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HomeMy WebLinkAboutBP24-171PERMIT # A�)/` SECTION TYPE OF WORK JOB LOCATIO OWNER 7/l ®(p, % 31 ohs CK LOT , S7 1A6QV16r0Q/V .ems o Va ri V4. Qe� ll h / . %rPsC�03)gloq/ eO63c. EST. COS7 FEE mm -� ✓CO it r FEE 4 3a.5 jo,b DATE 1 2 5 TCO # FEE DATE - INSPECTION RECORD I DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING Q j <j INSULATION PLUMBING (p RGH PLUMBING GAS 0 SPRINKLER ELECTRIC LOW -VOLT [] AS QUILT FINAL a 0 y B�aLase� E/P�c� ✓ices OTHER APPROVALS ARB BOT Ps ZBA OTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK \ � -,L- �; NO. 25-060 Certificate of Occupancy Ehis is to certify thatgi&br-d 80 ) of, Rue having duly filed an application on 20J5 requesting a Certificate of Occupancy for the premises known as, I U 9,Cd �j-' Dy) y L, , Rye Brook,NY, located in a P—)5 Zoning District and shown on the most current Tax Map as Section: B 5. 43 Block: ! Lot: �. and having fully complied w)ith the requirements of the Building Code and the Zoning Ordinance under Building Permit No. �� / , issued 3 1 20� such authority and permission is hereby granted to the property owner to lawfully occupy or use said premises or building or part thereof listed under the following New York State Classifications, Use: �- Inywo-roz"I Construction: for the following purposes: �rr1D renave.-I-- ion 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 hei sha be m e,no all the building be moved from one location to another until a permit to accomplish such change has en o fro t uilding Inspector. Building Inspector,Village of Rye Brook: Date: MAY - 6 2025 p 0 V L� BUILDI �7.dE_____ MENT For office use only: IDf PERMIT# —1 7/ I VILLAGE OF RYE BROOK ISSUED: '7--3/�q MAY - 2 2025 ) 938 KING STREET,RYE BROOK,NEw YORK 10573 DATE: 5-a-ate (914)9 -0668 FEE: PAID.R VILLAGE OF RYE BROOK www.aarpokuy.gov BUILDING DEPARTMENT T 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 ststssssssssssssns»rr«sss«r•rssrsssssssssssst»ssssssss»»»»tsrrrsr«srrs«sr«rssttsssssssssssssss»rss»sststssssssssttss»»asss»s• Address: 2cr �po F ly—I ✓C Occupancy/Use: Parcel ID#: /13J, 7 3 J`r, Zone: -/s Owner: }<�4 (4UccaJ t' b .7 Address:Lr R e[�:o o2 C P.E./R.A. or Contractor:Clp/-P.S Address: Person in responsible charge:".qax) Address: Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEW YORK, COUNTY OF WESTCHESTER as:t 6I 1 being duly sworn,deposes and says that he/she resides at 4.j�- '`0 6F I 1V (Print Name of Appl cant) (No and Street) in }�y-c Q (Leo` in the County of ��s l �'�eJ l in the State of ,that (City/Town/Village) he/she has supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$ j/- U coo -- for the construction or alteration of: M 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 16A'-% z� Sworn to before me this day of , 20 2 S day of , 20 re of Property Owner Signature of Applicant ii'lkle tPrtof Property Owner Print Name of Applicant %HAR� Notary Nbliiary Public,State Or ew YOM Notary Public No.OiME6160063 Qualified In Westchester County—) commission Expires January 29,20 �E BRC�k. cu � -:iV • 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 : `��� �) DATE: PERMIT# ( l t ISSUED: —3% SECT: BLOCK: LOT: LOCATION: ���f ''��� �� 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 �Qy6 4RQ), o tim �> -aO 1982 BUILDING DEPARTMENT BUILDING INSPECTOR ❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK ❑CODE ENFORCEMENT OFFICER 938 King Street• Rye Brook,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : DATE: 1 PERMIT# I ISSUED: `Q SECT: BLOCK: LOT: �' ��� LOCATION: ` 5 '`� ( C OCCUPANCY: ❑ Violation Noted THE WORK IS... u PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING J!P ❑ FOOTING DRAINAGE \\\ V ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: D' ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ Natural Gas ❑ L.P. Gas �] FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER : cr a-0 1-0 O a Z a d ~ O 0 O rTA� a a O F'-yam 0 O O u G o � y w a 00 O °a ' C� w 0 V) a a W z A 00 N a a o p� 'a,G _ _ rn J ° 0-4a. � W N ° o fir.' a 00 z Z, 9 d R. -' Fes+ o - a r+r � � ed N W Vol � N � F .� .y--� av � ° z00 ml u to o � � � w � � � wzv O Wi--i IJ-t M w 00 w b ,� a U . O Qtzr. : 00 W W 04 4 1-4CM �T1 �' (W.7 � C3 j• d w ° eta V, w p� ;, ' ° b . �1 u H a �94 u � � A © U U d U U N-10 aa, z wIOLI HO �-+ s 1-4 u7 [� Q , z � � aj v d' s w � .N u a V D U U Z � 0. r-+ 0 A w Z 0 9d ' BUICDMENT C� E C� E �I � --., ! VIL OOK 938 KINGR ,NY 10573 JUL 2 9 2024 Y 0ov VILLAGE OF RYE BROOK BIL)ILDING DEPARTNH:NT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: JUL 3 1 2 24 Approval Date: P mit Application Fee:$^7/ Approval Signature: Permit Fees: $ c�o — ,L)0 e Disapproved: Other: Application dated:7 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, q 1. lob Address•16 Red Roof Drive SBL: �� / 73 -�*?zone: J/S_ 2. Proposed Improvement.(Describe in detail): Remodel the Master Bathroom keeping all utilities in the same place. 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: Yes: If yes,indicate: TIER 1: TIER 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 I Hood,etc...) :No:X Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application& 2 sets of detailed engineered plans) 5. Occupancy;(I fain.,2 fam.,comm.,etc...)Prior to Construction: I Fam After Construction: I Family 6. MY State Construction Classification: N.Y.State Use Classification: 7. Property Owner: Kathleen and Richard Billie Address: 16 Red Roof Drive Phone# Cell# 917-9234868 email: richard.billig@gmail.com 8. Applicant: Address: Phone# Cell# email: 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# email: 11. General Contractor: Flores General Repair Inc. Address: P.O.Box 1902,Ossining,NY 10562 Phone# Cell# 203-814-6632 email: ftoresgeneral76@yahoo.com 12. Estimated cost of construction $40,000 (NOTE.The estimated cost shall include all labor,material,scaffolding,fixed equipment,professional fees-and material and labor which may he donated gratis.) 13. Job Timetable:Start; Asap Finish: 6 weeks (i) 6n nQ24 BUILD 1VIENT VIL E OF RY OOK (^ �� 938 KING ET RYE BR ,NY 10573 � J U L 2 9 2.0?4 I `� L__�_ ,1 '0 -� ov VILLAGE OF RYE BROOK BUILDING DEPAR-rI MENT 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, Richard Billig , residing at, 16 Red Roof Drive (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; 16 Red Roof Drive , 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. Signature of Properly Owner(o) Richard Billig (Print Name of Property Owner(s)) Sworn to before me this of U.�L 20 t (Notar) Public) SHARI MELILLO Notary Pubtic,State of New York No.OIME6160063 Qualified In Westchester County, Commission Expires January 29,20�� (Z) fill/2024 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 YQR( OUNTY OF WESTCHESTER ) as: Q,4�wAR-9 t ° ''�' ,being duly sworn,deposes and states that he/she is the applicant above named, ^(printnameof individual signingilsthe 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 l Sworn to before me this day of 1` f 20� day of , 20 S gnature of Property Owner Signature of Applicant tNa �Lt'^NPa � ,L f a of Property Owner Print Name of Applicant I 'm � L -a ;-) ublic Notary Public SHARI MELILLO Notary Public,State of New York No,01ME6160063 Qualified In Westchester Count` 7 Commission Expires January 29,20� (4) 6/1/2024 s � N N o �en G+ w rl C. En tc ►r� Fi.i 1 Ln U a f rW M ¢ s a � H N O W O 5 p w r- w H W J z Z w00 rq M m r 0 t , v � 00 00 � ; z > a Q � 00 p z o `Z C W w r cn W ZP4 z .; z Z A � c, .� CN 00 w cn . cn w a C Q z < w zCA z ° z Q o $ x - c Z z •. A .wa w N U o g b-W ISO � < w oG Q�I CA R-i l z C� G1-1 0 vi ; yCL�Rnv�_� DD BUIL IDE MENT OCT 3 0 2024 VIL ` E OF RYE OK 938 KING S�` ET RYE B ,NY 10573 ' VILLAGE OF RYE BROOK (914) - BUILDING DEPARTMENT WWW.r fttjo V. QY ELECTRICAL PERMIT APPLICATION Westchester County yy1Master Electricians License Required FOR OFFICE USE ONLY l31'#: c�l / Ell Approval Date: V� Permit Fee: Approval Signature: Other: DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR. THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated, 10-30-2 N is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove electrical equipment,wiring, fixtures,or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. 22 a pp 1.Address: � 1• Ant)(/ D r i✓c SBL: ���► yJ"�-�- / Zone: I�-3 2.Property Owner: 1 d VL(/d Address: Phone#: Cell#: q =A�23- y? email: z QI !/ . COl1l 3.Master Electrician/Licensed Installer: 9�7.�0 "Why -Address:. a!!I/ Lic.#:19 2ZPhone#: Cell#:I/ -5&5- Z?fd email:�Q r �pJl� Company Name: Jjj$F_L 91JZ46jc: ✓ILE-S Address: 4.Proposed Electrical Work/Fixture Count: n►EW W 6II Y WaTet P lI,zor� 5.3r°Party Electrical Inspection Agency: STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,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 efor rrl this U day of ,20 day of C 20 a Signature of Property Owner Signa re o Ap ant w i/k Print Name of Property Owner r ame of Applicant R 0 Notary Public Natacy.Pdbbdc,State of New York No 01ME6160063 6/1 24 �ifizd In Westchester Count lion Expires January 29,2 STATE WIDE INSPECTION SERVICES, INC. 0•0 • • SWIS • B APPLICATION tel 845.202.7224 1 fax 914.219.1062 1 SWISNY.coml SWISTRAINING.COM Office Use Elect. Permit# &i- D Date Bldg Permit# _ 2 - 131 Sq Ft Plumbing Permit# Final Certificate# City/Village (o Zip Building Dept. VY P)rpele County � Tt lr �E. Address Cross Street Section Block / Lot q Owner Name/Address(If different than above) r ; f r Contact Number t ❑Basement ❑ 1st FI. ®2nd FI. ❑3rd FI. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/0 Detector Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels 1P 3P # Meters 1-# Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair ❑Overhead ❑ Upgrade ❑ Disconnect Utility ID# ❑Con Ed ❑ NYSEG ❑Central Hudson ❑ Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect Junction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation MOCT 3 0 2024 ID 9 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 anytime of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other inspection company.The applicant, owner or authorized agent agrees to all the above terms and conditions asset forth for the application. Email Address / y rj/ Name License# / - Date/0-3J- Z Signature Address �r �U City/State !+),; -7��1; 1 zip Code �( Company Phone# - Sibs- �.. D 3DI State Wide Inspection Services 1080 Main Street FEB 2 6 2025 Fishkill, NY 12524 845 202-7224 Phone VILLAGE OF RYE BROOK 914-219-1062 Fax STATE WIDE INSPECTION SERVICES BUILDING DEPARTMENT Email: office@swisny.com - Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Laser Electric Services, LLC Richard Billing Gustavo Aquino 16 Red Roof Drive 137 Pelham Road Rye Brook, NY 10573 New Rochelle, NY 10805 Located at: 16 Red Roof Drive, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP24-218 135.43 1 5.9 J Certificate Number: 2025-1088 Building Permit Number: BP-24-171 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 Red Roof Drive, Rye Brook, NY 10573 The Second Floor Master Bathroom was inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 20th day of February 2025. Name Quantity Rating Circuit Type Bathroom Exhaust fan 01 Vanity Sconces 02 Wall Mirror 01 LED Strip Lights 81FT GFCI 03 LED Recessed Luminaires 09 Single Pole Dimmers 08 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. s Ln 1 r w n en W �'•I � z a o 0-0 cEn Gn m s Mil M U Z x , z a v � , M � z g x ¢ r� , O Z p Oc � wz 00 x O � w CA Z 00 U L 00CN z >- W a cA a< z z w z a N O c U 4 W a w Get x I l ao � E BR RN ECE E BUIL E MENT OCT 3 0 2024 -3D VIL E OF RYE OK 938 KIN ET RYE B ,NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT ny.gov PLUMBING PERMIT]APPLICATION / `/� FOR OFFICE USE ONLY BP#: — ( / PP#: c)`L/— /CO Approval Date: l O Permit Fee: S /��r-0Z Approval Signature: Disapproved: (fees are non-refundable) DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BV THE BUILDING INSPECTOR. THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12%OF THE TOTAL COST OF CONSTRUCTION WITH A MINIMUM FEE OF$750.00 Application dated, lD/2 .t 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 agreee &that said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. I.Address: l � keep DP I V C SBL: /35,#3 519 Zone:, I S_ 2.Proposed Work: Q--f P X CACI C CA �( (�(1(� r 1 (�1t/( \ �j X t_M 3.Property Owner: u G2e/� 1/ Address: b c -p�e_o J)Q'� Phone#: t91 -1`�Z3 - /eT6 8- Cell#: email: /?`C,�, '61//�4_s'N1d7 L.-cc, 4.Master Plumber: F,1yae C 1AZ6r Address: C C- e k IC43 C U N Lic.#: 601 Phone#:C{ to 24 (.01 5 Cell#: q 14 email: �aka7ct r .CorA Company Name: v- Pl --� Address: 2_ C D�FLIhCs Pk • �L ILiSCU (� 1 �ftA�A-N ram- l INDICATE FIXTURES&LIIVE�O BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers Bath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1 st Floor 2nd Floor 1 n 1 t 3,d Floor L 4"'Floor 5'h Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -1- 6/I/2024 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 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 Ockbul Sworn to before me this day of ay 20 ,-� day of 20 0�l ignature of Prope Ow er Signature i -� Print Name of Property Owner J Print Name of Applicant "'L '0A)LU V�AJIX I—Ae 46ACl— 4 No Public �'Y Notary Public A HILDA JEfN11� {N 1 4 Notary Public,Sgte of low VM Registration No.OIQr43347 Qualified in WestchesterCa Com miss lon Expires Nor,7,jp This application must be properly completed in its entirety an mu lude the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- 6/1/2024 BUILD MENT D F C � V F VIL E OF RY OOK 938 KING ET RYE BR ,NY 10573 OCT 3 0 2024 DD �4 - 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:All residing at, (Print name (Address wherc 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; /(e- Rye Brook,NY. (Jo ress) 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. aturc of Property Owner(s)i (Print Name of Property Owner(s)) Sworn to before me this day of p�� , 20�� � Notary Public,State 0t New York Registrationo.01Qlrj�7 rjA Qualified in Westd►tRer county (Notary Public) �jCommisslon Eapirenn , A �lip r.7,2OK - 6 1 2024 BuilduigPerrmt Check List&Zoning Analyju _ C Address: C SBL• Zone Use, l CotuL Type: Other: Subm=al Date: ` evulons Subnurtal Dates: Applicant Nature of Work -) _ (� Rends ZBA. JUL 3 1 2024 BOT: other. —K lLl l Filing. Flood Plant on;L.egaLuti ( ) ( P: Ducd Alourved �G SB[ ��tuss I.D. Cross Connection FLOA: ( ) ( ) Scanc Roads Steep Slopes Wetlands: Storm Water Renew: Street Opening: ( ) ( ) EIVVIRO Long Short Fecs: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection S/W Mgmt: Tree Plan. Other. ( ) ( ) SURVEY:Dated: Current Archival Sealed Unacceptable ( ` '( ) Due Stamped Scaled Copies: I lectroruc Other. Li(�( cense Workers Comp: I lability Comp. Waiver. Other. ( ( ) CODE 753#: Dated N/A: ( � ( ) f HC VOLTAGE ELEC�IRICAI:Plato: Permit N/A. Other ( ( ) LOW-VOLTAGE ELECTRICAL•Plans: Permit N/A: Other. ( ) FIRE ALARM/SMOKE DETEC 1-OR& Plans: Permit FL WIC:_Battery:_Other. ( ' ( ) PLUMBINCs Plans Permit NaL Gas: LP Gas: N/A/: Other. ( ( ) FIRE SUPPRESSION:Plans. Permit N/A r.Othe �: ( ) FLVAC.: Plans: Permit N/A: Other. ( ( ) FUEL TANK Pla ns: Pennu Fud Type. Other: ( ) 2020 NY Sure ECCC: N/A: Other. ( ( ) Final Sureey Final Top,: RA/PE Sign-off Letter: As-Built Plans: Other. ( ) BP DENIAL LL-1717111 C/O DLNIAL l_E ITEFL Other. ( � ( > Other: ( ;ARB mug.due approval;- notes: ( )ZBA mug.date: approval;- notes: PB mtg.date. approval notes: REQUIRED EMSIING PROPOSED ti_(_11--S Ara DateJUL 3 1 2024 FrF FF Front Sid Rw- Main Car Acca,Cc Ft.H/Sb: Sd H GE& T�llttc: p HgkZStones ----_---— nota: f A N N TV.�1Frt.. `i,< '+��yrti,'. a r `�I,..,�h .tip A- •��A�. � -1` f 'ram D ^ i��l/' q„rx ,1i• !� „� r11, `rQ , a �+ rr �IIlllPr" vro�E.,��r1trr`'a J �III�I%. 4414 1/3i�i�J r George Latimer S4r Westchester County Executive James 1ltaisano Director,Consumer Protect' •- Department of Consumer Protection Home Improvement License FLORES GENERAL REPAIR INC. PO BOX 1902 OSSINING,NY-10562 This license is issued in accordance with Article XVI of the Westchester County Consumer Protection Code and is t o presence of the official department seal. Proof of citizenship or immigration status is not required for issuance of this lice' NOT FOR FEDERAL PURPOSES `ot�onsu,77L r�e� .of Date of Expiration License Number co 11/25/2024 WC-21297-1-108 o � slet Cou��� 'jrl ��l!$�i�i• t '���l�l+i'r d�� 1 + ,"kit, � 1 ! }`I' ACC>OR ® CERTIFICATE OF LIABILITY INSURANCE DATE(M0/2024 Y) 16- / 07/3 / 024 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 CONTA NAME: T Heydi Ortega Lazaro FITZPATRICK INSURANCE CENTER PHONE 9147396117 FAX 9147391553 (A/C, /C No Ext: A/C No: E-MAIL di fitzinsctr.com 54 WELCHER AVENUE ADDRESS: he Y @ PEEKSKILL,NY 10566 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: MAIN STREET AMERICA ASSURANCE CO 29939 INSURED Flores General Repair Inc INSURERB: P.O.Box 1902 INSURER C Ossining,NY 10562 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I ADDL TYPE OF INSURANCE JUM SUER POLICY NUMBER MM/DDPOLICY LTR IYYYY MWDDNYYY LIMITS A ✓I COMMERCIAL GENERAL LIABILITY Y MPJ4736T 11/03/2023 11/03/2024 FACHOCCURRENCE $ 2,000,000 DAMAGE TO RENTED CLAIMS-MADE ✓ OCCUR PREMISES Ea occurrence $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 ✓ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY __.AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident L $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) List the certificate holder as additional insured. Job location: 16 Red Roof Drive,Rye Brook,NY. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village Of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVE _V � ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 0 I•• 0 ^^^A^A 262545639 FITZPATRICK INSURANCE CENTER ,},rt 54 WELCHER AVER PEEKSKILL NY 10566 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER FLORES GENERAL REPAIR INC VILLAGE OF RYE BROOK PO BOX 1902 BUILDING DEPARTMENT OSSINING NY 10562 983 KING STREET RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2296 223-7 468 08/24/2023 TO 08/24/2024 7/30/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2296 223-7, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK. TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRIES SERGIO FLORES FLORES GENERAL REPAIR INC THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. 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