Loading...
HomeMy WebLinkAboutBP21-327PERMIT #Q/" SECTION TYPE OF WORK JOB LOCATION OWNER:Z'/ CONTRACTOR ST. COST n� , c0 # TCO # i O/- 0 DATE: /ol4/ INSPECTION RECORD DATE I NSP FOOTI N G FOUNDATION FRAMING RGH FRAMING INSULATION -19 PLUMBING RGH PLUMBING GAS (] SPRINKLER ELECTRIC wOw -VOLT m ALARM 0 AS BUILT m FINAL LOT 00 :E 433 1 DATE-,,?,c •/���—utcjl/Ad cal44/�jy �T% OTHER APPROVALS I�:t? BOT PB _ ZBR OTHER VILLAGE OF RyE BROOK WESTCHESTER COUN V, NEW YORK NO. 22-046 Certiftrate of ®rrup urp This is to certify that/ / /e Irl's S- Shu3ler Reyaca-'ble / /' u,74 /r/s S Shuster. 7ruslee of, RIP, \ YDd k l /V 7 , having duly filed an application on mart_,," J as . 20�0�requesting a Certificate of Occupancy for the premises known as, -ee r Ru � , Rye Brook,NY, located in a Zoning District and shown on the most current Tax Map as Section: 135.l05 Block: / Lot: 37 and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building i —7 Permit No. — /, issued 20 :;2 1, 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: R _ I* Construction: for the following purposes: l r) ��/��D r ba r��0-VO-fIDYIfIDYI Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of the building or in the exit facilities shall be made, and no enlargement, whether by extending on any side or by increasing in height sh 11 be made,nor shall the building be moved from one location to another until a permit to accomplish such change has ben ined from the Building Inspector. Building Inspector,Village of Rye Brook: ate: MAR 2 5 2022 BUILDING DEPARTMENT For office use onl PERMIT# VILLAGE OF RYE BROOK ISSUED: - 60 MAR 2 2 2022 1 D938 KING STREET,RYE BROOK,NEW YORK 10573 DATE: — a (914)939-0668 FEE: rJ PAID VILLAGE OF RYE BROOK 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 sssssssssssssssss��ssppsssssasssssssssrssssssssssssssssssssssrrsssssssesrssssssasrsssssssssssssassssssssss•sssrssssssassssssssss Address: 3 VeEA RcL#1 R Y4 Q Rao K�-- I O ?3 Occupancy/Use: ))-Family i li ly-Parcel ID#: Zone: Owner:xl�Zg + 14Ak\jW SH L4STEZ. Address: 3 044_A guA/ Avg! 94e-04. tJ 05 -1 P.E./R.A. or Contractor: Address: Person in responsible charge.TRIS 4 j4A,9tlky 514 u 5 rE R Address:3 0 rc E* tau^! Rye i3 A&&IC, .44 Y /o f-13 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: G2�5 uaa�JE� s K u l%1, being duly swom,deposes and says that he/she resides at aEE RLW in in the County of W E51-C4 ILS7E& in the State of �that 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: 14 S, DD p for the construction or alteration of: K N'5 j j& 6 4` 4,k mA — Or F L O o& 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 theCode of the Village of Rye Brook. Swom to before me this Sworn to before me this day of M CZ, 20 day of , 20 /'� An� L. Signature of Owner Signature of Applicant P-P,fL.ft y L. s l-) US ►� Pint Name of Property Owner Print Name of Applicant Notary Public SHARI MELILLO Notary Public Notary Public, State of New York No.01 k iE6160063 O!ialified in Westchester County Commission Expires January 29,20 �yE BRC��. • 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK /❑CODE ENFORCEMENT OFFICER 938 KING STREET - RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www rKebrook.org - - - - - - - - - - - - - -- - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - 1 ADDRESS:— DATE: -Z n) PERMIT# 1 ` ISSUED: l SECT: BLOCK: LOT: LOCATION: OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... 0 ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ,,Q TROUGH PLUMBING LJ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER BR(b�ae � 04 1982 BUILDING DEPARTMENT ❑ UILDING 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 wwwxyebrook.ors - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - -- - - - ADDRESS :- DATE. PERMIT# 1 ISSUED: SECT: S �BLOCK: LOT �ri a-� LOCATION: tUCXX�I ""`' yY ` 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 ❑ CR0-9S CONNECTION ,❑'."FINAL ❑ OTHER _ a � N � NC7 N O = U N N N W O 120 _ W © Q = _, = W rz o, 0 > eg o ° C O > °gn, Z o m aco O pro M W oho w w � � i N Gz, ,� 00 Gam., o wo O cba W q'j s Mz d FW„ O p Z rk- a.-8 ? F� tn O a c ° o Ou O g � x z s E0 ICI G7 A z � a � •`'' � � � � Qd � oaa, aG p� > > �I � F11r a W � xm � ►; � � BUILDING DEPARTMENT 5 IEC IE Q E VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 in DEC 1 4 2021 (914)939-0668 VILLAGE OF RYE BROOK BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Approval Date: DEC i 4 APermit#:, t�l'.3,Q)7 Application Fee: $ /0 Approval Signature: Permit Fees:$ Z 63• T Disapproved: Other: �*3�e.+e.*w�����:�e*�e�e/�e**�t��**/*:*r�e��,r,.*::**.re�a,�*.a.**��a.xx�r�e�**x:::**��e��:.�***rs.f***�3��*�r�c•*aa,r:::3*�e::,� Application dated:��i�— j is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing building,or for a change in use,as per detailed statement described belom-. ^� L Job Address: 30rz69, [kL&4 Rye_ (5a001C, N�C'I3SBL: /Ilt � / —/^,3 Zone. r0- 2. Proposed Improvement. (Describe in cl ta,h: Reotoye -4-LooR 1k uJow- T.L* Ept.,4 a w (J 6.5` 44"a m Awo to 4L4- Acept Wee o4a •sro+rar, 0A•►hi%&ei s.nf io ui t A-i-L Mew tc►'.TaAffS a. A A — 4 r x - News Pt.rAsre 6PAAO at..�s. VE a.wcs vA 01Y 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rve Brook" No: f Yes: Ifves.indicate: TIER I: TIER 1I: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an existin automatic fire suppression system (l`ire Sprinkler.ANSL Sy stem, FM-200 System, TN pe I I lo?d.etc... l :No: Yes: (If yes,please submit a separate Automatic Fire Suppression Svstem Permit application&2 sets of detailed engineered plans) 5. Occupancy;(I faro.,2 fam.,comm.,etc...)Prior to Construction: [ FA" _After Construction: l F 4 H 6. N.Y State Construction Classification: N.Y. State Use Classification: 7. Property Owner:K k M R 5 . Nit R.VCy 1L. .S 1+u STC t,Address: 3 0 U R Rua , Iq Y iE ^1 Y 10�7? Phone# 7)q - ?39•ST11a„ Cell# 114-Sa�-q6�� _email: Ot;,11+LS1446E3e AoL.Cotl 8. Applicant: MaS {AA(We A-IAWS Address: 3 t)tCk Runt , dye 69ooK, 73 Phone#51q-939- S y'IA Cell# (71V - S'•72 - 9 11 G email: C� -Ry;1-Ser 3C— UL-C-004 9. Architect: /t.1 p T P P L 1 e-/1-15 L e, Address: Phone# Cell# email: 10. Engineer: ^I zi T /4 P P J-le-,4 a k a Address: Phone# Cell# email: t Ptn{Z Rl S�vr� 11. General Contractor: A 4 �" /+aKC LNQRoVt�+1t�T'Address: 2 fl�� �-✓t� . K"5 Q7i0 Phone#5t+f'376-S-g(o4 cell#gl%�-q1`{ ,$9 {(o email: o O Ol� t�1e .�d 12. Estimated cost of construction $ Q (NOTE:The estimated cost shall include all labor,material,scaffoldin&fixed equipment,professional tees,and material and labor which may he donated gratis.) 13. Job Timetable: Start: 7—61 0 Finish: 8/12/2021 BUILDING DEPARTMENT VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 xxxxxxxxxxxxxxxxxxxxxxxx�rxxxxxxx,ta*xxaxx*xxxx***xxx**x*x****xxx*x,�xx*xxxxxx**xx***x*xxxxx*�e*xxx+t+exx*xx* A.FFIDA'VIT OF COMPLIANCE VILLAGE 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: , residing at, - T) r p- u � 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; /?yv v- l D S 7 3 Rye Brook,NY. Further that all statements contained herein are true, and that to the best of histher 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. Sworn to before me this 1 q day ofDe r ,-n 20 a�— SHARI MELILLO Notary �Public, State of NPwYork y 61 O'lali ied in Westch."ier County 3 �2) Commission Exoires January 29.20� 8/12/2021 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: l`' '2 ,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. Swom to before me this r Swom to before me this 1/ day of �0 F C_ , 20 day of 1 e C' , 20 o� � _Ulu A4_� ^ — signature of Owner Signature of plicant L 5 UC3 T C-_K, q/r � l 1,. 51AAfT el Print Name of party Owner Print Name of AWhCant Public No tic ANNA 131NASCO NOTARY PUBLIC, STATE OF NEW YORK NO.01 B16405936 ANNA QUALIFIED IN WESTCHESTER COUNTY NOTARY PUBLIC, STATE NEW YORK COMMISSION EXPIRES MARCH 16,2024 NO-01816405936 QUALIFIED N WESTCHESTER COUNTY COMMISSION EXPIRES MARCH 16,2024 (4) &'1212021 f MM Ir f M ■ F Gil � � ` y � vi a c7 S b w t ~ z Otn ^ W o > tn O O Q ~ OF Q z Z a �' o � o , � � � ,,,a O F" v F• g , w MW W — U &A r, < 0. MA W � � � - O 104 � � w o' v co of z Z a .� a0.-0ID I oc � I1 � E• Z r3 C cr W z u a 3 m og v w cx a u 0 16 r— w � A F o o o 6 w M C a w 4 0 � • Mort BVtLN`Vi, K DEC 2 7 2021 938 KINY 10573 VILLAGE OF RYE BROOK BUILDING DEPP RTMENT ELECTRICAL PERMIT AP ATION Wmtrhostor County Master Elatrielans Lironw Rquirod FOR OFFICE USE ONLY BP#: c-W-3a7 EP#: 3S4;' Approval Aat@t DEC ? 202 hrmlt Fm 3 150 "�U Approval 81patur@t Othorf picappravodt (fee,are non-refundw t) AppWittion dated, is h@r@hy made to the Building Insp@@tor of the Viil#g@ of Ry@ Brook NY,for th@*fi#n@@ of #P@rtnit to install and/or r@tnav@ @I@@tri@#i quipwrlt,wiring,fftttttr@s,or to p@rfmm ath@r high or low volt#g@ @I@@t€i@#I worst as p@r th@ d@t#il@d statement d@s@rib@d Mow, Th@ #ppli@#mt & pmp@rty owner, by signing this do@um@nt #gr@@ that ail @i@@tri@#I work p@rform@d Will b@ in @onfbrman@@ With all appli@ahl@ F@d@ml,Stw,County#nd L@@ai C@d@s, I,Addr@§s: 3 wee r ��>J ��� 3,Property Awn@r: "Cie%Ma IS 5l,.)S.�a Address: Phan@#; SZ,Z • g(,ir(, dell#€ email:pro\CSC �.3�.�01 .Cbr+t M#st@r Pi@@tri@i##€ MMIT*)RA !Q. 'Xa*-%*Py-1y Address: 41 �A yux\ r+,e¢. Phan@# -111 -�}1��1 dell O�- `I�S3 email M> ����'Y•ti.�tz Company NI}tnp: M 4M t-14Z%Z N-r' K, Addre,, 4,Propas@d Ei@@fri@#I Wprk/Pijtar@ Count: STATE OF NEW YORJL COUNTY OIL WESTCHESTI'R ) �; Mt��nsts e.l n 7Cotr•.aAreing ditty swot#,d@pos@s and states that h@/sb@ is th@ it"Wit#t#Wv@##t#@d,and do@s f @r (print name of individual signing as the applicant) st#t@ that(s)h@ is the I@0 owner of tb@ prop@rl y to whi@h this appli@#lion p@ft#ins,of that(OW is the for ttt@ I@$#I own@r and is duly sutborWd to soak@##d fit@ this appli ittion, (indicate architect,contractor,agent,attorney,etc.) Th@ undirsipW fnrt#@r states that all stat@#MN @o#t#i#ed her@in ar@ trtt@ to the hest of his/her knowl@dp and belief,and last any work p@rfarm@d,or ns@ @mdu@t@d at th@ abov@ @optioned prop"will b@ in @onfot#ta#@@ with the d@t#ils#s s@t f0M and eo#tainO in this #ppli@#tio###d in my o@@ompa#ying approv@d pta#s and sp@@ift@#tions,#s w@ll as in a@@@rdm@@ with th@ N@w York htat@ U#i TM Fir@ Pr@v@nfion&Building Cod@,th@ Cod@ ofthp Villlip of Ky@ Brook and ail other#ppWable I#ws,ordina#@@s##d mool#lions. Sworn to hefft€@ m@this Sworn tab@for@ @ this Z'1 d#y of ,20 day of @ ,20 0 1iK,A.Q— 141 Sign#lure of Propwrty Own@r Signgtttr@ of Applt@ant M1K)bT3x,1 V* j oKMMC40 Print N#m@ of PrWrty Own@r Pri7'2=-10 � Notary Pohli@ N t#ry Pttb t@ CHRISTOPHER Notary Put)Ij .State off New York No.04RO6265750 Qualified in Westchester County, Commission Expires July 16,20 e/13/201 __ s-.a�.._('_ �i'. __ _ � rc ac.+ _....:f.+Y i'.s'i.�✓�.,F.r�.. _ -_. _ -rw_._�._ ti. -- �._ Westchester Rockland Electrical Inspection Services, Inc. L Phone: 914-347-3595 DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue r)jV�`�� Fax. 914-347-3596 Elmsford, NY 10523 `�F 1 f f I BUILDING PERMIT NO. TEMP a DATE CITY OR VILLAGE ZIP CODE TTOWNSHIP COUNTY STREET AND NO.OR ROAD POLE NUMBER J 13 BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT OCCUPANT'S NAME BUILDING OCCUPANCY i L OWNER'S NAME AND ADDRESS HOME TELEPHONE NUMBER 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 SOEWALL SWITCH INCADE FLUORE NO. H.P.EACH NO. WATTS EACH INSPECTION OUTSIDE - --� TVV BASEMENT L= I 1$1 FL. 2"FL. 66 pp I 3-FL BRO K ! BUIL ING Gtr ARTMF I NT REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: H . TT-7� r)-1 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,LABEUNG.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 A80VE TERMS AND CONDITIONS AS SET FORTH FOR THE APPLICATION. SIZE OF SERVICE FEEDERS CHARACTER OF WORK NEW❑ ADDITIONAL L 1 EXPOSED❑ CONCEALED 17 MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD C UNDERGROUND'_ .J AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. NAME OF COMPANY DATE OF APPLICATION SIGNATURE OF APPLICANT STREET ADDRESS TELEPHONE NO. CfTY OR P00j)RCE ZIP CODE LICENSE NO.WHEN APPLICABLE IF WESTCHESTER ROCKLAND ELECTRICAL INSPECTION ftTE10SERVICES.INC. 0L . 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: MAR ELECTRIC INC Iris S Shuster 9 HALL AVENUE NY, EASTCHESTER 10709 Located at:3 Deer Run Rye Brook, NY 10573 Certificate Number: 1033743 Section: 135,65 Block: 1 Lot:37 BDC: Permit Number:EP:21-336-BP:21-327 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: 3 Deer Run Rye Brook,NY 10573 ❑Basement 12 1st Floor 2nd Floor 3rd Floor Garage Attic f Outside Other: Inspection was conducted in accordance with the NYS and NFPA 70-2017 International Electrical Code and detail of the installation,as set forth below,was found to be in compliance therewith on 03/22/22 Name Type Quantity Receptacle GFCI ------- 3 Switch Single Pole ------- 5 Fixture-Luminaire Recessed LED 7 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. This certificate is valid for work performed before date of inspection only. • �Ipi�ilw�ii�i w` �"i��i�i�' �����`i�ri���r`+�i����i��'iw' ��i ,liw�` �i �i�ww` �iww�'�I�I , N \ \ p W 00 ►+ z H Wwa x a O C44 OVr 00 � w a F� �' \ � ►Nn s 7 W A � � z M v) en � � z W rr; 11 r ►.7 \ �f re W a w M 00 ONO z `z v v F" r24 zg v O z Q z o o � M p w z q Q on ' �y p U Wa �I a a 4.41x � D � � �M� BUILDING DEPARTMENT JAN - 3 2022 JD VIIAGE OF RYE BROOK 938 KIN STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT www.ryebrook org PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: PP#: OC)— �U / Approval Date: JAN - 3 1 Permit Fee: $ Approval Signature: Other: Disapproved: ************ees are*******refundabl**** ****** 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 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 ���� i ? 7 Zone:J / - 2.Proposed Work: �.� �1,,�, �_�.. � SBL: —f 3.Property Owner: ��L ,,� -<° , Address: Phone#:J`_i 1 i ,tl is C�L } email: 1 q f 4.Master Plumber: h e Address: --1 1 �3,-�; (-� 26� S c r,--S - Lic.#:_j� Phone#: 1� Cell#: S L( Ito email: c P l.. -z� ( -4��� Company Name: L,, a _ . Address: INDICATE FIXTURES&LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Dr Sinks Showers Bath Laundry Domestic Fire Sanitary NaturaU Other* Total inking Basement Closets Fountains Tubs Tubs Service Service Sewer LP Gas 1st Floor 2nd Floor , P Floor 4's Floor Sm Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -t- 8/12/2021 �C� C� OMC BUILDING DEPARTMENT VILLAGE OF RYE BROOK R JAN — 3 2022 0 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT www.rvebrook.org 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 (PITH 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, COUN FY OF WESTCHESTER ) as: 31, p4A✓E Z . .�fJu StE , residing at, 3 0FeA p larj 12 (� rsa/C N ► !o.S (Print name) (Address where you live) ) 7� 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; 3 D rwz Rut,( I'yl,� b3k,60K , 11 >1 I O S"7,3 , 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. a (Signature of Property r(s) (Print Name o roperty Owner(s)) Sworn to before me this �fl CLAUDIA UVALDO ay of a ' NOTARY PUBLIC,STATE OF NEW YORK NO.OIUV6107856 QUALIFIED IN WESTCHESTER COUNTY cc COMMISSION EXPIRES APRIL 12,2024 -3- 9/12/2021 } STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: 1 xf b ate`s om lade g y poses and states that he/she is the applicant above named, (print idante 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 �,o Sworn to before me this ,,2 day of L 20 02 day of ✓ 20.Z w' gnature of Prop wrier igna a of Applicant � / / c�:/� lame f Prop' weer Print Name of Applicant CLAUDIA UVALDO NOTARY PUBLIC,STATE OF NEW YORK NO.OIUV6107856 c QUALIFIED IN WESTCHESTER COUNTY No Public COMMISSION EXPIRES APRIL 12,2024 SANDR.k L ARNAU NOTARY PUBLIC.STATE OF NEW YOU Registrations,).61AR6077360 Qualified in Wes:;hester County This application must be properly completed in its entirety and must in r.•,'``' , (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- 9112n021 Building Permit Check List&Zoning Analysis Address: Z, SBL: — 7 Zone-2 ` 1 Z Use: Z Cont.Type: Other: Submittal Date: 1 l Ll Z f Revision Submittal Dates: Applicant: 5, 14-1 S-f4.-tL_ Nature of Work ►�1�F-1L��Ci_ ��`t� N �( �Z��7 Reviews:ZBA: D E C 1 2021 PB: BOT: Other. ( ( ) FEES:F BP i C/O: Legalization: ( ) (,"P: Dated: Notarized: ✓ SBL: -Truss I.D. Cross Connection: " H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening ( ) ( ) ENVIRO:Long. Shorn 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. ( ) (.,)'�Licene: ✓ Workers Comp: ✓ Liability: Comp.Waiver. Other. ( ) ( ) CODE 753#: Dated N/A: (ate ( ) 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:Plan: Permit: N/A Other: ( ) ( ) H.V.A.C.: Plans: Permit N/A Other. ( ) ( ) FUEL TANK:Plans: Permit Fuel Type: Other. ( ) ( ) 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter As-Built Plan: 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: AVVHUVLU REOUIRED EXIMNG PROPOSED NOTFS DEC 14 2021 Date: Cir 13�t Main Cov Accs,Cov Ft H/Sb: Sd.H/Sb SF&: Tot, Ft Imp: Perking Hag /Stories: notes: r 0 a� R N cl O cl c c r ca mn,nn CDD I '7 Gn Y O { 's CU Ln Qj D o a c, o ;, Erl- S-•4 z Z o v cfion LLI O > O W W i ¢ Ca a o C� <tcaD i CN „ y LU ° z 0 o o Qcz L CZ cz s~ I S. .� ri in.GQCZ17DD.�• I a O � � Z 00 U 4 � u a�i C � � �, •.i; f �. r a A�o' CERTIFICATE OF LIABILITY INSURANCE 12IOTl7G2i 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 INSURERtSI.AUTHORIZED REPRESENTATIVE OR PRODUCEFL AND THE CERTIFICATE HOLDER IMPORTANT: I the certificate hotter Is an ADDITIONAL INSURED.the pollcyiHIS)must haw ADDITIONAL INSURED tarevnlons Or be endorsed. If SUBROGATION IS VAMVED.subject to the!arms and conditions of the po1kV,cartaln poYctes may require an andorsement. A statement on this certsbcals does not confer npMs to the certificate holder In lieu of such andorsamengsj. /ROOYCvA CONTACT Snar.d.BrC n JAIL Ins...ran:i •AGE 1145!722 3597 AE 1a4SI 793 1713 44•Stale W h:0 1241AIt[SS, Stur41-4,nlrburance cam S.rw 323 POKA 13116,A"DMCMG COVERAGE aAICe Mc+r;o NY 'C45C aM1Ef11A: Utica Frsl rbnra-rca C,; IS125 tMSURCD Rulateaa: Ne•S"th Irso+arce Cc 11130 AAJ Hare Imtrotvrww.Grc p L.C ntsu 01 C HaTxd PrCper'.A CJISYARY 34697 1 Rd"Ave RISUREa o swesYn1 Scox1ty STD "$SUN"It y arlsars NY 1C710 COVERAGES CERMCATE NUM1KR: CL2'127onoe6 III OWN NUMBER: S S TO.`ERTIF'+T-AT THE POLICIES OF ASLAANCE LISTED SELU10 KAYE BEEN ISSLED TO THE INSURED NAMED ABOYE FOR THE POLIO Y PERIOD NDICATEC NOTN'•-�,STANDrvr ANY RECXAfiENEN-TERM OR-=ONC<T CA OF ANY CONTRACTOR OTHER 000AtENT%MTH RESPECT TO WHICH THIS CER-IFCA-E MAY CIE SSIAD OR AtAV PERTAIN THE INSURAN-E AF FORCE BY THE POUC+ES DESC REED IEREIN 15 Sk BJECT TO ALL TFE TERMS EXCLUS Cray AND C:NC-TCfS OF S:.CH PJLCIE S L MITS 5HO.NN MAY HAvE BEEN REDUCED BY PArD CLAIMS. LLTItR Type a6i!<AMCC O'OL/CY 1RMaa PADOMTOLICY II POLICY I" LIMITS :00 Ck"atIIOl/1L LIAINUTY to-q OCCLIWRRP= ! •,CC0,CC0 DAMAr:C rD q[N TED 50,043C "cat"''"—a.aany s 10.11cG A AR751A4409-01 0&1112D2• C611!2b22 ISNSz*Al sun L%JJRY s t,000.000 lUf. ::AT C L AN'API:1LS Ptn QA[RAL AG:MQATt S 2'00C'CC40 Cneo C ntLw-T:.ewmon..4.:: s 2,000.CCG Lr• LO: Emp"lle Berens 's 1LL1r00a2 LAARm ccviw%:7 SIhClL UY:T t WWAUTO aOLV LY rq rJNY-Pr a.ra¢+. ! 1CC CCC B a:)VwawS Dtar ! te'LL[c 2003.270753 CM,I I.M• OB'17,2022 sDCYIr I.IIJRY iPw r..I.rI a 3CC.000 "sea /01-'Yla1[fl 1`9l7T Rt Y DAM"at S JC.mc AVT❑L•^.K1 AJ TOS 0N4Y RVILAF s N�1111 Lw f:c,�A LA'q OCDJOSOi'C f CACESS LIAa _.AA"S_44Jt A::G!tC;�rt 1 --Cn I I M[TEV T:OY I S WD/IRe6 COMMIMA"M RR AND ROWWYMW LMaIhY Y i IN T, AK-MR VPIETC1MPAJ"TR L-LLJINT CL thCki A-CrJt%- t 1DO= C ,rtCM MO!'"u--.LCec C w,A 15NECATY4JCV 1125772+ 11!21V2022 .1hw,whw Y n IMN t L=ASL CA MM OV IX s 100,000 1—d.v.a.ndr 5410,0410 Ix Are P'r P/Of Zrr-tATrJKS a.ts EL at3[ASC mLrY UYR s (} R76579 COO '24B�ZC2 tzrzth2022 DCSCRIPTIOM OF OPERATIOMS'LOCATIONS'VCRCLES I&C M N aN d q na•..w:.a nquredl Br•+rn:crletcale na.xr is 1.tad as ayi0oral rrercd Do,pcl..y laws pmvatans and U`1CL6109: CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DE SC RIB®POUCIES BE CAMC ELLED BEFORE THE EXPIRATION DATE THEREOF NOTrCE WILL BE DELYVERED al vllalts cl Rya Brook ACCORDANCE WITH THE POLY PROVs31ONS 9M-4"street A V T I+OR tR 0 IR M[S[N TATIYC STATE OF NEW YORK WORKERS'COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la.Legal Name&Address of Insured(Use street address only) lb.Business Telephone Number of Insured A&J Home Improvement Group LLC 914-424-8616 2 Rider Ave Yonkers, NY 10710 lc.NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required if coverage isspecifecally 1d.Federal Employer Identification Number of Insured limited to certain lotions in New York State, Le-, a Wrap-Up or Social Security Number Policy) 202500858 2.Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Hartford Insurance company Village of Rye Brook 3b.Policy Number of entity listed in box"la" 938 King street Rye Brook, NY 10573 16WECAN9JCU 3c. Policy effective period 11/28/2021 to 11/28/2022 3d. The Proprietor,Partners or Executive Officers are included. (only check box if all partners/oMeers 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 "la" 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". The Insurance Carrier will also notify the above certificate holder within 10 days IF a policy is canceled due to nonpayment ofpremiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise,this Certificate is valid for one year after thisform is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form,if the business continues to be named on a permit,license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of 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 agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Joel Loeb (Print name of authorized representative or licensed agent of insurance carver) Approved by: 12/07/2021 (Signature) (Date) Title: Insurance Agent Telephone Number of authorized representative or licensed agent of insurance carrier: 845-782-3580 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(9-07) www.wcb.state.ny.us