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HomeMy WebLinkAboutBP21-194PERMIT O "I SECTION TYPE OF WORT 10B LOCATION OWNER /EST. COST v/ CO # TCO # dq baM- a9 a �- M-OCK / LOT l �1 P.�OV471i0/I �h ki FEE DATE 1{ySPECTIQN REC4� DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING [� RGH PLUMBING GAS SPRINKLER ELECTRIC LOW -VOLT ALARM AS BUILT FINAL 1 NSP t'f C9/Y)lo98 8o8o OTHER APPIKUWALD ARB BOT PS ZBA OTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 22-002 Certffirate of (Ortupaucp This is to certify that D o Id Amell ko� n A—mell of, A'Vf B VnO/`, / V 1 , having duty filed an application on J)eCCMY9er 1�4 20 4�2 1 requesting a Certificate of Occupancy for the premises known as, C;,(,35 Jk'-et1h?41 (, U� , Rye Brook,NY, located in a ,l -5 Zoning District and shown on the most current Tax Map as Section: 13 5• / J Block: ) Lot: ` 6. I , and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No.12 - �`�' , issued /7 Lc9� 20 4;12 1, 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 New York State Use Classification of: R-O / GY1e- F-0-M 1 , 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 heig sha be made,nor shall the building be moved from one location to another until a permit to accomplish such change has ben t in ilding Inspector. Building Inspector,Village of Rye Brook: Date: JAN — 5 2022 DI For office use onl : 3D BUILD �T'MFNT PERMIT# -i9y DEC 14 2021 VIL OFRYE BROOK ISSUED: 7 c)9—af 38 KING STRE YE BROO1:,rN YORK 10573 DATE: VILLAGE OF RYE BROOK 606 FEE: I���— PAIDS BUILDING DEPARTMENT 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 «++++r+rr+rrrrr++r+r++rr+t+r++►rr++*rr+rr*+*r+++r*+«rrs►+►►r►s►►►■s►►►►►sssss►s►►ass►►►■sssssssssrrrr+♦+rrrrr++ssr+srrr**+rsr Address: 5 A) V f . Occupancy/Use: Fzt b Parcel ID#: 35 �� — _ G/f• Zone: oe25_ Owner: T')(1'a L f I w rIYry 6 L-L Address:—<9 35 t ,�I U4- - P.E./R.A.or Contractor: Address: y`=� 1 �'t�Gs%�►-� �4„v� . /►-, ,n«f / Person in responsible charge: '�C v C>,a7vS ✓""v Address: -2>01--/ Z->(/I rq,4� 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: SC c being duly swom,deposes and says that he/she resides at 30 7 Z, �-1 1, (Print Name of Applicant) / (No.and Street) in i rm-V-1 J?- r�� ,in the County of ��QS -/Wea k-r in the State of �✓ ~,that (Cityfrown/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:$ 3�� 03y — for the construction or alteration of. Zr.t�.1 1v ,4- �V - �.Gt, o►/y'771� 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 tthe�e Code of the Village of Rye Brook. Sworn to before me this Sworn to before me this day of , 20 L day of z 20�1 -- —�O ! Signature of Property Owner Signature of Applicant 44vv\AP, t,Arts 'etia �• Print Name of Property Owner Print Na Applicant 1� Notary Public Notary Public CHFllS J.BRADBURY Notary Public,State of New York FRANCINE M. BRILL NOTARY PUBLIC-STATE Or NEW"'ORK No,01 BR6159985 NO. 01 DR616 i517 8/12/2021 Cunlilied in Westchester Courty� QUALIFIED IN QUEENS COUNTY Commission Expires Jarr wry?9. 9n `-3 MY COMMISSION EXPIRES MAY 7,2013 �QyE DR(Zj� o ti� • 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR SSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK Al❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : DATE: PERMIT# ISSUED: E NECT: BLOCK: LOT: LOCATION:` \ 1p� h +1 OCCUPANCY: ` \� ❑ VIOLATION NOTED THE WORK IS... [,� ACCEPTED CI REJECTED/ REINSPECTION ❑ SITE INSPECTION 1 REQUIRED FOOTING 1_�1 �C��1 t_N FOOTING DRAINAGE 11 ❑ 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 BR�k o`` tim 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR )EIASSISTANT 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: ` d� PERMIT# y ISSUED:' Z SECT: BLOCK: LOT: OCCUPANCY: 1 LOCATION: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED Q' REJECTED/REINSPECTION Cl SITE INSPECTION ! REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION {� _ ❑ NATURAL GAS �•_ ��i 1 �l 1 1C..� V�y� r,� L r bl�-� ❑ L.P. GAS / 1 ❑ FUEL TANK kC �C����, F� <�` l ��C�� -- L� 4 C_r�-- \ �1 cue� ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑r CROSS CONNECTION {� FINAL r❑ OTHER BRC�j�. 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 :_ DATE: PERMIT# i ` ISSUED: T- �LT: BLOCK: LOT: LOCATION: 1 1� OCCUPANCY: s ❑ VIOLATION NOTED THE WORK IS...f 11 ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION / REQv'IRED ❑ FOOTING W� c O 1 _�— ❑ 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 BR Q4 ti� BUILDING DEPARTMENT ❑BUILDING INSPECTOR ,/ASSISTANT BUILDING INSPECTOR 'VILLAGE OF RYE BROOK ODE ENFORCEMENT OFFICER 938 KING STREET - RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - - -- - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : ��-� DATE: ioA huz PERMIT# ?1 6� 1 ISSUED: 4 ` SECT: BLOCK: LOT: LOCATION: V 1 �-K�1�C`� CY�1 �1 \� OCCUPANCY: 7- r ❑ VIOLATION NOTED 1THE WORK IS... c ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION + 1� V r REQUIRED ❑ FOOTING W 1 ❑ 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 � ... N 96 tri If, Uen > g 4 W t- W UCD W g = F ce Co . � r A W $ � ' W ,'� � 5 J Q � A u � x T ~ Z> low ILL W � � Y•1 � ��/•' `� MM MElmo oe tn ►•� � � O C � � � � per. r 0-4 M N z O z c o` < _ Q c ° oc LIFOi < � M IIll $UILDXN� EPARTMENT r D VIL E OF RYE OK SEP Z 4 2021 938 KIN ET RYE B ,NY 10573 VILLAGE OF RYE BROOK W or BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County ]Master Electricians License Required Q FOR OFFICE USE ONLY BP #: I ' 4 EP#: Approval Date: S E P 2 7 1 1 Permit Fee: $ / r �� Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, 4? Z D 2 1 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: SBL: 3 - 12� ' I - ���� I Zone: /C 2.Property Owner: �DO Y)A C ( Address: aj' Fre 1�1 Yl Ul 1 Phone#:&0J--7W• 30-7Z Cell#: email: I ` 3.Master Electrician: ToVYt-rSI »t-- Address:r2 �7e Vl t A)q EC QOt M Q WI U~� � Lic.#: 2>5 Phone#:C1l1 '93r?-Q!B9 p Cell#:q�q 2 73-1 email: 1olVrtf99 IraWthCS Company Name lg- wr S Ylt? 'A C t� Address: 9-Z. }-tc'YI�YYIIXC [h 11"ta W1f�lX1JYtQ(IL _ 4.Proposed Electrical Work/Fixture Count: 'Vk W1 V STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: 7 IAVV T S 454—" ,being duly swom,deposes and states that he/she is the applicant above named,and does further (print natne of individual signing as the applicann state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the AU ]Q EAA! for the legal owner and is duly authorized to make and file this application. iin(ticatc 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. �a Sworn to before me this Sworn to before me this 71 © day of ,20 day of 'iG j 20 2- Signature of Property Owner Sig� Appl nt w,-05 C- Print Name of Property Owner Print Name of A plicant Notary Public Notary Pu t J NIFER 'RANSOM NOTARY UBLIC46TATE OF NEW YORK No.01RA6288703 Ouslified in Westchester County 8/12/2021 My Commission Expires 09-08-30OL3 Westchester Rockland Electrical Inspection Services, Inc. Phone: 914-347-3595 DO I`JOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue � ,� Fax: 914-347-3596 Elmsford, NY 10523 f� BUILDING PERMIT NO. TEMP it DATE CITY OR VILLAGE ZIP CODE TOWNSHIP COUNTY U tJ „ STREET AND NO.OR ROAD POLE NUMBER BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION - BLOCK LOT OCCUPANT'S NAME 17 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 NO. H.P.EACH NO. WATTS EACH INSPECTION OUTSIDE BASEMENT 1'"FL. 1 .Uj 2'a FL. 3-FL. VIL GE OF YE B OOK BUI REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: fIU'r �w; I� � Swl(j e Ov 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 APPUCATIONS 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 L ADDITIONAL C] EXPOSED[_] CONCEALED❑ MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD❑ UNDERGROUND[] AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. NAME OF COMPANY DATE OF APPLICATION SIGNATURE Of APPLICANT X STREET ADDRESS TELEPHONE NO, CRY OR POST OFFICE ZIP CODE LICENSE NO.VMEN APPLICABLE WESTCHESTER 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: James A Stone Electric Donald & Katlyn Amell 522 Fenimore Road NY, Mamaroneck 10543 Located at:235 Irenhyl Ave Rye Brook, NY 10573 Certificate Number: 1032109 Section: 135.75 Block: 1 Lot:45.1 BDC: Permit Number: EP:21-239-BP:21-194 A visual inspection of the electrical system at this premise described as a Residential occupancy,wherein the premises electrical system consisting of electrical devices and wiring,described below,located in/on the premises at: 235 Irenhyl Ave Rye Brook,NY 10573 Basement 12 1st Floor 2nd Floor 3rd Floor 0 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 12/06/21 Name Type Quantity Refrigerator ------- 1 Wine Chiller ------- 1 Toe Kick Heater ------- 1 Microwave ------- 1 Cook Top ------- 1 Receptacle GFCI ------- 6 Fixture-Luminaire Incandescent ------- 12 Dimmer 600 watts ------- 4 Switch Single Pole ------- 4 Receptacle Convenience ------- 4 Arc Fault Breakers ------- 4 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. ! Tara Gerardi From: marissa@westrockelectricalinspections.com Sent: Friday, December 3, 2021 1:32 PM To: Tara Gerardi Subject: 235 Irenhyl Ave Hi Tara, We did the final inspection today at 235 Irenhyl Ave EP-21-239. I wanted to let you know that James Stone did not end up needing to wire any smoke alarms. He only did wiring for the kitchen and the kitchen is all that we inspected. Thank you, Marissa Marissa Speirs Westchester Rockland Electrical Inspection Services Inc P.0 Box 208 Carmel, NY 10512 914-347-3595 845-225-6410 Fax 1 in r o 0 a Q s f r ~ try o ❑ ,D Z Es y w $ < Q a r 1■r■I w 3 ;c •a .. co Q , ov Z � o Q as ON 14 v t � a w r � U is > O'D B16 c • ;;yE �RC��� BUIL E MENT VIL E OF RYE OK SEP 2 8 2021 938 KIN ET RYE B ,NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT w oo .or PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: Z/ - 7X PP #: r�� SEP 2 9q IQJ'�--/fib Approval Date: Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, ? el is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install an or emove 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: 23S Z�C—y/�j/?r� /fUC SBL:/,3,5-, 75/—Y5_. _Zone:Je J 2.Proposed Work: ,K/'--6- /e,�>�o!//�Tlo�✓ 3.Property Owner: Address: Z 3.s- Phone#:&D 7-r7&o-3Q74 Cell#: email: 4.Master Plumber: "1/� �C�iyC:EZ a Address: Lic.#: G// Phone#: 777-6._606 Cell#: $"190 — 5"4 r email: CoC/�ir/G�Zc��Ceyy.Cr✓�1: �' Company Name: 4T/GC �aG*9�✓�GZu ��/c. Address: INDICATE FIXTURES&LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1st Floor if 2nd Floor 3,d Floor 4"Floor 5'h Floor Exterior 5.* List Other Equipment/Provide Details: 116 Z7• �^'�� q` Ta l�o �� c- ar✓Cy' ziv�S��el (Notarized Signatures Required Next 2 Pages) -I- 8/12/2021 STATE OF NEW Y/O�RK,COUNTY OF WESTCHESTER ) as: cSi` /�t/ aC�9�+ C-Zo ,being duly sworn,deposes and states that he/she is the applicant above named, (paint name of individual signing as the applicant) and further states that(s)he is the l�of he property to which this application pertains,or that(s)he is the �,G�wT /C4G. C�ii✓T/[gC7tiT 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 �L J nn ` day of ,20 0� day of Cam, ,20 'fit-\ J ignature of Property Owner Signature of Applicant Print Name of Property Owner Print Name of Applicant ota Publi . 1 � lE, ate of Now York ry ALEXAND MARSNALL No. 01 ME6160063 Notary Public,State of New York Qualified ill Westchester County No.01FR6363T11 Commission Expires J""-Iuary 29 20 Qualified In Westchester County Commission Expires August 28,2d�s This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- 8/1 21202 1 BUILD l MENT D IE C E � " F VIL E OF RY ooK SEP 2 8 2021 938 KING ET RYE BR ,NY 10573 VILLAGE OF RYE BROOK ro g BUILDING DEPARTMENT *********************kF c*: *:h*lrk*k�** .:F****kk********i;**** ;*lrl:;l:*lc it*k**k*k*fie*t lc•I:k1:i:le Vr lr****Y**fir***ie**4**k 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: 1()ooa '� T t , residing at, 235 1Yey111 Ay (Print n:jinc) tAddre,,s Micro you 11v I 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; QQJ�-, NJ IOS­13 , Rye Brook, NY. I.ob 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. 1 ignaturc of]'r( )., ty Ownerw) CPriniti.mtctf•I'rol�rh 1?tni•rjsl) 7� Sworn t?�LeT efore me this day of , 20 DREW P.ALEXANDER NOTARY PUBLIC OF NEW YORK I.D.#OIAL64I4646 tar Puhh ) MY COMIVIISION EXPIRES 03/0I/2025 _3_ 81 E 21202 i �] Building Permit Check List&Zoning Analysis Address V► �� � �� ` e- SBL• 1I2>5-I EJ. Zone: 5 Us Cont.Type: Other. Submittal Date: _11'2.?-)7p_ZA Revisions Submittal Dates: Applicant: S Nature of Work Reviews:ZBA: PB: BOT: Other. NEED OK pq &_" ( ) ( ) FEES:Filing. _16 BP: c7 C/o: Legalization: APP: Dated:_ i'_Notarized ✓ SBL y Tru s 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: ( } (t)-PLANS:Date Stamped y Sealed: f-- Copies:-2 Electronic: Other: ( } { License: Workers Comp:✓ Liability: mp.Waiver. Other. O { ) 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: REOMED EXISTING PROPOSED NOTES ) JUL Arc& kdv Fr r Front: Fr n Sides: R.Car. Main Cov Accs.Cov Ft.HS : Sd. S Tot,ELIM: Hight/Stories: notes: Tara Gerardi From: Tara Gerardi Sent: Tuesday,July 6,2021 2:51 PM To: scoff@douglasstreeterinc.com Subject: 235 Irenhyl Avenue Attachments: Exterior BP Full 8.3.2020.pdf Good afternoon, I was just going over the application you submitted and noticed some window changes. This change requires Architectural Review Board approval. Please submit an exterior building permit application along with elevation drawings.There are a couple pages in this application that are not applicable,you would just leave them out.The application you submitted is also missing the homeowners telephone number. Please feel free to call me if you have any questions. Tara Tara A. Berardi Secretary - PCanning Board Zoning Board of Ayyeafs & ArchitecturaCReview Board 'Village of Rye Brook 938 .?ling Street Rye Brook, New York 10573 Office (914) 939-0668 FaX (914) 939-5801 -_ ps` . ry H ` y�C 4. t o� 5; _#! 1. 1i,+1'1lil� �� . Ki++1+llri ��sa�� 1 l+l+r � � � 1•i � `l+• �� be- 4F a us ,i " R fC0 0. N LY t _ c0 I� )� rn OC, w t c cuca t ',\ r ca -s O z W m / �.J,.� �" W OQ j �rotectioq �� is W Z p& . T i� C c i W 0) codledaa ` CD72 a» Q W C) Q � LLI • co cl 15 Y I f(o s a� px .��♦ 0 �' J AN- v ` oLW T cn 3 A- ve.M) / ♦ram`. k �l .t ♦ 1 � J W U' � ,- .. ' ,.,.1j .' � •��. .` 1`!•1�,11 � ,i�' , =_°�1'i+�l���,��, ���;�,ilr +il,,� : u �' ilr4,�� ' � (cans i � A 5,' acoRf CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYYYY) 06/28/2021 THIZ 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(ies) 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). RODUCER CONTACT NAME: MARIE COLUCCI aDAMS STATION INSURANCE AGENCY INC LAC.No,Ext), 518-512-5247 lac,No): 518-512-5249 109 MAPLE AVENUE E-MAIL - _-_,. , _.......__._. ADDRESS: marie@adamsstatlOninsUrance.COm INSURER($)AFFORDING COVERAGE NAIC 0_ >ARATOGA SPRINGS NY 12866 INSURERA; ERIE INSURANCE 26263 ISURED INSURER 8 DOUGLAS STREETFR INC INSURERC. 309 LIVINGSTON AVE INSURERD; INSURER E MAMARONECK NY 10543 INSURER F 'OVERAGES 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. SR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EKP " POLICY NUMBER MMIDDIYYYY MM/DDIYYYY' LIMITS X COMMERCIAL GENERAL UABILITY EACH OCCURRENCE $ 1000000 E TO RE6_fE_6._..._.... c Airs-MADE X occ J DAMAG PREMISES(Ea occurren"I $ .....1000000 ,, 0467250057 10l22/2020 1012212021 M40 EhP IAry one persons 5000 " PERSONAL&ADVINJURY $ 1000000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGRFGATE y 2000000 _. X POLICY PRO- l CC PRO- JECT _...., PttOL)uCTS-C.Or,APJOPAGG $ 2000000 OTHER. % AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT LEn accidenl) > 1000000 X ANY AUTO 0107230107 10122/2020 10/22/2021 DODILY IN'JLJRY;Per r • ow $ OWNED SCHEDULED -. AUTOS ONLY _...- AUTOS - __..........._..._,_..._.. : BODILY INJURY,pis•ac�ulcnls $ ' HIRED NON-OWNED - PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY jeer accident).__ . UMBRELLA61A8 - OCCUR - EflCHIX:CURRFNCE $ EXCESS LIAB CLARAS-MADE . AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION FR OTH AND EMPLOYERS'LIABILITY Y J N 81A'l`L Est_ ANYPROPRIETUR'PAR TNLRiEXEC UTIVE O=FICERMEMBEREXCWDED? NIA E.L.LACH ACCIDENT g (Mandatory In NH) E.L,DISEASE-EA EMPLgYEE: $ It es,describe under ---.—__... ............. DESCRIPTION OF OPERATIONS Deiow F.L.DISEASE POLICY L€Id1T $ i 3 ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101,Additional Remarks Schedule,may be attached if more space is required) ERTIFICATE HOLDER CANCELLATION VILLAGE OFI-rRYE BROOK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 938 KING STREET rSET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. RYE BROOK, NY 10573 AUTHOR REPRESENTATIVE O 1988-2015 ACORD CaRPDRATION. All rights reserved. ,CORD 25(2016103) The ACORD name and logo are registered marks of ACORD N1W Workers' Certificate of Attestation of Exemption STATE Compensation from New York State Workers' Compensation and/or Board Disability and Paid Family Leave Benefits Insurance Coverage "This form cannot be used to waive the workers'compensation rights or obligations of any party.** The applicant may use this Certificate of Attestation of Exemption ONLY to show a government entity that New York State specific workers'compensation and/or disability and paid family leave benefits insurance is not required. The applicant may NOT use this form to show another business or that business's insurance carrier that such insurance is not required. Please provide this form to the government entity from which you are requesting a permit,license or contract. This Certificate will not be accepted by government officials one year after the date printed on the form. In the Application of Business Applying For: (Legal Entity Name and Address): Building Permit Douglas Streeter,Inc. 309 Livingston Ave From:Village of Rye Brook Mamaroneck,NY 10543-3524 PHONE:914-698-8080 FEIN.XXXXX6561 The location of where work will be performed is 235 Irenhyl Ave.,Rye Brook,NY 10573. Estimated dates necessary to complete work associated with the building permit are from August 9,2021 to October 29,2021. The estimated dollar amount of project is $25,001 -$50,000 Workers'Compensation Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE SPECIFIC WORKERS'COMPENSATION INSURANCE COVERAGE for the following reason: The applicant is acting as a general contractor with no employees,day laborers, leased employees,borrowed employees,part-time employees,unpaid volunteers and only has independent contractors that meet the standards of the New York Construction Industry Fair Play Act(Section 861 of the New York State Labor Law). Disability and Paid Family Leave Benefits Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE STATUTORY DISABILITY AND PAID FAMILY LEAVE BENEFITS INSURANCE COVERAGE for the following reason: The business MUST be either: 1) owned by one individual; OR 2) is a partnership(including LLC, LLP,PLLP,RLLP,or LP)under the laws of New York State and is not a corporation; OR 3) is a one or two person owned corporation,with those individuals owning all of the stock and holding all offices of the corporation(in a two person owned corporation each individual must be an officer and own at least one share of stock); OR 4) is a business with no NYS location. In addition,the business does not require disability and paid family leave benefits coverage at this time since it has not employed one or more individuals on at least 30 days in any calendar year in New York State. (Independent contractors are not considered to be employees under the Disability and Paid Family Leave Benefits Law.) I,Scott Ransom,am the Vice President with the above-named legal entity. I affirm that due to my position with the above-named business I have the knowledge,information and authority to make this Certificate of Attestation of Exemption. I hereby affirm that the statements made herein are true,that I have not made any materially false statements and I make this Certificate of Attestation of Exemption under the penalties of perjury. I further affirm that I understand that any false statement,representation or concealment will subject me to felony criminal prosecution, including jail and civil liability in accordance with the Workers'Compensation Law and all other New York State laws. By submitting this Certificate of Attestation of Exemption to the government entity listed above 1 also hereby affirm that if circumstances change so that workers'compensation insurance and/or disability and paid family leave benefits coverage is required,the above-named legal entity will immediately acquire appropriate New York State specific workers' compensation insurance and/or disability and paid family leave benefits coverage and also immediately furnish proof of that coverage on forms approved by the Chair of the Workers'Compensation Board to the government entity listed above. SIGN oe HERE Signature: Date: Exemption Certificate Number Received June 25, 2021 20.21-040124 r � « � NYS Workers' Compensation Board ti >t � b k m' � -u� at'' �*. y- .�wan.� " �ua-n� +„m sera«..a,�as�w��. '• `, `- ..�,, � CE-200 01l2018