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HomeMy WebLinkAboutBP21-273EST. v/CO # s �� y- • ►s log; eff �Fff wwaffir oil - DATE .�I3 TCO # FEE DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS SPRINKLER ELECTRIC LOW -VOLT C� `rALARM CJ AS BUILT FINAL INSPECTION RECORD \X "; c"i INSP �y Nla � r�" OTHER APPROVALS VILLAGE OF RYE BROOK WESTCHESTER CouNTY, NEW YOLK No: 22-©31 Certtftrate of Orrupaucp This is to certify that of, AI\7/ , having duly filed an application on (�(� /�20 O� requesting a Certificate of Occupancy for the premises known as, Z na ) bo rl-2 Pla c C , Rye Brook, NY, located in a )(-�FZoning District and shown on the most current Tax Map as Section: / �. Block: / Lot: c>2 / , and having fully compliedwith the requirements of the Building Code and the Zoning ordinance under Building Permit No. �/ " , issued !O L� 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 New York State Use Classification of- - n(f" l6 Mf/ , for the following purposes: Leonh -ze wind(Dw CEPIOC-eyyr':36�- boAiy-oe>� remodel U pgrad e 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 heights 11 be made,nor shall the building be moved from one location to another until a permit to accomplish such change has e n o ta' ding Inspector. Building Inspector,Village of Rye Brook: Date: MAR — 3 2022 p�7 BUILD R ME1�iT For office use onl D ; PERMIT# 7� VM OF RYE OK ISSUED:/0— a1 FEB 1 7 2022 8 KING STRE YE BROOK, YORK 10573 DATE: ar/7—�� \ 4)9 -0 0// FEE: A/ VILLAGE OF RYE BROOK w l t r BUILDING DEPARTME T �A?PL�CA 1 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 INSPECT.LUN Address: 10 Osborne Place, Rye Brook, NY 10573 Occupancy/Use: Single Family Parcel ID 9:141.28-1-21 Zone: R-3 Owner: Rafael & Priscila Ventura Address: 10 Osborne PI, Rye Brook NY 10573 P.E./R.A. or Contractor. Palette Pro Painting &Renovation, Inc. Address: 10 New King St,White Plains NY 10604 Person in responsible charge: Rafael Ventura 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 OF NEW YORK,COUNTY OF WESTCHESTER as: Rafael Ventura being duly swom,deposes and says that he/she resides at 10 Osborne PI (Print Name of Applicant) (No.and Street) in Rye Brook ,in the County of Westchester in the State of NY that (CitylTown,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:$ 22-000.00 for the construction or alteration of. Kitchen&Bathroom Remodel ' �,,/ I^t ulc_y C , 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 goveming 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. Swom to before me this (00 Sworn to before me this day of day of -G�Le 20 21Z� Sign of Property Owner SignatwCf Applicant O Pro- +���,��tt�rrREN••te�,P L4_91 KAI? N t N of Property Owner Print Name of Applicant '. No O;r p� _ . tom • r!7 y ` Notary blic m _ Notary blic p'�., C ' KAREN E.Gom� ^r�r NOTARY PUBLIC.STATE OF NEW YORK' '�'A, l/ NOTARY PUBLIC-SPATE OF NLt!►j' �. Registration No.OIG16016636 ''..4,Y :��-`-- ����` Regisue on No.01 G160166�b., Qualified in Westcbesta County 'a,• �Y YOFZ,"` Qushfiihlioweste6eeterCottnty ��rrU�ttrrttH Commission ExpiesIM3/20�2- ����������������" CouummooExpires1 1/2 31201 cu � 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR -PASSISTANT 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: � DATE: PERMIT# ISSUED: tCO l� ECT: 1 �} BLOCK: LOT? LOCATION: N e t lit _.�`��� 0� -" OCCUPANCY: 7 ❑ 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 ❑ FINA4 PLUMBING ❑_-CROSS CONNECTION o FINAL d ❑ 'OTHER QyE BRC�,�. o`` tim BUILDING DEPARTMENT ❑BUILDING INSPECTOR SSISTANT 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.or - - - - - - - - -- - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : �Q4 \ -Y DATE: � � r.�l z� PERMIT# y B^ ISSUED: (CT: BLOCK: LOT: LOCATION: �n �dtO �.T�1 UCH. OCCUPANCY: l ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ElREJECTED/ REINSPECTION ITE INSPECTION � �k REQUIRED j" 0 FOOTING �+ ,�� f ❑ 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 r M NO ■ � Coll ■ N N � a� � o ■ G4 o N x � � o v o ■ ra ..� o � ,� •� bra � , �t �L� N 00 A o o15 v O = ['^ 5 © � W 3 gz co •0 _ - 0 5: 0*4 > _ t� 00 ■ 00 a C Wz (4 -d lu a o o - b o a � qq .. ' �I QC1 a W W �► z � IM:4 � BUILD ,_-:D-WIWTMENT VILI OF R %OOx OCT 15 2921 938 KING ET RYE BR NY 10573 4)939-0 VILLAGE OF RYE. BROOK �UILDING DEPARTMENT 19612 ,� ADMINISTRATIVE EXTERIOR BUILDING PERMIT APPLICATION FOR EXTERIOR WORK WinCII DOES NOT REQUIRE VILLAGE ARCHITE( I I H \I REVIEW BOARD APPROVAL FOR OFFICE USE ONLY: _ APPROVAL DATE: OCT 18 2021 PERMIT#: r-�� '���: '-APPLICATION FEE: G`7 S , APPROVAL.SIGNATURE: PERMIT FEES: I 0 r H.O.A.APPROVAL: DATE: DISAPPROVED: OTHER: Application dated: 10/14/2021 is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the construction of buildings,structures,additions,alterations or for a change in use,as per detailed statement described below. 1. JobAddress: 10 Osborn Place, Rye Brook, NY 10573 2. ParcelID#: �'�/ Q0 I CD Zone: Ic- 3. Proposed Improvement(Describe in detail): Window replacement U 4. Property Owner: Rafael Vent Venh Ira Address: 10 Osborn Place, Rye Brook, NY 10573 Phone# 203-249-2028 Cell# e-mail rafael@paleffe-pro.com.. List All Other Properties Owned in Rye Brook: Applicant: Address: Phone# Cell# e-mail Architect: Address: Phone# Cell# e-mail Engineer: Address: Phone# Cell# e-mail Up Lh-11t i General Contractor: try) r4x. Address: I Phone# Cell# e-mail L.CJ►' (l) 8/12/2021 5. Occupancy;(I-Fain.,2-Fam.,Commercial.,etc...)Pre-construction: 1-Fain Post-construction: 1-Farn 6. Area of lot: Square feet: 5,037 Acres: 7. Dimensions from proposed building or structure to lot lines: front yard: rear yard: right side yard: left side yard: other: 8. If building is located on a corner lot,which street does it front on: 9. Area of proposed building in square feet Basement: la fl: 2'fl: 3id fl: 10. Total Square Footage of the proposed new construction: 11. For additions,total square footage added:Basement: 19'fl: 2rd fl: 3rd fl: 12. Total Square Footage of the proposed renovation to the existing structure: 13. N.Y.State Construction Classification: N.Y.State Use Classification: 00%— %All 1-1 - IZ—3 14. Construction Type&Location:()Typical Western Lumber Frame;()Timber Frame[TC];()Wood Truss[TT]; ()Pre-engineered wood[PW];Located;()Floor Framing[F];()Roof Framing[R];()Floor&Roof Framing[FR];Other: 15. Number of stories: Overall Height: Median Height: 16. Basement to be full,or partial: finished or unfinished: 17. What material is the exterior Finish: l& Roof style;peaked,hip,mansard,shed,etc: Roofing material: 19. What system of heating: 20. If private sewage disposal is necessary,approval by the Westchester County Health Department must be submitted with this application. 21. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...)Yes:_No:X— (if yes,applicant must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 22. Will the proposed project disturb 400 sq.ft.or more of land,or create 400 sq.ft.or more of impervious coverage requiring a Stormwater Management Control Permit as per§217 of Village Code? Yes:_No:)(_Area: 23. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: X (if yes,applicant must submit a Site Plan Application,&provide detailed drawings) 24. Will the proposed project require a Steep Slopes Permit as per§213 of Village Code Yes: No: X Cf yes,you must submit a Site Plan Application,&provide a detailed topographical survey) 25, Is the lot located within 100 ft.of a Wetland as per§245 of Village Code? Yes: No: (if yes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan) 26. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28107? Yes: No: X (if yes,the area and elevations of the flood plane must be properly depicted on the survey&site plan) 27. Will the proposed project require a Tree Removal Permit as per§235 of Village Code?Yes: No: X (f yes,applicant must submit a Tree Removal Permit Application) 28. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No: X Indicate:TIER 1: TIER 11:�TIER III:_ (tf yes,a Home Occupation Permit Application is requirec9 29. What is the total estimated cost of construction: S 7,000 Note:estimated cost shall include all site improvements, labor,material,scaffolding,fired equipment,professional fees,including any material and labor which may be donated gratis.If the final cost exceeds the estimated cost,an additional fee will be required prior to issuance of the CIO. 30. Estimated date of completion: October 2021 (2) 8112r2021 BUILD MENT vu. OF R OOK OCT 15 2021 938 Knvc ET RYIE BR ,NY 10573 4 VILLAGE 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: Rafael Ventura ,residing at, 10 Osborn PI, Rye Brook NY 10573 (Pnn1 name) (Address,�chere 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; 10 Osborn Place 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. (Signature Of Prope r(s)) UT—) tlm� (Print Name of Property Owner( ); +,`t+`aapun�n►p►►�►t►,r Sworn to before me this day of Dc,�obrjr , 20 z :r,,' N O , ( oiaN Public) '. / ; ` ri KAREN E.GOMEZ ' '•,.N�+l'v YO� `��'o• NOTARY PUBLIC,sTATE OF NEW YOR'K ��� VV a�r"��� Registration No.OIG16016636 Qualified in Weswheattr County (3) Commission Expires 11/23/20 2- 8/12/2021 This application must be properly completed in its entirety by a N.Y. State Registered Architect or N.Y. State Licensed Professional Engineer& signed by those professionals where indicated. It must also include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void, and will be returned to the applicant. Please note that application fees are non-refundable. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: _ RE%Sael �J gn*Urc- ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and furthers tes th (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. By signing this application, the property owner further declares that he/she has inspected the subject property, and that to the best of his/her knowledge there are no roof drains, sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. � 1 Sworn to before me this [ Sworn to before me this day of Q Q�-t�`� ,20 ), ` day of , 20 7- Sign of Property Owner Signature Applicant /��' ,,`,,,1�1111111 M/11j1j/,/ k4 / ,� VV// N •• (% AA Pnnt Name of Property Owner .� Q�E �;(jp'•,� Print Name of Applicant Notary Public Notary PAblic 01 GF 6•��' ,, - _. - 0 KAREN E.GOMEZ 4�WC' OlGt�t� ••''• F N EW �`��, NOWYPUBUC,STATE OF NEW YOfiti rtIt111nIt' ZypCl�� oo�°` Ca 0 �` Registration No.0[G16C 1Qu"ed6636 �N�in rtr',�ri�`� "t t1�312 Commission G/` ,,`, _KA,r ~,,,,•'',!. 0 i ,fr'rUld:. (4) 8/12/2021 n to eg N rr V p., tp i 14 T V! old log " N U u .s '7 N i•r•�l '� r. o � U 4 N w O � � G1 0-4 C4 fi �C E...i - •.• Ad O O ww z < OrAit h+i C) W r LO 3 a # a 3Y C ix 00 °� Q+ r h.� z96 Q "� a_ z Q a s m g � •- W z � o 29 U CIO O Fw �— G1 p �• a •' BUILDING DEPARTMENT OCT 15 2021 DD VILIGA OE OF.RYE OK 938 KINQ ET RYEB. NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT .or ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: ! 73 EP#: tom/r=**)& / Approval Date: OCT 1 8 X1 Permit Fee: $3'D 0 —Pb Approval Signature: Other: Disapproved (fees are non-refundable) Application dated,/Q JS'c)) 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. LAddress:_10 018000C PL , PyE Br7�k tiY iOS773 SBL:1"71• e —/o Zone:rteD—IC 2.Property Owner: lzaF4EL UEtiTy2a Address: 10 r/f pj , erg &bok- U& a Phone#:(2O3)2•49.202 S Cell#: email: I2A FA EL @ P4L6r7F--PRO_ear f 3.Master Electrician: 'jk2b= 4Qa_A5 CARE.r91A Address: 1 o' -DE — Si PLO 2 SLE£Py 44c)U,0c.J AJ y Lic.#: 1971 Phone#fq 4)V7q C7s Cell#: email: IYA1-i✓N60ECYQIC @ 1 C.L;)(JD- C-0M Company Name: I(k}1`(11-( E-CZC ?-(C Address: )g Tom(..(_ ST FQ2 2- -s LEEPI 4OCL-0 w ,V 4.Proposed Electrical Work/Fixture Count: SEQV i c e U PCz4Ai>C Tm 20© a qi-, a)ie19✓Ea A•C U N I fis, GESSt0 Lr6H S Inds r�1 LLA Tt 0n1 A RA " ?IE Ctou Se 1i7- e tl it F4 2 70 7n L pop G 16 Ors 24 j)�, STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: .hZ� Hk)t M S CpBIZE2A being duly swom,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 E,E C TZt U L (_0"Yl�►CT7).2 for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn t bef re me this 'k� Sworn to before a this day of P- ,20 7-- day of Q_r ,20 Sfi1,, a of Property Qwner t Name of Prop er' Print Name of Applicant Notary Public (184\�' ANotary Pubtfc t KAREN E.GOMEZ .- ALEXANDRA H.MARSHALL NOTARY MBljc,SATE OF NEW YORK , OF N� �. Notary Public,State of New York 1,0*atiom No.OIG16016636 '�r1,,,1,1ii1100% No.U1FR6363711 Qua in CmtyQualified In Westchester Count Co®aia Expires IV23120_ Commission Expires August 28,20 �g/12noz1 Phone: 914-347-3595 Westchester Rockland Electrical Inspection Services, Inc. DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue Fax: 914-347-3596 Elmsford, NY 10523 Ir BUILDING PERMIT NO. TEMP# DATE. CITY OR VILLAGE . Ir- ,ZIP GODE_ TOWNSHIP CO i� (J`1'�J I O j �} �'T STREET AND NO.OR ROAD y POLE NUMBER .�If,0(Z PJ a BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT OCCUPAIT'tl NAME JE BUILDING OCCUPANCY OWNER'S NAME AND ADDRESS �./^-i , 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. 1. INSPECTION OUTSIDE BASEMENT 1"FL. 2 O FL. ILLAG OF 3^' L ILDP G DEM RTMENIT REMARKS:LIST OTHER ELECTRICAL DEVICES//NOT WpT S,�^�ET FORTH ABOVE: wfCZiNG A- C. tJWiTS e-C-CF �-1614iZ 11V-, TA (-A 7-1z) J 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 a FXPOSED I I CONCEALED 0 MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD❑ UNDERGROUND t' AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNEp. NAME OF COMPANY DATE OF APPLICA N SIGNATURE OF APPLICANT 1 r flli L <1 L iLC Te.tC ,� ,472IX Q � ( f- I T- S I 2-^j D , L A TELEPHGNE NO Q 1/ 1) � 17 1 G� ry 9/�I' CIT11 OR TT(rn y �-- L c p'j zr OOP fY LICENSE NO.WHEN APPLICABLE WESTCHESTER ROCKLAND ELECTRICAL INSPECTION SERVICES,INC. BY THIS CERTIFICATE OF COMPLIANCE THE Westchester Rockland Electrical Inspection Services 43 North Lawn Ave, Elmsford, NY 10523 914-347-3595 (Office) 1 914-347-3596 (Fax) CERTIFIES THAT Upon the application of: Upon premises owned by: Matem Electric Rafael& Priscila Ventura 18 Delll Street 2nd floor NY, Sleepy Hollow 10591 Located at: 10 Osborn PI Rye Brook, NY 10573 Certificate Number: 1032909 Section: 141.28 Block: 1 Lot:21 BOC: Permit Number: EP:21-267-BP:21-273 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: 10 Osborn PI Rye Brook,NY 10573 0 Basement list Floor ®2nd Floor 3rd Floor Garage Attic Outside Other: Inspection was conducted in accordance with the NYS and NFPA 70-2017 International Electrical Code and detail of the installation,as set forth below,was found to be in compliance therewith on 02/07/22 Name Type Quantity Alteration Reinspection-Alteration ------- 1 Service up to 200 Amps ------- 1 Fixture-Luminaire Recessed LED 14 Fixture-Luminaire Incandescent ------- g Switch Single Pole ------- 2 Dimmers Led ------- 3 Switch Single Pole replaced 8 Replace Receptacle(s)Convenience ----- 10 Replace Receptacle(s)GFCI ------- 3 Arc Fault Breakers ------- 3 A/C Condenser ------- 1 Receptacle;Outdoor GFI ------- 1 This Certificate has been approved by Westchester Rockland Electrical inspection Services. This certificate may not be altered in any way. ` IL-This certificate is valid for work performed before date of inspection only. yy ' �I Min W � N � � O N N N N a o C � wCL z .� ►� U . r� a qT ON o Z z � rn Q oG Y Yij N x ,� zCq LLi A z o o (1coo oo u w ; w eu U .. U c7 r rN Mai ON y :4 U I x 4 O o t z i a 7 r- c " t Q w w � F E— c e.cc r Q © U O .j 7- 16 O BULL E MENT NOV 18 2021 VIL E OF RYE OK 938 KIN ET RYE B NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT or PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: I '�� /_ PP#: Approval Date: N0U 2 Z V 1 Permit Fee: S Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, 10122r21 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: 10 Osbome Pl. Rye Brook, NY 10573 SBL:,FYI. -/-e j zone:I.J-F 2.Proposed work: Kitchen bathroom and laundry plumbing 3.Property Owner: Rafael Ventura Address: 10 Osborne PI, Rye Brook NY 10573 Phone#: Cell#: 203-249-2028 email: rafvent@gmail.com 4.Master Plumber: Hugo Michilena Address: 24 Highclere Ln, Valhalla, NY10595 Lie.#: 1475 Phone#: 914-374-6738 Cell#: email L J Q Company Name: Roy Mechanical Inc. Address: 24 Highclere Ln, Valhalla, NY 10595 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 I st Floor 2 3 2nd Floor t 3 6 31 Floor 4's Floor 5*Floor Exterior 5. List Other Equipment/Provide Details: Bathroom: Connect Zsinks, 1 shower and 1 toilet. Laundry: Connect 1 sink and washer. Kitchen: Connect 1 sink, dishwasher and replace gas range. (Notarized Signatures Required Next 2 Pages) STATE OF NEW YOM COUNTY OF WESTCHESTER ) as: Rafael Ventura ,being duly swam,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 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 thi Sworn to ore me this day of ,20 day f ,20 Sig ppKue of Property Owner Signa of Applicant Rafael Ventura Rafael Ventura t Name of Property Owner Print Name of Applicant µlr�_nrllru - — N tary Pu ` Why blic fi:GQME� G EN G011�Z NO TI ' ttNY JCS ATE OF NEW YORK ebT1754, 36 y pr+nrrre �p 'rn 01GIbOlb636 r y completed in its entirety and mast ineZic r}3 E1 RN the lega•�cQ Kris) of III rElit ect property, and the applicant of record in the spaces provide ;,w ici��i�� O y � p not proper vy� 1 11 1 nth its entirety and/or not properly signed shall be deemed null and m returned to the applicant. O•. �4/C /I'''11lfll 11{111111,, _2_ 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 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 Sworn to before me this day of ,20 day of ]y(�yca ,20,:� i Signature of Property Owner Signatur f Applicant ALO mx/M Print Name of Property Owner Print NkAe of Applicant RarL A-A Notary Public Notaryliublic U NI :KKO�CHUmKAN GEEVARGHESE Public-State of New YorkNO,01GE6423824 ed in westchester CountyMmission Expires Oct 18,2025 This application must be properly completed in its entirety and must i )of the legal owner(s)of the subject property, and the applicant of record in the spaces provided. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- 8/1=02t J BUIL E MI V E OF RYE K 938 KIN ET RYE B NY 10573 or PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: PP#: Approval Date: Permit Fee: S 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: SBL: Zone: 2.Proposed Work: 3.Property Owner: Address: Phone#: Cell#: email: 4.Master Plumber: Address: Lie.#: Phone#: Cell#: email: Company Name: Address: s INDICATE.FIXTURES& LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Locatiok Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total 11 Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1 st Floor 2nd Floor 3'd Floor 4d'Floor 51 Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -i- 8/122021 BUILD bikR`I`MENT D ECE01WED VILL 'E OF RY OOK NOV 18 2021 � 938 KING SET RYE BR NY 10573 0 4 _Q VILLAGE OF RYE BROOK r n l ."r BUILDING DEPgRTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE 216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST REAR 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: Rafael Ventura ,residing at, 10 Osborne PI, Rye Brook NY 10573 (Prmtnannc) Oddr, swbcrc�ou1icyI 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; 10 Osborne Place , Rye Brook,NY. i lnb:\ddr�s,� 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. i ti�;n�uh.�r of PrnFnj �c'nciY�ll +ihnt A;ut:�� iPr�,,cn� tluncrl>II Sworn to befo e me this day of f, 20 -2_ �ye��,,,,,,KAR" ""''�•. ` Al y • NO PUBM STATE OF HEW YORK s • �f c :~ I N0.01OW16636 .` .` _ A 8/12/2021 flL[ copy ORDER NOTES: DELIVERY NOTES: Item Qty Operation Location Unit Price Ext.Price 400 1 Left Living Room $327,51 $327.51 RO Size=18"x 38" Unit Size= 17 1/2"x 37 1/2" 100CS 1' 5 112"X3'1 112", Unit, 100 Series Single Casement-CW,No Flange wlExterior Accessory Kerf(Insert),White Exterior Frame,White Exterior Sash/Panel,w/White Interior Frame.w/White Interior SashlPanet,Left, Dual Pane Low-E Standard Argon Fill Finelight Grilles-Between-the-Glass 2 Wide, 2 High, Specified Equal Light Pattern,White, wlWhite, 314"Grille Bar, Folding, 1 Sash Locks White.White, Full Screen, Fiberglass Insect Screen 1: 100 Series Single Casement-CW, 100CS 17.5 x 37.5 Full Screen Fiberglass White Exterior Frame Extenders: 100CS 17 5 x 37.5 White Unit# U-Factor SHGC Clear OpeninglUnd# Width Height Area(Sq. Ft) Comments: -------------------------------------- Al 0.28 0.25 Al 5.39700 31.8060 1.19210 ANDERSEN"100 SERIES WINDOW AND DOOR NFRC/ENERGY STAR"INFORMATION This document provides NFRC certified U-Factor,Solar Heat Gain Coefficient(SHGC)and Visible Transmittance(VT)values for Andersen"products along with the corresponding ENERGY STAR"Version 6.0(2015)climate zones in which the product and glass type are certified. �2 These products rated,certified and labeled y National Fenestration Rating Council" (NFRC)-a non-profit organization that provides fair, accurate and credible energy performance ratings for windows and doors. Many of our products meet the stringent energy efficiency certification criteria set by the U.S.Environmental Protection Agency and the U.S.Department of Energy. The certification criteria is based on the heat gain and loss of each product in various regions of the country. Check the Andersen product performance available at www.andersenwindows.com for units that are ENERGY STAR certified. United States ENERGY STARCH? Canada ENERY STAR® Climate Zone Criteria Climate Zone Criteria ENERGY STAW Nonhgrn Y,, ; ' s ? ZONE 3 ( _` -' ZONE 2 North-Central f .'f it.�ti ] ZONE 1 South-Centra V� ,• � Southern t. •so Windows Doors e Climate Golan, - Zone Leval S q27 Any Proscrpttive 71ding o Rating s 025ernsqI0gnbou _em s 025entralAk Leakag .3 cirruff s(130 s0.40 As Leakage for Swinging Doors s 05 dmV s0.3C s0.25 s 040 s0.25 Air Leakage s 3 c 'Btsdts Ra f a sea Her Gen Coancla,l 'The 0*111ve dole 101 the I' e"-"I*presumptive and egeWa l awrgy perfamenca o li—tar vvndovvn laaarua 1 201g For NFRC certified total unit performance for units with capillary breather tubes,pleate refer to the High Aptitude Information section foresch unit "U-Factor defines the amount of heat loss through the total unit In BTU/hr'B 2'•F,metric In W/m2'9.The lower the value,the less the he tls lost through the entire product. 'Soka,Hen Go in coefficient(SHGC defina the fraction of solar radotlon admitted through the glass both directly transmitted and absorbed and subsequently released Inward.The love r the value,the less heat Is transmitted through the product 'Visible Transmittance PM mean,res how much light comes through a product(Wso a no frame).The higher the value,from 0 to 1,the more daylight the product lets In over the product'stotal u nit area.Visible Transmittance Is measured over the 3soto 745o no nomeser portion of the solar spectrum. NFRC ratings arc used an modeling bya third parry agency as valldateci by an Independent rest lab In compliance with NFRC rpogram and prucedv roll requirements. Ifils dab Is acnmrtte as of January g,2017.Due to ongoing product changes,updated test resuks or new Industry standards or requirements,this data may changeover time.Due to variations In dealer and distributor Inventory levels,prod um that were manufactured before January A,2017 that were designed,tested and labeled with different NFRC W Nes may still be avolbble.Check the o dels on the product paclal ing to mrflrm NFRC values.Ratings are for sloes specified by NFRC for ten"ano ceNflcatbn.Ratings nay vary dependingon use of tempered foss,dlfferem grille options,glass for high a dhude,etc. Ail marks where denoted aretredemsris at their respealve owner. G 2017 Andersen corporation.All rights reserved. This information is for reference only. Performance varies by unit size and options selected. 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ANO 4"0904.ODW1 0.23 1.31 0.18 0.42 21 <0.2 4] NI SC S 21 2'L t ¢mutated Divided LIN(SO"or Imalled Interior Removade AND-141414.OD90400002 OM L31 017 038 20 <.1 41 NC ISSC(III S 21 72 1005":t. N', Y Casement _ Fin611rt^(grilles-0etweentlwglazsl- ANp444W-00911-001101 013 111 JUI .3 m <02 47 N(IS, 5 21 72 j Finelight^w/E�Itedor ApllOed(FLE) AND-MM- 911-00001 023 L31 20 <02 47 NC SC S ZlZ2Full Divided Lit.IFO) AM-M-11"2064-0OW1 025 L42 >a <01 47 NE SC 5 21 3.0mm Mottled or 3.imm Tenpered Gass-wJ Grill.I°or G-W, Simulated Divided Late(SDI)or lrwtalkrl bsterrer Removable AM-N-"11"-00003 0.27 1-93 0.23 038 19 <02 58 N1 5C 21 FineRBAt^�ieo4setweerMlrylwsl AND-N-844W913-OW01 11.28 1AS 0.26 0,63 19 - 3 Finefignt^w/Wed.Applied(FLEI vie rile Na Na .1. n/a .1. Na - Full Divided Litt VFDU nla Na Na Na n/a I. n/. Na - Sirmlated Divided Lite fSOL)or hetalledl t.6.111.11-Me AND-M-114-OD901-00003 OM IM UG OAS IS <02 59 NC SC S t W� FLneR011^(pilles-0etween-the-glass) AFON-g4-00915-0W01 0.28 1.59 017 038 34 <02 59 - N[ 5C S o Fineli�st^w/&trrior Applied(F1) Na rile Na via rile rile n(a rile Fan Divided Lite(FDL) Na a ola Na a N. .1. n/a n/a simulated Divided Lite JSDCl wlrpta8ed hrteriw Removed, AMID4&E4-0089600009 028 IM 038 0.42 28 <02 58 NC 11. W Flnelt M^Igiiles-between-the-glee( AIIPN•8b00912m 01 029 IM 0A2 DA7 27 <02 W 2i a S FmeBght^w(Exteries Applied(FLE) n(a ./a Na Na rile rile I. Na FallOivided Ede fFDLI rile rile Na Na n/a n/a N. Na Sim fated Oirided LitelSOLI of lrc'talled Interior Removed, AND-N-61-00903-0W03 am L36 0.23 036 23 <02 47 IC SC 5 21 Z2 e{t ... g Fk.%M^(pWes-0etweenthe-elassl ANW484m9174MM 00 IM 02S OA2 H <02 NC 47 SC S Z1 a'^ Finepght^w/Fxterty Applied EFlEI Na rile Na rile rile rile rile Na 9 Fldl Divided Lite IFOII Na rile Na rya nh Na rile Na Simulated Divided Lt.(SD)or IwAled Interior Rcmorahle ANO u-84i10904-00003 O.T3 131 0.15 034 19 <02 47 7 Finelight"'fgrilles-hemeeen4he-din) MIDF4WIM918-00001 0.24 1.6 0.17 038 19 <02 47 zJC SC 5 21 9 A E zv FinelidH^w/Eeterior Applied lFlE) via rile Na Na rile rile n/A rya Tull Divided LitafFDU rile n/a via Na n/a n/A n/a Na This information is for reference only, oataiea„ra wofianua,2017andiss bjecilomange Performance varies by unit size and options selected. P g.3o175 See page I for rrlwe in omiahoo For specific unit performance information,please contact your dealer or Andersen Sales Representative. U.S. Canada ENERGY ENERGY Mdersen' o 't STAR STAR Am- NFRC Certrfied Products product Lane& fYi16 TF06 i e u A Glass Directory Number LL LL ° _ - PrnduatTYPE T7pe u m i b y •• ^' °^ a z XE N € € b i uj 3.9mm(A-I.d.Tempered)Glass-wJ No Wks and Wit..tees Than I' No Grilles AND-WS"0920-00016 0.27 153 019 OA7 22 <03 98 NC - Z. SimuWed DNW d Lila ISOL).0eta0ed kdeAw Rerno M. AMA-64-00920-00017 017 133 025 OA2 20 <02 Si N SC 1 - 3 Finefight^(gri8es4mrt--the-glad AND- 44-00927-000D6 017 753 015 OAS 2D <DI Ss NC X '1 "-fght^w/Uteri.Applied(FEE) ANDal-64-00927-00006 027 359 015 PA2 20 <02 St NC X au Full Divided LRe(FMI AN A84-01067-00006 0.28 159 0.25 01412 19 <0.2 SUS NC - No Grilles AFD-N 9"0922 00016 0.26 IA2 0.19 DAZ 18 <0.2 59 NC t Simuaed Divided lite(SDL.)orlmteNed Interior 01--Ne ANDaa84-00922-00017 0.26 IAS 017 0.38 17 <0.2 59 NI eC FineWAw g&s41et-the-glall AND�1-A4-M29.00006 O.Z6 1A8 0.17 0.3817 <01 59 NC Fioelal;W wJ Enterer Applied(FLE) ANPN-80.00929-00006 0.26 1As 017 036 17 <0.2 59 NC full Divided Lite(FOL) AND-N•64-01069-00006 027 133 0S7 0.33 16 <02 S9 NC No Grill es AND41-9-00919-00016 027 L93 DA2 0.52 30 <0.2 57 Simulated Divided Lit.ISM).Mstalled latenor Renmv.Ne MID-N-M4-00919-00017 027 IM 038 OA7 21 <02 ;7 N ZI W Fineiight^Igriees-0etween-the4/asl ANIHI,91-00926-00006 0.27 353 03/ OR7 21 <01 57 N Z7 J S Firelight"w/Fated.Applied(FEE) AND-N-M,00926-DOOM 0.27 153 0.38 OA7 M 102 57 N 27 Full Ohided U1.(FM) AND21.84-01066-00006 018 1.59 0.34 OA7 26 <0.2 57 NC i1 No Gripes AD41- OD924-00004 024 1.M 0.27 OA6 25 <02 46 NC 23 ;.2 Simulated Mvlded Ute(SM)wimta0edlnteiar RemavaNe AND-N-84-00924-0000S 01a 1.36 025 OA7 14 <0.2 46 N 9C 2] W 5 S� Fineliprt"(pElks-natwaen-tNe-glad ANDN-s4-m931udoDx 014 136 D.n CAI 24 <tl2 46 Nc X 71 Firelight"w/Eateri.Apph,d EFLE) ANDf484-00931-MOD2 0.24 1.36 02S CAI 24 10.2 46 NC SC 5 27 Full DMded Lite IFM) AND-N-S"ID71-00002 0.25 L/2 02S 0.41 23 <02 46 4C 5C S No Grilles AND-N4"09ZS-Oil 023 1.31 OS8 0.41 21 <02 47 4C SC 5 27 c'd Simulated Divided Lite(SMl or lnstaRed Merior Rem Ale AND-N-84-0D92S-00005 0.23 131 0.17 Ox 20 .0.2 47 NC SC S Z� COasemeint e i FirelidH^(grilles4setereenthe-glad AND N-84A0932-00002 0.23 1.31 D27 037 20 <tl2 47 NC SC 5 n 2:2 i Fi-FOL^w/€eteri.Applied IFIE) ANDd6-0400932-00002 023 LM 017 037 M <02 47 NC SC 5 71 F vs Mod ed Litt IFM) AFD-N-84-01072-00002 025 IA2 017 D37 U <02 47 VC SC S 21 3.9mm(Annexed or Tengwed)Gbw-wJ Grilles 1'or Gremer SlmuMed Divided Lite 4 SM)or krrt Aed Interior Re mumble ANO f4.84-00920-00P18 027 133 023 038 19 <0.2 58 ',[ <_t 5 21 Finelight^)Silks-between-theylaF) AND-N-04-00934.00006 0.28 159 02S OAS 19 .0.2 Sa NC SL S 21 - 3 Fmel%M"w/Fated.Applied(FIE) Na n/a Na Ne n/a n/a n/a n/a - Full Daed L-de(FOL) Na nI. Na Na nJa n!a nh Na - - - - SrAubted Divided Lite(SM)or kateOed Interior Removable AID-N4K-W022-00019 0.26 L18 0.16 034 16 <01 19 NC c ...1 Fmolight"(griges4n1ween-the-Sims) ANPN-M-00936.00006 0.28 159 017 038 14 <0.2 59 N o t Fintljot"wl W.A.Applied(FEE) Na n/a Na Na I. Na nq n/a Full Divided Lfte(FMj Na n/a Na Na n/a .1. n/a n/a - - S-Mod DWed Lee ISM).Imtakol Interior R-ahle AND412400919-0OOSg 027 L53 035 OAZ 26 .02 57 N- 71 Finalbht^(�eles-betwawrtNe•gtas) AND-N-84-009334=06 OM La a." OA7 75 <01 57 N 2t s Firelight^wJ Eaterr.Applied iFLEI Na n/a Na Na n/a n/a n/a J47 FullOMviddtit.(FMj Nan/a Na Na A/. n/aSimuMed Dividd Lit.(SM).1-.Rd Wedor Rev-".. ANDJI$44092440�006 014 IM OM 0.37 22 .02NC SC 71 FlnaOgl-1willes-0etween�the-glass) AND-N-M-00938-00002 025 IAS OS CAI 23 <01Fine6gltl^w/Eakrwr Applied fF1El Na nh Na NaFull Dividd Lit.(FM) Na n/a Na Na .1. n/a n/. -SirruMd DFvidd Lit.(Worlrtalld Nteri.Removable AND-N44-D0925-00006 O23 ills oA3 19 <I2NC Sc SFinegdrtAND-N-84-00939-00002 0.74 1.X D]7 037 !9 <02NC 5[ SFkekytl^w/F1r:.Applied lFtE) n/a n/a Na Na n/a nJa nJaFun Divided tit.IFDQ nh nh Na Na n!a n/. n/a - This information is for reference only. pale is Qarard as or Jer.,ary 2D77 and n sit to cnan9a Performance varies by unit size and options selected. 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Canada c . ENERGY ENERGY c STAR STAR Andersen` Andersen NF RC CesMied Products Prod ud Line& GriDe Type N y ja Glass Type ,.irvctory kumber LL LL Product Type J u — 'g Ep C Z Z 31mm(Anneat.d a Tempered)Patterned Glass-wJ Grilles 1"a Greater Simulated Divided Like ISDLI w lrettalled listed.Remoralie ANDA484O0920-0WZ1 017 1S3 0.23 038 19 <D1 Se NC SC S Il ye Fdeiipst"(geJlesBetweenihe;hest AND�1-R<-00934-00D07 013 1S9 01S OA2 19 <O2 M - NC SC 5 21 11 Finelielnt—w/Eaterrw APOW(FIE) n/a ./a .1. n/a .1. ./a .1. -a Full Divided Ute(FDL) n/a n/. n/. nfa .1. .1. n/a W. Simulated Divided Eite1501)er hwtWkd i t.nw R.Moq*00 AO44te-W922-00021 0.M JAB DAIS 034 18 <0.2 M NC I cc Seriv� Fin.lidrt'"IpRles-between-she;las) "-0093bAD007 0-28 199 0.17 0.39 14 .02 S9 Casement C £ Finelighl' ur/Eaeriw Applied(FLE, n/a 0 n/a n/a nfa n/a n/a n/a Full Divided Lit.IFDI) n/a n/a n/a n/a nfa n/a n/a .1. Simulated D!vWed Like(SOL)wleeaalled lnt.rrw R.m.vable AND41-8LW919-00021 0-27 1.33 035 OA2 28 10.2 S7 21 3 Fine0�r1—IP�es-bttwe.n-the-elasl AiON484-00933-0W07 D29 1.65 038 OA7 2S <O14". Fineligrt^w/EMOwApplied(FIE) n(a n/a Na n/a n/a n/a n/a FuDDividedut.IFDLI r�/a n/. n/. n/a n/. n/a .1. This information is for reference only. Performance varies b unit size and options selected. O.F7d o.tat.tamed a,�,an.S eo,7 and....,O anpe y P poor s..pa0e,eor mar.irr—emn For specific unit performance information,please contact your dealer or Andersen Sales Representative. Building Pernut Check List&Zoning Analysis Address: SBI_ r + Z S) Zone: 2—� Use: ZIo Const.Type: li Other Submittal Date: I o t S Z( Revisions Submittal Dates: Applicant: A Nature of Work: LE4 A L t"ZPr— I i,) I.-J1,C5 1,J ���z�I.A C Fiwt�ti f �7�t�l•1-F� � &I-w, n geviews ZBA: 0 C T 1 8 2021 PB• BOT• Other: OK (11 ( ) FEES:Filing. S' 1 ,BP: t o C/O: Legalization: APP: Date& ✓ Notarized SBI_ ✓ 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 MgmL: Tree Plan: Other. ( } ( } SURVEY:Dated: Current: Archival: Seated- Unacceptable: ( ) { ) PLANS:Date Stamped: Sealed.. Copies: Electronic Other. License: ✓ Workers Camp: ✓ 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. (•�1 ( ) PLUMBING Plans: Permit Nat Gras: LP Gas: N/A/: Other: ( ) ( ) FIRE SUPPRESSION:Plans: Permit; N/A: Other: ( ) ( ) H.V.A..C.: Plans: Permit; N/A Other. { ) ( ) FUEL TANK:Plans: Permic 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: motes: { )ZBA mtg_date: approval: notes: ( )PB mrg.date: approval notes: REQUIRED EXISITNc PROPOSED NOTES APPROVED ADM. OCT 1 8 2021 Eaww Front Main Am&Q Ft HISb: Sd.H/SbTM in Heigbt notes: '�� - 1 A 1~ F--YP' S'A�tt: 'Rf1_ �T' 1i�A?' '•3i- �.•� •l'/�'/'4 IYCD �'A'�' -`)'I�"�' -`h'A�11 S `i'i�Y�'y' 4'il.,�'i'�u �_ 4,1,+,� =F� ��,,-�4'+1�� �,�►1►,J y,e1�,, ��- �,� e,z ,�1��i � «�) -.sh s ,,��,l,,' \> - s .:f1�11 .�'`i 3'-,1�y1i/�\`�'tt' S .:�►�� "H ti?• a �i I a•�t''� O aN Y o ✓ �. a s y W op �7 c l_ g cOp CD pd)> a! cd C, 0 F— ❑ �, ' N O U b] ! a. • • C7 _ rA 5CD ft r^! z V O W / Lij �'�`.. •am6l:" 1�' (LPL ` � ~ �M Q7 CD uj cc «O)R • � r ;•r d c.. N • z . /t�'a• '.fin : �' � � r--a �(e•)11/\\ i •� f � •� � !ice r' %1!f)► ,itF-...vi- ,1��/1, s. ��, ,� _ ;, 1 -�,�,�,� r_ .:y,'+j1+ .-.• •.:��►+1y.,�c .``gg3y ,,(►/'i'�' 'i�'i'�' gSg q@'{}yh F�'(�'i', i ,,,,+►�'1,1 ,����,� '� / A A �( �'HjA4�• 1�; (• Ir� s ♦♦ � $3A8$t4 ♦♦ � A9� ♦♦ ♦ - - t;��b.ry,J ACO® DATE(MM/DDIYYYYI CERTIFICATE OF LIABILITY INSURANCE I 10115=1 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 policylies) 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 CONTANAME:GT CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O.BOX 328 P.O.IIN E:1:888-333-4949 arc Na 507 446 4664 OWATONNA, MN 55060 EMAIL ADDRESS:CLIENTCONTACTCENTER FEDINS.COM INSURER(S)AFFORDING COVERAGE NAIL JJ INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 379_939-2 INSURER B: PALETTE PRO PAINTING &RENOVATION INC INSURERC: 10 NEW KING ST STE 209 WHITE PLAINS, NY 10604-1211 INSURER D: INSURER E: INSURER E COVERAGES CERTIFICATE NUMBER: 153 REVISION NUMBER:1 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 REQWREMENT, 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 DL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MINVOWYYYY MMIDDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED $100,000 PREMISES Ea occurrence MED EXP(Any one person) EXCLUDED A N N 0941594 11/12/2020 11/12/2021 PERSONAL&ADV INJURY $1,000,000 GEN-L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY ❑JEST ❑LOC PRODUCTS-COMPIOP AGG $2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1 000 000 teaaced n X ANY AUTO BODILY INJURY(Per person) OWNED AUTOS ONLY SCHEDULED A AUTOS N N 0941594 11/12/2020 11/12/2021 BODILY INJURY(Per accident) HIRED AUTOS ONLY NON SOWNEDLPROPERTY DAMAGE AUTOS ONLY Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $3,000,000 A EXCESS UA. CLAIMS-MADE N N 6056072 11/12/2020 11/12/2021 AGGREGATE $3,000,000 DED X RETENTION$10,0DO WORKERS COMPENSATION OTH- AND EMPLOYERS'LIABILITY .�y N X PER STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE E-L.EACH ACCIDENT $500,000 A OFFICERIMEMRFR EXCLUDED? ❑NIA N 0941595 11/12/2020 11/12/2021 (Msnr lory in Ni E.L.DISEASE-EA EMPLOYEE $500,000 11 yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $500,000 D DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required) CERTIFICATE HOLDER CANCELLATION 379-939-2 153 1 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 Q 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE F�T10/15t>rYYYY) 1alsrza2l 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 ri hts to the certificate holder in lieu of such endorsements. PRODUCER CONTACT FEDERATED MUTUAL INSURANCE COMPANY NAME: CLIENT CONTACT C NT RPHONE HOME OFFICE: P.O.BOX 328 A1C,No, o EXt:888-333-4949 FAX e No):507-446-4664 OWATONNA,MN 55060 ADDRESS:CLIENTCONTACTCENTER FEDINS.COM INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 379-939-2 INSURER B:FEDERATED RESERVE INSURANCE COMPANY 16024 PALETTE PRO PAINTING&RENOVATION INC INSURERC: 10 NEW KING ST STE 209 INSURER D WHITE PLAINS,NY 10604-1211 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 153 REVISION NUMBER_0 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. ILTR TYPE OF INSURANCE I M 1 SUBR POLICY NUMBER POLICY EFF POLICY EXP DIYYYY MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE ❑X OCCUR DAMAGE TO RENTED $100,000 PREMISES a MED EXP(Any one person) EXCLUDED A N N 0941594 11/12/2021 11/12/2022 PERSONAL&ADV INJURY $1,000,000 GEWL AGGREOATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 �OTHER: POLICY ❑JECT ❑LOC PRODUCTS-COMP/OP AGO $2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ea accident) $1,000,000 X ANY AUTO BODILY INJURY(Per person) A OWNED ATOS ONLY SAUTODULED U N N 0941594 11/12/2021 11/12/2022 BODILY INJURY(Per acddend HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE AUTOS ONLY Per X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $3,000,000 A EXCESS LIAR CLAIMS-MADE N N 6056072 11/12/2021 11/12/2022 AGGREGATE $3,000.000 DIED I X I RETENTION S10,W0 WORKERS COMPENSATION OTH- Y!N AND EMPLOYERS'LIABILITY X PER STATUTE ER r— ANY PROPRIETORIPARTNERIEXECUTIVE I E.L.EACH ACCIDENT $500 000 B OFFICERIMEMBER EXCLUDED? J N I A N 0941595 11/12/2021 11112/2022 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,desvibe ender DESCRIPTION OF OPERATIONS below E,L DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks SchedWe,may be alladted if more space is re%ired) CERTIFICATE HOLDER CANCELLATION 379-939-2 153 0 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 4, Cc 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD vORRK Workers' CERTIFICATE OF cf- STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board la.Legal Name&Address of Insured(use street address only) 1 b. Business Telephone Number of Insured PALETTE PRO PAINTING& RENOVATION INC 914494-2293 10 NEW KING ST STE 209 WHITE PLAINS,NY 10604-1211 1 c.NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required if coverage is specifically limited to 1 d. Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 47-2709745 2.Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Federated Reserve insurance Company Village of Rye Brook #153 3b. Policy Number of Entity Listed in Box"I a" 938 King St 0941595 Rye Brook NY 10573-1226 3c.Policy effective period 11/12/2020 to 11/12/2021 3d.The Proprietor, Partners or Executive Officers are included.(Only check box if all partners/officers included) ❑X all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business 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 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 carder 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 cancel the policy or eliminate the insured 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 must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Susan Auer Burton (Print name of authorized representative or licensed agent of insurance carrier) Approved by: _W "�/� 10n5121 (Signature) (Date) Title: Authorized Representative Telephone Number of authorized representative or licensed agent of insurance carrier: 888-333-4949 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