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HomeMy WebLinkAboutBP20-246� ER M IT # ��-"� `7 � DATE: � � � FJ(P; � % � � � � SECTION �� � , '7 BLOCK LOT /L__"_7 . , . � .: TYPE OF WORK JOB LOCATION OWNE CONTRACTOR �'; L,L, T. COST-=--�--�-i # a� TCO # INSPECTION RECORD DATE FOOTI N G FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING � RGH PLUMBING GAS 0 SPRINKLER ELECTRIC LOW -VOLT ALARM AS BUILT FINAL 1 NSP c� /G�x3�=7 �JL I► � .. • � � •� � ., ����-awl%5���.�1�'s��-10��' �T ,�°. OTHER APPROVALS -: :• .; := OTHER Expired Letter Sent 10/6/2022 �bliy�zz VILLAGE OF RyE BROOK WESTCHESTER COUNTY, NEW YORK - NO: 22-161 Certificate of Occupaucp This is to certify that� �`Cc 'Bach -- of, having duly filed an application on OCC;&db-er 20c2c9 requesting a Certificate of Occupancy for the premises known as, 1"'t': NuS!'t 7 1t% I bbj ae3CW-f Rye Brook,NY, located in a u Zoning District and shown on the most current Tax Map as Section: k2q, Block: / Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. of , issued / / / 20,�;;?,Q, 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: — — �\ Construction: for the following purposes: /�� f/ 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 shail be made,,aou,dalLthe building be moved from one location to another until a permit to accomplish such change has a obt ' om Inspector. Building Inspector,Village of Rye Brook: 31 Date: OCT 2 6 2022 D E C E� V BUILD ENT For office use onl PERMIT# ()- 40 VIL OF RYE K ISSUED: /1-/6 00 OCT 14 2022 8 KING SIRE YE BROOK, YORK 10573 DATE: -tea r O�c FEE: / PAID WOO VILLAGE OF RYE BROOK BUILDING DEPARTMENT 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 iiiftiffi/#/##tiiiiQ!!i#itfitifi#itiitii#fiifflii#iififii##liiiiifitif!#fi#it/�iiti�f i�tl/iftitii##iiftfiiiiiiiii#ffi#iii•#i#####ii Address: �T3 Asti A ko Occupancy/Use: 12,3 Parcel ID#: /�J�- ,lp/-// Zone: Owner: &,,K,6kjA_ Address: P.E./R.A. or Contractor: ,�L Jk-LA/_ -TI Address:3 3/ u A4�1'2(G 2 Person in responsible charge:��� /G�/i j Address: ���7 L11t.��/ 1 4 e.A4 2 671 CG�q 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 41-elo."i Y/ /`ORK,COUNTY OF WESTCHESTER as: 9'�mw ��I ` being duly sworn,deposes and says that he/she resides at �7 , ARO-W 66 5. (Print Name of Applicant) / (No.and Street) in �3.�d� in the County of in the State of ,.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:S /7, �-00 2 for the construction or alteration of /6 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. Sworn to before me this Sworn to before me this day of Omlaw'-" , 20 ZZ day of 20 Signature of Property Owner Signature of Applicant PrintRIJL�41�5; & Name of Property Owner Print Name of Applicant Pub' Notary Public ONNAUMANM Not"Pub1c Of New York t.D.Ol At641646 A/122021 COMMISSION EXPIRES 03/01/2025 �yE f3RC��. O� 2m �o BUILDING DEPARTMENT ❑BBUILDING 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 uS �-1 �W ( � DATE: PERMIT#k L ISSUED: 1 ECT: BLOCK: LOT: LOCATION: \C C'�oc-,, OCCUPANCY: 2— y ❑ 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 In Li is Ali 55 16 (A X 17 t z ta 16 cp te) L16; w �, _ i aI a, m � � w „ W � '� � �� in c rA co Oc f14 07 cpkk cc oc C6 z 96 �" U � � � Cb � $ it 4t a f z u c 96 I ECENE BUILI DE ;MENT DEC 18 2020 VIL E OF RYE OK 938 KING ET RYE F""� ,NY 10573 VILLAGE OF RYE BROOK (914)9 939-5801 BUILDING DEPARTMENT ww" ' ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: Cho '—'D LI& EP#: Q0`Q15) Approval Date: Permit Fee: $ � 16 Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, 1;�p a� 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 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: 112, &.,\, p��p.,✓ CivLSz�.�,� SBL: 12.9.76— 1 — 11-7 Zone: ,U 2.Property Owner: �o rb arA `j Q�� Address: 5 ayy%.i, WS, f4%41 Z Phone#: 9 31 — 9002 `Cell#: email: l V 3.Master Electrician: osr�p� Wo Address: � L a-off \..�. Lic.#: 21� Phone#: �l 7`,—�-�`'�3`` Cell#: emai �L� '-^ `'�1a anoa . c,a v�-\ Company Name: t-t—C- Address: .. \ 1- „A'% \ 4.Proposed Electrical Work/Fixture Count: ********* * ************************************************************************************ T ORK,COUNTY OF WESTCHESTER ) as: being duly sworn,deposes and states that he/she is the applicant above named,and does further (print narki igning s 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 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 ,20 day of ,20 Signature of Property Owner SignattAl A 1 Print Name of Property Owner Print Na of Applicant Notary Public Notary Public • STATEWIDE INSPECTION Service With r 1:1 Main Street,Fishkill, NY 12524 1 emoil:office@swisny.com SWIS JOBAPPLICATION12.7224 I fax914.219.1062 I SWISNY.com • • Office Use Elect.Permit# Date Bldg Permit# Utility ID# Final Certificate# City/Village Zip Township County Address ' y �s� ��•� �-z5 � Cross Street Section Block Lot Owner Name/Address(If different than above) Q Contact Number ` ❑Basement ❑-1st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps Range(s) 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 ECEN DEC 18 2020 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 are authorized to make the inspection and adjust 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 Inspector# Company Name Date Signature Address City/State Zip Code License# Phone# State Wide Inspection Services 1080 Main Street Fishkill, NY 12524 845 202-7224 Phone 914-2194-219-1062 Fax STATE WIDE INSPECTION SERVICES Email: office@swisny.com 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: Steadfast Home Improvement Barbara Bach 5 Carpenter Place 143 Brush Hollow Crescent Yorktown heights, NY 10598 Rye Brook, NY 10573 Located at: 143 Brush Hollow Crescent, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP20-251 129.76 117 Certificate Number: 2021-6128 Building Permit Number: BP20-246 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: 143 Brush Hollow Crescent, Rye Brook, NY 10573 The First Floor Kitchen was 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 23rd day of November 2021. Name Quantity Rating Circuit Type AFCI/GFCI Receptacles 07 Dishwasher w/Disconnect 01 Disposal w/Switch 01 Officer: Frank 1. 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. m N cc ` C s _ O IL .� S ad • �..� r- Z o0 00 • O In � w . O N - t W z O ^Q z O N $ Gz7 n Z y = .. 3 oc O00 U i W ►�-� �, z N N o6 O Z z Zw cwG C CN r� W .r w nFr Q C T if. g W i Z TWOQ C ' 0 W a w d • QI OCi C. r71 41 ml WWI2 v<i c S� BR BUILI ��E MENT VILGE OF RYE OK NOV _ l 938 K]Ndi` ,'i ET RYE B ,NY 10573 www7t or ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: ZDO— CD L1 �Q EP Approval Date: NOV — 3 1 Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, 11 1 21 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 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: I A 3 prv.S\-% ``►\-A .0\ 0 �.-,VSC.Cv\A4 SBL: 12�1-% —� ' 11-7 Zone: Py� 2.Property Owner: 1�0•Y ba�t. ` 44w 1 Address: Q.\b oVZ.- Phone#: - "Q 00Z Cell#: 11A-S�-B-0"I email: h v`^�� `•�� 3.Master Electrician: �O;b. F AA M;.Ao Address: L��;Ate. r�� �. , iS--�.iate', N Lic.#: 212 Phone#: Cell#: email: �t�� ya�.ae . �•.,., Company Name: � Tw— WV4• C-t'C- Address: bA\A^-tt; a S abovz 4.Proposed Electrical Work/Fixture Count: ��i�� ^V�-ci l�011­a� ********************************************************************************************************* STATE 1OF NEW YORK,COUNTY OF WESTCHESTER ) as: _,being duly swom,deposes and states that he/she is the applicant above named,and does further (print nano of indicidua signing as the applicant) � r state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the C-0" 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 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 befor me this day of 20 day o Signature of Property Owner Sign ture o pp is �v Print Name of Property Owner Print Name dY Applican Notary Public Notary Notary ublic,State of New York No.01FR6363711 Qualified In Westchester County Commission Expires August 28,20 Qn�nn�i STATEWIDE INSPECTION SERVICES, INC. Service With bilegritv 1080 Main Street,Fishkill, NY 12524 1 emod:office@swisny.com SWIS JOB APPLICATION tel 845.202.7224 fax 914.219.1062 1 SWISNY.com I SWISTraining.com Office Use Elect. Permit# /�a Q� Date Bldg Permit# Utility ID# ap Final Certificate# City/Village L Xa o�\ zip 1 U' 3 Township County Address p 1 e\ \� C Cross Street Section Block ` j�Lot It, Owner Name/Address(If different than above) 1 p `� Contact Number y 11 _ S�� _066\ ❑Basement ❑1st FI. ❑2nd FI. ❑3rd FI. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside �"�esidential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps Range(s) 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 �:\�(' l 'shy �SOo,�,,,�� �� �� �N�>✓`'\ coV A u1A� f NOV - 2 2021 1 VILLAGE OF t`r'E BROOK BUILDING DEPA 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 are authorized to make the inspection and adjust 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 C 1 Date Finalized Inspector# l Company Name �f. c �� Date ' _ Signature Address S T \ r \` (tea City/State av` s�, 1 M Ip C d License# 2 �1 Phone# State Wide Inspection Services 1080 Main Street Fishkill, NY 12524 a 845 202-7224 Phone 914-219-1062 Fax STATE WIDE INSPECTION SERVICES Email: office@swisny.com 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: Steadfast Home Improvement Barbara Bach 5 Carpenter Place 143 Brush Hollow Crescent Yorktown heights, NY 10598 Rye Brook, NY 10573 Located at: 143 Brush Hollow Crescent, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP21-282 129.76 117 Certificate Number: 2021-6127 Building Permit Number: BP20-246 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: 143 Brush Hollow Crescent, Rye Brook, NY 10573 The Hallways 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 23rd day of November 2021. Name Quantity Rating Circuit Type Panel 01 150AMP V J 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. Ln in C N N N N Gti ;D a = y Im z Q i lo-gz 3 _ 6 co x �-, A► W W O v W z N044% .c z p T roll Wz F ^, o ° 8 3 � o c _N r•+ �L F• W � � � � r Q�I m Ca R C C� [� ��.E__ BUILDING DEPARTMENT DEC - 9 2020 3D VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 FAX(914)939-5801 ; BUILn!NG DEPARTMENT www.ryet:(jok.org PLUMBING PERMIT APPLICATION 1,, / FOR OFFICE: USE ONLY BP q 40 PP#: CDO—/ 1�S6— DEC - 9 2020 Approval Date: Permit Fee: $ /�� Approval Signature: Other: Disapproved: (fees are non-refundable) ******************************** **************************************************************** Application dated, / 9 ao 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 etu l that said plumbing work will be in conformance with all applicable Federal, State,County and Local Codes. 1.Address: /-/.3 ACU S 1& CJ C�J�iC.s LC K r SBL: /t �9. 7b "1-1/ 7 Zone: Pub 2.Proposed Work: rC.GO/1^e,k- jG I t`G�C h S ' , `-t . 3.Property Owner: ,t /Gl Sac.; Address: / rus °M.w CLS CC.� Phone#: 9/y— 9.3 *7- 90 aao- Cell#: email: 4.Master Plumber: / L"_U fr o// Address: Kevin M Brady Lic.#: y L g Phone#: Cell#: 7 7y —11, N^emaff lumbing&Heating Co Inc PO BOX lurts Company Name: Address: Rve,Now York 105M 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 I st Floor ' 2nd Floor 3`d Floor 4 Floor 5` Floor Exterior 5.* List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) 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 Sworn to before this day of 20 day, 20 Aa""- Signature of Property Owner Si lure of Applicant Print Name of Property Owner Print Name of Applicant Notary Public Notary Public 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 �C� COM� BUILDING DEPARTMENT R 3D VILLAGE OF RYE BROOK DEC - 9 2020 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 FAx(914)939-5801 VILLAGE OF RYE BROOK BUILDING DEPARTMENT ww•w.I-y,�brook.org _ _.__...... .. ..___... 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 YORK, COUNTY OF WESTCHESTER ) as: 31, �Q,(6� �► , residing at, (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; 7.3 &JA /7 d f l0 w C re S c-.t_,. r , Rye Brook, NY. (Jot)Andre,;) 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. 9 9ewdIz - (Signature of Property Owner(s)) (Print Name of Property Owner(s)) Sworn to before me this day of 120 (Notary Public) -3- 3/21/19 QyE DR O t c' (� 4t" anniuwaW VILLAGE OF RYE BROOK MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A.Klein (914)939-0668 Christopher J.Bradbury www.ryebroo�k.orQ TRUSTEES BUILDING & FIRE INSPECTOR Susan R. 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 mizzo e,ryebrook.org /to cc: Steven E. Fews,Assistant Building Inspector Tara A. Orlando,Planning&Zoning Secretary Laura Petersen,Office Assistant 0 ti Ln O I O w O i � C) Ln N ` L a �r0 0 N O O r j M v Ln v O V o 0 v O Cdxz � � O S. en CQCQ CC1 � pG M n Y c 00 Z SEW Yp W Y p 30*4 W d V Q J on J c \ Y M Building Permit Check List&Zoning Analysis Address: l`A� ��/a tl t� L- o t,-) (fa;-,S SBL: 7 ZoneT,j Use: � Const Type: Other. Submittal Date: t k Revisions Submittal Dates: Applicant: Nature of Work: (-C-�ZPOP C, _ i`°_-Dyc-VTZ 0t.4 Reviews:ZBA: NOV - 9 2020 pB. BOT: Other. OK z �3. — c( ( ) FEES:Filing. Z S•�BP: /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:Dates tamped: Sealed Copies: Electronic: Other. ( ( ) License: V Workers Comp: Liability �mp.Waiver. Other. ( ) ( ) CODE 753#: Dated N/A: (Jl ( ) 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. (J� ( ) 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. ( ) ( ) 2020 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: APPROVED REQUIRED EXISTING PROPOSED NOTES NOV — 9 2�2� Anew �SZlZ Circle: Fron Front: Front: Sides: fir. Main Cov Accs.Cov Ft S S .HS : a Tot,imp: PP HHigk Stories• notes: Laura Petersen From: Laura Petersen Sent: Tuesday, November 10, 2020 1:24 PM To: HOFFNBACH@GMAIL.COM Subject: Building Permit Application - 143 Brush Hollow Crescent The building permit application has been approved by the Building Inspector, before I can issue the building permit the following items must be submitted to our office, ZGeneral contractor's contact name & phone number. Copy of general contractor's valid Westchester County Home Improvement License. ✓ 3. General contractor's valid liability insurance (the Village Of Rye Brook must be the certificate holder) /4. General contractor's valid workers compensation on a NY State Board form (C105-2 or U26.3) 5. Building permit fee $263.00 (due once permit is issued and ready for pick-up) This information can be emailed to me. Thank you and have a great day! 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 1 Ipetersen(cD[yebrook.org � Vl �9�"a Aa I OF r ){p1{ {)i�,",�- �+1 11 A% n o CL O = = Y« CN x \�t' B lL •� U 00 N as to -90 \v O L �� O 1 G 4-00 O ,ct LLJ a y o •° �pteCtion ct Of :• UJ Of W y a • ►. ,,� J W m o N daG Ci 0 of �C Z .I,���i � O ��T�<r`,•?fit -ffi A L z�• MU rr i OCN ... O d O CV) �� 61 W h U U •a. i v U i .aY. �f(R:i)Dyylu4�� c` 1 1'r'z=.�\^��?a::?1 += si'crc ?a'.• �:.3�_ ,c ^ .; ._ 'Ln— ``.Q':e:. _:y;i i �O)D 0 s p �N, ►{�NI 4 1 "'d #A��. 1r ♦1�� t1igAt"t �.11 1 )A{1 �1♦ RRA �.11g F[gA81s�, g11 Ail!. g1/ Ai� ♦ 7�A � "' '_�• l: i �fii .�. _, tsh i .�+.: Clf.. �9 �. I D v1�'",�,� r) � fit+ 4sD� ;q}� gL I 'k o f J 4 DATE(MN9DD/YYYY) AC_C>1?1X CERTIFICATE OF LIABILITY INSURANCE 11/17/2020 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 Danielle Kramer Albano Agency Insurance PHONE (845)621-1000 FAx 845 628-7421 566 Route 6 Bldg.#2 lac, AIC Nol: ( ) E-MAIL ffice�albanoinsurance.com Mahopac, NY 10541 ADDREss: INSU S AFFORDING COVERAGE NAIL• MUNERA: MAIN STREET AMERICA ASSURANCE CO 29939 INSURED JL Carpentry LTD INSURERB: 33 Quaker Ridge Rd rNsuRER c Bethel, CT 06801 INSURER D 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. ~ TYPE OF INSURANCE ADDL SUBR r POLICY NUMBER POLICY EFF POLICY EXPLTR O A COMMERCIAL GENERAL LIABILITY Y MPV17636 07/22/2020 7/22/2021 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED rJ00��� r,LAIMS-MADE OCCUR PREMISES Ea occurrence $ MED EXP(Any one Person) $ 10.000 PERSONAL&ADV INJURY $ 1,000,000 GENL AGGREGATE LIAR APPLES PER: GENERAL AGGREGATE $ 2,000,000 / PRODUCTS-COMP/OPAGG $ 21000,000 �/ POLICY JE�CT- LOC OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per ao*Wd) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UN13REL A U AS OCCUR EACH OCCURRENCE $ EXCESS LAB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION I SEAT T ORH_ AND EMPLOYERS'LIABILITY Y/N AWPROPRIETORPARTEWEXECUIIVE ❑ N/A E.L.EACH ACCIDENT $ R OFFICEMEMfiER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if nhore 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 Ryebrook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King ST Port Chester, NY 10573 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 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 J.L.Carpentry,LTD 33 Quaker Ridge Rd From:Village of Rye Brook NY Bethel,CT 06801-1253 PHONE:203-730-2919 FEIN:XXXXX8276 The location of where work will be performed is 143 Brush Hollow Crescent,Rye Brook,NY 10573. Estimated dates necessary to complete work associated with the building permit are from November 18,2020 to December 18,2020. The estimated dollar amount of project is $10,001-$25,000 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 one person owned corporation,with that individual owning all of the stock and holding all offices of the corporation. Other than the corporate owner,there are no employees,day labor,leased employees,borrowed employees,part-time employees,other stockholders,unpaid volunteers(including family members)or subcontractors. 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,John Luhrs,am the President 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 tlwg6vemment entity listed above. SIGN i.'.. HERE Signature: Date: he zc.-,g Exemption Certificate Number A 4 Received 2020-063714 November 17, 2020 4 S.'' 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