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HomeMy WebLinkAboutBP22-129PERMIT #/QL SECTION TYPE OF WORK JOB LOCATION OWNER/ L CONTRACTOR EST. COST / TCO # a9� DATE: c%c EXP: ��5 % BLOCK % LOT �I EE • '� R�hZ DATE INSPECTION RECORD 1 DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS C� SPRINKLER ELECTRIC C7 LOW -VOLT CI ALARM O AS BUILT FINAL -DOS! to e9q&v 80ff5 OTHER APPROVALS 'ARB SOT PB ZBA OTHER tt � 406af?nUlP.1 aW VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook, N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher j. Bradbury www.ryebrook.org TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Michael j. Izzo Stephanie j. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE October 14,2022 Xiaodong Zheng&Rita Fuller 4 Talcott Road Rye Brook,New York 10573 Re: 4 Talcott Road, Rye Brook, New York 10573 Parcel ID#: 135.57-1-11 Building Permit#22-129 issued on 7/22/2022 for 2 New Replacement Windows This certifies that the two new windows,installed under the above captioned permit have been satisfactorily completed. Sincerely, r Michael j. Izzo Building&Fire Inspector /to DBUILDWeiWRA�TMENT For office us onl : \\n PERMIT# c� a 7 OCT - 3 2022 VILLAGE OF RYE BROOK ISSUED: 938 KING STRE9Tj RYE BROOK,NEW YORK 10573 DATE: VILLAGE OF RYE BROOK (914)9 9-0668 FEE: e1/0— PAMN BUILDING DEPARTMENT w�ww r o k.or APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION i►tt•i•ititttt►Riti►rill►tiiRt■►►tttiiittttti►■ii4ttitittiiii►Riitititi►t►•R►•ttttttt■iRttt►ttttitttttttt►i•Rt►tititittttti►► Address: Q, ( 0 t e I r o o l L l v Occupancy/Use: i�qI74 Parcel ID#: 13 r- —I f Zone: -I Owner: U 2 Address: e,L[60: P.E./R.A. or Contractor: --�47)ru a 4 `- to S+Address:jA S�Pe-e - �.e��, Person in responsible charge: - iiu ��- _Address: Application is hereby made and submitted to the Building Inspector of the Village o Rye rook 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: Gt r/L" being duly sworn,deposes and says that he/she resides at (PrirNe of Applicant (No.and Street) in L �, "„ — ,in the County of Ca Q f ��� �� in the State of that ( ity/Town/Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$ a,-- ! 3 E d a- for the construction or alteration of: 2 14&—e—fuA ej� ,t)" t_..¢.[ :A " f 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 Z-V Sworn to before me this da of , 20 ZZ day of 0 , 20 Signature of Property Owner �Sigaa of Applicant Print Name of P pertyJ()Oyngk ("Name of Applicant SJL 7jl�'j(///v Notary Public Notary Public SCOTT GOWE SHARI MELILLO NOTARY PUBLIC OF NEW YORK Notary Public,State of New York I.D.#01GO6357188 No.OiME6160063 12�01 i MY COMMISSION EXPIRES 1'lZ21& Qualified In Westchester County Z-- Commission Expires January 29,20_ 0 [3k?k, BUILDING DEPARTMENT /Ass UILDING INSPECTOR ISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK i' [I CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS:_ `C CL v� DATE: 112 as PERMIT# / ISSUED: `� SECT: `35 BLOCK: LOT. I Q `y-� , ' 4 w 4 -?- LOCATION: t� 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 s ° r N M w N v rq CD IT lu k x a8.4 p 3 G=. h•l"�I t` a O W Q I�yl Ln 8 4-1 o Confl3o � � q w O Q O a �-, z © o � f� � o a a� �y N � d 'O 2i u ON 00 QCN r r � wW x110 00 F+ a A A U C V ICI O W O w o a U � v I.. a V 00 a W 0 t v Cn r oo W C7 cn -v tu a Z, ItT FF-i�l 00 C� O O W O O r O ut= A U d Uovo :cFg ' v w H W o � C CZ � � °� O © o a z o " y ° CIS Z �1 a a v vn �1I �Q � 1� W ►7 � vdi � � .�' -a r �4;4141414;aa4;41+14a4;a4;41414141aaaaaa44aa4aaa4;4141414;41414144 ED BUILDING 01KPARTMEN7' R [E C IE M 11 x-.Lc f off R4 x H>I�c�o JUL 2_� 2022 938 KI\( mrvi'RvF,BI2 K, NY 10573 (9s 4)939-066$ : VILLAGE OF RYE BROOK w11VIN � i c�k�orz BUILDING DEPARTMENT AD-IItiISTRATIVE EXTERIOR BUILDING PERM jrI' APPLICATION FOR 1'XI I- 1LIC)R ♦' ORK %% II1t 11 1l01'', NO ItI.t►( I R I Vii i %Gi? ARCIIFITClFHR I, RL% IEM I30-1141) 11'mm 11. FOR OFFICE USE ONLY: )5a APPROVAL DATE: d2 r;© 2U P MIT# 2 ` � APPLICATION FEE: APPROVAL SIGNATURE: PERMIT FEES: H.O.A. APPROVAL: DATE: DISAPPROVED: OTHER: ►#i#i#i#####i######t###t###########t#####i##i####►**##########iik#ii##ii#iii+l###iiiik#i#i####t##i###rn###### Application dated: -- is hereby made to the Building Inspectorof the Village of'Rye Brook.NY,for the issuance of-a Permit for the constriction of buildings,structures,addictions,alterations or for a change in use,as per detailed statement described Wow. 1. JobAddress: "' t °`-kA �_A ?. Parcel ID##: �-�>s - S� - k - k 1 _ Zone: 3. Proposed Improvement(Describe in detain)): 1P f�t?V Q 4. Property O%-ner: 1 CA O cc C x —ZA\f,� Address: Phone t! _q i `� 1�C1 -CTGL"- Cell# e-mail 'ant , }( . ZA'Q C� List All Other Properties Owned in Rye Brook: yv,-z,t Applicant: Address: Ne-r-'�".0-A[ fi�i-+.-.L.a �. C_ _a S w 1D �a 1111hone# o 'c3���4 cell e-mail 0t2 rr,�, t? �e�vv� its Architect: Address: Phone# Cell# e-mail Address: ..�. .---- Phnne# Cell it e-mail General Contractor: T i'j°tr` tC k (_kS�" Address: Phnne# Cell# e-mail 4 ay-T- {i) 4 � 5. Occupancy',(I-Fam..2-Fan.,Commen:ial.,etc...)Pre-construction: -�t^''"' Post-construction: 1 Pr' 6. Area of lot: Square feet: ___.__.._....._..._.__.._._..._................................._.. Acres:-----_.____ 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 corner lot,which street does it front on. 9. Area of proposed building in square feet: Basement: I"fl: 2nd fl: 31 fl: 10, Total Square Footage of the proposed new construction: _ 11. For additions,total square footage added: Basement: _ I s9 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 [IT]: ( )Pre-engineered wood[PWI;Located-,( )Floor Framing[F];( )Roof Framing[R];()Floor&Roof Framing[FR];Other: 15. Number of stories: 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: 20. If private sewage disposal is necessary,appro,al by the Westchester County Health Department trust be submitted with this application. 21. Will the proposed project require the installation of a new,or an extensionlmodification to an existing automatic fire suppression system?(Fire Sprinkler,ANSL System. FM-200 System,Type i Hood,etc...)Yes: No: y (if yes,applicant must submit a separate Automatic Fire Suppression Svstem Permit application&2 sets of detailed engineered plans) 22. WiI I the proposed project disturb 400 sq.ft.or more of land,or create 400 sq.ft.or more of impervious coverage requiring a Stortnwater Management Control Permit as per§217 of Village Code? Yes:_No: x Area: 23. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: 'Y (if ves.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: y` (if yes,,vnu 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 properiv depicted on the survey&site plan) 26, Is the lot or any portion thereof located in a Flood Plane as per the FIR'vt Map dated 9i28107? Yes: __ No: v (i f yes,the area and elevations of the flood plane must be properiv depicted on the sum*,&.site plan) 27. Will the proposed project require a Tree Removal Permit as per§235 of Village Code?Yes: No: � (ffyes,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 if: TIER lif: (iJ:yes.a Home Occupation Permit Application is required) 29. What is the total estimated cost of construction: S t�-0-1 -.�> .Note:estimated cost.shall include all site improvements, labor,material..scaffolding,fixed equipment,prn)essional fees, including any material and labor which may be donated gratis. Ifthe final cost exceeds the estimated cost,an additional.fee will be required prior to issuance of the GO. 30. Estimated date of completion: (2) W122021 BUILD �." MENT D VIL or �tYi ' nj 938 K[N61$I- l'a RYf.BR!4 NY 10573 JUL 20 202z jk4l) 0668` VILLAGE OF RYE BROOK «i .r��lirE .trr6� , 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: Ckov, `"!� , residing at, l� —T,k �f i ml IAdiirrtis%k here vole!'�et 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; Rye Brook, NY. (Job;1 l,lr ti�f 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, sunup 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. Sworn to before me thisy day of Ji . 20 tt LAN S LANDSMAN Notuy Public of New York 17 REGISTRATION SOI A6428985 COMMISSION EXPIRES 02/07/2026 I_ _le 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. STAT OF NEW YORK,COUNTY OF WESTCI IE;STER av k CA'-0 ,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 CAc;,C,NA- 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 regulation,%. 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 (7 Sworn to before me this do day of_ ,/ ( I I� day of�lA , 20 aj k Sign rc of Property Owner Signature )fApplicant X f'&0 � 0 M t1 Z C�--.:. Print Name of Property �nc r Print Name of Applicant Notary Public Public SHARI MELILLO Notary Public,State of New York IAN S LANDSMAN No.O1ME6i60063 Notary Public of New York Qualified In Westchester County. REGISTRATION MOtLA642M5 Commission Expires January 29,262� COMMISSION EXPIRES 02/07/2026 Home Improvement Agreement: Page 1 km Home Depot License#'s - For the most current listing visit www.Homedepot.com/LicenseNumbers Jeffrey Colthup Salesperson Name Registration # (Req. in CA,CT,M ,MD,MI,NJ,DC) Home Depot U.S.A.,Inc.("Home Depot") or Authorized Service Provider named below will fumish, install and/or service the equipment listed below at the price,terms and conditions as outlined on this form. 11 1. Service Provider Contact Information The Home Depot The Home Depot Service Provider Contact Name Service Provider Company Name (914) 347-6 icustomercancellationnortheast@hom Phone # 99HP&TV6vider Email Address Service Provider License #(s) 2. Customer Information Zheng James Westchester 1-20BL85K9 Customer Last Name Customer First Name Store #/Branch Name Customer Lead/PO# 4 Talcott Road Rye Brook NY 10573 Customer Address City State Zip (917) 692-0051 1 iames.x.zheng@gmail.com Home Phone# Work Phone# Cell Phone# Customer Email Address 3. NOTICE OF RIGHT TO CANCEL YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY CONTACTING THE SERVICE PROVIDER OR STORE DIRECTLY; EMAILING SERVICE PROVIDER AT: customercancellationnortheast@homedepot.com OR DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 6 Skyline Drive Hawthorne NY 10532 Address City State Zip BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A DIFFERENT CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR SERVICE PROVIDER, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAW REQUIRES THAT THE HOME DEPOT GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE OF Y UR RIGHT TO C Acknowledged by: 07/12/2022 Customer' gnature Date 460 Standard Form HIA(21 Jul.21)(E) Generated Date N./92/2022 Lead/PG# 1-20BL85K9 ` 0.112 MHome Improvement Agreement: Page 2 4. Description of Work to be Performed A detailed description of the work to be performed is included in the paragraph entitled Scope of Work, Specification, Customer Summary Sheet, Quote Form, Estimate, Invoice or Measure which is included in this Agreement. 5. Anticipated Delivery Date/Installation Schedule Approximate Start Date: o1/os/2o23 Approximate Finish Date: 02/07/2023 All dates are approximate and subject to change based on unforeseen events including inclement weather, permitting delays, and delays in confirming insurance coverage of Your claim for any repair, if applicable. 6. Electronic Records Authorization You are entitled to a paper copy of this Agreement if you choose. If you consent to an e-mailed copy, your consent applies to this Agreement and all subsequent documents and written communications related to this Agreement. By contacting your Service Provider,you may update your email address,withdraw your consent,or obtain a paper copy of the Agreement or related documents at no charge. By providing your consent and verifying your email address above,you confirm that you have access to a computer that can receive and open emails and PDF documents. 7. Contract Price and Payment Schedule Payment of the Contract Price is due upon signing unless a different payment schedule is required by law, specified below or in a payment addendum. Contract Price: $ 12073.02 Includes all applicable taxes. Excludes finance charges.* Sales Tax: $ 10.00 (If applicable, total amount of taxes included in Contract Price) *Maximum deposit ONL Y applicable in MD, MA,ME(33%),NJ, W1(99516) Deposit% 1100.0 Deposit Amount $ 12073.02 Remaining Balance $ 10.0 8. Finance Charges Any interest payments or other finance charges will be determined by Customer's separate cardholder or loan agreement, to which Home Depot is NOT a party, and will be in addition to Customer's payment under this Agreement. Customer is subject to the terms and conditions of the cardholder or loan agreement, as applicable. No funds should be made payable to Service Provider; however, Service Provider may collect Customer's payments made payable to Home Depot. 9. Acceptance and Authorization By signing below, you authorize Home Depot to: (a) arrange for Service Provider to perform any Services or (b) order and arrange for the delivery of special order merchandise, including special order merchandise that may be custom made, as specified in this Agreement. Do not sign if blank or incomplete. (Service Provider's or permitting information may need to be provided to You later.)By signing,you acknowledge that: (i)You have read,understand, and accept this Agreement in its entirety, including the General Conditions and State Supplement, if any; (ii) You are receiving a complete copy of this Agreement; (iii) all rights and interests under this Agreement are solely vested in the person listed as "Customer" above; and (iv) Electronic signatures will be deemed originals for all purposes. X 07/12/2022 Customer's S41ature Date X I/s/The Home Depot 07/12/2022 The Home Depot Digital Signature Date For questions related to your installation, contact Service Provider at (914) For any other concerns, contact The Home Depot at 1-800-466-3337 460 Standard Form HIA(21 Jul,21)(E) Generated Date O7/12/21)22 Lea"O# 1-?0R1.R5K9 ` � �� WINDOW SPECIFICATION SHEET - Spec.Sheet Y. 1-2081.85K9 Sheet, I of I Customer.James Zheng Job k.1-2081.850 Consultant. .Ie Hrey COlthup Date. 07,12,2022 New Winoow E%i5bng Wndow Hog.Ladal,ons Measurements Grins Product Options Labor OPllons Fran outsde. Leh to R,ghl Bays.Bows Location Colo, Rough Opening a of bare a of bars Csmnts.1 Pnl. use L.RaS Glass Misc Items Hardware Cade Screens For doors use m _ m Mull "S"=Slelgnery or SO' 'V=operating r _ TR- 1., SCode vjvMl Style Cade Series Cafe $TO,Whi . GI ass Pack:METAL, r BED 2nd SB-2P y 2PNL 5100 WN pZ 46 d) 93 smndard WRAP % S NL STD,White,Glass Pack-METAL, 2 BED 2nd SB-2P Y 2 PNL 5100 WH BZ 10 35 105 Standard WRAP % S NL SPECIAL CONSIDERATIONS. 1 Dark Bronze,2:Dark Bronx, Line level Nolen. r Wrap ou r isde stop only 2 Wrap outside stop only Wrap cot. nlenor Casing Type Bay a Bow window: earooard matenal(myl only-Bach or Oak) ay Project Angle(30 or 45) ay Flanker Type OH.SH.or CSmnr) Op of ynndow to sof1H(n he5) I I,ed to 50111I.Color of SOH.I malenel I have reviewed and agree wan all Me)do SpeGf-hdn5 above aW the onslrucl Roof(Yes or No)' Spec,al Terms end Condit*ns on the lollowirg page Garden Window ealboard Material(myl only Whde Pgrule,Birch or Oak) A' 4 �y�•4, �': 1 { ; , �/y//y 1 .yam. { •,.�. ,` �r" 'a"k ,IL�"��t��. �... \. ELI- PRS 51i l Series Brown Vin\/l windows Exr.lusively lnstciNad ThrougF Pape 2 of 7 WIND( S ur�&Op. 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Minted.6"V2011 Building Permit Check List&Zoning Analysis Address: A L- _T2�r, SBL: 3 S i ? L ` l Zone: 72- Use: 2 D Const.Type: Other. A ,C ,S Submittal Date: 'I Z Z'L Revisions Submittal Dates: Applicant: Z'H q__t''67 Nature of Work:_ Z A % l'o k Reviews•ZBA: J U L 1 9 2022 PB• BOT• Other. OK ( ( ) FEES:Filing.i S'�BP: � dP- C/O: Flood Plane: Legalization: (,y APP: Dated: Notarized SBL " Truss I.D. Cross Connection: ✓ H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening. ( ) ( ) ENVIRO:Long Shore 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 7S3#: Dated. N/A; ( ) ( ) HIGH-VOLTAGE ELECTRICAL-Plans: Permit N/A Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL-Plans: Permit: N/A Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Pemrit H.W.I.C.:_Battery:_Orher. ( ) ( ) 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 APPROMU A=& nate- JUL nl O 2022 --- F�r: From: Front 13� Main COP A<cs.cap Ft.H Sd.H/Sb: CE Perking: HHci /Stoles notes: RD JUL 21 2022 Talcott Woods Home Owners Association VILLAGE OF RYE BROOK OFFICE USE BUILDING DEPARTMENT _._.. .�.__..�._._.��._ Rec'd By Date REQUEST FOR ARCHITECTURAL COMMITTEE REVIEW Document Check List Request From Survey/Plot Plan Specifications Date Bldg. Plans Permit Mr./Mrs.:Elevations Photos James Zheng, Rita Fuller Details Other(noted) Address: 4 Taicott Rd,Rye Brook, NY 10573 Phone No.: 917-692-0051 Brief description of addition,altera ion, improvements, etc.: eOrr' oorv-. W i rJ'p o W S 0 g2 S '7_0 L3 E p�gcefl Contractor: t40r^iEHOMEOWNERS AFFIDAVIT Address: 9 le-y it fZ i I have read the covenants and restrictions A w T o,rr..,ni d OV 0 2 of my Associations and agree to abide by such covenants and restrictions. No work Cert.of Insurance Attached ✓ will be commenced without the approval of my Association. Date: Signed:, Please check with Village of Rye Brook for Building Department Approvals FOR ASSOCIATION USE ONL Approved by Homeowners Association "j y Preliminary Approval Subject to Review Insufficient Information Submitted- Resubmit UAppved wit the Fo I nditions Vt1.1.k ny or- 9-'i r. z PooV_ Chairp son,Architectural R view B d Ia �Tl I'LLA' 0K3 OF W IN ODLJS EL Date: 0 Qj o ��e A \W cs4 0 04 u E- ej CA 0 U W co a 0 F-m LO IL C) D 0 LL, w 0 co C) LU w 0 E-4 14-1 CL4 0 (0 aj ell CID Q) 00 Cl) .......... A ,,.j jigi yj-kf tj gg• I lzrn wo�, Sol" it m N VIM 1 (V DATE(MM/DD/YYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE `�. 03/0112022 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 MARSH USA,INC. NAME` _- PHONE FAX TWO ALLIANCE CENTER c No Ext: C No): 3560 LENOX ROAD,SUITE 2400 E-MAIL ATLANTA,GA 30326 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC a CN101642069-HomeD-GAW.-22-25 INSURER A: Id Republic Insurance 24147 INSURED INSURER B: New Hampshire Ins Co 23841 THE HOME DEPOT,INC. HOME DEPOT U.S.A.,INC. INSURER C: ACE AMermCan InStjranCe CoMpany 22667 2455 PACES FERRY ROAD INSURER D: BUILDING C-20 ATLANTA,GA 30339 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: ATL 004348037 16 REVISION NUMBER: 1 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 ADDLPOLICY TYPE OF INSURANCE INSD SUER POLICY NUMBER M DY E FF POLICY EXP LTR YY M DD LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY316648 03101/2022 03/01/2025 EACHOCCURRENCE $ 1,000,000 CLAIMS-MADE X� OCCUR PREMISES Ea occurrence $ 1,000,000 X SIR:$1,000,000 M E D E X P(Any one person) $ EXCLUDED PERSONAL&ADV INJURY $ 1,0W.000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑PRO-JECT ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ A AUTOMOBILE LIABILITY MWTB316649 03/01/2022 03/01/2025 EO aBINEDtSINGLE LIMIT $ 1,000.000 X ANY AUTO SELF INSURED AUTO PHY DMG BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident A UMBRELLA LIAB N OCCUR MWZX 316647 03101R022 03/01/2025 EACH OCCURRENCE $ 10,000,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $ 10,000,000 EXCESS I I RETENTION$ I $ B WORKERS COMPENSATION WC 065886029(WI) 03/01/2022 03/01/2023 X I STATUTE I I OERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECU I IVE YIN N/A WLR C68916409(AZ,L) 0310112022 03101R023 E.L.EACH ACCIDENT $ 5,000,000 (MandaOFFICEtory in ER EXCLUDED? ❑N Continued on Additional Page E.L.DISEASE-EA EMPLOYEE $ 5,000,000 (Mandatory in NH) 9 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) VILLAGE OF RYE BROOK IS INCLUDED AS ADDITIONAL INSURED IF REQUIRED BY WRITTEN CONTRACT ON THE ABOVE GENERAL LIABILITY POLICY,BUT ONLY WITH RESPECT TO LIABILITY ARISING OUT OF THE OPERATIONS OF THE NAMED INSURED. CERTIFICATE HOLDER CANCELLATION VILLAGE OF RYE BROOK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 938 KING STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN RYE BROOK,NY 10573 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Gt2c2� V/_57"'jK © 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD o K workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a. Legal Name&Address of Insured(use street address only) 1b. Business Telephone Number of Insured Home Depot USA, Inc. 770-433-8211 2455 Paces Ferry Rd.,C-20 Atlanta,GA 30339 1c.NYS Unemployment Insurance Employer Registration Number of Insured 76011130 Work Location of Insured(Only required if coverage is specifically limited to 1 d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 58-1853319 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) AIU Insurance Co. 3b. Policy Number of Entity Listed in Box 1 a" WC 065886028 Village of Rye Brook 938 King St 3c. Policy effective period Rye Brook,NY 10573 03/01/2022 to 03/01/2023 3d.The Proprietor, Partners or Executive Officers are �✓ included.(Only check box if all partners/officers included) ❑ all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"1 a"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 must notify the above certificate holder and the Workers' Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers' Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers' compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Michael Price (Print name of authorized representative or licensed agent of insurance carrier) Approved by: 'f'V'� April 05, 2022 ,/, (Signature) (Date) Title: C.E.O. North America Telephone Number of authorized representative or licensed agent of insurance carrier: 212-770-7000 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. C-105.2 (9-17) www.wcb.ny.gov