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HomeMy WebLinkAboutBP21-204PERMIT #/Jtm� SECTION TYPE OF WORK, JOB LOCATION _ OWNER__ CONTRACTOR) EST. COST vCO# (2f 0' TCO * i Qy q DATE: ,5 �I �/co) cs- OtJ v f Ort lu s /� a a e//i /y�'�97- O3 07 4 ' , ; C' /�y✓, 1 ��'. — }�llid•� �'ezf► re/% �9/�/��03--10/ 79 INSPECTION RECORD 1 DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING 21 RGH PLUMBING GAS SPRINKLER ELECTRIC LOW -VOLT OJ ALARM AS GUILT FINAL kc-�-y � — C. �i°o �� J�1. OTHER APPROVALS ARB BOT P8 ZBA OTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO. 22-032 (Certtftcate of errupaucp This is to certify that J1Le a ,V i , of, ��( Q�, / � having duly filed an application on � — �] V if ��� 20�_requesting a Certificate of Occupancy for the premises known as, / n !t OQ ,Rye Brook,NY, located in a -7 Zoning District and shown on the most current Tax Map as Section: Block: _,a_Lot: , and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No.o?�`v7 , issued 2 20 , such authority and permission is hereby granted to the property owner to lawfully occcupy r use said premises or building or part thereof listed under the New York State Use Classification of: R-J e — / IV for the following purposes: 1a cerrr n s r It" r nbot- 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 the building be moved from one location to another until a permit to accomplish such change has been om ilding Inspector. Building Inspector,Village of Rye Brook: Date: MAR — 3 2022 V7 � �����. For office use opal : BUILD � A�tTMENT PERMrr# a Q JAN 2 5 ZO � Z2 � VILLAGE OF RYE BROOK ISSUED: R e►/ 938 KING STRE#� BYE BRooK,NEw YORK 10573 DATE: VILLAGE OF RYE i3ROOK (914)939-0668 FEE:%y/Rs, PA1D)q BUILDING DEPARTMENT M2M,nAfookorg 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 iittiti#tt#t#it4tt#t##kk###lift##VV###i###iGGi#tt4##fifitiiiif##4#�k 1` /#4tttff##k�##41+ttft#ti###+i4#tft#fftf##t4t4####t##f##f#####tt Address:�' �b�C�1 1 Y� /UC I�(JGU ,)C &,/ji< &-"y• Occupancy/Use: Parcel ID#: I�,3s, 5e3-—3— � Zone. Q Owner: (�0 rr�a 1 f!C ! I Address: �1 `-2 bi , 2&r 1164-/ �067-3 P.E./R.A. or Contractor:Pu'4'((y f c dpc•rtj{, L nSCf 3 LtLu l Address: I IJ G{fk 4,L Mornr ran rr e l"5'�3 Person in responsible charge: (A I-, ;c n/) (�rrC�[r 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 YOM COUNTY OF WESTCHESTER as: n I 1 I�kqf ray Cc,�DG rf i being duly sworn,deposes and says that he/she resides at ( �� j J i ,r ru Gd (Print Name of An cant) (No and Street) in � G 1�rcf,') ,in the County of 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:$ for the construction or alteration of: (d Gr c rY1 c fe (, 1 , f1 jUW; l .�;r. t (� 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 Sworn to before me this day of J t ,20 day of ,20 Signature of Property Own I Signature of Applicant PrInt Name of Property Owner Print Name of Applicant 'Act I-, ��& Notary blic Notary Public SHARI MELILLO Notary Public, State of New York 8/12/2021 0!ialified in Westch Ater County Commission Expires Januanr 29.20 QR O �m • 19&2• BUILDING DEPARTMENT ❑BUILDING INSPECTOR I)IRASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK DCODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 /// (914) 939-0668 FAX (914) 939-5801 www ryebrook.orS - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : DATE: ° PERMIT# _ ISSUED. SECT.I BLOCK: LOT: LOCATION: C-�. " `9 "V`1"_;�U OCCUPANCY: 2 ❑ VIOLATION NOTED THE WORK IS... / ACCEPTEIY ❑ REJECTED/ REINSPECTI©N 0 SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ .CROSS CONNECTION f INAL OTHER w � 1' 1932 • �© BUILDING DEPARTMENT UILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK t' ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 ww w.ryebrook.ors; - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - \ (�ADDRESS :— � � � I� �L� � v l DATE: 2� 1 102 ISSUED:� �� - S�CT: � ~BLOCK: `—LOT:PERMIT# ` , LOCATION: i`— `�^ �' � w' 4�C ` '�"'� OC UPANCY: cti sO ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED / ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION -� ❑ NATURAL GAS }, 1 � L.P. GAS �\ ❑ FUEL TANK FIRE SPRINKLER �� < OC ' Cu ❑ FINAL PLUMBING 1 ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER BUILDING DEPARTMENT ❑BU LDING INSPECTOR SSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK j ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.nLebrook.org - - - - - - - - - - - - - - - - - -- - INSPECTION REPORT - - - - - - -- - - -- - - - - - - - - ADDRESS :_ j L2— DATE: � PERMIT# ISSUED: SECT. BLOCK: LOT: LOCATION: tk'LJ2' t� �1 l� v p C��I c� �(� s.,� OCCUPANCY: 2—� V ❑ VIOLATION NOTED THE WORK IS... ._ ACCEPTED ❑ REjECTEDJ REINSPECTION ❑ SITE INSPECTION REQUIRED Cl FOOTING ❑ FOOTING DRAINAGE Cl FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING "INSULATION xtl NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING [] CROSS CONNECTION ❑ FINAL ❑ -OTHER QyE BRC>v�• O� 2� w � • �9�2 BUILDING DEPARTMENT ❑BUILDING INSPECTOR 10 ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK [I CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - -- - ADDRESS : 1 I �-�lJ C�l� �-'� / DATE: PERMIT#Y� 5 ISSUED: 1-�ECT: BLOCK: LOT: LOCATION: _S L� (o p�(011 OCCUPANCY: V. ') ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION J REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION UNDERGROUND PLUMBING NOTES ON INSPECTION: LOUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER aE�E DR(��2 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR [�YASSISTANT 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.orr - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - --- - - - - - - - - - - - - - - - - - ADDRESS : PERMIT# l� %� , _ ISSUED: SECT: BLOCK: LOT: LOCATION: ` NQ N 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 ❑ INSULATION ❑ NATURAL GAS 3t 7 �C �(, cs, u C"e Q5 ❑ L.P. GASH C v ❑ FUEL TANK - ❑ FIRE SPRINKLER ❑ FINAL PLUMBING 1 `_ ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER ` \'Vi r 0 L cy C 14 p C, oG k Ln pir > 16 T3 ' r• Z ae U y Liz Otn PLO Z • W �" ° '' > w A � < a PLO CO co 00 O j Z Z O w �•' w o z z rT`� i�M'b Z O ►--I .1 U n M� 00 W i' Z 04 Q w CIO va N .. Gz7 z u wo 3 jQ � oFs z a rA ° ° d G w Z U A ° � VIE • BUIieorl ENT ID VIOK OCT — 1 2021 938 KINNY 10573 VILLAGE OE RYE BROOK BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY #; ��Lf EP Approval Date: r � Permit pp rt e Fee: S ,30o Approval Signature: Other: Disapproved: 9 QBc) (fees are non-refundable) Application dated, bj 302 is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/ r 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. ll ll QQ 1.Address: / W I>1 �Sa� Qpr�sG) SBL: 36 c) -3-qJ Zone:te— 7 2.Property Owner: 2_0 b er" Address: Phone#: Cell#: C? 0,317 email: (SGa `n oo. t'Ot'j 3.Master Electrician: 1 �9 D%Vt4,o �z\ec-krt,c Address: W Lie. #: ?ib?— Phone#: e_1q 0f?6Cell#: 7 email: Company Name: �\�� (DiVALce VAe�t� aKC Address: Z?C 4.Proposed Electrical Work/Fixture Count: ppt STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,being duly swom,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant) state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn to before a this day of ,20 day of ,2 Signature of Property Owner Signa re pplic Print Name of Property Owner n Name of Applic Notary Public Notarf' i Sl to of New York r No. 01 PAE6160063 Qualified in Westchester County Commission Exoires JanuPN 2.9 20 sn 2/202 t Ilk- `.. Westchester Rockland Electrical Inspection Services, Inc. Phone: 914-34 -3595 DO NOT WRITE HERE-FOR OFFICE USE ONLY L�r Fax: 914-347-3596 43 North Lawn Avenue Elmsford, NY 10523 BUILDING PERMR NO. TEMP R DATE / I CITY PR VILLAGE ZIP CODE TOWNSHIP COUNTY STREET AND NO.OR POLE NUMBER BETWEEN WH.fT f iC OSS STR ETS IS PREMISES LOCATED? SECTION BLOCK LOT OCCUPANTS NAME BUILDING OCCUPANCY OWNER'S NAME AND ADDRESS / �� r HOME TELEPHONE NUMBER CURRENT SUPPLIED BY FROM EIR i 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, kf£A _ v INSPECTION I OUTSIDE BASEMENT 1p1 FL 2'aFL F R E BR0 K 3p0FL BUILDI G DE AR .- REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: THIS APPLICATION IS INTENDED TO COVER THE ABOVE LISTED ITEMS TO BE INSPECTED.IF AT ANY TIME OF INSPECTION ADDITIONAL ITEMS HAVE BEEN INSTALLED,YOU ARE AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE FOR THE ADDITIONAL ITEMS INSPECTED AS PROVIDED BY THE APPLICANT.THE APPLICANT DECLARES THAT THERE IS NO OPEN APPLICATIONS FOR THE ABOVE WITH ANY OTHER INSPECTION COMPANY WREIS,INC,IS NOT LISTING,LABELING,UNDERWRITING OR CERTIFYING ANY EQUIPMENT, MATERIALS OR DEVICES WHICH ARE PERFORMED BY OTHER CERTIFIED TESTING AGENCIES OR INSPECTION COMPANIES,THE APPLICANT,OWNER,OR AUTHORIZED AGENT AGREES TO ALL THE ABOVE TERMS AND CONDITIONS AS SET FORTH FOR THE APPLICATION. SIZE OF SERVICE FEEDERS CHARACTER OF WORK NEW LI ADDITIONAL❑ EXPOSFD D CONCEALED❑ MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD C- UNDERGROUND L7 LLI I I I I AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. NAME OF CQMPANY BATE OF/APPLICATION SIGNATURE OF APPLICANT x I J - STREET ADDRESS TELEPHONE NP. <- fllJ� Cl/ UE CITY OR POST OFFICE ZIP CODE LICENSE NO.WHEN APPLICABLE y r 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) 1 914-347-3595 (Fax) CERTIFIES THAT Upon the application of: Upon premises owned by: Alfred DiFalco Electric Roberto&Alesandra Capparelli 276 Madison Rd. NY, Scarsdale 10583 Located at:71 1/2 Windsor Rd Rye Brook, NY 10573 Certificate Number: 1032859 Section: 135.52 Block: 3 Lot:41 BDC: Permit Number: EP:21-250-BP:21-204 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: 71 112 Windsor Rd Rye Brook,NY 10573 Basement 1st Floor 2nd Floor 3rd Floor Garage Attic ❑Outside Other: Inspection was conducted in accordance with the NYS and NFPA 70-2017 International Electrical Code and detail of the installation,as set forth below,was found to be in compliance therewith on 01125122 Name Type Quantity Range Hood ------- 1 Cook Top ------- 1 Receptacle GFCI ------- 9 Switch Single Pole ------- 27 Dishwasher ------ 1 Fixture-Luminaire Incandescent ------- 9 Panel ------- 1 Service up to 200 Amps ------- 1 Receptacle;Outdoor GFI ------- 3 Receptacle Convenience ------- 36 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. f�--7�J/4 This certificate may not be altered in any way. ILThis certificate is valid for work performed before date of inspection only. YYY O �O � OCO 04 � � O o� Un n U 6TJ C6 I••I o� oG NED tn rn Z O Q WJ W rj 4. .. 96w CA y Q a co o 000 u 0. ',team* u F o a Con pGFE 4t N r7 C6 v t' 2 96 a o w BUILD]NGDEPARTMENT R [E 'BD VILLAGE OF RYE B' k0OK OCT 14 2021 938 KINUREET RYE BROOK,NY 10573 (914) 939-0669 VILLAGE OF RYE BROOK wwwAVikook.org BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP #: C�;>/`ao ( F'P #: OCT 1 8 ,2021 Approval Date: Permit Fee: $ � lob Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, a_�// 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. y 1.Address: /! �� VVIAWPi-/�,'/. r 11�� 11 .� SBL: 1 .i• .�c�— 7l Zone: 2.Property Owner: eman any,%, ou-1 Address: JA ME Phone#: I l� - a 3a7, cell#: email: 3.Master Eleis n: �fC*j %�lMI/! Address: W1610X 1JT,1f u'1 ��7f0/04. r /UW/ Loa91 Phone{�#:fV�kW '741 7Y- Cell#:q 1 YO�'f1 V email: f1 q D */CZi�r71 S{,1Gtl e%7���- Company Name:�ffvr � l/�`�f // ,�, Address: /,D• Jn l T� � whil tir fD5qJ h 4.Proposed Electrical Work/Fixture Count: kyl VDkrM6 .J'9.Lugj2 V Py - e0fM A&I ,chi-WOY4E >D�°D/ Cf1oN *********9;#;F�:�Y�:*k9:*�c�:****kk*******k********;kA•k*k*kk*•k*k**k7l k•k*kk•k.YoF*******************�F*at**k***k*:k k*k**** STATE NEW YORK,COUNTY OF WESTCHESTER ) as: (r/�D//Jl/ //K-1 lei 'bj ,being duly sworn,deposes and states that he/she is the applicant above named,and does further (print nanie 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 �e— Nf7,4, .Ta7 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 before rVe this 1414, day of 20 day of Ct _ ,20 'k r Signature of Property Owner Sin re of Ap cant Print Name of Property Owner Print Name of Appli ant Notary Public �Nota �ND �HMARSMLI.. Notary Public,State of New York No.01FR6363711 qualified In Westchester County Commission Expires August 28,20 ` 8/12/2021 � 1< Phone: 914-347-3595 Westchester Rockland Electrical Inspection Services, Inc. '. DO NOT WRITE'�iERE-FOR OFFICE USE ONLY 43 North Lawn Avenue ` `� Fax: 914-347-3596 Elmsford, NY 10523 � r til BUILDING PERMIT NO. TEMP it DATE ��] CRYOR',ftU.AGE I� ZIP CODE TOWNSHIP COUNTY /� SOU STREET.A�Cl N9.PR POLE NUMBER 1 �. t.�1/1r S0r �O _ BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT OCCUPANT'S NAME BUILDING OCCUPANCY be r,10 r I 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 INCAUE FLUORE NO. H.P,EACH NO. WATTS EACH INSPECTION OUTSIDE I BASEMENT 1 11'FL. 3'^FL. F-1EPARTUDIT REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: Fk rc �,n�l C: iirlU�n Y?or1oklcf< �r�lec T� o►y 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[1 ADDITIONAL[] EXPOSED❑ CONCEALED fj MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD I] UNDERGROUND J 17 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 rf� S e X STREET ADDRESS TELEPHONE NO. \o�,I H � �o CITY OR POST OFFICE C�I''n r ,f.CID� LICENSE NO.WHEN APPLICABLE I'C (J(r(f,�. IF Ift 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: AM SECURITY SYSTEMS, INC Roberto &Alesandra Caparelli P.O. Box 8587 NY,Tarrytown 10591 Located at:71 112 Windsor Rd Rye Brook, NY 10573 Certificate Number: 1032668 Section: 135.52 Block:3 'Lot:41 BDC: Permit Number:EP:21-260-BP:21-204 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 inlon the premises at: 71 1/2 Windsor Rd Rye Brook,NY 10573 ©Basement 17 1st Floor V 2nd Floor 3rd Floor « Garage Attic Outside Other: Inspection was conducted in accordance with the NYS and NFPA 70-2017 International Electrical Code and detail of the installation,as set forth below,was found to be in compliance therewith on 01/14/22 Name Type Quantity Smoke Detector ------- 3 Smoke Detector/Co2 Combo ------ 3 Heat Detector ------- 2 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. '��G �' This certificate may not be altered in any way. /A��'' ' This certificate is valid for work performed before date of inspection only. N � C4 N N C x of 3 CA b F = Q N r'ery ° y y ti w o p a � c w C� a CA 20 rA LQ � o � w E� Z W z 0-4 L� A � ! s � M � Q �. as p4 U a. a1 1 Q a V o �z F CQ N °� I vi o ` � � g o fin, OW m a a S wW ° F I �Q e ■ s _ Y BUILDING DEPARTMENT VILL AAGE OF RYE BROOK AUG 2 0 2021 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK wow jyebrook_org BUILDING DEPARTMENT PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY lip#: -ova 7� IT#: Approval Date: / Permit Fee: $ Approval Signature: AM Other: Disapproved: (fees are nun-refundable) Application dated, C)0 C is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/ r rem ve 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: 2 1 ,( - W i-S 4-0 r , t e�-- SBL: r ����--3 Zone:k -,+ — / 2.Proposed Work: __ ��4? La C F-I Y,- i tz o -S 3.Property Owner: .' a Cc.0 ode 1('A'ddress: Phone#: Cell#: 9/�� / /�-0317 email: 4.Master Plumber: `{' 7 GcSGdC Address: Lie.#: Phone#:_ �( S— ell#: email: Company Name• f i1�- Address: � �tr�_ � 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 1 st Floor 2nd Floor 3"d Floor 4`1 Floor 54h Floor Exterior 5.* List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -I- 8/12/2021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: tzio �--a 6 j c(—' — ,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 ether applicable laws,ordinances and regulations. Swum to before me this \ Sworn to before me this day of - k 20 day of ' 20 ignature of Property Owner Signature pplicant Print Name of Property OA& Print Name of Applicant %19-A""t- l Nota Stale of New TOM rNoulifRub iPublic,State of New York NO l� ic, `�'� N o.01 M E6160063 No.01 ME6160063 Qualified in Westchester County Qualified In Westchester County. Commission Exnires Januprf 29 20 Commission Exolres Januery 29 2(1 This application trust 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- 8/12/2021 BUILDING DEPARTMENT D D VILLAGE OF RYE BROOK R AUG 2 0 2021 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK w��w.ryebrool:.ti>r BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 - STORM SEWERS AND SANITARY SEWERS `'HIS 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(J ��OF NEW YYORK, COUNTY OF WESTCHESTER ) as: �f 3, UI_r- O L,G W 64-c f l,' , residing at, 1 ) , �R( ,0 r Ld Print nalyle 1 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; :71 11,2 1-4—) ncrgcxr-d , Rye Brook,NY. 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. i r Sworn to before me this ay of , 20 4\ SHARI MEULLO Notary Public,State of NewYork No. 01 ME6160063 _3_ Ouali ied in Westchester County Commission Exoires Jmusnf P9 2 8/12i2021 Building Permit Check List&Zoning An4sis Address:� l ,/Z lA I J�S lz)rL_ —rz7� sBL: Zone:'-a-7 Use: Cont.Type n JL� LtT W Submittal Date: 7 Revision Submittal Dates: �' 3 Z k ` Applicant c-LFL L-L t Nature of Work:�z L G F W Nb �'�S 'Z S i Reviews:ZBA P& BOT: Other. TLOK_ x � ( ) FEES:Filing.�;a BP: ( C/O: Legaliza ( ) (&KAPP: 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: Sitf Protection: S/W Mgmt: Tree Plan: Other: ( ) (. SURVEY:Dated Z( Current: ✓ Archival• Sealed ✓ Unacceptable: ( (,APLANS:Date tamped: Sealed -/Copies: ectronic- Other. ( ( ) License Workers Comp: ty Comp.Waiver. Other. O O CODE 753#: Dated N/A:. (• ( ) HUGH-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.: Plan: Permit N/A Other. ( ) { ) FUEL TANK:Plans: Permit: Fuel Type: Other. O { ) 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other: ( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other: ( ) ( ) Other: ( )ARB mtg.date: approval notes: ( )ZBA mtg. date: approval notes: ( )PB mtg.date: approval:- notes: REQUIRED EX=NG PROPOSED NOTES APPKOVLU AUG - 4 2021 Circle: Fie Fmnc Front: Sides: ram: Main Cov &HISh: Sd.H/Sb: CIE Imo imp Ft.imp HHckk roles notes: BUILD /�G DEPARTMENT[A-M AUG - 3 2021 VILL�YUE OF RYE�R,OOK 938 KING STREET RYE BRoa1,NY 10 � K (914)939-0668 FAX(914)'939-5801 BUILDING DEPARTMENT ook or ARCHITECTURAL REVIEW BOARD CHECK LIST FOR APPLICANTS This form must be completed and signed by the applicant of record and a copy shall be submitted to the Building Department prior to attending the ARB meeting. Applicants failing to submit a copy of this check list will be removed from the ARB agenda. Job Address: Date of Submission: Parcel ID#: Zone: Proposed Improvement(Describe in detail): APPLICANT CHECK LIST: MUST BE COMPLETED BY THE APPLICANT The following items must be submitted to the Building wo tz �.�,L�( Department by the applicant-no exceptions. djovv 1l i I r ,h 1. ( )Completed Application 2. ( )Two(2)sets of sealed plans. (one full size{maximum Property Owner: allowable plan size=36"x 42"}and one I 1"xl7") Address: 3. ( )Two(2)copies of the property survey. 4. ( )Two(2)copies of the proposed site plan. Phone# 5. ( )One electronic/disc copy of the complete Applicant appearing before the Board: application materials.6. ( )Filing Fee. 7. { )Any supporting documentation. 8. ( )HOA approval letter. 0fapplicable) Address: 9. ( )Photographs. Phone# 10.( )Samples of finishes/color chart. (a sample board or Architect/Engineer: model may bepresented 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 , 20 day of , 20 Signature of Property Owner Signature of Applicant Print Name of Property Owner Print Name of Applicant Notary Public Notary Public III Y2l/19 BUILDING DEPARTMENT D E C ENE VILI.A0E OF RYE BROOK DD JUL 2 ] 202� 938 KING� ET RYE BROOX,NY 10573 (914)9 39-5801 VILLAGE OF RYE BROOK BUILDING DEPARTMENT ARCHITECTURAL REVIEW BOARD CHECK LIST FOR APPLICANTS This form must be completed and signed by the applicant of record and a copy shall be submitted to the Building Department prior to attending the ARB meeting. Applicants failing to submit a copy of this check list will be removed from the ARB agenda. Job Address: 2� Z1 iIs Qp Date of Submission: Parcel ID#: c�J , Z 3 I Zone: Proposed Improvement(Describe in detail)�qe APPLICANT CHECK LIST: ,N yt �l0 pP L � MUST BE COMPLETED BY THE APPLICANT The following items must be submitted to the Building 'JAC (� ('} ©� Dep t by the applicant-no exceptions. Woz)0✓0i M 1. ( "mpleted Application 2. ( _or (2)sets of sealed plans. (one full size(maximum Property Ow�neer� r—Pn CA� feAPE L t-1 allowable plan size=36"x 42") and one 11"x17") Address: ( l+y lam+1 tit` ' l� C�J, r4 /1�,� `� (2)copies of the property survey. 4. ( T1 0(2)copies of the proposed site plan. Phone#_ I �( � —b` j 5. (l�'One electronic/disc copy of the complete p Applicant plication materials. appearing the Board: 6. Oiling Fee. 7, ( )Any supporting documentation. oVq F(�c tom, kll-r— 8. Address: C' ( } A approval letter. (jappiicable) �/�9. ((�' otographs. Phone# (4- - 0 10.( )Samples of finishes/color chart.(a sample board or Architect/Engineer:� model may be presented the night of the meeting) r _ � ��- ��, Phone# ! �r�� By signature below, the ownerlapplicant 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 Q 5 Sworn to before me this day of 20 day of , 20 Sighature of Property Owner Sightuir of ' licant erne of Property Owner P�nnt Name of Applicant Notary Public Notary-ftblic III SHARI MELILLO SHARI MELILLO Notary Public, State of New York Notary public,State of New York No. 01 ME6160063 No.01 ME6160063 Ouafified in Westchester County Ot ialified jr,Westchester County 3/21119 Commission Exnfras Jani mr-Pa ?n 7i.� Commission Expires Janua^'?.9 2027 �\\�`�ffnf 1I17^����k , D E C IE � 4..I u 3472 shut 1 AUG - 2 2021 VILLAGE OF RYE BROOK BUILDING DEPARTMENT MAP OF r - - TAMARACK GARDENS �! IN THE TOWN OF RYE, N. Y. y � 1 1HE PROPERTY OF 1 _ TAMAIZAcy- GARDENS ,ter`•�— � � � � � �' w N •+ ar w ..N .. .. �ii�il� / / ■ N u r w If rr �• r � n � ROAD �■ N ■ ■ ■ • ■ S/ n # MA / ■INY.N � / / M Y - Y. �y Np`/P/ / YN 4 ♦r� n x 1' r •r' N • r ' ' 5yLVAN n r t r `'n ♦ ' era w^/n w^ " �r■r .. r .Ir it M■• ROAD lk ■ .�/1 NOSOR I!' " n ,�s / o a s r u r e ,• r s r r s �r r ■ R r Q t _.®c—. _ter/■. C it .+ r • o . +.�r / t ■.. 7,Af.4ARAGK ROAD @ry ~ �' ■ � IK" r � 1"" •"� F i n • TERRACE k1ALLEY , r s , r ■ � r N M w x � "r N / w ■ ■ �— �■ � � M f A a Y � r T�(� Y 1 ~ - R_ 06'r r• THE JUDICIAL TITLE INSURANCE AGENCY LLC Title Number: 121185FA-W SCHEDULEA ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon erected, situate, lying and being in the Village of Port Chester, Town of Rye, County of Westchester and State of New York, known and designated as Lot Nos. 114 and 115 in Block J, on a certain map entitled, "Map of Tamarack Gardens in the Town of Rye,N.Y.,the property of Tamarack Gardens, Inc.", dated July 1929 made by J.A. Kirby & Co. and filed in the County Clerk's Office of Westchester County, Division of Land Records,on July 27, 1929 as Map No. 3472. BEGINNING at a point on the easterly side of Windsor Road, where the same is intersected by the dividing line between Lot Nos. 113 and 114 in Block J on said map; RUNNING THENCE northerly along the said easterly side of Windsor Road,on a curve to the left having a radius of 1,279.37 feet, a distance of 50.00 feet,to the southerly side of Lot No. 116 in said Block J; THENCE along the southerly side of said Lot No. 116, south 85 degrees 23 minutes 52 seconds east, a distance of 109.04 feet to the westerly side of Lot No.26 in said Block J; THENCE along the westerly side of Lot Nos. 26, 27 and 28 in said Block J, south 54 minutes west, a distance of 60.00 feet to the northerly side of Lot No. 113 in said Block J; THENCE along the northerly side of said Lot No. 113, north 80 degrees 28 minutes 30 seconds west, a distance of 116.96 feet,to the aforesaid easterly side of Windsor Road,at the point or place of BEGINNING. The policy to be Issued under this report will Insure the title to such buildings FOR and Improvements erected on the premises which by law constitute real CONVEYANCING property. ONLY TOGETHER with all the right, title and interest of the party In the first part, or, In and to the land lying In the street In front of and adjoining said premises. 0 W M — 0 } 0 �. 00 C%jw 00 > QD w W, 0 o CD > CL C CD 0Lr)'" LLJ 0 to _J w. 0 0 `, Q �D NORTH W � � 0 L m w0 mNow. Z z C D Of C3 IV) U LL- 0Of — O Li Z cn CV Z O ,r Z >z d z II LLJ a- w , 0 Lo Ln 0 -J W w Z _ 00 N L1- Lo w J LU LJ � . � D C"� CD � ,� C) (D . ^ C) L�J .- ' z U Lr) � ■ r+` ' `-' �' 0 �C/I (Y) L 0 Lr) c .— � --� J �ILL. u �' r .�F- < Z V)-jC)� m 0 C.3 LsJ err z LLJ LL. Lu Ld z t Ld CK 13L LL C/) . 0 0 C\l w Z) � � . 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''`:,rrl�itii _ j:ylililr .: fib� s�€��.:��I�lii�_s.���. �t;'FtVP;/y}Ij�i ''�� �; .. �t}li111%l�n�i�g r�� :��r}}}+1i1liF_�.'�i���•� :�11i}i}iilf '�,a M1 ••3s; '`, '�>a. ., �� �.-{1rM}}i��$ } !}}}}4}}1!!j g�,3�-'a. },1��4f .....,=aa 'Y) 1}i{ .3- 'fl ►If/ �.sfi !! �1!'{ � e;'1��}I'�-:.r,2_n itaicaf)s..�� .c'_�s../x�: i�.3.aa..... �s,.. .?��1� �?•: :° m�i..._-��.�.a� a+..-r,..,_' t ;�i(�} � O G •� p y��is�r?>�` •r.a1 �t C3 ` rA \ LO n e/3 . a ction a is .r (n Z ^t,C, to ✓G erg .. .! 4—J s vt i s � rn t3 7 a rx �• . r 4" � e Lq a- edaCl < Z Q +, 03 } q ' Q }.yam ��;��.• p� `. v° T 1 'ar 1 Co 1 cj ZI •�. �'' of+ � � t zx 1 fq(Cs�IA -*-rrW"r- na t ,wca ,;lFliltrr� se{!1}�!}sz'.,'''°"`ta*�.'7�!!!+M}�.'-.f; p nr!}}}lh.W �44 i� w1� �. ua�6 '. ;'r ,► { ' .,tA7'�tae,.. w 7 v + oz DATE(MMIDD/YYYY) ACC?R" CERTIFICATE OF LIABILITY INSURANCE 07/26/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. If the certificate holder is an ADDITIONAL INSURED,the policy(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►. PRODUCER CONTACT Marcie Squillante NAME: Borrelli Partners Insurance Agency Ac r o E t, (914}939-7900 Arc No): (914)407-5088 287 Bowman Avenue E-MAIL msquillante@borrellipartners.com ADDRESS: Suite 406 INSURER(S)AFFORDING COVERAGE NAIC N Purchase NY 10577 INSURER A: Ohio Security Insurance Co 24082 INSURED INSURER B: NGM Insurance Company 14788 Pantaleo Capparelli Landscape&Cement Work INSURER C: Ohio Casualty Insurance Co 24074 621 N Barry Ave INSURER D INSURER E: MaMAroneck NY 10543 INSURER F: COVERAGES CERTIFICATE NUMBER: Certs 20-21 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 CONTRACTOR 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. ILSR TYPE OF INSURANCEAIJULIbUISH POLICY EFF POLI Y EX IN SD WVD POLICY NUMBER MMIDDNYYY MMOOIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 30D,000 MED EXP(Any one person) $ 15.000 A Y BKS59055162 09124/2020 09/24/2021 PERSONAL aADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: LGENERAL AGGREGATE $ 2,000,000 X POLICY JET LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1.000,000 Ea accident ANYAUTO BODILY INJURY(Per person) $ B OWNED X SCHEDULED B2U3830V C9/24/2020 09/2412021 BODILY INJURY(Per accident) $ AUTOSONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY Per acc dent $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 C EXCESS LIAB CLAIMS-MADE US059055162 09124/2020 09/24/2021 AGGREGATE $ 5.000,000 DIEDXD RETENTION$ 101000 v $ WORKERS COMPENSATION X STATUTE /% EORH AND EMPLOYERS'LIABILITY YIN 1,000,000 ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ C OFFICER/MEMaER EXCLUDED? Y NIA XVVp59055162 09/2412020 09124l2021 (Mandatory in NH) E L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E-L-DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) Certificate holder is listed as additional insured as per written permit,Contract or agreement. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD NEW Workers' • sOR Compensation CERTIFICATE OF Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE la.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured Pantaleo Capparelli Landscape & Cement Work 914-698-9286 621 N Barry Avenue 1 c.NYS Unemployment Insurance Employer Registration Number of Mamaroneck, NY 10543 Insured Work Location of Insured(Only required if coverage is specifically limited to 1 d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 13-2849328 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Ohio Casualty Insurance Co. Village of Rye Brook 3b.Policy Number of Entity Listed in Box"Ila" 938 King Street Rye Brook, NY 10573 XWW59055162 3c.Policy effective period 9/24/2020 to 9/24/2021 3d.The Proprietor.Partners or Executive Officers are included.(Only check box it all partners/officers included) ® all excluded or certain partnerstofficers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"'I a"for workers' compensation under the New York State Workers'Compensation Law. (To use this form, New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". Will the carrier notify the certificate holder within 10 days of a policy being cancelled for non-payment of premium or within 30 days if cancelled for any other reason or if the insured is otherwise eliminated from the coverage indicated on this certificate prior to the end of the policy effective period? YES KNO This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form, if the business continues to be named on a permit,license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,I certify that 1 am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Marcie Squillante (Print name of authorized representative or licensed agent of insurance carrier) Approved by: 704s,4c 7/26/2021 (Date) Title: Senior Account Manager Telephone Number of authorized representative or licensed agent of insurance carrier: 914-939-7900 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-15) www.wcb.ny.gov CAPPARELLI RESIDENCE - RENOVATION PRW E psz y�L DATE ARP 4 SHEET LIST TABLED SHEET NUMBER SHEET TITLE 7 -S__{`Ati' paw. Ap01 COTE SHEET A002 GEV-RAL NCTES� �mGL� � Vt�VA4F N1 D1 ROPOS=D LQC�PLAN) �F Z`-fF L�CT-oDFt DLPL�J rX15'iNG N00 F NCE 60.00' EXISTING r L PRC �� EnTER1CRELEVATDONJ 100 'k EXSTINJ L PLANE FILE COPY F'1 -X2C� EXISTING ELEVATIONS'I I `t S� LOCATION: 71 1,2 AINDSOR RD,R'.E RROGK,NY 10573 ZONING TABLE ,. 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