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HomeMy WebLinkAboutBP24-120PERMIT # / �A L Id 0 DAB;
SECTION BLOCK
TYPE OF WORK % ar 4 7rQQooy
JOB LOCATION lZZD 9 ree �7nA
CONTRACT0
EST. COSTA
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FEE�I;SD-/ L3
TCO # FEE DATE
Mflm
. - .;.
FoonNG
FOUNDATION
FRAMING
RGH FRAMING
INSULATION ,�,/
PLUMBING cv 1 " &3 AL'a
RGH PLUA48ING `1 17' ZatY q►S�e D
GAS m
SPRINKLER
ELECTRIC
LOW -VOLT CI
ALARM O
AS BUILT O
FINAL
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OTHER APPROVALS
ARB
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OTHER
VILLAGE OF RYE BROOK
WESTCHESTER COUNTY, NEW YORK
No: 24-1:34
Certificate of Occupancy
his is to certify that ] e ,,?, 0c9 I OcoceI la rams lU I Yyey Gable -A al
of, f-qf 6kon k) /V 7 , having duly filed an application on
rlln ber (�2 ), 20 424 requesting a Certificate of Occupancy for the premises known as,
d l 0 / Yee To L2 0-tasren Rye Brook,NY, located in a Y' ULD Zoning
District and shown on the most current Tax Map as Section: L? 7 Block: J—Lot:
and having fully
'complied
/with the requirements of the Building Code and the Zoning Ordinance under Building
Permit No.l? `-f-14-2CJ , issued hoz 20-�,&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: V - Construction:
j.�� LhY�for the following purposes: U
T Y I � Y m
r rld V� �Jay�
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 facilit' 11 be made,and no enlargement,
whether by extending on any side or by increasing in h ' lit shall be made,n the building be moved from one location
to another until a permit to accomplish such change s b tai d fr t lding Inspector.
Building Inspector,Village of Rye Brook: Date:
OCT 2 5 2024
BUILD :BROOK,
KTMENT For office use onl :
PERMIT
VIL E BROOK ISSUED: —OCT 2 1 2024 938 KING STRE Y YORK 10573 DATE:/Oi_______ 6 O` FEE: $ �,'Sn PAID
VILLAGE OF RYE BROOK w ov
BUILDING C+FPARTMENT
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
#iiffktt#t#t######ttitrt�trt#if#rt####}#4iii►ffkt#i#rtt###it###i►#t}#rttktrtirtt#rtii##i}ii►i►tti#t#i►f#rt#t'ii}Iiikiii►iff►►trtff#ii#ii#
Address: / i-"s
Occupancy/Use: I r-4AI arcel ID#: l 9, 7(o —1 -CP 3 Zone: /
Owner: C Address: o� /
P.E./R.A. or Contract o : 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:
7, being duly swom,deposes and says that he/she resides at
Pr' t Name of Applicant) )� (No.and Str t)
in in the County of in the State of ,that
(City/rown/Village)
he/she lias 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
t9 V
have been donated gratis was:$ ®a ,
for the construction or alteration of Va
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 I Sworn to before me this
day of 914
, 20 day of ,20
ignature of Prop Owner Signature of Applicant
.& "t./A/ //*) AC10 C—4
Print ame of Pro y 6,hner Print Name of Applicant
Notary is Notary Public
GREGORY M.RNERA 6n i2oza
Notary Public,State of New York
No.OIR16441398 j
Qualified In Westchester County
Commission Expires September 26,202(�/
OBORC,��
'9a2 BUILDING DEPARTMENT
^^❑,,BUILDING INSPECTOR
[Jt(SSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK
❑CODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,`NY 10573
(914) 939-0668 FAx (914) 939-5801 /
www.ryebrook.org
- - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - -
ADDRESS : 1 1 R e G TJ P CJ10_ S DATE: I r)
PERMIT# ISSUED: -12' SECT BLOCK: I LOT: 63
LOCATION: rA ty , �L 4-ti --.-- 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
0 FINAL
❑ OTHER
�E Bk
cu '9 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 : I 2 C— ,>o t— DATE: 10 — Z—� C J L'l
PERMIT# —7 ISSUED: 6 SECT: P BLOCK: LOT: 6
LOCATION: �' : (� 1 J V Z + ' tc� I �" \ OCCUPANCY:
❑ VIOLATION NOTED THE WORK IS... O'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
�J FINAL PLUMBING
❑ CROSS CONNECTION
❑ FINAL
❑ OTHER
QyE BR
C��•
s tim
1982 BUILDING DEPARTMENT
❑BUILDING INSPECTOR
0 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 :- 2- I "n 1 T 2 GG _J i F l/lQ,S Q .J y DATE: ( `-) z
PERMIT# T C Z y - o C/ 7 ISSUED:SECT: 125•71, BLOCK: LOT:
LOCATION: SP c! 41y'1 I19A-3 +C, 'Y4 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 ✓` I�
❑ L.P. GAS
❑ FUEL TANK
❑ FIRE SPRINKLER 5C } e� r�.� -. r� S
❑ FINAL PLUMBING
❑ CROSS CONNECTION
❑ FINAL
❑ OTHER
�yE BR(�k
uJ �
• 1932 BUILDING DEPARTMENT
❑BUILDING INSPECTOR
2/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 : 2 1 q (f- 07(P_S CA,,, DATE:
PERMIT# 17 J ISSUED:!,-) Z. SECT: BLOCK: LOT: �J
LOCATION: �(� � , �� Y� OCCUPANCY:
❑ VIOLATION NOTED THE WORK IS... 0 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
�E BRcb,
Fo
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 : , Tr e. 11 DATE: Z z
PERMIT# ISSUED: SECT: BLOCK: LOT:
LOCATION: _�f' ( ),-1�? OCCUPANCY:
❑ VIOLATION NOTED THE WORK IS... 0 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
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BUILDJNG MPARTMENT
V1L E OF RY F$ R
OOK MAY 2 1 202i4
G E 938 KING RYE BRO NY 10573
l� 1 939-066
4 8 VILLAGE OF RYE BROOK
�, ryebrookmrp- BUILDING DEPARTMENT
INTERIOR BUILDING PERMIT APPLICATION
FOR OFFICE USE ONLY:
3 0 4 l�/ \
d Approval Date: P rmi Application Fee:$ 1007ALJ
Approval Signature: Permit Fees:$
Disapproved: Other:
Application dated: 6`_��-��7 is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance ofa Permit for the
interior alteration of an existing building,or for a change in use,as per detailed statement described below.
1. Job Address:ot d i SBL: Zone:
2. Proposed Improvement.(Describe i detain: v
Afe-W 6©f• 1-- -e
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 1: TIER I1: TIER III:
4. Will the proposed project require the installation of a new,or an extension/modification to an extsti automatic fire
suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) :No: Yes:
(If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans)
5. Occupancy;(I fam.,2 fam.,comm.,etc...)Prior to Construction: I JPa M. After Construction: I -fit in,
6. N.Y State Construction Classification: / N.Y.State Use Classification:
7. Property Owner:_ Ot 1r-I `JV n I CQ! 4 Address: 9 7il'�,iAo r�
Phone# Cell email- 0. s 0-0 c -
8. Applicant- ' Address: At 9 7;: r, �C_ /`
Phone# I 3 Cell#? /'j. 71%— fq email: lhp,
9. Architect: Address:
Phone# Cell# email:
10. Engineer: Address:
Phone# Cell# email:
11. General Contractor: Address:
Phone# Cell# email:
12. Estimated cost of construction $Z, Q 00
(NOTE:"The estimated cost shall include all labor,mat al,scal7olding,fixed equipment,professional tees,and material and labor which may be donated
gratis.)
13. Job Timetable:Start: Finish:
(1)
6/l/2023
ED
BUILD#N� DEPARTMENT D E C IE M
VIL� E OF RYE BROOK MAY 2 1 2024
938 KING V*EET RYE BROOK,NY 10573 l
;\,04)939-0668 VILLAGE OF RYE BROOK
3ij li.rvebrook.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 YORK, COUNTY OF WESTCHESTER ) as:
IV4 h CO a elk residing at, �-� 9 r'-t� �C-ft l
(Print-flame) (Address N0 c 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;
pC 1 're-ee,+-,p p C regc-ont 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.
h'uj6��)
Ail jet��
(Signature of Purl, y Owner(s))
Aa/ o 9r G C e— //L?
(Print Name ot'P o r1 wner(s))
Sworn to before me this7k'��14 }
20 C9
(Nolan I'ubWARI MELILLO
Public,State of New York
wo.OIME6160063
red in Westchester County
ai.un Expires January 29,20 (2)
8/12/2021
This application must be properly completed in its entirety and must include the notarized
signature(s) of the legal owner(s) of the subject property, and the applicant of record in the
spaces provided. Any application not properly completed in its entirety and/or not properly
signed shall be deemed null and void and will be returned to the applicant.
Please note that application fees are non-refundable.
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
, being duly sworn, deposes and states that he/she is the applicant above named,
(print name of individual signing as the applicant)
and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the
for the legal owner and is duly authorized to make and file this application.
(indicate architect,contractor,agent,attorney,etc,)
That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed, or use
conducted at the above captioned property will be in conformance with the details as set forth and contained in this application
and in any accompanying approved plans and specifications, as well as in accordance with the New York State Uniform Fire
Prevention & Building Code, the Code of the Village of Rye Brook and all other applicable laws, ordinances and regulations.
By signing this application, the property owner further declares that he/she has inspected the subject property,and that to
the best of his/her knowledge there are no roof drains, sump pumps or other prohibited stormwater or groundwater
connections or sources of infiltration into the sanitary sewer system on or from the subject property.
Sworn to before me this 2\ Sworn to before me this
day of , 20 day of , 20
igAMTre of Pro "vne Signature of Applicant
C
t ame of Proper?O er Print Name of Appl icant
1
QoPryPublic Notary Public
SHARI MELILLO
Notary Public,State of New York
No.01ME6160063
qualified In Westchester County
,ommisslon Expires January 29,20L
(4)
8/12/2021
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BUIL E MENT
Va, Q Rom; OK JUL 18 2024
938 K1N T2YE NY 10573
> VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
ELECTRICAL PERMIT APPLICATION
Westchester County MasterElectricians License Required
FOR OFFICE USE OIV,, Mp#: _Q T— �\ EP#: CD Z �-
Approval Date: (( Permit Fee: $
Approval Signature: Other:
Application dated, 7/17/24 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.
LAddress: 219 Tree Top Crescent SBL: 129.76-1-63
Zone:
2.Property owner: Marilyn Acocella Address: 219 Tree Top Crescent
Phone#: 9147144999 Cell#: email:
3.Master Electrician: Angelo Zaccagnino Address: 81 Maple Ave Rye NY 10580
Lic.#: 755 Phone#: 914-921-3244 Cell#: email:Office Zaccagnino net
Company Name: Zaccagnino Electric Address:
4.Proposed Electrical Work/Fixture Count:
Wiring for bathroom renovation
5.31 Party Electrical Inspection Agency: SWIS
STATE OF NEW YOM COUNTY OF WESTCHESTER ) as:
Angelo Zaccagnino ,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 legal owner of the property to which this application pertains,or that(s)he is the Electrician
for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.)
The undersigned fiuther 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,day of to fore me this '20 Sworn to be#'pre me s t
y day ,20�
C—
ign ture of roper' Owner Signature of pli
STE EN J. AGNON
i1L YORI< Ang
Print Natp$ob)� Q er H >{I>rjq@f IEW YORK
Qualified I es Sic Count
No. 01GF.51 8
KWdlmyrd?ubdtcExpires October 14. 20___
QcPnblSttes a rrr Countly�
My Commission Expires October 14, 20
6/23/2022
• STATEWIDE INSPECTION SERVICES, INC
1080
SWIS JOBAPPLICATION I ' Ifax914.219.10621SWISNY.com I SWISTraining.com
Office Use Elect.Permit# //) \�+ / Date � 117
Bldg Permit# , /! / �� Utility ID#
Final Certificate# y
City/Village Zip Township k,, k County - �
Address Cross Street Section ,IH 7(- Block I Lot ;
Owner Name/Address(if different than above) Contact Number
❑Basement ❑1st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside Residential ❑Commercial
Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact
Amt Amps
Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw
Incandescent Fluorescent
SERVICE
Amperage Voltage 1 P 3P #Meters #Disconnect ❑Underground ❑New ❑Reconnect
❑Overhead ❑Change
❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection
Additional Information
t
D �C� COM�
I
JUL 18 2024
VILLAGE OF RYE BROOK
I 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.
Inspector Date Finalized Inspect
Company Name Date ) 1 I-r L, Signature
Address City/State Zip Code
License# Phone#
D ECENED State Wide Inspection Services
1080 Main Street
Fishkill, NY 12524
OCT 18 2024 845 202-7224 Phone
914-219-1062 Fax
STATE WIDE INSPECTION SERVICES VILLAGE OF RYE BROOK Email: office@swisny.com
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:
Zaccagnino Electric Christina&Jonathan Acocella/Acocella
Angelo P. Zaccagnino Family Irrevocable Trust
81 Maple Avenue 219 Tree Top Crescent
Rye, NY 10580 Rye Brook, NY 10573
Located at: 219 Tree Top Crescent, Rye Brook, NY 10573
Section: Block: Lot: Electrical Permit Number: EP 24-151
129.76 1 63
Certificate Number: 2024-5516 Building Permit Number: BP 24-120
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: 219 Tree Top Crescent, Rye Brook, NY 10573
The Second Floor: Bathroom 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 17`h day of October
2024.
Name Quantity Rating Circuit Type
GFCI 01 20AMP
Exhaust Fan 01
Wall Sconce 01
Switches 03
Shower LED Luminaire 01
LED Luminaire 01
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.
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BUILDING DEPARTMENT JUN 2 2024
VILLAGE OF RYE BROOK
938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK
(914)939-0668 BUILDING DEPARTMENT
www.ryebrookny.gov
PLUMBING PERMIT APPLICATION j� Q
FOR OFFICE USE ONLY BP#: Q 7—j 40 PP#: ��—�/ /
Approval Date: 6 - 2 N - L O Z 4 Permit Fee: S
Approval Signature: �--� C� 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, 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.
1.Address: I 7rc<- �.VG� SBL: AA 710—1-63 Zone:PUb
2.Proposed Work: J & G -Qr v J V ) 1_{_
VA V k cr�t hK
3.Property Owner: F Address: c, ALL
Phone#: Cell#: email: �^
4.Master Plumber: ( ��/G Address:
Lic.#: a-71 Phone#: C)l�{ ���o (� II #: email: �elv I a ifip• L-90
-T
Company Name: Address: :1 1
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
2nd Floor rr /
I�
3,d Floor
4'Floor
5'Floor
Exterior
5.* List Other Equipment/Provide Details:
(Notarized Signatures Required Next 2 Pages)
-1- 6i u2o24
A
STATE OF NEW YO {,COUNTY OF WESTCHESTER ) as:
1/ ,being duly sworn,deposes and states that he/she is the applicant above named,
(print name 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 0 Sworn to before me this a \
day of 71no1 20 day of -2 ,20
hio�� , al'—N
� Cq-L -A)
ignature of Ploperty Owner Signatur of Applicant
t /V io G
rint Name of Pro rty Owner Prin Name of Applicant
Z�6p/�b &uw
�n I QL
Notary u lic a9 iPRbMELILL0
GREGORY M.RIVERA Notary Pubiic,State of New York
Notary Public,State of New York No.01ME6160063
No.01R16441398 Qualified in Westchester County
Qualified In Westchester County , Corrrr,ission Expires January 29,20—t-)
ill s a if i Ex re ��ocompleted in its entirety and must include the notarized signature(s) of
pl I
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/l/2024
BUILD IrMENT D E C E V E
VIL E OF RY OOK D,
U N 2 1 2Q24
938 KING H ET RYE BR ,NY 10573
( 4 o VILLAGE OF RYE BROOK
www.rye otttdy: ov 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: /�y
,e_�
31, Ai IVIA &Z C , residing at, �)
(Print name) (Address here 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;
co--S C ,Rye Brook,NY.
(.)on 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.
/VA4'u'4�
(Signaturcot'Property wner(s))
(Print Name of Property )%vncr(s))
Sworn to before me this `l
day of l , 20��
(Not.n% P )
GREGORY M.RIVERA
Notary Public,State of New York
No.01 R16441398
Qualified In Westchester County -'-
Commission Expires September 26,2 ,
6/l/2024
Building Pemut Check List&Zonin is
Adder � , `c_ \, 0,(7
Zone: �� 'se: 2-W C.orist.Type: inz Other.
Subunmal Date. 5�2` 'Z� Revuioru Subnurtal Dates:
Applicant (L v\C-_,e \`4"
Nature of Work C'A-�-�1 C1 rl ZBA)UN 0 2024 PB BOT: Ocher.
� . . OK
(�=PP-
Fd mg. L BP: ✓ C/O Flood Plane: Legalizsnon:Duel Notanzed: SBL Taus I.D. Cross Connection H OA:
( ) ( ) Sceruc Roads: Steep Slope& Wetlands: Storm Water Review: Street Opening.
( ) ( > ENVIRO: Long Short Fees: N/A
( ) ( ) SITE PLAN:Topo: Site Protection; S/W Mgrm: Tree Platt Other.
( ) ( ) SURVEY: Dated: Current Archival Sealed: Unacceptable
( ) ( ) PLANS:Date Staged Sealed Copies: E:lecr**,.••�- _Other.
(♦/ ( ) License Workers Comp: Lability: Other.
( ( ) CODE 753#: Dated N/A
( � ( ) FBGH-VOLTAGE ELECTRICAL.•Plats: Permit N/A Other.
( ) ( ) LOW-VOLTAGE ELECTRICAL Places: Permit N/A Other.
( ) ( ) FIRE ALARM/SMOKE DETECTORS Plans: Permit FLW.I.C.:_Buttery:_Other.
( ( ) PLUMBING:Plans: Permit Nat Gas: I-P Gas: N/A/: Other.
( ( ) FIRE SUPPRESSION:Plans. Permit N/A Other.
( � ( ) I-VAC- Plus: Perrnit N/A Other.
J
( ( ) FUEL TANK Plus: Pcm= Fud"I"ype. Other.
( ( ) 2020 NY State ECCC: N/A: Other.
( ( ) Final Survey Final Topo: RA/PE Sign-off Letter: As-Built Plans: Other.
( ( ) BP DENIAL_L E-FFER• C/O DENIAL LE-I TER Other.
( ; O Other.
( ARB mtg.dui; approvaL• notes:
( )ZBA mtg.due: approval• notes:
( )PB mtg.date: approvaL• notes:
REQLq ExISIi:vG PROPOSED NOTHS Date: JUN 0 3 2024
Area
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notes:
1
Affidavit of Exemption to Show Specific Proof of Workers' Compensation Insurance
Coverage for a 1, 2, 3 or 4 Family, Owner-occupied Residence
"This form cannot be used to waive the workers'compensation rights or obligations of any party."
Under penalty of perjury, I certify that I am the owner of the 1, 2, 3 or 4 family, owner-occupied residence
(including condominiums) listed on the building permit that I am applying for, and I am not required to show
specific proof of workers' compensation insurance coverage for such residence because (please check the
appropriate box):
❑ I am performing all the work for which the building permit was issued.
❑ I am not hiring,paying or compensating in any way,the individual(s)that is(are)performing all the work
for which the building permit was issued or helping me perform such work.
I have a homeowners insurance policy that is currently in effect and covers the property listed on the
attached building permit AND am hiring or paying individuals a total of less than 40 hours per week
(aggregate hours for all paid individuals on the jobsite) for which the building permit was issued.
I also agree to either:
♦ acquire appropriate workers' compensation coverage and provide appropriate proof of that coverage on
forms approved by the Chair of the NYS Workers' Compensation Board to the government entity issuing
the building permit if I need to hire or pay individuals a total of 40 hours or more per week(aggregate hours
for all paid individuals on the jobsite) for work indicated on the building permit.or if appropriate,file a CE-
200 exemption form, OR
♦ have the general contractor, performing the work on the 1, 2, 3 or 4 family, owner-occupied residence
(including condominiums)listed on the building permit that I am applying for,provide appropriate proof of
workers' compensation coverage or proof of exemption from that coverage on forms approved by the Chair
of the NYS Workers' Compensation Board to the government entity issuing the building permit if the
project takes a total of 40 hours or more per week(aggregate hours for all paid individuals on the jobsite)for
j wo* indi ted on t building permit.
( tgnature of Homeowner) ate Sig ed)
Ma r,I')I I I., M. AC p C e, q Home Telephone Number
(Hom owner's Name Printed)
Sworn to before me this _ day of
Property Address that requires the building permit: — 0-A
(County Clerk or Nota Public)
SHARI MELILL
Notary Public,State of New York
No.01ME6160063
Qualified In Westchester County
Ccrr.mission Expires January 29,20,��
Once notarized,this BP-1 form serves as an exemption for both workers'compensation and disability benefits insurance coverage.
BP-1 (12/08) NY-WCB
Questions about your Policy? Policy Number: Report a Claim: VO
Libertv
Call 1 800 869 4009 C' H37 228-1088 40 4 7 1 800 2CLAIMS or Mutual.
' ��A//L�, LibertyMutual.com/insurance INS
vURANCE
, t (
ACTION REQUIRED: '/ tt. -1 9
PLEASE REVIEW AND KEEP FOR YOUR REC RDS. /
Policy Declarations
Total 12 Month Premium: $ 1 ,866.00 'fir q
4"' Homeowners Policy Declarations provided r LlbertyGuard Deluxe Homeow y
and underwritten by Liberty Insurance Corporation (a stock
insurance companyl, Boston, MA. / l/
Your discounts and benefits have been applied. Includes local fees and charges where applicable. J—L
Through your affiliation with the Penn State Alumni Association your policy includes special group savings on
your home insurance.
Insurance Information
Named Insured: The 2021 Acocella Family Policy Number: H37-228-108868-40 4 7
Irrevocable Trust
Mailing Address: 219 Treetop Cres Policy Period: 03/12/2024-03/12/2025 12:01 a.m.
Rye Brook NY 10573-1639 standard time at the address of the
Named Insured at Insured Location.
Insured Location: Same as Mailing address above Declarations Effective:03/12/2024
DISCOUNTS AND BENEFITS SECTION
Your discounts and benefits have been applied to your total policy premium.
• Inflation Protection Discount • Off Premise Theft Exclusion
• Multi Policy Discount - Auto • Multi Policy Discount - Personal Liability
• Basic Home Safety
• Smart Home
• Theft Protection
• Fire Protection
Coverage Information
Standard Policy with HomeProtector Plus
SECTION I COVERAGES LIMITS PREMIUM
A. Dwelling with Expanded Replacement Cost $ 360,300
B. Other Structures on Insured Location $ 36,030
C. Personal Property with Replacement Cost $ 270,230
D. Loss of Use of Insured Location Actual Loss Sustained
FMHO 3047 05 16 THIS IS NOT YOUR HOME INSURANCE BILL YOU WILL BE BILLED SEPARATELY. Page 1 of 3
Want to Add a Coverage? Policy Number: Report a Claim: Liberty
Call 1-91 7-968-3034 to talk to j H37-228-108868-40 4 7 1-800-2CLAIMS or Mutual.
your agent about the availability LibertyMutual.com/insurance INSURANCE
of this coverage and whether it
meets your needs.
Coverage Information continued
SECTION II COVERAGES LIMITS PREMIUM
E. Personal Liability (each occurrence) $ 100,000
F. Medical Payments to Others (each person) $ 1,000
POLICY DEDUCTIBLES
Losses covered under Section I are subject to a deductible of: $500
If losses are a result of Wind they are subject to a deductible of: $500
If losses are a result of a Hurricane they are subject to a deductible of 5%: $18,015
[Total Standard Policy with HomeProtector Plus $ 1,866
ADDITIONAL COVERAGES DEDUCTIBLE LIMITS PREMIUM
Credit Card, Fund Transfer Card, Forgery $ 1,000 $ 0
Workers Compensation Coverage INCL
Total Additional Coverages $ 0
Additional Coverages and Products Available"
We've reviewed your policy and have identified additional optional coverages and products that can add valuable
protection. Talk to your agent about purchasing the following coverages and products and whether they meet
your needs.
• Home Computer and Smartphone: If your smartphone or other devices are not insured, repairing or replacing
them can be expensive. Did you know you can Insure multiple devices for up to $10,000 with a deductible of
$50.00?
• Identity Fraud Expense: A stolen identity can be scary and expensive. We'll provide counseling, and pay up
to $30,000 for expenses such as lost wages and attorney fees incurred to recover your identity.
• Water Backup and Sump Pump Overflow: Water damage can ruin your possessions. If your sump pump fails,
or you suffer water damage from a sewer or drain backup, we'll pay for covered home and personal property
losses.
"These optional coverages are subject to policy provisions, limitations, and exclusions. Daily limits or a
deductible may apply. For a complete explanation, please consult your agent today.
FMHO 3047 05 16 THIS IS NOT YOUR HOME INSURANCE BILL. YOU WILL BE BILLED SEPARATELY. Page 2 of 3
Want to Add a Coverage? Policy Number: Report a Claim: Liberty
Call 1-917-968-3034 to talk to H37-228-108868 40 4 7 1 -800-2CLAIMS or 10k mutuil.
your agent about the availability LibertyMutual.com/insurance NsuRAN:F
of this coverage and whether it
meets your needs.
Coverage Information continued
SECTION II COVERAGES LIMITS PREMIUM
E. Personal Liability leach occurrence) $ 100,000
F. Medical Payments to Others leach person) $ 1,000
POLICY DEDUCTIBLES
Losses covered under Section I are subject to a deductible of: $500
If losses are a result of Wind they are subject to a deductible of: $500
If losses are a result of a Hurricane they are subject to a deductible of 5%: $18,015
[Tota
l Standard Policy with HomeProtector Plus $ 1,866
ADDITIONAL COVERAGES DEDUCTIBLE LIMITS PREMIUM
Credit Card, Fund Transfer Card, Forgery $ 1,000 $ 0
Workers Compensation Coverage INCL
Total Additional Coverages $ 0
Total 12 Month Policy Premium: $1,866.00
Additional Coverages and Products Available"
We've reviewed your policy and have identified additional optional coverages and products that can add valuable
protection. Talk to your agent about purchasing the following coverages and products and whether they meet
your needs.
• Home Computer and Smartphone: If your smartphone or other devices are not insured, repairing or replacing
them can be expensive. Did you know you can insure multiple devices for up to $10,000 with a deductible of
$50.007
• Identity Fraud Expense: A stolen Identity can be scary and expensive. We'll provide counseling, and pay up
to $30,000 for expenses such as lost wages and attorney fees incurred to recover your identity.
• Water Backup and Sump Pump Overflow: Water damage can ruin your possessions. If your sump pump fails,
or you suffer water damage from a sewer or drain backup, we'll pay for covered home and personal property
losses.
*These optional coverages are subject to policy provisions, limitations, and exclusions. Daily limits or a
deductible may apply. For a complete explanation, please consult your agent today.
GMHO 3047 05 16 THIS IS NOT YOUR HOME INSURANCE BILL. YOU WILL BE BILLED SEPARATELY Page 2 of 3