HomeMy WebLinkAboutBP25-046PERMIT MQ`7C,;� Dq 9•3 =)6 S �3
SECTION , RI ACK / LOT
TYPE OF WORK r / yj� V/// .—
JOB LOCATION CCU aley&s rNl
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F,ST. COST
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FOOTING
FOUNDATION
FRAMING
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INSULATION
PLUMBING O
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ALARM 0
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REQUIRED PRIOR TO
FINAL INSPECTION
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VILLAGE OF RYE BROOK
MAYOR 938 King Street, Rye Brook,N.Y. 10573 ADMINISTRATOR
Jason A. Klein (914) 939-0668 Christopher J. Bradbury
www.ryebrookny.gov
TRUSTEES BUILDING& FIRE INSPECTOR
Susan R. Epstein Steven E. Fews
David M. Heiser
Donald T. Krom,Jr.
Salvatore W. Morlino
CERTIFICATE OF COMPLIANCE
August 21,2025
Michael Fisher&Jaclyn Fisher
108 Country Ridge Drive
Rye Brook,New York 10573
Re: 108 Country Ridge Drive, Rye Brook,New York 10573
Parcel ID#: 129.67-1-9
Building Permit#25-046 issued on 3/26/2025 for a New Fence
This certifies that the new four foot high white vinyl fence and gates,installed under the above captioned
permit have been satisfactorily completed.
Sincerely,
Steven E. Fews
Building&Fire Inspector
/to
D [E c 2 ��/7 rE BUILDING DEPARTMENT For office use only:
VILLAGE OF RYE BROOK ISSUED: - of
AUG 13 2025 38 KING STREET,RYE BROOK,NEW YORK 10573 DATE:
(914)939-0668 FEE: /AS U PAB)Q"
VILLAGE OF RYE BROOK
BUILDING DEPART
A/lE
CERTIFICATE OF OCCUPANCY, CERTIFICATE OF COMPLIANCE,
�1V(<1�RT?Tr1Rr!"ATrllNnr. F><tvAr �l1CTC
TO BE SUBMITTED ONLY UPON COMPLETION OF ALL WORK, AND PRIOR TO THE FINAL INSPECTION
►s►sssarsssssssss►assssaasssssss►sasssssstsssaarssssrssars•ssrttsssss►rts►rrsrssrstssrsssssaassass•sesssssastssa►sssssssasss.
Address- )Off Cd -0 .+v-f P-'je eye- 5ro"
Occupancy/Use: Parcel ID#: /o�� 7- /-5 Zone:
Owner: rvlt("el � dr-6"e J.51.1' Address: SAt*"r 'e
P.E./R.A. or Contractor: �3✓C,« I4 t/c; Address:
Person in resnonsible charge- 0 ''« 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
STATE OF NEW 1Y-ORK, COUNTY OF WESTCHESTER as: 109 heino duly sworn denoses and says that he/she resides at
(VQt f / 0 Yv112—
in ��e 53 v�k N in the County of W p f4-c Q f in the State of /vy that
he/she has supervised the work at the location indicated above.and that the actual total cost of the work.includine 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: p 41a0 D
/
for the construction or alteration of
Deponent further states that he/she has examined the approved plans of the structuretwork 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,annroved nlans and anv amendments thereto excent in so far as variations therefore have been legally authorised 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 nartly in its use or stricture until a Certificate of tk-eimanev or Certitiente of Comnliance shall have been dub 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
'lay or 2iy� day of 20
Signature of Property Owner Signature of Applicant
Print Name of Property Owner Print Name of Applicant
,1-GLC t yh F;S�- ,�
NNa'v R.hlir
SHARI LI N�ta+�R.hlir
( jawr wre, York
No.01ME6160063
Qualified In Westchester County
Commission Expires January 29.20z-
QyE DRCi,
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/�• 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 : f O t c�Uy �� _� 1 ✓ 0DATE: ✓��
PERMIT# Z S V y ISSUED: 6- SECT: 4?7- L BLOCK: LOT:-'`
LOCATION: 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 J
❑ Natural Gas r V I ^J X - c- V /�
❑ L.R Gas /
[I FUEL TANK t Jt �P/�'
❑ FIRE SPRINKLER
❑ FINAL PLUMBING C.
❑ CROSS CONNECTION
[] FINAL
OTHER
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VILt,'OEET
E/of R ROOK
938 KIN RYE B NY 10573 MAR - 7 2025
4 39-0 6t
ov VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
FOR OFFICE USE ONLY:
Approval Date:_ AQT_4 )nqcP mit Application#
Approval Signature: ARMTECTURAL REVIEW
BOARD: _
Disapproved: Date: / o�
BOT Approval Date: Case# Chairman:
PB Approval Date: Case# Secretary
ZBA Approval Date: Case#
Other: `
Application Fee:4� L , �� Permit Fees:
FENCE / WALL / GATE PERMIT APPLICATION
Application dated: 2�— is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Pennit
for the installation,construction,repair or replacement of a Fence,Wall or Gate,in accordance with Section 250-6 B.(1)(g),of the Code of the Village of
Rye Brook,as per detailed statement described below. Swimming pool fences must conform to the State Code.
I. Job Address: (j �vi fV- ,d (7 r,ve Q
2. Oc �cupancy/Use: / 4 S.B.L.#: / c)9i i 6' 7—/— 1 Zone: —fS
3. Proposed Fence/Wall/Gate(describe in detail):
VNe11 jW r� �/ �11�w+ I�► t��► -f��►le S ft'a v n �� ram„ -ArJ b�,),tS
101 o �l ra✓ SEG
4. Property Owner:
Address: 10 rD v14 r e(d 5 U
Phone# Cell#q I`(—3 —email: �e. L, F f y 1�fP 0)I'r''Gl t .L 0 ►'�
J
Applicant:
Address:
Phone# Cell# email:
Architeet(Engineer:
Address:
Phone# Cell# r email:
Contractor: t4i r (f -, I
Address&Phone: '+ �ca� a W �/M (e f C�"r` 7�' wr
5. If building is located on a comer lot,which str t does it front on:
6. What is the estimated cost of construction Oc), O G
(NOTE:The estimated cost shall include all site irfiprotrements,labor,material.scaffolding,fixed equipment,professional fees.and
material and labor which may be donated gratis.)
7_ Estimated date of completion: CO--
Please note that this application must include the notarized signature(s) of the legal owner(s)
of the above-mentioned property, in the space provided below. Any application not bearing
the legal property owner's notarized signature(s) shall be deemed null and void, and will be
returned to the applicant.
STATE OF NEW YORK, COUNTY OF WESTCHESTER ) as:
,being duly sworn,deposes and states that he/she is the applicant above named,
(print name of individual signing as the applicant)
and further states that (s)he is the 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.
Sworn to before me this Sworn to before me this
day of 24 2� day of , 20
of Property Owner Signature of Applicant
Print Name of Property Owner Print Name of Applicant
Notary P Notary Public
GRSGM M.RNERA
Ntrtary public,State of New York
No.01 RI6441398
Qualified In Wastcbester County
Commission Expires September 26,20
2
Building Permit Check List&Zoning Analys
is
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Address: 1 GSBL•
Zone: `� Use: 2 Cont.Typ Other:
Submittal Date: \� �-S Revision Submittal Dates:
Applicant: S�,p
Nature of Work
0--vec, c- v cAc
rj
Reviews:ZBA: 5 PB: BOT: Other.
NE K
( ( FEES:Filing: \ P: C/O: Flood Plane: Legalization:
( ) (t.-A P: Dated .—Notarized: --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.
( ) ( URVEY:Dated Currents Archival Sealed: Unacceptable:
PLANS.Date Stamped Sealed Copies: Electronic Other.
(�) License: Workers Comp: Liability Comp.Waiver. Other.
(��( ) CODE 753#: Dated: N/A:
HIGH-VOLTAGE ELECTRICAL:Plan: Permit: N/A: Other.
( ) ( ) LOW-VOLTAGE ELECTRICAL:Plan: Permit: N/A: Other:
C ) C ) FIRE ALARM/SMOKE DETECTORS:Plan: Permit H.W.I.C.:_Battery:_Other.
( ) ( ) PLUMBING Plan: Permit: Nat.Gas: LP Gas: N/A/: Other.
( ) ( ) FIRE SUPPRESSION.Plan: Permit: N/A: Other.
C ) C ) H.V.A.C.: Plan: Permit N/A: Other.
( ) ( ) FUEL TANK:Plan: Permit: Fuel Type: Other.
( ) � ) 2020 NY State ECCC: N/A: Other.
Final Survey: Final Topo: RA/PE Sign-off Letter. As-Built Plan: Other.
C ) ( ) BP DENIAL LETTER C/O DENIAL LETTER Other.
( O-ARB mtg.date: ` approval:- 3' *1- L notes: �Q
( )ZBA mtg.date: approval:- notes:
( )PB mtg.date: approval• notes:
REQUIRED EXISTING PROPOSED NOTES
Area: Royrrn
Circle:
F�c
Front:
Front:
Sides:
Rear.
Main Cov:
Accs.Cov:
Ft.H Sb:
Sd.H Sb:
GFA.
Tot :
Ft.Imp:
pmhw.
H62k/Stories:
notes:
KUII.D p IECIMWEVII. OF RFNT
K ]D
938 Krnc ET RYE Y 10573 MAR - 1 20254 9 !-WWI VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
ARCHITECTURAL REVIEW BOARD CHECK LIST FOR APPLICANTS
This form must be completed and signed by the applicant of record and a copy shall be
submitted to the Building Department prior to attending the ARB meeting. Applicants
failing to submit a copy of this check list will be removed from the ARB agenda.
Job Address: 0, I08 Ca,,1+r J �,J, Q r,•e Date of Submission:
Parcel ID#:/C)- ,G 7—/-9 Zone: - A l a
Proposed Improvement(Describe in detail):
(4 -Ict r- J T-e vl(C- CA ry v 11 d r o,/ APPLICANT CHECK LIST:
MUST BE COMPLETED BY THE APPLICANT
The following items must be submitted to the Building
Department by the applicant-no exceptions.
Property Owner:M tCkutel 1. (Completed Application
2. ( )Two(2)sets of sealed plans. (one full size ;maximum
Address.- w vH4 v e113 e Q✓ allox%able plan size- 36"x 42") and one 11"x17)
Phone# q t`1 - ��f 3. (vf*Tw°o(2)copies of the property survey.
4. (Jf)4o(2)copies of the proposed site plan.
Applicant appearing before the Board: 5. ( e electronic/disc copy of the complete
d6. plicationmaterials.
ng Fee.
Address: 7. ( )Any supporting documentation.
Phone# 8. ( )HOA approval letter. (if applicable)
9. ( Photographs.
Arch itect/Engineer: 10.( )Samples of finishes/color chart, to Sample board or
Phone# model may be presented the night of the meeting)
By signature below, the owner/applicant acknowledges that he/she has read the complete Building Permit
Instructions& Procedures, and that their application is complete in all respects. The Board of Review reserves
the right to refuse to hear any application not meeting the requirements contained herein.
Swom to before me this 1� 1
Sworn to before me this �^
day of ��Ll 20 S day of► ✓'4-c 11 , 20 2 —
a e of Property Owner atme o Applicant
' (�'e ( -�-, S IMI(Aa ( F61�/
Print Name of Property Owner
Print Name of Applicant
N Public \utarV Public
7�- 3F
�� MR
�yC BROI Village of Rye Brook ML �/ ✓
O� yAgend FB y SE
Architectural Review Board Meeting AC ✓ AD
Wednesday,April 16,2025 at 7:30 PM
Q Village Hall,938 King Street JM ✓ SF
1. ITEMS:
1.1. ARB25-032(Consent Agenda)
Thomas Commons&Nicole Pelosi
391 North Ridge Street
4'high black chain link fence and black aluminum gates.
1.2. ARB25-033 (Consent Agenda)
Christopher Pascuma&Julie Pascuma
2 Latonia Road
6'high white vinyl fence and gates.
1.3. ARB25-034(Consent Agenda)
Min Sik Pang&Gui Suk Pang Yeon
7 Maple Court
Legalize patio.
1.4. ARB25-035 (Consent Agenda)
Christopher Light&Emily Light
7 Bishop Drive South
6'high white vinyl fence and gate.
1.5. ARB25-036 (Consent Agenda)
Michael Gorman&Alysse Schumacher
4 Magnolia Drive
Rooftop solar array.
1.6. ARB25-019(Consent Agenda) (Amendment to Approved Plans)
Michael Fisher&Jaclyn Fisher
108 Country Ridge Drive
4'high white vinyl fence and gates.
1.7. ARB25-014(Consent Agenda) (Amendment to Approved Plans)
Joseph Bradford&Amanda Bradford
304 Betsy Brown Road
6'high chocolate woodgrain composite fence.
1.8. ARB25-037 (Consent Agenda)
Scott Levy&Nicole Levy
42 Meadowlark Road
Re-do and extend existing patio with bluestone.
1.9. ARB25-038 (Consent Agenda)
Olfer Danilo Mendieta Saraguro
227 Irenhyl Avenue
4'&6'high white vinyl fence.
Page 1of5
Architectural Review Board
April 16,2025
1.10. ARB25-004(Consent Agenda) (Amendment to Approved Plans)
Arun Acharya&Bhargavi Panjala
16 Country Ridge Circle
Window and door changes,interior alterations.
Consent Agenda
Approvals: Motion�l Second Abstention
Aye; Nay; Adjournment;
Notes
1.11. ARB25-039
Michael Weinberg
505 Con-Ay Avenue
Enlarge existing deck.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.12. ARB25-040
Marianne Landa Chao
6 BelleFair Road
Rear deck.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.13. ARB25-041
Washington Park Plaza Associates LLC
275 South Ridge Street
New signs,"Blackstones Steakhouse&Fusion"
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
Page 2of5
Architectural Review Board
April 16,2025
1.14. ARB25-042
Ethan Hoch&Haleigh Hoch
13 Old Orchard Road
Rear window&door changes and interior alterations.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.15. ARB25-043
Joshua Blackwood&Gretchen Blackwood
6 Dorchester Drive
Legalize new wall and extension of existing patio.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.16. ARB25-044
Creighton Cray&Julia Gans
5 Talcott Road
Replace rear deck in kind.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.17. ARB25-045
Jamie Billington&Kara Billington
6 Bonwit Road
New rear deck and patio.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.18. ARB25-046
Evan Haskell&Sabrina Haskell
22 Red Roof Drive
Rear window&door changes and interior alterations.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
Page 3 of 5
` Architectural Review Board
April 16,2025
1.19. ARB25-047
Daniel Marks&Yael Marks
18 Hillandale Road
New deck,renovate existing deck and extend patio.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.20. ARB25-048
Marc Testerman&Kristin Testerman
3 Sunset Road
In-ground swimming pool and re-locate existing shed.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.21. ARB25-049
Francisco Lopez Calderon
30 Brook Lane
Second floor addition and interior alterations.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.22. ARB25-050
Rohit Sharma&Lovleen Sharma
64 Rock Ridge Drive
Second floor addition,new deck and interior alterations.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
Page 4of5
' Architectural Review Board
April 16,2025
1.23. ARB25-051
Michael Varela&Joan Varela
21 Wilton Road
In-ground swimming pool and patio.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.24. ARB25-052
Michael Cohen&Allison Cohen
34 Woodland Drive
Change existing vinyl in-ground swimming pool to gunite,add spa and reconfigure patio.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
NEXT MEETING:
May 21,2025
Page 5 of 5
y Village of Rye Brook ML MR
a �y
,Ca FB SE
Architectural Review Board Meeting AC AD
W Wednesday,March 19,2025 at 7:30 PM
Village Hall,938 King Street I JM F71SF
1. ITEMS:
1.1. ARB25-015 (Consent Agenda)
Max Woltshock&Amanda Chiu
67 Rock Ridge Drive
5'high aluminum and chain link fences&gates.
1.2. ARB25-016(Consent Agenda)
Frank Gabriel&Danna Gabriel
432 North Ridge Street
Rooftop solar array.
1.3. ARB25-017 (Consent Agenda)
Janine Hannon
20 Country Ridge Circle
5'high white vinyl fence and gate.
1.4. ARB25-018 (Consent Agenda)
Mark Bronzo&Meredith Bronzo
8 BelleFair Road
5'high cedar fence with black welded wire and gates.
1.5. ARB25-019 (Consent Agenda)
Michael Fisher&Jaclyn Fisher
108 Country Ridge Drive
4'high black aluminum fence and gates.
Consent Agenda
Approvals: Motion rj2--) Second /V1 (� Abstention
Aye; Nay; Adjournment;
Notes
Page 1 of 4
Architectural Review Board
March 19,2025
1.6. ARB25-020
Thomas Tempesta&Jeannine Tempesta
29 Brook Lane
2nd story dormer addition.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.7. ARB25-021 (Amendment to Approved Plans)
Vivian Nolan&Sonia Patel
4 Maple Court
Construct second floor addition and new balcony.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.8. ARB25-022
Vivian Nolan&Sonia Patel
4 Maple Court
In-ground swimming pool.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.9. ARB25-023 (Amendment to Approved Plans)
Scott Schwartz&Stacy Schwartz
35 Meadowlark Road
Siding,stone and roof material changes.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
Page 2 of 4
Architectural Review Board
March 19,2025
1.10. ARB25-024
Washington Park Plaza Associates LLC
259,261,263,265 South Ridge Street
New signs, "Rye Brook Wine&Spirit Shop",Villa Rustica Trattoria",
"salon la bottega"&"Rye Ridge Cleaners".
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.11. ARB25-025
Win Ridge Realty LLC
14B Rye Ridge Plaza
New awnings,
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.12. ARB25-026
Michael Chiappini&Joanne Chiappini
10 Paddock Road
Rear yard paver patio,steps to landing and gas fire pit.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.13. ARB25-027
Easwaran Nambudiri&Draupat Nambudiri
9 Castle View Court
Window changes.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
Page 3 of 4
v
Architectural Review Board
March 19,2025
1.14. ARB25-028
Eric Steinert&Caryn Steinert
24 Meadowlark Road
Front porch roof extension,siding and roof changes.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.15. ARB25-029
Corey Shulman&Lindsay Shulman
40 Meadowlark Road
Facade,windows,siding and roof material changes.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
1.16. ARB25-030
Daniel Fix&Glenna Fix
7 Oriole Place
Demo screened porch,construct new deck and interior alterations.
Approvals: Motion Second Abstention
Aye; Nay; Adjournment;
Notes
NEXT MEETING:
April 16, 2025
Page 4 of 4
Laura Petersen
From: Bruce Hirsch <bruce@hirschfence.com>
Sent: Wednesday, March 19, 2025 1:58 PM
To: Laura Petersen
Subject: 108 country Ridge
Hi everybody, I'm going to appear tonight for this homeowner who can't make it originally they wanted to do
aluminum in front but they may switch to Pickett either way it's still 4 foot high. Nothing changes on the diagram.
I'm just sending a picture to attach to their file for the meeting thank you so much as always!!!
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VIL OF; ROOKID
938 Klan ET RYE B ,NY 10573 MAR - 7 2025
�j 4 9-
00
. ov VILLAGE OF RYE BROOK
BUILDING DEPARTMENT
FOR OFFICE USE ONLY: 81-1d
Approval Date: MAR 24 9n'[P mit Application# A�� 5— 6� J
Approval Signature: ARCHITECTURAL REVIEW
BOARD:
Disapproved: Date: / d2
BOT Approval Date: Case# Chairman:
PB Approval Date: Case# Secretary
ZBA Approval Date: Case#
Other: :
Application Fee: Permit Fees:
FENCE /WALL / GATE PERMIT APPLICATION
Application dated: 3/V2(�- is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit
for the installation,construction,repair or replacement of a Fence,Wall or Gate,in accordance with Section 250-6 B.(1)(g),of the Code of the Village of
Rye Brook,as per detailed statement described below. Swimming pool fences must conform to the State Code.
1. Job Address: o 'i f"V - pq'Ve
2. Occupancy/Use: / /f/f S.B.L.#: 7— q Zone:
3. Proposed Fence/Wall/Gate(describe in detail):
W"II �,.� ►'IQ �q l y►^/►n i�� fG✓l to S �r o n �+� ✓ear •/ct r� b�cNJ��-,S
I ✓ 1 � � �' � 1( IU' CJ> G 1
4. Property Owner: �IC e Address: t 0g? CD v►'I 4 r/ ej 5 Q O r
Phone# Cell#!I ) —3 Lf —?4- )-I email:V'I'LeL. F I lv cn C v ►"^
Applicant:
Address:
Phone# Cell# email:
Architect/Engineer:
Address:
Phone# Cell# email:
Contractor: ( L' PLo H CC V1 �-
Address&Phone: t-{
5. If building is located on a comer lot,which sft7t does it front on:
6. What is the estimated cost of construction Q , O G
(NOTE:The estimated cost shall include all site fifiproVements,labor,material,scaffolding,fixed equipment,professional fees,and
material and labor which may be donated gratis.)
7_ Estimated date of completion:�/��Z
Please note that this application must include the notarized signature(s) of the legal owner(s)
of the above-mentioned property, in the space provided below. Any application not bearing
the legal property owner's notarized signature(s) shall be deemed null and void, and will be
returned to the applicant.
STATE OF NEW YORK,COUNTY OF WESTCHESTER ) as:
,being duly sworn,deposes and states that he/she is the applicant above named,
(print name of individual signing as the applicant)
and further states that (s)he is the 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,anornev,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.
Swom to before me this :7Swom to before me this
day of MfA F1 201_�_ day of 120
of Property Owner Signature of Applicant
Print Name of Property Owner Print Name of Applicant
NotalyrpovNotary Public
GR€6M M.RIVERA
Notary Pubile,State of New York
No.OIRI6441398
Qualified In weatchester County
Commission Expires September 26,204(
2
Hirsch Fence Install & Design
747 Route 9W
Valley Cottage, NY 10989
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PERM:T,INSPEC N INFORMATI N
Yes ONO to obtain permA L.Wtaffebw ran,
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APPROXN 1TELIIYOUT
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DATE(MMIDDIYYYY)
ACORO CERTIFICATE OF LIABILITY INSURANCE
1111 1 02/24/2025
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
NAME Courtney Potter
McCarthy Insurance PhONE (9u)7s9 o417 FAX
No.ao 378 Elwood Avenue E-MAIL
ADDRESS courtne h nsuran n ce. et
Hawthorne, NY 10532 INSURERS AFFORDING COVERAGE NAIC9
NSUREIIIA: Preferred Mutual Insurance ComMy 15024
INSURED B:
Hirsch Fence Install 8r Design LLC .mac:
747 Rt 9w Cottage#4 NSURERD:
Valley Cottage, NY 10989 PISURERE:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 00002210-0 REVISION NUMBER: 18
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 CONTRACTOR 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 WAVE BEEN REDUCED BY PAID CLAIMS.
INSRR' TYPE OF INSURANCE ADDL,SURR ICY NUMBER POLICYEFF P UIVIF W LIFTS --
A , X tOrlrMERCIAL GENERAL LIABILITY Y N BOP0100721375 11111212024 11112112M EACH OCCURRENCE $ 1 000 000
DAE NTED
CLAIMS-MADE X. OCCUR PREMISES R occurrence $
MED E)P one S 10,000
PERSONAL&ADV INJURY $ 1 000 000
GEN'L AGGREGATE LIMIT APPLIES PER i GENERAL AGGREGATE $ 2,000,000
POLICY OX jEECT I LOC PRODUCTS-COMProP AGG S 2,000,000
X OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
(Eant
ANY AUTO BODILY INJURY(Per person) Is
OWNED SCHEDULED BODILY INJURY(Per sddeM $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY eociderin
$
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LWB CLAIMS-MADE AGGREGATE $
DED I I RETENTION$ $
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY YIN STAME I I ER
ANY PROPRIETOR)PARTNERIEXECIITIVE EL EACH ACCIDENT $
OFFICERIMEMBER EXCLUDED? ❑ NIA
(Mandatory in NH) EL DISEASE-EA EMPLOY $
If yes,describe under
DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Address : 108 Country Ridge Dr. Rye Brook NY 10573
Certificate holder listed as Additional Insured
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 Street ACCORDANCE WITH THE POLICY PROVISIONS.
Rye Brook NY10573
(CPO)
�— YORK j -- " vct uin,aic vt ryucoLauvl t vt L-AVI I t}iuvi i
STATE Compensation from New York State Wbrkers' Compensation and/or
Board Disability and Paid FamilyLeave Benefits Insurance Coverage ge
**This form cannot be used to waive the workers'compensation rights or obligations of any pan),.
The applicant may use this Certificate ofAttestation of Exemption ONLY to show a government entity that New York State
3ecinc workers'compensation and/or disabilitv and paid familv leave benefits insurance is not required. The applicant
may NOT,use this form to show another business or that business's insurance carrier that such insurance is not required.
Please provide this form to the government entity from which you are requesting a permit,license or contract. This Certificate will
not be accepted by government officials one year after the date printed on the form.
In the Application of Business Applying For:
(Legal Entity Name and Address): Building Permit
Kirsch Fence InstaO&Design LLC tea® y of a Brook
Route 9w#
valley Cottage,NY 10989-2452
PHONE:845-304-8622 FEIN:XXXXX0091 The location of where work will be performed is
108 Country Ridge Dr,Rye Brook,NY 10573.
Estimated dates necessary to complete work associated with the building
permit are trom February 24,2025 to February 23,2026.
The estimated dollar amount of project is S0-S 10,000
Workers'Compensation Exemption Statement:
The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE SPECIFIC
WORKERS'COMPENSATION INSURANCE COVERAGE for the following reason:
The business is a LLC,LLP,PLLP or a RLLP;OR is a partnership under the laws of New York State and is not a corporation. Other
than the partners or members,there are no employees,day labor,leased employees,borrowed employees,part-time employees.unpaid
volunteers(including family members)or subcontractors.
Partners/Members: Bruce Hirsch
Disability and Paid Family Leave Benefits Exemption Statement:
The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE STATUTORY
DISABILITY AND PAID FAMILY LEAVE BENEFITS INSURANCE COVERAGE for the following reason:
The business MUST be either. 1) owned by one individual; OR 2) is a partnership(including LLC,LLP PLLP,RLLP.or LP)under
the laws of New York State and is not a corporation; OR 3) is a one or two person owned corporation,with those individuals owning
all of the stock and holding all offices of the corporation(in a two person owned corporation each individual must be an officer and own
at least one share of stock); OR 4) is a business with no NYS location. In addition,the business does not require disability and paid
family leave benefits coverage at this time since it has not employed one or more individuals on at least 30 days in any calendar year in
New York State. (Independent contractors are not considered to be employees under the Disability and Paid Family Leave Benefits Law.)
I,Bruce Hirsch,am the Member with the above-named legal entity. I affirm that due to my position with the above-named business I have the
knowledge,information and authority to make this Certificate of Attestation of Exemption. I hereby affirm that the statements made herein are true,that I
have not made any materially false statements and I make this Certificate of Attestation of Exemption under the penalties of perjury. I further affirm that
I understand that any false statement,representation or concealment will subject me to felony criminal prosecution,including jail and civil liability in
accordance with the Workers'Compensation Law and all other New York State laws. By submitting this Certificate of Attestation of Exemption to the
government entity listed above I also hereby affirm that if circumstances change so that workers'compensation insurance and/or disability and paid
family leave benefits coverage is required,the above-named legal entity will immediately acquire appropriate New York State specific workers'
compensation insurance and/or disability and paid family leave benefits coverage and also immediately furnish proof of that coverage on forms approved
by the Chair of the Workers'Compensation B to the government entity listed above.
SIGN
HERE I Signature: Date:
Exemption Certi/cate ber Received
2025-012207 February 24, 2025
NYS Workers' Compensation Board
Laura Petersen
From: UDig NY Exactix <tickets@exactix.udigny.org>
Sent: Thursday, March 20, 2025 1:05 PM
To: Steven Fews
Subject: Message from UDig NY
****REGULAR****
DIG REQUEST from UDig NY for: VIL RYE BROOK Taken: 03/20/2025 13:05
To: VIL RYE BROOK PRIMARY Transmitted: 03/20/2025 13:05 00001
Ticket: 03205-001-250-00 Type: Regular Previous Ticket:
------------------------------------------------------------------------------
State: NY County: WESTCHESTER Place: RYE BROOK
Addr: From: 108 To: Name: COUNTRY RIDGE DR
Cross: From: To: Name:
Offset:
------------------------------------------------------------------------------
Locate: BOTH SIDES AND THE BACK
NearSt: DORCHESTER DR & ROCKINGHORSE TRL
Means of Excavation: POST HOLE DIGGER Blasting: N
Site marked with white: N
Boring/Directional Drilling: N
Within 25ft of Edge of Road: N
Work Type: INSTALL FENCE
Estimated Work Complete Date: 04/08/2025 Depth of excavation: 24 INCHES Site dimensions:
Length 300 FEET Width 9 INCHES Start Date and Time: 03/25/2025 07:00 Must Start By:
04/08/2025
------------------------------------------------------------------------------
Contact Name: BRUCE HIRSCH
Company: HIRSCH FENCE INSTALL & DESIGN
Addr1: 747 RT 9W Addr2:
City: VALLEY COTTAGE State: NY Zip: 10989
Phone: 845-304-8622 Fax:
Email: bruce@hirschfence.com
Field Contact: BRUCE HIRSCH
Alt Phone: 845-304-8622 Email: bruce@hirschfence.com
Working for: HOMEOWNER
------------------------------------------------------------------------------
Comments: Lookup Type: PARCEL
------------------------------------------------------------------------------
Members: CONED SUEZ WTR WESTCHESTER
VIL RYE BROOK WESTCHESTER CTY SWR
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