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HomeMy WebLinkAboutBP21-212PERMIT # 0 /e � c; DATE;�ma�� �(p' :• SECTION/ �J . a 7 BLOCK LOT. 3 TYPE OF WORK ��//fit rl OVa 4wr O � JOB LOCATION S D/o! ©✓ AO rd Q CONTRALTO EST. COST ✓cO �.�w,c m 0 :fir *a ,rat � �37 9i$0 (q/4q)7�0-<D&89 TCO # FEE DATE �^�SPECTI�CORD i DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS SPRINKLER ELECTRIC LOW -VOLT Q ALARM �-{� AS BUILT cl FINAL OTHER APPROVALS (OTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK No: 22-141 Certificate of Occupancy This is to certify that y/C�y' R-1�-exfio . Ann-mar/e /a-/-Zfno of, f 5 me, / V 7 having duly filed an application on Vc o2720 c24-�)- requesting a Certificate of Occupancy for the premises known as, 1 115 O I� C)YC_M rCJ Ric,d , Rye Brook,NY, located in a Pl- Zoning District and shown on the most current Tax Map as Section: 5. p� / Block: Lot: and having fully /complied rwith the requirements of the Building Code and the Zoning Ordinance under Building Permit No.�/-c> , issued C� L2 20 c--<7/, 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 following New York State Classifications, Use: _ �� / Construction: '13 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 hei ht s all be made nor shall the building be moved from one location to another until a permit to accomplish such change has e e ilding Inspector. Building Inspector,Village of Rye Brook: - Date: R 3D �� For office us onl BUILDING DEPARTMENT PERMIT# SEP 2 7 2022 VILLAGE OF RYE BROOK ISSUED: 938 KING STREET,RYE BROOK,NEW YORK 10573 DATE: �o�7—cam VILLAGE OF RYE BROOK (914)939-0668 FEE: A( Q3,j— PAID7� BUILDING DEPARTMENT ,r wwwvgbrookor>? 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 a r+►•►►►+■p►►►►•+►►►►►►r►r+•rr rr r r+►•+r r■•r+•r e•r►►►r►•r r►►►nn►►►►►►►►►►►►►►►►►►►►►+►►+►►►►+►►►►►►►r+►pr r r+r►rr rrrrrr rr r■ Address: '� d1 ek Cctkjc� Rd. -�u A,— F3 E! trj C, N y I 10S l Occupancy/Use: l�//6���d1'1 Parcel ID#: ' 3 �C)c e F-Am,� 5/►3S,-L-7-1 3 Zone: Owner: \tCSC { Address: A n Cz-1Z Rti AGM& P.E./R.A. or Contractor: "tiy,(On ddress: Person in responsible charge: Address: Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW 1YORK,COUNTY OF WESTCHESTER as: being duly swom,deposes and says that he/she resides at 1,S (Print Name of Applicant) ,`1 (No.and Street) in � k.y E 6 C-Oc in the County of \`1��SVt=6 S >+� in the State of ,v y 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:$ -1 S t C)t`—_'0 for the construction or alteration of -1 CAXI Cal 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 S ep�P�.�r ,20:�L_a day of , 20 Signature of Property Owner Signature of Applicant I-4YWAAOL Name of Property OOwner� Print Name of Applicant Notary Public Notary Public SHARI MELILLO Notary Public,State of New York 8/12/2021 No.OIME6160063 Qualified In Westchester County Commission Expires January 29,202--?> �E BRC�k• cu � 1982 BUILDING DEPARTMENT ❑�UILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ( -) *'-D \ o I LO luv- ADDRESS : DATE. PERMIT# 1 � '✓ ISSUED'.' 1Z, SECT: , 7�. BLOCK: 1 LOT: _ LOCATION: \C\ —r � v OCCUPANCY: ---L ❑ VIOLATION NOTED THE WORK IS... 0 ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL ❑ OTHER O Zm BUILDING DEPARTMENT ❑BUILDING INSPECTOR "ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK l❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - -- - - - ---- - --- - -<�ADDRESS :- ' 0\ DATE: �� 1 PERMIT# ISSUED: rl-SECT: BLOCK: LOT: 2 U LOCATION: \-�S �(, U 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 �E 4RO, • �9�2 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK �/ ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 f (914) 939-0668 FAX (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - -- - - - - - - - - - - - - - -- ADDRESS : o O� \ Ul DAT E: PERMIT# y '� ISSUED: 4 SECT: BLOCK: LOT: LOCATION: S � k'1(A A --�Y�,�l(� OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE 7(O ❑ 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 s r. a i' to 00eq a N N it x F M x s G C� w 00 � rT� r N v C 6yi H i' � U a ✓: 'r l Mrz Ln i L 1�1 ,�rT7 � O d �1 u 00 W � 94 W E y 00 o Vr W o 'Z ,� O x � vz z � z I ' W � L A d V R. < r" w a ►.� i� x N z Z 0f W U Q �i U t, U 4 /W O z F O O OF �'•+ Lt7 i A W C7 a O Z t O ►fir a .a W � ., g W O V W z a. z a A z ° o � A w a A a, a i �I as a a 0 a w z < ��w4 4% �rtwU'i 44;t4;t 4;4;4; 44;4at yE [lRCv F BUIL MENTUG 10 20VM E OF RYE OK 22938 KIN fire RxE ,NY 10573E OF RYE BROOK G DEPARTMENT w . .or ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: EP#: Approval Date: AUG Permit Fee: $ Approval Signature: Other: %Bu Application dated, P /d o2O.Q is hereby made to g Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install an or remove 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. 1.Address: /5 OG) 0gagt412D ROAD, RO WOX NV /057-3 SBL: /35,,)7—l—3 Zone: �5 2.PropertyOwner: OcmR hA/ a JE PATOw6b Address: /S Lip Q&2WpQ RnRD Phone#: Q/Lf- ?(x-0eRq Cell#: email: 3.Master ElectricianAxox V b Am)CD Address: 62/3 RHl LRbA L) 91) &OF-00`9 NY ipsu Lic.#:E' Phone#:q/U aUI (�QQ� Cell#: qly•UO3• _7_ y email: D✓�D�l)IF}/?IICOE(�(T'�21C, �j/}� Company Name: 17,A006 Fl-Eewle Address:p7 1 mg I R3 6EDFOR p jjj Y/ L� L� 4.Proposed Electrical Work/Fixture Count: K/-/0htp AiwoVaba) CQU pa" � iOJ'I C' / 5.31 Party Electrical Inspection Agency: JTm�' /, ID . 1NShTnON wyalf-S //,Jc. (SW IS) STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of indixidual 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 me this day of ,20 day,4 , Signature of Property Owner LI re of Applicant e1�_ _OC2 Print Name of Property Owner t Name of Appli nt Notary Public Notary Public SHARI MELILLO Notary Public,State of New York No.OIME6160063 Qualified In Westchester County 6/23/2022 Commission Expires January 29.20 STATEWIDE INSPECTION SERVICES, INC. Service With baeL:ri1.v 1:1 Main Street,Fishkill, NY 12524 1 emoil:• • SWIS JOBAPPLICATION tel845.202.7224 • • 1• • • • Office Use Elect.Permit# j� _ / �S Date S /O/'�) 11-4 Bldg Permit# ^� � t �^ � � Utility ID# Final Certificate r#L�J d)� City/Village Zip Townships County , �� C Address Cross Street Section Block Lot Owner Name/Address(If different than above) `_ j"J Contact Number (j / —76 C 03,99 ❑Basement 1st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside I__I 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 I 3P #Meters #Disconnect ❑Underground ❑New ❑Reconnect 113 Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information ' t IEC EE w[E DD AUG 10 2022 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by Wis.This application is intended to cover the above listed items to be Inspected,if at any time of Inspection additional items have been imtalksd,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other Inspection company.The soknt,owner or audwized agent agrees to all the above temp and conditions as set forth for the application. Inspector Date Finalized Inspector# Company Name L Date Flo J I Zv L� Signature Address ? 1t I City/State (rij Zip Code — ') License# Phone# DAnfico .,, ,�J= E IC 014-241-6900 213 Railroad Ave. AUG 10 2022 Bedford Hills, NY 10507 VILLAGE OF RYE BROOK BUILDING DEPARTMENT ATTN: Mike Izzo Village of Rye Brook BUILDING DEPARTMENT 938 King Street Rye Brook, NY 10573 RE: BP21-212 (15 Old Orchard Road Rye Brook, NY 10573— Paterno) August 101h, 2022 Dear Mike Izzo and the Building Department, I, Anthony D'Amico the owner and president of D'Amico Electric, allow Robert Ford to file the permit paperwork for the kitchen renovation at 15 Old Orchard Road Rye Brook, NY, on my behalf while I am away. If you have any questions or concerns, you may direct them to my contact information below my signature. Thank you for all your help on the matter! Regards, '4aaaguy D "140uca Anthony D'Amico D'Amico Electric 213 Railroad Ave Bedford Hills, NY 10507 0: 914-241-6909 info@damicoelectric.com State Wide Inspection Services CA-*> 1080 Main Street Fishkill, NY 12524 a s 845 2 Phone TO 914-219-119-1062 Fax STATE WIDE INSPECTION SERVICES Email: officeCcbswisny.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: D Amico Electric Inc. Paterno Residence 213 Railroad Avenue 15 Old Orchard Road Bedford Hills, NY 10507 Rye Brook, NY 10573 Located at: 15 Old Orchard Road, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP22-185 135.27 Certificate Number: 2022-4773 Building Permit Number: BP21-212 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: 15 Old Orchard Road, Rye Brook, NY 105073 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 17th Day of August 2022. Name quantity Rating Circuit Type Receptacles 10 Switches 12 Dimmers 02 GFCI 04 Exhaust Hood 01 Range 01 7kw Cooktop 01 3kw Dishwasher 01 2kw Refrigerator 01 LI, Microwave 01 Officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. er1 � o o N f ~ 14 �^ O% q 9 •E 0 O ry u O Ali $ - ooE- I..`j wz ° v w a ; - o 0 y o, O Z < 4 G, PLO m ►� d W ' W w A w co O W �o pZ Q r A M� oo M CN O oL OZ Z F O 116 "'� O F. 604 < .. Otn Q�I m Cam, .7 mi GA = v<, 9499 tog e9494;a cog 4aaaa4944a414att toga aaa9aaaa0aat IE BUILDIlDEARTMENTR I v E VILLAGE OF RYE BROOK FAUG 2 6 2021 938 KING STREET RYE BRgQK,NY 10573 (914)939-066 )939-5801 VILLAGE OF RYE BROOK wvuwl o or BUILDING DEPARTMENT RM ELECTRICAL PERMIT APPLICATION Westchester, ounty Master Electricians License Required / FOR OFFICE USE ONLY /— c� EP#: C�) l Approval Date: AUG 2 Permit Fee: $ I {�C Approval Signature: Other: Disapproved: (fees are non-refundable) **************** ********************************************************************************* Application dated, is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove electrical equipment,wiring, fixtures,or to perform other high or low voltage electrical work as per the detailed statement described below. The applicant & property owner, by signing this document agree that all electrical work performed will be in conformance with all applicable Federal, State,County and Local Codes. 1.Address: CrL— � ��? SBL: .�s.� , c->7—/-3 Zone: k—/,-'5 2.Property Owner: Address: S e-yo 6f Phone#: 612 g Cell#: ?I� yG3 �7_ email: `h e 3.Master Electrician: 1&k of '�� �tc L Address: r2I3 A&AYhil/C� &O aVO K S Lic.#:r'L30 Phone#:9/Y �/�t'o�0`f Cell#:�Y yo3 P7Y email: A roe 4 phicx e1 eCj''1 e- yfl Company Name: 1"t c.- P t C. Address: GC 4.Proposed Electrical Work/Fixture Count: &ME`O�F W YORK,COUNTY OF WESTCHESTER ) as: eLJ ( Lt--) being duly swom,deposes and states that he/she is the applicant above named,and does fiuther (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 F �G h 2L[�V for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) The undersigned finther states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn to before me day of ,20 day of c is 20 Signature of Property Owner Signature of pp 'cane Print Name of Property Owner t%Name of Applkant Notary Public &yRff WELO Notary Public,State of New York No.01 ME6160063 Oualified in Westchester County Commission Expires Januarf 99 20 j 3n1i19 A r��(-) c� Westchester Rockland Electrical Inspection Services, Inc. Phone: 914-34 -3595 DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue F �14-347-3596 Elmsford, NY 10523 Ir BUILDIN NO. TEMP# DATE CITY OR VILLAGE ZIP CODE TOWNSHIP C . 1- -� < FU STREET AND NO.OR ROAD t' M � BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT OCCUPANT'S NAME n/ r' BUILDING OCCUPANCY OWNER'S NAME AND ADDRESS f{'�l 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 8 MOTORS HEATERS OFFICE USE LOCATION LAMP RECEPTACLES ONLY SIDEWALL SWITCH INCADE FLUORE NO. H.P.EACH NO, WATTS EACH INSPECTION OUTSIDE BASEMENT 1"FL. 2"O FL. 3 FL. VILL B ILDING DE RTMENT REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: t -Pr w n%z THIS APPLICATION IS INTENDED TO COVER THE ABOVE LISTED ITEMS TO BE INSPECTED.IF AT ANY TIME OF INSPECTION ADDITIONAL ITEMS RAVE 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 15 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❑ 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 1 vt Lcu d= ec I y k z X ArloSTRBeT 'ADDR CN TELEPHONE NO. CITY OR POST OFFIC LICENSE NO.WHEN APPLICABLE i F•' W t=/1 X ►� � OWN a fool, _ � _ • F O it 0 d w 0-0 C °° $ z_ 01%4 y � r A z ^ z W r (� M � F °z16 F ot PLO V � � � 0. F0y11• �- (�j r r O 06 W p O2 [ r Q 55 Z 3 S ° s F 0 U C a akn Z e •• aw, z A G. ° C9 D DD ECENE BUIL MENT VIL E OF R`fE OK FAUG18 2021 938 KIN BT Kl ,NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT W or PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: 01—al a. PP#: 9 Approval Date: AUG 1 kP21 Permit Fee: S 360 D Approval Signature: Other: Disapproved: (fees are non-refundable) ****T7;* ********** Application dated, O �/ 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 be 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. L Address: SBL:1 3�47—J 3 Zone —)S_ 2.Proposed Work: , gig � e.11f6 r 4,0k- r gd A?AN 1 3.Property Owner: / Address: Phone#: 9/-'/—93 Q7— �/b 0 Cell#: email: 4.Master Plumber: So/ t,O�y6�9n Address: Lic.#: Phone#:Y,112'lf•2770 Cell#: email: 1 Osrl Company Name: 101""doei Address: INDICATE FIXTURES& LINES TO BE IN TALLER 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 Ist Floor J We 2nd Floor 31 Floor 4'h Floor 5'h Floor Exterior 5.* List Other Equipment/Provide Details: �f� (zf 1 (Notarized Signatures Required Next 2 Pages) -1- 8/12/2021 BUILDING DEPARTMENT Vn, o> : OOK AUG 18 2021 938 KING NY 10573 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, C UNTY OF WESTCHESTER ) as: r , residing at, �S (l�` (P t 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; / �6�z-'4 ci l' d ,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. ( ignature of Property Owner(s)) GJ r" , PeV �'rA o rint Name of Property Owner(s))1 Sworn to before me this \� of v` , 20,')_� (Notary Public) SHARI MELILLO Notary Public,State of New York No. 01 ME6160053 C�iali`ied in Westchester County -3- Commission Exoires January 29,20 8/12/2021 STATE OF NEW. Y RK,COU)11TY��O11 F WESTCHESTER ) as: ( v ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signiAg as the applicant) and furtther states that(s)he/is the legal owner of the property to which this application pertains,or that(s)he is the /L�rz&d-�l G , : C 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 6 Sworn to before me this ke day of ,20 day of 0 Ir J Signature of Property Owner Si ture of Applic t _lY/C�Or T• �a��'r Ina Print Name of Property Owner Aint Name of Applicant H E O IM No IC, Staffie of New York Not I No. 01 ME61 60053 I,.b 61 C00O3 O i2iMed in Westchester County Ctiaii.`ied in Westchester County22 Commission Expires Januar',29,20�93 Commission Expires January 29,20L 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- si1v2o21 Building Permit Check List&Zoning Analysis Address: 1 C�L_7 C-X2-C 4AA.�� —�� SBL: 3 Zone: Use: e3 Const.Type: Other. Submittal Date: Z Revisions Submittal Dates: Applicant: ��� t►�n Nature of Work: JUL 8 Reviews:ZBA 1 PB: BOT: Other. ]` OK ( ( ) FEES:Filing.�S'���BP: 4so�6 C/O: Legalization: ( ) (-APP: Dated: ✓ Notarized. ✓SBL-_-1-1 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 tamped: ✓Sealed: ✓ Copies: ?—Electronic Other. ( 4 ease Workers Comp: ility Comp.Waiver. 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: AMROVED REOLMED EXISTING PROPOSED NOTES JUL - 8 1011 Qm& Front: Front: Sidg�: Main COy Accs.COV FtHS : Sd H/Sb S1A: Tot.Imp Film: >� /Stoaes: notes: N ` .F L V N c ` O CL N ; e W � O L U W w s C.. ., > o O o .04J G� r••� Y o X N to�ecbon AN Q LLJ LU uimo N CI V L , co J � ILO U z CJ O a� O a ,F p� -tiJ �l GREEMIL-01 MV R A ACORO�� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 8/2/2021 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 endorsements. PRODUCER CONTACTNAME: York International Agency,LLC PHONE 914 376-2200 FAX No:(914)3T6-2891 500 Mamaroneck Avenue wc,NW_ )__ Uuc. ) Suite 220 ;o cettfflcabb@yowMnti.com Harrison,NY 10528 MSURERIS)AFFORDING COVERAGE NAIL# INSURER A:Southwest Marine&General Ins.Companv 12294 INSURED INSURER B:The NY State Insurance Fund(PARENT) 36102 Greenwich Milbank Group Inc. INSURERC: 215 Business Park Drive INSURERD: Armonk,NY 10504 INSURER E INSURER F:___ _ COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. DISK TYPE OF NSURANCE ADDL S IN DUBR POLICY NUMBER POLICY EFr POLICY EXP LMIrfS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ 1'0�r�0 CLAIMS-MADE X OCCUR GL2020RLH00565 11/9/2020 11/9/2021 AGE TORENTED 10Qr000 PREMISES(Ea occurrence) MED_EXP iAny one person) - 511)wo �PERSONAL3ADVINJURY 11000,000 OEN'LAGGRE_GATE LIMIT APPLIES PEM GENERAL AGGREGATE 210001000 POLICY FIR JEC LOC (_PRODUCTS-COMP/OPAGG 2'�01�0 OTHER: HNO 110001000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea acc de ANY AUTO BODILY INJURY(Per person) OWNED SCHEDULED AUTOS ONLY AUTOS _BODILY INJURY(Per accitlent _ HIRED NON-OWNED PROS GE AUTOS ONLY AUTOS ONLY Per - . UMBRELLA LIAR 7 OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE ---- $ DED RETENTIONS B WORKERS COMPENSATION X PER E 'OERH AND EMPLOYERS'LIABILITY - - --—ANY PROPRIETOR/PARTNER/EXECUTNE rIN❑ W2434 1968 1?l28/2020 12/29J2021 E.L.EACH ACCIDENT $ 1'000'S_00 QFFICER/MEMBER EXCLUDED? NIA 11oQO 00Q andatory In NN) E.L.DISEASE-EA EMPLOYEE $ if yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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,NY ACCORDANCE WITH THE POLICY PROVISIONS. Victor Paterno 15 Old Orchard St. Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1 0_1 \\ NYSIF New York State Insurance F.1• 1 WESTCHESTER ONE,44 SOUTH BROADWAY, LOTH FLOOR,WHITE PLAINS,NY 10601-4411 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE oa A^^^A^ 822682421 ;'•`';_ : Y: GREENWICH MILBANK GROUP, INC. 4 }�r+;i (A CT CORP) L jIW i 215 BUSINESS PARK DRIVE ARMONK NY 10504 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER VICTOR PATERNO GREENWICH MILBANK GROUP, INC. VILLAGE OF RYE BROOK NY (A CT CORP) 938 KING STREET 215 BUSINESS PARK DRIVE RYE BROOK NY 10573 ARMONK NY 10504 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2434196-8 761611 12/29/2020 TO 12/29/2021 8/11/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2434196-8, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:/fWWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT JESSICA STOCKEL VICE-PRESIDENT IRWIN STOCKEL GREENWICH MILBANK GROUP, INC. 2OF2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. BY CAUSING THIS CERTIFICATE TO BE ISSUED TO THE CERTIFICATE HOLDER, THE POLICYHOLDER UNDERTAKES TO PROVIDE THE CERTIFICATE HOLDER 5 CALENDAR DAYS' NOTICE OF ANY CANCELLATION OF THE POLICY. NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:624287789 U-26.3 Laura Petersen From: Laura Petersen Sent: Friday,July 9, 2021 9:02 AM To: PAW557@AOL.COM Subject: Building Permit Application - 15 Old Orchard Road Good morning, The building permit application has been approved by the Building Inspector, before I can issue the building permit the following items must be submitted to our office, heral contractor's contact name & phone number. 2 *�y of general contractor's valid Westchester County Home Improvement License. General contractor's valid liability insurance (the Village Of Rye Brook must be the certificate holder) General contractor's valid workers compensation on a NY State Board form (C105-2 or -6.3) Estimated cost of construction to determine the building permit fee ($15.00 per $1,000.00) (due once permit is issued and ready for pick-up) 35-k_ This information can be emailed to me. Thank you Laura Laura(Petersen Office Assistant Village of Rye Brook 938 King Street Rye Brook, New York 10573 Phone(914)939-0668 1 Fax(914)939-5801 1 Ipetersen(cDrvebrook.org 1 C LL v � LL xk � 3t tl F 3k = C� U Oa a 2 z 2"x10" 16' oR. Ic � �- PAf TC P OVER 2 00 v N v cc i �r / L_L_LLL I-Lzl >~ -JL LLLLL-z GREAT ROOM - ------- I _ " a I I-LL _L �3 yo ,LLLI- L L0 00EXIJI. 2x0 16Rc, �� - LLL > 7---RAETE1R OVER L_LL _ .y w - L-LLI-L I-L NE�4 4"x4"i�05TE1� L L v ��a TO FOUNDATION I_L L p� � L_LLLLL'L N PROF051 D HEADER :2.OE LVL 1N/s"STEEL s X157. x4 1105TEr;� - FLITCH LATE A/TAO ROAS 0"!8"5TEEL 5OL75 16"O.O. TO BE MELD 5FAN TO BE FIELD MEA51JRE1)FOR FABRICATION VERI IEO LQ 5' --- O ROWS OF 8"(P @ 16n �� - �� �..- o u¢Y W O.G.STEEL BOLTS WITH s d3 eP °'z 47�/7 MICRO WASHER5 AND NUT WAVE �- - T^O EX15T. x4 P05T5 OLD 0 0 0 �' ABOVE 70 SEAR ON #E?�eER Two 1-5i4"xW'LVL 2.OE CLEAR SPAN 20' 1 0 0 0 1 e"x 12"x20'LONG 5TEEL 0 RANGE l FLITCH PLATE u� I� KITCHEN —� SEGURE To POST r DENI l� o � __- - z� 50LID 4 X4'POST # EMOVE EX157. O WALL5 OABINE75 q U m - xR 0 m w X, - _ f N 6 1 � �� EIWI OAB I NET5 0 E-<IS - T IR$ REFRIG. APFLIANOE5. 5CALE: N75 I REr-ER TO CABINET z ,i - �E51 GNERS LAYOUT — U XTENI:)WALL IV' 1 FOYER 0 0 N I`IVNU Q U ROOM LDr - i a W ryW i O F"'1 ®/ MLAMIT# �Q J O x i 1 �Z-7!� o 0 3 3_ SSE# z oa U BULLRlNi,l SPELT R,Viiiags W"Maak,llr O O /rod I�+q C3O Ir FILE COPY 0 zfr Il�fl^ISUI JUL-7 2021 D � � 3 � w VILLAGE OF RYE BROOK CABUILDING DEPARTMENT '"'�