Loading...
HomeMy WebLinkAboutBP22-127PERMIT#A&e SECTION / TYPE OF WORK JOB LOCATION _ OWNER DATE: i �� D(P: ol/ 0l3 r _ BLOCK LOT XIC a137Y�14C>f%a� 4/.0 3�- EST. COST �t9 FEE tiS -- L� v/CO #Cw;CFEEW J5 r Pb 4 9�9DATE TCO # FEE DATE tNSPECTlON RECORD DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING O RGH PLUMBING GAS L7 SPRINKLER ELECTRIC O LOW -VOLT O ALARM O AS BUILT FINAL INSP tJ' QocD4:;)3—�►�70 OTHER APPROVALS ARB BOT PB ZBA BA s CC�L�oa J J V G u�u++vy � g 19 ¢0' an/Zllfl�1lACrW VILLAGE OF RYE BROOK MAYOR. 938 King Street, Rve Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.ryebrook.o&g TRUSTEES BUILDING& FIRE INSPECTOR Susan R.Epstein iNiichael J. Izzo Stephanie J. Fischer David M.Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE August 26,2022 Anne Rossmann 17 Pine Ridge Road Rye Brook,New York 10573 Re: 17 Pine Ridge Road, Rye Brook,New York.10573 Parcel ID#: 135.41-1-41 Building, Permit#22-127 issued on 7/21/2022 for New Replacement Windows This certifies that the new windows,installed under the above captioned permit have been satisfactorily completed. Sincerely, Michael J. Izzo Building&Fire Inspector /to BUILDWi 1_Wi TMENT For office use only: AUG 2 4 2022 VILLAGE OF RYE BROOK PERMIT# ISSUED: — a 938 KING STREET,RYE BRom,Ntw YoRK 10573 DATE: VILLAGE OF RYE BROOK 9I4 9 BUILDING DEPARTMENT ( ) 39�-0669 FEE: )IT /)o — PAEDU - WWW.rvebr©ok.arg 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 ■\►►I►►t\\1\\►►f►►►►tttt\►►►f►►►\\\iti►it►►t►t►\•t\t\ii►►►i►►►►►\\\ii►ii►►►►tttt\tiiiti►►I►►►►►\►►ttt\\\t\►i\/\►tt\\•i\\\\ii\ Address: P, IJfoo( IV Y 105:tS Occupancy/Use: "Parcel ID#: z// --/— -Y n Zone:/n�- Owner: Anne ROSSI'1nLl nn Address: 14 Pine ►C /C n/y P.E./R.A.or Contractor: it h NQFb A Address: k -rJd os Person in responsible charge: Address: 3/ 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: /� S. (u)V!o'.,D N I?�O being duly sworn,deposes and says that he/she resides at�L ki 6�ct A k'"Aoe 64w—ro; r (Print Name of Aplplli'ennt) l (No.sd Street) �. in C�19 5� ,in the County of e I in the State of��,that i (tity/Town/Village) 4 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 equipm t,p fessional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$ O®O for the construction or alteration of (iV 1W&.0Ws' 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 SwQm t me this day of fil 20 /-7, day of t) , 20� Signature perry Owner Si f cant Print Name of Property Own t e of A licant is CLAUDIA UVALDO NOTARY PUBLIC,STATE OF NEW YORK IRIAM P GOMEZ NO.of STCHESTE Notar Public, State of New York s/12/2021 QUALIFIED IN WESTCHESTER COUNTY COMMISSION EXPIRES APRIL 12,2024 Reg stration #01 GO 078 02 Quali ied In Westche r C unt Cmmn fission Expires �E BRC��. cu � 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 1 (914) 939-0668 FAX (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - �1VINQ- - 1- - ADDRESS . '` ATE: PERMIT# ISSUED: ' SECT: y 'BLOCK: ' LOT: LOCATION: !1 n�� OCCUPANCY' 22w ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION C 2 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 _Y ROSS CONNECTION FINAL ❑ OTHER x N CZ a+ R"1 \ N W u N w WW Cd O o M r"r Q z 0-4 to uz. ►� 0-4 N Q w � ti o O 3 U Ca N u 1� 'Ono �/ z ° w W (� W � U z N � N A Awb u = Z r O M M U z o a y z N w 0 �n F A Q ai ev rt) Ln O '� w Quo Qu O ON Wcn Cam• Gv p'��' ?/'��I = (�] 9 y 41 0 rr w u = H Ur p Wes; c!) v � vn+ cc A Q V �� o � W o v v U U z V w v o oA # � CL z BUILDING DE MTMENT VILLAGE OF RYE BROOK R JUL 19 2022 938 KING STREET RYE BRoOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK WWvo , BUILDING DEPARTMENT 19t32 ADMINISTRATIVE EXTERIOR BUILDING PERMIT APPLICATION FOR EXTERIOR WORK WIEIICH DOES NOT REoum VILLAGE ARCHITECTURAL REVIEW BOARD APPROVAL FOR OFFICE USE ONLY: _ APPROVAL DATE: J U L 1 g 7 22 PERMIT#:,UQQ 6 —I c) _ ' 7� APPLICATION FEE: APPROVAL SIGNATURE: PERMIT FEES: & H.O.A.APPROVAL: DATE: DISAPPROVED: OTHER: rt**wwrt+wwww*wwwww*wwww*+*ww+++rt++w++wrtw++*+w++w*w+w*wwwwwwwwwwwwwwwwwwwwwrtrt*rt*rt**rtrtrtrt++w+ww*ww++*w**w****** Application dated: •7`1 is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the construction of buildings,structures,additions,alterations or for a change in use,as per detailed statement described below. 1. JobAddress: Al {i►1¢ &A,n Rpal (11,0 &CA I 2. Parcel ID#: Zone: 01 3. Proposed Improvement(Describe in detail): Neg) _IAj6ft a015 - b o Qllib Whum J 9°al e 6 rug n r�r a �;��ino iutl 701,A a di,M c a,U 4. Property Owner: A n (� n �7 Address: A� Kid Roo I t ? Phone# qil As(6 1312 a Cell# T1 656 3332 e-mail U'C4 MCI l� Cb List All Other Properties Owned in Rye Brook: P,I)c Rip- KoDI] ' T Applicant: e ' Ne Address: 1 ,q I AA"b.(F 4 (rree f, vi i L CT 3 Phone# 2-AS 223 2116 Cell# 203 Z Z 3 2110 e-mail se 12S kek D _Ile ey&6 jkym Architect: Address: Phone# Cell# e-mail Engineer: Address: Phone# Cell# e-mail General Contractor: 5v oqs�n N 2 b E O(I l3 n/11 U,1 C ^ Address: IA I HabaC4 Avenue &(eynrw ,cf CT nf��l L Phone# 20 3 229 21 W� Cell# Z0 3 2Z 213 o e-mail 5e,xl Ilm , �e e (IlJ'hw (om (1} 8/12/2021 5. Occupancy;(1-Fam.,2-Fain.,Commercial.,etc...)Pre-construction; Post-construction: 6. Area of lot: Square feet: Acres: Q . 33 7. Dimensions from proposed building or structure to lot lines: front yard: rear yard: right side yard: left side yard: other: �} 8. If building is located on a comer lot,which street does it front on: �\wn<<r CIA RA)e 1 l\ea3 9. Area of proposed building in square feet: Basement: 1"fl: Zed fl: 31 fl: 10. Total Square Footage of the proposed new construction: 11. For additions,total square footage added:Basement: 11,fl: 2°d fl: 3`d fl: 12. Total Square Footage of the proposed renovation to the existing structure: 13. N.Y. State Construction Classification: N.Y.State Use Classification: 14. Construction Type&Location:()Typical Western Lumber Frame;()Timber Frame[TC];()Wood Truss[TT]; O Pre-engineered wood[PW];Located;O Floor Framing[F];O Roof Framing[R];O Floor&Roof Framing[FR];Other: 15. Number of stories: -19— Overall Height: Median Height: 16. Basement to be full,or partial: finished or unfinished: 17. What material is the exterior finish: 18. Roof style;peaked,hip,mansard,shed, etc: Roofing material: 19. What system of heating: }lam[ ekth 20. If private sewage disposal is necessary,approval by the Westchester County Health Department must be submitted with this application. 21. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...)Yes:_No:_ (if yes,applicant must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 22. Will the proposed project disturb 400 sq.ft.or more of land,or create 400 sq.ft.or more of impervious coverage requiring a Stormwater Management Control Permit as per§217 of Village Code? Yes:_No:_Area: 23. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: (rf yes,applicant must submit a Site Plan Application, &provide detailed drawings) 24, Will the proposed project require a Steep Slopes Permit as per§213 of Village Code Yes: No: (if yes,you must submit a Site Plan Application,&provide a detailed topographical survey) 25. Is the lot located within 100 ft.of a Wetland as per§245 of Village Code? Yes: No: (if yes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan) 26. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes: No: (if yes,the area and elevations of the flood plane must be properly depicted on the survey&site plan) 27. Will the proposed project require a Tree Removal Permit as per§235 of Village Code?Yes: No: (f yes,applicant must submit a Tree Removal Permit Application) 28. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No: Indicate:TIER 1: TIER II: TIER III: fff yes,a Home Occupation Permit Application is required) 29. What is the total estimated cost of construction: $ 7, 60n Note:estimated cost shall include all site improvements, labor,material,scaffolding,fixed equipment,professional fees,including any material and labor which may be donated gratis.If the final cost exceeds the estimated cost,an additional fee will be required prior to issuance of the CIO.30. Estimated date of completion; ! bC 644z G S,E/Y1 C ,v-)-, at9 s, ti,L�°Gy s 7�,e, ,C o u,, (2) 8/12/2021 BUILDING DEPARTMENT E VILLAGE OF RYE BROOK JUL 19 2022 938 KBVG DIET RYE ft x,NY 10573 }` �` VILLAGE OF RYE BROOK BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: �} II QQ � Ani, OS M Fk PA/ ,residing at, I P U Pine gidt 1Cal . fie 8fca6K NY 10�3 (Print name) (Address ere 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; �- Pr Ile Rtr� ' U5 , 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. rgnature Owner(s)) A N&F R6S5,MR A11V (Print blame of Property Owner(s)) Sworn to before mq this day of J , 2 • CLAUDIA UVALDO NOTARY P E3LIC,STATE V61071356 NEW YORE Public) QUALIFIED IN WESTCHESTER COUNTY COMMISSION EXPIRES APRIL 12. (3) 8/1212021 This application must be properly completed in its entirety by a N.Y. State Registered Architect or N.Y. State Licensed Professional Engineer& signed by those professionals where indicated. It must also include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void, and will be returned to the applicant. Please note that application fees are non-refundable. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Se msE+o Ncb -,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further state that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the CO Rrenr f 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 fiuther 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 S g Sworn to before me this day of , 20_Z2 day of ,2001-CKI � Signature o er Jgna of Applicant Anne Ras& ftm 5 0, txs jQ Q VD1q 11el]Q Print Name of Property Print a of Applicant Public CL.AUDtA UUALDONOTARY P No.oiSTIJE OF uV6107856EW YORK QUALIFIED IN WEFIRES APRR CO 202 1iii4 LJNTY P GOMEZCOMMISSION EX State of New York#01G06 78902stche Co tpires (4) 8/17J2021 FINFERGY Regions START," CertifiedIn Highlighted I OR Certified 103877274 N—06 16 09/10/2021 eNTHII - 280 - 1 RC Slimline DH 2 HIGH SHGC LOW— E:ARGON:DOUBLE GLAZED VINYL DOUBLE HUNG National Fenestration HII — M—34—03454 — 00002 Rating Council- . e ENERGY PERFORMANCE RATINGS U-Factor (U.S./I-P) Solar Heat Gain Coefficient 0 . 30 0 , 46 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance Air Leakage (U.S./I-P) 0 . 55 <_0 . 3 Nunufadurer stiputates that these ratings conform to applicat,ie m til; procedures for determining whole product performance NFRC ratings are determined for a fixed set of environmental conditions and a Specific prods size NFRC does not recommend any product and does not warrant the suitability of product for any specific use Consult manufacturers literature for other product performance infor ai www.nfrc.or p p matio� Building Permit Check List&Zoning Analysis Address: C r N F_ _Z tit;E��j SBL: - Zone:2- I Z Use: 2,1 Q Cont.Type Other. Submittal Date: 2 2 Revision Submittal Dates: Applicant tZ r->S_C vv4,r-_.1cv Nature of Work: L A-C���-t fr1v W t a�Q LM 1 Reviews:ZaA:J U L 1 9 2022 pg. BOT: Other. 1�1 OK r ( ( ) FEES:Filing. 72, 1�.BP: Z S' C/O: Flood Plane: Legalization: ( ) (-�'APP: Dated: ✓ Notarized: ✓ SBL ✓buss 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:Dats Stamped Sealed Copies: Electronic: Other. ( ) ( License: ✓ Workers Comp: ✓ Liability: Comp.Waiver. Other. ( ) ( ) CODE 753#: Dated; N/A: ( ) ( ) HIGH-VOLTAGE ELECTRICAL:Plan: Permit: N/A Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plan: Permit: N/A Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plan: 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 Plan: 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: APPROVED REQUIRED EXIMNG PROPOSED NOTES Date: JUL 1 9 2022 Cucic F� l� glat: Main Cov Accs.Gov Ft H/Sb: S&H/Sb: Io,I= Hsi&/Storiex notes: Laura Petersen From: notify@proudcity.com Sent: Monday, August 1, 2022 3:54 PM To: Tara Orlando; Pasquale Colantuono; Laura Petersen Subject: New payment from Building Permit Payment Name 2!Y-2)- 1-0 SEBASTIAO SILVEIRA I Io S �� Company P Y Name E & I CONSTRUCTION LLC / Address ( I O 3 1 191 HOBART AVENUE GREENWICH, CONNECTICUT 06831 United States Map It Email SEBASTIAN.NETOCa)YAHOO.COM 40 Phone (� S (203) 223-2170 V' Comments: 17 PINE RIDGE ROAD AMENDMENT Payment Information Permit Type Building Permit Amendment Credit Card Visa XXXXXXXXXXXX8886 Order Product Qty Unit Price Price Price 1 S125 00 $125.00 Transaction Fees:3%+$0.30 1 $4 05 $4.05 g) 1 � Total: $129.05 JQf S+eAlJe- D ik� 11 L% i BUILDING DEPARTMENT �---- VILLAGE OF RYE�ftOOK I AUG _ C�2� �--� 938 KING$TWET RYE BRUOIQ,NY 10573 (914)93 -OGb8 VILLA F- %r= RYE BROOK www-a br-00 a BUILDING DEPAR-MENT FOR OFFICE USE ONLY: Approval Date: Permit# Application# Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: : Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: Amendment Feed Permit Fee: APP1LICATION TO AMEND APPROVED PLANS Application dated: is hereby made to the Building Inspector of the Village of Rye Brook,NY,to amend the approved plans associated with an exis' g open permit,and/or from any prior approvals granted by the approval authority as per detailed statement described below. 1. Job Address: '7� Pik,,r il.L(," tC � Existing Permit#: bP Z2-112 72 2. Parcel ID#: ,��j 4 �/l •—f —y Zone: -)4 Original Approval Date: 7-/ 9-a 3. Proposed Amendment(Describe in detail): 4. Property Owner: Address: Phone# ql;,- 6s6 _�-332 Cell# 2-3,Z e-mail k- G 'Com Applicant: .54- ASS-IAO i.S_ & -ro Address: //O f3,4 it .14 d4- / A-41 VAC N C-� Phone# 203 3 2 ?-_� 2 / Cell# „Z03 a102-3 02/ U e-mail S,�B/JS /T/a�f/, t-'T df/ CO, Architect/Engineer: Address: //m/S4kT 4 U 676-,P.3/ Phone# �3 �,�,� 4 �Q Cell#2,!5), �3 ,-2/ 770 e-mail 42X�0e C-a, 5. Occupancy;(1-Fam.,2-Fam.,Comm.,etc...)Prior to construction: /-``✓j'/ After construction: /•`i�/�. 6. Will the proposed amendment require the installation of a new,or an extension/modification to an existing automatic fire suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...)Yes: Nox(if yes,you must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 7. Will the proposed amendment disturb 400 sq.ft.or more of land,or create 400 sq.ft.or more of impervious coverage requiring a Storm water Management Control Permit as per§217 of Village Code?Yes:_No:'�_-_'Area: t an 2/2021 8. Will the proposed amendment require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes:_No:/—(if yes,you must submit a Site Plan Application,&provide detailed drawings) 9. Will the proposed amendment require a Steep Slopes Permit as per§213 of Village Code Yes: No�(if yes,you must submit a Site Plan Application,&provide a detailed topographical survey) 10. Is the lot located within 100 ft of a Wetland as per§245 of Village Code? Yes: No:K(if yes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan) 11. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes: No: (if yes,the area and elevations of the flood plane must be properly depicted on the survey&site plan) 12. Will the proposed amendment require a Tree Removal Permit as per§235 of Village Code?Yes: No:,O>C (if yes,you must submit a Tree Removal Permit Application) 13. Does the proposed amendment involve a Home-Occupation as per§250-38 of Village Code? Yes: No:'If yes,indicate: TIER I: TIER II: TIER III: (if yes,a Home Occupation Permit Application is required) 14. Will the proposed amendment result in additional square footage to the building or subject structure, and if so,provide such additional footage here. (Please submit additional Bulk Regulation Application Pages for review) 15. What is the total added cost of the work associated with the amendment: $ 1 0�. 0o O (The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,including any material and labor which may be donated gratis.) 16. N.Y.State Construction Classification: N.Y. State Use Classification: 17. Estimated date of completion: S��� ��_ This application must be properly completed In Its entirety by a N.Y.State Registered Architect or N.Y.State Licensed Professional Engineer&signed by those professionals where Indicated. It must also Include the notarized signature(s)of the legal owner(s)of the subject property,and the applicant of record In the spaces provided.Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void,and will be returned to the applicant. Please note that application fees are non-refundable. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: 5'r 8A S'Tl rao k.S. ly'6- 0 ,being duly swom,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 r CD.b5Z&t✓T/p A/ Z/-C., 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 2C 2 2 Swom to before me this Q A day of�l' ,20� day �J , 20 Signature of Property Owner o M`Z t\otary Public, State of New York AMIP d n Registration#01G06078902 Print Name of Property er Q [cillest r uQunty Aires (�AU/Yn Notary Public I otary Public CLAUDIA UVALDO z � NOTARY PUBLIC,STATE OF NEW YORK NO.01UV6107856 OUALIFIED IN UNTY COMMISSION EXPIRES APRL 122,,202 8/12/2021 p ./ ,� �� + � � ` �, .t `,;� '�'.3.t � �� J � � ' � �� •. �1 � i �� '�tip,; rY•"' .. 1 _1 Y �' .Y, {� u{}}. {{ �� t� I ,a _: .� ;j �� �r ;� ' t � i` t �� ;� �" '�, t.. � 6F � � � . . � N. /�, a �' �. , � i � _. °- � ., '' �� �r. r � r � 1 �� � i �.1 r u .{j}�� � 1 >l. 1 J y ��1� � i i 1' 1 `� I. / � � � � ` oz-z ------------------- ' "•Wfi-•1'/�'f*- ;("•l./�'!'� ../ .ate„' 4 M;^Y'1--7 —'9' 'r l';""� �'j \ �/ ''�AP'+ A .•^i A N` t, /: •• �v /H + �� /11 r1/11 + 1111 1111 1 1IIIII Ii111///1i1:: Ii11111//i�_•.:,.- . :�Ii11111i11: 1 f11/1111i1's:; j 1►11111�` lill(lll a aA f -.�:. `��, ;.:"%s .1111/I11111: �=:'i• ,1) 11. '`IIIII.. ::1 1 3r 1 1 q►,q'sfis,IIIII{I r .,5�:ts'•?.IIIII r,�:e t� � �� -- O I '•. f.S •yam � � O � � ' ��_��.> ca � o L �y C 4•" �� . y C • • ,,� •� J M U a � t • r•k LLJ , Q 00 L1J o H v ;.. O m z n.u�. ro ay, "ico 4M.0 11 1 X O c� o Vic:• -' •��;� � = a�i o o � : Yp :: LO <c t" h •� L fy :: .� sir'm . . . .... . ... . . . . . . . b�. .�'11111 Illlll:.re .;• ::IIIII/�IIff11-+�;� a=s�.N111111�111111 u%s +BII{1/1�IIIII� max% y,;I11111�11fI113,r,:. ,11111111111 _ 1y1/j111 11 1 f I I/N � IIIII � � � 1111i � � � �111� � ` : 11./•1, ���� � 11.1111 /► �. i,� ^ �� , ^ k�.�#� r� �A �t ••�)� 0 �r��`'�Vt�k O k14�yff� ^'/` + �Oty� y+��t�4�'4' I,� $O + A "'i DATE(MMIDOtYYYY) AC40R" CERTIFICATE 4F LIABILITY INSURANCE 7/1812022 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(les) 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 Sha Insurance Services Inc CONTACT Moises Rosales 128 N Main St PHONE 2032479524 FAx ii 2036638200 Port Chester NY 10573 IAM,NCI: EMAIL mrosales shay sVCs.Com ADDRESS: P INSURER(S)AFFORDING COVERAGE - INSURER A Obsidian Specialty InsurameCompony 16871 INSURED E&I Constructbn LLC �e INSURER 8 191 Hobart AvwnuY Greenwich CT 06831 INSURER C INSURER D INSURER E 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' iA >S —__.__ _,._ -_ . .____._.POLICY EFF- POLICY EXP_ ---_______. LTR TYPE OF INSURANCE POLICY NUMBER (MMIDDIYYYYJ MWIn LWn'B ✓ COMMERCIAL GENERAL LIABILITY e/ ! 3t09(2022 03109/2023 EACH OCCURRENCE $1,000,000 -11"GE TO 30 oao ✓ CLAIMS-MADE OCCUR !FEMISES_(Eaoc�rtenoe $ A MED EXP(Any one persona S 5,000 PERSONAL&ADV INJURY i 1,000,000 GEN'L AGGREGATE L MIT APPLIES PER GENERAL AGGREGATE $2,000,000 ✓ POLICY 7 JECT LOC _PRODUCTS-CCMPIOPAGG $1,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLELI 1 = Ea accident) _ -_---- ._ ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Per socid") S AUTOS ONLY AUTOS HIRED NON-OWNED ERTY- � $ AUTOS ONLY AUTOS ONLY sodden i UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE f `—_-N_- DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ATLITE ANYPROPRIETORIPARTNERIEXECUnVE E.L.EACH ACCIDENT $ OFFICE RIME MBER EXCLUDED? El NIA f itendatwY in NH) E.L.DISEASE-EA EMPLOYE $ ayes describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT . S ao r7F7 J DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached it more space Is required) Additional Insured:The Certificate Holder Is endorsed as additional Insured CERTIFICATE HOLDER CANCELLATION Village of Rye Brook 938 King Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Rye Brook, NY 10573 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Moises Rosales Producer CP 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD /vmz�N NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 0 ❑E '^^^A A 371954820 SHARP INSURANCE SERVICES INC 128 N MAIN ST ' PORT CHESTER NY 10573 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER E&I CONSTRUCTION LLC VILLAGE OF RYE BROOK 191 HOBART AVE 938 KING STREET GREENWICH CT 06831 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE X2566 360-0 92911 03/10/2022 TO 03/10/2023 7/18/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2566 360-0, 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 THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. 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 7 �V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 866995712 1I 7a1