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HomeMy WebLinkAboutBP23-080PERMIT # SECTION /8� TYPE OF WORK JOB LOCATION CONTRALTO �3- OYC 'r I ri v ��37l0-01O34/ EST. COST �[ FEE ✓CO # FEES,& c��5�iDA `I TCO # FEE DATE INSPECTION RECORD E FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING O RGH PLUMBING GAS O SPRINKLER ELECTRIC 0 LOW -VOLT 0 ALARM C] AS BUILT O FINAL OTHER APPROVALS ARB BOT PB ZBA -- OTHER -r-- 6R(�v�. ur cc4.t° C U yu� Q V iGGi Vu W V V�J ' 19f3 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.tyebrookny.gov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE November 26,2024 Eric Gioseffi&Jacqueline Gioseffi 30 Lawridge Drive Rye Brook,New York 10573 Re: 30 Lawridge Drive, Rye Brook,New York 10573 Parcel ID#: 129.67-1-54 Building Permit#23-080 issued on 6/13/2023 to Repair&Waterproof Foundation This certifies that the repair and waterproofing of foundation,under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building& Fire Inspector /to ��33R\ For office use only: ----- BUILD 7 E TMENT PERMIT# c53-1 o JUG N 12 2024 1 1 VILLAGE OF RYE BROOK ISSUED: elo--/3 Q>3 p pp E! 938 KING STREET,RYE BROOK,NEW YORK 10573 DATE: 4j-- `Q—,D q VILLAGE OF RYE BROOK (914)93P-0668 FEE: A c) PAIDM BUILDING DEPARTMENT www.ryrookny.gov APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCES AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION t*tt*ststtstrtsttstt*ststsssssr*s**s**s*rsrsrrsssssssssessss*ssssssssresssrsssrsrsssssssssssrtsrssssttrsssssrrs*srssssrrsr*ss Address: Occupancy/Use: 14fY Parcel ID#: I Z 1.6 —<—s Zone: (C— Owner: � 14o5C�i Address: 3D 62,wd 9e D/.- Ny/e P.E./R.A. or Contractor: ►-�4ji fi,c��r'exe4t. AQ,,% Address: r_-b&yc ?3 6&AW Person in responsible charge: S_, Ry Address: ?D 3px %0 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: rll�_ Graa�/ i being duly swom,deposes and says that he/she resides at FO 4a•wn64C ar.. (Print Name of Applicant) .and Street) in (?yr< BebdL ,in the County o Gllr in the State of PV,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 2 have been donated gratis was:S J,&_-)o , for the construction or alteration of: /7ll�t,% I'�!r .AFW /ltcri 4.4t2 e"-ifS, r ��i��+�• 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 � � , 20 01-A day of 920 tgnature dfPropeg&owner Signature of Applicant P e of Property Owner Print Name of Applicant AX Notary Public Notary Public Notary Public,State of New York No.01ME6160063 Qualified in Westchester County Commission Expires January 29,2021 �yE BRCv�. 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 : L iit b'j r t � Q J21Y DATE: I�� PERMIT# Z2 O 0 ISSUED: " SECTJZI .C-) BLOCK: � LOT: LOCATION: 0 i h J OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING J2'.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 Q FINAL ❑ OTHER �yE BRC��. O� tim '9a2 BUILDING DEPARTMENT BUILDING INSPECTOR Al 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: r ` PERMIT#—4 j IS UE : 1 f I -SECT: BLOCK: LOT: LOCATION: `. C71 OCCUPANCY: ❑ Violation Noted THE WORK IS... J ' PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION ' s` REQUIRED ❑ FOOTING ❑y FOOTING DRAINAGE 1 FOUNDATION [,UNDERGROUND PLL$411i)1G� NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL Village of Rye Brook Public Works and Engineering Department 938 KING STREET•RYE BROOK,NY 10573 1982'� (914)939-0753 FAx(914)939-0242 INSPECTION REPORT Address: Date: Name:�)"'� d � i Location: 'O Ile f�� 0 Permit#: Phone: Email: Work being Inspected: Work Inspected is: Accepted.,' Rejected Re-Inspection Required Violation Noted Code Section Code Section: Action Taken Code Section: Action Taken 118 Erosion Sediment Pass Fail Violation 210 Storm Water Pass Fail Violation 135 Refuse Pass Fail Violation 215 Street Sidewalk Pass Fail Violation 213 Steep Slopes Pass Fail Violation 235 Trees Pass Fail Violation 216 Illicit Discharge Pass Fail Violation 245 Wetlands Pass Fail Violation Other: Pass Fail Violation Notes: Diagram: Signature QyE BRCv'�. O�` tim cu � 1 �i' 1982• BUILDING DEPARTMENT UILDING 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 - - - - - - - - - - - uj c6 ADDRESS :— ATE. PERMIT# ISSUED: 431-'�-�CT:JE t `� BLOCK: ! LOT: LOCATION: 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 ���� CJ\ � (� ,�� ✓��� ❑ Natural Gas ❑ L.P. Gas c�' �� �L ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ui n;c'�\00 r C ` y �N�� ^ t� -16 ❑ CROSS CONNECTION �1 1 ❑ FINAL ❑ OTHER : r r ■ � r 0 M N w r CD O .b N N v e E r. O ` w a W Z " o V. wrZo o. p = _ W : u 4 � eh 1•-I a � v � ,� � W ao � : Vr M O •d o : v r C ai 4J Ln ` H 1 -1 F all ■ co =e■ �WrT"'1 A�7 h� � a �C"�`� �ww \O�1 VWwwow? VW Ma- H�z Fvva w0u vtgy o�� aAi w T Q v p UO �w `"G (> aC Z O rr v ■ �--i i � � �-r M W I v 0 cr v 00 ob w tV ca > v ^ 0 O zz -d o uo r �" a? UO v l o .o .� pp v v w v v tZ I--� Q U W U U o o ° ■ 3 V 0 V ° 0 `� � cn 0 Z O �1 M A W Z .. a o W W = v av f 1 pI"dvLO BUILD TMENT L� I�urr� uv3 � �tr Viz , r'Cii oox S�� �to p [EC� C�W h `N toS � 938 RING tT BR. ,NY 10573 MAY 2 2 2023 _ �nS , 9ga2 ' VILLAGE OF RYE BROOK Cdd Pa'l � et BUILDING DEPARTMENT 001 ADMINISTRATIVE RIOR BUILDING PERMIT APPLI FOR EXTERIOR WORK WHICH DOES NOT REQUIRE VILLAGE ARCHITECTURAL REVIEW BOARD APPROVAL FOR OFFICE USE ONLY: y q APPROVAL DATE. J UN 0 i 20 ERMIT#&;)3_0 9 APPLICATION FEE: -75vj ' APPROVAL SIGNATURE: PERMIT FEES:A3002 b0E_ __ H.Q.A.APPROVAL: DATE: DISAPPROVED: OTHER: Application dated: is hereby made to the Building Inspector of the Village ofRye Brook,NY,for the issuance ofa Permit for the construction of building ,structures,additions,alterations or for a change in use,as per detailed statement described below. 1. JobAddress: S d C/ r..I'1JSG 94wo— o An�o _ Air L<?l 2. Parcel ID#: 2 �. Zone: te4-S n ' 3. Proposed Improvement(Describe in detail): /X'"k4lk_ !��.i/t�'` e• 9 ` VL'- daA A �b �-► k ! v a ci Jr�. 4. Property Owner: , ,/ l9 ' Address: 30 ZA&Ar, Qr &-t "t ,vt/ /°rr 3 Phone# Cell# ( 3L; -}'QfCo e-mail y� corK List All Other Properties Owned in Rye Brook:A Applicant: Address: Phone# Cell# e-mail Architect: Address: Phone# Cell# e-mail Engineer: Address: Phone# 1 Cell# e-mail General Contractor: l'�;�� 7-" Cam/ (A d-�CuAhan VA 4— Z 'Ti i*61/ Gi/,o✓3d' Address: Pig &'�c 3 �Cit�ILUns Imo' / Z ` Phone# Cell# (�YS� 3 - p(!w e-mail ,S' Pc Lj& it = WG- 5S"7-7-t - l+s'Z.. (1) 8/12/2021 5. Occupancy;(I-Fam.,2-Fam.,Commercial.,etc,..)Pre-construction: I-Fl" Post-construction: ` 6. Area of lot: Square feet: Acres: 7. Dimensions from proposed building or structure to lot lines: front yard: rear yard: right side yard: Ieft side yard: other: 8. If building is located on a comer lot,which street does it front on: 9. Area of proposed building in square feet: Basement: 1"fl: 2"fl: 3rd fl: 10. Total Square Footage of the proposed new construction: 11. For additions,total square footage added:Basement: 11,fl: 2nd fl: 3'fl: 12, Total Square Footage of the proposed renovation to the existing structure: 13. N.Y.State Construction Classification: N.Y. State Use Classification: 14. Construction Type&Location:O Typical Western Lumber Frame;O Timber Frame[TC];O Wood Truss[TT]; O Pre-engineered wood[PW];Located;O Floor Framing[F];O Roof Framing[R];O Floor&Roof Framing[FR];Other: 15. Number of stories: Overall Height: Median Height: 16. Basement to be full,or partial: finished or unfinished: 17. What material is the exterior finish: 18. Roof style;peaked,hip,mansard,shed,etc: Roofing material: 19. What system of heating: 20. If private sewage disposal is necessary,approval by the Westchester County Health Department must be submitted with this application. 21. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...)Yes:_No:„/' (if yes,applicant must submit a separate Automatic Fire Suppression System Permit application&2 sets of detatled engineered plans) 22. WiII the proposed project disturb 400 sq.ft. or more of land,or create 400 sq.ft.or more of impervious coverage requiring a Stormwater Management Control Permit as per§217 of Village Code? Yes:_No:j/ Area: 23. Will the proposed project require a Site PIan Review by the Village Planning Board as per§209 of Village Code? Yes: No: (if yes,applicant must submit a Site Plan Application,&provide detailed drawings) 24. Will the proposed project require a Steep Slopes Permit as per§213 of Village Code Yes: No: (if yes,you must submit a Site Plan Application,&provide a detailed topographical survey) 25. Is the lot located within 100 ft.of a Wetland as per§245 of Village Code? Yes: No:y (if yes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan) 26, 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) 27. Will the proposed project require a Tree Removal Permit as per§235 of Village Code?Yes: No: (f yes,applicant must submit a Tree Removal Permit Application) 28. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No: Indicate:TIER I: TIER II: TIER III: (if yes,a Home Occupation Permit Application is required) 29. What is the total estimated cost of construction: $_ f/I gFt90 Note:estimated cost shall include all site improvements, labor,material,scaffolding,fixed equipment,professional fees,including any material and labor which may be donated gratis.If the final cost exceeds the estimated cost,an additional fee will be required prior to issuance of the CIO. 30. Estimated date of completion: (2) 8n2/2o2i BUILD f �� MENT D IE C IE F Y I VIL I E OF RY ` OOK MAY 2 2 20231 DD 938 KING ET RYE BR ,NY 10573 `f 4 -0 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 PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: residing at, 3 r- Op eNC J/aoE A f kq"- (Print name) L ('Add ss where you live 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; & 3 , Rye Brook,NY. (Job Addre.s,) 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. (Signs ) Property 046er(s)) ���C3�' (Print Namc of Property Owner(s)) Sworn to before me this i da of'C`r� 0. , 20 (Notary Public) SHARI MEULLO Notary Public,State of New York No.01ME6160063 Qualified In YWestehester County (3) Commission Expires January 29,20 8/12/2021 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. ST4,T'E OF NEW YO C,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 Z Sworn to before me this day of LD , 20 day of , 20 Signatu of Vedy / Owner �/] Signature of Applicant Iry V 054 •, Print Name of Property Owner Print Name of Applicant No ary Public Notary Public SHARI MEULLO Notary Public,State of New York No.o1ME6160063 Qualified In Westchester County Commission Expires January 29,2020 (4) 8/12/2021 JMER Engineering, P.C. 55 Park Ave — I" Floor, Ossining, NY 10562 Tel: 914-255-5780 IE ENGINEERING REPORT: R (� L�SEP - 1 2023 S To: Eric&Jacqueline Gioseffi From: Jonathan Merheb, P.E. 11 VILLAGE OF RYE BROOK Date: September 1, 2023 BUILDING DEPARTMENT Re: Foundation Inspection 30 Lawridge Dr Rye Brook, NY 10573 As per your request, an inspection of the foundation was performed for the property located at 30 Lawridge Dr, Rye Brook, NY on August 31, 2023. The purpose of the inspection was to check the structural stability of the existing CMU wall on concrete footing foundation due to concern from the home owners that the CMU had appeared damaged. Upon visual inspection it appeared that portions of the CMU have deteriorated over years of exposure to water and moisture. The structural integrity of the CMU wall is compromised and in need of repair. The concrete footing below the CMU wall appears to be in satisfactory condition. Summary of Issue(s): 1. The lowest course of CMU is completely deteriorated on the outer face and compromises the structural integrity of the foundation. 2. There are areas on the upper portion of the CMU which also are slightly deteriorated. 1 moot o r �T. Photo Overall • the subjectfoundation. Photo 2: Left portion of deteriorated CIVIL)foundation wall. 1 2'X a ? yf }h MOW 71. •'�' 2 � - ' i L • v t� y�� .j,:. M , '. !• .� ref-x MaYI9 )ii' "'* a• .,, rot 'l��t�C�"-{sa �. ��.� 1 +E-..,: � 'iC `- �: i -�• wry 1°^v�,..4 :i'- . .,�?� a�._:,.j�tl may'"' �'-'"'y •e• --+. Ott k s t+ ; )56 Photo 5:Zoomed in view of lower course of CMU completely deteriorated on outer face. y�`��. - .. 'ia. •��\ ..a i 4 < �.'t 9'.' .�.. '4 L� .. ♦ti . j 1 Y� �*�a'Y_•t - yr -- '+• "-1 a, Photo 6:Zoomed in view of slightly deteriorated CMU at upper portion of the foundation wall. 4 L +. 1rti yt z, r5, . . ;,. 3 �g 40 ? `• C t,tNN '���\i�a-... - _• Ili _ 14- ..;.. - ... - .t Photo 7:Zoomed in view of slightly deteriorated CMU at upper portion of the foundation wall. 5 Summary of Repair(s): 1. The lowest course of CMU shall be completely removed and replaced in kind. The CMU shall be removed in sections no more than 2 full block lengths at one time. All existing CMU surrounding the removed sections shall be cleaned prior to installing the new CMU. If during the removal & replacement of the lowest course of CMU it is found that additional CMU above is also deteriorated, then that shall also be removed and replaced in kind. 2. The slightly deteriorated CMU located in the upper portion of the foundation wall shall be grouted solid and patched. r Upper area appears to "averteen,exposed to mot �'.. r If addition,{ deteriora is found, remove and rep ' additional b opk in kin � it •}t+ 1 o -of .0 Photo 8: Lowest course of CMU to be removed & replaced in kind. Any additional CMU that is found to be deteriorated during repairs shall also be removed & replaced in kind. 6 -yam_ • a fir, t ? �, +� y �"' ����'�' �'M.'(' Alt � \. i. Lt 1.rL �- ..� �% •� ,If'n� T��'N W1iT.Y / � \.. '�1M- r. gyp,, • 4r c e T r 4 *See note on Photo 10 L�. ._rt __ d. C. - .�.r'.M'.Y1iiC�A4e�`FS: r> • a.:r� . �;,..ti =..,•� 'y �•.`. Photo 11: Lowest course of CMU to be removed & replaced in kind. Any additional CMU that is found to be deteriorated during repairs shall also be removed & replaced in kind. +:x= !`{� y '� ;�� 'x�,Lh.+p "�Yr� �t'4 ��• � tiT�.r�. � z 71.:7"V�P. �F, ,� '#-�••. •�.�Yip �.� h , Y M ��. *See note on ,Y �. t, _ � '.x� _:;� ,�• we+ + ..� r� I Photo 10 11. a•3 �f. a.. 1.:. 1• Photo 12: Lowest course of CMU to be removed & replaced in kind. Any additional CMU that is found to be deteriorated during repairs shall also be removed & replaced in kind. 8 r It Photo 13: Lowest course of CMU to be removed& replaced in kind. Any additional CMU that is found to be deteriorated during repairs shall also be removed & replaced in kind. Ml�i illm w n. ' 8i La Photo 14: Lowest course of CMU to be removed & replaced in kind. Any additional CMU that is found to be deteriorated during repairs shall also be removed & replaced in kind. 9 Clean out hole and all loose CMU material. Grout the hole solid and patch face of deteriorated CMU. �m. �� •,-rl.!4R.Y.r1o`�,aYQ.. , � �,T�'��N.a+iii' _� 1 � -. y� :ate � y,.:i�v�yi>t'..il� ."�,<t• t�"'' ,. Photo 15:Slightly deteriorated CMU at upper portion of foundation wall to be fully grouted and patched `fit°.�3�_ + 'L.a .� ,�a•1.,.'Y�x ''_' i �' `i �'�i �'`��' ,�` �L��'ri. U h,�q,'� L^e4 ti .�'t �'t�l�►'�. tw ,� �. r`a ;,,� � F v. L1 Photo 16:Slightly deteriorated CMU at upper portion of foundation wall to be fully grouted and patched. 10 Any other areas of deterioration not specifically mentioned in this report shall also be repaired. Upon completion of foundation repairs, footing drains shall be installed, and the foundation shall be properly waterproofed and backfilled. If further damage is found which appears to be more severe than what is summarized in this report, please contact the engineer immediately. Respectfully, F NEwrO r I � n 2 �'J'FpA 097186 SIONP� Jonathan Merheb, P.E. NY PE#097186 11 I•. r r 1, - '1 •. / � � r)/ Sty !� - `/-' /�1 7{(�`f}`f � '�(' it f• lD �i y � ., � T to-l' �t <- ;'���• i re- —^t•/ ./ ���- � 1, rip,v ' 0w , �ooi��ollllll�lll� _ , A1 1 EFF�/�X�°//�/ /jl/Aj//A1A1AI"F� ♦ � ♦ ✓i rr �/nl•/'/1 1'I�Ijlllili'i'ell`..1" ski ; A, . -- e/Aee� t r � cf it f, i i 3 tea! 1 f o �w w ► Q m +sir —IN cp dut as ol: �1 ... O. .. . y { pop 'l X y % . w r � �r 72 A��® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 05/24/2023 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 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 CONTACT HOUSEACCOUNT NAME: Polly Insurance Agency,LLC aoNN Ext (845)896-4700 Fa,No 1134 Main St E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Fishkill NY 12524 INSURERA: MaxumldemmnityCompany INSURED INSURER B High Tech Concrete And Excavation Inc. INSURER c: PO Box 703 INSURER D INSURER E Glenham NY 12527 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2352423352 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 CONTRACTOR 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 A 04047808-1 09/16/2022 09/16/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X PRO POLICY 1,000,000 JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident N $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB Ll CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Job for Eric Gioseffi 30 Lawridge Drive,Rye Brook,NY 10573 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN VILLAGE OF RYE BROOK BUILDING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS. 938 KING ST 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 fil roRc 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 rights or obligations of any party.** 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 High Tech Concrete&Excavation Inc.10 Old Glenham Rd From Village of Rye Brook Glenham,NY 12527 PHONE:845-216-7769 FEIN:XXXXXI732 The location of where work will be performed is 30 Lawridge Drive,Rye Brook,NY 12527. Estimated dates necessary to complete work associated with the building permit are tcom May 24,2023 to July 30,2023. The estimated dollar amount of project is $10,001-$25,000 Workers'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 one person owned corporation,with that individual owning all of the stock and holding all offices of the corporation. Other than the corporate owner,there are no employees,day labor,leased employees,borrowed employees,part-time employees,other stockholders,unpaid volunteers(including family members)or subcontractors. 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: 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,James Lyons,am the President with the above-named 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 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 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 and/or disability and paid family leave benefits coverage and also immediately furnish proof of that coverage on forms approved by the Chair of the Workers'Compensation Board to the government entity listed above. SIGN HERE 6! Signature: Date: �L�/ve 2-2 .— Exemption Certi ate Number Rec d 2023-037639 May 24, 2023 NYS Workers'Compensation Board CE-200 01/2018 Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Tuesday, June 13, 2023 12:52 PM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 06/13/2023 12:51 To: VIL RYE BROOK PRIMARY Transmitted: 06/13/2023 12:52 00005 Ticket: 06133-001-733-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 30 To: Name: LAWRIDGE DR Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: WORKING ON THE RIGHT SIDE, LEFT SIDE AND BACK OF THE PROPERTY NearSt: SLEEPY HOLLOW RD & PARKWOOD PL Means of Excavation: SMALL EXCAVATOR Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: Y Work Type: DRAINAGE Estimated Work Complete Date: 06/21/2023 Depth of excavation: 8 FEET Site dimensions: Length 140 FEET Width 4 FEET Start Date and Time: 06/21/2023 07:00 Must Start By: 07/06/2023 ------------------------------------------------------------------------------ Contact Name: DONNA LYONS Company: HIGH TECH CONCRETE & EXCAVATION INC Addrl: PO BOX 703 Addr2: City: GLENHAM State: NY Zip: 12527 Phone: 845-216-7769 Fax: Email: suglyons@icloud.com Field Contact: JIM LYONS Alt Phone: 845-376-0634 Working for: ERIC GIOSESFI ------------------------------------------------------------------------------ Comments: Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA CONED SUEZ WTR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR i