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BUIL TEE MENT
VIL OF RYE OK R JUN 2 a 2025
938 KIN ET RYE B NY 10573
VILLAGE OF RYE BROOK
w n v I BUILDING DEPARTMENT
ELECTRICAL PERMIT APPLICATION
Westchester Coun ]Master Electricians License Required
FOR OFFICE USE 'Y N2 #•% EP#: C'
Approval Date: 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, CG'" 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: la �Aotrlt 9 i,ue D,4- SBL: /J !�.�'�"- / -Zone: ello
2.Property Owner:-I-)M 1YTj4 y P8 R-ro'l Address: A r4 dr
Phone#: tom, SR 7 -S 70,-Cell#: email:
3.Master Electrician/Licensed Installer: H r GNAiZ ItZOy Address: 7q t9,Cr4,L BR^E Ra ST4 M 'C'a
0&7io3
Lie.#: 13 8 0 Phone#: 3�a 76 �y�s cell#: C9 t j 879- sy 8 7 email:An E ecy tL 49 e rro V .�wlE .iy 67
Company Name: A--rA. Address: 5 4 M cr-
4.Proposed Electrical Work/Fixture Count:
"Ante aCO fAWI C,6� t S&L FRQM CALLL5 Ta r7�57'
5.3rd Party Electrical Inspection Agency: 5 y-j +�
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
d1C.NACa __rRd ,being duly swom,deposes and states that he/she is the applicant above named,and does further
(print name of individual s' n ng as Iie tl
state that(s)he is the�j [!909 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 f the Village of Rye Brook and all other applicable laws,ordinances,and regulations.
Sworn to be re me this l� Sworn to re me this
day of 20 day of 0 �
Signature of Property Owner Signature of App
.y Jed y
�Popewner fApli
cant
A�
No Publ' TIANNA MAJOR No a e o ew York
Notary Public-State of New York ' o.01fiAE6160063
NO.OIMA0005867 Qualified In Westchester Coun#1-�/2024
Qualified i Westchester County Commission E lres January My Commission
xn Expires Apr 19,2027 p Y 29,20 o
STATE WIDE INSPECTION SERVICES, INC.
Service Wilh Integrity
0:0 Main Street, Fishkill, NY.125241 Email:OFFICE@SWISNY.COM
SWIS • 0.
Office Use Elect. Permit# � � /f Date
1-2
Bldg Permit#
Sq Ft
Plumbing Permit#
Final Certificate#
City/Village q, n Zip 015' Building Dept. County
Address 1 A 'iD 1 Cross Street Section Block Lot
Owner Name/Address(if different than above) Contact Number
❑Basement ❑ 1st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic Jjr0utside Iii["ftesidential ❑Commercial
Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/O 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
Q(50 I I Froverhead ❑ Upgrade ❑ Disconnect
Utility ID# ❑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
Cr-I A/V -6 &XI sT1 0,CZ IN -T
o CECEME 3D
JUN 2 0 2025
VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
This application is valid for one lii year from the date received by SWIS.This application is intended to cover the above listed Items to be Inspected,Hat 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 with any other inspection company.The applicant,
owner or authorized agent agrees to all the above terms and conditions asset forth for the application.
Email Address �
A'_ I L 6arr oyLj,,jI6 Name t C 14A C Qc�v
License# Date 4 A., ds Signature
Address ate — *-
1 .rGld� City/S r A/`''�►'"O -o C-7 Zip Code 06 C-o 3
Company Phone# 203 17 _ r
C'E&- (91Y) F79 +9g0 7
ILA C�� `,�� ice; State Wide Inspection Services
1080 Main Street
AUG 2 7 ZG25 Fishkill, NY 12524
T a `-� 845 202-7224 Phone
_ 914-219-1062 Fax
STATE WIDE INSPECTION SERVICES VILLAGE OF RYE BROOK Email: office@swisny.com
BUILDING DEPARTMENT 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:
ATA Electric, LLC Cape Eland LLC
79 Briar Brae Road 12 Rock Ridge Drive
Stamford,CT 06903 Rye Brook, NY 10573
Located at: 12 Rock Ridge Drive, Rye Brook, NY 10573
Section: Block: Lot: Electrical Permit Number: EP25-163
135.35 1 49
Certificate Number: 2025-5777 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: 12 Rock Ridge Drive, Rye Brook, NY 10573
The Exterior 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 271h Day of August 2025.
Name Quantity Rating Circuit Type
Replaced Existing Service Riser& Installed Service Mast.
Officer: FrankllllJ. 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.