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BUILDING DEPARTMENT ' D FE�C W IE� ~1
VILLAGE OF RYE BROOK 1 1
939 ICING STREET RYE BROOK NY 10573 AUG 13 2024 I
(914)93'9-066K � E -
tttttt. ehtcu�ki � .tit�t 1 VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
ELECTRICAL PERMIT APPLICATION
Westchester County Master Electricians License Required ^�
FOR OFFI('F, USE ONLY BP #: EP #: �— b�o `/
Approval Date: ZUZ Permit Fee: $ /
Approval Signature: Other:
DO NO1'S C\R-I' \\ORK or CONSTRI CI 10\ t \ l'IL PFRNIIT IJA 19f.1 \ 1`ot ED Bl 1 lll•: lit ILDIN(; I\tiPh( I OR.
THE \UNIINISTR,%TIN'E FLE. FOR \\Y)RK PROGRESSED OR CO\II11-1 14 I) 1\ ITHOL"I' ,k PERMIT IS 12 OF I HE
'ro'll F\I, COST OF COtiSI'Rl C'I'10S WITH :� '�1INl\It \1 FEE OF$750.1111
Application dated, 17� is hcrebv 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 C`o/des.%
12
1.Address: � �11 A v\ 14 y�4 4� SBL:I-7�r �� done: �!-
2.Property Owner: a6bC MCV Address:
Phone#AW�r6;;>q kL _ceell,l,#: __email^ �� •CY j
3.Master Electrician/Licensed Installer: t � 1c�1� Address: $ [dB�
Lie.#:Phone#:l _7-3)LDS) Cell#:ALQq-GJ1to_] emai tCCJ(?'E:4eA ef�LP-Q 'kc.
Company Name: Cv— Address: rr 11
4.Proposed Electrical Work/Fixture Count: , V
- no -rf
5.3'Party Electrical Inspection Agency:
STATE OF NEW YORK,COUNTY OF WESTCHESTER I as:
being duly sworn,deposes and states that hcishe is the applicant above named,and does further
�"�{ C LLC
state that(s)he is the �((�4 t�1�[�t+aTi for the legal owner and is duly authorized to make and file this application,
The undersigned further states that all statements contained herein are true to the best of hisiher 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 appro�cd plans and specifications.as well as in accordance with the New York State Uniform Fire
Prevention&Building Code,the Code of the Village of Ryc Brook and all other applicable laws,ordinances,and regulations.
Sworn to before me this Sworn to before me this
day of .20 e� day of .20
Signature of Property Owner J /� 7L- Signature of Applicant
Print Name of Property Owner Print Name of Applicant
Notary Public Notary Public
6 1:20?4
Bt 11,DIN(; DEPARTMENT
V11.1-%(#'F OF R1 P-1 BRO()I% AUG 13 2024
938 Ki\(,SIRI I I RN I IiR()()K. NY 10573,
(914)939-066X VILLAGE OF RYE BROOK
BUILDING D.EPARTM ENT
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li'li etilcheour Counti Master Elvoricians Lict.n.
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Appi'll,lal Date: Pernjil Fvv: S*
Apprio.al Signature: Other:
\phfli,:a t loll klitickl. is 11CIL+ 111.1LIC It I the Build It il-, I I Is I),:ool 411 111L. \ I 11. R\ B:ook ol Ills 1.,Lk'mcc I'i
to perjorw iii1wr l)-y-ii or I' Cal \Xork .t. jvr
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114--ritlinicLi wll he In SHI conittIMMICC tkill't:'ill iIj)rlI A1..lhIC Federal, SI,IIt:. IIIj;)j% �tll(l I tlk�jl( ode,
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Print P Plopert\ ncr Print 'Natiric kit AppliCani
7ANL'A:
N J SCHLF:FMAN
Notary Public-State of New VOIK 101��VLJII
ESLER
0 5069 IIXRDAR�
N0,01SC5069499 B JE KEESLER
, a ,
Qualified in Nassau County
P N.
My c.rn�ssicn E:xpi,es Nry 25. 2026 NOTARY PUBLIC-STATE OF NEW'VORk
No. OIKE6297607
Qualified In Westchester County
My Commission Expires February 24. 2q4-v-CqC-";k0
STATEWIDE INSPECTION SERVICES, INC.
Service With Ititegrity
A'1 Main Street,Fishkill, NY 12524
SWIS JOBAPPLICATION tel 845.202.7224 fax 914.219.1062 SWISNY.com
Office Use Elect. Permit# -7 Date
Bldg Permit# Sq Ft
Temp#
Utility ID#
Final Certificate# R-y--I <2:�r76W�:
City lVillage n l � Zip � �'� Township (�, County��
Address 4 C t 1y� Cross Street SectionYl Block Lot
Owner Name/Address(If different than above) Contact Number( LA
❑Basement ❑1st FL ❑2nd Fl. ❑3rd FI. ❑More Than 3 FL ❑Garage ❑Attic ❑Outside 11 residential ❑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
1
AUG 1 .3 2024I '
VILLAGE OF i:Yr_ BROOK
BUILDING DEPART�,4ENT
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 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.
Inspector Date Finalized Inspector#
Contractors `f OD Date Signature
Address 1 City/State RTW Zip Coe
License# Phone# C�� ��� '�� ���++����✓✓
DD
State Wide Inspection Services
OCT 2 9 2024 1080 Main Street
Fishkill, NY 12524
Tb 845 202-7224 Phone
VILLAGE OF RYE BROOK 9({14-219-1062 Fax
STATEWIDE INSPECTIONSrRVICES BUILDING DEPARTMENT Email: office( 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:
Effective Electric, LLC Rye Brook Group LLC
1860 Jacob Street 18 Highview Avenue
Cortlandt Manor, NY 10567 Rye Brook, NY 10573
Located at: 18 Highview Avenue, Rye Brook, NY 10573
Section: Block: Lot: Electrical Permit Number: EP 24-167
141.35 I 2 25
Certificate Number: 2024-6329 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: 18 Highview Avenue, Rye Brook, NY 10573
The Exterior and Basement: Electrical Panel Area 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 111h day of September 2024.
Name Quantity Rating Circuit Type
Service 01 200AM P
Meter 02
Panel 02
Disconnects 02
Grounding and bonding of service to current codes.
��d
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.