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HomeMy WebLinkAboutBP23-195PERMIT k " SECTION _f TYPE OF WORK JOB LOCATIOJd _ i CONTRACT7F T. COST sJy q CO LL94 rco M FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING cylf RGH PLUMBINNG, FEE DATE Are wtAA 1 e)algPl�4M �9J1d y 9/Tosc pi, .0 � -Sufi 3 `�,' ,a CC of nf/7o pT}{�t APPROVALS VILLAGE OF RYE BROOK WESTCHES' ) 2 COuNT Y, NEW YORK NO. 24-024 Certif f cate of ®ccupoucp This is to certify that of, Phi izok /V y having duly filed an application on 20 O24/requesting a Certificate of Occupancy for the premises known as, • , e if Rye Brook,NY, located in a Zoning District and shown on the most current Tax Map as Section: NJt3 Block: / Lot: , and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. — `� , issued 20 �3, such authority and permission is hereby granted to the property owner to lawfully occupy or use saip premises or lding or part thereof listed under the following New York State Classifications,Use: / Construction: lzl� , 4 for the following purposes: G �aS 6��jyn Jb jg,kfa bj j r�o 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 nor shall the building be moved from one location to another until a permit to accomplish such change h een o me r m e Building Inspector. Building Inspector,Village of Rye Brook: Date: BUILD jy For office use o-niy: PERMIT MAR —5 202y VIL OF RYE OK ISSUED:/ v"Z vZ3 38 KING STRE YE BROOK, ��dV YORK 10573 DATE: —1ECENE AGE OF RYE BROOK9 -06 OI FEE: PAID LDING DEPARTMENT � •o lr�or jj 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 srsrtrrrstttstwrs*ss*trrrtrr**t*Lsssrrrrrrrrrr*rrr*rrrrrr*rrrr**rrrsrrrrrrr*+rr++s++rrr+srs+++++s++ssss+++ts+t+++tsrrts+stsr+ Address: 3 wtd h S T gy e S ro o k Occupancy/Use: -2 f�'I Parcel ID#: /` 4) - 4 Zone:_ F Owner: /A I r 3Gk 0( A4 evvk c �.( Address: ✓-o.f Q,-% r,,(gg P.E./R.A. or Contractor: Address: Person in responsible charge: Address: Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW YORK,COUNTY OF WESTCHESTER as: p / �/ , Y � C C(/ being duly swom,deposes and says that he/she resides at� //()Q y /� f C (Prii Na a of Applicant) I Q (No.and Street) ! in ,in the County of in the State of /`� ,that ( /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:$ ( $,0 1-9 b for the construction or alteration of: a..e o.t,, f �, ��C 3 5�o ra a'( 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 day of N)yt.-1 20-2-t day of , 20 , / Signature of P p rty Owner Signature of Applicant A 3aj 144mcuA Prin Name of Property Owner Print Name of Applicant w Notary b,c Notary Public GREGORY K RIVERA Netary Public,State of New York No.DI R16441398 Qualified In Westchester County C0=05 bn Expires September 26,20,, ��yE.4RC��• O Zm l7 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street. Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - --�_ ADDRESS : DATE: ` PERMIT# I� ISSUED: SECT: BLOCK: LOT: LOCATION: `+ lSelp-1 o T f OCCUPANCY: ❑ Violation Noted THE WORK IS... E� PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas y'�`=;xC) .�J a _` ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER �yE BRC�� • 1932• BUILDING DEPARTMENT ❑BUILDING INSPECTOR x' ❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street • Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - -- - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS :- ^- \ DATE: ! '' PERMIT# 1 _ ISSUED: SECT: BLOCK: LOT: LOCATION: 'J-�� ��� \ OCCUPANCY: ❑ Violation Noted THE WORK IS... �] PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ T;NDERGROUND PLUMBING NOTES ON INSPECTION: ,0-' ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION A ❑ Natural Gas ❑ L.P. Gas ❑ FUEL TANK \ � ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION - HER �yE BRC��. t7 BUILDING DEPARTMENT giUILDING 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 - - - - - - - - - - - - - - - - - - - - 21 � IZ�z� ADDRESS:— DATE..cv PERMIT# �� J ISSUED: , (22 SECT: BLOCK: LOT: LOCATION: OCCUPANCY' L `)�—' ❑ Violation Noted THE WORK,IS... ❑ PASSED FAILED REINSPECTION SITE INSPECTION ; REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas �\ ` Cc � � � " � 31 ❑ FUEL TANK �\� � ���` V� �\\��,p � �1 W� \• �v V ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL y ( /❑ OTHER 4- `PC 1► �� ��r � �. ��1 \ Q % '-v V1�, QyPC_BRC�k. '9a2 BUILDING DEPARTMENT UILDING 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: 2 PERMIT# V cl`(3 ISSUED: SECT: BLOCK: LOT: LOCATION: 2 `� - ���"— OCCUPANCY: ��V ❑ Violation Noted THE WORK IS... ❑ PASSED FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE O C� ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION �\ ❑ Natural Gas Q << ` 1 U ❑ L.P. Gas () c� Q ��lr1o��7 �( k-1 ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ttt ❑ CROSS CONNECTION ❑ FINAL ?) ¢�\Q �1 1(\ OTHER a Ln CN 0 0 W M N N a cq \ \ cn Z0-4 �. .14 cn x F u ° / "�" 1 '0 tit W a v �' I� Z ° y w F' Q ° � *' _ s U 1� O O et °o v v _ a 0n // F � - up �v � v cn a • 00 O Gti N (n CA N m >" F., o -S '5 o ' 0 � � ° ,, a a � � � v W W ai O a id cai CP 4 w �c 10. _ a ° 00 O Z 40, H Wo M W cWn yam', o oo ) % CJ} a ,t4. ° Lam A z w � Ag 07m r©lo zz 07 [ �1 a Q W cn olu W p; H O w O ar"i a U ,.., W Z o cF p ° g o U " cn U U fie. 9 � z O A a M 5 a, c x �' G: 0E� � d pp U a W o � a .o • x � � a s x s BUILD .. P MENT -' s VILL" OF RY OOK �f 938 KING A RT Roll;BRO" ,NY 10573 NOV - 8 2023 4 , _q 5� VILLAGE OF R'YLE BROOK __BUILDING DEPARTMENT I INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Approval Date: l "j �Application Fee:$ / Vy Approval Signature: Permit Fees:$ Disapproved: Other: Application dated: 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 Mow. 1. Job Address: 3 W 51 Sl3L:J�A "73 —/, /o Zone: kb—F 2. Proposed Improvement. (Describe in detail):/ t't+vt 0 V P Oi l v 1�( W A 1 l5 (t,, �ja ►a.e , I t t,f 5 IcQ f 5 (9.CI� r'ot� akweti, ?" 7o (r'Sf IrDor Crk 540t—trff Cap ct/C4-\ C'"A49V, 0 Mle cit641-fC pw 7 7 ►newt k9v- 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: X Yes: If yes,indicate: TIER 1: TIER II: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) :No: X Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 5. Occupancy;(1 fam. fam. Comm.,etc...)Prior to Construction: 2 Family After Construction: 2 Family 6. N.Y State Construction Classification: Residential N.Y.State Use Classification: 5B 7. Property Owner: d i r3 o-4 Aevv%CLL6 Address: pr--``�(f //�1� `� (05f,9 Phone# °�" 2 N Z Cell# email: _' YSad�e wtcti,� 8. Applicant: Address: Phone# Cell# email: 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# email: 11. General Contractor: Address: Phone# Cell# email: 12. Estimated cost of construction $ �. t9 0 O (NOTE,:The estimated cost shall include all labor,material,scatlhlding,fixed equipment professional fees,and material and labor which may be donated gratis.) 13. Job Timetable: Start: Finish: (1) 6/1/2023 $UILD#'NRTMENT VIL Lt ' o� R ooK NOV - 8 2023 938 Knvc S iWET RYE BROI tk,NY 10573 X 0668 VILLAGE OF RYE BROOK BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: I,- /'/(rSct d Altewi e'c& residing at, ��ferl �C6z )NYC A1Y 1 d 5 ZSD i k'rinl nautC l U (Addre„%%hcre%otj li%o 1 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; 3 W� &A 5 7 Vr e-f , Rye Brook, NY. (,lob Addres,) 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 storrnwater 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. �'A�l (Signatur<of l h Owner(s)) lal-ksmw ./!/level cCt (})rint Nwiie of-Property,UvIner(s)f Sworn to before me this day of 20 23 , - DOMPAGE GAYA VITHANAGE Notary Public-State of New York NO.01 V"642-t207 (Notary Public) Qual'fied in Westcnester Courty M/Ccmmissiar Expires Oet 2E. 202S r :- (2) 8/12J2021 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: /U[(_rs a d A4evvi caj _ being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing Ahm 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,attorney,etc.) That all statements contained herein are trite 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 8 7;011 Sworn to before me this day of /A0 M_ ,20231 day of vir__r'e.d6,rC 20 ?3 Signature of rty Owner Signaturree�of App 1 nt ,r✓llr f(j Pwlcd� '4 f r3WC� /�/{ �wtC! { Print Name of Property Owner Print Name of Applicant Notary Public Notary Public a DOMPAGE GAYA ViTHANAGE FNotary GAYA VITHANAGE Notary P.:blic•State of New Yo,k State of New York NO.01V16424207 1V16424207 Qualified in westcnester CourtyWestchester County My Commission Expires Cc:25. 2025 Expires Oct 25. 2025 (4) 9/12/2021 , n M N g W N �i 00 00\ W ' .r \ p W � U , y L h v R-4 a! (A � W bA ►x z 0.4 a v qj M W H � s O A A Zo � w � W N o ° o w O w � . o z F W Z w N z o H 010 Cl) >" 00 N U W o cn 0-4 x `n Ln w a E O _ O � o V P d 1-4W u w O o � Ra = O G7wo Z Q wa �, zuz rA .. o > o00 W cp • la w I—+ `� Q A `n A N a oD U o H a o oU � 7 a z H " 0 W � c Z off" p a o p.y w Ln V Ho U w z z w ° z A A. cn w w Z � w xa Angelo Zaccagnino D.0.13: 12/1111968 �lE dRr�� Company: BUIL MENT Zaccagnino Electric ~% ' ` VIL E OF RYE OOK 81 Maple Avenue I �^ Rye,NY 10580 938 KIN(q T RYE B NY 10573 icense No. 755 -� or Kpires on:12/31/2023 Peter Etorducci ,ECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: �'( EP#: Approval Date: A �O Permit Fee: $ 1 Approval Signature: Other: 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. 1.Address: 3 Wyman 67 f SBL: 141.43-1-9 Zone: 2.Property Owner: Mersad Memca. Address: 3 Wyman St,Rye Brook NY 10573 Phone#: Cell#: email: 3.Master Electrician: Angelo Zaccagnino Address: 81 Maple Ave,Rye NY 10580 Lic.#: 755 Phone#: 914-921-3244 Cell#: email: Office@zaccagnino.net Company Name: Zaccagnino Electric Address: 4.Proposed Electrical Work/Fixture Count: Wiring/clean up for demo of basement apartment&return to storage area with powder room. 5.31 Party Electrical Inspection Agency: SWIS STATE OF NEW YORY,COUNTY OF WESTCHESTER ) as: Angelo Zaccagnino ,being duly swom,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 legal owner of the property to which this application pertains,or that(s)he is the Electrician for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent.attorney,etc.) 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 re me this \ Sworn to b fore me this day of cam ' day of 20 a _ ,� Signature f Properly a Signature o Appli nt Prin am IN Print Name of Applt ant NOTARY PUBLI T OF NEW YORK STEVE NON Notary Pub - Nollf�l {1�11BL Qualified in J Rester County•A!_ No. 01 002ba Rom, My Commission/Expires October 14, 20�� Qualified in stc ester Coun T My Comm'ssion E ptres cfober 14, 100Z�?/ U23/2022 sSTATEWIDE INSPECTION k'A, Service With btlegril.v 1:1 Main Street,Fishkill, NY 12524 1 email:office@swisny.com SWIS JOB APPLICATION1 . 914.219.1062 • Office Use Elect.Permit# — � Date c) 5 7 Illy 3 Bldg Permit# '/^ Utility ID# Final Certificate# City/Village e �' Zip Township 11,_ County ,2 5k Pe Sic Address ~^fi�}n� ab , Cross Street Section 1411`L� Block Lot Q Owner Name/Acicli&( differlfittha ove) ;-`( 1 l� CA ; Contact Number f ❑Basement ❑1st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent SERVICE Amperage Voltage 1 P 3P #Meters #Disconnect ❑Underground ❑New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information i 1 ,Jj t 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. Inspector Date Finalized Inspector# Company Name Date Signatur Address City/State Zip License# Phone# R [EC IEWE State Wide Inspection Services 1080 Main Street C � MAR 11 20?4 Fishkill, NY 12524 ���� �.___ 845 202-7224 Phone VILLAGE OF RYE BROOK 914-219-1062 Fax STATE WIDE INSPECTION SERVICES BUILDING DEPARTMENT Email: officeCabswisny.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: Zaccagnino Electric Mirsad&Nensi Memcaj Angelo P.Zaccagnino 3 Wyman Street 81 Maple Avenue Rye Brook, NY 10573 Rye, NY 10580 Located at: 3 Wyman Street, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 23-257 141.43 1 9 Certificate Number: 2024-0840 Building Permit Number: BP 23-195 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: 3 Wyman Street, Rye Brook, NY 10573 The Basement 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 12`' Day of February 2024. Name Quantity Rating Circuit Type Luminaires 03 Switches 02 Receptacles 02 A Visual Inspection of existing conditions was performed on February 12" 2024 of the Basement and Conforms to NFPA 70-2017 NEC. No Defects Were Noted. Officer: Frank 1. 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%vork performed on the date of inspection only. � N ■ � N N a a N \ \ < W L wr T- 0? � C)14 Tr CN Ucn o z r" F� O = �4Nop O W Cl) � ; � PLO 11, N _ w ~ H r o x z �o V = 00 O w O �j w Uz 004% w00OCI x yQ V Z wz . • , CN H U � U a- " c Zp A ►� W � z � w � O a H o0 CAz o4 z o a w N V � ' M A .. p w a w � r JILDINc DEPARTMENT NOV 2 0 2023 1 VILLAGE OF RYE BROOK 938 KNG STREET RYE BROOK,NY 10573 VILLAGE= OF RYE BROOK I (914)939-0668 BUILDING D1N:f - I wwwn- ok.org PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: 0 3—j 7� PP#: C�)13 Approval Date: NOV 2 / H23 Permit Fee: $ Approval Signature: Disapproved: (fees are non-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, //dO'-c) 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: W W 0- S eye Arlo o/K P SBL: I I• �3 �— �j Zone:/C��l—F 2.Proposed Work: C 5 4 o L-.-e !a h�[ k t 7 c 4 ti s t w k ,/Q(n 6\4 Q- N 3.Property Owner: /"t I oct /I f ew Gct j Address: 47 F,/e /l�/``� 103 80 Phone#: Z Cell#: email: 4.Master Plumber: Address: Lic.#: _Ph e#: -OQ CO Cell#: WOAY � email: Company Name: Address: INDICATE FIXTIUN&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 / 1st Floor (/ 2nd Floor 3'Floor 4t6 Floor 5m Floor Exterior 5.*List Other Eq�ipmen ovide Details: b (Notarized Signat es Required Next 2 Pages) -1- 3/3/2023 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that(s)he is the Master Plumber for the legal owner and is duly authorized to make and file this application. That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this i7 -W Sworn to before me this day of /✓U✓E�/lSetit ,20 —2-3 day of(� l ,20� Signature o Lyperty Owner Si tore of 1ph I;so_L �11?wt C 6� I'd ,V�L�Cuk'D Print Name of Property Owner Print Name f f Appli ant 4%�J�• . ZL� WUMPAUt A VITHANAGE Notary Public Notary Public-State of New York Nor G RY M.RNERA NO.01 V 16424207 Notary Public,State of New York Qualified in Westchester Coum nt' N0.01R16441398 My Commission Expires Oct 25,2624 Qualified In Westchester County r Commission Expires September 26,2 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 BUILDING DEPARTMENT 1h I _ VILLAGE OF RYE BROOK `: NOV 2 0 2023 938 KING STIMET RYE BRoow,NY 10573 � _J (914� -Q �,. VILLAGE Or RYc E3ROOK—� `b i BUiLQi. G DEPART�MEPAi' WWW'******************************************************************************************************* 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 PLUMING PERMIT APPLICATION. ANY BUILDING OR PLUMING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT. STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: 31, A�trSao( lae-1 ca ,residing at, (Ncxfer5 C./rye ti>` loSBo (Print name) U (Address where you live) 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; 3 v�,�,„a S/r Pe, ,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. J"l .,/ (Signature of PrCIlly Owner(s)) lr�l,� /mac ew>, CGt (Print Name of Property Owner(s)) Sworn to before me this /7 day of ��.�de.� , 20 -2-3 (Notary Public) DOMPAGE GAYA VITHANAGE '-otary Pt:blic-State of New York NO.o,v16424207 ^ualified in Westchester County ommission Expires Oct 25. 2025 8/12/2021 \ .Building Permit Check List&Zoning_Analysis Address: w1�� Sc SBL: Zone:_LLLi Use: 2-2 Const.Type: Other. Submittal Date: S Revisions Submilfal Dates: Applicant: Nature of Work 9 �� c n Reviews:ZBA:_ - nB• BOT• > Q K '1-JLi �UQOthr 2� � , oo P `� FS:F�luig. _ C/O• Flood Plane: Legalizatio� ( ) ( P: Dated Notarized SBL: Truss I.D. Cross Connection H.O.A.: fo ( ) ( ) 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. ( ) ( ) VEY:Dated Current: Archival: Sealed: Unacceptable:( ) (` LANS:Date Stamped: Sealed Copies: Electronnir. Other. C License: Workers Comp: Liability Comp.Waiver. Other. ( ) ( ) CODE 753#: ate H Dated HIGH-VOLTAGE ELECTRICAL.Plans: Permit D N/A: ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit N/A: Other. FIRE ALARM/SMOKE DETECTORS:Plants: Permit: H.W.I.C.:_Battery:_Other. (t�l ) PLUMBING:Plans: Pen-nit: 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 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: E� REOUIItED EXLSIING PROPOSED NOTES _ Aux Circle: Fm e Front: Front: Sides: &ar. Main Cov Accs.Cov Ft.H Sb: S .HS • GGA: Tot : Ft.Im P ku' Height/Stories: notes: 6ROvk CERTIFIED MAIL -274C O ti� w BUILDING DEPARTMENT HAND DELIVERED VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK, NY 10573 (914) 939-0668 FAX (914) 939-5801 NOTICE OF VIOLATION AND ORDER TO REMEDY SAME OWNER: \.cz>QL a VIOLATION# 1912 S\ NOTICE:# SECTION: I N L� BLOCK: LOT' THE FOLLOWING VIOLATIONS OF THE NEW YORK STATE UNIFORM FIRE PREVENTION AND BUILDING CODE ANj R,THE CODE OF THE VILI AGE E BROOK WERE FOUND TO EXIST AT� ' ,`? LOCATED IN A ZONE, IN THE COUNTY OF WESTCHESTER,VILLAGE OF RYE BROOK,NY ON, \ 20 . CODE SEEjCTION TITLE/DESCRIPTIO ----�----?�_- -------------------------- 'N_\S�n -cc>n _ enr\o can -- ---------- - _ - -cf � - - -v - -c c� —_ �- ---------------------------- � N �------- a- fZQk ------------------------- >r ec� _— ----------- --------- ----- - - ------- - --- vk - - NOES'--- ------ -------'� � �s -- ----- -_ � Cb \C-4 1XV At C- C-C,>(%( IS c�u� uN S cQ 02 O iSrb t J AA Oc -p M- SA0qj5 l -2 You are hereby directed to contact this department, obtain all necessary per & commence to correct t e a ove captioned violation(s) immediately.Violations of the NYSUFP&BC must be remedied by, 20Z ,which is thirty (30) days after the date of this notice and are returnable at the rate of$1,000,00/day for each day of continued violation, or imprisonment not exceeding one year, or both. A re-inspection of the premises is required bylaw to confirm compliance with this notice& I applicable codes. FAILURE TO COMPLY WITH THIS NOTICE IS A CRIME PUNISHABL I RISONMENT OR BOTH. BUILDING INSPECTOR ❑ ASSISTANT BUILDING INSPECTOR ❑ VILLAGE ENGINEER Qy� 5R' CERTIFIED MAIL / BUILDING DEPARTMENT HAND DELIVERED VILLAGE OF RYE BROOK . 198 ' 938 KING STREET RYE BROOK, NY 10573 (914) 939-0668 FAX (914) 939-5801 NOTICE OF VIOLATION AND ORDER TO REMEDY SAME OWNER: `" `\(-SO L ` o \ CA VIOLATION# 1911 NOTICE:# SECTION: OC o BLOCK: LOT: Q THE FOLLOWING VIOLATIONS OF THE NEW YORK STATE UNIFORM FIRE PREVENTION AND BUILDING CODE A /OR,THE CODE OCF1THE VII J AGE OF RY B OOK WERE FOUND TO EXISTnAT.... '��-- (" \ , OCATED IN N "�2� ZONE, IN THE COUNTY 6F WESTCHESTER,VILLAGE OF RY BROOK,NY ON, 20 OC DE SECTION ITLE/DES RIPTION _ ► 2 Q— Cyr CG _ OCC �C O-z -y1� --C a -- 5 --------------------- ►' -- _ con e cs �oc,e 6 - ---------------------------- --- ---------------------------�S_ro_0Y - k�1 ---------------------------------QCCU.0�n_- -----`------------------------------�- -- --- NOTES: �1, ""� NSA C�-���l� t0� `C TV 2 c�► S h A- � us You are hereby directed to contact this department, obtain all necessary permits & commence to correct the above captione violations) �{�immediately.Violations of the NYSUFP&BC must be remedied by, ,20 ,which is thirty(30) days after the date of this V notice and are returnable at the rate of$1,000,00/day for each day of continued violation, or imprisonment not exceeding one year, or both. A re-inspection of the premises is required by law to confirm compliance i notice &a licable codes. FAILURE TO COMPLY WITH THIS NOTICE IS A CRIME PUNISHAB - BY NE, 'IP SO T OR BOTH. �01 UILDING INSPECTOR ASSISTANT BUILDING INSPECTOR ❑ VILLAGE ENGINEER T c� jor am" r IEI IL aw 004 ,ft } �..,, � ,!!� � is � is• . *�� �'� �. t 5 -. �_ � � �� ice►+ :��� A� r *wOOW maw maw Ad L ` 4 �- { r 3 ! fi '000 � r. �yE BR(�� 1932 BUILDING DEPARTMENT 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 : J\' fyA�V (-� DATE: PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: \ 1 !7� C y` OCCUPANCY(-,--2 y F0'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 r ` ` ❑ Natural Gas �`� �~-) ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER , N��► PC I ❑ FINAL PLUMBING ❑ CROSS CONNECTION C- ❑ FINAL %- ❑ OTHER � 1) 1L �,-,p \.f c -1 QyE BRC�k '9a2 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : DATE: PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: OCCUPANCY: 01 VIOLATION NOTED THE WORK IS... ❑ ACCEPTED Q-/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 , �i h a a z ++ a 0 1 N W u ` N \ CaaL M x to � Cs W W e"T-r O W h}y ON O 1.4 Q - = A - � - ' 00 00 N 4 U ON N ONLnce 00 v W o V = aV) Wz z 0 z ° � O 00 04 W Q o q wa _ V W W Q 0 � 1 14 a w o W z o of 1.0 V) a an `'� z VeC� �e� ��', l� 1��► S► 0n e U � p •3 °' o a� U C C O N • .� cps y rp vUi U s. " bA U O "'" �, ' p cz U 4+ N U ° b .d U 0 �+ � d = 5 o 0 p O cd OU O• p mu 64 c a p., C a) 64 O. � O c O. m I cl >, 4• a U rA Q O 3 O U u En CIS m cl cn U G. O 0 O '3 v �" 0. O � x 2o E.14 o o 03 �1 H . o A64 cd o H GA I ,�yES3RC�v [E V BUILDING E�'ARTMENT 3 0 2022 VILL�1E OF RYE BOOK 938 KINdi�� EETRYEB -,1C,NY 10573IVIUL:LAGEF RYE BROOK(914)9 ' 939-5801DEPARTMENT W .orc ELECTRICAL PERMIT APPLICATION Westchester Countv Master Ft^.tricianc License Required r FOR OFFICE USE ONLY h1' EP#: �c�—/ �7 Approval Date: Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, 2 4 2 is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/ remove electrical equipment,wiring, fixtures,or to perform other high or low voltage electrical work as per the detailed statement described below. The applicant & property owner, by signing this document agree that all electrical work performed will be in conformance with all applicable Federal, State,County and Local Codes. C� 1 1.Address: _ alL SBL:/, 11i ��`�— / Zone: �/ F 2.Property Own I5A--p Address: S C[.� U ",,Phone#: a Cell#: email: 3.Master Electrician: 9r4 p '&-Coq 01 A) Address: A IV Lic.#: Phone#lq-9cW 3-11�1�Cell#: fc�-90(" t"bu email: Company Name: 7- C Ca.h N/� a 7(C-� ° Address: 1"� pr t{ 4.Proposed Electrical Work/Fixture Count: ATE OF /�W� YORK,COUNTY OF WESTCHESTER ) as: U �1 X/(4U ,being duly swom,deposes and states that he/she is the applicant above named,and does further (pr t n me 6f individual signing as the applicants state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the ?,&Clc :F VIA o ���G for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor.agent.attorney,etc.) 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 'i✓ Sworn to befl�re me this day of Z day o < ,20 Z 2— Si e of Property O er Sign t e o AJl A; L� P t Namit, er A� y Print N me of Applicant •Ll NEW YORK Notary Puliliio. 0 � 1�t�K 1,'1vpllNo stitch atRr C ? No 14 23i My ComnlltiNon Expires Octotftr i�, !Q•w Guittlf 1 IIt he I Ceu�M rL3 My Commisslon fxphe OO/0RN 14.>a_:_C.. 3/21/19 STATEWIDE • kAO Service Willi hilegrit-v 1:1 Main Street,Fishkill, NY 12524 1 email:• • SWIS JOBAPPLICATION tel845.202.7224 • • 1•21 SWISNY.com I SWISTraining.com Office Use Elect.Permit#' — /�� Date L 1/ZZ� Bldg Permit# Utility ID# Final Certificate# �lct� 0 / a-&9� City/Village Zip V '7 3 Township Cou ES Address Crose�et/� /� Section Block Lot IC IQ/ s�� Owner Name/Addre (if different than above)�/TI 4JAd ��ff r Contact Number ❑Basement ❑1 st Fl. ❑2nd Fl. /`❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside Residential [:]commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent SERVICE Amperage Voltage 1 P 3P #Meters #Disconnect ❑Underground ❑New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional information ` 60//Z( p E C IE�WF MAY 3 0 2022 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by WAS.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. Inspector Date Finali ed Nwor# Company N �, l C:<1 Date Address L� GrE City/ fate Zip C License# a SS Phone# �� a raw ■�N ■ ■ ■ K ■ ■ I 0 of ' Laura Petersen From: Laura Petersen Sent: Friday, November 17, 2023 11:18 AM To: Mirsad Memcaj Subject: 3 Wyman Street - Building Permit Application Good morning, The building permit application has been approved by the Building Inspector. Before I can issue the building permit the following items must be submitted to our office, 1. General contractor's contact name & phone number. 2. Copy of general contractor's valid Westchester County Home Improvement License. 3. General contractor's valid liability insurance (the Village Of Rye Brook must be the certificate holder) 4. General contractor's valid workers compensation on a NY State Board form (C105-2 or / U26.3) '+ 5. Building permit fee $324.00 (due once permit is issued and ready for pick-up) Stop Work Order fee $500.00 ✓7. Legalization fee $2,160.00 Thank you Laura 1 — I 1 Laura Petersen Office Assistant Village of Rye Brook �11 938 King Street Rye Brook, New York 10573 [ Phone(914)939-0668 1 Ipetersen(tDryebrook.ong } l 1 'ni- Hanover Insurance Group,, 1W RENEWAL DECLARATION # 21 RENEWAL OF POLICY HVY J166650 H O M E O W N E R S P O L I C Y POLICY NUMBER POLICY PERIOD COVERAGE IS PROVIDED IN THE AGENCY CODE HVY J166650 09/19/2023-09/19/2024 MASSACHUSETTS BAY INSURANCE CO 860874800 440 LINCOLN ST WORCESTER MA 01653 NAMED INSURED AND MAILING ADDRESS AGENT MIRSAD MEMCAJ RIEMER INSURANCE GROUP INC 3 WYMAN ST 217 SOUTH RIDGE ST RYE BROOK, NY 10573 RYE BROOK, NY 10573 TELEPHONE : 800-742-1691 POLICY PERIOD- 12:01 A.M. STANDARD TIME AT THE RESIDENCE PREMISES THE RESIDENCE PREMISES COVERED BY THIS POLICY IS LOCATED AT: 3 WYMAN ST, RYE BROOK, NY 10573 CONSTRUCTION TERR. YR. SECTION I LOSS OCCUPANCY CONST. DEDUCTIBLE SIDING - VINYL WHA 1940 $2500 PER OCCURRENCE PRIMARY COVERAGE INFORMATION SECTION I COVERAGE LIMIT OF LIABILITY PREMIUMS A. DWELLING $689, 000 $1, 635.00 B. OTHER STRUCTURES $68, 900 C. PERSONAL PROPERTY $516, 750 D. LOSS OF USE $206, 700 SECTION II COVERAGE E. PERSONAL LIABILITY $1, 000, 000 EACH OCCURRENCE F. MEDICAL PAY TO OTHERS $10, 000 EACH PERSON $104 .00 STANDARD POLICY PREMIUM $1, 739.00 OPTIONAL COVERAGES HOME CYBER PROTECTION ENDORSEMENT $170.00 EQUIPMENT BREAKDOWN $35.00 ORDINANCE OR LAW COVERAGE $82.00 LIMITED WATER BACK UP & SUMP DISCHARGE OR OVERFLOW COV $75.00 OWNERS SELECT PLUS TRIM $136.00 TOTAL OPTIONAL COVERAGES PREMIUM $498.00 TOTAL POLICY PREMIUM $2, 237.00 YOUR PREMIUM INCLUDES THE FOLLOWING DISCOUNTS AND PREMIUM ADJUSTMENTS: NEW HOME DISCOUNT HOME BUYER DISCOUNT CONTINUED ON NEXT PAGE DIRECT BILLED 08/07/23 2137839235 PAGE 01 OF 03 231-6240 05 16 ORIGINAL/INSURED 1W RENEWAL DECLARATION # 21 RENEWAL OF POLICY HVY J166650 H O M E O W N E R S P O L I C Y POLICY NUMBER POLICY PERIOD COVERAGE IS PROVIDED IN THE AGENCY CODE HVY J166650 09/19/2023-09/19/2024 MASSACHUSETTS BAY INSURANCE CO 860874800 440 LINCOLN ST WORCESTER MA 01653 NAMED INSURED AND MAILING ADDRESS AGENT MIRSAD MEMCAJ RIEMER INSURANCE GROUP INC 3 WYMAN ST 217 SOUTH RIDGE ST RYE BROOK, NY 105 / 3 RYE BROOK, NY 10573 TELEPHONE : 800-742-1691 FORMS AND ENDORSEMENTS - The Declaration and the policy forms and endorsements listed below form your Homeowners Insurance Policy: HO 00 03 05 11 HOMEOWNERS 3 - SPECIAL FORM 231-6217 12 17 SPECIAL PROVISIONS - NEW YORK 231-0600 05 16 INFLATION GUARD HO 24 93 05 02 WORKERS COMPENSATION 231-6776 12 20 HOME CYBER PROTECTION ENDORSEMENT 231-5767 05 16 EQUIPMENT BREAKDOWN 231-6195 08 17 EXTENDED DWELLING REPLACEMENT COST 231-1937 08 17 IDENTITY FRAUD EXPENSE COVERAGE 231-6279 08 17 LOSS ASSESSMENT COVERAGE HO 04 77 10 00 ORDINANCE OR LAW INCREASED AMOUNT OF COVERAGE 231-6317 03 17 SERVICE LINE COVERAGE 231-5761 12 17 LIMITED WATER BACKUP & SUMP DISCHARGE OR OVERFLOW COV HO 24 86 10 11 PERSONAL INJURY COVERAGE - NEW YORK 231-2331 05 16 LOCK REPLACEMENT COVERAGE 231-6281 08 17 OWNERS - SELECT PLUS TRIM 231-6283 08 17 PERSONAL PROPERTY REPLACEMENT COST LOSS SETTLEMENT 231-2341 05 16 REFRIGERATED PROPERTY COVERAGE 231-5781 12 17 WINDSTORM DED - NY CAT PERCENT & NON-CAT FIXED DOLLAR MORTGAGEE NATIONSTAR MORTGAGE, LLC ISAOA P.O. BOX 7729 SPRINGFIELD, OH 45501 LOAN NUMBER: 0693778409 DISTANCE TO FIRE HYDRANT LESS THAN OR EQUAL TO 1000 FEET DISTANCE TO FIRE STATION 1 MILE OR LESS FINISHED LIVING AREA(SQ. FT) : 2475 NUMBER OF STORIES: 2 NUMBER OF FULL OR HALF BATHROOMS: 3 DESCRIPTION OF OPTIONAL COVERAGES HOME CYBER PROTECTION ENDORSEMENT AGGREGATE LIMIT - $100, 000 CYBERBULLYING EVENT SUBLIMIT - 50% OF THE AGGREGATE LIMIT PER OCCURRENCE DEDUCTIBLE - $500 CONTINUED ON NEXT PAGE DIRECT BILLED 08/07/23 2137839235 PAGE 02 OF 03 231-6240 05 16 ORIGINAL/INSURED Hanover Insurance Group 1W RENEWAL DECLARATION # 21 RENEWAL OF POLICY HVY J166650 H O M E O W N E R S P O L I C Y POLICY NUMBER POLICY PERIOD COVERAGE IS PROVIDED IN THE AGENCY CODE HVY J166650 09/19/2023-09/19/2024 MASSACHUSETTS BAY INSURANCE CO 860874800 440 LINCOLN ST WORCESTER MA 01653 NAMED INSURED AND MAILING ADDRESS AGENT MIRSAD MEMCAJ RIEMER INSURANCE GROUP INC 3 WYMAN ST 217 SOUTH RIDGE ST RYE BROOK, NY 10573 RYE BROOK, NY 10573 TELEPHONE : 800-742-1691 DESCRIPTION OF OPTIONAL COVERAGES EQUIPMENT BREAKDOWN LIMIT OF LIABILITY - $25, 000 EXTENDED DWELLING REPLACEMENT COST ADDITIONAL AMOUNT OF INSURANCE - 500 IDENTITY FRAUD EXPENSE COVERAGE LIMIT OF LIABILITY - $25, 000 LOCK REPLACEMENT COVERAGE LIMIT OF LIABILITY - $1, 000 LOSS ASSESSMENT COVERAGE RESIDENCE PREMISES - AMOUNT OF INSURANCE - $5, 000 ORDINANCE OR LAW COVERAGE - 500 REFRIGERATED PROPERTY COVERAGE LIMIT OF LIABILITY - $500 SERVICE LINE COVERAGE LIMIT OF LIABILITY - $10,000 LIMITED WATER BACKUP & SUMP DISCHARGE OR OVERFLOW COVG LIMIT OF LIABILITY - $25,000 PERSONAL INJURY COVERAGE WORKERS COMPENSATION NUMBER OF EMPLOYEES - 01 TYPE OF HOUSEHOLD EMPLOYEE - OCCASIONAL SERVICES CATASTROPHE WINDSTORM DEDUCTIBLE PERCENTAGE IS 5%, DOLLAR EQUIVALENT = $34, 450 BI 08/07/23 2137839235 DIRECT PAGELLED 03 OF 03 231-6240 05 16 ORIGINAL/INSURED Affidavit of Exemption to Show Specific Proof of Workers' Compensation Insurance Coverage for a 1, 2, 3 or 4 Family, Owner-occupied Residence "This form cannot be used to waive the workers'compensation rights or obligations of any party.** Under penalty of perjury, I certify that I am the owner of the 1, 2, 3 or 4 family, owner-occupied residence (including condominiums) listed on the building permit that I am applying for, and I am not required to show specific proof of workers' compensation insurance coverage for such residence because (please check the appropriate box): ❑ I am performing all the work for which the building permit was issued. ❑ I am not hiring,paying or compensating in any way,the individual(s)that is(are)performing all the work for which the building permit was issued or helping me perform such work. I have a homeowners insurance policy that is currently in effect and covers the property listed on the attached building permit AND am hiring or paying individuals a total of less than 40 hours per week (aggregate hours for all paid individuals on the jobsite) for which the building permit was issued. I also agree to either: ♦ acquire appropriate workers' compensation coverage and provide appropriate proof of that coverage on forms approved by the Chair of the NYS Workers' Compensation Board to the government entity issuing the building permit if I need to hire or pay individuals a total of 40 hours or more per week(aggregate hours for all paid individuals on the jobsite)for work indicated on the building permit,or if appropriate,file a CE- 200 exemption form; OR ♦ have the general contractor, performing the work on the 1, 2, 3 or 4 family, owner-occupied residence (including condominiums)listed on the building permit that I am applying for,provide appropriate proof of workers'compensation coverage or proof of exemption from that coverage on forms approved by the Chair of the NYS Workers' Compensation Board to the government entity issuing the building permit if the project takes a total of 40 hours or more per week(aggregate hours for all paid individuals on the jobsite)for /wwork indicated on the building permit. 20 ( ture of Homeowner) (Date Signed) l l Y�d laC m c a . Home Telephone Number (Homeowner's Name rinted) Sworn to before me this day of Property Address that requires the building permit: � _ (Count ie EM�cMaME0bli0 Notary Public,State of New York No.01 RI6441398 Qualified In Westchester County Commission Expires September 26,201 Once notarized,this BP-1 form serves as an exemption for both workers'compensation and disability benefits insurance coverage. BP-1 (12/08) NY-WCB r. V j� v E T _ � "T Ij O -t-1 v � �. Q c General Notes: cc= � �' z _ s o Q l ALL WORK AND MATERIAL5 SHALL CONFORM TO ALL LOCAL,GOUNTY AND STATE GODE5. z z c CONTRACTOR SHALL PROVIDE ALL LABOR,MATERIALS AND EQUIPMENT n C= .— Lu REQUIRED TO FULLY COMPLETE THE JOB.EXCEPT WHERE 5PEGIFIGALLY m A6REED ON BY OWNER,JOB SHALL BE READY FOR OCCUPANCY IN A "' w GOOD WORKMAN54P MANNER WITH ALL WORK DONE A5 SHOWN OR '-' c > REA50NA13LY INTENDED ON DRAwIN65,IT 5HALL INCLUDE BUT NOT BE ! =' LIMITED TO THE FOLLOWING: n` BUILDING PERMIT INSULATION W m IN5URANGE 6YPSUM BOARD 4 TAPING w w O 6 a TILE WORK Lo Q-x GAU CARPENTRY PAINTING$FINI5HIN6 °o ELECTRICAL a z \ PLUMBING J Lu W m Q \ SCOPE OF WORK: a v� o . EXI5TIN6 BASEMENT TO BE USED A5 STORA6E ONLY O< REMOVE INTERIOR WALL5 d SHOWER. s: REMOVE ALL GABINET5 4 PLUMBIN6 FIXTURE5 Exist.HrKbw Exist.window ALL FRAMIN6 LUMBER TO BE#2 DOU61LA5 FIR-LARCH OR BETTER. _ ALL NEW WORK AND MATERIALS,UNLE55 OTHERWISE SPEGIFIED,5HALL - G MATCH EXI5TIN6 GON5TRUGTION. Perimeter walls u_ ALL MATERIAL5 5HALL BE IN5TALLED IN 5TRIGT ACCORDANCE WITH To in Q7 MANUFAGTURER'S 5PEGIFIGATION5. o o w Remove 5t E w. i� z Gdbi" ove ELECTRICAL CONTRACTOR TO REMOVE EXISTING ELECTRICAL ct o✓1 PLUMBER CONTRACTOR TO REMOVE EXI5TIN6 FIXTURES f GAP PLUMBING `S Remove 5lnk Remove walls E Remove walls d Door 1 y r�Gap Plumbng Door - , - Keep Columns Keep Golumns r Remove Shower Cap Plumbing Lu Ref Ir Store e area s. ,f u U"uj d Cer.Tile Fir to Remain 111 111 7 li\ O Replace Old � � z ? Stairs O l�U-IIJ T- New C;�,..,� Continuous -n_z flcr&all <a \ SD w <W J y -- ? i- Ejectoj Exist.WYtdow <Z w 1 'n O J V7 U < 7. J X. �e end Revision Date s� a Date Existing 1441I Nov.6,2023 (To Remain) Proposed New Wail Job No 216-016 5P a 5 e m e n� P l a n De Drawing 5role: 1/4"=1'-0" OF