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HomeMy WebLinkAboutBP22-186PERMIT # CD DATE: Q EXP: /o S ., SECTION S� BLOSK TYPE OF WORK JOB OWN EST. COST �z V/co #_ TCO # FEE DATE INSPECTION RECORD DATE I NSP fJTHER APPROVALS ARS 'yc)'&734q BOT -- e S7 a ,/I�i�a Q o_3) =3-a / 7n PB A ;ZBA OOTH FOOTING - FOUNDATION FRAMING RGH FRAMING INSULATION � -/ 711 T - glb8ras7o ,B CC�A1 y PLUMBING 3d RGH PLUMBING GAS 0 SPRINKLER ELECTRIC 000,0 LOW40LT TALAR 0 AS LT 0 FINAL �a � VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 23-040 Certif irate of Orrupancr This is to certify that T Do 5din cua-t-7Qw of, 2)-C)C)VI NI , having duly filed an application on F�brOOk-LA .=?, Q.20 03 requesting a Certificate of Occupancy for the premises known as, ) 2, Lim ffi I I J J r l ye , Rye Brook,NY, located in a �I� Zoning District and shown on the most current Tax Map as Section: '5, Block: _J__Lot: , and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. ?- , issued L 200-� 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: - ral / , Construction. , for the following purposes: �rJ �/��(�}� hQ mr06rn re�6 yo fiar) 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, Lwhether by extending on any side or by increasing in height shall be made,nor shall the building be moved from one location toanother until a permit to accomplish such change has been ob d from the Buil Inspector. cting Building Inspector,Village of Rye Brook: DatcMAR 1 3 2023 3 DF C n v 1 R For office use only: DDBUILD ENT PERMIT FEB 2 2 2023 VIL OF RYE` OK ISSUED:/0--.55=c_)4 8 KING STRE YE BROOK, YORK 10573 DATE: VILLAGE OF RYE BROOK 193106 Cps FEE: PAIDAF BUILDING DEPARTMENT APPLICATION FOR CERTIFICATE OF OCCUPANCY, CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION ►if4#}#4}i►ttf►tt4#4###;4#}####}f}}f##4#f#fi#4}##}#►t,#fit##4if#kk#i#i}##kit►###4##4#kit######f►►i#f44####i#f##i#if►f►i►f####44 Address: �g ��/L( /�l/,C,C /�yf, �iC�©D� /Vy// Occupancy/Use: f `,4--'44 Parcel ID#: /35 5Q Zone: Owner: ,`tl hyowJ Address: 11.k Di�VE, RU 40sw of 4 P.E./R.A. or Contractor: Gp&5 7)(n 7-LW Address: /'?/ Alo�j 4 4-T i¢l/—,,=- Person in responsible charge: <<p g ���i4-S%� ,(/�To 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 NEW YORK,COUNTY OF WESTCHESTER as: ,5E 14.51'64 O A4 (> being duly sworn,deposes and says that he/she resides at Z�06,,(9- A i/� (Print Name of Applicant) (No.and Street) in `J� Al&,//G // ,in the County of �/�/� F/�L l� in the State of—j(�,-,—r,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: oOp for the construction or alteration of: 04 A �,,Q T/,l,�C0,4A /[ X//2 "El42 41- 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. J Y_ Sworn to before me this �V I Sworn to before me this 3 dayof SKP16wk , 20aL Aday �D , 2022 Signature of Property Owner Signature A Applicant _ utt 3 . 0 ko a,r S,--Bras-7_/A0 4. & tt Name of Property Owner Print Name of Applicant JOIM 1 FARIAti Nato Public,State of NtwrTo* I^ - No.Ot FA6252201 Ouefared in Queens Cmffft MaryPublic Certificate Flied In New York Countp o ry A Commission Fxpk"December 5,2023 P� NOTARY PUBLIC.STATE:OF EW YORK Registration Nil.OISA6365173 8 1?i'_01-1 Qualified in Westchester County Commission Expires 10-02-2025 o�A DRC�k 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 - - - - - - - - - - - - - - - - - - -- INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - 1 ADDRESS:— � ��l ` y Vp DATE: 1 TE. PERMIT# ``/ ISSUED: � T: BLOCK: LOT: LOCATION: AQ I L-�C CTQ(' 1( %CCUPANCY: ❑ 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 0INAL THER QyE BRI 04 1982 BUILDING DEPARTMENT /ASSISTANT UILDING INSPECTOR BUILDING INSPECTOR VILLAGE OF RYE BROOK DE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS:- � C � 1 -� I ' �� DATE: PERMIT# �� J 1�� ISSUED:ICE �ECT: 7✓� BLOCK: LOT: LOCATION: E1`x� �" 6 K�� �V�, 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 1 t M1 ■ w P4 a s 11 ■ W v W L ■ w � o � XI ■ 1"L"I CA �; '�a a i� nNi ti e L O V N ■ off. u rg 'd Ln 1,4 ■ z v� ° C3C/)O O v pp � � � ■ r h� 00 ff��] ~ b y z �.y G1 � � M '� z N W v� � . v ca � ■ �o Q o w Ayo � V a Z E"y v u �3p � v o p V CIN ■ M \ n ~ c Qom' `� w ll p f-� Cn N a o •� � � A F~1 V Vd d V r4, ° �oy HgjoQ ago z rT� CW7 QA " c � 0 A BUILD MENT D [E C IE O�E VIL E OF RY OOK 3D 938 KING t.'r RYIF.BR ,NY 10573 OCT `3 2022 `1 - VILLAGE OF RYE BROOK BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: OCT - 4 2021 Approval Dale: Permit Application Fee: S Approval Signature: Permit Fees:S 3�� Disapproved: Other: Application dated: is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing building,or for a change in use,as per detailed statement described below. J- 1. Job Address: /BL: 'tJ.J r�lV-1 bra Zone: 2. Proposed Improvement.(Describe in detail):, k-, F U1 ,E X l S Tom/(.? HA 4 6 Tf/6OU/Lt G - 1-015 f/ iV 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: ,-X' Yes: If yes, indicate: TIER I: TIER II: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system(Fire Sprinkler, ANSI,System, FM-200 System,Type I Hood,etc...) :No:�_Yes: (If yes.please submit a separate Automatic Fire Suppression Symem Permit application& 2 sets of detailed engineered plans) 5. Occupancy co 2 fam.,comm.,etc...)Prior to Construction: After Construction: 6. MY State Construction Classification: N.Y.State Use Classification: 7. Property Owner: h u d►! Address: $ I60i"C' o y Phone# Cell# oy% email: 8. Applicant: Sr-15,15714o 4-S. )J---T� Address:�� �/d/S,4�e T ,�I/�� 6iPELNIVC,fi G7, Phone# .20_�; 2,2 , / Cell# email:S_A'-f4Sr1AM•tiE7oe&Hoo. c—oro., 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# email: 11. General Contractor: 5",,4 S T1,i4c Nor- TO Address: 19/ p b�6— Phone# Cell# .Z©3,2.1 32I 0 email: 12. Estimated cost of construction $ .20. onO tNOOTF,:The estimated cost shall include all labor,material.scall'olding,fixed equipmeni,professional fee,,and material and labor which may be donated gratis,r 13. Job Timetable: Start: CSC%• 10711 Finish: (1) 8/12/2021 BUILD MENT VIL OF RY OOK 938 KING ET RYE BR ,NY 10573 <L 4 w ar lC**ir of it%*if lE]FJ4:F is ie l'C%]f]fif]fiC%it%F**%ie it i it ie se irx ie ie**%%ir:Fit*vF aF:k*:Fie*k 9e*%%%%%%%%%%if*ie74%*if]F]Fir%IF%*:F%ir%%%%%%ir SF'k sF]F***%%ie% 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: 1 .5, �01 3. 1l��rJ� , residing at, it ElM Rit,t (Print nanie) (Address%where)Diu 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; L-M f)-k v k�� v©'e , Rye Brook,NY. oh 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. 5 .le (Signattn•e ol'I'r( erty Owner(s)) 4o 19R IJ (}Tint Name of Property Ownci 11 Sworn to before me this y of S(MIAMA , 20 a:k JOHN I FAAIA$ —__- Notary Public,State of New llork No.01 FA6252201 Ouallfied in Queens County Qtary Public) Certificate F4edin New York County Commission Expires December 5,2023 i21 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: ,5t 13,45T/AD X.S. IV ETd ,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 i the legal owner of the property to which this application pertains, or that (s)he is the ,6 & 1 � - - ' /c-X1 SE sT/f for the legal owner and is duly authorized to make and file this application. (indicate architect,contracto,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. r4 Sworn to before me this ak=t Sworn to before me this 3 dayof S I'VAW , 20111 Jigna.turr.f a��r , 20 .22 Signature of Pr perty Owner Applicant 'C39ri 3, b w 0 lili s5,,&Vv'lple �- S. k' Pr' Name of Property Owner Print Name of Applicant JOHN 1 FARM Notary Public,State or New Ybrt r No.01 FA62522ol ary Public QualHied In Oueens county Notary Pu Certtrlcale Filed in New York county Commtsslon Expires December S.2023 ANA M!SALAZAR NOTARI'PUBLIC.STATE OF NEW YORK ReLislralion No.OISA6365173 Qualified in Westchester County Commission Expires 10-02-2025 l-11 8112l2021 N \ M W F A oG N k Z M N O I•-1 C � � � � ,�aS W z Q � � x Q ON c � � H x M C tn z g � O wr. Z o P.4 Z in a 04 a = A w CA x z oc 8 Z c 0 z u z 0 ` �T� �, c� 1•�1 M z W Z T w • � � V , , A H a w = .... w a m Qq w A 7Z A F N x H x � � w H O F .a (zZ c w z W v x o a 4 �+ 00 z wr. z Q o w a 9 a as z � w 0 � BUIL E MENT VIL E OF RYE OK NOV - 3 2022 jD938 IN LI RYi,.B NY 10573 �-----_ - VILLAGE OF RYE BROOK BUILDiivG DrP/,' T MENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP #: Q1 —� �(j EP Q) _CD 7 Approval Date: NOV — Permit Fee: $ Approval Signature: Other: Application dated, 3 c)" is hcreby�Jiade 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,JState,County and Local Codes. l 1.Address: 18 ,�i�/Yf �1/ Z U, �l%,QmD/�F'� SBL: 1 36-1 5-0 �"J�(D Zone:/C_/4 d(t 2.Property Owner: tt �, ��10 M/ Address: IS CLIN %. URIYF 91s. b4ows o Phone#: Cell#: Ill A 13' t1VA email: b �' e�e.�e•� y1�Ce�- 3.Master Electrician: "4 n' .O S 1 J_U A C Address: YIFt - i2N S 7� n I C l�'FS Lic.#:}�_Phone#:�° I H 4 Dj 31 S1 Cell#: q I LID) 31 Sj email: tf St t V A LJOCr 1 e0 L Company Name: H A fLi f) S il V 19 LZ I:CW C p-Z Address: 6V1a-6'e C h"y a ie ft 5 T PC 27 C N'-$ 4.Proposed Electrical Work/Fixture Count: W 1 ra t})C A:—i,+ (1 UC'( f3 y eop e I E to o'L 5 fli C eSSeb a-i b-f+'ry S -- 3 s Ul-� 3 WAIrLaL Seon'P-e al PILk3 " 5.31 Party Electrical Inspection Agency: S V-) ` S **tk ir:k**ir ie*ie:k'r t ie ie is icxxxxxic ie*ic is ie is it it ie*ir ie*ie is xi�ie it k it it icxi�ir*i<c i*ir rc i<F is it iexx xxx xxxic**c is icxir it it ie ie it xis it is is is k is*>F is is�F it�t**F*ic rc STATE OF NEW YO ,COUNTY OF WESTCHESTER ) as: S /'"1 a I'X. J L L (/,ibeing duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant) C�I� ./ r state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the t � i 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 a1" Sworn to before me this day of S0106cf ,2017—� da of 20 a:i Signature of operty Owner Signature of Applicant int Name of Owner JOHN t FARIAS tame of Applic Notary Public,State of New Yolk NM 01 FAM2201 OuelMed In Queens County otary Public Certtncate Flied In New Yod(County Notary PublisHARI MELILLO Commissi Expires December s,202! :'Votary Public,State of New York No.01ME6160063 Qualified In Westchester County Commission Expires January 29,20022 STATEWIDE • Service With hitegrity 0:0 SWIS JOBAPPLICATION0. Office Use Elect.Permit#� fJ � ` �/ Date �) t1 z 2� Bldg Permit# Utility ID# Zz - Final Certificate# City/Village 1 I C Zip Township CountyJ,l t ,,f / Address ` 1 L L Cross Street Sect I> V Block ' Lot / b Owner Name/Address'P�" ' f°�°"�+� f.��` Contact Number Q1 7- 73 41 ❑Basement W 1st Fl. �❑2nd FI. ❑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 1 P 3P #Meters #Disconnect ❑Underground ❑New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information ►�� � � v�J . NOV - 3 2022 � VILLAGE OF RYE B—R..IOOK P: 1ILDING DEP;'`.RTMENT This application is valid for one(1)year from the date received by SM.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 addttional 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 �rI� i (' I !. F: [_t <';a'K Ppi L T to Date j L Z Z Signature �. Address 1 q I C _ City/Stag �,1 Zip Code License# Phone# R [ECENF 1 - 3D State Wide Inspection Services cok-1) I DEC 2 3 2022 1080 Main Street Fishkill, NY 12524 4�/U jg VILLAGE OF RYE BROOK 845 202-7224 Phone �C,/ BUILDING_ DEPARTMENT 9114-2119-1062 Fax STATE WIDE INSPECTION SERVICES •^ --'�� Email: of I IcePswisny.com Service With Integrity Website: www.swisny.com BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Mario Silva Electrical, Inc. Bret&Stacy Danow Mario Silva 18 Elm Hill Drive 121 Grace Church Street Rye Brook, NY 10573 Port Chester, NY 10S73 Located at: 18 Elm Hill Drive, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP22-271 135.50 � 56 Certificate Number: 2022-7809 Building Permit Number: 22-186 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: 18 Elm Hill Drive, Rye Brook, NY 10S73 The First Floor 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 23rd day of December 2022. Name Quantity Rating Circuit Type Recessed Luminaires 05 Switches 03 Fan 01 Wall Sconces 03 Receptacles 02 y 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. 1 � N N a � a a �• k7 F+I a N z a c ►.� ' k Z V p w W u v M C Lnrr) en 0. V zLr) 00 CA CA .,� ✓-� v � H � 8 < can i P4Gy en r- ti z a �, � W o C!) � u 00 W 00 A w � z �•I �• w cs N p o V w � H z AQ0-4 i O Z a W o CN a 00 ON , r ~ Q p 00 w o w zz PLO t a it u4 ~" OC Sri O o cn a w N V � � w U a a 60). � c , 9 O 00 Z W Z oA � � l'I�3��� �1 V,r 9i�ll •�a �'� � � ��M� � �i�11�F C.tit; a E pRntJ D `L� V� L�� fli BUIL y E MENT VIL E OF RYE OK NOV 2 2 2�22 938 KIN T RYl B ,NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT or PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP 4: PP#: 7 Approval Date: NOV 2 3 2q47 Permit Fee: $ Approval Signature: Other: Disapproved: (fees are nun-refundable) Application dated, 4- 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.y' 1.Address: f g ,pCI A /�/(L bt SBL:��i 5(��/—s�Zone:p�-��- 2.Proposed Work: !{ EP�/�G� s/�/OA/E k tl/4Z 740 Ar- 3.Property Owner: %&0 3,b h A d w Address:«Eulk HI��p P�"r , Elf 6tioo w. M'l Phone#: Cell#: email: brrj'j�w„P.��1k►1 •Cor+ 4.MasterPlumber: ,,.� c,-,cytA MELA6P-A00 Address: () 92 WAVf=QL AUK D Lic. #: 1S a i Phone#: 914. 31cj a(.a-j Cell#: q 1 q-319••d(Da`1 mail: SMEL AGRA"O C'56MQ%L •QM Company Name: S. M E L(�G R A�y 4 C. =ryL Address: fY)A h'fA R "tCZ O Y IL W3 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 1st Floor 2nd Floor 3 31d Floor / 4''Floor 51 Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -1- 8/12/2021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: .,b5fr✓PF+ M E L P.GRAivcD ,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. S� Sworn to before me this a Sworn to before me this day of SE 1706L 2 al day of N J�Pry / 20 9L Vv Signature of Ploperty Owner t atur�Appficant Print Name of Property Owner Print Name of Applicant Public,State of New York No.O1FA625220tOua - L& 7*tary Public�7 NOW co a Riend Queens Notary Public Commission Expires December 6,2023 SHARI MELILLO Notary Public,State of New York No.O1ME6160063 Qualified In Westchester County y Commission Expires January 29,201 This application must be properly completed in its entirety and must include the notarized signatures) 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 BUILD MENT D E C E� v E ' VIL OF RY OK DD 938 Knvc wr RYF BR ,NY 10573 NOV 2 2 2022 � �c 40 VILLAGE OF RYE BROOK BUILDING DEPARTMENT xxxxx�xxxxxxxxxxxxxxxxxxx*xxxxxxxxxxxxxxxx*x*xx************xxxxx*xxxxxxxxx****xxxxx*x�x*�*xxxxxxx**x** 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 NEWn YORK, COUNTY OF WESTCHESTER ) as: 3, - �, U A r(u w , residing at, �� E lN1 4�1�� pal �E� Q'1 F �R aa. t f�I Y (Print name) (Address N+here you lire) 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; NP , Rye Brook,NY. (Job Addres,.) 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. 0 OKI, (Siunature ol'Prop ty Owner(')) �(wk 3, Nww (Print Name of Property'(teener(,,)) Sworn to before me this a 1 +,taonfPubfic) S(F144f. , 209,1 JOHN I FARIASPu Notary blic,State of New York No.01FA6252201 Ouaiified in Oueens County Certificate Fled in New York County Commission Expires December,),2023 ('—) 8 L 2o?1 Building Permit Check List&Zoning Analysis Address: 9L) L c. . SBL Zone:'2' Z- Use: Z 1 Cont.Type: Other. Submittal Date: D ZZ Revision Submittal Dates: Applicant: —y>A N o w Nature of Work: I N i o" TZ� �l, Ttn Reviews•ZBA: OCT - 4 Z OZ 2 PB• BOT• Other. OK ( ( ) FEES:Filing. Sz ,/ BP: C/O: Flood Plane: Legalization: ( ) (-3*�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: Sealed Copies: Electronic: Other. License: ,� Workers Comp: ✓ Liability: Comp.Waiver. Other. ( ) ( ) CODE 753#: Dated: N/A: (� ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other. O O 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:Plan: Permit: N/A Other. ( ) ( ) H.V.A.C.: Plan: Permit: N/A Other. ( ) ( ) FUEL TANK:Plan: Permit: Fuel Type: Other. ( ) ( ) 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter As-Built Plan: 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 REOUIRED EXISTING PROPOSED NOTES — 4 ZOZZ Ate: Date: c.;ntr Front: F >30r. Main Cow Acts.Cov Ft.H Sd.H/Sb: SOFA: Tot,Ian : Fc Imp Height/Stories notes: 7 � T \ c G 10 ism 00 Y 0 J o�2ciior� ` A>A , Pik uj 4 VOW ,� ✓ = tun) ti ) 41 �k C j ,4c R CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD(YYYY) 9/19/2022 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 Sharp Insurance Services Inc CONTACTNAME Moises Rosales 128 N Main St PHOA'C"E 2032479524 aC N, 2036638200 Port Chester NY 10673 AIL ADDRESS: mrosiiles@sharpsvcs.com INSURERS AFFORDING COVERAGE NAIC0 INSURER A:Obsidian Specialty Insurance Company 16871 INSURED E&I Construction LLC INSURERB: 191 Hobart Avenue INSURERC: Greenwich CT 06831 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DDIYYYY MM/DD/YYYY LIMITS 6/ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 AMAGE✓ CLAIMS-MADE 7OCCUR PREMISES Ea occurrence $50,000 A SCB-GL-000003675 03/09/2022 03/09/2023 MED EXP(Any one person) $5,000 PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $2,000,000 ✓ PRO POLICY❑ ❑ LOC JECT PRODUCTS-COMP/OPAGG $1,000,000 OTHER $ AUTOMOBILE LIABILITYLJ COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY AUTOS ( ) HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DIED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N ANYPROPR I ETOR/PART NER/EXECUTIVE OFFICE R/MEMBER EXCLUDE D? ❑ NIA E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ EDIIIF7 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Additional Insured:Village of Rye Brook is included as additional insured. CERTIFICATE HOLDER CANCELLATION Village of Rye Brook 938 king St SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Rye Brook, NY 10573 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Moises Rosales Producer 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD 4 \\ NYSI F New York State Insurance Fund PO Box 66699,Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 51 �' IN ^^^^^ 371954820 SHARP INSURANCE SERVICES INC 128 N MAIN ST a PORT CHESTER NY 10573 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER E&I CONSTRUCTION LLC VILLAGE OF RYE BROOK 191 HOBART AVE 938 KING STREET GREENWICH CT 06831 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE X2566 360-0 92911 03/10/2022 TO 03/10/2023 9/19/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2566 360-0, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STAT SU NCE FUND /vY �/ DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 866995712