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HomeMy WebLinkAboutBP21-228PERMIT # d Y DATE. SECTION Zc! 9 r 740 ` BLACK, LOT , �: / TYPE OF WORK JOB LOCATION. OWNER�Q CONTRACTOR_5 EST. V/CO # COST IGe�70✓a/o007 -�- c C' Q,l/1Cl�845)10c)* V5ai 7 — pz> TUV FEE l7ATE DATE INSP FOOTING FOUNDATION //�� FRAMING _�s(�,� Jazale I9. T/ RC FRAMING INSULATION PLUMBING RGH PLUMBICN7G CIieC4/lC �a'!G GAS cd;>/-��9�,SQc�oV1 SPRINKLER ELECTRIC a LOW-VOLj� Q [Jl' AS BUILTI FINAL OTHER APPROVALS ARB BOT PB ZBA OTHER VILLAGE OF RYE BROOK WESTCHEST R COUNTY, NEW YORK `j `aQc NO: 22-012 Certifirate of Occupaurp This is to certify that of, f� 1� / V having duly filed an application on t V �j . 20 —;2,;,c requesting a Certificate of Occupancy for the premises known as, '=23 I TLQ O+'C O.C` ) , Rye Brook,NY, located in a L Zoning District and shown on the most current Tax Map as Section: 16�?01. Block: ►� Lot: n , and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. / — e9j , issued E) 20 - / , 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: —,3 0/0 - F(.r i">7 i ,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 height shall be made,nor shall the building be moved from one location to another until a permit to accomplish such change has be bta ed rfLie`Building Inspector. Building Inspector,Village of Rye Brook: Date: JAN 2 5 2022 r� l �`� R `` For office use onl : D u U L� BUILDIlYd MENT PERMa# aal� VIL) XGE OF RYE BROOK ISSUED: —3O—Q �AN $ 2�2� ID38 KING STRE RYE BROOK,NEw YORK Id573 DATE: ^/ --a a \ ..,14)9 -:0%W FEE4 c-::)35— R,,,MJd, VILLAGE OF RYE BROOK W1W. BUILDING DEPARTMENT APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCES AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION ik#ti###rtt4R#tiR#tt#rttKtRtR##rtt##ti#Rrt#Rttrtrtktit#R}ti}}#it#iit}}}R#tkitt#tttrtR}iktiti#Rkii#R#itrtR i###4######4!#}ttt#t#t#ttt}♦ Address: 031 '�YQeb - Occupancy/Use: / Parcel ID#: I c)9, 74-/! S/ Zone: 61 Owner: 5ha/i1 � TinifthdA tSM' s Address: 1931 Emgkp 6-qatrq; R4?&60/< P.E./R.A. or Contractor: cSNS C&4MIC T�OC Address:,33 LOCju ) d t&W M' d2 PAC.-/l)l/ /05L/r Person in responsible charge: AiC'i C arinc1 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�.�OI:NEW YORK,COUNTY OF WI STCHESTER as: being duly sworn,deposes and says that he/she resides at � f 1'pGBI)�- (Print Name ot'Appiicant) o.and Street) in 019&00 —,in the County of hi in the State of that (City/Towni 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:$ 661 4101 II LL for the construction or alteration of: tkli{ Qld I"R Aa ✓ Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of tccupancy/Compliance is sought,and that to the beet 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 j Sworn to before me this; day of , 20^ day of , 20 01 Signature of Property Owner Signature of Applicant t Name of Property Owner Print Name of Applicant Notary Public SHARI MEULLO Notary Public Notary Public, State of New York 10110fied in Westchester County Commission Exla'rres January 29.20 � 4yE BRC,Jk. 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR J:I ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BrROOK /❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - �- - - - - - - - - - - - ADD :•R SS . ATE' PERMIT# — `i,-?-2y T�ISSUED: ' ECT: BLOCK: LOT: LOCATION: I Ca l OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION f REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS p L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION - �INAL OTHER QyE BRC�v� . 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR [a 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.Uebrook.org - - - - - - - - - - - - - - - -- - - - INSPECTION REPORT - - - - - - - - - - - - - - - - ADDRESS . 1 .� t—= DATE: PERMIT# ISSUED: :;A-4zf- SECT: BLOCK: LOT: LOCATION: [�C `-�c= � OCCUPANCY: —� ,d ❑ 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 QyE DRC��w . 1982' BUILDING DEPARTMENT ❑BUILDING INSPECTOR `TASSISTANT 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.ore - - - - - - - -- - - - - - - - - - - - INSPECTION REPORT - - - - -- - - - - - - - - - - - - - - ADDRESS : , \ ` \ DATE: 10 �-�GM PERMIT# � 2 r ISSUED: ?ICT: BLOCK: LOT: LOCATION: OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... �,"% ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P.GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER en ,. in N N i r1 cl 0 0 N 00 ' 00 .W O a Q C Z Ln .+ ON � O kn F in CJN py oo m • 16 _ w + Z O Q Q W ww Ch3 h Q G W c7 r • W z � � � � u z � ON r } o w Y Mr ICI L W N Z P" o f 0 4 i � O Z a a rA ce w v o o g N x H 6 w a 0. a r BUILDING DEPARTMENT VILLAGE OF RYE BROOK OCT 5 2�21 ID 938 KING STREET RYE BROOK,NY 10573 {9l4)4�9-0�658 VILLAGE OF RYE BROOK BUILDING DEPARTMENT W%vw.rvebrook.urb ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR C,1 FOR OFFICE USE ONLY BP #: Q I— Z)�V I:P#: dI-Cc )s / OCT 1 8 Ml Approval Date: Permit Fee: Approval Signature: (kher: Disapproved: (fees Are non-refundable) ************************************************************************************************** Application dated,/O /*r 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,fixtuees,or to perform other high or low voltage electrical work as per the detailed statement described below. The applicant St property owner, by signing this document agree that all electrical work performed will be in conformancc with all applicable Federal,State,County and Local Codes_ I.Address: �k31 Tye,f, , ('t-e vc&L ?�e6,ak' k SBL: /C)1- 716—/—_Sl zone:Pit 1� 2.Property Owner: Am&'A � ,��1!^1 .�ry>5 Address: .�31 i'e i tc' '���x �✓ k '�p Phone#: /�-%3%'`�L''l Cell#: f '`1�C 7&7� C'[ _� � email: .ACM•�►1 L e/ 1. rm 3.Master Electrician: J Q44-02 h S'�,©Q av, -v, Address: (Z�oL s; [Zli ( fs e„ f L.Q, Lic.#: Phone#: ell #: email: S',." cst/J:.,,e/P�Ci4 r r c. �u�uo a Company Name: pt;6v)r- /e y�i rt Address: 4.Proposed Electrical Work/Fixture Count: r e,rt d y c��-t �,r� /�1 r»•+5/ /-�j� S Syr 1 7 �lC Fj e V S1`� ��✓) S �� I�f /� P_5.S �/�h T/ � zl'cF, � 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 (paint name:ut indnaduai,tenitig as the arphLant) 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 duty authorized to make and file this application, ttndicate 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 acc-ompanying approved plans and specifications,as well as in accordance with the Ncw 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 befor e this 1S day of r 20 day of ZO Signature of Pro arty Owner Si a of Applicant FZl 1 M5 c s' P ' t Name of Propert eriqtNami of pplicant .r �1 ZJL Notary Public N()L8WA*4j ELILLO $HART ME Notary Public, State of New York Notary Public, Statee of N'�ewYork No. No.OIME6160063 01 r h este 3 O:tali`ied in WestStchStar County Oualified in Westchester County Commission Expires January 29.20 0orrrnisstnn Fxniras,l- t?w P9 209 U12021 Westchester Rockland Electrical Inspection Services, Inc. _Phone: 914-347-3595 t,f DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 Worth Lawn Avenue y�, Fax; 914-347-3596 L Elmsford, NY 10523r �1\ ► BUILDING PERMIT NO. TFMP# DATE 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'SNAME �l/ ( BUILDING OCCUPANCY T J"n', t OWNER'S NAME ANDADDOESS �- HOME TELEPHONE NUMBER CURRENT SUPPLIED BY FROM THEIR OFFICE WORK TELEPHONE NUMBER LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS NO,OF FIXTURES& MOTORS HEATERS OFFICE USE LOCATION LAMP RECEPTACLES ONLY SIDEWALL SWITCH INCADE FLUORE NO. H.P.EACH NO. WATTS EACH INSPECTION OUTSIDE I BASEMENT I !*'FL 1 7^FL I S'm FL. VILLAGE OF R E BR OK REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: THIS APPLICATION IS INTENDED TO COVER THE ABOVE LISTED ITEMS TO BE INSPECTED-IF AT ANY TIME OF INSPECTION ADDITIONAL ITEMS HAVE BEEN INSTALLED,YOU ARE AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE FOR THE ADDITIONAL ITEMS INSPECTED AS PROVIDED BY THE APPLICANT THE APPLICANT DECLARES THAT THERE IS NO OPEN APPLICATIONS FOR THE ABOVE WITH ANY OTHER INSPECTION COMPANY WREIS,INC.IS NOT LISTING.LABELING.UNDERWRITING OR CERTIFYING ANY EQUIPMENT, MATERIALS OR DEVICES WHICH ARE PERFORMED BY OTHER CERTIFIED TESTING AGENCIES OR INSPECTION COMPANIES.THE APPLICANT,OWNER.OR AUTHORIZED AGENT AGREES TO ALL THE ABOVE TERMS AND CONDFTIONS AS SET FORTH FOR THE APPLCATION. SIZE OF SERVICE FEEDERS CHARACTER OF WORK NEW j ADDITIONAL❑ EXPOSED 7 CONCEALED I 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 SIONATYRE OF APPLICANT ; c. rI / �_ / S 1 x _ STREET ADDRESS TELEPHONE NO. CRY OR POST OFFICE LP CODE ucamMQWmiN APOI IrAm E WESTCHESTER ROCKLANO 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: Sadovia Electric inc Jonathan &Shari Sims 226 Union Valley Road NY, Mahopac 10541 Located at:231 Tree Top Crescent Rye Brook, NY 10573 Certificate Number: 1032663 Section: 129.76 Block: 1 Lot: 51 BDC: Permit Number: EP:21-259-BP:21-228 A visual inspection of the electrical system at this premise described as a Residential occupancy,wherein the premises electrical system consisting of electrical devices and wiring,described below,located inlon the premises at: 231 Tree Top Crescent Rye Brook,NY 10573 F Basement 1st Floor 2nd Floor 3rd Floor Garage Attic Outside Other. Inspection was conducted in accordance with the NYS and NFPA 70-2017 International Electrical Code and detail of the installation,as set forth below,was found to be in compliance therewith on 01/14/22 Name Type Quantity Exhaust Fan ------ 2 Switch Single Pole ------- 6 Fixture-Wall Sconce(s)Lights Indoor ------- 3 Fixture-Luminaire Ceiling ------- 1 Receptacle GFCI ------- 3 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. �`W AL This certificate is valid for work performed before date of inspection only. ii z f f in WI *- " Z m O M Pi a Q N A a J N ' = F x n. f j MM� ON d ; x �I g O 0-4 O ! y C d C6 _ 'j 3 co � � U r � E-i O ✓� z CA , 0-0 Z c z 11 ul f r m w r � ., 0. a o F Z Y'. �I 4 f BUILDING DEPARTMENT SEP 2 4 2021 VILLAGE OF RYE BROOK 938 KrNG STREET RyE$ROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT www gook.org PLUMBING/PERMIT pAPPLICATION FOR OFFICE USE ONLY BP#: PP#: Approval Date: S E P 2. 7 7071 Permit Fee: 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 Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agree that said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address:." Tlreegop l (QSC�yt� � 1(��i'DZ��i �i y SBL:/a 9,7& --/—Si / Zone:P216 2.Proposed Work: I r, . ''A c'a"'a r►n 3.Property Owner: n�)nj< <1 nf;' (Address::(,,Aljl�{{��{ TrC1 P�L�Y� (yt-U Phone#: �tty�`�3`�'�0'�7 Cell#: p`lIA` � � =Z�2:17 1 email: _�c7r)Si rn.5 o`1(�ino • Cary 4.Master Plumber: bt-r Sq_ta_ yr Address: iri,,Tl ik Lic.#: 9 Phone#:9 ( J.P.tf'S t(2 Cell#: g f`/ t Y y"��-IT email: c -�w^- r T Company Name: Address: \ 'T 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 1st Floor 2nd Floor 3'Floor 4m Floor 5ea Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -t- 8/12/2021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: 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 ' eJ Mcur P+ �k %kc 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 � A Sworn to before me this , + �l day of , ,20_L� day of e c., .4> ,20 Z Signature of Property Owner Signature oTA—pplGint e � 5t uI5 �Lt S0,(6 z 4j(_ Print Name of Property Owner Print Name of Applicant No Notary Public,State of New York No "�'y No.Oi ME6t 60^S3OAVld C SLOAN [tary Public-State of New York Qualified In Westchester Courtty NO. OISL6318303 Commission Exoires Jamuary 29 201� Qualified in Putnam County ommission Expires Feb 28, 2023 This application must be properly completed in its entirety and must inclu e e s 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_ 8/1v2021 ' D E C IE ME BUILDING DEPARTMENT VILLAGE OF RYE BROOK SEP 2 4 2021 938 KING ET Ryc BRgox,NY 10573 2C 0 ET 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, COUNTY OF WESTCHESTER ) as: 3, :)4 ►'k 6kw 5 ,residing at, a3` '>; rr_-P4G+P ��C(.1"+'kK13axt (Print name) (Address whbre 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; �31 I eel cYGSC-0- `t ,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. 6" ( ignature of Property Owner(s)) (Print Name of Property Owner(s)) Sworn to before me this ay of '` , 20_Q (Notary Public) SHARI MELIU.O Notary Public,State of New York No. 01 ME6160063 Qualified in Westchester County � -3- Commission ExnirQs Janiisnf�a ?ndrY_.) Building Pemut Check List&Zoning Anal sis Address: l czt- , SBL: Zone: v-!:> Use: Const.Type Other. Submittal Date: Revisions Submittal Dates: Applicant; <�f Nature of Work: 1 t.i -ti.0 2 ►NI!�S'r�n--�1/i`Tt ar 7— FAA 6 c. �17TF —IN1"ram►_] evi ws:ZBA: A U G 2 3 2021 PB: BOT: OtheOK ( ( ) FEES:Filing: ZS BP: S CD . 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 PLAN:Topo: Site Protection S/W Mgmt.: Tree Plan Other. ( ) ( ) SURVEY:Dated: Current: Archival• Sealed: Unacceptable: ( } ( } PLANS:Date Stamped: Sealed: Copies: Electronic: Other. (✓� ( ) License: ✓ Workers Comp: V Liability: Comp.Waiver. Other. { ) { ) CODE 753#: Dated: N/A: (Jf ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit N/A: Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other. (Jf { ) 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: APPROVED REQUIRED EXISTING PROPOSED NOTFS per; AUG 2 2011 �: CIL&- FronW aidw. mam Cv. Accs.Cov F S : Sd.H/Sb a Tot 1 Ft Imp: Pr Hcight/Stories: notes: Laura Petersen From: Laura Petersen Sent: Thursday,August 26, 2021 2:01 PM To: jonsims2@aol.com' Cc: SNSCERAMICANDSTONE@OUTLOOK.COM Subject: Building Permit Application - 231 Tree Top Crescent 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, General contractor's contact name (first and last) v . 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 W105-2 or U26.3) 4. Building permit fee $900.00 (due once permit is issued and ready for pick-up) 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(&Eyebrook.org 1 To: Rye Brook Building Department Re: 231 Treetop Crescent General Contractor contact person for 231 Treetop: Nick Carinci SNS Ceramic and Stone v ., � • v �' f I V ?r"a@}4•N' of 'u.1� ..r �.- V V j�.`'"' •"! �. +�� ': • rt, - +'� ., fv 1f° ,hii` ` v� t•�N„ t;�, }� t�1 rt � v '.",1�♦ M lllt/+lj!''a�i �4�1�, r+l+/jll�+�r� t, t?��tsa ;j+I111N//��� sf,��°s���rk ,��r4/1 '�r+� 31��'�t�� -,f���►F1�1+1+�, }��4. s�IE€.{�i�+ � .�+htl� �s .{+ril�tl�ll r R. ' '. }(.' .'I' George Latimer .lames Maisano Westchester County Executive Director,Consunter Protection Department of Consumer Protection Home Improvement License SNS CERAMIC & STONE INC. 33 LOCKWOOD LANE MAHOPAC,NY-10541 This license is issued in accordance with Article X'VI of the Westchester County Consumer Protection Code and is valid only upon presence of the official depwirnent seal. Proof ofcitizenship or immigration status is not required fir issuance of this license. NOT FOE; FEDERAL PURPOSES 0 Const„�e� License Numher m Date of Expiration CT WC-25286-1-112 008/08I2022 sf c Mster ""+'c,i,...+.►�-'�'i;'s<"z_•� :_'ryx-.; +►! t+;c=; d +r >; ,� +h I' It+lr # � 1� + ( , 't+r11 ,llljl +1 #� +++/tttl+++l t#}�i rl+�/��I�r. !iltjt/�+►nr a ; + 1w ,N w .: !�• A .tl lTw +!��,� tSi wk "@t b .. i► '��+ 3113w �♦ + A •�! 6 S i r Rs y`N Fy, 'ry �, 0 .,.. LAW, DATE(MMMDNYYY) ACORD® CERTIFICATE OF LIABILITY INSURANCE 8/23/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(&), PRODUCER CT NAME Sherwood M Walls Walls Insurance Agency PHOIaE 607-723 6359 Fvc Nc:607-722-6928 15 Hawley Sto. ADDR€E-MAIL Binghamton NY 13901 ss: swalls@wallsinsurance.com INSURERS AFFORDING COVERAGE NAIC S License*BR-1638987 INSURER A: Citizens Ins.Co.of America 31534 INSURED SNSCERA-01 INSURER a: Massachusetts Bay Insurance 22306 SNS Ceramic&Stone, Inc. 33 Lockwood Lane INsuRERc: Hanover 22292 Mahopac NY 10541 INSURER D:Allmerica Financial Benefit INSURER E: INSURER COVERAGES CERTIFICATE NUMBER:1870041161 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. NOTWFfHSTANDING 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 SUBR POLICY POLICY NUMBER MMIDp EFF M L ICY EXP LIMITS LTRRM A X COMMERCIAL GENERAL LIABILITY Y ZBS0988336 V2112021 7/2112022 EACH OCCURRENCE $1,000,000 CLAIMS-MADE FXI OCCUR PREMISES Ea omurrencel $100,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2.000,000 POLICY 1 "I PERT LOC PRODUCTS-COMPIOP AGG $2,000,000 P1 OTHER: $ B AUTOMOBILE LIABILITY Y AWSD987537 7/2112021 7/2112022 COMBINED SINGLE LIMIT $1,000,000 Ee accident X ANY AUTO BODILY INJURY(Per person) $ OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ C X UMBRELLALIAB X OCCUR Y UHS0993277 712112021 7/21/2022 EACH OCCURRENCE $1,000,000 EXCESS LIAR CLAMS-MADE AGGREGATE $1,000,000 DED RETENTION$ $ D WORKERS COMPENSATION W2SD987605 7/21/2021 7121M22 X AND EMPLOYERS'LIABILITY PER ER YIN ANYPROPRIETORIPARTNERIEXECUTIVE [-�] N!A E.L.EACH ACCIDENT $500,000 CFFICER/MEMSER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yyes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 ET- DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Jon&Shari Sims are listed as Additional Insureds CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Village of Rye Brook 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a. Legal Name and address of Insured(Use street address only) 1 b. Business Telephone Number of Insured SNS Ceramic&Stone, Inc. 914-469-4439 33 Lockwood Lane Mahopac, NY 10541 1c. NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured (Only required if coverage is specifically limited to certain locations in New York State, i.e. a Wrap-Up Policy 1 d. Federal Employer Identification Number of Insured or Social Security Number 453800056 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Allmerica Financial Benefit Village of Rye Brook 938 King Street 3b. Policy Number of entity listed in box"1a1: Rye Brook NY 10573 W2S-D987605 3c. Policy effective period: 7/21/2021 to 7/21/2022 3d. The Proprietor,Partners or Executive Offers are: ❑Included. (Only check box if all partners/officers included) all excluded or certain partners/officers;exetuded. This certifies that the insurance carrier indicated above in box'3"insures the business referenced above in box"1 a"for Workers' compensation under the New York State Workers'Compensation Law. (To use this form, New York (NY) must be listed under Item 3A on the NFORMATION 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 "T', The Insurance Carrier will also notify the above certificate holder 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 cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices maybe 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. Please Note: Upon the 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 Worker's 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: She ood M Walls r (Print name of auth ed representative r I a ent of insurance carrier) Approved 1/T 4", 6_u23/2021 (Signature) (Date) Title: Agent Telephone Number of authorized representative or licensed agent of insurance carrier. 607-723-6359 Please Note:Only insurance carriers and their licensed agents are authorized to issue the C-f 05.2 form. Insurance Brokers are NOT authorized to issue it. C-105.2 (9-07) www.wcb.state.ny.us Form WC 88 31 21 C Printed in U.S.A_ Page 1 of 2 N N C N �O yry C AUG 2 0 2021 U VILLAGE OF RYE BROOK BUILDING DEPARTMENT o � A .�a o m 0b 57 3„ L 4cn4 O v vA M ° �wb i Boa•° / H � aco r-� U � 1 I I I ' 25 1 1 C w a r{v i L{) �f? I C;) I q 04 I I I I I 1 (o C •O o _ U > u 41 F3 U � rn � •^y G�� GgOI N .19£ � ° x v > E EL5 � �Qv „ u PERMITS 60 SBL# ILE COPY DATE APPROVED AUG 2021 TA- -Z->� I OUILDiNG WPE 7OR, i age of Rye Br*Ok,MY 1\ H O~ N � N 57 4 3 A P, 24 4„ ^v30 8" o m m' y 4 � i •GO y y d co Od M m 00 co y p H d o z 25 oco 77 " U i Ln •� m� y 0 ° > Q'nt►. o 'v� ay0IN a 1 .,9E �!