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HomeMy WebLinkAboutBP21-085PERMIT # C�� _ Q�� DATE: a, �� EXP SECTION � BLOCK � LOT TYPE OF WORK �2i`�O� �7�J E'/)01fr�7�7�� JOB LOCATION � �, CONTRACTOR_ T. COST � z #�_ TCO # ��CC/ �/� �� FEE. _ _ .__ .. __ DA � INSPECTION RECORD I DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING---�-�- INSULATION PLUMBING � •------�--- RGH PLUMBING GAS O SPRINKLER ELECTRIC LOW -VOLT ALARM O AS BUILT FINAL �i3 �a��a�. �� ,�N: � 011��.�io✓a 0 �/9!0!� ��'� �- I a �/�C d s�Lp //ate© �/ec-�►-ic : � VILLAGX OF RYE BROOK WESTCHES COUNTY, NEW YORK NO. 22-192 Certificate of Occupancy 'This is to certify thatMla?ael /tieol 0/ 1?e iAaT�cc/ of, Rye- &Q0 k,Al �-/ , having duly filed an application on 20 02 requesting a Certificate of Occupancy for the premises known as, �,0 , Rye Brook,NY, located in a Zoning District and shown on the most current Tax Map as Section: / `�'�� 35 Block: � Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. �I-GCSS , issued 20 e � ,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-�3 ��e- fa/-72 Construction: for the following purposes: /114erllpr ,U i7 mQ'7q z ,/ )I MY0110rl 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 heigh s 11 be hall the building be moved from one location to another until a permit to accomplish such change has a uilding Inspector. DEC 1 3 2022 Building Inspector,Village of Rye Brook: a e: D E CM W For office use onl : BUILD ENT PERMIT# /-O� MAR 2 4 2022 vIL o1+1 ox ISSUED: I a20-7> 9 8 KING STRE -M60 YoRK 10573 DATE: VILLAGE OF RYE BROOK 9 KQ OT FEE: PAID BUILDING DEPARTMENT APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLL4,NCE9 AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION wrr►rrrrwr/nr�rr11wrrrrrr►rwrrrrrrwrrrr■rrr►rrwrwrwwwr11wrr►r►w►r►w►wr►►►►s►♦►►►►►►►►rrrrr►rwrrwrwrwrrrrwwwwrrrr►r►►►r►r►►►►rr►►rr► Address: O � afl� �((;�( Sl, ��e Lwk lU 57 Occupancy/Use: - m i I Parcel ID#: NI Zone: " Owner: 0o1%A'b e 1 T�_}(J(: l Address: &0 _ P.E./R.A.or Contractor: p Address: GY, T Person in responsible charge: I ` 1 I �l t( OC( I Address: 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: V\l T _ c/p \Q e I Toa I being duly sworn,deposes and says that he/she resides at ��& (Print Name of Applicant) � ,p l,, (No.and S ) in I=- C)(V bk— ,in the County of )R S�(�t 7 P�S1t"(^ in the State of t y that ityfrown/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:$ a-)�4 L�D l) for the construction or alteration of: K i +'1 e N Jn a 41,- TY 1 20 U Za- Q 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 V-�R C� ,20�Q day of , 20 Signature of Property Owner Signature of Applicant ame of Property Owner Print Name of Applicant L.J Notary Public Notary Public SHARI MELILLO Notary Public,State of New York 8/12/2021 No. 0",ViiE6160C63 Q-_ialified in Westchester County Commission Expires January 29,20 o`` tim Q BUILDING DEPARTMENT /AssiSTANT ILDING INSPECTOR BUILDING INSPECTOR VILLAGE OF RYE BROOK DE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - -- - - - - ADDRESS' 9D)b DATE' `ZA-10 2 PERMIT# ISSUED: `\�% 4ECT: \ ALOCK: LOT: LOCATION: N'f-�U �� uV � 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 �Pl FINAL '///""-❑ OTHER BR BUILDING DEPARTMENT ❑BUILDING INSPECTOR ASSISTANT BUILDING INSPECTORI VILLAGE OF RYE BROOK [I CODE ENFORCEMENT OFFICER('/ `T 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.nLebrook.org - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - -- - -- ADDRESS :— y ��� DATE: PERMIT# y O37 ISSUED: SECT: BLOCK: LOT: LOCATION: ' � � � QC �Od �OCCUPANCY: 1 ❑ VIOLATION NOTED THE WORK IS... lJ ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: Q ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑' FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER ' a t s a . s s ■ ■ EE. ■ t a s EE s a f s , a ■ ■ 00 I N c W a a w O V x � N x 04 `f H Ln W a O Z ■ F� = w 11 �t p eq � U 19 rO- �° a a0ow V � �h ,..■, cn O a o o o p ;2 W A a s W a ~ 00 Ln � (�� 0. � � o � F a H � ►'" a N z w z a p cp e N o w z W q o0 0 U W F ■ �I 0.0 ' D EC ENE aRnv BUILD�I QiQ_rAR'T MEN T AUG 3 12122 VILLAGE OF RYE BROOK VILLAGE OF RYE BROOK 938 KINGSaREET RYE WOK,NY 10573 BUILDING UEPF,RTMENT (914)93,t, ; )939-5801 ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: O eS EP#: - Approval Date: SEP ��022 Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) ******************** **************************************************************************** Application dated, g 2 Z- is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install an 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 withall applicable Federal, State,County and Local Codes. c� P 1.Address: Z p �. t•tQf� �-{� SBL: �' � t�3 y 1one:/-3 2.Property Owner: I e- 'ry C C Address: A 2. C. t• Y C S Phone#: O y?(Pfo Cell#: email: nSQ �yCL t �aO�•C C, 3.Master Electrician: rvV i k C fie.4,S U 4 .o Address: S�' Q tr0 a OC cc,ca-,i Lic.#: 6 SL Phone#: Q l y'`I?d —67P Cell#: Q/t(-y¢D-09 2- email: I-✓'a 1 �C P„p e (tV Q0 •C 0111 Company Name: F- 6AS 4e l( a Iq O G l ec Address: 5_8' Q'"o J W aY, �"T�y✓1 DSO H 4.Proposed Electrical Work/Fixture Count: STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ro l at l< <--rr '�a"`O ,being duly swom,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant) ��QL state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the t C ",G r for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attomcy,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 of Signature of Property Owner Signature of Applicant Print Name of Property Owner Print Name of Applicant Notary Public Notary Public 3/21/19 STATEWIDE • Service Willi bile't:1-1.1), 1:1 Main Street,Fishkill, NY 12524 1 email:• • SWIS JOBAPPLICATION tel845.202.7224 • • 1• • Office Use Elect.Permit# e /2'D3— Qog Date Bldg Permit# /" Utility ID# Final Certificate# City/Village r Zip / j Township j County r Address Cross Street Section Block Lot Owner Name/Address(if different than above) T J Contact Number ' ❑Basement 0 1 st FI. ❑2nd FI. ❑3rd FI. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact L Amt Amps i Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Hint CG7 Z SERVICE Amperage Voltage 1 P 3P #Meters #Disconnect ❑Underground ❑New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ® Re-Inspection Additional Information �P � � �U S � e �✓J �P� � �J �� � ��, 1, �.CJ � ,�J � C' ID AUG 3 12022 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,If at arty time of inspection additional items haw been installed,y,,u rr- authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other Inspection company.The applicant,(iwnr� or authorized agent agrees to all the above terms and conditions as set forth for the application. Inspector Date Finalized Inspector# Company Name Date Signature Address City/State Zip Code License# Phone# State Wide Inspection Services CAS 1080 Main Street Fishkill, NY 12524 TO' w']U S 845 Phone '�� 914-2194-219-1062 Fax STATE WIDE INSPECTION SERVICES Email: office@swisny.com Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: F Castellano Electric Inc Mike Tucci 58 Broadway 226 South Ridge Street Harrison, NY 10528 Rye Brook, NY 10573 Located at:226 South Ridge Street, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP-22-208 141.35 34 Certificate Number: 2022-5388 Building Permit Number: BP-21-085 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: 226 South Ridge Street, Rye Brook, NY 10573 The First Floor Kitchen and Sunroom 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 13th day of September 2022. Name Quantity Rating Circuit Type Receptacles 04 Switch 01 Luminaires 04 Officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. • ���iw�����i �w����il��p�i�r�i��ip�il�ra�i�' �I�ilw�i " �i�ir��l�il�i�i�i�i d� lei r-1 Ono tn = u �O O, M � y" M = v0-0 CA W " CY GL F O U W � V� Q Z F oz a W1%0 Z O a U W z Z W. O C7 G� w Z m ►..� 0,4 V z �;) oo °�` z o U K' ON U � < a z 0 z u w o zd Cl1 .a � a Q w •• a °� V W z o. N F C N z z z 61. .. a w I m � � ►� m GWz. i �i yEBRnv D ECENE D BUIL MENT vII. OF RYE OK MAY 18 2021 938 K1Nc ET RYE B ,NY 10573 VILLAGE OF RYE BROOK (914)9 939-5801 BUILDING DEPARTMENT o :or _ ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY P#• �'" O 6 � EP#: Q J- I �4 -- Approval Date: MA Permit Fee: $ Approval Signatur Other: Disapproved: (fees are non-refundable) Application dated, c7 a� is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove electrical equipment,wiring, fixtures,or to perform other high or low voltage electrical work as per the detailed statement described below. The applicant & property owner, by signing this document agree that all electrical work performed will be in conformance with all applicable Federal, State,County and Local Codes. 1.Address: 2 S 1 q e SBL: /-71.3 -0-3y Zone: o1F 2.Property Owner: ✓ OtVT q-V C C I Address: AZ (p �, K�'�X�/-� T� Ir y e. Phone#: Cell#: �I it- A g 0• y 4 6 6 email: C •, ✓ 3.Master Electrician: fErd 4 4,'- C1 S 7 e 1(4 In Address: rif U✓y Q ku.JQ y. &-0V1 to h. Lic.#: b S Z Phone#: 7 7 7 q Cell#: 14 10 6 7 Z email: F"K 1 `vl O e@ q a, Company Name: r, <f;2 s 4e I t g h o C f-e e T,-c Address: T Q✓O g t�U a�/ �•�q r✓�'S o 7 /U.}� 4.Proposed Electrical Work/Fixture Count: dd ltJ iy' ; V% � 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 finther 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 day of ,20 day o l�� Signature of Property Owner Signa e of C can ,s A!/ �� o Print Name of Property Owner Prini Name of Applicant Notary Public Notary Pub 'c 3/21/19 Westchester Rockland Electrical Inspection Services, Inc. Phone: 9i4-347-359 L5 DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue �. Fax: 914-347-3596 _ \ . Elmsford, NY 10523 H � Ir BUILDING P NO. TEMP# DATE CITY OR VILLAGE ZIP CODE TOWNSHIP OU TY STREET AND NO.OR ROAD. POLE NUMBER � � t-, , e 4— BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT OCCUPANT'S NAME BUILDING OCCUPANCY Ire OWNER'S NAME AND ADDRESS I 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. HP EACH NO. WATTS EACH INSPECTION OUTSIDE BASEMENT I'FL, 2'FL. U- 4 MAY 18 2021 3-FL. PARTMENT RUIL= REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: _ w C, ( L P a -I l-c C() I 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[] UNDERGROUND❑ .�:) !-, AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. NAME OF COMPANYL / DATE OF APPLICATION SIGNATURE OF APPLICANT qf- STREET ADDRESS TELEPHONE NO. (�-OQ CCU cJ POST OFFICE �I ZIP) LICENSE NO.WHEN APPLICABLE !� CC < i z L' C g A w rp Ln N � u ■ a .r WLl M pa. � ti :� W ,� d '~ m r O a OF_w�,] Q N s F it At H w u z � W � � � z i 00 kn v� i i W a H 00 o zz o x U � rx U a W • 0 Ln M F S ►� Ocn" �I n Al 1-4 w = tn ■ n fl [EcE�wE BUILDING DEPARTMENT MAR 2 4 2012 VILLAGE OF RYE BROOK VILLAGE OF RYE BROOK BUILDING DEPARTMENT 938 KING STREET RYE BROE1ik,NY 10573 (914)93'9=066& www:try Qa.org PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: PP#: Approval Date: MAR 2 5 2022 Permit Fee: $ Approval Signature: V1 Other: Disapproved: (fees are non-refundable) Application dated, t2q a is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove 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: 2- (, SC V 4-ff S4- SBL: 1411, 3S -3y Zone: 2.Proposed Work: C(t a-y r�-/- fi v L S 3.Property Owner: M (= T y �_c- �� Address: Phone#: g/y r Q y0-'y 9 G` Cell#: email: 4.Master Plumber: ff .- > cG 65 c—L Address: .9--2, Lic.#: Phone#:��y�- Cell#: 'w 662 2c ((email: ' Company Name: J(J o W Address: 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 1st Floor ` 2nd Floor I r 31 Floor 4m Floor 51 Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -1- sil2no21 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,being duly swom,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 a� \ Sworn to before me this day of V'-\0 CY.\ ,20 Q- day of'lam ,sz��,20 a� Signature of Property Owner Siknature of Applicant t Name of Property Owner Print Name of Applicant Nq ra l tlic,State of New York N�u ic,Mate of New York 01%IE6160063 Nio. 01%iE616oc63 Q+.talified in Westchester County Q,ialified in Westchas tar County 3 Commission Expires January 29,20__ Commission Expires January 29, 20q 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- 8/12/2021 BUILDING DEPARTMENT FD f1l7CE � V/ E VILLAGE OF RYE BROOK MAR 2 4 2022 938 KnvG STIMET RYE BRom,NY 10573 ( 14)939-0668 VILLAGE OF RYE BROOK e k' 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: residing at, cx2.2 _5o -12 1,Zf S/-- L (Print name) (Address where you live) being duly sworn, deposes and states that(s)he is the applicant above named, and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; J __)L- Sz -4- s1-1 14 , 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 Property er(s)) C_ (Print Name of Property Owner(s)) Sworn to before me this day of'VN (N , 20 { (Notary Public) SHARI MELILLO Notary Public, State of New York No. 01 INI F-6^160063 C-la"ified in Westchester County Commission Exnires January 29,20�3 -3- 8/12/2021 Building Permit Check List&Zoning Analysis Address 2Z � S 12 kD F Ste. SBL: L4-1 l , 3 q� 3!' Zone:ZZ'F Use: Z Const.Type: Other. L_•F� ✓-a� L k Z A:-v7 o Submittal Date: l 2 Revisions Submittal Dates: Applicant: Nature of Work: L N_T-IL-i o A— IQSw -Ze,-° o o P�o N rt k,M Reviews:ZBA: APR - 7 2021 pB: BOT: Other. � K ( ( ) FEES:Filing: ZS4, BP: �7S•T A 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 7S3#: 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: REOUMED EXISITNG PROPOSED NOTES 11ste• APR 2 0 2021 circlForug Front: Front: Sides: Main cQv Accs.Cov Ft.HS : S .HS • Saga Tom: F Im : P HcighA/Stories: ZC2, Z3 J W Ft - c c 30 w CJ < � 964 a pQ 1 °> O to 5 w CIA a , -- ✓ C +m ° ' m z Cl) vi O A W ` - p c az Vp wg , � m 0.0 r o w w pG L d W w � � OCCIDENTAL FIRE & CASUALTY COMPANY OF NORTH CAROLINA Policy Declarations A Member Of: EmINSURANCE GROUP Policy Number: Statement Date: CUSTOMER SERVICE NYD283210601 August 5, 2020 For Policy Service Named Insured: Producer: Call Your Producer: MARGHERITA TUCCI E68965A (914) 478-4959 MICHAEL TUCCI FRANK CAMPO 95 FREMONT ST 572 WARBURTON AVE For Claim Service HARRISON, NY 10528 WESTCHESTER, NY 10706 Call Occidental Claims: (914)760-8062 frankcampo@allstate.com 1 (866) 969-3899 marghtucci@gmail.com Agent of Record: or file a claim online @ Additional Insured: SAGESURE INSURANCE MANAGERS LLC www,IATInsuranceGroup.com/ None PO BOX 12999 claims/report-a-claim-property TALLAHASSEE, FL 32317 For All Other Inquiries: (800)481-0643 Policy Period: Residence Premises: Transaction Type: Renewal Sept. 04, 2020 to Sept. 04, 2021 ' 226 SOUTH RIDGE STREET RYE BROOK, NY 10573 Trans Effective Date: Sept. 04, 2020 12:01 am local time at location of the residence premises Trans Amount: $1,488 Your Insurer: OCCIDENTAL FIRE&CASUALTY COMPANY OF NC TOTAL POLICY PREMIUM $1,488 702 OBERLIN ROAD This is not a bill, you will be invoiced separately. RALEIGH, NC 27605 This insurance applies to the Described Location,Coverages for which a Limit of Liability is shown and Perils Insured Against for which a Premium is stated. Policy Coverages and Limits of Liability: Policy Savings: "Coverages": Property Coverages Limit The following credits and discounts reduced your total A. Dwelling................................................................ $445,000 policy premium: Auto Policy Discount B. Other Structures................................................... $44,500 C. Personal Property................................................ $22,250 Policy Deductibles: D. Fair Rental Value & E. Additional Living Expense $89,000 In case of loss under Policy Coverages, we cover only that part of the loss over the deductible stated. Section II Liability L. Personal Liability- Each Occurrence.................... $1,000,000 Hurricane (3%of Coverage A)................... $ , 0 $1 All Other Perils........................................... M. Medical Payment to Others- Each Person........... $5,000 ,000 Fees &Taxes: Mandatory Forms and Endorsements: NY Fire Insurance Fee............................... $0 DP 00 03 12 02-Dwelling Property 3-Special Form DC0721301 03 12-Act Of A Tenant Or Guest Of Tenant Exclusion DC0721303 03 12-Lead Abatement Provisions-NY DC0721305 03 12-NY Mandatory Special Provisions DL 24 01 12 02-Personal Liability DL 24 03 12 02-Personal Liability Endorsement Schedule DL 24 15 12 04-Workers'Comp Certain Residence Employees-NY DL 24 16 12 02-No Coverage For Home Day Care Business DL 25 31 02 10-Special Provisions-NY DP 16 10 01 09-Water Exclusion HC0700014 06 15 Pagel of 2 OCCIDENTAL FIRE & CASUALTY COMPANY OF NORTH CAROLINA Policy Declarations A Member Of: 10 INSURANCE GROUP Named Insured: Policy Number: Statement Date: MARGHERITA TUCCI NYD283210601 August 5, 2020 Policy Forms&Endorsements: Limits of Liability($) Increase Total Premium($) DC075191 09 15-Special Provisions-NY Included Number of Consective Days:30 DL 24 11 12 02-Premises Liability-Non-Owner Occupied Dwelling Included 226 SOUTH RIDGE STREET RYE BROOK,NY 10573 Number of Families:1 DC074171 03 12-Hurricane Windstorm Deductible Cat 1 or Higher-NY Included DC0700001 03 12-Hurricane Windstorm Deductible Advisory Included DL 24 87 01 15-Cap On Losses From Certified Acts Of Terrorism 0 DP 05 37 01 15-Cap On Losses From Certified Acts Of Terrorism 0 DC075171 03 12-Limited Fungi, Mold,Wet or Dry Rot,or Bacteria 20,000 Included DP 04 63 12 02-Loss Assessment Property Coverage 1,000 2 Mortgagees & Other Interests: None IN WITNESS WHEREOF, the Company has caused the facsimile signatures of its President and Secretary to be affixed hereto, and has caused this policy to be signed by an authorized representative of the Company. Occidental Fire & Casualty Company of North Carolina August 5, 2020 David G. Pirrung Michael Blinson Countersign date President Secretary HC0700014 06 15 Page 2 of 2 NEW Workers' Certificate of Attestation of Exemption YORK 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 parry.** 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 Michael Tucci From:Village of Rye Brook 95 Fremont St Harrison,NY 10528 PHONE:914-835-1005 FEIN:XXYXX4186 The location of where work will be performed is 226 South Ridge Street,Rye Brook,NY 10528. Estimated dates necessary to complete work associated with the building permit are from April 14,2021 to June 14,2021. The estimated dollar amount of project is $10,001 -$25,000 Workers'Compensation Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE SPECIFIC WORKERS'COMPENSATION INSURANCE COVERAGE for the following reason: The applicant is a homeowner serving as the general contractor for a primary/secondary owner-occupied residence.The homeowner has ONLY uncompensated friends and family working on his/her residence or is hiring individuals a total of less than 40 aggregate hours per week and has a current homeowners insurance policy that covers the property. 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 applicant is a homeowner serving as the general contractor for his/her primary/secondary personal residence. The homeowner 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,Michael Tucci,am the Homeowner with the above-named legal entity. I affirm that due to my position with the above-named business I have the knowledge,information and authority to make this Certificate of Attestation of Exemption. I hereby affirm that the statements made herein are true,that I have not made any materially false statements and I make this Certificate of Attestation of Exemption under the penalties of perjury. I further affirm that I understand that any false statement,representation or concealment will subject me to felony criminal prosecution,including jail and civil liability in accordance with the Workers'Compensation Law and all other New York State laws. By submitting this Certificate of Attestation of Exemption to the government entity listed above I also hereby affirm that if circumstances change so that workers'compensation insurance and/or disability and paid family leave benefits coverage is required,the above-named legal entity will immediately acquire appropriate New York State specific workers' compensation insurance and/or disability and paid family leave benefits coverage and also immediately furnish proof of that coverage on forms approved by the Chair of the Workers'Compensation Board to the government entity listed above. SIGN HERE Signature: �� _�_�� Date: </�� /� �— Exemption Certificate Number Received 2021-022200 April 14, 2021 NYS Workers' Compensation Board CE-200 01/2018 i N ILI .01 CD p Y�" CDi_- 7 _ f � Oco O !�Q d_ CD IL (LL.mt CD lop" 00 n� w CD:J7; CDr 0 I $� ;uJ O J 0O E �' O >m OJ o N r°o V-+ CU O O 0E- o w r4 m Q O � Z / CD O O 0 0 z CD o �� �J� oe-• c CDQ- Q o 0 C tD O m - - o n " (D O o v J C`� U O O O o Mj 0 W W L © Oz R �� CN m Q --- -- o }CL o - cc LL0� O LuO� fi n fl Q =C)= �Cil o m O X O CD (0 0 Ln l Hrl rq Ll c6 V C) o pa C:) -7�:,o • -9 N ODHo 0 Li � U O J O CD Q (n F- W O N o M 0 2 O H � O 0 IT 0NO3: — ZOOS 0 Co 0 0 0 Q. o O" o (U 0 00 MAR 31 2021 01 VILLAGE OF RYE BROOK BUILDING nEPARTMENT