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HomeMy WebLinkAboutBP21-056ERMIT # n%c 1- 6I=CTfON _ l TYPE OF WORK 5& DATE: 3 aq al Eel /�0! "aS7e.e� JOB LOCATION 1 0 �� a' z oC OWNERiL6 b0e) __ elgeriel/o CONTRACTOR 5/Vv �er4•�>C `# EST. COST d ! vtfa er01W .�Ue7Wrie/%C9N)939 35� 97s �t�rli►C! �c11)5)l0c 9561 TCO # FEE DATE INSPECTION RECORD DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING Kef RGH PLUMBING GAS 0 SPRINKLER ELECTRIC LOW -VOLT ALARM AS BUILT FINAL INSP �I (oa /�r �lq oral-c) 7/s�4)00 � Co OTHER APPROVALS BOT PB ZBA OTHER VILLAGE OF RYE BROOD WESTCHESTPR CoUN'iTY, NEW YORK \>>, �°� No: 22-009 Certtf tote of Occupantp This is to certify that Mwato f LUr7a'L12 LI e/% .` weKQ)g1CG, LaWy-/e/le of, RV-e j&0 () f /j y having duly filed an application on JntnuRrq /LI. 20 requesting a Certificate of Occupancy for the premises known as, )?eo( Roof DY/yif , Rye Brook,NY, located in a )Q- 45 Zoning District and shown on the most current Tax Map as Section: t-'jf5. q3 Block: / Lot: 05, Fj and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. :�2/—O5 to , issued ; a? 20 ;? I , 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 New York State Use Classification of: n e - Fa rl) 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 heigh shal a nor shall the building be moved from one location to another until a permit to accomplish such change has be bta ed from th uilding Inspector. Building Inspector,Village of Rye Brook: Date: JAN, 1 9 2022 BUILDjM For office use only: D E� ENT E �W E r`t'�' PERMIT# VIL OF RYE OK ISSUED: JAN Z�22 38 KING STRE YE BROOK, YORK 10573 DATE: A6 C7 FEE: PAID wV VILLAGE OF RYE BROOK ��= r BUILDING DEPARTMENT APPLICATION 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 +++**+*+++t+ttt*+**t*+***++++++++*++**+++*+r*rrrrwtwr+rw+t+t+rrtwtrttrtt►t*►ttr*r►rr►►►r►r►rrw►trr►rrrrrrw*►wr►r+►t*►r**wwrrr Address: f $ Red Ropt h/i V e. Occupancy /Use: &cedehAa� Parcel ID#: 9-3/ 135.k3 _1 - S• Zone: K- 15 Owner: NJ,` Qe/ '` Veroajca Lunp/r; ello Address: I$ lid Rood' 1}rr✓2_ P.E./R.A. or Contractor:_IV;�,� Address: 33 Cvt�tkwvad �Ano 11e��iog�C, JOY /OSS�cp' Person in responsible charge: k,.6 i Address: 5NS Gervry,,o } l 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: 11C�ran�'� Lnaar,e/fv being duly sworn,deposes and says that he/she resides at /� � ,1'd �# j}r;✓e� (Print Name of Applicant) (No.and Street) in �y p 134 ,in the County of rlrlt 9X&J2e4_1C ' in the State of 1_,that (City/Town/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:$ v for the construction or alteration of: Ma 5 ier ba6rad:r> f,en 0'✓akQ 4. 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-IO.A of the Code of the Village of Rye Brook. Sworn to before me this 1 1 Sworn to before me this day of , 20 day of , 20 Signature of Property Owner Signature of Applicant Print Name of Property Owner Print Name of Applicant Notary Public SARI MELILLO Notary Public Notary Public, State of New York No. 01%,1L 61 ;�3 Rri ��ii21 O!lallfied in Westch; ter County Commission Expires January 29,20jl� <yE 4RC�ufi, 04 ti� cu � '9a BUILDING DEPARTMENT ❑////BUILDING INSPECTOR SSISTANT 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: 1 �� PERMIT# ' � ` '� IS UED' SECT: ] "LOCK: � LOTS LOCATION: OCCUPANCY: ❑ VIOLATION NOTED ' HE WORK IS... ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION P� ��� 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 r❑ FINAL ❑ OTHER QyE BRC���. ©4 tim w � �9b2 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 - - - - - - - - - - - - - -- - - - - l vim" C-��N�DATE: ADDRESS : �J Z' PERMIT# ` ` ISSUED: )ECT: BLOCK: LOT: LOCATION: t � OCCUPANCY: t ❑ VIOLATION NOTED THE WORK IS... ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION G 1 + ` REQUIRED ❑ FOOTING J l N ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ROUGH PLUMBING ROUGH FRAMING INSULATION I LJ NATURAL GAS p L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER BRC�k, w � BUILDING DEPARTMENT `BUILDING INSPECTOR T ASSISTANT BUILDING INSPECTOR VILLAGE OF RYE ROOK ❑CODE ENFORCEMENT OFFICER 938 KING STREET - RYE BROOK,NY 10573 (914) 939-0668 FAx (914) 939-5801 www.ryebrook.or� - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - -- - - - - - - - .- - -- - ADDRESS : `+ \' �' 'aC�k 40 DATE: PERMIT# , �[ ISSUED:�I� JECT: BLOCK: LOT: LOCATION: OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION 1 jjjjj REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: i❑' ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER �i�iTr�i��i�i� - •��i� R �������i� ������i�� \w�� l �i �i 1i��������i r i � T ' N _ z C4 r, a 0mo � ... t z T. C w a z « G [� ►►^r_' z a .. Cd f t w o z w o ° A v o, P.; .� 00 oc a � v mom w ~ W Z F 4 ., z e r, � ji w c, .. 9 r W O Q e 3 m G 16 �yt_, DRCtiuk- BUIL011 DEPARTMENT ] D VILL,_ E OF RYE �tOOK SEP - 9 2 221 938KIN rRYI B ,NY 10573 VILLAGE OF RYE BROOK BUILDING DEPARTMENT or ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: .Z 1 - c) G EP#: t:D/r C—)// f Approval Date: SEP - 9 204 Permit Fee: $ / a /— 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 an or remove electrical equipment,wiring, fixtures,or to perform other high or low voltage electrical work as per the detailed statement described below. The applicant & property owner, by signing this document agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: 1 � l.t ro v-0 fl r, I SBL: Zone: 2.Property Owner: fYj.G�G Q r' .� Uqr on tG� L"^5°�Address Sti.+� e- Phone#:9/-Y- 9 3 9—35 7S Cell#: email: 3.Master Electrician: )ate 4 Address: a �6 �n��� (�.-� 1�ty n Lic.#: 17.6'o Phone#: Cell#: 2/4 Company Name: S--l-0-1 Elo Lt'ri C .Tin e. - Address: S m i- 4.Proposed Electrical Work/Fixture Count: 8 c-4 .o rti rj e,n 6✓ ��f1 ��v►7c<_s /'� —�riv 't �� ur 4 T STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: being duly swum,deposes and states that he/she is the applicant above named,and does further (print name of individual signing as the applicant) state that(s)he is the 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.) The undersigned further states drat all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations. Sworn to before me this Sworn bef re me this day of ,20 day o ,20 X Signature of Property Owner Si of Applicant A Print Name of Property Owner Name of Applican Notary Public Notary Public SHARI MELILLO Notary Public, State of New York No. 01 ME6160063 Cluallfied In Westchester County Commission Exnires Januant 29 9 01 73, 8/12/2021 Westchester Rockland Electrical Inspection Services, Inc. 11�7 Phone: 914-347-3595 DO NOT WRITE HERE-FOR OFFICE USE ONLY 43 North Lawn Avenue Fax: 914-347-3596 Elmsford, IVY 10523 BUILDING PERMIT NO. TEMP k DATE ��] CITY OR VILLAGE ZIP CODE TOWNSHIP COUNTY 1 STREET AND NO.OR ROAD POLE NUMBER 4I BETWEEN WHAT TWO CROSS STREETS IS PREMISES LOCATED? SECTION BLOCK LOT ' f �)c, 1 .do OCCUPANT'S NAME BUILDING OCCUPANCY OWNER'S NAME AND ADDRESS y� HOME TELEPHONE NUMBER �\ , Vtk Nr _7e 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 I BASEMENT Lt 1"FL 2 FL. _ 3'FL RO K BUILDI G DEP RTME 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 15 NO OPEN APPUCATIONS FOR THE ABOVE WITH ANY OTHER INSPECTION COMPANY WREIS, INC. IS NOT LISTING,LABELING,UNDERWRITING OR CERTIFYING ANY EOUIPMENT, 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 L I ADDITIONAL❑ EXPOSED❑ CONCEALED❑ MUST ENTER APPLICANTS IDENTIFICATION NUMBER SERVICE ENTERS BUILDING OVERHEAD E UNDERGROUND L] AVOID DELAYS BY GIVING FULL AND ACCURATE INFORMATION.ALL SPACE MUST BE FILLED IN OR APPLICATION MAY BE RETURNED. NAME OF COMPANY DATE OF APPLICATION SIGNATURE OF APPLICANT STFIMADD� TELEPHONE NO. CRY OR POST OFFICE ZIP CODE LICENSE NO.WHEN APPLICABLE t t I D !' WESTCHESTER ROCKLANO ELECTRICAL INSPECTION NEISSFIVICES,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: Sadovia Electric Inc Michael&Veronica Lungariello 226 Union Valley Road NY, Mahopac 10541 Located at:18 Red Roof Dr Rye Brook,NY 10573 Certificate Number: 1031614 Section:135.43 Block:1 Lot:5.0 BDC: Permit Number:EP:21-217-BP:21-056 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: 18 Red Roof Or Rye Brook,NY 10573 Basement i ;1st Floor ®2nd Floor 3rd 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 12117121 Name Type Quantity Switch Single Pole --- 4 Electric Floor Heat Radiant --- 1 Fixture-Wall Sconce(s)Lights Indoor --- 2 Fixture-Luminaire Recessed --- 1 Exhaust Fan Bath --- 1 Receptacle GFCI --- 2 This Certificate has been approved by Westchester Rockland Electrical Inspection Services. This certificate may not be altered in any way. P G� f This certificate is valid for work performed before date of inspection only. In ko iE o .. N LFJ � a tn N a °� �• �# 4 w E' OBE N r+ QW .�. x 00 Gz7 Ifs os 0 t F� Z e; e? Z O On mt r� M ? F-+ Q w m Z w ~ � M � � M � Oti wa• _ W z � � f�r•� O U � N � a Gr U OC o wr = a w o WIN Lk H A a n ° 8 4 99 c R BUILDINGJ�,, NT MAY 18 2021 VIL E �938 K1N EY 10573 VILLAGE OF RYE BROOK (914)9 -5801BUSLDING DEPARTMENT PLUMBING PERMI//T APPLICATION ^� FOR OFFICE USE ONLY BP#: "C�SClJ PP#: c Approval Date: MAY I WN71 Permit Fee: $ ���' Ab 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: 18 P,f� R o o l�ll D,\Y G SBL: 1351 7 3 /— Sr Zone: 4-1 T 2.Proposed Work: M.ag_ 3.Property Owner: N C\kk CA J 11 n elGvrt C\ko &WPMCa Address: i g Re R o,,C LN k yt Phone#: Cell#:�)y �� �- SS- -'S -email:. 4.Master Plumber: �,� �G�Q2� Address: 3I L G CS,TnuT ?W Q/ PA. M-1, KISto by 4 Sy Lic.#: r&—Phone#: 91 J Z L Y•S Y 4 j Cell#: email uAji T Company Name: Jc- Jk i�L _ Address: 31 L cJTh- -T 94 � }''�\' Iw 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 ist Floor 2nd Floor 3`d Floor 4'"Floor 5'h Floor Exterior 5.* List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) 3/21/19 STATE OF NEW YORY,COUNTY OF WESTCHESTER ) as: F-be—r Smtaza,'(` ,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 0-4 in fra G 1 t A r 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 q Sworn to before me this I ry day of 0AIA 20 day of 20--24:. _ Signature of ProperCCQAer Signature of App[cant &k-�)k tt,/\9cotICAO dei' C'�4Lar Print Name of Property r Print ame of Applicant -/1 1;�. v , n24 Notary ubltc Notary Public SULEYMA B SALAZAR SULEYMA B SALAZAR NOTARY PUBLIC-STATE OF NEW YORK NOTARY PUBLIC-STATE OF NEW YORK No OISA6379344 No 01SA6379344 Qualified in Westchester County Qualified in Westchester County This ap fecfa*mivAisb begm+ ]pczaM1eted in its entirety and must inclodgc4wrnQW iii(gop ,i uf§W,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. -z- 3/21/19 r • BUILD ENT DD 938 Km1GL`" ETR E BR NY 10573 MAY 1 $ 202� (914)9 39-5801 VILLAGE OF RYE BROOK BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE§216 ESTORM SEWERS AND SANITARY SEWERS THIS AFFIDAVIT MUST BEAR THE NOTARIZED SIGNATURE OF THE LEGAL PROPERTY OWNER AND BE SUBMITTED ALONG WITH ANY BUILDING OR PLUMBING PERMIT APPLICATION. ANY BUILDING OR PLUMBING PERMIT APPLICATION SUBMITTED WITHOUT THIS COMPLETED AND NOTARIZED FORM WILL BE RETURNED TO THE APPLICANT. STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as: 3, /(-f C,1it9Q/ 4.,4,-7 a,-i e 11 cL , residing at, 19' P4 ieno P p r- (Print nanic) (Address%%here you lien) 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; Qa-A QocS Dr. , Rye Brook, NY. (Job Address) Further that all statements contained herein are true, and that to the best of his/her knowledge and belief,that there are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and further that there are no roof drains, sump pumps, or other prohibited stormwater or groundwater connections or sources of inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, County and Village Codes. (Signature of Prolxrt� O)� clerk)) r�'(C�aJ l dh ra{tc�to (Print Name of Property 0eener(s)1 Sworn to before me this day of (Notan I'uh 1c) SULEYMA B SALAZAR NOTARY PUBLIC-STATE OF NEW YORK No 01SA6379344 Qualified to Westchester County -3- MyCommission Expires08-13-2022 3/21/19 Building Permit Check List&Zoning Analysis Address: t pJ -IY7- SBL: ! �S ,�{3 - C - S• . Zone', IS Use: Const.TypiE� Other. Submittal Date: :3I t q Z Revisions Submittal Dates: Applicant: 1 0 0 4 9, ti-t �7_L L--'-) Nature of Work: 1 9 A-- 12' TF�- ��1��z� ��VAZ't Q,4 Reviews:ZBA: PB: BOT: Other. NEED OK r �zD - -��f, ( ) FEES:Filing. Z S- J�!.0 BP: C/O: Legalization ( ) ( ) APP: Dated: Notarized: SBL: Truss I.D. Cross Connection H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening. ( ) ( ) ENVIRO: Long. Short: Fees: N/A.- SITE PLAN:Topo: Site Protection: S/W Mgmt.: Tree Plan: Other. ( ) ( ) SURVEY-Dated: Current: Archival:- Sealed: Unacceptable: ( ) (•� LAMS:Date Stamped ✓ Sealed: Copies: --I- Electronic: Other. ( ) ( License: ✓ Workers Comp: -*/ Liability -7—Comp.Waiver. Other. ( ) ( ) CODE 753#: Date& 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: Perrot: Nat.Gas: LP Gas: N/A/: Other. ( ) ( ) FIRE SUPPRESSION:Plans: Permit: N/A: Other. ( ) ( ) H.V.A.C.: Plans: Permit: N/A Other: ( ) ( ) FUEL TANK:Plans: Permit: Fuel Type: Other. ( ) ( ) 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter: As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER: C/O DENIAL LETTER: Other. ( ) ( ) Other. ( )ARB mtg. date: approval notes: ( )ZBA mtg.date: approval: notes: ( )PB mtg. date: approval: notes: REOURED EXISTING PROPOSED NO AFVKU Arse: pate• AR 2 2 2021 LW . Fwnug� Front: Front: 5119s: R ag�r Main Cow. Accs.Cov Ft. b: Sd.H Sb: GGFA: Tot. Ft Imp: PP Hight/Stories: notes: \ I'• � :1�!`/`` ✓�w iq�+v.1'�+,�1�,��'1O -�,�1��!'LLy. ��_��,���� .•,,'�•��� .yew, N is 00 o c ar 0 r r-• a ..�. Z C, a L W Z MIT I r.r z '�' _ = section . l� U ' 'r QCIO 0 Z s f J '•►� i C? LLJ co CIO (� a .i..+ G < � v Q L fi 1 N I M R * �? O co J. N v 1 d O a ' g wr 4 ACC)ROP CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DDNYYY) Illik� 1 3/16/2021 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- Sherwood WaIIS Walls Insurance Agency P"°NE 607-723-6359 A/C N,: 15 Hawley Street EMAIL Binghamton NY 13901 ADDRESS: swalis wallsinsurance.com INSURER 5 AFFORDING COVERAGE NAIC A Li nse#:BR-1638987 INSURER A:CITIZENS INS CO OF AMER 31534 INSURED SNSCERA-01 INSURER B:Massachusetts Bay Insurance 22306 SNS Ceramic&Stone, Inc. 33 Lockwood Lane INSURER C:Hanover 22292 Mahopac NY 10541 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:145242312 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR TYPE OF INSURANCE ADDL SUBIR POLICY EFF POLICY EXP POLICY NUMBER MMIDDIYY LIMITS A X COMMERCIAL GENERAL LIABILITY ZBSD988336 7/21/2020 7/21/2021 EACH OCCURRENCE $1,000.000 CLAIMS-MADE y X I OCCUR PREMISES Ea occur*ence $100,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY JECT® LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER, $ B AUTOMOBILE LIABILITY AWSD987537 7121/2020 7/21/2021 COMBINED SINGLE LIMIT $1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident + I $ C X UMBRELLA LIAB X OCCUR UHS 0993277 01 7121/2020 7/21/2021 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE, AGGREGATE $1,000.000 DED X RETENTION$ $ g WORKERS COMPENSATION W2SD987605 7121f2020 7/21/2021 X STATUTE ERH- AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETORIPARTNERrEXECUTIVE E.L.EACH ACCIDENT $500.000 OFFICE RIM EMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE$500.000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500.000 DESCRIPTION OF OPERATIONS f LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Village of Rye Brook 938 King Street AUTHORIZED REPRESENTATIVE Rye Brook NY 10573 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 26(2016103) The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 Leaeggal Name and address of Insured(Use street address only) 1 b. Business Telephone Number of Insured SNS Ceramic& Stone, Inc. 914-469-4439 33 Lockwood Lane Mahopac NY 10541 1 Cr NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State, i.e. a Wrap-Up Policy 1d. Federal Employer Identification Number of Insured or Social Security Number 45-380005 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) All America Financial Benefit Village of Rye Brook 938 King Street 3b. Policy Number of entity listed in box"1 a": Rye Brook NY 10573 W2S-D987605 3c. Policy effective period_ 07/21/2020 to 07/21/2021 3d. The Proprietor,Partners or Executive Offers are: QIncluded. (Only check box if all partners/officers included) 17771 all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "T' insures the business referenced above in box "1a" 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 NFORMATION 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 will also notify the above certificate holder within 10 days iF a policy is canceled due to nonpayment of premiums or within 30 days 1F 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. Please Note: Upon the 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 Worker's 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: Steven W Cobb (Print name of uthorized representative or licensed agent of insurance carrier) Approved by: r !/t" ��`'" 03/16/2021 (Signature) (Date) Title: Agent Telephone Number of authorized representative or licensed agent of insurance carrier: 607-723-6359 Please Note: Only insurance carriers and their licensed agents are authorized to issue the C-105.2 form. Insurance Brokers are NOT authorized to issue it. C-105.2 (9-07) www.wcb.state.ny.us Form WC 88 31 211 C Printed in U.S.A Page 1 of 2 Y F- N o- cz PERMIT # 05 o w Cr! ,0 '41 say# A�R2_ ro 2*2� mow' DATE APPRO E — °�- ©0 A� Q wz BUILDING INSP TOR,Village of Rye gook,NY m y ` � Q t 103;` cc) a c cm 9r •yy � C f° O C'u T L: T lb M V C X --------------------- 0 �� < Dl w, �au LL I U 1 CIO < r] W I i 39 e" 1 I � �e ep C� co I zp r .+ �w�<s I .� I a a s 419 m / > = H = v Lo U) -� �,�^ mud i , O 1 1 < .o 1 I I O� _ �p a .5 � o y L b� � f�5f�34 z" M u 06 U I e a 4V 4 u � ' N 4) V 0. y� l� C: Cb O U ' cd o - it a � C c 10.0 N W cr u A 'O � r I q �§ o � / � 2 \ rA l � . �\7 §2 a k §� ! 7 -0 ƒ q .emu 2 �a2u CA CL U� � \ § OD § �/\ 0 � ! �§ ` � ° o 2 � � §22 > § © mFl ■ 24) U) W � ... . . � N O^ O 1 u M u a €bYA A C. i 16 fa o � k M � .d •y �r .0 p p�vy U vim, o s F O I � I i c I c G d ►. .. z AoE y > V�1 V 0 1 C U C •� Q•OC� tJ �7711 Qf 1_.Ql z i © i � N O cn .� A a i 3 � o 0 u`g y it. 0 � V 0 t :too C � V C� N W V Q 0 G 0 1 oQo � as A ~ s �O W �N 9 > u y -- o ''-, On c z u E a c r� E u b u K'C >.0 Q 00.�t7