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HomeMy WebLinkAboutBP21-326PERMIT # T �/ � �'�P DATE: �v1 7 a E�(P: �� % �- SECTION r LL BLOCK � //LOT - TYPE OF WORK Q�STP../ Q� �/701fQ770/� JOB LOCATION O OWNER Vtz� C OIC�/,7 .� /' Q .%!,'�/� � g(7`�q��D� q CONTRACTOR � /0�2r� C�� UG�74/7�-fi�,,i1 / !�' P/�D�CC/ �����y 3d��� �. COST � �� OCx'� -� F E � OO--, VCO # - FEE' DATE TCO # FEE DATE INSPECTION RECORD I DATE INSP FOOTING FOUNDATION �' FRAMING ,. RGH FRAMING INSULATION / � 1 . PLUMBING [� RGH PLUMBING GAS C7 - SPRINKLER ,.��/ ELECTRIC LYJ '��'aa LOW -VOLT C7 ALARM AS BUILT C7 FINAL ����� - oc�g�,�o�r ���o OTHER APPROVALS ��: :• .; ., • __ VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK No : 22-16.-) Certificate of Orcupatcp Ehis is to certif, that'SYeVe/? `. 'MOM f Ce tSeh�e� of, Rye- having duly filed an application on �,r 20 _-2,�2 requesting a Certificate of Occupancy for the premises known as, CIJ / Q 11! T6 aOO/ , Rye Brook,NY, located in a jQ-Jc;� Zoning District and shown on the most current Tax Map as Section: /35. 5Q Block: L Lot: a4 and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. d�, issued 1Q117 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: -3 10ne- Construction: for the following purposes:_ 1%Q��'rI 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 heig t shal ,n ftaff4be building be moved from one location to another until a permit to accomplish such change has It n t ' ed fr ng Spector. Building Inspector,Village of Rye Brook: 2? Date: NOV - 12022 D 0 BUILDING DEPARTMENT For office use only: PERMIT# ALb �- a40 VILLAGE OF RYE BROOK ISSUED: / 0 C T 17 2022 938 KING STREET,RYE BROOK,NEW YORK 10573 DATE: 10` - 5Xa (914)939-0668 FEE: PAID VILLAGE OF RYE BROOK wwyv.afta0lorg BUILDING DEPARTMENT PPLICATION 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 wwww►►s►s►►►►►wwwwwwwr►■s►►►s►►w►wewwrwwrwr►►►►s►►■s►►►►wwwwrww�rlrr►►►►►ss♦r►www►wrwrwwrwsr►►►srs►s►w►►►►►wwwwwwrwrwrrrwwrtr► Address: ��-:rW 6a �--r\ Occupanc Use: Parcel ID#: /. .�� ��� Zone: / 3E Owner: \0 S (r Address: P.E./R.A.or Contractor: 'Address: 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: STATES YF NEW YO IRK,COUNTY OF WESTCHESTER as: / I (� J�1 e ye,` � beingdui swo deposes and says that he/she resides at (I/� l � `� Y m, eP Y J� C (Pijnt Name Applicant (No.and Street) in �j � in the County of r in the State of that (City/Town/Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,p>ofg sional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$ for the construction or alteration of e Ov x S v- r' 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 ��� Swom to before me this day of day of ,20 tgnature of Properly Owner Signature of Applicant rft'Vrue of Property Owner Print Name of Applicant Notary Public Notary Public SHARI MELILLO Notary Public,State of New York No.OIME6160063 8/12/2021 Qualified In Westchester County Commission Expires January 29,202� o �m '9a2 BUILDING DEPARTMENT ❑BUILDING INSPECTOR [ ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK Al CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - L � -� ADDRESS:- t ` -- �-'CJ� \/ DATE: +�� ;-g'ao-2-z PERMIT# \ f� ISSUED:\ < I ' �ECT: 1 J BLOCK: I LOT: LOCATION: \ ' `��5� <' '' -vV 0 OCCUPANCY: Z-'y ❑ 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 �E BR o� tim 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:— `C �� \ -'A DATE: PERMIT# ? ISSUED: SECT: BLOCK: LOT: LOCATION: 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 _ N _ N � � W � � 3 �+ : a� N *� Q N � SO , 0 o CIO � b o lo- p0 O wG p I _ > v� cu a C% CIO, Oc O r00i w: O ° � oU � d a W W O O U z N Gr a Z 00 M rOl N W r� a� ° � rO1 • A v� 'IT w < Q4 � 04 ) C�s `. `CrA w z ® cn � ebo 00 A ° w°z � a�' � o � z OG1 Ui u c c o W 0.0 P ow 3 w a O p V o aa a, wo .. W v > > �I � a � W �' xr✓ � � � � a. a BuIL MOARTMENT VIL,4OF RY � OOK DEC 13 2021 938 KING ITREET RYE BR NY 10573 (914) 939-0668 VILLAGE OF RYE BROOK irvy .ryebrookmrg BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Approval Date: DEC 13 Pen-nit : --3a Application Fee:$ Approval Signature: vvr K Permit Fees: $ Disapproved: Other: Application dated: is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of Permit for the interior alteration of an exis/ng building,or f!or�a-chaannge in use,as per detailed statement described below. 1. Job Address: tp a-d cc r� Rd-) R e _a-r L _SBL: I,3Si 10—/—t)Y Zone: 2. Proposed Improvement.(Describe in detail): Vl 0 r v1 GO P� 3. Does the proposed improvement involve a Horne-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: 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 jjapplication&2 sets of detailed engineered plans) 5. Occupancy;(I fam.,2 fam.,comm.,etc...)Prior to Construction: I l,t l After Construction: 6. N.Y State Construction Classification: N.Y.State Use Classification: 7. Property Owner:�d nzP-+ t4i kee ba� Address: J p_fJ / Phone# 9/W- 6 qU''yt'(, !�' Cell# q1 7- Sf 4`2tQk& email: - 8. Applicant: Address: Phone# Cell# email: 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# n 1Cell �# email:/ n 11. General Contractor: faOr�O 7 f"� Address: _( /0rr'V h �{�Y" , y`�Z_ _Lo� o� Phone# O'-/'221 T`3 90 Cell# email: 12. Estimated cost of construction $ ��O (NOTE:The estimated cost shall include all labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may he donated gratis.) J / 13. Job Timetable:Start: Finish: I/ J —r (1) 8/12/2021 BUILDING 6FPARTMENT VILLAGE OF RYE BROOK DEC 1 3 2021 938 KING SrizvF r RYE BHooK,NY 10573 (914)939-0668 � � wr ;tyzl>trroak.or y VILLAGE OF RYE BROOK RUILDIIr1G DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: 9-0 } 1,�'I tL� SC�14C�- , residing at, (E� Q(( 1'1(' . fl�/A&]ZnK I Prim naamc) (rWdre: v+here you live) 'J - 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; �Q Tq I Cio( 1 Ed - , Rye Brook,NY. (.lob Address) Further that all statements contained herein are true, and that to the best of his/her knowledge and belief, that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. (Signature of Pro ll, uercrt.11 fret s Ghoet (Print Name of Property OEvneq,); Sworn to before me this r� �- day of beCe OJQP�, 20, '�_ {Notary l'olr1n'1 f Per! K ano c—a' l�1 Notary Public ate of ew York No. 02 14 68 Qualified in estchester County 8n212021 Commission Expires February 27, 20 Z L 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 WESTCHESTER ) as: 6110.t C [. (1Q dl_- ,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. 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 /©I` Sworn to before me this day of (- , 20,21_ day of 120 Signature o Property Owner Signature of Applicant Print Name-of Property Owner Print Name of Applicant Notary Public Notary Public Perl KadanI •�L-- v ` Notary Public of New York N0. 02KA6141668 Qualified in Westchester County Commission Expires February 27,20 Z Z (4) 8/12/2021 n N \ \ a a L, Ln w wI Ln 0en 1-0 u w lz 4 v O 0. CAN ` Cs IrT�I • z r" .. O v p I� z p v r� ~ tn ~en u 4 C� A . o Z PLO o W N � � w z � 3 w z o z z O W A t[1 z N ` /O Ln w ` 00 W a J w A � ocw � �� u p: O \ U U � C� ON`- �. � w �4 [ a oo a z at V a U M zz z H 7 w c z 28 �.y V of W OZ 0� d9 y x z DDBUILDING DEPARTMENT VILLAGE OF RYE BROOK AUG - 4 ZO2Z 938 KING STREET RYE B X,NY 10573 VILLAGE OF RYE BROOK (914)939-06 ' BUILDING DEPARTMENT wwwoebraok.org ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required _ FOR OFFICE USE ONLY BP#: �( ' 3�LO EP#: ' Approval Date: AUG - 5 1 Permit Fee: $ / .=�-�/ � Approval Signature: Other: Application dated, OBIQVI A22 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: 616 T Zcn SBL: /3 S-•-50 Zone: 2.Property Owner: _s'-AEac n Address: 6 B -o 1c+o-/ IarW Phone#: q/q - 6170- W G S Cell#: email: / 3.Master Electrician: 3�yo�y7/io n .�c7/r.c i yi c Address: /32 ,„y,�r Ajc /.1W0ie<-/Up/Qrj Lic.#: /&&A Phone#: / 1 Cell#: 91y-56y-V6,?5 email: e yolu-7eo.f Company Name: i�.rC. Address:t3s -;,r1.4 C 4ew Aa, olwc" 4.Proposed Electrical Work/Fixture Count: �clel_C�o 1 e;?&eto ya-'ori. r 5.3'Party Electrical Inspection Agency: 7W/S t STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: being duly swom,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 for the legal owner and is duly authorized to make and file this application. (indicate 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 before me this Swom to efore me. is day of ,20 day of 120 Signature of Property Owner tgna eg�oo/ Print Name of Property Owner -Name of Applic Notary Public Notary Public SHARI MELILLO Notary Public,State of New York No.01ME6160063 Qualified In Westchester County k/;3/2022 Commission Expires January 29,20 STATEWIDE • 1:1 Main Street,Fishkill, NY 12524 1 email:• • SWIS JOBAPPLICATION tel 845.202.7224914.219.1062 • Office Use Elect.Permit# lot / �� Date Bldg Permit# r f Utility ID# Final Certificate# City/Village Zip Township County Address Cross Street Section Block Lot Owner Name/Address(if different than above) Contact Number ❑Basement ❑ 1st Fl. ❑2nd FI. ❑3rd FI. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside ❑Residential [:]commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent SERVICE Amperage Voltage 1 P 3P #Meters #Disconnect ❑Underground [:]New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information AUG - 4 2022 VILLAGE OF RYE BROOK f BUILDING DEPARTMENT This application is valid for one(1)year from the date received by WAS.This application is intended to cover the above listed items to be inspected,If at any time of Inspection additional items haw been installed,you are authorized to make the inspection and adjust the fee for the additional hems 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. Inspector Date Finalized Inspector# Company Name Date Signature Address City/State Zip Code License# Phone# State Wide Inspection Services CAS 1080 Main Street Fishkill, NY 12524 U T 845 202-7224 Phone 914-219-1062 Fax STATE WIDE INSPECTION SERVICES Email: office@swisny.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: Evolution Electric Inc. Steven Schoen Franklin Salazar 68 Talcott Road 132 Fairfax Avenue Rye Brook, NY 10573 Hawthorne, NY 10532 Located at: 68 Talcott Road, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 22-175 135.50 24 Certificate Number: 2022-4509 Building Permit Number: BP#21-326 A visual inspection of the electrical system was conducted at the Residential occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at: 68 Talcott Road, Rye Brook, NY 10573 The Second Floor Master Bathroom was 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 9th day of August 2022. Name Quantity Rating Circuit Type GFCI Receptacles 03 Radiant Floor Heater 01 Shower Lights 02 Bathroom Fans 02 Recessed Luminaires 09 Decora Switches 07 Single Pole Officer: Frank 1. 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. � N N O N N \ N a = W. Ln Lnen as ` O P,M Ln is v G W rn FC ad 4 r� x C4 Ln Mcs N �� � r�1 x O U m �..y W in ►u U g O n .- A Ln z �" = O " a O 00 Ito 00 z w o w ^o V r CN V .. V U w z � V U U zz cn � o � H N � o w W 124 z0. < � $ O �: z x z r o c ° ■ V Z v o zoo a ,. w ►nai 8 ►� 00 J a r BUILD Q DEPARTMENT JAN 2 5 2022 VILI�A,GE OF RYE fli kOOK 938 K Nd`�t'ET RYE B ,NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT or ELECTRICAL PERMIT APPLICATION Westchester 6xi*t�ty Master Electricians License Required FOR OFFICE USE ONLY BP#: EP#: Approval Date: Permit Fee: $ 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 n be in conformance with all applicable Federal,State,County and Local Codes. n 1.Address: Ta,1Co4� �aa/-� SBL: /35.5d —1—Dil Zone: Ae-l 2.Property Owner: 5er 1c-t e,r Sf�p e-n Address: Phone#: G/`/ h qd- Cf/ 6S Cell#: email: / / 3.Master Electrician: ��yp�w'i�� s,�c�//iC /,iG Address: /�� fc,i X Svc- ,I-A4p_946,orr�e /U141pss Lic.#: JgEa Phone#: - /Cell#: -q6 35 email: Company Name: :,g=,Tv la fio� �ccTnc i=►C Address: / `1/dS37 4.Proposed Electrical Work/Fixture Count: ' �/Q STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: being duly swom,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 for the legal owner and is duly authorized to make and file this application. (indicate 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. 91- Sworn to before me this Sworn to before me this t:> day of ,20 day of ,20 Signature of Property Owner i%cant Print Name of Property Owner Name of Applicant V\.t_ Notary Public Notary Public SHARI MEULLO Notary Public, State of New York No. 011NiiE6160063 Qualified in Westch.:-ster County Commission Expires January 29.20;22 8/12/2021 Westcoester Rockland Electrical Inspection Services, Inc. a , Phone: 914-347-3595 DO 11 NOT WRITE HERE-FOR OFFICE USE ONLY T P.O. Box 208 Fax: 4-347-;596 Carmel, NY 10512 -n , BUILDING PERMIT NO. TEMP# DATE �. CITY OR VILLAGE ZIP CODE TOWNSHIP 1.1 COUNTY STREET AND NO.OR R AD `l &e) / q/C O-/7/ /<10'?"/ POLE NUMBER BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT OCCUPANT'S NAME BUILDING OCCUPANCY OWNER'S NAME AND ADDRESS HOME TELEPHONE NUMBER CURRENT SUPPLIED BY FROM THEIR OFFICE WORK TELEPHONE NUMBER `//- C Vi LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS NO.OF FIXTURES& MOTORS HEATERS OFFICE USE LOCATION LAMP RECEPTACLES ONLY SIDFWALL SWITCH INCADE FLUORE NO. H.P.EACH NO. WATTS EACH INSPECTION OUTSIDE - BASEMENT if FL. r AN 2 5 2022 2' FL 3' FL. -DING REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: 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 O EXPOSED❑ CONCEALED❑ MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD L I 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 APJPPCANi' STREETADORESS TELEPHONE NO. _- 7-�r LICENSE NO.WHEN APPLICABLE /�r- 4�4A4C= 41-0� N M f � N N O O W N N N N \ \ a � W Q+ o o H A w N ur-- w a W Nrn . Ln a �i � z � z � w a � � �► � f, .. y w � pogo x w Q00col 00 N C O oc • c r M—I `J z � � < 5 � CY� � f- , w u �, z z z N a v) z S ' 0 co � a w N " g � 00 z A Q Q r W Q C �I �1 041 CQl Vol = � f 4414t42.44;V.44;4R4;4;C.4 (i 4;(;,C ut.Vtsio#A9414;#A4;114;t.4;6414.40444g+ �E �1DO BUILT WIRP R/TMENT JAN 2 0 2022. VILLAIE OF RYE B1ZtOOK 938 KING,ST}EET RYE K,NY 10573 VILLAGE OF RYE BROOK (9J`4)4"T0=466 ; BUILDING DEPARTMENT wvvw'lyebrook.or� PLUMBING PERMIT APPLICATION FOR OFFICE, USE ONLY BP#: C-D I PP#: c;)Q—GO / Approval Date: JAN 2 0 qO2, Permit Fee: $ / c;),'�j4b Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, 1,2e9L is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/ r reniove 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. I.Address: (0$ TA LCd1T Rp' SBL: /358 Zone: /,' 2.Proposed Work: K4A6Tt&- VtMODF L , 1J i�iAD Sg aw'CQ, IWQ' , Z^ W blty S ¢ -MiuT 3.Property Owner: A U CE 'Scuo EI'Y Address: lQ$ TA 1,COT7 P Phone#: Cell#: 1-a11 -&I&H •-703 email: AiIce SCJ)o e n 0�'��9,,'�`MPA'�•COyv� 4.Master Plumher:;5TU& u- NN- 64AaW Address: 15 _n 6g il-S AN E W 441C po&o5 1�j 106a Lic.#: W79 Phone#: 914-g4Ct-(DV la Cell#: q 14 4%kl-5 2Q 1 email: 0m6afdo pAvtn n 400 •COM Company Name: "WP-0 O b&jc_j VA M- 1N1.,1 Pkddress: ):S IIWT6 Mf• WAI:W'PlJaWA 1� b 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 1 st Floor 2nd Floor I �1 3,d Floor 4'h Floor 5`h Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) 8/12/2021 p E C IE ME BUILDIN( DEPARTMENT VILLAGE OF RYE,,BROOK JAN 2 0 2022 ] ID 938 K>livc STREET RYE BRgot ,NY 10573 VILLAGE OF RYE BROOK (914)91'r, 970 BUILDING DEPARTMENT w .r a Ott /2 AFFIDAVIT OF COMPLIANCE VILLAGE CODE §2 16 • 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: ' n` 31,�)1 C e C 61le�' , residing at, �Gt ( . "'�6 (Print name) (Addres Nkhere you Ake) 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; «J� d Sr7- , Rye Brook, NY. T (Joh ASITeys) 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. l (Signature of Property()vmer( )} (Print Name of Property Owner(s)) Sworn to before me this d� day of 20 OL-1 (Notary('uhlw) SHAM MhLiLLU Notary Public, Stag;of NeWYork No, Qualified iil v,,estoh=ster Coun - Commission Exoires January 29,2�� 8/12/2021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Y 1 I (C D_ SG�n no ,being duly sworn,deposes and states that he/she is the applicant above named, t(print name of individual signing as the applicant) and further stal rs 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,attomey,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 I a—/ 2z Sworn to before me this c9c) day of ., ,20 2 Z. day o ,20 ��a vV Signature of Propenvowner S gnature of App scant el— e of Prop Owner Pint Name of Applicant tary Public Nb dyAOtiblic, State of New York Pert KadanoM Notary Public State of New York Qualified in Westchester County No. 02KA6141668 Cc-nmision Expires Janusry 29.20 Qualified in Westchester County ThA"ksA4",l "ftompleted 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 Building Permit Check List&Zoning Analysis Address: (9J �::'A L C D f SBL: 3-�'•-29 Zone \ Use: V2> Const.Type: Other. Submittal Date: I -L Z f Revisions Submittal Dates: Applicant: C C Nature of Work. Reviews:ZBA: DEC 1 3 2021 pB: BOT: Other. OK ( ( ) FEES:Filing. - BP: C/O: Legalizati ( ) (L)- 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. ( ) ( ) SURVEY:Dated: Current: Archival Sealed: Unacceptable: ( ) ( ) LANS: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 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 NOTES A Date: DEC 1 3 2021 ck F � Front: Main C l3� Accs.coy F S : Sd.H/Sb: S� T�Imo: Fc Imp Heighr/Stories: notes: // .q a\ i vti� •'r�rrN1�'y'� �'' , n',xsv t ���1i5 � �,�5 X•11 r --ME, ,a;td1•��°' t7+� �•-•,.: r�A�'. ^:. ., .rlp; '1�,..�•,, .' ,•..,,,� .^y�E7".y�:,jjptS�4�4..,1 rSS7;r�_%}�7�,:.`� , • .{ AR r , �5 7 AQ' },, k .. A t/j{ r t�t5+��y;�y A, t �(�4 r ��r, '• A n t P' '�% <RA eAyr�t�5.={ f'"�it! �P j+`7 t,'`('ty �Y '� fY=.kti�y�, �+tt'�•�,�{� R .t/Iilrr��".r�'iy Napirjet� .c;4?i5}t4Arr? ;�,y,.. \ ,, �' i*vk\ Ss`�fh•• 5�i' ;J+'Yk T$2`tr' �•. `r�5 '�,5�!` �A " H' C�' 1`k8titi •t ¢' ' t?!� V �_� tIP !A • wA�' r bR 1♦ -Is Y i{ {•♦ 'Nj • "dt. • }te ,r ,y�. • f ,.:f v �,.. 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'!:�r'i�Y�ti;i+!.� , s �ha.ss;: L S��h �,�; asy;�;;4ti7•pt..-: :.ilv'•r�w��11�+ir_. f.�1'?,�'1�c�41'p: + ��•. , +/ � �'�;a ��. ..,k•'�JNvti� .:��.• sW�.f. v���. :O� . ���,�:tsti,S.$i" > �N.1/.•• i;. 555+��•ti; i•, �s55�•}�;�,;`' .!'� �k���•. ,YD� _ +Itry`!', � � ^f�+`�v�ttta: 'r m';!, rk't}f� —C•t;i;j>��Q�s - 1+f'�4�ss V(:'t���!aj;i=,;Yr'_� a�t�7:��,\ltifiy;• e::ivtis�s ,r.c.�:,..y 'y,r.jv +k• �.. �V Z: 5••:fs r � •�•..tj'�Js V � (+j• ...,J �\ +.:• J,: �..s�' .�� ''lam 1f:� Client#:209612 BOTEO ACORD,., CERTIFICATE OF LIABILITY INSURANCE DATE 09/ 7/2027/20/V1 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Couch Braunsdorf Insurance Grp PHONE 800 223-5433 FA't Ext: A/C No 908-580-1274 A/C No PO BOX 888 EMAIL ADDRESS: 701 Martinsville Rd. INSURER(S)AFFORDING COVERAGE NAIC# Liberty Corner, NJ 07938-0888 INSURER A:Utica First Insurance Company 15326 INSURED INSURER S: Boteo Brothers Construction LLC 1 Tango Lane INSURER C: - - — Carmel, NY 10512 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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. POLICY EFF POLICY EXIP LIMITS T X TYPE OF INSURANCE S POLICY NUMBER (M_ MM/D LTA INSR WVD I -- - -- - - - - —— ULGENFRAI UMNLITY XART514642301 7/17/2021 07/17J2022.EACH OCCURRENCE $1 000000 CLAIMS-MADE [X OCCUR PREMISES EaEoccurrence) $5O OOO - MED EXP(Any one person) $5 000 PERSONAL&ADV INJURY $1,000,000 GENL AGGREGATE LIMIT APPLIES PIER: GENERAL AGGREGATE $2,000,000 X POLICY❑J� El LOC PRODUCTS-COMP/OP AGG s 2,000,000 OTHER: $ _ AUTOMOBILE LIABYJ TY C Ea OMBINEDtSINGLE LIMIT ag d 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 cci adent UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOFUPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMrr $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) The certificate holder is included as an Additional Insured in accordance with the terms,conditions and exclusions of the policy. CERTIFICATE HOLDER CANCELLATION Rye Brook Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y g par THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 938 King St ACCORDANCE WITH THE POLICY PROVISIONS. Brook, NY 10573 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S286764/M286763 LRICH 16 YORK Workers' Certificate of Attestation of Exemption STATE Compensation from New York State Workers' Compensation and/or Board Disability and Paid Family Leave Benefits Insurance Coverage "This form cannot be used to waive the workers'compensation rights or obligations of any party." The applicant may use this Certificate of Attestation of Exemption ONLY to show a government entity that New York State specific workers'compensation and/or disability and paid family leave benefits insurance is not required. The applicant may NOT use this form to show another business or that business's insurance carrier that such insurance is not required. Please provide this form to the government entity from which you are requesting a permit,license or contract. This Certificate will not be accepted by government officials one year after the date printed on the form. In the Application of Business Applying For: (Legal Entity Name and Address): Home Improvement Brothers Construction LLC 1 Tango Lu From:RYE BROOK BUILDING DEPARTMENT 1 Tau Carmel,NY 10512-2242 PHONE:845-902-0594 FEIN:XXXXX3935 Workers'Compensation Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE SPECIFIC WORKERS'COMPENSATION INSURANCE COVERAGE for the following reason: The business is a LLC,LLP,PLLP or a RLLP;OR is a partnership under the laws of New York State and is not a corporation. Other than the partners or members,there are no employees,day labor,leased employees,borrowed employees,part-time employees,unpaid volunteers(including family members)or subcontractors. Partners/Members: Wilber Y Boteo Rodriguez,Roy D Boteo Rodriguez Disability and Paid Family Leave Benefits Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE STATUTORY DISABILITY AND PAID FAMILY LEAVE BENEFITS INSURANCE COVERAGE for the following reason: The business MUST be either: 1) owned by one individual; OR 2) is a partnership(including LLC,LLP,PLLP,RLLP,or LP)under the laws of New York State and is not a corporation; OR 3) is a one or two person owned corporation,with those individuals owning all of the stock and holding all offices of the corporation(in a two person owned corporation each individual must be an officer and own at least one share of stock); OR 4) is a business with no NYS location. In addition,the business does not require disability and paid family leave benefits coverage at this time since it has not employed one or more individuals on at least 30 days in any calendar year in New York State. (Independent contractors are not considered to be employees under the Disability and Paid Family Leave Benefits Law.) 1,Wilber Y.Boteo Rodriguez,am the Member with the above-named legal entity. I affirm that due to my position with the above-named business I have the knowledge,information and authority to make this Certificate of Attestation of Exemption. I hereby affirm that the statements made herein are true, that I have not made any materially false statements and I make this Certificate of Attestation of Exemption under the penalties of perjury. I further affirm that I understand that any false statement,representation or concealment will subject me to felony criminal prosecution,including jail and civil liability in accordance with the Workers'Compensation Law and all other New York State laws. By submitting this Certificate of Attestation of Exemption to the government entity listed above I also hereby affirm that if circumstances change so that workers'compensation insurance and/or disability and paid family leave benefits coverage is required,the above-named legal entity will immediately acquire appropriate New York State specific workers'compensation insurance and/or disability and paid family leave benefits coverage and also immediately furnish proof of that coverage on forms approved by the Chair of the Workers'Com2cnsation Board to the government entity listed above. SIGN Signature: Date: 0 HERE 1-7 Z0Z/ Exemption Certifi 4r4e, Received 2021-060708 September 24, 2021 NYS Workers'Compensation Board CE-200 01/2018 r,4 m M 00 Z � 11 J 4 >� M .os 0 I OZ OZ n w 00 occ Lu o >- n n n cn fY d i Ql luul r- �G� U _ Wes: W Lf) (� (� 0 O p W u -�I Z JAI --- J ,v m C,'J cu \\ aLLJ N 1 1 9 0 4-J (( ww M yl > u ya o a M � z �. r` a - Q zLU N 00 a N _ _nowaft m lD (V \ lD N �� N 3 a z ME Ln L a v O o V s Ln +r Ln m L N M