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HomeMy WebLinkAboutBP24-002CONTRACTOR
EST. COST , U FEE l /
vCO# s FEE >q/In-'Pl, DAT —I
TCO # FEE DATE
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FOOTING
FOUNDATION
FRAMING
RGH FRAMING
INSULATION
PLUMBING
O
RGH PLUMBING
GAS
O
SPRINKLER
ELECTRIC
Low volr
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AS BUILT
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FINAL
OTHER APPROVALS
ARB
BOT
PB
ZBA
OTHER
VILLAGE OF RYE BROOK
WESTCHESTER COUNTY, NEW YORK
NO: 24-028
Certificate of ®ccup ucp
This is to certify tha !)2VYbarye2 Onlle&ll? Ybat-,nz
of k9 &641 , having duly filed an application on
�equesting a Certificate of Occupancy for the premises known as,
Rye Brook,NY, located in a kzz j Zoning
District and shown on the most current Tax Map as Section: Block: �Lot: ,
and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building
Permit No. , issued 20 � , such authority and permission is hereby granted
to the property owner to lawfully occupy or use said premises or building or part thereof listed under the following
New York State Classifications,Use: // Construction: ,
for the following purposes: - �1
P J
G y ilila
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 t shall be made,n 11 the building be moved from one location
to another until a permit to accomplish such change s b e ro Bu d' rispector.
Building Inspector,Village of Rye Brook: Date: MAR 2 7 2024
D , R For office use onI
BUILD ARTMENT PERMIT# —d0�
MAR 18 2024 VILOF RYE BROOK ISSUED: /— --�
938 KING STRE�IVE BROOK,;NEW YORK 10573 DATE: —j $--
VILLAGE OF RYE BROOK (914)9�9-06 FEE:,,&//O-- PAID$
BUILDING DEPARTMENT vvi�%�.ryebrool�.org
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
ttttiitiii♦#t#tt#tt#i#ktk#iik#####ttitftf it lt#t##i##flit fff ilk'f#4#ktiii#tf#tf#f##fi##f4#4i4#4iitii#iiiitf#ii4i4iiitiiiiit4#i►ti
Address:
Occupancy /Use: M Parcel ID / JS—i 411 Zone: e/3-
Owner: Address: 'go�JC'�j4� Gt/J 2
P.E./R.A. or Contractor: Address:
Person in responsible charge: Address:
Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a
Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance
with law:
STATE OF NEW YORK,COUNTY OF WESTCHESTER as:
Yf r^ being duly sworn,deposes and says that he/she resides at 45
(Print Name of Applicant) \ 1 .and Street)
in�&C_ N 11 ,in the County of �1�I�St �.,r in the State of �,that
(City/Town/Village)
he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements,
labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may
have been donated gratis was:$ ' \(-)o
for the construction or alteration of: c t Cn W� 1
Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of
Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in
accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and
as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an
owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly
or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building
Inspector as per§250-10.A.of the Code of the Village of Rye Brook.
Sworn to before me this \� Sworn to before me this
day of �``�,�Ci , 20-4-1— day of , 20
Signature
,00f Prof erty Owner Signature of Applicant
W'vl
�Lrl-
Pr' a of Property Owner Print Name of Applicant
Notary rblic Notary Public
SHARI MELILLO
Notary Public,State of New York
No.01ME6160063 N;12'2021
Qualified In Westchester anury 29 20 vj
Commission Expires
611 V,
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 - - - - - - - - - - - - - - - - - - - -
Li 7�)
ADDRESS: ( �t lY\f� tQ DATE: k.t
PERMIT# ISSUED: SECT: BLOCK: LOT:
l- 1 -�
LOCATION: P F I X OCCUPANCY:
❑ Violation Noted THE WORK IS... PASSED ❑ FAILED REINSPECTION
❑ SITE INSPECTION REQUIRED
❑ FOOTING
❑ FOOTING DRAINAGE
❑ FOUNDATION
❑ UNDERGROUND PLUMBING NOTES ON INSPECTION:
❑ ROUGH PLUMBING
❑ ROUGH FRAMING
❑ INSULATION
❑ Natural Gas
❑ L.P. Gas
❑ FUEL TANK '
❑ FIRE SPRINKLER
❑ FINAL PLUMBING
❑ CROSS CONNECTION
❑ FINAL
❑ OTHER
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BUILDRvE-
ENT d �/� �_ jD
F
VILOK
938 KING NY 10573 NOV 1 5 M23 VILLAGE OF RYE BROOK
I BIJII_ )ING ncPARTnIF01T
FOR OFFICE USE ONLY:
Approval Date: 00C'4- Application#
Approval Signature: ARCHITECTURAL REVIEW BOARD:
Disapproved: : Date:
BOT Approval Date: Case# Chairman:
PB Approval Date: Case#
ZBA Approval Date: Case#
Other: ? p
Application Fee: lb Permit Fees:
EXTERIOR BUILDING PERMIT APPLICATION
Application dated: /—f c�),� is hereby made to the Building Inspectorof the Village of Rye Brook,NY,for the issuance ofa Permit forthe
construction of buildings,structures,additions,alterations or for a change in use,as per detailed statement described below.
1. JobAddress: 4' 'k O%rAr\ krn4
2. Parcel ID#: D'A` _ y l -I-) Zone:
3. Proposed Improvement(Describe in detail): ` L 1
t� �nG b.}G�� IK ICE 1 lY1 ,\1 1 �� \ 11hr
n 4A
4. Property Owner: t t«
Address:
Phone# Cell# 0 e-mail M rn, � V_M"
List All Othe PPrope`rtie `Owned in Rye Brook:
Applicant: t .ro, U � lkfyr\ _
Address: Lis �n RW, 6104,
Phone#— Cell# �� �UU 5W e-mail pu,C aCr:T Pr ,
01
Architect: yLkn �p
Address:AA a�
Phone# Cell# e-mail rti. 5 , ,Corr\
Engineer:
Address:
Phone# Cell# e-mail
General Contractor:
Address:
Phone# Cell# e-mail
(1)
6/1/2023
5. Occupancy,(I-Farn.,2-Fam.,Commercial.,etc...)Pre-construction: 1-Fam Post-construction: 1-Farn
6. Area of lot: Square feet 12,484 Acres: 0.29
7. Dimensions from proposed building or structure to lot lines: front yard: 44.0'(porch) rear yard: NIA
right side yard: 25.7'(porch) left side yard: N/A 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: I'fl: 2nd fl: 3ed fl:
10. Total Square Footage of the proposed new construction:
11. For additions,total square footage added:Basement: 1"fl: 2°d fl: 31d fl:
12. Total Square Footage of the proposed renovation to the existing structure:
13. N.Y.State Construction Classification: V-B N.Y.State Use Classification: R-3
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: stone veneer(vertical surfaces), bluestone(horizontal surfaces)
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 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: X
(rf 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: X Area:
22. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code?
Yes: No: X (fyes,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: X
(rf yes,you must submit a Site Plan Application,&provide a detailed topographical survey)
24. Is the lot located within 100 ft.of Wetland as per§245 of Village Code? Yes: No: X
('dyes,the area of wetland and the wetland buffer gone 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: X
((yes,the area and elevations of theflood 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: X
(rfyes,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:I X
Indicate: TIER I: TIER If: TIER III: (dyes,a florae Occupation Permit Application is required)
28. List all zoning variances granted or denied for the subject property:
16.84'rear yard setback relief for deck, granted 02/06/2018
29. What is the total estimated cost of construction: $ I [, /OD Note:The estimated Bost shall
include all site improvements,labor,material,scaffolding,fired 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)
3/21/19
BUILD MENT
VIL E OF RY OOK NOV 15 2023
938 KING ET RYEBR ,NY 10573 L..
4)
'� VILLAGE OF RYE BROOK-0 BUILDING DEPARTMENT
www.ryebroo 2
AFFIDAVIT OF COMPLIANCE
VILLAGE CODE 4216 • 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:
, residing at,
G{Print name) (Add_; where you live)
being duly sworn, deposes and states that(s)he is the applicant above named, and further states that(s)he is the
legal owner of the property to which this Affidavit of Compliance pertains at;
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 vner(s>)
(Print Name of Property Owner(s))
Sworn to before me this
day of -e N• r , 201
(Notary Public)
SHARI MELILLO
Notary Public,State of New York
No.olMEU60063
Qualified In Westchester county
Commission Expires January 29,2 (6)
0-�
8/1 212 02 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.
ST TE O N W YORK,COUNTY OF WESTCHESTER ) as:
�p,t,� 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 stormwater or
groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property.
Sworn to before me this \S Sworn to before me this
day of � �' , 20� day of , 20
Signature of Ploperty Owner Signature of Applicant
Print Name of Property Owner Print Name of Applicant
N��V-\&�
Notary Public Notary Public
SHARI MELILLO
Notary Public,State of New York
No.01M E6160063
Qualified in Westchester County
Commission Expires January 29,2020
(8)
8/12/2021
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STOP111111NORK ORDER
DULY ISSUED BY THE
BUILDING DEPARTMENT, VILLAGE OF RYE BROOK, NY
938 KING STREET,RYE BROOK,NEW YORK 10573-(914)939-0668-FAx(914)939-5801 -www.ryebrook.org
-----------------------------------------------------------------------------------------
4
:E HEREBY DIRECTED TO STOP ALL WORK AND TO OTHERN
?z DESIST ALL UNLAWFUL USE OF THIS PROPERTY/PREMISE
LQ� , RYE BROt
dZ020 TIME ISSUED: , ' 00 (60I./P.M.)PERMIT#: VIOLATION#:
AUURESS& PHONE: CA
rmbem—
I ki ot) ltq% Ck r Ir tt� Ic
a
-or relocation of this iacard will result in a fine of 1000.00 in accordance with Villa- a Code. There is a non-w
removal of this placard. A re-inspection of the premises by the Building Department is re uired prior to resumin
EY THIS NOTICE IS A CRIME PUNISHABLE BY FINE IMP RI NM T
( BUILDING INSPECTOR ASSIST.
( CODE
•
t
Building Permit Check List&Zoning Analysis
`[
' I AFL/ `
. Address: ` � ho C��� �- SBL•
Zone.' 1`' k-L- Use: 2 l -D Const.Type: Other.
Submittal Date: 10 2 Revisions Submittal Dates:
Applicant: A
Nature of Work: --_1zE- -' - :: 2cal ' r v-1 Q 4L % TPtiy N LVA L( .
Reviews:ZBA T 1 0 PB: BOT: Other.
OK
( ( ) FEES:Filing. 7S�-� BP: � 3. �_C/O: Legalization:
( ) (,).-VP: Dated: ✓ Notarized: SBL: —Truss I.D. Cross Connection: '--� H.O.A.:
( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening.
( ) ( ) ENVIRO:Long. Shore Fees: N/A:
( ) ( ) SITE PLAN:Topo: Site P otection S/W Mgmt.: Tree Plan: Other.
SURVEY:Dated: <2 1 S Current: ✓ Archival: Sealed: ✓ Unacceptable:
( ) (-)* PLANS:Date Stamped: ✓ Sealed: ✓ Copies: 2 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.
( ) ( ) 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.
( ) ( ) 20I7 NY State ECCC: N/A: Other.
final Topo: RA/PE Sign-off Letter. As-Built Plans: Other.
( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other.
( ) ( ) Other.
GARB mtg.date: 16 2 Z-> approval: notes:
( )ZBA mtg.date: approval: notes:
( )PB mtg.date: approval• notes: PROVED
REOUMED EXISTING PROPOSED NOTES
ems: oats: OCT 2 7 2020
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ED
BUILDING DEPARTMENT R
IE C E M v
VILLAGE OF RYE BROOK OU -7 2020
938 KING STREET RYE BROOK,NY 10573 _
(914)939-0668 FAx (914)939-5801 VILLAGE OF RYE BROOK
www.ryebrook.orp, BUILD!NG 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 tosubmit a copy of this check list will be removed from the ARB agenda.//T Job Address: S MoK&&tA,5 L-AQIr Date of Submission:
Parcel ID#: 13�. �{( 'O 1 -2'�- Zone: Y.-('.Z
Proposed Improvement(Describe in detail):
APPLICANT CHECK LIST:
MUST BE COMPLETED BY THE APPLICANT
�-E Vt„1d� Exl ST►ay a-d'fM�INy WA4.tr. The following items must be submitted to the Building
4:�V-PT- W#Ax, Department by the applicant- no exceptions.
1. (X)Completed Application
l p 2. (K)Two(2)sets of sealed plans. (one full size(maximum
Property Owner: CAQ.I 15'ypjt¢I� allowable plan size=36"x 42")and one 11"xl7")
Address: µme j (."j 3. (ic)Two(2)copies of the property survey.
4. Two(2)copies of the proposed site plan.
Phone# o - 5. One electronic/disc copy of the complete
Applicant appearing before the Board: application materials.
6. Filing Fee.
W G&t-oFs o 7. (yQ Any supporting documentation.
Address: �� Bf�14.�1 11J1 � psm1L. I,J�
9. (X) Photographs.
Phone# SI(v- 3(�( (S g 10.(YJ Samples of finishes/color chart. (a sample board or
Architect/Engineer: f�
g W SA14D fs" AW(-Ar model may be presented the night of the meeting)
Phone# • -1(0-3 I Q . 13gcS
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 jrJ
day of Oct O ber , 20 a o day of C )C--b 6ec 20 2 o
Signature of Property Own r Signature of Applica
l
i 7v ��r✓r� � � � c;;� .a �JC�n .����:
Pnnt Name of Property Owne[ J Pr eofAppli t
04)T— � =cU
Notary Public Notary Public �
MITAR MARKOVIC RICH RD SAKOFS _
Notary Public,State of New York III Notary Public,State of New York
Reg.No.400359691 No.0?S,�4t373567
Qualfied in West'f eSster Cou t 7, No.
in Nassau County
commission F- Commission Expires February 28,�2 3
3/21/19
VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
938 KING STREET, RYE BROOK, NY 10573
(T) 939-0668 (F) 939-5801
ARCHITECTURAL REVIEW BOARD
Wednesday, October 21, 2020
Due to public health and safety concerns from COVID-19, the Architectural Review Board
meeting on October 21, 2020 will be closed to members of the public. The public can still
watch the live meeting online through Zoom through the app or through the following
https://us02web.zoom.us/j/81961552623
If any interested members of the public would like to provide comments during the meeting,
comments can be emailed to stevefews@ryebrook.org or called in during the meeting at +1
(929) 205-6099, meeting ID: 819 6155 2623
NAME & LOCATION TYPE OF APPLICATION MOTION SECOND APPROVED REJECTED APPL.#
1 Wyman St North Replace Existing 6' Fence in Consent 5079
(Garcia) Rear Yard (Stockade) Agenda
3 Country Ridge Re- Appearance- For Plans Consent 507 La
Close (Porter) Update Agenda
3 Country Ridge September 16th Documents 5071
Circle (Porter)
19 Maywood Ave Legalize Re-Configuration Consent 5080
(Guerrero) of Driveway & Retaining Agenda
Wall
2 Country Ridge Window Change to Consent 5081
Drive (Gonzalez) Accommodate Kitchen Agenda
Renovation
19 Dorchester Drive 6' High Vinyl Privacy Fence Consent 5082
(Rein) - Rear Yard (Oklahoma Agenda
Cedar Grain)
96 Brush Hollow 4' High Post & Rail Fence Consent 5083
Close (Tomback) Agenda
3 Valley Terrace 6' High White Vinyl Fence Consent 5084
(Vito) In Rear Agenda
ML NM
MR SE
JM SF
AC MI
KC
f`A1 -
17 Loch Lane Roof Top Solar Array Consent 5085
(Ashby) Agenda
9 Winthrop Drive Modify Front Walk, &New Consent 5086
(Geller) Landscape Wall Agenda
33 Whittemore Place Legalize Rear Patio Consent 5087
(Tina) Expansion Agenda
5 Red Roof Dr 4' High White Buffalo Style Consent 5088
(Fishbach) Privacy Fence Agenda
5 Little Kings Lane New 48" Rail Fence, Side Consent 5089
(Nathan) Yards Agenda
75 High Point Circle Replace Decking & Railing Consent 5090
(Germaine/Pinals) on Existing Deck Agenda
16 Maywood Ave Replace Rear Yard Wood Consent 5091
(Robles) Fence w/6Ft '"enda
45 Mohegan Lane Re- Do Front Steps w/B1 consent 5092
(Ybarra) Stone Treads, Mosaic Agenda
Risers, Walk, & Retaining
Wall
3 Mohegan Lane Rear Deck Over Existing 5093
(Gerchick) Patio
5 Jean Lane Roof Top Solar Consent 5094
(Scocchera) Array/System Agenda
6 Eagles Bluff(Ham Two Tier Block Wall, New Poss 5095
& Jones) Patio W/Fire Pit Above Consent
New Excavated Basement Agenda
Ext, SWM System
18 Rocking Horse Inground Swimming Pool 5096
Trail (Feist) w/Patio, Retaining Walls,
Partial Wood Fence, Partial
Wrought Iron Guard Rails.
Shed
72 Valley Terrace 2nd Story Additions, New 5097
(LLC) Front Portico, New Rear
Deck & Alterations
ML NM
MR f SE
JM ✓ SF ✓
AC t ✓ M
KC -✓
259 N. Ridge St New One Family 5098
(Lazz Development) w/Unfinished Basement,
Swimming Pool & Pool
Patio
1200 King St(Atria Front Vestibule Expansion, 5099
@Rye Brook) Replace Walkways, Patios,
Create A Memory Care
Garden, (other interior reno)
ML NM
MR- -- SE --- -
JM SF
AC MI
KC
�iA-lim; `-
Existing retaining wall, front walk, and front steps.
r I 45
U
y Y �
•si+ — —
Existing front walk and front steps.
Laura Petersen
From: Laura Petersen
Sent: Wednesday, October 28, 2020 4:03 PM
To: CARLEEN.YBARRA@GMAIL.COM
Subject: Building Permit Application -4S Mohegan Lane
The building permit application has been approved by the Building Inspector, before I can issue
the building permit the following items must be submitted to our office,
1. General contractor's contact name & phone number.
2. Copy of general contractor's valid Westchester County Home Improvement License.
3. General contractor's valid liability insurance (the Village Of Rye Brook must be the
certificate holder)
4. General contractor's valid workers compensation on a NY State Board form (C 105-2 or
U26.3)
5. Building permit fee $353.00 (due once permit is issued and ready for pick-up)
6. Contractor must call Dig Safe NY and get a ticket number.
This information can be emailed to me.
Thank you
Laura Petersen � FOR
Office Assistant 0. 0-1DATE TIME/ 3Q
Village of Rye Brook .J PM
938 King Street of Q V l/Q
Rye Brook, New York 10573
Phone(914)939-0668 1 Fax (914)939- v( , PHONE CELL
� I W MESSAGE / TELEPHONED U.J �•.+r 73 53�+ AE UACALL
1 0 EASE CALL
`T CAME To SEE YOU
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BUILDING DEPARTMENT --
VILLAGE OF RYE BROOK OrT - 1 2020
938 KING STREET RYE BROOK,NY 10573 �!
OW 3 -0668 Fax(914)939-5801 VILLAGE OF RYE BROOK
Uned
brook.or BUILD!NG DEPARTMENT
ARCH ED CHECK LIST FOR APPLICANTS
This form must be complete ay 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: T_ 5 AoK&.Apt L4036 Date of Submission:
Parcel ID#: 135-O ff I -O 1 -9-q Zone: Z--(2
Proposed Improvement(Describe in detail):
APPLICANT CHECK LIST:
MUST BE COMPLETED BY THE APPLICANT
pc.,l�� Exl Smay; Q-A'fM0IN�t W'4.1-. The following items must be submitted to the Building
Y�e(ptc� t Sm�G f"k,a-z- 1,,kX ?�K kol—UA Department by the applicant-no exceptions.
is�C15-nrJ S d- � 1. ()�Completed Application
2. (K)Two(2)sets of sealed plans. (one full size{maximum
Property Owner: CAQ-1 U `�,3pR�h allowable plan size=36"x 42") and one I 1"xi 7")
Address: �� �Iil c,�J (�► 3. (1c)Two(2)copies of the property survey.
4. (YC)Two(2)copies of the proposed site plan.
Phone# l [if - 11W 0 - 2(oQ3 5. (2F�One electronic/disc copy of the complete
Applicant appearing before the Board: application materials.
6. ()�Filing Fee.
JAN �ActLoFsl�"( 7. (yQ Any supporting documentation.
Address:_ L/J►!6 b �p��� 9. (X) Photographs.
Phone# Sl to- 3 ly (Sgs 10.(XJ Samples of finishes/color chart. (a sample board or
Apt*��""�� � ( model may be presented the night of the meeting
Architect/Engineer: 6,w &ft2ak /w
Phone# 5-1(o 3 Iq . 1395'
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 J +h Sworn to before me this Ord
day of OLlo o'✓er , 20 a o day of Q 40 6eC , 20 2 o
Signature of Property T Signature ofApplica
Pnnt Name of Property Owner e of Apph
u� Acll=c
Notary Public Notary Public
MITAR MARKOVIC RICH RD SAKOF
Notary Public,State of New York III
Notary Public,State of New York
Reg,No.400359691
No.02 SA4673567
Qualified in Westchester Cou tyZ,Z Qualified in Nassau County
Commission Exp Commission Expires February 28,,
BUILDING DEPARTMENT D F'E�C IE � V FE
VILLAGE OF RYE BROOK
938 KING STREET RYE BROOK,NY 10573 OCT - 7 2020
(914)939-0668 FAX(914)939-5801
www.ryebrookorE VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
FOR OFFICE USE ONLY:
OCT 2 7 2020
Approval Date: mit# Application#
Approval Signature: ARCHITEC VIEW BOARD:
Disapproved: ; Date: to Z - 7
BOT Approval Date: Case# ; Chairman:
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case#
Other:
Application Fee 461 Permit Fees: -
EXTERIOR BUILDING PERMIT APPLICATION
Application dated: 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.
1. JobAddress: 45 Mohegan Lane
2. Parcel ID#: 135.041-01-27 Zone: R-12
3. Proposed Improvement(Describe in detail):
Replace existing retaining wall. Replacing existing front walk. Refinish existing front steps and replace handrail.
4. Property Owner: Cadeen Ybarra
Address: 45 Mohegan Lane, Rye Brook, NY
Phone# Cell# 914-290-2693 e-mail carleen.ybarra@gmail.com
List All Other Properties Owned in Rye Brook:
Applicant: Evan Sakofsky
Address: 11 Berkley Ln, Rye Brook, NY
Phone# Cell# 516-314-1385 e-mail evan.sakofsky@gmail.com
Architect: Evan Sakofsky Architect
Address: 11 Berkley Ln, Rye Brook, NY
Phone# Cell# 516-314-1385 -e-mail evan.sakofsky@gmail.com
Engineer:
Address:
Phone# Cell# e-mail
General Contractor:
Address:
Phone# Cell# e-mail
(1)
3/21/19
5. Occupancy;(I-Fam.,2-Fam.,Commercial.,etc...)Pre-construction: 1-Fam Post-construction: 1-Fam
6. Area of lot: Square feet: 12,484 Acres: 0.29
7. Dimensions from proposed building or structure to lot lines: front yard: 44.0'(porch) rear yard: N/A
right side yard: 25.7'(porch) left side yard: N/A 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: I'fl: 2"d fl: 31 fl:
10. Total Square Footage of the proposed new construction:
11. For additions,total square footage added:Basement: I'fl: 2"d fl: 3rd fl:
12. Total Square Footage of the proposed renovation to the existing structure:
13. N.Y.State Construction Classification: V-B N.Y.State Use Classification: R-3
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: stone veneer(vertical surfaces), bluestone(horizontal surfaces)
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: X
(rf 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:X Area:
22. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code?
Yes: No: X (rfyes,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:.X
(rf yes,you must submit a Site Plan Application,&provide a detailed topographical survey)
24. Is the lot located within 100 ft.of Wetland as per§245 of Village Code? Yes: No: X
(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: X
(tf yes,the area and elevations of the,Jlood 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:X
('ryes,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: X
Indicate: TIER 1: TIER 11: TIER III: (rfyes,a Home Occupation Permit Application is required)
28. List all zoning variances granted or denied for the subject property:
16.84'rear yard setback relief for deck,granted 02/06/2018
29. What is the total estimated cost of construction: $ 23,500 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 thefinal cost exceeds the estimated cost,an additional fee will be required prior to issuance of the CIO.
30. Estimated date of completion: November 2020
(2)
3/21/19
BUILDING DEPARTMENT RFnr%
VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK NY 10573 T 7 20:
(914)939-0668 Fax(914)939-5801
VILLAGE OF RYE BROOK
www.ryebr�ook;yrg BUILDING DEPARTMENT
www.nWtaok.org
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 YOM COUNTY OF WESTCHESTER ) as:
3, a -r. , �� , residing at, L 1 J,,y,-!;�a Lj'f::J'.
(Print n mN (:Addres: erC you lire)
being duly sworn, deposes and states that (s)he is the applicant above named, and further states that (s)he is the
legal owner of the property to which this Affidavit of Compliance pertains at;
45 M a�l e L", , Rye Brook, NY.
(.Ioh: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.
ncv �LL
(Signature of Prulxm}O\v crO— 2,3k,� P_.2-.-A - *- � L
C i
(Print NameofProfvrty ner(J
Sworn to before me this Sty
day of DC{ )kV Y_ , 20,�LU
(A"04wc"
(Notan PLINIC)
MITAR MARKOVIC
Notary Public,State of New York
Reg.No.40 nester n Z
Qualified in Westchester C
Commission Expiros O L (6)
3/21/19
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.
***xxxxxKYrx>,:xxx*x**xxxxx****,�xxxrxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxrxxxxxxxxxxxxxxxxxxx�xx*xxxxxxxxxxxxxx
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
Enka SAKoFSKy ,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
A9zKtmuy- 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 stormwater or
groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property.
Sworn to before me this Sworn to before me this 3 ra!
day of 0C4GbC.V , 20, V day of er , 20 .Z-a
jL�
Signature of Pr er Signature of Applicant
1
tE,�1 _ (_ ("a w r a .Van
Print Name of Pro , y Print Name of Applicant
A;4—
Notary Public Notary Public
MITAR MARKOVIC RICHARD SAKOFSKY
Notary Public,State of New York Notary Public,State of New York
Reg.No.400359691 No.02SA4673567
Qualified in Westchester County Qualified in Nassau County q,L 3
Commission Expims OS/ L22 Cnmmission Expires February 28, ?
(Kl
3/21/19
--------+
.Boil Permit Check List&Zoning Analysis I — —
Address: SBL: -!
Zone: a.—V---Use: Const.Type: Other.
Submittal Date: 207 R�visions Submittal Dates:
Applicant f C,
Nature of Work: — (-rooV E C 1 TY
Reviews:ZI T'D BOT• Other.
( ( FEES:Filing. V23 BP:��� C/O: Flood Plane: Legalization:
( ) ( ) APP: 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:
( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmt.: Tree Plan: Other.
( ) ( ) SURVEY:Dated: Current Archival:- Sealed: Unacceptable:
( ) ( ) PLANS:Date Stamped Sealed: Copies: Electronic: ether.
License Workers Comp: Liability. �6mp.Waiver. Other.
O O CODE 753#. 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 2¢20 NY State ECCC: N/A: Other.
( ) (, /Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other.
( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other.
( ) ( ) Other.
( )ARB mtg.date: approval• notes:
( )ZBA mtg.date: approval• notes:
( )PB mtg.date: approval• notes: APPROVED
REQUIRED EXISTING PROPOSED NOTES NOW 1 r 2M
Circic
]�24�
Front
gl3t
Main Cov
Accs.Cov
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Sd.H
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:
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notes:
PAGE 1
WS M MAIL-GENR-I
US" HOMEOWNERS POLICY PACKET
EFFECTIVE: 08-04-23 TO: 08-04-24
CARLEEN A YBARRA
CSM USA
45 MOHEGAN LN
RYE BROOK NY 10573-1431
USAA 0150132 81 90A
IMPORTANT MESSAGES
Refer to your Declarations Page and endorsements to verify that coverages, limits, deductibles and other
policy details are correct and meet your insurance needs. Required information forms are also enclosed
for your review.
1) USAA considers many factors when determining your premium. Maintaining your
property to reduce the probability of loss is one of the most important steps
you can take toward reducing premium increases. A history of claim activity will
affect your policy premium.
2) Go to usaa.com to view policy coverages and home features.
3) Your policy does NOT cover loss due to flood from any source. For information about
obtaining flood coverage from the National Flood Insurance Program (NFIP) , call USAA
at (800) 531-8722, or contact the NFIP directly.
If you already have a flood policy, you should review it to make sure you have the
appropriate coverage and limits. No automatic increases or adjustments are applied to
your policy. Coverage for loss of household contents due to flood may be available at
an additional cost. If you have questions, please call a member service
representative at the phone number above.
This is not a bill. Any premium charge or return for this policy will be reflected on your next regular
monthly statement.
To receive this document and others electronically or view your policy summary online, go
to usaa.com.
For U.S. Calls: Policy Service (800) 531-81 11. Claims (800) 531-8222.
HOCS1 49709-0406
PACE 3
UNITED SERVICES AUTOMOBILE ASSOCIATION MAIL-GENR-I
USAA"* 9800 Fredericksburg Road - San Antonio, Texas 78288
RENEWAL DECLARATIONS PAGE
Named Insured and Residence Premises Policy Number
DAVID E YBARRA AND CARLEEN A YBARRA USAA 01501 32 81 90A
45 MOHEGAN LN
RYE BROOK, WESTCHESTER, NY 10573-1431
Policy Period From: 08/04/23 To: 08/04/24
(12:01 A.M. standard time at location of the residence premises)
SECTION I - COVERAGES AND AMOUNTS OF INSURANCE
COVERAGE A - DWELLING PROTECTION $577, 000
COVERAGE B - OTHER STRUCTURES PROTECTION $57,700
COVERAGE C - PERSONAL PROPERTY PROTECTION $432, 750
COVERAGE D - LOSS OF USE PROTECTION (UP TO 12 MONTHS) $115,400
SECTION II - COVERAGES AND LIMITS OF LIABILITY
Personal Liability — Each Occurrence $500, 000
Medical Payments to Others $5,000
DEDUCTIBLES (Applies to SECTION I Coverages ONLY)
We cover only that part of the loss over the deductible stated.
HURRICANE $11, 540 (20)
ALL OTHER PERILS $2,000
POLICY PREMIUM for Section I and Section II Coverages Above $2,682.93
CREDITS AND DISCOUNTS (Included in policy premium above.) $850.24 CR
Details on the following page. (If applicable)
OTHER COVERAGES AND ENDORSEMENTS $19.57
Forms and Endorsements are printed on the following page.
STATE SURCHARGES AND TAXES (Shown below if applicable)
TOTAL POLICY PREMIUM
Including Credits, Discounts, Optional Coverages, Endorsements, State Surcharges and Taxes
$2,702.50
PREMIUM DUE AT INCEPTION. THIS IS NOT A BILL. STATEMENT TO FOLLOW.
FIRST MORTGAGEE:
JPMORGAN CHASE BANK, N.A. , LOAN NR 1394539866
ISAOA/ATIMA
PO BOX 4465
SPRINGFIELD, OH 45501-4465
In witness whereof, this policy is signed on 06/05/23
411—
j0'(
Wayne Peacock
President,USAA Reciprocal Attorney-in-Fact,Inc.
REFER TO YOUR POLICY FOR OTHER COVERAGES, LIMITS AND EXCLUSIONS.
HO-D1 (07-08) ATTACH THIS DECLARATION TO PREVIOUS POLICY 87028-0708
/� PAGE 4
'NN'� UNITED SERVICES AUTOMOBILE ASSOCIATION
USAA© RENEWAL DECLARATIONS PAGE
Policy Number Policy Term: 08/04/23 08/04/24
USAA 01501 32 81 90A Inception Expiration
POLICY AND ENDORSEMENTS THAT ARE PART OF YOUR CONTRACT WITH US.
REMAIN IN EFFECT (Refer to prior Policy Packet (s) for documents not attached.) :
QR3 (02) (07-08) QUICK REFERENCE-SPECIAL FORM
HO-3R (02) (07-08) HOMEOWNERS SPECIAL FORM
HO-ACP (07-12) AMENDMENT TO CONTRACT PROVISIONS
HO-NY (08-17) NEW YORK SPECIAL PROVISIONS
HOSLS3 (02) (07-08) SPECIAL LOSS SETTLEMENT
NY HHO (01-15) NEW YORK HURRICANE ENDORSEMENT
HO-125 (07-08) HOME PROTECTOR
HO-208 (07-12) WATER BACKUP OR SUMP PUMP OVERFLOW
HO-728 (07-12) REPLACEMENT COST COVERAGE
HO-82NY (07-08) PERSONAL INJURY LIABILITY $19.57
ADDED:
HO-176NY (07-08) NEW YORK HOMEOWNERS RATING INFORMATION
HO-90NY (07-08) NEW YORK WORKERS COMPENSATION
YOUR PREMIUM HAS BEEN REDUCED BY THE FOLLOWING CREDITS AND DISCOUNTS:
AUTO AND HOME COMBINATION DISCOUNT $289. 16 CR
INSURANCE-TO-VALUE DISCOUNT $135.94 CR
HOME AGE DISCOUNT $397.29 CR
PROTECTIVE DEVICE CREDIT $27.85 CR
110-132 (07-08) 06/05/23
87029-0708
PAGE 5
USAA 01501 32 81 90A
HO-176NY (07-08)
HOMEOWNERS RATING INFORMATION - NEW YORK
Effective Date: 08/04/23 Expiration Date: 08/04/24
Form: HO-3R(02) (07-08)
Square Footage: 2578
Home Age: 66
Construction: FRAME
Roof Type: FIBERGLASS
Territory: 79
Protection: 4
Fire Department: 2 miles
Tier (Relationship Level): 31
Deductible: HURRICANE $11,540
ALL OTHER PERILS $2,000
Copyright, USAA, 2008. All rights reserved.
91282-0709
HO-176NY (07-08) Page 1 of 1
PAGE 6
USAA 01501 32 81 90A
HO-90NY (07-08)
WORKERS' COMPENSATION - NEW YORK
Certain Residence Employees
We agree, with respect to covered "residence The covered "residence employee's" last day
employees": of last exposure to the conditions causing or
aggravating such "bodily injury" by disease
Who Is Covered must occur during the policy period.
A covered "residence employee" under this Policy Provisions
endorsement is a "residence employee" who
is engaged in regular employment of less than This insurance is subject to all the provisions of
40 hours per week or is engaged in casual this endorsement and the following provisions
employment. of this policy:
However, as stated in New York Insurance Law a. Under Sections I and 11—Conditions:
section 3420 (i)(1), coverage does not apply to
an employee who is not required, under New 3. Waiver or Change of Policy Provisions.
York Workers' Compensation Law, to be 4. Cancellation.
covered. Attachment of this endorsement does
not constitute a voluntary election of coverage 6. Subrogation.
under New York Workers' Compensation Law. 8. Assignment.
Under Coverage I b. Under Section ll—Conditions:
To pay when due all benefits required of an 4. Duties After Loss.
"insured" by the New York Workers'
Compensation Law; and 7. Suit Against Us.
Under Coverage II 8. Bankruptcy of an Insured.
To pay on behalf of an "insured" all damages c. Our agreement to defend the "insured" as
for which the "insured" is legally liable provided under Coverage E—Personal
because of "bodily injury" sustained by a
Liability.
covered "residence employee". The "bodily d. Under Section 11—Additional Coverages:
injury" must be caused by accident or disease
and arise out of and in the course of 1. Claim Expenses.
employment by the "insured" while:
The definition of "bodily injury",
a In the United States of America, its e. "business", "insured" and "residence
territories or possessions, or Canada, or employee."
b. Temporarily elsewhere if the covered Additional Provisions Applicable to
"residence employee" is a citizen or Coverage I
resident of the United States or Canada.
Application of Coverage The following provisions are applicable to
Coverage I:
This insurance applies only to "bodily injury" a. As between the covered "residence
which occurs during the policy period. If the employee" and us, notice to or knowledge
"bodily injury" is a disease, it must be caused of the "occurrence" of the injury on the
or aggravated by the conditions of the covered part of an "insured" will be deemed notice
"residence employee's" employment by the"insured". or knowledge on our part.
91222-0709
HO-90NY (07-08) Page 1 of 2
PAGE 7
USAA 01501 32 81 90A
b. The jurisdiction of an "insured" will, for Exclusions
the purpose of the law imposing liability for
compensation, be our jurisdiction. This policy does not apply:
Additional Provisions Applicable to a. To liability for "bodily injury" arising out
Coverage II of "business" pursuits of an "insured."
Coverage II does not apply to any suit brought b. Under Coverage II:
in or judgment rendered by any court outside
the United States of America, its territories and 1. To liability assumed by the "insured"
possessions, or Canada, or to any action on under any contract or agreement.
such judgment. 2. To any obligation under a workers'
compensation, unemployment or
Limits of Liability Coverage II disability benefits law or any similar law.
We may not limit our liability to pay damages 3. To punitive or exemplary damage
for which we become legally liable to pay because of "bodily injury" to a
because of "bodily injury" to an "insured's" covered "residence employee"
covered "residence employees" if the employed in violation of law.
"bodily injury" arises out of and in the course 4. To "bodily injury" to a covered
of employment that is subject to and is "residence employee" employed in
compensable under the Workers' Compensation violation of law with the knowledge of
Law of New York. an "insured."
Other Insurance 5. To "bodily injury" intentionally caused
or aggravated by an "insured."
If a loss covered by this insurance is also 6. To damages arising out of the unlawful
covered by other insurance, we will not pay discharge or coercion of, or unlawful
more than our share of benefits and costs. The discrimination against, a covered
shares of all applicable insurance will be equal "residence employee."
until the loss is paid. However, if a loss
covered by this insurance is also covered by Except as specifically modified in this
insurance written to cover "business" endorsement, all provisions of the policy to
employees of an "insured" who is a sole which this endorsement is attached also apply
proprietor, this insurance is primary. to this endorsement.
Conformity to Statute
If any term of this insurance is in conflict with
the New York Workers' Compensation Law,
such term is amended by this statement to
conform to that law.
Copyright, USAA, 2008. All rights reserved.
Includes copyrighted material of Insurance Services Office, with its permission.
HO-90NY (07-08) Page 2 of 2
PAGE 8
USAA 01501 32 81 90A
USAA®
CREDIT DISCLOSURE NOTICE
As part of our normal underwriting process, we use a credit-based insurance
score in addition to traditional underwriting factors to determine the premium for
your property insurance policy.
This score uses information from the primary policyholder's credit report to help
predict the likelihood of future losses.
Typical items from a credit report that could affect a credit-based insurance score
include, but are not limited to, the following:
• Payment history
• Number of revolving accounts
• Number of new accounts
• Presence of collection accounts
• Bankruptcies
• Foreclosures
LexisNexis was the consumer reporting agency that provided the information used
to develop the insurance score.
UNITED SERVICES AUTOMOBILE ASSOCIATION
9800 Fredericksburg Road • San Antonio, Texas 78288 • 1-800-531-USAA (8722)
60676-0312
CDI-NYP02 Rev. 03-12 Page 1 of 1
PAGE 9
USAA 01501 32 81 90A
New York Hurricane Deductible Program
In addition to your All Other Perils deductible, your policy also contains a separate deductible for
hurricane losses. Your policy covers damage due to windstorm during a hurricane. It does not cover
damage caused by storm surge or flooding. Flood insurance may be purchased to cover this type of
damage. The Hurricane deductible applies only to losses caused by, or resulting from, a windstorm
during a hurricane, and may be higher than your All Other Perils deductible. This means, in the event of
a hurricane loss, your out-of-pocket expenses will be greater. The Hurricane deductible is mandatory
and cannot be removed from your policy.
About your Hurricane deductible
• The deductible can be either a fixed dollar amount or a percentage. A percentage deductible is
based on the Coverage-A Dwelling limit of liability. The Declarations page lists both the percentage
and the corresponding dollar amount of the hurricane deductible.
• If you have a percentage deductible, it will increase when your dwelling limit of liability is increased
due to inflation protection. Increases also occur if you make improvements or request a change to
your dwelling limit of liability.
• Non-hurricane windstorm losses are not subject to the Hurricane deductible. The All Other Perils
deductible will apply for non-hurricane losses.
When your Hurricane deductible is activated
• Your Hurricane deductible activates when the National Hurricane Center of the National Weather
Service declares a Category 1, 2, 3, 4 or 5 hurricane with sustained wind of at least 74 miles per
hour.
• Activation begins 12 hours before, and ends 12 hours following a hurricane declared anywhere in
the coastal counties of Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk, and
Westchester, regardless of the specific location of your property.
Coverages to which your Hurricane deductible applies
• Coverage A-Dwelling.
• Coverage B-Other Structures.
• Coverage C-Personal Property (if included on the policy).
The deductible applies to the entire loss, not each coverage separately.
61490-0914 01
NY HUR1 (Rev. 01-15) Page 1 of 2
PAGE 10
USAA 01501 32 81 90A
Here are examples of how your Hurricane deductible works in the event of a hurricane loss:
Policy coverages and deductibles
Coverage A - Dwelling $300,000
Hurricane deductible 2% (2% X $300,000) $ 6,000
Hurricane loss scenario 1 Hurricane loss scenario 2
Total covered damage $30,000 Total covered damage $3,500
Hurricane deductible-2% - $6,000 Hurricane deductible-2% $6,000
(your out-of-pocket expense) (your out-of-pocket expense)
Amount recovered from $24,000 Amount recovered from $0
insurance insurance
The entire loss is your out-of-pocket
expense since your damage is less than
your Hurricane deductible.
If you are interested in changing your deductibles or have questions about your policy, please call a
member service representative at (800) 531-8 1 1 1. If you wish to purchase coverage for storm surge
or flooding during a hurricane, please contact USAA Flood Operations at (800) 531-8444. Please read
your policy for the specific terms, conditions, exclusions, limitations and provisions.
NY HUR1 (Rev. 01-15) Page 2 of 2
• PAGE 11
USAA 01501 32 81 90A
IMPORTANT FLOOD INSURANCE NOTICE
Your homeowners or dwelling policy does NOT provide coverage for loss caused by flood or
mudslide, which is defined, in part, by the National Flood Insurance Program as:
A general and temporary condition of partial or complete inundation of normally dry land areas
from overflow of inland or tidal waters or from the unusual and rapid accumulation or runoff of
surface waters from any source.
If you are required by your mortgage lender to have flood insurance on your property, or if you feel
that your property is susceptible to flood damage, insurance covering damage from flood is available
on most buildings and contents in participating communities through the National Flood Insurance
Program.
Information about flood insurance and whether your community participates in the program can be
obtained from the USAA Flood by calling 800-531-8722 or directly from the National Flood
Insurance Program by calling (800) 638-6620 or via their website at http://www.floodsmart.gov.
25288-0220
25288 Ed. 2-20 Pagel of 1
PAGE 12
USAA 01501 32 81 90A
THIRD PARTY INSURANCE NOTIFICATION DESIGNEE
NEW YORK
A NAMED INSURED WHO IS 65 YEARS OF AGE OR OLDER AND A RESIDENT OF NEW YORK
STATE IS ENTITLED TO DESIGNATE A THIRD PARTY TO RECEIVE ANY CANCELLATION,
NONRENEWAL OR CONDITIONAL RENEWAL NOTIFICATIONS INVOLVING THIS NEW YORK
INSURANCE POLICY. SUCH NOTIFICATIONS WILL BE MADE TO THE DESIGNEE IN ADDITION TO
ANY NOTIFICATIONS MADE TO YOU, THE NAMED INSURED.
SHOULD YOU QUALIFY AND ARE INTERESTED IN APPOINTING SUCH A DESIGNEE, PLEASE
CONTACT US. YOU MAY CALL 1-800-531-8111. ADDITIONAL INFORMATION WILL BE MAILED
TO YOU.
NEW YORK INSURANCE LAW PROVIDES WE MAKE THIS NOTIFICATION ANNUALLY. YOU NEED
NOT CONTACT US IF YOU HAVE ALREADY APPOINTED A DESIGNEE. NATURALLY, PLEASE FEEL
FREE TO CONTACT US SHOULD YOU NEED TO CONFIRM OR MAKE ANY CHANGES TO YOUR
DESIGNEE.
40NY(O 1) 3-91
PAGE 13
USAA 01501 32 81 90A
CHARACTERISTICS OF YOUR HOME
Our mission at USAA is to help protect your financial security. We calculate the minimum estimated
rebuild cost of your home based on your home characteristics, but only you can decide if this is
enough coverage. Our estimates are based on average construction costs and labor costs for
geographic areas and may not reflect the unique features of your home or the area you live in.
On the back of this page, you'll find your home characteristics. If any of the information is incorrect,
the rebuilding cost may be affected, so please revise any inaccuracies by:
• Logging on to usaa.com, selecting your policy and then Home Characteristics, or
• Calling us at 210-531-USAA (8722), our mobile shortcut #8722 or 800-531-8722.
Should I adjust the coverage on my flood or wind policy?
If you have a separate flood or wind policy for this property, please call your agent or insurer to
confirm that your coverage is adequate. For flood or wind policies serviced by the USAA Insurance
Agency, please call us at the numbers listed above. Wind coverage is available in Alabama, Florida,
North Carolina, South Carolina, Texas and Mississippi.
60321-1022
60321(05) Rev. 10-22 Page 1 of 2
PAGE 14
USAA 01501 32 81 90A
CHARACTERISTICS OF YOUR HOME
YEAR BUILT: 1957
*TOTAL SQUARE FOOTAGE : 2002
NUMBER OF STORIES : TRI-LEVEL
*Total Square Footage:
Includes: Additions and Finished Attic Space
Excludes: Basements and Built-in or Attached Garages
GENERAL SHAPE AND STYLE : STANDARD
EXTERIOR FINISHES & FEATURES: STANDARD
INTERIOR FINISHES & FEATURES: UPGRADED
KITCHENS AND BATHS : UPGRADED
EXTERIOR WALL CONSTRUCTION: SIDING - CEMENT FIBER (CLAPBOARD)
FOUNDATION TYPE: SHALLOW BASEMENT
ROOF TYPE: COMPOSITION - ARCHITECTURAL SHINGLE
YEAR ROOF INSTALLED/REPLACED: 2011
GARAGE OR CARPORT TYPE/STYLE: ATTACHED/BUILT-IN - 2 CAR
FLOOR COVERING MATERIALS : HARDWOOD - PLANK, TILE - MARBLE/GRANITE,
TILE - CERAMIC, TILE - TRAVERTINE
KITCHEN COUNTERS: SOLID SURFACE COUNTERTOP
NUMBER OF BATHROOMS : FULL
FIREPLACES : 1
60321(05) Rev. 10-22 Page 2 of 2
Affidavit of Exemption to Show Specific Proof of Workers' Compensation Insurance
Coverage for a 1, 2, 3 or 4 Family, Owner-occupied Residence
**This form cannot be used to waive the workers'compensation rights or obligations of any party.**
Under penalty of perjury, I certify that I am the owner of the 1, 2, 3 or 4 family, owner-occupied residence
(including condominiums) listed on the building permit that I am applying for, and I am not required to show
specific proof of workers' compensation insurance coverage for such residence because (please check the
appropriate box):
❑ I am performing all the work for which the building permit was issued.
❑ I am not hiring,paying or compensating in any way,the individual(s)that is(are)performing all the work
for which the building permit was issued or helping me perform such work.
❑ I have a homeowners insurance policy that is currently in effect and covers the property listed on the
attached building permit AND am hiring or paying individuals a total of less than 40 hours per week
(aggregate hours for all paid individuals on the jobsite) for which the building permit was issued.
I also agree to either:
♦ acquire appropriate workers' compensation coverage and provide appropriate proof of that coverage on
forms approved by the Chair of the NYS Workers' Compensation Board to the government entity issuing
the building permit if I need to hire or pay individuals a total of 40 hours or more per week(aggregate hours
for all paid individuals on the jobsite)for work indicated on the building permit,or if appropriate,file a CE-
200 exemption form; OR
♦ have the general contractor, performing the work on the 1, 2, 3 or 4 family, owner-occupied residence
(including condominiums)listed on the building permit that I am applying for,provide appropriate proof of
workers' compensation coverage or proof of exemption from that coverage on forms approved by the Chair
of the NYS Workers' Compensation Board to the government entity issuing the building permit if the
project takes a total of 40 hours or more per week(aggregate hours for all paid individuals on the jobsite)for
work indicated on the building permit.
l
(Signature of Homeowner) (Date Signed)
►J�f(U` Home Telephone Number
(Homeowner's Name Printed)
Lounty
fore me this �S day of
Property Address that requires the building permit: t"
rk of Notary Prrblie)
HARI MELILLO
ublic,state of New York
.O1ME6160063
in Westchester County
Expires January 29,20
Once notarized,this BP-1 form serves as an exemption for both workers'compensation and disability benefits insurance coverage.
BP-1 (12/08) NY-WCB
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ARCH I T E C T
45 MOHEGAN LANE RYE BROOK , NEW YORK
11 Berkley Lane
GENERAL NOTES ZONING ANALYSIS Rye Brook•New York
10573
1 ALL WORK SHALL CONFORM TO THE NEW YORK STATE UNIFORM FIRE PREVENTION AND BUILDING CODE INCLUDING \ ZONING COMPLIANCE TABLE 516.314.1385
THE 2020 RESIDENTIAL CODE OF NEW YORK STATE(2020 RCNYS),THE 2020 ENERGY CONSERVATION CODE OF NEW \ 45 MOHEGAN LANE,RYE BROOK,NY,10573
YORK STATE(ECCNYS),THE 2020 PLUMBING CODE OF NEW YORK STATE(2020 PCNYS),THE 2017 NATIONAL ELECTRIC
CODE(NFPA 70-2017),LOCAL HEALTH DEPARTMENT REGULATIONS AND ALL OTHER APPLICABLE REGULATIONS BY \ ZONE RESIDENCE R-12
AUTHORITIES HAVING JURISDICTION
A SHOULD THERE BE ANY INFORMATION SUPPLIED ON OR OMITTED FROM THE DRAWINGS OR IN THE SPECIFICATIONS REGULATION REQUIRED/
THAT INADVERTENTLY DOES NOT COMPLY WITH CODE,THE CONTRACTOR SHALL BRING THE MATTER TO THE IMMEDIATE PERMITTED EXISTING PROPOSED
ATTENTION OF THE ARCHITECT AND RESOLVE IT BEFORE ANY CONSTRUCTION AFFECTING THIS MATTER BEGINS.
B.SHOULD THE CONTRACTOR KNOWINGLY CONSTRUCT ANYTHING IN NON-COMPLIANCE WITH ANY CODE WITHOUT
CONSULTING BEFORE HAND,THE CONTRACTOR SHALL BEAR FULL RESPONSIBILITY FOR CORRECTING THE MINIMUM LOT AREA 12,500 S.F. 12,484 S.F. 12,484 S.F.
CONSTRUCTION TO COMPLY WITH ALL LOCAL AND STATE CODES AND AT NO ADDITIONAL COST TO THE OWNER,EVEN IF MINIMUM FRONT YARD 35.0' 39.4' 39.4'
THE DRAWINGS OR SPECIFICATIONS CAN BE SHOWN TO CALL OUT NON-COMPLYING SITUATIONS. /
2.SHOULD UNFORESEEN CONDITIONS OR OTHER CAUSES NECESSITATE CONSTRUCTION DETAILS NOT IN ACCORDANCE / \ MINIMUM REAR YARD 35.0' 18.5' 18.5'
WITH THESE PLANS,THE CONTRACTOR SHALL NOTIFY THE ARCHITECT AND SUBMIT HIS DETAILS SHOWING THE PROPOSED MINIMUM ONE SIDE YARD 15.0' 14.4' 14.4'
METHODS TO ACCOMPLISH THE REQUIRED RESULTS.PATCH,REPAIR AND FINISH OF ALL DISTURBED AREAS. / \
3.VERIFY ALL DIMENSIONS IN THE FIELD.DISCREPANCIES BETWEEN ACTUAL CONDITIONS AND DRAWINGS AND/OR / \ MINIMUM TOTAL SIDE YARDS 40.0' 38.6' 38.6'
SPECIFICATIONS SHALL BE REPORTED TO THE ARCHITECT IN WRITING FOR CLARIFICATION.WORK SHALL NOT PROCEED
UNTIL SUCH CLARIFICATION HAS BEEN RECEIVED. / \ MAXIMUM IMPERVIOUS COVERAGE 4,650 S.F. 3,638 S.F. 3,648 S.F.
4.INSPECT THE PREMISES AND VIEW THE EXISTING CONDITIONS TO VERIFY ALL CONDITIONS,SIZES AND QUANTITIES.PLANS / MAX FRONT YD.COVERAGE 1,580 S.F.(40%) 1,075 S.F.(27%) 1,085 S.F.(27%)
ARE FURNISHED TO INDICATE THE SCOPE OF THE INTENDED CONTRACT WORK.EXISTING CONDITIONS WHICH MIGHT \
PRECLUDE OR INTERFERE WITH THE PROPOSED WORK AS DRAWN OR SPECIFIED SHALL BE BROUGHT TO THE ATTENTION / \ MINIMUM USABLE OPEN SPACE 1,200 S.F. >1,200 S.F. >1,200 S.F.
OF THE ARCHITECT AND OWNER FOR RESOLVING.RELOCATIONS MUST BE CHECKED TO VERIFY THEIR FEASIBILITY IN
ACCORDANCE WITH THE NEW REQUIREMENTS.
5.WRITTEN DIMENSIONS ON THE DRAWINGS SHALL HAVE PRECEDENCE OVER SCALED DIMENSIONS.VERIFY ALL DIMENSIONS W
AND CONDITIONS INDICATED ON THESE DRAWINGS. / \
8.ADEQUATELY BRACE AND PROTECT ALL WORK DURING CONSTRUCTION AGAINST DAMAGE,BREAKAGE,COLLAPSE, / O
DISTORTIONS AND MIS-ALIGNMENT ACCORDING TO APPLICABLE CODES,STANDARDS AND GOOD PRACTICE. /
7.MANDATORY INSPECTIONS:MANDATORY INSPECTIONS SHALL COMPLY WITH THE REQUIREMENTS OF THE AUTHORITIES / \
HAVING JURISDICTION.VISIT THE PROJECT SITE TO INSPECT THE SCOPE OF THE WORK IN RELATION TO THE EXISTING W
CONDITIONS. /
8.THE TERM°PROVIDE"MEANS TO"FURNISH"AND"INSTALL".
9.THE TERM'FURNISH'MEANS TO SLIPPY REQUIRED COMPONENTS AND DELIVER TO PROJECT SITE. /
10.THE TERM'INSTALL'MEANS TO INSTALL ALL REQUIRED ITEMS. / , z
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(MPH) CATEGORY TEMP REQUIRED INDEX TEMP
20 PSF 115 MPH C SEVERE 42' MOD TO HW 7 F YES LOCAL <1500 50 F /
yyy�
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REQUIRED 4A 035 055 0.40 49 20 OR 13+5 8/13 19 10/13 10/2 FT 10/13ij 4.,N 16
PROVIDED 4A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A \
01 OF 02
Evan Sakofsky
ARCH I T E C T
EXISTING HOUSE 11 Berkley Lane York
EXISTING ROOF Rye Brook New
EXISTING EAVE 10573
516.314.1385
EXISTING WALK NEW BLUESTONE TREADS&PORCH WITH
NEW THINSTONE VENEER APPLIED TO EXISTING FRONT DOOR
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\ / GENERAL RETAINING WALL NOTES
EXISTING HOUSE I I —————— 1. REINFORCING STEEL TO HAVE A MINIMUM YIELD STRENGTH OF 60 KSI
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REVISION DATE: REVISION NO.:
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