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HomeMy WebLinkAboutRP22-018PERMIT # / told- CJ/ CI_ DATE:ys,�aa EXP
SECTION BLOC14 LOT
TYPE OF WORK P/-kb /,
JOB LOCATION /' JQU //VP_
i53- 8661
�3)8/y-6634
/E�,T. COST IT6 - FEE,
\COO # FEE l IO'Pp
TCO # FEE DATE
INSPECTION RECORD
I DATE INSP
FOOTING
FOUNDATION
FRAMING
RGH FRAMING
INSULATION
PLUMBING
0
RGH PLUMBING
GAS
O
SPRINKLER
ELECTRIC
LOW -VOLT
O
ALARM
0
AS BUILT
O
FINAL
OTHER APPROVALS
ARB
BOT
PB
ZBA
OTHER
DRY '�A
198
t.CC 4�UJJV G
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VILLAGE OF RYE BROOK
MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR
Jason A. Klein (914) 939-0668 Christopher J.Bradbury
www.ryebrook.org
TRUSTEES BUILDING & FIRE INSPECTOR
Susan R. Epstein Steven E. Fews
Stephanie J. Fischer
David M. Heiser
Salvatore W. Morlino
CERTIFICATE OF COMPLIANCE
June 11,2024
Joshua Nachman &Stephanie Nachman
14 Berkley Drive
Rye Brook,New York 10573
Re: 14 Berkley Drive, Rye Brook,New York 10573
Parcel ID#: 135.34-1-49
Roof Permit#22-018 issued on 5/5/2022 to Re-Roof Existing Building
This certifies that the new roof,installed under the above captioned permit has been satisfactorily completed.
Sincerely,
Steven E. Fews
Building& Fire Inspector
/to
DE C E '- ����' " For office use only:
DBUILDING DEPARTMENT PERMIT
MAY 3 0 202 VVILLAGE OF RYE BROOK ISSUED:
938 KING STREET,RYE BROOK,NEW YORK 10573 DATE: S- 30•-2
VILLAGE OF RYE BROOK (914)939-0668 FEE: t(' //0— PAID*
BUILDING DEPARTMENT www.ryebrook.org
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
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Address: I _1 �-
Occupancy/Use: Parcel ID Ll9 Zone:
Owner:�T �� CIS m Address: 1
P.E./R.A. or Contractor: 1 2 S Cc4e — Address: P.o •,��'/9 01 QSS�/piny �J f/
Person in responsible charge: o-N CC—1 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:
STATF,OFF,N^EW /Y�O>RK, COUNTY OF WESTCHESTER as: n
being duly swom,deposes and says that he/she resides at irle I J
(Print Name of Applicant) (No.and Sttof
et)
in �; < L-% ,in the County of QC.s4C� "d-/ in the Stat ,that
(City own/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:$ DL5 c)
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 structure/work has been erected/completed in
accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and
as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an
owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly
or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building
Inspector as per§250-10.A.of the Code of the Village of Rye Brook.
Sworn to before me this 3 V c� Sworn to before me this
day of �Q , 20 /, day of , 20
Signatur f Property Owner Signature of Applicant
Print NP of Property Owner
Print Name of Applicant
M
Notary Public Notary Public
GREGORY NI.RIVERA
Ndry Public,State of New York 8;12/202 1
No.01R18M1398
QuWIlled In Wealthnter County
Conunktlon Expires Upbmber 26,20
QyE BR(��.
O� 2�
1982 BUILDING DEPARTMENT
WBUILDING INSPECTOR
b 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 : " 1./� DATE: 1 /
PERMIT# ISSUED: SECT: (+ BLOCK:LOT:
LOCATION: \/ 4p ',�Z� V - OCCUPANCY: z
❑ 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
❑ FINAL PLUMBING
❑ ROSS CONNECTION
- FTNAL
❑ OTHER
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BULL TMENT R
'='
V �E OF RYE MAY - 2OZ2
938 KIN .0
G ETA RYE BR NY 10573
-0668 VILLAGE OF RYE BROOK
VAM. ok or BUILDING DEPARTMENT
FOR OFFICE USE ONLY:Approval Date:MA Y - 5 20U Permit# c>c)� —oa Application#
Approval Signature: ARCHITECTURAL REVIE OARD•
Disapproved: Date: _-
BOT Approval Date: Case# : Chairman:
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case#
Other: Zz�
Application Fee%$ Permit Fees:
L GEC Q
Application dated: IZDZ:L_is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit to
Re-Roof an Existing Ohildind,as per detailed statement described below.
1. Job Address: - SBL:_35 —1— Zone:
Property Owner: Address: 19 btrhi-<4
Phone#: � ��� Cell#: Sze email:
2. Applicant:n-6-b% A bay- % Address: I t
Phone#: Cell#: emat :T.�.���„s,a� Ca�yaw�.ra•r•
3. Roofing Contractor: Cra w c A ,ter.._,, t m Wr-Addresf' /7°� o s s en%i&%y/. t 0 C 6 2
Phone#: 7A�_ ri fe 22 Cell#:nn email: -
4. Job Description,list all Methods&Materials: 14�- 9 Gr< s��4�� r"t✓'_ram
�j�.�vt Cafrtt .,
5. Estimated Cost of Job: $—Irk (NOTE:The estimated cost shall include all site
improvements,labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.)
6. If corner property,indicate street frontage:
7. Construction Type: NYS Constriction Class:
8. Number of stories: Height:
9. Is garage being re-roofed:No: Yes:{ )Att�ach�J No:( )*Yes:( )Number of Cars:
10. Is roof peaked,hip,mansard,flat,etc: C V kk ''
11. Estimated date of completion: W _
-1-
6h214021
Please note that this application must include the notarized signature(s) of the
legal owner(s) of the above-mentioned property, in the space provided below.
Any application not bearing the legal property owner's notarized signature(s)
shall be deemed null and void, and will be returned to the applicant.
STATE OF NEW 3ORK,COUNTY OF WESTCHESTER ) as:
�o, � A gCkM� ,being duly sworn,deposes and states that he/she is the applicant above named,
(print name of indi dual 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
1t0K4 rlC,,l Mn ` 1't4 ' IJI �. for the legal owner and is duly authorized to make and file this application.
(indicate ah6ect,contractor,ligent,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.
U�, vf�ti
Sworn to before me this -1 Swom to before me this
day of ,V , 20 Z L day of ,20 Z2
Signature Property r Sign of Applicant
JD
Prin awe o perry Owner Print N of Applicant
171 ry Public Not#y Public
RANDIG PATERNO RANDiti PATERNO
Notary Public,state of New York
No.02PA6117023 //Rotary Public,state of New York
Qualified in New York No.02PA61 17023
pommission Expires October 12,20 � Qualified in New Yn 1 qt/
t mm1stilon Expires Octut3er 12,20 d
-2-
8112@021
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CERTIFICATE OF LIABILITY INSURANCE DATE 1/05/20
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 John M Donohue
FITZPATRICK INSURANCE CENTER NAME:
54 WELCHER AVENUE PHONE INC, 914.739.6117 FAX 914.739.1553
PEEKSKILL, NY 10566 E-MALDRESS: JOHND@FITZPATRICKINSURANCE.COM
AFFOREIM COVERAGE NMC•
INSURER A: EVANSTON INSURANCE COMPANY 35378
INSURED Flores General Repair Inc INSURER 8:
P_O. Box 1902
INSURER C
Ossning, NY 10562
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.
NSR ADOTYPE OF INSURANCE L SUOR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS
A CwMERCLAL GENERAL UAButY Y 3AA474748 05/06/2021 D510612022 EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENrED
CLAIMS-MADE � � �
OCCUR PsEs(Ea $ 100,000
MED EXP(Any cne Prior,) $ 5,000
PERSCNALBADVINJURY $ 1,000,000
GE/NL AGGREGATE LIMIT APPUES PER GENERAL AGGREGATE $ 2,000,000
Y/ POLICY � LOG PRODUCTS-CC P/CPAGG s 2,000,000
OTHER $
AUTOMOBILE LU1BI.nY COMB(EaINED
tle SINCIE UMT S
ANY AUTO BODILY INJURY(Per person) $
O✓VNED SCHEDULED BODILY INJURY(Per accidert) b
AUTOS ONLY AUTOS
HIRED ONLY NON40WNED DAMAGEAUTOS 3
S
AUTOIS ONLY
UMBRELLA UAB OCCUR EACH OCCURRENCE b
EXCESS LIAR HCLAIMSAVDE AGGREGATE b
DED I I RETENTION S E
WORKERS COMPENSATION PER DTIi
AND EMPLOYERS LIABILITY YIN STATUTE ER
ANY PROPRIETORIPARTNER/EXECUTIVE NIA EL EACHACCIDENT $
OFT-ICERIMEMBER EXCLUDED?
(MsrxWory in NH) EL DISEASE-EA EMPLOYEE $
If yyes,desuilx nlndef
DESCRIPTICNOF CPERATIONS below EL DISEASE-POLICY LIMIT E
DESCRt?T10N OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101.Additimal Remarks SGaduK nay be altachd it more apace is requred)
LIST CERTIFICATE HOLDER AS ADDITIONAL INSURED
JOB LOCATION: 14 BERKLEY DRIVE, RYE BROOK, NY 10573
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
VILLAGE OF RYE BROOK BUILDING DEPARTMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
983 KING STREET ACCORDANCE WITH THE POLICY PROVISIONS.
RYE BROOK, NY 10573 1
AUTHORED REPRESENTATIVE f�
©1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
NYSIF
New York Fund PO Box 66699,Albany,NY 12206
1 nysif.com
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
40
AAAAAA 262545639
FITZPATRICK INSURANCE CENTER
54 WELCHER AVE
PEEKSKILL NY 10566
SCAN TO VALIDATE
AND SUBSCRIBE
POLICYHOLDER CERTIFICATE HOLDER
FLORES GENERAL REPAIR INC VILLAGE OF RYE BROOK
PO BOX 1902 BUILDING DEPARTMENT
OSSINING NY 10562 983 KING STREET
RYE BROOK NY 10573
POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE
W2296 223-7 63058 08/24/2021 TO 08/24/2022 11/5/2021
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE
FUND UNDER POLICY NO. 2296 223-7, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR
WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL
OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS
OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY.
IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS,
OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:IAMW.NYSIF.COM/CERTICERTVAL.ASP.THE NEW
YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS.
THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE
INSURED CORPORATION.
PRIES
SERGIO FLORES
FLORES GENERAL REPAIR INC
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: 213601360
U-26.3