Loading...
HomeMy WebLinkAboutBP15-0715 :LM DATE: 51I I I S EXP: I (0 BLOCK C_ LOT 8 G_ PERMIT # _ l SECTION I TYPE OF WORK JOB LOCATION . OWNER) CON'' TCO # __ FEE DATE INSPECTION RECORD DATE INSP FOOTI N G FOUNDATION O FRAMING RGH FRAMING INSULATION PLUMBING Cl RGIA PLUMBING GAS SPRINKLER ELECTRIC LOW -VOLT }- A LA R M AS BUILT 0 FINAL Open Permit Letter Sent 9/21/2016 Spnr< Roress n� VUi)ldaw ao3. C>�a3• (.05cl 15 � 0 " / i r& Prokavp 1-sfi ° - cc Ie�r � � Ii51a-oal 'i VILLAGE OF RYE BROOK WESTCHESTEld COUz,4'rY, NEW YORK NO. 21-183 Certificate of eccupaucp This is to certify that Fricnmv of, R-,'/n 6 r having duly filed an application on ACjb ey- zo l requesting a Certificate of Occupancy for the premises known as, -P P �i lce , Rye Brook,NY, located in a Zoning District and shown on the most current Tax Map as Section: J . Block: J—Lot: � , and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. `[jai 1 , issued 5 Il � 24 J5, such authority and permission is hereby granted to the property owner to lawfully occupy or use said premises or building]or part thereof listed under the New York State Use Classification of: n 12- F(D-Lry-i ! ,for the following purposes: LIC - 1 M ti use -Fi nc Subject to all the privileges, requirements, limitations and conditions prescribed by law, and subject also to the following: This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of the building or in the exit facilities shall be made,and no enlargement, whether by extending on any side or by increasing in height hall N made or shall the building be moved from one location to another until a permit to accomplish such change has bee o from the aui in In Building Inspector,Village of Rye Brook: TIZM% Date: NOV 1 5 2011 1j] {c4 CG.o�JJJ J��W ` 1 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Paul S.Rosenberg (914) 939-0668 Christopher J. Bradbun www.ryebtook.org TRUSTEES BUILDING& FIRE Susan R Epstein INSPECTOR Stephanie J. Fischer Michael J. Izzo David M. Heiser Jason A. Klein CERTIFICATE OF COMPLIANCE November 15,2021 Friendly Frog Inc. 185 Ivy Hill Crescent Rye Brook,New York 10573 Re: 185 Ivy Hill Crescent, Rye Brook,New York 10573 Parcel ID#: 129.76-1-28 Mechanical Permit#15-079 issued on 5/11/2015 for Limited Use Fire Sprinkler System This certifies that the limited use fire sprinkler system,installed under the above captioned permit,has been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector /tg 1 BUILD j s ENT For office use fn1x _TI VIL QF RYE . K ISSUED:_,5-1 I-—�Z015 OCT 18 2021 38 KING STREE 1T BnoaK, YoRK 10573 DATE: (914)9 939-5801 FEE: 1 OD PAID GM'/ VILLAGE OF BRCOK o .or EUILDiNr r.� r,j me 1.IT I 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 the Village of Rye Brook Address: ftZ& C)efSGIIE 1 Occupancy/Use: IM-51DENT18l, _Parcel ID#: 41(- Zone: Owner: p-le)&Y rp-666 Address: RD. r2Y N.Y losev P.E./R.A.or Contractor: A&jMi6s Address: S-'(S«S G✓f�1Gl1I VEIF, U>;. gyg gt�arx Person in responsible charge: Address: 749 e7COW 2 - -In D Gl. GkQoZi 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 YOM COUNTY OF WESTCHESTER as: 5iMLDOW kL 0 being duly sworn,deposes and says that he/she resides at S 5CIA +� 1W. (Print Name of Applicant) (No.and Street) in Q.y'er'- ,in the County of WL3TC ti-&37Z,P in the State of- /Q."�, -,that (City/Town/village) he/she has supervised the work at the location indicated above,and that the actual total cost was: /D,,6;i5G• , for the construction,alteration or repair of: �q ) rd, j%GW, Aaaftyo. 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. Sworn to before me this ,'I'Y-711.r- Sworn to bef a me this 5yh day of 0-C , 2 T day of , 20. lax/IL J44 Signature of Property Owner Signature of Applicant s t Print Name of Property Owner Print Name of Applicant Notary Public Notary Public CATHERINE C DUNNE CATHERINE C DUNNE 7/7/ NOTARY PUBLIC NOTARY PUBLIC State of Connecticut State of Connecticut my Commission Expires 3/31/2023 My Commission Expires 3/31/2023 1982 BUILDING DEPARTMENT BUILDING INSPECTOR 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 ryebrooLor - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS: V L �C F/�S DATE: I I-�- z PERMIT# � i D ��ISSUED: SECT: l 4 l $LOCK: LOB: Z LOCATION: F ALIZ F- FI -p0 q-- OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... [ACCEPTED REJECTED/REINSPECTION SITE INSPECTION I/ REQUIRED FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION r NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ROSS CONNECTION Cy FINAL !f�] OTHER 44y BRC�� � tim W Y }��• �9�2 •��� BUILDING DEPARTMENT i]IIpIN()INSPEC1bR VILLAGE OF RYE BROOK VILLAGE ENGINEER 938 KING STREET RYE BROOK,NY 10573 ❑ASSISTANT BUILDING INSPECTOR (914)939-0668 FAX(914)939-5801 - - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - -- ADDRESS: 4 t (' t .J� DATE: PERMrr#I �- O -7 �ISSEJED: BLOCK: LOT: 1 LOCATION: � rt i> 00 OCCUPANCY: z C ❑ VIOLATION NOTED THE wORK Is... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION Q UNDERGROUND PLUMBING NOTES ON INSPECTION: ICY ROUGH PLUMBING ROUGH FRAMING INSULATION 0 NATURAL GAS �A-C FL. (v h- r"r(z L.P. GAS FUEL.TANK ❑ FIRE SPRINKL$R ❑ FINAL PLUMBING ❑ FINAL ❑ OTTER avk, o � W � �a >� �a `1. 1902 BUILDING DEPARTMENT ❑BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑ VILLAGE ENGINEER 938 KING STREET RYE BROOD,NY 10573 / SSISTANT BUILDING lNspEGTOR (914)939-0668 FAX(914) 939-5801 -- - -- - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - - ADDRESS: DATE: I PERMIT# -�.'�rEn. SECT: LOT: LOCATION: OCCUPANCY: ❑ VIOLATION NOTED TIDE WORK IS... ACCEPTED ❑ REJECTED/REINSPECT[ON D SITE INSPECTION REQUIRED D FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P.GAS ❑ Fun,TANK B— FIRE;SPRINIuxR Cxr �I D FINAL PLUMBING D FINAL D OTHER rA In P4 : � o w � 40 > CL ai"i W Q � wa � to eq 00 Ic". 0. Ln 96 tn tn 1,6 00 14 1 .,,Q Cc en d-� I- 43 P60 en 104 ej E i 00 w to rul 00 '2 'El CL As Or. Z3 t ow E �E 00 > > D VE BUILDING DEPARTMENT VILLAGE OF RYE BROOK MAY -6 2z 938 K NG STPEF.T RYE BROOK,N7Y 10573 VILLgGE OF (914)939=4d68 FAx(914}939-5801 RYE gR44K BUILDING DEPARTMENT ���vw:r y eb r o o lt;,or g kk**k****k****YoR**�h iirfF+k**+k**Y:Y:at fk Y:Y:•hi:Y:l#•h.3:t.*kx kkkkkkkk**kkxk*xtxk*t�!}****Y:Y•.t.**Y:t.liP***hr.ftki:*Y:it i:5:*kkx**k74*kxkie FOR OFFICE USE ONLY: MAY - 6 2015 Approval Date: mil# Application Fee: 's Approval Signature: Permit Fees: Disapproved: Other: ! *Y**x*k*Y.xx*�!#x*k*thlFYtIYYYrirtY:Y:f.**xkkkkk*k�txxkkxxxxkkfk**Y:xk*Y:r'.*isf.Y:Y:Y:xi:tY:risirx•:#Y;:rkirx***wYr*fY**Y.•ak*Yc+F/eY:wYr*Rx****Y�Yt INTERIOR BUILDING PERMIT APPLICATION Application dated: is hereby made to theBuitding Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing building,or foi-a change in use,as per detalled statement described below. L Job Address: 185 Ivy Hill Crescent 2. Parcel I.D.#; 129.76--1-28 Zone: PUD 3. Proposed Improvement(Describe in detail): finish existing 3rd floors replace existinq window with new egress window; provide new residential fire suppression system 4. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? Yes: No: xX If yes,indicate: TIER I: TIER II: TIER III: 5. Will the proposed project require the installatiou of a new,or an extension/modification to an existing automatic fire suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) :Yes: xx No: (if yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 6. Occupancy;(l fam.,2 ram.,comm.,etc...)Prior to Construction: 1 fam After Construction: 1 fam 7. N.Y State Construction Classification: 5B N.Y. State Use Classification: R3 8. Property Owner: Friendly Frog Inc. Address: _8 Boulder Phone# 203-223--6519 Cell Fax# List All Other Properties Owned In Rye Brook: NA Applicant: Sheldon Kahan Address: 184 S. Water Street, Greenwich, Cr 06830 Phone# 203-223-6519 Cell# _Fax# ArchitectMngineer: Arconics Architecture, P*C. Address: 5453 Westchester- Avenue, Rye Brook, NY 10573 Phone# 937-559fi Cell# Fax# 939-1255 General Contractor: Address: Phone## Cell# Fax# 6.1,12 Ga odo .9. Estimated C4St Of ConStruCFltell $ � (NOTE.The estineatcd cost shot[include all labor,material,scaffolding,fixed cctuiprncni,professional fees,and material and labor which may be donated grafts.] 10. Estimated date ofcompletion, 11. The Slate Workman's Compensation Law provides that before a Building Permit is Issued,the Contractor,Owwrier, Archi(ect,etc.,shall produce the folloi%ing Information: Name of Compensation insurance Carrier-. Policy#: Date of Expiration: #+etrsrfc*a*,r***x,tx«irs*�*+r,a:.w,kart'*,►��.�#+e+r+r�rr.�,.+,trr��axtr*:*�rtaaiE*�t*�,A'��,t*,e:e*�,rrrr*:*+t�aw�x-�ax�.,�,rx�*,rtwx��a,�;e�+r STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: being duty sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the for the legal owner and is duly authorized to snake 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 sped fications,as well as in accordance with theNew 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 , 2©� 5 gnawre of Property OSYiler Signature of Applicant eN 0 YFi Imo' tory Print Name of Property Myner Print Name of Applicant Notary Pubh Nolary PdNic This application must be properly completed in Its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the Spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. Please note that application fees are non-refundable. NotJeanne Mi1l1W StatefClan ct MySsio plres 2/26/2018 61.2014.2014 = bfilull Q Ln N � a tn W .-p kn o en : O Q s a� C _ Cco E W r � a v� � U 3 U _ � w N F. .. U gz u o � *� w z U r o � I a1 A•, i••l � �i � x ri Q ECOVEF, BUILD�I ]� DEPAXZTMENT OV 19 2M _ VILIJAG7E OF Ryy,,BI oox- VILLAGE OF RYE blkU04t 1 938 KIIJG STRF�i:r RYE BIZ0.0K,NY 10573 BUILDING DEPARTMENT (914)939-.C1b58r(:9� j`939-SfiO] ww\A.� rtook."r, ELECTRICAL PERMIT APPLICATION This application must be filed in person at the Building Department by the Licensed Electrician of Record and must be accompanied by the completed Electrical Inspection Agency application form. Office Use Only: Date, Approval Signature: r Inspection Agency: Electrical Permit#: 4L 5 Fees: paid ( due ( ) Building Permit#: BPA- d� x.....w.wrrwwwwws.w.www...wr...w..w......w......w...............w....r..............i.wrxw..w.w.rx..wr r.—.................--......wx.w..a Application is hereby made to the Building inspector of the Village of Rye Brook NY, for the issuance of a Permit for ute installation/removal/repair of Electrical Equipment as per detailed statement described below, and in accordanu: with the Code of the Village of Rye Brook,NYSUFP&BC,NBC,NFPA and all other applicable State, County and Lu,,aj Laws. Address: ) Owner: I Address&Plioue: Ilse/Occupancy: Parcel 1.D.#: �'9• l Q' Zone: Proposed Electrical Work: LICENSED ELECTRICIAN'S INFO_ A`I`ION: Name(Please Print): Plione# C,,1 Q -- Signature: W estchester County License#: I� Company e: Company Address: CitylTown: — State, `'�Zip Code: I O Phone�ft: d — - Field Contact&Phone: — -- a a a a a.s a a r a 1 a•a..a a.a a a a a 5 4 a 0 a a r a a a a a..a r.a..■..... ..a l.a a.a.r■ s a i .a a a.a a.a a.a a.a a [a a a a a . Westchester Rockland Electrical Inspection Services, Inc. "' Phone: 914-347-3595 DO NOT WRITE HERE-FOR OFFICE LISF ONLY 43 North Lawn Avenue _ Fax: 914-347-3596 Elmsford, NY 10523 7U1,LDING PERMIT NO. TEMP# DATE L 15 CFTY OR VILLAGE _ LP CODE TOWNSHIP COGNj,'! ,/ STR/EET AND[*?-DR PdAD V -6U ` i In POLE NUMBER BETWEEN WHAT TWO UROSS STREETS IS PREMISES LOCATED? SECTION BLOCK _ LOT OCCUPANTS NAME BUILDING OCCUPANCY SOl OWNER'S NAME AND ADDRESS HOME TELEPHONE NUMBER II CURRENT SUPPUEDBY FROM THEIR OFFICE WORK TELEPHONE NUMBER LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS NO.OF FIXTURES& MOTORS HEATERS OFFICE USE LOCATION LAMP RECEPTACLES ONLY SIDEWALL SWITCH INCADE FLUORE NC. H.P.EACH NO WATTS EACH INSPECTION OUTSIDE BASEMENT T"FL ?'FL 3-FL. REMARKS:.LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: I THIS AAPLIC.AMON IS INTENOED TO COVER THE ABOVE LISTED ITEMS TO BE INSPECTED.IF AT ANY TIME OF INSPECTION ADDITIONAL ITEMS HAVE BEEN INSTALLED.YOU ARE AUTHORS TO MAKE THE INSPECTION AND ADJUST THE FEE FOR THE ADDITIONAL ITEMS INSPECTED AS PROVIDED BY THE APPLICANT THE APPLICANT DECLARES THAT THERE IS NO OPEN APPUCATIDNS FOR THE ABOVE WITH ANY OTHER INSPECTION COMPANY.WRE IS,INC. IS NOT LISTING,LABELING.UNDERWRITING OR CERTIFYING ANY EQUIPMENT. MATERIALS OR DEVICES WHICH ARE PERFORMED BY OTHER CERTIFIED TESTING AGENCIES OR INSPECTION COMPANIES.THE APPLICANT.OWNER,OR AUTHORIZED AGENT AGREES TO ALL THE ABOVE TERMS AND CONDITIONS AS SET FORTH FOR THE APPLICATION. SIZE Of SERVICE FEEDERS CHARACTER OF WORK NEW❑ ADDITIONAL[I EXPOSED 7 CONCEALED G MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD C UNDERGROUND I AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. MIME giF COMPANY DATE OF APPLICATION SIGNATURE OF APPLICANT �4 e t I cc tv iL-LC- l 1 5 ��I } srPJW DIIVEBB NO `lI� 1� zrn LACENSE NO.WHEN APPLICABLE BY THIS CERTIFICATE OF COMPLIANCE THE Westchester Rockland Electrical Inspection Services 43 North Lawn Ave, Elmsford, NY 10523 914-347-3595 Office 914-347-3596 Fax CERTIFIES THAT Upon the application of: Upon premises owned by: LaBella Electric Inc (EM) - Jerry LaBella Friendly Frog Inc - 145 South Main Street 185 Ivy Hill Crescent Port Chester, NY 10573 Rye Brook, NY 10573 Located at: 185 Ivy Hill Crescent, Rye Brook, NY 10573 Application Number: 2037200 Certificate Number: 2037200 Section: 129.76 Block: 1 Lot: 28 BDC: 003 Permit Number: EP15-309115-071 A visual inspection of the electrical system at this premise described as a Residential occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located inron the premises at: 185 Ivy Hill Crescent, Rye Brook, NY 10573 garage,outside was inspected in accordance with the NYS and NFPA 70-08 and the detail of the installation, as set forth below,was found to be in compliance therewith on the 24 Day of November 2015. Name Date fluantith Rating Circuit TNpe Srnnkloi Svslcm I This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. This certificate is valid for work preformed before date of inspection only. DSquillante 24 Thursday,Decenfter 03,2015 i 4 Page I of I Ln P4 48 El 0> 96 91. 0 O O 00 446.- c. 9 6. LE Af Fi a6 kn Cd 00 T n C u 7 M.4 0 = a) -0 U, Z too (lull' CJ Cr I Q CIS —, -4� : i� :� OE 'o �t u 00 b 'DNA ie Bu z aZ .5 i 5 z >4 > m 2 g I Iluj Z f4 Z > D � C� L� �a� BUII;nID ,R'TMENT MAY -s 2015 VLLLGG' OI RYEBltooK 1 ^ 0-0 r VILLAGE OF RYE BROOK 938 Kll\c S rl > x R� B Olix,1VI 10573 (914)939-65 81- �(9��939-5801 BUILbING DEPARTMENT ■[aa[a[ssss[aaaa■errs[[[[[■aa[[sassas[[a[[[a[aaa[s[[[[sa[ [[saa[aaa a a[[ sas ■ar[a[aa[aal FOR OFFICE USE ONLY, P Approval Date:—MAY ` 6 PP#: Filing Fee: 7 2.F o Approval Signalure, __ Permit Fee: Disapproval Date: Disapproval Signature: Other: of■s■■F a t.r■■■MONIER Down a■s■■■■■a[Oman Is NUNN■■a n mass■■■a■■■■a[s■r a■n a■■■a Mal a■[[■■[■■■■■■a 1 APPLICATION TO INSTALL FIRE SUPPRESSION /FiRE SPRINKLER SYSTEM Application dated: is hereby made to the Building Inspector of the Village of Rye Brook NY for the issuance of a Permit to install a Fire Suppression System as per detailed statement described below. i 1. Job Address: 185 Ivy Hill Crescent Parcel I.D. 129.76-1-2B zone:PUD 2. Proposed System(Describe system in detail including suppression agent): 3 f loor residential fire suppression system utilizing single recessed pendant in each of these locations: 1 @ 3rd floor room; 1 @ 2nd floor stair landing & 1 @ 1st floor stair landing/entry. Pendants supplied by 11` piping_through double check valve backflow preventor teed off frnam existing 3/4" water meter & service, connected to existing 8" main in street. a 3. Number&Types of Fire Sprinkler Heads: 3 Reliable Model F1 Residential Recessed Pendant 4. NX State Construction Classification: 5B N.Y.State Use Classification: R3 5. Cost of Construction: S ��2 .r (Cost shall include all.labor,materials,fixed equipment, professional fees,and materials and tabor which may be donated grabs.) 6. Property Owner: Friendly nmg Inc. Address: 8 Boulder. Road, Rye., NY, 10580 Phone#_ 203-2 -3.-6 51 9 Cell# Fax# Applicant: Sheldon Rahan Address: 184 S. Water Street Greenwich, CT 06830 Phone#_ ?_Q3-223-6519 Cell# Fax! Design Engineer: Mastrogiac©mo Engineerinai,_P.C. Address: 11 bock Street, Mount Vernon, NY 10550 Phone# 914--920-6372 --ill# F'ax# 206-888--6226 Installer: FPT Address: 1701 Highland Avenue, Cheshire, CT 06410 Phone 203-250-111S Cell# Fax# LAStREVISED:226.09 This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. Please note that application fees are non-refundable. STATE OF NEW YORE,COUNTY OF WESTCHESTER ) as: ,being duly swom,deposes anti states that hcdshe is the applicant above named, (whit rnrne orindividuai signing as tha applicant) and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the for the legal owner and is duly authorized to make and file this application. (indicate mclutem 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,system installed 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 Prevcntion& Building Code, the applicable sections of the N.F.P.A., the N.E.C.and with the Cade of the Village of Rye Brook,as_w!ZIl as all other applicable Federal,Stale or County laws,ordinances and regulations. Sworn to beforc me this 11 f-11) Sworn to before me this 4-6 day of Ham 20_ �_ day of am , 20 / 'ignattire of Property Owner S' nature of Applicant Print Name of Property Ow ier Print Natne of Applicant 1 Notary Pu Nola u Jeanne Milllot Notary Publn02 tale of C no& My Cornmig6ion Expires 2/28/2018 6.1.21?t4 Victor Scelia Plumbing & Heating, Inc Estimate 148 Halstead Ave BOX 46 Date Estimate# Harrison, IVY 10528 4/30/2015 821 Phone 914-835-0891 Fax 914-835-2907 MR.SHELDON KAHN D E 0 f� 184 SOUTH WATER STREET f GREENWICH.CT 06830 MAY -6 VIL GE QF gUrLDING DEPARTMENT Project Description Qty Cost Total RE: 185 IVY BILL,RYE BROOK WE PROPOSE THE FOLLOWING ESTIMATE;EXCLUDING ANY COMPLICATIONS,TO SUPPLY AND INSTALL WATTS LF007M1-QT*DOUBLE CHECK VALVE BACKFLOW PREVENTER PER PLAN SPECIFICATIONS. *PLAN SPECIFIES WATTS 007M3QT. M3 SERIES IS ONLY AVAILABLE IN 314 INCHES. MI IS THE CORRECT PART NUMBER. LICENSED PLUMBER AND HELPER 5 160.00 800.00 WATTS LF007MIQT,COPPER PIPE,COPPER PIPE FITTINGS,BRASS PIPE FITTINGS.WATTS 750.00 750.00 LF777SM120 STRAINER,BALL VALVE,HOSE BIBB,PRESSURE GAUGE,PIPE HANGERS AND MISC PLUMBING SUPPLIES. *PLEASE NOTE THIS JOB QUALIFIES AS A CAPITAL IMPROVEMENT. IF YOU FILE A NYS CAPITAL IMPROVEMENT FORM WITH OUR OFFICE YOU WILL BE EXEMPT FROM NYS SALES TAX FOR THIS PROJECT. *PLEASE NOTE IF WORK IS COMPLETED IN LESSER OR GREATER TIME THE LABOR WILL BE ADJUSTED ACCORDINGLY. *PLEASE NOTE IF MORE OR LESS MATERIALS ARE USED COST WILL BE ADJUSTED UPON COMPLETION OF WORK. *PLEASE NOTE ANY PERMITS REQUIRED WILL BE ADDED TO THE INVOICE, SALES TAX 7.375% 0.00 Total S1.550.00 Customer Signature April 24,2015 D � � � �� RREWrTMON NAM Interlake&Lakeland Lumber 184 South Water Street MAY -6 2015 Greenwich, CT 06830 OOFVILIN LgG ILL GE DE RYE BROOK Re: 185 Ivy Hill,Rye Brook, NYPARTMElVT Fie Protection Testing is pleased to quote a price for the installation of a fire sprinkler system at 185 Ivy All in Rye Brook,NY. Cost basis: • Standard hours • Adequate water is available and does not require a booster pump • Sprinklers • Assumes work area is asbestos free and OSHA compliant • Assumes work area is free&clear for work access • fire Alurms • Based on drawing(s): FP-001,FP-002,dated 4/29/2013,no revisions • Includes addenda numbers: none • Auto Cad files will be provided to us for our design • Extinguishers Cost includes: • Suppression • Material/labor to install sprinklers as shown on the refercneed plans • Heads types as shown • Head quantities as shown on drawings • Permits as required • Drawings as necessary for permit • Hydraulic calculations • Work to begin at connection to domestic water service • zest&Inspect Cost: $3,745.00,plus applicable sales tax • lnstollation We will run our pipe in locations as shown on the architect's plans and/or in locations where it can be concealed. However,we do not include cutting and patching of ceilings or wails, or the • Service installation of crown moulding or other means of concealing our pipe. Cast does not include: • Any work beyond scope described above • Cutting/patching • Electrical/alarm work • Requests by Authorities Having Jurisdiction exceeding minimum NFPA standards • Responsibility for,removal or protection of,contents �ESTING IN LARMS Page 1 of i 0 y♦ I Page 2 of 2 Re: 185 Ivy Hill,Rye Brook, NY HMPAotrMMn M Please sign this proposal as acceptance of this proposal and the terms and conditions as stated on attached pages.Thank you for choosing Fire Protection Team for all of your Life Safety needs. This proposal valid for 45 days from this date. , S igature, Hate Signed By; Pt# • Sprinklers • Fire Alarms 3iian e m Fire Protection Testing • Extinguishers 1701 Highland Avenue Cheshire,CT 06410 Phone 203-250-1115 Fax 203-250-1116 • Suppression Email: brianGfireprotectiontestinp.com • Test& Inspect • tnstollotion • Service t.ARMS ester [VIL JUL 3 0 2014 Robert P.Astorino LAGE OF RYE BROOK County Executive BUILDING DEPARTMENT Sheriita.-Lnler,XID Commi"ima er of Health July 18, 2014 Mastroglacomo Engineering, P.C. 11 Dock Street Mt. Vernon, NY 10550 Attn: Michael Mastrogiacomo, P.E. RE: Log #:1 0535-14-DCV Application for Backfiow Prevention Device Friendly Frog, Inc. 185 Ivy Hill Cres Rye Brook (V) Dear Mr. Mastrogiacomo: The plans and specifications for the above project have been reviewed and approved by this office pursuant to the provisions of Chapter 873, Article VII, Section 873.707.1 of the Laws of Westchester and Section 5-1.31, Subpart 5-1, of Part 5 of the New York State Sanitary Code. A Certificate of Approval is atta:,hed. Form NYSDOH-1013 is to be utilized as a Request for Completed Works Approval. This form can be downloaded from the following link: http:llheaIth.westchesterQov.comlimages/stories/pdfs/cross connection doh1013.odf. NYSDOH- 1013 consists of two parts: (A) the initial test of the device(s) by a certified backflow prevention device tester, and (B) a certification by a Professional Engineer or Registered Architect, licensed and registered in the State of New York, that installation is in accordance with the approved plans. This form must be completed and returned to our Department within 45 days of installation of the device(s). Respectfully, Ruben Bern s Assistant Engineer Bureau of Environmental Quality RB:plt cc: Erna Kahan, Friendly Frog, Inc. Kevin Kushnir, United Water New Rochelle Michael Izzo, Bldg. Dept., Rye Brook (V) File OWL Pvparimvnl of llerAtih l 13 Hua<uenr-t Street N(,%v I:tw:helle.New Y.irk 10801 l'viephone. (91 1)813-:3000 Fax, ()11)813-51.38 NEW YORK STATE DEPARTMENT OF HEALTH CERTIFICATE OF APPROVAL FOR BACKFLOW PREVENTION DEVICES This approval is issued under the provisions of 10 NYCRR, Part 5, Section 5-1.31, and Chapter 873, Article VII, Section 873.707.1 of the Laws of Westchester County. Log No. 1 0535-1 4-DCV Facility: The Friendly Frog City, Village, Town: County: 185 Ivy Hill Cres Rye Brook V WESTCHESTER Owner's Mailing Address: Erna Kahan, Friendly Frog, Inc. 185 Ivy Hill Cres Rye Brook, NY 10573 Physical Location of Backflow Prevention Device(s): In Mechanical Room At Rear of Dwelling Description of Device(s): ONE 1 — % inch Watts 007M3QT DCV Water Supplier: United Water New Rochelle Kevin Kushnir Name Designated Representative Mailing Address: Zip: 2525 Palmer Avenue, New Rochelle, NY 10801 Conditions of Approval: A. THAT the device(s) shall be installed within 90 days, and that within 45 days of installation the attached New York State Department of Health Form"DOH-1013 shall be completed and returned to the water supplier and the Westchester County Department of Health. B. THAT a certified backflow prevention device tester test the above backflow prevention device(s) at least yearly and report the results to the water purveyor indicated above. C. THAT any connection made prior to the backflow prevention device(s) shall render this approval void. D. THAT the proposed works be constructed in conformance with plans and specifications approved this day and any amendments thereto. E. THAT certification that installation of device(s) is in accordance with the approved plans, Form NYSDOH-1013, Part B, must be completed by a Professional Engineer or Registered Architect, licensed and registered in the State of New York. F. THAT the approved device(s) shall be so set that the test cocks are faced for easy access. G. THAT if facility construction has not commenced within 90 days of the issuance of this Certificate of Approval, then this Certificate shall become null and void unless an extension to the 90 day installation period is secured from the Westchester County Department of Health by the facility owner. Designated Representati ISSUED FOR THE STATE COMMISSIONER OF HEALTH BY: DATE: July 18, 2014 Ruben Berrios Assistant Engineer W=Ixster D (EcEgVE I� V.Gam FEB 16 1015 V1LI, GE OF RYE BRO0 Robert P.Astorino 8U,LDlNG DEPART K County Executive MENT Sherlita Amler,M.D. Commissioner of Health February 23, 2015 Friendly Frog Inc. 8 Boulder Road Rye, NY 10580 Attn: Sheldon Kahan RE: Extension of Backflow Approval Log# 10535-14-DCV Friendly Frog 185 Ivy hill Crescent Rye Brook Dear Mr. Kahan, Receipt of your letter dated January 6, 2015 regarding the above referenced application, is hereby acknowledged by this Department. Your request for an extension of the expiration date for the above referenced backflow prevention device approval has been consider4and is hereby accepted.The final expiration date for this approval is May 20, 2015. You are reminded that all conditions of the original approval,dated July 18,2014 still apply. Should you have any questions,please contact this writer at(914) 813-5149. Rpxpectfully, Natasha Court,P.E. Associate Engineer Bureau of Environmental Quality NC:rb cc: Michael Mastrogiacomo,RE Kevin Kushnir, Foreman—United Water Paul Rosenberg, Bldg. Inspector—Rye Brook File OOK Department of Health 1•15 Huguenot Street New Rochelle,New York 10801 Telephone: (914)813-5W) Fag: (914)813,5003 ' Friendly Frog, Inc. 8 Boulder Road Rye, New York 10580 203-413-5222 January 6, 2015 Ruben Berrios, Assistant Engineer Westchester County Health Department Bureau of Environmental Quality 145 Huguenot Street New Rochelle, NY 10801 Re: Log# 10535-14-DCV: Proposed backflow 185 Ivy Hill Crescent, Rye Brook, NY Dear Mr. Berrios: We wish to respectfully request an extension of the ipprovals granted on July 18, 2014 regarding the above-referenced property. The backflow device is required as part of a domestic sprinkler system which is required to finish a third floor space in this townhouse. Additionally,the finishing of the space requires the unit's exterior to be altered and the homeowners association has taken an extraordinarily long time to approve the exterior renovations. We wish to postpone the vork until late spring/early summer. _%' We thank you in advance for your kind consideration of this matter. Sincerely, fjLfF � AFFIDAVIT D IRE PRQTECTION TEAM Copy March 3, 2016 �`? : 2 VILLAGE aF RYE BRQQK G Building Department BUILDIN DEPARTII�EN7 Village of Rye Brook 938 King Street Rye Brook, NY 10573 Re: 185 Ivy Hill Crescent • Sprinklers We have completed the installation of a limited area fire sprinkler system in the residential unit at 185 Ivy Hill Crescent. • Fire Alarms As of this date the system is in service for operation. A local electric bell has been connected to the system, which will sound in the event of water flow. The bell has been • Extinguishers tested and functions properly. • Suppression 4Brian m Fire Protection Testing 1701 Highland Avenue Cheshire, CT 06410 • Test & Inspect Phone 203-250-1115 Fax 203-250-1116 Email: brianCa7.fireprotectiontesting.com • Installation • Service CT License Numbers Sprinkler. F1-0040798 Fire Alarm: L5-192633 ;PTESTING LARMS u V--!q� L_ J&j NX f 3 BACKFLOW DEVICE TESTERS (914) 235-3127 Cell (914) 403-0181 VfLLAGE of RYA BROOK11 Woodland Avenue, New Rochelle, NY 10805 BUfL DING DEPARTMENT NEW YORK$TAT OF HEALTH Report on Test and Maintenance Bureau of Public Water Supply Protection of Backfiow Prevention Device For the year Initial test - Complete entire form Please use a Separate form for each device. [} Annual test - Complete Fart A only Public Water Supply r7-sue Account No. Coynt�r� f31oc4c Lot II f Location of Devitt Facility Name _ � f Address tJ !j (1 7 street I city zip Device Manufacturer ,^ -rT;r Type RPz Model Size (in inches) Serial Number Information / ` l V ❑ DCV Chet*Valve No. 't Check Valve No. 2 Differential Pressure Lute pressure � psi Relief Valve Test Leaked ❑ Leaked ❑ before Closed tight ❑ Closed tight ❑ Opened at psid Date repair 1�.3!J Pressure drop across first m d y heck valve psid Repaired by Name Describe repairs and # materials Lic ❑ used Date repaired m d Closed tight Li teall Pressure drop across first Closed tight ❑ ©paned at psid Date check valve psid Im d Water Meter Number Meter Reading Type of Service: (check one) Domestic ❑ Fire ❑ Other Remarks (Describe deficiencies:bypasses, outlets before the device,connections between the device and pant of entry,missing or inadequate augap,etc.) Certification: This device❑ meets, ❑ does NOT meet, the requirements of an acceptable containment device at the time of testing i hereby certify the foregoing data to be correct. Print Name Certified Tester No. Signature Expiration Date Property owner's (or owner's agent) certification that test was performed: Cj 1`tl C((t3 N ik-4-1 ti{9 5 S y /J Print Name Title Signature Telephone Certification that installation is in accordance with the approved plans. (To be completed by the design engineer or architect or water supplier.) I hereby certify that this installation has been made in accordance with the approved plans. Nerve Tirle Date❑ 7� l l NYS DOH Log # I Vicenee Number Phone ( } m Representing Describe minor installation changes Address City State Zip Signature NOTE Send one completed ropy to the designated health department reprgsentarive and one copy to the water suppler within 30 days or Tasting of the device_ Notify owner and water supplier immediately if device fails test and repairs cannot immediately be made. DOH•1013(9191) 6-t45 �'/-- Fire Sprinklers Hydraulic Calculation RREPROTECTION TEAM Summary Sheet FIR#: BLD#: yy--- Hydraulic Calculation Design Area /Number: Plan Sheet No: F00 Project Name: !�� IvN /�tL4 �iZ��/7� Date: System Type: Wet rl Dry Pipe 0 Deluge ❑Antifreeze El Circulating Closed-Loop Cl Double Interlock Preactlon 0 Single Interlock Preaction Design Description: • Sprinklers 0 Light ❑Ordinary Group I 0 Ordinary Group II ❑ESFR L1 Attic Sprinklers 0 Extra Hazard I ❑Extra Hazard II ,❑,:other Special Application Sprinklers 0 Hlgh Piled Storage El Miscellaneous Storage �a Residential 13D El Residential 13R • Fire.Alarms /� Sprinkler Information: • Extinguishers Area Per Sprinkler: Sr Maximum Length&Width per Sprinkler: /� x � y. . Make,Model,SIN,K-Factor: �UA� 9-FC el 9 Number of Sprinklers Flowing: if • Suppression Design Method Applied: Ll Design Area(Indicate roof slbpe/pitch: ❑Using Quick Response Multiplier(Indicate ceiling height: ) g Room Design(Indicate wall ratings,and if self closing doors; ) 0 Unprotected Combustible Concealed Spaced-Minimum 3000 sf for Remote Area (This includes areas with composite wood jolst) Resfd.ential Sprinklers 11 Other(Indicate Design: 1 ` • Test& Inspect Flow Allowances: Hose Allowance; Rack Sprinkler Demand: Other: • InStallcrtbri Presgure Allowances: Backflow Preventer: 3' C) Water Meter: Other: • Service Hydraulic Summary: Static: Residual: —30 GPM: 1&11/ hate: 54 Total Design Operating Area: 3� SF Density: • Total Elevation Change(From Point of Water Purveyor Supply Information): f� Total Pressure Re S� I Total Flow Required(including hose flow)/:� Required; Available Pressure at Total Flow: COU � (At water supply source-flow test location) Available Pressure Cushion; Pressure: Z Notes/Comments: ;PTESTING #FALARMS Noulc :1,h6i l PIPC: 1��' EqUN. �a. flicdon 1:11mu a Normal dote -- Id��tt, Size v'ilfin,� Pips Loss S�znnzary Fressvre F.n"6gt Devlef (it) 1-7 T 35 ,n 5g _ E I-is 2 2 L 20 Pet -7 cQJtr ! j8-5 T -47 • USO Pf Z135 Z, 1 L Y4 P7 Z31 8 Pe �� os .�5o Pf 5.7 s rya, _ _ PE-SO- 00. P. C F -- PC —� F$, void +C. — L P, 3.q0 Ft. - PL p .351J � P" E ! 7 o I o F, .SO P, L 2'1 P`c .CFO Pt AT Col-Jl,,x `r - _ I L PG5 & apom Wr C,r%i K). F PE- P 0" PE pn f L Pk Ft T pf F. --- . L Pt Pt Pe - F T P'F P L Pt pt _ F P. P,. L Pt Pt -- --- ----- cy - F PC P", TQ._ . ..._.. .... Pf Ps Pt H U} W J 0 UM L.L co � J ❑ MQ \t• �Z O J LL t a `^ r 0-10 0 0 0 0 0 0 c7 0 w Cl 0 0 0 0 0 c�i fV O m a0 IL' h (if V' co fV �d (Y ;o a u N LL. LL m LL m. LL m m m m > + • � �� 'y� mrn p ;4 ■ U ¢c ❑c R 2 ;N cT 1512 u 0- o IQ 4] LCo �o �mb ;Eo C 0 w It co o ;v L.gC.a aggn nnnn naga o nn) Q� �GLL�ti�J rep, e . 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 13UILDING &FIRE Susan R. Epstein INSPECTOR David M. Heiser Michael J Izzo Jason A Klein Jeffrey B. Rednick September 21. 2016 Via US Mail Friendly Frog Inc. 8 Boulder Road Rye,New York 10590 Rg: 185 Ivy Hill Crescent,Rye Brook,New York 10573 Notice of$500.00 Fee for Expired Permits Open Building Permit#15-071 Issued: 5/11/2015 - Expiration Date: 11/11/2016 Dear Property Owner, Please allow this letter to serve as a reminder that your open permit(s)noted above,as is the case with all Building Permits issued by the Building Department must be closed out with a Certificate of Occupancy or Certificate of Compliance in accordance with §250-10.A. of the Code of the Village of Rye Brook. Building Permits have a life of eighteen (18) months and the expiration date is noted on the front of the permit. Please be advised that should you fail to properly close out your permit(s) in accordance with the law, effective November 1, 2009 the Village will be imposing a $500.00 Administrative Fee in connection with all open expired Building Permits issued after January I. 2003. Please note that this Administrative Fee applies to each individual permit and must be remitted in addition to any other required fees associated with closing the permit(s), as well as any court imposed fines should a summonses)be issued. 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@rycbrook.org /tg cc: Steven E. Fews,Assistant Building Inspector 7007 2680 0002 0552 2969 Buildin= Permit Check List & Zoning Analysis Address: OD S� lu y ��L L. C Cyr SBL: Zone: Use: 2.I---> Const.Type: ^T Other: �R Submittal Date: dD l Revisions Submittal Dates: 51 (o 11 Applicant:i_ I�F-�'h4 y C- StfCi a �'C,r4uN __. Nature of Work: -zF- RtJl t - A-,M C— ,( [M.STA L L G.�►.n�TF ij . �3� ;=tn� f'�Ri.� }-rc.Fs-+� f�� s,Pi�-�r t- �C� Reviews: ZBA: J UN 2 5 2 1'1 PB: BP: Other: njFD OK FEES: Filing: 7S-�,� BP: CIO: ( ) { APP.: Date Stamped: ✓ Properly Signed: �SBL Verified: Other: _ ( ) { ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening: ENVIRO.: Long: Short: Fees: N/A: ( ) { ) SITE PLAN: Topo: Site Protection: S/W Mgmt.: Tree Plan: Other: ( ) ( ) SURVEY: Dated: Current: Archival: Sealed: Unacceptable: {* -PLANS:Daxe Stampede Sealed; - -Capiesr' ,_Incomplete:` a —VA—. Other. - - ( (. License: Workers Comp: Liability. p. Waiver: f Other: O O Code 753#: Dated: N/A: ( ( ) HIGH-VOLTAGE ELECTRICAL: Plans: Permit: N/A: Other: ( ) ( ) LOW-VOLTAGE ELECTRICAL: Plans: Permit: N/A: Other: { { ) FIRE ALARM/SMOKE DETECTORS: Plans: Permit: N/A: Other: LP Gas: N/A/: Other: { { ) FIRE SUPPRESSION: Plans: ✓ Permit: N/A: Other: { ) { ) 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: approval: notes: ( )ZBA mtg. date: approval: notes: ( )PB mtg. date: approval: notes: REQUIRED EXISTING PROPOSED NOTES APPRQYED Area: n Tr-'— 6 Circle: Frontaize: Front: Front: Sides: Rear: Main Cov: Aces.Cov: Ft.H/Sb: Sd. H/Sb: GFA: Tot. Imp: Ft. I=: Parkin: Height/Stories: notes: TRANSMITTAL TRANSMITTAL TRANSMITTAL TRANSMITTAL TRANSMITTAL ARCOINICS ARCHITECTURE Architecture P.C. INTERIORS To: Building Dep ��] PROJECT: 185 Ivy Hill Crescent Village of Ry15UN � E � U E 0 1 S 2013 PROJECT NO: 21306 VILLAGE 01= RYE BRQOK DATE: June 18, 2013 WE ARE SENDING YOU: ®ATTACHED ❑UNDER SEPARATE COVER 0 VIA HAND DELIVERY THE FOLLOWING ITEMS: ❑SHOP DRAWINGS ® PRINTS ❑TRANSPARENCIES ❑SAMPLES ❑SPECIFICATIONS ❑COPY OF LETTER ❑CHANGE OF ORDER COPIES DWG. NO, DATE REV. DESCRIPTION 1 Interior Building Permit Application 1 Check #1466-$75 Application Fee 3 A-100 3/6/2013 First, Second, Third Floor Plans, Elevation Diagram, Notes 1 Fire Suppression/Sprinkler Application 1 Check#1467 - $75 Application Fee 2 FP-001 4/29/2013 General Notes, Vicinity Map, Plot Plan & Backflow Preventor Details and Specifications 2 FP-002 4/29/2013 Fire Sprinkler Floor Plans, Sprinkler Head Detail And Riser Diagram THESE ARE TRANSMITTED AS CHECKED BELOW: 10 FOR APPROVAL ❑ APPROVED AS SUBMITTED ❑ SUBMIT COPIES FOR APPROVAL ❑ FOR YOUR USE ❑ APPROVED AS NOTED ❑ SUBMIT COPIES FOR OUR USE ❑ AS REQUESTED ❑ RETURNED FOR CORRECTIONS ❑ RETURN CORRECTED PRINTS FOR RECORD ❑ FOR REVIEW AND COMMENT ❑ FORBIDS DUE 20- COPY TO: SIGNED: S. Kahan Gary Gianfrancesco, AIA, AICP, LEED AP 5451/2 WESTCHESTER AVENUE 914-937-5596 RYE BROOK, NY 10573 F 914-939-1255 w �y IOU. flit 99 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook, N.Y. 10573 ADMINISTRATOR Joan L. Feinstein (914)939-0668 • Fax(914) 939-5801 Christopher J. Bradbury www.ryebrook.ora TRUSTEES BUILDING&FIRE David M. Heiser INSPECTOR Toby S. Marrow Michael J. Izzo Jeffrey B. Rednick Paul S. Rosenberg June 7,2012 Friendly Frog Inc. Via Certified U.S.Mail 8 Boulder Road Rye,NY 10580 Re:Finished Third Floor, 185 Ivy Hill Crescent, Rye Brook,NY Parcel ID#:129.76-1-28 Dear Rye Brook Property Owner, It has come to the attention of the Building Department that your single family dwelling located at the above captioned address may contain a finished third floor. After conducting an exhaustive search of Village of Rye Brook and Town of Rye files, we can find no record of a permit or certificate of occupancy for this improvement. The Building Department considers this condition a potential life-safety hazard that requires your immediate attention. Please note that the building records on file show that none of the units in the Arbors Development were originally approved for or constructed with a finished third floor As a result,permits are required for such work.Whether the third floor was finished by you or by a previous owner,the legalization process must be completed by the current owner of record. Please contact the Building Department immediately at, (914) 939-0668,Monday through Friday, 8:30am to 4:00pm to schedule an inspection of the premises to confirm or refute the existence of the finished third floor, and to initiate the legalization process if applicable. Be advised that failure to contact the Building Department within ten(10) days of receipt of this notice will result in legal action. Thank you for your cooperation. Mic �_Zz_o Building&Fire Inspector mizzo(a)aebrook.org cc: Christopher J.Bradbury,Village Administrator Steven E.Fews,Assistant Building Inspector a E 2 \ \ \ ƒ k 2 f ccJ EE I ] � \ ¥ ))E o / § u mm o\ }§ \ \ Ln 7 / \ m t f E a) f / a m tm » \ o = � \ C . e + � EOE = c ] - k x a e 4 n 2 / / § | a * a e c - a of El en'0- 00 /I 'n m ?—'. 2 = ;a72E [ ] { o ! . 42a 6 # 2 7 E/ | $ mm ° ° / 2f § £!E ] of & k� 7J— CD EE{ - , o , \0 CD aIL< D \ . . „ \ E ' k? ) \ 9 ) balk ƒ FLa-Da . \ / N k en ~ K � _ \ cc C \« m & C> \ E \ %ca»/ 2 k q y � ) / $ \ § $ - e E C L § k / ( � z e � Q CW N l� IL LL `N nn�II: � W° �O 2 + N �4K cs X id iz w dui U) M `o ,U mF � Tqqn annn npgp and Lc) ti- r' 1 ; o { N '7LL CN 6�s 51-nl:�, 7007 2680 0002 0551 7231 U m:o a a r\ m O ° 3 n l.aL rn V m m m m m ie m m 9m 8m m °O �J m ru M v a co F ^^ N O ED Ypp o m Z w Y W B _ CC m Cr P 0LL T LU o to Y t*9 � R i b \ , 7. § $ a22 f ) I_- / W) O[ 2 EE I O a C, ) ) d E � £ { 2 � } fk [) § ƒ7 q f ƒ � � d FU \ E (P = _ ƒ ' q � A � E � 2 / / ) a § ° 2 ƒk f � � kOOO� J 3 k x a i cr 2 cc a r a) e ; ; £ C 3 0 co o SS\ \f k� 225/ % w �0 C § /GC � k\ f as / w13 - © �� 7 k a) 0 a) CD ilk/�) Ef co 7FX \ _ ) $ n § g'\ � - ` � � § [ o;t411 0 { E LL ■ ■ . E E m ;On n to ® (D �� LL LL LL LL m L L � N a= �= VJ; �¢ ¢ MM ;o is ■ U ¢ am ■ E.Ero �E 0 m ; w ¢w EO :vi `o ;C5 Q�,7J Tccn annn nD4a J nn) (N cl) qg Lo,; O'D Lo CD V cli 5 CD LU ;r zozo Z) 0z OZ o D (.) a.6F* LO �D . 0 (M 0 Q�hjCl) co 0 IT 7 1" Lr) Ln C4 < 23 < C,<D C:) �. � � ova co Ln Lrl C3 v ru ID =1 M C3 ru r�- r'l CDLM >: Uj UJ cc g LL. CD C)0 ce UJ LLJ ■ zf- w � I. go rU r-I Ln U1 Postage $ i Certified Fee Postmark [U Here O Return Receipt Fee p (Endorsement Required) E3 Restricted Qeltvery Fes p (Endorsement Required) CIO -3 Total Postage a Fees ru r Sent To T r c, --- �. ._... Street,Apt.No.r r� L1 - or PO i3ax No, C3 . ,�-1 Q + City State.Z1P+�� e 1 I 7aQ7 2680 �0132 C155], 7246 P I S i _•O I N w CN VE O P W O iII Q _ o � m o 0 0 V to O o o c�• 0 ab Ell 6 q — 4 P W r �S # 1 a o c �a g ,i�ew� w�uu n v a < V �y e� F � S �, a�► Z = H G 00 b � V P C7r v' CS7t y WK C � ` ? - r dor_ w 4 V s,WIlf11fIIH 11114A� g O d a o E p 4 n d c C y_ . 1 UP I r Id iff� « H FT1 N 0 < � I 44 _ -a- 0 5 - a I r O A u O ij Z U W O 0 z a N W < a 7 { 11(1, z y~t ILK 7 w, a 3 ✓ m z u<i S O a 3 s 4 >` y n ri a E o W i W m W N f�`« Woz � � �F� " �o W �Qzzo io.I� opz�v0 < <oauz < zo w m U Z _ M �I� m~• W N n « 0 m w W�j7 SJ uZa= m imi V m yt d T z t " H -�z z z z z z c ?u z Oz O o Q-„�mnm0000 s <'< z O v',m.o i.d V O.> >5 „< Z a atuc 4S Uo u 3 < ve w = s 3 d alm w V � pZ z o` O ooc, W 7 Zap, _ W`o z W +viz � °'� z S O�u+-tx03 1 uV � ZV zVwU 2 O ! t"s Wesco Insurance Company COMMERCIAL PROPERTY COVERAGE PART Policy Number WPP 7002998 00 Policy Period From 01/16/2015 To 01/1E/2016 Renewal of CPC 7029220 12.01 A.M.Standard Time at the Named Irsured's Address Transaction RENEWAL DECLARATION PAYPLAN: Direct— 30% Down— 2 Ecrual Installments Named Insured and Address Producer FR=ENDLY FROG, INC GLOBAL FACILITIES, INC. 0000393 8 BOULDER RD P.O. BOX 743 RYE NY 10580-4104 LYNBROOK NY 11563-0743 Telephone: 516-5 99-3800 Business Description Type of Business CONDO UNITS CORPORATION IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. DESCRIPTION OF PREMISES Refer to attached schedule. COVERAGES PROVIDED Refer to attached schedule, if any. OPTIONAL COVERAGES Refer to attached schedule, if any. MORTGAGEES AND ADDITIONAL INTERESTS Refer to attached schedule, if any. PREMIUM FOR THIS COVERAGE PART $ 352. 92 Forms and Endorsements Applicable to this Policy See Forms and Endorsements Schedule These declarations together with the common policy conditions, coverage part declarations, coverage part coverage form(s) and forms and endorsements, if any, 'issued to form a part thereof, complete the above numbered policy. Issued Date: 11/20/2014 CFDEC 0801 INSURED COPY Page 2 of 11 Includes copyrighted material of Insurance Services Office.Inc.,with its permission. Copyright,Insurance Services Office,Inc.. 1994. Policy Number: WPP 7002998 00 RENEWAL DECLARATION Named Insured: Wesco Insurance Company FRIENDLY FROG,INC COMMERCIAL PROPERTY DESCRIPTION OF PREMISES Prem. Bldg. Prot. No. No. Occupancy Construction Class Terr 00001 00001 APARTMENTS WITHOUT KERCANTILE' OCCUPANCIES Lr '10 10 UN --came 0'4 600 00002 00001 APARTMENTS WITHOUT MERCANTILE OCCUPANCIES — UP TO IC UN Frame 04 600 Issued Date: 11/20/2014 CFDEC 0801 INSURED COPY Page 3 of 11 _,R Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Copyright, Insurance Services Office,Inc„ 1994. Policy Number: WPP 7002998 00 RENEWAL DECLARATION Named Insured: Wesco Insurance Company FRIENDLY FROG,INC COMMERCIAL PROPERTY DESCRIPTION OF COVERAGES PROVIDED PREM. BLDG. LIMIT OF BLANKET COVERED W/H NO. NO, COVERAGE INSURANCE COVERAGE CAUSES OF LOSS COINSf DED, DED. 00001 00001 Business -ncome $40,000 SPECIAL 800 Without Extra Expense 00001 00001 Tenants Imprvmnt and Betterrnnt $200,000 SPECTAL BOA $1,00C 00002 00OC1 Business Income $40,000 SPECIAL 809 Without Extra Expense 00002 00001 'Tenants Imprvmnt and Bettermnt $225,000 SPECIAL 80% $1,000 IF EXTRA EXPENSE COVERAGE,LIMITS ON LOSS PAYMENT Issued Date: 11/20/2014 CFDEC 0801 INSURED COPY Page 4 of 11 ,,.... Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Copyright,Insurance Services Office,Inc., 1994. Policy Number: WPP 7002998 00 RENEWAL DECLARATION Named Insured: Wesco Insurance Company FRIENDLY FROG,ING COMMERCIAL PROPERTY DESCRIPTION OF OPTIONAL COVERAGES PROVIDED Valuation I Inflation Grd Monthly Maximum Extended Prem. Bldg, Agreed Pers Incl Pers Limit of Period of Period of No. No, Coverage Effective Date Expiration Date Value Bldg Prop "Stock" Bldg Prop Indemnity Indemnity Indemnity 00001 00001 BUSINC 00001 00001 IMPBET 00002 00001 BUSINC 00002 00001 1NIPBET RC=Replacement Cost FRC= Functional Replacement Cost ACV=Actual Cash Value Issued Date: 11/20/2014 CFDEC 0801 INSURED COPY Page 5 of 11 DE:_=:. Includes copyrighted material of Insurance Services Office,Inc..,with its permission, Copyright, Insurance Services Office, Inc., 1994. Wesco Insurance Company GENERAL LIABILITY COVERAGE PART Policy Number WPP 7002998 00 Policy Period From 01/16/2015 To 01/16/2016 Renewal of CPC 7029220 12 01 A.M.Standard Time at the Named insured's Address Transaction RENEWAL DECLARATION PAvPLAN. Direct- 30% Down- 2 Ecrual Installments Named Insured and Address Producer FR-ENDLY FROG, INC GLOBAL FACILITIES, INC. 0000393 8 BOULDER RD P.O. BOX 743 RYE NY 10580-4104 LYNBROOK NY 11563-0743 Telephone: 516-5 9 9-3 800 Business Description Type of Business Audit Period CONDO UNIT:` CORPORATION NONE IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. LIMITS OF INSURANCE General Aggregate Limit (Other than Products-Completed Operations) $ 2, 000,000 Products-Completed Operations Aggregate Limit $ EXCLUDED Each Occurrence Limit $ 1,000,000 Personal and Advertising Injury Limit $ EXCLUDED Medical Expense Limit, any one person $ 5,000 Damages to Premises Rented to You, any one premises $ 100,000 AMENDED LIMITS OF LIABILITY Refer to attached schedule, if any. LOCATIONS OF ALL PREMISES YOU OWN, RENT OR OCCUPY Refer to attached schedule. CLASSIFICATIONS Refer to attached schedule. TOTAL PREMIUM FOR THIS COVERAGE PART $ 642.00 Forms and Endorsements Applicable to this Policy See Forms and Endorsements Schedule These Declarations together with the common policy conditions, coverage part declarations, coverage part coverage form(s)and form(s) and endorsements, if any, issued, complete the above numbered policy. Issued Date: 11/20/20-4 GLDEC 0801 INSURED COPY Page 6 of 11 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Copyright,Insurance Services Office,Inc., 1994. Policy Number WPP 7002998 00 RENEWAL DECLARATION Named Insured: Wesco Insurance Company FRIFNDLY FROG,INC COMMERCIAL GENERAL LIABILITY EXTENSION OF DECLARATIONS LOCATION OF PREMISES Location of All Premises You Own, Rent or Occupy: 0000i 41 GREENWAY LANE RYE BROOK NY 10573 00002 185 IVY HILL CRE"- AYE BROOK NY 1C5i< PREMIUM Rate Advance Premium Location Classification Code No. Exposure Basis Prem.Ops. Prod/Comp Prem.Ops. Prod/Comp Ops. Ops. 00001 60010 1 - U 32_.10000 INCL S 321.0C APARTMENT BUILDINGS {NOC) "Products - Completed Operations are subject to the General Aggregate Limit" 00002 60010 1 - U 321.10000 INCL $ 321.00 INCL APARTMENT BUILDINGS {NOC) "Products - Completed Operations are subject to the General Aggregate Limit" Extension of Declarations -Total Advance Annual Premium $ 642.00 Includes copyrighted material of Insurance Services Office, Inc..with its permission. Copyright, Insurance Services Office, Inc., 1994, Issued Date: 1 1 /20/2014 GLDEC 0801 INSURED COPY Page 7 of 11 Policy Number: VVPP 7002998 00 RENEWAL DECLARATION Named Insured: Wesco Insurance Company FRIENDLY FROG,ING COMMERCIAL PACKAGE POLICY LOCATION ADDRESS SCHEDULE Prem # 00001 Prep: # 00002 41 GREENWAY LANE 185 IVY HILL CRESCENT RYE BROOK DIY 10573 RY3 BROOK NY 10573 Issued Date: - 1/20/2014 SCHED 0801 INSURED COPY Page 8 of 11 x�- Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Copyright,Insurance Services Office,Inc., 1994. Policy Number: WPP 7002998 00 RENEWAL DECLARATION Named Insured: Wesco Insurance Company FRIENDLY FROG,INC COMMERCIAL PACKAGE POLICY POLICY INTEREST SCHEDULE 00001 AQUIS=TION COMPANY LOAN#: 0 HERMITAGE Issued Date: 11/20/2014 SCHED 0801 INSURED COPY Page 9 of 11 -1- Ircludes copyrighted material of Insurance Services Office,Inc.,with its permission. Copyright,Insurance Services Office,Inc., 1994. Policy Number: WPP 7002998 00 RENEWAL DECLARATION Named Insured: Wesco Insurance Company FRIENDLY FROG,INC COMMERCIAL PACKAGE POLICY FORMS AND ENDORSEMENTS SCHEDULE Form Nbr. Ed. Date Description All Lines ILP00_ 01/04 PHN: U.S.Treasury Department's Office Of Foreign Assets Control IL0985 01/08 Disclosure Pursuant To Terrorism Risk Insurance Act Of 2002 IL90724 01/08 Notice of Terrorism Insurance Coverage Commercial Fire CP0018 06/07 Condominium Commercial Unit-Owners Coverage Fora. CP0032 06/07 Business Income Coverage Form(Withcut Extra Expense) CP009C 07/88 Commercial Property Conditions CP0133 01/11 New York Changes CP0164 _0112 New York Changes - Fungus, Wet Rot and Dry Rot CP0178 08/08 New York - Exclusion cf Lcss Due to Virus or Bacteria CP1030 06/07 Causes of loss-Special Form CP1033 06/95 Theft Exclusion CP90407 _1/C6 Equipment Ercakdown Cov-NY CP90723 06/13 CF Multistate Revision of Forms Notice to Policyholders CP90729 _1/13 Equiomenl. Breakdown Deductible Notice Lo Policyholders CP910!4 _2/12 Earth Movement Exclusion HIL0103 06/99 Policy Changes Actual Cash Val IL0017 _1/98 Common Policy Conditions IL0183 08/08 New York Changes - Fraud ILD268 01/14 New York Changes - Cancellation and Nonrenewal IL0935 07/02 Exclusion of Certain Computer-Related Losses ILD953 01/08 Exclusion Of Certified Acts Of Terrorism IL90402 09/08 Identity Recovery Coverage General Liability CG000_ l2/07 Commercial General Liability Coverage Form CGO068 05/09 Record/Distrib of Info in Violation of Law Exclusion CG0104 _.2/04 New York Changes - Premium. Audit CGO163 07/11 New York Changes Commercial General Liability Form CC2132 05/09 Communicable Disease Exclusion CG2138 _1/85 Exclusion - Personal and Advertising Injury CG2149 09/99 Total Pollution Exclusion. Endorsement CG2160 09/98 Ex-Year 2000 Computer Related & Other Electrical Problems CG2113 01/08 Exclusion Of Certified AcLs Of Terrorism CG262_ '-0/91 NY Changes - Tra.ns.of Duties When a Limit of Insurance CG90733 06/13 2007 GL Multistate Forms Revision Notice to Policyholders Issued Date: 11/20/2014 SCHED 0801 INSURED COPY Page 10 of 11 F�� Includes copyrighted material of Insurance Services Office,Inc.,with its permission, Copyright.Insurance Services Office,Inc.,1994. Policy Number: WPP 7002998 00 RENEWAL DECLARATION Named Insured: FRIENDLY FROG,ING COMMERCIAL PACKAGE POLICY FORMS AND ENDORSEMENTS SCHEDULE Form Nbr. Ed. Date Description CG92101 05/06 Asbestos Exclusion CG92102 03/08 Employment Discrimination. CG92103 05/06 Discrimination Exclusion CG92105 05/06 Assault and Ba:�tery Exclusion CG92106 05/06 Lead Based Paint Exclusion CG92152 07/C9 Prod/Completed ops Included in Gen Aggregate IL0017 11/98 Common Policy Conditions TL0023 07/02 Nuclear Energy Liability Exclusion Endorsemen 7 (Broad Form) IL0268 01/14 New York Changes - Cancellation and Nonrenewal Issued Date: 11/20/2014 SCHED 0801 INSURED COPY Page 11 of 11 �, Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Copyright,Insurance Services Office,Inc.,1994. i Affidavit of Exemption to Show Specific Proof of Workers l Coverage for a 1, 2, 3 or 4 Family, Owner-occ esi "This form cannot be used to waive the workers'compensation rights n nbdiga inrrN diYan�Wsr LZ_, !, VILLA(3ee(rr Under penalty of perjury, I certify that I am the owner of the 11 2, 3 or a�I �� � bide ce (including condominiums) listed an the building permit that I am applying for, and am o ' specific proof of workers' compensation insurance coverage for such residence because (please check the appropriate box): ❑ I am performing all the work for which the building permit was issued. ❑ lam not hiring,paying or compensating 'many way,the individual(s)that is(are)performing all the work for which the building permit was issued or helping me perform such work. I have a homeowners insurance policy that is currently in effect and covers the property listed on,the attached building permit AND am hiring or paying individuals a total of less than 40 hours per week (aggregate hours for all paid individuals on the jobsite) for which the building permit was issued. I also agree to either: acquire appropriate workers' compensation coverage and provide appropriate proof of that coverage on forms approved by the Chair of the NYS Workers' Compensation Board to the government entity issuing the building permit if I need to hire or pay individuals a total of 40 hours or more per week(aggregate hours for all paid individuals on the j obsite)for work indicated on the building permit,or if appropriate,file a CE- 200 exemption form, OR ♦ have the general contractor, performing the work on the 1, 2, 3 or 4 family, owner-occupied residence (including condominiums)listed on the building permit that I am applying for,provide appropriate proof of workers' compensation coverage or proof of exemption from that coverage on forms approved by the Chair of the NYS Workers' Compensation Board to the government entity issuing the building permit if the prof ect takes a total of 40 hours or more per week(aggregate hours for all paid individuals on the j obsite)for AWorkj&ated on the building permit. of Homeowner) (Date Signed) s Home Telephone Number,76-37 ZZ3 15" (Homeowner's blame Printed) Sworn to before me this - dery of Property Address that requires the building permit: (County Clerk or 1Votaril Public) l� _ U°IPaCc 73 Once notarized.this BP-I form serves as an exemption for both workers'compensation and disabifity benefits insuran!^e coverauc. N '-WCB i LAWS OF NO"` YORK, 19911 CHAPTER 439 The general municipal law is amended by adding a new section 125 to read as follows: 125, ISSUANCE OF BUILDING PERMITS. NO CITY,TOWN OR VILLAGE SHALL,ISSUE A BUILDIN(). PERIvIiT WITHOUT OBTAINING FROM THE PER-MIT APPLICANT EITHER; 1. PROOF DULY SUBSCRIBED THAT WORKERS' COMPENSATION INSURANCE.AND DISABILITY BENEFITS COVERAGE ISSUED BY AN INSURANCE CARRIER IN A FORM SATISFACTORY TO THE CHAIR OF THE WORKERS' COMPENSATION BOARD AS PROVIDED FOR IN SECTION FIFTY-SEVEN OF THE WORKERS' COMPENSATION LAV,' IS EFFECTIVE; OR 2. AN AFFIDAVIT THAT SUCH PERMIT APPLICANT HAS NOT ENGAGED AN EMPLOYER OR AN), EMPLOYEES AS THOSE TERMS ARL DEFINED IN SECTION TWO OF THE WORKERS' COMPENSATION LAII'TO PERFORM WORK RELATING TO SLJCFI BUILDING PERMIT. Implementing Section, 125 of the General Municipal Law 1.General Contractors--Business Owners and Certain Homeowners For businesses and certain homeowners listed as the general contractors on building permits,proof that they are in compliance with Section 57 of the Workers' Compensation Lam,(WCL)is ONE of the following forms that indicate that they are: ♦ insured(C-105.2 or U-26.3), ♦ self-insured(SI-12), or ♦ are exempt(CE-200), under the mandatory coverage provisions of the WCL. Any residence that is not a 1,2,3 or 4 Family,Owner-occupied Residence is considered a business(income or potential income property)and must prove compliance by filing one of the. above forms. 2. Owner-occupied Residences For homeowners of a 1,2,3 or 4 Family,Owner-occupied Residence,proof of their exemption from the mandatory coverage provisions of the Workers' Compensation Law when applying for a building permit is to file form BP-1. 4 Form BP-1 shall be filed if the homeowner of a 1,2,3 or 4 Family,Owner-occupied Residence is listed as the General contractor on the building permit,and the homeowner: 0 is performing all the work for which the building permit was issued him/herself, 0 is not hiring,paying or compensating in any way, the individual(s)that is(are)performing all the work for which the building permit was issued or helping the homeowner perform such work, or 0 has a homeowner's insurance policy that is currently in effect and covers the property for which the building permit was issued AND the homeowner is hiring or paying individuals a total of Tess than 40 hours per weel, (aggregate hours for all paid individuals on the jobsite)for the work for which the building permit was issued. ♦ If the homeowner of a 1,2,3 or 4 Family,Owner-occupied Residence is hiring or paying individuals a total of 40 hours or MORE in any week (aggregate hours for all paid individuals on the jobsite) for the work for which the buiidina permit was issued,then the homeownermay not file the"Affidavit of Exemption"form.BP-1(11/04),but shall either: 0 acquire appropriate workers'compensation coverage and provide appropriate proof of that coverage on fors approved by the Chair of the NYS Workers' Compensation Board to the government entity issuing the building;permit (the C-105.2 or U-26.3 form), OR 0 have the gerrcral contractor, (performing the wort: on the 1. 2. 3 or 4 family, owner-occupied resiticrice (including;condominiums)listed on the building permit)provide appropriate proof of workers'compuns mom coverage, or proof of exemption from that coverage.on forms approved by the Chair of the NYS Workcrs Compensation Board to the government entity issuing the building permit. BP-1 (12/08)ReNlerse www.web.statemv.us ACC) 76T (MMIDDNYYY) CERTIFICATE QF LIABILITY INSURANCE 30/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE 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 ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(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 certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT SUZ Page NAME: Y g Ferguson & McGuire, Inc. PHONE . (203)269-9565 FAX No):(203)269-9fi5fi 6 North Main Street -MaL s a erlfer usonmc uire.00m ADDRESS: P g g 9 P.O. Box 846 INSURERS AFFORDING COVERAGE NMS Wallingford CT 06492 INSURERA:Sverest Iudemnit _ Ins Co INSURED INSURER B.-Travelers Fire Protection Testing Inc, Fire Protection INSURERC: Alarms LLC, sec below for continued Named Insureds INSURERD: INSURER E: Cheshire CT 06410 INSURER r COVERAGES CERTIFICATE NUM BER:CL156128123 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN_ THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DDL,SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER I(MMfDDFYYYYI 1M1MID0NYYY1LIMITS a COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE g 11000,000 A CLA4,1S-MA0E g OCCUR PR MISES JEa occur ante $ 50,000 51GL004157-151 6/1/2015 6/1/2016 MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY 3 11000,000 GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY O JET LOG PRODUCTS-COMPIOPAGG S 2,000,000 OTHER Employee Benefits S 11000,000 AUTOMOBILE LIABILITY COMBINED SIMILE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident S AlJT05 _ AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS J AUTOS P. 1 $ _ S Y UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE S 51000,000 DED X RETENTION$ 10 000 51CCO01368-151 6/1/2015 6/1/2016 S WORKERS COMPENSATION PER TH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE OFFiCERfMEMBEREXCLUDED? ❑ NIA E.LEACHACCIDENT S (Mandatory in NH) E.L.DISEASE-EA EMPLOYE S If yes describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT I S B Crime 0106110845 6/1/2015 6/1/2016 Employee Theft of Client $1,000,000 Retention: 10,000 Property wi wntten contract DESCRIPTION OF OPERATIONS(LOCATIONS f VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached if more space is required) Named Insureds Continued: Fire Protection Extinguishers LLC, Fire Protection Team LLC, CGL Form: CG0001 (10/01) Location: 185 Ivy Hill, Rye Brook, NY CERTIFICATE HOLDER CANCELLATION jleichter@ryebrook.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. Village of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 938 King Street ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE Barbara Lucas/BLT, QI� sty ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025 New York State Insurance Fund Workers'Compensation A Disability Benefits Specialists Since 1914 105 CORPORATE PARK DRIVE SUITE 200,WHITE PLAINS, NEW YORK 10604-3814 Phone:(914)253-4851 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^AAAAA 061341105 FIRE PROTECTION TESTING, INC. (A CT CORP) 1701 HIGHLAND AVENUE CHESHIRE CT 06410 POLICYHOLDER CERTIFICATE HOLDER FIRE PROTECTION TESTING, INC. VILLAGE OF RYE BROOK (A CT CORP) 938 KING STREET 1701 HIGHLAND AVENUE RYE BROOK NY 10573 CHESHIRE CT 06410 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE W2332 579-8 864486 04/25/2015 TO 04/25/2016 6/26/2015 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO.2332 579-8 UNTIL 04/25/2016, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED,OR CHANGED PRIOR TO 04/25/2016 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE, NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT EDWIN NICHOLS "FIRE PROTECTION TESTING, INC." 1 OF 1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND jq;�ew, DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www.nysif.com/cerUcertval.asp or by calling (888)875-5790 VALIDATION NUMBER: 308156802 11-9a CJ e e m - o o m o(L Z oN q v 9 V w _ ro 0 m � 0 33SS U ~ FN N � W 0 � x ♦J � � S� O U 3�' L1 Q -A Ul Z l7 W Q W 9- UO ?n _�� NO �ON L, 0- U L1 z z to_ LL LLI � m s Y O � s H � 0- z w- r N I � � II �Z$ Y iF- ---�---- W W QW • UL La Q Q -A O O O n N LLL (u ❑ Q N— U � w d) n � > o a a ww �wz-' a vmu w U ~ - tII w cl Q U a N N cl = j u�X X y�/ [Y E< _ � T - r ❑ ❑ o p 8 � - W 1 3 F_ JI-J- S Q U W 3 W Q N L YO OLU Z Q V LU z iJ z n -_._-. _.-_-- • O w �� FLU } F r O O w co Q �o Z ° 0 W Q a w c ww ON UP N ZS Q U O 14R I3R p Q / QNQ "Q�QIll 'U Q n Q U n r W 0. Z Q O n Q m O i Q m LL Qm� (y LLww ) _ W N I1�I1�n-W Q CL 1 w IYZ n �QL z 0 U_ O U O O N1 K wWqn�r JU ly�l a 3 w J U H s <a XW S`�m ZF �< Z pU> NW NiA Z� OLd UN O p w3 W� cn C7 W W w Z a u� Wz aF �Of _ V)o �o �U) z �¢ o z� ... ................................ ....... ....................... Z o .ygH. Z� 3wZ J�VO a J�U U H} woa p0 ns L�3o W za N�Q owo¢C (n to (n�3 �>-z U u o w��lwi wp CwJ 4wU, } �� J a�Q W W U m S �i�a F- N 3ZC fO _WQU Y Rz U }(n'a IL LL ' w O�pL} TF Y W -z W W a w n Y Z �i m H a s `n wo LL a O z U a m L w dOUr wo}�zza z���aw �OZ�aF-w 0-uip I S.z���� W LL �mNo3 O w 3 o S.w o('�-'O �Um}wJ0 Z I J¢ a- (n -O ti z>"p¢ Z Z N J a z Q Q F W N w ¢ w O W_ O w z Z d O - own o w ��¢k���� ¢v�z�aN� U� U}Z O X Z m N x Z to U Z¢Y N U ulli ¢<¢YW z J¢W Z W o��'-' LLJ Li-ZZ W Q ¢ Z (/)000CL3J `n �z_1Ji N J Z 3 U WZ O C w N �Q 0(a1/Z�?i n a CY¢w E> ic 0 Z3 ¢OdJO �W��Na���� Z� Nr']4 O ov F- Y m Q cY1 w � O2 s _ Z) O a t 1 ^l Y Z � O N OZ yr1' w QLL co cU} wlwi O rl`„ m �, �a w Z OQ H m w O W Z o o s w to LijY O o o 1 i S U o� a° O 2 Z 0 U ui w Y rni H- J O d (/) w La Pi o (D o p w ~ a co 0 v o O O d =m — w''� c o >m w ZQ j 1 m W }} C.3 cn p > O W 16� w a i I.i1 rc�a 3 >ZH W�j aQ°� a�W W cc a-00 j 4 a r �_ LU __ e N Z� �o �J0Q LLaZ pp J 0� y 0) w� wR ° LLIJ w N N ON z v, m� Up ° 0. WZ = l�LLJW`ryW �°W Z �1-- FN Q WJ W LL V N Z J ZW W Zp N N�n ZN ` L°WFU.� �njZ ?� �r�z�z =wZ w O Jo W Q wU NLLQZ �QZ uOK 2 IY 7 0 w Q? 0 � �N =0. 07 N RO zc w �OQ �� OnOnON O �U wm w0. �01pN DwX wU J �W°(� p 0.vFz 0. 0. 0. Nz Q QXa O6Luw Q Wow zw r 5LLUp Z ��r W w W FLL E O 0.wl UQ —0.W zz w rfl�«� ��°zz�7 J JFJ 0. r Q— w �V w = w�3 ° w°wiz UQU=U x O N p°� 0 l7 �7L�Z ryUNnU�— u�f ~ XO ~ WW YW �X ww QQN 0.' >�a > O= ?Q �Wz, Fa1NL�Wzp� wlYwww� Q47 0. F xU1}a, Qra QZ Q-Z� U�n W O JE pN N� N mm�F Icy IC-1J�- ZQZ2Z� �Q 0 N Hq IY FN W F ~�1 Z5 QJO W 1IILLL Z 0- WNQ a ID W W�U(LW W IY WQ l7 LL°U • . • •g °U W ILQN pz d)-Z- 9 �J (o �W � N �2 ICW NU \\\ 2W N u�W -- - -LU W �� u � N� LU 1 mlxz cz Q m~_ m ° 0.W p Q w I — O Q N� W m 3 �w} O[��-m a� tt LU Wn PTIT! z § ° LL _ - W� W Fw O=Fwu� 0 QW T Wa HN Q�Ua, Q L----J - -_ -� N v Q _ J E N ~ z Na o� ? z ze Z o o zQ N �w `���io m z UE w £0 Nu~i� 0.��aw w N I O XZw, O I A N pU N WIUO wW�N F Q Q "� --7ilY� Q R� N Nm a MW N p w L_--_J I L----J O U— 11 0 ZQ w� W� Z W� WU w UO� 0p Ott 0 _�� K JZ Lu UR' V j >�r fo>�� J WQw��jr W1Zy��j 1Zy J C1 -J LLl� � LL-3i Q W N LL a Q t=- I DR Q - ------------ -------------- ccl Q N W LU Ua J Q ZLU W ClQ OHO C N Q gg C) w p m 0. Q w Q "I °I'do, 0 Q- w W Z 1=- Z W Z 2 = N ~ �_ mQ zaZZIzz X O a spa w, 0di 0 = m w w w E O N N �— ZZ�7JHJ.. 10.' _ 0 Dlwi N UP O O UW wUw�zQ UQU=U= 14R 13R U U Q N z p w w w w w n � N-1 LU = zaz=za o N cf)� WW7y�IY WQJU�U . . j. °U w tV p ID w w LU O WN¢ ww Z w i f po oo �N Q =Ud 77is r r i I I � ° - I � � z U > Z YI - MQ138 dooa of 1719 M072GEadaO o:�ooa (� Z } o LLI it, jL O a LU: LL LU Ci I RI O N 9 U!U U- � w Zq Z m 0 LL] 78 Z o 0 ;-4 •A E inal I cy >4 > u z o m Z- GL Z A Ha o c�P� ;-4 > u m;2, Na o�1-1 1 ni 0 Ira . I U " o�:) > Na -8, z 0 14 , .4� 0 -V) z -S 41-1 H Nit (Az 4-1 PI 29 z > u ;-4 00 u w W LL-ks) A Dl LU < > co Lu k D( IS) 'n SE X C) R z W f a LLI U-1 >: EL LL,IS) O n F-- A nz OL >G(Q) Q)IQL Qo biwo 0. T-az LU --I D-0 LL IL 6) V LU LU z w')"LLu 5 Lij 19 D- zo ci < LL< LL Lu Lu IS IL 3� I- -�< <-KD x7a� -V u) LU IL Lu Lu CD< x Lu v U. a-Lu m 0 j IL Q 6-A J IW6 9 Lu z noj 0 Lu LU N7 ul A LL J v===4 U) kD SD x LU X Lu Lu Lu (D T- L j)AL SS 1U x tu Lu LU Lu > LU <- u Lu i'c' > W ILI U- C) 17-' < < LU 0 LU W 00 -j-1 --1 11 > L L,; h t r4 ni W c d)= toa F -C-3 ro. ppo, VA LU z z j, LU c� IS) n mll z,.3 j.3. MD c 2 9 Y, II a ? Z* 4 vc Cis L- M 4� i a, yZD 0 w unx _.-, a� .71 CC_ L .:(. - P,, cl A-4..`iY'i"==- 0 - ),- .I......I... so Lu D� LLI lu -1 LL w uj w Ci w z LL LU LL LU D�uj uj cl n Lu uj 0 0 w- < G� c�Z Lij-j <T lu M T- -j(3 cj z z>m z m< LU uj CD Lp < LU z z :E z LLI LU m LU z<Lu �5< Lu < < ci w< F- (�Q� z T > LU ki) -j << > cz C/- LL Lu <J:Lu z z LU -j UJ T-�D T_ LL Lr) z << V < ly-< LU < S) <7- < < LU Z Z LU > >LUL)j D� <d) G�c�Q� < OD <LU LL > ui < < < <I-J z Ing 0- LU LU j J) LLI -i .I wtXpd o LU z CY D-— Lu Z LL 0 j W LL,CL I T D -r <LU LU LL <D- W W LL LW z z n LU L�u LU < z c�> — 0 0� \j(-�Z z c� < d- ci a- < c� LU <0 -1 D� > I LU < c� li, w 0 n LLJ uj LU < ID — kn n a) T LU< N z LLJ p 1r)(3 q)LLj LU 0 0 Lu 0< uj z < z �D �-I > LU V ui q) 0 Lu 0 < 0 0 z -J LU 0 cj Lu z z U) Z z z 00 LU�- <�- ui <�D ci 0 1 1 < -1 LU w(b Llj < 5 > Lf)< z 0 -1 0 -< <Z LU -1 D- < LU < UJ Z::) z LU-j LU LU g -j w (3 z N CD< W t-ci LU w z -J LL z 1)1 Q� Lu LLI -3 w>-J T W X w z LL LU y c� z> < LU 0 Lij -L -CL z Lij LL- D- <Uj LLJ LLI --j U -J< m U)Z LU LLI <Lu (3 z CO C) C) << -v <�:: -i �)q) I Z -J W << D- LU ED I T E LU =J:= >z w ui �D LLJ:< CD (3-V LU W kD < < z z co D- :D LU z D�Lr) LU LLJ (:)Lu 0 C)z 2� Lu-1 1:0 ,0 Z <Lu in < T- 6 Lu c�(�) w LL z c�0 -j Y <w -j W LL Lij LLJ _V LLJ Z:f LLI < F- D�(3 1 cz D-'Z C) M 0 LU �D LLJ D4 LU > z <(�- n z 0 LL<Lij :K OL-r LIJ z tu< z < Lu 0 z �D 0 t--LU rl\0- 0 z >w 0)< w Lij lu Lu LL Y-Lu -1 LL,6)-F Lu < LL LL < > <I- (3 -1 LL, LU uj z LU z 7- > LU LU< -i Lu >c�T 6 Dl Lu w Lu 2 D I z o D� LU U) LLI << Lu z w< T-<�n lij y Lu(3 < <ui -A Z LU M D� LU LLJ -i W ED D Qj Lli q)— -j LU D� <w > <LL, c� Dl(D z LL ui < LU CD LU -j 0) CL�3 < Q� S)(.D LU 0 z w > LL OD >I z< -j -i-j I SS T LW 0 z I LL z Lu < -j:K -1 L"Z LU o-LU CD ui w ID > <z w I al Y C)LU < < << Z-J CD z LL'< LLI cz < - >< Z Lij m v n W-D z>�= 6 Lu > lu m U Lu W < IL< 2�� < C) Z:--) j < LU LU < cy < LL, c� >:1 (3 c� ZLU v 0, Z LLJ Z z ED MS)w w < (S) --j z > LLI LLI 0 f)-- LU W c� ul IL C) 0 T LL is)w LLJ UJ LL <q< 0 z >> LU < > z 0 T CD �D -A Z Lu w LL Z LLJ LLI W LU LU W LU> < <LU U- -j 1(3 W-T .m < <z w LU < LLI Z IU n T-LL L'U<N LU W Q -j LU -r < -J -LL uj-j OL() <W-LLJ < D- M co- LU LU < LL,2: > n<LL C)< 13)Dl(3 << lu LU c� D LL--I LL viz -i U_ <LU < D- (MS) c� < -j C, LU S) z < w U-P LULL LLI > >LU T- z -1 cj-j z LU M < T D� > Dl UJ T !L w ci w D D-IL 13 m(3 �D ED LU w -U- <Z LU z V IL)—LL uj—i LL] -3) 3) < Lu C) �D > S) LU E W— < > �j—J —j LLJ CO LLJ ui Z Ulf << x—V (�n -1 LU > cj-j _j_I-1 LU <()T Lu �i T>< -j g z )- <-1 >Lu z L,u LIL)l L'di -V cz Dl < Z < LU < <-j LL ks) T- 4 Lu LU < c�z o L >< < U-LL - n U- < iD d) C) LU i=LU 3 >c�Z z z w Lu LLI LLJ Lli- W- v 0 0< < LU Lu p Y < z LL Z z D- Q tu Lu Lu 0 c�-1 Uj �S) -1 v -1< Lu < Lu z Q LLJ LL w D(3 Lu z <0 z z > :�:U- C) < < LU LU LLI lu 6 -1 < ai LU -j d) -j Iii LU-1 < Q LLJ_1 N LU w Z LU LU > I Lu U-< Lu Lu w z << z z QED -j LU H LL< CL LU U) LU-i LU LU <> D T--V Lu LU w LU CD > > Tu U- 0 z 1 0 LL 2 z�j w < 2: z < < <() aw ks)< < << LU -1 %l) LLJ < ui c�J) w Ill c�D F U- 0- Lli uj LU 6 LL P > w? LLI LLJ LU LU z LL z z < LL, a- X ID M iq��(Jzl-c), LU lu m Ow-w Q cl z LU ,6< 16 N 0 ID[D 11) �6 1 -1: TY U:L)U- lD-j T- I<0 N> qs 0 F�CD q: Li 0 Dl ED K LE m d)< < m Nry m z 51 a �N d o o'O �W ��.tu"� � W a � IL IM �O Q 10.6 F zQ ao �$ NF Q !� _� IM �uavW a,5e oc"a v o S ' Ur y ca uo jig�P- M Q aG� is oa F fi� �§z � ga W V [� 4-4OD U- 29 a x sus pek9 o M� w ti lilt LLI J ---------- - I I� I I �g ' � W II I Q tz — ' J M IL LU J G II W ® 13 L——————— -------------------------------------------------- I O _ =��vu w Q ro Ic V tlJ W ❑ ❑ F== A o Z OC o L o � O o O J i J 11 �— N L UP Im IdR 13R I � Q Q Q � 3 �m 0 0 awK �NUJ �ALL 5 LLi N� I I II, I � o W 22 - J s a pi o gp W w O¢ Y 8 b I LLI --------- g w $m CO �dlTfil I o a�x $ l III W 0 __ W W \ W II Z Woo w J w O O8 ; O ��L- N �a "*«* C� r� � � x: Q W Z Z F o �e�� W v oc m��z es (L _ s R.4. 8�1AIL R 30 �x W J N