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MAY 2 2 2024 DD
VILLAGE BirtUOK
BUILDING DEPARTMENT BUILD NG DEPA'RTMENT
VILLAGE OF RYE BROOK
938 KING STREET RYC Bkoo;,NY 1057
(914)939-0668
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ELECTRICAL PERMIT APPLICATI(M
Weslchesler County blaster , ec clans[ Ice 'Required
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Apprtnal Date: y qq(� (Fce:S /J0�OL
Approval Signature: MA 1 2 9 CU :
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Application dated"5- 1)1,D—cz�is hereby made to the Building Inspector of flits Village Of Rye Brook NY,for the issuance of
.r Perrim to install and/or remove electrical erluipmcnt,wiring,ftxturim or to perform other high or Cow vohagc elecuical work as per
11x detailed statelncnt described below.By signinf this document.the applicant& property owner agree That all electrical work
pertutmed will he in confonstonet:with aalll upplieahke F dcral,Slow,Cutnty and Local Codes.
1.Address:-7� V 1 1'^v� � _SBL J�i t�7° ��� Zone
L Property Owner t,'QL,-Y�r +"LCAtklrr s �DO T-,c a:t>Lrj Q-u o.a(t.ti* r'
_ x -Stew`e� s a \1�—
1'honcR Tj�b .l R ° >GCXcll71 cttlod e-IaNIC% n�.1-Q�7�t'`=� o`_,vg'0bW.
3.Mauer Electrictan/Licensed lnxlaller ">� + `1 G�`^L�. Add,-.. 3D_l rf,kat Lf h<5� u s It,t
Lic d a$3 Phone M:_ . . Cell a (lam L)U�'1,tti cnlad:hcr-if
Company Namc
4.Prupirwd Electrical Worwritrlure Count
Lis
i
S.3i'Party Electrical Ingseclion Agency.
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51ATF QF NEW YORK,COUNIYOF WFST0 STER ] us
being duly awom,dtposa end sm:es that hel6he is the epplicaru ebuvc noosed,and does further
�rr.A uvir eel v4rv«Ir.sl egn«eg x.11k•applh..al
oatc tka(.)he is ehe._____. fin die kgal owner and is duly Atldrorised to make and file this oppli:atinn.
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The undcrujp cd further stales Hied all sulentents contained hereda arc Inte to the best ofhw'her knowledge mid belief aril tbat any work
periarmed,or use conducted at the above cxpuntlod property will be in eonromuncc wah the dc(ails at set forth Aral cunrmned in this
application and in any ikwmpanying tspprnvcd plans and speci(ieanons,as well as in accordance with the New York Static Unifume Firs
I'mi,"lion&Bus ding Code,the C.odc+rf lbe V Unge of Rye Brook And all other uppli�able laws.ordinance.and rcgttlatinm)
Swo .fore this r1 S 1 Swom to before the this 0?/ _
V �p j�tJ d,r,.'(if I 20 2 y
ure of Prope, owner` 9 'nutu cif Applicant
Print A e y Owner Prsnl •me of A phcam
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µARLETI�'LflUtR'idre
R1el1i3rds NOTARY PUSUCS'TATE OF NEW YORK ry30:g31
Notary u Ile, State of New York OuNoa InLputnam
NC ny
Reg. No. 01 R14912913 Commku on Erpiros MARCH 23,2M
Qualified in Suffolk County
Commission Expires 11/15/2025
STATE WIDE INSPECTION SERVICES, INC.
Service With Integrity
080 • •
SWIS JOB APPLICATION0,
Office Use Elect. Permit# Date
Bldg Permit# Scl Ft
Plumbing Permit#
Final Certificate #
City/Village e 8�D \D Zip ,�� FwldingDept
. -�� County
Address Cf? C_ _`��S 's , Cross Street Section [Block Lot
!! J J `� L
Owner Name/Address(If different than above) Contact Number C�7
Basement ❑ 1st Fl. ❑ 2nd FI. ❑3rd FI. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial
Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/0 Detector Hood Trash Compact
Amt Amps
Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch
SERVICE
Amperage #Panels 1P 3P # Meters # Disconnect ❑Underground ❑New ❑ Reconnect ❑ Repair
Overhead ❑Upgrade ❑ Disconnect
Utility 1D# ❑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
MAY 2 2 2024
1
i D v OF RYE BROOK
BIUILD NG D PART MENT
This application is valid for one(t)year from the date received by SwlS.This application is intended to cover the above listed items to be inspected,if at any time 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 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 � �� V 'e � Name � .
License# Date Signature
Address `2,!'1 �� CA + C 1 City j State C; G � `l\ L 4 ip Code
Company v V , fF 1 L— G c�J f Phone # C 1 mO L� 1
State Wide Inspection Services
C � 1080 Main Street
JUN — 3 2:024 Fishkill, NY 12524
SICK U
S 845 202-7224 Phone
VILLAGE OF RYE BROOK 914-219-1062 Fax
STATE WIDE INSPECTION SERVICES BUILDING DEPARTMENT Email: office@swisny.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:
Healey Electric Service Inc Ridge Street Rye Brook LLC
30 Smalley Lane 93 South Ridge Road
Stormville, NY 12582 Rye Brook, NY 10573
Located at: 93 South Ridge Road, Rye Brook, NY 10573
Section: Block: Lot: Electrical Permit Number: EP24-105
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Certificate Number: 2024-3500 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: 93 South Ridge Road, 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 31st day of May 2024.
Name Quantity Rating Circuit Type
LED Strip Lights 22
Strip Lights 06
Drop In Fixtures 03 2x2
Drop In Fixtures 04 2x4
Exterior Fixtures 14 81,
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.