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HomeMy WebLinkAboutBP24-011PERMIT # O// DATE / c�y OTHER APPROVALS g� 7 BLOCKS LOT, ARS SECTION erJ Va 17/J TYPE OF WORK �Oi / C el?BOT -- oun� i 2 /� PB JOB LOCATION fn E'_%�np �GcST�PS / & 0763 ZBA — /UQn� �, _ �„�P //0�9 y) 7q/ OWNER /Q OTHER CONTRACTOR FEE _ EST. COSTrow11 FEE �_j- DATE ✓CO # DATE TCO # FEE DATE INSP FOOTING �— FOUNDATION FRAMING RGH FRAMING INSULATION _/ PLUMBING �Q RGH PLUMBING GAS SPRINKLER Z ELECTRIC LOW -VOLT a ALARM O AS BUILT FINAL s710t PP 0 'ja/e0/7 ��r/ VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 24-036 (fertif irate of ®ccupo.urp Ehis is to certify that of, zr having duly filed an application on 20�LZ requesting a Certificate of Occupancy for the premises known as, 360 A /e/ d®rd ezr ^/` , Rye Brook,NY, located in a )/5 Zoning District and shown on the most current Tax Map as Section: /�(9 / Block: / Lot: , and having fully/complied with the requirements'of the Building Code and the Zoning Ordinance under Building Permit No.6>9e -V! l , issued L4::?> q 20,:-?- / /Y , 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: IN Construction: , for the following purposes: 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 he t shall be made,nor 1�11 the building be moved from one location to another until a permit to accomplish such change ha bee obtaine om Building Inspector. APR 1 8 2014 Building Inspector,Village of Rye Brook: Date: �,,��33 For office use nl : p BUILDT1jE�1 �2TMENT PERMIT # C1) O11 VILLA4 OF RYE$*QOK ISSUED �y APR 15 2024 938 KING STREET�,'WYE BROOK,NiW YORK 10573 DATE —/5—c�q j94'4j 9 -0668 FEE �' /�S— PAMJ� VILLAGE OF RYE BROOK w: r o k or BUILDING DEPARTMENT APPLICATION FOR CERTIFICATE OF OCCUPANCY, CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION •ssss►rssrrssrssssssssssssss►►s►•sss•r►r►♦•••►r►••s•►rr►ur►►sssassssssss►r►sssws►s•ass►rsr►•s•►ssssr►s►►sssss►sass►s►sass►r Address 36 Country Ridge Circle Rye Brook Ny 10573 _ Occupancy/Use: /. F,#M —Parcel ID#: /s)9, 7`/ Q 1— / 9 Zone IC—1 S Owner: Nancy A. Delfino Address:_ 15 Chieftans Road Greenwich Ct 06831 P.E./R.A. or ContractorinCent Grillo, Grillo Brothers In CAddress: 19 Windingwood Road Rye Brook NY 10573 Person in responsible charge: _ Vincent Cirill0 Address:_ same as above Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy /Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW YOM COUNTY OF WESTCHESTER as: Vincent Cirill0 being duly sworn,deposes and says that he/she resides at 19 Windingwood Road (Print Name of Applicant) (No.and Street) in Rye Brook ,in the County of Westchester in the State of NY that (City/Town/Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$ for the construction or alteration of: Deponent further states that he/she has examined the approved plans of the structurelwork 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 e Code of the Village of Rye Brook. Sworn to before me this Sworn to b fore me this day of I ,20q day of , 20 D;z Si ure o perry Owner SignAAicant 1 5 L_r 1"q) t ame of perry Owner _ Print Name of Applicant _ No ry Publ otary Pub GREGORY AL RNERA GREGORY IN.RNERA Nebtry Public,State of New York Mary Public,Stab of New York 8i 12/2o21 No.CIRIS4413U No.MRI6441388 Qualified In Westchester county n/ QuaWW in Westchester county / Commission Expires September 26,20_ Commkolon Expires September 26,20 QyE BR(81 cu � '9a2 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 : P \� �.x✓ DATE: !�'- 1,6 Z,,)LX PERMIT# Z �! I ISSUED: ' z`( -2- '(SECT: JG 7 BLOCK:_LOT: LOCATION: , c ��QJ�� I.-)7 OCCUPANCY: ❑ Violation Noted THE WORK IS... a-1ASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas r ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION 4a FINAL ❑ OTHER �E BR(�� Zm cu � 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 - - - - - - - - - - - - - - - - - - - - �((2) � ' �Y �- 6 � � 'ADDRESS : C—D— ATE' 2- \ PERMIT# ISSUED: Z 2 SECT: BLOCK: LOT: LOCATION: 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 rq \ T W ^ N P-1 0+ a,eq 1] ~ • N w � � a nLo a +� en a c tJ) N cn a a� 4 \ a O w w et H w x � vv � W wo U04 C .d g }C� a PLO A4 C N V Fit [j] x w w N � s��i "� H � a TO O pCN _ a M rCY 04 C7 � A z O a cn > ��„•. p � 'y �a .a w 0C.A4 Ea H y 5 E rff� BUILDING.-DEPARTMENT VILLAGE OF RYE BROOK JAN i 0 2024 ID 938 KING 4EET RYE BROOK,NY 10573 (044)939-0668 VILLAGE OF RYE BROOK "-w,vv.rvebrook.on_, BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: f�Approval Date: 9 +� Application Fee:$ // 00 —P6 Approval Signature: mi Permit Fees:$ Disapproved: Other: Application dated: I © _� / is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of Permit for the interior alteration of an existing building,or for a change in use,as per detailed statement described below..7 / I 1. Job Address: 3(. C c���r�1 �1 Ara E L red� SBL: /a 9, /�7•mil—/ 9 Zone: 2. Proposed Improvement.(Describe in detail): VC'rC H z no V 0- c C. to c,. n,-7 e.+S .f 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: 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: 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: After Construction: 6. N.Y State Construction Classification: N.Y.State Use Classification: 7. Property Owner: NQtn r!q f�. De y Fin a Address: 1 S C h t(-'F4 e y'S U a' C$Ptn W A CLI C T_ Phone# 103 S-51 2%a1 Cell# email: 06,8 31 8. Applicant: 41rcC-4 C CC,C) Address: Rt�� S� rh S n , c 0rn Phone#314 U441 0��3 _Cell At l g emailk Q 9. Architect: Address: c t rJ � Y OC3,C�jvl Phone# Cell# email: 10. Engineer: — Address: Phone# Cell# yy email: p 11. General Contractor:_V th en-t C.r ,11-p Address: 1°�ca tl, od;� a� �Y 2 rJ+roO([ Wy Phone# f Cell# email: l O L 12. Estimated cost of construction $ D 5— 3©f O O Q (NOTE:The estimated cost shall include all labor,material,scatToldmg,fixed equipment,professional fees,and material and labor which may be donated gratis.) 13. Job Timetable:Start: TGn 1t, t202�F Finish: N P kf 79, Z o Z3 (1) 6i1/2023 AR © ECIEll V BUILDING DEPARTMENT�MENT ED VILLAGE OF RYE Jf4OOK JAN 10 2024 938 KiNIG"ET RYE BRd ,NY 10573 � *4)939-0668 VILLAGE OF RYE BROOK www.ryehrook.org BUILDING DEPARTMENT 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: A residing at, I S C h,C f'i-i S. RCk , seen Lo ich�T (Print name) (Address where Nou live) C70163 l 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; '3(. C oy,�ry k�� A G e C ( �-c ,Rye Brook,NY. (Joh 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. (S i gn a tT1 7.1 ol'Prorcrt )wncr(s) MtNciE � (Print Name uP1'r4 erh (hvner(s)) Sworn to before me this Vb of 20 � (Notary Public) SHARI MELILLO Notary Public,State of New York No.01ME6160063 Qualified in Westchester county-? commission Expires January 29,20, _ 1 (2) 8/12/2021 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: V ►-.,,e..} C.r A I to ,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 Sworn to before me this day of � L � , 20 l day of �, 20 Signiffudof Prop weer Signature of Applicant P tNameoi 'yoperwowncr Name of Applicant No ublic N Public SHARI MELILLO SHARI ME o Notary Public,State of New York ;tit;tary Public,Statee of f New York No.tJiME61600t83 No.O1MEfi180063 qualified In Westchester County Qtlailfled In Westchester Counter Qom mission in Expires January 29,20� Commission Expires January 29,20=! (4) 811212021 a L _ N w . oCD q-4 n1 C4 000 i 0 � O 00 w (7s z vw C4 0 w 00 ell Q Zo � z �-, � °z H � � � . O ; ;� ° z 0 O Z A A Z ' v� _ AOi L p4 c�, A ono Q z rx U ,� a w W w gta V z 1 CC)� t • O � 1 _ (n 0 z \ O \ F+ o o a ' Q � W C% z V z fn s O W c7 cn ` A z � ' � ►—� V H w cn o ►� oo O V w z w z s M „a ` ~ � � �- zz A 14 CA �"� ►—� � O U A F W Ia-� W O z $ a z a ["' v t V v `� cn W W 4. 0 C ° o ~ : x V v O W z P. � z w z 0 M 9 a w a a � a ►z �I r e f (-,)— : D E C ENE BUILDING DEPARYMENT VILLAGE OF RYE FEB - 1 2024 938 KING STREET RYE B K,NY 10573 -- g VILLAGE OF RYE BROOK (914� BUILDING DEPARTMENT wwrv�tbr6ok.org ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required �p� FOR OFFICE USE ONLY BP#: C�)�`O i / EP#: Approval Date- FEB 20 Permit Fee: $ Z,5 D-7 Approval Signature: Other: DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BV THE BUILDING INSPECTOR. THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated, ` �� is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove electrical equipment, wiring, fixtures,or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. q I.Address: _3(.o C_ 00%AAN, l��IN p C 2 , SBL:1 o1g) 72/M��� / Zonere�� 2.Property Owner: N ct 'j C_ oc.- (-e .N o Address: s"" _ Phone#:Cl/`>' 'fT/- 7L5"7 n Cell#: email: p / 3.Master Electrician/Licensed In//staller:'/Dk-o'j �� ;"... r�.� Address: I/`f leu fA sr Lic.#: l Z f? P one#: 87J J 7 9`�-`r SVCell#: email: n Company Name: C. C �N�. C� Address: i/'f Pam,4 S f 4.Proposed Electrical Work/Fixture Count: 5.311 Party Electrical Inspection Agency: SW 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 (print name of individual signing as the applicant) state that(s)he is the for the legal owner and is duly authorized to make and file this application. (Master Electrician/Licensed Installer) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances,and regulations. Sworn to before me this Sworn t b fore me this day of ,20 day of 20 Signature of Property Owner Signature of Applicant Print Name of Property Owner Pri ame of Applicant bb Notary Public No� G� M.RIVERA Ndwy Public,State of New York 10/30/2023 No.01 R16441398 Qualified In Westchester County / r.,......c.et,...C-1—ce..k,..w .ec on-j/ STATEWIDE • 1:1 Main Street,Fishkill, NY 12524 1 email:office@swisny.com SWIS JOB APPLICATION tel845.202.7224 fax 914.219.1062 1 SWISNY.com I SWISTraining.com Office Use Elect.Permit# /�� i / O � `-�— Date Bldg Permit# Utility ID# Final Certificate# City/Village Zip Township County Address Cross Street Section Block Lot Owner Name/Address(if different than above) Contact Number ❑Basement �] 1st FI. ❑2nd FI. ❑3rd FI. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside 0 Residential []commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact v Amt Amps Z- 11�.— Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent SERVICE Amperage Voltage 1 P 3P #Meters #Disconnect ❑Underground ❑New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information �3 .t.c �t,F� ! ,U EVE FEB 12024 VILLAG E t�l= RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by WAS.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. Inspector Date Finalized Inspector# Company Name Date Signature /i Yl _ /l. Address City/State r Zip Code _ License# Phone# �� DD State Wide Inspection Services APR - 2 2024 1080 Main Street Fishkill, NY 12524 SWW 845 202-7224 Phone VILLAGE OF RYE BROOK ! 914-219-1062 Fax STATE WIDE INSPECTION SE RVICES BUILDING DEPARTMENT ` Email: office@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: Power and Energy Corp. Nancy A Delfino&John Delfino Trustees 114 Pearl Street, Suite 1A 36 Country Ridge Circle Port Chester, NY 10573 Rye Brook, NY 10573 Located at: 36 Country Ridge Circle, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 24-025 129.74 1 19 Certificate Number: 2024-2006 Building Permit Number: BP 24-011 A visual inspection of the electrical system was conducted at the Residential occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at: 36 Country Ridge Circle, Rye Brook, NY 10573 The First Floor Kitchen 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 1st day of April 2024. Name Quantity Rating Circuit Type Receptacles 02 GFCI 02 Switches 02 Hood 01 Disposal 01 Panel Swap 01 Officer: Frank 1. 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. r r •' r r cog, N a ' \ � H a ■ N OOO Ln NN en M z W O en en im N \ Ln ' E L1 M IF r 00 co pt" 0 w = cn �T Q a Z uz 04% can W Q ►;7oc . O ►-, z � ■, �"'� U W x A w , a� � v' � O o can � o � a � � x oA 4041414aa4;aaa$+41441446aa4646*A#A9$4$4#W#Aaa$4$6*►04a44i4 4 a46444491i1 p ECENED OIR JAN 11 2024 BUIENT VILLAGE OF RYE BROOK VILOK BUILDING DEPARTMENT 938 KiNNY 10573 PLUMBING,[PERMIT /APPLICATION FOR OFFICE USE ONLY BP#: CD / ' 1 PP#: cz)q_ ©/ 1 Approval Date: Permit Fee: S- In9t )I n(j , Approval Signature: Disapproved: (fees are non-refundable) ************************************************************************************************** DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BV THE BUILDING INSPECTOR.THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated, 1-1 —Q 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: 3 Cc v•�� ,c�ct E C�rc�e Cry ��-00 l( SBL:/c) /, 77—/—I ZoneX— -S 2.Proposed Work: V"%TC IEw3 Reno..city- r-e^ovc- a^d rreplwc-1_ 51 -tL v, Qat��l4�c�C 3.Property Owner: Address: Phone#: 0 3 S 3 1 Z 1?>O\ Cell#: email: P ''\ , • G no bl331, 4.Master Plumber: ez I -o Address:q s,�7 '�vrr V►s� �/D t-I ' .'" jD 7aq Lie.#:-j-7?,_Phone#: Cell email: I C3 Company Name: A ?L-& t -4 I-ra Address: vyl c INDICATE FIXTURES&LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks. Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1st Floor 1 + 2nd Floor J 3'd Floor 4'Floor 5'Floor Exterior 5.* List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) 3/3/2023 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: C-'(Z I C Ov�"Scr- ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual 6igning 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 `1 day of �(�y-G-(�, ,20 day of ,20 ZCr �v i ature of roperty Ow r gnatur Appli ant NCAVncy A • .nt Name of Property Owner Print Name of Applicant w Notary Pu Nl011W f 1bkfr,State of New York Notary Public,State of New York No.OIME6160063 No.O1ME61.60063 Qualified in Westchester County Qualified In Westchester County Commission Expires January 29,20Z77 Commission Expires January 29,20 L This application must be properly completed in its entirety and must include the notarized signature(s)of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- 10/30/2023 p ECENE BUILD _ A MENT J A N 11 2024 VIL E OF RYEOOK 938 KING ET RYE B1100 ,NY 10573 VILLAGE OF RYE BROOK 4 9-066��`� BUILDING .DEPARTMENT 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: 3, k)0.-'c-( ,residingat, 1S' (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; 3/0 co"-�- t1. ki L , 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. (Signati c of Prop y ON%ner(s)) C-� (Print Namc of Property Owner(s)) Sworn to before me this %� O 20 r21 (Notary Public) SHARI MELILLO Notary Public,State of New York No.OIME6160063 Qualified In Westchester County _ Commission Expires January 29,20L _3 8/12/2021 132,E 77 E' 30. 24 o' 51" 81;6' 75"" Legend 1. BWBB15-2 24" (BWBB15-2) a 7 8 9 2 SB36 BUTT - — (SB36 BUTT) vl 0 3: BSS36L WD M M 5 6 (BSS36L WD) _ 4: WER2436R (WER2436R) Ln N w 5: B30 BUTT i I� , (B30 BUTT) 6: BPP9 (BPP9) 7: W1236L (W1236L) 8: W3018 BUTT a (W3018 BUTT) c0 N ;'� _ rn 9: W936R 41 (W936R) A 10: UT1824 X 901-4ROT 2 w (UT1824 X 90L4ROT) 1 11: DB24 0) (DB24) 1 X 12: RR96{Lj .- N (RR96L) BLB36/ a 13: RR96(R) v O (RR96R) -0 14: UF392{FOR 90"HIGH} m (UF392) J 15: OVD3090 AS BUTT (OVD3090 AS BUTT) 16: W2442 BUTT Cod� (W2442 BUTT) "' (a 17: W2436 BUTT (W2436 BUTT) 62e" 18: WBEP WBEP (WBEP) microw.base 132,." All dimensions size designations This is an original design and must Designed: 1/30/2022 given are subject to verification on not be released or copied unless Printed: 1/30/2022 job site and adjustment to fit.job applicable fee has been paid or job conditions. order placed. 1 1603d21 All Drawing tl: I,No Scale. 132 6' 24" 12" 30" 9" 57 6' 776' 308" 248" q2 000 N YT. LO LO W3018 BUTT 0 WER2436FW12361 "V936R O _ HOOD.3 00 V! T '—N'^^ YJ n CO N 0)rn jOV1:)3(UF392 BUTT - 0 CO .;KT.30 CO " BSS36L WD B30 BUTT BPP9 CO It M 36" 30" 9" 33" 24" 16 51" 8116' All dimensions size designations I This is an original design and must Designed: 1/30/2022 given are subject to verification on not be released or copied unless Printed: 1/30/2022 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. 11603d21 , - ---�EI 1\1 - Drawing.N:: I- No Scale.le. 141" 5111 24" 1 4 of 21' 2411 2 4 tr cr CO N C 'V3618 X 24 DP BUTT 00 C W2436 BUTT W2442 BUTT N CO ti r �N ' � - CV) UT1824 X 90OVD3090 AS BUl 9 96R cv MW.6PACE— REF.2D.36 N CO L CO DB24 B24R CO M f n n n 31t n 3„ 18 30 24 1 111 368 1 4 of 24 3 s rt d 63" 31 8" 468" All dimensions size designations This is an original design and must Designed: 1/30/2022 given are subject to verirication on not be released or copied tmless Printed: 1/30/2022 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. 11603d21 EI I\2 Drawing N: 1 7 No Scale. 126" 102" 2411 16 95 6„ 30 19611 MOD L J N 'f^ W r b CO - C - WER2436R M N 0),^ Y J V �N - ln N LO m(D - M M ' FP9 BLB36/39R UB15- SB36 BUTT BSS36L WD M 131 " "11 ,s 27 11 413 4„ 36 36" ,6 8 53 3 i 71 8 3n 4 8 All dimensions size designations This is an original design and must Designed: 1/30/2022 given are subject to verification on not be released or copied unless Printed: 1/30/2022 job site and adjustment to tit job applicable fee has been paid or job conditions. order placed. 11603d21 1i1 1\3 Drawing k: 1 No Scale. 3 "o .Building Permit Check List&Zoning Analysis Address ( Zone: Use: �A� Cont.T Other: Submittal Date: \ Revisions Submittal Dates: Applicant: Qpn fo Nature of Work: �Q= Reviews:ZBA:,AN 21 2024 PB: BOT• Other. (�( FEES.Filing._42�cP: 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 Play Other: ( ) ( ) SURVEY:Dated: Current: Archival• Sealed. Unacceptable: ( ) ) PLANS:Date Stamped Sealed: Copies: Electronic Other, t Gl�.tzc-1 C4� 1� ( ) 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:Plan: Permit: Nat.Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plan: Permit ( ) ( ) H.V.A.C.: Plans: Permit: N/A: Other. ( ) ( ) FUEL TANK:Plan: Permit: Fuel Type: Other: ( ) ( ) 2020 NY State ECCC: N/A Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plan: 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: J� REOUIRED EXISTING PROPOSED NOTES A P A y Area: ��� ►1 G 20?4 Circle: Fro ¢e Front: Front: Sides: Rear. Main Cov: Accs.Cov: Ft.H Sb: Sd.H Sb: GFA: Tot�ImD: Ft I D: pmkiw. Height/Stories: notes: ' rw i +C .+d.•. � naL� .'!',F':�?� v G'-F� ,�p �rx�'°�{e' r -ar'v+�+n�,�t� r+e�l'z'.- �rfcf.. '� •'r:4'A��R�ig3+lt� rty .`. !lil1�{ �ics��� it R�4Tfrr+ ;q��� i �~��r °��@� vir!0'i' ti' ♦i• v a yv � �t�'�:tf!!�!lilrJ�-- .�'.`ii4!!ftf�"�43' ;_�a;af�1011P''j.�..5s- �������I�f`�"�L� ;. s.l'1'a�j�� �`'��!!►�f'i�f � � rA '4�... - �+ f�,:ZS•'�'�"r±'�YX•RS`�JS"�3��T�f'°�°'LTt°L7�.Ti:�\UY"'+"h'nt^2"�'TC._.�/IS�'�+ .,: . . .. . . �__---—_ �����. ��:' '� ai O G U p '��" `•'' v a N00 T— H Go ice+ O H �dYmrc 1�"�fT.ES�C.Ya cd y C �rt�F op" i t Z Z In CD LIJ O m aAcc O Z w r- •� a O ¢ � A y k Uas iC `,4-4 a Ch z Cl LO y � p � N V cOi m .a op i> • AC"R"® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 01/06/2024 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 B I B ERK PHONE FAx P.O. Box 113247 EMAIL 844-472 0967 203-654-3613 INC,No. .>nIF � (A/C.No): Stamford, CT 06911 ADDREs: customerservice0biBERK.com _ INSURER(S)AFFORDING COVERAGE NAIC 0 INSURER A:Berkshire Hathaway Direct Insurance Company 10391 INSURED INSURERS: Cirillo Brothers Inc INSURER C: 19 Windingwood Rd N INSURERD: Rye Brook, NY 10573-1131 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILT R' TYPE OF INSURANCE nijs SUBR PO-LICPOLICY NUMBER MMIDDIYEFF MMIDDmYY LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 -- DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES SES aoocurrence f 50,000 A N9BP998576 05/06/2023 05/06/2024 MED EXP(Any one person) f 5,000 PERSONAL&ADV INJURY $ Included GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE t 2,000,000 PXPOLICY JJEECTT LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COM�BIIINEEDItSINGLEUWT $ (EaANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per acciden S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION S f WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y(N STATUTE I ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED7 ❑ NIA --- (Mandatory in NH) E.L.DISEASE-EA EMPLOY E If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT f Professional Liability (Errors & Per Occurrence/ Omissions): Claims-Made Aggregate DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 938 King Street ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD NEW YORK Workers' Certificate of Attestation of Exemption STATE Compensation from New York State Workers' Compensation and/or Board Disability and Paid Family Leave Benefits Insurance Coverage **This form cannot be used to waive the workers'compensation rights or obligations of any party.** The applicant may use this Certificate of Attestation of Exemption ONLY to show a government entity that New York State specific workers'compensation and/or disability and paid family leave benefits insurance is not required. The applicant may NOT use this form to show another business or that business's insurance carrier that such insurance is not required. Please provide this form to the government entity from which you are requesting a permit,license or contract. This Certificate will not be accepted by government officials one year after the date printed on the form. In the Application of Business Applying For: (Legal Entity Name and Address): Building Permit Grillo Brothers Inc. From:Village of rye brook 19 windingwood rd rye brook,NY 10573 PHONE:914-649-0263 FEIN:XXXXX8842 The location of where work will be verformed is 36 country ridge circle,Rye brook,NY 10573. Estimated dates necessary to complete work associated with the building permit are from January 15,2024 to March 30,2024. The estimated dollar amount of project is $10,001 -$25,000 Workers'Compensation Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE SPECIFIC WORKERS'COMPENSATION INSURANCE COVERAGE for the following reason: The business is a one person owned corporation,with that individual owning all of the stock and holding all offices of the corporation. Other than the corporate owner,there are no employees,day labor,leased employees,borrowed employees,part-time employees,other stockholders,unpaid volunteers(including family members)or subcontractors. Disability and Paid Family Leave Benefits Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE STATUTORY DISABILITY AND PAID FAMILY LEAVE BENEFITS INSURANCE COVERAGE for the following reason: The business MUST be either. 1) owned by one individual; OR 2) is a partnership(including LLC,LLP,PLLP,RLLP,or LP)under the laws of New York State and is not a corporation; OR 3) is a one or two person owned corporation,with those individuals owning all of the stock and holding all offices of the corporation(in a two person owned corporation each individual must be an officer and own at least one share of stock); OR 4) is a business with no NYS location. In addition,the business does not require disability and paid family leave benefits coverage at this time since it has not employed one or more individuals on at least 30 days in any calendar year in New York State. (Independent contractors are not considered to be employees under the Disability and Paid Family Leave Benefits Law.) I,vincent cirillo,am the President with the above-named legal entity. I affirm that due to my position with the above-named business I have the knowledge,information and authority to make this Certificate of Attestation of Exemption. I hereby affirm that the statements made herein are true,that I have not made any materially false statements and I make this Certificate of Attestation of Exemption under the penalties of perjury. I further affirm that I understand that any false statement,representation or concealment will subject me to felony criminal prosecution,including jail and civil liability in accordance with the Workers'Compensation Law and all other New York State laws. By submitting this Certificate of Attestation of Exemption to the government entity listed above I also hereby affirm that if circumstances change so that workers'compensation insurance and/or disability and paid family leave benefits coverage is required,the above-named legal entity will immediately acquire appropriate New York State specific workers' compensation insurance and/or disability and paid family leave benefits coverage and also immediately furnish proof of that coverage on forms approved by the Chair of the Workers'Compensation Board to the government entity listed above. SIGN Signature: Date: i `-i ti 20 Z 4 HERE Exemption Certificate Number Received 2024-001289 January 8, 2024 NYS Workers'Compensation Board r13-2M OP201"