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BP22-069
PERMIT # - DATE, 9 c Exist SECTION TYPE OF WORK JOB LOCATION OWN CONTRACT01 EST. COST 0 #._ TCO # FEE GATE FOOTI N G FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS SPRINKLER 00, ELECTRIC LOW -VOLT ALARM AS BUILT FINAL INSPECTION RECORD DATE ll�,np 110 � ze� 1 'l.li Gas �' a�1�b23 L ��� Ck'oCP•7o✓t,1 �t�� 6s (&/7)10a0-- w4100 i� (7/9) Z)iS- 7/6 z4- ypmb Qr)rJV Ilj�L�rI / 9::Pfa� - l37 Amoco 60S PPa3 ©l /TA q-e5e,1? /4 C4ae7iC.AJ C_0k OTHER APPROVALS ri�r�o, a0aa- Bd1 PB ZBA OTHER I r L AS-BUILT/FINAL SURVEY REQUIRED PRIOR TO FiPJAL INSPECTION THIS BUILDIt18 MUST BE POSTED WRH A PERMANENT WMIMMIMM TYPE IDENTIFICATION StON; V FR t•RiOR TO THE ISSUANCE OF A C/O, AS REQUIRED BY W STATE LAW. VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK No: 23-12:1 Certificate of ®ccupaucp This is to certify thatJe-}-(i P_o COcmbs f Vath run R ah Coomtq of, 'e byre V, having duly filed an application on J(,L n6 a� 20_gd__requesting a Certificate of Occupancy for the premises known as, /0 earl kl? L o e , Rye Brook,NY, located in a )2 Zoning District and shown on the most current Tax Map as Section: .4koZ Block: _/Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No.Ca&o , issued 51a 20—;2a2, 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: - jQmil Construction: for the following purposes: D il e < K44 LGL]!d l h-60 i nelU -avr deck- Injerl'aK z6aova4m)-) 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 he'ght shall be made,nor all the ilding be moved from one location to another until a permit to accomplish such change h s tai th B ' mg Inspector. AUG 0 9 1023 Building Inspector,Village of Rye Brook: Date: yE D °t . 19 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 August 9,2023 Jeffrey Coombs &Kathryn Rightmyer Coombs 10 Carlton Lane Rye Brook,New York 10573 Re: 10 Carlton Lane, Rye Brook,New York 10573 Parcel ID#: 135.42-1-5 This document certifies that the work done under Mechanical Permit #22-137 issued on 9/8/2022 for the installation of one above-ground propane tank has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to tLU 4.0 J�v �L L v 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 August 9,2023 Jeffrey Coombs&Kathryn Rightmyer Coombs 10 Carlton Lane Rye Brook,New York 10573 Re: 10 Carlton Lane, Rye Brook,New York 10573 Parcel ID#: 135.42-1-5 This document certifies that the work done under Mechanical Permit#22-172 issued on 11/16/2022 for the installation of a new condenser and Mitsubishi ductless system has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to BUILDING DEPARTMENT For office use only: I DD JUN - 2 2023 VILLAGE OF RYE BROOK PERMIT# c' -Ob'9 ISSUED:,S/9-ate VILLAGE OF RYE BROOK 938 KING STREET,RYE BROOK,NEW YORK 10573 DATE: /,_Q_a3 BUILDING DEPARTMENT (914)939-0668 FEE: 5- www.ryelrook.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 ■rwrss►►s►rwws■wrwrrsssssrrrrrsrassr►ss►•►ssrwwwrssr►s►►►►srrrssr►ssrsss►►rrrrr►►ssrsrrwrsarsssssrrr►ssr►►►s►►srrrrrr►s►sssss Address: I 0 C1-46-fvw C -IrvC , / Occupancy/Use: Parcel ID#: 13J 1 7 c)- Zone: Owner: s Erfice-li r C'D-V'J�-/ Address: /_ o C- �f'"`' Cif I P.E./R.A. or Contractor: ( `✓ CoNfv-'c n^',, L 1/ -Address: S bi-o,.2 11- I Person in responsible charge: aPC>'tA-1 CN(151 Address: o-E�- ,4 V , ,�,,,irc is, i✓i 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: c)L-FfTtk LI S , Cb"""3f being duly swom,deposes and says that he/she resides at I J C•+V- C k�- (Print Name of Applicant) (No.and Street) in P -1 C 3 �V-- ,in the County of W t S t E{C S R 1 Z in the State of A.)Y ,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:$ Z 5-C2 / 0,00 for the construction or alteration of: V""Vry� 1 S iv L� /}D� /».✓/ /V e w K 471 ✓J C c" lc✓,-t't'-' 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 da o �� ,20 Z day ,20z-3 Si e o operty Owner Signs of Applicant , J _ > .--I -� . C-0o COI Prin Mf erTy Owt r Printcan l7� Notary Public Notary Public SCOTT J.GOWE SCOTT J.GOWE NOTARY Puam OF NEW YORK NOTARY PUBLIC OF NEW YORK I.D.•01GOM718 I.D.it 01GO635718 >,zS MY COMMISSION EXPIRES Z�L MY COMMISSION EXPIRESL��=- QyE BR(��, 1982- 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 nXebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - `7 2.3 ADDRESS:- DATE' ))(I PERMIT# \� ISSUED. �-iE T' BLOCK: LOT: L�-LOCATION: �" r" �GCC �� t OCCUPANCY' ❑ Violation Noted THE WORK IS... [2f 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 ❑ CROSS CONNECTION FINAL ❑ OTHER i BUILDING DEPARTMENT DING 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: � c� vv\- `-' DATE: -2' PERMIT# ISSUED. ECT:jjS�'BLOCK: LOT: 5 LOCATION: c ��� ,S I)( a l cb OCCUPA 210 � N � pC � ,'� la�� ❑ Violation Noted HE WORK IS... ❑ PASSED FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas , ��� � ►` �� �G ��° U t`b,��Q ❑ L.P. Gas pp ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING 1 ❑ CROSS CONNECTION ❑ FINAL l ❑ OTHER f �E BR�uk 1982 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 :_ v C-a C ` ln-� `" y DATE: _ PERMIT# ` ISSUED: I `�Q O SECT: -"k2-BLOCK:�_LOT: \%\ LOCATION: \ OCCUPANCY: ❑ V OLATION NOTED THE WORK IS... ❑ ACCEPTED [� REJECTED/REINSPECTION livSITE 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 C>t OTHER l/ Bkj� ,�f '9�2 BUILDING DEPARTMENT 1�'J 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 : co 1 1 y V _ DATE: PERMIT# ` ISSUED:1 �SE.� CT: LOCK: LOT: LOCATION: OCCUPANCY: Z <l ❑ 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 p'L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ` )U ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER 6C\ l 1 � BR��. 0 2m 1952 BUILDING DEPARTMENT 91PUILDING 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 - - - - - - - - 7 - - - - - - - - - - - ADDRESS • \`�G"- ` � l.J�V Q DATE. PERMIT# ��� O \ ISSUED: : Il ECT: J BLOCK: LOT: r LOCATION: �to t I1C OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ,ACCEPTED ❑ REJECTED/ REINSPECTION ❑q SSITE INSPECTION REQUIRED 1/-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 1982 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:_ � � L��i v9 DATE: -2 ?02 PERMIT# Z ISSUED: 11 SECT: BLOCK: LOT: LOCATION: \ �'"C�� �� C `I J� ` OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... r '-ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ,.PG A L AN ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER �yE DRa? E BUILDING DEPARTMENT ❑BUILDING INSPECTOR ,ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ` [I CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www ryebrook.orQ - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS: ` DATE: PERMIT#�d22-2jO�A ISSUED 0'2 Z SECT: BLOCK: LOT: t \/ LOCATION: ICJ ' -� ��N V y OCCUPANCY: Z ❑ VIOLATION NOTED THE WORK IS..._ ❑ ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION -0 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 4ye Bkoot o`` �m cu � 1982 BUILDING DEPARTMENT ❑I�UILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK /11 CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.Uebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - (L-x ��-o L 277kLOT ADDRESS: � DATE' PERMIT# 22 ISSUED:3��"ECT: BLOCK: LOT: LOCATION: ` v�y `'' � OCCUPANCY: \`� ❑ VIOLATION NOTED THE WORK IS.— ❑ 'ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ,TROUGH FRAMING /INSULATION U NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER �E 4Ra? O� Zm 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 - - - - - - - - - - - - - - - - - - - - I c)[ ADDRESS : �Q 1, rZ-L lit-2 / A/�I_ DATE• Z Z� PERMIT# ISSUED: SECT: BLOCK: _LOT: LOCATION: I N -�,IJ lZ I�rti-J�1/�, 7nP OCCUPANCY: z� ,f ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ .FOUNDATION ❑'' UNDERGROUND PLUMBING -P��7S�"`' NOTES ON INSPECTION: ❑ .ROUGH PLUMBING 0 ROUGH FRAMING Tmcv 16L ❑ INSULATION ��- ❑ NATURAL GAS ❑ L.P. GAS , _ ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER �yE BRC��_ • 1982 BUILDING DEPARTMENT UILDING 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: OGhZ PERMIT# G, ISSUED:� SECT: BLOCK: LOT: LOCATION: PJ \�� �X�U `C��I�✓,`�Y �� OCCUPANCY: 2- �, ❑ VIOLATION NOTED E WORK IS... p ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION d,1 f / REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ROUGH PLUMBING Cl ROUGH FRAMING ❑ INSULATION j c ❑ NATURAL GAS " -�1 N C � J l n\C ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER QyE BRC�v� 193,2. BUILDING DEPARTMENT ❑BUILDING INSPECTOR p`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: f `Z2 - PERMIT# ` ISSUED: Fiv ? SECT: BLOCK: LOT: LOCATION: "- �1 \�. .� OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... d ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ . FOOTING ❑[ FOOTING DRAINAGE D, FOUNDATION i"❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: 'f ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER Q0 f3R(�j�• '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 - - - - - - - - - - - - - - - - - -= - L�t� ADDRESS: v DATE: PERMIT# ISSUED: \\ �';ECT: I /� \BLOCK: \ LOT: LOCATION: �"�� \L \X\y( OCCUPANCY: - vim-' ❑ VIOLATION NOTED THE WORK IS... I/ ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION tLU REQUIRED ❑ FOOTING v J ❑ FOOTING DRAINAGE 0 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 �E BRC�jk. O�` tim BUILDING DEPARTMENT ❑!BUILDING INSPECTOR /[J 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 `0 DATE: fv- PERMIT# - ISSUED: SECT: BLOCK: LOT: } LOCATION: C ` ` o- 1 OCCUPANCY: ��1 ❑ VIOLATION NOTED THE WO K IS...X ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION Jur l REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE FOUNDATION ���- �` V co� ❑ 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 QyE BRC��, 1932 BUILDING DEPARTMENT u UILDING INSPECTOR 6 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.or� - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS :— (/ �n-�- N "�'iJ� DATE: cJ Z Z PERMIT# ISSUED: ( � SECT: (�Si Z BLOCK: LOT: LOCATION: 4--�x2o" OCCUPANCY: Z ❑ 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.GASFL Fo� c NC' ❑ FIRE SPRINKLER f--, Ajlo�l ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL f t n�-- ❑ OTHER ��-7--�Irl� W O�l.�c)�(J t�7 a Q �J �O 1982• ILDING DEPARTMENT BUILDING INSPECTOR )ZASSISTANT 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:— `\' -�? t ^y DATE: PERMIT# r ISSUED: ' �. SECT: BLOCK: LOT: � LOCATION: U'Q��,\ OCCUPANCY: ` 0 VIOLATION NOTED THE WORK IS... /Ef ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED 'a-'-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 , C N O w � ■ ■ 1 N N v v N 44 CN W v O .fir td O L" w o 0 a; w O a cn ' � cd �o s J "') 96 a, � � � y i 6J rA ' H Q \ ^ O A o C $ A W 00 C) � .. �� • l� y w xu � � a o •g � CN V ■ '+�1 W ppV' w '� {� f� ��'t p 0 0 0 � �' C� �I u z � av . ■ M�1 G� �I M oG C7 W v' o a u Z ■ ■ � � C7 G1 I.,� � fY F, z `nrq 00 ■ c � W z � u 3 o C Cd U O U C a ¢ y o Cn o 'S -na � a '81 14 Jul ? ov U A z oar x 1. � 0. v °J � Z 0 Z a � W W. G15 o v a n BUILDING dlh TMENT G VILLAGE OF RYE BROOK D 938 KING S` REE1,RYE BROP ,NY 10573 APR - 6 2022 (914)939-066 w�vwxyebrook: re VILLAGE OF RYE BROOK BUILDING DEPARTMENT FOR OFFICE USE ONLY: -� Approval Date: MAY 1 24gk mit# /01-c:P1 �� Application# bq I Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: Date: ZEl BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: Application Fee Permit Fees: EXTERIOR BUILDING PERMIT APPLICATION Application dated: is hereby made to the,Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the construction of buildings,structures,additions,alterations or for a change in use,as per detailed statement described below. 1. JobAddress: 1 c� !',&1ZlytotJ LAIC uv� 2. Parcel lD#: r Zone: 3. Proposed Improvement(Describe in detail): L . 4. Property Owner. e{fyP CCU M US Address: e t ire COOM 6's M61 it, Phone# Cell# e-mail Q� List All Other Properties Owned in Rye Brook: Applicant: I tZ(L(,o A I � Address: t Zo'5 Ypwl� qjA6 1, /d ,j / Phone# 114:50-JZ31 Cell# e-mail r&r`•. Architect:�Ube- A I &,-(.i Address: Phone# Cell# e-mail Engineer: Address: Phone# Cell# e-mail General Contractor: �wr, ,e I r4yav� y G Address:} J I QV�l� i/i V is yt&vs, n� 10-7 Phone# Q I U { ��!1�C f Cell# e-mail (1) 8/1 212 02 1 5. Occupancy;(1-Fam.,2-Fam.,Commercial.,etc...)Pre-construction:__'�dN Post-construction: I EA 6. Area of lot: Square feet:_ -i o4 ,4 S� Acres: 7. Dimensions from proposed building or structure to lot lines: front yard: 2'1 ,S—rear yard: I i right side yard: 2 I. i left side yard: y b,'° other: 8. If building is located on a corner lot,which street does it front on:__ Nib. 9. Area of proposed building in square feet: Basement: p _ I"fl: t2o 2ndfl: 0 31d fl: t� 10. Total Square Footage of the proposed new construction: 11. For additions,total square footage added: Basement: '9W 18`fl: 5?,0 2nd fl: y 31d fl: -0 12. Total Square Footage of the proposed renovation to the existing structure: W 13. N.Y.State Construction Classification: '! $ N.Y.State Use Classification: -� 1 14. Number of stories: I. Overall Height: I Median Height: 15. Basement to be full,or partial: PyI,L , finished or unfinished: U0 noir►l w 16. What material is the exterior finish:rgyl. 01411, G J 4106 17. Roof style;peaked,hip,mansard,shed,etc:_G*81 Ll o4t�'D Roofing material: A S�lAJ of I& What system of heating: lot ulwL� 19. If private sewage disposal is necessary,approval by the Westchester County Health Department must be submitted with this application. 20. 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...) Yes: No:_Z (tf yes,applicant must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 21. Will the proposed project disturb 400 sq.ft.or more of land,or create 400 sq.ft.or more of impe ious coverage requiring a Stormwater Management Control Permit as per§217 of Village Code? Yes: No: Area: 22. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: ✓ (if yes,applicant must submit a Site Plan Application,&provide detailed drawings) / 23. Will the proposed project require a Steep Slopes Permit as per§213 of Village Code Yes: No: V1/ (if yes,you must submit a Site Plan Application,&provide a detailed topographical survey) 24. Is the lot located within 100 ft.of a Wetland as per§245 of Village Code? Yes: No: (if yes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan) 25. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes: No: V (if yes,the area and elevations of the flood plane must be properly depicted on the survey&site plan) 26. Will the proposed project require a Tree Removal Permit as per§235 of Village Code? Yes: No: (ifyes,applicant must submit a Tree Removal Permit Application) 27. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No: Indicate: TIER I: TIER II: TIER III: (if yes,a Home Occupation Permit Application is required) 28. List all zoning variances granted or denied for the subject property: to fl y ;� a 29. What is the total estimated cost of construction: $ 10 000. Note.The estimated cost shall include all site improvements,labor,material,scaffolding,feed equipment,professional fees,inNuding any material and labor which may be donated gratis.If the final cost exceeds the estimated cost,an additional fee will be required prior to issuance of the C/O. 30. Estimated date of completion: {C) m ' V (2) 8/12/2021 BUILDING DEPARTMENT VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 RESIDENTIAL LOT AREA COVERAGE Address: ID CAeLVr0 LAN& Section: Block: 1 I,ot: � PERMITTED COVERAGE RATIOS IN RESIDENTIAL DISTRICTS (Local Law 3-88) YOUR ZONE AREA IN MAIN ACCESS. DECK ZONE DISTRICT SQ. FEET BLDG. BLDG. MAX. CHECK MAX, R-35 35,000 14% 4% 5% R-25 25,000 14% 3.5% 4% R-20 20,000 14% 3.5% 4% R-15 15,000 16% 3.5% 4% R-15A 15,000 12% 3.5% 4% R-12 12,500 17% 4% 4% R-10 10,000 20% 4.5% 3.5% R-7 7,500 23% 4.5% 3.5% R-5 5,000 30% 5% 3.5% R-2F 5 000 30% 5% E3.5% Existing: Proposed: 1. AREA OF LOT _V4 I og,L-Sq. Ft. �&• _Sq. Ft. 2. AREA OF HOUSE a. Coverage of Main Building 1 /$ 99 (Including Attached Garage or Accessory Building) _ Sq. Ft. _ —Sq. Ft. b. Area of 15'Floor Divided By Area of Lot x 100 • 1 % f '% 3. AREA OF ACCESSORY BUILDING (Includes Detached Garages,Tool Shed, Playhouses) Sq. Ft. Sq. Ft. a. Coverage of Accessory Building Area of Accessory Building Divided By Area of Lot x 100 % % 4. AREA OF DECK Sq. Ft. SI Sq. Ft. a. Coverage of Deck Q Area of Deck Divided By Area of Lot x 100 •21/ % "` % I attest to the best of my knowledge and belief, the above information is correct. ignature (3) Sit 212021 BUILDING DEPARTMENT VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 (914) 939-0668 IMPERVIOUS COVERAGE RATIOS RESIDENTIAL DISTRICTS Address:/O CpW7P AJ j�AA)e Section: 13S.V L Block: / , Lot: ,S- ZOne: IMPERVIOUS SURFACES (Definition): All buildings, as defined herein, and all areas on the ground or elevated above the ground which are comprised of materials through which water cannot readily flow, including, but not limited to asphalt, concrete, masonry, wood, gravel and clay, and which consist of elements including, but not limited to, court yards,sports courts, swimming pools,patios,sidewalks,ramps,terraces and driveways. TOTAL MAXIMUM PERMITTED MAX. PERMITTED COVERAGE Zoning IMPERVIOUS LOT AREA BY IMPERVIOUS SURFACES District COVERAGE IN FRONT (sq.ft.) For Base Lot For Lot Area YARD(0/o) Area(sq.ft.)* Over Base R-35 15 Lot Area % R-25 20 0 to 4,000 0 55 R-20 30 4 001 to 6,000 2,200 35 6,001 to 12,000 2,900 27 R-15 35 12,001 to 16,000 4,520 26 R-15A 35 16,001 to 20,000 5,560 25 R-12 40 20,001 to 30,000 6,560 24 30,001 to 40,000 8,960 23 R-10 45 40,001 &larger 11,260 22 R-7 40 R-5 30 *"Base Lot Area"is the minimum end of the lot size R2-F j 30 range in the"Lot Area"column Area of lot: 04,Lf sq.ft. Existing_ Allowed Proposed S z23 Total impervious coverage = �� �� S .ft. S . ft. 33VI.315 S .ft. Front impervious coverage = N % lw P % N p, % I attest to the best of my knowledge and belief,the above information is correct. Architect's Signature (4) 8/12/2021 BUILDING DEPARTMENT VILLAGE OF RYE BROOK 938 KFNG STREET RYE BROOK,NY 10573 (914)939-0668 BULK REGULATIONS IN RESIDENTIAL DISTRICTS Address: -/0 6yE e,�- A) 4N e Section: I3 f V7- Block: 1 Lot: 5" MAXIMUM GROSS FLOOR AREA USE FORMULA: Maximum Grass Floor Area = 4,000 + [ (Lot Area—21,780) x 0.11478421 ]: a. Allowed = 3 1 $�, `� Sq. Feet b. Existing = Sq(/ / Sq. Feet c. Proposed = 19 Sq. Feet HEIGHT/SETBACK RATIOS FOR RESIDENTIAL DISTRICTS DEFINITION: A standard designed to regulate the height of a building in relation to the average grade of the corresponding portion of the lot line from which it is set back. The ratio modifies the maximum permitted Height of Building by forming an inclined plane beginning at the average grade along the portion of the lot line from which the setback is measured and rising toward the building at the specified ratio above which no part of any building, other than minor architectural features such as chimneys, skylights and dormer windows not covering more than 10%of the entire roof area,shall be permitted to extend. Height and Setback shall be calculated using the formula; Height/Setback=X, where X is the required side or front yard ratio for the zoning district in which a property is located as specified in Article Vlli of Chapter 250. A complete elevation view for the proposed improvement must be included on the drawings. FILL IN YOUR RATIOS: ZONE EXIS77NG PROPOSED REOLAMED FRONT: FRONT: FRONT: .44 /?-35 SIDE: SIDE: SIDE: 1.20 FRONT: FRONT: FRONT: .48 A?25 SIDE: SIDE: SIDE: 1.30 FRONT: FRONT: FRONT: .60 R--20 SIDE: SIDE: SIDE: 1.60 FRONT: FRONT: FRONT: .60 R-15 SIDE: SIDE: SIDE: 1.60 FRONT: FRONT: FRONT: .80 R 15A SIDE: SIDE: SIDE: 2.40 FRONT: FRONT: FRONT: .69 R-12 SIDE: SIDE: SIDE: 1.60 FRONT: FRONT: FRONT: .80 R f0 SIDE: SIDE: SIDE: 2.40 FRONT: FRONT: FRONT: .96 R-7 SIDE: SIDE: SIDE: 3.00 FRONT: FRONT: FRONT: 1.20 /t5 SIDE: SIDE. SIDE: 4.00 FRONT: FRONT: FRONT: 1.20 R-2F SIDE: SIDE: SIDE: 4.00 1 attest to the be <now ed a lief, the above information is correct. Architect's Signature (5) 9/12/2021 BUILDINODERAcRTMENT APR — 6 2022 VILLt�E OF RY1 00K 938 KING RYE BRt'r ,NY 10573 VILLAGE OF RYE BROOK�'� �ET BUILDING DEPARTIMP] r i wJOV. F000lr *}*Y*#**'k##******#*#**'k#***#**i*#*}}tt*#*ttt}t}tt}*#tt*tt****ic***********r,zF$*f:4-Mf*•}.�-t}*x****k kf�:k k**it 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 NEWS YORK,COUNTY OF WESTCHESTER ) as: >C O ff ✓.,/i/r-zl� ��,�c�(i(1tt r- 4, residing at, /(� f'E'�N'U f- A 5 z'02 1'01 �i 1 (Print name) (Address where you life) 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'4&/ U'0U '4 4 L , Rye Brook,NY. (Job Addresso 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. OU (Sipudurei�'PropertyOw s)) C 1' �'V �cv7� tT%� L—r ! e Hie. 5 (Print Name o Property Ownerl2)) �r Sworn to before me this Jof Z\ ,20 (Nalary Public) SHARI MELILLO Notary Public, State of New York No.01 i'«_61 e.>j063 Q!ialified in Westcha�ter County (6) Commission Ex0res January 29,20n 8!I J2021 This form must be properly completed ¬arized by the Design Professional of record and the Property Owner. Failure to provide this completed © motit- out--. _ permit application will delay the permitting process IE V/ E APR - 6 2022 Notice of Utilization of Truss Type, Pre-Engineered o d LAGE OF RYE BROOK or Timber Frame Construction. (Title 19 Part 1264& 1265 NYICRRjILDING DEPARTMENT To:The Building Inspector of the Village of Rye Brook. From: R/cA L /f1 !of i Subject Property: t D cidul Ai am SBL: �3 f'L Zone: Please take notice that the subject; of One or Two Family; o Commercial, ❑New Structure 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) V1're-Engineered Wood Construction(PW) ❑Timber Construction(TC) in the following location(s); o Floor Framing,including Girders&Beams(F) "oof 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 before me this L Sworn to before qi this day of <� ,20 day of 20�� S gna re of party Owner gna re o ign Professional t Name f Property weer ri of gn fessi al Notary ublic N �c SHARI MELILLO f4otary Public, State of New York LISA M.S. KATZ 9,)D. 01%1'.61 60063 NOTARY PUBLIC-STATE OF NEW YORK Q!iaiified in Westche_ter County No.02KA6242350 Commission Expires January 29.20_21� (7) Qualified in Westchester County My Commission Expires 05-31-2023 This application must be properly completed in its entirety by a N.Y. State Registered Architect or N.Y. State Licensed Professional Engineer & signed by those professionals where indicated. It must also 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,COUN QF WESTCHESTER ) as: ti , being duly sworn,deposes and states that he/she is the applicant above named, print name of individual signing as the applicant) 7d 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,stump 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 GTIA day of 20a day of ` ,20 ZZ ature o rVii wner ignatu Applicant Print Name of Property Owner Print Name f Applicant Notary Public Nola P he SHARI MELILLO Notary Public, State of New York LISA M.S. KATZ No. 01°,iL=61 C063 NOTARY PUBLIC-STATE OF NEW Y05K Qualified in Westche ter County No.02KA6242350 Commission Expires January 29,20_113 Qualified in Westchester County My commission Expires 05-31-2023 cx� $!12/202I L / r� BUILDING MPARTMEN T SEP 1 5 2022 VILLAGE OF?2YkftOOK 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK ("4)9 9-OCbB BUILDING DEPARTMENT wwwxv ookl., rg *********************************************************************************************************** FOR OFFICE USE ONLY': approval Date: SEP 2 6 ? 1 ermit#rj Z:2 " U) 6 T Application# Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: : Date: BOT Approval Date: ase# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: Amendment Fee-* Permit Fee: APPLICATION TO AMEND APPROVED PLANS Application dated: /—/.5-1)4 is hereby made to the Building Inspector of the Village of Rye Brook,NY,to amend the approved plans associated with an existing open permit,and/or from any prior approvals granted by the approval authority as per detailed statement described below. I. Job Address: C A Q.c;jpnJ f A-j E Existing Permit#: P Z Z - OV 1 2. Parcel ID#: ( 3$�- VI- - I -S- Zone: '!Z Original Approval Date: ��i9 L•tz 3. Proposed Amendment(Describe in detail): fjrVA-U tE (QI M EwJ k--j3 I L 4-Yaj i' OF A-Po ►tyb•vA"t Cp¢Av..,. MOO-n , s T-oa*b t , A-IVfl G t4 J vba-j '0 if P r2.F_y«L-1 6peiz-o��o A-DO% 4. Property Owner: Address: �,O ('_,,AYL--PrJ CA-r,/C- CNt b l 09-V-3 Phone# -COZO - 5- 'v Cell# 3Yr- S"98- '-/',S-z e-mail �ChfzEy- coo�+:u 4.e Applicant: mlCh79� n►GUf/" A�fez. xf--7 Address: �iNj-t�' 715'S 70lylk k1 u 10S'T1 Phone# %�--?40 lge Cell# e-mail M/C/hf'L-bGJ^11 1� �o Architect/Engineer:M1CAgl-t, Rtzliplif. /4"W'p("p-A p Address:S(K MA%t-s►T+ ��'►�11� ��� ��� TZty'� Out, Ny FC411 Phone# 71t/- 165-9�If Cell# e-mail Aft A(A06717W 5. Occupancy;(1-Fam.,2-Fam.,Comm.,etc...)Prior to construction: I After construction: I - FA"`^ 6. Will the proposed amendment 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...)Yes: No: t (if yes,you must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 7. Will the proposed amendment disturb 400 sq.ft.or more of land,or create 400 sq.ft.or move of impervious coverage requiring a Storm water Management Control Permit as per§217 of Village Code?Yes:_No:_Area: t 8/12/2021 8. Will the proposed endment require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: T(if yes,you must submit a Site Plan Application,&provide detailed drawings) 9. Will the proposed amendment require a Steep Slopes Permit as per§213 of Village Code Yes: No: ✓ (if yes,you must submit a Site Plan Application,&provide a detailed topographical survey) / 10. Is the lot located within 100 ft of a Wetland as per§245 of Village Code? Yes: No: ✓ (if yes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan) 11. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes : No: (if yes,the area and elevations of the flood plane must be properly depicted on the survey&site plan) / 12. Will the proposed amendment require a Tree Removal Permit as per§235 of Village Code?Yes: No: ✓ (if yes,you must submit a Tree Removal Permit Application) 13. Does the proposed amendment involve a Home-Occupation as per§250-38 of Village Code? Yes: No: Ifyes,indicate: TIER I: TIER II: TIER III: (if yes,a Home Occupation Permit Application is required) 14. Will the proposed amendment result in additional square footage to the building or subject structure, and if so, provide such additional footage here. A/b (Please submit additional Bulk Regulation Application Pages for review) 15. What is the total added cost of the work associated with the amendment: $ (D I (The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,including any material and labor which may be donated gratis.) 16. N.Y. State Construction Classification: 6 P5 N.Y. State Use Classification: 17. Estimated date of completion: M) 1 I Z o�Z This application must be properly completed in its entirety by a N.Y. State Registered Architect or N.Y. State Licensed Professional Engineer& signed by those professionals where indicated. It must also 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 YO/R/K, COUNTY OF WESTCHESTER ) as: .X461Q, O'gZ ,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 �lAO=i r 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 ( L-� d 'A, h? , 20 day of fi' 1202-2— SiZACtawofProperty Owner ' a e of Applicant Lb Pr t Na e of Property nt Na o Owner Prif Applican ublic Nota Pu lic PERRY DONDF STEVEN 2 Notary Public, Sta, New York LiSA M.S. KATZ No. 01 PE 6 361 NOTARY PUBLIC-STATE OF NEW YORK Qualified in New York County No.02KA6242350 Commission Expires December 13, 2025 Qualified in Westchester County My Commission Expires 05-31-2023 8/12/2021 M N c N N Ln CN00 a Qr w Fsr � i n s to � W rj � w v O z z QZ a ° U W O to QI-, C�� w � � W � v) C� a °per° W o o a. O o `� Z Uz z z i W Mil F M � °z W �. oo �--� C �' .a � w z i .� a w w O o � C Z E•+ p p r w Ln !. ►- U W Z a( V F A 0 C7 A pV) ., w � z �I as a a z a]a w z � • BMDING DEPARTMENT VILLA&OF RYE BROOK RIJUN - 2 2022 DD 938 KING STREET RYE BROOK,NY 10573 (914)939=0668 VILLAGE OF RYE BROOK www.lYebr".org BUILDING DEPARTMENT _.._. ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: Z Z 1 EP #: �d 1 00 Approval Date: JUN.; ,`2 20P Permit Fee: $ 3 75 Approval Signature: NY/ 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 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. 1 1.Address: 1 V G'�-l2 C,!v n`� (Ar/►Z SBL: /3 5s y Z- 1 - 5 Zone: 4 c- 2.Property Owner: 1E F Fq- 0 M 13.5 Address: 10 4_AP_(_%0 C-+rllk- 4.0 Phone#: , n _ ✓_ . ,,.i Cell#: (p I`1 . & ©• '5q# ) email: f f_FF , 3.Master Electric r" I�� r�1 t ✓ 2 Address: i3 / �� v r Lic.#: Phone#:N7 19 -09/3Cell#: email: Company Name: &)�y-010 F,2 e4,0 E f tcRVAddress: 3`1 % 4 l F-t-eF�/� i-� GP i/I'LT-O L,06" 4.Proposed Electrical Work/Fixture Count: laJ t IZtL 1'L e+,-/D ifA-r'/6 _ &e L r P0'—VAa , I-1G-va_F—S , P-PP I-+NL�c S , � •� �--� � �%�CZ7 S , STATE OF NE , �RK,COUNTY OF WESTCHESTER ) as: u 1!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 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 t fore me this day of 120 day of 20 Signature of Property Owner Signatu e o Applicant Print Name of Property Owner t Name of Appli t 71L Notary Public Notary P igl MELILLO Notary Public,State of New York No.OiME6160063 Qualified in Westchester County; Commission Expires January 29,20 8/12/2021 STATEWIDE • Service With Ititegrity 1080 I office@swisny.com SWIS JOBAPPLICATION tel845.202.72241 • • 1•2 SWISNY.corn I SWISTraining.com Office Use Elect.Permit# �`_}� � /O� Date G / Bldg Permit# � Utility ID#12- ZZ - 069 Final Certificate# City/Village Zip I ;= C Township County Address I `� /T U.�J �j Cross Street Se!95&5,'qZ Block I Lot cj Owner Name/Addre50f q f ef�nntt tosdn abo ,v --`F '!,�- �l pJ �l ;;t Contact Number ElBasement •1st Fl.. []'2nd FI. 3rd Ff. More Than 3 FI. Garage Attic Outside Residential Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps Range(s) Cooktop(s), ;Oven(s) Dishwashers Refrig ator D_jSp"al Microwave Warm Draw In andescent Fluorescent SERVICE ` Amperage Voltage ' 1P P #Meters '#Disconnect ❑Underground ❑New Reconnect 13 Overhead El Change Visual Re-Inspection Safety Re-Inspection 0 Re-Inspection Additional Information re r s, ,� r('7 LJUN - 2 120122 1 __jB VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected.d 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.The applicant declares that there is no open applications for the above address with any other inspection company.The applicant,owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Inspector Date Finalized Inspector# Company Nam*1 1' �; `I, Date l{ r 4- Signature Address ? �.� — Ci ipte C. C C Zip Code License# Phone# State Wide Inspection Services 1080 Main Street Fishkill, NY 12524 SWUS 845 202-7224 Phone 914-219-1062 Fax S7 A7F WIDE INSVECI ION', RV It I•. Email: office@swisny.com Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Antonio Ferrao Electric Coombs Residence 313 Highridge Court 10 Carlton Lane Peekskill, NY 10566 Rye Brook, NY 10573 Located at: 10 Carlton Lane, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP-22-106 Certificate Number: 2022-6766 Building Permit Number: BP-22-069 A visual inspection of the electrical system was conducted at the Residential occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at: 10 Carlton Lane, Rye Brook, NY 10573 The Basement, First Floor, and Garage were inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 25`h day of April 2023. Name quantity Rating Circuit Type Luminaires 106 Switches 56 Receptacles 66 GFCI 28 Hot Water Tank 01 30AMP Dryer Receptacle 01 30AMP Washer Receptacle 01 Furnace 01 Oven Receptacle 01 40AMP Condenser 01 50AMP Heat Pump 01 30AMP Mini Split HVAC Systems 02 Bathroom Exhaust Fans 04 Hood Exhaust 01 Name Quantity Rating Circuit Type Bathroom Floor Radiant Heater 01 Main Breaker Panel 01 200AMP AFCI Breakers 04 20AMP AFCI Breakers 05 15AMP Breaker 01 125AMP 2 Pole Subpanel 01 125AMP AFCI Breaker 11 20AMP AFCI Breaker 05 15AMP Smoke Detectors 08 Officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. Page 12 � N � N 00 " ELn - a `O W 00 > M 4 F �+ ' a p `y O w vs W a W ° 6 N F, Ln z N W LD tc x in z o • x �) w M eq MM � � a x a z • W � � Q „ � C7 � �., q , 00 O z w o O Sz ■z � � z 00 (3N wa � a v z 1 oz cn a m V z w ` a H w z O u 0.4 0 �q V V �y a a °' s Q z f...� •• A a" W A a a s �] �j �] s ■ Y ■ 3' m BUILDING DEPARTMENT `- VILLAGE OF RYE BROOKH AUG 18 2022 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF ,RYE BROOK (914)939-0668 BUILDING DEPARTMENT www.ryebrook.or PLUMBING PERMIT APPLICATION 1 FOR OFFICE USE ONLY BP#: ��_d�% PP#: ��,Io7 Approval Date: AUG I A 7n77 Permit Fee: $ 3 �AD CL Approval Signature: Other: Disapproved: (fees are non-refundable) ************************************************************************************************** Application dated, 210 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 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. 10 Carlton Lane Rye Brook NY 1.Address: SBL: ���� �� _�_Jr Zone: —/4 2.Proposed Work: Relocation of kitchen sink,Replace and relocate gas stove,New powder room(1 toilet,1 lav),New bathroom in extension(1 toilet,2 lav,tub),Relocation of fixtures in existing bathrooms.(2 lav,shower,1 toilet),electric water heater(power by other)xt 3.Property Owner: Jeffrey Coombs Address: 10 Carlton Lane Rye Brook NY 10573 Phone#: 617-620-54M Cell#: email: 4.Master Plumber: Lawrence Grossman Address: 492 City Island Avenue Bronx NY 10464 Lic.#: 999 Phone#: 917-642-3265 Cell#: Tax1 email: Ilgplbg@aol.com Company Name: LLG Plumbing&Heating,Inc. Address: 492 City Island Avenue Bronx NY 10464 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 CoC 2nd Floor or Yd Floor 4'b Floor 5`h Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -I- 8/12/2021 N N R., Ia. �t w van °� hit oo N o a z I w p re ►� o oqo H tn : OZ w a � < moo = A H z �.� aC A w zC4 CO'i w 0412 U, z 04% u: i �, cn c z M x U W u Z z � ~ a F a a O M MCI .a cn SIN M W Q o a wa I-D IOL 0 0 � ` .�...� w x Qr U H a ►•r 2 0 a w V H8 1-4 a M o >- o on z a BUILDING DEPARTMENT JAN 13 2023 VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914) 939-0668 L BUILDING DEPARTMENT v,�ww.rvebrook.org PLUMBING PERMIT APPLICATION 1 (0111. ()1 1 i( 1", 1 IN E ONIX B 1, = : _._ - -9---- IT P Approval Date: J AN 2 4 Permit Fee: S Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, / !"-1L 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. 1.Address: /0 �rLZ f8N -/'�'� SBL:_ /! ��/ ) /S Zone:)eyt)` 2.Proposed Work: JIZ,✓ Tflya 3.Property Owner: 1-6 kir- as'A ; Address: /D 0,4gl� Z,8L4�_, l$ Phone -162y -5yDU Cell#: email: ,Teff--fey ,3,C,,Cl" 4.Master Plumber: & ffS r)l_ v Address: ^�0 Lic. #: 0 1 Phone#: 5 W 26'1-J'?9V Cell#:RK-) it-yo! ,,,' email: , �� �(•�e,r ,is,6,1 Company Name: rJ►� Address: a VV e� k��Z�° �,e-/yt'"k. '`J /F4 13 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 2nd Floor 3`d Floor 4'"Floor 5"Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) ST�TE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Q—, L' ���"�7,e, , being duly sworn,deposes and states P thathe/she is the applicant above named, (pant 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 a thorized to make and file this application.(indica(e architect,contractor,agent,attorney,etc.) } g 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 I application and in any accompanying approved plans and specifications,as well as it 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 Swor i to before me this 5 day of 20 day o v S ,20 Z - Signature of Property Owner na lure' of Applicant Print Name of Property Owner e of A li t ccc���ppp Cl,EPYL A.ZASTEMC;I-IX I [Nmotary Ptlbtic data uP flow York ! Notary Public Wo,0-)IA60WU4s6 Qu:ilitimd in I'utnnt S:aunty Notar ubl' tnlSSloll 1i96_ _ Z This application must be properly completed in its entirety and must in Jude the notarized signature(s) of'the legal owner(s) ofthe subject property, and the applicant of'recor in the spaces provided. Any application not properly completed in its entirety and/or not properly si 2,ned shall be deemed null and void and will be returned to the applicant. i a i I i 6/t/2020 i S r;%TT OF NFW.Y ORK. t:'t mqy np 44 F.STCIWS IT•:R. � ak . . _ . hetng duly sworn,t7cpt>ct.s ►n41 rtatcs that hc'she i1 the applicam ahovc ,aute•.I. t,xnu 4ismr ni�tti:vufi�l cst;pi,n.u�th..t;+*+iY�nt� and further state that(s)he is tilt legal ownei at the prope tiv tit .vltich this application pertaitts,fir that lsthe :N 1tx the Ir dal owner an is dUJ, authoritcd to make ant+ ;:ele(Ili, I hat all 1731c7nt:nts ::onuined hercil)art true t4.r the hcQ nt'}tis her krtnw•ledge anti hciiet,:Ind that am Murk performed,ars toy ctanductt:t9+t ncc ahi!je,;eptiilncd pnaperttr-Will he in cont;:irmancc.with the details a.xtt forth and u,,tarned Ill tlti� .tpptrratiun and ill art} Accorrtpanring appAlved plans and spcci;ications.as well as in at:cor�tntce with the New York ;;talk:t: it<+rm Fort;Nrcectticln Rc Ruildin¢(c>,.IG,the(',uc„!'Che Yill tkc 'Rye BrOC)k and all tltt,r-spt+Iicr,Mle Jaw:.„f,Jinaiti:t:s :+-id reuoiati(tn: ytLi+m to 1)0 ire the this 25.- Sworn to hch,rt fltk this -- dal of ?ft Slgt tl rupert% 4}u11'1- Signoture of Applicam t° nt Na lit of Pr r• i?,:✓� L i :�t,. e.«.t"� rt�;(Jur Print X-4111C cd'Applicant r :1 Notary Putttic. 1171�ii�11•tLt1�t73tf� l � �':.._ ^... ;�!�•�'_ _.'' _, ^,". ... 1 i t "-t�i(at`rr 4tstrt sleEec! in It:e111!Tely iInd nI- t i lit:lude the rtt-t;trire 1 ,1 ttk 'sw Ll.sl !•;tint rE.Si oJ`(tic Stltat , t:9d tltr:tptitiant+at'rriurd to the tifr,tccs (�r4n�tltal :1t: al �li��tti��tt 1t4>t jm1p:rlr 0-11"Pleted in its entirel} artJ-t,r rt+.'t prep rlt• ti4111c.1 shall hc.Ic.mttl ,Itlll .tii.i "id sail •.gill hu ,,auritad t,1 rltt-appiwartt, B1 iLDING MPARTMENT VILLAGE OF RYE BROOK 938 Kt,,,(:STREET RN-F. BROOK, NY 10573 (914)939-0668 xwkw,rwwwwwwww,rwawwwwwwwwwwwwwwwrwww+rwww**wwxwex,rwrw,rww*w,rwrwwwwwww*wwwwwwww*wwwwwwwwwwwwwwwwtwwwww*wwww AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • STORM SEWERS AND SANITARY SEWERS W STATE OF NEW YORK. COUNTY OF WESTCHESTER ) as: �i. _�e.-f-r' � (;�c,► bS rest n a at. being duh, 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, L- A-,4 -- — -- —_�— ----- -. Rve Brook, NY. 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. Sworn to before me this �rtt tiSHN-K MAR MIJTREJA. day of P—iV �_—, 20�-3 Wory P,,jblic,Stale of New Jersey Conn •r My Ganrnissfon Emma 7r;1r"2027 ' �I����I�il�`I�i �ii�`il���i��l�i �I�l�il�I� ;` �'i�il�`li �I��'li �l` �l' �l` �'ili �l• �i �i �`il�i �`il�`li ��I`�i �`li�l` N "o n. fn plot Ln 0-4 o z , i Ln en N o 'C 00 ° 3 rot, ww w W w J a o O '' A cz w x � z � w ' .. � _ • a O w � z a A L 2 � v U a O 0. 7 �� E• o v w • �..� F'' W w Z '9 L C n �m. a, CN egtz � 0 z E f V " i ONO � V Q A � � w o ° ` , c.00 W M O W U C� O G� E O "e z 7 R Z W a r, cc vz, N Ir o ° Z U wO V a V � g � E cCL _ W U W `� a a' EC BUILD A MENT R IE � " VIL OF RYE,j OOK NOV - 7 2022 -D 938 KING ET RYE BR ,NY 10573 4 -0 , VILLAGE OF RYE BROOK BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY: PERMIT#:AOc; d—/ 7 d- Approval Date: NOV 16 1 Permit Fee: $ �300_A� Approval Signature: Other: Disapproved: (fees are non-refundable) REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 1. Properly completed& Signed Application. 2. Site/Staging Plan if Required by the Building Inspector. 3. Copy Of Licensed Contractor's Liability Insurance. (Village of Rye Brook must be listed as certificate holder) &Workers Compensation Insurance On a NYS Board form(Form#C 105.2 or Form#U26.3/or NY State Workers Compensation Waiver) 4. Payment of Fees/Unit: RESIDENTIAL =$100.00/unit • COMMERCIAL = $350.00/unit. 5. Inspection by the Building Department for removal and/or installation.(48 hour notice required 6. Electrical work requires a separate Electrical Permit&Electrical Inspection. 7. Plumbing/Gas work requires a separate Plumbing Permit&Plumbing Inspection. Application dated, — —34 is hereby made to the Building Inspector of the Village of Rye Brook for a permit for the installation and or removal of the HVAC equipment as listed below.The applicant and property owner,by signing this document agrees that said equipment will be installed and/or removed in conformance with all applicable Local,County, State& Federal laws, codes,rules and regulations. /� 1. Address: 10 CAg LTOAJ 1`.AAJV_ R`IE Caro,�C tJ� 103 &3L: /3J`i 7'/c� '/S Zone:4_14 2. Property Owner: $e cc.A GoOnks s Address: Ip CA&%_Taa rXJ to_Sj3 Phone#: Cell#: 6%q (6•10 S400 email:?e_ r2y •\• Caav�4��Jnna•� 3. Contractor: CoM � �nG.n.cEyrl i\Jc.L ���. Address: rJ2 5\,tC...)v0�� e�,n Jf Phone#: Cell#: 34'#-16-Ho-'L 13_ email: 00A! SA nkto.antcw�Q p 4. Applicant: e\^I-e Address: 52 Stx#z,0ocr9 A4\Je `C' Phone#: Cell#: -141 4r>N0 111\ email: QAQR�Q �a\\ec t r,+►ecYwn,cJ@-gaw 5. Scope of Work:New Installation • Replacement( )•Removal( )•Other 6. List Equipment: K,43o nA.�gK�iS� v.�cl\� ►.J�o e� \��e�� A,e h 5 01+2 a onc�t2 nS� u \ 7. Location of Equipment: A%e. \NP_AN S -.:I zso,Se me \A- L n� �SeIL SA c & �r\ON1tP . 8. Method of Installation/Removal(list all equipment needed to perform job): R Anck \00\S 1 8/12/2021 a • )V S S,¢V STATE OF NEW YORK,COUNTY OF ) as: <. t , r le �/ C j e- s ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signin 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 e o ,.,I ra c'-0.r 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 2 V Sworn to before me this d ,20 2 Z day of c)6 P/ ,20 r r l1.uclt�n -Sifnature of Property Owner Signature of Applicant Ifint ame of Prop O er I Print a Ap ant, t � —0 DON�{ DRE STEVEN Public PERK , `f orlc Notary Public Notary PUbIIC,State of Ne '� RI ARD JOSEPH WIEMER No 01 pE5;68561 NOTARY PUBLIC-STATE OF NEW YORK eWYcr�County NO.01WI6415974 Qualified In N 18, - QUALIFIED IN NASSAU COUNTY fission EXP1r�s D�Cember COMMISSION EXPIRES 04/05/2025 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. 2 8/12/2021 1 • • • SYSTEM Job Name: System Reference: Date: ,,I��uolllllllllllllllllll���11 �1�9eq, ��''� ,��IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIillll�� 1� �IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII� �� 'il IIIIIIIIIIIIIIIIIIIIIIIIIIIilllllllllllll' � IIII II,, 11 'IIIIIIIIIIIIIIIIilllllllllllllllllll 1) �nolllllllllllll��� FEATURES • Variable speed INVERTER-driven compressor • Optional base pan heater • Quiet outdoor unit operation as low as 52 dB(A) • High pressure protection • Compressor thermal protection • Compressor overcurrent detection • Fan motor overheating/voltage protection Specifications are subject to change without notice. ©2022 Mitsubishi Electric Trane HVAC US LLC.All rights reserved. ' • 1 Maximum Capacity BTUM 2BAW N 28AW//28,400 Rated Capacity BTU/H 26,400//27,900//27,400 Coaling'(Non-Ducted//Mix//Ducted) Minimum Capacity BTU/H 11,800//11,300//11.000 Maximum Power Input W 2,6W//2,680//2,680 Rated Power Input W 2,SW/!2,780//2,840 Power Factor(208V,2311 % 99.0,99.0//99.0.99.0/!99.01 99.0 Maximum Capacity STUM 38,000//36,0W It 36,000 Rated Capacity STUM 28,800//28,100 U 27,600 Heating at 47'11`1(Non-Ducted//Mix# Minimum Capacity STU/H 18,100//18,300//18,500 Ducted) Maximum Power Input W 3,3W//3,300//3,300 Rated Power Input W 2,1 SD//2,185//2,220 Power Factor(208V,230V) % 96.5,98.5//96.4.98.4//982.982 Maximum Capacity BTU/H 21,000//21,000//21,000 Healing at 17'P(Non-Ducted//Mbc// Rated Capacity BTU/H 17,800//17,800//17,80(11 Ducted) Maximum Power Input W 2,740//2,780//2,820 Rated Power Input W 1,780 H 1,830//1,900 Hassling at 5'F4(Non-Ducted//Mix// Maximum Capacity STUM 18,200//18,200//18"0 ate) Maximum Power Input W 2,310 H 2,355//2,400 SEER 19.0//17.6//16.2 EER' 10.6//10.12//9.85 HSPF(IV) 10.6 910.1/!9.6 EffM�Y Man-0ucted//Mix//Ducted) COP at 47'P 3.9//3.77//3.85 COP at 17'F at Merdmwm Capacity' 225//222//2.18 COP at 5'11F at Maximum Capacity' 2.31/!L25//222 ENERGY STAR'Carded No//No//No Electrical Power Requirements Voltage,Phase, 2081230 1 80 Frequency Guaranteed Voltage Range VAC 187-253 Voltage:Indoor-Outdoor,S7 S2 VAC 206230 Voltage:Indoor-Outdoor,S2S3 V DC 24 Electrical Short-circuit Current Rating(SCCR) kA 5 Recommended Fuse/Breaker Size A 25 Recommended Wire Sae AWG 14 Minimum ClrcukAmpacity A 22.1 Maximum Overcurrent Protection A 25 Fan Motor Full Load Amperage A 2.43 Airflow Rate(Coding/Heeling) CFM Z287/2,382 Refrigerant Control LEV Defrost Method Reverse Cycle Heat Exchanger Type Plate fin coil Sound Pressure Level,Cooling' dB(A) 52 Sound Pressure Level,Heating= dB(A) 58 Compressor Type DC INVERTER-driven Twin Rotary Compressor Model SNB220FOGMC Compressor Rated Load Amps A 12 Outdoor unk Compressor Looked RoterAmps A 13.7 Compressor Oil Type//Charge oz. FV50S//23.7 Base Pan Heater Optional W:In.[mm] 37-13/32[950] Unit Dimensions D:In.[mm] 13[330] H:In.[mm] 31-11/32[798] W.In.[mm) 40.15/18(1,0401 Package Dimensons D:In.[mm] 17-11/18[450] H:In.[mm] 40-11118[1,033] Unit Weight Lbs.p%l 137[fM Package Weight Lbss.[kg] 167[71] Cooling Intake Air Tamp(Maximum/Minimum A) 'FDB 115/14 Outdoor unk operating temperature Cooling Thermal Lookout/Re-start Temperatures 'FDS 10.4114 range Heating Intake Air Temp(Maximum/Minimum) 'FWB 6515 Heating Thermal Lockout/Re-start Temperatures 'FDB 1.4/5 Charge Lbs,oz 6.0,13.0 Refigerent Chargeless Piping Length FL[m] 98.0[30.0] Additional Refrigerant Charge Per Additional Piping Length ozJR.[g1m] - 0216[20] NOTES: AHRI Rated Conditions 'Cooling(Indoor//Outdoor) 'F 60 DB,67 WB//95 DB,75 WB (Rated data is determined at a fixed compressor speed) 'Heating at 47'F(Indoor//Outdoor) 'F 70 DB,60 WB//47 DB,43 WB 3Heating at 17'F(Indoor//Outdoor) 'F 70 DB,60 WB/I 17 DB,15 WB Conditions 'Heating at 5'F(Indoor//Outdoor) -F 70 DB,60 WB//5 DB,4 WB 'Applications should be restricted to comfort cooling only;equipment cooling applications are not recommended for low ambient temperature conditions. 'A 5'F DB-115'F DB when optional wind baffles are installed For actual capacity performance based on indoor unit type and number of indoor units connected,please refer to MXZ Operational Performance. Although the maximum connectable capacity is 130%,the outdoor unit cannot provide more than 100%of the rated capacity.Please utilize this over capacity capability for load shedding or applications where it is known that all connected units will NOT be operating at the same time. Specifications are subject to change without notice. ©2022 Mitsubishi Electric Trane HVAC US LLC.All rights reserved. • • 1 Madmwn Number of Connected IOU 3 Indoor unit connection Minimum Number of Connected IDU 2 Minimum connected cepedly BTU/H 12,000 Maximum connected capacity BTU/H 36,000 Liquid Pipe Size O.D.(Flared) In.[mm) A,B,C:1/4[A,B,C:6.351 Gas Pipe Size O.D.(Flared) In.[mm] A:1/2;B.C.3/8[A:1172;B,C:9.521 Total Piping Length FL[m] 2301701 Piping Maximum Height Difference,ODU above IDU Ft[m] "[IS] Maximum Height Difference,ODU below IDU Ft[m] 49[15] Farthest Piping Length from ODU b IDU Ft_.[m] 82[25] Mmdmum Number of Bends for IDU 70 NOTES: AHRI Rated Conditions 'Cooling(Indoor//Outdoor) -F 80 DB,67 WB//95 DB,75 WB (Rated data is determined at a fixed compressor speed) 'Heating at 47`F(Indoor//Outdoor) °F 70 DB,60 WB//47 DB,43 WB 'Heating at 17°F(Indoor//Outdoor) -F 70 DB,60 WB//17 DB,15 WB Conditions •Heating at 5°F(Indoor//Outdoor) °F 70 DB,60 WB//5 DB,4 WB 'Applications should be restricted to comfort cooling only;equipment cooling applications are not recommended for low ambient temperature conditions. I VF DB-115`F DB when optional wind baffles are installed For actual capacity performance based on indoor unit type and number of indoor units connected,please refer to MXZ Operational Performance. Although the maximum connectable capacity is 130%,the outdoor unit cannot provide more than 100%of the rated capacity.Please utilize this over capacity capability for load shedding or applications where it is known that all connected units will NOT be operating at the same time. Specifications are subject to change without notice. ©2022 Mitsubishi Electric Trane HVAC US LLC.All rights reserved. OUTDOOR UNIT ACCESSORIES: 1 Air Outlet Guide Air Outlet Guide(1 Piece) ❑ PAC.SH88SC,,E ReMgeration Ball Valve-1IT ❑ BV12FFSI2 Ball Valve ReMgeration Ball Valve-1W ❑ OV14FFSI2 Refrigeration Ball Valve-3W ❑ BV38FFSl2 Refrigeration Ball Valve-5/8' ❑ BV58FFSI2 Control Wire M-Net Control Wire.1,000'Roll(16-AWG,Standard,Twislad Pair,Shielded,Jacketed-Plenum rated) ❑ CW162S-1000 M-Nd Control Wire,250'Rdl(16-AWG,Standard,Twisted Pair,Shelded,Jacketed-Plenum rated) ❑ CW162S-250 Drain Socket Drain Socket ❑ PACSGOODS-E Heil Guards Hall Guard ❑ HG-M M-NET Converter M-NET Converter ❑ PAC-IFOIMNT--E 14 Gauge,4 wire MiniSplit Cable-2501t.null ❑ 5144-250 14 Gauge,4 wire MiniSpiit Cable-250 R.roil ❑ SYY144-250 14 Gauge,4 wire MiniSplk Cable--60 R roll ❑ 5144-50 Mini-Split Wire 14 Gauge,4 wire MlniSpiit Cable-60 R.roll ❑ SWI44-M 16 Gauge,4 wire MiniSplk Cable-2501L rail ❑ S164-250 16 Gauge,4 wire MiniSplkt Cable-2501L roll ❑ 3VV1 64-2r 16 Gauge,4 wire MiniSplit Cable--601L roll ❑ S164-50 18 Gauge,4 wire MiniSplk Cable-50 R roll ❑ SW18450 Mounft Pad Condensing Unit Mounting Pad:16'x 38'x 3' ❑ ULTRILITE7 Outdoor Unit 3-1/4 Inch Mounting Base(Pair)-Plastic ❑ DSD-400P Adaptor:1W x 318" ❑ MAC-A455JP-E Port AdWbr Adaptor..117 x 5/8' ❑ MAC-A456JP-E Adaptor:3W x 1W ❑ MAC-A454JP-E Adaptor.3W x 5/8' ❑ PACSG76RJ-E 18'Single Fan Stand ❑ QSMS1801M 24"Single Fan Stand ❑ QSMS2401M Stand Condenser Wall Bracket ❑ QSWB2000M-1 Condenser Wall Bracket-Stainless Steel Finish ❑ Q3YVB3S Outdoor Unit Stand—12'High ❑ OSMS1201M Specifications are subject to change without notice. ©2022 Mitsubishi Electric Trane HVAC US LLC.All rights reserved. OUTDOOR UNIT DIMENSIONS: MXZ-3C30NA3 Unit: inch (mm) -7/8' 23-5/8' -7/8' R—Ar 4 raakr 2-13/16' 9 2-1/32' 3 1116, 2-1.1 Sho ea Notched H01e 13/32' 3 /3 (Foundation Bolt M10) i2 m � a m m p � u n a � m N a SkY AF MalujDroin mPN6-01-5/16 Hole ^�` Ar ry 13/32' iv to �Discrwrge 13/32' 2-05/32'x1-13/32')Oval Hole 1-1/32' 2-07/8'knockout hole (Foundation Bolt M10) 1-1/2' (Connectingwire hole) 1-5/8' 3-07/8'punched hole 37-13/32' 31/32' 13' 19/32' (Connecting wire tel N R' w' wale O ,b 'wnae 0 O iv 2-3/4' Q® In Art Intake O® La ;aO O® GAS}Um C LIO 1/{-ift-1 FLARE m ® GAID S l)�Aw 8} GAS 3/6tN521FLARE � GAS f lh1H A— LIQ GAS 1/2'10 27IFLARE UQ 1-11/32' 1.FREE SPACE 0 E o W a E a 3-15/16' or morzl e a `0 P e � 8 3-15/16' or mare 13-25/32' or more 2.SERVICE SPACE E i E Conduit plates s 'O Conduit connector 3-15/16' or more _ 5ERv1[E —� 13-25/32' or more 13-25/32' or mare Lock nut 1340 Satellite Boulevard Suwanee,GA 30024 Toll Free:800-433-4822 www.mehvac.com 0.► us FORM#MXZ-3C30NA3-202206 Inteltek Specifications are subject to change without notice. 0 2022 Mitsubishi Electric Trane HVAC US LLC.All rights reserved 12.000 BTU/H WALL-MOUNTED INDOOR UNIT FOR MXZ-C MULTI-ZONE HEAT PUMP SYSTEMS ArIk ELECTRIC Job Name: System Reference: Date: Indoor Unit: Wireless Remote Controller MSZ-GL12NA I�Ul9 GENERAL FEATURES • Slim wall-mounted indoor units provide zone comfort control • The outdoor unit powers the indoor unit,and should a power outage occur,the system is automatically restarted when power returns • Multiple fan speed options:Quiet,Low,Medium,High,Super-high,Auto • Multiple control options available: Hand-held Remote Controller(provided with unit) kumo cloud®smart device app for remote access Third-party interface options Wired or wireless controllers • Hot-Start Technology:no cold air rush at equipment startup or when restarting after Defrost Cycle • Quiet operation • Smart Set:recalls a preferred preset temperature setting at the touch of a button Specifications are subject to change without notice. ©2020 Mitsubishi Electric Tirane HVAC US LLC.All rights reserved. SPECIFICATIONS: MSZ-GL12NA Cooling Capacityl.3 BTU/H 12,000 Heating Capacity2,3 BTU/H 14,400 Voltage,Phase,Frequency 208/230V,1 phase,60Hz Guaranteed Voltage Range V AC 187-253 Electrical Voltage:Indoor-Outdoor,S1-S2 V AC 208/230 Voltage:Indoor-Outdoor,S2-S3 V DC 24 Short-circuit Current Rating(SCCR) 5 MCA A 1 Blower Motor Full Load Amperage A 0.76 Blower Motor Output W 30 Airflow Rate at Cooling,Dry CFM 399-321-237-170-145 Airflow Rate at Cooling,Wet CFM 364-286-201-134-109 Airflow Rate at Heating,Dry CFM 406-321-237-170-145 Sound Pressure Level(Cooling) dB(A) 45-37-30-22-19 Sound Pressure Level(Heating) dB(A) 43-37-30-22-19 Drain Pipe Size In.(mm) 5/8(15.88) Heat Exchanger Type Plate fin coil External Finish Color Munsell 1.OY 9.2/0.2 W:In.(mm) 31-7/16(798) Unit Dimensions D:In.(mm) 9-1/8(232) H:In.(mm) 11-5/8(295) W:In.(mm) 33-1/2(850) Package Dimensions D:In.(mm) 12(300) H:In.(mm) 14(350) Unit Weight Lbs.(kg) 22(10) Package Weight Lbs.(kg) 26(11.5) Refrigerant Type R410A Piping Gas Pipe Size O.D.(Flared) In.(mm) 3/8(9.52) Liquid Pipe Size O.D.(Flared) In.(mm) 1/4(6.35) Notes: Nominal Conditions Cooling(Indoor H Outdoor) °F 80 DB,67 WB H 95 DB,75 WB 2Heating at 47°F(Indoor H Outdoor) °F 70 DB,60 WB H 47 DB,43 WB 3Capacity varies based on the number of indoor units operating and the model of the Multi-zone Outdoor Unit.For reference to connected capacity charts,please refer Multi-zone Outdoor Unit Operational Performance. Specifications are subject to change without notice. ©2020 Mitsubishi Electric Trane HVAC US LLC.All rights reserved. ACCESSORIES: Anti-allergy Enzyme Filter ❑MAC-408FT-E kumo touch"'RedLINK""Wireless Controller ❑MHK2 Deluxe MA Remote Controller) ❑PAR-40MAAU Simple MA Controller) ❑PAC-YT53CRAU-f Touch MA Controller' ❑PAR-CT01 MAUSB Wired Remote Sensor ❑M21-EAA-307 Wireless Temperature and Humidity Sensor o PAC-USWHS003-TH-1 System Control Interfacez ❑MAC-WIF-E Wireless Interface 2 ❑PAC-USWHS002-WF-2 Thermostat Interface ❑PAC-US444CN-1 kumo station® ❑PAC-WHS01 HC-E USNAP Interface ❑PAC-WHS0IUP-E IT Extender ❑PAC-WHS011E-E BACnet®and MODBUSO Interface ❑PAC-UKPRC001-CN-1 Lockdown Bracket for Hand-held Remote Controllers ❑RCMKPI CB Blue Diamond Sensor Extension Cable—15 Ft o C13-103 Blue Diamond Alarm Extension Cable—6.5 Ft. o C13-192 Blue Diamond MuldTank—collection tank for use with multiple pumps ❑C21-014 Blue Diamond Rubber Foot Pads o F10-010 Mini Condensate Pump—230 volt application ❑S130-230 MegaBlue Advanced Blue Diamond Condensate Pump w/Reservoir&Sensor ❑X87-835-110 to 250V MaxiBlue Advanced Blue Diamond Mini Condensate Pump w/Reservoir&Sensor(110V)up to 48,000 BTU/ ❑X87-711-110V H[recommended] Advanced Blue Diamond Mini Condensate Pump w/Reservoir&Sensor(208/230V)[recommended] o X87-721-208/230V MicroBlue Blue Diamond Mini Condensate Pump(110/208/230V)up to 18,000 BTU/H ❑X85-003 Fascia Kit for MicroBlue Pump—mounts the MicroBlue and sensor directly beneath the indoor unit ❑T1 B-016 Drain Pan Level Sensor ❑SS610E (30A/600V/UL)[fits 2"X 4"utility box]-Black ❑TAZ-MS303 (30A/600V/UL)[fits 2"X 4"utility box]-White ❑TAZ-MS303W I Requires MAC-3341F-E ZAllows indoor units to connect to an MA Controller Specifications are subject to change without notice. ©2020 Mitsubishi Electric Trane HVAC US LLC.All rights reserved. DIMENSIONS: MSZ-GL12NA Unit: inch 7/I6xl Oblong hole 7/1013/16 Oblong hole Installation Plafe 3-118 8-7/8 8 7/8 1/8 ,p 31-7/16 30-15/I6 I/4 N ao ao a 6-1/8 6-1/8 <o 2-3/ 13-5/16 13-9/16 A 2-1/8 9-118 3/16 Indoor unit ij 1n all hole 43 �74ouf tallation late Pi in ,y13/4 I 15116. 24 3/8 5 I/8 ^�- Drain hose6,;,,;2 5/16 3/4IIe 1� Insulation e1-318 O.D a Liquid line a1/419-11/16(Flared connection a1/4) 2 3/16 I I S/16 d Gas line o3/8 16-15/16 I-3/16 (Flared connection:e3/8(OUM12103TUM),e12(15 KU M) Drain hose Insulation a1-1/8 O.D Connected part o5/8 O.D 1340 Satellite Boulevard,Suwanee,GA 30024 Toll Free:800-433-4822 www.mehvac.com s FOR MSZ-GL12NA FOR MXZ-C MULTI-ZONE HEAT PUMP o us ME SYSTEMS-202003 Intertek Specifications are subject to change without notice. ©2020 Mitsubishi Electric Trane HVAC US LLC.All rights reserved. SUBMITTAL D . MSZ-GL18NA M-SERIES 18,000 BTU/H WALL-MOUNTED INDOOR UNIT FOR MXZ-C MULTI-ZONE HEAT PUMP SYSTEMS MITSUBISHI ArIL ELECTRIC Job Name: System Reference: Deb: Indoor Unit: Wireless Remote Controller MSZ-GL18NA GENERAL FEATURES • Slim wall-mounted indoor units provide zone comfort control • The outdoor unit powers the indoor unit,and should a power outage occur,the system is automatically restarted when power returns • Multiple fan speed options:Quiet,Low,Medium,High,Super-high,Auto • Multiple control options available: Hand-held Remote Controller(provided with unit) -kumo cloud®smart device sop for remote access -Third-party interface options -Wired or wireless controllers • Hot-Start Technology:no cold air rush at equipment startup or when restarting after Defrost Cycle • Quiet operation • Smart Set:recalls a preferred preset temperature setting at the touch of a button Specifications are subject to change without notice. ©2020 Mitsubishi Electric Trane HVAC US LLC.All rights reserved. r SPECIFICATIONS: MSZ-GL18NA Cooling Capacityt.9 BTU/H 18.000 Hoofing CapacKyz 9 BTU/H 21,8W Voltage,Phase,Frequency 208230V,1 phase,80Hz Guaranteed Voltage Range VAC 187-253 Electrical Voltage:Indoor-Outdoor,S1 S2 VAC 208/230 Voltage:Indoor-Outdoor,S2S3 V DC 24 Short-circuit Current Rating(SCCR) 5 MCA A 1 Blower Motor Full Load Amperage A 0.67 Blower Motor Output W 30 Airflow Rate at Cooling,Dry CFM 646-522-417-332-258 Airflow Rate at Cooling,Wet CFM 581470-375-299-232 Alrfbw Rate at Heating,Dry CFM 646-565-469-385-297 Sound Pressure Level(Cooling) dB(A) 4944-38-33-28 Sound Pressure Level(Heating) dB(A) 4843-38-33-28 Drain Pipe Size In.(mm) 5/8(15.88) Heat Exchanger Type Plate 8n coil External Finish Color Munsell 1.0Y 9210.2 W:In.(mm) 36-5/16(923) Unit Dimensions D:In.(mm) 9-13/16(250) H:In.(mm) 12(305) W.In.(mm) 39(990) Package Dimensions D:In.(mm) 13(330) H:In.(mm) 15(380) Unit Weight Ups.(kg) 28(13) Package Weight Lbs.(kg) 33(15) Refrigerant Type R410A Gas Pipe Size O.D.(Flared) In.(mm) 12(12.7) Piping Liquid Pipe Size O.D.(Flared) In.(mm) 1/4(6.35) Notes: Cooling(Indoor//Outdoor) T 80 DB,67 WB//95 DB,75 WB Nominal Conditions 21-leating at 47°F(Indoor H Outdoor) T 70 DB,60 WB//47 IDS,43 WB sCapaci y varies based on the number of indoor units operating and the model of the MuIB-zone Outdoor Unit.For reference to connected capacity charts,please refer Multi-zone Outdoor Unit Operational Performance. Specifications are subject to change without notice. ©2020 Mitsubishi Electric Trane HVAC US LLC.All rights reserved. ACCESSORIES: Anti-allergy Enzyme Filter ❑MAC-408FT-E kumo touch'■RedLINK-Wireless Controller ❑MHK2 Deluxe MA Remote Controller) a PAR-40MAAU Simple MA Controller' ❑PAC-YT53CRAU-J Torch MA Controller' o PAR-CT01 MAUSB Wireless Temperature and Humidity Sensor o PAC-USWHS003-TH-1 System Control Interfacez ❑MAC-3341F-E Wireless Interface 2 ❑PAC-USWHS002-WF-2 Thermostat Interface ❑PAC-US444CN-1 kumo stations o PAC-WHS01HC-E USNAP Interface ❑PAC-WHS0IUP-E IT Extender o PAC-WHS011E-E BACnete and MODBUSe Interface o PAC-UKPRC001-CN-1 Lockdown Bracket for Hand-held Remote Controllers ❑RCMKPI CB Blue Diamond Sensor Extension Cable—15 Ft. ❑C13-103 Blue Diamond Alarm Extension Cable—6.5 Ft. o C13-192 Blue Diamond MultiTank—collection tank for use with multiple pumps o C21-014 Blue Diamond Rubber Foot Pads o FIO-010 Mini Condensate Pump—230 volt application o S130.230 MegaBlue Advanced Blue Diamond Condensate Pump w/Reservoir&Sensor o X87-M-110 to 250V MaxiBlue Advanced Blue Diamond Mini Condensate Pump w/Reservoir&Sensor(110V)up to 48,000 BTU/H[recommended] o X87-711-110V Advanced Blue Diamond Mini Condensate Pump w/Reservoir&Sensor(208/230V)[recommended] o X87-721-208230V MicmBlue Blue Diamond Mini Condensate Pump(110/208/230V)up to 18,000 BTU/H o X85.003 Fascia Kit for MicroBlue Pump—mounts the MicroBlue and sensor directly beneath the indoor unit o T18-016 Drain Pan Level Sensor o SS610E (30A"V/UL)[fits 2-X 4'utility box]-Black ❑TAZ-MS303 (30A/600V/UL)[fits 2-X 4-utility box]-White ❑TAZ-MS303W Requires MAC-3341F-E Z Allows indoor units to connect to an MA Controller Specifications are subject to change without notice. ©2020 Mitsubishi Electric Tirane HVAC US LLC.All rights reserved. DIMENSIONS: MSZ-GL18NA Unit: inch 7116.13/16 Installation hob Indoor unit lx7/16 OWW hole 3.11116 M16 3.11/16 &718 B-7/8 35-13116 1/4 m m 9.13116 8.11116 &1/16 m 3l18 2416 15.7/8 153118 Air inWall hole 03 a V InstaYalm to 0 2.12 2-1116 27-15/16 65116 PI N fh < O \ Drein hose 2-5/16� F 4 2.9116 4-1/2Air out 5314 2�116 2-9/16 ,o 3-11/16 as Insulation 02 O.D •a. Liquid line 05/16 15-3/8 Flared connection 01/4 a Gas line 015/32 13-3/8 Flared connection 01/2 Drain hose Insulation 01-1/8 Connected art 05/8 O.D 1340 SaWIfte B-1—d,Suwanee,GA 30024 Toll Fm:800-4334822 www.mahvac.00m FORMN MSZ-GL18NA FOR MXZC MULTI-ZONE HEAT PUMP SYSTEMS-202003 clntm Specifications are subject to change without notice. 0 2020 Mitsubishi Electric Trane HVAC US LLC.All rights reserved. � H /N ev � <� �• a F+� \ 00 W L O a W a 94 O a N Wu & - o 2 �'. u ,,q W CO (� en W ~ Q O x o 9 o 72 U4 /"1 � ". Q N�.?d C ~ L VJ M O 4 O Q Q x a � ztl [ s � � J � � ~ W � � r• � N � � H u " ° 3 u r� W ►r z 0 i Aco O i L ►.4 •_ uOp ',r� v w 3 G r� moo C� Z �, ztoUO V f W 000 � � t t ^ C - O O W a mo o zz � e � � ' '� � w li� VrA cr � og v ° p v V C7 z F W z i BUIL '_ .... MENT R V 1 # VIL .E OF RY l . OOK _ 938 KING ET RYE B ",* ,NY 10573 IS EP 2 2022 (914)9 $� ' 39-5501 VILLAGE OF RYE BROOK w o r BUILDING DEPARTMENT Application for Permit to Remove Abandon and/or I stall Fuel Stora a 'dank (*Storage Tanks in excess of 1,100 gallons require registration with I lie,County of Westchester) "] FOR OFFICE USE ONLY: I'I:IZMIT N: SEP - T 2021, Approval Date: Permit Fee: $ Approval Signature: Other: _ Disapproved: (fees are non-refundable) RE UIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE QF COMPLIANCE: I. Application Completed by Bonded, Licensed Contractor. 2. Your contractor's valid proof of liability insurance. (Village of Rye Brook must be listed as certificate holder) 3. Your contractor's valid proof of workers compensation insurance (Form,#Cl 05.2 or Form#U26.3 /or NY State Workers CompensationWaiver) 4. Fee per Tank: Removal,Abandonment,or Installation: $185.00 per Tani. 5. Dig Safely New York#(dial 811): 6. Inspection by Building Department for removal/abandonment and/or installation. 7. Submit all Manifests&Reports(after work has been completed). 8. Certificate of Compliance will be provided when all requirements are fulf lled. Application dated, — ,is hereby made to the Building Inspector of the Village of Rye Brook for a permit to remove,abandon,and/or install a Fuel Tank as herein described.The applicant and property owner,by signing this document agree that the subject fuel tank(s)will be removed,abandoned and/or installed in conformance with ill applicable Village,County,State& Federal laws,codes,rules and regulations. Indicate Permit Type: Installation (Removal ( ) • Abandonment ( )/Above round ( • Buried in Ground ( ) I. Address: /a U1✓L SBL: Y d—1 5 Zone: —� 2. Property Owner&Address: �T—C' ' e 7.3 Phone 5�ro0 Cell#: email: ?C'o6�► 8� r�R+�.«. .c.r� 3. Contractorr&Address: Phone#:D K )-o7-S'77� Cell#: [ -�(1._S// email: �.'.u9. �e�e.�h l�� �eAt 4. Applicant: G"q, L- e Phone#:EYC 207--17`/ Cell#:�/>%J�6o —��/ email:i�j,„iro .L'/r e.��3t4g!�- C., 5. Indicate Fuel Type:Fuel Oil( )•L.P.Gas •Gasoline( )•Other( _ 6. Number and Capacity of each Tank: /2-0 L;t�o.✓ 7. Exact Location(s)of each Tank: -2-0 5*�0 v Z-vo rg-rvk 6-4 J r'� "Vee_4 b 'L 6/l/2020 i i ST TE OF NEW YORK,COUNTY OF WESTCHESTER ) as: �^'� being duly sworn,deposes and states that a/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 applicatic n pertains,or that(s)he is the for the legal owner and is duly a ithorized 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 bel ief,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 ir 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 Swor i to before me this S day of ,20 day o %3 Sf,20 2- Signature of Property Owner na ure of Applicant =F CoQ, bS ,f L• C'fis Print Name of Property Owners a of A li t CHERYL A.ZASTENCHiK Notary Public State of hlew York Notary Public No.o1ZA6098466 Nota ubl' Qualified in Putna County My commission Expires This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject properly, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly si aned shall be deemed null and void and will be returned to the applicant. 2 i c/l/2020 tifall ()F VFW YORK.COI N'IY OF WFSlCIfF1lTR ; a, tr+tnt( being duly sutxtt,dmo%cs and states that he%he is the applica�jtit above named non:t 4 ndivuitiai..01"tasfile.t I,canti and fi,rther states that ts>fte is the legal owner of the properly to which this application pertains,or that t:s)he is the ti+r the legal owner and is duly authorized to make and file this application.i,nd"fearcliricc, r+anuxta 4exIlt. Fhat all staterncrits contained herein arc true to the Nna of 1wi,her knowledge and belief,and that any work pert6r-med,or use conducted at the atx,ve captioned property will he in cor►t.irmat►ce with the details a.set birth and conlamed in this application and at any accompaming approved plans and specifications,as well a,m accordance with the tic" York St.jit• niform Fire!'revernun& Building mid reJ;nlatrrrni Gcoiie,the CAC of the Villagc of Rye lirmk and all tither applicablev. 1» -,,ordinance. a tiwtittn to bel'Ore ine this 25 ti"orn to before the this dal of _-10 Jign- a ruperty 0wj r - Signature of Applicant P nt Va u-of Prf. rly Own r _ Print Name of Applicant \„tart Public -. i. ,I Votary Public t hrti appTic;ittijli mint t��,hn l,�r(� �mpletet,I in it, rrttrrel� and mist include the n,,tariied 'i0nattn-0 ,I i the it zal i,��ncn.;; ,,l the :uhlct priipettt. ;utd file applicsnit of record to (tie space. applicaflolt 11401 pnrperlx c,)ntpletrd in il!�entiret\ antl-or rivet propMv ci"llcJ shall he demic(l null .end 'Id anti Will he Murned to the applicant. Lii W < RH aRa W ar s€ z '..' PERMITFILE COPY SBLV DATE Ai- S - 7 2022 BUILDIN;INSA4ZITJCoOkg6 Of R sk,1i co I �3 % I I w �a .00,9E l V l :s�. �` •Mao IraIN !o LU CU a -a_ c� k ` •oM 1 ' '� `/I � �� Roaanlp Col+laolg I 8 a3 0 ! :I � ,� � 6❑ � _ LIoM 6oq i II b "?� N mi I��[ ^�•�M�` l � d IV Z 0 o I �£S i 0-4 waa Z w i o E A o in +i W N Cr I_ "' - T o CD ccn lq- J CD 01 RO M V) W z ~ cn o 0 R Q (n N CC ;; U N �i Ov v0 S O Q^ M U o a M N (D ir7 \ W LJi. oW Z to �- ® ® w R W O ^ w J Cl- N Lq J U O op�pp +r-i 04 tm O 03 rZ � ~ z o i W W o tS x cn a O N X J co :a_ c Z 0 O N \ >p X C7 of CD Q CL: O Z 2 U- N LO \_ L'i Q O J M O Q w CD Ckf ? 5 Z FXW- N ZD F ~ Z 6 CDo0 z �� W u O 0 J O (C Q N W Y 2 p i o OC j Q V O Q 0 �CD goon N = x tJ U U U O\] F- m�- fi Of Cr m m W N CD d O Q M N I W N J~ O OfL� (i (n c C1::D O O O Z Z oO C O=(-D2 \ D 3 UN-1 oSS Of U U(Y Q~ GJ 4 W>O W U Z(nU W 2 ~��s \ �o�w =� M O g C7 N Z W= NJ QD mW ULAJ Z O a VZZ V)N0110d ao3 a3sV33a o da a3A0bddV mz VaN3aaV/3000 z N r•i� (D h N Z 0 a o w Laura Petersen From: Steven Fews Sent: Thursday, March 9, 2023 12:17 PM To: Laura Petersen Cc: Jeffrey Coombs Subject: Re: 10 Carlton Propane Tank Pad Mr. Coombs, this looks much better than the earlier picture where the pad looked flung on the spot like you might toss a frisbee. Because this pad is in an open and high traffic area near the fence gate, I would also required the tank to be either adhered or bolted to the pad in some way to keep it more secured from dislodgment. Let me know if you will be able to accomplish this aw well? Thank you Inspector Fews Sent from my iPhone On Mar 9, 2023, at 11:34 AM, Laura Petersen <LPetersen@ryebrook.org> wrote: Thank you Mr. Coombs. I have copied Mr. Fews on this email for review. Laura Petersen Office Assistant Village of Rye Brook 938 King Street Rye Brook, New York 10573 Phone (914) 939-0668 1 Ipetersen@ryebrook.org<mai Ito:Ipetersen@ryebrook.org> From: Jeffrey Coombs <jeffrey.j.coombs@gmail.com> Sent: Thursday, March 9, 2023 11:06 AM To: Laura Petersen <LPetersen@ryebrook.org> Subject: 10 Carlton Propane Tank Pad Hi Laura, See attached updated photos of the pad. It's squared up on crushed gravel. The trench will be infilled once the tank is moved and the piping is tested and connected to the tank. I took a video of me jumping on it and stepping on it I can send as well if that helps for context? Please let me know of any further questions. My family is anxious to get this resolved. Thanks, Jeff Coombs i , \\et \ !F T. �i i� 4.1 AL AM i _ -.fI'- •"!} .�• •� 1� ' fig,''+ � ��Ir. -•� .�•. _ fill �1 �r �S-, mwra 5 y no Ak i!f Il _ �, Laura Petersen From: Jeffrey Coombs <jeffrey j.coombs@gmail.com> Sent: Wednesday,July 26, 2023 12:52 PM To: Steven Fews Cc: Laura Petersen Subject: Re: 10 Carlton Propane Tank Pad Attachments: IMG-1226 jpg; heat detector mechanical roomjpg; IMG-1043.MOV; heat detector connection to smoke at bedroom jpg Good Afternoon Steve, Sorry for the delay, my electrician was on vacation for a few weeks so just getting the final items addressed on the C of 0 inspection from last month. • Self-Closing Hinges on Garage Fire Door: see attached video. • Vertical Pipe at PRV on HWH: See attached photo. • Heat Detector at Mechanical Room (Furnace): See attached. Hardwired and interconnected to smoke detector in basement bedroom. Please let me know if you need anything else from me to close out our permit/C of 0. Thanks, Jeff Coombs 10 Carlton Lane On Wed,Jun 21, 2023 at 12:17 PM Jeffrey Coombs<ieffrey.i.coombs@gmail.com>wrote: Afternoon Steve, Just wanted to check and see if 2:30-3:30 is still an accurate time frame. I'm coming from NJ so I want to make sure I give myself enough time to get home. Thanks, Jeff Coombs On Mon,Jun 19, 2023 at 4:06 PM Steven Fews<SteveFews@rVebrook.ors>wrote: Good Afternoon, probably between 2:30—3:30pm Thank You. Steven E. Fews Building Inspector& Fire Inspector Office (914) 939-0668 1 t .ice r � � .� -�.!/f �� � 1 � � �� �� �� i, /�: __ ,.-- /'� �. .:' ..-- �r ii i � r�r ii-✓..M;; �� �:%;.. � �.: .� % —�-� ..;:. •L. i � ){{ 0 �I s n. j> k :;t � d-d- -t. �, .' �� - •`� � � ` _ � . i� .ti �_J_'J ,y, _ _� + _ 't`_ � + 's�.� r � � � +',.. +_ � .-- _ �.� ter, w NlIzt j �r A• r s _ j i a' a awl s o rco Y 16.4 P y IL, �i it _ Ce ✓: N a z 1.� �• 00 �A r r Sib/Cam' �d�o�o�of� � S oo c 6U!�Sd J J b zCYi d1U d 7 � � '• � GAS '��-� ClN �� oz� -��� n 4 lu n N N i t 1 - N r vow A s 1 i _ • Building Permit Check List&Zoning Analysis .Address: t J G•Al �2W�- �..A-� SBL: l 3 Zone: -k Z Use: r2 Const.Type: D Other. Submittal Date: 'A 1 (0 Cz z Revisions Submittal Dates: Applicant: �-x Nature of Work:—IAA P— Reviews:zBA: APR 1 2 2022 PB: BOT: Other. NMW OK ( ( ) FEES:Filing. ZS-�BP: (. S�_(J• ' 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. Shore Fees: N/A: ( ) ( ) SITE PLAN:Topo: Sit Protection: S/W Mgmt.: Tree Plan: Other. : < l 11 1( ) (✓)' SURVEY:Dated Z Z— Current: ✓ Archival: Sealed: Unacceptable: PLANS:D7 Stamped:LL Sealed: ✓ Copies: Electronic: ✓ Other. ( (J License: Workers Comp: ty: Comp.Waiver. Other. ( (�CODE 753#: OLsa cam!—O 6.3 �00 Dated: c�3--ate- 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. mtg.date 7 approval: 4 D 2l-iiotes: ( )ZBA mtg.date: approval: notes: ( )PB mtg. date: approval• notes: REQUIRED EXISTING PROPOSED NOTES APPROVED t2,S'k 1�i7'J — '02- Date_ MAY 1 2 ;079 Circle: l oA Fr n !S Fronc: If o .D >3rar. 3s 5- Al 7 ,3 Main Cov 6 ° (� Z'�1 Accs.Cov F S : 6 s .Hs : Zk b (s' Z-a t-7 Tot imp: c_L7 !o 33 S'-:> C{2 Parkins Height/stories: notes: Ott v VILLAGE OF RYE BROOK BUILDING DEPARTMENT 938 KING STREET,RYE BROOK,NY 10573 ARCHITECTURAL REVIEW BOARD Wednesday,April 20,2022 @ 7:30 PM NAME& TYPE OF MOTION SECOND APPROVED REJECTED APPL.# LOCATION APPLICATION 22 Rocking Horse Install 4'Black Chain-Link Consent 5684 Trail(Leon) Fence&Partial 6'White Agenda Vinyl Fence in Rear Yard 14 Bobbie Lane Install Rooftop Solar Array Consent 5685 (Sorkin) Agenda 114 South Ridge New Tenant Sign Consent 5693 Street(Win Ridge "Madison's Niche" Agenda Realty LLC) 780 King Street Amendment-Change Gas 5134 (Heinberg) Fireplace to Wood Burning, Extend Chimney,Construct Built-in-Barbeque& Eliminate Two Skylights 545 Westchester Refurbish Exterior Steps, 5659 Avenue(Castiglia) Railings,New Aluminum Awning,Reface Retaining Wall&Repave Driveway 44 Lawridge Drive Partial Second Story 5686 (Bauer) Addition,Interior& Exterior Renovations,New Front Portico and Steps 28 Wilton Road Legalize Rear Yard Stone 5687 (Servedio) Patio&Retaining Wall 11 Carlton Lane New Pool Coping,New 5688 (Marconi G.de Fencing,New Steps, Arruda) Upgrade Pool Alarms& Reduce Impervious Coverage 32 Hillandale Road Second Floor Addition, 5689 (Bloomberg) Rear Addition,New Siding &Roofing 11 Berkley Lane Refurbish and Expand 5690 (Sakofsky) Existing Deck&New Stone Walk 10 Carlton Lane Rear One Story Addition, 5691 (Shirken) New Rear Deck&Interior Renovation 32 Country Ridge Second Floor Addition& 5692 Drive(Hochfelder) Interior Alterations ML SE MR SF * MI AC %C BUILD1FP r ;4\TMENT vIL oE'Ii,oOK u : APR - 6 2022 938 KING§ ET RYE BR6&,NY 10573 4. 9 VILLAGE OF RYE BROOK 1t, 39-0661f, ` BUIUMNG rn�PARTMENT wvv>Irookor ARCHITECTURAL REVIEW BOARD CHECK LIST FOR APPLICANTS This form must be completed and signed by the applicant of record and a copy shall be submitted to the Building Department prior to attending the ARB meeting. Applicants failing to submit a copy of this check list will be removed from the ARB agenda. Job Address: /O CR9t11DA (A*A, Date of Submission: Parcel ID#: ?� �' J' Zone: Proposed Improvement(Describe in detail): 96M 0.4G/.d 4"" AP Al 77 APPLICANT CHECK LIST: MUST BE COMPLETED BY THE APPLICANT The following items must be submitted to the Building ma. IAA 40"yf ka- Department by the applicant-no exceptions. Property Owner: LL fQ d .A/r✓li:.t.�e , � 1• ( ompleted Application 8�r f� 2_ ( Two(2)sets of sealed plans. (one full size {maximum Address: allowable plan size=36"x 42"1 and one I I"x I7") Phone# A? 0'3-Z7- C2 7 77 3• V wo(2)copies of the property survey. 4. ( Two(2)copies of the proposed site plan. Applicant appearing before the Board: 5. (►/ One electronic/disc copy of the complete application materials. 6. ( iling Fee. Address:�,[w}'�, � ertt- kj3i �x xy 7�t 11 y/orl 7. ( )Any supporting documentation. Phone#�/�1;63-��?� 8• ( ) OA approval letter. (if applicabie) '/ 9. ('j hotographs. Architect/Engineer:jAtA"- t'(L�l p/l/ �Jl� 10.(tsamples of finishes/color chart. (a sample board or Phone#_ t[A(- g(►64- i a model may be presented the night of the meeting) By signature below, the owner/applicant acknowledges that he/she has read the complete Building Permit Instructions&Procedures,and that their application is complete in all respects. The Board of Review reserves the right to refuse to hear any application not meeting the requirements contained herein. Sworn to before me this . Sworn to before me this 1 '� day of_NI , 20 day of 20 Z.Z St o Owner ofApplicant fX/;�CeN amc of PrOwNty Owner Pint N +of �zq 1. ta b isNotary Public SHARI MELILLO LISA M.S. KATZ Notary Public,State of New York hlC. 01-.IEril 600163 NOTARY PUBLIC-STATE OF NEW YORK Q+_Wified in Westch.—e-ter County No.02KA6242350 Commission Expires January 29.2061S Qualified in Westchester County My COmmigs►on Explrea 05.31=2 gel VILLAGE OF RYE BROOK-TOWN OF RYE Tax SECTION 135.42 � Lot r____� Tax I Lot 1 Lot "Lot" BLOCK 1 2 L----J Section 3, Pine Ridge L-L J \68 r LOT 5 County Clerk Mop No. 11525 N 75'50'30" W 81.13' w-o.s 70_+' (Friel x °x° _ Fee,. 20.8' rw-1.Y k`zz x z— . rJO' erleh robe x1� O 35.3' I • O r _ o • 38.9' Lot Tax o� " _ we.e o.rk i Lot ?7. St". . i 5 i: ' 61 i L____J Tax F7ts . -- r----1 o EiY7v Lot x n.nr rhL•e.rn 21.1• ''�! Ta f - / 4 i 23.0. mill A... 1 Story Frame r- �I I Lot I 1 w-a1 ?7� NVA Residence 6 11 ee F.ece V 31ep. `t ft 7 � , 0 e A # Gale •Far Lot , # 24k5'62 0 eNw rak n /M � in o r M 0 O rV& ° m s O Ra200.0p, a `^ I Z 164.13' O 4'2018,00. L=70.86' S 8'7T00" E 61.14 cure cu,e on W 31°n. tu.o CQr�toh Lane ( 50FLR. 0. W. ) APR -6 2022� VILLAGE OF RYE [3ROOK SURVEY OF LOT 62 AS SHOWN ON A MAP ENTITLED "SECTION TWO. PINE BUILDING LF RYE B ENT RIDGE FILED NOVEMBER 15, 1957 AS COUNTY CLERK MAP No. 11307. M SURVEYED AS IN POSSESSION date °y'• '95e THE MUNSON COMPANY Brought to dote..W.Yzx L958 9 NORTH GOODWIN AVENUE n(r. cew re sct7s+-2 Bought to date &.4e01,°lied Fah t+. mzl ELMSFORD, N.Y. Pod eW*ment A'h1YAG Unit added Feb. 17, ".F 10523 Scale 1"=20' "Unauthorized alterations or additions to o surrey mop is o AcIction of section 7209. PAb dMslon Z of the Now York State Education Low." 'Only Copies of the adglnd survey marked*0 the land surveyor's UNDERGROUND PIPES, WIRES, STRUCTURES, Inked or embassed seal shall be Considered o true and valid copy.' ETC., IF ANY ARE NOT SHOWN See J-4550.dwg J-4562 FOL-20 DATE(MM/DD/YYYY) ,aCoRo® CERTIFICATE OF LIABILITY INSURANCE 817/2022 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 UUNIACT NAME: Charles Frazer FAX Woodside Agency,Inc. A/C ON,NoInd: (718)476-3300 866 480-2448 3916 63rd Street ADDRESS: cfrazer@woodsideagency.com INSURER(S)AFFORDING COVERAGE NAIC 0 Woodside NY 11377 INSURER A: ATLANTIC CASUALTY INS CO 42846 INSURED INSURER B: NATIONAL CONTINENTAL INS CO Valley Mechanical HVAC Inc INSURER C: ACE PROPERTY AND CASUALTY INS CO 20699 52 Sherwood Dr INSURER D: NEW YORK STATE INSURANCE FUND 36102 INSURER E: Huntington NY 1 1 743-5 1 40 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. INSR LTR TYPE OF INSURANCE INSD NND POLICY NUMBER (MM/DD/YYYY) (MWDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 7 OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A Y Y L271002858 06/03/2022 06/03/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 RO- X POLICY PECT ELOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY Ea accident $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED AUTOS ONLY AUTOS CNY 000-6642-598-2 07/21/2022 07/21/2023 BODILY INJURY(Per accident) $ IfHIRED �/ NON-OWNED $ AUTOS ONLY I► AUTOS ONLY (Per accident) $ UMBRELLA LU1B X OCCUR EACH OCCURRENCE $ 5,000,000 C x EXCESS LIAR CLAIMS-MADE UMBNYF165712341 08/05/2022 06/03/2022 AGGREGATE $ 5,000,000 DED I I RETENTION$ I I $ ORKERS COMPENSATION y ND EMPLOYERS'LIABILITY Y/N Ia STATUTE I ER NY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 D FFICER/MEMBER EXCLUDED? �Y NIA 25715889 06/02/2022 06/02/2023 Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 f yes,describe under ESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more apace Is required) Certificate holder included as additional insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. Village of Rye Brook AUTHORIZED REPRESENTATIVE 938 King Street C>a—Ary C4—ac4.o Rye Brook NY 10573 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE o a ^^^^^^ 881073563 WOODSIDE AGENCY INC PO BOX 770090 ' WOODSIDE NY 11377 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER VALLEY MECHANICAL HVAC, INC. BUILDING DEPARTMENT 52 SHERWOOD DRIVE VILLAGE OF RYE BROOK HUNTINGTON NY 11743 938 KING STREET RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12571 588-9 128110 06/01/2022 TO 06/01/2023 8/3/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2571588-9, 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 POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT CLAIRE HUGHES 1 OF 1 VALLEY MECHANICAL HVAC, INC. THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. 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 SU NCE FUND TT �/ DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 992910629 U-26.3 .�i�IR1J1' ''.I:� ', ' '+•`,i� ,(lll�"r.,•'..o'�V ��II}I��1� �A1 I ��±��'�P�_( H- e4`,•'[ ...: c �� }'?�!'1 r•Y�Idr� ,�.�I�.�i 5' •III l,y 4j 1s}, _ ,��� ;�llnu;' �' 1'�1 t{� P ?•, I y . 1�,fah�;�,I� ', � � .. ' '��•.�h,: ���IdjlYuu WP�► ^! AtlJJI I"' }`: � � a �1qa ll�j I 1 �f Of Cl u I. •, �k l 11 t�,f'' I �' �'r� � � � :ij }�. • =r- Y�il Lr, a, 3 r ,;t ' 1 1 Frr,'n1,;X;•�Y �,'•; ita I I "ar lJ.l E i>, cn 14'qrr ISif N1I41 1��'%��;`�l `���ll,"•;t+" \`4"a^� � (�',�� .�.J. � 'lil.' � Eil a Q to�� b� a.,. I g Xtvrn b yI�. I wl l �rsb! wa I,.a f Il�riri!r.'�d})rir �rjll ul Rill .41 Y.1. �.` {r+, 1�9tM7 �r'��' •�reeA Inn Q _ LL, f dL4fi1�, '.4?�{rrwd5•b i.'�' At+'� `�•'"I7,- " , �� L•-! 'C1 da Q - J�' ll9'CrTJrj �jL7, I �' Iv r e . `ygrlgf�lulyr�l�'f �y J:'' k•i � �l A: /pp,,,11i �yi�yg�I"-'li f:' 4 .� � rJ Y"• � �.. �y'+!ti� I III��tih��ti�;Ir�,V,I. � �1U ,� ;i � � ���•��, .n J�"' �I'I 'I��I�P�Gh'�Yd}`II'"�{p p�rri Iryl% .I�/+� Iplpg} I Jf \ '��rt'hux3};:�� `r`�"i3`f< ;c-•.� - - _ _ ._ ��' - 1., if i I. 411 , II ,fib ��.� +, : W ! ., 1�.:,>t.i.�i �,��, ji, �," rIli +� 4 4 ae!1}�f���1j. I1fJf1)f��,,/ IIS�I�1;•iG � Q r t•�+ ���' DATE(MM/DDIYYYY) ACORO® CERTIFICATE OF LIABILITY INSURANCE 12/27/2021 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(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: Amanda Massa Edgewood Partners Insurance Center PHONE FAX 1 American Lane •203-658-0507 1(A/C,No): _ Greenwich CT 06831-2560 ADDRESS: amanda.massa@epicbrokers.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Charter Oak Fire Insurance Company 25615 INSURED PARAGASC INSURER B:Travelers Indemnity Company _ 25658 Paraco Gas Corp; Paraco Gas of CT Inc INSURER AXIS Surplus Insurance Co 26620 Paraco Gas of NJ LLC; Paraco Gas of NY Inc. - 800 Westchester Ave, Suite 604 INSURERD:Travelers Property Casualty Ins.Co. 36161 Rye Brook NY 10573 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:541915213 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. INSIR CY LTR ADDL UBR POLICY NUMBER MM DPOLIDY EFF IPA I DI EXP LIMITS TYPE OF A X COMMERCIAL GENERAL LIABILITY Y1 N-660-1 P009026-COF-22 1/1/2022 1/1/2023 EACH OCCURRENCE $2,000,000 CLAIMS-MADE JJ OCCUR PREMISES Ea occurrence) s 300,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY❑JECTPRO ❑LOC PRODUCTS-COMP/OP AGG $2,000,000 X PRO- OTHER $ o AUTOMOBILE LIABILITY TRJCAP7K029970TIL22 1/1/2022 1/1/2023 COMBINED SINGLE LIMIT $2,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS - HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident _ UMBRELLALIAB [I OCCUR P-001-000755209-01 1/1/2022 1/1/2023 EACH OCCURRENCE $3,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000 DED RETENTION$ $ q WORKERS COMPENSATION PER OTH- B AND EMPLOYERS'LIABILITY UB-8N686223-22-51-D 1/1/2022 1/1/2023 X STATUTE ER YIN UB-8N686223-22-51-R 1/1/2022 1l1/2023 ANYPROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? ❑ NIA - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000.000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 I i DESCRIPTION OF OPERATIONS/LOCATIONS I 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Village of Rye Brook 938 King Street 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 NEW Workers' YORK CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a. Legal Name&Address of Insured (use street address 1 b. Business Telephone Number of Insured only) 914-250-3700 PARACO GAS CORP. 800 WESTCHESTER AVE SUITE 604 1c. NYS Unemployment Insurance Employer Registration RYE BROOK, NY 10573 Number of Insured Work Location of Insured (Only required if coverage is specifically 1 d. Federal Employer Identification Number of Insured or Social limited to certain locations in New York State,i.e.,a Wrap-Up Policy) Security Number 133149941 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage (Entity Being Listed as the Certificate Holder) THE CHARTER OAK FIRE INSURANCE COMPANY 3b. Policy Number of entity listed in box"1a" Village of Rye Brook UB-8N687902-22-S1-D 938 King Street Rye Brook, NY lOS73 3c. Policy effective period 01/01/2022 to 01/01/2023 3d. The Proprietor, Partners or Executive Officer are ® 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 "T' insures the business referenced above in box "la" 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 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 contraci 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: Kim Owen (Prin thorized representative or licensed agent of insurance carrier) Approved by: 12/28/2021 ( gnature) (Date) Title: Manager, Domestic Operations Telephone Number of authorized representative or licensed agent of insurance carrier: 804 527 4872 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 W31F3117 �{+'�;z •QL•" +..A/ �'p",. `^C.,L .•tl,` JFLf�' Jn p't'`°ils. ,,`�`�A fi:'Yt'"�' S�k ♦A .e[ti`t '�+•ts �A �y. -\A J �i d `•'�+ ok S, - ' A� h• 'pA�n _1r VO l5`AQI �Agl) 7.\.A�j! F. 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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 Wendy Collins NAME. R.J.Fregenti Associates,Inc. PHHONrE Ext (516)681-0101 AAX No: (516)681-0227 350 Jericho Turnpike E-MAIL DDRESS: certs@RJFASsoc.com A Suite 200 INSURERS)AFFORDING COVERAGE NAIC# Jericho NY 11753 INSURERA: Merchants National Insurance Co INSURED INSURER B: Merchants Mutual Ins.Co. 23329 Crew Contracting Corp. INSURER C: Mt.Hawley Insurance Co 37974 5 Glover Avenue INSURER D: Sirius America Insurance Company 38776 INSURER E: Yonkers NY 10704 INSURER F: COVERAGES CERTIFICATE NUMBER: 2021-22 Master 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. LTR TYPE OF INSURANCE INSD WVID POLICY NUMBER MMIDDIYYY MWDD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR Eu PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 10,000 A X Includes Contractual Liability Y CEP2000365 10/30/2021 10/30/2022 PERSONAL BADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER. GENERAL AGGREGATE $ 2,000,000 PRO- POLICY©JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED CAP1076123 06/24/2021 06/24/2022 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Optional basic economic $ 25,000 X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 C EXCESS LIAB CLAIMS-MADE MXL0433019 10/30/2021 10/30/2022 AGGREGATE $ 5,000,000 DIED I X1 RETENTION$ 10,000 $ WORKERS COMPENSATION X S PERTUTE OTH- AND EMPLOYERS'LIABILITY TA YIN ER D ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NIA WC28910 02/22/2022 02/22/2023 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT E DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Village of Rye Brook;Kathryn and Jeffrey Coombs are additional insured under general liability where required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King St AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD PORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured Crew Contracting Corp. (914)349-9044 5 Glover Avenue Yonkers, NY 10704 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 811259654 2. Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Sirius America Insurance Company Village of Rye Brook 938 King St. 3b.Policy Number of Entity Listed in Box"1a" WC28910 Rye Brook, NY 10573 3c.Policy effective period 02/22/2022 to 02/22/2023 3d.The Proprietor,Partners or Executive Officers are ❑ included.(Only check box if all partners/officers included) ❑ all excluded or certain partners/officers excluded. This certifies that the insurance carder indicated above in box"3"insures the business referenced above in box 1 a"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 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: Robert Fregenti (Print name of authorized representative or licensed agent of insurance carrier) Approved by: OS/117077 (Signature) (Date) Title: Pres Telephone Number of authorized representative or licensed agent of insurance carrier:516-681-0101 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 Laura Petersen From: Mike Izzo Sent: Monday, May 23, 2022 4:52 PM To: Laura Petersen; Steven Fews;Tara Orlando Subject: FW: Message from UDig NY From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Monday, May 23, 2022 4:51:26 PM (UTC-05:00) Eastern Time (US & Canada) To: Mike Izzo Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 05/23/2022 16:46 To: VIL RYE BROOK PRIMARY Transmitted: 05/23/2022 16:51 00004 Ticket: 05232-003-225-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 10 To: Name: CARLTON LN Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: IN BACK OF THE PROPERTY NearSt: BONWIT RD Means of Excavation: BACK HOE, BOBCAT / SKID STEER Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: Y Work Type: ADDING EXTENSION Estimated Work Complete Date: 09/01/2022 Depth of excavation: 4 FEET Site dimensions: Length 14 FEET Width 40 FEET Start Date and Time: 06/01/2022 07:00 Must Start By: 06/15/2022 ------------------------------------------------------------------------------ Contact Name: BARRY CORBY Company: CREW CONTRACTING Addrl: 5 GLOVER AVE Addr2: City: YONKERS State: NY Zip: 10704 Phone: 718-213-7152 Fax: Email: barry@crewcontractingcorp.com Field Contact: BARRY CORBY Alt Phone: 718-213-7152 i Working for: H/O ------------------------------------------------------------------------------ Comments: WILL BE MARKED IN WHITE SHORTLY Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA CONED SUEZ WTR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR 2 VILLAGE OF RYE BROOK —TOWN OF RYE TITLE # TBT47965 Lot'N 67 .001) Tax Lot 2 L---- I N 75'50'30It W Tax SECTION 135-42 r Lot i ; Lot BLOCK 1 Section 3, Pine Ridgy �—_-� _J `� 68LOT 5 � ` County Clerk Map No. 11525 81.13' (Fence) W-0.5' 0) � W o 0 d X_F e c e (Fence) W-1.4 � Alf) _X 1� X V 0 0 E— 3.1 X t� X — U V X— ._ C c X m m V- X ,--� Lot\' X Tax 6 01 Lot ' X43 ox 0 Lot 2J .2 say Steps Window I I 1 5 1 X X ° 1 1 �� 61 Wood L------J a / Ta X 0 6 2' 1 Story Steps (Fence) X Fence f-------1 L O t �' _Frame — ._.. woad Platform 21.1' T I �-W-1.6' I/ Tax I �1 I 4 1 3o 23 00 3 Chim. � Stp �.. Y ra m@ 0 V �-----� 1 Lot 1 (Fence) 1----_-� W-0.1' u .� 2� HVAC Residence CX 4 Unit (House # 10 � I 6 I Wood Fence Steps (Fence) 0 E—on Line 3 �� L O t 3 X -x " 1 24.5 o w 62 / _0 `L Trench Drain O ``- / / Brick Walk /Q) 10 LLJ V a n I r ,, 3 o 0 �. o 3 • -x o 0 oo. 00� E„ 0° V) Z 164.13' , S t o n a = 20'� g,� ,� � L= 70.86 � 61.14' e o. ��� a S 8017 00 E C u r b Carit, ( 50 Ft. R. 0. W. ) CERTIFIED TO: THOROUGHBRED TITLE SERVICES, LLC, RADIAN TITLE INSURANCE INC., WEBSTER BANK, N.A., JEFFREY J. COOMBS AND KATHRYN RIGHTMYER COOMBS, THE LAW OFFICE OF DAVID M. GLADSTONE, PC Curb Cut Stone Curb Lane J L) L [F= � � Cap MAR 3 0 2022 r s�0 VILLAGE LAB E O i R Y iw. B F� O O K � BILDG w4 i".y �n•��7pky^t_R� ! SURVEY OF LOT 62 AS SHOWN ON A MAP ENTITLED "SECTION TWO, PINE RIDGE ," FILED NOVEMBER 15, 1957 AS COUNTY CLERK MAP No. 11307. SURVEYED AS IN POSSESSION Original dote Ahoy 1, 1958 THE MUNSON COMPANY Br-ough t to date Ju/y 23, 1958 9 N 0 R T H G 0 0 D W I N AVENUE /1/. License 5005�-2 Brought to dote & Redrafted Feb. 1� 2022 E L M S F O R D N. Y. Poo/ 6_gz10men t & HkIAC Unit added Feb. 17, 2022 Certif cation only added Alarch. 15, 2022 10523 Br-oogh t to date ItIol-ch 90, 2022 Scale 1"= 2 0 A -DUI Li'�'"► DOC(jMFNT "Unauthorized alterations or additions to a survey map is a violation of section 7209, sub —division 2, of the New York State Education Law." "Only copies of the original survey marked with 'the land surveyor's inked or embossed seal shall be considered a true and valid copy." 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Q m m o U ccnn 0 VILLAGE OF RYE BROOK —TOWN OF RYE TITLE # TBT47965 Tax Lot 4 L — — — — (Fence) W-0.1 Tax Tax Lot �, �____� F-----_ SECTION 135.42 67 ; ' Lot ' ; Lot ; ,' LoCN BLOCK 1 2 1 68 , Section 3 Pine Ridge L-----I LOT 5 ---- County Clerk Ma N 75°50'30" W P No. 11525 Post & ' _X�_X——.X___XW i X e e n c81Xe ,13 C u r b Curb Cut Cgr�tor� Lane ( 50 Ft. R. 0. W. DRIE /;�� [E W 1 r--j �9 -_ ItDl JUN - 2 2023 CERTIFIED TO: THOROUGHBRED TITLE SERVICES, LLC, VILLAGE OF RYE BROOK RADIAN TITLE INSURANCE INC., BUILDING DEPARTMENT WEBSTER BANK, N.A., JEFFREY J. COOMBS AND KATHRYN RIGHTMYER COOMBS, THE LAW OFFICE OF DAVID M. GLADSTONE, PC SURVEY OF LOT 62 AS SHOWN ON A MAP ENTITLED "SECTION TWO, PINE RIDGE FILED NOVEMBER 15, 1957 AS COUNTY CLERK MAP No. 11307. SURVEYED AS IN POSSESSION Original date May 1, 1958 i ' ,r' THE MUNSON COMPANY , }� Brought to dote /u/y 2,� 1958 9 NORTH G 0 0 D W I N AVENUE /V. Y. S. L iced, 50054-2 Brough t to dote �c f?edrafted Feb. 1 4 2022 E L M S F O R D, N.Y. Poo/ Ht1AC U171t added Feb. 17, 2022 Certifcatiort o17/y added March. 15, 2022 10523 Brought to date June 1, 2023 Scale 1 " = 2 0' "Unauthorized alterations or additions to a survey map is a violation of section 7209, sub —division 2, of the New York State Education Law." "Only copies of the original survey marked with the land surveyor's inked or embossed seal shall be considered a true and valid copy." UNDERGROUND PIPES, WIRES, STRUCTURES, ETC., IF ANY ARE NOT SHOWN See J-4550.dwg J-4!DbZ I-UL—ZU