Loading...
HomeMy WebLinkAboutBP21-211PERMIT # SECTION Z36�1 TYPE OF WORK _ e-XAe 10B LOCATION WINTRACTO COST NCO #__. _0 s�l 4L i 0 BLOCK INSPECTION RECORD D -TE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING 52010* RGH PLUMBING GAS C� SPRINKLER ELECTRIC LOW -VOLT 0 ALARM C7 AS BUILT CJ FINAL &a711/ OTHER APPROVALS ARB BOT �-T— P8 ��— ZBA �- OTHER --'- VILLAGE of RYE BROOK WESTCHESTER CoUNTY, NEw YORK No: 22-018 Certtftrate of (9ccupaucp This is to certify that ka ya n Sharm A k5 l i Ta Gf`'})ta of, R�/C Bj/dO L+ NY having duly filed an application on ,o n ua ry 20 a R requesting a Certificate of Occupancy for the premises known as, 14 lam.r V— -Dy i Ve , Rye Brook,NY, located in a R_ c Zoning District and shown on the most current Tax Map as Section: Block: Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No.69 — , issued 2 20 -P , 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 ,j'7�' - Qrr1 �� , for the following purposes: Subject to all the privileges, requirements, limitations and conditions prescribed by taw, 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 mad nor-shall the building be moved from one location to another until a permit to accomplish such change has been o from the Buil m Inspector. Building Inspector,Village of Rye Brook: Date: F EB 12022 �E��� For office use only: l � �UILDI TM ENT PMWT# Zt -2�l J ; VILY OF RYE OK ISSUED: -t Z-Z I 939 KING STRE i YE BROOK,N-EW YORK 10573 DATE: l —1 Z-ZZ OG n 668 FEE: t o S PAID V1LLF0� OF FB '� wry lkor 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 iPPf P*f PPPkiiPPki*k#tki*i4###*44##*i+####*###f#i##kiiFi###fill##*i#ii#i#7 iii#ii##!i######k!**#k*l PkPPPPPPf PPP#iiiil Piii#ii4# Address: ( �1 12'� N 1V O t 61 6c l4, N Occupancy/use: REs IDC-Ni 1/ L Parcel ID#: U' �3 I —21- Zone: - Owner: KPraAnt S�i K V F- Address: It M rV-4 b p 1 Y G �Y U A t-L 0 K P.E./R.A. or Contractor: :Ty uP+k KI KTFLL-'f Address: Person in responsible charge: Q NO"� Address: ti It M KK W lV L 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: bethg duly sworn,deposes and says that he/she resides at I q (Print Nance of:�ppli"m (No.and Street) in t?y'c >in the County of W r=s I CITES E in the State of W\,that (cite To%%n 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: $ - , 0 Q 0 i for the construction or alteration of: i W ' SM,ALV f,A B H JWQ N% 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 I� Sworn to before me this I ) lay of Jtinti64 20 0 a day of 20 0 Siginhfiiri of Property Owner Si of Appli t Print Name of P Owne Print Name of t w� Notary Public Notary Publ c SCOTT GOWE SCOTT GOWE NOTARY PUBLIC OF NEW YORK NOTARY PUBLIC OF NEW YORK I.D.#01GO635714 x I.D.#01 G0635718 ��,,,, MY COMMISSION EXPIRES 1 MY COMMISSION EXPIRES���_Z_ QyE BRC�j'�. O� 2� 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 : "1 1 y b v \c t J./ DATE: `)-��\���� PERMIT# 4 � ISSUED: O�1 �t� SECT: BLOCK: LOT: LOCATION: �-� tiW AQ Y �S OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION 1�G,t 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 ❑ CR,ASS CONNECTION ��'INAL r-o OTHER E 4Rnv�. Q 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR r}'ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK %❑CODE ENFORCEMENT OFFICER 93$KING STREET + RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - -- - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : r DATE: i J PERMIT# - ISSUED: SECT:BLOCK: LOT. LOCATION: f - �ulV 1�l / OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION � REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: p ROUGH PLUMBING ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER e-I Al I ... N ei o p � ti fh � W a3 y Y M S p ii7 N � off V� kn 2 o< 00 U CO � y _ r4 00 F. co ON w oo w au v z Ar 0.4 W olz ►� CG a o � z � � � �; a q ton U w z C6 z 444141949at0a44U4aaaaacoga ago 444aaaaeaaaaaaaaa • D \J V BUIL01 G APARTMENT SEP 17 2021 ID VILLAGE OF RYE 0I�00K 938 K1NO,�"ET RYE B ,NY 10573 VILLAGE OF RYE BROOK (94)930 ;' BUILDING DEPARTMENT wtv 1t do .org ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: EP#: I t�3 Approval Date: SEP 2 021 Permit Fee: $ /o A `S Approval Signature: 1, Z Other: Disapproved: (fees are non-refundable) Application dated, a1 is hereby made to the Building 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. 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: / G1✓e rz)r/ rile J SBL:�/� r �J 3 �- c�rah' Zone: 2.Property Owner: Xci rr#4 Jrhp!r,•g �5�ji 7'q / ,r�A ,A Phone#: - - 62-?y Cell#: email: 3.Master Electrician';F;ma,i g4� �' ,�,/or�?r_ Address: /� �i/'�X( ne A�nr /{��4W Lic.#: r11BB Phone#: `Cell#: 21Y-56y-Y&K5 email: Company Name: r::i:�Z161aAon Address:1j,1 e w arae &V'I cOS.rk. 4.Proposed Electric/al Work/Fixture Count: '/ ,�� c . 2ci77i�rao•+�s Agee .mac ti o with _ STATE OF NEW YYORK,COUNTY OF WESTCHESTER ) as: �JCi Pict 107� being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant) state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the //G ✓/ 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 me this day of ,20 day of Signature of Property Owner i c t L Print Name of Property Owner �Name of Applic ���A, — Notary Public NotaryW MELILLO Notary Public,State of New York No.01 ME6160063 Q!uali.'ied in Westchester County 2 Commission Exoires Jr uary 29.20 C9j g/12r2tn1 S Westchester Rockland Electrical Inspection Services, Inc. A Phon-W-341-3595 DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue Fax: 914-347-3596 Elmsford, NY 10523 BUILDING PERMIT NO. TEMP H DATE i f CITY OR VILLAGE ZIP CODE TOWNSHIP COUNTY ;; STREET AND NO.OR ROAD POLE NUMBER BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT OCCUPANT'S NAME BUILDING OCCUPANCY OWNER'S NAME AND ADDRESS HOME TELEPHONE NUMBER CURRENT SUPPLIED BY FROM THEIR OFFICE WORK TELEPHONE NUMBER UST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS NO.OF FIXTURES& MOTORS HEATERS OFFICE USE LOCATION LAMP RECEPTACLES ONLY SIDEWAU SWITCH INCADE FLUCRE NO. H.P EACH NO, WATTS EACH INSPECTION OUTSIDE {- I BASEMENT - k I"FL. 2-FL. EP 17 2021 3-FL. BUILDING DERINRTME T e 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 ADDTIONAL 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 USRNG,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 F3 ADDITIONAL❑ EXPOSED F) CONCEALED I] MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD U 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- CITY OR POST OFFICE ZIP CODE LICENSE NO.WHEN APPLICABLE AM 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: Evolution Electric, Inc. Karan Sharma&Akshita Goya] 132 Fairfax Avenue NY, Hawthorne 10532 Located at: 14 Mark Dr Rye Brook, NY 10573 Certificate Number: 1032856 Section: 135,33 Block: 1 Lot:22 BDC: Permit Number:EP:21-231-BP:21-211 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 inion the premises at: 14 Mark Dr Rye Brook,NY 10573 Basement list 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 01128/22 Name Type Quantity Switch Single Pole ------- 5 Receptacle GFCI ------- 4 Fixture-Luminaire Incandescent ------- 7 Exhaust Fan Bath ------- 2 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. `��� G� This certificate is valid for work performed before date of inspection only. YYYY I Ot a I N N +� rry M � Fes., v Mrr CT lw 0 �a $ F .r 0 �+ a C o 0 w � a .� 4 • p4 L c �. o tn a d p 00 co0-0 04 r. d `" �j � • 00opW Q r" ✓ > E 4 a, W 1 w , o � a z U , COD 10, 3 wo M F .. a a A a � di 0=G a J LT. • `��- DRC�v V BUIL MENT VILILA E OF RYE DOK SEP 13 2021 938 KIN(,STR ET RYEFB ,NY 10573VILLAGE OF RYE BROOK `�, BUILDING DEPARTMENT PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: I- PP#: CD I'H / Approval Date: SEP 1 3 2021 Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, /3 c; i 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 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. Q / 1.Address: 14c, Max 1-- p �!i j t SBL: /55i 3-3 —/'—c')­4 Zone: 2.Proposed Work: /�rj P c'f �V��/��1 rr7 j 3.Property Owner:_9Ate R K/ 5 H A A Address: N 1?1 A� X Phone#: ge*� 7 Cell#: email: 4.Master Plumber: R' Clc j C.t-t N Address: Z ( j'c, u nz T. \1 Lie.#: / Phone#2>cL(6 4 o (Cb Z Cell#:CG c�d cc, email:, m T,�cN rP/c.n b,kl q'!p Z,r'G,�r�G I - I I T ' / ® G rn ea-r/ .Cb rr Company Name: 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 1stFloor 2nd Floor 3'°Floor 4''h Floor 5'h Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) 8/12/2021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: �3 6�R l GC-- P n1 Ce- fr ,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 Vol U yrl e C for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attomey,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 10 T14 Sworn to before me this day of S jpA- ,20 day of QAKMb-Q-V- ,20 a-A S re of Pr perty Owner ignahue of Appli Print Name of Property Owner Print Name of Applicant '77- JULIAN B otary Publ' [my WJ- ary No:b� ` ' c 4 DREW P.ALEXANDER Quatified in Bronx county NOTARY PUBLIC OF NEW YORK ommtssion Expires Nov 16,2024 I.D.#01AL6414646 MY CONMSION EXPIRES 03/01/2025 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- 8/12/2021 . BUILD MENT R IE C F � W E VIL OF RY OOK D 938 KING ET RYE BR ,NY 10573 SEP 13 2021 4 -0 � VILLAGE OF RYE BROOK L 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 YOM COUNTY OF WESTCHESTER ) as: �^ .3, �AI,Ali 9 HAP k- , residing at, 1,t P Af � , ICY C- _ VD K . 4y (PI int name,) (Addre>,where you liv e) 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; {Li 0 A-P,>, T �-q-IF b t V D V . I J I , Rye Brook, NY. (.lob Addres,) 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. (Simnaw r��ll'ruh�rt� (hti n�r(s11 (Print Name oCProperty 0Nncr(s)1 T� Sworn to before me this day of �rp" i`�/!ef 4 20 21�1_ DREW P.ALExANDER NOTARY PUBLIC OF NEW YORK I.D.4OI AL641464b. MY COWASION EXPIRES 0310 rM5 (Notary (°Ll(�IIC) 8/12/2021 Building Permit Check List&Zoning Analysis Addresses SBL: Zone: 1 G t �/ Use Z '� Const.Type: Other. Submittal Date: Z.. Revisions Submittal Dates: Applicant +I A(L-VIAA Nature of Work Reviews•ZBAAUG - 9 2091 PB• BOT' Other. OK ( ( FEES:Filing. 7S r BP:m I� - i��2 C/O: Legalization ( ) (Jf APP: Dated: _-'—Notarized:- SBL Truss I.D. Cross Connection: —*" H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening { ) { ) ENVIRO:Long. Short: Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmt.: Tree Plan: Other. SURVEY:Dated: Current: Archival Sealed: Unacceptable: ( } LANS:Date Stamped: Sealed: Copies: Electronic: Other: ( } ( icense:LZ `Liabi Workers Comp: lity Comp.Waiver. Other. O 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: REQUIRED EXISTING PROPOSED NOTES APPRO% Ate: AUG - 9 2021 - Fmn c Front 1� AA__Main . S Sd.H/Sb: -GE&- T�Imn' Ftimp Hdght/Stories: notes: Laura Petersen From: karan sharma <karansharmamail@gmail.com> Sent: Tuesday, September 7, 2021 3:45 PM To: Laura Petersen Cc: Karan Sharma Subject: Re: New Contractor for 14 Mark Drive Hi Laura I'm changing my contractors from CCI home improvement to MHI Renovations Services. Hence the need for an updated permit. Please let me know when can I pick up the permit. Thanks, Karan Sharma On Sep 7, 2021, at 3:33 PM, Laura Petersen <LPetersen@ryebrook.org>wrote: Good afternoon and thank you for the information. Please reply to this email indicating that you are changing contractors. 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 a@ryebrook.org From: Karan Sharma <am.a.rash.rank@gmail.com> Sent:Tuesday,September 7, 20212:27 PM To: Laura Petersen<LPetersen@ryebrook.org> Cc: karansharmamail@gmail.com Subject: Re: New Contractor for 14 Mark Drive Hi Laura Attached are the documents and contractor details. 1)Julian Martelly- MHI Renovation Services-+1 (914) 656-0885 2) renovating two small bathrooms.Total cost$33k Please let me know if anything is missing. 1 Thanks, Karan Sharma On Aug 30, 2021, at 10:20 AM, Laura Petersen <LPetersen@ryebrook.orR>wrote: Good morning, Please send the following items for your new contractor; 1. General contractor's contact name & phone number. 2. Copy of general contractor's valid Westchester County Home Improvement License. 3. General contractor's valid liability insurance (the Village Of Rye Brook must be the certificate holder) 4. General contractor's valid workers compensation on a NY State Board form (C105-2 or U26.3) Please also send an email to me about the changes you are making with a new contractor and the new estimated cost of construction. 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 IoetersenOrvebrook.ora 2 r , ,.r .. -_.__._"----- — ttSt�L;•._ :.��_'"ran- -- ..: -_ 1 G"rpr I.s+ltlnrr �j�L )IT1 James Maisano 1}'rtichNrfrr�'otrntp F%erutfve Y y ., Wrector.Conrumer. Protect im, s' Department of Consumer Protection •F Home Improvement License �,�; M H I RENOVATION SERVICES INC. i. 48 EDGEWOOD AVENUE -#1 YONKERS,NY-10704 0.41 phis license is issued in accord.u,ce w ill,Article XVI of the Westchester County Consumer Protection Code and is valid only upon • �r presence of the ollicial department seal.Proof of citizenship or immigration status is not required for issuance of this license. NOT FOR FEDERAL PURPOSES `: ✓ aN GansLj,),Pto Date of Expiration Licensc Number o 05/14/2023 W C-27708-H 15 0 0 ester co .t � aco" CERTIFICATE OF LIABILITY INSURANCE DATE 12 0 2 1 YI a6/3orzozl THIS CERTIFICATE 13 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. It the certificate holder Is an ADDITIONAL INSURED,the policy(les) 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 certfflcate does not confer rights to the certificate holder in lieu of such endorsements. CONTPRODUCER NAME, LISA VITIELLO StateFarm LISA VITIELLO AGENCY INC. PMONE 914-337-4810 FAX No; 914-337-5746 ExOd 282 WHITE PLAINS RD EJR aE : EASTCHESTER,NY 10709 INSURE 5 AFFORDING COVERAGE NAIL e INSURER A. State Farm Fire and Casualty Company 25143 INSURED INSURER 8 MHI RENOVATIONS SERVICES INC. INSURER C 48 EDGEWOOD AVE INSURER D: YONKERS,NY 10704 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. NOTVIATHSTANDING 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. INSR ADCL SUBR POLJCYEFF POLJGYEXP LIMITS L TYPE OF INSURANCE POLJCYNUMBER COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1 1,000,000 CLAIMS-MADE ®OCCUR ...--.-----_ I' 1 100,D00 VIED W on. on) S 5,000 A Y 98-CM-D729-1 F 0911012021 09/10/2022 PERSONAL d ADV INJURY S 1.000,000 ' GENT AGGREGATE LIMIT APPLES PER: GENERAL AGGREGATE S 2•000•000 POLICY PRa LOC PRODUCTS-COMNCPAGO $ 2,000.OW OTHER, S AUTOMOBILE LIABILITY DNED SINGI UMI S d . ANY AUTO BODILY INJURY(Par permn) S W OWNED SCHEDULED BODILY INJURY(Per aaftt) S AUTOS ONLY AUTOS HRED NON-OWNED RTY DAMAGE S AUTOS ONLY AUTOS ONLY S UMBRELLA LIAII HOCCUR EACHOCCURRENCE S EXCESSLI CLAJµS-MADE AGGREGATE S DED I I RETENTIONS PFR S WORKERS COMPENSATION AND EMPLOYERS'LIABUTY YIN _TA tE R�ANY PROPRIETORIPARTNERIEXECUTIVE r NIA E.L.EACH ACCIDENT S OFFICERIMEMBER EXCLUDED? (Mandatory In NMI E.L DISEASE-EA EMPLOYEE S Iyea deacdDe undo' DESCRIPTION OF OPERATIONS tabu E.L DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additkmal Remarks Schedule.may be attached N more apace Is required) AND ADDITIONAL INSURED:VILLAGE OF RYE BROOK 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 Q1985-201 s/Acokb CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 10014e6 132949 12 03-15-2016 A6OR a CERTIFICATE OF LIABILITY INSURANCE DATE(MMiDONYYY) 08130/2021 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 f REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)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 Ileu of such endorsements. PRODUCER CONTACT LISA VITIELLO : StateFarm LISA VITIELLO AGENCY INC. PHONE 914-337. B10 PA't 914337-5746 ----- 282 WHITE PLAINS RD EMAIL ` ADDRE EASTCHESTER,NY 10709 INSURE S AFFORDING COVERAGE NAIC a INSURERA: State Farm Fire and Casualty Company 25143 INSURED INSURER a MHI RENOVATIONS SERVICES INC INSURER c: 48 EDGEWOOD AVE INSURER D: YONKERS,NY 10704 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. N01WTMSTANDING 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. INSR ADDLrUTYPE OF INSURANCE POLICY NUMBER MWO POLICY EFF POLICY YY LIMITS TR COMMERCIAL GENERALUABILITY EACHOCCURRENCE f 1,000,000 CLAIMS-MADE ®OCCUR P I „�„� s 100.000 MEO W(Any one arson S 5,ODO A Y 98-CH-BW-0 F ` 09110=20 09/1012021 PERSONAL&ADV INJURY f 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY 2]JPECOT- LOG PRODUCTS-COMWOPAGG 9 Z000,000 OTHER: 3 AUTOMOBILE LIA9rurl, COMBINED F LIMIT f Ea eoddatl ANY AUTO BODILY INJURY(Per Pasco) S OWNED SCHEDULED I BODILY INJURY(Per aaddaN f AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY i UMBRELLA 1JA8 OCCUR EACH OCCURRENCE $ EXCESS VA 3 CLAIMS-MADE AGGREGATE S DED RETENTION f f WORKERS COMPENSATION ATUTE ERA AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNEWEXECUTIVE NIA E.L.EACH ACCIDENT 6 OFFICERMIEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE S II yes des(71be"or DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT f DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101,Addlttonal Ramarks Schedule,maybe attached It more space Is required) AND ADDITIONAL INSURED:VILLAGE OF RYE BROOK 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 I AU 7'HORI2ED REPRE$ENTATNE I RYE BROOK,NY 10573 _,k" ©1988-2016 ACORD CORPORATION, All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 1OC1488 13284912 03-164016 4OEWWorkers' CERTIFICATE OF s Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE I 9 1a.Legal Name&Address of Insured(use street address orgy) 1b Business Telephone Number of Insured i 914-65"885 MHI RENOVATIONS SERVICES INC 48 EQGEWOOO AVE 1c.NYS Unemployment Insurance Employer Registration Number of YONKERS,NY iD7D4-2439 Insured Work Locatlon of insured(Only required if coverage is specifically limited to id.Federal Employer Identification Number of insured or Social Security certain locations in New York State,I.e.,a Wrap-Up Policy) Number 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate holder) STATE FARM INSURANCE COMPANY VILLAGE OF RYE BROOK 3b.Policy Number of Entity Listed in Box"I a" 93B KING STREET 98-CM-0882-4 F RYE BROOK NY 10573 3c,Policy effective period 0911012021 to 0911012022 3d.The Proprietor,Partners or Executive Officers are included.(only cneck box Nall partners/officers Included) �X all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box'3"insures the business referenoed above in box'la'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". WII 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? ZYES ❑NO 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 if confer any nights 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 I 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: G.GENTILE Print name of authorized representative or licensed agent of Insurance carrier) Approved by: �2 3r, f (Signature) (Date) Title- INSURANCE REPRESENTATIVE Telephone Number of authorized representative or licensed agent of insurance carrier: 914-337-4810 Please Note:Only Insurance carriers and their licensed agents are authorized to Issue Form C-105.2.Insurance brokers arebQ authorized to issue it. C-105.2(9-15) www.wrb.ny.gov 7— T PIEf Workers' YORK CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a, Legal Name&Address of Insured(use street address only) 1b Business Telephone Number of Insured 914-65"885 MHI RENOVATIONS SERVICES INC 48 EDGEWOOD AVE YONKERS,NY 10704-2439 1 c.NYS Unemployment Insurance Employer Registration Number at 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,1.a.,a Wimp-Up Policy) Number 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of insurance Carrier (Entity Being Listed as the Certificate Holder) STATE FARM INSURANCE COMPANY VILLAGE OF RYE BROOK 31b.Policy Number of Entity Listed in Box"1 a" 93B KING STREET 9B-CH-S104-2 F RYE BROOK.NY 10573 3c.Policy effective period 0911012020 to 09/10/2021 3d.The Proprietor,Partners or Executive Officers are EJ Included.(only check box a all partners/officers Included) QX all excluded or certain partnersJoffrcers excluded. This certifies that the insurance carder indicated above in box"3"insures the business referenced above in box'la'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? EYES []NO 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 nghts 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 I 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: G.GENTILE (Pnri name cf authorized representative or Itcansed*pent of insurance carver) Approved by: -�D126a (Signature) (Date) Title: INSURANCE REPRESENTATIVE Telephone Number of authorized representative or licensed agent of insurance carrier 914-337-4810 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 FPZ D C-4 0�cl-jC�: i m F- )}C= o° qM0 z c cl M >03 � a _ C gnomon LAM. p l L — )t—rtitdi l*s. CID 0 i t Q � C �1 l �- �l ti i I o nno� nn OZ L �J O ui Owl Ix- � WZ lug >In - I i IZ 10 L '- I ZC- k � I ! �. V, �.