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HomeMy WebLinkAboutBP22-031PERMIT #A — O3 _ DATE: EXP: �� CX of Ire SECTION /J7• TYPE OF WORKo6 JOB LOCAT� OWNER/ _/ CONTRACTOR EST. COST �CO /tj:2 TCO # LOT �sC)o-rA --- - , �L'�S' �.: XW7 NOW FEE qt FEE DATE i�itl! may! FEE DATE INSPECTION RECORp DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION _f PLUMBING PGH PLUMBING GAS 0 Sr RINKLER ELECTRIC 52 LU:`•! v'NLT O 6. c AS L: L. I LT O T INAL •�i�� - Oln 3/J'airr�s � Sy%�Q �f2c �i c OTHER APPROVALS ARB BOT P8 Z8A (OTHER VILLAGE,6PAyE BROOK WESTCHESTER Couly, Nrw YORK NO: 24-016 Certificate of ®ccupaucp This is to certify that /l h / of, 8 yo having duly filed an application on Ae—hyua l Cy c'? 20 4requesting a Certificate of Occupancy for the premises known as, z C-.� kcr-'L R1 D Rye Brook,NY, located in a Zoning District and shown on the most current Tax Map as Section: 15. 5 Block: Lot: , and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. p;" , issued \3 20 02Z2, 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: o Construction: , for the following purposes: Lie I ze, -16 Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of the building or in the exit facilities shall be made,and no enlargement, whether by extending on any side or by increasing in height shall be made,no all the building be moved from one location to another until a permit to accomplish such change h been obta' from a uild' Spector. Building Inspector,Village of Rye Brook: Date: F E B 2 6 2024 RF ` C R�� For office use on] BUILD , MENT PERMIT# — / FEB ' 2 2OZ4 VIL OF RYE OK ISSUED:13-� -r - 8 KING STRE YE BROOK, �V YORK 10573 DATE: —Q-07 VILLAGE OF RYE BROOK > 9 -06 O�� FEE: ,Ll�— PAID 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 rtrt+wrtrtsssiitisiititissstssi/s/iiiiiirt+*.*..+***.*waasaaasrssas+w**s*****s*s****w*s*w**+***+**rt*s*s**+srtsatwswwas+wtrtwwswsrt*+*** Address: b R I OGc R /AL D rj ye— Occupancy/Use: Parcel ID#: � �, �� �— 5a Zone: Owner: Ph Z%f/ 0//o Zr' /9Lt Y& S 67h o Address: 1 jC' Ra'k���L ��,'✓� P.E./R.A. or Contractor: A, w t:?►e,s Address:�o�)ee 0ac) )0 k5 C/ A)Y Person in responsible charge: 2 rdrre 'Dixoi✓ Address: < < < t 0 S 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: / I being duly sworn,deposes and says that he/she resides at le 4o e k / ' (Print Name of Applicant) (No.and Street) ill 'eye 13/o'k _ _ _ ,in the County of in the State of&Z,that City/Town/Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$ 900.00 , fortheconstructionoralterat ion of: LeS4.i�e Z./,eroA. &ao✓,,ti i-e..,a. 1� S�v� _l��,.C_c.y 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-IO.A.of the Code of the Village of Rye Brook. Sworn to before me this Sworn to before me this day of 20_'),X day of , 20 Signature of PropertfOwner Signature of Applicant O , Prin off Property Owner Print Name of Applicant Notary P*iimry Public,State of New York Notary Public No.01ME6160063 Qualified in Westchester County Commission Expires January 29,20 S/12 2021 O� 2m Q�/� •F6 '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 ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : I ( � ��C,\ 1 DATE: ( PERMIT# � 7 1 ISSUED: -I "ZZ SECT: �jS� �� BLOCK: _LOT: LOCATION: -R-�7A SI IIIA . OCCUPANCY: G /V ❑ Violation Noted THE WORK IS... VPASSED ❑ FAILED /REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION - �1 n ❑ Natural Gas J } �� ��.�P , �� c• 1 c��� ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL ❑ OTHER �E BRC�� O� 2m '9a2 BUILDING DEPARTMENT ❑_ BBUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK E► ❑CODE ENFORCEMENT OFFICER 938 King Street• Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org, - - - - - - - - - - - - - - -- - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS :- ' y `` nc- K I Atz e I vq DATE: - J L PERMIT# 2 y - 19 I ISSUED: 2-/6-2 SECT: /J --?5- BLOCK: LOT: -5 a LOCATION: e nu- N OCCUPANCY: G /U ❑ Violation Noted THE WORK IS... PASSED ❑ FAILED /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 J ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL ❑ OTHER QyE BRnuk o`` tim w � '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.ryebrook.ore - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : DATE: PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: OCCUPANCY: VIOLATION NOTED THE WORK IS... ❑ ACCEPTED �' REJECTED/ REINSPECTION SITE INSPECTION REQUIRED FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ll ❑ NATURAL GAS Q1 ol �o❑ L.P.GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ` J ❑ FINAL V 1 ❑ OTHER ell M M • .v. > � 9+Li m 4 M CL uj 4i a HO Lin a a •en 4 a U � = t ll7 Q 0 A 0 y v wi. '2 Go N M �. y 2 C) U W N dk`, 00 O 00 cs 00. 00 O W M w° c N A q U � u j _ o o V z a� ^7 O o p V v 7s .b 11 a q04 ~j a 000 ' 00 1 as �cy ~ o z z Q wcda Etta oz 0.0 ZO. Cc �W a !� Zb HawS � � H W � z H w w p o �' y 0 a � �a414a4;414410aa44;41414941904;a4; 4&4;a94;4;944;4;G4;4;4141,461 D ECEMED BUILDING DEPARTMENT 11 VILLAGE OF RYE$ROOK MARZQ2Z 938 KING STUET RYE$RoOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK BUILDING DEPARTMENT v�v,r�t�urook erg INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: MAR 1 4 2022 11` Approval Date: t#: Q Application Fee: S Approval Signature: Permit Fees: S 0 `b�V.__ Disapproved: , Other: Application dated: is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing building, �or�for a�csh"ange in use,as per detailed statement described bellow. 1. Job Address: I C.� ly t'-( Q `/�3 SBL: I3J,3 5--l-�e Zone: i4L9-10V 2. Proposed Improvement.(Describe in detail): -►( - s �,l fit, 3�c I ass �•S`r o��.� �L PAIA 3. Does the propose improvement involve a ome-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: Yes: If yes,indicate: TIER I; TIER II: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) :No: Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 5. Occupancy;(1 fain.,2 fam.,comm.,etc...)Prior to Construction: "`' After Construction: �t 6. N.Y State Construction/Classification: 1- N.Y.State Use Classification: k+1 7. Property Owner: le r Address: /i RQ k- 'C' ie 2)'-"V e yr n�f,Nf�oS 73 Phone# g 1 Y 4 3 Q U o S Cell# 11/,V 37y 3 Z 5'S email: ,p L l a 8. Applicant: C, f )(--rA Address: J Phone#4 Cell /L -� �� email: =! ✓I )&LJOC7r1If CA j4- 9. Architect: Address: Phone# Cell# email: 10. Engineer; Address: Phone# Cell# email: 11. General Contractor: rat '�'2L n l t�� Address: Phone# Db"Z f 6 Cell#11 t{-'Lf '�'� ����� email: (''4�C��� �'-� �L�-�• �c' � 12. Estimated cost of construction $ , yt�-f4 (NOTE:The estimated cost shall include all lab r material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 13. Job Timetable:Start: Finish: (1) 8112ntnl pLCENE BUILDING D-9PARTMENT VILLAGE of RYE SPOOK MAR 1 1 2022 938 K NG$t1WET RYE BRQ0%NY 10573 VILLAGE OF RYE BROOK 9�4' 0G BUILDING DEPARTMENT MM4 X_ AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: residing at, �s IracA /��' c !�✓cr ��/ �r+ e(iYeliT-7i name) IV (Address wh a 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; (F l�vc �� f ✓� /�•�C/�(/y S 7 3 , Rye Brook,NY. (Job Address) Further that all statements contained herein are true, and that to the best of his/her knowledge and belief,that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer,and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. �N_ ( Q'�_ (Signature of Property Owner(s)) 1% fir (Print Name of Property Owner(s)) Sworn tnbefore me this u day of �v , 20 ZZ (Notary Public) WILSON ALCANTARA NOTARY PU BLIG STATE OF NEW YORK (2) Registration No.O 1 AL6419415 Qualified in Westchester t� sn2/2021 My Commission Expim: D IECIEMED 2 This form must be properly completed & notarized by the Desi sg&ak 42022 record and the Property Owner. Failure to provide this complet fed E BROOK permit application will delay the permitting pros s.BUILDING DEPARTMENT Notice of Utilization of Truss Type, Pre-Engineered Wood, or Timber Frame Construction. (Title 19 Part 1264& 1265 NYCRR) To: The Building Inspector of the Village of Rye Brook. From: / /ter 4e Z��� Subject Property: SBL: Zone: Please take notice that the subject; ❑ One or Two Family; ❑ Commercial, ❑New Structure o Addition to an Existing Structure ❑ Rehabilitation to an Existing Structure to be constructed or performed at the subject property will utilize; ❑Truss Type Construction(TT) ❑Pre-Engineered Wood Construction(PW) ❑Timber Construction(TC) in the following locatiou(s); ❑Floor Framing,including Girders&Beams(F) ❑Roof Framing(R) ❑Floor Framing and Roof Framing(FR) Please note that prior to the issuance of the Certificate of Occupancy, the subject dwelling or building utilizing truss type, pre-engineered wood, or timber construction must be posted with a Truss Identification Sign, installed in conformance with NYCRR§1264 for Commercial Buildings, and NYCRR§1265 for One&Two Family Dwellings. Sworn to before me this illy Sworn to be e this M day of r i y 20 7-1- day of 20 Signature of Irroperty Owner Signature of Design Professional , Print Name of Pr ope wn Print Name of Design Pr f ssional Notary Public Notary Public WILSON .ALCANTARA WILSON ALCANTARA NOTARY PUBL1t FA'FE OF NEW YORK NOTARY PUBLIC,STATE OF NEW YORK Registration No.01 AL6419415 (3) Registration No,Ol AL6419415 Qualified in Westchest 0u9tY Qualified in Westcheste C ty My Commission 'Expires:p ° oz5 My Commission Expires: nt dZ 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. �ST'— -%r_kmW YnDY r.nrnKrrY OF Ww''QTCHESTER ) as: bung duly sworn,deposes and states that he/she is the applicant above named, (pnin name or,....... gab u e appnL—., and further,stJes that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the A, ` ,B t(,"' for the legal owner and is duly authorized to make and file this application. (indicate arcl�t,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. t� Sworn to before me this /y Sworn to before me this day ofG/t✓ , 20 day of 45 ,20 Signature of Property Owner Signature of Applicant ,O4/" d/.-, :T �Dk► (f-- -a Print Name of Property Owner Print Name of Applicant Notary Public Notary Public WILSON ALCANTARA WILSON ALCANTARA NOTARY PUBLIC,STATE OF NEW PORK NOTARY PUBLIC,STATE OF NEW YORK Registration No.01 AL6419415 Registration No.01AL6419415 Qualified in Westchester oyn Qualified in Westchester Co My Commission Expires:o n 6 Z IMY Commission Expiresv6 In��Zo'Z (4) 811 212 02 1 f* = M N o x W m u ►-i w tf) > o. W tA L Z 7 N00 'IT tn ~ t4c x M Qi W O s H L tn en O �y ern v w Z o W A o �I 1 .a W rA o •." w z o cn = en Cs CN ° z � cl, V A a w w zz _ -- w L6 W o v U z c z ~ 0 V r 00 z BUILDING DEPARTMENT DECIEME VILLAGE OF RYE BROOK 938 KINGSSTREET RYE BROOK,NY 10573 APR - 1 2022 "(9l 4)939-0668 www.U6brook.org VILLAGE OF RYE BROOK ELECTRICAL PERMIT APPLICATIO BUILDING DEPARTMENT Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP #: '� Z �� El'#: Q;�>� Approval Date: APR 12022 Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) ************************************************************************************************** Application dated, 11 ��_is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install an 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. r 1.Address: /$ R OC.k V_ O Gt le �2 SBL: /35 i 3J —/5 Zone: 2.Property Owner: PV11,1 ` ,P 0 4 O Address: Phone#:����7 3 / 00 Op / Cell#: email: 3.Master Electrician: Address:SZ 2, gACN1 M O Z 1�0 '- t Lic.#: 13g7 Phone#:ajLj,bp?js-�q Cell#: email: �QgAe o�aMd6V6At _ rW_-e_Cri► Company Name: :3�w F6 A C—LEC--nZ I. Address:622 FO'AMM0 1?d. MAIH�IG _Nf 10 4.Proposed Electrical Work/Fixture Count: STATE OF NW YORK,COUNTY OF WESTCHESTER ) as: �A Q S S ✓%�L ,being duly swom,deposes and states that he/she is the applicant above named,and does further (print name of i n ividual signing as the applicant) r r( state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the Q 2C+� Ca �� ro-C-L - for the legal owner and is duly authorized to make and file this application. tindicate architect.contractor.went.alturne.,ctc. 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 is l l day of ,20 d of � ,20 2- Signature of Property Owner Signature of Applicant �f.vie— Print Name of Property Owner Print Na of Applicant JENNIFER S NOTARY PUBLI N RK Notary Public No.04 c t6valified in West hester Cot�trty My Commission Expires 09-09-202e 8/12/2021 Westchester Rockland Electrical Inspection Services, Inc. Phone: 914-347 3595 DO NOT WRITE HERE—FOR OFFICE USE ONLY 43 North Lawn Avenue r� � Fax: 914-347-3596 • Elmsford, NY 10523 I BUILDING PERMIT NO. TEMP k DATE CITY OR VILLAGE CODE TOWNSHIP COUNTY ZIP . C--K i 41''`� 7--6 �S STREET AND NO.OR ROAD -� POLE NUMBER BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT OCCUPANT'S NAME BUILDING OCCUPANCY OWNER'S NAME AND ADDRESS n HOME TELEPHONE NUMBER CURRENT SUPPLIED BY FROM THEIR OFFICE WORK TELEPHONE NUMBER LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS NO.OF FIXTURES& MOTORS HEATERS OFFICE USE LOCATION LAMP RECEPTACLES ONLY SIDEWALL SWITCH INCADE FLUORE NO. H.P.EACH NO INSPECTION OUTSIDE L2 CC Hy BASEMENT 1"FL. 2-FL 3�FL. 131.111-DiNG DEPARTMENT REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: r 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 APPUCATION. SIZE OF SERVICE FEEDERS CHARACTER OF WORK NEW J ADDITIONAL❑ EXPOSED❑ CONCEALED❑ MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD❑ UNDERGROUND❑ L !LJ—; ti G 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 >sTREEf A0011®8 TELEPHONE NO. a CRY OR POST OFFNW. LP COD000 LKC NO.WHEN APPLM451LE WESTCHESTER ROCKLAND ELECTRICAL INSPECTION IRE15SERVICES,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: James A Stone Electric Philip& Phyllis Olio 522 Fenimore Road NY, Mamaroneck 10543 Located at: 18 Rock Ridge Dr Rye Brook, NY 10573 Certificate Number: 1034170 Section: 135.35 Block: 1 Lot:52 BDC: Permit Number: EP:22-063-BP:22-031 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: 18 Rock Ridge Dr Rye Brook,NY 10573 C5 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 04/15/22 Name Type Quantity Basement&bathroom Reinspection-Basement&bathroom ------- 1 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. �`��� This certificate is valid for work performed before date of inspection only. / z i ^ \ LL O z W CN W x fq W vLn W 04 0 ai •� Ln �/O A i+i O w =o w � � � . O H � �, W N H = c �' ono ►�, Q z in kn co A ,!�' � w �/ � w � \ O poi W � / w z1-1 � E„i QO p0Ot. ° v �*: z U z c/) _ j \ rr W I a f W 11 M �� r TO • Q (� C/7 � O a- A 00 cn oz' N a N o $ •- oG W F, w Ho z �+ z � o o ;D w � 00 z A a CIO .41 CA a 4a4;po Ogg go ago�� R ECENE 'UIL E MENT FEB 12 2024 VIL E OF RYE OK 938 KINO.. ET RYIE B ,` ,NY 10573 VILLAGE OF RYE BROOK \ BUILDING DEPARTMENT w .or PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: CQ�)—0�s / PP#: �— Approval Date: Permit Fee: $ Approval Signature: V Disapproved: ` (fees are non-refundable) DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR.THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12% OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated, Z Z is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/or femove 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: Ig /rj e c 'elecc ,Of/Ve SBL: /3S 3 5-i-Sa Zone; 2.Proposed Work: TO 3.Property Owner: /0171L U C/U ,A /� /ddress: �Q C��l*��`E /�0• Phone#: Cell#: Lh 4-3 77— 3o7SS email: 4.Master Plumber: �.S j�Ve / COL/J�/CCLO Address: /O S t�Ce%"xT sT Lic.#: 4 �qq i !Phone#: 777'GGdrG Cell#: y9C_S�SGS email:t:GCi¢�✓GABL ui r-161 ;Q 0_-%� Company Name: B�CL C oC�f.tiGN�a /�Gd( ACC. Address: /V r i INDICATE FIXTURES&LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement / 1 st Floor •J 2nd Floor 3`d Floor 4"Floor 5"Floor Exterior 5.* List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) I- STATE OF NEW YOORK,COUNTY OF WESTCHESTER ) as: S/"2VeN (cgf,f 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 archite ,contractor, gent,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 l ) day of �� 20 day of k 20 a �� tgnaHoferty Owner Signature of Applicant 4 P ' t Name o roperty Owner Print Name of Applicant S ARI Notar3NVlAMJDubiic,State of New or MELILLO No.01ME6160O63 ry u ic,State of New York Qualified In Westchester County No.01ME6160063 3cn-imission Expires January 29,20Zl Qualified In Westchester County oommiss!on Expires January 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. -Z- an 2i2o21 BUIq4) MENT D `� �/ VILOF RYE OOKID 938 KING RYE BR., ,NY 10573 FEB 12 2024 939-0668 �;ebrook.ony VILLAGE OF RYE BROOK 'If 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 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: 31, �� �! , residing at, l E X Pc z" �l �� �l� lir (Print name) (,address where you li%c) 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; /k �y��' �V"V--C , 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. (Signature of Proper -Owncr(s)) (Prim Namc of Properly Owllcr(s)) Sworn to before me this day of �� (�s� , 20Z�_ (Notary ublic) SHARI MELILLO Notary Public,State of New York No.01ME6160063 Qualified in Westchester County Commission Expires January 29,201- -3- 8/12/2021 Building Pe rmit Check List&Zoning Analysis Address: � ��G FL 1� ��L SBL �. l - Z Zone: 1_2-1 0 Use: 2 Const.Type: 321. Other. Submittal Date: I2 2 Revisions Submittal Dates: Applicant LI Nature of Work: LF C A 1-1 L►,J't'p-fL,.0 CL - y!��oy-a -1-, ► rR��k lL- RReeviie]ws:OZBA: MAR 14 2022 PB: BOT: Other. r ( ( ) FEES:Filing: 7 S r1r> BP: + '� e C/O: Legalization: ( ) (-Y 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 Stamped: Sealed Copies: Electronic. Other. ( ) ( License: ✓ Workers Comp: Liability: Comp.Waiver. Other. ( ) ( ) CODE 753#: Dated: N/A: (� ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit N/A Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL.Plans: Permit N/A Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit H.W.I.C.:_Battery:_Other. PLUMBING:Plans: Permit Nat.Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit N/A Other. ( ) ( ) H.VA.C.: Plans: Permit N/A Other. ( ) ( ) FUEL TANK:Plans: Permit Fuel Type: Other. O O 2020 NY State ECCC: N/A Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER. C/O DENIAL LETTER: Other. ( ) ( ) Other. ( )ARB mtg. date: approvaL notes: ( )ZBA mtg.date: approvaL notes: ( )PB mtg.date: approval notes: cPPROVED REOUIRED EXISTING PROPOSED NOTES MAR 1 4 2021 Arm: Date: ._._— Circle: Fmn ag ' Front Fron Ste: $sus Main Cov Acts.Gov Ft.H/Sb: Sd.H/Sb: SEA: : HH ht/Stoles: notes: ZZOZ/11/£ "'�Y1IZ311g0/}iooi�np�ua�uo�/aga���a /snnopuiM� osozaty��ao7/e��Qdd�/uasza�adl�szasn/:�///:� kit tip" - • -- 6=�1 C N 1, / p N ? - e Te G. - > a y (i] ce) - . C � � � p a/�y►� S / y-• 420 ( r. r 0 s � ri � '� �l�►J 4 � r Q d C a N aft..CM ,. Yr.l •" O In v LD 4— saw Z LIJ LL V W 0 N 3 y o m co ,`aw>Je aO s LZ, 3 i u Q � U a' ittis'� Z Jo j ast'd DATE(MM/DD/YYYY) AC")?" CERTIFICATE OF LIABILITY INSURANCE 01/24/2022 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 NAME: _ BIBERK PHONE 844-4 FAx203-654-3613 P.O. Box 113247 (AIC,No.F.IQj (A/C No: E-MAIL customerservice@biBERK.com Stamford, CT 06911 ADDRESS. _ INSURER(S)AFFORDING COVERAGE NAIL s INSURER A:Berkshire Hathaway Direct Insurance CompanY I SURFO INSURERB: ustln Renovations Corp INSURER C: 41 Storm St INSURERD., Tarrytown, NY 10591-3310 INSURERE: 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. tXP LT R- TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY POLMMMIDID/YYY LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1r000,000 DAMACLAIMS-MADE X OCCUR PREMISES Meocc occurrence) 50,000 PREMISES Ea occurrence $ � A N9BP062420 12/03/2021 12/03/2022 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ Included GWL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE is 2,000,000 POLICY❑JJEECTT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 X OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) S 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 LIAR __ HCLAIMS-MADE AGGREGATE $ DED RETENTION$ S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN ISTATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT S OFFICERMIEMBER EXCLUDED) ❑ NIA -- - ,(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 0 yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S Professional Liability (Errors& Per Occurrence/ Omissions): Claims-Made Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Resident Name:Philip Olio 18 Rockridge Drive Rye Brook NY 10573 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Ryebrook Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 938 King St Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 2 Workers' STATE CERTIFICATE OF TE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE la.Legal Name 8 Address of Irsured(use street address only) 1 b.Business Telephone Number of Insured Austin Renovation Corp 914-486-2346 6 Ridge Rd Apt 2 tc.NYS Unemployment Insurance Employer Registration Number of Insured Dobbs Ferry, NY 10522-3327 N/A 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 6 Ridge Rd Apt 2, Dobbs Ferry, NY 10522-3327 81-1040182 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carver (Entity Being Listed as the Certificate Holder) NorGUARD Insurance Company Billing Department of Rye Brook 938 King St 3b.Policy Number of Entity Listed in Box"'Ia" Rye Brook, NY 10573 AUWC355364 3c.Policy effective period 03/11/2022 to 03/11/2023 3d.The Proprietor,Partners or Executive Officers are included.(Only check box if all partners/officers included) © all excluded or certain partnersiofficers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box Aa'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 coes 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: Dave Simmons (Punt name of authorized representative or licensed agent of insurance carrier) Approved by: !j j 11 �� 03/11/2022 (Date) Title Vice President of Sales Telephone Number of authorized representative or licensed agent of insurance carrier: 800-673-2465 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 e:///C:/Users/lpetersen/AppData/Local/Microsoft/Windows/INetCache/Content.Outlook/OBUF2M... 3/11/2022