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HomeMy WebLinkAboutBP23-094PERMIT # / Z " 074 SECTION c� TYPE OF WORK / I 10B LOCATIDN I �� nIE CONTRACTORS/�.SCl7 T EST. COST v /C0 # TCO # FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS M SPRINKLER ELECTRIC 0 LOW -VOLT C� ALARM AS BUILT FINAL 46,.� 7U" �B FEE su LLO '/L"2 FEE DATE INSPECTION RECORD DATE INSP q/ 7)S75 & *6 �. LLC-,61eucv �%rs�� L��S)3a - 3 OTHER APPROVALS � / ARB `I u 2s d/ BOT Pa ZBA OTHER 3-BUILTiFINAL SURVEY REQUIRED PRIOR TO FINAL INSPECTION twJJV BR Vr CC4CLC J J Q V L�V V�Jv VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J.Bradbury www.ryebrook.org TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE December 11,2023 Brian Balanoff&Jamie Balanoff 1 Maplewood Lane Rye Brook,New York 10573 Re: 1 Maplewood Lane, Rye Brook,New York 10573 Parcel ID#: 136.22-1-16 Building Permit#23-094 issued on 7/5/2023 for a New Fence This certifies that the new five foot high white PVC fence,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building& Fire Inspector /to Q L� L� �/ � ! ��33-R-� For office use onl BUILDNd&-?�TMENT PERMIT# c�3"CJ77 N�V '2 2�23JJ VILLAGE OF RYE BROOK ISSUED: 7-5 d3 P38 KING STREET,RYE BROOK,NEw YORK 10573 DATE: //—1 —Q 3 VILLAGE OF RYc BROOK (914)939-0668 FEE: ,& //0— PA1DJN BUILDING DEPARTMENT M .�` �°rg 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 ►►►►•►•r•rrrrrrrrrr►►pr►►♦•►•rrr►•►••rrrrrrr►►••►►►►►►►►►►►►•rr►►rrrrrrrr►►►•rpr►►r►►►►►rrrrrrrrrrrr•r►►►►►►►►►e►►►rr►rrrrr Address: Ap l'-ty,Jc; Occupancy/Use: Parcel M#: Zone:?C—/S Owner: &I'di , j C41(k'►c;C Address: Mia414V J L� P.E./R.A. or Contractor: 1-,f'5(L-. �"C-z Address: ?97 401le 9L) ✓4/41 y Cv A Person in responsible charge: Ave c- 14-,rsc i' Address: le / I 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 YOR�K,COUNTY OF WESTCHESTER as: kel f q-\ (-1 a✓yo't"r / being duly sworn,deposes and says that he/she resides at ✓�k��r���� (Print Name of Applicant) .l I (No.and Street) in RI e 8 t-&o kl ,in the County of WP S'TcL..3 4ee- in the State of I)f ,that (Cityfrown/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:$ Z 0 r , for the construction or alteration of e w A-1 V-µ •, C�e 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 ly/o ri be!- ,20.?3 day of 920 Signature of Property Owner Signature of Applicant 6rl a►, 3aIc,q Prin Name of Property Owner Print Name of Applicant Notary Pu 'c Notary Public GREGORY K RNERA Notary Public,State of New York 8/12/2021 No.01 R16441398 QuaNfied In Westchester County Commission Expires September 26,20 j �E BRC�k. • 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 (D j J O0 L.) DATE: PERMIT# .l �� ' (--)I ISSUED: -S 'Z SECT: BLOCK: LOT: LOCATION: p- ��� S J 1 / '1� o-o9 h F E �C11 OCCUPANCY: ❑ Violation Noted THE WORK IS... v� 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 x +� s O M N w a v a rq O � co t'V N \ W N Ln [� • W v v � hr"1 N 1--� 0-4V Y Q m W V w 1'-'-7 V � V �� W = ��1 r--� U ° z rTl { h�1 f v v rWT� r�� may+ a � � C � O Q W a p4 H p 00 o a ~ a v a(An V 4 � o : N tnQ �Cd � t+ tiy".c a O zwy = co S � o �. � w � V = �/ J a A A U a v GC�s ~ M ~ W � rM. W e � o Q N O ' A C7c� � � � z � W � CDit W (� o I—+ � W w w ,a $y : u O w O a � . cn w p z 'Z '� v 4tj v O ] von -�" ° H O A a W zap a a y� V ° °i � Z a ✓ , p4 O H O v a � U eta O 6' � ? � N c77 A z O a � � ' Qrt. U cn . H �W pd � 'm N s L W ° v o o ? a i � I a a W001x � 0 -rj o" �r A����P�V 7•����7K1�Ir�tl1�tlY 7rf 7Mr�tl1 �llr�r mil■�7•7•����r��7ur�4•�`���1r�r W�P BUILDING DEPARTMENT rft VILLAGE OF RYE BROOK MAY 16 2023 938 KING STREET Rv1E BRom,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT wwwxyebrook.are rrrrrrrrrrrr+r♦lr+rl++i}!l+;r+irrrrrrrrrr+rrrirrtsrrrr tr+t+iisitttist+ststt+s+++s+;+++rrr}rrsrrrr+r}rrrer FOR OFFICE L SE ONL1: Approval Date: t Application# Approval Sign 0 2D48 \// ARCHITECTURAL REVIEW BOARD: Disapproved: Date: Z/ BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: ,! Application Fee: 7S— Permit IFeew r}!}!i}r!}rr}}}}rr!!!!;}r};};;}rrr}}}};}r};;ti+rrir+tirttrittri!}i};;;it}}}};}};}it++rtiiitiiitiilttitiitri FENCE / WALL / GATE PERMIT APPLICATION Application dated: _�`/&—t is hereby nude to the Building inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the installation,conduction,repair or replacement of a Fence,Wall or Gate,in accordance with Section 250-6 B.(1)(g),of the Code of the Village of Rye Brook,as per detailed statement described below. Swimming pool fences must conform to the State Code. 1. Job Address: ?kb At ee j L,^ ``� ('-,� - 2. Occupancy/Use: j4J S.B.L.#: /_3�, v1e7 —/—/ �O Zone: 3. Proposed Fence/Wall/Gate(describe in detail): '+ W�+r pyC f" - 2b " iu'l k„yl, 00e.- Qrkt 'Ap /1 �+ 4. Property Owner: Ai t h o f t:,o t—I Q Address: / 4a�wool It i2,r� /j,k Phone# Cell# `117 - 57s G1fL+< email: S$w1a•,aFQ i�er�no � .wr.-'>E Applicant: Address: Phone# Cell q email: Arch itect/Enginerr: Address: Phone# Cell# email: Contractor: / ,C e S/ LL C ess Addr &Phone: `�L ^ y L 5. If building is located on a corner lot,which street does it front on: !? Dbkt'xj �✓t 6. What is the estimated cost of construction � Z�rO (NOTE:The estimated cost shall include all site idprovements,labor,material,scaffolding,fixed equipment,professional foes,and material and labor which may be donated gratis.) 7. Estimated date of completion: t 9112021 Please note that this application must include the notarized signature(s) of the legal owner(s) of the above-mentioned property, in the space provided below. Any application not bearing the legal property owner's notarized signature(s) shall be deemed null and void, and will be returned to the applicant. STATE OF NEW YIORK,COUNTY OF WESTCHESTER ) as: 8rr'A� 6 w(C.e3 ,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 ofhis/her knowledge and belie&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. Swom to before me this J Sworn to before me this day of `(`� G ,20 day of 120 S p of Property Owner Signature of Applicant RAN1Name of Property Own er Print Name of Applicant A, N-6-tafyMblic Notary Public SHARI MEULLO Notary Public,State of New York No.OIME6160063 Qualified In Westchester County Commission Expires January 29,2{L-7 2 a/1212021 Building Permit Check List&Zoning Analysis r n Address: IC SBL: Zone Use I k3 Const.Type Other. Submittal Date: Revisions Submittal Dates: Applicant: r"l C.cl Nature of Work C\L Reviews:ZBA: MAY 2 5 2023 p& BOT Other. QK (. (.�' 1 FEES:Filing: BP: ���� C/O: Flood Plane: Legalization: ( ) ( �,APP: Dated. Notarized: '' SBL: �- Truss I.D. Cross Connection H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening: ( ) ( ) ENVIRO:Long. Short: Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmt.: Tree Plan Other. ( ) (),-SURVEY:Dated: 't_-1_2\ Current Archival Sealed Unacceptable: ( ) ( ) S:Date Stamped Sealed Copies: Electronic Other. ( ) (( �ense: ✓Workers Comp: ✓ Liab' mp.Waiver. Other. ( � ,r -ODE 753#:10-7r'�J 3 —UXJ- K O-<X.I) Dated: -7— -1 1-, :k N/A ( ) ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit N/A Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit N/A: Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit H.W.I.C.:_Battery:_Other. ( ) ( ) PLUMBING Plans: Permit Nat. Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A: Other. ( ) ( ) H.V.A.C.: Plans: Permit: N/A Other. ( ) ( ) FUEL TANK:Plans: Permit: Fuel Type: Other. O O 2020 NY State ECCC: N/A: Other. (� ( ) 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:- vl/ 3 notes: ( )ZBA mtg.date: approval• notes: ( )PB rntg.date: approval;- notes: REQUIRED EXISTING PROPOSED NOTES APPROVED AM. DabeAW 30 2023 Fronn Main Cov ecc&C Ft.H/Sb: Sd.H/Sb: fjEA, Tot,I_ HHei /Stories 5 notes: taro kb \�, r , D IEC EME BUILDING DEPARTMENT MAY 16 2023 31D VILLAGE OF RYE BROOK 938 KING STREET RYE BRooK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT www.ryebrook.or$ 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: 111/1�%P�t w�r>� L, Date of Submission: Parcel ID 4 Zone/- Proposed Improvement(Describe in detail): �hS ,ll priypcy >teH�t' SC1pa(aT+n' �✓i�wi✓c�7 APPLICANT CHECK LIST: MUST BE COMPLETED BY THE APPLICANT The following items must be submitted to the Building Department by the applicant-no exceptions. Property Owner: IJr;Q 416vr0t7 1. (Completed Application n,nn 2. ( )Two(2)sets of sealed plans. (one full size{maximum Address: I ►,14��w Lh allowable plan size=36"x 42"}and one I 1"x 17-) Phone# °l 57 S-- 6 8'� z 3. ( Two(2)copies of the property survey. 4. ( )Two(2)copies of the proposed site plan. Applicant appearing before the Board: 5. (.(One electronic/disc copy of the complete fJr r q n a'��GN o� application materials. 6. ((Fling Fee. Address: /7�4,4,o j Ln 7. (:f Any supporting documentation. Phone# 1/7 - 5--7 S- b eO 2 8• ( )HOA approval letter. (f applicable) 9. (`'-Photographs. Architect/Engineer: 10.( )Samples of finishes/color chart. (a sample hoard 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 �"1 (�1.� ,20a S day of , 20 Signa4ae of Property Owner Signature of Applicant ame of Property Owner Print Name of Applicant �'- I t--,\ILL N blic Notary Public SHARI MEULLO 'rotary Public,State of New York No.o1ME616000 Qualified in Westchester county 7 '1 CommissionS Expires January ! 8/12/2021 u Lc U ( 1 BUILDING DEPARTMENT jD VILLAGE OF RYE BROOK MAY 16 2023 938 KING STREET RYE BRoox,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT www.ryebrook.org FOR OFFICE USE ONLY: Approval Date: Permit# Application# Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: Application Fee: S� Permit Fees: sssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssss •� FENCE / WALL / GATE PERMIT APPLICATION Application dated )_�(0—3 3 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 be/low. Swimming pool fences must conform to the State Code. 1. Job Address: t ��pb w;�, LJ , t3�e14 2. Occupancy/Use: / //�-ry���7 S.B.L.#: I,3 LD r �Q Zone: 3. Proposed Fence/Wall/Gate(describe in detail): W4_1�e�� PVC .f ence. 26 )'0q w"4� arbor — no q S •4,j4 WA '5jje-A1ti/ 4P1� 4. Property Owner: Af r ti & o 1111/ Address:�-- 4��woo (,k gyy /Jrw�c Phone# Cell# f/7 - 5 7 5'-&84'4 email: ;;k 14 n c-40(9 �e, i zo•, .�s.-� Applicant: Address: Phone# Cell# email: Architect/Engineer: Address: Phone# Cell# email: Contractor: Address&Phone: 11� 5. If building is located on a corner lot,which street does it front on: M"Pp +'t 6. What is the estimated cost of construction ,$ ']-8'017 (NOTE:The estimated cost shall include all site iniprovements,labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 7. Estimated date of completion: t 8112021 DR(�v� Village of Rye Brook ML MR Agenda FB SE Architectural Review Board Meeting AC SF Wednesday,June 21,2023 at 7:30 PM Q �•� Village Hall,938 Ring Street JM 1. ITEMS: 1.1. ARB23-052(Consent Agenda) Brian Balanoff&Jamie Balanoff 1 Maplewood Lane 5'high white PVC privacy fence. 1.2. ARB23-053 (Consent Agenda) David Krahn&Catherine McManus 4 Elm Hill Drive 5'high white vinyl fence and gates. 1.3. ARB23-054(Consent Agenda) Brian Spohrer&Kristy Spohrer 781 King Street Replace existing pavers. 1.4. ARB23-055 (Consent Agenda) Michael Cambria&Jamie Chiariello 101 Brush Hollow Close New brick paver patio. 1.5. ARB23-056 (Consent Agenda) Mark Goldstein 40 Valley Terrace Rooftop solar array. 1.6. ARB23-063 (Consent Agenda) Daniel Brous&Jennifer Brous 52 Lincoln Avenue Replace decking and railing on existing deck. Consent Agenda Approvals: Motion M— Second_ Abstention Aye; Nay;_ Adjournment; Notes Page 1 of 3 Architectural Review Board June 21,2023 1.7. ARB23-012 (Amendment to Prior Approval) Lal Jhangimal&Prisha Parvani 4 Bobbie Lane Adding windows and color changes. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.8. ARB23-057 Sayim Malik&Uzma Malik 10 Lincoln Avenue Legalize rear retaining wall,masonry patio, fire pit,masonry steps at retaining wall,poured concrete apron around house,driveway expansion and new wood fence. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.9. ARB23-058 Kevin McNamara&Lillian McNamara 6 Tamarack Road New deck. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.10. ARB23-059 Srivatsan Raghavan&Janani Ranganathan 436 North Ridge Street Window and door changes. 5'high chain-link fence and 4'high white vinyl picket fence. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes Page 2 of 3 Architectural Review Board June 21,2023 1.11. ARB23-060 Shyam Sivakimar&Vimala Raman 52 Bonwit Road New boulder wall,bluestone steps and wood railing. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.12. ARB23-061 Frank Santorelli 15 Paddock Road New rear patio. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.13. ARB23-062 Irakh Odisharia&Victoria Goginava-Odisharia 18 Jennifer Lane Above-ground swimming pool. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.14. ARB23-044(Re-Appearance) Joshua Rosen&Alison Rosen 6 Fairlawn Parkway New two-story single-family dwelling with finished basement. Approvals: Motion Second Abstention Aye; NaN; Adjournment; Notes NEXT MEETING: July 19, 2023 Page 3 of 3 Hirsch Fence Install & Design 747 Route 9W Valley Cottage, NY 10989 n C11411 Only -— Customm's Last Name,FIM Mom ServFoe Address Cqy zip I Customer's Daymne Phone No. Customer's Evonng Phone No. rlomcf F mad Address Nearest Cron Street PERMITANSPECTION INFORMAT N Pertrw Yes L7N0 Homeowner to obtain permit nste t n pro essronal (nstsIgh n Aohsuona reQrxes copy rI mrm t erore Inotaf evon) 10 obtain rmA APPROXIMATE LAYOUT Selection i -�� V'— rCNCE/OOTAOE CONTAINED IN TMSI PROPOSAL IS ON F4LN Ty&pfw ANDS`SO'TlO*PRICE WLI BE ADIUSIED BASED ON ACTUAL FE14CE FOOTAGE USED AS S"iOUF(TN ADDITIONAL COST OPTIONS ADO THE PRICES N THS COLUMN TO THE SELECTION TAKE DOWN AND HALIL AWAY OLD FENCE S �r PERMI1 COST i J � SUEITOTAL S r SALES TAX $ rtock 5 duct Customer assumes all responslbllrbes as It relates to ail add4tonal.abor ana malenal costs as A relates Special Order P�oduct to the fence berg nstallcdon a neghbors property �U F /� Ues'77Approvrdeustomer_ -- — 1i 0� ;/7-/f EN INSTALLATION RELATED TO GRADE:PLEASE INITIAL ONE J I r / V' f".Ef.SiY.,TU THE EIL s-EPPED LSTA"ATrGV SU:;HTLY UNEVEN GRADE WITH FENCE :'s-o-e w�l�t rlxee.n•�r•.• FENCE TO aE UEVEL NATN MGNEST GRADE l+w:r_To FoLXAWA%ur.r - FOLLONWNG FLOW OF GROJND (CUSTOMER i0 FILL IN OAaBI FENCE vdLL BE Uh EVENAT TO> >T[nca wutTAc A4.[.:..• .+ rzrs usraR+roFu w ws Produ - Product Product Styles Height: Style Height Style: Height Footage: If Gates: Footage. If Gates Footage If Gates: Post Cap{u4 14e Post Cap: Color: Post Cap, Color: Rail Type: Poi ; Rail Type: Post Cap Rail Type Post Cap: Picket Type: $ Picket Type: 5 Picket Type: $ r R - f 4f. �za `ie, �. �jMltit4�ir;,:.• L -�'';�� Hai � k -•s` �;.r.�. f_f I -rs� k�.ar'��•�R -y Y7y„nRwY�> :�f, $t'�J,"r Ri: tr=:�� S" 1 1 L fr it !t • ... _ ,ti Ir—=•:r..rU'.._'_ly�r ::_. _:�..._. t3v�= ��c:p � y L t7 N c � y J co 1 73 OD • (n C) W ction W LU w J = — ue .. LL _ r - _ z � � o ✓ s r N i«a17 dr � C N J. r I L tf E 44Nts1► r. r ',1 �P.0j. 1 rr 7 r *ti rj " ,�,.� rig.� .. '�i.� ..1, I(j, .��,�f 11 �� •d 1►tl .� �, ,,Nl 1�. '� d ��� � •' ,. t �,'�.p1,-+,0•'. r ��6?.!fLf'"y' r � '�•+�. '�,� "�..i" ��• r••�y fin,. b , mis certmcate Does not comer n nts to the ceruncate nolaer In ueu or sucn ermorsement s. PRODUCER CONTACT Courtney PotEer McCarthy Insurance PtNxgE 814 FAX 378 Elwood Avenue ap I 1769-0417 __ _.n41, ADDRESS: courtneyamccarthyinsurance.net Hawthorne, NY 10532 INSURE S AFFORDING COVERAGE NAIC8 INSURER A' Pre erred Mutual __ 15024 INSURED Hirsch Fence Install & Design LLC INSURERB. 747 RT 9W INSURER Cottage#4 INSURER D Valley Cottage, NY 10989 INSURER E INSURER F. COVERAGES CERTIFICATE NUMBER: 00002206-527555 REVISION NUMBER: 1 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 TYPE OF INSURANCE ADOL,SUBR POLICY EFF POLICY EXP LTIR POLICY NUMBER LIMITS A X COMMERCIAL GENERAL LIABILITY Y BOP0100721375 11/12/2022 11/12/2023 EACH OCCURRENCE S 1,000,000 CLAIMS MADE a OCCUR _5NIJAGE TO N f MED EXP(Any,a eperson) S 10,000 PERSONAL i ADV WAIRY f 1,000 000 GEWL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2 000 000 POLICY EC El El LOC PRODUCTS-COMP/OP AGO s Z 0OO 000 OTHER: s AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT f I nl ANY AUTO BODILY INJURY(Per person) s OWNED SCHEDULED BODILY INJURY(Per acddant s AUTOS ONLY AUTOS ) HIRED NON-OWNED PROPERTY !AGE $ --" AUTOS ONLY AUTOS ONLY p s UNORMLLALL48 OCCUR EACH OCCURRENCE $ EXCESS L.IAB CLAIMS-MADE AGGREGATE f DIED RETENTION f WORKERS COMPENSATION PER O TH. AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORPARTNER.-EXECUTIVE r"1 OFFICER-MEMBER EXCLUDED? NIA E.L.EACH ACCIDENT S (Mandatory In NM E.L.DISEASE-EA EMPLOYEE S If yes.describe under - -".----- . DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I S DESCRIPTION OF OPERATIONS:LOCATIONS 1 VEHICLES (ACORD 11)1.Additional Remarks Schedule may be attached if more space is required) Fence Contractor Village of Rye Brook is Additional Insured Job Location: 1 Maplewood Ln., Rye Brook,NY 10573 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Rye Brook THE EXPIRATION DATE THEREOF.NOTICE WILL BE DELIVERED IN 938 King Street ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook NY10573 AUTHORIZ SEYrrawE�J a CPO ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Printed by CPO on 04/25/2023 at 02 21PM 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 R Design LLC 747 Route 9N M 4 Front: Village of Rye Brook %''site%Cottage.Nl'10989-2452 PHONE:945-304-9622 FEIN:XXXXX0091 The location of where work will be performed is I Nlaplewood Ln,Rye Brook,NY 10573. Estimated dates necessary to complete work associated ss ali the building permit are from April 25,2023 to July 25,2023. The estimated dollar amount of project is SO-SI0,000 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 LLC.LLP. PLLP or a RLLP;OR is a partnership under the laws of New York State and is not a corporation. Other than the partners or members,there are no employees,day labor, leased employees,borrowed employees,part-time employers,unpaid volunteers(including family members)or subcontractors. Partners/Members: Bruce Hirsch Disability and Paid Familh Leave Benefits Exemption Statement: The abo%c 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 arc not considered to be employees under the Disability and Paid Family Leave Benefits Law.) I.Bruce Hirsch,am the Member 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 1 make this Certificate of Attestation of Exemption under the penalties of perjury. I further affirm that I understand that any false statement.representation or concealment will subject me to felony criminal prosecution,including jail and civil liability in accordance with the Workers'Compensation Law and all other New York State laws. By submitting this Certificate of Attestation of Exemption to the _ovemment 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 paid family leave benefits coverage and also immediately fumish proof of that coverage on forms approved by the Chair of the Workers'Compensat' n oard to the government entity listed above. SIGN HERE Signature: Date: Exemption Certificate Number Received 2023-029020 April 25, 2023 NYS Workers' Compensation Board CL---')x)01 _D !, Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Friday,July 21, 2023 10:58 AM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 07/21/2023 10:58 To: VIL RYE BROOK PRIMARY Transmitted: 07/21/2023 10:58 00002 Ticket: 07213-000-830-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 1 To: Name: MAPLEWOOD LN Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: THE DRIVEWAY SIDE OF THE HOUSE. NearSt: TIMBERWICK Means of Excavation: POST HOLE DIGGER Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: FENCE INSTALL Estimated Work Complete Date: 08/09/2023 Depth of excavation: 2 FEET Site dimensions: Length 20 FEET Width 10 INCHES Start Date and Time: 07/27/2023 09:00 Must Start By: 08/10/2023 ------------------------------------------------------------------------------ Contact Name: BRUCE HIRSCH Company: HIRSCH FENCE INSTALL AND DESIGN Addrl: 747 RT 9W Addr2: City: VALLEY COTTAGE State: NY Zip: 10989 Phone: 845-304-8622 Fax: Email: bruce@hirschfence.com Field Contact: BRUCE HIRSCH Alt Phone: 845-304-8622 Email: bruce@hirschfence.com Working for: H/O ------------------------------------------------------------------------------ Comments: Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA BELL-VALHALLA/ WSCHSTR CONED SUEZ WTR WESTCHESTER VIL PORT CHESTER VIL RYE BROOK WESTCHESTER CTY SWR i Tillage of Rye Brook . jarchitectural Review Board Approval Date: Z/44S Chairman: y O Z - Ow W � x . 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