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HomeMy WebLinkAboutMP21-053PERMIT # R/ - Qii 0S3 DATE: -3k/ EXP: )4,3 SECTION ZQ94F TS BLOCK / � LOT TYPE OF WORK 3'- 1�1 p yCY144%/ c qeya4 r JOB LOCATION Z le�u0r EST. COT ®� FEE v'CO # in LEWC FEES A TCO # FEE DATE INSPECTION RECORD DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS 0 SPRINKLE_ y� LOW -VOLT CI ALARM 0 AS BUILT 0 FINAL OTHER APPROVALS ZBA OTHER L° . 19 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.ryebrook.org TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE July 19,2023 Blind Brook Club Inc 980 Anderson Hill Road Rye Brook,New York 10573 Re: 980 Anderson Hill Road, Rye Brook,New York 10573 Parcel ID#: 129.58-1-1 This document certifies that the work done under Mechanical Permit #21-053 issued on 4/13/2021 for the installation of a three-stop hydraulic elevator has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to ECENE DBUILD � ENT For office use onl VIL OF RYE K PERMIT# o� —053 AUG 2 6 2021 ISSUED: �3- 8 KING STREE >r'E BROOK, YORK 10573 DATE: VILLAGE OF RYE BROOK (914)9 "1 939-5801 FEE: �` (p/d— PAID^ BUILDING DEPARTMENT � a o 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 tlftf##tt##Ftt;it!!ltiiii;flittti##i!#!t!!liiifitfttttitt######■tiifitttiRt#!###f##ffitti###lfff##f##ti###tiiti;tiiftt#####i# Address: 980 Anderson Hill Rd, Purchase, NY Occupancy/Use: .4— v'�k Parcel ID#: 9 r SS— /1 Zone: ^35 Owner: P 1'A CA R f'oo K .Iu,6 Address: 9-D And-erwn P' i 1 QGte. k e N P.E./R.A. or Contractor: ]� �h✓� or Co('o Address: Soo Exec(A k,1110 I 1 a( . SF�. 135 £cl m sFv r�1 Person in responsible charge`�reSr— i fo„e Address:-500 CA e r+t.l-iue. l31 Jd S I-e j 3 5 a� +mS 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 YOM COUNTY OF WESTCHESTER as: TK Elevator Corporation being duly sworn,deposes and says that he/she resides at 500 Executive Blvd, Ste. 135 (Print Name of Applicant) (No.and Street) in Elmsford ,in the County of Westchester in the State of NY ,that (Cityrrown/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:S 105,000 for the construction or alteration of: Install a 3 Stop Hydraulic Elevator 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 by unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly, in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per §250-10.A.of the Code of the Village of Rye Brook. Sworn to before me this 3 04 h Sworn to before me this day of J',�, , 20A]_ day of , 20,:�L AA • �, Sign,uurr ut Prupcn caner Signature of Applicant Theresa Tirone Print Name of Property Owner Print Name of Applicant u lic - tary Publi ALEXANDRA H.FRANK %�`t�h� MANDY KAY JENKINS Notary Public,State of New York NOTARY PUBLIC-STATE OF NEW YCIAK No.O1FR6363711 No.01JE6327989 Qualified in Westchester County_ Qualified in Bronx County Commission Expires August 28,20°`1 My Commission Expires 07-20-2023 QyE BRC��. BUILDING DEPARTMENT IF,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 Uebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - --- - ��G � � I � �� -I� � 2A ADDRESS: `-' DATE: 1 PERMIT# - ✓ ISSUED: y 1I'-� SECT: BLOCK: LOT: T LOCATION: �- \ e VC 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 i ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING VOSS CONNECTION ALHER fir} Ln _ Q N N ` o 0 �y �' .-� 'J OD o 7 U w '�/ �' ^ � •--� �' � ��, p 3 3 � cad' U � � F-� CD O • L r tZ © on C to v aIT zr A.r 1 C*4) 40 zo O v O,r< O tn C w o `r7ul�, � U � c U W � � /`; � CO) wo rU Ca F + N v a � o o c0.11 W EE 9 M Q1 mzw L A 4 W A IR CIEOVIED � WILLS MF u BROOK Bu NG DEP , MENT APR - 1 2021 938 KI Nc :t.1, R t t R K,NY 10573 (914)939-0668 F q�, 5801 wwwxyebrook.ord VILLAGE OF RYE BROOK (32 BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL, MODIFY AND/OR APC-)9-n 3 REMOVE MECHANICAL EQUIPMENT OFFICE USE ONLY: APR Z021 f � r, 11 Permit#: /`9 06 3 Building Inspector: Fee Paid: r Date of Approval: Parcel ID#: /6i9.68-1--1 _ Bldg/Use Class:Res.{ );Comm. ( , '1 14SSPi�'16) **��*,��****�*******,�***�***,��r******:,�*,�**�**�***r�*�*****err►**�*�,�******�*��************ REouIREMENI'S FOR RELEASE OF PERMIT: (A CERTIFICATE Of COMPLIANCE 1S REQUIRED TO CLOSE OUT THIS PERMIT) I. Properly Completed& Signed Application. 2. Payment of Application Fee:Residential =$100.00; Commercial =$250.00 (fee.,am no.,-„e/,u d ble) 3. Site/Staging Plan as required by the Building Inspector. 4. Sealed Construction/installation Documents& Specifications as required by the Building Inspector. 5.Copy of Licensed Contractor's Liability Insurance.(Village of Rye Brook must he listed as certificate holder) & Workers Compensation insurance on a NYS Board form (Form#C105.2 or Form#U26.3/or NY State Workers Compensation Waiver) 6.Payment of Permit Fee: Residential =$15.00/1000.00 of Construction/Materials Cost with a minimum fee of$100.00. Commercial =$25.00/1000.00 of Construction/Materials Cost with a minimum fee of$275.00. 7. Inspection by Building Department for removal and/or installation. (48 hour notice required) 8.Any electrical work requires a separate Electrical Permit and Electrical Inspection. 9.Any gastplumbing work requires a separate Plumbing Permit and Plumbing Inspection. Application dated, I is hereby made to the Building Inspector of the Village of Rye Brook,NY,for a permit for the installation,modification,and/or removal of the specific Mechanical Equipment as listed below.The applicant and property owner,by signing this document agrees that said equipment will be installed and/or removed in conformance with the approved plans,and with all applicable Local,County,State& Federal laws,codes,rules and regulations. 1.Address: 980 Anderson Hill Ind, Rig 6rc3ok, Al y SBL: 1aq gg_/-I Zone: j2-3 erty 5 2.Prop Owner: 8�1»d' J3rQQk L LAb )r1C. Address: PO 80x Z?4 Pur-a7ase, /V y/0,577 Phone#: 6I34-/�5O Cell#: email:1�LArf"Jpb J��d bl fjrot�kCll ub,ovta 3.Contractor:'TK Lleva+or i"_orpgrahnn Address:5mbccclx+ve BW Sle 135, Q ns�`�1NYo589 Phone#: 9/4-3q5-5310— Cell#: gfy„205-1t,05St. email: ✓esa.4-tyorrt G-t-e-le .C&77 4,Applicant: TK Elevator Corporation Address: 500 Executive Blvd,Ste.135.Elmsford,NY 10523 Phone#: 914-345-5362 Cell: 914-208-1652 email: theresa.tirom@tketevator.com 5.Scope of Work:New Installation()0•Replacement( )•Removal( )•Other{ ) 6.Type of Equipment: 3 slap hWrauHc elevator 7.Location of Equipment: 8.Cost of Equipment including Installation Cost:$_ 105 000 I 6/112020 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: f�t a:1 t'orye— ,being duly sworn,deposes and states that he/she is the applicant above named, (print name or 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 C© rN�'ccx_)-oc' for the legal owner and is duly authorized to make and file this application. (indicate architect-contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed, or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention& Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn to before m��eJJthis day of ,20 day of M C�'1 ZQ Signature of Property Owner Sign�ature of Applicant Si1 kcCts &�- -Tt,rOnc Print Name of Property Owner Print Name of Applicant r Notary Public No4y Public 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 and/or not properly signed shall be deemed null and void and will be returned to the applicant. i?UARTARARO 1#50080873 N tate of New Jersey -ssion Expires 124,2023 2 6I rzo2u Quality Elevator Inspection Inc. Quality Elevator Inspection Michael A Byrnes P.O.Box 563 QEI Inspection Supervisor Millwood NY 10546 NAESA C-4063 & QEITF E-000283 50 Years' Experience,There is no Substitute Tel (914) 924-8563 fax(914) 762-0296 Email mbgeiAaol.com May 11,2021 Teri Tirone Coordinator New Installation/Modernization TK Elevator Corporation 500 Executive Blvd, Suite 135 Elmsford,NY 10523 Re; Blind Brook Club 980 Anderson Hill Rd. Purchase NY 10577 On May 11,2021 at your request, Quality Elevator Inspection witnessed a NYS full load final acceptance test on a Hydraulic Elevator located at Blind Brook Club, 980 Anderson Hill Rd. Purchase NY 10577. The test was performed by ThyssenKrupp Elevator Mechanics. The test was performed in compliance with the rules and regulations of the American Society of Mechanical Engineers,ASME A17.1 Safety Code for Elevators and Escalators. Car 1,ThyssenKrupp Endura TAC 32 SN#EFL691, 3 Stop, Capacity 21001bs. 125 FPM NL/184 PSI, FL/314 PSI, Relief 455/PSI Elevator passed full load Final Acceptance Safety test with no violations. If you have any questions or concerns, feel free to contact me at your convenience. Sincerely, Michael A. Byrnes QEI Inspection Supervisor D IE C �v 3D r OCT 2 0 202, VILLAGE OF RYE BROOK BUILDING DEPARTMENT Buildinggf Permit Check List&Zoning Analysis Address: �'J n S Q 0 LC, __Dp, SBL: Zone:t '?Z_�, Use: --2" Const.Type: Other. Submittal Date: l 1 Z Revisions Submittal Dates: Applicant: � 4` L r`' ,L�C)VZ_ Gt..s� Nature of Work. L,l C_ 1u—�- A11Xt_ Reviews:ZBA PB: BOT: Other. � OK ( ) (�ES:Filing. BP: 2 7-5- . . C/O: Legalization: P: Dated: L,,"' Notarized: ✓ SBL: ✓{Thus 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. ( ) ( ) rSURVEY:Dated Current Archival Sealed Unacceptable ( ) ( PLANS:Date Stamped: ✓ Sealed: ✓ Copies:_�Electronic: Other. ( ) ( License: Workers Comp:J�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. ( ) ( ) 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: ( )PB mtg.date: approval• notes: REOUIRED EX191IN PROPOSED NOTES APPROVED Area APR R 9 21 cir . Date: Fr n From Front: sides >3ar. Main Co Accs.Cov Ft.H/Sb: Sd.HS • Q Tot,Img: Ft M: Pazlung Height/Stories: notes: ACORO CERTIFICATE OF LIABILITY INSURANCE P:4 le DATE(M l 03/0512021YYY) /2021 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:Aon Risk Services Central,Inc. Aon Risk Services Central,Inc PHONE(A/C No.Ext): (866)283-7122 FAX(A/C No.Ext): 800 363-0105 200 East Randolph E-MAIL AODRESS:acs.chicago@aon.com CHICAGO IL 60601 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: HDI Global Insurance Company 41343 INSURED INSURER B: ACE American Insurance Company 22667 THYSSENKRUPP ELEVATOR CORPORATION INSURER C: indemnity Insurance Company of NA 43575 INSURER D: ACE Fire Underwriters Insurance Company 20702 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1943852 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 VITH 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 ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYY) (MMIDD/YYYY) A X COMMERCIAL GENERAL LIABILITY X X GLD5668800/GLD5668900 07/31/2020 10/01/2021 EACH OCCURRENCE $2,000 000 CLAIMS-MADE a OCCUR DAMAGE TO RENTED $100.000 PREMISES(Ea occurrence) MED EXP(Any one person) $5,000 GEN'L AGGREGATE LIMIT APPLIES PER PERSONAL&ADV INJURY $2,000.000 GENERAL AGGREGATE $2,000 000 X POLICY PROJECT LOC PRODUCTS-COMP/OP AGG $2,000.000 OTHER BAUTOMOBILE LIABILITY X X ISAH25313665 10/01/2020 10/01/2021 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $2,000.000 OWNED AUTOS❑SCHEDULED BODILY INJURY(Per person) ONLY AUTOS BODILY INJURY(Per accident) HIRED AUTOS [7 NON-OWNED ONLY AUTOS ONLY PROPERTY DAMAGE ❑ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE 4,GGREGATE DED RETENTION$ C WORKERS COMPENSATION y/N N/A X WLRC67462671(ADS) 10/01/2020 10/01/2021 X PER OTHER B AND EMPLOYERS'LIABILITY WLRC67462713(CA.MA) 10/01/2020 10/01/2021 STATUTE ANY PROPRIETOR/PARTNER/EXECUTIVE VVLRC67462671(TX) 10/01/2020 10/01/2021 E.L.EACH ACCIDENT $1,000 000 COFFICER/MEMBER EXCLUDED WLRC67462798(Wl) 10/01/2020 10/01/2021 E.L.DISEASE-EA EMPLOYEE S 1 000 000 D Mandatory in NH) E L.DISEASE-POLICY LIMIT $1,000 000 If yes,describe under DESCRIPTION OF OPERATIONS below Limits shown as requested DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Division Number 103800-Named Insured Includes Thyssen Krupp Elevator Corporation-Address 500 Executive Boulevard Elmsford. NY 10523 Project Number 114365-Project Name Blind Brook Club-Address 980 Anderson Hill Rd PURCHASE,NY 10577-Project Type(s) Elevator Installation CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF NOTICE VVILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Village of Rye Brook .- King Street PO PORT CHESTER NY 10573 United States 01988-2016 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD YO K Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board la.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured Thyssenkrupp Elevator USA Holding, Inc. 914-347-3450 519&h Avenue,6th Floor New York,NY 10018 1c. NYS Unemployment Insurance Employer Registration Number of Insured 12-70922 Work Location of Insured(Only required ifcovtrage is specifically lirrxted to 1d Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e., a Wrap-Up Policy) Number 62-1211267 2. Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Indemnity Insurance Company of North America Village of Rye Brook 3b Policy Number of Entity Listed in Box 1 a" 938 King Street WLR C67462671 Rye Brook, NY 10573 3c. Pdicy effective period 1 0/01 202 0 to 1 0/01 202 1 3d.The Proprietor,Partners or Executive Officers are �X Included.(Only check box if all partners/officers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"I a"for workers compensation under the New York State Workers'Compensation Law. (To use this form, New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers' Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. 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