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HomeMy WebLinkAboutOBA20-003PERMIT # �+C� SECTION TYPE OF WORK JOB LOCATION EST. COST DATE: 140VC6 EXPO -c97 13LOCK �- LOT TOO A � FEE DATE. DATE tN>�I3 --- FOUNDATION-- FRAMING - - - - -- RGH FRAMING - INSULATION - - - --" PLUMBING Q RGH PLUMBING --- - - - =-- - GAS Q SPRINKLER ELECTRIC- LGWN VC T ALARM Q _ AS BUSLTFVML pill wild © -_- , 0Iducci s lovers OTHER APPROVALS ARB BOT _ PB zBA OTHER QyE BRC�� O� Zm 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 wwwryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : C / \ DATE: PERMIT# `J`l-�� M3 ISSUED: O'"` SECT: � � ` BLOCK: �- LOT LOCATION: OV `:��C�-�� ��,��F �` l'���I�CCUPANCY: 2-lb ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION SITE INSPECTION REQUIRED FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING �� p ✓❑ ROUGH FRAMING ❑ INSULATION C�� V� v `� ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER Q�E BRc'b 4j''� F0 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: >► L C�2 PERMIT# � ISSUED: �C,� SECT: _ BLOCK: LOT:"' LOCATION: ou\ Qpn -TIM `^ o f r`OCCUPANCY: V ❑ 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. 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U ♦� p �{ Y,Z o W 3 �z it Q in z z z fpsp 7 c�Fy FCL< uj Q Q Q N o — — �- ` IEL z w x w= a oz �7LL a a12 CLZ a A� ® r ATE(MM/DD/YYYY) AC� CERTIFICATE OF LIABILITY INSURANCE s/lsizozo 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 Alliant Insurance Services, Inc. NAME` 32 Old Slip . 1-800-221-5830 (FAX, No:1-800-383.1852 New York, NY 10005 ADDRESS: INSURERS AFFORDING COVERAGE NAICS INSURERA:Hartford Fire Insurance COm art 19682 INSURED KBUSHO INSURER B: Balducci's Holdings, LLC INSURERC: 700 Lanidex Plaza Parsippany NJ 07054 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1961747587 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. IN>SR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP AM Jima POLICY NUMBER D M D LIMITS A X COMMERCIAL GENERAL LIABILITY 10ECSS26605 4/1/2020 4/1/2021 EACH OCCURRENCE $1,000,000 CLAIMS-MADE �OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $1,000,000 MED EXP(Any one ) $0 PERSONAL&ADV INJURY $1,000,000 GEN L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $15,000,000 X POLICY1:1 JECOT- LOC PRODUCTS-COMP/OP AGG $2.000.000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accid nt ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Peracddent) $ HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY H — AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under --d - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Village of Rye Brook is included as additional insured where required by written contract as respects to liability arising out of the operations of the named insured. 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 Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE ' / ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD