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Home My WebLink AboutBP21-164q/x A PERMIT #Ao DJ-1 & 2/1 � DATE: a, IXP: � c OTHER APPROVALS SECTION f .�. i 'y -MMMMM BLOCKK_ // r LOT ARB TYPE OF WORK //t')!" el ��7ea �.74o� BOT JOB LOCATION !f t O V e.'�I.�G-� PB OWNER /'C� C� o ® %/1�� yaoMm ��a ZBA OF OTHER :: CONTRACTOR EST. COST FEES vCO # FEE �' �'� DATE TCO FEE DATE.... �r N INSPECTION RECORD DATE FOOTI N G a a 0 INSP VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 23-041 Certiffcate of ®ccupaucp 'This is to certify that rRohq� S 4eln f�' of, u�, �r � / having duly filed an application on Ao"'hy I J19 VU a 20 c2 3 requesting a Certificate of Occupancy for the premises known as, U n oQl ,7 A vzf7 a , Rye Brook,NY, located in a�Zoning District and shown on the most current Tax Map as Section: 135.`7' Block: Lot: l , and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No.C�)—JW , 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 Q following New York State Classifications, Use: — / , Construction: LJ 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 shall be made,nor shall th ]ding be moved from one location Lto another until a permit to accomplish such change has been t ' ed ' the uildi In pector. MAR 1 4 2023 ctingg Building Inspector,Village of Rye Brook: Date: RME E C E Rn� For office use nl : D3BUILDI �WE�'A.TZTMENT PERMIT# •—/�� FFEB21 2023 VILLAGE OF RYE BRooK ISSUED: -- 38 KING STREET,RYE BRooK,NEw YoRK 10573 DATE: — — VILLAGE OF RYE BROOK (914)939-0668-FAX(914)939-5801 FEE: PAIDJO BUILDING DEPARTMENT g,�rook.org APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCES AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION M►ttgtikR#RRt/ft►gtitii#####RR#ffittftti►itkt##kt#tfRRtfittRttiiitkkiki#fRfiitRttitittikff#tit►t►ii/itik####Rf##ttit►►ittR Address: 3� L l h t&&,. 'A V L Occupancy/Use: Parcel ID#: 5, '�9 -- �— /77� Zone: Owner: r�� C.lner 3 L�L�(� Cc4Xdrdress: J� L,i n Loin Ok P.E./R.A.or Contractor: n jq Address: Person in responsible chargel�u�ntv-% Address: 3n Lin(.UAh !eYVL 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 YOM COUNTY OF WESTCHESTER as: 1\o urn !S\st,%h Pam" being duly swom,deposes and says that he/she resides at Y\ �- (Print Name of Applicant) (No.and Street) in -�_(� ?"en ddL in the County of in the State of N y ,that (City/Town/Village) he/she has supervised the work at the location indicated above,and that the actual total cost ofthe 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:$a S,0 o U for the construction or alteration of: K% Sjn� q'ems A Deponent fiirther states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly, in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per §250-1O.A.of the Code of the Village of Rye Brook. Sworn to before me this �j Sworn to before me this day of �-1��, , 20 _ day of —� igna f Owner Signature of Applicant �(60 V\- S •lhe r �c �,., pt. Sitt�rl G r TName df Property Owner Name o Applicant Notary Public Notary Public SHARI MEL.ILLO Notary Public,State of New York SHARI MEULLO No.01 ME6160063 Notary Public,State of New York 3/21/19 Qualified In Westchester County No.OIME6160063 Commission Exoires January 29 20 v23 Qualified In Westchester County Commission Expires January 29,20,',"-� �yE 4RCi' t7 >> �O 1982 BUILDING DEPARTMENT BUILDING INSPECTOR ❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : I 1 un) DATE: PERMIT#"-C "C f ISSUED: I �SECT:��_�$LOCK:_�LOT: LOCATION: Cy�c�s� l� \ �`4 V Qlan(SA(A 4QCCUPANCY: 1 ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION r , REQUIRED ❑ FOOTING �?✓� r� �� ❑ 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 j] FINAL ❑ OTHER �yE BRC�j�. O�` tim • �9a2 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.aebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - � ADDRESS:— 3 1 I C>cp_�,(AAJ'Q DATE' \�� i PERMIT# ISSUED: '1 SECT: BLOCK: LOT: LOCATION: � �P �l ��'� 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 ,0/ INSULATION -NATURAL GAS ❑ L.P.GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER QyE BRQ:� cu � Fo BUILDING DEPARTMENT ❑ WILDING 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 Uebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : ( —DATE: c = 1"I� , PERMIT# ^� ` ISSUED: �lf � ( ( SECT: BLOCK: LOT: LOCATION: C4111 r I`_� OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... P' ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQIIIRED ❑ 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 v W 0 s N i cq l "" u �y f M IRT g o � , oz o a a cq CA e z a 0 x Fa :° �► a w (� U U 6W W z T co 6dw00 044 a z UZ F V CA 00 " ►-y x at zCY en Cl V `i w 6 '��"' z ? A W z w v Z $ 44 , ►.� � � U � OG U � W , v w z v, dl a a 04z as w = � BUILDING DEPARTMENT D C C EOVI VIL .AGE OF RYE B#bOK JAN 19 2023 938 KIN `§TREET RYE BROOK,NY 10573 (914)93,9-0668 VILLAGE OF RYE BROOK wwry� dok.org BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required 1 FOR OFFICE USE ONLY BP#: 4�) /— /�o`7 EP#: JAN 2 / Approval Date: Permit Fee: $ Approval Signature: Other: Application dated, 1 is hereb ade�theBuilding Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or r ve electrical equipment,wiring, fixtures,or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. I.Address: 33L LZC[,o\n fw , SBL:jaS, y 9 Zone: 2.Property Owner: A E&Ik Address: Act L l car oI n 14d'Q. —�tODtOD Phone#: — 9'?J8 Cell#: email: 3.Master Electrician: I i" QMNI] Address:jQfi l -cA ( W Y f(;SA,j Lic.#: Phone#: DJ/-94/OWkell#: email: Company Name: Qi 111� �t.�f.�`t�� -� Address: 109 h.Cy0IP_ fW r �, 4.Proposed Electrical Work/Fixture Count: 5.3'Party Electrical Inspection Agency: \ S� STATE OF NEW .,`YORK,COUNTY OF WESTCHESTER ) as: CX- R%, \U ,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 caf* !,R�J�l 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 1 02 day of ,20 day of 20 4-'-� Signature of Property Owner FELICITY FULLER Signature oApplicant Notary Public-State of New York No.OIFU6425939 Q� Z Print Name of Property Owner Qualified in Westchester Count Print Name of Applicant My Commission Expires tt/2 36— Notary Public Notary lic 6/23/2022 • STATEWIDE INSPECTION Service With Integrity lil Main Street,Fishkill, NY 12524 1 email:office@swisny.com SWIS JOBAPPLICATION tel845.202.7224 • • 1• • • • Office Use Elect.Permit# Date / Bldg Permit# Utility ID# Final Certificate# City/Village Zip i J Township County Address -1 j_t o c of n Pe, Cross Street Section Block Lot Owner Name/Address(If different than above) Contact Number ❑Basement ❑ 1 st FI. ❑2nd Fl. ❑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 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 j or_ e D CC�LOMC 1AN 19 2023 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 authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is nor open applications for the above address with any other inspection compan y.The 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 ,% !t l.; Date j. Signature Address { City/State C __I t ; Zip Code License# �_ Phone# rij RState Wide Inspection Services 1080 Main Street �- FEB 16 2023 Fishkill, NY 12524 � 1111� 845 202-7224 Phone U S VILLAGE OF RYE BROOK 914-219-1062 Fax STATE WIDE INSPECTION SERVICES I BUILDING DEPARTMENT 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: Pinto Electrical Company, Inc Gerald Cooper& Robyn Steiner Mark Pinto 39 Lincoln Avenue 109 Maple Avenue Rye Brook, NY 10573 Rye, NY 10573 Located at: 39 Lincoln Avenue, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP23-014 135.49 11 Certificate Number: 2023-1008 Building Permit Number: BP21-164 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: 39 Lincoln Avenue, Rye Brook, NY 10573 The First Floor Kitchen 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 2nd day of February 2023. Name Quantity Rating Circuit Type Oven 01 5kW GFCI Receptacles 07 Dishwasher 01 Recessed Luminaires 06 Switches 04 Officer: Frank 1. 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. ao � % M � O W�W w � � m O en > leS GC t W a a F vp zE- z z fa Q o N 0. o g < � o, C U �- � A O00 z w w w z .oe .. w 1 0 � z � o z° a W Z ce o Z a z � ~ W �: m M , ' O A z ^ a 't C U U 04 3 0�0 0-4 `" � � rZ � � .� C � x (, °4 x ` M O W W OYw. W Q U 44 a W z w � 3mg V, O oC by u V � w H cw7 r o o e U c a w M c w z w I0�.. Zi 41 0 p ECENEB JUL 16 2021 VILLAGE OF RYE BROOK BUILDING DEPARTMENT BUILDING DEPARTMENT VILLAGE OF RYE TOOK 938 KING STREET RYE BROOK,NY 10573 (914)93M668`PAX(914)939-5901 www.ryebr ok.org ELECTRICAL PERMIT APPLICATION Westchester Codn *aster�Electricians License Required �J FOR OFFICE USE ONLY BP If. EP#: Approval Date: UL I UAMI Permit Fee:S Approval Signature: Other: Disapproved: tfees or' non-refundable) it#f fitftttittttft #tfff fitffit tit#t#ktfft#ttttt#ff#tt►itti##t#iitt#t#t#ft#itttitif#tit#######t# 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' remo a 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 pertorm.�d will he in contormance wnh all applicable Federal,State,County and Local Codes. 1� / 1.Address: SBL:I3�f 4 / / Zone: - 2.Property Owner:lkotoyn 1N. S :W-1'✓- Address:11 `I—MI Lk"l Wdf- 'k (SrtoCl(- Phone#: Cell#:9.l.H LW)cl-k�g- email: Y % L- 4tryzton 3.Master Electrician: DJ1, U— �1 f)-kc� Address: ` IL11 t710 ,Cx-u-__ Lic.#: �_3 Phone#: 4('4'�Z( Z"' Cell#: t(A 403 39 Z'�1 entail:Q\(�IJ�+t'[;�` �c1 1 C�6-01 ��n Comrany Name: b-l+ � �t 1= LL2( Address: ( IA� r. IA Ve-. 4.Proposed Electrical Work/Fixture Count: ( ✓ }}##}1}}f}fffffff#f#ff}}ff#fff}#�,f}f}ffffff#lfffffifRf#fff}}f}f}fffffi}iiffi}ff#}f}#fff}}}ffffff}f}f}ffff STATE OF NEW YORK,COUNTY OF WESTMESTER I as: �3 jt/ S`rtl'<</✓�`� ,being duly swum,deposes and states that he/she is the applicant above named,and does further (print name of tnil-du:d signing a.the applicaun state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the �/r/Li� /LI ft for the legal owner and is duly authorized to make and file this application. i indicate ar,hnrtit,ctanranor.agont.auon—.ci. . The undersigned further states that all statements contained herein arc 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 asset forth and contained in this application and in any accompanying approved plans and specification;,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Cale of the Village of Rye Brook and all other applicable lXordimancesbvlations. Sworn to before me this Sdayof \ ,202\ da20 Sign re of Property OvOWEtune of Applicant �00'46 Sk%oCf M A R Y ATFB___ _ t Name ofPr_opertyOwner 140TARY PUBLIC-STATE10 t _; 0-"k—LL, No. OISL61308 pp�Notary Public SHARIMELJLLO Qualified in WestCheS�er`y6ounty Notary Public,State of New York No.01ME61CoM MY Commission Expires 07-25-2021 C-rilified in Westchester County Commis-ion Expires.1:mi ta—w 2n ;:!Intr Phone: Westchester Rockland Electrical Inspection Services, Inc. 9ia-3i7 3595 DO NOT WRITE'HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue Fax: 914-347 3596 Elmsford, NY 10523 i BUILDING PERMIT NO. TEMP Y ti f CITY OR VILLAGE ZIP CODE TOWNSHIP COUNTY STREET AND NO.OR ROAD POLE NUMBER BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT OCCUPANT'S NAME BUILDING OCCUPANCY 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 P, -"'TACLES ONLY SIDEWALL SWITCH INCADE FLUORE NO. H.P.EACH NO, WATTS EACH INSPECTION OUTSIDE BASEMENT ,'FL. L U L 6 021 2-FL. _RGE UF R OOK 3' FL. BUILDING DF REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: ►7b 4�' 1,A) 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[I 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 I1 J X STREET ADDRESS TELEPHONE NO. CITY OR POST OFFICE ZIP CODE LMENSE NO.WHEN APPLICABLE O N N N � � w N ` C63 C/� > = � o ° � ¢ _ O � w LZ 8 M o s F J W F W S r �-r � �i � w O � U U cn iZ► r WOEM AONONO CIS Z � r►� w .i w o� L► [r �r � � � r A., O W w •• o c E� Q w cc _ WN i' BULL EPARTMENT JUL 2 8 20211 VIL E OF RYE BROOK 938 KTN ET RYE B ,NY 10573 VILLAGE OF RYE BROOK (914)�9 68FA 9 939-5801 BUILDING DEPARTMENT w*icy-y 9ok.org PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY RP#: LI PP#: C�) �rc Approval Date: Permit Fee: $ Approval Signature: L Other: Disapproved: (fees are non-refundahle) **************** *** ***************************************************************************** Application dated, e 0?002 is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/or r move 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: 2AJ C /[/ SBL:/, ?i y �� Zone: —�a- 2.Proposed Work: x/ e., -4 .J, --<i%A4 G Z.66.f- 0A1 Cj II s /4�aL,,�.Lle e 3.Property Owner: Address: `l L �r1 G� Vj 'j L. �yL rode Phone#: — Cell#: 14 LA'�Q C�01 D. email: r I r 00 , C.6--7 4.Master Plumber,d4elS 1d/G7T! Address: Aj utiIe� GAI��sC xj-1/OS12 Lic.#:33q Phone#: Cell F f y•7�,�„��,3 y emai ,v L Company Name:8,e. &4A4AJA g &,�e� AZ Address: CO�v1 l Z INDICATE FIXTURES& LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary NaturaU Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement Ist Floor / I 1 2nd Floor 3`d Floor 4'h Floor 5'Floor Exterior 5.* List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) 3/21/19 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,being duly sworn,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 � Sworn to before me this b day of LA\ ,20 Z 1 day of ,20 (� Signature of Owner Signature of Applicant e L l j •� A. 0 a�Q r G I.tTO �1C/E. (.tip, / Print Name of Property Owner ftint Name of Applic t IM ota bJic A� NDRA H. K M�4Y*t4 NotW blic, State of New York Notary Public,State of New4ork No. 01 M1=Ei1 t7!C63 No.OILFR6363711 Qualified in Westchester County Qualified In Westchester County Commission Exoires January 29 20�� Commission Expires August 28,20�2-k This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- 3/21/19 BUILDING DEPARTMENT [E E ME VILLAGE OF RYE] OOK J U L 2 8 2021 938 KING STOWET RYE BRgoI�NY 10573 (914)9 39-5801 .� VILLAGE OF RYE BROOK BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE§216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT. STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: 0- Is yck residing at, '�-J L, !2�-,C)1�1 A4L- RAC VSt`�'" ►�''` (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; `1 L�A lL)`n 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 Owner(s)) <1��.►,- �A Sit �, c`- (Print Name o Property Owner(s)) Sworn to before me this S� day of w�y , 20 l ary Public) L ALEXANDRA H.FRANK /?i Ok() Notary Public,State of New YOrk No.01FR6363711 _3_ Qualified in Westchester County Commission Expires August 28,20`mil 3/21/19 Building Permit Check List&Zoning Analysis Address:_� (! tJ c p L+J A y F--• SBL: 3 S AS i Zone l _7" Use: 2( o Const.Type: Other. Submittal Date: 'I -L ( Revisions Submittal Dates: Applicant: �i£l t-j 1p—cl— Nature of Work t,,rc�C2._. 9 — ��1-�� — i/'-'� y �►—� eviews:ZBA: 2021 PB: BOT: Other. OK ( ( ) FEES:Filing. 7S BP: 17 S C/O: Legalization: ( ) (CYAPP: 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: LiabilityComp.Waiver. _�7 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: APPROVED O /ED REQUIRED EXISTING PROPOSED NOTES Date:.JUL — 6 202 A� Circle: Fro=ve Front Front Si : 1g Main Cov. Accs.Cov F S S .HS • GFA: Tot.imp: Ft.Img: P ku' Utight/Stories: notes: 1W RENEWAL DECLARATION # 21 AC RENEWAL OP POLICY HNY 0301596 H O M E O W N E R S P 0 L I C Y POLICY NUMBER POLICY PERIOD COVERAGE IS PROVIDED IN THE r860856500 ENCY CODE FROM TO HNY D301596 06/30/21 06/30/22 THE HANOVER INSURANCE COMPANY NAMED INSURED AND ADDRESS AGENT GERALD COOPER TELEPHONE : 914-937-1230 STEINER BNC INSURANCE AGENCY ROBYN 39 LINCOLN STEI AVE 90 SOUTH RIDGE ST RYE BROOK , NY 10573 RYE BROOK , NY 10573 POLICY PERIOD- 12:01 A.M. STANDARD TIME AT THE RESIDENCE PREMISES THE PREMISES COVERED BY THIS POLICY IS LOCATED AT THE ABOVE ADDRESS. CONSTRUCTION PREM. NO. OF TERR. PROT. YR. SECTION I LOSS SEAS/SEC GROUP FAM. CODE CONST. DEDUCTIBLE FRAME 57 1 40 04 50 $1000 PER OCCURRENCE NO COVERAGE IS PROVIDED WHERE A PREMIUM OR A LIMIT OF LIABILITY IS SHOWNPREMIUMS SECTION I COVERAGE LIMIT OF LIABILITY $2,909.00 $61 A. DWELLING $ ,000 B. OTHER STRUCTURES 61,000 C. PERSONAL PROPERTY $457,500 D. LOSS OF USE $305,000 SECTION II COVERAGE $500,000 EACH OCCURRENCE E. PERSONAL LIABILITY $5,000 EACH PERSON $40.00 F . MEDICAL PAY. TO OTHERS TOTAL BASIC PREMIUM - - - - - - - - - - - - - $2,949.00 ADDITIONAL PREMIUMS $60 .00 EQUIPMENT BREAKDOWN COVERAGE $75.00 SELECT PREMIUM EXTRA $390.00 PLATINUM HO-3 SELECT PREMIUM $116.00 VALUABLE ITEMS COVERAGE $20.00 WATER BACKUP AND SUMP OVERFLOW COVERAGE $326.00 UMBRELLA ENDORSEMENT _ _ _ _ _ _ _ _ $987.00 TOTAL ADDITIONAL PREMIUMS - - - - - RATING CREDITS $291 .000R OPTIONAL DEDUCTIBLE $291 .000R TOTAL RATING CREDITS VALUED CUSTOMER CREDITS $145.000R CREDIT FOR PROTECTIVE DEVICES $29.000R NON-SMOKER DISCOUNT $727.000R 25% CREDIT FOR INSURING BOTH YOUR AUTO AND HOME WITH US $901 .000R TOTAL VALUED CUSTOMER CREDITS _ _ _ _ _ - _ _ $1,192.000R TOTAL CREDITS - - - - - - - - - TOTAL PREMIUM ADJUSTMENTS - - - - - - - - - - - - - $205.000R TOTAL ANNUAL PREMIUM - - - - - - - - - - - - $2,744.00 CONTINUED ON NEXT PAGE DIRECT BILLED 05/17/21 2112445755 PAGE 01 OF O� ORIGINAL/INSURED 001834 1W RENEWAL DECLARATION # 21 AC RENEWAL OF POLICY HNY D3015 H O M E O W N E R S P O L I C Y POLICY NUMBER FROM TO POLICY PERIOD COVERAGE IS PROVIDED IN THE AGENCY CODE HNY D301596 06/30/21 1 06/30/22 THE HANOVER INSURANCE COMPANY 860856500 NAMED INSURED AND ADDRESS AGENT GERALD COOPER TELEPHONE : 914-937-1230 ROBYN STEINER BNC INSURANCE AGENCY 39 LINCOLN AVE 90 SOUTH RIDGE ST RYE BROOK , NY 10573 RYE BROOK , NY 10573 MORTGAGEE WEBSTER BANK NA 4706016617 PO BOX 790267 SAN ANTONIO, TX 78279 FORMS AND ENDORSEMENTS - H00003 04/91 , H02343 04/91, 231-0600 04/83, 231-6073 03/13, 231-6217 11/15, 231-6026 03/12, H00435 04/91 , 231-5761 03/12, 231-2364 06/06, 231-2360 09/09, 231-2323 06/06, 231-2324 06/06, H00453 04/91 , 231-2326 06/06, 231-6242 08/16, 231-2325 06/06, 231-2328 06/06, 231-2341 06/06, 231-2331 06/06, 231-1937 01/01, H00490 04/91, 231-2329 06/06, H02312 04/91 , 231-6317 03/17, 231-5767 06/09, 231-5810 03/17, 231-5771 06/09, H02493 02/00, 391-0565 01/83, 231-6123 03/15. DESCRIPTION OF ADDITIONAL COVERAGES WATER BACKUP AND SUMP OVERFLOW COVERAGE $5,000 UMBRELLA ENDORSEMENT LIMIT OF LIABILITY IS $2,000,000 EQUIPMENT BREAKDOWN COVERAGE AMOUNT OF LIABILITY IS $ 50000. VALUABLE ITEMS COVERAGE JEWELRY LIMIT IS $ 7500 , TERRITORY IS 08. EMPLOYERS LIABILITY NUMBER OF EMPLOYEES IS 1 , COVERAGE FOR OCCASIONAL SERVANT. CREDIT FOR PROTECTIVE DEVICES PERCENTAGE IS 05 CONTINUED ON NEXT PAGE DIRECT BILLED 05/17/21 2112445755 PAGE 02 OF 04 ORIGINAL/INSURED Affidavit of Exemption to Show Specific Proof of Workers' Compensation Insurance Coverage for a 1, 2, 3 or 4 Family, Owner-occupied Residence "This form cannot be used to waive the workers'compensadon rights or owig dons of any port.•• Under penalty of perjury, I certify that I am the owner of the 1, 2, 3 or 4 family, owner-occupied residence (including condominiums) listed on the building permit that I am applying for, and I 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. Q� I am not hiring,paying or compensating in any way,the individual(s)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 AND 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. I also agree to either: ♦ acquire appropriate workers' compensation coverage and provide appropriate proof of that coverage on forms approved by the Chair of the NYS Workers' Compensation Board to the government entity issuing the building permit if I need to hire or pay individuals a total of 40 hours or more per week(aggregate hours for all paid individuals on the jobsite)for work indicated on the building permit,or if appropriate,file a CE- 200 exemption form; OR ♦ have the general contractor, performing the work on the 1, 2, 3 or 4 family, owner-occupied residence (including condominiums)listed on the building permit that I am applying for,provide appropriate proof of workers'compensation coverage or proof of exemption from that coverage on forms approved by the Chair of the NYS Workers' Compensation Board to the government entity issuing the building permit if the project takes a total of 40 hours or more per week(aggregate hours for all paid individuals on the jobsite)for work indicated on the building permit. CTX� -1I► l��Z� (Signature of Homeowner) (Date Signed) Qh40 a. -,-�sjc r Home Telephone Number (Ho eowner's Name Printed) FISwarn to before me this 3 day of Property Address that requires the building permit: _ j J ,l fu-W �1 G7 unty a or Nota y Pu ! ALEXANDRA H.F h —� Notary Public,State of New York No.03FR6363711 Qualified In Westchester County commission Expires August 28,20-2J— Once notarized,this BP-t form serves as an exemption for both workers'compensation and disability benefits insurance coverage. 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