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HomeMy WebLinkAboutBP23-033PERMIT# W-o33 SECTION J ;4 9. ?Y TYPE OF WOM7 S/-4// .5 JORLOCATION IeDCO2A EST. COST `� d V — FEE VCO# �C FEEW//O'Ab TCO # FEE INSPECTION RECORD I DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING O RGH PLUMBING GAS O SPRINKLER ELECTRIC ED LOW -VOLT O - ALARM AS BUILT/D'10t FINAL LOT S Scle -,z ncE ' ' ear i S o o � to / 7!0 `/ -,Grace r�iirch�P4��30'l-8l�a OTHERAPP OV S ARB 4r� /S�aoa:� BOT zBA OTHER ASBL'ILTIFINAL SURVEY REQUIRED PRIOR TO FINAL INSPECTION zceJve y a ay 4Rn O b(t1�V i�1 Z tt �VjJJ V V, VFW V 190 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 BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE April 11,2024 Daniel Lyons&Michele Lyons 12 Country Ridge Circle Rye Brook,New York 10573 Re: 12 Country Ridge Circle, Rye Brook,New York 10573 Parcel ID#: 129.74-1-25 Building Permit#23-033 issued on 3/22/2023 for a New Fence This certifies that the new five foot high white vinyl picket fence,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building& Fire Inspector /to EC E v < RR�,, For office use onlv: IDDBUILD ,DEPARTMENT PERMIT# 3 w3 3 APR - 4 2024 VIL OF RYE BROOK ISSUED: - 3 138 KING STRE YE BROOK,�)F� YORK 10573 DATE:--'-/— — VILLAGE OF RYE BROOK 939-0668�� FEE: �" �/0 — PAID BUILDING DEPARTMENT w rook:' 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 rwwr►wa►►►•rra►a►aa►a►►aurwrrwrw•rra►►r►a►a►►►ra■arwrwrwwwrawr►r►r►rr►►►►a►►►►r►wrrrrrrr►arrrrrwrrwwwr►rwrr►►►►►►►rr►►►rwww Address: Occupancy/Use: 0AC- Parcel ID#: Zone: Owner: 0,A,`V I o`/h" C4tG �-y°n f Address: oZ l-0 V rtfre P,,Cf G e Gn'C& P.E./R.A.or Contractor: �fly5CA Fe✓1Ge --/nS4--kdAddress: 7 q-7 VI �,+e VW, yaKry 1- 4,41 Person in responsible charge: G rVCf �-�f I7'G�i Address: 7Y7 of R� Fw l/"a Co ��Id' Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a $01$' Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW Y/ORK,COUNTY OF WESTCHESTER as: D� an`-y (,fX 00kc being duly sworn,deposes and says that he/she resides at co ukv e (Print Name of Appl •ant) ll (No.and Street) in�X e B(y OA ,in the County of w P S I-C n eS in the State of y 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:$ I 2 10 0 -0 for the construction or alteration of: ::r-Y-1 f k// 5 t h'1 h cAlk I V i P,-CSC C r -e ar o Ptoj� 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 Af r°I ,20 L/ day of ` , 20-�A— Signs re of Property Owner Signature of Applicant `jl Yll.✓lrc' �S Print Name of Property Owner 1�ww�r� eof Applicant Public JAY WARREN FUCHS Jlublic ARREN FUCHS Notary Public, State of NewYbrk Notary ic, State of Now York No. 01 FU4992547 No. 01 FU4992547 I'-"-"' Qualified in Nassau County � Qualified in Nassau County �! Commission Expires Feb.241 201C Commission Expires Feb. 24, 9036 QyE BR(�k, • �9�2 BUILDING DEPARTMENT �❑BBUILDING INSPECTOR b A'SSISTANT 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 : I I COUA /' DATE: �-/- /O - .20.27 _ n i PERMIT# Z 3 S-I 3 ISSUED:3.Z2_ ZSECT: Z 7 BLOCK: LOT: LOCATION: le -4 4" C h d aA- OCCUPANCY: ❑/Violation Noted THE WORK IS... [I PASSED ❑ FAILED REINSPECTION 2 SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION / ❑ Natural Gas /\j C Cam. ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER M M • F-"—I v y � avi rT Tlcnc� 0 rE a O a lz _ 4x4 H QN N �I w �, U t/) � � a 00 0 H o ^ E-� = LO p� v v as '' � a � 0 W GO O U Lei a V N Z " � = " � co z W00 \ +- ►+ 44 W Vr ^ V O >. p 00 A q 0 -0 � � � (c) P-4 a O O \ P.i z Uz 4 c A c7 ►wry �' inw d ` 0° b.0 CIA 5: (� v N 00 - �..� 4-41.0 x c � wa e � � C u � O " vo � .ti0 Fq � v AU -tq � � a � CO 0E--� ZCA F 3 z z � " � a � � uj z �pN ch X7 a 7, �w BUILD E� RTMENT c] DD VILL'a�c of RA ROOK FEB 2 7 2023 938 KINGSSTREET RYE B ,NY 10573 64 VILLAGE OF RYE BROOK BUILDING DEPARTMENT FOR OFFICE USE ONLY: Approval Date: MAR 2 1 7071C mit � � Application# Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: Date: —T7— BOT Approval Date: Case# Chairman: P$Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: r Application Fe J Permit Fees: J FENCE / WALL LL / GATE PERMIT APPLICATION Application dated: Z -7, 3 [/�Z St/ s 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. Job Address: [;- - C-0 lV h+tll 12 ` c;g e C: r G/e 'y Q- h 2. Occupancy/Use: Q, 10 S.B.L.#: / 9�►7—/—c3� Zone: fz` 5 3. Proposed Fence/Wall/Gate(describe in detail): `J 5 ` k% ° L WIJ-P V,hzl f`GICG4.1- P'e+iGG CtiIZDrw /`� T -ke- r"t'-d w�4-;-, 2 -t 1•-e_ „",' y 0 s es. 4. Property Owner: �" m S Address: la C-t ✓ ot CLf� '0 rl -fT� f2i d ' `tee- r 9i� 9` /�j/tfulL ,(� Phone# 5/ - 6 -I 16 '� email: d an C�• MG S 'e `II h C-_lt1a,(.�°^� Applicant: '`" 3 Address: l c c9u l^ r d e G rG LC /L l7:•sue /� Phone# / - r T t' -/?6q Cell# email: Architect/Engineer: H l Y J G {t Address: �1�y-7 U 11 f�f 9(h) Phone#-? / ' "Ll'V z2Cell# ^' email: r11G C Contractor: YS c 1 r-t-N G C f ►//�e /, Address&Phone: �(V -7 9,0t/4-Q Z ic� G�T�, �/, /0`f & y 5. If building is located on a comer lot,which street es it front on: 6. What is the estimated cost of construction 0 .0 t� (NOTE:The estimated cost shall include all site imp ements,labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) / 7. Estimated date of completion: �+ 1 8112021 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. #*****##**#**********#***##*#*##******####*R#*#**w wxw xwwwwww xx*wwwwwwwwwxww www www*ww wwww#www wxwwwxx#ww##*# STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Q G n,'Z 1 L,41"I J ,being duly sworn,deposes and states that he/she is the applicant abo%e 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. 'V 6 Sworn to fore me this Sworn to before me this day of y�+ ,20'�_I day of ,20 d Signature of Property Ownifr Signature of Applicant D a4,t4 4 o Print Name of Property wner Print Name of Applicant 1 *Nfic Notary Public JAY WARREN FUCHS Notary Public, State of New Ybrk No. 01 FU4992547 Qualified in Nassau Cout�lty Commission Expires Feb. 24, 2o�_'( 8/1212021 2/27/23, 11:37 AM image0.jpeg Kirsch Fence Install & Design 747 Route 9W Valley Cottage, NY 10989 J.t Jt Date C�•sroa+er'a last Name,First Nnme Service Addres �J , Os 7 City 51.Ru LP Cusloewr'6 DayemR Phone No Customer S E mim-g Phone No, Customers FFwol Address Ne rw Cross Street PERMIT/INSPECTION INFORM N q" ' ONO Homeowner to tarn permit nsn yTta tan pro oss Onal Onst&,Iwqn PrOesslonal rputes copy of perms oetom Instalwon 1 to obl9in rmd SL;Iectlon $ p0 APPROXIMATE LAYOUT �"�-- rCNCE FOOTAOE COHTNNW IN TMS PROPOSAL is APPROXIMATE BASED ON FIELD MEA3UREMEM9 FIIIAL PRICE NLLl BE ADJUSTED BASED ON ACTUAL FENCE FOOTAGE USED AS LET FOURTH IN TERMS AN CON WTIONS.Li ADDITIONAL COST OPTIONS ADD THE PRICES iN TIr:S COLUMN TO THE SUECTLON f - J J TAKE DOYYN AND MAUL S AY1NY OLD FENCE PERM!T COST 5 _ SALES TAX S FINALAMOJNT DUE ezeareonl � J Stock Probuc Customer assumes all responsibilities as it relates to As add6wal labor and mate,.*costs as d resales ISpecial Order Product to the tence been instalkdona neighbors property, Design Approved Customer _ FENCt INSTALLATION RELA ED TO GRADE:PLEASE INITIAL ONE K TO T III I FO.I:h1'r Fj y '--E�l iriTA.l *4 Fr r,<J r 0 aE LEM W"MOWST GRAUL SUGtfTLY L.'NCVEN GINDE LMTN FENCE 1`'r;TOMER ILL IN GAPS) rLMLOhINGFLIXVK JIp1sXr 't`�' - %�'E�:���.•���. FLWk LVLI PE LACWNAT TOP Product ` Product Product Stye: (Yi Height. ` Style: Height: Style: Height: FDotage:/�to If Gates: Footage: If Cates: Footage If Gates: Post Cap: �t r Color r Post Cap Color: Post Cap: Color: Rail Type: Post Ca Rail Type: Post Cap: Rag Type: Post Cap. Picket Type. 5 / ,J J Picket Type: S Picket Type, S https://mail.google.com/mail/u/0/#inboy/FMfcgzGrcXlgNLhTgRzZZLQTtrdmBVbV?projector=l&messagePartld=0.l 1/1 • Building Permit Check List&Zonific Anal sis Address: Zone: Use: Co Type:' 0410/161 Submittal Date 71 Z Revisions Submittal Dates: Applicana CC \6^6 \- Nature of Work S (1Nt_. a Reviews:ZBA: PB: BOT: Other. NEED OK � ( ) ( FEES:Filing-" BP: `y' ` ' C/ Flood Plane: Legalization: ( ) ( �A P: Dated. ✓ Notarized SBL Truss I.D. Cross Connection: H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening: ( ) ( ) ENVIRO:Long. Short: Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmt.: Tree Plan: Other. ( ) ( �, C RVEY:Dated: Current Archival: Sealed: Unacceptable: ( ) (�;=cens, S:Date Stamped Sealed Copies: '� Electronic Other. ( ) ( s Workers Co Liability Comp.Waiver Other. (J� DE 753#: 0 3 a 3 --Q0CD--(o viol-CX) Dated: 3--CJ 3--A_3 N/A: ( ) ( ) 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. ( ) ( ) PLUMBING:Plans: Permit: Nat Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit N/A: Other. ( ) ( ) H.V.A.C.: Plans: Permit: N/A Other. ( ) ( ) FUEL TANK Plans: Permit: Fuel Type: Other. O O 2020 NY State ECCC: N/A: Other. (a ( ) Final Survey Final Topo: RA/PE Sign-off Letter As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other. O O Other. (I.)W mtg.date \ approval• notes: ( )ZBA mtg_date: approvaL• notes: ( )PB mtg.date: approvaL• notes: APPROVED � o-cv REQUIRED ExrsrnyG PROPOSED NOTES Dom: a R�L,n�� Am Cu iy Fla Front: Front: Sides: RCr. Maui Cov Accs.Cov F S Sd,H S SOFA.' Tot, Im : P Hight/Stories \ \ _ notes: ��! l>�oS -e E' w 1�S E' .\\ BUILDING DEPARTMENT V � jD VILLAS B OF RYE,, ooK D FEB 2 7 2Q23 938 KING STREET RYE BROOK,NY 10573 9141 0 4;�� VILLAGE OF RYrC BROOK w.r ' roo or � BUILDING DEPARTMENT iiiiit#t#######titti##i######iii#tt#ti######■##itti######i###it#i################ttti#it#t####i#tttttititii 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: 19, C o u t1+v-Y Date of Submission: 7 Parcel ID#:f a9��—�—o�J Zone: Z 3 [ y Z 7 Proposed Improvement(Describe in detail): APPLICANT CHECK LIST: MUsT BE COMPLETED BY THE APPLICANT The following items must be submitted to the Building U yt� Fu,,t, (� fin)6 /(.'✓/,' 1 G�vu/11�,�S Depart nt by the applicant-no exceptions. Property Owner: Girt I vy �'t 1. TW 1 2)sets Application 2. ( 2)sets of sealed plans. (one lull sic;maxinuun Address: 12- Go✓ n`Fr Y k d� �'-46f, l wlC allowable plan sire 36"x 42") and one 1 1"x 17') Phone# [/7 ' g�6 - 7 3. ( 2)copies of the property survey. 4. ( 2)copies of the proposed site plan. Applicant appearing before the Board: 5. )On lectronic/disc copy of the complete -t✓ �� G,yen -5' plicationmaterials. O 6. ( 1 ing Fee. Z Address: 1 Ci yc9 h �'►-Y �'d I G'1C/C 7. ( Any supporting documentation. 8. ( ) A approval letter. (ifapplicable) Phone# /G 0— W T 6- 17 4 e-1 9. ( Photographs. Architect/Engineer: �SG h ����� e 10.( )Samples of finishes/color chart. (a sample board or Phone# q 5 J Ll_ e, / model may be presented the night of the meeting) D U 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. VA Sworn to bore me this + ^ Sworn to before me this day of ��0 Qk ,20�L day of ,20 Signature of Property Owner Signature of Applicant a'I't I &y-r j t Name of Property Owner �, Print Name of Applicant No lic Notary Public JAY WARREN FUCHS Notary Public, State of New Ibrk No.01 FU4992547 Qualified in Nassau County a6 8/12/2021 Commission Expires Feb. 24, 20r.. URCIv� Village of Rye Brook ML MR Agend FB SE Z� Architectural Review Board Meeting AC SF Wednesday,March 15,2023 at 7:30 PM JM Village Hall,938 King Street 1. ITEMS: 1.1. ARB23-008 (Consent Agenda) Gerardo Paico Eusebio&Libia Declet 493 Ellendale Avenue Rooftop solar array. 1.2. ARB23-015 (Consent Agenda) Blake Silverman&Alexa Silverman 18 Milestone Road Rooftop solar array. 1.3. ARB23-016 (Consent Agenda) Jose Sagastizado&Noemi Sagastizado 28 Division Street Rooftop solar array 1.4. ARB23-017 (Consent Agenda) James Bogucki&Nicole Zillitto 300 South Ridge Street 3'high white vinyl fence and gates. 1.5. ARB23-018(Consent Agenda) Greenway Close LLC 78 Greenway Close 4'high split rail fence w/black mesh. 1.6. ARB23-019(Consent Agenda) Daniel Lyons&Michele Lyons 12 Country Ridge Circle 5'high white vinyl picket fence. 1.7. ARB23-020 (Consent Agenda) Scott Levy&Nicole Levy 42 Meadowlark Road 6'high white vinyl privacy fence and 4'high gates. Consent Agenda Approvals: Motion -ML— Second A Abstention Aye;2A Nay; Adjournment; Notes Page 1 of 3 Architectural Review Board March 15,2023 1.8. ARB23-013 David Richardson&Alexandra de Vaux Richardson 44 Rock Ridge Drive Rear patio,driveway,walkways and fence. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.9. ARB23-021 Win Ridge Realty LLC (BondVet) 164 South Ridge Street Illuminated sign. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.10. ARB23-022 Jamie Billington&Kara Billington 6 Bonwit Road Front and rear two-story addition,covered front porch,deck and interior alterations. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.11. ARB23-023 Ervin Gomez&Maria Gomez 59 South Ridge Street 2nd story addition over existing two car garage. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes Page 2 of 3 Architectural Review Board March 15,2023 1.12. ARB23-024 Patrick Carroll 8 Oriole Place Rear deck,entry stoop repair,new railings, front door,windows above front door and siding. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes NEXT MEETING: April 19,2023 Page 3 of 3 27',3 '1 1 15 image0.jpeg r1 _ 1� x IIA it6kf r n. https:Hmail.google.com/mail/u/0/#search/bruce%40hirschfence.com/FMfcgzGrcXlgNLhTgRzZZLOTtrdmBVbV?projector=l&messagePartld=0.8 1/1 AM �iSV. I r' .� rst7�yyh�i'Y'�• � �- P aAT it .116 ' � ti. q,tu"�Y` � .,�•i �`� � •k _ lS4�3 �j� ,rhlC,-�� r �. -- - ..RR T^.'Fyr �,dt' PII►2+f�.�R��,t�'J �y������ '�;1. ,� , .:y' ` 4 � � '71 hiT _MT4 ��1«�tiM'Yh, �jv.1•v� r.�, a�`l°k�d'P-7'{�� c*;rOY' _ y�M� w_.C., .^� 1'�.. I �.t� �►T �f �Ti r s'' �s P� /t�y�� c .r'�`��a�;\���,'��V`,��ryY j �' �� 9 � '�""r t/ rp� i ..,. ��'•i `�'37�� -a a. y 0, � ilwk OM AM i � a 1 t:� ti.. ti. - 4 Mi . r it 40 RA 'All NO it - ' 1 F •► � 1i�tl .. ,�ay r. a Alz r I-MOU" ` A.1 VR ilk �k Vb. ,�- ,�►.► . 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W - t PRO _ > o Z ) co cc E qo p y ' fU c v S _ Q H j E v V U o N LL ` .n ri E N p a 2/27/23, 11:38 AM magel.jpeg --, CERTIFICATE OF LIABILITY INSURANCE °ATEIMM°°""" t(Y)K!) 1— F.208 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 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 endorsements . PRODUCER CONTACT gill McCarthy McCarthy Insurance PHONE 914 769 0417 Fax 914 769.0609 378 Elwood Avenue EMAIL 13ill/(�mccarth Insurance.net Hawthorne NY 10532 INSURER(S)AFFORDING COVERAGE NAJC r INSURER A Preferred Mutual INSURED INSURER Hirsch Fence Install&Design LLC INSURER 747 RT 9W-Cottage#4 Valley Cottage,NY 10989 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. INSR TYPE OF INSURANCE DDL UB POLICY EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY H - R 1 000,000 A CLAIMS-MADE O OCCUR DAMAGE TO RENTED 50.000 X BOP0100721375 11/12/2022 11/12/2023 MEDEXP An one $5,000 PERSONAL&ADV INJURY $1,000,000 GFKL AGGRE'��I LIMIT APP I S PER Q 'A ; c 2 000.000 POUCY I�JEc "LOCI PRODUCTS- MPS P As2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY IPer Perwnl S ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY IFW acnoenq S NON-OWNED PROPERTY DAMMGE S HIRED AUTOS AUTOS S UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB HCLAAAS-MAOF AGGREGATE F WORKERS COMPENSATION PER OTH y1 AND EMPLOYERS'LIABILITY Y,N ++�y ANY PROPRIETOR PARTNEREXECUTIVE' I OFFICERIMEMBER EXCLUDED? u N/A (Mandatory In NMI EL DISEASE-EA EMPLOYEE II ties descnoe under L DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101.Additional Remarks Schedule.may be attached It more sp-a is required) Fence Contractor Village of Rye Brook is Additional Insured Job Location: 12 Country Ridge Circle,Rye Brook,NY 10573 CERTIFICATE HOLDER CANCELLATION Village Of Rye Brook SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 938 King Street ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook NY10573 AUTHORIZED REPRESENTATIVE <CFP> S,1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD https://mail.google.com/mail/u/0/#inbox/FMfcgzGrcXlgNLhTgRzZZLQTtrdmBVbV?projector=l&messagePartld=0.6 1/1 2/27/23, 11:38 AM mage0.jpeg Yo K Workers' Certificate of Attestation of Exemption STATE Compensation from New York State Workers'Compensation and/or Board Disability and Paid Family Leave Benefits Insurance Coverage **This form cannot be used to waive the workers'compensation righb or obligations of any part)[** The applicant may use this Certificate of Attestation of Exemption ONLY to show a government entity that New York State specific workers'compensation and/or disability and paid family leave benefits insurance is not required. The applicant may NOT use this form to show another business or that business's insurance carrier that such insurance is not required. Please provide this form to the government entity from which you are requesting a permit,license or contract. This Certificate will not be accepted by government officials one year after the date printed on the form. In the Application of Business Applying For: (Legal Entity Name and Address): Building Permit Hirsch Fence Install&Desilta LLC From:Village of Rye Brook 747 Route 9N'#1 %'alley%Cottage,NY 10999.2452 PHONE:rift-304-8622 FEIN:XXXXx0091 The location of where work will be performed is 12 Country Ridge Circle,Rye Brook,NY 10573. Estimated dates necessary,to complete work associated with the building permit are from February 8,2023 to April 20.2023. The estimated dollar amount of project is $10,001-$25,000 %%orkers'Compensation Exemption Statement: 'File above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE SPECIFIC WORKERS'COMPENSATION INSURANCE COVERAGE for the following reason: The business is a LLC,LLP,PLLP or a RLLP;OR is a partnership under the laws of New York State and is not a corporation. Other than the partners or members,there are no employees,day labor,leased employees,borrowed employees,part-time employees,unpaid volunteers(including family members)or subcontractors. Partners/Members: Bruce Hirsch Disability and Paid Family Leave Benefits Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE STATUTORY DISABILITY AND PAID FAMILY LEAVE BENEFITS INSURANCE COVERAGE for the following reason: The business MUST be either: I) owned by one individual; OR 2) is a partnership(including LLC,LLP,PLLP,RLLP,or LP)under the laws of New York State and is not a corporation; OR 3) is a one or two person owned corporation,with those individuals owning all of the stock and holding all offices of the corporation(in a two person owned corporation each individual must be an officer and own at least one share of stock); OR 4) is a business with no NYS location In addition,the business does not require disability and paid family leave benefits coverage at this time since it has not employed one or more individuals on at least 30 days in any calendar year in New York State. (Independent contractors are not considered to be employees under the Disability and Paid Family Leave Benefits Law.) 1,Bruce Hirsch,am the Member with the above-mined legal entity. I affirm that due to my position with the above-named business I have the knowledge,information and authority to make this Certificate of Attestation of Exemption. i hereby affirm that the statements made herein arc true,that I have not made any materially false statements and 1 make this Certificate of Attestation of Exemption under the penalties of perjury. I further affirm that I understand that any false statement,representation or concealment will subject me to felony criminal prosecution,including jail and civil liability in accordance with the Workers'Compensation Law and all other New York State laws. By submitting this Certificate of Attestation of Exemption to the government entity listed above i also hereby affirm that if circumstances change so that workers compensation insurance and/or disability and paid family leave benefits coverage is required.the above-named legal entity will immediately acquire appropriate New York State specific workers' compensation insurance andor disability an id fi ily leave benefits coverage and also immediately furnish proof of that coverage on forms approved by the Chair of the Workers'Compensati B to the government entity listed above. SiGN Signature: Date: IIERE f, Tc� Exemption Certificate Number Received 2023-008249 February 8, 2023 NYS Workers'Compensation Board https://mai1.google.com/mail/u/0/#inbox/FMfcgzGrcXlgNLhTgRzZZLQTtrdmBVbV?projector=l&messagePartld=0.5 1/1 Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Thursday, March 23, 2023 10:30 AM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 03/23/2023 10:29 To: VIL RYE BROOK PRIMARY Transmitted: 03/23/2023 10:29 00001 Ticket: 03233-000-692-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 12 To: Name: COUNTRY RIDGE CIR Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: LOCATE THE ENTIRE PROP NearSt: COUNTRY RIDGE DR Means of Excavation: HAND TOOLS Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: FENCE INSTALL Estimated Work Complete Date: 04/04/2023 Depth of excavation: 2 FEET Site dimensions: Length 270 FEET Width 10 INCHES Start Date and Time: 03/30/2023 07:00 Must Start By: 04/13/2023 ------------------------------------------------------------------------------ Contact Name: BRUCE HIRSCH Company: HIRSCH FENCE INSTALL AND DESIGN Addrl: 747 RT 9W Addr2: City: VALLEY COTTAGE State: NY Zip: 10989 Phone: 845-304-8622 Fax: Email: bruce@hirschfence.com Field Contact: BRUCE HIRSCH Alt Phone: 845-304-8622 Email: bruce@hirschfence.com Working for: H/O LYONS ------------------------------------------------------------------------------ Comments: Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: CONED SUEZ WTR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR 1 ( "M FOR TITLE PURPOSES .— -r -1= JOB # 2003MB386 !©. I® I® lo' to �i• °I� Io' .1 ' i. .-. . � L Village of Rye Brook Irchitectural Rev ew Board .! Approva Date: Q Chalrmap: w. I Z �4 IM 12 TNT!STORY FRAME ? t� M uc AT aoeio mwr ui a ECIENE °' FEB 2 7 2023 1 ID uj g `= z s VILLAGE OF RYE BROOK LFU; 9 BUILDING DEPARTMENT r•��,��.j.r RKT73.0�' � N�T75']0•N�- Y36W'TD�.0 MUMMY RIDGE CIRCLE IIICX f ARIt10 ALrdUTONs em AOC N$To rH* ay.rv+y m A Mne vvoN ar eLm"ON 7260 or pF EW j• . • `ATr roan LeTATE 20w Tm uLcr. =7% SURVEYED ar TNiG aerrv.Lr R.a NOr rrARINC TWE Lwv ,tti t�• r T . rZk oa 9ktRpm ZZAL awl CO E+ JU\t 15 7003 war i::Corrsoaca TO R';A WLm T.74:Co". ----------....-- CWAr.WaV to CWAVOATWN.MmAym taLROOr. ♦ FINAL SURVEY :"'•:C.RUN ONLY TO MC meson s rrAO•.L TNs r PRLPAFtED !'OA RWN- E:R.Y1xR.7r./.NO ON MY rr..Lr rO ri AL.L Je 1(RS. HRANDta"'T M-COIo•Nnf. G&MR"E»TAL AOCNC{ Q' NO Llwoutc U0,11 aoN LYJTm MCNCON AN. D D=,vuT4xs ca suerLCRQT W.T.Ltt /v 't" S. aiacx:z� SiV afM EC SFC.110ht.Z_ j CquNTY: �YESfCFCESTER TOPOGRAPHIC SERVICES TC)WN —, RYE BR_DUKI 5700 ARLINGTON AVE. SU, 2pv OCT 13 2W C7-WU BY RIVE:RDALE NEW YORK 10471 YILIAGE OF RYE BROOK BUILDING DEPL DocuSign Envelope ID: CBE9151 F-6520-4FBA-8736-E473241 OAODF Surveyed 3.25.24 Map Drawn 3,26,24 1. BE TI- IN THE HKOHERIY, AND THIS IS SUBJECT TO ALL RESERVATIONS, RESTRICTIONS, EASEMENTS AND AGREEMENTS OF RECORD TO THE EXTENT THAT THEY LAWFULLY APPLY TO THE PROPERTY. 2. THIS PLAT IS BASED ON A CURRENT FIELD SURVEY AND RESEARCH PERFORMED ON OR PRIOR TO THE DATE SHOWN ON PLAT AND IS BASED ON MONUMENTS AND EVIDENCE FOUND IN THE FIELD AND MAY NOT CONFORM TO DEEDS, DESCRIPTIONS OR PLATS OF RECORD. 3. PROPERTY CORNER MONUMENTS WERE NOT SET DURING THIS SURVEY Richard , pinelli, L,S, NYS Lic, 50975 —Unauthorized additions to or alterations of this plan is a violation of Section 7209 of the N.Y.S. Education Law.