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HomeMy WebLinkAboutBP22-096(} 4/ OTH APPROVALS PERMIT # /- ��— 096 DATE"; ARB SECTION / ) 7 BLOCK, LOT I 114 PeiTYPE F WORK /-/!Q o %k � P�%�S //1 SO4 .s " �� O f JOB LOCATION 22 Cp` ShO���✓� OTHER OWNER i/1 p� L� ?aZ L� �/�J�1�0 CONTRACTO O �'I OBIS GGT/O/� �/ ure EST. COST =A2 '"4077 GQQO FEE 14 d �767 � V/CO # - FEE 4 &0C 06D DATE a s TCO # FEE DATE _ INSPECTION RECORD DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS SPRINKLER ELECTRIC LOW -VOLT ALARM AS BUILT FINAL INSP GAD -mil 3�/irks/cc��cv1 cC VILLAGE OF RYE BROOK WESTCHESTP COUNTY, NEW YORK ,��� NO: 22-134 �� 1 -2 Certificate of ®coup ucp Ehis is to certify that f L LC ooff,,^ having duly filed an application on ,_20 a a requesting a Certificate of Occupancy for the premises known as, Q36U M R;G�QC dMoeT , Rye Brook,NY, located in a ('J-P Zoning District and shown on the most current Tax Map as Section: I 7 Block: Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No.429 , issued cY 20 c2j, such authority and permission is hereby granted to the property owner to lawfully occupy or use said premises or building or/pant thereof listed under the following New York State Classifications,Use: ti c�% 9Yand" /"f Construction: for the following purposes: Mew -�e�-,Q1-z� ;6 4-- ��T li(�ow'jQ�7s NoMln-a MoM3,ay? Az/r;-jt-r Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: -MIS o IA �ye /&Wee as U/ . V lla�a� 00 01 e, O nd Av y S)a l e C'a 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 h 'gh all be made,nor shall the building be moved from one location to another until a permit to accomplish such change hVS11n771d.ing Inspector. SEP 2 2QZ2 Building Inspector,Village of Rye Brook: Date: R -01 BUILDING DEPARTMENT For office use on) : SEP - 6 2022 VILLAGE OF RYE i�OK PERMrr# a—1 9& ISVILLAGEsUE D: /$- 38 KING STREET,RYE BROOK,NEW YORK 10573 DATE: _ C'), VILLAGE OF RYE BROOK (914)939-0668 914)939-5801 FEE: PAIDJW BUILDING DEPARTMENT a"•H• ro' .or $ 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 FIXRL INSPECTION tt/t///1/1/►1111/tt/i11p111/If//Iff1►flfflfffii!ltif•///1/11/fftlf/t//t/iiiiflit/ifi/ItNfffNfll/p1/ii1f1//1///f///Ilfitii Address: I I s 4 t s e A-, &L u'e—sle- IVY 10 73 Occupancy/Use: ✓Yfv Parcel ID#: �i c17 � Zone: — Owner:M pul)&VE lefti }fit L1C Address: Z`� 1C P-;b6C— PLfl?-A P.E./R.A.or Contractor: m f C LLL Address: PIA J Ate, 3/c Person in responsible charge: < L r Nt C Address: �� 5 � ,.� 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 YOM COUNTY OF WESTCHESTER as: o o being duly sworn,deposes and says that he/she resides at 3 C? e-1jam! /Q—L— (Print Nana of pplicant) (No and Strectl � in S 4- �ti-A in the County of S e.A*`< in the State of // that i(74N Town'Villagct T� 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,fixedeuipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was: S T *a for the construction or alte 'on of: c7y e� S t ! Deponent fitrther 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 ('774 Sworn to before me this day of 11" 9 Z1, , 20 -Z-,7 day of 20 71?4- -4A &j5W&of Pro erq On-M, Signature of Applicant Print Name of Property nt ` me of Applicant i�& Notary bl Notary Public t SHARI MELILLO N- Notary Public, State of New York hJ 01°.,^i 1 6160063 r, 0,ln!ifiad in Westchester County Commission Expires January 29,20,1a QyE BRC��. 0 '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.ors - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS fl � �J U DATE: v. �( PERMIT# ISSUED: 15 LOCK: LOT:ECT: B LOCATION: Ml�, \ �' `v C\,(\ sz` OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... )d ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION W��C Q� //// 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 �E BRC��, '9a2 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 :— ' \ C-�" DATE: '1 PERMIT#�1�` ISSUED: 1S��SEm BLOCK: LOT: LOCATION: '-` cya`� 'C Q) �lC� OCCUPANCY: TZ1 ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION W e� 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 w a. Al VVD i Q V 8 �° rTl z Ln d F V u a w 0-4 to ° � H cc) F-� Z O CA � v O ON% d leb R o� u � z � bW �l W A oa ? ti ° '5 � Or-� [Lneq w FQi ../ 00 w U' " 0 -N y � ¢� g o w 50 Or- oo V r , M FwFill U CODO 12 0-14 ap,eq z P: "a 0 a b ~ �;) z �v N " . d cn b -O '� z W eW p4 (~.� W. d u a z DECEUVE BUILD 9WISED v><L OF R ��QPQ� A O f JUN - 6 20 2 938 KING RYE BR. � �12 ATE[?: VILLAGE OF RYE ROOK MENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: JUN - 8 02296 Approval Date: - Permit#: �� Application Fee:5 Approval Signature: Permit Fees:S O� Disapproved: Other: xxxxxxxxxxxxxxxxtxxxxxrxxxxx,tx*x:xxxxxxxxxxx:x*xxxxxxxxxxtxxxxxr*xx*xxxxxxkxxxrx*xt*xxxxxxxxxxxxxixx,exx*xxr Application dated: is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit for the interior alteration oran existing building,or fora change in use,as per detailed statemen(descriW belpw. 114 S. Ridge Street, Rye Brook, NY, 1057 Section: 141.27 Block: 1 C1P 1. Job Address: BL: Lot: 6 Zone: 2. Proposed Improvement.(Describe in detail): �\\'r 0 T ro FL. Nov T-P&pCv New flooring, replace damaged ceiling tiles, new 2x4 ceiling lights, paint walls replace damaged slat wall. All life safety devices and systems to remain Please see the letter attached. 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: X Yes: _ If yes,indicate: TIER I: TIER II: TIER III: 4, 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 flood,etc...):No: x Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 5. Occupancy;(1 fam.,2 fam.,cotton.,etc...)Prior to Construction: COMM. After Construction: COMM- 6. N.Y State Construction Classification: Type HA I I I B N.Y.State Use Classification: business 7. Property Owner:*14 l M ,1c Address: l4- I'* tagg Phone# 114--101—ft X5 Cell# email:M, 8. Applicant. Madison"e Niche Address: 40 Shore Road, Cold Spring Harbor, NY Phone#631-942-1535 Cell# email: Macxcorp@gmail.com 9. Architect: RJM Drafting and Design Address 7 Old Landers Ct, Smithtown NY Phone#516-818-5358 Cell# email: ralph@dmdesignsny.com 10. Engineer: Michael Angelone Address: 4 Pond PI Oyster Bay, N.Y. 11771 Phone# 516-922-2024 Cell#516-933-0622 email:angel ss@verizon.net 11. General Contractor, Macx Projects Corp Address: 367 Lake Avenue, St. James NY 11780 Phone#631-291-3456 Cell# email: Macx.Offce@gmail.com 12. Estimated cost of construction S 20,000 (NO I-E 'Ile estimated cost shall include all labor,matenal,scaffolding,faced equipment,professional fees,and matcnal and labor which may be donated grans) 13, Job Timetable: Start: 6/1/22 Finish: 6/21/22 (1) 9/1212021 BUIQRYE MNT E VILOOK 938 KING ,NY 1057 R ��N - 2 VILLAGE OF RYE BROOK BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 - STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: 31, bwc LN ws# residing at, 2-4- I C (92 un* (Print name) (Address where you live) being duly sworn, deposes and states that(s)he is the applicant above named, and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; I, S r , Rye Brook,NY. (Job Address) Further that all statements contained herein are true, and that to the best of his/her knowledge and belief, that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. L � Iti c ol.PI Ow4wrls)) (Print Name of Property Oe9ft"r(s))A6&1r Sworn to before me this Nrl�' day of , 20_) a (Notary Public) KFLLY SAMDLr7R Notary Pukif' "Ite 0f New York Qualified in V!1's,,ehc ter County (2) Commission Expires March b, 20zu 8/12/2021 This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. Please note that application fees are non-refundable. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and furthers es tha (s)he is the legal owner of the property to which this application pertains, or that (s)he is the Pn for the legal owner and is duly authorized to make and file this application. (indicate arcbhect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. By signing this application,the property owner further declares that he/she has inspected the subject property, and that to the best of his/her knowledge there are no roof drains, sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this Sworn to before me this day of , 20 a� day of ��iL 20 gnat a of Prope Ot i, AJ., rz!t Signature of Applicant Print Name of Property O Wiirr Print Name of Applicant 14 h — y_\& (I,1��kkL� 5e� " M-J— ' Notary blic Notary Public KFI_l.Y SAK!at.ER gF►ARI MELILLO Notary Public, Sete of New York No. Public,State of New York 01 S;, ;';C�3�3�2 Notary Oualified in Wts-chesier County No.olME6160063 Commission Expires March 5, 23�),� Qualified in Westchester 29 20 7 Commission Expires January (4) 8/12/2021 Y s e s' z Y' M M , 3 N N W 16 O 2 � � q Ap Z $ � Mr � � 1 � � � T^^ ►TI '�'' W � � � 1+^q a v F ` I(nyl N 00 ' V i F 00 o 0 �r die x a z Y H z z OPLO N V a w o < '. y a ¢ w � FS ' w6a ° r T-4 Z x z � < cz CA �I as a a 04. cA w i IDO!r D BUIENT DD VILOK SEP - 7 2022 938 KINNY 10573VILLAGE OF RYE BROOK BUILDING DEPARTMENT _ ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians lectricians License Required p FOR OFFICE USE ONLY BP#: — O 710 EP#: SEP - 2022 Approval Date: Permit Fee: $ Approval Signature: �'� Other: ********************************* *************************************************************** Application dated, g-7-�� 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. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance :/conformancewith all applicable Federal,State,County and Local Codes. f� 1.Address: • R1-� SBL o)-7 ea Zone:��y 2.Property Owner: Wll7 R-M'L f-�1'fl, LI-C, Address: f W� qini Y Phone#: '1 gy�pp'' C``e``l``l C/ email: f , 3.Master Electrician:. � �l n VLF�11I C� lddress: b C lk� l Lic.#: P on #: L ��2 '� l 1#: email: cc1 3 Y n Company Name: �J L �. I VI C- V dd 4.Proposed Electrical Work/Fixture Count:.PM kM' 6E-)'F`f-C L7k1T Ji&Kn 5.31 Party Electrical Inspection Agency: TATE OF TEW[Y RK,� //COUNTY OF WESTC14ESTER ) as:J I G1 liceing duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of indivi ual signing as the plicant) state that(s)he is the legal owner o e property to which this application pertains,or that(s)he is the ��U 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. Swom to before me this .30m Swonyto b fore me this day of 20 1-2- W;20 y aature ofro����(�1.rf t re p,cant h'nt Name of Pr perty O 1NT e f A is nt U o Public ublic KELLY SA►�!DLER 7PUIBLIC. ROMBACCO Notary Public, State of New York [NOTARYSTATE OF NEW YORK NC. O1SA;i i0,96,32 o #01TR6348329 Cualified in Westchester County utchess County Commission Expires March 9, CO res Sept she 6/23/2022 STATEWIDE • 1:1 Main Street, Fishkill, NY 12524 1 email:office@swisny.com SWIS JOB APPLICATION tel845.202.7224 fax 914.219.1062 SWISNY.com SWISTraininq.com Office Use Elect.Permit# �f�.�� \ _ Date Bldg Permit# /� ` 09G Utility ID# Final Certificate# f City/Village n jp Zip Township Coun Address � ' )�, ,v ' C-awStreet ./ Section Block t l Lot Owner Name/Address of different than above) ` / Z11 ! (,contact Numb@ t ❑Basement ❑ 1st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑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 Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent SERVICE Amperage Voltage 1 P 3P #Meters #Disconnect ❑Underground ❑ New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information I � R IECIE w ID Sl X EEP - 7 2022 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,if at any time of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.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 Finaliyed Inspector# Company NameNOS Date I Signature Address t �Y� ` by/State i 1/ L I 1.-Zip Code Y' r PC License# Phone# — State Wide Inspection Services 1080 Main Street _ Fishkill, NY 12524 a 845 202-7224 Phone 914-219-1062 Fax STATE WIDE INSPECTION SERVICES Email: office@swisny.com Service With Integrity Website: www.swisny.com BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Nick's Electrical Service, Inc. Win Ridge Realty, LLC Nicholas Camillone 114 South Ridge Street 48 Grand Street Rye Brook, NY 10573 New Rochelle, NY 10801 Located at: 114 South Ridge Street, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: E22-213 141.27 Certificate Number: 2022-5455 Building Permit Number: BP22-096 A visual inspection of the electrical system was conducted at the Commercial occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at: 114 South Ridge Street, Rye Brook, NY 10573 The Retail Store First Floor was 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 15th day of September 2022. Name Quantity Rating Circuit Type Fire Exit Signs 02 Receptacles 06 149—aj- 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. u ,u � R vis M�d��dh � r�► , � PLIC rio JUN -6 2022 DATED: VILLAGE OF Madison's Niche RYE B OK 114 Ridge Corp ENT 40 Shore Road Cold Spring Harbor,NY 11724 RE:Madison's Niche Building Application To whom it may concern, Please review the enclosed summary about Madison's Niche and the construction required to open the new store located at 114 South Ridge Street,Rye Brook,NY, 10573. Owner&Store Description Owner Entity Name&Address: 114 Ridge Corp-40 Shore Road,Cold Spring Harbor,NY 11724 Owner Name&Address:Karen McAvoy 114 Ridge Corp-40 Shore Road,Cold Spring Harbor,NY 11724 Email,Phone Number,Website: Karen@madisonsniche.com,631-942-1535 ,www.madisonsniche.com Description of Store: Madison's Niche is an exclusive selection of luxe women's fashion,accessories,home decor,kitchenware,gifts and baby products.Stepping into one of our boutiques is an experience for the senses.Candles burning,meticulously merchandised displays and vignettes that are ever-changing with the seasons! Ultimately,the idea of being able to positively influence someone's life through style is what we strive to achieve each day! We are a"LifeStyle"boutique! Proposed Improvement Description - Remove existing carpet/flooring and install new LVT flooring. - Remove existing damage ceiling tiles and install new replacement ceiling tiles. - Replace 2x4 ceiling lights. - Replace damaged slat wall. - Paint walls. - Supply furniture as needed for display use. - All life safety devices and systems to remain. - Please note:All of the existing trades/vendors used by the previous tenant&that are currently used at the shopping centre will be used now&moving forward. Corporate Head Quarters 83 Main Street Stony Brook, NY 11790 www.madisonsniche.com 1 631.364.9898 Building Permit Check List&Zoning Analysis J Address: t�� _S 7�''r� 7— SBL: I 2 — — Zone: C Use: ►'A Const.Type:—[ < r Other. Submittal Date Z Revisions Submittal Dates: �O/ <7- -z -L , Applicant: JA3 I ,!`► '� �Zj Nature of Work: N� — _ p C' TA,L� !J Reviews:ZBA: J UN — 8 2022 pB: BOT: Other. 1�1 OK ( ( ) FEES:Filing. 7-.�o•7 BP: 5 '�.� C/O: Flood Plane: Legalization: ( ) (�' APP: Dated: ✓ 0tarized: ✓ SBL- Truss I.D. Cross Connection: H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening: ( ) ( ) ENVIRO:Long. Short: Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection S/W Mgmr.: Tree Plan Other. ( ) ( ) URVEY:Dated Current Archival: Sealed: Unacceptable ( ) (�LANS:Date Stamped: ✓ Sealed: ✓ Copies: Z Electronic: Other. ( ( License Workers Comp: �ty; �mp.Waiver. Other. ( ) ( ) CODE 7S3#: Dated: N/A. (� ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit: N/A Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H.W.I.C.:_Battery:_Other ( ) ( ) PLUMBING:Plans: Permit: Nat.Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A: Other: ( ) ( ) H.V.A.C.: Plans: Permit: N/A Other. ( ) ( ) FUEL TANK:Plans: Permit: Fuel Type: Other: ( ) ( ) 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey. Final Topo: RA/PE Sign-off Letter As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER:tithe Ocher. ( ) ( ) r. ( )ARB mtg.date: approval• notes: ( )ZBA mtg.date: approval: notes: ( )PB mtg. date: approval• notes: REQUIRED EXISTING PROPOSED NOTES APPROVED Aux N - 8 2022 Cirde: fna+e U Fron Front Front: Si es: Rear. Main CQv: Accs.Cov Ft.H Sb: Sd.HS : GFA: Tom: Fc Im}I P Height/Stories notes: Laura Petersen From: Admin Macx <macx.office@gmail.com> Sent: Monday,June 13, 2022 11:40 AM To: Laura Petersen Subject: Re: Building Permit Application - 114 South Ridge Street "Madison's Niche" Attachments: Village of Rye Brook - Gotham Construction GL WC INS.pdf Good Morning, Please see the insurance documents attached. 1. Gotham Construction Inc. - License WC-34389-H21 (Partnered with Macx Projects Corp) -Aurel Sterkaj 914-826-5592 2.Attached 3.Attached 4. Will pay when we pick up Let me know if you have any questions. Thank you On Thu,Jun 9, 2022 at 1:45 PM Laura Petersen<LPetersen@ryebrook.ors>wrote: Good afternoon, The building permit application has been approved by the Building Inspector. Before I can issue the building permit the following items must be submitted to our office; V2General contractor's contact name & phone number. . General contractor's valid liability insurance (the Village Of Rye Brook must be the certificate holder) /3. General contractor's valid workers compensation on a NY State Board form (C105-2 or U26.3) 4. Building permit fee $500.00 (due once permit is issued and ready for pick-up) Thank you Laura Laura Petersen i .4coRd CERTIFICATE OF LIABILITY INSURANCEDATEIYY/pOrWYY) 06/10/2022 THIS CERTIFICATE 18 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(3), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: M the cOrtMcats holder Is an ADDfT10NA1 INSURED,the policy(wo) must I endorsed If SUBROGATION 13 WAIVED, subject to the terns 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 end or foment s . PRODUCER COWWACT ALBATRUST INSURANCE AGENCY : VAI 718-412-1778 GASHI Ax —--- 32 HANCOCK STREET �L - IAIC Nor STATEN ISLAND,NY 10305 ALB ATRUSTINSURANCE®GMAIL.COM _ INDURENIJ AFFORgNG COVERAGE N / -—— INSURED -- —. INSURER A; A FIRST GOTHAM CONSTRUCTION GROUP INC ateuptat a NYSIF — 420 Second Ave IrIst11RER c Pelham,NY 10803 �+sIIREn Dt- Y/SUlER E COVERAGES " F -- CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 7HE 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 alsR TYPE OF NaURANCE POLICY NLaYEq — i - EF — — GENERAL LIABILITYLONTS rX COMMERCIAL GENERAL LIABILITY I I I EAC ~OCCURRENCE s 1.000,000 CLAIMS#MADE OCCUR ! I P MI n S 1D0,000 A I X I ART3000220930 ED EXP( one 'S 5,000 02�22I2022 10212212023 LpERSON&8 ADV INJURY S E2O(00,000 00,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S X POLICY 1J PRO- LOC I I PRODUCTS-COMP/Op AGO S 2,000,000 AUTOMOMLE LIAWL" >j ANYAUTO I 1 Ili LLIMIT ALL OWNED SC I I BODILY INJURY(Pa Woon) S AUTOS I ED HIRED AUTOS NON-0 ' I I BODILY INJURY(P* r) _ AUT05 PR Por f U LLA LIAM OCCUR f - akCaaa U{AB CLAIMS-mApE EACH OCCURRENCE s D RETENTION I AGGRE C"A >i WORKERa COMPENBATMN S AND EYPLOYEW UTAaILfTY WC STATLF OTH- B ANY PROPRIETMPARTNERIEMCUTNE Y I N OFFICERIMEMeER EXCLUD (A11w4 ry In NN) E09 N/A I W2585 0961 02/21/2022 02l2112023 E.L.EACH ACCIDENT S 1,000,000 I RATt S epow I E.L.DISEASEEMPLOYED f 100,0 .000 E.L.DISEASE-POUCY LIMIT 1':--` 1.000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Aafclh&CORD 101,Addo_,a Rrmrts SCMdu/e,If"W"$P�Is npulna) Certificate Holder is Additional Insured- Village of Rye Brook 938 King Street Rye Brook, NY 10573 CERTIFICATE HOLDER CANCELLATION Village of Rye Brook SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 938 King Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED Rye Brook,NY 10573 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATNE VALON GASHI ACORD 25(2010/OS) 01 ON-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD N Y S I F PO Box 66699 Albany,NY 12206 New Volk state Insurance Fund I nysif.Com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^^ ^^ 851422187 ALBATRUST INSURANCE AGENCY INC O 32 HANCOCK ST STATEN ISLAND NY 10305 SCAN TO VALIDATE AND SUBSCRIBE F420 LICYHOLDER CERTIFICATE HOLDER OTHAM CONSTRUCTION GROUP INC VILLAGE OF RYE BROOK SECOND AVE938 KING STREET ELHAM NY 10803 RYE BROOK NY 10573 PERIOD DATE MBER P POLICY NUMBER CERTIFICATE NU02OLICY POLICY TO 02/21!2023 6/10/2022 W2565 096-1 889556 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO 2565 096-1 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THESTATE TH RESPECT OUTSIDE OF NEW YORK TOO OTHE POLICYHOLDER'S HOLDER'S REGULARRK, EXCEPT AS NEW INDICATED BELOW N YORK5TA E EMP OYEES ONLY TO OPERATIONS THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT AUREL STERKAJ GOTHAM CONSTRUCTION GROUP INC 1 OF 1 OF RS S NOR THIS COVERAGENCE IFICATE UPON I ISSUED AS A CERTIFICATEA�HOLDER.INHOTSMCERTIFATION OICATE NLY NDOONF NOT NAOMENDHTEXTEND IORUALTER THE COVERAGE AFFORDED BY THE POLICY THIS POLICY IS CANCELLED EFFECTIVE 05/2012022. 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