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HomeMy WebLinkAboutBP25-025PERM R # AJ/ SECTION TYPE OF WORK JOB LOCA71ON . OWNERc%;'1C>00 ST. COST oor CO #_0 TCO # DATE: a-- /34�� /3 7 76 BLOCK LOT A FEE C) FEE44ZD&5P6mw % _IF FEE DATE DATE IN&P FOOTING FOUNDATION FRAMING RGH FRAMING INSULATION PLUMBING i - 21 OL A3�E RGH PLUMBING GAS 1 SPRINKLER ELECTRIC nQ_/ LOW -VOLT 0 —�—; rl'ILARM 0 Tao AS BUILT O FINAL 7 Pam_ U,y q OTHER APPROVALS ARBIIIIIIF IIIIIIIs BOT PB ZBA OTHER VILLAGE OF RYE BROOK WESTCHESTER COUNTY, NEW YORK No: 25-092 Certificate of ®ccupaucp 1 Ehis is to certify that of. / Y having duly filed an application on / 20 requesting a Certificate of Occupancy for the premises known as, J440 n Q b�W CL�7/ , Rye Brook,NY, located in a J�(�7� Zoning District and shown on the most current Tax Map as Section: l 7 Block: Lot: and having fully complied with the requirements of the Building Code and the Zoning Ordinance under Building Permit No. 3 , issued 20 such authority and permission is hereby granted of 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: R-3142 e" /� Construction: for the following purposes: , � r/GiL ACh 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 ' ht shall be mad , shall the building be moved from one location to another until a permit to accomplish such change as a obt ' fro Building Inspector. Building Inspector,Village of Rye Brook: Date: JUL 2 2 2025 D "p''' For office use onl DBUILDING DEPARTMENT PERMIT# -0 JUL 17 2025 VILLAGE OF RYE BROOK ISSUED: 9-/3-aS- 938 KING STREET,RYE BROOK,NEW YORK 10573 DATE:-/-7 VILLAGE OF RYE BROOK (914)939-0668 FEE:,gC)�a,5— PAID. BUILDING DEPARTMENT Nvwa',ryeebr_ooknv.Eov 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 ssssrstst»»*s+**+**rrs►•sst*ss**s*****ssasr+++**tstrt»**»»tssss»s**s+s»s*s»s+****rss*rsrrrs*+t**ttstt»stttttttt*tts»rs*ttttr* Address: 1(a40 , 602 Occupancy/Use: gi�`v1�,Parcel ID#: O1 9, �(p- �—�� Zone: Owner: Address:g3-, hs� edgle b`A" [oX�> P.E./R.A. or Contractor: Address: Person in responsible charge: A peie` 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: //�� - �7 -P 0-AQt, being duly swom,deposes and says that he/she resides at t fa, erns tt 1 kle el Itc"e rint Name of Applicant)." (No.and Street) in tj jP S r&L p. ,in the County of T9 � �Q*C in the State of _,that Wit}'/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:$ O`Utv for the construction or alteration of: dt 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.1of the Code of the Village of Rye Brook. r Sworn to before me this \ Sworn to before me this day of S� , 20 �� day of 1, �\ , 20" Signature of Property'Owner � Signature of Applicant IYt a rwsr '% - rVl L(� t�u t nt ne of Property Owner int ame of Applicant Notary Pu li Notary SHARI MEULLO Notar Public,State of New York Notary Public,State of New York No.OIMES160063 No.OIME6160063 Qualified In Westchester County 6/I/2o2a Qualified In Westchester County Commission Expires January 29.20 1 Commission Expires January 29.2021 QyE BR�k, O� Zm uJ � • 19t32 BUILDING DEPARTMENT ❑B 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.or - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : I 26 lAoUo, ) C ,� DATE: '7-Z1- ZOO PERMIT# B Q�S ' ISSUED: Z-/j-Z1'SECT: Z/ 9 74 BLOCK: LOT: 11 LOCATION: OCCUPANCY: ❑ Violation Noted THE WORK IS... 9- YASSED ❑ FAILED /REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION ` / ❑ Natural Gas l ' �i2 t i 0Uj ❑ L.P. Gas ❑ FUEL TANK ❑ FIRE SPRINKLER ❑ FINAL PLUMBING ❑ CROSS CONNECTION FINAL ❑ OTHER QyE BRC�uk tip, 1932 BUILDING DEPARTMENT ❑BUILDING INSPECTOR O'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.or - - - - - - - - - - - - - - - - - - - - INSPECTION REPORT - - - - - - - - - - - - - - - - - - - - ADDRESS : ( �i �r(�.SI1 (1i1�.� l/w� • DATE: Z OZJ PERMIT# ISSUED: SECT: /Zf* 74 BLOCK: � LOT: LOCATION: k 1 i �'� OCCUPANCY: ❑ Violation Noted THE WORK IS... PASSED ❑ FAILED /REINSPECTION ❑ SITE INSPECTION REQUIRED ❑ FOOTING ❑ FOOTING DRAINAGE ❑ FOUNDATION ❑ UNDERGROUND PLUMBING NOTES ON INSPECTION: ❑ ROUGH PLUMBING ❑ ROUGH FRAMING ❑ INSULATION / ❑ Natural Gas s�.t�.� r J �^' lG 1•��..., ❑ L.P. Gas ❑ FUEL TANK a� ❑ FIRE SPRINKLER FINAL PLUMBING ❑ CROSS CONNECTION ❑ FINAL ❑ OTHER _ Lin V N NpZ abi m N 7.p. : \ T � a p o Cn L' �" a ° A ° ra � M � Ga � N o Z U y ti g v lr+l xj N - ;;600 Z O C w V Q0 uo o W V Z v - j..� 04Ix o Q t U o rm 1-4 a w `d A v 5 b M i H O z o a w A U V U " o 04 cr 441.0 w F O o o F-� O V O H $ a o - M u t w � t � p Z W od . a BUILD MENT vu. .., oOK FEB - 4 2025 938 KING ,NY 10573 VILLAGE OF RYE BRQOK ov BUILDING DEPARTMENT INTERIOR BUILDING PERMIT APPLICATION OR OFFICE USE ONLY: pproval Date: FFR 1 2 0 t Application Fee:$ Approval Signature: Permit Fees:$ Disapproved: Other: .*+•*,tr,r**«**«*:*c*�*«*,e,r*t,r*****«#*,r,�**�.*f*�****«**,r,►****,r,r,r****��*�**,t*,r**+:,r,r«**,rrr:***«t+***rrr*�**,e.****e Application dated: — 7`cis is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit for the terior alteration of an existing building,or for a change in use,as per detailed statement described below. 1. Job Address: I H(0 6/f t 1,W k Ld C -L"CX4&& SBL: l c�9, 7 6— Zone: YJL/ 2. Proposed Improvement.(Describe in detail): lc—ECif` J (��C _ "✓4�.1 G•9t .'-r r�u s �i X TJwr< a 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 I: TIER II: TIER III: 4. Will the proposed project require the installation of a new,or an extension/modification to an existing automatic fire suppression system(Fire Sprinkler,ANSI,System,FM-200 System,Type I Hood,etc...):No: Yes: (if yes,please submit a separate Automatic Fire Suppression System Permit application&2 sets of detailed engineered plans) 5. Occupancy;(1 fam.,2 fam.,comm.,etc...)Prior to Construction: After Construction: 6. N.Y State Construction Classification: N.Y.State Use Classification: 7. Property Owner: qoM t, M A.-o--i,s o n Trust Address: (100 bnS t e(at ��i Lt2 F-L. .03,401 Phone# a1 g g Cell 4 4- 484—13 Qa email: �+�Ohl °� �l~A b e_.n� 8. Applicant:b O,n�f c Co�4n Tr steli Address: 1 Q 6d inns L,(a , ( f.. �i L is ! Phone#h)Q., Cell#17(4^ �'�' 2._email:t3 Ca tl Xr+J C NE Hd C.n 9. Architect: Address: Phone# Cell# email: 10. Engineer: Address: ,5 Phone# Cell# email: 11. General Contractor g y C o•✓7ft4 cr an s' VvAddress: /S'_// /3 vJT4f ;z-2 Su-i f AFW4;ci/VL Phone# YIV //y 3 --// / ) Cell# /S'— 0-7 -i o email:k`r 4 Z ey­fM Cr-an t' i Y< 10 G.H.4•'c 12. Estimated cost of construction $ _?Z © -:;, 0 (NOTE:The estimated cost shall include all labor,material,scaffbMing,fixed equipment,professional&,es,and material and labor which may be donated gratis.) 13. Job Timetable:Start: Finish: 61112024 BUILD MENT Vim. oOK FEB - 4 2025 938 KING NY 10573 VILLAGE OF RYE BROOK w ov BUILDING DEPARTMENT AFFIDAVIT OF COMPLIANCE VILLAGE CODE V 16 - STORM SEWERS AND SAMTARY 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: a9 _A_ CCHA-EA residing at, qU a (Print name) (Address where you live) eing duly sworn,deposes and states that(s)he is the applicant above named,and further states that(s)he is the 1 Dgal owner of the property to which this Affidavit of Compliance pertains at; U # L.LO yJ CfAIE 5g-r , Rye Brook,NY. (Job Address) t Further that all statements contained herein are true,and that to the best of his/her knowledge and belief,that ere are no known illegal cross-connections concerning either the storm sewer or sanitary sewer, and further at there are no roof drains,sump pumps, or other prohibited stormwater or groundwater connections or sources f inflow or infiltration of any kind into the sanitary sewer from the subject property in accordance with all State, ounty and Village Codes. i - 6&' .0�0 (Sign&ae of Property Owner(s)) (Print Name of Property Owner(s)) T Sworn to.,before me this rd tolf , 20�1 : ' : TRACY LEWKU7Z Commission S HH 563803 Expires August 19,2028 (Notary Public) (2) 6/I/2024 i 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. TATE OF NEW YORK,�O N Y F WF�S�CHESTER ) as: i°l1 `fPt� Wig_ ¢ C,`ieIng duly sworn,deposes and states that he/she is the applicant above named, Ibrint name of individual signing as the ap licant) `nd further states that Whe is the legal owner of the property to which this application pertains, or that (s)he is the for the legal owner and is duly authorized to make and file this application. (indicate architect,contractor,agent,attorney,etc.) That all statements contained herein are true to the best of his/her knowledge and belief, and that any work performed, or use conducted at the above captioned property will be in conformance with the details as set forth and contained in this application and in any accompanying approved plans and specifications, as well as in accordance with the New York State Uniform Fire ` Prevention& Building Code, the Code of the Village of Rye Brook and all other applicable laws, ordinances and regulations. By signing this application, the property owner further declares that he/she has inspected the subject property,and that to the best of his/her knowledge there are no roof drains, sump pumps or other prohibited stormwater or groundwater connections or sources of infiltration into the sanitary sewer system on or from the subject property. Sworn to before me this Sworn to be re me this )td day of lA , 20 /(Y', day of Signature of Property Owner l' Signature of Applicant PriJLLName ofPrope weer Pri t ame ofAppii i L Notary Public No ry bhr i 1 ` TRACYLEWKUTZ ,�; �" TRACYLEWKUTZ A Commission#HH 563803 Commission#HW 563803 '•'.' '°. ;, °, Expires August 19,2028 f pa no� Expires August 19,2026 rpoK F'oPr 3 i� 3 I I )4) i 6/1/2024 i a a a a a OI N N rW i y Lin ►�I U 00CR 0 Z o Z Q U Nrq A , M L N Ln �j z z 00Ln ~ a rr 00 `o cn ON ''? T--i Ln pr Q P� cV a z Q Qk j CJ � �, w � � "" o o � '►� a P--4 V v H A z Rz pr � z x a w d `o, Z q Rd„ on c. U �n c4 C, z w x BUILDING DEPARTMENT C� V VILLAGE OF RYE BROOK FEE 21 2025 938 KING STREET RYE BR K,NY 10573 ___ (914) 39-0G VILLAGE OF RYE BROOK kN tti�vetx ' ny.gw BUILDING DEPARTMENT ELECTRICAL PERMIT APPLICATION Westchester County Master Electricians License Required FOR OFFICE USE ONLY BP#: EP#: �'O �� Approval Date: ' Permit Fee: $ I Approval Signature: 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,CD'--'�/-; 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.QQ 1.Address: y� fJ,, 1, l4o /jn w SBL:l Z`l. 76 -• ! — //'Y Zone: '1(')k6 2.Property Owner:-1 be e T-<-difress: Phone#: Cell#: email: 3.Master Electrician/Licensed Installer: Address: �� <,-nQ.�•l 5� J-N'm 1-1 /'o 5�3 Lic.#:12 L 7 Phone#: Cell 7 9 email: Company Name:, Address: 4.Proposed Electrical Work/Fixture Count: 5.3 d Party Electrical Inspection Agency: St., i 5 //�� STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as: Dl,%j :d 5 c ry%rra-, 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 r states t a a 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 me this day of ,20 day of 20 Signature of Property Owner Signature of Applicant 0A.0-J So r'-C- Print Name of Property Owner Prin Name of Applicant t,A�� P GREGORY M.RIV-RA Notary Public Notary Public,State of New lic No.01R16441398 GREGORY M.RIVERA 6/I/2024 Oualifisd In Westchester ConnW.r,m!pvbtic,State of New York STATE WIDE INSPECTION SERVICES, INC. •:0 • • SWIS JOB APPLICATION •. • Office Use Elect. Permit# �� Date / _ ✓ Z U Zg- Bldg Permit# P , Q Sq Ft Plumbing Permit# Final Certificate# City/Village Zip Building Dept. County Address Cross Street Section Block Lot Owner Name/Address(If different than above) Contact Number ❑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 2 ,G J 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 \�oa�= {> P �-. P �' U--�r 7 k�; FRFEB DDI VILLAGE OF RYE BROOK L BUILDING CEPARTMENT 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 , Name License# r, -7 Date Signature Address City/State Zip Code Company Phone# DE C E N " State Wide Inspection Services 1080 Main Street JUL 17 2025 Fishkill, NY 12524 845 202-7224 Phone VILLAGE OF RYE BROOK 914-219-1062 Fax ;TOTE WIDE INS FE•_TIf1NSERVtCI Email: office@swisn com BUILDING DEPARTMENT y 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: Power and Energy Corp. The Anne S Machson Trust 114 Pearl Street,Suite 1A 146 Brush Hollow Crescent Port Chester, NY 10573 Rye Brook, NY 10573 Located at: 146 Brush Hollow Crescent, Rye Brook, NY 10573 Section: Block: Lot: Electrical Permit Number: 25-049 129.76 11 1 114 Certificate Number: 2025-1330 Building Permit Number: 25-025 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: 146 Brush Hollow Crescent, 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 3rd day of July 2025. Name Quantity Rating Circuit Type Receptacles 02 GFCI 03 Hood 01 Range 01 Cooktop 01 Dishwasher 01 Disposal 01 Microwave 01 Panel 01 150 Amp 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. a _ N s' eel C N .'c7 o W c H n o ° A 04 co a Q, O Q s 00 w Ln 0-4 F ✓) O Zj �.ji M per•, •n 00Ln CA 00 Ln oZ ` ^^ . O u H 0 o H o CA i BR�t BUIL ----- vIL 938 KIN .�.. DDI JUL 9 2025 PLUMBING PERMIT APPI VILLAGE OF RYE BROOK BUILDING DEPARTMENT FOR OFFICE USE ONLY BP#t ��i PP#: �� r Approval Date: 19A Permit Fee: S Z Approval Signature: Disapproved: (fees are son-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 FEET OF S750 00 s Application dated, — — is hereby made to the Building Inspector of the Village of Rye Brook NY,for the issuance of a Permit to install and/or remove Plumbing as per detailed statement described below.iThe applicant&property owner,by signing this document agree that said plumbing work will be in conformance with all applicabl Federal,state,)C_ounty and Local Codes. y 1.Address: 1 r 1�fno SIIL• c�7� 7Cp-1-11 Ulm Zone: _ 2.Proposed Work: _ IT�1 t�yti 3.Property Owner qp� s pL q� (t —_Address: �� CDms4 t�aEr— ft- p t.. yAi0l Phone#: I'llq, Cell#: 1 q'A '�'a qa email:_RCp*%,&Al P AlEi19G�n 4.Master Plumber:ac,-c (' 11- Address:-a�{'a© A-- )k(i05 Lic.#-y%F�) Phone#:QltA-(o 30-t(,a ce Cell#: Company Name: -, Address.'a b. In o INDICATE FIXTURES&LINES TO BE INSTALLED AS PER THE FOLLOWING SCHEDULE: l ✓i`�Locatlon Water Urinals Drinking Sinks Showers Bath Laundry Domestic F Closets Fountains ' Sari * •� �y Natural/ Other Total Nibs Tubs Service S ice Sewer LP Gas Basement 1st Floor 2nd Floor 3rd Floor 4m Floor 5t°Floor Exterior � 5. List Other Equipment/Provide Details: (Notarized 3ignatur Required;Nezt 2 Pages) al II I STATE OF NE/W� YORK,,COUNTY OF WESTCHESTER ) as: �f� ,being duly sworn,deposes and states that he/she is the applicant above named, (print name of individual signing as 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 Mtn .me this � �A Sworn to before me this day of �20 day of d U j—�f ,20 _ . Sim of Property Owner Signaturif of Applicant Name of erty ��'�% (.A I,& I � Print Name of Applicant }� u LeNK ,R - - 00Mff0"#HMH* ARID OYEBISI • _ of Exp At�ust19, NOTARY PUBLIC BRONX COUNTY LIC.#01OY6258379 -- _ -- COMM.EXP.03126/2028 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- 61irz02a p EC IFN [ BUILD NT - Vu, ooK J U L - 9 2025 938 KMG NY 10573 `r VILLAGE OF RYE BROOK ov BUILDING DEPARTMENT *t*#*************#**#***#*tt********t**#**#**#*************************t**t*#*****t*ttt*tt**ttt***t*t*t 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 PLU10BING 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: AN/ue AAGfi5�AI ( gt11S{,' � x E ti> Coira l—r tstot-e- ,residing at, R66 "SU LA 1-E fl. T; (Print (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; 4 2 re ,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 Owner(s)) � (Print Name of Property Owner(s)).:nj S orn to b fore me this of 20 (Notary Pabli 'Rr s 7RACY t.EVAWU erc * Comnbslon#HH 563803 i'•.,,oFa„�." E*kwAugust 19,2= -3- 6/1/2024 ) Ltr Building Permit Check List&Zoning Analys V is t Address: (b \A � ,u� Zone: se 1O Const.Type: SIG . Other. Submittal DatcFEB 12 2025 Revisions Submittal Dates: Applicant " C' Nature of Work: cCi) Reviews:ZBA:FEB 12 2025 BOT• Other. NEED K /1 O�f` C� FEES:Filing: l C/O: Flood Plane Legalization. ( ) ( ) APP: Dated: Notarized: SBL: Truss I.D. Cross Connection: H.O.A.: ( ) ( ) Scenic Roads: Steep Slopes: Wetlands: Storm Water Review: Street Opening: ( ) ( ) ENVIRO:Long Short: Fees: N/A: ( ) ( ) SITE PLAN:Topo: Site Protection: S/W Mgmt.: Tree Plan: Other. ( ) ( ) SURVEY:Dated: Current: Archival:- Sealed: Unacceptable: ( ) (�4LANS:Date Stamped: Sealed Copies: Electronic Other. License: Workers Comp: Liability: Comp.Waiver. Other. ( ) ( ) CODE 753#: Dated: N/A: (� ( ) HIGH-VOLTAGE ELECTRICAL.Plans: Permit: N/A: Other. LOW-VOLTAGE ELECTRICAL:Plans: 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. ( ) ( ) 2020 NY State ECCC: N/A: Other. ( ) ( ) Final Survey Final Topo: RA/PE Sign-off Letter As-Built Plans: Other. ( ) ( ) BP DENIAL LETTER C/O DENIAL LETTER Other. ( ) ( ) Other. ( )ARB mtg.date: approval:- notes: ( )ZBA mtg.date: approval• notes: ( )PB mtg.date: approvaL• notes: REQUIRED EXISTING PROPOSED NOTES AreaPROVED Circle: Fronra e: Front Front Sides: Rear. Main Cov. Accs.Cov Ft.H Sb: Sd.H Sb: QFA: Tot.Im : Ft.Im : Parkin Height/Stories: notes: �Y.- ,err �. Q: •.:.� n ~ I ■ P �' V V I s CIE «i i.. t� e... !�� ���• tvr7 ,� tA.' .' Alt --act, , �S �tsaD! 1 `act _'�.''' 'dNi yd �� �- S r a>#y r` t� .'� .._ lOsa)►. Ir N N e — N Ln � E .o_ection goon.; v N Z •`. O .-Oomo " ^l• Ci Q � � = � C ems-'- "' ```y, - --. Ctcr> _ m oze C. , c a 3 N • = � �Cqa 10 V J J Y � r � `~w• Mi !IMM/ V"f. :£!�__rR! _ 'fi: -s-n .�_, ! 4s'`--r,�. ' zlyP-•-r�r•_- ���'."rf i�. �sl, KMICONT-01 AOELKE ACORO DATE IMMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 5/31/2024 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 endorsements. PRODUCER coI�z_ Jennifer Rosenberry McCartney 8 Rosenberry,Group Inc. PHONE eiq:(914)693-3500 2201 FAX NoI:('14)693-3980 477 Ashford Ave r M IL _ Ardsley,NY 10502 AooRESS:j�enberry@mvnagency.com -NISURERIS)AFFORDING COVERAGE a INSURER A:Southwest Marine&General INSURED INSURER B: KMI Contractors Inc INSYRERC: - 1511 Rt 22 Suite 161 INSURERO: _ Brewster,NY 10509 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DDL aUBR WVOPOLICY NUMBER POLICY OFF POLICY EXP _LnLA X COMMERCIAL GENERAL LIABILITY 1,000,000 _ _ _ EACH OCCURRENCE_ l CLAIMS MADE �OCCUR X -- - 1001000 L2024RLH00143 3J3012024 3/3O/2026 M TO RENTED MED EXP(AM one pereGn 5e00 PERSONAL&ADV INJURY 6 110001000 GENT AGGREGATE LIMIT APPLIES PER. GENERAL_AQ_QRg9ATE _ S _ 210N1ON 2 000 000 POLICY LOC PRODUCTS-COMPADP AGG s OTHER li AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY(Per Woon) OWNED SCHEDULED --_--_--- - AUT�O�SONLY AUTOS(..�� W1.� SODDIPLEY INJURYSPa�ocWaN AUTOS ONLY NOTOS ONLY PIROPEa , UMBRELLA WB OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS-MADE AGGREGATE DIED I I RETENTIONi S WORKERS COMPENSATION I PER OTI'(- AND EMPLOYERS'LIABILITY YIN ATUTE ANY PROPREIETgOERIPARTNER/EXECUTIVE ❑ ACCIDENT 11 OFFnE(R1ryE^BE;EXCLUDED? NIA - I% I NH E.L DICE_-_EA EMPLOYE 11 yes,describe under - ----------- DESCRIPTION OF OPERATIONS below E.L DISEASE-POU Y T DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101.Additional Remarks Schedule,may be attached if more spas isr�q cared) The certificate holder is included as additional insured with respect to gerwral liability per form number CG2012(attached). CERTIFICATE HOLDER _ _ CANCELLATION _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Village Of R ebrOOk THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 Y ACCORDANCE WITH THE POLICY PROVISIONS. 938 King Street Rye Brook,NY 10573 - -- --- — AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund PO Box 66699,Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE a. W 'a ^^^^^ 562512764 MCCARTNEY&ROSENBERRY GROUP .P DBA MVR AGENCY 477 ASHFORD AVE ❑� ..=7 ARDSLEY NY 10502 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER KMI CONTRACTORS INC VILLAGE OF RYEBROOK 1511 RT 22 SUITE 161 938 KING STREET BREWSTER NY 10509 RYE BROOK NY 10573 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE W2639 721-6 732780 01/04/2025 TO 08/15/2025 2/14/2025 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2639 721-6, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT SALVATORE PEPE 1-OF-1-KMI CONTRACTORS INC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE SUR NCE FUND F4 �V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 642334536 U-26.3 wJ c CN ..a p N r i L6 o Q 13 u ® io ® -� o M �(n fq L _ p u o 77 loc. � p i m 'Q U.00 CMo 0 oL R! 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