Loading...
HomeMy WebLinkAboutBP22-2474 PERMIT # / �� �- DATE: / l3 O(P: SECTION BLO K LOT TYPE OF WORK / /or / oe? JOB LOC�ATION OWNEFt�./IO, �U47 414 CONTRACTOR V 117C�fQolCO C-049aht �PSi9r TCO # FEE DATE INSPECTION RECORD DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION _ f PLUMBING RGH PLUMBING GAS (] SPRINKLER ELECTRIC LOW -VOLT (� ALARM 0 AS BUILT 0 FINAL 9 INSP oval i TAM ' M� �.3-�� y CSC /��u.,-►6iny ���'�'�� ���CYY7C Co,0 OTHER APPROVALS ARB BOT PS ZBA OTHER VILLAGEF R' E BROOK WESTCHESTER COUN'�, NEW YORK No: 23-090 Certificate of ®ccupaucp Ehis is to certify that Joshoa o sa"-) of, �JY��k� N r having duly filed an application on 20 requesting a Certificate of Occupancy for the premises known as, L U OVI- , Rye Brook,NY, located in a Zoning District and shown on the most current Tax Map as Section: Block: ,�;2 Lot: 37 and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. - , issued 20 4,�, 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: f �ez� 4rA":�/q gen6jla 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 ilities shall be made,and no enlargement, whether by extending on any side or by increasing in g shal de nor shallthe building be moved from one location to another until a permit to accomplish such change as be o tained th mg spector. Building Inspector,Village of Rye Brook: Date: J UN 0 8 2023 v " �� BUILD R MENT For office use onl PERMIT# MAY 1 1 2023 VIL © fit : OK ISSUED: i,�—/3-ac 38 KING STRE •$ t YORK 10573 DATE: 5 FEE: 9 PAMR— VILLAGE OF RYE BROOK 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 ..r....rrr..rrr.............r...rr.•.r.....r......r...............a........r.r.................................►............. Address: 3' Gr er..t�nny L O---t K., Occupancy/Use: / ,�i�1Y Parcel ID#: ()-")I .:�4 Zone: Owner:foS" sc-m. sal Sow Address: K/ till P.E./R.A. or Contractor: vk'AC, ,kram`Co 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/altemtion herein mentioned in accordance with law: STATE OF NEW YORK, COUNTY OF WESTCHESTER as: A Ill 11 � '' ++ qi r`C,t,✓t� �� C.D being duly sworn,deposes and says that he/she resides at L qS A �t A L�.dt-��- R.o,,A (Print Name of Applicant) ' I (No.and Street) in in the County of W LS c./ in the State of ,that (City/rown/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:E r�� 1 000 for the construction or alteration of- Ttn- e'1)0 e- Deponent further states that he/she has examined the approved plans of the structuretwork 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 I Sworn to b re this f day of ,20� day of /' ,20_�U Signature of Property Owner Si re W Arli7 Print P.m of Property -.nner Print Name of Applicant #k�/ " &�)� Votary PAblic NoiaryTubL4r GREGORY K RIVERA 1SUNG ST. LED ER Notary Public,State of New York Notary Pubbe-State Of New YOdl ,.l 2021 NO.OiST6361684 No.01 R16441398 OuaNfed in RoddwW County Qualified In Westchester County Q( ly Oon,mi:saort Expirets 11/tbZO aS Commission Expires September 26,2 _ For BUILDING DEPARTMENT ILDING INSPECTOR tssISTANT 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:\�`1� SECT: , BLOCK: LOT: LOCATION: \�,�c 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 ROSS CONNECTION / FINAL ❑ OTHER II w T' � t0 OM GV Ln " Gn M H U z ca 0Og i a o = by x _ ' N O ,n 4-4 A [-4 g y 0 3 a o Il CN s W M woo U z a o Q ovb �j 0 rTO 0 z n � z v 2 , n a o U ON Q `•�• 0 ' 1i7 o o w a SA p = w w w � ao � PIA W z c wA v Cl) y �., U '—' z u o o � � � w �D C� z z o E , uc � o z o p a 9 � �I U v o a u ° oC,� � uU W W F o Z bb O U o V ° $ ,g00 am ' (� z w pd : N W W � � �4404144414;41944;4;414;9 41414-6 9 A 4 A 41414 4 4 4 414 4 4 4 4 41414 4 4 41,61 BUILDING DEPARTMENT R E C EF Y IE VILLAGE OF RYE BROOK DEC - 8 2022 938 KING STREET RVE BRooK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK NN.w.w.rvebrook.or« BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: pp DEC 1 2 �21 � -��z/ pp --T�—� Approval bate: I'rrrnit = A lication Fee: $ 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 c7 interior alteration of an existing building,or for a change in use,as per detailed statement described below. 1. Job Address: 4 C"'^Z SBL: Zone: 2. Proposed Improvement. (Describe in detail): � �-^ 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 I: TIER 11: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an existiy g automatic fire suppression system(Fire Sprinkler.ANSL System. FM-200 System,Type I Hood,etc...) :No: V Yes: (If yes.please submit a separate Automatic Fire Supprc Sion System Permit application S _ sets of detailed engineered plans) 5. Occupancy;(1 fam..2 fam.,comm.,etc...)Prior to Construction: t—ptrrit After Construction: 6. N.Y State Construction Classification: N.Y.State Use Classification: 7. PropertyOwner:` 1 lsc \Address: �j Phone# ��`��1 ��j — �(sar Cell# � �1 \1 ��� �3 email:1`0s� 01al��,r..r2a��5io. �.te•.. 8. Applicant: ft"M'A, V t•2. Address: Phone#. 01` I�, S1`'f `510'�— C'{j�#I �b — �1 �O email: C�vv���c►�tSi ,nGonS +uc+ l 9. Architect: Address: Phone# Cell# email; 10. Engineer: Address: Phone# Cell# email: 11. General Contractor: F rcu-\CO Address: la 5 VtiOA LEA- e- Phone# {'`��� -166 -V3 Cell# (KIN �b� - ��`�� email: Viere�i {�its�S�•I�o�4c��nCo���•t 12. Estimated cost of construction $ � " 1d © _ C'>C !NOTT:The estiniatcd cost:hall include all lahat.uiatcrial.Sk;AGAdin;.!:.ed cyuihor.ent,hr,f"•i rnul fees.and materiel)aced la;,rr may be donated L!ratis.l 13. Job Timetable: Start: Finish: (1} 5/12/2021 BUILDING DEPARTMENT �] v VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 DEC " 8 2022 (914)939-0668 VILLAGE OF RYE BROOK %vw-,c.r%-ebrook.orL 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: 3, t�t,� SC,15 14 , residing at,_��f' �i.��„✓�/ L Sift L�� �x JC����s i frill+ ll.lwic I ldilreFs a 11Cr' ou n i 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; (-J IVY, /cs—y-) ,Rye Brook,NY. Oub Ad ressi 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 Oh%nert s)i Wrint Name of Pruperry ()kk ner(s(( Sworn to before me this S day of yece"Aer , 20_f?12=_ (Notarti ibiit•1 AISLING ST. LEDGER Notary Public-State of New Yak No.01 snw w Qualified in Roddand County (2) My Commission Bpires 11N5/20_gf 8/12/2021 This form must be properly completed & notarized by the Design Professional of record and the Property Owner. Failure to provide this completed form with your permit application will delay the permitting proces . D [E c [E ��/] � �`� DEC - 8 2022 Notice of Utilization of Truss Type, Pre-EngineeredJL ood GE OF RYE BROOK or Timber Frame Construction. (Title 19 fart ]?64 i'--6� t ILDING DEPARTMENT To: The Building Inspector of the Village of Rye Brook. From: ►.ra racy �.vN�.z:T iGcn> ;.! u�1 LtrCr Subiect Property: tc �►r►A� LA�� 1�`�ti 3��vK N1 SBL: Zone: 10513 Please take notice that the subject; One or Two Family; ❑ Commercial, ❑ New Structure ❑ Addition to an Existing Structure "ehabilitation to an Existing Structure to be constructed or performed at the subject property will utilize; ❑ Truss Type Construction(TT) ❑ Pre-Engineered Wood Construction(PW) ❑ Timber Construction(TC) In the following location(s); ❑ Floor Framing, including Girders &Beams (F) ❑ Roof Framing(R) ❑ Floor Framing and Roof Framing(FR) Please note that prior to the issuance of the Certificate of Occupancy, the subject duelling or building utilizing truss type, pre-engineered wood, or timber construction must be posted with a Truss Identification Sign, installed in conformance with NYCRR §1264 for Commercial Buildings, and NYCRR §1265 for One & Two Family Dwellings, Sworn to before a this Qe c e.J e T Sworn to before met is da of 20�`Z dayf .',te Signature of Property Owner Sign l ature-of Des^ign Professional ` iW C-E nr r g-h J Co Prin am of Property Owner Print Name of Design Professional Notary blic � otary lic =ST.. LEDGER AISLING ST. LEDGER tate of New York Notary Public State of New York 6361884 No.01ST6361884 ddand County , Qualified in Rockland County pin3s 11l15124 (3) i My commission Expires 11/15l20 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: YInJcF,..sT F9-'LPco , 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 (--O lirRI6,r_ ov- for the legal owner and is duly authorized to make and file this application. (indicate architec ontrac .agent,attorney,etc.) That all statements c d herein are trite 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 storrnwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. s� � Sworn to before me this Sworn to before me this 5 day of_��c eau1 e 1 , 20 daLloAft,, 20-20— Signant signa a of Property��O�/wner T Print Name of roperty Owner Print Name of Applicant Notary lic Notary Pu c AISLING ST. LEDGER =Public ,. LEDGER Notary Public-State of New York No.01ST6361884 ate of New York6361884Qualified in Roc land county cldand CountyMy Commission Expires 111151207ires 11115f20 (4) i O N N a cry 'v i o q w N � w v W Ln U Fs co a y 00 • O � � � C a. a o ° A in 00 A H x p V = H oc HF� w W v N w 5Q CA r ON a Q A w � A L J H $ ►. U W Z a is W " x on w a z as w 0 < BUILDING DEPARTMENT C E O VILLAGE OF RYE BROOK DEC 1 2 2022 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK Nv%y.ryehroo1,.ur�_ BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required [� FOR OFFICE USE ONL1 BI, #: � 7 C / Approval Date: DEC 1 4 Permit Fee: $ Approval Signature: Other: ********************************** * ************************************************************ Application dated, Z iZ Z � her y ade to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/or remove electrical eyu ent, 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. q '/ \ a Q j� 1.Address: l-� l r�e_�n(,c()(r-l— 1. 1 Q �.1►&)K SBL: Lc�+7, O 7 -d-J 7 Zone:/ �6 2.Property Owner: J J go Sam Address: Phone#: ( A/n - b113- W 1 Cell#: email: 3.Master Electrician: Address: Lic. #: PN00 Phone#: qIq- 8q-14y10 Cell #: 9jy-%O S75-1 email: 0 cc 1cAIa4tCt"rlC. (6m Company Name: j_F')1 d E) l C C r►� Address: � f 8r K 4.Proposed Electrical Work/Fixture Count: n 9'dloy"(4 ID outic C 5.31 Party Electrical Inspection Agency: �� 1 ,STATE F NEW YORK,COUNTY OF WESTCHESTER ) as: 5 5A ,being duly sworn,deposes and states that he/she is the applicant above named,and does further (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.went.auurne_v.etc.) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances,and regulations. Sworn to before me this ge C Sworn to before me this Y e c day of to ,20 Z Y day of /O ,20 D�2 Signature of Property Owner ,Sig>�ture of Ap ant _4y S "1_5� �.�'11 y i Pri Name of operiy O er ffy, f�.pplicant (' LAURA J DELU (( //}� Notary Pub Notary Public-State ofNO. Ol DE49985Qualified In WestchestMy Comm. Expires June 6/23/2022 Bum NG DEPARTMENT VILE OF RYE BROOK 938 KING, REET RYE BROOK,NY 10573 (914)939-0668 wwwv yebrdA.org ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY 131'#: E:P #: Approval Date: 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 all applicable Federal,State,County and Local Codes. 1.Address: SBL: Zone: 2.Property Owner: Address: Phone#: Cell#: email: 3.Master Electrician: Address: Lic.#: Phone#: Cell#: email: Company Name: Address: 4.Proposed Electrical Work/Fixture Count: 5.3 d Party Electrical Inspection Agency: xxx**x*�*x*xx*�*F*x*x*xx*x�xxxxxxx*x*xxxxxxx****���*xxx*x�****�x*xxxx**xxxx*x*�;*�x**xxxx*xxxx*x*xxxxxxx STATE F NEW YORK,COUNTY OF WESTCHESTER ) as: 'zf being duly swom,deposes and states that he/she is the applicant above named,and does further (print name of individual signing the applicant) state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is thee a � for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney.etc.) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances,and regulations. Sworn to before me this Sworn efore me is ID day of ,20 day of C ,20 Signature of Property Owner Signature of Applkant L�- !':1 ZLd-e Jcy/ Print Name of Property Owner Name of Appli t Notary Public Not AD ILLO N:otAfy Public,State of New York No.01ME6160063 ,�iaalkfl"In Westchester County �'.�CYtrnisEk�uu Expires January 29.20L�- 6/23/2022 • STATEWIDE INSPECTION Service With hilegrity 1:1 Main Street,Fishkill, NY 12524 1 email:office@swisny.com SWIS JOB APPLICATION845.202.7224914.219.1062 • • • Office Use Elect.Permit# �/,..�L/ Date V 1 Bldg Permit#� 7 Utility ID# Final Certificate# City/Village R y e— Q�J� Zip Township County Address d /� eems �p� f Cross Street Section Block Lot Owner Namae/Address(if different than above) Contact Number Basement ®1st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage Attic Outside Residential ❑Commercial Receptacles Special Recept FCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact 6i Amt Amp t5, Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent SERVICE Amperage Voltage 1P 3P #Meters #Disconnect Underground New EjReconnect ❑Overhead ❑Change Visual Re-Inspection Safety Re-Inspection Re-Inspection Additional Information S 1�I(q 11 � n 6C /' )n l _ cc,\_o me � t I DEC 12 202, 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 corer 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 terns and conditions as set forth for the application. Inspector Date Finalized Inspector# Company Name .(�j; �% ;�r +r f C o Date Signature Address !/ (` r"('{� =,l C� i ne, City/State Y` .�, v 4_ NJ. Zip Code Lr License# 1I j ��,`� Phone# f t _ b D �, State Wide Inspection Services DD 1080 Main Street E c E �y MAY — 2 ZU23 Fishkill, NY 12524 845 202-7224 Phone 914-219-1062 Fax STATE WIDE INSPECTION SERVICES VILLAGE OF RYE BROOK Email: officeCcbswisny.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: Lelia Electric Corp Joshua &Sarah Balsam Richard Zweig 48 Greenway Lane 47 Greenway Lane Rye Brook, NY 10573 Rye Brook, NY 10573 Located at: 48 Greenway Lane, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 22-304 129.84 � 37 Certificate Number: 2023-2948 Building Permit Number: BP 22-247 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: 48 Greenway Lane, Rye Brook, NY 10573 The First Floor Kitchen and Exterior 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 27th day of April 202 Name Quantity Rating Circuit Type Under Cabinet Lights 06 GFCI 06 15AMP Exterior Flood 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 work performed on the date of inspection only. / s rl • N n N N a Ia. W N H a W �j�J ,c ,,,^. S � h O w V J W w W C ce � bc CA M z m c W W a ° -- a v to � O z c �i z � - M C4 � � � co A OW CZ.7 w c� Q r "o � $ z O � � z A ON ON Z a Q V Q � 14 z8 � u W w o Z z � a w N V oc �I M y� l3R�v�. R BUII, � TMENT E OF RYE OK [L2 3 2023I DD 938 I�r1 VIULtiw' ET RYE B NY 10573 914 939-0668 VILLAGE OF RYE BROOK E BUILDING DEPARTMENT www.ryebrook.org PLUMBING PERMIT APPLICATION 1 FOR OFFICE USE ONLY BP#: PP#: Q3--0 1—T Approval Date: Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) 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/4 ove 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. 1.Address: r ! tJ(,t L SBL: e�g 3 7 Zone:t40UJ6 2.Proposed Work: C /�n Q�'f 1 3.Property Owner: ti17 Ba Isa Address: Phone#: _ 61 Cell#: email: r 4.Master Plumber: 6,0rZ)n Address: � et , Lic.#: �369 Phone#. /q� - 391 -Al-Alr Cell#: email: in - Company Name: (� ,( f ilk T �n�Address: (' / 6 I/L �4 �Il� INDICATE FIXTURES&LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: /bj yJ 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 31d Floor 4'Floor 5''Floor Exterior 5.•List Other Equipment/Provide Details: �/S{�CJ(i.S til- (Notarized Signatures Required Next 2 Pages) -l- 8/12/2021 BUILDING DEPARTMENT R VILLAGE OF RYE BROOK 1 D 938 KING STREET RYE BROOK, NN' 10573 JAN 2 3 2023 (914)939-0668 -,�`wNi.rNebrook.or(,,, 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 WESTCHESTE(R,�) as: 31, C-.S 4 b S ls�S/,S `� J I , residing at, "/ (r.��n t/C'; /aj? (Print na)ne) 011 i n c) 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; ����/"✓S ti/ ��l'La`, , Rye Brook, NY. (R)b,Addhc" ) 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. (Si,gnuaue ol'Propert_y Owner(s)) Wrist Nmi)e ut l'ropertti Ov ner(�,)) Sworn to before me this l day of �Q�r c to , 2O 2 ,3 AISLING ST. LEDGER Notary Public-State of New York No.0 1 ST6361884 Qualified in Rockland County My Commission Expires 11/15/20 's 8/12/2021 STATE OF'NEW YORK,COiJ;?JTY OF WESTCHESTER ) as: df'4 e /l- kb/,)being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual si ning as the a licant) and further states that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the DIL) bb l-� 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 Sworn to before me this day of ,20_�_ day of ,20 Signature of Property Owner Signature of Applicant Pttint Name of Property Owner Print Name of Applicant Notary blic Notary Public AIS ;ING ST. LEDGER Notary blic-State of New York No.0 1 ST6361884 Qualified in Rockland County My Commission Expires 11/16/20 This application mu, 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. 8/12/2021 STATE F NEW YORK,COr OF WESTCHESTER ) as: 0/G' 6 ^ing duly sworn,deposes and states that he/she is the applicant above named, (print name of individ4i signing as the licant) 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,anomey,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 Sworn to before me this day of 920 day of e:T.0"J( ,20 2-S Signature of Property Owner Signature of Applicant ;1 �T C D r Print Name of Property Owner Print Name of 411 ant Notary Public Notary�'ub ' 1 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 Buil_I nQ Permit Check List&Zoning Analysis Address: z Ie c. SBL ' R - 2 e -ZUsi4e nt!�Con�stT - Other. Submittal Date: Z `� Z Revisions Submittal Dates: Applicant: /, S ✓�. Nature of Work 11yT�-CLi flr(_ ki�`rG � —�r�t�c�y QTz�ti1 Reviews:ZBA: DEC 1 2 2021 PB: BOT: Other OK ( ) FEES:Filing: S � BP: 30. /O:-.Flood Plane: Legalization: ( ) ( ) APP: Dated ✓ Notarized SBL: ✓T'russ I.D. Cross Connection ( ) ( ) Scenic Roads: Ste Slopes: Wetlands: H.O.A.: �' Storm Water Review Street Opening. ( ) ( ) ENVIRO:Long Fees: ( ) ( ) SITE PLAN:Topo: Site Protection: S/W M t.: N/A: ( ) ( ) SURVEY:Dated gn' Tree Plan: Other. Current Archival Sealed Unacceptable: ( ) (� PLANS:Date Stamped Sealed Copies• 2 Electronic ( ) ( �License: ✓ Workers Comp: ✓ Co Other. ( ) ( ) CODE 753#• Liability mp•Waiver Other (� ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit: N/A Other. N/A'— ( ) ( ) LOW-VOLTAGE ELECTRICAL Plans: Permit: (� ( ) FARE I l SMOKE DETECTORS N/A Other. PLUMBING :Plans: Permit: H.W.I.C.:_Battery:_Other. (� ( ) c 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: REOU UQ EXisnNSa PROPOSED NOTES PPRevm Li Date: DEC 1 2 2 21 Fr n FronC Sides: RAw cor. Accs.Cov. Fc H/Sb. 51 H/Sb: Pao: HZig U/Stories: notes: 41y los :.4 ���:_i11�/(tl,,_.; �:�`-�f�(�4(��::�:sil��lltf,�;�(p�t;;- ,<'JI�����,`�(i'i;�,i_ -��''���:F-i,r� .���•�+�f '. ,,�;��(�i ��i11�'ly �t�(i'�(�t; , �v`�� _ 0 Z ^s N r "i.� > G N CN R ..� Z O o T 4 o = = z kection G LU 00 M CO apt •V LL W < i U 3 Z u k Y LO LO 04 _ J J:i it :*��� � � G `.:: ,'� •sue'"I <{a�s)1 �•it = f a(acs)> - . . . .— .— . . . . . .-- . . . . . . . . . �G' s - �;s's,'sa t:. "tsr" -�`-'*siS. saF :i'�tf:"i'L6,"'.-sr--e.'-��— hi'� •�(0 �� frrl���..: of,� ,y t Off u.sit ^ ! •• it wiv . � .•u#�2t� t rT�y".', ,:�a '�,'tv�44,�. :i3�-. ''N$-_.�C- �i,�s.. i�r�.,Hs,.. � .�!�. .. �' .��ll�: - j r�' 3;: /; `_� �� ACC>" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD YVYY) llh � 1 12/5/2022 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: Yesenia Maggio John M. Glover Agency PHONE FAX - 29 Haviland Street No.E : 203-702-7924 Alc No:203-672-4968 Norwalk CT 06852 =LESS: ymaggio@johnmglover.com INSURERS AFFORDING COVERAGE NAIL 0 INSURER A: Mt.Hawley Insurance Co. 37974 INSURED CDCLLCO-01 INSURER 8: CDC LLC, Vincent Franco Consult Design Construct LLC INSURER C: 125 A Marbledale Road INSURERD: Tuckahoe NY 10707 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1740103444 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 ADDLTYPE OF INSURANCE JNM SUER EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY Y MGLO194003 5/31/2022 5/31/2023 EACH OCCURRENCE $1,000,000 CLAIMS-MADE C"J OCCUR DAMAGE PREMISES S(Ea oc RENTED currence) $50,000 MED EXP(Any one person) $0 PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 X POLICY 7 RCOT- F LOC PRODUCTS-COMP/OP AGG $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 accident $ A X UMBRELLA LIAB X OCCUR MXL0435960 5/31/2022 5/31/2023 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED F I RETENTION$ $ WORKERS COMPENSATION STATUTE EORH AND EMPLOYERS'LIABILITY YIN --- ANYPROPRIETOR/PARTNERAL-XcuUTIVE E.L.EACH ACCIDENT $ OFF ICER/M EMBER EXCLUDED? ❑ NIA - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S If es,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) Village of Rye Brook 938 King Street Rye Brook,NY 10573 is included as an additional insured under the General Liability Policy,if required by written contract executed prior to a loss. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Village of Rye Brook 938 King Street Rye Brook NY 10573 AUTHORIZED REPRESENTATIVE lt,2n i. �Z2fGt!-� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSI F New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE o- � a ^A^^^^ 264356825 VINCENT FRANCO CONSULT DESIGN CONSTRUCT L.LC Imil` 125A MARBLEDALE RD TUCKAHOE NY 10707 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER VINCENT FRANCO CONSULT DESIGN VILLAGE OF RYE BROOK CONSTRUCT LLC 938 KING STREET 125A MARBLEDALE RD RYE BROOK NY 10573 TUCKAHOE: NY 10707 PO W2109 451-1 CERTIFICATE NUMBER 08 04 2 22 TO POLICY PERIOD R D DATE 08/04/2023 12 6 2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2109451-1, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. BY CAUSING THIS CERTIFICATE TO BE ISSUED TO THE CERTIFICATE HOLDER, THE POLICYHOLDER UNDERTAKES TO PROVIDE THE CERTIFICATE HOLDER 30 CALENDAR DAYS' NOTICE OF ANY CANCELLATION OF THE POLICY. NEW YORK STAT S7�v NCE FUND 4 DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 1045006316 U-26.3 I" 0 � C z N 00 r a cy) Q co Iwo UJ co (D °. ® • .� co . o V 0Vol Q � _ 0 co CO z U4 3 J _ (0 i _ H aim cy) It Cy) N A rA CL UJ o �i Il w m Q a v� c� m IE IE W IE ii9 11 lie 11 ls DEC - 8 2022 101 VILLAGE OF RYE BROOK 96 BUILDING DEPARTMENT . ii ri Cd LO Q 0) LO LO 0 co 0 lr� co co oo 0 0 r-jN Cd Co ,IN --IN 0 C (0 Cd cd IN 04 Cd 0 (Y) 0 Lo U') LO LO LLJ 40 z z Oo Ro 0 CD CY) cle) (Y) co 0 Ce) 0 0 0 P-d CY) 0 CY) 0 4j CY) Ce) (Y) o N +.) ON (0 CY) N Nli z L 7� I'T lie 119 1 11 v V K 9W- A A ' ¢ V 12" 41 12"7r � N z 711 3001 31' .. � .. .Pd , » j 12 11� 76 �, •� 3 E f rr rl /r A 2 a 2 , _................_.............................................. .��yz.r•r zr'c.�,xr v c'^v:^'c�>.•�4;�KSr'•: a E t>;cc:�rc:tx,cr Sc :w v ` zn trh<^= kzs..•,:z cns:'n.s•><:s?:i::y ,„x a i;k?;.c?:'w>wr?c,:c,"mK>,•v•wxK::rwr::: .t : ' :'Q.'\' n • ................................................. 2S.'vti:iivnv W.ti..vvnk}„vv:;•nwr,.,.i.S:w' ^.:V:::ikv.r:4r:.v.:Y.A+.:.Anv:•`: .~}.. i< n*:•„G'"'i<rS',::,.':n"'lx v'�"nY.i•. kY,,:}rn,,...,�.r.•n`"...,.wwr..;v:.,,.r•,.:,,..,•,,`�'.:•...^..•.,..•: ........................................................t :::'t`22.".n•:.:.:. ..�y, £�•2�:':.•.:,.•:A:;,.......,,:,...:• 7F 4'vmi"'rn'vi+$x".'• . ....:�{::SSLLSSSS:'SV:: _- ...... ^ahi:::SKi'Y'.•:'}.YS'ty:'GS:'ti:X' ' .^.::•i .. ... { ,•..ate r c" - tMm M zo - V O CO m f M st > N P c� > M I N N rA M ..................»....................._... �'• 'J O _ mow : V rA N N N N M j M o i o o TIN M O ,✓� U o y.........Oo m - .......�......... _........................ O o r- M M 3.11 EM i W r c� G C " i - ress: O w ♦! "�; M M ��tt^^ j It! :�,. O F �� o N ' V*\fir CG OwNi - N W-....._..»..... ...... _ .........* Qj ;wc;ti^ v _ a M r ! . cQ c� co cG .. E p� co = «� n U O r V1 •w..:.. ............. ^^ -TIN SIN �" - - r co O aA - ,� 0 Co CD `��� k M SIN M •n . +J M M M > 00 > JJ++ •.� co N �, o tt) coOD W .', fi r... _ �"" r 00 O CV) co •................................................................................................. - 4 o ,..� T- C4e) O .........._......._...._._..._................................................._....................................................... Cony.^•:?.::,.\\..... .:�v:\'u.\4av•k• ;9 lie L b IIE �8 b�11£