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HomeMy WebLinkAboutRP21-068PERMIT #A�r SECTION TYPE OF WORK JOB LOCATION OWNE CONTRACTOR EST. COST w/co #� TCO # FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING O RGH PLUMBING GAS ED SPRINKLER ELECTRIC M LOW -VOLT F1 ALARM C7 AS BUILT FINAL Q&8 DATE: //J! 2- ) / EXP: BLOCK LOT INSPECTION RECORD DATE INSP Via. •1fii�:r�y� � MAN // D, /gs,C%tas,�i �g/y)4al. 7 419L/ OTHER APPROVALS ARB BOT PB -- OTHER -- -- 1 0 �4✓la V,r`J DR C��tc C W� T V 4bnnium aW VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.Lyebrook.org TRUSTEES BUILDING & FIRE INSPECTOR Susan R. Epstein Michael J. Izzo Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE October 19,2022 Paul Snisky&Kelly Snisky 41 Meadowlark Road Rye Brook,New York 10573 Re: 41 Meadowlark Road, Rye Brook,New York 10573 Parcel ID#: 129.84-1-8 Roof Permit#21-068 issued on 11/12/2021 to Re-Roof Existing Building This certifies that the new roof,installed under the above captioned permit has been satisfactorily completed. Sincerely, r 1 Michael J. Izzo Building&Fire Inspector /to D BUILD �TMENT For office use only: ll ` PERMIT#3D � i � DVILE OF RYE OK ISSUED://--IQ DEC 2 2 2021 38 KING STREII '>, YE BROOK, YoRK 10573 DATE: A>h4 9 -0 O i FEE: �9Z f y - PArgX VILLAGE OF RYE BROOK w r r BUILDING ��PART FNT l 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 etwswsststtssrwssAts/s�swwswsswwstwssrsstesrerssssrwwwwstwsstrrwswssswseswstewr►ttssrsssssssssssrrs►sssssssssrsrstrwss►►►sssssss Address: 41 /"l U.A.AOW eA 67gmpr- 1 " y Occupancy/U e: /4�1. 0�_IQ Zone: "(-9-0)0 Owner: Address: P.E./R.A. or Contractor ddress 0J IC Person in responsible charge: /414, ✓l t Address: Application is hereby made and submitted to the B ilding 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: J �S being duly swom,deposes and says Atk that he/she resides at / /"` �� �1 in Xnot Name of Applicant / (No.and Street) Y5 �D O 4 ,in the County of U Gs+L t5 �-1 in the State of W ,that (City/Town/Village) I 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:$ O D O for the construction or alteration of: 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. N Sworn to before me this 1-� Sworn to before me this day of , 20 Z` day of , 20 Si ature of Property Own r Signature of Applicant Print Nam of Property Owner Print Name of Applicant Notary Public Notary Public ;ril,iUi- j-a'R J. BRADBURY Notary Public,State of New York No.01 BR6159985 Qualified in Westchester County Commission.Expires January 29,20 23 QyE BRC1v�. 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR JQ'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. , LJ PERMIT# ISSUED: ` I �ECT: BLOCK: LOT LOCATION: 0 �2 ��� OCCUPANCY: Z 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 OD lD 04 w x U w �r3 g 16 W � � U G p � old W s ° '� i 1� 4 C ,� tic o W Miy ,V ac? � x a,A a �,�v 4' p a� c aq z ;, o 0.+ � y+ � r�y � � � � � �00 '15 o 00 Cc, Vb - � m e ° ° c r/a oC C �'• co � .n L �"�� � Q � z U w oQw .� � •v � U .. fx °' o BUILD TMENT } i pE V E OF RY OK NOV _ 3 2021 938 KING ET RYE BR NY 10573 VILLAG`c t'I- f�Y BROOKEUILGIN;. DE AR 1WENT FOR OFFICE USE ONLY: Approval Date: NOV - 3 21 Permit# Application# Approval Signature; ARCHITECTURAL REVIEW $ Disapproved: Date: BOT Approval Date: Case# Chairman: P13 Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: f/ Application Fee: Permit Fees: 7 r- ROOF PERMIT APPLICATION Application dated: is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit to Re-Roof an Existing Buildiing�,as per detailed statement described below. p p 1. Job Address: '-f r /YI +-e—r4oW 1(2�(k IW B9VkSBL:4 7� 9e�_ /`Q Zone xo— �d Property Owner:JP4LL- S i Address: y��ok y 101 f (Zoe— Phone#: �jl 7d-5643 Jell#: 0I,4 -ua- 6U43 email: Ay- �AisLIl_ � C &'& L -e-OW( 2. Applicants k Address: _ �J Phone#: Cell#: email: 1 3. Roofing Contractor: G► *C< LN Ic epro. Ayddreess:71 rivi I h give, Caf Phone#: ?Iq ` 4q-7qqj ell#:�9�4 4c 4-_L�,�q1 +l email: l _ �l' r ►vl Ci�Cp.C�►vl 4. Job Description-all Methods&Materials: /V�Ltl goo- u)i S ✓'�� Le�C'. 5. Estimated Cost of Job:$ � lD 0 (NOTE:The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 6. If corner property,indicate street frontage: 7. Construction Type: NYS Construction Class: 8. Number of stories: p� eight: 9. Is garage being re-roofed:No:( )•Yes:( )Attached No:O•Yes:(.Number of Cars: C91 10. Is roof peaked,hip,mansard,flat,etc; PUJJ 11. Estimated date of completion: 3b 8/1212021 Please note that this application must include the notarized signature(s) of the legal owner(s) of the above-mentioned property, in the space provided below. Any application not bearing the legal property owner's notarized signature(s) shall be deemed null and void, and will be returned to the applicant. STATE OF NEW YORK,COUNTY OF WESTCI ESTER ) as: , being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and fixrther 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 20 day of , 20 Si a e f Prone Owner Signature of Applicant r 'S Print Name of Property Owner Print Name of Applicant Notary Public Notary Public SHARI MELILLO Notary Public, State of New York No. 01 ME6160063 C -iallf�ed in Westchester County Commission ExDires January 29,20 0�3 -2- 8/12/2021 Laura Petersen From: Laura Petersen Sent: Friday, November 5, 2021 9:13 AM To: gkcontracting1 @yahoo.com Cc: DRSNISKY@GMAIL.COM Subject: Roof Permit Application -41 Meadowlark Road Good morning, The roof permit application has been approved by the Building Inspector. Before I can issue the permit the following items must be submitted to our office; 1. General contractor's valid liability insurance (the Village Of Rye Brook must be the certificate holder) 2. General contractor's valid workers compensation on a NY State Board form (C105-2 or U26.3) 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 Ibetersen aarvebrook.org 1 Laura Petersen From: Laura Petersen Sent: Tuesday, November 9, 2021 8:38 AM To: Gregory Kloskowski Subject: RE: DOB Thank you for the liability insurance for 41 Meadowlark Road. Please also send the following: 1. General contractor's valid workers compensation on a NY State Board form (C105-2 or U26.3) 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 IpetersenCcD.ryebrook.org From:Gregory Kloskowski<gkcontractingl@yahoo.com> Sent: Monday, November 8, 20216:49 PM To: Laura Petersen<LPetersen@ryebrook.org> Subject: Fwd: DOB Sent from my iPhone Begin forwarded message: From: Imperium Group of NY<info@imperiumnyc.com> Date: November 8, 2021 at 10:11:30 AM EST To:Gregory Kloskowski<gkcontractingl@yahoo.com> Subject: RE: DOB Pozdrawiam Iola From: Gregory Kloskowski [mailto:gkcontractingl@yahoo.com] Sent: Monday, November 8, 20216:53 AM To: info@imperiumnyc.com Subject: Fwd: DOB Dzien dobry Pani Ewelino, bardzo pszepraszam A moze pani zrobic to jeszcze tax Sent from my iPhone i Begin forwarded message: From: Imperium Group of NY <info(a�imperiumnyc.com> Date: November 3, 2021 at 12:50:19 PM EDT To: Gregory Kloskowski <gkcontracting_1(a�yahoo.com> Subject: FW: DOB Hello Please approve below Thank you Jola From: Paul Snisky [mailto:drsnisky gmail.com] Sent: Wednesday, November 3, 2021 11:20 AM To: Imperium Group of NY<info@imperiumnyc.com> Subject: Re: DOB Good morning . I went to the Village and put in the permit application . They need some additional information that I didnt provide you with on the Certificate of Liability Insurance. Please add the full address in the Certificate Holder box. Village of Rye Brook 938 King Street Rye Brook, NY 10573 . The Same information has to be added to the Certificate of Workmans Compensation Insurance under Certificate Holder. Sorry for not having this information the first time. SO this has to be on both certificate holder areas : Village of Rye Brook 938 King Street Rye Brook, NY 10573 2 Please email me back when added and I will forward to the Building Department. Have a great day. On Wed, Oct 27, 2021 at 1:30 PM Imperium Group of NY <inf6@imperiumnyc.com>wrote: COI attached Ewelina From: Paul Snisky [mailto:drsnisky@email.comj Sent: Wednesday, October 27, 2021 1:21 PM To: Imperium Group of NY<info@imgeriumnvc.com> Cc:Gregory Kloskowski<g_kcontracting1@yahoo.com> Subject: Re: DOB Village of Rye Brook is the certificate holder for the Liability Insurance On Wed, Oct 27, 2021 at 11:46 AM Imperium Group of NY <info e,imperiumnyc.com> wrote: I never received info for Certificate holder only that this is needed to pull out permits. Please provide full name of Certificate holder and what Certificates are needed. Thank you Ewelina From: Paul Snisky [mailto:drsnisky@gmail.coml Sent: Wednesday, October 27, 2021 11:36 AM To: Gregory Kloskowski<gkcontracting1@vahoo.com>; info@imoeriumnvc.com Subject: Re: DOB I'm not sure if you what you sent is valid ( for the Village) proof of Liability insurance. Village of Rye Brook must be listed as a certificate holder. Is the Village listed on the document? On Tue, Oct 26, 2021 at 12:33 PM Gregory Kloskowski <gkcontractin lg_(a�yahoo.com> wrote: Sent from my iPhone Begin forwarded message: 3 10/26/21,8:41 AM IMG_3095.jpg r Own, 'q •. s., ll ^ Department of Con%umcr Protection Dome Improvement t.iccn%c CA OONTNAC 1 WM;COFtP 71 s im ORNE CAF**1.MI.10312 T1»Ir,ec.r u wwN x:w�LC��.aa Ar^Kk%V7 of Kr MRVnnR Cwwl L'.tW^!^hKKaf+x Cx6e w1 x�Yd aaY�� - 1 Pxnt d s 77"a pr.yrr+»Ms.�u w nga+d M.auKnc<of lAs IKtm^ pe�cwcrd nc uflsn>'f � N/^rfOR MR RAl.Pt'MMS d Con�y�r (lltN4'MRIIRT `si C 07/2ry70Y!1 WCG219 Vk" Y t � https://mail.google.com/mail/u/O/#inbox?projector-1 1/1 AC R" CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY) 11/8/2021 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 NAME: Imperium Group of NY, Inc PHONE 718-576-2212 a No): 718-576-1773 25 Driggs Ave ADDRESS: alex@imperiumnyc.com Brooklyn, NY 11222 INSURERS AFFORDING COVERAGE NAIC IF _ INSURERA: NORTHFIELD INS CO 15954 INSURED INSURER B: NYSIF 21199 GK CONTRACTING CORP INSURERC: GUARDIAN 21199 71 Fini Dr INSURERD: CARMEL, NY 10512 INSURER E: NY 10512 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 ADDLiSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE so I WVD POLICY NUMBER MM/DDNYYY) (MMIDDNYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE = 1 Q00 000 CLAIMS-MADE ❑X OCCUR MA E RENTE PREMISES Ea occurrence $ 100,000 -- MED EXP(Any one person) f 5,000 A WS481573 10/21/2021 10/21/2022 PERSONAL s ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JEST LOC PRODUCTS-COMP/OP AGG $ 2,000,000 000 ' OTHER: _ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $Ea accident ANY AUTO OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS ONLY AUTOS BODILY INJURY(Per accident) _ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LULB CLAIMS-MADE AGGREGATE _ DED RETENTION �/ $ WORKERS COMPENSATION X STATUTE ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE B OFFICER/MEMBER EXCLUDED? N/A W 2400 674.4 1 OM2021 10/6/2022 E.L.EACH ACCIDENT $ 1,000.000 (Mandatory In E.L.DISEASE-EA EMPLOYE $ 1 000 000 It yes,describe under nd DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 NYS DISABILITY NYS C 00933536-0000 1131/2018T 1/31/2022 STATUTORY LIMITS DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more apace Is required) Village of Rye Brook, 938 King Street Rye Brook, NY 10573 is included as additional insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 938 King Street ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE ©1988-2019 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 4 \\ NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE %a* * ^^^^^^ 203879520 IMPERIUM GROUP OF NY INC ATTN ALEX RIAZANOV 25 DRIGGS AVE BROOKLYN NY 11222 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER GK CONTRACTING CORP VILLAGE OF RYE BROOK 71 FINI DR 938 KING STREET CARMEL NY 10512 RYE BROOK NEW YORK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2400 674-4 71462 10/06/2021 TO 10/06/2022 11/10/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2400 674-4, 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://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT GRZEGORZ KLOSKOWSKI 1 OF 1 GK CONTRACTING CORP 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 STAT SU NCE FUND 7 4/ DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 755780331 U-26.3