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HomeMy WebLinkAboutRP23-016PERMIT #X/� SECTION _ Z TYPE OF WORK JOB LOCATION CONTRALTO COST \Oeo #�al TCO # 6)/%o DATE: aa? a3 ®cR a8 ?zj c.Soo*#?cJ7ez ��BSCo- 9a3a ohm Sow //q (9/4) 93 7- Ya 79 FEE DATE IN�cpFCT10N RECORD I DATE I NSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS SPRINKLER ELECTRIC 0 LOW -VOLT ED ALARM AS BUILT FINAL OTHER APPROVALS ARB iBOT PS ZBA OTHER (-Qy� DR . 19 V 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 July 13,2023 Nelson Sanchez&Irma Sanchez 9 Legendary Circle Rye Brook,New York 10573 Re: 9 Legendary Circle, Rye Brook,New York 10573 Parcel ID#: 124.65-1-11 Roof Permit#23-016 issued on 3/28/2023 to Re-Roof Existing Building This certifies that the new roof,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to 1j:E R For office use onl : BUILD MENT PERMIT# _VIL E OF RYE B>t OK ISSUED: 3G STRE RYE BROOK,! YORK10573 DATE: J— (O14)939-06680 FEE: // PAID APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION Address: �- �c�t' 1��� �N��c � l U� l Occupancy/Use: �v' Parcel ID#: N- 5 —)� Zone: Pu _ Owner: be�,)n n GIBZ Address: (9 � Y �l�C��- �ye �r� P.E./R.A.or Contractor: ������ P Address: `4 1 (,j d c, 4 Ave,, P 3 (+-d,r1ff_Q �F Person in responsible charge: 10�n Address: `1,s 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: h�b., .5.-. , being duly swom,deposes and says that he/she resides at 9 Leu y,'C AI in BPrint Name of Applicant) (No.and Street) y e- 6a�s K ,in the County of } L in the State of '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�1 V_=_I , OD , for the construction or alteration of: n e L-j rue 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. Swornr)-to before me this -v k�, Sworn to before me this day of A 6� 20)_> day of ,20 71 a, � 4�j Signature of Property dwrier Signature of Applicant Iye�S�' SlnV1LLt CJ1 �,� SS( &-4\ Print a of Pro erty Owner Print Aoif � ant ANNAKIELBASA ANNA KIELBA t Public Nota Public- Stat tpt Notary Public- State of Now York Reg,No.01 KI 78519 Reg.No.011(16378519 Qua ified In Putnam County Qualified In Putnam County l y Commission Expires July 30,2026 My Commission Expires July 30,2026 S!122m I �yE BRC��. O�` tim BUILDING DEPARTMENT ( JILDING 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 - - - - - - - - - - - - - - - - - - -- 7 � IC� 1�Z ADDRESS:- DATE. / i PERMIT# ISSUED' SECT: BLOCK: LOT: LOCATION: OCCUPANCY: I \ ❑ 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 p L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION INAL ❑ OTHER N � W •`� � v m M o\O 00 N j Cr a o a U W ' M M a O A ' Or W u Y oPLO w O = a e-' A O 9 + s O -o iC p s O v a I+1 i f..q � � Go • _ ren N � O deb 00.4 r a W 4 uW h Gs z y � av co O (►� W ! z U A A U 20 0jokk Z1wWU- z . 6 OCl cn G �1 V a G D -°d' 14 o 1-1a� � �U u W N O z z � 0 0 ° D ` � u ►--� C7 V O v o V � .� � N � x - W U�, z z �I � 'fir ►-� W � � � � � �" � s P4VVm mm44171P� a ]mm446-Y664 664;644;4;4;4;4144iQQ4iQQ4i4i4i6G66QQ44 H [EC� l BUILWYOK NT MAR 2 3 2023 VI E 938 KING ET 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT FOR OFFICE USE ONLY: Approval Date: ermi � Application# Approval Signature: ARCHITECTURAL REV BOARD: Disapproved: : Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: q Application Fee: Permit Fees: A J y��� }} ROOF PERMIT APPLICATION Application dated:a'd-`�—d.p is hereby made to the Building inspector of the Village of Rye Brook,NY,for the issuance of a Permit to Re-Roof an Existing Building,as per detailed statement described below. v r IS 1. Job Address: c �'Yl f �%('G �fl�Rue_ Q N f BL )Dy, '6(r�''� 'I� Zone:JQ Property Owner: >✓�5� G Address: L n ilc,l Q Ctrde. 9ye, faw Ml t vV Phone#:.9 V7 ' &- 9a3acell#: email: OSom 0090 0')h he.'V 2. Applicant: P"LI O-P. 9 �N-5 LL L Address: c6(I W 1II-e-f ' ✓rv`""— P c Py f nj-� Phone#:C1 1 q -'�.3� - `t� l Cell#: email: J A)IS. j 0"�1F_ r(@ g 3. Roofing Contractor: �b 1�1 P, P O.7 C�% Address: IA) A c k* V`e- p(, -GL94TA)Y14T9 Phone#: LT 7 - 3 9-y 229 Cell#: f email:�o vt5. bleif 9 1•c vrti 4. Job Description,list all Methods&Materials: (fie rn+� Q 5h ) ('DD ew)-N re, '�L• P �y cF I"S-)Zl ML j 5. Estimated Cost of Job:$ (NOTE:The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 6. If corner property,indicate street frontage: 7. Construction Type: NYS Construction Class: S. Number of stories: Height: 9. Is garage being re-roofed:No:(-4•Yes:{ )Attached No:(dl•Yes:O Number of Cars: 10. Is roof peaked,hip,mansard,flat,etc: 11. Estimated date of completion: -t- 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: Ne\j o, 3,,1n 6L z ,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 C.o.�+C�c4v� 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&i.Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations.J Sworn to before m this a Sworn to before me this ,V day of �C , 20 a-7 day of I& , 20 )--3 Signature of Prop rty Owner Signature of Applicant / Print Name of Property Owner Print Name of Ap licant �d�7,t t ry Public7 Notp Public ANNA KIELEASA 'Nowy Public• State of New York ANNA KIELBASA Reg.No.91"378519 Notary Public- State of New York auallved In Putnam county Reg.No,OIK C378519 My CMmissian Espi:sy July 30,2020 Clualified in Putnam County My Commission Uplrts July 30,2026 811212021 LICENSE NUMBER "THE ORIGINAL" Westchester WC-8561-H97 DO U B LE Family Owned And Connecticut 00556256 Operated Since 1960 All Home Improvements EST. 1960 439 Willett Ave. Port Chester,N.Y.10573 Tel#(914)937-4279 Fax(914)937-4172 http://www.DoubleRwindows.com Nelson Sanchez March 16,2023 9 Legendary Circle Rye Brook,NY 10573 Insurance: All work involved within the following proposal is covered by Workmen's compensation,Public Liability,and Completed Operations Insurance. Roof Contract Supply Labor& Material for the following • Remove existing shingled roof from entire house. • If any rotted plywood is found it will be an additional cost. • Supply and install ice and water shield over the eaves 6' up. • Install a synthetic Base sheet on remainder of roof. • Install all new F- 5 aluminum drip edge. • Install the new GAF Timberline roofing system in Hickory color. • Supply a dumpster to cart away job all related debris. • We are certified GAF roof installers Roofing price $14,600.00 ADDITIONAL OPTIONAL WORK L__ Terms: Painting,and windows cleaning to be done by others.Hidden rotten wood not included Standard industry cash term,one half with the order,balance due upon completion. Terms may be modified to meet special conditions. Past due balances are subject to a monthly service charge of 1 1/2%(18%per annum). If the account becomes delinquent,you agree to pay any legal or collection fees expended by Double"R"arising from collection of the account.Permit&Application fees not included.Due to the fluctuating prices in plywood we reserve the right to adjust price. Double"R^is not responsible for reconnecting existing alarm systems on windows and doors. You the owner may cancel this transaction at any time prior to midnight of the third business day. After the date of this transaction,such Cancellation must be made in person,at the offices of community improvements,or in writing postmarked prior to the fourth business day.We accept VISA or Mastercard with a 3%convenience surcharge on total amount being charged Acceptance: The above prices,specifications and conditions are satisfactory and are accepted. Double"W'is authorized to do the work as specified. Contractor Performance Warranty: Double"R"proposes to furnish and install labor and material in accordance with above specifications in order that the above qualifies for the Manufacturer's Long-Term Warranty. In addition,all labor provided by Double"It"is unconditionally warranted for a period of Ten years from the date of installation. Approximate Start Date: Approximate Completion Date: Customer: $14,600.00 (Amount) ROOFING Date: (Sales Tax) Double"R": $14,600.00 (TotalAmount) Date: $7,300.00 (Deposit) $7,300.00 (Balance Due Upon Completion) Return original contract to Double"R",retain a copy for your records. Visit Our Showroom Located At 439 Willett Avenue Port Chester,N.Y. 10573 nr. r ,r.• XY• F tYA III > '` ••%j C CO I '�CI I 0 O 4 E C " tts = N C) — o ction ya. Q Z U , CL �Q� rs' Lu �•� ON O 7 J m J • W .. M H N O !< �..► U O X 00., Z ` •_f�� � � U Qom. `Y{C,'• M re ca i� y N Q o o ° N > o s z U a� CO C (A ' G AC40® DATE(MM/DD/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE 1/17/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION 1S WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER UUNIAGI NAME: Betty Reyes The Willett Insurance Agency PHONE 914 481-5599 FAX 888 371-9783 A/C,No,Ext: (A/C,No): 331 Willet Ave ADDRESS: bettyreyes@thewillettinsurance.us thewillettinsurance.us INSURER(S)AFFORDING COVERAGE NAIC# Port Chester NY 10573 INSURER A: Westchester Insurance Company INSURED INSURER B Doublc R PEU,LLC INSURER C: 439 Willett Ave INSURER D: INSURER E: Port Chester NY 1 0573-3 1 79 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE FRIOCCUR PREMISES(Ea occurrence) S 100,000 MED EXP(Any one person) $ 5,000 A BP4904585Q2022 12/13/2022 12/13/2023 PERSONAL aADVINJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 RPOLICY ECT LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: S AUTOMOBILE LIABILITY UU(Ea accident) S ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) 5 HIRED NON-OWNED S AUTOS ONLY AUTOS ONLY (Per acadent) S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAR HCLAIMS-MADE AGGREGATE S DED I I RETENTION S S WORKERS COMPENSATION 1PER OIH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? Mandatory In NH) E.L.DISEASE-EA EMPLOYEE 5 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN The Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NEW K Workers' CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured Double R PBJ,LLC 914 937-2237 439 Willett Ave Port Chester,NY 10573 1c.NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 92-1106938 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) NYSIF The Village of Rye Brook 938 King Street 3b.Policy Number of Entity Listed in Box'1a" Rye Brook,NY 10573 8910587 3c.Policy effective period 19l12at?m2 to 17rw?n9i 3d.The Proprietor,Partners or Executive Officers are included.(Only check box if all partnerslofficers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"l a"for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". Will the carrier notify the certificate holder within 10 days of a policy being cancelled for non-payment of premium or within 30 days if cancelled for any other reason or if the insured is otherwise eliminated from the coverage indicated on this certificate prior to the end of the policy effective period? ZYES [:]NO This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed,nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit,license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,I certify that 1 am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Betty Reyes (Print nam uthorized representative or licensed agent of insurance carrier) Approved by: in A / 7/o2C) 2. (Sig ure) (Date) Title: Insurance representative Telephone Number of authorized representative or licensed agent of insurance carrier. 914 481-5599 Please Note: Only Insurance carriers and their licensed agents are authorized to issue Form C-105.2.Insurance brokers are NOT authorized to issue it. C-105.2(9-15) www.wcb,nygov