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HomeMy WebLinkAboutSWP23-001PERMIT SECTION TYPE OF WORK JOB Lf)rlAnnm • COST �` O #�G DATE: t� o� gyp. C� cJ7 BLO K LOT uc�,ao, e S�iao� OC�o3).;a3-Q/7o TCO # FEE T DATE INSPECmu TION RECORD DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING O RGH PLUMBING GAS SPRINKLER ELECTRIC LOW -VOLT ALARM AS BUILT FINAL INSP OTHER APPROVALS ARB BOT PB IZBA OTHER yE D ` tip 4.�a�J V L C�`Ltu V � ,(A.�W Y . 19 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0753 Christopher J. Bradbury www.iyebrook.org TRUSTEES SUPERINTENDENT Susan R. Epstein OF PUBLIC WORKS Stephanie J. Fischer Michal Nowak David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE July 24,2023 Anne Rossmann 17 Pine Ridge Road Rye Brook,New York 10573 Re: 17 Pine Ridge Road, Rye Brook,New York 10573 Parcel ID#: 135.41-1-41 Storm Water Permit#23-001 issued on 6/8/2023 to Install Drainage This certifies that the drainage,installed under the above captioned permit has been satisfactorily completed. Sincerely, ^4//464, Michal J. Nowak Superintendent of Public Works /to For office use onl D J� BUILDING DEPARTMENT PERMIT#,��P- I l� VILLAGE OF RYE BROOK ISSUED: (p-. 1-25 JUL Z ?O23 H G STREET,RYE BROOK,NEw YORK 10573 DATE: -7 a 1 -zo 3 oe (914)9 -0668 FEE: j/ PAID VILLAGE OF RYE BROOK r BUILDING DEPARTMEN TIFICATE 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 essssrssrsssrasrssssssrsrssss*srss*rsrssrssrss*srssrasasraassrsssrsrrssrrarasssrssrss*s*rrs*sasssasrrsrrsrsssrssssaassssarss Address: 41 8 nP A1,,, /D 5 7 3 Occupancy/Use: PlMaR4 Parcel ID#: 4ir, , o -- i -�{f nn Zonenn 9 — 1 t�-_ Owner: n n7 Q h 4 Address: 4 7 COOC� I(L>� /CVe 4 N P.E./R.A. or Contractor: / 6 Address: AI G �40VLUadQ Person in responsible charge: Address: Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW YORK, COUNTY OF WESTCHESTER as: (� ft lQ Ss 111G 1AA _being duly sworn deposes and says that he/she resides at / ( 6d &2 1 hP (i y( (Print Name of Applicant) (No.and. eet) in Rye 6(DA in the County of We)1 A in the State of� ,that (Ci /I'own/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:$ 45 Q e CQ for the construction or alteration of: WIN km 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 I y Sworn to before me this 02/ day of , 20� day L , 20 �KtL - - �/716t� Signa operty Owner S' tuie o pplicant koss ma 6 SC.�q S(l/;-0 �. S• N� 1 Pr' Na o Property Owner Print Name of Applicant ANA M SALAZAR N Ialic NOTARY PL BLIC.STATE OF NFW YORK � ENZA M. CUSENZA Reaistrauon No.01SA6365173 Notary Public, State of New York QaalifieJ in a'esichcstcrcounty No. 01 CU6183779 Commission Expires 10-02-2025 Oualiiied in Richmond County Commission Expires Mar 24,2024 BR(�k Village of Rye Brook Public Works and Engineering Department 938 KING STREET•RYE BROOK,NY 10573 ��• 1982. (914)939-0753 Fax(914)939-0242 INSPECTION REPORT Address: j / f`i �'�" J Date: C Name: �y� Location: Permit#: LPhone: Email: Work being Inspected Work Inspected is: Apce"ptid Rejected Re-Inspection Required Violation Noted Code Section Code Section: Action Taken Code Section: Action Taken 118 Erosion Sediment Pass Fail Violation 210 Storm Water _Passe Fail Violation 135 Refuse Pass Fail Violation 215 Street Sidewalk Pass Fail Violation 213 Steep Slopes Pass Fail Violation 235 Trees Pass Fail Violation 216 Illicit Discharge Pass Fail Violation 245 Wetlands Pass Fail Violation Other: Pass Fail Violation Notes: Diagram: lT- Signature z O CV N W p bp cr cu 4i I.,■I fl. O yZ z a A a w O cn LW 04 ■ z r\ M T-1 C k L „V� I ■ 00, c y4 ai tqoo : W v a O Why ,ram` w2 � ' ■ � ° cw W U W W o N eq �+� v w a q U f-I ■ 45,00 o ' rs / 1 ■ w ,'�.., �, � A or, � F' � x � ,a .� � U � W ■ V ° & W o � p W � �% � � g •� � � c '""i CAI V o O Z W W O �i u o U N U ! w I , o V. a �n a2 Ly A W OU Z C o a J404 n. �I pp N r4 W w L BUILD MENT E C E N E V1Li { E OF RY OOK 938 KING �,'E'T RYE BR ,NY 10573 APR - 4 2023 IV, - VILLAGE OF RYE BROOK BUILDING DEPARTMENT FOR OFFICE USE /ONLY: _ Approval Date: G - ' it#: (.(!t �� BP #: Approval Signature Permit Fee: Disapproved: Other: Attached Resolutions: ( ) B.O.T.; O P.B.; O Other: STORMWATER MANAGEMENT CONTROL PERMIT APPLICATION Application dated: is hereby made to the Building Inspector of tiic Village of Rye Brook,NY,for the issuance of'a Stormwater Managem nt Control Permit for work,as per detailed statement described below. 1. Job Address: el b("6 2. Parcel I.D. #; - ' -, ,y� r Zone: �- 3. Proposed Work(Describe in detail):T- D PpA CIE l<m f VL— 4. Property Owner: ,& Nti A.5 5,A Address: /jZ PIiV- 9/i)6,C i,�� J' C�01L�lV Phone# 6 5�5Z;�3.32 Cell# email:dW02 �C fff I�(�.•YJ,�/,e; .GC9 o Applicant: .5,654ST4{2 _AXE-7- A 77 t ca?/ST 'lfC,1/0,4/ �� G Address: 191 e a 2 7 4,kiE Phone# ,)03•2.23 21 7Z0 Cell# email: 5,7-14/ .4/? o a✓,CO Arch itect/Engineer: Address: Phone# Cell# email: General Contractor: 5464-!4 7,4o ),ETD .P T t_irgh S C- Address: AI/ 6626 f 4 T 74Y'4 _6Z,ItS,AVI Phone# ,r- Cell#e Wo;. � ,�/ ,email: , �` 'Ges�/lj 5. Estimated cost of site work $ >� `� — O ftl nkl/ ; -1 : ���(NOTE:The estimated cost shall include all labor,material,scaffolding.fixed equipment,pro essional fees,backfill,grading,site restoration,carting/tipping fees and material&labor which may be donated gratis.) 1 8/t 2/202 t STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,,Sr,26,4 3T/0 A/Z`F0 ,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 s, &/�-5 f/,ADD �/,s�T� 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 ofRye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this -3 rJ dao Sworn to before me this 071r,4 day of Ae t I , 202�3 daM of j , 20 a3 Signatw roperty(honer i tore o Applicant Print Name of Property Owner `'Print Name of Applicant of . - Notary CLAUDIA UVALOO DNA M SALA2AR NOTARY PUgI_1C, STATE C"i+_VJ YORK IJO.C' ST I �r� VOTARV' URLIC.STATE OFNEWYORK QUALIFIED II`d'v'JtcilCi E i I �i L�}ii,"7TY R gi,iraiiun No.01SA6365173 CQMMISSiC,ty EXPIRES AN IL 12,',024 QW!ified in WeslchcsierCoanty Commission Expires 10-02-2025 2 8/12/2021 BUILQ - MENT VIL E OF RY OOK 938 KKtNG ET RYE BR ,NY 10573 4 w AFFIDAVIT OF COMPLIANCE VILLAGE CODE_§21 b • 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: Anne Rossman , residing at, 17 Pine Ridge Road (Print name) (Addre s%%here%<Iu H\c) 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; 17 Pine Ridge Road _ , Rye Brook, NY. (Job Addres ) 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. rgm rrc ut Property OwnerO) Anne Rossman (Print Name ol'Propert� 0xuner(,)) Sworn to before me this 3( day of 0 (Notan.Public) CLAUDIA UVALD0 NOTARY PUBLIC, STA F -'=NEW YORK P��) o11_w 1- h QUALIFIrr�,1.4 INES[Ut,: .;TER COUNTY COMMISS.OIN EXPIRES APRIL 12,2024 8/12/2021 i oz-z L0.1 i cc CN �'1'1'�'� 11. �F:A .��;<'�'�� ��;i�,'/'1'�'�'�� ��'�'�'1'�'i � ` ,ih'�'�'1'� � �� 1��1'1•1�1,, � '1��11•1'�1+, ��� ':. r�'� '� s;:.hl�l� fr st',hl ��� : h�l�y'. 3, h�l��' • �i hN�d f E• '�:3-s� h�,�d `�s. �` ��11�' s. •n" �. 1 ;r. o0i Gx.� C0 • Cuss)I V a`. ` tr u o t H "a;,, �, •rr J W j U cr O 7 U) m °a 0 ,ito» f r l p Z Q Z 3 s c:. 0 r W u = JG t4 c:,*row W Oui �r x c0 Z ff(�)► � - � � � p 'i mitts) lo x t y •� � 1�1 'Z7 r I��'� N cct 'a N • L Lid C :! � _ An An • d 40 40 �t(o) '� 4;"'-- -r„"y'/h �^•r'-rf a=�'H-••-i`3s r•;,fi t4 I/hf . M? .�• v � ti ��g/ i�//1;: i��/,�l/;,r�$j +j�� � ,h� (/��f ��,'/,/'c,a. y��/'j/c,i i��/l l/�,i• j�t�� �'�iA .I��••�I�rp ^ �,►'l�l�,�,•,'•'' r��A �.�t�, •• ,l��^r• �� a�r���l��,�yi •1� 1 ' i► •� •• ;�A��,' •� .��.�.•� ACC?R" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/21/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Sharp Insurance Services Inc CONTACTNAME Moises Rosales 128 N Main St PHONE 2032479524 FVC No 2036638200 Port Chester NY 10673 ADDRESS: mrosales@sharpsvcs.com INSURERS AFFORDING COVERAGE NAIC 8 INSURER A:Obsidian Specialty/ Insurance Company 16871 INSURED E&I Construction LLC INSURERB: 191 Hobart Avenue INSURERC: Greenwich CT 06831 INSURER D INSURER E: 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. INCY EFF POLICY EXP TR TYPE OF INSURANCE INSO SUER POLICY NUMBER MM DPOLID/YYYY MMIDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY b/ II I EACH OCCURRENCE $ 1,000,000 ✓ TE CLAIMS-MADE OCCUR PREMISES(Ea oDAMAGE TO cicur ence $50,000 A SCB-GL-0000026446 03/09/2023 03/09/2024 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $2,000,000 ✓ POLICY❑ JE ❑ LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ RED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE i ER ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ F7 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Additional Insured: Village of Rye Brook CERTIFICATE HOLDER CANCELLATION Village of Rye Brook 938 King St SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Rye Brook NY 10573 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Moises Rosales Producer I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26(2016/03) The ACORD name and logo are reyistered marks of ACORD NYSI F New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE i '^^^^^ 371954820 SHARP INSURANCE SERVICES INC 128 N MAIN ST f PORT CHESTER NY 10573 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER E&I CONSTRUCTION LLC VILLAGE OF RYE BROOK 191 HOBART AVE 938 KING STREET GREENWICH CT 06831 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE X2566 360-0 20572 03/10/2023 TO 03/10/2024 3/21/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2566 360-0, 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 STAT SU NCE FUND 7 4/ DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 669661052 ii �aa