Loading...
HomeMy WebLinkAboutBP24-009PERMIT # e/ QA 00 / DATE. 13 4 Exp. / a3 aS SECTION 3J i OCK LOT TYPE OF WORK� 2nOVQ Owi cD ;0041S JOB LOCATION O 2 2 rj Ve OWNER VQi7 c?r!nQ f 4100id r 33-0T CONTRACTOR .CCO0C-�rS — u�/ „x EJ��. j/I/eirc 0Q3�y3a 0�35 EST. COST � O FEE4 ,D V/CO # FEEA ,;Q =f 6 DATE Jr TCO # FEE I DATE INSPECTION RECORD DATE '! INSP FOOTING FOUNDATION FRAMING 7�2aM p��4� � RGH FRAMING / v INSULATION PLUMBING Z�S' 2aZH CJ d RGH PLUMBING shwa GAS 0 SPRINKLER �/ 4%L�/ C cot Lo ELECTRIC LOW -VOLT F1 ALARM AS BUILT C7 FINAL J% ' .3204S OTHER APPROVALS ARB BOT P$ ZBA OTHER 2�M p"YL. Fb (�,gssed VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK Certificate of (9ccupaucp This is to certify that Evan) Q J0111' I r-e/7(f 7a/7/9 Q{--- of, Y K , having duly filed an application on 20 C>?Vrequesting a Certificate of Occupancy for the premises known as, / (il -Q &J �/ , Rye Brook,NY, located in a R/0 Zoning District and shown on the most current Tax Map as Section: Block: Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. `l7 -60-/, issued 11,23 20_2W, 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: ki / Construction: for the following purposes: 400 hQ- M)P-J15zt7)f 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 cilities shall be made, and no enlargement, whether by extending on any side or by increasing in heig s Il be made,no all the building be moved from one location to another until a permit to accomplish such change has en o ain fro th uilding Inspector. MAR 0 4 2025 Building Inspector,Village of Rye Brook: Date: �_ _L, iJ �J L� j For office use onl,,:// (� BUILDING DEPARTMENT PERMIT# 009 1 AUG 13 20 If VILLAGE OF RYE BROOK ISSUED: �3- 938 KING STREET,RYE BROOK,NEW YORK 10573 DATE: - — .3— --•--------R- (914)939-0668 FEE: — PAID VILLAG� Or RYc BROOK BUiLQIi1G Ol=1,gl?T',;"}r_r.ly www.ryebrookny.gov 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 rrrrwrwrw/rrrrrssrtrrrr`rrswrswrr�rfrarrrwrwtrrrrrrrsrt►♦rrtrrrrrrwrwrrsarrr■♦rrsrwrrrrrrrrrrrwrrtrwrrp►►rrrsrwwwwrrarwrrwrrarrr Address: ! L Ov)�&e� �-1 YT✓e k(' 13 Y DD I� Occupancy/Use: 11�A f Parcel ID#: / Zone: Owner: Address: �_�i O 7 6/o�7'<r j �u R Yf l�roe<' P.E./R.A.or Contractor: 6L GDn tr��c�m Address: JZ9 ,cf Ye'S /I�LCA a-T✓e br�� C� Person in responsible charge: (Sy lit�Lj t� L vc�,e 7 p Address: jdGYr- �lrz l&I Ile- 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: l„!J being duly sworn,deposes and says that he/she resides at (2 C re S4✓,� C ,(oo Nam (Print Na of Applican (No.and Street) in 7 L"''10>,- ,in the County of r ra e in the State of C,that (City/r wn/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:$ 4�1 tm . 00 for the construction or alteration of: /.,,,,joA hcc mim 4>l yK,"1 Apc*n a 1 . "IA� 60,*. nA"i 1A Re "wnhl�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.offt the -,Code of the Village of Rye Brook. Sworn to before me this 1� Sworn to before me this day of �y�� , 20 24 day of kQi4 S� 20 ,:v?4 Signature of Property Owner tgrtature of Applicant IPrintName T TIMOTHY R TRACY l/�,Ytnp Lc�r rdy r) o wrier TARY PUBLIC,STATE OF NEW YORK Gam!petty Print Name of Applicant Registration No.01TR6185472 Qualified in Westchester County Commission Expires May 25 , 2028 No Public LIGIA G. MAIA Notary Public, Connecticut My Commis w Expires 0010V �E 4Rnv�. 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 : I � .) -Zrt F "�'Q DATE: L �� PERMIT# � " con ISSUED:I 2 SECT: BLOCK: LOT: �v LOCATION: �` ^ `" �� u OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... 0 ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION �• fINAL ❑ OTHER QyE BR(��. 1932 BUILDING DEPARTMENT ❑BUILDING INSPECTOR Q'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 : L o J C � DATE: C7 Z PERMIT# ` '1 - ISSUED: SECT: I •(o(.o BLOCK: LOT: `� v LOCATION: S P C d-�' «/1 c-��•J 4 (-�- /C y�J`~ OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... a- ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS !"� ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER �f] FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER QyE 4RC�� �O /�• 19812 `� 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 : L-orJ 1 C C�cA --z--) c DATE: 7 ^LPL PERMIT# �� ISSUED:3 7-Z-/ SECT: /"k, BLOCK:LOT: ! c� LOCATION: 1 f�� G�'� ��V OCCUPANCY: ❑ Violation Noted THE WORK IS... i ASSED ❑ FAILED /REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: Z�-�ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION '� 1 ❑ Natural Gas ❑ L.P. Gas ti ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER �yE BRcbl 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 - - - - - - - - - - - - - - - - - - - - ADDRESS:— k3 A DATE: PERMIT# "� _ ISSUED: 'Z3rZ SECT: BLOCK: LOT: Vb/ LOCATION: �� l� ryAcJ OCCUPANCY: ❑ Violation Noted THE WORK IS... PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED f-1 FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas 12 ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER O�`wyC BRC��. 2m •F • �9b2 BUILDING DEPARTMENT ❑BUILDING INSPECTOR El'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 : L /e, Dl el le DATE: L - 9 Z(,72-/ PERMIT# / �U L ISSUED: Zj-Z YSECT:1 BLOCK: LOT: LOCATION: ry O W l_& 1 (,\',-) . OCCUPANCY: ❑ Violation Noted THE WORK IS... [ PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION ✓ REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: B' ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION _ ❑ Natural Gas Jr Lj v ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER O Zm w � FO 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: / 1 L b N4 L e, DATE: 2 Ll PERMIT# ISSUED: SECT: BLOCK:_LOT: �J LOCATION: OCCUPANCY: 2,/U ❑ Violation Noted THE WORK IS... 'PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: -0'-ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION � � -�� In ❑ Natural Gas 1 S O" ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL 0 "OTHER _ Q� "14 o � N N t N N v o" a N44 t N 0-4 cn R, O oo M� er V ) P.V v w �+ _ LDba Ln W © o u A Ln 1 N L Ct1 ' W M M 00 Z"'J' co v 10 coo Zj V7 1� oo Im lu A °� " � ' � � c� Zj H OF O zo °aa � v W ' a , pd O N 0 F,, ' -S U w - F, gw J y - ays y a _ Z W W O � r 9 'u o b as wv BUILD EPA MENT VIL �iGE OF RYE�OOK 938 KING REST RYI B1tooK,NY 10573 JAN 17 2(24 (914 i::0�4 INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: ��// ((�� y�nh n Approval Date: JAN 1 7 10 it#:0 !` 'QQ`1'j Application Fee:$ Approval Signature: Permit Fees:$ 1�— Disapproved: Other: Application dated: is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing building,or for a change in use,as per detailed statement described below. 1. Job Address: Janadwj SBL: Zone: 2. Proposed Improvement.(Describe in detail): I 1�n5 1 Yl�k 1 1 Yl r 1 ► ro 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 ll: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an existi utomatic fire suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) :No: V Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 5. Occupancy;(far)2 fam.,comm.,etc...)Prior to Construction: 1. Fcanr After Construction: Fm-o 6. N.Y State Construction Classification: N.Y.State Use Classification: 7. Property Owner:,G 1/ 1 1(2 1� PQ C Address: Phone#014 '3251-Ci U Cell#9 14 3o2'Q3 11 email:e YY1Q► / 8. Applicant: (�U 1 Meai YY1G )i t'J I V ei Address: ae4 01 2'-.J CT Phone# 0)0'3 " ��f Cell# email: t GC P Ci�d 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# L email: 11. General Contractor: 60 \ki W L DA ORddress: Cis 1cw�C. Phone koys-Z�_3 •06�S Cell#_c2d.5 "�N_,5 C.tD S email: te" 12. Estimated cost of construction $ —to I Qg. `) (NOTE:The estimated cost shall include all labor,material,scaffolding,Cured equipment,professional fees,and material and labor which may be donated gratis.) 13. Job Timetable: Start: Finish: (1) 6/l/2023 BUILD D"TMENT VIL E OF RYE OOK JAN 17 M4 938 KMG ET RYE BRO ,NY 10573 (9 4 � VILLAGE OF RYE BROOK w ■xe9 BUILDING DEPARTMENT *******************************WWWWW**WWW WWWWWWW**11r*WW*WW*WW*WWW**WWW***W*W***WW**********W*******W**** AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 - STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION_ ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YYORK, COUNTY OF WESTCHESTER ) as:I j� G1(in d t( , residing at, 1 L e� ' be, (- B(zlo (Print narne) ( ifdress ti iere you live) being duly sworn, deposes and states that(s)he is the applicant above named, and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; Rye Brook,NY. (Job Address) Further that all statements contained herein are true, and that to the best of his/her knowledge and belief, that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. (Signaurrcof Property U%�ner(s)) (Print Name of Property Uwner(s i S rn to before me this TitVTOTHy R. 1"tiACY ay of , 2� NOT Y PUBLIC,STATE O NEW YORK Registration No.01TR6185472 Qualified in Westchester County UA Commission Expires May(N�tary a ic} y 25,2024 (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. S AT OF NEW YqR1J1 THY I~ ESTCHESTER ) as: 6UL hcrrnr� �(� "COr!✓Coj ,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 q-41 Sworn to before me this 1041 day of 120 day of��('h i( 14 f L, 20 do-- of Property Owner �,Wpature of Applicant �U ?A (r�,�,l y da.51Jt/eqy7;� Name of Pro tty caner Print Name of Applicant t _L No7%0 Notaryw TIMOTHY R.TRACY =Public, IANOTARY pUBUC,STATE OF NEW YORKRegistration No.01TR6185472 ecticutQualified in Westchester County Commission Expires May 25,202A /31/2027 (4) 8/12/2021 r. O N � N � . a : 00 44 0 � N v A F Ln w ^ U a 00 p11, v w ow V : W Cjj O ZxL(i , ►zr y v x : ►� � W ZO v H ,o, � g a� H u H s Z 0 � ` N O A - O ! 1 0 00 ) 3 Q d w z , cn ow (Aen4 m z z enL� O V 0-4C� M z r� O p Q4 , U A a w v' H a o a g o zz W 0 A .94 a x w E0.4 N � F+ w z H o v, � W O z ►�i � fn 12 � d xE- , p C�C� C OML BUILDING DEPARTMENT FEB Z 1 M4 VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)"9-0668 BUILDING DEPARTMENT www ry brook.ur� ELECTRICAL PERMIT APPLICATION Westchester Countv Master Electricians License Required ,t3P0-C�y - 0c)9 FOR OFFICE USE ONLY BP#: — 33 EP#: �7 Approval Date: MAR 0 1 1 4 Perinit Fee:$ 3 / Z) Approval Signature: Other: **rtssss*s****tsssssssrtssssss*rtsrtrtss***rtrt*rt*rtsrt*****rtsssss*s*sssss*ss*ssssssrtsssssssrtss*sssssss»sss DO NUT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR. THE ADMU45TRATIVE 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, 02/20/24 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. 1.Address: 14 Longledge Drive,Rye Brook,NY 10573 SBL: Zone 2.Property Owner: Evan Tannor Address: 14 Longledge Drive,Rye Brook,NY 10573 _ Phone#:917-832-0711 Cell#: 917-832-071 I email: etannor85@gmail.com 3.Master Electrician/Licensed Installer: Thomas E.Jocelyn Address: 1475 E.222nd St.,Bronx,NY 10469 Lic.#: 1144 Phone#:718-320-2023 Cell#: 917-559-1258 email: tjocelyn@scientificelectric.com Company Name: Scientific Electric Company Inc. Address: 1475 E.222nd Street,Bronx,NY 10469 4.Proposed Electrical Work/Fixture Count: New Fixtures:29, New Outlets:2. Devices Replaced:67, New Smoke/Carbon Monoxide Detectors-4 5.31e Party Electrical Inspection Agency: State Wide Inspection Services wwwwwwwwwwr,tw*w,►wrww*a+wrrwwwwrwr#rwrarw,wwrawwwr,erwrawwrwww*rwwr*,r*,►cow,ttrtw,t*,e,►w,r#*rww,►w,eww*,r*rar#,rw*ww,►,►w STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Thomas E.Jocelyn .being duly swom,deposes and states that he/she is the applicant above named,and does further Y (pnm n,unc of indix•idual ii¢nink a�the applicant) state at(s)he is the Master Electrician for the legal owner and is duly authorized to make and file this application. a> > N that In !Master l'Ieeu elan/Liernzed lna c allc-i O 3 O The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work 0 a) O -y- ZccUiz performed,or use conducted at the above captioned property will be in confomtance with the details as set forth and contained in this c) ..- M 0 C)application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire o c( lv o C: a) Prevention&Building Code,the(:ode of the Village of Rye Brook and all other applicable laws,ordinances,and regulations. J N _ � m � o Sworn to(*- me this Sworn to *fore me this J : w U •V O •C C day of �0 day of 20 ut Z Z -o o C O w F Signature of Prope Owner TIMOTHY R.TRACY Si ture of )leant t'o Z't) E NOTARY PUBLIC,STATE OF NEW YOW �o E an Tannor Re*Vatlon No.OITR6166472 Thomas .Jocel n Z O 0 Pr�t Na e o P perty er wNfled In~chester Cotxrty Pri Name of plicant Commission Expires May 25,2024 Noli ryP4�id Notary Publi \ ta3ono23 STATE WIDE INSPECTION SERVICES, INC. ••0 • SWIS JOB APPLICATION tel 845.202.7224 1 fax 914.219.1062 1 SWISNY.coml SWI STRAIN I NG.COM Office Use Elect. Permit# eJy—U 4l / Date Bldg Permit# 00 j Scl Ft Plumbing Permit At Final Certificate At City/Village Rye / Zip /C '�7 Building Dept. k� li County f, / Address Cross Street Section Block tl � Oil vrrr( o Owner Name/Addres (If dif/erent than above) /-V v �n^n Contact Number 71 7 . o? _ v 71/ L 0 J ❑Basement Ist FI. ❑2nd FI. ❑3rd A. ❑More Than 3 FI. Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI F Switches 3 y hes Dimmers Smoke Alarms C/0 Detector Hood Trash Compact Amt Amps � / ) C 0/ o Range(s) Cocktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels 1P 3P # Meters tt Disconnect ❑Underground FEIew ❑ Reconnect ❑ Repair ❑Overhead pgrade ❑ Disconnect Utility ID« ❑Con Ed ❑NYSEG ❑Central Hudson ❑ Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect ]unction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation l�c I 11chi 1170f( 1 u,c /6C...,y 011P/aCif4�1 ✓ � fh�a., h P� tic.N , l �t7/1� D IEC1�� V I I FEB 2 7 2024 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application%valid for one(1)year from the date received by SWIS This application is intended to cover the above listed items to be inspected,of at any time of inspection additional items have been installed,you are authonzed 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 •T Email Address Joy S �.c �C f/ c O/'1 Name TA0r,c� E Or License# // y y Date )/) 7/J y Signature Address i L/ 75 City/State 1 Zip Code /O y& CI Company S(— r1 kJ;,L Cie(,{1-C C 1) Phone # DState Wide Inspection Services 1080 Main Street FEB 12 2025 Fishkill, NY 12524 � a� 845 202-7224 Phone � VILLAGE OF RYE BROOK 914-219-1062 Fax STATE WIDE INSPECTION SERVICES BUILDING DEPARTMENT Email: officeCabswisny.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: Scientific Electric Co., Inc. Evan &Ilene Tannor 1475 East 222nd Street 14 Longledge Drive Bronx, NY 10469 Rye Brook, NY 10573 Located at: 14 Longledge Drive, Rye Brook, NY 10573 Section: Block: lot: Electrical Permit Number: EP24-041 135.66 1 qg Certificate Number: 2025-0875 Building Permit Number: BP24-009, BP24-033 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: 14 Longledge Drive, Rye Brook, NY 10573 The First Floor Bedrooms, Bathrooms& Kitchen were 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 111h Day of February 2025. Name Quantity Rating Circuit Type Receptacles 34 Luminaires 28 Switches 09 Dimmers 04 GFCI 02 Exhaust Fan 02 C/O Smoke Combo 04 Sub Panel 01 In NO�-I- 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. r, ai Ln Ln 00 N f'4 n i fTl i v pp an cn x p P-4 Z W V 00 ,4 x Z cn z lz W Crap ISd �--, W v 4 Aen V. O w >4 � � � Z o ►7 � � z z � W $ < � �O y 5 H z H 00 O LO (A co � O V y, 00 en u (> CA F.I 0 M zz ao Vomits z ' C� A z � ao V O WQ n A 4 04 U W w O a Z Cl) oe. 4 Z V o � cn p I a w N " � u o a a 6n z A z o 06 �+ w A Z � z n O-FR- BUIENT JAN 2 4 2024 VILOK VILLAGE OF RYE BROOK 938 KINNY 1057BUILDING DEPARTMENT PLUMBING PERMIT APPLICATION \ FOR OFFICE USE ONLY BP#: PP#: C;)J�'O j d- Approval Date: **4Permit Fee: $ /1�)6--!" Approval Signature: Disapproved: (fees are non-refundable) 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%,O/F THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated, / a D-7 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-</c Lex c e SBL: �o4 r�yg Zone: 2.Proposed Work: Ke-t. v,Tie 1 'j FL. R 4i—b llZ - .,. 3.Property Owner: ►/,fl f TA cal'eQ 0 a Address: 3a ,d�%/ Cell#: email:Phone#: 9% 4.Master Plumber: Address: BdZ14jEL?= /4VF— Lic.#: g/3 Phone/ Cell#: email: /3j:& a 42sl�fS�'• �i9---- Company Name: gM1 j S%s 2 1f c.0 Pet wZ_ Address: a?/` 0,4 Z lk f.2 A1f- 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 1 st Floor 2nd Floor J 3,d Floor 4°i Floor 5'h Floor Exterior 5.* List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) '.STTATE OF Nf--W'YORK.COUNTY OF WESTCHESTEIC W ► ,is_ 1 If 10M �� +1 L .being duly sworn,dcpuscs and states that herdic is the applicant rd►a►vc named, 011111 ynry�ud�c ypk�ni�l and hirthcr itntcs thtit Issue it.the Amster Ptumher for die lerAl uwncr and is duly audkoured to make and file this awlication That all statente116 contained herein are truck)the best of h ii her knuwledgc mid W-;cf.and thus any wmk pertiwrncd.or uw Lxxiducted at the alx►vc captittried property will he in confiuntancc witli the dmuh.as set forth aril contained in this appti►;wkM and in any a—lnrpanyin9:tplxnved plans wW Spec ilicati-I%as well as in at;Lwdancr with the New York%late tIniforrn I'Ire Prrvrntion&- Building Code.the Code cif the VillaKc of Ry c Brook;rid till usher applicable laws,urdinwices and regulations SWxn k►�be/orc inic 11 is -zq '�►f Swim to before nic thrb-day of LLJ`+d _ N' �l day of-2. 24 1 N Signature of Prtrlterty Uwncr Signapue of Applicant TIMOTHY FLTRACY Q NOTARY PUWC.'aTAM OF NEW YORK - 7riI rM 0 h _. Registration No.01TIOSIL3 72 I'dof Pnrp t?a�ytcr t2iLi110w,ki 1Ymeria"-Corky PAW Vane of Applicant Coiarrss�'r,F�nv Rtay-25.2034 Ni; P b'c — Ito of New York No.01MEGM063 Quallflaq M Wastchestr.►CCU" COMM'ss'"Explres January 29.20L , this application rnust be properly cutttpkted in nti and mu%1 include the notarized signaurets)of the legal owaerY w) rl the wblrct pn.perf}..tad Iht applic It of rvcurd in the:puce,pan idetl. Applicutiorb not pn►perly completed in its entirety and.or not pnrperl+ siglied shall be deemed null and %aid and %%ill be reIUMCd to the applicant. ta3o�tza BUILDING DEPARTMENT VILLAGE OF Rvv BROOK 938 KING.STRUT RYE:BK(x)K,KY 10573 (914)939-06" %NH.r%tbrlK&OrL ..................A.AA.......►..♦ AAAAA........***iff*1h&&Ui a R6*Mi�N����♦}*t AFFIDAVIT OF COMPLIANCE VII.LAGI:CODE,,--4216• STORM SFWPRS AND SANITARY SLWEKti THis Aii"rDAVIT MUNT EIR" THR NOTARIZY2' SILWATUAL OF THE :.EGA!_ PiWVRtt'I'Y :71RtER AD(L t>• Stli!liT:EG ALONG WITII ANY EVILDING iAp PLUMBING PERMIT APPL:CATICN. ANY (V=rNG CA PLUMBING PKMUT APPLICKrION SUBMI- XD WITWatn THIS CQ4PLI:=, AND 9C1rANIYkD P`CJM WILL BE RtTt*W1Z T+'J THE APPLICMT. STA11: OF NI tt' N'ttltK. COUNTY Uh w[.STCHES-ITR ) as: 3I. 1�AN_7_RNI+�OR residing at.J-1 _�.+oNV R r — Et-_ Yft, being duly sworn,deposes and states that(s)hc is the applicant above named,and further states that(s)hc Is the legal owner ol'the property to which this Affidavit of Compliance pertains at: Rye Broom:.NY. Further that all statements contained heroin arc true.and that to the best of hiy'her knowledge and bcliet: that there am no known illegal cross-connections concerning either the storm sewer or sanitary sewer.and further that there avi no roof drains. sump pumps.or other prohibited stormwatcr or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sc%%-cr from the subject property in accordance with all State, County and Village Codes. F—VFlN -rPNNcP\ Sworn to befbrti me this TIMOTHY N.7FIACY da% (if_ N .20 � NOTARY KiBUC-":1'=•]f:NEW YCRK Ragisbution , Utl'R610S•t72 Chia tlaJ In v- ,test*r Canty CarnmrB9icT1 C A•;y 25.2U,4 K 12f20-11 � N N p C = \ [� 00 00 = N n \ r! M M 0% e} W pp [� Fr p c.0-4 � W ` a ~ W v w W s O H z x W boo ►�+ Ln = O Lr) H W g to CQ a z V x o A A W � O z _ zao = o o O W Z A w a ` Ici +� �[�U. O ti W O Cn J+ ` ` W w z H A z � w � �, z H O W� ` O �J u t .. z CM ~� O V O N C O A � _ oo GIN z z a Wx W a i-04 w •- 3 as as Q! oc N ON w a � rA zo Q-r v a a x z W z A < 1� a w w .. Q a z Q'1 O �„ a a S• BUILD DE T.MENT FEB 15 M4 VILlutcE OF RYE OK VILLAGE OF RYE BROOK 938 Km T RYE B ,NY 10573 BUILDING DEPARTMENT o6� --- --- www&cbrook.orb PLUMBING PERMIT APPLICATION - ��_ _ G3 � FOR OFFICE USE ONLY BP#: p� .3 PP#: Approval Date: Permit Fee: S \ " /- Approval Signature: MAR 0 1 2024 Disapproved: (fees are non-refundable) +**+**+*******rtrtrt****rt**++*++++**+******+***rt**rtrt*rt**+rt*rtrtrtrt***rtrtrt++rtrt+rt+rt*rtrtrtrt***rt*rtrtrt*****rtrtrt*rtrt 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, is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or femo a 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: ok C� ��- SBL: 13sl eo ���'"'7 Zone: '- 0 2.Proposed Work: 12 Oy� 611 P i 5 c,ttl4 Lo��S(U P e-? /' AS [ ;�I 6- �yR Xr4,1)6� , l 4AVATDR1 SiyK ,�vID tatCeT 3.Property Owner:E VAA-1 T`R N,40 D tt Address: Phone#: `T j) Y� 2- a-?I I Cell k: email: 4.Master Plumber: W t LL'Av4 -5t_-Ae5'(-,,o-v 6' sR.Address: a!A P Lic.#: Phone#: _Ccll#.?A ,4 q 9_0 email: c'o--- Company Name: M—tom N'n . Address: RJ,4 -f0,4IW ACr2- 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 'I'ubs 'I'ubs Service Service Sewer IT Gas Basement Ist Floor / o� 2nd Floor 3'd Floor 4d'Floor 5d'Floor Exterior 5.* List Other Equipment/Provide Details: _ (Notarized Signatures Required Next 2 Pages) %IAII.I* 1L'W YtIRI\•l'iit KlY tN W'h.\11'11f111 It . .1. W1 111(dal 5( Lk3l 1 04 L 1, .Mnu dutt .worn..I.In..«mlA\utcs that he-ow I+11w applicant alt.nc r6wk.1, 'M"I 16tn.r"I'1.1 t010...Aalk, .tr.'aIt•+.1.N1 and lurtilct +l.olc.!hilt I NII%:..the Alasler Number law the Ieµ.lt..wncr:uW 1s dull, aullkirved lu make aiKJ hie thl.apolCatltln I IIaI all-44unicoll>ronlained 1wrcul arc Itue 1.)llk'Ih•.1 ill IIle-hvf kIklwkNjg%:•urld beltel.wW duJ and wUr►per1.117rWd.or UfC ..wiJtletal 41 lift:alNtvl;captiotKA pntpcli) !till lw•lit-InkHI•Ia1Kc w.th the 1k'tad+a+%el#"rill load.00taulcd In this appltlatwn and too ant a.Cimipany ing approved plan►wW+p.•.111"Icoa n_a1 wCh a+of wu rJ:uL:atolls the New N nri, %late 1 indorm I'ua 11resenb.rt d: Ilwkling Code.the l.We 411 the\Illil4c.•I Hl c I li—k and all.ghcr.Ilnth:ahle laws..iNlnancc%allot rcitulailau %t...rn to before his:that, d da%111;n.Jurc•.�I I'IutxYlti th+nct all %ituabitt Of App1k:altt TI;+,OTHY R TRACY G V(�� ^ f10TA11Y PUIJLJC.t3TiVE O(W0 YORK C r'1 TAn1No K B4,01tit(bibm Nu.3111UJtt:j•t,--' I'n ant...I Ihup- rl..ticr ra.al,nr�I11VHAuia9lW Casty PAI►1%amcofAppheant _ \ V..1. -- 3t.rin u'Vnw\'.Nl• 111�'. .ipp U\all..h Itll/al to Ili..IK•fl. ...1111twilcil w 16. +11114C0 ilk; I11U`I oa lUJL' tUC h..tal l/\J+i�;Ii.tlu(i'I tl all Ilia Wg-111 ,•wlliyl+I.tl lh. .am\ti1 IM..Itrn. •utd Ilk ,tpplt.•u11 of ;rs.ud to tilt: %91"c% pt.'t odcd \pplivauans 1w•: pnq+cll. ..qupicled .0 Ii•Ctuirm. .uliJ•.I pI•,Iktl. .I►:JuJ.I1411 Ilv ckctucs twit.ual ..uJ is %I I I tic returned I..Hit:,ipltliaalll I.Y ilY�ll:! D L C IM Bll111I.DiNc. DFPAR'I*NtFN*I' FEB 15 2024 DD VILLAGE of Rvr Bk(x)k 938 Kim;Sr[ua:t Ri r:Hu(x):.nY 10s73 VILLAGE OF RYE BROOK (914)939-06" BUILDING DEPARTMENT wNN.nlel,r�M�k.ur� __ ____ ..........................................................................................I............ AFFIDAVIT ()I- COMPLIAN('I V11.1 A(cl t'uut. �''Ih• tilt►1(M til µl K♦ •A\I1tinKIfAI(Y til N'IiKS Tvii. A/TS«AY:1 emT us" TALL f'w>TAw311: J:•�1A.',Iu. rLL r�r.✓ICMTI memb AM;. M •ll�l:„CL ALAA16 Y1TM Qn Ip:L:,IM. .,y� VLUM111L rLIWt: wYYL. AT: t. Al1Y Ut)=LMG ;& pLZDft:Mb APPUCaTTaI mums-rT%L w:'rwAn r3i s •x*wLJ m AW w rrAM 1, -Y=g Y;u. w %&T Aum :' TIR AYYL:alrr STA'11:ur NEW YOKK.('(HIN fY(► - wlal('I11.S I IJ( ► u.. , L 31, F-VA N TA/JlvoR w0ding at. ' Al L-DN GL-" 1)Rzv� 09 N . being Jul% --or".dcpows and.later that(%)he I.the apphcalu alkiv a Itatned.and lurther.tales[hat(s)hc i.the /' k-gal owner of the prupen% au Ulrich[hi.Allidakit ol'( umpliance penains at. l unhcr that all -aatcnlcnt.+contained herein are Iruc.,Ind that to the beat ul'hes her knowledge and belici.that them am no known illegal cram-connections concerning either the storm sc%%Cr or switary mmcr.and lurthcr that there an no nlol drains.sump pump..or other prohibited stornlwater or groundwater connections or sources ot•inihm or inftttraUon ohany kind into the►anaar% %e►%cr Iron the subject prolvrty in accordance%4ith all State. t'ount% and Village( ikdes. EVAN 7ANNOA, Sworn to be•Ane nle I111, -2-0i 1" TIMM:% 't `•'ICY J:y It N _'I 17-4 NOTARY 1't1t1UC NEIY YCRK Ii4VtW�bCl1 .I i•::J'L•'rt/� _ O stilled in I' r i puny f •,i:l,2Ua ,1 o L O CD CCD D 409 W 1 Q o `o O Z_ ; Q W N .� o m W FO 1 /� /� 1 M C O a ui VCo H . i * 3 -= Z > C7 O o E W �. z O � Q l " Q � F 1 O W a V] NJ m _ Ucy O 1 M v � ' 0 Z0x -IOU Q cl W Oo W = 3 a0W cu x Wz3 W LL a _ _ � O .: w x M Q �W a x o Z V A Q� / r O N D/� Z J W ra a Q A � ;- = A a F Q LL (_ `° o ►.� 0-0 0 Q Lo -L) Cj) zc Q o 1 W J = j f � U N O J Z 1 o c (� 1 �a N W 1 'o ' E 0 > i W �'/w' ` W = W � Em 1 0 c a) W O r I I (Q N 1 L j = 0 W 1 -� 1 1 11 11 11 n . i W A Co = CU Q 1 cn w o � O V m J ' ` 1„ � N 0 Q r W W > a LL cu A O z m -a 0 o o T Qo N 2 w 7 w L < ;Z 1 i m Z N 1 Q W 0 � v ca t Ct O ° = N W ^ o O J F ` `° m } Noz � ZO � r- a � .2 � �. Q o � v� O Wa. o � ,� 1 c •• ' U C7 o/ LU I M c O 1 o dam CD v .�. t LL P�1 � (� �' E ^ cn f 5C v 3caCl CD m w O o L W 0w Q . 3 1 o m � Q W O a ° In z o � � ♦W^ a o - Z 0 C// !. o N w Z J w Lj z a LL a � 00 W o Q Nw Q Z Q) U O � Q W � o �N � Z 172 LLJ Z F- a s ' w 1 1 O W c J^ Li L > W 1 = W N " EO 1 0 Co W O � �. � 0 d 1 oa c LL 1 -� O 16 .i r a (� - /W/ 1 W I f6 LL 1 M � 1 O Q W L) U) o � ''1, 11 W W w W > LL G1 O Z a) a Rio5.1-41 L.- o 1 O o `O MO z W m 3 w v W .a OZ 0 C c .c Z > z z CL Vf .J m w O W ' r z O CF Lj LL _ ai Wuj a' a > � O � 3 = H cr W W aj Z 3 V LL w _ 0 � Q x c W O a cm2 °o ! W z o as W Q; x � n Z a) W CL A IL . a w r � Q z o .. o en ia) w U O J w sJ N O J L � Z c c )_ i LLI ' CZ i cc t = LLB ' 2 0 F— o _ N � W (/) - a > w = W N <r " E O 0 o LV i O Q � o Lu W Ca O QCOO U- co Z m .Building Permit Check List&Zoning Analysis Address- SBL: ii �— Zone: 1 . Use: Cont Type: Other. t Submittal Date: ` _ �— Revisions Submittal Dates: Applicant: C-4-" Nature of Work S - Reviews:ZBA: J AN 1 7 2024 PB. T: Other. A— OK ( ) FEES:Filing. BP: ` 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 Mgm.: Tree Plan: Other. ( ) ( ) SURVEY:Dated: Current: ArchivaL• Sealed: Unacceptable: ( ) ) PLANS:Date Stamped: Sealed: r. Copies: Electronic: Other. License: c--" Workers Comp: —' Liability:L. Cornp.Waiver. Other. ( ) ( ) CODE 7S3#: 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: FLW.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: REQUIRED EXLS"I'ING PROPOSED NOTES APPROVED Area: ., . 1 7 2D24 Circle: Frontage: Front: Front: Sides: Rear. Main Cov: Accs.Cor Ft.H Sb: Sd.H Sb: GFA: Tot In: Ft.Imp: P Height/Stories: `— ,c notes: Jn��1`Q �c l S'�: i C�l�t�� ��L�.YI�7 IBC z) ♦c�C � '1 �T"�— T ♦ltsH -ml%Myll�.1219 alll�'�� .` M1. .�, '�:,,.-•-'"y1�•�y� �1'�` ` ��� .�''y 9' !S�•/ � L ``ffrr ;C ` N a d w LtJ C E O V � V � 3 f u J W O U � LJ J > ca o cO c c I V U W .lo» Z W W v aLU U J o ` N .CL �4dtG� �zCL G . �.� � � � o a� `(ems>•^� �i off►~`~` � :./ V � �. . ` � T ^ C �r Z ~ 4 v 7 E it. 5 om .w o 7 M - r• , N } FiL glV yy 011, 111101 3 slo)lm, -Wr`9.. ,'��' lalll i i• �� rr f. �,��� :;5 +- SYr7:ij elt�" f r' ACORO DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 1 12024 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: H 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. I anola Macedo Associated Insurance Agency,LLC AICNo Eat: (203)748-9272 FAX (A/C,No 50 Newtown Road Suite I ADDRESS camila(gaia-danbury.com INSURER(S)AFFORDING COVERAGE NAIC Danbury Cl 06910 INSURER A. UTICA FIRST INS CO 15320 INSURED INSURER B: GI.Contractors LLC INSURER C 10 C restv,cw Dr INSURER D INSURER E Hndgcrx,n ('I ord,or. 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 CONTRACTOR 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 LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER NUMBER MMIDD/YY LIMITS COMMERCIAL GENERAL LIABILITY X EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR T *T PREMISES Ea occunence $ MED EXP(Any one person) $ 5,000 A Y ART3000637740 08/29/2023 08/29/2024 PERSONAL 6 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY ❑JECT ❑LOC PRODUCTS-COMPIOP AGG S 2,000,000 OTHER AUTOMOBILE LIABILITY OMBINS Liability $ IOO,IXX) Ea accident S ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED AUTOS ONLY AUTOS ONLY Per accident $ S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE AGGREGATE j DED RETENTIONS S WORKERS COMPENSATION _ AND EMPLOYERS'LIABILITY Y/N STATUTE ER - Y F TOW NE WEXECUTIVE FFICER/MEMBER EXCLUDED? ❑ N I A E.L.EACH ACCIDENT $ Mandatory In I E.L.DISEASE-EA EMPLOYEE $ nd Eea,describea und er SCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may he attached If more space is required) 1-he Village of Rye Brook is listed as additional insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King St AUTHORIZED REPRESENTATIVE Rye Brook KY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE �. *w 'p A A A A A 828478002 ASSOCIATED INSURANCE AGENCY t LLC 50 NEWTOWN RD STE 1 DANBURY CT 06810 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER GL CONTRACTORS LLC(A CT LLC) VILLAGE OF RYE BROOK 10 CRESTVIEW DR 938 KING STREET BRIDGEPORT CT 06606 RYE BROOK NY 10573 POLIC�NUMB�ER �CER�TIFICATE NUMBER POLICY PERIOD DATE W2 85 11/04/2023 TO 11/04/2024 1/12/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2600 279-0. COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY, NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 450062268 The Cincinnati Insurance Company POUCY NUMBER CINCINNATI 1101 1172074 INKAXANCECOMPANlft EXECUTIVE CAPSTONE"m HOMEOWNER Image 2 DECLARATIONS Pollcy Period: From I IA V2023 To 11117/2024 Endorsement 12:1)7 A m.Slandrd I-rne el Lhe Address of the Narned Insured Effeetive 11117n023 1101 1 172ZO ra Please refer any questions to your agent: Named Insured&Address Ow-ens Group Limited,Inc. Evan Tannor 619 E PALISADE AVE Ilene Tanner ENGIXWOOD CLIFFS,NJ 07632-1812 14 LONGLEDGE T)R 201-569-2300 RYE BROOK,NY 10573-1946 Agency 29001 Producer Robert o Owcns County of WESTCHESTER In the event of'a claim,you may call your aVnt or The Cincinnati Insurance Company at677-242-2544 Unless otherwise stated,the residence premises covered by this policy is located at the above address. PAYOR-Account Billing Method; Direct Bill Current Pay Plan: Quarterly Pay Total Premium: $9,082.00 THIS IS NOT A BILL. You will receive a separate invoice if a premium change or returts is due. I1110111I "II Private Client- DESCRIPTION OF CHANGES Rernuvc Umbrella i'kg credit,,Add VAC credit 619 Pall9ade Avenue Engwwood G1Ns,hU 07532 P.201.58B&2300;212-5W-C,600 Owens Group 'nr000vAnsgrouvcan DDH(1115) 1112012023 H01 1172074 1 of 3 ORIGINAL COPY Artk� The Cincinnati Insurance Company p y POLICY NUMBER CINCINNATI HOI 1172074 INStmNr[COMP/tWS EXECUTIVE CAPSTONET" HOMEOWNER Image 2 DECLARATIONS Pol Icy Period: From 1111712023 To 1111712024 Endorsement 12 01 a.m.SWida-d Tree al the/d&vsa of the Nwoed Dared Effective 11/1712023 COVERAGES AND LIMITS OF INSURANCE SECTION I A. Dwelling S2,544,000 B.Other Structures S508,800 C.Personal Property $1,272,000 D.Loss of Use Actual Loss DEDUCTIBLE(SECTION I ONLY) S2,500 Applies to all causes of loss unless otherwise noted. Equipment Breakdown: Limit $100,OW Deductible $500 SECTION Il E.Personal Liability a.Bodily Injury and Property Damage (Per Each Occurrenco) S500.000 b.Personal Injury(Aggregate) r.Medical Paymonts to Others-Each Person S50,000 The igwina credits have been applied to your policy: Back-lip 0cncratkw Credit Central Station or Coaxial Cable Alarm Credit Deductible Crcdit Explosive Gas Lcak Mutctor Crcdit Mature Homcowner Discoatnt Package Crcdit Private C011cc430ns P0licy Crcdit Rating Tier Credit Tcmperature Monitoring System Credit BASIC PF2l=MIUM SUBTQTAt. , $11.625.00 DDH(111 S) 1112012023 H01 1172074 2 of 3 ORIGINAL COPY The Cincinnati Insurance Company POLICY NUMBER CINCINNATI flat 11721174 INSUR&WE COMI'AwEs EXECUTIVE CAPSTONETm HOMEOWNER Image 2 DECLARATIONS Policy Period:From It 1171762_1 To 11117a024 Endorsement 12,01 a.m.Standanl Time at the Addrnrr6 d the Named insures EffeC#Ve 1111712023 OTHER COVERAGES,ENDORSEMENTS AND CHARGES Executive C'apstonc—Policy F..xecutive Capstones''"0 1115) Homenwricrs Policy Inflation Guard Endorvemcnt-New 11R709NY(7i10) York Special Provisions-New York HR 1072CNY(1123) Workccs'Compensation Ccnain Residence Employees-Neu, HR972NY(7/10) York No(Section 11)or Limited(Section 1) Coverages fur Home 1111973NY(7110) Day Cane Buximm Notice of Privacy Practices M11659(4/12) Your Insuraiice Scone MTt785A(10/13) Important Flood Insunance Notice MI178SNY(9A*) Notice to New York Ilomoowncr and Perscmel Auto M1196INY(5i 11) Program Applicants Capstoibe Family Shield Fiularscmcnt HRI066C(6117) S l 10.(() Service line Coverage Fsrdorsoncnl(S25,000) HRI 149(6/17) 540.00 Cincinnati Personal Cyber Protection-New York HRI I63NY(RV18) S,;2.00 Earthquake Exclusion Endoisentent HR772C(11115) Scetimi T-Fungi.Wet or Dry Rot,or Bacteria-Limit of HR929NY(I(kQ4) Insurance Schedule-Ncw York Equipment Breakdown HR%IC(7/16) t135.00 New Yogi,Notice to Policyholders Serving Tn Active M1 1721 NY 04 03 Military Duty Notice to Policyholders-New Yock Add 1999NY(1(1,111) Earthquake Coverage Excluded Earthquake Coverage Included fa Pcvvunal Property Guaranteed Replacement Cost Protection lncludoi OTHER COVERAGES.ENDORSEMENTS AND.CHARGES PREMIUM S457.04 TOTAL POUCY_PREMIUM _ .9 Terr-rary 82 1 Family Fam ly Frame Built 1993 Prole mon Class 4 Feel horn Wal-r Source. Dissents tram rre Depar"onl: <..1 Rules Tex tocaa,an: Fie Dept KYF BROOK NA l mry Cincinnati Personal Cyber Protection Schedule: Annual Aggregate Limit: 3100,000 (Applies per policy period to all coverages under this enCorsernrnl) Occurrence Deductible: S500 (Applies par occurrence to atl coverages untlor this endorsemoni) DDH(1/15) 11120/2023 H01 1172074 3 of 3 ORIGINAL COPY Affidavit of Exemption to Show Specific Proof of Workers' Compensation Insurance Coverage for a 1, 2, 3 or 4 Family, Owner-occupied Residence "This form cannot he wed to iwiw die workers'enomprmsm don rights or obligations of any p".•• Under penalty of perjury, I certify that I am the owner of the 1, 2,3 or 4 family,owner-occupied residence (including condominiums) listed on the building permit that I am applying for, and I am not required to show specific proof of workers' compensation insurance coverage for such residence because (please check the appropriate box): ❑ 1 am performing all the work for which the building permit was issued. ❑ I am not hiring,paying or compensating in any way,the individual(s)that is(arc)performing all the work for which the building permit was issued or helping me perform such work. l]0 I have a homeowners insurance policy that is currently in effect and covers the property listed on the attached building permit AND am hiring or paying individuals a total of less than 40 hours per week (aggregate hours for all paid individuals on the jobsite)for which the building permit was issued. I also agree to either: • acquire appropriate workers' compensation coverage and provide appropriate proof of that coverage on forms approved by the Chair of the NYS Workers'Compensation Board to the government entity issuing the building permit if I need to hire or pay individuals a total of 40 hours or more per week(aggregate hours for all paid individuals on the jobsite)for work indicated on the building permit,or if appropriate,file a CE- 200 exemption form;OR • have the general contractor,performing the work on the 1, 2, 3 or 4 family, owner-occupied residence (including condominiums)listed on the building permit that I am applying for,provide appropriate proof of workers'compensation coverage or proof of exemption from that coverage on forms approved by the Chair of the NYS Workers' Compensation Board to the government entity issuing the building permit if the project takes a total of 40 hours or more per week(aggregate hours for all paid individuals on the jobsitc)for work indicated on the building permit. - -- �--- _ l / a g 1 (Signature of Homeow-ner I (Date Signed) cell U A n) T A N N 0 P Rotas Telephone Number (Homeowner's Name Printed) ti..•orn IS before so* lAiJe day of Property Address that requires the building permit: 7 8 r�1l�l k (co anr ritkOf r f _Fi57reT__ I VAOTHY R.TRACY NOTARY v1i6UC,STATE OF NEW YORK ..k IT1961OU72 ,n Mr-.is t fly Once nuiyrued.thk HP-1 form serves its as exemption fur both rurhrra'cumpentallutl utd disabWt) b!> Illiasap0lgYR liP-1 (120) NY-WCB