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HomeMy WebLinkAboutBP22-100PERMIT SECTION TYPE OF WO 10B LOCATIO OWN CONTRALTO vCO # TCO # FEE DATE FOOTI N G FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING F1 RGH PLUMBING GAS SPRINKLER ELECTRIC LOW -VOLT ALARM AS BUILT FINAL INSPECTION RECORD DATE va INSP in )ee4r %4 l y�5YCC 35/Q► OTHER .APPROVALS ARB .11�c/1 4e %�i ac c BOT PB zaA OTHER AS-BUILTIFINAL SURVEY REQUIRED PRIOR TO FINAL INSPECTION QyC DR C� . 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 June 6,2023 Nancy Riesenfeld 5 Holly Lane Rye Brook,New York 10573 Re: 5 Holly Lane, Rye Brook,New York 10573 Parcel ID#: 129.59-1-39 Building Permit#22-100 issued on 6/16/2022 for a New Fence This certifies that the new five foot high black chain link fence,in rear yard,installed under the above captioned permit has been satisfactorily completed. Sincerely, "I Steven E. Fews Building&Fire Inspector /to D E C E NE For office use onl DDBUILDING DEPARTMENT PERMIT# - ~ 00 MAY 11 2023 VILLAGE OF RYE BROOK ISSUED: 938 KING STREET,RYE BROOK,NEw YORK 10573 DATE:-,'5--/'7—a--� VILLAGE OF RYE BROOK (914)939-0668 FEE: PAID,l BUILDING DEPARTMENT wwwxyebr© k on 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 ■►►t►►t/AAAt►►►t►t►►►tt►►►t►►►t►►►t►►t►t►t►►►t►►►t►►t►t►t►tt►►►t►ttt►ttt►t►t►tt►t►t►►►►tt►tt►t/►t►tttttt►►►►►►/►►►►►■►►►►►►tt Address: Occupancy/ e: / �� Parcel ID#: � 7� -� 9 -/_3 9 Zone:—A U Owner: �P/c / Address: IP.E./R.A. or Contra : Address: Y C1c?SSU Lo,, S Person in responsible charge: �C �i/J�i�/ Address: / / 10710 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 F NEW YORK, CO 1TY OF WESTCHESTER as: �4�4- my sworn,deposes and says that he/she resides at t in Name f li t (No.and S eet) � ,in the County of�/ Lys�—� in the State of ,that ity/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,fixed7e7m7enprofessional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$ , for the construction or alteration of: Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-10.A.of the Code of the Village of Rye Brook. Sworn to before me this �� Sworn to before me this day of �0.� , 2 day of , 20— Sighature of Prop er Signature of Applicant ame of. Owner Print Name of Applicant Lp Notary Public Notary Public SHARI MELILLO Notary Public,State of New York 8/12/2021 No.OIME6160063 Qualified In Westchester County Commission Expires January 29,207-7 QyE BRC�k, cu � /�• 1982 •� BUILDING DEPARTMENT AILDING INSPECTOR U ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street. Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - --- - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ' ADDRESS : 1 DATE: PERMIT ISSUED: �� S U ED• 0\6�4ECT: ]iLOCK: LOT. LOCATION: Q^� ' v - OCCUPANCY: 2—(Z) ❑ Violation Noted THE WORK IS..."-�PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION // REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING CROSS CONNECTION FINAL /� ❑ OTHER w0.0 � : W F� '`� a . o • �' 0-0 M ytu Nw W w � • © W va Z � G " 27 W °° ° aV 0 • a a4 O A `n ~ �'` `� v a W 0 U C h C V N 00 ;; © , `00 �`�' � M o ob 0 Z N w Wz � bQ ICI ^^ Qp 11 vI 5 -o ,�, M c` �-I �j p� v� ^ W A o Q w o CN A A wxN � � c W o �00 wo � v,o " z o � � LN ix W O T Z p J � aaJ Ln z W od . �v as `" � LL BUILDING DEPARTMENT R[EC[E �W[E VILLAGE OF RYE BROOK MAY 2 0 2022 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK vrg E BUILDING DEPARTMENT FOR OFFICE USE ONLY: C) Approval Dater U it# — 00 Application# Approval Signature: ARCHITECTURAL REVIEW BOA": Disapproved: Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: Application FeeJ b Permit Fees: ++*+w*+++++++*++++**++++*+*++*w**+++ww++++******w*+w*wwwwwwwwwwwwwwwwwwwwwwwww+w++++++w*+++**++****+++*++++ FENCE / WALL / GATE PERMIT APPLICATION Application dated: N5:—e)0—c) is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the installation,construction,repair or replacement of a Fence,Wall or Gate,in accordance with Section 250-6 B.(1)(g),of the Code of the Village of Rye Brook,as per detailed mtegwnt de scribed below, Sw `�g pool llJfences m t conform to the State Code. r 1. Job Address: C— --►'� 1 Q P V 2. Occupancy/Use: ��FWrl� S.B.L.#: C-)7- 5/ — / 3 7 Zone: —Is 3. Proposed Fencell ate(desc 'be ln detail): yet— v / 4. Property Owner: L- s G Address: J ( I o/I i LX�i- U S - Phone# jT��7-��g��Cell# — I1q, email:&MC 46&r-S Applicant: Address: Phone# Cell# email: Architect/Engineer: Address: Phone# Cell# email: Contractor: . ? .S Address&Phone: rAS.S lQ% n �P/ /V 1071 5. If building is located on a corner lot,which street does it front on: 6. What is the estimated cost of construction (NOTE:The estimated cost shall include all site improvements,la6or,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 7. Estimated date of completion: t 8/12/2021 Please note that this application must include the notarized signature(s) of the legal owner(s) of the above-mentioned property, in the space provided below. Any application not bearing the legal property owner's notarized signature(s) shall be deemed null and void, and will be returned to the applicant. STATE OF NEW YORK,COUNTY OF WESTCHESTER ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this I � Swom to before me this day of Mtty ,20� day of , 20 Signature o Owner Signature of Applicant Nrep( Print Name of Proubty �Ow..': Print Name of Applicant Notary Public Notary Public SHARI MELILLO Notary Public,State of New York No.O1ME616OO63 Qualified In Westchester County ll Commission Expires January 29,2013- 2 8/12/2021 Building Permit Check List&Zoning Analysis Address: V V SBL: Zvi ' - l -_31 Zone: 2-[!�_ Use: 1 'E' Const.Type: Other. Submittal Date: S Z 4--7—Revisions Submittal Dates: Applicant: IF,S N�- lr� Nature of Work / �D c( Al 4 H-1_i�c„a Ch- C4-0-t N - L, r--E :ZjjCF t►-5 i7F,0,ti y A R-,-\ Reviews•ZBA: PB: BOT• Other. NEW OK ( ) FEES:Filing ?-�' BP: t --0 • -_C/O: Flood Plane: Legalization: ( ) (✓)' APP: Dated. ✓ Notarized. ✓ SBL: —,Truss I.D. Cross Connection: H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening. ( ) ( ) ENVIRO:Long. Short Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection S/W Mgmt.: Tree Plan: Other. ( ) (�SURVEY:Dated: Current Archival: Sealed Unacceptable: ( ) ( ) PLANS:Date Stamped Sealed: Copies: Electronic: Other. ( ) (,�'License: ✓ Workers Coax ✓ Liabili �mp.Waiver. Other. ( ) ( ) CODE 753#: bw� ly 3—0__0 - `//mil-'CO Dated�—�lD—ol a- N/A: ( ) ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: I-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. O O 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: to V 5' Z approval notes: ( )ZBA mtg.date: approval:- notes: ( )PB mtg.date: approval• notes: REQUIRED EXISTING PROPOSED NOTES ED pate. J UN 16 1011 Cir : Fr n ge Front. Front: Sides: Main Coy Accs.Cov Ft.H Sb: S .HSb: CE& TTgt,lsn—g: Ft Im.� Pazkrnc HHight/Stories: notes: D Dill BUILDING DEPARTMENT VILLAGE OF RYE BROOK R MAY 2 0 2022 938 KING STREET RYE BRooK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK wr al BUILDING DEPARTMENT 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 copy of this check list will be removed from the ARB agenda. Job Address: f5&Lv— LA�(!�- " f Submission: Iff,, Parcel ID#:�a�},S9 /—.3 9 Zone:�L5- 4J� Proposed Improvement( escribe in detail). APPLICANT CHECK LIST: / MUST BE COMPLETED BY THE APPLICANT The following items must be submitted to the Building Department by the applicant-no exceptions. Property Owner: a/y _ 1. (11�completed Application / ( )Two(2)sets of sealed plans. (one full size(maximum Address: G� el allowable plan size=36"x 42")and one 11"xl7") Phone# / �7 �j l to 3. (,-)^fwo(2)copies of the property survey. 4. ( )Two(2)copies of the proposed site plan. Applicant appeaping before the Board: 5. VOne electronic/disc copy of the complete plication materials. 6. ( ;Any ing Fee. Address: J 7. (v supporting documentation. �� 8. ( )HOA approval letter. (if applicable) Phone# 9. (,—Ohotographs. Architect/Engineer: 10.( )Samples of finishes/color chart. (a sample board or Phone# 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 1� Sworn to before me this day of , 20 ' day of , 20 Sigha&r7e of Pro er Signature of Applicant `-I'Loin a Priht Parne of Owner Print Name of Applicant A, ��-�jk' Notary Public Notary Public SHARI MELILLO Notary Public,State of New York No.01ME6160063 Qualified In Westchester County Commission Expires January 29,201 8/12/2021 VILLAGE OF RYE BROOK BUILDING DEPARTMENT 938 KING STREET, RYE BROOK,NY 10573 (T) 939-0668 (F) 939-5801 ARCHITECTURAL REVIEW BOARD Wednesday, June 15, 2022 NAME & LOCATION TYPE OF MOTION SECOND APPROVED REJECTED APPL.# APPLICATION 5 Holly Lane New 5Ft High Black Consent 5710 (Riesenfeld) Chain Link Fence In Agenda 0 Rear Yard. 100 Country Ridge 4Ft PVC Privacy Consent 5711 Dr(Scheiner) Fence Front& 6Ft In Agenda Rear Yard 751 King St(Nagula) Roof Top Solar Array Consent 5712 System Agenda 8 Maple Ct(Ochoa) Roof Top Solar Array Consent 5713 System Agenda 17 Carlton Lane New 4Ft High Black Consent 5714 (Boduch) Aluminum Picket Agenda Fence 15 Carlton Lane New Rear Patio Door Consent 5693 (Amestoy) Agenda 75 Woodland Ave Roof Top Solar Array Consent 5694 (Mutino) System Agenda 94 Grant St(Parker) Roof Top Solar Array Consent 5715 System Agenda 27 Garibaldi (Cirioni) Re- Appearance 5703 Legalize Rear 2 Family, Driveway Expansion 27 Garibaldi (Cirioni) Original Submittal - 5703 Driveway Expansion, Legalize Rear House 2 Family, 3rd Story 12 Woodland Drive Re- Appearance - 5705 (O'Brien) Covert Exiting Garage to Conditioned Living ML f NM MR SE JM ✓ SF AC ✓ MI KC VILLAGE OF RYE BROOK BUILDING DEPARTMENT 938 KING STREET, RYE BROOK,NY 10573 (T) 939-0668 (F) 939-5801 ARCHITECTURAL REVIEW BOARD Wednesday, June 15, 2022 PAGE 2 NAME & TYPE OF MOTION SECOND APPROVED REJECT APPL# LOCATION i APPLICATION _ 12 Woodland Dr Convert Garage to Original 5705 (O'Brien/Sonenklare) living Space,New Submittal Two Car Garage& Regrade Driveway 4 Sleep Hollow Road Amendment to Prior 5716 (Cecere) Approve Side Yard Deck 8 Winding Wood Convert Existing 5717 Road(Garofolo) Screen Porch Into Living Space 7 Knollwood Dr Reconfigure 5718 (Rattner) Windows, Interior Renovations 48 Rock Ridge Dr New Single-Family 5719 ~' (Kouloukis) w/Attached Garage, Swimming Pool & Rear Patio 39 Tamarack Road 2nd Story Additions, 5720 (PK Real Estate Rear Porch, Rear Holdings) Patio Reconfiguration 4 Bolton Place Rear 2nd Story 5721 (McRedmond) Addition & Replace Rear Wood Deck and Stairs 167 Country Ridge Application to Amend 5722 Drive(Hugon) Prior Approval & Replacement of Wood Deck ML NM MR SE JM SF AC MI KC Y X. -�4.� �..C_ _i �: -.r .VGA�•� � �► qri-qq' - +r► �► � A�i�i .�� it LL}` �J(((S/ .. s- •i{r'><rih � V r, em v Q _ Co ' - 0 / = N S - O 4.0 CJ /1 � J - O ri W \;\ U LL 00 MEN" TT f •J � = 1 J Y . •��. - � S( ;r. ..L. .'!1 .1 .- r 1: _ �. 111 _ -1 Il � ,.:[ rh.• t i 1 rt �. ... J' CIPSFEN-01 LOLIVEIRA DATE(MMMDIYYYY) ;4COR� CERTIFICATE OF LIABILITY INSURANCE 511012022 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). CONTACT Liveen Nembhard NAME PRODUCER Ference GrayInsurance Brokerage,LLC PHONE 914 517-8682 FAX No:(914)696.0415 19 Mill Street E-0t sAIL Port Chester, NY 10573 INSURER(Sl AFFORDING COVERAGE NAIC INSURERA:Erie Insurance Corn an 26263 INSURED INSURER B CIPS Fence Co.Inc.dba King Fence INSURERC: FRANK CIPRIANI INSURERD: 48 GRASSY SPRAIN ROAD YONKERS,NY 10710 1 INSURERE: 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 'TYPE OF INSURANCE AWL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S Im 1,000,000 CLAIMS-MADE a OCCUR Q47-6950084 11/19/2021 11/19l2022 DAMAGE To RENTED 1,000,000 MED E(P An one arson 5,000 PERSONAL BADVINJURY 1,000,000 EN'L AGGREGATE LIMrr APPLIES PER: GENERAL AGGREGATE 2,000,000 POLICY❑X jER& LOC PRODUCTS-COMP/OP AGG 2,000,000 OTHER: -- COMBINEDtSINGLE LIMIT $ 1,000,000 A AUTOMOBILE LIABILDY ANY AUTO IQ11-6940010 11/19/2021 11M9/2022 BODILY INJURY Pe person OWNED X SCHEDULED BODILY INJURY Per accident AUTEO�S ONLY AUpTOpSy� PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLDY Per accident A X UMBRELLA LIAB X OCCUR EACH CURRENCE 1,000,000 EXCESS LIAB CLAIMS-MADE Q35-5170349 11/112021 11/1/2022 AGGREGATE 1,000,000 DIED X ' RETENTION$ 10,000 $ PER OTH- WORKERS COMPENSATION U TE AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ A E.L.EACH ACCIDENT FFICER/MEMBER EXCLUDED? N/ Mandatory in NH) E.L.DISEASE-EA EMPLOYE K If yyes,describe untlorE.L.DISEASE-POLICY u ID SCRIPTI^ P I N belm' DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERT OLDER 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 Street Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVE ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • CERTIFICATE OF PORK workers' NYS WORKERS'COMPENSATION INSURANCE COVERAGE TATF Compensation Board Insured Detail Ia.Legal Name and address of Insured(Use street address only) lb.Business Telephone Number of Insured Abel FIR IT,Inc.L/C/F Cips Fence Co,Inc. 860-609-0400 48 Grassy Sprain Rd Yonkers,NY 10710 1c.NYS Unemployment Insurance Employer Registration Number of Insured DBA:King Fence 1d.Federal Employer Identification Number of Insured or Social Security Number 134049813 Work Location of Insured(Only required if coverage is specifically limited to certain location in New York State,i.e.a Wrap-Up Policy) 2.Name and Address of the Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) AmTrust Insurance Company 3b.Policy Number of entity listed in box"la": Village of Rye Brook KWC1278802 938 King Street Rye Brook,NY 10573 3c.Policy effective period: 3/l/2022 to 3/l/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 carrier indicated above in boa"Y insures the business referenced above in bog"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 113c",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: Matt Zender (Print name of authorized representative or licensed agent of insurancc carrier) Approved By: 5/10/2022 (Signature) (Date) Title: Senior Vice President Laura Petersen From: Mike Izzo Sent: Thursday,June 16, 2022 2:33 PM To: Laura Petersen; Steven Fews;Tara Orlando Subject: FW: Message from UDig NY From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Thursday, June 16, 2022 2:32:54 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: 06/16/2022 14:31 To: VIL RYE BROOK PRIMARY Transmitted: 06/16/2022 14:32 00003 Ticket: 06162-001-912-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 5 To: Name: HOLLY LN Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: MARK OUT ENTIRE PROPERTY NearSt: FAIRLAWN PKWY & COUNTRY RIDGE DR Means of Excavation: POST HOLE DIGGER Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: FENCE INSTALL Estimated Work Complete Date: 06/23/2022 Depth of excavation: 3 FEET Site dimensions: Length 308 FEET Start Date and Time: 06/21/2022 07:00 Must Start By: 07/06/2022 ------------------------------------------------------------------------------ Contact Name: NANCY CIPRIANI Company: CIPS FENCE CO INC DBA KING FENCE Addr1= 48 GRASSY SPRAIN RD Addr2: City: YONKERS State: NY Zip: 10710 Phone: 914-337-8700 Fax: Email: info@kingfenceny.com Field Contact: FRANK CIPRIANI Alt Phone: 914-337-8700 Email: matthew.warne3@gmail.com Working for: RIESENSELD i ------------------------------------------------------------------------------ Comments: Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA CONED SUEZ WTR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR 2 7� (D 0 0 0 c z Z zo z 4 ❑ �-- 0 (f) \77 --i c zm> m --A r- M ;d > ---j > M r- I Moz M M > > -i ;u X 0 m C/) Z C: > M Z mr- ;u K K o u < Z 0 Z > 0 > Z Z Z C> > -0 r—z;d uj z m > --1 0 r- A > m m -r 0 M M > F9 >0 Z 0 0 0 W M M M 0 -0 I- r- m M > C) =T > Ix C) < IC3 V r- 0 m Z -% M m 0. m -% 0 Vnv2ri 2) l 0 Ij M ][ > 0 Sam W > CD x > F 0 rA F > rota, m cD tit 10% 0 0 < z > m Ci) CA ru < c "Mc 0 > CD 0 raw.. 0 m m x z 0 0 CD CJI MOO C4 rm C� 0 01 0 cp 0 Z 0 rn -n -n Z :v 0 OM 3:>. 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