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HomeMy WebLinkAboutBP21-157j t? PERMIT M C> - 15 7 DATE: n ExP; Q� SECTION / 3�i 60 BLOCK � LOT v1 � °� C� TYPE OF WORK Ale to ' L107L-:�c 6 JOB LOCATION OWNER r� ���I V1 TCO # FEE DATE INSPECTION RECORD DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING O RGH PLUMBING GAS SPRINKLER ��Tr ELECTRIC LOW -VOLT _s ALARM AS BUILT -- FINAL 3- LE- 2ot�f �- /� �P� a- 05/�c- M A \ � C C -O. 4 Esc Pl�� OTHER APPROVALS ARB �Q y 19. BOT P8 IZBA — OTHER r'�UILTlFINAL SURVEY REDUIRED PRIOR TO F1NAl. INSPECTION JaaU VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 24-023 Certificate of ®ccupanq This is to certify that ! /� / of, I DVIL /�/ having duly filed an application on vtk4 c,26, 20,E requesting a Certificate of Occupancy for the premises known as, CO (/( val , Rye Brook,NY, located in a Zoning District and shown on the most current Tax Map as Section: ' 5•(OG Block: / Lot: , and having fully co/mplied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. - /� , issued 20 c�1 , such authority and permission is hereby granted to the property owner to lawfully occup or//usse said,, premises or building or part thereof listed under the following New York State Classifications,Use: — J 0 n r' /az�j-16,1 Construction: , for the following purposes: Lk hQl I tx 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 h 'g shall be made,nor all the building be moved from one location to another until a permit to accomplish such change hbe n obtain ffem a ilding Inspector. MAR 1 8 2024 Building Inspector,Village of Rye Brook: Date: LJ BUILD ENT For office use nl E C- I� �— D PERMIT# �� /S 7 FEB 2 6 2024 VIL OF RYE OK ISSUED: _ : � 8KING STRE YE BROOKS YORK 10573 DATE: VILL;a.G! OF ,Y= BROOK 9 -06 FEE: PAID BU1LDiN DEPARTMENT f or APPLICATION FOR CERTIFICATE OF OCCUPANCY9 CERTIFICATE OF COMPLIANCES AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION ►►►►s♦ssss►►r►sspsrsss++w+++rsrrrrrwrrsrsrrs++r+++♦r+++srrwrrrrwrr,+�wJrrw►•rsw►ssrswr►•rwr+rrrrrrswrrrsrrr+rss+srswrsssrswrss Address: 2 I �u t d // nn 1L vv0 !mil 1 G Occupancy/Use: GM -Parcel ID#: l CJ — /— Zone: Owner: GNc11 J Y- r) Address: P.E./R.A. or Contractor: Address: Person in responsible charge: 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: ct�- r'1� 1 'I (� ') \ being duly swom,deposes and says that he/she resides at Z A (� �J� U d (Print Name of Applic ) , -I_ (No.an Street) in Cc � () ,r� ,in the County of W\ ���`� 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:$ (Do 0 C) for the construction or alteration of: LSO a-j� 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 6 Sworn to before me this day of , 20 4�1 day of , 20 Sign u o roperty Owner Signature of Applicant Pn a of Property Owner 0 1 Print Name of Applicant Notary Public SHARI MELILLO Notary Public Notary Public,State of New York No.01ME6160063 Qualified In Westchester County s l�i-�-� Commission Expires January 29,2019 QyE BRID (�k• I 1932 BUILDING DEPARTMENT ❑BUILDING INSPECTOR UASSISTANT 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: 2— I XZ-0. 1::�L V DATE: S _ Z U Z y PERMIT# I ISSUED: b 30-Z 1 SECT: i BLOCK:_ LOT: / LOCATION: '\ pin I C�JI. Nn' .. L� OCCUPANCY: ❑ Violation Noted THE WORK IS... 9- PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION II ❑ Natural Gas �� `-� ►, -� rsA��C C"'C . ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION � FINAL OTHER Py MM N N O eq er�M� a M a N \ 00 N w i o L O N y •� M o on • 1-i � � � � N ° � w n � _ H a w Z s < CA x N c O � N Q � w z IU4 o h+l w °�° O �7 � O g W a w z O a w z w � c�en w z -^ 00 G/ V 04 W d< Cn M1 q w Z Z V z 3 N 0V ov H °z F CIO y C7 c ° W) w 0.0 N Q a rA z a ° a z a�a w xy D CC EOVE 10 BUIL y� BRCv� MENT MAR 21 2022 VIL E OF RW OK VILLAGE OF RYE BROOK 938 KIN > ET RYL B ,NY 10573 BUILDING DEPARTMENT or ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: / 7 EP#: 'ZDQ� 0 I Approval Date: MAR 2 3 Permit Fee: $ C{ Approval Signature: V Other: Disapproved: (fees are non-refundable) Application dated, 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: 2-1 12 i d y ( 130 tlI C lh r d SBL:1,,31Ti �00 —Loll Zone: 2.Property Owner: Gej I t n /k✓Y q ;G4 Address: Phone#: 9/7���D —��9 7 Cell#: email: 3.Master Electrician:jt�(4 r(�_4W Ir-4- ,..S Address:-1-4 Ld2 pa h.., de Q et,�+4_rs yA A) Lic.#: (I I�_ Phone#: Q tp o G 1/rkell#: email: Company Name: Address: 4.Proposed Electrical Work/Fixture Count: W 1 r:m� F© r ✓1 i /�0 f f y (o STAT OF NEW YORK,COUNTY OF WESTCHESTER ) as: Nvis "\w 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) ,, 3 state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the CAI1 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 befor me this day of ,20 day o ,20 Signature of Property Owner Signature f Aipphc rlt Print Name of Property Owner Print N of Appli antant Notary Public CHA*P&-'4*9. BRADBURY Notary Public,State of New Yo No.01 BR6159985 Qualified in Westchester County Commission Expires January 29,20 8/12/2021 INSPECTIONSTATEWIDE Service Willi hilegritY 0:0 swis • • APPLICATION0. Office Use Elect.Permit# Date ? / Bldg Permit# Utility ID# Final Certificate# City/Village Zip Township County Address Cross Street Section Block Lot Owner Name/Address(if different than above) Contact Number ❑Basement ❑ 1 st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside ❑Residential [:]commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent SERVICE Amperage Voltage 1 P 3P #Meters #Disconnect ❑Underground ❑New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information D CEOVED V MAR 21 2M 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 any time of inspection additional items have been installed,you are th auomed 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 a other in com The M spoon wny� applicant owner 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 CA]) 1080 Main Street ishkill, NY 12524 TO845 2 Phone 914-219-119-1062 Fax STATE wioE INSPECT I()N SEHVit is 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: Mayker Electric, LLC Gellin Murguia 27 Lopane Drive 21 Ridge Boulevard Patterson, NY 12563 Rye Brook, NY 10573 Located at: 21 Ridge Boulevard, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP22-051 135.60 21 _1 Certificate Number: 2022-1544 Building Permit Number: BP21-157 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:21 Ridge Boulevard, Rye Brook, NY 10573 The Exterior was 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 31st day of March 2022. Name Quantity Rating Circuit Type Hot Tub 01 The electrical inspection of the Hot Tub is valid on and limited to March 31", 2022. 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 i6vork performed on the date of inspection only. Building Permit Check List&Zoning_Analysis r Address: Z l ���'�- ►�L SBL: Z Zone: 0- -� Use: '?-1 O Const.Type: ] Other. Submittal Date: S- 'z Revisions Submittal Dates: Applicant: /LG.0 c J, Nature of Work )�j *'u-) 40 ,, �� Reviews:ZBA: MAY 1 1 2021 PB: BOT: Other. NF OK r ( ( ) ES:Filing. ?S• BP: L �O- �' C/O: Legalization: ( ) (�P: Dated ✓ Notarized: SBL Thus I.D. Cross Connection: " H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening. ( ) ( ) ENVIRO:Long. Short: Fees: N/A: ( ) ( ) ITE 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._iZ 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. (4AP6 mtg.date: 5 1 l 2l approval `1 `Lh1- notes: ( )ZBA mtg.date: approval:- notes: ( )PB mtg.date: approval: notes: APPROVED REQUIRED EXISTING PROPOSED NOTES Ate: M,� Circle: Fr n Front: Front: Ste: R Main Cor Accs.Cov FtHS : Sd.H Sb: Tot, FtFt IM: Height/Stories: l CL� ,.a� •� fi,� SG C.�- lw 2 2 CJti S- Cp Lt ao v �R� BUILDING DEPARTMENT VILLAGE OF RYE BROOK MAY - 5 2021 3D 938 KING STREET RYE BROOK,NY 10573 (914)939 i_ 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 Jthis check list will be removed from the ARB agenda. Job Address: Z 1 R l d C c 6 1 V U Date of Submission: J I � I ZI Parcel ID#: Zone: Proposed hnprovem t(Describe in detail): APPLICANT CHECK LIST: h o V Ot rl O n MUST BE COMPLETED BY THE APPLICANT The following items must be submitted to the Building .plcltgrm . ►�h,�d vie , Department by the applicant-no exceptions. 1. (►Completed Application 2. (►f 1"wo(2)sets of sealed plans. (one full size{maximum Property Owner: U((AlJjq allowable plan size=36"x 42")and one 11"xl7") pp __11 n1 y, 3. ( )Two(2)copies of the property survey. Address: 2 h c�C�z 17 4. ( )Two(2)copies of the proposed site plan. Phone# (� 14 9 2 109- 5. (0-8'ne electronic/disc copy of the complete application materials. Ap licant appearing before the Board: 6. ( Wling Fee. m U i y► 7. ( )Any supporting documentation. Address: 2 t id 8. ( )HOA approval letter. (if applicable) 9. (t,�tographs. Phone# Li 1 L-A 4 L" 2 ( C) 10.( d5avfles of finishes/color chart. (a sample board or Architect/Engineer: model may be presented the night of the meeting) Phone# 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 2, 1 S , 20 t? ( day of , 20 — h � W Signa o P perty O er Signature of Applicant Lx Print Name of Property Owner Print Name of Applicant Notary Public Notary Public III 3/21/19 VILLAGE OF RYE BROOK BUILDING DEPARTMENT 938 KING STREET, RYE BROOK,NY 10573 (T) 939-0668 (F) 939-5801 ARCHITECTURAL REVIEW BOARD Wednesday, May 19, 2021 PAGE 2 NAME&LOCATION TYPE OF APPLICATION MOTION SECOND APPROVED REJECTED APPL.# 12 Ridge Blvd Roof Top Solar Array Consent 5193 (Mattinson) Agenda 65 Rock Ridge Dr Re-Do &Expand Front Consent (Ayala) Walk and Landing in Flag Agenda Stone 41 Country Ridge 6Ft Black Chain Link Consent 5195 Dr(Taxier& Fence& 6Ft White PVC Agenda Diamond) Fencing 8 Fairlawn Pkwy Expand Asphalt Driveway Consent 5196 (Levin) Agenda 24 Berkley Dr 6Ft White PVC Fence in Consent 5196 (Gisondi) Rear Agenda 21 Ridge Blvd New Hot Tub on Platform Consent 5197 (Murguia) In Rear Agenda 29 Lincoln Ave New Swim Spa on Consent 5198 (Burathoki) Extended Patio, Relocate Agenda Side Fence 547 Westchester Remove Front Walk, Consent 5199 Ave(Marshall) Expand Driveway &New Agenda Front Landing 59 High Point Circle Replace Existing Deck w/ 5200 (Mangino) New Deck 3 High Point Circle Enlarge Existing Rear 5201 (Cao) Deck 12 Birch Lane Amendment to Prior 5202 (Shaw) Approval NAME&LOCATION TYPE OF APPLICATION MOTION SECOND APPROVED REJECTED APPL.# ML NM MR SE / JM ✓ SF AC MI KC U M � R a • • • ID MAY - 5 2021 VILLAGE OF RYE BROOK ' • r BUIi_r;INr��DEPARTMENT • • 0 ••' tit •• �• • • • Dr. Wellness G- 6 Tran ul i Spa q w/Bluetooth Waterproof Au di ' (7 customer reviews) 12: 5 0 -V a google.com U . . A Hot Tub Insider Visit G6 Tranquility Series Spa - Hot Tub Insider 12:48 9 a aqualivingstores.com v SKU: G-6 Categories: Spas, Tranquility Series Tags: Spas, Tranquility Series Product Description Additional Information Tranquility Color Options Available Upgrades Reviews (9) Product Description Dr. Wellness chose to upgrade this spa in order to begin providing great advancement of health benefits with the luxury and relaxation one would expect from premium spas. Standard Features Includes: • Premium Multi Color Light Package — Perimeter Lighting — Underwater Light — Lit Fountain Jets — Lit Waterfall — Lit Cup Holders • Bluetooth Audio Package with Built-in Speakers & Sub Woofer • Cushion Head Rests • Digital Controls • Insulating Cover • Full Foam Insulation • Neck, Shoulder, Calf & Foot Jets • Comfort Cushioned Headrest • Factory Installed Ozonator • Multi-Layered Fiberglass Reinforcement • Synthetic Cabinet in Coastal Gray or Mocha • Plumbed using 100% Anti-Fungicide tubing to prevent nasty bacteria back- up in plumbing lines resulting in cleaner water and less chemical use • Proudly Made in the USA! Specs: • Seats: 6 • Gallons : 350 • Weight: 875 • Pumps : Two 6 Hp. Pump • Jets: 51 Jets • Electrical : Hardwired 230V 50 Amp • Dimensions : 84" wide x 84" long x 34" high Warranty: • Structure: 5 Years • Shell : 5 Years • Major Components: 5 Years • Plumbing: 5 Years • Labor: 6 Months .i1 Verizon ^ 5:14 PM 1 32%4# 8 aqualivingstores.com Go to... t . i Step Colors Reviews (7) Acrylic (", olors � •" ar K� • x. Laura Petersen From: gellin murguia <ggmurguia@yahoo.com> Sent: Thursday,June 3, 2021 5:12 PM To: Laura Petersen Subject: Re: 21 Ridge Blvd - Building Permit for Hot Tub The hot tub is going on a platform as per my conversation with mr Izzo ® •d LTE 94 .� d Concretebums. • increase the Flh of •y soil affecting the health of •ur Landscaping. C break down over • leak caustic moisture • surrounding soil. EZ Pads are Easy toRelocate GL EZ Pads can be easily P�ID- moved • your hot tub- It you sell your hot tub, you can sell Pads with it' On Jun 3, 2021, at 1:20 PM, Laura Petersen<LPetersen@ryebrook.org>wrote: 1 Laura Petersen From: Laura Petersen Sent: Tuesday,June 1, 2021 1:43 PM To: ggmurguia@yahoo.com Subject: Building Permit Application - 21 Ridge Blvd - New Hot Tub Attachments: BP -1 Form.pdf Good afternoon, The building permit application has been approved by the Building Inspector. Before I can issue the/permit, the following items will need to be submitted to our office: V/- Homeowners Insurance Declaration Page ✓ 2. The attached BP-1 form (this form requires your notarized signature) Please let me know if you have any questions. Thank you! Laura Laura(Petersen Office Assistant Village of Rye Brook 938 King Street Rye Brook, New York 10573 l ar (& � D Phone(914)939-0668 1 Fax(914)939-5801 Ipetersenrvebrook.org l� l_ 5 �+� 1I6L DI 1 OCCIDENTAL FIRE & CASUALTY COMPANY OF NORTH CAROLINA Policy Declarations A Member Of: MiINSURANCE GROUP Policy Number: Statement Date: CUSTOMER SERVICE NYP380805001 March 18, 2021 For Policy Service Named Insured: Producer: Call Your Producer: L-GELLIN MURGUTA E2000OG (855)721-9251 21 RIDGE BLVD GEICO INSURANCE AGENCY INC RYE BROOK, NY 10573 PO BOX 9503 For Claim Service (914)462-1097 FREDERICKSBURG,VA 22403 Call Occidental Claims: ggmurguia@yahoo.com homepolicyoccidental@geicomail.com (877)842-0227 Additional Insured: Agent of Record: or file a claim online @ None SAGESURE INSURANCE MANAGERS LLC www.IATlnsuranceGroup.com/ PO BOX 12999 claims/report-a-claim-property TALLAHASSEE, FL 32317 For All Other Inquiries: (800)481-0643 Policy Period: Residence Premises: Transaction Type: Endorse April 01, 2021 to April 01, 2022 * 21 RIDGE BLVD RYE BROOK, NY 10573 Trans Effective Date: April 01, 2021 * 12:01 am local time at location of the residence premises Trans Amount: $-46.00 Your Insurer: OCCIDENTAL FIRE&CASUALTY COMPANY OF NC TOTAL POLICY PREMIUM $1,008 702 OBERLIN ROAD This is not a bill, your mortgagee company will be RALEIGH, NC 27605 invoiced separately if needed. Policy Coverages and Limits of Liability: Policy Savings: Section I Property Limit The following credits and discounts reduced your total A. Dwelling................................................................ $427,000 policy premium: Auto Policy Discount-Protective Devices Discount B. Other Structures................................................... $42,700 C. Personal Property................................................ $213,500 Policy Deductibles: D. Loss of Use.......................................................... $85,400 In case of loss under Policy Coverages,we cover only that part of the loss over the deductible stated. Hurricane Section II Liability Windstorm deductible applies to all Section I coverages E. Personal Liability- Each Occurrence................... $300,000 except for Loss of Use.All Other Perils (including non- F. Medical Payment to Others-Each Person........... $1,000 hurricane windstorm)deductible applies to all Section I coverages. Mandatory Forms and Endorsements: Hurricane(2% of Coverage A)................... $8,540 HO 00 03 10 00-Homeowners 3 Special Form All Other Perils........................................... $1,000 HCO10010 03 10-Amendment of Policy Provision Water/Sewer Backup................................. $500 HO 01 31 09 15-Special Provisions-New York HO 04 96 10 00-No Coverage For Home Day Care Business HO 16 10 01 09-Water Exclusion Fees &Taxes: HO 24 93 05 02-Workers'Compensation Endorsement NY Fire Insurance Fee............................... $0 HCO100014 06 15 Page 1 of 2 OCCIDENTAL FIRE & CASUALTY COMPANY OF NORTH CAROLINA Policy Declarations A Member Of: MINSURANCE GROUP Named Insured: Policy Number: Statement Date: L-GELLIN MURGUTA NYP380805001 March 18, 2021 Policy Forms&Endorsements: Limits of Liability($) Increase Total Premium($) HO 04 90 10 00-Personal Property Replacement Cost Loss Settlement Included HCO14171 03 09-Hurricane Windstorm Deductible Cat 1 or Higher-NY Included HO 23 95 05 02-Off Premises Theft Exclusion Included HO 04 20 10 00-Specified Additional Amount of Insurance for Coverage A-Dwelling 25% Included HCO15211 07 09-Water Back-Up and Sump Discharge or Overflow 5,000 5,000 100 Mortgagees&Other Interests: Mortgagee: Mortgagee: WELLS FARGO BANK, CENTRAL LOAN NA#936 ISAOA ADMINISTRATION AND PO BOX 100515 REPORTING ISAOA/ FLORENCE,SC 29501 ATIMA LOAN#:0433820271 PO BOX 202028 FLORENCE,SC 29502 LOAN#:000000 Other Information: Rating Territory:49 Year Built:1946 Protection Class:3 Number of families:1 Construction:Masonry Rating tier:0.5 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 March 18, 2021 David G. Pirrung Michael Blinson Countersign date President Secretary For information about how the Company compensates insurance producers, agents and brokers, please mail your requests to Occidental Fire& Casualty Company and North Carolina, PO Box 12999, Tallahassee, FL 32317 HC0100014 06 15 Page 2 of 2 Affidavit of Exemption to Sho% Specific Proof of N%orkers' Compensation Insurance Coverage for a 1, 2, 3 or 4 Family. Owner-occupied Residence '*T1&et Jones cyan"be used so wiatwr the wwiers'conywAssnow r*ft or o6fttooet of any Pwn.'• Under penalty of perjure. I certih that I am the oAmff of the i.2.3 or 4 family, owner-occupied residence (including condominiums) listed on the bwldtng permit that I an applying for. and 1 am not required to show specific proof of workers' compensation insurance coverage for such residence because (please check the appropriate box). I am performing all the work for which the building permit was issued. ❑ I am not hiring,paying or compensating in any way.the rndividualts)that is(are)performing all the work for which the building permit was issued or helping me perform such work. ❑ I have a homeowners insurance policy that is currently in effect and covers the property listed on the attached building permit A_ND am hiring or paying individuals a total of less than 40 hours per week (aggregate hours for all paid individuals on the jobsite) for which the building permit was issued. 1 also agree to either. • acquire appropnate workers' compensation coverage and provide appropriate proof of that coverage on forms appro%ed by the Chair of the tiY'S V1'orkers'Compensation Board to the government entity issuing the building permit if I need to hire or pa) individuals a total of 40 hours or more per week(aggregate hours for all paid individuals on the jobsite)for w ork indicated on the building permit,or if appropriate.file a CE- 200 exemption form. OR • have the general contractor. performing the work on the I. 2. 3 or 4 familh, owner-occupied residence (including condominiums)listed on the building permit that I am applying for.prop ide appropnate proof of workers'compensation co%erage or proof of exemption from that coverage on forms approved by the Chair of the N'YS Workers' Compensation Board to the government entity issuing the building permit if the project tak a total of 40 hours or more per week(aggregate hours for all paid individuals on the jobsite)for work i on the building permit. ( I Xb1_z-._ (SiMiA ofHorruxmner► (Date Signed)) L4`l' f C 1-7 Home Telephone lumber -`� (0 2�� (Homeowner's Name Printed) Swroiw to before me this _ _ /�� -J Property Address that requires the building pernui 2 (� ) d" � tvo _ ___ i orwijr • AN __BURY C (� c� S Notary Public, Stat New York \ , No.018R6159985 N yl Qualified in Westchester County _ on ).nires January 2.9,202,.L Owa natarued.this BPA form senes as as ei<emptioa ff r k AtjMMd dnabdn%benefits insurance co%rraec BP-1 (12/08) NY-WCB G 22 `"' a � 5-1 f� y v ' ! i w r. ,ram 4E b D-CL f3 f Ai .03 Ic 23. 06 t .. J f >: jar{ %a "' i r` • r,�' �`�J, �, yPo �~ �E �'�y Z � f� � .. .�' �..�F t �f' �' r�r. ^w •ia Q �T7 4 Q �11 Ly.>. t�, �• �. luz vW,a•, l t� -Y )I �17 �, •Q . Q O , f ti: /O� �"` c�3 i `�'� "�.` t (', ''�- may. ' 1 1A, Q Q W r � _ .ate f'All f �9 shy A. cn fQ rl �wr W �qV N C S y, ��^w������'�� N �/j L` t � �v � '� 4� �.!' � � � � � Fes. JS. s•y � �` � `"'°f � ti � � �, •'3 n ., Q e.i • �l 4 y„„! � ~�` (\• N h �• L' - (g tit LS �%1 h�i r• f i 3 � ` iz ril�" con '"~C,• -' $ M • SrC.,t ,�'�,`,. �' Z.r a ems. ,mow., tr.. !•� w' ^� w�"`i.' y Ly � �` #?®y3 .• v; � �+'� �• � � � r~.. e�d ;e ""� ,�`�" � jrj� :n � �• r".• � � y. �• ..., �•~r•r tZ'e�� �• s >.,IS,R. IRR . ...•++�....-......,....� w""u4 %c,n0e""�. `"'S �"`.• ;• .y i .••,, ` ;,; cy..• �'+� • r•, t �,. ear. � fi f•., �' r� v C.Gj �.t�.r• ///5s Ilk - CA Z) tz, cl� -9 R iS '� F p � b •�Y ��.i � "`may y y"'�. S.; ,y�i .��` �; �. ii�LL` y' � s•�~" NIF Michelle 4 Peter Mara scoico Lot 30 Fik.+d M of. Ic M. 43675 :ueLujjeq3 zQl 6 T A VW :94e(l 1eA0jddV End fence PAP,08 MG1A0jj jejnj,39jj4,0jV West 0.60, 8e °f As��c�l1 %404� aA8 10 851141A Partof Fled loop Lot 39 Q) jj��< so h 0wh 0 3675 PERMIT if 1c�� 01 SBUMBRUMM DATE APPRQVE MA DUILDING INSP&TO,Village of Rye f '"A 03 43 AS-BUILT/FINAL SURVEY REQUIRED PRIOR TO FINAL INSPECTION vn'ORS� F, C 0 UP" C4 TION Oft OR PERMISSION L4KT J.00 op XYYG'f :M:FiordOP1­09.' Cor.Shed 'M, 75 est 0.16 CS It 26 W,6'— I Story Conc. Haire Shed Step Cor.Shed Flog. wo West 0,30' Wd Mop Lot 41 1,., T- ) w A. Pied Mop Lot 42 lb 4Z W F.M.00d ,t fe steps 0 6 0 ry End Fence West 1.35' 157 Cz Concrete 00d 135.6& 1-20 Platform k a IF Concettino G:ky,.)1Cuni 'K ErxJ FLrwe West 0,41 47 End Fence Wust 0.66# AWhalt Dove Iron Pipe Found North 0.194 E1W on Line 8 13.,31 OP °fyr``,�" CL#b ce AC 4*c. IK* Soy 8.02- 13.?g, =580. co L It C Ufb yal Ragstone Platform Roof Over Z � R-IDG13 CATCH BASIN 0'UL,PVA.R-D Aspha* Povement �sPhalt Cur, -rOSSY Are, o N 0 UPoie M3 19 zi THOMAS C. MERR.ITTS LAND SURVEYORS P.C. "ap 394 BEDFORD ROAD * PLEASANTVILLE N.Y.10570-'--".' (I14)769-8003 • (203)622-8899 AT** D MAY 5 2011 VILLAGE 0 I'll I I - BUILD ! �u'LUINGnPLDAE BR00K Filed Map Lot 43 F.M.#3675 135.60-1-22 N/F Benjamin Alper Dilrukshi Ekanoyake-Alper Residence Car. Fence S 06'00E West 0.5 1' n 5� 2� Part of Filed Map Lot 39 f South 32q, F.M. #3675 East3 a' O 7 Story Frgme N cU Ggrgge CVS Ba 326` Filed Map Lot 42 F.M.#3675 Fence - East 0.21' 135.60-1-20 N/F Shiro & Benjamin Chervin Concrete Platform & Steps Int. Stockade Fence On Line Residence Filed Map Lot 37 F.M.#3675 ti \ Conc. Step M Flag. Walk Filed Map Lot 41 F.M.#3675 _,e Wood / Steps Hot Tub r'7astic Pqd Wood1)eck Cor.Bui7din9 East8.op, ketory,6 aLcerick giet� 27 aec Bay Alete, ,yin ow --,, Filed Map Lot 38 F M. #3675 Eage o fAspha7t Rory L%nve of Pines Parf of Filed Map Lot 391,v F.M.#3675 Q Stockade Fence d Map Lot F.M.#3675 767j 7337, AC 7329' A Cor. Fence On LineLU Piggstor�c; 'tt ` O Flagstone ty� a Platform a M Roof Over Asphalt Drive TAX LOT 21 Z I Area = 6,694.8840Sq.Ft. = 0.1537 Acres Iron Pipe Found North 0.19' E/W on Line L_55.3a, DUE �� H BASINS Asphalt Pavement EARD Curb Grassy Area O NW O DOrUmlFNT Surveyed. • August 31, 2012 Map Prepared.• September 6, 2012 Map Revised. September 18, 2012 to show certification Map Revised. • February 8, 2024 to show as built hot tub and fence Map Revised. February 14, 2024 By: ot -inm New York State Licensed Land Surveyor No.050604 Only copies from the original of this survey marked with an original of the Land Surveyors embossed seal or red colored seal shall be considered to be true, valid copies. Said certifications shall run only to the person for whom this survey is prepared and on his/her behalf to the title company, governmental agency and lending institutions listed hereon. Certifications are not transferable to additional institutions or subsequent owners. Unauthorized alteration or addition to a survey map bearing a licensed Land Surveyors seal is a violation of Section 7209, Subdivision 2 of the New York State Education Law. Possession only where indicated. Adjacent properly lines and easements not surveyed or certified. Access to adjacent rights of way, easements and public or private lands not guaranteed or certified. Underground utilities shown hereon are approximate and should be verified before excavating. Additional underground utilities are not shown or certified. Encroachments and structures below grade, if any, not shown or certified. Subject to covenants, easements, restrictions, conditions and agreements of record. Premises hereon being Lots 40, 41 and part of Lot 39 in Block H as shown on a certain map entitled, "Revised Map of Tamarack Gardens, in the Town of Rye, N.Y The Property of Tamarack Gardens Inc." Said map filed in the Westchester County Clerk's Office, Division of Land Records August 6, 1930 as map number 3675. Premises shown hereon designated on the Town of Rye Tax Maps as: Section 135.60, Block 1, Lot 21_ Property Address. 21 Ridge Boulevard Rye Brook, NY 10573 THIS MAP IS FOR BUILDING DEPARTMENT PURPOSES ONLY. MAP IS NOT TO BE USED FOR TITLE TRANSFER PURPOSES. MAP MAYNOT BE CERTIFIED TO TITLE COMPANIES ANDIOR BANKS. AS BUILT SURVEY PREPARED FOR GEL LIN M UR G Un 4- SITUATE IN THE TOWN OF RYE PILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK SCALE. 1 " = 20' GRAPHIC SCALE 20 0 10 20 40 80 ( IN FEET ) 1 inch = 20 ft. D CfL�W FEB 2 6 202.4 U I'..D l ,Ir