HomeMy WebLinkAboutBP23-170PERMIT # /�-��C� 3" 70 PATE; v- v13 Exile a,? ,-.)
SECTION 3 � tI <= IIIIIIIBLOCKit IIIIIIIIIIIIIIIIIIw LOT %
TYPE OF WORK LeQQ /i
JOB LOCATION
OWNER
CONTRACTOR, AGi%/,
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FEE DATE '`"
FOOTING
FOUNDATION
FRAMING
RGH FRAMING
INSULATION
PLUMBING 0
RGH PLUMBING
GAS fl
SPRINKLER
ELECTRIC 0
LOW -VOLT C.7
ALARM 0
AS BUILT p
FINAL
4q)c �7a` �Psi� ri tLc
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ZBA
OTHER
�LTlFINAL SURVEY
REQUIRED PRIOR TO
FINAL INSPECTION
VILLAGE OF RYE BROOK
WESTCHESTER COUNTY, NEW YORK
NO: 25-115
(Certificate of (occupaucp
This is to certify that S000/-) Pa f- /k--
of, R(IC &06k, having duly filed an application on
20 d requesting a Certificate of Occupancy for the premises known as,
q7 ,���/. �Dt�l�, Rye Brook,NY, located in a 'Q-h Zoning
District and shown on the most current Tax Map as Section: Block: Lot: 7
and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building
Permit No. ( („� , issued 91,2e 20 a3, 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: �" �� Construction:
for the following purposes:
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 shall be , or shall t e moved from one location
to another until a permit to accomplish such chang btaine fro uilding Inspector.
Building Inspector,Village of Rye Brook: Date: SEP 1 7 2025
BUILDINr � '� _ TMENT office For use only:
PERMIT# o)3—/ 7i�
VIL4A�OF RYE I$RdOK ISSUED: 9—c�l —0�3
MAY 31 2024D ! 938 KING STRE> Ty''tYE BROOK,N>r w YORK 10573 DATE:
9 OG¢$ FEE: ,tj PAIDAr
VILLAGE OF RYE BROOK
BUILDING 0FPARWF7T" r ° ". r
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
tssrsssss:rsrsrssrts«ss«ssrssss+sssssrssss«srs«sss+srssrssssssssssrss«essssss++ssrssssssrss♦rsrsssssssses«ssssersesrrssasrsss
Address:Z4 7:�
Occupancy/Use: Parcel ID#: l�'��i c� -- �— Zone: e��-
Owner: S C",) �C�v Address4a 'RwN"k- V_WKd &rn:*— N`( 1 OS}
P.E./R.A. or Contractor:pef- �� L%yt', \MC_ Address:
Person in responsible chargevcQ 2\p 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:
`
y� j �Q�(V-- being duly swom,deposes and says that he/she resides at 4q ?_,o4yLx ,k 1r Zoo ck
(Print Name of Applicant) (No.and Street)
in ?_� DY pp)�_ in the County of in the State of�,that
(Cit)rroNNn/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:$ 376 ,ZOO
for the construction or alteration of:ulad-`i i',,p
Deponent further sta es that he/she Aas examined the approved plans of the c e/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 '�:k Sworn to before me this 3\SA-
day of , 20 ZL day of , 202_4_
Signatur Owner Signattu Y,t
Print Name of Property Owner 1:S GxF`N_,ROT Pgrt lfo�t
XAOT,q '•m
tary tili - ����'`" �' = _ 1 'R'6eorgiana Rothweiter
-oG .0 ,o
Georgiana Roth4itgi eL I G o�ry;'�= = 'n f8tary Public,State ol.
Notary Public,State of Conn FkP. 4 TNy Commission Expires 4/30/2029
My Commission Expires 4/30/202 �, FC v� .`���` ti` o`
Qyre,BR(��
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7932 BUILDING DEPARTMENT
❑BU LDING INSPECTOR
JR'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 - - - - - - - - - - - - - - - - - - - -
, 1
ADDRESS: �� T - --- -- DATE:
PERMITif_ -7_0 _ ISSUED:_ SECT': _ . BLOCK: I _ LOT:
LOCATION: (�� _ �q,+V I t7CiC. OCCUPANCY:
❑ Violation Noted THE WORK IS... BeIPASSED ❑ FAILED / REINSPECTION
❑ SITE INSPECTION REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION
❑ Natural Gas /0-- Al .0
❑ L.P. Gas
❑ FUEL TANK
❑ FIRE SPRINKLER CL I,v
❑ FINAL PLUMBING 61
C SS CONNECTION
INAL
❑ OTHER
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BVIL AGE OF RYE BROOK DEPARTMENT D E E � " E7
938 KING STREET RYE BROOK,NY 10573 JD
(914)939-0668 ESEP - 6 2023
www.EyArpok.org VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
FOR OFFICE USE ONLY: `` /
Approval Date: s E P 2 7 it# d 70 Application
Approval Signature: ARCHITECTURAL REVIEW BOARD:
Disapproved: Date: Polen
BOT Approval Date: Case# : Chairman:
PB Approval Date: Case# Secretary
ZBA Approval Date: Case#
Other: �' t
Application FeeA 00-' � r-7
ermit Fees: # /0 -, L)C
EXTERIOR BUILDING PERMIT APPLICATION
\\�
Application dated: '�r d `� is hereby made to the Building Inspector of the 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-
]. 3obAddress:47 Bonwit Rd. Rye Brook NY 10573
2. Parcel ID#: 135-42-1-7 Zone: R-12
3. Proposed Improvement(Describe in detail):
Replace the existing rear impervious patio with a pervious paver patio w/garden walls.
Existing fence to be replaced and fence outside property line to be removed as per attached plans.
4. Property Owner: Sooah Park
Address:47 Bonwit Rd. Rye Brook NY 10573
Phone#917-225-0329 Cell#917-225-0329 e-mail 47bonwit@gmail.com
List All Other Properties Owned in Rye Brook:
Applicant:Sooah Park
Address:47 Bonwit Rd. Rye Brook NY 10573
Phone# 917-225-0329 Cell # e-ma-I 47bonwit@gmail.com
Architect:Arq. Architecture P.C. (Jorge B. Hernandez R.A.) �� ����� � `�
Address: 100 Executive Blvd. Ossining Ny 10562 (suite 204)
Phone 4 914-944-3377 Cell # 914-944-3377 e-mail jb@argpc.com rjm@argpc.com
Fence contractor: Hirsch Fence Install & Design LLC
Address: 747 Rt 9W Cottage #4 Valley Cottage NY 10989
Phone# Cell # e-mail
General Contractor: Pfepatino Painting Inc.
Address: 119 Croton Ave. Ossining NY 10562
Phone#914-275-2570 Cell # 914-275-2570 e-mail pfepatino@icloud.com
(1)
6/1/2023
5. Occupancy,(l-Fam.,2-Fam.,Commercial.,etc...)Pre-construction: 1-fam Post-construction: 1-fam
6. Area of lot: Square feet: 16,391 Acres: .37
7. Dimensions from proposed building or structure to lot lines: front yard: N.C. rear yard: node
right side yard: 16.79 left side yard: 17.66 other. Corner lot
8. If building is located on a comer lot,which street does it front on: BonWit Rd.
9. Area of proposed building in square feet: Basement: I"fl: 2"d fl: 31d fl:
10. Total Square Footage of the proposed new construction: existing impervious 700 sf patio to be replaced with 1,074 sf pervious patio
H_ For additions,total square footage added: Basement: l at fl: 2°d fl: 3'd fl:
12. Total Square Footage of the proposed renovation to the existing structure:
13. N.Y. State Construction Classification: V-B N.Y. State Use Classification: 1-family
14. Number of stories: N.C. Overall Height: N.C. Median Height: N.C.
15. Basement to be full,or partial: under separate permit , finished or unfinished: finished under separate permit
16. What material is the exterior finish: existing cedar siding
IT Roof style;peaked,hip,mansard, shed,etc: existing open gable Roofing material: shingles
18. What system of heating:N.C.
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,ANSI,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 impeSvious coverage requiring a
Stormwater Management Control Permit as per§217 of Village Code? Yes: No: Area: Permeable pavers
22. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code?
Yes: Na: (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:_14—
(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 zone 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:-N4_
(if yes, the area and elevations of the flood 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:--,/--
(if yes,applicant must submit a Tree Removal Permit Application)
2T Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No: V
Indicate: TIER I: TIER II: 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: $ 38,700 ���eS�aC (> �c'�� ote.71ie estimated cost
shall include all site improvements, labor, material,scaffolding,fixed equipment,professional fees,including any material and labor which
may be donated gratis.If the final cost exceeds the estimated cost, an additional fee will be requiredprior to issuance of the CIO.
30. Estimated date of completion: 10-30-23
(2)
611/2023
BUILDING DEPARTMENT
VILLAGE OF RYE BROOK
938 KING STREET RYE BROOK,NY 10573
(914)939-0668
RESIDENTIAL LOT AREA COVERAGE
Address' 47 Bonwit Rd.Rye Brook NY 10573 Section: 1115 e2 Block' ' Lot'
PERMITTED COVERAGE RATIOS IN RESIDENTIAL DISTRICTS (Local Law 3-88)
YOUR ZONE AREA IN MAIN ACCESS. DECK
ZONE DISTRICT SQ. FEET BLDG. BLDG. MAX.
CHECK MAX.
R-35 35,000 14% 4% 5%
R-25 25,000 14% 3.5% 4%
R-20 20,000 14% 3.5% 4%
R-15 15,000 16% 3.5% 4%
R-15A 15,000 12% 3.5% 4%
R-12 12,500 17% 4% 4%
R-10 10,000 20% 4.5% 3.5%
R-7 7,500 1 23% 4.5% 3.5%
R-5 5,000 30% 5% 3.5%
R-2F 5,000 30% 5% 3.5%
Existing: Proposed:
1. AREA OF LOT Sq. Ft. N C Sq. Ft.
2. AREA OF HOUSE
a. Coverage of Main Building
(Including Attached Garage or Accessory Building) 2 5r Sq. Ft. N Sq. Ft.
b. Area of 1� Floor Divided By Area of Lot x 100 15 25 % N.C.
3. AREA OF ACCESSORY BUILDING
(Includes Detached Garages, Tool Shed, Playhouses) Sq. Ft. N G Sq. Ft.
a. Coverage of Accessory Building
Area of Accessory Building Divided By Area of Lot x 100 ''' oho N C
4. AREA OF DECK none Sq. Ft. Sq. Ft.
a. Coverage of Deck
Area of Deck Divided By Area of Lot x 100 % %
I attest the best of my knowledge and belief, the above information is correct.
X141A A
Archit is i re
BUILDING DEPARTMENT
VILLAGE OF RYE BROOK
938 DING STREET RYE B RooK,NY 10573
(914) 939-0668
IMPERVIOUS COVERAGE RATIOS RESIDENTIAL DISTRICTS
Address:47 Bonwit Rd.Rye Brook NY 10573 Section: 135,42 Block: 1 Lot: 7 Zone: R-12
IMPERVIOUS SURFACES (Definition): All buildings, as defined herein, and all areas on the ground or elevated above
the ground which are comprised of materials through which water cannot readily flow, including, but not limited to
asphalt, concrete, masonry, wood, gravel and clay, and which consist of elements including, but not limited to, court
yards,sports courts, swimming pools, patios, sidewalks, ramps, terraces and driveways.
TOTAL MAXIMUM PERMITTED MAX. PERMITTED
COVERAGE Zoning IMPERVIOUS
LOT AREA BY IMPERVIOUS SURFACES District COVERAGE IN FRONT
(sq.ft.) For Base Lot For Lot Area YARD(%)
Area(sq.ft.)* Over Base R-35 15
Lot Area % R-25 20
0 to 4,000 0 55 R-20 30
4,001 to 6,000 2,200 35
6,001 to 12,000 2,900 27 R-15 35
12,001 to 16,000 4,520 26 R-15A 35
16,001 to 20,000 5,560 25 R-12 40
20,001 to 30,000 6 560 24
30,001 to 40,000 8,960 23 R-10 45
40,001 & larger 11,260 22 R-7 40
R-5 30
*"Base Lot Area" is the minimum end of the lot size R2-F 30
range in the"Lot Area"column
Area of lot: 16,391 s .ft. Existing Allowed Proposed
Total impervious coverage = 3,347 Sq.ft. 5,695.51 S . ft. 2,647 S .ft.
Front impervious coverage = 998 % 40% % N C. %
I attes e best of my kno o ledge and belief,the above information is correct.
Arc ite s ignatur
(4)
8/12n021
BUILDING DEPARTMENT
VILLAGE OF RYE BROOK
938 KING STREET RYE BROOK, NY 10573
(914)939-0668
BULK REGULATIONS IN RESIDENTIAL DISTRICTS
Address-47 Bonwit Rd. Rye Brook NY 10573 Section: 135.42 Block: 1 Lot-
MAXIMUM GROSS FLOOR AREA
USE FORMULA: Maximum Gross Floor Area = 4,000 + [ (Lot Area -21,780) x 0.11478421 ]:
a. Allowed =4,208.9 Sq. Feet
b. Existing = N.C. Sq. Feet
c. Proposed = N.C. Sq. Feet
HEIGHT/SETBACK RATIOS FOR RESIDENTIAL DISTRICTS
DEFINITION: A standard designed to regulate the height of a building in relation to the average grade of the corresponding portion of
the lot line from which it is set back. The ratio modifies the maximum permitted Height of Building by forming an inclined plane
beginning at the average grade along the portion of the lot line from which the setback is measured and rising toward the building at the
specified ratio above which no part of any building, other than minor architectural features such as chimneys, skylights and dormer
windows not covering more than 10% of the entire roof area, shall be permitted to extend. Height and Setback shall be calculated using
the formula; Height/ Setback = X, where X is the required side or front yard ratio for the zoning district in which a property is located
as specified in Article Vill of Chapter 250. A complete elevation view for the proposed improvement must be included on the drawings.
FILL IN YOUR RATIOS:
ZONE EXIS77NO PROPOSED REOU/RED
FRONT: FRONT: FRONT: .44
JT-35 SIDE: SIDE: SIDE: 1.20
FRONT: FRONT: FRONT: .48
"S SIDE: SIDE: SIDE: 1.30
FRONT: FRONT: FRONT: .60
R--20 SIDE: SIDE: SIDE: 1.60
FRONT: FRONT: FRONT: .60
045 SIDE: SIDE: SIDE: 1.60
FRONT: FRONT: FRONT: .80
R--INA SIDE: SIDE: SIDE: 2.40
FRONT: FRONT: FRONT: .69
R-12 SIDE: SIDE: SIDE: 1.60
FRONT: FRONT: FRONT: .80
I?-10 SIDE. SIDE: SIDE: 2.40
FRONT: FRONT: FRONT: .96
PLY SIDE: SIDE: SIDE: 3.00
FRONT: FRONT: FRONT: 1.20
/P-S SIDE: SIDE: SIDE: 4.00
FRONT: FRONT: FRONT: 1.20
R2F SIDE: SIDE: SIDE: 4.00
1 attest he best of my kno ledge and belief, the above information is correct.
Archit c ' i n re
S/12/2021
BUILDING DEPARTMENT FD) �� U W H 1
I
VILLAGE OF RYE BROOK
938 KING STREET RYE BROOK,NY 10573 � SEP - 6 2023
(9t4)939-0668 _._.
wwg.ry!!i$YrooLorg VILLAGE OF RYE BROOK
I BUILDING DEPARTMENT
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AFFIDAVIT OF COMPLIANCE
VILLAGE CODE 4216 • 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, Sooah Park , residing at, 47 Bonwit Rd.Rye Brook NY 10573
(Print name) (Address Nt here%ouIi e1
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;
47 Bonwit Rd. Rye Brook NY 10573 ,Rye Brook,NY.
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 Vropers %%ncr(s))
Sooah Park
tPruft Nano of PropeaN 0%%ner(s))
Sworn to before me this
day of , 20
L�-
VE SSA VITIELI_O
NOTARY PUBLIC-STATE OF NEW YORK
No.01 VI6412798 (6)
Qualified in'Westchester County
My Commission Expires 01-1 1-2025
8/1 2120 2 1
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:
Sooah Park ,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
Owner for the legal owner and is duly authorized to make and file this
application.
(indicate architect,wntractor,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.j
Sworn to before me this Sworn to before me this 3 t7-
day of /Y� , 20 Zo day of 20 2
Signaer7fy Owner Signtj� pplic
Sooah Park Sooah Park.
Print Name of Property er Print Name of Applicant
Notary Pubic Notary Public
VEN SA V4TIELLO �ENESS
NOTARY PUBLIC-STATE OF NEW YORK NOTARY PUBLIC-STATEA VITIELLO
No.01 VI6412798
No.01 VI6412 9BNEW YORK
Qualified in Westchester County Qualified in
My Commission Expires 01-11.2025 MY Commission E Westchester County
Aires 01-i 1-2025
(8)
8/12/2021
' BtiILDING DEPARTMENT
p
VILLAGE OF RYE BROOK
938 KING STREET RYE BROOK,NY 10573 APR 16 2024
(914)939-0668
www.rve roolc.ore VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
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FOR OFFICE USE ONLY:
Approval Date: Permit# Application#
Approval Signature: ARCHITECTURAL REVIEW BOARD:
Disapproved: : Date:
BOT Approval Date: Case# Chairman:
PB Approval Date: Case# Secretary:
7_BA Approval Date: Case#
Other:
Amendment Fee: permit Fee:
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APPLICATION TO AMEND APPROVED PLANS
Application dated: is hereby made to the Building Inspector of the Village of Rye Brook,NY,to amend the approved plans
associated with an existing open permit,and/or from any prior approvals granted by the approval authority as per detailed statement described below.
1. Job Address: -7`7 �0 n W I r ��7 Existing Permit#: P,)3- 7 0
2. Parcel ID#: / 3 5i cz "' /— 7 "Lone: Original Approval Date:
3. Proposed Amendment(Describe in detail): /y '--W }-v 0.0 j S-7-O O;-- -t W A Lk W q� �
k 13 y`I (S- �1M i MATL`CL y A L 1 ,Q J W1}I` r ok -4 VL-l(L
A c Sao vt__)n
4. Property Owner: S O .0 A-A �A-dL 1L
Address: -i'n I 3 o r w rr- (-'' 1z y c 3 rL o o iL - -
Phone# 117-22 5- 0 3 2'1 Cell#
Applicant:_'pp A-n
Address:47 13D✓1 c- i I T /2 12Ye- 3,i-,,o,-L-
Phone# Cell# e-mail
Architect/Engineer:
Address:
Phone# Cell#
e-mail
5. Occupancy;(I--Fam-2-Fam.,Comm.,etc...)Prior to construction: After construction:
6. Will the proposed amendment 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:1-(if yes,you must
submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans)
7. Will the proposed amendment disturb 400 sq.ft.or more of land,or create 400 sq.ft.or more„of impervious coverage requiring a
m Stor water Management Control Permit as per§217 of Village Code?Yes: No: Area: 3 2 0
1
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• 8. Will the proposed amendment require a Site Plan Review by the Village Planning Board as per§209 of Village Code?
Yes: No: L�_(ifYes,you must submit a Site Plan Application,&provide detailed drawings)
9. Will the proposed amendment require a Steep Slopes Permit as per§213 of Village Code Yes: No:-k,/'(if yes,you must
submit a Site Plan Application,&provide a detailed topographical survey)
10. 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 zone must be properly depicted on the survey&site plan)
11. 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 flood plane must be properly depicted on the survey& site plan)
12. Will the proposed amendment require a Tree Removal Permit as per§235 of Village Code?Yes: No: v,"'(if yes,you must
submit a Tree Removal Permit Application)
13. Does the proposed amendment involve a Home-Occupation as per§250-38 of Village Code? Yes: No: If yes,indicate:
TiER I: TIER i1: TIER iii: (if yes,a Home Occupation Permit Application is required)
14. Will the proposed amendment result in additional square footage to the building or subject structure, and if so, provide such
additional footage here.
(Please submit additional Bulk Regulation Application Pages for review)
15. What is the total added cost of the work associated with the amendment: S /C GZ'�� (The
estimated cost shall include all site improvements,labor,material.scaffolding,fixed equipment,professional fees,including any
material and labor which may be donated gratis.)
16, N.Y. State Construction Classification: N.Y. State Use Classification:
17. Estimated date of completion:_ &/2 4
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 ) as:
being duly sworn,deposes and states that he/she is the applicant above named,
(pnnt 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
(indicate architect,contractor,agent,attorney,etc.) 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. 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 -L� Sworn to before me this
day of , 207-1+_ day of 20
Sign rop rty Ow�ner�y Signature of Applicant
MAI
Print Name r erty Owner Print Name of Applicant
ota lie Notary Public
ERINE P. CARPENTIEit 2
Notary Public.State of New Yorlt
Reg.NO.01CA6137915
Qualified in NASSAU County
Commission Expires DEC.5,20�
8,12.2021
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Building Permit Check List&Zoning Analysis Address: �'"l � ac � V� 1 � SBL• CIS,• Q('), — 1 '
Zone: use v Cont.Type: Other.
Submittal Date l(O 2o27111evision Submittal Dates:
Applicant Q r\C\ �p
Nature of ork: l 2 vC\ _
O A- 5 \1 Felt
Reviews:ZBA: S E P 1 3 2 0 2 3 PB: BOT: Other.
C�( (I—FPS:Filing. BP: C/O: Flood Plane: Legalization:
( ) ( ) APP: Dated:_Notarized: --Thm 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 Mgtnt.: Tree Plan: Other.
( ) ( r)�VEY:Dated: Current: Archival: Sealed Unacceptable
( ) ( ) PLANS:Date Stamped:_', Sealed Copies:'— Electronic Other.
( ) ( ) License: ✓ Workers Co Liabili ✓Comp.Waiver. Other.
� CODE 753#: ('_)9-_"9 3 -QQQ— 9 K 7-O 0 Dated: C}al`% aL N/A:
( HIGH-VOLTAGE ELECTRICAL:PLUM: Permit: N/A Other.
( ) ( ) LOW-VOLTAGE ELECTRICAL:Plan: Permit N/A: Other.
( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plan: Permit: H.W.I.C.:_Battery:_Other.
( ) ( ) PLUMBING Plan: Permit: Nat. Gas: LP Gas: N/A/: Other:
( ) ( ) FIRE SUPPRESSION:Plan: Permit: N/A: Other.
( ) ( ) H.V.A.C.: Plan: Permit: N/A Other.
( ) ( ) FUEL TANK:Plan: Permit: Fuel Type: Other.
O ) 2020 NY State ECCC: N/A: Other.
( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plan: Other.
( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other.
( ) ( ) Other
(�mtg.date• approval• notes:
( )ZBA mtg.date: approval• notes:
( )PB mtg.date: approval: notes:
REOLI,I-RyE-D�)
`_ �EXLsnN \ PROPOSED APPROVED
Arse \-q _'` J V�c
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BUILD NG DEPARTMENT D v�
VIL S E OF RYE 0,OOK D11
938 KING STREET RYE BR06K NY 10573 SEP - 6 2023
(9141939-066jj VILLAGE OF RYE BROOK
L I 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.
Job Address: 47 Bonwit Rd. Rye Brook NY 10573 Date of Submission:
Parcel ID#: 135.42-1-7 Zone: R-12
Proposed Improvement(Describe in detail):
Replace the existing rear impervious patio with APPLICANT CHECK LIST:
a pervious paver patio wl garden walls. MUST BE COMPLETED BY THE APPLICANT
The following items must be submitted to the Building
Existing fence to be replaced as per attached plans Depart nent by the applicant-no exceptions.
Property Owner: Sooah Park 1. (7 ompleted Application
2. ( �wo(2) sets of sealed plans. (one full size {maximum
Address:47 Bonwit Rd. Rye Brook NY 10573 _ allowable plan size=36"x 42") and one I1"xlT7
Phone# 917-225-0329 3. ( wo(2) copies of the property survey.
4. (� y wo(2) copies of the proposed site plan.
Applicant appearing before the Board: 5. (V)One electronic/disc copy of the complete
Sooah Park 4Filing
application materials.
6. ( Fee.
Address:47 Bonwit Rd. Rye Brook NY 10573 7. ( )Any supporting documentation.
Phone# 917-225-0329 8. ( )HOA approval letter. (ifapplicahle)
rq. Architecture P.C. 9. ( )Photographs.
Architect/Engineer: (Jorge B. Hernandez R.A. A.I.A.) 10.( )Samples of finishes/color chart. (a sample board or
Phone#
914-944-3377 model may be presented the night of the meeting)
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 .J Sworn to before me this
57�
day of rn�yc,. , 20 Z day of Se�)2Lin , 20 Z
Si 0pvrty(honer Si t Ap cant
Sooah Park Sooah ark
Print Name of Property er Print Name o Appli t
M)tary Public Notary Public
VENESSA VITIELLO III VENESSA VITIELLO
NOTARY PUBLIC-STATE OF NEW YORK NOTARY PUBLIC-STATE OF NEW YORK
No.01 V16412798 No.01 V16412798
Qualified in Westchester County Qualified in Westchester County
My Commission Expires 01-11-2025 My Commission Expires 01-11-2025 H 12/ 1 1
• l
Village of Rye Brook
Agend
V
Architectural Review Board Meeting
cv y Wednesday, September 20,2023 at 7:30 PM
Village Hall, 938 King Street
ITEMS:
1.1. ARB23-090 (Consent Agenda)
Volkert Braren&Maureen Braren
262 North Ridge Street
Rooftop solar array.
1.2. ARB23-101 (Consent Agenda)
Thomas Mariam&Alyce Mariam
89 Country Ridge Drive
4'high&6'high white vinyl fence.
1.3. ARB23-102 (Consent Agenda)
Jonathan Starr&Shanen Starr
20 Paddock Road
4'high black aluminum fence and gates.
1.4. ARB23-103 (Consent Agenda)
Samuel Marcus&Audrey Marcus
12 Bobbie Lane
Rooftop solar array.
Consent Agenda
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.5. ARB23-023 (Amendment to Prior Approval)
Ervin Gomez&Maria Gomez
59 South Ridge Street
Rear 2nd story addition.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
Architectural Review Board
September 20,2023
1.6. ARB23-104
Vanderlei Carvalho&Ehane Carvalho
770 King Street
Roof over existing terrace.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.7. ARB23-105
Suresh Shanmugam&Anisha Mathur
259 North Ridge Street
Enclose existing rear patio w/ steps to grade.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.8. ARB23-106
Lorenzo De Roni&Christine De Roni
16 Jennifer Lane
New walkways and retaining walls,install SWM system.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.9. ARB23-107
Win Ridge Realty LLC
104 South Ridge Street
New sign. "Mama Mia Dessert Bar"
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
Page 2 of 4
Architectural Review Board
September 20,2023
1.10. ARB23-108
Frank Nunziato&Kristina Nunziato
30 Argyle Road
2nd floor addition and interior alterations.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.11. ARB23-109
Washington Park Plaza Associates LLC
243 South Ridge Street
New sign. "Wells Fargo"
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.12. ARB23-110
Jing Xie&Margaret Chung
141 North Ridge Street
Renovate existing deck.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.13. ARB23-111
Sooah Park
47 Bonwit Road
New rear patio,retaining wall and fencing. �
Approvals: MotioM 2 Second �(` > Abstention
Aye; Nay; Adjournment;
Notes
Page 3 of 4
s
• Architectural Review Board
September 20,2023
1.14. ARB23-112
Lake Development Co LLC
11 Old Orchard Road
Legalize and renovate existing deck.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
NEXT MEETING:
October 18,2023
Page 4 of 4
Laura Petersen
From: Tara Orlando
Sent: Monday,July 28, 2025 11:43 AM
To: Laura Petersen; Steven Fews
Subject: FW:47 Bondwit Rd. - Permit Extension
Tara A Orlando
Secretary - Planning Board �Q -/,0)
Zoning Board of-Ayyea(s and -�
ArchitecturaCReview Board �
WCage of Rye Brook
BuikCing Department
938 Xing Street
Rye Brook, New York 10573
Office (914)939-o668
Village of Rye Brook Building Department Summer Hours,June 30th-August 29th
Monday-Thursday 8:30-4:00& Friday 8:30-2:00
From: E Park<47bonwit@gmail.com>
Sent: Monday,July 28, 2025 11:35 AM
To:Tara Orlando<torlando@ryebrookny.gov>
Subject: Re: 47 Bondwit Rd. - Permit Extension
Thank you,Tara! I finally got through to the surveying company previously used and they said they will
have my update survey within 2-3 weeks.They should have someone here this week.
Appreciate it.
Thank you, Sooah
On Jul 24, 2025, at 12:22 PM, Tara Orlando<torlando@)[yebrookny.gov>wrote:
Good afternoon,
I sent this to Steven to confirm.
Tara A Orlando
Secretary - Planning Board
Zoning Board of AyyeaCs and
ArchitecturaCReview Board
i
TU14ge of Rye Brook
Building Deyartment
938 Xing Street
Rye Brook, New York 10573
Office (914)939-o668
Village of Rye Brook Building Department Summer Hours,June 30th-August 29th
Mondat-Tl,ursdgv 9:10-4:00& Friday 8:30-2:00
From: E Park<47bonwit@gmail.com>
Sent: Thursday,July 24, 2025 10:39 AM
To: Tara Orlando <torlando@ryebrookny.gov>
Subject: Fwd: 47 Bondwit Rd. - Permit Extension
Hello Tara,
Nice to speak to you yesterday.
Please see below email sent back in June. Also, my contractor Steve spoke with Fred in
person discussing same topic prior so Fred said Steve should email Steve Fews office.
When I also stopped by to close down my other permit back in spring this year for the
bathroom, I believe it was Laura who also said that I could submit both front and back
survey together.
Could you please advise if my extension is still good till end of August. I'll find another
surveyor to do it for Weeden Survey is not responding.
Thank you, Sooah
47 Bonwit
917-225-0329
Begin forwarded message:
From: Carlos Espinoza
Sent: Wednesday, June 25, 2025 3:54 PM
To: Steven Fews <stevefews(a)1)[e brook.org>
Cc: Steve Di Sisto <steve@sdgcinc.com>
Subject: 47 Bondwit Rd. - Permit Extension
Steven, good afternoon,
2
We are currently done with the work at 47 Bondwit. The very last thing we are
waiting to be delivered is some railing so we can install it.
We may not get it delivered before the 5th of July, when the permit expires,
we're wondering if we could get a 30-day extension on said permit.
Thank you for your time and consideration.
Carlos Ernesto Espinoza
Project Manager
Steve Di Sisto
General Contractors, Inc.
Commercial& Residential
Licensed in NY,CT, NJ, PA
Mobile 617-888-2156
Office 914-402-4167
2117 Crompond Rd,Suite 25
Cortlandt Manor
NY 10567
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A( _ /rt0 CERTIFICATE OF LIABILITY INSURANCE oa;za;zozs
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(tes)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 CONTNAME. Heydi Ortega Lazaro
FITZPATRICK INSURANCE CENTER PHONE 9147396117 FAX 9147391553
_(A/C No Exb AJC No
54 WELCHER AVENUE ADDRESS: heydl@fitzpatrickinsurance com
PEEKSKILL,NY 10566 INSURERS AFFORDING COVERAGE NAIC•
_ INSURER A: ATLANTIC CASUALTY INS CO 42846
INSURED PFEPatino Painting,Inc INSURER B:
119 Croton Avenue INSURER C:
Ossining,NY 10562
INSURER D:
INSURER E
INSURER F:
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.
L R ADDLSUBR TYPE OF INSURANCE Jima POLICY NUMBER POLICYDIYY POLICY EXP LIMITS
A ✓(COMMERCIAL GENERAL LIABILITY Y L068027963-1 02.'06i2023 02106/2024 EACH OCCURRENCE S 1,000.000
CLAIMS-MADE ✓ OCCUR PREMISES Ea occurrence $ 100,000
MED EXP(Ariy ore person $ 5,000
PERSONAL 6 ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000
✓ POLICY PRO-
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OTHER. S
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT(Ea ai;Weritj $
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accidont) $
AUTOS ONLY _AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Pera t
$
UMBRELLA LIAR OCCUR EACH OCCURRENCE S
EXCESS LIAR CLAIMS-MADE AGGREGATE $
DED RETENTION S $
WORKERS COMPENSATION PER -
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ANYPROPRIETOPJPARTNERlEXECUTIVE ❑ NIA E.L.EACH ACCIDENT $
OFFICER/MEMBEREXCLUDED9
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OP TIONS below E L DISEASE-POLICY LIMIT S
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101.Additional Remarks Schedule,maybe anachad if more space Is required)
List the certificate holder as additional insured
Job location:47 Bonwit Road,Rye Brook,NY.
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
Building Department ACCORDANCE WITH THE POLICY PROVISIONS.
938 King Street
Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVE
G 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
NYSIF
Ncw York St,,t-tn:ura•,r-fw, I PO Box 66699,Albany, NY 12206
nysif.com
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
^^^^^^ 264733269
FITZPATRICK INSURANCE CENTER
54 WELCHER AVE
PEEKSKILL NY 10566
SCAN TO VALIDATE
AND SUBSCRIBE
POLICYHOLDER CERTIFICATE HOLDER
PFEPATINO PAINTING INC. VILLAGE OF RYE BROOK
119 CROTON AVENUE BUILDING DEPARTMENT
OSSINING NY 10562 938 KING STREET
RYE BROOK NY 10573
POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE
W2576 685-8 601615 04/21/2023 TO 04/28/2024 8/24/2023
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE
FUND UNDER POLICY NO 2576 685-8, 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.
PRESIDENT
PABLO ESPINOZA ESPINOZA
VICE PRESIDENT
KLINTON X ESPIN
PFEPATINO PAINTING INC.
TWO PERSON CORPORATION
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 NSU NCE FUND
7 �V
DIRECTOR.INSURANCE FUND UNDERWRITING
VALIDATION NUMBER 405671114
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AtC"s CERTIFICATE OF LIABILITY INSURANCE DATE,vo-YYYY,
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(les)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 Neu of such endorsements.
PRODUCER CONTACT
NAME - Courtney Potter
McCarthy Insurance PHONE 91a)769-0417 FAX
-MC.N%Ems( -. i",Fie):
378 Elwood Avenue E-MAIL
ADMI1s courtneyi1jmccalthyinsrrence-net
Hawthorne, NY 10532
._ p wsuRER�s Assowna NAx.
114SURER A Preferred Mutual -
eMUREO INSURER B
Hirsch Fence Install& Design LLC INSURER C
747 Rt 9w Cottage#4 INSURER D `
Valley Cottage, NY 10989 INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER. 00002210-549539 REVISION NUMBER: 3
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY 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
Irw1 TYP!e1 aMIIRANCE �ADOL SUMRshim isr'n POIXY wimw POUCr Err i►OUCv Lis
A lBCMl681&RKUAaIM Y BOP0100721375 11/12M22 11H2r= EACH OCCURRENCE t 1000000
CLAWS40M X,OCCUR UAMAUF TO Kt
PREMISES IF,ouwrituosl S 50,000
MED EXP V!Mte"e person f s,000
PERSONAL&ADV a julin S 1_000,000
GENL AGGREGATE UWT APPLIES PER GENERAL AGGREGATE is 000'000
POLICY --- � LOC .PRODUCTS-COMPIOP AGG S 2,10IM00-0
OTHER S
AUTOW06"LWe.ITY COMBINED UMrT S
.LUW.4dwu ---
ANY AUTO BODILY INJURY IPer Person {
OWNED AUTOSSCHEDULED BODILY INJURY.Per eccrderel S
AUTOS ONLY AUTOS �
HIRED N(N-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY LP*`4KC40MJ S
•S
UMBRELLA LW OCCUR EC
eIICESS LIAa ---ACH OCCURRENCE S
---' - ------ _
_-- _ CLAMAS-MADE AGGREGATE S
DIED RETENTION c
WORKER/CONPB/MTWN
OTH-
AND EAVLOVEM LuISNJTY Y I N
ANY PROPRIET0011+9AR7NEREXECUTIVE - — E.L.EACH ACC DENT S
OFFI:ER/WMMR EXCLUDED" NIA - .
PoWNSOMV in on E.L DISEASE-EA EMPLOYEE S
Dee"ft vide,
-' - -_
UDESCRIPTION OF OPERATIONS below E L DISEASE POLICY LIMIT S
DESCRIPTION OF OPERATIONS.LOCATIONS I VEHICLES IACORD 1e/ AAditg f Remar%.Schedule rn"tw sna h"d more eyece rs,*Ww*d)
Address :30 Lawridge Dr.,Rye Brook, NY 10573
Certificate holder listed as Additional Insured
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Village of Rye Brook THE EXPIRATION DATE THEREOF.NOTICE WILL BE DELIVERED IN
938 King Street ACCORDANCE WITH THE POLICY PROVISIONS
Rye Brook NY10573
AU TNOWZ����/
- --- r �-C CPO
O 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016M3) The ACORD name and logo are registered marks of ACORD Printed by CPO on 06/16/2023 a109 30AM
NEW Workers'
YORK Certificate of Attestation of Exemption
STATE Compensation from New York State Workers' Compensation and/or
Qoard Disability and Paid Family Leave Benefits Insurance Coverage
*(This forni cannot he user/to nmi►re the workers'rompensation rights or obligations of aleY part(:**
The applic:ult may use this C e(tilicale ol'Atlestatiotl of Exemption ONLY to show a government entity that New York Slate
specific%corkers'compensation anti/or disability and paid family(cave heneftts insurance is not rcquircd. 'fhc apl+licant
may NOT use this lim»to show another business or that business's insurance carrier that such Insurance is not rcquircd.
I'leaw pro.ide this form to the government entity from which you are requesting a permit,license or contract. This Certificale will
not he accepted by government officials one%car after the(lair printed on the form.
lit the Application of Business Applying For:
(Legal Entity Name and Address): Building Permit
winch Fence Install&oesiRn I.LC
74'Ruurc o..If 4 From:Village of Rye Brook
%allc%f office,\% 109aV_244.;2
Plttl\t:S45-304-ti6:: FEIN:.Xxxxxoo9l llic location of where work will be rxrlimned is
47 Bonwit Road,itye Brook.NY 10573.
f ynnraled chic.necessary I(,complete work associated with(he huilding
permit are twin Angnsl 21,2023 to December 21,2023.
The estimated dollar amount of protect is
orker.'Compensation Eccmption Statement:
The above named business is certifying that it is NOT REQUIRED TO OBTAIN* NEAV YORK STATE SPECIFIC
WORKERS'COMPENSATION INSURANCE COVERAGE for the following reason:
The business is a I.I.C. I.LP.PI.LI'or a RLI.P:OR is a partnership under the laws of New York State and is not a corporation. Other
Ihan the partner%or incinbers,there arc no employees.day labor,leased employees,borrowed employees.part-time employees,unpaid
coluntcen(including family members)or subcontractors.
Partners,,Members: Bruce Hirnch
Disabilit. and Paid Familv Leave Benefits Exemption Statement:
The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEVI'YORK STATE STATUTORY
DISABILITY AND PAID FAMILY LEAVE BENEFITS INSURANCE COVERAGE for the following reason:
The business MUST be either. 1) owned by one individual: OR 2) is a partnership(including LLC.LLP.PLLP.RLLP,or LP)under
the law>of New York State and is not a corporation: OR 3) is a one or two person owned corporation,with those individuals owning
all of the stock and holding all offices of the corporation(in a two person owned corporation each individual must be an officer and ou n
at leaaf one share of stock): OR 4) is a business with no NYS location. In addition,the business does not require disability and paid
family lease benefits coverage at this time since it has not employed one or more individuals on at least 30 days in any calendar year in
Kew York Stag. (Independent contractors arc not considered to be employees under the Disability and Paid Family Leave Benefits Law:)
I.Bruce I hrwh,am the Member with the above-named legal entity. I affirm that due to my position with the above-named business I have the
know ledge.information and authority to make this Certificate of Attestation of Exemption. I hereby affirm that the statements made herein are true,that I
hat c not made any,materially false statements and I make this Certificate of Attestation of Exemption under the penalties of perjury. I further affirm that
I understand that any false statement,rcpresenlation or concealment will subject me to felony criminal prosecution,including jail and ci%it liabiliq in
accordance with the Workers'Compensation Law and all other New York State laws. By submitting this Certificate of Attestation of Exemption to the
go%emmew entity listed above I also hereby affirm that if circumstances change so(lint workers'compensation insurance and`or disability and paid
family leave benefits coverage is required, he above-named legal entity will immediately acquire appropriate New York State specific w cukers'
compensation insurance and.'or disability nd paid family leave benefits coverage and also immediately famish proof of that coverage on forms approved
be the Chair of the workers'Compcns disability
oard to the overnincrit entity listed above.
SIGN Sirrnaturt Date:
HERE
Exemption Certificate Number ltceet�ed
August 21, 2023
2023-060410
NYS Workers' Compensation Board
Laura Petersen
From: UDig NY Exactix <tickets@exactix.udigny.org>
Sent: Friday, September 29, 2023 11:09 AM
To: Steven Fews
Subject: Message from UDig NY
****REGULAR****
DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 09/29/2023 11:09
To: VIL RYE BROOK PRIMARY Transmitted: 09/29/2023 11:09 00001
Ticket: 09293-000-857-00 Type: Regular Previous Ticket:
------------------------------------------------------------------------------
State: NY County: WESTCHESTER Place: RYE BROOK
Addr: From: 47 To: Name: BONWIT RD
Cross: From: To: Name:
Offset:
------------------------------------------------------------------------------
Locate: REPLACING EXISTING FENCE AT THE BACK AND SIDE OF THE PROPERTY
NearSt: CARLTON LN
Means of Excavation: POST HOLE DIGGER Blasting: N
Site marked with white: N
Boring/Directional Drilling: N
Within 25ft of Edge of Road: N
Work Type: FENCE INSTALL
Estimated Work Complete Date: 10/11/2023 Depth of excavation: 24 INCHES Site dimensions:
Width 8 INCHES Start Date and Time: 10/04/2023 07:00 Must Start By: 10/19/2023
------------------------------------------------------------------------------
Contact Name: BRUCE HIRSCH
Company: HIRSCH FENCE INSTALL AND DESIGN
Addrl: 747 RT 9W Addr2:
City: VALLEY COTTAGE State: NY Zip: 10989
Phone: 845-304-8622 Fax:
Email: bruce@hirschfence.com
Field Contact: BRUCE HIRSCH
Alt Phone: 845-304-8622 Email: bruce@hirschfence.com
Working for: HOMEOWNER
------------------------------------------------------------------------------
Comments: Lookup Type: PARCEL
------------------------------------------------------------------------------
Members: ALTICE USA CONED
SUEZ WTR WESTCHESTER VIL RYE BROOK
WESTCHESTER CTY SWR
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LICENSE NUMBER: 030424-1
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