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HomeMy WebLinkAboutBP20-105PERMIT # i* SECTION _ TYPE OF WORK JOB LOCATION EST. COST ✓CO #..0 TCO # FOOTING FOUNDATIO INGN FRAM RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS O SPRINKLER ELECTRIC LOW -VOLT ALARM O' AS BUILT FINAL EXP. -v2r �A 2'f LOT NeJ� OQ�70 - o n 9rc�'e lrQt�irLq�s�r�/a �bo�F-aoaa FEE DATE DATE INSP MalteI C-u" OTHER APPROVALS ARB jme L aa0 BOT PB ZBA S- ILTIFINAL SURVEY REQUIRED PRIOR TO FINAL INSPECTION eceIve 6 t&ay VILLAGE OF 1�TE BROOK WESTCHESTER COU1 , NEW YORK No: 24-094 Certificate of ®coup ucp 1 'This is to certify that �� MOW(Sef) s�CQOanlE! Ma-c&el? of, Pme F-)Ya-) , having duly filed an application on ,_20 requesting a Certificate of Occupancy for the premises known as, 1 ,Rye Brook,NY, located in a )2—-7 Zoning District and shown on the most current Tax Map as Section: ) •(06 Block: I Lot: "1—P and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. —' , issued 20,-,,U, 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: — e` rr,17 U Construction: for the following purposes: 1 V� oa-he y, de S IPyl VOLCLJ Anne 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 he t shall be r s a ,the building be moved from one location to another until a permit to accomplish such change s bee bta' ed fro Bu' ing Inspector. JUL 1 9 2024 Building Inspector,Village of Rye Brook: Date: R D ECENE BUILDING DEPARTMENT For office use only- DD PERMIT# JUL 1 7 2024 VILLAGE OF RYE BROOK ISSUED: 938 KING STREET,RYE BROOK,NEW YORK 10573 DATE: —7—/'7—,D-/ VILLAGE OF RYE BROOK (914)939-0668 FEE:,z� PAIDAS BUILDING DEPARTMENT wwwxyebrookny.gov 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 s Address: V �"j/ 17� l/�� l Occupancy/Use: Parcel ID#: 35-o, b O — /` one: OwnerPorr V /- 2 1— - /� / Address: L l✓✓ /��✓.� �q� P.E./R. tractor: /G �C7/ �j=?jl/N Address:O ^ �� i I /CJ��i /� /'✓G'V/%L' t Person in responsible charge:? d Address:0 /) A;11'<tii 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: 5 �/� �/y/' ✓'�being duly swom,deposes and says that he/she resides at00� (Print Name of Applicant) ' (No.and Street) in ,in the County of �TT'`/�, ��� in the State of ,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 a ment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$ l>� fo ecorirucqn or a tera ion of 634 D A,/ 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-I O.A.of the Code of the Village of Rye Brook. Sworn to before me this o �� Sworn to before me this ] day of u'y , 20 day of , 2U,( 1 wL Sign ure of Property Owner Signature o Applicant 17 1 5�n fl 4 J'an /D U Print Name of Property Owncyj Print Name of Applicant Notary Public Notary I 77 CARLOS H YAZNO ANA M SALAZAR Notary Public-State of New York NOTARY PUBLIC STATE OF NEW YORK N0.OtYA6440230 Reuistraiion No.OISA6365173 Qualifled in New York County Qualified in Wesichester County My Commission Expires Sep 6,2026 Commission Expires 10-02-2025 �E BRa? O� 2m 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 :- ' 1 I y / DATE: KYPERMIT# ISSUED: "1 SECT: BLOCK: LOT: LOCATION: (� ► T .( OCCUPANCY: ❑ Violation Noted THE WORK IS... "[PASSED ❑ FAILED /REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ] 'FINAL ❑ OTHER QyE BR(��, BUILDING DEPARTMENT BUILDING INSPECTOR I' ❑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: rERMIT# ISSUED: SECT:� T OCK:---JLOT: ` Z LOCATION: ' `i ° r`11 OCCUPANCY: ❑ Violation Noted THE WORK IS... ❑/PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION 1 REQUIRED ❑ FOOTING I L� ❑ FOOTING DRAINAGE ❑ FOUNDATION tr" ❑ 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 �E BR(��• 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 : / �� l C�14 �'J D (1/if P22--I U DATE: PERMIT# !� P -��`� ISSUED: -ZS-- ZOSECT:/2-5- -t/.O BLOCK: LOT: LOCATION: OCCUPANCY: ❑ Violation Noted THE WORK IS... ❑ PASSED g- FAILED /REINSPECTION a SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION / ❑ Natural Gas f'})/� Cr f_ Ct S/ �/S / C'( /'Z'(;y'/ ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER - "%/vifFZ4 ❑ FINAL PLUMBING �( ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER w € m 0 dQ2 a N a� _ to ;m � C X❑❑❑❑❑ O � 0 ;m ;Z` fA X d e9 f N� H 'V 2EE5 T292 Tooa OE9T 92oz ` k / mo �_\ o EE } <2 5 az X ® E O E a e o )}\ §}� k 2 f E ® /}�)°/\k \ = o !�£ea± {/ oe= c oo c , \ § \ - � ` 2 f } `�/ ) o \ /) R;;f�f/ ! . \ \- /w ' /#7;))(®®a juj ^� \}�(7\00220 < x = o °«)0000! � w0=o===: m 2 r , > % r / § _ o / $ x _ \ \ � \ �2f r 0\ 5{ , co { wfu � � o d o \ k R ]{ oo f � Lc C4 -0 Q §$ a_+ # - = N ) R \ 2 / ( ff . / ( � / a , L) L) § ; k . c ! !� = t . o / :,Z6 � \ \ �co k � , ow - E (0)Us _ < � ± ■ ■ ■ w 0 E L co U) O lL O U)0 O ca 0) Z N r ` CD co oU) a`) - LLaZ)a '+ c'') a_ N Y H o ° O Z c m 0 LU Nd LLI W m W m O UJ W w CD E ILL 0 Z co c Z O _ o LZ J 00O — HMO _ n a J m _n N m W m �- m a m a m � U _n ru ..n ru a ru O y CD w d = O NN C p �a r , QyE DR . 190 ltl Ct�ci�"v�v VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J.Bradbury www.ryebrook.orb TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino January 19,2024 Dear Rye Brook Building Permittee, It has come to the attention of the Building Department that your Building Permit has not been closed out in accordance with Village Code and is now expired.All Building Permits have a twelve (12) month lifespan starting from the date of issuance, and the permit expiration date is noted on the front of the permit. Please note that there is a non-waivable Expired Permit Fee of$500.00 now due in connection with your expired permit. Once payment is received,your permit will be reinstated for a period of six (6) months. Please be advised that it is a violation of Village Code to fail to close out a permit,and that a court summons could be issued, and fines may be imposed on the permit holder and/or property owner for failure to apply for and obtain a Certificate of Occupancy (C/O) or Certificate of Compliance (C/C),in accordance with Village Code section 250-10A. Please note that Temporary C/Os&C/Cs are available in accordance with Village Code section 250-10B should you require more time to perform whatever work remains in order to complete your project. Thank you for your attention in this matter, and please feel free to contact this office should you require any further information. Steven E. Fews Building&Fire Inspector stove fewsawryebrook.org cc:Alfredo DiVitto,Assistant Building& Fire Inspector Tara A. Orlando,Planning& Zoning Secretary Laura Petersen,Office Assistant /to Building Permit Check List&Zoning Analysis Address: g ���' — -�� SBL: �i Zone:�! U. 2 t O Const.Type: a ��� Other. Submittal Date: b l Z Z) Revisions Submittal Dates: Applicant: \�S-1>F N f Nature of Work lJ r y l -�-(�i� I ViQ 6-7 tEt--)CF -4- tyP�.-� Reviews:ZBA: PB: BOT: Other. NEW OK Due ( ( ) FEES:Filing. IS- �; BP: %-.O 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. Short Fees: N/A: ( ) ( )ISITE PLAN:Topo: Site Protection: S/W Mgmt.: Tree Plan: Other. ( ) (� SURVEY:Dated: Current: Archival• Sealed. Unacceptable: (� ( ) PLANS:Date tamped: `� Sealed: -/ Copies Electronic Other. ( (Vf License Workers Comp: Lability Comp.Waiver. Other. (� ( ) 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: 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. ( � O 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: (D 120 approval CP I 12 170 notes: ( )ZBA mtg. date: approval: notes: ( )PB mtg. date: approval: notes: REQUIRED EXISTING PROPOSED NOTES APPIOVED Area: H..._. t11iiVV2 3 1e Circle Frontal Front: Front: Sides: Rear. Main Cov: Accs.Cov: Fc H Sb: Sd.H Sb: GFA: Tot.I : Ft w Pa&jW. Height/Stories: notes: U �1' �E - Ml �_f t- -� ,M Coy N 2JAr— v, s _ 2- 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 5118 (Schaenman) Addition ML NM MR V,' SE f JM SF AC V 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 ff •� i� ' r r �"—7s 1 tg 'jai• m� 4 l � 1 � 1 ,4/tv �1 i1 i i • SFI� ++ ii t J • l� .l ♦♦♦ l w {r f F ' \ � ��� f� .:` � ,`� 'S"°..•'� fad � `�»'l�.�: r � . , �.� ..�. y�•�. !ice ``�� `� � � ` { eR- All ti ``tt i+ Q41 :. w - 11 �. ar• F •$ i .c _ � 3 5 PRIVACY STYLES I OKLAHOMA SOLID ■■ -- Lattice not available in Gray. The Oklahoma Style is the most commonly sold vinyl fence style for its diverse applications and maximum privacy. These sections are manufactured with our full privacy interlocking tongue&groove board and heavy duty 2" x 6" steel reinforced bottom rail. We offer the Oklahoma fence and matching gate in scalloped and crowned designs. The Oklahoma Privacy styles are available in heig s ranging from 3 to 8 feet. OKLAHOMA OKLAHOMA with OKLAHOMA TOPPER •. .ate , .nnunu.uuu u.n . n ■ .'� uu uuu. • u.na I OKLAHOMA with DIAGONAL MINI LATTICE TOPPER 2 Tone OKLAHOMA with SQUARE MINI LATTICE TOPPER �-i�i-i 7 7 �� ♦i i ii^3� - Illlllllli(Iflllll(I,II fff(ff(fffffffff"i •• �X� t _ 199 OKLAHOMA DELUXE DIAGONAL LATTICE OKLAHOMA with OPEN SPINDLE and a CROWNED WALK GATE 3 14 t A. � N L _ K rot 3 coo M r f— LQ � > c I i 04J Z a, ¢ o�ection ry; Q� ; i „•� O Z Z W [ G 2 C cn V L w _ O ¢ Z N -d Iwo � � d• O o y 4'1red80 � O CL O ; .. -v L r� CO ti U 14 c Mo y U N LA ' •� � Sri SERGGEN-01 KLPU A`ORO CERTIFICATE OF LIABILITY INSURANCE DATE 4113IM 20 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CER71FICATE 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 Via cer"cata holder is an ADDITIONAL INSURED,Ow pol"I")must have ADDITIONAL INSURED provisions or be endorsed K SUBROGATION IS WAIVED. subject to the terms and corlditlome 61111110 pot".cMtaln policies may require an endorsement A statement on this certificate does not Confer rights to the certificate holder in lieu of such endorsewhNN(a� Joyce Insurance AgNM1 PILDAIL t,, 2 Joyce Plaza (AC.No.END (U )_942-7200 A 1845)429.1591 Stony Point NY IOM ss;0lfY1cow"Ce111S.COrt1 NSIIRER(Sj AFFORDING COWERAGA . INSURER A:Met)Ife i INSURER B SERM GENERAL CONTRACTING CORP IN14MERC 22 NoEiN Road INSURER D: Greenwich.CT OSM INSLIIIER E ! INf1111ER COVERAGES _ CERTIFICATE_NUMBER. _ REVISION NUMBER: _ t-, 1 , CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 1 iNUK ATED NOTWITHSTANDING ANY RE0Uk1M1 ENT 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 EXCtUS10NS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN RFOLX:FD BY PAID CLAWS .LIR._ wimPOL)CT EFF POl1LYIX► MEIL TYPE lM INEIIRARCE _ .111115u 1nD. Pot RUMRER_ _ _ nry! LYIS A X cOs@mEREYL GLh[RAL LhmKiTY EACH A�COECC��URRE ICE S 2 000.000 CtAaASMAUF X LXLUR X 8P02236OP2020 3122fM 3I22MM PRE. ,T �I .S 50 000 NED EXP(Ary ale Person; I 5 000 PERSOIML A ADV INJURY IS ' GENL AGGREGATE ppL�AAIFTAPPMSPER GEWRALAGGrECIATE E A 000 000 II X POLICY JECT LOC PRODULis-LOW106,sic; S 4 000 000 AUTDYoeILE LIABILITY uddelal S ANY AUTO DIL TO BOY gAIRY"Pa Pa+ml ,S WRARIL O,,Y k ED pBODILY P&AIRY Psiscrldr R) s M7TOS 0'a. Ile iLALIAA OCCUR EACHOCCUINENCE 1 EXCESS LNs CLAIMS MADE AGGREGATE 1 GED RE TENTIONE E - ' AM' IE i eAEX CTNERAiXECuf ivE YIN NIA E L EACH ACGDENT i UUDDEEMM E L DISEASE EA EI111liIOYEg I M�we 4aLW ilea _Q�SOilP�ll9F9PEj T!p+g01b1r- -------EL 01sEAV POUCY1W,I I DE SCMPTIM of OPERATONS LOCATIDIIt,VEHICLE T IALOOD IOI.A/Meae1 RwwM kkearle.M ee MKboe/awe seen•ieeeaM VNlpa of Rye Book naRled"additional Insured. !CER.j��QLOER L 1 EYEnaA SHOULD ANY OF"ABOVE DESCRIBED POLICIES BE CANCELLED BEFOR) E Village of Rye Brook INN EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN 938 King St ACCORDANCE WITH THE POLICY PROVI{IONS' Rye Brook NY 10573 AUTIIOafTEO REPINE EERTATNE ACORD 20(20/0003) O IM4116ACORD CORPORATION. AN rights reserved The ACORD namhe and loge we r-gl.in mlBrite of ACORD \\ NYSIF kvw York Stato Iniuronce t and WESTCHESTER ONE 44 SOUTH BRO ADWAY. 10TH FLOOR WHITE PI AINS NY 1W)l 4411 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) """"A A 522454246 JOYCE INSURANCE 2 JOYCE PLAZA STONY POINT NY 10980 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER SERGIO GENERAL CONTRACTING CORP VILLAGE OF RYE BROOK 22 NORIAS ROAD 938 KING STREET GREENWICH CT 06830 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2275 662-t 1%698 04 20/2020 TO 04,20 2021 1 4/21,2020 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO 2275 662-1 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 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 PRESIDENT SERGIO ARAUJO SERGIO GENERAL CONTRACTING CORP 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 BY CAUSING THIS CERTIFICATE TO BE ISSUED TO THE CERTIFICATE HOLDER THE POLICYHOLDER UNDERTAKES TO PROVIDE THE CERTIFICATE HOLDER 5 CALENDAR DAYS NOTICE OF ANY CANCELLATION OF THE POLICY NEW YORK STATE INSURANCE FUND DIRECTOR INSURANCE FUND UNDERWRITING VALIDATION NUMBER 25562571 :J 1G 3 Tara Gerardi From: Mike Izzo Sent: Friday, June 26, 2020 9:57 AM To: Tara Gerardi Subject: FW: Message from Dig Safely New York, Inc. (DSNY) From: sadasupport@ufpo.org Sent: Friday, June 26, 2020 9:57:05 AM (UTC-05:00) Eastern Time (US & Canada) To: Mike Izzo Subject: Message from Dig Safely New York, Inc. (DSNY) ****REGULAR**** DIG REQUEST from DSNY for:VIL RYE BROOK Taken: 06/26/2020 09:51 To: VIL RYE BROOK PRIMARY Transmitted: 06/26/2020 09:56 00004 Ticket: 06260-225-009-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK /V Addr: From: 18 To: Name: RIDGE BLVD Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: LOCATE LEFT SIDE & REAR AS FACING NearSt: WINDSOR & TAMARACK Means of Excavation: HANDTOOLS Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: PATIO INSTALL Duration: 2 WEEKS Depth of excavation: 12 INCHES Site dimensions: Start Date and Time: 07/01/2020 07:00 Must Start By: 07/16/2020 ------------------------------------------------------------------------------ Contact Name: SERGIO ARAUJO Company: SERGIO GENERAL CONTRACTING Addr1: 22 NORIAS RD Addr2 City: GREENWICH State: CT Zip: 06860 Phone: 914-804-2022 Fax: Email: SERGIOCONTRACTING@HOTMAIL.COM Field Contact: SERGINO Cell Phone: 914-804-2022 Working for: H/O ------------------------------------------------------------------------------ 1 Comments: CALLER STATES AREA WILL BE MARKED IN WHITE 300 SQ FT Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA CON-ED SUEZ WTR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR 2 �D i O O �0 OZ _�_ p w Q. 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