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HomeMy WebLinkAboutBP22-224PERMIT #/V/- cDATE: Qa It P(P; //16, 3 SECTION 730. 7 7 BLOC � LOT TYPE OF WORK /0/0� VQ i. O /) JOB LOCATIONLL iluJloZri 0 d, OWNER<57�✓C�.�1 C % Z e /Z ���% .�lOdlO _ / CONTRACTO Q N i*` (!0l / O C� t��l�/Ip �7-3/OJ EST. COST � �O. C.' FEE l % V/CO # C9,: � ) 4 FEES A/0 Pb DATE iY3 TCO # FEE DATE DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS SPRINKLER E LECTRIC LOW -VOLT e ALARM AS BUILT FINAL {NSP 6c)3_ 03 7/,"l 1)-e iro ckC�l c OTHER APPROVALS ARB BOT PB ZBA OTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 23-084 Certificate of ®ccupaucp r his is to certify that ` `hi CC of, �Yo� t►v having duly filed an application on 20 0' � requesting a Certificate of Occupancy for the premises known as, &4 M110=Z2drhf R00a , Rye Brook,NY, located in a/� 5 Zoning District and shown on the most current Tax Map as Section: 00. / Block: / Lot: U and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. - 'q , issued 202J, 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: N ' ) Construction: for the following purposes: /� �—�/" d YP� Va-I'`6}� 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 th cilities shall be made,and no enlargement, whether by extending on any side or by increasing in heig s be de, or sh 11 the building be moved from one location to another until a permit to accomplish such change has be n o ed fr t ilding Inspector. Building Inspector,Village of Rye Brook: Date: MAY � 4 2023 D E C IE ��E BUILDING DEPARTMENT For office u nl : y PERMIT# ' DD9 VILLAGE OF RYE BROOK ISSUED: APR 19 2023 8 KING STREET,RYE BROOK,NEw YORK 10573 DATE: .4 (914)939-0668 FEE: A ��(�_ PAIDJK VILLAGE OF RYE BROOK � — wwwxyebrook.org BUILDI ;G DEPARTMENT PLICATION_'OIF��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 ffiifiif#iitititfifftifi###iikii#ttttttlfiflk!#t!ltitlkklilkliii#iikiitiiti#1i�fiiiffifiiift#iiititt#tttltitl44kkiiltf#iiiit#4► Address: 3�� / �C.f Ot a A 11 (� �� �I e U�t�00 k Occupancy/Use: 1,0CW,01 Parcel ID#: /3Q, 7 7 f— Zone: Owner: �S �—' _ / �/ Addd�ress: J� LI �1-�� �a a�P.E./R.A. or Contractor:ham4i-Q CA D'_S 69M 1/7 a C4)7 -'Address: ,Z y 4`M J0 AXIIA 4&4 CC W�u le 10c %� Person in responsible charge: J O i1 ix_ C c,a ew..7 Address: A q � 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: _ J T� %h.'•� being duly sworn,deposes and says that he/she resides at (10nnt Name of tkppuUaay (No.'and Street) in_ /� ( � i the County of W Q'�4 C 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:$ C7 0 0 , for the construction or alteration of: 1/�/ /-�N�')V / N 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 day of 920 day of , 20 X i Si p Owner Signature of Applicant (Tn Name of Property Owner Print Name of Applicant Notary Public SHARI MEULLO Notary Public Notary Public,State of New York No.01ME6160063 Qualified In Westchester County-Z-7 8/12✓2021 Commission Expires January 29,20— �yE BRC��. '9a2 BUILDING DEPARTMENT (�IfUILDING INSPECTOR T❑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 EPORT - - - - - - - - - - - - -- -- - - - - ADDRESS : � � ' 'Q/)QL4'Q 111/,�') 1 VVV!lJ "'��� DATE' 5) 1yb623_ PERMIT • ��� . # ISSUED. IECT: BLOCK: LOT: LOCATION: - OCCUPANCY:- 0 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 ❑ ,GROSS CONNECTION FINAL ❑ OTHER dye BRCOUk 1982 BUILDING DEPARTMENT 'OUILDINGINSPECTOR / ❑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 - - - - - - - - - - - - - - - - - - - - ADDRESS : 22�\ � ` ' T\-ODATE: -23 7 PERMIT# t JC ISSUED: I A21L;;E T: Q � OCK:�LOT:IR LOCATION: y U aQr caw 1 'c;�' OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION W�(J �L� REQUIRED ❑ FOOTING 0� ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING p ROUGH FRAMING �❑ INSULATION , ❑ NATURAL GAS ❑ L.P.GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER a N d " N N N c 0. a a 0 r-y v O a A, 00 Ci) S 'M N w a !' Z [� ~ oPQ OrW V J I+.I C, '+rJ q O "i a � � 0 0.4 4aa. o " � wo UZ4 7 Ln 5 Q ° t G � rU 00 W V N c°7 cn 5; - ° x c vv .+i a u H w zz � o v cn C7 o ° M v v s � z z a � O ? �0-+ N G o ob c H � .� � v W E� Z 2 � aQ RI H° o . � Au nn gw � �� u cn w A z o � � 00 w w U o .V iiO � � _ BuiL NQ_DEPARTMENT NOV 16 2 222 VILL��E OF RYE BROOK VILLAGE OF RYE BROOK 93$KING 'tFl�EET RYEBROr3K,NY 1057 BUILDING DEPARTMENT (914), 9-0668 www.ryi rook.org INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: 5- � \ _ Approval bate: NOV 2 1 [0i Permit#: c��� Application Fee:$ Approval Signature: Permit Fees: $ gcl�>- 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. 1. Job Address: 3`rt 1�1 141 9y ���' /,W, 7 7-14 zone:_A!Cro� 2. Proposed improvement.(Describe in detail): M2 07 6_L)5L— 3. Do th �,oposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No 1. 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 ex tin utomatic fire suppression system(Fire Sprinkler,ANSL System, FM-200 System,Type I Flood,etc...) :No: 7 Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application& 2 sets of etailed engineered plaits) 5. Occupancy;(1 fam.,2 fam.,comm.,etc...)Prior to Construction: !�7; After Construction: 6. MY State Construction Classification: N.Y.State fUse /Clla`ssiffication: 7. Property Owner: ► Address: ✓`t 1Y��-1r� +'��i'?!c Phone# - Cell# email: 8. Applicant: Address: Phone# �1,�/ ,Cell## / �email: �/ 9. Architect: � / D C-- =M '`& '5 ►ir/4 ddr�esss: �z ryl�yCr/T� Phone# - Cell#�,/ I��`�f _email: `�--564 6,Q0 c.t)A 10. Engineer: p i Address: Phone# l l� ����� yy l Cell# I�I email: - '��� 1�� S r `� o C y w�PpC1 �' h GIhY 11. General Contractor: , t N �lA Address: y Phone#_ Cell#� email: 12. Estimated cost of construction $ 10. 000 - ' �f� ���fP-)►O - Q1'- ;NOTE:The estimated cost:hull include all labor,mat•rial,scallolding,Anted equipment.prores..ional lees.and material and labor which may be donated gratis.) 13. Job'Timetable: Start: inish: Z` (ll 8112.'2021 4 I_� Q L�CIE �WE BUILD DEJVARTMENT ' '�: � NOV 16 2022 VILI.I4 of RYE ffROOK 938 KING $!RFF.T Ri F. I311oox,NY 1057 VILLAGE OF RYE BROOK -( f �939-0668 BUILDING DEPARTMENT rook.or2 AFFIDAVIT OF COMPLIANCE VILLAGE CODE 4216 • 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� 3I,X' S �� JLh i v , residing at, 3, / //Af 04C__7 5 ' Z I']ini :nnrt (Address where yell 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; )�6 ew- I� L �l� ,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 fiuher 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. X" Z"�e . (Signature of Property t (Print Name of Propeny 0wrier(c)) Sworn to before me this da 20 � (Nola ry Public) SHARI MEULLO Notary Public,State of New York No.OIME6160063 Qualified In Westchester county (') Commission Expires January 29.201_3 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: 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 %n_N CV (12r�m; for the legal owner and is duly authorized to make and file this application. (indicate archrtlecl,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. By signing this application,the property owner further declares that he/she has inspected the subject property, and that to the best of his/her knowledge there are no roof drains, sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this 1 L Sworn to before me this day of 0 e , 20 day of ,20 Signature 1 w er �\ Signature of Applicant P" Name of Property Owner Print Name of Applicant Notary Public Notary Public SHARI MELILLO Notary Public,State of New York No.OiME6160063 Qualified In Westchester County Commission Expires January 29,20, ,�~-to yt (4) 8/12/2021 N N uy �• •r. ao 00v W N L tc °J .� 00 H O O0 C y � p eq rq 00 'r F� ►� (, � n w OF� Z w 00 O � o z w - W ws i O � � z a s O O uz 0.4 00 z V A o ? • W c Z w a � U w w F r H � � � 1 —, Q d x '� G c� ►� W C z � 3 Q w LO U FS x V 0 w z A. un: M O O U a � a yE BR Bum MENT FEB — 8 2023 ti VIL 4 :` OK 938 KIN ,NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT .or ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required?? FOR OFFICE USE ONLY BP#: ��� EP#: s)`r 03 / Approval Date: F E B Permit Fee: $ 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 allapplicable Federal,State,County and Local Codes. —7�/7 9 1.Address: 3'1 I �0.n d��I?� KC� SBL: 13D, —L U ZoneZ- Q 2.Property Owner: J/ �10 l zc-l- I Z Address: Phone#:�' / 7�7- - 6 6 Cell#: email: 3.Master Electrician: E,rr f c. I o e I r p Address: j(5 Fro 3 P 2 G+ A V C, Lic.#: 15 q Phone#: 1l 8 email: p�n��r�212� s!� f•�G Company Name: +'��'2 ( r-U Address: S A w,2, c Fe�Z' Ga rYi 4.Proposed Electrical Work/Fixture Count: (N tr-e� tie t y bckliln ro o ram N lo,.r)1 5.31 Party Electrical Inspection Agency: ********s*,r,r********tr,t,t******,r*,r+t*,t***************rrw**,rw***rt*rt***,r*•**,t,t**,t,r******rt*,t****,t,r*•r**w***,r***rt STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: f C. ` l A e"L I'Q being duly swom,deposes and states that he/she is the applicant above named,and does fiuther (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 fiuther 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 f re me this b day of ,20 day of ,20 OL Signature of Property Owner Signature of Applicant f- I C- 1P1 I've 11✓-0 Print Name of Property Owner ame of Applicant Notary Public No Pub1i SHARcI MEULLO ?•notary Public,State of New York No.01ME61.60063 Q�iallfled in Westdteswr county-,, 6r23/2o22 rnmisslon Expires January 29,2 STATEWIDE • Service With hji1ci:ritY 1:1 Main Street,Fishkill, NY 12524 1 email:office@swisnycom swis JOB APPLICATION tel 845.202.7224914.219.1062 SWISNY.com • • Office Use Elect.Permit# r'— Date f Bldg Permit# 1ZQ1 Q—Q� Utility ID# Final Certificate# City/Village Y. '6f o Zip Township County k C4 Ne—St-c'-' Address Cross Street Section Block Lot Owner Name/Address(If different than above) lsC�l— Contact Number ❑Basement ❑1st FI. [3 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 *%wqd60W Fluorescent L > SERVICE Amperage Voltage 1 P 3P #Meters #Disconnect ❑Underground ❑New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information �F FEB - 8 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 cam 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 }- Date Signature Address City/State }I , r Zip Code License# i - _ Phone# t DL'C State Wide Inspection Services CADII 3 1080 Main Street Fishkill, NY 12524 ..��� U TOMAY ' 1 2023 845 202-7224 Phone 914-219-1062 Fax STATF WIDE INSPECTION SERVICES VILLAGE OF RYE BROOK Email: officeCabswisny.com BUILDING DEPARTMENT 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: Pineiro Electric Inc Steven & Angela Schiz Eric Pineiro 34 Hillandale Road 115 Prospect Avenue Rye Brook, NY 10573 Valhalla, NY 10595 Located at: 34 Hillandale Road, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 23-037 130.77 Certificate Number: 2023-2699 Building Permit Number: BP 22-224 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: 34 Hillandale Road, Rye Brook, NY 10573 The Second 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 20`h day of April 2023. Name Quantity Rating Circuit Type LED Recessed Luminaires 05 G FCI 02 Switches 06 Vent Fan 01 Vanity Light 01 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 Lvork performed on the date of inspection only. • ����'i�i��+�i�i�iii����`i�l�i �i �i �ii�i �i ���i�'i�i�'i'i�i ��i���`i������`ii��`r�`r�� w Ln A a .-, x cza a (�] h Q G w a 1�1 r74 _ F pC Z Z 00 00 � � wW -� �1 H �+ w °: �, W co oo �.y Z z N L9, O z w c0 Zcell ON a oo Z A0-4 06 ~ 1� O o4 h • ' O N W A N w z p y'�1, I > 9a F 0: V d U � W o Z z F a w a a o &nI—� H a W � BUILDING DEPARTMENT FEB 13 2023 1 3D VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)934-0668 BUILDING DEPARTMENT www.Ucbrook.org PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: 9,2J .`?Z`1 PP#: O�V Approval Date: Permit Fee: $ Approval Signature: ther: Disapproved: (fees are non-refundable) ************************************************************************************************** Application dated, v�3 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 agrees that said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: ✓ C� ��11a17 4�� U�-d rE /i�G�DL/ SBL: l�i / 7��—c"S Zone: 2.Proposed Work: 3.Property Owner: .ST Vrjf/ �'L H��' fE.�/��%�F S��Address: Phone#: /:P" Cell#: email: 4.Master Plumber: ;1-41arJ e u�`/ Address: 11, Lic.#:�Phoonne• #:9�Y S S Z//�, Cell#: /f� y j j�`�L/�/ email: Company Name:.r� �/� Address: 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 / 3nd Floor I/ 4m Floor 5m Floor Exterior 5.*List Other Equipment/Provide Details: ,&f-4l/ �J " �l/��� �/I ,► /" (Notarized Signatures Required Next 2 Pages) -1- 8/12/2021 STATE 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 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. Sworn to berre me this I Sworn to before me this day of ,20 day of l�'n ,20 Signatur erty Owner Signature of Applicant Print Name of Property Owner Print Name of pp icant L L ` SEWVIA Not publiPARI MIEULLO Pub heI Notary Public.,State cf Connecflcuf otary Public,Stets of New York My Cowission Expires 03131027 No.01ME6160063 Qualified In Westchester Countyr� 'ommisslon Expires January 29,20--- I 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 DEPARTMENT VILLAGE OF RYE BROOK RFEB 13 2023 3D 938 KING ftrnET RYE BROOK,NY 10573 � 14)9 Ob6 VILLAGE OF RYE BROOK 1 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, (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; 3 7 '���17 / , 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. (Signature of Property O (Print Name of Property Owner(s)) Sworn to before me this �C da Cof '�4\�,c'J4—L_, , 20�3 kL (Notary Public) SHARI MEULLO Notary Public,State of New York No.01ME6160063 Qualified in Westchester County Comnossion Expires January 29,2p` -3- 8/12/2021 Building Permit Check List&Zoning Analysis Address: 3� LL A e-�0 L-;F-- - SBL: Zone:2- 7-25- Use: Z 1 '2 Const.Type: Other. Submittal Date: 1 k I l 6 1 Z -2- Revisions Submittal Dates: Applicant _9 l Z• Nature of Work: t �P-R-( O Reviews:ZBA: N 0 V 2 1 2 D21 P& BOT• Other. QK ( ( ) FEES:Filing: IS,-y,> BP: 3-OC'• — C/O: Flood Plane: Legalization: ( ) (.YAPP: Dated: ✓ Notarized. ✓ SBL Truss I.D. Cross Connection: ✓ H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening: ( ) ( ) ENVIRO:Long Shore Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmt.: Tree Plan Other. ( ) ( ) SURVEY:Dated: Current Archival Sealed: Unacceptable: ( ) (� PLANS:Date Stamped: .,-/ Sealed: Copies: -- Electronic Other. ( ) (�License: ✓ Workers Comp: Liability Comp.Waiver. Other. ( ) ( ) CODE 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. (Jf ( ) 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: Ate. REQUIRED ExrsI'IlVG PROPOSED NOTES Date' N Q v 2 1 Z L 2 l~� g� Main Cov Aca Cov Ft H/Sb: Sd.H/Sb: _GE0 Tot.I=: a-imp: PatlLiOg: H 'ght/Stoles notes: � r ; �c�°iu> .h �1 �► 1 :i4 S � tco�s o •� 0*42n,�Am O ' a a> 6z1 1l\: 42 LO Q y (A «t>I)> V V Q J_f is • t: L10 pow a � �•. W CD r i V LU ++ V]a .Je O� a I.L LL O 7�' y O 0010tection <co» LLI o c W V a r O p Z o e Q O �. N x <, a t U LO 5 i c j ti I y L,. - � A 1<tib � A's•• 1�'•1 � -i.... - �1�1�1 A. -� 1�� � � A. -r�' � At A •� A A A r �A r �A I :A � l DATE(MMIDDIYYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE �i 11/14/2022 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 Michael J Donnelly NAME: Donnelly Insurance Center PHONE (914)347-6500 A (914)347-6303 A/C No Ext: A/C No 6 North Lawn Ave. ADDRESS: INFO@DONNELLYAGENCYCOM P.O.BOX 880 INSURER(S)AFFORDING COVERAGE NAIC N Elmsford NY 10523-0880 INSURER A: RUTGERS CASUALTY INSURANCE CO 41378 INSURED INSURER 8 Santiago's Contractor,Corp INSURER C: 24 Independence Street INSURER D: INSURER E: White Plains NY 10606 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2252432064 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. IN POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IN D WVD POLICYNUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ©OCCUR PREMISES Eaoccurence $ 100,000 MED EXP(Any one person) $ 5,000 A Y SKP 3110442 20 05/14/2022 05/14/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER I GENERAL AGGREGATE $ 2,000,000 X POLICY ❑JET ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DIED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CARPENTRY NO ROOF REPAIRS NO ROOF REPLACEMENT CERTIFICATE IS SUBJECT TO TERMS,CONDITIONS AND EXCLUSIONS OF THE ACTUAL POLICY AT THE TIME OF ISSUANCE.CERTIFICATE HOLDER IS/ARE ADDITIONAL INSURED WITH RESPECT TO WORK PERFORMED BY NAMED INSURED AS REQUIRED BY WRITTEN CONTRACT. JOB LOCATION:34 HILLANDALE ROAD,RYE BROOK,NY 10573 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. Building Department AUTHORIZED REPRESENTATIVE 938 King Street Rye Brook NY 10573 � ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund PO Box 66699.Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE L '��r •0 r• A A A A A A 223931930 •�` MICHAEL DONNELLY DBA DONNELLY INSURANCE CENTER �� i PO BOX 880 L• ELMSFORD NY 10523 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER SANTIAGO'S CONTRACTOR CORP. VILLAGE OF RYE BROOK 24 INDEPENDENCE ST BUILDING DEPARTMENT WHITE PLAINS NY 10606 938 KING STREET RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2255 751-6 458361 01/19/2022 TO 01/19/2023 11/14/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2255 751-6, 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:/ANWW.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 CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. JORGE A. CAAMANO-PRESIDENT SANTIAGO'S CONTRACTOR CORP. 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: 342178653 U-26.3