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HomeMy WebLinkAboutSOP2016 Village of Rye Brook ° tim Public Works and Engineering Department J SOT 938 KING STREET•RYE BROOK,NY 10573 1932 ,-� (914)939-0753 Fax(914)939-0242 INSPECTION REPORT Address: v 100 Date: Name • 1 �14 Location: Permit#: Phone: Email: ] Work being Inspected: Work Inspected is: (Accepted Rejected Re-Inspection Required Violation Noted Code Section Code Section: Action Taken Code Section: Action Taken 118 Erosion Sediment Pass Fail Violation 210 Storm Water * Fail Violation 135 Refuse Pass Fail Violation 215 Street Sidewalk Pass Fail Violation 213 Steep Slopes Pass Fail Violation 235 Trees Pass Fail Violation 216 Illicit Discharge Pass Fail Violation 245 Wetlands Pass Fail Violation Other: Pass Fail Violation Notes: Diagram: tt Signatur� ��/�'� VILLAGE OF RYE BROOK PERMITS 101 G STREET OPENING APPLICATION Public Works Dept. 939-0753 Building Dept.939-0668 fax 939-5801 Michal Nowak,Village Engineer/Superintendent of Public Works e-mail: mno%�ak(a rychrook.ore Grant Jednesty, Public Works e-mail: yiednestsia rsrbrook.ore #4i#i4#i44/44/44###///4t//4ffft/44W#ttttfft/#R♦4/####ftif44#*ff4t/4#/#44t/f*#fff4##44444ftttt# REQUIREMENT SUBMITTALS: WC.ti ►{.+pate: 2 2Z.`2p2Z UFPO No. WC Home Improvement License: v insurance:0 16 Map: Bond Deposit(refundable after final inspection): On File S ,Check#— —Date Paid Fee: (fees are non-refundable)d--of Openings x $475.00=S t S Date Paid: 24'JIS4r (Whichever is greater) Linear Feet x $3.00=$ Date Paid: Stotmwater Hook-up$ Date Paid: Application is made for a street Opening Permit at the following location: n l�~n�, lJ (� Rye Brook. N.Y. Nno No. & Street Name NUS F,W of(into, ecting street) For the purpose of. +1Vw f-(-o(Y-1 c\( LA )(�A X {fork io begin (Date): #of Openings: Expected date of completion: 71 1 Dimension(s): Job number if any: Residential V/ Or Conunercial (check one) Type of Pavement: ul� -- Maintenance nd restoratioon is the responsibilin�of the Pr erty Owner- �,� n A lica ro erty Own Contract r �' Z o s r r - ICY �e r F N11� F ddre s Itoo Q -- Conta P`lrs�on n hU, r1 C Contact Person�n q 3ci — y .Z Contact Phone Numbers vl �j Contact Phone Numhm 9 I4- Gam- �G 24 Hour mergenc Contact Number + 24 Hour Emergency Contact Number r - C�(1 Email Address Ijpermit is granted: 1 agree to cu{�ply with all rules and regulations set forth ht•the Federal,State. County,Local Laws. el"al Ordinances. General Or tancesgoverning Street Opening Permits. See reverse side for conditions. } Aatk (Complete reverse page) A ieant's signature • Office Use Only APPROVAL: _ DATE: - Z'� �T INSPECTIO - -- --_ !DATE: — -- RETURN DEPOSIT APPROVAL: _DATF OF APPROVAL: RETURN DATE_ Upon the following Conditions 1. The Undersigned agrees,in consideration of the granting hereof,that he will not permit said opening to remain open any longer than is absolutely necessary for the proper completion of the work for which this permit is granted; that he will keep the same sufficiently illuminated at night with at least two lights; that when said work is finished, he will restore said highway to its original condition using the Village pavement specifications and be responsible for settlement of the ground for any cause for at least 12 months;and that he will hold the Village harmless from all damages in connection with such openings or by reason thereof. 2. The undersigned having deposited with said Village the sum of: ($ ),the estimated cost of the work,agrees that in the event that said amount is not sufficient to cover the cost of opening and restoring said highway to its original condition,he will then pay said,Village the difference between the sum deposited and the cost of opening and restoring said highway; OR 3. The undersigned having filed a Bond with the Village of Rye Brook as herein provided,and not having made any deposit,agrees to pay the Village of Rye Brook the entire cost of opening and restoring said highway to its original condition. Utility companies shall have a bond on file with the Village as per Village Code 215-6B_ 4_ Proof of Insurance shall be provided, acceptable to the Village Engineer, in accordance with the following minimum coverage. a. General Liability, personal injury 5500,000 per occurrence, 5250,000 per claim, property damage, 550,000. b. The Village of Rye Brook shall be named as an additional insured. c. Workers Compensation Insurance. 5. And the undersigned permittee agrees to pay the Village of Rye Brook the entire cost of opening and restoring said public road,right-of-way,street or highway to its condition before the work under this permit was performed;in the event the Village of Rye Brook performs su restoration. Y�S�.QY11� icant's Signature Title Village of Rye Brook Code Section 215-7 Street & Sidewalk Specifications The street opening work and the final restoration shall be performed in accordance with specifications approved by the Building Inspector, which shall include the following minimum specifications: A. The trench shall be filled with K-Krete. B. if a new patch occurs where there is an existing patch, the entire existing patch shall be removed and replaced. C. if the patch falls within 18 inches of the curb or pavement edge, the patch shall extend to the curb or pavement edge. D. The final patch shall have a crown. E. The Code 53 case number shall be provided to the Village before any digging takes place. F. No digging shall start on a Saturday, Sunday, or holiday, except in an emergency. G. Concrete. if the street is concrete, the patch shall be concrete, The concrete shall be saw-cut to establish a clean, smooth surface. The existing concrete shall be drilled and 24" dowels inserted to a twelve-inch depth, and the dowel shall be two feet on center. The seam between the new and existing concrete small be sealed with tar. H. Asphalt. If the street is asphalt, the patch shall be asphalt.The existing asphalt shall be saw-cut to a depth of two inches and shall he 12 inches wider than the trench.A binder course of 4 112 inches and a top course of 1 1/2 inches shall be required. The seam between the new and existing asphalt shall be sealed with tar. I_ if a pipeline installation shall disturb more than 50% of the road width, the entire road width shall be resurfaced. J. All work shall be performed in a good and workmanlike manner, satisfactory to the Village Engineer/Director of Public Works. K. All street openings and work areas shall be provided with warning signs, barricades and lighting as necessary for public safety and in conformance with applicable provisions of the State of New York Department of Transportation Manual of Uniform Traffic Control Devices. -.`.;P' Al cryi'$� 4i`I. w r.•°��w''/' - wh ,y �• i1�.� •+fk � �n ./ja. y�ri• .._ y4��r�'c, )ir. k u•:: .► twn �► .,ash 8n .riNin./ .0 r�/ 1�;.�, `2 �'Y3 f�� � "" F � 5� f ii,141�yJ1 •. �y. �Q)1PW � ^• ti5�yr! 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II14►IIII J Y !i;I I'H Ala\ {p�@ !a 11I11 N1 P .�y j4 41i1 'a0�w°Iflc' •• � lw�nt.i 44li1i1(rw� l�' t!4♦ ti��8�w4,fJ{ a ♦(} �1lw4� t Ii/41/� i1([afwi� �141(4" ji�i'w�� dls(4 0 DATE(MWDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 2/22/2022 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 GONIAGI NAME. Andrea Koh[Dian Kohlman Agency LLC nlcNN Eat: (914)259-8988 (AIC,No); 888 Route 6 ADDRESS: Andrea(&,KohlmanAgency.com INSURERIS)AFFORDING COVERAGE NAIL II Mahopac NY 10541 INSURER A: ERIE INS CO 26263 INSURED INSURER B: ERIE INS PROP&CAS CO 26�30 ARENA CONTRACTING INC INSURER C: 132 PEARL ST INSURER D: INSURER E: _ PORT CHESTER NY 10573-7614 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 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. INISR LTR TYP£OF INSURANCE INSO WVD POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMBS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 tu CLAIMS-MADE ® S E OCCUR PREMISEa ence $occurr I,000.000 MED EXP(Any one person) $ 5,000 A Y Y Q39-6550172 03/15/2021 03/15/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY jERC7 LOO PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY Ea accident) $ 1.000,000 ANYAUTO BODILY INJURY(Per person) $ A OWNED - SCHEDULED Y Y 03-6540045 03/15/2021 03/15/2022 BODILY INJURY(Per accdent) $ AUTOS ONLY AUTOS Q HIRED NON-OWNED $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1.000.000 * EXCESS LIAR HCLAIMS-MADE Y l Q27-6570084 03/15/2021 03/15/2022 AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTNE E.L.EACH ACCIDENT S 100,000 B FFICERIMEMBER EXCLUDED? ❑ NIA Y Q87-6500555 03/15/2021 03/15/2022 Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,00(I f yes,"..I).under ESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101.Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER 1S LISTED AS ADDITIONAL INSURED. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ViOage of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 938 King Street AUTHORIZED REPRESENTATIVE Port Chester,NY 10573 Pa,lrL,-* 13. K&f kA -a.+,, ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD vORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS` COMPENSATION INSURANCE COVERAGE Board 1a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured Arena Contracting,Inc (914)939-1235 132 Pearl St Port Chester,NY 10573 1c,NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 161654097 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ERIE INSURANCE PROP/CASUALTY 3b.Policy Number of Entity Listed in Box"1 a" Village of Rye Brook Q87-6500555 Building and Code Enforcement 938 King Street Rye Brook,NY 10573 3c.Policy effective period 03/15/2021 to 03/15/2022 3d.The Proprietor,Partners or Executive Officers are ❑ included.(Only check box if all partnersiofficers included) ❑X 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 1 a"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 must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums 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 this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Patrick B. Kohlman (Print name of authorized representative or licensed agent of insurance carrier) Approved by: Aatus I . 2t22/2022 (Signature) (Date) Title: Principal Agent Telephone Number of authorized representative or licensed agent of insurance carrier: (914)259-8988 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(9-17) www.wcb.ny.gov Laura Petersen From: Dig Safely New York Exactix <tickets@exactix.digsafelynewyork.com> Sent: Thursday, February 24, 2022 10:37 AM To: Mike Izzo Subject: Message from Dig Safely New York, Inc. (DSNY) ****REGULAR**** DIG REQUEST from DSNY for: VIL RYE BROOK Taken: 02/24/2022 10:36 To: VIL RYE BROOK PRIMARY Transmitted: 02/24/2022 10:37 00001 Ticket: 02242-000-383-00 Type: Regular Previous Ticket: 02222-000-912-01 ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 7 To: Name: BEECHWOOD BLVD Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: BOTH SIDES OF THE RD AND ENTIRE FRONT OF PROP NearSt: WOODLAND DR Means of Excavation: EXCAVATOR Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: Y Work Type: STREET OPENING Estimated Work Complete Date: 03/08/2022 Depth of excavation: Site dimensions: Start Date and Time: 03/01/2022 07:00 Must Start By: 03/15/2022 ------------------------------------------------------------------------------ Contact Name: ASHLEY BONILLA Company: ARENA CONTRACTING INC Addr1: 132 PEARL ST Addr2: City: PORT CHESTER State: NY Zip: 10573 Phone: 914-939-1235 Fax: Email: info@arenacontracting.net Field Contact: DOMINIC ARENA Alt Phone: 914-906-1982 Working for: DOMINIQUE ------------------------------------------------------------------------------ Comments: WORKING ON BOTH SIDES OF THE STREET. : Lookup Type: MANUAL ------------------------------------------------------------------------------ Members: ALTICE USA CONED : SUEZ WTR WESTCHESTER VIL RYE BROOK 1 > mm ,g z O F-- ol =N 48*00,00"E 53.0' 6116. 0 .30 K m .()4 A > F'I X z 0. 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