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HomeMy WebLinkAboutBP24-254PERMIT # �d7 -� DATE: � SECTION f �i 47 3 BLOCK TYPE OF WORK 4e/ion OS .#` JOB LOCATION -&441 �ooK��d� C OWNER C!d I�U %cJQ llPl 4 K o` 4,4pi � J�lri CONTRAC70R' �! r/i�12 f EST. COST �ffi'cT FEE vCO # FEE ,4(Q( Pb DATE TCO # FEE DATE DATE INSP �l 0/7 able%S� ya-/3�7 Cl%40 ( 14)&10c 00gzl FOOTING - FOUNDATION FRAMING - RFRAMING �(,� /u� INSULATION � ��� � _ �f/M PLUMBING RGH PLUMBING , i 4' ZOLS GAS Cl cQr�/ �SPRINKLER / �L/ c31404 QSP/ F� C v ELECTRIC w LOW -VOLT O %`ALARM (] - AS BUILT CI .P� �! FINAL � ►y'^ 'ZOZ< OTHER APPROVALS ARB BOT PB ZBA OTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 25-029 Certiftcate of ®crupaucp s , This is to certify th wv / pe6ml('k of, Bkw-4 having duly filed an application on 20 requesting a Certificate of Occupancy for the premises known as, 5q bkzL ltyi" P,6 u`-1- , Rye Brook,NY, located in a 49 Zoning District and shown on the most current Tax Map as Section: Block: Lot: and having fully complied complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. `T" - , issued ),2/,320,,-�? , 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: R / Construction: , for the following purposes: )Yllerio" Jl- / / cw �/" r-en6 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 shall the building be moved from one location to another until a permit to accomplish such change h en obt ' fr the uilding Inspector. Building Inspector,Village of Rye Brook: Date: FEB 2 0 2025 D E C EN BUILDING` EPA�tTMENT For office use only: PE1tIvIIT# asy VILLAGE OF RYE BROOK ISSUED:DD FEB 12 2025 38 KING STREET,RYE BROOK,NEW YORK 10573 DATE: QS_ (914)9,19-0668 FEE: PAID W .. VILLAGE OF RYE BROOK wW*.ry ophbV.j!ov BUILDING DEPAR-IMIENT r� PPLICATION 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 ssssssssssssssassssssassssssssassasssassassassssssasssassssssssssssssaasssssssaasssssssusasssssssssassassssssesessassssassss Address: 54 �PK0oVV' 3 Occupancy/Use: Parcel ID#: (0 O Zone: —F Owner:{A)fe.,.ML(0(,'<k .a- C--,MrU V)aAe"(- Address: Sli- ll, lc»klli�e_ Ce,,� 1057 3 P.E./R.A. or Contractor:—I�Ae /7e {,�A 6,73�c-�4onpddress: Person in responsible charge: kel A ell%4rf0 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: c p_ being duly sworn,deposes and says that he/she resides at (Print Name of Applicant) - (No.and Stye in � u ,in the County of W�S�Z�`�3 ✓ in the State of ,that (CitN Tov%n 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: `6 o2g S/JD for the construction or alteration of: LAa54A�/ /I 0 VQ/10 7 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 Gl 20 day of , 20 Vrty Owner Signature of Applicant e of Property Owner Print Name of Applicant r__)n1 .XN I-LAS Notary Public SHARI MEULLO Notary Public Notary public,State of New York No.OIME6160063 Qualified In Westchester County 'u'I Commission Expires January 29,20 Z.l QyE BRC��• cu � '9a2 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: y L Z PERMIT# ISSUED: SECT: BLOCK: LOT: Z LOCATION: 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 I ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER 0 FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER QyE BRC�k, 1. 1932 BUILDING DEPARTMENT ❑JBUILDING INSPECTOR E 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 : `I Zz oo\- c C�S.x- , cum DATE: ? U - Z OZ S PERMIT# I)� 2 z �J `� ISSUED: Z-3 -Z SECT: BLOCK: LOT: b 0 LOCATION: cJ 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 A ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ALL W ❑ OTHER S (-A- n �yE BRCbk '9�2 BUILDING DEPARTMENT ❑I BUILDING INSPECTOR G 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... ❑ 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 �E BRC��• 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... ❑ 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 a = as v s x kin w = N a e) w a} _ N M � �ICA ` W oQ ■ n u -- ; 1 � Cn s �-t O Z a� ,e N T--4 H o Q F 80 W F � vsc � y a, W O w w . vov � •� V W00M z U jai p Q O U PG Vr \ a w � � � Q Wcn � ,.., W � � �• o � q u O ►� � r � H A �" w o � �o ° .S � � U � CN a A � z Wcn " eo a a Q -j� © 'r -o a z CA 0.0 z 4 x a. va a Ln cn _ p E C E WW BUILD J NOV 19 2024 V1L6kGE OF RYE ROOK$ 938 KING STREcr Ri*E BRd' NY 10573 VILLAGE OF RYE BROOK Z:1914)939-06fi�}�fi�}� BUILDINIG DEPARTMENT _ w11 ov INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Approval Date: � I' i ti #: Application Fee:$ Approval Signature: Permit Fees:$ Disapproved: Other: Application dated: / �4 _is hereby made to the Building Inspectorof 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'/3./ 1. Job Address: S4 &4dye) �dd'�� I&MV i p5g3 SBL: M /1 1 — // —1P0 Zone:�� 2. Proposed Improvement.(Describe in detatl): r 3. Does tv proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: V Yes: If yes,indicate: TIER L TIER 11: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an exrsti g automatic fire suppression system(Fire Sprinkler,ANSL System,FM-200 System,Type 1 Hood,etc...) :No: V Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application& ?sets of detailed engineered plans) 5. Occupancy;(I fam.,2 fam.,comm.,etc...)Prior to Construction: After Construction: l `fi7l 6. MY State Construction Classification: N.Y.State UseClasssific�ti,,on�: n 7. Property Owner: a ��L� �� 1G�' Address: 1J(OdkPAt Phone# C{ell# ��'i �(A�— email: � ( C�,�3 �1I,CM 8. Applicant: (}. IC�� �l �r��` _Address: �� Phone# Cell# 'CIJ�►.^��g� email: C �n1G1�13 S�y4,tol�j 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# email: 11. General Contractor: �� ��i12 � � �dcress: Phone#_ 91jf—&/Q —COYY Cell# email: 12. Estimated cost of construction $ (NOTE:The estimated cost shall include all lahuu.in tonal_scaffolding.fixed equipment,professional tees,and material and labor"hich may be donated gratis.) 13. Job Timetable:Start: Finish: (1) 6/l/2024 ! � MENT BUILDI N4- DI) VIL G E OF RYE- OOK NOV 1 9 2U24 938 KINGj RYE BR6' NY 10573VILLAGE OF RYE BROOK kn ' ()v 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: �6��� ,residing at, ;�{' N� Wrint ndmc) (Address 4 here you ine) k vlJ� 3 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; VP✓ , Rye Brook,NY. (J b 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. V ( igndt e of'Properh (h ner(s)) V)AAL/-� (\ � t � (Print ame of Propertc 0mier(s)) Sworn to before me this }q day of , 20 (Notary Public) CHRi3TOPH A BRADBURY Notary pubic, state of I ievv York No.of BRE150'995 oualified in Westchaster County ('-) commission Expires January 29,20 W7_ 6n/2oza 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. STAT OF NEW YOFX QO_UNT�'OF WESTCHESTER ) as; Ya� V f\ �,J'� '�A 1 ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the a�pp icant) 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 19 Sworn to before me this I da f `� 5,20 day of , 20 Si ue of ProperO Owner v Signature of Applicant 4tv;\�4t(y1 4)� i Name of Property er Print Name of Applicant Notary Public Notary Public CHRISTOPHER J.BRADBURY No'Lary Public,State of New York No.01 BR6159985 Owilified in Westchester County Commission Expires January 29,20 (4) 6/t/2024 Y � O a erg Ln en0-4 CA += _ WCZ 0-4 a M W ag 00 L of CA O W M, W F A Ln PLO 00 eq Zcc ram+ 00 Z �W enrM x0 � O r = W C W Wdo N OW U o z z 2Ln rq = C BUIL MENT VIL E OF RYE OK DEC 2 0 2024 938 KIN ia ET RYE B ,NY 10573 VILLAGE OF RYE BROOK �00 4 BUILDING DEPARTMENT ww�v c.gknY. ov ELECTRICAL PERMIT APPLICATION Westchester Cou^^n��ty//Master Electricians License Required FOR OFFICE USE ONLY BP#: Cy`7�� EP#: Approval Date: U Z� Permit Fee: $ Approval Signature: Other: DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSt'ED 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 hIINIMI`IVI FEE OF$750.00 Application dated, I d 15 oZ is hereby made to the Building Inspector of the Village of Rye Brook NY, for the issuance of a Permit to install and/or remo a 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 I.Address: 54 �60I [6 �G-1 /dlJt�`' SBL:nn��1�.�3� �— (00 Zone:,& F 2.Property Owner: Ee C C �� Address: 3;;( Ci NN�� Phone#: Cell#: email:1 � 3.Master Electrician/Licensed Installer: vs ko p9 kw Address: 1.37 Fel&.en Id, &% &Wk Lic.#: Phone#: Cell#: //d/- s6 s' "140 email: Company Name: (#Set 50?/I'>!cS Address: � adlkw LO 40Z 4.Proposed Electrical Work/Fixture Count: 5.3rd Party Electrical Inspection Agency: �71.1�1 S S TE OF NEW YORK,COUNTY OF WESTCHESTER ) as: l``l 11PV l¢llifYl� being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of individual Sig i as the applica t) / state that(s)he is the���Z ;'YC-1/16&14 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 beforq me this Sworn to before me this day of _ ,20 day of 20 g ature of Property Owner Signature oKApplic t 'Name of Property er Print Name of Appli ant Notary PubligHARI MELILLO Notary PL*IIic,State of New York No,01ME6160063 �Y�� ' to Ntitytl V� en/2024 qualified in Westchester Count NO.D/N1���73�9 y Commission Expires January �lfl ed In Weetri 3Wr County Cc+Nfmkolon Fxpire..L;Feheunry f Z 2M? STATE WIDE INSPECTION SERVICES, INC. Service With lwegt-i�v 0•0 • • SWIS JOB APPLICATION0. • Office Use Elect. Permit# cJ�1 3 C Date Bldg Permit# �� y.— �� Scl Ft Plumbing Permit# Final Certificate# City/Village Zip Fu,d,,gDept �/ Q Countyf Address get Cross Street Section/I / Block Lot Owner Name/Address(If different than above) tIN u J 1 ( Contact Number -t t ❑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 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 57t I-*,u FbF►� 0 20� E � J IL.'11L---�-� � 24 � .�/ :, 7 ( �T v '0CK This application is valid for one(1)year from the date received by SWIS.This application is Intended to cover the above listed items to be Inspected,if at anytime of Inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other inspection company.The applicant, owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Email Address Name License# > % ` Date Signature Address City/State Zip Code I Company _ f Phone# R 3D State Wide Inspection Services CA-Z) 1080 Main Street I FEB 12 2025 Fishkill, NY 12524 a _ 845 202-7224 Phone VILLAGE OF RYE BROOK 914-219-1062 Fax STATE WIDE INSPECTION SERVICES BUILDING DEPARTMENT Email: office(cbswisnv.com Website: www.swisny.com Service With integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Laser Electric Services, LLC Kathleen McCormick Gustavo Aquino 54 Brookridge Court, Rye, NY 10573 137 Pelham Road New Rochelle, NY 10805 Located at: 54 Brookridge Court, Rye, NY 10573 Section: Block: Lot: Electrical Permit Number: EP24-239 141.43 1 60 Certificate Number: 2025-0102 Building Permit Number: BP24-254 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: 54 Brookridge Court, Rye, NY 10573 The Second Floor Master Bathroom was inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 7" Day of February 2025. Name Quantity Rating Circuit Type L.E.D. Strip Lights 28 Feet Luminaires 03 Bathroom Exhaust fan 01 Sconces 02 GFCI 02 Wall Mirror 01 Wall Exhaust Fan Timer 01 L.E.D. 03 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. at a Lr, � s a T-0 \ \ U CA 0 N � z � C a M � q' OWN( � U z ca W ac x F ? � w z '� w Mx ,gip H x ' ►� ® z ►� _ 00 Fri z oo W ACN \� a � O � Z � h+y a � � p V a a W N oz E v� m d Q zS , : W = O F Z z z _ a 63 a w LO 6g, ° x z A z A o ; ' a A W z q d oA = U a y�DR'C,�f f r`, ; t BUIL EPA MENT II1 VIL E OF RYE OK ��� 938 KIN ET RYE B ,NY 10573 DEC 20 2 wZviv iY.gov PLUMBING PERMIT APPLICATION - c FOR OFFICE USE ONLY #: v — 5 P P #: Approval Date: Permit Fee: S 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, c)'--)0— is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove Plumbing as per detailed statement described below.The applicant&property owner,by signing this document agreee�th/at said plumbing work will be in conformance with all applicable Federal,State,County and Local Codes. n /^ 1.Address: 61 • 14 w C-f. Cr SBL: ���� �3—�—�� Zone: 2.Proposed Work: 13,,4-f4 A p,s 12evo 3 /�nt T ram.! /1 c �•t ,f /Lc) �. 3.Property Owner: Address:J 41 94 y o - /I1O is P C Phone#: 9/�jW /3 n Cell#: emailkA'- 4 -e 4A /ne(01 A lei 7+L 67 4�L 4.Master Plumber:*/C4 r / Cq/4'rSo Address: f0-' k3a,c al /t7-4q q✓ Z*A �3o�- l7 Lic.#: "Z �J Phone#: /�- 7 7 �f b p Cell#: 4t/J Jrdf J-�I _—email/r1��M a A,'c. � �a���� ti . Company Name:/7l'r/"�PAu� � t vicii-ess: /"t'_ d v w .7 / A7•,/r,&/ Zh ' .4/7.r�fV7 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 / 3 311 Floor 4,h Floor 501 Floor Exterior 5.*List Other Equipment/Provide Details: f), y1,1, ✓Z,t✓r i%: w l l2 t j A e',t2 3 (Notarized Signatures Required Next 2 Pages) 6/]no24 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 e this Sworn to before me this ` day of C " r ,20 Z`\ day of ,20 C�14 Sfoature of P perty Owner Signature of ppltcant A► j@m M ( �u /*I 1-c-4r %tNaurn�of Property Owner Print Name of Applicant r` Uk o- Notary Public SPA ,1 MELILLO No blic Notary au51i� Sate of New Yo;k REGO M.RNERA No.o::.n;F6160063 Nelmy Public,State of New York ti in westchester County� No.DIRI6441398 Cotntr:is.�ion,,xpires January 29,20_1 Qualified In Westchester County` Commission xplres Septeq)b@r 26,2 This application must be properly completed in its entirety and must include t e 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 � y � BUILDING DEPARTMENT VILLAGE OF RYE BROOK DEC 2 O 2024 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 www.ryebrookny.gov ******************************************************************************************************* 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 WESTC14ESTER ) as: 31, L''C �� 1� I , residing at, reek (Print name) (Address wher you live) being duly sworn, deposes and states that(s)he is the applicant above named, and further states that s) s the legal owner of the property to which this Affidavit of Compliance pertains at; e5 1} � , Rye Brook,NY. _ Jq (Job A dress) 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. I "PropetVy )) KA f � L (Print Name of Property Owne ) Sworn to before me this day of , 20 4 (Notary P ic) GREGORY M.RIVERA Netary Public,State of New York No.01 RI6441398 Qualified in Westchester County Commission Expires September 26,202( 6/1/2024 Building Permit Check List&Zoning Analysis Address V0 C —1-A V SBL'-A : G Zone: t�i_1 Use: "Zl y Const.Type Other. Submittal Date: t Revisions Submittal Dates: Applicant C��C C CD(-(--6� \. C Nature of Work _'1GS��.c— C�� Reviews:ZBA: Nov PB: BOT: Other. NEED K ( (�)"'FEES:Filing.�_BP: C/O: Flood Plane: Legalization: ( ) APP: Dated: Notarized: SBL: 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: ( ) LANS:Date Stamped: Sealed Copies: Electronic. Other. ( ( License: Workers Comp: Liability Comp.Waiver. Other. ( ) ( ) CODE 753#: Dated: N/A: (� ( ) HUGH-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 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. O O 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 EXISTING PROPOSED NOTES do ROVED Area: Date Circle: Frote Front: Front: Sides: Rear. Main Cov: Accs.Cov: Ft.H Sb: Sd.H Sb: GFA: Tott in: Ft.I : P Height/Stories: notes: If Cj CD a�_ • '�' c0. 44 > w '4 y R •Cam ` �� i V ELT( � •. / 70 CIO LLI In W lit'actiontco» C cr Q } �Q Z tJ a"i ELEI c Grf "�—� t� • low � 1,r � i•r � 2 Q y c � a� e5 � >> w / p CA z IT co tn fe �f(o)>�' � _: .�. �-,_ter.:,• �,i�.--. r-r.��r�n-� ••-� ��.-; r j�1,r ""'"- - � � t�•"�,�y=: � ��" s�d+i t(4�. T1'•1�j, �t rgI 1 j, r y' �� �yj �4p//��.l���s �) 1/11 Tot L�'e O I lklAw� yt� , ,��Al••�I'�tiei' 1�'�/A ��, 1it i �, AC"R" CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYY) 11/18/2024 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 CONTACT NAME: WB Wm.E. Morrell, Inc. �c"� )• (914)94"904 F0X 914 28-8999 128 Court St E-MAADOR'ESS: infoiftmorrell-insurance.com White Plains, NY 10601 INSURERS AFFORDING COVERAGE NAIC0 INSURER A: UTICA FIRST INSURED INSURER B: Timberline First Construction Co. LLC INSURER C: Keith INSURER O: 1330 Harrison Ave INSURER E: Mamaroneck NY 10543 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 DDL SUBR POLICY EFF POLICY EXP T POLICY NUMBER IMMID rn LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 000 000 R DAMAGE TO RENTED CLAIMS-MADEX OCCUR PREMISES a occurrence $ 5O 000 MED EXP(Any oneperson) $ rj 000 A ART3000564010 10/20/2024 10/20/2025 PERSONAL&ADV INJURY $ 1 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 000 OOO X POLICY❑JECOT LOC PRODUCTS-COMP/013 AGG $ 2,000,W0 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMB $ (Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per AUTOS ONLY AUTOS ( accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY er acc UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR—H CLAIMS-MADE AGGREGATE $ 1-1 DED 1 REfENT10N$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS LIABILITY Y f N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE EL.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ NIA (Mandatory in NH) EL.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) VILLAGE OF RYE BROOK NAMED AS ADD'L INSURED'S IN REGARD TO GENERAL LIABILITY-SUBJECT TO WRITTEN CONTRACT, TERMS, CONDITIONS& EXCLUSIONS OF THE ORIGINAL POLICY AT THE TIME OFISSUANCE BY THE INSURANCE COMPANY. CERTIFICATE HOLDER CANCELLATION VILLAGE OF RYE BROOK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 938 KING STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN RYE BROOK, NY 10573 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPIRESENT%TIVE ©1"8-2015 ACOR C R rI N- All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD YORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1 a. Legal Name&Address of Insured(use street address only) 1 b. Business Telephone Number of Insured Timberline First Construction Company LLC 914-610-0044 1330 Harrison Ave 1c. NYS Unemployment Insurance Employer Registration Number of Insured Mamaroneck, NY 10543 N/A Work Location of I nsured(Only required if coverage is specifically limited to 1 d. Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 72-1601686 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) NorGUARD Insurance Company Village of Rye Brook 938 Kings St 3b.Policy Number of Entity Listed in Box 1 a" Rye Brook, NY 10573 TIWC527861 3c. Policy effective period 10/18/2024 to 10/18/2025 3d.The Proprietor, Partners or Executive Officers are Included.(Only check box if all partners/officers included) XQ all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"la"for workers' compensation under the New York State Workers'Compensation Law. (To use this form, New York(NY) must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers' Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Adam Edelstein (Print name of authorized representative or licensed agent of insurance carrier) Approved by: 11/18/2024 (Dale) Title: President Telephone Number of authorized representative or licensed agent of insurance carrier 800-673-2465 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-17) www.wcb.ny.gov (V CA OZ � N IL Lu b4 G LU LL Cl > O O w 61410 - � y . i 3„ 4 4 � O 'cd U_ —, i (n b U LOLM a ° b a� N o � wv � „ 0 2 a) 30— .0 IA t� "" i 0 0.^d 6. E-4 r~ Cd O N ' U C* - -------------- N o W 00 H LO I ' LO ,i ------- N (`) i O i �— (fl GoO \ N X O 0 0 to on ° (D U) N O M 0D U Z ('� o�^� Z �. to) s L L „S m U) U) ,� M r U LLI a rn z a Q z 0 W m Q acnc m cq N C � N � O C N Aa 0 � o na� 0 0 ' 34Z�� 00.0 M 0 X 'ti c0i .0 _� � 00 � � C Do U 003 0 � 0 u v -0 " = ° o = F� aroo m U > Li H `r' in H 11110 �m LO �a � O Q.O O .O U °q w 0 N 0 r. 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