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HomeMy WebLinkAboutBP21-277PERMIT #A.:/ SECTION TYPE OF WORK JOB LOCATION OWNER CONTRACTOR-�� T. COST YcO # TCO # P/z7 DATE:/'o a7 d EXP; o off% z ' 0 BLOCK f LOT pi INSPECTION RECORD I DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING CO RGH PLUMBING GAS SPRINKLER ELECTRIC LOW -VOLT M ALARM _JJ AS BUILT [� FINAL t l 2i1, l2 _A2,_.... jD aor% 17AIwI ON U �'rlER APPROVALS BOT . PB ZBA OTHER �5 �UILPFINAL SURVEY UIRED PRIOR TO FINAL INSPECTION e c ?,v /ail/ O k V V✓y' ��V yOyJ r V ��4a av i l.G VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Paul S.Rosenberg (914) 939-0668 Christopher J. Bradbury www.r)7 ebrook.org TRUSTEES BUILDING& FIRE Susan R Epstein INSPECTOR Stephanie J.Fischer Michael J. Izzo David M. Heiser Jason A. Klein CERTIFICATE OF COMPLIANCE January 27,2022 Adam Polay&Bari Polay 31 Mohegan Lane Rye Brook,New York 10573 Re: 31 Mohegan Lane, Rye Brook,New York 10573 Parcel ID#: 135.41-1-42 Building Permit#21-277 issued 10/27/2021 for a New Fence This certifies that the new four foot high black aluminum fence,installed under the above captioned permit has been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector /tg D [ECEHE 2 BUILD R For office use only: M PERMIT# i Q77 VIL OF RYE R K ISSUED: JAN 10 2022 Kllv ENT c STRE VE BRooK YORK 10573 DATE: - p-' FEE: PAID CY VILLAGE OF RYE BROOK dW BUILDING DEPARTMENT APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION Address: 11epa ' Occupancy/Use:_AL,, ' Parcel ID#: 3 y — /-412 Zone: n Owner: Aid,,, r a-'r; P(c+y Address: / 1"Clow.,4 4i P.E./R.A. or Contractor: F(IT"e 64cc 0,u X-144 Y.t c. Address: �-Q �Q ' ¢��l`{ ki(L tAk fo of 4 Person in responsible charge: Address: VL� 1 bSy 3 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: STA�T.E OF NEW YORK,COUNTY OF WESTCHESTER as: A + eO/,, being duly swom,deposes and says that he/she resides at 31 /'4664c�- 4?-A e (Print Name ot Applicant) o.and Street) in 9ye rck x ,in the County of ���+� in the State of �� _ ,that (City/Town/Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$9, 1U0,DO , for the construction or alteration of: �3E'.(0 y �t (� Q(a�K_Ef ;,, � tre 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 Y'A�� Sworn to before me this !V day of SA L)o y , 20 Ja day of uo'y , 20 Si//g��nature of Pr rty Owner Sig fD re oppp/licant Prin Name of Pro er Name of A licant EL7�� T J C COWEN ;oWtary Public,State of New Yet k Notary Public, State of New York No.01 CO6230935 No. 01 C06230935 s 1- 21121 Qualified in Westchester Cou,-ry Qualified in Westchester County Commission Expires Nov. 15,2':_Z Commission Expires Nov. 15,20;-j �QyE BRa?� O Z� cu � • 1932 BUILDING DEPARTMENT ❑BUILDING INSPECTOR 5 ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK b CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : i G l l DATE: I PERMIT# ISSUED:SECT: BLOCK: LOT: LOCATION: V-!i .�M � IY� OCCUPANCY: � ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION `V���•! REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION NATURAL GAS ❑ L.P. GAS \� ❑ FUEL TANK ❑ FIRE SPRINKLER i\ ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL �� ❑ OTHER N C ■ � N � `.p3'r '� v '7 ■ �•'� FBI Gael Q C it a. � k Q W � v v •� .° a � v� x a O �I � � � o w 3 ; � 3 ° � f:A F■■i acc OO � � W > OFF• L U 5 pz;o 3 W w 3 �•, U A 0Lm V© W maZ r.�nE ° � o Z Z Q 00 v Q o u o o p • � cT' w Q W o4 � � O o a e � � � .� � � � �T i j p �-�- V Q� (�C � O �O a• y '��' IZy CA mw �LLJ � .Z MCI '' W z o C eaid nU +U� � oF G Q 3 ^ y y � o 0 ,iwZ '- �' d BUILD RTMENT VILIL OF R ROOK SEP 2 0 2021 DD 938 KINd EET RYE BR:kh ,NY 10573 j 4 9-0668' VILLAGE OF RYE BROOK ok.ora BUILDING DEPARTMENT FOR OFFICE USE ONLY: Approval Date: OCT 1 1011)wemiit# t X 7 7 Application# Approval Signature: ARCHITECTURAL REVIEW BOARD: OCT 2 0 2021 Disapproved: Date: BOT Approval Date: Case# Chairman: . PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other Application Fee& Permit Fees: t �` FENCE / WALL / GATE PERMIT APPLICATION Application dated: g�CDO a f v is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the installation,construction,repair or replacement of a hence,Wall or Gate,in accordance with Section 250-6 B.(1)(g),of the Code of the Village of Rye Brook,as per detailed statement described below. Swimming pool fences must conform to the State Code. I. Job Address: 31 Mohegran Lxjc_Rye Brook NY 10573 2. Occupancyllise:—InFW V _S.B.L.#: 13S.yj I JIQ Zone: l 3. Proposed Fence/Wall/Gate(describe in detail): Installation of approximately 220'of 4'H black aluminum fence by Vanguard.Price includes two walk gates,one 5'W walk -Rate on one side of property and second Rate to be 31W Gates to be self-closing and self latching.All posts set in concrete footings. 4. Property Owner. Adam Polay Address: 31 Mohegan.Lane,Rye Brook IVY 10573 Phone# Cell# -4 47 email: adam.polay(agmail.com Applicant: Adam Polay _ Address: 31 Mohegan Lane,Rye Brook NY 10573 Phone# Cell# email: Architect/Engineer: Address: Phone# Cell# email: Contractor: Future Fence and Painting,INC. — Q lL/ S�cc; CQ// 9/41- loJB- oo)��'/ Address&Phone: 336.F4vette Ave.Mamaroneck NY 10543 914-698-0150 5. If building is located on a corner lot,which street does it front on: 6. What is the estimated cost of construction $9 140.00 (NOTE:The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 7. Estimated date of completion: one week after permit is received i 8/1 212 0 2 1 Please note that this application must include the notarized signature(s) of the legal owner(s) of the above-mentioned property, in the space provided below. Any application not bearing the legal property owner's notarized signature(s) shall be deemed null and void, and will be returned to the applicant. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Fid4M 9 O ]CK�A ,being duty 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 (indicate architect,contractor,agent,attorney,etc.) for the legal owner and is duly authorized to make and file this application. 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 hire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this (7 Swom to before me this f 7 day of 20 day of.Z 3wk"�r , 20 _ 2-7 � C Mgnaffie of P �Owner Signature ofrApplicavV (! CJL '00 k tzl 6 / 1,1*lam,,Ofp party O er Pri Name of pplic tart' ublic -- Notary Public aof JONATHAN C COWEN JONATHAN C COWEN Notary Public,State of New York NO WY Public, State of New York No.01 C06230935 No. 01 C06230935 Qualified In Westchester County 0�in Westchester County Commission Expires Nov, 15,20 won Ex*m Nov. 15,20 8/1212021 Building Permit Check List&Zoning Analysis t Address: Z,1 O �' SBL: Zone " �Z Use 10 Consr.Type: Other. Submittal Date: 2-0 Z ( Revisions Submittal Dates: Applicant: A- I Nature of Work V-_ a 046 t--0Q rft�,7Crr Reviews ZBA: S E P 2 1 2021 pB• BOT• Other. sm SDK ( ( ) FEES:Filing: 7 S• BP: t - C/O: Legalization: ( ) (.,YAPP: Dated: Notarized: ✓ SBL: ✓Truss I.D. Cross Connection: H.O.A.: ( ] ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening: ( ) ( ) ENVIRO: Long. Shorr. Fees: N/A: ( ) ( ) SITE PLAN:Topo: SiteProtection: S/W MUM r:Tree Plan: Other. ( ) (../SURVEY:Dated 3 Z(o 7- 1 Current: ✓Archival Sealed: ✓Unacceptable: ( ) ( PLANS:D�Stamped: Sealed: Copies:Electronic:Z Other. License: Workers Comp. Liability Comp.Waiver. Other. CODE 753# a/Oa-7/ 0 e4.30 �Ca 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. (�'` mtg.date: 2 approval: �d n ( )ZBA mtg.date: approval:- notes: ( )PB mtg.date: approval• notes: REQUIRED EXISTING PROPOSED NOTFS 021 Ate: Date:, Cie : Fro E= Frame sidw Bar Main Cov Accs,Cov Ft.H/Sb: Sd.H/Sb: -GEA: : FL Imp Parking: Hdght/Stories notes: DR V BURM MENT RSEP Z O 2021 DIDVIL OF RY OOK VILLAGE OF RYE BROOK 938 KING SET RYE BR NY 10573 4 � � BUILDING DEPARTMENT > • ARCHITECTURAL REVIEW BOARD CHECK LIST FOR APPLICANTS This form must be completed and signed by the applicant of record and a copy shall be submitted to the Building Department prior to attending the ARB meeting. Applicants failing to submit a copy of this check list will be removed from the ARB agenda. Job Address: Date of Submission: Parcel ID 4: W-1—Ya Zone: —/01 Proposed Improvement(Describe in detail): Installation of approximately 220'of 4'H black aluminum APPLICANT CHECK LIST: fence by van �'1 UST BE COMPLETED BY THE APPLICANT d.Price includes two walk gales,one S'W The following items must be submitted to the Building and second to be TW.Gates to be self closing and self latching. Department by the applicant-no exceptions. Property Owner:Adam PolU I. ("I Completed Application 2. (L,)Two(2)sets of sealed plans. (one full size;utaxiniuni Address: 21 Molheizan lane Rye Brook NY 10573 ail(mahle plan sin=•h'x 42` end one I I.'\17") Phone# - -4 47 3. (L-)Two(2)copies of the property survey. 4. (-)Two(2)copies of the proposed site plan. Applicant appearing before the Board: S. (-One electronic/disc copy of the complete Adam Polav application materials. 6. (L}Filing Fee. Address: 1 h 7. (tr)Any supporting documentation. Phone# 973-632-4747 8• ( )HOA approval letter. fifapplicable) 4. (-IPhotographs. Arch itect/Engineer: 10.(`—jSamples of finishes/color chart. (a sample board or Phone# model may be presented the night of the meeting) By signature below, the owner/applicant acknowledges that he/she has read the complete Building Permit Instructions&Procedures,and that their application is complete in all respects. The Board of Review reserves the right to refuse to hear anyapplication not meeting the requirements contained herein. ( Sworn to before me this / Sworn to before me this-1 7 day of `6 ,20 Z/ day of ar 20� Signature of Prope Owner 49nat1W of AppyAnt PQlay TPUblic pe Owner r pplicant ATHAN C COWEN NATHAN C COWEN Notary Public, State of New York Notary Public,State of New York No. 01 CO6230935 No.01 C0623005 Qualified In Westchester County Qualiried in Westchester county, Commission Expires Nov. 15,2c_'�_) C4mmlssllon Expires Nov. 15, 20--' VILLAGE OF RYE BROOK BUILDING DEPARTMENT 938 KING STREET, RYE BROOK,NY 10573 (T) 939-0668 (F) 939-5801 ARCHITECTURAL REVIEW BOARD Wednesday, October 20, 2021 ANNOUNCEMENT: PER THE GOVERNOR'S EXECUTIVE ORDER THIS MEETING WILL BE HELD VIRTUALLY THROUGH THE ZOOM PLATFORM. THE PUBLIC CAN ACCESS THE MEETING THROUGH THE FOLLOWING LINK: https:11usO2web.zoom.usij/89381834463 OR BY OPENING ZOOM AND ENTERING THE MEETING ID: 893 8183 4463 NAME & LOCATION TYPE OF APPLICATION MOTION SECOND APPROVED REJECTED APPL.# 31 Mohegan Lane 4'- 0" High Black Consent 5628 (Polay) Aluminum Fence Agenda 0 2 Tamarack Road Roof Top Solar Array Consent 5629 (DiCostanzo) System Agenda 541 Westchester Roof Top Solar Array Consent 5630 Ave (Galvez) System Agenda 104 Country Ridge New Hot Tub On Concrete Consent 5631 Drive (Savitt) Patio Agenda 2 Wilton Road Roof Top Solar Array Consent 5632 (Chen) System Agenda 980 King Street Amendment Legalization 5260 (Perez) To Prior Approval (Window, Door&Fence) 13 Knollwood Drive Amendment to Rear Patio Consent 5633 (Luceno) Location Agenda 5 Little Kings Lane New Masonry Terrace 5634 (Nathan) W/Planters& Steps to Grade 24 Beechwood Blvd Amendment to Prior 5635 (Moore) Approval(Exterior Site Work) 7 Holly Lane 2nd Story Addition(Master 5636 (Chalfen) Suite) ML NAM MR SE JM SF AC MI KC tp U Q Q Z Ow u O O m2 U a Wix E > o Q a) Q O L �n � o �� N r tuJ cv tLp �� z � � r co iL Z LN WWI .�>mLLJ 0 R N N a z P fU O � OO I � X � O 4. tr n z Z U 00 a Li Q PO N N m ch 4-1 s � (U n C n � U m Q wvra 3IVaA38 83sn O0 u a fuuJ _ m a N LU Q a o m LL ILV) inLJ A r u t � IC14 u Im C7 m Ur a = °a a Q a w Z W 0. 0 t� Q D j. rJ ILO N M C p Y! C in o w a >ca Lip w N N N N Q >m C rL 4 O (A ® U W m 0 V J 0 m kn CT O cl 3 � fa0 (V V 4. , N N -0 Q N O c rty (Li : o W a, } C n a y E a _: u V a z' v C E go = c W 4 Q v o VTo +� _ C T �+ aM 0 0 'E C 00 CL U W U- u W IA X Z u a N M O Z N Y V O W ►A XC co V ~ V in O H a.r r/I O X 4 ll U Q r Zn M 'O X Ln L u U Q O: C O lfl lit lf1 IU = 'a �p M N X N N U +-� U N QJ v Q U Nx � N in v O N .-i -L. —9 " la J CO W +� u p q x a x W x x C CO � L R1 Q Q a W 3 3 O N Z r a C a ll R v m , .. C „ In � t� m w li {A � a M = }- VI U1 N (N N M <T Vy r) ry r, Vf CO Ni A U th N in W axe- n,� �1ti- / f,. ( ,.' � � ,a= � c�..� - •ter+ ,..y ,F `~ V11 S 8 �,O a c O •. o cu ea � Itr O • µ, G O oUll 0 4 • O 4 4 p O • p Y A O if q • O y � O r 0 • p : G O O � O O 6 4 yk LLJ � c ' d/ O • O o L„ A� } O 0 Ci • 4 ¢d, pL<L < 04O oLL 4°+ 4 {;' r ' O O fir. p e Y o p }o • o , LL X rat n 0 111 C CD h Yr c c • j.+'+t� p/ Y � p 2, • o 1cqO LL" O o _ O YYY p O C R O O O p 4 G O O O a . 0 o i,� :: ."�' `` \ °^..,.�" � A 1 ` ,� Z.L �'�t �t �` r,. ',_ �`�1 � ��'.'�'rSh'W'n h �••�f.�r�` � S Q , s c 4 ; DATE(MMIDD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 01/25/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Evelyn Valentin-SOraoco NAME: BNC Insurance Agency PHONE E (914)937-1230 FAX No: (914)937-1124 90 South Ridge Street E-MAIL escracco@bncagency.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC0 Rye Brook NY 10573 INSURERA: Selective Insurance Company of the Southeast 39926 INSURED INSURER B: Future Fence&Painting Inc INSURER C: 336 Fayette Avenue INSURER D: INSURER E: Mamaroneck NY 10543 INSURER F COVERAGES CERTIFICATE NUMBER: CL2112599687 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AVUL51JOR POLICY EFF POLICY EX LTR TYPE OF INSURANCE INSD yWVD POLICY NUMBER MMIDD!YYYY MMIDDtY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.000,000 CLAIMS-MADE ® cc OCCUR PREMISES Ea ourrence $ 500,000 MED EXP(Any one person) $ 15,000 A X Contractual Liability Y S2152994 01/27/2021 01/27/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY ©JEC7 LOC PRODUCTS-COMPIOPAGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 EA accdent ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED S 2152994 01/27/2021 01/27/2022 BODILY INJURY(Per acradent) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident b UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE S 2152994 01/27/2021 01/27/2022 AGGREGATE $ 5,000,000 DIED I X1 RETENTION$ 10,000 $ WORKERS COMPENSATION I SPER OTH- AND EMPLOYERS'LIABILITY y I N TATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Village of Rye Brook is included as an additional insured when required under written Contract or Agreement. 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(2016103) The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund WESTCHESTER ONE,44 SOUTH BROADWAY, 10TH FLOOR,WHITE PLAINS NY 1 0601-441 1 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE o ',o I A A A n 205724763 + 1W •J'V". BNC INSURANCE AGENCY Y` 90 S RIDGE ST O RYE BROOK NY 10573 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER FUTURE FENCE& PAINTING INC. VILLAGE OF RYE BROOK 336 FAYETTE AVENUE 938 KING STREET MAMARONECK NY 10543 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2366 499-8 679841 07/02/2021 TO 07/02/2022 7/2/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2366499-8, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK. TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:/IWWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT CARY SOCCI VICE PRESIDENT RAMIRO REYES 20F2 FUTURE FENCE& PAINTING INC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY NEW YORK STATE INSURANCE FUND z5?-arz-� DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 806157849 Laura Petersen From: Dig Safely New York Exactix <tickets@exactix.digsafelynewyork.com> Sent: Wednesday, October 27, 2021 2:18 PM To: Mike Izzo Subject: Message from Dig Safely New York, Inc. (DSNY) ****REGULAR**** DIG REQUEST from DSNY for: VIL RYE BROOK Taken: 10/27/2021 14:16 To: VIL RYE BROOK PRIMARY Transmitted: 10/27/2021 14:17 00032 Ticket: 10271-001-830-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 31 To: Name: MOHEGAN LN Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: WORKING AT THE REAR OF THE PROPERTY AND ALONG PINE RIDGE RD NearSt: PINE RIDGE RD & BONWIT RD Means of Excavation: HAND TOOLS Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: Y Work Type: FENCE INSTALL Estimated Work Complete Date: 11/08/2021 Depth of excavation: 2 FEET Site dimensions: Length 220 FEET Width 10 INCHES Start Date and Time: 11/06/2021 07:00 Must Start By: 11/23/2021 - ----------------------------------------------------------------------------- Contact Name: MR SOCCI Company: FUTURE FENCE & PAINTING Addrl: 336 FAYETTE AVE Addr2: City: MA.MARONECK State: NY Zip: 10543 Phone: 914-698-0150 Fax: Email: futurefence@aol.com Field Contact: MR SOCCI Alt Phone: 914-698-0150 Email: futurefence@aol.com Working for: MR AND MRS POLAY ------------------------------------------------------------------------------ Comments: Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: CONED SUEZ WTR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR 1 Z' > .0, > if En Ld "I Sc Rip 0 IL z < 0 9d R11; q 1 uh as ba .2 ZM m IN 8 �1,8 CL F- Z Z -!005 20, RO P:5 0 u g 5 C3 EL t- gill g Mon 0 Of 12 2 PERMIT to c), -2FINALx 'r, AS-BUILT/FINAL SURVEY E IRI 8130 REQUIRED PRIOR TO I L I 40 DATE APPROVED FINAL INSPECTION BUILDING M C R-,f,ITage of Rye Brook llr 0 z -5 C13 C14 < Lij NJ C-4 LL 0 0 CL (3 Rb Lu Wz (20 > al i COPY RDd B 1AIN MA i4'-,o cr village 0i kYe rk C — 9 , Arch itectura !f 5 ` irk ib i ew YO Approval Date: 1-31111,!Know whaftbeWw. 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