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HomeMy WebLinkAboutBP24-230PERMIT # / �% - O DATE:�O 3 �� a(P: /O 4 a SECTION 3J�� % BLOCj �% LOT LDa- TYPE OF WORK 4Pr16/ JOB LOCATION CONTRALTO ST. COST CO # C TCO # FEE A ��5�/%� FEE DATE INSPECTION RECORD DATE FOOTI N G FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING 52 RGH PLUMBING GAS C� SPRINKLER ELECTRIC LOW -VOLT ALA5AL,,O AS BUILT 0 FINAL I NSP 3 ve�q i o 414 uJo C9ry)?D#- ao OTHER APPROVALS ARB BOT Ps ZBA OTHJ=R VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK No: 25-022 Certificate of Occupancy This is to certify that of, having duly filed an application on o20 requesting a Certificate of Occupancy for the premises known as, 601� Jvop ) . p C�C� , Rye Brook,NY, located in a)eA--boning District and shown on the most current Tax Map as Section: Block: C--;� Lot: & and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building r. o Permit No. — issued 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: - / Construction: for the following purposes: f �� {� ���� Va 70'16 S 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 heigl4 shall be mad or shall the building be moved from one location to another until a permit to accomplish such change ha-0eeJ obt ' ed fr he Building Inspector. Building Inspector,Village of Rye Brook: Date: FEB 0 7 2025 D BUILD MENT For office use onl . PERMIT# -a3G I VIL ' l OFRYE�$*@OK ISSUED:/0 41 938 KING STREW YE BROOK, f v YORK 10573 DATE: JAN 3 0 2025 i 99 —0 -�L%i FEE: 4 C*��';)i5 PAID VILLAGE OF RYE BROOK W ov BUILDING DEPARTMENT R CERTIFICATE OF OCCUPANCY, CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION Address: U A)" �� G ` 9A01�- Occupancy/Use: �` -J Y Parcel ID#: /36 t 7- — c�)— Z% �) Zone: Owner: �� q 6? U,q'-.e Address:1o('),6 4 P.E./R.A. or Contractor: p ddress:c� _ p Person in responsible charge �/O A) l� / Address,y; A16 « �Al�1 [/ Application is hereby made and submitted to the Building Inspector of the Village of Rye Brook for the issuance of a Certificate of Occupancy/Certificate of Compliance for the structure/construction/alteration herein mentioned in accordance with law: STATE OF NEWYORK,COUNTY OF WESTCHESTER as: " being duly sworn,deposes and says that he/she resides at pc) A ypf\ Cl co C, Ong+ aP int Nam of Applicantnt) (No.and Street) in 0 F-- ,in the County of I/V�,ItC��QS r in the State of ,that (City/Town/Village) he/she is supervised the work at the location indicated above,and that the actual total cost of the work,including all site improvements, labor,materials,scaffolding,fixed equip ent,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$o d o // / , for the construction r alteration of: /V 1 ��v ` D 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 QZ11 Sworn to before me this day of Y) , 20 day of cam- Q U Q , 20�2 Signature of PAti—eF Signature of App iccaant . MMaa Lwu- t Nam o Pro rty r Print f4awe of Applicant otary P blic ANA M SALAZA NOTARY PUBLIC.STATE OF NEW YORK Notary Public • Slab of Now York Registration No.OISA6365173 6/i/2024 No. 01810023637 Qualified in Westchester County 17lualified in Westchester County Commission Expires10-02.2025 Ily Comm. Expires Apr. 17, 2028 QyE BRC��. BUILDING DEPARTMENT lifulLDING 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: ? , 0 2-5 PERMIT# ISSUED: u SECT: BLOCK: LOT,' LOCATION: \`\, \ \vim 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 Q FINAL ❑ OTHER O Z� BR cu � • 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# ISSUED: SECT: BLOCK: LOT: LOCATION: OCCUPANCY: ❑ Violation Noted THE WORK IS... 0 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 ❑ OTHER L 9 y 44 (u u 11 LO) U) a u ao vv v H L C y N w ~j Lr) L Q 11 OCL V J O Fi"1 G'i O m 00 O � i--i N u ■wir dLn CA C C a a �A M 6.). m WO ~ oa x � JJ Gya m 11 y O a z A ao F ww 00 N W O a v Eu w E Q V W O ^ z N W E-+ O C •o v V w � Q w Uzv � � ` 000 W cW7 -i bO Q (.� M et , 100CY L Ryp� C7 © O z z 'vCq ov � v � ■ a f� �' O -+ O Q v w u i U ►+i a 0.`8 V w O 000 , w �Q c� O A z O a d a : BUIg MENT VtOF RY OOK L� 1J 938 KING Rvl+,BR ,NY 10573 OCT 1 2024-0 ov VILLAGE OF RYE BROOK BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: L� Approval Date: O C T 1 202 rm' #: / '3�OApplication Fee:S Approval Signature: Permit Fees:$ Disapproved: k4KSOther: Application dated: 10/03/2024 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. Job Address: 60 Avon Circle Unit B SBL: 1-335"1 75-c)-&�•/ zone: — J 2. Proposed Improvement.(Describe in detail): Interior renovation of kitchen and laundry closet 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No:X Yes: If yes,indicate: TIER I: TIER 11: TIER IA: 4. WiIl 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 fam.,2 fam.,comm.,etc...)Prior to Construction:Condominiums After Construction: no change 6. N.Y State Construction Classification: residentail N.Y.State Use Classification: R-'31 } p p 7. Property Owner: N Q &� �Q[ �U ,L{y / Address:_ CVO AVO n C►rd R( �1 6. K9k 9yW Phone# �— Cell# 91 -D 4-50 ' email: i DPe(.IY1Q qA 1�►�}YvtgkC'M 1054 3 8. Applicant: Address: c/ Phone# Cell# email: 9. Architect: Demasi Architects PC Address: 105 Smith Ave, Mt Kisco NY Phone#914-666-3858 Cell# emau: Lou@demaslarchitects.com 10. Engineer: Address: Phone# _ ell# ema,il: �- 11. Ge I C tr tQrl l d ss L 1-)O 1 s Phone# Cell# email ra _ 12. Estimated cost of construction $ (� J (NOTE:The estimated cost shall incline all lab)r,m4terial,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 13. Job Timetable: Start: Within 1 week of permit Finish: 2 months GIMl2024 BUIJE,jr _\� .� MENT VIL OF RY OOK 938 KING RYE BR6 ,NY 10573 _0 Ov 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 OFN,E/�W YORK, COUNTY OF WESTCHESTER ) as: I, WAO'I 1 Lge'r , residing at, 02 G( JL(\ v &,4 Ave. POD + CK �, , tPrint n:micl I (Address\\hcrc c0ni li\c) being duly sworn, deposes and states that (s)he is the applicant above named, and further states that(s)he is t e legal owner of the property to which this Affidavit of Compliance pertains at; CO� A-Vp r- Cl r d Lk \ l.t ) , Rye Brook, NY. (Joh 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. (SiLalatUrC of 1'ru rtv 0 er(s Moo r f Print Nan c 'f 'noperty Owncr(s ) Sworn to before m\e�this �) day o t>fi g , 20-� Notary Public • State of New York No. 01B10023637 Qualified in Westcheller County ` my Comm. Expires r. 17, 2026 (2) 6/1/2024 This application must be properly completed in its entirety and must include the notarized signatures) of the legal owners) 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 n ndividttal signing 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,ammey,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 ! ! Swom to before me this 1 day of r , 20 ��f day of QcTob@ r , 20; 'f Signature of er Signature of Applicant Me_na,(n Lo Sergio P arm Prope er Print idp o applicant r e otary 1' blic Notary ANA M SALAZ.AR NUTARY PUBLIC.STATE OF NEW YORK Rcgisirafion Nu,OISA6365173 JENNA ELIZAKTH IMLLINGTOt Qualified in Westchester County Notary Public • State of New York Commission Expires.IM2-2025 No. 01810023637 Qualified in Westchester Count My Comm. Ea ire&Apr. t7, (4) 6/1/2024 This form must be properly completed&notarized by the Design Professional of record and the Property Owner. Failure to provide this completed form with your permit application will delay the permitting process. Notice of Utilization of Truss Type, Pre-Engineered Wood, or Timber Frame Construction. (Title 19 Part 1264& 1265 NYCRR) To: The Building Inspector of the Village of Rye Brook. From: Dernasi Architects PC Subject Property: 60 Avon Circle Unit B SBL: Zone: Please take notice that the subject; ❑ One or Two Family; ❑Commercial, ❑ New Structure ❑ Addition to an Existing Structure ❑ Rehabilitation to an Existing Structure to be constructed or performed at the subject property will utilize; ❑ Truss Type Construction(TT) ❑ Pre-Engineered Wood Construction(PW) ❑ Timber Construction(TC) NO TRUSSES OR ENGINEER LUMBER USED in the following location(s); ❑ Floor Framing, including Girders&Beams(F) ❑ Roof Framing(R) ❑ Floor Framing and Roof Framing(FR) Please note that prior to the issuance of the Certificate of Occupancy, the subject dwelling or building utilizing truss type, pre-engineered wood, or timber construction must be posted with a Truss Identification Sign, installed in conformance with NYCRR §1264 for Commercial Buildings, and NYCRR§1265 for One&Two Family Dwellings. Sworn to before me this Sworn to before me this day of ,20 — day of ,20 Signature of Properfy{honer ¢ A a Signature f Design Professional .►I Print Name of Property Owner 4 a,} Print Name of Design Professional f`7r. 01'C6% 0Q� Notary Public ` c:r'- r��N Notary Public (3) O N a W CIO �" w I—+ N ` W 1-1 N N A A ;-. OA x M F-tir A C A � � o W ` A W 000 r z � cn J w z W Z M z N r Z V r CIS CP Ii =• A o < V W a z N az$z v z z F � W V O W 5PLO Ua G Z U k 0 $ w a O w v o O c a w V H8 x V o w z � o z w z A c � zCA DC� ����r BUILDING DEPARTMENT NOV 2 5 J2024 VILLAGE OF RYE BROOK VILLAGE OF RYE 938 KING STREET RYE BROOK,NY 10573 BUILDING DEPARTMENT (914)939-0668.FAx(914)939-5801 V4 VVW' Y 6r k.org ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE O NL�. �`� 4: -��— ��_� _ NOV 2 024 Approval Date: Permit Fee: $ Approval Signature: Other: Disapproved: (fees are non-refundable) Application dated, 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. The applicant & property owner, by signing this document agree that all electrical work performed will be in conformance with all applicable Federal, State,County and Local Codes. / 1.Address:60 8 4MOW CMC44C SBL:I Si 73-c� Zone: :�?A-/ 2.Property Owner: /--/e4dA/ E ZOPPRj Address:IO0B /4 ULNA Phone#:9_�Y- 9Z4 -,ffSV Cell#: email: 3.Master Electrician:')10'4W C !LC-6deq h/Z e4 Lic.#: /l 3f Phone tCell#: ooemailTQftKIT��fQ7fQ�X�G(�� Company Name,-4 ;FMAQ ECE'C 1'&C- ZZC Address:X2 F/t 4"4',9,&d 6(/CL.eO 4.Proposed Electrical Work/Fixture Count:V (;;,V.L'G "-,",7 cZ /v74__-V L166177 /�/S�/.O.a�i�fE/1•l��/�'�4T1�2 -- ,�.�Uir2f�i STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: J'o�o �/,g��� 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) /� 1 state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the /(///1 S/ � ►' �l o' j L7 Ci 6TvJ for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) 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 kqfore me this day of 20 da of ,20 Signature of Property Owner e of Applicant ✓A�fcJ T«Oa Print Name of Property Owner Pr' ame of Applicant / Notary Public Notary Public Maribeth C Rizzardl NOTARY PUBLIC 7/7/17 State of Connecticut 1 My Commission Exoires Oct_3 1_7(� STATEWIDE • 1:1 Main Street,Fishkill, NY 12524 1 emod:office@swisny.com SWIS JOBAPPLICATION ;. 12.7224 I fax914.219.1062 • • • Office Use Elect.Permit# Date Bldg Permit# Utility ID# Final Certificate# City/Village Zip Township County Address Cross Street Section Block Lot Owner Name/Address(if different than above) Contact Number ❑Basement ❑ 1st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside ❑Residential []Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent SERVICE Amperage Voltage 1 P 3P #Meters #Disconnect ❑Underground ❑New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information IC IE VE NOV 2 5 2024 CC Ci 1 ,:� DEPARTMENT This application is valid for one(1)year from the date received by SMS.This application is intended to cover the above listed items to be inspected,if at any time of Inspection additional items have been irtstalled,you we 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,omwr or authorized agent agrees to all the above terms and conditions as set forth for the application. Inspector Date Finalized Inspector# Company Name Date Signature Address City/State Zip Code License# Phone# State Wide Inspection Services 1080 Main Street JAN 16 2025 Fishkill, NY 12524 4�US 845 202-7224 Phone VILLAGE OF RYE BROOK 914-219-1062 Fax STATE WIDE INSPECTION SERVICES BUILDING_DEPARTMENT Email: office(a)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: J.C.Toledo Electric Megan E. Loper John Toledo 60 B Avon Circle 42 Richmond Hill Road, Rye Brook, NY 10573 Norwalk,CT 06854 Located at: 60 B Avon Circle, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP24-229 135.75 2 62.1 Certificate Number: 2024-8913 Building Permit Number: BP 24-230 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: 60 B Avon Circle, Rye Brook, NY 10573 The First Floor: 1 Bathroom(s), Kitchen, Laundry Room 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 151h day of January 2025. Name Quantity Rating Circuit Type Kitchen Refrigerator 01 Microwave 01 Range 01 Dishwasher 01 GFCI 02 LED Luminaires 03 Pendant Lights 02 Switches 02 Laundry Washer 01 Dryer 01 LED Motion Lights 01 Name Quantity Rating Circuit Type Bathroom GFCI 01 LED Luminaires 02 Switches 02 GFCI Breakers 02 AFCI Breakers 07 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. Page 2 a' s r-1 N N a N \ \ W r s Ln it •� Z V) H W a N Q. `n W N W 0 si [l Z O � G W �. 41 Ln x00 r4 --s W W a� � H Fj O 00 u � 00 z Z o C'N Ln ` CN 14 v � c ZK owl ' O z o Ln U � L`� C, � a ° ►�i w Q o0 A a Z A a x s BUIL NG DEP��MENT VILLAGE OF RJB OK NOV Z Z 2�2� 938 KING STREET RYE NY 105734) 9- VILLAGE O!= RY!EBROOK - BUILDING DEPARTMENT PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: — 3 O PP#: / I L. cApproval Date: Permit Fee: $ 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$750.00 Application dated, 742- is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agree that said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: 60 Atlo jl "17- B SBL:/ - �-�/ /S—,)- / Zone: L 2.Proposed Work: P_e fiI(, riAL /7 e t(,IS/1A1 4 La�/���d�y h/"u'./9ej/,Aw / 5 7- 4a'l� k4s Lj.-,e.r A14[ Li i to �i yl? / 3.Property Owner: l it/ LO�V/ Address: �� ,�(/o.v C/lCl� L,i,ITS Phone#: Cell#: - W�/ email: Pl.A-l/yA?A Y G,wtiL, C a±j 4.Master Plumber: 6AL Ai au'I'C-o Address: /&A, r Lic.#: -���- Phone#: q11-/ )Ly/0/$yL Cell#: email: Company Name: Address: INDICATE FIXTURES&LINES TO 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 31 Floor 4w Floor 5'h Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) 6/l/2024 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: mt- ,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 '3A Sworn to before me this ;?I- day of Akt/irlb&- ,20 _ day of /t-yV ,20 Signatur f V,&ely Owner Signature of Applicant LO SSG yo hl lqa4t � Pr' a of P perty'Owner Print Name of Applicant Not Public N�gtanc ELILLO JENNA ELIYABE H ll rYY"Public,State of New York Notary Public • State of New York Na.01fiRE6160063 No, 01BI0023637 Qualified in Westchester County Qualified in Westchester County Commisslon Expires Jc_ My Comm. Expires A r. 17, s0at1 tt. Y 29,20 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/l/2024 BUILDING D f� MENT E v L " BUi D VIL, AGE OF RY OOK n 2 Z 2024 938 KING STREET RYE BR ,NY 10573 -0 L7 W OV xxxxxxKxxxxx,xxxxxxxxxx*,t*,t,t*,t*,t*,t*,t,t,t*,t,t,t,t,t*,t,t,t*,t*,t,t,t�,t#*�,t,t,t*,t,t,t,t,t,t,tx,t,t*x�x**,t*xxxxxx,, x�;xxxxxxxx,t** 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!, Wpm tAw residing at, Gro nAvi twi Abe..- Por-I—Citskr,N S, (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, (00 A von Circle V.r)i f g• &o0L 1" 05 ?J , Rye Brook,NY. (Job Addr s) 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. (Sii,nature of Prope n (s)) M eq an 1-0��r (Print Name o roperty Owner(- Sworn to before me this 13'4 day D ibex , 20 V V 1ENNA ELIZABETH BILLINGTON Notary Public • State of New York No. 01BI0023637 Qualified in Westchester County (Not• Pubh My Comm. Expires Apr. 17, 2028 6/l/2024 �cv Buildin Permit Check Lisa&Zonin Anal is Address: Zone:_ y . \ Const.Type: Other. Submittal Date: �L" 1 2` Revisions Submittal Dates: Applicant: Nature of Work: CxO-c_s C^- ` c)n E Reviews:zBA: OCT 1 8 2014 P& BOT• Other. FEES:Filing: BP: g;D\) BP: � C/O:. Flood Plane: Legalization: ( ) ( � 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 Play Other. ( ) ( ) SURVEY:Dated: Current: Archival• Sealed: Unacceptable: ( ) /( ,4LANS:Date Stamped Sealed Copies: Electrons 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: Permit: H.W.I.C:_Battery:_Other: ( ) ( ) PLUMBING:Plans: Permit Nan 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.dam approvaL• notes: ( )ZBA mtg.date: approval notes: ( )PB mtg.date: approval• notes: REQUIRED EXISTING PROPOSED NOTES APPROVED Area: Circle: Date: Frome Front: Front Sides: Rear. Main Cov. Accs.Cov: Ft.H Sb: Sd.H Sb: QFA: Tot.imp: Ft Imp: pgd�w. Height/Stones: notes: ,;r�yy:r.%•. a,r y v .:'ay..:y t+.•ar•;Yss•l j._, ,r ,ir:g,��p sv.i t' '. v r' ,,.,r ,� .._�,�S4k srdF',v'�','r,� i' 'a•�,4Nuyc CAM. :;IF "pip`�rj�n' #,y+; "....\,\ •vy' ,�`r ♦ n^tr4 y °.`� ♦♦ �,�i y .r! +♦♦ 1 y r ♦♦/ t erg �n+ 5�31 y1 ♦ '" y ^'1�t' ♦♦ lam y S 9�• a yI/♦1! `� 11Iffl� ��Nll�f4fs ,�� 1 Ifl ,� ►f�fl "� ?�r If/f � 1�r•1 ������ ` `a = 1) flll �*3 11,f111 .IIIIf�f11�.�t' r�` '=t;4,``•'r tI1f1" +1{►-rs:'` �q a�ee ss't=.11 1 N cc as •$go �•.1 ocr }` V ammo CL �1 (� ti O a Cat] �•. LLJ 411 Qtptiection UJ p z Y c�, �e aQ oW. CL 011 i �,, s O r„ Yam! fdm N C) / � y 6{ 01 � U .. moo► �` � <t ' ' 3 � c• Pico.»� �,t�Ra+<+.. )!m(�" ems• r m-s-z3-s�"�----:•. . . . . : . . . . �� . . . � _-_ o ui»il �)> i E� a ¢+1{f+l 111+111'_c c_•:;'Ili�lll r' c >� '1111113 .' -11�1i1 s -_ ;•111 111 �_.£�3 at-'11101y sl f/1/14 �' s ►1►1111+11 s' Illi�ii+ll 1111�j1/11 I►�If/1111 > �1 f+l Illf f l - ii4ti;s- 0 8�^ oltys ��s f♦/ yi A H/ tl�A •1• A. 1/♦ � :: TIP. ���".. ��'���+ �v �`s l t^ ♦�l�l��� "SSE �y v DATE(MMIOD/YYYY) ACORf>'11 CERTIFICATE OF LIABILITY INSURANCE `� 06/21 12024 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 Sharp Insurance Services Inc CONTNAME: Moises Rosales 128 N Main St PHONE'CN 2032479524 ac No:2036638200 Port Chester NY 10573 ADDRESS.mrosales@sharpsvcs.com INSURER(S)AFFORDING COVERAGE _ __ _ NAIL INSURER A:Third Coast Insurance Company INSURED Sergio General Contracting Corp INSURER B: 42 Sherman Street INSURER C Port Chester NY 10573 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. IPOLICY EXP LTR TYPE OF INSURANCE INSD ADDL V POLICY NUMBER M DDlYPOLICY EFF MMIDDlYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE RI OCCUR PREMISES Ea occurrence S 50,000 A GLSISTC006423424 06106/2024 06/06/2025 MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 ✓ POLICY PET LOC PRODUCTS-COMP/OPAGG S 1,000,000 CT HER: S AUTOMOBILE LIABILITY COMBINE SINGLE LIMIT S Ea accident ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) S HIRED HNON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY Per accident S UMBRELLA LIAB OCCUR Li EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE S DIED RETENTIONS S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY �,)N STATUTE I I ER ANYPROPRIETOR,PARTNER/EXECUTIVE ❑ N f A E.L.EACH ACCIDENT S OFFICERIM EMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS f LOCATIONS VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder named as additional insured. CERTIFICATE HOLDER CANCELLATION Village of Rye Brook SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 938 King St ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE Moises Rosales Producer ©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 A A A A A A 522454246 SHARP INSURANCE SERVICES, INC + 120 N.MAIN ST QIh, 4y. PORT CHESTER NY 10573 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER SERGIO GENERAL CONTRACTING CORP. VILLAGE OF RYE BROOK 22 NORIAS ROAD 938 KING STREET GREENWICH CT 06830 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2275 662-1 777951 04/20/2024 TO 04/20/2025 5/14/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2275 662-1, 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 SERGIO ARAUJO SERGIO GENERAL CONTRACTING CORP. 1 OF 1 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. NEW YORK STATE SUR NCE FUND ". _ I//, ti'M W09-Gpolipivismea :ajs!23M w0,)-5j')ajig0. vjG0wgd@n0 jahN Od N �OOJG 6 c� gS�d� 999 (-blb) 3N H 0 091,0%loo)UOAV O O 3N 00S � mnow 3m3Av HiIWS GOI 8 {� N b-bS I �� J. 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