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Final Expired Letter Sent
4/10/2017
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DATE WASP
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FRAMING Notice of Violation Sent
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VILLAGE OF RYE BROOK
MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR
Jason A. Klein (914) 939-0668 Christopher J. Bradbury
www.ryebrook.org
TRUSTEES BUILDING& FIRE INSPECTOR
Susan R. Epstein Steven E. Fews
Stephanie J. Fischer
David M. Heiser
Salvatore W. Morlino
CERTIFICATE OF COMPLIANCE
July 6,2023
Jorge Silva&Alison Silva
4 James Way
Rye Brook,New York 10573
Re: 4 James Way, Rye Brook,New York 10573
Parcel ID#: 135.43-1-22.3
Building Permit#11-014 issued on 8/23/2011 for a New Fence
This certifies that the new six foot high partial fence,in rear yard,installed under the above captioned permit
has been satisfactorily completed.
Sincerely,
Steven E. Fews
Building&Fire Inspector
/to
For office use oniv.. /),)4
_ BUILDiv ? T,MENT PERMIT#
i n VIL� I OF RYE) ' OK ISSUED:
! �3J$� ING STRE it YE BROOK, . t-1 YORK 10573 DATE:
DEC
6 20112 1 !IU (914)9 f� - 939-5801 FEE: AID 1W
VILLAGE OF RYF BROOK
BUILDING DEPAf APPLICATION FOR
CERTIFICATE OF OCCUPANCY / COMPLIANCE
AND CERTIFICATION OF COSTS
It shall be unlawful for an owner to use or permit the use of any building or premises or part thereof
hereafter created, erected, changed, converted or enlarged,wholly or partly, in its use or structure until a
certificate of occupancy shall have been issued by the Building Inspector.§250-10.A.Code of theVillageof Rye Brook
******************************************************************************************
Address: 4/ 1 w
Occupancy/Use: Parcel ID#: Zone:
Owner: �� /� r ✓ "/ Address:
P.E./R.A. or Contractor: /C��' t Address:
Person in responsible charge: Address:
Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a
Certificate of Occupancy/Certificate of Compliance for the structure herein mentioned in accordance with law:
STATE OF NEW YORK, COUNTY OF WESTCHESTER as:
41'-J J' It,�- being duly sworn,deposes and says that he/she resides at Z/1 ��`~ G' Y
(Print Name of Applicant) �( c (No.and Street)
in �j�c �!� , in the County of (./,7 4 in the State of �(/� ,that
(Cityfrown/Village)
he/she has supervised the work at the location indicated above, and that the actual total cost was: $ 7/2- 7 f ,
for the construction,alteration or repair of
Deponent further states that he/she has examined the approved plans of the structure herein referred to for which a Certificate
of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure has been erected in
accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally
authorized, and as erected complies with the laws governing building construction.
f
Sworn to before me this Sworn to before me this
day of (` p,l..`�¢ , 20_la_ day of , 20
Signature of Pfdperty Owner Signature of Applicant
Print Name of Property Owner Print Name of Applicant
otary Public SHARI MEUUA Notary Public
Notary Public,State of New York
No.01 ME6160063 2s 1 I
Cuatlfled In Westchester County /'
Commission Expires January 29.20,�
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• 19812. BUILDING DEPARTMENT
❑'$UILDING INSPECTOR
Ef ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK
❑CODE ENFORCEMENT OFFICER 938 King Street• Rye Brook,NY 10573
(914) 939-0668 FAx (914) 939-5801
www.Uebrook.org
- - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - --- - -
ADDRESS :— j, DATE: `-62
rERMIT# V ISSUED. SECT. BLOCK: LOT:
LOCATION: �" OCCUPANCY: `t
❑ Violation Noted THE WORK IS... PASSED ❑ FAILED REINSPECTION
❑ SITE INSPECTION REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION )
❑ Natural Gas C
❑ L.P. Gas
❑ FUEL TANK
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
❑ CROSS CONNECTION
❑'`FINAL
❑ OTHER
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BUILDING DEPARTMENT -----
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VILLAGE OF RYE BROOK R
l I—' �' 1v% —rcf
938 KING STREET RYE BROOK,NY 10573
(914)939-0668 FAx(914)939-5801 A1JI - 1 2911
www.ryebrook.org
VILLAGE OF RYE B BOOK
********************************************************************************** .L+ 4�WWF_NT
FOR OFFICE USE ONLY:
Approval Date: AUG 1 8 2011 permit # : Application #�� �
Approval Signature: :ARCHITECTURAL REVIEW BOARD:
Disapproved a/c: Date: l7
Other Approvals: Chairman:
ZBA Approval Date: Case # Secretary:
Permit Fee: IA
************************************************************************************************************
FENCE / WALL PERMIT APPLICATION
Application dated: / /J I is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the
issuance of a Permit for the construct on,repair or replacement of a Fence or Wall,in accordance with Section 250-6 B.(1)(g),of
the Code of the Village of Rye Brook,as per detailed statement described below.
1. Address:
2. Occupancy/Use:
S.B.L.#: l�S•4 3 - ( — 2 Z 3 �(�. ZSA 1(o Agione: ►L� fl
3. Proposed Fence/Wall(describe ' detail):
4. Applicant: ddress: Phone
Owner: :ZLZM S21/4;4' Address: � 9/11E.S- 42 z Phone:
J
Architect: Address: Phone:
Engineer: Address: Phone:
Builder: Address: Nye'
y/ Phone:
Work supervised by: �fy �l /� ?/� Address: �.�; PCs �/� �``�� V1 Phone:
5. If building is located on a corner lot,which street does it front on:
6. What is the estimated cost of construction$ / 2/33, ?/ 2 Ok\Z-
(NOTE:The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,and
material and labor which may be donated gratis.)
7. Estimated date of completion:
LAST REVISED6.1.09
8. The State Workman's Compensation Law provides that before a Building Permit is issued,the Contractor,Owner,
Architect,etc.,shall produce the following information: ✓
I—W
Name of Compensation Insurance Carrier:
No.of Policy: Date of Expiration:
Please note that this application must include the notarized signature(s) of the
legal owner(s) of the above-mentioned property, in the space provided below.
Any application not bearing the legal property owner's notarized signature(s)
shall be deemed null and void, and wall be returned to the applicant.
**********************************************************************************************************
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
'jo,2�C b. 3, 1,J r, ,being duly sworn,deposes and states that he/she is the applicant above named,
(print naWe of individual signing as the applicant)
and fiirther states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the
_ 0( n 15fL for the legal owner and is duly authorized to make and file this application.
(indicate architect,contractor,agent,attorney,etc.)
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 ^---1-- Sworn to before me this
day of U k , 20 day of , 20
rM*NPublic Notary Public
Signatur a er Signature of Applicant
Print Name of Property Owner Print Name of Applicant
JANINE M.CARIMN UO
rotary Public,state of New York
No.01CA6059M
Qualifled In Weelche WCOunty
Commission Expires June 4,201
LAST REVISED6.1.09
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Certified Mail
( � BUILDING DEPARTMENT Hand Delivered
VILLAGE OF RYE BROOK
938 KING STREET,Rl E BROOK,NY 10573
(914)939-0668 FAX(914)939-5801 vti-"m!.ryebrook.org
NOTICE OF VIOLATION AND ORDER TO REMEDY SAME
OWNER: Jorge Silva and/or Alison Silva VIOLATION#: E 1106
4 James Way ;NOTICE#: Final
Rye Brook NY 10573 S.B.L.: 135.43- 1-22.3
The following violations of the Code of the Village of Rye Brook, were found to exist at, 4 James Wav
located in an, R-10 zoning district, in the County of Westchester, Village of Rye Brook, NY on.
January 16`h 2019.
i
CODE SECTION&TITLE DESCRIPTION
VILLAGE CODE §91-2.B. EXPIRED BUILDING PERMIT#FWP 11-014 ISSUED 8/23/11
EXPIRED 2/23/13
i
VILLAGE CODE §250-10.A CERTIFICATE OF OCCUPANCY/COMPLIANCE REQUIRED.(FWP 11-014)
You are hereby directed to contact this department, obtain all necessary permits& commence to correct the above
captioned violation(s) immediately. Failure to comply with this notice by convecting the violations immediately
can/will result in a summons to court the Rye Town Court. Note that a re-inspection of the premises is required by
law to confirm compliance with this notice& all other applicable codes.
FAILURE TO COMPLY WITH THIS NOTICE IS A CRIME PUNISHABLE BY IN PRI�INMENT9 OR BOTH.
ASSISTANT BOIL ECTOR
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VILLAGE OF RYE BROOK
MAYOR 938 King Street, Rye Brook, N.Y. 10573 ADMINISTRATOR
Paul S. Rosenberg (914)939-0668 Fax(914)939-5801 Christopher J. Bradbury
www.ryebrook.org
TRUSTEES BUILDING&FIRE
Susan R. Epstein INSPECTOR
David M. Heiser Michael J. Izzo
Jason A. Klein
Jeffrey B. Rednick
April 10. 2017
Via I" Class Mail
Final Notice
Jorge Silva
4 James Wav
Rye Brook, Ne%% York 10573
Re: 4 James W'ay. Rve Brook. NeH York 10573
Parcel ID#: 135.43-1-22.3
Fence Permit 41 1-014 Issued: 8/23/201 1 - Expiration Date: 2/23/2013
Dear Property Owner,
It has come to the attention of the Building Department that your Fence Permit listed above has not been
closed out in accordance with Village Code, and has been expired since 2/23/2013. Please note that there
is a non-waivable expired permit fee of$500.00 now due in connection with your expired permit.
Please be advised that it is a violation of Village Code to fail to close out a permit, and that a court
summons could be issued and fines may be imposed on the permit holder and/or property owner for
failure to apply for and obtain a Certificate of Occupancy(C/O)or Certificate of Compliance(C/Q. in
accordance with Village Code section 250-10A.
Please note that Temporary C/Os& C/Cs are available in accordance with Village Code section 250-1OB
should you require more time to perform whatever work remains in order to complete your project.
Thank you for your attention in this matter,and please feel free to contact this office should you require
any further information.
Michael J. Izzo
Building& Fire Inspector
mizzo(a-ryebrook.org 1�
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cc: Steven E. Fews. Assistant Building Inspector
7016 1370 0000 1870 7598
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VILLAGE OF RYE BROOK
MAYOR 938 King Street, Rye Brook, N.Y. 10573 ADMINISTRATOR
Paul S. Rosenberg (914) 939-0668 Fax (914) 939-5801 Christopher J. Bradbury
www.rVebrook.org
TRUSTEES BUILDING & FIRE
Susan R. Epstein INSPECTOR
David M. Heiser Michael J. Izzo
Jason A. Klein
Jeffrey B. Rednick
April 15,2013
Via 1st Class Mail
Mr.Jorge Silva
4 James Way
Rye Brook,New York 10573
Re: 4 James Way,Rye Brook,New York 10573
Parcel ID#: 135.43-1-22.3
Fence Permit#11-014 Issued: 8/23/2011 -Expiration Date: 2/23/2013
Dear Property Owner,
It has come to the attention of the Building Department that your Building Permit listed above has not
been closed out in accordance with Village Code, and has been expired since 2/23/2013. Please note that
there is a non-waivable expired permit fee of$750.00 now due in connection with your expired permit.
Please be advised that it is a violation of Village Code to fail to close out a permit,and that a court
summons could be issued and fines may be imposed on the permit holder and/or property owner for
failure to apply for and obtain a Certificate of Occupancy(C/O)or Certificate of Compliance(C/C), in
accordance with Village Code section 250-10A.
Please note that Temporary C/Os&C/Cs are available in accordance with Village Code section 250-1 OB
should you require more time to perform whatever work remains in order to complete your project.
Thank you for your attention in this matter,and please feel free to contact this office should you require
any further information.
'nc ;ire
�i aelBuilds Inspector
mizzoaa,ryebrook.org
cc: Steven E.Fews,Assistant Building Inspector
Suzanne E.Volpe,Esq.,Keane &Beane, P.C.
Building Permit Check List & Zoning Analysis
Address: A A V" . .� SBL: ( SS.q3 - (- 22 3 Z6 •ZSA 16 A S
Zone: -( .� Use: 2 t o Const. Type: Other.
Submittal Date: l 1 t Revisions Submittal Dates:
Applicant: S((-V A
Nature of Work: IN 4c- �� 916 t} l,,, ,A�
N
Reviews: ZBA: AUG - 4 2011 PB: BP: Other:
NEED OK
(� FEES: Filing: ��
7 BP: C/O: Legalization:
( ) ( APP.: Date Stamped: / Properly Signed: ✓ SBL Verified: 7 Other:
( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening:
( ) ( ) ENVIRO.: Long: Short: Fees: N/A:
( ) ( ) SITE PLAN: Topo: Sit Protection: S/W Mgmt.: Tree Plan: Other:
SURVEY: Dated: -:•zT.o� Current: Archival: v"^ Sealed: r Unacceptable:
( ) ( ) PLANS: Date tamped: Sealed: Copies: Incomplete: N/A: Other:
(+License: Workers Comp: / Liability: Comp. Waiver: Other:
( ) Code 753#: Dated: N/A:
( ) ( ) HIGH-VOLTAGE ELECTRICAL: Plans: Permit: N/A: Other:
O O LOW-VOLTAGE ELECTRICAL: Plans: Permit: N/A: Other:
( j ( ) SMOKE DETECTORS: Plans: Permit: N/A: Other:
( ) ( } PLUMBING: Plans: Permit: Nat. Gas: LP Gas: N/A/: Other:
( ) ( ) FIRE SPRINKLERS: Plans: Permit: N/A: Other:
( � O 2010 NY State ECCC: N/A: Other:
( ) Final Survey: Final Topo: RAPE Sign-off Letter: As-Built Plans: Other:
( ) ( } BP DENIAL LETTER: C/O DENIAL LETTER Other:
( ( ) Other: -
( ARB mtg. date: iR 1 t approval: ('i l ( notes:
( )ZBA mtg. date: approval: notes:
( }PB mtg. date: approval: notes:
REQUIRED EXISTING PROPOSED NOTES
Area: QA �QUIPI 8 2011
Circle:
Frontage:
Front:
Front:
Sides:
Rear:
Main Cov:
Accs. Cov:
Ft.HJSb:
Sd.H/Sb:
GFA:
Tot.Imp:
Ft.Imp:
Parking:
notes: A7M ucAJ,, : C4- tf:? GgbICIL Locop o-) l-.C1 r µ^FAS SEA P., wtti S(t-VA / .
'-PARTMENT BUILDT" L1
i
VIL6&i OF RYE OOK +(�
938 KING S' "' ET RYE BR NY 10573 ! �! L AUG - 1 2011 l_J
(914)93 68- (91#,039-5801
=.ry ro'ok:erg
VILLAGE OF RYE BROOK
- '-; BIPL.DING DEP.ARTNIENT'
ARCHITECTURAL REVIEW BOARD CHECK LIST FOR APPLICANTS
This form must be completed and signed by the applicant of record and a copy shall be
submitted to the Building Department prior to attending the ARB meeting. Applicants
failing to submit a copy of this check list will be removed from the ARB agenda.
Job Address: `, 3A^ C-f L'" "y �j�C ��� �• Date of Submission: gI II
Parcel ID#: Zone:
APPLICANT CHECK LIST:
Proposed Improvement(Describe in detail): (The following items must be submitted to the Building
Department with the application,no exceptions).
1. COMPLETED APPLICATION
Property Owner: - < ✓ /V'` 2. ( )EIGHT (8) SETS OF PLANS
Address: Zl a �� �� 3. )EIGHT(8)COPIES OF SURVEY
Phone# I /4 7/ 7 4. ( )EIGHT(8) COPIES OF SITE PLAN
Applicant appearing before the Board: 5. FILING FEE
Q
r�°^ '/ � ��`� _ 6. )SUPPORTING DOCUMENTATION
Address: Lr' t f 4 Y e • 7. ( )PHOTOGRAPHS
Phone# 7 - 7 8. ( )SAMPLES OF FINISHES (a sample board or
Architect/Engineer: model may be presented the night of the meeting)
Phone#
By signature below, the owner/applicant acknowledges that he/she has read the complete Building Permit
Instructions& Procedures, and that their application is complete in all respects. The Board of Review reserves
the right to refuse to hear any application not meeting the requirements contained herein.
Sworn to before me this Sworn to before me this
day of , 20 day of , 20
Signature of Prop Owner Signature of Applicant
Print Name of Property Owner Print Name of Applicant
Notary Public SHARI MEUVA Notary Public
Notary Public,State of New York
No.01 ME6160063
Oualifled In Westchester County
Commission Expires January 2=-L0 )
4.7.I 1
DAMES WAY HOMEOWNERS ASSOC.
August 1, 2011.
To the Approval Board of the Village of Rye Brook,
As President of the James Way Home Owners' Association, I,Jorge B. Silva,
have gotten approval from the residents of this address for my home at 4
James Way to have a 6' h x 48 ' wood stockade fence put by our back deck on
our property.
If you need to contact me for any reason, please call my cell phone.
Sincerely,
11
- 2 2011 1 Dl�
AUG
Jorge . Silva VILLAGE OF RYE 8 OOK
President BUILDING DEPARTMENT
James Way Homeowners Assoc.
VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
938 KING STREET, RYE BROOK, NY 10573
(T) 939-0668 (F) 939-5801
ARCHITECTURAL REVIEW BOARD
Wednesday August 17, 2011
Meeting at 7.30 p.m.
AGENDA
NAME& LOCATION TYPE OF APPLICATION MOTION SECOND APPROVED REJECTED APPL.#
116 Country Ridge 1st& 2nd Story Addition 2378
Jacobs Stone Samples
38 S. Ridge St New Sign 2379
Digital Home
Solutions
4 James Way Partial Six Foot (6) 2380
Silva Stockade Fence ` A 2 ,�
5 Beechwood Blvd Revisons-New Front 2381
Scelfo Portico, Gable End Dormer
&Windows.
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CS MI
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From: "Jorge Silva" <j.silva-biotti@att.net>
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Check List For Release of Building Permits
Address: " S
Owner/Applicant: /
Phone Ws: 3 7 q 71 7
Dates Attempted To Contact Owner / Applicant:
Comments: Y� U, CoS--,-
D Comments: (.t/L(alt
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Comments:
Comments:
Comments:
NEED:
(- ilding Pernut Fee ? 0�
(ZPO #
( ) WC Home Improvement License
( ) Liability
( ) Workers Comp. / Comp Waiver
( ) General Contractor's Contact Information
( ) Fire Sprinkler Plans (2)
( ) Fire Sprinkler Application
( ) Fire S rinI ler Permit Fee
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06/50/2011 16:38 FAX 8459560267 BINDER AGENCY Z 002
ACa® CERTIFIC�►TE �F' LIABILITY INSURANCE. DATE(MhI1DD1YYYY)
�- 6/30/2011
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON 1F.IE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW- THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSJIING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certibil•ate does not confer rig-its to the
certificate holder in lieu of such endorsements . _
PRODUCER NAAMEAC ,JUDTTH POSNER -
BINpER AGENCY INC =PHONE
1C No�1: (849)-156-9000 FAx (845)356•-0267
LAIC.Nol:
E-MAIL osner@binders en oIn
24 South Main Street ADDRESS JP g ' -'
PRODUCER A0000663
GUSTOh1ER IRK.
Spring Va11ep _ NY 10977 INSURER(S)AFFORDING CO WRAGE _ NAIC A
INSURED INSURERA:Main Street America) 29939
INSURER a:NGM Insurance Comr-5my 11788
Fesco Fence Inc INSURER C:
237 S ROUTE 903 INSURER D: _
INSURER E:
WEST NYACK NY 10994-2715 N RERF-
COVERAGES CERTIFICATE NVMBER:CL:-142500876 REVISK!N NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED EELOW HAVE BEEN ISSUED TO THE INSURED NAMI;I)Aeov£ FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUM,e 4T WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERETI IS SUBJECT TO ALL TI-E TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
INS11 A15 POLICY EFF LI EX POCY P uMKS
LTR TYPE OF INSURANCE iNtft wvn POLICY NUM66R IMMIDQIYYXYI IMMIDOIYYYYI _
OENERAL LIABILITY I EACH CCDURRENCE $ —1 r 000,000
AMA -c RENTED
° ' Dcc_rre S 500,000
X COMMERCIAL GENERAL LlaealrY ! PREMI,-
A CLAIM&-MADE X I OCCUR DPV4il491D 4/15/2011 /15/2012 MED VP Any ona xroon 6 10,000
PERSOIL,J-&ADV INJURY S 11000,000
OENERV AGGREGATE $ .2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER; PRODU,-S-COMPIOP AGG S Z,000,000
X POLICY PRO• 77 WC S
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
(Es accl:b nN)
ANY AJTO BODILY 14JURY(Per Pn) S
B ALL OWNED AUTOS 1v5d91n /15/2D71 /15/2012 erso
BODILY rJJURY(Per aeClUenl) £ J
X SCHEDULED AUTOS PROPER-1'DAMAGE
X HIRED AUTOS (Per acr-Drt; -
][ NON-0WNEO AUTO5 PIP-Wok loss rardi:c $
_ ��-
MeolralE<Ranse $ 150,000
I -
UMBRELLA LIAB OCCUR EACH(-(�CURRENCE S ..
EXCESS LIAR CLAJMS-MADE AGGRE CRATE $
DEDUCTIBLE _ 6
RETENTION S S
WORKERS COMPENSATION Vi STATUS OTM-
AND EMPLOYERS'LIA610TY YIN li'�1JOfl
ANY PROPRIE70RIPARTNFR16XECUTlVE❑ NIA E.L.EA.1 ACCIDENT S
OFMCER/A'EMBER EXCLUDED?
(Mandatary In NH) E.L.DIZA ASE•EA EMPLOYE $
Ues. rcrlbe Undor E.L.DIF,EA&E-POLICY LIMB S
SCRIP n OF OPERATIONS bebW
DESCRIPTION OF OPERATION5I LOCATIONS I VEHICLES (Attach ACORD 101,AQdlttDnel Ram1rk15C11edula,Nr ft*11I101I1 roquked)
FENCE SALES/SERVICE/INSTALLATION
Regaxding: work to be performed at G James WaLy - Ryre Brook, Now York The Silva Residen,:.+
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRI11IF0 POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PRCv'SIONS.
Village of Rye Brook
938 King Street
Rye Brook, NY 10573 AUYNO RIZED REPRESENTATIVE
.9
Leonard Hindnr/JTJDY •
ACORD 25(2009/09) 1988.2009 ACORD C-)RPORATION. All rigFt-S reserved.
INS025<2co4c,, The ACORO name and logo are registered marks of ACORD
06/30/2011 16:38 FAX 8459560267 BINDER AGENCY IM004
'ST TE OF NEW YORK
WORKERS' COMPENSATION BOARD
CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE
Ia.Legal Name&Address of Insured(Use street address only) lb. Business Telephone Numl*r of Insured
(845)358-7900
Fesco fence Inc
237 South Route 303 Ic.NYS Unemployment Insurance Employer
West Nyack,New!Cork 10954 Registration Number of linared
Work Location of Insured(On(v required)'coverage Is specifically
limited to certain locations in New York State, i.e., a Wrap-CJp Id. Federal Employer Identification Number of Insured
Policy) or Social Security Number
13 2796617
2.Name and address of the Entity Requesting Proof of 3a. Name of Insurance Carrie
Coverage(Entity Being Listed as the Certificate Holder) Technology Insurance Comppmy
Village of Rye Brook
938 King Street 3b.Policy Number of entity h:ted in box"la"
TWC318680
Rye Brook,New York 10573
3c. Policy effective period
12-01-2010 to 12-01-2011
3d, The Proprietor,Partners ar Executive Officers are
X included. (only check tio:hall partners/officers
included)
all excluded or certain partners/officers
excluded.
This certifies that the insurance carrier indicated above in box "3" insures the business referenced 4—ove in box "Ia" for workers'
compensation under the New York State Workers'Compensation Law.(To use this form,New York(N1"1 must be listed under]Item 3A
on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Can'i tr or its licensed agent:vill send
ithis Certificate of Insurance to the entity listed above as the certificate holder in box"2
The Insurance Carrier will also notify the above certificate holder within 10 days IF a policy is canceled e!ue to nonpayment ofp.�emiums
or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the
coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise,this Ceri;i'rcate is valid for one year after
this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whu:hever is
earlier.
Please Note: Upon the cancellation of the workers' compensation policy indicated on this form,V the business continues to be
named on a permit,license or contract issued by a certificate holder,the business must provide thm certificate holder with a new
Certificate of Workers' Compensation Coverage or other authorized proof that the business is s:(mplying with the mandatory
coverage requirements of the New York State Workers' Compensation Law.
Under penalty of perjury,i certify that i am an authorized representative or licensed agent of the insurance carrier refferenced
above and that the named insured has the coverage as depicted on this form.
Approved by: Judith Posner _
(Winmeofauth ' d rcprese five or lice) d agent of insurance carrier)
Approved by: 06-28- 2'011
( ature) (Date)
Title: Binder Agency
Telephone Number of authorized representative or licensed agent of insurance carrier(845)356-9000__ _
Please Note, Only insurance carriers and their licensed agents are authorized to issue Form C-105 2. Insurance brokers are NOT
authorized to issue it,
08/22/11 11 : 16 AM 3154372621, 01/01
****REGULAR****
DIG REQUEST from DSNY for: VIL RYE BROOK Taken: 08/22/2011 11 :00
To: VIL RYE BROOK / DAY Transmitted: 08/22/2011 11 :18 00001
Ticket: 08221-040-054-00 Type: Regular Previous Ticket:
------------------------------------------------------------------------------
State: NY County: WESTCHESTER Place: RYE BROOK /V
Addr: From: 4 To: Name: JAMES WAY
Cross: From: To: Name:
Offset:
------------------------------------------------------------------------------
Locate: MARK CURB TO ENTIRE PROPERTY
NearSt: DEAD END OFF N RIDGE ST
Means of Excavation: HAND TOOLS Blasting: N
Site marked with white: N
Boring/Directional Drilling: N
Within 25ft of Edge of Road: Y
Work Type: INSTALLING FENCE
Duration: 2 DAYS
Depth of excavation: 3 FEET
Site dimensions: Length 110 FEET Width 12 INCHES
Start Date and Time: 08/25/2011 07 : 00
Must Start By: 09/09/2011
------------------------------------------------------------------------------
Contact Name: DENNIS POOL
Company: FESCO FENCE
Addrl : 237 S NY RT 303 Addr-^ :
City: WEST NYACK State: NY Zip: 10994
Phone: 845-358-7900 Fax: 845-358-7917
Email: INFO@FESCOFENCE .COM
Field Contact: DENNIS POOL
Cell Phone: 845-721-0496
Working for: SILVA
------------------------------------------------------------------------------
Comments: Lookup Type: STREET
------------------------------------------------------------------------------
Members: CBLVSN HUDSON VLY CON-ED
TWN-VIL HARRISN UNI WTR NW ROCH
BELL-VALHALLA / WSCHSTR VIL RYE BROOK
WESTCHESTER SWR
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DATEAPPROVED AUG 18 2011 1
8WILDING INSPECTOR, q•of Rye Brook,NY a /
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APPROVED
VILLAGE OF RYE BROOK
ARCHITECTURAL REVIEW BOARD
Date `
Cha an �' �� t`,�%
D i �:i L�
socrotary _ AUG - 1 2011 ILI
VILLAGE OF RYE BROOK
BUILDING DEPARPIENT
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TOWN OF RYE
Tax SECTION 135.43
rLot Formerly Louis Folk BLOCK 1
N 87'59'00" W 1 35 :N 83'58'40" W L---J LOT 22.3
40.00' 95.90'
/Wood Fence
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SURVEY OF LOT 4 AS SHOWN ON A MAP
ENTITLED "AMENDED MAP OF RYE COUNTRY EZ�CUMP,1T
HOMES," DATED AUG. 8, 1982 & FILED
AUG. 8, 1982 AS COUNTY CLERK MAP NO. 20343
SURVEYED AS IN POSSESSION
O�igino/ Oote-Sept. 22, 198> THE MUNSON COMPANY
B1-011ght to dote & 9 NORTH GOODWIN AVENUE Nr.s ' nse 500.5,of-2
Redrafted ✓une 26, 202j ELMSFORD, N.Y.
CERTIFIED TO : ALISON & JORGE SILVA 10523
Scale 1 "=30'
"Unauthorized alterations sl additions e o survey map Is a violatio /J r�—
of section 7209, sub—division 2, of the New York State Education Law." UNDERGROUND C�II[(/11Kt�'.7,
"Only copies of the original survey marked with the land surveyor's
Inked or embossed seal shall be considered a true and valid copy." ETC., IR'RE F
T SHOWN
VILLAGE OF RYE BROOK
BUILDING DEPARTMENT