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HomeMy WebLinkAboutBP22-022PERMIT #g'/ -CDATE: 4 7 as EXP: SECTION _[ TYPE OF WORK JOB LOCAT N OWNER CONTRACTOR,o EST. COST _T vt o # FEE se//D PlwJ DA TCO # FEE DATE INSPECTION RECORD DATE I NSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING Z Z RGH PLUMBING GAS SPRINKLER �✓,/ �-��j c ELECTRICLOW-VOLT �O ALARM-�--- AS BUILT ED FINAL i`/)937-9141 H7)o4189—H957 �) 0 3/,QI,7 OTHER APPROVALS OTHER FINISHED BASEMENT NOT � APPROVED FOR USE AS A SEPARATE APARTMENT OR DWELLING UNIT VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 22-098 Certificate of Occupaucp This is to certify that eGytr4i-,?ey� of, F_ 8i-oo y having duly filed an application on 3Lkn e— CD , 20 LQ,requesting a Certificate of Occupancy for the premises known as, 1 M ), 1 Ifs*p/1 C Kbac , Rye Brook, NY, located in a Zoning District and shown on the most current Tax Map as Section: Block: I Lot: b— . and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. 9 — , issued e2 7 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: n�e.— �QLyn / 1/ Construction: for the following purposes: "Co [ Ze. 7 remodel T i m l sy1P[ _ I-x�Ser�e�f Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: FINISHED BASEMENT NOT APPROVED FOR USE AS A SEPARATE APARTMENT OR DWELLING UNIT 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 shall be made,nor shall the building be moved from one location to another until a permit to accomplish such change has qein o aine gilding Inspector. JUN 3 0 1022 Building Inspector,Village of Rye Brook: D ate: 4V16 a#LIZftwm aW VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.tyebrook.org TRUSTEES BUILDING & FIRE INSPECTOR Susan R. Epstein Michael J. Izzo Stephanie J. Fischer David M.Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE June 30,2022 Richard Greenberg&Elizabeth Pena Greenberg 1 Milestone Road. Rye Brook,New York 10573 Re: 1 Milestone Road, Rye Brook,New York 10573 Parcel ID#: 124.65-1-60 Mechanical Permit#22-017 issued on 2/7/2022 to Legalize Fire Sprinkler Heads This certifies that the fire sprinkler heads,installed under the above captioned permit,have been satisfactorily completed. Sincerely, MichaelJ. Izzo Building&Fire Inspector /to D � � a BUILDINIE AfZTMENT For office u onl PERMIT# J U N ' 6 2022 VILLAGE OF RYE BROOK ISSUED:�- 38 KING STREET,RYE BROOK,NEw YORK 10573 DATE: — —� VILLAGE OF RYE BROOK (914)939-0668 FEE: /0 PAM= BUILDING DEPARTMENT ML%2.ryebrooMrP- 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 ►►sessssrr►r»»»»»r»»rrrr»trrt»rr»r»rrr»rrrrr»r►rr■srrrr►srarr►trr■trrrrrt►sat►►►►►►►s►r►►rr►rtss►s►►►s►►►►►t►►►s►►ss►sss►►sss Address: I M'JpLioa)-eQ Occupancy/Use: Parcel ID#: Zone: A U Owner: tC.hci ('a �? ``� -r n Address:Z M i �eS+,1 e- E 0LlA \egd&� J P.E./R.A.or Contractor: L T.Z CC)of�'Q�t l h)(11U Q Address: C �-4P-jf i_ irk USSi Yt1 Kl (1 �i��0s�o Person in responsible charge: PVC t\)o T3 D O h elIkI4 Address: S Q 41 ?- 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: Q 1 e being duly swom,deposes and says that he/she resides at- M,l eS-F o A )e. `\CAA t Name of Applicant) ( � (No.and Street) in J P R.t'�' ,in the County of w �'4'C,�{��-F��( in the State of ,that ( ityao V' ge) 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:$ 0 - b , for the construction or alteration of: 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 ,20 day of , 20 Signature of Property Owner Signature of Applicant `i L O s l - rV4t Name of Property Owner Print Name of Applicant AL Notary Public Notary Public SHARI MELILLO 8/12/2021 Notary Public,State of New York No.01ME6160063 Qualified In Westchester County Commission Expires January 29,20ZZ QyE BR�k. 1982 BUILDING DEPARTMENT ❑q BUILDING INSPECTOR �LJ 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: Cp. , t f,` ` DATE: a" PERMIT# V ISSUED: SECT: I 1 "LOCK: LOT: F LOCATION: " ``` h` �' C�Q OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... zi ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATIONS ❑ NATURAL GAS 1►� ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL ;'❑ OTHER QyE BRCv� cu � 1932 BUILDING DEPARTMENT ❑ ILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : DATE: v �� PERMIT# Cf 22, ISSUED-Z SECTN b BLOCK: 1,04� nn c� ° LOCATION: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING Q� ❑ INSULATIONS ❑ NATURAL GAS ❑ L.P. GAS \� �D12C�{'� f'�1 (\2!Z C ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION �-^`� Q• .I`� �^ _,( i p� � FINAL ❑ OTHER �E BR(�k, ti� 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 :-1 DATE: -1 PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: l J 1 /l�l 1 7 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 QyE BRC�v� 982 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: `IJQ_� � �� -DATE: -Z Z PERMIT# }LZZZ2- -C)Z ISSUED:-Z17h.ZSECT�ZL1 �� BLOCK: LOT: LOCATION: N\� :2, `, `�� OCCUPANCY: 2-1 --�> ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED -ID/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑JUNDERGROUND PLUMBING NOTES ON INSPECTION: �p ROUGH PLUMBING /',❑ ROUGH FRAMING ❑ INSULATION f ❑ NATURAL GAS J� wz� L- ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER a . � P Fyl N O N j� a vi O W .. P, U v w p" a In0 � N w s. x A ON cl a O 04 o^c c) � Coo $ z "w O ti CI ° I 11 CA 0-0W Cs O a 00 F+1 W xj C,w W ( Nto o '5! ] 0. a z M Tr 61). � orvti ca8e O a (� a UZ44 , o i M W W 1 v� 6 -o A - Z 00 r7 L1+ {-�..� U P .s4 a tel o u Z z G v o .° .� � � U tz A g O Q -0 U d O z LL, o z � ,� YCA d W LX Or C7 �.I c� Q � az r-� U V z wi' � o � m O Qj U' " A z O oW Ul W > a z cn F w C u a = cot oo A z V°j Z Q ui a LJ —1 C LF � t VJ7 :kEVISED DEC - 7 2021 BUILDIN(T DEPARTMENT PLANS VILLAGE OF RYE BROOK CEC - 2 2021 p Tip 938 KIN( Sff4EF.T RYE BROOK,NY 110_573 1�) OG68 VILLAGE OF RYF BROOK s BUILDING DEPARTMENT V1WIN '.C4'- -- -- INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: DEC — 9 2 k1 Approval Date: I'urmit a+ ��-dam Application Fee:S Approval Signature: Permit Fees:$ Disapproved: Other: LZ-4 A Lr 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 existing building,or for a change in use,as per detailed statement described helo%v 1. Job Address: 1 Milestone Rd, Rye Brook NY SRL: 124.65-1-60 Zone: P.U.D 2. Proposed Improvement.(Describe in detail):legalize fin basement and remodel existing bathroom 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: x Yes: If yes, indicate: TIER 1: 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: X Yes: (IfNes,please submit a separate Automatic fire Suppre cion Systcsn Permit application K 2 set`of detailed engineered plans) 5. Occupancy;(I tam..2 fam.,comm..ctc...)Prior to Construction: 1 FAM After Construction: 1 FAM 6. MY State Construction Classification: 56 N.Y. State Use Classification: R3 7. Property Owner: Richard Greenberg Address: 1 Milestone Rd, Rye Brook NY-� Phone . pis r a_Cell�j jr� �(o �D _.�errlail:f-b„ rPC �n` . - �N1-Vl�e.11i2'� 8. Applicant: nGc a la C e R b F[' Address:,O- S k-�► Q {l� B CGdI� �s 13 Phone t 9 "13 `9 _C'el - o"I _emai1:('D 4 e� e,A3b of t, 'I P o,ta+owl;A&. Vi,i 9. Architect: Sergio Mann Address:765 pinesbridge Rd, Ossining NY Phone#914 923030$ cell#914 907 1776 _email: sergio@smarin.com _�T-- 10. Engineer: _ Address: Phone# Cell# email: 11. General ontraactor: Loti Contracting Address: 4S p DPiJc_ C E Ll �ds�a Phone ��► - Cell c email: Q' �r � 12. Estimated cost of construction $ - (NO1I. 'tht esnmalH Lo5t n'A'Icilal scaitotdm I�.�c i ,tu€pmt��i,predis<<3rnai r. utd�,�:a: ,:.1 ari�E hiia,�� s�hn h i .trn.ft.:'? vwtis 1 13. Job Timetable: Start: O a a Finish: 2, 11 (I) 8I12/2021 D CECE_ � WF BUILDING DEPARTMENT DEC - 2 2021 VILLAGE OF RYE BROOK f 938 KING: S REF.T Ryr,BROOK, NY 10573 (914)939-0668 VILLAGE OF RYE BROOK BUILDING 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 BUILDTNG 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: (� I, Izal(AW a G 1 CCOD4.'M residing at, 7 s� being duly sworn, deposes and states that (s)he is the applicant above named. and further :states that (s)he is the legal owner of the property to which this Affidavit of Compliance pertains at: 11 ,t oo k l as '13 , Rye Brook, NY. 1"11 , .. Further that all statements contained herein are true,and that to the best of his/her knowledbe 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. �nd Sworn to before me this y ANA I MARTINS day Of -#J Q , 20 21 LNotaryblicState o4 New York.O1MA6396946 in Westchester?o6u 2023sion Expires Aug 8112,12021 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. STA OF NEW YORK CO OF WESTCHESTER ) as: 'I J d r r�r f e fi& ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicans�./ d further states that (s)he is the le al owner of the property to which this application pertains, or that (s)he is the (3 `C I [ink &G4i ry A L for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agen mey,etc.) That all statements eontame erein 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 an Sworn to before me this day of f ,20. day of , 20 Signature of Property Owner Signature of Applicant Print N er Print Name of Applicant Notary Public Notary Public ANA I MARTINS E public-State of New York No.O1MA6396946 ed fn Westchester County ission Expires Aug 26,2013 (4) 8/12/2021 D ECEUVE BUILDING DEPARTMENT VILLAGE OF RYE BROOK APR 1 12022 938 KING STREET RYE BROOK,NY 10573 VILLAGE O (914)939-0668 _BUILDING DEPA BROOK wwwxyebrook.ors RTM_--E-�_ FOR OFFICE USE ONLY: Approval Date: APR 1 2097 Pe t Application# Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: : Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: Amendment Fee:J9 Permit Fee: APPLICATION TO AMEND APPROVED PLANS Application dated: , '��' is hereby made to the Building Inspector of the Village of Rye Brook,NY,to amend the approved plans associated with an existing open permit,and/or from any prior approvals granted by the approval authority as per detailed statement described below. 1. Job Addresss U44- 0 YUg- Rn c d �,\/e Bw K N Y I CS93 Existing Permit#: l� P a — O a l y� 2. Parcel ID#: ,Z�u (p S — —�o� Zone: ?U-T) Original Approval Date: 1 o O a 3. Proposed Amendment(Describe in detail): • �Yl�f�l� �W�. (r�'�D 0 fi' TUB 4. Property Owner:UAn a i d G f 2 e W)j Q f Q Address ►1 e C'+0 NZ Ro a A IQ U e. � 4y i c s h 3 Phone o i 4 �2 r)- 4 41 1 —Cell�n) ' , (p' (o a (J� e-mail Applicant: So,m g LiS 1�fhOef+-q C>L)WQ_r Q,1Lh ►rd Grf-mbern a, Opt o y 1►► -• tye�l- Address•. OYU Phone 11� 3 r]-�T�Cell Sr') e-mail �pt Architect/Engineer: Imo,I p NA�6. 1 V3 ')�Op G(J 1 iyye. 1Q{- Address: (o S �f��S B0 P� P—D BSI h l✓I G Q U Phone# 5`E 'q 2--22 O3 07 Cell# G(I It I o-7 17 7& e-mail Sec Pld 0 6D G'M'A0 h &-C*0 5. Occupancy;(1-Fam.,2-Fam.,Comm.,etc...)Prior to construction: Z After construction: P-3 6. Will the proposed amendment require the installation of a new,or an extension/modification to an existing automatic fire suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...)Yes: No: ✓(if yes,you must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 7. Will the proposed amendment disturb 400 sq.ft.or more of land,or create 400 sq.ft.or more of impervious coverage requiring a Storm water Management Control Permit as per§217 of Village Code?Yes:_No:_Area: 1 8/12/2021 8. Will the proposed endment require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: (if yes,you must submit a Site Plan Application,&provide detailed drawings) 9. Will the proposed amendment require a Steep Slopes Permit as per§213 of Village Code Yes: No:Z(if yes,you must submit a Site Plan Application,&provide a detailed topographical survey) 10. Is the lot located within 100 ft of a Wetland as per§245 of Village Code? Yes: No: (if yes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan) 11. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes: No: (if yes,the area and elevations of the flood plane must be properly depicted on the survey&site plan) 12. Will the proposed amendment require a Tree Removal Permit as per§235 of Village Code?Yes: No: (if s,you must submit a Tree Removal Permit Application) 13. Does the proposed amendment involve a Home-Occupation as per§250-38 of Village Code? Yes: No:_If yes,indicate: TIER I: TIER II: TIER III: (if yes,a Home Occupation Permit Application is required) 14. Will the proposed amendment result in additional square footage to the building or subject structure, and if so,provide such additional footage here. p 0 (Please submit additional Bulk Regulation Application Pages for review) 15. What is the total added cost of the work associated with the amendment: $_I Q 6 U , 6 y (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.) 16. N.Y.State Construction Classification: N.Y.State Use Classification: 17. Estimated date of completion: 16 � 0� This application must be properly completed in its entirety by a N.Y.State Registered Architect or N.Y.State Licensed Professional Engineer&signed by those professionals where indicated. It must also 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. ********************************************************************************************************** SKiTE OF NEW YORK,CO OF WESTCHESTER ) as: �C.J Q fa t r yeQ40-Zr Q ,being duly swom,deposes and states that he/she is the applicant above named, (print name of individual signing as the a t) 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 U Sworn to before me this day of C)<-CA , ,202a day of , 20 Signature of Property Owner Signature of Applicant t Name of Property Owner Print Name of Applicant (�n �-' n&JL Notary Public Notary Public SHA4�i PJIELILLO Z Notary Public St.-:;: -f New York 8/12/2021 M 0 W o o Ln ° ON Cl) a t%1 uy w a H a O M n c Ca ,n ocz ti z pCz O o Q w n45 Io 4 U Q F O e z oo �; WZ � z F G1 H � � M w � Vv. ~ � � x a � O r-1 A z o o W • MM� � W I�1 F+ 1 �1 Z � � pG Li W e� �'� ►� O x w a a O 8 $ w ZO 0.4 o �- �, a w < �I a a a � ova w z � 4f494;99$:V9444;44&4444VOCA I44APAPA A��+� BUIL E MENT JAN - 6 2022 ID VIL E OF RYE OK 938 KIN ET RYE B ,NY 1057 VILLAGE OF RYE BROOK BUILDING DEPARTMENT Wyw1y c Z.org ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: — Oaf EP#: —U C_�3 Approval Date: FEB — 7 2022 Permit Fee: $ 3 / Approval Signature: 1 Other: Disapproved: (fees are non-refundable) Application dated, 12ANN 2k is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/or remove electrical equipment,wiring, fixtures ,or to perform other high or low voltage electrical work as per the detailed statement described below. The applicant & property owner, by signing this document agree that all electrical work performed will be in conformance with (all applicable Federal,State,County and Local Codes. rr nJw� 1.Address: t M 4 VQS-brl e kdt SBL: y a4 +1p 5- - lD C) Zone: 2.Property Owner: PACY'af d %"_tn bQ,lf Q Address: SO1_M'-- Phone#: 01 1` S'l le ' Cell#: S4un�- email: 3.Master Electrician: MOS k ash MO� Address:_r3S CU-�*kpp��Aq , 0-'�Sk r\l ng, ny (0S( a Lic.#: a1.-1 Phone#:gkAAk\IM Cell#: C114-"O- SS34 email: 1'CA�ntt�OJ�eC�ll.C&pfoi_.C1)rnn Company Name: f Uh n Vn-G Ofc-A"CCQ �rl G Address: 55 CtPAV_0A R4 d%tn l M_ l Q),S(0Z 4.Proposed Electrical Work/Fixture Count: beacl l20-'h Yl 6 - Yp_n S us C U? SU1 V-Vso l4 G��k 1 �mk3Ke_ r (4 coo SWA)YL lcoz " I STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: P'"d.7/?//d 5 being duly sworn,deposes and states that he/she is the applicant above named,and does further (prin(namc of individual signing as t applicant) n state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the L, C for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor.agent.attorney,etc.t 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 before me this 5 V day of 20 day of 1_6 Signature of Property Owner Signature 000 Ap scant Print Name of Property Owner Print Name pplicant Notary Public Notary Ou4llic N0VAY PWM 8M OF WW Y0W No.01E8610 M 8/12/2021 Qwifird in VVIll"Mbr C)owdy My Conn E*ft Owwav 9,2W Westchester Rockland Electrical Inspection Services, Inc. -- Phone: 914-347-3595 +DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue Fax: 9 �-347-3596 Elmsford NY 10523 -pa3 � BUILDING PERMIT NO. TEMP# DATE D� CITY OR VILLAGE Z P CODE TOWNSHIP C U STREET AND NO.OR AD POLE NUMBER iV�\ BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SET IBTK LOT OCCUPANTS NAME ,p BUIL7 G OCCUPANCY r�Y�V ,� I\Q OWNER'S NAME AND ADDRESS r1` HOME TELEPHONE NUMBERn CURRENT SUPPLIED BY FROM THEIR OFFICE WORK TELEPHONE NUMBER LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS NO.OF FIXTURES& MOTORS HEATERS OFFICE USE LOCATION LAMP RECEPTACLES ONLY SIDEWALL SWITCH INCADE HORS- -}tP. WATTS EACH INSPECTION IL Ire OUTSIDE I I I� I BASEMENT I A LJ Li 1"FL. - 2'o FL. F 1.,11. ,RTIt11 3-FL ..a.y.__ 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❑ EXPOSED O CONCEALED❑ MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD❑ UNDERGROUND❑ AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. NAME OF COMPANY DATE OF APPLICATION SIGNATURE OF APPLICANT x - STREET ADDRESS TELEPHONE NO,. '� zn-�r W P� 14- 1 ��qC1 CITY OR POST OFFICE n \ ZIP CODE 7LICENSE NO.WHEN APPLICABLE �,� WESTCHESTER ROCKLAND ELECTRICAL INSPECTION WRE15SERVICES,INC. BY THIS CERTIFICATE OF COMPLIANCE THE Westchester Rockland Electrical Inspection Services 43 North Lawn Ave, Elmsford, NY 10523 914-347-3595 (Office) 1 914-347-3596 (Fax) CERTIFIES THAT Upon the application of: Upon premises owned by: Fanning Electric Richard &Elizabeth Pena Greenberg 55 Central Avenue NY, Ossining 10562 Located at: 1 Milestone Rd Rye Brook, NY 10573 Certificate Number: 1033158 Section: 124.65 Block: 1 Lot:60 BDC: Permit Number: EP:22-023-BP:22-022 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: 1 Milestone Rd Rye Brook,NY 10573 112 Basement 1st Floor 2nd Floor 3rd Floor Garage Attic Outside Other: Inspection was conducted in accordance with the NYS and NFPA 70-2017 International Electrical Code and detail of the installation,as set forth below,was found to be in compliance therewith on 02/17/22 Name Type Quantity Basement Reinspection-Basement ------- 1 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. �G 'L /� j This certificate is valid for work performed before date of inspection only. i � N N Ln W ' � � M a CA w /1 I M RT uj it c tc EN '�T oGi $ CC Qli O w zm Z 00 w z 1 = O a z wzPLOC44 w oo z x O \ Cn O ~' a z° can z � C � � � W , WLon00 � a W ►--� M ~ � w z w � � H 0 I4, O U w it .. U W U. 0 z N F- o w x(71 o w � i ei 414 a 414 el 41 a c U 41 a a4aa4a V.t44;414$144&a4$A4a444144414144ON p ECENED BUILDING DEPARTMENT FEB 2 4 2022 VILLAGE OF RYE BROOK 938 KING 9"1'Ru;r RYI,Blit2oK,NY 10573 VILLAGE OF RYE BROOK %�' BUILDING DEPARTMENT iN!A -.or PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY IIP 4: 2 Z C`> �� 1'1'�: -_-C) _ _ .._ ................ __- Approval Date: FEB 2 51 Permit Fee: S. Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, ,I&W 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: l ��/G )O_ Ally' SBL: ay-6.4-'l T(PI0 Zone: pp v 2.Proposed Work: �vt�r,Uee�� /��t5 tt�o►F i2x(S /st,L'Rl}'GO�'� 3.Property Owner: l Address: �0116$ pZ� �Qoad Phone#: 2 Cell#: email: ``""��,,� 4.Master Plumbe . ( Address: `�afie//-S�/aonwy •r� & ,lam Lic.#: _Phone#: N Z7 t (o Cell#: 'I 1 q ttq D 3(e53 email: �j E&MC A-dc'm Company Name: Address:Q(�,�p� 3�,1 kUk�t�douA �GQr�r . •CC15Z0 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 I st Floor 2nd Floor 3'd Floor 4'Floor 5'Floor Exterior 5.*List Other Equipment/Provide Details: 11¢tv 'luh stwk ilccwiA1 1Df 4Et' lot SGlna EM�� (Notarized Signatures Required Next 2 Pages) -1- 8/12/2021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: 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 Sworn to before me this day of ,20 day of ,20 Signature of Property Owner Signature of Applicant Print Name of Property Owner Print Name of Applicant Notary Public Notary Public This application must be properly completed in its entirety and must include the notarized signature(s)of the legal owner(s)of the subject property, and the applicant of record in the spaces provided. Applications not properly completed in its entirety anal/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- 8/12/2021 STA OF��x�V(""K: O OF WESTCHESTER ) as: ;ing duly swom,deposes and states that he/she is the applicant above named, name of individual. gas a applicant) and further states�at(s)he is the legal owner of the property to which this application pertains,or that(s)he is the ��! .l lc s'r� for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this 15 Sworn to before me this 'C� day of ,20 day of ���( � ,20 -5e Qc'�& — (�— -ft� Signa a of-15roplerty Owner gnature of App cant s d Print Nade of Property Owner Prtnt Name of ApplicaiYt �1 LI Notary Public ;� k MeAtLILLU IVO. 01ME6160063 No ary a lic, State of New York Qualified in Westchester County cc��--�� 1V0- 01 /03160063 Commission Expires January 29.20 a-I Q,.ialified in Westchester County Commission Expires January 2.9.20QL This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s)of the subject property,and the applicant of record in the spaces provided. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- 8/12/2021 BUILDING DEPARTMENT R ECEWE VILLAGE OF RYE BROOK F E 6 2 4 2022 DD 938 KING STIMET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK wr .r aokore BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §21 E • 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: sb (��Ue �,rk�K� 31, ' , residing at, t eSt �� L�7`� 6-5 n, 7 (Print name) (Address where you live) being duly sworn, deposes and states that(s)he is the applicant above named, and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; t es•+aM_- 9, ?,14A, V,4ka t t6K 0 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. w ( ignature of Property Owne s)) 9�'-k C �e (Print Name of Property Owner(s)) Sworn to before me this D-21 o , 20\--/U__�L (Notary Public) SHARI MELILLO Notary Public, State of New York No. 01,M E6160063 -3- Q!ialified in Westchester County Commission Expires January 29.202a 8/12/2021 s O N M Iva. � W 0 Wa x a � k COL . � �x M ^ Os rQ � s, I�1 � ✓'' O O � z z � �'o � .q .0 � Fil ° O °W `� 4 0 E � � c7n Z o � � Q b V ~ V M u Z �tAV` a UC z V1 al �_ 5 -0 x O P � . 0 oa � ov t UII�D B MENT R [EC FEW F VEL O RYI OOK FEB - 7 2022 938 KING ET RYE BROOK,NY 10573 4 939-0 k VILLAGE OF RYE BROOK ookWp.. BUILDING DEPARTMENT APPLICATION TO INSTALL FIRE SUPPRESSION / FIRE SPRINKLER SYSTEM FOR OFFICE USE ONLY: �7 Approval Date: R — 0np#� —Q 4� MP#: O�— 0/1 / Application Fee: $ Approval Signature: Permit Fees:$ Disapproved: Other: Application dated: is hereby made to the Building Inspector of the Village of Rye Brook NY for the issuance of a Permit to install or modify a Fire Suppression/Fire Sprinkler System as per detailed statement described below. 1. Job Address: rn 1 ie STO1)e- 2. Parcel I.D.: ILI . 6 S 1 Zone: 3. Proposed Work(Describe system in detail including suppression agent): SI S+ /V\ rl ( I c k,r►k+l f T L a u>n� �luo�S �Jq*- r3ak 1 �S YS M Q .� S16an o 4. Number&Types of Fire Sprinkler Heads: r2x I A b ktiLan,� `F 5. NX State Construction Classification: N.Y.State Use Classification: Q-esi 6. Estimated Value of Job:$ I �'oo `c'-0 (Value shall include all labor mate als,fixed equipment,professional fees,and materials and labor/which may be donated gratis.) 7. Property Owner: I L ,,er .'-1`e�j J� _1 Address: I�1 6f, e- `2� Phone# Cell# R (,.A4- email• rbyl'eenberli O t tlI'lu-, /ki Applicant: Address: Phone# Cell# email: Architect/Engineer: Address: Phone# Ceell`# ''//f/ email: / �"" �) Sprinkler Contractor: /��QCO , //1,GK/ � Address:�a31 ,(QttLy�Q � ✓C oYJ�F1 Phone# Cell# �'y7� 677/ email: r017JC N 7 /0 7y 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 YOM COUNTY OF WESTCHESTER ) as: ,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. Swom to before me this Sworn to before me this day of 120 day iof ' Mc (��IGY►/ , 20 2�- Signature of Property Owner Signature of Applicant J06 e L_eC>,AJ Print Name of Property Owner Print Name of Applicant w,,cJ Notary Public Not Public YOHANNY PENA NOTARY PUBLIC-STATE OF NEW YORK No. 01 PE6411338 Qualified in Bronx count OC/, My Commission Expires _ L T 2 8/12/2021 NEW YORK STATE DEPARTMENT OF HEALTH J\a d 1 Bureau of Public Water Supply Protection Report on Test and Maintenance of Backflow Prevention Device For the year .. . Initial test- Complete entire form Please use a separate form for each device. 0 Annual test-Complete Part A only Public Water Supply Account No. County Block Lot /' I-fi r pq Location of Device Facility Name .lam !� �Address 1 ,� 1 ,� -+'t?tUl'c: ��_. �� Street City ZQ Device Manufacturer Type 0 RPZ Model Size (in inches) Serial Number Information ! '(( (`;; e_ ❑ DCV 6 r/ i'? / ✓1 a., Check Valve No. 1 Check Valve No. 2 Differential Pressure Line Pressure �� psi Relief Valve Test Leaked ❑ Leaked ❑ Opened at psid Date m m before Closed tight I❑ Closed tight ❑ repair Pressure drop across first M D Y check valve psid Repaired by Describe Name repairs and materials Lic# used Date repaired: ❑ m M M D Y Final Closed tight r� test Closed tight Opened�t_ psid Date W m Pressure drop across first M D Y check valve psid Water Meter Number Meter Reading Type of Service: (check one) (/ ❑ Domestic ❑ Fire ❑Other Remarks (Describe deficiencies:bypasses,outlets before the device,connections between the device and point of entry,missing or inadequate airgaps,etc.) Certification:This device❑meets,❑does NOT meet, the requirements of an acceptable containment device at the time of tesing. I hereby certify the foregoing data to be correct. Print Name CertifieclTester No. Signature Expiration Date Prope owner's (orowner's agent) certification that test was performed: s � - Print Name Title Signature Telephone Certification that installation is in accordance with the approved plans. (To.be completed by the design engineer or architect dYwater supplier.) I hereby certify that this installation is in accordance with the approved plans. Name Title Date NYS DOH Log# License Number Phone( ) M D I Representing Describe minor installation char Address IN FEB - 7 2 222 City State Zip Signature i VILLAGE OF RYE BROOK NOTE:Send one completed copy to the designated health department representative and one copy to the water su pli Notify owner and water supplier immediately if device fails test and repairs cannot immediately-5W-f 6d6-. DOH-1013(9/91) JJ Building_Permit Check List&Zoning Analysis Address: SBL 12,44 • (� ( - (o Zone Use: 7Z o Const.Type: 3 Other. Submittal Date: Revisions Submittal Dates: 1. Applicant: Gi Nature of Work tS 4P-3--, Reviews:ZBA: D E C - 3 202 PB: BOT: Other. NEEP-OK ( ( ) FEES:Filing. 7 9,� BP: C/O: Legalization: Z� � �•� . — ( ) 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: PLANS:Date : ✓tamped Sealed: ✓ Copies: Z c. Ot her. ( (�License Workers Comp: v Liability Comp.Waiver. Other. ( ) ( ) CODE 753#: Dated: N/A: (Jf ( ) 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. (Jf ( ) PLUMBING Plans: Permit Nat. Gas: LP Gas: N/A/: Other. FIRE SUPPRESSION:Plans: Permit N/A: Other. (� ( ) H.V.A.C.: Plans: Permit N/A Other. ( ) ( ) FUEL TANK:Plans: Permit Fuel Type: Other. ( ) ( ) 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER C/O DENIAL LETTER: Other. ( ) ( ) Other. ( )ARB mtg.date: approval: notes: ( )ZBA mtg.date: approval: notes: ( )PB mtg.date: approval: notes: REQUIRED EXISI•IING PROPOSED NOTES DEC - 9 2021 Date: Circle: Fm� Fnw Sides: $sir. Main Cov Accs.Cov Ft.H/Sb: Sd.H/Sb: _QE& Tot.Imp Fr.Imo P Hight/Stories 1 Mike Izzo From: Mike Izzo Sent: Friday, January 7, 2022 11:06 AM To: Job De Leon Cc: 'Tara Gerardi'; Steven Fews; Laura Petersen Subject: RE: 1 milestone rd ryebrook Attachments: Fire Suppression Full 9.2021.pdf Dear Mr. DeLeon, Thank you for the email. 1 Milestone Road has submitted a permit application to legalize and remodel their finished basement. The basement was originally finished sometime in the past without permits or inspections. To legalize the basement Mr. Greenberg must hire all the trades which would have been required to file for permits at that time to file for permits now like, electricians, plumbers, HVAC contractors, fire alarm installer, fire sprinkler contractors,etc... The building was originally equipped with a full fire NFPA 1sD fire sprinkler system but was designed for code compliant basement coverage without any partition walls. As such it's possible that additional heads may be required, or that you need to file for sprinkler work which was done in the past. In addition, the fire sprinkler backflow prevention device must be re-inspected and certified by a qualified backflow prevention device service professional. I've attached a copy of the correct permit application hereto for your convenience. Please contact me should you require any further information. Thank you. Michael J. Izzo Building& Fire Inspector Village of Rye Brook, NY (914) 939-0668 Original Message From:Job De Leon <jdeleon@alphacosprinkler.com> Sent: Friday,January 7, 2022 10:40 AM To: Mike Izzo <MIzzo@ryebrook.org> Subject: 1 milestone rd ryebrook Hi, inspector Izzo We went to look at mr greenburgs house at the above address. We reaching out to see what is required from us to submit or if you have any specific information required. Please call me at 3479966771. My name is job. Alphaco Sprinkler LLC Thank you. Sent from my iPhone 1 � AL r• •: � � O R r H O Y N �- L C) a «o» f u f ° Mo « i r ' : E o - LLJ �J Z U o a o .= Q °�ecti0n 4 ' Lr QQ v ell • O �y z U O 0 J > 4- CC 40 L.L 40 N 1 LU V OU cn L ►. 4•. a„ cv to = ao O r, Oj>>edaO o 440M)D. I••M J XZv Z co L E u `E .• ` O co a. 7 u v G O (� 7 ���: r �• w � Z M s• H U r ; G Ir� U (A u ,a co» SA 199M AC RO Ue DATE(MM caff"r #*� CERTIFICATE OF LIABILITY INSURANCE 11n&2021 THIS CER IFICATE 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 pollcy(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 endorsemen s. PRODUCER CONTACT NAME: Lwrz Brady G&N McGovem Insurance Agency,Inc. No : (914)803-1300 837 Mclean Avenue ADDRESS: info a@rncgoverninsurance-net Yonkea INSURERS)AFFORDING COVERAGE ►WC M NY 10704 ROURIE RA: UTICA FIRST INS CO 15326 INSURED INSURER B: L071 Contracting LLC INSURER C: 380 W SHORE DR INSURER D: INSURER E: Carmel NY 10512 INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POUCHES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDRIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER LIMITSX COMMERCIAL GENERAL LBIrTY LA EACH OCCURRENCE f 1,000.000 CLAIMS-MADE a O(tR PREMISES Ea oouararaa f 500,000 —A Y Y ART5111021-03 MED EXP Wry one pmm) $ 5.000 0226,2021 022&2022 PERSONAL t Any,W"1RY S 1,000,000 EN L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE 9 2,000,000 X POLICY ❑� ❑LOC PRooucTs-coaPloP AGG s 2.000.000 OTHER f AUTOMOBILE LIAMRm ____. LIMIT ANY AUTO a acooe,� f DAMNED SCHEDULEDBODILY INJURY(Per person) f AUTOS ONLY AUTOS BODILY INJURY(PerHIRED a�ddarlq i AUTOS ONLY AUTOS NON-OWNED (RUP acR"') f i UMBRELLA UAB OCCUREXCESS EACH OCCURRENCE S AGGREGATE f D® I I RETENTION f OOMPEflSATNON f ILITYY!N STATUTE ER NER/E)ECUTIVEUDEDI NIA EL.EACH ACCIDENT f EL DISEASE-EA EMPLOYEE f Ir ATIONS bebw E.L.DISEASE-POLICY LIMIT f DESCRIPTION OF OPERATIONS!LOCATIONS i VEHICLES(ACORD 101,Add",, Renwft ScheduW may be aead wd N morn apace is repaired) RE:Richard Growberg,1 Milestone Rd,Rye Brook, 10573 ADDITIONAL INSUREDS: Village of Rye Brook,938 King St,Rye Brook CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DEL)VERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King St AUTHORQED REPRESENTATIVE /� D Rye Brook NY 1057) 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSI F New York State Insurance Fund PO Box 66699 Albany.NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE o a A^A^A 935888194 G 8 N MCGOVERN INSURANCE AGENCYINC 0 Y 837 MCLEAN AVE YONKERS NY 10704 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER LOT[ CONTRACTING LLC VILLAGE OF RYE BROOK 380 W SHORE DR 938 KING ST CARMEL NY 10512 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2456 245-6 108004 10/18/2021 TO 10/18/2022 11/18/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO 2456 245-6, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK. EXCEPT AS INDICATED BELOW AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:/ANWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY AFFORDS COVERAGE TO THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY RONAN DOHERTY MEMBER OF LOTI CONTRACTING LLC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY NEW YORK STAT SU NCE FUND 7 �V DIRECTOR.INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 228953323 U-26.3 DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 01/25/2022 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 John Mobley y Citizens General Insurance a NE (800)498-0884 ac No: (530)477-0111 11601 Blocker Dr. E-MAIL ohnm citizens eneral.com ADDRESS: g Suite 110 INSURERS AFFORDING COVERAGE NAIL 8 Auburn CA 95603 INSURER A: Interstate Fire&Casualty Company 22829 INSURED INSURER B: Alphaco Sprinkler LLC INSURERC: 1231 Lafayette Avenue,2nd Floor INSURERD: INSURER E: Bronx NY 10474 INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR- TYPE OF INSURANCE 'ADDL SUBR POLICY NUMBER r MM DDLICY EFF POLICY MWDD EXP LIMBS LT LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PREMISES Ea occu DAMAGE O RENTErrence $ 50,000 MED EXP Any one person) $ 5,000 A SISAZGL0005967 9/15/2021 9/15/2022 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 X POLICY JECT M LOC PRODUCTS-COMP/OP AGO $ 1,000,000 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 OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N MA. ER _ ANYPROPRIETOR/PARTNER/EXEC:UTIVE ❑ E.L.EACH ACCIDENT $ OFFICERWEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ T_ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more apace is required) 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. AUTHORIZED REPRESENTATIVE 938 King street J<_ - 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 IN K workers' Certificate of Attestation of Exemption ATE 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): Building Permit Alphaeo Sprinkler LLC From:Village of Rye Brook 1231 Lafayette Ave Unit 2 Bronx,NY 10474-5367 PHONE:347-879-6410 FEIN:XXXXX7636 The location of where work will be performed is 1 Milestone rd,Rye Brook,NY 10573. Estimated dates necessary to complete work associated with the building permit are from January 25,2022 to March 31,2022. The estimated dollar amount of project is $0-$10,000 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: Job De Leon 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,Job De Leon,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 famish proof of that coverage on forms approved by the Chair of the Workers'Cowfenmtion Board to the government entity listed above. 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