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HomeMy WebLinkAboutMP20-084 �yE BR�'4'./ Q i�L r+y vu� ' 19 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J.Bradbury www.ryebrook.org TRUSTEES BUILDING& FIRE INSPECTOR Susan R.Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE February 29,2024 David Braunstein&Rachel Braunstein 5 Oriole Place Rye Brook,New York 10573 Re: 5 Oriole Place, Rye Brook,New York 10573 Parcel ID#: 129.83-1-15 This document certifies that the work done under Mechanical Permit #20-084 issued on 7/7/2020 for the installation of two above-ground propane tanks have been satisfactorily completed. Sincerely, 0"� Steven E.Fews Building&Fire Inspector /to �yE BRC�v�. 2m rc 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR 6/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 : OR O L E F L DATE: Z Z — Z 0 Z� PERMIT# M P Z O ' O-�3 4 ISSUED: SECT: BLOCK: LOT: LOCATION: ve, '"1WA OCCUPANCY: Z �U ❑ 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 ( Z 1 �1 5 v Ve C-<v z,-,j n ,P C Q--c- ❑ L.P. Gas Gl-. ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL ❑ OTHER �yE BRC�k. 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.ore - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - ------- - - - - - - - - --- - ADDRESS: I ' y C� DATE: PERMIT# g"10�w l ISSUED: I SECT: BLOCK: LOT: LOCATION: , No 1 U( ��C, X;Lv Q I NE OCCUPANCY: Z' ❑ 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 L ❑ FUEL TANK \ i �+ > ❑ FIRE SPRINKLER I�N<\ \ C��� j<,< _v : ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER O ` = a o _ 96 s o F• be oom i � rl Fir tV` a s w o -� z 13 vs, 9z � a ,5 � � _ � = �OC c .. O u I E-- Z a n z (> W Z z M N C f00 z . �?S m 0c) At a N ' Z � r Lzi Gi, x p 66 F [� o z t n .. d r C7 F w Z Q O � BUILDING DEPARTMENT VILLAGE OF RYE BROOK JUN 2 2 2020 938 KIN69TREET RYE BROOK,NY 10573 (914)93 T 66 _ 14)939-5801 VILLAGE OF RYE BROOK �. or BUILDING DEPARTMENT PLUMBING PERMIT APPLICATION 09 FOR OFFICE USE ONLY ; �V .O CJ / PP#: O(iJ O( Approval Date: JUL - 6 2020 Permit Fee: $ 1 15Pd Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, 6/4/20 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 Plumbing as per detailed statement described below. The applicant&property owner, by signing this document agree that said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: 5 Oriole Place, Rye Brook ,NY 10510 SBL: I 9q. a3- /- 15 Zone:R 2.Proposed Work: Run 30-40 feet of new propane piping from propane tank location to pool heater. 3.Property owner: David Braunstein Address: 5 Oriole Place. Rye Brook NY 10510 Phone#: Cell#: email: 4.Master Plumber: Marco Zefi Address: 711 Warren Ave, Thornwood,NY 10594 Lic.#: 1383 Phone#: 914-729-4722 Cell#: 914-564-5496 email: 7af Plurrmhing4gmail cnm Company Name: Zef Plumbing Inc. Address: 711 Warren Ave Thornwood NY 10594 INDICATE FIXTURES& LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Othcr* Total Closets Fountains Tubs Tubs Scrvice Service Scwer LP Gas Basement 1 st Floor 2nd Floor 311 Floor 4"Floor 5"Floor Exterior 5.* List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) 3/21/19 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: David Braunstein ,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 owner 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 rb day of 3 20" day of u 20 )—b _ Signature of operty Owner Signat;��pplicant Pr Print Name of Property Owner Print Namc of Applicant Notary Public Notary Public 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. -2- 3J21/t9 BUILDING DEPARTMENT VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 �x(914)939-5801 H'ww.rve ook.orP_ 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 PLUMING PERMIT APPLICATION. ANY BUILDING OR PLUMING PERMIT APPLICATION SU TTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT. STATE OF NEW YOM COUNTY OF WESTCHESTER ) as: David Braunstein , residing at, 5 Oriole Place, Rye Brook ,NY 10510 Wrint nunul �.\J+Irr: h r ni h+. 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; 5 Oriole Place , Rye Brook, NY. i olb 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. �l �rruurr ut Pn►perip th► �n>n (Print Nanic of Prolxriy 0%%ncr(.$)) Sworn to before me this day of , 20 ('rotary Public) -3- 3/21/19 % INS; MI AMR C Z, It C) En (D 0 U) 0-0 UJ tectio Z LU cr- 0 LLJ 0 CO (y) or �r. 0 -"- :n 2 Lij m 0 �Gd Lil c f'`r U >- OG (J) 0 0-0 LLJ < n Co 0 i co 0 cn (U ch 0 V1, cm en X,R " W N Wm.: sSy OPIK I R TloM. FDATE A �® E(MM/DD/YYYY) C CERTIFICATE OF LIABILITY INSURANCE l /rn2o2o 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 CONTACT NAME: Rusty Briante Edgewood Partners Insurance Center PHONE 203 658 0511 aC No 1 American Lane IA C.N Greenwich CT 06831-2560 ADDRESS: rusty.bdante@epicbrokers.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Charter Oak Fire Insurance Company 25615 INSURED PARAGASC INSURER B:The Phoenix Insurance Company 25623 Paraco Gas Corp; Paraco Gas of CT Inc INSURERC:AXIS Surplus Insurance Co 26620 Paraco Gas of NJ LLC; Paraco Gas of NY Inc 800 Westchester Ave, Suite 604 INSURER D:Travelers Indemnity Company_ 25658 Rye Brook NY 10573 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:2068900693 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. rA TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMIDD//YYYY MMtDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY Y Y Y1N6601P009026COF20 1/1/2020 1/1/2021 EACH OCCURRENCE E2,000,000 CLAIMS-MADE FxI OCCUR PREMISES jEa occurrence $300,000 MED EXP(Any one person) $5,000 PERSONAL 8 ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY❑IRO- JECT ❑LOC PRODUCTS-COMP/OP AGG $2,000,000 X OTHER $ B AUTOMOBILE LIABILITY Y Y Y1N8109J6196941ND20 1/1/2020 1/1/2021 COMBINED SINGLE LIMIT $2,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ 1AUTOS ONLY AUTOS ONLY Per accident E C UMBRELLA LIAB X OCCUR Y Y P00100005161202 1/1/2020 1/1/2021 EACHOCCURRENCE $5.000.000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $5,000.000 DIED RETENTION$ $ A WORKERS COMPENSATION Y TH- D WORKERS COMP NSATION UB8N6879022051D(AOS) 1/1/2020 1/1/2021 X STATUTE ER ANY AND EMPL ETOS'LIA ILITY ECUTIVE Y/N U B8 N6862232051 R(MA Only) 1/1/2020 1/1/2021 OFFICERIMEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $1,000.000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Additional Insured Forms. CG D2 46;CA T4 74 Waiver of Subrogation Forms:CG F2 04,CA T9 60;WC 00 03 13 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Village of Rye Brook 938 King Street AUTH R12ED REPRESENTATIVE Rye Brook NY 10573 4 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD YORK Workers' CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name&Address of Insured (use street address 1b. Business Telephone Number of Insured only) 914-250-3700 Paraco Gas Corp. 800 Westchester Ave Suite 604 1c. NYS Unemployment Insurance Employer Registration Rye Brook, NY 10573 Number of Insured Work Location of Insured (Only required if coverage is specifically 1 d. Federal Employer Identification Number of Insured or Social limited to certain locations in New York State,i.e.,a Wrap-Up Policy) Security Number 13-3149941 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) THE CHARTER OAK FIRE INSURANCE COMPANY 9ILLAGE OF RYE BROOK 3b. PolicyNumber of entity listed in box"1a" 938 KING ST Y RYE BROOK, NY 10573 UB-8N687902-20-51-D 3c. Policy effective period 01-01-2020 to 01-01-2021 3d. The Proprietor, Partners or Executive Officer are E 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 "1 a" 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 Workers' 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: Shikena Ruffin (Print name of authorized representative or licensed agent of insurance carrier) Approved by: A L IhIO, 12/19/19 (Signature) (Date) Title: Sr Customer Solutions Representative Telephone Number of authorized representative or licensed agent of insurance carrier: 804-527-6653 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. C-105.2 (9-17) www.wcb.ny.gov W31F3117 n 0 i > > t-4 w C) �x ) > Oyo 0, �� o ;V oldt4 �� 0> tz Z� 00 � J H OOZ dd w c z m 0 0 W OD (. i N 0 El r-- m 1 u 1 %j` O � TUB it OD oeeft `t de MOP Md 6e MMY OWN k is bayed wee for tea Kew YO k 91ata Asrac ioa of Lrd Baloeeh R. B", L.S. New Yak Slab Lic+ Nambw 060M. 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