HomeMy WebLinkAboutBP23-201PERMIT # p>C� I DATE, /a / �3 F'(P: / of
SECTION /35, 5a- BLOCK LOT
TYPE OF WORK e OlIze l i %S /S i1 cX�eck
JOB LOCATION oQCl
OWNER S n m Pl .3� L(�/e ! Cam/ / 775
CONTRACTOR lAE%77o2 &
EST. COST J� �v 5O - FEEAQ0C%.S
✓00 # - FEE DATE.]()
TCO # FEE DATE
INSPECTION RECORD
DATE , INSP
FOOTING '44 7 3)- Zol,x
FOUNDATION �+ Q ' 17' 20 L y P/,3$m
FRAMING
RGH FRAMING
INSULATION
PLUMBING
RGH PLUMBING
GAS O
SPRINKLER
ELECTRIC 0
LOW -VOLT O
ALARM O
AS BUILT O
FINAL
OTHER APPROVALS
ARB
BOT
PS
zBa
OTHER
VILLAGE OF RYE BROOK
WESTCHESTNP. COUNTY, NEW YORK
j\ NO. 24-1 6
i-a
Certificate of Occupaucp
This is to certifythat �/ / Juhto'lle klnclel-
J
kly-e, B'�-06 Ln /V y
of, , having duly filed an application on`CNZ0 02q requesting a Certificate of Occupancy for the premises known as,
60C , Rye Brook, NY, located in a �Zoning
District and shown on the most current Tax Map as Section: 135. Block: -3—Lot:
and having fully complied
complied /with the requirements of the Building Code and the Zoning Ordinance under Building
Permit No.�✓ / , issued 20 09-3, such authority and permission is hereby granted
to the property owner to lawfully occupy or use said premises or building or part thereof listed under the following
New York State Classifications, Use: C Construction:
for the following purposes:, I izeo s l� r
e x i 5�1 rek k)00CJ C ecic
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 Il the building be moved from one location
to another until a permit to accomplish such change ha e n obt ' e in the B nspector.
Building Inspector,Village of Rye Brook: Date: OCT — 4 2024
pCCENBUILD R MENT For office use only:
PERMIT#D —0�0
SEP 2 0 20240 VIL - � Ic OK ISSUED:
938 KING STRE VE$ QOilit PORK 10573 DATE: 9—,D0—cz)�L
VILLAGE OF RYE BROOK aQ 4�c FEE: 0 /` 0— PAID45
BUILDING DEPARTMENT N
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
sss►sssrsresssssstssssssssrrtssrsssrstsstsrsrsrsrrssrsrrsspsrsrrrsrtssssssssssssrssrsssssrrtrssrtsttstsssssssssssasssrssrrtr
Address: 9
Occupancy/Use: Parcel ID#: 1,35 3— 50 Zone:
Owner: u t , F rtc ; rt C c� / Address: Q G ^Y�S vJ. 2 D
P.E./R.A. or Contractor: 14i1(21re6<-) �u gt/S�i`�P Address: /I /Oul2i i 001 CQ,-�el Aj Y
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 NEWnYORK, COUNTY OF WESTCHESTER as:
fu 1; f rE R N 8 c,rz being duly swom,deposes and says that he/she resides at
(Print Name of Applicant) (No.and Street)
in V;I I R 4, Or- RYE C 2v O iL in the County of &1 aV-S i e H FS i C 2 in the State of /J that
ICnc/I own/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
for the construction or alteration of. /(/f6 ZZ�t
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-IO.A.of the Code of the Village of Rye Brook.
Sworn to before me this D � n Sworn to before me this �
day of day of ^ , 20 Z 3
�Co'ol
Sig e of Property Owner Signature of Applicant
�.11ti i —TWO/M A
Print Name of Property Owner Print a o �
f Applicant
t �A�-�
Nota Notary Public
LILLIAN SIERRA Nota DIANNE ROJAS
Notary Public-State of New York ry Public-State of New York
NO. 01S16280398 No.0IR06127547
tlualified in NJestchest r M Qualified in Westchester County
`�,' Y Gummission Expires May 23,2025
:rr;ire5-
QyC BR a—,,-
Fb
1
932• BUILDING DEPARTMENT
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 : DATE:
PERMIT# 2 ` ) ` Z �> 1 ISSUED: Z-1—13 SECT: 1.3 5 S Z BLOCK: 3 LOT: 5 D
LOCATION: �ZP L/� ��161, 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
Q OTHER
�yE BRC�k.
1982 BUILDING DEPARTMENT
❑B,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: y
PERMIT# l7� L ISSUED: SECT: ' - BLOCK: LOT:
LOCATION: r' 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 r
❑ NATURAL GAS J �i
❑ L.P. GAS
❑ FUEL TANK
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
❑ CROSS CONNECTION
❑ FINAL
❑ OTHER
�E BRO,
:iV
1982 BUILDING DEPARTMENT
❑BUILDING INSPECTOR
ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK
❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573
(914) 939-0668 FAx (914) 939-5801
www.ryebrook.org
- - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - -
ADDRESS : DATE: ��
PERMIT# ISSUED: SECT: BLOCK: LOT:
LOCATION: OCCUPANCY:
❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/ REINSPECTION
❑ SITE INSPECTION �plZ i y� REQUIRED
O FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION
❑ NATURAL GAS
❑ L.P. GAS C I� .
❑ FUEL TANK
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
❑ CROSS CONNECTION
❑ FINAL
❑ OTHER n
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BUIL MENT P--►� � /r c IIV E= DD
VIL F OF Rv' OOK
938 KING r*r RYr: BR: � ,NY 10573 i FSEP 19 2023
w , a r �--- —- —
1/ILLAi� C i' F3ROOK
BUiL.DING DEPARTtvIlz i
FOR OFFICE I fit: ONLN:
Approval Date: � Tez" ermit# QD 3 c-40 1 Application#
Approval Signature: ARCHITECTURAL RE W BOARD:
Disapproved: Date:
BOT Approval Date: Case# Chairman:
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case#
Other-
Application 4
Application Fee:(O ermit Fees: QUO y
EXTERIOR BUILDING PERMIT APPLICATION
Application dated: 9 f 9 d is hereby made to the Building Inspector of the Village of Rye Brook.NY,for the issuance of a Permit for the
construction of buildings,structures,additions,alterations or for a change in use,as per detailed statement described below.
I. JobAddress: 90 Windsor Rd
2. ParcelID#: 135.52-3-50 Zone: R-7
3. Proposed Improvement(Describe in detail); Existing wood deck to be legalization
� f
4. Property Owner: �l � vt
Address:
Phone# 15-3t`}" lv Cell# e-mail 1u1.C}}{Y„ny+t,rlTo�J�4W-0;L.ce,
List All Other Properties Owned in Rye Brook: r J
Applicant:
Address:
Phone# Cell# e-mail
Architect: Gabrielle Salman
Address: 467 Bedford Road, Suite 169 Pleasantville,NY 10570
Phone# (914)773-1618 Cell # e-mail GSalmanAIA@aol.com
Engineer:
Address:
Phone# Cell# e-mail
General Contractor: iqvl&P�({ J 9!{'.S -!r)-e` ,, i l'
Address: // I OIP� �C `�' j2Q,--A? 1� /y 7 /
Phone# �p 4/6- 3-3/- 5 '5' Cell# e-mail
(1)
6/1/2023
5. Occupancy;(1-Fam.,2-Fam.,Commercial.,etc...)Pre-construction: Post-construction:
6. Area of lot: Square feet: Acres:
7. Dimensions from proposed building or structure to lot lines: front yard: rear yard:
right side yard: left side yard: other:
8. If building is located on a comer lot,which street does it front on:
9. Area of proposed building in square feet: Basement: I"fl: 2°d fl: 3'fl:
10. Total Square Footage of the proposed new construction:
11. For additions,total square footage added:Basement: 1st fl: 21 fl: 3'fl:
12. Total Square Footage of the proposed renovation to the existing structure:
13. N.Y. State Construction Classification: N.Y. State Use Classification:
14. Number of stories: Overall Height: Median Height:
15. Basement to be full,or partial: finished or unfinished:
16. What material is the exterior finish:
17. Roof style;peaked,hip,mansard,shed,etc: Roofing material:
18. What system of heating:
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 System Permit application&2 sets of detailed engineered plans)
21. Will the proposed project disturb 400 sq.ft.or more of land,or create 400 sq.ft.or more of 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: (if yes,applicant must submit a Site Plan Application,&provide detailed drawings)
23. Will the proposed project require a Steep Slopes Permit as per§213 of Village Code Yes: No:
(if yes,you must submit a Site Plan Application, &provide a detailed topographical survey)
24. Is the lot located within 100 ft.of a Wetland as per§245 of Village Code? Yes: No:
(f 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:
(f 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 J, LO Dy 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 requiredprior to issuance of the CIO.
30. Estimated date of completion:
(2)
6/1/2023
BUILD MENT
VIL F, OF RYA', OOK
938 KING ET R),u BR61 ,NY 10573
4 t0
w
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:
3S, Efft RiAvCER , residingat, 90 ►��n�e7So2 RD
(Print nume) (Address wherc voki li%c)
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;
9 TC Rye Brook, NY.
(luh A(ldress)
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.
urcofProPcrt% Omicr(s)l
Sworn to before me this
day of ?0 2—' -7
(Notzm Public)
an►.�o
LILLIAN SIERRA
Notary Public -State of New York (6)
N0. 01SI6280398
Qualified in Westch?st(r i
My Comm: ='
�m� >, 8/12/2021
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:
A 1"I;;tti R;N G c R ,being duly sworn, deposes and states that he/she is the applicant above named,
print name of individual signing as the applicant)
and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the
for the legal owner and is duly authorized to make and file this
application.
(indicate architect,contractor,agent,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 storrnwater or
groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property.
Swom to before me this. O Sworn to before me this
day of d& , 20_q� day of , 20 G 3
Signature of Property Owner Signature of Applicant
Prin acne of Properly Owner Print Name of Applicant
ut�L=, Qjol_'C' j=
Notary Public NotaryPublic
DIANNE ROJAS
LILLIAN SIERRA Notary public-State of New York
No.01 ROG127547
Notary Public-State of New York Qualified in Westchester County
NO.01SI6280398 My Commission Expires May 23,2025
Qualified in Westchesq
� !
My Commission Expires
(8)
8/12/2021
Building Permit Check List&Zoning Anal sis
Address: ` O QJDSBL
tt a
Zone: Use: "I\ Const.Type: �l Other.
Submittal Date: Dates:
Applicant:
Nature of Work: -L-e- S i ` 1 U
Reviews:ZBA: S E P 2 8 2 0 2 3 B. TBOT• Other.
*APP-
:Filmg. BP: C/O: Flood Plane: Legalization.
Dated: Notarized: SBL: Truss I.D. Cross Connection: H.O.A.:
( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening:
( ) ( ) ENVIRO: Long Short: Fees: N/A:
( � ( ) TE PLAN:Topo: Site r ection S/W t: Tree Plan: Other.
(� VEY:Dated Current: ✓ Archival• Sealed: Unacceptable:
ULANS:Date S ed Sealed( farnp G Copies: Electronic: Other.
License: ,/Workers Comp: ✓Liability ✓Comp.Waiver. Other.
Dated N/A:
( ) ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit: N/A Other.
( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit: N/A Other.
( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H.W.I.C.:_Battery:_Other.
( ) ( ) PLUMBING Plans: Permit: Nat.Gas: LP Gas: N/A/: Other.
( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A: Other.
( ) ( ) H.V.A.C.: Plans: Permit: N/A Other.
( ) ( ) FUEL TANK:Plans: Permit: Fuel Type: Other.
O O 2020 NY State ECCC: N/A: Other.
( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other.
( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other.
approval• notes:
(�ZBA tog.date: approvaL• notes:
( )PB mtg.date: approvaL• notes:
REQUIRED EXISTING PROPOSED NOTES ,.
Ate: -7 5 7 N L c, L Date:MY 2 8
Circle:
Fr n e c"?
Front: �7
Fmxg-
Ste: ,�[ t-i C c—
RCMr 'N C- q y
Main Cov
Accs.Cov.
Ft.H/Sb:
Sd.H/Sb
SGFA
Tot imp:
Ft.Imo:
P
Hcight/Stories: 1
notes: G> �. C Q ��2 C c u v1-e
�\ C vk Cv l 4- reNs1 cY1
- ec (%CN 00
Residential Building Permit Fee Work Sheet
Permit#: Date Issued SBL: Zone:
Address:
Property Owner& Contact Info:
Job Description:
For all new dwellings and for additions measuring 800 sq. ft. or more made to existing
dwellings, the following fee schedule shall apply: (plus any alteration fees)
Total Sq. Ft. (excluding basements) x $300.00 x $I8.00/$I,000.00
Basement Sq. Ft. x $65.00 x $I8.00/$I,000.00
--------------------------------------------------------------------------------------------------------------------
New Construction Sq.Ft. • New Construction Cost • Building Permit Fee
Basement= sq. ft.x$65.00 = $ x$I8.00/$I,000.00 = $
Attached Garage= sq. ft.x$300.00 = $ x$I8.00/$I,000.00= $
I'�H. = sq. ft.x$300.00= $ x$I8.00/$I,000.00 = $
2nd Fl. = sq.ft.x$300.00 = $ x $I8.00/$I,000.00= $
3`d Fl. = sq. ft.x$300.00 = $ x$I8.00/$I,000.00= $
411 Fl. = sq. ft.x$300.00 = $ x$I8.00/$I,000.00 = $
Tot31 Sq.Ft. sq. ft. Total Cost = $ Total B.P.Fee= $
Total Amount Paid = $
Total Amount Due= $
Date: Signed:
D ;CE� IVE
BUILD MENT
VIL ox` OOK SEP 19 2023
938 KING NY 10573
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: 90 Windsor Rd Date of Submission:
Parcel I D#: 135.52-3-50 Zone: R-7 9j/„ 6 Z3
Proposed Improvement(Describe in detail):
Existing wood deck to be legalization APPLICANT CHECK LIST:
MUST BE COMPLETED By THE APPLICANT
The following items must be submitted to the Building
Department by the applicant-no exceptions.
AM+ry0ii, .�i{ ¢ ,� 1. (Completed Application
Property Owner:
p 2. (�T'wo(2) sets of sealed plans. (one full size (maximum
/a Address: �it� r$Q k� allowable plan size=36"x 42")and one I 1"x17")
3. (/j Two(2)copies of the property survey.
Phone#91-4-'71 S— 34140 4. ( )Two(2)copies of the proposed site plan.
Applicant appearing before the Board: 5. ( )One electronic/disc copy of the complete
j}�D/►�R uRV�I N 14 V application materials.
6. (4Filing Fee.
Address: I Z- e�^'t W�-I-L ��AtZ Mmee.44 LAKE 01 7. ( )Any supporting documentation.
eta I(,o�nc °s'h 8. ( )HOA approval letter. (ifappiicabie)
Phone# 9. ( )Photographs.
Architect/Engineer: 10.( )Samples of finishes/color chart. (a sample board or
model may be presented the night of the meeting)
Phone#
CmA>L -'rcKAVAIJfl(J--4aY4 H". C6 A
By signature below, the owner/applicant acknowledges that he/she has read the complete Building Permit
Instructions&Procedures, and that their application is complete in all respects. The Board of Review reserves
the right to refuse to hear any application not meeting the requirements contained herein.
Sworn to before me this Sworn to before me this j
day of 20 day of e � a , 20 2- 3
J
ure Property Owner Signature of Applicant
(v
mA S' kA v�l n/A J,5 4
Print Name of Property Owner Print-Name of Applicant
Notary h6ic Notary Public
_ _ ., DIANNE
LILLIAN SIEaftRRA h III Notary Public-State Of y W York
Notary Public -State of New York No.OIR06127547
Qualified in Westchester County
N0. O1S16280398 � My Commission Expires May 23
Qualified in Westchey {�% Y ,2025
My Commission Expires"* �k` 8/12/2021
'tea•-�- ;r••�.
Laura Petersen
From: thomas kavanaugh <tckavanaugh@yahoo.com>
Sent: Tuesday, November 7, 2023 12:14 PM
To: Laura Petersen
Cc: thomas kavanaugh
Subject: Fw: Building Permit Application - 90 Windsor Road (Deck)
Attachments: 123_2jpeg; attachment1.pdf, N9WC850399-ACORDAPP105.PDF
Laura,
Please find attached requested information.
General contractor's contact name & phone number Andrew Augustine 1-646-331-5665
Tom Kavanaugh
Please send the following items required for the issuance of the deck permit at 90 Windsor Road;
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 (C 105-2 or U26.3)
5. Building permit fee $100.00 (due once permit is issued and ready for pick-up)
Thank you
Laura
Laura Petersen
Office Assistant
Village of Rye Brook
938 King Street
Rye Brook, New York 10573
Phone(914)939-0668 1 Ipetersenaryebrook.org
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ACOR& DATE(MMIDDNYYY)
`� CERTIFICATE OF LIABILITY INSURANCE 11/06/2023
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsements.
PRODUCER CONTACTDJ1 Torpie
HA/AE: _
Northeast Agenciesllvantage BONE 914-576-1515 AC No: 914-834-8732
CIO Douglas Torpie Ea1Aa
DO;Ess- djtorpie@altstate.com
ieQ d allstate.Com
P
556 North Ave New Rochelle NY 10801 - INSURER(S)AFFORDING COVERAGE NAICS
INSURER A: Utica First
INSURED INSURER B
Andrew Augustine INSURER C.
11 Tower Rd INSURER D:
Carmel,NY 10512 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR I TYPE OF INSURANCE ADOLISUBRI
POLICY NUMBER POLICY EFF POLICY EXP LIMITS
Lyn X COMMERCUL GENERAL LIABILITY EACHOCCURRENCE S 1000000
CLAIMS-MADE OCCUR PREMISES Ea ooeunerlesl S 50000
NED EXP JAny one n S 5000
A ART3000276350 06116/2023 06/16/2024 PERSONAL&AOV INJURY S 1000000
GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2000000
X POLICY JEC 1OC PRODUCTS-COMPpPAGG f 2000000
OT 1ER: s
AUTOMOBILE LIABILIT' COMBINED SINGLE LIMI f
Ea aoddwt
ANY AUTO BODII Y INJURY(Per PM M) f
ALL
AUTOS OWNED AUTOEDULED ( III
BODILY INJURY(Par
NON-OWNED PROPERTYDAMAGE S
HIRED AUTOS AUTOS
S
UMBRELLA LIAR OCCUR EACHOCCURRENCE S
EXCESS LIAR CLAIMS-MADE AGGREGATE $
OED RETENTIONS S
WORKERS COMPENEI
SATION PER OTH-
ANDETaPLOYERS'LWBILTY YIN STATUTE ER
ANYPROPRIETORIPARTNERIEXECUTNE E.L. ACH ACCIDENT $
/M OFI'ICERIMBEREXCLUDED? O E.L.NIA
(iii mry in NMI E.L DISEASE-EA EMPLOYE S
H yes.R undo EL.DISEASE•POLICY LIMIT S
DESCRIPTIONIPTION OF OPERATIONS
Debw
DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(ACORD 101,Additional RomMks Schedule,may bo Mhehed If more apace ie reQulled)
Drywa111Wallboard Certificate holder is additional insured.
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 st
Rye Brook NY 10573 AUTI1ORIZED REPRESENTATIVE
DJ Torpie
®1 -2014 ACOR ORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
vYORK 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
Andrew Augustine
646-331-5665
11 Tower Road 1c.NYS Unemployment Insurance Employer Registration Number of
Insured
Carmel, NY 10512
N/A
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
133-50-7894
2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier
(Entity Being Listed as the Certificate Holder)
Berkshire Hathaway Direct Insurance Company
Village Rye Brook 3b.Policy Number of Entity Listed in Box"1 a"
938 King St
N9WC850399
Rye Brook, NY 10573
3c.Policy effective period
01/19/2023 to 01/19/2024
3d.The Proprietor,Partners or Executive Officers are
X❑ included.(Only check box if all partners/officers included)
all excluded or certain partners/officers excluded.
This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"1 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: Rakesh Gupta
(Print name of authorized representative or licensed agent of insurance carrier)
Approved by: _ y,,,� � 11/16/2023
(Date)
Title: Chief Operations Officer
Telephone Number of authorized representative or licensed agent of insurance carrier: 844-472-0967
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
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EXISTING BUILDING
WOOD RAIL
92 WINDSOR RD
N/F
GREGORY F ANDRONICO
135.52-3-51
115.00' . .
58.47'
FILED MAP NO. 3675 c�
4
l STEPS
Y
m Lot 5
FILED MAP NO. 3675
Ez WOOD DECK
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FILED MAP NO. 3675 s�
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— xx xx ENf N890 06' 00"W
EXISTING
2 STORY
BUILDING
SURVEY NOTES: /
1, Anastasia 1. Parsatoon, L.S., the surveyor who made this map, do hereby certify
that the field survey on which this map is based was completed on June 22, 2023
PORCH I.�
WOOD
FENCE
.STEPS
PIPE FND
CONC.
ASPHALT DRIVEWAY
OHW -_ OHW OHW
ANDV�4/L
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31.31,—
rC��C�� ;?�a
88 WINDSOR RD
N/F
MICHAEL ANDRUK
135.52-3-49
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and that this map was completed on July 19, 2023 in accordance with the existingJ. x�*
F Code of Practice for Land Surveys adopted by the New York State Association of O °
Professional Land Surveyors. r°
E a i
Reference is made to Deed Control No. 450030933 and to a certain map entitled, EXISTING BUILDING r
"Revised Map of Tamarack Gardens, in the Town of Rye, New York, the property of
Tamarack Gardens Inc.", premises being Lot Nos. 5, 6 and part of Lot No. 4, dated
June 1930 and filed in the Westchester County Clerk's Office, Division of Land CERTIFICATION NOTE:
Records, on August 6,1930 as Map No. 3675. LOT No. 51 6, and a Portion of Lot 4, WCLR Map 3675
Underground utilities, facilities and structures are not shown hereon. There may be This survey is hereby certified to the following:
Record and Return Title Agency, Inc. Lot Area = 7 187.50 Sq. Ft. (0.17 Ac. )
underground utilities the location of which are presently unknown. Any party utilizing . Stewart Title Insurance
' Company
the utility information and data depicted on this survey shall contact the "DIG . CrossCountry Mortgage, LLC
SAFELY NEW YORK" phone number at 800-962-7962 a minimum of forty eight underground utilities. Austin G. Ringer and Juliette N. Ringer GRAPHIC SCALE
G undhours prior to any construction activities to verify the location of any and all . Thomas Chester Kavanaugh, as Proposed Executor of the Estate of Doris L. Kavanaugh
. 10 0 10
I Property subject to any and all public or private restrictive covenants, declarations FEET
and/or easements of record, if any.
Dimensions shown from structures to property lines are not intended to be used for
the construction of fences, structures or other improvements.
Unauthorized alteration or addition to a survey map bearing a licensed land PRINT INVALID WITHOUT SEAL AND
surveyor's seal is a violation of Section 7209, subdivision 2, of the New York ORIGINAL SIGNATURE
Education Law.
TO THE BEST OF MY KNOWLEDGE AND BELIEF, THIS MAP IS
SUBSTANTIALLY CORRECT AS NOTED HEREON. yam.
1064atee'-p July 19, 2023
ANASTASIA 1. PARSATOON, N.Y. L.S. 051088 DATE
1 1 2 1 3 1 4 1 5
6 1 7 1 8
REV. #: REV. DESCRIPTION:
9 10 11 12
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LOCUS
SCALE 1" = 250'
LEGEND
—XX
XX— STOCKADE FENCE
VINYUPLASTIC FENCE
osiw--- OVERHEAD WIRE
Ur puo r
AH N MAN KI RBY
Ax**t-, ENGINEERS•S URVEYORS+PLANNERS
SINCE 1 S? 1
1171 East Putnam Avenue, Riverside, CT 06878
Tel: 203.869.7707 • Fax: 203.869.4606
www.ahnemankirby.com
DATE:
13 1 14 1 15 1 16 1 17 1 18
N/F NOW OR FORMERLY
R.O.W. RIGHT OF WAY
C
V
A
Date:
July 19, 2023
Scale:
1" =10'
Drawn/Checked By:
KBF, KW / TGA F
Book #:
262:27
Job #:
23-81-2-68
Reference:
2-68
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