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ECENE
BUILDING DEPARTMENT SEP 12 2025
VILLAGE OF RYE BROOK VILLAGE OF RYE BROOK
U3,1% K►•'.(,,STREET RYI BROUI(, NY 105" BUILDING DEPARTMENT
(9)4)939-0669
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ELECTRICAL PERMIT APPLICATION
Westchester Counh N aster Electricians License Required -- ��J
I I►k 01-f I( i I .F. ()NI , fill =: I t''. �5Q3Cfi
Appro\al irate: w1m,
crmit Fce: Sp�,sZ�
Appro%al Signature: lam/ ther:
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Appheditun ddlcd.�ll'Z'2� 1,hcreht made to the Budding Inspector tit the Villagc ul•Ryv Bitwl. `Y. lui the ,Suance ul
Permit ro m";ill and Air remote electrrtai cyuilpmew. ti\cure,. (,r it,peiltmn other high or lua tol!age c!cctncal stork i,pcl
the dcta,lcd statement de,ciibed btaut, Ii} signing tin> Jucutncnt. tic applicant & prupt:ny u,,ncr .ig-cc that A. JCOI A cork
pert,.:nncd tall he in can+.'orntancc tt th.ill app1,cdhic Feral.Statc.Comity and I
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clibrltt:d,or use conducted al iitc a,e, caplwned nt-..I"v1% 'Ad!he to rnoG•,nat:ce u,th the detail,J,.,el forth and contalred lit r,
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Silufaturc of Properivtiovioe Slenalu ul-Appii,
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SVETLANA MARGULES
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N&01MA114=3 VANESSA REIS CARDOSO
OurSi W 1nWs0c nW CNWj Notary Puolic-State of New York
My wrilrbsisn E*hs.knrry 19,2127 No.01 CA0021753
2,vuL �~ Qualitied in Putnam County
My Commission Expires 03/05/2028
BUIteETRYE
N
NT
VILK938 KINY 10573
ELECTRICAL PERMIT APPLICATION
Westchester County Master Electricians License Required
FOR OFFICE USE ONLY BP#: EP#:
Approval Date: Permit Fee: $
Approval Signature: Other:
DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BLILDING 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.
1.Address: \ 16 r STRF-eTF g. jt �6eoZk SBL: Zone:
2.Property Owner: V T A. M�-- eooy- L-L�L Address:-6CX� T-- KR2r-EX•S;'i Slag (00 LOU-MVS�f—'
Phone#: S2-SL4 Cell#: email:Tok. ONSL►"ATPs 11rssm=e-
3.Master Electrician/Licensed Installer: Vik; Qvfl S Address: 35
Lic.#:-2tLZO Phone#: 91L4-44'V-569qVell#: email:TAJEX&N_ �T
Company Name: LL4.Address: 3S VNeN RX0fi:F W. etAT-WWq&Ak-r
4.Proposed Electrical Work/Fixture Count:.
gneA�LmXr S2 cw�►�c _ J �F--t.Ac 33 ?C—#J �AA�� -r�StiA-cc 2� LFO
5.31 Party Electrical Inspection Agency:
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
t`t -Qoo being duly sworn,deposes and states that he/she is the applicant above named,and does further
(print nanic of individual sipnmQ a-th, nnnliernt)
state that(s)he is the L l�►the legal owner and is duly authorized to make and file this application.
(Master EI cian/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 of the Village of Rye Brook and all other applicable laws,ordinances,and regulations.
Sworn to before me this Sworn to before me this
day of ,20 day of ,20
Signature of Property Owner Signature of Applicant
Print Name of Property Owner Print Name of Applicant
Notary Public Notary Public
6/1/2024
STATE WIDE INSPECTION SERVICES, INC.
CA— Serji-iee With lniiegi-iq
0• • •
SWIS JOB APPLICATION •.
Office Use Elect, Permit# 5.�'� Date
Bldg Permit#
Sq Ft
Plumbing Permit#
Final Certificate #
City/Village �Y (�^` �K v Zip 10 -1 Building Dept. County
Hddressx2-,,#3 � 1 l Cross Sireec SeUiull oiucic cui.
Owner Name/Address(If different than above) Contact Number
❑Basement [: 1st Ff. [lind Fl. Q,1rd Fl. More Than 3 Fl. ❑Garage ❑Attic ❑Outside ❑Residential ffCommercial
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 iP 3P # Meters # Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair
❑Overhead ❑ Upgrade ❑ Disconnect
Utility ID# []Con Ed ❑NYSFG ❑Central Hudson ❑Oranae/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
Scope of Work
SEP 12 2025
VILLAGE OF RYE BROOK
BUILDIt4G 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 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 as set forth for the application.
Email Address ; — Name `i Z,Q Ze t L
License# 17 Date a.rJ Signature
Address J IF
4 T �� LA N City/State IV A"
W. Zip Codery
Company Phone# _
IID State Wide Inspection Services
RECEIVED 1080 Main Street
Fishkill, NY 12524
a 845 202-7224 Phone
VILLAGE OF RY'I BROOK 914-219-1062 Fax
STATE WIDE INSPECTION SERVICES Email: officeCc0swisny.com
BUILDING DEPAR-rMENT 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:
Reiset Electric, LLC VIR Rye Brook LLC
35 Partridge Lane 1200 King Street
Putnam Valley, NY 10579 Rye Brook, NY 10573
Located at: 1200 King Street, Rye Brook, NY 10573
Section: Block: Lot: Electrical Permit Number: 25-236
124.73 1 1
Certificate Number: 2026-0608 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: 1200 King Street, Rye Brook, NY 10573
The First Floor, Second Floor,Third Floor, and Fourth Floor 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 30`h day of January 2026.
Name quantity Rating Circuit Type
LED wall sconces 52
Ceiling Pendant lights 33
Recessed Down Lights 26
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.