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BUILDING DEPARTMENT D JD
VILLAGE OF RYE BROOK n JUN 16 2025
938 KIN(i ST4ET RYE BwoK.NY 10573
(9J41119-0668 VILLAGE OF RYE BROOK
tk%,. u�►Iin�.L.()y BUILDING DEPARTMENT
ELECTRICAL PERMIT APPLICATION
Westchester County Master Electricians License Required /5-&FOR OFFICE USE ONLY bii'�: EP#:
Approval hate: "u Permit Fee: S � >
Approval Signature: Other:
�*t********t****t**************# **•**#****#****#**#********ss�************s#***********s**s**ss**
i)o No SI'.%RT NNORK or CONS'fRU( TION I_NTIL A PERMIT IIAS HEL% I551 ED B) I'll-F B1 ILDIM. INtiPI;( IOR.
"I'llE ADVIINISIR:s.I IVE FEE FOR%NORK PRO►G HESSEI)OR( OMPLE-fED WIT1 Ot -f .% III kttll Is 12 OF I III
TO I A1.(OS I (►F ( 0\1%I Rill CTfO's %I ITfI % .N11N 1%11 N1 FEF:OF 5150.00
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: ` # �. SBL: ,3v, / -/-3 Zone: "lJ -4
2.Properly Owner: "L'C Vrr Address: 69 E
Phone#: Cell � (email: lee -,1 e-t �� gV43A�
3.Master Electrician/Licensed Installer: 1-4h Address: .� 1
Lic.#: rgslrPhone it: Cell #: 4 0 email: d
Company Name: 1fjL kipj , S CiterrL dVrr►. Address: .Z " + l y
4.Proposed Electrical Work/Fixture Count:
S.Yd Party Electrical Inspection Agency:
ii tA#t irA.F.R**A***�1*A***+YAA�*tk+l�.Jr iFf itf s►#iiY{fYt�if.k�#fA/t*iiii.F�rA+4brt.Y+F it�eM1M MiM+ki.I.irhhiri i.**fir lr*Rile**h/rAM.k*A�.*i.k#�rM irk ie
1 STATE OF NEW Y RK.COUNTY OF WESTCHESTER ) as:
r�Aj G.i�cing duly sworn.deposes and status that Itic she i,the applicant above namett and does further
tpnnt nanc(,I* kin idual.� Wing as thyappI ant
state that is is the r�r �(C(Li 1[Is✓�'or the legal owner and is duh authorized to make and file this application.
q%b%tc+I Ictitrktan,t.tcenwd In;tallc I
'rhe undersigned furder states that all statement..contained herein are true to the hi:st of his/her knowledge and beliel;and that any work
performed,or use conducted at the above captioned propert-,will he in conformance with the details as set forth and contained in this
application and in any accompanying apprcnLd plats and specification.-as%veil as in accordance with the New York State Vnifonn Fire
Prevention& Building Code.the(ode or the Village of Kyc[Brook and all other applicable la%%%.ordinance.and regulations.
Sworn to before met this Sworn to before me this
day of ,20 day of 20
Signature of Property Owrier Sig atu 4 c t
ri ame of Pr pe Ow r p�"' �ame of Applican
r tl�Ll
Nots o are York
'Sioy }tarI9tiIEULLO No. M pO63
Notary Public.State of New York Qualified in Westchester Coun -7 611,12D24
No.OIME6160063 '.ammission Fxpires January 29,20 fi�
Qualified In Westchester County
Commission Expires lantlaty 29,201zl
STATE WIDE INSPECTION SERVICES, INC.
0•0 • •
SWIS JOB APPLICATION tel 845.202.7224 1 fax 914.219.1062 1 SWISNY.comj SWISTRAINING.COM
Office Use Elect. Permit# ` s�/ �' Date Gh/
Bldg Permit# Sq R ID
Plumbing Permit#
Final Certificate#
City/VillagerO Zip Building Dept, County
Address Cross Street Section Block Lot
1 I
Owner Name/Address(I€different than above) J/e/ L"i Contact Number
Basement ❑ 1st FL ❑ 2nd FI. ❑3rd FI. ❑More Than 3 FI. Garage ❑Attic Q tside ❑Residential ❑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 [kUnlerground ❑ New ❑ Reconnect ❑ Repair
rhead ❑ Upgrade ❑ Disconnect
Utility ID# ❑Con Ed ❑ NYSEG ❑Central Hudson ❑ Orange/ Rockland
PHOTOVOLTAIC SYSTEM
PV Modules Inverters AC Disconnect ]unction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect
❑Legalization ❑ Safety Inspection ❑Consultation
P-a f,4,.(- Pro t SO A L i� 0 A4,jo Eervj 'ce , in-,gkll
rv.euj Vo
Q.e- vrJ 01 P �.. /� ra.t� ID
i^o vtndif
Y �E
C� �� �-
J U N 1 -FjD
L2025J
VILLAGE� OF RYE BROOK
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 ny ti�o��P}�.y'1Y"i'002 Ei1 A!' �d,yo are
authorized to make the inspection and adjust the tee for the additional items Inspected The applicant declares that there is no open applications forth er+yetherinSpeeNowbwaps nt.
owner or authorized agent agrees to all the above terms and conditions asset forth for the application. /
Email Address Ole—L�j'j [ ' 101�v1-6/ .� Name .C
License # ' Date & 16 `2- Signature
Address /f�;� ���t City/5 to f , /,��� N Zip Code (Tel
Company l G (r `e L l� V Ph A e#
1
State Wide Inspection Services
1080 Main Street
S VOW U
F2 1, 12524
02-
' 845 202-7224 24 Phone
5— nr.T - 2 LJ^� I 914-219-1062 Fax
STATE WIDE INSPECTION SERVICES Email: office(cbswisny.com
V,LL.,U-t OF RYE Website: www.swisny.com
Service With Integrity I "1 In I- n rlrr%P,
BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES
CERTIFIES THAT:
Upon the application of: Upon Premises Owned by:
Nicholas Electric Corp. Sheryl &James Velta
22 Cindy Lane 46 Hillandale Road
Putnam Valley, NY 10579 Rye Brook, NY 10573
Located at: 46 Hillandale Road, Rye Brook, NY 10573
Section: Block: Lot: Electrical Permit Number: EP25-158
130.77 1 22
I
Certificate Number: 2025-4204 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:46 Hillandale Road, Rye Brook, NY 10573
The Basement, Garage and 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 19th day of June
2025.
Name Quantity Rating Circuit Type
Service 01 200AMP
Meter 01
Panel 01 200AMP
Sub Panel 01 100AMP
Grounding and bonding of service to current codes.
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.