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HomeMy WebLinkAboutBP21-153PERMIT # VIZ) 3. DATE: 10 / � al EXP: � � SECTION S� BLOCK LOT c� TYPE OF WORK r ce 4ch/rne7P JOB LOCATION Ot� Ven1.�� OWNER �`iri5�o lie/ Q;ti� oiA__V//e__#e�7OuinSGn0/Zs-o1`i�q-�_935 CONTRACTOR- Ze ') c.0'121` QCIz. ..11►C - /I �I�Olo T. COST A 3 FEE # "FEE DATE co TCO # FEE DATE.. INSPECTION RECORD r 1 ATE INS FOOTING ^ �� FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING C� RGH PLUMBING GAS CJ SPRINKLER ELECTRIC C7 LOW -VOLT F1 ALARM AS BUILT FINAL t Zt OTHER APPROVALS j ARB � ns2 / aoal I BOT PS ZBA OTHER AS-BUILIIFINAL SURVEY REflUIRED PRIOR TO FINAL INSPECTION ReceIvea U121 wu ' a 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 J.Fischer Michael J. Izzo David M. Heiser Jason A. Klein CERTIFICATE OF COMPLIANCE December 15, 2021 Christopher Quinson&Yvette Quinson 23 Hawthorne Avenue Rye Brook,New York 10573 Re: 23 Hawthorne Avenue, Rye Brook, New York 10573 Parcel ID#: 135.83-1-27 Building Permit#21-153 issued on 6/18/2021 for an Outdoor Fireplace & Chimney This certifies that the new outdoor fireplace and chimney, constructed under the above captioned permit has been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector Ag D [E C E � 1J E BUILD R ENT For office use onl :/ PERMIT# —I�3 DEC �- 2 2021 VIL OF RYE OK ISSUED: - qn ) 38 KnvG STRE YE BROOK,'; YORK 110573 DATE: - f VILLAGE OF RYE BROOK 9 -06 , ©� FEE: PAID BUILDING DEPARTMENT ty 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 #..fti......................ttfRttlfiilttiit#ti Ktiti■Fttit Ktf......a... ............... ....................■■... ...t#i#it.... Address: 23 awi6ertr_ Aw nuc- , Rynnlri M Wsts Occupancy/Use:�mi- I Os- arcel ID#: - 2 Zone: Q -ISPt Owner: C(�tris avt �_Vc,{kt Q�inaon 11 , Address: 23 P.E./R A, or Contractor: l'�1 � L �ry~SpSfia Lfe�ilAddress: 14 Uncaly► ( 12•,e �� 1Or33 Person in responsible charge:Cj&&jS uj j,, M Address: _23 4.atl a,s; Ayt- eyx s)v* 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: STA TE OF NEW YORK, COUNTY OF WESTCHESTER as: A & &i 0 n being duly sworn,deposes and says that he/she resides at 2,3 4r�Ito✓Ye c rt�- t wale w� �rint Name of Applicant) (No.and Street) 10�`fi3 in Lt_ R 0my- ,in the County of We-a .- in the State of ,that (City/Town/Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:S 30-0 {0(00.00 for the construction or alteration of: r Tj ec'R Ir, �. 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/ber 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-I O.A.of the Code of the Village of Rye Brook. Sworn to before me this —9 w d Sworn to before me this 2 y day of c� f� , , 20 21 day of t �[ , 20 2J xgna a of Property Owner A\4vc�(- of pplicant SOt ojt ' 5 on Prin Name of Property Own,r Print ame of Applicant ) r No c Notary Publi CLAUDIA UVALDO CLAUDIA UVALDO NOTARY PUBLIC,STATE OF NEW YORK NOTARY PUBLIC,STATE OF NEW YORK NO,01 UV6107856 �, , , NO.OIUV6107856 QUALIFIED IN WESTCHESTER C011144'Y QUALIFIED IN WESTCHESTER COUNTY COMMISSION EXPIRES APRIL 12.2024 COMMISSION EXPIRES APRIL 12,2024 �E BRC���, 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. ebrook.or - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : v DATE' -2 1 PERMIT# ISSUED: 1ECT:�f BLOCK: LOT: LOCATION: O.J��-%��-� CUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED C1 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 �yE DRC��. 1982 BUILDING DEPARTMENT 'UILDING 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.or� - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - -- - - - - - - - - ADDRESS :. 2 h- - DATE: 2 PERMIT#�\ - {� ISSUED: vJ /-� Z{ SECT:I3 5-/ LOCK: 1 LOT: LOCATION: � `- 2� OCCUPANCY: Z r 7 ❑ VIOLATION NOTED THE WORK IS... [,"'ACCEPTED ❑ REJECTED/REINSPECTION ❑ ITE INSPECTION REQUIRED FOOTING FOOTING DRAINAGE '❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P.GAS - LA'Z' ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER Buildin Permit Check List&Zonin Anal sis 'Address: Z3 v SBL• Z Zones? 1 S Use: Z Cont.Type: Other. Submittal Date: r�{ o Z t Revisions Submittal Dates: Applicant: Q--I t+J S o ti Nature of Work: ©-111 Ooti Reviews:ZBA: MAY 1 0 7071 PB: BOT: Other. OK ( ( ) FEES:Filing: BP:_ � ��� _' C/O: Legalization; _ O (. 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 rotection S/W Mgmt.: Tree Plan: Other: ( ) (,.YSURVEY:Dated: �Z� Current Archival ✓ Syaled: Unacceptable: ( (. PLANS:Date tamped:�Z Sealed ✓ Copies: � Electronic: ✓ Other. ( ) License: Workers Comm: Liabilit)r Comp.Waiver. Other: ( ) CODE 753#. 3/— — `7, cc� 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. O O H.V.A.C.: Plans: Permit N/A: Other. ( ) ( ) FUEL TANK:Plans: Permit: Fuel Type: Other. O O 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: S Iq 2 approval notes: ( )ZBA mtg.date: approval notes: ( )PB mtg. date: approval notes: REQUIRED EXISTING PROPOSED NOTES �8t@t J UN 18 2021 Area Vie: Fr n e Front: Front Sides: Rear. Main Cow. Accs.Cov: Ft.H Sb: Sd.H Sb: Tot. tto 31f 67 Z Et-imp: P Height/Stories: notes: .( v C t W L� 2 L . BUILDING DEPARTMENT D u �J VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 APR 3 0 2U21 (914)939-0668 F (914)939-5801 VILLAGE OF RYE BROOK BUILDING DEPARTMENT ARCHITECTURAL REVIEW BOARD CHECK LIST FOR APPLICANTS This form must be completed and signed by the applicant of record and a copy shall be submitted to the Building Department prior to attending the ARB meeting. Applicants failing to submit a copy of this check list will be removed from the ARB agenda. Job Address:_ fltj rnp� h4fmye, Date of Submission: ��, r� Z Parcel ID#: (3�? . (J$— [`Z7 Zone: Proposed Improvement(Describe in detail): APPLICANT CHECK LIST: e l MUST BE COMPLETED BY THE APPLICANT The following items must be submitted to the Building (� j Department by the applicant-no exceptions. 1. (x•)Completed Application % `,� 1 2. (;K.)Two(2)sets of sealed plans. (one full size I maximum Property Owner: t�ii 1CI S V(0SOO S. ]VG''1��Jlyl allowable plan size=36 x 42-) and one 11 x 17 Address: QW�y_a e �P 3. w 4)Two(2)copies of the property survey. �1 Vl 4. (,A Two(2)copies of the proposed site plan. Phone# 914— ( 1 S —2—80 5. (A One electronic/disc copy of the complete Applicant appearing before the Board: application materials. 6. I Filing Fee. 2 0� In 7. ( )Any supporting documentation. Address: �--1 e E' n 4 8. ( )HOA approval letter.(fapplicable) jrN� 9. ( Photographs. Phone# {D�(Q' Z 4�37n 2 10.(2Q Samples of finishes/color chart.(a sample board or Architect/Engineer: Mae Q a V) W a I-IV V1 model may be presented the night of the meeting) ! d Phone# (Q�#lp " Z34 3?0:7—^ By signature below, the owner/applicant acknowledges that he/she has read the complete Building Permit Instructions&Procedures,and that their application is complete in all respects. The Board of Review reserves the right to refuse to hear any application not meeting the requirements contained herein. Sworn to before me this Sworn to before me this day of ��Y�r -. , 20 z! day of kon, l , 20 Z (7z�� 1 /�pu' Signatur of Property Owner Signature of Applicant /� v VCR (f-.4-4 of Property Owner Pnnt Name ofAppl" r f try Pubic Notary Public aLoan�rA cAs>Hi NOTARY PUBLIC SPATE.OP NEW'z O'', IQ DEAN ALDSANOER RADICE SR NO.OiGA640%87 'NOTARY PUBLJC QUALIFIED IN BRONX COUNTY CONNECTICUT COMMISSION EXPIRES MARCH 2,2024 MY COMMISSION EXPIRES NOVEMBER 30,2022 li2l/19 VILLAGE OF RYE BROOK BUILDING DEPARTMENT 938 KING STREET, RYE BROOK, NY 10573 (T) 939-0668 (F) 939-5801 ARCHITECTURAL REVIEW BOARD Wednesday, June 16, 2021 Due to public health and safety concerns from COVID-19, the Architectural Review Board meeting on June 16, 2021 will be closed to members of the public. The public can still watch the live meeting online through Zoom through the app or through the following https:llus02web.zoom.us/i/85411174403 If any interested members of the public would like to provide comments during the meeting, comments can be emailed to stevefews@ryebrook.org or called in during the meeting at +1 (929) 205-6099, meeting ID: 854 1117 4403 NAME & LOCATION TYPE OF APPLICATION MOTION SECOND APPROVED REJECTED APPL.# 78 Woodland Ave - Replacement of Railing 5186 (Freeman) and Decking on Front Porch 5 Charles Lane Re-Do Existing Front Consent 5208 (Gasparim) Walkway in Bluestone Agenda 1 Lincoln Ave (Parr) Replace Wood Retaining Consent 5209 Wall, w/Masonry Liberty Agenda Stone, & Walkway 4 Candy Lane Replace Decking & Consent 5210 (Dluzhevskiy) Railing on Existing Deck Agenda (PVC Paramount Sandstone) 2 Charles Lane New 6' High Rear Yard Consent 5211 (Kaplan) Fence Agenda 16 Legendary Circle New Deck, New Patio, 5213 (Abramsohn) Retaining Wall, Expand Driveway & Landscaping 18 Rocking Horse Amendment to Prior Consent 5214 Trail (Feist) Approval Fence Change to Agenda Vinyl & Steps 23 Hawthorne Ave Outdoor Fireplace & 5215 (Quinson) Chimney t.\C \'(L� j ML NM DO- &64M tW-) MR / SE i/ 1� O t J JM ✓ SF AC ME KC VILLAGE OF RYE BROOK BUILDING DEPARTMENT 938 KING STREET, RYE BROOK, NY 10573 (T) 939-0668 (F) 939-5801 ARCHITECTURAL REVIEW BOARD Wednesday, June 16, 2021 Page 2 NAME&LOCATION TYPE OF APPLICATION MOTION SECOND APPROVED REJECTED APPL.# 39 Country Ridge Amendment to Prior 5216 Drive (Austrian) Approval (Pool House Wrap Bottom in Stone Veneer) 65 rock ridge Drive Relocate Patio Door, New 5217 (Ayala) Windows, to Facilitate Interior Alterations 13 Knollwood Road Rear I Story Addition, 5218 (Luceno) Rear Deck, & Masonry Patio ML NM MR SE JM SF AC MI KC ga ° Am - row CL t` 5 +. N ii•'•�' ea = p Q+ N s CD , ".'• ': � a, Fes„ 1 �( .:)> Z CO I •ram 0 � � •`= '�' I cc y y ^ O a ,y / co LLf m Z o '° Q= n toklBCtic i W�••, �- Z U •a f r' G�1 Z Q LLj Q V hl, Z w O = ° ,y �� W 4+ lob �1 N Z ry Z y p ',E +� �Q LL Q tCL i \ A � C �1 d >V Lr] U V z� Cd 00 cri .NCl i44, ch �� � i may.; yf� .:,.. w � �. fl vw r DATE(MMrDDIYI'YY) ACORO® CERTIFICATE OF LIABILITY INSURANCE 04/28/2021 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(les)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 NAME: JEFFREY D KAVOVIT PHG IC,NNo, .845-562-0701 FAAIC No:845-562-0852 FARM FAMILY CASUALTY INSURANCE CO. =L 88 OLD RT.9W STE#100 INSU a AFFORDING COVERAGE NAIs111 NEW WINDSOR, NY 12553 INSURER A;FARM FAMILY CASUALTY INS.CO. 13803 NBURED XNSUREto:UNITED FARM FAMILY INSURANCE CO. 29963 FRANZE'S MASON CONTRACTOR INC INSUPMC: 41 OTSEGO AVE INSURER o NEW ROCHELLE, NY 10804 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR NSR I TYPE OF INSURANCE ADDL SUe WVD POLICY NUMBER �p EFF YM POLICY EXP LIMITS A X COMMERCIAL GENERAL LUMUTY X 3102XO666 01/31/21 01/31122 EACHOCCURRENCE S 1,000,000 CLAIMS-MADE X1 oecuR R $ 100,000 MED EXP(Any one person) S 5,000 PERSONAL S ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE f 2,000,000 X POLICY ❑JJEECTT LOC PRODUCTS-COMPIOP AGG S 2,000,000 OTHER: S B AUTOMOBILE 310105180 01/31/21 01/31/22 COMBINED eMB.,SINGLELIMT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY Ix AUTOS BODILY INJURY(Par aociderd) S HIRED NON-OWNED PROPERTY DAMAGE XAUTOS ONLY AUTOS ONLY a en $ $ UMBRELLA LIAO OCCUR EACH OCCURRENCE $ EXCESS LIAB El CLAIMS-MADE AGGREGATE $ DIED I RETENTION _ $ WORKERS COMPENSATION PER OTH- B 'AND EMPLOYERS'LIABILM YIN 3103W8376 04/23/20 04/23/21 X T TUT ER OFFICERIMEMBEANY RPEXCLUDEED7ECUTIVE NIA E.L EACH ACCIDENT S 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 DESCRIPi ON OF OPERATIONS belu E.L.DISEASE-POLICY LIMIT $ 1000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) THE VILLAGE OF RYE BROOK IS NAMED AS ADDITIONAL INSURED WITH RESPECT TO GENERAL'LIABILITY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE VILLAGE OF RYE BROOK THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 938 KING STREET RYE BROOK NY 10573 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Yo K 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 FRANZE'S MASON CONTRACTOR, INC. 914-632-4715 41 OTSEGO AVE. 1 c.NYS Unemployment Insurance Employer Registration Number of NEW ROCHELLE, NY 10804 Insured Work Location of Insured(Only required if coverage is specifically limited to ld.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e., a Wrap-Up Policy) Number 13 3262807 2.Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) UNITED FARM FAMILY INS CO. VILLAGE OF RYE BROOK 938 KING STREET 3b.Policy Number of Entity Listed in Box"la" RYE BROOK NY10573 3103W8376 3c. Policy effective period 4/23/2020 to 4/23/2022 3d.The Proprietor, Partners or Executive Officers are included. (Only check box if all partners/officers included) ® all excluded or certain partnerslofficers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"1 a"for workers' compensation under the New York State Workers' Compensation Law.(To use this form, New York(NY)must be listed under J,tem 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: JEFFREY KAVOVIT (Print name of authorized representative or licensed agent of insurance carrier) �a �rli Approved by: 4128121 (Signature) (Date) Title: AGENT Telephone Number of authorized representative or licensed agent of insurance carrier: 845-562-0701 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 Laura Petersen From: Mike Izzo Sent: Wednesday,June 23, 2021 4:00 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: Wednesday, June 23, 2021 3:00 PM To: Mike Izzo <MIzzo@ryebrook.org> Subject: Message from Dig Safely New York, Inc. (DENY) ****REGULAR**** DIG REQUEST from DSNY for: VIL RYE BROOK Taken: 06/23/2021 14:59 To: VIL RYE BROOK PRIMARY Transmitted: 06/23/2021 15:00 00002 Ticket: 06231-002-292-00 Type: Regular Previous Ticket: 06221-001-844-01 ---------------------•-------------------------------------------------------- State: NY County: WESTCHESTER Place: RYE BROOK Addr= From: 23 To: Name: HAWTHORNE AVE Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: LEFT SIDE AND LEFT FRONT - LEFT SIDE OF PROPERTY FRONT TO BACK OF THE : HOUSE NearSt: IRENHYL AVE Means of Excavation: EXCAVATOR Blasting: N Site marked with white: Y Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: EXCAVATION FOR FIREPLACE Estimated Work Complete Date: 06/28/2021 Depth of excavation: 42 INCHES Site dimensions: Length 20 FEET Width 6 FEET Start Date and Time: 06/28/2021 07:00 Must Start By: 07/13/2021 ------------------------------------------------------------------------------ Contact Name: ANTHONY FRANZE Company: FRANZE MASONRY i Addrl: 41 OTSEGO AVE Addr2: City: NEW ROCHELLE State: NY Zip: 10804 Phone: 914-632-4715 Fax: Email: franzemason@yahoo.com Field Contact: ANTHONY FRANZE Alt Phone: 914-906-5935 Email: franzemason@yahoo.com Working for: QUINSON ------------------------------------------------------------------------------ Comments: Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA BELL-VALHALLA/WSCHSTR CONED LEVEL 3 COMMUN SUEZ WTR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR 2 �102toZ 3WHN"AlAld41'z1O'Z if)Z QdV4'AI1e1 NOLI�IQ`O'�3i13AJ. 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