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BP20-173
PERMIT # 1+ SECTION TYPE OF WORK JOB LOCATION OWNER /EST. COST V CO # DATE: 0 EXP: BLOCK J LOT F1 .E%VeQJ :r TCO # FEE DATE INSPECTION RECORD DATE ,s FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING IV RGH PLUMBINGJ' GAS [� SPRINKLER ELECTRIC LOW -VOLT ALARM 0 AS BUILT / FINAL ^ „� ih l Shed .� f' FOTHER APPROVALS LC `7 (ol cw5GO Je orp v?a 41,505(0 ARB BOT ZBA OTHER AS-BUILT/FINAL SURVEY REQUIRED PRIOR TO FINAL INSPECTION �3 FINISHED BASEMENT NOT APPROVED FOR USE AS A P,Pao- / 3 ?jAulA /e6r4Syf'�,SEPARATE APARTMENT OR N .� I DWELLING UNIT cmoMpao � 00 14 f 4megf js�e Oec4e jjQa ) C04s14%a4S ofal Ca VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK N(): 23-046 Certificate of (9ccup ucp Ehis is to certify that 3C Ruel 6y O Ray'i'rer—S 4LLC of, &C)oy—. t\�J having duly filed an application on —Mo-rCo cQ, 20 requesting a Certificate of Occupancy for the premises known as, /0 Jos m/.ne 1a,7e , Rye Brook,NY, located in a Zoning District and shown on the most current Tax Map as Section: `—/. r Block: J Lot: . and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. C)' , issued 9 q 20 JQ, 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" 1 , Construction:_, for the following purposes: U ( uel 11 iln shed b� 'n --)J Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: FINISHED BASEMENT NOT APPROVED FOR USE AS A SEPARATE APARTMENT DWELLING UNIT 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 height shall be made,no the build' a moved from one location to another until a permit to accomplish such change has been o fro ie Builds Ins ctor. Acting Building Inspector,Village of Rye Brook: Date: MAR 2 3 1013 QyE DR �. VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.tyebrook.org TRUSTEES ACTING BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE March 23,2023 SC Rye Brook Partners LLC c/o Warjam Group LTD 4 West Red Oak Lane Suite 325 White Plains,New York 10604 Re: 16 Jasmine Lane, Rye Brook,New York 10573 Parcel ID#: 129.25-1-1.60 This document certifies that the work done under Mechanical Permit #21-086 issued on 6/7/2021 for the installation of a new gas furnace,a new condenser and related ductwork has been satisfactorily completed. Sincerely, Steven E. Fews Acting Building& Fire Inspector /to QyE DR L``ti�o vyy 'j,..v >� 19 W..•��O VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.tyebrook.org TRUSTEES ACTING BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE March 23,2023 SC Rye Brook Partners LLC c/o Warjam Group LTD 4 West Red Oak Lane Suite 325 White Plains,New York 10604 Re: 16 Jasmine Lane, Rye Brook,New York 10573 Parcel ID#: 129.25-1-1.60 Mechanical Permit#20-128 issued on 9/9/2020 for Fire Sprinkler System This certifies that the fire sprinkler system,installed under the above captioned permit,has been satisfactorily completed. Sincerely, 41, Steven E. Fews Acting Building&Fire Inspector /to F 'R!1, MENT For office use only: FMAR 2 2023 BUILDnwG; pMRST PERMrr# - 73 VILL; d OF RYE BROOK ISSUED: — —c10 VILLAGE OF RYE BROOK 938 KING STREET,' LYE BROOK, NE*YORK 10573 DATE: BUILDING DEPARTMENT (914)93=X .Azoote"o"'re 939-5801 FEE:,& ID— PAtoAL 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 sssaasssarsq»sasaassssasasssasasasaraassssssassssarassasssasss►ss►sssssasssrsasssrsssssrssrsssssssssswsssssaasssssrrs Address: l �(YI1l�l �l`�IJIC Occupancy/Use: Parcel ID#: 1?- Zr-. I-U C ry Zone: P WT) Owner: SC Oglt W-DDI- 11909T Wy LU4_ ACd resU P.E./R.A.or Contractor: Slf3jVIkI.OPfVI ACd less k �S Person in responsible charge: w(I'L11441 ""L Ad esrs: K)1411A PtA/NS� 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: w C L I fern j2104 L being duly sworn,deposes and says that he/she resides at (Print Name of Applicant) (No.and Street) in in the County of ite ut> in the State of C T ,that (City/Town Villagc) 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:$ 6 q 3 t 50D t 00 , for the construction or alteration of: IGq m I.Ly -Dlo IIJ A w( 1r1►J Mkb � i/NIwT 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. 1 Sworn to before me this 13 lt Sworn to before me this ,3 day of 20� day or 20 �;L Signature of Pro er Signature of Applicant w l (,U pa N'M k I ti vital tgal ( (- Print Name of Property Owncr Pri Name of Applicant Notary Public otary Public TRISHA M RTINEZ TRISHA MARTINEZ NOTARY PUBLIC-STATE OF NEW YORK NOTARY PUBLIC-STATE OF NEW YORK No.01 MA6331843 No.01 MA6331843 Qualified in Dutchess County Qualified in Dutchess County My Commission Expires 10-19-2023 My Commission Expires 10-19-2023 QyE[3RC�k. w �7 >>/�' 19b2•'��O BUILDING DEPARTMENT )p"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: ' lO S � G -Q DATE: PERMIT# �R, �y ISSUED: �1c� SECT: 1 %LOCK: 1 LOT: '.yO LOCATION: 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 �❑ CROSS CONNECTION ❑ FINAL ❑ OTHER QyE BRC��• 1982. BUILDING DEPARTMENT ❑BUILDING INSPECTOR P kSSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www Uebrook.or - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS: �� DATE: 2�2 PERMIT* 11 y ISSUED: /7-SiCT: BLOCK: LOT: LOCATION: �y �Clr6l I t OCCUPANCY: ❑ VIOLATION NOTED THE WORK IACCEPTED ❑ 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 BRCuk. 1982 BUILDING DEPARTMENT ❑ByILDING INSPECTOR JASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK //❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.aebrook.org - - - - - - - - - - - - - - - - - - -- INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : � 6 rN"Q Lc-- p DATE: l-':o �j PERMIT# 20 - ' �`' ISSUED: SECT: � LOCK: LOT:- LOCATION: �' `� �` �`�- " l OCCUPANCY: \ ❑ VIOLATION NOTED THE WORK IS... ACCTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ��- NSULATION v_0 NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER QyE 4RO BUILDING DEPARTMENT ❑BUILDING INSPECTOR SSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK "U LODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www Uebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - -- --- - - - ADDRESS : DATE: l�� O�I PERMIT LO ISSUED: C� 1C JECT: - BLOCK: LOT: , v�o : LOCATION: +V �\ �� OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ROUGH PLUMBING z ROUGH FRAMING INSULATION rr NATURAL GAS V Q AJO CNU4� C) � , 1 ► ` ` + �' L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER ��� � �G u � � k � � � • § 3 © ) ) 2 � � Cd k n % A u.§ � / Q cd / 2 00 � > 00 y o . \' ` �\ 2� 40, ® \ w .. � e 2 A § «txo § U 2 ? / / � \ P. k 2 0 c BRC�k. � 7982' BUILDING DEPARTMENT ❑BUILDING INSPECTOR 9 ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK If1 CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914)939-0668 FAx (914)939-5801 www.ryebrook.org -- --- - - ----- --- -- INSPECTION REPORT -- - - - - - - - - - --- - -- - - - ADDRESS: 1 S 1 N �^ ' NQ DATE: PERMIT# �'� 2O'1 ISSUED: SECT:. ` 'Z�BLOCK: 1 LOT: LOCATION: �2f OCCUPANCY: i ❑ VIOLATION NOTED THE'WORK IS... LI ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION I REQUIRED .EY2 FOOTING C-7,t ,�-Cco ❑ 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�k, O� tim 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 Uebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS: ` `� �`c�� \ 1� Uc-- C 'F DATE: Z I -Z'2h-ca I (� -�' `—' PERMIT# � 20 � S ISSUED: Q� cam' SECT: R�•7 a BLOCK: LOT: LOCATION: A c; 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 ❑ CROSS CONNECTION ❑ FINAL -THER E BRC��• • 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: , PERMIT 2 V - t--)3 ISSUED: SECT: LOCK: + LOT: LOCATION: C� C V� ` \l OCCUPANCY: �I ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING0 INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL OTHER QyE BRC��, 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 Uebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - --- - - - - ADDRESS . ' �J- 5�� DATE: I Z b2 I LOT: �� PERMIT# Zo ' ` ISSUED: �U SECT: BLOCK:_ _ LOCATION: �� ` ' Zp J q �2_ 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 ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL OTHER �E BRC��, Q�j/� Fo BUILDING DEPARTMENT ❑BUILDING INSPECTOR 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: PERMIT# ` ISSUED: T: �--U BLOCK: LOT:�_t_ C_1_ LOCATION: �e �-C tiSl LJ� OCCUPANCY: _ ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION Y REQUIRED ❑,;TOOTING ` ti v 6 6 FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING d- ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER i G f: �yE BRC��, O� 2m • 1932 BUILDING DEPARTMENT UILDING INSPECTOR 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.ry�brook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - ADDRESS: ` f" ` L(a,&E: PERMIT# 62 0 ISSUED: SECT: BLOCK: LOT: l LOCATION: (v OCCUPANCY: t ❑ VIOLATION NOTED THE WORK IS... ACCEPTE�j ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE I ❑ FOUNDATION q�UNDERGROUND PLUMBING ` NniES ON INSPECT N: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER QyE DRC�k. O� Z� 1982 BUILDING DEPARTMENT ❑B ILDING INSPECTOR 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.rygbrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - -- - - - - - - - - - - - - - ADDRESS: \ (") --Y �,K ZS A , t�_S2 Lr,(Vl DATE: I 1 y I PERMIT#, C� , ��r ISSUED: 1 � S&T: 1 (.Z BLOCK: LOT: Ic LOCATION: 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 ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER QyE BRC�k, O�` tim cu � 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 Uebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - -- - - - - - - - - - - - - ADDRESS:— DATE: -VI 2-0 PERMIT# ISSUED:��� N SECT: BLOCK: LOT: LOCATION: ON "` ' OCCUPANCY: C ,6 ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING R 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 r I w, QyE BR(�k. 1932 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK [I CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www.Uebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS :— I DATE: `0��d�0-6 T, 2 PERMIT ?C 1 ISSUED: ` JECT: `� BLOCK: ` LOT: v LOCATION: i"-'6 ` < < OCCUPANCY: 1 ❑ 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 ` ►'bV �1/h C'� ��o _r i e ❑ L.P.GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER �E BRC�jk, O�` tim BUILDING DEPARTMENT ❑B ING 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 DATE: ( l - I PERMIT# ISSUED: �ECT:��ZBLOCK: ' LOT: LOCATION: OCCUPANCY: l ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ Sl*nNSPECTION 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 t 10 O N O ry l!'i z N N O N � z tn tn +� oc a. 0-0 co O a U A i w W r c ,,.,., a, M ✓ Q woo. O Q Q z C4 00too x of "7 U O w z o: ran a tvt;i: =$ BUILDING DEPARTMENT VILLAGE OF RYE`BROOK DEC 3 0 2020 938 KING.STREET RYE BROOK,NY 10573 (914)939-0668 FAx:(C944,')939-5801 www.ryebro.ok.org ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: 20 ._ / 7 3 EP#: tQ 1^00 T Approval Date: J AN - 2021 Application Fee: $ Approval Signature: IJAY Permit Fee: $ Disapproved: Other: (fees are non-refundable) Application dated, s hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/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: 14 _f{S 17/A)C L44,de SBL: 2— 9.o?S-/ — C Zone: F U D 2.Property Owner: SC Rye Brook Partners, LLC Address: 5 International Drive Suite 114 Rye Brook, NY 10573 Phone#: 914-481-1531 Cell#: email: 3.Master Electrician: Denis M. Fortino Address: PO Box 713 Rye, New York 10573 Lic.#: E-51 Phone#: 914-760-5226 Cell#: 914-760-5226 email: dfortino@enterpriseelec.com Company Name: Enterprise Electrical Consulting Address: PO Box 713 Rye, NY 10573 4.Proposed Electrical Work/Fixture Count: uj 1 /Z/ G Ty 9 AJ(--bj >'4t;vse� /o© STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Denis M. Fortino being duly sworn,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 Electrical Contractor for the legal owner and is duly authorized to make and file this application. tindicate architect,contractor.agent.attorney,etc.) The undersigned further states 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 o90th Sworn to fore me is 20 day of 20 QQ day of ct er JAP20 Signature of Property Owner S' ure of Applicant Del is M. Fortino Print Name of Property Owner rint ame of Applic ... . . aor C'G% Notary Public of Public _ ;ReQ 4t7r'je, 6?e�i0 N N� . 11 o M.Fkp NT - s vj".A 2p?1Z_ `' Wettchester Rockland Electrical Inspection Services, Inc. r Phone: 914-347-3595 DO NOT WRITE HERE-FOR OFFICE USE ONLY Fax: 914-347-3596 43 North Lawn Avenue Elmsford, NY 10523 BUILDING PERMIT NO. TEMP# DATE CITY OR VILLAGE ZIP CODE TOWNSHIP COUr STREET AND,LNO.Oq ROAD/ POLE NUMBER ► BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT OCCUPANT'S NAME BUILDING OCCUPANCY OWNER'S NAME AND ADDRESS / I HOME TELEPHONE NUMBER 7 / lz 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 OUTSIDE ' BASEMENT 1'FL. 2-FL. 3 FL. REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: 2iItA, 15A 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 APPUCATIONS 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 CHARACTER OF WORK NEW;] ADDITIONAL❑ EXPOSED❑ CONCEALED EI MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD[, UNDERGROUND G L" I I I I 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 Zvi 9 ��X�� - - C X_ 7AD TELEPHONE NO. / va' 713 �- y ,/ 17�/41 LICENSE NO.WHEN APPLICABLE ,`�/ WESTCHESTER ROCKLANO 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: Enterprise Electric Inc SC Rye Brook Partners LLC 254 Sylvan Lake Road NY, Hopewell Junction 12533 Located at: 16 Jasmine Lane Rye Brook, NY 10573 Certificate Number: 1033446 Section: 129.25 Block: 1 Lot: 1.60 BDC: Permit Number: EP:21-004-BP:20-173 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: 16 Jasmine Lane Rye Brook,NY 10573 Basement 12 list 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 03/08/22 Name Type Quantity Receptacle Convenience ------- 78 Switch Single Pole ------- 98 Fixture-Luminaire Incandescent ------- 12 Fixture-Luminaire Undercabinet ------- 3 Fixture-Luminaire Recessed ------- 45 Cook Top ------- 1 Dishwasher ------- 1 Exhaust Fan ------- 6 Furnace Gas or Oil ------- 2 Electric Room Heaters ------- 1 Bell Transformer ------- 1 Dimmers Led ------- 23 Service Disconnect ------- 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. This certificate is valid for work performed before date of inspection only. YYY 41 Ift WESTCHESTER 71 ROCKLAND INEI;)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: Enterprise Electric Inc SC Rye Brook Partners LLC 254 Sylvan Lake Road NY, Hopewell Junction 12533 Located at: 16 Jasmine Lane Rye Brook, NY 10573 Certificate Number: 1033446 Section: 129.25 Block: 1 Lot: 1.60 BDC: Permit Number: EP:21-004-BP:20-173 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: 16 Jasmine Lane 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 03/08/22 Name Type Quantity Hot Water Heater ------- 1 Cable Homeruns ------- 5 Phone Lines ------- 4 A/C Unit ------- 2 Air Handler ------- 2 Sump Pump ------- 1 Panel 225 amps 1 Receptacle GFCI ------- 14 Smoke Detector ------- 4 Carbon Monoxide Detector ------- 5 Microwave ------- 1 Refrigerator ------- 1 Disposal ------- 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. 7��G 'L I This certificate is valid for work performed before date of inspection only. WESTCHESTER ROCKLAND ME 11)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: Enterprise Electric Inc SC Rye Brook Partners LLC 254 Sylvan Lake Road NY, Hopewell Junction 12533 Located at: 16 Jasmine Lane Rye Brook, NY 10573 Certificate Number: 1033446 Section: 129.25 Block: 1 Lot: 1.60 BDC: Permit Number: EP:21-004-BP:20-173 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: 16 Jasmine Lane Rye Brook,NY 10573 Basement 1st Floor i 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 03/08/22 Name Type Quantity This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. L 'L This certificate is valid for work performed before date of inspection only. N N F�i7 • a w N ��. � oc co 0 UJ LIJ Mcl, I Qr ~ C Z G c � E- _ i : D EC EHE ,��t4 -roc ; NOV 17 2020 ,_ .`•,. BUIL 'tNG-6EPAI2 IMENT VIL �` RYE�' 0OK ^� VILLAGE OF RYE BROOK L'' E OF ��2 I��,�,,h }t--1 BUILDING DEPARTMENT 938 KING` &ET RYC BRO`-.It,NY 10573 (914)9390668t 939-5801 wMvAweb-1•d.o ore PLUMBING PERMIT APPLICATION FOR OFFICE USE ON%V BP#: 0� y 1 73 PP#: O�V I3 I IV 1 9 2020 / n'!2"6 Approval Date: Permit Fee: S Approval Signature: Other: Disapproved: (fees are non-refundable) xk i<•J,c*o$k ic;c*hoc><***:kT"**xx:k>,ex�:k:<:k*** x�'-Rx%isKt:k��F:k:k:k:look:kti:k k i:•;e•i:<k:k#cka::k•:,:�:Fa:is�*XxY:k%r':k ak�c�Y%F x:k:k:k'.;.•%kxMi�a�.F k sc:k N Application dated, I I7 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 11 be in conformance with all applicable Federal,State,County and Local Codes. /� 1.Address: 6 WM(rw kr I SBL: /O 9•a 5/—/- 4PO Zone:PU D 2.Proposed Work: OjumbMq �6Y.new i n m64 djuYIN'nan -S (yk-el'1l 3.Property Owner: �,c fW f, bfOO (7�4 lea CLC Address: LA we j+ (; .I( Lane r ye-#�g 5 Phone#: `'11H._161 - Q-600 Cell#: G���'�a�y`5® email: ,��caSrt►Y��iO�hnCaY7�i�P(o%a1. 4.Master Plumber: -?t~o\ Address: + Lie.#: gJed Phone#: - Cell#:�lS-'8'—&6C1 email: ih(,o cmiflu, b'` c • ?M. Company Name: 10C��rj) = �( ltt J Address:J'OlCA KA 1 M `�a�` � Hnr��t�. Y�1�iI cl-so INDICATE FIXTURES& LINES TO BE INSTALLED AS PER TIME 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 r t +'� I st Floor 2ndFloor LA 1 \ I d1 3,d Floor t' 4'h Floor -- 5w Floor -- --- - Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -I- 321/19 �d STATE OF NEW YORK,COUNTY OF WESTCEESTER ) as: �/� �f/LVJ ,being duly sworn,deposes and states that he/she is the applicant above named, (print name or individual signing as theme applica—nt) and further states that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the &Vm 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 day of L c ,20 a 0 day of � 0�0Signatu f erty Owner Si atu tJk2 J'6r"- n b-ao ( s �a'U ras 1L� Print Name of Property Owner Print Name of Applicant Notary Public ABoyd NotaryPu l9 PUbk,Sty of NW York Na©l;l166307 is Gouty CommWm Fate May 21,Z C);-3 This application must be properly complete tl in its entirety and must include the r..e��•�t�x�.��t�,r yam. 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. WENDY J ABBAGLIATO NOTARY PUBLIC-STATE OF NEW YORK No.01AB6378708 Qualified In Orange County My Commission Expires 07,30-2022 -2- 3P_1119 D ECEMED B>L_.r>r><>D.>r TMENT NOV 17 2020 VIL�'AGI OF R �.HR,OOK VILLAGE OF RYE BROOK , ' �I` 938 KtrrccT RYL BRoroK,NY 10573 BUILDING DEPARTMENT (914) 939 46, (9,14J 39-5801 �i,._ ir1��ay.ry.e&_ooli:or6 AFFIDAVIT OF COMPLIANCE VILLAGE CODE �21E ° 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 YORK, COUNTY OF WESTCHESTER ) as: n/�� (� I br<3 , residing 0 at, `� - l�� --- 'ayay (Print name) (Address where 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 it; F� J og m we Lay-.-k , 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 fi•om the subject property in accordance with all State, County and Village Codes. (signature o rop wner(s)) �boe.,i 5 Print-t��mzoF-Propert}�Oi�•ner(s)) - - - Sworn to before me this 3 s " day of Cl-L'_ C (Notary Public) Christine A Boyd Notuy Public,Stag of New York No.OIW6166307 in Vinkhester Cmty _ 3 Commission Eames May 21, 3/21/19 CD N rt 0 N N y s t 3 N N N a F O u CIL V t0 u t C6 u � 60 (� ►"� : CL > ` ICI A_ N wo > " E y • E • O 00 � � � .'' O vpo .o � � o o V WINC z R -Bim 000 ICI Qr .� O 'E* u u tj z s F 72 o �, � u < � u c •� a a.� � F N d9 x i >R E 'E w f J Cw W HOC € vO> u � _ o 0 Qm OI+rr _ - a e s a = a a _ : C�C� L� OMC� BUILDING DEPARTMENT R VILLAGE OF RYE BROOK SCP 9 2020 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 FAx(914)939-5801 VILLAGE OF RYE BROOK BUILDING DEPARTMENT www.ryebrook.or . APPLICATION TO INSTALL FIRE SUPPRESSION / FIRE SPRINKLER SYSTEM FOR OFFICE USE ONLY: nn II\\ Approval Date: SEP — 9 ZOZ�P#: V� ��� �1P#: a0l �-73 Application Fee:$_75'ry Approval Signature: Permit Fees:$ C;)C)/ Disapproved: Other: ►+e,►+rx+tr+r,r+r�.****************,r***********,r,e*w***,r,r:***,t,r**,►*,►*:*******************************,r****,.�::****,r Application dated: Ci - a- a0 is hereby made to the Building Inspector of the Village of Rye Brook NY for the issuance of a Permit to install or modify a Fire Suppression/Fire Sprinkler System as per detailed statement described below. I. Job Address: 1 (o 71—osyyiin e— Lame f 2JL E�y-mlC, W 2. Parcel I.D.: 14q_r ' 1 - (p0 Zone: pU D 3. Proposed Work(Describe system in detail including suppression agent): I 4. Number&Types of Fire Sprinkler Heads: HS- 5. N.Y State Construction Classification: 4_3 N.Y.State Use Classification: -F2 6. Estimated Value of Job:$ /3)NOD (Value shall include all labor,materials,fixed equipment,professional fees,and materials and labor which may be donated gratis.) 7. Property Owner: W- 1�,,• 13roelt: 1�,er-4-,nex3 Address: Phone#tla �e - S(,ZIa Cell# email: Applicant:r/1AgLu- P,r a pr akcA=Vrovl Address: IS \ Q;T 064 S Phone#(°a 6a '$053 Cell# r&z))aq3 - "LA 11 email: f.4��nA►�3eL�j.�4�1L-+;ca .env✓\ Architect/Engineer: R. Address: S aoi- M iin acm . t_... V bZt1� Phone#- G1:3:��5 a3— $a�Cell# emati:�n. Q General Contractor: 2 ow., Address: Atyeh,31C . P,"V nq,UY Q%Lj Phone#(64S) 8 S 5-94 00 Cell# email: 1 1/30/2020 FIRE SUPPRESSION / FIRE SPRINKLER INSTRUCTIONS& PROCEDURES BUILDING DEPARTMENT VILLAGE OF RYE BROOK 938 KnvG STREET,RYE BROOK,NY 10573 PHONE(914)939-0668 FAx(914)939-5801 www.ryebrook.orQ DO NOT START CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR. THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12% OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 &A MAXIMUM OF$6,000.00 APPLICANT'S INITIAL SUBMISSION TO THE BUILDING DEPARTMENT MUST INCLUDE: 1. A properly completed application with notarized signatures where indicated. 2. Application filing fee: Residential= $75.00/ Commercial= $250.00 (Application fees are non-refundable) 3. Full payment of the building permit fee; Residential= $15.00 / $1,000.00 of Construction Cost with a minimum fee of$100.00. Commercial= $25.00 / $1,000.00 of Construction Cost with a minimum fee of$275.00. 4. One full size set and one scaled 11"x 17"copies of sealed design drawings prepared by a NY State Licensed Professional Engineer(maximum allowable plan size=36"x 42") 5. If the Fire Sprinkler System is being installed by a Plumber,the Plumber must file for a separate Plumbing Permit and provide a copy of his Westchester County Master Plumber's License to the Building Department. 6. All RPZ or Back Flow Prevention devices associated with the installation of a Fire Sprinkler System must be approved by the Westchester County Department of Health. It is the responsibility of the applicant, owner, installer or person in responsible charge to notify the Building Department(48 hour advance notice)to schedule any and all required inspections. Prior to the Building Department conducting a final inspection of the system, the applicant must submit an approval affidavit from the Westchester County Department of Health, an Application for a Certificate of Compliance and pay the requisite fee. Please keep these instruction sheets throughout the duration of the job for reference. 6/1/2020 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. Please note that application fees are non-refundable. 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 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 Sa day of , 20 day of 3 , 20 z o Signature of Property Owner i ofArplicant Print Name of Property Owner Print of Applicant Notary Public Notary Pu i MICHAEL SILVA NOTAR y PUBLIC MY COMMISSION EXPIRES OCT.31,2022 2 1/30/2020 �D O O x � N � N Nrs 3 y 14 005 F C _ 2 -5 `w C d m � 15 p. � Gil �"� � 3 •v •� .o ' r b' �y► ' Doc O/ rZ, � s � b � •u � s � � � .�C O � z � � � O C s •C W l / O Ono ' H� f'+ � � rr O � •v � �� � � �I i: aim MAI gz v-0 f, �A o - .8 1 CO2 1 w ON 8 O F.. 00 � .. W " �p Z, W ZONO �, O M■�I U f G Y ID e = Jos Z C4 O V " < uyEu � i CEE u w ►� z Zr Z Z u U08 � o .�r = O ►--i o c e $ E g Q h U U a EE A H �p v F■ w V � 0 �. .^ � � � G W Z G BUILDS .� RTMENT D (� cq VILE, E OF RYOOK ID 938 KING ET RYE BR��_G,NY 10573 JUN — 1 2021 (914)90# 1 9 39-5801 0 o VILLAGE OF RYE BROOK BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY:dUN — 8 1011 PERMIT#: _H P oQ)'0&(0 , Approval Date: Permit Fee:$ '�Do 0 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(Form#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, 7 I A&9/ 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. / 1. Address: I tP J s 1" ` e7 c LA-1 e SBL: (a q S " 14 W Zone: 2. Property Owner: (R �� &6 t k Address: Phone#: Cell#: email: 3. Contractor: 7141 CO M r. If Address: �D fA X 3 S CI ffi j1 n Al� I2Sy 7 Phone#: 0 3 - 3 - t 7 r e _Cell#: email: aJ qor l 4. Applicant: b 00( t� 1 Address: Phone#: a0 9 '� S —6 '76 Cell#: email: 5. Scope of Work:New Installation( PeReplacement( ) Removal(�)^ Other( Ca ): 6. List Equipment: l d I"' 7. Location of Equipment: &/(M, 8. Method of InstallatiorWemoval(list all equipment needed to perform job): 1 3/21/19 STATE OF NEW Y RK,COUNTY OF WESTCHESTER ) as: a c ,�A A(1� A being duly sworn,deposes and states that he/she is the applicant above named, (print name of individuaTsigning 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. j 1'- Sworn to before me this Sworn to before me this day of ,20 day of yn 120 Signature of Property Owner Signatur of Appl' t Print Name of Property Owner Print Name of Applicant TRISHA MARTINEZ Notary Public NOTARY PUBLIC-STATE OF NEW YONbtarypublic No.01 MA6331843 Qualified in Dutchess County My Commission Expires 10-19-2023 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 N9MSE Product Specifications HEATING& COOLING PRODUCTS Ur to 96% AFUE, Single Stage, PSC Gas Furnace EA Ur TO SELL • Up to 96%AFUE in upflow and horizontal positions. Up to 95%AFUE in downflow positions • Cabinet air leakage less than 2.0%at 1.0 in.W.C. and cabinet air leakage less than 1.4% at 0.5 in.W.C. when tested in accordance with ASHRAE standard 193 • Approved for Twinning applications(0601410 through 1202420) with accessory(order separately) • Approved for Manufactured Housing/Mobile Home applications (0401410 through 1202420)with accessory (order separately) • Low NOx units are designed for California installations and meet 40 ng/J NOx emissions. Can be installed in air quality management districts with a 40 ng/J NOx emissions requirement. TOUGHER • Flame roll-out sensors standard • Adjustable heating blower OFF delay • Factory set blower ON delay • RPJ` primary heat exchanger • Stainless steel secondary heat exchanger Illustrations and photographs are My representative • High temperature limit control prevents overheating Some product models may vary • Direct ignition with Silicon Nitride ignitor iHi h uaflt�,corrosion-resistant, prepainted steel cabinet WARNING AI�R TO INSTALL AND SERVICE • Direct vent(2-pipe), single-pipe venting or ventilated combustion Failure to follow this warning could result in personal injury, air death,and/or property damage. • 24 VAC humidifier terminal&electronic air cleaner terminal This furnace is not designed for use in recreation vehicles or • 35" (889mm) high,for ease of installation outdoors. This furnace is designed for use in manufactured • Simplified,factory installed internal condensate drain system (Mobile)homes when an optional Mobile Home accessory kit is door removal and secure installed. • Innovative knobs for easy Failure to follow this warning could result in personal injury, attachment death,and/or property damage. • Factory shipped for natural gas,with propane gas conversion kits available • Four position- upflow/downflow/horizontal (left/right) installation Elf • At least twelve different venting configurations • Through the casing flue pipe for counterflow or horizontal nnu-Ul—E-qq(11FUE1applications with accessory(order separately) • Concentric vent available rt Tr • Seff diagnostics with super bright LED • Slide out heat exchanger and blower assembly LIMITED WARRANTY-, 1 78% 82% or. 97% � . • 20 heat exchanger limited warranty �►,� • 5 year parts limited warranty With timely registration, an additional 5 year parts limited % a. , CERTIFIED rinwarranty " For residential applications only. See warranty certificate for complete details and restrictions including warranty coverage for Use or the AMRI caroa.e TM►lam,,,xmm a manulacturer 6c 5 pwLcoet m tiro popram For , other applications. vertbcatwn•r corvato �,ndnnduv p oduM go to a<W'fscror,o,g Efficiency AFUE Cooling Capacity Input CFM range Dimensions H x W x D Shipping Wt. Model Number (MBTUH) Upflow/Hz Downflow @.5 in.w.c.(125 pa) Inches(Millimeters) Lbs(Kg) N9MSE0261408A 745—,000 96.0% 95.0% 400-775 35 x 14-3/16 x 29-1/2(889 x 361 x 120(54) 9 0401410 40,000 96.0 95.0 625.905 35 x 14 1 x 1 (889 x 361 x 7 ) 123(55) NgMSE040171 40.000 96.0% 95.0% 650-1050 35 x 1 - x -1 2 889 x 445 x 750) 1 ( 1 N9MSED601410 .000 9 . 9 .0% 6 5-1130 35 x 14 /16 x -1/2(889 x 361 x 750) --IT7—(-57T— N9MSE0601714A 60,000 96.0% 95.0% 650-1420 35 x 1 -1 x 29-1/2(889 x 445 x 144(65 9 0801 16 80.000 96.0% 95. 810-1600 35 x 17- /2 x -1/2(889 x 445 x 750) 154(69) N9MS 0802120A 80.000 96.0% 95.0% 1335.1970 35 x 21 x 29-1/2(889 x 533 x 750) 162(73) 9 1 114 100.000 96.0% 95.0% 915-1545 35 x 21 x 29-1/2(889 x 533 x 750) 169 76) 9 1002120 100.000 96.0% 95.0 1345-2065 x 2 1 x -1/2(889 x 533 x 750) 169(76) 9 SE1202420A 1 120.000 1 96.0% 95.0% 1320- 10 x -1 x -1 x 622 x 186(84) 9 1402420 140.000 1 96.0% 94.4% 1290-2035 35 x x 29-112(889 x 622 x 190( ) Specifications are subject to change wthournotice. 440 11 4403 05 12/3/18 NXA6 Performance Series HEATING& COOLING PRODUCTS Product Specifications HIGH EFFICIENCY 16 SEER AIR CONDITIONER ENVIRONMENTALLY BALANCED R-410A REFRIGERANT 11/2 THRU 5 TONS SPLIT SYSTEM .. A r 208 / 230 Volt, 1-phase, 60 Hz +• , REFRIGERATION CIRCUIT •Scroll compressors on select models •Filter-Drier supplied with every unit for field installation •Copper tube/aluminum fin coil EASY TO INSTALL AND SERVICE .• • Easy Access service valves on all models • External high and low refrigerant service ports • Only two screws to access control panel • Factory charged with R-410A refrigerant BUILT TO LAST • Baked-on powder coat finish over galvanized steel • Post-painted (black) coil fins •Coated, weather-resistant cabinet screws • Coated inlet grille with 3/8" (10mm) spacing for extra protection LIMITED WARRANTY* ^ �E°ERGY svw item t r wwW to • 5 year compressor limited warranty mn �feftig arge��arr„a HUAVM ' to adveve rat•o capeaty and 904swK,y. inswlaon of 5 year parts limited warranty (including compressor and th6 pro&jd VWd follow the 's retngerant coil) Gtaryng and air Now vstn.Aobons. Fadure to oonfmn proper cNi ge and airlbw may reduce energy efficiency -With timely registration, an additional 5 year parts limited acid shorts'ecpipnwK We warranty (including compressor and coil) * For owner occupied, residential applications only. See warranty certificate for complete details and , C �` US restrictions, including warranty for other applications. LISTED Use of the AHRI Cerfi ied Tb1 Mask indicates a manufacturer s oart,apat or r .,,og•an) F or 'erd,cat,on or can;fCX 0- C..a xocucts go to w ahn^rectory a' Model Size Nominal Min. Circuit Max. Fuse Operating Dimensions Ship/Operating Number (tons) BTU/hr Ampacity or Breaker height x width x depth in. (mm) Weight lbs.(kg) NXA618GKA 1 18,000 11 8 20 28-11/16 x 25-3/4 x 25-3/4 154/ 125 (729 x 654 x 654) (70/57) NXA624GKA 2 24,000 17.7 30 28-5/16 x 31-3/16 x 31-3/16 147/ 183 (719 x 792 x 792) (83/67) NXA630GKA 2' 30,000 16.8 25 32-5/16 x 31-3/16 x 31-3/16 188/ 153 (821 x 792 x 792) (85/69) NXA636GKB 3 36,000 17.5 30 28-5/16 x 35 x 35 204/ 165 (719 x 889 x 889) (93/75) NXA642GKA 31/2 42,000 23.6 40 39-1/8 x 35 x 35 254/213 (994 x 889 x 889) (115/96) NXA648GKA 4 48,000 26.1 40 39-1/8 x 35 x 35 317/264 (994 x 889 x 889) (144/120) NXA660GKB 5 60,000 32A 50 45-11i16 x 35 x 35 318/280 (1161 x 889 x 889) (144/127) $pecrRCabons subject to change wdhout notice 421 11 6201 05 5/17/19 ester p EC ENE • o�rcom AUG 13 2021 George Latimer VILLAGE OF RYE BROOK County Executive BUILDING DEPARTMENT Sherlita Auld-,MD Conuni,,siuner of Health August 2, 2021 Russell Palucci, P.E. 140 Princeton Drive Shelton, CT 06484 RE: Log #: 13340-21-DCDA Application for Backflow Prevention Device Kingfield Development 16 Jasmine Lane Rye Brook Dear Mr. Palucci: The plans and specifications for the above project have been reviewed and approved by this office pursuant to the provisions of Chapter 873, Article VII, Section 873.707.1 of the Laws of Westchester and Section 5-1.31, Subpart 5-1, of Part 5 of the New York State Sanitary Code. A Certificate of Approval is attached. Form NYSDOH-1013 is to be utilized as a Request for Completed Works Approval. This form can be downloaded from the following link: https://health.westchestergov.com/images/stories/pdfs/crossconnection doh1013.pdf . NYSDOH- 1013 consists of two parts: (A) the initial test of the device(s) by a certified backflow prevention device tester, and (B) a certification by a Professional Engineer or Registered Architect, licensed and registered in the State of New York that installation is in accordance with the approved plans. The completed NYSDOH-1013 must be sent to our Department within 45 days of installation of the device(s). This form can be emailed to DOH-BFlowoa westchestergov.com . Respectfully, Delroy Taylor, Assistant Commissioner Bureau of Environmental Quality DT/RB:pm cc: Jeff Dubois — SC Rye Brook Partners, LLC Frank McGlynn, Manager— Suez Water Michael Izzo, Bldg. Insp. — Rye Brook ✓ File • +. a - USE 001- RECYCLE Department of Health 25 Moore Avenue Mount Kisco,NY 10549 'Telephone: (911)801-7296 Fax: (91I)813-1691 NEW YORK STATE DEPARTMENT OF HEALTH CERTIFICATE OF APPROVAL FOR BACKFLOW PREVENTION DEVICES This approval is issued under the provisions of 10 NYCRR, Part 5, Section 5-1.31, and Chapter 873, Article VII, Section 873.707.1 of the Laws of Westchester County. Log No. 13340-21-DCDA Facility: Kingfield Development City, Village, Town: County: 16 Jasmine Lane Rye Brook WESTCHESTER Owner's Mailing Address: Jeff Dubois SC Rye Brook Partners LLC 4 West Red Oak Lane-Suite 325 White Plains, NY 10604 Physical Location of Backflow Prevention Device(s): Dog House Description of Device(s): One 1 —2 inch Wilkins 950XLTDABF (DCDA Water Supplier: Suez Water Name Designated Representative: Frank McGlynn. Mailing Address: Zip: 10801 2525 Palmer Avenue, Suite 3, New Rochelle, NY Conditions of Approval: A. THAT the device(s) shall be installed within 90 days, and that within 45 days of installation the attached New York State Department of Health Form DOH-1013 shall be completed and returned to the water supplier and the Westchester County Department of Health. P. TH T a certified hor L- lr%%A prevention device fader tact the ahQVe hai-4firmAt rnre Mention device(s) at least yearly and report the results to the water purveyor indicated above. C. THAT any connection made prior to the backflow prevention device(s) shall render this approval void. D. THAT the proposed works be constructed in conformance with plans and specifications approved this day and any amendments thereto. E. THAT certification that installation of device(s) is in accordance with the approved plans, Form NYSDOH-1013, Part B, must be completed by a Professional Engineer or Registered Architect, licensed bnu registered in-the State of New York. F. THAT the approved device(s) shall be so set that the test cocks are faced for easy access. G. THAT if facility construction has not commenced within 90 days of the issuance of this Certificate of Approval, then this Certificate shall become null and void unless an extension to the 90 day installation period is secured from the Westchester County Department of Health by the facility owner. Designated Representative iCCI ip:n F(1R THE STATE CORAKAISSIONIER OF HEALTH BY: DATE: August 2, 2021 Del�r�oy Taylor, P.E. Assistant Commissioner MAR - 2 2023 1 ID VEN YORK ST,irE DF. 1'H 3uMdU &,vim Jf Slat- licOtero -;,.r:,y VILLAGE OF RYE BROOK eport on Test and Maintenance emprr Slab plaza-Corning Towyr Zoom' t= BUILDING DEPARTMENT Albany,-MY 12237 TMENTof Backflow Prevention Device pie300 uss a separalbe form for each devics. For the year Initial Se,:-:w"C4+re p•q.:. n , 'i ! � .L:neat�•i.J/llt7l9f9?!r.`A N'rj i �i51[c water 3uooly � A�,o;e�t Na. � �a'N block F adF y Max" 1N,•ti y j F. j 4 Lactation of�aa+ce sheet city �p Type I�p� �1 h �On inches) Sarfaf Number Check V-ANOw_1 Cbo*VahtiMo.2 Dttiaraetw1PmswxwRwW J L2nePrvssette�iKi valve, Test leaked _eai d 0 Date twe6re �yw-+g'tt Opened at psid rr _C�o-sgst Sight-�-, 0 3 n j! D- 1 treasure drop across first aheck valve D Y ps+d W Rsecrlbe repels and Repaired by ""*wrtete Name used tx it Date repaired. � mmm M 0 y Feat fast Closed tight Closed tight �f Opened at psid C� 03 Pressure drop across first `_to fJ«l 11 0 Y cheat valve�•7 paid Water Meter Number I Meter Reading Type of Services Gone) 9 Dcmat;V6 9 Rr@ '9 Cther Ramark9(Desonbe deficiencies:bypas3e&outlets before the davice,connections between the device and poh,t at.antry missing m inadequaw argaps.etc-) II 1 �^ Gentficattom This device L� meets, doea NOT meet,the requirements of an a tabl �ntain �Idevlco at the time of testing I beret t e "' teregan;data to be co lect tJ t�tS �F-�.5 ) r 3 Co,thad Tearer Ne. Slg Expinirtlon Date Property owner-e(w owners agent)cerifticcation that test was performed: Prim r4 m Title t Telephone Certtficetlon that installation Is in accordance,with the approved plan& /� (Te 1)e aomphaea by the design er4noer or archiiaci w wler auFpiier•) t hweby corky that this ireulation is In accort)arce with the approved plan& Name Russell Palucci Tme Ergineer � t Z �17oM Los A ucense Number 78721-1 Phone 1845 )327-6040 m d y 0— Repreaanting nme SCILVcnS. LLU onst ng tngrneers iJeedr)be minor inetallaSon d,angm Add. Princeton Drive city Shefton State CT 7Sp 06484 ` Sign" an0 aWa copy b gn nesll deparbnanl mpraeon:w-e ano one copy la Ulu water supp,ar wl ,n days tl :no a9 ng Caviop. Ndidy Owns!and W81Cr Wppllar,mRlotllete ly A tlevlGe!see tali area ropaln rennet:mmetlblaly be made. 0014- 1013(9191) Envelope Leakage Test R [E C [ �� Testing Company: Technician: MAR - 2 2023 Name: ProChek Name: Frank laconetti Address: 100 Mill Plain Rd Credentials: BPI I VILLAGE OF RYE BROOK Danbury, CT 06811 Email: info@prochek.conpUILDING DEPARTMENT Phone: 800-338-5050 www.prochek.com Building Information: Customer Information: Project ID: 3475-16 Jasmine Ln Rye Brook NY Name: Address: 16 Jasmine Ln Address: 16 Jasmine Ln Rye Brook, New York 10573 Rye Brook, New York 10573 Geo-Tag Data: Latitude: 41.048592 Longitude: -73.693930 Timestamp: 2022-06-20 09:07:26 Measured Leakage: 1.65 ACH50 Leakage Target: 3.00 ACH50 Compliance with Leakage Target: Pass Test ID: 3475-16 Jasmine Ln Rye Brook NY Purpose of Test: IECC 12/15 Env. Leakage Measured CFM50: 1,196.9 (+/- 3.2%) Effective Leakage Area: 62.9 in Building Volume: 43,397.0 ft3 Enclosure Surface Area: 4,726.0 ft2 Coefficient (C): 87.7 (+/- 23.9%) Exponent (n): 0.668 (+/- 0.066) Correlation Coefficient: 0.99516 Test Standard: ASTM E779 (single mode) Test Mode: Depressurize Test Characteristics: Pre Indoor Temp: 68 °F Post Indoor Temp: 68 °F Pre Outdoor Temp: 65 °F Post Outdoor Temp: 65 °F Altitude: 189.0 ft Time Average Period: 10 seconds Test Date and Time: 2022-06-20 09:14:36 2000 • Depressurize — w 1 En 800 Y 700 a 600 0 500 c 0 400 00 300 200 4 5 6 7 8 910 20 30 40 50 60 70 Building Pressure(Pa) Envelope Leakage Test Test Readings: Target (Pa). Bldg_(Pa). Adj Bldg_(Pa). Fan (Pa). Flow (cfm). Config Baseline -1.2 -60.0 -61.5 -60.3 -57.0 1,365.1 Ring A -54.0 -54.9 -53.6 -46.7 1,238.0 Ring A -48.0 -51.0 -49.8 -40.6 1,157.3 Ring A -42.0 -42.2 -41.0 -34.7 1,071.9 Ring A -36.0 -37.2 -36.0 -30.0 998.6 Ring A -30.0 -30.5 -29.3 -212.8 863.8 Ring B -24.0 -25.9 -24.6 -161.4 753.3 Ring B -18.0 -19.9 -18.7 -102.8 602.5 Ring B Baseline -1.2 Test Equipment: Flow Device: Model 3 110V Fan Pressure Gauge: DG1000 Serial #: 6006 Calibration Date: 2020-07-01 Deviations from Standard: • None Comments: None Report by TEC Auto Test 1.8.0 (206), © 2021 The Energy Conservatory, Inc. Page 2 of 2 i D �' MAR - 2 2023 r L_ VILLAGE OF RYE BROOK _BUILDING DEPARTMENT 16 Jasmine Lane Rye Brook NY 2015 IECC Energy Efficiency Certificate Insulation Rating R-Value Above-Grade Wall 19.00 Below-Grade Wall 14.00 Floor 30.00 Ceiling / Roof 38.00 Ductwork (unconditioned spaces): R8 Glass & Door Rating U-Factor SHGC Window 0.29 0.30 Door 0.30 0.30 CoolingHeating & Heating System: H.il#N4MS 1002120A 955% Cooling System: Heil 4 Ton#NXa648GKA 16 SEER Water Heater: Model VSCE32 119R 119 Gallon Electric Name: Jobe Leonard Date: 2l19N9 Comments \ Building Permit Check List&Zoning Analysis Address: l G J A S t SBL: l 2S 7 I — l G Zone: Use: Z(o Const.Type: Other. Submittal Date '--> Revisions Submittal Dates: Applicant: Nature of Work k PA"'� w ►-� �S ✓��. Reviews:zBA: A U G 1 9 1 Q1 f PB: BOT: Other. OK ( ( ) FEES:Filing._-I, BP: ��} � �rJ Z•� C/O; 42�G'� Z t ( ) (&KAPP: Dated: 1/ Notarized: ✓SBL: --miss I.D. Cross Connection: H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening: ( ) ( ) ENVIRO: Long. Short: Fees: N/A: ( ) ( ) SITE 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. ( ) ( ) 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. (� ( ) 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. ( )ARB mtg.date: approval• notes: ( )ZBA mtg.date: approval notes: ( )PB mtg.date: approval: notes: REQUIRED EXISTING PROPOSED NOTES APPROVED Art& ate: AUG 4 Circle: Fie From: Front Sim: sar Main Cov: Accs.Cov: Ft.H Sb: Sd.H Sb: GFA: Tot, EL IMP: PP Height/Stories: notes: Residential Building Permit Fee Work Sheet Permit#: Date Issued: SBL: Zone: Address: L (c> A S----\ " T— U^ Property Owner&Contact Info: Job Description: For all new dwellings and for additions measuring 800 sq. ft. or more made to existing dwellings, the following fee schedule shall apply: (plus any alteration fees) Total Sq. Ft. (excluding basements) x $225.00 x $I5.00/$I,000.00 Basement Sq. Ft. x $65.00 x $I5.00/$I,000.00 -------------------------------------------------------------------------------------------------------------------- New Construction Sq.Ft. • New Construction Cost • Building Permit Fee Basement= 9$S sq.ft. x $65.00 = $ D 2-f x$I5.00/$I,000.00 = $ �'(�0, 3� ° I'L Fl. = sq.ft. x $225.00= $ S $I 5.00/$I>000.00= $ 7 SS3�Z S� • 2"d Fl = i Q sq.ft. x $225.00= $ 42 '25, x$I5.00/$I,000.00= $ �3�c • �� Attic= sq.ft. x $225.00= $ ,�x$I5.00/$I,000.00= $+ Total Sq.Ft. sq. ft. Total Cost = $ �'L�i ��/� Total B.P.Fee= $ ° Includes Attached Garage if Applicable. Total Amount Paid = $ f6 Total Amount Due AUG 1 9 1010 Date: Signed: This form must be properly completed & notarized by the Design Professional of record and the Property Owner. Failure to provide this completed form with your permit application will delay the permitting process. Notice of Utilization of Truss Type, Pre-Engineered Wood, or Timber Frame Construction. Title 19 Part 1264 & 1265 NYCRR To: The Building Inspector of the Village of Rye Brook. From: F;C-I Y-1 N SN Subject Property: �� �1,� ll` � C� ( SBL: Zone: Please take notice that the subject; ❑ One or Two Family; ❑ Commercial, eNew Structure ❑ Addition to an Existing Structure ❑ Rehabilitation to an Existing Stricture to be constructed or performed at the subject property will utilize; Truss Type Construction(TT) ❑ Pre-Engineered Wood Construction(PW) ❑ Timber Construction(TC) in the following location(s); ❑ Floor Framing, including Girders&Beams (F) ❑ Roof Framing(R) 2rFloor Framing and Roof Framing (FR) Please note that prior to the issuance of the Certificate of Occupancy, the subject dwelling or building utilizing truss type, pre-engineered wood,or timber construction must be posted with a Truss Identification Sign, installed in conformance with NYCRR§1264 for Commercial Buildings, and NYCRR§1265 for One&Two Family Dwellings. Dale Dcsi m Pro Tonal Date Pr O er t4 - 8 -__�Uay Date Notary Public (7) TRISHA MARLEZ NOTARY PUBLIC-STATE OF NEW YORK No.01 MA6331843 Qualified in Dutchess County My Commission Expires 10-19-2023 CERTIFICATE OF LIABILITY INSURANCE " '0 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 °1 certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT d Aon Risk Services Northeast, Inc. NAME:PHONE (866) 287 Boston mA office (A#—No.EaN): 3- 122 Fi►nIC� (Boo) 363-D1o5 d 53 State Street -- - Suite 2201 EA o E v cSS: _ Boston MA 02109 USA INSURER(S)AFFORDING COVERAGE NAIC a INSURED INSURER A: Navigators Insurance Co 42307 SC Rye Brook Partners, LLC INSURERB: Guideone National Insurance Company 14167 230 Park Ave. New York NY 10169 USA INSURERC: Starr Indemnity NL Liability Company 38318 INSURER D: INSURER E. INSURER F: COVERAGES CERTIFICATE NUMBER:570082993250 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. Limits shown are as requested LTR TYPEOF INSURANCE Mo WVD POLICY NUMBER (MMDD'YYYYI 1MM1DOYYYY1 LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 5,000,000 CLAIMS-MADE M OCCUR DAMAGE TO RERTEU— PREMISES Eaoccurrenca $100,000 MED EXP IAny ons parson) EXCl uded PERSONAL&ADV INJURY S5,000,000 GENI AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE S5,000,000 POLICY X PRPRO'JECT LOC PRODUCTS-COMPrOPAGG $5,000,000 OTHER: co AUTOMOBILE LIASLITY COMBINED SINGLE LIT ANY AUTO BODILY INJURY(Per person) Z OWNED SCHEDULED BODILY INJURY(Per accident) d AUTOS ONLY HIREDAUTOS NON-OWNED PROPERTY DAMAGE t0 ONLY AUTOS ONLY Par axidenl u r d C UMBRELLA LIAR OCCUR 1 1 1 EACH OCCURRENCE V X EXCESS LIAR CLAIMS-MADE AGGREGATE S 5,000,000 DED RETENTION WORKERS COMPENSATION AND PER STATUTE T11- EMPLOYERS'LUMLITY Y/N r ANY PROPRIETOR;PARTNEP EXECUTIVE E.L.EACH ACCIDENT OFFICER MEMBER EXCLUDED' N/A (wardatorY In NIQ E.L DISEASE-EA EMPLOYEE 0 yes describe under DESCRIPTION OF OPERATIONS below El.DISEASE POLICY LIMIT DESCRIPTION OF OPERATIONS LOCATIONS VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is reawred) rJ �l a� 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 AUTHORIZED REPRESENTATIVE 938 King street Rye Brook NY 10573 USA r (01988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016,03) The ACORD name and logo are registered marks of ACORD Certificate of Attestation of Exemption from New York State Workers' Compensation and/or Disability and Paid Family Leave Benefits Insurance Coverage **This form cannot be used to waive the workers'compensation rights or obligations of any party.** The applicant may use this Certificate of Attestation of Exemption ONLY to show a government entity that New York State specific workers'compensation and/or disability and paid family leave benefits insurance is not required. The applicant may NOT use this form to show another business or that business's insurance carrier that such insurance is not required. Please provide this form to the government entity from which you are requesting a permit,license or contract. This Certificate will not be accepted by government officials one year after the date printed on the form. In the Application of Business Applying For: (Legal Entity Name and Address): Building Permit SC Rye Brook Partners,LLC 11oO King St Ste 114 From:The Village of Rye Brook NY Il Rye Brook,NY 10573-1057 PHONE:914481-1531 FEIN:XXXXX6509 The location of where work will be performed is 110 King Street,Rye Brook,NY 10573. Estimated dates necessary to complete work associated with the building permit are from March 17,2020 to March 16,2021. The estimated dollar amount of project is over$100,000 Workers'Compensation Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE SPECIFIC WORKERS'COMPENSATION INSURANCE COVERAGE for the following reason: The business is a LLC,LLP,PLLP or a RLLP;OR is a partnership under the laws of New York State and is not a corporation. Other than the partners or members,there are no employees,day labor,leased employees,borrowed employees,part-time employees,unpaid volunteers(including family members)or subcontractors. Partners/Members: Robert Dale Disability and Paid Family Leave Benefits Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE STATUTORY DISABILITY AND PAID FAMILY LEAVE BENEFITS INSURANCE COVERAGE for the following reason: The business MUST be either: 1) owned by one individual; OR 2) is a partnership(including LLC,LLP,PLLP,RLLP,or LP)under the laws of New York State and is not a corporation; OR 3) is a one or two person owned corporation,with those individuals owning all of the stock and holding all offices of the corporation(in a two person owned corporation each individual must be an officer and own at least one share of stock); OR 4) is a business with no NYS location. In addition,the business does not require disability and paid family leave benefits coverage at this time since it has not employed one or more individuals on at least 30 days in any calendar year in New York State. (Independent contractors are not considered to be employees under the Disability and Paid Family Leave Benefits Law.) I,Janice Heusser,am the Office Assistant with the above-named legal entity. I affirm that due to my position with the above-named business I have the knowledge,information and authority to make this Certificate of Attestation of Exemption. I hereby affirm that the statements made herein are true,that I have not made any materially false statements and I make this Certificate of Attestation of Exemption under the penalties of perjury. I further affirm that I understand that any false statement,representation or concealment will subject me to felony criminal prosecution,including jail and civil liability in accordance with the Workers'Compensation Law and all other New York State laws. By submitting this Certificate of Attestation of Exemption to the government entity listed above I also hereby affirm that if circumstances change so that workers'compensation insurance and/or disability and paid family leave benefits coverage is required,the above-named legal entity will immediately acquire appropriate New York State specific workers' compensation insurance and/or disability and paid family leave benefits coverage and also immediately furnish proof of that coverage on forms approved by the Chair of the Workers'Compensation Board to the government entity listed above. HERE Signature: Date: '- /a.2o2O Exem ate Number f.n ��. i A ve d 24 Ma 020 .... ' :NYS Worke ~ asatiora;Board CE-200 01n018 - -1 ® AFRO CERTIFICATE OF LIABILITY INSURANCE DATED4/13/�2020 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 endorsements. PRODUCER CONTACT FEDERATED MUTUAL INSURANCE COMPANY NA E. CLIENT CONTACT CENTER PHOE HOME OFFICE: P.O. BOX 328 (All:,N FA No Ext:888-333-4949 /c No):507-4464664 OWATONNA, MN 55060 ADDRESS:CLIENTCONTACTCENTER FEDINS.COM INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 149-868-2 INSURER B:FEDERATED RESERVE INSURANCE COMPANY 16024 MACK FIRE PROTECTION INC INSURER C: 15 INDUSTRIAL PARK PL MIDDLETOWN,CT 06457-1501 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:466 REVISION NUMBER:0 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 EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE ❑X OCCUR DAMAGE TO RENTED $100,000 PREM rence) MED EXP(Any one person) $10,000 B N N 6042334 05/11/2020 05/11/2021 PERSONALS ADV INJURY $1,000,000 G N'L AGGR GATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- X POLICY JECT ❑LOC PRODUCTS-COMPIOP AGO $2,000,000 EC OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 accident X ANY AUTO BODILY INJURY(Per person) OWNED AUTOS ONLY SCHEDULED B AUTOS N N 6042334 05/11/2020 05/11/2021 BODILY INJURY(Per accident) HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE AUTOS ONLY (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $10,000,000 B EXCESS LIAB CLAIMS-MADE N N 6042337 05/11/2020 05/11/2021 AGGREGATE $10,D00,000 DEC) RETENTION WORKERS COMPENSATION X PER STATUTE OTH- AND EMPLOYERS'LIABILITY Y/N ER ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $1,000,000 A OFFICERIMEMBER EXCLUDED? NIA N 6042338 05/11/2020 05/11/2021 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below I I E.L DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: KINGSFIELD 1100 KINGS ST RYE BROOK NY CERTIFICATE HOLDER CANCELLATION 149-868-2 4660 VILLAGE OF RYE BROOK NY BUILDING DEPARTMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 938 KING ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN RYE BROOK, NY 10573-1226 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1, O 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD YYORK Workers' CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE la.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured 860-632-8053 MACK FIRE PROTECTION INC 149-868-2 15 INDUSTRIAL PARK PL 1c.NYS Unemployment Insurance Employer Registration Number of MIDDLETOWN.CT 06457-1501 Insured Work Location of Insured(Only required if coverage is specifically limited to 1d. Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 04.3814418 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Federated Mutual Insurance Company Village of Rye Brook NY Building Department 9466 938 King St Rye Brook NY 10573-1226 3b. Policy Number of Entity Listed in Box"1 a" 6042338 3c. Policy effective period 05/11/2020 to 05/11/2021 3d.The Proprietor,Partners or Executive Officers are 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 1" insures the business referenced above in box"la"for workers' compensation under the New York State Workers'Compensation Law. (To use this form,New York(NY)must be listed under Item 3 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: Elizabeth Petersen (Print name of authorized representative or licensed agent of insurance carrier) Approved by: 9 �01�t� 04/13/2020 (Signature) (Date) Title: Authorized Representative Telephone Number of authorized representative or licensed agent of insurance carrier: 888-333-4949 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 ACOR� DATE(MM/DDr(YYY) CERTIFICATE OF LIABILITY INSURANCE 1/21/2021 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 NAME OTT AGENCY PHONE EXI (845) 895- FAX 8873 tC No PO Box 659 ADDRESS ottins2001@yahoo.com Wallkill, NY 12589 INSURERISI AFFORDING COVERAGE NAIC0 INSURER Main Street America INSURED Total Comfort Inc INSURER 8 National Grange PO Box 359 INSURER C National Grange 7 Ohara Rd INSURER D National Grange Milton, NY 12547 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 INSLTRR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYri MM/DD/YYYY LIMITS ][ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 7XOCCUR PREMISES Ea occurrence $ 5OO OOO �MPU7919F 1/21/2021 1/21/2022 MED EXP(Any one person) $ 10,000 A X X PERSONAL&ADV INJURY $ 1,000,000 GE N'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY 7 PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY Ea accident $ 1,000,000 ANYAUTO 1/21/2021 1/21/2022 BODILY INJURY(Per person) $ OWNED SCHEDULED BIU7 919F B AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ UMBRELLA LIAB OCCUR D EXCESS LIAR CW7919F 1/21/2021 1/21/2022 EACH OCCURRENCE $ 5,OOO,OOO CLAIMS-MADE AGGREGATE s 5,000,000 DIED I I RETENTION$ I $ WORKERS COMPENSATION _ AND EMPLOYERS'LIABILITY YIN 1/21/2021 1/21/2022 STATUTE ER ANY PROPRIETOR/PARTNERIEXECUTIVE WCU7 919E E L EACH ACCIDENT $ 1 C OFFICER/MEMBER EXCLUDED? ED N/A ,000,000 (Mandatory in NH) EL DISEASE-EA EMPLOYE $ 10,573 II yes,descrl be 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) CERTIFICATE HOLDER CANCELLATION VILLAGE OF RYE BROOK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 938 KING STREET ACCORDANCE WITH THE POLICY PROVISIONS RYE BROOK NY 10573 AUTHORIZED REPR SENTATI /! / ��V`-- 01988-2015 ACORD CORPORATION. All rights reserved. ACORD25(2016/03) The ACORD name and logo are registered marks of ACORD YORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured TOTAL COMFORT INC 203-223-6700 PO BOX 359 7 OHAR1c.NYS Unemployment Insurance Employer Registration Number of MILTON RD NY 12547 LTON Insured Work Location of Insured(Only required if coverage is specifically limited to 1 d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 141829022 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) NATIONAL GRANGE VILLAGE OF RYE BROOK 938 KING ST 3b.Policy Number of Entity Listed in Box 'la" RYE BROOK NY 10573 WCU7919F 3c.Policy effective period 01/21/2021 to 01/21/2022 3d.The Proprietor,Partners or Executive Officers are ❑ included.(Only check box if all partners/officers included) ❑X 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"I 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". Will the carrier notify the certificate holder within 10 days of a policy being cancelled for non-payment of premium or within 30 days if cancelled for any other reason or if the Insured is otherwise eliminated from the coverage indicated on this certificate prior to the end of the policy effective period? ©YES [:]NO 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. WILLIAM C OTT (Print name of authorized representative or licensed agent of insurance carrier) Approved by: (Signature) (Date) Title PRESIDENT 1/21/2021 Telephone Number of authorized representative or licensed agent of insurance carrier. 845-895-8873 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 (9-15) www wcb.ny.gov K I N F1 V RM NT �6'�Kt�■Ill OFB BDIt Yel Ir 11Q1 UM0 iWFR S 9ts Y1M COIEL1m W 11E EEltb1� 1 ro JASMINE LANE UNIT D 11;"�o � _ D�TIC 16'1M10 0// !17!19 h� OTTER ew 15 C= Go RYE BROOK N Y■ iprl WATER SUPPLY 9t5 �V STATIC PSI: 50 PS19 W RESID PSI: 40 PS © N >' N FLOW: 1050 GPM � FROM M A W CouIXG ON 11e0 In it �t If U. NFPA-13D GENERAL NOTES 2/19/2016 B MOW&V WER OW n, HOOD SCREW SIB 1 I \\\ I\\\ !16 !1i 1 1O SYSTEM DESIGN-RESIDENTIAL AREAS WET SYSTEM) I !,1\\ \\ 114U. W !HYDRAULICALLYNE SPRIMIKER SYSTEM IS A HYDRAULICALLY CALCULATED T SYSTEM � \\ \\\ !11 21 LAVENDER LANE W (� /��� \\\ \\\ nt� !15 -15 ROSE LANE U V PIPING HAS BEEN SIZED USING A LIGHT HAZARD DENSITY OF O5 GPM OVER MOST REMOTE 2 SPRINKLERS �I�� \\\ �, \\\ !1S 00����') -7 IIONE��KLE LANE IN A COMPARTWNT USING RESIDENTIAL SPRINKLER HEADS. LL��" !11 9t2 911 -3!�►t 15UCKLE LANE '� \\\' \\\ + Y ho MAXIMJM SPRINKLER HEAD SPACING-324 salt PIPE II.M FOR MI,-V -4 PRIMROSE LANE LANE SYSTEM DESIGN PER N.F.P.A./13D(2010 EDITION) 096SET HANGER ♦\\ ♦\\ �� In �'-927,IASY!NE LANE PIPE MATERIALS \\\ ❑ \\\ e10 R u OFFSET HANGER /q raj MM w� ALL PIPE AND FlrnNcs ARE BI.AjE11ASTER cPvE \\\ / \\\ -18 J0.S111NE t/VE h00D TRUSS OR BEAM WOOD SCREW 11B.t,':'J !S 14 JASMINE LANE !2 !1 !�u 111 21-14 JASMNE LANE O3 CONTRACT INFORMATION `` WOOD TRUSS OR BEAM ``` 'Ll'-10 JASMJNE LANE Le (� wot is 115 !" ! !1s QLLMW-1 1ULBERRI'MV WORK UNDER THIS CONTRACT CONSISTS OF THE FOLLOMG. DESIGN AND INSTALL A WORIONG 93MNKLER SYSTEM PER N.F.P.A.-13D 2010 EDITION OFFSET HANGER DETAIL HALF STRAP HANGER DETAIL !� !U!„ !,1 !' I R 90I -DRAFT STOPPING SHALL BE PROVIDED BY THE OWNER ACCORDANCE VATH THE I.B.0 20113 EDITION N rs NVT.S. 05 -BATHROOMS LESS THAN 55 SO.FT SHALL BE N COMPLIANCE VATH THE REOxIREMENTS OF NFPA-IJD a6 W !' 910 p ALL BATHROOMS ARE NONCOMBUSTIBLE SHEET ROCK VATH A 30 MIN nVWAL BARRIER / -CLOSETS LESS THAN 24 SOFT.94ALL BE IN COMPLIANCE WITH THE REOUREMENTS OF NFPA-13D a6.3 15 wTx Will! 16 EJS06 Is'tNlMAQICIIMD � II CLOSETS ARE CONSTRUCTED OF NONCOMBUSTIBLE 94EET ROCK WITH A 30 MN IS THERMAL BARRIER. 1lie �i !S p 1 ! -DVERIOR BALCONIES, SPRINKLER PROTECTION 6PROVIDED ON ALL BALCONIES AND PATIOS OF DWELLNC --- ! A 0714 ' UIATS IN ACCORDANCE 1MTH THE t8C 2003 EDITION.SECTION 903.11.21 _ `o � _ P -ATTICS ARE NOT USED FOR STORAGE AND DO NOT CONTAIN ANY FUEL FI(ED EDUPMENT - tY' ' - T; F !2 X ■ Y 11AN I��IIw MUE i OW ME=Amoy TRH SCJEIRD BJtTBMLT MIYFS RHU OJ(TAM A NRWIR U4PER StitOESNOTES TO THE OWNER - S/TEPLAN "Mww�rrNLn11ECTTDToTIED�PEP.NFPA 1ll'MNII(Brmlm66 9'MAINTEVANC= Ip-i ' SHE URAv OOGIM IN 11E N T S. FXfEROR OF THE&UK 24'INN. IEr d'GCE At%[■RN6 9 1 THE OWNER SHALL BE RESPONSIBLE FOP.THE COND TION 0=A SPR'.nLEP SYSTEMAND SHA-L KEEP THE SYSTEh1 ItJ NORMAL OPERAT NG CONDITION6 9 2 SPRINKLER SYSTEMS SHALL BE NSPECTED TESTED AND MAINTAINED 1N ACCORDANCE FINISHEDWITH NFPA 25 STANDARD FOR THE NSPECT ON TEST NG.AND MAINTENANCE OF 7 BASEMENT WATER-BASED FIRE PROTECT ON SYSTEMS ir i A 6 9 THE RESPONSIBILITY FOR PROPERL-MA NTA N NG A SPRINKLER SYSTEM IS THAT OF THE I lf04 OWNER OR MANAGER WHO SHOULD UNDERSTAND THE SPRINKLER SYSTEM OPERATION FOR FURTHER INFORMATION SEE NFPA 25 STANDARD FOR THE INSPECTION TESTING AND MA NTE'.A'•CE r t n OF WATER-BASED FIRE PROTECT ON S STEMS e e ADDITIONALLY L- - YOU MUST MAINTAIN SUFF C ENT HEA-THROUGHOUT THE PREMISES TO 1• PREVENT THE WET SYSTEM=ROM FREE?NG _ 3 YOU SHALL INFORM TENANTS OF PROPER CARE NECESSARY TO MAINTAIN I t•-I 1' 2.FIRESERYCZ�iER SIFPLT r SERVIZ GTER wM4LY LINE THE SYSTEM , + _ O 3 F THE CONSTRUCTION OR OCCUPANCY IS ALTERED IN ANY WAY THE SYSTEM WILL HAVE TO BE UPDATED ACCORDINGLY - ' F17Jyl g'i1EF MAN■(HE SEW �g or fJN TK IxCg41ROl FMM41iQD N THE BAS1110p I S�_+/Q��`6 u - Ul!FINISHED C UTILITY eos FA 1 'A ELEVA T/ON VIEW OF FIRE PROTECT/ON BACKFL OW DETAIL 1 1 UNFINISHED --AT MACES 00 NO]4WK FW 90KIN L N.T.S. UTILITY" PROTECTO PER r�PA 13D SEM&65 I WALE•-II J _ CL r- - ^ - - C - - -- - P E RMrQZ-- lag -- - ELEC • PANEL l S13L I BATH I_ u0 Co 0 C H4o/ 'm SIM so I�a�FIE kv e e DINE APPRO DIsm— � oclii $AIF _ I S4101 ID So.FIRE 00 NM CM OW SNO ffA6 I i -- BUILDING INSPECT go of 1Rye Brook,NV •' twcTEF ttE3loDrrrt HORaorrA stoEtru , 3'T u -er.% -i __._ J` 9TH+n.ET1 Hy aagN tJaTt n[ I - - E siAlNn I u D.O.H.APPROVAL REQUI RED FOR a or NCU1a Mm 1W warm BntET�ut WILA TM or*A 11IRAMl Wffl on BACKF'lOW PREVENTION DEVICE. >K M]F Sr NJi�1E D®1DIE�IIt I ML��, --• __ -- - wl l>:E R1OIH s1+laL woR RtEsstl6 Nwa i''1Esr�oN,N rtL1E DII J I I G o - —� ROOM - — Ui!EXCAVATED UI!FIT IISHED I FIRST F.00F H--- U i ILIT• ' -- ELE. =9 E' - cc n - - I .- u UNFIT IISHE PQI�Ni SPIiBIQFA PEN�Hi SPHill9QEA PE"a MOW {J\-}'�/\� BASEME 1 OJ• 1. t O1'-e;�- BASEMENT FL OOR FIRE PROTECT/ON PLAN BUILDING SECT/ON 'A —A" SCALE 14"=IV" SCALE:14"-IV- SYMBOL LEGEND SPRINKLER HEAD LEGEND JOB INFORMATION 1.All pipe locations are to be field measured Arlo-to fatinrat:o, vVnetne or not Indicated on the drawings the following terns are to be provided SYMBOL DESCRIPTION SYMBOL DESCRIPTION DRAWING TITLE:BASEMENT FLOOR FIRE PROTECTION PLAN PROJECT:KINGFIELD DEVELOPMENT IN and Installation by the sorinKler contractor tieao Cabinet snare heads Inc head wrench aer NF?;,13 F NEW y , - I=`""'='=:y" `= -_ -=�'=fit' I r',""_J T Tt: ODD REVISIONS: DATE: ADDRESS:INTERNATIONAL DRIVE ==- 2 All dimensions snot^n are end to end nrovls,ons for flushing connections and draining of a D Pe O O - GE•Nt; 9 Cur] _._•lc.._: ,:_ CITY:RYE BROOK STATE:NY ZIP:10573 3 High temperature heads are w be fte!d-stalled where req'ired nspector's test connection steal be provided for each system ���� a 4A t E..J ::7,r:_g J._"_:.- C; :_�;_:;�:ar:;_ ;:: =.-:: 5-=r,:°': :' °0=I CLIENT:THE WARJAM GROUP PHONE:(914)761.250 - - r - CON RAC 4 All pipes and han0ers are to be,nstalle^oe•^E7D•":3 Hydraulic identification plates&N=aA 13 required Sips - CONSTRUCTION:WOOD a 0 Y P 9' 9 co ti� �� v (T06 20-0) LTD. O 5 Gridded wet systems shall provide a relief valve per NI:PA 1"s • c L ,J t"V -- _ _•_. I 1, adequate. , neat I r i h r :B.I.;]:= ':J•:.:=°_5..=c9'b.-'rE: -SI:=�.._:7 __:1 »" ADDRESS:5 INTERNATIONAL DRIVE•SUITE 1 14 7 E All net.plpmg Is pe nyd osrat,Out tested a,no:,Ess tn_ 1JJ�5 s the o,i,ding owners respons,blllh to provide aoequa.e _at( all areas n the 4 _ _: OCCUPANCY:NFPA 13D CITY:RYE BROOK STATE:NY ZIP:105 3 'S INDUSTRIAL PARK PLACE,v IDDLETOWN,CT C6457 r� for 2 hours or at 50osi Ili excess o'the maximum pressure cuilding Drotected by a we:type sprinkler system and fo a';Ovate filed supply plpe.a ves 2 SYSTEM TYPE:WET P•860.632.8053 F:860.632.8054 >:men the•,ax mur-oressure to be r lamta,ned Is in excess u'50os and system risers to dry type systems 7 A quick open rig dev ce Is requ red when,dry systen vo ume eYceetls 41r pressure shall be ma,nta,ned on al,dry type systems oy an approved automat.a OpgOFF.55VOa DATE:1 1 l Or2017 FIRE SPRINKLER CONTRACTOR CONTACT WWW,MAC KFIRE.COM IL 500 gallons De N;;eA'3 compressor or plant air system speaflcafy appro.,ea:or and capable o'automatical/ =I:: DESIGNER:CHRIS JUDD PHONE:IB60)398.502 J.35sTI.,S AHJ:PORT CHESTER E-MAIL:CHRIS�MACKFIRE.COM LICENSEE: CT:F'-4C29' ti'A'SC-'2D494 RI:COC347 5 NFPA 133 Opp..as Ca,e� zlantamina the requlrec a'p essure � 01 -1- -1._1-j5'I TOTA.THIS SHEET:•ZD TeTA.THIS JOB: `7 FIRE MARSHAL �� Y _ IN F1 V RM NT 0z 1 6 JASMINE LANE UNIT D oW I K � RYE BROOK, NY. W C*%i 0< an W LL Q 0(9 WZ WD DECt OR Uj BLUEST011c, PAVER I-T-1 L+j 0 C� >co I TYDRAULIC DESIGN WALK-1111 CALL A11111%bI ';I-,(OND (-)')R HYDRAULIC DESIGN CRITERIA ---- Li I-an .05 Density T-111170 ILL V 11'FM VARIES Spacing /-AN VCR V-1gSppR4-40 4.9 K Factor ITCHEI IHose Allowance LI lie MASTER N_ This System is Designed to Discharge C� VP 4.1iBATH#4 MAS71!7 at a Rate of _0_5_jGPM per sq It 7 =0 lie BEiDROOM 1.14D 04P BAI-i of Floor Area Over a Remote Area of vs�s FRM PPE AIM It 10111 lIC W1111-\It* 0-8 JMAL- 2 Sprinklers when Supplied with Water 0 DOID OF K RQ ff at the Rate of 26.1 GPM at 38.7 PSI -I. at the FP 06DVM NO V a-! sz To 101111111)nm 41) LIVIIJU CUP FXM M JT T.�,� 1H 4 4 up FIK 14 X L V�-(5 P An ROOM TAE 111111IM11017 FA#0 0 ---- up N im PA *A 0 0 PRDOR I L f HYDRAULIC DESIGN M 1 ILe UP 10 Tic I-1.00RILNII MV i I= --lill"llo-W -t— 1,I — 4_1111 �!� lot V/ HYDRAULIC DESIGN CRITERIA TC—L BEDPOOM X4 I D11.111AG WALt-III osDensity RN i's CL ROOM CIL VARIES Spacing W 1114 K Factor Hose Allowance O�. r '901F This System is Designed to Discharge at a Rate of —.0-5--GPM per sq ft -0 11cs V-1 of Floor Area Over a Remote Area of UP to 2 Sprinklers when Supplied with Water [10 =1111111 RU 14\1�, .51 at the Rate of 24.4 GPM at 12.2 PSI I at the FP DSDM NU T W r1W 4 of up FM lit iiiniss RA go b -Ana LAUl IDRY 0 C, 53 or up usinaw rK sm Na LK tP r Z1111111 dm WVW Mix Ow MTMM may r, r LICUOUX FK SOMU 940 LK Wo A_ 1111111 VCR W-1- AID KM Tit MW RM R(MW IFSK eta Sit i lit lic \\-N=IaL C, AV Al W 1116.11,410 HU 91 FLa Ir-,090 lK I)v ra 0 GMA Mh7KM NM ROOR lie • D1 AWA ORMY MX D 1101111* "as PR no (I.Amftu Ox RM SPIRMS!Wilt EEDPOOM#-- FIE FRW BOUD SO M HW FRM Df Rn RIM OM"10 M AMW TOFFAW is�Ilk AM*rff PIPE Am 9"60 ► RW M A.OK,THE SIX Or K M II DM Of H IW RAw aix il&LArali k 4 C_Ll' sm 4V TRLSS iEATH C_ A I-#_ It MX FWAC ft_ESTCI!E R3Wrlk=4D PD[On 9RKD -ERPAC,- r INSUL A TION DETAIL FOR A L L SPRINKLER S1. IN OR A DJA CENT TO UNHEA TED SPACES N.T.S. FIRST R OOR FIRE PRO TEC TION PLAN- IC SIDEWkL SPRINKLERS r,%\THE SECOND FLOOR S'ik,BE LOCATED AT 0-7'BELOW THE CEILING SCALE-14"=IV�' SECOND FL OOR FIRE PRO TEC TION PLAN SCALE.-14"z 1t-0- 1 Al:pipe lo.-a#;ons are to be field measured prior to fabrication Whether or not indicated on the drawings tne foliov/inc items are to be provided SYMBOL LEGEND SPRINKLER HEAD LEGEND D PROTECTION PLAN JOB INFORMATION aria installation by the sprinkler contractor Head Cabinet snare heads and head wrencr,De N=P"'13 SYMBOL DESCRIPTION SYMBOL DESCRIPTION RAWING TITLE:FIRST&SECOND FLOOR FIRE PROT (D :.--- - REVISIONS: DATE: PROJECT:KINGFIELD DEVELOPMENT [,@-I Z.:-1� i-= ADDRESS:INTERNATIONAL DRIVE CIQ are,end to end -Provisions fo-flushing connections anci draining of a!Pipe _4 - .. 2 At dimensions shover, NEW CONTRACT#:DODO r r=D 3 high temperature heads are to be field installed where required Inspector's test connection snal!be provided to-each sysiem CITY:RYE BROOK :I 0. STATE: ZIP:10573 4 Al oipes and nanpers are to be Installed per NFPA 13 Hydraulic identification plates&N.=RA 13 req uire�signs co PHONE:(914)761.250 LL. 5 Gridded wet systems snail provide a relief valve per NFPA 13 ro (to& 20-0) CLIENT:THE WARJAM GROUP CONSTRUCTION;WOOD LTD. At nev.pinmg ic�to be h1drosiaticaliv tested at no;less triar.200ps 1!is the building owners resoonsioilit%to provide adequate nea:to-&a-eas vie F I R E P R 0 0 ADDRESS:5 INTERNATIONAL DRIVE ■-SUITE 114 for 2 hours o,a!50osi in excess of the maximum pressure oudding protected by a wet type sprinKie-s,,sten a-ic;o,al:orate-filled supply pipe-a-ves OCCUPANCY:NFPA 13D - enlen tne.maximum oressure to be r-aintained is j,excess of 150 psi and system risers to cry type systems 6r, 076712� 1 CITY:RYE BROOK STATE:NY ZIP:10573 INDUSTRIAL PARK PLACE,MIDDLETOWN,CT 06457 7 A quick open!-io device is required wher,dry system Volume exceeds Ai pressure shall be maintained on all ary type systems bk an aDDrOVed @1.1101118t C a.. SYSTEM TYPE:WET -632-8053 F:860-632-8054 FES DATE:I I if 1012017 FIRE SPRINKLER CDNT P:860 5OC;galia;isr)e;NFFIA 13 comDresso;or plant aii system specifically approved tD anoicapaD e c,auto?fat cal H. RACTDP CONTACT N=PA 13D aoojv as reqji:eo maintaining tne required air pressure :F 7-7:-77TT_11._z WWMACKFIRE.COM IL A PORT CHESTER DESIGNER:CHRIS JUDO PHONE:(860)398-51324 fill I:1::t H':FIRE MARSHAL E-MAIL:CHRIS�MACKFIREXOM LICENEEE: CUI.40291 MA:S[-*2Z494 RI:00C347 4-,_j.:jU..'-'�i 1 TOTAL THIS SHEET:-T7 To-A,THIS Joe:-S 7 FIELDWORK COMPLETED: February 3, 2022 Underground structures, if any exist, are not shown hereon, except as noted. The location of FILED__MAP REFERENCE: underground improvements or encroachments are . �1 not always known and often must 'y t be estimated. Subdivision Map of "Kingfield" F.M. No. 29210 4 If ,rovements i underground m easements, or g P filed August 30, 2018 encroachments exist and are neither visible during normal field survey operations nor described in Subject Lot: 86 or serve instruments provided to this the a P P y Y my Known as 16 Jasmine Lane not be shown on this ma and are not certified. Town Of Rye Tax ID: Section 129.25 Block 1 Lot 1.60 ' f This property may be affected by instruments which have not been provided to this surveyor. Users of this map should verify title with their 84 attorney or a qualified title examiner. Legend Frame Bail ing . . Onlycopies from the original of this serve _ P 9 Y AC Air Conditioning Unit marked with the surveyors embossed seal are ©- Sewer Cleanout genuine, true and correct copies of the surveyor's CRW-- Concrete Retaining Wall original work and opinion. A copy of this ® -- Curb Stop Water Service N59'04'42"E document without a proper application of the 90,17 P P ®- Electric Box 'surve ors embossed seal should b 0 - Electric Manhole utility Y e assumed to g be on unauthorized copy. � - Gas Valve Shed � a - -- Ligh t Pole w cb o- Telecommunication Box L aSOWS ®-- Transformer Pad Z Ln c w —� Water 00 -►e Valve � o � � ICU 3 00� Area 4,4921 Sqw Ft. Frame _ � Bull !n G7 D 01 CD 0 0 To date, no Title Report or Abstract of Title has o ► �. been provided. This survey is subject to a O 3 NMAR 2 2023 current, up to dote lltle Report. -i . �+ C(if _ ,. N VILLAGE OF Yt-- BROOK Property coFILErner monuments were not placed as U' co0�.,'IL�i� ; E '�R � � -�- part of this survey. a03 (b S59 04 42 W utility 90.17 This map may not be used in connection with a Shed COX "Survey Affidavit" or similar document, statement or mechanism to obtain title insurance for any AS�Bufft Survey subsequent or future grantees. . Frame Bbildi n • Unauthorized alteration or addition to a survey 16 Jasmine Lane map bearing a Licensed Land Surveyor's seal is 87 a violation of Section 7209, sub--division 2, of Unit ` A 4616 the New York State Education Low. BUILT� - � DOCUMENT_ Prepared for According to NYSAPLS policy adopted January 23, � Sun Homcas, Inc. 1993, the alteration of survey maps by anyone other than the original preparer is misleading, � 8fta to An am confusing and not in the general welfare and benefit of the public. Licensed Land Surveyors shall not alter survey maps, survey plans, or Town of Rye survey plats prepared by others. N is Ir EWes tches ter Coun ty, Ne w York ENGINEERING, SURVEYING & GRAPHIC SCALE s� � s ao� Date: F � �, �oz� LANDSCAPE ARCHITECTURE, P.C. 0 20 40, JEFFREY B. DeROSA, LS 3 Garrett Place Carmel, New York 10512 Phone (845) 225--9690 • Fax (845) 22 —9 717 New York State License No. 050749 www.Inslte--eng.com Q 2022 In si to Engineering, Surveying & Landscape Architecture, P.C. All Rights Reserved. (IN FEET) 1622 7.200 1 Inch = 20 ft. Lot Mops/Lot 86.d wg