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HomeMy WebLinkAboutBP24-014PERMIT k 4)l SkCTION TYPE OF WORK JOB LOCATION T. COST FEE, V CO H FEE .M // 0 �Iob �"y,07t FEE DATE " INSPECTION RECORD I DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION _ / PLUMBING RGH PLUMBING GAS SPRINKLER ELECTRIC LOW -VOLT ALARM 0 AS BUILT FINAL d'37- d'9 7/ &44)907-88#8 �PP��-Ol1l/T�1elay�ano � �oin�oanU OTHER APPROVALS ARB BOT PB ZBA OTHER — VILLAGE of RYE BROOK WESTCHESTER COUNTY, NEW YORK No : 24-050 1 , Certificate of ®ccupaucp This is to certify that � Imo, l� (10� Q. - f of, A�V , having duly filed an application on 6L / O?`_ 20C� requesting a Certificate of Occupancy for the premises known as, Qam )1h'11 DYl , Rye Brook,NY, located in a!�Zoning District and shown on the most current Tax Map as Section: / 5.50 Block: / Lot: 4) 7 , and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. ?1 , issued / o� 20 e? , 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: lionle- / Construction: for the following purposes: — Q 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 skn maw, or s 11 a building be moved from one location to another until a permit to accomplish such change has be om tie B '1 g Inspector. MAY 0 8 202a Building Inspector,Village of Rye Brook: �� Date: -IB For office use onl --� BUILD MENT PERMIT# -0/A/ j� I APR 2 4 2024 VIL E OK ISSUED:38 KING STRE YOK, YORK 10573 DATE: —3VILLAGE OF RYE BROOK O-c FEE: /�Q-- PAIDJW BUILDING DEPARTMIPNT W 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 #•t♦tF###k####k###########kk#W#k#k#k######rt##rt##rtrt####rt###irt#rtk####krt#rt#kkrtkkkk##k##k#krt#krt*wrtkkkkk#k######rt#rtk#k#####k#kk*## Address: 9 Elm Hill Drive, Rye Brook, 10573 Occupancy/Use: PH Parcel ID#: 134.5-1-47 Zone: R-3 Owner: DEREK SYKES Address: 9 Elm Hill Drive, Rye Brook, 10573 P.E./R.A. or Contractor: JAMES E HERBSTER CONSTRUCTION CO,%dress: 108 HOBART AVE PORT CHESTER NY 10573 Person in responsible charge: JAMES HERBSTER Address: T108 HOBART AVE PORT CHESTER NY 10573ype text here 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 WESTCHFSTER as: James E Herbster being duly sworn,deposes and says that he/she resides at 1 Oa HOBART AVE NY 10573 (Print Name of Applicant) (No.and Street) ill PORT CHESTER in the County ofWESTCHESTER 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:$ $5,000 for the construction or alteration of. FINISH BATHROOM 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 Inspec as per§250-10.A.of the Code of the Village of Rye Brook. S orn t before me this tJ t- Sworn to before me this day of ( , 20-1—� — day A 1ef&— , 20 3-0k, G true of Property Owner Si ature of Applicant Print N e f Property O Print Name of Applicant d JOHN M SUOZZO of Public Notary Public NOTARY PUBLIC,STATE OF NEW YOFK Registration No.01SU6070919 State of New York,Westchester County Cuallfled In Westchester County hEIEN J.TORNESE My Commission Expires March 11,2026 Notary Public State of New York Subscribed and swom to before me this No.62'T06346436 Qualrfied in Westdtestarc 7 Commission Expires August t5, _ /- day of 1 / C 20 L QyE BRC��. cu � 1982 BUILDING DEPARTMENT ❑ UILDINGINSPECTOR 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 : I lit g a& DATE: 5 ?- Z 0Z PERMIT# 1�` Z t-A - 01 q ISSUED: /"Z�e-Z SECT: /-i5.JD BLOCK: / LOT: LOCATION: 1 J�'►7�� /I00--n OCCUPANCY: ❑ Violation Noted THE WORK IS... P/ASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas �NG�—f' �„ /�6,0 ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ,a- FINAL PLUMBING ❑ CROSS CONNECTION 8_ FINAL ❑ OTHER QyE BRC��. '982 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 : C,f m P 1 ' ` �2 DATE: Z O - Z O L;, PERMIT# \/ ,ISSUE tD SECT: BLOCK: LOT: LOCATION: ��T_)� W0(Z K ?n d1� F o� '13tJ- U OCCUPANCY: ❑ Xiiolation Noted THE WORK IS... ❑ PASSED ❑ FAILED /REINSPECTION T SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ` ❑ Natural Gas sPe c J o `o P " J ❑ L.P. Gas l ❑ FUEL TANK J� Q. �1 O lilt U2 l� 5 Q{ �l J�3 e ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER QyE BR(��, 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 : ` `� \ l DATE: PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: J C~� F y �' ��S�&CCUPANCY: ❑ 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 l ❑ Natural Gas ❑ L.P. Gas C ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING r \ ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER <A 6� N .O m s 1 N N p�• yi H x x • .fir � Ow E w {Tl x v. hil o ' A a u _ 7 V p Gn • 0 oo WJo,40 Nt oo 0-4 o w m � w tp a0 ,v o o = ULdi �It T v F 4-4V J E�j �y Fes( `' r1 '`�' or. .� a, o W m 0-4 �c U O d Q -o yca r/y L 0 . W x c c 5 00 F. in In co 0 F� W oW z 4b �v o G Oo � G jO Ch z 1�1(z) ` _My xLa SO o \zo E Q V V 00 �j ►�r u 'v uo x z Cn A. �o ' v a b� o a.n Uogr' o Z a0 v 11��~11 W z o O 1-4PLO C7 O A �,.z O a o a x o H W Y"�� rram. ,� Q+v y" x D E E FW E BUILDING DEI ARTMENT JAN 16 2024 VILLAGE OF RY OOK 938 KING STREET RYE BR [)i,NY 10573 VILLAGE O1=RYE BROOK (914)939-06687 BUILDING DEL ART,�,ENT www.r-,,ehrook.orl! INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: �1 �� ��1Inn frl Approval Date:_ Al, 2 2� JA lication Fee:$ Approval Signature: Permit Fees:$ Disapproved: Other: Application dated: 1/10/2024 is hereby made to the Building Inspectorof 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: 9 Elm Hill Drive SBL: 135.50-1-47 Zone: R-12 2. Proposed Improvement.(Describe in detail): install 1 watec closet, 9 Sinks anci shower valve handles, on existing inspected and Approved roughed-in piping. installMe on floor and shower Walls 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:x 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: 1 family After Construction: 1 family 6. NX State Construction Classification: NA N.Y.State Use Classification: NA 7. Property Owner: Derek Sykes Address: 9 Elm Hill Drive Phone#914-837-8971 914i8A17#2627 email: dereksykes@verizon.net 8. Applicant:James Herbster Address: 108 Hobart Ave, Port Chester, NY 10573 Phone# Cell# email: 9. Architect:NA Address: Phone# Cell# email: 10. Engineer: NA Address: Phone# Cell# email: IL General Contractor: Herbster Construction Address: 108 Hobart Ave., Port Chester, NY, 10573 Phone#914-967-6955 Cell#914-907-8848 email: herbsterconstruction@gmail.com t2. Estimated cost of construction $ $5,000.00 (NOTE.The estimated cost shall include all labor,material,scaffolding,fixed equipment,professional tees,and material and labor which may be donated gratis.) 13. Job Timetable:Start: 1-16-2024 Finish: 2-16-2024 n) 6/I/2023 BUILDING DEPARTMENT Q [E C `��'V F VIL 'AGE OF RYE B ©OK JAN 16 2024 938 KING MTREET RYE BROO ,NY 10573 �� {9L4J 939-0668 +,r VILLAGE GE RYE I;E�GOK Nvww.rV'ebroolc.or BUJL[:)1C,'G DEFAR7MENT 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,Derek Sykes , residing at, 9 Elm Hill DriveRye Brook, NY 10573 (Print nano) (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; 9 Elm Hill Drive, Rye Brook, 10573 , Rye Brook, NY. (loh Addres,) 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 llage Codes. ure of Property O1wrer(sl) Derek Sykes 'a im Narne of Pi,,1-,:0v Oviner(s)) Sworn to before me this HERNANDO AGUILAR day of J G V 20 Notary Public,state of New York No.01AGG357182 Qualified in Westchester County Commission xpiresApril24,20z5_ (Notary Public) (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: .lames Herbster ,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 Contractor 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. Sw i to before me this [01-11 Sworn to before me this f y of , 20 day f O2?✓? , 20 ter toreof Property Owner ure o A plicant ek Sykes James Herbster Print Name of Property Owner Print Name of Applicant /Y� N�otaAr�yftblic Notary Public JOHN M SU07_ZO HERNANDO AGUILAR $WARY PUBLIC,STATE OF NEW YORK Notary public,State of New York Registration No.01SU6070919 No.01ACS157782 auaiKiad In Westchester County Qualified in`` rester county My commission Expires March 11,2026 commissic r,pril24.20tg- (A) ti/13�'0?I e-1 p N W N N N a W is W y M U O xp..l Clk c zLn Z a w o� ■ x M Leien i 4 , o F A , z4-4 H � z z w 0 _ 0-4 w C% o 00 PLO a � w06 x ti N � s ✓ w � � 0,7 ti U O W ao 0 Cn �" .. 0 can � "'' .. z c°� z � • w i Zen W ✓� c� w Q A � rA 00 ►..� Q ^ W cc) ►-� U ai cy zz ►'� �, �. o ch W Az w w I o L) H o x cn U R; U W w O F ~ cnLn Ln a w cq U Ho a v o � W z A z a o � H a p ECENE .�yE�i3RCv\ BUIL EF ,Iy MENT JAN 16 2024 VIL E OF RYE OK VILLAGE OF RYE BROOK 938 KIN GREET RYE BROOK,NY 10573 BUILDING DEPARTMENT 90)939-0668 ryebrook.or PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: c�)`f--U / 4 PP#: / r Approval Date: J AN 2 4 2 \ Permit Fee: $ 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%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated, 1/10/2024 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: 9 ELM HILL DRIVE SBL: 135.50-1-47 Zone: R-12 2.Proposed Work: FINISHED ROUGHED-IN BATHROOM 3.Property Owner: DEREK SYKES Address: 9 ELM HILL DRIVE Phone#: 914-837-8971 Cell#: email: DEREKSYKES@VERIZON.NET 4.Master Plumber: Joseph Melagrano Address: 628 Waverly Ave, Mamaroneck, NY 10543 Lic.#: 1521 Phone#: 914-319-2627 Cell#: 914-319-2627 email: Jelagrano@gmail.com Company Name: JMelagrano & Company, Inc. Address: 628 Waverly Ave, Mamaroneck, NY 10543 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 2nd Floor 2 3,d Floor 4'Floor 5'Floor Exterior 5.*List Other Equipment/Provide Details: Install on existing roughs, in one bathroom, 2 sinks, 1 watercloset and 1 shower valve handles (Notarized Signatures Required Next 2 Pages) 3/3/2023 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Joseph Melagrano ,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 40 Sworn to before me this / Z f 20-2-4_ day of J Oi r 20 t ature of Property Owner i naturof Applicant Print Name of Proper(y Owner Print Name of Applicant Notary Pu Notary P c HERNANDO AGUILAR JOBu M SUOZZO Notary Public,State of New York NtnAHV Patios STATE U 070 119 No.01AG5357782 Registration No.OtSU6070919 Qualified In Westchester County Qualified in YJestchester County r My Commission Expires March 11,20M Commissio^Expires April 24,20Z 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 BUILD -N DEPA RTMENT D E C E� " E VIL E OF RYE B;_,_C,00K JAN 16 2024ID 938 K><Ivc ET RvE Buo ,NY 10573 `t 4 0668 VILLAGE OF RYE BROOK ook.o►• 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: Derek Sykes , residing at, 9 Elm Hill Drive, Rye Brook, NY 10573 �I'rin! nanirl . 11 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; 9 Elm Hill Drive, Rye Brook, NY 10573 , Rye Brook,NY. (J('h,lddres,,) 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 infilU4ion of any kind into the sanitary sewer from the subject property in accordance with all State, 2u,ntyodes , �����s (Print Nunic of Propert} \%_i en;ll Sworn to before me this day of ��1� 20_ _ HERNANDO AGUILAR Notary Public,State of New York No.01ACi357782 (Notary Public, Qualified in" -nester County _ Commissio April 24,2OZ -3- 8/12/2021 G ( .Bui'lcling Pe1rmit Check List&Zoning Analysis Address: SBL: I Zone: , se: Const.Type: Other: Submittal Date: ZL Revisions Submittal Dates: Applicant: Nature of Work Reviews:ZBA: JAN Z 4 '2024 PB: BOT: Other. l,Ju I k'e� NEED OK (•')'FEES:Filing. 1 U BP: C/O: Flood Plane: Legalization: ( ) ( APP: Dated: Notarized: SBL: Truss I.D. Cross Connection: H O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review Street Opening. ( ) ( ) ENVIRO:Long. Short: Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmt.: Tree Plan: Other. ( ) ( ) SURVEY:Dated: Current: ArchivaL• Sealed: Unacceptable: ( ) { ) LANS:Date,amped Sealed��Copies: Electronic: Other. ( License: V,/Workers Comp:J`/ Liability. Comp.Waiver. Other. ( ) ) CODE 753#: Dated: N/A: ( ) ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit: N/A Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Pernik: N/A: Other. ( ) ( ) �ALARM/SMOKE DETECTORS:Plans: Permit: H.W.I.C.:_Battery:_Other. (J) (t yPLUMBING:Plans: Permit: Nat.Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Penns N/A: Other. ( ) ( ) H.V.A.C.: Plans: Permit: N/A: Other: ( ) ( ) FUEL TANK Plans: Permit: Fuel Type: Other. ( ) ( ) 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. O O Other: ( )ARB mtg.date: approvaL• notes: ( )ZBA mtg.date approvaL• notes: ( )PB mtg.date: approvaL• notes: APPROVED REQUIRED EXISTING PROPOSED NOTES Dsw*: J AN 2 4 Area: Circe: Fie: Front: Front: Sides: Rear. Main Cov: Accs.Cor. Ft.H Sb: Sd.H Sb: GFA: Tot : Ft.I : PAd6L'r. Heip-ht/Stories notes: Residential Building Permit Fee Work Sheet Permit#: Date Issued: SBI- Zone: Address: Property Owner&Contact Info: Job Description: For all new dwellings and for additions measuring 800 sq. ft. or more made to existing dwellings, the following fee schedule shall apply:(plus any alteration fees) Total Sq. Ft. (excluding basements)x $300.00 x $I8.00/$1,000.00 Basement Sq.Ft. x $65.00 x$I8.00/$I,000.00 ------------------------------------------------------------------------------- —---------------- New Construction Sq.Ft. • New Construction Cost Building Permit Fee Basement= sq.ft.x$65.00 =$ x$I8.00/$I,000.00= $ Attached Garage= sq.ft.x$300.00= $ x$18.00/$I,000.00= $ Is'Fl. = sq.ft.x$300.00= $ x$I8.00/$I,000.00 = $ 2"d Fl. = sq.ft.x$300.00= $ x$I8.00/$I,000.00=$ 3,d Fl. = sq.ft.x$300.00= $ x$18.00/$I,000.00=$ 4,I Fl. _ �sq.ft.x$300.00= $ x$18.00/$I,000.00=$ Total Sq.Ft._ ' q. ft. Total Cost= $ Total B.P.Fee=$ Total Amount Paid= $ Total Amount Due= $ Data Signed 0 I LO_ C71 Nc ~ 0 O Im G O M+�1 F� LTA _ � •ta •� ~ Q GZ w o O O d 661 O ^ lie > a U r Q. O as _ C4 W z r J w x ; 3 a� CF W • l t c n o A � w i Q � � .� LL ° A � � a � c z , N (D N W Cc p W 4v// �• cc Z W U co s _ Cl) o z w A W ,� oE mow . o 0 N E ° ELU Q � CU un IIJ p i LL 10 Z 1 -c�� t yy� t •i r I' 1 � � 1 CM/rT t w ,AAj I r , � i P x F F e i r raj f rd . 41 Y JA • _ ......IPA 75, rL CD Ion aim)>f b r 4�{#ab)7r w J w 3 i Ln In 4-1 1 ;o 1.,d W W ONO LU ONE (� `.j ✓ ,,, ` . W W r ._ w t!) i 1 W es I _ F, x9 J 00 ra On .r Ed 1 r•ll .. � ,oi : J 7f� �6aJ.^r' aYP ,C', « ,f*;�N 4 ✓R;S@ �,,3F n'h ';>9 Aco" CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDDIYYYY) �,, _ 10112/2023 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 Customer NAME:AME: p Service Department Statewide Commercial Insurance Brokers PHONE (626)744-2911 FAX (626)340-4807 AIC No Ext: (A/C,Nol: 2406 N Lake Ave E-MAIL mail@st8wide.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC III Altadena CA 91001 INSURER A. Sutton Specialty Insurance Company 16848 INSURED INSURER B. James E Herbster Construction Co Inc INSURER C P.O.BOX 153 INSURER D: INSURER E: RYE NY 10580 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2341 7 111 83 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 INSR AUUL SUHR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000.000 CLAIMS-MADE �OCCUR PRE A 50,000 PREMISES Ea occurrence) $ MED EXP(Any one person) s 5.000 A Y ISCP04000005579 04112/2023 04112/2024 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY ❑PEO LOC PRODUCTS-COMPrOPAGG s 1,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED .AUTOS ONLY AUTOS BODILY INJURY IPer accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETENTION S $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE I I ER ANY PROPRIETORIPA.RTNERIEXECUTIVE ❑ OFFICER'!MEMBER EXCLUDED? NIA EL EACH ACCIDENT $ (Mandatory in NH) E L.DISEASE-EA EMPLOYEE $ IF yes.describe under DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Village of Rye Brook is named 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 NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 17--01 \\ NYSIF Nrv,v,,rb Stc+t.e t".. d PO Box 66699,Albany,NY 12206 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^AA^ ^ 133113894 JAMES E HERBSTER CONSTRUCTION CO., INC. PO BOX 153 RYE NY 10580 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER JAMES E HERBSTER CONSTRUCTION CO., VILLAGE OF RYE BROOK INC. 938 KING STREET PO BOX 153 RYE BROOK NY 10573 RYE NY 10580 -T- POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE G1050 098-1 114180 06/29/2023 TO 06/29/2024 1!9/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1050 098-1. 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 CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION, JAMES E.HERBSTER OF JAMES E HERBSTER CONSTRUCTION CORP T/A BEAVER HOME REPAIR A/T/A BEAVER BUILDING REPAIR&MAINTENANCE 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 SUR NCE FUND T Z/ DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 13750579 U-26.3