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HomeMy WebLinkAboutBP21-236lJ4;.PERMIT # '" � DATE: � �s � QIXP:,�, SECTION I Q9� % BLOCK LOT 16 TYPE OF WORK JOB OWN EST. COST VcO Vi �Yu r DA TCO # FEE DATE INSPECTION RECORD DATE FOOTING FOUNDATION FRAMING RGH FRAMING b INSULATION PLUMBING RGH PLUM13INNG GAS cl SPRINKLER ELECTRIC [� LOW -VOLT C7 ALARM 0 AS BUILT 0 FINAL INSP y)qz/9 7L 999 7 i HER APPROVALS �ARB IBOi �B SBA QTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 22-122 (fertif tcate of ®ccupaucp This is to certify that LeVIA ZUEY 1�1170L Zusv of, )KOO/� /V having duly filed an application on S� 20 requesting a Certificate of Occupancy for the premises known as, , Rye Brook,NY, located in a /5 Zoning District and shown on the most current Tax Map as Section: Block: Lot: /t�o and having fully complied with the requireemments of the Building Code and the Zoning Ordinance under Building Permit No.c / ��cL, issued % 1 20 �I, such authority and permission is hereby granted to the property owner to lawfully occupy or use said premises or building or part thereof listed under the following New York State Classifications, Use: /`G+eJ ' �/ Construction: for the following purposes: I t? y�� )Ila O' r? 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, Lwhether by extending on any side or by increasing in height all be made,nor shall the building be moved from one location toanother until a permit to accomplish such change ha en tai ding Inspector. uilding Inspector,Village of Rye Brook: Date: SEP — 12022 2 f V ��" �' For office use onl BUILDING DEPARTMENT PERMIT# 07 31v AUG 2 6 2022 VILLAGE OF RYE BROOK ISSUED: 938 KING STREET,RYE BROOKS NEW YORK 10573 DATE: VILLAGE OF RYE BROOK (914)939-0668 FEE: g /.,:��— PAIDJW BUILDING DEPARTMENT www,r};jookorg 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 ►►►rtrr►rrt►ttt//wrr►•r►t►■r•rwwwwrrwwww►w►►►►►tr►t►►►t►►►r►w►rt►►ttrrrttrwrwwrww►ww�w/►1w/►►t►►t►►rtt►t►►t►►►rttwrrwtrwrrrwrwwww►• Address: U y 14-0 Ito F4. ye g r�o(< � JV 1 10 S 7 n Occupancy/Use: [P Parcel M#: �a�� 7s— 6 Zone: Owner: I<e V i l Rn j OGAA Z/S y Address: I� Sl elm P.E./R.A.or Contractor: �, {� p Address: Person in responsible charge: L jJ� C�l X Address: Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a 1oT44 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: 1 t t v'^ Z v 5'/ being duly swom,deposes and says that he/she resides at (Print Name of Applicant) J 1 (No.and Street) in e 91'I 1 ,in the County of e l / in the State of�,that Cityfrown/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:$ '"l O 0 n for the construction or alteration of: 2A-r410Vt V i V t V I J 1 — "T CAJV IJ 1 —.1_00 1 vik 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 farther 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 lS- ' Sworn to be re me this Z day of ,20 Z Z d of LA , 20Sio 22 i ature of Px Owner Si OofAkpplkant (-evi v, 2,tlj UJ\% to A i(A Print�erne of�?roperty Owner � / Name of Applicant ��i �' - Awe l/•/-� (/l/� ` ow `V Notary Ful-is Notary Public NURALLAH NAZERALI NURALLAH NAZERALI 8112,2621 NftrY Public,Slate of New Ynrk NotaryN Public,State of New Vr� w1Usli o In OINA62ew 98 NA6227598 term Expires September 7, Qualifies in New York County 20�ti'�/ Term Expires September 7.201d?w �E BR(bk, tim 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 - - - - - - - -i -306V, - - - - -- - - - ADDRESS :_ `� ' 'V kQjti D E. PERMIT# e2 , ISSUED: \SECT: %l� BLOCK: LOT: LOCATION: `� �� C.CQ1 �TI � OCCUPANCY: 1� ❑ VIOLATION NOTED HE WORK 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 ❑ OSS CONNECTION FINAL ❑ OTHER BR(��• o �m 1932 BUILDING DEPARTMENT [I UILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK [I CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - -- - - - - - - - - - - - - - - ADDRESS :_ 1 ' �+ 'DATE: PERMIT# 2- Z ISSUED: } 3NECT: BLOCK: LOT: LOCATION: `�S RUC -�( y-ti"' (J 1 OCCUPANCY: �J ❑ VIOLATION NOTED THE WORK IS... [I ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ SOUGH FRAMING INSULATION i ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER Q�E BRC��. Q) 1982 BUILDING DEPARTMENT [BUILDING INSPECTOR ❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK d CODE ENFORCEMENT OFFICER 938 KING STREET . RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : -- DATE: l o ZZ 17 PERMIT# 'Z " �_� ISSUED: SECT: BLOCK: LOT: LOCATION: OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑`ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: L I ROUGH PLUMBING O' ROUGH FRAMING [�] INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER �� <� ' I ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER �i�r��'i��i���`ir���`i�"i�`i�`r�`i�l��i`i�'ir�'s��i�`ii��i �`i�`i�il�i�l' �ii �` ��i�`i►�`il��i �i �i�il��ii • CD th 1.. C o 1 N oC N � � � = C en I M s 3 v F M1 so acc Q` tzl m m � � o O ON W ° M Z � V ; g + W z Ixzs F Q O e. a M tn co A O w o �oON 0y z � � � O � ✓: e � is U z o� w00 �••� �"" � � V C7 O a Q Q o4 � � � � ►� m o� N 96 W x z �- 0. c 6, F z ow. /C_DRC�uk FVI�L4AGCEOF BUILD �E �MENT VIL E OF RYE OK 2 3 2021938 KINc� ETRvEB ,NY 10573 RYE BROOK w or BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required ? Q FOR OFFICE: [ISE ONLY Bl'#: o)/-a 34 lG El'#: CD`—C-)JU Approval Date: Permit Fee: $ �SV lot) Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, T';3--r31 is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove electrical equipment, wiring, fixtures,or to perform other high or low voltage electrical work as per the detailed statement described below. The applicant & property owner, by signing this document agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. / 1.Address: j E t y f t L L OW (ZZ SBL: � �J� +'' I(� Zone:g`JN15 2.Property Owner: WEU tN ZUSY Q14+-A Z IJ�X_ Address: I� SLt-&-t?y IyLLrw 2A g:jj a,nL OK Py IoSl3 Phone#: eS ) (, y s 2,5 S Z Cell#: email: 3.Master Electrician: tT e f7, D S Address:-at G RJ-er OffulIc N �T /C vylo ? Lic. 4: L441, Phone#: TIC 9j!j Cell#: J.jq email: }-(5jL✓il rLtG�14��}L�(� tllr}j�.evof Company Name:Vl( Ili SIL)V+ CLtCl if L TNP Address:, I mar`L'14-tinclyS%.P,27011t;01 { 10P3 4.Proposed Electrical Work/Fixture Count: tV t(l c P 6� C µto, B A-T N nVol., R-�D STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of 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 for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc J 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 contbrinance 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 odter applicable laws,ordinances and regulations. lZ. Sworn to befor me this Sworn to bef e me this day of rE 1e l"AOVO 2— day of ALCM 4Cr-420-1_ Signattt of Property Owner Signature of Applicant 4 Name of ProDeA Owner _ D . Pri Name Lf W�4 t • N olaiy Public �_ Notary Public NURALLAH NAZERALI Notary Public,State of New Ynrk NURALLAH NAZERALI No.01 NA6227598 Notary Public,State of New Ynrk Qualified in New York County No.01 NA6227598 Term Expires September 7,201,?iv TQu$E�Pes Seew York Cptember ounty ?.,%M7i202I Westchester Rockland Electrical Inspection Services, Inc. A Phone: 914-347-3595 DO NOT WRWE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue \ Fax: 914-347 3596 • Elmsford, NY 10523 <� BUILDING PERMIT NO. TEMP# 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 !124T1 6 OCCUPANT'S NAME _ BUILDING OCCUPANCY OWNER'S NAME AND ADDRESS n HOME TELEPHONE NUMBER -) J-D rI 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 BASEMENT 1'FL. 2'O FL. 3 FL. VILLAGE OF RY BROO REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: I� i..-, � FTC- IJ �'P4 & !� cz �`!>Cc - THIS APPLICATION IS INTENDED TO COVER THE ABOVE LISTED ITEMS TO BE INSPECTED.IF AT ANY TIME OF INSPECTION ADDITIONAL ITEMS RAVE BEEN INSTALLED,YOU ARE AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE FOR THE ADDITIONAL ITEMS INSPECTED AS PROVIDED BY THE APPLICANT,THE APPLICANT DECLARES THAT THERE 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 CONDITIONS AS SET FORTH FOR THE APPLICATION. SIZE OF SERVICE FEEDERS CHARACTER OF WORK NEW❑ ADDITIONAL❑ EXPOSED L1 CONCEALED❑ MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD❑ UNDERGROUND❑ —i—t I I I I 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 llfil '- V ICVP Cl!l I., LdL`�C, X— --- STREET ADDRESS TMJ9400 E NO. 7 CITY OR �1 W LICENSE NO.WHEN APPLICABLE '?_. WESTCHESTER ROCKLAND ELECTRICAL INSPECTION WREIS,,,,I,,,,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: Mario Silva Electrical Inc Kevin&Dana Zusy 121 Grace Church Street NY,Port Chester 10573 Located at:16 Sleepy Hollow Rd Rye Brook,NY 10573 Certificate Number: 1032406 Section:129.75 Block:1 Lot:16 BDC: Permit Number:EP:21-238-BP:21-236 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 in/on the premises at: 16 Sleepy Hollow Rd Rye Brook,NY 10573 ❑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 12/23/21 Name Type Quantity Switch Single Pole ------- 13 Receptacle GFCI ------- 10 Fixture-Luminaire Recessed --- 17 Exhaust Fan Bath ------- 2 Fixture-Wall Sconce(s)Lights Indoor ------ 3 Switches 3 Way ----- 3 Fixtures Pendant ------- 1 Refrigerator ------- 1 Dishwasher ------- 1 Cook Top ------- 1 Range Hood ------- 1 Oven Gas or Electric ------- 1 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. This certificate is valid for work performed before date of inspection only. t i f in O C4 N N Q 16 ~ ~ r m i imp CAQ Q F � Z W c w o � - ISM w �w„ 3 �„� � Q �'' � • � ^ p� �. co qv 4 c �i �zLTJ M w O p, € A cncn oo � P. p Q r 0 a . L 0 a = p po .. _ CD 116 16 a• RECEWE ]D BUILDING DEPARTMENT SEP 2 � 2021 VMLAGE OF RYE IjkOOK 938 KING STREET RYE BROOJI ,NY 10573 VILLAGE OF RYE BROOK (914)939r-0668 BUILDING DEPARTMENT www.Mcbroolr.org PLUMBING PERMIT APPLICATION )�[" FOR OFFICE USE ONLY BP#: �—C PP#: Q // 3 Approval Date: Permit Fee: $ 17�5/ Approval Signature: Other: Disapproved: n (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 an 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: S P P (3`^' �� SBL: f p�`-7.2�L (Zone: g::-, 2.Proposed Work: ''//4� h � l 3.Property Owner: Vca \j t vim, Address: J�„ zQc-0 Phone#: Cell#: L" email: 4.Master Plumber: q Address: Ja-"S -3p..`^' f 00 Lic.#:lol 6,3 Phone#:20'3 5?S 69 3,Cell#:JO 4?G y -2 'd/email: U S P y Sa 4 'r"k o 6k c c .,.� 7 r r•-1}-�. srr-r� a CT— INDICATE Name: .ro Address: P�-� 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 31 Floor 4's Floor 5m Floor Exterior 5.*List Other Equipmenv?rovide Details: S i,.A Ix S+-o j C '� ► i,1`�'�S Y1- � ink (Notarized Signatures Re red Next 2 Pages) -1- 8/12/2021 S STATE/OF NEW YOM(-� COUNTY OF WESTCHESTER ) as: f Yl rIYJYt ( O J n'-2 4L�-f d ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and fpurther states that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) 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. t Sworn to before me this Sworn to before me this day of pt� �9-4t,20 Z day of AjPr""41"20-1- Sigfiature o Property Owner Signature of Applicant PjV I n Zt,S C S C,,,,,. Print Name of Property Own Print Name of Applicant K(4LI ku otary Public Notary Public NUp kLAH NAZERALI Nota NURALLAH NAZERALI No 01 A6�75N98 York Votary Public,State of New York OuaUfied in N Quaa�ff in 01NA�7598 hrm Expf s S�� aunty This appl' ^utg>>�„N leted in its entirety and must include the notarize sl<gna�6(sor 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 he returned to the applicant. -2- 8/12/2021 D E �i ` ''[g BUILDING DEPARTMENT VILLAGE OF RYE BROOK SEP 2 1 2021 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF R`' BROOK www.rvebrook.org BUILDING DEPf,,RTMENT ******************************************************************************************************* 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: V i N _V y ,residing at, (Print name) (Address where you live) N Y 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; 0—,,3 lee ",+0 , 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. (Si lure of ope wner(s)) 4VIV1 zol (Print Name of Property Owner(s)) Sworn to before me this =cs ep r&Ph8e Q , 20 oZ/ (Notary Public) NotaryRALLAH Public,State of New York No NA6227598 Qualified in Now York County -3- Term Expires September 7,2W 'L?/ 8/12/2021 (� Building Permit Check List&Zoning Analysis Address: �D \ — ' (T/ l�l w —�� SBL: 2 7S Zoned U. 2� �( Const.Type Other. Submittal Date: Revisions Submittal Dates: Applicant: Z-V S Nature of Work n__ � J�!E=0► J vi w :ZBA:S E P - 8 2021 PB: BOT: Other hMF 'JO OK ( ( ) FEES:Filing. ZS' BP: 6 1f � � 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. Shore Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection S/W Mgmt.: Tree Plan: Other. ( ) ( ) SURVEY.Dated Current: Archival• Sealed: Unacceptable: ( ) /( PLANS:Date tamped Sealed '✓ Copies: Electronic. Other. ( ( ) License Workers Comp: Vf" Liability- Comp.Waiver. Other. ( ( ) CODE 753#: Dated N/A: ( ( ) HIGH-VOLTAGE ELECTRICAL.Plans: Permit: N/A Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other. FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H.W.I.C.:_Battery._Other. PLUMBING Plans: Permit: Nat.Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A Other. ( ) ( ) H V.A.C.: Plans: Permit: N/A Other. ( ) ( ) FUEL TANK:Plans: Permit: Fuel Type: Other. ( ) ( ) 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other. ( ) ( ) Other. ( )ARB mtg.date: approval: notes: ( )ZBA mtg.date: approval:- notes: ( )PB mtg.date: approval: notes: APPROVED REQUIRED EMSTING PROPOSED NOTES Arc& Date: SFP Cir FronQge Fronc: Fronc: Sides: RCar. Main COP. Accs,COV F S : Sd,H Sb: SF_A. Tom: Ft Imp: Peskin Htig /Stories: notes: Laura Petersen From: Laura Petersen Sent: Wednesday, September 8, 2021 9:29 AM To: Kevin.zusy@gmail.com Subject: Building Permit Application - 16 Sleepy Hollow Road Good morning, The building permit application has been approved by the Building Inspector. Before I can issue the building permit the following items must be submitted to our office, ✓ General contractor's contact name (first and last) L"iS Z4e)1 9`) c/2. General contractor's valid liability insurance (the Village Of Rye Brook must be the certificate holder) ✓3. General contractor's valid workers compensation on a NY State Board form (C105-2 or U26.3) 4. Building permit fee $615.00 (due once permit is issued and ready for pick-up) This information can be emailed to me. Thank you Laura Laura(Petersen Office Assistant Village of Rye Brook 938 King Street Rye Brook, New York 10573 Phone(914)939-0668 1 Fax(914)939-5801 1 Ipetersen@ryebrook.org 1 i West c•corRc I.atime, Jamt'sNais,tno ttcstcr Couoh rotcction +' FAecin c U1)\ (()fin Consumrr P j h - �P Ulrrcu�r• r Department of Consumer Protection ' Home Improvement License LBZ PAINTING&RESTORATION INC. 3771 VALLEYVIEW STREET MOHEGAN LAKE,NY-10547 This license is issued in accordance with Article XVI of the Westchester County Consumer Protection Code and is valid only upon presence of the official department seal.Proof of citizenship or immigration status is not required for issuance oft his Iicense. NOT FOR FEDERAL.PURPOSES Qc`okconsjj,,, License Number o� Date of Expiration `~ t W C-22002-H09 07/22/2023 P Y ?> " �rOhesterCO WN, Ay ntf, t-' � ry ZUNIL-1 ACORO CERTIFICATE OF LIABILITY INSURANCE DATE( 09I10/20210/2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER 845-256-1200C4N TACT Deniece Carter Robert Alan Agency Highland w+ME _ 652 Route 299,Suite 104A PHONE N �):845-256-1200 A/c,No):845�58-6618 Highland,NY 12528 den ioce.carter@robertalanagency.com AIL Deniece Carter — INSURE S AFFORDING COVERAGE NAIC S INSURER A:Utica First Ins.Co. 15326 isuRE D a dba ni INSURER B: Luis Zu LBZ Painting&Restoration Inc INSURERC: 3771 Valleyvlew St Mohegan Lake,NY 10547 INSURERD: _ INSURER E. INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTRNSR I TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF POLICY UP LIMITS A COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE CLAIMS-MADE FW7 A I OCCUR ART133076411 06/1 Z/2021 06/12/2022 DAMAGE TO RENTED 50,000 X Business Owners 5,000 MED EXP An one person) PERSONAL&ADV INJURY 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,600 X POLICY JPCOT LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED(Ea identlSINGLE LIMIT ANY AUTO BODILY INJURY Perperson) OWNED SCHEDULED AU�TEOpS ONLY AUTNOSSyy Ep BODILY INJURY Per accident AUTOS ONLY A�TOS ONNLY PerOaER dent AMAGE UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAR HCLAIMS-MADE AGGREGATE DED I I RETENTION$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILI Y Y I N ANY PROM IMTOR/PA TNEDER/EXECUTNE NIA A Q� E g�� E.L.EACH ACCIDENT (Mandatory In NH) M yes,describe under E.L.DISEASE-EA EMPLOYEE ESCRIPTION OF OPERATIONS below LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) As regards work performed by the named insured. 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 Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE Deniece Carter ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. 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 a a A A A A A A 943452872 INFINITY AGENCY GROUP INC 95 CROTON AVENUE OSSINING NY 10562 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER LBZ PAINTING&RESTORATION, INC. VILLAGE OF RYE BROOK 3771 VALLEY VIEW ST 938 KING ST MOHEGAN LAKE NY 10547 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2531 051-7 832064 11/26/2020 TO 11/26/2021 9/10/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO, 2531051-7, 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. PRESIDENT LUIS B ZUNIGA OR LBZ PAINTING&RESTORATON 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. BY CAUSING THIS CERTIFICATE TO BE ISSUED TO THE CERTIFICATE HOLDER, THE POLICYHOLDER UNDERTAKES TO PROVIDE THE CERTIFICATE HOLDER 30 CALENDAR DAYS' NOTICE OF ANY CANCELLATION OF THE POLICY. NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:972190731 U-26.3 TAIM— A. "LIA �BApTT Ni)T[III N--To ALL REDBLINIS AT 01S AND 1MASTER BEDROOM Loc+ilorvs O 32 D1NN5340M I I L VL 300M BEDROOM D BEDROOM 2 { � iRs< FLOOR PLAN FILE COPY SCALE 1/4`=1'—C" rrIn�nS I1C�SEP 12021eD PAR!DE4 eeu 4,�c-I- LJ DATEAPPRO SE - euunwawsv REV.8-4-21 - REV.7-28-21 PAT M. A s SEEPY F011 Ow RCAD,RYF RRCOK,Nv 109 11111 PARt AVE ULITANO A H I�T EREEN iCIL CT N— FLOOR PLANS A T DATE'. 07-20-21 -ALE'.1/4°=1'—C•.. /�'i