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HomeMy WebLinkAboutTP23-002PERMIT #�/"��- �0 DATE: lc� 3 c r cP: Ala SECTION %31c r o7� _ BLOCK LOT TYPE OF WORK _ e t JOB LOC T10N I OWNER IV n CONTRACTOR 4A4411 EST. CO # FEE TCO # FEE DATE INSPECTION RECORD DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS LO SPRINKLER ELECTRIC LOW -VOLT 0 ALARM 0 AS BUILT L� FINALIN I million I NSP `0I/) T 9/4 &1117960 Sys 3 98--98a? pTHFR APPROVALS QyE DR 190 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J.Bradbury www.ryebrook.org TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE January 12,2024 David Lowenstein&Myra Lowenstein 802 King Street Rye Brook,New York 10573 Re: 802 King Street, Rye Brook,New York 10573 Parcel ID#: 136.21-1-12 Tent Permit#23-002 issued on 10/3/2023 to Install One Temporary Tent This certifies that the temporary tent installed under the above captioned permit has been satisfactorily removed. Sincerely, *;- 4 Steven E. Fews Building& Fire Inspector /to �E BR(�k, 2m • 1932 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street . Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS:- 801 h I j G L I DATE: 16 - 2 OZ V PERMIT# Z 3-D U Z ISSUED: SECT: /2 6• '/ BLOCK: / LOT: /Z LOCATION: Rt &-i `1(i_/I_C OCCUPANCY' �U ❑ Violation Noted THE WORK IS... PASSED ❑ FAILED REINSPECTION 3--SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION / ❑ Natural Gas Re��O t/P c - ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER N a 44 En w n w 4 N w H d V M h 400" T A : 0z � W o z M � � .� I--� m w � r, z � • o = p A w w A rA z � ic O04% � Oco `./ cm 00 w �o1-0 g U ri H00A W W ° R EC� E�WF�-. BUILD MENT I 3D SEP :2 :1:2:023] VIL ) E OF RY OOK 938 KINI ET Ryk BR, ,NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT TENT/ CANOPY / MEMBRANE STRUCTURE PERMIT APPLICATION FOR OFFICE USE ONLY: Approval Date: OCT Pg lit#� '00�'Application Fee: $ Approval Signature: Permit Fee: $ E)n' U Disapproved: Other: Application dated: is hereby made to the Building Inspector for the issuance of a Permit to place a Tent.Canopy,or other Fabric or Membrane Structure on public or private property within the Village of Rye Brook in conformance with Chapter 31 of the NY State Fire Code as per detailed statement described below. QQ f 1. Job Address: 802 King Street,Rye Brook,NY 10573 SBL: 13(p i c)/4 one: )C- 5 2. Business/Property Use: Residential NYS Use Class: 3. Property Owner: Myra Loewenstein Address: 802 King Street Phone#: Cell#: 914.659.7950 email: myraloew@gmail.com 4. Applicant: Address: Phone#: Cell #: email: 5. Tent Company: All State Party and Tent Rental Address: 170 S.Main St New City NY 10956 Phone#: 845-398-8888 Cell #: email: info@allstateparty.com allstateparty.com 6. Number, Size(s)&Use(s)of Tent/Canopy: 1 3000 tent 7. Exact Location(s)of Tent/Canopy: Loewenstein back yard at 802 King Street below walnut tree in flat grassy area 8. Installation Date: October 3-4,2023 Removal Date: October 8-9,2023 9. HVAC Required:No:(N•Yes:( )Describe: 10. Electrical Required:No:(X)•Yes:( }Describe: only using string lights connected to external home outlet 11. Plumbing/Sanitary Required:No:(N•Yes: ( )Describe: 12. Cooking Equipment:No Yes( )Describe: I 8/12/2021 STATE OF NEW YOR C,COUNTY OF WESTCHESTER ) as: !)k I V7A_ Lwyx -e y�Cj" , being duly sworn, deposes and states that he/she is the applicant above named, (print i ame 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. Swore to before me this Sworn to before rite this day of , 20 day of 20 Signature of Propery. O_w^n Signature of Applicant ki�Seri_ �C�',l l.e Irt-q<-IVA Print NNa e of Property Owner Print Name of Applicant V tr'tn— ►-tit Notary Puhlic a ��� Notary Public NOTAKY PL115M STATE OF NEW YM Re istration Number#01 AR62905--46 Qualified i.Westcltester County Commission Expires Oct. 15„mat.¢ This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. Please note that application fees are non-refundable. 2 s/1212021 Building Permit Check List&Zoning Analysis Address: V v `l 1 SBL: Zone (,+ l Use: Z 1 Cont.T e: V Other: Submittal Date 2 ZV Lvision Submittal ates: Applicant: U 1, (;� :1 Nature of Work: C `a C_ _ � Reviews•ZBA• S E P 2 9 2023 PB. BOT• Other. NEED OK i ( ) ( ) FEES:Filing. BP �� ��- C/O Flood Plane: Legalization: ( ) (V 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 Other. ( ) ( ) License Workers Comp: Liability: Comp.Waiver. Other: ( ) ( ) CODE 753#: Dated; N/A: ( ) ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit N/A Other- LOW-VOLTAGE ELECTRICAL:Plan: 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. ( ) ( ) Other. ( )ARB mtg. date: approval• notes: ( )ZBA mtg.date: approval• notes: ( )PB mtg.date: approval• notes: REOLMED EX19I'ING PR P NOTES APPROVED cirde: �`� per; CC T i! 3 0? FropW C- Fromu Front: Sides: 13� Main Cov Accs.Co Ft.H Sb: S . Sb: S� Tot: Fc Imp P k'n Htight/Stories: notes: CCU,\,a_o rt*_f GtN Jr \\-Z)Me cXX)Cjqy 2Q 2 "C S\fie 4 lS rcU Ix' F' � A '\ ) T J•,A ) )Inn J i -- a � � 1 "" o w wrK ' iF E Q N --- w = C \ Q Q �./ � M a C Z ~ C .0 Q Q (0 Q • � m Oa) ,U 2 C Cam/, v L b L a >, C > C) L O L Cl LL VN m o MMai N 0 cY) p cu Q m N l >-' U ll N a U z a ro Q 3 O Q0 co CO z cu o W a) J J o o CQ o o L1 a O .1 a) ~ ti N O D LL ® N o (T3 � O V V O v Q LO tl= fl W co C o m c -p Vw z o Q IL Z LJJ 4 _ d m w 4jEE (�!) z d Q) O Q Q LL -- w ^a a � W 2 '�^ N = 4A(b, I— f- t C U 4i�� AzZ7b? Q LL v� � G v O � o cn ai 0 o MpU, .w J r W (Y) O cn rn O ¢ Z xo O v o a U O� m :E Q W N U V F4•�'' a y LL v a o z Q U U ~ z F- 4 V v w � .I � F � \ O 4 Q U C b V 4 o p :3 0 D N U Z Q Q W M W • 0") N •V O LL W N 0 ,� C / CD co� o m ~ M00 a © 3 v z Q) D O ro 2' CO Q O C/) a� Z ° U) a� J 0. o J J W a p F- LL CL N 0 0 0 �� m p (4 U U � a �' O � L. c) z a. W a iz C '7v � wm (13 c V w o U) ( c� RY Q U) Z (D � ++ Z a-+ cow � `° U • �V U- w C3 Oo p � E = a, o u. w = �- � �, �, U ,C � ~ Q v.. 44 o'�N •' '•�'s'.c� O U � p = C O ai p ..�"Q r •.n`�"r J o w M o cn �y rn �*A � z XO ro Q W CL l6 Z O J Q- DATE(MMIDD/YYYY) ACC o® CERTIFICATE OF LIABILITY INSURANCE l 1 8/28/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: _ Erika PICInic ACrisure, LLC PHONE �AX 100 Passaic Ave, Suite 120 973-227-0025 aC,No):973-227-4026_ Fairfield NJ 07004-3508 nonRRess: epicinic@acrisure.com INSURERIS)AFFORDING COVERAGE NAIC# License#:0113123 INSURER A:Arch Insurance Company 11150 INSURED ALLSPAR-01 INSURER B:Arch Insurance Company 11150 Allstate Party and Tent Rentals INSURER c:New Jersey Manufacturers Insurance Company 12122 170 S Main Street, Suite 1 New City NY 10956 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:307459413 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 ADDLTYPE OF INSURANCE IN=SUER POLICY NUMBER L LTR D/YYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY PRPKG0110501 12/7/2022 12/7/2023 EACH OCCURRENCE $1,000,000 DAMAGE TO CLAIMS-MADE a OCCUR PREMISES EaE occurrence) $300,000 MED EXP(Any one person) $10,000 PERSONAL 6 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY PRO JECT F7 LOC PRODUCTS-COMPIOP AGG $2.000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea a.d.nt ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident e X UMBRELLALIAB X OCCUR PRFXS0066301 12f7/2022 12l7/2023 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ DIED 1 1 RETENTION$ $ C WORKERS COMPENSATION W423335 4/1/2023 4/1/2024 PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER j ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $100.000 OFFICER/MEMBER EXCLUDED? ❑ NIA --- -- (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $100.000 i If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500.000 B Equipment Floater PRPKG0110501 12/7/2022 12/7/2023 Blanket Limit $750,000 I � I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Village of Rye Brook 983 King Street Rye Brook NY 10573 AUTHORIZED REPRESENTATIVE rlzl� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NW Workers' CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured Allstate Party and Tent Rentals 845-398-8888 170 S Main Street 1c.NYS Unemployment Insurance Employer Registration Number of Suite 1 Insured New City, NY 10956 Work Location of Insured(Only required if coverage is specf1cally 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 20-2674530 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) New Jersey Manufacturers Insurance Company Village of Rye Brook 31b.Policy Number of Entity Listed in Box"l a" 983 King Street W423335 Rye Brook, NY 10573 3c.Policy effective period 4/1/2023 to 4/1/2024 3d.The Proprietor,Partners or Executive Officers are 7 included.(Only check box if all partners/officers included) EJ all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"T'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: Erika Picinic (Print name of authorized representative or licensed agent of insurance carrier) Approved by: C_ 10/3/2023 (Signature) (Date) Title: Client Advisor Telephone Number of authorized representative or licensed agent of insurance carrier: 973-227-0025 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 UI : G - 00 Lf 7M co ---- -� vi o c- b(A R 1 W �; I> ti