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HomeMy WebLinkAboutBP23-100PERMIT # 3- �� DATE; n 3 �(p; O SECTION B OCK '� LOT TYPE OF WOR o % / f Q 0� JOB LOCATION 4 OWNER AfQ�'! % CONTRACTO EST. COSTS — g cb D00 FEE —14 6 4 V/cO y - 7'% FEE A f/O 6b DA Tkj44a/ TCO # FEE DATE INSPECTION RECORD DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING .- RGH PLUMBING GAS CI SPRINKLER �� ELECTRIC LOW -VOLT 0 AS BUILT FINAL -o42(2/,lake71DOO?,�iu,>,�01�9 Q4f f40* VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 23-177 Certificate of Occupancp This is to certify that SCO YJ J�PLn F PY)1)t?Jzf Sk/-i? of, RQ8'y'cojf� Aj having duly filed an application on 20 requesting a Certificate of Occupancy for the premises known as, 79 4_,Y�aq Q S jj , RyyeyyBrook,NY, located in a PUO Zoning District and shown on the most current Tax Map as Section: /��1• Block: _4�2 Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. , issued /V 20 .23, 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: 'tJ Construction: 10 for the following purposes: 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 in the exit facilities shall be made,and no enlargement, whether by extending on any side or by increasing in height shall be ma e, or shall the building be moved from one location to another until a permit to accomplish such change has b n tain fr e Building Inspector. Building Inspector,Village of Rye Brook: Date: NOV — 6 2023 p C C IE M-E ' ))� PERMIT #)For office use only: BUILDING DEfATtTMENT3 `3_/0O � OCT 10 2023 VILLAGE OF RYE BROOK ISSUED _�-/0-,; 3 38 KING STREET,RYE BROOK,NFm,YORK 10573 DATE Z_0-�3 VILLAGE OF RYE BROOK (914)939-0668 Fer-. _ PAID BUILDING DEPARTMENT yy�yN,r�chrool:.ot --- 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 it♦4tk•ikktgk4 kt�tkikktlti�kt<k ik kt4kkktkkki kkk Rkktikkkkk♦kkkiktkiik kkktkttkt 4kkkkk ikkk/kk�kkkikkkkkkkkkkktkkakkRtkkk�skskkktk Address Occupancy/Use: ,PESIO _ Parcel ID#:_ �9i��" r —� __ Zone / U� Owner: '30'V&1C- JCofr S/ C-,e V __Address:_�� C�/L��EA/ rZbS��Kye �b,�� P.E./R.A. or Contractor: �6114 llfPj_1110 ITS Address: �6'. �/ e; ,0� TD�iy/ A j IZS'$Z Person in responsible cha : G�U�O 2 Address: 5 �Q. 57Ve17;1 IZ_56Z Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy / Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW YORK, COUNTY OF WESTC:HESTER as: / j'�� being duly sworn,deposes and says that he/she resides at /6! v —6l;r'.9 a� (Print Narne of Applicant) (No.and Street) -,in the County of J yrc' ss in the State of�,that (City/Town Village) he/she has supervised the work at the location indicated above•and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$ �t7 ��• ,q for the construction or alteration of: ST�� :J� �D�f -frN�yfd 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 hisber 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-IO.A.of the Code of the Village of Rye Brook. Sworn to before me this .-- Sworn to before me this &.42— day of ',,-/yAt 10— , 20 day of 2 St at rc of r erty O%tincr S' nal rc ul'Ap icam �^ f /� _<< � J --- Print Nano of Property Owner riot Name of Applicant i 01' 0 Not Public o blic ` DONALD GOLDSMITH SUSAN C TESTA Notary Public, State of New York Nntat y Public•State of New York No. 01 G05021034 NO.0)TE4857971 t;t,arrled in Westchester County r),talified in Westchester County My t.nnutti-,%ion Explres May 5,20� f. ;;4,4lun Expires Dec. 6, 20� QyE BRC�k cu � l7 XEBuILDING BUILDINGDEPARTMENT 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# 1�10� a ISSUED: CT: LOCK: LOT: LOCATION: ^Arl <��9� y - 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 1 [] OTHER �yE BR(��• 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 - - - - - - - - - - - - - - - -- -- - ~i n �ADDRESS :— � � `1 DATE: PERMIT# ISSUED: BLOCK: `LOT: LOCATION: l S `� .1 oUU 'OCCUPANCY: \� ,-,{ ❑ Violation Noted THE WORK IS... LI 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 : p a N .Yh : � N N P4 � pNp ■ a (`Lnj ►r N ww � py( / °� O ❑ CL4 M ` �W tn O � A v � � � :� � w _ � o -0 w x H y i-1 s O "~ at L W w° ocM9 A - w = o n Ocn 041 Cl � v�a a 0 aico Fes+ _ W z a O O O /y/ O u zI/ I x _ rT F�1 04% V] I F ..i Fit f� y Q ce GJ - BI u .0 �, w ti v 'S v 4 ozb p in L"45 VE o ff N v \ U ` W O z h9 Z V O � oo MM , O O A z[ 0 � � 0 �� a � > 0x O a u a " s .4 w x � �-M _ BUILDING DEPARTMENT VILLAGE OF RYE BROOK J U N 2 3 2023 938 Kuvc STREET RYE BROOK,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK www.ryebropk.orE BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: h� Approval Date:_ JUL-0 -6 -2 � Perini 3- Application Fee:$/©0—f�,6 Approval Signature: Permit Fees: $ 3 0 V Disapproved: Other: Application dated: &C)-3-C is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing building,or for a change in use,as per detailed statement described below. 1. Job Address: 7 ' 'G^� , �VE 16d)W, /y SBL:1�7 , �7��-�6 Zone: 2. Proposed Improvement.(Describe in detail): �;r 2 ��y ��{='' '� �'�✓� /U L(� -T 2 jAA Sj•kWelzz, Wdt-G 1l GAS 61,-�1U P011Pr.� SINIL VANI1� l�l��G'Pl u�7 rr16� !fir 1�11 5 tiCbll LlCdTS AC-kJ 00Pa �i;) I � rc-d-W '4Q4 h,S L'tr') :T9 2 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Tillage of Rye Brook? No: Yes: If yes,indicate: TIER I: TIER II: TIER III: 4. 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...) :No: 'X. Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 5. Occupancy;(1 fam.,2 fam.,comm.,etc...)Prior to Construction: / rA I J After Construction: 6. N.Y State Construction Classification: N.Y.State Use Classification: 7. Property Owner:5eot7 27 60AWit ✓ Address: q n '`""' / G� �"yPAWk, yf�� � Phone# Cell# �/� Z - Z +� email: 8. Applicant: :gI2(CL%�� Address: -n l t Phone# /y•a,Z Cell# / s s r l mail: I� H� Y414 [� 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# email: c �f--• -G 'T 11. General Contractor: >r� �, {�110 h, , Address:M5 U�� /1 r Gr ' Phone# 1/7• SZ ,�17 G� Cell# g� 5�- 51 L( email: 12. Estimated cost of construction $ 7 OCXJ -- (NOTE:The estimated cost shall include all labor,miterial,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 13. Job Timetable: Start: LI2 3/ Z-o2-3 Finish: ✓ZL?�ST Gf 7W-. (1) 6/l/2023 [E C IE `;J VE BUii,D]ING DEPARTMENT JUN 2 3 2023 VILLAGE OF RYE BROOK 938 KING STIMET RYF BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT N%ww.rN'ehrook.or•L1 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: I, Sl—c��"'t- � •�al/ ,residing at, 1.3 INrirti namci ( \ddre�",t+hers t-uu litc) 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; 9 G/r :,.vl✓/'y�I� f /Z�'�' f}/lxsyjZ 1/0��� , Rye Brook,NY. 0ob-\,Idrc,�r 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. J440�____ Sir::rt,r� r rt} t)ti�'nrrtti)! IPr'int \ ri.r � 1'r{tprrl) (hs'n�•risrt Sworn to before ine this day of \/ /3 v.�>✓ c � tir, rt Public) =Poblic - TESTA tate of New York4857971tchester County, (z� ires May 5, 20� s/1212021 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 property completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. (Tease note that application fees are non-refundable. S�TL- OF NEW YOR_K„ COUNTY OF WESTCHESTER ) as: /N � ,�- , being duly sworn,deposes and states that he/she is the applicant above named. (bruit 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 OJI dj��j�l%' _for the legal owner and is duly authorized to make and file this application. (indicate architect.contractor,agent,awimey,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. n. Sworn to before me this �7 Sworn to before me this flay of 120 day of Signa re of Prul Owner i azure of pplicant Print Aaine ol-Properry ON%mcr Print Name of Applicant V Public" Nntary' hlic SUSAN C TESTA Nntat Y i'ublic- St Ate of New York Nr1. 01TE4857971 DONALD GOLDSMITH Utialilird in Westchpsler County} Notary Public, State of New York My{.011111ti5Slnn Expires may 5, zoo No. 01 G05021034 Qualified in Westchester County Expires Dec. 6, 2015" (4) R t7't111 W O 00 z o a � w �"� � � � a �• `:, � W Q N to x z � N zg O W N o p A � W 'S ito z z Ito N w atz '-" � a oen 9 W z O V z x A N w O H z Uit � $ W a a z H . o W w oo C c a 0 U w z w ° h a z �I a a1 041 cQl w T � y���� R E Cc IE ME BUILI)� I�EFARTMENT AUG 17 2023 VILL►� - E OF RYE IN" OK 938 K1Nc� tET RYE B ,NY 10573 VILLAGE OF RYE BROOK �'"t- in 3s}e I BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: Q 3-J �cp EP#: �J—/J 751 Approval Date. AUG 17 2023 Permit Fee: $ Approval Signature:-- Other: Application dated, — 7-c is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove electrical equipment,wiring, fixtures,or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: e n/ Zone: 2.Property Owner: = Address: Phone#:�� �,,� —T 2 Cell#: nn email:S7er14/ alb // V� �� 4 `� (/l o PVC 3.Master Electrician/Licensed Installer: �� Ul d / S Address: Lic.#:�^ Phone#: Cell#.q Ik; G�— zs _email: J, -e Company Name: 111Z/ � Address: 4.Proposed Electrical Work/Fixture Count: / Zvi c P ( D U 5.31 Party Electrical Inspection Agency: d STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: being duly swom,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant) state that(s)he is the for the legal owner and is duly authorized to make and file this application. (Master Electrician/Licensed Installer) The undersigned finther states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances,and regulations. Sworn to before me this Sworn to efore me this day of ,20 day of ,20 Signature of Property Owner ature of Applicant Print Name of Property Owner %, lame of Applicant Notary Public NotarjSftftb%I.JLL0 Notary Public,State of New York No.01ME6160063 Qualified In Westchester County Commission Expires January 29,2 3/3/2023 STATEWIDE • Service Willi hile.qriq 181 Main Street,Fishkill, NY 12524 1 email:office@swisnycom SWIS JOB APPLICATION tel845.202.7224 I fax 914.219.1062 1 SWISNY.corn I SWISTraining.com Office Use Elect.Permit# Date ?/ /,, 7 Bldg Permit# Utility ID# , Final Certificate# City/Village Zip 10 J Township County - Address Cross Street Section Block Lot _ Owner Name/Address(if different than above) Contact Number ❑Basement g1 st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact ' Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent 19 �-F SERVICE Amperage Voltage 1 P 3P #Meters #Disconnect ❑Underground ❑New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information D L C� OMC AUG 17 2023 ID VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,If at any time of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional hems inspected.The applicant dedares that there is no open applications for the above address with any other inspection company.The applicant,owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Inspector Date Finalized Inspector# Company Name '. ; . Date ;; Signature j Address City/State Zip Code V License# Phone# D ECEME State Wide Inspection Services 8 2023 1080 Main Street _ Fishkill, NY 12524 aQ VILLAGE OF RYE BROOK 845 202-7224 Phone l.+*� BUILDING DEPARTMENT 914-219-1062 Fax STATEWIDE INSPECTION SERVICES Email: office@swisny.com Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: David Richards Electrical Contracting Bonnie Stern David Richards Scott Stern 24 Willow Avenue 79 Greenway Close Larchmont, NY 10538 Rye Brook, NY 10573 Located at: 79 Greenway Close, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP23-179 129.84 2 1 68 Certificate Number: 2023-6180 Building Permit Number: BP23-100 A visual inspection of the electrical system was conducted at the Residential occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at: 79 Greenway Close, Rye Brook, NY 10573 The First Floor Bathroom was inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation,as set forth below,was found to be in compliance on the 8" Day of September 2023. Name Quantity Rating Circuit Type L.E.D. 08 Dimmers 02 Receptacles 01 Switches 01 GFCI 01 Officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. _ _ PLO OC ao a O N � a O ►-� W ~ oo W ti N N z v W GL MM Zi z �j W z _ H ON H ppd Y [ H e-4 Z x 66 �j O-Z z a Q � �h oc a �% 0 OF U, z a , r--� 00 z � CN o Er o $ r N 0 F g ►� z W z od �I a as w � r , _ BUILDING DEPARTMENT AUG 16 2023 _D, VILLAGE OF RYE BROOK VILLAGE OF RYE BROOK 938 KING STRrr-.T RYE BROOK,NY 10573(914) 939-0668 BUILDING DEPARTMENT vti-ww.ryebrook.org PLUMBING PERMIT APPLICATION FOR OFFICE: LSE. O`LY BP##: /- a 3-/00 PP j� .Approval Date: AUG 1 71,-\/7 Permit Fee:S /d Approval Signature: f Other: Disapproved: (fees are non-refundable) Application dated, is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of' a Permit to install and/or remove Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agree that said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address 6 - e.-v wh Klv � � ;c j i-S RL: aS. !� Sc' k c g 00y_1c)-6 Zone:OU14 2.Proposed Work: 5 f ! A" in-, O W qC' 3.Property Owner—:5C, S7 i r✓ Address:// °11e('.1„)c,,r ��n$C_ Yam- ( � k /�'� /�'.S Phone#:-j/y-Z 3�, /c 7v Cell#:_X1Y .,�57G email: -rN 5 R Ze CiIrG ,'�.rG,4-7 4.Master Plumber: �Ald AA L.(f n, Address: Lic.#: NO M Phonc#:(LQ?.ZL �°IZHCcII>i: C�3��'Z�• �9?h email: n (�M Company Name: Hole 0 n P IUM S- & Address: /f IQjf 0 4 C T 6(06/7 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 i 1 Ist Floor i 'nd Floor 3"'Fluor 4ie Floor 511 Floor i Exterior 5.* Li26Vb1f her Equipment/Provide Details: � ` 64 Stl o- �g�/t (' 4-1 - (Notarized Signatures Required Next 2 Pages) 4- 3/3/'0'_3 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: (� (n ,being duly sworn,deposes and states that he/she is the applicant above named. (pnnt na Ie of individual signing as the appiicanti and further states that(s)he is the Master Plumber for the legal owner and is duly authorized to make and file this application. 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 die Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this 1;)0 _ Sworn to before me this day of 4'a dc. ,20 a•3 day of_ .21) 3 Sig ture ( roperty Owner Signatur�ofp�icant �Ccf rl�c l��ltc�-� n Print Name of Property Owner Print Name of Applicant qt�� OWV-A�� �L i ary Public JOANNEGRANCHELLI Nolary �yNELILLO WESTCHESTFRCOUNTY NOTARY Pv3L:C STATE .TY YORK Notary Public,State of New York LIC �OtGRs6t3a&9 No.OIME6160063 COMMISSION EXr'iRESOCT.31, Qualified In Westchester County --tt Commission Expires January 29,20�> This application must be properly completed in its entirety and must include the notarized signaturc(s)of the legal owners)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 3,2023 BUILDING DEPARTMENT R ECEE VILLAGE OF RYE BROOK AUG 16 2023 938 KING�+RFFT RYE BRQOIC,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK ����w.rvebrook.or; 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 YOR1K,COUNTY OF WESTCHESTER ) as: p 31, SG0� �7 e f-N1 ,residing at, 6 1re,,:,J,Ja� (Prim[name) iAddress-. sere you Iive) A/y being duly sworn, deposes and states that(s)he is the applicant above named,and further states that(s)he is the oS 75 legal owner of the property to which this Affidavit of Compliance pertains at; 7q Rye Brook,NY. (Job Addreas) 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. 'SI n' t:re of }l nv Owuen(.)) 0 ;Print Name ut Prnnrrly ON%nrrls)) Sworn to before me this oZ,� day of C41��. ,20_!�- _ �Public) - JOANNE GRANO ICW NOTARY PUBLIC STAI'E OF hEW YORK WESTCHESTrR COUNTY � UG #01GR4693369 l cJ COMMISSION EXPIRES OCT.31,20�a 8/12/2021 Budding Permit Check List&Zonm* Analysis r Address: - C SBL: Zone: Use: l Const.Type Gyf� Other. Submittal Date: evisions Submittal Dates: Applicant: Nature of Work l Q 1 cy-,6S Reviews:ZBA:_JUL 0 6 2023 eB: HOT: Other. ED K �� ✓`'' FEES:Filing. \ �BP: ✓✓J" 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: Current Archival;- Sealed: Unacceptable: ( ) ( ) LANS:Date Stamped: Seal Copies:,Electronic: Other. (�( License: "' Workers Comp: Liability: ✓ Comp.Waiver. Other. ( ) ( ) CODE 753#: Dated: N/A: HIGH-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other. LOW-VOLTAGE ELECTRICAL:Plans: Permit N/A: Other. (Y ( ) 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 notes: ( )ZBA mtg.date: approval: notes: ( )PH mtg.date: approval notes: APPROVED -- REQUIRED EXIMNG PROPOSED NO Date: JUL 0 6 2023 Arm Circe: Frontage Front Fron Sides: R.Car. Main Cov Accs.Cov Ft.H S Sd.HS : SFA. TAP: F Im : PazkinQ Hight/Stories: notes: IVA? 7 vi; ov 14 M.'""•ARA ARN. 'M !Q' A NR,45- 0 to N Ct 0 > C14 LU CMca cz cz cz un U WE Mea -4-0 le'W: N LU V- 00 u LC) 1 z W .0 ction LLJ N 4 > LU U Z Z LL.J > TZ w 0 tz —j :Lj 0 > CO L0 00 w Id "?S gg- C/) L) 0 Z ov N 0 cz 03 cle) OWNS.- .;16� E to v ........ A-1 ....... ...... SIM IN " N P 9."yIt #gillO o 1, MA' 4 A� DATE(MM/DD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE llifti 1 06121/2023 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 endorsements . PRODUCER CONTACT NAME: Melissa Bell W.J Farmer Insurance Agency,LLC PHONE (607)796-0551 aC No): (607)796 5591 106 C.John Street E-MAIL ADDRESS: )mbell wfarmerinsurance.com INSURERS AFFORDING COVERAGE NAIC# Horseheads NY 14845 INSURERA: ERIE INSURANCE COMPANY 26263 INSURED INSURER B: MARCELINO HERRERA D/B/A INSURER C: MEHL IMPROVEMENTS INSURER D: 185 JUDITH DR INSURER E STORMVILLE NY 12582-5261 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRR TYPE OF INSURANCE ADDL SUBR POLICPOLICY NUMBER MMIDDY EFF rYYYY) M LICDY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ❑X OCCUR DAMAGE TO RENTED CLAIMS-MADEoccurrence)PREMISES Ea $ 1,000,000 _ MED EXP(Any one person) $ 5,000 A X Q27-7620127 03/26/2023 03/26/2024 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea dent $ 1,000,000 acci X ANY AUTO BODILY INJURY(Per person) $ A OWNED V SCHEDULED AUTOS ONLY AUTOS Q03-6530504 03/15/2023 03/15/2024 BODILY INJURY(Per accident) $ /� HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LLAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LU%BILITY Y/N STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached if more space is required) ADDITIONAL INSURED: THE VILLAGE OF RYE BROOK,938 KING STREET, RYE BROOK, NY 10573 MR&MRS STERN,79 GREENWAY CLOSE,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 THE VILLAGE OF RYE BROOK ACCORDANCE WITH THE POLICY PROVISIONS. 938 KING STREET AUTHORIZED REPRESENTATIVE RYE BROOK NY 10573 M'dima Kett 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD i� NYSIF New York State Insurance Fund PO Box 66699,Albany. NY 12206 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE A A A A A A 203446691 �y� MARCELINO HERRERA F M. DBA MEHL IMPROVEMENTS 1 185 JUDITH DRIVE ~ r STORMVILLE NY 12582 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER MARCELINO HERRERA VILLAGE OF RYE BROOK DBA MEHL IMPROVEMENTS 938 KING STREET 185 JUDITH DRIVE RYE BROOK NY 10573 STORMVILLE NY 12582 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE A2475 494-7 440913 06/06/2023 TO 06/06/2024 6/22/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2475 494-7. COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK. TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE SUR NCE FUND 4 tl Z/ DIRECTOR.INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 373029241 U-26.3 'fit 1M m r WAl- _ o� C© Get t C (F� I h11f1i�fi1D1 toy P6mliq 1Fr L KtZ/,4VE F9CAET 00clZ -rd / P-ZM 411a1 �I 0011516L Sh0wr::liZ 4 AL 'S i"a, 4=-1°1 1t i A A o Ta eE - � rOA 2IzraV-E CZlL)A1G-,J f 1G { �xlsTr{rr & "Aire I s! it 1> 1�L�tG WL016k- � Rye Brook, SCE Al.t-. PLvv l j �Ix-tv12�s � �avc�rs 7-0 iZ e MA)iV EXt 'PUG 5H E);—' DPA 1� Ord b Q6M4IN D EC G UJ N 2 3 2023 ID VILLAGE OF RYE BROOK DEPARTMENT 07 0 1✓��d UPS �#A.id�, 1�/�/11�1�� Wirl4 Dov13L-- tlEb C4fitt, a � 1VCG/ L ED 2i5c6. 141; 1.161)rS 3 MM CXLdv.:5 r r,.4N 1 6 X gin 3wI�G o� bOO7Z 7� MA 0�4 i5)S-t/A2T 17�vTLS• l ,1 Ntu�1 FLanrl "7"1LFL= oti °M-�, S4? I-5 r/ G C tIJ�G r7 � `tom >EAT Z r/1.0�FS111 ttYj t1L� o"J r vP qF 9fzt1 wlr4 w,5r MchefJ p BOX FILE COPY