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Home My WebLink AboutBP25-027PERMIT # i �� 0N)DATE: 9 c�S p(p; SECTION / c9 i. TYPE OF WORK,4 JOB LOCATI 1 OWNER e" T. COST CO BLOC _/ (�'u -6�7o c�c /� TCO # FEE DATE FOOTING" �C-IL FOUNDATION FRAMING RGH FRAMING INSULATION PLUM0 iw %x (� �� r�-7�Zo2s P'is�ec� RGH PLUMBING GAS NKLE1:1R ! - `7 11 '�` �Q—f /d/n1 b 54 5► ELECTRIC L1Q .07 c(�V �'. Low -VOLT O ALARM [ -a . a � p 9 7�,-sue �%� Sys S AS BUILT O '� FINAL 3S7.0lr 4%Sl _ - INSr DATE `I-Z� 2o2S �'- s . 2 S S r OTHER APPROVALS VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK No: 25-059 Certificate of ®ccupaurp 2"' This is to certify that Ripma Tayno- of, 19kn6ko /V Y having duly filed an application on 20 requesting a Certificate of Occupancy for the premises known as, 140 Ani �b' 24)&,a) 54�ye Brook,NY, located in a Zoning District and shown on the most current Tax Map as Section: Block: / Lot: ZX and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No , issued a 20 , ,such authority and permission is hereby granted to the property owner to lawfully occupy or use said premises or uilding or part thereof listed under the following New York State Classifications, Use: 6 �/ Construction: for the following purposes: o/h if Y��6 yr t2 & �f�)6 �S I ak06 Y- k . 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 h ' t shall be ma or shall the building be moved from one location to another until a permit to accomplish such change he be ob fr he Building Inspector. Building Inspector, Village of Rye Brook: Date: MAY — 6 2025 D 7 �3R�, ``_� '-`' ��L�� For office use onl AI BUILD 1 &» 2TMENT PERMIT APR VILUOFBROOK ISSUED: cQ 2 12025938 KING STRE ,NE YORK 10573 DATE:41 c�/—lVILLAGE OF RYE BROOK 8 > FEE: X 7S� PAIDJR- BUILDING DEPARTMENT � ov 04 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 iiii tiiiiffiii t##4i Fit*i#;i*#4##4t**i****k*i#4#*i*ttk#kfitif kii#ftiifi#tk iiiiti ki#itiittititi4##i;;*i;;*#*4#*i*#;*#*t4#;*i#kk Address: ' `10 rush HDI( o W G eP ;(-"t Occupancy//Use: l /�t,41 Parcel ID 40 Zone: Owner: /V` I KO �D�Y �'e� Address: 0 rK�k a((o w is Ks Tq P.E./R.A. or Contractor: `(-�,T (0 t^t ra ct 0 V 01 Wddress: Person in responsible charge: F 1 r1 AA S"A I-4 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: Nl� T r -eP o �vks �o�lowc,b�s1 A �� being duly sworn,deposes and says that he/she resides at (Print Name of t- A l� ant) (No.and Street) PP \,� , in -( Q 17 tl ,in the County of `C`r s{�e e(� in the State of N ,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:$ for the construction or alteration of- h t �(�b r t� F&0^ SP At add "-�l 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 f irther 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 o �- 20 day of 920 ,I i y . Signature bf Property Owner'A Signature of Applicant /Ul I va, Ta 0 0 nt Name o Pro \ er, Print Name of Applicant o Public SHARI MEULLO Notary Public Notary Public,State of New York No.01MEM0063 6/I/2024 Qualified In Westchester County Commission Expires January 29,20 2� QyE BR(b 1982 BUILDING DEPARTMENT 9/ASSISTANT INSPECTOR 9'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 ADDRESS : C ,t',A . >' DATE: y PERMIT# �J\ L LOT: 77 ISSUED:Z "z s SECT: �.{ 7L_• BLOCK: LOCATION: OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... 01 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 1, ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ©'FINAL ❑ OTHER �yE BRC�jk cu � 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 : Z/7-JO ��dGdl Sig b G[-0 C DATE: J G UZ PERMIT# PPZS - 04 (o ISSUED: SECT: , ; BLOCK: / LOT: LOCATION: jr(YGL'- 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 ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER C Nci k O Z� t7 BUILDING DEPARTMENT ❑BUILDING INSPECTOR d 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 : IP.I ,� ► yL�J'.� lY� DATE: PERMIT# -� 'f,5' OQ:2 ISSUEDj/!q-.,6SECT: 1-2 y _BLOCK: LOT: 17 C LOCATION: '�� 1 �.+ OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED 9--REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ❑ NATURAL GAS M ❑ L.P. GAS ❑ FUEL TANK St ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION D FINAL ❑ OTHER J IL � LPDS . G QyE BRCv� cu � F �bi 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 `� `1" DATE: 7 Z yz r PERMIT# f l Z S ' 0 I O ISSUED: SECT: 129.7( BLOCK: / LOT: '120 LOCATION: 4 F <1 - 1 C. OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... Cil, ACCEPTED ❑ REJECTED/REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION 1 ❑ NATURAL GASAA L � A t t , (� ❑ L.P. GAS ❑ FUEL TANK J FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER ,�tRE 4Rcb 0 1' 19t32 lmO ❑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# ISSUED: SECT: BLOCK: LOT: W LOCATION: OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION ( J 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 ❑ FINAL v � ❑ OTHER i d �yE BRC�� 1932 .BUILDING DEPARTMENT ❑B LDING 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 - - - - - - - - - - - - - - - - - - - - INSPECTIONREPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : DATE: PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: 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 a ❑ L.P. GAS ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER BR O tim 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 : DATE: PERMIT# ISSUED: SECT: BLOCK: LOT: LOCATION: 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 ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER �yE BRC�k. Zm 1932 BUILDING DEPARTMENT ❑BVILDING 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: C ) PERMIT# ISSUED: SECT: ? BLOCK: LOT: LOCATION: OCCUPANCY: ❑ VIOLATION NOTED THE WORK IS... ❑ ACCEPTED ❑ REJECTED/ REINSPECTION ❑ SITE INSPECTION REQUIRED ,a FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATIONS ❑ NATURAL GAS Too I- f5 . ❑ L.P. GAS z J ❑ FUEL TANK v e ❑ 67 FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER I..V I xtN e�:v {�f�w vu•••• �Tfi4U- 1 i a (� O x O Ln 44 = M N N • � v '� � a F C'� O v Zo > 0 h x o v v 00 O A ? i �j O ( 1 w O f :, o F"1 W to ~ C? �+ W O ++ a a ►- r-. C p ... � E-•; u °-d � es � i z ° u w V (� W OQ a u U - W V O cq A, cn n W v o a v a� - O z z v w V H = -RO p w 00 W O FO a ;j U x W p�q I p p p P .. y z O C9 H A z O >4 . w w R4i _ D [ECEME ` BUILDIN ��+;PARTMENT VIL)G,� E OF RYE BROOK 938 KING�' ET RYE BROOK,NY 10573 APR 2 5 �nz� _/_/ �. 4668 W14. ok.or VILLAG= O *********************************************************************************************************** FOR OFFICE USE ONLY: Approval Date:- V Z� Permit# /- �� Application# Approval Signature: ARCHITECTURAL REVIEW BOARD: Disapproved: Date: BOT Approval Date: Case# Chairman: PB Approval Date: Case# Secretary: ZBA Approval Date: Case# Other:Application Fee: a>'!6 1b Permit Fees:4 1 qU /� EXT'`ERIOR BUILDING PERMIT APPLICATION Application dated:"/—�5��7 is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the construction of buildings,structures,additions,alterations or for a change in use,as per detailed statement described below. 1. JobAddress: rush h �d�73 2. Parcel ID#: 6- Zone: u 3. Proposed Improvement(Describe ' detail): ock, C* 4. Property Owner: Address:J b ` eF e rd� 1 VS 7 E Phone#917-5R�2- 9/20 Cell# e-mail (?M V"d( .eDCVI List All Other Properties Owned in Rye Brook: Applicant: Address: Phone# Cell# e-mail Architect: Address: Phone# Cell# e-mail Engineer: Address: Phone# Cell# e-mail General Contractor: T eO/17e-QC / IS U� LLC 14 Address: Phone# Q0 '940- 1437 Cell# e-mail /✓/�� +�5 (1) 6/1/2023 5. Occupancy;(I-Fam.,2-Fam.,Commercial.,etc...)Pre-construction: VI v,,post-construction: J.- F,gvv-., 6. Area of lot: Square feet: d a S C) Acres: 7. Dimensions from proposed building or structure to lot lines: front yard: 3 S rear yard: right side yard: left side yard: Yl P,v�r other: 8. If building is located on a corner lot,which street does it front on: y'N p,r\C. 9. Area of proposed building in square feet: Basement: hC),r\c I"fl: 2°d fl:_ 3`d fl: aQ0 10. Total Square Footage of the proposed new construction: 11. For additions,total square footage added:Basement: I"fl: �2"d fl: Y+cJ J1t 3`d fl: ZUO 12. Total Square Footage of the proposed renovation to the existing structure: '2 an 13. N.Y. State Construction Classification: ter. t,,,�N.Y. State Use Classification: QCSN r C 4 (A\ use 14. Number of stories: Overall Height: !A \ Median Height: 15. Basement to be full,or partial: finished or unfinished: 16. What material is the exterior finish: )"4 (9pf� r r 17. Roof style;peaked,hip,mansard,shed,etc: Roofing material: 6�,ABC Nf� 18. What system of heating: 19. If private sewage disposal is necessary,approval by the Westchester County Health Department must be submitted with this application. 20. Will the proposed project require the installation of a new,or an extension/modification to an exist. automatic fire suppression system?(Fire Sprinkler,ANSL System,FM-200 System,Type I Hood,etc...) Yes: No: (tfyes,applicant must submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 21. Will the proposed project disturb 400 sq.ft.or more of land,or create 400 sq.ft.or more of impervious coverage requiring a Stormwater Management Control Permit as per§217 of Village Code? Yes: No:-L�6-Area: 22. Will the proposed project require a Site Plan Review by the Village Planning Board as per§209 of Village Code? Yes:�No: (if yes,applicant must submit a Site Plan Application,&provide detailed drawings) 23. Will the proposed project require a Steep Slopes Permit as per§213 of Village Code Yes: No: (if yes,you must submit a Site Plan Application, &provide a detailed topographical survey) 24. Is the lot located within 100 ft.of a Wetland as per§245 of Village Code? Yes: No: (if yes,the area of wetland and the wetland buffer zone must be properly depicted on the survey&site plan) 25. Is the lot or any portion thereof located in a Flood Plane as per the FIRM Map dated 9/28/07? Yes: No:S� (if yes,the area and elevations of the flood plane must be properly depicted on the survey&site plan) 26. Will the proposed project require a Tree Removal Permit as per§235 of Village Code? Yes: No: (if yes,applicant must submit a Tree Removal Permit Application) 27. Does the proposed project involve a Home-Occupation as per§250-38 of Village Code? Yes: No: Indicate: TIER I: TIER II: TIER III: (ifyes,a Home Occupation Permit Application is requ red) 28. List all zoning variances granted or denied for the subject property: 29. What is the total estimated cost of construction: S Note:The estimated cost shall include all site improvements,labor,material,sca ing,fixed equipment,professional fees, including any material and labor which may be donated gratis.If the final cost exceeds the estimated cost,an additional fee will be required prior to issuance of the CIO. 30. Estimated date of completion: `Z��,�yy��Jef^ �c, /c J4 (2) 6/1/2023 BUILDING DEPARTMENT VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 RESIDENTIAL LOT AREA COVERAGE Address: i L4 D '�C)fUS� Aection.. Block: Lot: PERMITTED COVERAGE RATIOS IN RESIDENTIAL DISTRICTS (Local Law 3-88) YOUR ZONE AREA IN MAIN ACCESS. DECK ZONE DISTRICT SQ. FEET BLDG. BLDG. MAX. CHECK MAX. R-35 35,000 14% 4% 5% R-25 25,000 14% 3.5% 4% R-20 20,000 14% 3.5% 4% R-15 15,000 16% 3.5% 4% R-15A 15,000 12% 3.5% 4% R-12 12,500 17% 4% 4% R-10 10,000 20% 4.5% 3.5% R-7 7,500 23% 4.5% 3.5% R-5 5,000 30% 5% 3.5% R-2F 5,000 30% 1 5% 3.5% Existing: Proposed: 1.AREA OF LOT ot�Sc`�P> Sq. Ft. ��a Sq. Ft. 2. AREA OF HOUSE a. Coverage of Main Building (Including Attached Garage or Accessory Building) t�Sq. Ft. �Sq. Ft. b. Area of 1 st Floor Divided By Area of Lot x 100 3. AREA OF ACCESSORY BUILDING (Includes Detached Garages,Tool Shed, Playhouses) SA Sq. Ft. ?_Sq. Ft. a. Coverage of Accessory Building Area of Accessory Building Divided By Area of Lot x 100 7.� �% Z ,Ll % 4. AREA OF DECK erg Sq. Ft. _ OCSq. Ft. a. Coverage of Deck Area of Deck Divided By Area of Lot x 100 � % `L% tes the best of my knowledge and belief,the above information is correct. Archit t gnature (3) 8/12/2021 BUILDING DEPARTMENT VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 IMPERVIOUS COVERAGE RATIOS RESIDENTIAL DISTRICTS Address:ILIDBrul Rd6C) t Section: Block: Lot: Zone: IMPERVIOUS SURFACES (Definition): All buildings, as defined herein, and all areas on the ground or elevated above the ground which are comprised of materials through which water cannot readily flow, including, but not limited to asphalt, concrete, masonry, wood, gravel and clay, and which consist of elements including, but not limited to, court yards,sports courts,swimming pools,patios,sidewalks,ramps,terraces and driveways. TOTAL MAXIMUM PERMITTED MAX. PERMITTED COVERAGE Zoning IMPERVIOUS LOT AREA BY IMPERVIOUS SURFACES District COVERAGE IN FRONT (sq.ft.) For Base Lot For Lot Area YARD(%) Area(sq.ft.)* Over Base R-35 15 Lot Area % R-25 20 0 to 4,000 0 55 R-20 30 4,001 to 6,000 2,200 35 6,001 to 12,000 2,900 27 R-15 35 12,001 to 16,000 4,520 26 R-15A 35 16,001 to 20,000 5,560 25 R-12 40 20,001 to 30,000 6,560 24 30,001 to 40,000 8,960 23 R-10 45 40,001 &larger 11,260 22 R-7 40 R-5 30 *"Base Lot Area"is the minimum end of the lot size R2-F 30 range in the"Lot Area"column Area of lot: n6ao sq.ft. Existing Allowed Proposed Total impervious coverage = I ( 1 a S .ft. . ft. S .ft. Front impervious coverage = % % % I att t t e best of my knowledge and belief,the above information is correct. Archit ignature (4) 8/12/2021 BUILDING DEPARTMENT VILLAGE OF RYE BROOK 938 KING STREET RYE BROOK,NY 10573 (914)939-0668 BULK REGULATIONS IN RESIDENTIAL DISTRICTS Address: W U `6yush �66_z) Section: Block: Lot: MAXIMUM GROSS FLOOR AREA USE FORMULA: Maximum Gross Floor Area = 4,000 + [ (Lot Area —21,780) x 0.11478421 a. Allowed = Sq. Feet b. Existing = �(°; Sq. Feet c. Proposed Sq. Feet HEIGHT/SETBACK RATIOS FOR RESIDENTIAL DISTRICTS DEFINITION: A standard designed to regulate the height of a building in relation to the average grade of the corresponding portion of the lot line from which it is set back. The ratio modifies the maximum permitted Height of Building by forming an inclined plane beginning at the average grade along the portion of the lot line from which the setback is measured and rising toward the building at the specified ratio above which no part of any building, other than minor architectural features such as chimneys, skylights and dormer windows not covering more than 10%of the entire roof area, shall be permitted to extend. Height and Setback shall be calculated using the formula; Height/Setback =X, where X is the required side or front yard ratio for the zoning district in which a property is located as specified in Article Vill of Chapter 250. A complete elevation view for the proposed improvement must be included on the drawings. FILL IN YOUR RATIOS: ZONE EXIS77NG PROPOSED REOU/RED FRONT: FRONT: FRONT: .44 R-3S SIDE: SIDE: SIDE: 1.20 FRONT: FRONT: FRONT: .48 R-2S SIDE: SIDE: SIDE: 1.30 FRONT: FRONT: FRONT: .60 "0 SIDE: SIDE: SIDE: 1.60 FRONT: FRONT: FRONT: .60 R-fs SIDE: SIDE: SIDE: 1.60 FRONT: FRONT: FRONT: .80 R-fSA SIDE: SIDE: SIDE: 2.40 FRONT: FRONT: FRONT: .69 R-f2 SIDE: SIDE: SIDE: 1.60 FRONT: FRONT: FRONT: .80 R-f0 SIDE: SIDE: SIDE: 2.40 FRONT: FRONT: FRONT: .96 R-7 SIDE: SIDE: SIDE: 3.00 FRONT: FRONT: FRONT: 1.20 R-S SIDE: SIDE: SIDE: 4.00 FRONT: FRONT: FRONT: 1.20 R,2F SIDE: SIDE: SIDE: 4.00 1 attest th biest of my knowledge and belief, the above information is correct. Arch itect'N i ature (5) 8/12/2021 ILLUSTRATION OF HEIGHT / SETBACK RATIO Setback Line for I / Maximum Height / I // I REAR c I Minimum Setback Line `II a f I o c+ M r M r I o �J yJ Q A CQ Q M t LIJ HOUSE / POTENTIAL = E c c BUILDING S � Q`/ I ENVELOPE E Q O¢ Q O 4 ' FRONT Area in which Average Grade is Measured STREET Average Grade Along Property Line at Property Line E1 LVATION PLAN Table R301.2.0) 2020 IRC CLIMATIC & GEOGRAPHIC DESIGN CRITERIA FOR RESIDENTIAL DISTRICTS IN RYE BROOK GROUND- WIND SPEED TOPOGRAPHIC SPECIAL WIND- SEISMIC DESIGN SNOW LOAD (mph) WIND EFFECTS WIND BOURNE CATAGORY WEATHERING REGION DEBRIS ZONE 20 psf 115/120 NO NO NO 0 SEVERE FROST LINE TERMITE WINTER DESIGN ICE BARRIER FLOOD AIR FREEZING MEAN ANNUAL DEPTH PROTECTION TEMP. UNDERLAYMENT HAZARDS INDEX TEMP. REGUIRED REQUIRED 42" YES 15 YES FIRM MAP 1900 52.2 3GI19CO279F 9/213/07 (5a) 8/12/2021 BuILDIN6 fik ARTMENT L� C� Lc, �I �u VILLAgk OF RMftOOK 938 KING ET RYE BRO(lk,NY 10573 APR 2 5 2024 VILLAGE O RYE BROOK RUII_nt"'r- 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: je �Y\ / IL V V\� residing at, IL(() '_6mts� (cSC4 yye brcd< (Print name) (Address where you h%c) 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; e V eSfle, t" , 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. azure of Propert O, r(s)i (Print Name of P opertv Owners)) Sworn to before me this day of n- , 20 2 ( Puhlir) SHERI S.PADERNACHT NOTARY PUBLIC,STATE OF NEW YDRK No.01PA5035809 (6) Qualified In Westchester Cou My Commission Expires Not 14,2a491 9/12/2021 This form must be properly completed &notarized by the Design Professional of record and the Property Owner. Failure to provide this completed form with your permit application will delay the permitting process. Notice of Utilization of Truss Type, Pre-Engineered Wood, or Timber Frame Construction. (Title 19 Part 1264& 1265 NYCRR) To:The Building Inspector of the Village of Rye Brook. From: C Subject Property: I y '�r" NOI�r � Qlt-SCCJJ� SBL: Zone: Please take notice that the subject; ❑ One or Two Family; ❑ Commercial, ❑New Structure S U II ❑Addition to an Existing Structure — XRehabilitation to an Existing Structure APR 2 5 2024 to be constructed or performed at the subject property will utilize; _ _. ,_ VILLAGE OF FC'E �3ROOK ❑ Truss Type Construction(TT) EUILDIfvG C =P:;RTC EIvT ❑ Pre-Engineered Wood Construction(PW) ❑ Timber Construction(TC) in the following location(s); ❑ Floor Framing, including Girders&Beams(F) A Roof Framing(R) ❑Floor Framing and Roof Framing(FR) Please note that prior to the issuance of the Certificate of Occupancy, the subject dwelling or building utilizing truss type, pre-engineered wood, or timber construction must be posted with a Truss Identification Sign, installed in conformance with NYCRR§1264 for Commercial Buildings, and NYCRR§1265 for One&Two Family Dwellings. Sworn to fore me this �*'InI Swom to fore rr is day of 1 L ,20 day of << 20 2.11 ature perry Owner Signa a of n P esigrofessional 2e nx are �k THY"`� Print Name of P r peoy-6�ner Print me of Dew-Etofessio dal otary Public \V�� otary Public SHERIS.PADERNACHT SHERI S.PADERNACHT NOTARY PUBLIC,STATE OF NEW YORK NOTARY PUBLIC,STATE OF NEW YORK No.01 PA5035809 No.01PA5035809 (7) Qualified in Westchester Cou D Qualified in Westchester Coul _ My Commission Expires Nov 14,� My Commission Expires Nov.14, v 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 F� N ,,'� , � [ STCHESTER ) as: U Q � being duly sworn,deposes and states that he/she is the applicant above named, (pmt namet of individual signing A 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 bw�Ie K 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. Swom to before me this Z A Sworn to before me this day of Aro r f ,20 Z 4 day of , 20 lure of P pe Owner Signature of Applicant /1'l y �Gl h � [ c Print Name of Property Owner Print Name of Applicant ry Public Notary Public SHERI S.PADERNACHT NOTARY PUBLIC,STATE OF NEW YORK No.01PA5035809 Oualified in Westchestr:r County My Commission Expires Nov. 14,_ZQZ (8) 8/12/2021 s a = t N O N N ■ N N N e' � N •,y 47 a. M M OG U rT� f-� n a OG C> 0-0 ell W O ^ Gr 0, W 1 N ~ � � � w N o o � V � @ < 00 � w w00uI a w Q 1 z o a � t, a . O —,-) O z E r U r s x o � � W M � o z = ter. ZO .. ( h ^ w p� r } CZ d -� LL 4 t d � COR 00 rn z 8 �'W+ U � z V 0 W z a a ° C zz W t z d cn �. �• t. En CE BUIL MENT VIL iE oi, RYrJ OK MAR 11 2025 938 ICINc� r' TT RYE B ,NY 10573 s VILLAGE OF RYE BROOK - BUILDING DEPARTMENT v ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: �� EP#: Approval Date: MAR 1 8 Permit Fee: S Approval Signature: Other: DO NOT START G1 ORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BY THE BUILDING INSPECTOR. I-H.E 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„-3 1-7—<:�:; S 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: 140 Brush Hollow Crescent SBL: 129.76-1-120 Zone:1A44 2.Property owner:Remy & Mina Tamoff Address: 140 Brush Hollow Crescent Phone#: Cell#:201-920-4237 email: 3.Master Electrician/Licensed Installer:Anthony Cerniglio Address.7 Wharton Dr Lic.#: 1875 Phone#:914-338-3160 Cell#: email:ojeeleetdc@gmail.com CompanyName:OJC Electric, Inc Address: 7 Wharton Dr 4.Proposed Electrical Work/Fixture Count: Kitchen Electrical Work— Includes cutting in existing stove outlet into drywall, rework existing dishwasher and microwave outlets, demoing under-cabinet lights, relocating 4 switches, instal pendant light and outlet under the island, and running a dedicated 220V circuit for the fire pump. Attic Install 9 receptacles, 1 switch and six recessed lights. 5.31 Party Electrical Inspection Agency: STATEWIDE WIDE INSPECTION AGENCY STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: l,:e M V Tcwr n o 42 ' being duly swom,deposes and states that he/she is the applicant above named,and does further (print name of ntlividual signing as the applicant) state that(s)he is the Anthony cemigho for the legal owner and is duly authorized to make and file this application. (Master Electrician ILicensed 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 r lations. Sworn to before me this 1 S 'th Sworn to efore s 1-7 da 20 Z S day of ,20 ature of Prope O�nerzl n Si �of App Icant _ NMY Tsar» -P -- t Print Name of Pro rty Owner Joni Lttmaj 'P me of pplicant r� Commissiordl01LA0025681 ARI otary lic Notary Public,State of New York No IWF ' ME6160063 or< My Commission Expires:June 07,2028 Qualified In Westctlester Count)6/1/2024 Commisslon Expires Jantlary 29,20Z-7 STATE WIDE INSPECTION SERVICES, INC. Service With Iiiiegi-ily 0•0 • • SWIS JOB APPLICATION0. • Office Use Elect. Permit# - Date 0 7 Bldg Permit# J Scl Ft Plumbing Permit# Final Certificate# City/Village Zip F'< Building Dept. P County �I Address 1V /„ �I Cross Street / Section 9 Block Lot 142V� 7 Owner Name/Address(If different than above) )A-X rGL rQ Q Contact Number C ❑Basement ❑ 1st Fl. ❑2nd Fl. ❑3rd Fl. ❑More Than 3 Fl. ❑Garage ❑Attic ❑Outside ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/0 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 ❑ Jt[3JLK CMFT9Fl PHOTOVOLTAIC SYSTEM LJ PV Modules Inverters AC Disconnect Junction Box Combiner Box Load Center PV Monitor t ra to is VILLAGE OF R E BROOK ❑Legalization ❑ Safety Inspection BUILDING DE k,t'vtt,k) (CA-L'Ock - cat li - "Ir e \ : r A'0 t,t,� v�-�r C�c,6, �•v ' l t cs;��,�f-S r�,vc, S c�+t`c v� t-t,\.I-e e, Vl (w K- L( P,C iA l A ' e'P + ka-e 5 0 5; -ram iv 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. Email Address AA LL I Name License# Date 1. F Signature — Address ) City/State r n� Zip Code Company N Phone# f. ,�� U State Wide Inspection Services 1080 Main Street APR 2 9 2025 845 202-17224 Phone TO' U S 914-219-1062 Fax STATE WIDE INSPECTION SERVICES VILLAGE OF RYE BROOK Email: officeCabswisny.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: OJC Electric, Inc. Remy Tarnoff& Mina Tarnoff 7 Wharton Drive 140 Brush Hollow Crescent Cortland Manor, NY 10567 Rye Brook, NY. 10573 Located at: 140 Brush Hollow Crescent, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 25-072 129.76 1 120 Certificate Number: 2025-1866 Building Permit Number: BP 25-027 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: 140 Brush Hollow Crescent, Rye Brook, NY 10573 The First Floor: Kitchen and Attic 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 25t' Day of March 2025. Name Quantity Rating Circuit Type Receptacles 16 Special Receptacle 01 50AMP GFCI 05 AFCI 04 Switches 08 Dimmers 02 Range 01 Cooktop 01 Oven 01 Dishwasher 01 Refrigerator 01 Name Quantity Rating Circuit Type Microwave 01 Luminaires 16 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. Page 2 s =' : t i t i Ln i � N N 0 0 47 " W = ' N v" i ■ :. q W U 7 s :] v; v v MM t w z x o Vi N W ..� CD o i W ' ODOno _ Ln J. V :J Z a w : w Ln oC �, ' O V W z cn fel- M ON N V ,, �', z D3 o p z Z 0 m�, F o < Ma+ W F o i V O z Z Qly o s �s:�.�� sy=�1y s,�, `�' `_' s�' `*'��;�,��;�,�:``tee-�,a��-�a��-�. �`.!�' a��-� ,�', .�=I `6�=-�' ,�-' g(;�� '-�,��;�,�� `-� t-f ,,,��'''��a�--I� ,,,��•��' .a{'-�a��-�a��-. a{-� ,,,��'''��' _ • _�F'� BUILDING DEPARTMENT VILLAGE OF RYE BROOK APR 10 2025 938 KING STREET RYE BROOK,NY 10573 wiwtiN n v ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required pp��C� FOR OFFICE USE ONLY BP#: �0 7 EP#: a'S-'D ! 7 Approval Date: -$ - /O Permit Fee: $ ! / / Approval Signature: d Other: DO NOT START WORK or CONSTRUCTION UNTIL A PERMIT HAS BEEN ISSUED BV 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,'7-10-3-�;- 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. / �J�/\ 1.Address: 1 y 0 j3pus W j4j44rj&Lo C 12 r 3 er1U 7'' SBL:/ a 9f 7(0 l-/ a C) Zone: 2.Property Owner: R Er"V RUA Address: I Y() 'nAVj 14 Ali L"A?CSZyJZ- Phone#: Cell#: email: {- 3.Master Electrician/Licensed lnnstaller:WP '1M« MAQINA (-d—Address:I Lic.#: Phone#: q6 ell#:Y�/��G 7C)j email: ft)Aq 19P ��f�RS ifA1L l�Q,�{�I.AC r r 2 Compaby 1�dt'Re: 1�2�) L ►4 tf=JVl Address: 7�`IOh✓T Si' TCo1`Ta=v 4.Propose Electrical Work/Fixture Count: S 1 X L' X L IQreM f ale 5.3`d Party Electrical Inspection Agency: Sw/S STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: ,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 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 efore�{� this v day of 120 -- / day of \ 1 ,20 Signature of Property Owner Signature of Applicant t v CE Print Name of Property Owner Pn ame of Ap licant Notary Public No&ltV—WAA*%te of New York No.01ME6160063 6/1/2024 Qualified In Westchester County Commission Expires Jenalary 29,20 STATE WIDE INSPECTION SERVICES, INC. •:0 • SWIS JOB APPLICATION tel 845.202.7224 1 fax 914.219.1062 1 SWISNY.coml SWISTRAINING.COM Office Use Elect. Permit# s — D\ 9 Date 1 ,/0/1 �0� Bldg Permit# �� 5�V�� Sq Ft Plumbing Permit# Final Certificate# City/Village IZ� Zip Building Dept. County Address / L'O jZ Q u �L C Cross Street Section Block Lot Owner Name/Address(If different than above) ' c m\ Contact Number y t him 1 j U ❑Basement ❑ 1st A. ❑2nd FI. ❑3rd Fl. ❑More Than 3 FI. ❑Garage ❑Attic ❑Outside 1 ❑Residential ❑Commercial Receptacles Special Recept GFCI AFCI Switches Dimmers Smoke Alarms C/0 Detector Hood Trash Compact Amt Amps Range(s) Cooktop(s) Oven(s) Dishwashers Refrigerator Disposal Microwave Luminaires Generator Transfer Switch SERVICE Amperage #Panels I 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 % - c 2 rn� J U ;�W1 5 3 45 C [I W 17 APR 10 2025 ' VILLAGE K'T -.-:vQk: BUILDINK nEPARTMENT 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. Email Address p r} 1`;!i f9/i.L7 n' /jA4 + Name License# 1 f �.r] O L�a Date Signature 4 ��,,,� i Address -767 T S T City/State k 3 � 11p Cps//,? Company ^r 1/1 kS �c # /L 74 01 7 l�� DV E State Wide Inspection Services �"""'"`""`" I 1080 Main Street co" 2 4 2025 845 202-17224 Phone If— _ 914-219-1062 Fax STATEWIDE INSPECTIONS R"ICES VILLAGE OF RYi= BROOK Email: office(cbswisny.com BUILDING DEPARTMEN f 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: Marshall Alarm Systems, INC Remy& Mina Tarnoff Marshall C. Marinance 140 Brush Hollow Crescent 1767 Front Street Rye Brook, NY 10573 Yorktown, NY 10598 Located at: 140 Brush Hollow Crescent, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: EP 25-097 129.76 1 120 Certificate Number: 2025-2381 Building Permit Number: BP 25-027 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: 140 Brush Hollow Crescent, Rye Brook, NY 10573 The First,Second&Third Floor 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 23`d Day of April 2025. Name Quantity Rating Circuit Type Fire Alarm Control Panel 01 Horn/Strobes 04 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. i t i M M _ N a V � r G ap �' C4 C/) cc P� ' = O7 � �% z F O z H F uz a � Cf) . z �I a N E y F s o w V U zo W • cn w a ., w F L6 o F o c p w a: { BUILDING DEPARTMENT hl MAR 262025 L____ J ( VILLAGE OF RYE BROOK __.. j 938 KING STREET RYE B . ,NY 10573 VILLAGE OF RYE BROOK EUILDING DEPARTPJIENT WVVWaqe&Q*0Kny.gov PLUMBING PERMIT APPLICATION FOR OFFICE USE ONLY BP#: ;U�� PP#: C�� Approval Date: M 2 7 Z Permit Fee: $ Do r Approval Signature: 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,L3r 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 eejthat said plumbin work will be in conformance with all applicable Federal,State,County and Local Codes. X `�1.Address: ?GL� t G C�7e ' SBL: /c)�4F 70 �/—/d Zone: 2.Proposed Work: �l r16141 (,e I W h Ova to y SQ lYl ale to �'�e,G cw \i4 iAT alL ckek t4 - u_M v - Wtp 3.Property Owner: Cl'j'1 Address: 2i ti"r 490' Phone#: Q ��8Z- tkkgO Cell#: email: 4.Master Plumber: Le_Sctr.eG i Via Address: 12X) ✓S .Ly . 1--6S&.J Lic.#: _Phone#: rnb 1- 1' Cell#: (��(� Z,�1' 23qy email: TUlgl�ywtbIy) ItCchi �rrn[�(,�Gr I Company Name: UkQpiuli•')a J«- Address: 12_�C) Se-a-S 4&vc, (:�IvhsFoVJ 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 1st Floor 2nd Floor 3`4 Floor 4'Floor 5'Floor Exterior 5.*List Other Equipment/Provide Details: CY1 "v� 1 `N10 e1 z S (Notarized Signatures Required Next 2 Pages) -1- 6/1/2024 STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: CeSctYeC> 1 U 1.1 ,being duly swom,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 Ib Sworn to beforeme this day of Pat(� ,20�� day of NlA Q Y U, ,20 i ign.JurY of Property' Owner vSignature of Applicant ►'eo 1 19 Print Name of Property Owner Print Name of Applicant as- AL Notary PuW-HAEL A ZARKOWER Not C.STATE OF NEW YORK Notary Public, State of New York egistration No. 01 TU6425696 No. 02ZA5049082 Qualified in Westchester Canty County dualified In Westchester County Commission Expires Nov.29, 2025 Commission Expires September 5,20,._ 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. 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/I/2024 • BUILDING DEPARTMENT VILLAGE OF RYE BROOK MAR 2 6 2025 938 KING S�7 FET RYE BROOK,NY 10573 _ 14� -066� VILLAGE OF RYE BROOK ov 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 YOhR�K,,COUNTY OF WESTCHESTER ) as: ',1 31, r V`t �y�' 1 �� , residing at, �u 7Y�B� H 0�' W (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; �u5V, L-PIL kv ll0 �iVeS`L 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. C\ �At (Signal ofPro erty er(s)) p M X T�_Vvk b ri (Print Name of Property Owner(s)) Sworn to before me this day of Man cA\ , 20 Q� (Notan Public) 41 MICHAEL A ZARKOWER Notary Public, State of New York No. 02ZA5049082 Clualified in Westchester County Commission Expires September 5, 20 -3- 6/I/2024 :sa3ou =FOIS M . 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Tlg RDdl-IOA-nnO-I ( ) ( ) :zaLPO :d/N aTuuad :guEld-IdDRLLDR III 99VI'IOA-HJIH :y/N Fa;eQ :#£SL HGOD ( ) ( ) :ntpo :nATem•dTuoD :,i�Tpgrl :dLuoD sxanlsom -asaaarl ( ) ) _ tpo :Dmouaalg :saidoD :PaleaS :Pa&MS aleQ:SNV-Id ( N ) .alginda»eun FaleaS :p°nP-TV auaiTnD :Pa;eQ:.kIIA-dnS ( ) =IPO 'uId as-7l :WAW m/S :uona320sd 4!S3 :odo.L:NV Id II.I.IS ( ) ( ) :d/N :Saa3 =oigS 3uo-I:02II kNEI ( ) ( ) SuTuadO iaauS :,baTea2l gem uuoIS :slTusPam :sadolS dmS :sPeoZl aTua� ( ) ( ) :d•O•H :uouaauuoD ssolD Q I ssru.L : -IgS T22 ON ---T'PaieQ :ddy,(.j) ( ) .uonezgvsal -'uTId POOH O/� dg rnl -SUT :��_ x CORN aa�0 LOg gd :t/gZ:SAi2T°a2i -Isom3o 2=tN Q J aueajddd :saieQ ImnugnS sao77\� a�eQIeuTLugnS saLPOa&j_-3suo� as fI n _ � :auoZ �-Igs ' S(1 Ob ( :sSaaPPd c� a � �� utuoZ V ISTI)P;9D 3T=ad uTTmq' The Arbors Homeowners' Association 173 '/2 Ivy Hill Crescent Rye Brook, NY 10573 February 28, 2024 -TDD APR 2 5 2024 Remy and Mina Tarnoff 140 Brush Hollow Crescent VILLAGE OF RYE BROOK Rye Brook, NY 10573 BUILDING DEPARTMENT Re: 2 Skylights on Roof Dear Remy and Mina, This letter serves as confirmation that the Architecture & Grounds (A&G) Committee has reviewed and accepted your application for the above-named work. This approval is valid for six (6) months from today's date. If any changes need to be made to the original plans submitted to A&G either before or during construction, the Committee must be notified in writing and your application must be amended. Work must stop and cannot proceed until you receive written approval for those changes. A permit from the Village of Rye Brook must be presented to the property manager before work begins. You are also required to inform the Property Manager when work begins. When the project is complete, the Property Manager must again be notified so that an inspection may take place. Please include a photograph of the work as well. Failure to comply with these procedures will result in fines and/or work stoppage. If you have any questions, contact me at: Property Manager. Nicholas Salzarulo Property Manager r�rn-�o-a.�v� io•<o wia 163693e0840 P.030 3 A1le.p.0t t2su2lMi PXw Z 96 CFO " . J40 a' w3 139 41 o t mm;� t e tl a Le a 36 49 t, 46 Y 0 � # R4 m B o RUSH NoLL.4W CRESCENT sza F rr,� -nb Uzi TOTAL P.020 inn icon rA Laura Petersen From: T&T Contractor Guys <info@ttguys.us> Sent: Saturday, February 15, 2025 8:13 AM To: Laura Petersen Cc: Mina Tarnoff; Remy Hara Subject: Re: Building Permit Application - 140 Brush Hollow Crescent Attachments: COI-VILLAGE OF RYE BROOK.pdf;Westchester LIC..pdf,WC-VILLAGE OF RYE BROOK.pdf; DB-VILLAGE OF RYE BROOK.pdf Hi Laura, Hope you are doing well. Please see below the License,insurance and workers compensation as requested. Information regards to contractor: Name: Fitim Shala Company:T&T Contractor Guys LLC Phone: 2019204237 Email: info ttguys.us Thank you On Fri, Feb 14, 2025 at 11:57 PM Remy Hara <remyhara@gmail.com>wrote: Hi Tim, I need the below#1 -#4. Once the permit is issued and ready for pick-up, I need to pay the building permit fee. Thank you, Remy ---------- Forwarded message --------- From: Laura Petersen <LPetersenPryebrookny.gov> Date:Tue, Jan 14, 2025 at 1:56 PM Subject: Building Permit Application - 140 Brush Hollow Crescent To: remyhara(@gmaiL.com <remyhara@gmail.com> Good afternoon, The building permit application has been approved by the Building Inspector. Before I can issue the building permit the following items must be submitted to our office: 1 1. General contractor's contact name (first and last) & phone number. 2. Copy of general contractor's valid Westchester County Home Improvement License. 3. General contractor's valid liability insurance (the Village Of Rye Brook must be the certificate holder) 4. General contractor's valid workers compensation on a NY State Board form (C105-2 or U26.3) 5. Building permit fee $1,440.00 (due once permit is issued and ready for pick-up) Thank you Laura Laura Petersen Office Assistant Village of Rye Brook 938 King Street Rye Brook, NY 10573 (914)939-0668 2 W+ IN r ,•.l +; 1 ��lrtl�� .1 ; I�,I,�P - l�,ll 1 f t��1►� _ C o O N 'ftl a v W _ra- la °v r u r c Uzi$ n v U O Q r` ta•s 1� 4. a J U :9� w � � l v� D W ,tom? p D �.l O c/) 5 r'v C'm C U = Z E cwd a �v r,`ZK W X V co !I O F- N ' G LU O • �� ! h•r a� 00 X O Z s �a r �ato>io Mr � ,u � 1 itoHj -: Q � l: f4 FBI � yr a •= _ I ;ato>► , A Aa Y •rr Si+�' 1 0 ejcn ` C v .D N C, Ml o v U '.(era>►� i .0 tl {tatpi� , 1,1�+ ill�11'l � .; ill 11e ' 11111 ! It. �111,j 111•,111 �� ' • �� MI► '!tira� �.�.�, +►;tit W �.SN +..,� rii�tl�u ® DATE(MM/DD/YYYY)AC� �� CERTIFICATE OF LIABILITY INSURANCE 2/15/2025 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 CONTACT VALON GASH NAME: ALBATRUST INSURANCE AGENCY PHONE 718�12-1778 LAX No 32 HANCOCK STREET E-MAIL ADDRESS: INFO@ALBATRUSTINSURANCE.COM ADDRESS: STATEN ISLAND,NY 10305 INSURERS AFFORDING COVERAGE NAIC# INSURERA: Penn-Star Insurance Company 10673 INSURED INSURER B: T&T CONTRACTOR GUYS LLC INSURER C: 153 PARKVIEW AVE INSURER D: YONKERS,NY 10708 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 ADDL,SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR POLICY NUMBER MM/DDIYYYY MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 �/ AMA N 100,000 CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ 5,000 A X X PAV0516923 07/20/2024 07/20/2025 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X❑PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident 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 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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 938 King St. ACCORDANCE WITH THE POLICY PROVISIONS. Rye Brook, NY 10573 AUTHORIZED REPRESENTATIVE VALON GASHI ,J/ ©1 88-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD PORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured T&T Contractor Guys LLC 153 Parkview Ave 347 530 6619 Bronxville, NY 10708-1300 1 c. NYS Unemployment Insurance Employer Registration Number of Insured N/A Work Location of Insured(Only required if coverage is specifically limited to 1 d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 87-1653114 2. Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) National Liability &Fire Insurance Company Village of Rye Brook 938 King St. 31b.Policy Number of Entity Listed in Box"1 a" Rye Brook,NY 10573 V9WC526060 3c. Policy effective period 06/14/2024 to 06/14/2025 3d.The Proprietor,Partners or Executive Officers are ❑ included.(Only check box if all partners/officers included) XQ all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "I a"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 INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box '2". The insurance carrier must notify the above certificate holder and the Workers' Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that 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. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Peter Shelley (Print name of authorized representative or licensed agent of insurance carrier) Approved by: 02/15/2025 (Date) Title: Vice President Telephone Number of authorized representative or licensed agent of insurance carrier: 844-549-2512 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-17) www.wcb.ny.gov DATE(MIWDOM'YY) ACCO o CERTIFICATE OF LIABILITY INSURANCE 04/09/2025 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 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: Crystal Jacobs Balance Partners,LLC PHONE(AIC,No.E:t): 866-315-3835 FAX(AIC,No,Ert): PO Box 2550 E-MAIL ADDRESS: info@securityamericains.Com Huntington,NY 11743 INSURER(S)AFFORDING COVERAGE NAK:0 INSURER A: Certain Underwriters at Lloyd's of London AA-1126435 INSURED INSURER 8: Marshall Alarm Systems Inc. 1767 Front Street INSURER C: Yorktown Heights,NY 10598 INSURER D: 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. TYPE OF INSURANCE 'O0L wvo POLICY NUMBER POLICY EFF POLICY EX► LIMITS LT0. (MWDDNYYY) (MMMONYYY) X COMMERCIAL GENERALLIABILITY SARPG-000041-01 02/21/2025 02/21/2026 EACH OCCURANCE $1,000,000 CLAIMS- X/ OCCUR DAMAGE TO RENTED MADE /� PREMISES Eaocwrance $100,000 X MED EXP(Any one person) $10,000 A PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 aX POLICY PRO-JEC7 LOC PRODUCTS-COMPlOPAGG $2,000,000 OTHER: PROFESSIONAL LIABILITY $1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident V AUTO BODILY INJURY Per person) OWNED AUTOS SCHEDULED ONLY AUTOS BODILY INJURY(Per accident) HIREDAUTOS NON-OWNED ONLY AUTOS ONLY PROPERTY DAMAGE Per accident X UMBRELLA LIAS X OCCUR SARPGUMB-000041-01 02/21/2025 02/21/2026 EACH OCCURRENCE $5,000,000 A EXCESS LUIB CLAIMS-MADE X AGGREGATE $5,000,000 DED I X RETENTION f 10.000 WORKERS COMPENSATION PER OTH. AND EMPLOYERS'LU1BILI Y Y I N FR ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT OFFICEIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,d more apace le required) Certificate Holder is listed as Additional Insured as respect to General Liability Coverage related to operations of the Named Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF,NOTICE WIL Village Of Rye Brook ACCORDANCE WIDTH ATE THE POLICY PROV SIONSL BE DELIVERED IN 938 King Street Rye Brook,NY 10573 AUTHORIZED REPRESENTATIVE ACORD 25(2014/01) ©1988-2014 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD Docusign Envelope ID:7441084B-B4CD-4DDC-A5EB-6DE8D8E014F1 Y Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured MARSHALL ALARM SYSTEMS INC 1767 FRONT ST STE 1 YORKTOWN HEIGHTS,NY 10598-4662 1c.NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 13-3244781 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Indemnity Insurance Co.of North America Village of Rye Brook 938 King Street 3b.Policy Number of Entity Listed in Box"1 a" Rye Brook,NY 10573 C72485087 3c.Policy effective period 10/01/2024 to 10/01/2025 3d.The Proprietor,Partners or Executive Officers are ❑X included.(Only check box if all partners/officers included) ❑ all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"1 a"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 INFORMATION PAGE of the workers'compensation insurance policy).The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that 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. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Lex Smith (Print narn1—f a o{{ uth uS t ffllzed representative or licensed agent of insurance carrier) Approved by: p&gb. 4/9/2025 7A4 �p7 lg —C4 (Date) Title: Assistant Program Manager Telephone Number of authorized representative or licensed agent of insurance carrier: 214-777-4864 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2.Insurance brokers are NOT authorized to issue it. 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