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HomeMy WebLinkAboutBP15-083Open Permit Letter Sent PERMIT # a 6::()Y3 DATE: 1'05 EXP: IP -Ml 9/21/2016 SECTION 13 &1 a1 BLOCK LOT. o23 TYPE OF WORK n I f {fir ,bo JOB LOCATION _3 Cdah& OWNER epi ' PAY'GL — �QOG%S� Co :P30 `io2O'� CO)4TRACTOR 7_,[ J-)(, -- W2,/4e_,- cj y ,(-- AT. (. ,QST. COST f, (�} � FEE CO # FEE DATE TCO # FEE DATE INSPECTION RECORD DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS (] SPRINKLER ELECTRIC LOW -VOLT O ALARM AS BUILT FINAL MAYOR Paul S. Rosenberg TRUSTEES Susan R. Epstein David M. Heiser Jason A. Klein Jeffrey B. Rednick VILLAGE OF RYE BROOK — 938 King Street, Rye Brook, N.Y. 10573 (914) 939-0668 Fax (914) 939-5801 www.ryebrook.org CERTIFICATE OF COMPLIANCE Steven Berger & Debra Berger 3 Castle View Court Rye Brook, New York 10573 Re: 3 Castle View Court, Rye Brook, New York 10573 Parcel ID#: 136.21-1-28 Building Permit #15-083 issued on 6/9/2015 for New Fence ADMINISTRATOR Christopher J. Bradbury BUILDING & FIRE INSPECTOR Michael J. Izzo October 24, 2016 This certifies that the new 4 foot solid picket fence for dog run, installed under the above captioned permit has been satisfactorily completed. Si cerely, Mic e . zzo Building & Fire Inspector /tg BUILrYE'BROOK, VIL OFE I STREE (914)9' K i YORK 10573 939-5801 For office use only: PERMIT # - ISSUED: DATE: FEE: PAID E3 APPLICATION FOR OF OCCUPANCY / COMPLIANCE AND CERTIFICATION OF COSTS 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 shall have been issued by the Building Inspector. §250-10.A. Code of the Village of Rye Brook ****************************************************************************************** Address: 3 C N ST 1, G v\ C -.W C ou4� Occupancy/ Use: -RES 00ENT1AL-Parcel ID #: 13 (,o , � • 29 Zone: Owner: -T ejeM + � q'�e � G R 6 E� Address: 3 C 4&i� f V teW C* - -:,-Ig ,-Ig *--B�/rclo� 4 I P.E./R.A. or Contractor: 7c`) cam- Address: Lq 1 wi y `1"1- 9 `t 9 4 Person in responsible charge: W q � �Cj- 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 herein mentioned in accordance with law: N r -w yoRk.. ST RATE OF NEW YOM COUNTY OF __ _ _ � � as: J e%jq �i - `"(!-T being duly sworn, deposes and says that he/she resides at (Printme of Applicant) (No. and Street) `/ in �Q ftd r , in the County of \A1es2-C'�cr in the State of N r , that (City/rown/ Village) he/she has supervised the work at the location indicated above, and that the actual total cost was: $ 11 Ooo. o d for the construction, alteration or repair of: -; s C. r- CArcx., nd 60!t P W(1 0.8. o Deponent further states that he/she has examined the approved plans of the structure 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 has been erected in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized, and as erected complies with the laws governing building construction. Sworn to before me this 0?0f+�. day of OC16be-/ , 20 �o & 2e e� •Signature of Property Owner PrintNam f Property Owner N ary PublicLOR NotaryR blit, Sta el of NO New York No. O I M A4812593 Qualifled In Richmond County Certificate Expires September 30ed in New york � Commission Exp Sworn to before me this A C) day of C e.�'V20� , 20 Signature of Applicant Print Name Applicant N ry Ru LORRAINE MANISCALCO Notary Public, State of New Yortt No. 01MA4812593 6.1.2014 Qualified In Richmond County Certificate Filed in New York Co Commission Expires September 30u BUILDING DEPARTMENT ❑ BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑ VILLAGE ENGINEER 938 KING STREET RYE BROOK, NY 10573 ❑ ASSISTANT BUILDING INSPECTOR (914) 939-0668 FAX (914) 939-5801 --------------------- INSPECTION REPORT --------------------- ADDRESS: DATE: I f�T7h G g PERMIT # " `� _ C` ` SUED: V�`� S' SECT: +C� BLOCK: LOT: a LOCATION: --a 1 HiQ (' OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED / REINSPECTION ❑ SITE INSPECTION REQUIRED 0 FOOTING 0 FOOTING DRAINAGE ❑ FOUNDATION 0 UNDERGROUND PLUMBING ❑ ROUGH PLUMBING 0 ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS 0 FUEL TANK 0 FIRE SPRINKLER 0 FINAL PLUMBING 0 FINAL ❑ OTHER NOTES ON INSPECTION: n u n tt n n n 11 n a 1 n u n n n n n n u n n n n n n n n u n n n n n n n n n u n n n n n n n 11 n 11 n n n n It a n n n n n n ��••"••.� - VILLAGE OF RYE - BROOK PERMIT #: BP 15-083 - BUI' DgI�N"AR ENT ISSUED: 6/9/2015 11 9 STREP, �O Kms; hR a 573 EXPIRES: 12/9/2016 2 ( 4 939=0668yer0k.®xg ft +1"twTh'tn..py BUILD,G P' i . _.IO _ v-ONSTRUCT�ION OF' c n'k km5yy^� 8 jf Fh,N `1 ' INSTALL 4#OI'. iI �SO-L D ICWYC Tt _EJDow; 4 UN; 4'x 16' *Y •p°. 'moi {;t, >�+ ;: ♦S` - ./ AT: 3 CASTr VSift E Ow RSI'3Y .1 (-) ( �- BUILDING CLASS' ' C �'TIOIYx&?6 ARCELWDO: WN�%+�AM k4AWSID NTS / 13'C'2l -2r ffi 7 PROPERTY OWNJR: #iRGER �D BRA 13 GEsR 14) 93ZI0.98VT9: 4 11 11Tu� T5� 3 a91 51�. 11 r� �� LICENSED CO '.0 �' B �O� � • FACE OF PORTC . STER C ,9.14) 447 EMERGENCY COftAC '�W E AD,1(91,4)47-9494 , a m. „ . VALUATION OF O x ! .10 EF' : 5,1.00' f c HOURS OF OPERATION OF ONSTRUC f' Q Q MLI / �GCQDD 5g"�.{�4�:a AR --4,,& 0 TO 6XXOOP OR DUS CHEVER IS EARLIER; n ili�t,�eem i\�aiY.. Ar 11 SATURDAYS — 9:0OAM TO :OO '�4 O O S CTIONTaY ALLOV�'rE 1ftThis permit is valid for a period of to exce`e`d m , t om : at'e� o 1ss ce , approved pl`` s m be ep o the job site & be made available for review by the Buil ing Deme ug em epazate e tsts quire for any eleclum g, 1 srmkler, fire/smoke/carbon 11 } ndments or chan a fo the a ro must be.desi ed b our n monoxide detectors/alarms or an otl r wot not cov d under this pe y g p gn y y architect/engineer and submitted toe B din , { e� ©reviewa�ra rior to pe o g .. t�?^" C�.� f Co ' L` "a" lid g k' Sed in. 1 A Certificate o cenp _ cy or a eatemp I�Cerpuired in order c ose t t Other Approvals: Architectural Revie yard 9/20/2Qd�* s � Michael J. o � I lay Building & Fire Inspector :1 THIS .PERMIT MUST BE CONSPICUOUSLY POSTED AT THE JOB SITE " t I 11 II n t1 ,I 11 1 11 11 II t 11 t1 n - 11 1t t1 t1 11 11 11 It V 11 It V V n M O 1t 11 11 11 O It 11 11 It 1t n 11 n 11 11 11 n It 11 ,I It 11 11 n 11 n tt V 1t D ECEOVE BUIL RTMENT VIL OFR BROOK MAY -52015 938 KIN EET RYE BRO`�OK, NY 10573 VILLAGE OF RYE BROOK (914) 939-5801 BUILDING DEPARTMENT FOR OFFICE USE ONLY 01 \� Approval Date: JUN t # iApplication # Approval Signature: ; ARCHITECTURAL REVIEW BOARD: Disapproved a/c: : Date: ZBA Approval: Date: Case#: : Chairman: Other Approvals: : Secretary: Permit Fee: 7S/ FENCE / WALL / GATE PERMIT APPLICATION Application dated: ")ay S 110%> is hereby made to the Building Inspector of the Village of Rye Brook, NY, for the issuance of a Permit for the installation, construction, repair or replacement of a Fence, Wall or Gate, in accordance with Section 250- 6 B. (1) (g), of the Code of the Village of Rye Brook, as per detailed statement described below. Swimming pool fences must conform to the State Code. 1. Address: /� ^ 3 1. Q S�'1� V �µ/ Civ • t��� `y 2. Occupancy/Use: ti \', �QM 1 S.B.L.#: 3 (p •Z-, - Z g Zone: R - S 3. Proposed Fence / Wall / Gate (describe in detail): dov two\ ot, g:A.•- — w` w.�. �� �o� �. Jaz Oen <<.. d le W s t n o Ups'-t� o1P cant - c— L�` 1�is_1 t's4.ti1 4. Property Owner: %40, Vomk� � ee\% MW Address: 3 CA S4t\qL V%CCAt � C*- ��t �+ �C Phone #_C\\'Ayy) (oOgg Cell# (WA (•73 VIA i Fax 77q g Applica t• Address: Phone#A\4 - 413'1 -(oO*kQ Cell# Qt%y 1.7734 S—Fax # Architect/Engineer: Address: Phone # Contractor: Address & Phone: Cell # 5. If building is located on a corner lot, which street does it front on: C211.*) 4o),77T9 6.1.2014 6. What is the estimated cost of construction $ It c 00 (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.) 7. Estimated date of completion: �y 30� Z O \ �1 8. The State Workman's Compensation Law provides that before a Building Permit is issued, the Contractor, Owner, Architect, etc., shall produce the following information: Name of Compensation Insurance Carrier: No. of Policy: Date of Expiration: 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 YRRK, CO�U�`�TY OF WESTCHESTER ) as: �"�tjh OR �O4U,% , 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, e fnr thp 1.S@1 ., —A :.. ,7.,1.. a,.tti'iiiiiilid�P1M�MQi���41l�+�li��6 fi�i}iwQw��� (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 �� �✓ day of / , 20 / ' Signature of Property Owner J-r� Print N of Property Owner Public LORRAINE MANISCALCO Notary No. 01'State of w York MA4812593 Qualified In Richmond County Certificate Filed in New York Coun Commission Expires September 30, Sworn to before me this -56 i day of /-.'/ , 20 ;/� ,r ignature of Applicant �> 'i > --y*— Q (Z�- CC_jZ__ Print Name f Applicant ary Public LORRAINE MANISCALCO Notary Public, State of New York No. 01 MA4812593 Qualified In Richmond County Certificate Filed in New York Court �� Commission Expires September 30,GL'Al� 6.1.2014 U.S. Postal Service CERTIFIED MAIL RECEIPT M (Domestic Mail Only; No Insurance Coverage Provided) For delivery information visit our website at www.usps.corn _■ Postage 1 $ . I Postmark I Here Sent To Pic 17-1 -------•------ ----- ----- -...-•---------------------------;-------- Street, API. No.; f� a PO Box No. ►/I�Z� Lam. _ Clry, State, ZIP+4 Certified Fee rl O Return Receipt Fee O (Endorsement Required) M Restricted Delivery Fee (Endorsement Required) O f1J co 'o Total Postage & Fees I Postmark I Here Sent To Pic 17-1 -------•------ ----- ----- -...-•---------------------------;-------- Street, API. No.; f� a PO Box No. ►/I�Z� Lam. _ Clry, State, ZIP+4 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook, N.Y. 10573 ADMINISTRATOR Paul S. Rosenberg (914) 939-0668 Fax (914) 939-5801 Christopher J. Bradbury www.tyebrook.org TRUSTEES Susan R. Epstein David M. Heiser Jason A. Klein Jeffrey B. Rednick Steven Berger 3 Castle View Court Rye Brook, New York 10573 Re: 3 Castle View Court, Rye Brook, New York 10573 Notice of $500.00 Fee for Expired Permits Open Building Permit #15-083 Issued: 6/9/2015 - Expiration Date: 12/9/2016 Dear Property Owner, BUILDING & FIRE INSPECTOR Michael J. Izzo September 21, 2016 Via US Mail Please allow this letter to serve as a reminder that your open permit(s) noted above, as is the case with all Building Permits issued by the Building Department must be closed out with a Certificate of Occupancy or Certificate of Compliance in accordance with §250-IO.A. of the Code of the Village of Rye Brook. Building Permits have a life of eighteen (18) months and the expiration date is noted on the front of the permit. Please be advised that should you fail to properly close out your permit(s) in accordance with the law, effective November 1, 2009 the Village will be imposing a $500.00 Administrative Fee in connection with all open expired Building Permits issued after January 1, 2003. Please note that this Administrative Fee applies to each individual permit and must be remitted in addition to any other required fees associated with closing the permit(s), as well as any court imposed fines should a summons(es) be issued. Thank you for your attention in this matter, and please feel free to contact this office should you require any further information. Michael J. Izzo Building & Fire Inspector m izzona,�ryebrook.org /tg cc: Steven E. Fews, Assistant Building Inspector 7009 0820 0001 1408 2400 Building Permit Check List & Zoning Analysis Address: 3 G,4-s--c..v__ V 1 Fz w GT. SBL: l3 G • Z l - ( - 2 Zone:' -O- JS Use: 2 to Const. Type: Other: Submittal Date: S S S Revisions Submittal Dates: Applicant: �� 6 ('2_C rL-- Nature of Work: l U S ML L L( Reviews: ZBA: MAY - 6 2015 PB: BP: Other: NEER OK ( ( ) FEES: Filing: 7S, n-> BP: Z.S_ C/O: S_ Legalization: () ( 4/APP.: Date Stamped: ✓ Properly Signed: ✓ SBL Verified: Other: () () Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening: () () ENVIRO.: Long: Short: Fees: N/A: () () SITE PLAN: Topo: Sit Protection: S/W Mgmt.: Tree Plan: Other: () (-) SURVEY: Dated: 77 Current: -"Archival: Sealed: '_—Unacceptable: () (,;/PLANS- Date. Stamped: - - Sealed Copies Co Incomplete: - --- N/A: ---Other----- (� ( License: Workers Comp: V Liability: ✓ Comp. Waiver: Other: (� (V5 Code 753#: Dated: N/A: O O HIGH-VOLTAGE ELECTRICAL: Plans: Permit: N/A: Other: O O LOW -VOLTAGE ELECTRICAL: Plans: Permit: N/A: Other: O O FIRE ALARM / SMOKE DETECTORS: Plans: Permit: N/A: Other: O O PLUMBING: Plans: Permit: Nat. Gas: LP Gas: N/A/: Other: () () FIRE SUPPRESSION: Plans: Permit: N/A: Other: O O 2010 NY State ECCC: N/A: Other: () () Final Survey: Final Topo: RAPE Sign -off Letter: As -Built Plans: Other: O O BP DENIAL LETTER: C/O DENIAL LETTER: Other: () () Other: (vARB mtg. date: 5 20 t approval: S l. r, C notes: ( ) ZBA mtg. date: approval: notes: ( ) PB mtg. date: approval: notes: REQUIRED EXISTING PROPOSED NOTES Area: Circle: Frontage: Front: Front: Sides: Rear: Main Cov: _ Accs. Cov: _ Ft. 14/Sb: Sd. H/Sb: _ GFA: Tot. imp: Ft. Imn: Parking: Hei t/Stories: notes: BUILDING DEPARTMENT VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK, NY 10573 (914) 939-0668 FAX (914) 939-5801 www.n brook.org D C CEPYIED MAY- 5 2015 VILLAGE OF RYE BROOK BUILDING DEPAPTMENT ARCHITECTURAL REVIEW BOARD CHECK LIST FOR APPLICANTS This form must be completed and signed by the applicant of record and a copy shall be submitted to the Building Department prior to attending the ARB meeting. Applicants failing to submit a copy of this check list will be removed from the ARB agenda. Job Address:,9 CPlST\•E ` 11a Vi CT• 31t " Parcel ID #: %3( • 21- % —2, C Zone: _iZ -15 Proposed Improvement (Describe in detail): 4ck� scna\\ 4n..td %n ores, Vo S}k a 11%ws a Cr d a 4-0 '*C W% w:ds '► Property Owner: Sr%%&EN %. ruM Address: 3 rots*fit \I%' W/ Ck. -Ry7%toa\'L Phone # (*.-.4)v)S-S20'7 te\0 Applicant appearing beiuic t e Board: C ;5 Scr_1'z:l1 on �..�_ \ _ o Address: Phone # 'If! 0144880'FilitOe 1. mum Phone # Date of Submission:�! `a S ► 2.0 (N -- ARCHITECTURAL N APPLICANT CHECK LIST: (The following items must be submitted to the Building Department with the application, no exceptions). 1. (✓COMPLETED APPLICATION 2. ( ) EIGHT (8) SETS OF PLANS 3. (✓EIGHT (8) COPIES OF SURVEY 4. ( ) EIGHT (8) COPIES OF SITE PLAN 5. (XFILING FEE 6. ( ) SUPPORTING DOCUMENTATION 7. ( ) HOA APPROVAL LETTER (if applicable) 8. ( ) PHOTOGRAPHS 9. SAMPLES OF FINISHES (a sample board or model may be presented the night of the meeting) By signature below, the owner/applicant acknowledges that he/she has read the complete Building Permit Instructions & Procedures, and that their application is complete in all respects. The Board of Review reserves the right to refuse to hear any application not meeting the requirements contained herein. -Itis Sworn to before me this -_.� 6 day of /I " / , 20 5 Signature of Property Owner Print Name o ropertyOwner ry Public LORRAINE MANISCALCO Notary Public, State of New York No. 01 MA4812593 Qualified In Richmond County Certificate Filed in New York Co u Commission Expires September 30, Sworn to before me this 30 f t� day of 4-, 1 , 20 l � Signature of Applicant Print N of Applicant otary Public LORRAINE MANISCALCO Notary Public, State of New York No. 01 MA4812593 Qualified In Richmond County Certificate Filed in New York Coun� Commission Expires September 30, _* 6.1.2014 VILLAGE OF RYE BROOK BUILDING DEPARTMENT 938 KING STREET, RYE BROOK, NY 10573 (T) 939-0668 (F) 939-5801 ARCHITECTURAL REVIEW BOARD May 20th 2015 NAME & LOCATION TYPE OF APPLICATION MOTION SECOND APPROVED REJECTED APPL.# 7 Meadowlark Rd Side Addition & Interior AC CS 2794 Samchalk Alterations 19 Ridge Blvd 1 Story Rear Addition, New 2795 Clifford Windows & Interior Alterations 1 Little Kings Lane 4Ft High PVC Privacy 2796 Frieman Fence 156 Country Ridge New Rear Deck, 2797 Drive (Taerstein) (Replacement) 85 Tamarack Road 4Ft High open Picket Fence 2798 Van-Benschoten 3 Castle View Ct 4Ft High Solid Picket Fence \� 2799 Berger 8 Mark Drive 6Ft High White PVC 2800 Roy Privacy Fence In Rear Yard 18 Pine Ridge Rd 4Ft High Aluminum Open 2801 Goldberg Picket Fence In Rear Yard 65 Rock Ridge Drive 4Ft High White PVC Fence 2802 Ayala w/Gate 15 Country Ridge Dr 1 st & 2nd Story Additions, 2803 Cappelli New Front Portico 5 Boxwood Modify Rear Deck, New 2804 Biderman Windows & Door 26 Beechwood Blvd Remove Patio, Install 2805 Steinberg Composite Deck 139 North Ridge St New Concrete Terrace 2806 DeMarco ML SF MR MI A SE AC CS V ACORD CERTIFICATE OF LIABILITY INSURANCE MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH DATE(MM/DD/YYYY) rw DD' INSIR TYPE OF INSURANCE POLICY NUMBER PRODUCER POLICY EXPIRATION THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Village Insurance 216 Westchester Avenue ONLY AND CONFERS NO RIGHTS HOLDER. THIS CERTIFICATE DOES ALTER THE COVERAGE AFFORDED UPON THE CERTIFICATE NOT AMEND, EXTEND OR BY THE POLICIES BELOW. EACH OCCURRENCE $ 1,000,000 A 2nd Floor Port Chester NY 10573 MPU729OG INSURERS AFFORDING COVERAGE NAIC # INSURED Brothers Fence of PortChester, Inc. MED EXP oneperson) $ 10,000 INSURER A National Grange Mutual 29939 INSURER B: Travelers Ins Co 25623 249 Willett Ave (1) INSURER c: National Benefit Life Ins Co 61409 Port Chester NY 10573 INSURER D: National General GMAC 12130 INSURER E' COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. lNSR I TR DD' INSIR TYPE OF INSURANCE POLICY NUMBER POUCY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A Y X COMMERCIAL GENERAL LIABILITY MPU729OG 05/01/2015 05/01/2016 DAMAGE ro RENTED $ 500,000 MED EXP oneperson) $ 10,000 CLAIMS MADE Fx OCCUR PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 X POLICY PRO- LOC D N AUTOMOBILE LIABILITY ANY AUTO 2001710728 02/23/2015 02/23/2016 COMBINED SINGLE LIMIT $ 100,000 (Ea accident) BODILY INJURY $ (Per person) X ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per accident) HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LWBIUTY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMS MADE $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND X WC STATU- OTH- B EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE IOUB8B05333A 05/01/2015 05/01/2016 E.L. EACH ACCIDENT_ $100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 OFFICER/MEMBER EXCLUDED? If yes, describe under E.L. DISEASE - POLICY LIMIT $ 500,000 SPECIALPROVISIONS below OTHER NYS Statutory C NYS Statutory Disability Benefits 8-910-0238149 01/01/2015 12/31/2015 Mininimum Disability Benefits DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES! EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Certificate holder is also listed as additional insured with respect to licensing and/or permits issued by municipality or political subdivision. Work to be performed at: Steven Berger, 3 Castle View Court, Rye Brook, NY. 10573. CERTIFICATE HOLDER r'eWrFI I ATlnu Village of Ryebrook Building Dept 938 King Street Ryebrook, NY 10573 ACORD 25 (2001/08) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE <GN r> 1 AftR STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name & Address of Insured (Use street address only) lb. Business Telephone Number of Insured Brothers Fence of PortChester, Inc. 914-447-9494 249 Willett Avenue (1) lc. NYS Unemployment Insurance Employer Port Chester, NY. 10573 Registration Number of Insured Work Location of Insured (Only required ifcoverage is specifically Id. Federal Employer Identification Number of Insured limited to certain locations In New York State, ie:, a Wrap -Up or Social Security Number Policy) 46-0639862 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage (Entity Being Listed as the Certificate Holder) Travelers Village of Rye Brook 3b. Policy Number of entity listed in box "la" Building Department INU1381305333A 938 King Street Rye Brook, NY. 10573 3c. Policy effective period 5/1/2015 to 6/1/2016 3d. The Proprietor, Partners or Executive Officers are included. (only check box if an parinervoincers 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 "Ie for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under tem 3A on the INFORMATION PAGE ofthe workers' compensation insurance policy). The Insurance Carrier or its licensed agentwill send this Certificate of Insurance to the entity listed above as the certificate holder in box "2". The Insurance Carrier will also notify the above certificate holder within 10 days IFa policy a canceled due to nonpayment ofpremiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the Jmwredfrom the coverage indicated on thisCertoricate. (These notices maybe sent by regular mail.) Otherwise, this Certificateis validforoneyearafierthisform Is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed to box "3c' , whichever is earlier. Please Note: Upon the 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 bolder, 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: Approved by: X91 tative or licensed agent of insurance cemA Title: Agent Telephone Number of authorized representative or licensed agent of insurance carrier. (914) 934-8144 Please Note. Only insurance carriers and their licensed agents are authorised to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-M www.web.state.ny.us 06/09/15 02:05 PM 3154372621, 01/01 ****REGULAR**** DIG REQUEST from DSNY for: VIL RYE BROOK Taken: 06/09/2015 13:37 To: VIL RYE BROOK PRIMARY Transmitted: 06/09/2015 14:05 00002 Ticket: 06095-152-029-00 Type: Regular Previous Ticket: State: NY County: WESTCHESTER Place: RYE BROOK /V Addr: From: 3 To: Name: CASTLE VIEW CT Cross: From: To: Name: offset: ------------------------------------------------------------------------------- Locate: AS FACING, MARK RIGHT SIDE OF PROPERTY AND THE RIGHT FRONT CORNER OF : THE HOUSE NearSt: COMLY AVE Means of Excavation: HAND TOOLS Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: Y Work Type: INSTALLING FENCE Duration: 3 HOURS Depth of excavation: 24 INCHES Site dimensions: Start Date and Time: 06/17/2015 08:30 Must Start By: 07/01/2015 ------------------------------------------------------------------------------ Contact Name: WALTER JAPA Company: BROTHERS FENCE OF PORTCHESTER INC Addrl: 249 WILLETT AVE Addr2: City: PORTCHESTER State: NY Zip: 10573 Phone: 914-934-2239 Fax: Email: BROFENCE@OPTONLINE.NET Field Contact: WALTER Alt Phone: 914-944-7949 x4 Working for: STEVEN BURGER ------------------------------------------------------------------------------ Comments: LENGTH AND WIDTH OF THE DIG SITE ARE UNKNOWN : DIG SITE ALSO AFFECTS: PORT CHESTER /V : Lookup Type: MANUAL ------------------------------------------------------------------------------ Members: CBLVSN HUDSON VLY CON -ED : MCI UNITED WTR NEW ROCHELLE : BELL -VALHALLA / HDSN VLY BELL -VALHALLA / WSCHSTR : VIL PORT CHESTER VIL RYE BROOK : WESTCHESTER COUNTY / SEW Page 1 of 1 4 PERMIT # BP 15-063 SBL# �3 C� • `� - .1.=2 DATE APPROVED JUN - 1015 BUILDING INSPECTOR, Tof Rye Brook, NY APPROVED ,ALLAGE OF RYE BROOM: ,- CHITECTURAI_ RE �`�' BOAR►: http://www.hooverfence.com/wood/images/stockade/stockade-main.jpg 5/4/2015 1 TITLE NO. his is to certify that I have surveyed LOT No.48-4ARISTOTLE BO U R NAZOS, P.C. 1.S SHOWN pet SUINDVOSION MAP PRE4ARED OIL ANSLICAM CiWtCM OF TME ADVENT •' 1N LAND SURVEYORS -PLANNERS rRE VILLASEOF Ryf WLOOx,,1OWN OF ILyE, `JESTCMESTER. CC, N.Y, IMSTEVENSAVENUE uCE YORK NEVI VONN - MT VENNON.N.V 10550 91�lB99900, 0910 CONNECTICUT CUT NNECTI I Had in the Westchester County Clerk's Office Division of Land Records SEPT. 2S, 1981, as Map No•2293S. have located all existing buildings and lines of possession and have shown their positions hereon. yl r,•(E OF urveycompleted:' MARCK 22, 198-1 OtIEB t PF I lap drafted:- Nov. 15, 1988. on scaleof one inch to. -20 feet. 'STEVEN DEBRA BERGEc .. .... . . ....... . .. I hereby certify this. survey to Zc-"4.9M0 MoRTGg6E CORP-, /rJ SuccesSOES { qsS/6N5 ic. 57 . A -O. 0Pr 45065, JACT CAKE C-1, VrF4y .=1NAL SuIP�/E.Y CaMMONIYEALTH •LAND TilGE /NJupgycE Co. 7�` 4 Mfiy /5, /JB9 /t'ENNETH LOEWENrHE/L - SE.PPENT/.vE/ /HC, d �Q6553 yOQ• �qND _ SURV� :B�/�oi.YG ENVELePE ,YOPav: ,TUNE 6� /9JD (BVI Off"•'•'' /'� 'NA<ADAM O.P/VE //(/.si/ LOGATEO ,$Es7. 22, 20(O_ ---• --- — -- ..• A s b0 NAP w9Ra -p `7t All, meq. 6, ,.• 3 6� 01 4ea ,r5- �Ity LOT 48 -4 9 him �IY AT.LA _ 19, 181, 99 SQ. FT. o V o�J�� `Ys - v �j : _ SjONE-PLAY -LO✓FiP �. I41 V i Q 1Z Q CIO o 0 1 a N Q • � Vic•,, •�, � 2 L =40.Oa /3 / N/ E Ni V I.EW., °// ARISTOTLE BOURNAZOS, P.C. v�o yn to a 0 c1� 3 TV N to 0 I, D NOV qM 1 210 VILLAGE OF RYE BROOK BUILDING DEPARTMENT i INd Book No. Ppb No. Office Mop No. Cwrtifim a No. Surv&V No.