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HomeMy WebLinkAboutBP24-193PERMIT # /U/ SECTION _ ly TYPE OF WORK JOB LOCATION T. COST #� 1191L TC• # / 93 OAMm /o �# O(P. - aLpCK ,�.OT - etc � �iIC - 0VQ/71i afro/u�o �15/ 910�0 FEES 3 9 7 _ FEE4 A (D® P6 DATE J T FEE DATE INSPECTION RECORD I DATE INSP FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING ' 3� �a GAS L7 SPRINKLER -7-�- ELECTRICLOW-VOLT- t�rAi.ARM i) AS BUILT O FINAL Z OTHER APPROVALS ARB BOT PS ZBA OTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK c�: 25-045 Certificate of ®ccupaurr This is to certify tha S W al-) Of, �Ulfhaving duly filed an application on (o,UA/!/CQ/ v/ 3U, 20 requesting a Certificate of Occupancy for the premises known as, Rye Brook,NY, located in a K9-16 Zoning District and shown on the most current Tax Map as Section: 5 Block: / Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. `7- ''I , issued (?/� 2 V,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: hmp- ^� Construction: 1/ for the following purposes: � D YOAI/D, I Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of the building or in the exit facilities shall be made,and no enlargement, whether by extending on any side or by increasing in height shall be made,nor 's I the building be moved from one location to another until a permit to accomplish such change has b obtained the u the Inspector. MAR 2 6 �► Building Inspector,Village of Rye Brook: Date: allc.i E C E ��h BUILDIN(� � MENT For office use onl : p �J '`�:- PERMIT# 93 IRI 3D JAN 3 0 2025 VILLAGE OF RYE BROOK ISSUED: 938 KING STREET,RYE BROOK,NEW YORK 10573 DATE:/- 5— VILLAGE OF RYE BROOK (914)9 -0668 FEE: , —":�—C) — PAID BUILDING DEPARTMENT "wW ° k oN 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 itit iii##i######t#i}#t/i#i#ii##}}#ti#i#kkktkt#ikft tikktkk####f######k#i####ti######4ii#ititiif t##i ikt##i tt#ffkikkktkiktffifk#k Address: Occupancy/Use:, G� Parcel ID#: Zone: Owner: Z-2/ Qz 2'�f Address: P.E./R.A.or Contractor: (2z- . (10-chO-y ,✓I Address: Person in responsible charge: cio4lplll c> 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: y 04 being duly swom,deposes and says that he/she resides at (PP t Name of Applicant) //,, // / No.and Street) in yr j(VejQ i� ,in the County of We c/'',�� in the State of ,that (City/rown/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:$ for the construction or alteration of- 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 thej`C�ode of the Village of Rye Brook. Sworn to before me this �`J Sworn to before me this day of (� , 20`0� day of , 20 Signature o ropernry Owner Signature of Applicant in a of Property Owner Print Name of Applicant Notary Public Notary Public SHARI MEULLO Notary Public,State of New York No.O1ME6160063 6i I no2a Qualified In Westchester County 2 Commission Expires January 29,20 1 QyE BRC�� 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 : /� DATE: PERMIT# (a ` ISSUED: SECT: BLOCK: LOT: LOCATION: �*"�—� }� �' _�'1 �1, ��(� OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER QyE BRO Fo BUILDING DEPARTMENT ❑BUILDING INSPECTOR p�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 : L` _-Syn,C DATE: PERMIT# ' Z � ' i "1 � ISSUED: SECT:/SECT: 135- S6 BLOCK: LOT: LOCATION: �'` v �1 f )� t ( cr '� OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: 8 ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS LAI ❑ L.P. GAS ❑ FUEL TANK _ ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL //—'> ❑ OTHER a G1 v v (1 cn 04 o W no � � x a zen v H 1�t a - � a � C9 � �, � ; � co *Oulu o 00 Ln c!n OC7 wOo z A A H oQbvU Zw � 0 p � � .�., Uzvd � Q cn z W F-I V a � v, 5 -o o 'U bo. V . Oo H v cn Zy z = 1-4 u U � ° � v _ o O v a v Y U W ff z C.`, Luu Q x pl `� Z U ° o� o w N V O V o % - V z Az o 11v c c � .. a a. BUILDTMENT VIL " E ()F RY RkOOK 9.4 938 KIN(, �;v-v R)'r. Bag'( ,NNY10573 SEP - 4 f� {91 4 '0 5 ,� w r , ;J'ory INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: SEP 4 2024 �17��pplicationFee: $ f0O —A,6 Approval llate: Approval Signature: Permit Fees:$ Disapproved: Other: Application dated: is her ma to the Building lns eetor4t9c-V�gnve olo NY, �wis*i*ia*ti a�Pf�the interior alteration of an existing building,or for a change in use,as per detailed statement jdescribed below. q 1. Job Address: �- opt 1rd�- .Ln .KVT2610k,a rsBL:1361�—�5 Zone: IO 2. Proposed Improvement.(Describe in detail): t.'Sa �,,'C��� �1 tY\ ��. nl(pn t 7 �- , QC-0C4 Sh Vu lL VA 1 3. OS"oes he props r prow merit mvoWa Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: Yes: If yes, indicate: TIER I: TIER II: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system(Fire Sprinkler,ANSL System,FM-200 System.Type I Hood,etc...) :No: Yes: {61'Nes.l)lease submit a separate Automatic Fire Suppression System Permit application K 2 sci5 of d0Milcd eiigiuc•er d plans) 5. Occupancy;(I fam.,2 fam.,comm.,etc...)Prior to Construction: After Construction: _ G. N.Y State Construction Classification: N.Y. State Use Classification: rtY Owner: 7 7. Property �Qt�! C�)CA Address:Lf T_QCCf I� fX w, �r�'Y � Phone# C1 IA 5$y- -t-(lp 1 Cell# n email: 8. Applicant {:<� ,n ti IDy2� ""��i Address: a 0 C v-1 LJ k 1 r�Q ^ Phone# `t( ( 56 14 - 2 q b 1 Cell# email: 9. Architect: Address: Phone# Cell # email: 10. Engineer: Address: Phone# Cell# email: //�� 11. General Contractor:(4ai o"'I CC 11M Address: , � �L' C "W(2-6 , U"�lYy Phone# 1*4- QW-4 -(?tr/A Cell# 9(t-(,LN4- 9 CC a emailAr_[q(�I���- COM 12. Estimated cost of construction $ Es:o C—) (N(Yfl- the e%tintaled cost shall mclude all latwr.txaaicriaT sc>tf't:�ldtn,.lixecl equipment,professional fees,and material inrd labor%%hich may he donated t ratis) l f 13. Job Timetable: Start: �I � I Finish: ��� 1 � � (i) 6/t/2024 BUILD �� MENT I !^i VIL E OF RX OOK 938 KING d E�r RYE BR ,NY 10573 SEP - Ii 2024 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, 5 r_ 1,11A_ 614 tol4 ,residing at, � G Wrint namo (. dress where you li%e) 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; ea C- I- _z- �iGs� , 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. ".-Id ('�;iLmk ttre of Property 0"1 OF (Print Name u1 Propcm,, ( wner(.)) Sworn to b ore m`ePis dayof JI 2p Z. STEVEN C.BAGWIN Notary Public,State of New York No.02BA4947774 Qualified in Westchester County (Nntury uhftc) I Commission Expires February 27,207L.77 (2) 6/1/202A This application must be properly completes: in its entirety and must include the notarized signature(s) of the legal owner(s) of the subject property, and the applicant of record in the spaces provided. Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. Please note that application fees are non-refundable. STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,being duly sworn, deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) d further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the :n( , for the legal owner and is duly authorized to make and file this application. (indicate architect,contract gent,attorney,etc.) 7 hat 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 be ore the this Sworn to before me this J day of V -)0 day of l&vNv M , 20 Signature of Property(honer 'cant Print N e rtV Owner l' t Name of Applicant Af otary Public otary Public STEVEN C.BAG`NIN Notary Public,State of New York �GCUSS L6.f No.02BA4947774 Fr4� TARY PUBLIC,STATE OF NEW YORK Qualifled in Westchester County Registration No. 01 GU6432535 Commission Expires February 27,20 ? 4uali}6ed in Putnam County , n4ay 02, 2026 (4) 611/2024 a , 00 � N N NN N pe�eC W Ca C �a.r z G W U r v CA :r W = _ c P �5 , LC) y x _ W M oo 7, 'A 00 eq0-4 LO w to W d .t Q a ^ w z u < v u 00 • w f—r f � (�; � a U o - a V OC W R' 0-0N .a P-4 z � V a w 3 w ZZ w Z [� Q ✓? LY; L Z o ' W � W � w � p � F ►� , C7 o4 p r� .a w � _ s < lF 13RC��?.> ---... BUILUR DEPARTMENT RSEP E C E ��E VILE OF RYE$$OOK 938 KING if1�ET RYE BROOK,NY 10573 1 Z 2024 DD VILLAGE OF RYE BROOK BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester Co unty Master Electricians License Required FOR OFFICE USE ONLY BP#: /6� 3 up#: Approval Date: SEP 2 Permit Fee: S Approval Signature: Other: ************************************************************************************************** DO NUT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPEX I OR. THE ADMINISTRATIVE FEE FOR WORK PROGRESSED OR COMPLETED WITHOUT A PERMIT IS 12% OF THE TOTAL,COST OF CONSTRUCTION WITH A MINIMUM FEE OF S750.00 Q Application dated, %—/.D D1 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: L , A/ SBL:Z 3,)—A 3(—'t aZone: —/0 2.Property Owner: ' pkY"— 4 j Address: Phone#: Cell#: email: 3.Master Electrician/Licensed Installer: U C Address: Lic.#:jL Ck Phone#: Cell#: 0 (email: t�UA�.i�C.,�(o���= . COO'- Company Name:e e"' L 0 I.lc Address: 4.Pro ;d;zEltrical Work/Fixture Count: 5.3`d 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,ordinanc d regulations. Sworn to before me this S t f inth' day of .20 f 20 Z Signature of Property Owner Si a of plicaAt f� / Print Name of Property Owner of Appikan SHARI MELILLO Notary Public,State of New York < Notary Public No.OIME6160063 Notary Public Qualified in Westchester County Commission Expires January 29,20_ 6/1/2024 STATE WIDE INSPECTION SERVICES, INC. .- 0•0 • • swis JOB APPLICATION0. • Office Use Elect. Permit# Date Bldg Permit# 1�C — 6 Scl Ft Plumbing Permit# Final Certificate# City/Village Zip Building Dept. County Address L �/ r Al Cross Street Secti ��` Block`{ Lot S V`-` 1 Owner Name/Address(If different than above) Contact Number ❑Basement Eflst Fl. ❑ 2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/O 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 WE D SEP 12 2024 JD ' 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 AddressS LAZi k/A �/� �O A" L � � U�i� Name /7 u License# GN Date Q - - Signature Address City/State Zip Cde Company A /� (�.�-r� c Phone# O-3_ C/ - State Wide Inspection Services 1080 Main Street MAR 14 2025 Fishkill, NY 12524 Q 845 202 7224 Phone VILLAGE OF RYE BROOK 914-219-1062 Fax STATEWIDE INSPECTION SERVICES Email: office@swisn .com �3l1ll.DWG 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: C&C Electric Stephen Gaines &Teri Friedman Joseph Polito 4 Jacqueline Lane 13 Hull Road Rye Brook, NY 10573 Danbury, CT 06811 Located at:4 Jacqueline Lane, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 24-185 135.35 1 59 Certificate Number: 2025-1213 Building Permit Number: BP 24-193 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:4 Jacqueline Lane, Rye Brook, NY 10573 The First Floor 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 26th Day of February 2025. Name Quantity Rating Circuit Type Luminaires 03 Switches 02 GFCI 01 Exhaust Fan 01 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. i t Lneq N N = O N p c N N a o CA o en x � H O W ryo W 00 Ln u cl) a o to ,n 00 w a i O Z x � O z U l (n cn W , 00 4 , F� FBI LL W x Z z a zZs 1 ' O ;. a M 1�1 W O a a o o z 0g _ � A RBUILDING DEPARTMENT SEP 19 2024 VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT WWW.r rookn . =ov PLUMBING P MIT APPLICATION FOR OFFICE USE ONLY B #: — �- � C/ PP#: SEP 2 024 �� Approval Date: Permit Fee: $ l" Approval Signature: Disapproved: (fees are non-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, is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install an / r 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: RC Ou a SBL: �3�i 3J���—�� Zone: 2.Proposed Work: - i r jr C - c b wl rr� 3.Property Owner: F1 rLr a.t Address: �Pc _,ci r Phone �`yT�� W(D Cell#: email: 4.Master Plumber: (O—q rC/1 RecJO L G1 Address: C? R c x I yo I- Lic.#15 7 -� Phor #iG Cell#7 / - email:60' Company Name: rVb'A 0M Ia.. our t ',. rAddress: C .t INDICATE FIXTURES& LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: Location Water Urinals Drinking Sinks Showers !lath Laundry Domestic Fire Sanitary Natural/ Other* Total Closets Fountains Tubs Tubs Service Service Sewer LP Gas Basement 1st Floor \) 2nd Floor 7_ 3'd Floor 4'Floor 5'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 tonbdorp-m�e)his Sworn to before me this Aq,day of 0 day of Signature 4 Property Owner Signatu - Cctraa F'I e h d 0 Print Na of rope Owner Print Name of Applicant G Notary Public Not blicSHARI MELILLO Notary Public,State of New York NO.OIME6160063 Qualified In Westchester County Commission Expires January 29,20 2� This application must be properly completed in its entirety and must include the notarized signature(STof 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. STEVEN C.BAGWIN Notary Public,State of New York No 02BA4947774 Qualified in Westchester County Commission Expires February 27,20 Z7 -2- 6/1/2024 BUILDING DEPARTMENT D VILLAGE OF RYE BROOK SEP 1 9 2024 938 KING" ET RYE BROOD,NY 10573 ("4)W-0668 VILLAGE OF RYE BROOK w1�•w.ryeb`i kny.t_oy 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: --� 31, fL," l ,i , residing at, (Print name) (A(1 ss whercyou 11yC) 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; / vid i1-- , Rye Brook,NY. (.Ioh AJlll'Ca) Further that all stat ments 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*Propen (hvnx (�)) (Print Namc or Property O vner(s)) Sworn to befo e m this ! 0 day of . 20 2V G (Nolan Puhlic) STEVEN C. AGWIN Notary Public,State of New York No.0A3A4947774 Qualified in West-hester County 3- Commission Exnires February 27.20_�zl 6/1/2024 .Building Permit alys Check List&Zoning Anis Address: 6-c-,Q t 1C I I t J P- 1,.N_SBL: 1�S �j 1 - S 5 Zone: Q_Ab Use, 2�r-\ Const.Type: Other: Submittal Date: �1 �Z� Revisions Submittal Dates: Applicants Nature of Work: d 1 (w C-i S Reviews:ZBA:_ SE P R 9 n 9 nPB BOT: Other. NEED0K (.) (� :Filing.-,��BP• C/O: Flood Plane Legalization: O (� APP: Dated: --Notarized: , 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 Plan: Other. ( ) ( ) SURVEY.Dated: Current Archival;- Sealed: Unacceptable: ( ) ( ) PLANS:Date Stamped Sealed Copies Electronic Other: ( ) ( ) License 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: ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Pem» 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 LET IT-R: Other: ( ) ( ) Other: ( )ARB mtg.date: approval;- notes: ( )ZBA mtg.date: approval:- notes: ( )PB mtg.date: approval;- notes: QUIRED EXISTING PROPOSED NOTES A�: RE AP v Circle: Dam* Fro�taee: Front: Front: Sides: Rear. Main Cow Accs.Cov: Ft.H Sb: Sd.H Sb: GFA: Tot : Ft In' PP H41g Stories notes: Wpm je George Latimer U�rity James,'1laisano Westchester Count Evecutice Director.Consumer Protection Department of Consumer Protection , Home Improvement License I �'-• GC CONTRACTING INC. 326 SHEAR HILL ROAD offiMAHOPAC,NY-10541 ll This license is issued in accordance%%ith Article XVI of the Westchester County Consumer Protection Code and is valid only upon � presence of the official department seal.Proof of citizenship or immigration status is not required for issuance of this liceme. NOT FOR FEDERAL PURPOSES � Gonsumr, rA t GC �' O `€F License NumbL Date of Expiration WC-28363-1-116 01/05/2026 c «may F !.SfchEsterCo�°�� `�p,?'a! � '`�' !.��� '11 tiiHt.rjp�ys 'n'Nt,INII �;){ +a'1►Ig1�q.. ',S� 3nl�i�. �-�w-�e;��E*,sx r,�14', 'e . LIIMUNUb♦ DATE(MM/DDNYYY) AcoR" CERTIFICATE OF LIABILITY INSURANCE '%. / 08/24/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFIC7ATE 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 endorsemen s). PRODUCER CONTACT NAME: __ _ HISCOX Inc. FAX PHONE 5 Concourse Parkway UVC.E-MAINo,Exti,L (�)202 3007 - �1Alc No1:_ Suite 2150 ADDRESS: COntaCt�hiscox.COm Atlanta GA,30328 INSURERS AFFORDING COVERAGE NAIC N INSURER A: Hiscox Insurance Company Inc 10200 INSURED INSURER B: GC Contracting Inc. INSURER C 326 Shear Hill Rd Mahopac, NY 10541 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' TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP POLICY NUMBER LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR PREMISES DAMAGE T RENTED PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 A P100.644.629.6 10/10/2023 10/10/2024 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JECOT- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accdent $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per acodent) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per acadent S UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LU48 CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIM EMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Village of Rye Brook listed as certificate holder 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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD PO Box 66699,Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE a o_ ^^^^^^ 462336696 GC CONTRACTING INC. 326 SHEAR HILL RD f MAHOPAC NY 10541 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER GC CONTRACTING INC. VILLAGE OF RYE BROOK 326 SHEAR HILL RD 938 KING STREET MAHOPAC NY 10541 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2545 871-2 57099 04/28/2024 TO 04/28/2025 8/24/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2545 871-2, 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. PRESIDENT GIOVANNI CAPOLUPO GC CONTRACTING INC.- 1 OF 1 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. NEW YORK STAT SU NCE FUND TT �/ DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 309583404 U-26.3