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BUIL E MENT MAY - 8 2023
VR E OF RYE K VILLAGE OF RYE BROOK
938 KiNa STET RYE B ,NY 14573(914)939' BUILDING DEPARTMENT
)939-5801
ctttiw.ri or
ELECTRICAL PERMIT APPLICATION
Westchester Countv Master Electricians License Required
FOR OFFICE USE ON v HP#: EP
Approval Date: M A Y �-�Q 1� y
.Application Fee:S
Approval Signature: Permit Fee: S
Disapproved: Other:
(fees are some-refaedahte)
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Application dated. �. —0 3 is hereby made to the Building inspector of the Village of Rye Brook NY• for the issuance of
a Permit to install an&or remove electrical equipment,wiring, fixtures,or to perform other hilt or low voltage electrical work as per
the detailed statement described below. The applicant & property owner, by signing this document agree that all electrical work
performed will be in conformance with all applicable Federal, State,County and Local Codes.
I.Address:_ 11 Lawride Drive SBL:_ 129.67-1-34 _7.one:
2.Propem caner: Ryan Goldstein Address: 11 Lawtidge Drive Rye Brook NY 10573
Phone t?:— Cell>*: 917-763-9268 i email: ryan@ryangc ldsteinlaw.com
3. Aastcr electrician: Pat SpirelG Address:990 East Main Street Shrub Oak NY 105888
Lic.- E343 - Phone a: 914.455.2158 Cell#: _email: celia@spirelliekeeric.com
Company Name:_ Spirelli Electric Inc Address: 990 East Main Street Shrub Oak Ny 10588
d.Proposed Electrical Work Fixture Count:
Install a new customer_su lied Tesla Wail Connector with a new 240v 50 amp circuit on the left side of
the garage looking in.
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STATE OF NEW YORK.COUNTY OF WESTCHESTER ) as:
�pr r��_.being duty sworn,dgxx.,s and states that heishe is the applicant above narncd,and,does further
i ntnameof dividuat iEmng& theappii�znt)
state that Is)he is the legal owner of the property to which this application pertains.or that(s)he is the
for the k'lW o%%ncr and is duly auttxwiacd to make and file this application.
1 ttxticxtr architect.cpntraclw.agent,anom,.etc t
The undersigned further states that all statements contained herein are true to the bey of hisi%er know ledge and belief and that any work
performed.or use conducted at the above aiptioned propen) will be in conformance with the details as set revolt and contained in this
application and in any accompan)ing approved plans and specifications.as well as in acowdamc with the'.Sew York State Uniform Fire
Prevention&Building Code,the Code of the Village of Ryc Broil;and all ether applicable la%%s.ordinances arxi regulations.
Sworn to before me this S Sworn to before me is
of 207: day of 20_a
ry 15
Si ature o Signature o Appl nt
n LV
Pr arise of operty Pri Name o Applicant
�.�
?rotary Puhltc Notary Public
LA IM 8LYMOUR FISHER
NOTARY PUSUC,Stitt of New York NICOLE HERlilAttt�Ez
N0,011i'llZ 9121 M IAar MOM STATE of NI M roast
QUaMd In K County z awlMa/ M1101111 s !>a2l
EX**;"Martrtt is,
INSPECTIONSTATEWIDE
Service With hitegri�v
0•0
SWIS JOB APPLICATION0.
Office Use Elect.Permit# � // � Date
Bldg Permit# Utility ID#
Final Certificate#
City/Village /o� i/ Zip Township County
Address rC Cross Street,, Section Block Lot
Owner Name/Address(if differen an above) I/'C ``OJ � Contact Number L7/y_ 7&3. Fa &r
❑Basement ❑ 1st FI. ❑2nd Fl. ❑3rd ❑More Than 3 FL ❑Garage I__I Attic ❑Outside esidential ❑Commercial
Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact
Amt Amps
Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw
Incandescent Fluorescent
SERVICE
Amperage Voltage 1 P 3P #Meters #Disconnect ❑Underground ❑New ®Reconnect
❑Overhead ❑Change
❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection
Additional Information
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MAY 11 2023
VII_LAGI= k';� ;' BRO(--)K
This application is valid for one(1)year from the date received by SWS.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.
Inspector Date Finalized Inspector#
Company Nam j'r ! Date Signature
Address 1 n �� City/5tat� rub Qa p Code
License# Phone#
S�`
State Wide Inspection Services
C — -7�,,D 1080 Main Street
ID Fishkill, NY 12524
845 202-7224 Phone
MAY 2 6 2023 1 914-219-1062 Fax
STATE WIDE INSPECTION SERVICES Email: office@swisny.com
VILLAGE OF RYE BROOK Website: www.swisny.com
Service With Integrity BUILDING DEPARTMENT
BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES
CERTIFIES THAT:
Upon the application of: Upon Premises Owned by:
Spirelli Electric, Inc. Ryan Goldstein
Patsy F.Spirelli 11 Lawridge Drive
990 East Main Street Rye Brook, NY 10573
Shrub Oak, NY 10588
Located at: 11 Lawridge Drive, Rye Brook, NY 10573
Section: Block: Lot: Electrical Permit Number: EP 23-112
129.67 34
Certificate Number: 2023-3882 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: 11 Lawridge Drive, Rye Brook, NY 10573
The Garage 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 26`h day of May 2023.
Name Quantity Rating Circuit Type
EV Charger 01 50AMP 240V
officer: Frank 1. 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.