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HomeMy WebLinkAboutBP21-066o PERMIT# / )1'0&6 DATE:3/3) oD/ EXP.3 I c�C- SECTION _ 1 tiJ J`—s� BLOCK ` LOT F TYPE OF WORK ;�/I7e, /®/� A/kkel-7 0 4, 07 ZC17C)VQ,4G/7 JOB LOCATION OWNER CONTRALTO ,//EST. V CO # I G r eo"? �t d qc-- / .LT /J e //a 6a 1Q /yam 9 i &4100 swei 0 XZ7� z3T TCO # FEE DATE INSPECTION RECORD DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING J � INSULATION � C►�!!�! �C, �//9 ` ! / .J PLUMBING b RGH PLUMBING ,�,/ r 1' GAS - / C7� /� f✓ycx� SPRINKLER ELECTRIC �RM AS BUILT FINAL Q c� D 0 APPROVALS VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 22-077 Certificate of ®ccupaucp This is to certify that �O(�l of, PL4C rLl_11L ' having duly filed an application on 20�requesting a Certificate of Occupancy for the premises known as, p?7 TO /C 0 J-f POOd , Rye Brook,NY, located in a Jkl+)Q Zoning District and shown on the most current Tax Map as Section: k3f .,5 O Block: Lot: 75 and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No.�)"U 10CU, issued 3 6 1 20 .'2 /, such authority and permission is hereby granted to the property owner to lawfully occupy or use said premises or building or part thereof listed under the following New York State Classifications, Use: K— mi/ , Construction: for the following purposes: :�jQ f!'�Y©OyY1S r�°�'101/c� f10Y� Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of the building or in the exit facilities shall be made,and no enlargement, whether by extending on any side or by increasing in height shall be made,nor shall the building be moved from one location to another until a permit to accomplish such change has been o am d from the Buil ' Insp tor. Assistant Building Inspector,Village of Rye Brook: Date: MAY 1 8 2022 p For office use onl 3DBUILDING DEPARTMENT PERMIT# MAY 16 2022 VILLAGE OF RYE BROOK ISSUED: 938 KING STREET,RYE BROOK,NEW YORK 10573 DATE: VILLAGE OF RYE BROOK (914)939-0668 FEE: PA1DW BUILDING DEPARTMENT wwwxygbrao org 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 rrswrrrrrrrrrsrrsst►essst►sst►►tt►t►►►tt++r►rrrrrrwrrrrrttetsrstr►t►tt►►+ts►tr•rtrrrrrwrrrrrwrrrrrrrrrsrsws►ts►t+►t►►t+r►r++t Address: 7 �C'-� � /V,'5 -F 3 Occupancy/Use:/f(.,(��f/} Parcel ID#: /,35, .'S- !�0— �— 7� Zone: IC—/C)- Owner: /t'1 4 % v Address: o P.E./R.A. or Contractor: Address: / Person in responsible charge: i C lQtInspector dress: JApplication is hereby made and submitted to the Bui of the Village of Rye Brook for the issuance de- Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEEW1 YORK,COUNTY OF WESTCHESTER as: being duly sworn,deposes and says that he/she resides at CX17 Yam/(' t Name f A 1' t) (No.and Street) in ,in the County of �� in the State of that (city/fown/village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site im ovements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$ , for the construction or alteration f: 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 I b Sworn to before me this day of �N ck4 , 20 la�;k day of , 20 Uc"A- - Lqp4ateureof Property Owner Signature of Applicant erne of Property Owner Print Name of Applicant J Notary Public Notary Public SHARI MELILLO Notary Public,State of New York No.OiME6M60063 8/12/2021 Qualified in Westchester county Commission Expires January 29,20 2- :z- �yE BRC�� BUILDING DEPARTMENT ❑BUILDING INSPECTOR ,ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK 'r ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS C-C DATE: I ) I � PERMIT# l \� ISSUED: ` SECT: BLOCK: LOT:A�J U LOCATION: <`( OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION \ REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P.GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION 1z• FINAL ❑ OTHER QyE BRC�j�. 1. 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.ors - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS: �� �. +�� DATE: \ PERMIT# 'Z C ISSUED: 1�� SECT: BLOCK: LOT: LOCATION: C OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ROUGH PLUMBING ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER I 47. U : tY � n .:� c ' v a H tA Z u zig PLO coQ w camtn tr, a. w Z � � Z v i.r F- ON '� Z Qt z ✓ ^� , rl , C o F � � F w F Z C � � N Z U Z co = �: .• � o. W w 0 C. oG d'I m a, :31 41 WWIx° yE DRC�uk3D BUILIDll4G 116AR�MENT MAR 2 2 2021 VIL� GE OJEE OK 938 ETRYEB NY 10573 VILLAGE OF RYE BROOK (914) 39-5801 BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master ElectriciansLicense Required OFFICE FOR USE ONLY BP#: C�/ —0&6- EP#: c:;)J"—C 7 -2 Approval Date: MAR 2 2 202111 Permit Fee: $ Approval Signature: V Other: Disapproved: (fees are non-refundable) ************************************************************************************************** Application dated, !t2 02 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. / Q L Address: 02 I�-�dC � SB>`: ! /•����G'"����Zone:/�—I�- 2.Property Own D7 Address: OZ/ ,"Y 0 A-D A A-s�--e4- Phone#: Cell#: / �702�f—�.�a-� email: •d Q-L.44-4-. 06�lh 3.Master Electrician: d/A a A-) Address: 32Zt L SS, Lic.#: Phone#: 9/y yO3 d ,7 Cell#: email: f(Boyog Company Name: W13 Al&� "(f TX/C-n1//C,-4—Address: 3 y -'oeur/N��T�9GS 4.Proposed Electrical Work/Fixture Count: JIZT STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant) state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will 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 120 day 20 Signature of Property Owner ' ature of Ap 'cant l `�O� f''70/2Gtie(J Print Name of Property Owner Print Name of Applicant Notary Public Notary Public 3/21/19 , _.:-w:�.3►-.ors+at�8ar_;. .._. >sa..+ri-r Arr Westclester Rockland Electrical Inspection Services, Inchone: 914-347-3595 DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue Fax:,,914-347-3596 Elmsford NY 10523 BUILDING BUILDING PERMIT NO. TEMP# D TE CITY OR GE ZIP CODE TOWNSHIP COUNTY STREET AND NO.OR ROAD POLE NUMBER BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT OCCUPANT'S NAME BUILDING OCCUPANCY rNA-)LJ9: !))/`1f16/_ /T, 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. ,JLfLbAB INSPECTION OUTSIDE BASEMENT 1"FL. M R 2 2 2021 Z'FL. 3-FL. i BUILDING DF ARTME qT REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: NAil, //'j1fG( R%/ o/�- NC L✓ /ZC !E !lC �� L /GrlT//,�� 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 APPUCATIONS 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 C EXPOSED❑ CONCEALED❑ MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD[ UNDERGROUND❑ LI-i— I I I AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. NAME OF COMPANY DATE OF TION SIGNATURE,OF APPLIC#Ae //" GMEET ADDRESS TELEPHONE NO. OR POST OFFIC E ZIP CODE LICENSE NO.WHEN APPLICABLE L C F C PY S` WESTCHESTER -71 ROCKLAND ELECTRICAL INSPECTION WRE141SERVICES,INC. BY THIS CERTIFICATE OF COMPLIANCE THE Westchester Rockland Electrical Inspection Services 43 North Lawn Ave, Elmsford, NY 10523 914-347-3595 (Office) 1 914-347-3596 (Fax) CERTIFIES THAT Upon the application of: Upon premises owned by: KBM Service Corp Joanne DiMaggio 34 Continental Street NY, Sleepy Hollow 10591 Located at:27 Talcott Rd Rye Brook, NY 10573 Certificate Number: 1034120 Section: 135.50 Block: 1 Lot:75 BDC: Permit Number:EP:21-077-BP:21-066 A visual inspection of the electrical system at this premise described as a Residential occupancy,wherein the premises electrical system consisting of electrical devices and wiring,described below,located in/on the premises at: 27 Talcott Rd Rye Brook,NY 10573 Basement 1st Floor 2nd Floor 3rd Floor Garage Attic Outside Other: Inspection was conducted in accordance with the NYS and NFPA 70-2017 International Electrical Code and detail of the installation,as set forth below,was found to be in compliance therewith on 04/12/22 Name Type Quantity Fixture-Luminaire Recessed ------- 12 Ceiling Paddle Fan ------- 1 Fixture-Wall Sconce(s)Lights Indoor ------- 2 Receptacle GFCI ------- 2 Switch Single Pole ------- 3 Exhaust Fan ------- 1 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. This certificate is valid for work performed before date of inspection only. s ¢¢ N N N 0 G s i alk 00 oz al � � ^ fS+7 •~ S a 3 3 b r M O M g LIM CIO O L A� z ^ U �J Z V� a O � 0f z 96 c� 0 96 W o0 `Z 0 CLO , is f � p EC ENE BUIJ91n! MENT VIE x MAY - 6 2021938 KINB NY 10573 (914) 939-5801 VILLAGE OF RYE BROOK or BUILDING DEPARTMENT PLUMBING V PERMIT_APPLICATION /,/- FOR OFFTC'F USE ONLY 13P#: a I - O� (V PP#: C )/—" l0 Approval Date: MAV Q Permit Fee: S Approval Signature: Other: Disapproved: (fees are non-refundable) Application datedC-510 I QQa is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agree that said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: a 7 /� SBL: �`� ����'7� Zone:��- 2.Proposed Work: P7,1004 3.Property Owner: J Address: Phone#: ft Z1-�- _ff,3L_;Z Cell#: ?/442, 4_4FA® emai : W am. /loll 4.Master Plumber: Ml 'chAcl PC\je Q f,Nl o Address: HIS RA Nk &j rwT zhalciL - 3 Lic.#: IIV5 Phone#: Cell#: C114-4r{0 47A5 email: �"\ 1 f�Not G1 Ol. COM Company Name:2LIleur�"o j')JUm6n,a + Neat,=tj1 Address: f , ICI t tZ� c 1tt ► /V. /OS'13 INDICATE FIXTURES&LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1 st Floor 2nd Floor 1 31 Floor 4 Floor 5 Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) ;nl iv ST TE OF NEW YORR,K,,COUNTY OF WESTCHESTER ) as: 2 _ / I= J being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual sigMCfs 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 �clle�r�N o 91urn6.N4 t H e -ZNCI 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 920 i ature of Property Owner Signature of Applicant Print Name of Property Owner Print Name of Applican Notary Public Notary Public This application must be properly completed in its entirety and must include the notarized signature(s)of the legal owner(s)of the subject property, and the applicant of record in the spaces provided. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- 3/21/19 BUILDING DEPARTMENT DIE C F. Q V IE VILLAGE OF RYE-BROOK 938 KING STREET RYE BROOK,NY 10573 MAY Z021 (914)93 9 39-5801 VILLAGE OF RYE BROOK BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT. STATE OF NEW YOM COUNTY OF WESTCHESTER ) as: residing at, (Print name) (Address where you li\c) 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; Rye Brook, NY. (Job Addre�;) Further that all statements contained herein are true, and that to the 4strof 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. (Si ahi ofPloperty( Naner(s)) d (Print Name of Pro(x rt.\ Owner(s)) Sworn to before me this day of , 20 (Notary Public) -3- 3/21/19 Building Permit Check List&Zoning Analysis Address: Z-7 "t A L--Co jZD SBL: Zone:'N _ Z Use: Z Const.Type: Other. Submittal Date: 3 t 'E� Z Revisions Submittal Dates: Applicant: o Nature of Work: Krt-,'-ZrL-0/1-- views:ZBA: MAR 2 2 2 021 pB: BOT: Other. OK ( ( ) FEES:Filing. BP: ��.->�_ _ -� 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. Shore 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: V Workers Comp: ✓ Liability Comp.Waiver. Other. ( )1 ( ) 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: APPROVED REQUIRED EXISTING PROPOSED NOTES Ate: Date-MAR 2 2 02� Cir FFro ran gg Front Front Siam: Main Cov Accs.Cov Ft.H Sb: S .H Sb: S,FA: TOG in: EL!mm: Paz d-W. Hcj& Stories: notes: �\t. 4.1.�}�gY� t}r 4'�1� �v � �/�> v ♦1� � *+ ,1♦ •{ V ��> r •i �•�` �' •.::� ,. •� "'W�:^t 9'"�4.i1/,1� _11�11:.-r� e. i 1 4111{1 11`1 � i j�s� .r «O)> y,4`� 1 1 1 1� y�;�` r*• .11�/,1-�:r$ :S's�°F4t1�Ii1' 1/111: '�ti1/�1{,1`isx°�� n O = C CN 04 „ KA)> tic � ° •v •► .j,. �. <cws» q o cr y S , to e� ���� �'•�:�> 14�. !W� ram• u 2 F+I aoMAw � Q y rnO LO ection of CD U 25 1po W c ) CI�" t1. O Q z � 3 w � ,�j co acl g Nccma)a) CA wr. •� t S Sr• � :k' �.� L (� � U •tom-- �' �_v� �,'=:•` N N U � !+.���_'.••r��ig,1 it i,,p� �, �N � �-� •^�•'�1'�`�yv'�y A• i��,..4tv�4�+��M. �+^ _ 1���}�N E!�^���`,� ♦♦ ,.l w � � .." `t ��Ds ��.. p7, ��' x 0� 1rkiAL'..•. N`O� d'lY�j�'.�rk ,�0� � .t '{��H�• - �ib'{•'v(�„'��Y�lr„^�l � i j' ,Y.• �.� ..fig ��f .1, v. •.••:a!, r �.�( �, �!.�4 �r \t �,•Cs'fi` ���'Vie, • `�v'{r�v,' vy � rTi, �.fvi �a,ti mod. ,r„ �u `v',�� s•• DATE(MMIDD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 03/30/2021 1`� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Ellen Greig NAME: BNC Insurance Agency PHONE (914)937-1230 FAX (914)937-1124 (AC. 0 No A/C No 90 South Ridge Street E-MAIL ADDRESS: egreig@bncagency.com INSURER(S)AFFORDING COVERAGE NAIC p Rye Brook NY 10573 INSURER A: Main Street America Assurance Company 29939 INSURED INSURER B LADEL LTD INSURER C: 8 LIVINGSTON RD INSURER D: INSURER E CARMEL NY 10512-5100 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2081197687 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 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR PREMISES Ea occurrence S 500,000 MED EXP(Any one person) $ 10,000 A Y MPU9644U 08/15/2020 08/15/2021 -PERSONAL BADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY ®PRO ❑ 2,000,000 JECT LOC PRODUCTS-COMP/OPAGG S OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS accident)BODILY INJURY(Per acent) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT S OFFICERWEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Village of Rye Brook is included as an additional insured when required under written Contract or Agreement. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD 3/30/2021 Certificate of NYS Workers'Compensation Insurance Coverage NEW CERTIFICATE OF YORK Workers' NYS WORKERS'COMPENSATION INSURANCE COVERAGE STATE Compensation Board Insured Detail In.Legal Name and address of Insured(Use street address only) Ib.Business Telephone Number of Insured Ladel LTD 845-591-9542 8 Livingston Rd Carmel,NY 10512 Ic.NYS Unemployment Insurance Employer Registration Number of Insured Id.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required if coverage is speciftcally limited to 262114345 certain location in New York State.i.e.a Wrap-Up Policy) 2.Name and Address of the Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Ilolder) Technology Insurance Company,Inc. Village of Rye Brook 938 King Street 3b.Policy Number of entity listed In box"la": Rye Brook,NY 10573 TWC3963613 3c.Policy effective period: 2/21/2021 to 2/21/2022 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 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: Henry C.Sibley (Print name of authorized representative or licensed agent of insurance earner) e Ari Approved By:_ ~� 3/30/2021 (Signature) (Date) Title: Underwriting Manager Telephone Number of authorized representative or licensed agent of Insurance carrier:CarrierPhone Please Note:Only insurance carriers and their licensed agents are authorized to issue the C-105.2 form.Insurance brokers are NOT authorized to issue ir. https://wc.amtrustgroup.com/ANAWC/Pol icy NYCetficateOfWclns.aspx?Indexld=334093&In stance]d=ff0c6b7c-2f5a-407c-b21 e-6389bc35a535 1/2 Laura Petersen From: Mike Izzo Sent: Tuesday,July 6, 2021 1:04 PM To: Tara Gerardi; Laura Petersen Subject: FW: Message from Dig Safely New York, Inc. (DSNY) Michael J. Izzo Building & Fire Inspector Village of Rye Brook, NY (914) 939-0668 -----Original Message----- From: Dig Safely New York Exactix <tickets@exactix.digsafelynewyork.com> Sent: Tuesday, July 6, 2021 10:14 AM To: Mike Izzo <MIzzo@ryebrook.org> Subject: Message from Dig Safely New York, Inc. (DSNY) ****EMERGENCY**** DIG REQUEST from DSNY for: VIL RYE BROOK Taken: 07/06/2021 10:13 To: VIL RYE BROOK PRIMARY Transmitted: 07/06/2021 10:13 00002 Ticket: 07061-000-863-00 Type: Emergency Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 27 To: Name: TALCOTT RD Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: ALONG THE FOUNDATION WALL OF THE HOUSE NearSt: LINCOLN AVE Means of Excavation: SHOVEL Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: FOUNDATION CRAWL SPACE WATERPROOFING Estimated Work Complete Date: 07/06/2021 Depth of excavation: 4 FEET Site dimensions: Start Date and Time: 07/06/2021 10:10 Must Start By: 07/20/2021 ------------------------------------------------------------------------------ Contact Name: JOANNA DIMAGGIO Company: Addr1: 27 TALCOTT RD Addr2: City: RYE BROOK State: NY Zip: 10573 1 Phone: 914-329-5527 Fax: Email:joanna.dimaggio@gmail.com Field Contact: JOANNA DIMAGGIO Alt Phone: 914-329-5527 Working for: WORK TO BE PERFORMED BY: TOMMY THE MACIN ------------------------------------------------------------------------------ Comments: CALLER ADVISED TO HAVE CONTRACTOR CALL DIG SAFELY NEW YORK EMERGENCY, CREW IS ON SITE NOW, THIS IS A THREAT TO LIFE/PROPERTY/VITAL UTILITY. 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