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HomeMy WebLinkAboutBP21-221PERMIT # 3P - 9 1 DATE: ba( /p(p; SECTION `''4BLOCK i LOT, TYPE OF WORK JOB LOCATIONttOeQ ���l �A� C OWNER Ah SQk) n 1& 7•_`StCaC(e COST �i► ,�_ • #i• INSPECTION RECORD DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING 0 RGH PLUMBING GAS SPRINKLER ELECTRIC LOW -VOLT ALARM AS BUILT FINAL e Ia! 9)7. Cogc2- VQ76 ZBA OTHER AS-BU1LTipNAt SIfRVEY RIFIWIRED PRIOR TO NAL INSPECTION �ejvQ � �a/aa. VILLAGRbF RIVE BROOK WESTCHESTER COU , NEW YORK NO: 22-09:1 Certificate of ®ccup ucp This is to certify that ile l h (SC:�.l fjl k /d s ST n G/E cc of, Rytj BYOn V-. N 7 having duly filed an application on J�,c.rt f✓ I�� 20a requesting a Certificate of Occupancy for the premises known as, ® l(I OrCha l-d )2QQ 0 , Rye Brook,NY, located in a K' Zoning District and shown on the most current Tax Map as Section: I 5. `-f' Block: )Lot: J and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. c2/-02 c,2 ) , issued 2!� `7 20 -�2/, 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 V New York State Classifications, Use: / V1 e- FCt4*7/ l/ Construction: for the following purposes: ExPaO6 ltx1 k n ' -1 C 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 Patafi om t e lding Inspector. Iuilding Inspector,Village of Rye Brook: Date: JUN 2 3 2022 D r-� 1� For office u e only: BUILDING TjE#'ARTMENT PERMIT# VILLAGE OF RYE BROOK ISSUED: - I MJUN 13 2022 38 KING STREET S RYE BROOK,NEW YORK 10573 DATE:(—13, c� \`(914)939-0668 FEE: 1 O-- PAm VILLAGE OF RYE BROOK w �ytr bre4lcer� BUILDING DEPARTMENT APPLICATION FOR CERTIFICATE OF OCCUPANCY, CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION tt**++t*xstrrr+rr++s*+*er+rr++r++r**trr*sst*x***+*sts*+*ssxrtr+*t+rrs+rrxxr+rxrrsr+ssrrsssrxxr*trttr*srrsr**+xt*xrssrsssxsx** Address:IOCO Q02 C t- Aa'0 1ZL7 It R-1 IF, aV_00 lc Zone: R= Occupancy/Use: —�?SI p jd Parcel ID#: �1j 5 1 `��" _ ( '� IS Owner:SGTN eTAC1 Fr- 86Vj)N t=e LAD Address: 1- 0G9 O I2GtiAt20 O'D 7 G-C Afib �Lvpi S C Ott t>ftt C- ,fJ Y 10-r85 P.E./R.A. or Contractor: � WCrY Flhll/'r�' WC- Address: � Person in responsible charge: MA10ct=ZO fftn-2coti1 Address: SRME t`C 01'190V'� 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: }}O 1� 1243 ►4 �f�) J)6 being duly swom,deposes and says that he/she resides at 7 So u�V �� (Print Nalne of Applicant) (No.and Street) in in the County of �Pr���-t�'z V� in the State of GT that (City/'rown/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: S k 4z�7 L) ' for the construction or alteration of: 1% X P 4 N OI F-0 G LILA e 1570 I`_� p'4T la 121iS'���Ti D J�j 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 0C�g day of , 20 /Si at r, i—pertyO Signature of Ap icant g S' S Cr-,`W IrrL D N Name o roperty Owner Pri e o tic v ry u tic C' N Public o SHARI MELILLO Notary Public,State of New York No.OIME6160063 Qualifled In Westchester County Commission Expires January 28,20 21a BUILDING DEPARTMENT LDING 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 : �J1��"�\0 ` ORATE: l � I PERMIT# 1 t ISSUED: ` ECT: ' BLOCK: I LOT: LOCATION: '"' �s CCUPANCY: �� J ❑ 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 ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL ❑ OTHER Building Permit Check List&Zoning Analysis ` Address: SBL: Zone:11 l �� Us zfrJ Const.Type: Other. Submittal Date: y Z l Revisions Submittal Dates: Applicant: CA4 l P P Fi L-� Nature of Work:- Reviews:ZBA: A U G - 4 1011 PB: BOT: Other. NE OK _nn7 ( ( ) FEES:Filing: ' c-� `�BP: Z t - Y` C/O. Legalization: ( ) (�APP: Dated ✓ Notarized: BL Muss I.D. Cross Connection H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening: ( ) ( ) ENVIRO: Long. Shore Fees: N/A: ( ) ( ) SITE PLAN:Topo: ite P Fotection S/W Mgmt.: Tree Plan: Other. ( ) (�SURVEY:Dated IA I I ED Current Archival l Sealed Unacceptable: (� ( ) PLANS:Date tamped: / Sealed: Copies: Electronic Other. (, (vr License: V Workers Comp: ✓ Liability: Comp.Waiver. Other. (J� ( CODE 753#: O — 000-F�,c)I 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. O 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 l eO Z L approval: notes: ( )ZBA mtg.date: approval: notes: ( )PB mtg.date: approval:- notes: APPROVED REOUIRED EXISTING PROPOSED NOTES Ate: rSk, - na4g. AUG 1 9 1011 Circle: Fr n e Fr n Front: Sides: Main Cov Accs.Cov Ft.H S S .HS : Tot,imp: Ft.Injp PP Height/Stories: notes: ' , O/ZI �I r✓,4 t✓ ? BUILDk ,�'MENT D O v VILw� E O,FRY UOK 938 KING E t RvEDR olio,NY 10573 AUG - 4 2021 (914)9 39-5801 VILLAGE OF RYE BROOK BUILDING DEPARTMENT .•trrr��+t��t�srrtrrssrrrtttsssssrtrttrsssrssrrttrtrrrssttrrrrrrtrrsrrrrstrrrrttsrttrrtrsrsr+rrrrrttsttsrr• 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:-'2.01-b 012-61+ .r.p JZD Date of Submission: Parcel ID#: I'Tj - .?) 1-3 1 Zone: _tZ " )S Proposed Improvement(Describe in detail): APPLICANT CHECK LIST: MUST BE COMPLETED BY THE APPLICANT C-0NSI`1'AkC-T- S k Q s F c T- The following items must be submitted to the Building )tC � Department by the applicant-no exceptions. l1STIl�+b- t7,d,T lQ I ( )Completed Application 2. ( )Two(2)sets of sealed plans. (otte bill we ;maximum Property Owner: S WA- � 51t4c1%4. 5C-411 N )t IrI<.Y> alloik able Plan svc 16"x 42*'l and one l l"r l 7") 3. ( )Two(2)copies of the property survey. Address:2 D(,va o+7.G►}h�rQ,n {?-Yj 4. ( )Two(2)copies of the proposed site plan. Phone# 5. ( )One electronic/disc copy of the complete application materials. Applicant appearing before the Board: 6. ( )Filing Fee. ijT_y� 7. ( )Any supporting documentation. Address:_? 5o4T't1- tz110(->lsL 1 8. ( )HOA approval letter.0fapplicable) 9. ( )Photographs. Phone# 1" -41'I - 21q'71 10.( ) Samples of finishes color chart.(a sample bowd or h��plt— mode!mnv be presented Me night of1he meeting) Archttec EtI ngineer. , M1?40N J Z,4r'f-)4 JZL.4 Phone# V 42 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. 3 Sworn to be re me this Sworn to before me this � day of �S� day of , 20 21 St lure of P try Owrcr / Stymature o Appb nt 5 t; { e.�,N 1 g F -L-5S f�C i f S'C k t>v D Leonard N.Gruenfeld 246,t 00 Pnnt Na „er N-,_ry Public,State of New Yofk Pnnt Name of A itcant No.01 GA6037694 C Cja-Nied In Westchester Cotaty satnty Public Co;rm,,sion Expires February 22,20 aty Public SCOTT GOWE ill NOTARY PUBLIC OF NEW YORK I.D #01 G06357188 MY COMMISSION EXPIRESW�7�Z�� �t l� ` VILLAGE OF RYE BROOK BUILDING DEPARTMENT 938 KING STREET, RYE BROOK,NY 10573 (T) 939-0668 (F) 939-5801 ARCHITECTURAL REVIEW BOARD Tuesday, August 17, 2021 NAME_& LOCATION _ TYPE OF APPLICATION MOTION SECOND APPROVED REJECTED APPL.# 2 Old Orchard Rd Expand Existing Patio Consent 5204 (Zaino/Schinfield) Agenda )C- 44 Country Ridge Dr Amendment to Prior Consent 5205 (Wechsler) Approval, (Outdoor Agenda Kitchen Countertop Change), 226 S. Ridge St Change Exterior Brick Consent 5236 (Tucci) Facade To Vinyl Siding Agenda 1 Maplewood Lane Replace Existing Wood Consent 5237 (Balanoff) Decking w/Timber-tech Agenda Peakon, Existing Masonry Patio & Wall w/Westchester Blend Pavers 31 Talcott Road New Windows,New Patio Consent 5238 (Frank/Israel) Doors; & Replace Siding Agenda In-Kind 121 Country Ridge New Windows & Doors 5239 Drive(Novick) For Interior/Exterior Changes 2 Old Oak Road New Deck& Patio In Rear 5240 (Wexler) Yard 19 Beacon Lane Re-Appearance Exterior 5241 (Nebauer) Changes. New Front Porch& 2nd Floor Terrace 78 Tamarack Road Legalize Rear Deck 5242 (Zahl) Remodel 52 Valley Terrace Re-Do Driveway, 5243 (Uzzo) Retaining Wall & Walkway MIL NM MR SE AC MI KC VILLAGE OF RYE BROOK BUILDING DEPARTMENT 938 KING STREET, RYE BROOK,NY 10573 (T) 939-0668 (F) 939-5801 ARCHITECTURAL REVIEW BOARD Tuesday, August 17, 2021 NAME&LOCATION TYPE OF APLLICATION MOTION SECOND APPROVED REJECTED 22 Highview Ave One Story Side Addition 5244 (Saunders/Del- w/Finished Basement Rosario) 90 S. Ridge St(RSP) New Illuminated Sign 5245 Group "Walk In Care Center" 6 Jacqueline Lane New Rear Deck, Patio, 5246 (Gasparino) Windows, Siding& Front Door 108 S. Ridge St New Sign&Awning For 5247 (Win-Ridge) (City M.D.) 9 Charles Lane Legalize 2nd Fl Bedroom, 5248 (Straus) & Install 2 New Casement Egress Windows 2 Jennifer Lane 2nd Floor Addition,New 5245 (Bien LCC) Rear Patio & Renovations 33 Talcott Road Rebuild Rear Deck 5249 (Selzer) 11 Whippoorwill Rd 2nd Floor Dormer 5250 (Aspis) Addition 68 Windsor Road Replace Rear Exterior 5251 (Perry) Stairway 134 S. Ridge St(Win New Sign 'Buff City 5252 Ridge) Soap" ML NM MR SE JM SF AC MI KC 17 3�I - - a 4'Nw, 5*AIcrtA 7 11 SLATE PATIO SLATE PERGOLA ' 2 � S�PcrVEG 2 �A � 32.1' `* ONE ANG ONE hALF STCR ' FRAME OWELLING t J V . J2 2' 0 T R 8P`« - ! a \ •vl 0 � Q aQ o o D C� CD C OLD ORCHARD ROAD AUG -4 2 1 VILLAGE OF RYE ROOK 10 FOOT RESERVED STRIP RESERVED FOR MUNICIPAL USE B DING DEPAI MENT AS PER FILED MAP#7050 -Tr • PREMISES ARE DESIGNATED ON THE TAX MAPS FOR THE TOWN OF RYE SECTION: 135.34 BLOCK:1 LOT:31 SURVEY OF PROPERTY PROPERTY AREA: 19.248 Sq.Ft,-0.4418 ACRE SITUATE IN THE • SHOWN ONCERTAIN MAP ENTITLED "MAP OF SEHOWN HEREON BEING KNOWN AND CTIONS A- & 'BT RYEBLOCK ACRES. THE TOWN OF RYE PROPERTY OF RYE ACRES COMPANY' SITUATED IN THE TOWN OF RYE 'WESTHCESTER COUNTY. NEW YORK. PREPARED BY HOWARD-OCKWOOD LICENSED SURVEYOR DATEC WESTCHESTER COUNTY FEBRUARY 15 1950 AND FILED IN THE WESTCHESTER COUNTY CLERK'S OFFICE DIVISION OF LAND RECORDS.FORMERLY THE REGISTERS'OFFICE OF WESCHESTER COUNTY ON APRIL 26 NEW YORK •950 AS FILED MAP N°.705C • THE OFFSETS SHOWN HEREON ARE NOT INTENDED`O ESTABLISH PROPERTY LINES FOR THE ERECTION OF FENCES STRUCTURES OR ANY OTHER IMPROVEMENT. SCALE:V=20' • ENCROACHMENTS BE-GA'GRADE ANDIOR SUBSURFACE FEATURES IF ANY NOT_OCATED OR SURVEYED:MAY 21 2018 SHOWN-+EREON • UNAUTHORIZED AL TERATION OR ADDITION TO A SURVEY MAP BEARING A LICENSED LAND SURVEYOR'S SEAL.IS A!ICLAION OF SECTION 12C9 SUBDIVISION 2 OF-HE NEW YORK STATE EDUCATION LAWS. 1 • ONLY COPIES FROM THE ORIGINAL OF THIS'3URVEY MARKED KITH AN ORIGINAL OF-4E LAND + Link SURVEYOR'S SEAL SHALL BE CONSIDERED TO BE TRLE VALID COPIES _ • CERTIFICATIONS INDICATED HEREON SIGNIFY -HAT -HIS MAP ;,'AS PREPARED FROM AN Land Surveyors PC. i ACTUAL FIELD SURVEY COND':.CTED ON THE DATE SHO'NN AND THAT SAID SURVEY NAS PERFORMEO IN ACCORDANCE WITH THE EXISTING'CODE OF PRACTICE FOR.AND SURVEYS .. .._ -B PL°.e 845-628-5857 ADOPTED BY THE NEW VORK STATE ASSOCIATION OF PROFESSIONAL LAND SURVEYORS.THIS ...r 1;541 Fan 545462'�X'3 CERTIFICATION SHALL RUN CNLY TO THE PARTY FOR NHOM THIS SURVEY WAS PREPARED AND ON-HEIR BEHALF TO THE TITLE COMPANY AND LENDING INSTITUTION LISTED HEREON THIS CERTIFICATION SHA'_L NOT BE TRANSFERABLE CERTIFIED TO: .__ _._ __ FIDELITY NATIONAL TITLE INSURANCE COMPANY (Title No.17-740fi-51221-W7 ER IK J LINK NE'N PORK STATE_IC=NSEO SETH SCHINFELD .ANC.SUR)EYCR-41 15-2 STACIE SCHINFELD C")PYRIGHT-zGTB SINK ANC-RVE ALL RIGITS RESER`i_C'HE UNA�T4URIZED �EP_CUC-I::A ANIL )R OIST714UTICN'_F THIS RUC..'.-EN-tS IILEGPL 0.0 I :S A.ICW I'1N_VCE'".,NI�EO STAtES.,,;p.a,IUHT J::YS I Z r t a DD 3 AUG — 4 2021E<. . Y VILLAGE OF RYE BROOK �ti • s' 3Y ;• _ BUILDING DEPARTMENT a a WINDING WOOD ROAD SOUTH 44. zi --------------- --------------j I o� • yj 1G A 7 i Age", Np/l jJ J Laura Petersen From: Laura Petersen Sent: Friday, August 20, 2021 11:45 AM To: Anthony Zaino Subject: RE: 2 old orchard rd rye brook job insurance&WC HI license needed Thank you Anthony. What is Cello's last name? ��T r��J G�f 's 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 Ioeterseneryebrook.org From:Anthony Zaino<azaino@charter.net> Sent: Friday,August 20, 2021 11:39 AM To: Laura Petersen<LPetersen@ryebrook.org> Subject: Fwd: 2 old orchard rd rye brook job insurance &WC Hl license needed Laura please see the attached.The contract is cello from energy paving inc. cell 914 490-9846. My cell is 203 417-2979. Thanks for the assistance Anthony Zaino Raw cell Q Sent from my iPhone A-I Q,1(U Begin forwarded message: From:Anthony Zaino<azaino@charter.net> Date:August 20, 2021 at 11:18:21 AM EDT To:Steven Fews<SteveFews@ryebrook.ore> Subject: Fwd: 2 old orchard rd rye brook job insurance&WC HI license needed Steve please see the attached and let me know what the total fee is so I drop off the check and I pick up the permit. Please call me if you need any additional information. 203 417-2979 Thanks Anthony Zaino Sent from my iPhone Begin Good Morning Anthony, Please find certificates and license attached. Kind Regards, i Viviane Oliveira c/o ENERGY PAVING, INC. 62 Grand Blvd Scarsdale, NY 10583 From:Zaino, Anthony< �%�+r[� I anmrr • ��t�at•H.ar►r•ler(nunp Fucwp , Jamr•1lalvw,. �,•�'��»2 IMrttly.f,+mrarrr Prnrrau+,w � a, a Department of Consumer Protection - llome !nlpro►•ement license ENERGY PAVING INC. .� 62 GRAND BLVD i SCARSDALE.NY-10583 I hit license,t'"'C)In acc,.nlan•c rAh Mia is\%'1 411 Iht rela Cuwrly C'otuuntn Prcn�,choll Cwle slkl a�ahJ imly upon pncwnce ornccoRrtal dLT,1rj11nC t►aaal.Proa1 al.111. ship,a l ni,pahr•n sraluf i.txH rry Lviiauircd C)uuand of Iha Iw.rnsc. 1 Nr r 1 t)R I I hl R\1 P'URNiShS 1 Cony li{ Llcrnse\'unoher . o A Dare[it 1-%plrnh,wt WC-16411-HO6 ,? 4 10131/2022 s 'c Per COUR a 2 DATE(MM/DDIYYYY) A�ORO® CERTIFICATE OF LIABILITY INSURANCE 07/28/2021 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 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). I, PRODUCER CONTACT ArnV LItSI(V Barn Brokerage, Inc. PHONE FAX 169-04 Hillside Avenue 71 297-3 AC.No:(�18)739�992 E-MAILADDRESS: bamins1 aol.com Jamaica, NY 11432 INSURE S AFFORDING COVERAGE NAIC0 INSURER A: INSURED INSURERS: Energy Paving, Inc. INSURER C. 62 Grand Blvd INSURER ID: Scarsdale, NY 10583 INSURERE: 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. INSR TYPE OF INSURANCE ADDL SUBIR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DI MM/DD COMMERCIAL GENERAL LIABILITY A Q ETORENTED $2,000,000 CLAIMS-MADE OCCUR 09/02/2020 09/02/2021 PREMISES Ea occurrence $100,000 MED EXP(Any one person) $ PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO ❑ LOC S2,000,000POLICY 1-1JECT PRODUCTS-COMP/OP AGG OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea aa.d." ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED (Per accident) AUTOS AUTOS BODILY INJURY(P $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $0 DED RETENTION$ $ WORKERS COMPENSATION 11 PER OTH- .AND EMPLOYERS'LIABILITY Y/N STATUTE 11 ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDE[ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Certificate Holder is Additional Insured with regard to General Liability coverage as per written agreement.Coverage is Primary and Non-Contributory. Waiver of Subrogation applies.CGL181602016 form has been added. CERTIFICATE HOLDER CANCELLATION Village of Rye Brook SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 938 King Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Rye Brook, NY 10598 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund WESTCHESTER ONE,44 SOUTH BROADWAY, 10TH FLOOR,WHITE PLAINS,NY 1 0601-441 1 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE � 0 n n A A A A 134191664 BAM BROKERAGE INC o- e 169-04A HILLSIDE AVE JAMAICA NY 11432 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER ENERGY PAVING INC VILLAGE OF RYE BROOK 62 GRAND BLVD 938 KING STREET SCARSDALE NY 10583 RYE BROOK NY 10598 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE :] W2202 525-8 748085 01/28/2021 TO 01/28/2022 8/4/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2202 525-8, 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://WWW.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. CELSO GONCALVES ENERGY PAVING INC 1 OF 1 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. NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 867527673 U-26.3 Tara Gerardi From: Mike Izzo Sent: Monday, August 23, 2021 3:29 PM To: Tara Gerardi; Laura Petersen Subject: FW: Message from Dig Safely New York, Inc. (DSNY) Michael J. Izzo Building&Fire Inspector Village of Rye Brook,NY (914) 939-0668 -----Original Message----- From:Dig Safely New York Exactix<tickets@exacdx.digsafelynewyork com> Sent:Monday,August 23,2021 10:43 AM To:Mike Izzo <MIzzo@ryebrook.org> Subject: Message from Dig Safely New York,Inc. (DSNY) ****REGULAR**** DIG REQUEST from DSNY for:VIL RYE BROOK Taken:08/23/2021 10:41 To:VIL RYE BROOK PRIMARY Transmitted:08/23/2021 10:42 00001 Ticket: 08231-000-881-00 Type:Regular Previous Ticket: ------------------------------------------------------------------------------ State:NY County:WESTCHESTER Place:RYE BROOK Addr: From: 2 To: Name: OLD ORCHARD RD Cross: From: To: Name: Offset: ---------------------------------------------------------------------------- Locate:WORKING AT THE BACK OF THE HOUSE NearSt:BERKLEY DR&WINDINGWOOD RD S Means of Excavation:EXCAVATOR Blasting. N Site marked with white:Y Boring/Directional Drilling. N Within 25ft of Edge of Road:Y Work Type:INSTALL PATIO Estimated Work Complete Date:09/03/2021 Depth of excavation: 10 INCHES Site dimensions: Start Date and Time: 08/26/2021 07:00 Must Start By:09/10/2021 ------------------------------------------------------------------------------ Contact Name:MARCELO ALARCON Company: ENERGY PAVING Addrl: 62 GRAND BLVD Addr2: City: SCARSDALE State:NY Zip: 10583 Phone:914-490-9846 Fax: Email: energypaving@hotmail.com Field Contact:MARCELO ALARCON Alt Phone: 914-258-9334 Working for:HOMEOWNER ------------------------------------------------------------------------------ Comments:PATIO 400SQ FT 1 :Lookup Type: PARCEL ------------------------------------------------------------------------------ Members:ALTICE USA CON-ED SUEZ WTR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR z SECT10 N ..• • • N 7�o 5,91 /N DGe„ sT 0 Z NWgCC No. a Q Z a RAC y o �l�Cl -Ti n N ,y O C /A/ O z n A S P H A L r DRI V E W A Y /X 0 i%; :, O CD O O O / _ Un n / a Lo � Cn KJO � /�'. //:/ __��0.43cv Jam•-T��5��k 0 rij O O / C cz r a' pd� N CV i0O 09 9 1100 1 e79 oGn n' 1 V Q o • o _ HLOOS GVOY GOOM ONIGNIM 4 _ m _ �- 73 c-M 711 �D oa zm (T( ��D d - - A s V%co o �A Q �m c o o o O O O O O O 0 M • W tn0 m0c Mm m- n'D(n-1 /�/m n �Zmnm cz vc sz Wx a°J'Mno�ss Cn . •�/ D v m tnv�o�o�� �r cob O0 n"' �v�coom IT1 O m 0 s m np-iM'nC « n<c *� O D Z��� S r -i ii-qO n Dm-i z0 dM tn�c mZM Q n 9 3 ,1 111 — Mz-MMOar - 0p �-<s D 0 �m� � m - Z — to --q> M -� Nm z�� s m0 Z z M Q O m GF n = Z 0 nm0�a�0 � COm mm 0� von, 0 m � Z -n ; Sr = Z Mz�ZVZ om Mtn p -nD(n oN e �t D -� Gov = tn� ° Z� m= ��o� n� : E d z O -m�mDc_ O cn z0 �� ems 4 � m .. o szn z 0 -� o�°� p W m p M o Z z�9 p<v- _� �m m �z o x>� --1 01 rn v Z tiwA < < �/p• I'- V� r' n 2 D r - = V Z D k z /� M orn p D D �m <�° o �m omv.nz W o 0 2 13 r r�CODD0 1 rO O� �� o'xr-n�m m rn .p — ° c S `3S9 rpZ;a M m� O 0 Cm �rm� D G) m1 s ENE UrVe -� ziOxmz° nO �z 00 ��� m z O Rq � � r Omzcn vs Oz -° -jZ s_�0 0 D O O ^� Y 0 tiles m r��nm ZD ZD6 m cD MEMOmza K z Go Cfl m o p �s Z m�-gym=mm -0 0o mm m-q -0-Am jV r v O 01A N -ir0 •�°O °0 on �Z psoo R1 �� U) m D= z m �� v pp _m��Z�z Q O �J • •. , C �n-��mp rn= m0 0 004�m. m0oon Z mtznOm0 z� aF, 0Z Z o °A (� D O ENE •. 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