn Iw:�1,l,�a► ,"s0.wy.,
C-�r �Ja.►:....0 ouk��t t c1.w�.,ir+n OJT a,L FJIc� l:`Ilr.� $srk.,rn c.:�-w, ..�,...f w� :titil.ua�..� wF r'c:rJ« �c.\
(9
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
(prier name of indi%ideal signing as the applicant)
state that(s)he is the B olo.ra p;a, %I i, for the legal owner and is duly authorized to make and file this application.
(Master Electrician l 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 me this 23r-4 Sworn to before me this Z-�'
day of JUL ,20 Z 3 day of 7h ( ,20 ?,2-,
Sigrlat6CoIrPnoperty Owner Signature of Applicant
Print Name of Property Owner Print ame of Applicant
:LICNA V.INTAIAQO
Notary Publi ENOT ,STATE OF NEW YORK Notary lic atherine S Ahn
D 1N QUEENS COUNTY Notary Public State of New York
XPIRES MARCH 29.20� No.01 AH0004295
G 01IN0004398 Qualified in Westchester County
Commission Expires 03/28W3 23
STATEWIDEw
Service With IttlegritY
0•0 Main Street,
SWIS • : APPLICATION0. aSWISTraining.corn
Office Use Elect.Permit# ` —// 7 v� Date � `Y
Bldg Permit# Utility ID#d
Final Certificate#
City/Village Pl GbP10o Zip 0 .� Township County WeO-CGe4cr
gR
Address Cross Street FS,
on Block Lot
C7 a s"� S} :r~ — . 7!" �.
Owner Name/Address(If different than above) Contact Number
❑Basement ® 15t FI. ❑2nd FI. ❑3rd FI. ❑More Than 3 FL ❑Garage ❑Attic ❑Outside ®Residential ❑Commercial
Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact
u Amt Amps
Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw
Incandescent Fluorescent
SERVICE
Amperage Voltage 1P 3P #Meters #Disconnect ❑Underground ❑New ❑Reconnect
❑Overhead ❑Change
❑Visual Re-inspection ❑ Safety Re-Inspection ❑ Re-Inspection
Additional Information
E C IE �W l�l
ID
JUL 28 2023
VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
This application is valid for one(1)year from the date received by SWIS.This application Is intended to cover the above listed Items to be Inspected,If at arty time of Inspection additional items have been installed,you art
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 vmh any other Inspection comparry.The applkantt,owner
or authorized agent agrees to all the above terms and conditions as set forth for the application.
Inspector Date Finalized Inspector#
Company Name ,{rc4ir n,` Date ���$ Signature e
Address . City/State Ya t4 Zip Cade /C)/O
License# �U v Phone# 6 r 201
DL� State Wide Inspection Services
C—ADII 1080 Main Street
OCT 1 0 2023 Fishkill, NY 12524
R
a 845 Phone
I 914-2194-219-1062 Fax
STATE WIDE INSPECTION SERVICES VILLAGE OF RYE BROOK Email: office@swisny.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:
Dimella Electric Corp Robert Borzacchini
Robert Dimella 50 North Ridge Street, Unit D
233 Sprain Road Rye Brook, NY 10573
Yonkers, NY 10710
Located at: 50 North Ridge Street, Unit D, Rye Brook, NY 10573
Section: Block: Lot: Electrical Permit Number: EP23-170
135.75 2 3.2
Certificate Number: 2023-7486 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: 50 North Ridge Street, Unit D, Rye Brook, NY 10573
The First Floor Livingroom 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 4th Day of October 2023.
Name Quantity Rating Circuit Type
Luminaires 10
AFCI 02
Receptacles 01
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.