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HomeMy WebLinkAboutBP25-015PERMIT # 1.�! SECTION TYPE OF WORK JOB LOCATION CONTRACTOR �ST. COST ��� O # Off` T�0 # • �' �� � � � �i� • � � �� - INSPECTION RECORD I DATE INSP O(/Q�10� S I a �- da�� 9/�� '7(00-� yv �� 7f' '�• l c� fo %�� FOOTING FOUNDATION FRAMING RGH FRAMING -b INSULATION �.,( �'i°dS' �L`�/�Ose/D�j ,� • �j.(�� �P �0�1-.5 PLUMBING ICJ - 7' ZO"I,� +�ASSZ RGH PLUMBING 3' 18' 20'r- PAS - � - GAS 0 % � /' SPRINKLER � — _ ,a IS �/ �� (�y3/zGCCQ���nO �'�2C.-7�/ C_ ELECTRIC � LOW -VOLT O ALARM 0 AS BUILT FINAL .�l' �' %A�r �4 n OTHER APRROVALS ARB BOT PS ZBA OTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK NO: 25-06 2 Certificate of ®ccupoucp This is to certify that_�'�gretj Mar) Powelo waj-? 1s of, Pue AiDoe" having duly filed an application on c� J, 20 requesting a Certificate of Occupancy for the premises known as, Q?J �(�J/ ��}�C../ , Rye Brook,NY, located in a IQ—/c;2 Zoning District and shown on the most current Tax Map as Section: 5-50 Block: / Lot: 4 , and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No.(�2 5 , issued 4�g20 a5, such authority and permission is hereby granted to the property owner to lawfully occupy or use said premises or building or part thereof listed under the following New York State Classifications, Use: - - Construction:_ , for the following purposes:_8a 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 a ne he Bu - i nspector. Building Inspector,Village of Rye Brook: !�/� _ Date: MAY 0 9 2025 R For office use onl BUILDS ENT PERMIT# —O/ VIL) OF RYE OK ISSUED: /—a 9-4- APR 2 1 2025 938 KING STRE YE BROOK, YORK 10573 DATE: 9 0 FEE: y4 PAID OV 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 ..................... <. .«.*,..:......#....:.+<.:.::...:..<.....:.:..:.. Address: 0 *11 W I+ �_Oad Occupancy/Use: / I"I Parcel ID#: Zone:/e/c�_ Owner: �I 'F' l�t.d�UL� _f pp ol n Ko Address: a l 5 O I/1I,t,'(t 9 / _ - P.E./R.A. or Contractor: , G 11 _M oddl 0 S 4Address: 3� o ba rfi y4"IiC' A r t CNYshe 0— Person in responsible charge: I CQS d 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:P A_ P GLA Ko being duly swom,deposes and says that he/she resides at e U) RC—L (Print Name of Applic t) ' I (No.and Street) in I. B rFv ,in the County of �V�-S�C�tQS�e r in the State of 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,fixq equipment,professional fees,and including the monetary value of any materials and labor which may have been donated gratis was:$J 3 q o II ' for the construction or alteration of: i A 4 00 4 4- 00 S M&AIJA1441 1 ti f l 011S 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 Swom to before me this day of �n(i I 21 20 Z.� day of I Z( , 20ZI.C Signature of Property OwneV Signature of Applicant T,intName of Property Owner Print Name of Applicant Notary PublicbMARI MLULLU Notary Public rotary Public,State of New York No.OIME6160063 Qualified In Westchester County onnmission Expires January 29.20�f �E BRQ-), 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 :- '1 < > \�G�...� DATE' PERMIT# ISSUED: 1-25 -Zi SECT:/.3.5. SU BLOCK: LOT: LOCATION: > `- Vl�- t bA 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 Er FINAL PLUMBING ❑ CROSS CONNECTION f J 9 ti Q` FINAL ❑ OTHER r- �E BRC�Y. 1982 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.orS - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - r C`ADDRESS ' ; ��� „�, r< <?C�. DATE: PERMIT# ��` ISSUED: SECT: /3S SZ BLOCK: LOT: LOCATION: MA S�-1 '3q OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: 1:1 ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK L` J ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL 1�O }c--IX- ❑ OTHER c l e" a � N N w Ln w Mw oa _ U Y ,�y a 0 w � V �; z a 4 H ao f cn ✓ w ,, 0 u y a ° b W 010cn p C >4 _ o � �r ° •; O O W lz V U ° a Q. O g N 0 z r C a 17 Z. 0 Up Q �j zC U W w .. Cq 0-4 Ohl pq = zz � vo � � H - V © �. �± v� o � � u � " mp a IYi C.,a, 0-4 U 4 v � CA n � v � �l F" ob � •y a z o o a � ya — c N Q 5 ob : A 46 cl A U 46- 4 46 a A 0 46 a 46 4 4 40 46 9 9 Q 4 46- #A- 046- 46- 4-146046646- QQ446U4;4461�I-46 BUILD r , MENT VIL E OF Rytl" tQOK 938 KING ET RYE BR06�i NY 10573 ov INTERIOR BUILDING PERMIT APPLICATION FOR OFFICE USE ONLY: Approval pate: Perm' /—��mot./ Application Fee:$ t o �rj Approval Signature: Permit Fees:S Disapproved: Other: Application dated: 1�� � - is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the interior alteration of an existing building,or for a change in use,as per detailed statement described below. 1. Job Address: a� �t7y1 wl� SBL: 13Si SO 3 q Zone: —1 ft) 2. Proposed Improvement.(Pewribc in detail): Re-majeli,T6 I woo -- Ins-4 r b an r0on5 w i 71's- OJ I 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No:_Iz Yes: If yes,indicate: TIER is TIER ii: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system(Fire Sprinkler,ANSI.System.FM-200 System.Type I Hood,etc_):No: Yes: (If yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 5. Occupancy;(I fam.,2 fam_comm.,etc...)Prior to Construction:) f O Ak— After Construction: QW.� 6. MY State Construction Classification; v_ N.Y.State Use Classification:: 7. Property Owner: P0.�elk t�e1'T(ew _I ( KQ Address: aLl RQUI d)If K�% �,,-� Phone# (q 4) 939-7 ?- Cell#�� ]f �a U Z1 email: (y)t1 n fl ee5 (D Q� S. Applicant: pjaNe]A �T�'77r*1 MaAt O Address: Phone# Cell# email: 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# em il: 11. General Contractor &&ALz �r Address: Phone# _Cell# ^ f- email: 12. Estimated cost of construction (NOTE:The estimated cost stall include all labor,material,scaffolding,fixed equipment,professional fees,and niaterial and labut which=y Inc donated gratis.) 13. Job Timetable: Start: Finish: (1} 61ll2024 BUILPT,I T �D ll I VI4W4E of RYE'*ROOK 938 Kuvc �J, ET RYE BR(?o NY 10573 BAN 17 2025 -0 c ov VILLAGE OF RYE BROOK 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 wN�EW YORK, COUNTY OF WESTCHESTER ) as: I T)a.�+l�-1 6L 6-0-6 Kv ---, residing at, (Print name) (Address where you live) being duly sworn,deposes and states that(s)he is the applicant above named,and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; Bon w i� Pd , Rye Brook,NY. ( s 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. P"" (Signa ure of Property Owner(s)) pct (Print Name of Property Owner(s)) Sworn to before me this da of , 20 U (Notary ilir) GREGORY M.RIVERA Notary Public,State of New York No.01 RIS441398 (2) Qualified In Westchester County commission Expires September 26,2094 b/1/2©24 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 F NEW YORK, LINTY 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. 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 ,20 day of , 20 &4" V���o SigrwLureofPropertyOwner Signature of Applicant K ►✓1 �O Print ame of Property Owner Print Name of Applicant Notary P7 Notary Public GREGORY M.RIVERA Notary Public,State of New York No.01 R16441398 Qualified to Westchester County Commission Expires September 26,2© (4) 6/1/2024 a , = M O N N W s N N N a = s' 00 f W a rq ¢ v W rA k all M v o > c < w N < H Q s z O Imo, L1 Ln = ,,/ ^� W < W a N U ;04 Lr) w CDo = LnU zz oc cn z u w u Os a i 7 Z cai) H G1 CA r-� a0-0 f = M �' a/ ,.� w O N q can M c� T 'r, U � x < < W 07 W = Wz N v � it r ' �u„q)fl F..y u � � 14n j � x U o w z a w i U 00, A U A o ; N A w z Q Q oQ = ■ � Cs. W � .a �+ z OG BUILu4 E1101"IMENT VILL� E OF RYE FEB 14 2025 DD 938 KING! rkET RYE BR,64:C,NY 10573 VILLAGE OF RYE BROOK wwa�v _ oer(y.gov BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required ;�- 0 ,� FOR OFFICE :'r " ONLY BP#: C' J Cj I� EP#: q Approval Date: Fat Permit Fee: $SJd 12T) Approval Signature: Other: 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, 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. 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.Address:21 Bonwit Road SBL: 135.50-1-34 Zone: R-3 2.Property Owner:Jeffrey 8, Pamela Manko - Address: 21 Bonwit Rd, Rye Brook NY 10573 Phone#:917-225-0215 Cell#: email: Mankees@aol.com 3.Master Electrician/Licensed Installer: Angelo Zaccagnino Address: 81 Maple Ave, Rye NY 10580 Lic.#:755 Phone#:914-921-3244 Cell#; email:-Office@Zaccagnino.net Company Name:Zaccagnino Electric Address: 4.Proposed Electrical Work/Fixture Count: ` Wiring for hallway and master bathroom renovation 17 — iii`() Associated BP - 25-015 5.3"Party Electrical Inspection Agency: SWIS STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Angelo Zaccagnino ,being duly swom,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 Master EWctrician 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 b ore me this 1 Sw to bef this da of ,20 A Its d Signature of Property Owner SignatureVbf A H „E Angeicl:oac N Pri110WmcPaf 0. MfW YORK N¢1JR'ti %Y&I&p i No. 01 1 0238 NC. 0' 10 8 —� 1 NOtary ll, 1 My�B A' hires Oct bw 14, 20 My Commission Expires O tobor 14, 20 ---- 5/1/2024 INSPECTIONSTATEWIDE Service With Integriq 121 Main Street, Fishkill, NY 12524 1 email:office@swisny.com SWIS JOB APPLICATION84 1 914.219.1062 1 SWISNY.com • • Office Use Elect. Permit# Date Bldg Permit# Utility ID# Final Certificate# City/Village Zip Township County Address Cross Street Section Block Lot Owner Name/Address cif different than above) Contact Number ❑Basement ❑ 1 st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms Carbon Monox Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Warm Draw Incandescent Fluorescent SERVICE Amperage Voltage 1 P 3P #Meters #Disconnect ❑Underground ❑New ❑Reconnect ❑Overhead ❑Change ❑Visual Re-Inspection ❑ Safety Re-Inspection ❑ Re-Inspection Additional Information R�C� ��M� FEB 14 2025 VILLAGE OF RYE BROOK BUILDING DEPARTMENT 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 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.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. Inspector Date Finalized Inspecto Company Name Date Signat e Address City/State Zip de License# Phone# D ' _ State Wide Inspection Services 1080 Main Street CADIll APR — 8 2., c Fishkill, NY 12524 L 845 202-7224 Phone TOW U S VILLAGE 914-219-1062 Fax STATE WIDE INSPECTION SERVICES BUILDINC Email: office@swisny.com Website: www.swisny.com Service With Integrity BY THIS CERTIFICATE OF COMPLIANCE STATE WIDE INSPECTION SERVICES CERTIFIES THAT: Upon the application of: Upon Premises Owned by: Zaccagnino Electric Jeffrey&Pamela Manko Angelo P.Zaccagnino 21 Bonwit Road 81 Maple Avenue Rye Brook, NY 10573 Rye, NY 10580 Located at: 21 Bonwit Road, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 25-043 135.50 1 34 Certificate Number: 2025-2024 Building Permit Number: BP-25-015 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: 21 Bonwit Road, Rye Brook, NY 10573 The Hall Bathroom & Master Bathroom were inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 2,d Day of April 2025. Name Quantity Rating Circuit Type GFCI 03 Bathroom Exhaust Fan 02 Wall Scones 02 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. N s C N N W N ~ , � L • �, o w � o z �. � w O w � w CA a i..� 1 •� 00 Z a W ac 0-4 O v H Z r O W ?% o r PLO ON 77 a a [�, z : O V z Q w O A ~ � z >• O A z x o � < V Q CN z a .nad cn F. H u. c o ° z z z Fg O g °` x N Q w a Q - R C�C���dC� BUILDING DEPARTMENT VILLAGE OF RYE BROOK MAR 17 2025 938 KING STREET RYE BROOK,NY 1057 VILLAGE OF RYE BROOK (914)939-0668 BUILDING DEPARTMENT wv,.ryebrooknv.(ov PLUMBING PERMIT APPLICATION //�� FOR OFFICE USE ONLY BP#: �' ( � PP#: 0 2/y Approval Date: 3- l 16" ZO L`S Permit Fee: $ Approval Signature: ,J�o 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, 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. \\ I.Address: RV91AUJLA c[ SBL: 3'-.1/S Zone: — d- 2.Pro d Work: 3.Pr rty Owne : L.dbl �CU Address: d 1 �yi m Phone#:���� `�3 r]- j�0 Cell#: q(�l � -0 2,t�_ email: M to Qe 1, C o✓YL__ 4.Master Plumber: ��PO r Address: Las 60, Lic.#:(;W9 Plwu4FITU[JRF,- Cell II`//p email CWV Company Name: Mt#ress: INDICATE & LI 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 1st Floor 2nd Floor 31d Floor 401 Floor 50i Floor Exterior 5.*List Other Equipment/Provide Details: (Notarized Signatures Required Next 2 Pages) 6i1no24 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 me this Sworn to before me his \� day of ,20 day of �� ,20 Signature of Property Owner Sig ature of ppli an 4f ul l eJA� Al 6 Print Name of Property Owner P . Name of Applicant P,/V."/Yq Notary G tan I R GORY M.RIVERA Notary Pu blic,uubll�c,Statte of New York Notary Public,State of New York No.01MZ6160063 No.OIR16441398 Qualified In Westchester County �-7 Qualified In Westchester County commission Expires January 29,20Z This ppl�ication Expires Se proper1ompleted in its entirety and must include the notarized signature(s)of the legal owner(s)of the subject property, and the applicant of record in the spaces provided. Applications not properly completed in its entirety and/or not properly signed shall be deemed null and void and will be returned to the applicant. -2- 6/l/2024 BUIJD -D111MENTVIOF RY OOK 938 KING RYE BR NY 10573 MAR 17 2025 -0 �o� VILLAGE OF RYE BROOK BUILDING DEPARTMENT ***,►*****,t******,t***,t******************,t********,�xK�,t*****xxxxKKxxxxxxxxxx**������*�',�*�' AFFIDAVIT OF COMPLIANCE VILLAGE CODE 4216 • 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 YOR�K,COUNTY OF WESTCHESTER ) as: � � T, �(bu 6-1 k J If q4 �o , residing at, �.I 1,co lkJ �pd- (Print name) (Address where you live) being duly sworn, deposes and states that(s)he is the applicant above named, and further states that(s)he is the legal owner of the property to which this Affidavit of Compliance pertains at; ovl w/t PJ , 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. P�)U" (Signature of Property 0,Amer(s)) 60-o (Print Name of Property Owner(s)) Sworn to before me this day Qf , 20 (Notary P ) GREGORY h1.RIVERA Ne ary Public,State of New York No.01R16441398 -3- Qualifted In Westchester County COMMI5Si0n Expires September 26,202�1 6/l/2024 Building Permit Check List&Zoning Anal sis I Address: ` W �C SBL• Zone:`T Use: 2 Const.Type: Other. Submittal Date: Revisions Submittal Dates: Applicant: ��— Nature of Work: ID O\AVN Reviews:ZBA: PB: BOT: Other. NEE OK ((FEES:Filing. BP: C/O: Flood Plane: Legalization: O ( 1�-APP: Dated: N & 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: ( ) ( ) 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: Pennit: N/A: Other. ( ) ( ) FIRE ALARM/SMOKE DETECTORS:Plans: Permit: H.W.I.C.:_Battery:_Other: (p�/ ( ) 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 AppRq1JED Area: Circle: Date: Fron�tag Front: Front: Sides: Rear. Main Cov: Accs.Cor. Ft.H Sb: Sd.H Sb: GFA: Tot : Ft.Imy: Parlung. Height/Stories: notes: • ` 6 N 1. 't C 9- C r o a o 4 p i it a Z W o .> CD Z a • � iectioq i W Q � C W W yr Q cc) W O = U tr o Lb WON � o a� 0 1 u O �p R r c3 itl ' p Lam+ "� ��^-: •� I '' y o .3 l a Lp C I--1 .r 48 N, ►r r.11lri .,�. -mac .:.srh �•-^'-: ` , CASOREM-01 8PHINITSOVANNA ACORO E(MMID ��- CERTIFICATE OF LIABILITY INSURANCE DATE 2s 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 endomement(s). PRODUCER CO TACT Lori Kirk World Insurance Associates, LLC PHHO No,Ell),(845)230-3327 323 FAAIc No 616 Clock Tower Commons E-MAIL Brewster,NY 10509 ADDR ss:lorikirk@worldinsurance.com INSURERS AFFORDING COVERAGE NAIL N INSURER A:Evanston Insurance Company 35378 INSURED INSURER B:Preferred Mutual Insurance Company 15024 CASO REMODELING,INC INSURERC: 132 HOBART AVENUE INSURER D: Port Chester,NY 10573 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMBS LTRINSD MMIDDI YY M DDfYYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR 3AA793475 6/7/2024 6/7/2025 DAMAGE TO RENTED 100,000 X PREMISE occurrence) $ MED EXP(Any oneperson) $ 5,600 PERSONAL&ADV INJURY 2,000,ODU GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 X POLICY[_x1 j�T LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER. PER PROJECT AGG $ 5,000,000 B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 c • ANY AUTO PCA0100726256 8/14/2024 8/14/2025 BOOR Y INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY X AUTOS BODILY INJURY Per accident $ HIRED NON-OWNED PPeOacaCent AMAGE $ AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,descnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is additional insured on a primary and non-contributory basis with respect to General Liability CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village of Rye Brook THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 Y ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Rye Brook,NY 10573 -- -- AUTHORIZED REPRESENTATIVE �r�laDaS,{aeasra3a 01988.2015 ACORD CORPORATION, All rights re"mod. WM ACOOM 10W SO 08WOW 1A.VO#MW I'rl A##OT<i&C7 W /V NYSIF Now York SM4 Inoursn"fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) 0N-2-40 ^^A^A^ 133909107CASO REMODELING, INC. 132 HOBART AVENUE PORT CHESTER NY 10573 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 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2455 673-0 610506 08/11/2024 TO 08/11/2025 1/8/2025 THIS IS TO 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://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT 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 ST ATZCE FUND 4 DIRECTOR.INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 657124526 U-26.3