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HomeMy WebLinkAboutBP23-106PERMIT # AV/ QJ— Lg! DATE; i 9 a3 SECTION TYPE OF WORK JOB LOCATION FsST. COST v/CO #C 60 TCO # FEE DATE DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING Od RGH PLUMBING GAS Q SPRINKLER ELECTRIC LOW -VOLT Q ;r ALARM Q AS BUILT Q FINAL I NSP 6�'�- boob r;eJy(o C9/1) 779' oll7 %r OTHER APPROVALS ARB BOT PB ZBA OTHER VILLAGE OF RYE BROOK WESTCHESTE'R CouNTY, NEw YORK NO: 24-003 Certificate of ®ccupaucp Ehis is to certify that of, 1AV1 V&-& having duly filed an application on 2 0 requesting a Certificate of Occupancy for the premises known as, Rye Brook,NY, located in a Zoning District and shown on the most current Tax Map as Section: 13Q. / / Block: _L Lot: U , and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No.- tf/, issued 20o2&, 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: '0-'s a e� Construction: , for the following purposes: iri�1' �U Y / C &2 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 made,nor s puilding be moved from one location to another until a permit to accomplish such change has be o tained om a uil i Inspector. J AN 12 2D24 Building Inspector,Village of Rye Brook: Date: E `VE � VE R For office use only: BUILDQRO ENT PERMIT # DEC - 6 2023 VILK ISSUED 9 g KING STREYORK 10573 DATE VILLAGE OF RYE BRGGK BL'!LDiNG Di=PART�tv1ENT FEE — PAID X 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 ssssw�•r<»twssrwwtsttrtwwwtwttwwwwwsrwstwswwwr►swtwwsw■■sssssstssssrsrrssssttrwttstsrsrtstsssrrrtr►strrss►tssrtrsstsssrrsssss Address ST. Occupancy/Use: I V:AA. Parcel ID#: •77 — " (8• Zone /S Owner: ADWAID }ZUFF ,,(� Address:_ 7. K�l�(p ST P.E./R.A. or C ctor: OrP�1�V�1 ���I coa: Address:_A(A yC'N RZ '' jW Cr Q(v�' 03 Person in res charge: �L. Address: a U • 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 .00FF^NEW YORK,COUNTY OF WESTCHESTER as: V being duly sworn,deposes and says that he/she resides at �I f—I WO ST (Print Name of Applicant) (No.and Street) in V 1 &.(=�Q `( ,in the County of_WoOck 5aliL in the State of W 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:$ M&O for the construction or alteration of: K(TCRRA 1ZW a U AT(art 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 0l� 20 yj day of ,20 Signa re of Property Owncr Signature of Applicant Print Name of to r Print Name of Applicant Notary NJURA Notary Public Notary P II late of New York No10 A6082346 Oualified New York County 8/12/2021 Comm' , Ex0a�•21.2 .Li BR(�j�• O Zm t7 /�• 1982•� BUILDING DEPARTMENT ❑BUILDING INSPECTOR 9-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 GCS DATE:_ I Z o-L A PERMIT# L` Z ISSUED: -I - 2.5 SECT: 7 BLOCK:_LOT: _ LOCATION: �, I OCCUPANCY: Z 13 ❑ Violation Noted THE WORK IS... L7 YASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ��� 0 C ❑ L.P.Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION E31"FINAL ❑ OTHER : R ■ ■ ■ _ R � N N fY� � m ■ ■ rMl � � • d v y 7 h'r"I N cd h+l O z W � a o � = w In In j--1 ar/ 4. A w W (� h ~ p 4-4 v o O C A v 00 o O ' P-4 � � � oho C ►�► � z ,.a N ►W v O v � F1 w ,. 0 LL O ■ � W � F+1 U ��-+, L7r R� t�-� A A U c�a u � � (j V , \ V C a U Z v hl ■ � ^ s ON °a `- W .a Q� = w Phi N R W ^_ x� R Z a O 3 10 n o CA 00 09 � � � � 0 , a s R BUILD VI'AR.. MENT VIL OF RY> ° OOKFJUL �1�10253 938 KING �J 1.r.T RvF BR' NY 10573 ` (i11 4)439-0 VILLAGE OF RYE BROOK r4 I " BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY:JUL j6ApProyal Date: it#: Q3 106 pplication Fee:$ /fy Approval Signature: Permit Fees: $ 1 Disapproved: Other: is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of Permit for the Application dated: 7'/!'� interior alteration of an existing building,or for a change in use,as per detailed statement described below. 1. Job Address: 1212. V(Nrrb ST. SBL-. 130, 2. Proposed Improvement. (Describe in detail): M*00"1100 p'F e*_C.T06 K I IV40� COUPI RZbikP I AR(,tA_W_J61&. 1091AL V-160 ChNsGTS,. COUNMOMPS A440 3. Does theproposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: ti 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: Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) S. Occupancy;(1 fam.,2 fam.,comm.,etc...)Prior to Construction: I FA M. After Construction: 1 FA(A 6. N.Y State Construction Classification: N.Y.State Use Classification: 7. Property Owner: trou AW}-Wyr_ / Address: /����. _K-11`& G- '• Phone# Cell#(91A)513 Z— 13Ot)(o email: ko;-P 19&QK1 I•Cb/V( 8, Applicant: 5AA L- A-!5 O1 909— Address: Phone# Cell 4 email: 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# email: 11. General Contractor:_01MIA M1 %1 1W&(_L(JAddress: Phone# Cell# L914)-774-0117 email: 6CEi.FiL IaotuD•uM 12. Estimated cost of construction $ 69,249 _ (NOTE:The estimated cost shall include all labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 13. Job Timetable: Start: JOW 20Z:�p Finish: (l) 6/1/2023 BUILD �. MENT VIL E OF RY OOK JUL t 1 2023 938 KING ET RYE BR ,NY 10573 VILLAGE OF RYE BROOK 4 3E-[I BUILDING DEPARTMENT )r00 7 t5 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 APPLYCANT. STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: I, Gd , residing at, 16,,y4­ s/ ee.T /i: 6' (Print name) (Address where you live) Al I&T-7 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; Rye Brook,NY. (Job Address) Further that all statements contained herein are true, and that to the best of his/her knowledge and belief, that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and further that there are no roof drains, sump pumps,or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. (Signature of roperty Owner(s) /AV , (Print Munc of Property Owner(s)) Sworn to before me this 77 day of ��"1 , 20 Z3 (Notary Public) MICHAEL KELLMANI Notary Public,State of New York No.01KE5036394 Clualified in Westchester County (2) Commission Expires Nov.28. 202,b 8/12/2021 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. Please note that application fees are non-refundable. STAT4 OF NEW PR6, OUNTY OF WESTCHESTER ) as: w ,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 7 Sworn to before me this 7 day of liky , 204 day of vim/ , 20 2-3— Signature of opertyown Signal re Applicanf JW Print ame&Idv#= P Owner Print Name of Applicant Notary Pudic Notary 'ublic MICHAEL KELLMAN Notary Public, StRtA of New York MICHAEL KELLMAN No.01 KE50 36394 Notary Public,State of New York Clualified in Westchester County No.01 KE5036394 Commission Expires Nov. 28, Z�� Ouatified in Westchester County Corrtmtssion Expires Nov.28. (4) 8/12/2021 N e a+ N N ►. W W � o rl n u z v N � F v a x h x �-- O-W im a w 00 $ In O r N w ! C H p( W V 04 N W $Fo � (n ~ U N H 1 ^ 11, 00 e u W w z fT . A I•y W o� w O ,�o„c V W 00 E- c I�i G;: "; x z d , Z a A a Ca V 0-* a aj U z CG 00 CDi M U w c� :L1 rj Va C7 o z a cn I CL u $ 04 w a x Z F F- o0 w W w g z z v W z a. x " a o u A a � �.., a C �- x <(� A a 0 z as u. rt�••_ I BUII.DNG PARTMENT J U L 2 4 2023 1 ID VELLAGE-0F'R. YE'$ROOK 938 KING STx ETRYEB1to6k,NY 10573 VILLAGE OF RYE BROOK (914)93.9r066&F, x.(914)939-5801 BUILDING DEPARTMENT �%wwli`yeb�o Lrg ELECTRICAL PERMIT APPLICATION ;,� /'� �T r_7� Westchester County Master Electricians License Required FOR 97,4 CE USE®1,11-Y T. �--/O IL./ :� .• ��--I �� Approval Date: J U L 2 5 20 Applicat �ee-- - _ Approval Signature: Permit Fee: S Z Disapproved: Other: (fees are non-refundable) Application dated,'7 c-)4— 3 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. The applicant & property owner, by signing this document agree that all electrical work performed will be in conformance with all applicable Federal, State,County and Local Codes. 1.Address: 9 1 j- k i-� G STkect SBL: 1,30, 77-- / —/8 Zone:_a 3 2.Property Owner: �l)tUp2�\-l��A A� j kQ) F Address:_ 19 $TIL-ed Phone#: q 1 u- 'S 066 Cell#: email: 3.Master Electrician:S6 hr.1 e IEC C Address: (b Su fv �T IZ e,P cI fa-te 6"dt W N I o rya Lic.#: E,S 3 Ci Phone#:C/1 14-139'a?y 1 Cell#:9 1 8 19 SV 0'1"l email: ((1.G'(, i or Ig ho L. 5 n') Company Name: Lk I(2,4`l M n U. �1 Fc.T ti►L Address: 6 SLIrUyI" 0 P Q(u'(l<•.(l y 1 S�j 4.Proposed Electrical Work/Fixture Count: C i�rC�-` L i e.C`(11,.(C.-j C) Qeiv Ut s�wfl►N� Y\tli C ful Lkjo u 3 L4 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: _jr_c)6u � A-(.0 60 ,being duly sworn,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 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, eatmctor gent,attorney,etc.) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belie tat any work performed,or use conducted at the above captioned property ,operty 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 me this 1 day of ,20 da of LQ1,j 20�L 3 Signature of Property Owner Si6laturie o Applicant r Print Name of Property Owner M::f Applicant ��. n 0— Notary Public Notary PtSfYWI MELILLO Notary Public,State of New York No.01ME6160063 _Quallfled In Westchester County, Co'mmission Expires January 29.20 1/5/16 STATEWIDE • 1:1 Main Street,Fishkill, NY 12524 1 emoil:office@swisny.com swis JOB APPLICATION8. 1 914.219.1062 • • • Office Use Elect.Permit# Date Bldg Permit# Utility ID# (71 Final Certificate# City/Village i', I, Zip Township Coun r Address _ - Cross Street Sect n. — Block Lot Owner Name/Address(if different than above) Contact Number ❑Basement 12-In't 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 �J 1 Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent l5 SERVICE Amperage Voltage 1 P 3P #Meters #Disconnect ❑Underground ❑New ❑Reconnect l ❑Overhead ❑Change p 1 C. ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information E JC U This application is valid for one(1)year from the date received by SMS.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 Items Inspected.The applicant declares that there is no open applications for the above address with any other Inspection company,The appikaM,owner or authorized agent agrees to all the above temp and conditions as set forth for the application. Inspector Date Finalized Inspector# Company Name 1 }k' 7 '! t'`;, 4 ' (. { ; Date /L < Signature Address — City/State -i Zip Code d - . License# Phone# ` �' RState Wide Inspection Services FSEP 13 2023D 1080 Main Street Fishkill, NY 12524 a VILLAGE OF RYE BROOK 845 202-7224 Phone BUILDING DEPARTMENT 914-219-1062 Fax STATE WIDE INSPECTION SERVICES ._ Email: ofFceCcbswisny.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: Westmore Electric Howard &Regan Hoff 6 Sunset Road 812 King Street Rye Brook, NY 10573 Rye Brook, NY 10573 Located at: 812 King Street, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 23-162 130.77 1 18 Certificate Number: 2023-6776 Building Permit Number: BP 23-106 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: 812 King Street, Rye Brook, NY 10573 The First Floor Kitchen 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 13T"Day of September 2023. Name Quantity Rating Circuit Type Luminaires 15 Receptacles 08 Switches 04 GFCI 03 Hood 01 Oven 01 Dishwasher 01 Refrigerator 01 Microwave 01 Officer: Frank 1. 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. O N N W N cd a � � cd w H a p ~" oo� N 0-4 z o :=7 sac C Oen A 00 ^ , F 0 Cl) � o � � °p° +� zC7% ,� ✓ W � o cn oNo 71 00 cn ►--� r. x q ' ►..a tR o w K, as : H a O "m J cr Z x OVt• zZ � o a F z Q x O $ W pa WJ w o r = � r r D E L LI DE' C 13 2023 yE D] i3Rnv� L..___.�...�. BUIL E ENT VILLAGE OF RYE BROOK VIL/ E 0 RYE K BUILDING DEPARTMENT 938 KINCak RYE B NY 10573 or PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: 3— 06o PP#: 00 1 Approval Date: -12APermit Fee:S Approval Signature: Disapproved: (fees are non-refundable) ************************************************************************************************** DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR.THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 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: Olt V L N V ST SBL: 13o►7 7—/—/Q Zone: J/ e)1 2.Proposed Work: V..1 el �s4mu NA 3.Property Owner:JJOW WQ kAb FF Address: '9(2 V)N& 61, ME IN2pc) Phone#: Cell#: email: 4.Master Plumber: r ,o Address:_�2c ,J�-lo�� V fL c�U► �✓y Lic.#: Phone#: Cell#: (j—C��2C� C( email:/''c Company Name: 1% lNI �t—T tK(1y Address: riv+-t, , ro INDICATE FIXTURES&LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1st Floor 2nd Floor 3`d Floor 4's Floor 51 Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Nest 2 Pages) -I- BUILDa MENT D C [ �IV H VILLOOK DEC 2 8 2023 938 KING T ,NY 10573 4 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: fit, glamLc/ 'C , residing at, Si�/ Y f L i i✓y S� Aye. (Print name) (Address vAere you lip c) !JJ 73 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; //PC/ Sf r� ,�/ / y.1 7 ,Rye Brook,NY. (Job Address) Further that all statements contained herein are true, and that to the best of his/her knowledge and belief,that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. (Signature of Property Owner(s)) 1-7111 i'v 1--r-J /-� F/— (Prin(Narne of Property Owner(s)) Sworn to before me this day of Pr(6M611A- ,20 23 (Notary Public) MICHAEL KELLMAN Notary Public, State of 'Jew York No.01KE5036394 Qualified in westchoster County 3 Commission Expires Nov. 28. Z,2(, 8/12/2021 3/3/2023 STW"'/' F NEW YOM COUNTY OF WESTCHESTER ) as: '�'") �y fF ,being duly sworn,deposes and states that he/she is the applicant above named, (Print name of individual signmg as the apples) and finther 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 the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Z L Sworn to before me this day of -t>,c r;040f ti- ,20 7-3 day of 20_Z_ Sigdature of Pro erty Owner St of Applicant rr- EVC31AC C lz"-�::� Print Name of Property Wrner Prmt� Name of Applicant AWA(167,14- 97WLVM fi&-'J�w Notary Public MICHAEL KEILMAN NOS' M.RNERA Notary Public, State of New York Netary Public,State of New York No.01 KE5036394 No.01R16441398 Qualified in Westchester County Qualified In Westchester County Commission Expires Nov.28. ze-ZL Commission Expires September 26, 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. 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- 10/30/2023 -- '��:, +r 1, ' ��-r`` 1 j�y,: f� � - �� i - � i'�I� , r� �► '� �► �►�' � � ,► � . f 1 �t �A P VA Building Permit Check List&Zoning Analysis Address: SBL: - Zone: U e 2 ons Type: Other. Submittal Date: l 1 Z Revisions Submittal Dates: Applicant: �_ n Nature of Work Reviews ZBA.JUI 1 2013 BOT Other. FEES:Filing. BP:,4 a�' C/9: 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: (� ( ) PLANS:Date ed. Sealed Copies: Electronic. Other. ( License Workers Comp: "Liability- Comp.Waiver. Other. �- ( ) ( ) CODE 7S3#: 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. ( ) ( ) 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: A PpQnmicn REOLWD EXISTING PROPOSED NOrr±s Date JUL 1 g 2023 Am: Cir Fmu� Main Cov Acm Cov Ft H/Sb: Sd.H/Sb: SIF& : a-imp: HHd /Stoles notes: N C - C m U E g s � cv LaN 0 3e " O `x f o j CQ s rU� am. a �. a Z .eo►► , G j/ W N O = JAI-W I .J too p 2 a ►U- a d o a� �,� .. a. t L c a ; $ E o 0 un � � P wad 16- ACoOR" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYY1) 05 30 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 endorseme s. PRODUCER CONTACT EACT TONY CIRINO Anthony Cirino w�'IN,Ext) (8601329-0103 _ FAX.Not: (e60)62aoso4 426 North Main Street ADDDRIESS: In szuYpaol.com Southington,CT 06489 INSURE (s)AFFoRMO COVERAGE we a INSURER A. UNITED FARM FAMILY INS COMPANY 29963 INSURED sletllteR s; FARM FAMILY CASUALTY INSURANCE 04m1n*3 OPTIMUM BUILDING CORP Mama!C: 70 PROSPECT STREET INSURER D: PORT CHESTER,NY 10573 wwtmee: NY 1OS73 I 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. slMt TYPE OF INSURANCE -—ADDL1tiU AM M1111 POLICY NUMBER POLICY a" POLICY Ew YY LIMITS -- X CULL GENERAL LIMILITY EACH OCCURRENCE : 1,000,000 CLAMS-MADE ❑X OCCUR PREMISES 4 RENoqcumno ED f 100,000 - MED EXP(Any ors person) f — S1000 B _ Y Y 3101 L6417 02/01ae11 s1/61/M4 PERSONAL a ADV INJURY s 1000 000 GENt AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE t: 2,000,000 X POLICY SECT LOC PRODUCTS-COMPIOP AGG S 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE (Es scc4wd) - f 1,000,O00 ANY AUTO BODILY INJURY(Per person) S A OWNED SCHEDULED AUTOS ONLY X AUTOS 3101C7984 01/91/1023 03/01/2024 BODILY INJURY(Per acold@M S XHIRED X NON-OWNED PROPERTY DAMAGE _ AUTOS ONLY /� AUTOS ONLY War acciderd) UMBRELLA LLAB OCCUR EACH OCCURRENCE II_ A_ EXCESS LIAR CLAIMS-MADEAGGREGATE : DED I RETENTION ---- s ---- -- WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY YIN ..ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT s OFFICERIMEMBER EXCLUDED? ❑ NIA (Mandatory In NH) E.L.DISEASE-EA EMPIOYEE�1 II yyees,desmbe under $ - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101.Addition.]Remarks Schedule,may be attached It more specs in required) VILLAGE OF RYE BROOK IS INCLUDED AS ADDITIONAL INSURED ON GENERAL LIABILITY 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 NY 10573 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) a o A A A A A A 133887956 i OPTIMUM BUILDING CORP 429 DEN RD STAMFORD CT 069033811 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER 128 SOUNDVIEW OPTIMUM BUILDING CORP VILLAGE OF RYE BROOK 429 DEN RD 938 KING ST STAMFORD CT 069033811 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W1478 260-1 814511 04/09/2023 TO 04/09/2024 6/2/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1478 260-1, 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:I/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 CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. CHRISTOPHER SCELFO-PRESIDENT OPTIMUM BUILDING CORP ONE PERSON CORPORATION 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 STAT SU NCE FUND TT �/ DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 398236357 U-26.3 i � x �� YH QW tZl- t ( ww c., >-Q I ' „4 U_W 0 0! n � 01 0 E5 p f1 n f1 Q J • >m T x _ DOOR- C.M* c I 401i da n � ,DAI/ HAFELE 1 12►� lb ��� �" �norJ � �use r ►� O Q144 ` N 3& 1 LLCM- F--7,7—+-`_' 33 -�`♦' -+ I idZ ArELE 'tit '40, -+---33 33---� DUTS 3!0 --- - A17 F►t�R. A :tiaLL Qfi cu P194ww ,/ 3 f-;: D �K)k N U LA- v I b-vi 2-4 G 41 i 24 ltl I ��1�.t�_ WWII 9D O�. it S1 m L `