HomeMy WebLinkAboutRP23-007PERMIT # Y"% L
SECTION Lr
TYPE OF WORK
JOB LOCATION.
CONTRACTOF
T. COST
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BLOCK LOXiS n
939-31139
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FEE DATE
INSPECTION REGORD
DATE INSP
FOOTING
FOUNDATION
FRAMING
RGH FRAMING
INSULATION
PLUMBING O -
RGH PLUMBING -
GAS C7 -
SPRINKLER
ELECTRIC 0
LOW4OLT L� -
ALARM 0
AS BUILT O ---
FINAL Z1, 2o72
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.iyebrook.org
TRUSTEES BUILDING & FIRE INSPECTOR
Susan R.Epstein Steven E. Fews
Stephanie J. Fischer
David M. Heiser
Salvatore W. Morlino
CERTIFICATE OF COMPLIANCE
December 28,2023
Donald Fehr&Stephanie Fehr
34 Rocking Horse Trail
Rye Brook,New York 10573
Re: 34 Rocking Horse Trail,Rye Brook,New York 10573
Parcel ID#: 129.74-1-45
Roof Permit#23-007 issued on 2/15/2023 to Re-Roof Existing Building
This certifies that the new roof,installed under the above captioned permit have been satisfactorily
completed.
Sincerely,
Steven E. Fews
Building&Fire Inspector
/to
BFor office use only.
UILDING DEPARTMENT
' PERMTT# RM
VILLAGE OF RYE BROOK ISSUED: -1, - ;L 3
DEC 14 2023 938 KING STREET,RYE BROOK,NEW YORK 10573 DATE: 1 //4/-95
(914)939-0668 FEE: PAID 41-01
www.ryebrook.ori!
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
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Address: 34 Rocking Horse Trail Rye Brook, NY 10573
Occupancy/Use: Parcel ID#:129.74-1-45 Zone: R-3
Owner: Donald Fehr Address: 34 Rocking Horse Trail Rye Brook, NY 10573
P.E./R.A. or Contractor: Home Energy Repair LLC Address: 194 S Water St Greenwich CT 06830
Person in responsible charge: Andrew Prchal Address: 194 S Water St Greenwich CT 06830
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:
Andrew Prchal being duly sworn,deposes and says that he/she resides at 194 S Water Street
(Print Name of Applicant) (No.and Street)
in Greenwich ,in the County of Fairfield in the State of CT 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:S 14,700
for the construction or alteration of: Roof Replacement,Ashphalt Roof
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-IO.A.of the Code of the Village of Rye Brook.
Sworn t e o me this `pC Sworn to before me this 0?
day o V2G ,20 day of Qe�� � , 20
Si f Pro rty Owner Signature of ADpK-AT-
j alAT�
Andrew Prchal
Print Name of Property Owner Print Name of Applicant
ary Pu 'c �`��-•.' �`•.���% ary Publi
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• �9a2 BUILDING DEPARTMENT
❑BUILDING INSPECTOR
0-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: P OC , J N 3r f 0.t DATE: L " G G- 1 0 Z�
PERMIT# ` l� Zc�O� ISSUED:2-kJ"�3 SECT: Z9, ?`I BLOCK:_ LOT: 7S
LOCATION: K OO 't 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
❑ CROSS CONNECTION
FINAL
❑ OTHER
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BUILDING DEPARTMENT D E C EN E
VILLAGE OF RYE BROOK
938 KING STREET RYE BROOK,NY 10573 FEB 10 2013
(914)939-0668
www.ryebrook.or.g. VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
*****************************************************************************
FOR OFFICE USE ONLY:
Approval Date: FEB 1 4 2013 m' 4 �`-'� / : Application #
Approval Signature: ARCHITECTURAL REVIEW BOARD:
Disapproved: Date:
BOT Approval Date: Case# Chairman:
PB Approval Date: Case# Secretary
ZBA Approval Date: Case#
Other:
Application Fee: Permit Fees:4 a )�—
//�� ROOF PERMIT APPLICATION
Application dated:c� � �V�7 3 is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Pennit to
Re-Roof an Existing Building,,as per detailed statement described below.
1. Job Address: J -1 V—OI K-\N 6 N DQ-S-C 'VP-A\ Lr SBL: ��9.7y ��7s Zone:
Property Owner: Dpt"�o.'1,0 �-- Fti(L Address: 3q �bektN� OAS T(LA�L
Phone#: 6114 9 3T 3 q 55 Cell#: email: (�� PrS�P P hi q r�rCt��.COM
2. Applicant: t`N ND9_tEy.) �V-L ram, L- Address: f q N S W,A7 er_ S T C,GCENw!C.H C
Phone#: P 205 51133(g3 Cell#: email:_ efkC C lLk 111Q T606/ic (0/
3. Roofing Contractor: H�M� �/L-[�(� oVAj2 Address: 10/ 4 5 C S f (j/,enu�(Gf
Phone#: Z03 3 2l '7"7 3S Cell#: n email: 'j2 C V!j Q) ! ifut fin dl('Od-6119" G
4. Job Description,list all Methods&Materials: _ Ro cc( Q t'_ - /I -f--
5. Estimated Cost of Job: $ (1-1 1 -70 U (NOTE: The estimated cost shall include all site
imhro\cments,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: ( ) • Yes: O Attached No: ( )• Yes`: ( )Number of Cars:
10. Is roof peaked,hip,mansard,flat, etc: 'V-e(,4 k=ece -
11. Estimated date of completion:
-t-
8/122021
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, COUNTY OF WESTCHESTER ) as:
L 02'_�- ? -c.VyNl_ ,being duly sworn,deposes and states that he/she is the applicant above named,
(print name ot 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
r e--�N -ALP.C_-V7Z��?__ 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 20 day of � � 20/-3�
S' ature ro rty Owner Signature of A ant
A
t Name of Property Owner Print Name of Applicant
blic N t lic
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8/12/2021
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Client*:1952221 HOMEEN
ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
02/09/2023
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 AY THE POI Ir`IC
_E_
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(les)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 any rights to the certificate holder In lieu of such endorsement(s).
CONTACT
PRODUCER NAME: Carmel McCabe
USI Insurance Services LLC P�oNe —85S 674-0123 - No.203 884$701
530 Preston Avenue E-MAIL
Meriden.CT 06450 . uslctfxitlflcates@ualc.com
D RE
855 874-0123 ____ INsunER(s AFFOROIrK♦I aOvepApE wuC P
INSURER A:Admiral Insurance Company 24866
INSURED INSURER B:A►bella Protection Insurance Company 41360
Home Energy Repair LLC 194 S Water Street INSURER c: Liberty Mutual Insurance Corporation 33600
Greenwich,CT 06830 INSURER D:
INSURER E:
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 CONTRACTOR 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.
I TYPE OF alBlaIANCE a' R NGIRPOLICY NUMBER P EFF Y EXP LIMITS
A X COMMERCIAL GENERAL LIML" CA00004513601 112022 04/21/2023
pEAApcc�HpAppo��cccpuRgRENcE $1 000 00
C�A!�S-.4_4DE OCCUR PREMl�E9(E9ECEows S.r1O
X 5,0W ded BI,Phy MED EXP(Anyoneperson) $5 000
Dam,Per Ad) PERSONAL A ADV INJURY $1 000 000
GENt AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s 2,000,000
PRO-
X POLICY C JECT 7 LOC PRODUCTS-COMP/OP AGG $1 00o O
OTHER: s
B AUTOMOBILE LIABILITY 1020117559 1/2022 04021/202 COMBINED SI LIM 1,M0 00
X AAONNWYNNAUTO BODILY INJURY(Per Person) s
AUTOSDONLY SCHEDULED ALTOS BODILY INJURY(Per aoddent) s
AUTOS HIP.ED MO,N-OWNED PROPER YDAMAOE
-
X AUTOS ONLY X AUTOS ONLY P s
s
A UMBRELLA ILIAB X OCCUR X X CA00004513601 0402U70421/2023 EACH OCCURRENCE s5,000,000
X EXCESS UAB CLAIMS-MADE AGGREGATE $5,000,000
UEU I Y I MtItNIIUN- y
`+ WORKERS CON PENSATION X VIIC5�33-361014-019 1/1812023 01/19/'t024 X &H-
AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ SWAM
OFFICERIMEMBER EXCLUDED? C N/A
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE$ 500,000
MIT yyes describe under
dRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s.rItIQ
DFSCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101.Addnlonal Remarks Schedule,may be attached If mere apace Is required)
Village of Rye Brook its officials, agents and employees is Included as an Additional Insured under the
General Liability policy when required in a written agreement in accordance with policy terms,
conditions, and exclusions regarding services provided by the Named Insured.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCFilBED POLiCiES BE CANCELLED BEFORE
Village of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
938 King Street ACCORDANCE WITH THE POLICY PROVISIONS.
Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE
01988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016103) 1 of 2 The ACORD name and logo are registered marks of ACORD
#S35749643/M35749611 RXTCH
NYSIF
New York State Insurance Fund PO Box 66699,Albany, NY 12206
1 nysif.com
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
0 0
^A A^"A 832024199
HOME ENERGY REPAIR LLC
194 S WATER STREET
GREENWCH CT 06830 r
SCAN TO VALIDATE
AND SUBSCRIBE
POI ICYHOI DFR CERTIFICATE HOLDER
HOME ENERGY REPAIR LLC VILLAGE OF RYE BROOK
194 S WATER STREET 938 KING STREET
(]DCCAnA1f-H rr ncflon
V::LL:,,T•J `J: V.- RYE BRUUK NY 1Ub[3
POLICY NUMBER CERTIFICATE NUMBER I POLICY PERIOD DATE
VV248b U11-! b9tlUU3 U9/12/2U22 10 U9/12/1U23 "Ll1 UY m
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE
FUND UNDER POLICY NO. 2485011-7, 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:/IVNWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW
YORK STATEL:'.vSURA.NCL-FUND :S NOT L:ABLL IN TIIE LIE-NIT Vr "AILURE TO GIVE SUCH INC.IFIC ATIONIS.
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.
NEW YORK STAT SU NCE FUND
v
DIRECTOR,INSURANCE FUND UNDERWRITING
VALIDATION NUMBER: 932077998
U-26.3