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HomeMy WebLinkAboutBP21-321PERMIT#& /_ / DATE;Jc.J'7o��EXP;Z47ADLI SECTION B LOCK LOT TYPE OF WORK S74e !- Q /) U O JOB LOCATION S41i I /�/VC OWNER CONTRACTORS [��/!? �t'f~7Pi'�1 C�O✓�7�t?[7�7rZY_L C3��-- E'64.5 0 S/ (0)03)c EST. vcO # DA' FEE DATE„ �-- •,,,,,,,•,,�,., INSPECTION RECORD DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING L� Z RGH PLUMBING GAS 0 SPRINKLER ELECTRIC L]a "/ D'" ORE T� LOW -VOLT _ ALARM 0 -- AS BUILT FINAL _ ARB BOT OTHER APPROVALS P8 zB� OTHER VILLAGE OF'RIYE BROOK WESTCHEST) COU14TY, NEW YORK NO: 22-042 Certtficate of Occupantp J This is to certify that J000r) of, R)�e �Y�f�l� / V `/ , having duly filed an application on rch 7 20__Qg requesting a Certificate of Occupancy for the premises known as, q Elm A-,// yiye , Rye Brook,NY, located in a —��Zoning District and shown on the most current Tax Map as Section: -5•5 6 Block: I Lot: 3 , and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. (::;,?/— c , issued 1217 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: PFConstruction: for the following purposes: ai�7 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 h igh hall be made,nor shall the building be moved from one location to another until a permit to accomplish such change has b e Building Inspector. R 2 12022 Building Inspector,Village of Rye Brook: a Date: ' For office u e only: BUILD R ENT PERMIT# V a/ VIL OF RYE OK ISSUED: MAR 17 2022 8 KING STRE YE BROOK, YORK 10573 DATE: '� (� —PAID .��'— VILLAGE OF RYE BROOK FEE: A 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 i#iiifif#fitk##/#-##i##iii#ift#tf#tt####ii##f#if#t#t##i######i####f###ttf####i##t#f#if Address: 19 'C z/✓i bp,I VE ZE 4,400K , d Y Occupancy/Use: — Parcel M#: /35► 5-0 —/—413 Zone: —1 v1- Owner: SA SON T. i2/ k I• E I- Address: /q t/44 _tL / Z //ik P.E./R.A. or Contractor: ,C& g T/A.p At 0 Address: 1171 Yo A ie T A dL. (9�fEt.(i U/iG e r Person in responsible charge: 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,'C/OUNTY OF WESTCHESTER as: �/,—J�eing duly sworn,deposes and says that he/she resides at (Print Name of Applicant) (No.and Street) in !(// fi .in the County of l"0' f&_r') in the State of g f ,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 2 O.ovc? for the construction or alteration of: A.A 5 TL 4 E ti 0X Z 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 iti 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 hav:;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 the this_0.9, day of P&We f L 20_"Zz[ day o' 14, 7 Sign re of Prop Own r ig ture of Applicant Print Name of Property Ow Print Name of Applicant PA A CpROUNE MARA BLESSING Notary Public Notary Notary Public State of New York No OIBL6390871 Quatified in Westchester Cou 2 23 ANA M SALAZAR My Commission Expires Apr 22, NOTARY PUBLIC.STATE OF NEW YORR Registration 1vu.111SA6365173 I Qual i fted in Westchester County Commission Expires 10.02.2025 QyE BRC�v� 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - -- - - - - - - - - - - - - ADDRESS:_ DATE: PERMIT# �\ - ISSUED: 1 tE T: ' BLOCK: I LOT: 1 -� LOCATION: �� OCCUPANCY: 2 1 V ❑ 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 /D OTHER e-1 N fY'1 N N N 99 lz Q O _ a s o0-0 ,.., �C /Myy 1� tr) a M � M O Q o 3 � c � r� •.. © Nfq d0 A ,,� �" z Q � oa •� W O G�7 M 00 O O t O i•, O � �, � N O o u O Q 0000 w Z o m � 00 a W W N 314 W Q O d C •�' � 1 l '1 00 Z W W N p V VQ.i �- Oil Ono r oc FBI W W a o 9 OP u 0.0 i-- U ti Ey U a "� �n � � O i� z e •" a� Q BUILD M MENT 51ECIEMED VIL Off' RYE OOK 938 KING ' I RYF:BR ,NY 10573 DEC - 2 2021 d -0 � w VILLAGE OF RYE BROOK BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: �I Approval Date: DEC 021 Permit#:e�J—341 Application Fee: --75 Dd, Approval Signature: Permit Fees:$ QD Disapproved: Other: Application dated: �,QyJ is hereby made to the Building Inspector ofthe 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 described below. ^ 11j 1. Job Address:�q M ��! !,'I` SBL: .JL1_ �-`'E� Zone: 2. Proposed Improvement.(Describe in detail): rJy A'..T z Y i r 7 o k. Q, E ILL AG'5 vA�J ; r , IV,2 (AI i ✓ E" 5 w !0i16 r 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: X Yes: If yes, indicate: TIER I: TIER II: 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, ANSI,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;(I fam.,2 fam.,comm.,etc...)Prior to Construction: 1 A ti'l After Construction: 6. MY State Construction Classification: N.Y.State Use Classification: 7. Property Owner: :J�A.j ou /J /, L Lr )�- Address: I C Z.f11 I-1,1—/ Phone# 7 1 r �,.,7.6 y 86s Cell# email: 8. Applicant: Address: Phone# Cell# email: 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# email: 11. General ContraetorJoin "Imeral r4yacfirc W 4a 3i rmarl cS'f -eel pw` Phone# ^—T Cell# 3—D As---c� 70 email:. 12, Estimated cost of construction $ 0• f)lp (NOTE:The estimated cu,t sltalf include all Wloy,nruerial,scatlhlain�-lixcd cqu incnt_proiee,ional fees,and ma(erial wid labor v`rhich may be donated gratis.) 13. Job Timetable: Start: Finish:_rz (1} 8/121202 t BUIL MENT VIL OF RY OOK 938 KING ,t"r RY>F Bit' ,NY 10573 4 _0 - AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • ST'ORM 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: 11 :I_&50y1 (+dee__ , residing at, 1g jm i a�'r #JV lb��'I�3 (Print nano) (Addre„NNbere you ith e) 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; 11" 61rl/1 1-�<< D r• , Rye Brook,NY. lJob 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. (Si g❑ ure of Properl voter( )) J moo-, (Print Name o(ProperlY Ownrr(,)) Sworn to before me this l day Of r 7 y ,1 U" � , 20 _ =Qualffiedd RA BLESSING ate of New York 6390871 ttcheste`o 2023 ires Ap (Notary Public) (2) S t„_U2l 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 WESTCUESTER ) as: S,L t°�If', 71,4 -IL/C T-o ,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 SC r(,i (. �� ,('G `:,<7>1,7'10r C i!V t, 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 r Swom to before me this y vc` day of -AM�,� , 20� day of - -,N , 20 Si ature of PfopertY Owner tgn re of Applicant _Ja..s l. IA;I Sr140 /L. S, A TO Print tNName �of Pr Owner Print Name of Applicant Notary Public Nota NA ALAZAR NOTARY PUBLIC,STATE OF NEW YORK ReFistraiion N0.0ISA6365173 Qualirl,d in WestcheslerCounty Commission Expires 10-02.2025 CAROLINE MARA BLESSING Notary Public-State of New York No.O181.6390871 Qualified in Westchester County My Commission Expires Apr 22,2023 8/12/2021 Q�E BRC��. O�` tim cu � '9a2 BUILDING DEPARTMENT ❑BUILDING INSPECTOR 0-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.ors - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : \ \ � �\\ `�� DATE: 2\ PERMIT# ISSUED:�SECT: BLOCK: LOT: LOCATION: < — OCCUPANCY: ❑ VIOLATION NOTED THE WORK 'IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION f ^�(f3—'x REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: '`ROUGH PLUMBING 1`'f❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P.GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER eh � N O 04 O oL C N � f ..r M r � F S M H M W r••� Z � v� o � � C E.r cn o O A w � F W a ° ;CO �h oo � cn < C `V 0.0 aa r Q F � V A� w a w F W A z � Z Fr � •• p o i a 3 Q o g C. ° a y�-B_�_ ��. p CC�L�OMC BUIL E MENT VIL E OF RYE OK DEC 2 8 2021 938 KIN I:I RYE:Bl ,NY 10573 VILLAGE OF RYE BROOK or BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: 0 )' ,3Q j EP#: Q7/-. 33 -7 Approval Date: DEC(A9 2021 Permit Fee: $ )A)2ck Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, '��- 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 Codes. QQ 1.Address: I i 1r I t ,a, D21 fie- SBL: 19S7ra —1 ^ `(3 Zone:/e—lc-�. 2.Property Owner: '1S4s/^Yet •1• €R.W mill cr Address: 19 E I i,rl /Jill, l &Ve Phone#: 117-123 -2LOO Cell#: email: 3.Master Electrician: I?1 fifo Sa-1►NU Address: 94 SWeiWeie ST11f&Gf(few ta, CT 04430 Lic.#: yqj Phone#:_�}I�{-027�2-�S(o3 Cell#: email: �uSTleuf�9v Zt_YAlton CDn'I Company Name: S CkLU. L 1.CC Address: -7-`t57WC ile45T-APT5(5 6t�eer�rv+rcl�,G!D(vd'� 4.Proposed Electrical Work/FixtureCount: rC*,W'm'-ttW 04 -.'_ d F-tc0e 8a71m , To 161,n Re-L o'?t Q�cess L tGl t� ,G�Fca ti D,r�w �(,1 Wt>1es ad�ec7ta tS��2eNw��w ************etkic is it ica ie icxirxic 9c is is*ic is*x****************�F:F it ie icn**********i�xic ie*ic irxek:F*xic it ncxde vF is 9cxicxiexxirxxir i�**F F F is it is r. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: '21 ?--/L2 ' Y-4 rrl0ub _,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 C01'-) Ti2t� for the legal owner and is duly authorized to make and file this application. (iiidicate 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 be ore me this 1 Sworn to before me this O� da of 20 !!1, 20 -ZA gnature of Prope Owner Sigfiature of Applicant t. �A le.11ry 4;w7//L) Print a of Pro Owner Print N• Notary Public is CAROLINE MARA BLESSING JOSEPH SUNDHEIM Lmy _ tary Public-State of New York NOTARY PUBLIC STATE OFN8WT= NO.01 BL6390871 Registration Na OISU6151349 alified in Westchester County Qualified in Westeh0slixCour4 ommission Expires Apr 22. 2023 Commission Expitt s August 14,2022 Westchester Rockland Electrical Inspection Services, InC. ``�` Phone: 914-347-3595 L ' DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue Fax: 914-347-3596 Elmsford, NY 10523 BUILDING PERMIT NO. TEMP# DATE 4TV-9, CITY OR VILLAGE ZIP CODE TOWNSHIP COUNTY STREET AND NO.OR ROAD POLE NUMBER [`1`ui, BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION _ _ BLOCK LOT OCCUPANTS NAME BUILDING OCCUPANCY OWNER'S NAME AND ADDRESS HOME TELEPHONE NUMBER -s. CURRENT SUPPLIED BY FROM THEIR OFFICE WORK TELEPHONE 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 N0. WATTS EACH INSPECTION OUTSIDE BASEMENT 1"FL. T-FL. 3-FL ij ING PART ENT REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: " 1 [ Lf c1 i Lc.crkl r ;4c (S (21ffcZ 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❑ CONCEALED❑ 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 _/7 A DATE OF APPLICATION Sle"Tum OR ANT STREET ADDRESS TELEPHONE NM CRY OR POST OFFICE ,- ZW CODE UC04M NO.WHEN APPLICABLE WESTCHESTER RDCKLARD ELECTRICAL INSPECTION IRE15SERVICES,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: PS Electric Inc. Jason & Erin Miller 245 Weaver Street Apt 5G CT, Greenwich 06831 Located at: 19 Elm Hill Dr Rye Brook, NY 10573 Certificate Number: 1033493 Section: 135.50 Block: 1 Lot:43 BDC: Permit Number: EP:21-337-BP:21-321 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: 19 Elm Hill Dr Rye Brook,NY 10573 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 03/10/22 Name Type Quantity Fixture-Luminaire Vanity Light ------- 2 Exhaust Fan ------- 1 Switch Single Pole ------- 4 Receptacle GFCI ------- 2 Fixture-Luminaire Recessed ------- 4 Receptacle Convenience ------- 2 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. —7��L This certificate is valid for work performed before date of inspection only. YYY n N M W ~O : N � � NV' � 1 O. ■ C x GA en Ln p O °°L? cq 00 Q ACL� � W •-- r" of Z 00N 0-4W U uz 0-4 ►-� W zL o 14 Ln cn � � ■ Q or H �I as a OOFRYE D EC E WE BUIENT JANiVILOK3 Z�22 938 KIN NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT PLUMBING PE/RMIT APPLICATION FOR OFFICE USE ONLY BP#: 1 PP#: Approval Date: JAN n� Permit Fee: $ / r Approval Signature: Other: Disapproved: ' (fees are nun-refundable) Application dated, 11 1-31 ao a a is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/or 6nove Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agree that said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: I C1 tt-1M Dp-i U E. SBL: Zone: 2.Proposed Work:__�A S I L✓V- lbA VA P--NI : K,-fr-yj S+AcLyE.Q. ('ASI"s Aj`L W1 WC ELI m�tic>�Y,PND ��t��U� IJi�� �LIrniNA�`'� WNiQLW�L 3.Property Owner: ;P6ont RiN (Y)', 1.L E e- Address: 19 E -yyl +A M -D IZ . Phone#: Cell#: I O ag 5�6J� email: ERyNt460nNiK(PGma%L .Cc>m MAm A Q EGK 4.Master Plumber: -1 0 SE PN mE L A G R A roo Address:Hoag W AyEQL y AvE. p>LDG D. luY /0643 Lic.#: �rJ a ( Phone#: 9(4- -6I 0(0))Well#:cpq 319 aG 9Lr7 email: �('�ELftGRANn�C�MA�I•Cove Company Name: S, (Y)E L A&F-ANO .Cc. TNT._-Address: (oa$(.�av��Ly ave. 3�oG D tnA E.AN EGGi O INDICATE FIXTURES& LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Rath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains "Dubs Tubs Service Service Sewer LP Gas Basement Ist Floor 2nd Floor I I 3'Floor - -- - - 4'h Floor --� 5'Floor Exterior T-1 5.* List Other Equipment/Providc Details:tIAZ� 4"' Ott fCEPIQ� JE- 5 k P I k.) SCR- S-II ELI itiaTie_ W"112.L%0L DOA-6L't- BASim VJG . (Notarized Signatures Required Next 2 Pages) -I- 8/12/2021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,oSEptk MI-AGIZAuo ,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 ?l UA n41.'JC.- 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 3 day of ,20 _ day of SAW 4-k4 ,20ga _ Si ature of Prop rty Owner i nature of Applicant �a.5vtn � M1(� �osEQN l'''IF L AGR�aNC7 Print Name of Property Owner Print Name of Applicant � -- Notary Public Notary Puh CAROLINE MARA BLESSING r. Notary Public-State of New York FAHIM NAZ CHOUDHURY NO.018L6390871 Notary Public-State of New York Qualified in Westchester County NO.01CH6260770 My Commission Expires Apr 22, 2023 Qualified in Westchester County ?Ay Commission Expires Apr 30,2024 This application must be properly completed in its entirety and must include th no rtze signature s) o 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 BUILD MENT F E IEOM VIL OF RY OOK JAN 13 2022 938 KING 'vr Rvlr.BR ,NY 10573 VILLAGE OF RYE BROOK H BUILDING DEPARTMENT ***x*xxxxx*x*�*�xxxxxxx***x*xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx*xxxxxxxxxxxx*�x*x*******x*�*x**x**x AFFIDAVIT OF COMPLIANCE VII.LAGE 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: 31, ZGtson K) I(% , residing at, J q e)ry� �I(� D'-, Kae 5i2)e/L, oy ja—� (Print nanic) (Addre„%v licrc c,ui iw) 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; �9' �ry!✓ Y ,pr , 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. (Si nature of Props ti O er(s)) (Print Namc of Properts Owner(,)) — Sworn to before me this C► day of K)p , 20 CAROLINE MARA BLESSING Notary Public-State of New York NO.01 BL6390871 (Notary Public) Qualified in Westchester County My Commission Expires Apr 22. 2023 8/12/2021 1 Building Permit Check List&ZoningAn*sis Address: c1 SBL: 3 — L 3 Zon -- 12 Use: 12 l O Const.Type: Other. Submittal Date: Z �'t l 2 l Revisions Submittal Dates: Applicant: 1 L t,G CL Nature of Work- Reviews:ZBA DEC 7 , PB: BOT: Other. OK ( ( ) FEES:Filing. BP: ->00 • C/O: Legalization: ( ) (.,5"'APP: Dated otarized. ✓ SBL ✓Truss I.D. Cross Connection: — H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening. ( ) ( ) ENVIRO: Long. Shore Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmt.: Tree Plan: Other. ( ) ( ) SURVEY:Dated: Current: Archival: Sealed: Unacceptable: ( ) ( ) PLANS:Date Stamped: Sealed: Copies: Electronic: Other. ( ) ( License: Workers Comp: Liabilit)r 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. O O 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 REQUIRED EXISTING PROPOSED N� DEC - 7 2021 Ate: Date. Circle: Fr n e Front: Front: 51A.Q. Rear. Main Cow. Accs.Cov Ft.HS : S .H Sb: Tot. Ft Imp: Parking. HHd ht/Stories: notes: %rr O O o \+ k O 1��y1t4{t�� v 11t+'r� "i O il�ilt!�1tr 5 �Tr o v , .:.v ♦• `"M"' •♦ 'r + ♦ I' r ti4: t1♦ .,r. • �•t♦• r t+?v t♦1t f:lt r �i� a _" 001 �/111 1►1/11, • ,N/�i l .,:14041i'� � '��� �h'�'Ol�l.r: i� ..'i/11{/14�:-' � 1�1�111.; :3 rAOW 4 C 'y M d � 6 O • 3 r 40 rA U `� Q r fx y d O ow" �lflll rA oD ,lrl NOW �,,,� H w O o G� o U � g !. iq 4.,r ' ,.1 Z Z W i F 0 rA Sit nW . , k O J W a� Q W r 1 p Q wLL 04 = 4-1 �, Z (A H w O ,tOa e W O .. F r axe w (D a X o z „Iln, H Ur V O W d cad a 1/ n , in, Not ca Au n 4. o C O r r h �'• y >•. pun < ) Nr .aaF.•,1'11 •.1 .. a •• 11 11:. .a aif•11 '1, 1'fa a;. . I,,,p'?} .�-.,rg$:'„"h.y, ::re',11,1/, my o^- - ,/1/ pl, d{/ 11�' 1111/�/1�1 ( 1'11/1Yj�':- - - ,',{/NII 1111 4 p� �, �di//lilll •',.,. ::•-�n .� 11/111 '1 � 't1i1s1y w Ii;1/ � � t1♦1♦1 �A��t�r. t/ili` ,t t+aS���J�'i t�♦t r �, . . ' \ •�Zr'. � ♦• � � '` ♦� tM1 A 1.+� . � i, + A ,c'y' �31 A 't>.li<fi � A rt�M + � ,A...�q• r/ '.?�L�a�:• O'A` .. �— �Oi}rj! � 0�`lu ,.. 59 ., �.a .A; yrv� -. _...... ��v��q �+��t!t�/ - v..��si -.....I11�ae�r�Ar�� w:.:,:ra��'rG�s` �`"�r`'`�q�r����-Q+Ca•: '.rrt»�%-+`�...t9iaS9Vr�r��^_'�«.-'Wb3'i25 ..I� �-� .. .. DATE(MMIODNYYY) ,aco CERTIFICATE OF LIABILITY INSURANCE 3/24/2021 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). PRODUCERCONIACI NAME: Ken Libuit Joyce Insurance A/ No Ext; 8459427200 (Afc,No): 2 Joyce Plaza ADORERS: service Joyceins.com INSURER(S)AFFORDING COVERAGE NAIC# Stony Point NY 10980 INSURER A: EVANSTON'INS CO 15379 INSURED INSURER B: SERGIO GENERAL CONTRACTING CORP INSURER C: 22 NORIAS RD INSURER D: INSURER E: GREENWICH CT 06830-6916 INSURERF: 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDfYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE FXI OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A Y 3AA459355 03/22/2021 03/22/2022 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY PET 7 LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED FRUPl- UAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION ND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ Mdescribe under IPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Certificate holder named as additional insured. 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 St AUTHORIZED REPRESENTATIVE f3arwa,by Joye.� Rye Brook NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund WESTCHESTER ONE,44 SOUTH BROADWAY, 10TH FLOOR,WHITE PLAINS, NY 1 0601-44 1 1 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) pti:. El ^^^^^^ 522454246 'f JOYCEINSURANCE " �Y 2 JOYCE PLAZA STONY POINT NY 10980 i SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER SERGIO GENERAL CONTRACTING CORP. VILLAGE OF RYE BROOK 22 NORIAS ROAD 938 KING STREET GREENWICH CT 06830 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2275 662-1 732145 04/20/2021 TO 04/20/2022 7/27/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2275662-1, 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 SERGIO ARAUJO SERGIO GENERAL CONTRACTING CORP. 1 OF 1 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. BY CAUSING THIS CERTIFICATE TO BE ISSUED TO THE CERTIFICATE HOLDER, THE POLICYHOLDER UNDERTAKES TO PROVIDE THE CERTIFICATE HOLDER 5 CALENDAR DAYS' NOTICE OF ANY CANCELLATION OF THE POLICY. NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 1059180272 U-26.3