HomeMy WebLinkAboutBP21-140PERMIT #9�6al- I YO � DATE: 10 O o7 D(P;
SECTION 11), 35 BLOCKK^ � LOT,
TYPE OF WORK __Tn7t2r/0/ D400 'C@, 70V
JOB LOCATI / " I /Cyc4C22T
OWNER Ql.�1 i� OI %•�� SooLLC UPI 396 -
CONTRACTOR AQd4.)1ri4j W0101I'L Lc O Lc Q oe/ Zc
EST. COST 4 c 6D 000 _ FEE
✓CO # — 1,,Q4 FEE 0�/0-P % DATE
TCO # FEE DATE
INSPECTION RECORD
DATE
FOOTING
FOUNDATION
FRAMING
RGH FRAMING
INSULATION \ L�
PLUMBING
RGH PLUMBING
GAS 0
SPRINKLER
ELECTRIC
LOW -VOLT lye
ALARM O
AS BUILT O
FINAL
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OTHER APPROVALS
ARB
VILLAGE OF RYE BROOK
WESTCHESTER COUNTY, NEW YORK
No: 22-124
Certificate of (occupancy
This is to certify that
of, Byn / V 7 having duly filed an application on
1 ) 20 requesting a Certificate of Occupancy for the premises known as,
�/ / Sau fh 0)olGe 3fyeej , Rye Brook,NY, located in a �Zoning
District and shown on the most current Tax Map as Section: Iq J. 3 D Block: a Lot:
and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building
Permit No. Q , issued 20 /, 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: 6US) rIeSSC.0 Construction:
for the following purposes:
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 s 11 be made,nor shall the building be moved from one location
to another until a permit to accomplish such change hasp o a' om t e ding Inspector.
Building Inspector,Village of Rye Brook: Date: SEP 6 2022
D BUILDING DEPARTMENT For office use onl :
PERMIT# 1-
2X— 7O
APR 1 4 2022 VILLAGE OF RYE BROOK ISSUED: /0=a/
938 KING STREET,RYE BROOK,NEw YoRK 10573 DATE: —/#—
VILLAGE OF RYE BROOK (914)939-0668 FEE: 0 '7/O� PAID$
BUILDING DEPARTMENT I www.ryebrook.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
**rtwrtwrwwr*****ww*rtrtrtrrwwrw*****+**w++***rtwrrrwrwwrwr*rwr*w*w**++rtrtrtrtrtrtrt+rtrtrtwrtwwrww***rt*r+w+rtrtrt+*wwwwrrwrrww*++****+**w*++*w*
Address: all
Occupancy/Use: Parcel ID#: - Zone: CLe
Owner: Address: '
P.E./R. or Contrac or, c;' - t�e s:
Person in responsible charge: �(/1� l_(F / ZZ���d s: s L
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:
►`'ldd e, / being duly sworn,deposes and says that he/she resides at
(Print Name of Applicant) �) p (No.and Street)
in LJV t'� � 1 ,in the County of ��5y y�l � in the State of f,that
(Cityrrown/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:$ On C-2 ,
for the construction or alteration of: J, /�" / '
I
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 14 Sworn to before me this
day of , 20(�-7/ day of , 20
�Jfi—
Sign1re of erty Owner Signature of Applicant
Print Name of Property ner/ Print Name of Applicant
Notary Publiv/"TLZZ
Notary Public
STEVEN D. I
PUBLIC,STATE OF NEW YOW
Registrabon No.4864761
Qualified in Weetchmer Co
Commission Expkm June 18 20
�yE BRO
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1982 BUILDING DEPARTMENT
1nD
UILDING INSPECTOR
SSISTANT BUILDING INSPECTOR VILLAGE OFRYEBROOK
ODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573
(914) 939-0668 FAx (914) 939-5801
www ryebrook.org
- - - - - - - - - - - -- - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - -- - - - -
q'z�� �� '� � ,a-
ADDRESS: I 1 DATE: ;� "'--p
PERMIT# ' O ISSUED: 'D�2�ECT: `�"I�LOCK:�-- LOT:
,per !
LOCATION: T� �"� �y / C
D) �" " VCCUPANCY•
❑ VIOLATION NOTED THE WORK IS... d ACCEPTED ❑ REJECTED/REINSPECTION
❑ SITE INSPECTION ! REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION �1
�] NATURAL GAS
❑ L.P. GAS
❑ FUEL TANK
❑ Ff*E SPRINKLER
❑ FINAL PLUMBING
[].,CROSS CONNECTION
FINAL
❑ OTHER
�QyE BRC��•
O Zm
1982.
cu �
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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 : j �/ ` ST- DATE:
PERMIT#- 1 ` ` ISSUED: I D Z(SECT: BLOCK: LOT:
LOCATION: �O l�j��/ N �L \UR N�V OCCUPANCY:
❑ VIOLATION NOTED THE WORK IS... �P 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 2 G
❑ FUEL TANK 9 —7
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
❑ CROSS CONNECTION
❑ NAL
❑ THER`I
�E BRC�k,
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BUILDING DEPARTMENT
❑BUILDING INSPECTOR
SSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK
❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573
(914) 939-0668 FAx (914) 939-5801
r www.ryebrook.org
- - - - - - - - - --- - - - - -�= INSPECTION REPORT - - - - - - - - - - - - - - - - - - - -
ADAESS : l , V� ` Q ' \—Q.L? , DATE:a(�2. -Z I , ��'m -7�7
PERMIT# ISSUED: SECT:--�BLOCK: LOT:
LOCATION: OCCUPANCY:
❑ VIOLATION NOTED THE WORK IS... ❑" ACCEPTED ❑ REJECTED/REmSPECTION
❑ SITE INSPECTION REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
Z ROUGH PLUMBING
f ❑- ROUGH FRAMING
❑ INSULATION
❑ NATURAL GAS
❑ L.P. GAS
❑ FUEL TANK
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
❑ CROSS CONNECTION
❑ FINAL
❑ OTHER
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BUILDING DEPARTMENT JUL 2 8 20211 DD
VIL , E OF RYE BROOK
938K1Nq rT IYE B ,NY 10573 VILLAGE OF RYE BROOK
(914)9 )939-5801 BUILDING DEPARTMENT
.or
ELECTRICAL PERMIT APPLICATION
Westchester County Master Electricians License Required /
FOR OFFICE USE ONLY BP#: ��— O EP#: Q� 1—[ 9�
Approval Date: .1(A0 8 2021 Permit Fee: $ 3a-)
Approval Signature: Other:
Disapproved:
(fees are non-refundable)
****************** ***p* **************************************************************************
Application dated, O eD� 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 with all applicable Federal, State,County and Local Codes.
1.Address: 'Z1� S. lK% U� \\ SBL: I l.�1 I t 3 c7 —-�,--3�Zone: �2 I
2.Property Owner: 1 Q-C> I\o!c QL dress:
Phone#: Cell#:CW:� 39 tt "1 ill(U email:
3.Master Electric: ►t 1)CLc A 000n W(-j— Address: 3 U n A V-e-C
Lic.#:4 1 L Phone#: G11 N qCj 17 1ell#: email:
Company Name: E.C. eel LL �, G Address:
4.Proposed Electrical Work/Fixture Count: r tee ak i OfoLAes -!?iaaLKC
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 ,20 day of V 20
Signature of Property Owner ignature of Applicant
plchcvb Coo+11-Jt'
Print Name of Property Owner Name of Applicant
L�
Notary Public Notary Public
SHARI.MEULLO
Notary Public,State of New York
No. 01 ME6160063
Oualified in Westchester County
Commission Exnires Jantta-,Pq pn 3/21/19
Phone: 914-347-3595
Westchester Rockland Electrical Inspection Services, Inc.
DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue L Fax: 914-347-3596
Elmsford NY 10523 r�
� BUILOINO PERMIT NO.
TEMP# DATE _
CITY OR VILLAGE ZIP CODE TOWNSHIP COUNTY
STREET AND N0.OR 11 - POLE NUMBER
BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATE SECTION,' �-,BLOCK LOT
OCCUPANT'S NAME 0 BUILDING OCCUPANCY
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 N INSPECTION
OUTSIDE E al
BASEMENT
t"FL a� +
2-FL. VI LAGE
3-FL. 121 BULDING DEPARTMENT
REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE:
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 L-; 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 COMPANY DATE OF APPLICATION SIGNATURE OF APPLICANT
ct x
STREET ADDRESS TELEPHONE NO.
LICENSE NO.MRIEN APPLICABLE
IF
WESTCHESTER
ROCKLAND
ELECTRICAL
INSPECTION
VNE1%iSFRVICM 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:
GEC Electric Inc. Pawling Holdings LLC
33 University Place
NY, Portchester 10573
Located at:211 S Ridge St Rye Brook, NY 10573
Certificate Number: 1034069
Section: 141.35 Block:2 Lot:39 BDC: Permit Number: EP:21-190-BP:21-140
A visual inspection of the electrical system at this premise described as a Commercial occupancy,wherein the
premises electrical system consisting of electrical devices and wiring,described below,located in/on the premises at:
211 S Ridge St 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 04/11/22
Name Type Quantity
Switch Single Pole ------- 46
Receptacle Convenience ------- 35
Receptacle GFCI ------- 12
Fixture-Luminaire Incandescent ------- 112
Exhaust Fan ------- g
Microwave ------- 2
Cook Top 1
Exit Lights ------- 4
Emergency Lights ------- 6
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.
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�E �MENT
BUILale- NOV -$ 2021
VILLAGE OF RYE BROOK
938 KiNd.S tXEET RYE BM 9. ,NY 10573 VILLAGE OF RYE BROOK
(914)939-015 %' BUILDING DEPARTMENT
www. ytbiook.org
ELECTRICAL PERMIT APPLICATION
Westchester County Master Electricians License Required `p
FOR OFFICE USE ONLY BP#: C;/I— EP
Approval Date: NOV — 9 2 21 Permit Fee: $
Approval Signature: Other:
Disapproved:
(fees are non-refundable)
Application dated, U '2/ 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
1.Address: SBL: 1 71 i 3 —o�—3 / Zone C/
2.Property Owner: c ,c Address:
Phone#:9/7—39 6—91p lQ6 Cell#: email: ��C
3.Master Electrician: Address:
yihone#:ItyCell#:IF/I email: 5UYE j*42ui'(4140, MS-�,o•�
Company Name: Address: /0' MQ ow a le^-IDA Qr it AZ-a— n2emlraoil jnc�
4.Proposed Electrical Work/Fixture Count:
*********************************************************************************************************
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
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)
state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the
for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.)
The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work
performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this
application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire
Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations.
Sworn to before me this Sworn to before me this
day of ,20 day of ,20
Signature of Property Owner ignature o t
y.. C,y 'j- AncL':( ^2
Print Name of Property Owner ame of A an
Notary Public Notary B*jgi iOELLLO
Notary Public, State of New York
No. 01 v1E616!!r'�3
Q-ialified in Westchester County
Cornmission Expires January 29.20 L�
8/lv2021
Westchester Rockland Electrical Inspection Services, Inc. Phone: 914-347-3595
DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue lt/ Fax;9.14-347-3596
-i
ly BUILDING PERMIT NO.
Elmsford, NY 10523
TEMP# DATE -1 L! L
CITY OR VILLAGE ZIP CODE- TOWNSHIP COUNTY
STREET ANu,,K,6, ROAD So. R y _ - POLE NUMBER
BETWEEN WHAT TWO CROSS STREETS IS PREMISEStOCATED7 SECTION BLOCK LOT
OCCUPANT'S NAME BUILDIN OCCUPANCY
OWNER'S NAME AND ADDRESS fit <.' 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 I FLUORE NO. H.P.EACH NO. WATTS EACH INSPECTION
OUTSIDE
BASEMENT Q ,
1''FL. Nny - Q tf
2-FL. j
3-FL. B ' E
REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE:
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 CONDFTIONS AS SET FORTH FOR THE APPLICATION.
SIZE OF SERVICE FEEDERS
CHARACTER OF WORK NEW[I ADDITIONAL❑ EXPOSED I] CONCEALED❑ MUST ENTER APPLICANTS
IDENTIFICATION NUMBER
SERVICE ENTERS BUILDING OVERHEAD❑ UNDERGROUND L
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 TELE410M N0.
Cm OR "� LICENSE NO.WHEN APPUCABLE / '
WESTCHESTER 71
ROCKLAND
ELECTRICAL
INSPECTION
SERVICES,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:
Arcuri Alarm Systems Pawling Holdings LLC
1050 Mamaroneck Avenue
NY, Mamaroneck 10543
Located at:211 S Ridge St Rye Brook, NY 10573
Certificate Number: 1034027
Section: 141.35 Block:2 Lot: 39 BDC: Permit Number: EP:21-294-BP:21-140
A visual inspection of the electrical system at this premise described as a Commercial occupancy,wherein the
premises electrical system consisting of electrical devices and wiring,described below,located in/on the premises at:
211 S Ridge St Rye Brook, NY 10573
Basement E5 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
Smoke Detector ------- 44
Heat Detector ------- 1
Pull Stations Fire Alarm ------- 5
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.
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BUIL E v� MENT R
VIL E OF RYE OK AUG 12 2021 DD
938 KIN ET RYE B ,NY 10573
(914)9 939-5801 VILLAGE OF RYE BROOK
org BUILDING DEPARTMENT
PLUMBING PER1M'IT APPLICATION 2
FOR OFFICE USE ONLY BP#: p�I. 7O PP#: �— J
Approval Date: Permit Fee: $ A0
Approval Signature: Other:
Disapproved:
(fees are non-refundable)
**************************************************************************************************
Application dated, 08/2/21 is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of
a Permit to install and/or remove 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: 211 S Ridge St SBL: Zone: C
2.Proposed Work: Relocate plumbing fixtures for bathrooms
3.Property Owner: Address: 2111 S Ridge St
/
Phone#: Cell #: email: , �/0/1,
4.Master Plumber: Ken McCabe Address: P.O. Box 650 Briarcliff NY 10510
Lic. #: 983 Phone#: Cell#: 914-804-5412 email:
Company Name: VFR CONTRACTING Address: P.O. BOX 650 BRIARCLIFF NY 10510
INDICATE FIXTURES& LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE:
Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total
Closets Fountains Tubs Tubs Service Service Sewer LP Gas
Basement
i
1 st Floor /
2nd Floor
31 Floor 49,
l
4`h Floor
5`h Floor
Exterior
5.* List Other Equipment/Provide Details:
(Notarized Signatuces Required Next 2 Pages)
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BUILDDMENTD CCIEO VE
VI E'OOK
938 KING ET NY 10573 AUG 12 2021
(914)9 9-5801
ID
VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
xxxxx�xxxxxxxxxxx��xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx�xxxxxxxxxxxxxxxxxxxx�xxxxxxxxxxxxxxxxxxxxxxx*x
AFFIDAVIT OF COMPLIANCE
VILLAGE CODE §216 OSTORM 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:
3, "%3 L4V12 , residing at, )i FgK C S
(Print name) (Address where you liv
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;
211 S Ridge St , 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 Pro l sii
(Print Name of Property Owner(s))
Sworn to before me this 2nd
day of Aug '021
(Notary Public)
LAURA E SMITH
Notary Public,State of New York
Reg,No.01SM6387739
Qualified in Westchester Courtly
Commission Expkes 02 25=23
3/21/19
Building Permit Check List&Zoning Analysis
Address: Z l S - SBL: Z 3
Zone: G - Use: is Const.Type: ( Other.
Submittal Date: Z 1 Revisions Submittal Dates:
Applicant: t -Z k
Nature of Work: l to t{r-2-( D n— l) F r—l Lf V,A-I—e?r—.
vi ws:ZBA:-i I IN PB: BOT: Other.
hMp OK
( ( ) FEES:Filing. ZT BP: �2 S�. �� 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:
( (Jf PLANS:Date/Stamped: Sealed✓ Copies: ZElearonic Other.
( (�License ✓ Workers Comp: ✓ Liability U-- 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:
REOUIRED EXIMN PROPOSED NOTM APPROVED
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notes:
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BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERISI.AUTHORIZED
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CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF+ME ABOVE DESCRIBED►OLtCIES BE CANCELLED BEFORE
THE EXPIRATION OATS THEREOF NOTICE WILL BE DELIVERED IN
V,bge •Rr,.B,00u ACCORDANCE WITH THE POLICY PRONSIONS
938 Kmps Street
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1963.2015_ JACORD7CONOMATR31N. AN 091ft r=wv*d.
ACORD 25 12016,031 The ACORD name and logo are registered marks of ACORD
NYSIF
New York State Insurance Fund 199 CHURCH STREET.NEW YORK,N.Y. 10007.1100
nystf.com
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
O. '— Ail
A A A A A A 451481271
LEVITT-FUIRST ASSOCIATES LTD
520 WHITE PLAINS ROAD,2ND FL O
TARRYTOWN NY 10591
SCAN TO VALIDATE
AND SUBSCRIBE
POLICYHOLDER CERTIFICATE HOLDER
PAWLING HOLDINGS LLC VILLAGE OF RYE BROOK
25 South Regent Street(REAR) 938 KINGS STREET
PORT CHESTER NY 10573 RYE BROOK NY 10573
POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE
G2146 860-8 436679 06/29/2020 TO 06/29/2021 4/13/2 221
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE
FUND UNDER POLICY NO 2146 860-8, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR
WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL
OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW
IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS,
OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WESSITE AT HTTPS:/IWIWW.NYSIF.COM/CERTICERTVAL.ASP.THE NEW
YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS.
THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR,PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE
COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER
THE COVERAGE AFFORDED BY THE POLICY.
NEW YORK STATE INSURANCE FUND
DIRECTOR,INSURANCE FUND UNDERWRITING
VALIDATION NUMBER: 947891683
U-26.3