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HomeMy WebLinkAboutBP21-276OTHER APPROVALS PERMIT # 46 — DATE:/0Jc)7 / IXP;, SECTION `7 BLOCK____ LOT TYPE OF WORK JOT (�5)0 oo�n A zmoo4v, JOB LOCATI IN OWNER k�X CONTRALTO EST. Veo .w COST FEES #ot FEE IIJ4IVeQl DA /41)ozl19— % 9C-Yo e- o.�y-�rcci��Iy�o155 53/3 li'P TCO # FEE DATE _ INSPECTION RECOf�D OATS INSP FOOTING FOUNDATION - - FRAMI NG RGH FRAMING INSULATION PLUMBING 00001, - BING -_-- - RGH PLUM GAS 0 SPRINKLER ELECTRIC Ev LOW -VOLT ED ALARM 0 AS BUILT C� FINAL 1-311//-'j OTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 22-054 Certificate of ®ccupaucp This is to certify thatRobe-KT of, R�(e A-yco V—I N Y having duly filed an application on rnaf 1 "I 1 20 d requesting a Certificate of Occupancy for the premises known as, lCG Arm 1- Li.0 )e , Rye Brook,NY, located in a R—/0 Zoning District and shown on the most current Tax Map as Section: 135. Block: ) Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. /-a , issued AD 20 02), 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: — - �" Construction: for the following purposes: ) o4-erl'o' ra�'? Y-e1�G�lY 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 om the Bu-tkkng Inspector. APR 13 2011 Building Inspector,Village of Rye Brook: Date: Dv 1, For office use only:BUILDDD OF RYE MENT PERMIT# '/-c?7�p MAR 29 2012 :, OK ISSUED:�Q--�7 a/ 938 KING SIRE ; YE BROOK, iW YORK 10573 DATE: . VILLAGE OF RYE BROOK 9 �Q C�/ FEE: 1,00l PAID D BUILDING DEPARTMENT 2i�;i 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 ►►►►►►►►►►►►r►rwrrrprrrrrerrr►rrrrrrrrwrrrrrrrrwrrrwwrwrrrrrwwwwrrwww/w�rrrrrrrrrrrrrrrrrrrwrrrwwrrrrrrrrrwrrrrrrrrrrrrrrrrrr►r Address: �� P/GG �4/1� . kye Arm JL Occupancy/Use- _ Parcel ID#: 351 73 Zone: Owner: Iro nd-+ 6?!4'y /"3M-brce Address: /6 //o c k ZQ,t e ^(kc- P.E./R.A. or Contractor: 7 441n'd Address: I57 T b s & Yam 'N' Person in responsible charge: t7 j4ahx cc Address: max c�o�d L9ti�,�l,oii►a- /Vy r , 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 J / OF NEW YORK,COUNTY OF WESTCHESTER as: �l1 T nali k /mot c e I being duly sworn,deposes and says that he/she resides at (Print Ndme of Applicant) / (No.and Street) / in / /�C�'t�G.�oCtcll ,in the County of 5'���i 5- Z/' 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:$ 100, 00 0 / for the construction or alteration of !il /'J a P Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-10.A.of the Code of the Village of Rye Brook. Sworn to before me this Sworn to before me this z day of YN-\G rLh , 2021 day of T'- (-C t� ,20 12 Signaturi of Property Owner SiguaA of Applicant Ry6E9- - DAr,\BA C Or"IA SAm6ACC Print ame of Property Owner Print N of Applicant 17) No Public Notary Pu lic 8/12/2021 O� Zm cu � >9�2 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 - - - - - - - - - - - - - - - - - - - - ADDRESS . O DATE: Z PERMIT# �L — L� ISSUED:r 21 SECT: I �S� — BLOCK: LOT: LOCATION: n—� 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 2 ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ ROSS CONNECTION /19 FINAL OTHER QyE BR(�k, '9a2 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 - - - -- - - - - - - - - - - - - - - - ADDRESS: i v 1�.���C DATE: PERMIT# ISSUED: T: \3�77 BLOCK: LOT: LOCATION: � ` OCCUPANCY:kJ �- 1 ❑ VIOLATION NOTED THE WORK IS... CCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION (� REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING _IQANSULATION NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER clq N r y o W F w pG v OA c G o Q ■ �j w z 00 g M `o a •� E a a � � � �1 � W � � u . •fl a V1 00 tn CO w ," V 4 G >,$ 0 V a a ICI � E--� `p �+ �- 00 � � W w 0 , 5 3 2 V � 01% 04 ■ � V v� o � �: z ■ F = 2) a ea o s A rn :E -i y W ■ I� .� A � O �..� > 0 5 � � U 00 ■ 0\ .a V A °� .. ru ou ° ■ 00 WQ f=1 O •° t° _ wO Q a� 5 l a u O-W o � , `� � V d � V O '►• a G,,•�b � r�i Zog .n ^� � � d _ �, A � W a � C � � •o ■�i � o..hoo �I a1 a W W r7 � � � �r � � R ECENE BUILp�N D`: ARTMENT VIL , ,, OF RYi$ROOK OCT 2 5 2021 938 KING `)', ET Rim BR NY 10573 VILLAGE OF RYE BROOK 04)_ -0 BUILDING DEPARTMENT ww xvZ� 2ks02 INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Approval Date: O C T 2 5 kO 21 permit#: �/_ 0 7�7Application Fee: $ Approval Signature: Permit Fees:)$ Disapproved: Other: IV — .fit Application dated: /0_4 —'�/ is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing building,or for a change in use,as per detailed statement described below. 1. Job Address: gro a rte- SBL:4W 73—1`,S_ Zone: )e/ 2. Proposed In rov ent.(Describe in detail): a ✓ �or�/ co 3. Does the�¢roposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No:� Yes: If yes,indicate: TIER I: TIER II: TIER 1111: 4. Will the proposed project require the installation of a new,or an extension/modification to an existin automatic fire suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) :No: V Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed lengineered plans) 5. Occupancy;(1 fam.,2 fam.,comm.,etc...)Prior to Construction: 14 rl After Construction: ( '� 6. N.Y State Construction Classification: N.Y. State Use Cl as i.fication: ' 7. Property Owner: 4- Ct'l*�tq A4,�L4ee__ Address: ILI &'a' Z') Cad Phone# Cell# 6f 1 41.1 `-16 L,6 email: G m b 30 1 Ge o�- Co m 8. Applicant: h14Ch 6e r�C C'1 Address: X L. eO-J Z S n f, ea d Phone# Cell# - -; email: 9. Architect: r/ Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# email: 11. General Contractor: hG Address: r4 4 r ��'(� �n ✓5 Phone# 2 —_IYST—Qg00 Cell# 9/�{—Z5�7�S1�� email: 12. Estimated cost of construction $ (NOTE:The estimated cost shall include all labor,ma r�scaffolding,fixed equipment,professional fees,and mat and labor which may be donated gratis.) 13. Job Timetable: Start: Z'( Finish: (1) 8/12/2021 BUILDING LWARTMENT D C E VILLAGE OF RYE'` OOK OCT 2 5 2021 938 KING$TREET RYE BR NY 10573 (914)939-06 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: � ` C�,.YTr11A R✓Am314( , residing at, 10 ►3�ooK LAt�C (Print name) (Address where 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 E60I� LAVJF_ , 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 tture of Property Owner(s)) Voberf + (uhfihla l b&CA6- (Print Name of Property fl s)) Sworn to b ore me thisb`�" day of , 20 Z� (Notary Public) KOTARYPUBL:':, iAT7OFlvEr+ 'K) K No.01LE;i(+9sl1 QUALIF!EC IN V,i=S-iCE:ESTE-R COI�NIY (2) WC0WA1SF1r;1 XPIRFS,,A,*Ch 4,,'?0? 8/12/2021 This form must be properly completed &notarized by the Design Professional of record and the Property Owner. Failure to provide this completed form with your permit application will delay the permitting process. Notice of Utilization of Truss Type, Pre-Engin - or Timber Frame Construction. r �' Title 19 Part 1264 & 1265 NYCRR OCT 2 5 2021 To: The Building Inspector of the Village of Rye Brook. VILLAGE OF RYE BROOK BUILDING D_E_ PARTMENT From: ¢ Subject Propertv: /o roc: k SBL: Zone: Please take notice that the subject; Z One or Two Family; ❑ Commercial, ❑ New Structure ❑ Addition to an Existing Structure PC Rehabilitation to an Existing Structure to be constructed or performed at the subject property will utilize; ❑ Truss Type Construction(TT) ❑ Pre-Engineered Wood Construction(PW) g] Timber Construction(TC) in the following location(s); ❑ Floor Framing, including Girders & Beams (F) Roof Framing(R) fl Floor Framing and Roof Framing(FR) Please note that prior to the issuance of the Certificate of Occupancy, the subject dwelling or building utilizing truss type, pre-engineered wood, or timber construction must be posted with a Truss Identification Sign, installed in conformance with NYCRR§1264 for Commercial Buildings, and NYCRR§1265 for One&Two Family Dwellings. !a ZolII 'T_ .50up12eb C D,�_,WAf1 Jr, Date Design Professional w y 121 Date Pr erty weer to Date Notary Public (3) F, 1 1 ' to '� :t;:,,:,LE, ,,.'L;{-i1Ji�r� JT*.YPit'J' TATEOFiSi:WYORK :1J(:-O1 LE60?0511 FC;^,4;_STC`I ESTER C01A1Y fir!'; ;If;� SPIRES iF',iRCri 4,2! 1y 8/12/2021 This application must be properly completed in its entirety and must 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 WESTCBESTER ) as: �a bert 4 (+riMia h&mb66e ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of indi ' ual 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 a r�c� n`tr�cfi r for the legal owner and is duly authorized to make and file this application. (indic#architect,contractor,agent,attorn ,etc.) That all sta ements 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. Sworn to before me this ZQLII Sworn to before me this 26-'tk day of 'r- ,20 Z( _ day of 20 al _ A-) A'rI& SignatU4 of Property Ovker Siatire of Applicant W66e2T SAMBAI-/6 6qIJT/ JA 13�kmgA�E Print P Mne of Property Owner Print Name of Applicant )04',_ J��_� N tary Public Notary Public +�+�Ot'+/!-I`Jb4'N,�S�NIdX�klvfS514`!i'VG,^�,� NOTAAY Pf1ELav,ST,!iTF©F ivt:iN'1�l'l1�fS AJNR60 S31S3N3.ES:;MNI 031J11Vi1O No.Ofi_E6070571 1L40108?ll0'oN QUALIT11 IN V1 S-(0KESTER COI NTY AKIkM3N J0 3ib'iS'0.190d A 101►I NA'Cott W,II SSJPPf cXPIRES MARCH 4,202 (4) 8/12/2021 AFFIDAVIT IN SUPPORT OF FEE WAIVER RELATED TO HURRICANE IDA STATE OF Pe I-- j al COUNTY OF /—<- le 5 �`P�✓ Aail (insert name), being duly sworn, deposes and says 1. 1 am the applicant for uildin P it ertificate ofOcc�upant Demolition Permit ectrical P 7 Plum m Permi ence & Wall Permit Mechanical Permit/Pod Permit (circle all that apply) 2. I am the legal owner of property located at Rye Brook,New York (insert street address) OR I am the (Architec ontractor ngineer/Attorney) (circle one) for the legal owner of property located at /a A-C."o k C ire. , Rye Brook,New York and I am duly authorized by property owner h eri yh /h 1 9 X1A J4,cc to make and file the accompanying application. 3. The following is a description of(1)the work to be performed under the permit for which I am applying; and(2)how the work arose as a direct result of Hurricane Ida: 11-11�14 lecl- 4--,"7 IC4 4j �✓°/,� �h�l� r��S. ih.Pc1'�i�r� , ��or,.� , Core'/��c. lrr���{� 4. The work described herein arose as a direct result of Hurricane Ida and does not include Work which was not caused by Hurricane Ida. Sworn to before me this Day of 2n Notary Public NARY Pt1@M STAATE OF NEW YORK �— Me.OtCASSUM DD NY cO"wuION siou s W-»-emu FOC 2 5 2091 VILLAGE OF RYE BROOK BUILDING nc-PARTNIENT t � N N !� O M99 a tn M x en O en W W O w bi w a z T = Q te ait � � � a ,� Wo �- w � ►� Q o u 3 � f� Aau v �p O 4 rA z o- W � 00 O—+ d� m r � W W °� r•� Q o C� W ►� � a � 3aa � g F" 16 ED FNROV � 2 9 EN 20211 BUILDING DEPARTMENT V VILLAGE OF RYE BROOK VILLAGE OF RYE BROOK BUILDING DEPARTMENT 938 KING STREET RYE BROOK,NY 10573 (914)939-0668`FAX(914)939-5801 \\_ryehtook.org ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: E P#: Approval Date: D E C 1 2 Permit Fee: $ 1 Approval Signature: Other: w A]VJ�D J 24 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 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: /0 C.CJIG LA"', SBL: 135 7-3— —S Zone: /e_/d. 2.Property Owner: Or)hnn— 3PsM bf1 G e-- Address: I U B roo k (.An e �yc a� 'Cc l �y Phone#: 9 I q-LI I y - ?`10& Cell#: email: 3.Master Electrician: I;eoc!G&- Address: 6/ Z der AL C uc- 03AMAconec,(t�,liy 'p',t, ��Sy3 Lic.#:�Phone#: Cell#: email:Lio I r; uPy4e cTr,S=tq 9u!'ynA;1.• <<,,, Company Name:L iA hT .1T UP CI a r-c-- Address:Q Cef�i V' AVG. M AM Aceng=-c� .Uy l c6(4-S 4.Proposed Electrical Work/Fixture Count: !j STATE F NEW`YORK,COUNTY OF WESTCHESTER ) as: �30C t ,being duly sworn,deposes and states that he/she is the applicant above named,and does further (print tame of indi%«dual 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��2G�fr i CA L Cc�nT!A�lrr' for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor•agent,anomey.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 to before me this < Sworn to before me this day of c . ,20�L OJ�rrt�¢r 20 \ S e of Property Owner Signature of Applicant �ol,cart% �t. �� �� �j��fN�A QAmB�c� �ecx tT Ptint Name of Property Owner,i`!:J Zk=Nyne f Ap 7hicant N tary Public �* cfic, State of^dew York No. 0- c 3 o k i'.IL C1I - O taF;;ed irl Wcstchr,,"er County 3 Commission Expires January 29,20� 3/21/19 Westchester Rockland Electrical Inspection Services, Inc. - Phone: 914-347-3595 DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue Fax: 914-347-3596 Elmsford, NY 10523 Ir BUILDING PERMIT NO. TEMP# D NTE 1? fl�/ /`d�-c CITY OR VILLAGE ZIP CODE T WNSHIP COUNTY STREET AND NO.OR ROAD POLE NUMBER BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT -. OCCUPANT'S NAME BUILDING OCCUPANCY OWNER'S NAME AND ADDRESS 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 BASEMENT 1'FL. 2-FL. NOV 2 9 202 3'FL. B IL&I C EPART ENT 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 CONDITIONS AS SET FORTH FOR THE APPLICATION. SIZE OF SERVICE FEEDERS CHARACTER OF WORK NEW❑ ADDITIONAL❑ EXPOSED❑ CONCEALED❑ MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD LI UNDERGROUND❑ AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED, NAME OF COMPANY n _ f DATE OF APPLICATION SIGNATURE OF APPLICANT 1� Vt �1 �E roc_ X _-- L STREET ADDRESS TELEPHONE NO. CITY OR POST OFFICE \ ZIP CODE LICENSE NO.WHEN APPLICABLE AFFIDAVIT IN SUPPORT OF FEE WAIVER RELATED TO HURRICANE IDA STATE OF A)ekd VcA-, COUNTY OF (-,kjg!��� (insert name), being duly sworn, deposes and says 1. I am the applicant for a Building Permit/Certificate of Occupancy /Demolition Permit Electrical Permit/ Plumbing Permit/Fence & Wall Permit Mechanical Permit/Pod Permit(circle all that apply) 2. I am the legal owner of property located at Rye Brook,New York (insert street address) OR I am the (Architect/Contractor/Engineer/Attorney) (circle one) for the legal owner of property located at /U 001,-- 1 Ars , Rye Brook,New York and I am duly authorized by property ownerC� e to make and file the accompanying application. 3. The following is a description of(1)the work to be performed under the permit for which I am applying; and (2) how the work arose as a direct result of Hurricane Ida: �.r.na C', C- �eci'�ihCLn--S cy--, � i57/Z 4. The work described herein arose as a direct result of Hurricane Ida and does not include Work which was not caused by Hurricane Ida. -- - Sworn to before me this --� E�ahof 20 c)\ Notary Public SHARI fJIELILLO Notary Public, Etcats of New York NOV 2 9 2021 ..t:r Courty Commission Exnims.jRnu-:ry 9 2n-12-3 VILLAGE OF RYE BROOK BUILDING I) PARTMENT AM 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: Light It Up Electric Robert&Cynthia Bambace 617 Center Ave NY, MAMARONECK 10543 Located at: 10 Brook Ln Rye Brook, NY 10573 Certificate Number: 1033813 Section: 135.73 Block: 1 Lot:5 BDC: Permit Number:EP:21-311-BP:21-276 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 Brook Ln 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 03/24/22 Name Type Quantity Receptacle Convenience ------- 30 Dishwasher ------- 1 Oven Gas or Electric ------- 1 Receptacle GFCI ------- 2 Receptacle Weatherproof ------- 3 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. 't/� This certificate is valid for work performed before date of inspection only. • s , s N N N 1 N � a � o � � w g o � ►-� Lntc W ■ A Ln en H O y A Q 3 00 N v 9 z � z 0-4 z ►7 00 z CC a 0 U u z Ln z 00 s, z z U O C7 z $ o O O Z o _ a o3 N P g h� U a a Yet W °' x o z A z A o � w a o a ZF. vi 1616641;664t-wt4tot4 A44ti4 416 4tttc4;4p4�4tc6Ut-44i$6t 44&aaa4 4# �lE -aRnv.� D E C E NE BUIL E MENT APR - 1 2022 VIL E OK 938 KIN ET'.I�YI"B ,NY 10573 VILLAGE OF RYE BROOK = BUILDING DEPARTMENT pD .or; PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: /_ PP#: Approval Date: APR — 120 Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, "�► 2 Z 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 Ka bing work will be in conf rmance with all applicable Federal,State,County and Local Codes. 1.Address: (JC k t 4- BL: + Zone: 2.Proposed Work: I 94 3 3.Property Owner: Address: c ion Phone#: Cell#: email: e"!'l 301 ., 4.Master Plumber: q✓:t. /7e d a z Address: 1°v �a X 7rj c� (el /�(J� l ZO I Lic.#: (S 7 Phone#: Cell#: 9/y 3jy Z« email:—9a. ✓ >> e'er Company Name: & Address: 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 1 st Fioor 2nd Floor 3'd Floor 4'h Floor Floor Exterior 5.*List Other Equipment/Provide Details: C�tF�t 114 �1S � r S 4c7 ^Q U t ufc cP k 1 k JCt d nS o , / (Notarized Signatures Required Next 2 Pages) 8/12/2021 STATE F 7EW YORK,COUNTY OF WESTCHESTER ) as: n 01, 6i ,(, ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of indi dual 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 �rj hr/4 C Lk, 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 worn to before me t is day of f*y\aT Ct\ ,20 Z z da f ,20 Z 2— Signa a of Property Owner Signature of plicant 13AmBaGE A Print Name of Property Owner Print Name ppl' an Notary Public LLVAN/A CASTll6tary Pu blic NOTARY PUBLIC STATE OF NEW YORK No.OI CA6362630 MY COMMINON BxlptP.O 30-2962O21 2 This application must be properly completed in it entirety and must include the notarized signature(s)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. ---- EVE BUNTIN(3-SMITH Notary Public, State of New York No. 60-5520795 Qualified stchester County Commi o pir April 30,205" -2- �a f-C, © � � 8 /2021 BUILD MENT C MWED VIL O>l!RX '\ OOK APR _ , 20 938 KING ETR�E;$R , NY 10573 22 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:3J, t'�NrTf�I�l 1 AM1366C , residing at, le G�oe k L4he (Print name) (Address where 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; Q H e , 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. (Signatur f Property Owner(s)) T� IR SArn9A6t (Print Name of Property Owner(s)) Sworn to before me this 3 _ day of o -h , 20 2`2 - (Notary Public) -3- 8/12i2021 Building Permit Check List&Zoning Analysis Address: t O �.D.CA_ rj I-- SBL: 3 S 3 S Zone:, l�Use: Z Const.Type: Other.�f -JQ-A-( C a4✓Nr-_ V-> f Submittal Date: O Z Revisions Submittal Dates: Applicant: Nature of Work _2102-2, f1— evi ws:ZBA: 0 C T 2 5 2021 PB: BOT: Other. NEED ( ) (-FEES:Filing. BP: C/O: Legalization: ( ) (%4'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: ( GLANS:Datfp Stamped Sealed Copies: Electronic: Other. ( License: 'J Workers Comp:��t 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: REOLMED EXISTING PROPOSED NOTES 2 5 2021 Arse: DatO�T Sirs1� Erg Sides Main Sys Accs.Cov Ft.H/Sb: Sd.H/Sb: SEA: Tot.Imp a-imp: Hag /Stoaes: notes: Laura Petersen From: Laura Petersen Sent: Tuesday, October 26, 2021 9:48 AM To: ANTHONY@TSQUAREDCO.COM Subject: Building Permit Application - 10 Brook Lane 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, 1/2. . 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) 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 IoetersenCa)rvebrook.org 1 1 '� A� A�.r y ': AS�AY > -:'.,.. t t d���l,',3.` ..._. �{fs� Fli.:.• ct:Y��ibiFss� :i(,.�iY° 'rf+ '�f.� i ��Yf�l' ,�,,} d 75°sy1'��d )Q •5•'ii r} .O� w �yrf' yt�� n. 03' � {5 O� G�� 'J� O 'r_ /A°' O" tit�i O" � �,W1d,,r.� ' I� vt� } eF��/skk',�s�U: 'O f� sf1•n"' •t i q.`•� .:Ay,,p�• r�/��.1����;sr f #v s;f��11�Ri4'a� r ,rl •'�� [ �iir� ,' �/1"�!1`," v I�i F' �r �',, � V ,;:'i �,:! 19WW1 111111111�11►�i !&1� sffmn'11111jP1 i MI Sim 11111111�1111° #S�� ��1��5:�111��11111:�i, .# 11111/111►Il�,ii:���.��s�,,!1111/1/11►►p .,� � ` :=:,V11�1�11i1 -`.�.:IHI►` z. 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J' {�yY- � :,v �JQIi:'���+ :r,Vj M t:. �`r3•.•� :J�Vy v�`0•,��i.�rl '{eh i. ACODATE 1 o/z7/2oz® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/ I�021 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 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(s). PRODUCER CONTACT Cole Lahey NAME: PF Northeast Brokerage Inc PHONE (845)223-8107 (,AX (845)227-8816 A/C No Ext: A/C,No 1035 Route 82 E-MAIL cIahey@pfnortheast.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Hopewell Junction NY 12533 INSURERA: Ohio Casualty Ins Co. 24074 INSURED INSURER B: West American Insurance Company 44393 T Squared Contracting Inc. INSURER C 157 Tibbetts Road INSURER D INSURER E: Yonkers NY 10705 INSURER F: COVERAGES CERTIFICATE NUMBER: CL214212612 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD MM/DD/YY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR PREMISES Ea occurrence $ 300,000 X Contractual Liability MED EXP(Any one person) $ 15,000 A BL055885582 12/11/2020 12/11/2021 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: 2,000,000 GENERAL AGGREGATE $ POLICY X PRO JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED BA055885582 12/11/2020 12/11/2021 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED Ix NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE US055885582 12/11/2020 12/11/2021 AGGREGATE $ 5,000,000 DED I X RETENTION$ 10,000 $ WORKERS COMPENSATION X STATUTE ER ORH AND EMPLOYERS'LIABILrrY B ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ NIA XWW58749528 04/02/2021 04/02/2022 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached H more space Is required) 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 AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS'COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la.Legal Name&Address of Insured(Use street address only) lb.Business Telephone Number of Insured (914)965-5955 T Squared Contracting Inc. 157 Tibbetts Road lc.NYS Unemployment Insurance Employer Yonkers,NY 10705 Registration Number of Insured Work Location of Insured (Only required if coverage is 1d.Federal Employer Identification Number of Insured specifically limited to certain locations in New York State, i.e., a or Social Security Number Wrap-Up Policy) 36-4697199 2.Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) West American Insurance Company 3b.Policy Number of entity listed in boa"la" Village of Rye Brook XWW58749528 938 King Street Rye Brook,NY 10573 3c. Policy effective period _4/2/2021 to 4/2/2022 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 "Y' insures the business referenced above in box "la" for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"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 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. 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 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: Joseph W.Pires (Print name of orized representative or licensed agent of insurance carrier) Approved by: ! �� / 10/27/2021 (Signature) (Date) Title: President—PF Northeast Brokerage Inc. Telephone Number of authorized representative or licensed agent of insurance carrier: (845)223-8107 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(9-07) www.wcb.state.ny.us