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HomeMy WebLinkAboutBP21-222PERMIT # ��_ DATE: as �/�,., EXP SECTION 135, 3 3 BLOCK_ LOT TYPE OF WORK lPit) Jj( D y41_/446-jol JOB LOCATION! OWNER CONTRALTO EST. Veo # f Ya r O - fec Siof) 2�e -C�i u5e�o aval)o .o� iy 734*�0"4q TCO #! - F'EE - DaYEmmwm,s INSPECTION RECOR�1 DATE FOOTING - FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS SPRINKLER ELECTRIC LOIN -VOLT Q ALARM AS BUILT FINAL INSP OTHER APPROVALS ARB �I•Te�4.�G,�ll BOT PB ZBA OTHER AS-gUILTlFINAL SURVEY REQUIRED PRIOR TO FINAL INSPECTION L L ZL LC--; v V G 4 4V Vy'Ji 19 .I VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook, N.Y. 10573 ADMINISTRATOR Paul S. Rosenberg (914) 939-0668 Christopher J. Bradbury www.ry-ebrook.org TRUSTEES BUILDING& FIRE Susan R. Epstein INSPECTOR Stephanie J. Fischer Michael J. Izzo David M. Heiser Jason A. Klein CERTIFICATE OF COMPLIANCE November 23,2021 Gregory Bassuk&Dana Bassuk 20 Pine Ridge Road Rye Brook,New York 10573 Re: 20 Pine Ridge Road, Rye Brook,New York 10573 Parcel ID#: 135.33-1-19 Building Permit#21-222 issued 8/25/2021 for a New Fence This certifies that the new four foot high rear yard fence,installed under the above captioned permit has been satisfactorily completed. Sincerely, Michael J. Izzo Building& Fire Inspector /tg D V � '� For officM BUILDING, ti "A TMENT PERMIT Ql�l NOV 2a21 VILLAGE OF RYE BROOK ISSUED: 938 KING STREtT,RYE BRQOK,NEw YoRK 10573 DATE: VILLAGE OF RYE BROOK (914)939-0668 FEE:,S //©— PAmZ, BUILDING DEPARTMENT $� APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION kkkk#ktfsftt•ft••stttf►lrt►lrt►###rt##rt/f#t###i#f#i#i#rt###ff#iR#iR##►tf►►►fRfft►#t►►►RR►fft►►►►►►►t�►►►►►►i►►►►►►►#►►►►tft►►►tt►k# Address: _20 lam'�1/tl D6 f gy . Lf� I.7% c L,�"3 Occupancy/Use: /I i9 Parcel ID#: 13 S, '� A L c it -2 L er- (1 Zone: Owner:�t�rh 64 4 fvk c =&no b. 5 5jL Address: P.E./R.A. or Contractor:i�Aya N Ems" ddress: qif, - 1'?L- Z 6(0 Person in responsible charge:6[0:�J f e* e AkkLLtj Address: !fl;, 23(. �G y Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law STATE OF NEW YORK,COUNTY OF WESTCHESTER as: '] / r SS being duly sworn,deposes and says that he/she resides at t ame of Applic t) 1 (No.Ad Street) in 6130i in the County off i( rS�-_ ! in the State of `� ,that (City/Town!Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$ AC' p for the construction or alteration of: Ax-kj 4 ,A{+ U 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 rue this day of fl tf-\. , 2o2_ day of , 20 Signature'of operty er SigaatureofApphcant t.G. t Name of Pro a er Print Name of Applicant "A .. Notary Public Notary Public SHARi ML=LiLLO Notary Public, State of New York No. 01 ME616,9^G3 S/l2l2021 Oo,iafifed in Westchester County Commission Expires January 29,20� �E BRC�rJ,�. 1982 BUILDING DEPARTMENT BUILDING INSPECTOR QASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 rvww.Uebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : C\ DDRESS : C\ ` ,' ' DATE: t PERMIT# ISSUED: f ) C SECT: BLOCK: LOT: LOCATION: OCCUPANCY: 2 ❑ VIOLATION NOTED THE WORK IS... ACCEPTED © REJECTED/REaNSPECTION ❑ SITE INSPECTION ( _ f 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 c, ❑ OTHER Building Permit Check List&Zoning Analysis 1 E Address: �� !�+ ~� ���'�.{�� — SBL: Zone:�n—[<Use: Const.Type: Other: Submittal Date: (0 [Z q [Z d Revisions Submittal Dates: Applicant A S &u k- Nature of Work ) [ - G r- t^,� Reviews:ZBA JUL - 1 2021 PB: BOT: Other. ( ( ) FEES:Filing:T C/O: Legalization: ( ) (�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 FLAN:Topo: Site Protection S/W Mgmt.: Tree Plan: Other. ( } ( ) SURVEY:Dated: Current: Archival: Sealed: Unacceptable: ( } ( } PLANS:Dat tamped: Sealed Copies: ____Electronic: Other. License: ✓ Work ems C mp: +� Liability: l Comp.Waiver. Other. Cam( ) CODE 753#: o a�f- 0- �i -o ! Dana �-iapa l - 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. (-)'(RB mtg.date: T 2 I Z.1 approvak L�jnotes: ( }ZBA mtg.date: approval- notes: ( }PB mtg. date: approval- notes: APPROVED REOutRED ExrsT�v� PROPOSED NOTES .� 2 2 7Q Area Cu 21 FronC Fr sue: Main Cov Arcs,Cow Ft.H S Sd.H S !Q A. Tot.imp: Ft Imp: Hdght/Stories: notes: B'UILDkIN6& iRTMENT D 1ECMWE ID VILL Et1F.RY ` OOK JUN 2 4 2021 938 KING ,', FT RYE 1BR ` ,,NY 10573 VILLAGE OF RYE BROOK (914)93 439-5801 BUILDING DEPARTMENT ARCHITECTURAL REVIEW BOARD CHECK LIST FOR APPLICANTS This form must be completed and signed by the applicant of record and a copy shall be submitted to the Building department prior to attending the ARB meeting. Applicants failing to submit a copy of this check list will be removed from the ARB agenda. .lob Address: 20 Pine Ridge Road,Rye Brook,NY 10573 Date of Submission: June 24,2021 Parcel ID#: 135.33-1-19 Zone: R-15 Proposed Improvement(Describe in detail): APPLICANT CHECK LIST: MUST BE COMPLETED BY THE APPLICANT Installation of a 4'fence in backyard The following items must be submitted to the Building Department by the applicant-no exceptions. 1. ( )Completed Application 2. ( )Two(2)sets of sealed plans. (one full size (maximum Property Owner: Gregory Bassuk allowable plan size=36"x 42"� and one I 1"x 17") Address: 20 Pine Ridge Road.Rye Brook.NY 10573 3. ( )Two(2)copies of the property survey. 4. ( )Two(2)copies of the proposed site plan, Phone# 917.544.6548 5. ( )One electronic/disc copy of the complete Applicant appearing before the Board: application materials, 6. ( )Filing Fee, Gregory Bassuk 7. ( )Any supporting documentation. Address: 20 Pine Ridge Road,Rye Brook 8. ( )HOA approval letter. (ifapplicable)NY 10573 9. ( ) Photographs. Phone# 917.544.6548 10.( )Samples of finishes/color chart. (a sample board or model mmv be presented the night of the meeting) Architect/Engineer: Phone# By signature below, the owner/applicant acknowledges that he/she has read the complete Building Permit Instructions&Procedures,and that their application is complete in all respects.The Board of Review reserves the right to refuse to hear any application not meeting the requirements contained herein. t�-i't'� Sworn to bef e this 2 1 Sworn to be Mn-te this 2— r day of 2-1 day of 20 - AM h — Z signature of Propdrty Owner pp S i g n a t 6 A'of Ap-pi ant Gr r �7a5Sv�` rzjo !;5jc Print Name of O er Print Na of plicant Notary Public otary Public DREW P.ALEXANDER NOTARY PUBLIC OF NEW PORK DREW P.ALEXANDER I.D.#OIAL6414646 NOTARY PUBLIC OF NEW YORK3121r19 MY COMMON EXPIRES 03/01/2025 I.D.#OIAL6414646 MY COWSION EXPIRES 03101=5 ' VILLAGE OF RYE BROOK BUILDING DEPARTMENT 938 KING STREET, RYE BROOK, NY 10573 (T) 939-0668 (F) 939-5801 ARCHITECTURAL REVIEW BOARD Wednesday, July 21, 2021 NAME &LOCATION TYPEOF APPLICATION MOTION SECOND APPROVED REJECTED_ APPL.# 1 Lincoln Ave (Parr) Replace Wood Retaining Consent 5209 Wall, w/Masonry Liberty Agenda Stone, & Walkway 15 High Point Circle Re-Do Existing Deck in Consent 5219 (Hashimoto) Trex, Railing & Stairs. Agenda Paver Patio on Grade 8 Fairlawn Pkwy Roof Top Solar Array Consent 5220 (Levin) Agenda 17 Eagles Bluff 4' High Open Picket Fence 5221 (Seguljic) Rear Yard 4 Belle-Fair Road 6'0" Fence In Rear Yard Consent 5222 (Kitchin) Agenda 20 Pine Ridge Road New Fence Consent 5223 (Bassuk) Agenda U� 39 Mohegan Lane Replacement of Bluestone Consent 5224 (Sheinheit) Walks In Kind Agenda 7 Ridge Blvd Amendment To Prior 5225 (Holleran) Approval - omit window 16 Maywood Ave Rear Yard Deck 5226 (Robles) Expansion 17 Jeniffer Lane Above Ground Swimming 5227 (Dutra) Pool, Retaining Wall, Fence& Re-grade Yard 43 High point Circle Removed Old Existing 5228 (Goldman) Deck, To Build New Deck 8 Heirloom Lane New Rear Deck 5229 (Goldman) ML L,- NM MR SE JM (/ SF t/ 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 Wednesday, July 21, 2021 3 Edgewood Drive Exterior Projects, Deck 5230 (Feldberg) w/Stairs to Patio, Pergola, Outdoor Kitchen, Pond- less Water Feature 19 Beacon Lane Reconfigure Roof, New 5211 (Nebauer) Front Porch, & 2nd Floor Terrace 167 Country Ridge 1 Story Side In-Fill 5232 Drive(Hugon) Addition 11 Berkley Drive Rear 2nd Story Addition, 5233 (Signh/Gawtam) Rear Deck& patio. New Front Portico 19 Birch Lane In-Ground Pool, Turf 5234 (.laccoma) Patio, Rear Yard Fire Pit 51 Country Ridge Dr Enlarge Existing Deck, 5235 (Wolf) Enlarge Existing Patio, New Front Walk 108 Old Orchard New Front Gable Roof, 5236 Road (Martino) Masonry Steps, Patio, Flagstone Walk& Cupola Over Garage. ML NM MR SE JM SF AC MI KC Laura Petersen From: Laura Petersen Sent: Friday, July 23, 2021 3:24 PM To: gbdrl @yahoo.com Subject: Building Permit Application - 20 Pine Ridge Road Good afternoon, 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, V"L General contractor's contact name (first and last) v"'2. Copy of general contractor's valid Westchester County Home Improvement License. s"3. General contractor's valid liability insurance (the Village Of Rye Brook must be the certificate holder) VL4.)3eneral contractor's valid workers compensation on a NY State Board form (C105-2 or U26.3) - 5. Building permit fee $100.00 (due once permit is issued and ready for pick-up) 6. Contractor must call Dig Safe NY and get a ticket number. 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 Ii)etersenCc_D yebrook.org 1 Laura Petersen From: Greg Bassuk <gregbassuk@gmail.com> Sent: Sunday, August 8, 2021 7:40 AM To: Laura Petersen Subject: Fwd: Building Permit Application - 20 Pine Ridge Road Attachments: Certificate jpg; insurance-1.jpg; insurance-2.jpg Hi Laura, Thanks for your note below. I'd like to stop by your office to pay the$100 Permit Fee. Here is the other information you requested below: 1)Gener ractor's contact name(first and last) ...1-ram Giuseppe Cavallo Precision Fence (914)736 2664 2)Copy of general contractor's valid Westchester County Home Improvement License. Attached General contractor's valid liability insurance (the Village Of Rye Brook must be the certificate holder) Attached 4)General contractor's valid workers compensation on a NY State Board form (C 05-2 or U26.3) Attached 5) Building permit fee$I00.00(due once permit is issued and ready for pick-up) Can I drop off this payment on Monday? V/6)Contractor must call Dig Safe NY and get a ticket number. Contractor has called Dig Safe NY. I will provide you with the Ticket Number. Please let me know if you need any additional information, and when I can come to drop off the$100 payment. Thanks very much. Regards, Greg Greg Bassuk 917.544.6548 Begin forwarded message: From: Laura Petersen<LPetersen@ryebrook.org> Date:July 23, 2021 at 3:24:33 PM EDT To: bg drl@yahoo.com Subject: Building Permit Application-20 Pine Ridge Road 1 ----- - < C 7 QG yy � $ram � •�^ � .y � •;,� „j p i CC v 41 s \ y ° f •f w = Q ' U w a = - ck osecboq cry tit O > cnOZ LU �. O ,•• ,� 11 r uj — ?ledea a � y a � = CD 1! F j �Y _� � R t `�'•• c A��' CERTIFICATE OF LIABILITY INSURANCE DATE QW THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND COWERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate hokler is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed, It SUBROGATION I$ WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsemerd. A staternerlt on this certificate does not confer rlaffls to the certificate holder In Ifeu of such elTdorseerlerd s. PRODUCER CONTACT FEDERATED MUTUAL INSURANCE COMPANY -111AME; CLIENT CONTACT CENTER PHONE HOME OFFICE:P.O.BOX 328 wrc No ExR:BU-333 1949 we No):507-446-4884 CNVATONNA,MN 55060 ADMDRess:CUENTCONTACTCENT FEDINS.COM INSURERS AFFORDING COVERAGE NAFC p INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 178-846-2 INsuREa it FEDERATED RESERVE INSURANCE COMPANY 16024 CAVALLO&SONS LANDSCAPING CORP. INSURER D: 1517 MAIN ST PEEKSKILL,NY 1 0566-31 1 6 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:59 REVISION NUMBER:0 THIS IS TO CERTIFY THAT THE POLICIES OF INSL1RANC7 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. INUIR TYPE OF INSURANCE POLICY NUMBER LIMITS OL SUBR POLICY EFF POLICY EXP X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S1,o00,D00 CLAJMS-MADE OCCUR DAMPREEAGE TO RENTED 5100,000 MED EXP(Any one persm) EXCLUDED A Y N 61D1540 0711812021 07/18/2022 PERSON D0 AL aADVINJURY $1,O000 EOTHER:N'L ADOR OATS LIMIT APPLIES PER. GENERAL AGGREGATE S2 D0D 000 X POLICY JJEECT ❑LOC PRODUCTS-COMPIOP AGO $2,DDO,00O AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1 OD0 X ANY AUTO A OWNED AUTOS ONLY � SCHEDULED BODILY INJURY{par person) AUTOS N N 6101540 07/18/2021 07/18/2022 BODILY INJURY(Per oodeanQ HIRED AUTOS CNLY NON-OWNED AUTOS ONLY PROPERTY DAMAGE (Per acciftd X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $2,000,000 EXCESS LIAa CLAIMS-MADE N N 6101542 07/1812021 07/18/2022 AGGREGATE S2,000,000 ,c:) X RETENTION "AORKERS COMPIRSATTON AND EMPLOYERS"LIABILITY - X PER STATUTE I gR ANY PROPRIETORlPARTNERIEXECUTIVE E.L.EACH ACCIDENT OFFlCERIMEMBER EXCLUDED? MIA A N 6101543 07/18/2021 07/18/2022 51,000,000 IMandaRory In NMI E.L.DISEASE•EA EMPLOYEE $1,DOO,000 If yes,dasvibe under DESCRIPTION OF OPERATION$below ILL DISEASE•POLICY LIMIT S1,000,DDD -ESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES IACORD 101.AShcOenal Remarks SIMAIII a,maY be atiached if more spoor it repaired) SEE ATTACHED PAGE CERTIFICATE HOLDER CANCELLATION '78`846-2 590 VILLAGE OF RYE BROOK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 938 KING ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN RYE BROOK,NY 10573-1226 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE _ Z 1988-2015 ACORD CORPORATION.AN ri"reserved. ACORD 25(2018I03) The ACORD name and logo are registered marks of ACORD f_t �hw Workers' CERTIFICATE OF TE Bo� r�ard NYS WORKERS' COMPENSATION INSURANCE COVERAGE 13 Ia.Legal Name&Address of Insured(use street address only) 1b Business Telephone Number of Insured Cavalio&Sons Landscaping Corp. 914-788-1700 1617 Main St Peekskill,NY 10566-3116 1c. NYS Unemployment Insurance Employer Registration Number of Insured 0792057 Work Location of Insured fOnly,required it coverage is specifically limited to 1d Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i e.,a wrap-up Policy) Number i 20-1775094 2.Name and Address of Entity Requesting Proof of Coverage 3a Name of insurance Carrier (Entity Being Listed as the Certificate!-folder) Federated Reserve Insurance Company Village of Rye Brook 938 King St Rye Brook,NY 10573-1226 3b. Policy Number of Entity Listed in Box"1a" 6101543 3c. Po#icy effective period 0711812021 to 07i 1812022 3d.The Proprietor,Partners or Executive Officers are included.IOnly check:box if all partners'otficers included) ❑X all exrluded or certain partnerwoffieers excluded- This certifies that the insurance carrier 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". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancef the policy or eliminate the insufed from the coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c", whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed,nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business roust 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: Justin Gwaltney (Print name of authorized representative or ficen.9ed agent of insurance carrier) Approved by: �`V ' �,' ? > `A,t•`P. Title:Certificate Center Representative Telephone Number of authorized representative or licensed agent of insurance carrier: 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 (9-17` www.wcb.ny.gov Laura Petersen From: Mike Izzo Sent: Tuesday,August 10, 2021 10:05 AM 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@exactix.digsafelynewyork.com> Sent: Tuesday, August 10, 2021 8:18 AM To: Mike Izzo <Mlzzo@ryebrook.org> Subject: Message from Dig Safely New York, Inc. (DENY) ***'*REGULAR**** DIG REQUEST from DSNY for: VIL RYE BROOK Taken: 08/10/2021 08:16 To: VIL RYE BROOK PRIMARY Transmitted: 08/10/2021 08:17 00001 Ticket: 08081-000-014-01 Type: Regular Previous Ticket: ------------------------------------------------------- ...................... State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 20 To: Name: PINE RIDGE RD Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: REAR OF PROPERTY, RIGHT SIDE OF PROPERTY AS FACING, LEFT SIDE OF : PROPERTY AS FACING NearSt: LINCOLN AVE Means of Excavation: N/A Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: FENCE INSTALL Estimated Work Complete Date: 09/14/2021 Depth of excavation: Site dimensions: Start Date and Time: 08/13/2021 07:00 Must Start By: 08/27/2021 ------------------------------------------------------------------------------ Contact Name: GREGORY BASSUK Company: Addr1: 20 PINE RIDGE ROAD Addr2: City: RYE BROOK State: NY Zip: 10573 Phone: 917-544-6548 Fax: Email: gregbassuk@gmail.com Field Contact: GREGORY BASSUK Alt Phone: 917-544-6548 Working for: WORK TO BE PERFORMED BY: PRECISION FENCE ------------------------------------------------------------------------------ Comments: CALLER ADVISED TO HAVE CONTRACTOR CALL DIG SAFELY NEW YORK : Lookup Type: PARCEL Members: CONED SUEZ WTR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR 2 3dw�tr1i4"YM ONimine 8e � o 3E)VIIIA — ad IZOZ +r Nnr Im T�.3 �i1M•���1 � � I I M 6SW • 49i • - . .' ••��P ►� ?Msd tt►� �ati��y� � {e � �4 �aPun� i Z :II�LUl�By v} awa fewlddd I 00 O1•.v� �• - , 11A rr 0 � •M � � � O . .O N G 1 N0f Sa i• , )G01 S "1'dNti��illfl9"Sd oa'SZ j �•QO .Ot''95 'S i . •r 1 Ill VV �VJ L i W a = c u � 41 O c 0 a LLn l = a a o cc Ln Ln °� �J 00 L L v 0 Y i m aOy = O t � vi of a C d a n t7 CP ar m N Qz � 3 n 0 _ a m v 3 E Ln C 0 Y Y a u u E m R m c m m :r u a x x n a`a m V a a N ---------- --- +a 0 L v d Z Lly C JUN 2 4 2021 DD VILLAGE OF RYE BROOK BUILDING DEPARTMENT TOWN OF RYE/VILLAGE OF RYE BROOK N 35'40'00" E Tax Lot 25 120.00' N-0.4' Tax Lot 24 E—On line . 000Q � 0000 � . \f\ 6•6' Raw of Hemlocks \I X X X x X X X X X X X X X �17J( X114 X 6.4' O N_1.9^ Chain Link Fen c e 5-0.2 p E-6.6' 8.0' t!} S—O 8' Concrete Apron Wood m m 33.9' 33.6' shed u C� a 42.0' 7.8' a LO C N v `` Flag Wood Ramp Tax Step 5fl.1' tN-0.5' i Lot i Wood Deck 6.5'E50.0°c Conc.. Pad Chain L In k Fen ca Lot E —x x x x x x x '2 - Gate 2 Story Frame G a t e x x with Attic AC ❑ ( House # 20 ) Unit on Conc. Tax Pad I-----1 N--On Una 3.�' I Lot I —x Elect. Flog I 20 I Meter Porch gay 16.5' Window 3° Tax Flog Steps ---� Lot ` 0 0 ° Steps Platf. i Lot i i i fir; s I I t 4 19 I .,,y� 0 A 50.8' w 44.2' 0° 44.3 a�45.5' _ a U T 0 M 'NT 0 y� s eG L d W-0.3' n W 1 20 S t o e �Po .0�` Utilityy� Utility o !+ �$ Pole r Hydrant Pole S 35*40'00" W 1r6 S t o n e C u r b, S t o n e Cur b CERTIFIED TO : Pine Ridge R GREGORY BASSUK & DANA BASSUK SURVEYED AS IN POSSESSION Or'g,, a, date �ir�,e r96 THE MUNSON COMPANY -�--- Brought to dote Oct 25, 1965 9 NORTH GOODWIN AVENUE NYS [ - e .50054-2 Brought fo date & Redraffed Nov. 10 2021 ELMSFORD, N.Y. 10523 R �CIllWI j SURVEY OF LOT 3 AS SHOWN ON A MAP ENTITLED Scale 1 "=20' SECTION FOUR, PINE RIDGE" DATED AUG. 20, 1959 Igo Y 1 2 2021 & FILED NOV. 24, 1959 AS COUNTY CLERK MAP NO, 12212. SECTION 135.033 VILLAGE OF RYE BROOK Unauthorized alterations or additions to a survey map is a violation BLOCK 1 ��❑❑7}.t��t,,1��of section 7209, sub-division 2, of the New York State Education Law." UNDERGROU I EI't(CJ T 'Only copies of the original survey marked with the land surveyor's LOT 19 L inked or embossed seal shall be considered a true and valid copy." ETC., IF ANY ARE NOT SHOWN See J-4604.dwg J-4603