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HomeMy WebLinkAboutBP24-138PERMIT # SECTION 3� BLOCK LOT TYPE OF WORK 1J1pV(f e �4C2 ec'Wa� V S D ����Ce� /Souk 1OR LOCATION � a s�U OWNER a� C / (7) Li CONTRACTOR�Q e S G' / EST. COST a 1! FEE `� / 00077 V/CO # ►� FEE. LO50YP/J DATE TCO # FEE DATE •:• IZDA4� ..TING L ®✓ FOUNDATIONFRAMING _ �.. i RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS SPRINKLER ELECTRIC C7 LOW -VOLT O ALARM C� AS BUILT O FINAL OTHER APPROVALS ARB BOT PB ZBA OTHER 4R QL�+4'u1 i M O VILLAGE OF RYE BROOK MAYOR 938 King Street,Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914)939-0668 Christopher J.Bradbury www.ryebrookny.gov TRUSTEES BUILDING & FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J.Fischer David M.Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE August 28,2024 Win Ridge Realty LLC c/o Alena Hakanjin 24 Rye Ridge Plaza Rye Brook,New York 10573 Re: 158-204 South Ridge Street,Rye Brook,New York 10573 Parcel ID#: 141.35-2-36 Building Permit#24-138 issued on 7/2/2024 for Replacement Sidewalk Pavers & Curb This certifies that the new sidewalk pavers and curb,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to For office use onl AUG 2 0 2024 BUILD MENT PERMIT# - ,3$ VIL OF RYE OK ISSUED: — —� VILLAGE OF RYE BROOK 938 KING STRE YE BROOK, YORK 10573 DATE: —ol0—c�y BUILDIf�<r DEPARTMENT > 9 -0 0/ FEE:, �OS�— PAID I0- 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 stsssrtttrstttsssrs+♦ts+r+rsws+ssrsrstrrtrttssst+s+s+•srs•srssrtssrtsrrrttsssssrtt+ssssrr++tsssstsrrssesrrtrrrrrwttsstsssss++ Address: 182 South Ridge Street - Rye Ridge Shopping Center Occupancy/Use: Commercial Parcel ID#: 141.35-2-36 Zone: Cl-P Owner: Win Ridge Realty Address:24 Rye Ridge Plaza, Rye Brooke, NY 10573 P.E./R.A. or Contractor: Atlantic Asphalt and Earth, Inc.Address: 172 Ferris Avenue, White Plains, NY 10603 Person in responsible charge: Louis Bettino Address: 172 Ferris Avenue, White Plains, NY 10603 Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW YORK,COUNTY OF WESTCHESTER as: L-o J J� A 111140 being duly sworn,deposes and says that he/she resides at (Print Name of Applicant) (No.and Street) , in W I1MT6 f L*VM S in the County of w�� Sf�••� in the State of �Y that (Cityrrown/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:$ 32,440.00 excluding permit fees for the construction or alteration of, Replacement of Belgian block curbing with concrete curb along the front, installation of a concrete slab at the rear where pavers were. 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-IO.A.of the Code of the Village of Rye Brook. Sworn to before me this IS Sworn to before me this da of�SIT , 20 2t day of 920 iga of PropeV Owner a of A n i V er f�f?"L 1 S t� L.00.1's &C S1J v Pr' t N&ne of Prope n Pr t Na of Appl icant oLip lic fqo u i MINA RAKANJIN AIENA HAKANJIN i 2o24 NOTARY PUSIX.STATE OF NEW YORK NOTARY PUBLIC,STATE OF NEW YORK Registration No.OIHAOO13645 Registration No.OIHAO013645 Qualified in Westchester County Qualified in Westchester County My Commission Expires 9119r2o2' My Commission Expires 911912027 �yE BR(�k. 1932 BUILDING DEPARTMENT ❑�UILDING 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 \\ Cl_W, v`"T LDQ j DATE: Z - Z JL PERMIT# U� `f' �7 ISSUED: /' 2 -2 AECT: BLOCK: Z LOT: LOCATION: k- '\��� Lk)r) OL h`1 poi AA-� `I l J.V . OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... D'ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS v NL ❑ L.P. GAS ❑ FUEL TANK D ❑ FIRE SPRINKLER FA k t . ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL " OTHER���� �yE BROuk. '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 : DATE: PERMIT# J` l ' ISSUED: SECT:7l !_BLOCK: Z 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 5 QyE BRC�/f, �� Zm 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 : 102 5oa l DATE: (J - 7 - �7 PERMIT# 13 P 2 L/- ISSUED: ' Z" Z` SECT: lql YT- BLOCK:�T _LOT: J� LOCATION: �/ /t�) (, ��� OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... Q' ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS S ) ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER �yE BR(�k. w � BUILDING DEPARTMENT { UILDING INSPECTOR ru 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# C q ISSUED: SECT: 1 BLOCK: LOT: LOCATION: i �' } ` t'�- 1J 1 tr ` 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 a - a a 00 cr - MM n � s v u IW i _ � a _ W a �• cn o. v ,,e � � � i 'adi -0 ai p +� 0Q3o � v ° � � W ' 00 2 a Ln 0 � M � Ow dam' d O @ d ti a O ° C . ° 3 Ln ■ Mw � o Uzba � o r � p cn M U a U He o W S a y c as � VCN F OC 1 w Q v H w Cy - o v a M1 w z � M = o ' O _ A z a G; O o z a 60 Hz „ u U oQj 00 a n w cn Q ~ W 0 z z o 1 O V O V � o M . � 2 u V z w i' a � 0 7 = OO � vwi E� p d .- c ol 'MM-' ^^p rT 1 ��r ] z''��❑^ ° o W hl W �✓ W cn i F a F Q0V ) ECE 1JE BUII, ENTILOK JUN 2 5 202�938 KING NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT FOR OFFICE USE ONLY: Approval Date: JUL 0 �o P t# �2 ! C/ Application# Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: : Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# : Secretary: ZBA Approval Date: Case# Other: l L Q Application Fee: Permit Fees: EXTERIOR BUILDING PERMIT APPLICATION Application dated: June 5,2024 is hereby made to the Building Inspectorofthe Village of Rye Brook,NY,for the issuance ofa Permit forthe construction of buildings,structures,additions,alterations or for a change in use,as per detailed statement described below. 1. JobAddress: 182 S.Ridge Street,Rye Brook. 2. Parcel 1D#: I L4 1 .35-cD p Zone: 3. Proposed Improvement(Describe in detail): Remove approximately 300 linear feet of Belgian Block curb and replace with a concrete curb along with a 16 inch wide concrete band,Remove and reset unilock pavers to proper elevation,remove pavers in an area approximately 4.5 feet x 23 feet and replace with concrete sidewalk panels. 4. Property Owner: pW i`IV Q A ' 9 t�1 j, � Address: `-1 46 O l p VaA ''"•���T."_[[ Phone# q{4+ J(A-+W� Cell# e-mail '&jj WMV List All Other Properties Owned in Rye Brook: Applicant: Atlantic Asphalt and Earth,Inc Address: 172 Perris Avenue,White Plains,NY 10603 Phone# 914-761-5371 Cell# q14 n-4R31 e-mail AtlanficAsphaltWagmail.com Architect: Tk."R MS 566ixTE;5 Address: 5l Z h - Psi W A-f a vjHtTF, PLAiN6 10008 Phone# 914- 2b9 " b0 1( Cell# 914— 35 3—(tit e-mail JT@ TJ-W A"t1fbj6,COrn Engineer: Address: Phone# Cell# e-mail General Contractor:A_ LOU C AJ e HM,� f M& K • ,y ,, Address: I �S p�j s-5 ci , IV L(oC�3 �/ Phone# �r�T�+ Cell# _ 11 e-mail (1) 6/d/2024 5. Occupancy;(1-Fam.,2-Fain.,Commercial.,etc...)Pre-construction: Post-construction: 6. Area of lot: Square feet: Acres: 7. Dimensions from proposed building or structure to lot lines: front yard: rear yard: right side yard: left side yard: other: 8. If building is located on a corner lot,which street does it front on: 9. Area of proposed building in square feet: Basement: I'fl: 2nd fl: 311 fl: 10. Total Square Footage of the proposed new construction: 11, For additions,total square footage added:Basement: I'fl: 2nd fl: 311 fl: 12. Total Square Footage of the proposed renovation to the existing structure: 13, N.Y. State Construction Classification: N.Y.State Use Classification: 14. Number of stories: Overall Height: Median Height: 15, Basement to be full,or partiaL• finished or unfinished: 16. What material is the exterior finish: 17. Roof style;peaked,hip,mansard,shed,etc: Roofing material: 18. What system of heating: 19. If private sewage disposal is necessary,approval by the Westchester County Health Department must be submitted with this application. 20. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic re suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) Yes: No: (if yes,applicant must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 21. Will the proposed project disturb 400 sq.ft.or more of land,or create 400 sq.ft.or more of impewious coverage requiring a Stormwater Management Control Permit as per§217 of Village Code? Yes: No: V Area: 22. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: (if yes,applicant must submit a Site Plan Application,&provide detailed drawings) 23. Will the proposed project require a Steep Slopes Permit as per§213 of Village Code Yes: No: (if yes,you must submit a Site Plan Application, &provide a detailed topographical survey) 24. Is the lot located within 100 ft.of a Wetland as per§245 of Village Code? Yes: No: (if yes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan) 25. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes: No: (if yes,the area and elevations of the flood plane must be properly depicted on the survey&site plan) 26. Will the proposed project require a Tree Removal Permit as per§235 of Village Code? Yes: No: (if yes,applicant must submit a Tree Removal Permit Application) 27. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No: 1/ Indicate: TIER 1: TIER 11: TIER III: (if yes,a Home Occupation Permit Application is required) 28. List all zoning variances granted or denied for the subject property: 29. What is the total estimated cost of construction: $ $29,440.00 Note:The estimated cost shall include all site improvements,labor,material,scaffolding,fixed equipment,professional fees, including any material and labor which may be donated gratis.If the final cost exceeds the estimated cost,an additional fee will be required prior to issuance of the C/D. 30. Estimated date of completion: (2) 6i1/2024 BUILD MENT Vi E OF Rx OK 938 KING ET RZ E BR NY 10573 ,0 �c ov AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • STORM SEWERS AND SANITARY SEWERS 'PHIS 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 ��ii YORK, COUNTY OF WESTCHESTER ) as; pp p,�,/Pxb6� ojt u']A ,residing at, Zt FYe PIA?* (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; ��� ' ,"" 5 P I �(•`'� `�%(�,-E '�j" , 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. of Proper ("*.e . rN; DO "&lr15 (Print Name of Property Uwt}7:fts)) Sworn to before me this 71,71" da} o 01J� , 20 —7 ot (Notary Public) ALENA HAKANJIN NOTARY PUKX.STATE OF NEW YORK Regpistration No.01NA0013645 {��) Oualifled in Westchester County MY Commission Expires Oil91202T 1 6/1/2024 This application must be properly completed in its entirety by a N.Y. State Registered Architect or N.Y. State Licensed Professional Engineer& signed by those professionals where indicated. It must also 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 ofindividual 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. 1 Sworn to before me this Z' Sworn to before me this " day of �1 C. , 20 day of �'�l , 20 Z)rre of Pr erty,aRrt:r�}�/ ,,r Signature of Applicant .buGl-ISM !NO P int a of Property(jS�r er/} Print Name f Applicant Notary Public Notary Public ALENA HAKANJIN NOTARY FUSUC,STATE OF NEW YORK ALENA HAKANJIN Registration No.01HA0013645 NOTARY PUMX,STATE OF NEW YORtt Qualified In Westchester County Registration No.01HA0013645 My CoeMaisslon Explras 9119037 Qualified In Westchester county my eoeun"W ExpNas 9tt9027 (xl 6/1/202a Building Permit C(a�heck List & ZoningAnalysis OB & C ONLY Address: ► , SBL: ` Zone: - C Us. Const.Type: Other: Submittal Date: Revisions Submittal Dates: Applicant: Nature of Work: xf\ k �- Q�v L + \ 1 CC_q�- - Reviews:ZBA: t►Jvy� `I( �Q PB ^� BP: Other: N,EK OK/ ,��" (w FEES:Filing: BP: C/O Legalization: ( ) ( ) APP.: Date Stamped: Properly Signed: SBL Verified: Cross Connection: F.O.G.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening. ( ) ( ) ENVIRO.:Long Short. Fees N/A: ( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmt: Tree Plan: Other. ( ) ( SURVEY:Dated: Current; Archival Sealed: Unacceptable: ( ) PLANS:Date Stamped: Sealed: Copies:��Electronic Other. ( ( License: Workers Comp:�ry ✓ Comp.Waiver. Other. Code 753#: Dated: N/A: ( ) ( ) HIGH-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit: N/A: Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H.W.I.C.:_Battery _Other. ( ) ( ) PLUMBING:Plans: Permit: Nat Gas: LP Gas: Grease Trap: 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: REQLURED EXISTING PROPOSED NOTES Area- Cirde: APPROVED Frontaee Front Vate: JUL Front Sides: Rear. F.A.R.: en S ace Height: Stories: notes: ►r ,+ram-'_ Y � J..r�ti( � '. '�� � �y-,�r'r�(.s-.g.ws� Ilk �r /• I' i - �' '. „yid '� ..�. ti.. 1Ix .4 � / •. Tim ♦ �.I{/''_ I - , h, \ J, DATE(MMIDDIYYYY) A`OR131'® CERTIFICATE OF LIABILITY INSURANCE 06/26/2024 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 Ward Bennett NAME: MRE Insurance Agency PHONE (g14)696-3000 FAX (914)696-3020 AIC No Ext: A/C No 2975 Westchester Avenue E-MAIL Wbennett@insurancemre.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC• Purchase NY 10577 INSURER A: Charter Oak Fire Insurance Co. 25615 INSURED INSURER B: Travelers C&S Of Illinois 19046 Atlantic Asphalt and Earth,Inc. INSURER C: Travelers Indemnity Company 25658 172 Ferris Ave INSURER D: Phoenix Insurance Company 25623 INSURER E: ShelterPoint Life Insurance Company 81434 White Plains NY 10603 INSURER F: COVERAGES CERTIFICATE NUMBER: Master 23-24 GL BA WC REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOVV'HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ 300,000 X Blanket Additional Insured MED EXP(Any one person) $ 5,000 A X Primary&Non-contributory Y Y 680-3KO33457-23-42 11/02/2023 11/02/2024 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X PRO LOC PRODUCTS-COMPfOP AGG $ 2,000,000 JECT OTHER: CNTBL $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED Y Y BA-3P186180-23-42 11/02/2023 11/02/2024 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Medical payments $ 5,000 X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 C EXCESS LIAB CLAIMS-MADE Y Y CUP-5PO28228-23-42 11/02/2023 11/02/2024 AGGREGATE $ 5,000,000 X DED RETENTION$ 10,000 $ WORKERS COMPENSATION X1 PER STATUTE ERH AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 D OFFICERIMEMBEREXCLUDED9 NIA Y UB-3K035936-23-42 11/02/2023 11/02/2024 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Continuous until NY Disability&PFL E D290616 01/02/2018 cancelled DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if mom space is required) 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 Street 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 YORIC Workers' CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured 914-761-5370 Atlantic Asphalt and Earth,Inc. 172 Ferris Avenue White Plains,NY 10603 1c.NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 20-0516226 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Phoenix Insurance Company Village of Rye Brook 938 King Street 31b.Policy Number of Entity Listed in Box"1a" Rye Brook,NY 10573 UB-3K035936-22-42 13c.Policy effective period 1 1/0212 023 to 11/02/2024 3d.The Proprietor,Partners or Executive Officers are EJ included.(Only check box if all partners/officers included) nX all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box 1 a"for workers' compensation under the New York State Workers'Compensation Law. (To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: James Eleftherion (Pri na of au ri d r presenlatip or licensed agent of insurance carrier) Approved by: (Signa ure) (Date) Title: Press nt Telephone Number of authorized representative or licensed agent of insurance carrier: Please Note:Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-17) www.wcb.ny.gov Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Friday,July 5, 2024 9:43 AM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 07/05/2024 09:42 To: VIL RYE BROOK PRIMARY Transmitted: 07/05/2024 09:42 00002 Ticket: 07054-000-304-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 182 To: Name: S RIDGE ST Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: IN FRONT OF CVS STORE, ENTIRE FRONT CURB OF BELGIAN BLOCK NearSt: HIGH ST & ELLENDALE AVE Means of Excavation: JACKHAMMER Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: SIDEWALK REPAIR / RESTORE Estimated Work Complete Date: 07/31/2024 Depth of excavation: 1 FEET Site dimensions: Length 300 FEET Width 3 FEET Start Date and Time: 07/19/2024 07:00 Must Start By: 08/02/2024 ------------------------------------------------------------------------------ Contact Name: LOUIS BETTINO Company: ATLANTIC ASPHALT & EARTH Addrl: 172 FERRIS AVE Addr2: City: WHITE PLAINS State: NY Zip: 10603 Phone: 914-760-4631 Fax: Email: atlanticasphaltny@gmail.com Field Contact: LOUIS BETTINO Alt Phone: 914-760-4631 Email: atlanticasphaltny@gmail.com Working for: WINDRIDGE REALTY ------------------------------------------------------------------------------ Comments: WILL BE MARKED IN WHITE Lookup Type: MANUAL ------------------------------------------------------------------------------ Members: ALTICE USA BELL-VALHALLA/ WSCHSTR CONED LEVEL 3 COMMUN NYS THWY AUTH / NY SUEZ WTR WESTCHESTER i VIL RYE BROOK WESTCHESTER CTY SWR z Z- 71 v <2 'u x 3:0 uo v 3aao z ~ l&h w i 3 `In ! b N Y F— � ' Oz O W im /n1 of cl�j co d N O 0= _ N w IX U o s -Lij J Of M } Q ++ �e Z .a '°° V N LL Q °��� L1J ° >o ' W Z O(D N o N, ( o � w Z U >�mo z 0 w°mow <W°�� ` w N" Z <� <a ` ~ g J F �<�° _° _ >a U �N� < !� syQpa =wam o Q ILI �w o. i 7 d *� H r p p°c p a E O O zZ $O Jum GS * W 00z� N .ice OP - Q z v Z YId� aZZZ w a0 W W LL < x u o ¢fir yy Q 3 > zz u s� drcr . 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