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BP24-004
PERMIT B LOT SECTION ci BLOC Ps /pS B /D% TYPE OF WORK Zia JOB LOCATION o eO �C / 70 OWNER CONTRACTOR�/� cosr� J DA FEES TCO FEE DATE I! DATE INSP FOOTING FOUNDATION FRAMING L S _ Zoi4 RGH FRAMING p6se INSULATION PLUMBING _ OILGl� RGH PLUMBIO OAS SPRINKLER ®/ ELECTRIC LOWVOLT C ALARM r AS BUILT FINAL ooto/jo4Loot/ �U y -�oa�-olo���jOsP � �l Pic 03,91A AT Co"'"lerci �- C r� VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 24-026 Certificate of Occupaucp Ehis is to certify that j LAz of, y , having duly filed an application on requesting a Certificate of Occupancy for the premises known as, Rye Brook,NY, located in a Zoning District and shown on the most current Tax Map as Section: 7Block: Lot: , and having fully complied,,with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. (.I , 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: �/� 9 _ Construction: , for the following purposes: 4 y/ /� 0 / ./—a 1I6/-72 716 JL0,02-J-22 17-e I'W O of t l t�'e Ski/es /65 � /67 Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of the building or in the exit facilities shall be made,and no enlargement, whether by extending on any side or by increasing in height shall be made,nor shall the building be moved from one location to another until a permit to accomplish such change been obt�ne rom a Building Inspector. Building Inspector,Village of Rye Brook: Date: M BUILD nBROIK, NT For office a onnl VIL OK PERMIT#b{ f/(� ISSUED: FEB 2 9 2024 KING STRE `�YE YORK 10573 DATE:0 FEE: Cp ('j PAID VILLAGE OF RYE BROOK BUIL 4G DEPARTMENT 1. ERTIFICATE 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 tititiiiti#if#tiRtfpt#■tiff###ff#ii##ff##i#fiffif##fif###ff##k##f#kii#kkttiiffftiit#iitfifif#ifkff#fiiiiit#tfftfifiiifitiiti# Address: K iC F lbbc fUY AA 1 5 U,-7t .S C OS U 9 Occupancy/User 0~,'C/eW Parcel ID#: Zone: Cl l' Owner: W Address: Z`F M L R 1 b/iF e(At A P.E./R.A. or Contractor:L 'kk/-�Q 4a9e-,4e17-1- Address: /79 C4/i///e/b.SS AI GJ-H,/ ;--1 A)S- Person in responsible charge: Address: �l 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: 1%gf � ��qq,, t )S) )h TN) (!)f a 1 A being duly swom,deposes and says that he/she resides at CA�16,, (Print Name of Applicant) (No.and Street) in W , M 1(-1'0�-0 P ,in the County of W , M 1 Ll''aA p in the State of )y J ,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: for the construction or alteration of: Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-10.A. of the Code of the Village of Rye Brook. Sworn to before me this Z� Swom to before me this Z� day of 20 Z day of , 201t Si ire of Pro �'p Owner 4 T Signature of Aff icant Pript Name of Pro Owner Pdnt Name of Ap i ant - Notary Public No Public ALENA NAKAN,IIN ALE=HAKANJINNNOTARY PUf3EW YORKNOTARYPURC,STATEOFNENIYORK Registrati013645 8/12/2021 Rp00i104MionNo.01NA0013645 Qualified I CountyQwUsed In Westchester Courtry t!y Commis1911 Cewsmhebn ExpNes 011trt027 �yE BRC�j� O� �m • 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: I V I` R, SN 1 OS' DATE: - 20 - Z 0 2- PERMIT# 2 0LI ISSUED: I-lI-Z SECT: 7 /, 27 BLOCK: LOT: . LOCATION: 5�1 ' �� OCCUPANCY: ❑ Violation Noted THE WORK IS... U 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 �J � ['FINAL ❑ OTHER �yE BRC��. 1 cu � 1 982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR 6"A"'SSISTANT 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 : ' O 9'&-f- Q a e' PIA Z at Su i I C)-T DATE: J" Gt70oZ PERMIT# ?? Z� - 040l.v ISSUED: - 1- I SECT: /7/l7 BLOCK: LOT: (/0 LOCATION: OCCUPANCY: ❑ Violation Noted THE WORK IS... D PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas v QLA^nl�f� .4, r') 00 M S ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER f� FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER QyE BRC cu � 10� • �9�2 BUILDING DEPARTMENT ❑BUILDING INSPECTOR 2-) SSISTANT 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 : V' LA DATE: - ��S - a 0 Z- PERMIT# r.7jP - Z b ISSUED: SECT: �I 1 BLOCK: LOT: b LOCATION: '5L, I bS- /37 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 A L , ►-A 7 q ❑ L.P. Gas ❑ FUEL TANK Nk—hArv\ VVq� 4 0``� �UiL �I�✓t ❑ FIRE SPRINKLER aU i (V F� '� Q✓e j', ❑ FINAL PLUMBING ❑ CROSS CONNECTION /\I ❑ FINAL OTHER • 5o Q FF_"� Sic a-j "-�Oo2 fro"') ov� J r r bJ �E BRC�k. O� - 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 : !� ��� \�\ CO�� �LA� DATE: 2-" `� ' 207- PERMIT# oo� ISSUED: 1-11- Z SECT: 4 -7 BLOCK:_LOT: LOCATION: OCT" U pa ` OCCUPANCY: ❑ Violation Noted THE WORK IS... 0' PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING 0 ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER �yE BRC�k. O �'• �9a2 `� BUILDING DEPARTMENT ❑BUILDING INSPECTOR O 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: \27 �l�C� �LF1Z fl DATE: PERMIT# ?? Z`j- na`, ISSUED: SECT: I Lj 1 , �7BLOCK: r LOT: _ LOCATION: �_ 2[xr1 S 4- OCCUPANCY: ❑ Violation Noted THE WORK IS... [a PASSED ❑ FAILED / REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: 0 ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas _ S 1 H� C�''�Q Q 4 ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER H y N N � Lin UI � N CLT v ti t4 W a? O M � � v p o E W k t,; x as 0 o � A O +S lu a. W V a p C) r---4 w w ' m a. W A ZL A p $ aS W V O1�--I O w l O © Q s O WbUV1 H [ �C O J C O to W Q O O0-0 rr O o a O a pG a Ln Lnco d' n N f}} F r '" z o a o W 00 w n v . A O q U s �' O O p U A w U N F'' O o b v E -01 0�% r--{ W Fes) CN h+-I Fij .�i � o W V V .CIA -W � A A oocn , W . o w❑ v � M r W) o P. df U et O a~i v7z Z I- 1 144 y1i V o U z U 96,11 cn w w) � v a xi = H w W 0 >4 .4 -44 H BUILD MENT VILJ or R OOK - I, DEC 14 2023 938 KING u RYE BR ,NY 10573 BROOK INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Approval Date; JAN 0 g 2024 P rmit#: / 7 -�J_ Application Fee:$ C25 aod' Approval Signature: Pcrmit Fees:$. Disapproved:_ Application dated. is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance ofa Permit for the interior alteration of an existing building,or for a change in use,as per detailed statement described below. to 1zYe 1 G ��4 - " 105/107 1. Job Address: �WM04� kY f 4. 5R1VCafi��fgfA_ SBL: _Zone: 2• Proposed Improvement. (Describe in detail): MIIA* INTIlC)X &AW- -1(7i`) TO CC IP>t i 2 f•1�19T1N�J__ 10-7-1 M iNCE lq[} 1,VLX l nWAV,R�:eM rl 4J I t4�^ f A$-J9 MA7&aDO-6, Mit T. CEAuN& rk6rJ666, tr-4,D-V- AW'2,46 -f!NIqW-4 bola nc�-►s_Imo_] A 51N - 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No:X_ Yes: _ If yes, indicate: TIER 1: TIER II: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic Fire suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) : No: A Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application& 2 sets of detailed engineered plans) 5. Occupancy;(I fam.,2 fam„comm.,etc .)Prior to Construction: 15"�;6 (�) After Construction: Bps 6. N.Y State Construction Classification: _T 6 N.Y.State Use Classification: g r BSI <S 7. Property Owner: MN Ewe, P+Ai33 "'C' Address:Its &,U - SVI% ZOO Phone#_AA) 4(4-73O0 -Cell# _ email: 60" S. Applicant: — fr*Y- (A -A 1rr�' C''1j' A d d r e s s;577-a A B�Gi14�4!//��(�WTI rf,— 14�,N7 * 140 Phone#TIC) $ -Ot�l� Cell lQ��15�-oRQ email: JTt�T/��c- �'GN7 �S•�oM 9. Architect: � r7T1-N (M I?ft Wh LAA'4''5, NY 0(0p3 Phone#Irr��) q41-00 Cell "01g0 email: 10. Engineer: Address: Phone# Cell+ email: 1. General Contractor: I~ k /?EL . » 3 Address: [ C 1 C-C_('_no 5 S R p t"-, M/L/bi'2 0 AI J Phone#9_8 1 JR Cell#9L2q, ?� r email��,r K 0 v - 4,, N' 12. Estimated cost of construction (NOTE:The cstiniated cost shall include all labor,matenal,scaffolding,fixed equipment,professional fees,and material and labor which may be donated graus.) 13. Job Timetable: Start: /,Z./�$ ! �� Finish: /Z 4 (I) 6 12©23 BUILD MENT VIL E OF R OOK 938 KING ET RYE BR ,NY 10573 p I~, 14 2023 �C _0 •A•*A••k�:•k:l•*kd:A A A****�;�;**•k*****************ic*****:t*9:YN********lP**#****************************•k****1F1k**vMdwlr tk* AFFIDAVIT OF COMPLIANCE VILLAGE CODE §21 E • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM! WILL BE RETURNED TO THE APPLICANT. STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: I, PAW 4*4C�t-4 , residing at, 110 I�-�If 12i0��P�� . SO J(� foo (Print name) (Address where you live) being duly sworn, deposes and states that(s)he is the applicant above named, and further states that (s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; Fj t-Pik^ PLAZA — 0OANM/4N AAi.LG(f U17} 12tOG� !qFM , 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. v (Si a of Pmpe Brornet( )) t�N "61111 P F_ S (,1 G. (Print Nance of Property ))})� Sworn to before me this �/[� day of b'¢LAM tvL- , 20 23 1 to uhlic RICHARD A.YARMY Il NOTARY PUBLIC,STATE OF NEW YORK Registration No.01 YA0013323 Qualified in Westchester County (2) Commission Ex ices September 08,2027 811 212 02 1 This application must be properly completed in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. Please note that application fees are non-refundable. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: T°� 5 1 i tJ V T T" A ,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 the legal owner of the property to which this application pertains, or that (s)he is the o p�sry,A U () t 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 1 4 Sworn to before me this day of Dg," l.-01— ,20 2-3 day of 720 5>\Vtn el— 4�� ignature PropertyA yI- ignatureofApplicant �'!'_6; �1 to�v Or`� j A Print Name of Property 9wrrer —y��r Print Name of Applicant Not btic Notary Public (CHARD A. NOTAR PUBLIC,STATE OF NEW YORK Registration No.OIYA0013323 Qualified in Westchester County Commission Ex irtea September 0$ 2027 (4) 8/12/2©21 O d' o N w N � W o v� N a o y x O Z o �., �-, w � � a H o A w o Z V a N w $ H �j i cn o w N w O LO 1 a N W I.o o@ < eq � C4 Cl) � z x o � 0-4 A H W U u z V � � O Z ,� .� cn w o z Z ►—� � z N z c U Vit a a > Q V ,..., V a ai 00 M--� M Z u w w 5 N � p4 � � xoow a/ w H w a z o o ° ►�+ W N z x �+ a � � $ V W z a w o z0-4 w z Q o � x ` A a U) uz w a� oQc H � a �i I Gil '� � ►• G� W x +D M� VL� � 1�' IF, BUILDING DEPARTMENT DEC 14 1023 VILLApE OF RYE BROOK 93K KING�T,}tt ET RYF.BROoh ,NY 10573 �, VILLAGE OF RYE BROOK }4)939-06( j BUILDING DEPARTMENT wwwtyebr6o .orQ ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLI' BP#: J AN 0 8 1 Permit Fee: Approval Date: Approval Signature: Other: - DO NOT START MORK or CONSTRI C'fION t'N'I'lt.A PERMIT HAS BEEN ISSUED Bl'THE Bt1l DING INSPECTOR. THE ADMINISTRATIVE FEE FOR WORK 1'RO(:RF:Stit?U OR CON]PLEsTED N1 1"1-11OUT A PF.RMI-I- IS 12% OF THF: TOTAI.COS"I'OFCONS'TRUCTION WI'1'H ;k �IININItM F'EF OFS750.011 Application dated, 1, 12 123 is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/or remove electrical equipment,wiring,fixtures, or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. \ I.Address: 10 IW r �2Lr�G r 1�LI� �y t1l< �05 'I� '7_SBL: � / i y�'�-� Zone: 2.Property Owner: k.�J� Rr A I-a,j_U- -Address: 10 Q i- Q-A L'p Phone#: I I 'I - q(o`5 7 U .0 Cell#: email:Q 7N&Ll S h P-W I ti ?QQQ n1 3.Master Electrician/Licensed Installer: i Address: _ Lie.#: I l 19 Phone#: Cell#: l 2_&.t 9ail:P".9e 2 -_lee- C C' ww 9 ✓"P&! C_'P - <f Company Name: P t Z +�(�G T12/C �Address 3� e%� 4 ) 4.Proposed Electrical Work/Fixture Count: ZA)S7.1 L-L / £X 17" Ag'wl�i.2 ,,�N C y — CD C-f TLgET 5' (21 6:L.o Cl- 7 4� 5.3'Party Electrical Inspection Agency: 1 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: being duly swom,deposes and states that he/she is the applicant above named,and does further I print name of mdicidual signing nc tl,c apphram 1 state that(s)he is the for the legal owner and is duly authorized to make and file this application. I Maslcr Elcclnaan Llcrn.,d Iml�lkn The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances,and regulations. Sworn to before me this y fa da of�CLdM156yt- 20 Z,�_ Sworn to before me this day of 0 Si afore 'Prope 8wner �� f Si atu wan V f(J AN6Gr Lq ppt Print Name Property44W tr t5 �r✓Le; >�! 7�� `%ram et PrintNamc of Applicant Nut ARY P B Notary , 1 ORY M.RIVERA Regi ration No.OIYA001 Nefary Public,State of New Yorkl0/30/2023 Qualified In%stchester county No.OIR16441398 -� Commission Ex ices Se tember 08 2027 Qualified In Westchester County Commission Expires September 26,2 STATE WIDE INSPECTION SERVICES, INC. CAD Service WVilh Integi-itY 0•0 • • SWIS JOB APPLICATION0. • Office Use Elect. Permit# j l (� Date Z 3 Bldg Permit# 6/L:�- / --Coy S9 Ft Plumbing Permit# Final Certificate# City/Village ` _ 17n _^ _ Zip Building Dept. County Address •��+� Cross Street Section Block Lot Owner Name/A dress(If different than above) Contact Number ❑Basement 1st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/O Detector Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels 1P 3P # Meters # Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair ❑Overhead ❑ Upgrade ❑ Disconnect Utility ID# E].e6n Ed ❑ NYSEG ❑Central Hudson ❑ Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect Junction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation g - o Lf-rC46:-7-' DEC 14 2023 AGE OF RYE BROOK ,,(�/ / / L ILDING DEPARTMENT This application is valid for one(1)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,if at any time of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other inspection company.The applicant, owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Email Address Name �rrL IJC License# Date /2 Z 3 Signature Address 3-9 c�e� T' City/State Zip Code Company � �� 2 ,c���7—�C �� Phone# SU R V� W!E State Wide Inspection Services 1080 Main Street MAR ' 1 2024 Fishkihkill, NY 12524 TO�U TO845 2 Phone 914-219-19-1062 Fax STATE WIDE INSPECTION SERVICES VILLAGE OF RYE BROOK Email: office(d)swisny.com BUILDING DEPARTMENT Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Phase 2 Electric Corp Win Ridge Realty LLC Trevor Meikle 10 Rye Ridge Plaza 39 A Beech Street Rye Brook, NY 10573 White Plains, NY 10003 Located at: 10 Rye Ridge Plaza, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 24-010 141.27 1 f 6 Certificate Number: 2024-0505 Building Permit Number: BP 24-004 A visual inspection of the electrical system was conducted at the Commercial occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at: 10 Rye Ridge Plaza, Rye Brook, NY 10573 The First Floor Office was inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 2151 Day of February 2024. Name Quantity Rating Circuit Type Receptacles 05 GFCI Receptacles 03 Switches 04 Luminaires 01 Exit/Emergency Light 01 Officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. = Y Y 0 NLn N W Y N CD N N a o rA y L w N = O � � $ cn CO � • s = O z i � W z 5 20 O Q r "' x O ON z W w ° ■ _ O Ln C N O , �-1 W � w , . A �-+ w � � � u z �z x 5 O �, 8 • O Vwo z p A .tt �_ (A z � z = W z M Q! o o w z . r� V U o O • z pro w a >3 V CN A v N Wxen Y 00 i a w cap c, 1Ta1i Z a ■ zz U o � a W o a H N x H � o 5 W C7 H z � v z Y A pg „ U v w a W o z p � � z I O z w Ng v o z p F A a U A w � 0 � D C C IE ME ID y�_aR�`'k 1:72:j024] BUIL E MENT FEB :2 E OF RYE OK VILLAGE OF RYE BROOK 938 KIN Qt RYE B ,NY 10573 BUILDING DEPARTMENT .or ELECTRICAL PERMIT APPLICATION Westchester County Masterl Electricians License Required FOR OFFICE USE ONLY BP#: � vCi LI EP#: O Approval Date: \�� Permit Fee:$ V Approval Signature: / Other: +rt++*rtrt+rt++rtrt++rt+*rtrtrtrtrtrtrtrt++rt+++rt+*•*rt**rt****v�rtrt**+rt+rt**+*+++*+rt++*rt+++++++**+*+++**+*++*+**+++•+r DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR. THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12% OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750 00 Application dated, 2&ib_is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove electrical equipment,wiring, fixtures,or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. I.Address: /d R-W AIAW- *Z^� -eWk SBL: / l G Zone: 2.Property Owner: WJ IV (40" (2-f*i-T Address: Pr "r AIU#-e- el.*&f, /ty 0*L N Phone#: ! 7� — YwJ Cell#: Q�Y^?ti l"MOOS i tiriv email: 3. t terms Atp 3tan/Licensed Installer: �T [e w�M?E,Ce ig, � _ Address:(o Shlip >*t,rfre V? Lic.#: Phone#:114-It III"9t - Cell 44^ai°t1-044J"email:�ra_StQtiSlrs+�+ L 11j.4o) (-&0 Company Name: A'Pl' Address: t LJ,q,t,-„'twr,raL Py 4.Proposed Electrical Work/Fixture Count: n _'tr,Ska•hi o..� Oj- et g�l a.r ,n.�. ,Q (L S ,, 5.3'd Party Electrical Inspection Agency:_ 1� •*,t►a**,rt*rx+*r*R*t3t+rr►trr**,tf*rf*t.rr*,t,t:�;++,trrwt�*�srr**Rr,e:tf+**i*f r+t��***rtt+r:rtr�►*rk►,t*�+t*,it,rrRw• ^✓'(STATE OF NEW YORY,COUNTY OF WESTCHESTER ) as: C,C. t being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of individual sigQin&as tt�e ap�llcAnr) state that(s)he is the �n(�Q!'�Sl�' %4WVAr for the legal owner and is duly authorized to make and file this application. (Master Electrician Licensed Installer) The undersigned further states that all statements contained hereto are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances,and regulations. Sworn to�cf re me this Sworn to before me this d'3 dad of 20�_ day of F46 2 Lpetrm of perry Omer kb" Sigri5WEc of Applicant il)AV9 6;N kk —1oE Sm.t ?10"Iffied P kL�ST- Print Nam of Applicant NAHAKANJIN Nsuuat+IcortruC,STATE OF Notary Public•sta10 of ryw York I Q/2023 W 01HA M�v NO.OIXOG216660 QUallflyd fn w4nrchoster Counio My Cernmtrrlon tiplrn An IS,2021 I STATE WIDE INSPECTION SERVICES, INC. k C—Xk� Service VVi1h Integrity 0•0 • • swis JOB APPLICATION0. • Office Use Elect. Permit# Date Bldg Permit# 13 P2 L! O 0"-/ Sq Ft Plumbing Permit# Final Certificate# City/Village Zip Building Dept. t j It ,c f.�tfC ,�> County Address 7 r �i Cross Street Section Block Lot Owner Name/Address(If different than above) , N f )�. i l T Y Contact Number y j q- qq1 - ❑Basement ❑1st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside I ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/0 Detector Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels 1P 3P # Meters # Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair � ❑Overhead ❑ Upgrade ❑ Disconnect Utility ID# ❑Con Ed ❑ NYSEG ❑Central Hudson ❑ Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect Junction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation This application is valid for one(1)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,if at any time of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other inspection company.The applicant, owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Email Address Name J�r License# 2 ppr-, �� I(� ? (�, Date Z ? $lZy Signature --I/,— Address y I ,� ��r, ` C City/State )J ,J f i, or , Zip Code S Z. Company Phone# 9/cl _� �c, - C (� 9� State Wide Inspection Services C � [MAR 11 2 224 D1080 Main Street Fishkill, NY 12524 - - .. 845 202-7224 Phone VILLAGE OF RYE BROOK 914-219-1062 Fax STATE WIDE INSPECTION SERVICES BUILDING_DEPARTMENT Email: office(c�i swisny.com Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: ADT Commercial LLC Win Ridge Realty 6 Skyline Drive 10 Rye Ridge Plaza Hawthorne, NY 10532 Suite 105/107 Rye Brook,NY 10573 Located at: 10 Rye Ridge Plaza Suite 105/107, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP24-038 Certificate Number: 2024- 1497 Building Permit Number: BP24-004 A visual inspection of the electrical system was conducted at the Commercial occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at: 10 Rye Ridge Plaza Suite 105/107, Rye Brook, NY 10573 The First Floor was inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 11th day of March 2024. Name Quantity Rating Circuit Type Smoke Detectors 03 Heat Detector 01 Officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. � � N (� N Z x o w - M F4 w 0 a rA r. C7 a M °r° z A W bo �4 cn o rA W ap W O H Q R-1 ZCD V A z � � O � U C, � Q 0 V CA En a a w O � c � z I%► v z 8 A ituw W F wo Z z LO o v � $ � O z w z 0 � 0 � �E BRCw BUIL 4'y �... MENT VIL OK DEC 14 20?3 938 K1N 5 ,NY 10573 or PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: _ ��) PP#: CD�_OCG Approval Date: A,("A, Permit Fee: $ Approval Signature: Disapproved: (fees are non-refundable) kk*kk*k*kkkkk************************ok*****kkk+kk+kkkkkkkkkKkkkkk*k*kk*k#kkkkkkk*k*k�kkkk*kkkk&kkkkk DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR.THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF S750.00 Application dated, 12/4/23 is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove Plumbing as per detailed statement described below. The applicant& property owner, by signing this document agree that said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. 1. Address: 10 Rye Ridge Plaze Suites 105/107(bowman ave/s.ridge street SBL: / J I r Zone:(,/ 2. Proposed Work: Install two(2) 15x15 Exam room sinks with faucets and One(1)25x22 kitchen sink with faucet 3. Property Owner: Winn Ridge Realty LLC Address: 10 Rye Ridge Plaze-Suite 200 Phone#: 914-468-7300 Cell#: email:denglisli(@winprop.com 4. Master Plumber: Paul Nebrasky Address: Lic. #: 910 Phone#: 845-783-6661 Cell#: email: Info n,nebraskyplumbing.com Company Name: Nebrasky Plumbing Heating and Cooling Inc. Address: 1019 Rt. 17 M- Suite 3,Monroe,NY 10950 INDICATE FIXTURES& LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1st Floor 3 2nd Floor 3'd Floor 41 Floor 5t'Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -I- 3/3/2023 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Paul Nebrasky ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that(s)he is the Master Plumber for the legal owner and is duly authorized to make and file this application. That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn to before me this -J day of D EC6M b eX— ,20 23 day of 9. ,20a.� %WdOf re of Pto erty Quaer AT Signature of Applicant TAN to C�IJISi-�' 'a uJ NC bra sk� Print Name of Property Gw4=L Print Name of Applicant l � D WENDY J ABBAGLIATO Notary Publi RIC ARD A.Y TARY PUBLIC-STATE OF NEW YORK NOTARY PUBLIC,STATE OF NEW YORK No.01 A86378708 Registration No.01YA0013323 Qualified In Orange County Qualified in Westchester County My Commission Expires 07.30-202b Comrt#i�3t }Igopg� ompleted in its entirety and must include the notarized signature(s)of the legal owner(s)of the subject property, and the applicant of record in the spaces provided. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- 10/30/2023 i BUILDT ,d;bl 12TMENT V 1 L E OF RY :� OOK 938 KING 'FT RYF BR ,NY 10573 44 . 0 Xv eo n ******************************************************************************************************* AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT. STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: I, Dkip kt iC�1-lam , residing at, 0{Z0.Pl�� ZA , 150►(f PTO (Print name) (Address where'you live) being duly sworn,deposes and states that(s)lie 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; -� �12-1VC-_,f p(A-cA — goWMAN A if,.A.o qDi kl iQ& - !Tt � , 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. .T-� V P D T10t`; I Sid e of Propert Oerrrrri )) AC�NT (Print Name of Property )A6Wr Sworn to before me this N ty day of DW-ON 01-- , 20 23 ( tai 'abbe RICHARD A.YARMY 11 NOTARY PUBLIC,STATE OF NEW YORK Registration No.OIYA0013323 Qualified in Westchester County (2) Commission Expires September 08,2027 8/12/2021 Building Pernut Check List & Zoni*nq Analysis OB & C ONLY Address ` °" �• �2� SBL: �� 7_1 Zone: Q - Use: Const.Type: Other. Submittal Date: Z Revisions Submittal Date/s:� n Applicant �1 11' �"�. Nature of Work � " �( \)C D"�. -To cc_)"1 -� coo c>� cQ A— l O:Q Reviews:ZBA: DEC 2 O� 2023 pB: BP: other. ED OK (W FEES:Filing. 2�BP: \ti C/O: Legalization: ( ) ()/APP.: Date Stamped Properly Signed: SBL Verified Cross Connection: F.O.G.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Stone Water Review: Street Opening ( ) ( ) ENVIRO.:Long Short Fees N/A: ( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmt.: Tree Plan: Other. ( ) ( ) SURVEY:Dated Current: Archival:- Sealed Unacceptable: ( ) ) PLANS:Date Stamped Sealed Copies: Electronic: Other. (t)- ) 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 O*A r r (�( ) PLUMBING Plans: Permit: Nat.Gas: LP Gas: Grease Trap: 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: APPROVED REQUIRED EXISTING PROPOSED NOTES Date: JAN 0 8 2024,. Circle: Fr n E= Front: FAR.: Qpm S ac hldghL Stories: notes: —L' C11. _ calk ell \ eC (--e Frederick Taylor Associates 572 North Broadway Tel 914 289 0011 Architects, P.C. White Plains,N.Y. 10603 Fax 914 289 0022 Taylor Associates Architects TRANSMITTAL FORM TO: Steve Fews Job No. 10961 Village of Rye Brook Bldg. Dept. 938 King St Rye Brook, NY 10573 RE: Combined Suites 105 and 107 Date: 12/22/23 Rye Ride Plaza From: Rob Dallesandro Via: Fed Ex Copies Date No. Description 3 12/21/23 Full Set Revision 1 -Signed and sealed Steve, Attached are the revised drawings per your comments as below; 1. Added note stating there are Mens and Womens restrooms available for tenant. 2. Added Smoke Detectors in Exam Rooms 3 and 4 3. Added heat detector in Lounge _.,_..._ Thanks! Happy Holidays! R[R `(," [R �Y [` ID DEC 2 6 2023 VILLAGE OF RYE BROOK BUILDING DEPARTMENT Transmitted as checked below: X For Approval A—Pproved as Submitted For Your Use Approved as Noted As Requested Returned for Corrections For Review and Comment For Bids Due on Hetzel_052302.doc Last printed 12/22/2023 10:47:00 AM ACo CERTIFICATE OF LIABILITY INSURANCE DATE( 1') 11r16120 YYY6/2023 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: Grace Sabella NAESIP,LLC PHONE (201)932-1756 FAX (201)661-7823 A/C No Exn: (A/C,No 1200 MacArthur Blvd. n-MAJI.DDRE : gsabella@naesip.com Suite 302-A INSURER(S)AFFORDING COVERAGE NAIC 1f Mahwah NJ 07430 INSURER A: Evanston Insurance Company 35376 INSURED INSURER B. E 8 K Management,Inc./Bald Eagle Management INSURER C 179 Cahill Cross Road INSURER D Suite 311 INSURER E West Milford NJ 07460 INSURER F COVERAGES CERTIFICATE NUMBER: CL23111602299 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 MAYBE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TC ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCEAL)ULrX POLICY NUMBER MW DD'YYYY1 MM/DDNYYY LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 3,000,000 . 100,000 107 CLAIMS-MADE ®OCCUR PREMISES(Ea axurrcnce S MED EXP tAny one person) S 5,000 A 3AA672876.1 12/01/2023 12/01,12024 PERSONAL BAUVINJURY S 3,000,000 GENT AWREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 3,000,000 jE O- LCC PRODUCTS-COMP OP AGO S 3,000,000 POLICY ❑ OTHER S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 Ea aINEOr ANYAUTO BODILY INJURY(per person) 5 OWNED SCHEDULED AU 105 ONLY AUTOS BODILY INJURY IPer accdenl, S HIRED NON-OWNED PROPERTY DAIAAGE S AUTOS ON�Y AUTOS ONLY Per accideno 5 X UMBRELLA LIAB OCCUR EACH OCCURRENCE S 5.000.000 A EXCESS LIAR CLAIMS-MADE EZXS3136960 12'01/2023 12,101/2024 AGGREGATE S 5,000.000 DED RETENTION S WORKERS COMPENSATION PER OTH- AND EMPLOYERS*UABILITY Y/N 51AIUtE EH ANY PROPRIETOR!PARTNERiEXECUTIVE F_l_EACH ACCIDENT 5 OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E.L.DISEASE EA FMPLOYFF S II yos.describe,under DESCRIPTION OF OPERATIONS Wow E.L.DISEASE-POLICY LIMIT_ S DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES IACORD 101,Additional Remarks Schedule,maybe attached It more space Is required) Certificate Holder is included as Additional Insured(Forms MEGL 0009.01 09 18)On the General Liability,only if required by a wrdlen contract with the named insured,with respect to ongoing and completed operations of the insured,subject to policy terms and conditions. Policy includes Waiver of Subrogation(Form MEGL 024'-01 05 16)Policy includes Primary and Noncontributory(CG 20 01 04 13) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 iD 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 1NEW Workers' CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name 8 Address of Insured(use street address only) 1b.Business Telephone Number of Insured (973)657-1116 E 8 K MANAGEMENT,INC 179 CAHILL CROSS RD SUITE 311 1 C.NYS Unemployment Insurance Employer Registration Number of WEST MILFORD.NJ 07480 Insured Work Location of Insured(Only required if coverage is specifically limited to 1 d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State.i.e.,a Wrap-Up Policy) Number 46-4855311 2. Name and Address of Entity Requesting Proof of Coverage 3a. Namo of Insurance Carrier (Entity Being Listed as the Certificate Holder) THE TRAVELERS INDEMNITY COMPANY OF CONNECTICUT 3b.Policy Number of entity listed in box"1a" VILLAGE OF RYE BROOK UB-9K311184-23 938 KING ST 3c. Policy effective period RYE BROOK,NY 10573 05/02/2023 to 05/02/2024 3d.The Proprietor.Partners or Executive Officers are ❑ included.(Only check box If all partners/officers included) 11 all excluded or certain partnerslofficers excluded. This certifies that the insurance carrier indicated above in box "W 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 Now York State Workers'Compensation Law. Under penalty of perjury,I certify that 1 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: Michael James Mulligan (Print name of authorized representative or licensed agent of insurance carrier) Approved by: "illi ` 04/08/2023 (Signature) (Date) Title: 2VP BI Small Commercial Operations Telephone Number of authorized representative or licensed agent of insurance carrier: (877)677-0428 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 REFLECTED CEILING PLAN °FFI"A` KEY NOTES r's� 'e; ] A mwTN °rEx�,irti S T o i�<T„;�iw<v'ceA n �Hn r RM EXlsr. ------ ---- -- Roots uI JEFFREY « wnv " uew a_ TAYLOR NeYY 11—NCY W.HL PACK ARCHITECTS RooN«z EXERT.EXAR �IISTINIoo«AaM TEarTPaq EXAMRooR — t. w s RE F ooms E.. �. . EXsr 1 RaLLwav EAlTRlllEl se _ NE °LosEr X— I� G" y NE `LOUNGE �— � J �.. � ., NEW CLOBET � - L� r z am EE o e som t-- -r EXIST R°ERTI°N AREA — - -- CEILING LEGEND w y s® E .eoeerna[n ExIST. E L— r RT =rN«°L DESCRIPTION T. Ex ST,I.I SO-1ao01(z.z)CUIIING rLnry xoarn — -- LEsrroDRDRIEINDIACERENTRRTH 0 7 _� -- r�No ANRT°aR REP.) AREA EXIST.- G I.n ur N 1-1111 A N FOR L—IQN' EXIST.17 �sEs ruN FOR Local IIN a.HGRi REFLECTED CEILING PLAN 1 AI -' EXIST f-- Ex sr EMEaGEncr r GRT va MIN RarTERr EX A RnCKUE fSEE—N FOR EOCA+ON EXIST❑ Ex STwos S u—vorrusER EXISIST. R ExisrlNC RFruaN DiFwsea EXIST. SP Cl,: E ruN FOR�oGRON�fsE I i EXIST. a s SD s >,IM IE�FCTIoNI NEWS A y% 2 ISEE ILAN4roz LoGnorvl'GHT NEW T -' EX eTcr LIGHT vo MI.R-Ear on _ SD v- Is[E run FOR C) �_r �OW0 N n w HEAT RErEott�i111H,�H) HD fsE ru EOR� _ SNREFLECTED CEILING ILAN U �w Z f H —B. ram R G'tl E W NL K __W _ W m O In w �PaY o3� rc p LATEAll- 3 rc ������ A-200.00 RYE RIDGE PLAZALIE RE-DEMISING OF EXISTING OFFICE SUITES 105 AND 107 INTO ONE SUITE JEFFREY TAYLOR RYE RIDGE PLAZA ARCHITECTS RYE BROOK, NEW YORK wx;Eia,1:BA.11 ' GENERAL CONDITIONS GENERAL NOTES ABBREVIATIONS/SYMBOLS PROJECT TEAM DRAWING LIST(PERMIT SET) n aeLocoxonorvs FoLEI ory cumsxreslaucaFATE OWNER IATL a.woaorvaT oxoF woRxoxoFTsaacxrtwrAxo owxFas aFvaFSFaraT VF oaoarowmmsxcucwomc cxT CNLR a[o �EZop nwaisurw ap — NIT nCi....ENGLUH F°� aos.FTsIAL Yz a ussnoxs ascnao xcr sswx xor Fvrnen a nox. 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T-100.01 Noox a oFFIOEM SYMBOL LEGEND dslmlol❑ OENOTE xRA� nOREISEETx�,ORaw�NOI =s> Uss wNO axauwnv xooN a, JEFFREY TAY OR _ ARCHITECTS ll ___ L@J2,:III III TIIII,'I,IiIT.I l�lwlI AOOINNITI AIL EASES NORCHITECTS 1A E,vvoR,� G aonu'_N re IIANooIoe CONE ctt O AN' 11-or rnew11 "All R1111 nooxw t TI El ON CONCEPT RR OR TlAYO me START Or oemo�rouLe aOONs REMOVALS SPLAN DKEY NOTES � o eT IiI xaLLwx.a� ex xa ` I L c � �� � REEMREoOVERE�xS TRaiSNT owO NRaeONFaO,RrRNIaw EXI ,IlmlU�RNA«NEWPRNLO— �n� ON s s se - NO OIT < ReMO.eas nOREDx NOFxRNRE I- e T. ❑ ,NEsx SD a � OLOseTa: ®IREHONE SINK AND<ONNTERSallo<aRR,N�NO,NEs x r �. a. — RN R�O «EN��ROASR®�REo N�aLLwA. � � I LINES ,. I. V J ems, iNEWCLOSET I I - ? - — - x .. pFIRAEDE io a ` -- - --� s x .mae.nRDLA A / E -- - - - N sT oo�sT. oa H N. I - REMOVALS FLOOR PLAN 1 CONSTRUCTION KEY NOTES EARN a oerc'ea "ITALL 11NIII AND PAR lsl e oxsT.exam ❑ N NEWD,nm RooMs ao anowcaRin ex,eT. ROoxa, o a xSLwx. 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F m -� - x AREA T J (S Flo T LOR..<aeA - n w w �k� m i�p� GENERALCONSTRUCTION -- r" u - -� c ex s =..z — --I - wx N. w y Ex�sT �w - NOTES o`op Ra NT a,L RaR„r,ous N EoarnER SN,E,o,ro».aT<R SERE,os<O�ORS RE-RANT rc LI T -. - -_ xR� EUTREHa«wA.,o ENSUE'o' oRSONEORM z a 1- ---- '...., - z Raul OR Ro�SRa«000RSA1RII IN R.<oNSRR-<T ON ..m ' EXISTING MENS AND OMENS PUBLIC � a IN ALL NEw Rooms.inn uRaN RCNT nc AND RESTROOMS ARE AVAILABLE ON THIS FLOOR R"aA. RanET wNEREanv RowER oev cES AREeE nc C FOR TENANT USE LI.N=ITRUCTION FLOOR LA NMe TeR ones roexisTinc noT 2 A-100.00 1. eR REareRE ,NEw R� we Ex,uaes -_--. - - REFLECTED CEILING PLAN o.�Ea KEY NOTES Room. 'FI o • SGT THALLwAr EILINGI,DNI_ GfExIsnNG EXIST Roosmam wxv © Ne TAYLO Y m _ -- AYLOR NE ARCHITECTS RELOCATE Noxu/xRosf wNreoa Na,NLv,.owT o�os e.,._ ..._ .. REaoMu m c sxlsnNG mAURM veaw PROPRR woax NG oaDER TELs�ezasoo�� mLET ooms � EGRESS NAuwxvru x. STAIR CASE xev a I cL O .x �LDSET., oN ExNT NEw — __ pI — FQ O T �. LO E —E 'I ry� an NEWCLOSET I � � e � `--- __—, - I RECEPnox oEr s.w2L _ _.._ nREA 1 s1 >„ - - --I CEILING LEGEND b EXS EXISTING - --� 2'O� DESCRIPTION W I E O ti00 � I I SYMBOL T -—-- ---- -- - - - -wnSTING e xLEssr z.ns QN-lo LHG fEOOMTRE LACzx)cn AREA PUNNomH N uxaaan Rnl EX'I AT IS EE PUNfoR L11-11 oGAi-)R LIGHT EXIST�,.is Ex STNO S-E Ur NRDOR LIGHT AI (SEE PUN FOR LouToN) REFLECTED CEILING PLAN 1 EXIST. Exsi RMERGRNcv LGnTw MIN 6ArTERr E% (SEE I$EE.PIAN FOR LOunoN) I, EXIST.'�� 115r NG SUPILr offusER S ` � EXIST. R/A ISTwG RETURN DlffussR EXIST. ExIST.SPRIN HEAl SP ISEE PUN FORRSLOCATION) EXIST O ISEEPU=LocATZ I NEW NEW z. LIGHT p'R A " ISEE PUN<PORUr LOCATION) NEW ENCY LIGHT 9DMINSATTERY -ply j EX ISEE PUN orv) -FOR Lour N NEw SMOKE DETE"OR SD O (SIR PUN FOR LOCATION) N O IS EPtANW ND_ IND). HD RLLRTO I _ REFLECTED CEILING PLAN O V w 2 F f U J Vr w W amwz K O o W NF_ EL SE Z 3 SE O A-200.00