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HomeMy WebLinkAboutBP20-117a;rrliv/t riraizl�-� rc JOB LOCATION td7 '%i i OWNER C1701i�� i i • CONTRACTOR I FEEIIJHFr111�1. DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS SPRINKLER ELECTRIC 0 LOW -VOLT O ALARM AS BUILT 0 A518 FINAL 3'21.'2A2'1 F� MA14L 04 C.O. — 6cfIIaAl Gc+*Cn I- I`I LO Ly �Q`yE 4R3 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 March 27,2024 Christopher Kuhn 67 Greenway Circle Rye Brook,New York 10573 Re: 67 Greenway Circle, Rye Brook,New York 10573 Parcel ID#: 129.84-2-56 Building Permit#20-117 issued on 7/21/2020 for a New Fence This certifies that the new post and rail fence,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building& Fire Inspector /to p E�C711 VI FE .y "Ad IA I It\v LAi I ZAIV 11.I JU I\I PERMIT# c20 '( !UN 2 2 202t70 VILLAGE OF RYE BROOK ISSUED: 7 1 0 93f KING STREET,RYE BROOK,NEW YORK 10573 DATE: UP a&(a D VILLAGE OF RYE BROOK (914)939-0668-FAx(914)939-5801 FEE: 110 PA BUILDING DEPARTMENT �vv%vv.ryebrook.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 tRffffffftt#iRf#f#ifR##tiff###f#RffftRtR#R#tf#tt#Rfftf##tfifft##fRf#ii#i#####if##R#tifRit#Rtt;;i#f;#i;tft;ii#ti####Rf;tiiifi# Address: Occupancy/ se: Par el D#: p79. -'� Zone: Owner: Address: P.E./R.A.or Contractor: t Address: l�-1 t4� & �!A 6'4>4er Person in responsible charge: 7�;a Address: &ow Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: ST TE O NI W YO K, OUNTY OF WESTCHESTER as: C rt t! being duly sworn deposes and says at he/she resides at , 1 IS n S Y P Ys int Nai c ot'A tNo.and St et) in pplint) in the County of in the State of� ,that cm own/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 co tructio r alteration f: W (fx U �l Deponent fu states that he/she has ex ed 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 belied 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-IO.A.of the Code of the Village of Rye Brook. Sworn to before me this Sworn to before me this day of 0 day of Q 22 Signa re of (honer Si ture of p'cant Print Name of Pro y Owner Print Name of Ap icant Notary Public Notary Public �E BRC��, '9a2 BUILDING DEPARTMENT ❑,�B((UILDING INSPECTOR 0 SSISTANT 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: 2 (1 L 02 PERMIT# 7_C Y I I-? ISSUED: - SECT: 4W BLOCK•_LOT: 5 LOCATION: OCCUPANCY: ❑ Violation Noted THE WORK IS... B PASSED ❑ FAILED /REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION / Al❑ Natural Gas / fit/ F05 IZA AJee ❑ L.P. Gas x/a CA ❑ FUEL TANK C ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ,Q�FINAL `Is N LP OTHER QyE BRC�k, x BUILDING DEPARTMENT ❑/BUILDING INSPECTOR 0Q 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 : / r e e C DATE: �- Z y Z PERMIT# ISSUED: /-11"Zy SECT: /L 5 BLOCK: 2 LOT:_, LOCATION: E/ 0C.A OCCUPANCY: 2/L) ❑ Violation Noted THE WORK IS... ❑ PASSED ❑ FAILED REINSPECTION [9--SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION _ ❑ Natural Gas /✓�� t/ Pos /v 'i�Q / cl ❑ L.P. Gas � l�(-'G✓t �G--� Cy��l� ;�c, d . ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL s ❑ OTHER "1 Alfredo DiVitto From: Alfredo DiVitto Sent: Tuesday, January 9, 2024 8:48 AM To: cg.kuhnl @gmail.com Subject: permit bp20-117 post and rail fence replacement Good morning, Mr. Kuhn we met yesterday and spoke regarding your open fence permit. I spoke to Steve Fews the building inspector after our meeting and the village of Rye Brook requires a C.O. application with a $110.00 fee and an expired permit fee of$500.00 for us to close the permit and issue a certificate of completion. I investigated the fee you mentioned yesterday that you had paid. It was a legalization fee due to the doing work prior to obtaining a permit. Any questions feel free to give us a call. Thank you, Alfredo (Freddy) DiVitto Assistant Building Inspector Village of Rye Brook 938 King St. Rye Brook,N.Y. 10573 Office: 914-939-0668 1 & c - - � « } { \ m f � 37a- 2 7 2 J z Q E / 110 \\3 2 TC ` Gk /\�})/\) {± oeo 0 0 0 \ \ , - / ± ){ /j \7!;/§�])« \ } \/ j}/7\R\7\\ a x wouueooI m m ( —IQ Ln ] » � � 2 . % ® \ FIJ } 0 E = 00 f -0 \» o % { ® . a 0-2 f ) / } ® �o E zzz 2 § o ! E § ]a , m _ & w c r \ \� \ CZ C3� ) / 2 \ cm { o co o 0) \ \ \ j \ � 02- 3 f � / « o ± 2q / � / J � co a ®` - o & r c c § U) \ \ o 0 0t*< ■ ■ ■ - & / a — U o Fa a) ti o N 06 o -0 m Z N U rn �v a'€ c oct) (1) CV) + N pZ ° 0 LL, W LLI �o � wU1W — ai U- 0 Z _ O z - ��� W Z Y O O ° Q co 0 �Sf ru J p m m a m Lu m p_ ru U � � dr" ni Ir � d � d O N o- Ln (L) Ir = N C p �a � m 'nE d a �o � _ o LL • wmm D o h ¢ 2 m m • c ¢ rn rn V m G O D a � sip p f0 m r(❑❑❑❑❑ U �»w a 69 N� N U r-orr- rr-lnrr rrnnn nrnrr nrrrnj `c�yE DR . 193 L�+ 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 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 stevefews@ryebrook.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: � �i ,�- -tom!v-�`-� Ci/u- SBL: l _aD`t Zone�7y Use: 2 o Const.Type: --I x Other. LE.4 A L l Z/i1 n>J Submittal Date: (D/ZZ ,Z 2> Revisions Submittal Dates: Applicant: t-v,- y t4 t-.) Nature of Work: c-A G F F_-,-A 1 r B L- Reviews:ZBA: J UN 2 3 2020 PB: BOT: Other. OK ( ( ) FEES:Filing•. 7S-�BP: C/O: Legalization: 7�O_ ��,,p► 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: ( ) ( cYSITE PLAN:Topo: Site Protection S/W Mgmt.: Tree Plan: Other. ( ) ( SURVEY:Dated: Current: Archival: Sealed: Unacceptable: ( ) ( ) PLANS:Date Stamped Sealed Copies: Electronic: Other. ( ) (�License: ✓ Workers Comp:`� Liability: '� Comp.Waiver. Other. (4/ ( ) 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 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. ( ) ( ) Comer. l S 2.o ( )ARB mtg.date: -1 approval S 20 notes: ( )ZBA mug.date: approval- notes: ( )PB mtg.date: approval- notes: APPROVED REQUIRED EXISTING PROPOSED NOTES JUL2 1020 cird� -- Fr�nt�g Front: sides: Main C s Acos Ft.H Sd,H/SbTot.imp Ft.Imp HcLak/Stoles ` notes: BUILDING DEPARTMENT DD VILLAGE OF RYE.BROOK 938 KING STREET RYE BROOK,NY 10573 (L JN 2 2 2020 (914)939-0668. (9%939-5801 � VILLAGE OF RYE BROOK www o BUILD!NG DEPARTMENT 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 ARnB/�agnennda. Job Address: G 'i-�A ( Qez—.e Date of Submission: �� (.L_ WL�� Parcel ID#: IQ 9, 7— — Zone: Prop sed Improvement(Desc "be in detail): APPLICANT CHECK LIST: MUST BE COMPLETED BY THE APPLICANT C ^ C'1\G2 0.� oC�� The following items must be submitted to the Building r Department by the applicant-no exceptions. 1. ( ompleted Application 2. ( Two(2)sets of sealed plans. (one full size (maximum Property Owner. e!" Ku I\ allowable plan size=361 be 42 )and one 1111171) 3. ( Two(2)copies of the property survey. Address: Q pc°CnG�h�! ��-G e- 4. ( )Two(2)copies of the proposed site plan. 5. ( )One electronic/disc copy of the complete Applicant appearing before th Board: ,,application materials. 6. ( ) ding Fee. 7. ( y supporting documentation. 8. (✓�A approval letter. (ifapplicable) Address: V1 p eQn�„>�. ��rC, 9. ( Photographs. Phone# �� 7' 1 - S 10.( )Samples of finishes/color chart. (a sample board or model may be presented the night of the meeting) Architect/Engineer: Phone# 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 Sworn to before me this day o ?,d dag f 22 &AIL Signatur of Pro Im er Signatu of Appl car Print Name of Property er Print Name of Applilant Notary Public Notary Public Arbors Hoeowners Association :y '' m The Clubhouse 1Z�isk Ivy Hill Crescent '+' I r,_ r t4 Rye Brook,NY 11111 i � 'tar ARCHITECTURAL&GROUNDS COMMITTEE APPLICATION FORM IIOmCowner's'NAInC:1...�- �"r}��it'�l n — } , J Datc �+1'V 1 Address:_�" y // 1 1 Phone: 1 -n S V 1?Z" Email address: 1 - 1Lf� `�,ti�•'`1G` �M �� Reguircments and Conditions for Filin¢This Request Rorm• 1. Architectural changes and/or additions will require architectural plans and a plot plan of your property. 2. Upon receipt of request,A&G will survey the area. 3. Other requests such as patios,decks,fences,landscaping,brick walls and any attachments to outside of house require exact measurements,plot plan of property,and drawings and/or photos of areas where change will take place. 4. All requests must follow A&G guidelines. 5. HOA and A&G Committee are not liable for the cost of any plans regardless of whether this application is approved or declined. 6. A&G approval does not exempt homeowner from obtaining any and all Village permits, which may be required and otherwise complying with all Village and other municipal regulations. 7. Homeowners should consult AHOA Declaration of Covenants and Restrictions and The HOA By-laws before submitting plans. If plans are in opposition to the Declaration and/or By-laws,such plans will not be approved by A&G Committee. 8. Renters may not apply for any changes. 9. The property manager must be notified no less than three(3)business days prior to the onset of work and no more than three(3)business days after the completion of the project. 10. Upon notification that work has been completed,an inspection will be performed by A&G and the Property Manager to ensure all work was done as per this request and approval policy. 11. Failure to comply with the terms of this application and/or the scope of any work approved may result in fines and/or assessments being levied against the homeowner in accordance with A&G Guidelines. i' I-huivc rtyyjl�d the a1``�ovc rc�ulru/m tents A/nd condit ns ns well ns the A&G Guidelines rind 3grce to bide by the CCglll]tlnnf JI�iCO AbOYC4 Signature of Iromcb,ulper DA a Write request below and/or on the back of this sheet please: At the request of the A&G, I fixed the fence by replacing it with a new one since it was in such disrepair. I submitted the proper forms and thought I included the A&G application but must not have. After submitting the forms I got the fence replaced since the deadline was approaching and before the ground froze. I wanted to put in a new fence to enhance the community given it is near the path that many people walk by. I hope the board takes this into consideration. Thank you. A&G rtgrw sc• ��'' //!!�� Dare rcvlemd: APPROVED:Jf f// DECLINED: COMMENTS: // // iI A&C COMMITTEE SIGNATURES(mpJu{tr requlrs�t �1 Gy? P_�+q v� j� U` r-m 1 Page I of I Revised November 2015 car:H CV ^ ._ 10 10 IQ g . �• ��e� � .� � � off" 5 NSF•e� O F O� �pv�iF;: \\ l° lk \\ IL Z CL Tara Gerardi From: Tara Gerardi Sent: Tuesday, July 21, 2020 9:23 AM To: cg.kuhnl @gmail.com' Subject: Fence Permit Application 67 Greenway Circle The building permit application has been approved by the Building Inspector, before I can issue the building permit the following items must be submitted to our office, 1. Contractor must call Dig Safe NY and get a 10 digit ticket number. 2. Building permit fee $100.00 (due once permit is issued and ready for pick-up) 3. Legalization fee $750.00 (due once permit is issued and ready for pick-up) TARA A. GERARDI SECRETARY -- PLANNING BOARD, ZONING BOARD OF APPEALS & ARCHITECTURAL REVIEW BOARD VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK, NEw YORK 10573 OFFICE (914) 939-0668 FAx (914) 939-5801 N = _ _ C N r � CO giis►► � � st yCA 0 O LU Pl- OL H ch L C ? z v `Qc ^'r eci'On z x - Fm G� r CA OL a w w L - h v LL. > H 4a�s►► ya O > O Q w w _ U Lu w LL J F- Ge(G 9g w N 4 r 7 . L 7 N ARE> CERTIFICATE OF LIABILITY INSURANCE QATEINMUU.YYYVI 09,2412019 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., It the certificate holder Is an ADDITIONAL INSURED,the pollcy(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 NANTACT 1.1ehsSa Crosson C Quick Insurance Agency PIIONE m N W.No): 13 W hlan Street ADDRESS: melc@cgWCklnsurdnce com INSURERIS)AFFORDING COVERAGE NAIC a WashlrTgtonvllle NY 10992 INSURERA: Main Street America 29939 INSURED INSURER B: New South Insurance Co 12130 Brothers Fence ofPanChester,Inc INSURER C; Phoenix Insurance(PHX) 25623 249 WILLETT AVE INSURER : AmTiust Financial Services.Inc INSURER E: PORT CHESTER NY 105734214 INSURERF: COVERAGES CERTIFICATE NUMBER: CL1972502791 REVISION NUMBER: IHIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAL!ED 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 T.AY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERI.IS EXCLUSIONS AND CONOITIONS OF SUCH POLICIES LIMITS SHOWTJ MAY HAVE BEEN REDUCED BY PAID CLAIMS IITR TYPE OF INSURANCE INS POLICY NUMBER 16W,'DDl(YYY) POLICY EXP (MMLODYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1 OOO.ODO CL"AS!'ACE ©OCCUR FREMISEStEa arreace S 500,000 MED EXP]Any one pefsom 5 10.000 A MPU72906 05.101R019 05/010020 PERSONAL aADVINJURY S 1000.000 GENL AGGREGATE LIVIT AFFL1FS PER GFIIERAI AGGREGATE S 2 GW,000 FOLICY❑PRO LOC PRODUCTS CONP,OPAGG S 2.000.000 OTHER Empl Practices Liab Ins s AUTOMOBILE LIABILITY COMBINED SIRGLE LIMIT S 100 000 (Eaaca W) ANY AUTO BODILY INJURY(Per person) S B OVINED SCHEDULED 2001710728 02J23.12019 02J23f2020 BODILY eJJURV IFer acodel111 S AUTOS ONLY AUTOS HIRED NON 0':,7iED FROFERTY DAMAGE S AUTOS ONLY AUTOS ONLY /Per academe Medical payments 5 5.000 UMBRELLA LIAB OCCUR EACH OCCURRENCE 5 EXCESS LIAR CL&'!AS4AADE AGGREGATE S _ De0 RETENTION S ��qq S WORKERS COMPENSATION IF TATUTE ERH AND EMPLOYERS'LIABILITY YIN _ C ANY FROPRIETORPARTNER'EXECUTIVE a NIA U65K525263 OSVv2019 05.012020 EL EACHACCIDENT s 100.000 OfF10ERMEIAeER E(CLUD£D1 11H1 000 flik"alory MI NH) EL DISEASE EAEIAPLOYEE S it yes.1be uno" 500 000 GESCRPTION OF OPERATIONS ccor. EL DISEASE-POLICY LOUT S D OlsabrLty WOL10275796 Ot'012019 O1t012020 NYS 5atutory benefits OESCRIPMN OF OPERATIONS I LOCATIONS(VEHICLES(ACORD 101,Additional Remarks SchaWle,may be ansched d more space Is re0uded) Work to be performed for Chnelopher Kuhn at 67 Greerr:+ay Cu In Rye Brook,NY 10573 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN FifstService Residential Cynthia Brunner Property Manager ACCORDANCE WITH THE POLICY PROVISIONS. 173 12 Ivy Hill Crescent AUT14ORLCO REPRESENTATIVE Rye Brook NY 10573 C" L ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD STATE OF NEtV YORK WORKERS'COhIPENSATION BOARD CERTIFICATE OF NTYS NVORKERS'COiiIPENSATION INSUR INCE COVERAGE la.Legal Name S Address of Insured(Use street address only) lb.Business Telephone Number of Insured Brothers Fence of Port Chester Inc 914-934-2239 249 Willett Ave lc NYS Unemployment Insurance Employer Port Chester NY 10573 Registration Number of Insured Work Location of Insured(Only required ifcoverage issperiftcallp Id.Federal Employer Identification Number of lusured limited to certain locations in A'ew Ibrk State, i.e., a ll"rap-(p or Social Security Number polio) 46-063986 2.Name and Address of the Entity Requesting Proof of 3a. lame of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Travelers Insurance Company FirstService Residential 3b.Policy \umber of entity listed in box"la" Cynthia Brunner UB5K52563 Property Manager 173 112 Ivy Hill Crescent 3c. Policy effective period Rye Brook, NY 10573 05101/2019 to 05/01/2020 3d. The Proprietor,Partners or Execuln•e Officers are included. (Onlr check box if all parturrslofricers 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 tinder the New York State Workers'Compensation Law.(To use this form,New York(NI')must be listed under Item 3A on the L\-FORhLaTION 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"_'". TheI surance Carrier rt•ill also notifi•the above certificate holder,t•irhin 10 dm s IFapohr.v is canceled due to nonpm merit ofprentiuus or within 30 dar s IF t/rere mr reasons other than nonptn•ment gfprentiums that cancel thepoliq•or eliminate the ins ra•etf f tom the co+•erage indicated on this Certificate. (These notices men•be sent br regular mail) 011jerrrise,this Certificate is valid for one year after this form is approved by lite insurance carrier or its licensed agent,or until the polio—evI iralion date listed in box"3c",u•hirliever is earlier. Please Note:Upon the cancellation of the workers'compensation policy indicated on this forur,if the business continues to be named oil 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 willi the mandator.% coverage requirements orthe New York State Workers'C'onrpensation Law. Under penalty of peljnry.I certify that I am au authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this forur. Approved by: Laura Quick (Prue wtn^_of authorized representauve or licensed agent of u utaoce gamer) Approved by: Laa,-a i&d 09/29/2019 (Stgr nue) (Date) Title: Licensed Agent Telephone Number of authorized representative or licensed agent of insurance carrier: 845-497-1119 Please Note:CIO-insurance carriers and their licensed agents are authori--ed to issue Form C-105 2. bsurance brokers are A10T onrhori--ed to issue it C-105 1(9-07) wsslv.svcb.state.ny.us CERTIFICATE OF INSURANCE COVERAGE e rd DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier la. Legal Name and Address of Insured(Use street address only) 1b.Business Telephone Number Of Insured BROTHERS FENCE OF PORT CHESTER INC 249 WILLETT AVE PORT CHESTER,NY 10573 Work Location Of Insured(Only required If coverage Is specifically 1c.Federal Employer Identification Number of limited To certain locations In New York State,i.e.,a Wrap-Up Policy) Insured Or Social Security Number 46-0639862 2.Name and Address of the Entity Requesting Proof 3a.Name of Insurance Carrier of Coverage(Entity Being Listed as the Certificate Holder) FirstService Residential Cynthia Brunner Property Manager WESCO INSURANCE COMPANY 173 1/2 Ivy Hill Crescent 3b. Policy Number of entity listed in box"la.": Rye Brook,NY 10573 WDL10275796 3c.Policy effective period: 9/24/2019 to 12/31/2020 4.Policy provides the following benefits: 'A.Both disability and paid family leave benefits. B.Disability benefits only. C.Paid family leave benefits only. 5.Policy covers: X A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. B.Only the following class or classes of employer's employees: 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 NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 912412019 By l f (Signature of insurance carrier's aulhonzed representative or NYS Licensed Insurance Agent of that insurance career) Telephone Number 800-535-2711 Title Vice President IMPORTANT:If Boxes 4A and 5A are checked,and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE.Mail it directly to the certificate holder. If Box 48,4C or 5B is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS Disability and Paid Family Leave Benefits Law.lt must be mailed for completion to the Workers'Compensation Board, Plans Acceptance Unit, PO Box 5200, Binghamton,NY 13902-5200. PART 2.To be completed by the NYS Workers'Compensation Board(Only If Box 4C or 5B of Part 1 has been checked) State of New York Workers'Compensation Board I (According to information maintained by the NYS Workers'Compensation Board,the above-named employer has (complied with the NYS Disability and Paid Family Leave Benefits Law with respect to all of his/her employees. Dale Signed By __ (Signature of Authonzed NYS Workers'Compensation Board Employee) Telephone Number Title Plase Note:Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue form DB-120.1. Insurance brokers are NOT authorized to Issue this form. DB-120.1 (10-17) Tara Gerardi From: Mike Izzo Sent: Thursday, July 23, 2020 11:1 S AM To: Tara Gerardi Subject: FW: Message from Dig Safely New York, Inc. (DSNY) From: sadasupport@ufpo.org Sent: Thursday, July 23, 2020 11:15:10 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: 07/23/2020 11:07 To: VIL RYE BROOK PRIMARY Transmitted: 07/23/2020 11:15 00001 Ticket: 07230-071-034-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK /V Addr: From: 67 To: Name: GREENWAY CIR Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: RIGHT SIDE OF PROPERTY AS FACING NearSt: GREENWAY LN Means of Excavation: HAND TOOLS Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: REPLACING FENCE Duration: 1 DAYS Depth of excavation: 24 INCHES Site dimensions: Length 100 FEET Width 6 INCHES Start Date and Time: 07/28/2020 07:00 Must Start By: 08/11/2020 ------------------------------------------------------------------------------ Contact Name: WALTER B JAPA Company: BROTHERS FENCE Addrl: 249 WILLETT AVE Addr2: City: PORT CHESTER State: NY Zip: 10573 Phone: 914-447-9494 Fax: Email: BROFENCE@OPTONLINE.NET Field Contact: WALTER Cell Phone: 914-447-9494 Working for: CHRIS K ------------------------------------------------------------------------------ Comments: Lookup Type: PARCEL 1 ------------------------------------------------------------------------------ Members:ALTICE USA CON-ED SUEZ WTR WESTCHESTER TEN GAS-HDS VLY BELL-VALHALLA/WSCHSTR VIL RYE BROOK WESTCHESTER CTY SWR 2 a �N 6 h �\ \� A 2020 PERMITD -II \\ \ �� lLLAGE OF RYE BROOK SBL# Z�7' 4'f — BUILDING DEPARTMENT �D APPROV D Architectural ReW gird 3 / 2 O Approval Date: BUILDING INSPECT Ilage of Rye B�qk NY ----- �� L cV c .10 ' i 'St G b �`Q 0 1p IQ ILE COPY Ile c, Ile \ \\ ��' ��—�CF IN IZ.�►r.f� // / z 41 /