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HomeMy WebLinkAboutBP24-076PERMIT �7^ 7(LDATE: a ay [*p SECTION 5� 35 BL��O//CI Ez / LOT TYPE OF WORKy�nC✓ �00/77QDiY JOB LOCATION :�r 7rORWU2 %/J2 Z Qn0 T. COST U FE � O CO # o FEEAIO.' DAT TOO # FEE DATE INSPECTION RECORD I DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION Kl PLUMBING RGH PLUMBING GAS SPRINKLER ELECTRIC 0 LOW -VOLT O ALARM 0 AS BUILT FINAL (Q/y�77N-9D/9 Q&3//.j.V/'lNMb%i!9 �M@CiianiCR� OTHER APPROVALS ARB 80T PB ZBA OTHER VILLAGE OFE BROOK WESTCHESTP#t CO , NEW PORK NO: 24-069 d �7. 1nf17 i. (Certificate of ®ccupaucp 'This is to certify that L° aja &!'1610& -' y Q of, Pue &OO)e f N Y , having duly filed an application on OLtA e �j, 20 O?y requesting a Certificate of Occupancy for the premises known as, aJ Ja C �� // �ti R e Brook,NY located in a )n P to y �-'(� Zoning District and shown on the most current Tax Map as Section: /35 ':3 J Block: Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. "V /lQ, issued ;2 20-a!V, 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: kJ - P r ConstructVB ion: for the following purposes: rev-7 o v� 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 h ' t shall be made,nor sh ll the building be moved from one location to another until a permit to accomplish such change h be obtained the B ding Inspector. JUN - 7 2024 Building Inspector,Village of Rye Brook: Date: Q �� � ��� � i�,R' For office use only. ~7 DBUILDING" DEPARTMENT PERMIT# "O /6 JUN - 6 2024 VILLAGE OF RYE BROOK ISSUED —07� 938 KING STREET,RYE BROOK,NEW YORK 10573 DATE: VILLAGE OF RYE BROOK (914)939-0668 FEE:�d ,�S_CD— PAID BUILDING DEPARTMENT www.rvebrook.org 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 ssrssssgsss+-r�st�t*"*stttttt*stts**arsrsrrrrsstrp+ssrssssssrrsrtasttrttttt*t***srrsrrssusssssssrrto+r**trarrsrsrrrssrstststs+ Address: 3 AcQy1,t lI N'Q Utz e Occupanccc--y / Use: / ,41 Parcel ID#: ��� / �� — —�� Zone: Owner:.�C��OAit�A+N $ T2&C'*y 14 00 10 4 -� Address: �`J QC 'u��i�Q �Q n2 �4e P.E./R.A. or Contractor:6,9^VI pc-v� /d✓tom ��� Address: /, ,(2S/')"eAy2 6?ryeiioic.Li C 7- Person in responsible charge• 'e C/7-W/k4l Address: i ( i ( 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: S e6w l AtA P A-R-o 10�k being duly swom,deposes and says that he/she resides at .3 %1 qc&k t b (Print Name of Applicant) (No.and Street) in Not6''00 t in the County of W'e Sj Cjk_'e& T f a in the State of A/ 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:$ 3d O O / for the construction or alteration of r#a�� Q l��7i/o d �► o�N>] (oolZ d2Q AIVV',,r _6_4 Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-10.A.of the Code of the Village of Rye Brook. Sworn to before me this Sworn to before me this day of �L�e , 20 _ day of , 20 Signature of Property Owne Signature of Applicant i ame of Property Owner Print Name of Applicant No Public Notary Public SHARI MELILLO Notary Public,State of New York 2,202 1 No.01ME6160063 Qualified In Westchester County Commission Expires January 29,20 M �yE BRC�k cu � Fb 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 : U-P Z/ DATE: C �� PERMIT# bIl 2 f/' G 26, ISSUED: ' Z" Z SECT: BLOCK: LOT: LOCATION: IJ�2 hALL G OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... Q ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING [I INSULATION ❑ NATURAL GAS ❑ L.P. GAS Ap C-/ 4 /, ❑ FUEL TANK o /,``'" ❑ FIRE SPRINKLER L j] FINAL PLUMBING ❑ CROSS CONNECTION FINAL ❑ OTHER �yE BRC�� cu � '9a2 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 :� �G 1 DATE: OZ 11 PERMIT# ` Z y - b (G ISSUED:� SECT: BLOCK: / LOT: 2y LOCATION: h Lc 1 -1 OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION �i ❑ NATURAL GAS �'`� C'-` ❑ L.P. GAS M ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION {] FINAL ❑ OTHER �E 4ROO/ o`` tim 1982 BUILDING DEPARTMENT ❑B ILDING INSPECTOR l rSISTANT 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 : AC_Q Ij f- LA -JL '�Ci � P DATE: -'� J Z UZ�/ PERMIT# l �w Z ISSUED:_L2- SECT: BLOCK: LOT: LOCATION: L) OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... [I 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 I ❑"FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER a w ^^ N \ k y h n v y � w tn W O (� x a v , ■ P 04 oo V LnFle x a C / w b H 1 , o a v ° wLn v H 7 � 04 `, \ ��* �o A o � o ,-14 g o cn Fq A 8 ° c7 F a Va] A x I -gv _ � • w W {� � � � z © � a w � a QH Op i' t vw V a0 O _ 00en CN v Z66 �y o zo k u 0j cn O V p � A z o °` o a > 0 o o x M Z a uwa w . a I a a x D BUILDOrET kNG DEPARTMENT VIL OF RYE OK APR 2 2 20?4 938 KING RYE BR �f,NY 10573 VILLA OF RYE -o Y� alaaK �: iUILDING L�E�ARTMENT rookbrg INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Approval Date: S�Z�Z Permit#: '(J Application Fee:$/00_/06 Approval Signature: Permit Fees:$ ` (/00 Disapproved: Other: Application dated: is hereby made to the Building Inspectorofthe Villageof 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. [� 1. Job Address: a ��1�.t L ztn� SBL:/36,F 3�j)—•7d Zone: 2. Proposed Improvemen .(Describe in detail): t 1/S '7t -f7* 400 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 IL• TIER III: d. 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;(1 fam.,2 fam.,comm.,etc...)Prior to Construction: 1 After Construction: 6. N.Y State Construction Classification:rr�� N.Y.State Use Classification: 7. Property Owner:5{ t3c.s- is vt &r_T010N Address: 3 �u uLt�r�1►u I-a 11-C Phone# Cell# 91 q- a)s-- / email: �6x�_i 11ah oo� cc�-, 8. Applicant: Address: Phone# Cell# email: 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# email: 11. General Contractor:. Address: L c'SIIr-[ �� �c e Phi,.,t, ("_/ Phone# Cell# �®/! email: - M 12. Estimated cost of construction $ '� (NOTE:The estimated cost shall include all labor,r4aterial,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 13. Job Timetable:Start: ��,0--e /I{?a�Finish: mva (1) Iz j 7 L/ (]O / % 6112023 R Nk BUILDING DEPARTMENT VILLAGE OF RYE',1II'OOK i APR 2 2 2024 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 ( VILLAGE OF RYE BROOK www.rvebrook.org BIJ!l.'r3I�-IG 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 YO/R��K, COUNTY OF WESTCHESTER ) as: _ I, -5,:, 9►�► +C�GfE>��,residing at, 3 aw '` /t/y (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; Z_ , 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. (Signature ol£Property Owner(s)) (Print Name of Propem Ov%ncr(s)) Sworn to before me this l� day of � Lzi20 (Notary PuhliC) SCOTT J_GOWE NOTARY PUBLIC OF NEW YORK I.D.0 01 GO6357188 MY COMMISSION EXPIRES Ylgl (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: � •s��. [� C f7 Cc f1'—, , 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 l / nn Sworn to before me this day of rid-, , 20 -L day of , 20 4 Signazure of Property Owner Signature of Applicant Print Name ofpyb pe O er Print Name of Applicant Notary Public Notary Public SCOTT A Got* NOTARY PUBLIC OF NEWYORK I.D.#01G063571 / MY COMMISSION EXPIRES f 1 (4) 8/12/2021 f i f s N 0r ■ N N w N � i W i Q W 1-4 1�1 w � u � A, W 00 a 1~ Ln ���jjjMrrr F� a W 'GJ�sQ i i Ln ~ M ►_I p �1 fOZLn Ljr) w � � o A cFn o Z Q � O i c i W W >4 xw w N 'moo V , i O � z V N � A V ►-� i("'J V J {si o W z i ,Z O "? V A1 Z � ,..a F. a Q a W e O i f h�l F V It H W a a oo c� Z Q A Q W W a p x pQ W f W a z as i o � W z � �, o f � Z O U z a 0-4w W w W c , o o W a aeq V u v o g °` x �-, Z w Z A o I.., M w w q a on .. , a f i �yE dRC�L�� : ! i.j BUILIEFR�'MENT VILI A, E OF RYE OK APR 16 2024 3D 938 KINd,9ET RYE BIB,NY 10573 VILLAGE - OF RYE BROOK BUILDING DEPARTMENT WWW orpr PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: /' Q_?L PP#: Approval Date: 0 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, �-��p-�y 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. L Address: nn`� C,Q i 3 I IV L czyh c 1�� sLL/ SBL:�3�i 3._11��-J Zone: -1 C� 2.Proposed Work: 1'� r 'r^ . 'T'G G a soQu- 6� Kl SAi 3.Property Owner'11_4� SrA6 J- . vZG7 4- Address:a N c- Z<IA- e' 16�73 Phone#: Cell email: 4.Master Plumber: �� ���5 ddrress: Co Vf6 UL c,N cc- ( s /6 Lic.#:/7 e/ Phone ���� �&6 07+ Cell Y !�� ;M? email: v �, N c 4 • I Company Name: A,V \v) Ulf 15� t✓lc� /Address� R,�6c 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 3 31 Floor .J► 41 Floor 5"'Floor Exterior 5.* List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -t- 3/3/2023 TAT\E OF NE YORK,COUNTY OF WESTCHESTER ) as: +n U N ��fir ' ,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. �h Sworn to be re me is Sworn to before me this �l day of r' ,2 day of 20 CV Signature of Property Owner Signature of Applicant Print Name Property Owner DEBRA ZACCARIA Print Name of Applicant NOTARY PUBLIC,STATE OF NEW YORK Registration No.01ZA5045309 Qualified in Westchester County Nota b 1c Commission Expires June 12,2027 N ry Public Damon Eskew Notary Public of New York I.D.OIESS442996 COMMISSION EXPIRES 10/7N2026 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 ID] BUILDING DEPMENT VIL E OF RY OOK APR 16 2024 ! 938 KING 4 ET RYE BR ,NY 10573 J VILLAGE OF RYE BROOK N�ww:ryebrook.ora BUILDING DEPARTMENT xx,x,.,.x,., xxxx�xxxxxxx********;xxxxxxxxxxxxxxxxxxx, xx**********�*xxx*xxx,,.xxxx*xxxxxx,xx�*xx*�xxxxx**,x, 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: wr�r 1 (� 1 �/ � SCIO 0 S I cgN Ky-4r, ,Hc' , residing at, _-_S ` C q U (e_ r.< ��i n•� (Print name) ( ddress 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; I N Lc,.J Z I oS 7.3 , 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. X r"",/, A'4� (Signature of Property Ov�ner(s)) (Print Name of Property Owner(s)) worn to be ore me this day of , 20 (Nola Damon Eskew Notary Public of New York I.D.01ES6442995 COMMISSION EXPIRES 10/24/2026 8/12/2021 Building Permit Check List&Zoning AngWis C� Q Address: ' , N 1._arl SBL• 1 y• �� - - O Zone: P'�-1 U�(s (� O Const.Type: Other: Submittal Date: 7�22 2 Revisio Submittal Dates: Applicant: T (A.VC-, Nature of Work: v Reviews:ZBA: 2 2�\ P& BOT: Other. NEED OK ( n C .FEES:Filing: \ BP: `` \1 C/O. Flood Plane: Legalization: ( ) ( ) APR Dated: Notarized: SBL• Truss I.D. Cross Connection: H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening. ( ) ( ) ENVIRO:Long Short Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmt.: Tree Plan: Other. ( ) ( ) SURVEY:Dated Current: Archival• Sealed: Unacceptable: ( ) ( ) 'PLANS:Date Stamped Sealed Copies: Electronic Other. ( License: Workers Comp: Liability Comp.Waiver: Other. ( ) ( ) CODE 753#: Dated N/A: (� ( ) HIGH-VOLTAGE ELECTRICAL Plans: Permiu N/A: Other. All ii " iA 3%i C ( ) ( ) LOW-VOLTAGE ELECTRICAL Plans: Permit: N/A: Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H.W.I.C.:_Battery:_Other. (� ( ty PLUMBING Plans: Permit: Nat:.Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A: Other. ( ) ( ) RV.A.C.: Plans: Permit N/A: Other. ( ) ( ) FUEL TANK:Plans: Permiu 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 DENLU LETTER Other. ( ) ( ) Other: ( )ARB mtg.date: approval:- notes: ( )ZBA mtg_date: approval• notes: ( )PB mtg.date: approval• notes ]APPPn Z`t�. REQUIRED EXISI NG PROPOSED NOTES Lul Date: Y_U Area: Cirde: Fron�ta¢e Front: Front: Sides: Rear. Main Cov Accs.Cov: Ft H Sb: Sd.H Sb: GFA. Tot : Ft�Im PP Height/Stories notes: `''SA ,h��• AJA A .:t A .A -- 1• 'AJ➢1 tl�.- A A ? •15�IA961 A A �:;': � == :.. ' ' !cc♦ci • c�c�c�� �ci�PP � �ci4ci�� ��c�'�ci�� _ , ��'i � 1 a 1 _ LIJ C)LO / CCA ca K. y ; d U U _ r o ci L i •� ..iIncn ca \ tt oi)> rn� ► �'+ coo c O w »�to i �•+ z o o .° o�ection LLI �/� a•a : � Jtu LLJ 0 ' J w CL J r w �s�► ' �.�' p � � `— � o := `z' w�E' as Z r..+ � \ P X 4- r •j � N s 3 G • Ira: : � c � %�iiu «�� \ (xov )> R ,\ �' 't— L W •� V .D V=, ill; �1.•ti• d E i ., <co)> _ :•5����h_ s �, s�:,••r.���d�/4�b.,.`� .����. � �1�1� �� �5�/�� • «o " A A ♦• A '1 •• • • ♦• A ♦♦ A ♦• A •1 v - __i A��® 7EM (M /DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE /18/2024 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 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 Genesis Mariscal NAME. _ North Main Street Insurance Agency PHONE (914)481-5334 ac No: 375 North Main St. E-MAIL nmsinsuranoel@gmaii.com @9mail.com Port Chester, NY 10573 INSURERS AFFORDING COVERAGE NAIC# INSURER A: Utica First Insurance Company INSURED INSURER 8: Ganim Improvements LLC INSURER C: 15 Leslie Ave. INSURER D: Greenwich,CT 06831 INSURER E 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. INSR TYPE OF INSURANCE NAR SU L POLICY NUMBER PMO/IDICIYEFF POUMID Y EXY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY PRME SES AG ToE.occurrence $ 50,000 CLAIMS-MADE ® OCCUR ME EXP(Any one person) $ 5,000 A ART3000261460 06/23/2023 06/23/2024 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO-JECT LOC i $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea .den,) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PerOacER-Z'DAMAGE $ HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ 1 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ _ Hyes describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule.if more space is required) Additional Insured Rye Brook Building Department Job location: 3 Jacqueline Ln. 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 St. ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE I Glu C_9-Vi. 0.t-'Vi fiGL L ACORD 26(2010/06) ©1988-2010 ACORD CORPORATION. All rights reserved. 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 ^^^^^^ 133873544 GENESIS MARISCAL D/B/A NORTH MAIN STREET INSURANCE 375 N MAIN ST PORT CHESTER NY 10573 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER GANIM IMPROVEMENTS, LLC VILLAGE OF RYE BROOK C/O CHARLENE GANIM 938 KING ST. 15 LESLIE AVENUE RYE BROOK NY 10573 GREENWICH CT 06831 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2270 408-4 702532 04/17/2024 TO 04/17/2025 4/18/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2270 408-4, 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 STAT SUR NCE FUND 7 �/ DIRECTOR.INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 313588381 U-26.3