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HomeMy WebLinkAboutBP23-049PERMIT # SECTION TYPE OF WORT 10B LOCATION OWNER EST. COST �CO #� FEE„/ 3 ExP: LOT 0 TCO # FEE DATE INSPECTION. RECORD DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING O RGH PLUMBING GAS O SPRINKLER ELECTRIC LOW -VOLT C� ALARM C� AS BUILT [� FINAL INSP OTHER APPROVALS ARB2dorl/ / 9, 0C;Q3 BOT _l ps ZBA OTHER AS-BUILTlFiNAL SURVEY REQUIRED PRIOR TO FINAL INSPECTION 2C�/Y a3 ci DR tc 4YaJ�V i . 19 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.rvebrook.orQ TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE July 18,2023 Jonathan Fox&Alison Fox 1 Country Ridge Circle Rye Brook,New York 10573 Re: 1 Country Ridge Circle, Rye Brook,New York 10573 Parcel ID#: 129.82-1-31 Building Permit#23-049 issued on 4/28/2023 for a New Fence This certifies that the new four foot and six foot high white vinyl fence and gates,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to EcE �wE ID R a For office use onl : BUILD INt��EPA kTMENT PERMIT# FA—C#9 JUN 2 3 2023 VILLAGE OF RYE BROOK ISSUED: 938 KING STREET,RYE BROOK,NEw YORK 10573 DATE:6-,)3—a3 VILLAGE OF RYE BROOK (914)939-0668 FEE: ,[�� PAJR BUILDING DEPARTMENTYv, _eok.erg 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 ►tt►tttt#•\\##►#t\►►►►►►►►ttt►►ttt■ttttt►1♦tt##tt#####tt•tt►►►t►►►►►/••t►t►►tt►t►►#####►\•tttttt#tt►■ttt►►t/►tt##tt##tt#\\\\t Address: 1 Country Ridge Circle Rye Brook, NY 10573 Occupancy/Use:���/� �Y/ Parcel ID#: c� , �c� — — 3/ Zone: Owner: "tf 1 OL' - nX Address: P.E./R.A. or Contractor: Hirsch Fence Install& Design LLC Address: 747 RT 9W- ottage OP Valley Cottage, NY 10989 Person in responsible charge: Bruce Hirsch 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/construction/alteration herein mentioned in accordance with law: STATE OF NEW YORK,COUNTY OF WESTCHESTER as: Jonathan Fox being duly sworn,deposes and says that he/she resides at 1 Country Ridge Circle (Print Name of Applicant) (No.and Street) in Rye Brook, NY in the County of Westchester in the State of NY ,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:$ $11,700 for the construction or alteration of new white vinyl fence 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 )3 Sworn to before me this day:of , 20 0�� day of , 20 Si lure of Prop Signature of Applicant JOC)C, Drbtt.Name of Property Owner Print Name of Applicant Notary Public Notary Public SHARI MEULLO Notary Public,State of New York 8/12/2021 No.OIME6160063 Qualified In Westchester Coun Commission Expires January 29,2�� �E 6RC��• 1982• BUILDING DEPARTMENT ❑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 DATE. PERMIT# `� 15) ISSUED: SECT: BLOCK: LOT: LOCATION: `-�.J p��Q � + CCUPANCY: ❑ Violation Noted THE WORK IS... PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION �l _M` � REQUIRED ❑ FOOTING 1 U ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING a'CROSS CONNECTION / FINAL ❑ OTHER ■ s ■ C a a O C 4 a N v $ s //CyyV eq a 4-4 a FM+ 1 a 0 W h+y LI) a � � per( }-� ICI U �y•�-- O ,�^� w h�l � y V N x09 y m u C W ■ � I� � N N 14 00 ■ O U ''� 1 Q 330OQ 14 cav : � .b Q 'O 0 C a v � � w z � to � 14s eq _ eq © w z two ~ a 4 ■ V z _ yy v o ., p .., O -8 o V = z �fi W00 '� �►aoa' rj C _ o s 7 ° Z z co 0-0 1-4` O ~CO 0 cn w Z O u 4-4 C1} aao MM� p Vg ? per �+■1 0 V V LLW2 V H W W O >+ .� a71 y " ' yfl' u' ►� �4 d OH aa 'u° s ■ BUILDING DEPARTMENT D VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 MAR 31 2023 (914)939-0b68 VILLAGE OF RYE BROOK WWWd;t4)ro2&org BU!LI7Ii�C DE!�ARTMENT _-.. FOR OFFICE USE ONLY: (� f�J!7,I� r�,�' Approval Date: 4 Pe t / Application# ,t'j/C.r[ ,7f r� Approval Signature: ARCHITECTURAL REVIEW BOARD Disapproved: Date: �/7�{ r�� BOT Approval Date: Case# Chairman: (/V! PB Approval Date: Case# Secretary: G ZBA Approval Date: Case# Other: Application Fees,�` J_ Permit Fees: FENCE / WALL / GATE PERMIT APPLICATION Application dated: � Z 4`a I Zc) Z �) 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. Job Address: I (_-©�.1/l �A`a q-e C l�I� 2. Occupancy/Use: I;5;411'1 S.B.L.#: A-)9, 9 4 —/—31 Zone: — 3. Proposed Fence/Wall/Gate(describe in detail): / ,, f W �l V s V1 {'e Jl�'_ 4 r ( G I !O� '� l CJ reg1 a 15 I 4, Property Owner: an TAIQ rt X Address: crkMn r-0 CArC Ce Phone# Cell# 2 d-J-7 67- 1 Sq S email: Applicant: Address: Phone# Cell# email: Architect/Engineer: Address: Phone# Cell# email: 1� Contractor: f ldC� r�cL% k-1 r sCL% 4-�oC_e_ f�S �� ,w,rII V e Sv L-L Address&Phone: �� 'e � !V Y 5. If building is located on a comer lot,which street does it front on: C"-iy-,, �-1 6. What is the estimated cost of construction (NOTE:The estimated cost shall include all site improveme ts,labor,material,scaffolding,fined equipment,professional fees,and material and labor which may be donated gratis.) �J,� 7. Estimated date of completion: /"I u� I , 74-) 1 811212021 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. t**wwwwwwwwwwwwwwwwwwwwww**,t*ww**ww*wwwwwwww*w*w*www*wwwwwwwwwwwwwwwwwwwwww***,tww�r*w,r*,�,�twwwwwwwwwwwwwwwww STATE OF NEW YORCOUNTY OF WESTCHESTER ) as: ,�or10-(nc�o_ ,being duly sworn, deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further st'aje\s tha (s)he is the legal owner of the property to which this application pertains, or that (s)he is the (LAU- 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 z�l� Sworn to before me this day of �VNC,4 20 day of "a ��� , 20 of Property Owner tgnature of Applicant Ac"L_ ,Prjqt Name of Property Owner P ' e of Applicant Notary Public Notary Public SHARI MELILLO Notary Public,State of New York SHARI MELILLO No.01ME6160063 Notary Public,State of New York Qualified in Westchester 29u 20-7 No.o1ME6160063 3o+rmission Expires January Quaittled In Westchester coun ,,ommission Eyplres January 29.20 2 8/12/2021 Building Permit Check List&Zoning Analysis c \ Address: 1 �SZJJ n (c \ SBL• Zone: ��S `Use: 2)D Const.Type: � r.Othe Submittal Date: \A\ 102--3, Revisions Submittal Dates: Applicant: 1�7 (::) Nature of Work Reviews:ZBA• Z PB: BOT Other. FEES:Filing. BP:,# � lv'�/O: Flood Plane: Legalization: ( ) (0-'APP: Dated 1L otarized:_�SBL:��Truss I.D. Cross Connection: H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Stone Water Review: Street Opening ( ) ( ) ENVIRO:Long. Shore 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: `�Other: ( ) /(�cense: ✓Workers Comp: �` Liability Comp.Waiver. Other. �/ Jr CODE 753#. 0'��7_0' - j --(;9 Dated: -41•—a 7—Q 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. 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. (�mtg.date approval k notes: ( )ZBA mtg. date: approval;- notes: ( )PB mtg.date: approval• notes: REOURED EXISTING PROPOSED NOTES PPROVED Area: Date: APR 2 4 2021 Circle: Frontage: Front: Front Sides Main Cov Accs.Cov: Ft.HS • S .H Sb: Tot.Im . P Height/Stories• notes: BUILDING DEPARTMENT VILLAGE OF RYE BROOK RMAR 31 2023 ] JD 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK www.rve rook.ore BUILDING DEPARTMENT 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: ' ( iK�l 6-r /4?- Date of Submission: Parcel ID#: Zone: Proposed Improvement(Describe in detail): APPLICANT CHECK LIST: MUST BE COMPLETED BY THE APPLICANT OVJ The following items must be submitted to the Building S) It ¢-CIS Dep nt by the applicant-no exceptions. Property Owner: - GV)ti )AVl. X 1. (VCompleted Application 2. ( )Two(2) sets of sealed plans. (one full size (maximum Address: / —6-e-C-44-6q, L7�- -� Aallowable plan size=36"x 42")and one 11"x17") Phone# !,y �� ?— u 3. owo (2)copies of the property survey. T 4. wo(2) copies of the proposed site plan. Applicant appearing before the Board: 5. ne electronic/disc copy of the complete Jon 4 aA X pplication materials. 6. Tailing Fee. Address: 7. ( )Any supporting documentation. Phone# 2d _ _ S 8. ( �HOA approval letter. (if applicable) 9. ( Photographs. Architect/Engineer: 10.( ) Samples of finishes/color chart. (a sample board or Phone# 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. Sworn to before me this ` Sworn to before me this day of \' \0. ON ,�201-)- day of , 20/,)3 O ature of Pr Owner/ ' ature of Applicant Prrt-b�C�✓1��a� (� �� cJaVJ�-r 7"��� U 7� ame of Property Owner Name of Applicant > UL Notary Public Notary Public SHARI MELILLO SHARI MELILLO Notary Public,State of New York Votary Public,state of New York No.01ME6160063 No,01ME616OO63 Qualified In Westchester County, Qualified In Westchester County Commission Expires January 29,200 -imission ft:res January 29.20�� 8/12/2021 URnv� Village of Rye Brook ML I., MR J`` n cc� AQ�da FB SE Architectural Review Board Meeting < Cit. + AC SF �� c` Wednesday,April 19,2023 at 7:30 PM Village Hall,938 Ring Street JM �7. 1. ITEMS: 1.1. ARB23-025 (Consent Agenda) James Luciano&Helen Luciano 14 Lyon Street Rooftop solar array. 1.2. ARB23-026 (Consent Agenda) Karina Yapur 30 Tamarack Road Rooftop solar array. 1.3. ARB23-027 (Consent Agenda) Han-Hsuan Liu&Haoyun Feng 27 Mohegan Lane Rooftop solar array. 1.4. ARB23-028 (Consent Agenda) Victor Paterno&Annemarie Paterno 15 Old Orchard Road Replace front walk,entry steps,driveway retaining wall and re-pave driveway. 1.5. ARB23-029 (Consent Agenda) Christopher Davis&Lauren Davis 1 Whippoorwill Road Replace front walk, front steps,re-do concrete patio with pavers and install gas firepit. 1.6. ARB23-030 (Consent Agenda) Jonathan Fos&Alison Fog 1 Country Ridge Circle 6'&4'high white vinyl fence and gates. 1.7. ARB23-031 (Consent Agenda) Cape Eland LLC 12 Rock Ridge Drive 4'high welded wire fence and gates. 1.8. ARB23-032(Consent Agenda) Scott Stern&Bonnie Stern 79 Greenway Close 3'high split rail fence and gate. 1.9. ARB23-033 (Consent Agenda) Fabricio Denadae&Luciana Chieus do Amaral 110 Brush Hollow Close Replace decking on existing rear deck. • architectural Review Board April 19,2023 Consent Agenda Approvals: Motion Second Abstention Aye; Nay;�_ Adjournment; Notes 1.10. ARB23-034(Amendment to Prior Approval) Matan Dvir&Ilana Dvir 1 Dorchester Drive Dormer modifications. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.11. ARB23-035 Eric Goldstein&Rebecca Kleban 5 Berkley Drive Rear covered porch,stone walkway and drainage. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.12. ARB23-036 Scott Hirsch&Christine Staeger-Hirsch 1 Beacon Lane Remove rear door,install window.Remove side bay window,install sliding doors. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.13. ARB23-037 (Amendment to Prior Approval) Win Ridge Realty LLC 166 South Ridge Street New store front"Amazing Lash Studio" Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes NEXT MEETING: May 17, 2023 Hirsch Fence Install & Design 747 Route 9W Valley Cottage, NY 10989 Q�a �Cusrtxrer's Last Name.F.TsI hk"e ' I In Sc�soe Ad3eeax SIA!e lap I :.:ntm+cf s DftWm 0tm.r No CusfimRr'9 rvannQ Phone No. rustomar'z F-mnilf_rYJresx Newest GmPs stmet �... PERM]TIINSPEC OroINF MATION rWrttft'ec„Ara�o�: r omeowner obtain permit naUsltatgn pro ervonal eS NO :3{Ing au : asmz rail I ne �^r nr tw rm Mu n IMIDee Y l (0 obtain =-64 A LAYOUT Selection J,�,iol APPROXIMATE rLNCE FOOTALiE CONTA<NED IN THf@ NR(iPOG/y KApPRG%{MATE BASED ONFtElO McJ.SUdEYEMS F7f1AJ.PFb_E WILL h£ADJUSTED BASED ON ACTUAL FENCE FOOTNTE UgAO AS SM FOURTH Of TERW AND 1,0NOfT10NS.1 ADDITIONAL COST OPTIONS ADO THE AWES N THIS COLUMN ro THE SEL>CPON TAKE OOwN AND Ii4lJ1. S h0( W 1 i AWAY OW FENCE f L.fitAT COST $ 1 SuE TDTJ: SALES TAX $ FINAL AMOUNT DUE i;x a IA.roan e tson; Stock Product Customer assumes all resporm ihUes as 4{dries to all aadflbral labor and matenai psis es n relates I ❑ Special Order Product to ITv fence"Nrstattctfunan'.Quosproporty. a (!r� 424; :fn,) I ",HSrrji�Y yi SI�r�L rr,r.�(S ENC INSTALLATION RELATED T GRADE.PLEASE INITIAL ONE V tT M-TO THE EYr 5'9PE5 NST,i UT N li,t?'h �'cY lick. r F%IGE TO W Lr:Fl W"H HIC. ..ST GRAM L`MV;NG`t, hYa XFEN-E �F`ib�s-*""t^^em s•+="��Ji sic.. (CL6f:7tf.P.1G F:L:rvGAK)I fOLLI):9ING FL M OF GPJJN encS�:fir'>.:ON LAAYN4 r'aibt FENCE VILL@L UNEVEN AT TOP rrt�M-S efxeTf6wlMel�ivrS Va+a+ FIKi CU4fO1Lq TD 11.13heS Product ( Product Product Style / kqx Height: Style: Height Style. Height. Focrage �� if Gates'7,T Footage' If Gates Footage: If Gates: Post Cap: Color. .rt Q Post Cap: Color: Post Cap: Color. Raii?ype: Post Cap, Rail Type Post Cap Rail Type Pcst Cap rolcxet Type. 5 ! 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'r ,y'�,-t y Id it 7 ILA WI 'i TU -Z-A Ai + r t 77 ,G r 55lobis s IiL7 1 r�=o .�6 E3e pxo{Y u7t+.!'� Ckf 's'! ixr___ lt•vu r« a O sI Ito tl. 1 Bill IBM :34i1► a8M gft$ P! q�� ! i 9 Z cum D1 R Own ti Oo'uciz-r; CK t o;o z zz a a b «o g$ <> m� —-------- 44 ®M00 7 O CiN j �Q II U Na N f O P� �f{C�fgS A ��loim I s' 3 ��bja obi I 1I1 r��5t2 "PY�� — ----- a e e� F .9l'40t ' 9 h'.. .� W N0018 )OW OZ9t BLl LBO ; sb3t $ ZBOO60L9f/1i11N0 w m � � �� l3NNV1 1/NHP!, ` w � � Ot 00 cr Lu to k LLJ (b LLJ L.1 0 L) z LLJ e LLJ U- C CN 00 C'4 tj V G. . •� ..-,•-�-,.•-:: ^+- .---n"-.-^-m.• ,�y-.� .•� .-•.. t!f•..iiia.v-wJWw,f«^`$'Y+w.�w s}N�t�fii/kS�Ji'i'aL,vrAH.:sRY-owi,+w!ltEs+'a•AMh"�1c- _ { J -� CERTIFICATE OF LIABILITY INSURANCE DATE!MM4'DDYYVVI 0 312 312 0 2 3 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 endorsement(s) PRODUCER CONA.TACT Bill McCarthy McCarthy Insurance Pr+oNE 914 769 0417 FAx 914 769-0609 378 Elwood Avenue E-MAIL Bitl mccarth insurance.net Hawthorne NY 10532 _ I s RER 1 AFFORDING COVERAGE INSURER A Preferred Mutual INSURED INSURER Hirsch Fence Install&Design LLC 747 RT 9W-Cottage 94 INSURER 0 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 DM B POLICY EFF POLICY EXP LIMITS - man pot Icy NUMBER 111111,111110iYYYY,I X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE c 1,000 000 A CLAIMS-MADE Fx]OCCUR DAMAGE TO RENTED 50 000 X BOP0100721375 11/12/2022 11/12/2023 NIEo FXP,Am o e pefsonj ,$5,000 PERSONAL&ADV'NJURV $1,000.000 G N'L AGGREGATE LIMB APPLI S PER GENERAL AG GATE s2,000,000 POLICY a'T LOC PRODUCT -COMPIOP AGG c 2,000,000 OTHER s AUTOMOBILE LIAEILfTY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY iPw personI S ALL OKTIED SCHEDULED BODILY INJURY IPar a:cmeotl s AUTOS AUTOS NON-OWNED PROPERTY DAMAGE s HIRED AUTOS H AUTOS s UMBRELLA LIAB rCCUR EACH OCCURRENCE $ EXCESS LIAR CiAWS MADEAGGREGATE PFTENTIONS WORKERS COMPENSATION I PER OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETORlPARTNER'EXECUTIVE� - e OFFICER/MEMBER EXCLUDED":' N J A (A1andelory in NH) I E.L DISEASE-EA EMPLOYEE S I! es.describe order ^ c.7RIP710N OF OfERATPONSbetagL DISEASE-POLICY LIMIT I DESCRIPTION OF OPERATIONS:LOCATIONS VEHICLES {ACORD 101.AddiSonai Remarks Schedule.may be attached if more space is regwred) Fence Contractor Village of Rye Brook is Additional Insured Job Location: 1 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> 0 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD r"o 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 forte cannot be used to waive the workers'compensation rights or obligations of any part)t** 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&Design LLC 747 Route 9N#4 From: Village of Rye Brook \'alley%Cottage,NV 10999-2452 PHONE:845-304-8622 FEIN:XXXXX009r The location of where work will be verform d is l Country Ridge Circle,R%c Brook,NV 10573. Estimated dates necessary to complete work associated with the building permit are from Marco 23,2023 to Mav 23,2023. The estimated dollar amount of project is $10.001-$25.000 N orkers'Compensation Exemption Statement: The 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 arc no employees,day labor, leased employees,borrowed employees,part-time employees,unpaid volunteers(including family members)or subcontractors. Partners/Members: Bruce Hirsch Disabilith and Paid Famih 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: 1) 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) I. Bruce Ilirsch.am the Member Hith the above-named legal entity. 1 affirm that due to my position with the above-named business 1 have the knowledge,information and authority to make this Certificate of Attestation of Exemption. 1 hereby affirm that the statements trade herein are true,that I have not made any materially false statements and I 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 1 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 and/or disability turd paid family leave benefits coverage and also immediately fumish proof of that coverage on forms approved by the Chair of the Workers'Compensatio to the government entity listed above. SIGN Signature: y Date: y2 HERE Exemption Certificate Nu ber Received 2023-019692 March 23, 2023 NYS Workers'Compensation Board CE-200 01/2018 Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Thursday, April 27, 2023 1:33 PM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 04/27/2023 13:32 To: VIL RYE BROOK PRIMARY Transmitted: 04/27/2023 13:32 00004 Ticket: 04273-001-679-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 1 To: Name: COUNTRY RIDGE CIR Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: BOTH SIDES OF HOUSE NearSt: COUNTRY RIDGE DR Means of Excavation: POST HOLE DIGGER Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: Y Work Type: FENCE INSTALL Estimated Work Complete Date: 05/09/2023 Depth of excavation: 2 FEET Site dimensions: Start Date and Time: 05/02/2023 07:00 Must Start By: 05/16/2023 ------------------------------------------------------------------------------ Contact Name: BRUCE HIRSCH Company: HIRSCH FENCE INSTALL AND DESIGN Addr1: 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: LAST NAME OF FOX ------------------------------------------------------------------------------ Comments: 10 INCH DIAMETER Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA CONED SUEZ WTR WESTCHESTER TEN GAS-HDS VLY VIL RYE BROOK WESTCHESTER CTY SWR 1 aI all 1, his its rY g „n N Z k7 C ' t .•n� 'ta:[: :er MO fi�l�g� Efei WS r---- � D C r F-36 _ _ _ e Z It----- - { ft Din 0- J. ju - Mea lenojddH 11 p.jeog M Inaa ea ao d a c 'b Z'o}. 1 0 logo, a S mW, - iiii O v 9 ` V ' 6oCos�j a-t-vLep in � NO AL vot I t0006OZOV VIt d/N _ V WI ee gg R �bu�1 11�3W �1`dd3a JNIUl1f18 11110 Z0Z l £ Hvw C� KI rt '� 101 *U) C wtoDZoww C p= z -I c< m c -i C z xO t- DmDpDDx D (n n 0 iU OJ m O f T1 O -0 r- 'U 0 XC � rnMD�DM c D0� O z C� -0 D me Y mp �O nZmOM O -1 -t z -0 au U)-D.qOc�D��� o (n -i 0 0 M x M 0 M-0-0 C7 �1 M 0 < zm X O:�z-ODD Z z� 0 Zr- 0 Z C7 n G7 (mil O m 0 -0 z D -{ r- Z n . 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