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HomeMy WebLinkAboutBP20-099PERMIT # SECTION i TYPE OF WORK JOB LOCATION OWNER CONTRACTOR I • II FOOTING FOUNDATION FRAMING RGH FRAMING DATE:(OaQcx�E.Xp; l SJ 78_ BLOCK I LOT a INSPECTION RECORD DATE INSULATION PLUMBING RGH PLUMBING GAS Lwj SPRINKLER 3K ELECTRIC LOW -VOLT Q ALARM AS BUILT FINAL I NSP yvl rrda v�/,� Ih err or, a1*!ra*0e7.w) runfrev - hvc �aenmar> 93a-foil/ i �7 z-1- OI I-7 /- 0ll ol/�lu.� . itJc t,J LLC. APPROVrALlS 24 I� -cam Lei-I-er' �ofa�%acr�a VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK No: 22-154 Certificate o f ®ccupancp This is to certify that /Mal of, ���lraC� having duly filed an application on -FbY�rjQJ"V a5. 2 ' requesting a Certificate of Occupancy for the premises known as, , Rye Brook,NY, located in a �r l5 Zoning District and shown on the most current Tax Map as Section: Block: Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. ) , issued 20 1.;76, 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 following New York State Classifications, Use: — O w Construction: for the following purposes: / S-1- V� l oca-(e GUI n rIG�ys 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 LN mplying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. o changes or rearrangement in the structural parts of the building or in the exit facilities shall be made,and no enlargement, hether by extending on any side or by increasing in hei ht shall be made,nor shall the building be moved from one location another until a permit to accomplish such change has tain Building Inspector. uilding Inspector,Village of Rye Brook: Date: OCT 2 0 2022 SCR 9 ,r A"��" annla8rlfi AW VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.ry:eb rook.or TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Michael J. Izzo Stephanie j. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE October 20,2022 William Schaenman&Audrey Schaenman 13 Magnolia Drive Rye Brook,New York 10573 Re: 13 Magnolia Drive, Rye Brook,New York 10573 Parcel ID#: 130.78-1-2 This document certifies that the work done under Mechanical Permit #22-049 issued on 3/30/2022 for the installation of a new heat pump and ductless system has been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector /to D E C E� V E BUILDING DEPARTMENT For office use only: PERMIT# 'O VILLAGE OF RYE BROOK ISSUED: Z020 FEB 2 5 2022 111 KING STREET,RYE BROOK,NEW YORK 10573 DATE: 2 25 ZD22 (914)939-0668 (914)939-5801 FEE:_ a3 5 PAID VILLAGE OF RYE BROOK � BUILDING DEPARTMENT www.rbrook.or� 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 +ssrrtrtsrwrtrtrt+rtrtsrtrt►►►►+s►►srrrtr++rt♦•+srtss•rt+rtsrrt►rt+rt►►rt+r+r+++rtrtrrt+rs+ssrtsrtrtrts►►►+►+►rsrrrtr►•rsrrtsrt►►►►s►rrrsrrrrts►+rrtrs+rtrrt Address: 13 Occupancy/Use: ( "FAA Parcel ID#: 1,W 17 ( ' Z • Zone: Owner: �+(��(,�/�p(1��kstf' y TAIAWO>; A Address: MA(Pf-1 A- DP_ P.E./R.A. or Contractor: OPMMU14 P, l bbl► O' Address: J29' AN P2D• 9MMFOW C 06903 Person in responsible charge:Nw.? ff-&* Address: It " f, 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 YOM COUNTY OF WESTCHESTER as: 4&!0q2, 9!Ct�WN mN'A being duly sworn,deposes and says that he/she resides at 1 3 �fJOli!A� De- (Print Name of Applicant) ��yH (No.and Street) �/ in Q�� �K-- in the County of UJ ,I in the State of_� 7 that (City/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,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$ ") for the construction or alteration of: 41-m Ko'\ - E SCT'EtJ D Lq U No fZ�( o O M 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 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 or Certificate of Compliance shall have been duly issued by the Building Inspector as per §250-1 O.A.of the Code of the Village of Rye Brook. Sworn to before me this Swom to before me this daY4 �IIG�'TG� , 20 -�2 day of , 20 Sign a of Property Owner Signaed<of Applicant 1v i� 1 � �►�y�r�/ Print Name of Propeig Owner tnName of Applicant N° b►ic MINDY BIEGELMAN Notary Public NOTARY PUBLIC,STATE OF NEW YORK Registration No.01 BI6036803 121.'19 Qualified in Queens County Commission Expires February 7,2022 QyG 1962 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 - - - - - - - - - - - - - - - - - - - - (� 1 i I lIr 1 ADDRESS :- '� �� ` � �` �� � v 0 o DATE: PERMIT# ISSUED: `' ECT: Q LOCK: LOT -21 U LOCATION: 1 ` ` 11 rk W OCCUPANCY: C'i F�CJ C?S C Q. ❑ VIOLATION NOTED THE WORK IS--.-2f;7ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION '/FINAL ❑ OTHER QyE BRC�,�. O� 2� 1932 BUILDING DEPARTMENT ❑BUILDING INSPECTOR D ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK d `❑CODE ENFORCEMENT OFFICER 938 KING STREET - RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS• ` (^ "' DATE• \�v� PERMIT# _ ISSUED: SECT: BLOCK: LOT: LOCATION: , �� V � `:_( �DE� u'< OCCUPANCY:oe ❑ VIOLATION NOTED THE WORK IS.. ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION c REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING INSULATION NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER gyp;— Y'f s l min iw�• � � i A � � K QyE BRC�v� '9©2 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 ry6rook.orzs - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : n"'�` 1�''�C/� /-� �Lr DATE: Ll PERMIT# V l UJ � ISSUED: (0 7S) CT: �J0'`LOCK: LOT:-2- LOCATION: J�T7 ~I_`�i -- J?�D ��n�V . ' N�` �L�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 ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ ROSS CONNECTION INAL OTHER v QyE BRC��, cu � 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 ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS :— � ` DATE: ` o-Z PERMIT# � 20� O ISSUED: SECT: I �Y BLOCK: LOT: _ LOCATION: UtK V of-' t Vcl��1 Wj o OCCUPANCY: 2 ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ROUGH PLUMBING ROUGH FRAMING ❑ URAL GAS AT ❑ L.P.GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ ROSS CONNECTION OTHER al t i C rq N N y a (1l N N � s a f E: s w 40 '- � ' -- bj � fil W �• o � �, u O $ � G � r 5Z p( de to X w 9 to co t 04 G� Li �. a A Or [a.y V o p O Z ZOno M V 4 Z � ONO 1�4rn > d p i V qlilt o � o � � a W � o � a a F o o _ W tn Z. O ' fill) o r s •• o o. Z w o Now C Of " � E ff ¢¢ E EE i f . R EC ENE DD yE DRC�uk BUIL MENT MAR 3 0 2021 VIL E OF RYE OK 938 KIN EET RYE B ,NY 10571 VILLAGE OF RYE BROOK (914)9 939-5801 1BUILDING DEPARTMENT w n or ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required �-7 FOR OFFICE USE ONLY BP#: -O 7 L EP#: 0/—O / 3 Approval Date: MAR 3 20 Permit Fee: Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated 33 -30 0l is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install an or remove electrical equipment,wiring, fixtures,or to perform other 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: 1 ( pip It a Dan u e-, SBL: �1 - � — a Zone: le g- 2.PropertyOwner:W;jL-:jn-k tou 02 SrAd Q A% OR-A) Address: G5 9t?"e Phone#: Cell#: email: 3.Master Electrician: - c6 �U &P-Ac"-G Address: Sul"s"R044 gu k uy/ar;".0 Lic.#:L Phone#Q/`/-9.�1-.) L/Z / Cell#:C1/ V 7(-SYJ V email: c 00 (,C-' � Company Name: El G.t�" Address: J 6"n 4.Proposed Electrical Work/Fixture Count: Tf') D"'5 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: _J on 4/ 6xi e co being duly swom,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 for the legal owner and is duly authorized to make and file this application. (indicate architect,c actors gent,attorney,etc.) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,at�hat 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 day of ,20 da f ,20 Signature of Property Owner /� Applicant I y�.�o/ U to P'e'li Print Name of Property Owner Print Name of Applicant Notary Public Notary Public 3/21/19 JR Westchester Rockland Electrical Inspection Services, Inc. Phone: 914-347-3595 DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue Fax: 914-347_ -3596 Elmsford, NY 10523 BUILDING PERMIT NO. TEMP N DATE CITY OR VILLAGE ZIP CODE TOWNSHIP COUNTY STREET AND NO.OR ROAD POLE NUMBER BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT OCCUPANT'S NAME BUILDING OCCUPANCY nn k OWNER'S NAME AND ADDRESS HOME TELEPHONE NUMBER 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 t OUTSIDE BASEMENT t j 1'-FL. 1 2-FL. L _ 3�FL. I LLAG � i REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: r 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 ;Lo x CHARACTER OF WORK NEW - ADDITIONAL❑ EXPOSED❑ CONCEALED❑ MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD D UNDERGROUND p AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. NAME OF COMPANY DATE OF APPLICATION SIGNATURE OF APPLICANT ( l )'/ !/)r'()/iX- �5-1 u j "i X STREET ADDRESS TELEPHONE NO. Imo}44 CITY GR TST FFIPE LICENSE NO.WHEN APPLICABLE (f WESTCHESTER ROCKLANO ELECTRICAL INSPECTION IWE15SERVICES,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: Westmore Electric William &Audrey Schaenman 6 Sunset Road NY, Rye Brook 10573 Located at: 13 Magnolia Dr Rye Brook, NY 10573 Certificate Number: 1029157 Section: 130.78 Block: 1 Lot:2 BDC: Permit Number: E12:21-073-1313:20-099 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 in/on the premises at: 13 Magnolia Dr Rye Brook,NY 10573 Basement a 1st Floor 2nd Floor 3rd Floor Garage Attic 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 06/21/21 Name Type Quantity Receptacle Convenience ------- 12 Switch Single Pole ------- 12 Fixture-Luminaire Incandescent ------- 24 Dishwasher ------- 1 Oven Gas or Electric ------- 2 Refrigerator ------- 1 Freezer ------- 1 Microwave ------- 1 Sub Panel ------- 1 Beverage Refrigerator ------- 1 Cook Top ------- 1 Range Hood ------- 1 Clothes Dryer ------- 1 Continued on next page... This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. �`X'_ G� This certificate is valid for work performed before date of inspection only. WESTCHESTER ROCKLAND IRE la 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: Westmore Electric William &Audrey Schaenman 6 Sunset Road NY, Rye Brook 10573 Located at: 13 Magnolia Dr Rye Brook, NY 10573 Certificate Number: 1029157 Section: 130.78 Block: 1 Lot:2 BDC: Permit Number: EP:21-073-BP:20-099 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 in/on the premises at: 13 Magnolia Dr Rye Brook,NY 10573 Basement 12 1st Floor 2nd Floor 3rd Floor Garage Attic 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 06/21/21 Name Type Quantity Clothes Washer ------- 1 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. r This certificate is valid for work performed before date of inspection only. ■ E m i a o N .d N N N e a a ✓� 2 v� 3 E` Ci ■ ►.., 14 ... ° ► O c u W a P� IiM r••. M � � c ° ,� 0.1 � W A. 0 r.96 co Oc Q C*4 o U O V W Z p z ta/� moo w w �y , a ° o� �Z A � O u 3 a � w m O � . ■' Q Q O C]: N C o F •• 6 >. Z � � +A li`�aaaaaaa44444444a C;t.c- too444cl via `V1 E O V E BUIL EIAIgl MENT VIL E OF RYE OOK APR - 8 2OZ1 938 KING' AE T RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939,,�066 ' Ax(�14)939-5801 BUILDING DEPARTMENT t _N\.Yye .A.org PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: (J d PP#: C�? Approval Date: A P R _ 9 02 1 Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, ;5�0D�. / is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install an or remove Plumbing as per detailed statement described below. The applicant&property owner,by signing this document agree that said plumbing work I be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: !I SBL: 130. 7R-/—� Zone: 2.Proposed Work: 3.Property Owner: 4kv e N_4,vt �;C.h ckey1 Address: IA o k I. Phone#: Cell 4Jp ' 0?00 email: Gy�reYSL�►gen(a�VCt�oa C�►vt 4.Master Plumber:re ei l C'c e) '1'5!3_e ?— Address: 5CL--�4 (t— Lic.#: �Phone#: Cell#:� �b�o102G email: f u �,, ��cQ 6 Company Name: ,��`r C�l rJ Address: 61 ,— -r— ® ` INDICATE FIXTURES& LINES TO BE INSTALLED A�PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1 st Floor 2nd Floor 31 Floor 41 Floor 51 Floor Exterior 5.* List Other Equipment/Provide Details: Nov✓ W P/0<-c (4� )C (Notarized Signatures Required Next 2 Pages) -1- 3/21/19 ti 1 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: being duly 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 make and file this application. (indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belie!•;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 3 / Sworn to before me this 31 day of Marry ,20� day of MeZ-.,-64 ,20 -2 i e of Property Owner !�ignatdre of Applicant 41S&'wr'A Al AL1) 1 �-1 ti' Print Nam of Property Owner Print Name of Applicant No blic V Not blic 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. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. MINDy BFNOTARy DY BIEGELMAN IEGELMAN BLIC,STATEOF NEW YORKNOTgRy pUBLIC,STATE OF NEW Yop ation No.O1BI6036803 Registration No.OlBI6036803 fied inQualified in Q�s Coun Queens County Commission Ex ' h' n Expires February 7,2022 __. o _.._ Pines February 7,2022 - BUILDD319-5801 ENT p C C �Q E VIL E OOK 938 KING ET NY 10573 APR - $ 2021 (914)9 VILLAGE OF RYE BROOK W BUILDING DEPARTMENT xx:�*x�x**x��x*x�*�xx*�x*�x*�x**xx*x**x*�:�xxxxxxxxx�**xxxxx,�x*x*x*x*xx*xx,�x***xxxxxx****x*xxx*xxxxxxx*xx AFFIDAVIT OF COMPLIANCE VILLAGE CODE§216 STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT. STATE OF NEW YORIK_", COUNTY OF WESTCHESTER ) as: '. I ti �J, AU Q rcV S Cv QC i\OA av\ , residing at, Tint name) (Address NcJere you live) being duly sworn, deposes and states that(s)he is the applicant above named, and further states that (s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; 1 VA y,,z>�" (,— D" \`J*4-31 , Rye Brook, NY. (Job Address) Further that all statements contained herein are true, and that to the best of his/her knowledge and belief, that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. k �gna re of Property Owner(s) 4(pinN 6e of Kyferty Owne s)) Sworn to before me this day of 111a/6L , 20 021 7-11 MINDY BIEGELMAN N1)t<11-11 1ic) NOTARY PUBLIC,STATE OF NEW YORK Registration No.01BI6036803 Qualified in Queens County Commission Expires February 7,2022 -3- 3/21/19 i CPA N _ • a W � y a � .� � }� v ° o yw O W Q Ln N rS is u O' V W � wPLO 64 W ~ W a a � I o s 9 L�nI o� - Z H = \ A z g a cg � Q v cn • �r'q FBI c1� C� w �,,,� d � W V v� ,v a, � crn, at i �c8 . b `o W W _ P80 z o -d -tZ HU Ca r. a V � WC � E � � o q Vi • 011 CQ .zp C �.a v �.. W t - $ a $ ■I Z p W UO � R. � �� C7 o M z o F w z c � - •�.� �. � �I a ►.a m ' n , D � �/� ice' \11' i�� L� lBUILDING ;DEPARTMENT I VILLAGE OF RYE BROOK MAR 2 9 2022 938 KING STREET RYE BROOK, NY 10573 (914)939-0668 FAX(914)939-5801 VILLAGE OF RYE BROOK H �.tyebrook.or� BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY: PERMIT#: Approval Date: MAR 3 1 2022 Permit Fee: $ /ok)- 106 Approval Signature: Other: Disapproved: (fees are non-refundable) REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 1. Properly completed& Signed Application. 2. Site/Staging Plan if Required by the Building Inspector. 3. Copy of Licensed Contractor's Liability Insurance.(Village of Rye Brook must be listed as certificate holder)& Workers Compensation Insurance on a NYS Board form(Fora,#C 105.2 or Form#U26.3/or NY State Workers Compensation Waiver) 4. Payment of Fees/Unit: RESIDENTIAL=$100.00/unit•COMMERCIAL=$350.00/unit. 5. Inspection by the Building Department for removal and/or installation. (48 hour notice required 6. Electrical work requires a separate Electrical Permit& Electrical Inspection. 7. Plumbing/Gas work requires a separate Plumbing Permit& Plumbing Inspection. Application dated,,3`4b1?_*�0 is hereby made to the Building Inspector of the Village of Rye Brook for a permit for the installation and or removal of the HVAC equipment as listed below.The applicant and property owner,by signing this document agrees that said equipment will be installed and/or removed in conformance with all applicable Local,County,State&Federal laws,codes,rules and regulations. s� l. Address: JOaQW21LA A- 1XIZ- SBL:130� —�— Zone: V-5— 2. Property Owner: kU/ LkAN 6W A k444 Address: 1-3 LkC Phone#: q(tt A5-0'' 0,5gy Cell#: email: kXMd0A 3. Contractor: t 1��' Address: Phone#: I `7� `Sb 5 Cell#: I''� 7196' J4 9 P email: �I�LI�A�ICCQk�r Ne�l�tuC,C� 4. Applicant: _X&npIA-cnv( 1 cl- ' Address: Phone#: Cell#: email: _ 5. Scope of Work:New Installation(Vf•Replacement( )•Removal( )•Other � L'r�u K Al 6. List Equipment: Zfa 7. Location ofEquipment: C�'X\'� SP�2-- �,bC f o& l e_ - "[ 8. Method of Installation/Removal(list all equipment needed to perform job): Iy� i'l�q .At¢-t+A;4mFZ Vjkll t 3/21/19 STATEQF NEW, RK,YQ i QUNTY OF WESTCHESTER ) as: ,2 (( 1 ` ,being duly sworn,deposes and states that&she is the applicant above named, (print name of individual signing as the applicant) and further sues hat( )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 architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention& Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn to before me this 1-7— day of M01,0,14 2011/ day of h 1W ,20� igna ure of Property wner Signature of Applicant Mta� f Pro erty wner Print Name of Applicant quillo JUUE HARRISON tary PubliPubk SteteofNowYak NOT RY PUBLIC,STATE OF NEW YORK No.02HA4966574 + Registration No.01CA6184261 OwMW In WeddmilerCourdyy Qualified in z4QWLhsete►County Commission Expires Sepiiivnber25, Commission Expir s April 28,2024 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. 2 3/21/19 FUJITSU SUBMITTAL 9RLS3Y a�n Inverter Driven Heat Pump 9,000 BTU Single1 1 Mounted System job Name Location Date Engineer Approval Submitted To Construction Submitted By Unit No Reference Drawing No PRODUCT FEATURES Auto Changeover Weekly&24 hr.Timer Auto Louver:4 way Minimum Heat Mode W. Built in WiFi Auto Restart Economy Mode Energy Saving Program(ESP) Wireless Remote control Outdoor Unit Low Noise Schedule WI"FI ENABLED _ — MINN. MODEL , Indoor Unit ASU9RLS3Y Outdoor Unit AOU9RLS3 - System 9RLS3Y eaf 7 Year Compressor,5 Year Parts out-of-the-box Warranty SEER 33 WA11 A ANT T EER 18 HSPF 14.2 COP kW1kW 5.33 Btu/hW 18.20 ` 10 Year Compressor,10 Year Parts Warranty when registered within TEMPERATURE OPERATION 60 days of Installation in a residence Cooling •F(.C) 14 to 115(-10 to 46) Heatin -5 to 75(-21 to 24) Cooling Rated 9,000 12 Year Compressor,12 Year Parts Warranty when registered within Min.-Max. BTU/hW 3100-12000 60 days of installation In a residence,and installed by a Fujitsu Elite Heating Rated 12,000 contractor Min.-Max. 3100-22000 91 / Connection Method Flare Liquid in(mm) 0 1/4(0 6.35) Gas 0 3/8(0 9,52) A(CESSORIES Pre-Charge Length 49(15) UTY-TTRX 3rd Party Thermostat Converter Minimum Length ft(m) 10(3) UTY-TWBXFI Interface Kit Maximum Length 66(20) UTY-RNNUM Wired Remote Max.Height Dlff. 49(15) UTY-RVNUM Wired Remote w/backlight "INDOOR DIMENSIONSUTY-RSNUM Simple Remote Net(H x W x D) in 11-5/8 x 37 x 10-5/8 UTY-XWZXZS Dry Contact Wire Kit mm 295 x 940 x 270 Gross(H x W x D) In 14-3/8 x 40-15/16 x 14 mm 365 x 1040 x 355 Net Weight I (kg) 31 (174)) Gross Weight 3 (1 This system combination is Energy Star qualified OUTDOOR DIMENSIONS Net(H x W x D) in 24-1/2 x 31-1/8 x 11-7/16 mm 620 x 790 x 290 PP Gross(H x W x D) in 28-1/16 x 37-3/16 x 15-9/16 +A available in mm 713 x 945 x 395 Apple®App Store and Net Weight lb(kg) 84 Google®Play Store. Gross Weight 38 A_ IndoorUnit ETL4:3170288 In tertek Outdoor Unit ETL#:91987 Due to continuous product improvements,specifications are subject to change without notice. Please log in to the Fujitsu Portal for the most up-to-date documentation Effective Date: 5/7/2019 Version 9RLS3Y-2019A https:/Iportal.fujitsugeneral.com e t t 1 11 r ::: r• t FUJITSU SUBMITTAL 9RLS3Y a Inverter Driven Heat Pump 9,000 BTU SingleF t System 1SPEOFKATIONS High 489(830) Voltage/Frequency/Phase 208/23OV-60HZ Cooling Medium 400(680) Voltage Range 187-253V-60HZ Low 341 (580) Cooling Rated 2.5 Indoor Unit Airflow Quiet 224(380) Current Heating Rated 3.3 Rate High 489(830) Cooling A 9.4 CFM(m3/h) Maximum Operating Current Heating Medium 400(680) Heating 10.9 Low 341 (580) Starting Current 3.3 Quiet 224(380) MCA 13.4 Outdoor Unit Cooling 989(1,680) Maximum Circuit Breaker 15 Airflow Rate Heating 1,082(1,840) Rated 0.5 SOUND Cooling Min.-Max. 0.20-0.85 Input Power kW High 42 Rated 0.66 Medium 37 Heating Min.--Max. 0.20-1.93 Cooling Low 32 Power Factor Cooling % 87 Indoor Unit Hi iet 41 1 Heating 87 9 dB(A) INI Heating Medium 35 Moisture Removal pints/h(Uh) 1.2(2.6) Low 31 Energy Star Yes Quiet 23 Drain hose Material PP+LLDP Outdoor Unit Cooling 42 Size in(mm) 0 9/16(013.8)(I.D.)0 5/8 to 011/16(0 15.8 to 0 Heating 47 16.7)(O.D.) REFRIGERANT -1 Operation Cooling °nF(°C) 64 to 90(18 to 32) Type R41CA Range /aRH 80 or less Charge lb oz 21b 14oz Heating 'F(•C) 60 to 88(16 to 30) kg 1,300 Oil Type POE(RB68) Data: 37(940) 18-112(470) 18-1/2(470) 0 3-1116 3-1/4 (77) 15-7116(393) 15-1/4 387 (83) m i I all Q IJ51 i M for pipe inlet 0 2-9/16 65 Outline of unit i 15-1/4(387) 14-3/4(375) for pipe inlet 0 2-9/16(65) r� The Fujitsu logo Is a worldwide trademark of Fujitsu General Limped.The Halcyon logo and name Is a worldwide trademark Note:Specifications are based on the following conditions: of Fujitsu General Limited and Is a registered trademark In)apan,the USA and other countries or areas.Copyright 2018 Cooling:Indoor temperature of 807(26.7'C)DBI67•F(19.4'C)W8,and outdoor temperature of 95'1'(35'C)DO/757 Fujitsu General America,Inc.Fujitsu's products are subject to continuous Improvements.Fujitsu reserves the right to modify (23.9'()W11.Heating:Indoor temperature of 70'F(21.1'0 DB760'F(15.6'C)W8,and outdoor temperature of 47F(8.3Y) product design,specifications and Information in this brochure without notice and without Incurring any obligations. D0143-F(6.1'0 WK.Pipe length:25ft.(7.5m).Height difference:Oft.(Oml(Outdoor unit-Indoor unit). FSEMIZIN r rim FUJITSU SUBMITTAL 9RLS3Y a Inverter Driven Heat t 9,000 BTU Single (' 1 Mounted System DIMENSIONS Units:In.(mm) Unit: in(mm) r 37(M) 10-5/8 270) 1 f i Unit:in(mm) my Top view so n v) z-sro Ie71 6 M. f M - O +t s 3.7.® 352 Front view Side view 2`-VA 540 atVav 10, O 0 eV r �= b B-110 I2(*) �n prpe mounting Va. 4-07.11611 t.3)roe 10i?31 16 L20)1 Bottom view The Fujitsu logo Is a worldwide trademark of Fujitsu General Limited.The Halcyon logo and name Is a worldwide trademark Note:specifications are based on the following conditions: of Fujitsu General Limited and Is a registered trademark In Japan,the USA and other countries or areas.Copyright 201E Cooling:Indoor temperature of 807(26.7•C)DB167'F(19.4'C)WB,and outdoor temperature of 947 J35'Q DB175T Fujitsu General America,Inc.Fujitsu's products are subject to continuous Improvements.Fujitsu reserves the right to modify (23.9Y)WB.Heating:Indoor temperature of 707(21.1Y)08160•F(15.6•C)WB,and outdoor temperature of 471(8.3'CI product design,specifications,nd Information in this brmhdre vdthoil notke and wlthout Incorrino am obiioatloos DBt417 In i-ri we Pipe length.?51t.(7 Sn,).He qht(I fie,nce Oft lOm)fouldoor unit-Indn,urtt). Building Permit Check List&Zoning Analysis Address: ( � (�1/�l�ri �I— � ,4 �/L— sBL �� � ,7� — L — z— Zone:1,7—- i Use: Z l Const.Type Other. Submittal Date: 4 111 70 Revisions Submittal Dates: Applicant: S G 14 A ti wt A,ls� Nature of Work: 1 A Vj Fk L L- — ( t o ti. �1�1�No4�O"oL Reviews:zBA: A P R 2 3 2020 PB: BOT: Other: NEED OK ( ( ) FEES:Filing._LZ BP: Z?-�. 't-gC Legalization ( ) (.)- APP: Dated: Notarized: L. -- 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: PLANS:Date tamped: ✓ ale J Se Copies: Electronic Other. License Workers Comp: LiabilityV Comp.Waiver. Other. ( ) ( ) CODE 7S3#: 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: H.W.I.C.:_Battery:_Other. PLUMBING Plans: Permit: Nat. Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit N/A: Other. (•� O 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. GARB mtg.date: approval- Z 4 notes: ( )ZBA mtg.date: approval: notes: ( )PB mtg.date: approval- notes: REQUIRED EXISTING PROPOSED NOTES APPROVED Area l dl-t. .,_�. _ulUN 2 3 2020 Circle: Frontage Front: Front: Sides: Rear Main Cor Accs.Cor. Ft.H Sb: Sd.H Sb: GFA: 3�3'2 0 i 2i Tot : Ft.Im : Parlung Height/Stories: notes: BUILDING OEPARTMENT D E U V E VILLAGE OF RYE.BROOK t 938 Kltic S-rwxr RYF BROOK, NY 10573 APR - 8 2020 (914)939-0668 FAX (914)939-5801 VILLAGE OF RYE BROOK ��Hti�.r�eltrook.nrt_ BUILDING I_tr_-'ARjTAENT **#***#**#s*##s#*##**#s*s#**#**#***s*****#*#*#s*#****#s*#s**s##s#s#*ss#***s#*####*rts*rtrt**ss*#*r##*##s#*#**# 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: I J �bzal.J� Ui�. ref=ter= Date of'Submission: - Parcel ID ; : -- —Zone: -- Proposed Improvement (Describe in detail): APPLICANT CHECK LIST: ' s �I I sT [IF,: CONIPI F, I F.I) B1 I�HF, APP1.ic.%N r/ F[�t`/�D�1T1 ' L�f 1Dc�k �"/`' ' ''ti The lo1lo\%11l9 itetnS must he Submitted to the Building � Department b\ the applicant - no exceptions. . I --Y('ompleted Application � -+ ` _. ( \CO(_) �ei� Uf sCeled plans. ivt�lull.vc 'ntuunum Property O\%ner: L)ILL Address:_1 M�a+�{L�!� �� ?. 1 I T\%o(2)copies of the property surves. 1. (.,fFao(-)copies of the proposed site plan. Phone# "/4�939•(0/4( 5. (t,-Mne electronic,disc copy of the complete Applicant appearing heture the Board: application materials. 6. f✓fFiling Fee. 6TEP#6-1� /U1WNe� 11 - 1 Any Supporlinz documentation. Address: 5 5C6-7T CI eC.ttT. PUP-C.HIJI;F Ny ' I '"A appro\al letter. n/uppli chic, Photographs. Phone;: / (S /�(� - ___ 1(I.( 1 Samples of finishes inishes,color chart. (u su,np/e hound or Arch itect'Engineer: > nnrd.l nn �,t, he l,, -t �l rb, mght of the inccung, `:�i�-t•,�� , ;�r ��t � Phone# `71 4 By signature below, the owner/applicant acknowledges that he/she has read the complete Building Permit Instructions& Procedures, and that their application is complete in all respects. The Board of Review reserves the right to refuse to hear any application not meeting the requirements contained herein. Sworn to before me this Shorn to bcfure me this d•t.% 200U - -- - - dav of' Signaturcot'Propern(hencr / �ignanueaf:�pplir:uv �9�+..�L.74�1. u to�GIJ►� ��/��`�V W�� �/l Gu V Print N'anx of Propem Ouner f Print\amr ot'Apphcant -- -- — -- — \otary Pt lic _-- ------ -. MINDY BIEGELMAN \o1a1N hi1ilt` NOTARY PUBLIC,STATE OF NEW YORK Registration No.01BI6036803 Qualified in Queens County Commission Expires February 7 1011) - ----� 3 21 14 VILLAGE OF RYE BROOK BUILDING DEPARTMENT 938 KING STREET, RYE BROOK,NY 10573 (T) 939-0668 (F)939-5801 ARCHITECTURAL REVIEW BOARD Wednesday, June 17, 2020 Due to public health and safety concerns from COVID-19, the Architectural Review Board meeting on June 17, 2020 will be closed to members of the public. The public can still watch the live meeting online through Zoom through the app or through the following https://us02web.zoom.us/j/87400707035 If any interested members of the public would like to provide comments during the meeting, comments can be emailed to stevefews@ryebrook.org or called in during the meeting at +1 (929) 205-6099, meeting ID: 874-0070-7035 NAME & LOCATION TYPE OF APPLICATION MOTION SECOND APPROVED REJECTED APPL.# 18 Paddock Road Replace Fence/Gate @ Side Consent 5511 (Wynn) Yard (Black Aluminum) Agenda 7 Edgewood Dr 5' Ft High White PVC Picket Consent 5112 (Levine) Fence @ Rear Yard Agenda 27 Boxwood PI 4'Ft High White PVC Picket Consent 5113 (Demarco) Fence @ Side Yards, 4'Ft Agenda Black Chain Link @Rear Property Line 5 Horseshoe Lane New Hot Tub with Steps. Consent 5114 (Sassower) Extend Height Stone Wall to Agenda 42" 19 Bonwit Road New Blue Stone Walkway Consent 5115 (Kulekofsky) From Deck to Patio, Hot Agenda Tub on Existing Patio 18 Ridge Blvd 6'High Privacy Fence & Consent 5116 (Masden) Rear Patio on Grade Agenda 4 Bobbie Lane Install Rear Paver Patio On Consent 5117 (Jhangimal) Grade. Agenda 13 Magnolia Drive Re-Appearance 1 Story , R O 5118 (Schaenman) Addition ML \/ NM MR SE JM ✓ SF AC ✓ MI 67 Hillcrest Ave Cut Back and Legalize 5119 (Delcid) Covered Patio 980 Anderson Hill Reappearance Club House& 5011 Rd(Blind Brook Pump House Addition Club) 44 Rock Ridge Dr Amendment To Prior 5020 (Parker Lauren LLC) Approval 65 Rock Ridge Drive Amendment To Prior 5021 (Ayala) Approval 14 Paddock Road Rear Wood Deck &Patio 5022 (Stevens) 7 Beechwood Blvd Full 2nd Story Addition, 1 5023 (Yellon) Story Garage Addition, Expand Front Porch, Rear Covered Deck& Reconfigure Driveway ML NM MR SE JM SF AC MI JB VILLAGE OF RYE BROOK BUILDING DEPARTMENT 938 KING STREET, RYE BROOK,NY 10573 (T) 939-0668 (F) 939-5801 ARCHITECTURAL REVIEW BOARD Wednesday, May 20, 2020 NAME&LOCATION TYPE OF APPLICATION MOTION SECOND APPROVED REJECTED APPL.# 7 Agryle Road Re-Appearance To Show Consent 5000 (Mack) Exterior Lighting Agenda 16 Maywood Ave Roof Top Solar Array Consent 5001 (Robles) Agenda 1 Elm Hill Drive Rear Yard Fence Consent 5002 (Mayell) Replacement Agenda 33 Country Ridge 6 Ft High Fence &Replace Consent 5003 Drive (Umbro) &Expand Existing Patio Agenda 177 North Ridge St Revision To Prior Approval 5004 (Lovallo) 5 Brooksideway Re-Appearance Detached 5005 (Con Edison) Accessory Bldgs 13 Magnolia Dr 1 Story Addition& 2 Story 5006 (Schaenman) Addition �i C-),-A0, S 67 1/2 Winding In-ground Swimming Pool. 5007 Wood Rd(Coffey) W/Paver Patio, 6-0" Privacy Fence 6 Country Ridge Dr In-Ground Swimming Pool 5008 (Scala) &Patio 27 Dortchester Dr In-Ground Swimming Pool 5009 (Rosson) &Patio 47 Rock Ridge Dr Revisions To Prior Approval 5010 (Nurik) 980 Anderson Hill New Pump House & 5011 Road(Blind Brook Clubhouse Addition Club) ML NM MR SE JM V SF AC V MI JB �f x J KEEPITC-01 MLOPEZ A��RO CERTIFICATE OF LIABILITY INSURANCE DAT/25/2D/Y 325l2021 1 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 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 C TACT World Insurance Associates,LLC HONE,Ext: (914)747-1181 FAX No 3 Starr Ridge Road,Suite 100 Brewster,NY 10509 INSURERS AFFORDING COVERAGE NAIC# INSURER A:Merchants Insurance Group INSURED INSURER B:Merchants Preferred Insurance Company 12901 Keep It COOT Inc. INSURER C: 363 Elwood Ave INSURER D: Hawthorne, NY 10532-1257 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 SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR DfYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE a OCCUR X BOP1084760 4/17/2021 4/17/2022 DAMAGE TO R(EaENTED oCcurrence� g 500,000 ISESMED EXP(Any oneperson) S 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY❑PECT 71 LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,006 (Ea acc4dent)X ANY AUTO CAP1064945 6/5/2020 6/5/2021 BODILY INJURY Perperson) S OWNED SCHEDULED BODILY INJURY Per accident S AUTOS ONLY AUTOS BODILY R AUTOS ONLY AUU ONLY PPe�a,.ZtDAMAGE g S A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE CUP9147494 4/17/2021 4/17/2022 AGGREGATE S DED I X I RETENTION$ 10,000 $ 1,000,000 WORKERS COMPENSATION PER I I OTH- AND EMPLOYERS'LIABILITY Y/N A ER ANY PROP II E TgOERR/PARTNER/EXECUTIVE ❑ �Vlendatory In NH)EXCLUDED? N/A E L.EACH ACCIDENT g E L DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Certificate holder is Additional insured on a primary and non-contributory basis with respect to General Liability for the purpose of Issuing licenses or permits. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g y ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Rye Brook,NY 10573 ---- AUTHORIZED REPRESENTATIVE i , ICA ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NYSIF New cork state Iri;urance Fund 199 CHURCH STREET,NEW YORK,N.Y. 1 0007-1 1 00 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) ^^^^A^ 133905398 KEEVILY,SPERO-WHITELAW INC. o 500 MAMARONECK AVENUE 0 ; ,u HARRISON NY 10528 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER KEEP IT COOL INC VILLAGE OF RYE BROOK 363 ELWOOD AVENUE-SUITE B 938 KING ST. HAWTHORNE NY 10532 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE G 1302 944-2 352910 05/01/2021 TO 05/01/2022 3/23/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1302 944-2, 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. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. MICHAEL MCCARVIL-PRES KEEP IT COOL INC 1 OF 1 THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. 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 Z5-7--k-� DIRECTORJNSURANCE FUND UNDERWRITING VALIDATION NUMBER: 33065717 U-26.3 i �y e:rortr l.wuwer ,1� `. ��M*Iw* 11'� i17 OIHrI*r.[owwn*r Pol.11w WnIf 114frrfouwh FirruO•r (\ Department of Consumer Protection r Home Improvement License !�- OPTIMUM BUILDING CORP 70 PROSPECT STREET PORT CHESTER.NY-10573 This hcenw i%L"ued in Wcordonce Mnh Ankh XVI of Me WeNclrwrCorty Catwmcf P,vteciion Cod**ftd is valid only upon PMw=c or the ol{Ki*I dcptnmcm sdl Pton(d ckWM"ip w* 'M -1 omen i+no required for izsUWWc of this lio - NOT FOR FEU ML PURPOS S i i Ucenw Numrxr Ualc of Exppruiott WC-07584-H96 05117M22 1 � ly CO d CERTIFICATE OF LIABILITY INSURANCE °"TT' '" THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RNWTS UPON THE CERTIFICATE HOLDER. THNI CERTIFICATE ODES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLJCES BELOW. THO CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORED R€PRESENTATIVE OR PRODUCER.AND THt'_CERTMICATE HOIJ]ER. IMPORTANT: If the oartNlcab holder Is an ADDITIONAL INSURED,the po"Ies)apse!have ADDITIONAL INSURED provisions or be endorsed. IF SUBROGATION IS WAIVED, sub)ect to the terms and condibons of ttw poYCy,oerbhl poBcles may require ar endorsement A Nsaelawll on this cerbftams does not confer to the he Neu such andorswnwI s. potmwat r e car oldr in o lyyr SABINEFAX - Anthony Chino X.F.La; (960)321F0103 >..I (960)ti2041104 426 North Main Street *D Ess, InSRNAW-Com Southington.CT 06489 dOUFAM ArrORDNO DOVERAaE RAE0 NSURrR A FARM FAMLYCASUALTY INSURANCE 04011d7M! NNtellllD wsuReR e OPTIMUM BUILDING CORD - -- - - - WOU11 o_t_t_: _ 70 PROSPECT STREET POST CH ESTE&NY 1073 NY JOU3 elwaNalt B COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTVY THAT THE POLICIES OF INSl1RANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PeROM INDICATED NOTWITHSTANONrG ANY REQUIREMENT TERM OR CONOITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TIC CERTIFICATE MAY E NINUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT r0 ALL TINE 1111111011% EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY MAVE BEEN REDUCED BY PAD COWS. Twa OP slwslMu PoUcv rrrwre It POLO/ff" 1NwT{ oa1rR7AL aMML uABs ITr 00H OCCUrAVOCa t t I CLA195+waE X I OCCUR A I Y Y 3141L1417 02JO1120 0210/121 PEMWM LaAWNKAM >t I�ILABONr-i►1�0LYfAPR�N� aw1KAfORifL►Tl _ ANnarawa N,�Rr I � ANTI Avro OOWV OMUry Frr OILY .sooir wuRr Frrri.N 4 day AV=*NLY • - t UNION" B 00011NN BIYi,7100N7tsaMQ N) otetua u'a_ 1 �� � Aoalttol►a. � -— sloNsolle CO�MATNON ---- - Aw�rLorwr LNNIBaIrY OP a I A F L RAdI AOCMW Mesta/H E.L.D -M i OF QprA7vNf war i.L.ONWMa-11 XVWr (l' TIOa OF OPEAAT-ONS LOCATIONe I VIPNCUS(ACM III Aewww-R---t.ya..a,r "v M*Rwftd•ron ewe.•t r.q w d) VILLAGE OF RYE BROOK 19 INCLUDED AS ADDITIONAL INSURED ON GFNFRAL LIABILITY COMICATIE tg&M CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES M CAMCOAMD�t VILLAGE OF RYE BROOK THE ExwRATION DAT* rnEREOF. aNE NOTICE WILL SE ow M POLICY 938 KING ST ACCORDANCE WRH THE ►R6Viil RYE BROOK NY 10573 AImrORms RrPREWWTATNE _-.- —_-- — �— —-- Ir lSM-2015 ACOR'D CORPORATION. AS rIOMs np6wwvad ACORD 25(201&V3) The ACORD male and logo are roglatered marks of ACORD I NYSIF N.w w.a$We Inwisn"Plund VVESTCHESTER ONE,W SOUTH BROAGMIAI'. 1UTI1 FLOOK VVHRE PLAINS,NY 1 ON14411 1 NrySN.com CERTIFICATE OF WORKERS'COMPENSATION INSURANCE(RENEWED) a• .o �Y� pCt - AAAAAA 13368T9M OPTIMUM BUILDING CORP C/O CHRISTOPHER SCELFO [ as 429 DEN ROAD STAMFORD CT 08003MI 1 SCAN TO VAUDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER OPTIMUM BUILDING CORD VILLAGE OF RYE BROOK 5 BEECHWDOD BLVD ge KING ST RYE BROOK NY 10573 RYE BROOK NY 10573 POLICY NUMBER CEITIVIC►TE NUMBERT POLICY PERIOD DATE W1478 2E0-1 243200 DOW= TO 04COMI SI2620M TINS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED VMTH THE NEW YORK STATE INSURANCE FUND UNDER POUCH NO IITS MID-1. COVERING THE ENTIRE OBLIGATION OF THIS PoucyHoLDER 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 POUCYHOLDERS REGULAR NEW YORK STATE EMPLOYEES ONLY K YOU WISH TO RSCENE NOTIPICATKM REGARDING SAID POLICY,INCLUDSIO ANY NOTIFICATION OF CANCE.LAT10Ni, OR TO VALDATIE THIS C0ffN CATS,VISIT OUR WEBMT7!AT HTTPSAVANWJW AL.ASP.THE NEW YORK STATE INIURANCE/UND 0 NOT UASL!IN THE EVENT OF FAILURE TO ONE SUCH MCTIPICA710NS. THIS POUCY DOES NOT COVER CLAIMS OR SUfTS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. CHRISTOPHER SCELFO-PRESIDENT OPTIMUM BUILDING CORP ONE PERSON CORPORATION 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 DIRECTOR,INSURAHCE FUND UNDERWRITING VAUOATION NUMBER 91301752 U-26 3 I