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HomeMy WebLinkAboutBP22-240PERMIT /- Q - o� DATE!/a a ®(P;" SECTION /04/Y, d % BLOCK LOT,_,ry� TYPE OF WORK 1 r / Co'7 JOB LO TION Q �/ Q C-r2 OWNER CONTRACTOR � EST. COST V/CO # TCO # Fi :Ed %SCE E� DATE FEE DATE INSPECTION RECORD I DATE I NSP FOOTI N G FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING CJ RGH PLUMBING GAS 0 SPRINKLER ELECTRIC LOW -VOLT C� ALARM r7 AS BUILT C] FINAL b914/)� ey 7b0� OTHER APPROVALS VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK No: 25-086 Certificate of Occupancy This is to certify thatl)or)'U�7. Szereko ck S z e, of, 2cg &oox,,N having duly filed an application on 20 05 requesting a Certificate of Occupancy for the premises known as, C). 1 I y, 4 I C(CC , Rye Brook,NY, located in a R9—P-Zoning District and shown on the most current Tax Map as Section: .3-7 Block: / Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. C7f V , issued c:.?, 20 0, 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: — /� Construction: for the following purposes: Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of the building or in the exit facilities shall be made, and no enlargement, whether by extending on any side or by increasing in height shall be made,no all the building be moved from one location to another until a permit to accomplish such change has b in the uilding Inspector. JUL 17 2025 Building Inspector,Village of Rye Brook: Date: I n For office use only: D BUILDING DEPARTMENT PERMIT VILLAGE OF RYE BROOK ISSUED: aa- JUL - 9 2025 B38 KING STREET,RYE BROOK,NEW YORK 10573 DATE: -7-9—a., (914)939-0668 FEE: /-f�-U—_PAIDD VILLAGE OF RYE BROOK A'w .ryebrookny.gov 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 Address: !! tiiiit#tiit/irtrtrtrt##iit##irttrtt4#i4kt 4t tt##t4t4iitt#44#tiitii t4tt#itiiiti tiiititti if iitiiii#iiititt##rtirtitii#tits ttit##ttii itttt / Occupancy/Use: Q rC�'�/ Parclell ID#: �'`j1/, a 7—J—� 1p Zone:/e Owner: � ^gQ ICr Address: 671-e6oC le 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 � YYO`�RK, COUNTY OF WESTCHESTER as: ^ n IF-&4 S�C,C°K.�7tU being duly sworn,deposes and says that he/she resides at / c�/7 !e (Print Name of Applicant) (No.and Street) in Q in the County of L,�'F,07- /-e,f'S Z ER in the State of ,that (Cm/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:$ 3oo ---- for the construction or alteration of �(_( / -/�/I/ �'J� //�/ J 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. e Sworn to before me this 1 Sworn to before me this day of a �A=\y , 20 9L7�� day of 20 Signature/of Property Owner Signature of Applicant P of Property Owner Print Name of Applicant ' e \--",' Notary ublic SHARI MEULLO Notary Public Notary Public,State of New York No.01ME6160063 6/I/2024 Qualified In Westchester County-? Commission Expires JenUary 29,20 yE BR, 4 � T urLDING .DEPARTMENT ❑BUILDING INSPUCTOIl S A'SNIS1AMF BUILDING INSPECTOR VILLAGE ON RYE BROOK ❑CODE ENVORCEMENI'OFFICER 938 KING STREET • RYE BROOK,NY 10573 (91.4) 939-0668 FAx (914) 939-5801 wwlw ry_b oc�►kor - - -- - - - - - - - - - - - - - --- INSPECTION REPORT - - - - - - - - - - -- - - - - - - - - - ADDRESS:_ � �r..t.e DATE: 7 "/s ZOz PERMIT{_ �Z 2 yC7 ISSUED: SECT: /7/-Z 7 BLOCK: LOT: 3(am LOCATION: -- -� 090-�C. � OCCUPANCY• ❑ VIOLAPION NOTED THE WORK IS... 8'ACCEPTE), ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTFS ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATuRA.I,GAS ,�y / D ^� sec C j ❑ L.P. GA.S ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION JFINAL ❑ OTHER a a _ a O � " NN o `"IS N d v , N � w N o `fl '� A -u o \ 4 N u [� Ix I� Cn pG k, CA rn r. O °t O � � w V � � o00 ION o 4-4 Z ° .a Ln oo W + W � et v o © a F�'1 v r�,/1 a! Ln �" et awl a " 00 Cn zo00 HCIS o IU 00 ti CA 0 1.0 ZO W P • I , 6J R 44 � P 'b " U � 07 ` q W U ECENE BUILDING D19PARTMENT R I VILLAG'E OF RYE BROOK NOV 3 0 2022 .3D 938 KING STRFEET RYIF'BROO—X,NY 10573 (914)93,9�066$ VILLAGE OF RYE BROOK � Aui ' .Q BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Y� Approval Date: D E C — P #: 6 )d- Application Fee:$ JJ�/- 6 Approval Signature: Permit Fees:$ (. - Disapproved: Other: *�r********#,►**•*****,e,►*****,�,r*,r*******�*,►***,r*,�********,r****,r,+*******,r,r,r****;r*****,r,r,r,r,a�,r,r***�,r****x******* 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 fr I2bE.Q_ JAL Yt= c3 �� SBL: 7�� =a�"—/'�� done:,�� 2. Proposed //Improvement.(Describe in detail): IfvSi,oc_r/vC Ar" i(u -/V CAI?)irvrT-s Iry k/nJ-7 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: Yes: If yes,indicate: TIER 1: TIER II: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) :No: ,Y 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: 111 After Construction: !�( 6. N.Y State Construction Classification: N.Y. State Use Classification: 7. Property Owner: EiA 52EJZEJ4'.o Address: -Q 0 1 0-Y V`/ 105 7 3 Phone# Cell# q I Ll_ g YW 7 6 09 email: 8. Applicant: 1= h!t9 S?e �.CU Address: I I l')13 t3 F p t2L YE ' IVY 1 0'73 Phone# — Cell# L jj tl— 7 L1 �� 0 email: E�QL,1, i Q- C M 131 L,coke 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# email: 11. General Contractor: j F— Address: Phone# Cell# email: 12. Estimated cost of construction $ (NOTE:The estimated cost shall include all labor,material,scaffolding,fixed equipinent,professional fees,and material and labor which may be donated gratis.) ! f �} 13. Job Timetable:Start: III��/ ��.2 Finish: �� �d .6 / 2 C-2 2, (1) 9/12/2021 BUILDING DEPARTMENT VILLAGE OF RYE BROOK R NOV 3 0 2022 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 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: r 3, �1-�19 5 .� � , residing at, 11 f�/-) l�tic�- -PL. 10— fie l (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; P)Ai kJ?)F P_ Lh 42 CIF 2)k0CP_ /V�/ I L3 7-1 � �D c� :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 Owner(s)) (Print Name of Property Owner(s)) Sworn to before me this (Notary Pubi6ARI MELILLO ",otary'Public,state of New York No.01ME6160063 .)ualifled In Westchester County ")n mission Expires January 29,2013 (2) sit2n021 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: t=h/t4 .5 ZEJZE.Lrk,(J ,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. Sworn to before me this k�) Swom to before me this day of � �� , 20_�� day of , 20 Signature of Property Owner Signature of Applicant Pp"ame of Property Owner Print Name of Applicant Notary Public Notary Public SHARI MELILLO Notary Public,State of New York No.O1ME6160063 Qualified in Westchester County ;ommission Expires January 29,20 (4) 8/1 212 02 1 Building Permit Check List&Zoning Analysis Address: t L ::�, • SBL: l Zone U e: 7, Const.Type: Other; Submittal Date: 1 Revisions Submittal Dates: Applicant: S k,o Nature of Work. !N­V �t art_- -- Reviews:ZBA: 0 E C - 1 2011 PB: BOT• Other OK ( ( ) FEES:Filing. 7s•�p BP: ► C/O: Flood Plane: Legalization: ( ) (1)' APP: 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. '`bieeasr- Workers Comp: Liability. mp.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: Permia 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: REOLMED EXISTING PROPOSED NOTES APPROVED Am: Date• DEC - 1 201 Circle: Frontag Fron Fron Sides: R.Car. Main Cov: Accs.Cov. Ft.H S S .HS • SOFA: Tom Ft Imp. PP Height/Stories: notes: w e rarm rare ana tasuaity company u A Stock Company With Home Offices in Bloomington. IUinors PO Box 2356 Bloomington IL 61702-2356 A StateFarm, H 28 9 01, PROD F H W 720n RENEWAL DECLARATIONS SZEREJKO, DARIUSZ & SZEREJKO, EWA 11 BARBER PL }'r,W, RYE BROOK NY 10573-3514 AMOUNT DUE: None c,lylnc:nr is due by BILLED THROUGH SFPP Policy Number: 32 BW N832 4 g s Policy Period: 12 Months Effective Dates: NOV 27 2022 to NOV 27 2023 The policy period begins and ends at 12:01 am standard time at the residence premises. Homeowners Polinv Your State Farm Agent THE O'BOYLE AGENCY INC Location of Residence Premises 235 MAMARONECK AVE 11 BARBER PL WHITE PLAINS NY 10605-1315 RYE BROOK NY 10573-3514 Phone:(914) 948-3500 Construction: Frame Roof Material: Composition Shingle Year Built: 1953 Roof Installation Year: 2005 Automatic Renewal If the POLICY PERIOD is shown as 12 MONTHS,this policy will be renewed automatically subject to the premiums, rules, and forms in effect for each succeeding policy period. If this policy is terminated,we will give you and the Mortgagee/Lien- holder written notice in compliance with the policy provisions or as required by law IMPORTANT MESSAGES NOTICE: Information concerning changes in your policy language is included. Please call your agent with any questions. Zone: 12 Subzone 09 Please help us update the data used to determine your premium. Contact your agent with the year each of your home's utilities (heating/cooling, plumbing, or electrical)and roof were last updated. Annual Premium $2,068.00 Your premium has already been adjusted by the following.- Home/Auto Discount Lead Poison Excl Total Premium Prepared OCT062022 ��//� p� y',;,y� Page 1 �f 'I HO-2000 /1l. ,60-L"o 4W Sf''PY'e� �AE(gyp wAez a4- �(vw aetiQN'�I`�, 005491 420 1 // N G,AL,J,TR,GB n uienra na na irn ^StateFarm- NAMED INSURED MORTGAGEE AND ADDITIONAL INTERESTS SZEREJKO, DARIUSZ & SZEREJKO, EWA Mort a gge SAOAPI jN BANK OF GREENWICH Loan Number: 444 E PUTNAM AVE COS COB CT 06807-2577 SECTION I - PROPERTY COVERAGES AND LIMITS Coverage Limit of Liability A Dwelling $ 628,600 Other Structures $ 62.860 Building Ordinance/Law - 10% $ 62.860 B Personal Property $ 471.450 C Loss of Use $ 188.580 Fungus (including Mold) Limited Coverage $ 20.000 Additional Coverages Credit Card. Bank Fund Transfer Card. Forgery, and Counterfeit Money $1,000 Debris Removal Additional 5%available!$1,000 tree debris Fire Department Service Charge $500 per occurrence Fuel Oil Release $10,000 Locks and Remote Devices $1,000 Trees, Shrubs, and Landscaping 5%of Coverage A amount/$750 per item SECTION II - LIABILITY COVERAGES AND LIMITS Coverage Limit of Liability L Personal Liability (Each Occurrence) $ 500.000 Damage to the Property of Others $ 1,000 M Medical Payments to Others (Each Person) $ 5,000 INFLATION Inflation Coverage Index: 403.7 117DUCTIRtF� Section I Deductible Deductible Amount Other Losses $ 2,500 Hurricane 5.00% $ 31,430 LOSS SETTLEMENT PROVISIONS Al Replacement Cost - Similar Construction B1 Limited Replacement Cost - Coverage B HO-2000 Page 2 of 4 u 32-BW-NO32-4 State Farm FORMS, OPTIONS. AND ENDORSEMENTS HW-2132 Homeowners Policy Option ID Increase Dwlg up to $125,720 Option JF Jewelry and Furs $1,500 Each Article/$2,500 Aggregate HO-2687 Work Comp Select Residence Emp HO-2684 Hurricane Deductible HO-2304.1 'Amendatory Endorsement HO-2807 'Back-Up Of Sewer Or Drain - 5%of Coverage A/$31.430 g 'New Form Attached N ADDITIONAL MESSAGES State Farm®works hard to offer you the best combination of price, service, and protection. The amount you pay for homeowners insurance is determined by many factors such as the coverages you have, the type of construction. the likelihood of future claims. and information from consumers reports. Other limits and exclusions may apply - refer to your policy Your policy consists of these Declarations,the Homeowners Policy shown above,and any other forms and endorsements that apply,including those shown above as well as those issued subsequent to the issuance of this policy. This policy is issued by the State Farm Fire and Casualty Company. Participating Policy You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of Incorporation,as amended. In Witness Whereof,the State Farm Fire and Casualty Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. Secretary President Prepared OCT052022 Page 3of 4 HO-7000 005492 420 N StateFarm- Your coverage amount.... It is up to you to choose the coverages and limits that meet your needs. We recommend that you purchase a coverage limit at least equal to the estimated replacement cost of your home. Replacement cost estimates are available from building contractors and replacement cost appraisers, or, your agent can provide an Xactware estimate using information you provide about your home. We can accept the type of estimate you choose as long as It provides a reasonable level of detail about your home. State Farme'does not guarantee that any estimate will be the actual future cost to rebuild your home Higher limits are available at higher premiums. Lower limits are also available. which it selected may make certain coverages unavailable to you. We encourage you to periodically review your coverages and limits with your agent and to notify us of any changes or additions to your home. HO-20D0 Pege 4 of 4 Affidavit of Exemption to Show Specific Proof of Workers' Compensation Insurance Coverage for a 1, 2, 3 or 4 Family, Owner-occupied Residence **This form cannot be used to waive the workers'compensation rights or obligations of any party.** Under penalty of perjury, I certify that I am the owner of the 1, 2, 3 or 4 family, owner-occupied residence (including condominiums) listed on the building permit that I am applying for, and I am not required to show specific proof of workers' compensation insurance coverage for such residence because (please check the appropriate box): XI am performing all the work for which the building permit was issued. ❑ I am not hiring,paying or compensating in any way,the individual(s)that is(are)performing all the work for which the building permit was issued or helping me perform such work. I have a homeowners insurance policy that is currently in effect and covers the property listed on the attached building permit AND am hiring or paying individuals a total of less than 40 hours per week (aggregate hours for all paid individuals on the jobsite) for which the building permit was issued. I also agree to either: ♦ acquire appropriate workers' compensation coverage and provide appropriate proof of that coverage on forms approved by the Chair of the NYS Workers' Compensation Board to the government entity issuing the building permit if I need to hire or pay individuals a total of 40 hours or more per week(aggregate hours for all paid individuals on the jobsite)for work indicated on the building permit,or if appropriate,file a CE- 200 exemption form; OR ♦ have the general contractor, performing the work on the 1, 2, 3 or 4 family, owner-occupied residence (including condominiums)listed on the building permit that I am applying for,provide appropriate proof of workers'compensation coverage or proof of exemption from that coverage on forms approved by the Chair of the NYS Workers' Compensation Board to the government entity issuing the building permit if the project takes a total of 40 hours or more per week(aggregate hours for all paid individuals on the jobsite)for work indicated on the building permit. (Signature of Ho eowner) (Date Signed) El rh- r 9Z Home Telephone Number Q14—68y 7_z ZS (Homeowner's Name Printed) Sworn to before wee this day of Property Address that requires the building permit: j�,Z lot /v� D� (County Clerk or I MEU Public) F.- SHARI MELILLO !votary Public,State of New York No,01ME6160063 Quaiified In Westchester County„ ,?3M ntssi0n Expires January 29.20`3 Once notarized,this BP-1 form serves as an exemption for both workers'compensation and disability benefits insurance coverage. BP-1 (12/08) NY-WCB