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Home My WebLink AboutMP23-165PERMIT # StOTION TYPE OF WORK46 JOB LOCATION/_ OWNER Il/! it E5T. V CO #, TCO # FOOTING - �'Ad FOUNDATION FRAMING RGH FRAMING INSULATION /lo 5L DATE: // / a3 u(P: t� — C'e// FEE DATE INSPECTION RECOR,Q DATE PLUMBING[_ ,ry3L f RGH PLUMBINGy --7-- J"r `y if GAS ® SPRINKLER02 = 79(o0 ,yu aSos7 )L//Zl/n 6 %.l f 7/ter 4*ri 'o0)71/0 c.a�rvr2 ELECTRIC i�_Qv,,-voLT C] _ Cl AS BUILT I-INAL OTHER APPROVALS ARB BOT PS ZBA OTHER 'AS-[3UILTIFINAL SURVEY REQUIRED PRIOR TO FINAL INSPECTION yE DR c 7. t9 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J.Bradbury www.ryebrookny.rgoov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE March 4,2025 Village of Rye Brook 938 King Street Rye Brook,New York 10573 Re: 938 King Street, Rye Brook,New York 10573 Parcel ID#: 129.68-1-14.1 Mechanical Permit#23-165 issued 11/17/2023 for a New Generator This certifies that the 25kw natural gas fired generator,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to QI� R \ For office use only: BUILD S TMENT PERMIT# �,D,3 � FEB 18 2025 v,L oyc OK ISSUED: i-i 7—a3 938 KiNG STRE YORK 10573 DATE: a VILLAGE OF RYE BROOK 4 4 FEE: j(aA5 ~ PAFWW BUILDING DEPARTMENT E o ov 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 +sr+sstwsrsrstrrsrtr*+srs*rtrrwr*attrw+t*rtstr*twsrssrtrtrsrt+*rrtw*+sswrr+stsrsrtt+kss*rtrswsswsrss+r+rtstssskwtssrsswtrtstsrrswrr Address: 938 King Street Rye Brook, NY Occupancy/Use: Parcel ID#: cj�/ �0 8—�— / Zone: Owner: V�g-2 OyC�I�Q A-d0/- Address: 1'7 P.E./R.A.or Contractor: SBA Network Address: 3a6 Old Bridge TNPK East Brunswick. NJ 08816 Person in responsible charge: Jean Dorlus Address: 386 Old Bridge TNPK East Brunswick, NJ 08816 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/consttuction/alteration herein mentioned in accordance with law: STATE OF NEW YORK,COUNTY OF WESTCHESTER as: Jean Dorus being duly sworn,deposes and says that he/she resides at 938 King Street (Print Name of Applicant) (No.and Street) in Rye Brook ,in the County of in the State of NY ,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 15-000.00 , for the construction or alteration of: T-Mobile Generator install 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 tlrat 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 unlawfid for an owner to use or permit the use of any building or premises or pact 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 `14 day of rehy'UpIJu , 20 3� day of Fe 5 el 20 Q'LS Signature of t*opetYy vner Sige a r au Jokley Garcia Print Name of Property Owner Print f Applicant a e o Notary Holtlic Notat'5r.T 6/1,2024 COMMONWEALTH OF/ENNSYLVANIA•NOTARY SEAL Jennifer Mayer,Notary Public lot:ksrintu County v - - - ---- My COMMISSlon E><pTres 2/912029 COMMISE1011 0 1305481 �yE BRC�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 : DATE: .7 " 7 0 r 2 01 PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: , ` =�� '� OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ` LI y J'` I C. 1,, (/• ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER �yE BRC��. 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 Uebrook.org - - - - - - - - - - - - -- - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : 1� ��'C� F 1. DATE: J PERMIT# ISSUED:117"L3 SECT: Z 1•(O 8 BLOCK: LOT: �! LOCATION: OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION � �4� 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 PLUMBINGt'- ❑ CROSS CONNECTION V (� El FINAL o O�OV,Qd' ❑ OTHER �yE BRC�� cu � BUILDING DEPARTMENT ❑BUILDING INSPECTOR ry 0p 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 : V �J J� DATE: 1 1 - no PERMIT# A Z _I C) 3,-( ISSUED: I-/7 Z'SECT: BLOCK:/LOT: LOCATION: -�'Ll�_� OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ['ACCEPTED ❑ REJECTED/ 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 QyE BRC��, O� Zm FO cu � • 19,82 BUILDING DEPARTMENT ❑BUILDING INSPECTOR aASSISTANT 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 : / K l kJ G1 S#lo4` DATE: 2- 16 - Z o Z y PERMIT# M J Z 2 -Z(,- ISSUED://-0 "1 SECT:/Z�' O BLOCK: LOT: /y LOCATION: RF�2 S/d E 7� /�2 /�' �u 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 f ❑ Natural Gas SL/9 i3 �/y S f e �/� lolz &A.Jei-c, . ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL OTHER QyE BR��, cu � 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 :- (� K ►Q DATE: PERMIT# 7► J - D 3 `� ISSUED: 3- ZV' SECT: BLOCK: i LOT: LOCATION: ►C �'Y 1 c� �U� c'1 `4 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 Q" Natural Gas A /U-w ." fw-, p e /J M c ❑ L.P. Gas ❑ FUEL TANK -' 9 ❑ FIRE SPRINKLER ❑ FINAL PLUMBING i3 / ,•(�/ e f�Cl 3-l . - 2U Z ❑ CROSS CONNECTION ( C'�,�/ ❑ FINAL ❑ OTHER Ln1.0 a T-4 N N CA �j a ~ a � O T►/��+ 24' o O a O Zo � w • • � � � � o ° � � � c � L w 4-4 00 W � 1p O r+1_ U C a3i V N ora o O 'w 80 o 0 -9 vz . 0 v1 o - o ;g � v � O 0 o c= V c v�00 - �I M �-1 a W Q � � w � u �.+ ■ ■ O p 0CA v a O ICI x .a 0 .22 Q [� ° o Wo _ c a d W F., z a` vQ rALU " _ mop Ul) Z CLa. V U z O US ti z a0 C7 H A O A en Z C� W Gd >� In fr- r q W Z a o � ob a C1 O W a a a a a BUILDI MENT AUG 21�2 3 jD VILL OF RYE OK 938 Kirk S T RYE BRO NY 10573 ------ VILLAGE CI= RYE BROOK 4 93 -46 'c BUILDING DEPARTMENT FOR OFFICE USE ONLY: Approval Date: _ er �� ,y �� Application# Approval Signature: ARCHITECTURAL REV BOARD: Disapproved: Date: BOT Approval Date: Case# : Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other: Application Feet, Permit Fees:,9 c7� � APPLICATION,1 TO?INSTALL A PERMANENT STANDBY BACKUP GENERATOR Application dated: is hereby made to the Building Inspector of the Village of Rye Brook for the issuance of a Permit to install a permanent standby backup generator in accordance with§250-4.1.of the Code of the Village of Rye Brook,as per detailed statement described below. Please note that electrical and plumbing permit applications must be filed separately by those licensed professionals,and that separate permits are required for the installation of any related fuel tanks. Further note that all applications for commercial use will require a site plan approval from the Village Planning Board prior to the issuance of any permit. f. Job Address: 938 King Street Rye Brook, NY 10573 2. Parcel M 4: 12906000010330000000 Zone: 3. N.Y.State Construction Classification: N.Y. State Use Classification: 4. Proposed Generator&Fuel Type(Describe in detail): Install of new 25kW Natural Gas Emergancy Back Up Generator on new slab All work conforms to parameters of an Eligible Facilities Request under Section 6409 of the Middle Class Tax Relief Act. 5. Property owner:Village of Rye Brook Address: 938 King Street, Rye Brook, NY 10573 Phone#914-939-1121 Cell# email: Applicant: John Morrison - SBA Communications as Lessee Address: 134 Flanders Road, Westborough, Ma 01581 Suite 125 Phone# cell#508-768-7960 email: J,�oMo�rrison@sbasite.eom Architect or Engineer(if applicable): Trylon l' c} Address: 1825 W. Walnut Hill Ln, Irving Tx 75038 Phone# Cell#412-215-3668 email: devans@sbasite.com General Contractor: SBA Network Services LLC Address: 1480 Rt. 9 North Woodbridge, NJ 07095 Phone# Cell# 508-768-7960 email: weastro@sbasite.eom t 6/112023 6. Give exact dimensions from proposed generator to lot lines: front yard: 101 rear yard: 41 right side yard: 10, left side yard: 41 7. If building is located on a corner lot,which street does it front on: N/A 8. Will the proposed project disturb 400 sq.ft.or more of land,requiring a Stormwater Management Control Permit from the Village Engineer as per Chapter 217 of the Code of the Village of Rye Brook? Yes: No: X 9. Will the proposed project require a Site Plan Review by the Village Planning Board as per Chapter 209 of the Code of the Village of Rye Brook? Yes: X No: (provide detailed drawings as per Chapter 209) 10. Will the proposed project require a Steep Slopes Permit as per Chapter 213 of the Code of the Village of Rye Brook? Yes: No: X (provide a detailed topographical survey) 11. Is the lot or any portion thereof located in a Wetland as per chapter 245 of the Code of the Village of Rye Brook? Yes: No: X (provide a detailed survey indicating the Wetland&Buffer Zone) 12. Is the lot or any portion thereof located in a Flood Zone as per the FEMA Flood Insurance Rate Map#36119CO279 dated 9/28/07? Yes: No: X 13, Will the proposed project require a Tree Removal Permit as per Chapter 235 of the Code of the Village of Rye Brook? Yes: No: X (a tree replanting schedule may be required) 14. Does the proposed project involve a Home-Occupation as per Chapter 250-38 of the Code of the Village of Rye Brook? Yes: No: X If so,indicate: TIER 1: TIER II: TIER III: 15. What is the total estimated cost of construction: $ o (The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis) 16. Estimated date of completion: 10/31/2023 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: John Morrison ,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 for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attornev,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. /L Sworn to before me this 1 —' Sworn to before me this day of , 2 day of V U 20 Z? Signature of Propewy Owner Signa re o Applicant Print Name of Property Owner Print Name of pl;�itg1 ape,WO �,��G�,P. sitZri .00�•, r. Notary Public Notary Public y This application must be property completed In its entirety and must include the nolso si (s),of legal owner(s)of the subject property,and the applicant of record in the spaces provide `aYt Oat properly completed in Its entirety and/or not properly signed shall be deemed null and Jlgi � ned to the applicant. Please note that application fees are non-refundb ` �/// aC 2 /lllltlt 611/20-13 • a = s = f s = . � r O N N W = N N M �C r v , W rn �t � Z � � Lz. � • U oA W AN o V x = s � v Z p (n W M-1 O � Q i.n O a = O O N F � A, • O A w = z Cl) W °O '� z w eq V W A^ O a 44 0 1uz (w� F T, o cn 0 zCl) , c1r) Z O O e O ■ ■ I V v V \0 �D w A zz O CAh�l a , V �j w Q4 U. O a z x a O a Ln H ' ` M z w ° A oCN ■ �I a a a oz-1 , a a ■ a ■ ■ ■ ■ e ■ , ■ , e e , a ■ e ■ Ea a ■ ■ a r = f r , a a , , ■ ■ , , BUIiQ0rN1 ENT D VIOK FS 23 M4 938 KINNY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required � FOR OFFICE USE ONLY EPc�-- Approval Date: MAR 11 202 Permit Fee: Approval Signature: Other: DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR. THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated, is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove electrical equipment,wiring,fixtures,or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. I.Address:938 King Street sBL: /�9, lo —/—/'yi l Zone: 2.Property Owner:SBA 2012 TC Assets, LLC Address: 8501 Congress Avenue, Boca Raton, FL 33784 Phone#: Cell#: email: 3.Master Electrician/Licensed Installer: Edward Cuff Address:3178 Hemlock Farms, Hawley, PA 18428 Lic.#: 1267 Phone#:570-296-6663 Cell#: email:rebecca@ec-electric.net Company Name:E.C. Electrical Contractor, Inc. Address: 103 Unfranchise Way, Shohola, PA 18458 4.Proposed Electrical Work/Fixture Count: Install 25KW Gas Generator on new concrete pad. Install (1) 200amp ATS. 5.31 Party Electrical Inspection Agency: S W I S STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Edward Cuff 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 Master Electrician 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 before me this Sworn to bef re me this 2--)rid day of ,20 day of 20 -Cammonwealth of Pennsylvania-Notary Seal Signature of Property Owner JESSICA SAVELY-Notary Public Signature of Applicant Pike County t3 l/ys^r 1 Cj y Commission Expires October 5,2027 (lu Print Name of Property Owner Commission Number 1293721 Print me of Applicant Notary Public Notary u lic 10/30/2023 STATE WIDE INSPECTION SERVICES, INC. CA0 Service With Integrity 0•0 • • SWIS JOB APPLICATION •2.7224 1 fax 914.219.1062 1 SWISNY.coml SWISTRAINING.COM Office Use Elect. Permit# Date Bldg Permit# Sci Ft Plumbing Permit# Final Certificate# City/Village Zip Building Dept. County Address Cross Street Section Block Lot Owner Name/Address(If different than above) Contact Number ❑Basement ❑ 1st FI. ❑2nd FI. ❑3rd Fl. ❑More Than 3 A. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/O Detector Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels 1P 3P # Meters # Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair ❑Overhead ❑ Upgrade ❑ Disconnect Utility ID# ❑Con Ed ❑ NYSEG ❑Central Hudson ❑ Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect Junction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization Fj Safety Inspection ❑Consultation FiCIENIE [MAR -6 2024 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by SMS.This application is intended to cover the above listed items to be inspected,if at anytime 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 Name License# Date Signature Address City/State Zip Code Company Phone# D ECENE ID State Wide Inspection Services COCO MAY 15 2024 1080 Main Street Fishkill, NY 12524 asw a 845 202-7224 Phone VILLAGE OF RYE BROOK 914-219-1062 Fax STATE WIDE INSPECTION SERVICES BUILDING DEPARTMENT Email: office(d)swisny.com Service With Integrity Website: www.swisny.com BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: E.C. Electrical Contractor, Inc. Village of Rye Brook Edward Cuff 938 King Street 103 Unfranchise Way Rye Brook, NY 10573 Shohola, PA 18458 Located at: 938 King Street, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP24-042 129.68 1 14.1 Certificate Number: 2024-3048 Building Permit Number: lD ' 3- f)_ A visual inspection of the electrical system was conducted at the Commercial occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at: 938 King Street, Rye Brook, NY 10573 The Exterior was inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 15`t'day of May 2024. Name Quantity Rating Circuit Type Generator 01 25KW ATS 01 200A M P 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. � N N \ W 4 .� N W a W 4 N a o vi T-4 W �C � ►.r U y O ' rl � ~ O y ^� Oz � Wxo � A 0 z w 00 ' � = I� � wOC) � oo � a _ O �f W I ti a C7 Az H en oLn a \A v = M ~ W ~ tn a f M C.1 M 11 U [sl n " i en W Q Cn o f H w O v w a o z c a v a M z w Q o I--i • 02 1 � �I Ca �•'+ � � W 0 v�i D IEC [ �MC MAR -4 2024 BULL E MENT VEL OF RYE K VILLAGE OF RYE BROOK 938 KIN , ET RYE B ,NY 10573 BUILDING DEPARTMENT wWW*r PLUMBIN,(G PERMIT APPLICATION !� FOR OFFICE USE ONLY �ti� /7/ �'�C P� PP#: � / —03 Approval Date: MAR - A ) Permit Fee: $ Approval Signature: Disapproved: (fees are nun-refundable) DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR.THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated, 02/22/2024 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: 938 King Street / SBL:�o�gil0�� i � Zone: 2.Proposed Work: Installation of Gas piping for generator 3.Property owner: Town of Rye Brook Address: 938 King Street, Rye Brook NY 10573 Phone#: Cell#: email: 4.Master Plumber: Frank Sabia Address: 8 Garyann Terr. Stony Point NY 10980 Lie.#: 1543 Phone#: 347-810-0939 Cell#: 914-414-3159 email:�iC ql a mb:n�LLg,o Q e�ai Company Name: _Hudson Plumbing& Mechanical LLC Address: *8 Garryann Terr.Stony Point 0 1680 INDICATE FIXTURES&LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1 st Floor 2nd Floor 31 Floor 41 Floor 51 Floor Exterior 1 5.*List Other Equipment/Provide etails: Kon 2-` tGOP— (Notarized Sign tures Required Next 2 Pages) • 3/3/2023 STATE OF NEW YOM COUNTY OF WESTCHESTER ) as: ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that(s)he is the Master Plumber for the legal owner and is duly authorized to make and file this application. That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. It is the opinion of Swom to before me th SBA that a completed Sworn to before me this day of Building permit and day of Alcllley wireless telecom permit constitute Signature of Property I sufficient Signature of App cant authorization for this field as the 6ay, Print Name of Pro property is owned by Print Nameo Applicant p the town of Rye Brook. Notary Public NlMdrJAGMEh J.BRAHUO Notary Public,State of New York No.01 BR6159985 Qualified in Westchester County Commission Expires January 29,20M 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- 10/30/2023 4i IL 79 j' I -144 Y^ •i s �'I 41 $'+'rs_M�• - .. Jf- .ate rvo- AIN 'rI� 3W;rf�'f 4, .'t '�`tip.' )a►r �' } Mid '.�,`i►. __� '��,-a�F��tF+' �`'TI.�� +'Ytf��r�'.~1,+r.1L � } �:` j,.ylb 0A.. .` Try I on FCCA LETTER January 20, 2025 Attn: Hani Sayegh D SBA Communications Corporation 134 Flanders Road JAN 2 2 2025 Westborough, MA 01581 VILLAGE OF RYE BROOK Site ID: NY09264A BUILDING DEPARTMENT Site Address: 938 King Street Rye Brook, NY 10573 Site Coordinates: 41.03422120, -73.674181° To Whom it may Concern: Construction at the referenced site has been completed. Our office has reviewed the as-built photos from the construction team and found that the installation is in compliance with the construction drawings produced by this office, dated 7/21/2023. The new generator and associated equipment shown on those drawings have all been installed in accordance with both the construction drawings and the manufacturer's requirements. If you have any questions or require any additional information, please do not hesitate to contact Trylon. Res I O by: _ w F 1 2 /J02 � OA r043A 9�FESSO,o Cliff Aberna y, PE New York License No: 104314 www.trylon.com 1825 W. Walnut Hill Lane, Suite 120, Irving,Texas 75038 1 �. SBAMI D F C EE WEn October 10 2023 OCT 16 2023 .'Ij Re: 938 King Street Cell Site: VILLAGE OF RYE BROOKBUILDING DEPARTMENT As a part of the ongoing T-Mobile national cellular site hardening program, SBA(on behalf T- Mobile) is proposing adding of a 25 Kw LNG generator to be added to our site. There is an existing generator on site, originally designed to power the entire 4 carrier compound. I have been informed that it is not currently in service,and not available to T-Mobile. I have also been informed that AT&T is looking to purchase & refurbish it as part of their own upgrades to the First Net emergency services program,though this has not occurred yet. While originally designed to run the site in the event of an emergency outage, modern liability is such that SBA is no longer willing to take on that obligation to service and maintain the generator to provide emergency power to the site for their carriers. Obviously, it would not be an option to have one carrier using a second competitors' equipment either. As regards to the customer: With current roaming technology, its much safer to have carriers keep their own backup systems and operate them in parallel rather than have a single point of failure shut all service to an area down. Thank you, John Morrison SDS Specialist 1 S B A Pi SBA Communications Corporation 134 Flanders Road Suite 125 Westborough, MA 01581 x3808 +T 508.768.7960+C JoMorrison(afsbasite.com Your Signal Starts Here. SBA October 10 2023 FILE COPY Re: 938 King Street Cell Site: As a part of the ongoing T-Mobile national cellular site hardening program, SBA (on behalf T- Mobile) is proposing adding of a 25 Kw LNG generator to be added to our site. There is an existing generator on site, originally designed to power the entire 4 carrier compound. I have been informed that it is not currently in service, and not available to T-Mobile. I have also been informed that AT&T is looking to purchase & refurbish it as part of their own upgrades to the First Net emergency services program, though this has not occurred yet. While originally designed to run the site in the event of an emergency outage, modern liability is such that SBA is no longer willing to take on that obligation to service and maintain the generator to provide emergency power to the site for their carriers. Obviously, it would not be an option to have one carrier using a second competitors' equipment either. As regards to the customer: With current roaming technology, its much safer to have carriers keep their own backup systems and operate them in parallel rather than have a single point of failure shut all service to an area down. Thank you, John Morrison SDS Specialist i SBA SBA Communications Corporation 134 Flanders Road Suite 125 Westborough, MA 01581 x3808 +T 508.768.7960+ C JoMorrison(a-)sbasite.com Your Signal Starts Here. Steven Fews From: Jennifer L. Gray <jgray@kblaw.com> Sent: Tuesday, October 31, 2023 12:28 PM To: Steven Fews;Tara Orlando; Christopher Bradbury; Robert C.Zitt Subject: 938 King Street -T Mobile Generator F I L E Can we schedule a time to discuss this application and its processing?There have been a lot of emails over the last day or so and I want to make sure we are all on the same page. Based on our review, it appears possible that the installation of the new generator is an "eligible facilities request" (EFR). An EFR includes any request for modification of an existing base station that does not substantially change the physical dimensions of the base station, involving(1) collocation of new transmission equipment, (2) removal of transmission equipment, or(3) replacement of transmission equipment. "Base station" is defined to include back up power equipment, and "transmission equipment" is defined to also include back up power equipment. Steve should review the definition of substantial change under section 250-39 and compare the definition against the proposed plans to make this determination. I've copied the definition below and highlighted the relevant language. SUBSTANTIAL CHANGE A modification substantially changes the physical dimensions of an eligible support structure if it meets any of the following criteria: For towers, other than towers in the public rights-of-way, the modification increases the height of the original height of the tower by more than 10%, or by the height of one additional antenna array with separation from the nearest existing antenna not to exceed 20 feet, whichever is greater; for other eligible support structures, it increases the height of the structure by more than 10% or more than 10 feet, whichever is greater; (2) For any eligible support structure the modification involves the installation of more than the standard number of new equipment cabinets for the technology involved, but not to exceed four cabinets; or, for towers in the public rights-of-way and base stations, it involves installation of any new equipment cabinets on the ground if there are no preexisting ground cabinets associated with the structure, or else involves installation of ground cabinets that are more than 10%larger in height or overall volume than any other ground cabinets associated with the structure; For towers other than towers in the public rights-of-way,the modification involves adding an appurtenance to the body of an existing tower that would protrude from the edge of the existing tower more than 20 feet, or more than the original width of the tower at the level of the appurtenance, whichever is greater; for other eligible support structures,the modification involves adding an appurtenance to the body of the structure that would protrude from the edge of the structure by more than six feet; i The modification involves any excavation or deplovment outside the current existing structure site,defined as the current boundaries of the leased or owned property surrounding the existing structure and any access or utility easements currently related to the site; ( The modification defeats concealment and/or stealth elements of the support structure; or The modification does not comply with prior conditions of the approval for the existing structure and/or site; provided, however, that this limitation does not apply to any modification that is noncompliant only in a manner that would not exceed the thresholds identified above. Jennifer L. Gray Member KEANEIBEANEPC. ATTORNEYS AT LAW Serving the Hudson Valley and Beyond for over 40 Years 445 Hamilton Avenue, Suite 1500 White Plains, NY 10601 (914) 946-4777 Ext: 336 (914) 946-6868 (Fax) jgray@kblaw.com www.kbiaw.com Follow us on Twitter Follow us on Facebook Follow us on LinkedIn PERSONAL&CONFIDENTIAL The information transmitted herein may contain privileged and/or confidential material.Any disclosure,copying,distribution or other use of, or taking of any action in reliance upon, information contained herein or attached hereto by persons or entities other than the intended recipient(s)is prohibited. Any misdirection or other error in the transmission of this information is not and shall not be considered a waiver of any applicable privileges. If you have received this transmission in error, please Immediately notify the sender and destroy the original transmission and Its attachments without saving, distributing or copying in any manner. 4F Please consider the environment before printing this email message. 2 SBA PJ � b r August 14 2023 Eligible Facilities Request to Modify Transmission Equipment at an Existing BaseFFEAg- q fyg R�[�Location: 938 King Street, Rye Brook, NY 10573 TMO Site No: NY0964A UG 2 2 2023 SBA Communications: Agent for SBA Network Services LLC and T-Mobile VILLAGE OF RYE BROOK T-Mobile is Filing an Eligible Facilities Request BUILDING DEPARTMENT SBA Communications, on behalf of T-Mobile and SBA Network Services, is submitting an Eligible Facilities Request to add, remove, modify, or replace Transmission Equipment at an Existing SBA Telecommunications Base Station located at Rye Brook Town Hall. The Base Station is a structure that is 125' high and presently contains wireless facilities.The existing Base Station meets the Federal Communications Commission ("FCC") definition of a Base Station and T- Mobile is an FCC licensed wireless carrier. The list of equipment identified in this Eligible Facilities Request application is Transmission Equipment as determined by the FCC, and as defined as follows: "any equipment that facilitates transmission for any Commission-licensed or authorized wireless communication service, including, but not limited to, radio transceivers, antennas and other relevant equipment associated with and necessary to their operation, including coaxial or fiber-optic cable, and regular and back-up power supply. This definition includes equipment used in any technological configuration associated with any Commission-authorized wireless transmission, licensed or unlicensed,terrestrial or satellite, including commercial mobile, private mobile, broadcast and public safety services, as well as fixed wireless services such as microwave backhaul or fixed broadband." Administrative Review and Approval While local jurisdictions retain discretionary zoning review over the construction of new towers, collocations and/or equipment upgrades such as reflected in this application must now be approved administratively. The new law provides, in part,that: "a State or local government may not deny, and shall approve, any eligible facilities request for a modification of an existing wireless tower or base station that does not substantially change the physical dimensions of such tower or base station." (Emphasis added.) The FCC, in a Report and Order adopted on October 17, 2014, determined that any modification to an existing telecommunications Tower that meets the following six criteria does not substantially change the physical dimensions of the existing Tower and therefore is an Eligible Facilities Request which must be granted: SBA 1. The modifications to the Transmission Equipment do not increase the height of the Base Station by more than 10 percent (10%) or ten (10) feet, whichever is greater. 2. The modifications to the Transmission Equipment do not protrude from the edge of the support structure by more than six (6)feet. 3. The modifications to the Transmission Equipment do not involve the installation of more than the standard number of equipment cabinets for the technology involved, not to exceed four. 4. The modifications to the Transmission Equipment do not entail any excavation or deployment outside of the Base Station site. 5. The modifications to the Transmission Equipment do not defeat any existing concealed or stealth-design. 6. The modifications to the Transmission Equipment comply with prior conditions of approval of the Base Station, unless the non-compliance is due to an increase in height, increase in width, addition of equipment cabinets, or new excavation that does not exceed the corresponding "substantial change"thresholds in numbers 1-4. We are providing certification that each of the six review criteria identified by the FCC will be met,and that the proposed modifications fully conform to Section 6409(a)as enacted by Congress and as interpreted by the FCC. Expedited Permit Processing and Deemed Granted Designation Under federal law, an Eligible Facilities Request is deemed granted sixty(60) days after a complete application is filed with a local jurisdiction.Accordingly, this Eligible Facilities Request must be approved within 60 days, as required by federal law and FCC regulations. If sixty days pass after the submission of T-Mobile's application and the Village of Rye Brook has not acted to grant or deny the request, it will be deemed granted. SBA ELIGIBLE FACILITIES REQUEST (EFR) APPLICATION FORM Date of Submittal: 8/14/2023 Submitted by: Name: John Morrison Title: Site Development Specialist on behalf of SBA Network Services and T-Mobile Contact Information: JoMorrison@sbasite.com 508-768-7960 Name of Jurisdiction: Village of Rye Brook Address of Jurisdiction: 938 King Street, Rye Brook Contact Name for Jurisdiction: Click here to enter text. Name of Local Government Permit Application: Application to install a Permanent Stand by Generator Local Government File#: Click here to enter text. Street Address of Site: 938 King Street Tax Parcel#of Site: 12906000010330000000 Latitude/Longitude of Site: 41.034221; -73.674181 List Each Piece of Transmission Equipment that will be Collocated or Added: (#) (1) Generac RG025 List Each Piece of Transmission Equipment that will be Removed: (#) xxx List Cabinets that will be Collocated or Added at the Site: (#) xxx List Cabinets that will be Removed at the Site: (#) xxx Permit Application Deposit Amount: $400 Municipal Consultant Review Fee Deposit: Click here to enter text. SBA ELIGIBLE FACILITIES REQUEST (EFR) CERTIFICATION OF NON-SUBSTANTIAL CHANGES TO AN EXISTING BASE STATION "Base Station" means the equipment and non-tower supporting structure at a fixed location that allow Commission-licensed or authorized wireless communications between user equipment and a communications network. The term base station includes any equipment associated with wireless communications services, including but not limited to, radio transceivers, antennas, coaxial or fiber-optic cables, regular or back-up power supply, and comparable equipment.The term existing base station also includes a structure that currently houses or supports an antenna, transceiver or other associated equipment that constitutes part of a base station at the time the application is filed, even if the structure was not built solely or primarily to provide such support. "Base Station" includes the relevant equipment in any technological configuration, including small cells and DAS. Remember "Base Station" has two separate meanings: (1) the supporting structure that houses FCC licensed or authorized wireless equipment; and (2) the wireless equipment itself. Keep this distinction in mind when calculating a substantial change in physical dimensions. "Transmission Equipment" means any equipment that facilitates transmission for any FCC licensed or authorized wireless communication service, including but not limited to, radio transceivers,antennas and other relevant equipment associated with and necessary to their operation, including coaxial or fiber- optic cable, and regular and back-up power supply. This definition includes equipment used in any technological configuration associated with any Commission-authorized wireless transmission, licensed or unlicensed, terrestrial or satellite, including commercial mobile, private mobile, broadcast and public safety services, as well as fixed wireless services such as microwave backhaul or fixed broadband. "Collocation" means the addition, removal or replacement of Transmission Equipment to an existing tower or base station.This means that the existing support structure, be it a tower or a building or some other structure, must presently support FCC licensed or authorized wireless facilities. The FCC further requires that the site (tower, building, or other structure) was previously approved by the appropriate agency of government to house wireless facilities. Illegal wireless installations cannot be the basis for an Eligible Facilities Request. However, if a communication Tower was erected at a time when it was exempt from zoning,the Tower can be modified through the Eligible Facilities Request process even if the Tower is no longer exempt from zoning. ------------------------------------------------- Site Address: 938 King Street, Rye Brook Existing Facilities This is an existing Base Station with existing FCC licensed or authorized wireless equipment. SBA 1. Height of Base Station Height above ground level of the tallest point on the existing base station: 125' (feet) Height above ground level of the tallest point of the existing base station after the installation of the proposed equipment: 125' (feet) Does the height above ground level of the proposed equipment exceed the height of the tallest point on the existing base station by more than 10 percent(10%) or ten (10) feet, whichever is greater? ❑ Yes © No 2. Width of Base Station Will any of the proposed equipment protrude from the edge of the support structure by more than six (6)feet? ❑Yes © No 3. Excavation or Equipment Placement Will the proposed changes in Transmission Equipment involve excavation or placement of new equipment outside the existing Base Station site or outside any access or utility easements currently related to the site? ❑ Yes ® No 4. Equipment Cabinets Will the proposed modification in Transmission Equipment involve installation of more than the standard number of new equipment cabinets for the technology involved, but not to exceed four? ❑ Yes ® No 5. Concealed or Stealth-Designed Wireless Facilities A. Is the existing wireless facility concealed or stealth-designed? ❑ Yes ® No B. If the answer to 5a) is "Yes," will the proposed modification in Transmission Equipment defeat the existing concealed or stealth-design? ❑Yes ❑ No 6. Compliance with Preexisting Conditions of Approval for the Base Station A. Were there any conditions of approval stated in the original government approval of the Base Station? ❑ Yes ❑ No SBA b) Will the proposed modification in Transmission Equipment comply with conditions of approval imposed on the Base Station prior to February 22, 2012? ® Yes ❑ No c) If the answer to 6b) is "No," is the non-compliance due solely to any of the conditions addressed in Questions 1-5 above? ❑ Yes ❑ No If the answers to questions 1-4 are "No,"the answer to either 5a)or 5b) is "No," and the answer to 6a) is"No" or the answers to either 6b)or 6c)are "Yes,"then the proposed modifications do not substantially change the physical dimensions of the existing Base Station. Explanatory Comments(if needed): Question No. n a Comment: n a This certification is dated this 14th day of AEU t, 2023 Signaot,ure John Morrison /Site Development Specialist on behalf of SBA Network Services and T-Mobile Name &Title SBA Village of Rye Brook g Street , 938 Kin Str AUG 2 2 2023 Rye Brook, NY 10573 VILLAGE OF ;RYE BROOK Attn: Clerk-Shari Melillo BUILDING DEPARTMENT Re: T-Mobile Project No. NY09264A ----•---•• -- _. SBA Site No. NY47400 T-Mobile Cell Site—Generator installation 938 King Street, Rye Brook, NY Re: OWNER'S CONSENT LETTER Dear Shari, T-Mobile plans to install an emergency backup generator at our cell site adjacent to Rye Brook Town Hall,at 938 King Street. Plans are attached for your review and reference. Would you kindly sign below and return to Rye Brook building dept,as well as email to me below. Thank you, John Morrison on behalf of T-Mobile JoMorrison()bsasite.com i-5o8-768-796o I hereby certify that the Village of Rye Brook is the owner of the property located at 938 King Street and that the town hereby consents to the application by T-Mobile to the Rye Brook Planning Board/Zoning Board and Building Dept,to install an emergency back-up generator on the Property. Village of Rye Brook By: Name: Title: Date: AUG 2 9 2023 Es B A VJ August 14 2023 To whom it may concern Re: 938 King Street Enclosed, please find permit applications and related materials for T-Mobile wireless upgrades at the existing SBA telecommunications site adjacent to the town hall.' As several places on the applications require the live signature of the landowner, I am including an LOA for signature of the appropriate person with the village administration to act in their sted. A prepaid FedEx return is included, if there is no local FedEx drop box or pickup location, please contact me below to schedule a remote pick up for the return shipment. Please let me know if you need anything further for review and I will be more than happy to assist. Thank you, John Morrison SDS Specialist I S B A U SBA Communications Corporation 134 Flanders Road Suite 125 Westborough, MA 01581 x3808+T 508.768.7960+C JoMorrisonasbasite.com Your Signal Starts Here. 'This application is eligible for relief under the parameters of the Eligible Facilities Request("EFR");Section 6409 of the Spectrum Act(Pub. Law No. 112-96, 126 Stat 156)(codified at 47 U.S.C. § 1455),as well as the FCC's subsequent Report and Order of October 17,2014,and Declaratory Ruling of June 9, 2020. Therefore,the proposed upgrades are not subject to discretionary review and are admissible per Federal Law. qBuilding Permi Check List&Zoning Analysis Address: 1 \ SBL: ZA Zone: _Use: Type: Other. Submittal Date: C )-�— Revisions Submittal Dates: Applicant: Nature of Work: NL X"C, Reviews:ZBA: A U G 2 9 �l7.l PB _ BOT• Other. Nj OK ��7 (210 (� ( ) ES:Filing. BP: t�'e °UC/O: Flood Plane: Legalization: ( ) (�P: Dated. Notarized. SBL: Truss I.D. Cross Connection H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening ( ) ( ) ENVIRO:Long. Shore Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection S/W Mgmt.: Tree Plan Other. ( ) ( ) SURVEY:Dated: Current Archival• Sealed: Unacceptable: ( ) ( S:Date Stamped Sealed:_�Copies: Electronic: Other. ( ) (�e Workers Comp: Liability. Comp.Waiver. Other. ( CODE 753#:j/,)0 � �I/y—CCU Dated — — 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: 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. ( ) ) 2020 NY State ECCC: N/A: Other. ( ) Final Survey. urvey 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: ( ) A mtg.date: approval:- notes: ( gnoteso _ REQUIRED EXIS__I'ING PROPOSED NO•I-FS APPROVED _��y, l c� etc NOV 1-? 20F3 • - - 1 SUM Main C Acts.Cov H/Sb Sd.H/Sb: jEA- To�: Hkight/Stories: notes: ` J O� SBACOMM-01 HJSESERKO AFRO CERTIFICATE OF LIABILITY INSURANCE DAT8 912 DIYYYY) 19/2023 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 endorsements). PRODUCER NOMTACT Henderson Brothers Inc PHONE FAX 920 Ft.Duquesne Blvd. (AIC,No,Ezt):(412)261-1842 (Alc,No):(412)261-4149 Pittsburgh,PA 15222 E-MAIL ,mailroom@hendersonbrothers.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Travelers Property Casualty Company of America 25674 INSURED INSURER B:The Hartford Company Payable 29424 SBA Communications Corporation INSURER C: 8051 Congress Ave. INSURER D: Boca Raton,FL 33487 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FX]OCCUR TC2J-GLSA-9P530142-TIL-23 3/15/2023 3/15/2024 DAMAGE TO RENTED SE,,E.occurrence) $ 1,000,000 REMMED EXP(Any oneperson) $ PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑X PEST LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT.dent $ 1,000,000 X ANY AUTO TC2J-CAP-474M814A-TIL-23 3/15/2023 3/15/2024 BODILY INJURY Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ AUTOS ONLY AONO-OWNED PP OacEcRident AMAGE $ SS OOttJJ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 15,000,000 EXCESS LIAB CLAIMS-MADE CUP-1T38674A-23-NF 3/15/2023 3/15/2024 AGGREGATE $ 15,000,000 DED I X I RETENTION$ 10,000 A WORKERS COMPENSATION X PER OTH- ANDEMPLOYERS'LIABILITY Y - - - - 5/2024 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ UB4LO991022351K 3/15/2023 3/1 E.L.EACH ACCIDENT $ %FICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Worker's Comp UB-31_884966 3/15/2023 3/15/2024 Each Acc/Policy Lmt 1,000,000 B Prof/Poll 40 CPI HA6405 3/15/2023 3/15/2024 Claim/Agg 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached N more space Is required) Site location:938 King Street(Rye Brook Town Hall) T-Mobile/NY09264A/SBA NY47400A CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g y ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NEW Workers' STATE Compensation CERTIFICATE OF Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a. Legal Name&Address of Insured(use street address 1 b. Business Telephone Number of Insured only) (770)733-1575 SBA COMMUNICATIONS CORPORATION 8051 CONGRESS AVE 1 c NYS Unemployment Insurance Employer Registration BOCA RATON, FL 33487 Number of Insured Work Location of Insured(Only required if coverage is specifically 1d. Federal Employer Identification Number of Insured or Social limited to certain locations in New York State,i.e.,a Wrap-Up Policy) Security Number 65-0716501 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) THE CHARTER OAK FIRE INSURANCE COMPANY Village of Rye Brook 3b. Policy Number of entity listed in box"1a" 938 King Street Rye Brook, NY 10573 UB-4L099102-23-51-K 3c. Policy effective period 03-15-2023 t0 03-15-2024 3d. The Proprietor, Partners or Executive Officer are ® included. (Only check box if all partners/officers included) ❑ all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"S' insures the business referenced above in box"Ila" 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: STEPHANIE BAKER (Print name of authorized representative or licensed agent of insurance carrier) Approved by: STEPHANIE 4AKER 08-10-2023 (Signature) (Date) Title: SR CUSTOMER SOLUTIONS REPRESENTATIVE Telephone Number of authorized representative or licensed agent of insurance carrier: 804-527-4852 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-17) www.wcb.ny.gov W31F3117 Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Thursday,January 25, 2024 10:12 AM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 01/25/2024 10:12 To: VIL RYE BROOK PRIMARY Transmitted: 01/25/2024 10:12 00001 Ticket: 01254-000-343-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 938 To: Name: KING ST Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: LEFT SIDE WHERE SHELTER IS LOCATED ON KING ST WHERE MARKED IN WHITE NearSt: ARBOR DR Means of Excavation: MINI EXCAVATOR Blasting: N Site marked with white: Y Boring/Directional Drilling: N Within 25ft of Edge of Road: Y Work Type: TRENCHING FOR ELEC Estimated Work Complete Date: 02/13/2024 Depth of excavation: 3 FEET Site dimensions: Length 10 INCHES Width 9 INCHES Start Date and Time: 01/30/2024 07:00 Must Start By: 02/13/2024 ------------------------------------------------------------------------------ Contact Name: CARLOS HERRERA Company: SBA Addrl: 386 OLD BRIDGE TPKE Addr2: City: EAST BRUNSWICK State: NJ Zip: 08816 Phone: 561-546-3352 Fax: Email: caherrera@sbasite.com Field Contact: JEAN BORLUS Alt Phone: 609-455-6965 Working for: SBA FOR T MOBILE ------------------------------------------------------------------------------ Comments: Lookup Type: MANUAL ------------------------------------------------------------------------------ Members: ALTICE USA AT&T BELL-VALHALLA/ WSCHSTR CONED MCI NYSDOT TFC POKPSE 1 Laura Petersen From: UDig NY Exactix <tickets@exactix.0 dig ny.org> Sent: Monday, November 20, 2023 11:08 AM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 11/20/2023 11:08 To: VIL RYE BROOK PRIMARY Transmitted: 11/20/2023 11:08 00004 Ticket: 11203-000-814-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 938 To: Name: KING ST Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: BEHIND PROP, NEXT TO VILLAGE SQUARE PARKING LOT NearSt: HUTCHINSON RIVER PKWY & ARBOR DR Means of Excavation: EXCAVATOR Blasting: N Site marked with white: Y Boring/Directional Drilling: N Within 25ft of Edge of Road: Y Work Type: TRENCING TO INSTALL ELECTRIC AND GAS SERVICE Estimated Work Complete Date: 12/04/2023 Depth of excavation: 3 FEET Site dimensions: Start Date and Time: 12/04/2023 07:00 Must Start By: 12/18/2023 ------------------------------------------------------------------------------ Contact Name: CARLOS HERRERA Company: SBA Addrl: 386 OLD BRIDGE TPKE Addr2: City: EAST BRUNSWICK State: NJ Zip: 08816 Phone: 561-546-3352 Fax: Email: caherrera@sbasite.com Field Contact: CARLOS HERRERA Alt Phone: 561-546-3352 Working for: SBA ------------------------------------------------------------------------------ Comments: Lookup Type: MANUAL ------------------------------------------------------------------------------ Members: ALTICE USA AT&T BELL-VALHALLA/ WSCHSTR CONED MCI NYSDOT TFC POKPSE SUEZ WTR WESTCHESTER VIL RYE BROOK 1 WESTCHESTER CTY SWR z • • • ■ • • -V -n ~ w o frrlw nomo> � � D z O Z O O M r*I n G7n Zm� D D o 0 0 0 3 0 p D -m �DD(Ayy (�Z(nCZ�(��"� -Ummm cnoo�o U)Mo o�o�oo �z� z n Z z n "v Z0� �� I��m$ O D rn ~ zo-mvuiD��zZ -01 �nDZzDC FOR° n z "'i z D r V7�n —C� n �o ZDDi.xm In O �z�m�r T`n3 O 3 G-) Vi G) `~ � �N Om �m O D nD oZrn- O� O p z O D T M cn �, Z~ �� = 1 G� I �Z -" Z DzzzzQp� z C7 cn M -1 � d -vC0 �zo <��r �zD�O rvcnD>D� -�� z o D z c��QfC�**1J1�Z� c mrn �rnm -ox N�-„'- rnC� nDD -� O -zj r O z 3 `V7o G NNCN v mmrno v rn *XO70�mr-Z:M G7CIrnQDrnp �Dcr' czi� D rn O m m z �1 S S� O K z_ m- DoN(n_I rn r rn Q p n D z ��7 cn x z �R n OH 8! 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