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HomeMy WebLinkAboutBP18-134PERMIT # 13P` j- DATE: EXP., SECTION �. �� ; �## BLOCK LOT_ TYPE e1= WORK !OD LOCATION EST. v co w SATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING GO RGH PLUMBING GAS 0 SPRINKLER ELECTRIC Q LOW -VOLT O ALARM AS BUILT FINAL iNSP 1120 ZBA OTHER PPROVALS AS-BEltLTFriIRFI) PRIOR TO SURVEY RFINAL INSPECTION Expired Letter Sent Open Permit Letter Sent Gl •[G�4[t�. a�� VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook, N.Y. 10573 ADMINISTRATOR Paul S. Rosenberg (914) 939-0668 Christopher J. Bradbury www.ryebrook.org TRUSTEES BUILDING & FIRE Susan R. Epstein. INSPECTOR Stephanie J. Fischer Michael J. Izzo David M. Heiser Jason A. Klein CERTIFICATE OF COMPLIANCE November 23,2021 Pat Lovallo 177 North Ridge Street Rye Brook,New York 10573 Re: 177 North Ridge Street, Rye Brook,New York 10573 Parcel ID#: 135.43-1-25 Building Permit#18-134 issued 8/20/2018 to Legalize Fence This certifies that the new six foot high stockade rear yard fence and the three Foot high open picket side yard fence,installed under the above captioned permit has been satisfactorily completed. Sincerely, r Michael J. Izzo Building&Fire Inspector Ag DFor office use onl : BUILDING DEPARTMENT PERMIT# _/ y VILLAGE OF RYE BROOK ISSUED: -cZ0- NOV 1 :0:2Q2�] 0 938 KING STRECT,RYE BROOK,NEW YORK 10573 DATE: //—/0-3l VILLAGE OF RYE BROOK (9 j4)939-0668 FEE: ar //0— PAID BUILDING DEPARTMENT W '� � °� °rg APPLICATION FOR CERTIFICATE OF OCCUPANCY, CERTIFICATE OF COMPLIANCES AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK AND PRIOR TO THE FINAL INSPECTION #RRR#f4ii44;#;;;4#tlRtf•ifk♦ff;;;f#RR#R#i#Riif444R;#;;##ttki#tktRRtt4tifff;#fR#R###RR#;iif4#4;;F;4R;#fWtRt#R4#tiRRR;R4fRtif#• Address: -7 Jt-I �-I- S ' -- & C. � v � 7_� Occupancy/Use: /--AIt}p't Parcel 1D#: 13,1-1 7 3 Zone: Owner: Pc-A- Looc- 0 o Address: 1 -7 7 Al (Z\ P.E./R.A. or Contractor: ---�- F �� Address: i`t<� 3 C W - A Le y Person in responsible charge: <-- g v c-( y o 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: S ATE OF NEW YOM COUNTY OF WESTCHESTER as: �'' being dui sworn, -7 � !V R b -S`'� g y m,deposes and says that he/she resides at 5 (Print Name ofA licant) ` r (No.and Street) in the County of l--) in the State of LU `� ,that (City/own/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:$ /G) o l> f , 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 fuurther 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. LA Swom to be/fore me this Sworn to before me this day of 1 L)v- l , 2{} day of , 20 Si of Property(Twaer Signature of Applicant Print Name of Property Owner Print Name of Applicant Notary Public ALEXANDRA H.MARSHALL Notary Pubilc,State of New York No.OIFR6363711. 811212021 Qualified In Westchester county commission Expires August 28,20� �ie Bkj BUILDING DEPARTMENT ❑BUILDING INSPECTOR �WASSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK /`❑CODE ENFORCEMENT OFFICER 938 KING STREET - RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.Uebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - ADDRESS• D ATS. PERMIT#\'' ISSUED: SECT: BLOCK: LOT: LOCATION- OCCUPANCY: IZD r ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION f REQUIRED x ❑ 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 INAL OTHER LU � .pa" -.i • 8 r C uiu"}❑❑❑❑❑a in° ym Kn �c3 I 71 c IR7QIR T19nri 11C01P OTIIJ L�SY V1.�V' L4L.'4 Mr'ki VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook, N.Y. 10573 ADMINISTRATOR Paul S. Rosenberg (914)939-0668 Fax 1914) 939-5801 Christopher J. Bradbury www.ryebrook.org TRUSTEES BUILDING& FIRE Susan R. Epstein INSPECTOR Stephanie J Fischer Michael J Izzo David M. Heiser Jason A. Klein September 25,2019 Via 1°Class Certified Mail Pat Lovallo 177 North Ridge Street Rye Brook,New York 10573 Re: 177 North Ridge Street, Rye Brook,New York 10573 Parcel ID#: 135.43-1-25 Building Permit#18-134 Issued: 8/20/2018 - Expiration Date: 8/20/2019 Dear Property Owner, It has come to the attention of the Building Department that N our Building Permit listed above has not been closed out in accordance with Village Carle,and has been expired since 820/2019. Please note that there is a non-waivable expired permit fee of$500.00 now due in connection with your expired permit. Please be advised that it is a violation of Village Code to fail to close out a permit,and that a court summons could be issued and fines may be imposed on the permit holder and/or property owner for failure to apply for and obtain a Certificate of Occupancy(C/O)or Certificate of Compliance(C/C), in accordance with Village Code section 250-10A. Please note that Temporary C/Os&C/Cs are available in accordance with Village Code section 250-IOB should you require more time to perform whatever work remains in order to complete your project. Thank you for your attention in this matter,and please feel free to contact this office should you require any further information. Michael J. Izzo Building& Fire Inspector mizzo ct ryebrook.org /tg cc: Steven E. Fews. Assistant Building Inspector Ln VD O c rA 0 Npr 51 MLN ti cr I ru Er Lr) ru Q) CD z M CZ C3 4'> ;. C3 -90 z 0 m cz t— co MENOMONEE cc CO ty) to ce z. ui 5. L.6 C) cc ui o to co W 3t1 1 . i • • lL ILLLL •^, 9 u�� LL m r5 ?`fir 0 a a° M i 1 1 1 T-1 -Ym r7 PI f71 L r LrPn [ VILLAGE OF RYE BROOK MAYOR 938 King Street, Rye Brook, N.Y. 10573 ADMINISTRATOR Paul S Rosenberg (914) 939-0668 Fax (914) 939-5801 Christopher J Bradbury www.ryebrook.org TRUSTEES BUILDING & FIRE Susan R. Epstein INSPECTOR David M Heiner Michael J Izzo Jason A Klein Jeffrey B. Rednick March 1, 2019 Via 1"Class Certified Mail Pat Lovallo 177 North Ridge Street Rye Brook,New York 10573 Re: 177 North Ridge Street, Rye Brook, New York 10573 Notice of$500.00 Fee for Expired Permits Open Building Permit#18-134 Issued: 8/20/2018 -Expiration Date: 8;20/2019 Dear Property Owner, Please allow this letter to serve as a reminder that your open permit(s)noted above, as is the case with all Building Permits issued by the Building Department must be closed out with a Certificate of Occupancy or Certificate of Compliance in accordance with §250-10.A. of the Code of the Village of Rye Brook, Building Permits have a life of twelve (12) months and the expiration date is noted on the front of the permit. Please be advised that should you fail to properly close out your permit(s) in accordance with the law, effective November 1, 2009 the Village will be imposing a $500.00 Administrative Fee in connection with all open expired Building Permits issued after January 1, 2003. Please note that this Administrative Fee applies to each individual permit and must be remitted in addition to any other required fees associated with closing the permit(s),as well as any court imposed fines should a summons(es)be issued. Thank you for your attention in this matter, and please feel free to contact this office should you require an% further information. Michael J. Izzo Building& Fire Inspector mizzoQ rvebrook.org /ec cc: Steven E. Fews, Assistant Building Inspector 111 O O w n ar7e� k. L 4.2 rL 4a tea, 0 nj y z ni .. a Mom $ o > w z G4 I t ..+� rn mmmmommmmm� p� z W U. LLJ J �J C q Building Permit Check List&Zopj Lag Anal sis -Address: l `L S�R�Z-� � � �`Z SBL Zone: Use 'Ltd Const.Type: Other Submittal Date: t Revisions Submittal Dates: t.•- L>y Applicant: P 1-L '•> Nature of Work: G, .G A C_l ZF FP,rj C F Reviews:ZBA: OCT 1 ��� PB: BOT: Other. NFED OK _. ( ( } FEES:Filing: 75z' 'tm- BP: I oo - C/O: Legalization: �S� ( ) ( �IAPP: Date Stamped Properly Signed: SBL Verified H.O.A.Approval: Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening: ( ) ( ) ENVIRO: Long Short: Fees: N/A: ( ) ( ) SITE PLAN:Topo: ire Protection S/W Mgmt.: Tree Plan: Other. SURVEY:Dated: 2 6 � 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: 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. ( ) ( ) 20I6 NY State ECCC: N/A: Other. (, ( ) Final Survey: Final Topo: RA/PE Sign-off Letter. As-Built Plans: Other: C/O DENIAL LETTER Other. (v� ( ) �� +.2 Za approval• i2 ? notes: mt date: g• ( )PB mtg.date: approval: notes: REQUTAE EXISTING PROPOSED NOTFs APP�OVED DA Area C 2 Circle: Frome Front: Front Sides: Rear. Main Cov Accs.Co r Ft.H Sb: Sd.H Sb: GFA: Tot : F_c._.- P Height/Sr�tories: ►�F � 1Iz n— i BUILDING DEPARTMENT ID VILLAGE OF RYE,$ROOK OCT - 42017 938 KING ET RYE BROox,NY 10573 (914)93F Q G C91` 39-5801 VILLAGE OF RYE BROOK i• BUILDING DEPARTMENT ARCHITECTURAL REVIEW BOARD CHECK LIST FOR APPLICANTS This form must be completed and signed by the applicant of record and a copy shall be submitted to the Building Department prior to attending the ARB meeting. Applicants failing to submit a copy of this check list will be removed from the ARB agenda. Job Address: 1 S�C- S � Phone# Parcel iD#: Zone: Date of Submission: Proposed Improvement(Describe in detail): C-e- ,[ In v �� APPLICANT CHECK LIST: ,r ` The following items must be submitted to the Building 'e Ic _e_ �C �: ..s Department with the application-no exceptions. 1. ( )Completed Application p ��` � 2. ( )Three(3)sets of sealed plans. (one full size]maximum �Property Owner: t ` allowable plan size=36" x 42"} and two 11"x17") Address: 3. ( )Three(3)copies of the property survey. 4. ( )Three(3)copies of the proposed site plan. Phone#_ 9 ( `rt 14 4 '7 � 5 G�� ( 5. ( )One electronic/disc copy of the complete Applicant appearing before the Board: application materials. V � \~ �`�l 6. ( )Filing Fee. \ { n 7. ( )Any supporting documentation. Address: S S. ( )HOA approval letter. 0fapplicablel r 9. ( ) Photographs. Phone# L 4 t L 7 S^D c l 10.( ) Samples of finishes/color chart. (a sample board or Architect/Engineer: model may be presented the night of the meeting) By signature below, the owner/applicant acknowledges that he/she has read the complete Building Permit instructions&Procedures,and that their application is complete in all respects.The Board of Reviewreserves the right to refuse to hear any application not meeting the requirements contained herein. Sworn to before me s Sworn to before me this day of J C +— , 201 day of 20 signs a of P;O--PC4 Owner ( Signature of Applicant Print Name of P arty Owner Print Name of Applicant Notary b Notary Public RLE)t SIJtIrOS NOYARY PU9t1C STATE OF NEW YORK WESTCMSSTER COUNTY L1C.001SA690"44 COM ExP 7I7117 VILLAGE OF RYE BROOK BUILDING DEPARTMENT 938 KING STREET, RYE BROOK,NY 10573 (T) 939-0668 (F) 939-5801 ARCHITECTURAL REVIEW BOARD Wednesday, December 20, 2017 NAME& LOCATION TYPE OF APPLICATION MOTION SECOND APPROVED REJECTED APPL.9 177 N. Ridge St ( 6Ft High Stockade Fence - Consent 4507 Lavollo) Rear(Legalization)& 3ft - High Open Picket -Side 285 Neuton Ave Replace Failing Rail Road Consent 4508 (Montagnese) Tie Walls @ Driveway With Willow Stone Block 110 S. Ridge St New Front Door Consent 4509 (Win-Ridge) 11 Talcott Road Rear Yard Stone Retaining 4510 (Frieder Wall, Elevated Deck & Patio 12 Lincoln Ave Remove Existing Carport& 4511 (Bainton) Elevated Deck, To Construct 2nd Story Addition So&Kelley Revisions To Prior Approved 4512 Application. 24 Country Ridge Dr Enclose Front Porch, Portico, 4513 (Brookman) New rood Siding& Windows 31 Woodland Dr Amendment To Prior 4514 (Caren) Approved Application 3 Winding Wood Rd 2nd Fl Addition; Convert 4516 (Pohlman) Garage To Living Space, 1 New Roof And Siding ML MR JM MI AC SE ' LO 5F;�'cx _ -_. --- ---- i TRLELM:_QQ.S, TITLE SURVEY OF `� E �. /Psf'�� �E'm Vl.Q-J v�p As SHOWN ON p cog e M�v� r SITUATED IN -cD W Yt. oSS�� 1"� �. 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Izi/ �j y 1. Copy of Westchester County Home Improvement License. 2. Liability insurance (the Village Of Rye Brook must be the certificate holder) 3. Workers compensation on a NY State Board form (C105-2 or U26.3) 4. Building permit fee $100.00 (due once permit is issued and ready for pick-up) TARA A. GERARDI SENIOR OFFICE ASSISTANT, OFFICE MANAGER VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK, NEW YORK 10573 OFFICE (914) 939-0668 FAx (914) 939-5801 Check List For Release of Building Permits Address: I 71 ! n `Y� I l,C . S+- Owner/Applicant: Loya f ho Phone #'s: Dates Attempted To Contact Owner/ Applicant: �'Comments: VAS C.� Comments: emw led 1�0 Comments: NEED: ( Building Permit Fee $ 00 (tATPO # (L^C Home Improvement License ( iability OyWorkers Comp. / Comp Waiver ( ) General Contractor's Contact Information ( ) Fire Sprinkler Plans (2) ( ) Fire Sprinkler Application ( ) Fire Sprinkler Permit Fee ( ) Estimated Cost $ ( ) SWO Fee $ ( ) Legalization Fee $ { ) Other Tara _, •. -�w r T`rx� .� w r t.+.�.,`'c. �k�,F. w � w w �'�,�".,�,'Ft,` '�w t !I 1� ��{r�}�Ff}�i�;)yr• ' c�rF1�FF�}r(!'�-.�` 4 f4�r, f� it}11111iSry,�9����€};+r}I�r �. �(o)�✓ `a- �.. �=tr�l�r �ag�; ��.41 rrr_ +fb}r°. � 4f11}r:- r}4f�rr_� � f: OC 3.rz C : ►�� \ 9 W et A ,��• tom- rr.r `.r � � � ,'� a- uj U LU / Z LLI '.�s',� � ,far '•° `�' .,�_ �, z✓ z 0 w � N � .q }r}�jlr k�- }t�4 r i'►1�1r' r4S�}Nr �� +'}p+�rar� r+}A.4"b . I� N �$A i �4i� 4�sE� �� a 4-:�� ��♦ ti Px��t � � �}3ITS, �,A � l� i `� +c';` ,�. �:.rs) +� t�'• � ^ : dS �': °` e..,��� ,ti+,.:'..: '" +alp'{Yr"w+y� H � Vl it (MMfDDffYYYI AC" CERTIFICATE OF LIABILITY INSURANCE DATE D8/0&20180812D18 THIS CERTIFICATE 1S 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(F4,AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if 4he certificate holder is an ADDITIONAL INSURED,the policv(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 endorsements). PRODUCER CONTACT Tina Bonfiglio NAME., BNC Insurance Agency,InG PHONE AfC No (914)937-1230 FAX (914}937-1124 90 South Ridge Street E-MAIL ADDRESS: ttK)nfiglio@bnCagency oom INSURER(S)AFFORGING COVERAGE NAIL Ii Rye Brook N'Y 10573 INSURERA: Main Stcee:Ameraea Assurance Company 29939 INSURER INSURER a' FLPW,LLC INSl1RERC 436 WILLETT AVE INSURER O INSURER E: PORT CHESTER NY 10573.3176 INSURER F: COVERAGES CERTIFICATE NUMBER: wL1$6183889 REVI&ON 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 CON7,PACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE PCL'CIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWY MAY HAVE BEEN R=:�I;CED BY PAID CLAIMS. INSR gg POLICY EFF POLICY EXP MMfDDIYYYY M/DiYYYILTR TYPE IN SO aOLICY NUMBER - LIMITS COMMERCIAL GENERALL:ABI_ITY i EACH OCCURRENCE S 2,000,000 CCCURR oCLAWS•MADE X EEa urren 500,000 MEQ EXP(Arly one parson} 5 10.000 A I Y I MPV05203 06130/2018 06/30/2019 PERSONALBADV INJURY S 2,000,000 GEN'LAGGREGATEUMITAPPLIESPER GENERAL AGGREGATE 5 4,000,000 POLICY �PEST LOC PRODUCTS-COMPIOPAGG S 4,000,000 OTHER 5 AUTOMOBILE LIABILITY COMBINEC SINGE.LMIT $ swcanti ANYAUTC BODILY INJURY(Per person) S OWNED SCHEDULED AUTOSONLY AUTOS BODILY INJURY(Per aeudenti S HIRED NO'4-OWNED ROPER DAMAGE 5 AUTOSCNLY AUTOS ONLY Per acudent $ i UMBRELLA UAB OCCUR = - :.CURRENCE 5 EXCESS LIAR CLAIMS-MADE .3GREGA7E $ DIED I I RETENTION $ S WORKERS COMPENSATION PER - OTH- AND EMPLOYERS'LIABILJTY Y I N I STATUTE ER ANY PROPR I ETORIPARTNER,EXECUTIVE =.L.EACH ACCIDENT $ OFFICERIMEMBEREXCLUDE01 NIA' (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S If yes,oes=a under DESCRIPTION OF OPERATIONS cezw =.L.DISEASE-POLICY LIMIT 5 DESCRJPTION OF OPERATIONS I LOCATIONS r VEHICLES (ACORD'.31,Additional Remarks Schedule,maybe attached if mare spaces required) RE:177 North Ridge Street,Rye Brook NY 10573.T 1e C€Rificate Holder is included as an additional insured when required under written Contractor Agreement. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Stree. i ;-'77tDRIZZEC REPRESENTATIVE Rye Brook NY 10573 O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Certificate of NYS Workers'Compensation Insurance Coverage Page 2 of 4 CERTIFICATE OF N � Workers' NYS WORKERS'COMPENSATION INSURANCE COVERAGE STATE Compensation Board Ia.Legal Name and address of Insured(I'se street address only) lb.Business Telephone Number of Insured FLPW,LLC 914-937-2237 436 Willett Avenue Port Chester,NY 10573 lc.NYS Unemployment lasurance Employer Registration Number of Insured Id.Federal Employer Indentification Number of Insured Work Location of Insured(Only reyu;retl)fcavrruKe is.specificwlly or Social Security Number limited to certain location in New Pork.State,Le'.a Wrap-llp i'olicy) 205611509 2.Name and Address of the Entity Requesting Proof of Coverage 3a.Name of Insurance Carver (Entity Being Listed as the Certificate Holder) Wesco Insurance Company village of Rve Brook 939 King Street 3b.Policy Number of entity listed in box"la": Rye Brook,NY 10573 WWC3357124 3c.Policy effective period: 7:2512018 to 7/2 5120 1 9 3d.The Proprietor,Partners or Executive officers are: included(Only check box ifall partners officers included) all excluded or certain pariners)off eers excluded This certifies that the insurance carrier indicated above in boa"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 INFOMIATION 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 carved 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 bov"3r",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 Henry C Sible} (Print nan:c al authOrucd represcntauve w licensed agern cC uisu.-arce carser) rt Approved By - �v/ 8 8 20I8 (Sgnatumi tome) Title, Underwriting Manager Telephone Number of au th orixed representative or licensed agent of insu ranee carrs'er:CarrierPhone please Note:Only insurance carriers rind their li+.•enwd agent�rrre authorized ao ivr♦,r fhe C-iIYS.Zfurmn Insurance broken we NArawhoriwil to;mxe it. https://wc.amtrustgroup.com/anawc/PolicyNYCeri ificateQfWc Ins.aspx?IndexId=23003... 8/8/2018 Tara Gerardi From: Mike Izzo Sent: Friday, August 17, 2018 12:28 PM To: Tara Gerardi Subject: FW: Message from Dig Safely New York,Inc. (DSNY) From: sadasupport@ufpo.org Sent: Friday, August 17, 2018 12:27:56 PM (UTC-05:00) Eastern Time (US & Canada) To: Mike Izzo Subject: Message from Dig Safely New York, Inc. (DENY) ****REGULAR**** DIG REQUEST from DSNY for: VIL RYE BROOK Taken: 08/17/2018 12:19 To: VIL RYE BROOK PRIMARY Transmitted: 08/17/2018 12:27 00001 Ticket: 08178-048-013-00 Type Regular Previous Ticket: ------------------------------------------------------------------------------ State: NY County: WESTCHESTER Place: RYE BROOK /V Addr: From: 177 To: Name: N RIDGE ST Cross: From: To: Name: Offset: ------------------------------------------------------------------------------ Locate MRK AREA NEXT TO SIDEWALK (ADDING TO EXISTING FENCING) NearSt: BETSY BROWN RD AND JAMES WAY Means of Excavation: HAND TOOLS Blasting: N Site marked with white: N Boring/Directional Drilling: N Within 25ft of Edge of Road: Y Work Type: INSTALL FENCE Duration: 2 DAYS Depth of excavation: 3 FEET Site dimensions: Length 15 FEET Width 2 FEET Start Date and Time: 08/22/2018 09:00 Must Start By: 09/06/2018 ------------------------------------------------------------------------------ Contact Name: PAT LOVALLO Company: FACELIFT LLC Addr 1: 436 WILLET AVE Addr2: City: PORT CHESTER State: NY Zip: 10573 Phone: 914-937-2237 Fax: Email: PAT@FACELIFTPAINTING.NET Field Contact: PAT Cell Phone: 914-447-5064 Working for: SELF ----------- ------------------------------------------------------------------ Comments: Lookup Type: PARCEL i ------------------------------------------------------------------------------ Members: ALTICE USA CONED SUEZ WTR WESTCHESTER BELL-VALHALLA/WSCHSTR VIL RYE BROOD WESTCHESTER COUNTY/ SEW z ;[CT Xs eLOCII: MLE M 0 R>2? CQ5 i L©Tfsh,..�w MO TITLE SURVEY P A- riL ''Ra.r�a cr�n n�+�L.O AS SHOWN ON 51TUATED IN 00-kI� E'- ;Q 4 IYiAPtif �FILED IN THE COUNTY CLSRK'S DOIF^�F PREPARED BY: --- ie ew EDWARD[i.AlIHALCZO � e .pc LAND SURVEYOR LLC w a�s � .'eL 24DERKSHUMROAD tTws r r wtuRrurtrtn YONKERS14,NEW (9 1Y4O)9R8K9.12037415 0F AX �r ""s""�aa��rr+�raAwr T:4 ML uwnan "wNRwn�lvr^eorN.u.rwervi�nwuner r law Mori rrioNrerf ar>Kni lNr NirM1'NrN rOKa�VwiRwilM � uxemruroaarnww a[rrus rorTri lwr wornaeruis,SOrIM[1oMt rIMRh ami1�aran Nrrmm wrNwiarrvrsiRN�+rrpgtw �tM wwiiYaM4a�inxTirrwri arwarTaimwp.uwicwrla.rrs�s 0WM96 N%C=L4M iH�KTVN cae �rmc lwYNlf1MlrYHIINl�Pwa � wawwnw,enw "myoM 4T Ttucg1Riltitf } w ew w �lrw. tBGWtlrwnialLwr ■rNa wpa�( �� .� • TaNifAR lwlilBlaiwNl /MfM/t,mwwwv-m lmgwr.r\M'�rM 4 tlr F 09 w"unualarraKwou"p wr waw rr nw ri •• I CtrtRlwr wNi.ttaa Nwl+ MR 11 4cm vtmt%MAr pear aP nww"v 'rGO� mrtrau�wa itirrrronnenwp twwvnwwrwsnawr w i3yard wwrrtarwwaa ArchlteCtrlra 3 -Ix Appraval Date: Q 1°01 oc) .50 r 001 Chairman: nn ------------ too—* V..�C�a1Q �J f- 1� c� - _ �. {L oIL r ` > YLA-%I Twg o � ,> � r uj -T, a Z ca ,0 �i� i t1 "J Is Q UJ co 1 i t o .f Y LL! CO Q m I r fl 7-0 FE w R MrF P and r �, L nl r OCT - 4 2011 VILLAGE OF RYE BROOK BUILDING DEPARTMENT