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HomeMy WebLinkAboutSP19-002Pihmif Nc i SECTION TYPE OF WORN JOB LOCATION - m FEE DATE - DATE INSP FOOTING FOUNDATION FRAMING ----�- RGH FRAMING INSULATION PLUMBING 0 �_ RGN PLUMBING GAS SPRINKLER ELECTRIC-'�'f""-/' LOW -VOLT ALARM AS BUILT ASS FINAL OTHER APPROVALS Awning orNewTaan�;"Compass MT ZBA y Mu5chinsk5 860 5a3-8835 OTHER Electrical Contractm9 �yE 4R t si VILLAGE OF RYE BROOK MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A.Klein (914)939-0668 Christopher J.Bradbury www.tyebrookny.gov TRUSTEES BUILDING & FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M.Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE December 3,2024 Win Ridge Realty LLC c/o Alena Hakanjin 24 Rye Ridge Plaza Rye Brook,New York 10573 Re: 138A South Ridge Street,Rye Brook,New York 10573 Parcel ID#: 141.27-1-6 Sign Permit#19-002 issued on 7/2/2019 for New Sign &Awning This certifies that the illuminated sign and fabric awning,"Compass",installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to ID BUILDING, DEPARTMENT For office use oni : Pr.ltmrr# 9-00 a NOV 21 2024 Vlt.LAGiV,OF RYr Brill)O: ISSUL'D: 7—a-P�j 938 KING S rRk. ,i-;1tvF.BROOK,Nv%%-YORK 10573 DATE: VILLAGE OF RYE BROOK (914)90,-0668 F6t?: & CP'So— PAID ICI BUILDING DEPARTMENT rvww,rytWruokttyaaov APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION ...........................................................................................................0................. Address: IR—q SOu;t-H (LInLiE Sjr I?� 3D�aOk-,_ kA6 IDS�3 Occupancy/Use: d►tn {,gyp Parcel ID 4: Cl[4 1• Zone: C 1- P Owner: w i W t2l D.Ltt>: a Gv t.r-tp r LL v Address: I �� �l��'L-._L�t.t`L �► _}Ortt _06 t£ 13r2�v P. R.A, or Con tractor: ti f R)-le" M(x�( Address: I� _ 1tL4 Kl3 .Pt.rr NUCtM,.Y1ru±2tt.ltw.t.I,NJ IU Person in responsible charge: '� G q_LL(;�� Address: 11 U.5.1'" hYg - qT"RP, Pf�, d� A_Q—D.LL_ 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/construction/alteration herein mentioned in accordance with law: STATE OF NEW YORK,COUNTY OF WESTCHESTER as: SKO CACA*ft-6 being duly swom,deposes and says that he/she resides at 10 S-Irt t } r� V� I�)b (?nnt Name of Applicam) (No and Site tl U in (Vk pfn►t% t'CY(r,4 in the County of � iIf� in the State of' ,that (Ow Town/village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,%affbldin&�,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been dunate'd gratis was:S ��(p flo for the construction or alteration of: Ale—!.J�II U4)i.17gk / /c- 1 kl).,7/,'7j L`Co�►�tPA s S '� . Deponent further states that he/she has examined the approved plans of the structure/work 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/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful loran owner to use or permit the use ofany 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 or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-10.A.of the Code of the Village of Rye Brook. Sworn to betbre me this 1044 Sworn to before me this day of04 6 ,201!j_ day of . 2014 Signature of Property Signalur• .Applicant i Me6f4 . lft�f IU,T Skralfr ciuno Print Mrca rrolmay Prmt,V'M,:u Applrcan: ——— r bl r +•�c •+,•�++ KE "•, Notary Public STATE RICHARD A.YARMY 11 ' �F NEW I oRK�'��' NOTARY PUBLIC,SPATE OF NEW YORK " s :NOTARY PUBS 1C70 Registration No. 01YA0013323 Qualified in Westchester County ot1O"��a`""'•'�ti�' ,�'onunission Expires September 08,2227 o �E BRC�v�, '9a2 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.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : .7 0 A S-),A L�SIP. S � DATE: PERMIT# S� I ` Qy ISSUED: 7-1- 19 SECT: iyl Z I BLOCK: LOT:(_ LOCATION: C S S OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... []-'ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS r`w kl� 1 —i—,%J S ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ✓ 7L� ❑ FINAL PLUMBING c ❑ CROSS CONNECTION FINAL �/- [I OTHERCQA-51 Q -4 A ETA ON elf) 8- kn IL fn op W4 A-, 47; rn 10 L4 NO cc Cit V� M. 44 C6 cc W & z u yE BRC�u BUIL MENT VIL B+ Ali OK + _ 938 KIN ,NY 10573 SEP 3 0 2019 (914)9 939-5801 VILLAGE OF R�',- B�pr�K . .or Sl1iLQl�i�'� �E9'ARTI',�lENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY #: SP 19-002 F.P#: I US ILJV - 1 Approval Date: OCT Z Permit Fee: S SO Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, 10otO is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/or remove electrical equipment, wiring, fixtures,or to perform other high or low voltage electrical work as per the detailed statement described below. The applicant & property owner, by signing this document agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. (� 1.Address: 138A South Ridge Street, Rye Ridge Shopping Center SBL: 141.27-1-6 Zone: C 1_ F� 2.Property Owner: Win Ridge Realty LLC Address: Phone#: (914) 701-4005 Cell#: email: 3.Master Electrician: David Wardell Address: 66 S. Central Ave, Elmsford, NY 10523 Lic.#: E-30 Phone#: (914)592-4744 Cell#: email: dkempter@belwayelectric.com Company Name: Belway Electrical Contracting Corp. Address: 66 S. Central Ave, Elmsford, NY 10523 4.Proposed Electrical Work/Fixture Count: Connection of 1 sign (1 feed) STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: David Wardell being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant) state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the Electrician for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn to before me this 2-7 day of ,20 day of Se t'e,n b er )2.0_1421 7D� (AkLw Signature of Property Owner Signature of Applicant Print Name of Property Owner Name of Applic Notary Public DIANE M KEMPTER Notary Public-State of New York NO.01KE6391666 Qualified in Westchester County My Commission Expires May 13, 2023 3121/19 Westchester R e: 94=347-35 Rockland Electrical inspection Services, Inc. Phon 1 DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue Fax: 914-347-3596 Elmsford, NY 10523 BUILDING PERMIT NO. TEMP# DATE ] -j i -I "�U_ CITY OR VILLAGE ZIP CODS TOWNSHIP COUNTY P STREET ND'OR ROAD POLE NUMBER �1 .1--e 1r3pA BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION \ BLOCK LOT I.Cl OCCUPANT'S NAME BUILDING OC PANCY U ! r M) OWNER'S NAME AND ADDRESS HOME TELEPHONE NUMBER a41+y L c CURRENT SUPPLIED BY 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 NO. H.P.EACH NO. WATTS EACH INSPECTION OUTSIDE BASEMENT 1S'FL I ---- 2-FL. IUp I 3-FL. VIL GE C' REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: L 5A sv) 1 +oQ a THIS APPLICATION IS INTENDED TO COVER THE ABOVE LISTED ITEMS TO BE INSPECTED.IF AT ANY TIME OF INSPECTION ADDITIONAL ITEMS HAVE BEEN INSTALLED,YOU ARE AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE FOR THE ADDITIONAL ITEMS INSPECTED AS PROVIDED BY THE APPLICANT.THE APPLICANT DECLARES THAT THERE IS NO OPEN APPLICATIONS FOR THE ABOVE WITH ANY OTHER INSPECTION COMPANY.WREIS, 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❑ EXPOSED❑ CONCEALED❑ MUST ENTER APPLICANTS IDENTIFICATIION NUMB SERVICE ENTERS BUILDING OVERHEAD❑ UNDERGROUND❑ � � AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. "ME OF��PANY L� I DATE OF APPLICATION SIGAR712 OF/4P T-L 1 STREET APDRESS TELEPHONE M�` E �P LICENSE NO.WHEN AP�,ICAB WESTCHESTER ROCKLAND -1E1 ELECTRICAL INSPECTION SERVICES,INC. BY THIS CERTIFICATE OF COMPLIANCE THE Westchester Rockland Electrical Inspection Services 43 North Lawn Ave, Elmsford, NY 10523 914-347-3595 (Office) 1 914-347-3596 (Fax) CERTIFIES THAT Upon the application of: Upon premises owned by: Belway Electric Win Ridge Realty LLC. 66 South Central Avenue "Compass" Elmsford NY 10523 Located at: 138A S Ridge Street, Rye Brook, NY 10573 Certificate Number: 653280 Section: 141.27 Block: 1 Lot: 6 BDC: Permit Number: EP:19-260 BP:19-002 A visual inspection of the electrical system at this premise described as a Commercial occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: 138A S Ridge Street, Rye Brook, NY 10573 ❑Basement ❑1st Floor ❑2nd Floor ❑3rd Floor ❑Garage ❑Attic ❑X Outside Other: Inspection was conducted in accordance with the NYS and NFPA 70-2017 International Electrical Code and detail of the installation, as set forth below, was found to be in compliance therewith on 12/15/2019 Name Quantity Rating Circuit Type Sign 1 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. `��� G�L2 This certificate is valid for work Performed before date of ins ection onl . YYY Building Permit Check List&Zoning Analysis A Address:' )A l -2 SZ SBL: Zone: G t- Use: Const.Type: l 33 Other. Submittal Date: (D S 1 Revisions Submittal Dates: Applicant: W 1 tj a S F, Nature of Work L--L-,-j "\k r-&A-�E� $ lei N r FASIP-1 C A,I-j rj ttj lz ©w.'>A S S Reviews:ZBA: J UN - 5 2019 PB: BOT: Other. NE OK ( ( ) FEES:Filing. 3aJ BP: Z�, 2A,M- C/O: Legalization: ( ) ( ) APP: Dated Notarized SBL: Truss I.D. Cross Connection H.O.A ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening. ( ) ( ) ENVIRO: Long. Shore Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmt.: Tree Plan: Other. ( ) ( ) SURVEY:Dated: Current: Archival: Sealed. Unacceptable: ( ) (Jf PLANS:Date Stamped. ✓ Seale • ,' Copies: Electronic:✓ 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. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H.W.I.C.:_Battery:_Other. ( ) ( ) PLUMBING:Plans: Permit: Nat. Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A: Other. ( ) ( ) H.V.A.C.: Plans: Permit: N/A Other. ( ) ( ) FUEL TANK:Plans: Permit: Fuel Type: Other. ( ) ( ) 20I7 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other. ( ) ( ) Other. (LARBmtg.date: approval• Z5 l notes: ( )ZBA mtg.date: approval: notes: ( )PB mtg.date: approval:- notes: REQUIRED EXISTING PROPOSED NOTES APPnf"% 19 Area: wam. Circle: Fro n�taee Front: Front: Sides: Rear. Main Cov Accs.Cov: Ft.H Sb: Sd.H Sb: GFa Tot : Ft.I : PP Height/Stories: notes: BUILD�N9_DREPARTMENT JUN - 5 2019 VILLA E OF RYE�i ROOK 938 KING TREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)93§bW E,AX(91"'39-5801 BUILDING DEPARTMENT D s»s+s»t»s»tsst►trrrtrstss+r►rrs►rrasrssrstrttsrttrraratrrrrsssrssss+ss»»»»++sirs+►+slit+sttsssrttttttttrttrt 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: 138 S.Ridge Road Date of Submission: June 5,2019 Parcel ID#: 141.27-1-6 Zone: Cl-P __ Proposed Improvement(Describe in detail): APPLICANT CHECK LIST: MUST BE CONIPLETEI) BN THE APPLICANT Signage&Awnings at Storefront. Signage to be halo- The following items must be submitted to the Building illuminated fabricated lettering. Existing three(3x)awning Department by the applicant-no exceptions. frames to be recovered with land-lord approved fabric. 1. (x)Completed Application 2. (x)Two(2)sets of sealed plans. ((xm lull%ve I,maxrmum Property Owner: Win Ridge Realty,LLC a1h)%%ah1c plan size ,6"x 42"1,and one 1 1'xIT•) 24 Rye Ridge Plaza,Rye Brook,NY 10573 3. ( )Two(2)copies of the property survey. NA Address: Y g Y 4. ( )Two(2)copies of the proposed site plan. NA Phone# 914.701.4005 __ 5. (X)One electronic/disc copy of the complete Applicant appearing before the Board: application materials. 6. (x)Filing Fee. Adams IAhern Sign Solutions,Inc. 7. (x)Any supporting documentation. 120 Vanderbilt Ave. West Hartford CT 06110 8. ( )HOA approval letter.(rfoppltcable) NA Address: --- 9. (X)Photographs. Phone# 860.513.883S _ _ 10.(X)Samples of finishes;'color chart. fa sample board or model may be presented the night of the meeting) Architect/Engineer: Vocon Phone k 646.865.1200 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 jany application not meeting the requirements contained herein. Sworn to before me this 'T�L k_ Sworn to before me this day of 20\,q day or , 20�_ �p s%&uAre of Prop ty Owner signature of Applicant LJtA L._Si( ! vPHIb4is Pnnt Name of Property Owner me of App is C ` Not Pu is Notary Public r1 ........•0Iw�/- KEI LY SANDI ER `x�� \ D i,�� Notary Public,Sta:e of `law York �1%`40 miss,o�••." 1.11 No. 01SA6::033B2 Qualifi3d in Westchester County _V:�NOTAgyo':• Commisalon Expires March 9, 20');Z = ►•� jOvB11C "' 3nlrle 1-20 ���'%.,ENE C T►GJ•``��• VILLAGE OF RYE BROOK BUILDING DEPARTMENT 938 KING STREET, RYE BROOK,NY 10573 (T) 939-0668 (F) 939-5801 ARCHITECTURAL REVIEW BOARD Tuesday, June 25, 2019 NAME&LOCATION TYPE OF APPLICATION MOTION SECOND APPROVED REJECTED APPL.# 40 Tamarack Road Install Temporary Prefab Consent 4749 (Grumm) Above Ground Swimming Agenda Pool 5 Parkridge Ct New 4ft High Black Consent 4750 (Wishnow) Aluminum Fence Agenda 19 Bonwit Road 2nd Story Addition, 1 st 4751 (Kulekofsky) Story,New Front Porch& Rear Deck 37 Hillandale Rd Amendment to Project 4752 (Fischer) (permit not yet issued) 173 Country Ridge Demo Existing House and 4753 Dr(NDRB Construct New One family, Development) New Swimming Pool 980 King Street New Driveway Pillars 4754 (Perez) w/Lights, Driveway Expansion& 6ft High PVC Privacy Fence 52 Tamarack Road New Rear Yard DecAr k 4755 (Miranda) 14 Whippoorwill New Rear Deck&Patio 4756 (Martel) 138 S. Ridge St New Illuminated Sign& 4557 (Win-Ridge) Fabric Awning "Compass" 34 Woodland Drive New Windows, Doors, & 4758 (Tokarz) Siding ML NM MR (/ SE JM SF AC MI is y3 i Han1eq 1 1 1 Spec Phoenix Series Specifications PF-2030 Mini Viewing Angle 1600 Input Voltage 12YDC Watts .3w/mod(132w/ft.) Luminous Efficacy 113(Im/W) [ fi Modules/Foot 4.4/ft.fully stretched Protection Grade IP68 water proof �`,ssrF,fo Packaging Anti-static bag,150 modules(34ft)/bag warranty �� — -- c us 5P 5L constant c �� Ds s 0• Warranty 5 Year(Product)/5 Year(Labor) careen E4O 2629oa Operating Temp. -40°—+60°C /-130—+1401 Pe 9 P� Storage Temp. -400 _-70°C /-130—+158 OF + Cascade 50 mods single-ended power feed ideal depth 100 mods double-ended power feed Features -Compact miniature module with maximum brightness Color Part# Color Temp Lumens -For small stroke and low profile signs -Premium components,high efficiency chips,and great heat dissipation White HLED-PF203OWP 7000K 34 Im/mod(150 Im/ft.) for longer,reliable life. -DIY Layout Tool at hanleyledsolutions.com (Available in English,Spanish,and French) Profile Drawings Unit:mm[inch] 69[2.72] 43(1.69] Max: 50PCS • • • 53[2.08] 3407[134.1] 3513[138.3] Light Distribution 12[0.47] 8.4[0.33] 7.2�[0.28] ,so ,so 22.4[0.88] ,z0 ,za 26[1.02] MAX POWER SUPPLY LOAD -9U ° 90 MODEL 35W 60W 100W 150W 3 PF 2030 116mods 200mods 333mods 500mods 6 60 60 1 0 -30 30 1 0 0 www.hanleyledsolutions.com Your Local Distributor:Grimco HanleyLED PF-203OWP Spec Sheet Updated 1/14/19 US www.grimco.com •800.542.9941 1 Canada www.grimco.ca •800.263.1421 1 International 305.885.0088 p , ,���.�V�•qq wlrw•..r. r yM♦WFW}le .��ri A. • M.�Nw1•r1+ww�r+.N�1Y..'1 • - ...wM.aww.aww...•.•H.. •.ate .wwr'�r Mom• • 1 • 1 ' / 1 , .♦.N W rN•.^.e.•w...�rH. •:Mw..O+..M w•1.. 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':..i� f i .:" f.:lw."`%"M%. .• M _ .""w. �HH s}H. ..wa• ♦ t�N�i+ • n'w ..rs.a A G E M I N I v STANDARD PAINTED Ct 5687 White 2025 Black 2418 Brown 2162 Hunter Green 2280 Black Cherry 2030 Dark Green 0401 Aztec Gold 0400 Brilliant Gold 2756 Metallic Gold* 0253 Copper 0402 Aztec Copper 0312 Medium Bronze* 4) 0314 Old Copper* 3130 Duranodic Bronze' 8886 Metallic Silver* High C:,loss Fuusil Semi-Gloss Finish Matte Finish STANDARD GLOSS LEVELS *Indicates colors that do not have a full gloss fir s `a -- S r fit �K I ' v1 f ' � � r =z iy Check List For Release of Building Permits Address: Owner/Applicant: RcLc`=-J�- Phone Ws: I 70 t 5 Dates Attempted To Contact Owner/ Applicant: Comments: ea):?aled- OWn!��rj Qj-c� 44, GC Comments: Comments: NEED: (Building Permit Fee $ ( ) UFPO # ( W Home Improvement License —;�4&446"8 flap. Gomr-44tiver ( ) General Contractor's Contact Information ( ) Fire Sprinkler Plans (2) ( ) Fire Sprinkler Application ( ) Fire Sprinkler Permit Fee ( ) Estimated Cost $ ( ) S WO Fee $ ( ) Legalization Fee $ ( ) Other Liz Caruso From: Liz Caruso Sent: Friday, June 28, 2019 2:20 PM To: 'sibley@adamsahern.com'; 'chris@adamsahern.com' Cc: 'denglish@winprop.com'; 'julieann.soeder@vocon.com' Subject: Sign Permit Application for 138 South Ridge Street Good Afternoon, The sign permit application for 138 South Ridge Street has been approved by the Building Inspector. Before we can issue the permit, the following items must be submitted to our office: 1. General contractor's valid liability insurance (Village of Rye Brook must be the certificate holder) 2. General contractor's valid workers' compensation on a NY State Board form (C105.2 or U26.3) 3. Sign permit fee of$250 (due at the time of permit pickup) Thank you. Liz CARUSO OFFICE ASSISTANT BUILDING DEPARTMENT VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK, NEW YORK 10573 OFFICE (91 4) 939-0668 FAX (91 4) 939-5801 A M ®C` DATE(NNVDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 07/02/2019 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()es)must have ADDITIONAL INSURED provisions or 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 Janice Dix Woodford Insurance NAM: PHONE 860-236-5861 FAx�; 860-232-7887 10 N Main Street No.Exbo ll West Hartford, CT 06107 ADDmESS:: jdix@aewoodford.com INSURER(S)AFFORDING COVERAGE NAIL 0 INSURERA: Sentinel Ins CO LTD 11000 INSURED Adams Ahem Sign Solutions Inc,AA 120 Vanderbilt LLC INSURERS: Hartford Accident& Ind Co 22357 120 Vanderbilt Ave INSURERC: Twin City Fire 00914 West Hartford, CT 06110 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 ADDL USK POLICY EFF POLICY EXP LTR POLICY NUMBER LIMITS A COMMERCIAL GENERAL LIABILITY 02SBAIA8402 04/13/2019 4/13/2020 EACHOCCURRENCE S 1,000,000 CLAIMS-MADE OCCUR PREMISES Ea occurrence S 1,000,000 MED EXP(Any aria ) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 9 2,000,000 POLICY P� LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ B AUTOMOBLELIASLRY 02UECAY9175 04/13/201904/13/2020 COMBINED SINGLE LIMIT $ 1.000,000 (Ea accident J ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED pRGpE�Y DAMAGE $ AUTOS ONLY ALTOS ONLY Par accident $ A ✓ UMBRELLALIAB OCCUR 02SBAIA8402 04/13/2019 04/13/2020 EACH OCCURRENCE $ 10,000,000 EXCESS LIAII CLAIMSAMIDE AGGREGATE $ 10,000,000 DED RETENTION $ 10,000 $ C WORKERS COMPENSATION 02WECE18247 04/13/201904/13/2020 V1 PER AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRETOR/PARTNERIEXECUTNE E.L.EACHACCIDENT $ 500,000 OFFICERMEMBER EXCLUDED" ❑ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 A 02SBAIA8402 04/13/2019!04113/2020 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached M more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE VMTH THE POLICY PROVISIONS. 938 King Street AUTHORIZED REPRESENTATIVE Port Chester, NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NEW Workers' RK STATE Compensation CERTIFICATE OF Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a. Legal Name and address of Insured (use street address only) 1b. Business Telephone Number of Insured ADAMS AHERN SIGN SOLUTIONS INC 1c. NYS Unemployment Insurance Employer 30 ARBOR ST Registration Number of Insured HARTFORD CT 06106-1215 1d. Federal Employer Identification Number of Insured or Work Location of Insured (Only required if coverage is specifically Social Security Number limited to certain locations in New York State, i.e. a Wrap-Up Policy) 06-9351434 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage (Entity Being Listed as the Certificate Holder) Hartford Fire Insurance Company Village of Rye Brook 19682 938 KING ST 3b. Policy Number of Entity Listed in Box 1 a": PORT CHESTER NY 10573-1226 02 WEC E18247 3c. Policy effective period: 04/13/2019 to 04/13/2020 3d. The Proprietor, Partners or Executive Officers are Included. (Only check box if all 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 above in box "la" for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box "2". The insurance carrier must notify the above certificate holder and the Workers' Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums 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 Certificate 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", whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Worker's Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying 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 referenced above and that the named insured has the coverage as depicted on this form. Approved by: Danielle Clausen (print name of authorized representative or licensed agent of insurance carrier) Approved b ((, 4 pp Y� :�T,19�ruo�.f.C.�.G�.a,du r7 07/01/2019 (Signature) (Date) Title: Operations Manager Telephone Number of authorized representative or licensed agent of insurance carrier: (866) 467-8730 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. 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