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HomeMy WebLinkAboutBP23-009PERMIT #L=?2 SECTION TYPE OF WORK JOB LOCATION OWNER CONTRACTOR EST. V/CO # COST \a TGO # FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS SPRINKLER ELECTRIC LOW -VOLT P fALARM AS BUILT FINAL 0 1 a / DATE: FEE DATE INSPECTION RECORD DATE I NSP 3t &0#910vom,S Alt scD3 - 99106 3 eell01AA.ILWILt to �66�Q�v 3- OI �%eora�o%�e6�ra'�%uM6% OTHER APPROVALS ARB BOT P8 ZBA OTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 23-058 Certificate of Occupancy This is to certify that �� ,� , Q (fie///'Jlose of, R010, having duly filed an application on 20Q—'� requesting a Certificate of Occupancy for the premises known as, ?-A6 • V , Rye Brook,NY, located in a)Q 15 Zoning District and shown on the most current Tax Map as Section: 0 / Block: ) Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No , issued / 20,23 , 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 t facilities shall be made,and no enlargement, whether by extending on any side or by increasing in height a be ade,nor all the ing be moved from one location to another until a permit to accomplish such change has bee obt ' d from the uildin Ins ctor. APR 2 4 1013 Acting Building Inspector,Village of Rye Brook: Date: (� I �1�� f` BUILDIN � TMENT For office use onl : D �J�� J rr_ PERMIT# —OI09� VILLAGE OF RYE BROOK ISSUED: %—31—a 3 [MAR 3 0 2 938 KING STREET,RYE BROOK,NEW YoRK 10573 DATE: (914)939-0668 FEE: �i //0-- PAIDAR VILLAGE OF RYE BROOK E www,ry btreok.org APPLICATION FOR CERTIFICATE OF OCCUPANCY, CERTIFICATE OF COMPLL,NCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION rsssrssssssssrsrssrrrsssssssssr�ssssss►srsrrsrrrssssssssssss►ssssserasssrsssssssssssssrrssrsrrssssssssssrssrrrrssssssssssssrss Address: �� 1�w-�'��/e _ , 12411C P Occupancy/Use: j� Parcel ID#: Zone: Owner: Address: 'SD 6wq�x l�c ,)y/os-?-� P.E./R.A. or Contractor: _� Address: Person in responsible charge: ef�7 C Address: 30l�vn B �rt�ro ti 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 YYORK, COUNTY OF WESTCHESTER as: GEC 6195ex. being duly sworn,deposes and says that he/she resides at 51 !/� On r. (Print Name �of_Applicant) / o.and Street) in 9;-yC 9S�x ,in the County of (,t1'CSoes k, in the State of� ,that (Cityfrown/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:$ for the construction or alteration of: A"eA I Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-10.A.of the Code of the Village of Rye Brook. Sworn to before me this Sworn to before me this -�day of (1 , 200( day of G r, I rr) , 20,1n � ignature of WeK Owner Signature Ap Print Name of Property Owner Print tNName �of Applicant otary PO is GREGORY K RNERA Notary Public GREGbRY M.RNERA Notary Public,State of New York NMNV Public,State of New York No.01RIW41398 No.01RIWI398 8/12/2021 Qualified to Westchester County n/ QualOed In Westchester County n/ Commission Expires September 26.2 CommBsisn Expires September 26,2 ��yE aRnv� w � 9� BUILDING DEPARTMENT 9BUIWING INSPECTOR VILLAGE OF RYE BROOK D VILLAGE ENGINEER 938 KING STREET RYE BROOK,NY 10573 O ASSISTANT BUILDING INSPECTOR (914)939-0668 FAx(914)939-5801 - - - - - - - - - - - - - - ---- - - - INSPECTION REPORT - - - - - - - - - - - - -- - -- - - -- ADDRESS: � LIJ (- DATE: y PERMIT# ISSUED: ' {� SECT: BLOCK: LOT: LOCATION: (n OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED 0 FOOTING / 0 FOOTING DRAINAGE ❑ FouNDATIoN ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING 0 INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING O FINAL 0 OTHER QyE 4Rot o`` tim BUILDING DEPARTMENT Q'BUILDING INSPECTOR ❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : �1 Q DATE: PERMIT# `" ISSUED: SECT: BLOCK: LOT: LOCATION: t 01(� h pk OCCUPANCY: THE WORK IS... ❑ ACCEPTED ?RE ECTED/ REINSPECTION Q VIOLATION NOTED /// T SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ` ' _ \ \f r ❑ NATURAL GAS 00\-C)O � U\�tS {v ��� `� ❑ L.P. GAS , CMG 2 ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING _ ❑ CROSS CONNECTION 0� \ \� `2Q-S O b l 1 ❑ FINAL F- \Q-�41 Se C nn C 4LjC� �L�Q O ❑ OTHER C) , J. 1L Vim\ (�� _ N M as °! (U Qr W Q op114 z� o 0 x . wp x 0 re 4 ° c o CA �I C o a 72 A a •. c. C Ln ,� I 14 w b U� = O u V Ln 3EU � u cl� Z; co „ w U v� 8 b 0 Itkor IAOV . oc a ON cin Mr �•1 '-q z z p4 � o W w w - i--� w z o o ff a4 v cn q w © � -JE ab PO u .. BUILDING DEPARTMENT VILLAGE OF RYE ROOK JAN 2 4 2023 ID 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK M2=-ryeb>rook org BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Approval Date: J AN 2 3 t#: 3— W / Application Fee:$_-75 Approval Signature: \APPermit Fees: $ 4. Q Q� Disapproved: Other: Application dated:/' / - is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing building,or for a change in use,as per detailed statement described below. I 1. Job Address: 30 LA W r 1 C�(V— Ve, �,f SBL: !v� / t� '�—Sy Zone: IS 2. Proposed Improvement.(Describe in detail): V!4 J U(-D(� 04f',l(OPI (CP.12)ri-Q'S ai 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 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:\,Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 5. Occupancy;(I fam.,2 fam.,comm.,etc...)Prior to Construction: After Construction: 6. N.Y State Construction Classification: N.Y. State Use Classification: 7. Property Owner: C 61-I Address:_ O 1 k�Y 1 c: G.Q Qrf yc- Phone# Cell#L-I S..323 '19(o (f email: ek)'lam L'^'G''m®i1.C Q Irn 8. Applicant: Address: Phone# Cell# email: 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# email: 11. General Contractor: Address: Phone# Cell# email: 12. Estimated cost of construction $ 5 J 000 (NOTE:The estimated cost shall include all labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 13. Job Timetable:Start: Finish: (1) 8/12no21 BUILDING DEPARTMENT JAN 2 4 2023 VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 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: residing at, SC) brkw 4 :' (Print name) (Addreq 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; 3 O za W'�J g� �� �"e k I y f D � , 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 Owners ir^t� 1..7rJ� (Print Name of Property Owner(s)) I Sworn to before me this I day of laior 20 (Notary Pu)Mc) GREGORY K RIVERA Notary Pubilt,Stets of New York No.01 MU1399 (2) QuaNtied in Westchester County Commission Elopers September 26,20!�L' 8/12/2021 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 YPIR&COUNTY OF WESTCHESTER ) as: I eC (SicSP ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of in vidual 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. n� Sworn to before me this Sworn to before rue this day of 2013 day of ( 20� Signature of Propgft Owner Signature of Ap-plim0t i Print)Name of Property Owner Print Name of Applicant Notary Pu c Notary Puiffic CJ GREGORY M.RIVERA GREGORY M.RNERA Newry Public,State of New York Notary Public,State of New York No.01 R1601399 No.01 R16441398 oua0fied in Westchester County �' Qualified in Westchester County q�_ Commission Expires September 26,20„� Commission Expires September 26,20—C' (4) 8/12/2021 Ln N 6Z• � w o r e� o o cn u N w ~' �+ Ln M a x r••� � .= N cA W W � � v O Z o 0-4 Ln 00 M Q z O 00 o w f- o a Z o uZ � � z M o pis z W � cn C7 Q z � a V ,� V A ,t., am. �_ W 00 0-4 O z V Z cy ° a W O F a � w � A � �I go a Z. CQ w se i yE_BRnv BUIL E MENT D VIL E OF RYE OK JAN 21 2023 938 KIN , ET RYE B ,NY 10573 VILLAGE OF RYE BROOK W or BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP EP#: d J f✓�`--� Approval Date: JAN 2 7 2023 Permit Fee: $ 15a� Approval Signature: Other: Application dated,/ - 7 a 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: © G.p �l//�f'�(�F Qe U�" SBL:��� —6 �-t�� � Zone: )` 2.Property Owner: FF I Address: � �� Phone#: Cell#: 323 V966, emai/l:, 3.Master E�ctrician: ,6, Cf�IQL Address: /-I IG��L�^ N/Q Lic.#:�Phone Cell#: J 03 mail: • �r`t r--I-E W OZ- - 6 0/1/L Company Name: Address: 4.Proposed Electrical Work/Fixture Count: 41t14 1-/ fs z- T6PEN C -(corS 5.31 Party Electrical Inspection Agency: xxxxxx,�xx,�xx:�xxxxxxx�xx�xxxxxxxxxx�:���xxxxxxxxxxxxxxxxx***�xxxxxxx,:xxxxxxxxxxxxxY�xx��xxx�, x,xxxxxxxxxxx STATE OF NEW YOR��K,��C`�ODUNTY OF WESTCHESTER ) as: LA [A,2 � U C14- ing duly swom,deposes and states that he/she is the applicant above named,and does further (print nar of individual signing as the applicant) N'�� dA b c'/'T state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the L- (� /� 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 to fore me this day of ,20 day of ,209�--Z-_ Signature of Property Owner Signat6re of Applicant Print Name of Property Owner I i Name of Applican Notary Public N State of New York No.OIME6160063 QualMed In Westchester County. Commisslon Expires January 29,20Z� 6/23/2022 STATEWIDE • Service Willi Inlegrily 1:1 Main Street,Fishkill, NY 12524 1 email:office@swisny.com SWIAS JOB APPLICATION tel84 1 914.219.1062 SWISNY.com • • Office Use Elect.Permit#Z_�� \ ��� Date ` �� 60 �1 Bldg Permit# /�/ n Utility ID# Final Certificate# City/Village Zip Township County Address 7 D `A����/ r UC Cross Street Section Block Lot Owner Name/Address(If different than above) r Contact Number r-- ❑Basement ❑1 st FI. ❑2nd FI. ❑3rd FI. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent SERVICE Amperage Voltage 1 P 3P #Meters #Disconnect ❑Underground ❑New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information JAN 2 7 2023 ID 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 cover the above listed items to be Inspected,if at any time of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items Inspected.The applicant declares that there Is no open applications for the above address with any other Inspection company.The applicaM,owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Inspector Date Finalized Inspector# Company Name Date Signature Address City/State Zip Code License# Phone# D �� Y State Wide Inspection Services 1080 Main Street Fishkill, NY 12524 MAR 2 8 2023 845 202-7224 Phone 914-219-1062 Fax STATE WIDE INSPECTION SERVICES VILLAGE OF RYE BROOK Email: office@swisny.com BUILDING DEPARTMENT Website: www.swisny.com Service With /ntegriry BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: AG Miele Eric &Jacqueline Gioseffi 47 Highland Avenue 30 Lawridge Drive New Rochelle, NY 10801 Rye Brook, NY 10573 Located at: 30 Lawridge Drive, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 23-025 129.67 � 54 Certificate Number: 2023-1736 Building Permit Number: BP 23-009 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: 30 Lawridge Drive, Rye Brook, NY 10573 The First Floor, Second Floor, Garage, 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 17th day of March 2023. Name Quantity Rating Circuit Type Receptacles 44 Switches 32 Light Fixtures 04 Recessed Luminaires 45 Kit Lines 02 20AMP GFCI Receptacles 04 Smoke Detectors 04 C/O Smoke Detectors 04 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. \ Jul, hrl a p0-4 40 r w a , � � z � Z � � � W � � � • o w en o a a Z a v A co W o \ z , (� 00� > z p p 1.0 v w0 p W � 3z° vai W � V) Z M W � �, z C7 A z � ~+ a g CA o A G V M. Z p q W z • M a as a3 T W w w r ►..� A z � o � o � � H a W ! a W � $ c� A a M a z w �I � cog � w x � p CC ENE BUILDING DEPARTMENT JAN 2 5 2023 1 0 VILLAGE OF RYE BROOK VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 1057 BUILDING DEPARTMENT (914)939-0668 www.ryglXook.org PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: �a—w g PP#: Approval Date: J AN 2 Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) ****************Z-;316��L3 Application dated,/ is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install d/or femove 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: 3`7 eo'—.,•d�g Dc, &m- ,)y /wi- i SBL: I aq,�JZ —I- sy Zone: 2.Proposed Work: 1�!!L� SC-Mt lt9IA on 3.Property Owner: Address: 3� pE Phone#: Cell#:& n _3Z I- q F66 email: e 4.Master Plumber: �,�(p!'«��bb���a12. Address: 1 GvG Lic.#: lq� Phone#: Cell#: T 14 f- qj'O 1 Ulemail: me6S °�-4+so tP Company Name: Address: ve-e I Zj2r) rye t INDICATE FIXTURES&LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1st Floor 2nd Floor 31 Floor 4m Floor 5th Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -1- 8/12no21 STATE OF NEW YOM COUNTY OF WESTCHESTER ) as: ,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. Sworn to before me this r\1.'�! q Sworn tobefore me this day of:20 QU ,20 day of ,20 3 Signattuur of Prop rty weer Signature of Ap cant Print Name of Property Owner Print Name of Applicant "''z ALL.— tldL Notary Putdc Nay Notary ow lic Pubk State of New York H Rb MELILLO No.OIR16441398 Notary public,State of New York QuaRW In Westchester County No.O1ME61.60063 Commission Expires September 26,20l Qualified In Westchester County,---, Con'►missl n This application must be properly completed in its entirety and must incluPep IR AINTY $8 (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- 8/12i2o21 BUILDING DEPARTMENT R E C E Q V `-� VILLAGE OF RYE BROOK 938 KING STREET RYE BRQOK,NY 10573 JAN 2 5 2023 (914),939-0668 ww .r.ry ro4k.erg 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 YORRpK, COUNTY OF WESTCHESTER ) as: 67,&5e, ' ,residing at, 3 o La� (Print name) ( dress 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; /a>�✓1 A �1�c , y /-0S7 , 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. Z., "O�z (Signature of Property Ownec(s)) I,I,C 6�WA,0 (Print Name of Property Owner(s)) Sworn to before me this day of QnU O 6) ,20-23— (Notary lic) GREGM AL RN M Nary Publk,SLb of Now York No.01RI 11M Q nowd in Wastcha tff County _3_ CommhWon E*ms"inbsr 25,2 8/12/2021 _ _ _ 1"� N 1 N \ w 0 Ul O a F Z 4 z a N LL. W e-+ g 0 z C) mow, O W 0.0w F a z a z z W g cn A �, z �l W a/ _ z W � ono z �Z co Qo044a z z z c� z W z Z M , .. � n z �"' o a r a �o V s 000 z LL J �, M W cn CA r a z zz a oD M Z h1 Ln o W N U v C+ a o z Q o A a, w a 9 s a;M) w = � _ i p ECEME BUILDING DEPARTMENT FEB - 7 2023 1 DD VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT www.rychrook.org PLUMBING PERMIT APPLICATION / FOR OFFICE USE ONLY BP#: CD J"—00 %Q PP#: Approval Date: �2' Permit Fee: $ Approval Signature: Other: Disapproved: X)t7 (fees are non-refundable) Application dated,7� ;), is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agree that said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: 14-."e. &,tE i )X /0-5:Z5--SBL: jZ`1 *7' Zone: —1 S 2.Proposed Work: 1 St'{.AI�F,W��( T � � 1 - Cl C"c U, k lr 1 r�G�� � rC3 ir-O 3.Property Owner: cy ti P Address: A&AcX-41-J, Phone#:Ef 1 n .�c'3 - �f�� Cell#: email: cwcf.,Bse: .t4a,( (,V,24 4.Master Plumber: f{. 1f ATt�C �iF�iT3 Address: 1c, t Lic.#: �Phone#: Cell#: 21 ' (C> '(; 3!�"jemail: Company Name: Address: y fEkeA7- Ft T INDICATE FIXTURES&LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1st Floor 2nd Floor 3'd Floor 4'h Floor 51 Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) 4- si12no21 a BUILDING DEPARTMENT D D VILLAGE OF RYE BROOK R FEB - 7 2023 9 938 KING Q ET RYE BROOK,NY 10573 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 PLUMING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT. STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: 31, C�r�IC CJ/ ,residing at, 30 zow,,4� 44- )?Y�7 (Print name) (Ad s 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; 3o 45�`-''nA - l�E _61i� /-N Iry_F_? , 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. ( afore of Prope Own (Print Name of Property Owner(s)) Sworn to before me this day of , 20 (Notary blic) GREGORY M.RIVERA Notary Puplk,Silts of New York 3 No.DIR11141098 Qwd#bd In Westchester County Commission Expires September 26,64y 8/12/2021 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,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. Sworn before me this Swom to before me this l day of 20 day of k'r 20 Signature of Prop wner Signature of Applicant 6�� 6",54q. L�EjQ 4SI A-�� 5-?-, Print Name of Property Owner Print Name of Applicant /P ;�7& owz�,J/97&6-4 Notary lic Notaryp'yblic MMOM IL GREGORY K RNERA NNfy('dk 8db of Now York Notary Pubik,State of New York NL 01R"1898 No.01111110098 011W IN Ylte winder counI► CuWM*d In Westchester County Commission Expires September 26,2t� This application must be properly com eted in its entirety and must include the notarized signature(s)of the legal owner(s) of the subject property,and the applicant of record in the spaces provided. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- 8/1v2o21 Building Permit Check List&Zoning Analysis Address: \V SBL: Zone — use: 'Z Coast Types Other. Submittal Date: ���- �- Revisions Submittal Dates: Applicant: C�5 Nature of Work ► N e .c �c �C>V n�S �E�"e�S �A `�OCX�S Reviews.ZBA'�A� 2 6 2 P& BOT• Other. y NEED OK S� 6)"l- G ( ) (, FEES.Filing: BP.� PC/O: Flood Plane Legalization: k o ( ) (Y} APP: Dated: ✓ Notarized: i SBL: _Truss I.D. Cross Connection: H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Stone Water Review: Street Opening. ( ) ( ) ENVIRO:Long. Short Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection S/W Mgmt.: Tree Plan: Other. ( ) ( ) SURVEY:Dated: Current: Archival:- Sealed: Unacceptable: ( ) ( ) PLANS:Date Stamped. Sealed: Copies: Electronic: ther. ( ) (;) License: Workers Comp: Liability Comp.Waiver. r/ Other. ( ) ( ) CODE 753#: Dated: N/A: (yY ( ) 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. (VPLUMBING:Plans: Permit: ✓Nat.Gas: LP Gas: N/A/: Other. l � ( ) 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: APPKUVED REQUIRED EXLMNG PROPOSED NOTES Date: , Cube: Fmmg From Front: Sees: lip Main Cov Accs,Cov F S Sd,H/Sb: GF To,LM: Ft.Imo: P Hg ht/Stori notes: \ Q_ c _ 1Y LL4 VI S l N 1� 0 9 • 1 ' ` �I. s 1 4 *00 Q� f 1 A p a � .a ' w N F~ 3 Ewa mum 1 F � n - W z . t V• 4.,r C'� � � r� � � � �F I s m QUOTE#:Q19690992 ERIC GIOSEFFI EFF DATE:05-25-2022 PRINT DATE:05-09-2022 n c m-s. New York Central Mutual Fire Insurance Company 1899 Central Plaza East,Edmeston NY 13335-1899 INSURANCE 800.234-6926 www.nycm.com NYCM HOMEOWNER QUOTE APPLICANT NAME AND ADDRESS: AGENCY NAME AND ADDRESS: ERIC GIOSEFFI BRADLEY&PARKER INC JACQUELINE GIOSEFFI PO BOX 9081 30 LAWRIDGE DR MELVILLE NY 11747 RYE BROOK NY 10573-1021 DOWNLOAD TRACKING#: AGENCY CODE:01094 TERRITORY: LI PHONE H: W: C: PHONE 0:631-981-7600 F:631-981-7681 EMAIL: EMAIL:cpaola@bradley-parker.com Policy Effective Date: 05-25-2022 Policy Premium: 2160.00 Policy Term: 1 YEAR Minimum Down Payment: 324.00 Tier: 41 Coded Insurance Score: B LOCATION 1 LOCATION 2 LOCATION 3 LOCATION 4 LOCATION DETAILS LOCATION TYPE PRIMARY NO LOCATION NO LOCATION NO LOCATION ADDRESS 30 LAWRIDGE DR RYE BROOK,NY 10573-1021 Construction Type FRAME #of Families 1 #of Apartments Territory 49 Premium Group Protection Class 4 COVERAGE DETAILS Basic Form NYC HO 00 03 Deductible 2,500 A:DWELLING 950,000 1,493.00 B:OTHER STRUCTURES 95,000 INCL. C:PERSONAL PROPERTY 665,000 INCL. D:LOSS OF USE 285,000 INCL. E:PERSONAL LIABILITY EACH 1,000,000 82.00 OCCURRENCE F:MEDICAL PAYMENTS TO OTHERS 5,000 17.00 OPTIONAL FORMS HO 04 90-PERSONAL PROPERTY 186.00 REPLACEMENT COST LOSS SETTLEMENT NYC HO 04 55-IDENTITY FRAUD EXPENSE 25.00 COVERAGE NYC HO 23 85-LIMITED WATER BACK-UP 188.00 AND SUMP DISCHARGE OR OVERFLOW COVERAGE-NEW YORK NYC HO 23 95-OFF PREMISES THEFT INCL. EXCLUSION-NEW YORK NYC HO 24 86-PERSONAL INJURY-NEW 25.00 YORK NYC HO 500 25-ADDITIONAL LIMITS OF 24.00 LIABILITY FOR COVERAGE A,B,C AND D NYC 113-EQUIPMENT AND APPLIANCE 60.00 BREAKDOWN COVERAGE PAGE 1 OF 2 QUOTE#:Q19690992 ERIC GIOSEFFI EFF DATE:05-25-2022 PRINT DATE:05-09-2022 NYC 114-UTILITY LINE EXPENSE 60.00 COVERAGE LOCATION PREMIUM AMOUNT 2,160.00 LOCATION 1 LOCATION 2 LOCATION 3 LOCATION 4 MODIFICATIONS/CREDITS Total 71.00 HOME BUYER DISC RENO NEW ROOF DISC Coverage is not bound by this quote nor will a policy be issued until an application is received.Application acceptance is subject to company approval. If you have any questions,please contact your agent. PAGE 2 OF 2 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 w ive the workers'compensation rights or obligadow of any pony.** 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): 0 1 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 f r 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. Z`-I 1 2 3 (%ignaydr&&Homeowner) (Date igned) rye=— r yt Home Telephone Number � JS 3 Z5 k) 6 (Homeowner's Name Printed) Ec before m this day of Property Address that requires the building permit:'J' vVY_ Y 'V5-7 > er o�ti�liV 1. ) 5 Netary Public,Stats of Ntw Yor1cNo.01R16441398 Qualified In WestchesterCountynommission Expires September 26,2t1" 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