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HomeMy WebLinkAboutBP23-208DATE: KRMIT #I 9 3 tP: 1/ SECTION Q9, 74Y BLOCK LOT //�� //� � /Ce?Q� � TYPE OF WORK %O`IPVa Oe,,S ° %O�Ke2e)0va 76^5 oovav2 AealQ Aho JOB LOCH ION '71V Cj2LLp k'/Wqe %2/e 1 / OWNER Q 7e 1114*e14?/%o1� 'i 0 % Q17/e71 xolalI( Q� sq�7" O�%� CONTRACTO 0/? 44 400 o /i?o C9m)-Y90-1 %o4% COSTS` -FEES "' f ,& 9 0 -10 4 V CO # FEE4 5Q60:�P D DATE TCO # FEE DATE INSPECTION RECORD] DATE 1 NSP FOOTING ' �Z"Z°Zs� FOUNDATION FRAMING RGH FRAMING INSULATION/ 21' Loty 000,0 � PLUMBING L� jO'!0- LOL*&( -� A RGH PLUMBING 3-%Z- z" L`{ �� �1S GAS �- �Z- 2oz� PA SS SPRINKLER ` ELECTRIC LOW -VOLT ALARM AS BUILT O ASi� FINAL IO- 2 - Zo OTHER AS-BUILTIFINAL BURVEY REQUIRED PRIOR TO FINAL INSPECTION THIS BUILDING MUST BE POSIfD WTi}i A PERMANENT CONSTRUCTWN i7PE IDENTIFICATION SIGN, T PRIOR TO THE ISSUANCE OF A C/0 ►0 3�]ac��p REQUIRED BY NY STATE LAW. VILLAGE OF RyE BROOK WESTCHESTER COU , NEW YORK - 0 NO. 24-136 8-2i (fertif trote of ®rrupeurp This is to certify that.ma�)hau q'I60Aqlllma'o of, �Wbv,N)k. NV , having duly filed an application on nCkb / P.T_20_(:�)L4 requesting a Certificate of Occupancy for the premises known as, CD unlyu Kdnr , Rye Brook,NY, located in a f__15 Zoning District and shown on the most current Tax Map as Section: )420- 74 Block: / Lot: and having fully complied with the requirement of the Building Code and the Zoning Ordinance under Building Permit No. 2J0 , issued 9 20,=,?3, such authority and permission is hereby granted to the property owner to lawfully occupy or use aid premises or building or part thereof listed under the following New York State Classifications, Use: calnllllR Construction: �0 for the following purposes: bck VIL-1 Y- C_ V yo 121 rp ae-ale 1 y4c r iby 'r-M611rTh6' n_P yemy rear Pa-f 16 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, shall the building be moved from one location to another until a permit to accomplish such change h n o ed fro th Building Inspector. Building Inspector, Village of Rye Brook: Date: OCT 3 1 2024 QyE BR L VILLAGE OF RYE BROOK MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A.Klein (914)939-0668 Christopher J.Bradbury www.nLebrookny. TRUSTEES BUILDING & FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M.Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE October 31,2024 Matthew Gillman&Danielle Gillman 49 Country Ridge Circle Rye Brook,New York 10573 Re: 49 Country Ridge Circle,Rye Brook,New York 10573 Parcel ID#: 129.74-1-38 This document certifies that the work done under Mechanical Permit#24-134 issued on 10/11/2024 for the installation of new make-up air unit and exhaust pipe has been satisfactorily completed. Sincerely, Steven E.Fews Building&Fire Inspector /to DR 19 ���C u4 ivy' 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.gov TRUSTEES BUILDING & FIRE INSPECTOR Susan R.Epstein Steven E. Fews Stephanie J. Fischer David M.Heiser Salvatore W.Morlino CERTIFICATE OF COMPLIANCE October 31,2024 Matthew Gillman&Danielle Gillman 49 Country Ridge Circle Rye Brook,New York 10573 Re: 49 Country Ridge Circle,Rye Brook,New York 10573 Parcel ID#: 129.74-1-38 This document certifies that the work done under Mechanical Permit#24-127 issued on 9/30/2024 to relocate six supply registers have been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to D LD R ENT For office use only: p DB� PERMIT# ©,3 OCT - 8 2�24 VIL OF RYE OK ISSUED: Q-19-a-S 938 KING STRE YE BROOKS YoRK 10573 DATE: /O VILLAGE OF RYE BROOK 9 -06 OY FEE: � PAID BUILDING DEPARTMENT w .20v 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 sssssss+»+*+++**s*sssssssssss»ssss»»***sssssssssss*ssss+*»**+n*****++ssssssssssssss»»»sss1****»+s+*+*sssssss-sssrs**sss»s»»*+s** Address: L 0-� RA6 U�G` ��� N 0 l7 3 pp Occupancy/Use: ,� �/f, Parcel ID#: /c�cJ, y — — Zone: /C-/S Owner: 0�4 \C-W ( l Address:LI �ZJ 6!nL C< f ej L P.E./R.A.or Contractor: 1pn RfmD� (Q)o IN U Address: Person in responsible charge:MMS'- R V 55 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: C�\N�4C,02 CT I I I P�Q being duly swom,deposes and says that he/she resides at (Print Name of Applicant) a\\ (No. d Street) in�_ (b0 ,in the County of -� '(��TG in the State of��,that (City/rown/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:$ 3' S, on) 0 for the construction or alteration of: 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 I Sworn to before me this day of V , 202�- day of , 20 Signature of Property Owner Signature of Applicant Print ame of Property Owner Print Name of Applicant ,rJ17 neln? otary P Notary Public GREGORY M.RIVERA ,1, ,4 Notary Public,State of New York No.01 RI6441398 Qualified In Westchester County Commission Expires September 26,20Z �yE[3RC>Uk• uJ � 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ErASSISTANT 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 : L1, DATE: PERMIT# � �� C� ISSUED: SECT: BLOCK: LOT: LOCATION: 2 D -..> '>`J,--- � 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 �yE BRC��. 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR Q 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 : t 1 twJ VA-J DATE: PERMIT# P Z `�- 'J ISSUED: SECT: IZ . 7Y BLOCK: LOT: LOCATION: -1" ' '� +' I1J A ti t� 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 T ❑ L.P. GAS M L\ U ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL ❑ OTHER �E BRC�uk • 1932 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.ori; - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS :- L� " t �u �L, DATE: 7 C l.� PERMIT# �� Z � ���V ISSUED: _SECT: BLOCK: LOT: LOCATION: OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED E 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 l�. (� , /'d PPI ! cc-- FINAL PLUMBING f ❑ CROSS CONNECTION L` , P A c e ❑ FINAL ❑ OTHER '-iE BRO - 1. ,iV 1932 BUILDING DEPARTMENT ❑BUILDING INSPECTOR 0 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 : 9J 1 DATE: PERMIT# 7� - Q L � ISSUED: Z _L r SECT LOT: -��BLOCK: %� LOCATION: J ac' �' J 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 OBRe ID I Iw9-8i; 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 : L,12 G DATE: - Z Z O L y PERMIT# `, L L y ISSUED: 2 I9 ZJ SECT: 12 A, ?7 BLOCK: LOT: 3 S LOCATION: rt��Rc��IG�.Y� 0 OCCUPANCY: ❑ Violation Noted THE WORK IS... Er PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION ?4MA 1j (� REQUIRED ❑ FOOTING (P ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ET'INSULATION / ❑ Natural Gaso ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION / ❑ FINAL ❑ OTHER ('4. �E BRC��, • �9�2 BUILDING DEPARTMENT ❑B/UILDING INSPECTOR SSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK{'-A ❑CODE ENFORCEMENT OFFICER 938 King Street• Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : \ ' J 'C ^ r 2 DATE: I Z G UZ 7 PERMIT# \ �-I C� Z ISSUED: ' Z' Z SECT: 12 / BLOCK: LOT: LOCATION: I� 1 4 j�/�1 ct U Vi✓1 OCCUPANCY: ❑ Violation Noted THE WORK IS... LEI PASSED ❑ FAILED /REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION Natural Gas ❑ L.P. Gas ❑ FUEL TANK 1,,4 �C �✓ ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION }~j �� pry` ❑ FINAL 1aAlC. ❑ OTHER �yE BRC�k. uJ � FO • 1982• BUILDING DEPARTMENT AS VILDING INSPECTOR SISTANT 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 : 1 11 7U� l :j 9. 1 A" l 12(-�o DATE: 3 - 12 - z OZ PERMIT# 1�7, ?% l� l� ISSUED: b SECT: L 22�/ BLOCK: LOT: LOCATION: ,�/ OCCUPANCY: ❑ 9 Violation Noted THE WORK IS... PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING "OUGH FRAMING ❑ INSULATION 1 ❑ Natural Gas A nI L J �P -P L'o", t u ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION 'p� ) •p�j� ❑ FINAL �rC 1 �Q '�f'G P'1 l7✓-a1, 0 --Pvl ❑ OTHER l r\J I '-r n \ i(W"-\ i 7 5 m/ �A�) QyE BR(��, cu � • 19812 BUILDING DEPARTMENT ❑BUILDING INSPECTOR 2'kSSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street. Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : Q � DATE: 7_' l Z - Z O7-`I PERMIT# �T 2 Z ISSUED: 17 -M-23 SECT: 129, 7 BLOCK: LOT: 13 LOCATION: OLA5 , kL, l_M-)t-SPACA y r/Wo1� rlLJ C�� . OCCUPANCY: ❑ Violation Noted THE WORK IS... 2 PASSED ❑ FAILED /REINSPECTION ❑ SITE INSPECTION REQUIRED a-TOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION II ❑ Natural Gas yaot i v kS i 2st A^. b ❑ FUEL Gas ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER ,� "�, �, ,� ��..�Y , ��; � � - -..�2 �� � - =,�� t •.:1 '� V • �� _.. ' ',' � i wj �' I' y � `,. ' ` IY .. i ` . �7 ' �•I � � I ' .� ,� �� ,_�� `�F ��- F '��� t _�`�` �� - � :� A ,� �#,,. 4 N 00 G i w -�. cu w a o (� F O w a V - � � � 011.. "00 _ a CA � r °� © z A o � 3 � C7 W V4 10, v a, 0 O Lr, ��t �, � cn °V ' n !� O A o w 00 V Ow 020 ° b A 1�4 � 0 0 H '1, A O 00 !�1 � C' `� � � u ram'' '' � �" � � � � o •~ �-I ° Ln 0 V u PLO W p V "a a x V H A H B «O � Z � z o ` q o 4 w W O � ° „ �, V rr rryy H oo z a tt A W V ° o V W O a o H o o b v 5 V044 Uz94 � o z W ,� W 0-4 0-4 00 �.-, w V w a � ° H � cn cy v 0 'r.v -o c. ° �1 Ra z nc o z z V B A o?3 w O o ° �:; V v .s0 _ oC Cd H w � d ��1 • � � b - wi > o v � ? G1 z J � a A W z xCY o ogW � _ ° BUILQfNY ENT VILOK D E C E ��E 938 KING 105730 CT - 2 2023 VILLAGE OF RYE BROOK FOR OFFICE USN "Nn" 0CT%2 ` I'Per Application iJ_ • nn # I r � • ■ Approval Date: Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: Date: D BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary' ZBA Approval Date: Case# +i` Other: Application Fee:&/00-- lS Permit Fees:S'7 EXTERIOR BUILDING PERMIT APPLICATION Application dated: is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of Permit for the construction of buildings,structures,additions,alterations or for a change in use,as per detailed statement described below.t 1. JobAddress: u n 6ZA VGA Cat 1 x L-e. 2. Parcel ID#: l Z ct -7 ,4 — ♦ - 3 % Zone: r 1 S 3. Proposed Improvement(Describe in detail): 4Y+ Q E ->WfTt1 ri�r 7y''� f vim_f 1-bny,�,�.•,�p/� a !� �''"1�- I'��iw /'►'t ti.g�•r' `6/t. Q nr� �ic�91_�����uvy" 1'7•C'.cr �C,/I Ggud� )q 1,nn V1 r�nA �Ga+� j�����lJt<c.r Pd�S.L i v.a J�wT 4. Property Owner: CLn l?:�D a Y► i �,�� t;► , Y�'+cxt� !gin r� r-e�e�f (l2hf�e�P Address: L u n. o 6�!s J 0 ! Phone# Cell# .r l . 57 - O a e-mail IM 1WW. 1.. 111 run List All Other Properties Owned in Rye Brook: c 1 Q_,n e, Applicant: Address: Phone# Cell# e-mail Architect: of 4br G .5C-a r"," Y ' Address: +ra r- }fi I I Pv Pa maw IG, N Phone# 9/ Z73- -73sD Cell# 9 7/ !SZ e-mail"TG5CAkr-" C G1na1L C:d^ Engineer: Address: Phone# Cell# e-mail ,� General Contractor: an - It r�C/ -0 er �/1 C — Address:J ') D ; O- lIe 1f�/I LI40 - Phone# 1L 90- / 20 Ll Cell# e-mail ,(_2QSSQ.1Co�? q (f C)"1-7 �l) 6/E/2023 5. Occupancy; (1-Fam.,2-Fam.,Commercial.,etc...)Pre-construction: Post-construction: L J 6. Area of lot: Square feet: I ( 5(s k Acres: 0 3-7 7. Dimensions from proposed building or structure to lot lines: front yard: `A rear yard: Gg right side yard: /$'W left side yard: 7-1 other: 8. If building is located on a corner lot,which street does it front on: 9. Area of proposed building in square feet: Basement: 1"fl: 2nd fl: 3`d fl: 10. Total Square Footage of the proposed new construction: O 11. For additions,total square footage added:Basement: O 151 fl: 0 2n1 fl: C 3,d fl: 12. Total Square Footage of the proposed renovation to the existing structure: 7 35.54 fT 13. N.Y. State Construction Classification: ZF=- N.Y. State Use Classification: 14. Number of stories: Z-. Overall Height: Z..3— Median Height: Z 1,5' 15. Basement to be full,or partial: , finished or unfinished: 16. What material is the exterior finish: C_c,.1 a4,.ol344/%'? 5 I lntr+v 17. Roof style; peaked,hip,mansard,shed,etc: Roofing material: 18. What system of heating: N-T' WfL 19. If private sewage disposal is necessary,approval by the Westchester County Health Department must be submitted with this application. 20. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) Yes: No: +/ (if yes,applicant must submit a separate Automatic Fire Suppression Svstem Permit application&2 sets of detailed engineered plans) 21. Will the proposed project disturb 400 sq. ft.or more of land,or create 400 sq.ft. or more of impervious coverage requiring a Stormwater Management Control Permit as per§217 of Village Code? Yes: No:*!Area: 22. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No:�L (ifyes,applicant must submit a Site Plan Application,&provide detailed drawings) 23. Will the proposed project require a Steep Slopes Permit as per§213 of Village Code Yes: No: ✓ (f yes,you must submit a Site Plan Application, &provide a detailed topographical survey) 24. Is the lot located within 100 ft.of a Wetland as per§245 of Village Code? Yes: No: ✓ (if yes, the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan) 25. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes : No: ✓ (if yes, the area and elevations of the flood plane must be properly depicted on the survey&site plan) 26, Will the proposed project require a Tree Removal Permit as per§235 of Village Code? Yes: No: ✓ (if:yes,applicant must submit a Tree Removal Permit Application) 27. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No: Indicate: TIER I: TIER II: TIER III: (if yes, a Home Occupation Permit Application is required) 28. List all zoning variances granted or denied for the subject property: 29. What is the total estimated cost of construction: S 29' LJ0- Note: The estimated cost shall include all site improvements, labor, material,scaffolding,fixed equipment,professional fees, including any material and labor which may be donated gratis. If the final cost exceeds the estimated cost,an additional fee will be required prior to issuance of the C/o. 30. Estimated date of completion: (2) 6/L/2023 BUILDING DEPARTMENT VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 RESIDENTIAL LOT AREA COVERAGE Address: 4 1 &-ur}kj I2tr4e GKck Section: /Z`/- 7 `F Block: / Lot: PERMITTED COVERAGE RATIOS IN RESIDENTIAL DISTRICTS (Local Law 3-881 YOUR ZONE AREA IN MAIN ACCESS. DECK ZONE DISTRICT SQ. FEET BLDG. BLDG. MAX. CHECK MAX. R-35 35,000 14% 4% 5% R-25 25,000 14% 3.5% 4% R-20 20,000 14% 3.5% 4% R-15 15,000 16% 3.5% 4% R-15A 15,000 12% 3.5% 4% R-12 12,500 17% 4% 4% R-10 10,000 20% 4.5% 3.5% R-7 7,500 23% 4.5% 3.5% R-5 5,000 30% 5% 3.5% R-2F 5,000 1 30% 5% 3.5% Existing: Proposed: 1. AREA OF LOT 16361 Sq. Ft. 16361 Sq. Ft. 2. AREA OF HOUSE a. Coverage of Main Building (Including Attached Garage or Accessory Building) ASH Sq. Ft. Z,-S4 Sq. Ft. b. Area of 151 Floor Divided By Area of Lot x 100 3. AREA OF ACCESSORY BUILDING (Includes Detached Garages, Tool Shed, Playhouses) Sq. Ft. d Sq. Ft. a. Coverage of Accessory Building U Area of Accessory Building Divided By Area of Lot x 100 % % 4. AREA OF DECK 0 Sq. Ft. 0 Sq. Ft. a. Coverage of Deck Area of Deck Divided By Area of Lot x 100 0 % % I attest to the best of my knowledge and belief, the above information is correct. chitect's Signaty e {3} 8112/2021 BUILDING DEPARTMENT VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 (914) 939-0668 IMPERVIOUS COVERAGE RATIOS RESIDENTIAL DISTRICTS Address: 9 Cuj rota VA. Section: 129,74 Bloch: 9 Lot: 3'� Zone: -/T IMPERVIOUS SURFACES (Definition): All buildings, as defined herein, and all areas on the ground or elevated above the ground which are comprised of materials through which water cannot readily flow, including, but not limited to asphalt, concrete, masonry, wood, gravel and clay, and which consist of elements including, but not limited to, court yards, sports courts, swimming pools,patios, sidewalks,ramps, terraces and driveways. TOTAL MAXIMUM PERMITTED MAX. PERMITTED COVERAGE Zoning IMPERVIOUS LOT AREA BY IMPERVIOUS SURFACES District COVERAGE IN FRONT (sq.ft.) For Base Lot For Lot Area YARD(%) Area (sq.ft.)* Over Base R-35 15 Lot Area % R-25 20 0 to 4,000 0 55 R-20 30 4,001 to 6,000 2,200 35 6,001 to 12,000 2,900 27 R-15 35 12,001 to 16,000 4,520 26 R-15A 35 16,001 to 20,000 5,560 25 R-12 40 20,001 to 30,000 6,560 24 30,001 to 40,000 8,960 23 R-10 45 40,001 & larger 1 1,260 22 R-7 40 R-5 30 *"Base Lot Area"is the minimum end of the lot size R2-F 30 range in the "Lot Area"column Area of lot: 1 GI s .ft. Existing Allowed Proposed Total impervious coverage = 3520 S .ft. 5 G 5-0 S . ft. 35'70 S .ft. Front impervious coverage = Z.(-' 4 % :55' % ZG•¢ % I attest to the best of my knowledge and belief, the above information is correct. rchitect's Signa e (4) 8/1 21202 1 BUILDING DEPARTMENT VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 BULK REGULATIONS IN RESIDENTIAL DISTRICTS Address: Al U nLt pio" to rok. Section: 1 Z.q, 7 A Block: I Lot: 3 8 MAXIMUM GROSS FLOOR AREA USE FORMULA: Maximum Gross Floor Area = 4,000 + [ (Lot Area —21,780) x 0.11478421 ]: a. Allowed = 3 3'?Cd Sq. Feet b. Existing = 3 5 9 Sq. Feet c. Proposed = 3 3 L Sq. Feet HEIGHT/SETBACK RATIOS FOR RESIDENTIAL DISTRICTS DEFINITION. A standard designed to regulate the height of a building in relation to the average grade of the corresponding portion of the lot line from which it is set back. The ratio modifies the maximum permitted Height of Building by forming an inclined plane beginning at the average grade along the portion of the lot line from which the setback is measured and rising toward the building at the specified ratio above which no part of any building, other than minor architectural features such as chimneys, skylights and dormer windows not covering more than 10%of the entire roof area, shall be permitted to extend. Height and Setback shall be calculated using the formula; Height_I Setback = X, where X is the required side or front yard ratio for the zoning district in which a property is located as specified in Article VIII of Chapter 250. A complete elevation view for the proposed improvement must be included on the drawings. FILL IN YOUR RATIOS: ZONE EXISTING PROPOSED REOU/RED FRONT: FRONT: FRONT: .44 R-35 SIDE: SIDE: SIDE: 1.20 FRONT: FRONT: FRONT: .48 R25 SIDE: SIDE: SIDE: 1.30 FRONT: FRONT: FRONT: .60 R-20 SIDE: SIDE: SIDE: 1.60 FRONT: .41 FRONT: .41 FRONT: .60 R-f5 SIDE: I,oI ��y� SIDE: SIDE: 1.60 FRONT: FRONT: FRONT: .80 R 15A SIDE: SIDE: SIDE: 2.40 FRONT: FRONT: FRONT: .69 R-12 SIDE: SIDE: SIDE: 1.60 FRONT: FRONT: FRONT: .80 R-f0 SIDE: SIDE: SIDE: 2.40 FRONT: FRONT: FRONT: .96 R-7 SIDE: SIDE: SIDE: 3.00 FRONT: FRONT: FRONT: 1.20 R-5 SIDE: SIDE: SIDE: 4.00 FRONT: FRONT: FRONT: 1.20 R2F SIDE: SIDE: SIDE: 4.00 1 attest to the best of my knowledge and belief, the above information is correct. chitect's Signatur (5) 8/12/2021 This form must be properly completed & notarized by the Design Professional of record and the Property Owner. Failure to provide tlus completed form with your permit application will delay the permitting procem D E C IE N E OCT - 2 2023 Notice of Utilization of Truss Type, Pre-Engineered Woo or Timber Frame Construction. (Title 19 Part 1264& 1265 NY GE OF RYE BROOK DING DEPARTMENT To:The Building Inspector of the Village of Rye Brook. From: Mnn G SC_ca.,r kr.,7 5 Subject Property: -4 � CoUy C9 . 74" 1 `3�J Zone: Please take notice that the subjject;,' One or Two Family; o Commercial, o New Structure o Addition to an Existing Structure r�Rehabilitation to an Existing Structure to be constructed or performed at the subject property will utilize; ❑Truss Type Construction(TT) lwFre-Engincered Wood Construction(PW) ❑ Timber Construction(TC) in the following location(s); Floor Framing, including Girders&Beams(F) ❑ Roof Framing(R) ❑ Floor Framing and Roof Framing(FR) Please note that prior to the issuance of the Certificate of Occupancy, the subject dwelling or building utilizing truss type, pre-engineered wood, or timber construction must be posted with a Truss identification Sign, installed in conformance with NYCRR §1264 for Commercial Buildings, and NYCRR§1265 for One&Two Family Dwellings. Sworn to before me this t l Sworn to f e me this duty of ,2� r ? day of , 20' Signature of Property Owner / signature,of Design Professional (V�'c�}i,�U���r,{1^•--,�, �1 I�I C�I z l�,1 I N`E.'� ,/�'1 n G ,S C�-r/:t.�-o ,J�"t� Print Name of Property Owner P n acne of Design Prorossi I Notart J jg<au an Notary Public NOTARY PUBLIC OF NEW JERSEY SHARI MELILLO My commission expires 3/i,Z 3 Notary Public,state of New York No. 01ME6160063 Quallfleci In Westchester countyn (7) won mission Expires January 29,20 BUILD MENT D ECENE D VIL �?i ` OOK 938 KING '' I ` NY 10573 OCT - 2 2023 VILLAGE OF RYE BR OK BUILDING DEPARTMENT Ar*+°r*x•k54+k�r*:h*:1•k�c:4:41t'A•*ir yN 7t it it#•hie'7r fF t it*ir*t*f4t•k•h 4r Yr***A7r************:Mtr**it iF'k***1k*tRlktk74*5k*********�4h*****•kYr****tF** 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: C0'nAr I' (Ienrwe 1Ar•a,n , residing at, 6roolc, (Prins Mime) (Address w3t�you live) being duly sworn, deposes and states that (s)he is the applicant above named, and fiuther states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; (Ay+nA-ty bz.L P -L Cf,ct-, , 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. (Signature of Property Owncr(s)) (Print Name orProperty Owoer(s)) _;26�,C Sworn to before me this Z 1 day of 20 c (Notary Publhwrence J Kaufman NOTARY PUBLIC OF NEW JERSEY My commission expires 3/-1/1'' (6) 8/1 21202 1 This application must be properly completed in its entirety by a N.Y. State Registered Architect or N.Y. State Licensed Professional Engineer & signed by those professionals where indicated. It must also include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void, and will be returned to the applicant. Please note that application fees are non-refundable. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: h� G SGc�✓ lw1;—�ing duty 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)lie is the for the legal owner and is duly authorized to make and file this application' (indicate architect,wwrac(or,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief, and that any work performed, or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention &Building Code, the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. By signing this application, the property owner further declares that he/she has inspected the subject property, and that to the best of his/her knowledge there are no roof drains,sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. 4 _ Sworn to before me this Z`i Sworn to before me this t day of `)z� , 20 13 day of '� , 20 l..3 Signature of Property owner Signature of Applicant n 1 0cwt i t o /fit" � -i jIM NL?�1[(l[ �}� �t �LYl4!_tCLJ Print Name of Properly Owner � Print Na ne of Applicant Notary Pu 1 NOTARY PUBLIC NEW JERSEY Ltcawrence J Kaufman NOTARY PUBLIC OF NEW JERSEY fly commission expires 317123 My commission expires 3/i,1 za (8) Sl 121202E O O N N O m N N ^ \ O a cn 00 � W a ] 00 wP4 00 O r+ � cQi� a W ao ►�W+ A let U a v W z ° v M Z _ O Z o \ 0,0 N O `" ts t W O (� C O Ln Ln 00 x u w w v' w00 O Q Q a '� w O o U Rr = O V '�' w z U4 cn z V A z go� wa. 00 C*N ►--� O W a A oo cn a Q cn zz 0 a osU a Z W z H o H o ° pW,, c� p o cn O O a d w V P $ x w W a. HI � a a z � w 0 � _ I r L BUILDII� �EPARTMENT -- , ! VILLAGE OF RYE BROOK ! 938 KING STREET RYE BROOK,NY 10573 F,, N - 5 2024 ) � \F�1 _ 1--- -- VILLAGE Of- P r E BROOK w ` or BUILDING r'--?IAE - Mw -NT ELECTRICAL PERMIT APPLICATION ��� Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: C"J EP#: Approval Date: Permit Fee: $ l �� 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. y 9 C©Un y ' t` q C ` L 1 — SBL: /C)9 7/ /— 3 /S 1.Address: �� � r (/p r Zoone: �- 2.Property Owner: 4 +1Ae W G i1 I 'r�n Address:p T ( �Dun� y R,'Sye e,'rc)e, Ate Phone#: Cell#: S a1 I OD 7 I email: 3.Master Electrician/Licensed Installer: m('C1 yq er/ �i+�'1 hcr✓rtta''J" f� Address: ?b �,f St'' ��a Lic.#: oL Phone#: 9I Y-FO(/-; / Cell#:�IY-!/OY-e 36 /email: C L14r�tIPC'IPLtr��L�� yrnk: .L Company Name: C k ztM 12 6 lectr,IG , ✓16 f Address: �O WeSt St, t ,r (fArr,'W,Ivy, it, 4.Proposed Electrical Work/Fixture Count: r"r S+ G n u 5 ecoJ I tv/- r f-rW yc-1"a" 60 hew 5.31 Party Electrical Inspection Agency: STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: J I Naij e) 41 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 /Yf,'c Arne Ztimf hH�a,t 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 W,,before me this Sworn to before me this day of OM-K �20 o day of .20 c Signature of Property Owner Signature of Applicant Pri Name of Property myj t Na/' / ALVIN BALCHAN Notary Public-State of New York NotRNERA NO.OIBA0008780 t4etary Pubiie,8 is of New York Qualified in Westchester County No.011116441398 My Commission Expires ay 31, 2027 10/30/2023 c-ninA Glion Exo es SePt berr 26,2 0, M STATE WIDE INSPECTION SERVICES, INC. 0•0 • • swis JOB APPLICATION0. • Office Use Elect. Permit# ) � _ . )ram S Date l ` 7 d 3 / Bldg Permit# ���- � `C�) D 9 S Ft Plumbing Permit# Final Certificate# City/Village P K �/ �+( � zip i©j 14 7-T auming Dept. V,A,!y County Address 00 or Cross Street Section Block Lot Owner Name/Address(If different than above) m r,I Contact Number S !I _ b 9 7 ❑Basement ❑ 1st Fl. ❑2nd FI. ❑3rd FI. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/0 Detector Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels 1P 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 ❑ Safety Inspection ❑Consultation G JAN -5 2Q4 IL VILLAGE OF RYE BROOK i BUILDING U-, RTM-N 1 li 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 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. c'1 Email Address L�nLAVn13 !tL- -f ( lJ 1��'�' I . C0,�/�1 Name 0, I �e G ►�� �1�GtTC License# d-Q q Date ` ) � Signature - Address ,? \4f'7" A 1 1 ` City/State �.1 r r n Zip Code 0 a Company V\ ? 1 f c+ ' G. Phone# 11111 State Wide Inspection Services SEP 3 0 2024 1080 Main Street Fishkill, NY 12524 VILLAGE OF RYE BROOK 845 202-7224 Phone BUILDING DEPARTMENT 914-219-1062 Fax STATE WIDE INSPECTION SERVICES Email: oI I ice(Q swisny.com Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Champ Electric Matthew& Danielle Gilman Michael Zambernardi Jr 49 Country Ridge Circle 70 West Street,Apt B11 Rye Brook, NY 10573 Harrison, NY 10528 Located at: 49 Country Ridge Circle, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 24-005 129.74 1 38 Certificate Number: 2024-6734 Building Permit Number: BP 23-208 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: 49 Country Ridge Circle, Rye Brook, NY 10573 The First Floor: Dining Room, Family Room, Kitchen, Livingroom, Mudroom Second Floor: 3 Bedroom(s), Laundry Room, Master Bathroom were inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below, was found to be in compliance on the 26Th day of September 2024. Name Quantity Rating Circuit Type Kitchen GFCI 02 Microwave Circuit 01 Compactor Circuit 01 Refrigerator Draw Circuit 01 Dishwasher Circuit 01 Gas stove/ Hood Circuit 01 Refrigerator Circuit 01 Bathroom GFI Circuits 01 Washer Circuit 01 Gas Dryer Circuit 01 Laundry Room GFCI Circuit 01 Luminaires 58 Light Fixtures 12 Name Quantity Rating Circuit Type Light Switches 50 Exhaust Fans 03 Receptacles 35 Garage GFI Circuit 01 Garage Door GFI Circuit 01 Floor Heat Circuits 02 Smoke/CO Combos 04 Smoke Detectors 04 Exterior GFI Receptacles 03 Ring Camera Spotlights 04 Arc Fault Breakers 11 20AMP Arc Fault Breakers 08 15AMP Breakers 06 20AMP 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. Page 2 N C 00 :a z w u Cl) Q a U 0.0 0 x c O = w Cl) W " w 00 en S f� oYj z A ; z �--4 VL 00 ` zLwz NCA w ° v' C:D O P--� � z ti W oc r �'` z � N r O w V rV•� w r Uz cn z (> 0-4 GN u 0 f Y j z 00 a cn CP z A � i �.-4 04 o H U oz U V W Z w r C H o ° � 0 � P-4 64 � � x z w z Q od H a �yEC1RC��� D F� !� � V BUILDING DEPARTMENT VIL"GE OF RYE ROOK FEB 2 0 2024 938 KING}S'rUET RYE BipgK,NY 10573 VILLAGE OF RYE BROOK ' BUILDING DEPARTMENT M�yW 'Qok org PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: PP#: Approval Date: Permit Fee: $ �0 Approval Signature: Disapproved: (tees 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, �" 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. / D 1.Address: AIJt /C e i/� �v/� �SBL: 2.Proposed Work: IlN'c7�f //off /U>F- rfra�, t'�c�� /jrfA /SaIJ-"y / 3.Property erlq •� a tiK/r y �" �i //�fSti Address: � �O(r/-��r �iGf� (rc- /r Phone# S t;r �� d�7Z Cell#: G _C 0 97-:1 email: 4.Master Plumber: ( 7�/ �j✓ Address: Lic.#: (�Z� Phone#: _e Cell#: Z g�� email: V (��u(vl w>> M t c 5 y,cC y�5it , c� v� Company Name: A�J Q►r''i b i �d �t� c . Address: C_(. ffi�,r c- 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 I st Floor rep r �(� 2nd Floor I l Fik- 3`d Floor 41 Floor 51 Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -t- �� P, � 3/3no23 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: being duly swom,deposes and states that he/she is the applicant above named, (print name of in-J dividual 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 00 Sworn to bef re me this day of rtlerr� ,20 day of 20 Signature of Property Owner Signature of Applicant �i tit lJ m l%t I� /���Qr U✓J--1 Print Name of Property Owner t Name of Applicant ,--� Nota Public No OiW MELILLO notary Public,State of New York No.01ME6160063 Qualified in Westchester County- , Commission Expires January 29,2061 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. Morgan Mae Hart Notary Public State of Vermont No.157.0015259 Commission Expires 1/311 z,5 -2- l05won p EC ENE BUILD y TNIIXNT 3D ' ~ E BROOh FEB 2 0 2024 938 KING S_rREET: . . NY 10573 (94) _ ' -�` VILLAGE OF RYE BROOK � •' BUILDING DEPARTMENT 1%I w.r a �re - Vu �. 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 WESTCNESTER ) as: A�f4' ( �(mg ►.j ---,--, residing at, CcA_1,_� r ( _ (Print name) (Address khcre 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; Rye Brook,NY. (.lob A ress) _ Further that all statements contained herein are true,and that to the best of his/her knowledge and belief, that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. (Signature of Property Oemer(s)) -- - (Print Name of Property Owtler(s)) Sworn to before me this- 20 _ Morgan Mae Hart day of f�y,,� ,20 ay Notary Public State of Vermont No.157.0015259 Commission Expires 131/L6 (Notary Pu f ` -3- 9/12/2021 = s� zl •� s • s s ^ Vi M 3 _ Lin rl V N N `e i � O N _ f 1 z am. Ls. 00 -Sp 73 0 0 oc en W v u W < ° o c. c ' a un ,. . Y z z o W P4 z z W w , aw 4.0 op zIt W o A - 2 R ►--, ai E 1, p o e R u w w E-r c z zo Y Ln I R 7 p96 Y CN z w z a o >- ; . � w o CA A Q c E° �, C• oa .D 94 :1 e BUILDING DEPARTMENT VILLAGE OF RYE BROOK OCT 1 1 2024 938 KING$TR ET RYE BROOK,NY 10573 V L4)939-0668 wyVW.ryebrookny.Lov T APPLICATION FOR PERMIT TO INSTALL AND/OR REMOVE HEATING, VENTILATION AND/OR AIR CONDITIONING EQUIPMENT FOR OFFICE USE ONLY: PERMIT#: AMC) Approval Date: 1 O - I S- Zo =-y` Permit Fee: $ Approval Signature: �` �1 �� Other: 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 REQUIREMENTS FOR RELEASE OF PERMIT&CERTIFICATE OF COMPLIANCE: 1. Properly completed& Signed Application. 2. Site/Staging Plan if Required by the Building Inspector. 3. Copy of Licensed Contractor's Liability Insurance. (Village of Rye Brook must be listed as certificate holder)& Workers Compensation Insurance on a NYS Board form (Form#C 105.2 or Form#U26.3/or NY State Workers Compensation Waiver) 4. Payment of Fees/Unit: RESIDENTIAL=$150.00/unit• COMMERCIAL=$450.00/unit. 5. Complete specifications for each unit being installed. 6. Inspection by the Building Department for removal and/or installation.(48 hour notice required 7. Electrical work requires a separate Electrical Permit& Electrical Inspection. 8. Plumbing/Gas work requires a separate Plumbing Permit& Plumbing Inspection. ************************************************************************************************* Application dated, is hereby made to the Building Inspector of the Village of Rye Brook for a permit for the installation and or removal of the HVAC equipment as listed below.The applicant and property owner,by signing this document agrees that said equipment will be installed and/or removed in conformance with all applicable Local,County,State&Federal laws, codes,rules and regulations. 1 {� 1. Address: 14 9 1^r3 oil I r!� (RIAe - it C(Q SBL: 12Q'. 14 1 3 9 Zone: 2. Property Owner: HrAfj h e.o . C i ll Mr.n Address:�1/T��,a Q,t ae t r c Phone#: `S/b S2y olgU Cell#: email: 3. Contractor: ITV-& ( !AcAc%\ �n %0 . CAJ Coo y,A LLC Address: 7_4S kkki�,61" to S�' Phone#: 44d q 2p 1% Cell#: email: 4. Scope of Work:New Installation( )•Replacement( )•Removal( )•Other( ): 5. List Equipment: —T nPLL3 tr,41 e��r �v 4ie I,Jchert nn i 1l `` sKJ� GJ1Qu�• � eUf ,,� �1ine �rJJ'1 �t �ChQV1 �J D )l���Q 6. Location of Equipment: 7. Method Of Installation/Removal(list all equipment needed to perform job): 1 6/l/2024 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 Heating,Ventilation and/or Air Conditioning Contractor 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 Sworn to before me this day of ,20 day of 20JI Signature of Property Owner Signature of Applicant a4Jt#J-J Lqe% 44.[ - Print Name of Property Owner Print Name of ApplVeant z Notary Public Notary Oftc GREGORY M.RNERA Nobily Public,State of New York No,01RI6441398 Qualified in Westchester County n/ 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. 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. z 6/l/2024 N W ■ N N .:I T CL� :t s r \ \ W x � � ' • e � I !tILILn Fil �, _ OC V � E o cr _. cr _ 0-4 cr wCN — PO _ � E 1-4ci S^ f t uU. wo oyE ff V o v fin cc 7 - _ ='� �����i�il�l����r��ii�il�ii�i��"r�l� ii ii�=■�� �I�ii�il���l�il�ii�l��a���i� ��'�r =' VILLAGE OF RYE BROOK FFSEP � � �V/[E D BUILDING DEPARTMENT 00 2024 938 KING STREET,RYE BROOK,NY 10573 (914)939-0668 4-0'0brooknv.cy_ VILLAGE OF RYE BROOK BUILDING DEPARTMENT APPLICATION FOR PERMIT TO INSTALL, MODIFY AND/OR REMOVE MECHANICAL EQUIPMENT OFFICE USE ONLY: Q� >��J BP23-208 ` / / Fred Devito Permit#: Building Inspector: Application Fee: Date of Approval: J O— I — 240 Z�{ Permit Fee: !�/�6 Bldg/Use Class: Res. ( ); Comm. ( ); DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BV 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 REQUIREMENTS FOR RELFASE OF PERMIT: (ACER IFICAreorCOMPLIANCE isRf:Quuzeo roCLosE:OurTnis Pi.KMrr) 1. Properly Completed & Signed Application. 2. Payment of Application Fee: Residential =$100.00; Commercial =$250.00 (fees are non-refundable) 3. Site/Staging Plan as required by the Building Inspector. 4. Sealed Construction/Installation Documents& Specifications as required by the Building Inspector. 5. Copy of Licensed Contractor's Liability Insurance. ivillaee orRYe Brook must he listed as certificate holder) & Workers Compensation Insurance on a NYS Board form 6. Payment of Permit Fee: Residential =$18.00/1000.00 of Construction/Materials Cost with a minimum fee of$150.00. Commercial =$25.00/1000.00 of Construction/Materials Cost with a minimum fee of$275.00. 7. Inspection by Building Department for removal and/or installation. (48hourno,;cereguired) 8. Any electrical work requires a separate Electrical Permit and Electrical Inspection. 9. Any gas/plumbing work requires a separate Plumbing Permit and Plumbing Inspection. Application dated, 08/30/2024 is hereby made to the Building Inspector of the Village of Rye Brook,NY,for a permit for the installation,modification,and/or removal of the specific Mechanical Equipment as listed below.The applicant and property owner,by signing this document agrees that said equipment will be installed and/or removed in conformance with the approved plans,and with all applicable Local.County,State& Federal laws,codes,rules and regulations. 1. Address: 49 Country Ridge Circle SBL: 129.74 1 38 Lone: 2. Property Owner: Matthew Gillman Address: 49 Country Ridge Circle Phone#: 516-524-0871 Cell#: 516-524-0871 email: matthew.l.giliman@gmail.eom 3. Contractor: DKG Legacy Heating & Cooling LLC Address: 345 Washington Street Phone#: 347-784-2013 Cell#: 347-784-2013 email: monjevinny@gmail.eom 4. Scope of Work: New Installation(V. Replacement( )-Removal( )•Other NJ 5. Type of Equipment: ajocu�g_ p g2i r u� e y 6. Location of Equipment: ,'t> 6 o f 7.Cost of Equipment including Installation Cost: $ 7 V)() 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 Mechanical Equipment Contractor 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 Rve Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn to before me this day of ,20 day of In 20 Signature of Property Owner Signature of Applicant a-I0-3 Pik,- Print Name of Property Owner Pri Name ot'Applicant Notary Public otary is ts0 RNERA Notary PublIc,State of New York No.01R16441398 Qua0 W In Westchester Counk�ture(s) This application must be properly completed in its entirety and RIMY" Ramtomh�� 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. 2 6/1/2024 HUNTSMA dation Certif icate APR 15 2024 $4B U I L D I N G S O L U T I O S Iosed-Cell Spray Polyurethane Foam info VILLAGE OF RYE BROOK BUI-DING DEPARTMENT This form must be filled out and posted to comply with building code requirements. Meets IRC Chapter 11 Energy Efficiency Requirements and IECC Chapter 4, Commercial Energy Efficiency Requirements. The following spray polyurethane foam product(s) has/have been installed. ❑ Heatlok HFO PRO 2.0-2.4 Ibs/ft3 IAPMO LIES ER-0565 Heatlok HFO High Lift 2.0-2.4 Ibs/ft3 ICC-ES ESR-4073 ❑ Heatlok XT High Yield (s) 2.23 Ibs/ft3 ICC-ES ESR-3824 (w) 2.17 Ibs/ft3 ICC-ES ESR-3883 U Heatlok XT High Liii (s) 2.23 Ibs/IV ICC-ES ESR-3824 (w) 2.17 Ibs/ft3 ICC-ES ESR-3883 ❑ Foam-Lok 2000-4G 2.0-2.2 Ibs/ft3 CCRR-1025 ❑ Foam-Lok 2000-3G 2.0-2.3 Ibs/ft3 ICC-ES ESR-450"I ❑ Foam-Lok 2000 2.0-2.3 Ibs/ft3 ICC-ES ESR-2629 ❑ Proseal HFO 2.0 Ibs/ft3 CCRR-1108 ❑ Proseal LE 2.2 Ibs/ft3 ICC-ES ESR-3500 ❑ Proseal 2.2 Ibs/ft3 ICC-ES ESR-3500 ❑ Heatlok Eco 2.0 Ibs/ft3 ICC-ES ESR-3198 Consult International Building Code, Chapter 26-Plastic and International Residential Code (IRC) R316 Foam Plastics for specific requirements.The spray polyurethane foam insulation system(s)has/have been installed in accordance with manu- facturer's processing guidelines to provide a thermal resistance of: Area Insulated Aged R-Value Thickness" Vented Attic Floor Area R- At inches Unvented Attic/Under Roof Deck Insulation R- At inches Sloped Ceilings/Cathedral Ceilings R- At inches Walls (Location: ) R-'2:)�, At 3 inches Walls (Location: ) R- At inches Floors(over an unheated crawl space) R- At inches Crawl Space Perimeter R-\� At inches Basement Walls R- At inches Other(Location: ) R- At inches `"Nominal thicknesses are representative of field,spray-applied foam material. Jobsite Address: 49 Country Ridge Cir Rye Brook NY Date of Installation: 03/14/24 Building Contractor: Icon Remodeling HBS Contractor: Hudson Insulation of NY Phone: 347-7284184 Installed By: Adelson Castro / Jose Victor Garcia -Post Near Electrical Panel- BUILDING SOLUTIONS Dpen-Cell Spl"ay Polyurethane Foam This form must be filled out and posted to comply with building code requirements. Meets IRC Chapter 11 Energy Efficiency Requirements and IECC Chapter 4, Commercial Energy Efficiency Requirements. The following spray polyurethane foam product(s) has/have been installed. ❑ Sealection 500 0.45 Ibs/ft3 ICC-ES ESR-1172 (CCRR-1063) ❑ Sealection NM 0.55 Ibs/ft3 ICC-ES ESR-2668 ❑ Foam-Lok 450 0.45 Ibs/ft3 ICC-ES ESR-4242 (CCRR-1091) L] Foam-Lok 500 0.45 Ibs/ft3 ICC-ES ESR=4242 ❑ Foam-Lok 750 0.70 Ibs/ft3 ICC-ES ESR-4322 ❑ OC No-Mix 0.50 Ibs/ft3 CCRR-1123 ❑ Classic Ultra Select 0.50 Ibs/ft3 ICC-ES ESR-1826 ❑ Classic Plus 0.70 Ibs/ft3 ICC-ES ESR-1826 ❑ Classic Ultra 0.50 Ibs/ft3 ICC-ES ESR-1826 ❑ APX 1.2 0.45 Ibs/ft3 ICC-ES ESR-3470 ❑ Agribalance 0.70 Ibs/ft3 ICC-ES ESR-2600 Consult International Building Code, Chapter 26-Plastic and International Residential Code (IRC) R316 Foam Plastics for specific requirements.The spray polyurethane foam insulation system(s)has/have been installed in accordance with manu- facturer's processing guidelines to provide a thermal resistance of: Area Insulated Aged R-Value Thickness" Vented Attic Floor Area R- At inches Unvented Attic/Under Roof Deck Insulation R- At inches Sloped Ceilings/Cathedral Ceilings R- 3 0 At inches Walls (Location: ) R- At inches Walls(Location: ) R- At inches Floors (over an unheated crawl space) R- At inches Crawl Space Perimeter R- At inches Basement Walls R- At inches Other(Location: ) R- At inches ""Nominal thicknesses are representative of field,spray-applied foam material. Jobsite Address: 49 Country Ridge Cir Rye Brook NY Date of Installation: 03/15/24 Building Contractor: Icon Remodeling HBS Contractor: Hudson Insulation of NY v _ _ Phone: 347-7284184 Installed By: Adelson Castro / Jose Victor Garcia -Post Near Electrical Panel- �\4Eglk0Or fF I 2 in oi Coatin 9 Description c, tip, ,' � /~ � • • r DC315 is a single component, water based intumescent coating tested to meet Building Code requirements for the fire protection of for Spray Polyurethane Foam (SPF). Tested and evaluated in the USA by UL and ICC-ES, and in Canada by ULC and CCMC. DC315 is fully AC456 Compliant and satisfies the International Building Code(IBC), International Residential Code(IRC), National Buiidi ,g Coda ol and many ocher National and 'N:`-_ International building codes. DC315 offers more tested systems to meet interior thermal and ignition barrier requirements AND DC315 has been tested as a component of exterior wall systems in accordance with the NFPA OG315 285 and meets IBC Section 2603.5 with various architectural cladding options. The Choice is clear: DC315 is the most tested and approved fire �_��,,,�, �a protective coating for SPF insulation on the market today! - DC315 Tested Solutions for Spray Polyurethane Foarn •More certified full scale alternative Thermal and Specifications: Ignition Barrier tests over SPF Finish: Flat •Code Compliance Evaluated by ia'R4lr Fl?-499 and- Color: Icr.-Grim;Vhite and fharcoat Biack ICC-ESR 3702 for the USA market -- -- 10.2 d't TVGC •Code Compliance Evaluated by Cr:MC f040:,6-l-, and V.O.C.: ULC ER39793 for the Canadian market 16.6`git VCC Less Water •NFPA 285 Tested and Listed by UL File_R40016 as a Volume Solids: 5'J1 component of exterior wall systems with various Drying Time: 10 ioucir. 1-2 hours architectural claddings at 7' F K 5036 RH le:coat G to o hours -DC315 manufacturing facilities are 3rqj?arty_Listcd and Inspected Type of Cure: LA,)I6SCenCe -Tested useful life, fire performance not compromised Flash Point: fdnne after 50 years. Reducer/Cleaner: :'.'atcr -Topcoat for color, weather and moisture protection, Shelf Life: 1f %G months(unopened) tested full scale via NFPA 286 -ANSI 51 testing for incidental food contact Packaging: 5-S 55-yatlen containers •Passed CA-t a,O-qualifies DC315 as a low-ernitting 5-g�rtlon i:a+l- '38 ihs. material for LEEDS and Green Building standards Shipping weight: ,r-54 t•wi(or:drum- 64(]tbs. -Passed strict EPA—VOC and AQMD air emission requirements Application: brush,roller,airless spray •No formaldehyde, RoHS -"Single Coat Coverage"on walls and ceilings QAI Listed: fih 111? -Meets Life Safety Code NFPA 101 ZNAOx I T CCMC C VAlV AT10N U CCA' u.. :.-1�..,...i Abt2l,!*0#"W.K y 4 L approved with as Thermal or ignitioll !-.-arricrs. L$f 1-ocit? the 1:)y 15-r-ninute tio;iiii;ii h-iiii-!f .,pfll +* certi ,d NFPA 286 testino over llfl iis. (his finished assi rnt7ly testing. conducted by IAScettffied tCstillg lacilitles, VOth th(+� I`U(II.Jirernents ofi-1012 IRC' Section 803.12 and Section 26013.10. 2015 1RC &3ctioll i3(10 sfwtioll 303.1. Alternative Ignition Barrier Assemblies: DC 31,15 meels the r0Q,L11rertionts for ic.!ntiori barrier protection in linaccutpied spaces, as per AC 377, Appendix X. Exterior Wall Systems. DC315 has been tested a",a corripollent of exterior &-cdi sybl.ums in accordance with lkha NFPA 285 and meets 2015 IBC Section 2603.15 with various ar0lill,citiral cladding options- ! ..... I .t, . National Building Code of Canada: DC315 prevents flashoverfoi 10 minutes for Combustible Construction or 20 minutes for Non-Corlibustible constniction " ion tested to the CANil-11-C S-145 Stendard-This testing has beeti.4ho\Ain to exceed the. protection of CANIULC S-124 tested materials and n,.ec.-ts the Intent of NBC Section 3.1.5.12 for the protection of foamed plastics. European Union: DC315 has been tested over both medium density and low-density spray polyurethane foam and provides all EN13501- 1 Fire Classification of B-S2-D0. Australia and New Zealand: DC315 has been tested to the AUS ISO-9705 standard over spray polyurethane foam and meets Group 2 Classification. IS05660(part 'I and 2)tests confirm Group number classification as 1 which allows for the audition of the thermal barrier coating to upgrade the fire rating Of the Underlying spray foam. END USE APPLICATIONS: DC315 is designed for interior conditioned spaces.It is the responsibility code and inspection authorities, architects, specifiers, contractors. installers or any end user Of IFTI products to Contact IFTI to discuss their application to ensure it compiles with manufacturers recommendations and meets their intended end use. The Use of topcoats, though not required to meet the fire rating, may be Included as part of tile overall system to address specific conditions required for the project and address use in specified conditions such as, but not limited to, exterior wall systerns, cold storage, parking garages or high humidity environments. Testing USA • ASTM E84-Flante Spread 0 Smoke 10 AustralialNew Zealand AUS ISO 9705 • NFPA 286-Complies with Acceptance Criteria of IBC/l!`-,C . AS/NZS 1530.3 4• ASTM E2768-30-minute Ignition Resistant 1 AS 5637.1 Group Classification 2, NZBCviaterial Group 2-S • NFPA 285-Exterior VVall System with various claddings ISO 5660 Parts I and 2 Canada 5 Physical Properties Testing CANIULC S102-FSR 0 SOC 2 CANIULC S 101 -- up to I In r assembly rating ASTM D522 Flexibility.Mandrel Bend ASTM D4541 Adhesion pull off strength CANIULC 9705- 10-and 20-minute testing ASTM D4585 Moisture resistance for 100 hours CANIULC S-145-20 Minute Rating ASTM D4587 I ASTM G154 Accelerated kNeather QUV 1000 hours European Union ASTM D3359 Tape Adhesion • IRS 476 Part 6 & 7 ASTM D2486 Scrub Resistance BS EN ISO 11925-2 ASTIVI E661 Durability, Impact.Concentrated • EN 13823 load • EN 13501 Classification B-S2-dO International I-reproof Ilechili Inc. Ulleinatintial I'llreproof Tedmology,Inc, cc,Q49-975-81,88 A e I llimate he Fievop&dn do.�nor!I*ir I 1-favi,e 1�528 Von Kdmianhe,IMne,CA92614 Wi po* Rev.101129/2020 Email:ptp@paintioproteGt.com /4c/V,sed COi�-�✓a L� � — ve -Building Permit Check List 8t Zoning Analysis 1 q Address: 1 e [ SBL 2 I o Zone:=- Use- ��t Const.Type. U Other. Submittal Date: �VZ 2evis' Submittal Dates: Applicant:—_ ���"" • r� C ". — C Nature of Work n�-�1(�U�" QCA-t'tc1 Reviews:ZBA Q C T (L��� - BOT• Other. K ( ( FEES:Filng P. C/O. otscT Plane: Legalizatiorr. ( ) (.)-'Arr: Dated: otarized: SBL: Tn.I.D. Cross Connection: H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Stone Water Review: Street Opening ( ) ( ) ENVIRO:Long. Short: Fees: N/A: ( ) (�SITE PLAN:Topo: Site Protection S/W Mgmt.: Tree Plan: Other: ( ) (�SURVEY:Dated: Current: Archival: Sealed Unacceptable: ( ) ( S:Date Stamped Sealed Copies:: Electronic. Other: (�' ( License: ✓ Workers Comp: ✓ Liability: ✓ Comp.Waiver. Other. ( ) ( ) CODE 753#: 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. (✓Y ( ) PLUMBING:Plans: Permit Nat. Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans:_ Aermit: 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. mtg. date: 'O pprovab notes: ( )ZBA mtg.date: approval• notes: ( )PB mtg.date: approval• notes: RE01 JIRE EXEMN PROPOSED NOTES C1 l M N c ar. AP = & _ `V I • K Q r FF -1 ZC 2 (--4C O c a e: Fronc - L Front: sRAW Ne F Main Cor,—lam_ —12,G o IS Accs.Cor i d`h i Ft.H S : r it:.Uj rt;C,"; Sd.H Sb: ELhn Height/Stories - notes: BUILD r. M MENT D F CC � �V F VIL :+ul =f OOK ;.. � 2 DD 938 KING f $, ,NY 10573 OCT — 2023 VILLAGE OF RYE BROOK BUILDING DEPARTMENT ARCHITECTURAL REVIEW BOARD CHECK LIST FOR APPLICANTS This form must be completed and signed by the applicant of record and a copy shall be submitted to the Building Department prior to attending the ARB meeting. Applicants failing to submit a copy of this check list will be removed from the ARB agenda. Job Address: A q 6c� [z i06-P— C \rc�Le_ Date of Submission: Parcel ID#: —1 —3 Zone: Proposed Improvement(Describe in detail): (Le+l•o,wa;-Ron of ) orne.� qaw k I fie, ape, U, r-ct,.,.,,y rim APPLICANT CHECK LIST: n4,,,,rr,ca) My" 1=,bm purr oe 6aA-14— 14e,,o tneeik,-84%, MUST BE COMPLETED BY THE APPLICANT a» The following items must be submitted to the Building Qn)2�c(L�co. � � -1 �— Department by the applicant-no exceptions. Property Owner: In cyVAjj P—w t -Dctn i r-k •e 6111 Gn 1. (,,I Completed Application i , t p� 2. ( ,Ytwo(2) sets of sealed plans. (one full size {maximum Address: 9 !�� y 1 .QWe. , f 'i-e. ormir- >Uy allowable plan size=36"x 42"1 and one I 1"x 1 ") Phone# 'Y / G 3. ( .,fTwo (2)copies of the property survey. 4. ( )Two(2)copies of the proposed site plan. Applicant appearing before the Board: S. One electronic/disc copy of the complete tin G Sc�rt� �� application materials. 6. Filing Fee. Address: 33 23i Timm H'0 t 72rD , Af0riun ir,Lq 7. ( )Any supporting documentation. Phone# `( /-4 Z,'7 3- ?3S-0 /oS 8. ( )HOA approval letter. (ifapplicable) 9. (-f Photograplis. Architect/Engineer: 5 4rhe- a S AS6 , 10.( ) Samples of finishes/color chart. (a sample board or Phone# model may be pt esenied the night of the meeting) By signature below, the owner/applicant acknowledges that he/she has read the complete Building Permit Instructions& Procedures, and that their application is complete in all respects. The Board of Review reserves the right to refuse to hear any application not meeting the requirements contained herein. ,,'' � I� Sworn to before me this 1-i Sworn to before me this Gi day of �� , 20 -L day of , ZO "�3 Signature of Property Owner Signature of Applicant pCwell� 6,,,1 iocvjrncC-10� Print Name of Property O ner Print Name of Applicant 4, 4\ Notary Public ail man Lawrence J Kaufman lli NOTARY PUBLIC OF NEW JERS NOTARY PUBLIC OF NEW J� SEY My commission expires 3/i L� My commission expires 3� l 8/12/2021 ���- 13R Village of Rye Brook ML MR <1 enda FB SE Architectural Review Board Meeting AC SF "vJ`v C_�t 4 Wednesday,October 18,2023 at 7:30 PM Village Hall,938 King Street J 1. ITEMS: 1.1. ARB23-113 (Consent Agenda) Jesus Gonzalez&Beatriz Gonzalez 505 Franklin Street Rooftop solar array. 1.2. ARB23-114(Consent Agenda) Muharrem Deliallisi&Raimonda Deliallisi 26 Valley Terrace Rooftop solar array. 1.3. ARB23-115 (Consent Agenda) The Concepcion Revocable Family Trust 38 Hawthorne Avenue Black aluminum fence and gate. Consent Agenda Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.4. ARB23-116 Michael Holmes&Patricia Holmes 34 Hawthorne Avenue In-ground swimming pool&black aluminum picket fence. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes Page 1 of 3 Architectural Review Board October 18,2023 1.5. ARB23-117 Matthew Gillman&Danielle Gillman 49 Country Ridge Circle Exterior elevation changes,interior renovations and renovate rear patio. Approvals: Motion rn a— Second � Abstention Aye; _ Nay; V Adjournment; Notes 1.6. ARB23-118 Amelia Irizarry 6 Lincoln Avenue Remove rear window and door. Install new slider. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.7. ARB23-119 Adolfo Waisburg&Mariela Cohen Sabban 63 Talcott Road Exterior elevation changes and interior renovations. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.8. ARB23-120 Jordan Sedler&Roberta Sedler 10 Elm Hill Drive Relocate side door,new steps and interior kitchen renovation. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes Page 2 of 3 A • Architectural Review Board October 18,2023 1.9. ARB23-121 2 Elm Hill LLC 345 Betsy Brown Road Single family dwelling. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.10. ARB23-122 Hidden Falls Homeowners Association Hidden Pond Drive,HOA Common Area Replace tie wall with Redi-Rock wall. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes NEXT MEETING: November 15,2023 Page 3 of 3 JOHN G. SCARLATO JR. ARCHITECT 33 Byram Hill Road Armonk, N.Y. 10504 Phone: (914) 273-7350 Fax: (914) 273-9222 JGSCARLATO@a GMAIL.COM 10/18/23 Building Department Village of Rye Brook 938 King Street Rye Brook,NY 10573 RE: 49 Country Ridge Circle Siding Hardie Artic white Clapboard Trim Azak or Equal composite White Columns White azak Roof shingle existing timberline 40 year black color Metal roof silver gray Portico floor Blue stone Stucco paint light slate gray Globe Electric Hurley Black Modern Indoor/Outdoor 1-Light Wall Sconce (269) v Questions&Answers(56) r i r a Hover Image to Zoom LNC (Brand Rating: 4.5/5) Matte Black Rustic Outdoor Hanging Lantern, Mini Farmhouse 1-Light Square Outdoor Pendant Light with Seeded Glass Shade * *y1 00) v Questions&Answers(3) _1 Hover Image to Zoom JOHN G. SCARLATO JR. ARCHITECT 33 Byram Hill Road Armonk, N.Y. 10504 Phone: (914) 273-7350 Fax: (914) 273-9222 JGSCARLATO@GMAIL.COM 9/23/24 Steven Fews Building Inspector Village of Rye Brook 938 King Street Rye Brook, NY 10573 Dear Steven: RE: 49 Country ridge circle Enclosed are one 24 x 36 and 11 x 17 set of as built drawings for the Certificate of occupancy. This reflects some items omitted because of cost and structural additions due to site conditions during constriction. If you have any questions or need anything else, please give me a call. Thank you for your help. REVISED Sincerely, -- ; PLANS SEP DATED: OK John G. Scarlato Jr. BU� CEPAfe i NAENT BEARINGS SHOWN HEREON ARE BASED ON MAP NI 14$34 SYMBOL LEGEND C IVA m'. E:3 0Ir Jlz=1 In vat DZY04113 a &"'D- A 1V r!(q C­- PLXF PLtTrm c�0/1 Cl 7A.N -Illc ac upasun mm W CF Un Fif 1.07' 77 TAX LOT 44 jr'5q6 FA[LOT n TAX LOT 37 '-Nlot O 40" 1466"' fo FM LOT 28 TAX LOT 38 LOT le TAX LOT 5 6if cw 2 pw n w _zT CQ 1!! )rm r 19 AZ1 1 4 007 150.24' S87'09'50" Im f-� T C) FAf 1.07 27 TAX LOT 39 OCT 2 2023 COUNTRY RIDGE DRIVf (50' WIDE) VILLAGE OF RYE BROOK � BUILDING DEPARTMENT GRAPHIC SCALE 0 0 w E GUARANTEED TO: 7TLE NUMBER: LT-307C3-NY-S LOT AREA .A,Ew CILLMAN MO DMIELLE QLLMANI �%� MTRUST TITLE INSURM COMPANY( IN FEET ) WORDWIDE LAND TRANSFER,INC I inch = 30 ft. S CA L I C E SURVEY OF PROPERTY 49 COUNTRY RIDGE CIRCLE RYE BROOK, NEW YORK 1057� -Vey LOT 28, BLOCK M a n d I s Ll I In SUBDIVISION MAP OF g COUNTRY RIDGE ESTATES mjslcndsurvey.com P:631 —957-2400 SECTION 13 1 South Bay Avenue, Ishp, NY 11751 FILE DATE: 11/18/1964 MAP NO 14134 SITUATE DR.:M C CREW:JG SCALE: I" = 20'I VILLAGE OF PORT CHESTER I TAX MAP NO. DATE SURVEYED:06/29/2023 JOB No W23-22951 129 74-1-38 TOWN OF RYE WESTCHESTER COUNTY, NEW YORK Laura Petersen From: jgscarlato@gmail.com Sent: Tuesday, October 24, 2023 2:02 PM To: Steven Fews; Laura Petersen Subject: 49 country ridge circle Steve and Laura Estimated construction cost for the project is $ 250,000.00 they are still to pick the final contractor and they did the application contract vendee at this time the c osing date is 12/14/23 The seller is moving into a new condo it was to be done in November but it got pushed back. Best Regards, John John G. Scarlato, Jr., Architect 33 Byram Hill Road If Armonk, New York 10504 _ 0: (914) 273-7350o.� .� jgscarlatoCa)gmail.com www.scarlatoarchitects.com /_ L/ , 41 I 0 /2�ZOSS nn rc•,.o d e 11'4 -o _ G o evk V i —Bargain and Sale reed,with Covenant against Grantor's Acts—Individual tx Cotporalim(Single Shcct I CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT—THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY. THIS INDENTURE,made the 14th day of December,in the year 2023 BETWEEN Sherry Salzman,as surviving tenant by the entirety with Alan H.Salzman,deceased 49 Country Ridge Circle Rye Brook,NY 10573 party of the first part,and Matthew Gillman and Danielle Gillman,husband and wife 9 Holly Lane Rye Brook,NY 10573 party of the second part, WITNESSETH,that the party of the first part,in consideration of Ten(S 10)dollars paid by the party of the second part.does hereby grant and release unto the party of the second part,the heirs or successors and assigns of the party of the second pan forever, ALL that certain plot,piece or parcel of land,with the buildings and improvements thereon erected,situate,lying and being in the See Schedule A SAID premises also being known as Section 129.74, Block 1,Lot 38 on the Official Tax Map of the Town of Rye in the Village of Pon Chester. SAID premises being and intended to be the same premises as conveyed in Deed recorded in Liber 6756 CP.190. TOGETHER with all right, title and interest, if any, of the party of the first part in and to any streets and roads abutting the above described premises to the center lines thereof;TOGETHER with the appurtenances and all the estate and rights of the parry of the first part in and to said premises;TO HAVE AND TO HOLD the premises herein granted unto the party of the second part,the heirs or successors and assigns of the party of the second part forever. AND the party of the first part covenants that the party of the first part has not done or suffered anything whereby the said premises have been encumbered in any way whatever,except as aforesaid. AND the party of the first part,in compliance with Section 13 of the Lien Law,covenants that the party of the first part will receive the consideration for this conveyance and will hold the right to receive such consideration as a trust fund to be applied first for the purpose of paying the cost of the improvement and will apply the same first to the payment of the cost of the improvement before using any pan of the total of the same for any other purpose.The word"party"shall be construed as if it read"parties"whenever the sense of this indenture so requires. IN WITNESS WHEREOF,the party of the first part has duly executed this deed the day and year first above written. IN PRESENCE OF: p �.,Qw,w .,�cL�ararrevr✓ SHERRY SAL MAN OR .Yg -A O�. / QA ASlip iA. 7r 1, - Q ��: /� Q S,yy�,qp_ A Q } �_ A, QIA+y t',3• it Y ♦• Y a •. Y /♦♦/ Y �:♦. Y 1.. 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DATE(MM/DD/YYYY) ACORO� CERTIFICATE OF LIABILITY INSURANCE 12n z/2oz3 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME. Kathy Sulla Rivers Edge Insurance Agency,Inc. n�, (AX Nx84742 No): 227 S Middletown Rd ADDRESS: riversedgeinsuranceagency@gmail.com Suite 1 INSURER(S)AFFORDING COVERAGE NAIC# Nanuet NY 10954 INSURER A: ATLANTIC CASUALTY INSURANCE CO 42846 INSURED INSURER B I CON REMODELING GROUP INC INSURER C: 19 Washington ave INSURER D: INSURER E: Pleasantville NS lu>iu 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. LICY EX LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE F-K OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A Y M068002426-2 06/112023 06/11/2024 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X PRO- POLICY ECT LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: $ AUTOMOBILE LIABILITY (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED $ AUTOS ONLY AUTOS ONLY Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTIONS I $ ORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I ER ANY PROPRIETOR/PARTNER[EXECUTIVE❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Carpentry/Contractors The Certificate holder is listed as additional insured on the General liability,if required by written contract,subject to the terms,conditions and exclusions of the actual policy CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Village Of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street AUTHORIZED REPRESENTATIVE Ka![Mj$a�A.Cp. Rye Brook NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD PORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured ICON REMODELING GROUP INC 914-490-1704 19 WASHINGTON AVE PLEASANTVILLE,NY 10570 1c.NYS Unemployment Insurance Employer Registration Number of Insured 09145132 Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 824319347 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) NorGUARD Insurance Company Village of Rye Brook 938 King Street 3b.Policy Number of Entity Listed in Box"la" Rye Brook,NY 10573 ICWC488312 3c.Policy effective period 01/01/2023 to 01/01/2024 3d.The Proprietor,Partners or Executive Officers are included.(Only check box if all partners/officers included) �x all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"I a"for workers' compensation under the New York State Workers'Compensation Law. (To use this form, New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit,license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Mary P.Storti (Print name of authorized representative or licensed agent of insurance carrier) Approved by: 12/13/2023 (Signature) (Date) Title: Sr.Operations Manager Telephone Number of authorized representative or licensed agent of insurance carrier: 877-266-6850 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 AC Rr? CERTIFICATE OF LIABILITY INSURANCE DATE(WNWA-M) 09l27l2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER. IMPORTANT If the certificate holder is an ADDITIONAL INSURED.the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy.certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER - - - CONTACT NAME F.Williams : Mary_ _ Mary Williams Insurance Agency {nHONo,Eaq: (914)935-3383 ���� (914)935-3317 125 N Main St Suite 501 ADDRESS trankiewilllams ms9..agmail.com Port Chester.NY 10573 tNSURER(S)AFFORDING COVERAGE_ NAIC X Phone (914)93_5-3.3.83 Fax (914)_9_35-3317 INSURER A: Penn-Star Insurance Co. INSURED INSURER B: Progressive Insurance Cc DKG Legacy Heating 8 Cooling LLC INSURER C: 345 Washngton Street INSURER D: INSURER E: Peekskill NY 10566- 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 CLAMS INSR ADDLSUBR POLICY EFF _POUCY EXP TYPE OF INSURANCE (MMIDDrYYYY).(IMM/DDrYYYY) _ - __ LTR ___ - _ ,INSR WVD. POLICY NUMBER LIMITS COMMERCIAL GENERAL LMIrTY EACH OCCURRENCE - S 1,000,000.00 ❑ CLAMS-MADE W OCCUR DAMAGE TO RENTED 100,000.00 PREMISES(Ea occunencej S A l O Y PAV0500460 09;03i2024 09103/2025 MED ExP(Any one person) S 5,000.00 PERSONAL S ADV INJURY+5--1,000,000.00 GENL AGGREGATE LIMIT APPLE S PER GENERAL AGGREGATE-- . S 2,000,000.00 ❑ POLICY D JE T ❑ LOC PRODUCTS-COMPIOP AGG I s 2'000,000.00 OTHER f AUTOMOBILE LIABILITY COMBINED SINGLE EMIT ---- (Ea accident: - . s 500.000 00 ❑ ANY AUTO BODILY INJURY(Per person) S -- OWNED SCHEDULED --- --- - - AUTOS BODILY INJURY!Per WCKkN) $ B ' AUTOS ONLY 974306821 10'16/2023 10l16l2024 _ __ HIRED NONOWNED PROPERTY DAMAGE -S AUTOS ONLY CPer accrderH) AUTOS ONLY -- - ❑ IS C UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE 5 ❑ EXCESS UAB ❑CLAMS-MADE AGGREGATE S Ell DIED ❑ RETENTIONS WORKERS COMPENSATION PER 1-1 OTH- AND EMPLOYERS'LIABILITY YIN - :❑STATUTE '.-J ER ANY PROPRETOR/PARTNER.'EXECUTIVE F L EACH ACCIDENT S OFFICERMEMBER EXCLUDED' NIA -t - (Mandatory In NH) -— E L DISEASE-EA EMPLOYE]< If yes descnce under ' DESCRIPTION OF OPERATIONS GeIp1N -E L DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEMCLES (Attach ACORD 101,Additional Remarks Schedule,d more space is required) Village of Rye Brook Is included as Additional Insured as respect to General Liability and Subject to Policyr.Terms and Conditions Location Of The Job 49 Country Ridge Circle Rye Brook.New York 10573 L— -_ CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village Of Rye Brook THE EXPIRATION DATE THEREOF.NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street AUTHQ�[ZED REPRESENTATIVE Rye Brook.NY 10573 kA988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03)QF The ACORD name and logo are registered marks of ACORD NYSI L New York state tnsur,-. - PO Box 66699.Albanv.NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE A I A^^^ 92236305441 l+'. MARY F WILLIAMS INS AGENCY � xy 219 WESTCHESTER AVE 4TH FL �` } PORT CHESTER NY 10573 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER DKG LEGACY HEATING&COOLING LLC VILLAGE OF RYE BROOK 345 WASHINGTON STREET BUILDING DEPARTMENT PEEKSKILL NY 10566 938 KING STREET RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2587 590-7 264384 04/25/2024 TO 04/25/2025 9i27/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE iS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2587 590-7. COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK. EXCEPT AS INDICATED BELOW. AND. WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK. TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY.INCLUDING ANY NOTIFICATION OF CANCELLATIONS. OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:INVWW.NYSIF.COMIC ERTICERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR.PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE SUR NCE FUND 7�v r �/ v DIRECTOR.INSURANCE FUND UNDERWRITING VALIDATION NUMBER:649860614 U-26.3