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HomeMy WebLinkAboutBP22-167PERMIT # /,J/ SECTION TYPE OF WORK JOB LOCATION EST. COST v/c0 # c J 7 DATE: 9 4 c c� EXP:. TCO # FEE DATE INSPECTION RECORQ I DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING lz qTraVel�soc/4e/KeSFn31e,IWo(9/tt) YQ6 3/mil - rAe(:)o1w10 �je O/i✓eir4 C9/y),DI7- eW19 Pc 39/ 4fUdS)%7 �� GAS ,.CI ELECTRIC SPRINKLER LOW -VOLT O r ALARM AS LUILT 0 FINAL MEN I OTHER APPROVALS VILLAG9 F RYE BROOK WESTCHESTER COUNTY, NEW YORK No: 23-151 Certificate of Occup ucp Ehis is to certify thatt��10 "/y V?ros' U/-e I /e lQ LUOc060 -7�OVsa cle- 9� Jae 16 of, tQue- Byonkt /V 7 having duly filed an application on -SPy 7, 20 requesting a Certificate of Occupancy for the premises known as, Rye Brook,NY, located in a Zoning District and shown on the most current Tax Map as Section: 1 5•Z S Block: Lot: 43 and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. - , issued 1v2 20, , such authority and permission is hereby granted to the property owner to lawfully occupy or use said premises or building or part thereof listed under the following New York State Classifications, Use: 10ne-J22ml'A Construction: for the following purposes: rP,!'�UyQ�IOYI Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of the building or in the exit facilities shall be made,and no enlargement, whether by extending on any side or by increasing in hei shall be made or all uilding be moved from one location to another until a permit to accomplish such change has ee obta' o the ilding Inspector. SEP 2 1 1013 Building Inspector,Village of Rye Brook: Date: JD �R� For office use onl SEP - 7 2023 BUILDITMENT PERMIT# _ _/6 7 VILLAGE OF RYE BROOK ISSUED: /l Q- VILLAGE OF RYE BROOK 38 KING STREtT,RYE BROOK,.NEW YORK 10573 DATE: BUILDING DEPARTMENT (914)939-0668 FEE: , //D— Pe.>DJiii� —`--- www.rytbrook,ori! 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 ►f/t/tt/ttt♦t►f►■f►■ ►►ftf►►►t►►►####ttt##■f####tf►#t#►l►ttltt►►tt■t►►t►tt►►4####t##tff#ffft►►flft►tt►t►##►###t#tttftttt####t# Address: 260 l n-124Sy L�r`-O w v% 1,\8 Occupancy/Use: N/ Parcel ID#: "� �� �' 3 Zone: Owner: br,& `.'o Vey,„4 fj el r- \71.e Address: 'z'- 6 D e y ,l-ow t-, P.E./R.A. or Contractor:-�,aplw L44 A Address: Person in responsible charge: /V/(gR k /r��IMA Address: J /V Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance o a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF 7W YOR1 K,COUNTY OF WESTCHESTER as: eQ /J being duly sworn,deposes and says that he/she resides at �- (Print tq..Y7 of A 'cant) (No. d Street) 1in �e / �,in the Countv of y v p S C r�'S _ _in the State of— that (City/Town/Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$ 1� for the construction or alteration of �!-7 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 Sworn to before me this © T day of AV4 V K- ,20 day of g s vP� , 20 Signature of Property Owner Signature of Applicant BA A00 VkZ,s JQ �e�� ,�✓� `mod eto�� Print Name of Property Owner Print ame of Applicant Notary Publi Notary Pu6bc GREGORY M.RNERA N11CHELA PAGLLaRA Nelxy pUbk,slat.oI new pork 1/1 212 02 1 NOTARY PUBLIC No.01R"1398 STATE OF 01 YORE: Raei;crarionNo. QYa1�d in Waskhesler County � 01PA6•�19s:a Qua ,d in New York Ciry CCIIIIb 1 Expirn Uptbmber K, Q.. Nf%Commission Expires' L.L•� ,n,: QyE BRC�k. Q 1982 BUILDING DEPARTMENT UILDING INSPECTOR ❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street . Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INS P CTION REPORT - - - - - - - - - - - - - - - - - -- - 0J � � ADDRESS • 1 DATE' 1 ' A PERMIT# / 2 L- I ` 1 ISSUED: `JECT: BLOCK: LOT: LOCATION: �_. `moonS�UCX OCCUPANCY: 1 b ❑ Violation Noted THE WORK IS..I 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 FOSS CONNECTION AL HER , m t x Q W m CV r� M c, s °, CIAlit O `n 1 L P-� a mt L � a 1 z o O ►,_� IR c � O Z Y! +r � T W co 0 o � rl A o o p 00 y W p W N 3 .; - O � z a wo b C a � ^ ,��., ICI � � ,�W z N � � � � � o •5 c�a 'Ico O w o w � O z A A� R. � a o o w w O c°� zI) b a oON 04 n I W H � �'`� Z CI O c u pp v �7 a c ' n '00 �► V� H ° ° � vo o N x o U . Xo � a H A U O4q -cy o h °' W x © O W u 8 ,0 A .� A w � cU.7 � A Z O � i � � o � � • m v� � a•v o �""� _ w z a ° � 5 0 �2i-sil GQ RW 0 BUILDING DEPARTMENT �r— ��� VILLAAGE OF RYE BROOK SE - 6 2022 938 KING STREET RYE BRook,NY 10573 _ (914)939-0668 VILLAGE OF RYE BROOK www.ryebrook.ore BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Approval Date: S E P — 8 2 Z Permit Application Fee: $ Approval Signature. Permit Fees:$ ( �d • "' Disapproved: Other: Application dated:C f 0 is hereby made to the Building Inspector of a Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing building,or for a change inWIJ11 per de state t describedbelow. [f1. Job Address: YUJISBL: a� /` /3 Zone: 2. Proposed Improvement.(Describe* detail): t� r 3. Does the roposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No:7 Yes: If yes,indicate: TIER I: TIER H: TIER III: 4. Will the proposed project require the installation of anew,or an extension/modification to an existin automatic fire suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...):No: Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed ngmeered plans) 5. Occupancy;(1 fam.,2 fam.,comm.,etc...)Prior to Construction:_L,—TQM After Construction: 6. N.Y State Construction Classification: N.Y. State Use Classification: f ,� �^ �, r�,.,,, 7, Property Owner:, r'J a yr4 i ., 2, Address: ZbC� `�/ tCr' t Z Z 2 2 Phone# Cell �,�'�/ 'S� email: }��yy��,, 8. Applicant: �, Address: i 0 Phone# - i' Cell# em 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# email: 11. General Contractor: t •I Address: 0J 4 y ll Phone# Cell# email: V 't 12. Estimated cost of construction $ (NOTE:The estimated cost shall include all labor,Aterial,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 13. Job Timetable: Start: Finish: (1) 8/12/2021 BUILD MENT VIL E OF RY OOK ----� 938 KING ET Ri,E BR ,NY 10573 SEP - 1 2022 I L -0 �I VILLAGE OF RYE BROOK BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE Z 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: 3J, bRuNO UL M,S b f'tE L'J , residing at, Z� W C�2y N 2� (Print name) (Address where you live) being duly sworn, deposes and states that(s)he is the applicant above named, and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; flkoW N R_'_1 , 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. (Sign turc ofProperty Owner(s)) (Print Name of Property Own er(s))Sworn to efore me this 2T' da of 1yw sr . 20 yz/ Y I otar� ' DREW AL6CMDER Nofdly Nft of Now York LID.OVA"160 COON i1 031W/2025 8/12/2021 This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. Please note that application fees are non-refundable. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: L�kvNo Vc"q D� ark Lo ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. 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. T" q Swom to b ore me this i Swom o bbefflore me,thi - day of U 6vf , 20� day o , 20 S' ature of Property Owner Signature of Applicant Print Name of Prop er t Nanle of Applicant i Notary Publ' No b�ro DMW ALECANM _ Notay PtAft of Now York AT L L N M 0 D i I.O.C"ALM1W COMMISSION EXPIM 03/01/2025 NOTARY PUBLIC.STATE OF NEW YORK Registration No.01 M06234649 Qualified in Westc °st fou t My Commission Expires: _771- (4) 8/12/2021 a i Y 1 i' ■ � i L r � c w rA 1..1 r+ w v: :� �- .:: x ►� ¢Lin H oH 2 w tnqttLr) x A oz � 04� o � N w � w ad Ln 44 00z o w Q o06 w z W 00 M MM 9cy V � i °" F 0 - ° ° a c� z c z w z A 0 >- a H rA Z a w = � a a MEcFE �Y[F' D BUILDING DEPARTMENT MAR 2 3 2023 VILLAGE OF RYE BROOK VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573(914)939-0668 BUILDING DEPARTMENT www.iyd_gg2k.org ELECTRICAL PERMIT APPLICATION Westchester County Master ElectriciansLicense Requirred2 FOR OFFICE USE ONLY BP#: Q D— J b / EP#: Q 3 —O 71 Approval Date: MA 2023 Permit Fee: $ 50 —) Approval Signature: Other: Application dated, is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove electrical equipment,wiring, fixtures, or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicableFederal,State,County and Local Codes. 1.Address: 6 C) 4�� S p r�U�✓� 1`C:� SBL: /3 Zone: f C) 2.Property Owner: A f'-\V el.e 54-.e.v hcx n Address: Sgn1c Phone#: Cell#: e `'S 10-9— email: 3.Master Electrician/Licensed Installer: t/. e/ke Address: l02 &k / Lic.#:_/863 Phone#: q/�/-S(� ')/'( Cell#: email: Company Name: —Z.4 D Address: /p) 4.Proposed Electrical Work/Fbx ure Count: 5.31 Party Electrical Inspection Agency: 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 for the legal owner and is duly authorized to make and file this application. (Master Electrician/Licensed Installer) 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 Q cc�c_ 2p 2 Signature of Property Owner iMa" a of A�cant C'leiy Print Name of Property Owner t ame of Applicant No Public , STY No Public SHARI MEULLO Notary Public,State of New York No.01ME6160063 Qualified In Westchester County Oommission Expires January 29 � STATEWIDE • Service Willi haegril.v 1:1 office@swisny.com SWIS JOB APPLICATION84 1 914.219.1062 SWISNY.com • Off,ce Use Elect.Permit# /'/�3 Date Bldg Permit# Utility ID# .1 4� ,�) - 6 Final Certificate# City/Village Zip Township County Address v b 6� C - \ ;) Cross Street Section Block lot Owner Name/Address(If different than above) tV Ic �, Contact Number V1 U/ `LS Basement ❑ 1 st FI. 2nd Fl. 3rd FI. ❑More Than 3 FI. ❑Garage Attic Outside Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent SERVICE Amperage Voltage 1P 3P #Meters #Disconnect ❑Underground New Reconnect / ❑Overhead ❑Change Visual Re-Inspection Safety Re-Inspection Re-Inspection Additional Information MAR 2 3 2023 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,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 applcant,owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Inspector Date Finalized Inspector# Company Name �,q - Z/f .i � Date 5 �� , Signature �" v Address City/Sta� Zip Code License# /�V 3 Phone# Ct f _ S' / D State Wide Inspection Services 1080 Main Street Fishkill, NY 12524 a APR 14 2023 JD 845 202-7224 Phone I_ 914-219-1062 Fax STATE WIDE INSPECTION SERVICES VILLAGE OF RYE BROOK Email: office@swisny.com I Service With Integrity BUILDING DEPARTMENT Website: www.swisny.com BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: A-ZAP Electric Bruno Stephan Veras De Melo & Paul Cilento Luciana Traverso De Resende Melo 12 Harmon Street 260 Betsy Brown Road White Plains, NY 10606 Rye Brook, NY 10573 Located at: 260 Betsy Brown Road, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 23-071 135.43 � 43 Certificate Number: 2023-2135 Building Permit Number: BP 22-167 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: 260 Betsy Brown Road, Rye Brook, NY 10573 The First Floor Master Bathroom was inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 14th day of April 2023. Name Quantity Rating Circuit Type GFCI 01 AFCI 01 Switches 03 Recessed Luminaires 03 Exhaust Fan 01 AFCI Breaker 01 A Visual Inspection of existing conditions was performed on April 14`h, 2023 of the First Floor Master Bathroom and Conforms to NFPA 70-2017 NEC. No Defects Were Noted. .� �7_ �- r1=- 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 � O O � O W N � L a a F+� (zo N M W t. a W enw 0 ti er V AW, °� N W O M A z Ln 1' z ci r h� 00 O W V w � H o g A �, o " a e, U Z W Z � � � x z 00 MM ~ O w z g r a z Z (i zz eq 5 , F+ r 00 U ,�4 W C oar U 4~9 i C � N Q a z R EC EHE D BUILDING DEPARTMENT OCT 2 6 2022 11 VILLAGE OF RYE BROOK VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 BUILDING DEPARTMENT (914)939-0668 www.rytybrwk.org PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: PP#: � Approval Date: OCT 2 7 2022v Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) ************************************************************************************************** Application dated, /O-2 G Z Z is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agree that said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: 0?60 'EeASt l 'hrOtx1 n R0 CLd SBL: /35- L43 �-3 Zone: /d 2.Proposed Work: r orn L-e-and i 7-.-Mori 3.Property Owner::// F/ rL*4D 5 6e I�4() Address: J c/ r064-J4 2C AK Phone#: 17-/ 3/y� Cell#: email: -� �, - 8 Gary 4.Master Plumber: till( a-%o l /Address: fy /C��'44ce �T4�y /Vy Lic.#: 1543 Phone#: 3y 7-�1 D"09 CeeAll��#: 9 "V1'1-31J-9 email: //__ Company Name:riUejun of i n�y� "LA!@�"ddress: �j�i✓t,/!!/I/! �/�'LcCC �Tt7/�U �o/'fle /V/ L.,-L rT� 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 2nd Floor 1 3'Floor 1 4th Floor 51 Floor Exterior 5.*List Other Equipment/Provide Details: e- of, B T 22 -' 6 (Notarized Signatures Required Next 2 Pages) -1- si12no21 BUILDING DEPARTMENT D D VILLAGE OF RYE BROOK R OCT 2 6 2022 938 VJNG ET RYE BROOK,NY 10573 -0 �$ 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 YORKII, COUNTY OF WESTCHESTER ) as: residing at, 2EYU (Print name) (Ad ess where you live) being duly sworn, deposes and states that(s)he is the applicant above named, and further states that(s)he is the Nei legal owner of the property to which this Affidavit of Compliance pertains at; , 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. (Signs e of Property Owner(s)) (Print Name of Property Owner(s)) �Tµ Sworn to before me this day of a-FOO61— , 20 22 DREW AU ANDER Notory Put)NC of New York I.D.DIAL641646 COMMISSION EXPIRES 03/01/2025 blic -3- 8/12/2021 STJLU OF NEW YORK.COUNTY OF WESTCHESTER ) as: being duly swom,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and fiirther s Mu,"h hat(s)he is the legal owner of the property to which this application pertains,or that(s)he is the 5 4 A, 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. r Tit Sworn to efore me this26 Sworn to before e this b day of OTb/3fr— ,20 ?/ day of b C 9L e� O� Si ture of Property Owner Signature of Applicant _ "s d o )'��V/- C 9-,—121 Print Name of perry Owner t Name of Applicant S I E � c No r DIMW A,N,NR o.01ME6160063 Notary A+tft of Now York Qualified In Westchester County 1D.OIAL641646 Commission Expires January 29,2423- OOMM MON EXPRES 03/01/2025 This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s)of the subject property, and the applicant of record in the spaces provided. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- 8/12/2021 Building Permit Check List&Zoning Analysis ,Address: la-:1 SBL: __Z1 3 Zone:.2"l o Use: Z( o Const.Type Other. Submittal Date: Revisions Submittal Dates: Applicant: C_ V ill--g, Nature of Work: L rc1 A L,I ZF-- 11.)717 Z_,z 0— Z.kTlA- -0Z 0 u 11�co�_1 Reviews:ZBA:` S E P 8 - 2-011 PB• BOT• Other. NEED QK (✓f ( ) FEES:Filing. 7 S BP: l D - _C/O: Flood Plane Legalization: ` 't O• � ( ) (✓)' APP: Dated: ✓ Notarized. ✓ SBL: ✓ Truss I.D. Cross Connection H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening. ( ) ( ) ENVIRO:Long. Short: Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection S/W Mgmt.: Tree Plan Other. ( ) ( ) SURVEY-Dated: Current Archival Sealed Unacceptable: PLANS:Date Stamped ZSealed Copies: 2 Electronic Other. ( ( License: ✓ Workers Comp: sty: V Comp.Waiver. Other. ( ) ( ) CODE 753#: Dated N/A: (Jr ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit N/A: Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other. ( ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit H.W.I.C.:_Battery:_Other. PLUMBING:Plans: Permit: Nat.Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A: Other. ( ) ( ) H.V.A.C.: Plans: Permit: N/A Other. ( ) ( ) FUEL TANK:Plans: Permit: Fuel Type: Other. ( ) ( ) 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other. ( ) ( ) Other. ( )ARB mtg. date: approval notes: ( )ZBA mtg.date: approval notes: ( )PB mtg.date: approval notes: REQUIRED EXISTING PROPOSED NOTES APPRUVLU Date: SEP - 8 2022 Front: Main Cor. Accs.Cor. H S S .H Sb: Tot.imp: Fc Imp Pang HHight/Stories: notes: r ` Y� ul c r I/ �l O O �� Ir•I � M[� (�t � S � p cc o � m E"y a � z '� w o cm 46 46 oo , v , O � m m C :s W a • "'' �"� a a .92 , ^ V6o -let w �, � z ICU �I� I O �lr 4� 4. 7• _ r �f A+ ri ow ' �I •fi.i� tti'1.- r ;�,.,_ ...--� �r v.,G � � �. A 1� ��`-.�. `, �'+ `� � � / �� ,!'''1i � ' � All' .., � .. - ,. ��� � ��� / � R „ `\ �`� ,�,�%' \- \`\ I 1 w r 1 h l 4p 9. SAY t 1 � ok .00 ko Of is r_ t 16 e v - t- - tIj•, . JA . .1 _.;. ' L __ � t, 1 _ , �, _ �, 1 �: . ��� ��� f� =-- ��. :� _ _. yy: �..,,�� r�► t „�:. .,ems . �. ��� e - _ __ s =:.'�w � ��—�--� r ~""^'e.. �. , � � +�tv r - Laura Petersen From: Theophilo De Oliveira <tappanzhomeimprovement@gmail.com> Sent: Friday, September 9, 2022 3:47 PM To: Laura Petersen Subject: Re: Building Permit Application - 260 Betsy Brown Road Hey! Thanks for the email Theophilo De Oliveira (me) 914-217-6648 Thanks Laura! Kind regards, Theo On Fri, Sep 9, 2022 at 3:45 PM Laura Petersen <LPetersen@ryebrook.ors>wrote: Good afternoon, The building permit application has been approved by the Building Inspector. Before I can issue the building permit the following items must be submitted to our office, 1. General contractor's contact name & phone number. Thank you Laura Laura Tetersen Office Assistant Village of Rye Brook 938 King Street Rye Brook, New York 10573 Phone(914)939-0668 1 Igetersen(Wrvebrook.org 1 ^ Q •, „ ��g/�►►ill ` �ti 0, gyp ' ► � . co ro u j f.: k �• 4"r G. v � t� Co)►� 7,7 r ltp . J t *t,~Lli > 164 e Ction ' ui ^,�r� � W J o I Y' rvly: > W CL u ~ c =M R?c" U j 6(acm)> J 'J 4 :, •,.� z 1. __•-':,.cam_ `��Y-�_ Y� '��� ry����'tl�lh\�"+�,� f Z-��- � � �. _''-r,.:tom-_ �'��'! +y4p�y�,��1'/ti� :'�-•,�ti;,""�„ '� . ^m Iq� K' ACC{ ('� DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 8/29/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: WB Wm. E. Morrell, Inc. PH (A 914949-0904 Fac No: 914 28$999 128 Court St EAD�DRess: inf orrell-insurance.com White Plains, NY 10601 INSURERS)AFFORDING COVERAGE NAIC# License#: INSURER A: UTICA FIRST INSURED INSURERB: Tappan Z Home Improvement Inc. INSURERC: INSURER D: 21 Prospect St. INSURERE: White Plains NY 10605 INSURERF: 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 �ypE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRINSD Ma I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 RENTED CLAIMS-MADE X j OCCUR PREM SES GE ToE.occurrence) $ 50,000 MED EXP(Any one person) $ 5,000 A ART3000296720 6/25/2022 6/25/2023 PERSONAL&ADv INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JEC7 LOC PRODUCTS-COMPIOP AGG $ 2,000,O00 OTHER: I s AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT = E accident ANY AUTO BODILY INJURY(Per person) t OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOSHIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY E AUTOS ONLY Per accident a UMBRELLA LIAB OCCUR EACH OCCURRENCE t EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDT I RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE ❑ NIA EL EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) EL DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Village of Rye Brook named as add'I insured's in regard to general liability-subject to written contract,terms, conditions 8r exclusions of the original policy at the time of issuance by the insurance company. 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 REPRESEN7TIVE ©,"A8-2015 ACOR C R RQIT1 N. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD / • NEtlI' v�^ CERTIFICATE OF i - NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a.Legal Name&Address of Insured(use street address only) 1 b. Business Telephone Number of Insured TAPPAN Z HOML 21 PROSPECT ST WHITE PLAINS, NY 10605-1114 1c.NYS Unemployment Insurance Employer Registration Number of Insured 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 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Village of Rye Brook St. Fire alty Company 938 King Street 3b.Policy Number of Entity Listed in Box"1a' Rye Brook, NY 10573 98-CR-13'9: c. 3c.Policy effective period to 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"2". 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: Terence (Print name of authorized representative or licensed agent of insurance carrier) Approved by: 19AAe4C _ rruBCA4iLAZ_ C)g/29/702Z (Signatu (Date) Title: Agent Staff Telephone Number of authorized representative or licensed agent of insurance carrier: 914-372-777C 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 Y F- Z 0 z (� oW o x � oj� 0 o m x o W cli Q CD jl ' a c� �, o L �� g Cl- J _ Q C_ d C 00 O O 'MA co N • I C 0 o o Ln c U' o � JL H r Q 0 0 T I �- r+o c z ca 1:3 ca ED N N c � N I CL cp ; tD cD N C •O 00 r W•Q r � W az uO •- QmWm �`tQ � n�