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HomeMy WebLinkAboutMP24-091 6 V t+ VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR Jason A. Klein (914) 939-0668 Christopher). Bradbury www.ryebrookny.gov TRUSTEES BUILDING& FIRE INSPECTOR Susan R. Epstein Steven E. Fews Stephanie J. Fischer David M. Heiser Salvatore W. Morlino CERTIFICATE OF COMPLIANCE August 21,2024 Washington Park Plaza Associates 275 South Ridge Street Rye Brook,New York 10573 Re: 275 South Ridge Street, Rye Brook,New York 10573 Parcel ID#: 141.35-2-51 Mechanical Permit#24-091 issued on 7/11/2024 for Fire Sprinkler System Repairs This certifies that the fire sprinkler system repairs,under the above captioned permit,have been satisfactorily completed. Sincerely, Steven E. Fews Building& Fire Inspector /to E BRC�k. cu � 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:— 1 0�\ DATE: rERMIT$ ISSUE>): SECT: BLOCK: LET: LOCATION: ` ��� `. �' ���� OCCUPANCY: ❑ Violation Noted THE WORK IS... ❑ PASSED ❑ FAILED REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING C, C } ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION � \ 1� C ❑ Natural Gas 1 l + ❑ L.P.Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ["FINAL PLUMBING '❑ CROSS CONNECTION ❑ FINAL ❑ OTHER = CT '° = cV N o.•^ � x F, II/^ y FI H W can w a N A. W °' �' CA m o x OO bb Woo w o .� - '� a a o 0 O M r-C Woad i•l "' w W11 HO ° v � •v W w W H x ° 0 ICE " @: A p v w V W oo 071 � v a ' v v w C7 VA Qo o Z N � 0 OC 0 mm) �/ eIS � o W tz W O 1�2 -o a QI V �t o .rl 8 a w = o ff a z N © O co, 0 5 �I U V � V L`3 I ro o N z p A O s ' of A O W W v 4 �o tu 'C BUILDN4i,,',, DF,PA RTMENT E C LC VILLAGE OF RYE Bf�)OK MAY 16 20214 938 KING STREET RYE Blzo( ,NY 10573 (914)939-0668 VILLAGE OF RYE BROOK wwti�.tvebrexrk.or BUILDING DEPARTMENT APPLICATION TO INSTALL FIRE SUPPRESSION / FIRE SPRINKLER SYSTEM FOR OFFICE USE ONLY: C� �PD Approval Date /�20214 f31-- MP#: `-0 r / Application Fee:$ c�j�6 , \ approval Signalurc: Permit Fees: $ ��' P L� Disapproved: Other: Application dated: 5!l b/ aD@q is hereby made to the Building Inspector of the Village of Rye Brook NY for the issuance of a Permit to install or modify a Fire Suppression/Fire Sprinkler System as per detailed statement described below. 1. Job Address: Oq 61► �3 e�)o)K N to S T3 r- 2. Parcel I.D.: � /i 35 c —n Zone: 3. Proposed Work(Describe system in detail including suppression agent): &K_JMCtij (P-00j(- -�D -tVhe �4 99 1 n KI Vt 5yjA ) A 4. Number&Types of Fire Sprinkler Heads: k 5. N.Y State Construction Classification: N.Y.State Use Classification: 6. Estimated Value of Job:$ i S� (Value shall include all labor.inaterials,fixed equipment,professicmal`fees,and materials►nd labor which may be donated graris.) 7. Property Owner: UJQ5 hi nq b?o TlaLQ oNf N lEm;Address: Phone# ���- 23- �6 f� Cell# 9/7"�jf/9 3/6, email: T� S. Architect/Engineer: Address: Phone# Cell# X- email:. t_/`p,�� pp��II ,,JJ 9. Sprinkler Contractor:&CjQ F►�e.mm he( 3*,-t -NS Address: 3TS n - IDiVU/ Phone#M-325-54o of 107 Cell# 914' 649"l96 T email:�TA !�t ��II IC,�1 ��d j'ckL)c4trn t 3,32023 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: &e 1 � , being duly sworn, deposes and states that he/she is the applicant above named, (print nanic of individual signing 5s the applicant) and further states that (s)he is the Sprinkler Contractor 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 ofof the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this �Q Sworn to before me this day of , 20 day of 20 1 Signature of Property Owner Signature of Applicant & L= r /J?r9 rtJ ° f I ame of Property Owner Print Name of Applicant Nola Public Notary Public SHARI MELILLO Notary Public,State of New York No.01ME6160063 Qualified In Westchester County ornmission Expires January 29,20?, MAY 3 0 2024 VILLAGE OF RYE BROOK BUILDING DEPARTMENT 2 3/3/2023 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?I,EW YORK,COUNTY OF WESTCHESTER ) as: 1•nV t ! ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the p icant) and further states that (s)he is the Sprinkler Contractor 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. Swom to before me this Z 6 Sworn to before me this Wh dat,of , 20 v 7 day of !I Ate , 20.e Gagaturef Property wrier Signature of Applicant CcDfn1 A k r k Mi c n a Print(Same of Property Owner Print Nay of Applicant Notar uhli Notary Public ERegjsWadwi SERAHA F EOWARDS NOtsry Public-State of Hew York 919 NO.0fED6/34559 QwllAed fn Westchester County My Commission Expires Jun 6, 2026 Laura Petersen From: Laura Petersen Sent: Thursday, May 30, 2024 1:06 PM To: ATapia; martha7087@aol.com Subject: RE: 275 South Ridge Street - Sprinkler Permit Application Signature Page Yes thank you! Please provide the payment of$250.00 for the application fee and $275.00 for the permit fee. Laura S e n Laura(Petersen Office Assistant C.*44 Village of Rye Brook 938 King Street Rye Brook, New York 10573 Phone(914)939-0668 1 1petersen(cDryebrook.org From:ATapia<atapia@allsafefireprotection.com> Sent:Thursday, May 30, 2024 1:04 PM To: Laura Petersen<LPetersen@ryebrook.org>; martha7087@aol.com Subject: RE: 275 South Ridge Street-Sprinkler Permit Application Signature Page Hi Laura, Martha confirmed that she dropped off the necessary proxy statement. Please let me know if anything further is needed.Thank you! Sincerely, Adrian Tapia All Safe Fire Sprinkler Systems, 375 Executive Blvd, Elmsford,NY 10523 1888-325-5723 EXT 107 From: Laura Petersen <LPetersen@ryebrook.org> Sent:Wednesday, May 29,2024 2:49 PM To:ATapia<atapia@allsafefireprotection.com>; martha7087@aol.com Subject: 275 South Ridge Street-Sprinkler Permit Application Signature Page Good afternoon, Please have the attached signature page signed and notarized by the property manager of Washington Park Plaza and send back to me. Thank you Laura Laura(Petersen i ul Ja IS-01, MEN, 1-70 I-I'M 5-1-1 SNE g— El� s &MR,��N A 5210 31� mk MEN- I .......... Client#: 2498 ALLSAF2 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE 1 2/2(0/2024YYY) 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Edgewood Partners Ins. Center NAME: Commercial Support __J 40 Marcus Drive PMONE 631-390-9700 FAX 3rd Floor (A/C,No.Ext): (MC.No):631390-9790 E-MAIL NEConstructioncerts@epicbrokers.com Melville, NY 11747 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC M INSURER A:Crum✓f Forster SpeclaHy Insurance Co 44520 INSURED INSURERS:NorGUARD Insurance Company 31470 All Safe Fire Protection&Mechanical Inc INSURER C:Merchants Mutual Insurance Company 23329 All Safe Fire Sprinkler Systems Inc 375 Executive Blvd INSURER D: Elmsford, NY 10523 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUB POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDiYYYY) A X COMMERCIAL GENERAL LIABILITY Y GL0099737 9/11/2023 09/11/2024 EACH OCCURRENCE $1,000 000 I DAMAGE TO RENTED $50,000 I v`' PREMISES(Ea occurrence) L ICLAIMS-MADE XIOCCUR X BI/PD Ded:5 000 MED EXP(Any one person) $5,000 XI COntractuaI Liab. PERSONAL&ADV INJURY $1,000,000 GE/'LAGGREGATE LIMITAPPLnnIES PER: GENERAL AGGREGATE a2,000,000 X�OLOICYJElCJ_I LOC PRODUCTS-COMP/OP AGG a2+000,000 OTHER: $ I C AUTOMOBILE LIABILITY CAP9269941 9/16/2023 0911612024 COMBINED SINGLE LIMIT a1,000,000 _ (Ea accident) ANYAUTO BODILY INJURY(Per person) $ ~' OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED X AUTOS ONLY X AUTOS ONLY PROPERTY DAMAGE $ (Per accident) - $ -- A I UMBRELLA LIAB X SE0125991 9/11/2023 09111/2024 EACH OCCURRENCE $1 000000 EXCESS LIAB X OCCUR $1,000,000 CLAIMS-MADE AGGREGATE _ DED_ _ RETENTION$ _ _ $ B WORKERS COMPENSATION ALWC450938 9/16/2023 09/16/202 X PER OTHE AND EMPLOYERS'LIABILITY Y/ STATUTE ANY PROPRIETOR/PARTNER/EXECUTIVE OPFICER/MEMBEREXCLUDED? N/A E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 if yes,describe under $1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is included as additional insured for general liability coverage as required by written contract. CERTIFICATE HOLDER CANCELLATION Village of Rye Brook 938 King Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Rye Brook, NY 10573 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN y ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S63474461M6331707 CCA03 N Y S 1 F New York State Insurance Fund PO Box 66699,Albany, NY 12206 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE o a I A A A A 061503131 EPIC INSURANCE BROKERS tf�:sl &CONSULTANTS 40 MARCUS DR, 3RD FLOOR MELVILLE NY 11747 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER ALL SAFE FIRE PROTECTION, INC. VILLAGE OF RYE BROOK 375 EXECUTIVE BLVD 938 KING ST ELMSFORD NY 10523 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2593 528-9 245923 07/07/2023 TO 07/07/2024 12/20/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2593 528-9, 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. VICE PRESIDENT MAUREEN ULLEY ONE OF TWO OFFICERS OF ALL SAFE FIRE PROTECTION INC 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.