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HomeMy WebLinkAboutRP22-053PERMIT # f- - DATE: Q Q,4 SECTION a BLOCK TYPE OF WORK � n l JOB LOCATION CONTRALTO �O # .G� FEES �D TCO # LOT FEE DATE INSPECTION RECORD DATE FOOTI N G FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING L RGH PLUMBING GAS SPRINKLER ELECTRIC LOW -VOLT a ALARM AS BUILT FINAL INSP &/y)9 7 rj S�� C9/1) 939- 77/0 i OTHER APPROVALS �ARB BOT PB OTHER yE D �y Cl�t u4 V yyj y O . 19 401A CZrLIZUlmovt* VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J.Bradbury www.ryebrook.org TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Michael J. Izzo Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE December 29,2022 The Anne M. Shafgat Living Trust Anne M. Shafgat,Trustee 1 Loch Lane Rye Brook,New York 10573 Re: 1 Loch Lane, Rye Brook,New York 10573 Parcel ID#: 136.21-1-8 Roof Permit#22-053 issued on 12/6/2022 to Re-Roof Existing Building This certifies that the new roof,installed under the above captioned permit has been satisfactorily completed. Sincerely, 0� - Michael J. Izzo Building&Fire Inspector /to BUILDING DEPARTMENT PERMIT For o a onl T VILLAGE OF RYE BROOK ISSUED: DEC 2 0 2022 7.38 KING STREET,RYE BROOK,NEW YORK 10573 DATE:Ja-c)Cp-�� (914)93,-0668 FEE:k //0— PAID= VILLAGE OF RYE BROOK w�ww.r��'' ±ruplc.orP. 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 sasssrssssarrrgsrrrssssasasaraasars•♦aarrsarsa•rrrrsssasaarsssssaaresrrasar♦saasrrrrssaasrrsararrarrrsrssa»rssasasaarsassa• Address: i L q H LANe 21( ' n-u u�- Occupancy/Use: Z ag Iq Parcel ID#: 1310 1-)I°—I-E Zone: Owner. l t NiiNF M, c-AAF( 4! Address: r.( ),n<N I,/rn)L-, 4. eyl� jc ill � 10 343 -� P.E./R.A. or Contractor: Dbt.cgLL Pz CnNS�can1J CorLp Address: q c-Av J LAo- Person in responsible charge: Ilk" ov 71"\-f Address: &?j?ajj Tilt it 0&t JU-( 10.�}? 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: 11-O 1 M , S144 r-Q/47- being duly swom,deposes and says that he/she resides at I L0 LN L/}x)C-- thin JNo_and Street) in g &LD L ,in the County of���J�l tL-����- in the State of 1V ,that WaN town N'illaget 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:S �5 I 1",W for the construction or alteration of: ao 61-►nl 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§250-1 O.A.of the Code of the Village of Rye Brook. Sworn to before me this /y Sworn to before me thisC� day of20 201L� Signature of Property Owner S' tore of Applicant Print Name of Property Ow et 1 Print Name of Applicant — JOHN 1N SUE>2z0 A�ff&I - otary ►c NOTAR7 PuBUC,STATE OF NEW 1'0lrl Notary Pbf1c Registration No.OISU6070919 GREGORY M.RIVERA Qualified in Westchester Courtly MY Commission Expires March 11,20M 1•ietary Public,State of New York No.01 R16441398 C?liaiified In Westchester County "otnmission Expires September 26,20:, QyE BRC�j� cu � 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.ors - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : , �'" �A `^"� DATE: ! 6z PERMIT# ISSUED: SECT: ' BLOCK: LOT: LOCATION: V �' ( v�eJ"" ' � � (�?—OCCUPANCY: y _ ❑ VIOLATION NOTED THE WORK IS... ,EI^ 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 _ L y e en N N w � ■ a N W u t a� N � as o cat 00 v 0. W Lnro r ■ _ F+I � � 0.' +'.' 0. ed � by ■ cn n O Z o O Q' oA3 � � ° Q w e W o �e -04 ro, a, M rON Q M a, c O x ] � o � a ■ J' ~ c!a w w z z z � ya � V ,o,G 0 �« v o -o c R+ v u, b Q W � 4`r « Or et A °all 00 C e 19 G�1 Y ■ cy A Q Z -° o „ O � V � 4J N W F O F� Z w L � z W ✓� C7 � O � ' q ,C .o BUILDING DEPARTMENT VILLAGE OF RYE BROOK DEC - 6 2022 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK Y y .ryebrook.org. L BUILDING DEPARTMENT" FOR OFFUC USE ON Approval Date: DEC G 6 Per it# _p, Application# Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: : Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: c Application Fees *� A Permit Fees: / / ROOF PERMIT APPLICATION Application dated:/ )r[p � is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit to Re-Roof an Existing Building,as per detailed statement described below. 1. Job Address: k Lo ck Lcocr Ye,L SBL:"3�,c-)J Property Owner: _ann'o_ Slr'Srj:pq Q I Address: I LDS Lj2j_ >►� Phone#: ej iLl' Q 37- us$ Cell##: email: Qnf)C 5WC qCLt 1e, "AW. 2. Applicant: RcX10_. SC')n M"Q Address: Jean Lh . ►� BY IC, A_X'/9 WIV1 Phone Cell#: email: f-r Qy L t" 3. Roofing Contractor: /Z A 0,C/'1.T'IWCh or1 Address: �QrL (any Ero P-44 .. w Phone#: 9 R 131 7?10 Cell#: email: ( COOA 4. Job Description,list all Methods&Materials: 400�_F I�tKKa,f'/1MA (pmEr a yo F+ Q W ling- knou N L hdArlaw nwL, AAA s -ejj,(- V na W _Tf%A a LA— 5. Estimated Cost of Job:$ Li S. CC) (NOTE:The estimated cost shall include all site improvements.labor,material ing,fixed equipment,professional fees,and material and labor which may be donated gratis.) G. If comer property,indicate street frontage: 7. Construction Type: NYS Construction Class: 8. Number of stories: .3 Height: 9. Is garage being re-roofed:No:( )•Yes: )Attached No:( )•Yes:( )Number of Cars: 10. Is roof peaked,hip,mansard,flat,etc: f'EQK'-_t1 11. Estimated date of completion: W212021 Please note that this application must include the notarized signature(s) of the legal owner(s) of the above-mentioned property, in the space provided below. Any application not bearing the legal property owner's notarized signature(s) shall be deemed null and void, and will be returned to the applicant. **ic*-:tk************1F*f***k**#R##Rtk*R#*ir******Rk*#R#*##*•k is*******A-1k*1t****il*'kk**#****'.t'k*****-k***k*#***'h t****# STATE OF NEW YOM COUNTY OF WESTC14ESTER ) as: �1. ij rA being duly sworn,deposes and states that he/she is the applicant above named, (print name of Mvidual 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)hc 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 before me this 16 Sworn to before me this day of 20 Z da of 0 Signer re of Property OwnW igna a of Applicant tA. 5AAF 1 M/IVIA �Obrr_ Print Name of Property Owner Print Nfime of Applicant Notary is wotmy is JOHN M SUOZZO NOMW PUSUC,STATE OF NEW 1ftJ!!t( Registration No,01 SUW10919 C ua I ied In Westchester County GREGt}RY M.RIVERA My Commission Expires March 11,202e Notary Public,State of New York No.91 RI6*11398 Qualified In Westchester County Commission Expires September 26,20 &I 2021 .+ 1 Loch Ln•Rye Brook,NY r' 10573 !?ru. Oct 20 12.59 Plvi by Maria Sotire .li!!1l g1,7 - �'Ap�••` ., A�i� -. ��A �a`,A;�(•� `t(0) _..L..fi�»sus, ti,.e.:�s.�v�.L .:u�a.�.. aa.,.::'s�.�•� .�va*.�e's:_K•.s,aa.�+ t = �. I•i aw 6! J C�3 N LLI . : 6tC ] t(tacs)> �. r '~ CL Q 3 k-• .. in Cl 2 0. �c.�r» ;.. G� Z } U a QtokeCtioR (03 ViN w v c.u.0 w - uj ONO � 0 z °o O ` f -°,,.., i�•l 3 c cz a 1 •� Q Q O 1i iLOF i Q •t0 rj w +I,a=�t1:�"�'_ s••r--- {�/�h-;�--��^a�:; �It+IN+'•T'`"<Rg II-r 1�f���,�'r�.'i.-�t1 1�'.��3`^•"� �rt d 11+ r..�: ics y`�' ... f-vllibl'+;d .��Ly� 1�t/1//1♦111 t€ tll'y//ll�r, a�j 1+//1♦I+iY1�r l`e�� y+//11/'/1 t+Illi�+' q��� 'lil�i�+ ° •Z�•♦ �ATj� .: •7 vv ��A� ♦1= ,, t�A � •• 3c7�A�}T;.. •1� A�. J��♦.. 'IA�� •• A � ,i `,..Nr 'Yv ? �&7Fv0 �"t'� DATE AC� � CERTIFICATE OF LIABILITY INSURANCE 11/03/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: George DOuramanls Dur-America Brokerage Inc PHONE (212)302-2672 AX Not;(718)956-9731 214 W 39th Street, Suite 207 EMAIL ADDRESS: certificates@duramerica.com New York, NY 10018 INSURER(S)AFFORDING COVERAGE NAIL# INSURER A: ATLANTIC CASUALTY INSURANCE CO 42846 INSURED INSURER B: Double R A Construction Corp INSURIERC: 9 Jean Lane INSURERD: Rye Brook, NY 10573 INSURERE: INSURER F COVERAGES CERTIFICATE NUMBER: 00003019-1904718 REVISION NUMBER: 164 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. ILTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF MP�Y y"Y LIMITS A X COMMERCIAL GENERAL LIABILITY Y L302001498-0 10/15/2022 10/15/2023 EACH OCCURRENCE $ 1,000,000 AMAGE O ENTED CLAIMS-MADE X OCCUR PREMISES Eaocalrrence $ 100,000 MED EXP(Any one person) $ 5 000 PERSONAL 3ADVINJURY $ 1,000000 h CEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JET LOC PRODUCTS-COMP/OPAGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY 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 ecddent $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STAT TE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Village of Rye Brook is included as additional insured CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Rye Brook THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street AUTHORIZE REPRESENTATIVE Rye Brook, NY 10573 F P ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are r istered marks of ACORD Printed by FP on 11/03/2022 at 12:17PM NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) sreot , ^^^A^^ 061605879 DURAMERICA BROKERAGE INC214 W 39TH ST STE 207 NEW YORK NY 10018 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER DOUBLE RA CONSTRUCTION CORP VILLAGE OF RYE BROOK 9 JEAN LANE BUILDING DEPARTMENT RYE BROOK NY 10573 938 KING STREET RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2336 816-0 972357 06/13/2022 TO 06/13/2023 11/3/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2336 816-0, 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 CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT ANTHONY SOTIRE VICE PRESIDENT MARIA SOTIRE DOUBLE RA CONSTRUCTION CORP 2OF2 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 F �V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 773230516 U-26.3