HomeMy WebLinkAboutBP23-146PERMIT # TD 3 _ 11 DATE: liKP: S
SECTION /3: S/ 3 BLO _
TYPE OF WORK � yOi roo rlc2v47 /on
JOB LOCATION
OWNERS.
CONTRALTO C� OL/C /%9 Q�/✓I / / O PQ•� tlee7, pma C7��I� / 36' �9% c
. COST FEE
FEE AT `f
TCO # FEE DATE
FOOTING
FOUNDATION
FRAMING
RGH FRAMING
INSULATION
PLUMBING
RGH PLUMBING
GAS
SPRINKLER
ELECTRIC
LOW -VOLT C7
ALARM
era1M
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OTHER APPROVALS
VILLAGE OF RYE BROOK
WPSTCHPS COUl T-X, NrW YORK
NO. 24-007
Certificate of ®ccupoucp
This is to certify that3&V-1 1&
of, having duly filed an application on
\J�W 20_tLj?�/requesting a Certificate of Occupancy for the premises known as,
51 ke�t� �&x& Avo/. ,Rye Brook,NY, located in a )( -/5 Zoning
-�
District and shown on the most current Tax Map as Section: / Block: --L Lot: 9 ,
and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building
Permit No. , issued 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
1 '
New York State Classifications,Use: - -Z / Construction: ,
for the following purposes: �rl-�e`�QY '0774 X*ice' ,2Q7OV7,e eo
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 be or 1 e building be moved from one location
to another until a permit to accomplish such change has be nob d from B nspector.
Building Inspector,Village of Rye Brook: Date: d AN 2 3 2024
D BUILDING DEPARTMENT PERMIT
VILLAGE OF RYE BROOK ISSUED:VTZ
JAN -9 2024 38 KING STREET,RYE BROOK,NEW YORK 10573 DATE:(914)939-0668 FEE: WOO
VILLAGE OF RYE BROOK
BUILDING C1EPAR V,'—::1'T
APPLICATION FOR CERTIFICATE OF OCCUPANCY, CERTIFICATE OF COMPLIANCE,
AND CERTIFICATION OF FINAL COSTS
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Address: Jr_ (f �' LC,�C�!� �C l% N / S 7
Occupancy/User Parcel ID#: 3 i 3 3 Zone:
Owner: Al k0l L- l S i t/.4 It i 6 ELi;?r$-�r'—6 Address: S/ &( m,Ll nl Oeyc)41 A e 3tewl- A
/ �� 3
P.E./R.A. or Contractor: Jr-AN/ kIF/X I- Address:AZ ,a&,46 f/PLZ ly� —
ft-
Person in responsible charge:J r A-N D c n F I/RR 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: /')
d)0-/A,C) l3A/-76 being duly sworn,deposes and says that he/she resides at .5 /
in 1 l 2 r: ,intheCountyof /,%2 c r2_ in the State of ,U y ,that
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: ,�
for the construction or alteration of /�R 4 ki-I
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.
th
Sworn to before me this Sworn to before me this
day of , 20�LZ day of -1:)i L e-m b i 2 , 20 '•�j?
Signature of Property Owner Signature of Applicanel2k
f.-1 A L
Print Name f roperty Ow Prmt ame of Appl" t
"f
, �
No r lic Notary blic
MICHAEL ESQUIVEL
Notary Public-state of New York MICHAEL QUIVEL
NO.0 6442359 Notary Public-state of New York
Qualified i stchester County NO.01ES6442359
My Commis 0n xp'res Oc 1,2026 Qualified in stchester County
My Commissi E ires Oct 26
eMolr- ,
�E BRC��.
F
• 1962' BUILDING DEPARTMENT
❑BUILDING INSPECTOR
[kXSSISTANT 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: S I Vv ( ") I � •J Q, WOO L� �a (J 0�-� DATE: � �J ZO2 Y
PERMIT# & 13- 0( ISSUED: 21-23 SECT: S* .33 BLOCK:_LOT:
LOCATION: / /�`1 J 'l U� ' OCCUPANCY:
❑ Violation Noted THE WORK IS... [T PASSED ❑ FAILED REINSPECTION
❑ SITE INSPECTION REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION I �
❑ Natural Gas ��� �hlc)rL �� C(Z✓�'� e t� Ct /�d / f" ^')
❑ L.P. Gas
❑ FUEL TANK
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
❑ CROSS CONNECTION
FINAL
❑ OTHER
�E BRC��.
l7
/'• 1982. BUILDING DEPARTMENT
'Qj1VtrWNG 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 : J �3�J t ,� DATE:
PERMIT# ISSUED: SECT: BLOCK: LOT:
LOCATION: �l 1 OCCUPANCY:
❑ Violation Noted THE WORK IS... [:]/*ASSED ❑ FAILED /REINSPECTION
❑ SITE INSPECTION REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
INSULATION
❑ Natural Gas
❑ L.P. Gas
❑ FUEL TANK
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
❑ CROSS CONNECTION
❑ FINAL
❑ OTHER
�E BRC��,
O� 2m
cu �
• 1982• BUILDING DEPARTMENT
AR"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 • ATE•
PERMIT# � ISSUED: �: BLOCK: LOT:
LOCATION: L.�� Q C�� `k�7 OCCUPANCY: ( t
❑ Violation Noted THE WORK IS...i/ PASSED ❑ FAILED REINSPECTION
❑ SITE INSPECTION ` or: REQUIRED
❑ FOOTING }
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
- /ROUGH PLUMBING
ROUGH FRAMING
' ❑ INSULATION
❑ Natural Gas
❑ L.P. Gas
❑ FUEL TANK
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
❑ CROSS CONNECTION
❑ FINAL
❑ OTHER
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BUILDklI ,q DEPARTMENT ® I,G E N F.
VIL EIRYE
E BROOK �f1
938 KING EROOK,NY 105'73 AUG - 8 2023
668
k.t,r, VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
INTERIOR BUILDING PERMIT APPLICATION
FOR OFFICE USE ONLY: y� ,�1
Approval Date: AUG 2 4 20 tit# "_r
a Application Fee:$ I00— b
Approval Signature: Permit Fees: $ u
Disapproved: Other:
Application dated: ' is hereby made to the Building Inspector of the Village ofRye Brook,NY,for the issuance of Permit for the
interior alteration of an existing building,or for a change in use,as per detailed statement described below.
1. Job Address: 5\ W 16416 6 W NA> SBL:/1!�,3-3 /rA-la zone: -/5
2. Proposed Improvement. (Describe in detail): \w�1 k714�q-COm QLWQ'4I�►'� I U
0G vn u, v
J. Does thyproposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook?
No: Yes: If yes,indicate: TIER 1: TIER II: TIER III:
4. Will the proposed project require the installation of a new,or an extension/modification to an existiA 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;(I fam.,2 fam.,comm.,etc...)Prior to Construction: After Construction:
6. N.Y State Construction Classification: N.Y. State Use Classification:
7. Property Owner: 'r Addresrs:- 9 k lJJlv'�>\O6 UJZCt> t '-i
Phone# Cell# "11-`' 1 '�D� email: a � �
8. Applicant: r� %A�klrh Address:16k `Q 0ko ' !Q-Oli1A N" khmll 9y 0Q10(1
Phone# Cell# —email:
9. Architect: Address:
Phone# Cell# email:
10. Engineer: Address:
Phone# l nnCC�_elll�l# email: (, , e ,� 1� �/, , i /�,
11. General Contractor: M `�`"►�„Vo Address:2�DI �Q11��"���L�-17 ��t ko �`W� "4 �.1�91�
Phone# Cellnll#r �l"1- - email:
12. Estimated cost of construction
(NOTE:The estimated cost shall include all labor_material.scaffolding,fixed equipment,professional fees.and material attd labor which may be donated
gratis.) ,(
13. Job Timetable: Start: Finish: '1
(1)
BUILDING;DEPARTMENT ECE]WED
Vu,LAGE OF RxE$ROOK AUG - 8 2023
938 KING STREET RYE Mom,NY 10573
(914)939,0668 VILLAGE OF RYE BROOK
`y ,R.rylkare BUILDING DEPARTMENT
AFFIDAVIT OF COMPLIANCE
VILLAGE CODE §21 6 • 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 PLUMING PERMIT
APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT.
STATE OF NTEW YORK, COUNTY OF WESTCHESTER } as:
I, A bA LA lu (G U W ,residing at, r W(1A 11 V14 Y t/(lip Pb . Pq t��?'VDK �
(Print name) (Ad(h4ss where you live)
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;
5 i 11V (h d(V1 G �y 1 00 L , 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 Own )
(Print Name of Property Owner(s))
Sworn to before me thisr�
day of tJ I , 20 a3
4�� 00�_/
(Notary lic)
kr11}I LEMCK
NdW 021�63ate YOr t
Qualified in New York County,,�2
CorraruWAM Evit"14209:i-
8/12/2021
STA �.dj,.
ORI ,COUNTY O WESTCHESTER ) as:
being duly sworn,deposes and states that he/she is the applicant above named,
(print name o signi gas 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.
Swom to before me this � Sworn to before me this
day of ' `" 5 ` 20-;Z 3 day of ,20
Signature Pro er Signature of Applicant
Print Name of Property Owner Print Name of Applicant
)Z
Notary 9fiblic V Notary Public
ITH
11c,State oP PSe y York
. 02LE6325855
Sltaalhied in New York County
missions Expires 10-7-'p-q)3
i
(4)
8/12/2021
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BUILDXNG DEPARTMENT SEP 12 2023
VILLAGE OF RYE BROOK
938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK
39-0668 BUILDING DEPARTMEN"i
w*w&6ros#.org
ELECTRICAL PERMIT APPLICATION
Westchester County Master Electricians License Required
FOR OFFICE USE ONLY BP#: EP#:
Approval Date. s P 1 3 3 Permit Fee: $ ( !`'
Approval Signature: Other:
************** ********** **********************************************************************
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 electrical equipment,wiring, fixtures, or to perform other high or low voltage electrical work as per
the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work
performed will be in co ormancelwith al applica le Federal,State,County and Local Codes. c�
1.Address: I � SBL:�� _ 33 —�—� / Zone:
2.Property Owner: 5 — 3Aik Address:
Phone#: Cell#:�q 1 q) '� l)Zj email:
3.Master Electrician/Licensed Installer: Addr^eAddress:Lic.#:�Phone#: I L ell#: email: e> 4 bYl6ti
Company Name: (�C (( C Address: ` 1
4.Proposed Electrical Work/Fixture Count:
M A�fFiZ ` la- cos
5.31 Party Electrical Inspection Agency: 1
STATE,OFPWO COUNTY OF WESTCHESTER ) as:
7'# i being duly swom,deposes and states that he/she is the applicant above named,and does further
(print name of individual s' un a pp i t ' r
state that(s)he is the yl for the legal owner and is duly authorized to make and file this application.
aster Electrician/Licensed Installer)
The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work
performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this
application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire
Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances,and regulations.
Sworn to before me this Sworn to for e this
day of ,20 day of ,20
Signature of Property Owner eEofApplhioi
t
��O/Z
Print Name of Property Owner t ant �(
Notary Public Notary Public
SHARI MELILLO
Notary Public,State of New York
No.O1ME6160063
Qualified in Westchester County / 023
Commission Expires January 29,20
STATEWIDE •
Service With haegril.'ll"
1:1 Main Street,Fishkill, NY 12524 1 email:• •
SWIS JOBAPPLICATION tel845.202.7224 I fax9l4.219.10621 SWISNY,corn I SWISTraininq.com
Office Use Elect.Permit# /� f Date
Bldg Permit# /� ` � ' / , / � Utility ID#
Final Certificate#� ) y/
City/Village .�' Zip Township County
Address S 1��)f o Cross Street Section Block Lot
Owner Name/Address(If different than above) ( A)'. r �- Contact Number I („ In�/
❑Basement ❑ 1 st A. r]2nd Fl. ❑3rd Fl. ❑More Thann33 Fl. ❑Garage ❑Attic ❑Outside [!�R[essiidential ❑Commercial
Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact
Amt Amps
Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw
Incandescent Fluorescent
SERVICE
Amperage Voltage 1 P 3P #Meters #Disconnect ❑Underground ❑ New ❑Reconnect
❑Overhead ❑Change
❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection
Additional Information
i
SEP 1 2 2023 3D
VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
This application is valid for one(i)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 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,Tht applcant,owner
or authorized agent agrees to all the above terms and conditions as set forth for the application.
Inspector n Date Finalized Inspector#
Company Name t I t ` I\ Date J Signature
Address City/State t ` i Y Zip Code 'O
License# cam, Phone#
R :1%
State Wide Inspection Services
C—A�o 1080 Main Street
JAN 1 2 2Q24 Fishkill, NY 12524
845 202-7224 Phone
VILLAGE OF RYE BROOK 914-219-1062 Fax
STATE WIDE INSPECTION SERVICES BUI[DING DEPARTfNIcNT Email: office0swisny.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:
BNA Electric Corp Stuart Gelbard &Adrian Gelbard
Rafael Guedes 51 Winding Wood Road
18 Daniels Place Rye Brook, NY 10573
White Plains, NY 10604
Located at: 51 Winding Wood Road, Rye Brook, NY 10573
Section: Block: Lot: Electrical Permit Number: EP 23-198
135.33 1 29
Certificate Number:2024-0247 Building Permit Number: BP 23-146
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: 51 Winding Wood Road, Rye Brook, NY 10573
The 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 10"day of January 2024.
Name Quantity Rating Circuit Type
Dedicated Line 02 20AMP
GFCI 01
Sconce 02
Thermostat 01
Floor Heat 01
Jacuzzi GFCI 01
Light Fixture 01
Luminaires 05
Switches 05 �
Officer: Frank J. 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 tivork performed on the date of inspection only.
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BUILDING DEPARTMENT SEP 12 2023
VILLAGE OF RYE BROOK
938 KING STREET RYE BROOD,NY 10573 VILLAGE OF RYE BROOK
(914)939-0668 BUILDING DEPARTMENT
ilkzlal
PLUMBING PERMITAPPLICATION
FOR OFFICE USE ONLY BP#: PP#: J rD g
Approval Date: SEP 1 3 201 Permit Fee: $
Approval Signature: Other:
Disapproved:
(fees are non-refundable)
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: l �✓i'NA�' �- �.(�C'�p SBL: �VJ f ''� / Zone://�—/S
2.Proposed Work: �tf'y rc,L
3.Property Owner: u-4-1-y Ql bard Address: s l w►ti C`t W f-)
Phone#: Cj1K q39 35--t *Cell#: j I`I G 3-36ay email: SGe�kl-4 arr.nq`tz �-
4.Master Plumber: Zr-LdMAjS Address: yp
Lic.#: Phone#: Cell#: S/Y-S 3%-.,3 email:
Company Name:f/Y' -// Address:
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 a '
3'Floor
4m Floor
51 Floor
Exterior
5.*List Other Equipment/Provide Details:
(Notarized Signatures Required Next 2 Pages)
-I-
3/3/2023
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 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.
d �`/
Swornto before me this �Z Sworn to before me this
day of ,20� day of ,20 42,
71VIA
Signature of Prop Si e f Applicant
Ct Name of Property Owner Print Name of Applicant
° Y: c RACHEL COLON Notary Public ^�
Notary Public-State of New York 9 3
NO.01 C06212134 NORA HILDINGER
Qualified in Westchester C unty NOTARY PUBLIC.STATE OF NEW YORK
%ly Cornmission Expires . Registration No.01H16377888
This application must properly completed in its entirety and must 'nC1umMdWpa s1jgi1 *) f
Co mission Expires y 6,J021.
the legal owner(s)of the subject property,and the applicant of recorns
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-
3/3/2023
R
IECr � `� FEE
MPARTMENT ID
SEP 12 2023
--
VILLAOE OF RYE BROOK
938 KING NY 10573 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 PLUMING 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,
(Print name) (Address here you live)
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;
d✓�7e_4 , 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.
Q
(Signature of Property Owner(s))
-%,to"t Ge-IL'_J
(Print Name of Property Owner(s))
Sworn to before me this d'�_
20��
otary Pu -C)
z, 0
RACi1EL COLON
Notary Public-State of New York -3-
NO. 01C06212134
Qualified in Westchester Co nt
^.ly Comimission Expires �L 8/12/2021
.Building,Permit Check List&Zo7'.
' Analysis
Address: �c
Zone: Z' ` _Use: oast.Type: v Other.
Submittal Date: Revisions Submittal Dates:
Applicant
Nature of Work 1Y `C,,v AC L1a5 ctr �cQv4 ,pC�
�1
Reviews:ZBA: AUG 1 4 2023 P& BOT: Other.
NEED OK (_ � -
(G� (FEES:Filing: BP: y� C/O: Flood Plane: Legalization:
O ( VAPP: Dated: &---Notarized: r SBL: --Truss 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:__7,�LArchival• Sealed: Unacceptable:
( ) ( S:Date Stamped: Sealed. Copies: Flectroni Other.
( ) (J/License. ---Workers Comp: ''Eiability Co er Other.
( ) ( ) CODE 753#: Dated N/A:
HIGH-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other.
LOW-VOLTAGE ELECTRICAL:Plans: Pemut 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:P�' Permit N/A: Other.
H.V.A.C.: Plans: Per N/A Other. OC — (2,A _ t en'
( ) ( ) 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: Aim
REQUIRED EXTSITNG PROPOSED NOTFS
Arm: Date: Ali 3
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,---04N NICETOU-01 BEGEL1
A►coRO CERTIFICATE OF LIABILITY INSURANCE DATE(MNI/DD/YYYY)
8/2/2023
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 ISSU96G 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.
ff SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
tllis certificate does not confer rights to the certificate holder in lieu of such endorsement(s)-
PRODUCER CCD!(i�CT Ellen Goldman(egol lmanobutwin.Com)
Nathan Butwin Company,Inc. PINOrIE FAX
60 Cutter Mill Rd.Ste.414 (AIC,Ns,Efd#(516)4664200 ( ,No: 516 466-4213
Great Neck,NY 11021 mwn
MSUR AFFORDNO COVERAGE NAIC f
INsr,HetA:Utica First Insurance Co. 15326
INSURED INSURER B:
Nice Touch Remodeling Corp 911SUI®11C:
261 Broadfield Road D:
New Rochelle,NY 10804
INSURER E-
IMSUIIIIE2F: I --
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.
INSR TYPEOFIIISURANCE DDL:SUBR �� POLICY EFF POLICY EXPLTR -� - LIMITS - - -
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000
CLAIMS-MADE ❑X OCCUR ART3000621790 11/16/2022 11/1612Q13 DAMAGE TOR9NTED 50,000
IVIED EXP(Any oneperson) 5,000
PERSONAL&ADV INJURY 1,0009000
GE Nt AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000
X POUCYEl mf LOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER:
AUTOMOBILE LIABILITY COMEIINED SINGLE LIMIT
S
ANY AUTO BODILY MLILM Per memo $
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY RLIIURY Mer accidad $
AUTOS ONLY A IR SO Y aaadmrt�_-
UMBRELLA LIAR OCCUREACH OCCURRENCE $
EXCESSLIAB CLIU�MDE AGGREGATE
DED RETENTION$ y
WORKERS COMPENSATION PE2 (7TH-
AND EMPLOYERS LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTNE ❑ EL-EACH ACCIDENT f
��FFlCERMEIdBERDUIUDED? NIA
(Aland=in NH)
EL DISEASE-EA EMPLOYEE $
IT yes,describe under
DESCRIPTION OF OPIERATIONS below E I DISEASE-POLICY LIMIT
T-
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,AddfiorrM Remarks Schedule,may be attached f more space 6 requamd)
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
g y ACCORDANCE WITH THE POLICY PROVISIONS.
938 King Street
Rye Brook,NY 10573 r -
AUTHOR®REPRESENTATIVE
GAILMO-7
NYSIF
New York State Insurance Fund PO Box 66699,Albany, NY 12206
1 nysif.com
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
^A^^A^ 263244395 'r
RELVAS TRAVEL CENTER
86 GRAMATAN AVENUE
MT VERNON NY 10550
SCAN TO VALIDATE
AND SUBSCRIBE
POLICYHOLDER CERTIFICATE HOLDER
NICE TOUCH REMODELING CORP VILLAGE OF RYE BROOK
261 BROADFIELD RD 938 KING STREET
NEW ROCHELLE NY 108042412 RYE BROOK NY 10573
POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE
W2049 922-4 512763 10/15/2022 TO 10/15/2023 8/2/2023
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE
FUND UNDER POLICY NO. 2049 922-4, 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 CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE
INSURED CORPORATION.
NICE TOUCH REMODELING CORP
JEAN PERIRA-PRESIDENT
1 OF 1
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 SUR NCE FUND
T4 �V
DIRECTOR,INSURANCE FUND UNDERWRITING
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