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DDBUILDING DEPARTMENT JUL , Z�23
VILLAGE OF RYE BROOK A
938 KTNo STFJ-FT RYE,BRooK,NY 10573 VILLAGE OF RYE BROOK
c9la BUILDING DEPARTMENT
ELECTRICAL PERMIT APPLICATION
Westchester County Master Electricians License.Required
FOR OFFICE USE ONLY BP#: � E P 0: �_ re 3.1�W
Approval Date: 'Permit Fee:S Z 7S-�.t�
Approval Signature: Other:
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Application dated, is hereby made to the Buildirg`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 8c property owner agree that all electrical work
performed will be in conf an with all applicable Federal,State,County and Local Codes. ? J f
1.Address: 4 l b�GU, (l L14s/ _51 t'ee I SBL:�T / 'J ZfJ ZonP46
2.Property Owner:_/p y f t-(t(t 1 L� _- .. Address: t yl �
Phone#: ( Cell#: email:_ IcE 13
3.Master Eleariciatr/Liceased Ins ler: Address: I
� 73.
Lic.#:6174 Phone#: Cell N: - a email f f
Company Name: Address:/5�5 %nLj {fI&Lh � y
4.Proposed Electrical Work/Fixture Count:
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5.31 Party Electrical Inspection Agency: t
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STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
f r ® being duly sworn,deposes and states that Wshe is the applicant above named,and does further
print name f individuali in q• the Pcant�
state that(s)he is the i for the legal owner and is duly authorized to make and file this application.
IN 4er E.i-Iriclan r Licensed tisstalltr:
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 R Building Code,the Code of thc Village of Rye Brook and all other applicable laws,.ordinances,and rcguletia
Sworn to be me this L 7 ' Sworn to be this
f 20�-____ day o 2
Signature of Property Owner of Applicant
Y1�L111� Q. �Cll1iC.�1 �/7774 G�2
Print N of Pro er rknt,! a of Ap carrt
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Notary Pklic DONALD GOLDSMITH tblic
Notary Public,State of New York
No.01 GO5021034
Qualified in Westchester County 3/312023
Commission Expires bec.6,20_1
USA MOCC10
NOrrY Ptr" . :'tate of New York
No t819030
File In Westchester
L 6ar lmi,sJQrl
INSPECTIONSTATEWIDE
Service With Inlegriq
0•0 Main Street,Fishkill, NY 12524 1 email: •
SWIS JOBtel APPLICATION0.
Elect.Permit# � _/ Date
L13 �3
Bldg Permit# Utility ID#
Final Certificate#
City/Villag rOok Zip 5 Township County r
Address Cross Street Section Block Lot
Owner Name/Address cif different than above) On /-a/'n Contact Number
❑Basement ❑ 1st FI. ❑2nd FI. ❑3rd FI. ❑More Than 3 FL ❑Garage ❑Attic WfOutside &Illesidential []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 1 P 3P #Meters #Disconnect ❑underground ❑New ❑Reconnect
❑Overhead ❑Change
❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection
Additional Information
` <2�re_�fX rSfi� P6u1�'
t ® fir T� - '&� a�i'
nit . C ) fo P �° D CCU
JUL 19 M3
VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
76,00V1
This apokatfon is valid for ane(1)year from the date received by SWIS.This appkwnon Gs intended to cover the above listed items to be inspected,if at any time of inspection additional items have been installed,you arr
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 Inspectton company.The applicant,owner
or authorial agent agrees to all the above terms and conditions as set forth for the application.
Inspector Date Finalized Inspector#
Company Name c�— Date 3 Signatur
�.
Address City/State Zip Code S/
��
License# ! Phone# - 0,26
State Wide Inspection Services
— 1080 Main Street
FSEP 5 2024 DDFishkill, NY 12524
TOW U Tb
i 845 202-7224 Phone
� 914-219-1062 Fax
STATE WIDE INSPECTION SERVICES + VILLAGE OF RYE BROOK Email: officeCa�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:
La Bella Electric Inc. Anthony Paniccia
Jerry La Bella 496 West William Street
145 South Main Street Rye Brook, NY 10573
Port Chester, NY 10573
Located at: 496 West William Street, Rye Brook, NY 10573
Section: Block: Lot: Electrical Permit Number: EP23-158
141.36 3 6
Certificate Number: 2024-6208 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: 496 West William Street, 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 26th day of July 2023.
Name Quantity Rating Circuit Type
GFCI Receptacles 02
Temporary Service 01 100AMP
Meter 01
Panel 01
Grounding and bonding of service to current codes.
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.