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HomeMy WebLinkAboutBP23-128VI TCO N FEE DATE NaPECT10N RECOR9 DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMINGl-11�.7_ t INSULATION PLUMBINGmr RGH PLUMBING t!AS O SPRINKLER I)Q ELECTRIC LOW -VOLT ALARM AS BUILT O ASt FINAL r f4" �OZ'f '095 880 -lullrluon mq s 1 y Solu tes 0�3�a01/NKElec is LLc �Teckaf��/ OTHER APPROVALS ARB 80T PB zeA OTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 24-059 (Certificate of Occupancp JEhisis to certify that C.(.t.J 1744 R),�4-n / #h of, JFU / having duly filed an application on a' u (6. 20 Q?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: 'V5 . Block: Lot: 6, and having fully complied with the requirements �7ofthe Building Code and the Zoning Ordinance under Building Permit No. � — issued U / 20.=�, 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: �' ie" Construction: for the following purposes: )6 Y 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 ' taming the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of buil ing or in the a ac ties shall be made,and no enlargement, whether by extending on any side or by increasing in eight s e de, r shall a ilding be moved from one location to another until a permit to accomplish such change h bee tain from B mg Inspector. MAY 2 0 1024 Building Inspector, Village of Rye Brook: Date: D BUILD R NT For office use only.. PERMIT# 016 VIL OF RYE OK ISSUED: MAY - 6 2024 38 KING STRE YE BROOK, YORK 10573 DATE: — —d 4/ 9 -0 0 FEE.-4 Q,55 PAIDA VILLAGE OF RYE BROOK BUILDING DEPARTMENT 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 Address: Occupancy/Ujse: /C /t� Parcel ID#: Zone: �S Owner: / Address: P.E./R.A. or Contractor: / p Address: k/ y-lljr/I/ V 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 YOM COUNTY OF WESTCHESTER as: 2 1-A A • L-k'--Or 417(1 Ubemg duly swom,deposes and says that he/she resides at L,2 ��.���4 },�t Vr 6 w lC w (Print Name of Applicant) (No.and Street) in �; - �i cA-t- ,in the County of ��Mtn in the State of c�_ ,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 equippm'e'nt,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:S ✓ for the construction or alteration of: 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. Swom to before me this Y--� Sworn to before me this day of 20,) day o , 20 S" tore of p Owner Si ture of Applicant L lemk Eel e of perry Owner Print Nam Applicant Notary blic SHARI MELILLO Notary Public Notary Public,State of New York ANNY POLANCO No,01ME6160063 Qualified in Westchester County NOTARY PUBLIC Commission Expires January 29,20� STATE OF CONNEC0120TICU2 MY COMM. EXP.11/30/202a QyE BRC��. �m • 1982 BUILDING DEPARTMENT ILDING 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.ors - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - -- - ADDRESS : -I 1C e [` '��1 1 ✓� DATE: PERMIT# ?�� Z �� ISSUED: a 7"23 SECT: �J� BLOCK: LOT: J •� LOCATION: M�G- k\ o' OCCUPANCY: ❑ Violation Noted THE WORK IS... a"PASSED ❑ FAILED /REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas 1� -� u `c� J 04- �y4 ^- ❑ L.P. Gas ❑ FUEL TANK U ❑ FIRE SPRINKLER �- FINAL PLUMBING ❑ CROSS CONNECTION ❑FINAL ❑ OTHER �E BRcbl O� Zm cu � ��/�• 198,2 BUILDING DEPARTMENT `2 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 - - - - - - - - - - - - - - - - - - - - 0- Q CLL ADDRESS :— DATE: PERMIT# ISSUED: �1 SECT: BLOCK: LOT: LOCATION: ��C� C � 'y OCCUPANCY: ❑ Violation Noted THE WORK IS... PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ XIOUGH PLUMBING rROUgRFRAMING -1-1b SULATION ❑ Natural Gas �- ❑ L.P. Gas ��L - ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER L f ■ W L1 y w u � c �; Z A � � o � � �~ ai W ■ PLO Mayruas � o o A CIS ~ 7 ■ O W 00 CQ o o o v V o x N O o Q .e W � .. � y we W rTl � � " � � ►�i � J � u'� a U Cl3 IS CIA z � 12. co ° ""o920E O O Ur W oo �/ o O wv . � o � u ON V _ � O O � a0 � � U z ro `� a. � O t F� ■ W Z a a z v .. a Mw M M W o °��'" u G� L Chi \p O w vw C z j C) w oz b uga oz " BUILD MENT t� C E ��IU VIL E OF RY OOK 938 Knvc ET RYE BR` ,NY 10573 JUL j 2013 4 VILLAGE OF RYE BROOK BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: 2 gApplication Approval Date: � P it#: Fee:$ Approval Signature: Permit Fees:S Disapproved: _._Other: ***wwwwwww****t*****wwww****wwwwwwwwww**twwwwwww,tww,r*ww,t*w,t*w,r*www,r*,�ww**:t:�:tw:�w****t****,tw*w*,tw:c�rwww:tw*tt:tw Application dated: is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing building,or for a change in e,as per detailed statement described below. ��1. Job Address: /�-'`- APO 1 Gle' SBL lr,3Jr / 3'I-a+ Zone: 2. Proposed Improvement.(Describe in detail): 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: Yes: If yes,indicate: TIER I: TIER II: TIER III: 4, Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) :No: Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 5. Occupancy;(1 fam.,2 fam.,comm.,etc...)Prior to Construction: After Construction: 6. MY State Constru f n Classificatia N.Y.State Use Class' ►caa�tion: �1I Addre �� Or T k L 7. Property Owner: ss:p h� Phone#— rC) _ Cell# r '% Z — 'P email: /r'7'S` �� � �4�+ 8. Applicant: /e Address: if C -1 ,r�.,r Phone# ,y© '�/ �1 — ell# emaill: k1'G 4 L� ''0P o /rfL//TK,! 9. Architect: ' r�l U `I S� /,�Lr Address: -3 ��r G/ �y'/I� Ale- ,/ e pt r� &'/ Phone# o3- 6 S_- 3 Og Cell# email: y 9�/ PAPJI'& 10 B4/° 10. Engineer: Address: C � ' e o dy Phone# Cell# _ 22 e ail: 11. General Contrac 10 `� Address: `//I/� t W/ Phone# d©S-46 �__CSTO Cell# 10 J- S3 `-7'IS / email: �1 rr 12. Estimated cost of construction $ Cf y 0 OD (NOTE:The estimated cost shall include all labor,material,scaffolding,fixed equipment,professional fees,and Inaterial and labor which may be donated gratis.) 13. Job Timetable: Start: 'Zp 1 Finish: (l) 6/1/2023 BUILDZBR00x, MENT p [ C �I VIL E OOK 938 KING 4 ET NY 1057 JUL 17 2023 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: residing at, �} Kf DI I�aT m I I'rinl nsi77�1 l \Jdrr .a hic vut I' , i 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; 2• ,Rye Brook, NY. Doh Addressl 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. ISit itur f I'nrl ti L ancr'1 )I {3'rini N;in� rnperrc(?nj�rl�l) Sworn to before me this day of U1 L 20 7, JAKE k UPMAN IV, o"public,SUN d Nsw Vbrk (Notary Puhli•} egistrotion IOtl1i1729SS OusiiMd in Now Ya*Gou" liy ro7> 0116 NO Pub rrrrwMon Et�rra s1+0 Sim ton too w�Jiy�V >MM ��fl - illr!`on"04 �1; x,1-) 021 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. MSLPF EW YQRI�,,_CQ[J1�iT16 QFyJESTCHESTER ) as: �j► (��{'/I/-�/ [,' J ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and f rt r ktates 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. (i dicate architect,contractor,agent,attorney,etc.) That a statements contained herein are true to the best of his/her knowledge and belief, and that any work performed, or use ted 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 bef, re me this f Sworn to before me this day of , 207 day of 120 c atu of Property Owner Si cure of lic t ����'►G c1 nip 4 Print Name of erty(honer Print]Tame of A#licant LJ Notary Publ' h"otary Pu lic JORDAN VERA 'Notary Putiic,swe of Connecticut My Commission Expires 04 I2025 J"S A. UPMAN Notary PubNC,Shft of MM VS* R9918trdk►n sat LOS 17341145 Oka M W to Now Y**County owen*Wn Eq n f"pbntbw 10,20 14) srl2/2021 O N N N W N N N W a s Z x N v M ul Ln � � .ran a � � � r 7 z Ln 00 ^ cr W 0en 00 s _ w ✓ � Z O � V cv W 8 � � ' a Ln uj 00 O Q ^ . C04 o �+ A 'Wow, U in z U z Ln A z a 00 ' V x H = w z O U og U 4 zz z 4 3 d U Ln V � 8 it Q t Q • aR� p -AE-- "&i . BLTIL , ENT SEP 13 2023 VEL E OF RYE " OK 938 KIN ET RYE B ,NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT '.or ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: �3 - / EP#: Q,3—Q O I Approval Date: SEP 1 8 202 Permit Fee: $ /"J V —fi8 jD Approval Signature: - Other: ****************** 7tBuilding Application dated, 9 S zo2.3 is hereby mad Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install an r ove electrical equipmentes, or to perform other high or low voltage electrical work as per the detailed statement described below. By signing , the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal, State,County and Local Codes.1.Address: 2�{ (L¢� jLoaf' Sjc-'�V>: SBL: 13S �{3 - �•� Zone: 1n`- 2.Property Owner: ('��-ei-�,,,� .Se��v�:f v f cb-n, Address: 7-4 IZALy� V—ucA' v4L-/ Phone#: Cell#: (o�« - 7L42..- FscRS email: i•t•S-t ftFralF-a5 lei 3 T 3.Master Electrician/Licensed Installer: is y VgS Address:7.o. 'R4'o X < < C4--T-r 'k ww-j5w Lic.#: /S l Phone#: Ql i-Z:"-�k -OZZ-Z- Cell#: Q14 - V'87, email: @.v.k-ekecez•:'- ILY tasZI • Company Name: t A)fr� =_\fit-;L ,l L=- Address: '41.,Gnrw .� a.,d5�nn chr y /cSL-► 4.Proposed Electrical Work/Fixture Count: W l "I-11 ar •\\"rc-r;o r 1AA.^-$Crs- tooe-�a t.1 h a, o ti 5.31 Party Electrical Inspection Agency: 5 ra.c t�; e �j,vrSPe.cr�av� �y�cA-S STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: 14 i \'r" k V./aS ,being duly sworn,deposes and states tha% a he is the applicant above named,and does further (print name of individual si&ning as the applicant) state that V the Z.,e clCe f Lta r—for the legal owner and is duly authorized to make and file this application. (Master Electrician/Licensed Installer) The undersigned further states that all statements contained herein are true to the best 4/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 me this s day of ,20 day of ,20 7-3 i Signature of Property Owner Signature of Applicant Alick )O9 Y✓.4S Print Name of Property Owner Print Name f Applicant Notary Public V"y P Mo-Ka d Mew rblk N0.011ll 1876$6 za L 3/3/2023 STATEWIDE INSPECTION SERVICES, INC. 1:1 Main Street,Fishkill, NY 12524 1 email:• SWIS JOBAPPLICATION tel845.202.7224 • 1• SWISTraining.corn Office Use Elect.Permit#'�f— nQ 3_ 3O ' Bldg Permit#� %� � / Utility ID# Final Certificate# City/Village yC �,w;� Zip A) ` 7� Township �- County S�Z"� r: Address ` Q / f ^� Cross Street Section/3 L Y3 Block ! Lot S- S /J Owner Na" dd s(If diffe nt th n a Contact Number r ry, ` ✓r ran� ,w7-r;, ❑Basement ❑1st Fl. R2nd 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 7 Amt Amps 01 C' Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent / S SERVICE Amperage Voltage 1 P 3P I #Meters #Disconnect ❑Underground ❑New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information SEP 33 2023 VILLAGE OF RYE BROOK BUILDING DEPARTME_ T This application is valid for one(1)year from the date received by SWIS.This application Is intended to cover the above listed items to be inspected,if at any time of Inspection additional iterm haw 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 applicant owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Inspector Date Finalized Inspector# Company Name /tij K L t ` y C I,L L Date /2 /Z j Signature Address oSS 4 CA A J City/State �r 0 Zip C VSZ,,-7 License# S'o Phone# --�— DState Wide Inspection Services 1080 Main Street DEC ' 6 2023 Fishkill, NY 12524 asw u 845 202 7224 Phone VILLAGE OF RYE BROOK 914-219-1062 Fax STATE WIDE INSPECTION SERVICES BUILDING DEPARTMENT Email: office(a)swisny.com Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: NK Electric LLC Matthew &Jenifer Proto Nick Kalyvas 24 Red Roof Drive P.O. Box 171 Rye Brook, NY 10573 Croton-on-Hudson, NY 10520 Located at: 24 Red Roof Drive, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP23-201 135.43 1 I 5.5 Certificate Number: 2023-6944 Building Permit Number: BP23-128 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: 24 Red Roof Drive, Rye Brook, NY 10573 The Second Floor Master Bathroom was inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 6T" Day of December 2023. Name Quantitv Rating Circuit Type Luminaires 15 Switches 08 Receptacles 02 GFCI 02 Officer: Frank]. 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. ■ �", N N M t � C N M tti cn Z w u a 1-4 sn Z c� y LT. :z. lu Z o w Q w o � H z Z C O Q � x w y '' 0 {' Q M 00 Q a 4 Z w C4 ^ x a m W w F wO a z ob � ' Q ^ z 00 z o N 0 Z, a, Z00 a M 0-0 C F-� cN 5 � n � zz Q pD a M Q z N L • Q z o V v a a fia a a n a • �r �r� %—s I�,..f—I \\..�_Imo_ E BRC�vu BUIL � MENT SEP 21 2023 V1L E OF I�YE OK 938 Krly ET RYE B ,NY 10573 VILLAGE OF RYE BROOK (914)9 939-5801 BUILDING DEPARTMENT or PLUMBING PERMIT APPLICATION / FOR OFFICE USE ONLY B -3' �� PP#: cD� ''/ o/ � Approval Date: q` 2 !Permit Fee: $ /�' p� Approval Signature: Other: Disapproved (fees are non-refundable) Application dated, c)/'a 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 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: Z4 ea kfv--,F SBL: J� 7�--5-,,-5Zone: 2.Proposed Work: 0 - 3.Property Owner: Address: Phone#: Cell#: email: �� 4.Master Plumber: NLC hr�PwC� Q `��� Address: t'2 C t)t y 1�k Abo OW 1 Lic.#:20-Phone#: Cell#: 91 462-6 3�3 email: * COtr\ Company Name: ttlnnl�t.net rrhY1t ,l ta;�� ),�Address: c lv,y 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 2 / 3'Floor 4`h Floor 5`s Floor Exterior 5.* List Other Equipment/Provide Details: Notarized Signatures Required Next Page ��las 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. 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 10 Sworn to before me this day of s 1.'t/ 20 'L day of , TSiatuJr 'roperty Owne Signature of Applicant 4P nt of Pro erty Owner Print Name of plicant -6�4114 M 4 Not ry blipAK q LIPMAN� No ta Public �C 'itergistr�ation NoA016173955 TR7.TON TATE Cualiied in New York C011n N7TARY _�?''.,i"' �'5V YORK My Cortm'ssionEx i.— MUM co' � ata a 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- 6/1/18 r BUILDING DEPARTMENT VILLAGE OF RYE BROOK SEP 2 1 2023 938 KING IT RYE BROUK NY 10573 0 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 O,F+ nN,EWwY�ORK, COUNTY OF WESTCHESTER ) as: 3, JQ 'h (YYl'tl�e W ff-bf-m- , residing at, � PQaCJ kUip ;fit k (Print name) (Address where you livA 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; R&Y rl U �k- , 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. r (Si& ture of ULopirty O er(s)) �NVUA Prt t (Print Name Qf roperty Owner(s)) n Sworn to before me this U day of � X`���( , 20 Sarah BridginS NOTARY PUBLIC.STATE OF NEW YORK Registratiat No.01 BRh_h50S7 (Notary Public) Qualified in King Count Commission Expires 09:5'2025 -3- 8/12/2021 .Building Permit Check List&Zoning Anal sis Address: J \ J SBL Zone: Use: Const.Type: _� Other. Submittal Date: —1 �1 2O� Revisio Submittal Dates: Applicant: Nature of Work Reviews:ZBA: BOT• Other. QK �,h � (� FEES:Filing. BP: C/O: Flood Plane: Legalization. APP: Dated: i.-—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,,StamPed: - Sealed: --,-Copies: 'Z Electronic. Other. ( ) (a License: ✓ Workers Comp: Liability �mp.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. ( ) ( ) 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. O O Other. ( )ARB mtg.date: approval: notes: ( )ZBA mtg.date: approval: notes: ( )PB mtg. date: approval notes: APPROMU —� REQUIRED ExISTING PROPOSED rroz-E,s Dom, J U L 3 1 2023 Cir : - Fie Front Froru Ste: Main Cov Accs.Cov F HS : Sd.H/Sb T !rrr : Pkrnv HHrght/Stories: notes: Laura Petersen From: John L <johnl@formlimited.com> Sent: Friday, August 4, 2023 2:56 PM To: Laura Petersen Cc: itstheprotos@gmail.com Subject: 24 Red Roof Drive Hi Laura, My name is John A. Leontiou, I am one of the partners at Form Ltd. We are doing the bathroom renovation at 24 Red Roof Drive. You can use my name John A. Leontiou or my partner's name John J. Waters (John Waters is the person who will be on the job site ). Let me know if you have any other questions. Thank you, John A. Leontiou Form Ltd 32 W Putnam Ave Greenwich, CT 06830 203-869-6880 johnl(c)formlimited.com 1 gt I rKI- I'll KMMM-2t: WIMP 1A AK. CD (D BY C) Ln ft ----- gz 0a M! 0 CD 7Q -1 -9 CA CD 0 CD C) CD V CD CD I-V �-W _ ~ tom.`. < # Depa C) CD M .......... 0 C') CO) C—D C) > En -e�z CrQ > 1110 A E1011 0) OD w CD O"o) CD CD F r. A w- V* ft,.... .... .. . .... CD'w aw CD 0 ic. C17 CD • N3 'w rA Fit . . . . . . . . . . . . ;64 5 . O , W-M- M" - , A Y. 5 M 7 , fy "iPJ111 iffloy J l "g , ATl av SMR Roti! t %o DATE(MMDYYY) ACORO® D /Y CERTIFICATE OF LIABILITY INSURANCE 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). CONTACT Katy Zelz PRODUCER NAME: Mullen and Mahon,Inc. PA/C HONE No, o Ert (860)684-4236 Fvc No): (860)684-3473 72-I West Stafford Road E-MAIL katyzelz@mullenandmahon.com ADDRESS: PO Box 85 INSURER(S)AFFORDING COVERAGE NAIC B Stafford Springs CT 06076-0085 INSURER A: Selective Insurance Co of America 12572 INSURED INSURER B: FORM LTD INSURER C: 32 W PUTNAM AVE INSURER D: INSURER E: GREENWICH CT 06830-5341 INSURER F: COVERAGES CERTIFICATE NUMBER: 23-24 MASTER 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. INS TYPE OF INSURANCE POLICY NUMBER MM DD/YYY MMDDIYYYY POLICY EFF POLICY EXP LIMITS LTR INSD WVD X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 RENTEDDAMAGE TO 500,000 CLAIMS-MADE Fx_]OCCUR PREMISES Ea occurrence $ MED EXP(An one person) $ 15,000 A Y S 2445013 05/29/2023 05/29/2024 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 3,000,000 PRO- LOC PRODUCTS-COMP/OP AGG $ 3,000,000 POLICY �JECT $ OTHER AUTOMOBILE LIABILITY Ea acccident SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LAB HCLAIMS-MADE Y S 2445013 05/29/2023 05/29/2024 AGGREGATE $ 1,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- STATUTE ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ _T I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Jenny&Matt Proto,24 Red Roof Dr.,Rye Brook,NY.10573 Village of Rye Brook,NY and Jenny&Matt Proto,24 Red Roof Dr.,Rye Brook,NY 10573 shall be listed as Additional Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 / ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF Y R Workers' NYS WORKERS'COMPENSATION INSURANCE COVERAGE STATE Compensation Board Insured Detail Ia.Legal Name and address of Insured(Use street address only) lb.Business Telephone Number of Insured Form LTD 203-869-6880 32 West Putnam Street Greenwich,CT 06830 lc.NYS Unemployment Insurance Employer Registration Number of Insured Id.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required(/'coverage is specifically limited to 061219046 certain location in New York State,i.e.a Wrap-Up Policy) 2.Name and Address of the Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Technology Insurance Company,Inc. Village of Rye Brook 938 King Street 3b.Policy Number of entity listed in box"la": Rye Brook,NY 10573 TWC4252181 3c.Policy effective period: 5/29/2023 to 5/29/2024 3d.The Proprietor,Partners or Executive Officers are: 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"la"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. Approved By: Matt Zender (Print name of authorized representative or licensed agent of insurance carrier) Approved By: 6/16/2023 (Signature) (Date) Title: Senior Vice President FORMLTD 18" 611'4 ------ 7 Z" r- 56I4" 2834" 6yl'4" 171.2 5614, KITCHEN AND BATH 23.75-63- 23.75-63- I B.Q.PENDANT TOBE MINIMUM 8-0 ABOVE TUB ri �� \ B.O.TUB INTERIOR NOTEs:11 60X32 n A PERMIT/ J CENTER LIGHT FIXT. " - ELECTRICAL: ON CEILING SLOPES SBIJI > SMOKE DETECTORS -- PER 1.ALL WORK IS TO DATE A�P NYS BUILDINGf RED SCODE CONFORM T O CURRENT \\ D STATE 8 LOCAL ! C SULDpWINSPECT R_ dwpm"w ELECTRICAL CODE. l I 2.RECEPTACLES FILE SHOWN ON THIS fff LU , ro U A A Co py DRAWING ARE IN r7 N I M,BATH f _ 'I rn o r I 1 I A ADDITION TO THAT 94.75" m118" j m94.75" E m94,75" 4 REQUIRED BY CODE. 2 I M.BAT 4 a m118" -- - ---- 3.ALL NEW RECESSED I - Q _ a STAR TILE 7 421 5 D CENTER LIGHT ' w FIXT.ON CEILING LIGHTS ARE TO BE LED m STAGGERED 6 o w ELEC SLOPES 1. 12X24 - - r W o RADIANT 4.GFCI OUTLETS ARE o ¢ __ TO BE PROVIDED WHERE w ` REO'D BY CODE. w n T o �i A i = , 3 o x $ O 1 I �^ _-a I T l wo 3 a; Aw j SHELVES A �\ I' N NEW 30X8 J s` - w POCKET DO . N, 9 - - E� - ----- _ - ---- ---- ..`--- .. ... LEGEND: m 118" m96' "' `� -- --- 96 - -.-- NEW WALL N _.._.__- rn I�rn i I \1 I CJ N J Q 3 8 42 DEMO: w CDa DOUBLE HANGING - _ Q Of SHELF ABOVE SHOE �' Ewsnrvcwu SHELF - '.. ID BEAMMALLABOVE I 1 74 1" 65" 13" �REMOVE EXIST 421 - ------' NO LOAD BEARING 96%" 561/4" 21" PARTITIONS&DOOR -- _- _______- _ � ELECTRICAL LEGEND: '3 3/ 43/ 153" - �- RECESSED: O A 48" 4,r4 34;4" 4 i4' 52" ----- - ---- � _--- - ----- �--y-- - RECESSED,WET LOC.: O AW EXISTING PLAN PLAN O ELECTRICAL PLAN / ELEVATION RECESSED,DIRECTIONAL: SCALE:1/2"=I'-D SCALE:I/2"=I'-0" 4 SCALE:1/2°=1'-0' AD DECO.FLUSH: B DECO.HANGING: C DECO.SCONCE: D FAN. `�E FAN B LIGHT: \(�n'�F PUCK LIGHT: 0 G ,. UC LIGHT STRIP; off CENTER LIGHT 8.0,PENDANT TO FIXT.ON CEILING BE MINIMUM 8'-G" SWITCH: SLOPES ABOVE B.O.TUB INTERIOR SWITCH.,5 WAY: 3 ^.--� — 24��g" 3414 sw1rCH.DIM.; OUTLET: OUTLET.ABOVE DTOP: k I � _ OUTLET.GFCI: I11)GfCI a JACK,TV: TV JACK,DATA: I JACK,PHONE IN SMOKE DETECTOR. O O I-O — - N 1 N ALL DRAWINGS MUST BE APPROVED BY CLIENT PRIOR TO START OF WORK SIGNATURE: 1 DATE: i r _ y PROJECT: 353'4' -�---33" 74" 48" 4<------4 --- y2„------ 4 I%"! 61�/" I 31/ 29 y PR�TQ aL" 35I/' 6 1 23�' 2 16 -�? 32" %2, >l- 24" _IN 2 21" " 423 4" 1531, 1423 4' 55 2" 48" 52 DRAWING: ELEVATION ELEVATION ELEVATION CLOSET ELEVATION CLOSET ELEVATION CLOSET ELEVATION MASTER BATH //''� 7 }^( --- PLAN&ELEVATONS 5 SCALE'1/2"=-D' SCALE:1/2"_-D° SCALE:1/2"= SCALE:112"=1'-0 SCALE 112"=1'-0" I 0 SCALE:I/2"=I'-0" SEAL •'`?y �r n� —. k �OF tad` DATE: Oa/05n023 DESIGN BY: JAL w DRAWING BY: NJDV SCALE: 110--11F 7DEPARTMENT REV.DATES: 05105/2023 DWG NO:J A-421.01 CAD FILEPROTO-2O230E03VILLAG °F BUILDI