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HomeMy WebLinkAboutBP22-120PERMIT # QL SECTION TYPE OF WORK JOB LOCATION _ OWNER =0 CONTRACTORS EST. COST vo60 # TCO # — A) Q DATE: ,-) c� p(p; 7 BLgCKT'T. OT J kmol.ie ,��o s /y C139-4Y1/<'5 _ FEE ,&.� 1O� 7-)06 FEE4 c 035: /Oo DATE FEE DATE INSPECTION RECORD I DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION Z PLUMBING RGH PLUMBING GAS CI SPRINKLER ELECTRIC LOW -VOLT 0 ALARM 0got> AS BUILT op FINAL w " v OTHER APPROVALS ARB BOT � PB ZBA OTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 23-014 Certificate of ®ccupaucp Ehis is to certify that �./b �(�PJ� LQ(,� �/ ZQ/7 U Pf Of, �✓�� S.&On y having duly filed an application on JQ�L{G{�l/ -,, 20-s2,3-requesting a Certificate of Occupancy for the premises known as, ,l�or��es�eI^ Z Ve' , Rye Brook,NY, located in a JQ-/5 Zoning District and shown on the most current Tax Map as Section: J Block: / Lot: !q -- and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. a-� , issued 1 20 o7a; 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: - - n(, , Construction: , for the following purposes: WCri 0Y 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 height shall be made,nor shall the building be moved from one location to another until a permit to accomplish such change has been obta, o Buildi g pec Acting Building Inspector,Village of Rye Brook: Date: J AN 2 e 2023 BUILD AA ,MENT For office use only. PERMIT# - t=)0 JAN 10 2023 VIL „ OF RYE OK ISSUED: `7-J 3H KING STRE1''l'11 YE Bt+QOKt jW YORK 10573 DATE: /-/C VILLAGE OF RYE BROOK ` FEE: A 1�3;5 PAIDJSt BUILDING DEPARTMENT 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 ssrrrr►•rrarssssa►►assasass►sarwssrwrrrrrrrrrrsararssaasssra►ss►s►•ssss••rwwrwrrwrsrsrarsasaraaraaa►ssrssss►sss►sss►wsss►rwsw Address: cT b o ,v Ch c-s4T b 6- `-U e 5CQ6 K . N IDS 73 /►=Anti Occupancy/Use: j�es1 d e nc a Parcel ID#: /c)9, & 7- / y Zone: Owner: Lu c r i e r jo�n L a►i As Address: q Jo a6ieS4 r br P.E./R.A. or Contractor: S.0 -F P4±4:q� 63!!p_Address: Z6 /21) Person in responsible charge: �gv�+6s -F"rwLt Address: 606 44-e4 .,*xmw 2 o A-ROSirv, 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: C L gt u r i G L 4 r, Cl rS being duly swom,deposes and says that he/she resides at -I b6 R Gh es�e r (Print Name of Applicant) (No.and Street) in Rv e P P-n d K ,in the County of 1' in the State of ,that I- (City/Town/Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:S _ R c O, to , for the construction or alteration of: k J c he n 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. Swom to before me this Sworn to before me this day of n , 20_a day of , 20 Zr 1114 Al Signature____of Property Owner Signature of Applicant eau rle La ryes Print Name of Property Owner Print Name of Applicant ��17.i v(fv Notary Pub' Notary Public CaRLGaRY M.RNERA Notary public,State of New York No.01 R"139a s/12/2021 Quali W In Westchester County ComrmissloaEgyes September 26,20 QyE 4Ra? O� 2m '9a2 BUILDING DEPARTMENT UILDING INSPECTOR tt 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 : Duv� DATE: l 1 L� (-26�3 PERMIT# 2Z ISSUED: SECT: ! BLOCK:_ LOT:' LOCATION: \" ` �`� `(�1(� `�11 �C��(� �CC OCCUPANCY: (U ❑ VIOLATION NOTED THE WORK IS... P ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION fY EQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING / ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS �QC. cz-� ❑ L.P. GAS n c�vcis ❑ FUEL TANK ❑ FIRE SPRINKLER NC� C V ❑ FINAL PLUMBING ❑ CROSS CONNECTION [i FINAL 'OTHER QyE BR(Zjk O� 2m cu � '9a2 BUILDING DEPARTMENT ❑BUILDING INSPECTOR XSSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : ( C S;� ` DATE: ' \ ' PERMIT# 1 ISSUED: XS ZSECT: BLOCK: LOT: LOCATION: N l� eC§CJ1 (f::Z OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P.GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER O N Ncqh = w N oc a� u : v �j rya y o v w a w CZO x a ao P. 14 a to 0. v A o p 3 � (Sn 1 r f m O ' V ° O agaCU A • a a ° ' 4 " 8 rJ y V Syr Rt Q d d o PLIW „� M G'' O W o . (41a vcs t; j A co u►� Ln zaoa `° 8 W V O A O wv � 6V ~ a O � N A q c� u a H O C3 A4 v z (> En Q 1 N ad Q *%%j ° J, _ 00 W O�4 vo5b a. W 1 v C b v cy Fa e H O O O N 0 wti gi !z Q O qo W a V H p z pS _ J _ M O U O V z 96,119 z W W O d .Y � CIS p 8 0 � A z x b .� A4 u 6 pE" •y y ,a .�" BUILDING DEPARTMENT VILLAGE OF RYE BROOK h JUL1 1 2022 1 938 KING STREET RYF,BRoox,NY 10573 - ____j (914)939-0668 VILLAGE OF KYE BROOK BUILDING UILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Approval Date: #: 6;4� — /C>0 J UL 1 3 2022 _P c Application Fee: $ Approval Signature: Permit Fees: $ Disapproved: Other: Application dated: is hereby inade 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. 1. Job Address: ac 0 S-7 ct?_ -/6 SBL: A)�,,lo 7 q Zone:./('),S 2. Proposed Improvement.(Describe in detail): ___( I.�C �� C A-�et n,e ti &,),ALL -7 6 Ize,v,o-c"� cm- 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 11: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an existin r tomatic fire suppression system(Fire Sprinkler,ANSI,System,FM-200 System,Type I Hood,etc...) :No: k" Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 5. Occupancy;(I fam.,2 fam.,comm.,etc...)Prior to Construction: k f�..\y After Construction: 6. N.Y State Construction Classification: N.Y.State Use Classification: 7. Property Owner:Zlujur- -f Address: CJ t6 9CS-rV V_ Phone#_?_/� 132-246E Cell# ///-/ 5'92, - 72/4—email: 8. Applicant: -Address: Phone# Cell# —email: 9. Architect: Address: Phone# Cell# email: 10. Engineer: -Address: Phone# Cell# 11. General Contractor: Address: LE124-10e(47 di ?( P Nq--M/:S-70CIL(Phone# Cell# q 114 email: :Sn r-C,,TAoL4c-!t,1 I(' a 12. Estimated cost of construction $ a-7 6�0,0c) C-1 *l�L', CeZ,-4 (NOTE:The estimated cost shall include all labor,material,scaffolding,fixed equipment,professional fees,and material and labor which maybe donated gratis.) 13. Job Timetable: Start: —IC6 tc - Finish: CAROLYN MARIE CANNISTRARG, Notary Public-State of New York No.01CA6177080 Qualifled in Westchester County 811 212 02 1 My Commission Expires Nov.5,2023 BUILDING.RE,PARTMENT J J VILLAGE OF RYE BROOK JUL 1 1 2022 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF- RYE BROOK .r a BUILDING DEPARTMENT ►+.*wwwwww*w*•wwwwwwwww,t,tw,twwwwww,rw*wwwwwwwww**,r,r*wwwwwwwww,t*,rwwwwwwwwwwww***ww**wwwwwwwwww**ww**wwwwww 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 SU1i1MITTED 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: ^ 3f, L a u ri e L G nc�e5 ,residing at, t�(� red e6�C' D l te— RI e ejrow (Print name) (Address where you live) N Y 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; 174 rC I'1 eS -e r D 1 ye" , 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. (Signature of operty Owner(s)) LeLAr1e— LCinde'_S (Print Name of Property Owner(s)) _�1Sworn to before me this � — CAROLYN MARIE CANN15TRARC Notary Public-State of New York f ,20 2— � No.OICA6177080 clualifled in Westchester County My Commission Expires No a.2U23 otary Pubb (2) 8/12/2021 This form must be properly completed &notarized by the Design Professional of record and the Property Owner. Failure to provide this completed form with your permit application will delay the permitting process. J U L 1 1 2022 Notice of Utilization of Truss Type, Pre-Engineered Woad or Timber Frame Construction. (Title 19 Part 1264& 1265 NYCRR) ,D�i�i�.=, r)FIaARTI`,"ENT To: The Building Inspector of the Village of Rye Brook. From: L O u r►e, L G r-N d es Subject Property: q _N eCirl- 34c f D ir SBL: Zone: Please take notice that the subject;W One or Two Family; ❑Commercial, ❑New Structure ❑ 6ddition to an Existing Structure ehabilitation to an Existing Structure to be constructed or performed at the subject property will utilize; ❑ Truss Type Construction(TT) ❑Pre-Engineered Wood Construction(PW) ❑Timber Construction(TC) in the following location(s); ❑ Floor Framing, including Girders&Beams(F) ❑Roof Framing(R) ❑Floor Framing and Roof Framing(FR) Please note that prior to the issuance of the Certificate of Occupancy, the subject dwelling or building utilizing truss type, pre-engineered wood, or timber construction must be posted with a Truss Identification Sign, installed in conformance with NYCRR §1264 for Commercial Buildings, and NYCRR§1265 for One&Two Family Dwellings. Sworn to before me Sworn to before me this day of ,2 "� day of ,20 Si a e of Property — ! — Signature of Design Professional L�t t t fP" ' lac Vl Gtc� riot Name of Pr erty Owner Print Name of Design Professional t1 � � Notary lic Notary Public CAROLYN MARIE CANNISTRARO Notary Public-Stale of New'v'ork No.OrCA61770130 CA LYN NIAf21E CANNISTRARO No ary Public-St• f New Yurk Qualified in Westchester Colin!" (3) CA6177080 My Commission Expires Nov.�5.2023 Qu ed in Westchester County My C Sion Expires Nov, `,.2023 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: '1— a>-t t fi L a n d t'� ,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 w le� Co n WZ AC T l ad� for the legal owner and is duly authorized to snake and file this application. (indicate architect,contractor,agAlit,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. Swor2br me this Sworn to before me this day o ,20 Z Z day of , 20 Signafde f Property Owner Signature of Applicant Print Name of Property Owner Print Name of Applicant Ac ILXt.rr�� Notary Pub' Notary Public CAROLYN MARIE CANNISTRARO Notary Public-State uI New York No,01 CA6177080 Qualified in Westchester County My Commission Expires Nov.5.2023 (4) gn212021 N N o w N � N "o W r a u �t �wwi w V rK .N � W o � � H ot) H FBI M W �^ O � W O °° � o /y� N 0 L 6. z a o x � � < U a M v � o N A00z � \ s M � u z z Z z W M a ° < O it A - a c W V 1 a _ w � .4 w s x Z o a z N it H W H a Z o z a W " � ° s O o w z w g6 W W ° z A o � a w a a °� D C i �yER��? � JUL 2 7 2022 BUILDING DEPARTMENT VILLAPE OF RYE LOOK VILLAGE OF RYE BROOK 938 KING ET RYE B ,NY 10573 BUILDING DEPARTMENT or ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required +� FOR OFFICE USE ONLY BP#: ��~ 1'1° EP#: Qd J JUL 2 7 2 J Approval Date: Permit Fee: $ Approval Signature: Other: Application dated, is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/or remove electrical equipment,wiring, fixtures,or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all f(appplicable Federal,State,County and Local jjCooddQes. 1.Address: 00 RChf L�7e=2 olz/ ✓e SBL: 09- 67 —/—4 Zone: 2.Property Owner: ' 0 H r.t (,A n! IP FS Address: S A M(� Phone#: (9jg 31 " F4 81 Cell#: email: /� 3.Master Electrician: tit Cll Act 7 Y 2d Address: 71 nR t A X 8 eAA C (b JTA M FO2-6 C7 00 Lic.#: 13 I3(o Phone 403)' 7fi -/�l SS Cell#:(q y)87 9- �3` o 7 email:ArA�[�'lG e- 0 eP70N e.jnJ b. AFT Company Name: A 1 A EL�TtI C- Address: sA� Pl a 4.Proposed Electrical Work/Fixture Count: � 1' ksr <1-rcui E�� f/�ts.-JO U^?/O L 6#TS 0 u iJ-,.✓AS Ifea R e F(z,G Ei2 A702 0 ve/4 Co ox-To /-j CEO.) AeA co,J,/I ^/e-F O(17L f>� 5.3'Party Electrical Inspection Agency: ********************************************************************************************************* f�,�STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: I I IC JA AC IQ,( `r being duly swom,deposes and states that he/she is the applicant above named,andZ ther (print name of individual signing as the applicant) \ state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the Q g i ;Te A .) for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attomey,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 b re me this vZ day of 20 day of 0. Signature of Property Owner S M Applicant A&L Print Name of Property Owner NnjName of Applicant Notary Public Note tSte of New York No.01ME6160063 Qualifled In Westchester County Commission Expires January 29,202-3 6/23/2022 • STATEWIDE INSPECTION Service Willi liilcgri�v 1:1 Main Street,Fishkill, NY 12524 1 email:office@swisny.com SWIS JOB APPLICATION tel 845.202.7224914.219.1062 1 SWISNY.com • • Office Use Elect.Permit# \ / C4 Date 71. LgV Bldg Pr,ni # Utili ID# Final Certificate# City/Village 9 S Oo Zip o S 73 2 Township County Address G�C ' Cross Street -/ Sedio 6 Block Lot Owner Name/Address(If different than above) \ l ,� N D� Contact Number 9 ❑Basement 0 1st FI. 2nd FI. J❑3rd 4. - -C]More Than 3 FI. ❑Garage ❑Attic ❑Outside JaResidential O❑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 K�7ctM&J IECIEME JUL 2 7 2022 VILLAGE OF RY= 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,Hat any time of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional Hems inspected.The applicant declares that there is no open applications for the above address with arty 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 A rA z ! Date �7 Signature . Address R io A/l Ads ,, City/S� A Ft Fo k i) G7 zip c v 7 J License# / Phone# 1c1 579- CI State Wide Inspection Services C� 1080 Main Street Fishkill, NY 12524 845 202-7224 Phone a 914-219-1062 Fax STATE WIDE INSPECTION SERVICES Email: ofFce@swisny.com Website: www.swisny.com Service With /nregrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: ATA Electric, LLC John Landes 70 Briar Brae Road 9 Dorchester Drive Stamford,CT 06903 Rye Brook, NY 10573 Located at: 9 Dorchester Drive, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP22-152 129.67 Certificate Number: 2022-7200 Building Permit Number: BP22-120 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:9 Dorchester Drive, Rye Brook, NY 10573 The First Floor Kitchen 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 28th day of October 2022. Name Quantity Rating Circuit Type Receptacles 08 GFCI 03 Switches 04 Cooktop 01 Oven 01 Dishwasher 01 Refrigerator 01 Microwave 01 Luminaires 18 Officer: Frank 1. 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. ■, O0 Nam, ■ a 00 ,� H a a o ►0 wi H a z z x a CQ Z Ln O � � Z a s � o tin A � ` Ln 0 V O C� w r! a A c0 0 a , U h� A M H < GN � 00 Z o A ` W C � r Z Z , cn O Z u 8 W w r V v w a z a ° ` O V a a � °` x • A z z A o � O a w A a ° a �I as a 041 MI 441 = i' D LCD��' '� r^ BULL DEIAR MENT AUG 19 2022 f�fJ VIL E OF RYE B' OK VILLAGE OF RYE BROOK 938 KIN ET RYE BR ,NY 10573 BUILDING DEPARTMENT (914)9 6 939-5801 o .or PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY AP#: :may'_/C_=')_0 PP#; �i/ow Approval Date: AUG 1 9 11 Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated,!j�-/0-d is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/or remove Plumbing as per detailed statement described below. The applicant&property owner,by signing this document agree that said plumbing work will be in conformance with all applicable Federal, State,County and Local Codes. 1.Address: SBL: L 3 /p, 6 7 q Zone://S 2.Proposed Work: A t to 3.Property Owner: 4�©h .1 �...►� �}ol(� i Address: Lt( `y (, - +r1 (�t� Phone#:' 1y-q 3 S- Srµq Cell#: email 4.Master Plumber: ' o ' Address: lop- I-App Lic.#: An' `i/b - �'[/ d1I ! �-c%� 3 j email: rR�v►} cZOLI Company Name:i ,��r} �{ e7 �., n�c1 r Z f-I t t l I'vc Address: 3 MAi.j.Z C e &2 L l INDICATE FIXTURES&LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Other* Total Closets Fountains Tubs Tubs Service Service Sewer as Basement 1st Floor oiS P% _d) 2nd Floor A 3 Floor 41 Floor 5 Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -1- 3/21/19 STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: Lazf, —I Awk2 S ,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 L,Zt 6—— 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 /M/l Sworn to before me this // f4 day of G✓I, 20 Z Z— day of /�VG 1')� 20 Z Z Signatire of Property Owner Signafure Ckpplicanf Print Name of Pro Owner P�h' Print Nat a of Applicant NOtdYPUbliC J.DAVID-1W1\IVA 'lo Public No.01 NA6067123 A D NANNA Notary Public,State of New York No.01 NA5067123 Qualified in Westchester Cou91 ,/ Notary Public,State of New York My Commission rxpirea (.�11/2 :_ Qualified in Westchester Cour y 6 My Commission Fxaires _ Z 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- 3/21/19 BUILD DEP MENT VIL E OF RYI'� OOK AUG 1 9 2022 938 KING SET RYE BRooK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 (914)939-5801 BUILDING DEPARTMENT ww ok. r AFFIDAVIT OF COMPLIANCE VILLAGE CODE U 16 • 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: , residing at, ct 60CCkeS4 bt (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; Z�)C \ Je— �� � � �GJK � Ny l �s `73 , 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. (SignaturolofProperty Owner(s)) L-a Y\4eS (Print Name of Property Owner(s)) C, Sworn to before me this /Z day of Il G v o'i , 20 Z (Notary ublic) J DA\/lD N/NNNA No.01 NA5067128 Notary Public,State of New York Qualified in Westchester Cou ty_ My Commission Expires Z.— -3- 3/21/19 C1 w -Building Permit Check List&Zoning_Anal�si`s Address: �� C��(�-'S�e�- SBL: - Zone: - S Use: Z C o n s t Typed Other. Submittal Date: "l` kk Z Revisions Submittal Dates: Applicant: \ Nature of Work -C C't (� ` 'I-C (L2-'6 01�GA ��l Reviews:ZBA jut M2 PB: BOT: Other. NEED OK /� �� LP FEES:Filing. BP: � C/O: Flood Plane: Legalization: APP: Dated Notarized:- --_ SBL —T.I.D. Cross Connection H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Stone 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: mp.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: REQUIRED EXISTING PROPOSED NOTES APPROVED Au: Date;. --- FronWe Front Fro= Sides: R Main Cov: Accs.Cow F H S S .H Sb: To— Ft.In' HHight/Stories: notes: ���'���� .�8 :.t'-"-db�''""fir.;�,-s�",�'�A��^•I�-�+r �-f�.a n•-�"�"�Nr��..a. •,,�`'��' ""`: 1 _� r •S � i• } ro 1, �� t 1y ` ;.'�. � }�;p�( �''R. ���c� 'ram+•��j�; '^rU � '�L' ��.T .'u�F ;�� .'� 1 ► yR?4 a-x�lF. .�a1�i .it%..�r1�{' ems': .a';•'$t.' �: ..i,::t: � : t_ vet' F''�N• ��•. � _iLti i�i�?l� +��7 I .._ ._____ _,_ -_ ......_. Y.):YY.'.CfX.•fYX%%7CA7.^+... � 1P11 N'.I. f, y� 75 gy ' .� fY ❑ `o lo EL 0 AW 4. As 'L` .i.,►. • � � rr III @ ^_ --� � (�••_ v : :.i IX �4 :S I L^ H W CC J O z _ � . Wmd ty „ ,9S!fWb: { r — i15 .S ,dmd +d T co du r' -r ► J W 'L`LYSv_�YYY.?_�"YS�_Y-.Y.Y.Yr"1L.'L'LY�Y�^2"Y" YY7. ^^v��7t��.YY%YY.YYY"LYY%l"X%, t• �'`�' ot.. �, xxrrsxxxx "4' _. �''�"s d� .itti•.�} 1� i����y'i4 J{ �' Y ..1 � �y�� 3� ���� t i y ����•,f(� ��}"'r "p' A ' '.•'%lam VOL +'.'�5��' .!:a'�{� T�`� ''F ! ����?'i'4�1 r� �} �j�i!•A�. .i#��y�' iP✓i�.il � a�.',t.�YwYR . .�� .Ar-.3' V y,..t` " .�_Y_C '�'' r. '•y �. r.}} ��, •w4r �,. DATE(MM/DDYYY) A�o® /Y CERTIFICATE OF LIABILITY INSURANCE 7/11/2022 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: Janice Caldararo John M.Glover Agency PHONE FAX Insurance Services :914-829-9077 ac No:203-274-9471 P.O. Box 700 ADDRESS: jcaldararo@jmg.com Norwalk CT 06852 INSURERS AFFORDING COVERAGE NAIC0 _ License#:PC-9047 0 INSURERA:Southwest Marine&General Ins Company 12294 INSURED JNFCONT-01 INSURER B:New York State Ins.Fund 4029 J.N.F. Contracting Corp 66 Heatherdale Road INSURERC: Ardsley NY 10502 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:687512276 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. LPOLICY NSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMMD/EFF MMMD EXP LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y GL2022RLHOO199 5/12/2022 5/12/2023 EACH OCCURRENCE $1,000,000 X OCCUR RENTEDi DAMAGE TO CLAIMS-MADE PREMISES Ea occurrence $100,000 MED EXP(Any one person) $5,000 PERSONAL 6 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY E T LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident. _ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident 1 L E A UMBRELLA LIM X OCCUR EX2022RLH00018 5/12/2022 5112/2023 EACH OCCURRENCE $2,OD0,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $2,000,000 DED RETENTION$ $ B WORKERS COMPENSATION W13265293 7/20/2021 7/20/2022 PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $100,000 OFFICER/MEMBEREXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Re:9 Dorchester Drive Rye Brook,NY 10573 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Village of Rye Brook 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook, NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26(2016103) The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 0 � ^^^^^^ 223567582 JOHN M GLOVER INSURANCE AGENCY PO BOX 700 NORWALK CT 06852 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER J.N.F.CONTRACTING CORP VILLAGE OF RYE BROOK 66 HEATHERDELL ROAD 938 KING STREET ARDSLEY NY 10502 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W 1326 529-3 977690 07/20/2021 TO 07/20/2022 7/11/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1326 529-3, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. JAMES FARRELL-PRESI DENT FRANCES FARRELL-V.P. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STAT SU NCE FUND TT �/ DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 747417804 U-26.3 ' __-k-__ . __ __- ' - -_—_'- -- --- --- -- --- ' '-� �- ------- -- ' ' -- --- ---- --- ------� . . 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