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HomeMy WebLinkAboutBP22-228PERMIT #j4 V SECTION --� TYPE OF WORK JOB LOCATION . CON COST N/' O #---��.e TCO # DATE; LIL 4 BLOCK I ic✓ 0 FEEjtUe4? INSPECTION RECORD DATE i NS P FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBINGi w GAS — SPRINKLER ELECTRIC ftooloo���� �LLL� LOW -VOLT AS BUILT C� FINAL pi zdoc)A)z LOT � OTH ,R APPROVALS ARB _ BOT PB 'ZBA VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK No : 23-115 Certificate of Occupaucp Ellis is to certify that of, Pue, 6ronk-, , having duly filed an application on Ju�e 20 o?3 requesting a Certificate of Occupancy for the premises known as, Rye Brook,NY, located in a P&O Zoning District and shown on the most current Tax Map as Section: •roc.7 Block: J_ Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No.R,?';,0B , issued 20o2a?, 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: P-LI IU Construction: VJq for the following purposes: Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of the building or in the exit facilities shall be made,and no enlargement, whether by extending on any side or by increasing in height shall be made,nor shall the building be moved from one location to another until a permit to accomplish such change has obt ' from th Buildi Inspector. Building Inspector,Village of Rye Brook: Date: JUL 2 5 2023 D (� �/(� For office(� use onl :- L� E �J E BUILDING DEPARTMENT PERMIT# VILLAGE OF RYE BROOK ISSUED: - 'q aQ JUN - 7 2023 38 KING STREET,RYE BROOK,NEw YORK 10573 DATE: LP- 7-oZ 3 (914)939-0668 FEE:j /Qj _PAID VILLAGE OF RYE BROOK www,rygbrook org BUILDING DEPARTMENT APPLICATION OR 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 ►►►►►r►►►►►►rrrf►►►►►►►►►►►►►►►►rr►rwrrr►►►►q►►►►►►r►rrr►►►►►►►►►►s►►►►►►►rrrrrr►►►►►►►rrrrrrr►p►►►►►►►►rr►►r►►►►►►►►►►►►■ Address: I /C Pb9A L 6"j2EG,J3 1� +�/c CAS I /��/E�¢�{� tg l Occupancy/Use: 'Faj-n 1 4 Parcel ID#: . v2 7- - a Zone: U D Owner: 41,4,j -r 64f-1--1-7-CR Address: S14 -tC7 AS P.E./R.A. or Contractor: Address: Person in responsible charge: Address: Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW YORK, COUNTY OF WESTCHESTER as: RyE 6�ot,,r �y /mSa3 /'�.t/S T�i2 being duly sworn,deposes and says that he/she resides at 19 �oR,4 t�j2ca'��3 LAewe- A-A s (Print Name of Applicant) (No.and Street) in /Z yz /fie,-k ,in the County of ae s-cdtS rCQ in the State of N `f ,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:$ �r A Q S• o� for the construction or alteration of U DOTE b /C i'rc K r i 6 ►t Ti„t 9 D R w 9 QT <tRe P1,4"s ; R1W wow F'{00 eS 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 Trre ,20 a 3 \��`` �pl1A I��O /*i day of 20 NO.Q1006251779; ignatute of Property er = QU A L I F 1 E D IN = Signature of Applicant KINGS COUNTY = / COMM. EXP. _ ALA✓ T, I✓lE rsTc=R s'. 11-21.2023 Print Name of Property er '�'��9' PV B L C, p�( '� l ' •..,,,,. y \� Print Name of Applicant Notary Public Notary Public 8/12/2021 �yE BRC��. ��• �9ti2 �' BUILDING DEPARTMENT ❑BUILDING 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 - - - - - - -- - - - - - - - - - - - - ADDRESS : < ��'- ����-DATE: PERMIT# '' ` +� ISSUED:, SECT: BLOCK: LOT: LOCATION: 1� �� '�'l\1�� OCCUPANCY: ❑ 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 s,Q-)CROSS CONNECTION FINAL ❑ OTHER Syr BRC�,� cu � 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 - - - - - - - - - - - - - - - -- - -� 7 r� /202,�ADDRESS . � DATE• PERMIT# ', ISSUED: �( ECT: ' BLOCK: LOT:L LOCATION: ' , 1 S V� W - OCCUPANCY: �- ❑ Violation Noted THE WORK IS... ❑ PASSED C�2 FAILED REINSPECTION ❑ SITE INSPECTION , e �� V REQUIRED ❑ FOOTING C C F ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P. Gas ` ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ ROSS CONNECTION FINAL ' ❑ OTHER 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ®ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK /❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www Uebrook.or - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS:— 5 DATE: PERMIT# 22 ISSUED: � I BLOCK: LOT: LOCATION: �� uV� OCCUPANCY: / l ❑ VIOLATION NOTED THE WORK IS.. ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING (�J 1 o ( 1� ❑ FOOTING DRAINAGE ' ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION t M l] NATURAL GAS C Inc�c on -`❑ L.P. GAS -4'1) 1 �`1(� tr Sze- VJOC� n!1 . ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER �yE BRC�k w � BUILDING DEPARTMENT ❑BUILDING 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 aebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : DATE: 7 2 y PERMIT# u> / /� ISSUED: I � SECT: 1— BLOCK: LOT: LOCATION: �c �q ?� �� 11 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 QyE BRC�v�. cu � 1932 BUILDING DEPARTMENT ❑BUILDING INSPECTOR Q]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 : DATE: PERMIT# 00 ISSUED: SECT: BLOCK: LOT: LOCATION: ' �\ \Aj—"A t-- �C `a G-)'-� �OCCUPANCY:-z ,V VIOLATION NOTED THE WORK IS... ❑ ACCEPTED REJECTED/REINSPECTION P 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 15A ❑ OTHER i a m 00 7 s i 11 rT � � � � � ■ OW a o v tn _ N ~ O .� "0 1°�'p'ter o � '^'�aaOOq++q ►.Tip+ 3 U C a y �i Z 0 H So , O h Q -g ° ° N ■ v V o � � � wE'r i W Fryer• hii. I :I Z ~ [� O LW U tc� y oCo u 00 ^ 00 W W 0 W © a o w s i C7 w, so A u F^j/•I �TT W Z ` w Mom■1 �'" G1 h+� .� M t W W c9 o � a 00 En _ ON00 a F� W tx U cn ua 3oc V� Z 1� O Z w 5 H o ° � � vo �J o v G O U oO I'll 41 14 �(u Aam y a. „ o G1 z w W H W. d . cu a BUILJET MENT Q IE C [E Q v VILOOK 938 KING ,NY 10573 NOV 18 202 VILLAGE OF RYc BROOK BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: 11 Approval Date: NOV 2 2 2O Permit#:)6/�'d39Application Fee: $ —/pis Approval Signature: Permit Fees:$ 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: /1 (�c�daI- 496CyS 7iPr.rt &dS-r &-ot SBL: 9, a7.- Zone: 116 2. Proposed Improvement. (Describe in detail): 3. Does the proposed improvement involve a Horne-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: 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,ANSL System,FM-200 System,Type I Hood,etc...) :No:Yale Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 5. Occupancy; (1 fam.,2 fam.,comm.,etc...)Prior to Construction: owe;a After Construction: 6. N.Y State Construction Classification: N.Y. State Use Classification: 7. Property Owner: ,/flow ' A4,risTre Address: /9 �ocesst 2.£ews 2�ef er-as7- �aQ Phone# 91 33I Cell# pT ��96 email: 1�IE1 S Te,'�.1�►1 ar-�c•CCJl 8. Applicant:-&-T�-Io,J%t �gc q"C3 Address:Ar)N/;.v Phone# Cell# email: 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# email: 11. General Contractor: A Dv,-, y r C Address: &j h©1, c-� 5C rl t r b Phone# 5n// _Cell#_ F3`fT 6 b :7 7:Fo// email:APVl-+ e-Q ovT1�C• 12. Estimated cost of construction $ 1<04>0 (NOTE:The estimated cost shall include all labor,material.scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 13. .lob Timetable: Start: ASAP Finish: - /o 0a t's 8/12/2021 BUILDING DEPARTMENT VILLAGE OF RYE BROOK NOV 18 2022 938 KING STREET RYE ftom,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK w w.ryft oakor� BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST SEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT. STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: /Yl c t s-:,�7 , residing at, i- 67ae-cN3 De o j g- c A 5­11- Ryr Qeao4- (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; -73 ,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 Pro rty Owner(s)) � 4A (Print Name of Property Owner(s)) Sworn to before me this 1� day of�10 V tf t)cr , 20 (Notary Pu ic) l GREGORY K RWERA Wtm Public,State of New York (2) No.01 RI6441398 Qualified in Westchester county 8112/2021 Commission Expires September 26,20- 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: A L-^•a ''-- CA tr% i 3' z4R ,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� Sworn to before me this�� Sworn to before me this day of A1o,=,.v3r,e , 20 oh3_ day of AJc>J1eprq,1A , 20 2-2 P 5111alure of Property Ow signature of Applicant ner 'srcR AMTH-AJ s ►t'nes t Name of Property Owner Print Name of A Ti Ant Notary Public SHARE MELI�LO Notary ro'li Notary Public,State of New York 12M QNG MCCARTHY No.O1M£6160063 Statc of New Yorkuai1fled In Westchester County. LR6165467;orn fission Expires January 29,2Ct estehey;r.r Countyxpires May 7, 2023 (4) 8/12/2021 b � N _ nNi z F, rz O W r-i z W N w O 5 00 U W W = fn w Q w00 �► O � x o Z, j E•+ � w U � z c� z Z z V ~ M � oo w o , V o D 6 , � pZpc5 .. w O a w L V ° U W z a pC6 CA � c x .r Ca pr ., G1 z x < w < T--4 Z G a � a • � w a w � . 3 t" E BUI ,,MENTVEF RYE K DEC - 7 2022 938 KIN RYE B ` , ,NY 10573 (914)939-(16 VILLAGE OF RYE BROOK ��,���.lyebtoc .org BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ON IIP #: ' c3 EP DEC - 8 2022 Approval Date: Permit Fee: $ Approval Signature: Other: ******************************* * *************************************************************** Application dated, l a c_=) is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove electrical equipment,wiring,fixtures, or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: I a J)%>I&p I- Gg cm N Z g*,,e 6 asl SBL: � ,-)7- Zone: 2.Property Owner: AI.NAG, sL Address:lcj!2Dp.Al.�GgEC,01 alL%ti` E/ � Phone#: Cell#: Qt?_-J,3 l_ 7 3 96 email: 3.Master Electrician:$y RV N Pl d%L.V" Address: v Lic.#: l 7 3 q Phone#: Cell#: 44- V06 cc Z3 email: �.I,a_�da&loa,s(Af-MAiL.e Company Name:101APowd 616wiap l Cad Address:707&L,.nw ¢,I A?T l h ►' AO k, 191;yt 4.Proposed Electrical Work/Fixture Count: ( j 0►w� I 5.31 Party Electrical Inspection Agency:16mr-< GLas- &A�. t�V_ S�i0�4.ov1 llti �Qsa1 tlotc��st�, n� tobo�} STATE OF NEW YORY,COUNTY OF WESTCHESTER ) as: irk U4k717, ,being duly sworn,deposes and states that he/she is the applicant above named,and does further (pnn ame of individual siping as the applicant) /� ,C a / state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor.agent,attorney.etc.) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances,and regulations. ti Sworn to before me this Sworn t!b efo r�rea this day of 920 day of 4W4W 1 b?r ,20 2--Z Signature of Property Owner tgn I o A B rUyi u hfni Print Name of Property Owner f Appl' t Notary Public jrtary Public ADAM E KINTISH NOTARY PUBLIC,STATE OF NEW YORK NO 01K16001686 QUALIFIED IN WESTCHFSTER COUNTY 6/23/2022 COMMISSION EXPIRES IANUARY 20, Z D Z STATE WIDE INSPECTION SERVICES, INC. Service With Integrity 0:0 • • SWIS JOB APPLICATION0. • Office Use Elect. Permit# Date Bldg Permit# Scl Ft Plumbing Permit# Final Certificate# City/Village Zip Building Dept. County Address Cross Street Section Block Lot Owner Name/Address(If different than above) Contact Number ❑Basement ❑ 1st FI. ❑2nd Fl. ❑3rd FI. ❑More Than 3 A. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/0 Detector Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels 1P 3P # Meters # Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair ❑Overhead ❑ Upgrade ❑ Disconnect Utility ID# ❑Con Ed ❑ NYSEG ❑Central Hudson ❑ Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect Junction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation p F � DEC VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(t)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,if at any time of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other inspection company.The applicant, owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Email Address Name License# Date Signature Address City/State Zip Code Company Phone# ~� �1/I i State Wide Inspection Services D 1080 Main Street Fishkill, NY 12524 C ' MAY - 3 2023 ]D 845 202-7224 Phone 914-219-1062 Fax STATE WIDE INSPECTION SERVICES VILLAGE OF RYE BROOK Email: office@swisny.com 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: Highpoint Electrical Cont. LLC Robin &Alan Meister Byron Haughton 19 Doral Greens Drive East 707 Palmer Court,Apt 1D Rye Brook, NY 10573 Mamaroneck, NY 10543 Located at: 19 Doral Greens Drive East, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 22-295 129.27 Certificate Number: 2023-3134 Building Permit Number: BP 22-228 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: 19 Doral Greens Drive East, Rye Brook, NY 10573 The First Floor Kitchen and Living Room were inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 2nd day of May 2023. Name Quantity Rating Circuit Type Receptacles 09 GFCI 06 AFCI 02 Switches 06 Dimmers 04 Hood 01 Cooktop 01 Oven Receptacle 01 Dishwasher Receptacle 01 Refrigerator Receptacle 01 Microwave Receptacle 01 Luminaires 12 e` 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 l O F o a x °- CA ' W ,UZ J O a Z 0-4 0.4 45 CL q 2S 1 Lr) ^ O Owe reZD = V► w oo rA (� Q OM H W a 3 � O Z0-4 o H � w N zz ' � � N o � E oi U fx U a W z a � o = O O W V Gh C7 Q C7 A O z w z Q oA �I w x < H CCENFc. BUILDING DEPARTMENT SEC " 9 2022 VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)S 39-0669 BUILDING DEPARTMENT wcvWv rook.org PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: �c�—'c� PP#: Approval Date: — 9 A71 Permit Fee: $ Approval Signature: Other: Disapproved• (fees are non-refundable) ********************p****************************************************************************** Application dated, Ion— /—c--)c)- 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. I.Address: I9 IJOCO( Gre/'S Af J,V t�_ L-AS7- SBL:z Q f—4 Zone:4 — 2.Proposed Work: Alt-'V �Oy 'ID Q, .� `� f rl� Al d tv 5/ 3.Property Owner: Address: / Lf A j Xee. /1 S &1�k �4�,5 Phone#: J7- 3 3/ 23 9& Cell#: email: L 4.Master Plumber:{t,Arh V pJ /l,/d�Gf f —Address: .30 -A-A IC41164 Lic.#: 7 Phone#: Cell#:9/y y�7 email: A AA AJJP Company Name: &2�W A A)6_tAA6 f Address:�tG Sf�f 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 f 3 2nd Floor 31 Floor 41 Floor 51 Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -1- 8/12/2021 BUILDING DEPARTMENT D ID VILLAGE OF RYE BROOK DEC - 9 2022 938 KING STMET RYE BRgox,NY 10573 (914)9 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 YORK, COUNTY OF WESTCHESTER ) as: sr-,4 7-7 31, A .7- - !&-rg i�,�- , residing at, `� �c�k,1 5 'bed kt.0 Q•'�-'-W (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; 12 A) J vs" 2 , 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 Propdrty Owner(s)) (Print Name of Property Owner(s)) Sworn to before me this � L day of 20 _ (Notary flub.) GREGORY N.RIVERA Notary Public,State of New York -3- No.01 RI6441398 Qualified In Westchester County / siizizort Comnd& w Expires September 26,20 ? 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. Swom to before me this Sworn to- before me this _ C day of m,h�� ,202 day of \ �C ���a �,20 i X�� Ail�"' D ignature of Prope Owner Signature o Applicant A � �Lci s-rrck' e v ' N rd Print Name of Property Owner #r&Name f Applicant 2zu� / tll� I 1 E Notary Pubtic GREGORY M.RIVERA o. EMM63 Netary Public,State of New York Qualified In Westchester County No.0,State of N Commission Expires January 29,2� Qualified In Westchester County This ---'6 b@q*Efs 9f i ;p pleted 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- 8/1v2o21 z. �:�s�r.°�;..�.: �jy� �i ��: __..c. ___.__ ,_....E_ � ��� - ,- � , i �,��k J(/� � 1 70 �3 �: ' ' _ ._ � _ � _ �., t r ,�aA i a , �,. .�L � �� .�+�t1�1 �.�$/ �.� clo OR filll T-.3 .•`' )+Z't•I � INS �, _ _ . /.'/,y •�i -� _� _` �� i .� :f i�I gg T • W � � ! l� i I O m � z c i w IA Bpi .v A 78 1 aC4 cc �-n E mms moo • 1 � � V 1 � S f :► ' m m ot.. ' o �j = c WEN � � A LD E AD I+r' i7 `^ 3 O C a' Building Permit Check List&Zoning Analysis Address: ( '-2Z=r::L12 2 s SBL: �— Zone U Use: Z a Const.Type. Other. Submittal Date: 1 S Z z Revisions Submittal Dates: Applicant: Vtl F_I Nature of Work t►- i:F0 -t o —OFrJ o v=7V7 0 a Reviews:ZBA: NOV 2 2 2022 pB: BOT: Other. OK - ( ( ) FEES:Filing.222=psa BP: 7}- C/O: Flood Plane: Legalization: ( ) WAPP: Dated ✓Notarized: ✓SBL: Truss I.D. Cross Connection: H O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Stone 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. ( ) ( ) 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 APPROVED A NOV 2 2 2022 circle: Frame Emar. >mnt Si : Main coy Accs.c�v F S S .H Sb: -GFA.' Tom: EL-Imp: Hag Stories: notes: 1 ±wires T A A q ` •Ji�S¢ 'y�'� • �r ,GS...O `. t'V �o *:t`�l��rr't •'o .:1sti'^S. .0:�''.•'.rh;��I1�,.. .o t9�kK; k/j,'�. o ..iht�r�e� o sa.^.'`yid, h`/'r� o ..t� / I � .,, � t,n Sr/,•3. � fyr,'yti rrn h V _ r v � � � _ x., 4.,� `�v��c�,;,, ♦• �Vic( vfazt;,l•�'�i.r ` r f• "�. .'^'ss • r.t � ..•r;�.j'#�� � &t,, V� f�•��.• =�a, r�� 's.��...!�,� � F =�� 11//ll//llf s�i x�l III/Ii///l�f :s��z s��$: f�l/lll/i'�u-�i� !? �I/jly/li'_i131< 'a.11/�11/1 � c�c: 111/1/1/111 •'sc %� ^:'.11/1///111 1 t;• 'tie 04 Y' -�C•'�a c _ C) CO > � - \".{. 04 . E O Rsov. p ca � AAM,_5 y o v .= a* :r�rw uJ, O O .yam, L O •v ` �' '� �'•'. .sa jw � ., oY' CA LLI a •� _ U C/) _ o o tiection 0 O caQUO '�{! s":'•:�T�=� :1 .) LU L3] C @; U co f . C4.4 N ea y 7_ O Gam) L •�� w O G tt.., .••. L 1•Ip a t��i'�'t 0 7— •3 [ iil,- � t co o to ;: i• Gp U L �• •l+•1. t`=,:. co cz r _',,: •�� � Liz C •U � = i\rl 04 M N � ,lr, •'Tom_--'.•.-`.�_�• e'i N y � �1 t'.r• '. ulni p 'A . . . . .. . . r.IS Nt"WI / 19r J 111'j111� . . 1 '1 1/,j1,1 2 f - 1,1111,1` M. c t t fi►i •/.li/ n► /.ci) A li/ . < .1.1.1.s .: t£A$�r�,'bbc A�i�€ /.bc A l Apt`1.1d uv A A A ` A 7 r/�} +`Uti ^ i/r A + . +� .�'�' .7 '•'�l/�{ .... �ti\��'.-.. 1���jQ�� �' 'S:rS1f��tiQ.y'' Jr 'yL ��-.r1y, -�ti M1.,�. �Yf �, ri ... a� .,;�:• ..,.��� _.f-t!• �sr>`� "�"�i" ti.,z.ty"w:.1 '-.:��,��� 9i � �t '" ear'.{':;+L � I�.--�\ `!tY,'�•�+•�+t .. •�- �`-,�,Nw,.:,,� �t,�" +�`Y...-.' ; ' DATE(MM/DD/YYYY) 'ACOR" CERTIFICATE OF LIABILITY INSURANCE `� 11/10/2022 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 Kaitlain Wray NAME' Antalek 8 Moore Insurance Agency,LLC. p1tONE (845)831-4300 FAX (845)831-5631 A/C No Ect: A/C,No 340 Main Street E-MAIL kwray@antalek-moore.com ADDRESS PO BOX 31 INSURER(S)AFFORDING COVERAGE NAIC# Beacon NY 12508 INSURERA: Mid Hudson Co-op Ins.Co 35866 INSURED INSURER B: Preferred Mutual 15024 ADVIN,Inc. INSURER C: Twin City Fire Insurance Co 29459 238 Maple Rd. INSURER D. INSURER E: Mahopac NY 10541 INSURER F COVERAGES CERTIFICATE NUMBER: CL2241107843 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 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FX__1 OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ 2,000 A 41013217 04/06/2022 04/06/2023 PERSONAL a ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 3,000,000 ❑PRO- ❑ 1,000,000 POLICY JECT LOC PRODUCTS-COMP/ AGG $ OTHER'. Employee Benefits $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 500,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ B OWNED IX SCHEDULED PCA0100710714 03/22/2022 03/22/2023 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGEAUTOS ONLY AUTOS ONLY Per accident Uninsured motorist S 500,000 UMBRELLA LIAB ...............1.— OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE S DED I RETENTION$ $ WORKERS COMPENSATION PFR OTH- AND EMPLOYERS'LIABILITY STAT Y/N UTE ER G ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA 16WECAJOKJ5 10/15/2021 10/15/2022 E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBMBER EXCLUDED? 100,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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. 938 King Street AUTHORIZED REPRESENTATIVE �� Rye Brook NY 10573 A�� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name&Address of Insured(Use street address lb. Business Telephone Number of Insured only) lc. NYS Unemployment Insurance Employer ADVIN,Inc. Registration Number of Insured 238 Maple Rd Mahopac,NY 10541 Id. Federal Employer Identification Number of Work Location of Insured (Only required if coverage is Insured or Social Security Number specificallylimited to certain locations in New York State,i.e.,a Wrap-Up Policy) 471325732 2.Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Hartford Property& Casualty Village of Rye Brook 3b. Policy Number of entity listed in box"la" 938 King Street 16WECAJOKJ5 Rye Brook, NY 10573 3c. Policy effective period y 1011512022 to 1011512023 3d.The Proprietor,Partners or Executive Officers are ® included. (Only check box if all partners/officcrs included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "Y' insures the business referenced above in box "la" for workers' compensation under the New York State Workers'Compensation Law. (To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy).The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"T'. The Insurance Carrier will also notify the above certificate holder and the Worker's 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, not does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers's Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon the 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. C-105.2 (9-17) Form WC 88 3121 F Printed in U.S.A. www.wcb.nV.gov 1 1 P a g e FI O`Zc �=G tr / N o cV LL w I_ WA LJ II r l r 1 r l r l r l d O 0 �' - (�/)) C 11J z / I I I I I 6 Z U' r �r CttMID LMLMj �. 00 s,a A II II a � LL i I I I TV q I w 2 U I J6 z > 0 oC a F ce in 12 MA I :• m N J�-� n Ki I a�x I I I C i I 8 I I n z IA x 6 0 J O r 1 Q J Q Z W W II � v V1 n O II II I I II II \ \ I I \ I I II II \ I C I I I I✓ II \ p�p II II \ II II / Q 1 K II II