HomeMy WebLinkAboutBP20-179TCO # FEE DATE INSPECTION RECORD DATE FOOTI N G FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING C� RGH PLUMBING GAS CD SPRINKLER ELECTRIC 0 LOW -VOLT 0 ALARM AS BUILT FINAL -- INSP OTHER APPROVALS BOT PB ZBA OTHER AS-BUILTlFINAL SURVEY RIw WIRED PRIOR TO FINAL INSPECTION VILLAGE of RYE BROOK WESTCHESTER COUNTY, NEW YORK No: 22-139 Certificate of ®ccupaucp This is to certify that rla Lu CICt �17err?andeZ of, r��l� [��k� nj l having duly filed an application on � Or c2 l, 20 LQ,2.requesting a Certificate of Occupancy for the premises known as, Rye Brook,NY, located in a PU D Zoning District and shown on the most current Tax Map as Section: Block: _ Lot: R4 and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. QQ` , issued `7 a ( 20 J 0, 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: — oyy— fo-z" Construction: •for the following purposes: Ne u) V 10a.-J/ Pig lio /��V(Q�O— V Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises. building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of the building or in the exit facilities shall be made,and no enlargement, whether by extending on any side or by increasing in height shall be made,nor shall the building be moved from one location to another until a permit to accomplish such change has e n bt ' om uilding Inspector. Building Inspector,Village of Rye Brook: Date: SEP 2 6 2022 �/7 BUILDING DEPARTMENT For office use only: D E C E � ��J E PERMIT# VILLAGE OF RYE BROOK ISSUED: SEP 21 2021 ING STREET,RYE BROOD,NEw YORK 10573 DA"fE: 7- (914)939-0668 FEE: 1110 PAID VILLAGE OF RYE BROOK www,ryebrook.orp, BUILDING DEPARTMENT PPLICATION V OR C RTIFICATE 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 Address: 67 Bellefair Road, Rye Brook, New York 10573 Occupancy/Use: 1-Fam Parcel ID#: 124.64-1-16 Zone: PUD Owner: Karla Lucia Hernandez Per6 Address: 67 Bellefair Rd, Rye Brook, NY 10573 P.E./R.A. or Contractor: JL Pavers Incorporated Address: 47 Uncas Road, Stamford, CT 06902 Person in responsible charge: Jose Carlos de Freitas Address: 47 Uncas Road, Stamford, CR 06902 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: Karla Lucia Hernandez being duly sworn,deposes and says that he/she resides at 67 Bellefair Rd (Print Name of Applicant) (No and Street) in Rye Brook in the County of Westchester in the State of NY that (City/town/Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$ 9.300 for the construction or alteration of: Driveway and new rear patio Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-I O.A. of the Code of the Village of Rye Brook. Sworn to before me this 17th Swon o be for me this ), day of Sept 20 21 d of Sept 2 Signature of Property Owner s ature of Applicant Karla Lucia Hernandez Atilio Carbo Print Name of Property Owner Print ame of Applicant Notary Public Notary Public SHARI MEULLO Notary Public, State of New York No.01 ME616OC63 xn 2/2021 Qualified in Westchester County Commission Expires J- -ua►v 29 20 9S QyE BRC�v� BUILDING DEPARTMENT ❑iUILDING INSPECTOR /)ffAssiSTANT 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: ( �J` � / DATE• _A �rt(20 ( fI } PERMIT# �Y4 _ I ISSUED: I SECT: BLOCK: I LOT. LOCATION: ` -' �e y �� '� 'A y OCCUPANCy_ �\O ❑ VIOLATION NOTED THE WORK IS...�' _ ACCEPTED [IREJECTED/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 )21�'FINAL ❑ OTHER Mike Izzo From: Mike Izzo Sent: Tuesday, March 22, 2022 2:06 PM To: Atilio Cc: Steven Fews;Tara Gerardi; Laura Petersen Subject: RE: Building permit BP20-179 67 Belle Fair Road Dear Mr. Carbo, Thank you for the email. I am pleased to inform you that a six (6) month extension to your subject open permit has been approved, and that the new permit expiration date is, September 21, 2022. Please note that this is the final permit extension I am authorized to grant. Please arrange for all work to be completed and successfully inspected, and for all paperwork & fees to be remitted to the Village such to facilitate the issuance of the Certificate of Occupancy/Certificate of Compliance closing out the permit on or before that date. Thank you. /ff/�4ae/(l /zza Building& Fire Inspector Village of Rye Brook, NY (914) 939-0668 From:Atilio<atiliocarbo@gmail.com> Sent:Tuesday, March 22, 2022 9:02 AM To: Mike Izzo<Mlzzo@ryebrook.org> Cc:Steven Fews<Steve Fews @rye b rook.o rg>;Tara Gerardi<tgerardi@ryebrook.org>; Laura Petersen <LPetersen @ ryebrook.org> Subject: RE: Building permit BP20-179 Dear Mr Izzo Regarding the open permit BP20-179, could you give me another extension as the survey company has not finish the survey yet? I already asked them to do it and should be finished shortly. Thanks for your understanding. Best Regards Atilio Carbo Cel:914-343-9123 Sent from Mail for Windows 1 From: Mike Izzo Sent: Monday,September 27, 20219:25 AM To:Atilio Carbo Cc:Steven Fews;Tara Gerardi; Laura Petersen Subject: RE: Building permit BP20-179 Dear Ms. Carbo, Thank you for the email. I am pleased to inform you that a six (6) month extension to your open permit #BP 20-179 has been approved, and that the new expiration date is March 21, 2022. Please arrange for all work to be completed and successfully inspected, and for all paperwork& fees to be remitted to the Village such to facilitate the issuance of the Certificate of Occupancy/Certificate of Compliance closing out the permit on or before that date. Thank you. A k7e,/[T /zzo Building& Fire Inspector Village of Rye Brook, NY (914) 939-0668 From:Atilio Carbo<atiliocarbo@gmail.com> Sent:Tuesday,September 21, 20213:22 PM To: Mike Izzo<Mlzzo@ryebrook.org> Subject: RE: Building permit- Patio and tree removal Hi Michael I wanted to confirm that the Patio and Driveway were completed. The address is:67 Bellefair Road, Rye Brook, NY 10573. Permit BP 20-179 In my call to your office last week, I was informed that the Certificate of Compliance had to include a new survey. I have being trying to get the new Survey with the company Ward Carpenter Engineers. I left them a message but have not responded yet. The reason of this email is to ask for an extension of time to submit the new survey. The construction is completed though. Best regards Atilio Carbo Cel 914.343.9123 From: Mike Izzo Sent: Friday,July 24,2020 1:15 PM 2 To:Atilio Subject: RE: Building permit- Patio and tree removal Thank you. Please submit this along with the application. IWad(7, /zzo Building& Fire Inspector Village of Rye Brook, NY (914) 939-0668 From:Atilio [mailto:atiliocarbo@gmail.com] Sent:Thursday,July 23, 202011:18 AM To: Mike Izzo<Mlzzo@rvebrook.org> Subject: RE: Building permit- Patio and tree removal Dear Mr. Izzo Thanks for your email. Please find the approval from the Bellefair Homeowners Assoc. for the propose patio and tree removal. I will ask my contractor to follow with the permit from your office before starting the work. Have a great day Atilio Carbo Cel +1.914.343.9123 From: Mike 177C Sent:Wednesday,July 22, 2020 15:09 To:Atilio Subject: RE: Building permit- Patio and tree removal Dear Mr. Carbo, Thank you for the email and for the photos. There is no Village permit required for the removal of the small tree on private property shown in the photo. However the patio does require a permit from the Building Department and approval from the Village Architectural Review Board. Please note that both the proposed patio and the tree removal require permission from the Belle Fair Homeowners Association, and proof of such permission must be submitted to the Village along with the patio permit application. I have attached the appropriate application hereto for your review. Please review the filing instructions and application and feel free to contact me should you require any further assistance. Thank you. lffjc4ad(T Izzo Building& Fire Inspector 3 Village of Rye Brook, NY (914) 939-0668 From:Atilio [mailto:atiliocarbo@gmail.com] Sent: Wednesday,July 22, 20201:13 PM To: Mike Izzo<Mlzzo@ryebrook.org> Subject: Building permit- Patio and tree removal Dear Michael I just call you regarding a patio that I want to build at: 67 Bellefair Road, Rye Brook, NY 10573 The idea is to remove the tree and put bricks instead of the grass. Please see the photo included. Area 20 X 10 Behind the house Excavate the area and apply 6"of crushed stone; Apply 1"of stone dust; Install 6"x9"Cambridge Brick Pavers on Onyx/Natural coior with Dark border; How do I apply for the permits for the tree removal and work that needs to be done? This is important for my family to maintain social distancing. Best Regards Atilio Carbo Cel +1.914.343.9123 4 Building Permit Check List&Zoning Analysis r _ Address: 6'7 1 �Fi�-�-F Cam. /t— �� • SBL: l Z--1- • �O�{ `" L — Zone:_Use: Z( 0 Const.Type: Other. Submittal Date: ZS Z-'-� Revisions Submittal Dates: `1 l Z Z D Applicant: G A 0-3 0 Nature of ork. 4 Q Reviews:ZBA: S E P - 2 1010 PB: BOT: Other. NFM OK ( ( ) FEES:Filing. 7 SS BP: �D ` ' C/O: Legalization: ( ) (�APP: Dated ✓ Notarized: SBL: Truss I.D. Cross Connection: H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Stone Water Review: Street Opening. ( ) ( ) ENVIRO:Long. Shore Fees: N/A: ( ) ( ) SITE PLAN:Topo: SiteProtection: S/W Mgmt.: Tree Plan: Other. ( ( SURVEY:Dated Current: Archival• •Scaled. Unacceptable: ( ( ) PLANS:Date Stamped Sealed Copies: Electronic: Other: (• (� License: ✓ Workers Comp: ✓ Liability: -**" Comp.Waiver. Other. (� ( ) CODE 753#: 09 a)o Dated —Q I—al0 N/A: ( ) ( ) HIGH-VOLTAGE ELECTRICAL.Plans: Permit: N/A: Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit N/A: Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H.W.I.C.:_Battery:_Other. ( ) ( ) PLUMBING Plans: Permit: Nat.Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A: Other. ( ) ( ) H.V.A.C.: Plans: Permit N/A: Other. ( ) ( ) FUEL TANK:Plans: Permit: Fuel Type: Other. O O 20I7 NY State ECCC: N/A Other. Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other. ( ) ( ) Other. VAARB mtg.date: l Z.o approval notes: ( )ZBA mtg.date: approval: notes: ( )PB mtg.date: approval: notes: REQUIRED EXISTING PROPOSED NQ= APPROVED Alga, ns,A*w SS E P 1._ 20 Cir e: Froze Front: Front: Sides: fir. Main Cov Accs.Cov Ft.HS : S .HS : GFA Tiro. Et I : PP Height/Stories: notes: _ -�NRTMENT D E C E � V E REV � E OF RYi OOK pLLq I SEF ' 2 202Q93 IN ET RYE BR', 'i ,NY 10573 AUG 2 5 2020 i DAFT D.-. 939-5801 VILLAGE OF RYE BROOK BUILDIN D PART .1ENT o '`� BUILDING DEPARTMENT ARCHITECTURAL REVIEW BOARD CHECK LIST FOR APPLICANTS This form must be completed and signed by the applicant of record and a copy shall be submitted to the Building Department prior to attending the ARB meeting. Applicants failing to submit a copy of this check list will be removed from the ARB agenda.\\ Job Address: 677 Bellefair Road, Rye Brook, NY- 10573 Date of Submission: �� V Parcel ID#: 04.(94-1r 10 Zone:�1J Proposed Improvement(Describe in detail): APPLICANT CHECK LIST: Driveway: 1900 sqft Repave&Belgium Block Curb Reset MUST BE COMPLETED BY THE APPLICANT The following items must be submitted to the Building Back Patio:20'X 10'Excavate, apply 6"of crushed Department by the applicant-no exceptions. Apply 1"of stone dust,Install 6"x9"Brick Pavers; 1. ( 'Completed Application 2. ( )Two(2)sets of sealed plans. (one full size (maximum Property Owner: Atilio Carbo allowable plan size=36 x 42F} and one 1 1111T) Address: 67 Bellefair Road, Rye Brook, NY- 10573 3. ( �rrwo(2)copies of the property survey. 4. ( )Two(2)copies of the proposed site plan. Phone# 5. ( )One electronic/disc copy of the complete Applicant appearing before the Board: application materials. 6. (4Filing Fee. Sandra Regina Costa de Freitas 7. ( )Any supporting documentation. Address: 47 Uncas Road, Stamford, CT-06902 8. (el'90A approval letter. (if applicable) 9. ( ) Photographs. Phone# 203-658-6744 10.( ) Samples of finishes/color chart. (a sample board or model may be presented the night of the meeting) Architect/Engineer: Phone# By signature below, the owner/applicant acknowledges that he/she has read the complete Building Permit Instructions&Procedures,and that their application is complete in all respects.The Board of Review reserves the right to refuse to hear any application not meeting the requirements contained herein. Sworn to be e me this L/ Sworn to before me this /.Zo day of , 20 CJ day of '!Sus 7 , 20 a%L' i1,4 Signature of Property Owner Signature of Applicant 5 o '`r, S PriTN 'perty Owner Print Name of Appli� t BRYAN E. WOLKIND = j ll Y I tit; Not Pub e Notary Public. State 01 tr,iew York Notary Public No: 02W06004979 Qualified in Westchester County 7Notary ZA PTEIXEIRA Commission Expires March 30, ICI blic,State of New York 01TE6137774 �;Westchester Count Commission Expires Dec.05,20 .,,. Aemra•arrl�rrear[un.Ix. 13eirA a/Durctorr S EP — [,I/� n.. .r pr/1.F.ur BAd.Frr BraeA..Y.7.Ipc^: 2020 July 22, 2020 FVILBelleFair ARBAGE OF RYE BROOK LDING DEPARTMENT Fig - 24 Bellefair Blvd Rye Brook, New York 10573 Karla Hernandez 67 Bellefair Road Rye Brook, New York 10573 Re: Installation of Patio Et Awning and Transplanting of Tree Dear Karla, We write in response to your request to the ARB for approval of the installation of a patio and awning in the rear of your residence and the transplanting of a tree from the rear of your property to the front of your property situated at 67 BelleFair Road, Rye Brook, New York. We are pleased to inform you that based on the details of your application, your application has been approved. Please note that the color of the awning you select must blend with the color of your home and/or the color of your shutters. Once this installation is complete contact our FirstService representatives, Rafael Reyes or Michael Napolitano so that a final inspection may take place. Please be advised that our approval will be expressly conditioned upon your continued compliance with Schedule D of the Declaration, Accordingly, if the aforementioned fails at any time to comply with the Regulations, the ARB reserves the right to direct modification or the removal of the improvements at your sole expense to ensure compliance. Please note that approvals are valid for one year as of the date of this letter. As a reminder, certain alterations will require the approval of the Village of Rye Brook's Building Inspector or Engineer. You shall be responsible for obtaining all required approvals and permits. The Village of Rye Brook will consider applications after BelleFair ARB approval is given. The Village of Rye Brook approval does not preclude the need for ARB approval, nor does ARB approval relieve you from any responsibility of obtaining Village of Rye Brook approval. If you have any questions, please do not hesitate to contact us. Very truly yours, The BelleFair Architectural Review Board VILLAGE OF RYE BROOK BUILDING DEPARTMENT 938 KING STREET, RYE BROOK,NY 10573 (T) 939-0668 (F)939-5801 ARCHITECTURAL REVIEW BOARD Wednesday, September 16, 2020 Due to public health and safety concerns from COVID-19, the Architectural Review Board meeting on September 16, 2020 will be closed to members of the public. The public can still watch the live meeting online through Zoom through the app or through the following https://us02web.zoom.us/j/87221419610 If any interested members of the public would like to provide comments during the meeting, comments can be emailed to stevefews@ryebrook.org or called in during the meeting at +1 (929) 205-6099, meeting ID: 872 2141 9610 NAME &LOCATION TYPE OF APPLICATION MOTION SECOND APPROVED REJECTED APPL.# 14 Carlton Lane Re-Appearance To Show Consent 5052 (Khobragade) Finishes, and Details On Agenda Plan(Portico& Windows) 432 N. Ridge Street Re-Appearance To Show Consent 5058 (Gabriel) Details In-Ground Pool, Agenda Patio SWM System 30 Woodland Ave 4' & 6' White Vinyl PVC Consent 5061 (Blanco) Fence Agenda 2 Brook Lane Amendment to Shed Size 8' Consent 5062 Camacho X 10' - 8'X 12' Agenda 165 Betsy Brown Rd Replace Existing Deck Consent 5063 (Valad) Boards With Trex, Add Agenda Cable Type Railing 67 Bellefair Rd Re- Do Existing Patio Area Consent 50.64 (Carbo) in Paver Stones, Re Black Agenda Top Driveway w Belgi/ Block Borders 2 Millenium Place Construct Stair Run Down to Consent 5065 (Prathy) Grade From Existing Deck Agenda to Match 15 Country Ridge Dr Roof Top Solar Array Consent 5066 (Cappelli) Agenda ML toll NM MR JM SF AC MI 14 Wyman Street Roof Top Solar Array Consent 5067 North(Garrick) Agenda 2 Latonia Road Re-Appearance To Add Consent 5068 (Pascuma) Colors&Details On Plan Agenda For Deck 8 Concord Place Replace Decking/Railing On Consent 5069 (Levine) Existing Deck w/Tuscany Agenda Timbertech/Westbury 36 Roanoke Ave Legalize Rear Elevated Consent 5070 (Veloz) Deck,New Patio Door& Agenda Egress Window 3 Country Ridge Rear Addition, Elevated 5071 Circle(Porter) Deck, Rear Patio, Legalize Side Steps, Remove Patio 221-223 S. Ridge St Remove Rear Porticos& 5072 (Sadofsky) Elevated Decks, Replace Doors w/Casement Windows 11 Berkley Dr New Rear Deck&legalize 5073 (Sabato) Rear Patio Door 7 Berkley Lane Replace Existing Deck 5074 (Kaplan) 998 King St(Cohen) Construct 16 X 20 Pergola 5075 On Existing Deck 4 Sleepy Hollow Rd Side Yard Deck, 6'PVC 5076 (Cecere) Privacy Fence, Shed& Reduce Impervious Coverage 39 Meadowlark 2nd Story Addition, Front 5077 Road(Rose) Porch,New Deck; Interior Alterations 25 N. Ridge St Replace Existing Side 5078 (Montanez) Entrance Deck& Stairs; Replace Rear Entrance Steps, ML NM MR SE JM SF AC MI JB t a E' h 4. • � a IN I -�' 74 f 1 4 AM't � 5'.�^�/ �� ,� !1 //�►� �, to Ll x � r a, �r r• �+ i.4 l.. dL � �: f�a .t�:• �� ;i. .�!` ram; w s i AL Y•r •. .. �• Sri', h _ t- S55FFF Ljj O.o �� �: f� � 1 � �� .., \ \ ,\ \ �� s � '� �� � � � / � '� � . � � i °� � �`� ,, �, \ i i �,, � �� �� �� � � ,� :; `, M / � � .� w tit U �, 1 I ��, i ;, ��� �� � �� •� ; ;� � �' � �� ��,r ., � ��, Yy /: ., , t'4 � I y l `' 1 �, � 1 � '� w.d ,14 � ` �. / ;' l � '� j � d s . •• r -P • r. ' � i r lo + On `;. Tu 11. } t f DRIVEWAY AND PATIO 67 BELLEFAIR ROAD :M #A ry� nib k ` � y t >' o f Gt `� 1' L f Title No. 231—W-10953 11 6 5 \�sJ -16 J. S O a / ^ S Lor Je lt.1r 5 � \ i k09 a NI Lot 40 $ \ .00o / o -16 \ o •6` Lot Area = 6 SOO sq.ft. Survey of P ro p e rty prepared for 13elle Cam lr Home a Land Company in the Village of Rye Brook Town of Rye Westchester County , N .Y. Scale 1 "=20' Sept . 30, 1999 FoundOlim Sruwy'0 comber JO, 199.9. Cerlircolim added Sept ?7 2000 Amo/Survey Oclober 5 ?MV Aye premises being Lot J9 as shown on a mop entitled ?lensed Subdinsion Atop of prepared/or the salt -'r Nome et Land Company"doted Lkcember 7, 199B, lost mwsBw February 1, /999 and fixed A&V 12 1999 as Couny C/e*,Uop No. ?&U5. Certified to A/&+T Ala?goge Corparalion Fitst American rifle/nsuronce Company of New eo and Harvey SAew tein and Alam4on B. Si%verstein. Note: L/tiliy information shown hereon os per Couny ClenF Atop No. 26190. ?fnouthorirad Moro?/ms or odditi&7s to a survey mop/s a Woolalim of sect/m 7709, rub-e4i�'sri+� ? cJ M-A4w KW*State Edwrotroa Low. ?)n/y copies of the original survey molked with the fond surw. inked or embossed sea/shall be cwsoWvd o hue and valid copy. Z'erti%cohons fndieoted hereon signi/y thol this survey was prepored in accordance with the oDr� ems6179 code o/practice for Land Surveys adopted by the New York State Association of �! "`-��• 4�I/.0 pm/essimol Cond Surveyors Sold certiFications shall run to the person for whom the survey is prepared m/y, and m his behalf to the rrUe Company, gowmmenta/agency and Arnding inshlulion listed hereon and to the assignees o/the/ending institution . CERAf)GA[.WS ARE NOT 7RINSFFR&,f 717 AOD/AOr1G9L INSl7AI;o2 AYS OR SUBSEDUENT OlYNERS. 76 AlomomnecR Avenue Copyright(cf 1999-2000 /Yard Carpenter Engineers Inc. All Rights Reselwd White Ploins, N.Y. 10601 Job - 1 -414 -4 LL L 1 r a L a cn �+ W .r A J Q o r `otieclion ,(/V,, ell f CD Z U c fo ti� 4-4 LiJ r W > E c C Y to L U 1 ri a� r C I 3 i xv .y,r I A C(:)l`RL)l`® DATE(MMfDOIYYYY) �. CERTIFICATE OF LIABILITY INSURANCE 08ro7,2020 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) mast 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 Andre S ant0 ana oS NAME: p P 9 StateFarm State Farm:Andre Spantopanagos PHONE Eaq: 914-481-4747 FAX No, 914-481-5959 as 118 N Main St Ste 2A EA-MAIL andre@myagentandre.com Port Chester,NY 10573 INSURERS AFFORDING COVERAGE NAIC p INSURER A: State Farm Fire and Casualty Company 25143 INSURED INSURERS: JL Pavers INSURER C 111 W Sanford Blvd INSURER D: Mount Vernon,NY 10550 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. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LT TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MMIDDI"YY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,0()0 _bTWAGM R E N CLAIMS-MADE .00CUR PREMISES Ea occurrence' S MED EXP(Any ore person) S 5,000 A Y Y 98-CN-B613-6 12/20/2019 12/20/2020 PERSONA-BAOVINJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY❑JECT LOC PRODUCTS-COMPIOPAGG S 2,000,000 CTHFR II S AUTOMOBNJ:LIABILITY Y Y 286 1433-620-52-001 02/20/2020 02/20/2021 COMBINED SINGE LIMIT S 1,000,UUU a accident ANY AUTO 286 1431-B20-52-001 02/20/2020 02/20/2021 BODILY INJURY(Per person) S A OWNED SCHEOULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS ! HIRED NON-OWNED 286 1432-620-52-001 02Y2O/2020 02/20/2021 PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY Per accident 2861429-820-52 02/2012020 02/20/2021 S UMBRELLA LIAR OCCUR EACH OCCURRENCE S 2,000,000 A EXCESS LIAS CLAIMS MADE Y Y 98-CP-J945-3 06/12/2020 06/1212021 AGGREGATE S 2,000,000 DED ' RETENTION E $ OTK- WORKERS COMPENSATION 7 AND EMPLOYERS'LIABILITY ATUTE ER ER Y 7 N ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICERIMEMBER EXCLUDED? ❑Y N f A Y 98-CN-6618-7 12/20/2019 12/20/2020 (Mandatory In NH) I E.L.DISEASE•EA EMPLOYEE S 1,000,000 It yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S I i DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be aNached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Village Of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street AUTHORIZED REPR48ENTATI Rye,NY 10573 i / I © 8-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORO '0_11496 i32849.12 13-le-2016 STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name&Address of Insured (Use street address only) I b. Business Telephone Number of Insured JL Pavers Inc 914-447-5124 III W Sanford Blvd Mount Vernon, NY 10550 le. NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured (Only required if coverage is specifically limited to certain locations in New York State, i.e., a Wrap-Up Policy) Id. Federal Employer identification Number of Insured or Social Security Number 45-3205938 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) State Farm 31). Policy Number of entity listed in box "I a" 98-CN-B618-7 Village of Rye Brook 3c. Policy effective period 938 King Street Ryc Brook NY 10573 Dec. 20, 2019 through Dcc. 20,2020 3d. The Proprietor, Partners or Executive Officers are ❑, included. (Only check box if nll parinerstofficcrs included) X all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box 'T' 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 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 "T'. The Insurance Carrier will also notify the above certificate bolder within 10 days IF a policy is canceled drte 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 approver/ by the insurance carrier or its licensed agent, or until the policy expiration date listed in bo.r "3c", whichever is earlier. Please Note: Upon the 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 Nvith 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: Diana Novoa (Prig ame f authorized representative or licensed agent of insurance carrier) Approved by: � � �yC'l� DU 01 (S ure) (bate) Title: Licensed Agent Telephone Number of authorized representative or licensed agent of insurance carrier: 914-481-4747 Please A'ole: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are A'OT authorized to issue it. C-105.2(9-07) www.wcb.state.ny.us Laura Petersen From: Clensett Carvalho <clen.oak@jlpavers.net> Sent: Monday, September 21, 2020 2:04 PM To: Laura Petersen Subject: Re: Building Permit - 67 Bellefair Road Here is ticket#09210-001-895. Thank you! On Mon, Sep 21, 2020 at 1:54 PM Clensett Carvalho <clen.oak_,'I avers.net>wrote: No problems, I'll call put in a digital ticket request right now. Kindly, On Mon, Sep 21, 2020 at 1:28 PM Laura Petersen <LPetersen&yebrook.org> wrote: Good afternoon, The building permit is ready for pick up. Our office is open Monday—Friday 8:30am to 4:00pm. The permit fee is $140 (check can be made out to The Village of Rye Brook) I will also need a dig number before I can release the permit. Thank you! Laura (Petersen Office Assistant Village of Rye Brook 938 King Street Rye Brook, New York 10573 Phone(914)939-0668 1 Fax(914)939-5801 ! Iaetersen(&Eyebrook.or4 1 (EEn OZ ,�. OW w N �� c� 0 © � 0>-a o c CCW o� tL, p CL. O � WZ Z O_ W :50 21 . D ' V 0 >m = O Ol Q) oil o 00 y / tea. o� •h q Ln / / 0 (D 0 Ln,xlll(� \ c 4 0-0 C 4-J iL s. /tip LK o 04- ! ood w \ r''' a �` Q Q� �� � 6�1 �► Q � � °v o°', � >1 vei 4-J CD 4-J (n CN 6 .— LIS NI LZ ' /0 4' CP is . 0� .o� b W 0 00 N / �• •y � � Ln kLO h J c0 4a4� �� N lb . a 00 . v I g ° • � 0 �