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BUIL MENT SEP 13 2023
V1L E OF RYE OK VILLAGE OF RYE BROOK
938 KIN TRYA ,NY 10573 BUILDING DEPARTMENT
.or
ELECTRICAL PERMIT APPLICATION
Westchester County Master Electricians License Required / C �,l
FOR OFFICE USE ONLY BP#: EP#: ��`/ ! /
SEP a /'50-lam'
Approval Date: Permit Fee: $
2S
Approval Signature: Other:
Application dated, `����-�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.
1.Address: aa-S CUu'i�YZ.y Ztd�g� P�\�C- SBL: e)! �c� / -�l�p�� Zone:tells
2.Property Owner: Ut Address:
Phone#: Cell#: ���"�j��,'�1 O\ email: VVIt Ci V-C'V%C.CL,ao\•Cck-
0
3.Master Electrician/Licensed Installer: NC.c2_Va\n--\ Address:
Lic.#: 1�Phone#: Cell#: q,--I -77 t"> 50 9 5 email: �o yylc fge�r c�e.trYz t� t� y Ghc c
L-o—�
Company Name: Address:
4.Proposed Electrical Work/Fixturc Count: Ckck'r—c-�c5, W �c 5 C^"'c-1 )� �s �\�
5.31 Party Electrical Inspection Agency: �w( S
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 si��g as the applicant)
state that(s)he is the ;!(1 />444/ 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 me this V� Sworn to before me s 3
day of ,20 day of ,20
l
Signature of Property Owner Signature qf Applicantsn
ame of Property t e of Applicant
aa k,.
\-�-\lj_�'
Notary PublicSHARI MELILLO No Publi
Notary Public,State of New York bARI W
Notary Public,Stateate of
�1 New Paris
No.OJLME6160063 No.01ME6160063
Qualified in Westchester County Qualified In Westchester County/ 3
Commission Expires January 29.20 l Commission Ezplres Janus 29,20 L�
►Y
D),
BUILINGMPO�A/_i T M E N T 1 SEP 15 2023
VELLAGE OF RYE BROOK
VILLAGE RYE
938 KINd PET RYE B ` ,NY 10573 BUILDING DEPARTMENT
(914)939-066$
www:ad 1'ook.org
ELECTRICAL PERMIT APPLICATION
Westchester County Master Electricians License Required
FOR OFFICE USE ONLY BP#: EP#:
Approval Date: Permit Fee:$
Approval Signature: Other:
**************************************************************************************************
Application dated, 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,S ,County and Local Codes.
1.Address: 7 ✓/�e SBL: Zone:
2.Property Owner: Address:
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 swum,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 efore me this O Sworn to before me this
day of ,20 a, day of 120
SignaFffe of pe I wrier Signature of Applicant
Py
Name of Property w7 er Print Name of Applicant
f
Notary.AlubW Notary Public
GREGORY K RIYEU
Notary Public,State of Now York
No,01 R*"1 M
3/3/2023
QuiMfied In Westchester County !
Commission Expires September ti,20
STATEWIDE INSPECTION
Service With Integrit-y
0:0
SWIS JOBAPPLICATION0. •
Elect. Permit#�f� `>� i � � Date
j'Cy
Bldg Permit# Utility ID#
Final Certificate#
City/Village � Zip Township County
Address 2 ^2 S_` ('O�r� /`� Cross Street Section Block Lot
GG
Owner Name/Address of different than above} Contact Number
asement ❑ 1st FI. ❑2nd FI. ❑3rd FI. ❑More Than 3 FL ❑Garage ❑Attic ❑Outside Idential ❑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 afety Re-Inspection ❑ Re-Inspection
Additional Information`3 (7
D
+
� I
SEP t 3 2023
_ VILLAGE OF RYE BROOK
BIJU)7 NG DEPARTMENT
This application is valid for one{II year from the date received by SWIS.This application is intended to cover the above listed items lobe inspected,if at anytime 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 wish any other inspection company.The applicant.owner
or authorized agent agrees to all the above terms and conditions asset forth for the application.
Inspector Date Finalized Inspector#
-509
Company Name �eesPr PCT!'1 Date /3 Z 3 Signature
Address F. D Q��C 3-7 Z City/State0Q ` r�G� Zip Code
Ucense#I /sz Phone# 2' `7 7 `'
C BRcb
O Z�
BUILDING DEPARTMENT
•'u BUILDING INSPECTOR
❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK
❑CODE ENFORCEMENT OFFICER 938 King Street • Rye Brook,NY 10573
(914) 939-0668 FAx (914) 939-5801
www aebrook.org
- - - - - - - - - - - - - - - - - - - - INSPECTIONREPORT - - - - - - - - - - - - - - - - - - -
- r ` > >
ADDRESS:-
Z�
.? BATE:
PERMIT# ISSUED: SECT: BLOCK:*
J Q LOT:
LOCATION: ` �""-`
� OCCUPANCY:
❑ Violation Noted THE WORK IS... ❑ PASSED FAILED REINSPECTION
❑ SITE INSPECTION REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION
❑ Natural Gas
❑ L.P. Gas
❑ FUEL TANK �r
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
❑ CROSS CONNECTION
❑ FINAL
❑ OTHER ; -7 ) l 1 r
l }(f
x.�
State Wide Inspection Services
r 1080 Main Street
C � MAR 12 2024 �) Fishkill, NY 12524
L.__ _ __ f 845 202-7224 Phone
VILLAGE OF RYE BROOK 914-219-1062 Fax
STATE WIDE INSPCC71ON SERVICES BUILDING ^' DARTMENT Email: ofFiceCcbswisny.com
~' ^� 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:
SOMERSET ELECTRIC Howard &Barbara Eisenberg
MARK DOLAN 225 Country Ridge Drive
P.O. BOX 372 Rye Brook, NY 10573
MAHOPAC FALLS, NY 10542
Located at: 225 Country Ridge Drive, Rye Brook, NY 10573
Section: Block: Lot: Electrical Permit Number: EP 23-197
129.82 1 15
Certificate Number: 2024-1474 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: 225 Country Ridge Drive, 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 12th day of March 2024.
Name Quantity Rating Circuit Type
Repair Damaged Wires & Install (3) New Wall Switches Only
Officer: Frank 1. 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.