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HomeMy WebLinkAboutBP24-086PERMIT # 7 �O �(D DATE; /3 WXP; S3 aSS OTHER APPROVALS SECTION S� S9 BLOCK T 5 ARB TYPE OF WORK P �/%T r'op /) S BOT JOB LOCATION N Q2 �a C e Ps OWNER J /�U Z20 / �'% 0)6 7 ZBA OT HER CONTRACTOR o4/9,eC/7' GrJ4 P�4 S 7/ OT,S5 C -Ja c�ep3c)� 4e/7 y �0 )00a - a8 vo EST. COSTS %O FEE vc0 * FEE L� DA TOO * FEE DATE INSPECTION RECORJ? DATE I NSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING 0 RGH PLUMBING GAS 0 SPRINKLER ELECTRIC 0 LOW -VOLT 0 ALARM C� AS BUILT C7 FINAL 102- O` GG tus y V✓� YGG �tCC4uuJJ� G CCC+.(Go QR 4 J�Jot,V4 W V `C . 19 VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher J. Bradbury w-.yw.ryeb rookny.g_ov TRUSTEES BUILDING&FIRE INSPECTOR Susan R. Epstein Steven E. Fews David M. Heiser Donald T. Krom,Jr. Salvatore W. Morlino CERTIFICATE OF COMPLIANCE May 14,2025 Linda Uzzo 52 Valley Terrace Rye Brook,New York 10573 Re: 52 Valley Terrace, Rye Brook,New York 10573 Parcel I D#: 135.59-1-45 Building Permit#24-086 issued on 5/13/2024 for Basement Waterproofing System This certifies that the basement waterproofing system,under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to E C E � V E BUILD R TMENT For office use oniv. PERMIT# MAY - 9 2025 VIL OF RYE ROOK ISSUED: J ' 9 8 KING STRE YE BROOK,NiFE, YORK 10573 DATE: VILLAGE OF RYE BROOK 9 -06 O�c FEE: pYelll, ID E3 BUILDING DEPARTMENT APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION #}#k}kiii4i4444#4####rt•krtkk4rt4}####kiti#i##4####k44#ki■kliik#,##/##444#!rt}}#4#4k#rtiii#4#rt##k#iirt444#4}#kilo#k4####4}##44kkf#44# Address: 5 �' Fu LC � ,06c , /) 1 Occupancy/Use: - Parcel ID#: 0,. , 5 Zone: —-7 Owner: L i„Ja Uzza Address: Q Vu nje AQ„!, 1V V /05�3 P.E./R.A. or Contractor: Address: 33 Person in responsible charge: Address: / 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 YO RK,COUNTY OF WESTCHESTER as: /7 S� e',4 /6 I r c 4' being duly sworn,deposes and says that he/she resides at (Prin ameofApplicant) (No.and Street) in Ae ,,,,, f in the County of 11u✓«-7 in the State of�,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*nated gratis was:S "s, )C, ? �O for the construction or alteration of5�,yr�s� 1 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 ��-h Gdt= day of /� l / , 20 4"_ IW� Signature of Property Owner Signature of Applic t r Prin Name of Proper Owner Pri t Name of licant s Notary Fu lic Notary Public Jackson Francis Jackson Francis Henry Notary n Francis HenryH my Notary Public-Connecticut My Commission Expires My Commission Expires February 28, 2029 February 28, 2029 JR E. �W E- BUILD) T R ENT For office use only: DPERMIT#�,�ay VIL OF RYE OK ISSUED: S /,3-,4y APR 162025 938 KING SIRE YE BROOK,; YORK 10573 DATE: FEE: /,'CCU— PAIDS VILLAGE OF RYE BROOK BUILDING CEPARTME:Ni" w ov APPLICATION FOR CERTIFICATE OF OCCUPANCY,CERTIFICATE OF COMPLIANCES AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION ######\##f####iii♦iiiiii#`#/##i4##4•ii#ii##t###############►##♦iii♦##♦i#i■##i4##}##/##��iiii###4#i##i##4##i#i#i##4####4#####i## Address: �/�LL6 71� eJ4 C,C- /� �/ZP�O/L / 1 01-D Occupancy/Use: � Al Parcel ID#: �S5, 59 /- 7 Zone: Owner: L-/o9 A- Address: P.E./R.A. or Contractor: &AIIV, Address: �a VM-L-L rt,� Person in responsible charge:���Ks&-i ",n( yAddress: / 'jam oA-- o S 73 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/iJ j A- l� 2-2-0 being duly swom,deposes and says that he/she resides at 5 a VA-C-LE- Ap", nt Name of Applicant) (No.and S eet) inC^ I//,in the County of ✓y�TC fft-i 7�-tZ, in the State of that (Cityfrown/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:$ 14(69, 7 for the construction or alteration of. W 7't= tog- 1 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 ls�Nr , 20 J day of , 20 gifnature of Property Owner Signature of Applicant �� ZZ0 ame of Property Owner Print Name of Applicant No Public Notary Public S►ARI MEuuo Notary Public,State of New York 6/I/2o2a No.OiIVIM60063 Qualified In Westchester County Commission Expires JanUary 29.20-Z �E BRC�v�t BUILDING DEPARTMENT VILDING INSPECTOR SISTANT 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 : Y a L to �, QJV�. �=- �Z DATE: / ^2 0 zJ PERMIT# ISSUED.:5 1-3-Z I SECT:Imo• I BLOCK: f LOT: �J LOCATION: �`> t►'�EtiT ���-lN\ � OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑CCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION J ❑ NATURAL GAS �L �e�L/ ❑ L.P. GAS Li ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ .CROSS CONNECTION �� tA © FINAL S ❑ OTHER /� �E BRC�uk O�` tim w � BUILDING DEPARTMENT ❑BUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - -- - - ADDRESS : . P\ T p DATE: -/. _) v -.boo PERMIT# ISSUED: 13-l SECT:/7iS, S'� BLOCK: f LOT: X5 LOCATION: /r\42A� L �_.� -F ! `j OCCUPANCY' ❑ VIOLATION NOTED THE WORK IS... El' ACCEPTED ❑ REJECTED/ REINSPECTION 'EYr 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 �( /� � � LA C,n c( ❑ FINAL PLUMBING G —�j ❑ CROSS CONNECTION - ❑ FINAL OTHER e" .-,.M ; V PC� -e- BR ��/ FT_, �0•� 1932 BUILDING DEPARTMENT ❑BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑ VILLAGE ENGINEER 938 KING STREET RYE BROOK,NY 10573 0 ASSISTANT BUILDING INSPECTOR (914) 939-0668 FAx(914) 939-5801 - - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - - ADDRESS: S Z 1%A 1_c �/ �r R 2 c c DATE: / - Z 3 - 2 0 L 11 PERmrr# ISSUED: - Z SECT: �3S S BLOCK: LOT: LOCATION: f OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... Id ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING sc t77 e jyjs ❑ INSULATION ❑ NATURAL GAS ❑ L.P.GAs I ❑ FUEL TANK S C a z ; ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ FINAL ❑ OTHER QyE BR cb uJ � • �9�z BUILDING DEPARTMENT ❑ByILDING INSPECTOR aASSISTANT 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 :--. A LU V1 I-e,. DATE: - �yd Q PERMIT# 7 \ Z `' 0��' ISSUED: SECT: BLOCK: LOT: LOCATION: T'LJ-)� . 1j OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION eon- } i REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS /t " ❑ L.P. GAS J ❑ FUEL TANK s ❑ FIRE SPRINKLER I r) Ali L ❑ FINAL PLUMBING ❑ CROSS CONNECTION ; ❑ FINAL l [j OTHERN rLtb �A Ile_S s s 00� N 4 w G7 w r' � Cti Q AN 14 Ln a a u, w�/ � �i O ag y � 0 cn FBI P3 � W `� CD w° c ° o� � ° O Mai zeno pQ O z A o � 3 � a-CD In u O p d' p a N O � ¢ -� � uan x O " � � a 5 co OR OZ F' W A �, U p p ob Z w z w zi -fj � -, p w � � 81. V W M W M cn 0 p � A en �., O o a a� ro U H F Fi.� NYC W V V �i � � zz b „ `� O C3 v T"� v a b e z W O A �► ono Off ° Iti 1.1 �1 z 0 ' V Z tz Cn A '� "j uo -f w O �" O H Gj °' w V x Ed OZ V G " V Eyo �° � N b O � ° N z E� W. v a a W z x Q 9 �I ¢, W �� BUILD! R` MENT VIL E OF R OOK MAY - 2 2024 938 KING ET RYE BR NY 10573 1 4 4 VILLAGE OF RYE BROOK BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATIOIN FOR OFFICE USE ONLY: / ,�✓� Approval Date: MAY 2 24 r #:&Z) V-0&2Application Fee:$ / o Q Approval Signature: Permit Fees:$ 3 7d'�' Ue 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: 61 N SSL:1 J 6 9 I"'�f�•� Zone: _ 2. Proposed Improvement,( escribe in detail):. 4 j • : a k 1 oa wk 105 A- A l `o i r ffi_ Lee. 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 I: TIER IT: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) :No: Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 1 f 5. Occupancy; ,2 fam.,comm.,etc...)Prior to Construction: I Al/?,. After Construction: I i tt�,1in. 6. N.Y State Construction Classification: SA N.Y.State Use Classification: Q/- dw c,-w ' 7. Property Owner: �i4.,du_ �2Lt� Address:�Q �i 1/tu r ,1�, ,NY l©sF) Phone#__ )q-V37- 1� 4 Cell# email: 4r} S. Applicant: 6dwepcu>L sue-..,wit LSzc"s Address: f,,p ``pp�� 11 4 Phone# 2d kQ 4,,f'YO Cell# emait Orrin i fj r� l L �Ss.e ct�, 9. Architect: /1.4 W. 1�Yi*zs Address: Feti welcic &. or-ymk#, eT C%C// Phone# Cell# email: &�Y1 TCMFQ 10. Engineer: Address: Phone# Cell# email: 11. General Contractor: /�tlii� ucr G .rx�/ Sk dress: to cc T 6 Phone# Cell p# email: r .r 12. Estimated cost of construction (NOTE:The estimated cost shalt include atl labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 13. Job Timetable: Start: Finish: (l) 6/l/2023 F�� DBUILDING DEPAR 1VIENT MAY - 2 2024 VILLAGE OF RYE. OOK 938 KING STREET RYE BR6' ,NY 10573 VILLAGE OF RYE oROOK (914)939-©6� �c BUILDING DEPARTMENT w .r ki.or - 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 Y O RK, COUNTY OF WESTCHESTER ) asE'+L : I, L i N D A N ��, ,residing at, s-; Lt� (Print name) (Addre�.N%�here NOU In t i 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; rlt e- Rye Brook,NY. 01- r 1ub:lddmss r 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 of Property OwnerlslJ f Print Nan1C ul'Property Ownch,i) Sworn to before me this 'l day of , 20 ) Jackson Francis Henry Notary Public-Connecticut My Commission Expires February 28, 2029 (Notary Pul'h I (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 Y%K,COUNTY OF WESTCHESTER ) as: ►..��*—=�t2� ,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. ttorney,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 2.17 Sworn to before me this -nA day of , 20 d 1 L ,2 Signature of Property Owner Signature of A lira �/Al 4 U Z Prin Name of Property Owner Print Name of Applicant Notary Public o ary Pubhc E Francis Henry Daniel Medina ublic-Connecticut Notary Public, State of Connecticut mission ExpiresMy Commission Expires ®ct.31,2026 uary 28, 2029 ,^ (4) 8 11 212 02 1 x L- t . - �.-W mot. - ,+ � • � � lr, r ...� ,:-.�r' �:< Loll . ♦ . I 4i&9 K WA W- Ilk by f .. —►� ..i I. � . i ' I `�• '"� ';I k�A�('�,,,a yam,.. +: J• ,-;�+. ,'} f, .•+ _ ^y ��. ,� 'to 1 ,� r ./,�, ~ ` �. X. � ,Ir v .•, y car LS ICC-ES Legacy Report 98-63 Reissued May 2020 This report is subject to renewal May 2021. www.icc-es.org 1 (800) 423-6587 1 (562) 699-0543 A Subsidiary of the International Code Council® Legacy report on the BOCA'National Building Code/1999 and the 1997 International Plumbing Code® DIVISION: 33 00 00—UTILITIES supplementary to a foundation drain. In applications where Section: 33 46 OO—Subdrainage water permeates through the rubble stone, brick or cast-in- place concrete foundation wall, the drainage system is REPORT HOLDER: intended to discharge the water as described above for BASEMENT SYSTEMS, INC. concrete masonry unit foundation walls. WaterGuard®Subfloor Drainage System Components EVALUATION SUBJECT: ■ Drain channel: A 0.1-inch-thick (2.54 mm), one-piece ® construction of extruded, solid polyvinyl chloride (PVC). WATERGUARD SUBFLOOR DRAINAGE SYSTEM Drainage holes, 0.75-inch-diameter (19.1 mm) and 3 inch (76 mm) on center, are located at the base of the EVALUATION SCOPE: channel on the side facing the foundation wall. Compliance with the following codes: The component cross section is a 3.13-by-1.85 inch BOCA®National Building Code/1999 (80x47 mm) rectangle with a 2.43 inch (62 mm) flange Section 1710.1 General on top. Two 0.35-inch-long (8.89 mm) spacers are attached to the flange on the side facing the foundation SUBSOIL DRAINAGE SYSTEM wall. The spacers are intended to provide a means of 1997 International Plumbing Code® directing the flow of moisture which may penetrate the foundation wall. See Figure 3 at the end of this report for ■ Section 105.2 Alternative materials, methods and an illustration of the drain channel component. equipment ■ Drain outlet: A 0.1-inch-thick (2.54 mm), one-piece ■ Section 1111.1 Subsoil drains construction of extruded, solid polyvinyl chloride (PVC) ■ Section 1111.2 Building subdrains that is friction-fit to the drain channel component. The ® component cross section is a 3.13-by-1.85 inch (80x47 BOCA National Building Code/1999 mm) rectangle with a 2.43 inch (62 mm) flange on top. ■ Section 106.4 Alternative materials and equipment The component extends at the base to accommodate a ■ Section 1813.5 Subsoil drainage system 4-inch-diameter (102 mm) drain opening. The drain opening is intended to be located at the point where the DESCRIPTION WaterGuard®Subfloor Drainage System is attached to a WaterGuard® Subfloor Drainage System is a subsurface drain or sump. See Figure 4 at the end of this report for drainage system, consisting of a polyvinyl chloride (PVC) an illustration of the drain outlet component. drain pipe, a PVC drain outlet, and crushed stone. The ■ Crushed stone: Minimum 0.5-inch-diameter (12.7 mm) system is located below the interior concrete slab of a below crushed stone shall be placed on one side of the drain grade story or basement floor and on top of the foundation channel with the side facing the footing left free of stone wall footing. The WaterGuard® Subfloor Drainage System is to allow an air space to exist between the footing and intended for use with foundation walls of concrete masonry channel. units, rubble stone, brick or cast-in-place concrete construction. See Figures 1 and 2 of this report for CONDITIONS OF USE illustrations of the Water-Guard® Subfloor Drainage System This report is limited to the applications and products as when used with a concrete masonry unit foundation wall and stated in this report. The ICC-ES Subcommittee on National a cast-in-place concrete foundation wall, respectively. Codes intends that the report be used by the code official to When used with a concrete masonry unit foundation wall,the determine that the report subject complies with the code system functions by collecting water or moisture permeating requirements specifically addressed, provided that this through the wall assembly or through weep holes placed on product is installed in accordance with the following the inside face of concrete masonry units. The water is then conditions: discharged from the system by gravity or mechanical means. ■ The WaterGuard® Subfloor Drainage System shall be When used with rubble stone, brick or cast-in-place concrete installed in accordance with the manufacturer's foundation walls, the drainage system is to be installation instructions and the limitations of this report. ICC-ES Evaluation Reports are not to he construed as representing aesthetics or am other unrihutes not specilic'alll'addressed,nor are they to he construed US on endorsement of the subject of the report or a recommendation for its use.There is no warranty by ICC Evaluation Semice,LLC,express or implied,as Ilk to any(nduig or other matter to this report,or as tounr produce covered hi the report. Tx L ` Copyright 0 2020 ICC Evaluation Service,LLC.All rights reserved. Page 1 of 4 98-63 1 Most Widely Accepted and Trusted Page 2 of 4 ■ The footing shall not be undermined under any INFORMATION SUBMITTED circumstances during the excavation required for the E VTEC Laboratories, Inc., Test Report No. 100-886, installation of the WaterGuardO Subfloor Drainage dated October 22, 1998, containing results of physical System. testing performed in accordance with Section 1710.3 of ■ The WaterGuard® Subfloor Drainage System shall not the BOCA®National Building Code/1999. be installed where the load-resisting capability of the 0 VTEC Laboratories, Inc., Test Report No. 100-950, wall is not adequate or is jeopardized by the excavation dated March 11, 1999, containing results of structural and/or installation. testing performed on concrete masonry units with and ■ Evaluation of the WaterGuard® Subfloor Drainage without drainage holes. System when utilized with a rubble stone, brick or cast- ITEMS REQUIRING VERIFICATION in-place concrete foundation wall is limited to installations that comply with Section 1813.5.2 of the ✓ Water which drains into this drainage system shall be BOCA®National Building Code/ 1999. collected and disposed of in accordance with the 1997 ■ The WaterGuard® Subfloor Drainage System is limited International Plumbing Code®. The collection and to applications where the ground water table disposal system shall be installed in accordance with investigation determines that a subsoil drainage system the 1997 International Plumbing Code . is required by the code. ✓ The floor shall be resurfaced with concrete meeting the ■ For installation with foundation walls constructed of minimum requirements as set forth in Sections 1905.0, concrete masonry units, a maximum of one 5/8-inch- 1906.0, 1907.0, and 1908.0 of the BOCA' National diameter (15.9 mm) weep hole shall be drilled in each Building Code/1999. core of every block in the bottom course of blocks. ✓ Methods required to enhance the capacity or stability of ■ This report is subject to periodic re-examination. For the foundation system, including modifications and information on the current status of this report, contact repairs of structural cracks in existing foundation walls, the ICC-ES. shall be determined by a registered design professional and are outside the scope of this report. APPLICATION FOR PERMIT PRODUCT IDENTIFICATION To aid in the determination of compliance with this report, All Basement Systems Inc., WaterGuard®Subfloor Drainage the following represents the minimum level of information to System components, or their packaging, manufactured in accompany the application for permit: accordance with this report shall bear the following ■ The language "See ICC-ES Legacy Report No. 98-63" identification: or a copy of this report; ■ "See ICC-ES Legacy Report No.98-63." ■ Type of foundation wall construction; ■ Manufacturer's name and product name. ■ Method for disposal of water from the system; The report holder's contact information is the following: ■ Instructions regarding investigations of the load carrying BASEMENT SYSTEMS, INC. capacity of the wall to determine adequacy; 60 SILVERMINE ROAD ■ Specifications for all destructive operations; and SEYMOUR, CONNECTICUT 06483 ■ Specifications for location, number, and size of weep www.basementsystems.com holes in concrete masonry unit foundations. 98-63 Most Widely Accepted and Trusted Page 3 of 4 —illy Concrete Concrete Poured Block Well Floor Concrete a / Wall Concrete r Floor i. Crushed 4 \\U a stone a °. ,u Crushed Stone Footing ' y WaterGuard WaterGuard Footing \=\\�\`///_ FIGURE 1'—WATERGUARD®SUBFLOOR DRAINAGE FIGURE 2'—WATERGUARD®SUBFLOOR DRAINAGE SYSTEM CONCRETE MASONRY UNIT FOUNDATION WALL SYSTEM CAST-IN-PLACE CONCRETE FOUNDATION WALL ± .020 �---.350 ± 100 4.275 7f075 1.850 ±.075 3.125 For SI: 1 inch=25.4 mm FIGURE 3'—DRAIN CHANNEL COMPONENT 98-63 ( Most Widely Accepted and Trusted Page 4 of 4 Mates to WaterGuard ~Male to 4" PVC pipe to sump FIGURE 4'—DRAIN OUTLET COMPONENT 'THESE DRAWINGS ARE FOR ILLUSTRATION PURPOSES ONLY.THEY ARE NOT INTENDED FOR USE AS CONSTRUCTIONDOCUMENTS FOR THE PURPOSE OF DESIGN,FABRICATION OR ERECTION. 3�sem TripleSafe- SUMrPUMP SYSTEM Specifications Manufacturer Product Basement Systems Inc. TripleSafe Sump System 60 Silvermine Rd. Seymour, CT. 06483 Part# 02040B 800-640-1500 The TripleSafe is a combination of patented and custom components which make up a highly Description efficient and reliable pressure relief system and water evacuation system for basement water controls stems. Utilizing 2 120v pumps and 1 12v battery backup system. Use TripleSafes are designed to relieve sub floor water pressure and evacuate water from the basement water control system. TripleSafe Height: 22 3/8" Physical TripleSafe Width: 18" • Length 24" Capacity 23 Gal. Properties TripleSafe Shipping Weight: Approx. 80 Lbs.(No BBU.) Components The Liner has a 24" X18" dual liner configuration, is 22" deep and made of structural Liner polyethylene foam. The liner also features exclusive pump stand locator tabs, which ensures proper pump location to prevent the pump float switchs from hanging up on the sidewalls of the liner by kee in the pump properlypositioned in the liner. Two-piece structural polyethylene foam lid that bolts down to the liner. Lid has floor drain with a Lid ball float and rubber grommets for the electrical cord and discharge lines. Hex Indented Screws for Lid 5 Part# 02012 (1) Zoeller M-53 1/3hp. Part# 02201 and (1) Zoeller M-98 1/2hp. Part#02202 Cast iron submersible pump with non-clogging vortex impeller and a automatic mechanical float switch. Pump(s) The Primary 1/3 hp. pump will pump 2240 gallons per hour at an 8' head, Startup Wattage:2980w, Run Wattage:1115w. The secondary '/2 hp. Pump will pump 3900 gallons per hour also at an 8' head start up Wattage:3360w, run wattage:1 080w. The UltraSump 3 Battery Backup Unit has a pumping capacity of 1970 gallons per hour at an 8' head. WaterWatch alarm system, which sounds off when water rises above the point where the pump Alarm should normally turn on. The WaterWatch alarm runs on a 9V battery and sounds off when the water level is within 6" below the sump lid and before any water can reach the floor. Part# 02400B Check Valve A full flow 1-1/2" check valve that screws directly into the pump with a rubber hub to help control noise and vibration. Part# 02290 Cord Made of PVC, Yellow in color. Comes with a hose clamp, mounts on discharge line to keep Captain TM cords neat. Service log envelope ties to Cord Captain TM to hide pump and charger cords. Part# 02093 CleanPump The CleanPump stand is designed to fit in the bottom of all of our sump liners, insuring that silt Stand and sediment build-up without affecting the pumps performance. Part# 02013 TripleSafe bridge is added to provide support to the center of the 2-piece lid, discharge lines Bridge and also has cutouts to provide wire management of the sump pump and UltraSump power cords. Part# 02014 Accessories What you need each year to service a system that already has the service envelopes Part# 02087S includes: Annual 0 (2) Screw-in check valves Service Kit 09v Battery • 2 Wire Ties • 2 "Next service due" labels • 1 "This basement protected by" label System Comes with each complete sump package. Attach the envelope to the top of the Cord Service Captain with the included wire tie. Part # 02082S Includes: Envelope 0Service Envelope • Wire tie (8") • Owner's Manual • 2 "Next service due" labels • 1 "This basement protected by' label • 1 Condensation indicator strip • 2 Electrician notes Electricians Lists electrical requirements for Basement Systems products, leave with the homeowner to Notes give to their electrician. Part# 02038 No-Hub Rubber fitting serves as a quick release point or vibration suppressor on 1'12" discharge line Fitting Part# 02300 2-Piece FPatented 2-piece lid with floor drain and check ball included. Part# 02012 Sump lid Sump Lid Grommets Kit Part # 02601 Includes: Grommet 0 1 Blue pipe grommet Part# 02601 Set 0 1 Yellow cord grommet (Single hole) Part# 02602 • 2 Wire ties 2" Part# 02605 Discharge 1 Grommet Black 2" Grommet Installation Procedures Create a hole in the floor approximately 27" in diameter and excavate down 24"from the floor surface. Set the liner in the hole with the lid approximately W below the surface of the floor and back fill with clean stone. First install 1 pump stand into the positioning tabs at the base of the liner then install the primary pump with Ultrasump pump preinstalled; with check valve and section of 1-1/2" pvc discharge pipe that extends above the floor. Next position 2 pump stands stacked on top of each other into the other set of positioning tabs and set the secondary pump . Slide the lid around the discharge pipe and pull the electrical cord through the top and then bolt the lid into place. Install airtight grommets and WaterWatch probe alarm. Mount CordCaptain to the 1'/z" discharge line using supplied pipe clamp for wire management, hang system service envelope using 8"wire tie supplied and fill out all information on labels. Version 6 3/18 DocuSign Envelope ID:6DE37FDA-3831-44D9-8DEF-2BE8B64914BF n � Prepared by: Prepared for: Proposal oJeffrey Wade Linda Uzzo �OIYltMUM jwade@ljctbs.com ►adybug52@optonline.net Since 1987 fY IIK Connecticut Basement Systems Inc. H (914)937-2674 Waterproofing to Rnishingl CT#0526823 WC#0644- P (914)937-267 4 ^ n H94PC5504MA147215 Job location: ((L; \\`(// IE connecticutbasementsystems.com 52 Valley Terrace TF(800)541-0487 Rye Brook,NY 10;; D F (203)463-9339 MAY - 2 2024 License#CT:0526823 WC:06440-H94 MA:147215 RI:38081 VILLAGE OF RYE BROOK Prepared on: BUILDING DEPARTMENT 2-26-24 revision Product List WaterGuard ........................... 94ft WaterGuard Port ......................... 3 IceGuard ................................. 2 LawnScape Outlet ......................... 1 Exterior Discharge Line ................. 30 ft SoakAway ................................ 3 Triplesafe without UltraSump .............. 1 BrightWall ............................. 90 ft SaniDry Sedona ......••••••.•............. 1 Project Summary 0 My Basement ................................................ $19,126.00 Total Investment ............................................. $19,126.00 �.A r Preferred Customer Discount $956.30 ""'�'�—►................................... Total Contract Price ................................ $18,169.70 �-�— Deposit Required-30% $5,450.91 0 ...................................... Deposit Paid .......... $4,842.30 - Amount Due Upon Installation ................. $13,327.40 Customer Consent Customer fully understands and accepts the transferable warranty provided,which covers only the areas of the basement addressed and does not cover water damage to home,property,or personal items.Partial perimeter systems carry a limited warranty.Unless in the notes,installation of the system does not include painting,finished carpentry,electrical work,or replacement of floor tile or carpeting.Contractor cannot be responsible for frozen discharge lines without an IceGuard.Warranty does not cover condensation,damp spot discoloration,and window well flooding.Customer shall grant contractor a 60 day right to remedy any problem after reported.Homeowner responsible for moving objects away from walls and back again.Some dust should be expected from work.Additional work needed will be at customer expense.Homeowner assumes all responsibility for damages due to breakage of any hidden fuel/water/utility service lines on surface or below. Authorized Signature Date Any alteration from the above specifications and corresponding price adjustment(if necessary)will be made only at the Customer's request or approval. Completing the work in this Proposal at the time scheduled is contingent upon accidents or delays beyond our control.This Proposal is based primarily on the Customer's description of the problem.This Proposal is valid for 30 days. Acceptance of Contract—I am/we are aware of and agree to the contents of this Proposal and the attached Limited Warranty(together,the"Contract'). You are authorized to do the work as specified.Payment will be made as outlined above.I/we understand that all deposits paid are non-refundable after expiration of three day right of rescission.I am/we are aware of and agree to the entire contents and additional pages of this proposal,(together,the ..contract'),by signing signing all pages. Customer Signature Date 3/6/20 8 PM PST A full perimeter system with a TripleSafe Pumping System was recommended Initial Sales Tax is not included and will be billed separately if applicable. Initial Connecticut Basement Systems Inc. Job Location Page 1/7 33 Progress Ave Seymour CT 06483 52 Valley Terrace Rye Brook NY 10573 2-26-24(7) DocuSign Envelope ID:6DE37FDA-3831-4D9-8DEF-2BE8B64914BF Job Details D E F A B 5 west apart abrg C 130 Fwt Front of Ha ; rowWw"W" P TS O Typeof Wall ........................................................................................................................... Poured Concrete ExistingWall Finish .................................................................................................................................. Plain ExistingFloor Finish ............................................................................................................................ Concrete Discharge line length away from house ...................... ......................... 30 .............................................................. Connecticut Basement Systems Inc. Job Location Page 2/7 33 Progress Ave Seymour CT 06483 52 Valley Terrace Rye Brook NY 10573 2-26-24(7) DocuSign Envelope ID:6DE37FDA-3831-44D9-8DEF-2BE8B64914BF Job Details (Continued) A)SoakAway 1 B)SoakAway 2 Q SoakAway 3 D)Street E)Property Line F)Property Line Connecticut Basement Systems Inc. Job Location Page 3/7 33 Progress Ave Seymour CT 06483 52 Valley Terrace Rye Brook NY 10573 2-26-24(7) ' DocuSign Envelope ID:6DE37FDA-3831-44D9-8DEF-2BE8B64914BF Job Details (Continued) Specifications 1)Install WaterGuard sub-floor drainage system as indicated in job drawing. 2)Install WaterGuard Port for access to system. 3)Install IceGuard to prevent floods from clogged or frozen discharge line. 4)Install LawnScape outlet at end of discharge line. 5)Install discharge line as shown. 6)Install SoakAway as indicated in drawing. 7)Install TripleSafe pump system with twin liner,1/3 hp cast iron primary AC pump and 1/2 hp cast iron AC back-up pump.Includes 3 CleanPump stands,airtight lid with airtight floor drain,and WaterWatch alarm system.DOES NOT INCLUDE UltraSump battery back-up pumping system with charging/control box with alarm,and 120 amp sealed maintenance free battery which can be added for an additional cost. 8)Install BrightWall paneling system on walls as shown on drawing. 9)Install SaniDry Sedona with SaniDry Stand to keep humidity low. Contractor Will 1.)Pull necessary permits and schedule necessary inspections.An administration fee of$250 and permit fees will be billed to customer separately. Ds Customer Will o` 1.)Provide proper dedicated electrical outlets for all pumps,and other electrical devices after the completion of the installation. 2.)Move items 4 feet away from perimeter. 3.)Remove shelving/cabinets/sink/workbench. 4.)Customer understands that there may be ponding of water in discharge area under certain conditions. 5.)Complete and agfe—effgany items mentioned in this Contract under"Customer Will"and/or"Additional Notes"that apply. --Customer Initials: JVA� Ds j Additional Notes : (� Additional work may be required at added costs.Initial All jobs are subject to Production review,In the unlikely event a job is not approved,the job will be canceled and deposit will be returned to customer without penalty. NOTES TO CREW:Entry through first floor of home.home currently has 2 sump pumps in different corners.fill in current sump holes and remove discharge lines.best spot for discharge is out front of home into front yard.we are doing brightwall on walls of basement tied into waterguard system.Drain sedona into either wg port or directly into triplesafe.the town requires we use soakaways in the front yard as a form of a drywell system.I ran 3 SoakAways to be placed along the discharge line. DS v � Connecticut Basement Systems Inc. Job Location Page 4/7 33 Progress Ave Seymour CT 06483 52 Valley Terrace Rye Brook NY 10573 2-26-24(7) DocuSign Envelope ID:6DE37FDA-3831-44D9-8DEF-2BE8B64914BF Products WaterGuard WaterGuard Port IceGuard LawnScape Outlet 1qFi oil -CZMMM- e B►ightWali SanlDry Sedona Connecticut Basement Systems Inc. Job Location Page 5/7 33 Progress Ave Seymour CT 06483 52 Valley Terrace Rye Brook NY 10573 2-26-24(7) DocuSign Envelope ID:6DE37FDA-3831-44D9-8DEF-2BE8B64914BF Limited Warranty The warranty is considered in effect when job is completed and paid in full. If water from the walls or floor wall joint passes through the perimeter water control system and onto the basement floor,we will provide the additional labor and materials to fix the leak at no additional charge to the homeowner.This warranty applies to WaterGuard and Two Stage systems,along with the specific areas where the system is installed.Said warranty will be in effect for the lifetime of the structure.This warranty may be transferred to future homeowners provided we are notified within 30 days of the real estate transfer. The water control system shall not rust,rot,or corrode for as long as you own the home. If the entire perimeter of the basement was not treated,then additional work at an additional charge to the customer could be necessary to extend the system or treat other areas or other problems not addressed by this work.Pump or power failure may be possible, therefore this warranty is not a guarantee of a dry basement,as the scope of this work cannot guarantee that in all circumstances This warranty shall not apply to:condensation,or any system that has been altered in any way,water vapor transmission,concrete discoloration from capillary action,water squirting out of the walls over the system,window well flooding,plumbing leaks,surface water flooding,leaks from chimneys or garages,or efflorescence(white powder)on concrete.Contractor cannot be responsible for peeling paint,water that has been pumped from the house,dust created from installation,damage to hidden fuel lines or plumbing,or frozen discharge lines without an IceGuard.A DryTrak system alone will not eliminate seepage from floor cracks.Floor cracks are warranted against leakage with full perimeter WaterGuard or full perimeter Two Stage systems. Primary AC operated sump pumps are covered under a separate manufacturer's warranty which is 36 months from date of installation. DC operated back-up pumps are covered under a separate manufacturer's warranty which is 36 months from date of installation.Failure of any pump for any reason is outside the scope of this warranty.Back-up pumps that run off a battery,if not maintained,or that are called on to run beyond the current life of the battery,can fail.These systems are very much recommended but cannot be relied upon to work in every situation.Annual maintenance is recommended to find potential problems,but not required for this warranty to be in effect.Electrical work is not included in the contract and problems from electrical connections or lack thereof are disclaimed. Drainage systems clogging or malfunctioning from iron ochre,iron gel,or iron bacteria from the soil are rare,the contractor cannot be responsible for these situations,and that system will require cleaning,flushing,or other service as necessary to keep it functioning for that particular situation. A CleanSpace crawl space encapsulation system will isolate the home from the earth.The humidity level in the air will be lowered, reducing moisture needed for mold growth,however the encapsulation system does not claim to be a mold mitigation system.Wet crawl spaces require a drainage system,and a SmartSump system to remedy the problem with water below the CleanSpace liner.CleanSpace has a transferable 25-year warranty—there will be no charge for service calls on any tears or holes in the CleanSpace liner,in the unlikely event this occurs.Sump pumps are covered under a separate manufacturer warranty.Installation of the system does not include extending discharge lines,or electrical work unless specified.Contractor is not responsible for frozen discharge lines without an IceGuard,water once it is pumped from house,or condensation. THIS WARRANTY DOES NOT COVER,AND THE CONTRACTOR SPECIFICALLY DISCLAIMS LIABILITY FOR WATER DAMAGE TO FLOOR COVERINGS,FURNITURE,STORED ITEMS,FINISHED WALLS,AND OTHER OBJECTS INSIDE THE FOUNDATION.Contractor will not be responsible for any damages caused by mold;to include,but not be limited to,property damage,personal injury,loss of income, emotional distress,death,loss of use,loss of value,any adverse health effects,or any other effects.Homeowner agrees to keep area dry and report all other obligations on contractor's part.There are no other warranties verbal or written. Items For Which Customer Is Responsible-Customer is responsible for: 1)making full payment to the crew leader upon substantial completion of the work; We accept all standard forms of payments-Cash,Check and ACH. As a convenience we also accept credit cards with a 3%convenience fee. 2)preparing the work area for installation;3)any finish carpentry,painting,paneling,landscaping,etc.that may be necessary after Contractor's work is finished;4)marking any private lines such as satellite cables,propane lines,sprinkler system lines,etc.;and 5)any items mentioned in this Contract under"Customer Will"or"Additional Notes." FlexiSpan Wall cracks repaired with FlexiSpan are warranted against leakage for 10 years. Connecticut Basement Systems Inc. Job Location Page 6/7 33 Progress Ave Seymour CT 06483 52 Valley Terrace Rye Brook NY 10573 2-26-24(7) DocuSign Envelope ID:6DE37FDA-3831-44D9-8DEF-2BE8B64914BF Notice of Right to Cancel You are entering into a contract.If that contract is a result of,or in connection with a salesman's direct contact with,or call to you at your residence without your soliciting the contract or call,then you have a legal right to void the contract or sale by notifying us within three business days from whichever of the following events occurs last: 1.The date of the transaction,which is: 3/6/2024 12:o8 PM PST 2.The date you received this notice of cancellation. How to Cancel If you decide to cancel this transaction,you may do so by notifying us in writing at: Connecticut Basement Systems Inc. TF(800)541-0487 F (203)463-9339 connecticutbasementsystems.com 33 Progress Ave Seymour,CT 06483 You may use any written statement that is signed and dated by you and states your intentions to cancel,or you may use this notice by dating and signing below.Keep one copy of the notice because it contains important information about your rights. I wish to cancel. Owner's Signature Date Owner's Signature Date The undersigned acknowledges receipt of the two copies of the Notice of Right to Cancel. D SbA443 y: 3/6/2024 1 12:48 PM PST Owner's Signature Date Owner's Signature Date Connecticut Basement Systems Inc. Job Location Page 7/7 33 Progress Ave Seymour CT 06483 52 Valley Terrace Rye Brook NY 10573 2-26-24(7) .Building Permit Check List&Zoning Analysis C ( r Address: VC,A I SBL: Zone: U e 2NO Unst.Typo Other: Submittal Date: a 2 Revisions Submittal Dams: Applicant:Applican Nature of Work ' \ ^ � Y l Reviews:ZBA; MAY 0 8 2024 Pa: BOT• Other: NEED OK 2 (� (.-)"FEES.Filing \. P• C/O: Flood Plant Legalization: ( ) (0�, APP: Dated: Notarized.- rSBL• rrnm 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. ( ) ( ) �URVEY:Dated: Current: Archival Sealed Unacceptable: ( ) (, LANS:Date,Sukmped. Sealed Cop Electronic Other. ( ) ( License ✓ Workers Comp: �Lubility. Comp.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 H.W.I.C.:_Battery:_Other. ( ) ( ) PLUMBING:Plans: Permit Nat.Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit N/A: Other. ( ) ( ) FLVA.C.: Plans: Permit N/A: Other. ( ) ( ) FUEL TANK Plans: PermiC Fuel Type: Other: ( ) ( ) 2020 NY State ECCC N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign offLetter: As-Built Plans: Other. ( ) ( ) BP DENIAL L.ETI-ER C/O DENIAL LETTER Other: ( ) ( ) Other. ( _ZB mrg.due: approval:- notes: ( )ZBA mtg.date approval• notes: ( )PB mtg.date approval;- notes: REQCnRED ExisnNG PROPOSED c OMS APPROVED Areas, Mny n 2024 Circle Fr° c Frc Front: Sides: Rear. Main Cov Accs.Cov. Fc H Sb: Sd.H Sb: QFA Tom: Ft.imp: pmkw. Height/Sto. notes: ' O 1/�L//�'� .• t • d .. �t 1/ {4�) •• t` II � •1t 4t) y 4ptt`:' ♦• �L • t� .. iT� r ]tpt!'i » Pt, • / ` � ��36••,:..Ib)'/dill ,�i I�i'��ill ���'�1�f�.., y��10111,,.t�l� ���y!11'�11�1+'Nl���l�fi��bi'I�i 1 1��1�' ,1'10101'Ir i�l����if 'Ip�i)Pi'�''.����_ V` � 4 = 0 cc CD i > a; R = c c � ...'";4. R cl 10 o d U �' '• I y C� W oLLJ W t cn "� N p o» ; r• �-1 } Z to section <co)s G --• _ W cn U y ECO ry PIN W ¢ o G� 111 W y L o a rA a M j CZ } W y o '•.r. 7•r Fy i�l Z •y. .•.. '.t in y� ju •3 c cz '. cu •i Cui cc L �'+�• 1 fJ (� �• • 1[ e0 t0 • : L ' cam'� � � O = � > �_• i .wr. .r <i>•)> � All�.;1j 1�--: _ 3.. .1t 11.s 4 :;•rsii 11 1 - 1j 11\....�'kg"'3.r' •-r�m�^�:-:_s- ' „��. .a•SL il'1+1'//111 _:A 1'1,1,11 .�. 1,�,11 4 illll/l'lll, �I;I,jl�l��•:..f. r •�1�1'/'/,1�1� '� - '�w '0�.` +t hillt... lift" E. .. w... �t+►iA��r� � .. r`���,;.v .. ��►�;��►��:;,....��,�+►►A�ir� ' y l r1'4''� a .'Gf 1Fi 1T..� Qt�{��� .IIt•, �'� �"� '..� O O ryv+rk� /� :0 f� Nr\ -Nr ire• �'.:� .�VJ •5 ./�\ ' '' ... •w�,ti. i��.�'�� ..•• ACO CERTIFICATE OF LIABILITY INSURANCE DATE(MWODNYYY) 51=024 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 poilcy(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 endorsemsn ai, PRODUCEIR Arthur J.Gallagher Risk Management Services,LLC PN of CONTACT_ Fox FAx 30 Century Hill Drive -516-556 3113 :A',—.;518-869-3580 Suite 200 E-NAIL OR Liz Fox a .com _ Latham NY 12110 INSURER S AFFORDINGCCVERAGE NAICs wsURERA:Wesco Insurance Company 25011 INSURED INSURER is:Travelers Property Casualty Co of America 25674 Connecticut Basement Systems,Inc.33 Progress Ave INsuRERc:CorePointe Insurance Company 10499 Seymour,CT 06483 INSURERD:Milford Casualty Insurance Company 26662 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:203622T326 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 10 ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIL)CLAIMS. LTR 7YP6 OF INSURANCE SDeR POLICY EFF POLICY EXP WvD POLICY NUI6ER MIDDIYYYYI (MMIDorfym LIMITS A X COMMERClALGENERALLAMLITY WPPI91228803 5/12024 5I12025 EACH OCCURRENCE _ $1.000000 CLAIMS-MADE 1-wi OCCUR PREMISES(Fa aoalnen e s 300,OOD X PO Ded$1,000 MED EXP Wy oneperson) $10,000 X CDntraftal Limb PERSONAL d ADV IWURY S1,000,000 GENI.A GREGAATT�ELIMITAPPLIESPER: GENERAL AGGREGATE s2,000,C00 �� POLICY I--I JECaT LOO PRODUCTS-COMP/OP AGG $2.000,000 OTHER: S A AUTOMOBILE LIABILITY WPPISS551303 5/1/2024 5/1/2025 iEaaceideI SINGLE LNIT S1,000,000 Ix AUTO _ BODILY INJURY(Per person) s OWNEAUTOS AU`rOSSCHED EDBODILY INJURY(Per a¢Ident) S AUTOS ONLY AUT09HIRED X NOWOWNED PROPERTY DAMAGE AUTDS ONLY AUTOS ONLY 'dent ; s A X LUORELLALIAS X OCCUR WUM204ON700 5/112024 5112025 EACH OCCURRENCE S5,DO0,000 EXCESS LIAR CLAIMS-_MADE AGGREGATE s5,000,000 DED I X RETENTION3 in aW $ C WORKERS COMPENSATION OPWI002471 5J12024 512025 X ER D AND EMPLOYE LIABILITY YIN MWC1036M 5/12024 5 RS 112n25 OTH ST MUTE ANYPROPRIETORIPARTNEP/FJ(ECUTIVE O NrA E.L EACH ACCIGNT 51,000.000 Orno[R/MEwERexcLUOED7 (M.ndau+y in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 if yes,dascdbe under DESCRIPTION OF OPERATIONS bolas E.L.DISEASE-POLICY LBdIT S 1,000,000 B LeasedfRenled Equipment QT63D2T247171TIL24 5/12024 5/12025 3100,000 Special Form DESCRIPTION OF OPERATIONS I LOCATIONS I VENICLES(ACORD 101,Additional Remarks Schedule,may be attadbed itmore space is required) RE:Job Location:52 Valley Terrace Rye Brook,NY 10573.The Village of Rye Brook is added to the General Liability as an Additional Insured if required by written contract.. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DFSCRIBED POLICIES BE CANCELLED BEFORE The Village of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 938 King Street ACCORDANCE WrTH THE POLICY PROVISIONS. Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD NEW Workers' Certificate of Attestation of Exemption YORK STATE Compensation from New York State Workers' Compensation and/or Board Disability and Paid Family Leave Benefits Insurance Coverage "Thu form cannot be used to waive the workers'compensation rights or obligations of'any party." The applicant may use this Certificate of Attestation of Exemption ONLY to show a government entity that New York State specific workers'compensation and/or disability and paid family leave benefits insurance is not required. The applicant may NOT use this form to show another business or that business's insurance carrier that such insurance is not required. Please provide this form to the government entity from which you are requesting a permit,license or contract. This Certificate will not be accepted by government officials one year after the date printed on the form. In the Application of Business Applying For: (Legal Entity Name and Address): Building Permit Connecticut Basement Systems Inc. 33 Progress Ave From:Village of Rye Brook Seymour,CT 06483 PHONE:800-541-0487 FEIN:XXXXX0272 The location of where work will be performed is 52 Valley Terrace,Rye Brook,NY 10573. Estimated dates necessary to complete work associated with the building permit are from May 30,2024 to June 30,2024. The estimated dollar amount of project is $10,001-$25,000 Workers'Compensation Exemption Statement: The applicant is NOT applying for a workers'compensation certificate of attestation of exemption and will show a separate certificate of NYS workers'compensation insurance coverage. Disability and Paid Family Leave Benefits Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE STATUTORY DISABILITY AND PAID FAMILY LEAVE BENEFITS INSURANCE COVERAGE for the following reason: The business MUST be either: 1) owned by one individual; OR 2) is a partnership(including LLC, LLP,PLLP,RLLP,or LP)under the laws of New York State and is not a corporation; OR 3) is a one or two person owned corporation,with those individuals owning all of the stock and holding all offices of the corporation(in a two person owned corporation each individual must be an officer and own at least one share of stock); OR 4) is a business with no NYS location. In addition,the business does not require disability and paid family leave benefits coverage at this time since it has not employed one or more individuals on at least 30 days in any calendar year in New York State. (Independent contractors are not considered to be employees under the Disability and Paid Family Leave Benefits Law.) I,Lawrence M.Janesky,am the President with the above-named legal entity. I affirm that due to my position with the above-named business I have the knowledge,information and authority to make this Certificate of Attestation of Exemption. I hereby affirm that the statements made herein are true,that I have not made any materially false statements and 1 make this Certificate of Attestation of Exemption under the penalties of perjury. I further affirm that I understand that any false statement,representation or concealment will subject me to felony criminal prosecution,including jail and civil liability in accordance with the Workers'Compensation Law and all other New York State laws. By submitting this Certificate of Attestation of Exemption to the government entity listed above I also hereby affirm that if circumstances change so that workers'compensation insurance and/or disability and paid family leave benefits coverage is required,the above-named legal entity will immediately acquire appropriate New York State specific workers' compensation insurance and/or disabilitl and paid family leave benefits coverage and also immediately furnish proof of that coverage on forms approved by the Chair of the Workers'Compensaa Board to the government entity listed above. SIGN HERE Signature: 1 Date: j i j Z Exemption Certificate Number Received 2024-033122 May 1, 2024 � NYS Workers' Compensation Board\ CE-200 01/2018 Job Details Rry P LA MAY - 9 2025 DAT QrL BUILDIN D E F A B ways 5 feet apart along U C " 30 Feet Front of Home TS ` O Typeof Wall .................................................................................................................................. Poured Concrete ExistingWall Finish ......................................................................................................................................... Plain ExistingFloor Finish ............................... ..._.......... .. .... ... ..... .... ...... ............................................... Concrete Discharge line length away from house ... ..... .... ........................... .. _............ ..................................................... 30 Connecticut Basement Systems Inc. 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