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HomeMy WebLinkAboutBP20-229PERMIT # Aocx) �;) DATE: a EXF SECTION / Q r 73 BLOCK )J LOC/I TYPE OF WORK r/ Oe� el7/�c'�7 Q7"7 10B LOCATION U2 Z Q il" BOCCI OWNER_ David ko6el CONTRACTOR_ Ej5T. COST 5m O# TGO # FEE DATE INSPECTION RECORD DATE I NSP FOOTI N G FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING V�- RGH PLUMBING GAS 0 SPRINKLER �{ -�- ELECTRIC Ll 7'dV'��3 AY LOW -VOLT C7 ALARM C� A� BUILT L7 FINIAL ja' zqop sse RD Aiolho4lf Aucc/ C91 y),)55�,T313 �f t�ll;y- I31 OTHER APPROVALS ARB BOT Pf3 ZBA OTHER Expired Letter Sent 10/6/2022 VILLAGE-PV-Rk,XE BROOK WESTCHES COU I"I', NEW YORK NO: 24-137 Certificate of Occupancy 'Chis is to certify that,1)1) vi Lobel a b it-) LQ be of, Rqc )qy6611,r 7 , having duly filed an application on JV l 20 /� requesting a Certificate of Occupancy for the premises known as, &)le rol� MOCID/ , Rye Brook,NY, located in a PU D Zoning District and shown on the most current Tax Map as Section: )c2/) T5 Block: / Lot: b 9 , and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. �� / , issued �� o� 20 �6), 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" / Construction: JW , for the following purposes: '�'r-CY 1 /�I �� o-/ / / 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 hei t shall be made,no . 11 building be moved from one location to another until a permit to accomplish such change ha bee btain m th B it ng Inspector. Building Inspector,Village of Rye Brook: Date: OCT 3 1 2024 E DD D E C E N BUILDING DEPARTMENT For o>i'tice use oniv. EAR:- 2022 VILLAGE OF RYE BROOK P RMI# %22- 9 8 KING STREET,RYE BROOK,NEW YORK 10573 DATE: d� VILLAGE OF RYE BROOK (914)939-0668-FAx(914)939-5801 FEE: PAID BUILDING DEPARTMENT wwwxyebrook.ore 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 ##/i�#4/ift#ttQ#t#tt####/i#ii#ifiiffikifittfQ#####4#HiDi4ififiitftft###i#i4#f##ftiitfiitfittt##tt#tt###4#i####tiiiittit#tt#fft# Address: 7b Pel�G t`9.r /�}'G nA',.- C7 /t/? / ,,103-7 3 Occupancy/Use: �'t h Parcel ID#: �OC 4. /3 -/- Co% Zone: P V Owner: Agile lroSel Address: yV Bc Ile A,,- /Q�/QL� B-ao /,-.V P.E./R.A.or Contractor: fn_yW/✓ej Con �+�sds s Address: j ��qh !� S�r�c/a� /�/qcr f'o.�rE�ir /t'f' /c7 Person in responsible charge: AACIAy rSc C. Address: $' Foxwmad Lg,,P T7ta�.rt..��ivy /osys Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance ofaCertificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW YORK,COUNTY OF WESTCHESTER as: u/ fiiVG being duly sworn,deposes and says that he/she resides at -/b Be , (Print Name of A licant) / J (No.and Street) in yP ra o k ,in the County of Lv C s7 ��S 7 ��/ in the State of�,that ( ity/rown/Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements,labor, materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$ t'I -4 -�4aq 5`t� for the construction or alteration of t'l C 4 i n -�— 9 T h/a3c 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 §250-10.A.of the Code of the Village of Rye Brook. �y Sworn to before me this ' Sworn to before me this -\ day of , 20� day of ra , 20 Signature of Property`Owner \ Si na of Applicant CA�J�c/� h O J.t c C e rint Name of PjopeA O er ` Pint Name of Applicant Notary blic I-dINA i iC SHAF P LO NOTARY PUBLIC,STATE OF NEW YORK Notary Public, QUALIFIED IN WESTCHESTER COUNTY ry biic, State of New York REG.#01 D16216118 No.01 ME6160063 3/21/19 [AY COMM.EXP.JAN. 11,2e" Oualifled in Westchester County ZpZZ C0mmis51on Exnirns Jarttla-"P9.20 �� �yE BRC�v� cu � 1932 BUILDING DEPARTMENT ❑I)UILDING 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 : 4 b �' `Lp -A g`_ DATE: ,f %- cr- PERMIT# if ZO- -2_ Z. I ISSUED: I SECT: BLOCK: LOT: b ` LOCATION: �r� ��A V_ a. 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 4-J N -J ❑ L.P. GAS ❑ FUEL TANK h; ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL ❑ OTHER QyE BR(��. O� tim 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR fiff"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: LA V 2 `1` � i r cL,(� DATE: l f PERMIT# �� Z-Z- l ISSUED: [f ( 1h, 1 SECT: BLOCK: LOT: LOCATION: q C\\ 1�16( �'� OCCUPANCY: �. V ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION /f 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 ■ ■ , � o o � ■ N N N W \ � W fs+ N w rA o H i F Ca W Q , , � M W -+ N-1 � � O � ■ co,; , O s A�• � � T� � Ni W z w O C� ' r-i �00 0-4 O z \ m C 00 w I w ` O � � " � Z . C7 Q z wlut _ N ait w � = W MMC .� v H w ,� 5 y , M1 MCI r °� W A � Of w A ' V p a N zz W a w N x � i--� N _ AIt ■ W ,0 ^W O OF 11 O Cn ■_ l W F--i .� V V O w z CL, z w z A o � a A o w , DD BUILD �E Ry MENT JAN 3 0 2023 VIL E OF RYE OK _ 938 KING .ET RYE B ,NY 10573 VILLAGE BROOK BUILDING DE R I TNIENT wwvy (,jo mug ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians I i--nse Required �/ 1 FOR OFFICE USE.ONLY BP#: EP#: MArn 2023 Approval Date: Permit Fee: S Approval Signature: Other: Application dated,I is hcreb 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. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: �/6 �e //,f'� ' !\`� - —SBL: /c-)7i 7,3 Zone:A6 f -- 1 2.Property Owner: A{ v f Loh C I _--- -- Address: GJ ��Ile r-,r j �e+ Phone#: (F17-S//1-37 Z Cell #: — email: Y 1e6 r�.e?) e'o r� 3.Master Electrician: 0 J��D 7F 0 I� _ -_ _ Address: 31 , ae aa/!�f Lic. #:�D�,� Phone N: ✓ Cell #: Qly;jS6 tit email: Company Name:, ;U�l�c���_ G� —Address: 3 f l,O+h�y Grvr�nS/fj./1c � �( 4.Proposed Electrical Work/FixturcCount:_ � I( ra 4IDh 4F It �11is� UP /l'1/i1 ar d I,,Z&J4"(1 a! y dtvm�hoi�>'s I� •ee !!/f �/ .sc„,�ch� , n,Slit,, r Nm.-O/ v use _ S.3'a Party Electrical Inspection Agency: Wz )� a6eer- iw I STATE OF NEW YORK,COUNTY OF WESTull-STER ) as: ! 'C�o /UI__ _,being duly swum,deposes and states that he/she is the applicant above named,and does further (print nay of individual.jgning 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 far the legal owner and is duly authorised to make and file this application. (indicate architect,contractor,agent,attorney.ytc.) The undersigned further states that all statements contained herein arc true to the best ofhis/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will he in conlonnance 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 Cpd f the Village of Rye Brook and all other applicable laws,ordinances,and regulations. Sworn bclbre me his _ Sworn to before me this_ 5J day of {/-/ 20 day of L 1 20 Signature of Property Owner Signature of Appfijdht Print N c of Pr p rt cr �� Print N c of Appli antes Not f ERIN A!PA A DA r'�,1 Notary Public 1� ''blic, State of New York No. 438d001 L QusljW in viesichester Cou� Commission`E` iTes March 2* ��' 6i23/2022 INSPECTIONSTATEWIDE 0:0 SWIS • 0. Office Use Elect Permit t Date IS Bldg Permit# Utility ID# Final Certificate# City/Village �% Zip Township County Address i ; Cross Street Section Block Lot Owner Name/Address of ddferem than above) ' Contact Number 1 EDBasement 1st Fl. ❑Znd Fl. 3rd Fi More Than 3 Fl. Garage 0 Attic Outside O Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps j ;« Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent SERVICE Amperage Voltage 1 P 3P #Meters #Disconnect Underground New Reconnect Overhead Change Visual Re-Inspection Safety Re-Inspection Re-Inspection Additional Information r IFC CAVE FI 9 ' AN 3 0 2023 I VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application Is valid for one(1)year from the date received by SWis.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 ere aulhsorized to make the inspection and adiust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other inspection company.The applicant.owner or authorized agent agrees to all the above terms and conditions as set forth for the application Inspector Date Finalized tnspector# Company Name Date Signature Address City/State Zip Code License# Phone# ® E C LE � V LE State Wide Inspection Services 1080 Main Street SEP 2 5 2024Fishkill, NY 12524 U S 845 202-7224 Phone as SWO rK914-219-1062 Fax STATE WIDE INSPECTION SERVICES VILLAGE OF RYE BROOK Email: officeCcbswisny.com BUILDING DEPARTMENT Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: D Tapia Electric, LLC David & Robin Lobel 37 Stone Avenue 46 Bellefaire Road Ossining, NY 10562 Rye Brook, NY 10573 Located at: 46 Bellefaire Road, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP24-131 124.73 1 69 Certificate Number: 2024-6552 Building Permit Number: BP24-128/BP20-229 A visual inspection of the electrical system was conducted at the Residential occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at: 46 Bellefaire Road, Rye Brook, NY 10573 The Basement and First Floor Kitchen were inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 20th day of September 2024. Name Quantity Rating Circuit Type Receptacles 12 GFCI 02 Switches 04 Hood 01 Range 01 Dishwasher 01 Refrigerator 01 Microwave 01 Luminaires 14 A Visual Inspection of existing conditions was performed on September 201h, 2024 of the Basement and First Floor Kitchen and Conforms to NFPA 70-2017 NEC. No Defects Were Noted. I. Officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. = A r _ o s Rr nor w ^ \D C CL M1 O V y �" :L 04 _ M C z M \c IV A v o F G 09 Ln a .. J � 00 ;r ^" a] ' _ w z - w A00 09 v z 00 ot �. Cf< v� V O o o ? ZZ z 0-4 s M U O w z r M+i V F Q O V A . �.y - z W. < i, 4 p((� E �WC BULL, E MENTR JAN 30 M3 VIL E OF RYE K 938 KIN , , ET RYE B � , DD NY 10573 VILLAGE BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required 7 FOR OFFICE USE ONLY BP#: - ' '9 . 1 F;1' #: , _ �ll/ MA�j 202 Approval Date: Permit Fee: S /J G 0 Approval Signature: Other: Application dated,I-30-:a3 is hereb 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. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. q Q/,/� 1.Address: L/� /oe SBL: �e�7� 3 I-& / Zone:A6 2.Property Owner: P<_ c 1 Go l Address: LJ 6 4�'e Ile il� c j 1<j Phone#: g17"f/y'-i7Z Cell#: email: 0 Lo6r�,0) /'6P/5 .t'o r" 3.Master Electrician: i,eS el T 1 � d Address: 3 1 <- -k/]p az'le�f Lic.#%2eal Phone#: Cell#: email: Company Name: cif LLG Address:'T3 7!V� e7 gj:! 4.Proposed Electrical Work/Fixture Count: Z 4 iQ t') Q / ar d I,zu v �. (e 1 to e I y um,hoy S . >���s o sti•,�ttie�Q shy �>,me� _ S.3"'Party Electrical Inspection Agency: c 1/ �I(>, ! 125, e j04 ,5Z r y Ce':9 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: D/LC D _Q D/Ul ,being duly Swom,deposes and states that he/she is the applicant above named,and does further (print narlWof individual.igning 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 for the legal owner and is duly authorized to make and file this application. (indicate 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 Ik 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 Cp�e,�of the Village of Rye Brook and all other applicable laws,ordinances,and regulations. S71p � Sworn before me his � Sworn to before me this day of -ear ,20 day of r\ ,20 Diew Signature of Property Owner Signature of Applic t CIL „L & vn 'p Print N e of P p ^r �� Print N c of Appli ant No ER1N AIDA A 0A[!PA Notary Public blic, State of New Yttdi �:nt,.v,Public,St2t^1.I No. 4384001 QualijW in o+eslchester Cou 1 Commission March Z� 6/23/2022 STATEWIDE - (A—) Service Widt Integrity 0:0 Main Street, Fishkill, NY 12524 1 email: • SWIS JOB APPLICATION0. Office Use Elect Permit q Date� Bldg Permit A r i Utility ID At irS3 IV Final Certificate# City/Village R Lp Township County _ fop` Address Cross Street Section Block Lot 1 Owner Name/Address(If different than abowl / Contact Number f' Basement 9 1st FI 2nd FI 3rd F1 More Than 3 F! Garage Attic Outside XResidential OCommercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps Range tsl Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Inc andes ent Fluorescent SERVICE Amperage Voltage 1 P 3P N Meters N Disconnect Underground New Reconnect Overhead ❑Change Visual Re-Inspection Safety Re-Inspection Re-Inspection Additional Information MId RFjAN � C �U 3 0 M23 DDI VILLAGE OF RYE BROOK BUILDING DEPARTMENT "us application is valid for one(1)year from the date received by SWK This applkNton is intended to cover the above Haled items to be inspected if at time of in arty tpectson addmonat items haw Wen tnuaWd,you an author med to make the inspectiort and adfust the fee for the addltionai items inspected The appkcarif declares that there is no open applications for the above address with"other inspection company The appkar*owner or authorized ag"agrees to ax the above terms and cortdittom as set forth for the application Inspector Date Finalized Inspector N Company Name �-+-Lt JLv� 'G L Date Q Signature Address r C,ty/State l� Zip Code License M Phone M 01 0 � cm N w c , cn Oro --� o M .° MEN) O W PLO WLLI co ;.TO AOno 4 �. U tn W z N o Atn0-0 oc a , z t ce fio� w aF 16 � z Q � •• ° a w � a o �I co a J M 401 S BUILDING DEPARTMENT ID VILLAGE OF RYE BROOK DEC 1 4 2020 938 KING STREET RYE BROOK,NY 1057 VILLAGE OF RYE BROOK (914)939-0668 FAX(914)939-5801 BUILDING DEPARTMENT www&ebrook.org PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: �'-c� / PP#: C)o Approval Date: DEC 1 5 MO Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, /vZ / 41LJO is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove Plumbing as per detailed statement described below. The applicant&property owner,by signing this document agree that said plumbing work will\\ R be in conformance with all applicable Federal,State,County and QLocal Codes. Q>' 1.Address: 6 6e ill. 4 i e 9d e �l-oo t SBL: � , 73- 1-6 I Zone:/ N 2.Proposed Work: y5 1 4_ �� c, l✓t )��/`?o 3.Property Owner: !moo ,�e Address: y9 Phone#: 1/7-S/1/- -j7 2 Cell#: email A V 4.Master Plumber: C�Q rn\1 d o Zj Address: P U B o k / Yn r) �P� p oy Lic.#: .s Phone#:qlr-3 C- D/4Y Fj Cell#: f -3 8 'tl Z( 6 email:(gyp rah P roll 4 (2 'Qe-) . Lb►'✓A Company Name: (J C C I I ✓1 C - Address: 0 Oy INDICATE FIXTURES& LINES TO BE INSTALLED AS PER THE 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 1 st Floor I Z 2nd Floor 31 Floor 1 411 Floor 51 Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -1- 3/21/19 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 "9, 57 Sworn to before me this LA +tl day of ,20 Z day of q° bw- 20 cID Signature of Property Owner SI of pplicant t a-*V-A (,-�' Q am V P 'nt Name of Pr weer Print Name of Applicant Notary Public WTAirl PUBLIC, TATEOF::EW YORK N i J OUAL15 IED 1?4 V.EvYCHES TER CCUN I"Y No ary ublic,State of Newyork REV.401U162 6118 Qualified in Bronx Coun No.01BA6356241 SAY CO"!P,A.EXP. IA*-!.11,201T L;Qmmi Sion Expirres March 27,2021 This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s)of the subject property, and the applicant of record in the spaces provided. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- 3/21/19 D BUILD MENT ViL E oR OK DEC i 4 2020 938 KING `ET. NY 10573 (914)9 39-5801 VILLAGE OF RYE BROOK BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR 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 YOR/K, COUNTY OF WESTCHESTER ) as: 1 3J, ' ) a ,-/. � L-o h t` , residing at, t'I ep��x Ro .,a @� t-U��� , ✓`'7 (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 at; �(6 -0 F- 1JV Nz c � � � 3 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 from the subject property in accordance with all State, County and Village Codes. i (Signature of Property Owner(s)) (Print Name of Property Owner(s)) / Sworn to before me this / d of , 20 (Notary Public) JINN CJCJL.) 1ti:J'l ii'?v pupu.c,wrl--'of t"E!MAtwK. t Y -3- 3/21/19 y Y 40* Cann emowV VILLAGE OF RYE BROOK MAYOR 938 Bing Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A.Klein (914)939-0668 Christopher J.Bradbury www.ryebrook.org TRUSTEES BUILDING & FIRE INSPECTOR Susan K Epstein Michael J. Izzo Stephanie J. Fischer David M.Heiser Salvatore W.Morlino October 6,2022 Dear Rye Brook Building Permittee, It has come to the attention of the Building Department that your Building Permit has not been closed out in accordance with Village Code and is now expired.All Building Permits have a twelve (12)month lifespan starting from the date of issuance,and the permit expiration date is noted on the front of the permit. Please note that there is a non-waivable Expired Permit Fee of$500.00 now due in connection with your expired permit. Once payment is received,your permit will be reinstated for a period of six(6)months. Please be advised that it is a violation of Village Code to fail to close out a permit,and that a court summons could be issued,and fines may be imposed on the permit holder and/or property owner for failure to apply for and obtain a Certificate of Occupancy(C/O) or Certificate of Compliance (C/C),in accordance with Village Code section 250-10A. Please note that Temporary C/Os&C/Cs are available in accordance with Village Code section 250-10B should you require more time to perform whatever work remains in order to complete your project. Thank you for your attention in this matter,and please feel free to contact this office should you require any further information. Michael J.Izzo Building&Fire Inspector mizzong.ryebrook.org /to cc: Steven E. Fews,Assistant Building Inspector Tara A. Orlando,Planning&Zoning Secretary Laura Petersen,Office Assistant 0 LOCD O a o � M M O s.4 O c 3 � v z ci !+ —0 ca O 1., O O y Q � M n Y _o ® i CO Z �E W Yp LLJ cc CC �O39d��\C W v V J of > Y CC M Q• Building Permit Check List&Zoning Analysis 't Address: 14 b L,L �1 /-- —7 > - SBL. i ZT • -7 3— t Zone^,_,�'&t! Use: 2-1 Const.Type: �� Other. Submittal Date: 1 0 1 Z Revisions Submittal Dates: Applicant: Nature of Work: t Lj—t�F4Z_t 0!l— Reviews:ZBA: PB: BOT: Other. OK ( ( ) FEES:Filing. S- BP: 7�'o C/O: Legalization: ( ) (�APP: Dated: ✓ Notarized: SBL: --truss 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 tamped Sealed Copies: Electronic Other. ( ( ) License Workers Comp: Liability. Comp.Waiver. Other. ( ) ( ) CODE 75 #: Dated N/A: (� ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit: N/A Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit: N/A Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H.W.I.C.:_Battery:_Other. (� ( ) PLUMBING Plans: Permit: Nat.Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A: Other. ( ) ( ) H.V.A.C.: Plans: Permit: N/A Other. ( ) ( ) FUEL TANK:Plans: Permit: Fuel Type: Other. O O 20I7 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other. ( ) ( ) Other. ( )ARB mtg.date: approval: notes: ( )ZBA mtg.date: approval notes: ( )PB mtg.date: approval notes: REQUIRED EXISTING PROPOSED NOTES AFPROVED Area: Date- OCT 2 12020 Circle: Fr n e Front: Front- Sides: Rear. Main Cov Accs.Cov Ft.H Sb: S .H Sb: SOFA: Tot,Im : E IMP: Parking Height/Stories: notes: :_ ^ �.�.. ..Al: =`:1Rv� _.t. ,,''.�jv�� `y(�,..-w• r kr+ .�_ -,A ,�y�,K.?�s.A :C?""t�rr A� «kj�y '�iA'• 1 i V � �. y. .�.a• ��W.. y �i�4!'r1��. V �41JS�'. 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AC"RE)® DATE(MM/DDYYYY) `� CERTIFICATE OF LIABILITY INSURANCE 10/14/2020 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 endorsement(s). PRODUCER CONTACT Cole Lahey NAME: PF Northeast Brokerage Inc A/CONE. EXt: (845)223-8107 FAAc,No): (845)227-8816 1035 Route 82 E-MAIL clahey@pfnortheast.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Hopewell Junction NY 12533 INSURERA: Ohio Casualty Ins Co. 24074 INSURED INSURER B: American Fire&Casualty Co. T Squared Contracting Inc INSURER C. 157 Tibbetts Road INSURER D INSURER E Yonkers NY 10705 INSURER F COVERAGES CERTIFICATE NUMBER: CL2052811635 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, I NTRR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD YYYY MMIDDYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 _177MAGE TO RENTED CLAIMS-MADE � OCCUR PREMISES Ea occurrence $ 300,000 X Contractual Liability MED EXP(Any one person) $ 15,000 A BLO55885582 12/11/2019 12/11/2020 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED BA055885582 12/11/2019 12/11/2020 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LAB CLAIMS-MADE US055885582 12/11/2019 12/11/2020 AGGREGATE $ 5,000,000 DEC) I X1 RETENTION $ 10,000 $ WORKERS COMPENSATION X STATUTE EORH AND EMPLOYERS'LIABILITY YIN 1,000,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE NIA XWW58749528 O4/02/2020 04/O2/2021 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Provided it is required by written contract,the following are named as additional insured as respects general liability with regard to the insured's ongoing operations under form CG8810 0413,to the extent provided therein:Village of Rye Brook. 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 REPRESENTATIVE Rye Brook NY 10573 C*(C. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a. Legal Name& Address of insured(Use street address only) 1 b.Business Telephone Number of Insured (914)965-5955 T Squared Contracting Inc. 157 Tibbetts Road lc.NYS Unemployment Insurance Employer Yonkers,NY 10705 Registration Number of Insured Work Location of Insured (Only required if coverage is Id.Federal Employer Identification Number of Insured specifically limited to certain locations in New York State, i.e., a or Social Security Number Wrap-Up Policy) 36-4697199 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) American Fire&Casualty Co. 3b.Policy Number of entity listed in box"la" Village of Rye Brook XWA58749528 938 King Street Rye Brook,NY 10573 3c. Policy effective period _4/2/2020 to 4/2/2021 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 "Y' 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 holder 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. 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 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: Joseph W.Pires (Print name ofthorized representative or licensed agent of insurance carrier) Approved by: 1 *`/r4t r 4 10/14/2020 (Signature) (Date) Title: President—PF Northeast Brokerage Inc. Telephone Number of authorized representative or licensed agent of insurance carrier: (845)223-8107 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(9-07) www.wcb.state.ny.us a e= _ 1 E • ap ILF COPY ..: li M� F rtl 3 t ;a _ ! i i S13L# I , T t 5 LG[t� �� DATE APPR MV/��D �� lJ` F RYE BROOK 1` — iVlENT�4 BUILDING INSPECT® , illage of Rye Brook, NY I+chen r� 4 �',�`"' i F 4 wry a � If -iJOW 9 i i • ,6 i ■i a 1 ■ ,1 ' qS. 1� ��C i v H _ _ � t r 4'. Alamo r l6 �Z- . - U lkn .. ,..- � 0•