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HomeMy WebLinkAboutBP23-152PERMIT # /- 3� 6c4 DAB; of 3 p SECTION BLOCK IpT TYPE OF WORK eAicLeCie) JOB LOCATIQAI Yo llllrl®lz 1; Ti7 %// y TCO # FEE DATE INsI'FbcTION RECORD .-. 1 DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING CO RGH PLUMBING GAS C� SPRINKLER ELECTRIC O LOW -VOLT C� ALARM a/ AS BUILT FINAL OTHER ZOVALS BOT ZBA OTHER ILTIFINAL SURVEY UgtED PRIOR TO FINAL INSPECTION �QyE'4R, . 1911 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury www.ryebrook.org TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE January 9,2024 Blind Brook Club Inc PO Box 229 Purchase,New York 10577 Re: 880 Anderson Hill Road, Rye Brook,New York 10573 Parcel ID#: 129.58-1-1 Building Permit#23-152 issued on 9/12/2023 for a New Entry Gate This certifies that the new vehicle entry gate at the maintenance building,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to DBUILD EPARTMENT For office use onl PERMIT#Z D�19 VILkf4) OF RYE BROOK ISSUED: 9—/a—,)3 938 KING STRE BROOK, 1W YORK 10573 DATE: VILLAGE OF RYE BROOK 939-0668, FEE: PAID..0 BUILDING DEPARTMENT www.ryebrook.ora 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 rtrsrtssrrrrsrtrswrsrstrssrrtrttt+rrrrtssssr+wr*rrrrrt+sr+rrrw*+r+•+rr*rrr++rr*s++r+rsrrrr*rr*rs*wr+r*rsssstrtrrrrrttrrrrrt+* Address: �� Occupancy/Use: Parcel ID#: �fi�c`^�q� G`�`"'`P /d�J, J�—/—� Zone: —3� Owner: CIL)JO Address: ,, )) // P.E./R.A. or Contractor: C c' eoi�3he�cr'`�'"1��. Address:�gP�� Akzc)1-i 41izl C/ Person in responsible charge: Ti k, g I aO m &^ 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: _�bKlx't- (?zt---P 6 e I I being duly swom,deposes and says that he/she resides at (Print Name of Applicant) 1 1 (No.and Street) in �yE C�r�� - ,in the County of WQStct — in the State of N Y- ,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:$ V-0,6'*_ � , for the construction or alteration of: t/P t l dG _ 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-IO.A.of the Code of the Village of Rye Brook. Sworn to before me this Sworn to before me this day of 20 day of , 20 7 Sii�uieollro,,rty' / Owner I Signature of Applicant Name of Property Own Print Name of Applicant Nowry rublic Notary Public SHARI MELILLO Notary Public,State of New York No.01ME6J60063 �''`�'I Qualified In Westchester County.—., Commission Expires January 29,20_ QyE BR1982 C��• BUILDING DEPARTMENT ❑BUILDING INSPECTOR a-I(SSISTANT 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 : 8 �l l A'1 At r SO C� . DATE: - Z j2 1 PERMIT# C- 1 ' 15Z ISSUED: SECT: I7-01• J tS BLOCK: J LOT: LOCATION: M G 1 Q\C v G"C-0 Lu O ��� C" 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 LA mr, N ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ C,ROSS CONNECTION IJT�/FINAL ❑ OTHER QyE BR(�k. cu � • 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 :- 50 `_'�� �C l I DATE: i PERMIT# .� ISSUED: SECT:'2` ( BLOCK: I LOT: LOCATION: ` `�'+� OCCUPANCY: /y ❑ 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 ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER : a ■ , O� 00 r °00 O w � ■ 1^I O `ti t7 qp 00 0 `0' A ■ a W � 00 'Lln Ono co s O V w C7 Z M '� H 0 0 ti P3 w l QI O t ON cy" 4Z V z -a ° z V " z � � � V OO �7 h+K ,.� �.7 z Pr 00 aJ � .o v .d rrTT11 it. s W ~ W 0 W o z z ti cq h Z z A v o va� � a W O o W �, O og C a � �. o v � v YU �' 4-4 on v p V p V Now �.Vu ? Cla. 1 N o. cn y w °00 I..( � a � Q2 E a go cog 4;4;6G49414494;9aa a aaU4;6 0a414;goo 4 go4a 4 4aa4441 DULL l�Vt� V r,rAK 1 Ivt>r.IN i D �5 �/] vVIL LOF YE BROOK E1J938 KING Suooi ,NY 10573 JUN 3 0 2023 okorE VILLAGE OF RYE BROOK BUILDING DEPARTMENT FOR OFFICE USE ONLY: ,�" Approval Date: P r it 3"' +J , Application# Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: Date: BOT Approval Date: Case# : Chairman: I✓r PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: / v Application Fee: ermit Fees: ryEXTERIOR BUILDING PERMIT APPLICATION Application dated: M aJ is hereby made to the Building Inspector ofthe Village of Rye Brook,NY,for the issuance of a Permit for the construction of buildings,structures,additions,alterations or for a change in use,as per detailed statement described below. 1. JobAddress: 880 Anderson Hill Road 2. ParcelID#: 129.58..r1-1 Zone: R-35 3. Proposed Improvement(Describe in detail): Installation of Vehicle Entry Cate at Maintenance Facility 4. Property Owner: The Blind Brook Club Inc. Address: 980 Anderson Hill Road Phone# 914-939-1450 Cell# e-mailbcaiapbell@blindbrookelub.org List All Other Properties Owned in Rye Brook: Applicant: Address: Phone# Cell# e-mail Architect: Rogers McCagg Architect Address: 44 North Main Street South Norwalk, CT 06854 Phone# 203-354-5210 Cell# e-mail tpanza@rm-arch.com Engineer: Address: Phone# Cell# e-mail General Contractor: Clark Construction Inc. — Address: 30 Bridge Street New Milford, CST/06776 Phone# 860-799-7344 Cell# � -►i �''6 D o—e-mail jlyon@clarkci.com {1) 6/l/2023 5. Occupancy; (1-Fam.,2-Fam.,Commercial.,etc...)Pre-construction: COMM Yost-construction: Comm 6. Area of lot: Square feet: 7,069,788 Acres: 162.3 7, Dimensions from proposed building or structure to lot lines: front yard: 155.22' rear yard: right side yard: left side yard: other: 8. If building is located on a corner lot,which street does it front on: N/A 9. Area of proposed building in square feet: Basement: N/A I st fl: N/A 2ndfl: N/A 3rd fl: N/A 10. Total Square Footage of the proposed new construction: N/A 11. For additions,total square footage added: Basement: N/A Is,fl: N/A 2od fl: N/A 3rd fl: N/A 12. Total Square Footage of the proposed renovation to the existing structure: N/A 13. N.Y. State Construction Classification: N/A N.Y. State Use Classification: N/A 14. Number of stories: N/A Overall Height: N/A Median Height: N/A 15. Basement to be full,or partial: N/A finished or unfinished: N/A 16. What material is the exterior finish: Painted Steel 17. Roof style;peaked,hip,mansard,shed,etc: N/A Roofing material: N/A 18. What system of heating: N/A 19, If private sewage disposal is necessary,approval by the Westchester County Health Department must be submitted with this application. 20. 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...) Yes: No: % (if yes,applicant must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 21. Will the proposed project disturb 400 sq. ft.or more of land,or create 400 sq.ft. or more of impVvious coverage requiring a Stormwater Management Control Permit as per§217 of Village Code? Yes: No: ft Area: 22. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No:X (if yes,applicant must submit a Site Plan Application, &provide detailed drawings) 23. Will the proposed project require a Steep Slopes Permit as per§213 of Village Code Yes: No:x (if yes,you must submit a Site Plan Application, &provide a detailed topographical survey) 24. Is the lot located within 100 ft.of a Wetland as per§245 of Village Code? Yes: % No: (if yes, the area of wetland and the wetland buffer.one must be properly depicted on the survey&site plan) 25, Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes : % No: (if yes, the area and elevations of the,hood plane must be properly depicted on the survey&site plan) 26. Will the proposed project require a Tree Removal Permit as per§235 of Village Code? Yes: No: % (fl'yes, applicant must submit a Tree Removal Permit Application) 27. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No: % Indicate: TIER I: TIER It: TIER III: (if yes,a Home Occupation Permit Application is required) 28. List all zoning variances granted or denied for the subject property: 29. What is the total estimated cost of construction: $ 20,000.00 Note:The estimated cost shall include all site improvements, labor,material,scaffolding,.lixed equipment,professional,fees, including any material and labor which may be donated gratis.If the rnal cost exceeds the estimated cost, an additional/ee will be required prior to issuance of the C/©. 30. Estimated date of completion: Suer 2023 (2) 6/1/2023 BUILD MENT ECIEMED E VIL E OF RY OOK 938 KING ET RYE BR ,NY 10573 JUN 3 0 2023 <c. � _0 ��--c 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: 3), Bruce Campbell, General Managerresiding at, Blind Brook Club 980 Anderson Hill Road (Print name) (Addre 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; Blind Brook Club 880 Anderson Hill Road , Rye Brook, NY. (Joh Adl lice l 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. Z�� / '�;, M . (Sifnnature of Property O%vner(s)) Bruce Campbell (Print Name of Property Owner(s)) Sworn to before me this f -r; , 20 4 (Notary Public) SHARI MEULLO 'Votary Public,state of New York No.O1ME6160063 Qualified In Westchester County (6) Commission Expires January 29, 20Z_J &/1212021 This application must be properly completed in its entirety by a N.Y. State Registered Architect or N.Y. State Licensed Professional Engineer & signed by those professionals where indicated. It must also 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. STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: Bruce Campbell ,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 Bruce Campbell 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 SSworn to before me this day of "N- , 20 �� day of 520 Signature of Property Ow er Signature of Applicant Print Name of Property Owner Print Name of Applicant 2�� t—\' " Notary Public Notary Public SHAM MELILLO Notary Public,state of New York No.0iME6160063 Qualifled In Westchester county 2. commission Expires January 29,20_ (8) 8/12/2021 R�C� O`er ID I AUG 252023 THE BLIND BROOK CLUB L . P. O. BOX 229 ! VILLAGE OF RYE BROOK ' BUILDING DEPARTMENT PURCHASE, NY 10577 TEL. (914)939-1450 FAX(914)939-4520 August 25, 2023 Mr. Steven E. Fews Assistant Building & Fire Inspector Village of Rye Brook 938 King Street Rye Brook, N.Y. 10573 Re: Entrance Gate at 880 Anderson Hill Road Dear Mr. Fews: As you are aware the Blind Brook Club recently received approval to install an entrance gate at the vehicle entrance to the golf course maintenance area at 880 Anderson Hill Road. It is our intention to install a Knox Box at the gate, properly located, after discussion with the Rye Brook Fire Department before the gate becomes operational. Please let us know if this meets with your approval. Sincerely, Bruce L. Campbell General Manager cc: Michael Ford, Golf Course Superintendent O \ f • i' 00 Y { T 1 r spa- . 4 " 00 j1 \ ! Q Tara Orlando From: Steven Fews Sent: Monday,August 14,2023 3:58 PM To: Tara Orlando Subject: FW.Blind Brook Gate Please advise Expires: Tuesday,December 12,2023 12:00 AM FYI Thank You. Steven E. Fews Building Inspector&Fire Inspector Office(914) 939-0668 -----Original Message----- From:Michal Nowak<MNowak@ryebrook.org> Sent:Monday,August 14,2023 3:42 PM To:Laura Petersen<LPetersen@ryebrook.org>;Steven Fews <SteveFews@ryebrook.org> Subject:FW:Blind Brook Gate Please advise -----Original Message----- From:Robert Goodman <rig_lawyer@hotmail.com> Sent:Monday,August 14,2023 3:41 PM To:Michal Nowak<MNowak@ryebrook.org> Subject:RE:Blind Brook Gate Please advise Michael:After reviewing the documentation you attached,I concur with Jen and Sarah that the matter should not have to go to planning as the set back is sufficient enough that the gate will not be visible from the road.Thank you for bringing this to my attention.Regards,RIG -----Original Message----- From:Michal Nowak<MNowak@ryebrook.org> Sent:Monday,August 14,2023 3:33 PM To:Robert Goodman<rig_lawyer@hotmail.com> Subject:RE:Blind Brook Gate Please advise -----Original Message----- From:Michal Nowak Sent:Wednesday,August 2,2023 2:46 PM To:Robert Goodman<rig_lawyer@hotmail.corn> Subject:FW:Blind Brook Gate Rob, Please see attached,Jeri and Sarah both reviewed and feel it should not go to Planning as it is so far back from the road. Please advise thoughts Mike -----Original Message----- 1 From:Michal Nowak Sent:Monday,July 17,2023 5:00 PM To:Jennifer Gray<jgray@kblaw.com>;Sarah Brown<sbrown@hardestyhanover.com> Subject:Blind Brook Gate Hi Ladies, Got this application from Building,for a new gate.Steve has it marked to go to Planning. But site is over 4 acres,so that would be BOT in theory. Its for a gate 155 feet from the road,on their private property.Do not even think it would be visible from road even. Thoughts? Michal J.Nowak Superintendent of Public Works And Engineering ISA Arborist Village of Rye Brook 938 King Street Rye Brook,NY 10573 P: 914-939-0753 x 2965 F: 914-939-5801 "Public Works-The heartbeat of this Village" 2 Laura Petersen From: Nancy D'Amico <nancy@clarkci.com> Sent: Monday, September 11, 2023 11:54 AM To: Laura Petersen Subject: FW: Building Permit Application - 880 Anderson Hill Road - Entry Gate Attachments: Village of Rye NY-Certificate of Insurance.pdf; C105.2 Village of Rye Brook.pdf Good morning Laura, Please see information below and attachments. My apologies, as I misspelled your last name the first time. Thank you. Nancy D'Amico Clark Construction Incorporated 30 Bridge Street,Suite 204 New Milford,CT 06776 Phone: (860) 799-7344 Email: nancy@clarkci.com From: Nancy D'Amico Sent: Monday, September 11, 2023 11:46 AM To: LPeterson@ryebrook.org Cc: Bruce Campbell<bcampbell@blindbrookclub.org>;Tony Panza <tpanza@rm-arch.com>;Joshua Lyon <jlyon@clarkci.com>;Tim Blakeman <tblakeman@clarkci.com> Subject: Building Permit Application -880 Anderson Hill Road - Entry Gate Good morning Laura, Please see information and attached as requested. • General contractor's contact name: Tim Blakeman-Mobile#(860)488-5820 • General Liability and Worker's Compensation Insurance • UDig NY Ticket# 09083-001-144-00 If there is anything else you need, please do not hesitate to contact me. Thank you. Sincerely, Nancy D'Amico Office Manager Phone: (860)799-7344 Mobile: (860)488-3227 Email: nancydclarkci.com 30 Bridge Street, Ste 204 New Milford, CT 06776 ,Milding Pemit Check List & Zon Anal --) OB & C ONLY Address: > �. l ` 1 ( SBL Zone: Use: Z Const.Type: 1 Other. nHV Submittal Date: Revisions Submittal Dates: jV Applicant: \� �� c o V � 'Ii , ,�, ,n, `` `� Nature of Work S `� ��\�UJ Reviews:ZBA•—JUL 1 3 2023, BP' Other. _ NEED IC ( ) ES:Filing n: BP: C/O: Legalizatio ( ) (�P.: Date Stamped: Properly Signed: SBL Verified: Cross Connection: F.O.G.: 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: ( ) ( ) LAMS:Date Stamped Sealed: Copies: Electronic: Other. (r ( License: _Workers_Comp: Liabili . mp.Waiver. Other. ( V Code 753#: 0 9 C - —CX% •-14'q—CEO Dated: Q_?— � 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: Grease Trap: 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. _ ( ) ( ) Other. (I RB mtg. date. i V approval• notes: ( )ZBA mtg.date: approval: notes: (&�fB mtg. date: approval: _notes: - 2 I Cc REOUIRED EXISTING PROPOSED NO= APPROVED Area . AUG 2 6 1�23 Cir e: FFm=g _ Front _ Fmnt Sides: F.A.R.: Onm Space: H�ht: Stories: notes C C 1 �C{ 2 BUILD MENT D c C rC' G V E VIL OF RY OOK U �/ 938 KING ET RYE BR ,NY 10573 JUN 3 0 202 ID 3 4)9 9-0 VILLAGE OF RYE BROOK �..- 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 to submit a copy of this check list will be removed from the ARB agenda. .lob Address: (i►oABroo _ 'A� Un P"eoa � Date of Submission: Parcel ID#: 1a �y ,58 , I —"� Zone: -3 > �D�3o��ja3 Proposed Improvement(Describe in detail): OF- Vert iC l_';;�- APPLICANT CHECK LIST: MUS"C BE COMPLETED BY THE APPLICANT G f,7F_ 0'+ ✓\+eN The following items must be submitted to the Building Department by the applicant - no exceptions. er Owner: I►.i I. ('-'Completed Application Property ty a + I�r oak C'�b we- 2 0 (VfTwo(2) sets of sealed plans. (one full size {maximum Address: Q go fl�b�R�orJ �' 11 Ka. allowable plan size=36"x 42"} and one 11"x 17") 3. (X�wo(2)copies of the property survey. Phone# I� -q3�1- I+}�b 4. ( � I wo(2)copies of the proposed site plan. Applicant appearing before the Board: 5. ( ) One electronic/disc copy of the complete /iling plication materials. 6. ( Fee. Address: 7. ( -,e;'�ny supporting documentation. S. ( )P OA approval letter. ri/opphruh/e) Phone# 9. ( 'Photographs. Architect/Engineer: 10.( ) Samples of finishes,,color chart. (a sample bona/or model marc be presented the night o/the meeling) Phone# 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 Sworn to before me this day of ���' , 20 t ` day of , 20 -"/,, 6,4a4 C. V0 - Signature of Property Owner V Signature of Applicant int Name of Property Ow her ` Print Name of Applicant Notary Public Notary Public SHARI MEULLO IiI (Votary Public,State of New York No.OIME6160063 Qualified In Westchester County Commission Expires January 29,202 { 12 2021 Laura Petersen From: Laura Petersen Sent: Wednesday, September 6, 2023 4:03 PM To: jlyon@clarkci.com; Bruce Campbell Cc: tpanza@rm-arch.com Subject: Building Permit Application - 880 Anderson Hill Road - Entry Gate Good afternoon, The building permit application has been approved by the Building Inspector. Before I can issue the building permit the following items must be submitted to our office; A. General contractor's contact name (first and last) & phone number. XGeneral contractor's valid liability insurance (the Village Of Rye Brook must be the certificate holder) 3. General contractor's valid workers compensation on a NY State Board form (C105-2 or U26.3) Building permit fee $500.00 (due once permit is issued and ready for pick-up) . Contractor must call UDig NY and get a ticket number. Thank you Laura Laura (Petersen Office Assistant Village of Rye Brook 938 King Street Rye Brook, New York 10573 Phone(914)939-0668 1 Ipetersenervebrook.org 1 CLARCON-02 SONYACONK A�iRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/Y " 12/2112022 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 BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSU THE POLICIES I BY REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. R BY AUTHORIZED IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED, 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 endorsemen s). PRODUCER C TACT NFP Property&Casualty Services,Inc. PHONE 159 Wolf Road A/c No Ext:(518)244-4245 Ark No: 518 244�262 Suite 200 M Albany,NY 12205 INSURER S AFFORDING COVERAGE NAIC 9 IN--A:Selective Insurance Co of the Southeast 39926 INSURED INSURER B Clark Construction,Inc. IN RER C 30 Bridge Street,Suite 204 New Milford,CT 06776 INSURER D INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION N MBER: 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 ADDL SUB TYPE OF INSURANCE POLICY NUMBER ��EFF POLICY EXP LIMITS A FXcouftrERCIAL GENERAL LIABILITYEACH OCCURRENCE $ 1,000,000MS MADE ❑X OCCUR S 2378526 12/30/12022 12/30/2023 DAMAGE TO RENTED $ 500,000 MED EXP An one rson 15,000 PERSONAL&ADV IN Y 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 POLICY JEL'TF7x LOC PRODUCT'S-COMP/OPAGG $ 2,000,000 OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 ANY AUTO S 2378526 $ OWNED 12/30/2022 12/30/2023 B OILY INJURY Per arson $ AUTOS ONLY X ASUTOSULED ARE �µ.pyyT.�Ep BODILY INJURY Per accident $ X AUTOS ONLY X AAR01 W %0PPERTY DAMAGE A X UMBRELLA UAB X OCCUR FF 5,000,000 EXCESS UAB CLAIMS-MADE 2378526 H OCCURRENCE $ 12/30/2022 12/30/2023 AGGREGATE 51000,000 DED RETENTION$ WORKERS COMPENSATION PER TH- AND EMPLOYERS'LIABILrry ANF PPERO�PMREIM O�EXCLUDED7 ECUTIVE Y/❑N N/A E.L.EACH ACCIDENT (Mandatory In NH) Ay es des" under E.L.DISEASE-EA EMPLOYE DESCR PTION OF OPERATIONS below EL.DISEASE-POLICY LIMB DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) (Operations usual an incidental to the business of the named insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The Village of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 938 King Street ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Us YORK Workers' CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a. Legal Name&Address of Insured(use street address only) 1b. Business Telephone Number of Insured: CLARK CONSTRUCTION INC (860)799-7344 30 Bridge St Ste 204,New Milford,Cr 06776-3517 Work Location of Insured(Only required if coverage is 1 c. NYS Unemployment Insurance Employer Registration Number of Insured: specifically limited to certain locations in New York State,i.e.,a 1467119 Wrap-Up Policy) 1d. Federal Employer Identification Number of Insured or Social Security Number: 880 Anderson Hill Road,Purchase,N.Y. 10577 26-3709863 2.Name and Address of Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Selective Insurance Company of America The Village of Rye Brook 3b. Policy Number of Entity Listed in Box"la" 938 King Street WC 9080109 Rye Brook,N.Y. 10573 3c. Policy effective period: 12/30/2022 to 12/30/2023 3d.The Proprietor,Partners or Executive Officers are included.(Only check box if all partners/officers included) X I all excluded or certainpartners/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: Michael Walsh (Print name of authorized representative or licensed agent of insurance camer) i YV 9/11/2023 (Signature) (Date) Title: President Telephone Number of authorized representative or licensed agent of insurance carrier: 845-350-3800 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.n ov Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Friday, September 8, 2023 12:38 PM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 09/08/2023 12:37 To: VIL RYE BROOK PRIMARY Transmitted: 09/08/2023 12:37 00001 Ticket: 09083-001-144-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 880 To: Name: ANDERSON HILL RD Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: BLIND BROOK COUNTRY CLUB MAINTENANCE FACILITY MARKED BY STONE PILLAR ENTRIES WITH ADDRESS ON IT - 30 INCHES DIAMETER PER POST NearSt: CAROL CT & LINCOLN AVE Means of Excavation: MINI EXCAVATOR Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: INSTALL FOOTERS FOR MAINTENANCE GATE Estimated Work Complete Date: 09/20/2023 Depth of excavation: 48 INCHES Site dimensions: Start Date and Time: 09/13/2023 07:00 Must Start By: 09/27/2023 ------------------------------------------------------------------------------ Contact Name: TIM BLAKEMAN Company: CLARK CONSTRUCTION INC Addrl: 30 BRIDGE ST Addr2: STE 204 City: NEW MILFORD State: CT Zip: 06776 Phone: 860-488-5820 Fax: Email: tblakeman@clarkci.com Field Contact: TIM BLAKEMAN Alt Phone: 860-488-5820 Email: tblakeman@clarkci.com Working for: BLIND BROOK COUNTRY CLUB ------------------------------------------------------------------------------ Comments: WILL BE MARKED Lookup Type: MANUAL ------------------------------------------------------------------------------ Members: ALTICE USA AT&T i eJaA!JU! 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