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HomeMy WebLinkAboutBP24-147PERNHT # SEC71ON 3 TYPE OF WORK JOB LOCATION OW N o O=va*#�/ CONTRACTOR - E COST 7 DATE: , L/ �. S )CK LOT / /J 0 S/VU�CCPSS�yorLl Sf�ov�'PO����4f �p.vla P S l�P/l �Q 4,(,, (4 j &Pewmoo all TCO # FEE v DATE DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS m SPRINKLER _ ( ELECTRIC �Q LOW -VOLT M r, AS BUILT C� FINAL I NSP 1�TI�L' _�JLC OTHER APPROVALS ARB BOT PS ZBA OTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK No: 25-028 Certificate of ®coup ucp J00,0 E1�6M6)JkP74�� Ellis is to certify that Q li of, PIDLki having duly filed an application on %YJ1bJk144 1 U,, 20,2,5 requesting a Certificate of Occupancy for the premises known as, 14P �H//Cyes� 0 Ile— , Rye Brook,NY, located in a Zoning District and shown on the most current Tax Map as Section: /, / Block: / Lot: / and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. ` - 7, issued / O¢ 20 2 , 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: p-,J — - I' for the following purposes: ( Q /'7Of '40yrloe 'Ce WB�J -e�� Jv TIM p2tfmf aj� 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 height shall be made,tLor shall ft building be moved from one location to another until a permit to accomplish such change x5sNen obta' fro t e B mg Inspector. Building Inspector,Village of Rye Brook: Date: FEB 2 0 2025 D [E C EV BUILD ENT For office use onl PERMIT# 7 VIL OF RYE OK ISSUED: FEB 10 2025 8 KING STRE YE BROOK YORK 10573 DATE: FEE: PAID VILLAGE OF RYE BROOK > ov BUILDING DEPARTMENT APPLICATION FOR CERTIFICATE OF OCCUPANCY, CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION Address: I C> H 1 I l A yQ. Occupancy/Use: Parcel IV#: Zone: Owner: OAO 6. t10- C 0JCk m Q11(I Q Address: IG O1 I I Cry /4U Q, P.E./R.A. or Contractor: 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: . being duly sworn,deposes and says that he/she resides at G 14 1 xA� A~,fi.Q_ nt Name of App'cant) 1 ) , (No.and Street) in T fOOV ,in the County of W a 1 c'Y l toe Y 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 incllfupdin�g,the monetary value of any materialsr-Lo-61 d labor which m y have been donated gratis was:$ .� • �� (-T2�ar� t Yl c C�N1t� (J.q O) �, for the construction or alteration of: LJ SfZ �Q 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 0 Sworn to before me this to day of f} , 20Z-\2, day of C_LiA , 20 '�5 Sign a of Property Owne \ Signaltwdof Applicant N"\E_'\Y� ){Va-�nclC- ,a F_U0L-6,C_�c1►S)�Cx, Print Name of Property Owner SHARI MEULLO ame of Applicant Notary Public,State of New York No.01ME6160063 Aa' blic Qualified In Westchester County Public Commisslon Expires Jendary 29,20Z 6/I/2024 �E BRC-' 1982 BUILDING DEPARTMENT El 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# 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�k• BUILDING DEPARTMENT P 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 - - - - - - - - -2-Z�--- - - - - - - - - - �S ADDRESS : DATE: `` 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��. O�` tim cu � 1982 BUILDING DEPARTMENT 0 BUILDING INSPECTOR f ❑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 V t�l 4 V- ` `\' DATE: ?���� 2 PERMIT# �',��� > ISSUED: SECT: BLOCK: LOT: LOCATION: \ � � "-} OCCUPANCY: ❑ Violation Noted THE WORK IS... ❑ PASSED ❑ FAILED REINSPECTION SITE INSPECTION �� `�'�r.� REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ) ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P. GasU � ►� �� c:� L� ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ` r/ ❑ FINAL i ,c :,� t cl ❑ OTHER c L cX_'s c r)�.S ■ ■ ■ �' � N W � TT z 'T N ■ _ W v N Oo \ A Q. a.Q ■ ' P-4M4 4-4 m V w c/i 11 ■ E" A O M ^a 0 Cl) F� ,.., ad' c%� a v � m ergg' � wM ■ V v W x a 0 v a W � a -�o �� o o ao F ■ F+ ,n o E� O Z{ © ` M ck Q W Ln 3 v ~ W V Y w .� z o° O W A � � � v � �✓ y . �i ' _ O c� as a G � aH� �x � o CZ w VVv� o O _ ° f h w rT� � y ' .u ie 2 O H H A ° �' v U z - � z ° z � � �, o = moo; v!I or � V ■ 4 , p X o _ c, 4. v� H zzb ,� �� cj �.., o p O U a Q Is,OW 0 a . CA cn U o ob O.� 0 a v F � �� . D "0 BUILPJN � ,__ TMENT D VIL)LAE OF R �, ROOKni 1 938 KING Sd':Y4 ET RYE BROOK,NY 10573 JINN 1 8 2024 VILLAGE OF RYE BROOK ov BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: _C� (� Approval Date: JUL 0 2 ?OZ4 /- / 7Application Fee:$ 00 to Approval Signature: Permit Fees: S. Disapproved: Other: Application dated: fD 4 4 'c�# is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing building,or for a change in use,as per detailed statement described below. 1. Job Address: N') 41 f-4_C LEST EVE. SBL: 4M•46 • 4 Zone: 4Z9P-"F 2. Proposed Improvement.( escribe in detail): C I o<--`r - 1i n C e o �X i S 'YI t1 ' Q'� O r -r� 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: >� Yes: If yes,indicate: TIER I: TIER II: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type 1 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: o)- M• After Construction: c� . 6. N.Y State Construction Classification: V6 N.Y.State Use Classification: V 8 7. Property Owner: _SaA,O Address: ACo kIiLLG� ST ' Phone# Cell# 914 41q 5-4-_�D email 8. Applicant: Address: Phone# Cell# email: 9. Architect: AP-LC�t5 Address: 155a T*A) RJOP<fl Phone# Cell# 'i I/f 3b4 -1A3 email:;7Z-1005,0 r*5 N @-4601 MA.t L. cAQ4v\ 10. Engineer: Address: Phone# Cell# email: 11. General Contractor: Address: Phone# Cell# email: 12. Estimated cost of construction $ Z 000 (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: (1) 6/1/2024 BUILD - MENT VEL E OF R OOK 938 KING ET RYE BRO ,NY 10573 7JU 18 2024ov VILCIF RYE FsQOOKBU DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 • STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: I �1 0� FVrAM� IS�H ,,residin at, 10 � I 1 CYQ.&l ACk } (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 A,fnfidavit of Compliance pertains at, AoQ % 1C(-a' 6�'C� '{ Rye Brook,NY. (Job Address) Further that all statements contained herein are true, and that to the best of his/her knowledge and belief, that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and 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. Q-- (SignaNWof Property O r(s'I) (Print Name of Property Owner(s)) Sworn to before me this 204 (Notary ublic) SHARI MELlLLO Notary Public,State of New York No.01ME6160063 Qualified In Westchester County Commission Expires January 29,20 t%zl (2) 6YI12024 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 Sworn to before me this day of , 20 0- day of , 20 Sign f Property O er Signature of Applicant ame of Property Owner Print Name of Applicant Notary Public Notary Public SHARI MELILLO Notary Public,State of New York No.OIME6160063 Quallfled in Westchester CountxZ-7 Commission Expires January 29,20_ (4) 6/l/2Q24 , O , Ln Ln CV N N G! w y W G Li v. pq • � � a o O Z z Ln o A • .. j z O W v - c 00 8 E� • s W eq w ILn 00 N , _ ,� w z � • • �,.► CAA (� Z w ° O o U = O v w Z w W Uz _ o � _� w M It Z W x o w " O ci � N ry Q � • . a z t c a w A V w O N . o E• x =z Ln x V w o �" � • z w H z A o � z oa E� O z � ' _ - E15R� BULL ADu NT VIL E OF RYE K �----- 938 KIN ET RYE B ,NY 10573 MAY Y 2 8 2024 DD .or VILLAGE OF RYE BROOK ELECTRICAL PERMIT APPLICATIO BUILDING DEPARTMENT Westchester County /JMaster �Electricians License Required / FOR OFFICE USE ONLY BP#: _/ / / 7 EP #: t7D Approval Date: Permit Fee: $ /\ 0 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,S 3 g- )# is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove electrical equipment,wiring,fixtures,or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with,all applicable Federal,State,County and Local Codes. / p 1.Address: L /i'� L , SBL: l.3Si 7 —l—1 Zone:xC )_F 2.Property Owner:�;�iO&,G �� C C �.(YQ�Q ��1 Vt Address: Q. Phone#: in S"� :>V Cell#: email: 3.Master Electrician/Licensed Installer: 0 Address: Lic.#: 410Z Phone#: 1Z Sl Cell#: email: Company Name:,f (;4r- CW C .Q _Address: + l le C 4.Proposed Electrical Work/Fixture Count: 5.3'Party Electrical Inspection Agency: �,5TATJ�OFXWYOR�,COUNTY OF WESTCHESTER ) a.(� 1' being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant) state that(s)he is the for the legal owner and is duly authorized to make and file this application. (Master Electrician Licensed Installer) The undersigned further states that all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances,and regulations. Sworn to before me this Sworn to befor e thi day of 20 day of Signature of Property Owner i •of A tc t Print Name of Property Owner a of Ap Ii� t Not e Q�" Notary Public NotogtMME6160063 Quallf led In Westchester County Commission Expires lanuafy 29,20 Z STATE WIDE INSPECTION SERVICES, INC. 0:0 • • Swis JOB APPLICATION0. • Office Use Elect. Permit# -/ _ / Iry Date 5 Bldg Permit# �y— /�-/ Sq Ft Plumbing Permit# Final Certificate# City/Village e Zip '1 5 Building Dept. `\v Izv-k County Address 6 1*L; ` KQ9 ' Cross Street Section Block Lot Owner Name/Address(If different than above) d, Contact Number 0 ❑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 C/0 Detector Hood Trash Compact Amt Amps 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 ,rgLegalization ❑ Safety Inspection ❑Consultation [VC p CE� ���I MAY 2 8 2024 VILLAGE OF RYE BROOK BUILDING DEPARTMENT This application is valid for one(1)year from the date received by SWIS.This application is intended to cover the above listed items to be inspected,if at any time of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other inspection company.The applicant, owner or authorized agent agrees to all the above terms and conditions as set forth for the application. r � ) Email Address .�ivy l V) -, Name bo -00 License# (1 Z Date Signature Address City/State r r ++ Zip Code .� Company T l L }c ) Phone# DState Wide Inspection Services 1080 Main Street FishkiJAN 2 4 2 225 845 202-17224 Phone a914-219-1062 Fax STATE WIDE INSPECTION SERVICES I VILLAGE OF RYE BROOK Email: office@swisny.com BUILDING DEPARTMENT 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: BNA Electric Corp Joao& Maria Evangelista Rafael Guedes 16 Hillcrest Avenue 18 Daniels Place Rye Brook, NY 10573 White Plains, NY 10604 Located at: 16 Hillcrest Avenue, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP24-150 135.76 1 1 Certificate Number:2024-8476 Building Permit Number: BP24-147 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: 16 Hillcrest Avenue, Rye Brook, NY 10573 The Basement:Storage Area 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 27th day of November 2024. Name Quantity Rating Circuit Type Smoke Detectors 03 GFCI Receptacles 05 Switches 02 A Visual Inspection of existing conditions was performed on November 27`h, 2024,of the Basement: Kitchen and Storage Area and Conforms to NFPA 70-2017 NEC. No Defects Were Noted. r r 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. _ _ _ g _[ Ln N O = N \ t N � w = N t e R, cn a H W O xw a A a .. n Qa ►—+ c z ° 09 Li; a F Ln 00 i 0o P Q O x N w u - 00 z " M M , ayy z A o f , ai W ° w a w a W� Ln a (Al � a Q I m BRnvD E[ ' WL� BUIL G E MENT R D, VII. E OF RYE OK SEP 2 4 2024 938 KIN ET RYE BR ,NY 10573 VILLAGE OF RYE BROOK BUILDING DEPART MENT n ov ----_ -- -- PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLI BP#: c_—)'// / 7 Approval Date: SEP 2 Permit Fee: $ / 0 —�� Approval Signature: Disapproved: (fees are non-refundable) DO NOT S I ARI NNORK or CONS I RLL I ION LN I ILA PERt�HT HAS BLLN ISSLLD BN Till: BUILDING INSPECTOR.THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12% OF THF. TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF S750.00 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: 16 HILLCREST AVE RYE BROOK, NY 10573 SBL:/,3Si 76-,, --/—/ Zone:/Q 2.Proposed Work: BASEMENT LEGALIZATION -CUT AND CAP PLUMBING FIXTURES 3.Property Owner: JOAO BATISTA EVANGELISTA Address: 16 HILLCREST AVE RYE BROOK, NY 10573 Phone#: Cell#: (914)419-5730 email: JOAOEVAN1960@GMAIL.COM 4.Master Plumber: CARLOS DIAS Address: 131 CRARY AVENUE MOUNT VERNON, NY 10550 Lic. #: 1533 Phone#: Cell#: (914)230-6834 email: HYDROTEKMECHANICAL@GMAIL.COM Company Name: HYDRO TEK MECHANICAL Address: 131 CRARY AVENUE MOUNT VERNON, NY 10550 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 1 2 1 st Floor 2nd Floor 3`d Floor 4ch Floor 51 Floor Exterior 5.* List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -i- 6/1/2024 BUILD MENT �7 VIL OF RYE OOK 938 KING ET RYE BRO ,NY 10573 SEP 2 4 2024 4 -0E�6�� ± ov VILLAGE OF RYE BROOK BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216 - STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT . STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: JOAO BATISTA EVANGELISTA , residing at, 16 HILLCREST AVE RYE BROOK, NY 10573 (Print name) (A,i,iress where..Ou liN C) 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; 16 HILLCREST AVE RYE BROOK, NY 10573 , Rye Brook,NY. (,lob 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. A'5��A (Signature of Operty Owner(s)) (Print Name of Property Owner(s)) Sworn to before me this /B day of , 20 2L,L _ Jon'LaninJ conunission#O1 LA0025681 Notary public State of New York M3 C°mmission Expires.June 07,2028 t ubl'(No -3- 6/1/2024 STATE OF NEW YOM COUNTY OF WESTCHESTER ) as: CARLOS DIAS ,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 / 6P "I.% Sworn to before me this;q.1 r day of 20 VI day of-1 20 of Signature operty Owner Signature of Applicant JOAO BATISTA EVANGELISTA CARLOS DIAS Print Name of Prope Owner Joni Lamaj Print N of n plic t Commission#Ol LA0025681 Notary Public,State of New York My Commission Expires:June 07,2028 o Public /auy fblic JoseO' " n ,olo Notary Pubs+ .t of New York Rea C )027568 Qualifip• ester County This application must be properly completed in its entirety and must include QWfttari zed sigsiatu*s)bpn')° 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. Joseph Cinicolo Notary Public, State of New York Reg. No. 01 CID027568 Qualified in Westchester County Commission Expires August 5. 2028 6/l/2024 LOG IN DATE: BUILDN&DEP'RTMENT V1L' ,GE OF RYE BROOK COMPLETION DATE: 938 Y,l Z70�4) ET RYE BROOK,NY 10573 939-0668 ASSIGNED TO: ASSIGNED BY: COMPLAINT#: COMPLAINT FORM DATE: / dW RECEIVED BY: LOCATION: PARCEL I.D.#: Zone:,e USE: Ql /0,-M OWNER: C) 4e-vQ17 ge//S v Address&Phone: 16 7`�/ �'/PS 4yQ12G1 Q 2,va SOURCE: Q/'j'I/ (,z�e,� 2A0/01Qr Phone/Letter/(they ? Address&Phone: cy/ COMPLAINT: /UO A(7-/- A)aI-Q112 -vl/ O"- Al 2.) Cj POSSIBLE VIOLATION: INSPECTORS LOG DATE STATUS INSPECTOR k0c) to Mrs C�f�n tS� � er,\C, n�- O,Nq or r« *� Property Description Report For: 16 Hillcrest Ave, Municipality of Village of Rye Brook Status: Active Roll Section: Taxable r Swis: 554805 Tax Map ID #: 135.76-1-1 '1 71 �.i Property Class: 220 - 2 Family Res .. Site: RES 1 n i In Ag. District: No I — Site Property Class: 220 - 2 Family Res Zoning Code: 03 Neighborhood Code: 01001 - VPC/VRB/PCSD Total Acreage/Size: 0.11 School District: Port Chester-Rye Land Assessment: 2023 - $167,000 Total Assessment: 2023 - $541,800 Full Market Value: 2023 - $541,800 Equalization Rate: ---- Property Desc: Deed Book: 41121 Deed Page: 137 Grid East: 718688 Grid North: 793042 Area Living Area: 1,648 sq. ft. First Story Area: 824 sq. ft. Second Story Area: 824 sq. ft. Half Story Area: 0 sq. ft. Additional Story Area: 0 sq. ft. 3/4 Story Area: 0 sq. ft. Finished Basement: 0 sq. ft. Number of Stories: 2 Finished Rec Room 0 sq. ft. Finished Area Over 0 sq. ft. Garage Structure Building Style: Old style Bathrooms (Full - Half): 3 - 0 Bedrooms: 5 Kitchens: 2 Fireplaces: 0 Basement Type: Full Porch Type: Porch-coverd Porch Area: 244.00 Basement Garage Cap: 0 Attached Garage Cap: 0.00 sq. ft. Overall Condition: Normal Overall Grade: Average Year Built: 1926 Eff Year Built: 1980 Owners Joao B Evangelista Maria Evangelista 16 Hillcrest Ave 16 Hillcrest Ave Port Chester NY 10573 Port Chester NY 10573 j Sales Property Value Arms Addl. Deed Book Sale Date Price Class Sale Type Prior Owner Usable Length Parcels and Page 4/4/2001 $300,000 210 - Land & HALLENGREN, Yes Yes No 41121/137 1 Building MARY LOUISE Family Res 1/15/1988 $0 210 - Land HALLENGREN No No No 9087/184 1 Only OLOF Family Res Utilities Sewer Type: Comm/public Water Supply: Comm/public Utilities: Gas &elec Heat Type: Hot wtr/stm Fuel Type: Oil Central Air: No Improvements Structure Size Grade Condition Year Porch-coverd 244.00 sq ft Average Normal 1926 Special Districts for 2023 Description Units Percent Value CS482-VPC Sewer 0 0% $541,800 SW481-Solid Waste All 0 0% $541,800 Vlgs Exemptions Year Description Amount Exempt % Start Yr End Yr V Flag H Code Own % 2023 BAS STAR $76,420 0 2006 0 Taxes Year Description Amount 2019 County $1,581.51 * Taxes reflect exemptions, but may not include recent changes in assessment. Certified Mail 4W yf 4W BUILDING DEPARTMENT Hand Delivered ' VILLAGE OF RYE BROOK 938 KING STREET,RYE BROOK,NY 10573 PAGE 1 OF 2 (914)939-0668 FAX(914)939-5801 www.ryebrook.org NOTICE OF VIOLATION AND ORDER TO REMEDY SAME Joao Evangelista and/or Maria Evangelista VIOLATION#: E 2120 16 Hillcrest Avenue NOTICE#: is Rye Brook, N.Y. 10573 S.B.L.: 135.76-1-1 The following violations of the Code of the Village of Rye Brook, and/or the New York State Uniform Fire Prevention & Building Code were found to exist at, 16 Hillcrest Ave. located in an R-2F Zoning District, in the County of Westchester, Village of Rye Brook, NY on, April 24, 2024 9:00 a.m. CODE SECTION&TITLE Village Of Rye Brook CODE: *91-4. A Building Permit Required (Construction/Alterations to create a Finished Basement without permit) *250-25. A Two Family Districts Permitted Uses (Three Unit/Family Dwelling in the Two-Family Zone) *250-10. A Certificate of Occupancy Required (No Certificate of Occupancy for Finished Basement dwelling) *113-6 Electrical Permit required (Electrical work including but not limited to, wiring, lighting, outlets switches and fixtures in the basement w/out permit *180-23 Plumbing Permit Required (Bathroom created, with plumbing fixtures & other fixtures, piping sinks w/out permit) *91-4. A Mechanical/HVAC Permit Required (Heating/ Cooling in Basement) In that upon information, belief and site inspection on or about April 24, 2024 it has been determined that the above named violations exist at the subject premises. You are hereby directed to contact this department, obtain all necessary permits & commence to correct the above captioned violation(s) immediately. Violations of the NYSUFP&BC must be completely cured by no later than, , which is thirty(30) days after the date of this notice and are returnable at the rate of $1,000.00/day for each day of continued violation, or imprisonment not exceeding one year, or both. PAGE 2 of 2 Note that a re-inspection of the premises is required by law to confirm compliance with this notice & all other applicable codes. FAILURE TO COMPLY WITH THIS NOTICE IS A CRIME PUNISHABLE B NEB ISO FAN R BOTH. ( *) BUILDING INSP CTOR ( ) ASSISTANT BUILDING INSPECTOR a � � w W 0 3 a �n N Om C J I I I w I O p I N /S u N r C I 0 (� 4 O vi 0o v� _ N .L W C W F •- u > W a 0 > � } Q 3 o wN W Oo D O W U O J W ;W CD oz m ° .17 a W W a a a 0 J > > > V1 o „ a W v� o W ` a Mr^ Q x O ° — N O F E ° LL w Z d ° y ° v. a c° o a z c v F Z O V M a - a n p F 0 c a O N c u O s Z V a ° a a w c N= I o Z Z V 0 ^' O N) CL Z O.�. 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Z< o W ae `IZ Z O a O O O Zi°G-�0 <IQ O °C U Zioe eae o O O yIW O o v o x d �•u a er xN xIw W 7 a�O z, m,m,� 3 m N Z z N 0 r u I x 0 N W W z ` Z V O N _O W J J IC7 W z m w N N p oo W W � l9C� C9GO.C9Z >W Y ~ Z,ZZ O o F F p m �J� z 0 pN � I IzZZZZZoele > uz000 w °L OOW - o oe ` oe a er J Ioe <w 00 'uxi O x vxi �'h y N m mom 0 0 0 Z W m oc oc J a m iflZ oFc °m' N N < m Z U u v �i� '° Q d <i< <i0O'�,� �I� Z < < H W f w Z = F o d,3,Q 3 aialFu IY IN N'N N N — d3 0. Q,.m I� Ogg I �� Za •- . z p 8N^ 0 J O IWI N O m W W H 7 Z'W N Vf 47 OI k m _ W_F I mF=I W oWoe T0;wiN N$1I0<F F Zw Wu y <<Woe oJe00 NZ 2 0 7 WZ .11ImW UZN'I f o.Z O u CI Oo p N ZZ < t- SO oO < < a o 'O O i0'3V wV �<O s°a a Ln � E E d- v V .� LL LPL m CU CU 4A N Ln N l0 N N CC L i Q t" u 00 ^ ' ~ ' O \ U M O ' I U X IT Ln M O W O O M O UU t' N N M � Q 6 lhrr'+++�tiY Q m .-q N ce Z N O O > d ON .--i 00 O O N O r-I O O rrTOT � O O L. WO Q ►h'-`�'�i L �I L U a �+ C O V O a+ m L O O L. 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JTJ� O m h m a Q O W QQ a � 3 x u a M a 2: O LLO L o a (7 Q ~ F o-6 c - > Z C Lny (A JCO JO > i) () W U L y U L T0 Lv= a � a T Crt E D a° O R o EuL o Ea E -6 uL 0 ONa V N .--L lL� N .--L IL LY EO m - O O Ln O a o Z U l7 O y 0 N_ a p N N � p d = L^n v o O O L M O cn L a.� .-� a tf} to 4+ !n 4J C M Q ` G1 a O -ptn o F LW L Q) U C a r E i m co V U cn C ON � ~ O V t O am y P (Aatj co m U. % 0 M Am (A 0a % O C 3 O o C_ o y y m m = C r' r' m > Ln � m v LL > C Q � v M L W c �o .c Ln 4J o o (A N C C a o o 00 C o Ln `O E e Q en m ++ E a y +1 W O C C «C O O O y o a a c E M O o o Q + C u O N c K c. O W — 's+ a �< U Q) cn 4l 3 y a C A C N o O Vl E o � cz a K N M .0 •v co co � C ` M ` P4 (Un 3 2 k o afar o ~ {A cn G v (n > W > N E-I > N jE M ILI OPY itSUR Certified Mail UILDING DEPARTMENT Hand Delivered y VILLAGE OF RYE BROOK • �98Z • 938 KING STREET,RYE BROOK,NY 10573 PAGE 1 OF 2 (914)939-0668 FAX(914)939-5801 www.ryebrook.org NOTICE OF VIOLATION AND ORDER TO REMEDY SAME Joao Evangelista and/or Maria Evangelista VIOLATION#: E 2120 16 Hillcrest Avenue NOTICE#: 15 Rye Brook, N.Y. 10573 S.B.L.: 135.76-1-1 The following violations of the Code of the Village of Rye Brook, and/or the New York State Uniform Fire Prevention & Building Code were found to exist at, 16 Hillcrest Ave. located in an R-2F Zoning District, in the County of Westchester, Village of Rye Brook, NY on, April 24, 2024 9:00 a.m. CODE SECTION&TITLE Village Of Rye Brook CODE: *91-4. A Building Permit Required (Construction/Alterations to create a Finished Basement without permit) *250-25. A Two Family Districts Permitted Uses (Three Unit/Family Dwelling in the Two-Family Zone) *250-10. A Certificate of Occupancy Required (No Certificate of Occupancy for Finished Basement dwelling) *113-6 Electrical Permit required (Electrical work including but not limited to, wiring, lighting, outlets switches and fixtures in the basement w/out permit *180-23 Plumbing Permit Required (Bathroom created, with plumbing fixtures & other fixtures, piping sinks w/out permit) *91-4. A Mechanical/HVAC Permit Required (Heating/ Cooling in Basement) In that upon information, belief and site inspection on or about April 24, 2024 it has been determined that the above named violations exist at the subject premises. You are hereby directed to contact this department, obtain all necessary permits & commence to correct the above captioned violation(s)immediately.Violations of the NYSUFP&BC must be completely cured by no later than, , which is thirty (30) days after the date of this notice and are returnable at the rate of $1,000.00/day for each day of continued violation, or imprisonment not exceeding one year, or both. PAGE 2 of 2 Note that a re-inspection of the premises is required by law to confirm compliance with this notice & all other applicable codes. FAILURE TO COMPLY WITH THIS NOTICE IS A CRIME PUNISHABLE E, I SO ME�TH. ( *) fiLYLDING INS ECTO ( ) ASSISTANT BUILDING INSPECTOR Building Pefflut Check Luc&Zoning Analysis Address: _ to ►* 1 \ \� `_ C� `� S'BL• Zone 2`Use: (7��� Conn.Type: Other: Subrnittal Date: Revisions Subrrurtal Bares: Applicant: C V l s , Nature of Work e4c. \ Q- S S1� 0m- (DLry)o N -e v - t Renm ZBA BOT: er FEMS Fig: BP: C/O Flood Plane LegaL=oa J — ( ) (t�/APP: Dated Notuized:_L----SBL' /I`nus I.D. Cross Connection H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes Wetlands: Storm Water Revrew Street Opea.. ( ) ( ) ENVIRO: Long Short Fees: N/A ( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgrnt.: Tree Play Other. ( ) ( ) SURVEY: Dated Currenc Archival Sealed sc Unceptablc PLANS:Darr Stamped Scaled copies: Electronic Other ( ( ) License Workers Comp: I.ubthv Comp. Waiver. Other. (� ( ) ODE 753#: Dated N/A: (� (a HIGH-VOLTAGE ELECTRICAL-Plato: Permit N/A Other. ( ) ( ) LOW-VOLTAGE ELECTRICAL Plans: Permit N/A Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:PL.: Permit H.W.I.C.:_Battery _Other ( ( ) PLUMBING:Plans: Pemuc Nat. Ciu: LP Gas: N/A/: Other. ( � ( ) FIRE SUPPRESSION:PLC Pentut N/A, Other: ( ) ( ) H.V.A.C.: Plaris: Permit N/A Other. ( ( ) FUEL TANK Plato: Pemic Duel'hype: Other. ( ` O 2020 NY State ECCC: N/A: Other. ( ( ) Final Survey Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other. ( ; ( ) BP DEI,'IAL LETTER. C/O DD41AL LE:I"IUER: Other. Other: ( ARB mrg.date: approval;- notes: ( )ZBA mtg.due: approval;- notes: ( )PB mrg.date: approval;- notes: REQUIRED EXL51ING PROPOSED 1cl"I�:ti Ara: .� ticm Front; Dates 0 9 Im Maul Ca.- Acm Cc — — Ft.H/Sb: Sd.H S ' — QA_ - T°c-Imo: Fc lrao P Ha¢ht/Stones _-- notes: I State Farm Fire and Casualty Company A Stock Company With Home Oflioas in Bloomington,Illinois PO Box 2356 Bloomington IL 61702-2356 AStateFarm° H 28 9D66 FBOD F HW azoo RENEWAL DECLARATIONS EVANGELISTA, MARIA C 16 HILLCREST AVE RYE BROOK NY 10573-2965 AMOUNT DUE: None Payment is due by TO BE PAID BY MORTGAGEE Policy Number: 32-CK-W878-4 Policy Period: 12 Months Effective Dates: MAY 10 2024 to MAY 10 2025 The policy period begins and ends at 12:01 am standard time at the residence premises. Homeowners Policy Your State Farm Agent DALILA D NAMY Location of Residence Premises 150 S REGENT ST 16 HILLCREST AVE PORT CHESTER NY 10573-3569 RYE BROOK NY 10573-2965 t9 Phone:(914)481-8989 Construction: Frame Roof Material: Composition Shingle Year Built: 1926 Roof Installation Year: 2012 Automatic Renewal If the POLICY PERIOD is shown as 12 MONTHS,this policy will be renewed automatically subject to the premiums,rules, a and forms in effect for each succeeding policy period. If this policy is terminated,we will give you and the Mortgagee/Lien- R holder written notice in compliance with the policy provisions or as required by law. IMPORTANT MESSAGES NOTICE: Information concerning changes in your policy language is included. Please call your agent with any questions. Zone:12 Subzone:09 Please help us update the data used to determine your premium.Contact your agent with the year each of your home's utilities(heating/cooling, plumbing,or electrical)and roof were last updated. PREMIUM Annual Premium $2,160.00 Your premium has already been adjusted by the following: New York Tier Rating Home/Auto Discount Lead Poison Excl Total Premium $2,160.00 Prepared MAR192024 �/ e / Page 1 of 4 i,n��M /hI�MA;Prnc��`ir✓I,iaP.(i/Y.�CId,( StateFarmo NAMED INSURED MORTGAGEE AND ADDITIONAL INTERESTS EVANGELISTA,MARIA C Mortgagee BANK OF AMERICA NA Loan Number: ISAOA ATIMA 0208945827 PO BOX 7265 SPRINGFIELDOH 45501-7265 SECTION I-PROPERTY COVERAGES AND LIMITS Coverage Limit of Liability A Dwelling $ 561,200 Other Structures $ 56,120 Building Ordinance/Law-10% $ 56,120 B Personal Property $ 420,900 C Loss of Use $ 168,360 Fungus(including Mold)Limited Coverage $ 20,000 Additional Coverages Credit Card,Bank Fund Transfer Card,Forgery,and Counterfeit Money $1,000 Debris Removal Additional 5%available/$1,000 tree debris Fire Department Service Charge $500 per occurrence Fuel Oil Release $10,000 Locks and Remote Devices $1,000 Trees,Shrubs,and Landscaping 5%of Coverage A amount/$750 per item SECTION II-LIABILITY COVERAGES AND LIMITS Coverage Limit of Liability L Personal Liability(Each Occurrence) $ 500,000 Damage to the Property of Others $ 1,000 M Medical Payments to Others(Each Person) $ 5,000 INFLATION Inflation Coverage Index:441.1 DEDUCTIBLES Section I Deductible Deductible Amount Other Losses $ 2,000 Hurricane 5.00%, $ 28,060 LOSS SETTLEMENT PROVISIONS Al Replacement Cost-Similar Construction B1 Limited Replacement Cost-Coverage B 32-CK-W878-4 A StateFarm° FORMS,OPTIONS,AND ENDORSEMENTS HW-2132 Homeowners Policy Option JF Jewelry and Furs$2,500 Each Article/$5,000 Aggregate Option ID Increase Dwlg up to$112,240 HO-2687 Work Comp Select Residence Emp HO-2684 Hurricane Deductible HO-2727 Cyber/ID Restoration/Fraud Cov HO-2439 Energy Efficiency Upgrade End HO-2441.2 Home Systems Protect-$50,000 HO-2442.2 Service Line Coverage-$10,000 HO-2807 Back-Up Of Sewer Or Drain- 10%of Coverage A/$56,120 HO-2304.1 Amendatory Endorsement HO-2373 `Ting Labs Ting Service Endorse 'New Form Attached ADDITIONAL MESSAGES State Farm®works hard to offer you the best combination of price,service,and protection.The amount you pay for homeowners insurance is determined by many factors such as the coverages you have,the type of construction,the likelihood of future claims,and information from consumers reports. Other limits and exclusions may apply-refer to your policy Your policy consists of these Declarations,the Homeowners Policy shown above,and any other forms and endorsements that apply,including those shown above as well as those issued subsequent to the issuance of this policy. This policy is issued by the State Farm Fire and Casualty Company. Participating Policy You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of Incorporation,as amended. In Witness Whereof,the State Farm Fire and Casualty Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. *.�bi-�� Secretary President Prepared MAR 19 2024 Page 3 of 4 Affidavit of Exemption to Show Specific Proof of Workers' Compensation Insurance Coverage for a 1, 2, 3 or 4 Family, Owner-occupied Residence **Thu 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 work indicated on the building permit. t t 0,A"CV& -— -fl o � �2� ( �gnature of omeowner) (Date Signed) i a E y� e 1 S4►4 Home Telephone Number (Homeowner's &ame Printed) worn to before me this a"I Property Address that requires the building permit: _� ,/ - _- C a6 i IIc.rP.J Aue ol_k tfi &,�ry Notary Public,State of New Yori. No.01 RUM 398 5 QuaNfkd In Westchester County Commission Expires September 26,20� Once notarized,this BP-1 form serves as an exemption for both Aorkers'compensation and disability benefits insurance coverage. BP-1 (12/08) NY-WCB i Evangelista fit[ Residence 16 Hillerest Ave. E V A N G E L I S T A Rye Brook,NY EX. R SID NC PATIO A A BASEMENT LEGALIZATION PERlIAIT# To� SOL* 16 HILLCREST AVE. Jb, 10 p RYE BROOK, NY B KWAN TJ U L 0 2 2024 EX. 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NO CHANGETOTI I ETREILNtA L ENVI-LC"IE ARE IVOIX)SED AND/OR REQL'IRED 51 -5rDRAI�,INCZ-;ANt)Slli'-CFFICATID\SlfAVI 51:1-NMEVARED L I I)Q I I rww cruir-Y'rutAT mr, BA T�ROCM. 01 k(y SL;PERVISIaN,AND THAT TO'UIE,DEST OF)d)IQN01VI.IbIxE AND PROFENSIONAL B PATCH lkt FLOORS SIB,JC4. )LILCMENT,THE OFSJGN HAS HEENSIADE IN.CONNO"11ANCE WITii ALL AN'LICABLI EX. mm rcwsum wwo CAP PLWf�.NG MKS RFQ1)1RE1AM7S OF Trnx I9(NNC.RRJ-C1IArrTr-,RXXXII1 SURC11AFTENA I.NT)TIME FOLLOWI-W, STORAGE ON"Lts REFLRENCED CODN OFNEW YORK 5-TATE: F1J V SPA( t IONYI-11001k J U N 8 202� ii',6r(1G.I IGT LEGE14D SYMBOLS DESCRIF rtQN SO BROOK VILLAGE OF RYE 0 RECESSED DOWNLIGHT BUILDING DE_-P/-'kRT*MENT SCONCE SURFACE MOU14TED FIXTURE 50 a PENDANt UGHT IIXTURE EX. CLOSET SMICH 3 WAY SOTCH $3 1/2 SI/ATCHED RECE-TACLE Franco Designs li SW TCH OUADRUPLEX OUTLET %2 Go q 84 5 smfgi4 C7 Qm, EX. FIJINA(4t k Aw STORAG E ash j 50 S D-OPLEX(YUTLE1 EXISTINCi BASEMEN r PLAN FL0,0R OUTLET 16 i,-ILICKST AW ZONING MMRMATION EX. 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