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HomeMy WebLinkAboutBP24-121PERMIT �� SECTION L TYPE OF WORK JOd LOCATION _ OWNER �J�-t � �/-/�-/ ATE: � i� � �;� �� �s BLOC � LOT SO. CONTRACTOR EST. COSH �co #� TCO � D� �'. I�� n �b �/ %2/12 rl/I �� FEE DATE �N�pECTION RECORD I DATE I NSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUI1gBING GAS SPRINKLER _/ ELECTRIC �J LOW VOLT C� ALARM . 1 � L ��� �� AS BUILT 0 _ 2a7, �'� FINAL � - � O� a� a 9/ _ 3y�- a�a� s/>z-.�C n-� Q� .�pd�vo �iy�3��-� 8a� CP�y- � 3y� U�-�Q f�,'� C/e��'� C OT}{E,I� APPROVALS ARB BOT PB ZBA OTHER �.1 VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 24-165 Certif irate of ®ccupaucp This is to certify that lJuoti ldK6yn of, RiLe kI N having duly filed an application on 20 requesting a Certificate of Occupancy for the premises known as, c:,?,- 7 kV1 Rye Brook,NY, located in a / Zoning District and shown on the most current Tax Map as Section: ! , (0(r, Block: / Lot: , and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No.� — / / , issued lL! ' 3,20 Oq, 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 n New York State Classifications,Use: "� LJ Construction: , for the following purposes: WkyoK r' Y ov f�' Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of the building or in the exit facilities shall be made, and no enlargement, whether by extending on any side or by increasing in Aight shall be made,nor shSa!Jthc building be moved from one location to another until a permit to accomplish such change as obt ' e om th uilding Inspector. Building Inspector,Village of Rye Brook: Date: DEC 2) 3 2024 D IE BUILD :FRt NT For office use only: PERMIT# 10�'7-1c) DNOV 2 2 2024 VIL OE OK ISSUED: - a-� 38 KING STRE YEOK,1 YORK 10573 DATE:VILLAGE OF RYE BROOK 0668 .� FEE: �' aaS- PAID,®.BUILDIN DEPARTMENT w lkn ov 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 ,� I Address: U 1� �L1 lv- S Occupancy/Use: P44 Parcel ID Zone: Ownerjan l Yelp ` tLy1 C.t Y1 Address:2,7{ Vl1)Itch ' � e 8 cos P.E./R.A. or Contractor:y-o/,-pVo & Coa/l rV16"Address: 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 YORK,COUNTY OF WESTCHESTER as: t�:4n � ifra e/� being duly swom,deposes and says that he/she resides at e (Print Name`o,Applicant) n (No.and Street) in (1 AID f f ,in the County of V y� -�1 eS K 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 donated gratis was:$ • 0 0 0• for the construction or alteration of: >n L h '/ ^ Y\ 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 NO -- 209 day of , 20 G � re of Property Owner Signature of Applicant J � m ame of Property Owner Print Name of Applicant Notary Public SHARI MELILLO Notary Public Notary Public,State of New York No.OIME6160063 6/l/2024 Qualified in Westchester County � Commission Expires R•u y 29,20_Z �E BR�jk, O�` tim Q,>I/ . •F�O,c 19432 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 : DATE' I J PERMIT# ISSUED: SECT: BLOCK: LOT: 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 QyE BRC�j�. • 1932 BUILDING DEPARTMENT VBILDING INSPECTOR ISTANT 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 : 2--7 1 DATE: PERMIT# ?? 2 LI _ ISSUED: SECT: BLOCK: LOT: 7� LOCATION: Ir 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 QyE BRCS,. w 1982 BUILDING DEPARTMENT ❑BUILDING INSPECTOR 0ASSISTANT 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 - - - - - - - - - - - - - -- - - - - - INSPECTIONREPORT - - - - - - - - - - - - - - - - - - - - ADDRESS :- ?- W I L"J Ir C- DATE: PERMIT# ?�� 24 - I Z ` ISSUED: -�Z�L`I SECT: BLOCK: LOT: LOCATION: OCCUPANCY: �! . ❑ VIOLATION NOTED THE WORK IS... El ACCEPTED 2 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 ■ 3 i _ ■ � S s N G w e : ! CS N p4 w ■ N e� cr : lr�T..� s � r � fL' +N•' � C sa � n z w a O w Uaw p4 r W v�i o w U a a O s i O W p A. O a �+ ICI uy ,� c v n '4 s4 Ln = O W o O O a v e 4-4 CIS F:, �o w ° ° a cj !'++1Z N o z _ J w N - r0 O00 �i a ll W n O� WW1 O C4 y O s �X, g Im. co O w O H w 0 "� `o 0104 = rw o ti N a Z Wz v v cn x I~ z r ~ �o ficc t , � cA a 3 00 /■/ rTl ^ ~ rn 16 I�I—I W w p ] �' v o iS� ■ z z 14 � 7 H ^ o � �! -�, 00 L•! , p V a O w a� a U pQ U ox oovv �U _ o � as L e N z w w o � : �� s z IS a OR w �I � W ✓ ".lr � � cd v v : e BuIL14NOI , . MENT VILI*:E OF RY OOK 2024 938 KING STREET RYE BR NY 10573 (914)939-0668 VILLAGE OF RYE BROOK w�r•yebrook.are BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Approval Dater mit �` Application Fee:$ Approval Signature: Permit Fees:$ Disapproved: Other: Application dated: — /' + q is hereby made to the Building Inspectorof the Village of Rye Brook,NY,for the issuance ofa Permit for the interior alteration of an existing building,or fN change in use,a per detailed statement described below. --1. Job Address: W yo h, Q, SBL:f31-�5 1 6(0—�' .� Zone: te 1© 2. Proposed IgLprovement.(Descr'be in detai 3. Does the roposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: Yes: If yes,indicate: TIER 1: TIER 11: 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,ANSI.System,FM-200 System,Type I Hood,etc...) :No: Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 5. Occupancy;(1 fam.,2 fam.,comm.,etc...)Prior to Construction: After Construction: 6. N.Y State Construction Classification: i N.Y.State Use Cl ssiffcation: 7. PropertyOwner Yle CtY+Q ress: W I t' �� Phone (Q� &�f, Cell4141)3�62 FANU email: iVe Lo 9 7sS- Address: Phone# Cell# email: 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# I email: it. General Contractor:taro /0 by uMl - WAddress: SCA. Me- 9-S IZ 6dvC, Phone# Cell# email: 12. Estimated cost of construction [ ?a �Q0() (NOTE:The estimated cost shall include all labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 13. Job Timetable: Start: Finish: (i) 6/l/2023 BUI4ET G DEPARTMENT VIL OF RY OOK APR 2 9 2024 938 KING RYE BR ,NY 10573 4)939-0 VILLAGE OF RYE BROOK www.ryehrook.org 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 YOR``K,COUNTY OF WESTCHESTER )pp as:An pI�Juon ��u�h� (G� �� 11�ndoesidingat,��"W R� �',�� fsfoo r� (Print name) (Address where you live) being duly sworn,deposes and states that(s)he is the applicant above named, and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; 2 3-U J I �ILY) U �qe� &W� � tU- y Ed S13 , Rye Brook,NY. (Joh Address) Further that all statements contained herein are true, and that to the best of his/her knowledge and belief, that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer,and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. w roperty Owner(s)) Wrinl Name of Property 0%%ner(s)) Sworn to before me this "1 6 day of A7r, 20 A r (Not 'ubli I3REOM M.RIVERA NOzy Public,State o1 New York Na.DIR16441398 (�) 0WI1Nd In Westchester County Comedsslon Expires September 25,20�2 8/1212021 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: ,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,attomey,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 C4 Swom to before me this day of A , 20 C141 day of , 20 ignature of Property Owner Signature ofApplicant L�10 111a print Name of Property Owner Print Name of Applicant #./M &)Cetw' — otary Pti Notary Public GREGORY M RNERA Newry Public,State of New York No.01 R1601398 Qualified In Westchester County n Con mfsston Expires September 26,2Mf (d) 8/12/2021 'ice N N N x r � r �4 O w — Cn 00 x oo � x z Q Q a h-� C 1 MMoc U W z U w N ,� Q z > o < c H z < U W z 0. A. z A p z a ° < A a z BUILoj1���EP MENT VIL J E OF RYE OK DEC - 6 2024 938 KIN ET RYE B ,NY 10573 n . = v ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required � FOR OFFICE USE ONLY BP#: O��—/ �/ EP #: Approval Date: 12 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, 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 conformajice with all ap icable Federal,State,County and Local Codes. 1.Address: N h} I SBL: Zone: 2.Property Owner:' V �C �C") Address. t n Y`� Phone#: -�I KK n Cell#:� 1���c'lE �:- email`�t Q �z i1_'Agj0_ �v � `l C.O., 3.Master Electrician/Licensed Installer: .Ote¢D �G A/ Address: 3 S70,I).e L7y'e_' Lic.#:a OQR Phone#: Cell#:�/T���S6 t�2Memail: Company Name: 04n pia _4,e4f L L.L L Address: 41//� JJ 4.Proposed Electrical Work/Fixture Count: kiTChPdi `Ly //, � , (>'+J O lj %/iq C U UMid 5.31 Party Electrical Inspection Agency: 64de- ll de_ T os LPG e N e STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: al Z'A i i4 ,being duly sworn,deposes and states that he/she is the applicant above named,and does further (print n�vid I s}*m�i ing as the ap ant state that(s)he is the I)_iP40 ,plc, for the legal owner and is duly authorized to make and file this application. (Mast lectrician/ficensed 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. Z Sworn to before me this 5 Sworn to b re me this `T ct� ' day of ,20 2J4 _ day of -P ,20 igna er Sign t ru eea of Applicant L Y �i��o TD � 0 e of Pro Owner Print N e of Applican MAIDA A DA EIRA ` G ofaarryy Pu l antalnaria Notary Public-State of New York Otary En NOTARY PUBLIC,STATE OF NEW YOP No 01, 1 DA6135830 Registration No,01SA6440536 Qualified in Westchester County Qualified in Westchester County My Commission Expires i0i2a/2025 Commission Expires 09.'12 2026 `— STATE WIDE INSPECTION SERVICES, INC. CA:) Service With Integrity 0•0 • • SWIS JOB APPLICATION0. • Office Use Elect. Permit# C:; Date Bldg Permit# 4 —/ c� Sq Ft Plumbing Permit# Final Certificate# City/Village Zip Building Dept. County Address L p Cross Street Section Block Lot Owner Name/Address(If different than above) v� n Contact Number / _& ` _c ❑Basement 1st Fl. ❑2nd FI. ❑3rd FI. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/0 Detector Hood Trash Compact Amt Amps ^, J 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 Junction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect Legalization ❑ Safety Inspection ❑consultation ,( and"'i ra liwd )",1,�, �F�i����, l og J �on� ;; 1 rr-T fP,Plo loirlG DEC —6 W i r1; V! . ... P" 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 )�Q �Qf/P<�r; C Gdy�! �C/1 i Name i License# QQ8 Date Signature ���•7C� 1 Address ' 11 ` C h� / ame City/State ` ✓J�`��`f NY I J Zip Code d Company lO lf1 fl Phone# �! 'J✓ - e-e-�7/1 p State Wide Inspection Services CsA(�> 1080 Main Street DEC 18 2024 Fishkill, NY 12524 845 202-7224 Phone VILLAGE OF RYE BROOK 914-219-1062 Fax STATE WIDE INSPECTION SERVICES BUILDING DFPAR- kA1FNT Email: office(cbswisny.com �._ Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: D Tapia Electric, LLC Juan V. Idrovo 37 Stone Avenue 27 Wilton Road Ossining, NY 10562 Rye Brook, NY 10573 Located at: 27 Wilton Road, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP24-234 135.66 1 s0 Certificate Number: 2024-8941 Building Permit Number: BP24-121 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: 27 Wilton Road, Rye Brook, NY 10573 The Kitchen 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 171h day of December 2024. Name Quantity Rating Circuit Type Luminaires 06 Refrigerator 01 Hood 01 Range 01 GFCI counter outlet 01 Under cabinet light 01 Switches 03 A Visual Inspection of existing conditions was performed on December 17, 2024,of the Kitchen and Conforms to NFPA 70-2017 NEC. No Defects Were Noted. Officer: Frank 1. 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. g N N t u N L; z 0-0 H O w CD o E CA N z �cn O CN A Q oo v 0 u, Ozv � o moo - a C� ACA Itsz O V C7 A a z f z z I_+ w w o0-4 Ln z z � �6 BUILD DE MENT VILLAGE OF RYE OK DEC - 4 2024 938 KING ST4ET RYE B NY 10573 PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: / PP#: 73? Approval Date: Permit Fee: $ Approval Signature: V Disapproved: (fees are non-refundable) DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR.THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated, is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agree that said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: Z 7 1,Z f ha ko Ad 3�i f SBL:_1 40 Zone: Q IO 2.Proposed Work: Rer41rcd �Y�r I � xc-c TC�t�i�� 51-1k i 9'.4'G✓t , See w-.c L oGa A,A I S 3.Property Owner: 1Jt/Z d i/b rr/V&LI-iAl l- Address: 2 7 Wa //V 4,A leegr4/ Phone#: Cell#: email: 4.Master Plumber: I'h 4"T k L/+:C0+2 Address: /J /�/l>K'-ty �, � , /LTG tyiiw, /yYi vS3t< Lic.#: 5¢Ir Phone#: 'T/Il-Iv 3 -ZS 53 Cell#: 1/f 403 Z 51 3 email: tlUr-/��, 0 yOtAfh n Company Name: /y��ik L�t�r b�l✓n,{�,., �k ��l ey �� �L Address: /l//✓o/� L��.,e, �tc fD�-,�,�� /�I�/ INDICATE FIXTURES&LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary a Other* Total Closets Fountains Tubs Tubs Service Service Sewer L as Basement 1 st Floor , 2nd Floor 3"d Floor 4m Floor I"Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -1- 6 1'2014 BUILD MENT VILL�E OF RYE OOK DEC - 4 2024 938 KIING ET RYE BR NY 10573 4)939- '� WNV*Vt'yebro0k 0v *'Ckk*9Ck*:F�:]F**kkk:F*k9C*k:t*k-,'r iF k'3:x:F]Fkv?i:F kA'k.F*:Fi:*kF�Ck]F'4.'t]F:Fk-F Fk kk9:�:f:�.*t;F%]l-k:C�:f*knF 9F*x'7kiY t Y kF F iFt k*i:k:F**:F k'kkk9:]F Fk AFFIDAVIT OF COMPLIANCE VILLAGE CODE V 16 - 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: -ifl , residing at, Z 7 W /hn �pqW i Pnnt name) (Address where you live) being duly sworn, deposes and states that(s)he is the applicant above named, and further states that (s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; 27 U)t 'i ,Rye Brook,NY. (Job Address) Further that all statements contained herein are true, and that to the best of his/her knowledge and belief, that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. al::1:7 (TigriffffFF70roperty Owner(s)) 3jGe) Tdywo (Print Name of Property Owner(s)) Sworn to ore m day L' P 10 pABLO .FERNANDEZ-HERRERA NOTNRY PUBLIC,STATE OF NEW YORK Registration No.02FE8020781 Qualified in Westchester C u _3_ Commission Expires Marc'S.20 6/1/2024 STATE OF NEW YOM COUNTY OF WESTCBESTER ) as: M4V k asar ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that(s)he is the Master Plumber for the legal owner and is duly authorized to make and file this application. That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this 3 Sworn to before me this day of 3t=nN6v- 20 2t _ day of De C 20A_ *S' ae of Property Owner Signature of Applicant Print Nadie of Property Owner Print Name of Applicant APIR M SAL AR A #tq.0 W MY.pLg3LIC,STATEOFNEWYORK Notary Public,State of New York. Registration No.OISA6365I73 No.011;;E6160063 Qualified in Westchester county Qualified in Westchester County Commission Expires IO-02-2025 Commission Expires Jc.u., y 29,20� 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- 6/1/2024 ildin Pcrrruc_Check res Luc u & Zoning Analys Adds. - — - SBL 1 _ G0.7 Zone: - U61q Cone Type: Other. 1- " Subrrnttal Date: l Revisions Sub tul I)arm: 0 Applicant Nature of Work: t v�1 k_ Rcvicw ZBA- PB BO r: Other. NEED QK ( ( FEES Filing ( ) � BP: alusaon— a g (,�APP: Duel -� Notarized! SBIL COI'russ I.D. Cross Connection; H O.A.: ( } ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening. ( } ( ) ENVIRO: Long Short Fees: N/A ( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmt.: Tree Plan Other. ( � ( ) SURVEY:Dated Current Archival Scaled Unacceptable ( ( ) PLANS:Date�Sc=rrped Sealed Copies Electronic Other ( ( rl_icense: ✓ Workers Cornp: l ity: Comp.Waiver. Ocher: ( ( ) CODE 753#: Dated. N/A ( ( ) HIGH-VOLTAGE ELECTRICAL.•Plans: Permit N/A: Ocher. ( ; ( ) LOW-VOLTAGE ELECTRICAL-Plans: Pernuc N/A: Ocher: (►;� ( ) FIRE ALARM/SMOKE DETECTORS: Plans: Permit I-W.I.C.:_Battery:—Other. (�( ) PLUMBING Plans Permit Nar_Gas: I-P Gas: N/A/ Other. ( ( ) FIRE SUPPRESSION:Plans: Permit N/A Other. ( ( ) I-VA.C.: Plans: Permit N/A Other. ( ( ) FUEL TANK:Plans: Peru: Fuel Type: Other. ( ( ) 2020 NY Slue ECCC: N/A: Other. ( ( ) Final Survey Final Topo: RA/PE Sign offletter. As-Built Plans: Ocher. ( ) BP DENIAL E1:- n--R C/O DENIAL lE:7 I"I1R Other. ( ; O Other: ( )ARB mtg.dam- approvaL• notes: ( )ZBA mug.date: approval• notes: PB mtg.dace: approvaL notes: REQUIRED EX1511NG PROPOSED ti0THS PR- -- _ ----- APPROVED CIrC1G FF r From Front: Sides: Rear. Main Cov. A4 Co-v --- - -- Ft.H/Sb• — — Sd H GFA — T2L InT: i EL-1mm: Haght/Stones — notes: o°P J 9� 7 Q -- h Cf o � s � � o rl i�R�; BUILDING DEPARTMENT VIL E OF RYE OK 938 KIN , ET RYE B ,NY 10573 =f)668 . 7N&W2kny.gov ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: EP#: Approval Date: Permit Fee: $ Approval Signature: Other: DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BV THE BUILDING INSPECTOR. THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated, is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or 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: SBL: Zone: 2.Property Owner: Address: Phone#: Cell#: email: 3.Master Electrician/Licensed Installer: Address: Lic.#: Phone#: Cell #: email: Company Name: Address: 4.Proposed Electrical Work/Fixture Count: 5.31 Party Electrical Inspection Agency: STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: .being duly swom,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 before me this day of 20 day of 120 Signature of Property Owner Signature of Applicant Print Name of Property Owner Print Name of Applicant Notary Public Notary Public 6/l/2024 F i a 1 1 1 77 r , vs AIL � t1 �e��- /` � ee��- i/� �•�®veer _,.. owl �1►�.r ] A-� �,►Id i �, yn> YEJ.2� �'op l� awl' _• ,;,� ll - T: I I °•- r, e �lY o ° r ' r . J ;k f `I FI" ilhl 1 f - � � t i � I i +�r 1 [3 ji p . 1 ' - RIT, Ll � 1 _ v � rw7r r•' �� /_fir 3�gt'�s`� PR P�kjl I - • v.1pro , 5 .�Ems'^� ��'�� ,�; •ems+ �t� �` 1 ry �►6�' .�► Aim `otsi �t;�, � � '` Ail . . ` s;. xxx,�)))) •RS�I• 'x� aa'xxH,,,,,.•� H A , .h A. A h4jp�ih A to :4 A H CD cq ". ^.I O r c r 0 •Fug.'' N ram,,, bI U y' • � y O U � i %�i a a •� C� CO o w �I •.•r W M U VLO (OMO o o °� ction co z I y E U) c Q J O o Wn VLu y p ` O CD Q vp � '• i I � MCI > I <co» cl A cl i -moo N Z M a L 4. fn co 1_ co WOO a� F ri w ?�f / • F F;acoRo CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 05/02/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Michael Donnelly NAME: Donnelly Insurance Center Agency Inc AICC No Ext: (914)347-6500 aC No: (914)347-6303 6 North Lawn Ave. E-MAIL ADDRESS: info@donnellyagencycom P.O.BOX 880 INSURER(S)AFFORDING COVERAGE NAIC# Elmsford NY 10523-0880 INSURER A: Utica First Ins Co(Mutual) 15326 INSURED INSURER B: IDROVO DRYWALL SERVICES LLC INSURER C: INSURER D: 27 Wilton Rd INSURER E Rye Brook NY 10573 INSURER F COVERAGES CERTIFICATE NUMBER: CL2312434150 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AUDL 5U5K POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 FZ7e DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 A Y ART3001035270 11/30/2023 11/30/2024 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 X POLICY ❑JECT PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER_ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DIED I I RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) DRYWALL OR WALLBOARD HANGING AND TAPING-NO ASBESTOS REMOVAL OR INSULATION WORK. CERTIFICATE IS SUBJECT TO TERMS,CONDITIONS AND EXCLUSIONS OF THE ACTUAL POLICY AT THE TIME OF ISSUANCE.CERTIFICATE HOLDER NAMED AS ADDITIONAL INSURED AS PER WRITTEN CONTRACT CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN VILLAGE OF RYE BROOK ACCORDANCE WITH THE POLICY PROVISIONS. 938 KING ST AUTHORIZED REPRESENTATIVE RYE BROOK NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 0 0 ^^^^^^ 922725160 DONNELLY INSURANCE CENTER AGENCYINC PO BOX 880 ELMSFORD NY 10523 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER IDROVO DRYWALL SERVICES LLC VILLAGE OF RYE BROOK 27 WILTON RD 938 KING ST RYE BROOK NY 10573 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2601805-1 740697 03/01/2024 TO 03/01/2025 5/2/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2601805-1, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:/MIWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STAT SU NCE FUND T �V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 1063390976 U-26.3