Loading...
HomeMy WebLinkAboutBP23-184PERMIT R SECTION j TYPE OF WORK 10B LOCATION EST. COST j�O Of CO TCO # �3 DATE on 3�I BLOC LOT C e l7ol� O� lk)iodl l0000& co 70 0/7 - e w ao /vel�q �, •III �Q �7.��i� • � � � • � i.(�Il i�i I DOTE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PlUM81NG � RGH PLUMBING GAS SPRINKLER ELECTRIC 021 LOWVOLT 0 •it.ARM O AS BUILT FIcVA! INSP -/�Pa3- l l8/ 1��l /WQ"s"L'e *4, 1/13 OTHER APPROVALS ARB BOT Ps zBA OTHER - VILLAGE OF RyE BROOK WESTCHESTER COU , Y, NEW YORK NO: 24-017 Certificate of (Occupaurp This is to certify that / ol )Uel"OV? / of, having duly filed an application on T el�kua��W ok6,20 requesting a Certificate of Occupancy for the premises known as, Rye Brook,NY,located in a )2-/5 Zoning District and shown on the most current Tax Map as Section: 3qBlock: Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No J- , issued 7 20.�, such authority and permission is hereby granted to the property owner to lawfully occupy or use said premises or building or part thereof listed under the following New York State Classifications,Use: �' ��l�, / Construction: , for the following purposes: / 1' /�l_��a y 7 ��� Q Va / ,/0/7 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 made, hall the building be moved from one location to another until a permit to accomplish such change h ee ob fro ilding Inspector. Building Inspector,Village of Rye Brook: Date: FEB 2 6 2024 R For office use onl -: 1 BUILD ENT PERMIT ,)3—/Y ID VIL OF RYE OK ISSUED: //— 7�3 FEB 2 0 2024 38 KING STRE YE BROOKf YoRK 10573 DATE:p-) a0 a5Y 9 -Q6 OY FEE: 35- PAID 1.VILLAGE OF RYE BROOK BUILDING DEPARTMENT IYOL 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 twtwwtw*rt**st+stw***st*ss**tsrtt**sstt*t**swst*tt*t*t*rt*srts*+**s*rt++*s*+rt+s+rtrt+***ssa**ws**stt*rt*ts***s*ss+s***t*rt*ts*tt*t*tts Address: 5 0 '4)t:VVj j _ Occupancy/Use: Parcel ID#:_ 3�5/ 34--1—J 0 Zone: �e— Owner: 5,4,V V Ahb ,/SAC AOb Z El,/ Address: ':�0 W'ItU b(,V 6 VUyab Q � P.E./R.A. or Contractor: T m.S 1�CUG7ioAI l 4 G Address: Jq 14064Ar 64AENW/CH GT Person in responsible charge: S[g,45r/rb ;V E-T-0 Address:_r4� 4,64 r,, 4 yc, G A---f-yali6 1-i C 7' 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: )A O .Nor being duly sworn,deposes and says that he/she resides at (Print Name of Applicant) (No.and Street) in��j��,�,(JGU/G ,in the County of�,d/l7��� in the State of C�,that (City/Town/Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements. labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:S S-C oov* for the construction or alteration o£ K! TL.og-u k C lyo u kT ei Ar Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-10.A.of the Code of the Village of Rye Brook. Sworn to before me this Sworn to before me this o2� day of Ochkf , 20 day o' GAO , 2023 Signature of P Owner j S ature o Ap PrurrVame of r Owner Print Name of Applicant �1 ick� 'A� tary Public - ANA M SALAZAR RANDIEPATERNO FQuatifsed PU11LIC.slAI'l orNFW1t�K Notary Public,State of New York Registration No.OIJ:16}t 5I73 No.02PA61 17023 inWcstchestcr CountyR:`12 20 1 Qualified inNewYork U mission Expires lu-0'_-'u'-5 t mmission Expires October 12,20.4 I �E BR(��. Zm • 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 : S D l/V I V I y G, ��� DATE: 2 ' Z.L- Z p2-y PERMIT# �?>P 2Z ISSUED: 11 '7- z 3 SECT: 13S• 3 BLOCK:i LOT:)Q LOCATION: 1 G J tCC'NOV a ►O- OCCUPANCY: Z 10 ❑ Violation Noted THE WORK IS... TIPASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas �' ^'� �- �a (U ��v K- c►-D ❑ FUEL TANK v ❑ FIRE SPRINKLER ❑ FINAL PLUMBING " ❑ CROSS CONNECTION FINAL ❑ OTHER m 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 : � �Q� 1 ��C -�J`�` '4l DATE: PERMIT# ISSUED: ECT: BLOCK: LOT: LOCATION: r1 ( U OCCUPANCY: --2-1 y ❑ VIOIadin Noted THE WORK IS... 4 ] 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 : � s v A.72 is ^ z O .ova ° � u F, U O rn � W v : O W a y cl 14 o : V 11 O O ai v _ O H. x � gpo � w0 � ry a.� O W O `WWn D; O CN en " - .6 E -:- - co s L A �-I ? " z ba+ y O d u MO w z � 0*4 V N b 104 o ' Q� H O ° c IQrv,laz wz v � � w . o � W— w zCl 0 � "� aa G4 ° z w tn z a a u lu tz 1-4 U $o � W F,, O z z 4 w 1-4 o o ° � °Al E a O V V v � z � " > � Q � C7 A z O a CD o z 0: rA CW7 �" � '+- u as W O � z x u o ti di I "" W pp P-i *4 W .TO. � � o B TLD M T R IE WW L U EN V1L E OF R OOK OCT 2 5 2023 938 DING E'r RYI,BR ,NY 10573 "fl VILLAGE OF RYE BROOK BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Approval Date: 202 c ' #: &�—1 W Application Fee:$ ZL?O r Approval Signature: Permit Fees:$1 O �" bo E s Disapproved: Other: Application dated: 1� is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing building,or for a change in use,as per detailed statement described below. 1. Job Address: SCE 1-114 Lh/Nr L100 ZRh S . SBL: 135 - I - A-0 Zone: R — i J 2. Proposed Improvement.(Describe in detail): FI'PL GE W511 AJ G K,l}C� HE PJ A LOUT) , A C BUD Lob /°► l 3. Does theproposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No:Z Yes: If yes,indicate: TIER 1: TIER IL• TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an exist' g automatic fire suppression system(Fire Sprinkler,ANSL System.FM-200 System,Type I Hood,etc...) :No: Yes: (If yes.please submit a separate Automatic Fire Suppression System Permit application&2 sets o detailed engineered plans) 5. Occupancy;(I fam.,2 fam.,comm.,etc...)Prior to Construction: ± FAM I L After Construction. 1 FAM I L. }/ 6. N.Y State Construction Classification: N.Y.State Use Classification: 7. Property Owner:bbc .5AAID 64V Address: _F�r) W I 1J`1*1)1 n1G IV nnjl_�. R6 S . Phone# pp Cell# q�� qC? 9S 0�email:5 Al )L kkic I Al F1 (26�u 1L.0 8. Applicant:&Z C�/S5'R(/CT/OtJL[.r%Address: f`�� (/l �R'� � ve 6eF H-C Phone# Cell# ?�'/J email: 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# email: 11. General Contractor: SE, A T/ A O NE5SQddress: ��'C E Phone# Cell#o�Q3��_ / '7Q emaiL•&Jr_-BAS'r1A AL IV E TO 0Q f/©O,ri 12. Estimated cost of construction $ (NOTE The e�tintaled cost shall include all labor.tnateri:0 ti,A1i)1dint,,fixed equipment,pnotessional lee,,and material:Ltd labor which tnay be donated gratis.) 13. Job Timetable: Start: -ti 1.21 t ,;--3 Finish: 0 it '3 1 (1) 6/1/2023 BUILD MENT D vDD VIL E'OF OOK OCT 2 5 2023 938 KING �'.R iB t; ,NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT ��*x,�x�**x�,�**:�,�xx�*�x*xxxxx�xxxx,��**x,,�*;,�Kxxx�:;:x�xri*x�x*���:,���xx�-�KxxxR,xx,><**,>•*,�*,�**���xx*F�*,�xxx�**x 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 YO/RK, COUNTY OF WESTCHESTER ) as: I, 5 N�y /t �/�/� ,residing at, .5-0 WQF�1''� loG ' IA-06 9� S (Print name) (Address where you lite) 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; -50 �lI/U �I,U C �°� 1C �. , 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. (.S'_nalurc of Pro 1y wncr(s)) 56kNk� V,Ile (Print Natnc of Property Owner(s)) Sworn to before me this 21 RANDIE PATERNO Notary Public,State of New York day of d , 20 Z No.02PA61 17023 Qualified in New York ,� t1pmmission Expires October 12,20:.Ll (No Public) RANDIE PATER NO ftlAry Public. Stnre nt No.02PA r,I I Qualified in 00MIIIission Exprr,., (2) 8/12/2021 This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. Please note that application fees are non-refundable. STATE OF NEW'YORK,COUNTY OF WESTCHESTER ) as: being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the ,—_ c cPN$71-,e 1_/oN for the legal owner and is duly authorized to make and file this application. (�indt�a 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 11 Sworn to before me this 2157- day of 1 12023 day of `i-n&Fj , 20QZ '/L - ) V. P ZA�. 'gnature of Owner lure f App scant Sct��..0 kl�r►1 5����r� r. s. N,�a Print Prope ner Print Name of Applicant N ary Public Not t AN AM SA'.AZAR RANDIB PATERNO NO�A[tY Pl;,ll 1C.STATI:OF NEW PORK potary Public,State of New York Rc_,u.t,,,,, ivo W SA6365173 No.02PA6117023 t3ttaliiic;'t m G<<```h`5�`r County Qualified in New York 4 comints,iun la1 ito lU U':625 ammission Expires October 12,203T� (4) 8112/2021 e a O o M � 00 w a N o N w Z W a VI ell OH O Z o � w° � w O tn 44 �WWn c� a 'n m O v x a °..° ti � z r� O U U w w o cn • gn7 W E V u t Z o Z A z w Z w V cn w s w oo F a Q w � � r° � o � z a O og " z vi W cW,7 o O ° cn ►-+ a ¢ w ,n V H 8 ,y3 u o w z P. x o z W z A oa .. � a T yC 13RC�v BUIL E MENT VIL E OF RYE OK ID I�___ 938 KIN , 'ET RYE B ,NY 1057 � NOV 28 2023 . VILLAGE OF RYE BROOK org BUILDING DEPARTMENT - - .... ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP : 6y - 194 EP#: c-)3- NO ��Approval Date: 2 2 Permit Fee: $ Approval Signature: Other: Application dated, //8+ "r�3 is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/or remove electrical equipment,wiring, fixtures, or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with ,,all a,,ppllicaabole Federal,State,County and Local Codes. 1.Address: ,S-0 W/!�//9 / ae /Cps SBL: JJ�. ;4+1 Zone: 2.Property OwnerA& �P/n Address: .S/he Phone#: 11 qGA- QSO4- Cell#: email: 3.Master Electrician/Licensed Installer: A4"G-J 4/jcr7c6 Address: 1- -44(f ,r'an Lic.#: c c c—Phone#: '14'-o(Sa--4-05e Cell#: T14- *j Q-'7V0 email: MAS'ff 3�t/ Gi l �i11 Company Name: 1AIcI14Lt & 1ch ��r'`l� -. Address: 1�¢ P ,-4,,,1 k, if �ly�•!cf &ocI,-/11e _ N� 4.Proposed Electrical Work/Fixture(fCount: (&�1 0 gn7 .hex : A-14 lL---'Shr_r 4 .,10Aer 5.31d Party Electrical Inspection Agency: -q a4C wj c�- l n uz9 --4yil —<�—V(«s , 1/1 C /� STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: 11(ll[h(6k1 k ho (GD ,being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant) state that(s)he is the for the legal owner and is duly authorized to make and file this application. (Master Electrician/Licensed Installer) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances,and regulations. Sworn to be�fgg��a me this al I Sworn to efore me this i day of IC: W. ,20 a 3 .20 rn 7 Sirtur ro�L,p((erty Owner Signature ppltcantt N f IVA GREGORY M.RIVERA `e / L Iame perty Owner Newry Public,State of New York Pr' NameoA�plic6t No.01 RIWI 398 Qualified In Westchester County(XIotary Publi tary Public `Camrr epte rtssion Expires Smber26,2 RANDIB PATERNO aREGORY M.f?IVEri;. 010tary Public,State of New York,Stilly J;:�1 No.02PA6117023r Qualified in New York rut NO.01R1644`.`�� 3/3/2023 ftmmission Expires October 12,2020 QuaNBld In Weston..:-:�• :y STATE WIDE INSPECTION SERVICES, INC. ••0 • • swis JOB APPLICATION0. Office Use Elect. Permit# L J— �i Date Bldg Permit# Sq Ft Plumbing Permit# Final Certificate# City/Village Zip F ding Dept. County Address �� G/ J, Cross Street Section ��S $lock Lqt /J Owner Name/Address(If different than above) 711' /� Contact Number ❑Basement 1st FI. ❑ 2nd Fl. ❑3rd FI. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside ❑Residdential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/0 Detector Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels 1P I 3P # Meters # Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair ❑Overhead ❑ Upgrade ❑ Disconnect Utility ID# ❑Con Ed ❑ NYSEG ❑Central Hudson ❑ Orange/Rockland PHOTOVOLTAIC SY 11 PV Modules Inverters AC Disconnect Junction Box Combiner Box Load Center DC Disconnect I wn T M lu ❑Legalization ❑ Safety Inspection Consultation BUILDING DEPq T ENT t � rrs This application is valid for one(1)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,if at any time of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other inspection company.The applicant, owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Email Address u �%v (G Gc U/-�p/!� Name 'y"-'fiG� l 1C c License# Dat Signature Address /!l/ -� City/State y /� Zip Code , L54 Company � � / fr" � / o -;;_ Phone# R D DDState Wide Inspection Services 1080 Main Street C� FEB 14 2024 Fishkill, NY 12524 as ,-low US 845 202-7224 Phone y VILLAGE OF RYE BROOK 9(1{4-219-1062 Fax STATE WIDE INSPECTION SERVICES BUILDING DEPARTMENT Email: office(c swisny.com Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Alberico Electric Alexander&Sandy Klein Michael Alberico 50 Winding Wood Road 14 Portnellan Avenue Rye Brook, NY 10573 New Rochelle, New York 10804 Located at: 50 Winding Wood Road, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 23-244 135.34 1 Certificate Number: 2024-0722 Building Permit Number: BP 23-184 A visual inspection of the electrical system was conducted at the Residential occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at: 50 Winding Wood Road, Rye Brook, NY 10573 The Basement&First Floor were inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 61' Day of February 2024. Name Quantity Rating Circuit Type L.E.D. 22 Plug Mold 01 10 Feet Under Cabinet Strips 03 Microwave 01 Dishwasher 01 Wall Oven 01 Refrigerator 01 Gas Stove 01 _ Exhaust Hood 01 �c�...t�L Officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. M d' p� N Cq 00 W r� O o v a �y W oo cn Z ca rx o A A F 00 ZZ � W z Z a p H - .F p, z ►-a ° cco cn E• ... o' t V O W00 o W M hl G� 2 al N cn F. oo z Q p ►-� z en 0.4 !� Z z z � ,:f H a F d V o8 o ° z z o p3 V O a. a 66- " x o � H p QI ra a. a w xcn BR BUIL MENT NOV 2 0 2023 VIL R OK 938 KIN ,f ,L' ,NY 10573 nror PLUMBING PERMIT APPLICATION ? FOROFFICE USE ONLY B1'#: 2 $ PP#: c;)J Approval Date: �'/ Permit Fee: $ r Approval Signature: Other: Disapproved: (fees are nun-refundable) Application dated, --=2 is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/or remove Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agree that said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: __5 O WI N DI N& W)�qp 12 CL s SBL: /3 s. —/ —' f O Zone: 19-3 2.Proposed Work:�Lep r�YkENT D 1� 6X-15J t,6.- k)t TdNEJV rXTIJAeC—,5 IA&156 3.Property Owner: J1q 4- S /�(.0 1 N Address: -SO lt,►AQjA/r kobaD 12D. ACl,8ro.&A N J Phone#: Ccll#:_91?' 44 at — `/,5-04mail: 4.Master Plumber: 40--r MAgN S FlGr'0 '2 &Wjen DRIB iY, /Myo 1 �+ Lic.#: 211 Phone#: 9/41 40-6 v 78/ Cell#: email: ilM,'L'tS77G r eol Company Name: 0'rf ft t F 1 . Address: Det uE� t1/c�r INDICATE FIXTURES&LINES TO 13 OSTAT LE AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer hi6ci e Basement 1 st Floor A y 2nd Floor 3rd Floor 416 Floor 5'Floor Exterior 5.*List Other Equipmenv?rovide Details: P I S 14 t.jyl-smite C.C- nake' 2, Po66j aLe 1�5T t=/LAW (Notarized Signatures Required Next 2 Pages) 3/3/2023 STATE OF NEW YORK.COUNTY OF WESTCHESTER ) as: '&r er 640 ,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. Sworn to before me this at Sworn to efore me this day of a ,20 a3 day of _ -15 - ignat a erty Owner Si of pph ant Prin am Property Owner Print Name of Applicant tary Public RANDiE PATERNO Nota 1 t c Y Public,State of New York Notary Public, State of New York No.02PA6117023 No. 01 VE5084028 Qualified in New York Qualified in Westchester Count Ownd ion Expires October 12,20._., Commission Expires August 25,20 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 BUILD MENT VIL OF RY OOK ? I 938 KING ,Er RYE BR ,NY 10573 NOV 2 VILLAGE Jh R r':- BROC" *x*xxxxx*x**x**xxxxxxxxxxxxxxxxxxxxxxx�xxxxKx*******xxxxxxxxxx**xx*xxx*xxxxxxxxxxxxxxxx**xxxxxxxxxxxxxx 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: S gND Y kluA , residing at, 30 1,jiNDN✓G Wppj) & 51 1&g Brbs��AL S� (Print name) (Addre..where y,,u lire) 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; �b ?.ilt id4�iyG k✓oso /1p ) 5 , 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. . iwlatttrc of I 0 perty Onner(<)) (Print Name r roperty Sworn to before me this a`Sr day of ✓ , 20 L06�4 (Notary ublic) RANDIE PATERNO wry Public.State of New York No.02PA61 17023 Qualified in New York won Expires October 12,20 8/12/2021 .Building Permit Check List&Zoning Anal sis Address: SBL. Zone: Q=�Use: Co ype: Other. Submittal Date LO --3 Revisions Submittal Dates: Applicant: 1 C Nature of Works Reviews:ZBA: PB• BOT• Other: LYBF�./l2� 5' ��(7 ) :Filing'— ?P: 11 C/O: Flood Plane: ( ) ( APP: Dated: Notarized; Legalization: SBL: Truss I.D. Cross Connection H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening. ( ) ( ) ENVIRO:Long Short: Fees: N/A. ( ) ( ) SITE PLAN:Topo: Site Protection S/W Mgmt: Tree Plan: Other. ( ) ( ) SURVEY:Dated: Current: Archival:- Sealed: Unacceptable: ( ) �JPLANS:Date Stamped: Sealed: Copies: Electronic Other. ( (1License �/ Workers Comp: Liability: �mp.Waiver. Other. ( ) ( ) CODE 753#: HI Dated. N/A: Date (►� ( ) HIGH-VOLTAGE ELECTRICAL:Plans: permits NIA�D Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit: N/A Other ( ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit H.W.I.C.:_Battery: _Other. ( ( ) PLUMBING:Plans: Permit: Nat. Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit N/A: Other. ( ) ( ) H.V.A.C.: Plans: Permit: N/A Other. ( ) ( ) FUEL TANK:Plans: Permit: Fuel Type: Other. O O 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. ( )ARB mtg. date: approval:- notes: ( )ZBA mtg.date: approval• notes: ( )PB mtg. date: approval:- notes: R_EOLURED EXISTING PROPOSED NOTES D Qf DateHOV E� F� Main Cov: Accs.Cor. Ft,H/Sb: Sd.H/Sb: Tot,Im : a�',-.yim'.,,.. Hck r/ notes: vg i "r 4 V V r >���'a � ,s> i�". ._ ��1`��1�).`•: � ...`tr.'.� Ii�l Y- ' '� f,5��11 ",:�t����. h � " .3 N . C N to � �? J L O 40 U r J W M v r V —� CO � � +w z z o o o��ction aj LIJ • '�" U �ly�jp 8Q �� E` LJ 1, r W 4.4 v — Y el a y 4 i A Q> CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDYYYY) 10112/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONT PRODUCER Sharp Insurance Services Inc NAMEACT Moises Rosales 128 N Main St P"C,NEx& 2032479524 FAX No):2036638200 Port Chester NY 10673 AIL ADDRESS: mrosalies@sharpsves.com INSURERS AFFORDING COVERAGE NAIC X INSURER A:Obsidian Specialty Insurance Company 16871 INSURED E&I Construction LLC INSURERB: 191 Hobart Avenue INSURER C Greenwich CT 06831 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. INSRR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMIDD YYYY MM DD YYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 DAMAGE TO RENTIT-- ✓ CLAIMS-MADE ❑ OCCUR -PREMISES Ea occurrence $50,000 A SCB-GL-0000026446 03/09/2023 03/09/2024 MED EXP(Any one person) $6,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 ✓ POLICY PRO LOC PRODUCTS-COMP/OP AGG $1,000,000 OTHER $ AUTOMOBILE LIABILITYLi COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ E]r7I DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule.may be attached if more space is required) Additional Insured: Village of Rye Brook CERTIFICATE HOLDER CANCELLATION Village of Rye Brook 938 King St SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Rye Brook NY 10573 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Moises Rosales Producer 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund PO Box 66699,Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 51 f' [i) 'A^^A A 371954820 SHARP INSURANCE SERVICES INC 128 N MAIN ST Q f PORT CHESTER NY 10573 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER E&I CONSTRUCTION LLC VILLAGE OF RYE BROOK 191 HOBART AVE 938 KING STREET GREENWICH CT 06831 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE X2566 360-0 20572 03/10/2023 TO 03/10/2024 10/12/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2566 360-0, 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 THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. 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 SU NCE FUND T4 4/ DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:669661052 i I III its , 31; i --.fz .fri► - ZA LZ-- —_fz W w J rT � o � w m U c f~ Stl3M•if(: (a O A; � Z o a u U �r � W U) Z W b UZap r ���1� • � U 7D w a s`oW D tl O CL a b I U U) a fZ — < N I~ cr w W _ � Yam O $ W } " z c _ b UW � ! `—- - | ■! , . & k |'.||| ||�■ ||| 1 � $ I � `! ! � � w � s | ■,■| � | � � i ; .. | |�� |� | ! |�|•�||�-�||����| , � � ! �} | � �) !� ■| \ � � '� �|�`-■�����| � ! ! ■ , ■ i � �77 � ��fƒ� � ��i�!�! � \ • � � / | � ! ,|�||!||!|�!|�I�| 2; _ }� ¥2xx $ i /) L ƒ� : ' I ¥ , k ! � 2 § `) i i= f \$ �§ I � G a z E2 ——-- - - - -——-- ~ � , , ■ \ $ | f t }| ! |\ ° � � � ` ,�!!;�||��||�'� �|�| | � �|| .© $• i� \ � � - \ i ���' ����� w � § �� 7 ��J | 7f�!|!� |�! \ | . | | | � ' ■||||||�||�|��l�� i � I a § . . k - � � ■ kk § ) � � I. I � G I I � . � !� ! | �� � � a �| ' . �|'�| |�■���|| � | ° } | z§ !n !� � ; , •| , |�■.|'|f; � � � §!!|!|� | |§!| |!, !�| = , | ., | | ` a|�|■!■,■|!.!|i,. � ». « { § K4,cf PC— ui\ I 77 \ | \ � I ¥ \ @ , 3 . 2AK— . ar --=L2 m -e fit tililf.tl ,s I w O I � w Z i . U � .q 1 Q � 38,Lt \ ! 0 x t a w � � � I i i I I oIEI a I � I I i .66 S Zn 96 ti} E w � pf� jx M Y V i ti v r f7 O> W I S Z ? w n UW Y z PA _ � � - � © an « \ ) § \ \ z \ § ® § » § k c 0 2 - Lai ■ � o � CL zz ¢ � ■ ° ƒ � = g LM / LLJ LU @ a / § 0 / ( Go $ m \ k § ° p _ a w - _ ; 2 Q } § cm m / - © `| 7 L " / } w q ® LU % $ k / / ƒ z r 7c K � 2 �� \ J ƒ } 2 o / ] / ! a a 2 \ - On f « � } N j Lu § 0 @ :E m \ k R > � G j o2 § § R � � ® $ 2 � px0� � � // } c 7) E} o a k , C) w CL y , Q = 2 \E}} E o 2 Sa 2 i \ o C cLL O % R 3: 6 7 � � { § } � & to u 2 |ECD .2 § ƒ � �■ LL. o @ o Q ) a » o ■ §