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HomeMy WebLinkAboutBP22-119PERMIT # SECTION TYPE OF WORT( JOB LOCATION OWNER CONTRACTOR EST. COST \./C0 # c Tro # FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS 0 SPRINKLER DATE- % / 3 c)Q EXPO �5 BLOCK LOT, FEE DATE INSPECTION RECORD DATE INSP ,�,/ ELECTRIC L1Q-- LOW-VOLT O ALARM AS BUILT M FINAL dj4 P 710 IIjw 40/7e 17C a f os)CZD°S 695L/ /al (9/40703- 6540 ,�aa-/y�/�b� OTHER APPROVALS ARB BOT Pe ZBA `OTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK 1yo: 22-149 Certificate of ®ccupaucp This is to certify that lht / [} T znl l—y :PLU l of, ��e e)yjy having duly filed an application on , �0Pk /��I 20 �requesting a Certificate of Occupancy for the premises known as, &s ki ei r-oc- , Rye Brook,NY, located in a k,4-1 Zoning District and shown on the most current Tax Map as Section: 5.75 Block: � Lot: / , and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No.12�_ ' issued J 20 , 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: ;� / one ram/&y Construction: for the following purposes: 1 k34-erjor YW/7&)VCc_/io dbe _�_6 A-?u`�r c� � e 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 heig t s 11 be made,nor shall the building be moved from one location to another until a permit to accomplish such change has b o aine nth i g Inspector. OCT 1 12022 Building Inspector,Village of Rye Brook: 7 Date: D [E(9� BUILDING DEPARTMENT For office use only: DD PERMIT# — �9 SEP 3 0 2022 VILLAGE OF RYE BROOK ISSUED: — —a 938 KING STREET,RYE BROOK,NEW YORK 10573 DATE: VILLAGE OF RYE BROOK (914)939-0668 FEE: _ U P RMO-0-- BUILDING DEPARTMENT NN����.r�chruul..nr�„ 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 Address: Occupancy/Use: Marcel ID#:13�� 7S - '�s� � Zone: �- Owner:1 �fcl�4Y✓l 1 R ICL U Address: 759 A ( rt—Z P.E./R.A. or Contractor: eI)P- S �Fj J7 Z 4Ce-_. ` G,,�-T'«Address: 2-le /4Uf�Dw 06ZI �D Person in responsible charge: �I��-S T �?_ S' L-r>4 L D Address: 21, 406DwtV C4 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: it 1 d being duly swom,deposes and says that he/she resides at "j[i V DLtJC'Cir ,1' lilt "alm:'4 A111111..11111 ,"�, .uld"nrrt in S i rr 1 tL� �7 in the County of TAIl-t-- ' in the State of e r -,that 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: ' C coC ,JJ C C; /ECG for the construction or alteration of: . L'A T/1i AL a� 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 thenV,illage of Rye Brook. Sworn to before me this ,1 63g CL� /� v ' Sworn to before me this day of , 20 ��-{ �Q I day of C , 20 Signature of Property Owner Signature of Applicant Print Name of Property Owner Pr t Name of A�,ppllicant Notary Public Notary Public HENRIOM PU a . d N�Ir rbAt MerryNNo.DIHE ouaW In WEtTCHESTER � Intl,toww sown Expires May 20.20 2 p [EC ENE SEP 3 0 2022 VILLAGE OF RYE BROOK BUILDING DEPARTMENT CALIFORNIA JURAT GOVERNMENT CODE § 8202 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of California Countyo;� t+r _ �1 Subscribed and sworn to (or aaff'i�rmed) before me on this hay of� e'/n 120jD;D.,`by Date 4 Month Year (2) CAMI EVANS COMM. #2273282 = (and(2) ), Zs Notary Public •Califomis m Name(s)of Signer(s) Santa Clara County Comm.Ex 'es Jan.20,2a23 proved to me on the basis of satisfactory evidence to be the person(s)who appeared before me. nA Signature 0�a"K—X)� Place Notary Seal and/or Stamp Above Signature of Notary u OPTIONAL Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s)Other Than Named Above: C2019 National Notary Association 1982 BUILDING DEPARTMENT YZSILDING INSPECTOR SISTANT 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;,,, `ok I 2 PERMIT# L-� ISSUED: 1 � SECT: BLOCK: �- LOT: _• LOCATION: � OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/RuNSPECTION ❑ 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 4eBkj� . cu � 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 - - - - - - - - - - - - - - - - - - - - INS ECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS:_ � DATE• I PERMIT# ISSUED: iECT: BLOCK: LOT: LOCATION: '"�' \(-.) V 0� I.Y ' OCCUPANCY: < `.J ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ -UNDERGROUND PLUMBING vv NOTES ON INSPECTION: .❑'f ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ' ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER s s , a x a "14 '. s c. 41 CA o u A o � � N � Q H _ Cep �-1 M o b .� yIn ( a �7 w ` Ln G, fl O ° o o s Q m F-1 O H �D I? F C 4 '- O ooc � ao W O Z � Z n co O 3 P4 C 2 �l Ln ° *4 '? w co 00 j � M a, Uo z i v o u� W A � � W '' ° � �Qu �►` � O 0 v Q a W � \O � 4w � v u a g C 1411 w u� ❑ zNo a ai 0 .0 ED BU>�,DING DE P - i O PARTMENT VILLAGE OF RYE BROOK JUL 1 1 2022 938 DING STREET RYE BROOK,NY 1.0573 _J (914)939-0668 VILLAGE OF RYE BROOK wwvw.ryebrook.or1! BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: �+� Approval Date: etmit / Application Fee:$ eD Approval Signature; Permit Fees: $ IS) 1i()wVC—124 Disapproved:; Application dated: 123 2 2 is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing building,or for a change in use,as per detailed statement described below. r7� 1. Job Address: *'A l� 1'kC �� / SSL:I3�i o)4-Ine: 2. Proposed Improvement.(Describe in detail): ;2 I fr j&4k R 14 p ©WC- A T,y-,to ro rl o '7�- 4 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: 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 Hood,etc...):No: V. Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) S. Occupancy;(1 fam.,2 fam.,comm.,etc...)Prior to Construction: 11 After Construction: d0 6. N.Y State Construction Classification: N.Y.State Use Classification: 7. Property Owner: --J-6:-Av4 -Dpcm I W 6 Address: 7 --AyVi L C i kX165- Phone# Cell# 't7lf)�—aU5- S email: 8. Applicant: 2 r �� /L/4 L 7� Address: Z V(-D moo r> ST m e T Phone# � 14 Cell#_�w q6 --s-SLio email: • Gew, 9. Architect:. RA Address: Phone# Cell# ems: 10. Engineer: A Address: Phone# Cell email: 11. General Contractor: ,Address: 4 1] �?(aj¢ f_/� T. Phone# Cell# / '- -S`S U email. ra -3 dF do Tp W/L Cc:r•, 12. Estimated cost of construction (Num:The estimated cost shall include all labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 13. Job Timetable:Start: ��/ 7 f f 4! 2 Z Finish. o (1) 8/12/2021 BUILDING DEPARTM ENTLJ VILLAGE OF RYE BROOK J U L 2�22 938 KING STREET RYE Mom,NY 10573 VILLAGI OF RYE B OK ( 14}939-0668 BUILDING DEPARTMENT www r-vebFeal-orl: _._...__ __.. , AFFIDAVIT OF COMPLIANCE VILLAGE CODE 4216 • STORM SEWERS AND SANITARY SEWERS .!'EIS .P=IDAV'_rT MUST BEAR THEE NOTARIZED SIGNATURE OF T? LEGAL PROPER--. OT Nz'.,k. A.B D 3fi SUB1,f- ..'a: ALCMG .I=TR A?rf BUILDING OR PLUMBING PERMIT APPLICATION.. ANY BUILDI'Lir- OR PLUZMN IXG PERMIT APPLICATION SUBMITTED WITHOUT THIS CO"—LETIED AND NOTARIZED FORM WILL BE RETURNED TO TEE AAPLICVi'. STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: 10 ftA i , residing at, 7 Ik (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; rJ C A\.)0 a .i ,r i C= 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. (Signahue of Prop erty awner(s)) ,P-rint Name of Property Owner(s)) Sworn to befo me this day of 120 (Notary Pubhc) (2) 8/12/2021 5 EC WE J�I JUL 1 1 2022 VILLAGE OF RYE BROOK BUILDING DEPARTMENT CALIFORNIA JURAT GOVERNMENT CODE § 8202 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of CaliforniaCl- r ,( Cou my of Subscribed and sworn to (or affirmed) before me on this 'Si—Nay of, I 20 2:�b Date Month Year (1) .TTa `�ll C) (and(2)CAM ), COMM. $227$282 Nome(s)of Signer(s) Nn� n� SSal C an Ceu Comm..E ,Zp,2a23 proved to me on the basis of satisfactory evidence to be the person(s)who appeared before me. Signature —el� Place Notary Seal and/or Stamp Above Signature of Notary Public OPTIONAL Completing this information can deter alteration of the document or fraudulent reattachment of this form to on unintended document. Description of Attached Document r Title or Type of Document: • � V�v Document Date: r — c5 — Number of Pages: Signer(s) Other Than Named Above: U019 National Notary Association n his application must be properly completed In its entirety and must include the notarized signature(s) of the legal €wner(s) of the subject property. and the applicent of refte d :- "„ spaces provitaed. Any application not properly completed in its entirety and/or not propp.r v, sunned small be deemed null and void and Sarni be returned to the applicant. Please note that application fees are non-refundabier. 5 �TE OF NEW FORK,COUNTY OF WESTCHESTER ) as: d I t--i tz- ',ei A L v , being duly sworn,deposes and states that he/she is the applicant above named,. (print name of individual a ' gas the applicant) and fprther states that (s)he is the legal owner of the property to which this application pertains, or that (s)be is the C=0 it-J-i 1L r1'( - 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 Swom to before me this \1 day of ,� u , 20� day of , 20,1)_ signature of Property Owner Signature of Applicant J E A N L , -DAM-1 8 N� Print Name of Property Owner r Print Name of Applicant CX Notary Public N '^ ~ otary Public ea �l � SHARI MELILLO Notary Public,state of New York No.01ME6160063 Qualified in Westchester County Commission Expires January 29.2oLl (4) 811 212 02 1 D EDl JUL 1 1 2022 VILLAGE OF RYE BROOK BUILDING DEPARTMENT CALIFORNIA JURAT GOVERNMENT CODE § 8202 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of California 0�I Countyof'��� �LW0. Subscribed and sworn to (or affirmed) before me on this• day of 20aaby (Date Mon h Year CAMI EVANS COMM. 02273262 Notary Public •CaliWaW o Santa Clara Co 0 (and(2) }, Comm.E� fires tan.2D,2p23 Nome(s)of Signer(s) proved to me on the basis of satisfactory evidence to be the person(s)who appeared before me. Signature r'x�) Place Notary Seal and/or Stamp Above Signature of Notary OPTIONAL Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document I Title or Type of Document: AQP I C a-�/ f � 7Z�Qo' - i Document Date: Number of Pages: Signer(s) Other Than Named Above: s .: ©2019 National Notary Association AFFIDAVIT IN SUPPORT OF FEE WAIVER RELATED TO HURRICANE IDA STATE OF kfb-) COUNTY OF /1 f_ r;� ,, (`1/U 3 `f-1 111GF&CP (insert name), being duly sworn, deposes and says 1. I am the applicant for a uilding Permit Certificate of Occupancy/Demolition Permit Electnca ermit/Plumbing Permit/Fence& Wall Permit Mechanical Permit/Pod Permit(circle all that apply) r 2. 1 am the legal owner of property located at -7 9 A � Rye Brook,New York(insert street address) OR I am the (Odekit.ect/Contractor/bnginoer afney) (circle one) for the legal owner of property 8ke)f alocated at �A AIJO �L ,Rye Brook,New York 1 and I am duly authorized by property owner D4 4"Aw to make and file the accompanying application. 3. The following is a description of(1)the work to be performed under the permit for which I am applying; and(2)how the work arose as a direct result of Hurricane Ida: VItCALU LEAL, Re,6ou4/on Z) k-')e 4. The work described herein arose as a direct result of Hurricane Ida and does not include Work which was not caused by Hurricane Ida. Sworn to before me this 77Z- 5a of �� 20 fir? Notary Public SHARI MELILLO Notary Public,State of New York Nd in we 6 pester IE C F V IE qualified In Westchester County Commission Expires January 29,2023 JUI. 1 1 20Z2 VILLAGE OF RYE BROOK BUILDING DEPARTMENT i tt ` � N N o W w � ti c LAo x �Ln ` F 00 0.4 T O v ' Qi � °� � '" F i Q rZ•+ � � O W O uz a cn o z OR W N ' w Ha U. w w °z " R' v A W � Q � z � o � i w a are � BUIL y� Eu MENT JUL 19 2022 VIL E OF RYE OK 938 KINGS ET RYE B NY 10573 VILLAGE OF RYE BROOK \� BUILDIIJG DEPARTMENT w or ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: EP#: �-I � �J Approval Date: JUL 1 9 1 Permit Fee: $ i Approval Signature: Other: Application dated, is leby 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 with all applicable Federal,State,County and Local Codes. //���� 1.Address: Iq A &06 clYrI f SBL: �3:�+7S"�"e�5�/ /'fit" Zone. 2.Property Owner: CE ; quo Address: Phone#: S S q Cell 4: ern 'I: h 3.Master Electr' 'an: ©��a G4tMte*1d x At 's Lic.#: G Phone#/n-'� ��jOG'f9 —, #: pail: — Company Name: GTc4 J tV e-AA[f /C Address: 4.Proposed Electrical Work/Fixture Count: f'6W 14 }- lam.� l 5.31 Party Electrical Inspection Agency: STATE OF NEW Y /K,COUNTY OF WESTCHESTER ) as: being duly swom,deposes and states that he/she is the applicant above named,and does further (print n e of individual signing as the applicant) p state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the l= 7L Pcri IV 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 to before me this day of ,20 day of TL'�-q ,20 Signature of Property Owner 9iina-ArLme o Af p Print Name of Property Owner rt Name f Applica I. Notary Public Notaibl c���E}te of New York No.01ME6160063 Qualified In Westchester County Commission Expires January 29,20� 623/2022 STATEWIDE • Service Willi litlegril.v 1:1 Main Street,Fishkill, NY 12524 1 email:office@swisny.com SWIS JOBAPPLICATION tel845.202.7224 • • 1•2 SWISNY.com I SWISTraining.corn Office Use Elect.Permit# /}� ` _ / Date L 2 Bldg Permit# r d Utility ID# Final Certificate# City/Village txq Zip Township County VYPSI� Address `) � � .f k Cross Street Sedioq-- ock � Lot Owner Nam(e/Address(If different than above) Contact Number ❑Basement ❑1st A. ❑2nd FI. ❑3rd FI. ❑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 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 IE C IE E JUL 19 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,H 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 Name Date -;,,Signature ft Address �,�. /� `'/ City/State F_ cl c l zip code a License# [ Phone# ECENE JUL 192022 , VILLAGE OF RYE BROOK AFFIDAVIT IN SUPPORT OF FEE WAIVER RELATED TO HURRI AW1 WAG DEPARTMrzNT STATE OF y COUNTY OF �— P0(il/k�l/'/ (insert name),being duly sworn, deposes and says 1. I am the applicant fora BuildingT t Certificate of Occupancy/Demolition Permit Ejed&l Permit'Plumbing Permit/Fence& Wall Permit a Permit/Pod Permit(circle all that apply) 2. I am the legal owner of property located at -74?A Rye Brook,New York(insert street address) OR I am the (Architect/Contractor/Engineer/Attorney) (circle one) for the legal owner of property located at , Rye Brook,New York and I am duly authorized by property owner4X'1)�1aJ1 D / T'� �r to make and file the accompanying application. 3. The following is a description of(1)the work to be performed under the permit for which I am applying; and(2)how the work arose as a direct result of Hurricane Ida: 4. The work described herein arose as a direct result of Hurricane Ida and does not include Work which was not caused by Hurricane Ida. Sworn to before me this-f D of �� , 20 Notary Public SHARI MELILLO Notary Public,State N New York No.01ME6160063 Commission ExpltresJanuary 29,20 g3 State Wide Inspection Services CAD 1080 Main Street Fishkill, NY 12524 a s 845 2 Phone To 914-219-119-1062 Fax STATE WIDE INSPECTION SERVICES 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: Grandview Electric Damiano Residence Roy Duckworth IV 79 Avon Circle, Unit A 87 Greenleaf Drive Rye Brook, NY 10573 Stamford,CT 06902 Located at: 79 Avon Circle, Unit A, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP22-146 135.75 15.1 Certificate Number: 2022-4146 Building Permit Number: BP22-119 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:79 Avon Circle, Unit A, Rye Brook, NY 10573 The First Floor Kitchen and Bathroom 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 14th day of September 2022. Name Quantity Rating Circuit Type GFCI 05 AFCI 05 Switches 06 Hood 01 Range 01 Dishwasher 01 Refrigerator 01 Microwave 01 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. s a i tn C,4 M N \ N N \ a a z cz IA Ln cl vi p wW v Cn , W P� Lncs �..+ O Z � Aw oLn Ow ~ -� � � A i' z r•a Ln 00 i O (� Lj� � `F� z v o, Q u 0-4 U u Z W A z � *"l z z N p a z A 5 ' Z V e x a m Z8 � z Z co 0 � . I 7LU BUILDING DEPARTMENT VILLAGE OF RYE BROOK VILLAGE_ O; RYE !BROOK 938KNG,STREETR,,,EBRoox,NY10573 BUILDING DEPARTMENT `\(914)939-0668 www.ryebrook.org PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP P. ��.�—I l 1 PP Approval Date: Z �-�— Permit Fee: $ A a1 yed_a, Approval Signature: C Other: Disapproved: \_ (fees are non-refundable) Application dated,7- I W 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 Federaall,State,County and Local Codes. 1.Address: ~/� GILD ! t [ b / Iq SBL:�J`J+ 7� �'`�S� Zone: 4- 2.Proposed Work: W f 0_h t-AJ, I&ITH 24E40 Z L)is :TL 14- />1 EUX I) 3.Property Owner: Fi_AA __DAMM�V- Address: 75 /1 A it oa 6 12t l e Phone#: lzc 2-C'S' 9-5 Cell#: 94Pv)t�- email: 4.Master Plumber: .�! _���� Address: f �f+ DFn 7.�'K Gfi = �t _ .$_2 Lic.#: l J "1 Ph•�one#: Cell#: `1�`t'75`5 I���email: P-4T+� �:nlx'.`'Z'p-MA-1 z..a, ` -t Company Name: 1 h� t- .'.;rd bc.' ;� � Address: I � Yi M _ r?r�i INDICATE FDCrURES&LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water I Urinals Drinking Sinks Showers Bath Laundry I Domestic Fire Sanitary NaturaU Other* Total Closets Fountains Tubs Tubs I Service t.Servicej Sewer LP Gras Basement 1st Floor !� 2nd Floor 3rd Floor I 40'Floor i 51 Floor i. Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next Z Pages) 8/12/2021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: :i e IA # (_.w 114E ,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 Sworn to before me this 40 day of ,20 day of �-l\ ,20 S*nature of Property Owner Signature of Applicant TE I N VI M Vqq \1 D Print Name of Property Owner Print Name of Applicant — at z- 1. Ll&, Notary�Public �1 Notary Pu�q6�ry Public,State of New York `( a t/ iT/t�l Y 1( (�(,/ L�(�i No.01ME6160063 Qualified In Westchester County Commission Expires January 29,20,23 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.Applications 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- sn2120zi BUII.D MENT Vu. 'OF R oOK JUL 2 0 2022 938 KING T R�(E B NY 10573 i4 939-0fi8Y VILLAGE OF RYE BROOK BUILDING DEPARTMENT eoia.+of ___ _ h *iF*F:F it it*k9t r.�'*k]tit*****it F aF*aF*intiC'k**:t it it***1Fit14**#i'lt lYlFit*it'.P'k]F]F k�!'ic'k�'F'ai'**�'iC k#*F***'A"R]Y'X*lkY#'k**1l�F tit lYtic]F'l'ktfY*'k'k�i�h]t 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: 1, T LA)-4 JDfkn1 ZAN Q ,residing at, A Aic*-- C�i'd c- (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; 9 A AV(,h4 C i V_"t � ,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. (S' of Property Owner(s)) T-r- P) N -D0MIAN6? (Print Name of Property Owner(s)) Sworn to before me this day of ,ZO-i� (Notary Public) _3- gn=021 JUL 2 0 2022 VILLAGE OF RYE BROOK BUILDING_ DEPARTMENT CALIFORNIA JURAT GOVERNMENT CODE § 8202 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of California Countyof(saptc/L Lkm- Subscribed and sworn to (or affirmed) before me on QOZ'OZ saj.dx3 wu�o� (luno�e�el�etueS l y I 2 by z this ` day o �`` x elu,olyeo- aggnd ARION go M z Z8Z£LZZ# 'WW00 Date Mo th Year SNWA3 IWW3 D av `�y�1 CANT EVANS o COMM. #2273282 z (and(2) ), Notary Public -California A Nome(s)of Signer(s) Santa Clara Counq t%71*Comm. An.20,2023 proved to me on the basis of satisfactory evidence to be the person(s)who appeared before me. Signature Place Notary Seal and/or Stamp Above Signature o otary P is --- OPTIONAL -- Completing this information con deter alteration of the document or fraudulent reattachment of this form to on unintended document Description of Attached Document . �Q r Title or Type of Document: Document Date:.—? l —a Number of Pages: Signer(s)Other Than Named Above: ©2019 National Notary Association D FCE ,i- D�) JUL 2 0 2022 VILLAGE OF RYE BROOK CALIFORNIA JURAT BUILDING DEPARTMENT _ GOVERNMENT CODE § 8202 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of Califorrnia,.� t4Countyof 5ft Subscribed and sworn to (or affirmed) before me on '� this day ofC) , 20�ay Date Month Year Dapil k Qjj CAMI EVANS (and(2) ), p COMM, #2273282 = z Notary Public •California o Nome(s)of Signer(s) Santa Clara County Comm.Expires Jan.20,20231 proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. Signature Place Notary Seal and,%r Stamp Above Signature of Notary Pu lc OPTIONAL Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document Document Date: 7 —`/ (0 -a-tNumber of Pages: Signer(s) Other Than Named Above: ©2019 National Notary Association AFFIDAVIT IN SUPPORT OF FEE WAIVER RELATED TO HURRICANE IDA STATE OF ! Vbv 1) �'C,r V- COUNTY OF (insert name),being duly sworn, deposes and says 1. I am the applicant for a Building Permit/Ce ificate of Occupancy/Demolition Permit Electrical Permit Plumbing Permit Fence&Wall Permit Mechanical Permit o ermrt(circle all that apply) 2. lam the legal owner of property located at A Rye Brook,New York(insert street address) OR I am the (Architect/Contractor/Engineer/Attorney) (circle one) for the legal owner of property located at 9'1 ��1 e,-n C�a ��z ,Rye Brook,New York and I am duly authorized by property owner,\,'SCC to make and file the accompanying application. 3. The following is a description of(1)the work to be performed under the permit for which I am applying; and(2)how the work arose as a dpirect�resul�t of Hurricane Ida: L-\,-,CCry r C-.�6 4c�-d ck-"�C-tem 4t ifty "k '-j coo k . 4. The work described herein arose as a direct result of Hurricane Ida and does no include Work which was not caused by Hurricane Ida. Swom to before me this _ Notary Public SHARI ME of C ( 1�S Notary Public,State e of New York l� L No.O1ME6160063 Qualified in Westchester County Commission Expires January 29,223 J UL 2 0 2022 VILLAGE OF RYE BROOK BUILDING DEPARTMENT C� Building Permit Check List&Zoning Analysis A- ( 1 Address• 1 kQC� C\ c C e- SBL: Zone: P v• Use: Z k b Const.Type: Other. s Submittal Date: Revisions Submittal Dates: Applicant:Nature of Work Y`l 1\ �r C\ecb ?Qs—vgYq 3n Ox-o Reviews:ZBA: PB• BOT• Other DEED Q( o,%v� �� FEES:Film `�) ( ) g BP: C/O: Flood Plane: Legalization: ( ) (vYAPP: 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 Comp: Liability Comp.Waiver. Other. ( ) ( ) CODE 753#: 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: Other. ( ) ( ) Other. ( )ARB mtg.date: approval:- notes: ( )ZBA mtg.date: approval• notes: ( )PB mtg.date: approval: notes REOUM EXRMNG PROP Dt, `l `� F-rontage: Front Front Sides: lr Main Cor. Accs.Cov: F S Sd,H/Sb SFA_ Tot,Im : Pr H"g Stories: notes: ro � '� 111i41i11 _ 1y1i10i'1 �t§ a 1y1i41i'1 ` ,•E .1111i11/i'1 ,D= i y111/11111� 14/i41i'1.._1 +t111/1111►p �ie3 nw �/(!)�nn� �I►IIII'--tea'-`•rt :'is;.t11I111.: ::r sv_111I111:•,v.r�'zzo.: .111I111 s ::'IIIIII:::vc.=s' s::'11II1' rri:r. 33�.'►IIII'>^•' ::`i�i��0)>� b o NY. y7afuu co «s +' fi 3 L > O Qr CV Fmp C _ d u U e•. � 0 Fy G. M wo cn CD W-4 cat..-_ ��11 lip YOB VOI �IAIh<c W, � � � � Q Z U a \o eCtian I •.r- `: U W Q U 3 yw 0 y Q Ri y0 r ���• s$i ,lamol = Q O �pdaa . .r ,.r y co r x _ � Gam' • C O (6 n. e`a O O O Z N f rn O ;. On rA rA ?f O)>Anx - :.• ripe: �s ali �0)) / ''� A t 1111♦111•c 1t1 A � ,Ic♦1•1' s I111l 1I/11I1:FM A s -r1 t1,l1cl1i11cl1l 1t 1 i 1I1I11I1I//1c11 1t1 is. ._r 1t1,11c11Ic11c11 11 y •mil ..�y,St u 10. 1.1 s A s ' •♦ f is s •♦ f A �' /7 v ' & DATE(MM/DDIYYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE llli- � 1 06/22/2022 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 CONTACT NAME: Arica Corrin Rosenstrach ARICA'S INSURANCE PHONE (518)320-8210 F't'x No: 518-32"207 209 FAIRVIEW AVE E-MAIL ADDRESS: aricaC aricasinsurance.00m INSURE S AFFORDING COVERAGE NAIL# HUDSON NY 12534 INSURER A: DRYDEN MUT INS CO 13919 INSURED INSURER B: _ Chris Fitzgerald Inc. INSURERC: 1 Landmark Sq Apt 603 INSURER0: INSURER E: Port Chester NY 10573-3385 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 INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY M IYYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 2,000,000 To CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ 50,000 _ MED EXP(Any one person) $ 5,000 A X CFT00097660 02/10/2022 02/10/2023 PERSONAL&ADV INJURY E 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 XLOC PRODUCTS-COMP/oP AGG S 5,0oo,00O POLICY❑JE'COT OTHER: $ AUTOMOBILE LIABILITY COMBINEDt SINGLE LIMB $ Ee acciden 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 t $ L UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ ... RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/E)(ECUTNE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If as, describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is included as additional insured CERTIFICATE HOLDER CANCELLATION Village of Rye Brooke SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 938 King St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brooke, 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 STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name& Address of Insured(Use street address only) lb. Business Telephone Number of Insured 914-703-5540 CHRIS FITZGERALD INC c. NYS Unemployment Insurance Employer 26 AULDWOOD RD Registration Number of Insured STAMFORD CT 06902 Work Location of Insured(Only required if coverage is specifically limited to certain locations in ,New York State, i.e., a Wrap-Up Id. Federal Employer Identification Number of Insured Policy) or Social Security Number 13-3616317 2. Name and ,Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) VILLAGE OF RYE BROOK STATE FARM FIRE& CASUALTY CO 938 KING STREET 3b. Policy Number of entity listed in box"la" RYE BROOK NY 10573 98-CR-0091-6F 3C. Policy effective period: 12/01/2021-12/01/2022 3d. The Proprietor,Partners or Executive Officers are ILA11excluded luded. (Only check box if all partners/officers included) or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "Y' insures the business referenced above in box "Ia" 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"T'. The Insurance Carrier will also notify the above certificate holder 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. Please Note: Upon the 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 1 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: CHRISTINE AJOR (Print n e sut rived reprksentative or licensed agent of insurance carrier) Approved by: G- • 06/22/22 (signature) (Date) Title: AGENT 0- Telephone Number of authorized representative or licensed agent of insurance carrier:_(914)835-6000 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.