Loading...
HomeMy WebLinkAboutBP24-159PERMIT ## _ SECTION TYPE OF WORK Za JOB LOCATION ;59 DATE: ay W. LJ fe i0i.!�y/`�@ate va/d �eeCe �� �• . • HMO � - IN$pECTION RECORD I DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING O RGH PLUMBING GAS CJ SPRINKLER ELECTRIC O LOW -VOLT C� ALARM C� AS BUILT FINAL 7 12-" l Dom( OTHEf2 A—PPPRROVALS ARB �J u I � c3oa BOT PB ZBA OTHER AS-BULL#IFINAL SURVEY REQUIRED PRIOR TO FINAL INSPECTION PCewe �o ay �yE BR(� �CVC4�UJJ V tC � 4 J�LC'vV W V 190 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 September 16,2024 Craig Bergman&Samantha Bergman 11 Jennifer Lane Rye Brook,New York 10573 Re: 11 Jennifer Lane, Rye Brook,New York 10573 Parcel ID#: 135.58-1-21 Building Permit#24-159 issued on 7/19/2024 for a New Fence This certifies that the new six foot high white vinyl fence,installed under the above captioned permit has been satisfactorily completed. Sincerely, Steven E. Fews Building&Fire Inspector /to D B For office use onl BUILDING DEPA RTMENT PERMIT# '7 SEP 1 0 2024 VILLAGE OF RYE BROOK ISSUED: —138 KING STREET,RYE BROOK,NEW YORK 10573 DATE: VILLAGE OF RYE BROOK (914)939-0668 FEE: PAIDJS BUILDING DEPARTMENT wNii,.rvebrooknc.( o% 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 trsrssssarsssatssstrstaasstrrssstsssarrasaasretrssssstarasssaarrraaassssrrrssssrsrrssssssrrsssssssrsssrsrrsssarsrrsssssrsrass Address: n(� I \'X Lane Famr ty _ Occupancy//Use:[K l Cjf j]401 Parcel ID#:1'j ej .c 5 ' " Z Zone: _ 0 Owner: �&fq 0L" —*t XaZ C c ct Q ?)(IQ 1n n j'--�Address: I I J Pit f)I (;f,r L a"_ P.E./R.A. or Contractor:}- 1 f S;cb i'Pn(e h1S+Q11/►DeSigh Address: -1141 2pi14.e qW #y V0111iLA (°pTftt <.M�-4 Person in responsible charge: F3rQ U �h(S Gil Address: trru 0S "6y e- I DL)ge 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: k3o"nth 3P.l'QMOr)being duly swom,deposes and says that he/she resides at I I iTP n fl i R�,r L Q (Print Name of Applican -- (No.and Street) in (a Q ()k in the County of w e Sr c N S - i(— in the State of ►v ,that ( nyToaha ge) 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:5 4 I QO(D for the construction or alteration of _I'e(��C}GQ C6)J O-C - t n u Dn 1 Deponent further states that he/she as 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 rnvmPr to ncr nr nrrmit the ncr n£anv hnilriino nr nrnmicrc nrnnrt thrr�nfhs•rPaRNr r rPatrri Prrr tPri r hanrrPri nmrPrtPri nr PnlaroPri urhnlly 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.off the Code of the Village of Rye Brook. Swom to before me this Sworn to before me this day of ,20 (WY of , 20�� �'gignature(�� y PPrroppe�rtyy Ojwn/err ' ature o�R� U pplicant�J..I i c t l t 1 V-` ��� SHARI MELILLO o l.J P' t Name of Property Owner Notary Public,State of New York, %ame of Applicant No.OIME6160063 Qualified in Westchester County t Notary Pubhu Commission Expires January 29,20 Notary rubhu �yE BRC�v�. 1932 l7 BUILDING DEPARTMENT ❑BUILDING INSPECTOR Q�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 : ' ' N ►.1 N }� 1 a.AE'� DATE: PERMIT# ` - S i ISSUED: l " z'/ SECT: I�3s ,9 BLOCK: LOT: LOCATION: 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 ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER ■ e = : ■ ON lLn H � s N © w • ram. �n c�a p s F■1� 1ti � id fn LL C �k � w •� a s o W a a y H r. p U y LL s a W vi o 00 W PC i y a� Lei en Ln 00 0 e bA � M O ?4 C c ° W 00 00 64 p Cd - _ •-� Z G W W F u ° O © e T - cn ■pry N a v a Ne rq C� W 00 A V g � V Rt = uz ICI W M F M W w O t7 � e � � � � � � Wry � �^ 00464 dd 'n3 ° S ''6 0• ■ 1� W d L7 v x p =0 H tzW U low > � z O V o H 0 w F O d3 z ,Z � Q x cnOV a�j V 0 ° oo o � y J Le ut tLLa LL � ? z w w 0 >4 4 a o = P � a �' A w z 4 ° � o W W 2 � � � -o 0 a BUILDING DEPARTMENT [� 0 VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 JUL ' 9 2024 (914)939-0668 wNi,s%x%ebrookm.<--oy VILLAGE OF RYE BROOK BUILDING DEPARTMENT FOR OFFICE USE ONLY: PCVr Approval Date: JUL 1 8 1P tit# /' Application# A q-n Approval Signature: : ARCHITECTURAL REVIEW BOARD: Disapproved: : Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other• _n Application Fee"0/0&1 Permit Fees: t>;IPXjd"V / A17 A I I / 4" A TU DU131%4TT A 001I If" A 9rT4-%1\t Al L' 1\%.ju / V T L1LL / "I-w A jUd A A.ix%-1TXi A .tl..l A LAgk—P%A A Vl 14 Application dated: 2`9/ C) is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the installation,construction,repair or replacement of Fence,Wall or Gate,in accordance with Section 250-6 B.(1)(g),of the Code of the Village of Rye Brook,as per detailed statement described below. Swimming pool fences must conform to the State Code. 1. Job Address: I I J-en[)I k,Y La ry.- 2. Occupancy/Use: I FCAf1r11 I U1 S.B.L.#: 13 I 2 Zone. 3. Proposed Fence/Wall/Gate(describe in detail): () W I 1lnu 4. Property Owner: Sam Cx-nfi-yA Owd C.C ai Q ��a M.(a.n Address: n I X L01rAIL =J Phone# Cell# 9 14— O Llo-toy S ( email: Sam l . ryx)qPn (�11104 Applicant: Address: Phone# Cell# email: Architect/Engineer: Address: Phone# Cell# email: Contractor:_H t(Se h Ft`.-OCP_ I Mia D CS t q n L L L Address&Phone: '] Ll-1K 0 yA A< q W .04 ) I je4 [CTk�4U i h)--) 1 CA&9 2 4S Z gum- 3oy, k4�2-2 5. If building is located on a corner lot,which street does it front on: r'�l�l �( a rk 6. What is the estimated cost of construction 9 t U D o k OTC, lui cstimatzil cost y1611 lilt iikl� nll sitc in-p oYb�Lb11tJ,i-L- � nad iL�liuiu l Gu ui lawn' ��Ir---:___I r___ --J t Y� � `+Y�� material and labor which may be donated gratis.) 7. Estimated date of completion: 1 611/2024 Please note that this application must include the notarized signature(s) of the legal owner(s) of the above-mentioned property, in the space provided below. Any application not bearing the legal property owner's notarized signature(s) shall be deemed null and void, and will be ret,�rnor) in thn annlirant S,16TE OF NEW YORK,COUNTY OF WESTCHESTER ) as: i)-\CA. g duly sworn,deposes and states that he/she is the applicant above named, fnnnt name❑f individual sivnina ac the ia�r 'rand and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the f A 1 1 1. 1 1 .1 t, 1 t 1, .. . 1' fur we legal Uwttcr auu is uufy auuiufiLCU to HIdKC tMU.DIC tuts appilcaLlUu. (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 anv accompanving 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 T Sworn to before me this day of 24L day of , 20 4op ,gn eeatu ofPrerty Owner V Signature of Applicant Swo i kof\ Print Name of Property Owner Print Name of Applicant Notary c Notary Public GREGORY M.RIVERA Netary Public,State of New York No.01 R16441398 Qualified In Westchester County Commission Expires September 26,20 W12024 .Building Permit Check Lut&Zoning Attalysu �e� Q L- Addnsx: A` SB Zones "1 t y 'se: q�D Corot.Typc: Other Subnunal Data ���Z Revuioru Submittal Dates: Applicant C Name of Work. 0 ;/��\ Re.invx 2BA1JL — 9 2024 PB: BOT: Other. NEW- O FEES Filing U BP: Flood Plana L egaliunon ( ) (�APP: Dated L-Notarized: ---SBI_ truss I.D. Cross Connection H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes Wetlands: Storm Water Review Street Opening: ( ) ( ) ETIVIRO Long Short Fees: N/A; ( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmr.: Tree Plan Other. ( ) (,,rSURVEY: Dated: Current 0*—�- Archival Sealed Unacceptable ( � ( ) PLANS:Date Stamped Scaled Copies: Electrorue Other. License Workers Comp: Liability Comp. Waiver. Other CODE 753#: Dated. N/A: ( ( ) HIGH-VOLTAGE ELECTRICAL.•Plans: Pemuc N/A Ocher: ( ) ( ) LOW-VOLTAGE ELECTRICAL-Pl m: Permit N/A: Other ( ) ( ) FIRE ALARM/SMOKE DETECTORS: Plans: Pemuc Fi W.I.C.:_Battery:_Other: rm( ) ( ) PLUMBING:Plans: Peit Nac.C'ns: LP Gas: N/A/ Other. ( ( ) FIRE SUPPRESSION:Plans: Permit N/A Other. ( l ( ) H VA.C.: Plans: Permit N/A Other: ( O FUEL TANK Plans: Pemc Fuel"Typo: Other. ( ( ) 2020 NY State ECCC: N/A: Other. (✓ ( ) Final Surveys Final Topo: RA/PE Sign-off Letter As-Built Plans: Other. ( ( ) BP DU,-IAL C/O DENIAL Other. ( ) ( ) Other (,,)-ARB mtg.dare- 7 2.L4 approval• 7'/7 Z notes: 1V2 „ y—y 5 ( )ZBA mtg.due: approval:- notes: ( )PB mtg.date: approval;- notes: REQUIRED EWJING PROPCGM APWqVETP Ares Curia -- F Front; 1=t� �4 �n Mon Cov: Acg Co HS : Sd.H iUA: Tom: FLU: P Hnght/Stones notes: BUILDING DEPARTMENT JUL - 9 2024 VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT ARCHITECTURAL REVIEW BOARD CHECK LIST FOR APPLICANTS This form must be completed and signed by the applicant of record and a copy shall be submitted to the Building Department prior to attending the ARB meeting. Applicants failing to submit a copy of this check list will be removed from the ARB agenda. Job Address:l Mn I f e i i n n e, Date of Submission:: ` Parcel ID#: I 1 5- bg' I "Z 1 Zone: 0 !o `7 Proposed Improvement(Describe in detail): eplcme APPLICANT CHECK LIST: iMusT BE COMPLETED BY THE APPLICANT �Mfwctrd I I}�' — The following items must be submitted to the Building Department by the applicant-no exceptions. 1. (Completed Application PropertyOwner: r,� 2. ( )Two(2) sets of sealed plans. (one full size {maximum Address: I I ,� � —111 fie-( !—a 1 allowable plan size=36"x 42"; and one 1 I"x 17") Phone# 9 1 y ' j Lp (()151 3. (> f Two(2)copies of the property survey. 4. (►/ Two(2)copies of the proposed site plan. Applicant appearing before the Board: 5. (v)'One electronic/disc copy of the complete --��7d-a h1 Y;i application materials. 'I j I�Y-`� � 6. (✓�F" " g Fee. Address: 11 7e-i l f)I C Lan& 7. ( "Any supporting documentation. Phone B �) . �� 8. ( )HOA approval letter. (if applicable) 7. ll/)r nutugi alllJ. Architect/Engineer: I 10.( ) Samples of finishes/color chart. (a sample board or Phone# model may be presented the night of the meeting) By signature below, the owner/applicant acknowledges that he/she has read the complete Building Permit Instructions&Procedures, and that their application is complete in all respects. The Board of Review reserves the right to refuse to(near any application not meeting the requirements contained herein. Sworn to before me this Y Sworn to before me this ddv of 20 of 20 dlljl�a",- Signature of Property Owner Signature of Applicant �lmn4v-, Print Name of Property Owner Print Name of Applicant Notary u lic Notary Public GREGORY K RNERA Notary Public,Star•of New York No.01 R16441398 OuaNfied In Westchester County Comndasion Expires September 26, 6/1/2024 �y() �. Village of Rye Brook ML �/ MR O� y end FB �/ SE Architectural Review Board Meeting AC AD W Wednesday,July 17,2024 at 7:30 PM Q Village Hall,938 King Street JM SF 1. ITEMS: 1.1. ARB24-063 (Consent Agenda) (Amendment to Approved Plans) Eric Steinert&Caryn Steinert 24 Meadowlark Road Install two skylights on rear deck roof. 1.2. ARB24-069 (Consent Agenda) Eric Steinert&Caryn Steinert 24 Meadowlark Road 6'high white PVC fence and gate. 1.3. ARB24-084(Consent Agenda) Jeffrey Mensch&Hannah Mensch 10 Red Roof Drive Rooftop solar array. 1.4. ARB24-085 (Consent Agenda) Craig Bergman&Samantha Bergman 11 Jennifer Lane 6'high white vinyl rear yard fence. 1.5. ARB24-086 (Consent Agenda) Norman Wang&Esther Wang 180 Country Ridge Drive 6'high white vinyl rear yard fence&gates. Consent Agenda Approvals: Motion Second 'XV*1 Abstention Aye;J15� Nay; Adjournment; Notes Page 1 of 4 Architectural Review Board July 17,2024 1.6. ARB24-020 556 Westchester Ave LLC c/o Anthony Guastella 556 Westchester Avenue New rear windows. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.7. ARB24-078 G&G Homebuilders Corp 18 Rock Ridge Drive Second story addition,deck and fence. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.8. ARB24-083 Robert O'Neill&Melissa ONeill 4 Loch Lane Garage door overhang. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.9. ARB24-087 Win Ridge Realty LLC 19A Rye Ridge Plaza New awning, "Mendel Optical Insight" Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes Page 2of4 s • Architectural Review Board 1.10. ARB24-088 July 17,2024 Paul Cuzzupoli&Pamela Lustig 7 Lincoln Avenue Two-tier retaining wall and drainage. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.11. ARB24-081 (Re-Appearance) Kenneth Gerchick&Amy Bernstein Gerchick 3 Mohegan Lane Second floor dormer addition. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.12. ARB24-089 Emily Groglio Irrevocable Trust,Shari Melillo,Trustee 5 Paddock Road Enlarge rear deck. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.13. ARB24-090 Christine Sciandra 47 Roanoke Avenue Window and door changes,rear paver patio,relocate mechanical equipment. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes Page 3of4 Architectural Review Board July 17,2024 1.14. ARB24-091 Francesca Italiano 31 Arrowwood Circle Extend existing deck. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes 1.15. ARB24-092 Michael Oles&Kathleen Oles 33 Arrowwood Circle Extend existing deck. Approvals: Motion Second Abstention Aye; Nay; Adjournment; Notes NEXT MEETING: August 21,2024 Page 4 of 4 JR AN Ye.- tdIRA - t l yy 1 {y ' 2 IN ,tr f. S `� �,.;. } {^ aj �I �•.. :� V..:. i i .� � I i j� ', 3� .����-' r .����� ,��;�� �� t,. Y - `/ \. • `t � � .,' / � l 'a. � .;� ` ; li ,� - - -' � �� �. , - � .�� �.�- .. ,` I, �(1 � ; . \ � f- '- . §{$ ! hp } ) }06 } \ $ ! #| ■ § i / . K «� � ri � \CD / j � | � � �y • ) 2 � \ ` ` ƒ � � t � ! � / * \ ! ■ § � $ . . & Li 2 16 tm �AA1 ! $ , $ ! % | ! 7 Cl - §]f ! ! }�f £ \ ) §k| � �� $ & f i / ass .M a AMR- Zc- vR 15• dp��� 0'�yr�r` `•� P 1+r�j1 r1ll Ff r+e` + y r"f .tb ,a James Maisano i George Latimer A. �t�l Nestcheter(bunk farcuthe Direelor.Consumer Protection a" > Department of Consumer Protection Home Improvement License HIRSCH FENCE INSTALL&DESIGN.LLC ... A 747 ROUTE 9W f -'R VALLEY COTTAGE.NY-10989 Qy `. phis license is issued in aceonlaw with Article XVI of the Westchester Count%Concumer PrOfAcfion Code and is salid onh upon f ` pre+once of the ufliaal del,uvwnt seal.Proof of citizenship or immigration,,taILI,is+rot 1\'qUkW for issuance of this license. N01 FOR l+Dl RAI.PURPOSFS 'ittatwr iuonJ sr'- c`okConsu,,,�A e r �c 4, Liccnsctiumhc+ m K °� Date ofFxpiratiun WC-27282-1-1 14 s 1 1/1 812024 S��heSter co tt.. .. ti .. - "zs 1 r s / 1 DATE(MMIDD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 6/28r2024 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 NAME: Courtney Potter McCarthy Insurance PHo'IE 14}Z69-"17 FAX 378 Elwood Avenue INC,met, ADDRESS- courtney@mccarthyinsurance.net Hawthorne, NY 10532 INsu S AFFORDMIGCOVERAGE NAIL# _ INSURER A: Preferred Mutual Insurance Company 15024 INSURED INSURER 5: Hirsch Fence Install&Design LLC INSURERC: 747 Rt 9w Cottage#4 INSURERD: Valley Cottage, NY 10989 MSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 00002210-0 REVISION NUMBER: 9 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS -- -- POLICY EFF POLICY --- EXP LTR TYPE OF INSURANCE POLICY NUMBER LIMITS A X COMMERCIAL GENERAL LIABILITY Y N BOP0100721375 11/12/2023 11/12/2024 EACH OCCURRENCE $ 1,000,000 CLAIMS MADE X OCCUR DAMAGE TO N D L� PREMISES We occurrence f MED EXP one person) $ 10,000 PERSONAL 6 ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 HPOLICY U JECT U LOC PRODUCTS-COMP/OP AGG $ 2,000.000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE _ AUTOS ONLY AUTOS ONLY Par accident i UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAR F]�CLAIMS-MADE AGGREGATE _ DED ' ' RETENTION$ $ WORKERS COMPENSATION OTIi- AND EMPLOYERS'LIABILITY YINI STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? n N/A EL EACH EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Address : -11 Jennifer Lane Rye Brook New York 10573 Certificate holder listed as Additional Insured CERTIFICATE HOLDER CANCELLATION CE LATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village Of Rye Brook THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 938 King Street ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook NY10573 CPO ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by CPO on 06/28/2024 at 10:20AM YORK I Workers' Certificate of Attestation of Exemption %.V 1911JR�IV1l ' 1'JC1 from New York State Workers' (.:ompensatlon and/or Board Disability and Paid Family Leave Benefits Insurance Coverage **This form cannot be used to waive the workers'compensation rights or obligations of any party.** The applicant may use this Certificate of Attestation of Exemption ONLY to show a government entity that New York State specific workers'compensation and/or disability and paid family leave benefits insurance is not required. The applicant may NOT use this form to show another business or that business's insurance carrier that such insurance is not required. Please provide this form to the government entity from which you are requesting a permit,license or contract. This Certificate will not be accepted by government officials one year after the date printed on the form. In the Application of Business Applying For: /7'�e-gal Entit j Name and A ddrpa5'l• Building Permit \ Hirsch Fence Install&Design LLC e of R 747 Route 9W#4 From:Village e BrookS y Valley Cottage,NY 10989-2452 PHONE:945-304-8622 FEIN:XXXXX0091 The location of where work will be performed is 11 Jennifer Lane,Rye Brook,NY 10573. Estimated dates necessary to complete work associated with the building pe—it are�`m J:ne 28,202*to.June 24,2025. ( I The estimated dollar amount of project is $0-$10,000 Workers'Compensation Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE SPECIFIC WORKERS'COMPENSATION INSURANCE COVERAGE for the following reason: The business is a LLC,LLP,PLLP or a RLLP;OR is a partnership under the laws of New York State and is not a corporation. Other than the partners or members,there are no employees,day labor,leased employees,borrowed employees,part-time employees,unpaid volunteers(including family members)or subcontractors. Partners/Members: Bruce Hirsch I I Disability and Paid Family Leave Benefits Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE STATUTORY DISABILITY AND PAID FAMILY LEAVE BENEFITS INSURANCE COVERAGE for the following reason: The business MUST be either: 1) owned by one individual; OR 2) is a partnership(including LLC,LLP,PLLP,RLLP,or LP)under +U.1u_Of KT-1:Y.k urwt-and is.ivt u".OirOiM..t:wy vp 3) io u yaw v�.:'O peon Oi.ned corporation,nth ruivse indrviduaiu Owning all of the stock and holding all offices of the corporation(in a two person owned corporation each individual must be an officer and own at least one share of stock); OR 4) is a business with no NYS location. In addition,the business does not require disability and paid family leave benefits coverage at this time since it has not employed one or more individuals on at least 30 days in any calendar year in New York State. (Independent contractors are not considered to be employees under the Disability and Paid Family Leave Benefits Law.) y ArrrCe u:=Cy, .2TM..the 11R ha ,rrr.rl,e»hC...-..^.:e.i leb�l ro..2h j'. .T_fE that t�'=��pasiwC^^ir/.the»b ."e .i h.:.�.^.:SS T he a the knowledge,information and authority to make this Certificate of Attestation of Exemption. I hereby affirm that the statements made herein are true,that I have not made any materially false statements and I make this Certificate of Attestation of Exemption under the penalties of perjury. I further affirm that I understand that any false statement,representation or concealment will subject me to felony criminal prosecution,including jail and civil liability in accordance with the Workers'Compensation Law and all other New York State laws. By submitting this Certificate of Attestation of Exemption to the government entity listed above I also hereby affirm that if circumstances change so that workers'compensation insurance and/or disability and paid family leave benefits coverage is required,the above-named legal entity will immediately acquire appropriate New York State specific workers' compensation insurance and/or disability an paid family leave benefits coverage and also immediately furnish proof of that coverage on forms approved by the Chair of the Workers'Compensatio oard to the government entity listed above. SIGN I Signature: Date: HERE Exemption Certificate umber R ceiVd lv#no 'IQ ")nlA iv cet-030675 --. --- NYS Workers' Compensation Board CE-200 01/2018 Laura Petersen From: UDig NY Exactix <tickets@exactix.udigny.org> Sent: Monday,July 22, 2024 11:47 AM To: Steven Fews Subject: Message from UDig NY ****REGULAR**** DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 07/22/2024 11:46 To: VIL RYE BROOK PRIMARY Transmitted: 07/22/2024 11:46 00074 Ticket: 07224-001-251-00 Type: Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK Addr: From: 11 To: Name: JENNIFER LN Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate: WORKING IN THE BACK YARD NearSt: LINCOLN AVE Means of Excavation: POST HOLE DIGGER Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: N Work Type: FENCE INSTALL Estimated Work Complete Date: 08/02/2024 Depth of excavation: 24 INCHES Site dimensions: Length 66 FEET Start Date and Time: 07/26/2024 07:00 Must Start By: 08/09/2024 ------------------------------------------------------------------------------ Contact Name: BRUCE HIRSCH Company: HIRSCH FENCE INSTALL & DESIGN Addrl: 747 RT 9W Addr2: City: VALLEY COTTAGE State: NY Zip: 10989 Phone: 845-304-8622 Fax: Email: bruce@hirschfence.com Field Contact: BRUCE HIRSCH Alt Phone: 845-304-8622 Email: bruce@hirschfence.com Working for: CUSTOMER ------------------------------------------------------------------------------ Comments: Lookup Type: PARCEL ------------------------------------------------------------------------------ Members: ALTICE USA CONED = SUEZ WTR WESTCHESTER VIL RYE BROOK WESTCHESTER CTY SWR i 9 u "50 a s3s €t �W��2°v 4j u C• $e0U JI y a U 3.y g E n g F a F r os z 'e Village of R Brook dtN Architectural 8W Boa Approval Date: Chairman: e gg Cub APfff rE O L Edge'd Paveme^ x u'p C O W a w TERRACE COURT -- I N �� wed.Rytildww �R 9 Q) 1.L Fdp.al Pwemed 1O^,^.�,d falLL o PERMIT f — OICub a R. 3 —� °� wZ 0- Q J ATE APP RQYC 08' l y —� ��J - .53T20'E 81.00' lilt �y >m ��BUILDiN pL�, L ....k.. o Cn a 1 I O e� D Z Yl � lipd.Yd`r I O O z W J Cn N 3 Raa110.10 Ik Z Y'^ M�1 a any•wls �A` a 8 � (� y� IS Q' L•] C. W �S\0eS"a O a, a m —20.77 I I rQt FI eU � W O K //1 aa:..i ul yw� I _v f� §„03 io U•1 T'§ AS-BUILTIFINAL SURVEY S s REQUIRE PRIOR TO 0 a Z D g s E 3 F FINAL I SPECTION �Z 5 ¢ 9 g .L' I S g u y I - Manhole Manhole Rim=171.14 Drain Inlet Rim=170.00 Only copies from the original of this survey marked with an original of the Land Surveyors embossed seal or red colored seal shall be considered to be true, valid copies. Said certifications shall run only to the person for whom this survey is prepared and on his/her behalf to the title company, governmental agency and lending institutions listed hereon. Certifications are not transferable to additional institutions or subsequent owners. Unauthorized alteration or addition to a survey map bearing a licensed Land Surveyors seal is a violation of Section 7209, Subdivision 2 of the New York State Education Law. Possession only where indicated. Adjacent property lines and easements not surveyed or certified. Access to adjacent rights of way, easements and public or private lands not guaranteed or certified. Underground utilities shown hereon are approximate and should be verified before excavating. Additional underground utilities are not shown or certified. Encroachments and structures below grade, if any, not shown or certified. Subject to covenants, easements, restrictions, conditions and agreements of record. Premises hereon being Lot 91 as shown on a certain map entitled, "Map of Rye Hills, Town of Rye, Westchester County, New York." Said map filed in the Westchester County Clerk's Office, Division of Land Records on May 17, 1950 as map number 7064. Surveyed in accordance with Deed Control Number 563543752. Premises shown hereon designated on the Town of Rye Tax Maps as: Section 135.58, Block 1, Lot 21. Property Address: 11 Jennifer Lane Rye Brook, NY10573 THIS MAP IS FOR BUILDING DEPARTMENT PURPOSES ONLY. MAP IS NOT TO BE USED FOR TITLE TRANSFER PURPOSES. MAP MAYNOT BE CERTIFIED TO TITLE COMPANIES AND/OR D �CIE�W� DD SEP 1.0 2024 VILLAGE OF RYE BROOK BUILDING DEPARTMENT _ A -Bu�- CUM NT ASBUILT SURVEY PREPARED FOR CRAIG J. BERGMAN AND SAMANTHA MORGAN BERGMAN SITUATE IN THE TOWN OF RYE WESTCHESTER COUNTY, NEW YORK E SCALE. 1" =10' GRAPHIC SCALE Ili 10 0 5 10 20 40 916 Map Prepared.• December 12, 2016 Map Revised: November 27, 2017 to show as built survey Map Revised December 6, 2018 survey update and certifications added Map Revised: July 26, 2019 to show as built new improvements Map Revised: August 28, 2024 to show as built fence and new improvements ( IN FEET ) i inch = 10 ft.