Loading...
HomeMy WebLinkAboutBP23-114PERMIT #XC7T SECTION TYPE OF WORK JOB LOCATION DATE• 7. , P. r�rn?)g4 e e 0,a0)0/ 6Q70 s OWNER r/C' %QA aFi AC G�E'�%/!� C�SE� Y5% je c 5, 9966 CONTRACTO t4vrh J40 �,(eaee 1 /%1.Sc /, (84 MOY 0 EST COST' - FEE I " V/CQ # FEE�1,S'Q �,4b DA T TCO # FEE DATE DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING O RGH PLUMBING GAS C] SPRINKLER ELECTRIC O LOW -VOLT C� ALARM C� AS BUILT (p FINAL I NSP R APPROVALS ZBA OTHFft 4'S�UILTlFINAL SURVEY REQUIRED PRIOR TO FINAL INSPECTION Q ve / ! 8 c) (.Qy�DR VILLAGE OF RYE BROOK MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J.Bradbury www.aebrookny.gov TRUSTEES BUILDING & FIRE INSPECTOR Susan R Epstein Steven E. Fews Stephanie J. Fischer David M.Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE November 26,2024 Eric Gioseffi&Jacqueline Gioseffi 30 Lawridge Drive Rye Brook,New York 10573 Re: 30 Lawridge Drive,Rye Brook,New York 10573 Parcel ID#: 129.67-1-54 Building Permit#23-114 issued on 7/25/2023 for a New Fence This certifies that the new 41/2 foot high black aluminum fence and gates,installed under the above captioned permit have been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to I I For office use only: BUILDING;DEPARTMENT PERMIT#6100 3-// VILLAGE OF RYE BROOK ISSUED: J U N 12 20.24 � j 938 KING STREETS RYE BROOK,NEW YORK 10573 DATE: &—/a—� VILLAGE OF RYE BROOK (914)939-0668 FEE: ,8 /,'5-0 PAID$ BUILDING DEPARTMENT www,ryiroQkny.>?ov 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 \\#iiiifitiiiiiiii\tits\iififititiiti#fiiiiifi##tit#iif♦itf#iti\\ifti#tfitff\ii\t#tii#i\#fttii#it\###f\\#i\#\\fititfi\if#i\\\ Address: X ~iA Z e "Ic N py j Occupancy/Use: A4 Parcel ID#: /Z°f. G7-1 '�-y Zone: (iZ/S- Owner: 6,otell�' Address: 3-d la w (yL Dr. 9+ooe !(tV/o-S'7P P.E./R.A. orContractor: 3NCrm Ihntt^ rta srrrf,ac Wddress: 'W 9ytf- pw �Vy A910 Person in responsible charge: Ic�!'')" (&0k MrSC4 Address: 1�7 Rsyk- ?w i#Y j/44!,. 6,,Mt is Ny /om 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: ?�)c- &;-y—q' being duly swom,deposes and says that he/she resides at 3a 4 4n (Print Name of Applicant) (No.and Street) in &e &yo&- ,in the County of 4Z;ae.'k. in the State of t,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:S S, &O0 , for the construction or alteration of:.hit Q ,�rtS�lt((zeQ an T�s4 11 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 thereofhereafter 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§250-1O.A.of the Code of the Village of Rye Brook. Sworn to befo me this I Sworn to before me this day of v L'�1'C , 20 1 day of , 20 gnature of Property` er Signature of Applicant Print of Property Owner Print Name of Applicant r Notary Public SHARI MELILLO Notary Public Notary Public,State of New York No.O1ME6160063 _ Qualified in Westchester County Commission Expires January 29,20 z� �E BRC��. �m 1982 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 - - - - - - - - - - - - - - - - - - - - ADDRESS : 3G DATE: 02 y PERMIT# ISSUED: SECT: ' BLOCK: LOT: LOCATION: ��+)C P_ OCCUPANCY: r ❑ VIOLATION NOTED THE WORK IS... ❑ 'ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS s ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL 0 OTHER }pJ� E A : M \ n W ^N.. N N � 14 a r^ �7 0i .7y P. +- s v' ^ Grii ., o W E W O O W v�i -5 c Wto z CDs a r N! N � � � Oo w00x Hcv � A _ � M cvo � a p4 � O AN00oe 1-1 LO Q � a 0-4 z O ° V W w CD P3 aTim co s 01% oo � � u z � a q � W FBI G1 hr"1 M a M (7a CW7M, o O• -4 �'•-.. M v O z � w y o Q'� U m 0 CA 44 V W V W O Q w x Q,I V7 cn O zz •� vw U N p `I Z (� µ+ �Mq Q ate, a b❑❑ W O 08 \ A W ICI U ° y C a4J Fr �. A 4a � Q p V O Vg � � IL V U W Z C7' A Z O E OQd � � o � C1Z M W W Q ] ii ZLu a � u. Sao u O B►UILD,I. 1G0 ARTMENT H C E� �"/ VILL,kCi'� OF R �RROOK SUN 302023 938 KING tEET RYE B k,NY 10573 VILLAGE OF RYE BROOK r BUILDING DEPARTMENT FOR OFFICE USE kONLY: h Approval Date: yUL 2 4 3 er Application# 3-'o� a Approval Signature: ! ARCHITECTURAL REVIEW BOARD: Disapproved: Date: BOT Approval Date: Case# Chairman. PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: �� 1 Application Fee: Permit Fees: `&]'��' Uvc FENCE / WALL / GATE PERMIT APPLICATION Application dated: V/ is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of Permit for the installation.constructio i,repair or replacement of a Fence.Wall or Gate,in accordance with Section 254-6 B.(1)(g),of the Code of the V illage of Rye Brook,as per detailed statement described below. Swimming pool fences must conform to the State Code. 1. Job Address: 3o l.Qu�r�"`7� �cir. /Z�C t 4y� /.qy?�3 _._--.- 2. Occupancy/Use: 5 G c�Nr'I S.B.L.#: /2- (al -$1f Zone: jZ�j s 3. Proposed Fence/Wall/Gate(describe in detail): ��// �Slr .4v a1r, ��-A v,9 5, ( an '&-It. g& 544Ql a.sa e� .t>L r.' l a� /I a vd r 4. Property Owner: Address: �v C Aer, 3 Phone# CelI# enj .3r`T-&W _email: ��i r� gfra r. copy Applicant: 5&me 'PNea* Address: Phone# Cell# email: Architect/Engineer: Address: Phone# Cell# email: 1 Contractor: �� Address& Phone: 2 ,Jk QGr/ Vellel Cp yG dyy /49� O 30�- 5. If building is located on a corner lot,which street does it front on: 6. What is the estimated cost of construction 1 '-�00 (NOTE:The estimated cost shall include all site improvements,labor,material,scaffolding,faced equipment,professional fees,and material and labor which may be donated gratis.) 7. Estimated date of completion: G��fp�Z� t 6/1/2023 Please note that this application must include the notarized signature(s) of the legal owner(s) of the above-mentioned property, in the space provided below. Any application not bearing the legal property owner's notarized signature(s) shall be deemed null and void, and will be returned to the applicant. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,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. Sworn to before me this SU Sworn to before me this day of 20 day of 120 ignature of Pro wner Signature of Applicant P ' erne of Property O r Print Name of Applicant Notary Public Notary Public SHARI MELILLO Votary Public,State of New York No.01ME6160063 Qualified In Westchester County ^ommission Expires January 29,2W 2 6/1/2023 ' 1 Buildinv Permit Check List&Zoning Analysis { Address: ASBI,: Zone: �^ se �� Const.Type: � O her. Submittal Date: N3 �J L visions Submittal Dates: Applicant: OSL \ Nature of Work: i NS �'t I (A— q lnly�1 Reviews:ZBA: I111 1 1 2073 PB: BOT: Other. P ( ES:Filing.�=BP: \ J C/O: rlood Plane: Legalization: ( ) (� P: Dated: - Notarized: ✓ SBL: toss I.D. Cross Connection H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening ( ) ( ) ENVIRO:Long. Shore Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection S/W Mgmt.: Tree Plan: Other. ( ) (�),,SURVEY:Dated: Current: Archival Sealed: Unacceptable: ( ( ) PLANS:Date Stamped Sealed Copies:y�—Electronic: Other ( /( License: Workers Co Liability • ✓ Comp.Waiver Other CODE 753#: ( ) ( ) 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. ( ) ( ) I-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. (t� �O Other. \ ( ,ARg mtg. date pprovaL• ` r3otes• ( )ZBA mtg. date: approval: notes: ( )PB mtg.date: approval• notes: APPROVED REQUIRED EXLSI'ING PROPOSED NOTES ate: pie: JUL 2 4 2023 sue: l� Front: Si : Main CoP. Ac_cs,COy: Ft.H S .HSb: QE&- Tot.!=: Ft..3mg: Pr H"/Stories: notes: p BUILD..; � CC� COMC�RTMENT JUN 3 0 2023 VILL OF RY OOK 938 KING ET RYE BR NY 10573 VILLAGE OF RYE BROOK 101 4 9 �#j BUILDING DEPARTMENT ARCHITECTURAL REVIEW BOARD CHECK LIST FOR APPLICANTS This form must be completed and signed by the applicant of record and a copy shall be submitted to the Building Department prior to attending the ARB meeting. Applicants failing tosubmit a copy of this check list will be removed from the ARB agenda. Job Address: Date of Subm•ssion: Parcel lD#: Proposed Improvement(Describe in detail): e-,-- �,+ D � /�J�� APPLICANT CHECK LIST: MUST BE COMPLETED BY THE APPLICANT 6, The following items must be submitted to the Building P Department by the applicant-no exceptions. Property Owner: (r�szst�ot 1. ( �ompleted Application 2. ( )Two(2)sets of sealed plans. Address: ?D Zf.✓ e- &, !S/e B/ k A.)� allm�ahlc plan si/.c ?6...\ 42"; ,in(l rn,,: 11"\17") 3. ( }'Two(2)copies of the property survey. Phone# a---) �Z3 -776/6 4. ( Two(2)copies of the proposed site plan. Applicant appearing before the Board: 5. (v j One electronic/disc copy of the complete application materials. e1riL ok1ff- 6. ( )Filing Fee. Address: 30 4a,,4 fo", ec„ k vY lo3 7 ( )Any supporting documentation. 8. ( )HOA approval letter. (ifopplicable) Phone# �73 3L3 -9'9�ro 9. (✓)Photographs. Arch itect/Engineer:�Zn�c• 44M�� 10.( )Samples of finishes/color chart. (a sample board or Phone#-4��o model may be presented the night of the meeting) Z'���6 Z Z v By signature below, the owner/applicant acknowledges that he/she has read the complete Building Permit Instructions&Procedures, and that their application is complete in all respects. The Board of Review reserves the right to refuse to hear any application not meeting the requirements contained herein. Sworn to before me this L) Sworn to before me this day of �L�e , 20 a day of , 20 ignatur Prop er Signature of Applicant m e of Property Owner Print Name of Applicant Notary Public Notary Public SHARI MEULLO Notary Public,State of New York No.01ME6160063 Qualified In Westchester County Commission Expires January 29,20PL-7 8/122021 ��� 1} ���• Village of Rye Brook enda �16�%P Architectural Review Board Meeting Wednesday,July 19, 2023 at 7:30 PM Village Hall, 938 King Street �J I 1. ITEMS: 1.1. ARB23-064(Consent Agenda.) DRJ West LLC 32 Lincoln Avenue 4'high white vinyl fence with driveway gate. 1.2. ARB23-065 (Consent Agenda) Brian Zelesky&Alexandra Zelesky 26 Hawthorne Avenue 4'high PVC picket fence,4'high black chain link fence,4'high white PVC driveway gate and 6'high black chain link fence. 1.3. ARB23-066 (Consent Agenda) Alexander Sherman&Samantha Sherman 26 Lawridge Drive 4'high white vinyl fence and gates. 1.4. ARB23-067 (Consent Agenda) Richard Billig&Kathleen Billig 16 Red Roof Drive Replace walkway and front steps. 1.5. ARB23-068 (Consent Agenda) Sherree Amar 45 Lincoln Avenue Rooftop solar array. 1.6. ARB23-069 (Consent Agenda) Sujan Vasavada&Sujasha Vasavada 2 Heritage Court Rooftop solar array. 1.7. ARB23-070 (Consent Agenda) Michael Rackenberg&Stefanie Rackenberg 144 Country Ridge Drive Rear patio. 1.8. ARB23-071 (Consent Agenda) Karen Kuznetzow 267 North Ridge Street 6'stockade fence,post and rail fence along retaining wall and gate. Architectural Review Board July 19,2023 1.9. ARB23-072(Consent Agenda) Eric Gioseffi&Jacqueline Gioseffi 30 Lawridge Drive 4'-1/2"high black aluminum fence and gates. 1.10. ARB23-073 (Consent Agenda) Thais Cunha&Marcela Melgarejo 17 Lincoln Avenue Replace patio and walkway. Consent Agenda Approvals: Motion "-- Second ;1 Abstention Aye; Nay; Adjournment; Notes 1.11. ARB23-074 Jose Sagastizado&Noemi Sagastizado 28 Division Street Rear deck. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.12. ARB23-075 Sheryl Brauman 12 Magnolia Drive Rear deck. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.13. ARB23-076 Joshua Kirsch&Kristen Kirsch 2 Lee Lane One-car attached garage and driveway parking court. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes Page 2 of 4 Architectural Review Board July 19,2023 1.14. ARB23-077 Win Ridge Realty LLC 13 Rye Ridge Plaza New awning. "Stretch Lab" Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.15. ARB23-078 Win Ridge Realty LLC 112 South Ridge Street New facade sign and awning. "DIG." Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.16. ARB23-079 (Amendment to Prior Approval) 760-800 Owner LLC 760 Westchester Avenue Change from Betafence Guardian Dutyguard fence to black chain link with privacy green hedge inserts. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.17. ARB23-080 Jacob Gebrael&Marleine Ishak 1 Hunter Drive In-ground swimming pool. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes Page 3 of 4 r ' Architectural Review Board July 19,2023 1.18. ARB23-081 Gregory Varone 47 Hawthorne Avenue New single-family dwelling with attached garage,in-ground swimming pool,spa,cabana, deck,patio and fencing. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.19. ARB23-082 Richard Gasparino&Bridget Gasparino 6 Jacqueline Lane Legalize 12x24 storage shed. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.20. ARB23-083 Srivatsan Raghavan&Janani Ranganathan 436 North Ridge Street Window and door changes. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.21. ARB23-084 Christopher Baildon&Tamzin Manning 72 Valley Terrace Legalize 10x23 rear paver patio. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes NEXT MEETING: August 16, 2023 Page 4 of 4 Hirsch Fence Install & Design 747 Route 9W 1 Valley Cottage, NY 10989 tEE9!I }-3 Cun«,Tr,LIII NIf1rFFI RM Noft ` Deb sarvre{Aoereu O I 911011111111111 zip [, CUtlomN'tl C�• TA/V1I Pnone fVe Cusbrner I F mail Addrns ■ Na■r■y Clow stwo PERMITANSPEC N INFORMA es No J1 (neon ain 5iF, f� nala qn as"of lyrrTy be"YNta/Wan u (NO {{�onsl 1 to o01p1n .rm�t Sell bw,n s AIroRO1tIfAATE LAYOUT NCE FOOTAGE CONTAtNW N THta" OUNCE WILLN ANUITEO HEED ON ACTUAL FE FOOTAGE S OT Ali SET F WN?ft"ED ONr�� 1� '�r v'r('{FINAL�q� ADDITIONAL COST OPTIONS AX TIE 111100 a N n" O.IiN`1 TO THE SELECTTC IN 'AKE D LD F NAIIL AwAr OLD FEW NCE PERM?COST S / I SUB TOTAL SALES TAX FINAL AMOUNT DUE (Do in fts dpon cco 0 c ❑ Stock Product Ll :.uaf o•nef assumes all rCSponsLWlM1ies as d relates to aft addltonal tabor and nutenal Costs as 9 re aVes 1/, �r Special Order Product to u,e fence bong nstaned on a nnghbors property - J"f I •'// C �/� �/ ,�/ Grs.gn�.pprovW Customer �j ` ��,aM� T•,/�+/(� /Jr'—JI/�y EN E INSTALLATION RELATED T GRADE:PLEASE INITIAL ONE /�4pm*`,� � ' a ,�n(�(~ , ".(:5.., _•.�E E�L ".� .:,•..r AN FISTEUPM NiTALLATUM(— FEW-ETO aE LL:� N'+ �-;n��'GW:± So. TIT U'EVEN GRIDS METH FENCE ,OK�MIal Kacrcwur uc. l W h TO 1111-M"IX MG 1�V5?��Eo•._�...�e,G.i:.. FEEW WLL BE U.EVEKA•TO7 rTr.eo ses.�tswo■:.ine.ws..os� re at ws�ar.ro ru.yn Product J IL Product Product Sty e ft Height Style Height Style: Height Footage: 1 if Gates: Footage. If Gates Footage. If Gates post Cap. Color / Post Cap Color Post Cap Color Rail Type' Post Cap Rail Type Post Cap Rail Type Post Cap Placet Type $ FMdcet Type. S PlCkel Type. $ f S � '• , Rom. r �� a: .�•`. P ; -t I b�rra a' '3 r♦� s—� w� 3tt Y ,piit ,ya �i � �1 {+ � a • { r , s�� / �V �`� wIf ? ♦ ` fy ♦ M { P /r�r1 •fi i � 1 M .r C �ft0)1AR MR.,-it sr 'y wt y� ,',.- 1q Vt':. 1�`. fxawa�� �#�brc..,�lT«it::.� t(!sl• `y F c w ¢;3-. aA fj 0 ' tn GO LJ :. V �. v u , itw m L Go 46---K r% V Q) o :a x ... ~low W C) J LLi LLJ IV CC c Imp Poll LU _ v L mom = Qa_S � ' 'J 90 1r n a 7 � � c {•,,vim � _ �. ' y ORco -Z 0 o v N y i . C itls»' (<�M/F�►s►f * 4 '���.yu7i"-f,-.�.) K;T�((( !/ '.".?Fl?' �itri�'':!ll �� �y ' i;.d� �� ,.'"`, ■� ir.,�^,�' `9a } (�1,1�,,'[ i).e }il!!)►', '•, 1,' w `•� w 'AA�1 » ��IAt��` L`(�1t '1'j^,�1 i..5i DATE(MMIDDNYYY) ACOROI CERTIFICATE OF LIABILITY INSURANCE `� 1 06/16/2023 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 CONTACT Courtney Potter McCarthy Insurance PNO11E E-ti (914)769-0417 378 Elwood Avenue EAQDI)RESS. Courb*y@mccarthyinsuranc*jwt Hawthorne, NY 10532 INSURERS AFFORDING COVERAGE NAIL• INSURER A INSURED INSURER B Hirsch Fence Install & Design LLC INSURER C: 747 Rt 9w Cottage#4 INSURER D: Valley Cottage, NY 10989 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 00002210-549539 REVISION NUMBER: 3 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CHUMS. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LTRCY NUMBER fmLIMITS A X COMMERCIALGENERALLIABLI Y Y BOP0100721375 11111212022 11/12/2023 EACHOCCURRENCE '$ 1.000,000 CLAIMS-MADE OCCUR DAMAG TO RENTED tEas occufferKe 50.000 MED EXP An one ) S 5,000 _ PERSONAL a ADV INJURY S 1,000,000 GENL AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY Is LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER. S AUTOMOBILE LtA KM COMBINED SINGLE L09 $ i n ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLYaccident) f UMBRELLA I" OCCUR EACH OCCURRENCE S EXCESS LIAB CLAA484AADE AGGREGATE S DED RETENTION S $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YINSTATUTE -EI• ANY PROPRIETOR•PARTNER'EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED-' El NIA (Ma dMory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS;LOCATIONS'VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached if more space is required) Address :30 Lawridge Dr., Rye Brook, NY 10573 Certificate holder listed as Additional Insured CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Rye Brook THE EXPIRATION DATE THEREOF.NOTICE WILL BE DELIVERED IN 938 King Street ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook NY10573 AUTJH/ORIZ�rs "47, ---�--_ ' CPO © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by CPO on 06/16/2023 at 09 30AM ZSi YTOATEK Workers' Certificate of Attestation of Exemption Compensation P from New York State Workers' Compensation and/or Board Disability and Paid Family Leave Benefits Insurance Coverage "This form cannot be used to waive the workers'compensation rights or obligations of any party." The applicant may use this Certificate of Attestation of Exemption ONLY to show a government entity that New York State specific workers'compensation and/or disability and paid family leave benefits insurance is not required. The applicant may NOT use this form to show another business or that business's insurance carrier that such insurance is not required. Please provide this form to the government entity from which you are requesting a permit,license or contract. This Certificate will not be accepted by government officials one year after the date printed on the form. In the Application of Business Applying For: (Legal Entity Name and Address): Building Permit Hirsch Fence Install&Design LLC 747 Route 9w#4 From: Village of Rye Brook Valle%Cottage,NY 10989-2452 PHONE:945-304-9622 FEIN:XXXXX0091 I he location of where workwill be Derformed is 30 Lawridge Dr,Rye Brook,NY 10573. Estimated dates necessary to complete work associated with the building permit are from June 16,2023 to August 16,2023. The estimated dollar amount of project is SO-S10,000 NN'orkers'Compensation Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE SPECIFIC WORKERS'COMPENSATION INSURANCE COVERAGE for the following reason: The business is a LLC,LLP,PLLP or a RLLP;OR is a partnership under the laws of New York State and is not a corporation. Other than the partners or members,there are no employees,day labor, leased employees,borrowed employees,part-time employees,unpaid volunteers(including family members)or subcontractors. Partners; Members: Bruce Hirsch Disability and Paid Familv Leave Benefits Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE STATUTORY DISABILITY AND PAID FAMILY LEAVE BENEFITS INSURANCE COVERAGE for the following reason: The business MUST be either: 1) owned by one individual; OR 2) is a partnership(including LLC,LLP,PLLP,RLLP,or LP)under the laws of New York State and is not a corporation; OR 3) is a one or two person owned corporation,with those individuals owning all of the stock and holding all offices of the corporation(in a two person owned corporation each individual must be an officer and own at least one share of stock); OR 4) is a business with no NYS location. In addition,the business does not require disability and paid family leave benefits coverage at this time since it has not employed one or more individuals on at least 30 days in any calendar year in New York State. (Independent contractors are not considered to be employees under the Disability and Paid Family Leave Benefits Law. 1,Bruce Hirsch,am the Member with the above-named legal entity. I affirm that due to my position with the above-named business I have the knowledge,information and authority to make this Certificate of Attestation of Exemption. 1 hereby affirm that the statements trade herein are true,that I have not made any materially false statements and I make this Certificate of Attestation of Exemption under the penalties of perjury. I further affirm that 1 understand that any false statement,representation or concealment will subject me to felony criminal prosecution,including jail and civil liability in accordance with the Workers'Compensation Law and all other New York State laws. By submitting this Certificate of Attestation of Exemption to the government entity listed above I also hereby4ffirm that if circumstances change so that workers'compensation insurance and/or disability and paid family leave benefits coverage is require t e above-named legal entity will immediately acquire appropriate New York State specific workers' compensation insurance and/or disabilitiadd paid family leave benefits coverage and also immediately furnish proof of that coverage on forms approved by the Chair of the Workers' ti oard to the government entity listed above. HERE Signature: Date: j Exemption Certificate Number Received 2023-044311 June 16, 2023 NYS Workers' Compensation Board CE-200 01/2018 Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Wednesday,July 26, 2023 2:13 PM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 07/26/2023 14:12 To: VIL RYE BROOK PRIMARY Transmitted: 07/26/2023 14:12 00001 Ticket: 07263-001-842-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 30 To: Name: LAWRIDGE DR Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: BOTH SIDES OF HOUSE NearSt: BOXWOOD PL & SLEEPY HOLLOW RD Means of Excavation: POST HOLE DIGGER Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: FENCE INSTALL Estimated Work Complete Date: 08/18/2023 Depth of excavation: 2 FEET Site dimensions: Length 70 FEET Start Date and Time: 08/04/2023 07:00 Must Start By: 08/18/2023 ------------------------------------------------------------------------------ Contact Name: BRUCE HIRSCH Company: HIRSCH FENCE INSTALL AND DESIGN Addrl: 747 RT 9W Addr2 City: VALLEY COTTAGE State: NY Zip: 10989 Phone: 845-304-8622 Fax: Email: bruce@hirschfence.com Field Contact: BRUCE HIRSCH Alt Phone: 845-304-8622 Email: bruce@hirschfence.com Working for: H/O ------------------------------------------------------------------------------ Comments: LOIN DIAMETER Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA CONED SUEZ WTR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR 1 v1 C Zcc C= 0 O O gJ y N •O G¢ .off lei 2PcU Z 1i g UQ N z1� c p C7Q uuzco CA �5 Av �rod� +♦ lIP'_ =gy�pp .boLti_h C O} T O •ti O r-a '^ a"i Z >,'.. W o Z o W C�Yi._U C IY Mu EtQ v � z 2 y W sl3\3H'1,u, ql 7� Ol o � oa 0 0 5. W �bOls r 2 a h N_ d O a ,� ~_O m F- � coL (3NIl NO-IN) ` c U.3ON33)NJII NMiOl3ON3i yI Z lNN 41SOd 30 SNIVM(3N�� to Z6l 3.00 60o6b N =� Q O I CO uZ. M _ Q E LL: x \J +yr a a , # Z a jeAOaddd O V' Z WgOe ' @1f1�O3�luOatl r_` Mal w M� W Mooch eAti ;o OW13111A