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HomeMy WebLinkAboutBP23-060PERMIT # � � DATE: S sk*�Sp ®(pa SECTION .3Si BLOC TYPE OF WORK I /0.4l / (>j o/ V ,i" JOB LOCATION, OWNER Y0�l ol< CONTRALTO EST. v/C0 #, TCO # FEE DATE INSPECTION RECORD DATE I NSP FOOTING FOUNDATION FRAMING RGH FRAMING {� , INSULATION 4p/t)3� 0C� /"� PLUMBING RGH PLUMBING GAS C� • • ®AS 13UILT r �► _ 1III FINAL OTHER APPROVALS ARB VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 23-133 Certificate of ®ccupaucp This is to certify that l of, having duly filed an application on 20 requesting a Certificate of Occupancy for the premises known as, re a Rye Brook,NY, located in a a Zoning District and shown on the most current Tax Map as Section: - q1 Block: f Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No.�,�' ����, issued 20,3, such authority and permission is hereby granted to the property owner to lawfully occupy or use said premises or building or part thereof listed under the following New York State Classifications,Use: Cam- /� Construction: 1 for the following purposes: y-e1'1a Val Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises. building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of the building or i e exit facil'ties shall be de, and no enlargement, whether by extending on any side or by increasing in h 'g shall be ade, r shall a build' a moved from one location to another until a permit to accomplish such change has e n d from t e Buil pector. AUG 16 1013 Building Inspector,Village of Rye Brook: Date: DD BUILDING DEPARTMENT For office u , nlv: PERMIT# •'ao0 AUG - 7 2023 VILLAGE OF RYE BROOK ISSUED: 938 KING STREET,RYE BROOK,NEW YORK 10573 DATE: —� VILLAGE OF RYE BROOK (914)939-0668 FEE: jtllQ PAID' BUILDING DEPARTIviENT Www'.ryebrook.orp- 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 fti##i##tiifiii#####sit't�(iitf###itfiiiiit#i#,i,#�i/i�i####t##tiifit###i##t#####i#it#f###t####itiifi#4fif#i#i###i#iffftfi#######i#i Address: wGStPN'l Ne? yj Ali Cc"'t— Occupancy/Use: vL1 Parcel ID#: �3�, 7/ --/—f Zone: Owner: Q 6 L 1 � Address: P.E./R.A. or Contractor: Address: Person in responsible charge: 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: ,L/ 7�" 1� being duly sworn,deposes and says that he/she resides at Z V vest/ 161' (Print e of AppI—�i tl (No.and Street) in ! e ealO ,in the County of �1.�� NZ F�S� in the State of C ,that (City/1'own/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:$ <91P 0r, 0 for the construction or alteration of � �, �^, JU 6C 119 4 . Reno l/ig 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§250-1 O.A.of the Code of the Village of Rye Brook. Sworn to before me this Sworn to before me this day of F�LI. S} , 2012- day of0 � , 20 ignat of Propem, Owner Signature of Applicant rw wv L- j4/ Zo/;/4 c / c, Pn t i e of Property Owner PriN Na of Applicant LLL Notary ublic Notary_ blic SHARI MEULLO SHARI MELILLO Notary Public,State of New York Notary Public,state of New York No.01ME6160063 No.OIME6160063 Qualified In Westchester County Qualified In Westchester Coun" Commission Expires January 29,20�� Commission Expires January 29,20 Cam, �E BRC��• cu � 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:— DATE' PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: \N �� ""t1 U� "�C\ OCCUPANCY: ❑ Violation Noted THE WORK IS... PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL ❑ OTHER _ v `n • °' y w • � a � O z � � v .� - V v � o v ; Wi V z c � _0 o way ■ y V +� ^o � 9 = IPQ H M • tiz g col r%- 00 H Fr'i w O Ui © ° y o a O O © z v Z �. o .;ill 00 ONO Nj A o eo r` We OC O U oz .� 14 O F 1--1 � zwz o z Z 3 V o c V 8 -° a w V z °� � ad .� _ N A w x ¢ w � � o � � v o W w � rA a a = O O N 00 ' 8-4 O a _n M ►n a� v U 04 N ° w U & O.� � � v� CA O a o 84 Ln ep u V cooz b Aa A to >0 ° ad -o a � F1 �1 i i 1 L�1 "q o x 3 � VSO,' C � � cn � 0 12.CU z o a o W 10, 9 o obi z C� s t-) M 00 W iW7 cn b Q a QVftaft (n Cc, Lin tz 1 O� o o - U _ 5 >1wo, o ' z er 04 b a H V A � x a � 0 pZ c � 0 Z oo H h I „ b N V © $ Cvv ,,� U d - A f� UohEv - If -o = ECE9 WE -n) BUILDING DEPARTMENT MAY - IM3 VILLAGE OF RYE BROOK I 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT wwwxyebi-ooLoi-2 INTERIOR BUILDING PERMIT APPLICATION 9/ �.3 NAY 0 4 2023 000Application Fee: S Pennit Fees: Other: Application dated: Y"q LOL ishercbv madcto theStrilding hispcclorof the Village of R%e Brook,NY,for the issuance ol'a Permit Im interior alteration of an exAdng building,or for a change in use.as per detailed state Went jescnblpd bplo%i 13's— ."A ' 2, PA-ur few�p 1. Job Address. SBL Zone: 2. Proposed Improvement. (Describe in detail!: &el qte- b ner- anef; e- _,P ki-fcAem hem 3. Does the proposed improvement involve a Hoine-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: Yes: -A If yes, indicate: TIER 1: TIER If: TIER lll: 4. Will the proposed project require the installation of a new,or an extension/modification ication to an existing automatic fire suppression stein(f ire ANSI_- S%slem FNI- sy -, . 200 ti\,,Icm. TN pk: I llood.c1c x No: Yes: I . 1e 5. Occupancy;(I fam..2 fam.,comm..etc...)Prior to ConstL �' /ten di hO OAfter Constnict I�, ( C( 6. N.Y State Constniction Classification: —N.Y. State Use Classification: 1. Properh-Owner: Address: .2- P1104 7—Cell email: 8. Applicant: Address: Phone# rCC1I# email: 9. Architect: Address: Phone# _Cell# email: 10. Engineer:^ Address: Phone# Cell# email: 1111. General Contractor: —Address: Phone#_ --Cell#_ 12. Estimated cost of construction 1v 13. Job Timetable: Stan: l7 2 7 Fitiish: . 0 8/12/2021 BUILDING DEPARTMENT DECENIED VILLAGE OF RYE BROOK MAY - 1 2023 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK iN-,i" rvehrook.or BUILDING DEPARTMENT xx:t�xxxxxxxxxxxxxxtxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxr.xxxxxxxxxxxxxxxxxxxxxxxxxxxxxtxe:xxxxxxxxxxr::xt.xxt:� AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • STORM SEWERS AND SANITARY SEWERS STATE OF NEW YORK. COUNTY OF WESTCHESTER ) as; I, \10161 L I residing at, 2 WQS f"jW 'y9 being duly swom. deposes and states that(s)he is the applicant above named. and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at: Rve Brook, NY. Further that all statements contained herein are true. and that to the best of his/her knowledge and belief: that there are no known illegal cross-connections concerning either the storm sewer or sanitan- sewer. and further that there are no roof drains, sump pumps, or other prohibited storm�Nater or groundxN ater connections or sources of inflow or infiltration of any kind into the sanitary sever from the subject property in accordance with all State. County and Village Codes. Swom to before me this 1 day of VN,aL-\ 20 01 SHARI MELILLO Notary Public,State of New York No.OIME6160063 Qualified In Westchester County Commission Ezplres January 29,20j:�l 5/12/?0?1 This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety andlor not properly signed shah be deemed null and void and will be returned to the applicant. Please note that application fees are non-refundable. STATE OF NEW YORK, COUNTY OF WESTCHESTER ► as: ,being dull sN%orn.deposes and states that he/she is file applicant above named. (print name of individual signing as the applicant) and further states that (s)hc 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 hereon are true to the best of his/her knowledge and belief,and that anN 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. By signing this application.the property owner further declares that he/she has inspected the subject property,and that to the best of his/her knowledge there are no roof drains, sump pumps or other prohibited stormwater or ground%atcr connections or sources of infiltration into lie sanitary scNN er system on or from the subject property. Sworn to before me this 1 Sworn to before me this day of CA 20 day of . 20 Signature pert) Owner Signature of Applicant y, I NA L I P i� me o P pert w cC r -A Print t aaue of Applicant \otan Public Notary Public SHARI MELILLO Notary Public,state of New York No.OIME6160063 Qualified In Westchester County_ Commission Expires January 29,20 L I� A/12/2021 B DING DEPARTMENT Ri 1, LS� L� � COUNTY LICENSED VILLA GE OF RYE BROOK MAY 10 2023 PLUMBER 938 KING STREET RYE BROOK,NY 10573 REQUIRED TO FILE (914)939-06.o VILLAGE OF R'r"E BROOK / w.r�ebrool:.o t; BUILDING DEPARTMENT FOR 'ICE I SE OVI,I": qg / Approval Date: 2023 Permit 4dr_)3-'060 Application# Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: U y Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: tt //�� Amendment Fee:1(t�,5—Pb Permit Fee: APPLICATION TO AMEND APPROVED PLANS Application dated: Mftis hereby made to the Building Inspector of the Village of Rye Brook,NY,to amend the approved plans associated with an existin open permit,and/or from any prior approvals granted by the approval authority as per detailed statement described below. 1. Job Address: we's-rP,(', . Existing Permit#: 23 —0 2. Parcel ID#: ��kA 1 _ !L/... ��i lone: Original Approval Date: 3. Proposed Amendment(Describe in detail): 2 4. Property Owner: Address: Phone#A 4 -312 _t7t 7 Cell# e-mail Ver! n Applicant: Address: Phone# 1.2 — Cell# e-mail Architect/Engineer: Address: Phone# Cell# e-mail 5. Occupancy; -Fam 2-Fam.,Comm.,etc...)Prior to construction f' �G er construction: 6. Will the pro amendment require the installation of a new,or an extension/ odification to an existin automatic fire suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...)Yes:_No: (if yes,you must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineere p ans) 7. Will the proposed amendment disturb 400 sq.ft.or more of land,or create 400 sq.ft.or m re of impervious coverage requiring a Storm water Management Control Permit as per§217 of Village Code?Yes:_No: Area: t 8/12/2021 8. Will the proposed amendment require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: ,(if yes,you must submit a Site Plan Application,&provide detailed drawings) 9. Will the proposed amendment require a Steep Slopes Permit as per§213 of Village Code Yes: No: K,_(if yes,you must submit a Site Plan Application,&provide a detailed topographical survey) 10. Is the lot located within 100 fi of a Wetland as per§245 of Village Code? Yes: No:—I&(if yes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan) 11. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes: No: (if yes,the area and elevations of the flood plane must be properly depicted on the survey&site plan) 12. Will the proposed amendment require a Tree Removal Permit as per§235 of Village Code?Yes: No:)(_(ifyes,you must submit a Tree Removal Permit Application) 13. Does the proposed amendment involve a Home-Occupation as per§250-38 of Village Code? Yes: No: X,Ifyes,indicate: TIER I: TIER II: TIER III: (if yes,a Home Occupation Permit Application is required) 14. Will the proposed amendment result in additional square footage to the building or subject structure,and if so,provide such additional footage here. 14 (Please submit additional Bulk Regulation Application Pages for review) 15. What is the total added cost of the work associated with the amendment: $ 900 (The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,including any material and labor which may be donated gratis.) 16. N.Y.State Construction Classification: N.Y. State Use Classification: 17. Estimated date of completion: d i l u This application must be properly completed in its entirety by a N.Y. State Registered Architect or N.Y. State Licensed Professional Engineer&signed by those professionals where indicated. It must also include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided.Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void, and will be returned to the applicant. Please note that application fees are non-refundable. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,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 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.By signing this application,the property owner further declares that he/she has inspected the subject property,and that to the best of his/her knowledge there are no roof drains,sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this 00 Sworn to before me this day of , 20 day of ,20 Signature of Pro y Owner Signature of Applicant �- YOA16 L 114 P ' ame of Property Ow r Print Name of Applicant Notary Public Notary Public SHARI MELILLO 2 Notary Public,State of New York No.01ME61-60063 Qualified In W 1a8sterY Co'2 1 Cturtmisslon Expires 8/12/2021 . . p DD BUILDING DEPARTMENT �CCOdEMAY - 12023 VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT www x%ebrook.or INTERIOR BUILDING PERMIT APPLICATION - 14AY U 4- 2023 'cr li 0420Application Fee: — - - - - Permit Fees: -- Other: *�i:�:t:��aat,�:�•:•:::�,:,:•:ttt.x::�:x�:e:ttttt.:ct�a�����x:tttt::text:: :,:rttxsxt:et,:•:•:�::it*xt�:�x:�::�:�::��,:i,:•:•:*�:xxe:i:::ttt.::a:::xi: Application dated: 1M 4 is hereby made to the Building Inspectorof the Village of Rye Brook,NY.for the issuance of a Pernut for tote interior alteration of an exi ng building,or for a change in use.as per detailed stateln��e�b/ed b�. ^ . ;�� ��f I 1. Job Address: ��(// SBvL: /V' ( Zone: ----- --�y--- ------- 2. Proposed Improvement. (U scribe in detail l:�P lq(.2 t0cyLb inC/� *1l _L'o 11�er 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: ___ Yes: �_L If yes,indicate: TIER I: TIER II: TIER III: 4. Will the proposed project require the installation of a new,or an extensionJinodification to an existing automatic fire suppression system(Fire Sprinkler. .ANSL S,,stun. F%1-200 SN steni.T.pe 1 Hood.etc ..1 : No: X Yes: ll 5. Occupancy;(1 fani.,2 fani.,conim..etc...)Prior to Constn c >r OeAftcr Construction/ a m N D U5C 6. N.Y State Construction Classification: N.Y. State Use Classification: _ .7. Property Owner:X?yr G -Z;k- - -- Address: 2- w - Pl„ - Phone# I / - �_-� /2 Cell#- - - - -- email: 8. Applicant: Address: Plione# Cell# email: 9. Architect: Address: Phone# Cell# entail: 10. Engineer: _ _ - Address: Phone# Cell# email: 11. General Contractor: Address: Phone# Cell# email: 12. Estimated cost of constriction 13. Job Timetable: Start: 2 0 2 Fmish: do 2,3 (1) 8/12/2021 BUILDING DEPARTMENT D C V VILLAGE OF RYE BROOK MAY - 1 2023 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK wNw".rvebrook.or,_, BUILDING DEPARTMENT ::�txttix��*�:,,•;Est•;t��,:to:a:::t::r:x*::t::�**x�:*���te:�t*��i:*t�:e*xxt*xix�**tx::zx:::�*t���;::::t���::t�*t�xx��:•;*;;� AFFIDAVIT OF COMPLIANCE VILLAGE CODE &216 - STORM SEWERS AND SANITARY SEWERS STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: 31_ \ ONUI L I q , residing at, 2— 14/9 'f av being duly sworn, deposes and states that(s)he is the applicant aboN a named, and further states that(s)he is the legal owner of the property to which this Affidavit of,pCompliance pertains at. Rye Brook,NY. Further that all statements contained herein are true, and that to the best of his/her knowledge and belief, that there are no known illegal cross-connections concerning either the storm sewer or sanitan- sewer, and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitan, sewer from the subject property in accordance with all State. Count\ and Village Codes. Sworn to before me this 1 day of VN a!, 20 :3 SHARI MELILLO Notary Public,State of New York No.OIME6160063 Qualified In Westchester County Commission Expires January 29,20 - s/ta?o?1 This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owners) of the subject property, and the applicant of record in the sqaaces provided. Any application not properly Completed in its entirety andior not properiy signed shall be deemed null and void and will be returned to the appli{.;ant. Please note that application fees are no n-refundable. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: .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 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. By signing this application,the property owner further declares that he/she has inspected the subject property,and that to the best of his/her knowledge there are no roof drains, sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before nic this 1 Sworn to before ine this day of "CA V\ 20413— day of 20 Si ature drProperty owner Signature of Applicant Ye WA L I :K Pht nic of Property cr pert)*0 n A Print Name of Applicant Notary Public Notary Public SHARI MELILLO Notary Public,State of New YorK No.OIME6160063 Qualified In Westchester County Commission Expires January 29,20Z� 8/12/2021 N N a00 00 M O H a 1--1 N n at ►r W ■I bz a F1 0.0 cz Ln O = U z �' 'n H a o W x o s- �. z o V O Q y A " l U T _ W O w z Lg h +� \� V s eq .� M� CN a w � � � O � w o w o • V a ] o oz s a U w U g F, o 0 p Z o � Cn .a w N V " 0.0 16 v A z A oe N z w W A a � a � U 3D BUILWI , DEPARTMENT AUG - 3 2023 VIL I E OF RYE OOKt4i VILLAGE OF RYE BROOK 938 KIN ET RYE BW ,NY ]0573 BUILDING DEPARTMENT (914)99 I rt 939-5801 Xdro PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: - c- 0& PP#: ,c�3 C�U Approval Date: AUG 0 3 20PVI Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) #################ode### ##### ##################################################################### Application dated, U .�is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/ r res6ove Plumbing as per detailed statement described below. The applicant&property owner,by signing this document agree at said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. 1 1.Addres IjAr 44d6Q_S&7& BL: � '�r�� I Zone:/p0 —/—" IF 2.Proposed Work: = — j 3.Property Owner: r Addres — 6 s��Ny Phone#: / _�7 Cell #: email:y 4.Master Plumber: " — � Address / �' `,5 Ny Lic.#: /Ivt hone Cell#: email Company Nam — .G Addres INDICATE FIXTURES& LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1st Floor 2nd Floor 3`d Floor 4� Floor 5'Floor Exterior 5.* List Other Equipment/Provide Details: /s ,y AS/�AAU GAS (Notarized Signatures Required Next 2 Pages) Aix 4M S J 3/21/19 BUILDJIbjgP-RTMENT Vn,,i 6�o E of RYOK AUG - 3 2023 938 KING �L ET RYE BR�66 NY 10573 (914)9 39-5801 VILLAGE OF RYE BROOK BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT. STATE OVF NEW YORK, COUNTY OF WESTCHESTER ) as: � /' l 3J, 42A 0 L , residing at, li �VPiS�6I e4, CiG� (Print name) (Address where you li ) being duly sworn, deposes and states that (s)he is the applicant above named, and further states that (s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; 2 6'Vl✓�� / 4 , Rye Brook, NY. (.lob Address) Further that all statements contained herein are true, and that to the best of his/her knowledge and belief, that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. (Signature of Property Owner(s)) yal'16 « 4� (Print Name of Property Owmer(s)) Sworn to before me this day of A6U- 5 , 20 (Not ubli MARYEANG Notary Public-State York NO. 01 AN624 Qualified in Westch nt -3- My Commission Expire:: D 3/21/19 hTATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: r GTD /�/ ,being duly sworn,deposes and states thatgshe 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( is the G0 NT"C!TG ee— 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. .'10 Sworn to before me this ' Sworn to before me this day o Q4 20,RJ_ day of&6asr20 2?,3 !� ry Signature of Property Owner Signature of Applicant J /orII� / % q V 6 4-6 2-f�—J .S f.-w-4 R Print Name of Property Owner Print Name of Applicant Notary 1' ARY E AN ANO MARY E ANGARANO Notary Public-State of New York Notary Public-State of New D NO. 01 AN6246783 NO. 01 AN6246783 Qualified in Westchest r County Qualified in Westchester Cou My Commission Expire My Commission Expire This application must o nd must ' e the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- 3/21/19 Building Permit Che�ck1 List&Zoning Anal sis Address: WC5NC ` '�l CT C SBL: �_�ILA 1 Zone a Const.Type: N Other. Submittal Date: �� (,2 f�11-�7 Revisions Submittal Dates: Applicant: ` V L i- V Nature of Work: AZy 1 or NQ Ccbin e 5 co-x Ana--s Reviews:ZBA: MAY 0 4 2023 PB: BOT• Other. NEE_Q QK 0 FEES:Filing. BP: \v' olfC/O: Flood Plane: Legalization: O ( 1)�,APP: Dated: Notarized:_ SBL: Truss I.D. Cross Connection: H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm 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: fdther. ( ) (k,} icense: Workers Comp: Liability: Comp.Waiver. 77 Other. ( ) ( ) CODE 753#: Dated: N/A: ( y ( ) 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. (Vf ( ) 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. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other. ( ) ( ) Other. ( )ARB mtg.date: approval• notes: ( )ZBA mtg.date: approval: notes: ( )PB mtg.date: approval:- notes: APPROVED REQUIRED EXISTING PROPOSED NOTES Arca: Dalm MAY 0 4 2023 Cir : Frontag Front sda 1=� &W. Main Cov Accs.Cov Ft.H/Sb: Sd,HTat,Imp SEA: Ft Imp P n • Hight/Stories: notes: Amended House & Home Policy Declarations WAllstate . Your policy effective date is July 8,2022 Page 1 of 4 Total Premium for the Policy Period Information as of April 14,2023 Premium for property insured $4,305.14 Summary Total $4,305.14 Named Insured(s) Yong Liu, %,aopan Long • Workers'Compensation And Employers'Liability Coverage For Residence Employees Mailing address Coverage Form Included in Total Policy Premium 2 Westerleigh Ct Purchase NY 10577-2520 Discounts (included in your total premium) Polic number Protective Device $213.63 Renewal $454.19 978 595 473 Multiple Policy $2,007.17 Claim Free $119.14 Your policy provided by Allstate Easy Pay Plan $215.16 Allstate Vehicle and Property Total discount savings $3 009.29 Insurance Company A Stock Company 2775 Sanders Road Northbrook,IL 60062 Insured property details* Policy period Please review and verify the information regarding your insured property.Please Beginning July 8,2022 through July 8, refer to the Important Notice(X73182-1)for additional coverage information. 2023 at 12:01 a.m.standard time Contact us if you have any changes. Your Allstate agency is Location of property insured: 2 Westerleigh Ct,Purchase,NY 10577-2520 Richard McKenna Agy 100 Plandome Rd Location zone: NY0577 Manhasset NY 11030-2325 Your location zone is based on the location of the insured property and is one of many (516)621-5700 factors used in determining your rate. rmckenna2(L�allstate.com Dwelling Style: Some or all of the information on your Built in 1986;1 family;3600 sq.ft.;colonial-2 stories Policy Declarations is used in the rating Foundation: of your policy or it could affect your Below grade basement,100% eligibility for certain coverages.Please Interior details: notify us immediately if you believe One builders grade kitchen One single fireplace that any information on your Policy Three builders grade full baths One softwood straight staircase Declarations is incorrect.We will make One builders grade half bath corrections once you have notified us, and any resulting rate adjustments,will Exterior wall type: be made only for the current policy 100%vinyl siding period or for future policy periods. Interior wall partition: Please also notify us immediately if you 100%drywall believe any coverages are not listed or Heating and cooling: are inaccurately listed. Gas heating,100% Central air-same ducts,100% Additional details: (continued) o Q 0 0 r z Amended House&Home Polic Declarations Page 2 of 4 Policy number: 1978 595 473 Policy effective date: July 8,2022 Insured property details*(continued) Standard wood sash with glass,100% Interior wall height-8 ft,100% Two exterior wood doors Laminated windows-no Fire protection details: Fire department subscription-no 2 miles to fire department Roof surface material type: Composition 100%asphalt/fiberglass shingle .................................................................................................................................................-. :Roof details: :Predominant roof type:Composition Age of roof-3 years :Roof geometry-Gable :Metal Roof Surfaces Cosmetic Damage Exclusion: ;Your policy does not provide coverage for cosmetic damage(damage that only changes :the appearance of your roof)caused by hail to a metal roof surface. ••..................................................................................................................................................... Mortgagee-None Additional Interested Party-None *This is a partial list of property details.If the interior of your property includes custom construction,finishes,buildup,specialties or systems,please contact your Allstate representative for a complete description of additional property details. Coverage detail for the property insured Coverage Limits of Liability Applicable Deductible(s) Dwelling Protection $1,300,000 - Hurricane Deductible Applies- - $5,000 All other perils Other Structures Protection $130,000 - Hurricane Deductible Applies- -$5,000 All other perils Personal Property Protection $975,000 - Hurricane Deductible Applies- -$5,000 All other perils a Additional Living Expense Up to 24 months not to exceed$325,000 0 — - o Family Liability Protection $1,000,000 each occurrence 'z Guest Medical Protection $1,000 each person Building Codes Not purchased* Building Structure Reimbursement Not purchased* Extended Limits 0 Water Back-Up Not purchased* o Optional Protection for Mold Not purchased* - No Workers'Compensation and Included Employers'Liability Coverage for See Form S Residence Employees Q 9 a, 0 0 v O n m N �O O Z ��O O�� O O O N a Amended House&Home Polic Declarations Policy number: 978 595 473 Policy effective date: July 8,2022 Page 3 of 4 WAllstate, ► Other Coverages Not Purchased: •Additional Fire Department •Extended Coverage on Sports • Increased Coverage on Business Charges* Equipment* Property* •Building Materials Theft* •Extended Premises* • Increased Coverage on Theft of •Dwelling in the Course of •Fair Rental Income* Silverware* Construction* •Functional Replacement Cost* •Loss Assessments' •Electronic Data Recovery* •Golf Cart* •Optional Protection for Mold* •Extended Coverage on Cameras* •Green Improvement* •Secondary Residence* •Extended Coverage on Jewelry, •Home Day Care* •Select Value* Watches and Furs* • Identity Theft Expenses* •Service Lines* •Extended Coverage on Musical •Yard and Garden* Instruments* *This coverage can provide you with valuable protection.To help you stay current with your insurance needs,contact your agent to discuss available coverage options and other products and services that can help protect you. **$65,000(S%of your Dwelling Protection-Coverage A Limit of Liability)is your hurricane deductible amount,which applies to the total of all losses under the coverages indicated above. Scheduled Personal Property Coverage Your policy does not include Scheduled Personal Property Coverage.This coverage can provide you with valuable protection.To help you stay current with your insurance needs,contact your agent to discuss available coverage options and other products and services that can help protect you. Your policy documents Your House&Home policy consists of the Policy Declarations,any Policy Declarations Addendum,and the following documents. Please keep them together. • AVPIC House&Home Policy-AVP117-1 • Metal Roof Surfaces Cosmetic Damage Exclusion Endorsement-AVP172 • Amendatory Endorsement-AVP381 • New York Amendatory Endorsement-AVP342 • New York Hurricane Deductible Endorsement-AVP114-1 • NY Workers'Compensation and Employers'Liability Coverage For Residence Employees Coverage Form- AV P106-1 • Depreciation Amendatory Endorsement-AP4991 • New York Declarations Supplement Page-AVP107 Important payment and coverage information Here is some additional,helpful information related to your coverage and paying your bill: ► The Property Insurance Adjustment condition applies using the Marshall Swift Boeckh Publications building cost index. ► Please note:This is not a request for payment.Any adjustments to your premium will be reflected on your next scheduled bill which will be mailed separately. In the meantime,if you have any outstanding or unpaid bills,please pay at least the minimum amount due to assure your policy continues in force.If you have any questions,please contact your agent. a 0 n 0 z g,�xx Amended House&Home Policy Declarations Page 4 of 4 Policy number: 1978 595 473 Policy effective date: July 8,2022 Allstate Vehicle and Property Insurance Company's Secretary and President have signed this policy with legal authority at Northbrook, Illinois. William Hill Susan L.Lees President Secretary 0 Q 0 n O } Z O O • O O O r+ O O m T O O O Q m rn m 0 O V O n N O,CO ON 0 o m nn0 O V� O O C.cc Policy Endorsement (QlAflstater� Policy number: 978 595 473 Page 1 of 1 Policy effective date: July 8,2022 The following endorsement changes your policy. Please read this document carefully and keep it with your policy. Metal Roof Surfaces Cosmetic Damage Exclusion Endorsement -AVP172 In Section I—Your Property,under Losses We Do Not Cover Under Coverages A and B,the following item is added to paragraph D: Cosmetic damage caused by hail to the surface of a metal roof,including but not limited to,indentations,dents,distortions,scratches,or marks, that change the appearance of the surface of a metal roof . This exclusion applies to all of the components of the surface of a metal roof,including but not limited to,panels,shingles,flashing,caps,vents, drip edges,finials,eave and gable trim and snow guards, coatings and other finishing materials. We will not apply this exclusion to sudden and accidental direct physical damage to the surface of a metal roof caused by hail that results in water leaking through the surface of a metal roof or that compromises the ability of the surface of a metal roof to shed water. All other policy terms and conditions apply. Y� 'S Important notices Page 1 of 1 Policy number: 978 595 473 Policy effective date: July 8,2022 Your Estimated Home Replacement Cost home's characteristics is provided in the"Insured property details"section of your Policy Declarations. Allstate has determined that the estimated cost to replace Please note:Your Dwelling information is used to estimate your home is:$1,034,179. your home replacement cost.It's important to review and We based your estimated cost on information provided by you update this information so we're using the most accurate and selected data that was available to us,which is described details to estimate your home's replacement value. in the"Insured property details"section of your Policy If the information about your home shown in your Policy Declarations.Please review all the information in this section Declarations requires any change or if you have any questions to ensure the accuracy of the information used to determine or concerns about the information contained in this Important the estimated replacement cost of your home. Notice,please contact your Allstate representative,or call us The enclosed Policy Declarations shows the limit of liability at 1-800-ALLSTATE. applicable to Dwelling Protection-Coverage A of your homeowners insurance policy.The estimated replacement X73182-1 cost of your home is the minimum amount for which we will insure your home. The decision regarding the limit applicable to your Dwelling We Have Changed Your Policy Protection-Coverage A is your decision to make,as long as,at a minimum,your limit equals the estimated replacement cost We have some good news.Because we recently recovered as determined by Allstate and does not exceed maximum some or all of the damages we paid on a prior claim,we have coverage limitations established by Allstate. adjusted your premium.Enclosed you will find Amended Policy It is important to keep in mind that your Coverage A limits Declarations that reflects this change. reflect a replacement cost that is only an estimate based on Please read your new Policy Declarations carefully,and note data that was available to us when we made this estimate(this that your premium may have changed. For more detailed information is described in the"Insured property details" information regarding your policy change and the effect it may section of your Policy Declarations).The actual amount it will have had on your premium,please contact your Allstate cost to replace your home cannot be known until after a representative. covered total loss has occurred.Please keep in mind that we do X73183 not guarantee the adequacy of the estimate to cover any future loss(es). How Is the Replacement Cost Estimated? Many factors can affect the cost to replace your home, including its age,size,and type of construction. For example, the replacement cost uses construction data,such as labor and materials,that are available to us when we made this estimate. This estimate is also based on characteristics of the home, which include information that you provided to us.You might have chosen to insure your home for a higher amount than the estimated replacement cost shown above. Note to Customers Renewing Their Policy o The estimated replacement cost for your home may have o changed since the last time we communicated this information o to you.This is because,at renewal,Allstate uses the home 9 10 characteristics that you have provided to us to recalculate and S update the estimated replacement cost.Using updated labor a and material rates for your zip code,Allstate takes the home characteristics you have provided and determines the updated m estimated replacement cost.The information about your a 0 C m co N �N O O O m ��O O V 0 ,0 ry a Affidavit of Exemption to Show Specific Proof of Workers' Compensation Insurance Coverage for a 1, 2, 3 or 4 Family, Owner-occupied Residence **This form cannot be used to waive the workers'compensation rights or obligations of any party.** Under penalty of perjury, I certify that I am the owner of the 1, 2, 3 or 4 family, owner-occupied residence (including condominiums) listed on the building permit that I am applying for, and I am not required to show specific proof of workers' compensation insurance coverage for such residence because (please check the appropriate box): KI am performing all the work for which the building permit was issued. ❑ I am not hiring,paying or compensating in any way,the individual(s)that is(are)performing all the work for which the building permit was issued or helping me perform such work. I have a homeowners insurance policy that is currently in effect and covers the property listed on the attached building permit AND am hiring or paying individuals a total of less than 40 hours per week (aggregate hours for all paid individuals on the jobsite) for which the building permit was issued. I also agree to either: ♦ acquire appropriate workers' compensation coverage and provide appropriate proof of that coverage on forms approved by the Chair of the NYS Workers' Compensation Board to the government entity issuing the building permit if I need to hire or pay individuals a total of 40 hours or more per week(aggregate hours for all paid individuals on the jobsite)for work indicated on the building permit,or if appropriate,file a CE- 200 exemption form; OR ♦ have the general contractor, performing the work on the 1, 2, 3 or 4 family, owner-occupied residence (including condominiums) listed on the building permit that I am applying for,provide appropriate proof of workers' compensation coverage or proof of exemption from that coverage on forms approved by the Chair of the NYS Workers' Compensation Board to the government entity issuing the building permit if the project takes a total of 40 hours or more per week(aggregate hours for all paid individuals on the jobsite)for work indicated on the building permit. (Signature of Homeowner) (Date Signed) Y®/I/C1► L I Home Telephone Number (Homeowner's Name Pri ted) f Sworn to before me this _ `_ day of Property Address that requires the building permit: JCL dL(7 a 3 _ o) • Anlo nt lerk or Not�Rublic ---- • y c y ) /9Ve 9`a0k, A)y /0-5 73 SHARI MEULLO Notary Public,State of New York No.OIME6160063 Qualified In Westchester county Commission Expires January 29,202;7 Once notarized,this BP-1 form serves as an exemption for both workers'compensation and disability benefits insurance coverage. BP-1 (12/08) NY-WCB