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HomeMy WebLinkAboutBP24-105PERMIT # ti/ SECTION TYPE OF WORK !08 LOCATION OWNER ���/ � a� �. �g � _� LOT � / O �NSPEGTION REGOB� 1 DATE I NSP FOOTING FOUNDATION FRAMING L-14" 201�( �(�� �' - RGH FRAMING INSULATION � b. Lo Z PLUMBING RGH PLU11gBING oZ GAs p � �3� � 3 _ z0 �1 • .� "s/ •� f, SPRINKLER � � ELECTRIC � LOW -VOLT � ---- v ALARM _.,---�- AS BUILT � � OLD �4��' FINAL ®� L`� P� �9�y���� �30� '�Y) 5�-y7- ��sa �P � s _ ��i��y� P ,�� �' OTHER APPROVALS VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK No : 25- 143 Certificate of ®ccupaurp 'This is to certify thatu��as of, having duly filed an application on Axne— 20 5 requesting a Certificate of Occupancy for the premises known as, LJ.Ta -TO Ico +�- '�oo+d , Rye Brook,NY, located in a �" Zoning District and shown on the most current Tax Map as Section: 135,50 Block: __I_ Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No.-J Li , issued )oqCl% _20 c w-f 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: /�" 101f- J/ Construction: for the following purposes: 1 1-7 1,r 10 re! I V yo V k7 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 19. I shall b ad r7%all the building be moved from one location to another until a permit to accomplish such change as be obt ned om the Building Inspector. Building Inspector,Village of Rye Brook: Date: NOV 1 2 2025 D E C E � V ED BUILDIIV��ll���'A�2TMENT For office use only: JUN - 4 2025 VILL'Aa OF RYE BROOK PR-MIT SUUEED#�Y S f,�i 9 8 KING STREti�� }i/RvE BROOK,{'*W YORK 10573 DATE: -- VILLAGE OF RYE BROOK g 4a 93. 0661'-3, FEE: �jo'7 PAID1112r< BUILDING DEPARTNIIENT wK�a' itg1 fit 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 Address: ( rsrswssrrtr+wrrtsrtwrrsrtsrtrtrrrtrrrttssrrtttrrtsrrr+rsrssssrrs++r+ssrts+srssssrrtrrsrtrtstsrsrsssr+ssssss+rsstrrrtrssrrtstssrrrttsr u� Occupancy/Use:Z4 10G/►44i �-3 Parcel ID#: I3� • " I ` �D Zone: Owner: -j-3v,01-t C'CyV24 Address: �j Co>r r A(Y P.E./R.A. or Contractor:30504 &A-46 AO, I'15<ddress: 694__ RU64J dplVc- Ndw Person in responsible charge:S0166% 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: 0 O V(riAl CDr4/QA4 being duly swom,deposes and says that he/she resides at H)' -;Cow-' Ro (Print Name of A��licant) �e (Na and Street) in L ooli ,in the County of v"L/1 1 C-MvJ I lJN in the State of that (CitN,Tovvni Villagc) 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:S 1) 0 000, for the construction or alteration of: :LKY I&LCA 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. Swornto before me this Sworn to before me this day �^'�/ 20� day of 20 gnaatture of Irroperty Owner Signature of Applicant V Pri �ae of Property 'ner Print Name of Applicant Not Public Notary Public JUtM CAMPMML Notary Pubk,State o1 New York I_r2r No.01CAS073100 CuMBed in Westchester Oounyr Commission Expires Feb.18,2027 � E BR(��• o tim BUILDING DEPARTMENT Zss '"ING INSPECTOR ItiTANr BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑C:ODE 1?NFORCEMENT()rrICER 938 King Street • Rye Brook, NY 10573 (914)939-0668 FAx (914) 939-5801 www.rycbrook.org - - - - - - - . _ _ - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDREss : 2 ►-d.xC'ou � 1)At'L':_/ _ ! — 20ZS PI4RMIT# O-S. ...... ISSUED: S'=21-Z/SECI': 1.3S-a . BLOCK:_ LOT•_0 'J — OCCUPANCY: ❑ Violation Noted THE' WORK IS... PASSED ❑ FAILED / REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ TOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPF.cn0N: ❑ ROUGii PLUMBING ❑ 1ZOUGII FRAMING ❑ INSULATION / ❑ Natural Gas 1N0R.LL C#m Qj-c� O• /Lu eS4, 0 L.P.Gus ❑ UUEL TANK ❑ DIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION O-TINA1. ❑ OTHER _ QyE BRC�k cu � 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR O 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 : DATE: PERMIT# ISSUED: SECT: BLOCK: LOT: /J LOCATION: 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 ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ` ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER �yE BRC�uk cu � 1932 BUILDING DEPARTMENT ❑BUILDING INSPECTOR ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAX (914) 939-5801 www.ryebrook.org - - - - - - - - - - - — - - — - - - - — INSPECTION REPORT — — - - - - - - - - - - - - - - - - - - ADDRESS : y Z DATE: _ t; J Z y PERMIT# \ 7 Ll e 0 ISSUED: SECT: BLOCK: LOT: �) LOCATION: Yy�l�sz V' OCCUPANCY: i ❑ VIOLATION NOTED THE WORK IS... QT ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER �yE BRC�k• p'c Zm BUILDING DEPARTMENT ❑�BUILDING INSPECTOR E,ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET . RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : 1 ��` L `C � .. i DATE: '�, �.� C ✓ r PERMIT# \ ` 1+ '.01-s ISSUED: I Z 9-Z SECT:�_liS� S� BLOCK: LOT: /J LOCATION: �� g ice- 1s 1t �rlu� 1 C�l!h9 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 ❑ NATURAL GAS ❑ L.P. GAS C� ❑ FUEL TANK❑ FIRE SPRINKLER �4400�1` ❑ FINAL PLUMBING ❑ CROSS CONNECTION l ❑ FINAL E f C 0 ❑ OTHER _ I �yE BRC��, O�` tim cu � 1932 BUILDING DEPARTMENT ❑BUILDING INSPECTOR p ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS :— 1 1 A� CO DATE: L / PERMIT# z 4 ISSUED:—`-I SECT: 8j . 3y BLOCK: LOT: /J LOCATION: Iy 'J�\ jA - U, ) ''\ 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 ❑ NATURAL GAS �7J> ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION t ❑ FINAL ❑ OTHER QyE BR(��, cu � 1932 BUILDING DEPARTMENT 9ILDING 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 : �A _ Oln(,`. DATE: PERMIT# Z 1 - 0 8 ISSUED: SECT: BLOCK: LOT: IO LOCATION: /\ `.� u�Ei. 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 ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER PAS, QyE BRC��. 1. cu � 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 : q C ' DATE: f/ PERMIT# 0 �� ISSUED: 19 z` SECT:/31 �-0 BLOCK: LOT: LOCATION: �l� �/� Q�� d l- XJ /J�r�h L-V"�CCUPANCY: ❑ 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 ❑ NATURAL GAS y" ❑ L.P. GAS ❑ FUEL TANK J ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER �yE BRC�k. '9a2 BUILDING DEPARTMENT ❑BUILDING INSPECTOR _ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK, NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.org - - - - - - - -- - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : ! TA k L C(� DATE' Z PERMIT# -�P 2- l - C) 9 3 ISSUED: _SECT: /3.5 BLOCK: LOT: �U LOCATION: ?Q�.Q � 9I0l> 51 �'t 0."7 (;4-1 tLALX�. OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: Z ROUGH PLUMBING ❑ ROUGH FRAMING P [IINSULATION n ❑ NATURAL GAS ro ci ❑ L.P. GAS 9� ❑ FUEL TANK OA Gu ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER _ x s x Ln ° a � O = Qr v N N N G. M Ln w Ln 41, a ( 1 L9 I1 O -0 v Ln to M r-+ �P-4 g a u � ' z O A T�.{ (U ,Q = F.ln, j z y z O W as o E a,Cr, ccn j. o ►7" CC)I V = Iv p LO W \ a+ u FBI aa Ln ea Q V W � � qU �, ° � � U � OF) a W ci ON O H cn CN 00 I� CNvo z 0 O G/? m v v u I� V F ZO z A z o W � d .•�- � •• p., 04 u s BUILD MENT Q [�C E WE VIOL E OF RY� OOK 938 KING ET RYE BRO, 'NY 10573 OCT 2 6 2023 VILLAGE OF RYE BROOK BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Approval Date: NOV R Q 1.0-23 'fFfflu4 c e_1 ZQ�_Application Fee: Approval Signature: Permit Fees:$ tJ� Disapproved: Other: Application dated: l0&Izov---3, is hereby made to the Building Inspector of the V i I lage 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: 'H 2— '_r 1L C42T_l 1 1? SBL: �i .Jed ��Zone: '��- 2. Proposed Improvement.(Describe in detail):I N'rtD(LAU �OV# ]S N S �() tSl l" �411S►��R� 2UONL eyv"046 f it ►Prt(L 70 t �SZ 1`� W FT AND rnar ACC WITH t�►/1C__5-1 t12� 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 11: TIER III: 4. Will the proposed project require the installation of anew,or an extension/modification to an existin}automatic fire suppression system(Fire Sprinkler,ANSL System, FM-200 System,Type I Flood,etc...) :No: 1 Yes: l'y es,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: ll 1;AM 1Ld After Construction: P'611A l L-4 6. N.Y State Construction Classification: V N.Y.State Use Classification: I�- 7, Property Owner Jlh `'� nnM Address:TZ k Phone#�114 `41� `� 3b � Cell A�`[ ' 1� �� 5 01 email: t? �eC G Q. L�l''R 8. Applicant: + a6 Co Add-ress:4 Z- J lr.0 A 0 t d Phone#° N -H 11 -7_ _Cell#�14 ' 11 -y 1t _5 0 email: 0 E) lbe-,L 0VI C L . (0 m, 9. Architect:'IOSL': * G111a\:U'm _Address:&q 194)CIac> NOW Phone#!M' go 4l- 11 S 7 Cell# email: NYa r G4► ^'lAlt. cc'r�t 10. Engineer: 14 /n _Address: Phone# `_ Cell# email: ff�� AA,,,�, 11. General Contractor: 1). e S' 1 Address:`T4�2 OFO 1 /`f�a / f�X7�'N � /t� Phone# �/�'�'7 '' �� P /yar11f4 A1$11A__ email: 12. Estimated cost of construction $ 4 J (NOTE:The estimated cost shall include all labor,material,scatTolding,fixed equipment,professional fees,and material and labor Mich may be donated gratis.) 13. Job Timetable: Start:_lAcu Finish: Qr (l} 6/l/2023 BUILD.t: ; -. ARTMENT D [E C I E V E V1LC F OT OF RN 1' 4 OOK 938 KING ET RvE 13w)(IT4, NY 10573 OCT Z d4 939-0668 V lehr t'�r VILLAGE OF RYE BROOK 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: I, 0Q%(r LAi `- 0 RAC residing at, )R�-Go j i � ,� C /r`( i Print name) (Address where you lip e) 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; jx�c� & , 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 fiirther 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. coemm i l'ri+,i\,rntC i�1 iTl ctp.rty(7�cnc r(.1} Sworn to before me this day of 0 cl, 7201) (Nu'al-7 PXTR 1C►A X RM PATRICIA A.RM NotaryPUNIC,S14 ,110 of NoWti6fk Net xy P161, S1A1,1 o+Nvw lfxk No.01 R14662024 ouareda� Camrniss�on X I?!'_1121 This form must be properly completed&notarized by the Design Professional of record and the Property Owner. Failure to provide this completed form with your permit application will delay the permitting pros(s V IE D OCT 2 6 2023 Notice of Utilization of Truss Type, Pre-Engineered Woo or Timber Frame Construction. (Title 19 Part 1264&. 1265 YGE OF RYE BROOK WDING DEPARTMENT To: The Building Inspector of the Village of Rye Brook. From: Subject Property:_g2 —TAl K_a-TT SBL:1-55, 60- ` VD Zone: Please take notice that the subject; ❑ One or Two Family; ❑ Commercial, ❑ New Structure ❑ Addition to an Existing Structure rehabilitation to an Existing Structure to be constructed or performedat the subject property will utilize;// Truss Type Construction(TT)l 54'f0Jd6 fpwof G) ❑ Pre-Engineered Wood Construction(PW) ❑ Timber Construction(TC) in the following location(s); ''Floor Framing,including Girders&Beams(F) ❑ Roof Framing(R) ❑ Floor Framing and Roof Framing(FR) Please note that prior to the issuance of the Certificate of Occupancy, the subject dwelling or building utilizing truss type, pre-engineered wood, or timber construction must be posted with a Truss Identification Sign, installed in conformance with NYCRR §1264 for Commercial Buildings, and NYCRR§1265 for One& Two Family Dwellings. Sworn to before me this 2 G Swo ltoe=t s so day of C c 20 da of 202,3 Signature of Property Owner r art. of Design o essional 0 o gq'dw o Print N f Properly Offer Print Nam of Desig rof I �i/ Not Public Notary lic PATRICIA A.Rm N 5fW r'ubliC,state of New lbi k No.011214662024 WR ICIA A.RM Ounrfied in We t cou Rotary Rublic,State of New%rk Camission Fxpiros No.OIR14662024 Qualified in Westchestu gun CO Mnission z; 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: O being duly sworn, deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further st tes that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the —___0 ! 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 110 Sworn to before me this day of , 20)-3 day of , 20-3 Signature of Properly Owner Signa re of Applicant DID Print Na rcperty Oa ner Print Name of Ap licanl NOta ublic Notary Public PATRICIA A.RM Notary Public,State of NewWk PARR ICIA k RM No.01 R 14%2024 Nobvy Pubrrc,Stale of New York ouarrfied in Westch Co my No.01R14662024 Commisston Expires J 1 OuarAed in Westchester Commmsron � 1 (4) I n'1 r N , N ~ N N W w No � o o a u W H o a a V w tn y ; W r a y ° v � x ' M ~ z a' Vn CO E'� •�i M W Z ,� 0 g H O O s z o 0 A N W qqt 1-1 t :J00 a O a = z z �"' w � C � V c � F. s � p • �i W � � w A � � z � � • � ° o ° • C� w � p w w a F-� rn o Z \ x W W z WCN ►� oo Z w W z = � fin) 1-� 2 z a � CY a Ono � w Q W o qrt z Q , W Acn 0 z a 08 V W. ` O z W a W H o off v W a N z w '" z A p � a z w Q o � F a 0 U CAW r �I a, z EBUILDINGODEPA:RTMENT C� D BUILDING DEPARTMENT VILLAGE OF RYE BROOK JUN - 5 938 KING STRLE'I'RYE;BROOK,NY 10573 (914)939-0668 GE F RYOOK www.ryebrookny.gov ELECTRICAL PERMIT APPLICATION Westchester County Masher Electricians License Required J FOR OFFICE USE ONLY BP#:,�p / —" / EP#: Approval Date: Permit Fee: S Approval Signature: Other: 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, b is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove electrical equipment, wiring, fixtures,or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. p 1.Address: 2 JD°&C 0 Tr 1=�+ / SBL:�3J' -0 �— Zone:_/`—I 1�1`- 2.Property Owner: I)OU G LA-5 C DrJ R Address: Phone#: Cell;: 9 14 '4 1 7-1 3 oI email: p 3.Master Electrician/Licensed Installer: 6 - P If 0-1 0 Address: l Prf—S-1 13SZ I RoP�3 Lic.#:Lt q 9 Phone#: 9 ICI '(610-5 4 bOCell #:g I L4 160,9 q CO email: P-1—Ot-TY e A 0 L- (2 Company Name: Jqrbjnt0.1 C- - V�(10 , Address: L I I C ED Pd- ST• 0J 9W kki 4.Proposed Electrical Work/Fixture Count: 12 e)'J OVfl fl bfJ o E- I rJ 1�I M 5 Pfl c- t'�Afii(-QQM S l'�71'(�L �+ 1,►Q I tJ OM 5.3`d Party Electrical Inspection Agency: JV•11 S 1 IJ C'. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant) state that(s)he is the for the legal owner and is duly authorized to make and file this application. (Master Electrician/Licensed Installer) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances,and regulations. Sworn to before me this Sworn to be re me this day of 20 day of ,20 1. Signature of Property Owner Signature of Applic t AV Print Name of Property Owner Pr me of Applicant S AR Notary Public Notary FNIt WP0I%f New YorK No.01ME6160063 Qualified in Westchester County 6/v2024 Commission Expires January 29,20ZI STATE WIDE INSPECTION SERVICES, INC.! Service Willi 1wegrily 0•0 • • SWIS JOB APPLICATION0. • Office Use Elect. Permit# C/o,) / a Date V J L Bldg Permit# /�1 y, Sq Ft Plumbing Permit# v Final Certificate # City/Village R-I c f Q uor T- Zip t1 Building Dept. County Address qZ yl Lc DI" Cross Street Section Block Lot Owner Name/Add+r7es�s fir different than above) '1O, 1 G l Ae 3 �Q I� 1 ! h Contact Number 4� i y _ ❑Basement ❑ 1st FI. ❑2nd FI. ❑3rd Fl. ❑More Than 3 FI. '❑Garage ❑Attic ❑Outside residential 1 ❑commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/0 Detector Hood Trash Compact Amt Amps t 0 Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer switch SERVICE Amperage #Panels 1P 3P # Meters # Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair ❑Overhead ❑ Upgrade ❑ Disconnect Utility ID# ❑Con Ed ❑ NYSEG ❑Central Hudson ❑ Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect )unction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation �toovA-nori o Sp�cE � , ��� �-► i� �oa�5, "L A LI U ► n) �-�01v) R' JUN - 5 2024 DD VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,if at anytime of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other inspection company.The applicant, owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Email Address TOPS 7 -S Q,Ao (,. (-O Name A TVfl� Q Q L I vJ License# { -! Date Signature Address ' L I u p p„ �� City/State �0�� Zip Code aC,�.� Company t 7 r`v I k t Q Phone# I LI 6 0-'�q co D [E C IEN IE State Wide Inspection Services 1080 Main Street MAY 15 20253D Fishkill, NY 12524 � W a -- 845 202-7224 Phone i VILLAGE OF RYE BROOK 914-219-1062 Fax STATE WIDE INSPECTION SERVICES I Email: office@swisny.com BUILDING DEPARTA.1ENT Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Anthony E. Pircio,Jr. Douglas Conrad 111 Cedar Street Judith Fried Conrad New Rochelle, NY 10801 42 Talcott Road Rye Brook, NY 10573 Located at:42 Talcott Road, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP24-122 135.50 11 1 10 J Certificate Number: 2024-3853 Building Permit Number: BP24-105 A visual inspection of the electrical system was conducted at the Residential occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at:42 Talcott Road, Rye Brook, NY 10573 The Basement Other:Subpanel area, First Floor : 3 Bedroom(s), 1 Bathroom(s), Closet(s), Dining Room, Kitchen, Laundry Room, Master, Bathroom, Pantry, Other, First Floor Other: Hallways Second Floor : Office, Other Second Floor Other: Reading room were inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation,as set forth below,was found to be in compliance on the 5th day of May 2025. Name Quantity Rating Circuit Type Kitchen 4" LED gimbal wafer fixtures 15 Plug strips GFCI w/led combo 04 Island Receptacles 02 Wall oven 01 Hood/exhaust fan 01 Cooktop 01 Dishwasher outlet 01 Microwave outlet 01 Disposal 01 Switches 06 Name Quantity Rating Circuit Type Laundry 4' LED strip light 01 Switches 02 GFCI 04 Dryer outlet 01 30AMP 4" LED wafer fixtures 02 Dining area 9 4" LED gimbal wafer fixtures 09 8 switches 08 5 outlets 05 1 pendant 01 Living room 13 4" LED gimbal wafer fixtures 13 8 switches 08 6 outlets 06 Exterior 8 wall fixtures 08 WP GFCI 03 4" LED wafer fixtures 06 Ceiling paddle fan 01 Master bath Floor warming system 01 Fan/light/heat ceiling unit 01 Wall sconce 01 GFCI outlets 02 LED wafer fixtures 04 Switches 04 Hall bath Fan/light/heat ceiling unit 01 Wall sconce 01 GFCI 02 4" LED wafer fixtures 03 Switches 03 Master bedroom Wall sconces 02 Switches 08 Receptacles 06 4" LED gimbal wafer fixtures 15 8' LED strip light 01 4' LED strip light 01 Page 2 Name Quantity Rating Circuit Type LED wafer fixture 01 2nd floor bedroom Ceiling paddle fan 01 Receptacles 08 Switches 02 4" LED wafer fixtures 07 Small hall powder room GFCI 02 4" LED wafer fixtures 02 Exhaust fan 01 Switches 03 Wall sconce 01 Existing middle bedroom LED gimbal wafer fixtures 06 8' closet LED strip 01 Switches 02 Receptacles 05 Hallways LED gimbal wafer fixtures 05 Officer: Frank J. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. Page 3 a t 00 1 i N \ N o � W 0 00 e z 3 .L . W ` 1.�1 ' `r' "' — '" •r, chi ON M 0 GO C00 z V h+y WU c "' u z F-� w f z CN VJ h�1 zCN oo a � Liz N _ H ►••+ Z Q A C z o Lgi tN `~ z V � V W z a 440 W z w A a °LA 05 1444444444 :.� EC ENE BUILDING DEPARTMENT VILLAGE OF RYE BROOK SEP 17 2025 938 KING STREET RYE BROOK,NY 10573 � OffB VILLAGE OF RYE BROOK wbKi Sftjg#nv.gov BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Mast e Electricians/License Required FOR OFFICE USE O LY BP#: �-I' — I aL} EP#: 5 Approval Date: ` A Permit Fee: $ Approval Signature: Other: ************************************************************************************************** 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 -LaTis hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and r remove electrical equipment,wiring, fixtures,or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: �Z 1 q It COTT r_u l.'SBL: 1 J•5 �10 Zone: �'�2 2.Property Owner: pout cots Address: 41 TPjLCbT Phone#: Cell#: email: 3.Master Electrician/Licensed(Installer: Address: Lic.#: W1 Phone#:-1 1,14-1 0 -V-Well #: email: P� p��-. Company Name: PS 1�►1 t t_J`i e • P } k(d W-Address:ZLIt- M N IQ S s !-OCVt f t T 4.Proposed Electrical Work/Fixture Count: SM4K-cs Q ET�`_L yg DC 3 C0� SWt o����`1tiZ`TD 1�S 5.31 Party Electrical Inspection Agency: Su�� S y l N C_ STATE OF NEW �Y/1O,RK,COUNTY OF WESTCHESTER ) as: �t / W StI) O01 p • i"L1L.l I O JA being duly swom,deposes and states that he/she is the applicant above named,and does further (print name of indivi signing Tdual si nin a[s�h� l icant) state that(s)he is the for the legal owner and is duly authorized to make and file this application. (Master Electrician/Licensed Installer) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances,and regulations.1 Sworn to before me this Sworn to before me this __1 day of 20 If } ,20 Signature of Property Owner Signature of Appli ant ktglib� I& - ki l o Print Name of Property Owner P ame of Applicant ,- '� V"� Notary Public Notary Notary Public,State of New York No.01ME6160063 6/1/2024 Qualified In Westchester County commission Expires January 29,20L STATE WIDE INSPECTION SERVICES, INC. Service It i1h Inlegri1v 0•• • • SWIS • ; APPLICATION tel 845.202.7224 1 fax 914.219.1062 • Office Use Elect. Permit# 6 Date 17 I 101 Bldg Permit# _ !0 i —';_ C_ Sq Ft Plumbing Permit# Final Certificate# City/Villages( W \ Zip Building Dept. County , l (}�m Address Z1-h L C M F R Cross Street Section Block Lot Owner Name/Address(If different than above) )oU( V►j f " Contact Number ❑Basement ❑1st Fl. a2nd Fl. ❑3rd A. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/0 Detector Hood Trash Compact Amt Amps r Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels 1P 3P # Meters # Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair ❑Overhead ❑ Upgrade ❑ Disconnect Utility ID# ❑Con Ed ❑ NYSEG ❑Central Hudson ❑ Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect ]unction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation M u i C01 UC-,-Q C 14 5 1-f'L•-P i K r TC tt 1'�J o IE�'CEoW[E [SEP 17 2025 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,if at any time of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other inspection company.The applicant, owner or authorized agent agrees to all the above terms and conditions as set forth for the application. -gyp Email Address ir, v(, .C c)el Name A")J-}'( WJ License# �q Date Signature Address � JN1 i P F( J City/State JC Z Code�CX lt Company Phone# 1(00 �(7 `C�1-f W D f� n/7(� 03State Wide Inspection Services C � �-c �/ �C 1080 Main Street Fishkill, NY 12524 To IV U A OCT - 6 2025 845 202-7224 Phone 914-219-1062 Fax STATE WIDE INSPECTION SERVICES Email: office(aswisny.com VILLAGE OF RYE BROOK Service With Integrity BUILDING DEPARTMENT Website: wWW.swisny.com BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Anthony E. Pircio,Jr. Doug Conrad 111 Cedar Street 42 Talcott Road New Rochelle, NY 10801 Rye Brook, NY 10573 Located at:42 Talcott Road, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 25-238 135.50 1 10 Certificate Number: 2025-6545 Building Permit Number: BP 24-124 A visual inspection of the electrical system was conducted at the Residential occupancy described below.The electrical system consisting of electrical devices and wiring is located in/on the premises at: 42 Talcott Road, Rye Brook, NY 10573 The Garage was inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 25th day of September 2025. Name Quantity Rating Circuit Type Smoke Detectors 03 C/O Smoke Detectors 03 Heat Detectors 01 J/crvc• EL-��� JL rF �/. officer: FrankkJJ. Farina This certificate may not be altered in any way and is validated only by the presence of a seal at the location indicated.This certificate is valid for work performed on the date of inspection only. ■ N N N � , _ \ ON W , 04 Z oLn en en ° z o F' ■ v A Q = = O • �"� C y O o N >. A4 - ` �' A Q ° a „ I c0 z can Z x = = W M..� ✓; Z M H � W Z = 00 W " W a MM� � Ce Q ° N z Z r = ■ � `" N LY Z ■ � U A 04 � R; 08 W a G CH) ■ _ 0 = a V S ►-• ■ ■ •• 04 W A W a PG -- RCE ENE BUIL DEPARTMENTJD VIL E OF RYE BROOK ISEP 18 2024 938 KIN ET RYE BROOK,NY 10573 4 68 VILLAGE OF RYE BROOK warm ,n9§[ookny.Rov BUILDING DEPARTMENT PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: — 07 PP#: -7 Approval Date: SEP 2041 , 0Permit Fee: $ Approval Signature: Disapproved: Al (fees are non-refundable) DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BI' THE BUILDING INSPECTOR. THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERRMIT IS 12% OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated, 7 f/-a 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. I.Address: Y Z —r11 fCo 7—T— SBL: (35`So/l` /yr Zone: 2.Proposed Work: 12,e I o C►4 4­--' 9 ►i S+L—_ A P 1-17--/ /i lge6 I c-keYl S1y1 K /4ht9 L 14u nd,-y lDo'�e' /'00 k%dew�e X"(! u 3.Property Owner: d Vl rZrl Address: q Z -f11e'e)7 T •2i� Phone#: �j D N Cell#:W ly- ql,?-- _Dj© ( email: (2- bee ,-,RA C40A .CeA 4.Master Plumber: ✓yl t S d r I` U Address: Lic.#:Phone#: `tt(-735-09f�/ Cell#: 9IV-yV-;�5-3/ email: �flKir/i;c�e�c�f�Su6Krbg,� PG..►i� Company Name: t'6 A✓1 P((,t VK b i nS Address: F1 h,, v Az1 `161r, itiy /0g�3 INDICATE FIXTURES&LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1 st Floor 2 2nd Floor 31 Floor 4'b Floor 51'Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -I- 6/l/2024 BUILDING DEPARTMENT D FZ (� VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 SEP 18 2024 ID (914)939-0668 www.ryebrookny.gov 1 VILLAGE OF RYE BROOK 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: p 31, D O V G LAS LOIkR/40 , residing at, �.,� '�AT�-.-��� RJ . I� B1? oK N K10_ I'ruu nam.i Wd� "„k\here ,ou live) T— 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; 1 --f A LC,O� r RA , Rye Brook,NY. 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. —Z Z� �5i�uauucofProper() Uunci�")) poUkiAt GONRM (Print Name of Property Owner(s) Sworn to before me this _1 ,�� day of SC �.w. .� , 20.2 4 (,'WL irV PLINIC) VOLKERT E.BRAREN NOTARY PUBLIC,state of New York No.01 BR-4759109 Qualified in Westchester County -3- Commission Expires 6/t/2024 U;� W YORK,COUNTY OF WESTCHESTER ) as: n if— J ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual sigiiinos 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. 44 Sworn to before methis f Sworn to fore a is / O day of ✓C Te'+^�,v ,20 2-7 day of Signature of Property Owner Signa a of licant 20 �N rf I C Print Name f Property Owners Print Name of Applicant Notary Public USAA SUGAR VOLKERT E.BRAREN Notary Public,State of New York NOTARY PUBLIC,State of New York No.OI SU4906681 No.01 BR-4759109 Qualitled In Bronx C n Qualified in Westche er County COfT1fnI3SI0n r ou ty S—�S Cotnmission Aires /�/27 es v- This application must PC pro r 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- 6/1/2024 ■ � c � oZ' N N = N IC W . Rr v� a a ►--� z v v� c z a toLn x M s. v ~ as o (n � t�0r z � ■ UO uz � a ° V _ M O Z a.~ a<O cn '� w U zz cn Z o eq d u W = w O = O N w p o cn r. gcq ►.. 0 � A a z W BUIL MENT VIL %' EOFRYE* K DW- BUILDING938 KINGT RYE B NY 1057 �� n �.or J IEFYIE PLUMBING PERMIT APPLICATI NvILL _FOR OFFICE USE ONLY BP#: �� PP#: Approval Date: 1� 7' Permit Fee: $ CR 9 f? _ Approval Signature: Disapproved: (tees are eon-refhndable) DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING FNSPECTOR.THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A URMIT IS 12% OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated, &-7 c�zl 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. Li I.Address: 12- (k -ZciQ-b SBL: 136-,5-0- CQ Zone: -7�- 2.Proposed Work: JAg 1 - �e IDS►4{-� , ts;w 0 I o/ , i �aC t 5 h&.ve r Z&t -f- fie/ ',4{e pik- S,ryr AN Afr - f-tlof`4� - U2 t-7-/+4k f iJI�S/�/t E 3.Property Owner: I cz.3 Address: q Z -r ALCc T F IZ � Phone# t - 156)f Cell#• q 17 4.Master Plumber. C 14 Q 1(h j U•e- 6?C t p Address: ' Lic.#: 2?T:�/ Phone#: 9 l q- 73 Y'A�e11#: 9/5t YV7-y5-51 email: e4,4,Q fi,7 e byT lX•i� Company Name: 0( 1 5 u(pu n Pfwytq,�jcj Address: ZIV 4 K,6"A 4 /� h^t4" tit /Pf . 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 :3 ( 5 2nd Floor 3'd Floor 4m Floor 51 Floor Exterior 5.* List Other Equipmenv'Provide Details: pP rvh k* )? -e,( (Q W Abkl !A M eNA fr (Notarized Signatures Required Next 2 Pages) -t- 3/3=3 STATE OF NEW YOM COUNTY OF WESTCHESTER ) as: 64tM<12e— -:5V�Z4 Q 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. Swom to before me this v Sworn to before me this day of v h ,20 day of ,20 tgnature of Property Owner Signature of Van Do.. Print NYme of Property Owner Print Name of Applicant „a�" SUSAN SUGAR Public jotary Public,State of New York otary Public SU6AN Su Ail No.01 SU4906681 Notary Public,State of New York Uualified in Bronx County No.01SU4906681 Commission Expires Cd� _Z S Qualified in Bronx County GpOm tission Expires 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✓3or2o23 • BUILD. :D MENT D C IE � v F DO VIL E OF RY PO SUN - 7 2024 938 KING � ET RYE BR `, NY 10573 4 '� VILLAGE OF RYE BROOK BUILDING DEPARTMENT **,►ws,►+**,tit********#*****«**********,e*************#**.*********f,r**********,r*,r,r**********,r***********«* AFFIDAVIT OF COMPLIANCE VILLAGE CODE 4216 • 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: Y)Ou!�L�"5 C9 V 4 , residing at, qZ Td 1 J OT T /LGt Print name) (Address N%here N ou i).e) 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; TA lco4 g2� , Rye Brook,NY. (Job Address) Furdw that all statements contained herein are true,and that to the best of his/her knowledge and belief,that there wLrno known illegal cross-connections concerning either the storm sewer or sanitary sewer,and further that are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of in loyrm infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. 01 (Sign re of Property Owner(s)) -bQd('y4] C- w" (Print Name of Property Owner(s)) Sworn to bef re me this day of !/ 20 ^ SUSAN SUGAR �-- Notary Public,State of New York No 01SU4906681 C Qualified in Bronx County (No n ubhc) Commission Expires ��•— S — j -3- 8/12l2021 CC E� V E J05EPH C&LIEWO ARCH11�C7' 64 VOGEV512VK AUG 2 1024 NEW VOCHELLE, NY 10604 914-604-1I 57 VILLAGE OF RYE BROOK JGNYarch@gmail,com BUILDING DEPARTMENT August 14, 2024 Mr. Steven Fews Building Inspector AUG 2 7 2024 Village of Rye Brook 938 King Street Rye Brook, NY 10573 Re: 42 Talcot Rd To Mr. Fews, As requested, I have reviewed the completed footings in the basement below the master bedroom and the kitchen as well as reviewed documentation provided by the contractor and owner pertaining to the construction of the 2 footings and installation of the rebar for the new support indicated on the plan set for the renovations at 42 Talcot Rd and, This letter is submitted to certify, to the best of my knowledge and belief,that the rebar and footings have been completed in conformance with the approved plans and specifications dated October 16, 2023 and the 2020 Residential Code of New York State. If you have any questions or comments please let me know. REDC %�! G Ij Thank u, o. *1 6 Josep ugli m , q �• 033'�0�� OF NO L. L V-.-mt i I� 1/301'L5, 10:51 AM Mail-Doug Conrad-Outlook RHUNTSMAN JAN 3 0 2025 BUILDING SOLUTIONS VILLAGE OF RYE BROOK BUILDING DEPARTMENT July 6,2023 To Whom it May Concern, Please take this letter as confirmation that Foamco Is an active authorized contractor for Huntsman Building Solutions(HBS)and is authorized)to purchase and Install IHBS wall foam products as of January 22,2021.. This status Is subject to.change at any time and at the sole discretion of HBS: HBS account number 0008958. Please feel free to reach out to me for any additional questions. Bost Regards, Ellzabeth Cain-Reese Global Vke President✓Risk Management risk@huntsmanbudds.com 10003 Woodloc h Forest Drive. The Woodlands.Texas 77380 Tel:281.719.6000 130f1.123.4567 www.huntsmanbulldingsolutions.com A dlinam urd d 11,nitmw Crsporvon https://outlook.office.com/mail/inbox/idlAAQkAGVkYTUSYjc1 LWMwYWYtNGQ4Yy04N2UOLWFmNTM3NzNjNzJmMgAQALHgb%2BOISjpltQ2SyGDMI... 1!1 1/30/25, 10:51 AM Mail-Doug Conrad-Outlook ICC EVALUATION SERVICE' ICC-ES Evaluation Report FSP-2600 Rsms=ad Februmy 2024 This rsporl also commis: -CSC supptemenL Su*ci to rwwhyol Nbr wy2025 'CC ES evi6 mun Rgtlrrs am am m tie cufitiri i 2s a oesenim uarx4es o,ary sos assures n41 smawh a4ftssed,mr am Urcv to be co nre,md as an ewo"arrusit ar IM MOW!d br MPM a a=Mrnmiabm kr is iea.1 Me a rq awrramy bi ICC EraLaereon Sarveee,tr r e%ire$ar Ir-YJ ell n m any IreOry m Queer maser heat rcepon.v m m errs pmoun cawrm her ma rsferc Ccpffk"t 02024 ICC Wmhhadm huts,LLC.N mans rdervarl DIVISION:0700DO— REPORT WOLDER: EVALUATION SUBJECT: Q Q. THERMAL AND HUNTSMAN BUILDING AGRIBALANCO SPRAY MOISTURE SOLLMONS FOAM INSULATION PROTECTION I Section:07 21 Do— Thermal Insulation 1.0 EVA LUATI ON SCOPE 1.1 Compliance with the following codes: ■2021.2018.2015,2012 and 20D9 International Bulldlna Ctxfea lIBC1 ■2021, 2028, 2015, 2012 and 2009 tnttunitimiki ftg4.qnW Code'URCI ■2021,2018.2015,2012 and 20D9 Intematlanal Erxrav Conservation CC46PI IIECCI ■2013 Abu Dhabi International Building Code(ADIBC)t "beADIBC Isbasd onlhe 2009 IBC 2000 IBC cote sections relerenoed in this report are the same se csiom in the ADIBC. • Other Codes(see Section 8.0) Properties evaluated; •Surface-burning characteristics • Physical properties •Thermal resistance ■Attic and cravd space installation ■Air pelmealolity 1.2 Evduation to the following green standard: 2008 [CC 700 Nwic a l Green Buildinit Starmlarril(ICC 70D-2006) Attributes verified; See Section 2.0 2.0 USES Agribalance° spray foam insulation is used as a nonstructural thermal insulating material In Type V•8 construction under the IBC and dwellings under the IRC-The insulation is for use In wall cavities,Door. assemblies,rooUceiing assemblies or anics and crawl spaces when installed In accordance with Section 4.4. Under the IRC,the insulation may be used as air-impermeable insulab om when installed in accordance with Section 3.4, Am Pats or r https://outlook.office.com/mail/inbox/id/AAQkAGVkYTU5Yjc1 LWMwYWYtNGQ4Yy04N2UOLWFmNTM3NzNjNzJmMgAQALHgb%2BOISjpltQ2SyGDMI... 1/1 1130/25, 10:51 AM Mail-Doug Conrad-Outlook ICC EVALUATION SERVICE" IMES Evaluation Report ESR-4073 Ramwcd August 2024 Thu nyort aO=cmh": -cac 9upvlwlMnt Sugvcr b rwwwW August 2021 +EGGS tivAwyou Itiprt:no rrat h i+wngncd s nlvusnlrp weNohm w o'4 anu emaasa nN a»nhaW aoMaaicO.ntv M IMY M w mnsYub x m dMbfnneiM'1r d IAn x/�cel d9n igwrl a�naorM�atladun iex IN tuw them n(In wAn"M=Er-VwMA-,tine ttC smear w mpk t MAD Mw,*T tp- CcawvY4 a 2024 ICC VwVk on Bar"m,LLC.An narlk rmmnvd DIVISION:07 00 DO— REPORT HOLDER: EVALUATION SUBJECT:THERMA 1-W21 Q MOISTURE AND HUNTSMAN BUILDING HEATLOKa HFO HIGH MOISTURE SOLUTIONS,LLC LIFT SPRAY FOAM PROTECTION INSULATION Section:07 21 DO— Thermal Insufalfon 1.0 EVALUATION SCOPE 1.1 Compliance wish the following codes: ■2021,2018,2015,2012 and 20091ntem&Wrml&iOdina CodO ISCi •2021,2018,2015,2012 and 20091wornabonaf ResIdenhal Code"flRC1 ■2021,2018,2015,2012 and 2009 tntemaliarrat Enmov c'.wlaeryarinn rAxle,(IECCi Properties avaluated: ■Surface-burning characteristics •Physical properties •Thermal resistance ■Attic and crawl space Installabon ■Water vapor transmission •Alr permaabllity ■Exterior wells in Types I through IV construction 1,2 Evaluation to the following green standard: •2008 ICC 700 NaM)nal Green flitik&nn,Standard'(ICC 700-2008) 2.0 USES Heatoka HFO dosed call spray foam is a sprayappiled polyurethane foam plastic insulation used as a nons"Mral thermal insulating material in all Types of construction(Types I,11,Ill,IV and V)under the IBC; and in dwellings under the IRC.The insulation is Intended for use In wall cavlMs,flooriceiling assernblies,the underside of on-grade slabs,or attics and crawt spaces when installed in accordance with Section 4.4.Under the IRC and 2021,2018 and 2015 IBC,the insulation may be used as air-Impermeable insulation when Installed in accordance with Section 3.5. The insufatlon may be used In exterior watls of Type I, II.III or IV construclon when used as described In Section 4.5. The attributes of the insulation have been verified as conforming to the provisions of ICC 700-20M Section 703.2.1.1.1(c)as an air impermeable insulation. Note that decisions on compliance for those areas rest with the user of this report.The user is advised of the projed specific provisions that may be contingent s"" AIL. 9eW 1 d] https://outlook.office.com/mail/inbox/id/AAQkAGVkYTU5Yjc1 LWMwYWYtNGQ4Yy04N2UOLWFmNTM3NzNjNzJmMgAQALHgb%2BOISjpltQ2SyGDMI... 1/1 1/30/25,10:51 AM Mail-Doug Conrad-Outlook FOA*nw IIN November L 2024 MR Design Mau Romtto 448 5th Ave Pelham NY 1OW3 Re: 42 Talcott Rd' Rye Brook, -NY Dear'M att,, This letter Is to eertlfy that the Insulation work completed at the above referenced location was installed under the manufacturer's specifications, and:;Mews the foiipwi iq,It-velues. R-52 Agribalance Foam —Roof Slopes and Garage Slopes R•22 Closed Cell Foam —Ekterior Walls, Garage Exterior Wells end Wall Separating Garage From Living Space Manufacturers: Agribalance Foarn —Huntsman posed Cell Foam Huntsman -Evaluation reports under FSR Should you have any questions please do not hesitate to contact our office- Sincerely, David Crawford Davld Crawford Presi dint https://outlook.office.com/mail/inbox/id/AAQkAGVkYTUSYjcl LWMwYWYtNGQ4Yy04N2UOLWFmNTM3NzNjNzJmMgAQALHgb%2BOISjpltQ2SyGDMI... 1/1 --------+ .Buildiing,,��``Peer�rmit Check List&Zoning Analys`iss Address: � � �� �--E.�T�' � SBL: Zone: -1 -us, 1 Const Type: _ other. - - Submittal Date: \. I Z�evisions Submittal Dates: Applicant: CC Nature of Work _ '�r^(�2 1 c�C- (� �C.'r CA I OCr S 'k' C�1(Gt—tl C 1RS Reviews:ZBA: `` —I B: BOT: Other. �tFS:Filing- P: ��`` �"C/O; Flood Plane: LegalizationP. Dated:�/Notarized: ,i SBL __,_,�ruus I.D. Cross Connection: H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening: ( ) ( ) ENVIRO:Long. Shore Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection S/W Mgmt.: Tree Plan: Other: ( ) ( ) SURVEY:Dated: Current: Archival:- Sealed: Unacceptable: ( ) ( LANS:Date$tamped _ Sealed: `copies: ✓ Electronic: Other. ( License: /Workers Comp: Liability ✓ Co aiver. t-,� Other. ( ) ( ) CODE 753#: 11 Dated HIGH-VOLTAGE ELECTRICAL:Plans: Permit r.N/A: Other N/A ( ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit N/A: Other. (y ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H.W.I.C.:_Battery:_Other. (� ( ) PLUMBING Plans: Permic Nat.Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit N/A Other H.V.A C.: Plans Permit N/A: Other. ( ) ( ) FUEL TANK Plans: Permit Fuel Type: Other. ( ) ( ) 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other: ( ) ( ) Other. ( )ARB mtg.date: approval:- notes: ( )ZBA mtg.date: approval• notes: ( )PB mtg.date approval: notes: REQUIRED E?ignNG PROPOSED NOTES �O V Amv fk&. oafa: Fro" Front: Froru: Si s: R� Main Cov: Accs.Cov: F S • S .HS • ToL imp: F I : P k'n Hcght/Stories: notes: Laura Petersen From: Laura Petersen Sent: Thursday,January 25, 2024 11:41 AM To: Doug Conrad Cc: jgnyarch@gmail.com;Alfredo DiVitto; Steven Fews Subject: RE: Building Permit Application -42 Talcott Road ****2nd Request**** Good afternoon, Please advise of the status of submitting the contractor information from my email below for the bathrooms and stairs renovations. Thank you Laura Laura Tetersen 5 3 ay Office Assistant P�2 Village of Rye Brook 938 King Street Rye Brook, New York 10573 Phone(914)939-0668 1 petersenCa)rvebrook.org �� ' ' 1/•/ / � r��� From: Doug Conrad<Doug@deconradcpa.com> Sent: Friday, November 17, 2023 2:53 PM To: Laura Petersen<LPetersen@ryebrook.org> Cc:jgnyarch@gmail.com Subject: Re: Building Permit Application-42 Talcott Road Thank you Ms Peterson. Get Outlook for iOS From: Laura Petersen<LPetersen@ryebrook.org> Sent: Friday, November 17, 2023 2:19:46 PM To: Doug Conrad<Doug@deconradcpa.com> Cc: iffnyarch@gmail.com<ignyarch@gmail.com> Subject: Building Permit Application-42 Talcott Road Good afternoon, The building permit application has been approved by the Building Inspector. Before I can issue the building permit the following items must be submitted to our office, 1. General contractor's contact name & phone number. 2. Copy of general contractor's valid Westchester County Home Improvement License. 3. General contractor's valid liability insurance (the Village Of Rye Brook must be the certificate holder) 4. General contractor's valid workers compensation on a NY State Board form (C105 2 or U26.3) 5. Building permit fee $900.00 (due once permit is issued and ready for pick-up) 1 �Ape. rMl " F���r'' ;� �'S? ,, !`� 0 .;^� S5Y.79• O '� 0.. `� OTL` F,�' � `any. �' ��� )�♦( v {ERc'1♦♦'♦' $"t a�v3a *�♦�'i£ si� <�t'a;�.�'' s by ♦ �' � ! �♦♦ � - �♦♦ �� - MF cu `mnN�; by►►�i����4h►►).A�►fir 1►;►��)►�_�' � ►h►►��1►►►� z s► t�l�►►���v\ h►1►►��� �����1►�: � iti��j;; ry A C �uo)s o 0 1to)i i c Y o ,.q,.��: •R � ca 15 p..� •� U Y vwi LLI Z w o U a `Qc ection ,� \ r/� Q Z u ' (40 77\ if '' U 1,,► oo w �,y• 4••i p., � v d � N o a� �e ,, ►- r..► 5 o bO �--_ x4- z 10 (� U CN I dN aN � truer. . t .] w y to O � a v cA U m .. w ' �� s.0 � �: ♦ h = ti�►�►�►�►�� �g 4 ia�►�►���►�� ��. ��►�►�%►i�� ��.��;i►♦►��♦►i;� � ' ►►►�jh► ` x��a��'i►i►i►'� � ' / � A A �♦♦�! 1�7�A ig# �♦♦� �a�A�� �♦♦� $`A..lc y�yJ�♦�� A ♦ A s :��♦• ^ � ' rt ti..• . .,< ays.,..,1�„ '--�. (MMIDDIY Yr ACO 05/06/2024 CERTIFICATE OF LIABILITY INSURANCE GATE0612024 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 ail ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. It SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statemont on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME an McDonnell-Farucci Hallahan,McGuinness and Lorys,Ltd PHONE (914)939-8895 17ANC Nd (914)939-3104 553 Westchester Avenue ADDIREss Marian@hmlinsurance.com INSURER(S)AFFORDING COVERAGE NAIC Rye Brook NY 10573 INSURER United States Liability Insurance Company 25895 INSURED INSURER B State Insurance Fund 35076 MR Design Inc INSURER ShelterPointlnsu ran ceCompany 81434 448 Firth Ave INSURER D INSURER E Pelham NY 10803 INSURER F COVERAGES CERTIFICATE NUMBER: 23-24 w/updatedwc 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 NOTWITHSTANDINGANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO MICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDOPYYYV)) MMIDDIVVW LIMITS COMMERCIAL GENERAL UABILrrY FAO+OCCURRENCE S 1,000.000 ® 100.000 ��NM$-MAOE � PR I ru rr n - MCD FXP(Anv one oetson - 5,000 A Y GL3001415C 08/04/2023 08/04/2024 PERSONAL 8 ADV INJURY 1,000.000 GCN'L AGGPEGATE LIMIT APPLIES PER GENERAL AGGREGATE 2.000.000 PP0 FD PRODUCTS-COMPIOP AGG c 2.000,000 POUCY JECT LOC f ,THEP CrjMBINE 9NGLEUMI AUTOMOBILE LIABILITY JFa arnderlt ANY AUT j nonILY INJURY(Par person) S JWNED SCHEDULED BODILY INJURY(Per a(wentl $ AUTOS ONLY AUTOS HIRED NON-OWNED (Pw Ti aruAent�rAMAGE S AUTOS VNLY AUTOS ONLY Par f UMBRELLA LIAB CCJP FAC-)+OCCURRENCE f EXCESS LIAB H:-'LAiMc;.MAOE Ar,-,PF�,ATF 5 P,TEriT!(,N f PL1 E')PI WORHERS COMPENSATION TAT - EH T AND EMPLOYERS'LIABILITY Y 1 N - 100.000 B ANY PRO--T IETOWPARTNLRIE%ECUTIVE ❑ NIA W 2441 89B-0 04113/2024 04113/2025 E EACH ACCIDENT OFF I CERIMCMBER ExCLIAED'> - 100.000 (Mandatory in NFf♦ F'.. DISEASE-EA FMPI.;YFF I vcs,descnbe tinder 500,000 n-qf RPTIOr+_F^?PE�ATIONS bekw F_ DISEASE-POLICY LIMIT NYS Disability C D531403 04112/2024 041112025 Continuous Statutory DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (A CORD 101,Addlt lonal Remarks Schedule,may be attached If more apace is re qulr ad) Certificate Holder is listed as additional insured CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Building Department Village of Rye Brook AUTHORIZED REPRESENTATIVE 938 King Street Rye Brook NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD fi� NYSIF Y:�r^•>?:,::>::>.<::,>>,,:::s :::a PO Box 66699.Albany.NY 12206 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 'TVa ^^^"^ 0436s7574 HALLAHAN MCGUINNESS&LORYS PO BOX 570 Dli�.d y PURCHASE NY 10577 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER MR DESIGN INC BUILDING DEPARTMENT 448 FIFTH AVENUE VILLAGE OF RYE BROOK PELHAM NY 10803 938 KING STREET RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2441898.0 747185 04113!2024 TO 04,113!2025 5/6/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2441898-0. COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK EXCEPT AS INDICATED BELOW. AND. WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY.INCLUDING ANY NOTIFICATION OF CANCELLATIONS. OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:/iWWW.NYSIF.COM/CERTICERTVAL.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. PRESIDENT N4A1THEW RON41TO MR DESIGN INC ONE PERSON CORPORATION 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. 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