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HomeMy WebLinkAboutSP21-005PERMIT #k,,)� SECTION TYPE OF WORK JOB LOCATION OWNER !i(JJi T. CCOSiT O #.Q TCO # FOOTI N G FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING C] RGH PLUMBING GAS 0 SPRINKLER ELECTRIC LOW -VOLT 0 ALARM AS BUILT _ CI FINAL Sip DATE: %y of % EXP: / c/ / 1% c) a 7 BLOCK LOT S! " 7 , r_ eel - C�o.:7 w,��� (9iy)937 �360 FEE BATE INSPECTION RECORD DATE INSP Zvi OTHER APPROVALS BOl PB ZBA OTHER l �� o 2yE BRn h' 190 t'l ..°IiJJ V 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 Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE January 16,2024 Win Ridge Realty LLC c/o Alena Hakanj n 24 Rye Ridge Plaza Rye Brook,New York 10573 Re: 17 Rye Ridge Plaza, Rye Brook,New York 10573 Parcel ID#: 141.27-1-6 Sign Permit#21-005 issued on 12/14/2021 for a New Sign This certifies that the new sign;JECT,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building& Fire Inspector /to E C E ��/7 E ( I I' � For office use only: D v BUILDI�Td DEP�A.RTMENT PERMIT#SP-' /- VILI��E OF RYE BOOK ISSUED: /a- /Y'dZG l JAN 19 2022 KING STRE)1 lim BROOK(y,$'1N`W YORK 10573 DATE: FEE: L-V/O PAID m VILLAGE OF RYE BROOK BUILDING DEPARTMENT PLICATION FOR ERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION 1 � Address: //7 ) e�, Occupancy/Use: r Farcel ID#: d 7 -I ' Zone: — Owner: dz L q LL Address: ,6&6 eqz P.E./R.A.or Contractor: J/u Address: �6 l ✓e. /( 73 Person m responsible charge:���� 1i 11?�C,L Address: 40 / C 4 ai m /dSz3 Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW YORK,COUNTY OF WESTCHESTER as: being duly sworn,deposes and says that he/she resides at 46 4 Gd d l G y e (Print Name of Applicant) r / (No.and Street) in 1�--L ,in the County o in the State of that (Cityrrown/Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$ for the construction or alteration of:__ /L� L) 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 L Sworn to before me this 10 day of :j ��� �� , 20 Z 2 day of , 20 Z,Z S' a e of pro rty G 0..l}�,,,r�; Signature of Applic t u lV�l� aS�e�Gt t Name of Pm AwnerT t N of Applican Public "utbIS NIETO Kr, Ivnr,s -, f Yr)rk r'OTARY PUBLIC, STATE OF NEW YORK FA0,01N148N825 8i12i2021 a QUALIFIED IN WESTCHESTER COUNTY _y2Z COMMISSION EXPIRES DECEMBER3,202Z QyE BRC��, • 1982 BUILDING DEPARTMENT ❑B//UILDING INSPECTOR J-EISSISTANT 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 I je- �40- 2l.0 TCC- L L I DATE: PERMIT# S� 2� ��� ISSUED: IL-H-47/ SECT: 1Y1, 27 BLOCK:LOT: LOCATION: �) �I OCCUPANCY: ❑ Violation Noted THE WORK IS... [/PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas 1 (-r i c Nf Ltl 7 "-'N i4 ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER 600o r , ae ❑ FINAL PLUMBING (17 ❑ CROSS CONNECTION [�FINAL ❑ OTHER : Ln O a � N N p� •cd v > b . W Owl aj U t� E G s W VJ ii++C� Cy7 O y 6 w a� c ¢A.- p, a 4 E ti a o Hwy rl f1� O �I ✓�' �4 FyE II rrWI�� d O Z p Q CL Id � Co . 00 Z ai O.i s cn It ^ > O 8 fl- Gj C1 oc A W z a u y C7 Z � C p � � ao •� O W Novo W Z F o f •• o O N v� C7 A G a A > .. A z BUILDIN04k. RTMENT �� Q VILE E OF RY OOK 938 KiNc ET RYE BR NY I0573 NOV - 2 2021 ( VILI_!,CrA VF RYA: BROOK ********************rtrtrtrtrtrtrtrtrtrtrtrtrtrtrtrtrtrtrt*rtrtrt*rtrt*********rt**rt**rtrtrt*rtrtrtrt*rt*rt*****rtrt***********rt*rtrt****rtrtrt***** FOR OFFICE USE ONLY: Approval Date: OV 1 $ l Permit# Application# � Approval Signature: VT ARCHITECTURAL RIMEW BOARD: Disapproved: Date: t BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# ; Other: Application Fee: Permit Fees: **********..*****rtrtrtrtrtrt+rtrtrt****rtrtrtrt*+�*�+***�******.#•**rtrts*��•�*rt***rt+*.+.*******rt*rt**+***�*****rt********* SIGN PERMIT APPLICATION Application dated: '��• 1 is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the construction/installation of a sign in accordance with Village Code§250-35 as per detailed statement described below. 1. Address:L� �>f� 1 da f _J&%ZGi SBL: /ry/, 7 Zone:G l 7 T 2. Property Use or Business Name: ll' --�' 3, Proposed Sign(s)(Describe in detail including number of signs,types,sizes,exact location(s),and illumination method(s)if applicable.) 111� LA separate Electrical Permit will be required for any associated electric I work.} �py1�t L 1�E' Idle A '^-'i�-�•w' 3 'Tw+ �f-4"..+ vi' S'i.��F �$�c_i 4 a c .;"Cz.t 1 P ti �,r A.N a.!,ti.'� . ��j ti L"� '�-I I �:,►w�R:c�>~ Sr�►J C- b,«+� "} t CU't �J ,ct,;= �;S,wS � IZK���C,rc S�b�•s ► a� Lf iN SY �' 1..F1�.-.�. ?'A'tC-2 501 � _ —V*-,Jsh °Tkr-j LI- I'Tlc._i..S- ayyXc7J G "�, 1�.a �(N�L-�' \Z ��! h+•wa.� C'i�i ��i 04 1� �► b-i cvi<<:r rr 4. Height from grade to highest point of sign: r Z- to lowest point of sign: 5. Property Owner:W 14 -��� ���i Address: ? Lf �4 L P Ld N4rr A VNi at-wV L;f 1054; Phone# Ci fLl J$ qoc_ Cell# email:14-�A(k VNJAN 5. Applicant-S��cL b&3/ AI_= . e_,4,Jn ins Address: 16373 Phone# Q/ n Cell# emai1:. ii e pA.)y,:�l<-,Al 7. Architect/Engineer: Address: Phone# Cell# email: 8. Sign Contractor:S hl fe," c_ALL r�P Address: DJ (),!j j�4Jc. �Q4 L e- tet� 1.1 /qs7 Phone# ` 1 q-q 3? -�,34 d Cell# email{Suz-O/)V s/ dLY5-/4�?✓1<0 rn -1- 8/12/2021 9. Will t4Le proposed sign require a Site Plan Review by the Village Planning Board as per§209 of Village Code? No:_'?S (If yes,you must submit a Site Plan Application,&provide detailed drawings) 10. Does the proposed sign involve a Home-Occupation as per§250-38 of Village Code? Yes: No:L If yes,indicate: TIER I:_TIER IL_TIER III: (If yes,a Home Occupation Permit Application is required) 11. If building is located on a corner lot,,w}hic s�t/reet does it front on: �1 r- R u�G PL A 12. Property frontage: I V IIZA � �t4Y- 13. Property size:Sq.Ft.: Acres: 14. What is the total estimated cost of construction: $ 1 tn o (The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,including any material and labor which may be donated gratis.) 15. Estimated date of completion: *wwwwwww,r*w**w,►wwwww*w*w**,rwwwwww*,r*****wwwwwwwwwwwwwwwww*ww*wwwwww*w*ww*w*w+r***+t**w*wwwwwwwww**r+ttw*w***w This application 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. w,rwwwwww,rw***w**w*wwww*wwwww*�wwww********wwww*******w*+rwwww*w****wwww*w**w*wwwwwwwwwwww*wwwww***ar*w*wwwww STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Jl%f* G4N�!A ,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 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 1 Swom to before me this day of 1`1�rltii ( L� , 20 2� day of A10 y 520 z I kippire of PntertyQwwr AtVIT. W 4i ,ue igna e of App ican b Leh . P 'nt Name of Property t�""t"r�,_(A)"A l lo& t lLC PrinkName of Applicant CI.0. Notaij Public otary Public E.OIS NIETO KI.L`f Sn���i F"Alew York R NOTARY PUBLIC, STATE OF NEW YORK NO. OIN14899825 County QUALIFIED IN WESTCHESTER COUNTY COMMISSION EXPIRES DECEMBER 3,2021 8/12/2021 s s� e M O N L W `N N N ` ■, aj \ .� O a u 0. Wp hi1 ^ 4 a .c u c°� ; � - F-I � o � � p � Q 'ITW u Gja W o % Cn °oo `' A N cn F u Z 0%% Cl) � z z `� CA M ., V U u `n a G oo w d z a Ln • � � � '-' d � W �'' w f"' S r H H ¢ w A a wQ ��rr o � �G � W O � ►-' H o OH � H W z z F z cn V 7 n 08 Z C. c E� 0 0 z N it o 0 0 < Ln V 8 �-; o r r u z c Li T < r Ic. ID C_ DR BUILDI E� MENT VIL E OF RYE OK FJAN - 4 2024 ' 938 KIN ET RYE B ` ,NY 10573 - -- - - VILLAGE OF R't BROOK wvaw�tWeb-roo .ort; ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY ` �`/ vim" EP M If cvq—co� Approval Date: AJ� � Permit Fee: S Approval Signature: Other: ********************************** ***** ************************************************* DO NOT START WORK or CONSTRUCTION UNTIL MIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR. THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 // Application dated, /(y Z`1 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. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. / 1.Address:17 �Y c k�i'tL P 14212 SBL: I�1 i 4 7--/—C.O Zone: 2.Property Owner: JJ[A 4Pk � Address: Phone#: '9 7 261— �C�jr Cell#: email: 3.Master Electrician/Licensed Installer: � � Address:J/G /_, 3 �'�"► ?o��f'��J Lic.#:�2��Phone#: 1 Cell#: g9U —qf-Y/ email: �I1 �'K�/�LA�Ho'` Company Name: l�ll�`1 ��f 7,Q1 C `2/ C Address: �U � 34 12`''�k�r'''/ /077, 4.Proposed Electrical Work/Fixture Count: W I A IAZ- 'k- (ilk ig-)7 6e'�' S((. y P ?1—Cl,J� ! LEA SiG� /'L7ac ( .17cr4 5.311 Party Electrical Inspection Agency: �S !�T t �t0� l'1 J/�tC7v✓ <,I l�J STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: .being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of individual signing asthe applicant) state that(s)he is the for the legal owner and is duly authorized to make and file this application. (Master Electrician/Licensed Installer) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances,and regulations. Sworn to before me this Sworn to be ore me this day of 120 day o / — 20 -3L Signature of Property Owner �gnatuire of Applicant U Print Name of Property Owner P t me of Applicant Notary Public Not WLILLO ary° b ic,State of New York No.01ME6160063 10/30/2023 Quallfied In Westchester County Commission Expires January 29,20a_� STATE WIDE INSPECTION SERVICES, INC. Service Willi litlegrily 0•• • • SWIS JOB APPLICATION •2.7224 1 fax 914.219.1062 1 SWISNYcoml SWISTRAINING.COM Office Use Elect.Permit# � L� v� Date #' I �d/`CJIJ� Sq Ft Plumbing Permit# Final Certificate# City/Village 2`1 7 0 Zip v�3 Building Dept.�`� C County( ,0/7CL/'epZ— Address J '` /J� p� E Cross Street Section Block Lot Owner Name/Address(If different than above)w W Q),y_C 444JXLL(L Contact Numberq/y ?0 + gcbj ❑Basement ❑1st Fl. ❑2nd FL ❑3rd FI. ❑More Than 3 FI. ❑Garage ❑Attic Outside I ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/0 Detector Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels 1P 3P #Meters # Disconnect ❑Underground ❑New ❑ Reconnect ❑Repair ❑Overhead ❑Upgrade ❑ Disconnect Utility ID# ❑Con Ed ❑NYSEG ❑Central Hudson ❑ Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect Junction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation SP 2,1 - 005'. D Qg -- JD JAN -4 M4 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(t)year from the date received by SWIS.This application is Intended to cover the above listed Items to be inspected,if at anytime of Inspection additional Items have been Installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other Inspection company.The applicant, owner or authorized agent agrees to all the above terms and conditions as set forth for the application. y `� / Email Address j �/ d Name /T !//`� License# 12,L Date Signature Address Q fix 3ZS City/State „QU/�G7�/ Zip Code Company / �Q/C Ica 740L p CC IEME DState Wide Inspection Services JAN 11 2024 1080 Main Street Fishkill, NY 12524 845 202-7224 Phone VILLAGE OF RYE BROOK 914-219-1062 Fax STATE WIDE INSPECTION SERVICES BUILDING DEPARTMENT Email: office(cbswisny.com Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Tilley Electric Co. Inc. Win Ridge Realty LLC Jeff L.Tilley 17 Rye Ridge Plaza P.O. Box 325 Rye Brook, NY 10573 Irvington, NY 10533 Located at: 17 Rye Ridge Plaza, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP24-003 141.27 1 [1: 6 Certificate Number: 2024-0206 Building Permit Number: SP21-005 A visual inspection of the electrical system was conducted at the Commercial occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at: 17 Rye Ridge Plaza, Rye Brook, NY 10573 The Sign, Photocell, and Switch were inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below, was found to be in compliance on the 11th day of January 2024. Name Quantity Rating Circuit Type Exterior Sign 01 Photocell 01 Switch 01 Officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. Building Permit Check List s&-�Zoning Anks' OB & C ONLY Address: I �./ F� �C i SBL• 2? - - Zone: t i I ` Use: Const.Type: Other. Submittal Date: < < 7- —L( Revisions Submittal Dates: Applicant I ri :1 z%.t,S F_ Nature of Work: s <<i N Fy 2— ��— � 1' ►� +`� � Ec, � c Reviews:ZBA: N Q V - 3 2021 PB: BP: Other. OK ( ( ) FEES:Filing. 3 Ct:). '— BP: O • r C/O: Legalization: ( ) (u./APP.: Date Stamped ✓ Properly Signed ✓ SBL Verified. ✓ Cross Connection: F.O.G.: ( ) ( ) 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: ( ) (,' LANS:Date Stamped Sealed: ✓ Copies: Z 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 H.W.I.C.:_Battery:_Other. ( ) ( ) PLUMBING:Plans: Permit Nat.Gas: LP Gas: Grease Trap: 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: t1 1 approval:- 1 0 tes: ( )ZBA mtg.date: approval:- notes: ( )PB mtg.date: approval: _notes: REQUIRED EXISTING PROPOSED NOTES APPROVED Circles F Front Ste: F.A.R.: Qpen Space: H�ht Stories: notes: LL BLJ1LDtN4.bikRTMENT VIL OF RY ' OOK NOV - 2 2021 938 KING ET RYE BR I,NY 10573 4 9 9-0 VILLA,(_ _ '_,. BUILI)!P! 1 "��,F�i MEN''T *********************************************************************************************************** ARCHITECTURAL REVIEW BOARD CHECK LIST FOR APPLICANTS This form must be completed and signed by the applicant of record and a copy shall be submitted to the Building Department prior to attending the ARB meeting. Applicants failing to submit /a� copy of this check list will be removed from the ARB agenda. Job Address: /2 kQ, 'e'1 a� Date of Subm' s io Parcel ID#: l ( , 2 1—/ —SO Zone: v: Proposed Improvement(Describe in detail): t2Cca( R C—�C15�11��Fusul�WG s APPLICANT CHECK LIST: MUST BE COMPLETED BY THE APPLICANT The following items must be submitted to the Building Department by the applicant-no exceptions. Prop it��wner��� i 1. f Tompleted Application 2. �}1 wo(2)sets of sealed plans. (one full size {maximum Address: ffbf3E AAZf1 allowable plan size=36"x 42") and one 11"x17") t�11 3. ( )Two(2)copies of the property survey. Phone# -t I�" �D j' 9-a,� 4. ( )Two(2)copies of the proposed site plan. Applicant a�aripg before the Board: 5. ( )One electronic/disc copy of the complete ja y�LOr t�� application materials. 6. �Filing Fee. Address: D e. �J 7. ()Any Any supporting documentation. Phone# �� g�')- �3G� l 3 8. ( )HOA approval letter. (ifapplicable) 9. (f j Photographs. Architect/Engineer: 10.( ) Samples of finishes/color chart. (a sample board or model may be presented the night of the meeting) Phone# By signature below, the owner/applicant acknowledges that he/she has read the complete Building Permit Instructions&Procedures,and that their application is complete in all respects. The Board of Review reserves the right to refuse to hear any application not meeting the requirements contained herein. Sworn to before me this 4r Sworn to before me this l57- day of �A [V j� , 20 2 day of ol( , 20 Z/ Si e of Prope Carr t— 1'�f�'I1 ; Signature of Ap 'c t Print Name of Property 6rw*r '(„}y7,1 111 ILL Print Name A Applicant N blic Notary Public v�rk LOIS NIETO ;y NOTARY PUBLIC,STATE OF NEW YORK Commission txpifes Iblatuh 0, 2-JI-L NO.01N14899825 QUALIFIED IN WESTCHESTER COUNTY COMMISSION EXPIRES DECEMBER134MI VILLAGE OF RYE BROOK BUILDING DEPARTMENT 938 KING STREET, RYE BROOK,NY 10573 (T) 939-0668 (F) 939-5801 ARCHITECTURAL REVIEW BOARD Wednesday, November 17, 2021 ANNOUNCEMENT: PER THE GOVERNOR'S EXECUTIVE ORDER THIS MEETING WILL BE HELD VIRTUALLY THROUGH THE ZOOM PLATFORM. THE PUBLIC CAN ACCESS THE MEETING THROUGH THE FOLLOWING LINK: https://us02web.zoom.us/i/81417970741 OR BY OPENING ZOOM AND ENTERING THE MEETING ID: 81417970741 NAME& LOCATION TYPE OF APPLICATION MOTION SECOND APPROVED REJECTED APPL.# 22Valley Terrace New Partial 6ft High 5640 (Camacho) Privacy Fence In Rear Yard 1 Mohegan Lane Roof Top Solar Array Consent 5641 (Daraio) Agenda 11 Candy Lane Legalize Existing Patio w/ 5642 (Gordon) Alterations 26 Beechwood Blvd 4ft High Black Chain Link Consent 5643 (Elkins) Fence In Rear Agenda 4 Bobbie Lane 4ft Black Chain Link Consent 5644 (Jhangimal) Fence& White PVC Agenda Fencing 3 Lincoln Ave( Roof Top Solar Array Consent 5645 Paniagua) Agenda 17 Wilton Circle 2nd Story Addition, Front 5638 (Tabakhov) Portico, Rear Patio& Interior Alterations 17 Rye Ridge Plaza New Sign For Tenant 5646 (Sign Design) "Ject" V 42 Lawridge Drive Egress Window for 5647 (Altman) Basement Legalization 26 Latonia Road Rear Deck Expansion 5648 (Messafi) Remodel ML NM MR SE JM SF AC V MI KC v AC"R" CERTIFICATE OF LIABILITY INSURANCE DATE( 1120 Y „ro1/2o1 21 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 Stacie Washington NAME Borrelli Partners Insurance Agency PHONE (914)939-7900 FAX (914)407-5088 A/C No E#: A/C,No 287 Bowman Avenue E-MAIL swashington@borrellipartners.com ADDRESS: Suite 406 INSURER(S)AFFORDING COVERAGE NAIC# Purchase NY 10577 INSURER A: Travelers Casualty Ins Cc Of America 19046 INSURED INSURER B: Travelers Indemnity CO 25658 Lanza Corporation INSURER C Travelers Casualty&Surety Co 19038 d/b/a Sign Design&J C Awning INSURER D 404 Willett Ave INSURER E Port Chester NY 10573 INSURER F COVERAGES CERTIFICATE NUMBER: 21-22 Cent 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 CONTRACTOR 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 INS POLICY TYPE OF INSURANCE INSD WVD POLICY NUMBER MM R DD/YYYY MM/DDfYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTE15 CLAIMS MADE Fx_]OCCUR PREMISES Ea occurrence $ 300,000 MED EXP(Any one person) $ 5,000 A 6805J175092 06/05/2021 06/05/2022 PERSONAL&ADV INJURY S 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER I GENERAL AGGREGATE S 2,000,000 X POLICY JEC7 7 LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB M OCCUR EACH OCCURRENCE S 5,000,000 B X EXCESS LIAB CLAIMS-MADE EX5J175240 06/05/2021 06/05/2022 AGGREGATE s 5,000,000 DED RETENTION S 10,000 S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STAT Y/N UTE ER C ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA UB5J175160 06/05/2021 06/05/2022 E.L EACH ACCIDENT S 500,000 OFFICER/MEMBMBER EXCLUDED? (Mandatory in NH) E.L DISEASE-EA EMPLOYEE S 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) BLANKET Al-OWNERS,LESSESS OR CONTRACTORS,AI-MANAGERS OR LESSORS OF PREMISES,AI-STATE OR POLITICAL SUBDIVISIONS PERMITS RELATING TO PREMISES,Al LESSOR OF LEASED EQUIPMENT.PRIMARY&NON-CONTRIBUTORY WORDING,WAIVER OF SUBROGATION-WC POLICY INCLUDES BLANKET WOS 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 YNoa Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a-Legal Name&Address of Insured(use street address only) 1In Business Telephone Number of Insured Lanza Corporation 914-937-6360 DBA Sign Design and J C Awning ic.NYS Unemployment Insurance Employer Registration Number of 404 Willett Avenue Insured Port Chester, NY 10573 Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of Insured or Social Security certain locations to New York State,i e a Wrap-Up Policy) Number 13-3525268 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Travelers Casualty& Surety Co Village of Rye Brook 3b Policy Number of Entity Listed in Box 1 a" 938 King Street UB5J175160 Rye Brook, NY 10573 3c Policy effective period 06/05/2021 to 06/05/2022 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"T'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" Will the carrier notify the certificate holder within 10 days of a policy being cancelled for non-payment of premium or within 30 days if cancelled for any other reason or if the insured is otherwise eliminated from the coverage indicated on this certificate prior to the end of the policy effective period? YES ®NO 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 agetit of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by T1��L e y Mel 1 t 1-0— ------ (Print name of authorized representative or licensed agent of insurance carrier) Approved by: tiy 11/01/2021 Date Title. ASS t (�, Vy,'C t­r i Gi La✓y- Telephone Number of authorized representative or licensed agent of insurance carrier: 914-939-7900 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-105.2 (9-15) www wcb.ny.gov 0m *CDF m -n m-nnz 0-1 10 �n � o rn 0<o 0 M;u Om� Xm� V rn i Cl)zo ri Z8;0 z _. 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