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HomeMy WebLinkAboutRP21-010PERMIT # '-010 DATE 9ki SECTION *�DJ TYPE OF WORK p JOB LOCATION C /&_V/JC �-� %mov 7 11 OWNER CTa� `�C?�C"e_` Q��/P /a(le n9�t%�007-t�JrcDS CONTRACTOR1MP77©iyl��%1'YI��C�QFh�=.yl�p(_.iN�%I /,EST. COST FEE 5- CO # L FE DATE o� o�� TCO # FEE DATE INSPECTION Rtl��Jrc� DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING ED RGH PLUMBING GAS SPRINKLER 0 ELECTRIC LOW; VOLT C7 ALARM a AS BU:LT FINAL I NSP OTHER APPROVALS BOT j PS ZBA OTHER Cc pus7su+ 1)1� copy O� VGL11 lrtrPS �iPJ�Q�COu') 41 l/ C7r / P/o✓el)�o7e•o7y" ) C2nS2 o� C 0 led 3/a//�0- CCy��ta � t� i4c.�vy,J VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Paul S. Rosenberg (914) 939-0668 Christopher J. Bradbury www.ryebrook,org TRUSTEES BUILDING& FIRE Susan R. Epstein INSPECTOR Stephanie]. Fischer Michael J. Izzo David M. Heiser Jason A. Klein CERTIFICATE OF COMPLIANCE March 25,2022 Victor Piacente &Jackie Piacente 204 Betsy Brown Road Rye Brook, New York 10573 Re: 204 Betsy Brown Road, Rye Brook, New York 10573 Parcel ID#: 135.44-1-7 Roof Permit#21-010 issued on 3/29/2021 to Re-Roof Existing Building This certifies that the new roof,installed under the above captioned permit has been satisfactorily completed. Sincerely, Michael J. Izzo Building& Fire Inspector /tg `�// BUILD R ENT For office use only: v PERMIT# l O�Q VIL OF RYE K ISSUED: 3-0? Gb2l APR 2 7 2021 ING STREE YE BROOK, YORK 10573 DATE: -a7 aOal (914)9 939-5801 FEE: / PAID VILLAGE OF RYE BROOK U BUI DING DEPARTMENT ERTIFICATE 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 LL ,,##`####i##iitiiii###############i#ii#iii##########i##i###i/ii/il/i#i#######i########### Address: 02Q0 & 5U 46�eQUJfl) kd. Aye dyboK Occupancy/Use: C )C01" Parcel ID#: 7 Zone: /6_ Owner: Vl(hi yr + AcILI e P) A CeYo Address: P.E./R.A. or Contractor: Qrjme Ot me_ TfY1Arrck jero,'►`' Address: 37D el-MA Q �e� H14w-t O&/UC N�• Person in responsible charge:Giut> �!U�4'r 1 e Address:G 4'AW—V OL NWAJL N 4 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: �/ it's() being duly sworn,deposes and says that he/she resides at 4 I'IAy-e�l PL('C e— (Print Name of Applicant) \ L (No.and Street) ,, 1 in Q M O N V--- ,in the County of (1l�Phi 6 Te If in the State of 1�4�-. that (City/Town/Village) he/she has supervised the work at the location indicated above,and that the actual total cost ofthe 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:$ 0 , for the construction or alteration of: O 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 I s/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments reto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing bu.'_ o construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or p iereof hereafter created,erected,changed,converted or enlarged,wholly or partly, in its use or structure until a Certificate of Occupancy r ertificate 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 A4 day of , 2027� day of , 20 '.)-A_ Si of rty Owner gignature of Applicant TI ,To,o a 1Jim A 6 )ol) C�\'L $ Print Name of Prope er Print Name of Applicant otary is Nota ublic MICHAEL CAVALLERO PETER J. CHO NOTARY PUBLIC-STATE OF NEW YORK UBLIG, STATE OF NEW YORK �lOTARY 2/"�19 No.O 1 CA6373230 NO. O t CH8308766 �f Qualified In Westchester County gUALIFIEp IN WESTCHESTER COU My Commission Expires 06-04-2022 MY COMMISSION EXPIRES DULY 28,20, �E BRC��. 1982 BUILDING DEPARTMENT �UILDING INSPECTOR A SSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK �❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.orS - - - - - - -- - -- - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS: O �" C DATE: 7S I2 Co '`Z PERMIT# 2 C) 1 ISSUED: ECT: I W 1"�, y BLOCK: I LOT: 14 LOCATION: ' CL�Qx CJLJ OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑' ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION , REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GASHSQ. wu cr ❑ L.P. GAS , �r1 C'C 0 ❑ FUEL TANK ^ ,^ ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL SQ OTHER — ``BuildiiIng Perm naly it Check List&Zoning Asis ( r 1 Address: `` TS�1 �`C��N M_2 SBL: Zone: t t'�` Use:' Const.Type: Other. Submittal Date: 2 `Revisions Submittal Dates: Applicant \ G•C Nature of Work \ C ` 0� MAR Reviews:ZBA:_ - p. nB: BOT: Other. OK DIP ( ) FEES:Filing. BP: �cb • ��� C/O: Legalization: ( ) ( �APP: Dated: Notarized: -'SBL: Truss I.D. Cross Connection: H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening. ( ) ( ) ENVIRO:Long. Short: Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection S/W Mgmt.: Tree Plan: Other. ( ) ( ) SURVEY:Dated: Current: Archival• Sealed. Unacceptable: ( ) ( ) PLANS:Date Stamped: Sealed Copies: Electronic 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. ( )ARB mtg. date: approvaL• notes: ( )ZBA mtg.date: approval- notes: ( )PB mtg.date: approvaL• notes: REQUIRED EXISTING PROPOSED NOTES APPROVED Sidw &W. 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'��,��,�._- :o ���Z��--=.� e�� o -sue n. .L..:u =':'x±�"'�� ys '!1,'.^�. rJ�E'n.�+Fi.^� �j"��.. 1A..a':l•�' ;A.S•v �Y��. O DATE(MM/DD/YYYY) ACORH CERTIFICATE OF LIABILITY INSURANCE 03/23/2021 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 ACT NAME: _ A_LEXIS ANN SALUBRO _ Albert Palancia Agency, Inc. PHONE (914)698-1373 FAX(AtC No:(914)698-0125 PO Box 26 ADDRESS: alexis@palanciainsurance.com Mamaroneck, NY 10543 INSURERS AFFORDING COVERAGE NAICF INSURER A: Evanston Insurance company 35378 INSURED INSURER B: PRIME BUILDING SERVICES, INC. DBA PRIME HOME IMPROVEMENT INSURER C: 370 ELMWOOD AVE, SUITE 202 INSURERD: HAWTHORNE, NY 10532 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 10009084-425347 REVISION NUMBER: 9 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 CONTRACTOR 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 EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYY MWDD/V Y LIMITS A COMMERCIAL GENERAL LIABILITY Y 2DD3679 03/14/2021 03/14/2022 EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ X POLICY D jEa LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DIED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.N/A EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101.Additional Remarks Schedule,may be attached It more space is required) Village of Rye Brook is included as Additional Insured with respect to General Liability CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street RYE BROOK, NY 10573 AUTHORIZED REPRESENTATIVE AAS 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by AAS on March 23,2021 at 03:11 PM Y R Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1 a. Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured (914)683-8081 PRIME BUILDING SERVICES,INC. DBA PRIME HOME IMPROVEMENT 1c. NYS Unemployment Insurance Employer Registration Number of 370 ELMWOOD AVE,SUITE 202 HAWTHORNE,NY 10532 Insured Work Location of Insured (Only required if coverage is specifically limited to 1d. Federal Employer Identification Number of Insured or Social Security certain locafions in New York State,i.e., a Wrap-Up Policy) Number 13-4047830 2.Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) National Liability&Fire Insurance Company Village of Rye Brook 3b. Policy Number of Entity Listed in Box"l a" 938 King Street V9WC204687 Rye Brook, NY 10573 3c. Policy effective period 02/28/2021 to 02/28/2022 3d.The Proprietor,Partners or Executive Officers are ❑ included. (Only check box if all partners/officers included) X all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"la"for workers' compensation under the New York State Workers'Compensation Law. (To use this form, New York(NY) must be listed under Item 3 on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Joseph T.Palancia (Print name of authorized representative or licensed agent of insurance carrier) Approved by: J 'mac t_ �_ 03 � 2e2 (Signature) (Date) Title: Agent Telephone Number of authorized representative or licensed agent of insurance carrier: (914)698-1373 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-17) www.wcb.ny.gov