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HomeMy WebLinkAboutBP21-284PERMIT #�I- (- L DATE: /L,,�_..� � L07 SECT10N „f=, TYPE OF WOR JOB LOCATIM OWNERZ * �EST. COSH V'B�CO # n L - a4chez a� ,ia�(91y)8T67" Z,, �79 �•� y Domes (9/Y) 097/- 73%3 7 � j FEE. �, > 7=" oil TCO # INSPECTION RECORD DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING 0 RGH PLUMBING GAS L SPRINKLER LOW -VOLT �I ALARM AS BUILTFiforli INSP -d/y//TYin r �S,� �i,11 OTHER APPROVALS ARB BOT PS ZBA OTHER AS-SUILT/FINAL SURVEY l�EQUIRED PRIOR TO FINAL INSPECTION VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 24-157 Certif irate of Occupaucp Zhis is to certify that i( �fQ`�//Q/� /-l�hoz k-rO G� Qq�Ji/Qr of, .Q VD 7 having duly filed an application on 20�requesting a Certificate of Occupancy for the premises known as, El/� 17d l U����� , Rye Brook,NY, located in a 1`lJ Zoning District and shown on the most current Tax Map as Section: /`4 0 7 Block: / Lot: '5 J , and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. o2i': , issued 20 , such authority and permission is hereby granted to the property owner to lawfully occupy or use said pre mis or building or part thereof listed under the following New York State Classifications, Use: �c L_1� /L Construction: , for the following purposes: 141 7e ex r J Q r S f 4to Jry)12yovemr,03, 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 i'Ttatl l be made, shall the building be moved from one location to another until a permit to accomplish such change a' ed o t Building Inspector. Building Inspector,Village of Rye Brook: Date: DEC 1 2 2024 D BUILDIl�TU��3lEYATtTMENT For office use only: OCT 18 2022 VILLAGE OF RYE BROOK ISSUED: VILLAGE OF RYE BROOK 938 KING STREET,RYE BROOK,NEW YORK 10573 DATE:/Q- J$--3� BUILDING DEPARTMENT (914)939-0668 FEE: /(�-- PAID _.. - www,ry4b_r9ok.or2 APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION rss»»»»►»•s►r»»»r►re►rss►s»►s►►►sse''s//ss►e►t►tssr►s►►rt►►■rrr►r►►rrr►rrr»»»rs»»»»»»»»»»•r»»»»�»»•»►s►sss►»s♦►»►►►ss►►ss►►tts►t► Address: S Z3 Z -lle 4 66 le- A Ve- 12le Dj -d©� A Occupan�se: cD)C;4M Parcel ID#: /''�//, 7-/- S/ Zone: ��F Owner: /CGS Address: :5­Z3 L.Z a VT Y,e�OO� P.E./R.A. or Contractor: �c; yee /7 Address: ��Qom u��qce A)ew e"e/ NYPerson in res onsible char e: � T09OS p g ��yl h/��/ /�Y�e S Address: Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW YORK,COUNTY OF WESTCHESTER as: �AAl g ,� uiL/a/L being duly sworn,deposes and says that he/she resides at S �_ FQ� /�Z y e- vim/ (Print Name of Applicant) (No.and Street) in g y e_ 6 -y0� ,in the County of�{/E?S �/C S�Q�' in the State of� ,that (City/Town/Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$ d • 0 for the construction or alteration of ! Z_e Q r/O 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 O Sworn to before me this day of c)C�� ,20 day of , 20 Signature of Propeify Owner Signature of Applicant ame of Properly Owner Print Name of Applicant Nobuy Public SHARI MELILLO Notary Public Notary Public,State of New York N9.01ME6160063 8/12/2021 Qualified in Westchester County Commission Expires January 29,20:1 �yE BRC�v� cu � 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - -- -- - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : J 7 DATE: PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: OCCUPANCY: - ,t ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER CBR '9a2 BUILDING DEPARTMENT ❑ ILDING 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 : \ DATE' PERMIT# ISSUED: �! SECT: ` BLOCK: LOT: LOCATION: :� � � OCCUPANCY' ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION ' REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL c ) M ❑ OTHER s co . � O N N w ta to Im a �'7 W �rA G1; Q W U Q.•v 4Ln ILO .+ s IZ6 O L o 'O 4 Q o 3 �+ ■ �.i� ICI p � �^ E.r � l Q � Q cCd � ® � A e 00 • n ICI �� [� '� > y v tu40 ' aom ' x a, cj 0 01% M LL] 6T, 0. M W Z ^ W wQs N c � O� [� ..� .ar —7 C � y ° A FA� �.. W W A > = o5 w m W w w c I� M 00 W U o end aCi v 17 • W Q o E� o W°z ,� a�, �, � E., ` V � � � /y1� O � 1 )t � •Vf � •� L -- 0 Sm. C a� O 'R O CO �++ •• F. ++ L ? 8. "4 u� 0 � z Oo oaa `S Za `ya \ a O U © � °� � E OEV U z tiWZ �, J � J W � � W � �, Fd � pQ�G ~ �o •vTs BUILDING DEPARTMENT REVI VILX.AGE OF RYE':$ROOKLA 938 KING STET RYE aR910X,NY 1 ,� 0 C T - 1 2021 (014)9,39LO668, BAT 1xi"M to j ore - BUILDING DEPARTMENT FOR OFFICE USE ONLY: /� Approval Date: - 202 r rmit#IV '_ � Application# Approval Signature: ARCHITECTURAL REVI BOARD: Disapproved: 1117Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# : Other: Application Fee:75'/D 'Permit Fees: l !EXTERIOR BUILDING PERMIT APPLICATION Application dated: J0"r—a©t2-1 is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the construction of buildings,structures,additions,alterations or for a change in use,as per detailed statement described below. 1. JobAddress:523 1/2 ELLENDALE Avc. RYL BRW)K , uY 10.513 2. Parcel ID#: - I - 51 Zone: R 2 E 3. Proposed Improvement(Describe in detail): c Z4 /I 72 r o rlzn Oarp✓C 11,1ely 4. Property Owner: MW AND MR 5 AGUIL.AR Address: 52?5 Y2 ELLI=ND�A RK LE AVG. RYE BaD , 1.MY 10,1513 ,�� Phone# gII/—d $ ,p ��6� QJ /! Cell# e-mail M V yez List All Other Properties Owned in Rye Brook: M Applicant: Address: Phone# Cell# e-mail Architect: MAX PA R A N G 1 , Address: 5un-k I lLi i 399 KNOLLWWD RD. . WHITE PLAINS NY 10603 Phone# 914 — i g 6— 53.5 2 -Cell# e-mail NI AX PA R AN Cy I G MA I L •C6N1 Engineer: Address: Phone# Cell# e-mail General Contractor: ©rre's rpQ wcz /'7 - "' 0/7/7 p/re S Address: ZQ &^-7e-dGLt /4C e t `- 2rc'Ael v S_ Phone# Cell# 1- .3/3 e-mail (1) 8/12/2021 5. Occupancy;(1-Fam.,2-Fam.,Commercial.,etc...)Pre-construction: 1 Post-construction: 6. Area of lot: Square feet: ± J I L 0 . © Acres: a Q �" 7. Dimensions from proposed building or structure to lot lines: front yard:�hs /t)6. _rear yard: right side yard: �� left side yard: other: -Fl�t _ fowl 'moo 8. If building is located on a comer lot,which street does it front on: ��'L� t �P1 L-z '=L �' 1 C. 9. Area of proposed building in square feet: Basement: I It fl: 2°dfl: 31d fl: 10. Total Square Footage of the proposed new construction: & 11. For additions,total square footage added:Basement:IIt fl: t) �A_ tad fl: P/A- 31d fl: _ 12. Total Square Footage of the proposed renovation to the existing structure: �f 13. N.Y.State Construction Classification: N.Y.State Use Classification: 14. Number of stories: Overall Height: Median Height: 15. Basement to be full,or partial: finished s ed: 16. What material is the exterior finish: f`r i-)► !_ 'SL 0-;). 17. Roof style;peaked,hip,mansard,shed,etc: � VLc"r> Roofing material: S 1'+i A C�- 18. What system of heating: �� 19. If private sewage disposal is necessary,approval by the Westchester County Health Department must be submitted with this application. 20. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic firms suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) Yes: No: ✓ (r(yes,applicant must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 21. Will the proposed project disturb 400 sq.ft.or more of land,or create 400 sq.ft.or more of impervpas coverage requiring a Stormwater Management Control Permit as per§217 of Village Code? Yes: No: Area: 22. Will the proposed 1;?Ozes, e a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: applicant must submit a Site Plan Application,&provide detailed drawings) 23. Will the proposed project require a Steep Slopes Permit as per§213 of Village Code Yes: No: (f yes,you must submit a Site Plan Application,&provide a detailed topographical survey) / 24. Is the lot located within 100 ft.of a Wetland as per§245 of Village Code? Yes: No: V (tf yes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan) / 25. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes: No: V (if yes, the area and elevations of the flood plane must be properly depicted on the survey&site plan) 26. Will the proposed project require a Tree Removal Permit as per§235 of Village Code? Yes: No: (rf yes,applicant must submit a Tree Removal Permit Application) 27. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No: Indicate: TIER I: TIER H: TIER III: (if yes,a Home Occupation Permit Application is required) 28. List all zoning variances granted or denied for the subject property: , 29. What is the total estimated cost of construction: $ Wo Note:The estimated cost shall include all site improvements,labor,material,scaffoldiRg,fixed equipment,professional fees,including any material and labor which may be donated gratis.If the final cost exceeds the estimated cost,an additional fee will be required prior to issuance of the C/O. 30. Estimated date of completion: � 7, (2) 8n2na21 BUILDING DEPARTMENT VILLAGE OF RYE BROOK 938 KrNG STREET RYE BROOK,NY 10573 (914)939-0668 RESIDENTIAL LOT AREA COVERAGE Address: 2-5 V2- ELLEHDALE AVC,Section: I 1 21 Block: I Lot: 5 � PERMITTED COVERAGE RATIOS IN RESIDENTIAL DISTRICTS (Local Law 3-881 YOUR ZONE AREA IN MAIN ACCESS. DECK ZONE DISTRICT SQ. FEET BLDG. BLDG. MAX. CHECK MAX. R-35 35,000 14% 4% 5% R-25 25,000 14% 3.5% 4% R-20 20,000 14% 3.5% 4% R-15 15,000 16% 3.5% 4% R-15A 15,000 12% 3.5% 4% R-12 12,500 17% 4% 4% R-10 10,000 20% 4.5% 3.5% R-7 7,500 23% 4.5% 3.5% R-5 5,000 30% 5% 3.5% R-217 5,000 30% 5% 3.50/ Existina: Proposed: 1.AREA OF LOT 3.�6©• O Sq. Ft. 2�176Q^Sq. Ft. 2.AREA OF HOUSE a. Coverage of Main Building (Including Attached Garage or Accessory Building) 6-J Sq. Ft. 6j k 6.-�_Sq. Ft. b. Area of 1 Floor Divided By Area of Lot x 100 26 • f % a % (-�°I� - �O �-+- �i o�]�j .�l W y i�►L tp jr I O W � e�t'Ef3 ,1�Qc�.S, IFLi' �a�S `Lt-c`S —p.> 3. AREA OF ACCESSORY BUILDING (Includes Detached Garages,Tool Shed, Playhouses) Sq. Ft. _�Sq. Ft. a. Coverage of Accessory Building Area of Accessory Building Divided By Area of Lot x 100 % % 4. AREA OF DECK Sq. Ft. Z& Sq. Ft. a. Coverage of Deck Area of Deck Divided By Area of Lot x 100 % % I attest to the best of my knowledge and belief,the above information is correct. P Archilwtrign tore (3) 8/12/2021 BUILDING DEPARTMENT VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 (914) 939-0668 IMPERVIOUS COVERAGE RATIOS RESIDENTIAL DISTRICTS Address:5 2 51/2 I~LLF-W DALE- A L.Section: I Li 1.2 T Block: I Lot:51 Zone: 1�2 IMPERVIOUS SURFACES (Definition): All buildings, as defined herein, and all areas on the ground or elevate the ground which are comprised of materials through which water cannot readily flow, including, but not limited to asphalt, concrete, masonry, wood, gravel and clay, an which consist o e emen s including, but not limited to, court yards, sports courts,swimming pools,patios,sidewalks,ramps,terraces and driveways. TOTAL MAXIMUM PERMITTED MAX. PERMITTED COVERAGE Zoning IMPERVIOUS LOT AREA BY IMPERVIOUS SURFACES District COVERAGE IN FRONT (sq.ft.) For Base Lot For Lot Area YARD(%) Area(sq.ft.)* Over Base R-35 15 Lot Area % R-25 20 0 to 4,000 0 C5 R-20 30 4,001 to 6,000 2,200 35 6,001 to 12,000 2,900 27 R-IS 35 12,001 to 16,000 4,520 26 R-15A 35 16,001 to 20,000 5,560 25 R_12 40 20,001 to 30,000 6,560 24 30,001 to 40,000 8,960 23 R-10 45 40,001 &larger 11,260 22 R 7 40 R-5 30 *"Base Lot Area"is the minimum end of the lot size R2-F 30 range In the"Lot Area"column Area of lot:t 3 T 6 0- U sq.ft. Existing Allowed Proposed Total impervious coverage = 2,265 - 1 sq.ft. 2,0 68 s . ft. 2,0 60.11 sq.ft. Front impervious coverage = Lf if % 50 % 2 q A % I attest to the best of my knowledge and belief,the above information is correct. ArchitectTkgna e (`t) 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-Engineered Wood, or Timber Frame Construction. Title 19 Part 1264 & 126.5 NYCRR To: The Building Inspector of the Village of Rye Brook. From: Ksoe_` .2 2617-3 Cam, 52 , Subject Property: 523 1/2 ELLENDALE AVE. 9,Y9BRo BL: I> 1.27 -1--51 Zone: NY 10573 Please take notice that the subject."P(One or Two Family; ❑ Commercial, ❑ New Structure '0'Addition to an Existing Structure C "t r�?~o tZG fv�(a l`&rl 3C L1I2 A t-o ❑ Rehabilitation to an Existing Structure to be constructed or performed at the subject property will utilize; ❑ Truss Type Construction (TT) VPre-Engineered Wood Construction (PW) ❑ Timber Construction (TC) in the following location(s); Nr'Floor Framing, including Girders & Beams (F) ❑ Roof Framing (R) ❑ 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. L-7, yc;-�_ Date Design Profe al Date Prop wner as a Date Notary Ablic (3) EDILIA I. PEDROSO Notary Public, State of New York No.01PE5046902 Qualified in Westchester County 8/1212021 Commission Expires July 17,_c�Q,-o ME BUILDING DEPARTMENT LE C E VILLAGE OF RYE BROOK OCT , 2021 938 KING >�T RY"BRIT NY 10573 14)939 q6,6 C VILLAU`` QE RYE BROOK EUILDIrAG 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: 31, ' ALZ ,residing at,c7�3 2 1/C', /�[p 1,le— P_� (Prin Warne) (Address where you five) 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; Ala-_ 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. ch z 1- (Signature of Property er(s)) (Print Name of Property O r(s)) Sworn to before me this day of J�� , 20 3 (Nota6 Public) EDILIA I.KDROSO Notary Public,State of New Yolk No.DIPE5646902 (6) Quallf+ed in Westchester NrAy Commission Expires July 17,�3 8/12/2021 This application must be properly completed in its entirety by a N.Y. State Registered Architect or N.Y. State Licensed Professional Engineer & signed by those professionals where indicated. It must also include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void, and will be returned to the applicant. Please note that application fees are non-refundable. STAT-OF NEW YO COUNTY� OV WESTCHESTER ) as:�#.)) a Z,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individ&signing as the applicant) and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief, and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. 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. / �f J . Sworn to before me this Swom to before me this day of , 20J3 day of , 20 L�L r� k�G l Ile,G �� Z Signature of Properry Owner Signature of Applicant to ►J u 1 Print Name of Prop caner Print Name of Applicant Na Public Notary Public EDILIA I. PEDRDSQ Notary Public, State of New York No.DIPE5D46902 Nalified in Westchester Coun Comrnission Expires July 17, (8) 9/12/2021 f N N �+ a� w xx O N W W o z o A as CY A w U 00 00 0-4 U cw i z M N a 1v ' ' 21 Z A �= W oo Z (A �C aM �...� M�1 U a Q can s a N o = � H N o 8 W W rALn w c z a a r- ° o U g x . N zAzA a ; _ W O ` ) w Q z q oA � x �I ►� w x � J A N 2 8 2022 BUILDING DEPARTMENT VILLAGE OF RYE BROOK VILLAGE OF RYE BROOK 938 KINTkEET RYE B ,NY 1057 BUILDING DEPARTMENT .or PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: d / — �� PP#: Approval Date: F EB Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) ************************************************************************************************** Application dated, / a3 d I is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remo a Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agree that said binrrg work will rbe in conformance with all applicable Federal,State,County and Local Codes. r 1.Address: 5 d 3 d G I`P./�O�ti le �. SBL: I`7I. c17--/--SI Zone:eo')"r 2.Proposed Work: rf n'�4cl (I (a 4 S 1 inQ �'O ' p v�v��Q 3.Property Owner: »0.✓\ Aq 1/l Ltr sga&CkaZ- Address: 3 yd I lC Phone#: Cell#:_ L email: M M G$ / p.(-n b o-(� 4.Master Plumber: Fred-en R C ck RGLr(&5 Address: �7.l E l t-ell4{. /- P6r` C.��S`�' `�, �0573 Lic.#: 1 Od.A Phone#: Cell#: ! �6 J�� � email: 64UL/I Ak7 el r,. (',C rJ;Yn Company Name: Agll� cyt����►�j z,�C� t >>'��Address: !6"-G'E'rAl plp4e- ' pc Val(ty AI!�f � 097-7 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 Qas Basement 1st Floor 2nd Floor 3'Floor 4'h Floor 5te Floor Exterior 5.*List Other Equipment/Provide Details: -tOLAdCAd /04r�[U (Notarized Signatures Required Next 2 Pages) 4- 8/12i2o21 BUILDING DEPARTMENT01 VILLAGE OF RYE BROOK J A N 2 8 2-022 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK MM.ryebrook"g 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: JV A,) AY Yi w 1iaL_!� ac' j z ,residing at, — L��F��C�/ - (Pant 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; 5o �Z C��efi/��i�l �T ✓�� , 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. 'Zgignature of Prope wner(s)) AJe (Print Name of Property O er(s)) Sworn to before me this day of r& , 20 (Notary Pub� - EDILIA I. PEDROSO Notary Public,State of New York -3- No.01PE5046902 Qualified in Westchester C'2'f,� Commission Expires July 17, airzr2o2r STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn to before me this day of 1 z. ) ,20 day of 20� Signature of Property Owner gnature of Applicant z- Print Name of Property Owner Print Name of Applicant x'taryEDILIA I. PEDROSO ° Pu Notary Public,State of New York Notary Public,State of New York No.01PE5046902 No.01PE5046902 Qualified in Westchester Cour�y Otialified in Westchester�� Commission Expires July 17,o�Oa3 Commission Expires July 17, 3 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.Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- gn2i2o21 Building Permit Check List&Zoning Analysis t Address: �2 v �GLt.E��pA(.� ��� SBL: Zone:ZZ' Use: Z Const.Type: Other. L o r-3 Submittal Date: Z Z t Revisions Submittal Dates: 10 1 Z Applicant: v i L 2 Nature of Work: L fl-4 A S.1 z s rr F 1 !:24-z nV P_L,-tF -h Reviews:ZBA: S F P 2 9 7 V I _PB: BOT: Other. sdu (hMF4 OK( ) FEES:Filing. 7S•J�,, BP: C/O: Legalization: O . (� ( ) 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: SiteProtection: S/W Mgmt.: Tree Plan: Other. ( ) (,)/SURVEY:Dated iTZ( Current ✓ Archival;- Sealed '" Unacceptable: ( ) ( ) PLANS:Date Stamped Sealed Copies: Electronic Other. ( (� License: —"'Workers Comp: ✓ Liability: -�Comp.Waiver. Other. (. (� CODE 753#:_Z10//"'OGlt4-3Ce-0 C7 Dated/—/—a / 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. ( )= g• BAtg.date approvaL notes: ( )PB mtg.date: approvaL• notes: REQUIRED EXISTING PROPOSED NOTES ATP.a: S k • PPWRO-VED 0 � A(o —/ . 91191 Ckde: From Front: From Sides: RR Main Cov O o Z S• - Accs.Cov. Ft.HS : Sd.H S : S Tot, Z0 ZZ 6S', t Z;JGO • Ft,Im : 30 4? , `{ Z , L p P i . Hd ht/Stories: '`t17-07 �!_FV SFzT� �•4NS . BUILDING DEPARTMENT E V CS VILLAGE OF RYE BROOK 938 KING$TWEET RYE BRooK,NY 10573 OCT - 1 2021 �'Jk4)939_-006$. VILLAGE OF RYE BROOK 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:52 Y5 I/2 FLLENDALE AVPt RYE BROOK N Date of Submission: Parcel ID#: I Lr I-2j —1 — 51 Zone: R2 Proposed Improvement(DI escribe in detail): L e z f'e ►,7 1p✓Q r'!{ APPLICANT CHECK LIST: // MUST BE COMPLETED BY THE APPLICANT The following items must be submitted to the Building Department by the applicant-no exceptions. ( Property Owner: MR. AND MRS. AG U 1 LAR 1. Completed Application2. ( )Two(2)sets of sealed plans. (one full size(maximum Address: 523'/2- E LLEN D ALE AVE. R' U BROOK HY allowable plan size=36"x 42")and one I I"x17") 10 513 3. (vTwo(2)copies of the property survey. Phone# 4. (V jTwo(2)copies of the proposed site plan. Applicant appearing before the Board: 5. ( )One electronic/disc copy of the complete application materials. 6. Filing Fee. Address: 7. ( )Any supporting documentation. 8. ( )HOA approval letter. (if applicable) N/X Phone# 9. ( )Photographs. PIA- Architect/Engineer: MAX PA R AN 6,1 Q .A. 10.( )Samples of finishes/color chart. (a sample board or PIA model may be presented the night of the meeting) Phone# 91 I-t - 686 - 3 3,59 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 any application not meeting the requirements contained herein. Sworn to before me this �� Sworn to before me this ,20 day of , 20 JUc j� C � � heZ Signature of PropiTTi Owner Signature of Applicant l z Print Name of Property owner Print Name of Applicant Notary Py i - Notary Public EDILIA E PEDROSO Notary Public,State of New llak i No.01FE946902 Ouatlfied in Westchester I oouu�� Commission Expires Juy 17.240 8/12/2021 Q�E BRC�� 07 BUILDING DEPARTMENT ❑BUILDING INSPECTOR Q 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 : �_ ' ' � �v DATE' PERMIT# JU ISSUED: SECT: BLOCK: LOT: r ( -V LOCATION: �'��1 �`� OCCUPANCY: -z C C O�S THE WORK IS... ❑ ACCEPTED RE1L(- ED/ REINSPECTION ❑ VIOLA"f10N NOTED I SITE INSPECTION h ` L // REQUIRED ❑ FOOTING ``O Z--s ❑ FOOTING DRAINAGE v 2 _ `' ` I� ❑ FOUNDATION f� ❑ UNDERGROUND PLUMB1372 9 13 NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P.GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER x � 1 � w i i 9 a� MAX PARANGI ARCHITECTS P.C. Certified by the National Council of Architectural Registration Board,Washington D.C. 523 1/2 ELLENDALE AVE., RYE BROOK, NY 10573 Exterior Building Permit (September 30, 2021) • PHOTOGRAPHS TW _ 4 Photo# 1 — 523 112 Ellendale Ave., Rye Brook (Front view of Property in Question) NEW YORK OFFICE NEW JERSEY OFFICE 399 Knollwood Road,Suite 114 7 Daniel Drive White Plains, New York 10603 Englewood, NJ 07631 TEL: (914)686-3359 FAX: (914) 686-3319 Tel: (201)567-5880 Website: www.maxparangi.com E-mail: MaxParangi@gmail.com q t AI Photo# 2— 523 112 Ellendale Ave., Rye Brook (Left side view of Property in Question) _77- Photo#3— 523 112 Ellendale Ave., Rye Brook (Right side view of Property in Question 2 - r _ r }i t Photo#4 - 523 Ellendale Ave., Rye Brook (View of house across from Property in Question) -•--__.._.--tee` - - Photo#5- 525 Ellendale Ave., Rye Brook (View of house to the Left of Property in Question) 3 i 1411 r� Photo# 6- 519 Ellendale Ave., Rye Brook (View of house to the Right of Property in Question) 4 iok r � f `ice .. � �• 4 r 1 4r + ♦ ♦.n At. VAL. vat- r a(. �1 � �:� ', �f �, �� • "�, � �f� �a 1 �,�. 9 �, � �. �F �;� �, x 4•: 1 s ' .� � #' . . A.. ��'�. '�ti� � ' , �` �. 1 �.. �• r �„ �� !�� .l 't Yo ` � ►'.�. -- S • •� ,� 1, �, , � ' � :a_. .. _ _ �.., ��., 1_ a - ''3 _ r �. f I 1 'f. ���. � � $x .5. , 'f, + � �L�; 16 Lis r' a . t i �i M� Steven Fews From: Steven Fews Sent: Tuesday, April 25, 2023 2:19 PM To: JUAN AGUILAR Cc: Laura Petersen (Ipetersen@ryebrook.org) Subject: RE: Permit Expension Expires: Wednesday, August 23, 2023 12:00 AM Good Afternoon Mr. Aguilar, I will grant you the second 6 month extension requested. Yet, this project must be wrapped up or you could likely face fines and expiration fees. You new expiration date is 11/1/2023 Thank You. Steven E. Fews Acting Building Inspector& Fire Inspector Office (914) 939-0668 From:JUAN AGUILAR<jmkm68@yahoo.com> Sent: Monday, April 24, 2023 10:01 PM To: Steven Fews<Steve Fews @ryebrook.org> Subject: Permit Expension Good evening Mr.Fews, Today April 24th, 2023 1 called you at Rye Brook Village and I spoke to the secretary because I do want to ask you for a permit extension.They told me to email you and to ask for your help.The exterior job is finished only the inside-work is not finished yet that's why I am asking for the 6 month extension. I'll try ti complete it as soon as possible and will let you know to do the final inspection. Thank you for your help. Thanks for everything. Juan Aguilar Sanchez 9148862179 Sent from Yahoo Mail for iPhone 1 Mike Izzo From: Mike Izzo Sent: Thursday, October 27, 2022 9:49 AM To: JUAN AGUILAR Cc: Steven Fews;Tara Orlando; Laura Petersen Subject: RE: 523-1/2 Ellendale Ave Permit Extension Dear Mr. Sanchez, I am pleased to inform you that a six (6) month extension to your open permit # BP21-284 has been approved, and that the new permit expiration date is, May 1, 2023. Please arrange for all work to be completed and successfully inspected, and for all paperwork & fees to be remitted to the Village such to facilitate the issuance of the Certificate of Occupancy/Certificate of Compliance closing out the permit on or before that date. Please note that in accordance with Village Code§250-10.A., it is a violation to use or occupy or to allow the use or occupancy of any building, premises, or part thereof without a Certificate of Occupancy duly issued by the Building Inspector. Thank you. Ac4ad(7, Izzo Building& Fire Inspector Village of Rye Brook, NY (914) 939-0668 From:JUAN AGUILAR<jmkm68@yahoo.com> Sent:Thursday, October 27, 2022 8:58 AM To: Mike Izzo<Mlzzo@ryebrook.org> Subject: Re: Working Permit Good morning Mr Mike Izzo. It's taking longer because of the pandemic.The contractor stop working in all the Jobs contracts that he had and was behind with the jobs. Actually he's catching up with all his projects. He say that he spects to finish as soon as possible. 3 month to six months period.Thank you Sent from Yahoo Mail for iPhone On Wednesday, October 26, 2022, 8:04 PM, JUAN AGUILAR <jmkm68@yahoo.com>wrote: Hi Mr.Michael, My name is Juan Aguilar Sanchez, I live on 523 1/2 Ellendale Ave, Rye Brook NY.The permit I have for the exterior and interior of my home to be complete expired on November 1st, 2022. Last week, I went to the village and the secretary told me to email you and ask you for a permit extension. Thank you very much,for your help. If you have any questions feel free to contact me at 914-886-2179 or you can email me back with your response. 1 Sent from Yahoo Mail for iPhone z Laura Petersen From: Laura Petersen Sent: Thursday, October 7, 2021 8:54 AM To: maxparangi@gmail.com Subject: Building Permit Application - 523 1/2 Ellendale Avenue 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, q! ,7(— 2471 ✓ General contractor's contact name & phone number. 60 nny -To�rPs '7 313 4/ 2. Copy of general contractor's valid Westchester County Home Improvement License. ✓3. General contractor's valid liability insurance (the Village Of Rye Brook must be the certificate holder) ve 4/. General contractor's valid workers compensation on a NY State Board form (C105-2 or U26.3) 5. Building permit fee $100.00, Stop Work Order fee $500.00 and Legalization fee $750.00 (due once permit is issued and ready for pick-up) 6. Contractor must call Dig Safe NY and get a ticket number. Please forward this email to the property owner. A phone number or email was not provided on the application. Thank you IV Laura 5,0 Laura Petersen �Q4 4Z Office Assistant 9lA — - Village of Rye Brook 7 y gA00, COm 938 King Street ��'jAC m Rye Brook, New York 10573 Phone(914)939-0668 1 Fax(914)939-5801 1 IpetersenO-rvebrook.org 1 Laura Petersen From: JUAN AGUILAR <jmkm68@yahoo.com> Sent: Thursday, October 7, 2021 12:45 PM To: Max Parangi; Laura Petersen Cc: Mike Izzo; Rajvee Patel,- Chenghui Nan Subject: Re: Fwd: Building Permit Application - 523 112 Ellendale Avenue Thank you. My email is jmkm68@yahoo.com and my phone number is 9148862179 Sent from Yahoo Mail for iPhone On Thursday, October 7, 2021, 12:15 PM, Max Parangi <maxparangi@gmail.com>wrote: Laura, Thank you for the heads up. I am forwarding your email to the homeowners to take it up from here. Juan, see forwarded below email from Laura. Your plans have been approved. In order to pull the actual permit you will need to go through the steps outlined by Laura in their email (see below in red).Also Laura does not have your phone number and email................... Best Max -T ---- - --..___. www.maxparangi.com 1 ---------- Forwarded message--------- From: Laura Petersen<LPetersen@ryebrook.orp,> Date:Thu, Oct 7, 2021 at 8:53 AM Subject: Building Permit Application-523 1/2 Ellendale Avenue To: maxparangi@email.com <maxparanei@Rmail.com> 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. General contractor's contact name & phone number. 2. Copy of general contractor's valid Westchester County Home Improvement License. 3. General contractor's valid liability insurance (the Village Of Rye Brook must be the certificate holder) 4. General contractor's valid workers compensation on a NY State Board form (C 105-2 or U26.3) 5. Building permit fee $100.00, Stop Work Order fee $500.00 and Legalization fee $750.00 (due once permit is issued and ready for pick-up) 6. Contractor must call Dig Safe NY and get a ticket number. Please forward this email to the property owner. A phone number or email was not provided on the application. 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 Iaetersena-Eyebrook.org 2 Z � Y L o 4 ao R •7 � h� '� ; t1 iz _ G y w . x 'h a ow G Z O IAJ ► ; ^ � T � � r AWW0A G> 1, ot7:z L DATE(MM/DDNYYY) ACORO® CERTIFICATE OF LIABILITY INSURANCE 10/27/2021 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). CONTACT PRODUCER Liberty Mutual Insurance NAME: PO Box 188065 PHCN o 800-962-7132 Fa No: 800-845-3666 Fairfield, OH 45018 ADDRESS: BusinessService Libe Mutual.com INSURERS AFFORDING COVERAGE NAIL 0 INSURERA: Ohio Security Insurance Company 24082 INSURED INSURER S: Torres Green Landscaping Corp INSURERC: 12 Bonnefoy PI New Rochelle NY 10805 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 64725499 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 ADDLSUBR POLICY EFF POLICY EXP LTR POLICY NUMBER M/DD M/DD LIMITS A V COMMERCIAL GENERAL LIABILITY BLS60189891 8/7/2021 8/7/2022 EACH OCCURRENCE $1 000 000 ENTED CLAIMS-MADE 711 OCCUR PREMISES Ea occurrence $300 000 MED EXP(Any one person) $15 000 PERSONAL&ADV INJURY $1 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 ✓ POLICY JJECT F1 LOC PRODUCTS-COMP/OP AGG s2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per AUTOS ONLY AUTOS (P dent) S HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accdent $ r L i UMBRELLALIAB H OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION R OTH- AND EMPLOYERS'LIABILn'Y Y/N I STATUTE ER ANYPROPRIETOR/PARTN ER/EXECUTI VE OFFICER/MEMBEREXCLUDED? ❑ N/A E.L.EACH ACCIDENT $ (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/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION VI)�a a Of Rye Brook SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 938 Kln Sheet THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Rye Brook re 10573 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATNE Jeremy Cupp ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 64725499 1 60189891 1 21-22 GL I Jeremy Cupp 1 10/27/2021 10:42:57 AN (EDT) I Page 1 of 1 -ot�11\ NYSIF New York State Insurance Fund WESTCHESTER ONE,44 SOUTH BROADWAY, 10TH FLOOR,WHITE PLAINS,NY 106014411 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 0QL61�,�o ^^^^^^ 824644420 TORRES GREEN LANDSCAPING CORP. 12 BONNEFOY PLACE APT.6 � NEW ROCHELLE NY 10805 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER TORRES GREEN LANDSCAPING CORP. VILLAGE OF RYE BROOK 12 BONNEFOY PLACE APT. 6 938 KING STREET NEW ROCHELLE NY 10805 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2480 270-4 38706 08/02/2021 TO 08/02/2022 10/26/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2480 270-4, 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:/M/WW.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 FAVIOLA HERNANDEZ 1 OF 1 TORRES GREEN LANDSCAPING 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:281885112 U-26.3 Laura Petersen From: Dig Safely New York Exactix <tickets@exactix.digsafelynewyork.com> Sent: Monday, November 1, 2021 3:49 PM To: Mike Izzo Subject: Message from Dig Safely New York, Inc. (DSNY) ****REGULAR**** DIG REQUEST from DSNY for: VIL RYE BROOK Taken: 11/01/2021 15:48 To: VIL RYE BROOK PRIMARY Transmitted: 11/01/2021 15:49 00023 Ticket: 11011-002-308-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 523 To: Name: ELLENDALE AVE Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: OUT SIDE OF HOUSE NearSt: S RIDGE ST Means of Excavation: HANDTOOLS Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: REMOVE PAVERS, REMOVE BLACKTOP Estimated Work Complete Date: 11/11/2021 Depth of excavation: 5 INCHES Site dimensions: Length 20 FEET Width 3 FEET Start Date and Time: 11/04/2021 07:00 Must Start By: 11/19/2021 ------------------------------------------------------------------------------ Contact Name: DANNY TORRES Company: TORRES GREEN LANDSCAPING CORP Addrl: 12 BONNSOY PLACE Addr2: City: NEW RACHELLE State: NY Zip: 10805 Phone: 914-471-7313 Fax: Email: torresdanny554@gmail.com Field Contact: FAVIOLA HERNANDEZ Alt Phone: 914-471-7313 Email: torresdanny554@gmail.com Working for: JUAN AGUILAR ------------------------------------------------------------------------------ Comments: WILL BE MARKED IN WHITE Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA CONED SUEZ WTR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR i z Z Q — d to d m ry R tV +i o P sAaujo +P Q +; +P +ti v, 0 0 Rl V aR aR �'") P o¢ t 4 Q. 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C7 i 1 l = r `s' l o� C) c ao 01 0 I � -sS C I PAF M F l Lc C C7 l VN _ — O.H.U. a� GV WALK DROP CURB DROP CURB ELLENDALE AVENUE This is to certify that this map and the survey on which it is based were Summit Land Surveying P.C. made in accordance with the "Minimum Standard" Detail Requirements 21 Drake Lane for the New York State Association of Land Surveyors. White Plains NY 10607 Rakesh R. Behal, L.S. New York State License Number 050666. (914) 629-7758 Info@ summitsurveyingpc. com