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Home My WebLink AboutDP22-003PERMIT # toJ! SECTION TYPE OF WORK JOB LOCATION CONTR EST. COST YqooFCo # TCO # DATE: - P07 t pFEE FEE W /%Q-2p t3AT r/ e� nri ,`7OS/7e� �c�O�S3-0 �%%7 . c- vid �a�erl �;�C9/y)9o10-�373 FEE [3ATE.� _ INSPECTION RECORD DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING ED RGH PLUMBING) GAS SPRINKLER ELECTRIC LOW -VOLT L� ALARM AS BUILT �J FINAL INSP ✓er C/�c74i L QTNER APPROVALS t�TtiER _ AS-BUILT/FINAL SURVEY REQUIRED PRIOR TO FINAL INSPECTION �yE 6R tV 4 u tj V CtivL�"'vYy �' . 19 19 .Y Q VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J.Bradbury www.Eyebrook.org TRUSTEES BUILDING & FIRE INSPECTOR Susan R. Epstein Michael J. Izzo Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE April 5,2022 The Estate of Arlene Shirken 10 Carlton Lane Rye Brook,New York 10573 Re: 10 Carlton Lane, Rye Brook, New York 10573 Parcel ID#: 135.42-1-5 Demolition Permit#22-003 issued.on 3/7/2022 to Demolish& Remove In-Ground Pool,Pool Deck and Pool Equipment This certifies that the in-ground pool,pool deck and pool equipment,demolished under the above captioned permit has been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector /tg R v For office use onI DDBUILDVNTV K PERMIT# C3 MAR 3 0 2022 ISSUED: 3--7-D 4 38 KING SIRE YORK 10573 DATE:VILLAGE OF RYE BROOK FEE: 49 /JQ-- PAwX,, 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 ►ittiti#titiifitifitittttlR►\tttif\■i4iitik#iR#i#it\ttiit4ktkiRi#Ri\♦t\■t444iRR#iitiitiii#ttkk#R♦#■\itit\♦ittit##lift\tifiiii Address: 10 Cark i)n L—cLne' 1, Occupancy/Use: Parcel ID#•2 7 C3 "� 'J� 'Lone: —��- Owner: r7 7 e- 0 tT �r�e r/�e,y Address: 9?aa&& A41 �Q �A^�t/If/O� pe7 P.E./R.A. or Contractor:L D sn4%C�IC�f/ ((10'%/O It1 Address:IiZFgle-' ��A-xo' 1.0 /V I' A!95 y Person in responsible charge: J C®& -eYCGW'tr1- Address:9Qp�J7j`finl/r/��,Q ,O/fJ QD (i/ e96f6 7 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'Otl .911teo being duly sworn,deposes and says that he/she resides at j 7417Pr,41VA LA (Print Name of Applicant) _ (No.and Street) in ";ZWZAQ ,in the County of/`' /G�'l�L in the State of C7 ,that (City?owni Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:S IZ -;75-�-v/" / for the construction or alteration of: �/Yl x/��j � PD 0l� G/(- ' 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 3 i�) Sworn to before me this 9Z day of �ok' `G� , 20 a a day of ��G , 20 gL a afore o perty Owner \sigr;sUK OVWXppji i (PNt Name of Property )�rint Name of Apphcaw, No ry Public Notary-Public SHARI MELILLO SHARI MELILLO Notary Public, State of New York Notary Public, State cf New York V.1t-6 L., 03 I z zoz l Q-_talified in Westcl—tt ter County 0,ta!ified in ' f.er Coun Commission Exoires January 29.20 93 Commission Exrires Jnnuan 29.?_0�3 QyE BRC��. Zm cu � • �9a2 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 rygbrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : I l_p LA-CLai-ob-, `^�' DATE: -12-7-2- L PERMIT# ,�2''y�?-L ISSUED: 1 Z[- SECT: I� t2BLOCK: LOT: LOCATION: I� — \�'1'�-T' � ��/ 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 �Wn "1 ►ti t ( N!� .0!� � ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER A ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL OTHER �yE BRC��. 2m cu � '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.ors - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - -- - - - - - - - - - -- - - - co�� U�� ADDRESS :- �-{ DATE: g PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: •j�P —�!""` OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/REINSPECTION B SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION \ _ ❑ NATURAL GAS �00 U ��0\ 1 S►Y. .^' � ❑ L.P.GAS ` C 2 ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER QyE BRC��, BUILDING DEPARTMENT ❑BUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK El CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.ors - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS: t� � � 1`,V� ` `1 DATE: PERMIT# � ISSUED: �IZ? SECT: BLOCK: LOT: LOCATION: ` 1 �� \ n` 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 ° a N N44v W wg ■ W 1-4r w � intn � v o �J � O M A o 00 1-4 a W O en u O z c 11 ern- a 4 U " o C ~ En V rH cd00 m z z z � , a � u ■ W CY Cn v} C O ►� uu� 'L � w rg Z 4 O zoc �, v ,y _ ° 0 � W O o '1%4LU IL ? a in V C7 A z O Wpp _Z •• A P" W ] MENT DIECIENIED OF RY OOK 938 KING ET RYE BROOK,NY 10573 MAR - 4 2022 Q39-0 VILLAGE OF RYE BROOK w BUILDING DEPARTMENT DEMOLITION PERMIT APPLICATION FOR OFFICE USE ONLY: MAR +� Approval Date: �AR — + 4D2 Permit#: d—W3 Application Fee:$ Approval Signature: V Permit FeMS Disapproved: Other: Application dated: 0" s 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 below. / 1. Job Address: J b 0,0 it j.I,a Laird, SBL: /35 t`'y�—/—S Zone: 2. Proposed Demolition.(Describe in detail): rCrnry �� prol e Q U k DY1ii f+ er 3. Property Owner:-The c&f(t-�O c^ 14rtene— 6 i> kcri Address: 10 Cnr L- t'N Gi_ 4e b i-cok Phone#10:5 A53-b.177 Cell#In a j'3- t"j-r7 email:5i,t�(9 yp4imulm tlGt Applicant- Se.t* S; i rkffl_ exe cAJ or Address:q9 &LftZrnli-I~ �a. %awl o -r Phone# C , , Cell#jo! 5 3-Lti"l 7`T email: SOUS 1 Qj 0lrt i W)i.UN1 Architect/Engineer: Address: Phone# Cell# email: / General Contractor: 0 � -C $ Address: K� FcArA R d I7A1 O.lAJ,+_ /0.55� Phone# Cell# - 6/ -Tin email: 4. Estimated cost of construction $ MQ (NOT$:The estimated cost shall include all labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 5. Type of construction:(wood frame,masonry,steel,etc...) 6. Method(s)of Demolition: 7. Number&Location of Fuel Oil Tanks to be Removed: S. Number of Stories: Height to Highest Ridge: To Highest Chimney: 9. Estimated date of completion: I 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: ✓57c-e& S'�J ;-'k0a ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual sighing as the applicant) and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)hc 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. Swam to before me this Sworn to before me this day of 2( day of , 20 rty Owner Signature of Applicant tint Narne oforopperty Owner Print Namc of Applicant Notary Public Notary Public SHARI MELILLO Notary Public, State of New York i'.o. 011ME6160063 09alified in Westchester County Commission Ex0ires January 29, 20 C941`7 2 8/12/2021 � MN e� W Lr) cc u W / rA w .. N : M4 Fri M er v CLn WI W �J.) .. 4 Ln 0.4 coW aL 4w A ,x 00NO w x x as ~ 'S Z H A j V J U V O U r , �� • � w V " W 'n U U v W QI V W C Zp W z tn F.g °` x o �I a; a z A w z < �yE 4R_C�v� D [ECIE VIED BUILDINa�EPARTMENT 1EP VIL" E OF RYE BROOK MAR 14 2022 938 KING ET RYE BROOK,NY 10573 'wWWAT tQ =0668 VILLAGE OF RYE BROOK k.org BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: '�4A —oO"n" EP#: 0Q-0q Approval Date: MAR 1 5 Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, 3 2 Z is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install an or r move 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. p 1.Address: 10 C Ae 1 4o- L ot n e SBL: (3 s • Le _L 1 S Zone:'C—1e�- Lj#%- mosmer- 2.Property Owner:4r 1 t,%c S h i rk(� o to S Address: Phone#: ;Ld?— od S 3 ^ C Cell#: email: 3.Master Electrician: Grt o L ale r r GG Address: Q 0 W h`t "CI er Lic.#: I N9i Phone#:qly-�sit k,(eSUS Cell#: I I'1--1`4-Li " 9LtgIm 0. ai1: C IV'E -J& O&C"(I� ^�"• Company Name: , Iv d)o r. (Zt✓e r E(e c Address: 4.Proposed Electrical Work/Fixture Count: ID,e,K c 06 C k., yo•..-r,�fi TATE OF//NEW YORK,COUNTY OF WESTCHESTER ) as: being duly sworn,deposes and states that he/she is the applicant ab ve na ed,and does further (print name of individual signing as the applicant) state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the �� for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this `l Sworn to before me this day of c� 03-1- day of Ar ,20 Z,,-, �natur of Prope Owner ature of Applicant t Name of Property wnennr cc �ri �Namepplicant Notary Pu Notat�}.�AM91ELILL0 Notary Public,State�ARI ME Notary Public, State of New York o of f New York N No.Ot I•.tE6160C63 No. 01 I!°iE6160C63 Qualified in Westchester Counh� Cualified in Westchester Countwrz Commission Expires January 29,2 Commission Expires January 29,2 8/12J2021 Westchester Rockland Electrical Inspection Services, Inc Phone: 914-347-3595 DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue �A7�, Fax: g14-347-3596 E NY 10523 ( lmsford ♦ BUILDING PERMIT NO. TEMP N DATIF CRY OR LLAG } \ - Zlq C9 -z TOWNSHIP COUNTIA STREET AND NO.OR ROAD POLE NUMBER BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT OCCUPANT'S NAME P Q r BUILDING OCCUPANCY OWNER'S NAME AND ADDRESS /' r r. J HOME TELEPHONE NUMBEFE 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 FLUORE NO. H.P.EACH NO, WATTS EACH INSPECTION OUTSIDE BASEMENT 1"FL. 2'FL. ILRYE BROOK 3'FL. REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: l 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[-! 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 STREET ADDRESS TELEPHONE NO. CITY OR POST OFFICE ZIP CODE LICENSE NO.WHEN APPUCABLF- IF MIESTCHESTER ROCKLAND ELECTRICAL INSPECTION SERVICES,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: Hudson River Electric Arlene Shirken C/O Scott Shirken &Lynn Mosner 8 Downing Court NY, Irvington 10533 Located at: 10 Carlton Ln Rye Brook, NY 10573 Certificate Number: 1033838 Section: 135.42 Block: 1 Lot: 5 BDC: Permit Number:EP:22-048-BP:DP 22-003 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: 10 Carlton Ln Rye Brook,NY 10573 Basement 1st Floor 2nd Floor 3rd Floor Garage Attic 13 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 03/25/22 Name Type Quantity Demolition Removal of existing electrical work pool equipment 1 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. WG '�� This certificate is valid for work performed before date of inspection only. , N c O N N yr s a w " ~ y u Cn : a � k CA w A W Ldr) z � U Z r 00 Q cc0-14 a" vj C O Z w w o o ° fd� O i V ' z U a on t H o U a � , p ID BUILDING DEPARTMENT MAR - 8 2022 VILLAGE OF RYE BROOK VILLAGE OF RYE BROOK 938 KING STREET RYE BROOx,NY 10573 BUILDING DEPARTMENT (9.14)939-06W' www:iyebrook.org PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY W-W.- b —O O J PP#: C;)Q'030 Approval Date: MAR . Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) ************************************************************************************************** Application dated, 34-cDa 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. p 1.Address: / �� L y �-^N� SBL: �35, / —�r S Zone: F-_I a- 2.ProposedWork: eAP OFf' OA5 L/N,.s —, Z7 f'aoc 17'O ►TC117 3.Property Owner:A se L e b a✓ S N/C Ke 0"j Address: /O 6A 2 G r0/' GA N& Phone#:.D0 3-aS3-O 77 7 Cell#: email: 4.Master Plumber: 1'4" e14/A 1'A,,)A-L-_1 Address: /D.7 toq,_1'APce5 Ave /YA[Q iyot- N 7 Lic.#:<6 -` Phone#: Cell#: q1 y-75S-o7 3 3 email: L'NRIS r Company Name: G/{/✓L R,4 0K Address: /o-7 AW,4"6CS AY4' /yW'0 A/Y /oS 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 1st Floor 2nd Floor 3'd Floor 4m Floor 5d'Floor Exterior 5.*List Other Equipmenv'Provide Details: elff of r4o Poa[ (Notarized Signatures Required Next 2 Pages) -1- si12/2021 4 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: elOYM I A-114,L G ,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 /oG'-'"x n 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 S G r\ ,20," day of 20 v� S gnature of Proper Owner Signature of Applicant �r'oi.-yJtioa L'/�'�A/LA✓rI L int Name of Property caner Print Name of Applicant I& IL H RI &LIA-0 NR it l lic, State of New York N poh�blic, State o ew or r c. 01' 01: t .n160^S3 Qualified n Westche-�ter County Qualified in Westchester County 3 Commission Exnires January 29, 2.0 3 Commission Expires Janua-29.20 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 BAR - $ Z0t2 D ' VILLAGE OF RYE]BROOK 938 KING STPEET RYE BR4)m,NY 10573 VILLAGE OF RYE BROOK (914)939-066$ BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MOST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT. STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: n G c� �, J G=O� )��C , residing at, g 10 AI p (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 a is the legal owner of the property to which this Affidavit of Compliance pertains at; 162 a Zk,/La 15r1V / �� ,Rye Brook,NY. (Jo 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. �ignae Property 0wner(s)) (Print Name 6T Property s)) 1 Sworn to before me this day of �('a � ,20 9'(;� (Notary Public) SHARI MELILLO Notary Public,State of New York No. 014+i E61 EOC63 Qualified in Westchester County Commission Expires January 29,20� an2/2021 Elmsford Ticket No.: 2158513 Warehouse Lane Elmsford, NY 10523 Date: 3/16/2022 Time: 3:32:01 PM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer : 1550-SRL Tare 0 0.00 0.00 Order : 2022-PRICING-2022-PRICING Net 0 0.00 0.00 Cust Job: P.O. : Product: SELSTRUCFILL-Select Structure Fill 22.80 Ton Price 0.01 0.23 Carrier: - Freight 0.00 0.00 Vehicle : - D �� Tax WEST 0.00 0.02 Total: 0.25 MAR 17 2022 Today: 111.60 Loads: 5 VILLAGE OF RYE BROOK Ticketed By: JESSIE LOZADA BUILDING DEPARTMBNg1ev d by: FF Elmsford Warehouse Lane Ticket No.: 2158513 Elmsford, NY 10523 Date: 3/16/2022 Time: 3:32:01 PM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer : 1550-SRL Tare 0 0.00 0.00 Order : 2022-PRICING-2022-PRICING Net 0 0.00 0.00 Cust Job: P.O. : Product: SELSTRUCFILL- Select Structure Fill 22.80 Ton Price 0.01 0.23 Carrier : - Freight 0.00 0.00 Vehicle: - Tax WEST 0.00 0.02 Total: 0.25 Today: 111.60 Loads: 5 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Ticket No.: 21 58513 Warehouse Lane Elmsford, NY 10523 Date: 3/16/2022 Time: 3:32:01 PM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer : 1550 -SRL Tare 0 0.00 0.00 Order: 2022-PRICING-2022-PRICING Net 0 0.00 0.00 Cust Job: P.O. : Product: SELSTRUCFILL-Select Structure Fill 22.80 Ton Price 0.01 0.23 Carrier : - Freight 0.00 0.00 Vehicle : - Tax WEST 0.00 0.02 Total: 0.25 Today: 111.60 Loads: 5 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Ticket No.: 2�5HO27 Warehouse Lane Elmsford, NY 10523 Date : 3/15/2022 Time: 7:34:15AM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer: 1550-SRL Tare 0 0.00 0.00 Order : SR150-497-21-2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. : Product : SELSTRUCFILL-Select Structure Fill 10.60 Ton Price 0.01 0.11 Carrier : - Freight 0.00 0.00 Vehicle: - Tax WEST 0.00 0.01 Total: 0.12 Today: 10.60 Loads: 1 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Ticket No.: 2� 5HO27 Warehouse Lane Elmsford, NY 10523 Date: 3/15/2022 Time: 7:34:15AM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer : 1550-SRL Tare 0 0.00 0.00 Order : SR1 50-497-21-2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. : Product : SELSTRUCFILL-Select Structure Fill 10.60 Ton Price 0.01 0.11 Carrier : - Freight 0.00 0.00 Vehicle: - Tax WEST 0.00 0.01 Total: 0.12 Today: 10.60 Loads: 1 Ticketed By: JESSIE LOZADA Recieved by: FF 'r Elmsford Ticket No.: 2�5HO27 Warehouse Lane Elmsford, NY 10523 Date: 3/15/2022 Time: 7:34:15AM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer : 1550 -SRL Tare 0 0.00 0.00 Order: SR150-497-21 -2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. : Product : SELSTRUCFILL- Select Structure Fill 10.60 Ton Price 0.01 0.11 Carrier : - Freight 0.00 0.00 Vehicle : - Tax WEST 0.00 0.01 Total: 0.12 Today: 10.60 Loads: 1 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Ticket No.: 2158055 Warehouse Lane Elmsford, NY 10523 Date: 3/15/2022 Time: 8:30:25AM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer: 1550-SRL Tare 0 0.00 0.00 Order : SR150-497-21-2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. : Product : SELSTRUCFILL- Select Structure Fill 10.20 Ton Price 0.01 0.10 Carrier: - Freight 0.00 0.00 Vehicle: - Tax WEST 0.00 0.01 Total: 0.11 Today: 20.80 Loads: 2 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Warehouse Lane Ticket No.: 2158055 Elmsford, NY 10523 Date: 3/15/2022 Time: 8:30:25AM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer : 1550-SRL Tare 0 0.00 0.00 Order : SR1 50-497-21-2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. : Product: SELSTRUCFILL-Select Structure Fill 10.20 Ton Price 0.01 0.10 Carrier: - Freight 0.00 0.00 Vehicle: - Tax WEST 0.00 0.01 Total: 0.11 Today: 20.80 Loads: 2 Ticketed By: JESSIE LOZADA Recieved by: FF '7 Elmsford Ticket No.: 215HO55 Warehouse Lane IMI Elmsford, NY 10523 Date: 3/15/2022 Time: 8:30:25AM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer : 1550-SRL Tare 0 0.00 0.00 Order : SR150-497-21 -2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. : Product: SELSTRUCFILL- Select Structure Fill 10.20 Ton Price 0.01 0.10 Carrier : - Freight 0.00 0.00 Vehicle : - Tax WEST 0.00 0.01 Total: 0.11 Today: 20.80 Loads: 2 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Ticket No.: 215H079 Warehouse Lane Elmsford, NY 10523 Date: 3/15/2022 Time: 9:22:31AM Pounds Tons Metric Location: Elmsford Gross 0 0.00 0.00 Customer : 1550-SRL Tare 0 0.00 0.00 Order: SR150-497-21-2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. : Price 0.01 0.11 Product: SELSTRUCFILL- Select Structure Fill 10.80 Ton Freight 0.00 0.00 Carrier : - Vehicle : - Tax WEST 0.00 0.01 Total: 0.12 Today: 31.60 Loads: 3 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Warehouse Lane Ticket No.: 2158079 Elmsford, NY 10523 Date: 3/15/2022 Time: 9:22:31AM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer : 1550-SRL Tare 0 0.00 0.00 Order : SR1 50-497-21-2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. : Product: SELSTRUCFILL- Select Structure Fill 10.80 Ton Price 0.01 0.11 Carrier: - Freight 0.00 0.00 Vehicle: - Tax WEST 0.00 0.01 Total: 0.12 Today: 31.60 Loads: 3 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Ticket No.: 2158079 Warehouse Lane Elmsford, NY 10523 Date: 3/15/2022 Time: 9:22:31AM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer : 1550 -SRL Tare 0 0.00 0.00 Order: SR150-497-21 -2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. : Product : SELSTRUCFILL-Select Structure Fill 10.80 Ton Price 0.01 0.11 Carrier : - Freight 0.00 0.00 Vehicle : - Tax WEST 0.00 0.01 Total: 0.12 Today: 31.60 Loads: 3 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Ticket No.: Warehouse Lane 2158118 Elmsford, NY 10523 Date: 3/15/2022 Time: 10:35:35AM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer : 1550-SRL Tare 0 0.00 0.00 Order : SR1 50-497-21-2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. . Price 0.01 0.10 Product: SELSTRUCFILL- Select Structure Fill 10.30 Ton Freight 0.00 0.00 Carrier : - Tax WEST 0.00 0.01 Vehicle : - Total: 0.11 Today: 64.50 Loads: 5 Ticketed By: JESSIE LOZADA Recieved by: PF 'rElmsford Ticket No.: 2158118 Warehouse Lane Elmsford, NY 10523 Date : 3/15/2022 Time: 10:35:35AM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer: 1550-SRL Tare 0 0.00 0.00 Order : SR150-497-21-2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. : Price 0.01 0.10 Product: SELSTRUCFILL-Select Structure Fill 10.30 Ton Freight 0.00 0.00 Carrier: - Tax WEST 0.00 0.01 Vehicle: - Total: 0.11 Today: 64.50 Loads: 5 Ticketed By: JESSIE LOZADA Recieved by: FF Elmsford Ticket No.: Warehouse Lane 2158118 Elmsford, NY 10523 Date: 3/15/2022 Time: 10:35:35AM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer: 1550-SRL Tare 0 0.00 0.00 Order: SR150-497-21 -2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. : Price 0.01 0.10 Product: SELSTRUCFILL-Select Structure Fill 10.30 Ton Freight 0.00 0.00 Carrier : - Vehicle : - Tax WEST 0.00 0.01 Total: 0.11 Today: 64.50 Loads: 5 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Warehouse Lane Ticket No.: 2158150 Elmsford, NY 10523 Date: 3/15/2022 Time: 11:38:24AM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer : 1550-SRL Tare 0 0.00 0.00 Order : SR150-497-21-2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. : Price 0.01 0.10 Product : SELSTRUCFILL-Select Structure Fill 10.20 Ton Freight 0.00 0.00 Carrier : - Tax WEST 0.00 0.01 Vehicle : - Total: 0.11 Today: 74.70 Loads: 6 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Ticket No.: 215H15O Warehouse Lane Elmsford, NY 10523 Date: 3/15/2022 Time: 11:38:24AM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer : 1550-SRL Tare 0 0.00 0.00 Order : SR150-497-21-2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. : Price 0.01 0.10 Product: SELSTRUCFILL- Select Structure Fill 10.20 Ton Freight 0.00 0.00 Carrier: - Tax WEST 0.00 0.01 Vehicle: - Total: 0.11 Today: 74.70 Loads: 6 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Ticket No.: 2158150 Warehouse Lane Elmsford, NY 10523 Date: 3/15/2022 Time: 11:38:24AM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer : 1550-SRL Tare 0 0.00 0.00 Order : SR150-497-21 -2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. : Price 0.01 0.10 Product : SELSTRUCFILL- Select Structure Fill 10.20 Ton Freight 0.00 0.00 Carrier : - Tax WEST 0.00 0.01 Vehicle : - Total: 0.11 Today: 74.70 Loads: 6 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Ticket No.: 2158185 Warehouse Lane Elmsford, NY 10523 Date: 3/15/2022 Time: 12:27:57PM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer : 1550-SRL Tare 0 0.00 0.00 Order : SR150-497-21-2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. : Product: SELSTRUCFILL-Select Structure Fill 10.11 Ton Price 0.01 0.10 Carrier: - Freight 0.00 0.00 Vehicle: - Tax WEST 0.00 0.01 Total: 0.11 Today: 84.81 Loads: 7 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Ticket No.: 215H1 H5 Warehouse Lane Elmsford, NY 10523 Date: 3/15/2022 Time: 12:27:57PM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer: 1550-SRL Tare 0 0.00 0.00 Order : SR1 50-497-21-2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. : Product: SELSTRUCFILL-Select Structure Fill 10.11 Ton Price 0.01 0.10 Carrier: - Freight 0.00 0.00 Vehicle: - Tax WEST 0.00 0.01 Total: 0.11 Today: 84.81 Loads: 7 Ticketed By: JESSIE LOZADA Recieved by: FF Elmsford Ticket No.: 2158185 Warehouse Lane Elmsford, NY 10523 Date: 3/15/2022 Time: 12:27:57PM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer : 1550-SRL Tare 0 0.00 0.00 Order : SR150-497-21 -2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. : Product: SELSTRUCFILL-Select Structure Fill 10.11 Ton Price 0.01 0.10 Carrier : - Freight 0.00 0.00 Vehicle : - Tax WEST 0.00 0.01 Total: 0.11 Today: 84.81 Loads: 7 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Ticket No.: 2158219 Warehouse Lane Elmsford, NY 10523 Date: 3/15/2022 Time: 1:33:59PM Pounds Tons Metric Location: Elmsford Gross 0 0.00 0.00 Customer: 1550-SRL Tare 0 0.00 0.00 Order : SR150-497-21-2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. : Price 0.01 0.10 Product: SELSTRUCFILL- Select Structure Fill 10.20 Ton Freight 0.00 0.00 Carrier : - Tax WEST 0.00 0.01 Vehicle: - Total: 0.11 Today: 95.01 Loads: 8 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Warehouse Lane Ticket No.: 2158219 Elmsford, NY 10523 Date: 3/15/2022 Time: 1:33:59PM Pounds Tons Metric Location: Elmsford Gross 0 0.00 0.00 Customer : 1550-SRL Tare 0 0.00 0.00 Order : SR150-497-21-2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. : Price 0.01 0.10 Product: SELSTRUCFILL-Select Structure Fill 10.20 Ton Freight 0.00 0.00 Carrier: - Tax WEST 0.00 0.01 Vehicle: - Total: 0.11 Today: 95.01 Loads: 8 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Ticket No.: 2158219 Warehouse Lane Elmsford, NY 10523 Date: 3/15/2022 Time: 1:33:59PM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer : 1550-SRL Tare 0 0.00 0.00 Order : SR150-497-21 -2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. . Price 0.01 0.10 Product: SELSTRUCFILL- Select Structure Fill 10.20 Ton Freight 0.00 0.00 Carrier : - Tax WEST 0.00 0.01 Vehicle : - Total: 0.11 Today: 95.01 Loads: 8 Ticketed By: JESSIE LOZADA Recieved by: F 'rElmsford Warehouse Lane Ticket No.: 2158251 Elmsford, NY 10523 Date: 3/15/2022 Time: 2:28:58PM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer : 1550-SRL Tare 0 0.00 0.00 Order : SR150-497-21-2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. : Price 0.01 0.10 Product: SELSTRUCFILL- Select Structure Fill 10.30 Ton Freight 0.00 0.00 Carrier: - Tax WEST 0.00 0.01 Vehicle : - Total: 0.11 Today: 127.31 Loads: 10 Ticketed By: JESSIE LOZADA Recieved by: F Elmsford Ticket No.: 2158251 Warehouse Lane Elmsford, NY 10523 Date: 3/15/2022 Time: 2:28:58PM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer: 1550-SRL Tare 0 0.00 0.00 Order : SR150-497-21-2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. : Product: SELSTRUCFILL-Select Structure Fill 10.30 Ton Price 0.01 0.10 Carrier : - Freight 0.00 0.00 Vehicle : - Tax WEST 0.00 0.01 Total: 0.11 Today: 127.31 Loads: 10 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Ticket No.: 2158251 Warehouse Lane Elmsford, NY 10523 Date: 3/15/2022 Time: 2:28:58PM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer: 1550-SRL Tare 0 0.00 0.00 Order: SR150-497-21 -2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. : Product: SELSTRUCFILL- Select Structure Fill 10.30 Ton Price 0.01 0.10 Carrier: - Freight 0.00 0.00 Vehicle : - Tax WEST 0.00 0.01 Total: 0.11 Today: 127.31 Loads: 10 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Ticket No.: 2158271 Warehouse Lane Elmsford, NY 10523 Date : 3/15/2022 Time: 3:12:58PM Pounds Tons Metric Location: Elmsford Gross 0 0.00 0.00 Customer: 1550-SRL Tare 0 0.00 0.00 Order : SR150-497-21-2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. . Price 0.01 0.10 Product : SELSTRUCFILL- Select Structure Fill 10.30 Ton Freight 0.00 0.00 Carrier : - Tax WEST 0.00 0.01 Vehicle: - Total: 0.11 Today: 160.11 Loads: 12 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Ticket No.: 2158271 Warehouse Lane Elmsford, NY 10523 Date: 3/15/2022 Time: 3:12:58PM Pounds Tons Metric Location: Elmsford Gross 0 0.00 0.00 Customer : 1550- SRL Tare 0 0.00 0.00 Order : SR150-497-21-2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. : Product : SELSTRUCFILL-Select Structure Fill 10.30 Ton Price 0.01 0.10 Carrier : - Freight 0.00 0.00 Vehicle: - Tax WEST 0.00 0.01 Total: 0.11 Today: 160.11 Loads: 12 Ticketed By: JESSIE LOZADA Recieved by: OF Elmsford Ticket No.: 2158271 Warehouse Lane Elmsford, NY 10523 Date: 3/15/2022 Time: 3:12:58PM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer : 1550- SRL Tare 0 0.00 0.00 Order : SR150-497-21 -2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. : Product: SELSTRUCFILL- Select Structure Fill 10.30 Ton Price 0.01 0.10 Carrier: - Freight 0.00 0.00 Vehicle : - Tax WEST 0.00 0.01 Total: 0.11 Today: 160.11 Loads: 12 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Warehouse Lane Ticket No.: 2158379 Elmsford, NY 10523 Date : 3/16/2022 Time: 10:59:20AM Pounds Tons Metric Location: Elmsford Gross 0 0.00 0.00 Customer: 1550-SRL Tare 0 0.00 0.00 Order : 2022-PRICING-2022-PRICING Net 0 0.00 0.00 Cust Job: P.O. : Product: SELSTRUCFILL- Select Structure Fill 21.40 Ton Price 0.01 0.21 Carrier : - Freight 0.00 0.00 Vehicle: - Tax WEST 0.00 0.02 RYE NY Total: 0.23 Today: 65.40 Loads: 3 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Warehouse Lane Ticket No.: 2158379 Elmsford, NY 10523 Date : 3/16/2022 Time: 10:59:20AM Pounds Tons Metric Location: Elmsford Gross 0 0.00 0.00 Customer : 1550-SRL Tare 0 0.00 0.00 Order : 2022-PRICING-2022-PRICING Net 0 0.00 0.00 Cust Job: P.O. : Product: SELSTRUCFILL-Select Structure Fill 21.40 Ton Price 0.01 0.21 Carrier: - Freight 0.00 0.00 Vehicle: - Tax WEST 0.00 0.02 RYE NY Total: 0.23 Today: 65.40 Loads: 3 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Ticket No.: 2158379 Warehouse Lane Elmsford, NY 10523 Date: 3/16/2022 Time: 10:59:20AM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer : 1550 -SRL Tare 0 0.00 0.00 Order : 2022-PRICING -2022-PRICING Net 0 0.00 0.00 Cust Job: P.O. : Product : SELSTRUCFILL-Select Structure Fill 21.40 Ton Price 0.01 0.21 Carrier : - Freight 0.00 0.00 Vehicle : - Tax WEST 0.00 0.02 RYE NY Total: 0.23 Today: 65.40 Loads: 3 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Warehouse Lane Ticket No.: 2158353 Elmsford, NY 10523 Date: 3/16/2022 Time: 10:02:07AM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer: 1550-SRL Tare 0 0.00 0.00 Order : 2022-PRICING-2022-PRICING Net 0 0.00 0.00 Cust Job: P.O. : Product : SELSTRUCFILL-Select Structure Fill 22.20 Ton Price 0.01 0.22 Carrier : - Freight 0.00 0.00 Vehicle: - Tax WEST 0.00 0.02 RYE NY Total: 0.24 Today: 44.00 Loads: 2 Ticketed By: JESSIE LOZADA Recieved by: F Elmsford Warehouse Lane Ticket No.: 2158353 Elmsford, NY 10523 Date : 3/16/2022 Time: 10:02:07AM Pounds Tons Metric Location: Elmsford Gross 0 0.00 0.00 Customer: 1550-SRL Tare 0 0.00 0.00 Order: 2022-PRICING-2022-PRICING Net 0 0.00 0.00 Cust Job: P.O. : Product : SELSTRUCFILL- Select Structure Fill 22.20 Ton Price 0.01 0.22 Carrier : - Freight 0.00 0.00 Vehicle: - Tax WEST 0.00 0.02 RYE NY Total: 0.24 Today: 44.00 Loads: 2 Ticketed By: JESSIE LOZADA Recieved by: F 'rElmsford Ticket No.: 2158353 Warehouse Lane Elmsford, NY 10523 Date: 3/16/2022 Time: 10:02:07AM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer : 1550 -SRL Tare 0 0.00 0.00 Order : 2022-PRICING -2022-PRICING Net 0 0.00 0.00 Cust Job: P.O. : Product : SELSTRUCFILL-Select Structure Fill 22.20 Ton Price 0.01 0.22 Carrier : - Freight 0.00 0.00 Vehicle : - Tax WEST 0.00 0.02 RYE NY Total: 0.24 Today: 44.00 Loads: 2 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Ticket No.: 2158108 Warehouse Lane Elmsford, NY 10523 Date: 3/15/2022 Time: 10:21:19AM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer : 1550-SRL Tare 0 0.00 0.00 Order : SR150-497-21-2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. . Price 0.01 0.23 Product: SELSTRUCFILL-Select Structure Fill 22.60 Ton Freight 0.00 0.00 Carrier: - Tax WEST 0.00 0.02 Vehicle: - TRUCK-DHK Total: 0.25 Today: 54.20 Loads: 4 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Ticket No.: 21581 O8 Warehouse Lane Elmsford, NY 10523 Date: 3/15/2022 Time: 10:21:19AM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer: 1550-SRL Tare 0 0.00 0.00 Order : SR150-497-21-2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. . Price 0.01 0.23 Product: SELSTRUCFILL-Select Structure Fill 22.60 Ton Freight 0.00 0.00 Carrier: - Vehicle : - Tax WEST 0.00 0.02 TRUCK-DHK Total: 0.25 Today: 54.20 Loads: 4 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Ticket No.: 215$1 O8 Warehouse Lane Elmsford, NY 10523 Date : 3/15/2022 Time: 10:21:19AM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer: 1550-SRL Tare 0 0.00 0.00 Order: SR150-497-21 -2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. : Price 0.01 0.23 Product: SELSTRUCFILL-Select Structure Fill 22.60 Ton Freight 0.00 0.00 Carrier: - Tax WEST 0.00 0.02 Vehicle : - TRUCK-DHK Total: 0.25 Today: 54.20 Loads: 4 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Ticket No.: Warehouse Lane 2158266 Elmsford, NY 10523 Date: 3/15/2022 Time: 2:52:10PM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer : 1550-SRL Tare 0 0.00 0.00 Order : SR150-497-21-2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. : Price 0.01 0.23 Product: SELSTRUCFILL- Select Structure Fill 22.50 Ton Freight 0.00 0.00 Carrier : - Tax WEST 0.00 0.02 Vehicle: - Total: 0.25 Today: 149.81 Loads: 11 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Warehouse Lane Ticket No.: 2158266 Elmsford, NY 10523 Date: 3/15/2022 Time: 2:52:10PM Pounds Tons Metric Location: Elmsford Gross 0 0.00 0.00 Customer : 1550-SRL Tare 0 0.00 0.00 Order : SR150-497-21-2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. : Price 0.01 0.23 Product: SELSTRUCFILL-Select Structure Fill 22.50 Ton Freight 0.00 0.00 Carrier: - Tax WEST 0.00 0.02 Vehicle: - Total: 0.25 Today: 149.81 Loads: 11 Ticketed By: JESSIE LOZADA Recieved by: IF 17Elmsford Ticket No.: 2158266 Warehouse Lane Elmsford, NY 10523 Date: 3/15/2022 Time: 2:52:10PM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer: 1550-SRL Tare 0 0.00 0.00 Order: SR150-497-21 -2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. . Price 0.01 0.23 Product: SELSTRUCFILL- Select Structure Fill 22.50 Ton Freight 0.00 0.00 Carrier: - Tax WEST 0.00 0.02 Vehicle : - Total: 0.25 Today: 149.81 Loads: 11 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Ticket No.: 2158231 Warehouse Lane Elmsford, NY 10523 Date: 3/15/2022 Time: 1:59:21 PM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer: 1550-SRL Tare 0 0.00 0.00 Order : SR150-497-21-2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. : Price 0.01 0.22 Product: SELSTRUCFILL-Select Structure Fill 22.00 Ton Freight 0.00 0.00 Carrier : - Tax WEST 0.00 0.02 Vehicle: - Total: 0.24 Today: 117.01 Loads: 9 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Ticket No.: Warehouse Lane 2158231 Elmsford, NY 10523 Date: 3/15/2022 Time: 1:59:21 PM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer : 1550-SRL Tare 0 0.00 0.00 Order : SR150-497-21-2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: Product SELSTRUCFILL-Select Structure Fill 22.00 Ton Price 0.01 0. 22 Carrier : - Freight 0.00 0.0000 Tax WEST 0.00 0.02 Vehicle: - Total: 0.24 Today: 117.01 Loads: 9 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Ticket No.: 2158231 Warehouse Lane Elmsford, NY 10523 Date : 3/15/2022 Time: 1:59:21 PM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer: 1550-SRL Tare 0 0.00 0.00 Order : SR150-497-21 -2021-497-PRODUCTS Net 0 0.00 0.00 Cust Job: P.O. : Price 0.01 0.22 Product : SELSTRUCFILL- Select Structure Fill 22.00 Ton Freight 0.00 0.00 Carrier: - Tax WEST 0.00 0.02 Vehicle : - Total: 0.24 Today: 117.01 Loads: 9 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Ticket No.: Warehouse Lane 2158447 Elmsford, NY 10523 Date: 3/16/2022 Time: 1:07:53PM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer : 1550-SRL Tare 0 0.00 0.00 Order : 2022-PRICING-2022-PRICING Net 0 0.00 0.00 Cust Job: P.O. : Price 0.01 0.23 Product: SELSTRUCFILL-Select Structure Fill 23.40 Ton Freight 0.00 0.00 Carrier : - Tax WEST 0.00 0.02 Vehicle : - Total: 0.25 RYE NY Today: 88.80 Loads: 4 Ticketed By: JESSIE LOZADA Recieved by: Elmsford Warehouse Lane Ticket No.: 2158447 Elmsford, NY 10523 Date: 3/16/2022 Time: 1:07:53PM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer: 1550-SRL Tare 0 0.00 0.00 Order : 2022-PRICING-2022-PRICING Net 0 0.00 0.00 Cust Job: P.O. Price 0.01 0.23 Product : SELSTRUCFILL-Select Structure Fill 23.40 Ton Freight 0.00 0.00 Carrier: - Tax WEST 0.00 0.02 Vehicle: - Total: 0.25 RYE NY Today: 88.80 Loads: 4 Ticketed By: JESSIE LOZADA Recieved by: IF '7Elmsford Ticket No.: 2158447 Warehouse Lane Elmsford, NY 10523 Date: 3/16/2022 Time: 1:07:53PM Pounds Tons Metric Location : Elmsford Gross 0 0.00 0.00 Customer: 1550-SRL Tare 0 0.00 0.00 Order : 2022-PRICING -2022-PRICING Net 0 0.00 0.00 Cust Job: P.O. : Price 0.01 0.23 Product : SELSTRUCFILL-Select Structure Fill 23.40 Ton Freight 0.00 0.00 Carrier : - Tax WEST 0.00 0.02 Vehicle : - Total: 0.25 RYE NY Today: 88.80 Loads: 4 Ticketed By: JESSIE LOZADA Recieved by: Building Permit Check List&Zoning Analysis Address: l A C AJLL-r,0►.0 L,l,-,r SBL t 3 S d-2 - - S Zone:71 t Z Use: Z( Const.Type: Other. Submittal Date: 3 2 Z Revisions Submittal Dates: Applicant: �.4 t eL�1� Nature of Work: iti Reviews:ZBA: MAR - 7 2022 PB: BOT: Other. 1�1 OK ( ( ) FEES:Filing. BP: l .-�� ' �-C/O: Legalization: ( ) ( ) APP: Dated Notarized: SBL: Thus 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 Stamped: Sealed Copies: Electronic: Other. ( ) ( License: '/ Workers Comp: / Liability. -'7-Comp.Waiver. Other. (J�rs (Jl CODE 753#: Q 3 Q7Q—cam I-Soh--oo Dated: N/A: (� ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit: N/A Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H.W.I.C.:_Battery:_Other. (JJ ( ) 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: APPROVED REQUIRED EXISTING PROPOSED NOTES Aug: Date: MAR 7 20" Cu : Fro F� E� Main Cov AccL Cov Ft�-,/Sb: Sd.H/Sb: SrFA: Tot, Ft.imp HciWx/storks notes: il n f i4or" AG� tAA / .iwAy�l+ SIi�Ai --�./ ♦ii-A �.:T , �:�;� 0� t r''' .C4 h' 0.• h1 "�'a� ( 0 ."�L"�i . .0.. Y;5'55�151 ..toy! 5' .", O 'N,ly �'••Ct�1r,..t,��• •' � t � y Iy� .`, r!a•••H � - ♦�r 1 � tl �� gir. v _ ' Nr�� g�,� �D•r.'� �y�4� 1� g� -.��_s1 111/////111.° .1111/1/1111.. ::1�1111//111 �� •:1111/111111- �� 11111/111' 'ri 6' •..I IIIj1/1js1.-,- •-r1111/1/1f11 s�� r \ 1 1�•?-:, st''..11 111 a;::: :_'-1 1 1 1 1 1.. �„� I ��I�-I 1 ��_ �r I��Oi>� :.Ill/lfl,�•'.it .••:•NIII.. �, s / t'<.1 /1 .:11111 s��:.1►NI.:'13;:;.�� ..IINI_-:�, i m<(o)>' I rr r N 2�• ', t. 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'i'�cnYa'f '��?.nvl2+' '• '--�" '.w+j•�},�b, _vl�";v '. �v„�, .. �1 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDNYYVY) os/1s/2o21 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 ER.POL THIS BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING ORDERINSURE BY 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 Robert Forbes Robert J Forbes NAME:_ _ dba Forbes Insurance A nc PHONE FAx 9e Y C.Na.EEa u: 562 Commerce Street E-MAIL lac NuI Thomwood,NY 10594 o--" — ---._—._-- --- MMURWSJ AFFOnOMIG CoVatAaE NAIL e — _ _ __ INSURER A: FMM Lake National Insurance Company 31925M INSURED Losat Construction Co Mc STATE INSURANCE FUND 12 Foley Road INSURERS: _ 36188 Katonah.NY 10536 INSURER.c: SHELTER P6NT LIFE INSURANCE CO A05116 INSURER D: --- - - - _INSURER E. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BFLOW 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 l� TYPE OF INSURANCE - —- •--- — y -7--/p�LY OP POLICY i NkAlm A toEMIMCIAL GOORAI UYIMR.ITY LIMITS_ SKP2013602 04/18=21 04/16/2022 EACH OCCURRENCE s _ 1.000.000 DAMTr�_-CWMSMADE OCCUR PRIrEMI, IEaWtuMo,l 3 100.000 --- - — I l MEDEXtMp«r puma)—S — 5,000 GENT AGGREGATE LIMIT APPLIES PER _PERSONAL d ADV INJURY S 1,000,000 POLICY❑ LOC GENERAL AGGREGATE f 2,000,000 PRODUCTS_COMPIOP AGO S 2,000,000 OTHER ArT'OMONLE LIANUTY s N ANY AUTO i i tEa acuggng = OWNED SCHEDULED BODILY INJURY(Per p"W) t AUTOS ONLY AUTOS 80DILYINJURY(Peratud" E- — MIREO II---1 NONOWNED _ AUTOS ON_Y AUTOS ONLY PR : �lP Ott UMBRELLA LIAR -— :-- {....�I OCCUR EACH OCCURRENCE I: �EXCESS LUIa_ I I�� I+-- 1LLL111 AGGREGATE _ OED I RETENTION E -- _—_ B WORKERS COMPENSATION W14848067 f AO KERSCOEMPLOYERS'LL&BILITyION 07/11l2021 07111/2022 .IACTAIS1tE_ 1•:N v PPr—!:TnP,PARTAERir1fECUTIVE YIN OFFICER,MEMBER EXCLUDE ❑ NIAJ E L,EACH ACCIDENT f 100000 (Menastory in NH) _ If issaa E L_OI d scribe un OPERATIONS tleba SEASE•EA EMPLOYEE— s 100,000 n C Disability E.L ISEASE POLICY LIMIT S 500,000 O4193T2 01/01/2021 01101,2022 Statutory Limits I � I , DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (ACORD 101,Adds onal Reaanls Schsdllr,Maur Oe 98*thed M wAm sp ace Is raVwndl Carpentry-All Locations-Exludes Roofing 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. Building Department 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook. NY 10573 ,)1988-2015 ACORD CORPORATION. All rights reserved ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD NYSIF New York State insurance.rij_4 WESTCHESTER ONE,44 SOUTH BROADWAY.LOTH FLOOR,WHITE PLAINS,NY 106014411 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) 0-0*.� AAAAAA 133275833 FORBES INSURANCE AGENCY 562 COMMERCE ST THORNWOOD NY 10594 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER LOSAT CONSTRUCTION COMPANY INC 12 FOLEY RD VILLAGE OF RYE BROOK KATONAH NY 10536 938 KING STREET RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD W1484 606-7 937723 E-7 07/11/2021 TO 07/11/2022 DATE 9/16/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1484 606-7, 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. VISI1 OUR WESSITE AT HTTPS //WWW.NYSIF.COMIC ERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. DAVID SATENSTEIN-PRESIDENT OF LOSAT CONSTRUCTION COMPANY INC 1 OF 1 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 STATE INSURANCE FUND DIRECTOR.INSURANCE FUND UNDERWRITING VALIDATION NUMBER:934610108 U-26 3 Laura Petersen From: Dig Safely New York Exactix <tickets@exactix.digsafelynewyork.com> Sent: Monday, March 7, 2022 4:54 PM To: Mike Izzo Subject: Message from Dig Safely New York, Inc. (DSNY) ****REGULAR**** DIG REQUEST from DSNY for: VIL RYE BROOK Taken: 03/07/2022 16:52 To: VIL RYE BROOK PRIMARY Transmitted: 03/07/2022 16:53 00011 Ticket: 03072-001-506-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 10 To: Name: CARLTON LN Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: BACK OF THE HOUSE ON PROPERTY NearSt: BONWIT RD Means of Excavation: MINI EXCAVATOR, SKID STEER Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: FILL IN IN GROUND POOL Estimated Work Complete Date: 03/14/2022 Depth of excavation: 7 FEET Site dimensions: Length 40 FEET Width 20 FEET Start Date and Time: 03/10/2022 07:00 Must Start By: 03/24/2022 ------------------------------------------------------------------------------ Contact Name: DAVID SATENSTEIN Company: LOSAT CONSTRUCTION CO INC Addrl: 12 FOLEY RD Addr2: City: KATONAH State: NY Zip: 10536 Phone: 914-906-4373 Fax: Email: dave@losatconstruction.com Field Contact: DAVID SATENSTEIN Alt Phone: 914-906-4373 Working for: SHIRKEN ------------------------------------------------------------------------------ Comments: WILL BE MARKED Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA CONED SUEZ WTR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR i V) z mot- w • w O LC) titLL- Lo CV �-"- L) � N N Ir A-a X IV— \ 0 Qo I Ljj N Qcl. co En O _1 0 O ---- �. o�c wi Z I W \\� Li0 /� 00�` ° m h IL EL O • I �oo s�� c I 3 «oo,C-e.6o N z � -� v_3 �3 -~ � � E V �O Q v _ ---- uaA Ilo �! �'8 sod olWaH � o M0 � ii cr ��QXD X X X X X X �1JJ � t X ( 4-1 ! 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CD o m I h P o N- youa co '� Q 0� Q> > 3 � O M cy pk h pooh c �� g h `D N 3 `60' a� `y 0 O VL x� N Q Q ` � ° z i .� c cV �V 0 o z � .. v •- cy M 3 d 0 v p �, �, x V) w 'lb o N = (n m Q o s'_n v s O = Q W ._ •- 0 3 O• , cn 0 .C �.. °� 0 1 o ��--� O c z .O, 'cam v �' 0 LL- Q1 0 � 1 01 > ww �oN ON � � LLJ D o v Y °a REc [ED D �wr Property: 10 Carlton Lane, Rye Brook, NY 10573 MAR - 4 2022 Owner: Estate of Arlene Shirken VILLAGE OF RYE BROOK Applicant: Scott Shirken, Executor BUILDING DEPARTMENT��-- --��---�--- Contractor: LOSAT Construction Scope of Work: • Removal of wood deck Removal of all construction materials Removal of all footings above ground Area to be graded and cleaned ready for grass seeding All work to be completed by a licensed contractor/subcontractors in compliance with applicable Village of Rye Brook and New York State Building Codes • Removal and filling of pool Pump pool Remove vinyl liner and all construction materials associated with the pool installation including but not limited to support frame, coping material, and stairs Area to be graded and cleaned ready for grass seeding Fill pool area with appropriate material in accordance with Village of Rye Brook and New York State Building Codes Disconnect gas to pool heater Disconnect electric to pool equipment All work to be completed by a licensed, insured contractor for each phase of the project: plumbing, electrical, demolition and pool abandonment with all applicable permits as required PERMIT SBL# DATE APPRO MA BUILDING INSPECT II ge of Rye Brook,NY SURVE A REQUIRED PRIOR TO FINAL INSPECTION `s 'a •a `e `a % % ., V I Nt � J • � � - Oz� O LC) • O IAs LL- L) O oa > z U i p O i O COLi E: m I ~- 6 %-.,k 0 < aouad Ilo ISod v0 UL' H � ° Mod m r ---� x x x x x x x 0 LL- � I +_J ri X o Li 0 X —X X X X uad p o 0M 0 a o u a p o o M Z.- U-F•- I I N w -----J LC) 0o x - �; r-----� m J r- .11 U-) W X I „�, I N c, v X . •— O o W z � cn v W � N CL S o m 9 } > w raj x / Z Q Z Z _� oo c qJ � � auo � S W W 3r. � U o o w U � O V) > O N ' m o .� W O w Q , o M �toManla,� doMoo18 O ci mi V) O O Lo E0 0 C3 ---- I L 00 z ZLi r— LC)c . m vm ° I I °Al u o �X o O O x S Z W Q a L O O N r- _ 7- :2L----� w L f- 0 .ac �J O w -- Q) L� V) L.LJ c a� vCL 0 �-.- v 0 m 4-; Z: Z +, to w O�� 1�\ x 3 T II O 0 � v o-o Cl. 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