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HomeMy WebLinkAboutBP22-032PERMIT # � ��"a©Je� DATE:��� v�c� SECTION �'��i .J BLOCK I TYPE OF WORK JOB LOCATI OWNER CONTRACTOR_ EST. COST ✓CO # TCO # FOOTING FOUNDATION FRAMING >' FEE DATE INSPECTION RECORD DATE INSP RGH FRAMING �'— INSULATION � � PLUMBING RGH PLUMBING GAS 0 SPRINKLER � � a��c7e� �� 5 ELECTRIC LOW -VOLT 0 - , F.LARM AS LUILT 0 { � FINAL ��������� E/��-� VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 22-200 Certificate of (9ccupaucp This is to certify that rlvqlnla Reot of, P)1!f 'erDo K f /y 7 having duly filed an application on .Pee-ember 20 ---?.'2 requesting a Certificate of Occupancy for the premises known as, Rye Brook,NY, located in a Zoning District and shown on the most current Tax Map as Section: )4J. Block: i Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. - 63a, issued 3 20 ,:29 , 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: i�"�/ DrI(f- FGL(T) ) 1 Construction: for the following purposes: 10 4-e r IO Y k—J k- /ex-? Pe-Mn Cie 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 a made,nor shall the building be moved from one location to another until a permit to accomplish such change has be btai in th Inspector. DEC 2 1 2017 Building Inspector,Village of Rye Brook: Date: R BUILDING DEPARTMENT PERMIT# Dj Ao3a- DEC - 9 2022 VILLAGE OF RYE BROOK ISSUED: 8 KING STREET,RYE BROOK,NEW YORK 10573 DATE: — —c4,=4- VILLAGE OF RYE BROOK (914)939-0668 FEE: 9 PA & BUILDING DEPARTMENT www.ryebrook.org APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS ssssssassssssssssssssssssssss sssssssssesssss«sssssssssssstssssssssssas sssssssssssssssssssssssssssssssssssssssssssss Address: Occupancy/Use: Parcel ID#: I - S Zone: 1C SIC Owner: / - / -�/ Address: P.E.AtA. or Contractor: Address: C-I' v U Person in responsible charge � 0,? 19 Address: 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: t r j�z! Y,ftv� being duly swom,deposes and says that he/she resides at � �` int ame f Applicant) (\,,.amd Street) in ,y� in the County of in the State of that m 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,profT2,, fees,and including the monetary value of any materials and labor which may have been donated gratis was:$ l�� for the construction or alteration of: ��) Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structuretwork 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 '� Sworn to before me this day of 20� day of 20 Signature f Pro er Signature of Applicant Name of Property Owner Print Name of Applicant . �� L-' 11 otary Public SHARI MEULLO Notary Public Notary Public,State of New York No.OIME6160063 Qualified In Westchester County �J Commission Expires January 29.20i7 �E BRC�v�. 1932 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:— ` DATE: ' y 1 LU PERMIT# � (`J ISSUED: �k�prl�ECT: ` I. BLOCK: LOT: LOCATION: N l� V OCCUPANCY: -- � 0 ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION K REQUIRED ❑ FOOTING 111 ❑ 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 _ N ' M etrrg� = N N w o m M M M • w � � 14 FM rT �t a 4-4 00 o. N O W ONO N v o . N Q .� M x v =� = V TT o bv ° W -g g r cl _ O w � � Q � c o o O z N co O C q z O -- CA O �_ d u O a a O O �. R� Ln in d,x o o 40 oo � � rW� cMd `4 wA p; D o a t00 W = w N aft o 5v a m R-t W� ON c z z ZP,,n c o mo U. > M�1 0 © " Z o p v t p w Uo = � a W O G � U a� u G � 4= -u : M V O V rxi w c7 F A Z O 00 Z " W) 0 1n A W z 41 m R BUILDING DEPARTMENT EC EE V i VILLAGE OF RYE BROOK FEB 11 2022 ] li'Jo 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 Fax(914)939-5801 VILLAGE OF RYE BROOK wwwxvebrook.om. BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION Approval Date: MAR I 4 20 P rtr�it / '►V� Application Fee:$ JJr Approval Signature: Permit Fees:S '_(M • Other: Application dated: is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of Permit for the interior alteration of an kistinibuilding,or for a change in use, as per detailed statement described below. J, ✓~y+p Z1. Job Address: _Q—F 2. Proposed Improvement.(Describe in d tail): v 1 3. Does the (yes: improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: Yes: If yes,indicate: TIER I: TIER 11: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modificatio 540an existing automatic fire suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood-etc ) :No: Yes: 5. Occupancy,(1 fan.,2 fam.,comm.,etc...)Prior to Construction: 14M After Construction: 4or 6. N.Y State Construction Classification: N.Y.State Use Classification: 7. Property Owner: >F /IV'$� elf Address: — Phone# Cell# &— i/ . email: 8. Applicant: :519141f- Address: Phone# Cell# email: 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# /Cell# email: 11. General Contractors: 7LIA%��n/4 /l� /� ��,y Address: - ./= f - �� 0� Phone# 61- k-1 ` Cell# "` '�'�i� j, email: 12. Estimated cost of construction $ 13. Job Timetable:Start: mw Finish: ( ~� (I) 3/21/19 BUILDING DEPARTMENT [E C IE M VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 FEB 11 2 222 (914)939-0668 FAX(914)939-5801 wwwxyebrook.orp- VILLAGE OF RYE BROOK L BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 ESTORM SEWERS AND SANITARY SEWERS STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: / residing at,;�- &—py' CzE 6'x4zC 1'nni namcl 1:11rlrr„ Itcrr ,u lici being duly sworn, deposes and states that(s)he is the applicant above named,and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; > 11 e& tom , Rye Brook,NY. 7' (iob Addr«�) 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. (S'_natnrc or Prore_rt� (h ncr 1 nuc�Cal�s f Print Namc<f ilroi)cri%l t ncrlsl l Sworn tfore me this day of J\�" 2022, (Notary Public) 2 Awwd C.tm Notaryry Pum.State of NX M1{o.01 Lv@03242ty (2) eas ed in wr ' r C�2L t G�<O romm- 3121119 ST TE OF NEW YORK,COUNTY OF WESTCHESTER ) as: t114ia',Is , being duly sworn,deposes and states that he/she is the applicant above named, (print Affie of indiviltual signmg as the applicant) and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. By signing this application,the property owner further declares that he/she has inspected the subject property, and that to the best of his/her knowledge there are no roof drains, sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this Sworn to before me this day of 20 day of , 20 Sign e K Prop&t a Signature of Applicant Print Namd of Property Owner Print Name of Applicant 1, AIL-'a-. '__7 Notary Public l4htud G.Lentx Notary Public M N�Itr PuDIIC,3vW tti N}'. . Rb-21M (4) 8/12/2021 c � ■ O �C M : N N \ N aoOC W r Gn a u ►.r to Ln � 6J ■ W M C. 41 � oo x C °° U s oo o�--� z q a 0 w \C O LI= c Z w M W WizCl A a o o � W ■ r x .� 0-� a mq V V a x x o zz 41 W H N L W _ � p � c o < cn U o W z w ' ■ � � q O V Q �� Oo z z �. Ln w o c A o N A a19 E(c . ffr ■ ■ t r . ■ �- e : �■+ s _�f�R(7)�_, D ECE • BUILDAG DEPARTMENT R v VIL ACE OF RYE BROOK MAR 2 8 2022 938 KiN ET RYE BR(8)ok NY 10573 ( VILLAGE OF RYE BROOK or BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: � EP#: QZ-)—0&0 MAR 2 9 1 Approval Date: A Permit Fee: $ 6LQ OL Approval Signature: y Other: Disapproved: (fees are non-refundable) Application dated, 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 lbb/e�in conformance with all applicable Federal,State,County and Local Codes. 1.Address: >2S C Q[ap 1�R I G6 LT SBL: I`f I. y3 -1 - Sg Zone: tS� 2.Property Owner: r(ZANGS &EID Address: 4Q/liK Phone#: 914-a/6—901S_ Cell#: email: 3.Master Electrician:HjcWAa-Tttoy Ian ;Lc crAle-) Address:7_q &i Aa &Ag Ra STAn FoaD C,-r o(,v0. Lic.#: (�S� Phone#: 9/1/479 44 Zell#: email: A-rAELECTRIC&OPTD/�1LJnks.NFT Company Name: ATA ELECTRIC Address: S140 0 4.Proposed Electrical Work/Fixture Count: T�GT W 1 ALA f�I�CN t=/J A ' r l,1 ti`Gtr'3 I,OCfiT DACS -To S'rrAL( S,IM& /qS e_X067/en)G) is is is xic iexxx xxx xx k:F iir it F is is F*ic**ie kic is it is xic ix it ie is ie ix is is is it iexxxie*ic ix is*ic it is k*k is is ix*Fkkie icx xic is ix Y is is is is is is is ix ir:F is it is'r ie*ic it is is it it icxxic is it it STATE OF NEW YOM COUNTY OF WESTCHESTER ) as: t GA A6L � L')j ,being duly swom,deposes and states that he/she is the applicant above named,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 [.• C7 1 GVI IJ 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 Sworn to before me this 8 day of ,20 day of Signature of Property Owner Si a of Applicant 16 d lqel 6,0 Print Name of Property Owner Tame of Applicant Notary Public No L Notary Public,State of New York No. 011ME6160063 Oualified in Westchester Coun 2 Commission FXI71res January 29,2 8/12/2021 Phone 914-347-3595 Westchester Rockland Electrical Inspection Services, Inc. DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue y/ Fax:_914-347-3596 Elmsford, NY 10523 /'``� BUILDING PERMIT NO. TEMP# DATE CITY OR VILLAGE ZIP CO - TOWNSHIP COUNTY r; c ,z o U — l 0-�7 STREET AND NO'ODROAD POLE NUMBER BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT OCCUPANT'S NAME BUI NG OCCUPANCY nvc.j 5 12 'l d � OWNER'S NAME AND ADDRESS HOME TELEPHONE NUMBER CURRENT SUPPLIED BY FROM THEIR OFFICE WORK TELEPHONE NUMBER LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS NO.OF FIXTURES& MOTORS HEATERS OFFICE USE LOCATION LAMP RECEPTACLES ONLY SIDEWALL SWITCH INCADE FLUORE NO, H.P EACH NO. WATTS EACH INSPECTION OUTSIDE BASEMENT 1"FL. 2"O FL. 3'�FL. NT REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: K r TCN c-n/ A fAi A/\/CcY LSIQ LOCAW0--1 DVS 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 APPUCATIONS 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 p,��`DXPOSED n CONCEALED f7 MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD C 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 SIGNATUREAFfiMICANT STREET ADDRESS ��Qp TELEPHONE NO. lI 4,ArL 4 2�QAe i�0 9/y "d 7�+d j CRY OR POST OFFICE— � 6 �� ZIP CODFn D 3 LICENSE NO.WHEN APPLICABLE wESTCHESTER ROCKLAND ELECTRICAL INSPECTION VRE111SERVICES,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: ATA Electric Francis &Virginia Reid 79 Briar Brae CT, Stamford 06903 Located at:58 Brookridge Ct Rye Brook, NY 10573 Certificate Number: 1034319 Section: 141.43 Block: 1 Lot:58 BDC: Permit#: EP:22-060-BP:22-032 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: 58 Brookridge Ct Rye Brook,NY 10573 Basement Ci 1st Floor 2nd Floor 3rd Floor Garage Attic --j 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 07/07/22 Name Type Quantity Refrigerator ------- 1 Dishwasher ------- 1 Microwave ------- 1 Receptacle GFCI ------- 5 Fixture-Luminaire Undercabinet ------- 4 Inspection Perform on 4/22/22 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. _ N ' O N N 0� C. 00 W O W v belog u r; H cell z s z C M s • Fil � ''� O A v "' z �, � r = N w Q z�'z , �" w z A �'O Q u o a W j=•y � OF-1 � M � � � �, z ¢ V J C _ O s x A W N Of � z Z 0PLO f r, PLO � � w og p o < n NFs ►� _ x ao z w z a c A In a o w a a m w = y BUIL y� E_A. MENT D L�� L� U v � F ! � VIL E OF RYE ; QOK ' J N 2 1 2022 938 KIN ET RYE B ,NY 10573 VILLAGE OF RYE BROOK w o g BUILDING DEPARTMENT PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY13P#: �—03 PP =)�4 Approval Date: JUN 2 1 20R Permit Fee: $ / '� A� Approval Signature: l Other: Disapproved: (fees are non-refundable) Application dated, hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install an or ove 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: SK9�'" � ('- � 7J SBL: �'y�•'�J ���SO Zone 2.Proposed Work: 2Z' Z 'A� ��/�f�l� 3.Property Owner:_j�r_ ,rj5 C; � �� / Address: Phone#: �� 111'1�7 Cell#: email: - �6'�J� 4.Master Plumber: / r6 Address: `�3 s ymA/t'T" A L/J , X-N!{ER S /o -7 O y Lic.#: ? Phone#: Cell#:'Iry 7G0 - 3 /10 email: E2 I c R a,fGO 6 MAj L, Lorh Company Name: Pau--.C-rA& 40 L 6 . a f"-67• co" . Address:9.3 -r m A✓t-1-6"/E- 7 a y 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 ' a 2nd Floor 3'd Floor 41 Floor 5'h Floor Exterior 5.* List Other Equipment/Provide Details: I N-(-TW LL I✓�I,✓ K fT G l+�>✓ �C i�/K * ,0 i 1 h w A ti�'l t-)jD S_M v g (Notarized Signatures Required Next 2 Pages) 8/12/2021 BUILD G MENT VIL E 4BR OOK 938 KWG ET ,NY 10573 ?214 VILLAGE Of RYc BROOK BU!LDIN(7? nEPARTMEN3 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, (Print name) (Address where you liIc) 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; (' [R� , Rye Brook,NY. (.lob Addre—) 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. (Sign h e of Property 1 ee (Print Name of Property ONNner(s)1 Sworn to before me this 2� day of 4U4 20 LJ, (Notar-, uhlic) G. 42 RIMea tn L� Comfit~! '203'1 -3_ 8/12/2021 STATE OF NEW j YORRK,COUNTY OF WESTCHESTER ) as: �44 2 J,���/b ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual sigung as the applicant) and further states that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn to before me this day of ,20 Z�Z— day of 20 1X2 <� 1 � t S&&we of p caner ignature of pp cant Print Name of PropertyyOw er— Print Name of Applicant Notary Pry 0,�,tn Nola'j4g�LILLO � f,}o.001LA6003242N Notary Public,State of New York &IMUtoV�eesZ D O No.OIME6160063 Co —.'mm -A Qualified In Westchester County, commission Expires January 29,203 This application must be properly completed in its entirety and must illciude the uutarized 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 Permit Check List&Zoning Analysis Address: . SBL: Zone.,_ -T Use: 7i Const Type: Other. Submittal Date: 21-2--2- Revisions Submittal Dates: Applicant: --L�r l 17 Nature of Work. C_ Reviews:ZBA: F E 6 1 4 2022 pB: BOT: other. OK ( ( ) FEES:Filing: 74Z• 4t, BP: ��� � � '-2L2iC/O: Legalization: ( ) (�APP: Dated: Z Notarized ✓SBL: ✓ Truss I.D. Cross Connection: L✓ 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: ( ) (vy License: ✓ Workers Comp: ✓ Liability: Comp.Waiver. Other. ( ) ( ) CODE 7S3#: Dated N/A: (Jf ( ) HIGH-VOLTAGE ELECTRICAL--Plans: Permit N/A: Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit: N/A Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H.W.I.C.:_Battery:_Other. 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: AtTROVED REOUIRED EXMIN PROPOSED NOTES MAR 1 4 2022 Am: Date: C'irrlr Fs� Fs� Sidw &W. Main Cov Accs.Coo Ft.H/Sb: Sd.H/Sb: SiEA: Tot,Imp: Ft.Imp Pddw. Hckbt/Stories notes: 0 , Z I l e, :firC' ,. air .o\ yc :1,�"►. 4'1 �'� \' \ Iti 'R �• �zs+"'�`I�Er�c a 1�1�1 � 'r ♦1f r ♦♦ K ♦0• '/ •♦ vF e N• • ♦♦ •d 3�, Ja. i+aa< •>ew £_.c 1�111 11 sy h1111l111�1 � 1�11l111j1 = 1�111/1111 ���� 111111i1``1,,1 `11111 � t!11/11�j/1 �`�m. 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THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. RYE, NY 10580 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A UTICA HIRST JOHN MAZZOLA DBA MAZZOLA FAMILY RESTORATION INSURER a ALLSTATE INSURANCE 46 TYLER CIRCLE - RYE, NY 10580 INSURER C: NEW Y RK STATE INSURANCE FUND INSURER Dr. INSURER E COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR IADD'L POUCY NUIMBE t POLICDATIEY EFFECTIVE POLICY EXPIRATION LH/TS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ART5135886 t W621 10/26/22 DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES occurence s 50,000 A CLAIMS MADE I OCCUR MED EXP one ) s 5,000 PERSONAL&AM INJURY $ 1.000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1 WO OOO POLICY PRO LOC AUTOMOBILE LIABILITY ANY AUTO 648868M 10/26/21 10/26M COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ALL OWNED AUTOS BODILY INJURY $ B SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC S OTHER THAN AUTO ONLY: AGG $ EXCESSI MABRELLJI LIABILITY EACH OCCURRENCE $ OCCUR ❑CLAMS MADE 0507000903 AGGREGATE $ s DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND I✓ VYC STATU- OTH- EMPLOYERS LIABILITY W2403 718-G 11/15M 11/1522 TORY LIMITS C ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ OFRCER/MEMBER EXCLUDED? describe under EL DISEASE-EA EMPLOYEES H yes, SPECIAL PROVISIONS below EL.DISEASE-POLICY LIMIT $ OTHER C DISABILITY DBL377157 05/03/21 05=121 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Village of Rye Brook, 938 King St, Rye Brook, NY 10573-additional insured CERTIFICATE HOLDER X CANCELLATION Village of Rye Brook SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 938 King St DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN Rye Brook, NY 10573 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001108) 0 ACORD CORPORATION 1988 NYSIF PO Box 66699,Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ol 5 +:. :. ' ❑ A^^^^ 114481175t�; tY ALBERT PALANCIA AGENCY INC ={� Y 116 MAMARONECK AVE i PO BOX 26 MAMARONECK NY 10543 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER JOHN MAZZOLA D/B/A VILLAGE OF RYE BROOK MAZZOLA FAMILY RESTORATION 938 KING STREET 45 TYLER CIRCLE RYE BROOK NY 10573 RYE NY 10580 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2403 718-6 395572 11/152021 TO 11/152022 2/7/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2403 718-6, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STAT SUR NCE FUND T �V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 779926500 U-26.3 /0``'Yl/ // bj <�� FEB 11 2022 I \ VILLAGE OF RYE BROOK E BUILDING DEPARTMENT i n � v 1\ �� 9� GW�) D FEB 1 1 2022 _1D VILLAGE OF RYE BROOK BUILDING DEPARTMENT 9££ 9£££M -1-9£LZM IS860£H1M 2J-9£FZ,9££ CO v W N £9 1�J££9 6Z80£ -0£'9b'J'�JNb'' d-Hd9£ W N S 00 j O j i � U) � " � 1 W co 06 ?:J-061 z8 n 19 06LL CD cr) N I I �