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HomeMy WebLinkAboutBP22-145PERMIT # �/ / DATE: EXP:, SECTION 3 B OCK LOT, TYPE OF WORK JOB LOCATION C� OWNER sWC 4Jv'!/G- v i cvw f ONTRACTOR V �GV CO 'J�i7YNch 114ye ilrvlPr�'oj i �"QM%d C9�y�s�5 ��� ST. COST 1�' / ��, OC J ` FEE "" '✓ CO C:gFEE DATE TCO #F FEE DATE DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING 5z vt# RGH PLUMBING GAS 0 SPRINKLER ELECTRIC L At ARM AS BUILT C] FINAL 1 NSP PPa�—ll3�yQr�o� /��0Ae7Inc. OTHER APPROVALS ARB - BOT PB ZBA OTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK N c�: 23-130 Certificate of Occupaucp Ehis is to certify that Jose 3100a'(3-1-lzacyo /V y, having duly filed an application on 20 requesting`a Certificate of Occupancy for the premises known as, JI , Rye Brook,NY, located in a Kyc' Zoning District and shown on the most current Tax Map as Section: 5. Block: / Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No.Cr , issued �! 20 oU, 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 1 0 New York State Classifications, Use: Q / Construction: for the following purposes: 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 sho be made, and no enlargement, whether by extending on any side or by increasing in h ' ht shall be made,nor all th ding be moved from one location to another until a permit to accomplish such change h m from the ing Inspector. Building Inspector,Village of Rye Brook: Date: AUG 1 4 2023 R BUILD R� ENT For office use only- yS PERMIT# VIL OF RYE OK ISSUED: 'a AUG - 4 2023ID38 KING STRE E BROOK, , YORK 10573 DATE: 9 -06 FEE: 4 II Q-- PAIDAL VILLAGE OF RYE BROOK BUILDING DEPARTMENT � PPLICATION FOR UERTIFICATE 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 ifilfttttififiiiiiii!ltttltfiriiililiil►►tfAt►Iffiiililf►►f tiiti!!#liiifff►i►t►iiliiitttttfiiffiiffiifftf tfii►►iiiitiiiit►i►►►fi Address: Occupancy/Use: t Parcel ID#�ZC 124-7Z Zone: Owner: \Q.S (L Address: 2 n J (l15(o/Lj sl �z�JE!� iill-.f1. or Contractor: (k) 1 (-01 F!q. C'0-,:) t7t' t Address: S( I/ VyfU S �f�er�ujs�n� Person in responsible charge: Address: 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 gNEW YOooR``K..,COUNTY OF WESTCHESTER as: J aZN1 ing duly sworn,deposes and says that he/she resides at ( Name o licant `- (No.and Street) �1`1 in P ,in the County of 1 � �ve� in the State of ` ,1 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: $ 174 0 00— // v for the construction or alteration of: �rl O/ A1Te l4 o� 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 Swom to before me thisT&--A y o T 209-2- day of T 20�3 to e of Property Owner Signature of App.can O a zJ'-� W I L61PR C cJ (Mml? ) Prb ame of Prope ner Print Name of Applicant b�wo-;� &��- 4 Notary Public Notary, Public TIANNA MAJOR TIANNA MAJOR 121 2021 Notary Public-State of New York Notary Public-State of New York No.OIAA0005867 No.01MA0005867 Qualified in Westchester County Qualified in Westchester County My Commission Expires Apr 19,2027 My Commission Expires Apr 19, 2027 QyE BRC�j�. '9a2 BUILDING DEPARTMENT UILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street• Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www Uebrook.org, - - - - - - - - - - - - - - - - - - ---- INSPECTION REPORT - - - - - - - - - - - - - --- -- -- ADDRESS: `� 1 /l \ \ ��� �l� \ DATE: i �[ PERMIT# �1 1 1 ISSUED: SECT: �ILOCK: LOT: LOCATION: 1 �'1 \�� l IC.) V`✓ ! �` i' ' ` OCCUPANCY: —v ❑ Violation Noted THE WORK IS... PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION '] FINAL ❑ OTHER QyE 4RI o`` tim 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK [I CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www rxebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS: 10 3 `V, S` �J` y �` DATE: ' v PERMIT# `r ISSUED:-S �ECT: BLOCK: LOT: LOCATION: l� J �� V1 �J V ` OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... {:f ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ OUGH FRAMING INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER �QyE BRC�v� 0 2m w '9a2 BUILDING DEPARTMENT LDINGINSPECTOR SSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.Uebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : �/0 \ >) DATE: Z �� PERMIT# , �C\ ISSUED. SECT: BLOCK: LOT: 12 LOCATION: OCCUPANCY: �- V ❑ VIOLATION NOTED THE WORK IS... d ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION p-` '' 1 REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑���R,OUGH PLUMBING L HOUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER I BUILDING DEPARTMENT ❑B�RLDING INSPECTOR •ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK 'y ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.or8 - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - 7 - -- - - - - - - - - - ADDRESS: � � DATE' � ' t PERMIT# `�� ISSUED: SECT: BLOCK: LOT: LOCATION: �� OCCUPANCY: y ❑ 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 t ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER 1 s _ N w Q ° QI 00 0° y e o � L o fl L • V 00 O di O o o F ua W 04Le) v ,�/ .•, z o �.., o , .� Coo 0 o .� :J u ° Co. e [7� 0 W Z 00 W LO A q p -d U f. W I CD ,y Q O. Z C%] WLA O 00 00 aa 6 H d F V ~ a W Q O14 vW U A p ul4s o ° � � -� A C7 A O a c, x Vf 4 V ) 04 �„ . BUILDING DEPARTMENT U C r� � W IE VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 HAUG - 3 Z022 (914)939-0668 wwww.rvebrooLor! VILLAGE OF RYE BROOK BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE i. -- ---y Approval Date: AUG 8 Permit�: �i� �Application Fee: Approval Signature: Permit Fees: Other: Application dated 7 h,Z ,"is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of Permit for the interior alteration of an xisti g building,or for cha ge in use,as per detailed statement described below. 1. Job Address: �`� S► �� SBL: S• -1- Zone: 2. Proposed Improvement. ;Ileserihe in detail0: �- L v S MR )JCI 3. Does the roposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: Yes: If yes,indicate: TIER 1: TIER II: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an existiniz automatic fire suppression system St, 1cm, FM-2M Sy 4nn_7 ype I Hord,ete.._�: No: Yes: 5. Occupancy;(1 fam.,2 fam.,comm.,etc...)Prior to Construction: After Construction:6114 6. N.Y State Construction Classification: N.Y. State Use Classification: 7. Property Owner: {{ Y"( 6 46 F `^Address: ZZ AlifCS/eWti Phone 22 Cell# email: or 8. Applicant-:--' .� Address: r (1c ` 4 ,Il Phone# l S �tlt f 1A T�� Cell#f �-�j st email: yy�� 9. Architect: 1 ,' Address: Phone# Cell# email: 10. Engineer: 1 Address: Phone# Cell# ''�� email: 11. General Contractor: � '-��i'&Address: 211J��— -{�'.=/ Phone halA Cell# email: 12. Estimated cost of construction $ 13. Job Timetable: Start: A06. t�,.2h U/ Finish: vAJ. ;o 2617/ (1) si 12i2o21 ED BUILDING DEPARTMENT R [E C E � v VILLAGE OF RYE BROOK AUG - 3 2022 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK www.ri!ebrE►o1{•org BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE 4216 • STORM SEWERS AND SANITARY SEWERS STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: } residing at, 2,Q ,�`�t utQ©N Sr R51 P�Qnok 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; AIL-' 7� , Rye Brook, NY. 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. Sworn to before me this day of c k , 20 012 WILLIAMS (tEJASMEN c•State of New York1W16418709 Westchester County Expires Jun 21, 2025 8/12/2021 4 y This applicatic,i Iniis% t.,e Properly completed in its entirety and must include the notarized signature(s) of th, lcoal o,.vner(s) of the sub'ect property, and the applicant of record in the spaces provided. Air y application not property completed in its entirety and/or not properly signed be deemed null and void and will be returned to the applicant. -'lease note that application fee:, are non-refundable. STATE }OF Y F CO T =9cFIFG;T-r-I.R—) L- as: A I ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of indivi ual signing akthe applicant) and further states that (s he i the legal o ner of the property to which this application pertains, or that (s)he is the AJ 1 for the legal owner and is duly authorized to make and file this application. ( dicate architect,con etor,agen,attomey,etc.) That all statements contained herein are true to the best f his knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in con ance 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 andAll other applicable laws,ordinances and regulations. By signingOw pplication, the property owner further declares th tltas inspected the subject property,and that to the best o his nowledge 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, r yTII' Sworn to before me this 2 Sworn to before me this Ze. day of , 200?� i Owner gnature of Applicant Pri t Name of Property -ner Prm Na of Ap licant 2 f Notary Public Notary Publi LUCY A STUART Notary Public Connecticut My Commission Expires Apr 30, 2025 (4) JURAT WITH AFFIANT STATEMENT State o""rox,171" ss. County of 5 &See Attached Document(Notary to cross out lines 1-7 below) ❑See Statement Below(Lines 1-7 to be completed only by document signer[s],not Notary) Signature of Document Signer No. 1 Signature of Document Signer No. 2(if any) Subscribed and sworn to(a affir ed)before me this day of by Date Mont Year 2 C% KAREN A GALA550 Name f Signer No. Notary PubliC State of New York N0.01GA6301751 Qualified in westcfweste r 2O�tY My Commission Expires Ap Nam of ig r No.2(if any) Si r of Notary Public Place Notary Seal/Stamp Above An Oth i Required Information (Residence, Expiration Date, etc.) OPTIONAL This section is required for notarizations performed in Arizona but is optional in other states.Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Docume t Title or Type of Do711", L ent: Document Date: A 1� O � Number of Pages: Signer(s)Other Than Named Above: .V2019 National Notary Association M 1304-06 (09/21) Used for states (AL, AR, AZ, CO, CT, ID, IN, KY, LA, ME, MS, NE, NV, NJ, NM, NY, RI, SC, SID, TN, TX, VA, WY) eq p Cp C ell k en w C. vi 04 96 cq ❑] h ►-� x r; Z o � c z Z C z N $ � 00 r� z ►-� _ A 00 O w � L Z cn Uz°00 4. z 00 M--i a 1 rn Lin NT wa !' Cl) 3 z z V '5 w N ° n04 • a N CC) a W y3 z Q O •• 0 8 R: O U V U -- z � 3 „Wa d w ►ten H 8 ►-r U00 �- c� z { _ "Eq� EV`•' E� �"I E Bum �� 'FMENT VI L ' GE OF RYE BROOK AUG 3 1 2022 938 KlrtcET RYA B ,NY 10573 VILLAGE OF RYE BROOK E4 BUILDING DEPARTMENT or ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONk�p BP#: �� l l [ EP#: 1 2021 Approval Date: Permit Fee: $ Approval Signature: LQ� Other: Application dated, 8 1—Zk7i� 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 applicable Federal,State,County and Local Codes. '1 Z18 S 7.3 — I — `i'� Zone: �3 1.Address: 1 �S1c� 5 r� SBL: I3 , 2.Property Owner: OSe S n Address: Phone#: (W)b w Cell#: email: `' 3.Master Electrician: 1 S E S 6y"r n • Address: k lmx 4�1 , Vex DVAY1CK— Lic.#: 16S`7 Phone#: Cell#: ° 4.]0 3 SO°i email: cz`^n. Company Name: %WQX "e_c k�C• Address: O tPOx 4.Proposed Electrical Work/Fixture Count: - \.N 1tr1 QkNV�I\M" Vt 1\� �AX �M�X — C U�_' - 6 &�c o U Ss6 Eke, 6 6sc-6.1 IL U e 1 i SW GAVW - 5.3'd Party Electrical Inspection Agency: SW S. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: being duly swom,deposes and states that he/she is the applicant above named,and does further (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 for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances,and regulations. Sworn to before me this Sworn to before me this day of ,20 day ofA 20 Signature of Property Owner Signature of Ap licant Print Name of Property Owner t Name of Applic Notary Public Notary Pub§RARi MEULLO Notary Public,State of New York No.OIMESIM63 Qualified In Westchester County Commission Expires January 29.20 2022 • STATEWIDE INSPECTION Service With liaegriq 1:1 Main Street,Fishkill, NY 12524 1 email:office@swisny.com SWIS JOB APPLICATION ;. 1 914.219.1062 • • • Office Use Elect.Permit# Date Bldg Permit# Utility ID# Final Certificate# h City/Villagefl�i Zip Township County �I�V � L"V Address z� �1V 1 S; S Toss Street Sects 1� Block i Lot �j r 1=- T Owner Name/Address(If different than above) T�;e : �,_ Z Contact Number 1 ' v ❑Basement D 1st FI. ❑2nd FI. ❑3rd FI. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps L l Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw C IncandCent Fluorescent SERVICE Amperage Voltage 1 P 3P #Meters #Disconnect ❑Underground ❑New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information D EC Eg VE AUG 3 1 2022 BUI DVILLA N EOF P E BROOK ' AR _10ENT 1 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,if at any time of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other Inspection company.The applicant,owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Inspector Date Finalized Inspector# Company Name ` , )v ; _ Date V . Signature % _ Address 1 City/State ' �,.'i,} Zip Code 1 r r. �, License If ! i Phone# D �( ��� �' I State Wide Inspection Services V �/ 1080 Main Street Fishkill, NY 12524 MAR 21 2023 845 202-7224 Phone 914-219-1062 Fax STATE WIDE INSPECTION SERVICES VILLAGE OF RYE BROOK Email: office@swisny.com R(lIL�INr r'�r'ART�". ^�� Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: M&JP Power Inc. Jose Sagastizado Luis Estupinan 28 Division Street 134 3rd Street Rye Brook, NY 10583 Verplanck, NY 10596 Located at: 28 Division Street, Rye Brook, NY 10583 Section: Block: Lot: Electrical Permit Number: EP22-207 135.83 � 49 Certificate Number: 2022-5515 Building Permit Number: BP22-145 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: 28 Division Street, Rye Brook, NY 10583 The First Floor Kitchen and Powder Room were inspected in accordance with the NYS and NFPA 70- 2017 and the detail of the installation, as set forth below, was found to be in compliance on the 21st day of March 2023. Name Quantity Rating Circuit Tvpe Receptacles 06 GFCI 06 AFCI 06 Switches 08 Hood 01 Range 01 Dishwasher 01 Refrigerator 01 Microwave 01 Luminaires 10 Officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. ■ N �I N ! I N N 4r N � N E" fa a � ■, ^ r OR 0 Ln 0-0 en U OF, _ w LL; w a t z °° H z 00 w u " • wcz � Cn O c� z a `° .� W 0■■1 ✓� G1 F� C M r� 0 z .. ell, H �+ 04 ~ < O 0-4 oo cs Z 9 a W Q F z Z N N ^ ate ug a zo W o a" O U w N � $ 00 z F A z A 0 H U w � 0 - - D F EN ID BUILD I ER 'I MENT AUG 2 5 2022 VIL E OF RYE *)OK 938 KING C ET RYE�B NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT w�vw4ft( ok.org PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: PP#: d— Approval Date: AUG 2 6 Z Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) 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 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. r 1.Address: l D t V���d //�� SBL:� �J/��'/'L / Zone:/�� 2.Proposed Work: r� 3.Property Owner: cJ�'-� �, p�yR-3 %l ZAb,! Address: [(�C� N 3 F Phone#: 14-9 f5— �PCs�O 3 Cell#: email: 4.Master Plumber: "`-e aa4 Address: �b ,p t Lic.#: rc�l Phone#: ?1'lVo241 3(d Cell#: email: Company Name: Address: 1 c INDICATE FIXTURES& LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1 st Floor 2 2nd Floor J 3rd Floor 4`h Floor 5'h Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -1- 8/12/2021 BUILDING DEPARTMENT L� '=' VILLAGE OF RYE BROOK AUG 2 5 2022 938 KING STREET RYE BROOK,NY 10573 ID (914)939-0668 VILLAGE OF RYE BROOK wwwxvebrook.org 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: residing at, 2$ Ac y(S(0 .4 nil i Addic«\chrrc ion lip: 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; C Ji.sr,-, .ti •s% , Rye Brook,NY. (Job.\ddre„i 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 y II Vner(s)) V +Dy`a S 4-664�i 1_=.4-A C> �!Print Name of Property Owner(sl) Sworn to before me this a3 dD Nday of -I V A yJ T O ' 20 2-2- DOMPAGE GAYA VITHANAGE Notary public-State of New York No*OIV16424207 j �• .���- Qualified in Westchester County �} (\ot:u-% Puhhc J My Commission Expires Oct 25,2025 1 7 -3- 8/12/2021 STATE OF NEW YOM COUNTY OF WESTCHESTER ) as: U 7�A1-1 a, M U/L,(A, ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as tfle a licant) and further states that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the el b '-r"Z2-1?- 6,r n 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 �2-3 Sworn to before me this 20 22 day of AI uS T ,20�� Sign to operty Owner SilKatuk of plicant N -7 Print Name of Property Owner Print Name of Applicant MPAGE GAYA VITHANAGE Put:liC•State of New YorkNotary Public NO.01V16424207 Notary Pkblic ed in Westchester County Mphen Smith [:Notary mission Expires Oct 25, 2025 otary Public, State of New York Reg. No. 02SM6418527 Qualified in Westchester County This application must be properly completed in its entirety and mugt R?V&�ofhgfAfagA)Mii'ha?g;t Rs) 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- 8/12/2021 Building Permit Check List&Zoning Analysis Address: 2 _.>ty SBL• Zone�t� ' � U1;� ZL_2_� 'D Const.Type.^� Other. Submittal Date: � Revisions Submittal Dates: Applicant: s/1 6, Z Z�, Nature of Work hN•T�r , 4 Reviews:ZBA: A U G — 8 2022 PB: BOT: Other. OK ( ( ) FEES:Filing.a NotariP: Z SS= '— C/O: Flood Plane: Legalization: ( ) (�APP: Dated zed SBL � n H.O Actio ( ) ( ) 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. ( ) ( RVEY: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: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 EXIsnNG PROPOSED NOTES APPROVED Aux AUG 8 2022 F� Sidw bdain C eccL C Ft H/Sb: Sd.H/Sb: spa: Imp Piddw- HCiAL7Stories notes: Nll":` "t"OOk- A qk-&--:1�1,w ;rO- A., , . . ... .1.1 0, 40 -7,em too, S K SAM V.�t ,m J� . ,. NK OW- MR.I Oil No 0 CN LC > C> cDD C%4 w cz A'Et, j 0 uj 4t m z: V) u 'S w LO cn CD —i LLJ 0 All. ui ui C-0 artion u coo z -10 W4 LiJ 0 0 Z (n dD C\j C) 0 co ci Ctl 0 Q cw 0 co cc M 0 CN .4 1 cd Nf, X X*P- 1p ACCWL> CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) a/1/2022 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 SharpInsurance Services Inc CONTACT Moises Rosales NAME: 128 N Main St PHONE EM).2032479524 FNJC NO:2036638200 Port Chester NY 10573 EIS mrosales@sharpsvcs.com INSURE S AFFORDING COVERAGE NAICS INSURER A:Third Coast Insurance Company 10713 INSURED VMW CONSTRUCTION DELUXE LLC INSURERS: 29 Washington St Apt 1 INSURERC: Port Chester NY 10573 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 ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER M M LIMITS COMMERCIAL GENERAL LIABILITY ✓ EACH OCCURRENCE $1 r000,000 '.',.AIMS-64ADE OCCUR PREMISES Ea occurrence) S SOr000 A GLSIST0001108721 10/02/2021 10/02/2022 MED EXP(Any one person) $5,000 PERSONAL d ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY❑JET LOC PRODUCTS-COMP/OP AGG $1,000,000 OTHER: $ AUTOMOBILE LIABILITYLi 11 COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLALUIB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION L—JSPER TATUTE ERA AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S OFFICER/MEMBEREXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 0�H:' DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (AC ORD 101,Additional Remarks Schedule,maybe attached if more space is required) The Village of Ry Brook is included as additional insured. Operations:Commercial and Residential General Contractor,Roofing. CERTIFICATE HOLDER CANCELLATION The Village of Ry Brook 938 King St SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Port Chester, NY 10573 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Moises Rosales Producer ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD N YS I F New York State neuranco PO Box 66699,Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 0 0 ^^^^^^ 814250493 1 LYNNE MAISONET AGENCY +=� 238 WESTCHESTER AVE � i r:: i PORT CHESTER NY 10573 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER VMW CONSTRUCTION DELUXE LLC THE VILLAGE OF RYE BROOK 29 WASHINGTON STREET 938 KING ST PORT CHESTER NY 10573 PORT CHESTER NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2442 601-7 120473 04/20/2022 TO 04/20/2023 8/1/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2442 601-7, 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 STATE SUR NCE FUND T �V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER 341954076 U-26.3 YORK Workers• CERTIFICATE OF INSURANCE COVERAGE STATE Compensation Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that carrier 1a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured VMW CONSTRUCTION DELUxE LLC 914-S65-1214 ATTN: WILMER COJITAMBO 29 WASHINGTON STREET PORT CHESTER.NY 10573 1 c.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Onlyrequired if coverage is specifically limited to certain locations in New York State,i.e.,Wrap-Up Policy) 814250493 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company THE VILLAGE OF RYE BROOK 938 KING ST 3b.Policy Number of Entity Listed in Box 1a" PORT CHESTER, NY 10573 DBL502830 3c.Policy effective period 03/24/2022 to 03/23/2023 4. Policy provides the following benefits: © A.Both disability and paid family leave benefits. B.Disability benefits only. ❑ C.Paid family leave benefits only. 5. Policy covers: © A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. ❑ B.Only the following class or classes of employer's employees: 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 NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 8/1/2022 By )IJ40 V f (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Name and Title Richard White, Chtief Execrative Officer IMPORTANT: If Boxes 4A and 5A are checked,and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE. Mail it directly to the certificate holder. If Box 4B,4C or 5B is checked,this certificate is NOT COMPLETE for purposes of Section 220, Subd.8 of the NYS Disability and Paid Family Leave Benefits Law. It must be emailed to PAU@wcb.ny.gov or it can be mailed for completion to the Workers'Compensation Board, Plans Acceptance Unit, PO Box 5200, Binghamton, NY 13902-5200. PART 2.To be completed by the NYS Workers'Compensation Board (only if Box 4e,4C or 5B have been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law(Article 9 of the Workers'Compensation Law)with respect to all of their employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note:Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1. Insurance brokers are NOT authorized to issue this form. 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