HomeMy WebLinkAboutRP23-003PERMIT #,.L
SECTION
TYPE OF WORK
JOB LOCATIO
OWNER
CONTRACTOR
EST. COj/SST 1.
N/CO #
TCO #
3 DATE: / / q3 E11(P:
BLOCK_ OT,
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FEE DATE
INSPECTION RECORD
DATE INSP
FOOTING
FOUNDATION
FRAMING
RGH FRAMING
INSULATION
PLUMBING 0
RGH PLUMBING
GAS
SPRINKLER F1
ELECTRIC
LOW -VOLT 0
ALARM 13
AS BUILT
FINAL
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OTHER APPROVALS
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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 ACTING BUILDING & FIRE INSPECTOR
Susan R. Epstein Steven E. Fews
Stephanie J. Fischer
David M. Heiser
Salvatore W. Morlino
CERTIFICATE OF COMPLIANCE
February 21,2023
Rehana Ali
196 Ivy Hill Crescent
Rye Brook,New York 10573
Re: 196 Ivy Hill Crescent, Rye Brook,New York 10573
Parcel ID#: 129.76-1-17
Roof Permit#23-003 issued on 1/19/2023 to Re-Roof Existing Building
This certifies that the new roof,installed under the above captioned permit has been satisfactorily completed.
Sincerely,
Steven E. Fews
Acting Building&Fire Inspector
/to
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For office use onl :
FEB - 6 2023UU BUILCYEBROOK,'
ARTMENT PERMIT# -Gb3
VILE BROOK ISSUED: 9—a3
VILLAGE OF RYE BROOK 38 KING STREPORK 10573 DATE:BUILDING DEPARTMENT O FEE: '4 //O— PAIDJ*
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: MJ yen + Aye (3(-U,) N k� 1 5 3
Occupancy/Use: Parcel ID#: I 9,fi7 6— I — I I Zone:
Owner: AIo>7ie Ab' Address:
Ig671vy I))'11 C1,,.scm kee I§a,>1 S�
P.E./R.A. or Contractor: 00"We— � PQS II Address: 1/31 WiileIf Ay\-.. Po Py/bS73
Person in responsible charge: �54 h S a r bE. Address: K3 9 w)`1 ie j k A✓L P6(4-J-c- 4 �J LA/V/cS,)
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:
An n;e- AI being duly Swom,deposes and says that he/she resides at I q 6 -I U y H%o C reSC-en+
Print Name of Applicant) (No.and Street)
in_ y rv� in the County of w(, 1+Ji-5+W_ in the State of �j 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:5 % 9"1 d, D O
for the construction or alteration of: N pi�-'j ( d ,�
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 Y, Sworn to before me this
day of I1 4-uLA/�, 20a3 day of 20 'D 3
J4IRMAQUEZADA
Signature of Property Owner NOTARY PUBLIC,STATE OF NEW YORK
Registration No.01QU6186064 Signa ure of Applicant
Qualified in WESTCHESTER COUNTY
n rn`c. Commission Expires AD61 28.2024
Print Name of Property Owner Print Name of Ap licant
Not ub�c Nota li
QyE BkjC .
932 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 - - - - - - - - - - - - - - - - - - - -
ADDRESS :_ � �� �--DATE:
1 ohs
PERMIT# Q� ISSUED: 1 SECT: , �tLOCK:_ LOT: —I
LOCATION: v (2_Q)Q--L ��-) OCCUPANCY: 1�Fi
❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/REINSPECTION
❑ SITE INSPECTION w,r 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
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BuIL DEPARTMENT JAN 18 2023
ViE or RYE BIOOK VILLAGE OF RYE BROOK
938 KING '-FT RYE BROOK,NY 10573 BUILDING DEPARTMENT
914.)9 9-0668
FOR OFFICE USE ONLY: p �v-�
Approval Date:. 1 4 91199 mit# / `�'�� Application#
cvc�
Approval Signature: ARCHITECTURAL REVIEW BOARD:
Disapproved: Date:
BOT Approval Date: Case# : Chairman:
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case#
Other:
Application Fe L.,Permit Fees:,N/z�-1b U&
�7 ROOF PERMIT APPLICATION
Application dated: /'�C]-`� 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. �j �J nn(Os93// �]
t. Job Address: 196 Ivy Rill C rf scein�' (�`7� ��oSBL: / {oe'1.�t>J ` { "�?zone: PU6
Property Owner: An h j`L A)I' Address: r�0 _T U- H 1��) 'Cyt CCeO+ }AYa'6�k!a Y
Phone#: 3"[ 9-t46 9,,rr�� �s�f Cell#: email: (e an►'� 8 9 D l"_', n h dv,1-,,,
2. Applicant: 06"bi.p, rf� P&y Address: H3 WjI lip >~'}- 4vv-- Pu,-
Phone#: "!1q ` -I 3 / y-{a� t nS. a�+
Cell#: email: )°hbl ouh), r 1`,�p
p <v�+,
3. Roofing Contractor:
PO b b)e � I �J� Al ddress: �3 9 iv,)l e+� Po f� t-�'� �y
Phone#: 1�"l - IL _ga?cj cell#: e►"�01'► " �ehns, ;;)e'�mA(00;1.Go—A'11 4a. da�,bJ�r� 10S9'
4. Job Description,list all Methods&Materials: kemoVe- EKIIOi n�) n.; 5u�njT gn. /3,
5� owe�ylS C-orn;0A hqse, AgA, F-5- gIL'y—q, U v---�ens cornrly) p h'61)
i Jhc Y-b a I.' rIs?�t I �as>7 wt c ✓+r✓ .
5. Estimated Cost of Job:$ �, /y 0, U C) (NOTE:The estimated cost shall include all site
improvements,labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.)
6. If comer property,indicate street frontage:
7. Construction Type: NYS Construction Class:
8. Number of stories: Height:
9. Is garage being re-roofed:No:(v�•Yes:( )Attached No:(4-Yes: O Number of Cars:
10. Is roof peaked,hip,mansard,flat,etc:
11. Estimated date of completion:
-t-
are�r�m�
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.
STATE OF NEW YORK,COUN OF E'STCHESTER ) as:
�Yli4' 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
AM C-0 t)ty- ,(40 r 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 I
day of 5 L�vj , 24'J3 day of t'l n J , 20,13
Signature of Property Owner Sign a of Applicant
IRMA QUEZADA
+ NOTARY PUBLIC,STATE OF NEW YORK
nn '�- I' Registration No.01OU6186064oPfint
^ ti
Print Name of Prope ner Quallfied in WESTCHESTER COUNTY of Applicant
Cornttission Expires ApH128.2024
ota Public blic
-2-
811 2)2 0 2 1
JAN 18 2023 -DD
VILLAGE OF RYE BROOK 173'/2 Ivy Hill Crescent
BUILDING DEPARTMENT Rye Brook NY 10573
914-939-2440
January 13, 2023
Rehana Ali
196 Ivy Hill Crescent
Rye Brook, NY 10573
Re: Emergency Entire Roof Replacement
Dear Rehana Ali,
The Architecture and Grounds Committee (A&G) has reviewed and
approved your application for the above named work. This project requires
a permit from The Village of Rye Brook. You are directed to submit this
letter to the Village along with your permit application. Once the permit is
obtained, a copy must be provided to A&G.
Work on the project may not begin until you receive written notice of
receipt of your permit from A&G.
If any changes are made to the original plans submitted to A&G, due to
input from the Village or arising during construction, the Committee must be
notified in writing. Work cannot proceed until you receive written approval
for those changes.
Failure to comply with these procedures will result in fines and/or work
stoppage.
If you have any questions, please contact me at: Property Manager.
Ashlee Adragna
Property Manager
LICENSE NUMBER "THE OR/G/NAL"
Westchester WC319241119 ppUBLE Family Owned And
Connecticut 00556256 Operated Since 1960
All Home Improvements
EST. 1960
439 Willett Ave. Port Chester, N.Y. 10573
Tel#(914)937-4279 Fax(914)937-4172
http://www.DoubleRwindows.com
Annic Ali January 10, 2023
196 Ivy Hill Crescent
Rye Brook NY 10573
347-469-5957 reann8979(a-)yahoo.com
Insurance: All work involved within the following proposal is covered by Workmen's compensation,Public Liability,and Completed Operations Insurance.
Roof Contract
Labor and material for the following
• Remove existing roof from entire house down to the deck.
• If any additional rotted plywood is found it will be an additional cost. Cost to be determined.
• Supply and install two rolls of ice and water shield over the eaves and one on the valleys.
• Install an Owens Corning Pro armor synthetic Base sheet on remainder of roof in place of tar
paper.
• Install all new F- 5 white aluminum drip edge around the entire perimeter edge of roof.
• Install the new Owens Corning Duration lifetime architectural asphalt roofing system with the
sure nail technology system in the color of your choice
• Supply and install new copper flashing on the chimney.
• Supply a container to cart away job related debris.
• I am a preferred certified Owens Corning Dealer you will get the extended 10 year labor
warranty.
Terms: Painting,and windows cleaning to be done by others.Hidden rotten wood not included. Standard industry cash term,one half with the order,balance due upon
completion. Terms may be modified to meet special conditions. Past due balances are subject to a monthly service charge of 1 1/2%(18%per annum). If the account becomes
delinquent,we agree to pay any legal or collection fees expended by Double"It"arising from collection of the account.Permit&Application fees not included.Due to the
fluctuating prices in plywood,we reserve the right to adjust price.
Double"R"is not responsible for reconnecting existing alarm systems on windows and doors.
You the owner may cancel this transaction at any time prior to midnight of the third business day. After the date of this transaction,such Cancellation must be made in person,at
the offices of community improvements,or in writing postmarked prior to the fourth business day.We accept VISA or Mastercard with a 3%convenience surcharge on total
amount being charged.
Acceptance: The above prices,specifications and conditions are satisfactory and are accepted. Double"R"is authorized to do the work as specified.
Contractor Performance Warranty: Double"R"proposes to furnish and install labor and material in accordance with above specifications in order that the above qualifies for
the Manufacturer's Long-Term Warranty. In addition,all labor provided by Double"R"is unconditionally warranted for a period of Two years from the date of installation.
Approximate Start Date: Approximate Completion Date:
Customer: $7,940.00 (Amount)
Date: 6% (Sales Tax)0
Double"R': $7,940.00 (Total Amount)
Date: $3,970.00 (Deposit)
$3,970.00 (Balance Due Upon Completion)
Return original contract to Double"R", retain a copy for your records.
Visit Our Showroom Located At 439 Willett Avenue Port Chester, N.Y. 10573
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• DATE(MM/DD/YYYY)
ACOKO® CERTIFICATE OF LIABILITY INSURANCE
64. / I/17/2023
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 NAME: Belly Reyes
1 he Willett Insurance Agency PHO FAX
AIC NNo Ext: 914 491-5599 (A/C,No): 888 371-9783
138 Willet Ave ADDRESS: bettyreyes(a_)thewillettinsurance.us
INSURER(S)AFFORDING COVERAGE NAIC#
Port Chester NY 10573 INSURER A: Westchester Insurance Company
INSURED
INSURER 8
Double R PBJ,LLC INSURER C
439 Willett Ave INSURER D
INSURER E:
fort ChcstcT NY 10573-3179 INSURER F
COVERAGES CERTIFICATE NUMBER: 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.
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 F_v�OCCUR PREMISES(Ea occurrence) $ 100,000
MED EXP(Any one person) $ 5,000
A BP4904585Q2022 12/13/2022 12/13/2023 PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000
FIOTHER: $
AUTOMOBILE LIABILITY $
(Ea accident)
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
A U TOS ONLY AUTOS
HIRED NON-OWNED $
AUTOS ONLY AUTOS ONLY (Per accident)
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
ORKERS COMPENSATION -
ND EMPLOYERS'LUIBILRY STATUTE ER
%NY PROPRIETOR/PARTNER/EXECUTIVE Y I N
FFICER/MEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT $
Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
f yes,
SC describe under
RIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
E
DESCRIPTION OF OPERATIONS I LOCATIONS/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
The Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS.
939 King Street AUTHORIZED REPRESENTATIVE
Rve Brook NY 10573
Cc;1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
NEW Workers'
YORK CERTIFICATE OF
Board
STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE
la.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured
Double R PBJ,LLC 914 937-2237
439 Willett Ave
Port Chester,NY 10573 1c.NYS Unemployment Insurance Employer Registration Number of
Insured
Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of Insured or Social Security
certain locations in New York State,i.e.,a Wrap-Up Policy) Number
92-1106938
2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier
(Entity Being Listed as the Certificate Holder) NYSIF
The Village of Rye Brook
938 King Street 3b.Policy Number of Entity Listed in Box"la"
Rye Brook,NY 10573 8910587
3c.Policy effective period
19i9cwro? to 19r9onms
3d.The Proprietor,Partners or Executive Officers are
included.(Only check box if all partners/officers included)
all excluded or certain partners/officers excluded.
This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"l a"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"2".
Will the carrier notify the certificate holder within 10 days of a policy being cancelled for non-payment of premium or within 30 days if
cancelled for any other reason or if the insured is otherwise eliminated from the coverage indicated on this certificate prior to the end of
the policy effective period? ZYES ENO
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,nor does it confer any rights or responsibilities beyond those contained in the
referenced policy.
This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect.
Please Note: Upon 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.
Approved by: Betty Reyes
(Print name uthorized representative or licensed agent of insurance carrier)
Approved by:
(Sign ure) (Date)
Title: Insurance representative
Telephone Number of authorized representative or licensed agent of insurance carrier: 914 481-5599
Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2.Insurance brokers are NOT
authorized to issue it.
C-105.2(9-15) www.wcb,nygov