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Home My WebLink AboutMP22-046 4CWJ V�WS J/ VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Paul S. Rosenberg (914) 939-0668 Christopher J. Bradbury www.ryebrook.org TRUSTEES BUILDING& FIRE Susan R. Epstein INSPECTOR Stephanie J. Fischer Michael J. Izzo David M.Heiser Jason A. Klein CERTIFICATE OF COMPLIANCE April 1, 2022 Win Ridge Realty LLC c/o Alena Hakanjin Rye Brook,New York 10573 Re: Buddha Asian Bistro, 1 Rye Ridge Plaza, Rye Brook, New York 10573 Parcel ID#: 141.27-1-6 Mechanical Permit #22-046 issued on 3/29/2022 for Repairs to Existing Fire Suppression System This certifies that the fire suppression system repairs, under the above captioned permit,have been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector /tg QyE BRC��• tim '982 BUILDING DEPARTMENT UILDING INSPECTOR pASSISTANT 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.orl; - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : I - ` A'2_A DATE: PERMIT# ✓"1 �Z� ` v ISSUED: Zf/2�ECT:fI 2� BLOCK: LOT: (-:p LOCATION: 2f- L -i1P.. C.F 2 F- OCCUPANCY• 4- _-- ❑ VIOLATION NOTED THE WORK IS...rACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING f ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS 2- ✓`1 LF�'�t= ❑ L.P. GAS }ZR �L c (� N o Z Z. L F S ❑ FUEL TANK /+ ❑ FIRE SPRINKLERS CiL R (C� FL S n1 ❑ FINAL PLUMBING ❑ CROSS CONNECTION �� FINAL �.� OTHER a a � 0 y � v n L O s aG s w e71000co— It qvt � O }7 a ~ R'i G7 Ra �LI 4-4 00 14 00 Lo ti -d W M „or- co ..y " AO p -o v aoi U-E "I C�% P.� s H , M rTl v .2 s r x a z bv� � 0 � ", 'm , o w 0 ; W i h�l w d O O W A O � •� .�•,� o-. r..r W Z op •� C � •• a Cy W cry vu 0 v a N $UILDING DEPARTME T D VILLAGE OF RYE BROOK MAR 2 822 938 KING SMET RYE BROoK,NY 10573 (914 939-066$ } VILLAGE OF RYE BROOK www,_rye9kNk yrg. I BUILDING DEPARTNIEN APPLICATION TO INSTALL FIRE SUPPRESSION / FIRE SPRINKLER SYSTEM FOR OFFICE USE ONLY: Approval Date: MAR 2 MP#: Q' Application Fee: $ Approval Signature: Permit Fees: $,&Q-7�--1J Disapproved: Other: Application dated: Z Z is hereby made to the Building Inspector of the Village of Rye Brook NY for the issuance of a Permit to' stall or modify a Fire Suppression/Fire Sprinkler System as per detailed statement described below. 1. Job Address:_. K e t4* & W F'l RL /J•>�El 2. Parcel I.D.: Z1 —1-49 Zone: (2 — 3. Proposed Work(Describe system ipfietail inclu cto suppression agent): d rFe --W 020 10 . 4. Number&Types of Fire Sprinkler Heads: 5. N.Y State Construction Classification: N.Y.State Use Classification: 6. Estimated Value of Job:$ b JPC9' Q (Value shall include all labor,materials,fixed equipment,professional fees,and materials and labor which may be donated gratis.) 7. Property Owner: I.N'k/V\�P r1�')e L Pam{ �� f �L� Address:(0 �e Ot'dc)&`IPA Phone# l%�T' c7-:' Ceu# email:: / .0 Applicant: /� /�vp /a7 Address: .(/ d�� Phone# ,S`- b`Y333 Cell# 7I?�J/?-tg fP? email: Architect/Engineer: Address: 4s j Phone# Cell# email: Sprinkler Contractor: Address: Phone# Cell# email: 8/12/2021 This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. Please note that application fees are non-refundable. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: t>�Vtt) t,fi ,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 I " VP o for the legal owner and is duly authorized to make and file this application. (indicate architect contractor"attorney,etc.) That all statements contained erein 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. {M Sworn to before me this h Sworn to before me this dayof Ma),c.h ,20 12- day of MI'l"th 2Z 7�_ gnatur f q ffln Signature 'Apphc / U Two l L C H-- t:C/� I ^ / Print N� �p 1�TT print Nam pplicant Notary l&blic Notary Public THOMAS J CURTIN THOMAS J CURTIN Notary Public,State of New York Notary Public,State of New York Reg.No.OICU6341697 Reg.No.OICU6341697 Qualified in Westchester County Qualified in Westchester County Commission Expires May 9,2024 Commission Expires May 9,2024 2 8112/2021 NRLFI-1 OP log L ACORl7 CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DD/YYYY) 08/23/2021 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(les) 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 203-268-9999 1 CONTACT John M.Rodrigues John Rodrigues Ins.Assoc. — — __ __ . Monroe Insurance Center Inc. PHONE 203-268-9999 SAX 203-2614436 INC,No,Ert): _--INC,No): 501 Main Street - --— Monroe,CT 06468 John M.Rodrigues _ _- INSURERL$1AFFQRD1WCOVERAOENAIC# INSURER A•Admiral Insurance Company _ INSURED INwReR a•National Grange Mutual 1476g N R L Fire Protection Services - - I c. 4 2 Pepper Street IIMRR C` Monroe,CT 06468 -- --- ---- --- -- INESIRERD:-_ INSUffiRE;_-- ---- - ---'- - INSURER F: COVERAGES T CATNUMBER: 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. "liPOLICY EFF 1. TYPE OF INSURANCE ADOL SU --- --- - POLICY EXP — —---- - POLICY NUMBER LIMITS A X COMMERCIAL GENERAL LLABILITY EACH CURRENCE 1,000,000 CLAIMS-MADE �OCCUR X FAMM50-06 05/17/2021 0�'17/2022 �M ENTED 60,000 M EXP My one�enpn 5.000 X Designated COn Pr_-- PgRSONAL&AADV INJURY t _ 11000,000 GENL AGGREGATE.LIMIT APPLIES PER GENERAL AGGREGATE 2,000,000 POLICY pea LOC OTHER. 2,000$000 _PRODUCTS-COMP/OP AGG E B AUTOMOBILE LIABILITY OMBt.ED SINGLE LIMIT 1,000rOOO i X ANY AUTO 62T1103U 05/17/2021 05/17l2022 OWNED SCHEDULED BODILY INJURY(Per parson >; AIURRTEEO��S ONLY ApUTNOSv� Ep FRDILY INJUpRy1ftreccitl1M) — AII S ONLY _ ALIT ONNLY Le sER nq AGE t UMBRELLA LIAB OCCUR H OCCURRENCE. •EXCESS LIAR CLAIMS•MAOE EA. --- - AGGR TE -- RE`EN710N: ----- -- --- B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X PERTUT OTH- B ANY PROPRIETOR/PARTNER/EXECUTIVE x1N �WCP4723V (CT) 05/17/2021I05/17/2022 600r000 Q(IF�FICER/MEEM BER EXCLUMD9 NIA E.L, ACH ACGDENT S (Mandatoryln NH) --I W1P4723V (NY) 05/17/2021 05/17/2022 500,000 If ym.describe under E.L.DISEASE_EA MPL YE Dail. OF CPERATIONS below .L.DISEASE-POLICY LIMIL 3 500r0w I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remark$Schedule,may be attached 11 more space is required) Certificate holder included as additional insured. CERTIFICATE HOLDER CANCELLATION VILLRYE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Rye Brook, NY THE EXPIRATION DATE THEREOF, N0710E WILL BE DELIVERED IN 938 King Street ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVE John M. Rodrigues f.,•J ACORD 25(2016/03) C 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD INEW KR Workers' CERTIFICATE OF ATE Board Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a.Legal Name 8 Address of Insured(use street address only) 1 b. Business Telephone Number of Insured N R L Fire Protection Services Inc 203-395-3300. 472 Pepper Street Monroe,CT 06468 1c.NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required if coverage Is specifically limited to certain locations in New York State,i.e.,a Wrap-Up Policy) 1d.Federal Employer Identification Number of Insured or Social Security Number 201023368 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Main Street America Village of Rye Brook 938 King Street 3b.Policy Number of Entity Listed in Box"1 a" Rye Brook NY 10573 W1P4723V 3c.Policy effective period May 17,2021 to May 17,2022 3d.The Proprietor,Partners or Executive Officers are QX included.(Only check box if all partners/officers included) all excluded or certain partners/officers excluded This certifies that the insurance carrier indicated above in box'3"insures the business referenced above in box"1a"for workers' compensation under the New York State Workers'Compensation Law. (To use this form,New York(NY)must be listed under twin 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate (These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect Please Note: Upon cancellation of the workers'compensation policy indicated on this form,If the business continues to be named on a permit,license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named Insured has the coverage as depicted on this form. Approved by Laura wolff (Print name of authorized rnpresentative or licensed aynnt of insurance carrier) f- -::�-<':+�iJ/i ;.1 Jry!U•-,, APPROVED Approved by ; (Signature) (Date) Title- Account Executive Telephone Number of authorized representative or licensed agent of insurance carrier: 203-268-9999 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