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HomeMy WebLinkAboutBP21-060PERMIT # SECTION TYPE OF WORK JOB LOCATION FEE DATE.__ INSPECTION RECORD ``D^ATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION -/ PLUMBING L1C RGH PLUMBING —y- GAS o V SPRINKLER ELECTRIC LOW -VOLT ALARM AS BUILT Q FINAL iowpcy E APPROVALS--ra l)VO�T cal aOJI /�o.-J�-ollealclrla-ks )uLc� I p e 562�i Y VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 24-061 Certificate of eccupanq Ehis is to certify that f 77 of, �of 8ycn.? /V having duly filed an application on 20 requesting a Certificate of Occupancy for the premises known as, 617eoll? Ovel-)ae , Rye Brook,NY, located in a �Q-le) Zoning District and shown on the most current Tax Map as Section: �• Block: Lot: _a , and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. d, issued 20_C�2/ , such authority and permission is hereby granted to the property owner to lawfully occupy or use said Apremises premises or building or part thereof listed under the following New York State Classifications,Use: /X Construction: , for the following purposes: :]&u 0 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 facilitie shall be made,and no enlargement, whether by extending on any side or by increasing in hei t shall be made,nor a building be moved from one location to another until a permit to accomplish such change has e n obtain fro the Iding Inspector. Building Inspector,Village of Rye Brook: Date: MAY 2 9 2W 4 o y tab 4.°�aJ�V t7 .. Q 19 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.ryebrook.org TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE May 29,2024 Hiddenfield77 Corporation 12 Lincoln Avenue Rye Brook,New York 10573 Re: 12 Lincoln Avenue, Rye Brook,New York 10573 Parcel ID#: 135.73-1-26 This document certifies that the work done under Mechanical Permit#22-008 issued on 1/19/2022 for the installation of a new condenser,gas furnace,coil and associated ductwork has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to DE BUILD R NT For office use Only: PERMIT# - 0 APR -8 2024 VIL OF RYE OK ISSUED: 38 KING STRE YE BROOK, YORK 10573 DATE: - -2 VILLAGE OF RYE BROOK A6 FEE: '�, PAID 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 Address: 12 LINCOLN AVENUE, RYE BROOK, NY 10573 Occupancy/Use: 1-FAM Parcel ID#: 135.73-1-26 Zone: R10 Owner: KENNETH BAINTON Address: 180 CABRINI BLVD., NYC 10033 P.E./R.A.or Contractor: Address: RFF AROVF Person in responsible charge: Kenneth Bainton Address: SEE ABOVE 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: Kenneth Bainton being duly swom,deposes and says that lie/she resides at 180 Cabrini Blvd. Apt.101 (Print Name of Applicant) (No.and Street) in New York City ,in the County of New Yolk 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:$_ 24* &ap& + *p for the construction or alteration of: ADDITION & RENOVATIONS TO EXISTING SINGLE FAMILY RESIDENCE IN ACCORDANCE WITH ASSOCIATED BUILDING PERMITS. 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 ,20 24 day of 20 24 Sign re of Property Owner Signature of Applicant Kenneth Bainton Kenneth Bainton ame of Property Owner Print Name of Applicant Notary Public SHARI MELILLO Notary Public Notary Public,State of New York No.01ME6160063 Qualified In Westchester Countyr7 s/t2/2o21 Sc:-,mission Expires January 29,20_=, �QyE BR(�k• O Zm cu � l7 1982 BUILDING DEPARTMENT ,4'BUILDING INSPECTOR t❑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 :_ ' I � \ ,v V Dv"'� DATE: '�L'�� PERMIT# � � � ' lv 6b ISSUED-�I -I�I( SECT: BLOCK: f LOT' LOCATION: f ) OCCUPANCY' .X ❑ Violation Noted HE WORK IS.. PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL OTHER �E BRC��, • �9�2 BUILDING DEPARTMENT BUILDING INSPECTOR 'u ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street- Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - --- - - --- - - ADDRESS : L ` c-\ 4 ` DATE: PERMIT# JCS ISSUED: SECT:yl� / -�iSLOCK: I LOT: Z� LOCATION: �.�``"` w OCCUPANCY: � ' G ❑ Violation Noted THE WORK IS... ❑ PASSED ❑ FAILED 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 i , �E BRC�k, O�` tim • 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - -- - - -- - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS: ' L n ( V\` i tw DATE: PERMIT# �' ISSUED: '��-2"ECT: BLOCK: LOT: LOCATION: t =5 1 \--A ��` �:`�� OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION !a,�� � ro�l d REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING Q INSULATION ❑ NATURAL GAS ❑ L.P.GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER i �E aRC�k, F o 1932. BUILDING DEPARTMENT ❑BUILDING INSPECTOR OASSISTANT 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 :— I I l- I n r� kvg DATE: � !-I OR PERMIT# k O ISSUED: I 1 i SECT: BLOCK: LOT: LOCATION: 1 n `1( 1 Ci�i OCCUPANCY: �, v ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBINGlq, ` `'ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS �CV _ 'CP Q o--tt "L ❑ L.P. GAS �ac ❑ FUEL TANK C• � lX 'd C' ❑ FIRE SPRINKLER 11 ❑ FINAL PLUMBING L ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER cu � 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR f0 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 : `� ce)I n & �i- DATE: ' -Z ) i -a I(j-2/ PERMIT# ISSUED: �-�'SECT: BLOCK: LOT: LOCATION: 6� �" �-= Q� OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING W ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: 0 ROUGH PLUMBING ❑ ROUGH FRAMING ❑t. INSULATION NATURAL GAS � ❑ L.P. GAS❑ FUEL TANK V Cl FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION c\ y ❑ FINAL ❑ OTHER U 1/ * o * OCIS * CL v * p" Cl * * � a Rs cl o 0z � d W x �x a (v W „o * W 1 f v it Al 3 A a v 86 00 cl s. * Cd * to Fo a o 71 �C BROv�. o`` tim BUILDING DEPARTMENT ❑ UILDINGINSPECTOR 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 :— ATE. L `� '" D d�� l�Oa! PERMIT# �Q -2` ISSUED: " � SECTAr��- BLOCK: LOT: LOCATION: OCCUPANCY: s-' ❑ VIOLATION NOTED TH WORK IS... J ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ..0 UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION \ \ ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER 11 - ❑ FINAL PLUMBING c� ck 1 ! ❑ CROSS CONNECTION l ❑ FINAL �c�S1e NHS v W� ❑ OTHER 4 Qy6 BRC�U� cu � 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS:— ` ` C Li DATE: 1 0 PERMIT# h I / ISSUED: Z SECT: BLOCy LOT: LOCATION: �l n l Q JC4 0,mil` (�`���UPANCY: ❑ VIOLATION NOTED THE WORK IS... LJ ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER QyE Raj 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR t SSISTANT BUILDING INSPECTOR VILLAGE OFRYEBROOK ODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www.Uebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS :— � DATE: � L PERMIT# 1 ISSUED:SE CK: ( LOT: LOCATION: S� �` �� � it OCCUPANCY: V ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED OOTING ❑ 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 i N O 7 b E O C N v m O N \ W • h+� M N M � � � O � N �Q N z a � a s G ■ ., o» ' w „W) a FBI �wr1h� N Cn v O w LL aI V M a .g � yvc w M"4 C cO b do's ° � W Ir r Ln , 0 cnni x . O Wo o H N w° CA o'yC� A • s 00 z 00 cc) O Q o c c M oo ° Q O W C W o .n U �b C QI In 0 N � V a H � o �zooa � N r � v a c°S W z tg X � . o z • � v) E `05 0 c � c w-e o V Ono z r W W A o w F o f H ".• U ZON U 04 O o rQ Ev _ H oz '° vw � p z w w o a � � ^ : . Z w (� ,n o 5 . � p o x W g "a f=r pC F O V z aa� b °' � ,.., vga � � x oc 2 coo W V U 0 ° H U O U i cd Z w w O Cam ." �� N Z3 v � 5J `� A w Z tea' Q o � v o v s � O1 •• a a0 w W � a � 4c �I m P. .4 W � x � � 414144I4464 coo goaago44404 agog�1���1��1��I��i�I�i�l�l�1����1 BUILDING DEPARTMENT D VILLAGE OF RYE-UROOK V 938 KING"', ET RYE BROOK,NY 10573 (914)93=4fto"rg 8 i4)939-5801 DEC 3 1 2020 _ VILLAGE OF RYE BROOK BUILDING DEPARTMENT *********************************************************************************************************** FOR OFF WE' SE ONT) : Q ) �!1 Approval DateMAR 1 8 2021 rmit#9 )l—o6 c) Application# Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: ; Date: 2 BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case Other: vV Application FeeA 5�� Permit Fees: 2 I. 7�S -D EXTERIOR BUILDING PERMIT APPLICATION Application dated: is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the construction of buildings,structures,additions,alterations or for a change in use,as per detailed statement described below. 1. 1obAddress: 12 LINCOLN AVENUE 2. Parcel ID#: 135.73-1-26 Zone: R 10 3. Proposed Improvement(Describe in detail): Relocate 1 st floor bathroom into partially enclosed portion of existing porch & utility closet. Relocate stair, add eyebrow for headroom. Renovate existing kitchen. Replace original sanitary piping. Add 2 dormer windows on west (back yard) side of second floor. 4. Property Owner: KENNETH BAINTON Address: 180 CABRINI BLVD. APT.101, NYC, NY 10033 Phone# Cell# 347-721-2400 e-mail kbainton@kbarchiteets.eom List All Other Properties Owned in Rye Brook: NONE Applicant: KENNETH BAINTON Address: 180 CABRINI BLVD. APT.101, NYC, NY 10033 Phone# Cell# e-mail kbainton@kbarchitects.com Architect: KENNETH BAINTON Address: 180 CABRINI BLVD. APT.101, NYC, NY 10033 Phone# Cell# 347-721-2400 e-mail kbainton@kbarchiteets.com Engineer: Address: Phone# Cell# e-mail General Contractor: CEIMER CONSTRUCTION Address: Phone# Cell# e-mail ciemer1300otmail.com (1) 3/21/19 5. Occupancy;(1-Fam.,2-Fam.,Commercial.,etc...)Pre-construction: 1-FAM Post-construction: 1-FAM 6. Area of lot: Square feet: 17,250 SQ. FT. Acres: 7. Dimensions from proposed building or structure to lot lines: front yard: 38FT. rear yard: 78 FT. right side yard: 10.3 FT. left side yard: 15 FT. other: 8. If building is located on a corner lot,which street does it front on: 9. Area of proposed building in square feet: Basement: 0 1-fl: 1753 sf 2nd fl: 1727 sf 3rd fl: 0 10. Total Square Footage of the proposed new construction: 73 SQ.FT. 11. For additions,total square footage added:Basement: - 1,`fl: 29 SF 2°d fl: 44 SF 3`d fl: 12. Total Square Footage of the proposed renovation to the existing structure: 750 SF 13. N.Y.State Construction Classification: TYPE 5B N.Y.State Use Classification: Detached 1-family 14. Number of stories: 2 Overall Height: 251-611 Median Height: 19'-6" 15. Basement to be full,or partial: NONE , finished or unfinished: 16. What material is the exterior finish: HARDI PLANK SIDING 17. Roof style;peaked,hip,mansard,shed,etc: PEAKED / HIP Roofing material: ASPHALT SHINGLES 18. What system of heating: FORCED HOT AIR VIA GAS FIRED FUNACE 19. If private sewage disposal is necessary,approval by the Westchester County Health Department must be submitted with this application. 20. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) Yes: No: X (ifyes,applicant must submit a separate Automatic Fire Suppression System Permit application&2 sets ofdetailed engineered plans) 21. Will the proposed project disturb 400 sq.ft.or more of land,or create 400 sq.ft.or more of impervious coverage requiring a Stormwater Management Control Permit as per§217 of Village Code? Yes: No: X Area: 0 SF 22. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: X _ (ifyes,applicant must submit a Site Plan Application,&provide detailed drawings) 23. Will the proposed project require a Steep Slopes Permit as per§213 of Village Code Yes: No: X (ifyes,you must submit a Site Plan Application,&provide a detailed topographical survey) 24. Is the lot located within 100 ft.of a Wetland as per§245 of Village Code? Yes: No: X (ifyes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan) 25. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes: No: X (ifyes,the area and elevations of the flood plane must be properly depicted on the survey&site plan) 26. Will the proposed project require a Tree Removal Permit as per§235 of Village Code? Yes: No: X (if yes,applicant must submit a Tree Removal Permit Application) 27. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No: X Indicate: TIER 1: TIER I1: TIER III: (ifyes,a Home Occupation Permit Application is required) 28. List all zoning variances granted or denied for the subject property: NONE 29. What is the total estimated cost of construction: S 185,000 Note.The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,including any material and labor which may be donated gratis.If the final cost exceeds the estimated cost,an additional fee will be required prior to issuance of the CIO. 30. Estimated date of completion: 6 MONTHS FROM PERMIT APPROVAL (2) 3/21/19 BUILDING DEPARTMENT VILLAGE OF RYE BROOK 938 KfNG STREET RYE BROOK,NY 10573 (914)939-0668 FAX(914)939-5801 RESIDENTIAL LOT AREA COVERAGE Address: 12 LINCOLN AVE. Section: 135.73 Block: 1 Lot: 26 PERMITTED COVERAGE RATIOS IN RESIDENTIAL DISTRICTS (Local Law 3-88) YOUR ZONE AREA IN MAIN ACCESS. DECK ZONE DISTRICT SQ. FEET BLDG. BLDG. MAX. CHECK MAX. R-35 35,000 14% 4% 5% R-25 25,000 14% 3.5% 4% R-20 20,000 14% 3.5% 4% R-15 15,000 16% 3.5% 4% R-15A 15,000 12% 3.5% 4% R-12 12,500 17% 4% 4% R-10 10,000 20% 4.5% 3.5% R-7 7,500 23% 4.5% 3.5% R-5 5,000 30% 5% 3.5% R-2F 5,000 30% 5% 3.5% Existing: Proposed: 1. AREA OF LOT 17,250 Sq. Ft. 17,250 Sq. Ft. 2. AREA OF HOUSE a. Coverage of Main Building (Including Attached Garage or Accessory Building) 2263 Sq. Ft. 2263 Sq. Ft. b. Area of 1 st Floor Divided By Area of Lot x 100 13.2 % 13.2 % 3. AREA OF ACCESSORY BUILDING (Includes Detached Garages,Tool Shed, Playhouses) 0 Sq. Ft. 0 Sq. Ft. a. Coverage of Accessory Building Area of Accessory Building Divided By Area of Lot x 100 0 % 0 % 4. AREA OF DECK 112 Sq. Ft. 112 Sq. Ft. a. Coverage of Deck Area of Deck Divided By Area of Lot x 100 0.65 % 0.65% % I attest to the est of knowledge and belief, the above information is correct. itect's Signature (3) 3/21/19 BUILDING DEPARTMENT VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 (914) 939-0668 Fax(914) 939-5801 IMPERVIOUS COVERAGE RATIOS RESIDENTIAL DISTRICTS Address: 12 LINCOLN AVE. Section: 135.73 Block: 1 Lot: 26 Zone: R10 IMPERVIOUS SURFACES (Definition): All buildings, as defined herein, and all areas on the ground or elevated above the ground which are comprised of materials through which water cannot readily flow, including, but not limited to asphalt, concrete, masonry, wood, gravel and clay, and which consist of elements including, but not limited to, court yards, sports courts, swimming pools, patios, sidewalks,ramps, terraces and driveways. TOTAL MAXIMUM PERMITTED MAX. PERMITTED COVERAGE Zoning IMPERVIOUS LOT AREA BY IMPERVIOUS SURFACES District COVERAGE IN FRONT (sq.ft.) For Base Lot For Lot Area YARD(%) Area(sq.ft.)* Over Base R-35 15 Lot Area(%) R-25 20 0 to 4,000 0 55 R-20 30 4,001 to 6,000 2,200 35 6,001 to 12,000 2,900 27 R-15 35 12,001 to 16,000 4,520 26 R-15A 35 16,001 to 20,000 5,560 25 R-12 40 20,001 to 30,000 6,560 24 30,001 to 40,000 8,960 23 R-10 45 40,001 & larger 11,260 22 R-7 40 R-5 30 R2-F 30 *"Base Lot Area" is the minimum end of the lot size range in the "Lot Area"column Area of lot: I -7 L -z �r� s .ft. Existing Allowed Proposed Total impervious coverage = 4655 Sq.ft. 5872 Sq. ft. 4655 S .ft. Front impervious coverage = 2•2 % 1 45 % 1 2.2 % I attest to e b m of my k ledge and belief, the above information is correct. itect's Signature (4) 3/21/19 BUILDING DEPARTMENT VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 FAX(914)939-5801 BULK REGULATIONS IN RESIDENTIAL DISTRICTS Address: 12 LINCOLN AVE. Section: 135.73 Block: 1 Lot. 26 MAXIMUM GROSS FLOOR AREA USE FORMULA: Maximum Gross Floor Area = 4,000 + [ (Lot Area —21,780) x 0.11478421 ]: a. Allowed = 3480 Sq. Feet b. Existing = 3407 Sq. Feet c. Proposed = 3480 Sq. Feet HEIGHT/SETBACK RATIOS FOR RESIDENTIAL DISTRICTS DEFINITION: A standard designed to regulate the height of a building in relation to the average grade of the corresponding portion of the lot line from which it is set back. The ratio modifies the maximum permitted Height of Building by forming an inclined plane beginning at the average grade along the portion of the lot line from which the setback is measured and rising toward the building at the specified ratio above which no part of any building, other than minor architectural features such as chimneys, skylights and dormer windows not covering more than 10%of the entire roof area, shall be permitted to extend. Height and Setback shall be calculated using the formula, Height/Setback=X, where X is the required side or front yard ratio for the zoning district in which a property is located as specified in Article VIII of Chapter 250. A complete elevation view for the proposed improvement must be included on the drawings. FILL IN YOUR RATIOS: ZONE E%ZMNG PROPOSED REO[NRED FRONT: FRONT: FRONT: .44 R-35 SIDE: SIDE: SIDE: 1.20 FRONT: FRONT: FRONT: .48 RL25 SIDE: SIDE: SIDE: 1.30 FRONT: FRONT: FRONT: .60 AL20 SIDE: SIDE: SIDE: 1.60 FRONT: FRONT: FRONT: .60 R-15 SIDE: SIDE: SIDE: 1.60 FRONT: FRONT: FRONT: .80 RLISA SIDE: SIDE: SIDE: 2.40 FRONT: FRONT: FRONT: .69 AIL12 SIDE: SIDE: SIDE: 1.60 FRONT: 0.35 FRONT: 0.80 FRONT: .80 R-110 SIDE: 1.50 SIDE: 2.40 SIDE: 2.40 FRONT: FRONT: FRONT: .96 R7 SIDE: SIDE: SIDE: 3.00 FRONT: FRONT: FRONT: 1.20 R,S SIDE: SIDE: SIDE: 4.00 FRONT: FRONT: FRONT: 1.20 R41F SIDE: SIDE: SIDE: 4.00 I attest to th b of o nd belief, the above information is correct. Archit is Signature (5) 3/3/2020 BUILDING DEPARTMENT D v v F VILLh6E OF RYE'0ROOK DEC 3 1 20?_0 938 KING�.'I�EET RYE BitociK,NY 10573 (914)9 939-5801 VILLAGE OF RYE BROOK w t_ 4m 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 YORK, COUNTY OF WESTCHESTER ) as: 3j, KENNETH BAINTON , residing at, 180 CABRINI BLVD. APT.101, NYC, NY 10033 (Print name) (Address where you lice) 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; 12 LINCOLN AVENUE, RYE BROOK, NY 10573 , 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. (Signature of I' �rty Owner(s)) KENNETH BAINTON (Print Name of Property Otiner(s)) Sworn to before me this day of , 20 (Notary Public) (6) 3/21/19 This application must be properly completed in its entirety by a N.Y. State Registered Architect or N.Y. State Licensed Professional Engineer & signed by those professionals where indicated. It must also include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void, and will be retp,r-ed to the applicant. Please note that application fees are non-refundable. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: I*K7�'il� e,,,2#.-,G/J L_13%�,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. By signing this application, the property owner further declares that he/she has inspected the subject property, and that to the best of his/her knowledge there are no roof drains, sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this s 77{ Swom to before me this day of A1�lu Li , 20 day of , 20 Si ature of Propeftylbwner Signature of Applicant Print Name of Property Owner Print Name of Applicant Notary Public Notary Public (g) 3/21/19 BUILDING DEPARTMENT D [E C @� V E VILLAGE OF RYE$ROOK 938 KING STREET RYE BROOK,NY 10573 APR 2 8 2021 (914) 939-0668 W(914)939-5801 VILLAGE OF RYE BROOK www r a 1c or BUILDING DEPARTMENT _. FOR OFFICE USE ONLY: Approval Date: M Permit# Application # PP PP Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: ; Date: MAY I Q 2021 BOT Approval Date: Case# Chairman: / PB Approval Date: Case# Secretary: {4" ZBA Approval Date: Case# Other: ��11 Amendment FeeAA)S / b Permit Fee: APPLICATION TO AMEND APPROVED PLANS Application dated: 0)J is hereby made to the Building Inspector of the Village of Rye Brook,NY,to amend the approved plans associated with an existing open permit,and/or from any prior approvals granted by the approval authority as per detailed statement described below. 1. lob Address: 12 LINCOLN AVENUE, RYE BROOK, NY 10573 Existing Permit#: BP 21-060 2. Parcel ID#: 135.73-1-26 Zone: R-10 Original Approval Date: 3/24/2021 3. Proposed Amendment(Describe in detail): REVISE CONFIGURATION OF DORMERS TO COMBINE (2) WEST DORMERS INTO (1) DORMER AND EXTEND COMBINED DORMER OVER EXISTING RIDGE TO EAST. NO CHANGE TO FLOOR AREA OR COVERAGE IS PROPOSED BY THIS AMENDMENT 4. Property Owner: KENNETH BAINTON Address: 180 CABRINI BLVD. APT.101, NYC, NY 10033 Phone#212-781-9204 Cell#347-721-2400 a-mail kbainton@kbarchitects.com Applicant: Address: Phone# Cell# e-mail Architect/Engineer: KENNETH BAINTON Address: 180 CABRINI BLVD. APT.101, NYC, NY 10033 Phone# Cell#347-721-2400 e-mail kbainton@kbarchitects.com 5. Occupancy;(1-Fam.,2-Fam.,Comm.,etc...)Prior to construction: 1-FAM After construction: 1-FAM 6. Will the proposed amendment require the installation of a new,or an extension/modification to an existing automatic fire suppression system?(Fire Sprinkler,ANSL System, FM-200 System,Type I Hood,etc...)Yes: No: X (if yes,you must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 7. Will the proposed amendment disturb 400 sq. ft. or more of land,or create 400 sq. ft.or more of impervious coverage requiring a Storm water Management Control Permit as per§217 of Village Code?Yes: No: X Area: 1 3/21/19 8. Will the proposed amendment require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: X (if yes,you must submit a Site Plan Application,&provide detailed drawings) 9. Will the proposed amendment require a Steep Slopes Permit as per§213 of Village Code Yes: No: X (ifyes,you must submit a Site Plan Application,&provide a detailed topographical survey) 10. Is the lot located within 100 ft of a Wetland as per§245 of Village Code? Yes: No: X (if yes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan) 11. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes: No: X (if yes,the area and elevations of the flood plane must be properly depicted on the survey&site plan) 12. Will the proposed amendment require a Tree Removal Permit as per§235 of Village Code?Yes: No: X (if yes,you must submit a Tree Removal Permit Application) 13. Does the proposed amendment involve a Home-Occupation as per§250-38 of Village Code? Yes: No: X Ifyes,indicate: TIER I: TIER II: TIER III: (if yes,a Home Occupation Permit Application is required) 14. Will the proposed amendment result in additional square footage to the building or subject structure,and if so,provide such additional footage here. NO (Please submit additional Bulk Regulation Application Pages for review) 15. What is the total added cost of the work associated with the amendment: $ 17,500 (The estimated cost shall include all site improvements, labor,material, scaffolding, fixed equipment,professional fees,including any material and labor which maybe donated gratis.) 16. N.Y. State Construction Classification:_TYPE 513 N.Y.State Use Classification:_Detached Single Family 17. Estimated date of completion:9/1/2021 This application must be properly completed in Its entirety by a N.Y.State Registered Architect or N.Y.State Licensed Professional Engineer&signed by those professionals where indicated.It must also include the notarized signature(s)of the legal owner(s)of the subject property,and the applicant of record in the spaces provided.Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void,and will be returned to the applicant. Please note that application fees are non-refundable. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: KENNETH BAINTON ,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 ARCHITECT 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 ofthe Village of Rye Brook and all other applicable laws,ordinances and regulations.By signing this application,the property owner further declares that he/she has inspected the subject property,and that to the best of his/her knowledge there are no roof drains,sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this 2 5 6`', Sworn to before me this 28TH day of w , 20 ­7 I day of P 2 21 S' re of Property Owner Si re of Applicant KENNETH BAINTOIN Print Name of Property Owner Print Name of Applicant Notary Public Notary Public 2 3/21/19 BUILDJNG DEPARTMENT ILL-1 1�j VIL6WE OF RYkjWOOK 938 KING S�JWET RYE B1140' C,NY 10573 LAN - 3 2024 (914)9�39 0668 www. roo"re VILLAGE OF RYE BROOK BUILDING DEPARTMENT FOR OFFICE USE ONLY: i Approval Date: JAN 2 4 rmit Application# A�—�'—�� i Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: : Date: BOT Approval Date: Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: l�11 Amendment Fee:41A��AZ Permit Fee:. L� APPLICATION TO AMEND APPROVED PLANS Application dated: 1/2/2024 is hereby made to the Building Inspector of the Village of Rye Brook,NY,to amend the approved plans associated with an existing open permit,and/or from any prior approvals granted by the approval authority as per detailed statement described below. 1. Job Address: 12 Lincoln Ave., Rye Brook, NY 10573 Existing Permit#: BP21-060 2. Parcel ID#: 135.73-1-26 Zone: R10 Original Approval Date: 3/24/2021 3. Proposed Amendment(Describe in detail):_ Misc. additional fencing on site, including 50 Lin.Ft. (aD. SW cornE Modifications to utility routes & meter locations per utility requirements; New porous paving blocks apron at existing driveway (6ft. x 17ft); Minor interior partition and window & door modifications. 4. Property Owner: Kenneth Bainton & Mary Broaddus Address: 180 Cabrini Blvd. Apt. 101 Phone# Cell# (347) 721-2400 e-mail kbaintonCaD_kbarchitects.com Applicant: Kenneth Bainton Address: see above Phone# Cell# (347) 721-2400 e-mail kbainton(a)-kbarchitects.com Arch itect/Engineer: Kenneth Bainton,l:�,A Address: see above Phone# Cell# e-mail 5. Occupancy;(I-Fam.,2-Fam.,Comm.,etc...)Prior to construction: 1-Fam. After construction: 1-Fam 6. Will the proposed amendment require the installation of a new,or an extension/modification to an existing automatic fire suppression system?(Fire Sprinkler,ANSL System, FM-200 System,Type I Hood,etc...)Yes: No: X (if yes,you must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 7. Will the proposed amendment disturb 400 sq.ft.or more of land,or create 400 sq.ft.or more of impervious coverage requiring a Storm water Management Control Permit as per§217 of Village Code?Yes: No: X Area: 0 SF I 8/12/2021 8. Will the proposed amendment require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: X (if yes,you must submit a Site Plan Application,&provide detailed drawings) 9. Will the proposed amendment require a Steep Slopes Permit as per§213 of Village Code Yes: No: X (if yes,you must submit a Site Plan Application,&provide a detailed topographical survey) 10. Is the lot located within 100 ft of a Wetland as per§245 of Village Code? Yes: No: X (if yes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan) 11. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes : No: X (if yes,the area and elevations of the flood plane must be properly depicted on the survey&site plan) 12. Will the proposed amendment require a Tree Removal Permit as per§235 of Village Code?Yes: No: X (ifyes,you must submit a Tree Removal Permit Application) 13. Does the proposed amendment involve a Home-Occupation as per§250-38 of Village Code? Yes: No: X If yes,indicate: TIER I: TIER II: TIER III: (if yes,a Home Occupation Permit Application is required) 14. Will the proposed amendment result in additional square footage to the building or subject structure, and if so, provide such additional footage here. No (Please submit additional Bulk Regulation Application Pages for review) 15. What is the total added cost of the work associated with the amendment: $ 27,000.00 (The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,including any material and labor which may be donated gratis.) 16. N.Y. State Construction Classification: TYPE 5B N.Y. State Use Classification: Detached 1-Family 17. Estimated date of completion. 1/31/2024 This application must be properly completed in its entirety by a N.Y. State Registered Architect or N.Y. State Licensed Professional Engineer& signed by those professionals where indicated. It must also include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided.Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void, and will be returned to the applicant. Please note that application fees are non-refundable. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Kenneth Bainton , 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 architect & owner 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. By signing this application,the property owner further declares that he/she has inspected the subject property, and that to the best of his/her knowledge there are no roof drains, sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this 3 Sworn to before me this 3 r day of , 20 24 day of , 20 24 Si re of Property Owner Y911a6re of Applicant Kenneth Bainton Kenneth Bainton Print Name of Property Owner Print Name of Applicant ,L Notary Public Notary Public SHARI MELILLO SHARI MELILLO Notary Public,State of New York 2 Notary Public,State of New York No.01ME6160063 No,01ME6160063 Qualified In W hester County 20?!� Qualified In Westchester County Commission Expiresconitwasi�on Expires January 29,20_ 8/12/2021 , , , � w N � O 1 O N iL' y ONO c " F Ln Ln ci \ CL P W 8 d pz � N � o - � z3 c) F ti o Q N N pr oe ~ Q y J 1-4 W >4 w w Z or*4 `� h ~ ONI I-W ~ O y 00 w z 1-4 • I1 wl �I y'Z z x Q cn q O j ! V ', Z a p A°c 3 0 ,• � z � .00\ x H z a H a0.0 414 Z < � r• � 0 8 CL c z � d w V H8 a v W o a fig, N .a a. 04 w `� A BUILDING DEPARTMENT RIECEMED VILLAGE OF RYE BROOK NOV - 9 2022 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required >P—��o Approval Date: f 1It Permit Fee: S �C�k Approval Signature: Other: Application dated, ( ;IX is hereby m e 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: j;L L we-v I N iwt SBL: 3 S 7 3 - I Zone:4I0 2.Property Owner:Kt') &jiv/o" l4Jd e,N Cie tJ 77 Cyi&,LAAd11ress: 1.2 LiP.4 r""ti' *V 6, Phone#: 3`J?-7a11 ',7 Cell#: email: Kl�+tratcN ki3n�zct,1T ��J 3.Master Electrician: pIP-civ 5-A /[NV Address: (.7—,0L,'31 Lic. #: i'l ( Phone#: I y-a�L7-?;-6 3 Cell#: email: Tc6T04b&vje,YA-�(,-V Company Name: Fs aeoe,tc LPL- Address:.ZyS'w M:C eavw(ci, c i�G 4.Proposed Electrical Work/Fixture Count. Ple l72 I?>V fVA,Ti ,V c4 1 Sir f ?,,d F&ck__. ti m Norte E - 'JW— s w ojc -t- Cfalqv 5"tr e 3 Neui d eQccow-J SEt:v i cf 76t, TU Vl,GC e 4)QS7'[Ncr 2wAny 6bqt1 -QA-� SEzytce- k)&WCLeael(AL. To 4--�)tTI,-1-j 4 CA57'[N4 hvvnc- S.3'Party Electrical Inspection Agency: RRRRRRRRRRRRRRRRRRRRRRRR}RRRRRRRRRRRRRRRR RRRR RRRRRRRRRRRRR}RRR}RR}RRRRR}RR}RR RRRR RRR RRR RR}}R RRRRRRR RRR RRR STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: U being duly swom,deposes and states that he/she is the applicant above[tamed,and does further state that(s)hc is the legal owner of the property to which this application pertains,or that(s)hc is the CLV+TYIII't^rotz— for the legal owner and is dul authoriicd to make and file this application 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 abm c captioned property will be in conformance with the details as set forth and contained in this application and in an,, accompanying appro%ed 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 /da�� ,20 --- - < 0 Signature of Property Owner Si nature of�pplica�nt Al Print Name of Property Owner Print N Epf Applicant Notary Public No ONY M PROVENZANO otary Public,State of New York #4869239 Qualified in Westchester Cou rdk CommrsZon Expires September 8, bib -/ #auo4d .,C� #asua�l� *p�d1Z l 've�J aids/4� Tq�a S L ssalppv �'111� al leu6lS �—�r alep , �� 7 S aweN AuedwoD •looadsul pazlleuy aleo 1013adsul uo4tAP"•W g)4lq)W It%u JIPW)pu• d41 Ile 01-&16a 1ua61 Pali ql-11, ,auwu 711nudsV MU'Amed qJ ual)adsu1�410 Aw 4Wa{w/pp•—W a41 q/suo1K3IId&undo O 11­41/P41 w/a1 w 1wMdd•a41 pat3W%.—v 1,—pppa a41 q1 a.j a41 1s.lp•pw ua1>,ldaw a41 aVn of p11i i ,l1 •n,wA V WWO uosq&W4 suo"1. upp•u 1 ckui p aw11 Aw M N pa1.&m aq o7 sutra pa1sN 6^04•.41 law)01 W Wqw u uoll•>tl r u U SIMS A4 P-4-1 a1W-41—14 naA(l I auo ql p1p-)-u Illddc 1141 1N3W18Vd3O �07aJNI(rine A008e 3A8 d0 30Y111n ZZOZ 6 AO3 1 ?J- oil uboOr -3-)11"1-9 SaQnrY) MAN OqW17? r-A,;4*D (-9) -7;� ("Iry ai0�7� 1'r 1 51 � ) p l 1 t/r�'►�2 7����?/1 ��a � '� 7 J7J �,� uollewlo)ul leuolllppv uolhadsul-aa ❑ uol)Jadsul-aa Ala^ ❑ uolhadsul-ay lenslA❑ a6ue4D pea4,anp hauuo3aa❑ maN❑ puno161ap1iaQ 1 abellOA abeladwy 3:)1na3s iva:)salon13 1ua:)sapue)ul 1 1 I me11J wlem anemol.)ly,) IeSodsip 1o1eia6uyaa sJa4Sem4S,(_ (s)uano (s)dol-,—_) ls)a6uea sdwv lwv pedwo)4Se11 POOH I xouoyy uogle:) swlely alows slawwl4 sa4:)llmS OAV 019 lda)aa IeuadS sapeida3aa lel)lawwo:) lelluaplsaa❑ aplslno 3114V❑ a6e1e9❑ Id E Ue41 aJoW IJ P IE H Pu 9❑ d� lagwnN Peluo� 1- LL t P) l l 'N NO, LN1 —qP"41 wa,"pt SsaJPPV!aweN/aumo L lob Tole A S laa,isSsol� � ;v,�'7�JN�� Z ssalPPy )Q-Ac)p Sd(I I(luno:) dl4sunnol L 0 dlZ a6elll/1/Ally #alny1 )leUld Ci ��all I In 0 I��—8 rC II #UwJad 6P18 (iL �leo �L — d� - #llwlad Oa13 asn a3y4o • • • I I '1P1t4s!J'1aaJ1SU1PVV0130[ Sims i • State Wide Inspection Services 1080 Main Street JAN 2 4 2024 Fishkill, NY 12524 a845 202-7224 Phone VILLAGE OF RYE BROOK 914e(c0sw sny Fax z,ATE WIDE NSOEC, "N`FR�„fs BUILDING DEPARTMENT_ , Email: officeCa�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: P.S. Electrical Contracting Kenneth Bainton & Mary Broaddus 4 New Kings Street,Suite 150 12 Lincoln Avenue White Plains, NY 10604 Rye Brook, NY 10573 Located at: 12 Lincoln Avenue, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP22-276 135.73 26 Certificate Number:2022-8143 Building Permit Number: BP18-040/BP21-060 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: 12 Lincoln Avenue, Rye Brook, NY 10573 The First Floor&Second Floor 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 27th day of December 2023. Name Quantity Rating Circuit Type First Floor Kitchen GFCI 04 Receptacles 04 Dishwasher 01 Refrigerator 01 Hood 01 Oven 01 Instant Hot Water 01 20AMP Microwave 01 Name Quantity Rating Circuit Type 151 Floor Dining Room Recessed Luminaires 02 Receptacles 06 Electric Heater 01 1" Floor Living Room Receptacles 04 Sunrooms Receptacles 08 Recessed Luminaires 06 LED Strip Lights 02 1" Floor Bathroom GFCI 01 Toe Kick Heater w/Thermostat 01 Exhaust Fan 01 Recessed Luminaires 05 Vanity Light 01 Steam Unit 01 30AMP 15` Floor Switches 25 Exterior GFCI 08 Exterior Luminaires 12 Exterior Sconces 05 HVAC System 01 2nd Floor Library Receptacles 10 Recessed Luminaires 05 LED Strip Lights 03 Bedroom Receptacles 08 Sconces 05 LED Cove Lights 04 Recessed Luminaires 02 Page 12 Name Quantity Rating Circuit Type Master Bathroom GFCI 02 Sconces 02 Recessed Luminaires 03 Toe Kick Heater w/Thermostat 01 Bathroom 2 GFCI 02 Recessed Luminaries 02 Vanity Light 01 Strip Light 01 Toe Kick Heater w/Thermostat 01 Study Receptacles 08 LED Strip Lights 05 Dryer 01 30AMP Washing Machine 01 20AMP LED Strip Lights 04 Sconces 04 Second Floor Switches 16 Smoke Detectors 03 C/O Smoke Detectors 02 Sub Panel 01 100AMP AFCI Breakers 25 15AMP AFCI Breakers 22 20AMP Service 01 200AMP Meter 01 Panel 01 Grounding and bonding of service to current codes. 7w,�,r,.,�1 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%vork performed on the date of inspection only. Page 13 _ LLL 0.1 to of ii W ur r• o c FF- �i p .� ENO W z �/ a 'LQ .a N CA A00 o CA a U w za, eq z E. Z A � < Q c BUILDING DEPARTMENT � u�� VILLAGE OF RYE BROOK SEP 2 8 2021 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK NvwAw.ryebrook.org BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License R uired �- D&O Approval Date: SEP Permit Fee: Approval Signature: Other: Disapproved: tfecs are non-refundable) Application dated,����-� 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: / ;Z L I NCb QiJ R-u e -T SBL: 13 S 7 3_ Zone: 2.Property Owner: AleW�t le d 77 t^_c2Pv,^-> 7t'ax,� Address: 1 � -I'V 641 iQV Phone#: Cell#: 3q 7- 7.2-1' R`f 0(l email: 14b k t N I eN e K b"e�i rt-r5.cvHt 3.Master Electrician: e(eco SA-riiy ) Address: a 41- W64WOt 5'% Ere4)"C4 t e-T-04 '3/ Lic. #: t Phone#: Cell#: 1/Y';L,61Z-F l0 3 email: Company Name:PS &t<t' 144 Ltc Address: a (5 We)Were. 5r of e4tuic4 1 L'_d 6F f 4.Proposed Electrical Work/FixtureCount: (20K r(eTe_ l�>etr,,r r�x; O� �t d ✓1'1M1V 40VS'e- �� i i� �(Srno1[e �s- a �2b�,v 5,,'►2B11.e C-owt bo 1 S >L� u,Ndey-6 r�wcl �rvl�e �o F{.ed �u sru�, tau��Suer cue STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: P1 e-ro SAT14 being duly swom,deposes and states that he/she is the applicant above named,and does further (print name of 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 4py- miLT0 P_ 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 d 0 te Signature of Property Owner Signature of App scant Print Name of Property Owner Print Name of Applicant Notary Public Notary 7ualified HONY M. PROVENZANO Public, State of New York #4869239 Commission Expires September 8,n an 2r2021 Westeh`ester Rockland Electrical Inspection Services, Inc Phone: 914-347-3595 DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue Fax: 47-3596 Elmsford, NY 10523 Ir TEMP# DATE CITY OR VILLAGE ZIP CODE TOWNSHIP UNTY STREET AND NO.OR ROAD POLE NUMBER BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOB( LOT OCCUPANT'S NAME _ BUILDING OCCUPANCY I OWNER'S NAME AND ADDRESS HOME TELEPHONE NUMBER CURRENT SUPPLIED BY FROM THEIR OFFICE WORK TELEPHONE NUMBER LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS NO.OF FIXTURES& MOTORS HEATERS OFFICE USE LOCATION LAMP RECEPTACLES ONLY SIDEWALL SWITCH INCADE FLUORE NO. H.P EACH NO, WATTS EACH INSPECTION OUTSIDE �� ' I 1 BASEMENT rI 1"FL. 2-FL. I 3'FL. VILL GE OF RYE BR OK ^_ REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: .51�`!( t C llr.vr�. hcav��(' ✓l( f THIS APPLICATION IS INTENDED TO COVER THE ABOVE LISTED ITEMS TO BE INSPECTED,IF AT ANY TIME OF INSPECTION ADDITIONAL ITEMS HAVE BEEN INSTALLED,YOU ARE AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE FOR THE ADDITIONAL ITEMS INSPECTED AS PROVIDED BY THE APPLICANT.THE APPLICANT DECLARES THAT THERE IS NO OPEN APPLICATIONS FOR THE ABOVE WITH ANY OTHER INSPECTION COMPANY.WREIS,INC. IS NOT LISTING,LABELING,UNDERWRITING OR CERTIFYING ANY EQUIPMENT, MATERIALS OR DEVICES WHICH ARE PERFORMED BY OTHER CERTIFIED TESTING AGENCIES OR INSPECTION COMPANIES.THE APPLICANT,OWNER,OR AUTHORIZED AGENT AGREES TO ALL THE ABOVE TERMS AND CONDITIONS AS SET FORTH FOR THE APPLICATION. SIZE OF SERVICE FEEDERS CHARACTER OF WORK NEW❑ ADDITIONAL❑ EXPOSED❑ CONCEALED❑ MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD G UNDERGROUND❑ AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. NAME OF COMPANY DATE OF APPLICATION SIGNATURE OF APPLICANT X - STREET ADDRESS TELEPHONE NO. CTTY OR POST OFFICE ZIP CODE LICENSE NO.WHEN APPLICABLE i 01 e-1 N N 00 00 F = w Lr C6 U 3 W) F- N tn r.r v Y �i v4en z m rA L r gz mo U w Q O ? 0z' C M • M� Zt oom ao � � z E- °� z 0 x9 a CLI ONO �I W z �' ✓� ►Zi Q v 0 3 �<c�5RQ [ECIENIED BUIL DES MENT JUL 2 6 2021 VIL Q OK VILLAGE OF RYE BROOK 938 KIN ra'��t� NY 10573 (914) 939-5801 BUILDING DEPARTMENT 9 or PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: �/— v�O PP#: c:;) I—I / Approval Date: 3 Permit Fee: $ 4q60(L Approval Signature: Other: Disapproved: (fees are non-refundable) ***************** *** *** ********************************************************************** Application dated, FO is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or r ove Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agree that said plumbing work will be in conformance with all applicable Federal, State,County and Local Codes.p 1.Address: 1 Z 44&�L/h. /y't/�-�- / SBL: 1 US,73"1-016 Zone:/C —/0 2.Proposed Work: 9-0ta(k �— 4 nt t i k D L o. `1� l ZakC/ A-0r tW z z �30#w4.- jd&ft 9�4 a 3.Property Owner: a11t�.' 11�.,� Address: Phone#:3y7—7c->/—ay0o Cell#: email: • , 4.Master Plumber: � ar K.&& B rtc c S Address: X} to 07' /�itt �{�lji /�¢/�tS N y ,6 Lic.#: 1?G 3 Phone#: Cell : email: Company Name:, �� Ll Address �i 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 " 2 x 1 st Floor 2nd Floor 3`d Floor 4`g Floor 5T Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -1- 3/21/19 ED BUILDING DEPARTMENT IE C `E M VILLAGE OF RYE BROOK JUL 2 6 2021 938 KING STREET RYE BR661C,NY 10573 (914)9394668 FAX(914):939-5801 VILLAGE OF RYE BROOK ok• 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 YOM COUNTY OF WESTCHESTER ) as: ik�, residing at, CA-i;oz4�0 6 D a (Print name) (Address where you live) being duly sworn, deposes and states that(s)he is the applicant above named, and finiher states that (s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; 0 S7�. , 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 finiher 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. (Signature r perry Owner(s)) (Print Name of Property Owner(s)) Sworn to before me this d a day of J , 20 _ (NOt u RANDY D INNOCENT Notary Public, State of New York P 10. 01 I N S287683 Qualified in Queens County Commission Expires August 19,20.E 1 -3- 3/21/19 STAIOF NEW YQ COUNTY OF WESTCHESTER ) as: QC✓j�L 5 /'t ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing asALI 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 ` t L. �-o✓14 1-61-t5l✓ for the legal owner and is duly authorized to make and file this application. (9dicate 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 2-2- Sworn to before me this � b day of 20_-24— day of �� 20 a r / Si e of Pr erty Owner Sign of Applicant 1 ('� �t ��'J IU�J J-Ll p �C l 5 Print Name of Property Owner Print Name of Applicant RANDY D INNOCENT No �blic ����Otary Public, State of New York Notary Public SHARI MELILLO No.011v6287683 Notary Public, State of New York Qualified in Queens County No. 01 ME6160063 Commission Expires August 19,20a( Qualified in Westchester County Commission ExnirPS,l-mi ian,9q ?n Z3 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- srzvl9 ii QD Y N N y Q E _ ^itj Z W c 01000 • 00 Wtu C� W n H H M ( F-' w °' Ca ►Z F'1 �i C a+ C W -Poo Q to Q it o � 00 1- 1 Z A O 5 ` " o . �► c/� ►TI Q z a A W °4 PZ o ►� W W V u o Q+ * ° 15 o � Z � ur) c° �.b W O w rx w H Q c0o �� � y �j QW-� z A u Q 'o GT c z _ BUILDING DEPARTMENT R DD VILLAGE OF RYE BROOK D 938 KING STREET RYE BROOK,NY 10573 JAN - 4 2022 (914)939-0668 VILLAGE OF RYE BROOK www.ryebrook.or� P(_(I(-DING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EOUIPMENT FOR OFFICE USE ONLY: PERMIT#: da—0 0 Approval Date: AN 1 O 1012 Permit Fee: $ Q00 Approval Signature: Other: Disapproved: (fees are non-refundable) REQUIREMENTS FOR RELEASE OF PERNUT&CERTIFICATE OF COMPLIANCE: I. Properly completed& Signed Application. 2. Site/Staging Plan if Required by the Building Inspector. 3. Copy of Licensed Contractor's Liability Insurance. (Village of Rye Brook must be listed as certificate holder)&Workers Compensation Insurance on a NYS Board form(Form#C105.2 or Form#U26.3/or NY State Workers Compensation Waiver) 4. Payment of Fees/Unit: RESIDENTIAL=$100.00/unit• COMMERCIAL=$350.00/unit. 5. Inspection by the Building Department for removal and/or installation.(48 hour notice required) 6. Electrical work requires a separate Electrical Permit&Electrical Inspection. 7. Plumbing/Gas work requires a separate Plumbing Permit&Plumbing Inspection. ************************************************************************************************* Application dated, —a e1 is hereby made to the Building Inspector of the Village of Rye Brook for a permit for the installation and or removal of the I VAC equipment as listed below.The applicant and property owner,by signing this document agrees that said equipment will be installed and/or removed in conformance with all applicable Local,County,State&Federal laws, codes,rules and regulations. 1. Address: Aile— SBL: i-; G 73 Z& Zone: 0 2. Property Owner: �/� /�L,1 C}�-� Address: -- I$Q CAZwol �� D Phone#: 2,1 Z '2,0I 9104- Cell#: 3k7-7L-2-400 email: k) 3. Contractor: CoNva y C A Vk,�-"t? Address: p Q �cJ►�'L Phone#: 4- 1�j� 50cy) Cell#: ( t ¢ 41 7f�)3 k email: �Aii't�C%(y��1TIZUl.I�17 G.1 M��L4 rCV 4. Applicant: Address: Phone#: Cell#: email: 5. Scope of Work:New Installation K.Replacement( )•Removal( )•Other( ): 6. List Equipment: 60� IN t%NhCf- Wl-gNf X I?b i4k b 691 L- 1 tLT (7M-C? 7. Location of Equipment: 1^U�N AlGf—� 8. Method of Installation/Removal(list all equipment needed to perform job): 1 8/12/2021 my* WIL—YOR�C,C OF WESTCHESTER ) as: l ,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 she' 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 arcliitecA 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 q Sworn to before me this V day of day of Signs a of Property Owner Signature o Ap rProperty er t Name of Applicant SHARI MELILLO Wfc, State of New York Notary Public, State of New York No. 0111.'iE 616t^53 Q�ialified in Westch ster Coun No. 01;iiE cter County Commission Exr)ires Janua.nr 29.20 Q�ialified in Westch� ter a�2 Commission Expires Januan,29. 20 This application must be properly completed in its entirety and must include the notarized signature(s)of the legal owner(s)of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. 2 8/12/2021 rn Q z Q ❑ n C� Q Ta V/ T�T N co v' M C I I I Q I z— — — — — — — — — — ---- XI: i i 1 0 Q 00 i i r 0 N i i T � l 00 n o m Q z -- ----------r'------i -Y ---- --- -- ❑ L• Y O _� I I O I I I i iIr ------1------� 01) T X P W m� ^C < M 0 I m X ____________ __ L______--___---L _ _ ----------- -- W C � C7 C� C 8" X 4" I I 8" U 0 C I i 8" X 4,1 z < I I p e c0 m I I D D nn c/) 8" X 4" I TI O ai(n0 N� I 9" DIA. c non I Oz O r7l - ---- - D � I � M ca O K A D n iv O O N O �� OTl oN x C) O M Z X CIO >OO O* - �N Z Xcl) � Z cN ------j— ----------------------- D 0CD 0 m m 0 X ------ 1----- -- I A m ���CD I u (:D --- I n �0> � � CD -rI �> te 0 --1 M 0 DD��O cf) Z - N X I I 8„ X 41, r- I ={O Dz J i�l O C0 O Z 0 0 C.1 no (MCP -n x,. -n � I K410 K D=Z� O Cl r D Z �Zc� ter/ I I O�\Z O Drn0 O r m I I I O m I c � I / W N v/ D v I �/ nrn e � I � _ .,� • ,i y I c N m 000 O c:-D D Z � x �- ' n m Z O z n*i-+ ► �+— �_i i, I -TI cn c m O n I F m .. X Z I 1 N �� O Ox�o "^ 1 S f i ja k.c•.x �n+�u. .,c:.-nr_n.ves.+..:i .mac �.5 �� f 1 .�w.�+�a.•.ar.�.�+w;n,•w.z.�,.rruo.,rna.:�wna x•scu. �•:..r o >_ om D m n Z C) C V) A D O m z n Z N � ' m A z ❑ o II- OZj z N o ch 0 M a _U (X G 0 D o 0 CD m CO m vZ Z c � v m O � m � o m m �� M o o N O N o it N X 0) O C a �7 D I c/) m D--io CA fJ N N n� NM o� o 00 O RESIDENCE ADDITION 12 LINCOLN AVENUE, RYE BROOK, NEW YORK 10573 M -4 O m r i D co n Gl -4 O N N N N N N N N N = -n m f1 W p D n p Z D D G_ �� m D r W D M D D D 3 m m N _ =Z Z MG) Gl G) m r D N Z cn D Z O� ��D� O O Z r r r m O -n z Z N N G r p o-n p _ D r -n O �N D O � o ��c-"00 coo in N W C > Z n 0 0 p 0 0 2� C 0 m O- p 0 m z m W p O O z w O Z D Z W 0 ;0 O D N Pi 00 00 0 A A N 1 + 00 00 000ivrlarnu,0 O 00 Q1 O 00 M O O O F+ A F- LD .A �I N arnrnO-l0o�N.D oc Ln O O -1 0 lD a) O N O O �1 In C T O V O N N O F- F- 00000 N O M O w 1-4 N Ln �1 O lnw 0 O . r m0 D O Lm M c P z M K C� K0Z M A0 s B A I N T 0 N ARCHITECTS 2 v 0 � r a 535 8-,n Avenue, Suite 21 N. New York, N.Y. 10018 Phone: 212-290-8616 Fax: 212-290-8624 Email: kbarchitects,n)att.net £L901 A80A M3N'AMle 3A1 ] o o Q O •L'•'• s s '3nN3nd N10ON11 ZL N01NIy63AAONvyyznoN'•i " NOIllaaV33N3aIS321 Oz O:E u c.i m a ! u qq ' 001 n1 R J as w J X � ffi f 0( - Ea a aQ s p � k G5Ga 'e dR SY O AXJ P .g xA .rxA I is fi ffi l O ao ast� _ �$ 0 m 4y N u a 3 • Ra z z � Am�99smaA aRA�So II I_1 � � I I- - 8g R���BY�tAA A�AB�B = ®p®p55 i mm m 0 L w w �RAXza7tai6 �dasdp p+ a aY TLMiit al,•,tl[lC.�wu •m• •uve�rw ni�1M,w•,�v•u,Rf C� £LSO L AbOA M3N NOOH9 3Ab o o p ,.,,,, '3nN3AV Nl00NII Zl t N OJ-Ni v wzno� N011laab 3JN3QIS321 p �� '--= O z V �+ m Q w z 0 i C) co /b_8 Ya U c �� /� 2 os a Beg wi co Wa rT— lJ U.I _� Yz G W tz u z zz 91. n to t 1 : I I I I I I ° I I w O 0. Ov m 3 R 0 �� cz wow it =u7 W c r �O J � a o ~ � a x umf'+...eRr. �11�OQtIt.I.IY .I..I . m..,.,....W.. . .. £LSOl NNOA M3N'NOON13 3AN N ..,..I., 'anN3AV NIOONII Zl Y $ O A jo N w z n o N Nounsnusia OVAH 3JN3aIS321 x ��$ lz ---------------- _ I I I I I I � I I I r PEII /;.g •ti A LJ L _____________� xz& _ E] , I 0 0 � I I IIL JI fill 141.11ti Ig cV�c � t�mi Frv� U NO2 w 6ozp W VJ. 20N I I I I � I I I I I I g I I j J I I 5 I j a I � � I j � L---------------------- -----------------------j o J a Laura Petersen From: Kenneth Bainton <kbainton@kbarchitects.com> Sent: Wednesday, November 3, 2021 1 1:50 AM To: Laura Petersen; Mike Izzo Subject: 12 Lincoln Avenue, Rye Brook, NY 10573 - HVAC Permit MP-21-012 - Change of Contractor Attachments: Control ledClimates_ExemptionCertif icate_20211018.pdf; Control ledClimates-Certificate_ 20211018.pdf Dear Mr. Izzo, Regarding the HVAC work (Permit MP-21-012) at 12 Lincoln avenue, we are hereby requesting to replace the current contractor(AIC Mechanical) with a new contractor for the project. The current contractor's work load will not allow him to install the ductwork this month, significantly impacting the project schedule. Our goal is to complete all roughing for inspection by the end of this month. Accordingly we propose to substitute Controlled Climates LLC.as the contractor of record for this project. They are familiar with the job and are prepared to begin work upon this approval. Attached please find the Certificate of Liability Insurance and Exemption Certificate for Controlled Climates LLC. Please let me know if you have any questions, or if you need further information. Best regards, Ken Bainton KENNETH BAINTON KOUZMANOFF BAINTON Architects www.kbarchitects.com 347 West 36th Street,Suite 302 New York,NY 10018 o:212 290 8616 c:347 7212400 This message may contain privileged and confidential information intended solely for the use of the addresses(s) named above. Any disclosure, distribution, copying or use of the information by others is strictly prohibited. If you have received this message in error please notify the sender and immediately reply and delete the original message. 1 o � � owl, ga cc oc = `� o IEL O �/ 1 E T n < a, _ mob O E M w � '�' —•' t $ _ � 3 � � � � •; x 6. ! w CNo W °u u y � - y 2 rA W }. -- OM � co ;D O ono �,, = z � Ono U c m V g u yy G a 41 w .. .. z Q 3 Z o � g � '� •� � Q '� ►-� � (� Z O (� bN14 � � � � E E r Q N V O F• A p` � •= � � �i UU< a. u a ae fWil t = c n n. QI W� G, .i WWI i i 1 i E i S i t i i RBUILDING DEPARTMENT JAN 15 2021 VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 FAx(914)939-5801 BUILDING DEPARTMENT www.aebrook.ors APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY: PERMIT#: _)W4<V Approval Date: Permit F /1/ d bo Approval Signatur . Other: 'd )00— Pb l�/ slal Disapproved: (fees are non-refundable) REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 1. Properly completed& Signed Application. 2. Site/Staging Plan if Required by the Building Inspector. 3. Copy of Licensed Contractor's Liability Insurance.(Village of Rye Brook must be listed as certificate holder)& Workers Compensation Insurance on a NYS Board form(Form#C 105.2 or Form#U26.3/or NY State Workers Compensation Waiver) 4. Payment of Fees/Unit: RESIDENTIAL=$100.00/unit•COMMERCIAL=$350.00/unit. 5. Inspection by the Building Department for removal and/or installation.(48 hour notice required 6. Electrical work requires a separate Electrical Permit& Electrical Inspection. 7. Plumbing/Gas work requires a separate Plumbing Permit& Plumbing Inspection. ************************************************************************************************* Application dated, is hereby made to the Building Inspector of the Village of Rye Brook for a permit for the installation and or removal of the HVAC equipment as listed below.The applicant and property owner,by signing this document agrees that said equipment will be installed and/or removed in conformance with all applicable Local,County,State&Federal laws,codes,rules and regulations. 1. Address: / a L i 1V C o L 1VA✓L SBL: %35,73` j'a l Zone: 2. Property Owner: Kc-iv fwa r i 4 /3 4 iv 7-6 R/ Address: IQ L 11y f v L iy /4✓&�- Phone#: Cell#: email: 3. Contractor: A Address: 3ij& 10/EASi)d7 �iO4t kJu/ gc N�/ Phone#: 84T 235-L 7/3 Cell#: g-,VS- 2 3_5-Z 17/ 3 email: 4. Applicant: JA),L L t'A JM TO,vFS Address: Phone#: 4 S 2 3 S- 6'713 Cell#: email: 5. Scope of Work:New Installation()•Replacement( )•Removal( )•Other( ): 6. List Equipment: /G/1IVICC `•'ZA G ['a c , Co.un[=�u Scf a I&I r -k D T 5r 7. Location of Equipment: 197TIL 8. Method of Installation/Removal(list all equipment needed to perform job): 1A9,)0 Tom/S t 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 me this day of ,20 day of ,20 Signature of Property Owner Signature of Applicant Ct.)1tc ,4 So'OE5 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. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. 2 3/21/19 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 ofthe Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn to before me this day of 120 day of 120 afore of Property Owner Sigpkture 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. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. 3/21/19 2 V=LE OF RY BROOK � �� �NG DEPA`� MENT NOV - 2 2020 938 KING%,ET,RYE BROOK,NY 10573 (914)939-0668 F - 1 wwwx ehrook. VILLAGE OF RYE BROOK o <� 0 BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL. MODIFY AND/OR REMOVE MECHANICAL E U WMENT OFFICE USE ONLY: Permit#: Building Inspector: Fee Paid: 19 Date of Approval: - Parcel ID#: L 1 -Z Bldg/Use Class:Res. ;Comm. REQUIREMENTS FOR RELEASE OF PERMIT: (A CERTIFICATE OF COMPLIANCE Is REQUIRED TO CLOSE OUT TFIIS PERMIT) 1.Properly Completed&Signed Application. 2.Payment of Application Fee: Residential=$100.00. Commercial=$250.00 Fees are non-refundable) 3.Site/Staging Plan as required by the Building Inspector. 4.Sealed Construction/Installation Documents&Specifications as required by the Building Inspector. 5.Copy of Licensed Contractor's Liability Insurance.(Village of Rye Brook must be listed as certificate holder)& Workers Compensation Insurance on a NYS Board form (Form#C 105.2 or Form#U26.3/or NY State Workers Compensation Waiver) 6.Payment of Permit Fee: Residential=$15.00/1000.00 of Construction/Materials Cost with a minimum fee of$100.00. Commercial=$22.00/1000.00 of Construction/Materials Cost with a minimum fee of$250.00. 7.Inspection by Building Department for removal and/or installation. (aa hour notice required) 8.Any electrical work requires a separate Electrical Permit and Electrical Inspection. 9.Any gas/plumbing work requires a separate Plumbing Permit and Plumbing Inspection. **xi:�:xi:xic i�C***z�k irx�c r.is�c*******icxx�cxxxxx r.r.zr.r.x�c*************�c is�c icxxicx xzxz�c is icx�Fx***�'cz is is i:xr.x Application dated, 10/28/2020 is hereby made to the Building Inspector of the Village of Rye Brook,NY,for a permit for the installation,modification,and/or removal of the specific Mechanical Equipment as listed below.The applicant and property owner, by signing this document agrees that said equipment will be installed and/or removed in conformance with the approved plans,and with all applicable Local,County,State&Federal laws,codes,rules and regulations. 1.Address: 12 LINCOLN AVENUE SBL: 135.73-1-26 Zone: R-10 2.Property Owner: KENNETH BAINTON Address: 180 CABRINI BLVD. APT.101 Phone#: 212-781-9204 Cell#: 347-721-2400 email: kbaint@gmail.com 3.Contractor: Address: Phone#: Cell#: email: 4,Applicant: KENNETH BAINTON Address: 180 CABRINI BLVD. APT.101 Phone#: Cell: 347-721-2400 email: kbainton@kbarchitects.com 5.Scope of Work:New Installation(X)•Replacement( )•Removal( )-Other( ) 6.Type of Equipment: HEIL MODEL G9MXT, 78,000 BTU GAS FIRED FURNACE WITH COOLING COIL WITH YORK MODEL TCHD48 EXTERIOR CONDENSER 7.Location of Equipment: SECOND FLOOR ATTIC IN ADDITION 8.Cost of Equipment including Installation Cost:$$10,500 1 3/21/19 CO < ,—JAuJ CF 0 �I Z l� Z �? cc) o O r= co o O CD D O � D ;0 O (fi < O -u D C) m 0 O w w � N O GO O O O 0 C7 n C7 C C C C m m 0 Ln O O o o m CID c 0 C C C 00 77 U/ z O _ O D D 00 CO UJ UD O O O O CC) CC) C C C 0 m 0 z no mm m �7 ;;u - z X 0 O p D U)� K 00 M n _ Z N O p O oo M _ 0 O D (�, i D D N) Q0 N 0 m o m o r > r 0 _ -no m C m D X z C m m �;u .41 NJ O tv o F7 m co n F7�� 0 m z N I CIS J � J O O C 00 O O O CD C A N D C)i _�,�] Q ciCD V/ O C T cz T C N O� O d� O O O -n O O O Cn \ z Ci F7 D p� ci) F7 F7 X r- �7D FT� �m O� D n O D;:0 :E �- O � m O mZ I O � X n �� T�1 /v O co Zm 0 Oz O 0< z � I O J -u O C7 O D fTl c-) z m. z m� of D D 0 OFri Z T m 'rT-f > CC-i > Z n m 3 ��O m m � 1 W T T O � D \ N \ V A z 0 I I o D m N O O r z D z n Z 0 C F- 7) F- 0 z .70 �m m0 m Fr-1 z --� F7 -0 C) z FTl G7 1-u < m C n X K mz OC/-) 0-0 TI fTl D Z D O D >m n---qDO r mn(f).70 m O z Z ` c D p r- n p m < O - Z O mZ CF7 0CC)KM-T-1 <zOOXC Z r7 p Z C C D O n D = -;am � ; D z m 0 M mCll Zcl)Cnp.70 � C m Z �_ �7 �7 D 71 ip p z O N � 1 �aA r-00 m ZJ �D O N - N N �X - N n m mmC7 ti mVIM i �7 D c Dm C C sF- Z QDC O ;;u p M�J G� C C7 ...err.... _.�:.w".:.7� �.. Z A T N O m o 71 pD C� m � m U) z Z C �m O c- m o m m A m m RESIDENCE ADDITION 12 LINCOLN AVENUE, RYE BROOK, NEW YORK 10573 � o m � ^� ��m N 0 m0 z0 M }i C7D Z =Z U) POC7z n I <O� cn ,=o�zn m��D " m pZ=Fri D C D Z j D D F m� m V) O� D O p F7 O = p Z D Om O = F7O D aOcA D � O m C Fri r- (n r- - C Z p Z Z V l m K0UZMANOFF B A I N T 0 N ARCHITECTS 535 8th Avenue, Suite 21 N, New York, N.Y. 10018 Phone: 212-290-8616 Fax: 212-290-8624 Email: kborchitectsCqatt.net VJ W m Z m c � r v O O m 3 1 \ O O p N N Cnl p Z p n z CO -< cD t-J 0) Np m U) Z a] 00 O CD 0 A L m D N p m m m CD u O � m p z RESIDENCE ADDITION 12 LI NCOLN AVENUE, RYE BROOK, NEW YO RK 10573 K 0 U Z M A N 0 F F B A I N T 0 N ARCHITECTS 535 8th Avenue, Suite 21 N, New York, N.Y. 10018 Phone: 212-290-8616 Fax: 212-290-8624 Email: kbarchitects@att.net • rye . .fir- ^'�'� �+- ^� �`i'M a• :aw`�t . 4w 1 '��" � � tAa 1.1 }�AY 1 3A qr �A� .ha„rSfi• �^Y ��A9 ( ��^Y '�I' ,Ilctilc/ll • r ' ,jjcMcl,l. ,jci/icit� � �jlci1�41,1 Ij�icl� Ilccicl�, ;: / � > Nn�€r't �:, t •.111 11: Ff "tt.`: 1�11��"��'s "'s t:111�11 .: 11�11.x 1 ..1/1 11... •t �1 (0)f�l N co d V O .. cs ' CU to. otectioq N • i1�•lI LU G `; w ►- �, J bedaG co ^C7 > r ;! M i CA .14 ►a : ea o vn Y}.y M M ryy M ��: eLn:: U a� N �.•���r• •� d �i C N ��: I!(0)�i�' a Wo"O", � •4A�•'+� •• A{l� •• �F'4AV •• A \ �i Via. 1�. t�.�Y .k•..r� � Y�rp• \ �' � •"�� ACORa CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDDIYYYV) �1 01/14/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S). AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. iIMPORTANT: It the certirlcate holder is an ADDITIONAL INSURED,the poiicy(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 chic rprtifiratp rinpc not rnnfpr rinhtc to the rprtifiratp hniripr in li-,of ctich PnrinrsnmenNet. PRODUCER NAME: E _ AUTOMATIC DATA PROCESSING INSURANCE AGENCY, INC. PHONE A1C Nv'. 1 ADP BOULEVARD E_Mell Roseland, N] 07068 nDDR INSURER(S)AFFORDING COVERAGE N=9 INSURER A: AmGUARD Insurance Company 42390 INSI1RFn If/�,�F,B: AIC Mechanical Inc INSURER C: 34io rlCdldlll rlILIy" ru iNSURERD. Wingdale, NY 12594-1407 INSURERS: _ I I NSURER F. 1 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: TI-IIC IC Trl C PPTIPV THAT TWP: Pill IrIFC r-w MCI-IPORIrF I ICTr:n PFI n%A/WAIM RFFPI ICCI ipn T/l THE MCI IAFr)mahAr:n ARrwr PnP THE Prll Iry pF glrl�) 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 A,"."..`CONDITIONS OF SUCH F v':!C!ES.LIMITS SHO IN 1!AN H,A,VE BEEN REDUCED BY RAJO CL JMS. INSR- ADDL SUER POLICY EFF POLICY EXP - LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YY MMIO LIMITS COR:.Y.ERCJtLC�`:ER;LLIABlLRY EACH OCCURRENCE $ i UUV 000 DAMAGE To A X CLAIMS-MADE I X�OCCUR I PREMISES RENTED occu ence $ 50,000 HIDYIAFO/TU 1OiiSi2020 #0115/2021 MLU LAP(Any one pawn) $ 5,000 PERSONAL 8 ADV INJURY $ Included GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 I X POLICY j� 71 LOC I PRODUCTS-COMP/OP AGG $ 2 000 OOO OTHER: $ AUTOMOBILE LIABILITY CO1?NEDSINGLELIMIT $ Ea accident ANI AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-CM PROPEPTYDAMr_ INED ac AUTOS ONLY AUTOS ONLY $ I UMBRELLA LIA8 OCCUR I EACH OCCURRENCE $ —I EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED i RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS LIABILITY YIN STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE I E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUE N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If," describe urder I D6kRIPrION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION ®ro SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THP FXPIRATIr�N nATF TFIFRFr1F Nr)TIrF WII I RF nFIwF:RFn IN The Villa 40573 ��.9ACCORDANCE WITH THE POLICY PROVISIONS. 938 Kin Rye Brook, AUTHORIZED REPRESENTATIVE 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NEW 14EW Workers' Certificate of Attestation of Exemption YORK `--- ?TATE Compensation from New York State Workers' Compensation and/or Board Disability and Paid Family Leave Benefits Insurance Coverage "This form cannot be used to waive the workers'compensation rights or obligations of any parot" 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 AIC Mechanical,Inc From:Village of Rye Brook DBA:AIC Mechanical 3418 Pleasant Ridge Rd Wingdale,NY 12594 The location of where work will be verformed is PHONE:845-235-6713 FEIN:XXXXX6649 12 Lincoln Ave,Rye Brook,NY 10573. Estimated dates necessary to complete work associated with the building permit arc from January 15,2021 to January 14,2022. The estimated dollar amount of project is $0-$10,000 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.) 1,William Jones,am the President with the above-named legal entity. 1 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'Cowensation Law and all other New York State laws. By submitting this Certificate of Attestation of Exemption to the government entity listed above 1 also hereby affirm that if stances change so that workers'compensation insurance and/or disability and paid family leave benefits coverage is required,the above- ed 1 entity will immediately acquire appropriate New York State specific workers' compensation insurance and/or disability and paid f t ve nefits coverage and also immediately furnish proof of that coverage on forms approved by the Chair of the Workers'Compensation Board go ment entity listed above. SIGN I HERE Signature: Date: //;-5-/Z / Exemption Certificate , u Received 2021-001844 January 12, 2021 NYS Workers' Compensation Board CE-200 01/2018 Building Permit Check List&Zoning Analysis ` Address: 2 �- t N ( rJ Vti SBL: `7B —1 Z Zon . , 1 D Use: 2 t iJ Cont.Type: Other: Submittal Date -7- Revision Submittal Dates: Applicant: Nature of Work: -7, ^- t�U Tz f1-wm o t� S Reviews:ZBA: J AN - 5 2021 PB: BOT: Other. ( ( ) FEES:Filing. 7 S• BP: _Z-'i'Z Z S- 'F"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. ( ) (v) SURVEY:Dated t 1 l 0 )2 o Current: -/ Archival• Sealed: Unacceptable: ( ) (� PLANS:Date Stamped: ✓ Sealed: ✓ Copies: 2 Electronic: '�Other. ( ( ) License: L/0'Workers Comp: V_Liability: L.-*�Conip.Waiver. Other. (� ( ) CODE 753#: 03 9J--00Q— 0-OC Dated: 3—a9—&J N/A: (Jf ( ) HIGH-VOLTAGE ELECTRICAL:Plan: Permit: N/A: Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plan: Permit: H.W.I.C.:_Battery:_Other. PLUMBING:Plan: Permit: Nat.Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A: Other. H.V.A.C.: Plan: Permit: N/A Other. ( ) ( ) FUEL TANK:Plan: Permit: Fuel Type: Other. O O 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plan: Other. ( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other. ( ) ( ) Other. mtg.date: Zo 2 1 approval tes• ( )ZBA mtg.date: approval• notes: ( )PB mtg.date: approval• notes: A�� O�C REQUIRED EXIMNG PROPOSED NOTFS r 1 l gF n Ar l D k t ZS� - D� ns.s. 921 Cir FroaW &o ' Fronc: Front: Sides: Main Cov Accs.Cov: F S Sd,H/Sb: Z Tot, S-Z")l Z Ems. m : Ll Parkin IHht/Stories notes: J b�- r-' �M L i O -147 C�Ns n-d O N w e L F C �- .Building Permit Check List&Zoning Analysis Address: A �� L ;, �i�'- SBL: > _ - �� Zone: �' Use: Const.Type: Other. Submittal Date: 31 Revisions Submittal Dates: Applicant: \ L� Nature of Work c C lCti v Ci�i Ql'�C Reviews:ZBA: JAN 0 8 20?4 PB: BOT: Other. NE D OK, (� ( � FEES:Filing: BP: C/O. Flood Plane: Legalization: ( ) (�APP: Dated ✓ Notarized: SBL: Truss I.D. Cross Connection: H.O.A.: (V ( ) Scenic Roads: Steep Slopes: Wetlands: Stone Water Review: Street Opening. ( ) ( ) ENVIRO:Long. Short: Fees: N/A; :AN:Topo: Site Protection: S/W Mgmt.: Tree Plan: Other: JY.Dated: urrent: Archival• Seald Date Stamped Sealed Copies: Flectroni� Other. ( ) License: Workers Comp: Liability Comp.Waiver. Other. /( ) CODE 753#: 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. ( ) ( ) 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 GARB mtg.date: 1 ) s Z approval• notes: ( ) mtg.date: approval:- —notes: ( approval• notes: REQUIRED EXISTING PROPOSED NOTES�C APPROVED PPROVED Area: Cirde lL — Date: ` Fro�taee Front: Front: 1�3 36 y� Sides: - U �1s Rear: � L Main Cor. Accs.Cor. �T \ Ft.H Sb: "� CU v�_ Sd.H Sb: l V Ll GFA: Sao ( k Tot 1W. F- Ft.Im : 7.7 Pg;jW. Height/Stories: " notes: M (. gXA n d (-\ t(1 G r bg9 g 0 Or EBUILDING NE I BUILDINq- itTMENT VILLA,�;O E OF RYOK020 938 KING��'I7bEET RYE BR �,NY 1057 (914)9�-� 9 39-5801E BROOK ARTMENT 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: 12 LINCOLN AVENUE Date of Submission: 12/30/2020 Parcel ID#: 135.73-1-26 Zone: R-10 Proposed Improvement(Describe in detail): APPLICANT CHECK LIST: M UST BE COMPLETED BY THE APPLICANT Enclose portion Of existing porch. Relocate kitchen, The following items must be submitted to the Building bath, laundry & interior stair. Replace plumbing. Department by the applicant-no exceptions. Add 3 dormers, replace some windows & doors. 1. (X)Completed Application 2. (X)Two(2)sets of sealed plans. (one full size (maximum Property Owner: Kenneth Bainton allowable plan size=36"x 42") and one I 1"xi 7") Address: 180 CABRINI BLVD. NYC, NY 10033 3. (X)Two(2)copies of the property survey. 4. (X)Two(2)copies of the proposed site plan. Phone# (347) 721-2400 5. (X)One electronic/disc copy of the complete application materials. Applicant appearing before the Board: 6. (X)Filing Fee. SAME AS ABOVE 7. ( )Any supporting documentation. 8. ( )HOA approval letter. (if applicable) Address: 9. (X)Photographs. Phone# 10.( )Samples of finishes/color chart. (a sample board or Architect/Engineer: SAME AS ABOVE model may be presented the night of the meeting) 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 before me this Sworn to before me this day of day of , 20 Sign re of Property Owner Signature of Applicant Kenneth Bainton Kenneth Bainton Print Name of Property Owner Print Name of Applicant Notary Public Notary Public 111 3/21/19 = VILLAGE OF RYE BROOK BUILDING DEPARTMENT 938 KING STREET, RYE BROOK, NY 10573 (T) 939-0668 (F) 939-5801 ARCHITECTURAL REVIEW BOARD Thursday, January 21, 2021 Due to public health and safety concerns from COVID-19, the Architectural Review Board meeting on January 21, 2021 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/i/82284377958 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: 822 8437 7958 NAME & LOCATION TYPE OF APPLICATION MOTION SECOND APPROVED REJECTED APPL.# 165 Betsy Brown Amendment to Prior Consent 5128 Road (Valad) Approval, (Front Door Agenda Change) 2 Wilton Circle Legalize New Rear Raised Consent 5129 (Charney) Patio & Sitting Wall Agenda 6 Loch Lane Roof Top Solar Array Consent 5131 (Orselli) Agenda 24 Latonia Road 6' High White Vinyl Fence Consent 5132 (Rothbart) w/ Gates Agenda 39 Country Ridge Dr Swimming Pool Fence. 6' Consent 5119 (Austrian) Hight White PVC @ Side Agenda Yards & Black Chain link 6' @ Rear 15C Rye Ridge Plaza New Sign & Awning "Green 5133 Win - Ridge and Tonic" 5 Parkwood Place In-Ground Swimming Pool, 5130 (Kohn)) Patio, Outdoor Kitchen & Fence 780 King St Extend Existing Deck w; 5134 (Heinberg) New railing & Decking. New Roof Over Deck 39 Meadowlark Re-Appearance to Show 5122 ML NM MR SE JM SF AC MI KC 4VOX? ' Road(Rose) Revisions 24 Sleepy Hollow Rear Addition, Deck, Patio 5135 Road(Iacobelli) & Front Covered Porch 980 Anderson Hill Amendment To Prior 5136 Road Approval. Construct New Blind Brook Club Golf Teaching Building, Reconfigure Front Entrance & Golfing Landscape 6 Latonia Road Re-Appearance To Show 5120 1 (Casino) Revisions 12 Lincoln Ave Two Rear Dormer Additions 1 5137 (Bainton) & Interior Alterations 57 Hillandale n O 1 Story Addition, 2nd Story �Q 5138 (Grossberg) Addition, Rear Covered Porch & Front Portico ML NM ✓ MR SE JM ✓/ -8F AC V MI KC VILLAGE OF RYE BROOK BUILDING DEPARTMENT 938 KING STREET, RYE BROOK,NY 10573 (T) 939-0668 (F) 939-5801 ARCHITECTURAL REVIEW BOARD Wednesday, May 19, 2021 PAGE 3 eltt�l 1 Westridge Dr 1 Story Side Addition, Fire 5203 (Tauber) Pit in Rear Yard& Legalize Rear Patio Expansion 12 Lincoln Ave Amendment to Prior 5204 (Bainton) Approval �LC JQA 16 Birch Lane In-Ground Swimming Pool 5205 (Wilk) w/Patio, Deck, Fence, & Plantings 44 Country Ridge New In-Ground Swimming 5205 Dr(Wechsler) Pool, Patio, Outdoor Kitchen, Hot Tub, & Regrade rear Yard 259 N. Ridge St Amendment to Prior 5206 (Lanz Development) Approval, Reducing From 3 Garage Bay to Two Garage 20 Old Orchard Rd Legalize Elevation 5207 (Tillison) Changes ML NM MR SE JM SF AC MI KC ,/ i y DR Village of Rye Brook ML Oe MR Agend FB SE Architectural Review Board Meeting AC AD Wednesday,January 17,2024 at 7:30 PM Q Village Hall,938 King Street JM SF 1. ITEMS: 1.1. ARB24-001 (Consent Agenda) Emilio Espinosa,Emilio Espinosa,Jr.&Eduardo Espinosa Venegas 50 Bowman Avenue Rooftop solar array. 1.2. ARB24-002 (Consent Agenda) Steven Brauntuch&Jennifer Brauntuch 55 Hillandale Road Rooftop solar array. Consent Aanda Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.3. ARB24-003 Matthew Garry&Lauren Garry 6 Magnolia Drive Rear one-story addition and interior alterations. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.4. ARB24-004 Jocelyn Diaz 10 Maple Court Legalize rear yard deck. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes Page 1 of 2 Architectural Review Board January 17,2024 1.5. ARB24-005 Michael Cohen&Allison Cohen 34 Woodland Drive Second story addition,raised front entry portico and interior alterations. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.6. ARB24-006 Jason Gorsky&Allison Gorsky 15 Eagles Bluff Remove side entry&steps,finish basement,install egress window and interior alterations. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.7. ARB24-007 (Amendment to Prior Approval) Hiddenfield77 Corporation c/o Kenneth Bainton 12 Lincoln Avenue Exterior elevation changes,windows, fencing and interior alterations. Approvals: Motion Second YA Z Abstention Aye; l Nay; Adjournment; Notes NEXT MEETING: February 21,2024 Page 2of2 CONTCLI-01 BEGEL1 ACORO DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/18/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate-does-not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER C TACT Ellen Goldman(egoldman@butwin.com) Nathan Butwin Companyy,Inc. PHONE N 60 Cutter Mill Rd.Ste.414 :(516)466-4200 FAx Ne:(516)466-4213 Great Neck,NY 11021 IM33.lnfo@butwin.com INSURE S AFFORDING COVERAGE NAIL a INSURER A:Utica First Insurance Co. 15326 INSURED INSURER B: Controlled Climates,LLC INSURERC. Po Box 1547 INSURER D: Port Chester,NY 10573 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COIMERCUIL GENERAL LIABMJTY EACH OCCURRENCE _ 1,000,000 CLAIMS-MADE X OCCUR ART513613302 10/28/2021 10/28/2022 PREMI ESORENTED 50,000 (Es occurrence) MED EXP(Any one neon 1,000 PERSONAL&ADV INJURY 1,000,000 GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 2,000,000 X POLICY❑ipta ❑LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY Perperson) OWNED SCHEDULED AIURTEO�S ONLY AUTOS BODILY Ep BODILY INJURY Per accident AUTOS ONLY AUTOS OS PeraaEo dent AMAGE UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT FICER/MEMBER EXCLUDED? NIA andatory In NH) - E.L.DISEASE-EA EMPLOYEE I}yes,descnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT III DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLU(ACORD 151,AddUlwal Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 938 King Street ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVE to- ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD " Workers' Certificate of Attestation of Exemption :STATE Compensation from New York State Workers' Compensation and/or Board 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 carver 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 Controlled Climates LLC 2 Highland St,Suite 3 From:Village of Rye Brook Port Chester,NY 10573 PHONE:914-939-5800 FEIN:XXXXX2286 The location of where work will be performed is 12 Lincoln Ave,Rye Brook,NY 10753. Estimated dates necessary to complete work associated with the building permit are from October 18,2021 to March 3,2022. The estimated dollar amount of project is $0-S10,000 Workers'Compensation Exemption Statement: The applicant is NOT applying for a workers'compensation certificate of attestation of exemption and will show a separate certificate of NYS workers'compensation insurance coverage. 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,Donell Oliver,am the Member 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 eutity-vGil1 unm ' tely acquire appropriate New York State specific workers' compensation insurance and/or disability and paid family benefits coverage and so immediately furnish proof of that coverage on forms approved by the Chair of the Workers'Compensation Board to entity listed above. HE> Signatus`e: 1: Date: ( ®6 z 2- Exemption Certificate Numb r Received 2021-065606 October 18, 2021 NYS Workers'Compensation Board CE-200 01/2018 Laura Petersen From: Laura Petersen Sent: Thursday, March 18, 2021 12:14 PM To: 'CIEMERI3@HOTMAIL.COM' Cc: 'KBAINTON@KBARCHITECTS.COM' Subject: Building Permit Application - 12 Lincoln Avenue 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, ��O_3., 1. General contractor's contact name & phone number. �s�e/J�� cowlo ✓2. 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 $2,775.00 (due once permit is issued and ready for pick-up) 6. Contractor must call Dig Safe NY and get a ticket number. This information can be emailed to me 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 IpetersenOrvebrook.oro 1 fi WO oaC ? L TZ CD ..r •� O � 3 �o O > JQ On w U O LL LIJ �. O ^ u !`awueda0 ttstap ram. IMO W_ Odom 44 � L 0 Y SOO z 04 Mom^ t ,aco CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDD/YYYY) 03/19/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must 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 NAME: Genesis Mariscal North Main Street Insurance Agency PHONE FAX AIC No): 375 North Main St. E-MAIL ADDRESS: Port Chester,NY 10573 INSURERS AFFORDING COVERAGE NAIC N INSURER A: Main Street America Assurance INSURED INSURER B: NGM Insurance Co. Ciemer General Contractor LLC 92 Edison Ave INSURER C:Old Dominion Insurance Co Fairfield CT 06825-4200 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. INSR TYPE OF INSURANCE ADDL UBR POLICY NUMBER ? MM DIYYYY MM POLICY LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $1 QQQ QQQ x COMMERCIAL GENERAL LIABILITY F r PREMISES Ea occurrence $5QQ 000 _ CLAIMS-MADE a OCCUR I MED EXP(Any one person) $10 000 A MPU6096J 02/03/2021 02/03/2022 PERSONAL&ADV INJURY $1 000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2 QQQ QQQ X1 POLICY 7 PRO- LOC $ COMBINED AUTOMOBILE LIABILITY Ea accident SINGLE LIMIT r $1 QQ QQQ ANY AUTO I BODILY INJURY(Per person) $ ALL OWNED Ix SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON-OWNEDB1U6Q96J 02/03/2021 02/03/2022PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ AUTOS Motorist $1,000,000 X UMBRELLA LIAB M OCCUR F F EACH OCCURRENCE $5 000,000 B EXCESS LIAR CLAIMS-MADE CUU6096J 02/03/2021 02/03/2022 AGGREGATE $5,000,000 DED I x I RETENTION$ $ WORKERS COMPENSATION x WC STORYTAJIMTU- OTH- AND EMPLOYERS'LIABILITY I ER C ANY PROPRIETOR/PARTNER/EXECUTIVE Y IN❑ WCU6096J 03/26/2020 03/26/2022 E.L.EACH ACCIDENT $1 QQQ QQQ OFFICE/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1 000,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $1,000,000 r I F DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Job Site:12 Lincoln Ave.Rye Brook,NY CERTIFICATE HOLDER CANCELLATION Village of Rye Brook SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 938 King St ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVE Genesis Mariscal/GM ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Clear All STATE OF NEW YORK WORKERS'COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name& Address of Insured (Use street address only) Ib.Business Telephone Number of Insured CIEMER CONTRACTOR LLC 203 280 2189 92 MADISON AVE FAIRFIELD, CT 06825 lc.NYS Unemployment Insurance Employer Registration Number of Insured Rork Location of Insured(Only required if coverage is specifically Id.Federal Employer Identification Number of Insured limited to certain locations in New York State, i.e., a R'rap-Up or Social Security Number Policy) 26-0155258 2.Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) NGM Insurance Co VILLAGE OF RYE BROOK 3b.Policy Number of entity listed in box"la" 938 KING ST WCU6096J RYE BROOK, NY 10573 3c. Policy effective period 03/26/2020 to 03/26/2021 3d. The Proprietor,Partners or Executive Officers are included. (Ong check box if all partnerstofficers included) 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: Genesis Mariscal (Print name of authorized representative or licensed agent of insurance carrier) Approved by: Cerwgil 7l arrscal 03/19/2021 (Signature) (Date) Title: Agent Telephone Number of authorized representative or licensed agent of insurance carrier: 914-481-5334 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 STATE OF NEW YORK WORKERS'COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la.Legal Name&Address of Insured(Use street address only) lb.Business Telephone Number of Insured CIEMER CONTRACTOR LLC 203 280 2189 92 MADISON AVE FAIRFIELD, CT 06825 lc.NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required if coverage is specificall-v ld.Federal Employer Identification Number of Insured limited to certain locations in New York State, i.e., a Wrap-Up or Social Security Number Policy) 26-0155258 2.Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) NGM Insurance Co VILLAGE OF RYE BROOK 3b.Policy Number of entity listed in box"la" 938 KING ST WCU6096J RYE BROOK, NY 10573 3c. Policy effective period 03/26/2021 to 03/26/2022 3d. The Proprietor,Partners or Executive Officers are included. (Only check box If all partners/officers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "3" 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"2". The Insurance Carrier will also notify the above certificate holder within 10 days IFa 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: Genesis Mariscal (Print name of authorized representative or licensed agent of insurance carrier) Approved by: GeneS'4 An-13ca! 03/19/2021 (Signature) (Date) Title: Agent Telephone Number of authorized representative or licensed agent of insurance carrier: 914-481-5334 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.web.state.ny.us i Laura Petersen From: Mike Izzo Sent: Monday, March 29, 2021 3:40 PM To: Tara Gerardi; Laura Petersen Subject: Fwd: Message from Dig Safely New York, Inc. (DSNY) Michael J. Izzo Building & Fire Inspector Village of Rye Brook, NY Sent from my iPhone Begin forwarded message: From: Dig Safely New York Exactix<tickets@exactix.digsafelynewyork.com> Date: March 29, 2021 at 10:39:46 AM EDT To: Mike Izzo <Mlzzo@ryebrook.org> Subject: Message from Dig Safely New York, Inc. (DSNY) Reply-To: Dig Safely New York Exactix <tickets@exactix.digsafelynewyork.com> ****REGULAR**** DIG REQUEST from DSNY for: VIL RYE BROOK Taken: 03/29/2021 10:38 To: VIL RYE BROOK PRIMARY Transmitted: 03/29/2021 10:39 00010 Ticket: 03291-000-901-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 12 To: Name: LINCOLN AVE Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: ENTIRE FRONT OF PROPERTY AS FACING, AT ORANGE MARKED AREAS NearSt: WESTCHESTER AVE Means of Excavation: HAND TOOLS Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: Y Work Type: ADDITION BUILD, SEWER HOOK UP Estimated Work Complete Date: 04/05/2021 Depth of excavation: 42 INCHES Site dimensions: Start Date and Time: 04/05/2021 07:00 Must Start By: 04/19/2021 ------------------------------------------------------------------------------ Contact Name: EMERSON COUTO Company: CIEMER GENERAL CONTRACTING Addr1: 92 EDISON AVE Addr2: 1 City: FAIRFIELD State: CT Zip: 06825 Phone: 203-280-2189 Fax: Email: ciemerl3@hotmail.com Field Contact: EMERSON COUTO Alt Phone: 203-280-2189 Working for: KEN BATON ------------------------------------------------------------------------------ Comments: WORK WILL BE TAKING PLACE IN JUNE, TICKET NEEDED FOR PERMIT ONLY AREAS ARE MARKED IN ORANGE Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA CON-ED NYSDOT TFC POKPSE SUEZ WTR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR z .rarvar.a---•�a.'.zais_..:,..a...,.r•......_......r�a..T-s.u,a.....�arru---- OCO-V � Oil 83eWnN 9NIMVaO t�8f� � N hZOZ C - NVF I d SMOV913S0 104 NV_1d 311S '7'�b►y 03a�j17 { ' - �� �,1 T q �'' � NVId 31IS Nolldlax3o --- __ __.. _� OZOZ/lC/Z l Z# 1N3NGN3VYV�ZOZ/sL/Z L© ONOI 1333 tZ •XOdddb 30N33 NI`dIN3d 01 43dldd3v 38 01 ONOI 1333 tL 'XOdddd ONOI 1333 CV 'XOdddd 30N33 31V0 i- HOIH 1003 t M3N a3SOdOdd 30N33 ONIISIX3 - 30N33 HOIH 1003 9 ONIISIX3 HOIH 1003 9 M3N a3SOdOdd ,►� :�- t too—, �0 •l—,�g ` 31YOS 8A 8>i 03H33H3 AS Nmwa -------— ---- ------------ - ----- ----- ----- - - -- � Y ll,� 0013 ON003S V 1ShcJ01 I II II I I ---- -- --- .syxr•: c:.:.�'r• ;' 3NII ONIal1f18 ONIISIX3 of of ofI I I� H H ,, a � ► l��'-�'.� v 3n08b' d0013 aNZI I _ y... o I I I L' Co I _LV >iO3a ONIISIX3 3NIl J�1d3dOdd Aovel3S (MvIk - 3NII )dd3dOdd 30S 'lA S l I I I � I Nlb'W3d Ol d31S I`____ 1 30N33 ONIISIX3 3ZII1OViS ----- ------ - - -� H0d0d QOOM ONIISIX3 NIdW3d Ol Sd31S Ol S1SOd 30N33 M3N NOI1dIaaS3a 31da I I I 3NOlS ONIISIX3 ' SNOIS6UN A3V813S adds - --- -- --- _ - - - - - - - - - - - - - - - - INO83 13 0� I NZ do I NI`dW3d 01 #103f 021d I I NIdW3d Ol HOdod ONIISIX3 SIII3d1 0NI1SIX3 ` a3ewnN 133ro8d ONVH83AO , M11 -- _ , I I ���1� *30V83no0 NI 30 0 ON - 3008 7F1 a3nOW3d 38 Ol I LN011��dS 103"d ONVH63AO 300d Nfl dldO ONIISIX3 I IIdM d01d31X3 UN Slll381 0NI1SIX3 V 1�d � ��`�n ONIAVd snoln83d ' 3SOdO8d ' I 3n001d ALAI fl M3N I aO 14j 1-�'` s N Z o I 1 I ns �dN mr oNol 1333 z xo b' 30N33 �' ooJg e/CS 10 a 01�3dSNl IQllf18 - BR � HOIH 1003 t M3N , 3SOdO8d I --- --- 3n08d dO013 ON003S NIISIX �N x I I � �°r 0 3 � O r' I II M0I38 H080d d0013 1Sd13 30 n O o I :R I I i t 36nSOlON3 1VN011140`d a3SOdOdd ; 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