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HomeMy WebLinkAboutBP19-107PERMIT #� SECTION TYPE OF WORK JOB LOCATION OW I0T. COST c t> .. .fF107. 401 TCO # FEE DATE INSPECTION RECORD DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING RGH PLUMBING GAS C7 wow -VOLT m ALARM Lmi AS BUILT CI FINAL INSP s IQ 10o/4a.� �+Pw �le 'roe 4 �r;;na) OTHER APPROVALS ARB BOT P8 ZBA OTHER VILLAGE OF RYE BROOK WESTCHEST �NTY, NEW YORK �� N o• 23-056 Certificate of ®ccupancp Ehis is to certify that//2 l a7aev- of, Rae 8r o6k, T having duly filed an application on 20 c>23 requesting a Certificate of Occupancy for the premises known as, , Rye Brook,NY, located in a -15 Zoning District and shown on the most current Tax Map as Section: / 4 Block: Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. /9— ) , issued 20 1, 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: - CA / , Construction: , for the following purposes: Subject to all the privileges, requirements, limitations, and conditions prescribed by law, and subject also to the following: This certificate does not in any way relieve the owners or any person or persons in possession or control of the premises, building,or any part thereof from obtaining such other permits or licenses as may be prescribed by law for the uses or purposes for which the building or premises is designed or intended. Furthermore, it does not relieve such owners or persons from complying with any lawful order issued with the object of maintaining the premises or building in a safe and lawful condition. No changes or rearrangement in the structural parts of the building or in the exit facilities shall be made,and no enlargement, whether by extending on any side or by increasing in height shall be made,nor shall the building be moved from one location to another until a permit to accomplish such change has be ta ed from the in spe r. Acting Building Inspector,Village of Rye Brook: Date: A P R 1 6 2023 IBIUILIDING (� BUILDIl' CI-R Aft � For office use onlVILLAGE OF RYE BROOK ISSDT#APR - 4 2023 938 KING STREET,RYE BROOK,NEw YoRK 10573 DATE: - MZ3 (914)939-0668 FEE: PAID AGE OF RYE BROOK www.rvpbt©okorg DEPARTMENT APPLICATION FOR CERTIFICATE OF OCCUPANCY, CERTIFICATE OF COMPLIANCE, AND CERTIFICATION OF FINAL COSTS TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION tt►►t►►tt•itttttill►iff►f•►tt♦t►tt•ttt►t►iititfift♦■■i♦t•tiff•ttttitit►till•tilt♦•\►ft•tt•■ttttitit♦♦ttttf•t•■►ttt\itiitiiitf Address: OL > OIZC+J A i'-1:> P--O A D I ?,y E 6 P �e N -I 1 o57 3 Occupancy/Use: fe5i cleiTha I Parcel ID#: 135 , 34 ' 1 2-9 Zone: R_115 Owner: i>,A1) ]C 1�+ f ,tip I C 4A E L Ck S-0 Address: P.E./R.A. or Contractor: CA,30 IZ C Nl-0bf L(M 6 1T1C.Address: 13Z fitu FART ^\iE , PI>i?--T"C 4OTER'N y Person in responsible charge: 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: PAIR(C i A C-As U being duly swom,deposes and says that he/she resides at S �-►'� -o eC H (Print Name of Applicant) (No.and Street) in �-J E E*O D j C ,in the County of (.)C>*h<eP r in the State of ,that (Cityfrown/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:S 25 000 for the construction or alteration of: K 11z k-e n 4 h ct"R Y-p g� Deponent further states that he/she has examined the approved plans of the structure/work herein referred to for which a Certificate of Occupancy/Compliance is sought,and that to the best of his/her knowledge and belief,the structure/work has been erected/completed in accordance with the approved plans and any amendments thereto except in so far as variations therefore have been legally authorized,and as erected/completed complies with the laws governing building construction.Deponent further understands that it shall be unlawful for an owner to use or permit the use of any building or premises or part thereof hereafter created,erected,changed,converted or enlarged,wholly or partly,in its use or structure until a Certificate of Occupancy or Certificate of Compliance shall have been duly issued by the Building Inspector as per§250-10.A.of the Code of the Village of Rye Brook. Sworn to before me this Sworn to before me this day of �\\ , 20 day of , 20 ignature of Property Owner Signature of Applicant Pr"t ne of Property Owner Print Name of Applicant 1� �'BU Notary Public SHARI MELILLO Notary Public Notary Public,State of New York No.OI.ME6160063 8/12/2021 Qualified in Westchester County Commission Expires January 29,20� BRC>v�- o tim 1932 BUILDING DEPARTMENT ❑BUILDING INSPECTOR VILLAGE OF RYE BROOK o VILLAGE ENGINEER 938 KING STREET RYE BROOK,NY 10573 ❑ASSISTANT BUILDING INSPECTOR (914) 939-0668 FAx(914) 939-5801 - - - - - - - - - - - - - - - - -'- - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - - ADDRESS: `J 1\ `-Y ,� Y �( `. y DATE: 1 PERMIT# , Y 'ISSUED: (A 1 � SECT: 1 fBLXNX: LOT: 1 LOCATION: I a R t OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING 0 ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P.GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ FINAL 0 OTHER QyE BR(�v�. O� 2m 19812 �7 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# \ 'V ISSUED: SECT: S` ' BLOCK: LOT LOCATION: �� n-l r)r-'' OCCUPANCY: A ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: a ROUGH PLUMBING �� - (❑ ,.ROUGH FRAMING INSULATION �❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK `" C ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER QyE BRnv� - '932 BUILDING DEPARTMENT ❑BUILDING INSPECTOR SSISTANT BUILDING INSPECTOR VILLAGE OF RYE BROOK J 'U LODE ENFORCEMENT OFFICER 938 KING STREET • RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www ryebrook.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : O i 0 ("ATE: G PERMIT# 4' ISSUED: SECT: ��� ALOCK: / LOT: LOCATION: v r T`\1 OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: U ROUGH PLUMBING 1 (���V� �❑ ROUGH FRAMING j Vl-1 ] INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER B1jILDjN0-&#A►RTMENT D [E (CIE M VIL4ET J ZRYE-B OOK 938 KING ,NY 10573 JUN 14 7019 (914)93 =Qfi39-5801 VILLAGE OF RYE BROOK _ BUILDING DEPARTMENT FOR OFFICE USE ONLY: Approval Date: J U N 1 9 20 9 Permit# P19- Application# Approval Signature: ARCHITECTURAL REVIEW BOARD- Disapproved: Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# ; Secretary: ZBA Approval Date: Case# Other: Amendment Fee: 61254alftrmit Fee: APPLICATION TO AMEND APPROVED PLANS Application dated: /a is hereby made to the Building Inspector of the Village of Rye Brook,NY,to amend the approved plans associated with an existing open permit,and/or from any prior approvals granted by the approval authority as per detailed statement described below. p 1. Job Address: (QU Existing Permit#: /J/lo— 7 - �c? 2. Parcel ID#:_ I3 f-I 3 C� — / — Z9 Zone: _ Original Approval Date: 3. Proposed Amendment(Describe in detail): 4. Property Owner: r o -,—C � Address: l i ec © X Phone of 30 Cell# e-mail Applicant: Address: Phone# Cell# e-mail Architect/Engineer: Address: Phone# Cell# e-mail 5. Occupancy, 1-Fam 2-Fam.,Comm.,etc...)Prior to construction: After construction: 6. Will the proposed amendment 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...)Yes:_No:_(if yes,you must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 7. Will the proposed amendment disturb 400 sq.ft.or more of land,or create 400 sq.ft.or more of impervious coverage requiring a Storm water Management Control Permit as per§217 of Village Code?Yes: No:_Area: 1 3/21/19 8. Will the proposed endment require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes: No: 0 (if yes,you must submit a Site Plan Application,&provide detailed drawings) 9. Will the proposed amendment require a Steep Slopes Permit as per§213 of Village Code Yes: No:_.�Jifyes,you must submit a Site Plan Application,&provide a detailed topographical survey) 10. Is the lot located within 100 ft of a Wetland as per§245 of Village Code? Yes: No: K"(if yes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan) 11. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes: No: (if yes,the area and elevations of the flood plane must be properly depicted on the survey&site plan) 12. Will the proposed amendment require a Tree Removal Permit as per§235 of Village Code?Yes: No:Aclof yes,you must submit a Tree Removal Permit Application) 13. Does the proposed amendment involve a Home-Occupation as per§250-38 of Village Code? Yes: No: yes,indicate: TIER I: TIER H: TIER III: (if yes,a Home Occupation Permit Application is required) 14. Will the proposed amendment result in additional square footage to the building or subject structure,and if so,provide such additional footage here. (Please submit additional Bulk Regulation Application Pages for review) 15. What is the total added cost of the work associated with the amendment: (The estimated cost shall include all site improvements,labor,material,scaffolding fixed equipment,professional fees,including any material and labor which may be donated gratis.) 16. N.Y.State Construction Classification: N.Y.State Use Classification: 17. Estimated date of completion: This application must be properly completed In its entirety by a N.Y. State Registered Architect or N.Y.State Licensed Professional Engineer&signed by those professionals where indicated. It must also include the notarized signature(s)of the legal owner(s)of the subject property, and the applicant of record in the spaces provided.Any application not properly completed in its entirety and/or not properly signed shall be deemed null and void,and will be returned to the applicant. Please note that application fees are non-refundable. STATE OF IgENV YOM COUNTY OF WESTCHESTER ) as: — M %i, ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as the applicant) and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the ��for the legal owner and is duly authorized to make and file this application. (indicate arc titect,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 ofthe Village of Rye Brook and all other applicable laws,ordinances and regulations.By signing this application,the property owner further declares that he/she has inspected the subject property,and that to the best of his/her knowledge there are no roof drains,sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this Sworn to before me this day of , 20A__ day of , 20 Signature of Property Owner Signature of Applicant Avt6 . Aso Print N e of Prop Owner Print Name of Applicant Notary Public Notary Public CHRISTOPHER J. BRADBUiiY 2 Notary Public,State of New York No.01 BR6159985 OUalified in Westches.er!'r wrty Commission Fxn' J r'u^" 7" 3. 3/21/19 4 00 O+COA CC :: • �A z co LL. Z 01% zm .3 Q Z < 16 7.1 10 S. w z V) �n � a z w aj 16 oo > z 6 4;4 4 41 4A 4;46 41*4 410 to 4! 4A 0 4 0 4 4 4;41.4 4; A$4 V.4 Vs 414 410 4 9 9 4;49;0 4 6 BUILDING DEPARTMENT M ED VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 FAX(914)939-5801 VILLAGE OF RYE BROOK BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY ist, ,r: 19 - /(97 Approval Date: jUN 12019 Permit Fee: $ Approval Signature: , Other: Disapproved: (fees are non-refundable) Application dated, I 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 Fed ral, Stat ,County and Local Codes. 1.Address: old 0 fJ)ard Kool SBL: 1�5 3(`iL Zone: 2.Property Owner: Ed wa(d, a Tina CCU K I e,6A Address: Phone#: 3 0 3 -71 1 -a'-3 b I Cell#: email: ff 3.Master Electrician: ZG C C a A ito P"(J-(I Cl Address: Ch Lic.#:?575 Phone#: GI��. �1"3 3�1 Cell#: 11' (��0 4 y 7 �t'-�7 email: 1 h C 71(CC uVd'10•I'1 e, Company Name: Address: 4.Proposed Electrical Work/Fixture Count: 11'1-�-C�f/1 �Y 1/rti C � ********************************************************************************************************* STATEtNEW YORK,COUNTY OF WESTCHESTER ) as: NU ,being duly sworn,deposes and states that he/she is the applicant above named,and does further state that(s)he is the legal owner of the property to which this application pertains,or that(s)he is the P,1enfn 1a -) for the legal owner and is duly authorized to make and file this application. 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 bgfbmitle this Sworn to of a me thi u` day Al day o 20-4— afore o Prope O er < ign a of pplic �.U�jC�p Gccc C�GgJ; a d Print Name Ze Owner Print V&g a1E N TARY llgl�iiME O NEW•YORK NotarYftbip NO. 1 36 Qualified i hesiN County G� 00011Ne he l Cow�t1 My Commission E fes Octobe 14, 20_L I Ny Commission Etphes Oct f 11. 3/21/19 Phone: 914-347-3595 Westchester Rockland Electrical Inspection Services, Inc DO NOT WRITE�HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue �� ✓ Fax: 914-347 3596 Elmsford, NY 10523 f BUILDING PERMIT NO. TEMP DATE CITY OR VILLA r ZIP CODE TOWNSHIP X Q C J /, STREET AND Np" ( r r POLE NUMBER v �=- BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? '� ?4 rgLOCK„ LOT OCCN ✓ I d(, OWNER'S NAME AND ADDRESS HOME T#1E911 r;NUIM1514 CURRENT SUPPLIED BY FROM THEIR OFFICE WORK TELEPHONE NUMBER LIST BELOW ALL EQUIPMENT WHICH YOU INSTALLED NUMBER OF OUTLETS NO.OF FIXTURES& MOTORS HEATERS OFFICE USE LOCATION LAMP RECEPTACLES ONLY SIDEWALL SWITCH INCADE FLUORE NO. H.P.EACH NO. WATTS EACH INSPECTION OUTSIDE In In n I BASEMENT 1"FL. i ini 2^FL 3-FL VILLAGE O RYE B OOK REMARKS:LIST OTHER ELECTRICAL DEVICES NOT SET FORTH ABOVE: THIS APPLICATION IS INTENDED TO COVER THE ABOVE LISTED ITEMS TO BE INSPECTED.IF AT ANY TIME OF INSPECTION ADDITIONAL ITEMS HAVE BEEN INSTALLED,YOU ARE AUTHORIZED TO MAKE THE INSPECTION AND ADJUST THE FEE FOR THE ADDITIONAL ITEMS INSPECTED AS PROVIDED BY THE APPLICANT.THE APPLICANT DECLARES THAT THERE IS NO OPEN APPLICATIONS FOR THE ABOVE WITH ANY OTHER INSPECTION COMPANY WREIS,INC.IS NOT LISTING,LABELING,UNDERWRITING OR CERTIFYING ANY EQUIPMENT, MATERIALS OR DEVICES WHICH ARE PERFORMED BY OTHER CERTIFIED TESTING AGENCIES OR INSPECTION COMPANIES.THE APPLICANT,OWNER,OR AUTHORIZED AGENT AGREES TO ALL THE ABOVE TERMS AND CONDITIONS AS SET FORTH FOR THE APPLICATION. SIZE OF SERVICE FEEDERS CHARACTER OF WORK NEW❑ ADDITIONAL❑ EXPOSED❑ CONCEALED❑ MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD❑ UNDERGROUND❑ I - AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. NAMEQF COMPANY �D`ATE OF APPLICATIO SIGNATURE OF APPLICANT 4�` C u�*n ►� .I eG 1 r I C' (p (�I (GI Xi �. STREET ADDRESS 4 NO. CITY OR POST OFFICE D ZIP I LICENSE NO.WHEN APPLICABLE S S IF WfSTCNESTER ROCKLIMO Ar' RICTBICAL INSPECTION SERVICES.INC BY THIS CERTIFICATE OF COMPLIANCE THE Westchester Rockland Electrical Inspection Services 43 North Lawn Ave, Elmsford, NY 10523 914-347-3595 (Office) 1 914-347-3596 (Fax) CERTIFIES THAT Upon the application of: Upon premises owned by: Zaccagnino Electric Michael & Patricia Caso 81 Maple Avenue Rye NY 10580 Located at: 5 Old Orchard Rd, Rye Brook, NY 10573 Certificate Number: 616361 Section: 135.34 Block: 1 Lot: 29 BDC: Permit Number: EP:19-138 BP:19-107 A visual inspection of the electrical system at this premise described as a Residential occupancy,wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: 5 Old Orchard Rd, Rye Brook, NY 10573 ❑Basement ❑X 1st Floor ❑X 2nd Floor 03rd Floor ❑Garage ❑Attic ❑Outside Other: Inspection was conducted in accordance with the NYS and NFPA 70-2017 International Electrical Code and detail of the installation, as set forth below, was found to be in compliance therewith on 8/26/2019 Name Quantity Rating Circuit Type Fixture-Luminaire 28 Recessed Exhaust Fan 2 Bath Receptacle 2 GFCI Switch 14 Single Pole Refrigerator 1 Dishwasher 1 Hood Line 1 Oven Gas or Electric 1 Microwave 1 Wine Chiller 1 Sub Panel 1 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. ll—This certificate is valid for work performed before date of inspection only. r WESTCHESTER I CKLAND EIECTRICAI INSPECTION IWE15SERVICES.INC. Name Quantity Rating Circuit Type Dual function afci/gfci circuit breaker 7 Outlets 3 Island Fixture-Luminaire 2 Ceiling Fixture-Luminaire 5 Undercabinet Low Voltage 5 Data/TV Cat 6 5 Data Cable(s) Ceiling Paddle Fan 3 Receptacle;Outdoor GFI 1 Outlet 5 Wall Heat Detector 1 i I This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. � � This certificate is valid for work performed before date of inspection only. til. C6 CA Not co C�s W a l � � O ,., ? �? F.. � "M" ,� �, � yam, v p CN rl moo 00) �w Lb 0-0 19 4t C6 4t y BUILD tWEA K MENT JUN 1 7 2019 VIL E OF RYE OK 938 KING ET RYE B NY 10573 � r VILLAGE OF RYE BROOK (914)9 1939-5801 BUILDING DEPARTMENT .or PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: 10— M-7 PP#: Approval Date: J UN 1 9 1019 Permit Fee: $ I ! k5 ooL 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 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: 5- r k-0 l d /ar �&V- C1 SBL: I�J' .Jl T+ ' O� / Zone: -2.Proposed Work: �Q 9 v 4 • es'L 3.Property Owner: / 1rC.�r. Q 1 �S Address: Phone#: Cell#: email: n/� � 4.Master Plumber: L^wrp k 10 k a n Address: 1 l Al/ Lic.#: 8T Phone#: 0/`�/1 3�7 Cell l#: gyS^�9r -yy2 email< ,m i n r e:n4r-tjllb% r c(113 AC97 Company Name:7"' F114!^ (-dNCu7s �1fh Address:rl 11I-4 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 11 I 3rd Floor e� 4ih Floor 5'h Floor Exterior 5.* List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) -1- 3/21/19 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 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. Sworn to before me this 1 Sworn to before me this I day of ,20 l� day of 1�t1�'- ,20 l� Signature of Property Owner Signature of Applicant 1)1'aalp— ( 6'�Z J- Print Name of Property Owner Print N e of Applicant Notary Public Notary Public CHRIST R J.BRADBURY Notary Public,State of New York CHRISTOPHER J.BRADBURY No.01 BR6159985 Notary Public,State of New York ousiftc!in Wp,;tchester County No.01BR6159985 23 Qualified in Westchester County This application must be properly completed in its entirety and 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- 3/21/19 BUILDING bii"TMENT D V VILLA ;i OF RYE�.I�ROOK 938 KING ST ET RYE BR6o` NY 10573 JUN 172019 (914)63', ra 9x9 939-5801 WwW sE►ok:or VILLAGE OF RYE BROOK I BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE §216• STORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT. STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: jJ ,Q, �, �l(`G`l U"l ( Co � , residing at, � Old 0✓G�Ot �� � 2 l�✓0 d L �(l� (Print narue) (Address where you live) l r71 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; J0 d �YGG �Q �cJ( , �,/c 6rtoL. ck� el0 f_T 3 , Rye Brook,NY. (Job Address) 11 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. `e, '4/�: (Si&mature of Property Owner(s)) (Print Name of Property Owner(s)) e Sworn to before me this \¢ day of f L , 20 " (Notary Public) CHRIST6PHEJ .BRADBURY Notary PState of New York No.01 BR6159985 Oualified in Westchester County Commission Expires January 29,20 _3_ 3/21/19 Building Permit Check List&Zoning Analysis Address: SBL: ! 3Si3'tf Zone:,J L` Use: —at o Const.Type::2 1 Other. Submittal Date: S 1 S 15 Revisions Submittal Dates: Applicant: L.F'Q AtJ Nature of Work: 1"'T4ZCL1 0 ST C2_,_J rTxLa( __ —i A--W --t2r,- v-t Cri. C_l—, Reviews:ZBA: MAY 16 2019 pB. BOT: Other. NEED OK ( ) FEES.Filing. TS' � BP: 3 7S C/O: Legalization: ( ) ( ) APP: Dated: ✓ Notarized: ✓SBL ✓Truss I.D. ✓ Cross Connection: ✓ H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Stone Water Review: Street Opening. ( ) ( ) ENVIRO:Long: Short: Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection S/W Mgmt.: Tree Plan: Other. ( ) ( ) SURVEY:Dated: Current: Archival• Sealed: Unacceptable: ( ) (� PLANS:Date Stamped ✓ Sealed. Copies: 2- 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. O O 20I7 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 Ara: Date: MAY 1 6 2019 Circle: Frontag Front: Front: Sides: Rear. Main Cov Accs.Cor. Ft.H Sb: Sd.H Sb: GFA: Tot : Ft I : Parlanr. Height/Stories: notes: t _rc.... 5fi �3i� (o)►�' c lip- MUM L i o N O o to on O O Q t;_- `oi-k.�r_A. O ar '�(--(ii�) N: ~ ^ •~ U : ^ i� ►"� — 0 section . �1k• �d � i'•+ V Z � > c Quo G ,,, �; W CO - Y O U v c oGa ey�o -_ 41 J� 1. CI l cLn L U 0 C) _ ONO! t T 'K : -•+ , T - 4 ss. tts s�. � YO t 11�%,- � t %Rw,F L ^ ?C�J4���� �q�ai'' <<,�4✓ ^I�j Y. ACO oa1zar2ols CERTIFICATE OF LIABILITY INSURANCE DATE24rnlg THIS CERTIFICATE IS ISSUEDASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOTAFFIRMATIVELY 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 pollcy(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: Karen Welch Haflahan,McGuinness and Lorys,Ltd P1Est: (914)939 B895AIX (914)939 3104 553 Westchester Avenue A-MAJL : karen@hmbnsurance.com INSURER(S)AFFORDING COVERAGE NAIC I Rye Brook NY 10573 INSUiERA: Morstan General Agency Inc. INSURED INSURER B: State Insurance Fund Caso Remodeling.Inc UNSURERC: ShekerPointlnsurance Company 01434 132 Hobart Avenue INSURER D: INSURER E: Port Chester NY ID573 INSIRERF: COVERAGES CERTIFICATE NUMBER: CLIS112901842 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OFANY 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, EXCWSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSD yyyp POUCY NUaBER QIMIODIYYYY) UMRS COMMERCIAL GENERAL UABLRY 2,000,000 EACH OCGlJRREJJCE E CLAIMS-MADE ®OCCUP PREMSES Eaoccurrence S 5,000 MED EXP(AM one person) $ 100,000 A Y L146001467-3 06/12/2018 06/12/2019 PERSONAL&ADV INJURY $ 2,000,000 GEN1-AGGREGATE LIMIT APPLIES PER- GENERAL AGGREGATE $ 2,000,000 POLICY ®jECar LOC PRODUCTS-COMPIOPAGG f 2,000.000 OTHER. _ _ $ AUrOMOBLE IJABIJTy COMBINED SINGLE LIMIT $ Ee accident ANY AUTO BODILY INJURY(Per person) f OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OV4WD PROPERTY t~GE $ AUTOS ONLY AUTOS ONLY Per accident f UAO�LA I" OOCUR — ----------- -- -- - EACH OCCURRENCE f EXCESS LIAR HCLAIMS-MADE AGGREGATE RE S DED TENTIONS f WOMM CORVIENSAAND EMPLOYERS' A�ITM Y/N SPER UTE CRT' ANY PROPRIETORIPARTNERAECUTIVE EL EACH ACCIDENT $ 1,000,000 B OFFICER&EMBER FX(LUDED? FYINIA W24556730 10/tt/2018 10/112019 ( Y in I'N EL DISEASE-EA EMPLOYEE S 1'mo•ow If yes,describe under 1.0�.000 DESCRIPTION OF OPERATIONS below E L DISEASE POLICY LIMIT S Disability C D420051 01/01/2014 01101l9999 Statutory DESCRIPTION OF OPERAT)OW i LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attacted if more space is required) Certificate Holder is Wed as additional insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DEUVERED IN Village of Rye Brook ACCORDANCE WITH THE POLICY PROVISIONS. 938 King St. AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 0 1 988-201 5 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD New York State Insurance Fund Workers'Compen.w ion A Divabilily Benefils Specialists Since 1914 WESTCHESTER ONE,44 SOUTH BROADWAY,10TH FLOOR,WHITE PLAINS,NY 10601-4411 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE a o A A A A A A 133909107 HALLAHAN MCGUINNESS&LORYS PO BOX 570 PURCHASE NY 10577 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER CASO REMODELING, INC. VILLAGE OF RYE BROOK 132 HOBART AVENUE 938 KING ST. PORT CHESTER NY 10573 RYE BROOK NY 10S73 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2455 673-0 879923 10/11/2018 TO 08111/2019 412412,119 THIS IS TU CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2455 673-0, 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://WVVW.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 SAL CASO CASO REMODELING, INC. 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 INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER'225642872 U-26.3