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BUILI)IN(,' DILPAIt'I IMEN'I' �C � � E
'1'll.l,f'1t�1f Uh Itl'1? ��iltOt)lr
(O'N ':(i�f�Zl I I Rt 'h IIEt,(1m, NY 1057 p NOV - 1 2024
(y 14) 939-0669
\v\vtv._rv.c•h!-'M)l:l) ', ov VILLAGE OF RYE BROOK
WILDING DEPARTMENT
LI,I';(: rim'Al, Pli;lc,1'II'1'_/11'f'I,ICitl
A\reslchcxtel, 0milly IMIlstel• hrlerll•i 'hIlls I.icellse Re(Illirell
FOIL 0FI I('F l IS11 0\t I \ 111, 1r: _ F1' ll: / ` c4�o
Approval Date: NOV 0 4 2024..v - 11c•rnlil Fee: S . I- -
Approval:Signatut•c: _. Othee•: , - --
DO \O'I NTA 10,11Olt (It.( O\S I'I(1 I 110\ 1 t 11. \ I'I•101I I II » Ii1?h.\ I:Sh1 I':I) B\ I Ili( IIIALD1\(i I\SI'I•:(:TOR.
'I'llE A1)11INIti•fltATI1't., FEE FOIL \\f llik I'UM;111'SSF.111 OR ('0111'I.I:'I'!:I) WITI101'TA 1'1';IthlIT IS 12t:i1 OF TIII?
TOTAI. ('Oti I Oh COW tit ( 110\ \1 IT11 A VI\INIUM FI'.h: M. N7511.1111
Applieatiun cLueil, _. IN hcrch\ Imldr to the building Inspecltn-ill'Ilie Village ul'R cc Ilrnuk NY, I'm-the issmince of
it Permil to inslall andlor remove cicciric;ll cclntpmeal. \vlrinL. li\Itlt•rs. or to Iler101-111 Ulher high or Ill\%- %oluige electrical work as per
the detailed smienical described below. li\ signing tali. document. [he applic.ulf & properly uanel agree that all electrical work
performed will be in condom mcc\+•ills all appl
icable 1:cderal.Slate.(•aunty and Luca)('odes.
1.Address: '—�- -- - A - •__ -- �_ .__ —7onc:
2.1'ruprrty0\t'ncr: bi( ;-_ ��1 `MQjn- Address: �� .�-(}4'rR�t,� .— —
Phone : �AQl q0�L- ('ell u:. _- -email: 1 kd5C_hq j" i • r tA-
1,\l;tstrr I IcctlieisulJl.icensed Inslslllrr:,__� U l5 uf1 �1' Address:_ -P0 tk'✓ Ave- C 1
n -��o dam' isriv c -,
l.ir, ft: 01�]'Iu1nc fl:. `t Iy�"+� 5 ell T: cm:til:_Geri L (.� C+rG>t n .{►�rsi'► f��✓►1
('onlpalny Avumc: ! ( �Q n1(v) 1dllrr.;.: `J4t�1'►'IL- as C pdo YC: -_--
4.Proposed Eleciriclll Work' ixlure Count: - -
on
5 1°I Party Flertr•Ieal inspection
irk;} :•::4tsh:4kai:s4 ti eY:Y sl Y:xt$t:,e5:::r::`,::t:::isi:::is it>r::::::l::;t:••A:rx:r'r:'.•ir:'ruCail 9i fr a:ti4!$St dr:::'rti:};;::i::'r fr t.isti:if::::fii.........ksi:::::::(:k:.is Qi:is rr is of d:it'x i7 u.:�:
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STATE OF NI-AV YORK.COUNTY OF
'C j)L _-__--T.�.bring dld\ „\tin.tIC110Se.stud Slides 11111t hr ;lie i.Ih.slpplictlnl uhuvc immed,quad dues full tier
I[,nut lultilcol ludi\ulual.ie1+u11�m the mJ l�dIC t:
stale Ihat Is►hr is the �D'Ll f ill t or � the Icgitl tIu nrr and i;duly mitlhurlfed lu alnikc and liIc Ihis IppIicaliun.
t ;I,IvI I IV,II' lull I h„t .J In [;IIlci:
'I he under;1glied farllrcr slsltcs that all slnlenlcnt,c•tinmmulcd herein arc Ituc tit the h-[of hi; hc1 knowledge mut hchc[.mid that any workperformed.Ili INC eunducled al the iillovc CnIlli 111ct1 ItrullCl'i\ \\ill he in conlotnulncc\\ilh lilc details a;;col firth mill contained ill Ihis
mplllicaliun wall io um ❑ceuugr,utying appru\ed p1:311p mid sperlliemiiun>.a u ell as is arcul'tlanc4 with Ilse•Nca York Smic Unilial'nt Fier
Prc\•enlion d•• Building("title,the Code uflhc\'illslge of R\c•Bluuk anJ Al other upplicahlr Im\\+.urdioancr;.old 1rgltlations.
fff 'Sworn to lar k lr 11ar Ihis :4\wtll-11 M heli,rr m this
day ut_[�'� i.Pi^ .20 j,, -- (141v of 1- < i. 20 Tl
t>Z'�Y7QrW.�+t.
Si tnalitre of Properly Otvaer Sig , tir f rY lead
Prii Name ref Properly O\\nC1 l'ifipt \anti of \plaiicmnt
Noma v Public , , -T
SHAWN P.FOX 1111a:I�t r llhr,r• :;',,t;:tit Ar a Yr,r1c
Notary Public, Slate of New York (,1 M,; ,:t t,11nr,:t 6t1121124
No..02FOG118924
01.1alifle(I in Kings County t :tI1H,i U11 !:.y1ur•.),nlhll\' '.1,:'!)_�
CommlSSion expires 01/03/20?$
STATE WIDE INSPECTION SERVICES, INC.
Service With Integrity
s:0 • •
SWIS JOB APPLICATION tel 845.2023224 1 fax 914.219.1062 1 SMSNY.coml SWISTRAINING.COM
Office Use Elect, Permit# !�r a Date
10 - �
Bldg Permit# Sq Ft
Plumbing Permit#
Final Certificate#
City/Village e 1 Zip r�C� 2 Building Dept. County e
Address �'l ,n !� Cross Street -7 Se Block t Lot
—1
Owner Name/Address(If different than above) Contact Number
❑Basement ❑ 15t FL ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside [9 Residential ❑_(Commercial
Receptacles Special Recept GFCI AFC( 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 4 Meters # Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair
Overhead ❑ Upgrade ❑ Disconnect
Utility ID# ECon 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
PRIE CIE �'
NOV -� 1 2024
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 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 0E �C,e r vr� Name r\
License# ��Q ,� Signature
Address i7 :_ CitySt e 1�0( Zip Code +ilr 0-
Company Ct- Phone # 0%
D EC IENE
State Wide Inspection Services
1080 Main Street
CAD NOV - 8 2024 Fishkill, NY 12524
SUPW I 845 202-7224 Phone
VILLAGE OF RYE BROOK 914-219-1062 Fax
STATEWIDE INSPECTION SERVICES 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:
A Perfect Goldman Electric Greg& Lauren Mann
48 Potter Avenue 57 Country Ridge Drive
New Rochelle, NY 10801 Rye Brook, NY 10573
Located at: 57 Country Ridge Drive, Rye Brook, NY 10573
Section: Block: Lot: Electrical Permit Number: EP24-220
129.59 1 9
Certificate Number: 2024-8000 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: 57 Country Ridge Drive, Rye Brook, NY 10573
The Basement &Garage 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 8`h Day of November
2024.
Name Quantity Rating Circuit Type
Service 01 200 Amp
Meter 01
Panel 01
Disconnect 01
Grounding and Bonding of Service to Current Code.
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.