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HomeMy WebLinkAboutBP21-317i OTHER APPROVALS IPERMIT # / DATE: 4 a� E�(P: j I. ACTION TYPE OF WORK JOB LOCATION _ OWNER CONTRACTOR T. COST �szo # C TCO # LOT G7 FEE DATE r, �_ INSPECTION RECORD FOOTI N G FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS SPRINKLER ELECTRIC LOW -VOLT ALARM ALARM BUILT 0 FINAL DATE �TiT11�� r INSP o ARB BOT PB ZBA OTHER VILLAGB`PF RYE BROOK WESTCHESil COUNTY, NEW YORK NO: 22-047 Certificate of ®ccupaurp This is to certify that Vim/J .' Jamie Allen of, R (e, BY-CCk � /V , having duly filed an application on MarchQ2��20 ��requesting a Certificate of Occupancy for the premises known as, �elje Fir &ule v,� ,-cjRye Brook,NY, located in a J Zoning District and shown on the most current Tax Map as Section: / `-f' Block: -->? Lot: 1 , and having fully compliedwith the requirements of the Building Code and the Zoning Ordinance under Building Permit No. p2/" , issued 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: — D _ Construction: for the following purposes: hi 4-erlor b % i' 1/boa rn rPr)o yo-476K? 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 s all be made,nor shall the building be moved from one location to another until a permit to accomplish such change has b n o taine uilding Inspector. Building Inspector,Village of Rye Brook: Date: MAR 2 9 2022 E(g W E E� BUILDING [W-PARTMENT For office use only: `�� PERMIT# 612,J2L-317 VILLAGE OF RYE'RAOOK ISSUED: MAR 2 2 2021 8 KING STREETS RYE BROOK,NtW YORK 10573 DATE: a— (9t4)9 -0658 FEE: �5 PAm VILLAGE OF RYE BROOK NvwR r k:,orU BUILDING DEPARTMENT APPLICATIONERTIFICATE 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 **s*♦r+ssss+ss+s*srsr►► s*s►ss►*s*►ss•ss*s*es+stssr►►+s**r++*■ss*rss►ss*srs►ss**+►►►+stss►s+sttt►s►sssr*+►+tst**►sss**+►*+►s* Address: lle,4l"r 91v41 Occupancy/Use: — OM Ilyparcel ID#: 124.-73 -2 — L n Zone: Owner: lG/340C Address: �� r r BI✓/ P.E./R.A. or Contractor: Cer., ,! *4 SSiiwe, Address: LOGkWO C 4 ,fL. Y /USY/ ' Person in responsible charge: 5y ey,G lce 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: � &-c o�!�i� ]tr being duly sworn,deposes and says that he/she resides at "! G k Ile'�`�� — (Print Name of Applicant) ',/ / (No.and Street) �/ in�� &-ook ,in the County of W L s?r �s�"`� in the State of W /that (City/Town/Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:S y 3, 0/6 / for the construction or alteration of: ,Gq4-c a4 S Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-10.A. of the Code of the Village of Rye Brook. Sworn to before me this Sworn to before me this day of 20a a day of , 20 Signature of Property Owner Signature of Applicant IName of Property Owner Print Name of Applicant Notary Public Notary Public SHARI MELILLO Notary Public, State of New York No. 01 f,iE6160063 Qualified in Westchester County Commission Expires January 29,209-i QyE BRC��, 1982 BUILDING DEPARTMENT ❑/DUILDING 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 !/� �`� DATE: PERMIT#' li_ I ' �� ISSUED: SECT: BLOCK: LOT: ( ' �i LOCATION: / i L' - 7 ,7 % OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... Is-1 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 QyE BRC�v�. O� 2m 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 rKebrook.or¢ - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - -- - - - - - - - - - - - - ADDRESS : , QA `e (i3` V ' / DATE: 1 S PERMIT# ISSUED: ` C(T: BLOCK: LOT: LOCATION: l�f '� OCCUPANCY: Zb ❑ 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 �yE BRC�uk. • �9a2 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.or - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - AIIRESS �S V� / DATE: PERMIT# � ISSUED: \2�42�ECT: BLOCK: LOT: LOCATION: �� � Y `�►V- 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 ❑ OTHER �yCC,BRC��. O�` tim • 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.or - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - --- - -- - - - ADDRESS : % DATE: PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: \Ql C�� (A '�� OCCUPANCY: ^� ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING -�^ `(��-�L❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: -d ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER a x JJ� {"1 a� t� o 4 x 4d a pp a _ W O y O > ■ F W �Oj W tog. nC~i ° 0.0 0 ' "o [—� � OC y o > 4• p o Ir■q ® g �0. 0 a A 0 0 O p va 0 � bo a 3 � a I a o 0 o °' a O ■ 00 W W U C w wo U b o �o o V ■ W Z a � tn W 02, O Farad !h ►Wr Gw7 ►. .O r Q a A cn gz OCR W W U �. y o coo aoi u a 01 haul w U E u a � U V ow o W O U y O x 'V kn CFr o 0 o W O�., y Gos a o 5 � a z a �' G E« ONO w a C. a o BUILD M ENT VEL E OF RY OOK NOV 2 2 2021 938 KING Kir RYE BR NY 10573 0 VILLAGE OF RYE BROOK `s $�c, BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: f Approval Date: t Permit#: / Application Fee: $ Approval Signature: Permit Fees:$ G 7 S- Disapproved: Other: Application dated: is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing building,or for a change in use,as per detailed ddlstatement described below. 1. Job Address: � G t� Rid, 44111 X&A- SBL: /c-)q, 3 —e)—I Zone: P110b 2. Proposed Improvement.(Describe in detail): 4-trl 4-et 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: Yes: If yes,indicate: TIER 1: 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.,comet.,etc...)Prior to Construction: After Construction: 6. MY State Constru tion Classi cation: N,Y.State Use Classification: .�,e� ,./ p /' p 7. Property Owner: P��n �e'.,�P(- A//d''dress: LL"t AL��f�f�t ter b ✓� Phone# Cell# I V 7',T7�2 ail: •S �° 1' /yra t /.0 8. Applican NIP aid "A �e,��(✓ _ Address: I r ``✓�� email: 1 sl)-e l shed Phone# Cell# q�'�"—�117� 1�'Z e 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# email: 11. General Conttr�a(ct�or: f NC Alt' Address: Phone#�S Zg—YSO I Cell#1 � email: ll 12. Estimated cost of construction S I�!'J' "TS��a (,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: TI+7J►/r p �ec�m,6 20 1 Finish: (1) 8/12/2021 ® 1ECE V E $UILD MEP�TT VIL OF RY OOK NOV 2 2 0021 938 Ki G ET RYE Bit NY 10573 A 010 �$�� VILLAGE OF RYE BROOK BUILDING DEPARTMENT ***•kH::**yF********+F****************************•F.*****i*#*****•k+ic*yY Y**:F it a*i:********:F***t*F:F:t****i*i**:4:Fx* 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, ` P�- Ue e i i' (Print name) 1 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; qCie ` (e-'t`'Rt r ! ✓a - , 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. -I—, _�&a- �&--- — (Si;nnl -e ofProperty Owner(s)I Qef'34r- (Nni Name ol'Propert) O%kner(s)i Sworn to before me this X;k day of 1No�-C��- , 202�__ .o iNotary Public) SHARI MELILLO Notary public,State of New York No. 01 ME6160063 Ouall,ied in Westchester County (2) Commission Exoires January 29, 20 an 2i2021 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. STAT�F NEW YOM COUNTY OF WESTCHESTER ) as: 4_ v-en R{r's 4 rr ,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 forthe legal ownerand 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 D_'), Sworn to before me this day of 20 �;i-) day of , 20 Siignature of Property Owner Signature of Applicant S+ey{n Re,'s 6- F�rint Name of Property Owner Print Name of Applicant No ary Public Notary Public SHAM MELILLO Notary Public, State of New York No.01 ME6160063 Oualified in Westchester County Commission Expires January 29,20 (4) 8/12/2021 M In _ _o N N OC Vy C4me C v, e. � � a $ = F O p j HON A w a o Q a W H `-' o. W �ONO, VOC ' ICI � (� a _ F �+ < 6w cw 96 16 aag a. = w OC1 0. z.a r. f� G� = v: [E E V E BUILDING DEPARTMENT DEC 17 2021 IDD VILLAGE OF RYE BROOK 938 KIN� ET RYE B ,NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT .or ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY B #: 1 EP#: Approval Date: \X Permit Fee: $ Approval Signature: Other: Disapproved: — (fees are non-refundable) ******************* *** ************************************************************************** Application dated, 7 2 is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/oi remove electrical equipment,wiring, fixtures,or to perform other high or low voltage electrical work as per the detailed statement described below. The applicant & property owner, by signing this document agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: �P,1I SBL: j y 7 3' LI Zone: 2.Property Owner: S e„i e_n F I Q i<A p, r ., N j t5k dress: Phone#: j J N J ? SDI `/Cell#: email: 3.Master Electrician: _�v s e,r2 h Address: r.d r, Lic.#: j 7�d Phone#: Cell#: /q y9 N S G I S' "lemail p� L N V Company Name: Address: 4.Proposed Electrical Work/Fixture Count: 4 c.44 s e,-►n /%e rn e. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: J_S d � S et- fur ,being duly swom,deposes and states that he/she is the applicant above named,and does ther (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 e 1 e G4 r C, 1 for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attomey,etc.) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Swom to before me this Sworn to before me this day of ,20 day of Signature of Property Owner Si tur of Applicant Print Name of Property Owner t�Name of Appli Notary Public Notary Public SHARI IJIELILLO Notary Public, State of New York No. 01 P:5E:616!)^53 Q�ialified in Westch ester Courty� Commission Expires Janua,\,29.20t� 8/12/2021 Westchester Rockland Electrical Inspection Services, Inc. c� Phone: 914-347-3595 DO NOT WRITE HERE-FOR OFFICE USE ONLY P.O. BOX 208 �l Fax: 914-347-3596 Carmel NY 10512 - f � BUILDING PERMIT NO. TEMP# DATE CITY OR VILLAGE ZIP CODE TOWNSHIP COUNTY 1 STREET AND N0.OR ROAD POLE NUMBER BETWEEN WHAT O CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT 2 LI OCCUPANT'S NAME BUILDING OCCUPANCY rI be r OWNER'S NAME AND ADDRESS HOME TELEPHONE NUMBER CURRENT SUPPLIED BY FROM THEIR OFFICE WO•RK YELEPHONE NUMBER LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS NO.OF FIXTURES& MOTORS HEATERS OFFICE USE LOCATION LAMP RECEPTACLES ONLY SIDEWALL SWITCH INCADE FLUORE NO. H.P.EACH NO, WATTS EACH INSPECTION OUTSIDE BASEMENT 1� FL. InTi 2-FL. 3-FIL UZI VIL GE O RYE BROOK`, REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: DEPARTMENT THIS APPLICATION IS INTENDED TO COVER THE ABOVE LISTED ITEMS TO BE INSPECTED.IF AT ANY TIME OF INSPECTION ADDITIONAL ITEMS HAVE BEEN INSTALLED,YOU ARE AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE FOR THE ADDITIONAL ITEMS INSPECTED AS PROVIDED BY THE APPLICANT.THE APPLICANT DECLARES THAT THERE IS NO OPEN APPLICATIONS FOR THE ABOVE WITH ANY OTHER INSPECTION COMPANY WREIS,INC. IS NOT LISTING,LABELING,UNDERWRITING OR CERTIFYING ANY EQUIPMENT, MATERIALS OR DEVICES WHICH ARE PERFORMED BY OTHER CERTIFIED TESTING AGENCIES OR INSPECTION COMPANIES.THE APPLICANT,OWNER,OR AUTHORIZED AGENT AGREES TO ALL THE ABOVE TERMS AND CONDITIONS AS SET FORTH FOR THE APPLICATION. SIZE OF SERVICE FEEDERS CHARACTER OF WORK NEW❑ ADDITIONAL❑ EXPOSED F 1 CONCEALED O MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD❑ UNDERGROUND❑ AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. NAME OF COMPANY DATE OF APPLICATION SIGNATURE OF APPLICANT � u > r /� 1 K STREET ADDRESS TELEPHONE NO. CITY OR POST OFFICE C ZIP CODE LICENSE NO.WHEN APPLICABLE ^ ! } WESTCHESTER ROCKLANO ELECTRICAL INSPECTION SERVICES.INC. BY THIS CERTIFICATE OF COMPLIANCE THE Westchester Rockland Electrical Inspection Services 43 North Lawn Ave, Elmsford, NY 10523 914-347-3595 (Office) 1 914-347-3596 (Fax) CERTIFIES THAT Upon the application of: Upon premises owned by: Sadovia Electric Inc Steven Fleisher&Jamie Allen 226 Union Valley Road NY, Mahopac 10541 Located at:9 Bellefair Blvd Rye Brook, NY 10573 Certificate Number: 1033753 Section: 124.73 Block: 2 Lot: 14 BDC: Permit Number: EP:21-333-BP:21-317 A visual inspection of the electrical system at this premise described as a Residential occupancy,wherein the premises electrical system consisting of electrical devices and wiring,described below,located in/on the premises at: 9 Bellefair Blvd Rye Brook,NY 10573 L Basement 1st Floor 2nd Floor 3rd Floor Garage Attic Outside Other: Inspection was conducted in accordance with the NYS and NFPA 70-2017 International Electrical Code and detail of the installation,as set forth below,was found to be in compliance therewith on 03/22/22 Name Type Quantity Receptacle GFCI ------ 5 Fixture-Wall Sconce(s) Lights Indoor ------- 7 Switch Single Pole ------- 7 Exhaust Fan ------- 2 Fixture-Luminaire Ceiling ------- 2 Electric Floor Heat Radiant ------- 1 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. This certificate is valid for work performed before date of inspection only. iiiiiiiiiiiiiiiiiij �O 01 N � N a N N a o a tA0-0 log u all _ o hil 0. rr ■' O � w o Q o 3 F'r kf) F „ ■ p C z 0ON c ■ I�'"I W � 3 a O � � Q 3 � O ► cz z N � c � � 00 w W O Q 0 a ■ ■ w �o O t vn 1 � I z en ~ x Q \./ 1 >Ono v m O� Q W Q z H ►•� � � z w x N � W ►-� ONO Ls M V C. 4 Go9 I = o, a _ BUILDING DEPARTMENT R E C E��E VILLAGE OF RYE BROOK DEC 13 2021 938 KING STREET RYE BRooK,NY 10573 10 (914)939-0668 VILLAGE OF RYE BROOK tyebwokor(" BUILDING DEPARTMENT PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP #: c —3/ PP#: Approval Date: DEC 1 4 1 Permit Fee: S Approval Signature: Other: Disapproved- (fem are non-ref mdabie) Application dated,ld'13- 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 Plumbing as per detailed statement described below. The applicant&property owner,by signing this document agree that said plumbing w�r+ork will be in conformance with all applicable Federal,State,County and Local Codes./� 1.Address: e e tr i �1U v Qc SBL:is y.73-�-�# Zone:PEA 2.Proposed Work: `�,�...� t fit)b,Ll�� rN$-TU _rWo "" 3.Property Owner: S n- sd' Address: dal y- 1" cuim,r j- Phone#: Cell#: 1::-s c(-t(L email: 4.Master Plumber: 6be( S ak 0.2 0"r Address: 3fL ae-0'nJr 91�4 St lX4. hr. KI$Co Lic. #: 10gPhone#: Cell#: email: �Ct(,Gr'G�(�wndivi(c. ,dLcu`Ty�,� r..r Company Name:�M(ctZce- p IKC , Address: 3(L deff-ati- yy 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 Gas Basement 1st Floor 2nd Floor J— 1 3'Floor y 4*'Floor 5'Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -1- 8/12/2021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: SCA C e / P tr �L t"�. ,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 'tty' r,e���—I�. I 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 15 Sworn to before me this 13 day o �Lc( .n� ,20 2t day of Pcceai � 20 2t Signature of Property Owner Signature of AppV=1 l i JL� �t i Situ L �a�Ct.2a,r Print Name of Property Owner Print Name of Applicant Notary UBLIC STATE OF NEW YORK Not L`PUBLIC-STATE OF NEW YORK No 01SA6379344 No 01SA6379344 Qualified in Westchester County Qualified in Westchester County My Commission Expires 08-13-2022 'Wy COMMissi0n Expires 08-13-2022 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- 8/12/2021 ECENE BUILDING DEPARTMENT DD VILLAGE OF RYE BROOK DEC 13 2021 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT �Nvw.r%'ebrook.or __-- 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 PLUMING PERMIT APPLICATION. ANY BUILDING OR PLUMING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT. STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as:: 3f, gc�\ce1 c�.r e - \A , residing at, �(L Ch"T„JT 1��3y c PQ. 1A_T• K4Sco (Print name) \\herc Doti 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; 6"� 1eic"rA Rye Brook, NY. (Job Addres„ 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 41 roperty Oxxner(s)) Srt Vice, f Ie�Sl le-r (Print Name of Property Ouner(s)) Sworn to before me this 13 day of e 120 21 (Notary Puh c) SULEYMA B SALAZAR NOTARY PUBLIC-STATE OF NEW YORK No 01 SA6379344 -3 Qualified in Westchester County My Commission Expires 08-13-2022 8l12/2021 Building Permit Check List&Zoning Analysis ' Address �F L(�� �-� sBL: I a Y• 7.3 — a—1-1 Zone: Use: ` l Z� Const.Type: Other. Submittal Date: 1 I ZZ- ,Z 1 Revisions Submittal Dates: Applicant L E 1 S 4j C2 Nature of Work: % lZ.c.O n__ ��rAT�t Vf�')►J Reviews:ZBA: Noll 2 9 2091 PB. BOT: Other. NEW OK ( ( ) FEES:Filing: 7S, BP: &12L C/O Legalization: ( ) ( ) APP: Dated. ✓ Notarized: ✓ SBL: .Truss I.D. Cross Connection: / H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening. ( ) ( ) ENVIRO:Long. Short Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmt.: Tree Plan: Other. ( ) ( ) URVEY:Dated Current Archival Sealed Unacceptable ( ) ( P S.Date Stamped ✓ Sealed Copies: �� Electronic Other ( ) (.. License ✓ Workers Comp: '� Liability `� Comp.Waiver Other ( ) ( ) CODE 753#: Dated: N/A: ( ) ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit N/A: Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit N/A: Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit I-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 EXIMNG PROPOSED NOTES Avr UV Date' Cir FroaW Front Front Sides Rcjr. Main Cov Accs.Cov. F S S .HS • a Tot,Im : Et.Im : ParkLng. HHight/Stories: notes: Amon Mrr.r/tNrr(w..n 1 rW d.f )%Xq HTl bhrh�.(r+r r�.wr Prdrr�rr 6 r � Department of Consumer Protection Home Improvement License SNS CERAMIC 6 STONE INC 33 LOCKW000 LANE MAMOPAC NY-10541 Thn)srn.a•....sxerl rn&:"wd2wt NIA Arlick W o(tAt and K,sld unh urw tKsx+wr a/tIK.Alw uI 4towtum ud.hw(0(C0wg".p.K own go n M#rFp�ad kw w•nr¢r..(tfin Iwtwrc N(►T f(llt f!bf](AI IM'NPlMtiI1 • I tcernr 4(rrtM 04k of VapnUm WC-2529"12 05 08/2022 DATE(MM/DD/YYYY) ACORO"" CERTIFICATE OF LIABILITY INSURANCE F11/15/2021 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 NAME: Sherwood M Walls Walls Insurance Agency PHONE 607-723-6359 :'% No:607-722-6928 15 Hawley St E--MAIL Binghamton NY 13901 ADDRESS:_swallS wallsinsurance.com INSURERS AFFORDING COVERAGE NAILS is s INSURER A:Citizens Ins.Co.of America 31534 INSURED SNSCERA-01 INSURER B:Massachusetts Bay Insurance 22306 SINS Ceramic&Stone, Inc. INSURER C:Hanover 22292 33 Lockwood Lane Mahopac NY 10541 INSURERD:Allmerica Financial Benefit INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:539099744 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 A L EFF P POLICY OLICY EXP LIMITS LTIRTYPE OF INSURANCE POLICY NUMBER MMIDD A X COMMERCIAL GENERAL LIABILITY ZBSD988336 7/21/2021 7/21/2022 EACH OCCURRENCE $1,000,000 DAMAGE To REE CLAIMS-MADE Fx]OCCUR PREMISES Ea oxu ence $100,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,0W,W0 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000.000 POLICY�JECT 11 LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILELlABtLrrY AWSD987537 7/21/2021 7/21/2022 COMBINED SINGLE LIMIT $1,000 000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED X ASCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY UT OS HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ C X UMBRELLA LIAR X OCCUR UHSD993277 7/21/2021 7/21/2022 EACH OCCURRENCE $1,000,000 EXCESS LIAR CLAIM E AGGREGATE $1,000,000 DEC) I I RETENTION$ $ p WORKERS COMPENSATION W2SD987605 7/21/2021 7/21/2022 X I STATUTE I I ER AND EMPLOYERS'LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE -y NIA El EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) EA_DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below El DISEASE-POLICY LIMIT $500,000 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101.Additional Remarks Schedule.may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Village of Rye Brook 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name and address of Insured(Use street address only) 1 b. Business Telephone Number of Insured SNS Ceramic&Stone, Inc. 914-469-4439 33 Lockwood Lane MahopaC, NY 10541 1c. NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State, i.e.a Wrap-Up Policy 1d. Federal Employer Identification Number of Insured or Social Security Number 453800056 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Allmerica Financial Benefit Village of Rye Brook 938 King Street 3b. Policy Number of entity listed in box"la": Rye Brook NY 10573 W2S-D987605 3c. Policy effective period: 7/21/2021 to 7/21/2022 3d. The Proprietor,Partners or Executive Offers 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"1 a"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 NFORMATION 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 will also notify the above certificate holder 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. Please Note: Upon the 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 Worker's 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: Sh;1,e ood M Walls (Print name of authgrized representati�Xwe"8/23/2021 en of insurance carrier) Approved Lam? ! �` j1 (Signature) (Date) Title: Agent Telephone Number of authorized representative or licensed agent of insurance carrier: 607-723-6359 Please Note:Only insurance carriers and their licensed agents are authorized to issue the C-105.2 form. Insurance Brokers are NOT authorized to issue it. C-105.2 (9-07) www.wcb.state.ny.us Form WC 88 31 21 C Printed in U.S.A. Page 1 of 2 N 00 r L_ o z ., w i N m� I�J FILE COPY cv, 0�w cV LL p CD CD w z nn n Z 00 luul _7J G _J y'- _ L_�J >m0 C C G Q epp0 3't0 Oq y ¢ C I 1 16'—e" — •p u �' � �.74" Vi +— * 35s" 5 ° tA Zim ZA ?� vv Sit W 3 N yy Or N z to GA N nr �p w rf� BENCH O I GGC11111 V � NoRio w IN N O ad O ~jrA 3 Q, G�_' � M r ; J t a PERMIT# SBL# lZ . 73 — z — l DATE APPR V D 2021 I BUILDING INS of Ry*Smak,NY i 0` z , N z �n O W O M IY 2i o (b H I'ti 7t ! 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