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HomeMy WebLinkAboutBP21-290PERMIT # l' )) pL (J DATE: 4IZ/ oZ/ SECTION EX, a BLO K LOT TYPE OF WORK VS, I JOB LOCA IOq S ' SSOC WIN I RACTO EST. COST voo/cO # i FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING I1 RGH PLUMBING GAS 0 SPRINKLER ELECTRIC LOW -VOLT ALARM r7 AS BUILT 0 FINAL W1%7'�e / Z / U FEE DATE INSPECTION RECORD DATE INSP OTHER APPROVALS ARB BOT PB ZBA OTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 25-014 Certtf tra.te of Orrupaurp This is to certify that ,a LIU L&C of, kap having duly filed an application on Q20�aa c� requesting a Certificate of Occupancy for the premises known as, Rye Brook,NY, located in a Zoning District and shown on the most current Tax Map as Section: L Block: _,,—? Lot: , and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No.a)7Z--2 p U , issued � 0 20 ;>?/ , 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: &S/na' Construction: 2L5 for the following purposes: l 1i4-e{116 y 0 Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of the building or in the exit facilities shall be made,and no enlargement, whether by extending on any side or by increasing in height shall be made,nor shall the building be moved from one location to another until a permit to accomplish such change been obt ' d fro a Building Inspector. Building Inspector,Village of Rye Brook: Date: p 1E 3D BUILD,1J4C4' TMENT PERMIT IT#use onl :_Q 9 o LUI MAY 2 0 2024 VIE OF RYE i t OK ISSUED: VILLAGE OF RYE BROOK 938 KING STRE6T`(RYE BROOl< w YORK 10573 DATE: _?t; /_—) BUILDING DEPARTMENT �(9?1.4�:939_,C/_ FEE: ;$ �� (� PAIDA 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 rrrsrrrrrrrrrrrrrrrarrrrrrrrr«rrrarr«r+rrr«r+rrrrr+rrrrr+tartr+arrarrrrrarrrrarr•rrrrrraaarr++rarrararrrar++rr++aa+r+rr♦rrra+ Address: 158 South Ridge Street-Rye Ridge Shopping Center South Occupancy/Use: Parcel M#: 141.35-2-36 Zone:CI-P Owner: Win Ridge Realty LLC-(914)701 -4005 Address: 24 Rye Ridge Plaza P.E./R.A. or Contractor: EZ Carpentry LLC(203)515-3102 Address: 9 Arnold Lane-Norwalk,CT 06853 Person in responsible charge: Elton Dias Address: 9 Arnold Lane-Norwalk,CT 06853 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: Elton Dias being duly swom,deposes and says that he/she resides at 9 Arnold Lane (Print Name of Applicant) O (No.and Stroct) in Norwalk ,in the County of ,C I.\J e=t / in the State of CT that (CityrFow•n/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 32,000.00 for the construction or alteration of: Interior Alterations for Massage Envy 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 7 -1 Sworn to before me this day of &1 20 day of _ ,20.;L S gn •of Prormi Owner ljt7eA I - Sig attire; L' SA Print N me o Property ?- `- Print Name of licant No ary oblic ��?ls96ro Notary P ALENA7NI, AN" NOTARY PUBLIC OF NEW YORK 8/12l2021 RegistrationHA0013645Qualified in wesler County my Commission Expires 911912027 �E 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 - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : I �U K <<, �-�1.(� DATE: PERMIT# U ISSUED://"Y" -/ SECT: 3� BLOCK: Z LOT:2A�l LOCATION: \` ' G F fjv OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS.'_ ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: e' ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS — ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION -a-FINAL 5 i ❑ OTHER x ■ s O a (V ■ ■ t nl lV O O ,s4 � t a el 6 op rn ° ° v a [ \p 3 E 3 -00 W p � � � � oQo � � oo A ■ to Ij tn to c v Od co O [� oo U a o o A 1 O en W A •• .� ■ � CO 6 y '> z oc � � � w 'L7 U V F.1 MCI h `� pG e � q�Z S �o : a � L x v O Z V W. oQw`a, '" � � � a. w aq a v O 2t 5 r BUILDING DEPARTMENT � E C�E �i�V� ICE T 1 VI LLA-0E OF RYE BROOK li 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 OCT 2 8 2021 wWW.ryebropk.or VILLAGE OF RYE BROOK BUILDING_ DEPARTMENT INTERIOR BUILDING PERMIT APPLI C5 _. FOR OFFICE USE ONLY: a r� Approval Date: NOV 8 202 Permit#: 1- c�+ 0Application Fee:$ (J Approval Signature: Permit Fees: $ � Disapproved: Other: Application dated:/ `r is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing building,or for a change in use,as per detailed statement describedbelow. 1. Job Address: 15 5' ?-SD6C 51"V�T SBL:/4/// ) Q-34o Zone , 2. Proposed Improvement.(Describe in detail): C G1 i Ajetu J.v 1 �e — S 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code the Village of Rye Brook? No: )0 Yes: If yes,indicate: TIER I: TIER 11: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) :No: Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 5. Occupancy;(1 fam.,2 fam.,comm.,etc...)Prior to Construction: After Construction: 6. N.Y State Construction Classification: N.Y. State Use Classification: 7. Property Owner: WQ4 R t ", LXC Address: 24 9-yC R P Phone# �" -�,' C15 Cell# email:AD I S W �Q 8. Applicant: C- Z P, Address: C: L Phone# Cell# o2c 3 575 3 10 Z email: ELtow t.3S,b �t l 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# email:11. General Contractor: 6 Z C11,2pI Address: q a :, Q )IV, I 06 06-3 Phone# Ce # 20 3 15 3 10 9 email: C.Vofv D 1 wS AV (m L-),G• &M 12. Estimated cost of construction $ (NOTE:The estimated cost shall include all labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 13. Job Timetable: Start: Finish: 5-6 (1) /U c r(C 8l12/2021 orte BUILDIM615kiARTMENT E c LS 0 WE5 VIL�'ACE OF RYE BROOK 938 KDi �,'t'�:E'r RYE BROOK,NY 10573 OCT 2 8 2021 �,-514)939-0668 N��v�i�.n�ebrook.or� VILLAGE OF RYE BROOK gp I[t_p!Nr, nFnARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE 4216 - 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:3f, OP41�b residing at, 2` 9*,(C (_T[ FLf1q_7t\ (Pnnt mane) (Address«here�mi lice) 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; a n J, 1-5v ef,-F , 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. ( to ^— lr�lt ��y IACr (Print N8WIC 01 PIVPe-rt} (_4A.664+1) Sworn to before me this day of , 20 Z 1 I Y SANIDI ER 1::w York :ounty 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-Engine eit. v +d or Timber Frame Construction. D � � J/ Title 19 Part 1264 & 1265 NYCRR OCT 28 2021 To: The Building Inspector of the Village of Rye Brook. VILLAGE OF RYE BROOK BUILDING DEPARTMENT From: __ Subject Property: SBL: Zone: Please take notice that the subject; ❑ One or Two Family; ❑ Commercial, ❑ New Structure ❑ Addition to an Existing Structure ❑ Rehabilitation to an Existing Structure to be constructed or performed at the subject property will utilize; ❑ Truss Type Construction (TT) ❑ Pre-Engineered Wood Construction(PW) ❑ Timber Construction (TC) in the following location(s); ❑ 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§iz65 for One &Two Family Dwellings. Date Design Profession Date �1 v oP AGCn4 r Date Notary Public (3) I/ CAM,)! r_P York r, Linty 9/12/2021 This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. Please note that application fees are non-refundable. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: C,/_f p/v W!4 S ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) th and further states that (s)he is e 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. Sworn to before me this Sworn to before me this X day of �C� , 20_271L day of 0 , 20Z� rq SignWai of Propel(vwTEr At �. WA_ V-A of Applicant P- V 1 !J -0 L 45 Print Name of Property Owner D f� �t t/ f Applic4nt No Pu lic No P lic K!71.I_`(S��•ar)! ER w York r• LARISSA MORAES RODRIGUES Co Notary Public,SIB of Wow York 9, �'' No.01ROW61454 QuOMM in vioddww County Corm Won Expim July 10,=5 (4) 8/12/2021 • ���'i�ii�"il�l�il��i��il��i'�r�l�l�i�ii�i��'ii�l` �il�i�'i�i�'ii�il�l�il�ii���il�l�'i��i����il��l N N v Na ag 0-4 w H q _ O ° 04 C4 y W Z W ►O, log • Q V V5 H LO 000 OZ � z 1.0 � w a w QQ � r O v aPLO � ,�� a O a zo i A z Ono c, M ~ w 0z � ■ 11 c a a Iy V p a A z N 9 ° H w x m V w O A cw7 H g z o (Q C Ln V 8 w z w W , x coo z w ° z Q 0 < H v. W w aW. a s z � CtoC4:to4A4:4A4:4444&4!44At t4:$44141444444444444444444444 RBUILDING DEPARTMENT DEC - 6 2022 VILLAGE OF RYID E OOK 938 KING STREET RYTB NY 10573 VILLAGE OF RYE BROOK (90)'939 BUILDING DEPARTMENT www�ih ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: 2-1 —Zjg EP#: Approval Date: D E C 0 6 2 Permit Fee: $ 15 Q �J Approval Signature: Other: Application dated,/c-D 4r s 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. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: l 5 �� C7 E SBL: y 1.3 -Z—3 Zone: e — 2.Property Owner: iP l M Z D&t= _,E AL" L L C Address: Phone#: 9 /—762- 1100-5, Cell#: email: M Pm Nq&ALB to (a)Lt ve-.Co M 3.Master Electrician:M14UV Et_ <5A L i d!--n Address: 3 1 0 L-p�O 5T L i}- N k M*KoAj ec_K N q l 0 y 3 Lic.#: (0 1, Phone#: °1 1�{ 8 0 q 5" D Z OCell#: email:D Company Name: !may� �Z!L Address: 3`�0(� I�0 s-r ►�, �{►4 M A Q�nP6C/C,I y 10�J y3 4.Proposed Electrical Work/Fixture Count: w A-t L 5 cu f rCH-&5, 'Z., uJ A LL C /��►Tj Y 0 UPE CA N Y E-r- �t5 5.31 Party Electrical Inspection Agency: 5 uJ i Jt STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: M"U87L Z5z�(./'Voo being duly swom,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant) state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the ��fZlCA L 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 be re me this 0 Sworn to before me this day of ,20—` day of ,20 Signa rty wner Signature of Applicant Print Name of Property Print Name of Applicant Notary Public ARGELYS A RODRIGUEZ— Notary Public NOTARY PUBLIC, STATE OF NEW YORK Registration No. 01 R06323825 Qualified in Bronx County 6/23/2022 My Commission Expires April 27, 2023 STATEWIDE • Service With Integrity 1:1 Main Street, Fishkill, NY 12524 1 emoil:office@swisny.com SWIS JOB APPLICATION tel845.202.7224914.219.1062 1 SWISNY.com • • Office Use Elect.Permit# ; _ -�l C4 Lt Date Bldg Permit# Utility ID# Final Certificate# City/Village Zip Township County Address Cross Street Section Block Lot Owner Name/Address(if different than above) IT Contact Number ❑Basement ❑1st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent SERVICE Amperage Voltage 1 P 3P #Meters #Disconnect ❑Underground ❑New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information ,z�-t .;e` r z.N _ r DEC -6 2022 BUILGE OF RYE BROOK ILDING DEPARTMENT This application is valid for one(1)year from the date received by SWIS.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.The applicant declares that there is no open applications for the above address with any other inspection company.The applicant,owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Inspector Date Finalized Inspector# Company Name Date Signature Address City/State Zip Code License# Phone# State Wide Inspection Services 1080 Main Street NOV 2 5 2024 Fishkill, NY 12524 A90VK/ U 39 �s 845 202-7224 Phone VILLAGE OE RYE BROOK 914-219-1062 Fax STATEWIDE INSPECTION SERVICES BUILDING DEPARTMENT Email: office@swisny.com -"' Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Rye 1 Electric Win Ridge Realty LLC 39 Old Post Lane 158 South Ridge Street Mamaroneck, NY 10543 Rye Brook, NY 10573 Located at: 158 South Ridge Street, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 22-294 141.35 2 36 Certificate Number: 2024-3610 Building Permit Number: BP 21-290 A visual inspection of the electrical system was conducted at the Residential occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at: 158 South Ridge Street, Rye Brook, NY 10573 The First Floor was inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 271h day of June 2024. Name Quantity Rating Circuit Type Quad Receptacle 03 GFCI 05 Luminaires 13 Wall Switches 04 Under Cabinet Lights 04 Officer: Frank 1. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the indicated.This certificate is valid for%vork performed on the date of inspection only. O 01 flq 1 ." N N o 0 . a a a � = o 0tn a H 96 oC > ■ TZ� W W —; aid M V am = ■ Q Z O ■ iil W o Z � �+ � � O a Q G O Fiy Q w w o v V ,, 0 w 00 . � A0-4 � T a/ CL w U N16 T 00 Cc 5 E DRCv D BUL oiiQ" "TMENT OCT 2 $ 2021 V ILLAGE OF RYE�ROK 938 N( ZREET RYE Bl ,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING. DEPARTMENT www6ftoo#.ora ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required p FOR OFFICE USE ONLY BP#: I -a 9 o EP#: /_C ` Approval Date:_ rJ O u _ 1 Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) ************************************************************************************************** Application dated,/0-c)9-3/ 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 Co`d/e/s. 1.Address: f P ( O Cam-E- SBL: /-T/,4-36 0 36 Zone:` 2.Property Owner: U) �I l! �1 ��!1_T`� Address: � 'S 7 Zk Phone#: Cell#: email: n' 3.Master Electrician: M a 114 U�1, CTA L I NCD 0Address: 3�0 LD tPo 5T I� 1�1 R M A Z-0 jU ECK /y V l 0 03 Lic.#:�Phone#: �1 I ©y 50 Zp Cell#: email: m ANAY GI-AL& 2 L( V E., GC Company Name: 2-14 E F-L t CT Lt C Address: 3 9 9 L D ?0 57-/_04 ZV A M 4/Z-0W£KK Yy 0Y 4.Proposed Electrical Work/Fixture Count: �/ Cy �C/ ( IaJ�LL Silll�GfF i , Z�f/14-L L L,,r fr5 VAIDk72r4n.s ///&-r L7`:5 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: VA AkkU EL G-6 L/Al b-0 being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant) state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the 05Z:7r/C AQ77Z4cf1'Q for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn to before e this Q-F day of ,20 day of ,20 a Signature of Property Owner i p cant L ,O>O Print Name of Property Owner �1ame of Applicant Notary Public NotaVAKAELILLO Notary Public, State of New York No. 01 AE6160063 Oualijied in Westchester CountX Commission Expires January 29.20 -a 8i12/2021 Westchester Rockland Electrical Inspection Services, Inc. _ Phone: 91{4 34M595 DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue Fax: 914-347-3596 Elmsford, NY 10523 BUILDING PERMIT NO. ig* TEMP# DATE CITY OR VILLAGE ^ ZIP G j�E TOWNSHIP `. .. OUNry STREET AND NO.OR ROAD !V) L/POLE NUMBER BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT OCCUPANT'S NAME BUILDING OCCUPANCY OWNERS ME ND ADDRESS HOME TELEPHONE NUMBER rc URRENT SUPPLIED BY IFROM THEIR OFFICE WORK TELEPHONE NUMBER LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS NO.OF FIXTURES S MOTORS HEATERS OFFICE USE LOCATION LAMP RECEPTACLES ONLY SIDEWALL SWITCH INCADF FLUORE _ NO- _ .-..-- WATTS EACH INSPECTION OUTSIDE E 11 § L BASEMENT 0 T 2 8 N21 , 2"°FL. y ' 3-FL. Bl_11LDi G D' RTME, T f REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: Z 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 a EXPOSED❑ CONCEALED❑ MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD(' UNDERGROUND❑ - - 1- AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. NAME OF_fOMPANY * DATE OF APPLICATION SIGNATURE OF APPLICANT STREET ADDRESS TELEPHONE NO. CRY OR O E ZIP o LICENSE NO.WHEN APPLICABLE Building Permit Check List&Zoning Analysis Address S�� S • �I� F �1' SBL• Zone: G Use Const.Type. —� Ocher. Submittal Date: O Z!�) Z( Revisions Submittal Dates: Applicant: W i tJ ­12 >D rr-- Nature of Work O �� L�• A S�� � Reviews:ZBA: NOVPB: BOT: Other. QK ( ( ) FEES:Filing.Z��BP: C/O: Legalization: ( ) (-), APP: Dated: ✓ Notarized: SBL: gnus I.D. Cross Connection; H O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening: ( ) ( ) ENVIRO:Long. Short: Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmt: Tree Plan: Other. ( ) ( ) SURVEY:Dated. Current Archival; Sealed. Unacceptable: ( ) (t)-/ LANS:Date Stamped. Sealed. `J Copies:_ZG Electronic. Other. ( ) ( License: ✓ Workers Comp: ✓ Liability: ✓ Comp.Waiver. Other. ODE 753#: Dated N/A: ( ) ( HIGH-VOLTAGE ELECTRICAL.Plans: Permit N/A: Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H.W.I.C.:_Battery:_Other. ( ) ( ) PLUMBING:Plans: Permit: Nat Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A: Other. ( ) ( ) H.V.A.C.: Plans: Permit N/A Other. ( ) ( ) FUEL TANK:Plans: Permit: Fuel Type: Other. ( ) ( ) 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER Other. ( ) ( ) Other. ( )ARB mtg.date: approval;- notes: ( )ZBA mtg.date: approval;- notes: ( )PB mtg.date: approval;- notes: REQUIRED EXLTrING PROPOSED NOTES APMUVED bate:-Nay V - R m i Frontzg� l Sides: Main C Bscs. Ft H/Sb: Sd.H/Sb: sfa: Tot,Imp L L A.k+ S 0— W &RAO L J�0 '"��/�� �'VyY�Ys15,`A1� 1}/J/f ) milt Gam- �'�. 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" - .© ^^^^^^ 831388495 MARY F WILLIAMS INS AGENCY 125 NORTH MAIN STREET STE 501 PORTCHESTER NY 10573 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER EZ CARPENTRY LLC(A CT LLC) VILLAGE OF RYE BROOK 9 ARNOLD LN 938 KING STREET NORWALK CT 06853 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2547 543-5 610821 05/19/2021 TO 05/1912022 10/18/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2547 543-5, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS W 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:IrAA".NYSIF.COM/CERTICERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR,PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY 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. 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