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HomeMy WebLinkAboutBP25-029PERMIT # SECTION TYPE OF WORK JOB LOCATION CwNTRACTOR EST. COST ✓c� � c FEE_ TCO FEE DATE DATE FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMING C] RGH PLUMBING GAS C7 SPRINKLER ELECTRIC LOW -VOLT S ALARM AS BUILT FINAL I NSP �411659-aao 7 OTHER APPROVALS ARB BOT PB ZBA -- OTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK Certificate of Occupancy This is to certify that ke-1, )u :To ?jct r7- of, g u if y(--�0 k t N Y , having duly filed an application on r ILd J�C 1 ?qi 20 0�� requesting a Certificate of Occupancy for the premises known as, V J: ) �L'U0CJ .3 .1/V j L) , Rye Brook,NY, located in a—P—)C Zoning District and shown on the most current Tax Map as Section: Block: / Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. 4, issued JIC25 20,;?in, 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: P-31./ ' Construction: Yb L 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 heig all be made,nor shall the building be moved from one location to another until a permit to accomplish such change has be o i fro the (ding Inspector. Building Inspector, Village of Rye Brook: Date: APR 2 2 2025 _U 1E FD11 ) BUILDINif�EIN 6 T ENT For office use on1 PERMIT# r3S 9 MAR 24 2025 IL—J VIL OF RYE BROOK ISSUED: 38 KING STRE YE BROOK,It YORK 10573 DATE: 3_c)`/—c-)S -0668 ) FEE: /��— PAID JL VILLAGE OF RYE BROOK BUILDING CEFr\RT'M4EN1- 'Ookittv.20V 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 tffi#iikik tikk#i##tt#ki#i iii#######4rt4rt#rti4rtirtirtkikitiiiki kkkit#kki tkif#if4F#tif#irti*44i##rt#44##iiktkki kiiiiktk#iitiktti##**# Address: g k YV Ow40 0 N I V G Occupancy/Use: / r4M Parcel ID#:13 Jam, -11 3 —/— 3 1 Zone: ')O Owner: 4w,`I ��K �. Address: Q N l L(i5 10 E kp le Vt= /LV /0 P.E./R.A. or Contractor: Address: Person in responsible charge: �So Li S C/4(&t ) �( Address: 6J-A40jES P1 /VAh a-t ( N V l 05-y 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: being duly sworn,deposes and says that he/she resides at �yi/y0(1i ✓ 6 J6 PO VE (Print Name of Applicant) I" ' (No.and Street) in me 1346v1�. ,in the County of ►v 6;. l �Ei5 � in the State of-11�L 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:$ , 0 23 , for the construction or alteration of: l J !V 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 f Sworn to before me this,p_J- I� 1 d Nf= , 20 �'J day of ��L � (z�///�� Signature of PYoperty Own Signature of Apolicant t Name o P operry Owner rint Name of#pl icant Notary Public Notaly Public SHARI MEULLO SHARI MEULLO Notary Public,State of New York Notary Public,State of New York No.01ME6160063 No.01ME6160063 6/1/2024 Qualified In Westchester County Z� Qualified In Westchester County Commission Expires January 29,20_ Commission Expires Jantlary 29,20Z-- QyE BRcb 0 1982- BUILDING DEPARTMENT ❑BBU'ILDING 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 O , l►� l ((� 1 1�>✓ DATE: t L PERMIT#TES'- O Z- ISSUED: %e�) " 1 SECT: I • `/ BLOCK: LOT: l LOCATION: 1c 1 ilr + 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 E ❑ NATURAL GAS ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL ❑ OTHER �E BRC��, 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.org - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : V_X60\\W W - DATE: CS -?bs)r, PERMIT# ISSUED: �SECT: BLOCK: LOT: LOCATION: t \U ` Y 'J I M OCCUPANCY: �t ❑ 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 wc CQ17­" \ o ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL ` ❑ OTHER N N N W m O �p � � � W x ^N Lin N p. U cq a h+ l N N �T O W x FFWTT l�•'+e _ 0-4 � w O z V " w x M otc y � [� O \ a a x ° 0El0 " W ap yz C c wao - ■� � � � O v ^� ter- � � � � ,., a Q 45 W + L a yr N W N ° E y - 48 r U ■ 000 ` N '� W v Z o Z m q, z w oo QM O v Q Z a a w � A ° �p C� 00 a .v ; m W a W. c p o7- V H o z u � W p U �O yaN � x p " V V � a6 r �il R-4 W ✓ x � � v BUILD.JNG DEPARTMENT VIL GCSE OF RYE 13P oax FEB - 7 2025 938 Kim Q ET RYE BRoo ,NY 10573 VILLAGE 39-0668 Ov OF RYE BROOK BUILDING DEPARTMENT INTER 10 R B U I L DING PERMIT APPLICATION FOR OFFICE USE ONLY: Approval Date: EE 2025 op,, 04 Application Fee:$ Approval Signature: Permit Fees:$ t)-7o `6 ACDisapproved: Other: .,.xx*,�;.xxxxxx�x,.,,.xxxxn�,.xxxx�x�,��,�,:xxxFx,.xxx�***�*,�•**,►**r****x;x,:,:,�xxxx�*�*�******�*,�***,�*******�*�**���: Application dated: ) is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit forthe interior alteration of an existing building,or for a change in use,as per detailed statement described below. 1. Job Address: > y�/G LL[V I1G l) 1 X PA N'tbi SBL: I351 ��`3 Zone: _/O 2. Proposed Improvement.(Describe in detail): �A+( U10 Q U_ 3. Does the proposed improvement involve a Home-Occupation as per§250-38 of the Code of the Village of Rye Brook? No: Yes: If yes,indicate: TIER l: TIER 11: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an e)ts ng automatic fire suppression system(Fire Sprinkler,ANSL 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;(1 fain.,2 fain.,comm.,etc...)Prior to Construction: I r-A NA Ater Construction: r� 6. NX State Construction Classification: N.Y.State Use Classification: 7. Property Owner: FICA. +fir. Address: Phone#Q MR CINA 1��'� Cell# email: 8. Applicant: f JL. Address: Phone# Cell# email: 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: Phone# Cell# / email: 11. General Contractor: �'Ad r se s: �✓Ie 2 '�_So A S Phone# email: 12. Estimated cost of construction $ (NOTE:The estimated cost shall include all labor,material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.) 13. Job Timetable: Start: I ) Finish: t V IJ (I) 611/2024 BUILDING DEPARTMENT Vn, AGE OF RYE OROOK FEB -l 2025 938 KnNG , ET RYE BRd NY 10573 (914)939-066�U VILLAGE OF RYE BROOK okn4ov 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 OFWESTCHESTER ) as: 1 1C.Z ,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; IC f�f I U GVW ID 0 V>jL b 4f D bt 01 I WT�) 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 Property Own s)) 61, (Print Name of Property Owner(s)) Sworn to b f re me this day f 20__Z� (Notary 001ic) GREGORY M.RIVERA Nvbq Public,State of New York (2) No.01 RI6441398 Qualified in Westchester County Commission Expires September 26,20� 6 l/2024 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. STATE;OF NEW YORK,COUNTY OF WESTCHESTER ) as: ft)A) �� !/'�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 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 —1 Sworn to before me this day of Kd , 20 day of , 20 Signature Property Owner— Signature of Applicant - // Print Name offroperty Owner Print Name of Applicant r otary lld Notary Public GREGORY M.RNERA Newry Public,State of Now York No.01 R16441398 Qualified In Westchester County Commission Expires September 26,20 (4) 6/l/2024 i = Y ■ _ i C.� : 00 M O O Cr, � M ■ i N N i ■ � N N O aWC LO L; w N N O ■ � N N � W � W CA t U 0-4 Ad 0 w � •' � w x a f " y � ■ J r. , a i��i w � f-+ M z � y w � O ■ = H � '� U J A W dt � ■ • � I� M C W OG y %� w►r� ao ■ -� Z Q W N rn O 00 �. ■ w 3 w Z _ teAl 00 all U M 'L � — O r F� U V z ^ W w d �.. ... rt A o ;:) CN cn o A w OU ►�G �jj r O 0 g J U w z w 0 O o F 0.0 x a (AW c c14 O d N Ho U O w z � W (z z z z ., x 'n z w � A V BUILDING DEPARTMENTDD VILLAGE OF RYE BBQOK FEB 2 0 2025 938 KING;ST!k RYE B ,NY 105.- VILLAGE OF RYE BROOK W'*4k zy.gov BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required ( ;Q FOR OFFICE USE ONLY P#: / EP Approval Date: Permit Fee: Approval Signature: Other: ********************************************** *************************************************** DO NOT START'WORK or CONSTRUCTION t Nl lL.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 CONSTRL'{'TION WITH A MINIMUM FEE OF$750.00 Application dated, - IP- 2S is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove electrical equipment,wiring, fixtures,or to perform other high or low voltage electrical work as per the detailed statement described below. By signing this document, the applicant & property owner agree that all electrical work performed will be in conformance with all applicable Federal,State,County and Local Codes. 1.Address: g Kr01L=d *1n y'e- SBL: 199•43-1- 34 Zone: 2.Property Owner: KAI !!Ek-a -L Address: V &n01L'=M d R d- g 0 (yrantt. Phone#: Cell#: email: 3.Master Electrician/Licensed Installer:Jast SGIJ.CL Address: IS C IOVC 1Q- Lj\ik lmaS1n$ Lic.#: Z04V Phone#: Cell#: -TOM-3C39 email:l,(Qt-riquez t>y)yicel\-elec�YiC -COM Company Name: A4C(1J CleCfirSCak C oY\N YmC4-il+Q Address: IS- C I OYC R 1 uJV Ire. ACA I"S 10 CM3 4.Proposed Electrical Work/Fixture Count:D ,)rcM o -AAO - 'Z`)• 1 hlcrJ dMIcYf1s,JRJ� sn s k"Z 3)- `i otti�x�- h �l�vsl 5.3`d Party Electrical Inspection Agency: 5.1�• l.S- �***���x�**�*****:�xxxx�x*����xxxxx�x*xxxxxxxYxxxxxxz�:xxxY,:<x�xrxxxxxxxxx*xxxxxxxxxxxFxxxxxxxxxxrx�xxxx*x STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: XCyC being duly sworn,deposes and states that he/she is the applicant above named,and does further (print name of individual siyhing as the applicant) state that(s)he is the u yC01.l E tskr:C 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 before me this Sworn to before me this day of 'b(UQ� ,20 day of _�t(L� 20 Z5 Si ature ope er . nature of App ' ant Prin am of Property Owner Pri_j Name of Applican LAUrREN BUM ,^� ry Public Notary Pub:i:-State of New York Votary blt�C+� No.01 BU6293236 ; Notary public-State of New YaIC Qualified in W: `+-ster County No.OIBU62932361/2024 My Commission Expa :: ember 09,20 Qualified in VJestchester County My Commission Expires December 09, STATE WIDE INSPECTION SERVICES, INC. Set-vice With btlegi'il.v 0:0 • • SWIS JOB APPLICATION tel 845.202.7224 1 fax 914.219.1062 • Office Use Elect. Permit# J ` Date '1 _ — Ik' 2 Bldg Permit# C:) — U s4 R Plumbing Permit# Final Certificate# City/Village Zip (nTl Building Dept. t/P (ZY County Address a Cross Street Section Block Lot o1�..am� 12 Owner Name/Address(If different than above) Contact Number ` l0�C 7 yell I -6i� nY b- to ❑Basement ❑ 1st FI. ❑ 2nd FI. ❑3rd A. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside esidential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/O Detector Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels 1P 3P # Meters # Disconnect ❑Underground ❑ New ❑ Reconnect ❑ Repair ❑Overhead ❑ Upgrade ❑ Disconnect Utility ID# ❑Con Ed ❑ NYSEG ❑Central Hudson ❑ Orange/Rockland PHOTOVOLTAIC SYSTEM PV Modules Inverters AC Disconnect Junction Box Combiner Box Load Center PV Monitor Energy Storage System DC Disconnect ❑Legalization ❑ Safety Inspection ❑Consultation (Ae TU ( \ak, L�C� rot�/a`�!2 DD FEB 2 0 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 anytime of inspection additional items have been installed,you are authorized to make the inspection and adjust the fee for the additional items inspected.The applicant declares that there is no open applications for the above address with any other inspection company.The applicant, owner or authorized agent agrees to all the above terms and conditions as set forth for the application. Email Address ; YOc)iii uC, Name License# ,�U(,1 Date - Signature Address S— �� / City/State A" t� <�)C i � Zip Code Company I 1 1 r > I PICA IV CA C ol, � ► �r �t �I � Phone# co} ( -(T"ll State Wide Inspection Services 1080 Main Street CAC) RMAR 2 5 2025 Fishkill, NY 12524 TO 0 S 845 2 Phone 914-219-119-1062 Fax STATE WIDE INSPECTION SERVICES VILLAGE OF RYE BROOK Email: office@swisny.com BUILDING DEPARTMENT 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: NYCON Electrical Contracting, LLC Kelly Toahrz Jose M. Rodriguez 8 Knollwood Road, 15 Clove Road Rye Brook, NY. 10573 White Plains, NY 10603 Located at: 8 Knollwood Road, Rye Brook, NY. 10573 Section: Block: Lot: Electrical Permit Number: EP-25-048 125.43 1 34 Certificate Number: 2025-1631 Building Permit Number: BP-25-029 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:8 Knollwood Road, Rye Brook, NY. 10573 The First Floor Kitchen was inspected in accordance with the NYS and NFPA 70-2017 and the detail of the installation, as set forth below,was found to be in compliance on the 19" Day of March 2025. Name quantity Rating Circuit Type Demo Existing Receptacle 01 Receptacle GFCI Microwave 01 GFCI Receptacles for Island 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. Building Permit Check List&Zoning Analysis Address Zone: Q)-1 0 Use: Const.Type: v Other. Submittal Date: �-?- Revisions Submittal Dates: Applicant: L) Q' -Z Nature of Work: N -P— ( x Q(- V---) \�jC (� (�\�zcCk 1 QC� \ 1 o Reviews:ZBA: FEg 102�� PB: BOT: Other. NEED K ,.- FEES:Filing. BP: C/O: Flood Plane: Legalization: ( ) (t�-APP: Dated: Notarized:— SBL:sL 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. ( Y ( ) 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 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: REQUMED EXISTING PROPOSED NOTES APPROVED Area Circle: Dal.: Fro�taee Front: Front: Sides: Rear. Main Cor Accs.Cov: Ft H Sb: Sd.H Sb: GFA: Tot Iry Ft Imp: PariunQ Height/Stories: ,v- '\ 1 _ notes: I w G►.k ,I� Cx'O g C C�r1 �C�'s �e P 0 C1,`�•�3.�t ,15 T aS' R3, - A c� �#Yy r 1 a e h . - .✓lei. : .: i A •.Il` 1 - r . . Ptih to L V ^ Q N CN LLJ w cm Qecuon t _ ' O > j G Qi .! U Q Z rr too a � �n Z O u :. J E ~ ti 0 Go i = •J _ S I? k �'•'�stoail ♦_ . "--aaasal,l ® DATE(M M/DOtY'YYY) ACORO CERTIFICATE OF LIABILITY INSURANCE 0 13,2025 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 CON ACT Michael J Donnelly NAME. Donnell Insurance Center Agency PHONE (914)347-6500 FAX (914)347-6303 Y 9 �Y C No Eat: laic No 6 North Lawn Ave E-MAIL INFO(8DONNELLYAGENCYCOM ADDRESS PO Box 880 INSURER(S)AFFORDING COVERAGE NAIL 0 Elmsford NY 10523-0880 INSURER A RUTGERS CASUALTY INSURANCE CO 41378 INSURED INSURER B Solis Carpentry.Inc INSURER C 5 James Drive INSURER D INSURER E Nanuet NY 10954 INSURER F COVERAGES CERTIFICATE NUMBER: CL2472435038 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 AUUL13UUK1 POLICY EFF POLICYEXP LIMITS LTR TYPE OF INSURANCE IN SD WV POLICY NUMBER MMJDDIVYYY MMIDO[YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.000.000 DAMAGE RENTED CLAIMS-MADE a OCCUR PREMISES Ea occurrence S 100,000 MED EXP tAny one person) S 5.000 A Y SKP 3112315 18 07/22/2024 07/22/2025 PERSONAL s ADV INJURY y 1,000.000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000 X POLICY E]PECT ❑LOC PRODUCTS COMPrOPAGG S 2.000.000 OTHER S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S )Ea a.dent ANYAUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Per accdenll S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY CAMAGE S AUTOS ONLY AUTOS ONLY Per emtlenn S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAR HCLAIMS-MADE AGGREGATE S DED I I RETENTION S $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPR,ETOR,PARTNER/EXECUTIVE ❑ NIA E L EACH ACCIDENT S OFFICERMIEMBER EXCLUDED (Mandatory In NH) E L DISEASE-EA EMPLOYEE S It yes describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if mom space is-qulred) CARPENTRY CERTIFICATE IS SUBJECT TO TERMS,CONDITIONS AND EXCLUSIONS OF THE ACTUAL POLICY AT THE TIME OF ISSUANCE CERTIFICATE HOLDER NAMED AS ADDITIONAL INSURED AS PER WRITTEN CONTRACT CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN VILLAGE OF RYE BROOK ACCORDANCE WITH THE POLICY PROVISIONS. 938 KING ST AUTHORIZED REPRESENTATIVE RYE BROOK NY 10573 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD STATE OP NEW YORK WORKIAS' COMPI:NSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVF.RACF. la. Lvgal Name& Address of Insured(Usc street address onll) Ih. business"Telephone Nurn her of Insured SOLIS CARPENTRY INC (845)659-2267 5 JAMES DR NANUET NY 1095.3 Ic. NYS unemployment Insurance Employer Registration Number of Insured \%ark Location ofInsured((lrl/'vre•quiredl /c'overuj;eAcpcc'iJicalll• N/A lindled In cerfoin Incatiaty in ;Nca• )"rrrh .Vfure•, i.e., a 11"rap-1'p Id. Federal Employer Identification Number of /'nlicll Insured or Social Security Number: Tax 11)n: 2. Nantc and Address of the F.nlity Requesting Proof of 3a. Name of Insurance Carrier Covcrage(Entity Being Listed as the Certificate Ilolder) State Farm Firc and Casualty Company 31). I'olicv Number of entitv listed in box "la" VILLAGE: OF RYE BROOK 938 KING Sh 98-C2-F696-8 RYE BROOK NY 10573 3c. Policy effective period 04-26-2024 to 04-26-2025 3d. Hic Proprietor, Ilariners or Executive Officers are included. (0nl, cluck ho%if all partnerslnffcrrs included) all excluded or certain partners/officers cu•ludcd. I ltisccrlilics that the inwranrc can'icr utdio:aleJ uhotc in hm '1":nsurcs the husines<rclerencrJ ahme in hrt�"la' G,r tvnrkels'eontpcnsation unJerthc Nc%% York State I saw (To use this form.New\ork(N\)must be listed under Item 3A on the INFORMATION PACE:of the workers'compensation insurance policy). fhe Insunutce farrier or its liccnsesl a en1%%ill send lhis(ertiticale of Insurance to thecntilN listed aN,%c a,the ccililicatc holder in hos"T" the lrrcur•rurc•c•(yore rcr it ell als•a Iron/t Ihc•rrhat•c cerillic•ate/raider it rthin l fl da'vs I/•a poli{v is cum:elect dine Ir,nompm•nremt(4 pretrurrnt a/•within 30d in-s !h Ihrr•r rn•c rru.rnns nthdv them monput nrcvrl nJ prr•rnimnrc dear dunce/Ihr/adrd't r,r chrnmrute the insurc•dlrnm Nrc rvx•rru•ec mdn•uk•d r,n Ihic f•c•rtrlirutc I/br.vr uanrr.c roar h,•seine M vrgular email) Otherwise,Iris(•erl/flrale is rn/ill for one t e nr nfrrr I/tie%nrrrr is npproeed hl'the insurance carrirr ar in' licensed uMenr,or until the polic i.e.vpirnlion dole li.wed in hose"sic", whic•hever .A enrlier. Please Note:l lion the cancellation of the workers'compensation policy indicated on this form.if the business continues to be named on a permit, license nr contract issued by a certificate Mulder, the business must provide that certificate holder with a new• Certificate of Workers' Compensatino Covcrage or other authorised proof that the business is complying wilt the mandaurrs coverage requirements of the Ncw York Stale Workers' Compensation I.aw. I nder penalty of perjury.I certify Thal 1 am an authorize(/representative or licensed agent urthe insurance carrier referenced ahnve and that the named insured has the coverage as depicted on this form. t '(J Vlf"Y\ [l�, JavlL) (Print name ul'aulhunowd representative or licensed itgenteof)insurance carrier) Approved hy: — Mgnulurc) (Date) Tills: I elephonc Number of authorised representative or licrnscd agent of insurance carrier. /'lease,Virile:(doh atsrrranrr crm r'rrrs crud their licensed ayrrrls are authrrt•i_ed to issue h sane f-!fl5.2 Anurnm r hrnkcrc der YOT urdharr_c rllo r.r.rur n C-105 2(9-071 stssss.ttch.slalr.nv.us Workers' Compensation Law 1468 8 566 , 504„ 39 y 31 8„ 274„ 6518" -- " 11 oil r r WFW1536L , W15:WF1NDC2436R �o W361824 I -' 401891 — 0i EGDT635HSMSSI —5= B21 R BF6,l— TF696 RErovvu ZWE23PSHSS �� �— r r II- Cn A r N V ,t T G _ N Z W O Cn TP033601 `___ - "� o� cn = U) 02 BMC24 B30 o 38 F" / n 0- U �l w PAN-1/4(4X8') 5 85" A (D 0) m 0 o� 146" FEB - f 2025 ' I " VILLAGE OF RYE BROOK BUILDING_ DEPARTMENT__ All dimensions-sire designations "This is an original design and must tgn 170-02 given arc subject to verification on 'not be released or copied unless Printed: 1/17/2023 job site and adjustment to fit job applicable fee has been paid or job conditions. n Cyndy order placed. - 146 8 - " 7n - - 36" - ---- 1 15" - 00 W361824 -- WFW1536L t_ W15:WFMDC2436R 00 0 J TF696 REP3096 - ---401891 - ZWE230SHSS -_ - ----- 00 to --- O C _ - EGDT635HSMSS SB33 B21 R BF6BLB42/45L 39 B 11 111 234" 33" 21 " 3 24„ 4 —21 8n 31 A11 27 all . 65H1i All dimensions size designations Ibis is an original design and must Designed: 1/17/202 given arc subject to verification on not be released or copied unless Printed: 1/17/2025 job site and adjustment to fit job � nCI\/ applicable fee has been paid or job `/ conditions. I I ordLi placed. 1 65�6" - 24'' 21" 30" 21" 24" 45;6" No J N WVU15 — WDC2436R W2136L W2136R W2436 HPWB30FS_ 0 166 * �Im i o (I o 0 o 0 BLB42/45L Z09FDR-DB36-BEPGP3�S B CO f i fb" 39" 30"- 9" ,f- 36" 45,6" 4 ------ 60�� - _ 105' All dimensions size designations ['his is an original design and must Designed: 1/17/202 given are subject to verification on not be released or copied unless Printed: 1/17/2025 job site and adjustment to tit job applicable foe has been paid or job conditions. M Cyndy order placed. I I 1 I 71E ARA U U DD � DD B30 PAIBMC24K8') B30 n 30" 24" 30" 85" -All dimensions sire designations this is an original design and must Designed: 1/17/202 gi%cn arc subject to verification on not be released or copied unless Printed: 1/17/2025 job site and adjustment to fit job applicable fee has been paid or job conditions. fl Cyndy order placed.