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HomeMy WebLinkAboutBP21-295PERMIT #!.J �- 7�� DATE: SECTION TYPE OF WORK JOB LOCATION OWNER ' CONTRACTOR4�%G . ,,EST V`O # LOT % ruslo �,g /ve/ _ r©s>a �f/1/ 3�h--DOt33. FEE b FEE *V/JQ?- ON DATE agaa TCO # FEE DATE INSPECTION RECORD DATE FOOTI N G FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING 0 RGH PLUMBING GAS 0 SPRINKLER ELECTRIC 0 LOW -VOLT 0 ALARM O AS BUILT O FINAL INSP OTHER PA ROP VALS ARB 8GT PB ZSA OTHER C C 4 J . 19 4U" LbutivmaW VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.ryebrook.org TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Michael J. Izzo Stephanie J. Fischer David M. Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE July 13,2022 Joseph D'Ambrosio&Pamela D'Ambrosio 34 Talcott Road Rye Brook,New York 10573 Re: 34 Talcott Road, Rye Brook,New York 10573 Parcel ID#: 135.50-1-6 Building Permit#21-295 issued on 11/12/2021 to Replace Three Trapezoid Windows This certifies that the three new windows,installed under the above captioned permit have been satisfactorily completed. Sincerely, Steven E. Fews Assistant Building&Fire Inspector /to D V BUILD NT For office use 311, DD PERMIT# VIL OF RYE OK ISSUED: APR 12 2022 938 KING STRE YE BROOK, YoRK 10573 DATE: y—/1—cam 3 9 -Q6 �� FEE: ,g //D r PAID M VILLAGE OF RYE BROOK BUILDING DEPARTMENT APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION ***srsrsssttr+st****sssarstrrtrstrt*s+ssrsrssrrtrr+++++*srstrrttsrwrsssrrtr*t*ssssrsstwsww*srstrts*ssrsssr+r***rrrsrrsrws*rss Address: �) 1 �i Occupancy/Use: I F-4eV Parcel ID#: Zone: —/�— Owner:16 5 1 I- 13 wiA 5 — .Address: 3 q cc cp`f f /2 e /Z t3 os-� 'G P.E./R.A. or Contractor: z,�zcS o ro ,ak���ih; D 'F'•-b`�ddress: 3 �; f v {�v.y. ; �r ro, Person in responsible charge: 6*(e n&.' i 4•"fin 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: et r``e, la- Q""l �� '4"'�'�""S'being duly sworn,deposes and says that he/she resides at , 4 "e (Print Name of Applicant) (No.and Street) in in the County of(/) s f 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:$ for the construction or alteration of: k,_47�4 c 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. Swom to before me this 1 G3-- ^A Sworn to before me this day of ryQt!A , 202'2- �~ day of , 20 'Signature of Property Owner Signature of Applicant Print Name of Property Owner Print Name of Applicant Notary Public Notary Public CHRIST044ER J.BRADBURY Notary Public,State of New York 8/12/2021 No.01 BR6159985 Qualified in Westchester County r orrmrr,is�;ion Expires January 29,20 �3 dye 4RCuk o`` tim 1982 BUILDING DEPARTMENT ❑ UILDING 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 - - - - - - - - - - - - - - - - - - - - I-AADDRESS : r\ `'` ` cm cc DATE: PERMIT# ~� ISSUED: �ECT: ` BLOCK: LOT C(2-- C�JC S� LOCATION: �cl �OCCUPANCY:- 1 ❑ 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 l s = x Ln Vi ' N L A' � "^ rl Wo d \ H - rl \ Li W _ o Q � o W � � L L• �+ ` ~ tn N E- lil z N cu •� t PLO 0.0 co O lol, c a' a O w d .. r ._ w Z M Q w wig Q Z ~ E z0 bn B. o 1.0 ago x a o H Q u 0o .r Q Q 3 z c 87 U y, ;; W. E V i > � B � W aa� 0a x � � � � � BUILD TMENT ECEHED VIL OF RYE OOK 938 KING 4LT RYE B[tc ,NY 10573 [NOV — 2 2021 (914)939-064- ivvvw xyebrook.ort,, VILLAGE OF RYE BROOK BUILDING DEPARTMENT ADMINISTRATIVE EXTERIOR BUILDING PERMIT APPLICATION FOR EXTERIOR WORK WHICH DOES NOT REQUIRE VILLAGE ARCHITECTURAL REVIEW BOARD APPROVAL FOR OFFICE USE ONLY: 7 �l�/ APPROVAL DATE: V L�� PERMIT#:I APPLICATION FEE:,CD /5—A APPROVAL SIGNATURE: PERMIT FEES: H.O.A. APPROVAL: DATE: DISAPPROVED: OTHER: Application dated: y 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: Cl 2. Parcel ID#: J 35. ,SD —/ to Zone: 3. Proposed Improvement(Describe in detail): r t l4 [�d— )�; v�Gt v t� I n V o D vh G .e, 41 Property Owner: f 6 ty k P A," b"5I O G h � �( ._ Zli�-�� 1�/► '"� �S o T Address: 36( I u ( fit" I-'" Phone#gi�j - (o3(o - Ob>-> —Cell# �Iu - CA. - q-.ry(Pa►- mail f24A . 6tJdyda—br S,"o List All Other Properties Owned in Rye Brook: M� Applicant: Address: Phone# Cell# e-mail Architect: Address: Phone# Cell# e-mail Engineer: Address: Phone# Cell# e-mail Genera Contracto : o 0 7.17 4� ,1f Address: 10 v�L� J A fiA 1� f-av�-fTr - 14 —d S',s,.. o �D Phone#Ll j`f a l S ��-Cell# e-mail (1) sn2/2021 5. Occupancy; (1-Fam.,2-Fam.,Commercial.,etc...)Pre-construction: Post-construction: 6. Area of lot: Square feet: Acres: 7. Dimensions from proposed building or structure to lot lines: front yard: rear yard: right side yard: left side yard: other: 8. If building is located on a corner lot,which street does it front on: 9. Area of proposed building in square feet: Basement: 15"fl: 2°d fl: 3`d fl: 10, Total Square Footage of the proposed new construction: 11. For additions,total square footage added:Basement: I"fl: 2°d fl: 3rd fl: 12. Total Square Footage of the proposed renovation to the existing structure: 13. N.Y. State Construction Classification: N.Y. State Use Classification: 14. Construction Type&Location: O Typical Western Lumber Frame;O Timber Frame[TC];O Wood Truss[TT]; O Pre-engineered wood[PW];Located;O Floor Framing[F];O Roof Framing[R];O Floor&Roof Framing[FR];Other: 15. Number of stories: Overall Height: Median Height: 16. Basement to be full,or partial: finished or unfinished: 17. What material is the exterior finish: 18. Roof style;peaked,hip,mansard, shed,etc: Roofing material: 19. What system of heating: 20. If private sewage disposal is necessary,approval by the Westchester County Health Department must be submitted with this application. 21. Will 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...)Yes:_No:_ (f yes,applicant must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 22. Will the proposed project disturb 400 sq. ft. or more of land,or create 400 sq. ft. or more of impervious coverage requiring a Stormwater Management Control Permit as per§217 of Village Code? Yes:_No:_Area: 23. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: (tf yes, applicant must submit a Site Plan Application, &provide detailed drawings) 24. Will the proposed project require a Steep Slopes Permit as per§213 of Village Code Yes: No: (if yes,you must submit a Site Plan Application,&provide a detailed topographical survey) 25. Is the lot located within 100 ft.of a Wetland as per§245 of Village Code? Yes: No: (if yes, the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan) 26. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes : No: (if yes, the area and elevations of the flood plane must be properly depicted on the survey&site plan) 27. Will the proposed project require a Tree Removal Permit as per§235 of Village Code?Yes: No: (if yes, applicant must submit a Tree Removal Permit Application) 28. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No: Indicate:TIER I: TIER II: TIER III: (f yes,a Home Occupation Permit Application is required) V 29 �I at is the total estimated cost of constructi $ , 00 Note:estimated cost shall include a or,matena,sca o ding,fixed equipment,professional fees, including any material and labor which may be donatedgratis.If theftnal cost exceeds the estimated cost, an additional fee will be requiredprior to issuance of the CIO. 30. Estimated date of completion: (2) 8/12/2021 BUILD EPA MENT D E C IE Q�E VIL OF RYE, OOK 938 KIN ICREEF RYE BRO NY 10573 NOV - 2 2021 (914)9339-0668 r VILLAGE OF RYE BROOK BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE &216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: , residing at, (Print name) (Address where you live) being duly sworn, deposes and states that(s)he is the applicant above named, and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; 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. (Signature of Property Owner(s)) , , 1,- r3 �y . (Print Name of Property Owner(s)) Sworn to before me this 1 day of Yr\ , 2Q \ KATHLEE N KILLIM AC Qual fyublic State°GB K 1Nestc Nevv fork (Notary Public) �Ommissionip# 0tKi5 713S,q Unty Expires:January 13,2 2-C 13 (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. STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: .eA,- 3 — ".,'b ,being duly sworn, deposes and states that he/she is the applicant above named, (print name of individuat 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. Sworn to before me this / 7 Sworn to before me this r day of J�;(�'�Q ��go , 20 ( day of {�, �2 rv. , 20 & l JJSignature of Property Owner Signature of Applicant (3—.'Qr/` ''�-�?r�s,'7i �Cr r►, (� LJ(-t�P��7 �...b✓"S,•u Print Name of Property Owner Print Name of Applicant � P Notary Public Notary Public Notary P b EN KILLING84CKkA Quaiifi; ;in Mate of rHLF, ID# Q st esterlCo County Q ai fY AU iic SKateiNCBAC Commission Count Aires:Januarys 3, C3 ComntissiQn i #0 Kls;aster York ir8s.JaaUa�330�� -J (4) 8/12/2021 I W-r ce FRANZOSO 1v11MBtk Ad CONTRACTING ce "We Have a Showroom to Every Neighhorhood" hfember Sin,e2000 www.franzoso.com 33 Croton Point Avenue*Croton on Hudson,New York 10520*(914) 271-4572 Mark Franzoso,President Licensed&Insured Westchester:WC-01795-H88/Putnam:PC-375/Yonkers:1325/Rockland: H-09940-136-00-00/ CT:HIC.0632079 November 3, 2021 Please see window specs in reference to permit for 34 Talcott Road I1EQuv/E NOV - 8 2021 LAGE OFRYEBROOKLDING DEPARTMENT Detailed Quote - Customer Pricing QUOTE NAME PROJECT NAME QUOTE NUMBER DEALER PO# TRADE ID FRANZOSO GLENN Unassigned Project 1002020 ORDER NOTES: DELIVERY NOTES: Line# IDescription 100-1 400 Series Specialty Trapezoid Overall Rough Opening = 60 1/2" x 43 5/8" Overall Unit= 60" x 43" Overall Dimensions = RO: 60 1/2" x 43 5/8" UNIT: 60" x 43" Left Facing Dimensional Entry Type = Width-Height-Short Side Select U.S. ENERGY STAR® Climate Zone = Northern 1 " Select Your Sizing Method = Custom Size Facing = Left �I Frame Width = 60 1 - Frame Height = 43 _ RO-o.s Frame Short Side = 23 Venting / Handing = Fixed Exterior Frame Color= Terratone Room: None Interior Frame Wood Species = Pine Assigned Interior Frame Finish Color = White - Painted Glass Construction Type = Dual Pane Glass Option = Low-E4 High Altitude Breather Tubes = No Glass Strength = Standard Glass Tint = No Tint Gas Fill =Argon Glass/ Grille Spacer Color= Stainless None Instructions To Manufacturer= No Extension Jamb Type = Interior Extension Jamb Extension Jamb Profile = Standard Extension Jamb Species = Pine Extension Jamb Color= White - Painted Overall Jamb Depth =4 9/16" Extension Jamb Configuration = Complete Unit Extension Jambs Extension Jamb Application Location = Job Site Applied Add On = No Unit U-Factor = 0.27 Unit Solar Heat Gain Coefficient (SHGC) = 0.33 Unit CPD Number = AND-N-17-01445-00001 U.S. ENERGY STAR Certified = Yes SKU = 289185 t'J Catalog Version Date = 03/28/2021 ll "V - 8 2021 VILLAGE BUILDING F RYE BROOK DEPARTMENT Quote#: 1002020 Print Date: 7/9/2021 2:10:23 PM UTC Page 2 of 5 All Images Viewed from Exterior Detailed Quote - Customer Pricing QUOTE NAME PROJECT NAME QUOTE NUMBER DEALER PO# TRADE ID FRANZOSO GLENN Unassigned Project 1002020 ORDER NOTES: DELIVERY NOTES: Line# IDescription 200-1 400 Series Specialty Trapezoid Overall Rough Opening = 60 1/2" x 70 5/8" Overall Unit = 60"x 70" Overall Dimensions = RO: 60 1/2" x 70 5/8" UNIT: 60" x 70" - Left Facing Dimensional Entry Type = Width-Height-Short Side Select U.S. ENERGY STAR®Climate Zone = Northern Select Your Sizing Method = Custom Size ^ Facing = Left Frame Width = 60 Frame Height = 70 1 Frame Short Side = 50 Venting / Handing = Fixed R° 605 Exterior Frame Color= Terratone Room: None Interior Frame Wood Species = Pine Assigned Interior Frame Finish Color= White - Painted Glass Construction Type = Dual Pane Glass Option = Low-E4 High Altitude Breather Tubes = No Glass Strength = Standard Glass Tint = No Tint Gas Fill =Argon Glass/Grille Spacer Color= Stainless None Instructions To Manufacturer= No Extension Jamb Type = Interior Extension Jamb Extension Jamb Profile = Standard Extension Jamb Species = Pine Extension Jamb Color= White - Painted Overall Jamb Depth = 4 9/16" Extension Jamb Configuration = Complete Unit Extension Jambs Extension Jamb Application Location = Job Site Applied Add On = No Unit U-Factor= 0.27 ���� Unit Solar Heat Gain Coefficient (SHGC) = 0.33 D E (� Unit CPD Number = AND-N-17-01445-00001 U.S. ENERGY STAR Certified = Yes NOV SKU = 289185 8 2�2� Catalog Version Date = 03/28/2021 VILLAGE OF RYE BROOK BUILDING DEPARTMENT Quote#: 1002020 Print Date: 7/9/2021 2:10:23 PM UTC Page 3 of 5 All Images Viewed from Exterior Detailed Quote - Customer Pricing QUOTE NAME PROJECT NAME QUOTE NUMBER DEALER PO# TRADE ID FRANZOSO GLENN Unassigned Project 1002020 ORDER NOTES: DELIVERY NOTES: Line# IDescription 300-1 400 Series Specialty Trapezoid Overall Rough Opening = 60 1/2" x 96 5/8" Overall Unit = 60" x 96" Overall Dimensions = RO: 60 1/2" x 96 5/8" 1 UNIT: 60" x 96" Left Facing Dimensional Entry Type = Width-Height-Short Side Select U.S. ENERGY STAR®Climate Zone = Northern Select Your Sizing Method = Custom Size Facing = Left Frame Width = 60 Frame Height = 96 Frame Short Side = 75 Venting / Handing = Fixed RO-W5 Exterior Frame Color= Terratone Room: None Interior Frame Wood Species = Pine Assigned Interior Frame Finish Color= White - Painted Glass Construction Type = Dual Pane Glass Option = Low-E4 High Altitude Breather Tubes = No Glass Strength = Standard Glass Tint = No Tint Gas Fill =Argon Glass/Grille Spacer Color = Stainless None Instructions To Manufacturer= No Extension Jamb Type = Interior Extension Jamb Extension Jamb Profile = Standard Extension Jamb Species = Pine Extension Jamb Color= White - Painted Overall Jamb Depth = 4 9/16" Extension Jamb Configuration = Complete Unit Extension Jambs Extension Jamb Application Location = Job Site Applied Add On = No Unit U-Factor= 0.27 Unit Solar Heat Gain Coefficient (SHGC) = 0.33 Unit CPD Number= AND-N-17-01445-00001 U.S. ENERGY STAR Certified = Yes D P � V� rN SKU = 289185 Catalog Version Date = 03/28/2021 NOV - 8 2021 VILLAGE OF RYF BROOK BUILDING DEPARTMENT Quote#: 1002020 Print Date: 7/9/2021 2:10:23 PM UTC Page 4 of 5 All Images Viewed from Exterior R L�21E W E � , December 12, 2021 DEC 15 2021 VILLAGE OF RYE BROOK BUILDING DEPARTMENT Village of Rye Brook Building Department 938 King Street Rye Brook, NY 10573 Hello, I am writing to request that the building permit for the replacement windows be sent to my home. I am unable to come to your office as my work hours correspond with the building department's hours. Thank you for your time and attention to this matter. r erely, I�A�--b Pamela Buddy-D Ambrosio 34 Talcott Road Rye Brook, NY 10573 Cell: 914-522-9214 Building Permit Check List&Zoning Analysis Address: .3-4� �A SBL: — Zonal Use: 7-1 O Const.Type: Other: Submittal Date: 1 \ 2 Z 1 Revisions Submittal Dates: l Applicant: O S►-2 Nature of Work: Reviews.ZBA: N O V - 3 2021 PB. BOT• Other. OK ( FEES:Filing -S• BP: ' C/O: Legalization: ✓APP: Dated:�tarized:__\_ABL: L-truss I.D. Cross Connection: ✓ H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Stone 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: ( ) ( ) PLANS:Date Stamped Sealed Copies: Electronic Other. ( ) (4License: ✓ 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. ( ) ( ) 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: APPROVED REQ PROPOSE N UIRED EXLSTING D OTES w. NOV — 8 2021 Cu : > � Front: Front Sides: Main Coy Accs.Cow F S : Sd.H/Sb QFa Tot.in: Ft.Imp: P Hcj&/Stories: d DUalcott Woods Home Owners Association NOV - 2 2021 OFFICE USE VILLAGE OF RYE BROOK Rec'd By Date BUILDING DEPARTMENT REQUEST FOR ARCHITECTURAL COMMITTEE REVIEW Document Check List Request From Survey/Plot Plan Specifications Date 47 Bldg. Plans Permit Mr./MSS.: /n b Elevations Photos `)p���i .j- 1 a Details Other (noted) Address: Phone Brief description of addition, alteration, improvements, etc.: ('en(acc ,,e o� f G.�eP -4-7(ceez6,*6( �✓��o�,s Contractor: ✓Ah�sb �owcfi�G HOMEOWNERS AFFIDAVIT Address: .3 C�o }o� p�; + �tvc. I have read the covenants and restrictions (f"4-oti - o, , p o . IV of my Associations and agree to abide by such covenants and restrictions. No work Cert. of Insurance will be commenced without the approval of my Association. Date: Signed: Please check with Village of Rye Brook for Building Department Approvals FOR ASSOCIATION USE ONLY Approved:byyomeowners Associ Preliminary Approval Subject to Review Insufficient Information Submitted - Resubmit Not Approved Approved with the Following Conditions Ch erson, Ar/chiteJural Review Board Date: I i yW A AO P ..l A J ) ' t A r 'jF^'_ _ A( -at1 A + ?"' '`t•�`-`°�A( *mt ''p ... �. - �At/jy %.y}'•,'GA.+1C'\ ipA� / AI/1 IAA -.-. s\�A �\.: ti�A ..pA \ �� � rr`� 1'•�,5�1 vt. Y ����l�fi. , 3i� r �SrF ��`. .�'{' �I' � 1 �,r � t'� � T�1 4 a- r3 A?;a �� Y r i A;N �� I f r �g lCv t1• �l r� �If�` •• �i` t irfy'tN r f'' t1• � r �{°� ♦fit �'�;�" �I �� \ "`���_8idlC"j 4'i'�'�'1 t������ ,.Fy'�'�ti'1 �'���j�,.�h'i'Pi'1 tip ��� �,Ilr�tl,, (�'��� .�1����1�1�, � �` ,11�1��1�� : ��9�� ,►M�'i'� ��Z�.'(ij_.��- �: �. 5..�.1 ►.fi 1 , .- _ 1 1- Ih 1 1 1:t 1 1 1 1 - �..a�65 <t0)!)' t-'L=:.::[ 11/11:r.ti,' :.11 11.! � p.11111 ?..-ea,-.s::��9 1 NI;. a .:N 1/::�-::: 11111 ::�=::_- .� ::NIII �;:'.�_ _ n�to)►� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �3 C) u NO / 04 • / a C A" O W t0 �= li:• an E to M O 00 M ,� • N C p 0N+ CEO N : ' cr Ho cn _� C O W tiection «o)►,u O a = y O Q o «s00 �edaQ cLL <So s N �% I ccaa ci %! U00 00 'n eR O y y J _ a I ; _ w o rel `ae;:x 11 1 11 rf'a 11MT . .� =rY 11 12:% :_y 11 I1� ':`d1 �//'�" � � 1� 11 FACORO' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYV) 09/20/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Certificates NAME: ROBERT T.KIRKWOOD, INC. PHONE (914)769-9070 FAX (914)769-4706 AIC No Ezt: AIC,No 91 Washington Avenue E-MAIL certificates@kirkwoodinsurancecom ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Pleasantville NY 10570 INSURER A: Selective Insurance Company of the Southeast 39926 INSURED INSURER B: Merchants Mutual 23329 Franzoso Remodeling Corp.DBA:Franzoso Contracting INSURER C: Selective Insurance Company ofAmerica 12572 33 Croton Point Ave. INSURER D INSURER E Croton On Hudson NY 10520 INSURER F COVERAGES CERTIFICATE NUMBER: 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 ADDL 5UHR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MMIDDIYYYV LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED 500.000 PREMISES Ea occurrence $ ME EXP(Any one person) g 15.000 A S2332054 04/01/2021 04/01/2022 PERSONAL&ADV INJURY g 1,000.000 GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2.000.000 POLICY � PRO ❑ LOC PRODUCTS-COMP/OP AGG g 2,000,000 JECT ROTHER Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT g 1,000,000 Ea acadent X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED S2332054 04/01/2021 04/01/2022 BODILY INJURY(Per accadent) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Uninsured motorist s 1,000,000 UMBRELLA LAB 4.000.000 OCCUR EACH OCCURRENCE $ B EXCESS LAB HCLAIMS-MADE CUP0000898 04/01/2021 04/01/2022 AGGREGATE $ 4,000,000 DED I X1 RETENTION $ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STAT YIN UTE ER 1,000,000 C ANVPROPRIMBER/PARTNER/EXECUTIVE NIA WC9082556 04/O1I2021 04/O1/2022 E.L.EACH ACCIDE NT 5 OFFICER/MEMBER EXCLUDED? (Mandatory In Ni E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,descnbe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Vllage of Rye Brook,and Joe&Pamela D'Ambrosio,34 Talcott Road, Rye Brook,NY 10573 are additional insured under general liability per blanket endorsement as respects work performed for Joe&Pamela D'Ambrosio,34 Talcott Road, Rye Brook.NY 10573 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD YORK Workers' CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a. Legal Name&Address of Insured(use street address only) 1b. Business Telephone Number of Insured Work Location of Insured(Only required if coverage is specifically limited to (914) 271-4572 certain locations in New York State, i.e., a Wrap-Up Policy) 1 c.NYS Unemployment Insurance Employer Registration Number of Franzoso Remodeling Corp., DBA Franzoso Contracting Insured 3 Croton Point Avenue Croton on Hudson, NY 10520 1d. Federal Employer Identification Number of Insured or Social Security Number 471320112 2. Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Selective Insurance Company of America Village of Rye Brook 3b. Policy Number of Entity Listed in Box"1a" 938 King Street WC9082556 Rye Brook, NY 10573 3c. Policy effective period 04/01/2021 to 04/01/2022 3d.The Proprietor,Partners or Executive Officers are ® included.(Only check box if all partners/officers included) ❑ all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box 1a"for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York(NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy).The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers' Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers' Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Robert Kirkwood (Print name of authorized representative or licensed agent of insurance carrier) Approved by: A � 09/20/2021 (Signature) (Date) Title: Principal Telephone Number of authorized representative or licensed agent of insurance carrier: 914-769-9070 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-106.2 (9-17) www wcb.ny.gov