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HomeMy WebLinkAboutBP21-231PERMIT # DATE: C1 07/ F3(P:, SECTION f 3*r 7 t9 BLOCK LOT, TYPE OF WORK �Jml7i✓r/C7�_/ JOB LOCATIC OWNER, 4 CONTRACTO EST. COST _ VetO # TCO # FEE DATE NKC RECORD DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION , PLUMBING RGH PLUMBING GAS SPRINKLER Sx ELECTRIC LOW-VOLT7 ALARM AS,BUILT 0 FINAL a- �a3- /9'/a %Qbloo4g421eo L9/jjm)403- / 9#a. �1 OTHER APPROVALS BOT PB ZBA OTHER VILLAGE oiP RyE BROOK WESTCHIMSTsu Coui4TY, NEW YORK NO: 22-038 Certif icate of (9ccupancp This is to certify that46DOI!�he'oHAD of, R�/Ps- (�� , N 7 having duly filed an application on Harch a; 20_requesting a Certificate of Occupancy for the premises known as, /G To/ )(16ff Pond , Rye Brook,NY, located in a P-I'Q Zoning District and shown on the most current Tax Map as Section: 135. Block: / Lot: 14 , and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. -0?3 J, issued ) 20v2 I , such authority and permission is hereby granted to the property owner to lawfully occupy or use said premises or building or part thereof listed under the following New York State Classifications,Use: R-3 C)n - / Construction: for the following purposes: I ri J -er I DY `A?/' /nt-i S bomy-(Y)m ���a yafiUrl 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 st&all be made nor shall the building be moved from one location to another until a permit to accomplish such change has e e ilding Inspector. Building Inspector,Village of Rye Brook: Date: MAR 16 1022 D "� BUILD. R NT For officML D . PERMIT# 3/ MAR ' 8 2�22 VIL ' OF RYE OK ISSUED: 938 KING STRE YE BROOKS YORK 10573 DATE: 3-8—aZk VILLAGE OF RYE BROOK 4)9 -06 O�c FEE: q& PAIDJL BUILDING DEPARTMENT IwH°R r 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 rrrrrsrrrrrrrsrssrss►rsrrrrrrrsrrrrsrrrrrrssst*x******************x*xxx*xx****s**xsxxxxxs*sxsx*x**x**xxxss*xxxxxxxxx*s*xxxx** Address: 10 F40,67—7 )114-0 Occupancy/Use: l�/Ci4 Parcel ID#: 3 J5, 219 Zone: 01—/ Owner: � i�7j /L. Address: 4—'A X)sy/vim P.E./R.A.or Contractor C71w a Address: 'c- 'Vy /O-Ab Person in responsible charge: 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 W,��Y.�OiRK,COUNTY OF WESTCHESTER as: 1 c� G�u�'G being duly sworn,deposes and says that he/she resides at0- ( t Y M Y A;;�w plicant) / (No.and Street) in ,in the County of t(56 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: S 016 OO/ , for the construction or alteration of aA' 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 da of �� , 20 Z2 day of ,20 A—�� gna a of property Owner Signature of Applicant Print Name of Own Print Name of Applicant VA i No Pub Notary Public NOTA JJBUC,STATE OF NEW YORK Registration No.OIJI6428953 1,2 -11 Qualified in Bronx C un Commission Expires: 3 Z-'� QyE BRC), O� tim �7 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK [I CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www.rygbrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : �J '- ` f \ DATE: PERMIT# l �� ` ISSUED �� ` SECT: 1�� BLOCK: LOT: LOCATION: OCCUPANCY: Z' ❑ 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 n \CSC ❑ L.P. GAS a ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL ❑ OTHER QyE BRC��, 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 - - - - - - - - - - - - - - - - - - - - INSPECTIONREPORT - - - - - - - - - - - - - - - - - - - - ADDRESS: 0 DATE. PERMIT# ' ISSUED: SECT: 1 '"' (BLOCK: ' LOT: I Nis No( es< ._ LOCATION: OCCUPANCY: f ❑ VIOLATION NOTED THE WORK IS... ElACCEPTED REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAsv �1 ❑ FUEL TANK ` , ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑CROSS CONNECTION FINAL an UDC ,,.❑ OTHER � �^„`\�1-� C � _t C-�-)coO �(�' �5 Olt1� � ���►-x���5 � ��i �' C cxzn ��1 a(� U7 �yE BRC��. 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR •ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www rygbrook.ors - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS• \C \ r ­y<. 0-2 ,��`s'� f DATE• PERMIT# ��i� 1 ISSUED ,A SECT: BLOC LOT: LOCATION: � - " ' may OCCUPANCY: L` y ❑ VIOLATION NOTED THE WORK IS... [�� ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION o REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑^�j UNDERGROUND PLUMBING NOTES ON INSPECTION: ROUGH PLUMBING U ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER a r4 C" (q rq p a a, ■ � N p Q +� x �- a 0 aci CL a Ncl w _ = Qr Q = C q ` Q 6 F � � W Q p y a Q ^J dN C n ^do z �0 4 MM rT, 02 0 C6 �Tr Qr rra ;? a .ter 'CO 0 W wo U a o .a o o 0" Z Q I C > en ~ 00 fit/ W O O " u ; c•a a, aEi a r/► � d � d Q a p � f � y � � Q O �1 yg F c c a � pr,r o o � - � U 6Q .14 r•* .a v a w > o s BUILDS MENT vIL ` E OF R OK AUG 18 2021 938 KING ET Rl'E BR NY 10573 (914)9 168 9 39-5801 VILLAGE OF RYE BROOK BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: ^^�� Approval Date: AUG 2 3 2021 Permit#:,(,IQ w' d3, Application Fee:$ !ZT, � Approval Signature: Permit Fees:S (D Disapproved: Other: Application dated: 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 a4existigg,building,or for a change in use,as per detailed statement described below. ( �0T7 f l — /1. Job Address: J14 �Zone:r 2. Proposed lmpr vement.(Describe in detail): A-, i i 3. Does the roposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: l Yes: If yes,indicate: TIER L TIER It: TIER III: 4. WiIl the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system(Fire Sprinkler,ANSI.System,FM-200 System,Type I Hood,etc...) :No: ✓Ycs: (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 5. Occupancy,(I fam.,2 fain.,comm.,etc...)Prior to Construction: I After Construction: 6. N.Y State Construction Classification: _ / N.Y.State Use Classification: /4 ,�} /� I J 7. Property Owner:/ 2�1_4/ J�Q{ 65S/��k Address:�g j j + /[.r t ��L K 46 (h fi QLf N Phone# Cell II{-�lb3-19�/.� email:Qd+�i� a�ATSM.dQA0%, lob 1'9 � /7.- A e Ka �(�7r' $. Applicant: 'HI 1 Addre�ss: Phone# Cell# �' `t(f 03- 1 t7 Z, email: 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# email: 11. General Contractor: i '&, Address: X Phone# Cell# — email: 12. Estimated cost of construction $ qLA= f (NOTE:The 041110ed rest shall include all hboi,in:nerial, eatIblding,tined equipment,professiotal fees,and material and labor which mat'be donated gratis.) 13. Job Timetable: Start: Finish: (1) 3121119 1 BUIL>,�r� R MENT CIEME D) V1 ��F,of RR.77. OK AUG 18 2021 938 KING ET Ryi Bits f f,NY 10573 (914)9 1 Elk.- 39�-5801 VILLAGE OF RYE BROOK . >E u�l br BUILDING DEPARTMENT 7'U< 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 YO COUNTY OF WESTCHESTER ) as: residing at, � (Print name (Address where you livc) 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; 'Jog -FT �b p_ �, Rye Brook, NY. (.fob 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 Mow or infiltrat'on of any kind into the sanitary sewer from the subject property in accordance with all State, County and Villa Codes. (Signature of 0) ONNI n(s)) (Print Name of Properm nvnci�s)) Sworn to before me this 13j'-�r_ JOY E CAROZZA NOTARY PUBLIC-STATE OF NEW YORK day of , 20 11 No.01 CA6291400 Qualified in Dutches$County My Commission Expires 10-15-2021 L�(No (2) 3/21119 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. STA�F NSW Y COUNTY OF WESTCHESTER ) as: ►� f'o JM4 ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further sta s that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the CA I &a f j2/ /'L 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. Sworn to before me this Sworn to before me this day o , 20 day of P. , 20 I _ Si a Property si re f Applicant 09, 46 1 Print Name of Property Owner Pn me of Applicant 11 Diary Pub N(taZPubl' JOY E CAf?OZZA Np Y Pt18t lGSTATE Ry P�0!IC. CAROZZ4 OF NEW YORiC rArE OF No.01 C Cu81i{etY O 1 CA82914Q0NE yaRK Qualified in pA6291400 utchess County My Ccrnrf)ission E klchess C°u My commission Expires 10- nty 15-20Z f Aires 10.15-202 1 (4) 3/21/19 �O in C-4 ap oG .. 00 06 1 F C twat ►--i � 1 � / C m 4 1 z ° O o O w o c w xc) w � Z z �+ QC . a CA ►� W � � = c U _ coo A V V OF 00 w °` O wIC 0 .. W )�% � Z ,va u � z MCI r►i � � �• VON � O oo E-' w o x W O °� a z a w a o A W N a r F � Q3m Q .. Z ci u u Q jo jQ s O IL � � F W F■ � e � e z W Q jC O y Z w06 p CC ENE 3D BUILDING DEPARTMENT OCT 13 2021 VIL$sr0.GE OF RYE BROOK V 938 KIN( IREET RYE BR� VILLAGE OF RYE BROOK K,NY 10573 ILLANG D 4)939-0668 BUILDING ---EPARTMENT-. or ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#,:)L-/ — EP#: �CIJ Approval Date: OCT 21 Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) ****************************** ******************************************************************* Application dated, /0 43-a/ 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. 11 1.Address: I`,y �T SBL:_�35, 7���—/ / Zone: �e-ld 2.Property Owner: ess: Phone#: !T J 5`— 4 0 3 r 19V Z Cell#: email: 3.Master Electrician: k-�"' 1 J Address: L Lic.#: i"1 Phone#: Cell#:'�'l^'� V-3¢--e>QQW email: •C•e2�r zb C�sib Company Name:Cf1t. ''4c Address: 4.Proposed Electrical Work/Fixture Count: L 4:�w F W ORK,C9UNTY OF WESTCHESTER ) as: 9'�"`�`�� ,being duly swom,deposes and states that he/she is the applicant above named,and does er (print name of individual signing as the applicant) '?�— j� state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the f 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. Swom to before me this Sworn to before me this day of ,20 day of , Signature of Property Owner Si a of Applicant Print Name of Property Owner Print Name of Applicant Notary Public -- Pttlahe--,.— ALEXANDRA H.MARSHALL Notary Public,State of New York No.01FR6363711 Qualified in Westchester County Commission Expires August 28,20021 .7-:76 �1 Westchester Rockland Electrical Inspection Services, Inc. �L,�� Phone: 914-347-3595 DO NOT WRITEiHERE-FOR OFFICE USE ONLY 43 North Lawn Avenue FqX 914-347-3596 Elmsford, NY 10523 r� f BUILDING PER NO. TEMP# DATE ::] CITY OR VILLAGE f, ell, ZIP CODE TOWNSHIP COUNTY STREET AND NO.OR ROAD ,i� ;!n POLE NUMBER BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT OCCUPANT'S NAME BUILDING OCCUPANCY OWNER'S NAME AND ADDRESG 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 SIDLWALL SWITCH INCADE FLUORE NO. H.P.EACH NO, WATTS EACH INSPECTION OUTSIDE \� i BASEMENT T"FL 0 T 13 2021 FL Ft. ILDI G DEP RIME T REMARKS:LIST OTHER ELECTRICALDEVICES 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[I MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD C UNDERGROUND -j --LA- 1 I I L- AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. NAJIEW COMPANY DATE OF APPLICATION SIGNATURE OF APPLICANT STREET ADDRESS. TELEPHONE NO. 6V 577- y',,� 3 _tea C cxly OR POST OFFICE v� LICENSE w No. HEN AmxASLE /L3 7b/ 17- WESTCHESTER moll 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: Current Contracting MAD Real Properties LLC 3 Church Street Suite 875 NY, New Rochelle 10801 Located at: 10 Talcott Rd Rye Brook, NY 10573 Certificate Number: 1032300 Section: 135.49 Block: 1 Lot: 14 BDC: Permit Number: EP:21-256-BP:21-231 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 Talcott Rd Rye Brook,NY 10573 17�Basement l 1 st Floor 2nd Floor 3rd Floor Garage Attic Outside Other: Inspection was conducted in accordance with the NYS and NFPA 70-2017 International Electrical Code and detail of the installation,as set forth below,was found to be in compliance therewith on 01/31/22 Name Type Quantity Receptacle Convenience ------- 30 Switch Single Pole ------- 15 Receptacle GFCI ------- 10 Fixture LED ------- 36 Exhaust Fan ------- 2 Refrigerator ------- 1 Dishwasher ------- 1 Microwave ------- 1 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. V< This certificate is valid for work performed before date of inspection only. r r in in CPA a N O ac C r t Oe a w CCK ou p A4 z Z et C r co O w � z oZ _ ti] 'so (A p U Q O I 04#4 W M••d wl i a' U oo Z � w a 8 0 � _ a w A, �) 06 BUILDING DEPARTMENT SEP 2 4 2021 VILLAGE OF RYE BROOK 3 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT www.ryebrook.org PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: r-DI-2)3 PP Approval Date: SEP 2 2021 Permit Fee: $ Za5_'Y b 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: c [: t'� T 14 SBL:�3Si y9����' Zone: �/ a 2.Proposed Work: C A G i-J G G mb fN G N (x<<J f"'_ e` /�✓ l�r��r2o�►',s ab�� /-C✓Tc�-1 ran/ n , J_ 3.Property Owner: �V�[r(a(, ARaP��R%iL�S !�L Address: �S�C- �(3 V tOk Iq Y L k/c)Aki5 Phone#: / 2 Cell#*V'(LF 3 email: 4.Master Plumber: ro L Address:3 Z �,..��9F�f(7 r/7 TVC5PAJ9 N A EW 1014 Lic. Phone#: Cell# email:1AM7CGKFfd/►'1b t nLCj- aMol t!6j9T,NC Compa✓✓ny N�,ame .�1 /1/ Address: 15 L��iQJ�/77% Ili o57-&7o INDICATE FIXTURES& LINES TO BE INSTALLED AS PER THE FOLLOWIN 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 Floor AZ / 2nd Floor 3'Floor 4°i Floor 51 Floor Exterior 5.* List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) 8/12/2021 ` - p �C� [�OM� r R (� BUILIj NjC _DE; R�TMENTDD VIL��OFRYE 21v'., OK SEP 2 4 2021938 KING T EET RY E BRNY 10573 (914)93 .4 668 Ta►X ir9'939-5801 VILLAGE OF RYE BROOK wwaV.ry�eb7r�6k�r� BUILDING DEPARTMENT ******************************************************************************************************* AFFIDAVIT OF COMPLIANCE VILLAGE CODE§21 C • 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: �'rJ t I �► O } !"f� Ik J, , residing at, ��5 , A 1 P k 2S (Print uante) (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; /0 Co 77 / R z1 , 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 infiltratift of any kind into the sanitary sewer from the subject property in accordance with all State, County and Villa e Codes. (Signature of Pr perty O% ner(s)) i' l�4ko - ro 'DES (Print Name of Property Owner s)) Sworn to before me this 7J�' JOY E CAROZZA ('1 NOTARY PUBLIC-STATE OF NEW YORK day of R , 20� No•01 CA6291400 Qualified in Dutah06000Unty My Commission eolfu 10.15.2021 (Notary uhlic) (2) 3/21/19 �iL STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: /GK, ��6'�•/n1 ,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 arc 'test,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 t before me this Sworn to before me this day o ,20- day of 20 tgnatur of Property Owner Signature of Applicant voprZ���uuuun, Print Name of Property Owner �.�`� ----- .6V fQ;Name of A plic t 'lb OT % S • o q JNo % �Fs s �9 ;qI,_F � ,` � �Pubic J CAROZZA=>; `�e�c�q ,ti I110 Public NOTARY U STATE Of N61 i, No.01 CA6291400 Q� �q Qualified in Dutchess Counfla, My Commission Expires 10-15-2�7�,;��N %0 This application must be properly completed in its entirety Idff ust 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. an 2i2021 Building Permit Check List&Zoning Analysis Address: l ro --T AL coT?- j G��. SBL. !3 5•�� — C-l '-f Zone: -1 Z Use: Z f Const.Type. Other. Submittal Date l 2 Revisions Submittal Dates: Applicant: V('l+4�__0rA l, i�CLrsPrr�-�r rnJ Nature of Work �1.9��CL-�O/ice �TLF4F.r-� +�g�-t-L'TZN�JIrTrOti] Reviews:ZBA A U G 2 .3 2021 PB: BOT: Other. OK ( ( ) FEES:Filing. 7S, m�t_BP: � '� • � C/O: Legalization: ( ) ( ) APP: Dated: ✓ Notarized: SBL: Truss I.D. Cross Connection: H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening. ( ) ( ) ENVIRO:Long. Shore Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection S/W Mgmt.: Tree Plan: Other. ( ) ( ) SURVEY:Dated Current Archival:- Sealed: Unacceptable: ( ) ( ) PLANS:Date Stamped Sealed: Copies: Electronic Other. ( ) (•�License: ✓ Workers Comp: `-" 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. (Jf ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H.W.I.C.:_Battery:_Other: (Jf ( ) 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: REQUIRED EX19IT-4 PROPOSED NOTES APPROVED A�s& AUGtim"s onn, Cir Fr n Front: Front: Silo: R&jLr. Main Cov Accs,Cov H S S .HS T !my: Ft.IM Pku�e Hight/Stories: notes: si A � 4t'> �'`KA/11 _ � �►+1�1+�+-- �k- INj���t?•�# 1f�1t AM i'+++i{�': c3..+++ � '4�t'++ �" ,► tea• q 'i� r ) rA ac ELI \ t v L1J r Llj \ P �..1 Q O ecti a , CU : � y \�t+�1)� Imo, �_ � `^� � 1 _ �.� S...••.! 3 Or 1 rr9 I CL O /�<t®5 �,•-`;..11`�t �ti _v*�r=i + + "'�'c'3_c �. . . .�F�1 . . ' I . . . — -_ — __ _ _ _ _ �� e aF�?,'yt i R= %"MIS` 3w3'1+.. 'i�)oej+a�� +j�e+e1�vfl— �'g✓ ' C'o#�{f " 44)�j+f1�Cf f1�j1 GftSQl�+j►r 9Aq '�lW' � �y a�i� k of �w :.�tH� "•� of ij� 11i �.+ A�' f♦ '� a;L y ii r s 4f f .Qf � ��� ,� T� �• i �� r+.�v.k -.: ��.kr =:."-.: A y �M1�������/ � �� � '.t'fa w,'������..a.�1���t]�.,�� •llti'� .nA �.!„ P` yam' �St 4Y.�, � t`k. .may, yfr��� �•: �, _ C�4� _ �'i - \L:T-�^VY�ty -:., yr��M1tl� {�K:.y•1'�{If _ '�'.:�r l�'`� \ j�—�� '� -. %\ "�E`�%�` .'`.'/ �Nd�_�\`�y.,y(�"/.�� s`�:�(tt� .�s.':•v '"T•,�jYti Y ACO® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE s/13/zOz1 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 NAME: EVlta Dermanls _ _ _ Mt Pleasant Capacity PHONE FAX P.O. Box 1689 •914-205-7682 A/C No):914-205-7682 Pearl River NY 10965 ADDRESS: Evita.Dermanis@mtpcap.com INSURERS AFFORDING COVERAGE NAIC t _ INSURER A:Western World Insurance Company 13196 INSURED GEDMCON INSURER B:Main Street America Assurance Company 29939 GEDM Construction Corp. 1955 Central Park Avenue INSURERC: Suit 6 INSURER D: Yonkers NY 10710 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:32201963 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM POLICY EFF POLICY EXP LTR IDD/YYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY NPP8790860 5/15/2021 5/15/2022 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTE5__ CLAIMS-MADE rx-1 OCCUR PREMISES Ea occurrence $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY JEa LOC PRODUCTS-COMP/OP AGG $1,000,000 OTHER: $ B AUTOMOBILE LIABILITY 131 U 1997Y 9/9/2020 9/9/2021 C Ea OMBINED SINGLE LIMIT acddenl $1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if 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 Building Department ACCORDANCE WITH THE POLICY PROVISIONS. Village of Rye Brook 938 King Street UTHORIZED 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 NYSIF New York state Insurance Fund WESTCHESTER ONE,44 SOUTH BROADWAY, 10TH FLOOR,WHITE PLAINS, NY 10601-4411 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE EX.."'" .Fil ^^^ ^^^ 134080355 :•r' MT PLEASANT CAPACITY AGENCY . Wn 1 BLUE HILL PLAZA STE 1689 i PEARL RIVER NY 10965 7y. SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER GEDM CONSTRUCTION CORP BUILDING DEPARTMENT 1955 CENTRAL PARK AVE STE 6 VILLAGE OF RYE BROOK YONKERS NY 10710 938 KING STREET RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2344 774-1 766611 09/23/2020 TO 09/23/2021 8/13/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2344 774-1, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK. TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT EMILIO DIMATTEO 1 OF 1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 469839852 U-26.3