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HomeMy WebLinkAboutBP22-033PERMIT # It SECTION TYPE OF WORK JOB LOCATION OWNER CONTRACTO T. COST CO # Lil•J�i FOOTING FOUNDATION FRAMING ] RGH FRAMING INSULATION /- PLUMBING Mal, ZZ RGH PLUMBING GAS 0 / /�C� ����`-' ' 1#b SPRINKLER � c1 FCTRIC 3 DATE: / %Jc�� D(P, BLOCK LOT •,Duets= i e c 4p a Vic Qoop) e rsscA .cam/i za n DA FEE DATE INSPECTION RECORD DATE I NSP S�i�Je/Jt OTHER APPROVALS i ARB �03 73 BOT PB ZBA OTHER VILLAGE OF RYE BROOK WESTCHESTPR co NTY, NEW YORK NO. 22-104 Certificate of ®ccupaucp This is to certify that L-%oy n of, )Q�to Byno k N 7 , having duly filed an application on Ma V cM 20 a2o? requesting a Certificate of Occupancy for the premises known as, 3 J7Q )(p/ L .r>e , Rye Brook, NY, located in a _Zoning District and shown on the most current Tax Map as Section: p? 5 Block: ) Lot: , :3 , and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. O -63 3, issued 7 20�, such authority and permission is hereby granted to the property owner to lawfully occupy or use said premises or building or part thereof listed under the following New York State Classifications, Use: P 3/ One- F� Construction: for the following purposes: ,��i'IYDDrr� 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 ade,nor shall the building be moved from one location to another until a permit to accomplish such change has been ob ine from the Inspector. Building Inspector,Village of Rye Brook: Date: JUL 2 5 2022 R n For office use only: v BUILD ENT PERMIT I ID] VIL OF RYE K ISSUED:��—/7 MAY 2 3 2022 H KING STRE YE BR00Xt YoRK 10573 DATE: - - oL�Z 00, ti0 O'� FEE: PAID VILLAGE OF RYE BROOK iffEg 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 sssssssssrsssrstsrsssss►tssrts►►sstssssttsstssssstsrssr,�/stssssssssssssssssssssssrstsssssssssrss►rsstsssssstsssssssrrsssssssss Address: G V1 CY U l�y l 5 V'O C �( � /V / e S Occupancy/Use: Parcel ID#: A 3 - 3 Zone: Owner: J�f V e(/1 +- /l 0(3 e` h t 7 r S C-(ti Address: 3 /�Gl Vl Lt'oIcl f u? P.E./R.A. or Contractor: Co fil e� C6 w e 61`*' 1 `L C Address: 4R l�q r� Y / U�� f�`"��rvvl, N /UJ7oG Person in responsible charge:,D/1O I'VI CC)C'��� I h Address: 1` 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: 1� 1 �� ylk�L-q being duly sworn,deposes and says that he/she resides at "Print Name of Applicant) (No.and Street) in TN:yE _8 R vt K ,in the County of � 57�-uF �,� in the State of� ,that (Cityfrown/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:$ ,---)("1 O 610 > for the construction or alteration of. 1 e 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 )� Sworn to before me this day of , 20 DQ day of ,20 nature of Property er Signature of Applicant .5 14 . Nam of Property Owner Print Name of Applicant Notary Public SHARI MELILLO Notary Public Notary Public,State of New York No.O1ME6i60063 8/12/2021 Qualified In Westchester County Commisslon Expires January 29,20?l- �yE BRC��. �m cu � . t BUILDING DEPARTMENT ❑BUILDING INSPECTOR CrASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK `❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www y brook.or - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : �_ �( 1�f t DATE: PERMIT# '!O ISSUED: "JECT: ��LOCK: ' LOT: LOCATION: _ 6 � �� / 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 �yE 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 - - - - - - - - - - - - - - - - - - - - 113 2 ADDRESS :_ - " ' L �--- DATE: � PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: _ OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION %/ REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ XNDERGROUND PLUMBING NOTES ON INSPECTION: NO ROUGH PLUMBING l ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER a a M ' N o � � � v� � •� � O a I..I Ln x o :i O r W � LO W Cn F N 0 C C H a 7 Ln a M in 00 00 �c 00 R a � eq., �-I O fil � au�i" o � � '� {r� ►TI Q�' x M O �i C aM u Fes+ l+i F•L� � � V p � ego. H .� � � '� O = W "o h+�l U w W Ln Wz � � Q � � m >� oV110 O a 00 h� 11 ^W Q vvi w a d v UU 0 o v v u U h+q N a © p� � " A z w o � Lpa .0 c 0 � � M a BUILD s MENT V`� VIL OF RY OOK 938 KING ET RYIE BR ,NY 10573 FEB 2 2Q22 -r 4 - VILLAGE OF RYE BROOK BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Approval Date: MAR 1 7 1 2 ermit ? D-3� Application Fee:$ / ) Approval Signature: Permit Fees:$ s' 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 change in use,as per detailed statement described below. 1. Job Address: � /)a VI �'l/ 0/q PV 0k SBL:/a9t 3S—/"/4, 3 Zone: 14-1 _ 2. Proposed Improvement.(Describe in detail): i6Cf rn-e> � hQ 77� r 0 v m S i ti K i 3. Does the proposed 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 It: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an exist` 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: / 7�u m After Construction: 1G m 6. N.Y State Construction Classification: N.Y.State Use Classification: 7. Property Owner: f-en Address: 3 ea v1 Cf oecw W f Koo�{ Ike# c,403 -S-bI - li34S Cell# —7, 3 -sue! - V email: ► trseh , sYeVein. e e ryar !. o nn 8. Applicant: Address: Phone# Cell# email: 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# 6=S. email: , ) o 10 O 11. General Contractor: C.b w p f e k CO r f�_Address: 1 ei')If /V8 .ke&A)y Phone# Cell# Qfy`�Sa `�ySJ� email: �Omple`� , (�({'Pt°ih 12. Estimated cost of construction $ 11, 000 Amot eaw gc*00 Cvrv\ (Nam The estimated cost shall include all labor,material,scaffolding,fixed equipment,professional fees and nratcrial and labor which may be donated gratis.) 13. Job Timetable: Start: �� � ��2 Jk Finish: / 1 (1) 8Y1212021 BUILD MENT VIL + OF!RY OOK 938 K NG ET RvE BR ,NY 10573 4 -0 �� 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: S�f C V t 11 6+ /_/ r S c..tl , residing at, /0 0 Vd C( _,�G fLe, K U/ e- A r c3 D f� 1Print name) (Address where you live) being duly sworn, deposes and states that(s)he is the applicant above named, and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; t'G vI Rye Brook,NY. lob 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 Property Owner(s)1 J)(f Ve1-) C. 'rSc h (Print Name of Property Owner(s)) Sworn to before me this day of , 20 22Z r'�J+ilan Pubficl M10,1 y y G at KV QualHed In We��Co L 2 1`AnMf41^n rr . s Feh.23, -�'" ( ) sn2/2021 This form must be properly completed & notarized by the Design Professional of record and the Property Owner. Failure to provide this completed form with your permit application will delay the permitting process. 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: Subject Property: 10 Q 1 a­Iq YL-e— SBL: Zone: Please take notice that the subject;V One or Two Family; ❑ Commercial, ❑New Structure ❑ Addition to an Existing Structure roe 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 location(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. Swom t efore me this Sworn to before me this day of 20-LL day of 120 Signature of Props Owner Signature of Design Professional Print Nam f Pr er Print Name of Design Professional Notary Public Notary Public II.Y. (3) 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 flees are non-refundable. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: 4 c V if (\ C r fN r�Gk ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. 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. Swom to before me this /� Sworn to before me this 9 day of ,* , 20,2__ day of oC�_- /t , 20';-0 Si ature of Propdrty Owner _ Signature of Aploicant Print Name of Property Owner Print lName of Applicant ��y r Notary Public Notary Public Rid�ald f,.t-0�+t AIo pDG042 i- , Wo 'N.Y, V QuamW in westhesw 1y 2� CnrnmM^! ,r^irns Feb.23 QEd ' �Di�� 4ri"WAon EzpYes r.. .'.3. (4) 8/12/2021 , � o N o � w v v w Ln in Ln H \ ONLn W �` W o U H W v=i M en v Lin ' It, rAW � o k- c x c , M � W O � > •y Lr) ONO z ^ c � � Z n en x � v w Q • C7 x —00 00 ~ Z a " MCll� U li V a x o v oz w o w, a w N a • H oA a u � 8 Q w a t z g z0 Qr Ln ° $ v O w z a � " x a , , . yE_4Rnv� D BUIL011V EPARTMENTiD VIL�rr��" E OF RYE BROOK 1 MAY 16 2022 ID 939 K1Nar��ET RYE Burxiu Ny 1nS73 7 ° VILLAGE OF RYE BROOK BUILDING DEPARTMENT www�►� ook.org ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required / FOR OFFICE USE ONLY BP#: Z2' o3 , EP#: 091 Approval Date: Permit Fee: $ rf — Approval Signature: — Other: Disapproved: (fees are non-refundable) ***************** ******************************************************************************** Application dated, 5 1(012.1 is hereby made to die Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/or remove electrical equipment, wiring, fixtures ,or to perform other high or low voltage electrical work as per the detailed statement described below. The applicant & property owner, by signing this document agree that all electrical work performed will begin conformance with all applicable Federal,State,County and Local Codes. / L/ 1.Address: J V Q.V I d LG,1�e. SBL: l�-/9j 3S'—/—/7+3 Zone: T1 2.Property Owner: Sk1/P.11 E IJ 1 i 1&JatA t j j-9 C, 7 Address: 3Da,VI d L_ AfLf- Phone#: 2u.3. G63, B 13 Cell#: email: 3.Master Electrician: k-()\f _0(A(,tWU(4-h Address: kr? waaf bf... S+Qmftffd�, LF 0(o5Q2 Lic.#: I r?(99 Phone#: Cell#: q1q.9(D0•C65S email:gj-Md 1QurQ([Cj-ri C I I C(B wyn Company Namc: ej(Qt dyl mil) ekk6 f C Address: �q&ttnl�D!!� S 4"ft6j,C T CXagUZ 4.Proposed Electrical Work/Fixture Count: fwS l j 11 ********************************************************************************************************* STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name ofindividual signing as the applicant) state that(s)he is the legal owner of the property to which this application pertains,or that(s)be 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 rtl y `i hianrfmi nr� P Con{�rtnL at the�hn.e�antinnni rnnnrl� will be in rnfnn�nrn� ith the details asset fC r t " 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. l- Sworn to before me this Sworn to before me this day of 120 day of �� 20 t Signature of Property Owner Sig a of Applicant c o q �IJ� Print Name of Property Owner P �= Na of App t Notary Public Not Public RII MELILLO Notary Public,Stab of New York No.OIME6160063 Qualified In Westchester County commission Expires January 29,202S sir 2/2021 -ss+ItACM+.ur.,:.-....,.:...•:�...._._.....r.-:.—-- —---9c'S�T...:.rs:w�t:.sk:::.�-•sv..ra..:.ni....•.�... Westchester Rockland Electrical Inspection Services, Inc. _L Phone: 914-347-3595 DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue Fix. 4-347-3596 4`o-7 Elmsford, NY 10523 T�4g3 BUILDING PERMIT NO. TEMP# DATE CITY OR VILLAGE {J/' 1, r ZIP CODE TOWNSHIP COUNTY • �U i. I 2 4Y ,(_ g f STREET AND NO.OR ROA T ` POLE NUMBER BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT OCCUPANT'S NAME BUILDING OCCUPANCY 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 I FLUORE NO. H.P EACH NO. WATTS EACH INSPECTION OUTSIDE BASEMENT 1"FL. 7^FL. VIL LAC E OF i E BROOK 3'�FL. III n, 4G DE T REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: l�C770(_ 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 APPLICATION. SIZE OF SERVICE FEEDERS CHARACTER OF WORK NEW ADDITIONAL❑ EXPOSED F 1 CONCEALED C MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD L_ UNDERGROUND'—' --LL I I I J_ AVOID DELAYS BY GIVING FULL AND.ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. NAME OF COMPANY .� G/� r/� DATE OF APPLICATION . SIGNATURE OF APPLICANT STREET ADDRESS CRY OR POST OFFICE Z� G - LILI M NO.WHEN APPLICABLE wESTCHESTER ROCKLANO %W E I 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: Grandview Electric Steven & Elizabeth Hirsch 87 Greenleaf Drive CT, Stamford 06902 Located at:3 David Ln Rye Brook, NY 10573 Certificate Number: 1034875 Section: 129.35 Block: 1 Lot: 14.3 BDC: Permit#: EP:22-091-BP:22-033 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: 3 David Ln Rye Brook,NY 10573 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 07/12/22 Name Type Quantity Inspection Perform on 5/24/22 1 Exhaust Fan ------- 1 Switch Single Pole ------- 2 Fixture-Luminaire Incandescent ------- 2 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. 11 This certificate may not be altered in any way. V-7`WL A '— This certificate is valid for work performed before date of inspection only. i � � a a a o Ln H 0-4 Owl � w w v F A en a z x w en peqI.y N N L co O I~ W ►n o ow A Owe - '�' z z z M Co z $ Q Z w 00 -r 0-4O , No Cf) Ln eq �.. Z O woogz "'D v) 02 a (� A z � 0.0 00 SIN z ,.., �-+ Z u w "' a z z `� `� W o � > ate. � .- �' • � H 0; N44 PLO w M w CA E o0 i a x a BUIL MENT APR - 5 2022 V E OF RYE K 938 KIN , ET RYE B ,NY 1057 VILLAGE OF RYE BROOK BUILDING DEPARTMENT .or PLUMBING PERMIT APPLICATION ^^�� FOR OFFICE USE ONLY BP#: QQ--0 3 :3 PP#: Approval Date: APR - 5 2412 Permit Fee: $ Approval Signature: 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 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. ,l I.Address: 3 'D u �,eIX4 44"Z._ SBL: / c)Y,3,5--/-jyi 3 Zone: 2.Proposed Work: G o t�.,..7k � (-a e 4-1 GA 3.Property Owner: ( ,4t, 14)r Scl,- Address: j Ddw)e Phone#:d b 3 S& 1 -r 4 Cell#: email:�,;rsGf�-t(:�,�t`� 01 �1411I l•`uc. 4.Master Plumber: tze- Address: 'j /L,'_keor _1'4--� IC u_ Lic. #: /b`fl Phone#: Cell#: 4/ar� email: Company Name:gow�(L,.,y� V YS e -c- Address 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 41 Floor 51 Floor Exterior 5.* List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) 8/12/2021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: R-12 � ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) (' JJ and further states that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the l Z6- 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 202A day of 20,A-'C— � G cae'� Signature of Property Owner Signature of Applicant /V c Print Name of Property Owner Print N Applic t �/y� '2, ti �,r�°sue Az . to Notary Public�ttaaryryR C. ar e�ro ova No.OI LAf 3? c� Quallied we �peSum Commfssromn Explr .23 Qpt^ V7t This application must be properly completed in its entirety and must include fhe notarize gnature(s)of the legal owner(s) of the subject property, and the applicant of record in the spaces pr ed. 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 O21 BUILD MENT p Q Y E VIL E OF RY OOK 938 KING ET RYE BR ,NY 10573 APR - 5 20_ 22 4 . -0 VILLAGE OF RYE BROOK BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY 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: 04/ ,-S /� ,residing at, y �',0 Z S&o (Print name) (Address whe(e yo 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; _:4b/6 4�4� &4 o or y /d_S 73 , 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 Property Owner(s)' Qs�r-r- iPrint Name of Property Oakner(s)) Sworn to before me this day of , 207 tNotar, Public( �p�ry���d N.Y N0.011A6003212 / Commfnsd n� esFeb. -3- 8/12/2021 Building Permit Check List&Zoning AjWysis Address: �Q y �� �.A� - SBL 2-�(' , 3 S - l - I 3 Zone: Use: Z I Const.Type jer.:Submittal Date: 2 l 2212 Z Revisions Submittal Dates: Applicant: n,. ,G 4 Nature of Work �11��-o a U A-TF� �D L �i�L�-`fi-� l ►--3 -3A S Z wta.— eviews:ZBA: 2 PB: BOT: Other. OK ( ( ) FEES:Filing: BP: C/O: Legalization: ( ) (�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: Z 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.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: REOLMED EXISTING PROPOSED NOTES AvkjxuvLu MAR 1 7 Asp: Dole: 2022 Qr&. Fromm Front: Front: Main COV. Accs.Cov Ft.H/Sb: SSnd,H /Sb Q Tom' Ft.Imp Hag /Stones: notes -T-JUDIZZ, r tr `^� a �ifi � 1rFs ! }}}ti — ^r�, 3 IO A � IA` �1ilO i11�,�11�1 +5€ o/, .► �— 1 _ �A (11� s.s 1WY. � 11 .1 i.-s. If }`M, 4 Pit "r;lmsl�ltrl All ' N N O 00 iZ- r.; C ► C O O c U '- � •.4 � y O c r, .,:... E . co N . _ 4 u C) cfl ULO < �. ' L � o c y �.r W Z CO w } = section U �O Q p x S:i Z W fffa7)! O > Q 5a- LLj Q Q 772 �s ✓, p w ED r G� �C aXi o z p O t: Cu JL co CN v 1 co �rcn d11 r :••-_ _ __ • f,� �-��� ;��i�il •''Ili il���:v,� — -_ 40:.r` •y V� � �,�: ^ %� / / u)II�IAK7F 111�1�1111' r` t3A_�Ir n /� .'%1r',. -,y ,F��•' "'�f�Yjy�t ^r .�,r' �� } �.�1 ,����Ij,�,/11�1�. .�s ..�_.•.-..��,._ •.!'--- - r .CSC i•X � COMPL-2 A�ORO CERTIFICATE OF LIABILITY INSURANCE DATE 02 2212022Y) o2n2/2oz2 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 endorsements . PRODUCER 845-278-7070 NAMCONTACT Brendan Mulvihill E: Feehan Insurance Agency PHONE 845-278-7070 FAX 845-278-2886 P.O.Box 870 (ac,No,Eat: Arc No Carmel,NY 10512 E ren anm @e an nsurance.com Brendan Mulvihill INSURERS AFFORDING COVERAGE NAIC II INSURERA:Utica First Insurance Company 15326 INSURED INSURERS: Complete Carpentry Services LLC 7 Ridge Way Ave INSURERC: North Salem,NY 10560 INSURER D INSURER E: 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. INSRLTR TYPE OF INSURANCE ADDL SUB POLICY NUMBER POLICY EFF POLICY 10131YYY LIMITS A X COMMERCLAL GENERAL LIABILFTY 11000,000 EACH OCCURRENCE CLAIMS-MADE F—X]OCCUR ART5156965 04/07/2021 04/07/2022 DAMAGE TO RENTED 50,000 MED EXP(Any oneperson) 5,000 PERSONAL BADVINJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER, GENERAL AGGREGATE & 2,000,000 X POLICY❑Pea LOC PRODUCTS-COMP/OP AGG 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY(Perperson) OWNED SCHEDULED AUTOS ONLY AUTOS BODILY BODILY INJURY Per acGkWA AUTOS ONLY AUTOS ONLY F EgR�t AMAGE UMBRELLALIAB HOCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTIONS WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE QFFICER/MEMBER EXCLUDED? NIA E.L.EACH ACCIDENT (Mandatory n N ) If es,desc be under E.L.DISEASE-EA EMPLOYE SCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 Y ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE — ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NEW YORIK Workers' Certificate of Attestation of Exemption STATE Compensation from New York State Workers' Compensation and/or Board Disability and Paid Family Leave Benefits Insurance Coverage **Thu form cannot be used to waive the workers'compensation rights or obligations of any party.** The applicant may use this Certificate of Attestation of Exemption ONLY to show a government entity that New York State specific workers'compensation and/or disability and paid family leave benefits insurance is not required. The applicant may NOT use this form to show another business or that business's insurance carrier that such insurance is not required. Please provide this form to the government entity from which you are requesting a permit,license or contract. This Certificate will not be accepted by government officials one year after the date printed on the form. In the Application of Business Applying For: (Legal Entity Name and Address): Building Permit Complete Carpentry Services llc From R e Brook 7 Ridgeway Ave y North Salem,NY 10560-1032 PHONE:914-276-1444 FEIN:X30OM666 The location of where work will be Derformed is 3 David Lane,Rye Brook,NY-10573. Estimated dates necessary to complete work associated with the building permit are from February 22,2022 to September 1,2022. The estimated dollar amount of project is $0-$10,000 Workers'Compensation Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE SPECIFIC WORKERS'COMPENSATION INSURANCE COVERAGE for the following reason: The business is a LLC,LLP,PLLP or a RLLP;OR is a partnership under the laws of New York State and is not a corporation. Other than the partners or members,there are no employees,day labor,leased employees,borrowed employees,part-time employees,unpaid volunteers(including family members)or subcontractors. Partners/Members: William A Coughlan Disability and Paid Family Leave Benefits Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE STATUTORY DISABILITY AND PAID FAMILY LEAVE BENEFITS INSURANCE COVERAGE for the following reason: The business MUST be either: 1) owned by one individual; OR 2) is a partnership(including LLC,LLP,PLLP,RLLP,or LP)under the laws of New York State and is not a corporation; OR 3) is a one or two person owned corporation,with those individuals owning all of the stock and holding all offices of the corporation(in a two person owned corporation each individual must be an officer and own at least one share of stock); OR 4) is a business with no NYS location. In addition,the business does not require disability and paid family leave benefits coverage at this time since it has not employed one or more individuals on at least 30 days in any calendar year in New York State. (Independent contractors are not considered to be employees under the Disability and Paid Family Leave Benefits Law.) I,William A.Coughlan,am the Member with the above-named legal entity. I affirm that due to my position with the above-named business I have the knowledge,information and authority to make this Certificate of Attestation of Exemption. I hereby affirm that the statements made herein are true,that I have not made any materially false statements and I make this Certificate of Attestation of Exemption under the penalties of perjury. I further affirm that I understand that any false statement,representation or concealment will subject me to felony criminal prosecution,including jail and civil liability in accordance with the Workers'Compensation Law and all other New York State laws. By submitting this Certificate of Attestation of Exemption to the government entity listed above I also hereby affirm that if circumstances change so that workers'compensation insurance and/or disability and paid family leave benefits coverage is required,the above-named legal entity will immediately acquire appropriate New York State specific workers' compensation insurance and/or disability and paid family leave benefits coverage and also immediately ftunish proof of that coverage on forms approved by the Chair of the Workers'Compensati oard to the government entity listed above. SIGN S HERE ignature: Date. C 22 ,? _ Exemption Certificate Number­ x;> K� R eived 2022-010105> - r x ,� February 22, 2022 NYS Workers'Compensation Board .'4xX..'`�`',',� xz`�xx! � x-��� iC. 'S`'�c•_ �c -">%�- 'k:'�c' ')':�'k„ 'i^ �,,`�c r : CE-200 01/2018 EXl�T''SUMP wombs VR" �J"04�4JW�VF f ILE COPY 0 00 L6T ell" -- COVE 7 -_ PERMIT# R [E /� DATE APP E MAR 1 7SBL# 73> LIAR 16 2022--2&22 1 VILLAGE OF RYE BROO BUILDING INS CT o lags of Brook NY BUILDING DEPARTMENT Genera) Notes 1}All work to be done according to 2020 Residential Code of New York State and local codes 2)All plumbing work to be done by a licensed plumber 3)All electric work to be done by a licensed electrician ' SEAI,- *DFARCyO j� P Draw g Number ��U � SMM Architect PLLC Drawing -Date .3,�.��Z� 416450ti � 5 Scott Circle Scale y�J-.,C Q A E OF ��� Purchase New York 10577 �'�`�� Drawn By 4511