HomeMy WebLinkAboutBP24-183PERMIT #t y �l?
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VILLAGE OF RYE BROOK
WESTCHESTER COUNTY, NEW YORK
N o : >j-077
Certificate of ®ccupoucp
This is to certify that * ) )(A bu(Jde
'
of, R &n e N having duly filed an application on
20 Of) requesting a Certificate of Occupancy for the premises known as,
(,! Rnn4 rl r* Cl Rye Brook,NY, located in a �Zoning
District and shown on the most current Tax Map as Section: l 47. 7L3 Block: (;-;? Lot: `7 ,
and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building
Permit No. , issued 3 20-2v 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: A?-�-3 "Lis— /� Construction: I 2 ,
for the following purposes:
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 ' ht shall be mad , shall the building be moved from one location
to another until a permit to accomplish such change as in
o mer
wilding Inspector.
Building Inspector,Village of Rye Brook: Date: ��N 2 3 2025
r
REcEpwE
BUILD R \ MENT For office use only:
PERMIT# ?j
JUN 1 Q 2025 VIL OF RYE OK ISSUED:ID
9 N KING STRE YE BROOK, YORK 10573 DATE:--&— TO__L'2j1
VILLAGE OF RYE BROOK ".6 FEE: AID
BUILDING DEPARTMENT N_VV, 0 .20V
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
##k#irtrttttttt#ki#ii#iitittfkkf#f###kttitkitf#rt###rtrtrt#ittff#ikfk#irttftitirtt#rt######i#ttittfiffiik#k##k#######t##rtitffkk#kkk##rt
Address: 10 1JIGH P01/V7_ CIRC'LG- -, RYE 13ROOK NY 10573
Occupancy/Use: /—FQ/77 Parcel ID#: / 941, 73 - -2 -OCR Zone:
Owner: K1=LL`( BUDDp Address: /0HIC-H POINT CIR RYE BROOX
P.E./R.A. or Contractor: Address:
Person in responsible charge: kFLLY BODDE Address: /0 HI G-H POINT r IRT RYE W00/4 10573
Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a
Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance
with law:
STATE OF NEW YORK, COUNTY OF WESTCHESTER as:
/«L LY 13 U D D�E being duly sworn,deposes and says that he/she resides at /0 H 1 GH PO I N F C I R C L E
(Print Name of Applicant) (No.and Street)
in RYE 8R 00 K ,in the County of W ES'FC H E.S?�ER in the State of N Y ,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: -
fortheconstructionoralterationof: INTERIOR 9EN0✓R770NS
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 Sworn to before me this
day of 20 day of , 20
e 1
yjl�� jaA
gnature oLTmperty Owner Signature of Applicant
KELLY uv -
rin Name of Property Owner Print Name of Applicant
Notary PublibKAFU MEULLU Notary Public
Notary Public,State of New York
No.01ME6160063
Qualified in Westchester County 61/l r202a
Commission Expires January 29,20�-7
�yE BRC�uk
• �9�2 BUILDING DEPARTMENT
BUILDING INSPECTOR
i' 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: r' \s`S ` lC 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
.0 FINAL
❑ OTHER
QyE BR�k,
O� Zm
• 1932 BUILDING DEPARTMENT
BUILDING INSPECTOR
❑ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK
❑CODE ENFORCEMENT OFFICER 938 King Street . Rye Brook,NY 10573
(914) 939-0668 FAx (914) 939-5801
www ryebrook.org
- - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - -
ADDRESS : ' \ r\ �� DATE: I '1
PERMIT# ISSUED: SECT: BLOCK: LOT:
LOCATION' OCCUPANCY'
❑ Violation Noted THE WORK IS... PASSED ❑ FAILED 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
Q=FOTHER
�E BRC�v�
04
1982 BUILDING DEPARTMENT
V
ILDING INSPECTOR
SISTANT 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 O II G N �O I V DATE:
PERMIT# ?Q L y• l'—) ISSUED: SECT:I ZN- 73 BLOCK: LOT:
LOCATION: r"�_� C o OCCUPANCY:
❑ VIOLATION NOTED THE WORK IS... D"rACCEPTED ❑ 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
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BUILDING DEPARTMENT
VILLAGE OF RYE'OROOK -a ' AUG 2 2 2024
938 KING STREET RYE 131200K,NY 10573
(444)939-0668 � V '
wwwrryebrookny.i!ov
INTERIOR BUILDING PERMIT APPLICATION
FOR OFFICE USE ONLY: yf� ,/ //��
Approval Date: AUG 2 3 2024 P rmit#: / ��pplication Fee:$ / 00—'66
Approval Signature: Permit Fees:$_ (P _ DISC _
Disapproved: lather:
Application dated: is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of Permit for the
interior alteration of an existing building,or for a change in use,as per detailed statement described below.
1. Job Address: ID HIGH PPIMT CIR- RYE L FOQK SBL: IQ ,'73 39 zone:.
2. Proposed Improvement.(Describe indetail): K1I7HL1v ISA-CI<SPL SH1. UPDATE t_rCrHril�lG�
BRTHROoM ReN0VAno1VS 1/z GAT-H Hr+L-L)NAV &A rH IVIASTI~R6ATH . t--lV/N& koom
,4ND 3fd FLOOR UPDATT W&HT7NG_
* S4ME LOCAT70NS
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 I1: TIER Ill:
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: 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: After Construction:
6. N.Y State Construction Classification: N.Y.State Use Classification:
7. Property Owner: KELLI BUMF Address: 10 HI61 POINT GIR
Phone# Cell# (110 830-7249 email: ke11v, budde77t,!atnaH.com
S. Applicant: Address:
Phone# Cell# email:
9. Architect: Address:
Phone# Cell# email:
10. Engineer: Address:
Phone# Cell# email:
11. General Contractor: Address:
Phone# Cell# email:
12. Estimated cost of construction $ ono
(NOTE The estimated cost shall include all labor,material,scat7'olding,flxe equipment,processional ices,and material and labor which may be donated
gratis,)
13. Job Timetable: Start: R U 6-US T 2(, 20 2 4 Finish:
(I)
6/l/2024
BUILD) 1k0AR MENT JaD
VtL,� E OF RY OOK I AUG 2 2 2024
938 KING _ ET RYE Br; ,NY 10573 �
�`�
4)939-OC�Ir VILLAGE OF kYiv BROOK
>�7
www.ryebrookn�iy.�ov BDI.I`?Il1MG DE PARTfI,IEPJT
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, KELLY BL)W ,residing at, HIGH POINT CIRCLE
('Print name) (Address where you lip 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;
10 1-11 (,H POlN T' CIRCLE ,Rye Brook,NY.
I.lull 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.
iU4 &' te6l L
(Signature ofPropelM) [)'Cr("))
KELLY 60bbF
(Print Name of Property Owner(s))
Sworn to before me this
da of 20 a*'�
(Notary ihlic)
SHARI IJIELILL0
Notary Public,State of New York
No.01NI E6160063
Qualified in westchester County, (2)
Commission Expires January 29,2D�
brI r2o2a
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:
KE LILY SUDDE ,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 A u g U S{ , 20 Z H day of 20
ignature of P erty 04iferw v Signature of Applicant
kfLLY BUDDE
ame of Property Owner Print Name of Applicant
n�L' &'Lv.
Notary Public SHARI MELILLO Notary Public
Notary Public,State of New York
No.01NIE6160063
Qualified in Westchester County
--ommission Expires January 29,20V
(4)
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BUIL E MENT -
VIL E OF RYE OK I OCT - 4 2024
ID
938 KfN ET RYE BG� E�h'.,NY 10573 �__ - -__J
VILLAGE OF RYE BROOK
&pool&IVgov BUILDING DEPARTMENT
ELECTRICAL PERMIT APPLICATION
Westchester County Master Electricians License Required
FOR OFFICE USE ONLY BP#: �� EP#: Qq — C-)0
Approval Date: Permit Fee: $
Approval Signature: Other:
t Na
DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED Bl"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,Oc-f S --A 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.
1.Address: )O ;-li-.%.— 11 o : :k C.c Cie SBL: I a 4 19 -c� —3q Zone:^D
2.Property Owner: KELLY BuflDE Address: l0 HIGH POINT CIRCLE
Phone#: Cell#:(QIy)830-72g7 email: Kell &bu.dde77mgmarl.com
3.Master Electrician/Licensed Installer: Address: 3-2q VAS-W- f—b NP4
Lic.#: IS Phone#: Cell#: 84� "SO] - ci q I email: I? ZAt-,NRfliey t-a j96 L• (�o N
Company Name: _'C D EL L i rZ I(; Address:
4.Proposed Electrical Work/Fixture Count: QC C e C+i!.1 I s+ f I,
5.31 Patty Electrical Inspection Agency: S1.J l 5
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 i I Sworn to before me this
day of SET 20 2-4 day of ,20
ignature Pr p wner Signature of Applicant
KEEL BubbE _
Print Name of Property Owner Print Name of Applicant
N Public JOHN M SUOZZO Notary Public
NOTARY PUBLIC,STATE OF NEW YOM
Registration No.01 SU6070919 6/1/2024
Ouallfled In Westchester County
My Commission Expires March 11,2020
STATE WIDE INSPECTION SERVICES, INC.
Service VVith Integrity
0•0 • •
SWIS JOB APPLICATION tel 845.202.7224 1 fax 914.219.1062 1 SWISNY.cornl SWISTRAINING.COM
Office Use Elect. Permit# ,J�y Date
Bldg Permit# y� Scl Ft
Plumbing Permit#
Final Certificate#
City/Village tb r OCR Zip Building Dept. County WC_ S ?--
Address Cross Street Section Block'I
Lot 3
Owner Name/Address(If different than above) \� Contact Number 11
i
❑Basement Plst FI. ❑2nd A. ❑3rd Fl. ❑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 # 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
ID
OCT - 4 2024
I
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.
Email Address (ri �L�; �, ��lU � Name Q.Q �Se i 1►1(
License# i Date Signature Z
Address -1 �/ �./,ll c .„n ;n C.. City/State i i� ;i C Zip Code
Company Phone# U� - So --)ct `I
State Wide Inspection Services
1080 Main Street
JUN - 5 2025 Fishkill, NY 12524
845 202-7224 Phone
914-2194-219-1062 Fax
STATE WIDE INSPECTION SERVICES 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:
I.C.D. ELECTRIC Kelly Budde
Russell Zaharko 10 Highpoint Circle
374 Vassar Road Rye Brook, NY 10573
Poughkeepsie, NY 12603
Located at: 10 Highpoint Circle Rye Brook, NY 10573
Section: Block: Lot: Electrical Permit Number: EP-24-202
124.73 2 39
Certificate Number: 2025-3691 Building Permit Number: BP24-183
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: 10 Highpoint Circle Rye Brook, NY 10573
The First&Second Floor were 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 3`d Day of June 2025.
Name Quantity Rating Circuit Type
First Floor
Luminaires 20
Second Floor
Luminaires 13
Floor Heat 01 110 Volt
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.
,
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BUIL �E k OCT 6 2024 DD
MENT
VIL E OF RYE OK VILL.AG= OF RYE BROOK
938 KIN ET RYE B ,NY 10573BUILGI('��' DEPARTMENT
- i
wwwhQ�Boo . . og_v
PLUMBING PERMIT APPLICATION
FOR OFFICE USE ONLY BP#: �'7'- g PP#: 0 T— 149 0
Approval Date: C)J-2,1 Permit Fee: S
Approval Signature: Disapproved:
(fees are nun-refundable)
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, /O'-�to"c)y 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: !0 /"[< d A�-/ Orc- '- SBL: Zone: U6
2.Proposed Work: C-A-f cAzAv
3.Property Owner: KELLY BUDDE Address: /0 HIGH POINT CIRCLE
Phone#: Celll#: (9tq)830-72 4q em ' Kell . bLt dde77 mai-/.com
17-7 el
4.Master Plumbe Address: 2-e-7 AI
Lic.#: Phone# 2A6( Cell#: `T/'` — ail: 1 Q 00
Company Na -Q %l Address:
INDICATE FIXTURES& LINES— BE IN TA LED 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 /
3'd Floor
4's Floor
51 Floor
Exterior
5.*List Other Equipment/Provide Details:
(Notarized Signatures Required Next 2 Pages)
-1- 6/1/2024
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 1 Sworn to befo a me this Ib
day of SEPTF-MBI fZ ,202111 day of OC ,20144IZ7-t� I lsre�--
Z
Signature 6tPioperiy Owner ature of Applicant ]
KELLY BUDDE
Print Name of Property Owner Print Name of Applicant
of P blic JOHN M SUOZZO 0ZT` R*%ldk3 UolSsl
NOTARY PUBLIC,STATE OF NEW YORK
Registration No.01SU6070919 /(lunoO�a?s3�0i5^��V!PdlNfw
Qualified In Westchester County 8866519�ifl l0'oN
My Commission Expires March 11,2M 31-10,k mGN to GMIS'ollgnd AM011
Aanea` ue'r d3Hd01$lUH3
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. 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
• BUILDING DEPARTMENT D � (C PH
V
VIL ``����E OF RY&$ROOK
938 KING�TR�ET RYE BRVOK,NY 1057 OCT 16 2024 ;
(00)939-0668
wNr-wlryebrookny.aov VILLA.CE OF RYE BROOK
I 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:
3, KF_LLY BUDDE , residingat, 10 HIGH POINT CIRCLE
(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;
0 HIGH POINT CIRC L r:: 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.
- alty-
(Si nature of ro rty O%vn!�i
KELLY BUDO�
(Print Nameol'PmpeoN ()\vncr(s))
Sworn to before me this
day of 5EPTF,1V8FR . 202 y
(Not/ UhhC) JOHN M SUOZZO
NOTARY PUBLIC,STATE OF NEW YOHK
Registration No.OISU6070919
Qualified in Westchester County
My Commission Expires March 11.2WO
-3-
6/1/2024
.Building Permit Check List&Zonin Anal sis 1
Address: ' O t c n CA VW SBL: ��` ^L -
Zone: se: Const.Type Other.
Submittal Date: Z Z 2� RevisiVon�s Submittal Dates:
Applicant: U n( l�--
Nature of Work
Ql�1s
-AUG 2 3 B24
Reviews:ZBA: Pik. BOT: Other.
NEED OK _ 1
(L�( ,KFEFS:Filing. I C C/O} Flood Plane: Legalization:
( ) ( P: Dated:_ _�LNotarized: SBL: Truss I.D. Cross Connection: H.O.A.:
( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review Street Opening-
) ENVIRO:Long. Short: Fees: N/A:
( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmt.: Tree Play Other.
( ) ( ) SURVEY.Dated: Current: Archival• Sealed: Unacceptable:
( ) ( ) PLANS:Date Stamped: Sealed: Copies: Electronic er.
ense Workers Comp: Liability Comp.Waiver. Other.
CODE 753#: Dated: N/A:
HIGH-VOLTAGE ELECTRICAL-Plans: Permit: N/A: Other.
( ) ( ) LOW-VOLTAGE ELECTRICAL:Plans: Permit: N/A Other.
(Pj ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H.W.I.C.:_Battery:_Other:
PLUMBING:Plans: Permit: Nat.Gas: LP Gas: N/A/: Other.
( ) ( ) FIRE SUPPRESSION:Plans: Permit N/A Other.
( ) ( ) H.V.A.C.: Plans: Permit: N/A: Other.
( ) ( ) FUEL TANK Plans: Permit: Fuel Type: Other.
( ) ( ) 2020 NY State ECCC: N/A: Other.
( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter As-Built Plans: Other.
( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER Other.
( ) ( ) Other.
( )ARB mtg.date: approval• notes:
( )ZBA mtg.date: approval• notes:
( )PB mtg.date: approval• notes:
REQUIRED EXISl'ING PROPOSED NOTFS
Ara: APPROVED
Circle: 1111 7014
From a Date: °�
Front:
Front:
Sides:
Rear.
Main Cov.
Accs.Cov:
Ft.H Sb.
Sd.H Sb:
GFA:
Tot imp:
FtFt.Imn:
PP
Height/Stories:
notes:
Laura Petersen
From: Kelly Budde <kelly.budde77@gmail.com>
Sent: Friday, August 23, 2024 9:09 AM
To: stevefews@rybrook.org
Cc: Laura Petersen
Subject: Estimate cost
Good Morning Steve,
The estimated cost for the work at 10 High Point Circle would be $12,000.
Kind regards,
Kelly Budde
Sent from my iPhone
i
American Bankers Insurance Company of Florida
[A Stock Insurance Company]
[11222 Quail Roost Drive, Miami, FL 33157-6596• 305.253.2244]
CONDOMINIUM INSURANCE PROGRAM
APPLICATION
POLICY EFFECTIVE DATE EXPIRATION DATE POLICY NUMBER ACCOUNT NUMBER
INFORMATION 07/30/2024 07/30/2025 CND0300347 QQQ0089743
INSURED KELLY BUDDE ADDITIONAL
NAME AND 10 HIGH POINT CIR INSURED
MAILING RYE BROOK NY 10573 NAME AND
ADDRESS MAILING
Area Code& Phone Email ADDRESS Area Code& Phone
(914)830-7249 Kelly.Budde77@Gma
il.Com
MORTGAGEE AGENT NAME GEICO Insurance Agency, LLC.
NAME AND AND ADDRESS One Geico Blvd
ADDRESS Fredericksburg,VA 22412
Loan No.
PRINCIPAL
LOCATION
OF YOUR 10 HIGH POINT CIR
CONDOMINIUM RYE BROOK, NY 10573
(if different from
mailing address)
UNDERWRITING INFORMATION
Construction Type Protective Device(documentation must be submitted to Company with application)
❑ Frame ❑ Masonry ❑ Central Station Alarm ❑ Sprinkler System
1. Are you the owner of the insured property? ❑ Yes ® No
2. Is the insured property vacant, unoccupied or in foreclosure? ❑ Yes ® No
3. Is any business conducted(including child care)on the premises that bring visitors to the insured property? ❑ Yes ® No
4. Excluding storms,floods and other natural causes, how many losses have you had in the past three years? ® None❑ One
❑ 2 or more
[4a Related to the loss above, what was the date of loss? ]
5. Excluding service animals,do you own or care for an animal that has previously bitten, attacked or inflicted ❑ Yes ® No
injury on a person or animal?
6. Do you rent your condominium to others? ❑ Yes ® No
7. In what year was your condominium built? 2001
COVERAGE AMOUNTS:
Personal Property $25,000 Personal Liability $300,000
Building &Additions Coverage $77,000 Medical Payments to Others $1,000
Loss of Use Coverage $10,000 [Scheduled Jewelry] [ ]
Loss Assessment $1,000 [Unscheduled Jewelry] [ ]
Deductible $500 [Other Scheduled Property] [ ]
OPTIONAL COVERAGES:
Comprehensive Coverage for Building Additions&Alterations (not available for rented condominiums) ❑ Yes ® No
Identity Fraud Expense Coverage ($15,000 single occurrence limit with a $100 deductible) ❑ Yes ® No
Replacement Cost Coverage(for Personal Property) ® Yes ❑ No
Water Backup of Sewers or Drains ($2,500 per-occurrence limit with a $500 deductible) ® Yes ❑ No
TOTAL POLICY PREMIUM $533.00
A1036APC-0912(HISASH06APP) Page 1
SELECT YOUR PAYMENT PLAN
❑ Annual Payment ❑ [4] Payments* ❑ [6] Payments* ® [8] Payments
* If an installment plan is selected, a [$5.00]fee will be added to each installment. This fee is not applicable to the initial
payment. [Premiums shown may have been rounded to the next whole dollar amount; actual installment payments may
be less.]
SELECT AND AUTHORIZE YOUR PAYMENT METHOD
CREDIT CARD
I hereby authorize the necessary premium(s)to be charged to my credit card for the coverage I have selected.
❑ Discover Card® ® MasterCard® ❑ VISA® ❑ American Express® ❑ Diners Club QD
Credit Card No. Exp. Date
AUTOMATIC FUND WITHDRAWAL
I hereby authorize the necessary premium(s)to be deducted from my bank account for the coverage I have selected.
❑ Checking Account ❑ Savings Account
Routing No. F Account No.
CHECK/MONEY ORDER—make check payable to American Bankers Insurance Company of Florida.
Check/money order is enclosed for the premium amount I have selected.
BILL MORTGAGEE
By completing this application and signing my name below, I request coverage provided by Condominium Insurance
Program and authorize the billing of the cost of the insurance to my credit card.
[This insurance product is not a deposit, nor is it insured or guaranteed by the FDIC, any bank or Federal Government
Agency. By signing below, I acknowledge having received this disclosure.]
FRAUD NOTICE
Any person who knowingly and with intent to defraud any insurance company or other person files an application for
insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading,
information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be
subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.
COMPLETE AND SIGN
APPLICANT'S SIGNATURE APPLICATION DATE
Kelly Budde
07/26/2024
[AGENT'S NAME (IF APPLICABLE)] [AGENT'S NUMBER]
GEICO Insurance Agency, LLC. 228579
A1036APC-0912(HISASH06APP) Page 2
Application Number
CND0300347
Effective Dates
07/30/2024 to 07/30/2025 12 V AM
A S S U R A N I Yearly Premium
$533.00
CONFIRMATION OF INSURANCE For Services, call 1-877-900-0354
Agent Address Company Address
GEICO Insurance Agency, LLC. American Bankers Insurance Company of Florida
One Geico Blvd 11222 Quail Roost Drive
Fredericksburg, VA 22412 Miami, FL 33157-6596
Insured Name(s) & Mailing Address Risk Address
KELLY BUDDE 10 HIGH POINT CIR
10 HIGH POINT CIR RYE BROOK, NY 10573
RYE BROOK NY 10573
Section I Coverage Information Amount
DWELLING .................................................................................................................. $77,000
CONTENTS ................................................................................................................. $25,000
LOSSOF USE ........................................_.................................................................. $10,000
Section I Deductible Information Amount
DEDUCTIBLE .............................................................................................................. $500
Section 11 Coverage Information Amount
PERSONALLIABILITY ............................ .. ............................................................... $300,000
MEDICAL PAYMENTS TO OTHERS ........................................................................... $1 ,000
Other Coverages
X Replacement Cost Coverage for Contents ❑ Identity Fraud Expense Coverage
❑ Comprehensive Building Additions and Alterations ❑ Rental Surcharge
® Water Backup of Sewers and Drains ❑ Scheduled Personal Property
NOTE:ALL COVERAGES ARE SUBJECT TO THE TERMS AND CONDITIONS LISTED IN THE POLICY FORMS.
HISASH06DP-1217 Page 3
Application Number
CND0300347
Effective Dates
07/30/2024 to 07/30/2025 12:01 AM
A S S U R A N T Yearly Premium
$533.00
CONFIRMATION OF INSURANCE For Services, call 1-877-900-0354
Additional Interest and Mailing Address
HISASH06DP-1217 Page 4
0
ASSURANT
Payment Receipt For Application # CND0300347
Total Yearly Premium $533.00
Down Payment $85.28
Remaining Balance $447.72
Effective Dates 2024-07-30 12 V AM to 2025-07-30 12 V AM
For Service, Call 1-800-432-8612
Agent Address Company Address
GEICO Insurance Agency, LLC. American Bankers Insurance Company of Florida
One Geico Blvd 11222 Quail Roost Drive
Fredericksburg, VA 22412 Miami, FL 33157-6596
Insured Name & Mailing Address Risk Address
KELLY BUDDE 10 HIGH POINT CIR
10 HIGH POINT CIR RYE BROOK NY 10573
RYE BROOK NY 10573
I
Additional Interest Name & Mailing Address
HISASPRC-1217 Page 5
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 ind' ated o he bui in permit.
8 12ZIr2nq
(§igna6re of omeowner) (Date Signed)
KE LL`( BUDGE Home Telephone Number
(Homeowner's Name Printed)
Sworn to before me this 9a day of
Property Address that requires the building permit: �,,��5� —
10 HIGH POINT CIK
..nry .y p�.bir�j
RYE 89 0 0 K� NY l u 5-7� Notary Public,State of New York
No.011YIEU60063
Qualified in Westchester County
Commission Expires January 29,20_!'=:i_ I
Once notarized,this BP-1 form serves as an exemption for both workers'compensation and disability benefits insurance coverage.
BP-1 (12/08) NY-WCB