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Home My WebLink AboutPP23-093 a a s s M s N � � �I Oo 00 N _ cn x 0 w M z u a F A W 000 _.� ►-� U O s s , I--i 117 r" z A04 W ao w = cp 0 O cn a Z o oa Q = � e U4-4 00 cn w H z ►� , M� cq W _ w a r L- OG 0 7 co W 00 ^ �p w �i W O WUO V a O O s W � � � ", z Uz � W ►-� G1z C'� w w i , Z � "I A04 �4 �C�-+ 3 J � I ; Z , M0 ►-1 C� ,4 V �+ z Z Q = Z d A oo Fil w (il H w O a W O ZO F Ln o W a V w v � r,l w Cf) Q w oA � ax 0 � R CC IEN BUILDING DEPARTMENT VILLAGE OF RYE BROOK AUG 2 9 2023 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914) . -0668 BUILDING DEPARTMENT www.rr&Qok.org PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP #: PP#: Approval Date: AUG 2 9 2923Permit Fee: $ Approval Signature: Other: Disapproved: ', (fees are non-refundable) Application dated, • ' 2-92:5is 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: )k1r1 j LL600 SBL: Zone: 2.Proposed Work: a---' L 3.Property Owner: \J' 1 Clot Address: �,p � � r Phone#: � tS 5 Z Cell#: "N Szo ►0? .email: p 4.Master Plumber:�41 'w C_� ��\��` Address: S ;AjAya,'- '`� TTV 'L 1►n�C Lic. #: 41 oS Phone#: Af�-7 Cell#: 9ILt ZZI 7>(. email:_/A C-H- /AD/ ar/Si Company Name: Q/ N� it V c Address: z rj AYE qV� • GaM INDICATE+IXTURES& LINES TO BE INSTALLED AS PER THE FOLLO NG 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 1 st Floor 2nd Floor 3,d Floor 4'Floor 5'b Floor Exterior t/ 5.* List Other Equipment/Provide Details: Ek e Gi: Qc.4'D (Notarized Signatures Required Next 2 Pages) -1- 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. P Sworn to before me this Sworn to before me this 1 day of 1.��1— ,20 93, d o l� ,ID 20 jA�7 Signature owner ature of Applicant f Property O �)n,A d Imo/' xlwq4!t�: Bid Print Name of Property Owner Print Name of Applicant Av-�- \�\f\ 0 Notary P3'}i 1RI MEULLO Notary icMEULLO Notary Public,State of New York Notary Public,state of New York No.OIME6160063 No.01ME6160963 Qualified In Westchester County Qualified In Westchester County ,_ Commission Expires January 29,20 Commission Expires January 29.20�27 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- 3/3/2023 BUILDING DEPARTMENT RAUG CI � vE D VILLAGE OF RYE BROOK 2 9 v/ 938 KING STREET RYE BROOK,NY 10573 023 0 (914)939-0668 VILLAGE OF-RYE Hww.ryrook.ora 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, S4 e g+Uu�� (Print nano) i Ak1ic.. ��herr gnu licr 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; v Q c�� VJ ` OS 1,2 , 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. vii - (Si�-naturc of Pru1)crl� 0 (Print Nam f Prope y Owner(s)) Sworn to before me this zzqw__�' day of , 20 23 (Notary PUbh JANETTE SANCHEZ NOTARY PUBLIC,STATE OF NEW YORK Registration No.OISA638787 Qualified in Westchester County My Commission Expires: 8/12/2021 QyE BR�k, • �9a2 BUILDING DEPARTMENT ❑BUILDING 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 : I _.) -DATE: PERMIT# ISSUED: 3,D 2 1 SECT: 35, G BLOCK:_LOT: 3 � LOCATION: t- p,J-} 0, OCCUPANCY: '� / O ❑ Violation Noted THE WORK IS... LJ PASSED ❑ FAILED REINSPECTION D/SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION [� 1 ❑ Natural Gas 1"20 ��a L �k S �,� 1 ti U rz c►-Qn a ❑ L.P. Gas S-PO k_c ❑ FUEL TANK Pic'" � � n ❑ FIRE SPRINKLER (,J LQp �, 1 ►. p ��v`Y..l`� �„C �C, Pi( �/�) O I ❑ FINAL PLUMBING ❑ CROSS CONNECTION ►�Q h Q FINAL ❑ OTHER RQTO_ Roto-Rooter Plumbing & Drain Services ROOTER 525 Waverly Avenue PLUNIRING & Mamaroneck, NY 10543 DRAIN SERVICE (914) 777-1791 23423355 -Aug 29, 2023 View Report Online eDAVID DICKER adivitto@ryebrook.org O 1 DEER RUN (917)520-8922 RYE BROOK, NY 10573 REPLC/RELINE .ti yR �c X. ,y e.w �K 7 }1 VID_20230830_152649 Follow Up �E BRC�k• 1982 BUILDING DEPARTMENT BUILDING 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 :- (/. [ ` DATE: PERMIT# ISSUED: 1 ECT: BLOCK: LOT: LOCATION: ` OCCUPANCY: 2' ❑ Violation Noted THE WORK IS... ❑ PASSED FAILED REINSPECTION Q'/SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas C 1 ❑ L.P. Gas r ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER �E 4R(b FO t7 c BUILDING DEPARTMENT 0 BUILDING 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 :— - DATE: PERMIT# / / ISSUED: I I SECT: BLOCK: LOT: r ` ) LOCATION: OCCUPANCY: ❑ Violation Noted THE WORK IS... ❑ PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas C ! ' 3. - L ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER C ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Wednesday, August 30, 2023 6:45 AM To: Steven Fews Subject: Message from UDig NY ****EMERGENCY**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 08/30/2023 06:44 To: VIL RYE BROOK PRIMARY Transmitted: 08/30/2023 06:44 00001 Ticket: 08303-000-058-00 Type: Emergency Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 1 To: Name: DEER RUN Cross: From: To: Name Offset: ------------------------------------------------------------------------------ Locate: BOTH SIDES OF THE ROAD TO THE FRONT OF THE HOUSE NearSt: LINCOLN AVE Means of Excavation: BACKHOE Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: Y Work Type: INSTALL CURB STOP Estimated Work Complete Date: 08/30/2023 Depth of excavation: Site dimensions: Start Date and Time: 08/30/2023 06:44 Must Start By: 09/14/2023 ------------------------------------------------------------------------------ Contact Name: JASON FIGUEROA Company: SUEZ WATER, WESTCHESTER Addrl: 2525 PALMER AVE Addr2: City: NEW ROCHELLE State: NY Zip: 10801 Phone: 914-632-6900 Fax: Email:jason.figueroa@suez-na.com Field Contact: JASON FIGUEROA Alt Phone: 914-632-6900 Email:jason.figueroa@suez-na.com Working for: ------------------------------------------------------------------------------ Comments: WORKING ON BOTH SIDES OF THE STREET. EMERGENCY, CREW IS ON WAY TO SITE NOW, THIS IS A THREAT TO LIFE/PROPERTY/VITAL UTILITY. Lookup Type: PARCEL ------------------------------------------------------------------------------ 1 Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Tuesday, August 29, 2023 9:14 AM To: Steven Fews Subject: Message from UDig NY ****EMERGENCY**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 08/29/2023 09:13 To: VIL RYE BROOK PRIMARY Transmitted: 08/29/2023 09:13 00001 Ticket: 08293-000-531-00 Type: Emergency Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 1 To: Name: DEER RUN Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: FROM CENTER LINE TO FRONT OF THE HOUSE NearSt: LINCOLN AVE & JENNIFER LN Means of Excavation: MINI EXCAVATOR, HAND TOOLS Blasting: N Site marked with white: Y Boring/Directional Drilling: N Within 25ft of Edge of Road: Y Work Type: SEWER REPAIR Estimated Work Complete Date: 09/07/2023 Depth of excavation: Site dimensions: Start Date and Time: 08/29/2023 09:10 Must Start By: 09/13/2023 ------------------------------------------------------------------------------ Contact Name: OSWALDO INTERIANO Company: ROTO ROOTER, MAMARONECK Addrl: 525 WAVERLY AVE Addr2: City: MAMARONECK State: NY Zip: 10543 Phone: 914-447-3528 Fax: Email: firielsalvador@gmail.com Field Contact: OSWALDO INTERIANO Alt Phone: 914-447-3528 Email: firielsalvador@gmail.com Working for: HOMEOWNER ------------------------------------------------------------------------------ Comments: EMERGENCY, CREW IS ON SITE NOW, THIS IS A THREAT TO LIFE/PROPERTY/VITAL UTILITY. Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA BELL-VALHALLA / WSCHSTR 1 V Y C C A r tV t x 10, _ w N tm E � E U a Or .J Wo. A3 a c o-00 � `aCOLm a� T C E N C f fV 7 FL `r T 0 V 'A •- a Y N `� N « H Z O (D tog 3 th c u cYi a • �s` J W Cl 105 7(0 � c�c�ltoo DATE(MWDD/YYYY) A`ORO® CERTIFICATE OF LIABILITY INSURANCE 04/04/2023 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. o 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 4) Aon Risk Services Northeast, Inc. PHONE C/o Aon Client Services (Nc trio.Ext); (866) 283-7122 FAX (800) 363-0105 y MC.No.: 4 overlook Point E-MAIL Lincolnshire IL 60069 USA ADDRESS: _ INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: Old Republic Insurance Company 24147 RR Plumbing services corporation INSURERB: XL Specialty Insurance Co 37885 525 Waverly Avenue Mamaroneck NY 10543 USA INSURERC: Midwest Employers Casualty Company 23612 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570098870626 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. Limits shown are as requested LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MWDDfYYffi IMIgD LIMITS A X COMMERCIAL GENERAL LIABILITY MwZY EACH OCCURRENCE S2,000,000 CLAIMS-MADE X❑OCCUR DAMAGE TO RERTE15 PREMISES Ea occurrence) $750,000 MED EXP(Any one person) $15,000 PERSONAL 6 ADV INJURY $2,000,0QQ N GENLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $6,000,000 n POLICY ❑PRO IX LOC PRODUCTS-COMP/OPAGG $6,000,000 2 JECT OTHER: Total Aggregate Limit $20,000,000 0 A AUTOMOBILE LIABILITY MwTB 21957 23 04/01/2023 04/01/2024 COMBINED SINGLE LIMB (Ea accidentl 55,000,000 X ANYAUTO BODILY INJURY(Per person) 0 Z OWNED SCHEDULED BODILY INJURY(Per accident) d AUTOS ONLY AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE sa ONLY AUTOS ONLY Per accident O t: d B X UMBRELLALUIB X OCCUR Us0007484OL123A 04 0112023 04/01/2024 EACH OCCURRENCE S5,000,000 U umbrella EXCESS LIAB CLAIMS-MADE AGGREGATE S5,000,000 DED I X RETENTION S10,000 A WORKERS COMPENSATION AND rtwc11826423 04/01/2023 04 1 4 X PER STATUTE I IQTH- EMPLOYERS'LIABILITY R v/N work Comp - A05 it A ANY PROPRIETOR ER/EXECUTIVE Mwc30193423 04/01/2023 04/01/2024 E.L.EACH ACCIDENT $1,000,000 EXCLUDED? OFFICER/MEMBER EXCLUDED? N I A (Mandatory In P" WC - TX E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,descrbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,Q00- C Excess workers Compensation EW0006308 04/01/2023 04/01/2024 Employers Liability $1,000,000— XS WC - OH Retention $500,000 SIR applies per policy ter s 6 condi ions DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Addhional Remarks Schedule,may be attached tt more space In required) certificate Holder is included as Additional Insured in accordance with the policy provisions of the General Liability and a+� Automobile Liability policies. L� CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Village Of Rye Brook AUTHORIZED REPRESENTATIVE 938 Kings Street Rye Brook NY 10573 USA !>Gf0f3 iJ��Irit+1�C9Ed C//LzEL�?IG��f1Ci (01988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD PORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured RR Plumbing Services Corporation 525 Waverly Avenue Mamaroneck,NY 10543 1c.NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(On/yrequiredifcoverage is specificallyAlnitedto 1d.Federal Employer Identification Number of Insured or Social Security certain locations in New Yodr State,i.e.,a Wrap-Up Policy) Number 31-1143999 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Old Republic Insurance Company Village of Rye Brook 938 King Street 3b.Policy Number of Entity Listed in Box"l a" Rye,New York 10573 MWC118264 23 3c.Policy effective period 04/01/23 to 04/01/24 3d.The Proprietor,Partners or Executive Officers are a included.(Only check box if all partners/officers included) 13 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 1 a"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: Laura LeBeau (Print name of authorized representative or licensed agent of insurance carrier) Approved by: (�� 03/16/23 (Signature) (Date) Title: Policy Production Associate Supervisor Telephone Number of authorized representative or licensed agent of insurance carrier: (262)797-3400 Please Note: Only Insurance carriers and their licensed agents are authorized to Issue Form C-105.2.Insurance brokers are NOT authorized to issue it. C-105.2 (9-17) www.wcb.ny.gov