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BUILDING DEPARTMENT
DC � �C
VILLA,OE OF RYE HkOOK MAY 2 0 2025
938 KING SLR ET RYE Bl;p ,NY 10573
� VILLAGE OF RYE BROOK
wwwXV oo ny.gov BUILDING DEPARTMENT
ELECTRICAL PERMIT APPLICATION
Westchester County Master Electricians License Required
FOR OFFICE USE ONLY BP#: EP#: C-),-�-
-/3314
Approval Date: CMAMqW, Permit Fee: $
Approval Signature: Other:
**************************************************************************************************
DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR.
THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE
TOTAL,COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00
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,State,County and Local Codes.` / j p /
I-Address: I----��f/'/ q�/✓1 ��r✓1./ SBL:j�3J/7/-1 D Y Zone/ "/
2.Property Owner:�J-} ,,+/10 1, / V P r Ci1aC-?l5; Address: LY1 �,Y/_ D QCIj I� y
Phone#: yr� Cell#: Y I 7�C - -�G�-C email: nod, ,C b/h
3.Master Electrician/Licensed Installer: Gj r6I cgrn Gnn' �f i L' Address:l0 Tfle0✓1 / � �0� � 1/
Lic.#: Phone#: Cell#: N-' -Y--IZ2�p email: �(e✓1SiC_GL��c� t';CQ11ZMin_(�✓)
Company Name: iC� �i{o Address: /(� 1`50/x�ll�f'
4.Proposed Electrical Work/Fixture Count:
lP ir1,caj 1 -Sef 1 Ce La f
s
5.31 Party Electrical Inspection Agency: 9-4er 67ed c ieA SCCUJrE,S_ 1100.,
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
' P yl q M 0 &ql/1 0 ,being duly sworn,deposes and states that he/she is the applicant above named,and does further
(print name of individual si ing the applicant)
state that(s)hc is the a:� j'�'1 Gl of yl 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 Co of the Village of Rye Brook and all other applicable laws,ordinances,and regulations.
Sworn to fore me this Sworn to before mtw this G
day of ,20 day ofISWIC( � .20
,(
ignature of Property Owner REEt,%SAMARNEH Signature of Applicant , r
kISa rnkIc,,oIQ —� NotaryPublic-StateofNewYork �'rCSI`�MQ Cl`�II b
--r Nc.o1SA6155217
t Na of roperty Owner
Qualified is Westchester Cot�k t Name o App Leant
Nly(;crn liSSlOr1 Expires Nov 6, -S&A A" ,I,,
Notary is ❑ANIEL GROARKE X66tary Public
Notary Public-State of New York
NO.OIGR6435852 r 6/l/2024
Qualified in Westchester County t
My Commission Expires Jul 5, 201 ,b f
ems.
S Buckout Road
BETTER H a West Harrison,.NY 10604
Phone:914-906-0443
ELECTRICAL INSPECTION SERVICES INC. " " Email:lyetterhomtas252iagmail.cam
APPLICA11ON DATE: r ELECT.PERMIT N0.
�2 Z
CI Y/VILLAGE , f Cnd+ ZIPCO(E BLDG PERMIT NO.
ADDRESS: J BUILDING DEPT COUNTY
rol
PHONE# SECT1flN BLOCK LOT UTILITY
EMAIL ADDRESS:
Residential Commercial ❑
OWNER'S NAME AND ADDR SS r'
ToArl 4 v, �'1qr,(yv, ►�hge1 - ire v _ _._ -
�j�' rho�e �✓1 �,�.
MAY 202025
1
WORK LOCATION: VILLAGE OF RYE BKUUK,
Outside A Basement []Garage ❑Attic ❑Porch - BUILU1 I -
Floor: ❑1 st floor ❑Znd floor ❑3rd floor ❑4th floor ❑Other floor
Reinspection ❑Renovation ❑Generator ❑New home ❑OtherL
Comments: 4E-/ecl C�eq er vice, L4
SERVICE AMPS 20() CASE NO. SERVICE ENTERS BUILDING:
CON EDISON Overhead, Underground ❑
COMPANY NAME: DATE OF APPLICATION: LICENSE#WHEN APPLICABLE:
Kel\S ;co '�-Ic-c4r;c- 1 Fllk-2-12,5 /-�zlzl
STREET ADDRESS: KITTY: STATE: ZIPCODE:
0 �i`j Uvl {�l/e, �`�11i4 dq r
TELEPHONE CELL PHONE: EMAIL:
SIGNATURE OF _
APPLICANT: X ,f� ��,✓�� �L,,�
The application is intended to cover the above listed items to he inspected.It at any time of inspection additional items have been installed,we are
authorized to make the inspection and adjust the fee for the additional sterns inspected as provided by the applicant.The applicant declares that there
are no open applkations for the above with any other inspection company.Application only good one year after filing date-
D E C E �Vj LIE` D
I
MAY 2 8 2025
BY THIS CERTIFICATE OF COMPLIANCE
OF RYE BROOK
Better Homes Electrical Inspection Services Inc:`��ARTMENT
5 Buckout Road, West Harrison, NY 10604
914-906-0443
CERTIFIES THAT
Upon the application of: Upon premises owned by:
Kensico Electric John & Marilyn Michaels
90 Jefferson Ave Irrevocable Trust
Vahalla, NY 10595 51 Mohegan Lane
Ryebrook, NY 10573
Certificate Number: 4197
Certificate Date: 5/27/25
Located at: 51 Mohegan Lane Occupancy Type: Residential
Ryebrook, NY 10573
Permit Number: EP-25-134 Section: 135.41
Building Permit Number: Block: 1
Lot: 24
A visual inspection of the electrical system at this premise described above, wherein the premises
electrical system consisting of electrical devices and wiring, described herein.
All inspections are in accordance with the National Electrical Code and the details of the installation,
as set forth below, was found to be in compliance therewith on the date of the inspection.
Name Quantity Rating Circut Type
200 amp service upgrade 1 240v 200a Meter pan outdoor
1 240v 200a Main breaker panel 42 circuit
in
This certificate may not be altered in any way. :.`�;LVORZZ
'��
SEAL
This certificate is valid for work performed 2022
before the date of inspection only. %�y'2�`1v voF`�,arc Licensed Inspector
Sa\\\�,.